Year in review in Intensive Care Medicine 2012. II: Pneumonia and infection, sepsis, coagulation, hemodynamics, cardiovascular and microcirculation, critical care organization, imaging, ethics and legal issues.

Journal ArticleSCOPUS: re.jSCOPUS: re.jinfo:eu-repo/semantics/publishe

Variación estacional de la gastroenteritis verminosa y presentación de brotes clínicos, diagnosticados en caprinos en la provincia de Formosa, Argentina

Resumen Se describen brotes de presentación clínica de gastroenteritis verminosa (GEV) en caprinos de la Provincia de Formosa (Argentina), en todas las estaciones del año, recopilando los resultados obtenidos durante un período de 5 años, en una población de 2320 caprinos de 146 hatos. En el lustro fueron diagnosticados 72 brotes clínicos de la enfermedad confirmados por análisis coproparasitológicos(hpg), mientras se determinaron los géneros por coprocultivo. En el clima subtropical la enfermedad se presentó durante las 4 estaciones del año, pero los brotes tuvieron mayor prevalencia en otoño-invierno y en menor escala en primavera-verano. Los géneros de mayor prevalencia fueron Haemonchussp.; Trichostrongylussp.; Strongyloidessp.; Oesophagostomumsp.; Trichurissp., y Bunostomumsp. Hubo una relación directa de la presentación de la GEV con el aumento de la humedad ambiental proporcionada por lluvias en los 90 días anteriores a la aparición del brote. En cuanto a la relación del cuadro sintomático con los hpg, se observó en el 87.5% de los brotes que los recuentos de huevos por gramo fueron iguales o superiores a 1000, mientras que en el restante 12.5% los conteos fueron inferiores a este número, pero superando 700 hpg. No obstante estas variaciones, el hallazgo del cuadro sintomático fue similar y en los dos grupos hubo mortandad de animales. De la información obtenida de las encuestas efectuadas a los productores se desprende que el 82.4% desparasitan, de los cuales el 11.7 % efectúa un único tratamiento al año, el 39.5% dos, el 7.8% tres y el 11.7% cuatro tratamientos anuales. El restante 11.7% manifestaron desparasitar cuando observaban muertes, enflaquecimiento, diarreas o mal estado general de los animales. El 17.6% de los productores declararon no realizar ningún tratamiento. Con referencia a los criterios utilizados para decidir realizar él o los tratamientos antiparasitarios, la mayoría de los productores declararon proceder con él o los tratamientos cuando la enfermedad estaba en plena evolución clínica y aparecían casos de mortandad. Solo el 7% utiliza el servicio de diagnóstico coproparasitológico. Surgió de la encuesta que el 63% de los productores tratan la manifestación clínica de parasitosis en sus hatos con ivermectina, el 15.6% opta porbencimidazoles e ivermectina de manera alternada y el 7.8% administra solamente bencimidazoles. El 100% de los productores no realiza un control coproparasitológico postratamiento. Para optimizar el control de las parasitosis gastrointestinales en los hatos caprinos, en las condiciones de cría de Formosa, surge como muy necesario implementar un programa de extensión destinado a ofrecer y difundir mayores conocimientos a los productores de caprinos tendiente a lograr mayor productividad, mediante el desarrollo de un programa de control voluntario y eficiente de la enfermedad.Outbreaks of parasitic gastrointestinal enteritis are described in a population of 2320 goats from 146 caprine flocks, in the subtropical climate Province of Formosa, in the northeast of Argentina, during the four seasons of the year, summarizing the results obtained over a 5 year period. A total of 72 outbreaks were clinically diagnosed, and confirmed byf aecal examination (epg) and faecal cultures for the classification of parasite genera. Although the disease was present all 4 seasons of the year, the highest prevalence was in autumn-winter and to a lesser degree in spring-summer. The most prevalent genera wereHaemonchus sp.; Strongyloides sp.; Oesophagostomum sp.; Trichuris sp. and Bunostomum sp. A direct relation exists between the outbreaks and the increase of environmenta lhumidity from rainfalls, during the previous 90 days. With reference to clinical symptoms and epg counts, in 87,5% of the outbreaks epg counts were equale or higher than 1000, whilstin 12.5% failed to reach 1000 but were higher tan 700 epg; however symptomology in both groups were similar and mortality a constant feature. From the survey made with the caprine breeders who participated in the study, 82.4% treated their flocks, of which 11.7% treated once in the year, 39.5% twice, 7.8% three times and 11.7% gave a total of 4 treatments. The report indicated that 11.7% give treatment only when mortality, loss of condition and weight were apparent. A total of 17.6% of the surveyed owners do not submit their animals to any treatment. With reference to the criteria used to decide onthe momento to dose, it was clear that the mayority depended on the manifest clinical symptoms and deaths. Only 7% depended on a prior parasitological diagnosis. As to drug preference, 63% used ivermectin, 15.6% administered ivermectin and bencimidazoles alternatively and 7.8% only bencimidazoles. No owner used thea bailable post-treatment faecal analysis for control. To optimize the control of gastrointestinal parasites it is necessary to establish a Project whereby caprine breeders receive more and better knowledge, increase productivity and make any treatment programme a successFil: Mancebo, Orlando Antonio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro de Investigaciones y Transferencia de Formosa. Provincia de Formosa. Centro de Investigaciones y Transferencia de Formosa. Universidad Nacional de Formosa. Centro de Investigaciones y Transferencia de Formosa; ArgentinaFil: Giménez, Juana Noemí. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro de Investigaciones y Transferencia de Formosa. Provincia de Formosa. Centro de Investigaciones y Transferencia de Formosa. Universidad Nacional de Formosa. Centro de Investigaciones y Transferencia de Formosa; ArgentinaFil: Russo, Ana Maria. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro de Investigaciones y Transferencia de Formosa. Provincia de Formosa. Centro de Investigaciones y Transferencia de Formosa. Universidad Nacional de Formosa. Centro de Investigaciones y Transferencia de Formosa; ArgentinaFil: Monzon, Carlos Manuel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro de Investigaciones y Transferencia de Formosa. Provincia de Formosa. Centro de Investigaciones y Transferencia de Formosa. Universidad Nacional de Formosa. Centro de Investigaciones y Transferencia de Formosa; ArgentinaFil: Bulman, G. Mauricio. No especifica

