El estudio de instrumentos de viento se asocia con un patrón obstructivo en la espirometría de adolescentes con buena capacidad de resistencia aeróbica

ResumenObjetivoExiste controversia en la literatura médica respecto al efecto beneficioso o perjudicial de la práctica con instrumentos musicales de viento sobre el sistema respiratorio. El objetivo de este estudio es analizar esta relación en sujetos jóvenes en periodo de aprendizaje, ponderando su nivel de condición física.DiseñoEstudio observacional transversal.EmplazamientoCentro Integrado de Enseñanzas Artísticas y Musicales (estudios musicales reglados de Grado Medio) y de Educación Primaria y Secundaria, de titularidad pública.ParticipantesJóvenes estudiantes de entre 13–17 años.Mediciones principalesSe recogieron parámetros epidemiológicos básicos (sexo, edad, peso, talla, estado de salud) y a cada sujeto se le realizó un test de condición física (prueba de aptitud cardiorespiratoria de «course navette»), y una espirometría forzada.ResultadosSe incluyeron 90 alumnos, 53 mujeres y 37 varones, de los cuales 32 eran instrumentistas de viento y 58 de otros instrumentos. Los 2 grupos fueron homogéneos respecto a sexo, edad e índice de masa corporal. El consumo máximo de oxígeno no mostró diferencias significativas (p=0,255), manifestando además un adecuado nivel de condición física respecto a la población general. La CVF fue normal y comparable en ambos grupos (p=0,197). El VEMS porcentual y el cociente VEMS/CVF fueron significativamente menores (p<0,0005) en el grupo de viento. La práctica con instrumentos de viento se comportó como variable predictora de VEMS/CVF patológico (<70%) en el análisis multivariante (p<0,0005).ConclusionesEl estudio de instrumentos de viento se asoció con un patrón espirométrico obstructivo en músicos jóvenes con un nivel normal de condición física.AbstractObjectiveThere is controversy in the medical literature regarding the beneficial or detrimental effects of playing wind musical instruments on the respiratory system. The aim of this study is to analyse this relationship, taking the physical condition of the subjects into consideration.DesignCross-sectional observational study.SettingPublic institution with coordinated medium grade musical instruction and primary and secondary education.ParticipantsYoung performers (between 13 and 17 years).DataWe collected basic epidemiological parameters (gender, age, weight, size, heath status), and each subject underwent a fitness test (“course navette” cardiorespiratory fitness test) and a forced spirometry.ResultsWe included 90 students, 53 females and 37 males. Thirty two were wind instrument players and 58 studied other instruments. The two groups were homogeneous with respect to gender, age and body mass index. The maximum oxygen uptake showed no significant difference (P=0.255), further demonstrating an adequate level of fitness compared to the general population. FVC was normal and similar in both groups (P=0.197). The FEV1 percentage and the FEV1/FVC ratio were significantly lower (P<0.0005) in the “wind” group. Practice with wind instruments behaved as a predictor of pathological FEV1/FVC (<70%) in the multivariate analysis (P<0.0005).ConclusionThe study of wind instruments was associated with an obstructive spirometric pattern in young musicians with a normal level of physical fitness

Life histories of Mediterranean pines

Abstract The life history of Spanish pines and their relation to fire as the main disturbance factor in their ecosystems was analysed. The primary ecological attributes studied were the canopy seed bank (onset of cone production, percentage and persistence of serotinous cones), seed and cone morphology, sprouting and bark thickness. Four ecological groups were separated using multivariate cluster analysis and their life-history characteristics are discussed. Serotiny and early flowering in Pinus halepensis and P. pinaster reflect their evader strategy in relation to fire as this character is advantageous to survive frequent crown fires and to attain successful post-fire recruitment. Late flowering and absence of serotinous cones in P. nigra, P. sylvestris and P. uncinata indicate that their natural forest did not evolve under frequent crown fires. P. canariensis and P. pinea appeared in two single groups because of their sprouting capability and their seed size respectively. Intraspecific variation in P. pinaster was also analysed using the same criteria and high variability was found in its life history traits. A group of P. pinaster populations showed high levels of serotiny and thin bark as a possible adaptation to frequent stand-replacing crown fires. In contrast, a group of non-or weakly-serotinous populations seems to have evolved under a low-intensity fire regime where the best fitness corresponds to thick-barked individuals capable of surviving ground fires. Intermediate strategies were also evident in this species and were discussed in relation to the effect of different fire regimes caused by the understorey vegetation

Effects of Albumin on Survival after a Hepatic Encephalopathy Episode: Randomized Double-Blind Trial and Meta-Analysis

No therapies have been proven to increase survival after a hepatic encephalopathy (HE) episode. We hypothesize that two doses of albumin could improve 90-day survival rates after a HE episode. Methods: (1) A randomized double-blind, placebo-controlled trial (BETA) was conducted in 12 hospitals. The effect of albumin (1.5 g/kg at baseline and 1 g/kg on day 3) on 90-day survival rates after a HE episode grade II or higher was evaluated. (2) A meta-analysis of individual patient's data for survival including two clinical trials (BETA and ALFAE) was performed. Results: In total, 82 patients were included. Albumin failed to increase the 90-day transplant-free survival (91.9% vs. 80.5%, p = 0.3). A competing risk analysis was performed, observing a 90-day cumulative incidence of death of 9% in the albumin group vs. 20% in the placebo (p = 0.1). The meta-analysis showed a benefit in the albumin group, with a lower rate of clinical events (death or liver transplant) than patients in the placebo (HR, 0.44; 95% CI, 0.21-0.82), when analyzed by a competing risk analysis (90-days mortality rate of 11% in the albumin group vs. 30% in the placebo, p = 0.02). Conclusions: Repeated doses of albumin might be beneficial for patient's survival as an add-on therapy after an HE episode, but an adequately powered trial is needed