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INTRODUCCIÓN: la mayoría de las investigaciones del crecimiento facial se enfocan hacia la documentación y predicción del crecimiento puberal opacando la descripción del crecimiento antes de los 12 años de edad. Aunque hay varias investigaciones en poblaciones caucásicas que han reportado los picos tempranos de crecimiento, ninguna lo ha ubicado y dimensionado con relación al pico puberal. En mestizos latinoamericanos no hay estudios reportados en la literatura. MÉTODOS: desde 1992 el Grupo de Investigación de Labio y Paladar Hendido, Fisiología Oral y Crecimiento Craneofacial, CES-LPH, está haciendo un estudio longitudinal del crecimiento facial en 44 mestizos colombianos sin tratamiento con una muestra de 373 radiografías cefálicas laterales obtenidas durante 18 años de seguimiento. RESULTADOS: de las 28 niñas de la muestra, 21 (75%) presentaron incrementos bienal mayores de 5 mm en la altura facial anterior (AFA) antes de los 12 años. En la altura facial posterior (AFP) hubo 9 (32%) niñas con incrementos bienales mayores a 5 mm antes de los 9 años. En 7 (43%) niños se presentaron incrementos bienales mayores a 5 mm en AFA antes de los 12 años y para la AFP hubo 9 (56%) niños con el mismo comportamiento antes de los 12 años. Para 5 de las niñas y 3 de los niños (18%), este fue el mayor pico de crecimiento en todo el seguimiento de la muestra desde los 6 hasta los 19 años, hallazgo no reportado anteriormente en la literatura. CONCLUSIONES: los picos tempranos de crecimiento vertical (AFA y AFP) en niños menores de 9 años pueden explicar el éxito de las terapias tempranas de ortopedia funcional de los maxilares.

Se expone el caso de una perra Bulldog Inglés que presentaba una gestación aproximada de 36 a 38 días, con secreción sanguinopurulenta por vulva y decaimiento, siendo éstos los únicos hallazgos al examen físico general. Al realizar procedimientos diagnósticos complementarios se evidenció que había productos vivos en un cuerno uterino y el otro estaba ocupado por fluido.Simultaneous pyometra and gestation in a bitch

The diagnostic tools in Dentistry that includes sequential measurements present several problems concerning its reliability, due to the techniques and human factors. Among those variables, there are some static such as cephalometric, anthropometric or dental studies and some functional such as those that evaluate electrical and mechanical activity of the craniofacial muscles. Objective: the aim of the study was to evaluate the reliability of the measurement criteria of the Upper Orbicularis Oris muscle electromyographic activity registration (AEMG) during swallowing and phonation in two sessions separated by 8 days. Materials and Methods: 15 healthy subjects of both sex between 18 and 25 year old participated in the study. The swallowing and phonation were evaluated with superficial electromyography (EMG), three times a session with a resting time of 60 seconds between them in two different days separated by 8 days. Results: the obtained data presented in the study show a high reliability of the Upper Orbicularis Oris muscle during phonation and swallowing for the numerical integration and for the normalized RMS in the time as well.

Este articulo presenta una revision de la computacion evolutiva como una alternativa en la generaciOn de conocimiento, se exploran los conceptos basicos de la tecnica y algunas aplicaciones en ciencias de la salud. Se presentan los mas importantes aspectos en la modelacion de sistemas y procesos biolagicos. Estos modelos pueden ser utilizados para la toma de decisiones en la vida real.

Background: Venous thromboembolism is a common disease seen in the emergency department and a cause of high morbidity and mortality, constituting a major health problem. Objectives: To assess the potential benefit of follow-up ultrasound of patients who attended the emergency department with suspected superficial venous thrombosis or deep venous thrombosis and were found to have an initial negative whole-leg (or arm) ultrasound study. Methods: This retrospective study included patients aged 18 years or older who were consecutively referred to a thrombosis clinic from the emergency department, with abnormal D-dimer test and moderate to high pre-test probability of deep venous thrombosis (Well's score ≥ 1), but a negative whole-leg (or arm) ultrasound. Demographic characteristics, symptom duration, laboratory and ultrasound data were recorded. At one-week follow-up, an experienced physician repeated ultrasound, and recorded the findings. Results: From January 2017 to April 2018, 54 patients were evaluated. The mean age was 66.8 years (SD 15.0) and 63% were women. The average D-dimer was 2159.9 (SD 3772.0) ng/mL. Ultrasound abnormalities were found in 12 patients (22.2%; 95% confidence interval of 12.5 to 36.0%), with 4 patients having proximal deep venous thrombosis, distal deep venous thrombosis in 2 patients and superficial venous thrombosis in 6 patients. We did not find any significant differences in demographic characteristics, venous thromboembolism risk factors or laboratory parameters between patients with negative and positive follow-up ultrasound. Conclusions: These preliminary findings suggest that a negative whole-leg (or arm) ultrasound in addition to an abnormal D-dimer in moderate to high deep venous thrombosis pretest probability patients, might be an insufficient diagnostic approach to exclude suspected deep venous thrombosis or superficial venous thrombosis. Confirmation of this higher than expected prevalence would support the need to repeat one-week ultrasound control in this population. [ABSTRACT FROM AUTHOR]

Aims. Our aim is to determine the distribution of stellar population parameters (extinction, age, metallicity, and star formation rates) of quiescent galaxies within the rest-frame stellar mass–colour diagrams and UVJ colour–colour diagrams corrected for extinction up to z ∼ 1. These novel diagrams reduce the contamination in samples of quiescent galaxies owing to dust-reddened galaxies, and they provide useful constraints on stellar population parameters only using rest-frame colours and/or stellar mass. Methods. We set constraints on the stellar population parameters of quiescent galaxies combining the ALHAMBRA multi-filter photo-spectra with our fitting code for spectral energy distribution, MUlti-Filter FITting (MUFFIT), making use of composite stellar population models based on two independent sets of simple stellar population (SSP) models. The extinction obtained by MUFFIT allowed us to remove dusty star-forming (DSF) galaxies from the sample of red UVJ galaxies. The distributions of stellar population parameters across these rest-frame diagrams are revealed after the dust correction and are fitted by LOESS, a bi-dimensional and locally weighted regression method, to reduce uncertainty effects. Results. Quiescent galaxy samples defined via classical UVJ diagrams are typically contaminated by a ∼20% fraction of DSF galaxies. A significant part of the galaxies in the green valley are actually obscured star-forming galaxies (∼30–65%). Consequently, the transition of galaxies from the blue cloud to the red sequence, and hence the related mechanisms for quenching, seems to be much more efficient and faster than previously reported. The rest-frame stellar mass–colour and UVJ colour–colour diagrams are useful for constraining the age, metallicity, extinction, and star formation rate of quiescent galaxies by only their redshift, rest-frame colours, and/or stellar mass. Dust correction plays an important role in understanding how quiescent galaxies are distributed in these diagrams and is key to performing a pure selection of quiescent galaxies via intrinsic colours. [ABSTRACT FROM AUTHOR]

Aims. We aim at constraining the stellar population properties of quiescent galaxies. These properties reveal how these galaxies evolved and assembled since z ∼ 1 up to the present time. Methods. Combining the ALHAMBRA multi-filter photo-spectra with the fitting code for spectral energy distribution MUFFIT (MUlti-Filter FITting), we built a complete catalogue of quiescent galaxies via the dust-corrected stellar mass vs. colour diagram. This catalogue includes stellar population properties, such as age, metallicity, extinction, stellar mass, and photometric redshift, retrieved from the analysis of composited populations based on two independent sets of simple stellar population (SSP) models. We developed and applied a novel methodology to provide, for the first time, the analytic probability distribution functions (PDFs) of mass-weighted age, metallicity, and extinction of quiescent galaxies as a function of redshift and stellar mass. We adopted different star formation histories to discard potential systematics in the analysis. Results. The number density of quiescent galaxies is found to increase since z ∼ 1, with a more substantial variation at lower stellar mass. Quiescent galaxies feature extinction AV <  0.6, with median values in the range AV = 0.15–0.3. At increasing stellar mass, quiescent galaxies are older and more metal rich since z ∼ 1. A detailed analysis of the PDFs reveals that the evolution of quiescent galaxies is not compatible with passive evolution and a slight decrease of 0.1–0.2 dex is hinted at median metallicity. The intrinsic dispersion of the age and metallicity PDFs show a dependence on stellar mass and/or redshift. These results are consistent with both sets of SSP models and assumptions of alternative star formation histories explored. Consequently, the quiescent population must undergo an evolutive pathway including mergers and/or remnants of star formation to reconcile the observed trends, where the "progenitor" bias should also be taken into account. [ABSTRACT FROM AUTHOR]

