Invasive Pulmonary Adenocarcinoma with Lepidic Growth Pattern in a Pregnant Patient

Among the differential diagnoses that should be considered in acute respiratory failure (ARF) are infectious processes, autoimmune diseases, interstitial pulmonary fibrosis, and pulmonary neoplasia. Timely diagnosis of lung neoplasia is complicated in the early stages. An opportune diagnosis, as well as the specific treatment, decrease mortality. ARF occurs 1 in 500 pregnancies and is most common during the postpartum period. Among the specific etiologies that cause ARF during pregnancy that must be considered are: (1) preeclampsia; (2) embolism of amniotic fluid; (3) peripartum cardiomyopathy; and (4) trophoblastic embolism. The case of a 36-year-old patient with a 33-week pregnancy and ARF is presented. The patient presented dyspnea while exerting moderate effort that progressed to orthopnea and type 1 respiratory insufficiency. Imaging studies showed bilateral alveolar infiltrates and predominantly right areas of consolidation. Blood cultures, a galactomannan assay and IgG antibodies against mycoplasma pneumoniae, were reported as negative. Autoimmune etiology was ruled out through an immunoassay. A percutaneous pulmonary biopsy was performed and an invasive pulmonary adenocarcinoma with lepidic growth pattern (i.e. lepidic pulmonary adenocarcinoma, LPA) result was reported. This etiology is rare and very difficult to recognize in acute respiratory failure cases. After infectious, autoimmune and interstitial lung fibrosis have been excluded the clinician must suspect of lung cancer in a patient with acute respiratory failure and chest imaging compatible with the presence of ground-glass nodular opacities, a solitary nodule or mass with bronchogram, and lung consolidation. In the presence of acute respiratory failure, the suspicion of pulmonary neoplasia in an adult of reproductive age must be timely. Failure to recognize this etiology can lead to fatal results

Effect of High-Intensity Interval Training on Body Composition, Cardiorespiratory Fitness, Blood Pressure, and Substrate Utilization During Exercise Among Prehypertensive and Hypertensive Patients With Excessive Adiposity

Indexación: Scopus.Regular exercise training is a recognized lifestyle strategy to lower resting blood pressure (BP), but little is known about substrate metabolism in population with high BP. Thus, the purpose of this study was to investigate the effects of 16-weeks of HIIT on body composition, BP, cardiorespiratory fitness by (Formula presented.) O2max, and substrate utilization during exercise among prehypertensive and hypertensive patients with excessive adiposity. We also aimed to test the potential association between changes in cardiorespiratory fitness, substrate utilization during exercise and BP. Forty-two physically inactive overweight/obese participants participated in 16-weeks of HIIT intervention. The HIIT frequency was three times a week (work ratio 1:2:10, for interval cycling: rest period: repeated times; 80–100% of the maximum heart rate). Groups were distributed based on their baseline BP: HIIT-hypertensive (H-HTN: age 47.7 ± 12.0 years; body mass index [BMI] 30.3 ± 5.5 kg/m2; systolic [SBP]/diastolic BP [DBP] 151.6 ± 10/81.9 ± 4.2 mmHg), HIIT-pre-hypertensive (H-PreHTN: age 37.6 ± 12.0 years; BMI 31.9 ± 5.3 kg/m2; SBP/DBP 134.4 ± 3.2/74.9 ± 7.0 mmHg), and a normotensive control group (H-CG: age 40.7 ± 11.0 years; BMI 29.5 ± 4.2 kg/m2; SBP/DBP 117.0 ± 6.2/72.4 ± 4.1 mmHg). Anthropometry/body composition, BP, and metabolic substrate utilization during exercise (fat [FATox], carbohydrate [CHOox] oxidation, respiratory exchange ratio [RER], and (Formula presented.) O2max), were measured before and after the 16-week HIIT intervention. Adjusted mixed linear models revealed a significant improved in (Formula presented.) O2max were + 3.34 in the H-CG, + 3.63 in the H-PreHTN, and + 5.92 mL⋅kg–1⋅min–1, in the H-HTN group, however, the Time × Group interaction were not significant (p = 0.083). All the exercise types induced similar decreases on SBP (−8.70) in the H-HTN, (−7.14) in the H-CG, and (−5.11) mmHg in the H-PreHTN, as well as DBP levels (−5.43) mmHg in H-CG group (p = 0.032 vs. H-HTN group). At 16-week, no significant correlations were noted for the changes of blood pressure, cardiorespiratory fitness or exercise metabolism substrates outcomes. In conclusion, our results suggest that a 16-week HIIT-intervention improved (Formula presented.) O2max and blood pressure BP, but these changes are independent of substrate utilization during exercise in normotensive and hypertensive participants with excessive adiposity. © Copyright © 2020 Delgado-Floody, Izquierdo, Ramírez-Vélez, Caamaño-Navarrete, Moris, Jerez-Mayorga, Andrade and Álvarez.https://www.frontiersin.org/articles/10.3389/fphys.2020.558910/ful

