Study of nitrogen fluxes across conventional solid floor cubicle and compost-bedded pack housing systems in dairy cattle barns located in the Mediterranean area: Effects of seasonal variation.

The aim of this study was to determine the effect of housing system (or manure management system) and season on manure N recovery and volatilization using an N mass balance. Dietary, milk, and manure N were monitored together with outside temperatures in 6 dairy barns. Three barns were designed as conventional freestalls (cubicle, CUB) with an automatic manure scraper system and concrete floor, in which the gutter in the middle was continuously scraped (every 2-4 h) and the slurry was conveyed toward an open-air concrete pool. The other 3 barns were designed as a loose housing system (HS) with a compost-bedded pack (CB) and conventional confinement housing provided with a feed alley that was cleaned mechanically (2-3 times per day). The farms under study were located near Lleida in the center of the Ebro valley, in northeastern Spain. Nitrogen recovery was measured twice under farm-like conditions either during spring-summer (3 mo of increasing temperatures) or fall-winter (3 mo of decreasing temperatures). The number of cows per barn ranged from 99 to 473, and average age, mean lactation, and parturition intervals were 4.1 yr, 2.43 lactations, and 426.6 d, respectively. In spring-summer, animals ate more [26.3 vs. 23.8 kg of dry matter (DM)/d] and produced more milk (34.6 vs. 31.3 kg/d ± 0.68). However, milk composition did not change. Stored manure from the CB system showed a higher DM concentration with respect to the CUB system (379.15 vs. 97.65 g/kg of fresh matter); however, N (31.45 vs. 40.2), NH3-N (5.3 vs. 18.9) and its ratios with phosphorus (NH3-N:P, 3.52 vs. 5.2) and potassium (NH3-N:K, 0.615 vs. 2.69) showed the opposite trend. No differences were found in N intake (653 vs. 629.5 g/d) or milk N secretion (190 vs. 177.8 g/d for CUB and CB barns, respectively) although net N recovery of the excreted N (Nintake - NMilk) was significantly lower in manure in CB barns than in CUB systems (193.8 vs. 389.3 g/d). The proportion of N irreversible loss in relation to the N intake was higher in CB than in CUB barns (42.3 vs. 11.0%). There was no clear association between season and irreversible N losses; however, the housing system was pivotal in the association between N recovery in manure and irreversible losses by volatilization.

Parenteral drug use as the main barrier to hepatitis C treatment uptake in HIV-infected patients.

OBJECTIVES: Our objective was to identify patient factors associated with being untreated for hepatitis C virus (HCV) infection in HIV-coinfected patients. METHODS: A prospective longitudinal study was carried out. HIV-infected patients with active chronic HCV infection included in the HERACLES cohort (NCT02511496) constituted the study population. The main study outcome was receipt of HCV direct-acting antiviral (DAA) treatment from 1 May 2015 to 1 May 2017. The population was divided into patients who were receiving HCV treatment during follow-up and those who were not. RESULTS: Of the 15 556 HIV-infected patients in care, 3075 (19.7%) presented with chronic HCV infection and constituted the study population. At the end of the follow-up, 1957 patients initiated HCV therapy (63.6%). Age < 50 years, absence of or minimal liver fibrosis, being treatment-naïve, HCV genotype 3 infection, being in the category of people who inject drugs using opioid substitutive therapy (OST-PWID), and being in the category of recent PWID were identified as significant independent risk factors associated with low odds of DAA implementation. When a multivariate analysis was performed including only the PWID population, both OST-PWID [odds ratio (OR) 0.552; 95% confidence interval (CI) 0.409-0.746) and recent PWID (OR 0.019; 95% CI 0.004-0.087) were identified as independent factors associated with low odds of treatment implementation. CONCLUSIONS: We identified factors, which did not include prioritization of a DAA uptake strategy, that limited access to HCV therapy. The low treatment uptake in several populations seriously jeopardizes the elimination of HCV infection in the coming years.

Impact of universal access to hepatitis C therapy on HIV-infected patients: implementation of the Spanish national hepatitis C strategy.

