Broodstock nutritional programming differentially affects the hepatic transcriptome and genome-wide DNA methylome of farmed gilthead sea bream (Sparus aurata) depending on genetic background.

BACKGROUND: Broodstock nutritional programming improves the offspring utilization of plant-based diets in gilthead sea bream through changes in hepatic metabolism. Attention was initially focused on fatty acid desaturases, but it can involve a wide range of processes that remain largely unexplored. How all this can be driven by a different genetic background is hardly underlined, and the present study aimed to assess how broodstock nutrition affects differentially the transcriptome and genome-wide DNA methylome of reference and genetically selected fish within the PROGENSA® selection program. RESULTS: After the stimulus phase with a low fish oil diet, two offspring subsets of each genetic background received a control or a FUTURE-based diet. This highlighted a different hepatic transcriptome (RNA-seq) and genome-wide DNA methylation (MBD-seq) pattern depending on the genetic background. The number of differentially expressed transcripts following the challenge phase varied from 323 in reference fish to 2,009 in genetically selected fish. The number of discriminant transcripts, and associated enriched functions, were also markedly higher in selected fish. Moreover, correlation analysis depicted a hyper-methylated and down-regulated gene expression state in selected fish with the FUTURE diet, whereas the opposite pattern appeared in reference fish. After filtering for highly represented functions in selected fish, 115 epigenetic markers were retrieved in this group. Among them, lipid metabolism genes (23) were the most reactive following ordering by fold-change in expression, rendering a final list of 10 top markers with a key role on hepatic lipogenesis and fatty acid metabolism (cd36, pitpna, cidea, fasn, g6pd, lipt1, scd1a, acsbg2, acsl14, acsbg2). CONCLUSIONS: Gene expression profiles and methylation signatures were dependent on genetic background in our experimental model. Such assumption affected the magnitude, but also the type and direction of change. Thus, the resulting epigenetic clock of reference fish might depict an older phenotype with a lower methylation for the epigenetically responsive genes with a negative methylation-expression pattern. Therefore, epigenetic markers will be specific of each genetic lineage, serving the broodstock programming in our selected fish to prevent and mitigate later in life the risk of hepatic steatosis through changes in hepatic lipogenesis and fatty acid metabolism.

Impact of Covid-19 on farming systems in Europe through the lens of resilience thinking.

Context: Resilience is the ability to deal with shocks and stresses, including the unknown and previously unimaginable, such as the Covid-19 crisis. Objective: This paper assesses (i) how different farming systems were exposed to the crisis, (ii) which resilience capacities were revealed and (iii) how resilience was enabled or constrained by the farming systems' social and institutional environment. Methods: The 11 farming systems included have been analysed since 2017. This allows a comparison of pre-Covid-19 findings and the Covid-19 crisis. Pre-Covid findings are from the SURE-Farm systematic sustainability and resilience assessment. For Covid-19 a special data collection was carried out during the early stage of lockdowns. Results and conclusions: Our case studies found limited impact of Covid-19 on the production and delivery of food and other agricultural products. This was due to either little exposure or the agile activation of robustness capacities of the farming systems in combination with an enabling institutional environment. Revealed capacities were mainly based on already existing connectedness among farmers and more broadly in value chains. Across cases, the experience of the crisis triggered reflexivity about the operation of the farming systems. Recurring topics were the need for shorter chains, more fairness towards farmers, and less dependence on migrant workers. However, actors in the farming systems and the enabling environment generally focused on the immediate issues and gave little real consideration to long-term implications and challenges. Hence, adaptive or transformative capacities were much less on display than coping capacities. The comparison with pre-Covid findings mostly showed similarities. If challenges, such as shortage of labour, already loomed before, they persisted during the crisis. Furthermore, the eminent role of resilience attributes was confirmed. In cases with high connectedness and diversity we found that these system characteristics contributed significantly to dealing with the crisis. Also the focus on coping capacities was already visible before the crisis. We are not sure yet whether the focus on short-term robustness just reflects the higher visibility and urgency of shocks compared to slow processes that undermine or threaten important system functions, or whether they betray an imbalance in resilience capacities at the expense of adaptability and transformability. Significance: Our analysis indicates that if transformations are required, e.g. to respond to concerns about transnational value chains and future pandemics from zoonosis, the transformative capacity of many farming systems needs to be actively enhanced through an enabling environment.