Context. Knowing the exact shape of the ultraviolet (UV) luminosity function (LF) of high-redshift galaxies is important to understand the star formation history of the early Universe. However, the uncertainties, especially at the faint and bright ends of the LFs, remain significant. Aims. In this paper, we study the UV LF of redshift z = 2.5 – 4.5 galaxies in 2.38 deg2 of ALHAMBRA data with I ≤ 24. Thanks to the large area covered by ALHAMBRA, we particularly constrain the bright end of the LF. We also calculate the cosmic variance and the corresponding bias values for our sample and derive their host dark matter halo masses. Methods. We have used a novel methodology based on redshift and magnitude probability distribution functions (PDFs). This methodology robustly takes into account the uncertainties due to redshift and magnitude errors, shot noise, and cosmic variance, and models the LF in two dimensions (z, MUV). Results. We find an excess of bright * M*UV ~ M UV * $\tilde{\ }M_{\rm{UV}}^{*}$ galaxies as compared to the studies based on broad-band photometric data. However, our results agree well with the LF of the magnitude-selected spectroscopic VVDS data. We measure high bias values, b ~ 8 – 10, that are compatible with the previous measurements considering the redshifts and magnitudes of our galaxies and further reinforce the real high-redshift nature of our bright galaxies. Conclusions. We call into question the shape of the LF at its bright end; is it a double power-law as suggested by the recent broad-band photometric studies or rather a brighter Schechter function, as suggested by our multi-filter analysis and the spectroscopic VVDS data. [ABSTRACT FROM AUTHOR]

The original ALHAMBRA catalogue contained over 400 000 galaxies selected using a synthetic F814W image, to the magnitude limit AB(F814W) ≈ 24.5. Given the photometric redshift depth of the ALHAMBRA multiband data ( = 0.86) and the approximately I-band selection, there is a noticeable bias against red objects at moderate redshift. We avoid this bias by creating a new catalogue selected in the Ks band. This newly obtained catalogue is certainly shallower in terms of apparent magnitude, but deeper in terms of redshift, with a significant population of red objects at z > 1. We select objects using the Ks band images, which reach an approximate AB magnitude limit Ks ≈ 22. We generate masks and derive completeness functions to characterize the sample. We have tested the quality of the photometry and photometric redshifts using both internal and external checks. Our final catalogue includes ≈95 000 sources down to Ks ≈ 22, with a significant tail towards high redshift. We have checked that there is a large sample of objects with spectral energy distributions that correspond to that of massive, passively evolving galaxies at z > 1, reaching as far as z ≈ 2.5. We have tested the possibility of combining our data with deep infrared observations at longer wavelengths, particularly Spitzer IRAC data. [ABSTRACT FROM AUTHOR]

Due to its biocompatibility, handling and industrial production capacity, collagens have been increasingly attractive in the manufacture of scaffolds for Tissue Engineering. The aim of the present work was to present an analysis on the progress in research, development and production of human recombinant collagens, expression systems and their uses in Tissue Engineering. A review of the international scientific peer-reviewed literature in databases such as Scopus, PubMed and Google Scholar was done and that relevant to our objective was employed. The development of human recombinant collagens was found to be significant, and currently the expression systems, like bacteria and plants, show advantages over structure quality and biocompatibility, albeit with still restricted yields. However, there is narrow information about its applications in Tissue Engineering, mostly studied for cartilage and bone, in animal models and clinical studies. We did not include patents in the study, thus our findings are limited to scholar data. The present work presents the most recent advances in the engineering of recombinant collagens and their biomedical applications in the manufacture of tissues with potential clinical applications. The potential of recombinant collagens in regenerative medicine is promising and more research is needed that might allow a broad application in the near future. [ABSTRACT FROM AUTHOR]

Background and Aims The safety of foods and beverages is a prerequisite for consumers. The aim of this study is to check whether a low concentration of pesticide residues can be further reduced with the addition of a low dose of charcoal during white fermentation. Methods and Results Thirteen fungicides, boscalid, cyprodinil, fludioxonil, fenhexamide, pyrimethanil, cyazofamid, dimethomorph, fluopicolide, iprovalicarb, metrafenone, penconazole, spiroxamine and trifloxystrobin, were added together to five well-clarified and stabilised juices to reach a final fungicide concentration in juice slightly higher than that observed in bottled wines. Juices were fermented with two types of charcoal, both added at 20 and 50 mg/L. The course of fermentation was monitored, and the concentration of residual fungicides and of fermentative aromas was analysed by ultra-high performance liquid chromatography-MS/MS and GC-flame ionisation detector, respectively. Conclusions Charcoal removed up to 130 µg/L of fungicides. Compared with the control wines, those fermented with charcoal had 30-80% less fungicides. Only iprovalicarb was not significantly reduced. Aroma composition was not affected. Significance of the Study Low doses of charcoal added during fermentation can positively contribute to wine safety without penalising aroma and colour. [ABSTRACT FROM AUTHOR]

