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Hepatic encephalopathy is uncommon in the absence of cirrhosis. We report a 71-year-old woman who presented with altered mental status in the setting of hyperammonemia for the second time in 6 months. Magnetic resonance imaging of the abdomen revealed an uncommon portosystemic shunt involving an enlarged posterior branch of the right portal vein and an accessory right hepatic vein, with no features of cirrhosis. Appropriate management of these patients with ammonia-lowering therapy can reduce repeat episodes and improve quality of life. This case demonstrates the importance of diagnosing non-cirrhotic hepatic encephalopathy in patients with altered mental status.

Abstract This study aimed to assess pulmonary and muscle dysfunction by analyzing the slow component of oxygen uptake (VO2SC), and mechanical and ventilatory efficiency in adult women recovered from the severe acute respiratory syndrome coronavirus type II (SARS-CoV-2) during a constant load test. 32 women (N = 17 patients with SARS-CoV-2; N = 15 control group) performed two cardiopulmonary exercise tests (CPX) on a cycle ergometer. In the first test, the participants performed incremental CPX until extenuation. In the second test the participants performed a 10-min CPX at a constant load intensity (watts) corresponding to the first ventilatory threshold. There was a 48–72 h rest period between the two tests. There was a significant increase in the VO2SC in the patients recovered from SARS-CoV-2 (160.4 ± 60 mL min−1) in comparison with the healthy participants (59.6 ± 65 mL min−1) (P

Abstract Cigarette smoking remains an important health concern and is still a leading cause of preventable mortality. Nicotine is the substance responsible for sustained tobacco use and dependence. Identification of biomarkers underlying nicotine dependence behavior is important to identify people at risk for this dependence. In the present study, we identified biochemical and genetic biomarkers of nicotine dependence detected by the Fagerström Test for Nicotine Dependence (FTDN) in Mexican smokers. The nicotine metabolites nicotine‐N′‐oxide, trans‐3′‐hydroxycotinine‐glucuronide (3HC‐O‐Gluc), and nicotine‐N‐Gluc (Gluc) were useful to differentiate nicotine‐dependent from non‐dependent subjects (p

Abstract Rheumatoid arthritis (RA) is a systemic autoimmune disease whose main extra-articular organ affected is the lung, sometimes in the form of diffuse interstitial lung disease (ILD) and conditions the prognosis. A multicenter, observational, descriptive and cross-sectional study of consecutive patients diagnosed with RA-ILD. Demographic, analytical, respiratory functional and evolution characteristics were analyzed to evaluate the predictors of progression and mortality. 106 patients were included. The multivariate analysis showed that the diagnostic delay was an independent predictor of mortality (HR 1.11, CI 1.01–1.23, p = 0.035). Also, age (HR 1.33, 95% CI 1.09–1.62, p = 0.0045), DLCO (%) (HR 0.85, 95% CI 0.73–0.98, p = 0.0246), and final SatO2 (%) in the 6MWT (HR 0.62, 95% CI 0.39–0.99, p = 0.0465) were independent predictor variables of mortality, as well as GAP index (HR 4.65, 95% CI 1.59–13.54, p = 0.0051) and CPI index (HR 1.12, 95% CI 1.03–1.22, p = 0.0092). The withdrawal of MTX or LFN after ILD diagnosis was associated with disease progression in the COX analysis (HR 2.18, 95% CI 1.14–4.18, p = 0.019). This is the first study that highlights the diagnostic delay in RA-ILD is associated with an increased mortality just like happens in IPF.

