El urbanismo como instrumento de poder. Las ciudades canarias del siglo XIX

El análisis de las ciudades no se debe fundamentar, exclusivamente, en la valoración formal, espacial y semántica de sus edificios. Como muestra este artículo, al analizar las ciudades canarias del siglo XIX, se observa que convergen motivos económicos y políticos, aspectos que definieron la nueva imagen urbana, como la División Municipal (1833) Estas ciudades canarias fueron los instrumentos que la burguesía utilizó para legitimar su riqueza, prestigio y poder.The analysis of cities should not be based exclusively on the formal, spatial and semantic valuation of their buildings. As this article shows, when analyzing nineteenth century Canarian cities, it is observed that economic and political reasons converge, aspects that defined the new urban image, such as the Municipal Division (1833) These Canarian cities were the instruments that the bourgeoisie used to legitimize its wealth, prestige and power.peerReviewe

Acupuncture and rehabilitation of the painful shoulder: study protocol of an ongoing multicentre randomised controlled clinical trial [ISRCTN28687220]

BACKGROUND: Although the painful shoulder is one of the most common dysfunctions of the locomotor apparatus, and is frequently treated both at primary healthcare centres and by specialists, little evidence has been reported to support or refute the effectiveness of the treatments most commonly applied. According to the bibliography reviewed, physiotherapy, which is the most common action taken to alleviate this problem, has not yet been proven to be effective, because of the small size of sample groups and the lack of methodological rigor in the papers published on the subject. No reviews have been made to assess the effectiveness of acupuncture in treating this complaint, but in recent years controlled randomised studies have been made and these demonstrate an increasing use of acupuncture to treat pathologies of the soft tissues of the shoulder. In this study, we seek to evaluate the effectiveness of physiotherapy applied jointly with acupuncture, compared with physiotherapy applied with a TENS-placebo, in the treatment of painful shoulder caused by subacromial syndrome (rotator cuff tendinitis and subacromial bursitis). METHODS/DESIGN: Randomised controlled multicentre study with blind evaluation by an independent observer and blind, independent analysis. A study will be made of 465 patients referred to the rehabilitation services at participating healthcare centres, belonging to the regional public health systems of Andalusia and Murcia, these patients presenting symptoms of painful shoulder and a diagnosis of subacromial syndrome (rotator cuff tendinitis and subacromial bursitis). The patients will be randomised into two groups: 1) experimental (acupuncture + physiotherapy); 2) control (TENS-placebo + physiotherapy); the administration of rescue medication will also be allowed. The treatment period will have a duration of three weeks. The main result variable will be the change produced on Constant's Shoulder Function Assessment (SFA) Scale; as secondary variables, we will record the changes in diurnal pain intensity on a visual analogue scale (VAS), nocturnal pain intensity on the VAS, doses of non-steroid anti-inflammatory drugs (NSAIDs) taken during the study period, credibility scale for the treatment, degree of improvement perceived by the patient and degree of improvement perceived by the evaluator. A follow up examination will be made at 3, 6 and 12 months after the study period has ended. Two types of population will be considered for analysis: per protocol and per intention to treat. DISCUSSION: The discussion will take into account the limitations of the study, together with considerations such as the choice of a simple, safe method to treat this shoulder complaint, the choice of the control group, and the blinding of the patients, evaluators and those responsible for carrying out the final analysis

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Qualidade nutricional de cenoura e alface cultivadas em Mossoró-RN em função da densidade populacional Nutritional quality of carrot and lettuce grown in Mossoró-RN, Brazil, as affected by plant densities