Functional insights into the infective larval stage of Anisakis simplex s.s., Anisakis pegreffii and their hybrids based on gene expression patterns.

BACKGROUND: Anisakis simplex sensu stricto and Anisakis pegreffii are sibling species of nematodes parasitic on marine mammals. Zoonotic human infection with third stage infective larvae causes anisakiasis, a debilitating and potentially fatal disease. These 2 species show evidence of hybridisation in geographical areas where they are sympatric. How the species and their hybrids differ is still poorly understood. RESULTS: Third stage larvae of Anisakis simplex s.s., Anisakis pegreffii and hybrids were sampled from Merluccius merluccius (Teleosti) hosts captured in waters of the FAO 27 geographical area. Specimens of each species and hybrids were distinguished with a diagnostic genetic marker (ITS). RNA was extracted from pools of 10 individuals of each taxon. Transcriptomes were generated using Illumina RNA-Seq, and assembled de novo. A joint assembly (here called merged transcriptome) of all 3 samples was also generated. The inferred transcript sets were functionally annotated and compared globally and also on subsets of secreted proteins and putative allergen families. While intermediary metabolism appeared to be typical for nematodes in the 3 evaluated taxa, their transcriptomes present strong levels of differential expression and enrichment, mainly of transcripts related to metabolic pathways and gene ontologies associated to energy metabolism and other pathways, with significant presence of excreted/secreted proteins, most of them allergens. The allergome of the 2 species and their hybrids has also been thoroughly studied; at least 74 different allergen families were identified in the transcriptomes. CONCLUSIONS: A. simplex s.s., A. pegreffi and their hybrids differ in gene expression patterns in the L3 stage. Strong parent-of-origin effects were observed: A. pegreffi alleles dominate in the expression patterns of hybrids albeit the latter, and A. pegreffii also display significant differences indicating that hybrids are intermediate biological entities among their parental species, and thus of outstanding interest in the study of speciation in nematodes. Analyses of differential expression based on genes coding for secreted proteins suggests that co-infections presents different repertoires of released protein to the host environment. Both species and their hybrids, share more allergen genes than previously thought and are likely to induce overlapping disease responses.

Analysis of stroke care resources in Spain in 2012: have we benefitted from the Spanish Health System's stroke care strategy?

INTRODUCTION: The Spanish Health System's stroke care strategy (EISNS) is a consensus statement that was drawn up by various government bodies and scientific societies with the aim of improving quality throughout the care process and ensuring equality among regions. Our objective is to analyse existing healthcare resources and establish whether they have met EISNS targets. MATERIAL AND METHODS: The survey on available resources was conducted by a committee of neurologists representing each of Spain's regions; the same committee also conducted the survey of 2008. The items included were the number of stroke units (SU), their resources (monitoring, neurologists on call 24h/7d, nurse ratio, protocols), SU bed ratio/100,000 inhabitants, diagnostic resources (cardiac and cerebral arterial ultrasound, advanced neuroimaging), performing iv thrombolysis, neurovascular interventional radiology (neuro VIR), surgery for malignant middle cerebral artery (MCA) infarctions and telemedicine availability. RESULTS: We included data from 136 hospitals and found 45 Stroke Units distributed unequally among regions. The ratio of SU beds to residents ranged from 1/74,000 to 1/1,037,000 inhabitants; only the regions of Cantabria and Navarre met the target. Neurologists performed 3,237 intravenous thrombolysis procedures in 83 hospitals; thrombolysis procedures compared to the total of ischaemic strokes yielded percentages ranging from 0.3 to 33.7%. Hospitals without SUs showed varying levels of available resources. Neuro VIR is performed in every region except La Rioja, and VIR is only available on a 24h/7 d basis in 17 cities. Surgery for malignant MCA infarction is performed in 46 hospitals, and 5 have telemedicine. CONCLUSION: Stroke care has improved in terms of numbers of participating hospitals, the increased use of intravenous thrombolysis and endovascular procedures, and surgery for malignant MCA infarction. Implementation of SUs and telemedicine remain insufficient. The availability of diagnostic resources is good in most SUs and irregular in other hospitals. Regional governments should strive to ensure better care and territorial equality, which would achieve the EISNS objectives.