We consistently analyse for the first time the impact of survey depth and spatial resolution on the most used morphological parameters for classifying galaxies through non-parametric methods: Abraham and Conselice-Bershady concentration indices, Gini,M20moment of light, asymmetry, and smoothness. Three different non-local data sets are used, Advanced Large Homogeneous Area Medium Band Redshift Astronomical (ALHAMBRA) and Subaru/XMMNewton Deep Survey (SXDS, examples of deep ground-based surveys), and Cosmos Evolution Survey (COSMOS, deep space-based survey). We used a sample of 3000 local, visually classified galaxies, measuring their morphological parameters at their real redshifts (z ~0). Then we simulated them to match the redshift and magnitude distributions of galaxies in the non-local surveys. The comparisons of the two sets allow us to put constraints on the use of each parameter for morphological classification and evaluate the effectiveness of the commonly used morphological diagnostic diagrams. All analysed parameters suffer from biases related to spatial resolution and depth, the impact of the former being much stronger. When including asymmetry and smoothness in classification diagrams, the noise effects must be taken into account carefully, especially for ground-based surveys. M20 is significantly affected, changing both the shape and range of its distribution at all brightness levels. We suggest that diagnostic diagrams based on 2-3 parameters should be avoided when classifying galaxies in ground-based surveys, independently of their brightness; for COSMOS they should be avoided for galaxies fainter than F814 = 23.0. These results can be applied directly to surveys similar to ALHAMBRA, SXDS and COSMOS, and also can serve as an upper/lower limit for shallower/deeper ones. [ABSTRACT FROM AUTHOR]

Aims. Our goal is to estimate empirically the cosmic variance that affects merger fraction studies based on close pairs for the first time. Methods. We compute the merger fraction from photometric redshift close pairs with 10 h-1 kpc ⩽ rp ⩽ 50 h-1 kpc and Δv ⩽ 500 km s-1 and measure it in the 48 sub-fields of the ALHAMBRA survey. We study the distribution of the measured merger fractions that follow a log-normal function and estimate the cosmic variance σv as the intrinsic dispersion of the observed distribution. We develop a maximum likelihood estimator to measure a reliable σv and avoid the dispersion due to the observational errors (including the Poisson shot noise term). Results. The cosmic variance σv of the merger fraction depends mainly on (i) the number density of the populations under study for both the principal (n1) and the companion (n2) galaxy in the close pair and (ii) the probed cosmic volume Vc. We do not find a significant dependence on either the search radius used to define close companions, the redshift, or the physical selection (luminosity or stellar mass) of the samples. Conclusions. We have estimated the cosmic variance that affects the measurement of the merger fraction by close pairs from observations. We provide a parametrisation of the cosmic variance with n1, n2, and Vc, σv ∝ n-0.54 1 V-0.48 c (n2/n1)-0.37. Thanks to this prescription, future merger fraction studies based on close pairs could properly account for the cosmic variance on their results. [ABSTRACT FROM AUTHOR]

Background and Aims Grape maceration plays an important role in the formation of precursors of 3-mercaptohexan-1-ol ( 3MH), 3- S-glutathionyl mercaptohexan-1-ol ( GSH- 3MH) and 3- S-cysteinyl mercaptohexan-1-ol ( Cys- 3MH), but its contribution is still not well understood. The aim of this paper was to study the effect of oxygen deprivation on the concentration of these 3MH precursors during skin-contact maceration in two grape cultivars. Methods and Results Müller- Thurgau ( n = 19) and Sauvignon Blanc (32) grapes from Trentino ( Italy) were hand harvested and processed under the following conditions: reductive (air protected; 80 mg/kg sulfur dioxide, 80 mg/kg L-ascorbic acid, and 200 mg/kg dimethyl dicarbonate) and oxidative (no addition of adjuvants and air contact). After maceration, GSH- 3MH and Cys- 3MH were analysed by liquid chromatography-mass spectrometry and isotopic dilution. Conclusions Both GSH- 3MH and Cys- 3MH were identified for the first time in Müller- Thurgau juices. Oxidative maceration increased the GSH- 3MH concentration in 16 out of 19 Müller- Thurgau and in 23 out of 32 Sauvignon Blanc juices, while Cys- 3MH was higher in 13 and 20 juices, respectively, of the two cultivars. Parametrical and non-parametrical statistical tests confirmed that oxidative maceration of Müller- Thurgau increased GSH- 3MH concentration significantly ( P < 0.01). Significance of the Study This work highlights the complexity of the mechanisms involved in the potential de novo formation of thiol precursors. [ABSTRACT FROM AUTHOR]