In April 2015, the Spanish National Health System (SNHS) developed a national strategic plan for the diagnosis, treatment, and management of hepatitis C virus (HCV). Our aim was to analyze the impact of this on human immunodeficiency virus (HIV)-infected patients included in the HERACLES cohort during the first 6 months of its implementation. The HERACLES cohort (NCT02511496) was set up in March 2015 to evaluate the status and follow-up of chronic HCV infection in patients co-infected with HIV in the south of Spain. In September 2015, the data were analyzed to identify clinical events (death, liver decompensation, and liver fibrosis progression) and rate of treatment implementation in this population. The study population comprised a total of 3474 HIV/HCV co-infected patients. The distribution according to liver fibrosis stage was: 1152 F0-F1 (33.2 %); 513 F2 (14.4 %); 641 F3 (18.2 %); 761 F4 (21.9 %); and 407 whose liver fibrosis was not measured (12.3 %). During follow-up, 248 patients progressed by at least one fibrosis stage [7.1 %; 95 % confidence interval (CI): 6.3-8 %]. Among cirrhotic patients, 52 (6.8 %; 95 % CI: 5.2-8.9 %) developed hepatic decompensation. In the overall population, 50 patients died (1.4 %; 95 % CI: 1.1-1.9 %). Eight hundred and nineteen patients (23.56 %) initiated interferon (IFN)-free treatment during follow-up, of which 47.8 % were cirrhotic. In our study, during 6 months of follow-up, 23.56 % of HIV/HCV co-infected patients included in our cohort received HCV treatment. However, we observed a high incidence of negative short-term outcomes in our population.

Residential greenness is differentially associated with childhood allergic rhinitis and aeroallergen sensitization in seven birth cohorts.

BACKGROUND: The prevalence of allergic rhinitis is high, but the role of environmental factors remains unclear. We examined cohort-specific and combined associations of residential greenness with allergic rhinitis and aeroallergen sensitization based on individual data from Swedish (BAMSE), Australian (MACS), Dutch (PIAMA), Canadian (CAPPS and SAGE), and German (GINIplus and LISAplus) birth cohorts (n = 13 016). METHODS: Allergic rhinitis (doctor diagnosis/symptoms) and aeroallergen sensitization were assessed in children aged 6-8 years in six cohorts and 10-12 years in five cohorts. Residential greenness was defined as the mean Normalized Difference Vegetation Index (NDVI) in a 500-m buffer around the home address at the time of health assessment. Cohort-specific associations per 0.2 unit increase in NDVI were assessed using logistic regression models and combined in a random-effects meta-analysis. RESULTS: Greenness in a 500-m buffer was positively associated with allergic rhinitis at 6-8 years in BAMSE (odds ratio = 1.42, 95% confidence interval [1.13, 1.79]) and GINI/LISA South (1.69 [1.19, 2.41]) but inversely associated in GINI/LISA North (0.61 [0.36, 1.01]) and PIAMA (0.67 [0.47, 0.95]). Effect estimates in CAPPS and SAGE were also conflicting but not significant (0.63 [0.32, 1.24] and 1.31 [0.81, 2.12], respectively). All meta-analyses were nonsignificant. Results were similar for aeroallergen sensitization at 6-8 years and both outcomes at 10-12 years. Stratification by NO2 concentrations, population density, an urban vs rural marker, and moving did not reveal consistent trends within subgroups. CONCLUSION: Although residential greenness appears to be associated with childhood allergic rhinitis and aeroallergen sensitization, the effect direction varies by location.

Parental allergic disease before and after child birth poses similar risk for childhood allergies.

Whether the strength of associations between parental and child allergic diseases differs by whether the first onset of the parental disease is before or after a child's birth has never been examined and is the aim of this study. Yearly childhood asthma, allergic rhinitis, and eczema diagnoses were longitudinally regressed against the effect of a parental disease (pre- vs post-child birth) of the same type separately for each parent using generalized estimation equations. Both a maternal and paternal history of asthma were associated with childhood asthma prevalence up to 15 years of age. Effect estimates were similar for parental asthma with first onset before and after the birth of the child. The results for allergic rhinitis and eczema were less consistent. Parental allergic diseases with first onsets before and after the birth of a child both pose risks to childhood allergic disease in the offspring, especially for asthma.

