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The objective of this article is to analyze the capital structure adjustment of Latin American firms through the pecking order and trade-off theories using a sample of 975 non-financial firms for the period 2000-2017. The results support the existence of a target capital structure. Adjustment speeds ranged between 48.9% and 74.3% and generate a rapid convergence of leverage towards its target level. Financial deficits explained less than half of the changes in debt, which contradicts the pecking order theory. The results of the error correction model indicated that companies dynamically deviate from their long-term capital structure. The convergence speeds in the partial adjustment model increased up to 69.5% and 91.7% with the error correction method. These results are relevant for firms and investors.

We analyze the relationship between the exchange markets and the integration process of the Latin American stock markets (MILA), focusing the analysis on two points. First, we evaluate the existence and nature of exchange risk premium and its relationship with the uncovered interest parity (UIP) bias. Second, we analyze the effect of MILA on Latin American foreign exchange markets. We use monthly time series between January 1997 and December 2021 for the exchange markets of Brazil, Chile, Colombia, Mexico and Peru. The econometric analysis was based on OLS, GARCH-in-Mean and DCC-MGARCH regressions. Our results indicate that UIP is does not meet. Even the GARCH-in-Mean models results indicates that there is no individual risk premium that corrects UIP bias. However, the results of the DCC-MGARCH model show that there is a risk premium generated simultaneously by the correlation between markets. Finally, MILA increased the dynamic correlations of exchange returns and risk premiums, mainly among the MILA markets. These results have relevant implications for policymakers and investors due to the impacts on exchange markets dependence and international investment decision-making.

Objective This study evaluates whether clinical phenotypes of small for gestational (SGA) fetuses can be identified and used for adverse perinatal outcome risk stratification to facilitate decision-making. Methods This multicentre observational cohort study was conducted in two tertiary care university hospitals. It included 17,631 consecutive singleton pregnancies, among which 1274 (7.2%) were defined as SGA at birth according to INTERGROWTH-21st standards. The main outcome was the development of clinical clusters of SGA phenotypes. Results Nine SGA clinical phenotypes were identified using a predefined conceptual framework. Every delivery and perinatal outcome analysed showed statistically significant differences between phenotypes. The total SGA cohort had a 3 times increased risk of perinatal mortality than non-SGA fetuses (1.4% vs 0.4%; pConclusions We identified nine SGA clinical phenotypes associated with different patterns of risk for adverse perinatal outcomes. Our results suggest that adding clinical characteristics to ultrasound results would improve risk stratification and decision-making for SGA fetuses. Future clinical trials on the control of fetuses with SGA should take into account, in addition to Doppler and estimated fetal weight, this clinical information.

Colitis-associated colon cancer (CAC) is one of the most common malignant neoplasms and a leading cause of death. The immunologic factors associated with CAC development are not completely understood. Signal transducer and activator of transcription 6 (STAT6) is part of an important signaling pathway for modulating intestinal immune function and homeostasis. However, the role of STAT6 in colon cancer progression is unclear. Following CAC induction in wild-type (WT) and STAT6-deficient mice (STAT6–/–), we found that 70% of STAT6–/– mice were tumor-free after 8 weeks, whereas 100% of WT mice developed tumors. STAT6–/– mice displayed fewer and smaller colorectal tumors than WT mice; this reduced tumorigenicity was associated with decreased proliferation and increased apoptosis in the colonic mucosa in the early steps of tumor progression. STAT6–/– mice also exhibited reduced inflammation, diminished concentrations COX2 and nuclear β-catenin protein in the colon, and decreased mRNA expression of IL17A and TNFα, but increased IL10 expression when compared with WT mice. Impaired mucosal expression of CCL9, CCL25, and CXCR2 was also observed. In addition, the number of circulating CD11b+Ly6ChiCCR2+ monocytes and CD11b+Ly6ClowLy6G+ granulocytes was both decreased in a STAT6-dependent manner. Finally, WT mice receiving a STAT6 inhibitor in vivo confirmed a significant reduction in tumor load as well as less intense signs of CAC. Our results demonstrate that STAT6 is critical in the early steps of CAC development for modulating inflammatory responses and controlling cell recruitment and proliferation. Thus, STAT6 may represent a promising target for CAC treatment. Cancer Immunol Res; 5(5); 385–96. ©2017 AACR.

Data about primers used for RT-PCR analysis, including number of cycles and melting temperature

Dear Editor: Chronic rhinosinusitis with nasal polyps (CRSwNP) affects 1.0-2.6% of the population (1) and results in relevant direct and indirect costs. Recently, several randomized controlled trials (RCTs) with Type 2-targeting biologicals (anti-IL4Rα, anti-IL5R, anti-IL5 and anti-IgE) opened a new treatment field for patients refractory to first-line treatments (2,3).

Objective: Evaluate the use of Ethylene Glycol (EG), Dimethyl Sulfoxide (DMSO), Sucrose and Fetal Bovine Serum (FBS) as cryoprotectants and their effect on the organization of chromosomes and the arrangement of microtubules, during the vitrification process in goat oocytes matured in vitro and in the development of preimplantation embryos produced in vitro. Design/methodology/approach: In vitro matured oocytes were divided into 3 groups (control group, cryoprotectant exposed group, vitrified group). A mixture of 15% EG, 15% DMSO, 0.4 M sucrose and 20% FBS was used for the vitrification using the Cryotop device. In vitro matured oocytes were warmed and afterwards each group was divided into two more groups. Both groups were subjected to immunofluorescence, the first group to observe the damage produced to the chromosomes and microtubules and the second group to observe the effect on the in vitro embryo development. Results: The combined use of 15% EG, 15% DMSO, 0.4 M Sucrose and 20% FBS during vitrification did not prevent cryoinjuries in goat oocytes and in vitro produced embryos, since embryo development was disrupted before the blastocyst stage by stopping cleavage at the morula stage. This disruption was associated with chromosome decondensation and the absence of a microtubule network, thereby hindering chromosomal segregation. Limitations on study/implications: The effect of conventional cryoprotectants on chromosomes and microtubules arrangement on vitrified goat oocytes and in vitro embryo production. Findings/conclusions: The combined use of 15% EG, 15% DMSO, 0.4 M sucrose and 20% FBS as vitrification cryoprotectants did not prevent cryoinjuries in caprine oocytes and did not improve caprine embryo development in vitro.

Hydatid disease is one of the important health problems in developing countries. Can affect any part of the human body, it commonly affects lungs and liver. Because of poor data and preventive measures in Sub-Saharan Africa, cystic echinococcosis (CE) is regarded as endemic disease. This is a retrospective study of children ages of 3 to 12 years admitted in pediatric surgical unit at Nelson Mandela Academic Hospital (NMAH), from April 2015 to aril 2020. We studied groups of age, sex, organs affected, treatment and complications. We studied 56 children; the group of age most affected was 5 to 10 years, females accounted for 51.8%, and male for 48.2%, lung hydatid cysts in 44.6% of cases, 41.1% had liver cysts, 8.9% of the patients had cysts in multiple locations. In 46 cases (82%), the treatment was surgical: punction-aspiration-injection and respiration (PAIR) removing the germinal layer, following in the post operatory with Albendazole and Praziquantel. In 10 cases (18//%) was given only medical treatment. Females were most affected, and the lungs were the organs most affected followed by liver.

The present study aims to analyze the prevalence of depressive symptoms and its sociodemographic-associated factors in Peruvian adults. Data was extracted from a nation-wide representative survey in which depression symptoms were measured with the PHQ-9 and sociodemographic information was extracted from household data. Depression severity rates were estimated for each symptom, and responses were modeled through the Rating Scale Model to obtain a depression measure used as dependent variable on a Generalized Mixed Linear Model. The most frequent depression symptoms were emotional, such as discouragement, sad mood, hopelessness, and lack of pleasure when doing activities. Our model showed that, after controlling the effects of all the variables considered, the most relevant predictors were gender, education level, physiographic region, age, marital status, and number of coresidents. Higher depression levels were found in women, people who did not complete higher education, participants living in the Highlands, older adults, single participants, and people living alone. Thus, interventions to promote or prevent depression severity during similar situations as the pandemic should focus on specific sociodemographic groups and their particular needs.

In this paper we propose to study the banana by problematizing the exoticism, mythification, fetishization and scientism of the colonial view. To do this, we approach the work Musa paradisiaca, a video installation by the artist José Alejandro Restrepo, and the dialogue that it holds with the text “Volver a comer del árbol de la ciencia” by Juan Cárdenas. Our main hypothesis is that in the articulation of these works the image of the banana becomes a sign of duration. As an expression of multiplicities, contradictions and heterogeneities of times, the duration is expressed in the modes of presence of a pattern (which in the case of our study is the banana) that is detached from the merely common and static and expresses a multiple, contradictory and heterogeneous presence that configures variations displayed in the extension of time. The inscription of banana as a pattern entails a departure from context, a search for the gaps where the disorder of the dominant and the norm occurs, that is, a variation.

The Greater Everglades Ecosystem is a globally important ecoregion, home to 68 threatened or endangered species and the largest designated wilderness area in the Eastern United States. Anthropogenic manipulations of the natural hydrology have led to widespread degradation of this ecosystem and monitored population declines across multiple taxa. Simultaneous introductions of hundreds of non-native species into South Florida and their subsequent invasion into the Everglades has further impacted native Everglades communities. Predictions for future climate change suggest that the Everglades is headed towards a drier future, making it crucial to understand how changes in hydrological regimes will impact both native and non-native fauna. Our study combines the results of a landscape-scale experimental manipulation conducted to assess the impact of differing hydrological regimes at the Loxahatchee Impoundment Landscape Assessment between 2018 and 2020 with a community composition analysis of data collected across multiple habitat types throughout Everglades National Park between 2000 and 2002. Both datasets used a variety of survey methods to extensively characterize the amphibian and reptile amphibian assemblage across habitat types and hydrological regimes. An NMDS analysis indicated that variation in hydrology is the primary axis structuring reptile and amphibian habitat usage across the Everglades, with non-native species more likely to be indicators of drier habitat types. This result concurred with those from the landscape-scale manipulation, in which non-native species were significantly favored by drier hydrological conditions. Taken together, these results suggest that a drier future within the Greater Everglades Ecosystem may facilitate further spread of South Florida’s diverse non-native amphibian and reptile assemblage.

Resumen Introduccion La enfermedad pulmonar obstructiva cronica (EPOC) esta considerada un problema de salud publica, afectando al 10,2% de la poblacion espanola entre los 40 y 80 anos. Muchos pacientes no realizan bien la tecnica inhalatoria. La tasa de error varia entre el 50-80% segun el dispositivo estudiado. Se ha demostrado como las intervenciones educativas disminuyen estos valores. Objetivo Determinar si una intervencion educacional grupal es superior a una individual o a un abordaje habitual en estos pacientes, en funcion de calidad de vida mediante puntuacion total del COPD Assessment Test (CAT), de adhesion al tratamiento, exacerbaciones y hospitalizaciones. Material y metodos Ensayo clinico controlado aleatorizado por cluster, multicentrico y multidisciplinar, con tres ramas (intervencion habitual, intervencion individual e intervencion grupal), de una cohorte de enfermos con EPOC. Se recogieron datos sociodemograficos, factores de riesgo y de distintos cuestionarios (CAT, BODEx, Barthel, Lawton y Brody). Se ha realizado analisis descriptivo de variables cualitativas y cuantitativas, asi como regresion lineal multiple. Resultados Se incluyeron cuarenta y nueve pacientes de edad media de 69,08 anos (DE 1,26). Se observaron diferencias significativas en el CAT en los distintos grupos de intervencion segun el nivel de gravedad BODEx. La proporcion de pacientes que realizan la tecnica inhalatoria correcta fue menor significativamente al inicio del estudio y el numero de exacerbaciones fue menor tras la intervencion. Ademas, el numero de exacerbaciones e ingresos hospitalarios disminuyeron. Conclusiones Se obtuvieron mejores resultados con la tecnica habitual y con la individual. Encontrandose una disminucion en numero de exacerbaciones, hospitalizaciones, puntuacion CAT y tecnica inhalatoria post-intervencion.

We appreciate the interest in our article describing transcriptome changes in a transgenic mouse model carrying an APC gene mutation and would like to reply to the reader [...]

Resumen Objetivo Valorar el tratamiento de pacientes con dolor pelvico cronico mediante terapia neuroadaptativa. Material y metodos Se presenta un estudio observacional, longitudinal y retrospectivo de 18 pacientes que presentaban dolor pelvico cronico refractario a tratamientos convencionales con analgesia y terapia fisica, y que fueron tratadas mediante terapia neuroadaptativa. Resultados Se objetivaron antecedentes relacionables con el dolor en 15 casos: en siete (38,88%) pacientes, existio un parto reciente; en cinco (27,77%) pacientes, habia una histerectomia reciente; en un (5,58%) caso, una fractura pelvica y en dos (11,16%) pacientes, protusiones discales. Se obtuvo una curacion o respuesta completa en 15 (83,32%) pacientes, con una desaparicion total de los sintomas tras tres (2-4) sesiones de tratamiento. En dos (11,16%) pacientes se obtuvo una respuesta parcial. La satisfaccion obtenida en estos dos casos fue muy elevada, 10 (8-10), y la puntuacion EVA bajo de 10 (9-10) a 3 (2-5), p Conclusion Con las limitaciones propias de unos resultados preliminares, la terapia neuroadaptativa parece ser un procedimiento eficaz para el tratamiento del dolor pelvico cronico de origen musculoesqueletico.