Temperature variation in nests of Paleosuchus palpebrosus (Crocodylia: Alligatoridae) near the southern edge of the species´ range, Brazil.

We monitored the temperature of seven Paleosuchus palpebrosus nests found on the banks of streams surrounding the Brazilian Pantanal, near the southern limit of the species´ distribution, between 2008 and 2013. The mean temperature of the nests between 45 and 68 days incubation, the presumed period of sex determination, varied between 26.1 and 31.5o C. Nest temperatures were 2 to 5°C higher than air temperatures, presumably due to metabolic heat of decay of material within the nests, but air temperature explained 10-50% of the variance in egg-chamber temperatures. The estimated incubation periods for nests from which eggs hatched were 80, 84, 86, 90 and 104 days with a mean of 89 (SD =9.23) days, though these are probably slight overestimates because eggs may have hatched in the period between inspections. For these nests, there was no significant relationship between mean temperature and incubation period (r2 = 0.23, p = 0.411).

[Concomitant Ulcerative Colitis and Neurofibromatosis type 1: possible common origin?] / Colitis Ulcerosa y Neurofibromatosis tipo 1 concomitantes: ¿posible origen común?

In the last 15 years, 3 cases of concurrent Ulcerative Colitis with Neurofibromatosis Type 1 have been described in adults and adolescents, but not in children; although it may be a casual finding, a com mon pathogenic pathway between both diseases is postulated, based on mast cell dysregulation in the gastrointestinal tract. OBJECTIVE: To report the clinical case of a toddler with onset of concomitant Ulcerative Colitis with CMV infection, with history of Neurofibromatosis Type 1, and to discuss the common origin between both diseases. CLINICAL CASE: We describe the case of a 2-and-a-half-year-old toddler with history of Neurofibromatosis Type 1 who presented with bloody diarrhea. On endos copic examination, the mucosa from the anal margin to the cecum was erythematous, with loss of vascular transparency. Biopsies of colonic mucosa showed signs of chronic inflammation, consistent with the diagnosis of Ulcerative Colitis, and CMV infection was diagnosed by PCR. CONCLUSION: Previous studies have suggested that mast cells may have a pathogenic role in the development of UC, however, the clinical significance of these findings is unknown. Future research is needed to further investigate the role of mast cells in the development of UC and to confirm a genetic association bet ween the two diseases.

Health care resources for stroke patients in Spain, 2010: analysis of a national survey by the Cerebrovascular Diseases Study Group.

INTRODUCTION: Stroke is currently a major social health problem. For this reason, the Spanish Ministry of Health approved the Stroke National Strategy (SNS) in 2008 to improve the prevention, treatment and rehabilitation of stroke patients. This plan intends to guarantee 24-hour, 365-days neurological assistance in the whole country by the end of 2010. Our aim was to analyse the situation of stroke assistance in Spain in 2009. MATERIAL AND METHODS: A committee of neurologists practicing in the different autonomous communities (AC), and who had not participated in the preparation of the SNS, was created. A national survey was performed including the number of stroke units (SU) and their characteristics (monitoring, 24-h/7-day on-call neurology service, nursing staff ratio and the use of protocols), bed ratio of SU/100,000 people, availability of intravenous thrombolysis therapy, neurovascular intervention (NI) and telemedicine. RESULTS: We included data from 145 hospitals. There are 39 SU in Spain, unevenly distributed. The ratio between SU bed/number of people/AC varied from 1/75,000 to 1/1,037,000 inhabitants; Navarra and Cantabria met the goal. Intravenous thrombolysis therapy is used in 80 hospitals; the number of treatments per AC was between 7 and 536 in 2008. NI was performed in the 63% of the AC, with a total of 28 qualified hospitals (although only 1 hospital performed it 24h, 7 days a week in 2009). There were 3 hospitals offering clinical telemedicine services. CONCLUSIONS: Assistance for stroke patients has improved in Spain compared to previous years, but there are still some important differences between the AC that must be eliminated to achieve the objectives of the SNS.