Dimension of chronic hepatitis C virus in HIV-infected patients in the interferon-free era: an overview from south Spain.

The implementation of hepatitis C (HCV) direct-acting antiviral drugs is prioritized in several populations in which its application provides the most immediate and impactful benefit. In this scenario, a precise knowledge of the situation of human immunodeficiency virus (HIV)/HCV chronic co-infection is required to adequately address this disease. This cross-sectional study was performed in 21 hospitals in Andalusia (Spain). The study population consisted of HIV-infected patients with an active HCV chronic infection who were not receiving HCV treatment at the time of inclusion. A total of 13,506 HIV-infected patients were included in the study. Of them, 2561 (18.9 %) presented chronic HCV infection. The majority of the patients included were on highly active antiretroviral therapy (HAART; 96.2 %), showed plasma levels with an undetectable HIV viral load (92.5 %), and had a good immunological status (median CD4+ cell count of 486 cells/mL). The HCV genotype distribution was as follows: 58.1 % were genotype 1, 1.1 % were genotype 2, 16.1 % were genotype 3, and 22.1 % were genotype 4 (2.6 % were missing data). In total, 24.8 % of the patients showed liver fibrosis stage F0-F1, 27.9 % showed stage F2, 16.7 % showed stage F3, and 21 % showed stage F4 (9.6 % were missing data). With regards to previous HCV treatment experiences, 68.05 % of the patients were naïve and 31.95 % had failed to respond to a previous treatment. The burden of HCV/HIV co-infected patients in our population was reported as one in five HIV-infected patients requiring HCV treatment. The implementation of extra resources to face this important health challenge is mandatory.

Invasive assessment of coronary flow reserve impairment in severe aortic stenosis and ecochadiographic correlations.

OBJECTIVES AND BACKGROUND: Patients with aortic stenosis (AS) may have impaired coronary flow reserve (CFR) despite angiographically normal coronary arteries. This is the first report of invasive thermodilution-derived CFR and IMR in patients with AS and their associations with echocardiographic parameters for AS assessment. METHODS: Thirty-six consecutive severe AS patients and ten patients without AS underwent prospectively cardiac catheterization and coronary physiological parameters were determined in the left anterior descending (LAD). Mean transit time (Tmn), a surrogate of absolute coronary flow, was obtained from the coronary thermodilution curve. RESULTS: In AS patients we found a high LAD flow at rest (Tmn rest 0.55±0.3 vs 0.99±0.4, p=0.01) and a low flow at hyperemia (Tmnhyp 0.44±0.2 vs 27.7±0.1, p=0.02) and consequently a severe CFR impairment (1.4±0.4 vs 3.8±1.4, p<0.001) compared with controls. An elevated index of microvascular resistance (IMR) (32.7±16 vs 17.8±6.5, p=0.01) and a low baseline microvascular coronary resistance (48.1±29 vs 84±34, p=0.02) were also found. In AS patients there were significant correlations between CFR and left ventricular mass index (r=-0.32; p=0.02), and the ratio of acceleration time to ejection time (AT/ET) (r=-0.4; p=0.01) a non-flow dependent echocardiographic parameter for AS assessment. Multiple linear stepwise regression analysis showed that AT/ET (ß=-0.441, p=0.019) was the only independently variable associated with CFR CONCLUSIONS: In severe AS, invasive CFR shows a progressive decrease with AS severity and a good correlation with echocardiographic parameters of AS, especially with flow-independent ones.

Mother's body mass index and food intake in school-aged children: results of the GINIplus and the LISAplus studies.