Approximate Bayesian Computation Reveals the Crucial Role of Oceanic Islands for the Assembly of Continental Biodiversity

The perceived low levels of genetic diversity, poor interspecific competitive and defensive ability, and loss of dispersal capacities of insular lineages have driven the view that oceanic islands are evolutionary dead ends. Focusing on the Atlantic bryophyte flora distributed across the archipelagos of the Azores, Madeira, the Canary Islands, Western Europe, and northwestern Africa, we used an integrative approach with species distribution modeling and population genetic analyses based on approximate Bayesian computation to determine whether this view applies to organisms with inherent high dispersal capacities. Genetic diversity was found to be higher in island than in continental populations, contributing to mounting evidence that, contrary to theoretical expectations, island populations are not necessarily genetically depauperate. Patterns of genetic variation among island and continental populations consistently fitted those simulated under a scenario of de novo foundation of continental populations from insular ancestors better than those expected if islands would represent a sink or a refugium of continental biodiversity. We, suggest that the northeastern Atlantic archipelagos have played a key role as a stepping stone for transoceanic migrants. Our results challenge the traditional notion that oceanic islands are the end of the colonization road and illustrate the significant role of oceanic islands as reservoirs of novel biodiversity for the assembly of continental flora

The amount of preoperative endometrial tissue surface in relation to final endometrial cancer classification

Diagnosis; Endometrial carcinoma; Endometrial samplingDiagnóstico; Carcinoma de endometrio; Muestreo endometrialDiagnòstic; Carcinoma endometrial; Mostreig endometrialObjective To evaluate whether the amount of preoperative endometrial tissue surface is related to the degree of concordance with final low- and high-grade endometrial cancer (EC). In addition, to determine whether discordance is influenced by sampling method and impacts outcome. Methods A retrospective cohort study within the European Network for Individualized Treatment of Endometrial Cancer (ENITEC). Surface of preoperative endometrial tissue samples was digitally calculated using ImageJ. Tumor samples were classified into low-grade (grade 1–2 endometrioid EC (EEC)) and high-grade (grade 3 EEC + non-endometroid EC). Results The study cohort included 573 tumor samples. Overall concordance between pre- and postoperative diagnosis was 60.0%, and 88.8% when classified into low- and high-grade EC. Upgrading (preoperative low-grade, postoperative high-grade EC) was found in 7.8% and downgrading (preoperative high-grade, postoperative low-grade EC) in 26.7%. The median endometrial tissue surface was significantly lower in concordant diagnoses when compared to discordant diagnoses, respectively 18.7 mm2 and 23.5 mm2 (P = 0.022). Sampling method did not influence the concordance in tumor classification. Patients with preoperative high-grade and postoperative low-grade showed significant lower DSS compared to patients with concordant low-grade EC (P = 0.039). Conclusion The amount of preoperative endometrial tissue surface was inversely related to the degree of concordance with final tumor low- and high-grade. Obtaining higher amount of preoperative endometrial tissue surface does not increase the concordance between pre- and postoperative low- and high-grade diagnosis in EC. Awareness of clinically relevant down- and upgrading is crucial to reduce subsequent over- or undertreatment with impact on outcome