Acute intermittent porphyria (AIP) is a rare autosomal dominant inherited disease, predominantly seen in female patients, caused by mutations in the hydroxymethylbilane synthase gene. When impaired, elevated heme biosynthesis precursor levels accumulate in the liver, resulting in neurological symptoms, psychiatric disturbances, darkened urine color, abdominal pain, nausea, vomiting, and ileus. We present a 22-year-old Hispanic female with diffuse abdominal pain and no bowel movements for 8 days. She reported recent antibiotic and oral contraceptive pill use. Computerized tomography of her abdomen revealed a dilated small bowel and marked colonic distension. A colonoscopy found mild nonspecific inflammation in the rectosigmoid and terminal ileum. Her abdominal pain persisted despite interventions and improvements in appetite, bowel movements, abdominal imaging, and treatment of an identified Clostridium difficile infection. A random urine porphobilinogen was then obtained and found to be elevated. Fractionation of plasma and urine porphyrins was suggestive of AIP. Her symptoms improved with 3 days of intravenous (IV) hematin and IV dextrose. This is a unique case of a rare disease due to her clinical presentation with ileus, unremarkable past medical history, family history, and the prehospitalization and intrahospitalization factors that likely exacerbated the patient AIP.

En Política para perplejos, Daniel Innerarity nos presenta una lectura bastante clara de nuestra realidad global y donde apunta una cuestión con la cual todos podemos coincidir pero que no habíamos descrito con tanta vehemencia: asistimos a una época en la que la política nos llena de desconcierto e incertidumbre.

The aim of this study was to analyze the influence of age and sex on kinematic gait parameters in preschool children, and derive reference values for this population. A total of 383 preschool children (age 3–5 years; 207 girls, 176 boys) participated in this study. We used the OptoGait system to assess the kinematics of gait at a comfortable and self-determined speed. No significant differences between the sexes were found for the main gait parameters. Among the participants, there was a significant increase in double support, reductions in absolute cadence and the coefficient of variation (CV) of cadence, an increase in absolute step length (SL), and an increase in the walk ratio (WR) from 3 to 5 years of age. However, the normalized SL and normalized WR displayed a significant reduction in both sexes. Partial correlation indicated a significant association of age with SL and normalized SL, and WR. Additionally, WR showed a significant correlation with the CV of cadence. To summarize, no relevant differences in gait performance were found according to sex; however, age was found to influence gait maturation. The normative values established for Spanish preschool children can be used to monitor healthy gait development.

El objetivo de este estudio fue analizar el efecto agudo de la técnica de estiramiento active isolated stretching (AIS) y el efecto del reposo en sedestación sobre la altura de salto registrada mediante el test Squat Jump (SJ) y Counter Movement Jump (CMJ). Un total de 22 varones con un rango de edad entre 21 y 24 años (edad 22,9 ± 2,03 años; masa corporal 69,7 ± 5,60 kg; altura 173,6 ± 7,37cm) completaron el estudio. Se utilizó un diseño intragrupo pretest-postest con dos situaciones experimentales (estiramiento y reposo en sedestación). A los sujetos del grupo de estiramiento se les evaluó la altura de salto en SJ y CMJ antes e inmediatamente después de aplicar el AIS (15 s después) en el cuádriceps femoral y tríceps sural en una única sesión de entrenamiento. Se realizaron 4 series de 12 repeticiones alternando la extremidad inferior izquierda y derecha con el siguiente orden: tríceps sural derecho, tríceps sural izquierdo, cuádriceps femoral derecho y cuádriceps femoral izquierdo. El tiempo de estiramiento total de cada grupo muscular fue de 96 s, con un tiempo total de trabajo de aproximadamente 15 min. A los sujetos del grupo de reposo se les evaluó la altura de salto en SJ y CMJ antes e inmediatamente después de un reposo en sedestación de 15 min. Tras la aplicación de AIS, los resultados mostraron pérdidas agudas de altura de salto de 2,14 cm (-7,13%) en SJ y de 2,65 cm (-7,22%) en CMJ. Después del reposo, las pérdidas producidas en la altura registrada fueron de 1,90 cm (-6,41%) en SJ y de 2,38 cm (-6,46%) en CMJ. Por tanto, la utilización de un protocolo de estiramientos utilizando la técnica del AIS o de un periodo de reposo en sedestación influye de forma negativa en la capacidad de salto. Abstract The aim of this study was to analyze the acute effect of stretching technique Active Isolated Stretching (AIS) and repose sitting with the lower extremities raised of rest over on the high jump in Squat Jump (SJ) and Countermovement Jump (CMJ). Twenty two males aged between 21 and 24 years (age = 22.9±2.03 years; body mass = 69.7±5.60 kg; height = 173.6±7.37cm) who volunteered to participate in the study. An intragroup pre- post-test design with two experimental situations (stretching and resting) was used. The height of the SJ and CMJ jumps of the stretching group was measured before and 15 s after only one session of AIS on the femoral quadriceps and triceps surae. The treatment consisted of 4 sets of 12 repetitions with each leg alternating following this cycle: right triceps surae, left triceps surae, right femoral quadriceps and left femoral quadriceps. The total stretching time of each muscular group was 96 seconds with a total working time of 15 minutes. The height of SJ and CMJ jumps of the resting group was measured before and immediately after a 15-minute sitting at rest with the lower extremities raised. The results showed an acute loss of 2.14 cm (-7.13%) in SJ and 2.65 cm (-7.22%) in CMJ after the application of AIS in the stretching group, as well as in the resting group being 1.90 cm (-6.41%) in SJ and 2.38 cm (-6.46%) in CMJ. Therefore, the stretching protocol using the AIS technique and or a period of repose both influenced negatively in the jumping capacity.