Aims. We aim to illustrate the potentiality of the Advanced Large, Homogeneous Area, Medium-Band Redshift Astronomical (ALHAMBRA) survey to investigate the high-redshift universe through the detection of quasi stellar objects (QSOs) at redshifts higher than 5. Methods.We searched for QSOs candidates at high redshift by fitting an extensive library of spectral energy distributions - including active and non-active galaxy templates, as well as stars - to the photometric database of the ALHAMBRA survey (composed of 20 optical medium-band plus the 3 broad-band JHKs near-infrared filters). Results. Our selection over ≈1 square degree of ALHAMBRA data (~1/4 of the total area covered by the survey), combined with GTC/OSIRIS spectroscopy, has yielded identification of an optically faint QSO at very high redshift (z = 5:41). The QSO has an absolute magnitude of ~--24 at the 1450 Å continuum, a bolometric luminosity of ≈2 x 1046 erg s-1, and an estimated black hole mass of ≈108 M☉. This QSO adds itself to a reduced number of known UV faint sources at these redshifts. The preliminary derived space density is compatible with the most recent determinations of the high-z QSO luminosity functions. This new detection shows how ALHAMBRA, as well as forthcoming well-designed photometric surveys, can provide a wealth of information on the origin and early evolution of this kind of object. [ABSTRACT FROM AUTHOR]

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Context. Even the spectroscopic capabilities of today's ground and space-based observatories can not keep up with the enormous flow of detections (>105 deg-2) unveiled in modem cosmological surveys as: i) would be required enormous telescope time to perform the spectroscopic follow-ups and ii) spectra remain unattainable for the fainter detected population. In the past decade, the typical accuracy of photometric redshift (photo-z) determination has drastically improved. Nowdays, it has become a perfect complement to spectroscopy, closing the gap between photometric surveys and their spectroscopic follow-ups. The photo-z precision for active galactic nuclei (AGN) has always lagged behind that for the galaxy population owing to the lack of proper templates and their intrinsic variability. Aims. Our goal is to characterize the ability of the Advanced Large, Homogeneous Area Medium-Band Redshift Astronomical (ALHAMBRA) survey in assigning accurate photo-z's to broad-line AGN (BLAGN) and quasi-stellar objects (QSOs) based on their ALHAMBRA very-low-resolution optical-near-infrared (NIR) spectroscopy. This will serve as a benchmark for any future compilation of ALHAMBRA selected QSOs and the basis for the statistical analysis required to derive luminosity functions up to z ∼ 5. Methods. We selected a sample of spectroscopically identified BLAGN and QSOs and used a library of templates (including the SEDs of AGN and both normal and starburst galaxies, as well as stars) to fit the 23 photometric data points provided by ALHAMBRA in the optical and MR (20 medium-band optical filters plus the standard JHKs). Results. We find that the ALHAMBRA photometry is able to provide an accurate photo-z and spectral classification for ∼88% of the 170 spectroscopically identified BLAGN/QSOs over 2.5 deg2 in different areas of the survey and brighter than m678 = 23.5 (equivalent to rSLOAN ∼24.0). The derived photo-z accuracy is below 1% and is comparable to the most recent results in other cosmological fields that use photometric information over a wider wavelength range. The fraction of outliers (∼12%) is mainly caused by the larger photometric errors for the faintest sources and the intrinsic variability of the BLAGN/QSO population. A small fraction of outliers may have an incorrectly assigned spectroscopic redshift. Conclusions. The definition of the ALHAMBRA survey in terms of the number of filters, filter properties, areal coverage, and depth is able to provide photometric redshifts for BLAON/QSOs with a precision similar to any previous survey that makes use of medium-band optical photometry. In agreement with previous literature results, our analysis also reveals that, in the 0 < z < 4 redshift interval, very accurate photo-z can be obtained without the use of NTR broadband photometry at the expense of a slight increase in the outliers. The importance of NIR data is expected to increase at higher z (z > 4). These results are relevant for the design of future optical follow-ups of surveys containing a large fraction of BLAGN, such as many X-ray or radio surveys. [ABSTRACT FROM AUTHOR]