Microcyn: a novel super-oxidized water with neutral pH and disinfectant activity.

A new super-oxidized water (SOW) product, Microcyn, was tested for in vitro antimicrobial and antiviral activities. The effectiveness of this neutral-pH SOW at killing Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Salmonella typhi and Candida albicans in pure culture was evaluated. One millilitre (approximately 10(8)colony-forming units/mL) of each micro-organism was subjected to 9 mL Microcyn or sterile water at room temperature for 30s. Under these conditions, a log(10) reduction factor of 8 in the level of all pathogens occurred in the treatment samples. In addition, results of tests with three batches of Microcyn exposed to Bacillus atrophaeus spores for 5 min demonstrated complete inactivation of the spores within 2-3 min (log(10) reduction factor >4). The effectiveness of Microcyn in reducing human immunodeficiency virus-1 (HIV-1) on hard surfaces (glass) was also evaluated in compliance with Environmental Protection Agency requirements for virucidal claims. After exposure of the tested surfaces to Microcyn for 5 min without agitation, there was a log(10) reduction factor >3 in the viral load as measured by both cytopathic effect and antigen p24 of HIV-1 production in MT-2 cultures. Microcyn activity against adenoviral vector type 5 was also analysed under simulated laboratory in-use conditions with viral suspensions. In order to increase the sensitivity of the test, the fluorescent light emitted by AdGFP-infected cells was measured with the use of a flow cytometer. A log(10) reduction factor >3 in the viral load was achieved after a 5-min exposure to Microcyn under these strict conditions. These results show that Microcyn exerts a wide antimicrobial spectrum with major advantages over acidic SOWs, including neutral pH, lower free active chlorine (51-85 ppm) and long shelf life (1 year).

Dynamic intracoronary thrombosis does not cause significant downstream platelet embolization.

OBJECTIVE: A mural intracoronary thrombus is a potential source of platelet emboli that may obstruct downstream microvessels, but this phenomenon has not been characterized. The present study aimed to assess the magnitude of myocardial platelet accumulation downstream of a mural intracoronary thrombus and its modification by a concomitant transient coronary occlusion (OC) or by treatment with aspirin. METHODS: The myocardial content of 99mTc-labelled platelets was analyzed in 26 pigs submitted to intimal injury of the left anterior descending coronary artery (LAD) followed by no intervention (n=6), 25-min OC (n=6), or 48-min OC preceded (n=8) or not (n=6) by intravenous administration of 250 mg aspirin. RESULTS: After 2 h, 24 animals had had 12+/-1 cyclic flow reductions (CFRs) reflecting dynamic LAD thrombosis. Myocardial platelet content in the inferior region was similar among groups. Platelet content in the LAD region was not significantly different to that in the inferior region (129+/-19%, P=NS) in the no intervention group, but was increased following OC (172+/-20 and 312+/-71% after 25- and 48-min OC, respectively, P<0.05). Pre-treatment with aspirin lessened the number of CFRs but did not reduce platelet accumulation in LAD myocardium (483+/-148%). Myocardial platelet accumulation was not associated with the magnitude of platelet deposition in the LAD nor with the number of CFRs, but was correlated with myeloperoxidase activity (r=0.91, P<0.001) and with infarct size (r=0.52, P=0.05). Histological analysis frequently showed sparse platelets or small platelet or leukoplatelet aggregates in small vessels, but arteriolar emboli were rare. In none of seven additional experiments coronary angiography showed obstructions of arterial branches during CFRs. CONCLUSION: The magnitude of platelet embolization from a mural intracoronary thrombus into downstream myocardium is small despite the presence of repetitive CFRs.

