Small bowel enteroscopy - A joint clinical guideline from the spanish and portuguese small bowel study groups

The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication and on its diagnostic and therapeutic yields. A set of recommendations were issued accordingly.Estas recomendações baseadas na evidência detalham o uso da enteroscopia assistida por dispositivo no manejo clínico das doenças do intestino delgado. Um conjunto de Gastrenterologistas diferenciados em patologia do intestino delgado foi selecionado pelos grupos de estudos Espanhol e Português de intestino delgado para rever a evidência disponível sobre as principais indicações desta técnica, o seu papel nos algoritmos de manejo de cada indicação e sobre o seu rendimento diagnóstico e terapêutico. Foi gerado um conjunto de recomendações pelos autores

Caracterización ecológica del área marina del banco de Galicia

Se integra información hidrográfica, geomorfológica, sedimentológica, biológica, sobre hábitats marinos y pesquera, para establecer las bases ecológicas necesarias para la protección y conservación del banco de GaliciaEl banco de Galicia es un monte submarino profundo situado a 180 km de la costa gallega, con una cima situada entre los 650 y los 1.500 m de profundidad y rodeado de zonas abisales de más de 4.000 m de profundidad. El relieve de las montañas submarinas interactúa con la circulación oceánica modificando las condiciones de oligotrofismo imperantes en el mar profundo. El cambio de dirección de las corrientes marinas, al chocar con el banco, produce las llamadas columnas de Taylor que tienen como consecuencia giros sobre la cima y finalmente un enriquecimiento de las aguas que bañan el banco, lo que influye, a través de la cadena trófica, en las especies de cetáceos, aves y tortugas. Estas condiciones, junto al aislamiento de estos bancos, convierten a estos bancos en puntos calientes de biodiversidad. Esta teoría se ha visto corroborada por los estudios realizados en el proyecto INDEMARES, basados en dos campañas de investigación, dónde se ha encontrado una elevada biodiversidad y la presencia de hábitats vulnerables. El banco de Galicia está bañado por tres capas diferentes: la masa de agua central del Atlántico nordeste europeo (East North Atlantic Central Water: ENACW), por debajo de las aguas superficiales y hasta los 500-600 m; la masa de agua mediterránea (Mediterranean Outflow Water: MOW) y la masa de agua del Labrador (Labrador Sea Water: LSW), que es la capa más profunda. En cuanto al tipo de fondo, se encuentra roca en el área del flanco oriental y hacia el sureste y en los montes adyacentes como el Rucabado, distinguiendo claramente dos tipos en cuanto a la pendiente, correspondiendo con la roca plana de la cima y la roca en pendiente del borde del banco y paredes. En la cima se encuentran fondos de arenas medias, de reflectividad media y baja según el espesor de sedimento, y arenas finas en los fondos sedimentaruios de los flancos, a profundidades mayores de 1.500. En el banco se han identificado hasta el momento 793 especies, con taxones que superan las 100 especies como son moluscos, peces (con especial énfasis en los elasmobranquios), crustáceos y cnidarios. Este inventario incluye especies nuevas para la ciencia, primeras citas para aguas españolas y europeas y especies de gran interés científico y biogeográfico. Este último punto se explica por la situación del Banco entre regiones biogeográficas conectadas por corrientes y masas de agua. El estudio de las conexiones tróficas entre este elevado número de especies ha mostrado el reforzamiento de las rutas bentopelágicas (gambas y macrozooplancton) frente a las dietas epi- y endobentónicas más habituales en otros fondos equivalentes. Mediante técnicas de muestreo extractivas (arrastres, dragas) y de vídeo, y su proyección sobre la interpretación geomorfológica realizada a partir de la sonda multihaz, se ha obtenido una estimación de la distribución de los hábitats bentónicos del banco. Los hábitats identificados en fondos sedimentarios son 1) arenas medias con ofiuras Ophiacantidae y Flabellum chunii, 2) arenas medias con arrecife de corales profundos de Lophelia pertusa y/o Madrepora oculata, y 3) arenas finas con holoturias elasipódidas (Benthogone rosea). En fondos rocosos se han caracterizado los hábitats de 4) roca batial sin pendiente con gorgonias y corales negros, 5) roca batial de talud con comunidades de corales y esponjas, 6) roca batial de talud con corales blancos, bambú y negros, gorgonias y esponjas, 7) arrecife de corales profundos de Lophelia pertusa y/o Madrepora oculata y 8) roca con nódulos manganésicos. El único tipo de hábitat de la DH descrito en la zona es el 1.170 (arrecifes). Sólo se han incluido en la Directiva Hábitats como 1.170 aquellos que presentaban una densidad y diversidad suficientes para cumplir la definición de “arrecifes”. De los hábitats descritos en el banco (ver características ecológicas y biológicas más arriba) solo se han incluido en el 1.170 los arrecifes de corales blancos situados en las arenas medias de la cima del banco, los arrecifes de corales blancos de aguas frías de las especies Lophelia pertusa y Madrepora oculata sobre la roca de la cima del monte Rucabado, las comunidades de roca batial de talud de la ladera sur del banco constituidas por colonias de corales blancos de aguas frías de las especies Lophelia pertusa y Madrepora oculata, y una fauna acompañante muy diversa de escleractinias solitarias, corales bambú, corales negros, gorgonias y esponjas de gran porte, y el resto de zonas de roca batial de talud con comunidades de corales y esponjas. Muchos de los hábitats pueden ser incluidos en los listados de hábitat vulnerables de OSPAR, en los tipos jardines de coral, agregaciones de esponjas de profundidad, arrecifes de Lophelia y montículos carbonatados. En cuanto a las especies de interés para la protección, de las citadas en el banco, el delfín mular (Tursiops truncatus) y la tortuga boba (Caretta caretta) son las únicas especies que figuran en el Anexo II de la Directiva de Hábitats. Sin embargo, muchas epecies de elasmobranquis y algunos peces óseos son consideradas vulnerables, amenazadas o en declive según los criterios definidos por OSPAR y la lista roja de especies amenazadas de IUCN. Algunas de están protegidas por el reglamento europeo 1262/2012 que regula la pesca de especies profundas. La lejanía del banco respecto a los principales focos de presión y la ausencia casi total de presión pesquera hace que el grado de conservación sea muy alto, pudiéndose hablar de un ecosistema prácticamente prístino. Las recomendaciones para la gestión de esta zona van encaminadas a garantizar esta calidad ambiental actual.Instituto Español de Oceanografía, Comisión Europea Programa LIFE+, Fundación Biodiversida