Indication of oxygen therapy in fibrotic interstitial lung diseases is not standardized and its specific requirements are not well defined. The objective of this study was to evaluate ambulatory oxygen therapy features in lung fibrotic patients. Clinical and exploratory data, including 6-minute walking test and pulmonary hypertension, from one hundred and seven patients with fibrotic interstitial lung disease that received ambulatory oxygen treatment were studied. In up to 40% of cases the prescription of oxygen therapy was made after performing a 6-minute walking test. Patients who required ambulatory oxygen only during exercise presented a mild to moderate reduction of the predicted % FVC (62.1 ± 19) and DLCO (49 ± 14.4) while patients who had respiratory failure at rest (mean PaO2 51.9 ± 6.7) presented a moderate reduction of %FVC (56.8 ± 15.6) but a severe decrease of %DLCO (31.67 ± 12). Pulmonary hypertension (PH) was evaluated in 47.7% of patients and occurred in 60.8% of them. In conclusion, there is no pulmonary functional predictor of oxyhaemoglobin desaturation during exercise. PH is frequently associated with interstitial lung diseases, mainly when respiratory failure at rest appears. The heterogeneity of the patients and limitation of retrospective studies could be the cause of the tributes for potential benefits of oxygen treatment in interstitial lung diseases.

Purpose: The aim of this study was to evaluate the performance of healthy Chilean children aged 3–10 years in the 6-minute walking test (6MWT) and cardiometabolic risk variables and to determine sex- and age-specific reference values. Methods: This study involved 1165 healthy children (age = 6.36 [1.70] y old). The 6MWT was used to evaluate exercise performance. Furthermore, anthropometric measures were collected, like weight, height, body mass index, waist circumference, and skin folds. Resting heart rate and blood pressure (BP) were also evaluated. Results: The prevalence of overweight and obesity was 35.0% and 25.4% in preschoolers and 29.0% and 36.2% in school-age children, respectively, showing significant differences (P <.05) between age groups. The distance walked (6-min walk distance) increased significantly year on year at ages from 3 to 10 years. According to the regression analysis, 6MWT performance was positively related to age, systolic BP, and height, whereas it was negatively related to ∑4 skinfold fat, resting heart rate, diastolic BP, and waist circumference. Conclusions: This study provides a reference equation and an age- and sex-adjusted percentile curve to assess the predicted 6MWT performance in a cohort of prepubertal Chilean children. The 6-minute walk distance depends mainly on age; however, other variables, such as resting heart rate, BP, skinfold fat, and waist circumference, add significant information and should be taken into account. [ABSTRACT FROM AUTHOR]

Adipose-derived mesenchymal stem cells (ADMSCs) are inducible to an osteogenic phenotype by the bone morphogenetic proteins (BMPs). This facilitates the generation of implants for bone tissue regeneration. This study evaluated the in vitro osteogenic differentiation of ADMSCs transduced individually and in combination with adenoviral vectors expressing BMP2 and BMP7. Moreover, the effectiveness of the implant containing ADMSCs transduced with the adenoviral vectors AdBMP2/AdBMP7 and embedded in demineralized bone matrix (DBM) was tested in a model of tibial fracture in sheep. This graft was compared to ewes implanted with untransduced ADMSCs embedded in the same matrix and with injured but untreated animals. In vivo results showed accelerated osteogenesis in the group treated with the AdBMP2/AdBMP7 transduced ADMSC graft, which also showed improved restoration of the normal bone morphology.