BACKGROUND/OBJECTIVES: Mother's body mass index (BMI) is a strong predictor of child BMI. Whether mother's BMI correlates with child's food intake is unclear. We investigated associations between mother's BMI/overweight and child's food intake using data from two German birth cohorts. SUBJECTS/METHODS: Food intakes from 3230 participants were derived from parent-completed food frequency questionnaires. Intakes of 11 food groups were categorized into three levels using group- and sex-specific tertile cutoffs. Mother's BMI and overweight were calculated on the basis of questionnaire data. Multinomial regression models assessed associations between a child's food intake and mother's BMI/overweight. Linear regression models assessed associations between a child's total energy intake and mother's BMI. Models were adjusted for study region, maternal education, child's age, sex, pubertal status and energy intake and the BMIs of the child and father. RESULTS: Mothers' BMI was associated with high meat intake in children (adjusted relative risk ratio (RRR (95% confidence interval))=1.06 (1.03; 1.09)). Mothers' overweight was associated with the meat intake (medium versus low RRR=1.30 (1.07; 1.59); high versus low RRR=1.50 (1.19; 1.89)) and egg intake (medium versus low RRR=1.24 (1.02; 1.50); high versus low RRR=1.30 (1.07; 1.60)) of children. There were no consistent associations for rest of the food groups. For every one-unit increase in mothers' BMI, the total energy intake in children increased by 9.2 kcal (3.7; 14.7). However, this effect was not significant after adjusting for children's BMI. CONCLUSIONS: Our results suggest that mother's BMI and mother's overweight are important correlates of a child's intake of energy, meat and eggs.

Early life risk factors of being overweight at 10 years of age: results of the German birth cohorts GINIplus and LISAplus.

OBJECTIVE: To develop a prediction model that quantifies the risk of being overweight at 10 years of age. SUBJECTS/METHODS: In total, 3121 participants from the GINIplus (German Infant Nutritional Intervention plus environmental and genetic influences on allergy development) and LISAplus (Influences of Lifestyle-Related Factors on the Immune System and the Development of Allergies in Childhood plus Air Pollution and Genetics) German birth cohorts were recruited. We predicted standardized body mass index (BMI) at 10 years of age using standardized BMIs from birth to 5 years. Parental education, family income and maternal smoking during pregnancy were considered as covariates. Linear and logistic regression models were used to evaluate the impact of risk factors on BMI and on being overweight at 10 years of age, respectively. RESULTS: Birth weight, standardized BMI at 5 years (60-64 months) (ß=0.77; 95% confidence interval (CI): 0.73-0.81) and maternal smoking during pregnancy were positively associated with standardized BMI at 10 years of age. Standardized BMI and overweight at 5 years were strongest predictors of being overweight at 10 years. Conversely, high parental education conferred a protective effect (ß=-0.15; 95% CI: -0.29 to -0.01). Being overweight at 5 years (60-64 months) increased the risk of being overweight at 10 years of age with odds ratios above 10. Among children who were predicted to be overweight at 10 years, cross-validation results showed that 76.8% of female subjects and 68.1% of male subjects would be overweight at 10 years of age. CONCLUSION: BMI and being overweight at 5 years of age are strong predictors of being overweight at 10 years of age. The effectiveness of targeted interventions in children who are overweight at 5 years of age should be explored.

Tratamiento mediante terapia de presión negativa VAC® de herida infectada tras artrodesis raquídea / Treatment of infected wound secondary to spinal arthrodesis with negative pressure therapy VAC®

Las complicaciones cutáneas secundarias a artrodesis raquídea son un problema frecuente que requiere la colaboración de los Servicios de Cirugía Plástica y en cuyo tratamiento la terapia de presión negativa puede resultar útil. En este artículo presentamos el caso de un paciente afectado por metástasis vertebrales de adenocarcinoma gástrico que requirió artrodesis raquídea y desarrolló posteriormente una úlcera por presión dorsal debido al material implantado. El sistema VAC® permitió la limpieza y disminución de tamaño de la lesión, siendo posible la cobertura posterior de la misma con un colgajo miocutáneo de dorsal ancho. En este artículo discutimos la utilidad de la terapia depresión negativa en este tipo de lesiones (AU)