Indicaciones inhabituales de trasplante hepático. resultados / Unusual indications for liver transplantation. results

Resumen Introducción: El trasplante hepático (TH), es una terapia establecida en el tratamiento de diversas enfermedades del hígado agudas y crónicas terminales y del carcinoma hepatocelular (CHC). Las principales indicaciones en nuestro medio son la cirrosis de diferentes etiologías, el CHC, la atresia de vías biliares en niños y la falla hepática fulminante (FHF). Menos del 10% corresponden a indicaciones inhabituales, que incluyen pacientes con una miscelánea de enfermedades entre las cuales están la enfermedad poliquística hepática (EPH), enfermedades metabólicas (Niemann-Pick, otras), el síndrome hepato/portopulmonar, metástasis de diferentes tumores, etc. Objetivo: Describir y evaluar los resultados obtenidos con el trasplante hepático en estas indicaciones. Materiales y Método: Estudio de cohorte no concurrente que incluyó los TH por indicaciones inhabituales realizados entre marzo de 1997 y diciembre de 2016. De 295 TH realizados, 34 (11,5%) fueron por estas indicaciones. Resultados: Las causas más frecuentes fueron el síndrome porto/hepatopulmonar en 11 (40,7%) pacientes y la EPH en 9 (26,5%). Las enfermedades metabólicas representaron la tercera indicación, con 5 (14,7%) casos. Siete (20,6%) pacientes eran menores de 18 años. Las complicaciones más frecuentes fueron biliares y la trombosis de arteria hepática en 6 (17,6%) y 4 (11,8%) casos respectivamente; estos últimos eran portadores de una EPH masiva. Cuatro (12,5%) pacientes requirieron retrasplante. La mortalidad a 90 días fue de 2 (5,9%) enfermos. Conclusión: El TH es una opción factible en este grupo de pacientes con resultados similares a los obtenidos en las indicaciones clásicas.

Introduction: Liver transplantation (LT) is an established therapy in the treatment of several acute and chronic end-stage liver diseases and hepatocellular carcinoma (HCC). The main indications worldwide are cirrhosis of different etiologies, HCC, biliary atresia in children, and fulminant hepatic failure (FHF). Less than 10% concerns unusual indications which include patients with miscellaneous diseases among which are hepatic polycystic disease (HPD), metabolic diseases (Niemann-Pick, others), portal/hepatopulmonary syndrome, metastasis of different tumors, among others. Aim: The objective of the study is to describe and asses the results obtained with liver transplantation in these indications. Materials and Method: We performed a non-concurrent cohort study that included all LT due to unusual indications between March 1997 and December 2016 in a university medical center. Of 295 TH performed, 34 (11.75%) were due to these indications. Results: The most frequent causes were the portal/hepatopulmonary syndrome in 11 (40.7%) patients and HPD in 9 (26.5%). Metabolic diseases accounted for the third indication in 5 (14.7%) cases. Seven (20.6%) patients were less than 18 years old. The most frequent complications were biliary and hepatic artery thrombosis (HAT) in 6 (17.6%) and 4 (11.8%) cases, respectively. Patients complicated by a HAT suffered a massive EPH. Four (12.5%), required retransplantation. Mortality at 90 days was 2 (5.9%). Conclusión: LT is a feasible option in this group of patients with results similar to those obtained in classic indications of LT.

[Cost-effectiveness analysis of serum ferritin screening in periodic physical examinations of women at the fertile age]. / Análisis coste-efectividad de la determinación de ferritina sérica de cribado en los exámenes periódicos de salud en las mujeres en edad fértil.