Identification of regulatory variants associated with genetic susceptibility to meningococcal disease.

Non-coding genetic variants play an important role in driving susceptibility to complex diseases but their characterization remains challenging. Here, we employed a novel approach to interrogate the genetic risk of such polymorphisms in a more systematic way by targeting specific regulatory regions relevant for the phenotype studied. We applied this method to meningococcal disease susceptibility, using the DNA binding pattern of RELA - a NF-kB subunit, master regulator of the response to infection - under bacterial stimuli in nasopharyngeal epithelial cells. We designed a custom panel to cover these RELA binding sites and used it for targeted sequencing in cases and controls. Variant calling and association analysis were performed followed by validation of candidate polymorphisms by genotyping in three independent cohorts. We identified two new polymorphisms, rs4823231 and rs11913168, showing signs of association with meningococcal disease susceptibility. In addition, using our genomic data as well as publicly available resources, we found evidences for these SNPs to have potential regulatory effects on ATXN10 and LIF genes respectively. The variants and related candidate genes are relevant for infectious diseases and may have important contribution for meningococcal disease pathology. Finally, we described a novel genetic association approach that could be applied to other phenotypes

Plasma lipid profiles discriminate bacterial from viral infection in febrile children

Fever is the most common reason that children present to Emergency Departments. Clinical signs and symptoms suggestive of bacterial infection are often non-specific, and there is no definitive test for the accurate diagnosis of infection. The 'omics' approaches to identifying biomarkers from the host-response to bacterial infection are promising. In this study, lipidomic analysis was carried out with plasma samples obtained from febrile children with confirmed bacterial infection (n = 20) and confirmed viral infection (n = 20). We show for the first time that bacterial and viral infection produces distinct profile in the host lipidome. Some species of glycerophosphoinositol, sphingomyelin, lysophosphatidylcholine and cholesterol sulfate were higher in the confirmed virus infected group, while some species of fatty acids, glycerophosphocholine, glycerophosphoserine, lactosylceramide and bilirubin were lower in the confirmed virus infected group when compared with confirmed bacterial infected group. A combination of three lipids achieved an area under the receiver operating characteristic (ROC) curve of 0.911 (95% CI 0.81 to 0.98). This pilot study demonstrates the potential of metabolic biomarkers to assist clinicians in distinguishing bacterial from viral infection in febrile children, to facilitate effective clinical management and to the limit inappropriate use of antibiotics

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Handbook of Active Ageing and Quality of Life: From Concepts to Applications

La edición de este libro estuvo a cargo de Fermina Rojo-Pérez y Gloria Fernández-Mayoralas.El documento adjunto contiene la cubierta, portada e índice del libro.This handbook presents an overview of studies on the relationship of active ageing and quality of life. It addresses the new challenges of ageing from the paradigm of positive ageing (active, healthy and successful) for a better quality of life. It provides theoretical perspectives and empirical studies, including scientific knowledge as well as practical experiences about the good ageing and the quality of later life around the world, in order to respond to the challenges of an aged population. The handbook is structured in 4 sections covering theoretical and conceptual perspectives, social policy issues and research agenda, methods, measurement instrument-scales and evaluations, and lastly application studies including domains and geographical contexts.Peer reviewe

