A Review of metabolic staging in severely injured patients

An interpretation of the metabolic response to injury in patients with severe accidental or surgical trauma is made. In the last century, various authors attributed a meaning to the post-traumatic inflammatory response by using teleological arguments. Their interpretations of this response, not only facilitates integrating the knowledge, but also the flow from the bench to the bedside, which is the main objective of modern translational research. The goal of the current review is to correlate the metabolic changes with the three phenotypes -ischemia-reperfusion, leukocytic and angiogenic- that the patients express during the evolution of the systemic inflammatory response. The sequence in the expression of multiple metabolic systems that becomes progressively more elaborate and complex in severe injured patients urges for more detailed knowledge in order to establish the most adequate metabolic support according to the evolutive phase. Thus, clinicians must employ different treatment strategies based on the different metabolic phases when caring for this challenging patient population. Perhaps, the best therapeutic option would be to favor early hypometabolism during the ischemia-reperfusion phase, to boost the antienzymatic metabolism and to reduce hypermetabolism during the leukocytic phase through the early administration of enteral nutrition and the modulation of the acute phase response. Lastly, the early epithelial regeneration of the injured organs and tissues by means of an oxidative metabolism would reduce the fibrotic sequelae in these severely injured patients

Interface electronic system for measuring air acidity with optical sensors

Environmental acidity is a key parameter in Cultural Heritage conservation issues since it has a direct impact on degradation of both exposed and stored materials. Unfortunately, most of the acidity sensors now available are electrodes, which are not able to measure pH in gaseous phases and, therefore, are not suitable for measuring the environmental acidity of the air. This paper describes the development of an interface electronic system designed for the practical application and using of environmental acidity sensors prepared by the Sol–Gel procedure. These chemical sensors were investigated previously. They have optical response: their color changes reversibly depending on the pH of the surrounding environment (air). A simple portable unit with a wireless ZigBee interface has been designed and developed to measure the environmental acidity in museums, showcases, store and exhibition rooms and several Cultural Heritage buildings. Main achievements of the interface electronic system have focused, on the one hand, on conversion of the optical signal of sensors into an electric current and, on the other hand, on the computer interfacing to obtain quantitative data of environmental pH. Quantitative data are obtained through the calibration curve of sensors and the software designed for managing the whole system.The authors acknowledge partial funding of programs: Geomateriales (ref. S-2009/Mat-1629, Regional Government of Madrid), Consolider Ingenio 2010 (ref. TCP CSD2007-00058, Spanish Ministry of Science and Innovation), and project ref. HAR2012-30769 from the Spanish MINECOPeer reviewe

Auditory P3a and P3b neural generators in schizophrenia: An adaptive sLORETA P300 localization approach

The present study investigates the neural substrates underlying cognitive processing in schizophrenia (Sz) patients. To this end, an auditory 3-stimulus oddball paradigm was used to identify P3a and P3b components, elicited by rare-distractor and rare-target tones, respectively. Event-related potentials (ERP) were recorded from 31 Sz patients and 38 healthy controls. The P3a and P3b brain-source generators were identified by time-averaging of low-resolution brain electromagnetic tomography (LORETA) current density images. In contrast with the commonly used fixed window of interest (WOI), we proposed to apply an adaptive WOI, which takes into account subjects’ P300 latency variability. Our results showed different P3a and P3b source activation patterns in both groups. P3b sources included frontal, parietal and limbic lobes, whereas P3a response generators were localized over bilateral frontal and superior temporal regions. These areas have been related to the discrimination of auditory stimulus and to the inhibition (P3a) or the initiation (P3b) of motor response in a cognitive task. In addition, differences in source localization between Sz and control groups were observed. Sz patients showed lower P3b source activity in bilateral frontal structures and the cingulate. P3a generators were less widespread for Sz patients than for controls in right superior, medial and middle frontal gyrus. Our findings suggest that target and distractor processing involves distinct attentional subsystems, both being altered in Sz. Hence, the study of neuroelectric brain information can provide further insights to understand cognitive processes and underlying mechanisms in Sz.Postprint (author's final draft

Incidence and risk factors of delayed development for stoma site incisional hernia after ileostomy closure in patients undergoing colorectal surgery with temporary ileostomy.

Background: Stoma site incisional hernias after ileostomy closure are complex hernias that can be associated with abdominal pain, discomfort, and a diminished quality of life. The aim of this study was to determine the incidence of incisional hernia (IH) following temporary ileostomy reversal in patients undergoing colorectal surgery, and the risk factors associated with its development. Methods: This was an observational study of patients undergoing ileostomy reversal between January 2010 and December 2016. Comorbidities, operative characteristics and postoperative complications were analysed. Bivariable and multivariable analyses were used to assess IH incidence and risk factors. Results: A total of 202 consecutive patients were prospectively evaluated (median follow-up 46 months; range: 12 - 109). Stoma site incisional hernia occurred in 23% of patients (n=47). The reasons for the primary surgery were colorectal cancer (n= 141, 69.8%), inflammatory bowel disease (n=14, 6.9%), emergency surgery (n=35, 17.3%), and other conditions (n=12, 5.9%). Statistically significant risk factors for developing an IH were obesity (higher BMI) (OR 1.15, 95% CI (1.05 – 1.26)). Other comorbidities such as diabetes, immunosuppression, and anaemia, as well as surgical technique variables, surgical wound infection and other post-surgical complications were not predictive of hernia. Conclusions: 23% of patients developed surgical site IH, a higher BMI being the only risk factor found to be statistically significant in the development of an incisional hernia.pre-print3507 K