BACKGROUND: Fertile-aged women are a population group at special risk for developing ferropenia. In the periodic health care examinations, hemogram, among other tests, are included to detect the most advanced state of iron deficity, ferropenic anemia. Likewise, preanemic ferropenia presents a certain morbidity. The aim of this study was to analyze the cost-effectiveness of screening serum ferritin determination in health care examinations of fertile-aged women. SUBJECTS AND METHODS: An observational transversal study was carried out in 322 women in whom hemogram and serum ferritin were determined. The effects of serum ferritin determination were simulated in a hypothetical cohort of 20-year old women annually examined up to the age of 50 years (mean age of menopause). RESULTS: The prevalence of preanemic ferropenia (serum ferritin < or = ng/ml) was 44.1% and that of ferropenic anemica (Hb < 120 g/l and serum ferritin < or = 25 ng/ml) was 3.4%. Hemogram sensitivity for detection of ferropenia was 7.2% (3.6-12.5). By means of the screening program with serum ferritin avoiding of one year with ferropenia costs 2,428 pesetas. Prolonging the program to longer than 35 years largely increases the marginal cost. Cost-effectiveness analysis is specially sensitive to the cost of the diagnostic tests and disease prevalence. CONCLUSIONS: Ferropenia in fertile-aged women is a frequent disorder. Avoiding ferropenia by early diagnosis may be performed at a relatively low cost.

[Platelet function study in primary Raynaud's phenomenon and Raynaud's phenomenon associated with scleroderma]. / Estudio del funcionalismo de las plaquetas en el fenómeno de Raynaud primario y fenómeno de Raynaud asociado a esclerodermia.

We evaluated platelet function in 59 patients with Raynaud's phenomenon (RP): 24 had primary RP (PRP) and in 35 RP was associated with diffuse scleroderma (DS). In the group with PRP there were 10 males and 14 females, with a mean age of 43 +/- 12 years and a time of evolution of 5 +/- 5 years. In the group with RP associated with DS there were 31 females and 4 males with a mean age of 53 +/- 12 years and a time of evolution of 9 +/- 7 years. The control group consisted of 20 healthy individuals (14 males and 6 females with a mean age of 40 +/- 12 years). In all patients and controls beta-thromboglobulin (BTG) and platelet factor 4 (PF4) levels were measured in plasma, and platelet aggregation was evaluated in the presence of adenosine diphosphate (ADP), collagen and arachidonic acid. The patients with RP associated with DS had BTG and PF4 higher than those with PRP and controls (p less than 0.02). The BTG/PF4 ratio was also significantly greater in patients with DS (p less than 0.005). The platelets from patients with DS had a greater aggregation with ADP (1 microM and 0.5 microM) than those from PRP (p less than 0.03). We concluded that patients with RP associated with DS had in vivo activation and a greater aggregation of platelets, in contrast with the absence of these findings in the group with PRP and in controls.

[A study of anemia in 86 patients on hemodialysis (author's transl)]. / Estudio de la anemia en 86 pacientes en hemodiálisis.

Anemia is one of the complications of terminal chronic renal failure that may worsen with periodical hemodialysis because of residual blood losses in the dialyzers that may be significant if clotting occurs within the circulation system. The potential iron deficiency component of the anemia has been studied in 86 patients submitted to periodic hemodialysis by measurement of hemoglobin, serum iron, transferrin saturation, total iron binding capacity, and ferritin. The following correlations were investigated: degree of anemia and type of renal disease, months on hemodialysis and hemoglobin, months on hemodialysis and serum ferritin, and liters of blood transfused and serum ferritin. Statistically significant correlations were found between months on hemodialysis and hemoglobin, and between liters of blood transfused and serum ferritin. From the correlation between serum iron and ferritin the patients could be classified in three groups: 1, with either normal or low serum iron and ferritin, candidates to iron therapy; 2, with elevated serum iron and ferritin, needing no iron treatment; and 3, with unequal changes of serum iron and ferritin, in whom iron kinetic studies are indicated in order to discover the patents that may benefit from iron therapy.

[The effect of 2 lipid emulsions on platelet function]. / Influencia de dos emulsiones lipídicas en la función plaquetaria.