Loss of Free Fatty Acid Receptor 2 leads to impaired islet mass and beta cell survival

The regulation of pancreatic β cell mass is a critical factor to help maintain normoglycemia during insulin resistance. Nutrient-sensing G protein-coupled receptors (GPCR) contribute to aspects of β cell function, including regulation of β cell mass. Nutrients such as free fatty acids (FFAs) contribute to precise regulation of β cell mass by signaling through cognate GPCRs, and considerable evidence suggests that circulating FFAs promote β cell expansion by direct and indirect mechanisms. Free Fatty Acid Receptor 2 (FFA2) is a β cell-expressed GPCR that is activated by short chain fatty acids, particularly acetate. Recent studies of FFA2 suggest that it may act as a regulator of β cell function. Here, we set out to explore what role FFA2 may play in regulation of β cell mass. Interestingly, Ffar2(-/-) mice exhibit diminished β cell mass at birth and throughout adulthood, and increased β cell death at adolescent time points, suggesting a role for FFA2 in establishment and maintenance of β cell mass. Additionally, activation of FFA2 with Gαq/11-biased agonists substantially increased β cell proliferation in in vitro and ex vivo proliferation assays. Collectively, these data suggest that FFA2 may be a novel therapeutic target to stimulate β cell growth and proliferation

The PROMIZING trial enrollment algorithm for early identification of patients ready for unassisted breathing

Background: Liberating patients from mechanical ventilation (MV) requires a systematic approach. In the context of a clinical trial, we developed a simple algorithm to identify patients who tolerate assisted ventilation but still require ongoing MV to be randomized. We report on the use of this algorithm to screen potential trial participants for enrollment and subsequent randomization in the Proportional Assist Ventilation for Minimizing the Duration of MV (PROMIZING) study. Methods: The algorithm included five steps: enrollment criteria, pressure support ventilation (PSV) tolerance trial, weaning criteria, continuous positive airway pressure (CPAP) tolerance trial (0 cmHO during 2 min) and spontaneous breathing trial (SBT): on fraction of inspired oxygen (FO) 40% for 30-120 min. Patients who failed the weaning criteria, CPAP Zero trial, or SBT were randomized. We describe the characteristics of patients who were initially enrolled, but passed all steps in the algorithm and consequently were not randomized. Results: Among the 374 enrolled patients, 93 (25%) patients passed all five steps. At time of enrollment, most patients were on PSV (87%) with a mean (± standard deviation) FO of 34 (± 6) %, PSV of 8.7 (± 2.9) cmHO, and positive end-expiratory pressure of 6.1 (± 1.6) cmHO. Minute ventilation was 9.0 (± 3.1) L/min with a respiratory rate of 17.4 (± 4.4) breaths/min. Patients were liberated from MV with a median [interquartile range] delay between initial screening and extubation of 5 [1-49] hours. Only 7 (8%) patients required reintubation. Conclusion: The trial algorithm permitted identification of 93 (25%) patients who were ready to extubate, while their clinicians predicted a duration of ventilation higher than 24 h

Analysis of vibration impact on stability of dewetting thin liquid film

Dynamics of a thin dewetting liquid film on a vertically oscillating substrate is considered. We assume moderate vibration frequency and large (compared to the mean film thickness) vibration amplitude. Using the lubrication approximation and the averaging method, we formulate the coupled sets of equations governing the pulsatile and the averaged fluid flows in the film, and then derive the nonlinear amplitude equation for the averaged film thickness. We show that there exists a window in the frequency-amplitude domain where the parametric and shear-flow instabilities of the pulsatile flow do not emerge. As a consequence, in this window the averaged description is reasonable and the amplitude equation holds. The linear and nonlinear analyses of the amplitude equation and the numerical computations show that such vibration stabilizes the film against dewetting and rupture.Comment: 19 pages, 11 figure