The relative importance of small- and medium-sized enterprises (SMEs) and large firms is a recurrent topic in the small business economics literature. This paper presents a real and financial social accounting matrix (FSAM) capable of distinguishing the direct and indirect effects that are transferred from micro-, small, medium, and large firms to the rest of the economy. We use the hypothetical extraction method (HEM) to explore the sequence of reactions associated with shocks that arise from the COVID-19 lockdown. Using a structural model for the Spanish economy, we identify the role of different firm size categories in the aggregate gross domestic product (GDP). Our results allow us to reconcile the mixed narrative that accompanies the evaluation of the role played by these categories in economic activity by revealing that both SMEs and large firms are important for supporting economic activity. In particular, SMEs help explain 43% of the income and two-thirds of the unemployment decline caused by the COVID-19 pandemic. Our findings also show the importance of conditioning SME industrial policy to sectoral analysis. Plain English summary The effects of the macroeconomic lockdown and its transmission to the rest of the economy differ by firm size and across sectors. Using the Spanish context for micro-, small, medium, and large firms, we distinguish the direct and indirect effects caused by the COVID-19 pandemic. The main implications are the following: (1) Research: results emphasize that SMEs and large firms are both important to support economic activity but, in order to account for the relative effects on SMEs, it is crucial to consider the specific sector that receives the disruption. 2) Policy: SMEs are an important focus of business support policies within the EU. According to our estimations, disruptions in SMEs produce larger reductions in demand. These results could support credit policies for SMEs with a strong impact on the aggregate economy due to their greater productive and financial linkages with the domestic economy.

Cancer-associated fibroblasts (CAFs) are the most abundant cells in the tumor microenvironment. Crosstalk between tumor cells and CAFs contributes to tumor survival in most epithelial cancers. Recently, utilizing gastrointestinal stromal tumor (GIST) as a model for sarcomas, we identified paracrine networks by which CAFs promote tumor progression and metastasis. However, the mechanisms by which CAFs arise in sarcomas remain unclear. Here, RNA sequencing analysis revealed that transforming growth factor-β1 (TGF-β1) is highly expressed in both tumor cells and CAFs. To determine the functional role of TGF-β1, we treated normal gastric fibroblasts (GFs) with recombinant TGF-β1, which caused the GFs to adopt a more stellate morphology, as well as increased the mRNA expression of CAF-mediated genes (CCL2, RAB3B, and TNC) and genes encoding fibroblast growth factors (FGFs). Moreover, while either GIST or CAF conditioned media enhanced the transition from GFs to CAFs, a TGF-β1-blocking antibody attenuated this effect. Transwell migration assays revealed that the TGF-β1-mediated transition from GFs to CAFs enhanced tumor cell migration. This migratory effect was abrogated by an anti-TGF-β1 antibody, suggesting that TGF-β1 secreted from GIST cells or CAFs is associated with GIST migration via GF-to-CAF transition. In addition, the murine spleen-to-liver metastasis model showed that GF pre-treated with TGF-β1 promoted GIST metastasis. Collectively, these findings reveal unappreciated crosstalk among tumor cells, CAFs, and normal resident fibroblasts in the stroma of sarcomas, which enhances a GF-to-CAF transition associated with tumor migration and metastasis.

Pregnancy planning in women with highly active multiple sclerosis (HAMS) who need a high-efficacy disease-modifying therapy (heDMT) currently requires a careful risk-benefit evaluation. This includes minimizing fetal drug toxicity and preventing MS reactivation. We describe our experience with natalizumab in women with HAMS and unplanned pregnancy by implementing a clinical practice protocol (NAP-30) designed to maintain the effectiveness of natalizumab during pregnancy, reduce fetal exposure and prevent complications.This was an observational retrospective study including women with HAMS on active treatment with natalizumab who became unexpectedly pregnant in the period 2018-2021 and continued this treatment during pregnancy according to the NAP-30 protocol. MS clinical and radiological variables were analyzed before and during pregnancy and in the postpartum period, along with maternal and fetal toxicity during pregnancy and safety findings in newborns. We also describe the NAP-30 protocol, which includes the use of a bridging dose to adjust and maintain natalizumab infusions every 6 weeks during pregnancy up to week 30 and scheduled delivery at week 40.Six women (one in her first gestation) with a median age of 31.5 years at the onset of pregnancy (min-max: 24-37 years) were included. All were negative for anti-John Cunningham virus (JCV) antibodies and were on treatment with intravenous natalizumab 300 mg every 4 weeks. At the time of conception, three patients had received 12, 17 and 53 infusions of natalizumab, respectively, while for the remaining three patients natalizumab was their first DMT (two patients had received 6 infusions and one patient had received 3 infusions of natalizumab). All six patients received 6 doses of natalizumab during pregnancy according to the NAP-30 protocol. After delivery, all six patients restarted natalizumab every 4 weeks (median: 3 days; range: 2-4 days). No patients had relapses during pregnancy or at 6 months postpartum, nor did they develop any general health or laboratory abnormalities. The MRI scan performed at 4-6 months postpartum showed no new T2 lesions or gadolinium-enhancing lesions. No miscarriages or threatened miscarriages were reported. One of the patients underwent elective preterm delivery at week 35 after mild-to-moderate anemia was detected by fetal Doppler scan. The newborn had low birth weight (2080 g) and mild anemia, which resolved within two months with oral iron supplementation. The other infants were born with normal birth weight and showed no blood count abnormalities. After a median follow-up of 10 months, all six babies showed normal development with no complications detected.Based on our experience, the implementation of the NAP-30 protocol in women with HAMS and unplanned pregnancy undergoing treatment with natalizumab allows the continuation of natalizumab during pregnancy, with a very favorable clinical and radiological effectiveness and maternal-fetal safety profile during pregnancy and postpartum. Both in pregnancy with HAMS and in general, and particularly for successful implementation of the NAP-30 protocol, obstetric support and monitoring is essential for adequate pregnancy management.

The rarity and anatomical complexity of brachial plexus tumors (BPTs) impose many challenges onto surgeons performing surgical resections, especially when these tumors invade the cervicothoracic spine. Treatment choices and surgery outcomes heavily depend on anatomical location and tumor type. The authors performed an extensive review of the published literature (PubMed) focusing on “brachial plexus tumors” that identified invasion of the cervicothoracic spine. The search yielded 2774 articles pertaining to “brachial plexus tumors”. Articles not in the English language or involving cervicothoracic spinal invasion were excluded. Recent research has shown that the most common method used to resect tumors of the proximal roots is the dorsal subscapular approach. Despite its association with high morbidity rate, this technique offers excellent exposure to the spinal roots and intraforaminal portion of the spinal nerve. The dorsal approach is used to resect recurrent lower trunk tumors and dumbbell-shaped neurofibromas, yet it is also the least common overall approach used in brachial plexus tumor resections. The ventral or anterior technique is commonly used to resect tumors at the cord to division level, and root to trunk level. Motor complications, transient nerve palsy, and bleeding are among the most common complications of the anterior supraclavicular approach. Further controlled studies are needed to fully determine the optimal surgical approach used to obtain the best outcomes and least complications for each type of brachial plexus tumor.

Introduction and aim: There are discrepancies in the diagnosis and management of cow’s milk protein allergy (CMPA) in Spain and Latin America. The aim of the present study was to find out how Spanish and Latin American pediatric gastroenterologists diagnose and treat CMPA. Materials and methods: Pediatric gastroenterologists, members of the Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición, were invited to fill out a structured survey, the results of which were then compared with the 2012 and 2014 diagnosis and treatment guidelines, respectively. Results: The survey results showed that 17% of the participants follow the diagnostic recommendations based on the published consensus and guidelines. To diagnose non-IgE-mediated CMPA, 15% of the participants utilize IgE-specific skin prick tests, 22% use IgE-specific blood tests, and 45% employ oral food challenges. To diagnose IgE-mediated CMPA the percentages for the same diagnostic methods were 57%, 83% and 22%, respectively. Once diagnosis is confirmed, 98% of the participants provide dietary recommendations. In children that are not breastfed, 89% of the participants prescribe an initial extensively hydrolyzed formula, 9% an amino acid formula, 1% a soy formula, and 1% a hydrolyzed rice formula. In patients with IgE-mediated CMPA, 34% of the participants carry out an oral challenge once treatment is completed, 39% according to symptom severity, and 27% in relation to IgE-specific testing. Conclusion: CMPA management is diverse and there is poor adherence to the clinical practice guidelines. Resumen: Introducción: Existen discrepancias en el diagnóstico y manejo de alergia a las proteínas de la leche de vaca (APLV) en Iberolatinoamérica. El objetivo del estudio fue conocer la forma como el gastroenterólogo pediatra en iberolatinoamerica realiza el diagnóstico y el tratamiento de APLV. Material y métodos: Se invitó a los gastroenterólogos pediatras miembros de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición a contestar una encuesta estructurada y se comparó con las pautas de diagnóstico y tratamiento expresadas en el consenso y la guía publicadas en 2012 y 2014 respectivamente. Resultados: El 17% sigue las recomendaciones diagnósticas basadas en la evidencia del consenso y guía publicada. Para la APLV no mediada por IgE (APLV-No IgE) el 15% utiliza pruebas cutáneas IgE específicas vs. 57% en las mediadas por IgE (APLV-IgE); el 22% vs. 83% realiza determinación de IgE específica en sangre, respectivamente. La confirmación diagnóstica con prueba de reto oral es realizada por el 45% vs. 22% respectivamente. Una vez confirmado el diagnóstico, el 98% entrega recomendaciones dietarias. En niños no alimentados con leche materna, el 89% inicia con fórmula extensamente hidrolizada, 9% con aminoacídica, 1% fórmula de soja y 1% fórmula de arroz hidrolizada. La prueba de tolerancia en APLV-IgE se realiza en el 34% una vez cumplido el tiempo de tratamiento, en el 39% según la gravedad de los síntomas, y en 27% con la negativización de test IgE específicos. Conclusión: Existe mucha diversidad en el manejo de la APLV y pobre adherencia a las guías de práctica clínica.