XVI International Congress of Control Electronics and Telecommunications: "Techno-scientific considerations for a post-pandemic world intensive in knowledge, innovation and sustainable local development"

Este título, sugestivo por los impactos durante la situación de la Covid 19 en el mundo, y que en Colombia lastimosamente han sido muy críticos, permiten asumir la obligada superación de tensiones sociales, políticas, y económicas; pero sobre todo científicas y tecnológicas. Inicialmente, esto supone la existencia de una capacidad de la sociedad colombiana por recuperar su estado inicial después de que haya cesado la perturbación a la que fue sometida por la catastrófica pandemia, y superar ese anterior estado de cosas ya que se encontraban -y aún se encuentran- muchos problemas locales mal resueltos, medianamente resueltos, y muchos sin resolver: es decir, habrá que rediseñar y fortalecer una probada resiliencia social existente - producto del prolongado conflicto social colombiano superado parcialmente por un proceso de paz exitoso - desde la tecnociencia local; como lo indicaba Markus Brunnermeier - economista alemán y catedrático de economía de la Universidad de Princeton- en su libro The Resilient Society…La cuestión no es preveerlo todo sino poder reaccionar…aprender a recuperarse rápido.This title, suggestive of the impacts during the Covid 19 situation in the world, and which have unfortunately been very critical in Colombia, allows us to assume the obligatory overcoming of social, political, and economic tensions; but above all scientific and technological. Initially, this supposes the existence of a capacity of Colombian society to recover its initial state after the disturbance to which it was subjected by the catastrophic pandemic has ceased, and to overcome that previous state of affairs since it was found -and still is find - many local problems poorly resolved, moderately resolved, and many unresolved: that is, an existing social resilience test will have to be redesigned and strengthened - product of the prolonged Colombian social conflict partially overcome by a successful peace process - from local technoscience; As Markus Brunnermeier - German economist and professor of economics at Princeton University - indicates in his book The Resilient Society...The question is not to foresee everything but to be able to react...learn to recover quickly.Bogot

Time to Switch to Second-line Antiretroviral Therapy in Children With Human Immunodeficiency Virus in Europe and Thailand.

Background: Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand. Methods: Children aged <18 years initiating combination ART (≥2 nucleoside reverse transcriptase inhibitors [NRTIs] plus nonnucleoside reverse transcriptase inhibitor [NNRTI] or boosted protease inhibitor [PI]) were included. Switch to second-line was defined as (i) change across drug class (PI to NNRTI or vice versa) or within PI class plus change of ≥1 NRTI; (ii) change from single to dual PI; or (iii) addition of a new drug class. Cumulative incidence of switch was calculated with death and loss to follow-up as competing risks. Results: Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7-10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, 2.9-8.3) years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%-23%), with significant regional variations. Median time to switch was 30 (IQR, 16-58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch. Conclusions: One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch

Plasma lipid profiles discriminate bacterial from viral infection in febrile children

Fever is the most common reason that children present to Emergency Departments. Clinical signs and symptoms suggestive of bacterial infection ar

Classification, prevalence, and outcomes of anticancer therapy-induced cardiotoxicity: the CARDIOTOX registry

Aim: Cardiotoxicity (CTox) is a major side effect of cancer therapies, but uniform diagnostic criteria to guide clinical and research practices are lacking. Methods and results: We prospectively studied 865 patients, aged 54.7 ± 13.9; 16.3% men, scheduled for anticancer therapy related with moderate/high CTox risk. Four groups of progressive myocardial damage/dysfunction were considered according to current guidelines: normal, normal biomarkers (high-sensitivity troponin T and N-terminal natriuretic pro-peptide), and left ventricular (LV) function; mild, abnormal biomarkers, and/or LV dysfunction (LVD) maintaining an LV ejection fraction (LVEF) ≥50%; moderate, LVD with LVEF 40–49%; and severe, LVD with LVEF ≤40% or symptomatic heart failure. Cardiotoxicity was defined as new or worsening of myocardial damage/ventricular function from baseline during follow-up. Patients were followed for a median of 24 months. Cardiotoxicity was identified in 37.5% patients during follow-up [95% confidence interval (CI) 34.22–40.8%], 31.6% with mild, 2.8% moderate, and 3.1% with severe myocardial damage/dysfunction. The mortality rate in the severe CTox group was 22.9 deaths per 100 patients-year vs. 2.3 deaths per 100 patients-year in the rest of groups, hazard ratio of 10.2 (95% CI 5.5–19.2) (P < 0.001). Conclusions: The majority of patients present objective data of myocardial injury/dysfunction during or after cancer therapy. Nevertheless, severe CTox, with a strong prognostic relationship, was comparatively rare. This should be reflected in protocols for clinical and research practices