Small for gestational age moderate to late preterm children: a neuropsychological follow-up

[EN] Determine whether SGA constitutes a neurodevelopmental risk-factor of MLP, exploring if potential developmental difficulties at toddlerhood persist and are related to school-age performance. 109 SGA and 109 adequate for gestational age MLP children were evaluated at 2 and at 6.5 y.o. SGA children obtained poorer results in several areas at both timepoints; and their development at toddlerhood strongly correlated with only some results at school-age. SGA confers vulnerability to MLP, evolving from global/unspecific difficulties in toddlerhood to a domain-specific profile (attentional/dysexecutive) at 6.5. Findings claim the need for neuropsychological follow-up in MLP to identify emerging difficulties

Incidencia, factores de riesgo e impacto pronóstico de la infección por citomegalovirus tras el trasplante cardiaco

[Abstract] Introduction and objectives. To assess the risk factors of CMV infection after heart transplant (HT) and its influence on long-term prognosis. Methods. We conducted a retrospective single-centre study of 222 H T recipients. Risk factors for CMV infection were identified by means of multivariable Cox´s regression. Kaplan-Meier analysis and Cox´s regression were used to assess the long-term prognostic impact of CMV infection during the first post-transplant year. Results. Donor-recipient CMV serologic matching (hazard ratio [HR] 1.92, 95% confidence interval [95% CI] 1.2–3.09, p = .007), recipient age (HR 1.02, 95% CI 1.00–1.1, p = .02), diabetes mellitus (HR 1.86, 95% CI 1.4–3.05, p = .01), pre- transplant circulatory support (HR 1.59, 95% CI 1.06–2.38, p = .03) and the use of tacrolimus (HR 1.64, 95% CI 1.13–2.36, p = .009) were independently associated with increased risk of CMV infection. CMV infection during the first year post-HT was not associated with worse transplant outcomes in terms of mortality, incidence of heart failure, cardiac allograft vasculopathy or acute rejection. Conclusions. CMV infection was not associated with impaired long-term prognosis after HT.[Resumen] Introducción y objetivos. Analizar el impacto pronóstico de la infección por Citomegalovirus (CMV) durante el primer año tras el trasplante cardiaco (TC) y describir factores de riesgo. Métodos. Se realizó un estudio retrospectivo unicéntrico incluyendo 222 receptores de TC. La identificación de factores de riesgo de infección por CMV se llevó a cabo mediante regresión multivariable de Cox. Mediante los métodos de Kaplan-Meier y Cox se analizó la influencia de la infección por CMV durante el primer año sobre la supervivencia e incidencia de eventos clínicos adversos en el seguimiento a largo plazo. Resultados. En el análisis multivariante, el estado serológico donante/receptor frente a CMV (hazard ratio [HR] 1,92, intervalo de confianza 95% [IC 95%] 1,2–3,09; p = 0007, la edad del receptor HR 1,02, IC 95% 1,00–1,1; p = 0,02), la diabetes (HR 1,86, IC 95% 1,4-3,05; p = 0,01), el soporte circulatorio mecánico (HR 1,59, IC 95% 1,06-2,38; p = 0,03) y el uso de tacrolimus (HR 1,64, IC 95% 1,13-2,36; p = 0009, resultaron predictores independientes de infección por CMV post-trasplante. No se detectó una influencia significativa de la infección por CMV durante el primer año post-trasplante sobre la mortalidad, la incidencia de insuficiencia cardiaca, enfermedad vascular del injerto o rechazo agudo. Conclusiones. La infección por CMV durante el primer año post-trasplante no se asoció a un peor pronóstico a largo plazo

Hydrothermal carbonization and pellet production from Egeria densa and Lemna minor

Biofuels are seen as a potential option for mitigating the effects of fossil fuel use. On the other hand, nutrient pollution is accelerating eutrophication rates in rivers, lakes, and coastal waters. Harvesting aquatic plants to produce biofuels could mitigate this problem, though it is important to attack the problem at source, mainly as regards the contribution of nutrients. For the first time, solid biofuels were obtained in the forms of carbon and pellets from the aquatic plants Egeria densa, which is classed as an invasive plant under the Spanish Catalogue of Exotic Invasive Species, and Lemna minor, both of which can be found in the Umia River in north-west Spain. The essential oils and macro- and microelements present in both these plants were also extracted and analyzed. The higher heating values (HHVs) of the carbon products obtained ranged from 14.28 to 17.25 MJ/kg. The ash content ranged from 22.69% to 49.57%. The maximum yield obtained for biochar for Egeria densa at 200 °C was 66.89%. Temperature significantly affects solid hydrochar yield. The HHVs of the pellets obtained ranged from 11.38 to 13.49 MJ/kg. The use of these species to obtain biofuels through hydrothermal carbonization (HTC) and pellets is a novel and effective approach that will facilitate the removal of nutrients that cause eutrophication in the Umia River. The elements extracted show that harvesting these plants will help to remove excessive nutrients from the ecosystem

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease