Do the low molecular weight heparins improve efficacy and safety of the treatment of deep venous thrombosis? A meta-analysis

We compared the efficacy and safety of low molecular weight heparins (LMWH) and unfractionated heparin (UFH) in the treatement of deep venous thrombosis (DVT). A comparison between two daily subcutaneous injections of LMWH against a single injection was also performed. DESIGN AND METHODS: The study was performed by a meta-analysis. Clot improvement in venography, recurrency, total mortality and major hemorrhages were assessed in 4,472 patients with DVT from 21 studies treated with subcutaneous LMWH or UFH. RESULTS: An improvement in clot reduction (odds ratio 0.73, 95% confidence interval 0.59 to 0.90, p = 0.004), a decrease in total mortality (0. 68, 0.50 to 0.91, p = 0.012) and a lower incidence of hemorrhage (0. 65, 0.43 to 0.98, p = 0.047) were observed in LMWH treated patients. There were no differences in recurrences (0.78, 0.59 to 1.04, p = 0. 10). A single dose of LMWH was better than two in reducing major bleeding (c2 = 4.99, p = 0.025); however, the two dose regimen was more effective in clot reduction (c2 = 8.56, p = 0.004). INTERPRETATION AND CONCLUSIONS: LMWH is superior to UFH in terms of safety and efficacy. A single daily dose of LMWH dose is a suitable therapeutic regimen and could facilitate the outpatient treatment of venous thromboembolism

Distribuição e ajuste do comportamento sob condições de entrega de água contingente e não contingente

The observation of similar functional relations under Pavlovian and operant contingencies could support the idea that both respondent and operant behaviors are the result of the same process. The effects of the sequence of exposure to non-contingent and contingent water delivery on the occurrence, temporal distribution, andbehavioral adjustment were assessed. Lights or tones were used as antecedent stimuli between subjects. The required responses under each condition of water delivery (nose-poking and lever-pressing) increased and decreased in correspondence with the ongoing contingency. No differences in the temporal distribution of both responses were observed when they were required by the ongoing contingency. Under both sequences of exposure the behavioral adjustment was higher in the second than in the first condition of water delivery. The results are discussed considering the possibility of a single behavioral process under both conditions of water deliveryLa observación de relaciones funcionales similares bajo contingencias pavlovianas y operantes podría apoyar la idea de que los comportamientos respondiente y operante son el resultado de un mismo proceso. En el presente estudio se evaluaron los efectos de la secuencia de exposición a la entrega de agua no contingente y contingente sobre la ocurrencia, distribución temporal y ajuste del comportamiento. Entre sujetos se utilizaron luces o tonos como estímulos antecedentes. Las respuestas requeridas bajo cada condición de entrega de agua (asomarse y apretar la palanca) aumentaron y disminuyeron en correspondencia con el tipo de contingencia vigente. No se observaron diferencias en la distribución temporal de ambas respuestas cuando fueron requeridas por la contingencia en vigor. En ambas secuencias de exposición se observó que el ajuste conductual fue más elevado en la segunda condición de entrega de agua que en la primera. Los resultados se discuten atendiendo a la posibilidad de un mismo proceso conductual bajo ambas condiciones de entrega de agua. A observação de relações funcionais similares sob contingencias Pavlovianas e operantes poderia apoiar a ideia de que os comportamentos respondente e operante são o resultado de um mesmo processo. No presente estudo se avaliaram os efeitos da sequência de exposição à entrega de água não contingente e contingente sobre a ocorrência, distribuição temporal e ajuste do comportamento. Entre sujeitos utilizaram-se luzes ou tonos como estímulos antecedentes. As respostas requeridas sob cada condição de entrega de água (assomar-se e puxar a alavanca) aumentaram e diminuíram em correspondência com o tipo de contingência vigente. Não se observaram diferenças na distribuição temporal de ambas as respostas quando foram requeridas pela contingência em vigor. Em ambas as sequencias de exposição observou-se que o ajuste comportamental foi mais elevado na segunda condição de entrega de água que na primeira. Os resultados se discutem atendendo à possibilidade de um mesmo processo comportamental sob ambas as condições de entrega de água

Predicting aging-related decline in physical performance with sparse electrophysiological source imaging

Objective: We introduce a methodology for selecting biomarkers from activation and connectivity derived from Electrophysiological Source Imaging (ESI). Specifically, we pursue the selection of stable biomarkers associated with cognitive decline based on source activation and connectivity patterns of resting-state EEG theta rhythm, used as predictors of physical performance decline in aging individuals measured by a Gait Speed (GS) slowing. Methods: Our two-step methodology involves estimating ESI using flexible sparse-smooth-nonnegative models, from which activation ESI (aESI) and connectivity ESI (cESI) features are derived. The Stable Sparse Classifier method then selects potential biomarkers related to GS changes. Results and Conclusions: Our predictive models using aESI outperform traditional methods such as the LORETA family. The models combining aESI and cESI features provide the best prediction of GS changes. Potential biomarkers from activation/connectivity patterns involve orbitofrontal and temporal cortical regions. Significance: The proposed methodology contributes to the understanding of activation and connectivity of GS-related ESI and provides features that are potential biomarkers of GS slowing. Given the known relationship between GS decline and cognitive impairment, this preliminary work opens novel paths to predict the progression of healthy and pathological aging and might allow an ESI-based evaluation of rehabilitation programs