Topography of activation deficits in schizophrenia during P300 task related to cognition and structural connectivity

Background The study of cerebral underpinnings of schizophrenia may benefit from the high temporal resolution of electromagnetic techniques, but its spatial resolution is low. However, source imaging approaches such as low-resolution brain electromagnetic tomography (LORETA) allow for an acceptable compromise between spatial and temporal resolutions. Methods We combined LORETA with 32 channels and 3-Tesla diffusion magnetic resonance (Dmr) to study cerebral dysfunction in 38 schizophrenia patients (17 first episodes, FE), compared to 53 healthy controls. The EEG was acquired with subjects performing an odd-ball task. Analyses included an adaptive window of interest to take into account the interindividual variability of P300 latency. We compared source activation patters to distractor (P3a) and target (P3b) tones within- and between-groups. Results Patients showed a reduced activation in anterior cingulate and lateral and medial prefrontal cortices, as well as inferior/orbital frontal regions. This was also found in the FE patients alone. The activation was directly related to IQ in the patients and controls and to working memory performance in controls. Symptoms were unrelated to source activation. Fractional anisotropy in the tracts connecting lateral prefrontal and anterior cingulate regions predicted source activation in these regions in the patients. Conclusions These results replicate the source activation deficit found in a previous study with smaller sample size and a lower number of sensors and suggest an association between structural connectivity deficits and functional alterations.Postprint (author's final draft

Aerobiología y alergias respiratorias de Tenerife

Esta publicación resume los resultados obtenidos en casi cinco años del proyecto de "Impacto de las intrusiones atmosféricas africanas en la calidad del aire en Canarias y de la Península Ibérica" (2004-2009), entre los que cabe destacar una caracterización completa de los pólenes y esporas de hongos muestreados en el aire de Santa Cruz de Tenerife, la elaboración de predicciones semanales de pólenes y esporas de hongos, así como la obtención de un calendario polínico de utilidad para aquellos profesionales de la medicina que trabajan en alergias y afecciones respiratorias, y para los ciudadanos de Santa Cruz de Tenerife y visitantes que sean alérgicos al polen

Estudo histórico e arqueométrico de dois vitrais da Catedral de Astorga

Se estudian las vidrieras de la Catedral de Astorga a partir de dos ejemplos representativos: la Aparición de Jesús resucitado a la Virgen María y el Apóstol San Simón (ss. XVI-XVIII). Se realizó su estudio histórico-artístico y el arqueométrico de una selección de fragmentos de vidrio, con el fin de obtener información sobre su tecnología de producción. El estudio arqueométrico consistió en la determinación de la composición química de los vidrios, la caracterización de sus cromóforos y el estudio de las grisallas. Se determinaron distintos tipos de vidrio, lo que permitió establecer su posible cronología, y diversos cromóforos y grisallas de sombreado y de contorno. El análisis crítico de los datos histórico-artísticos y los arqueométricos puso de manifiesto convergencias y divergencias de datación así como restauraciones anteriores que ubicaron fragmentos en posiciones inadecuadas.The stained glass windows of the Astorga Cathedral have been studied from two representative examples: the windows of the Aparición de Jesús resucitado a la Virgen María and the Apóstol San Simón (16th-18th centuries A.D.). The historic and artistic study of such stained glass windows was accomplished and a selection of glass fragments was used to undertake the archaeometric study in order to obtain information on their production technology. Chemical composition of glasses, chromophores characterization and study of grisailles contributed to the archaeometric objectives. Different types of glasses, chromophores and grisailles were determined, which allowed the establishment of their possible chronology. Critical analysis of historical, artistic and archaeometric data demonstrated both convergences and divergences on chronology of glasses as well as the inadequate reusing of glass fragments during past restorations.Estudaram-se os vitrais da Catedral de Astorga a partir de dois exemplos representativos: a Aparição de Jesus Ressuscitado à Virgem Maria e o Apóstolo São Simão (séculos XVI-XVIII). Realizou-se o estudo histórico-artístico e arqueométrico de uma seleção de fragmentos de vidro, a fim de se obterem informações sobre a sua tecnologia de produção. O estudo arqueométrico consistiu na determinação da composição química dos vidros, na caracterização dos seus cromóforos e no estudo das grisalhas. Foram determinados distintos tipos de vidro, o que permitiu estabelecer a sua possível cronologia, e diversos cromóforos e grisalhas de sombreado e contorno. A análise crítica dos dados histórico-artísticos e dos arqueométricos revelou convergências e divergências de datação assim como restauros anteriores de fragmentos em posições inadequadas.Los autores agradecen a la Comunidad de Madrid y Fondos Estructurales (FSE y FEDER) la financiación del programa Geomateriales 2 ref. S2013/MIT-2914. Asimismo, agradecen el apoyo profesional de TechnoHeritage, Red de Ciencia y Tecnología para la Conservación del Patrimonio Cultural