In this paper, an approach referred to as IoTsecM is proposed. This proposal is a UML/SysML extension for security requirements modeling within the analysis stage in a waterfall development life cycle in a Model-Based Systems Engineering Approach. IoTsecM allows the security requirements representation in two very well-known modeling languages, UML and SysML. With the utilization of this extension, IoT developers can consider the security requirements from the analysis stage in the design process of IoT systems. IoTsecM allows IoT systems to be designed considering possible threats and the corresponding security requirements analysis. The applicability of IoTsecM is demonstrated through applying it to analyze and represent the security requirements in an IoT real-life system in the context of collaborative autonomous vehicles in smart cities. In this use case, IoTsecM was able to represent the security requirements identified within the system architecture elements, in which all countermeasures identified were depicted using the proposed IoTsecM profile.

Infants recovering from anesthesia are at risk of life threatening Postoperative Apnea (POA). POA events are rare, and so the study of POA requires the analysis of long cardiorespiratory records. Manual scoring is the preferred method of analysis for these data, but it is limited by low intra- and inter-scorer repeatability. Furthermore, recommended scoring rules do not provide a comprehensive description of the respiratory patterns. This work describes a set of manual scoring tools that address these limitations. These tools include: (i) a set of definitions and scoring rules for 6 mutually exclusive, unique patterns that fully characterize infant respiratory inductive plethysmography (RIP) signals; (ii) RIPScore, a graphical, manual scoring software to apply these rules to infant data; (iii) a library of data segments representing each of the 6 patterns; (iv) a fully automated, interactive formal training protocol to standardize the analysis and establish intra- and inter-scorer repeatability; and (v) a quality control method to monitor scorer ongoing performance over time. To evaluate these tools, three scorers from varied backgrounds were recruited and trained to reach a performance level similar to that of an expert. These scorers used RIPScore to analyze data from infants at risk of POA in two separate, independent instances. Scorers performed with high accuracy and consistency, analyzed data efficiently, had very good intra- and inter-scorer repeatability, and exhibited only minor confusion between patterns. These results indicate that our tools represent an excellent method for the analysis of respiratory patterns in long data records. Although the tools were developed for the study of POA, their use extends to any study of respiratory patterns using RIP (e.g., sleep apnea, extubation readiness). Moreover, by establishing and monitoring scorer repeatability, our tools enable the analysis of large data sets by multiple scorers, which is essential for longitudinal and multicenter studies.

Purpose: The aim of this study was to evaluate the performance of healthy Chilean children aged 3-10 years in the 6-minute walking test (6MWT) and cardiometabolic risk variables and to determine sex- and age-specific reference values., Methods: This study involved 1165 healthy children (age = 6.36 [1.70] y old). The 6MWT was used to evaluate exercise performance. Furthermore, anthropometric measures were collected, like weight, height, body mass index, waist circumference, and skin folds. Resting heart rate and blood pressure (BP) were also evaluated., Results: The prevalence of overweight and obesity was 35.0% and 25.4% in preschoolers and 29.0% and 36.2% in school-age children, respectively, showing significant differences (P < .05) between age groups. The distance walked (6-min walk distance) increased significantly year on year at ages from 3 to 10 years. According to the regression analysis, 6MWT performance was positively related to age, systolic BP, and height, whereas it was negatively related to ∑4 skinfold fat, resting heart rate, diastolic BP, and waist circumference., Conclusions: This study provides a reference equation and an age- and sex-adjusted percentile curve to assess the predicted 6MWT performance in a cohort of prepubertal Chilean children. The 6-minute walk distance depends mainly on age; however, other variables, such as resting heart rate, BP, skinfold fat, and waist circumference, add significant information and should be taken into account.