Resumen: Introducción: Existen discrepancias en el diagnóstico y el manejo de la alergia a las proteínas de la leche de vaca (APLV) en Iberolatinoamérica. El objetivo del estudio fue conocer la forma como el gastroenterólogo pediatra en Iberolatinoamérica realiza el diagnóstico y el tratamiento de la APLV. Material y métodos: Se invitó a los gastroenterólogos pediatras miembros de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición a contestar una encuesta estructurada y se comparó con las pautas de diagnóstico y tratamiento expresadas en el consenso y la guía publicadas en 2012 y 2014, respectivamente. Resultados: El 17% sigue las recomendaciones diagnósticas basadas en la evidencia del consenso y guía publicada. Para la APLV no mediada por IgE, el 15% utiliza pruebas cutáneas IgE específicas vs. el 57% en las mediadas por IgE; el 22 vs. 83% realiza determinación de IgE específica en sangre, respectivamente. La confirmación diagnóstica con prueba de reto oral es realizada por el 45 vs. el 22%, respectivamente. Una vez confirmado el diagnóstico, el 98% entrega recomendaciones dietarias. En niños no alimentados con leche materna, el 89% inicia con fórmula extensamente hidrolizada, el 9% con aminoacídica, el 1% con fórmula de soja y el 1% con fórmula de arroz hidrolizada. La prueba de tolerancia en APLV-IgE se realiza en el 34% una vez cumplido el tiempo de tratamiento, en el 39% según la gravedad de los síntomas, y en 27% con la negativización de test IgE específicos. Conclusión: Existe mucha diversidad en el manejo de la APLV y una pobre adherencia a las guías de práctica clínica. Abstract: Introduction: There are discrepancies in the diagnosis and management of cow's milk protein allergy (CMPA) in Spain and Latin America. The aim of the present study was to find out how Spanish and Latin American pediatric gastroenterologists diagnose and treat CMPA. Material and methods: Pediatric gastroenterologists, members of the Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición, were invited to fill out a structured survey, the results of which were then compared with the 2012 and 2014 diagnosis and treatment guidelines, respectively. Results: The survey results showed that 17% of the participants follow the diagnostic recommendations based on the published consensus and guidelines. To diagnose non-IgE-mediated CMPA, 15% of the participants utilize IgE-specific skin prick tests, 22% use IgE-specific blood tests, and 45% employ oral food challenges. To diagnose IgE-mediated CMPA the percentages for the same diagnostic methods were 57, 83 and 22%, respectively. Once diagnosis is confirmed, 98% of the participants provide dietary recommendations. In children that are not breastfed, 89% of the participants prescribe an initial extensively hydrolyzed formula, 9% an amino acid formula, 1% a soy formula, and 1% a hydrolyzed rice formula. In patients with IgE-mediated CMPA, 34% of the participants carry out an oral challenge once treatment is completed, 39% according to symptom severity, and 27% in relation to IgE-specific testing. Conclusion: CMPA management is diverse and there is poor adherence to the clinical practice guidelines.

The increasing concern of possible adverse effects on human health derived from occupational engineered nanomaterials (ENMs) exposure is an issue addressed by entities related to provide guidelines and/or protocols for ENMs regulation. Here we analysed 17 entities from America, Europe and Asia, and some of these entities provide limits of exposure extrapolated from the non-nanosized counterparts of ENMs. The international landscape shows that recommendations are mostly made for metal oxide based ENMs and tonnage is one of the main criteria for ENMs registration, however, sub-nanometric ENMs are emerging and perhaps a novel category of ENMs will appear soon. We identify that besides the lack of epidemiological evidence of ENMs toxicity in humans and difficulties in analysing the toxicological data derived from experimental models, the lack of information on airborne concentrations of ENMs in occupational settings is an important limitation to improve the experimental designs. The development of regulations related to ENMs exposure would lead to provide safer work places for ENMs production without delaying the nanotechnology progress but will also help to protect the environment by taking opportune and correct measures for nanowaste, considering that this could be a great environmental problem in the coming future.