Alcohol injection treatment of essential blepharospasm, meige syndrome and hemifacial spasm. Alcohol (ethanol) was injected as treatment to 14 patients, seven with Meige syndrome, five essential blepharospasm and two with hemifacial spasm, who rejected surgery and they were minimally responsive to psycopharmacos and botulinum toxin treatment; from Jan/01 to Jan/05 in the National Institute of Neurology and Neurosurgery. Average follow up was 11.6 months. The mean interval of relief spasm was 7.9 months. The injection technique used is illustrated; only transitory severe facial edema, no blepharoptosis either diplopia as a complication was observed. The treatment was effective in virtually all patients, the main advantage of this procedure are minimal local and no systemic side effects, low cost, longer interval of relief and technically simple. Alcohol injection shows promise in this preliminary study. [ABSTRACT FROM AUTHOR]

Abstract: Surgical intervention causes oxidative stress leading to an adaptive responses by the body. To evaluate changes in the defense capacity of antioxidant enzymes, we determined the activity of glutathione reductase (GR) levels among liver transplant recipients with due to hepatitis C virus cirrhosis. The study was performed in 22 patients (16 males and 6 females) of average ages 52.63 ± 5.49 years for males and 59.67 ± 5.65 years for females. Blood samples for glutathione reductase activity were drawn on admission before as well as at 1, 6, and 12 h and 1, 2, 3, 5 and 7 days after the liver transplantation. Perioperative glutathione reductase levels were significant (P = .014) over the period using Bonferroni tests. GR activity reached a maximum (15.6112 ± 6.56035 nmol/mg protein) at 3 days after liver transplantation (T3d) (P = .001). The increased GR activity values detected perioperatively indicated scavenging of reactive oxygen species generated after liver transplantation of hepatitis C virus cirrhosis patients. [Copyright &y& Elsevier]

Background We describe the results of our liver transplantation (LT) patients for hepatocellular carcinoma (HCC) in 2004 to 2012 to determine the differences on the basis of time on the waiting list to establish the risk of recurrence of liver disease. Methods Clinical variables were recorded for both donors and recipients as well as variables of diagnosis, the use of transarterial chemoembolization during the waiting list time (WLT), complications, re-transplantation, and exitus. Fifty-eight patients were analyzed. Mean age was 57 ± 8 years (men, 83%; 48 patients). Viral etiology of HCC was 50% (n = 29); alcoholic, 26% (n = 15); and others, 24% (n = 14). Results Exitus was established in 24 patients (41%); only 5 patients (7%) were attributable to HCC. In the cohort of patients with less than 6 months of WLT, we registered both higher rates of downstaging protocols (10.7% vs 7.5%) and tumor size (3 cm vs 2 cm) compared with the other group. Bivariate studies were conducted according to the WLT (WLT <6 months, WLT ≥6 months), finding differences in recurrence of liver disease ( P < .05). This fact was confirmed after a binary logistic regression. Conclusions Our results in a subgroup of less than 6 months of WLT included patients with increased tumor size or presentation of multiple nodes, with a worse prognosis and therefore to be prioritized in the treatment of LT. Therefore, in our population there is a significant risk of tumor recurrence in patients with less WLT for LT, but it cannot be overestimated to all type of patients with HCC. [ABSTRACT FROM AUTHOR]

Abstract: Reactive oxygen species play a central role in ischemia-reperfusion injury after organ transplantation. They are degraded by endogenous radical scavengers such as antioxidant enzymes. The purpose of this study was to evaluate the temporal variation in glutathione peroxidase (GPX) activity and malondialdehyde (MDA) levels among alcoholic cirrhotic recipients of liver transplantations. The study included 30 recipients: 26 males and 4 females in the provided blood samples before and after transplantation. The results showed significant enhancement of MDA levels at 1 and 6 hours after transplantation: 4.458 ± 2.273 μmol/L and 4.4628 ± 2.405 μmol/L respectively (P < .001). In contrast, GPX activity showed a maximum at 3 days there after 3.541 ± 2,315 nmol/mg protein. In conclusion, although MDA levels show an enormous increase at 1 hour after transplantation suggesting lipid peroxidation, they were compensated by GPX activity thereafter, indicating control of the oxidative stress generated by liver transplantation. [Copyright &y& Elsevier]