Cutaneous complications secondary to spinal fusionare a common problem that requires the collaboration of the Department of Plastic Surgery and in which negative pressure therapy treatment may be useful. In this paper we present the case of a patient with spinal metastases secondary to gastric adenocarcinoma that required spinal fusion and developed a dorsal pressure ulcer secondary to the implanted material. VAC® therapy system allowed cleaning the wound and decreasing the size of the injury,thus making it possible subsequently to cover it with alatissimus dorsi myocutaneous flap. In this paper we discuss the usefulness of negative pressure therapy in this type of injury (AU)

Tratamiento de la fascitis necrosante por E. Coli mediante desbridamiento quirúrgico y terapia Vac®, a propósito de un caso / Treatment of necrotizing fasciitis caused by E. Coli with surgical debridement and vacuum assisted therapy (Vac®), case report

La fascitis necrosante es una rara infección de tejidos blandos con una alta tasa de morbi-mortalidad. Presentamos el caso de una paciente de 44 años diagnosticada defascitis necrosante por E. coli en el contexto clínico de inmunosupresión por trasplante renal. Logramos un tratamiento exitoso mediante la asociación de desbridamiento quirúrgico, antibioticoterapia intravenosa y curas con terapia de presión negativa (VAC ®), seguido de injertos autólogos de piel parcial. Remarcamos las ventajas clínicas de la terapia de presión negativa en el manejo y curación de heridas complejas (AU)

Necrotizing fasciitis is a rare soft tissue infection which presents a high rate of morbi- mortality. We describe the case of a 44 years old patient diagnosed with necrotizing fasciitis caused by E. coli, in the context of immunosuppression due to renal transplantation. Successful treatment was achieved by combining surgical debridement, intravenous antibiotic treatment and vacuum assisted closure therapy (VAC ®) completed by autologous split skin grafts. We stress the clinical benefits of subatmospheric pressure therapy in the management and healing of complex wounds (AU)

Tratamiento de la fascitis necrosante por E. Coli mediante desbridamiento quirúrgicoy terapia Vac®, a propósito de un caso / Treatment of necrotizing fasciitis caused by E. Coli with surgical

La fascitis necrosante es una rara infección de tejidos blandos con una alta tasa de morbi-mortalidad. Presentamos el caso de una paciente de 44 años diagnosticada defascitis necrosante por E. coli en el contexto clínico de inmunosupresión por trasplante renal. Logramos un tratamiento exitoso mediante la asociación de desbridamiento quirúrgico, antibioticoterapia intravenosa y curas con terapia de presión negativa (VAC ®), seguido de injertos autólogos de piel parcial. Remarcamos las ventajas clínicas de la terapia de presión negativa en el manejo y curación de heridas complejas (AU)

Necrotizing fasciitis is a rare soft tissue infection which presents a high rate of morbi- mortality. We describe the case of a 44 years old patient diagnosed with necrotizing fasciitis caused by E. coli, in the context of immunosuppression due to renal transplantation. Successful treatment was achieved by combining surgical debridement, intravenous antibiotic treatment and vacuum assisted closure therapy (VAC ®) completed by autologous split skin grafts. We stress the clinical benefits of subatmospheric pressure therapy in the management and healing of complex wounds (AU)

Nuestra experiencia en el tratamiento de úlceras crónicas mediante PRF-Vivostat®. Serie de 10 casos / Our experience in the treatment of chronic ulcers by PRP-Vivostat®. Series of 10 cases

Pretendemos mostrar nuestra experiencia clínica en el manejo de úlceras crónicas de distinta etiología, mediante tratamiento conservador con gel rico en fibrina autóloga más factores de crecimiento plaquetarios o PRP, experiencia que reafirma los buenos resultados obtenidos en estudios anteriores referentes a Cirugía Plástica, Estética y Reparadora El hecho diferencial de nuestro estudio es el trato de las lesiones única y exclusivamente con PRP, sin otros tratamientos adyuvantes como es habitual en otros estudios acerca de este tema Entre los años 2002 y 2007 tratamos con PRP 10 pacientes con historia de fallo en los tratamientos convencionales, con una edad media de 65.6 años. Se realizaron entre 3 y 5 sesiones por paciente, espaciadas por una semana. El método de obtención elegido fue el sistema VIVOSTAT® (MBAGroup). Se realizó un control fotográfico en cada sesión. Realizamos un seguimiento visual de las lesiones (pretratamiento-postratamiento), valorándolas según una modificación dela escala de Valbonesi et al a la que llamamos “Escala de Zaragoza”, siendo el resultado pobre en 1 paciente, regular en2, bueno en 5 y excelente en 2.El uso de PRP para úlceras crónicas en pacientes refractariosa otro tipo de tratamientos, tanto conservadores como quirúrgicos, es actualmente una alternativa real para conseguiruna mejoría evidente e incluso la curación completa delas lesiones (AU)