Methodology for the Study of the Envelope Airtightness of Residential Buildings in Spain: A Case Study

Air leakage and its impact on the energy performance of dwellings has been broadly studied in countries with cold climates in Europe, US, and Canada. However, there is a lack of knowledge in this field in Mediterranean countries. Current Spanish building regulations establish ventilation rates based on ideal airtight envelopes, causing problems of over-ventilation and substantial energy losses. The aim of this paper is to develop a methodology that allows the characterization of the envelope of the housing stock in Spain in order to adjust ventilation rates taking into consideration air leakage. A methodology that is easily applicable to other countries that consider studying the airtightness of the envelope and its energetic behaviour improvement is proposed. A statistical sampling method has been established to determine the dwellings to be tested, considering relevant variables concerning airtightness: climate zone, year of construction, and typology. The air leakage rate is determined using a standardized building pressurization technique according to European Standard EN 13829. A representative case study has been presented as an example of the implementation of the designed methodology and results are compared to preliminary values obtained from the database

Rationale, design and organization of the delayed antibiotic prescription (DAP) trial: a randomized controlled trial of the eficacy and safety of delayed antibiotic prescribing strategies in the non-complicated acute respiratory tract infections in general practice

Background: Respiratory tract infections are an important burden in primary care and it's known that they are usually self-limited and that antibiotics only alter its course slightly. This together with the alarming increase of bacterial resistance due to increased use of antimicrobials calls for a need to consider strategies to reduce their use. One of these strategies is the delayed prescription of antibiotics. Methods: Multicentric, parallel, randomised controlled trial comparing four antibiotic prescribing strategies in acute non-complicated respiratory tract infections. We will include acute pharyngitis, rhinosinusitis, acute bronchitis and acute exacerbation of chronic bronchitis or chronic obstructive pulmonary disease (mild to moderate). The therapeutic strategies compared are: immediate antibiotic treatment, no antibiotic treatment, and two delayed antibiotic prescribing (DAP) strategies with structured advice to use a course of antibiotics in case of worsening of symptoms or not improving (prescription given to patient or prescription left at the reception of the primary care centre 3 days after the first medical visit). Discussion: Delayed antibiotic prescription has been widely used in Anglo-Saxon countries, however, in Southern Europe there has been little research about this topic. The DAP trial wil evaluate two different delayed strategies in Spain for the main respiratory infections in primary care

Targeted Next-Generation Sequencing in a Large Cohort of Genetically Undiagnosed Patients with Neuromuscular Disorders in Spain

This article belongs to the Special Issue Genetic Advances in Neuromuscular Disorders: From Gene Identification to Gene Therapy.The term neuromuscular disorder (NMD) includes many genetic and acquired diseases and differential diagnosis can be challenging. Next-generation sequencing (NGS) is especially useful in this setting given the large number of possible candidate genes, the clinical, pathological, and genetic heterogeneity, the absence of an established genotype-phenotype correlation, and the exceptionally large size of some causative genes such as TTN, NEB and RYR1. We evaluated the diagnostic value of a custom targeted next-generation sequencing gene panel to study the mutational spectrum of a subset of NMD patients in Spain. In an NMD cohort of 207 patients with congenital myopathies, distal myopathies, congenital and adult-onset muscular dystrophies, and congenital myasthenic syndromes, we detected causative mutations in 102 patients (49.3%), involving 42 NMD-related genes. The most common causative genes, TTN and RYR1, accounted for almost 30% of cases. Thirty-two of the 207 patients (15.4%) carried variants of uncertain significance or had an unidentified second mutation to explain the genetic cause of the disease. In the remaining 73 patients (35.3%), no candidate variant was identified. In combination with patients’ clinical and myopathological data, the custom gene panel designed in our lab proved to be a powerful tool to diagnose patients with myopathies, muscular dystrophies and congenital myasthenic syndromes. Targeted NGS approaches enable a rapid and cost-effective analysis of NMD- related genes, offering reliable results in a short time and relegating invasive techniques to a second tier.This study was granted by FIS PI15/01898, funded by ISCIII and FEDER, ‘Una manera de hacer Europa’ and by Fundación Mutua Madrileña in the “Convocatoria de ayudas a la Investigación en Salud 2015”. It was also funded by an ACCI grant from CIBERER. Daniel Natera-de Benito is the recipient of a grant from the Instituto de Salud Carlos III (Contrato Rio Hortega, CM17/00044)