Malolactic fermentation (MLF) is a key feature in the production of high-quality wines. Its evolution is not always guaranteed, especially in white wine, due to certain limiting factors (low pH, sulphur dioxide, low temperature) acting against malolactic bacteria. The inoculation of grape must with bacteria is an alternative approach to the management of oenological fermentation, favouring the survival of bacteria due to the absence of ethanol or sulphur dioxide - toxic compounds made by yeasts in the first stages of winemaking. We compared the activity of two strains of Oenococcus oeni during MLF in wines made from an emerging white grape variety, native to north-eastern Italy, namely Incrocio Manzoni. Different winemaking protocols were assayed, comparing sequential or simultaneous inoculation of microbial starters. The monitoring of bacterial viability through fermentations and a comprehensive characterisation of the volatile profile of the wines were achieved by advanced analytical approaches, flow cytometry and GC-MS respectively. According to the preliminary hypothesis, the chemical composition of the grape must was characterised by high acidity, which represented a serious barrier to bacterial development. Simultaneous inoculation of the two O. oeni strains ensured a regular evolution of MLF. Some differences were highlighted, both in terms of fermentation kinetics and the aromatic profile of the wines obtained, in relation to the strain of lactic bacteria. The work provides an exhaustive overview of the opportunities and risks related to different wine fermentation approaches in order to enhance the quality of white wines made from "new" or "local" wine grapes. [ABSTRACT FROM AUTHOR]

The practice of treating candidates for liver transplantation (LT) for hepatocellular carcinoma (HCC), with locoregional therapies, is common in most transplantation centers. We present our results using transarterial chemoembolization (TACE) as a neo-adjuvant treatment in our center between 2002 and 2013 to determine its effectiveness in downstaging (DS) HCC within the Milan criteria (MC). Clinical variables were recorded of both donors and recipients, such as diagnosis and treatment, variables related to its etiology, the use of TACE as a neo-adjuvant treatment, immunosuppressive therapy, toxicity, recurrence of disease, exitus, and others. Sixty-four patients were analyzed. Median age was 57 (range, 51–64) years. In this study, 84% (54) were male and 16% (10) were women. Etiology of HCC was viral in 47% (30), alcoholic in 25% (16), and other in 28% (18). TACE was conducted in 45 patients (70%). Every patient included in our study presented a T2 stage (of tumor-nodes-metastasis [TNM]) before surgery, thus within the MC. However, DS protocol was performed in 5 patients (7.8%). We performed a bivariate analysis, having assessed that the use of TACE decreases T2 stage into T1-T0 stage ( P < .05). We have also calculated the recurrence-free survival, which reaches up to 80% to 125 months. Furthermore, even though the statistical differences are not consistent due to the simple size presented, we conclude that TACE is a safe and effective therapy to control HCC progression during the waiting list time. [ABSTRACT FROM AUTHOR]

Background Obesity is a global epidemic that continues to increase in a great number of countries, and it has become a major public health problem in Spain. Unfortunately, the impact of obesity on survival in liver transplantation (LT) recipients is underestimated and controversial. The aim of this study was to determine if obesity is a risk factor for morbidity and mortality after LT. Methods In a retrospective cohort study of the records of 180 consecutive patients who had undergone to LT from 2007 to 2013, 11 obese patients with body mass index (BMI) >35 kg/m 2 were identified. Their data have been compared with recipients with BMI 20–25 kg/m 2 . Results There were no differences in demographic data, Child-Pugh score, Model for End-Stage Liver Disease score, or cause of liver failure. BMI >35 kg/m 2 recipients had a significantly higher rate of portal vein thrombosis before LT, compared with the BMI 20–25 kg/m 2 group (36.5% vs 13.9%; P = .041). There were also no differences in development of post-reperfusion syndrome. The groups were also comparable concerning morbidity rate after LT, stay in the intensive care unit, and global hospital stay. However, the mortality rate was significantly higher in the obese group compared with the nonobese group (72.7% vs 38.9%; P = .032). Conclusions The results of the study clearly demonstrate higher mortality rates in obese patients undergoing LT; thus, it is fair to consider obesity as a poor prognosis predictive factor concerning mortality rate. [ABSTRACT FROM AUTHOR]