The aim of this study is to evaluate our clinical experience in the management of chronic ulcers by conservative treatment with autologous fibrin-rich gel further platelet growth factors or PRP. This experience reaffirms the good results obtained in earlier studies relating to Plastic, Reconstructive and Aesthetic Surgery; moreover, the strength of our study is the use of PRP as the only treatment of such injuries, without other adjuvant treatments as usual in other works on this topic. From 2002 to 2007, we treated with PRP 10 patients with a history of conventional treatments failure, with an average age of 65.6 years, 3 to 5 sessions per patient, one week spaced, were carried out. The method was obtained through VIVOSTAT® System (MBA Group). A photographic control was also performed in each session. We conducted visual tracking of the lesions, evaluated according to a modification of the scale of Valbonesi et al, the new “Zaragoza scale”. The outcome was poor in 1 patient, fair in 2, good in 5 and excellent in 2.Use of PRP for chronic ulcers in patients refractory to other treatments, both conservative and surgical, is now a real option to achieve a clear improvement and even a completecure (AU)

[Epidemiological study of attempted suicide managed at the hospital emergency department]. / Estudio epidemiológico de las tentativas de suicidio atendidas en la urgencia hospitalaria.

PURPOSE: The authors investigate psychiatric and sociodemographic characteristics of the patients attended at the emergency department in the General Hospital of Mostoles, after their suicidal intent, and of those who repeated a suicidal intent in the first year of follow-up. METHODOLOGY: It is a prospective study, with a duration of one year, in a real sample with 119 patients randomized as a stratified sample from the population attended after their intent. Data recollection was made with a psychiatric semi-structured interview and Beck's letality and suicidal intent scales. Recruitment and follow-up periods were one year long for each of them. Statistical analysis was realized with the chi square test and Fischer's exact test to evaluate associations among cualitative variable and the variance analysis of the relations between qualitative and quantitative variable. RESULTS: Suicide intent ratio was 82/100,000 inhabitants, being in 83% by medicament ingestion. 71% were women, 66% were between 15 and 30 years old, 50% were unmarried and 12% were separated. 33% suffered from a affective disorder, and 23% were alcohol abusers. 6% of them bad a psycotic disorder. 52% of the patients had previous psychiatric disorders and 43% had been in treatment. 46% of them had someone in their families with a psychiatric disorder. 29% were repeaters after a previous attempt. Concerning to a prior contact with the Mental Health Services in the preceding month Significant differences were observed by age, but no significant differences were observed by sex. 26% used alcohol prior to the intent, mainly men. EIB and ELB ratings were significatively higher in retired than in students. Among the patients who repeated their intent (14.5%) of the followed, 78% were women, with an age between 30 and 56 years old. 61% were diagnosed having an affective disorder and 10% had psycotic disorders. 88% of the repeaters were in psychiatric treatment for five years or more.

Pressure-induced contraction of the juxtamedullary afferent arterioles in spontaneously hypertensive rats.

1. In the SHR juxtamedullary nephron preparation, the increase of the perfusion pressure from 80 to 160 mmHg increased the diameters of arcuate arteries but produced a pressure-dependent contraction of the afferent arterioles, a response that can account for renal autoregulation. 2. The pressure-induced contractions of the afferent arterioles were abolished by 1 microM nifedipine and by 10 microM furosemide, suggesting that the autoregulatory responses are mainly mediated by tubuloglomerular mechanisms and can be abolished by calcium antagonists.