Improving air quality in metropolitan Mexico City : an economic valuation

Mexico City has for years experienced high levels of ozone and particulate air pollution. In 1995-99 the entire population of the Mexico City metropolitan area was exposed to annual average concentrations of fine particulate pollution (particulates with a diameter of less than 10micrometers, or PM10) exceeding 50 micrograms per cubic meter, the annual average standard in both Mexico and the United States. Two million people were exposed to annual average PM10 levels of more than 75 micrograms per cubic meter. The daily maximum one-hour ozone standard was exceeded at least 300 days a year. The Mexico Air Quality Management Team documents population-weighted exposures to ozone and PM10 between 1995 and 1999, project exposures in 2010, and computes the value of four scenarios for 2010: A 10 percent reduction in PM10 and ozone. A 20 percent reduction in PM10 and ozone. Achievement of ambient air quality standards across the metropolitan area. A 68 percent reduction in ozone and a 47 percent reduction in PM10 across the metropolitan area. The authors calculate the health benefits of reducing ozone and PM10 for each scenario using dose-response functions from the peer-reviewed literature. They value cases of morbidity and premature mortality avoided using three approaches: Cost of illness and forgone earnings only (low estimate). Cost of illness, forgone earnings, and willingness to pay for avoided morbidity (central case estimate). Cost of illness, forgone earnings, willingness to pay for avoided morbidity, and willingness to pay for avoided mortality (high estimate). The results suggest that the benefits of a 10 percent reduction in ozone and PM10 in 2010 are about $760 million (in 1999 U.S. dollars) annually in the central case. The benefits of a 20 percent reduction in ozone and PM10 are about$1.49 billion annually. In each case the benefits of reducing ozone amount to about 15 percent of the total benefits. By estimating the magnitude of the benefits from air pollution control, the authors provide motivation for examining specific policies that could achieve the air pollution reductions that they value. They also provide unit values for the benefits from reductions in ambient air pollution (for example, per microgram of PM10) that could be used as inputs into a full cost-benefit analysisof air pollution control strategies.Montreal Protocol,Public Health Promotion,Global Environment Facility,Air Quality&Clean Air,Health Monitoring&Evaluation,Montreal Protocol,Air Quality&Clean Air,Health Monitoring&Evaluation,Global Environment Facility,Transport and Environment

En la costa aún sin mar

Los trabajos que conforman este volumen son una muestra de la presencia y actualidad de la obra de César Vallejo. Su poesía aún da lugar a nuevas y diversas interpretaciones; también a ciertas reconsideraciones. Asimismo, la narrativa del escritor peruano, poco atendida, está presente y exige estudio además de revalorización. La persona y obra de César Vallejo, en fin, son actuales incluso como un fenómeno metapoético.César Vallejo es un escritor esencial en el ámbito de la literatura contemporánea. Su obra literaria, escrita a principios del siglo pasado, sigue vigente. En su poesía, en particular, captó la sensibilidad de toda una época. Asimismo, supo traducir lo que él llamaba “el ritmo interior y el espíritu que se desprende de la realidad actual”. En cuanto a su obra en prosa, los estudios recientes dan muestra de su importancia, valor social y artístico. A casi cien años de la publicación de libros como Trilce y Los heraldos negros, la obra de César Vallejo sigue siendo fuente de goce estético y, por su complejidad, de búsqueda de conocimiento profundo de la realidad social y humana

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

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

The Genome of Anopheles darlingi, the main neotropical malaria vector

Anopheles darlingi is the principal neotropical malaria vector, responsible for more than a million cases of malaria per year on the American continent. Anopheles darlingi diverged from the African and Asian malaria vectors ∼100 million years ago (mya) and successfully adapted to the New World environment. Here we present an annotated reference A. darlingi genome, sequenced from a wild population of males and females collected in the Brazilian Amazon. A total of 10 481 predicted protein-coding genes were annotated, 72% of which have their closest counterpart in Anopheles gambiae and 21% have highest similarity with other mosquito species. In spite of a long period of divergent evolution, conserved gene synteny was observed between A. darlingi and A. gambiae. More than 10 million single nucleotide polymorphisms and short indels with potential use as genetic markers were identified. Transposable elements correspond to 2.3% of the A. darlingi genome. Genes associated with hematophagy, immunity and insecticide resistance, directly involved in vectorhuman and vectorparasite interactions, were identified and discussed. This study represents the first effort to sequence the genome of a neotropical malaria vector, and opens a new window through which we can contemplate the evolutionary history of anopheline mosquitoes. It also provides valuable information that may lead to novel strategies to reduce malaria transmission on the South American continent. The A. darlingi genome is accessible at www.labinfo.lncc.br/index.php/anopheles- darlingi. © 2013 The Author(s)

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p &lt; 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

The Helicobacter pylori Genome Project : insights into H. pylori population structure from analysis of a worldwide collection of complete genomes

Helicobacter pylori, a dominant member of the gastric microbiota, shares co-evolutionary history with humans. This has led to the development of genetically distinct H. pylori subpopulations associated with the geographic origin of the host and with differential gastric disease risk. Here, we provide insights into H. pylori population structure as a part of the Helicobacter pylori Genome Project (HpGP), a multi-disciplinary initiative aimed at elucidating H. pylori pathogenesis and identifying new therapeutic targets. We collected 1011 well-characterized clinical strains from 50 countries and generated high-quality genome sequences. We analysed core genome diversity and population structure of the HpGP dataset and 255 worldwide reference genomes to outline the ancestral contribution to Eurasian, African, and American populations. We found evidence of substantial contribution of population hpNorthAsia and subpopulation hspUral in Northern European H. pylori. The genomes of H. pylori isolated from northern and southern Indigenous Americans differed in that bacteria isolated in northern Indigenous communities were more similar to North Asian H. pylori while the southern had higher relatedness to hpEastAsia. Notably, we also found a highly clonal yet geographically dispersed North American subpopulation, which is negative for the cag pathogenicity island, and present in 7% of sequenced US genomes. We expect the HpGP dataset and the corresponding strains to become a major asset for H. pylori genomics