O experimento foi realizado durante o período de junho a setembro de 2003, na área experimental do departamento de Ciências Vegetais da Universidade Federal Rural do Semi-Árido (UFERSA), em Mossoró-RN, com o objetivo de avaliar o efeito de densidades populacionais de cenoura e de alface, em segundo, cultivo na qualidade nutricional desses cultivos em sistema de consorciação em faixa. O delineamento experimental utilizado foi o de blocos casualizados, com os tratamentos arranjados em esquema fatorial 4 x 4, com três repetições. As populações de referência para o cultivo solteiro (PRCS) foram de 500.000 plantas.ha-1 para a cenoura e de 250.000 plantas.ha-1 para a alface, que corresponderam à densidade populacional de 100%. Os tratamentos foram resultantes da combinação de quatro populações de cenoura (40%, 60%, 80% e 100% da PRCS) com quatro populações de alface (40%, 60%, 80% e 100% da PRCS). As características avaliadas nas raízes da cenoura foram firmeza, conteúdo de vitamina C, carotenóides totais e beta-caroteno, e nas folhas da alface firmeza, conteúdo de vitamina C, carotenóides totais e clorofila total. Foram utilizadas a cv Brasília (cenoura) e a cv. Tainá (alface). As associações de densidades populacionais de cenoura e alface não afetaram qualquer característica de ambas as culturas. Porém, as densidades populacionais da cenoura influenciaram as características da cenoura, e as densidades de alface afetaram as características da folha de alface. A firmeza, conteúdo de vitamina C e de beta-caroteno nas raízes da cenoura diminuíram com o aumento da densidade deste cultivo, enquanto que o conteúdo de carotenóides totais aumentou com o incremento na densidade populacional desta cultura. Mesmo comportamento decrescente também foi observado no conteúdo de vitamina C, carotenóides totais e de clorofila total nas folhas de alface com o aumento da densidade populacional de alface.<br>The experiment was carried out from June to September of 2003, in the experimental area of "Universidade Federal Rural do Semi-Árido" (UFERSA), in Mossoró, Rio Grande do Norte state, Brazil, in order to evaluate the effect of carrot and lettuce populational densities in a second growing period on their nutritional quality in a strip-intercropping system. A randomized complete block design was used with the treatments arranged in a 4 x 4 factorial scheme with three replications. The treatments consisted of the combination of four carrot-plant densities (40%, 60%, 80% and 100% of the recommended sole crop density - RSCD) with four lettuce-plant densities (40%, 60%, 80% and 100% of the RSCD). The reference populations for carrot and lettuce in sole crop, corresponding to 100%, were of 500,000 plants.ha-1 and 250,000 plants.ha-1, respectively. Carrot cv. Brasília and lettuce cv. Tainá were planted. Quality characteristics evaluated were firmness and content of vitamin C, total carotenoids and beta-carotene for carrot roots and firmness, contents of vitamin C, total carotenoids and total chlorophyll for lettuce leaves. The associations of plant densities of carrot and lettuce did not affect any of the assessed characteristics in both crops. However, both carrot and lettuce plant densities affected the traits evaluated in both crops. The firmness, contents of vitamin C and beta-carotene in carrot roots decreased as the plant densities of carrot increased, while the content of total carotenoids increased as carrot population increased. The same decreasing behavior was observed in contents of vitamin C, total carotenoids and chlorophyll in the lettuce leaves with an increase in the plant densities of lettuce

Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study

International audienceBackground: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences.Methods: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes.Results: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1-6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2<90% for 60 s) was reported in 40%. No associated risk factors could be identified among co-morbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality.Conclusions: The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event

Correction to: Tocilizumab for patients with COVID-19 pneumonia. The single-arm TOCIVID-19 prospective trial (Journal of Translational Medicine, (2020), 18, 1, (405), 10.1186/s12967-020-02573-9)

Following publication of the original article [1] the authors identified that the collaborators of the TOCIVID-19 investigators, Italy were only available in the supplementary file. The original article has been updated so that the collaborators are correctly acknowledged. For clarity, all collaborators are listed in this correction article

Tocilizumab for patients with COVID-19 pneumonia. The single-arm TOCIVID-19 prospective trial

BackgroundTocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in pathogenesis of pneumonia the most frequent cause of death in COVID-19 patients.MethodsA multicenter, single-arm, hypothesis-driven trial was planned, according to a phase 2 design, to study the effect of tocilizumab on lethality rates at 14 and 30 days (co-primary endpoints, a priori expected rates being 20 and 35%, respectively). A further prospective cohort of patients, consecutively enrolled after the first cohort was accomplished, was used as a secondary validation dataset. The two cohorts were evaluated jointly in an exploratory multivariable logistic regression model to assess prognostic variables on survival.ResultsIn the primary intention-to-treat (ITT) phase 2 population, 180/301 (59.8%) subjects received tocilizumab, and 67 deaths were observed overall. Lethality rates were equal to 18.4% (97.5% CI: 13.6-24.0, P=0.52) and 22.4% (97.5% CI: 17.2-28.3, P<0.001) at 14 and 30 days, respectively. Lethality rates were lower in the validation dataset, that included 920 patients. No signal of specific drug toxicity was reported. In the exploratory multivariable logistic regression analysis, older age and lower PaO2/FiO2 ratio negatively affected survival, while the concurrent use of steroids was associated with greater survival. A statistically significant interaction was found between tocilizumab and respiratory support, suggesting that tocilizumab might be more effective in patients not requiring mechanical respiratory support at baseline.ConclusionsTocilizumab reduced lethality rate at 30 days compared with null hypothesis, without significant toxicity. Possibly, this effect could be limited to patients not requiring mechanical respiratory support at baseline.Registration EudraCT (2020-001110-38); clinicaltrials.gov (NCT04317092)