Modelización Econométrica mediante mínimos cuadrados ordinarios para la detección de factores determinantes del salario en la ciudad de Cuenca-Ecuador

La determinación de salarios en Ecuador es un tema que cada año despierta el interés colectivo, debido a que los salarios son uno de los principales ingresos de los ecuatorianos. Comprender los factores determinantes de los salarios en Ecuador es muy importante para los ciudadanos porque podrán invertir tiempo y recursos en incrementar su valor para el mercado laboral. Por otro lado, las instituciones públicas del Ecuador requieren tener información relevante acerca de las variables que determinan los salarios, con la finalidad de que puedan incidir a través de la política pública. El presente estudio tiene como objetivo identificar los factores que afectan la determinación de salarios de los habitantes de la ciudad de Cuenca. Para el efecto, se planteó un modelo de regresión lineal múltiple que explica la variable salarios mensuales en función del nivel educativo, sexo, experiencia laboral, tamaño de empresa y tipo de empresa. Los datos fueron extraídos de la Encuesta de Condiciones de Vida Sexta Ronda 2014 realizada por el Instituto Nacional de Estadísticas y Censos del Ecuador. Entre los principales resultados del estudio se encontraron evidencias de discriminación salarial por género y que los individuos que laboran en el sector privado tienen en promedio salarios más altos.La determinación de salarios en Ecuador es un tema que cada año despierta el interés colectivo, debido a que los salarios son uno de los principales ingresos de los ecuatorianos. Comprender los factores determinantes de los salarios en Ecuador es muy importante para los ciudadanos porque podrán invertir tiempo y recursos en incrementar su valor para el mercado laboral. Por otro lado, las instituciones públicas del Ecuador requieren tener información relevante acerca de las variables que determinan los salarios, con la finalidad de que puedan incidir a través de la política pública. El presente estudio tiene como objetivo identificar los factores que afectan la determinación de salarios de los habitantes de la ciudad de Cuenca. Para el efecto, se planteó un modelo de regresión lineal múltiple que explica la variable salarios mensuales en función del nivel educativo, sexo, experiencia laboral, tamaño de empresa y tipo de empresa. Los datos fueron extraídos de la Encuesta de Condiciones de Vida Sexta Ronda 2014 realizada por el Instituto Nacional de Estadísticas y Censos del Ecuador. Entre los principales resultados del estudio se encontraron evidencias de discriminación salarial por género y que los individuos que laboran en el sector privado tienen en promedio salarios más altos

Exploring the magnetic topologies of cool stars

Magnetic fields of cool stars can be directly investigated through the study of the Zeeman effect on photospheric spectral lines using several approaches. With spectroscopic measurement in unpolarised light, the total magnetic flux averaged over the stellar disc can be derived but very little information on the field geometry is available. Spectropolarimetry provides a complementary information on the large-scale magnetic topology. With Zeeman-Doppler Imaging (ZDI), this information can be retrieved to produce a map of the vector magnetic field at the surface of the star, and in particular to assess the relative importance of the poloidal and toroidal components as well as the degree of axisymmetry of the field distribution. The development of high-performance spectropolarimeters associated with multi-lines techniques and ZDI allows us to explore magnetic topologies throughout the Hertzsprung-Russel diagram, on stars spanning a wide range of mass, age and rotation period. These observations bring novel constraints on magnetic field generation by dynamo effect in cool stars. In particular, the study of solar twins brings new insight on the impact of rotation on the solar dynamo, whereas the detection of strong and stable dipolar magnetic fields on fully convective stars questions the precise role of the tachocline in this process.Postprin

The Effect of Macular Hole Duration on Surgical Outcomes: An Individual Participant Data Study of Randomized Controlled Trials

Topic: To define the effect of symptom duration on outcomes in people undergoing surgery for idiopathic full-thickness macular holes (iFTMHs) by means of an individual participant data (IPD) study of randomized controlled trials (RCTs). The outcomes assessed were primary iFTMH closure and postoperative best-corrected visual acuity (BCVA). Clinical Relevance: Idiopathic full-thickness macular holes are visually disabling with a prevalence of up to 0.5%. Untreated BCVA is typically reduced to 20/200. Surgery can close holes and improve vision. Symptom duration is thought to affect outcomes with surgery, but the effect is unclear. Methods: A systematic review identified eligible RCTs that included adults with iFTMH undergoing vitrectomy with gas tamponade in which symptom duration, primary iFTMH closure, and postoperative BCVA were recorded. Bibliographic databases were searched for articles published between 2000 and 2020. Individual participant data were requested from eligible studies. Results: Twenty eligible RCTs were identified. Data were requested from all studies and obtained from 12, representing 940 eyes in total. Median symptom duration was 6 months (interquartile range, 3–10). Primary closure was achieved in 81.5% of eyes. There was a linear relationship between predicted probability of closure and symptom duration. Multilevel logistic regression showed each additional month of duration was associated with 0.965 times lower odds of closure (95% confidence interval [CI], 0.935–0.996, P = 0.026). Internal limiting membrane (ILM) peeling, ILM flap use, better preoperative BCVA, face-down positioning, and smaller iFTMH size were associated with increased odds of primary closure. Median postoperative BCVA in eyes achieving primary closure was 0.48 logarithm of the minimum angle of resolution (logMAR) (20/60). Multilevel logistic regression showed for eyes achieving primary iFTMH closure, each additional month of symptom duration was associated with worsening BCVA by 0.008 logMAR units (95% CI, 0.005–0.011, P < 0.001) (i.e., ∼1 Early Treatment Diabetic Retinopathy Study letter loss per 2 months). ILM flaps, intraocular tamponade using long-acting gas, better preoperative BCVA, smaller iFTMH size, and phakic status were also associated with improved postoperative BCVA. Conclusions: Symptom duration was independently associated with both anatomic and visual outcomes in persons undergoing surgery for iFTMH. Time to surgery should be minimized and care pathways designed to enable this