Objective Chronic pain is frequently comorbid with opioid abuse and severe depression, a combination that greatly compounds suicide risk. In addition to the therapeutic value of buprenorphine in addiction and analgesia, growing evidence suggests potential use as an antidepressant. Data supporting buprenorphine antisuicidal properties are scarce. We aim to contribute to the discussion of buprenorphine antisuicidal potential in patients with significant psychiatric and medical comorbidity. Methods We performed a chart review of suicidal adult depressed patients with comorbid chronic pain and opioid use disorder who received off-label buprenorphine in outpatient and inpatient settings in a university hospital between 2013 and 2016. Results Four of the patients had an early positive response. However, only three continue to adhere to treatment for six months or longer. Conclusions More severe opioid use disorder seems to more negatively influence clinical outcome, independently of cluster b personality traits. Identification of patients who could benefit from buprenorphine will require further studies.

espanolEl presente articulo considera el proceso creativo y transformativo por el que pasa el/la protagonista transexual de “La piel que habito” (2011) y lo equipara al proceso antiguo de la alquimia, pues ambos tienen como objetivo el perfeccionamiento, la imitacion y la adulteracion, o falsificacion, de la naturaleza. El proposito principal del ensayo, aparte de delinear los elementos alquimicos presentes en el filme, es explorar la (con)fusion de ciertos binarios, como lo autentico y lo artificial, lo masculino y lo femenino y el Yo y el Otro. Se plantea que, como en la alquimia, Almodovar presenta a la figura del transexual –o del hermafrodita– como el ser perfecto, o la Piedra Filosofal, ya que encarna tanto lo femenino como lo masculino en un solo cuerpo. Ademas, a semejanza del oro alquimico y de las obras de arte, se propone que el/la protagonista, Vicente/Vera, representa una copia mas perfecta de su referente original, lo cual subraya su nebulosa autenticidad existencial. Al final de este estudio, se establece un vinculo entre la transformacion fisica y ontologica de Vicente/Vera y la “mise-en-scene” que este realiza para poder sobrevivir. Se concluye que el caracter transformativo e ilusorio de lo teatral concuerda con el aspecto experimental y artificioso de la alquimia. EnglishThis article considers the creative and transformative process undergone by the main protagonist –a transsexual– of “La piel que habito” (2011) while comparing it to the age-old alchemical process, as the two share a common objective: the perfection, imitation, and adulteration-or falsification-of nature. The main purpose of this essay, aside from delineating the alchemical motifs present throughout the film, is to explore the (con)fusion of a particular set of binaries, such as the authentic and the artificial, the masculine and the feminine, and the Self and the Other. The author maintains that, as with alchemy, Almodovar presents the figure of the transsexual, or of the hermaphrodite, as the perfect being, or the Philosopher’s Stone, as s/he embodies both the feminine and the masculine in one body. Moreover, like alchemical gold and works of art, this study proposes that the protagonist, Vicente/Vera, represents a more perfect copy of the original, which underscores his/her ambivalent existential authenticity. The author highlights the similarities between Vicente/Vera’s physical and ontological transmutation and the “mise-en-scene” in which he/she must embark in order to survive. Finally, the essay concludes that the transformative, illusory nature of the theatrical parallels the experimental and deceiving aspect of alchemy.

Titanium dioxide (TiO2) is present in many different food products as the food additive E171, which is currently scrutinized due to its potential adverse effects, including the stimulation of tumor formation in the gastrointestinal tract. We developed a transgenic mouse model to examine the effects of E171 on colorectal cancer (CRC), using the Cre-LoxP system to create an Apc-gene-knockout model which spontaneously develops colorectal tumors. A pilot study showed that E171 exposed mice developed colorectal adenocarcinomas, which were accompanied by enhanced hyperplasia in epithelial cells, lymphatic nodules at the base of the polyps, and increased tumor size. In the main study, tumor formation was studied following the exposure to 5 mg/kgbw/day of E171 for 9 weeks (Phase I). E171 exposure showed a statistically nonsignificant increase in the number of colorectal tumors in these transgenic mice, as well as a statistically nonsignificant increase in the average number of mice with tumors. Gene expression changes in the colon were analyzed after exposure to 1, 2, and 5 mg/kgbw/day of E171 for 2, 7, 14, and 21 days (Phase II). Whole-genome mRNA analysis revealed the modulation of genes in pathways involved in the regulation of gene expression, cell cycle, post-translational modification, nuclear receptor signaling, and circadian rhythm. The processes associated with these genes might be involved in the enhanced tumor formation and suggest that E171 may contribute to tumor formation and progression by modulation of events related to inflammation, activation of immune responses, cell cycle, and cancer signaling. ispartof: NANOMATERIALS vol:12 issue:8 ispartof: location:Switzerland status: published