We examined the effect on platelet aggregation and activation and the production of eicosanoids in nonseptic critical patients of two lipidic emulsions administered with total parenteral nutrition. The two lipidic emulsions, Intralipid (20% of long chain triglycerides) and Lipofundina (10% each of long and medium-chain triglycerides), of differing essential fat acid content, provided 43% of the non-protein calorific requirements calculated for each patient. There were no other variables in the parenteral nutrition administered: the patients were distributed in two groups on a randomized basis according to the type of lipids received. We assessed the parameters demonstrating platelet function before parenteral nutrition, and after 4 and 7 days of such nutrition. Throughout the study, platelet aggregability was seen not to differ significantly from normal, even though the activation parameters controlled, beta TG and PF4, were from the outset significantly higher than normal; the thromboxane B2 averages calculated remained high, with wide individual variability, while averages for 6-keto-PGF1 alpha [correction of 0], which were initially high, showed a tendency (not statistically significant) to drop after 4 and 7 days nutrition. We did not observe that the administration of LCT or MTC/LCT led to changes in platelet aggregation and/or activation in the patients studied.

[Analysis of puberal development and influence of weight loss in obese adolescent girls]. / Análisis e influencia de la pérdida de peso en el desarrollo puberal de adolescentes obesas.

OBJECTIVES: To study several aspects of puberal development in obese adolescent girls, and the influence of weight loss on these aspects. METHODS: A longitudinal retrospective study was performed of a sample of 26 adolescent girls with normal weight and 46 obese adolescent girls at the onset of puberty. The obese teenagers were further divided into two groups (normal and obese) according to their body mass index (BMI) at the end of puberty. Height, chronological and bone age, and growth velocity were evaluated in both groups. RESULTS: Of the teenagers who were obese at the onset of puberty, 63 % remained obese at the end of puberty. The obese teenagers were significantly taller than non-obese teenagers at the onset of puberty (143.2 +/- 6.96 vs 138.9 +/- 5.95 cm, respectively; p < 0.01). However, there were no differences between the two groups in final height. No differences were found between obese teenagers who lost weight and those who did not. There were no differences in chronological or bone age throughout puberal development in any of the groups. The mean growth velocity during puberty was significantly lower in obese teenagers than in non-obese teenagers (6.18 +/- 1.94 and 6.90 +/- 127 cm/year, respectively; p < 0.02). However, there were no differences between obese teenagers who lost weight and those who did not. CONCLUSIONS: Height gain in obese girls is greater in childhood but lower in adolescence. Final height is similar in both groups. Chronological age at the onset and end of puberty and bone maturation are similar in both groups. Weight loss during puberty does not modify growth pattern during this period of development.

[Audiometric threshold shift in patients with cochlear implantation]. / Variación de los umbrales audiométricos en pacientes implantados.

A great number of studies have been carried out during many years in order to evaluate the histological changes that take place after the insertion of a cochlear implant, having been experimentally and histologically, in temporal bones, demonstrated its relative harmlessness. We have focused our functional investigation induced by the implants through the shift of pre- and postoperative tonal audiometric thresholds, in 13 carriers on an C. I. Nucleus 22. Most of them suffered minimal or even showed no shift of thresholds. Therefore we consider the functional alterations due to the insertion of electrodes as practically nonexistent.

[Vertigos in childhood. Characteristics according to our results]. / Vértigos de la infancia. Características según nuestros resultados.

The paper deals with a review of 25 cases of infantile dizziness done for a term of 10 years. The protocol employed in the study, the characteristics and the follow-up of the crises are contemplated.

[Emergency amygdalectomy and adenoidectomy in children with upper respiratory obstruction]. / Amigdalectomías y adenoidectomías urgentes en niños por obstrucción de la vía aérea superior.

Hypertrophy of the adenoids and tonsils in children sometimes produces life-threatening upper airway obstruction that requires emergency endotracheal intubation followed by adenotonsillectomy. Four patients, age range 18 months to 3 years, who required emergency treatment in the Pediatric Intensive Care Unit were studied for acute respiratory distress syndrome with cyanosis and use of accessory respiratory muscles. Two had orotracheal intubation to stabilize their cardiorespiratory situation before surgery. One presented cardiomegaly and secondary pulmonary arterial hypertension. The third remained stable and adequately ventilated with naso-hypopharyngeal ventilation. The fourth remained in intensive care for its clinical situation, but did not require exceptional measures.