Large-scale magnetic topologies of early M dwarfs

We present here additional results of a spectropolarimetric survey of a small sample of stars ranging from spectral type M0 to M8 aimed at investigating observationally how dynamo processes operate in stars on both sides of the full convection threshold (spectral type M4). The present paper focuses on early M stars (M0--M3), i.e. above the full convection threshold. Applying tomographic imaging techniques to time series of rotationally modulated circularly polarised profiles collected with the NARVAL spectropolarimeter, we determine the rotation period and reconstruct the large-scale magnetic topologies of 6 early M dwarfs. We find that early-M stars preferentially host large-scale fields with dominantly toroidal and non-axisymmetric poloidal configurations, along with significant differential rotation (and long-term variability); only the lowest-mass star of our subsample is found to host an almost fully poloidal, mainly axisymmetric large-scale field ressembling those found in mid-M dwarfs. This abrupt change in the large-scale magnetic topologies of M dwarfs (occuring at spectral type M3) has no related signature on X-ray luminosities (measuring the total amount of magnetic flux); it thus suggests that underlying dynamo processes become more efficient at producing large-scale fields (despite producing the same flux) at spectral types later than M3. We suspect that this change relates to the rapid decrease in the radiative cores of low-mass stars and to the simultaneous sharp increase of the convective turnover times (with decreasing stellar mass) that models predict to occur at M3; it may also be (at least partly) responsible for the reduced magnetic braking reported for fully-convective stars.Comment: MNRAS, in pres

International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines

The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent

Haplotype analysis of the internationally distributed BRCA1 c.3331_3334delCAAG founder mutation reveals a common ancestral origin in Iberia

Background: TheBRCA1c.3331_3334delCAAG founder mutation has been reported in hereditary breast and ovarian cancer families from multiple Hispanic groups. We aimed to evaluateBRCA1c.3331_3334delCAAG haplotype diversity in cases of European, African, and Latin American ancestry. Methods: BC mutation carrier cases from Colombia (n = 32), Spain (n = 13), Portugal (n = 2), Chile (n = 10), Africa (n = 1), and Brazil (n = 2) were genotyped with the genome-wide single nucleotide polymorphism (SNP) arrays to evaluate haplotype diversity aroundBRCA1c.3331_3334delCAAG. Additional Portuguese (n = 13) and Brazilian (n = 18) BC mutation carriers were genotyped for 15 informative SNPs surroundingBRCA1. Data were phased using SHAPEIT2, and identical by descent regions were determined using BEAGLE and GERMLINE. DMLE+ was used to date the mutation in Colombia and Iberia. Results: The haplotype reconstruction revealed a shared 264.4-kb region among carriers from all six countries. The estimated mutation age was similar to 100 generations in Iberia and that it was introduced to South America early during the European colonization period. Conclusions: Our results suggest that this mutation originated in Iberia and later introduced to Colombia and South America at the time of Spanish colonization during the early 1500s. We also found that the Colombian mutation carriers had higher European ancestry, at the BRCA1 gene harboring chromosome 17, than controls, which further supported the European origin of the mutation. Understanding founder mutations in diverse populations has implications in implementing cost-effective, ancestry-informed screening

Large-scale magnetic topologies of mid-M dwarfs

We present in this paper the first results of a spectropolarimetric analysis of a small sample (~ 20) of active stars ranging from spectral type M0 to M8, which are either fully-convective or possess a very small radiative core. This study aims at providing new constraints on dynamo processes in fully-convective stars. The present paper focuses on 5 stars of spectral type ~M4, i.e. with masses close to the full convection threshold (~ 0.35 Msun), and with short rotational periods. Tomographic imaging techniques allow us to reconstruct the surface magnetic topologies from the rotationally modulated time-series of circularly polarised profiles. We fnd that all stars host mainly axisymmetric large-scale poloidal fields. Three stars were observed at two different epochs separated by ~1 yr; we find the magnetic topologies to be globally stable on this timescale. We also provide an accurate estimation of the rotational period of all stars, thus allowing us to start studying how rotation impacts the large-scale magnetic field.Comment: 17 pages, 14 figures, accepted for publication in MNRA