[EN] Numerous approaches have attempted to develop systems that more appropriately manage street crossings in cities in recent years. Solutions range from intelligent traffic lights to complex, centralized protocols that evaluate the policies that vehicles must comply with at intersections. Such works attempt to provide traffic-control strategies at intersections where the complexity of a dynamic environment, with vehicles crossing in different directions and multiple conflict points, pose a significant challenge for city traffic optimization. Traditionally, a traffic-control system at an intersection gives the green light to one lane while keeping the other lanes on red. But there may be situations in which there are different levels of vehicle priority; for example, emergency vehicles may have priority at intersections. Thus, this work proposes a distributed junction-management protocol that pays special attention to emergency vehicles. The proposed algorithm implements rules based on the distributed intersection management (DIM) protocol; such rules are used by vehicles while negotiating their crossing through the intersection. The proposal also seeks to affect the traffic flow of non-priority vehicles minimally. An evaluation and comparison of the proposed algorithm are presented in the paper., This work is partially supported by grant RTI2018-095390-B-C31 funded by MCIN/AEI/ 10.13039/501100011033 and by "ERDF A way of making Europe".

Disruption prediction and avoidance is a critical need for next-step tokamaks, such as ITER. Disruption Event Characterization and Forecasting (DECAF) research fully automates analysis of tokamak data to determine chains of events that lead to disruptions and to forecast their evolution allowing sufficient time for mitigation or complete avoidance of the disruption. Disruption event chains related to local rotating or global magnetohydrodynamic (MHD) modes and vertical instability are examined with warnings issued for many off-normal physics events, including density limits, plasma dynamics, confinement transitions, and profile variations. Along with Greenwald density limit evaluation, a local radiative island power balance theory is evaluated and compared to the observation of island growth. Automated decomposition and analysis of rotating tearing modes produce physical event chains leading to disruptions. A total MHD state warning model comprised of 15 separate criteria produces a disruption forecast about 180 ms before a standard locked mode detector warning. Single DECAF event analyses have begun on KSTAR, MAST, and NSTX/-U databases with thousands of shot seconds of device operation using from 0.5 to 1 × 106 tested sample times per device. An initial multi-device database comparison illustrates a highly important result that plasma disruptivity does not need to increase as βN increases. Global MHD instabilities, such as resistive wall modes (RWMs), can give the briefest time period of warning before disruption compared to other physics events. In an NSTX database with unstable RWMs, the mode onset, loss of boundary and current control, and disruption event warnings are found in all cases and vertical displacement events are found in 91% of cases. An initial time-dependent reduced physics model of kinetic RWM stabilization created to forecast the disruption chain predicts instability 84% of the time for experimentally unstable cases with a relatively low false positive rate. Instances of the disruption event chain analysis illustrate dynamics including H–L back transitions for rotating MHD and global RWM triggering events. Disruption warnings are issued with sufficient time before the disruption (on transport timescales) to potentially allow active profile control for disruption avoidance, active mode control, or mitigation.

We extend the publicly available quantumfdtd code. It was originally intended for solving the time-independent three-dimensional Schr\"odinger equation via the finite-difference time-domain (FDTD) method and for extracting the ground, first, and second excited states. We (a) include the case of the relativistic Schr\"odinger equation and (b) add two optimized FFT-based kinetic energy terms for the non-relativistic case. All the three new kinetic terms are computed using Fast Fourier Transform (FFT). We release the resulting code as version 3 of quantumfdtd. Finally, the code now supports arbitrary external file-based potentials and the option to project out distinct parity eigenstates from the solutions. Our goal is quark models used for phenomenological descriptions of QCD bound states, described by the three-dimensional Schr\"odinger equation. However, we target any field where solving either the non-relativistic or the relativistic three-dimensional Schr\"odinger equation is required., Comment: 7 pages, 2 figures, Contribution to the proceedings of the XVth Quark Confinement and the Hadron Spectrum (CONF15). Aug. 1 - 6, 2022. Stavanger, Norway