Background We describe an observational, retrospective study that included patients who underwent a liver transplantation (LT) for hepatocellular carcinoma (HCC) in our center between 2004 and 2012. Methods Clinical variables were recorded for donors and recipients as diagnosis and treatment, immunosuppressive therapy, toxicity, graft dysfunction, recurrence, and exitus. Fifty-eight patients were analyzed. The mean age was 57 ± 8 years. The viral etiology of HCC was 50% (n = 29), alcoholic 26% (n = 15), and others, 24% (n = 14). Regarding initial immunosuppressive strategy (IS), 51 patients (87.9%) were treated with standard regimen with corticosteroids (CS) and tacrolimus (TA), compared with 7 patients with impaired renal function (12.1%) who underwent a delayed therapy with calcineurin inhibitors (CNI) + mycophenolate mophetil (MMF) + CS. Concomitant use of anti-CD25 monoclonal antibodies was less than 10%. Regarding maintenance, 43 patients (74.1%) were treated with MMF + CNI versus 15 treated only with TA (25.9%). Results Recurrence of HCC was approximately 12%: 7 patients (2 hepatic only, 5 also extra-hepatic). Exitus was established in 19 patients (32.75%); only 3 patients (5.17%) were attributable to HCC. Bivariate studies were conducted according to the initial IS (standard regimen versus delayed therapy) and maintenance therapy (MMF + TA versus TA alone), with no differences in any of them in recurrence, treatment toxicity, graft rejection, and dysfunction. Conclusions In our experience with the IS, we found no differences in the development of recurrent disease, treatment toxicity, development of graft dysfunction, or rejection. We believe that individualized immunosuppressive therapy in these patients is safe and effective. [ABSTRACT FROM AUTHOR]

Abstract: We present our experience with a split liver (SL) program shared with the children's liver transplantation (LT) program from 2 different hospitals in the use of partial grafts from cadaver donors in brain death. We describe an observational, retrospective study, which included patients who underwent a SL transplantation in our center between January 2006 and December 2012. Clinical variables were recorded of both donors and recipients and their data were analyzed using SPSS 19.0 software. Of a total of 204 LT, 4 (2%) patients were treated with a SL. The causes of LT were alcoholic cirrhosis in 2 cases, cryptogenic cirrhosis, and primary biliary cirrhosis (PBC). In all cases there was a temporary portocaval shunt. The confluence of the hepatic veins of the recipient was anastomosed to the donor vena cava and arterial anastomosis was performed. The reconstruction was hepato-choledochal in all cases. There were no cases of postreperfusion syndrome or vascular thrombosis and no retransplantation was necessary. Currently, 3 of the 4 cases are still alive. Death in the other patient was due to mesenteric ischemia. Our center has participated in the development of a protocol that considers the indication of this technique provided expert groups are involved in its development, regardless of hospital level. This will expand the pool of donors and partially solve the current problems with available grafting. [Copyright &y& Elsevier]

Abstract: The main objective of this study was to define a gene network profile network in liver transplant recipients with alcoholic cirrhosis before and after liver transplantation. Genes were selected from data obtained in a previous study of liver transplant recipients with alcoholic cirrhosis. Selected up-regulated genes were further validated by quantitative real-time polymerase chain reaction in different groups of liver transplant recipients with alcoholic cirrhosis (n=5). Selected genes up-regulated before transplantation were: TNFRSF9 (tumor necrosis factor [TNF] receptor superfamily, member 9); IL2RB (interleukin-2 receptor beta); BCL2L2 (BCL2-like 2); NOX5 (NADPH) oxidase, EF-hand calcium binding domain 5); PEX5 (peroxisomal biogenesis factor 5); PPARG (peroxisome proliferator-activated receptor gamma); NIBP (IKK2 binding protein); NKIRAS2 (NFKappaBeta inhibitor interacting Ras-like 2); IL4 (interleukin-4); IL-4R (interleukin 4 receptor); ADH1A (alcohol dehydrogenase 1A, class 1); ALDH1L1 (aldehyde dehydrogenase 1 family, member L1); MPO (myeloperoxidase); NPPA (natriuretic peptide precursor A); BCL2A1 (BCL2-related protein A1); GADD45A (growth arrest and DNA-damage-inducible alpha); TEGT (Bax inhibitor 1); PIK3CA (phosphoinositide-3-kinase, catalytic, alpha polypeptide); IFNGR2 (interferon gamma receptor 2); JAK2 (Janus Kinase 2); FAS (Fas, TNF receptor superfamily, member 6); TANK (TRAF family member-associated NFKB activator); TTRAP (TRAF and TNF receptor-associated protein); and ANXA5 (annexin A5). [Copyright &y& Elsevier]

Abstract: Given the shortage of donors, it has become increasingly necessary to use alternative sources to meet the growing demand for organs, and evolution in the use of asystolic donors is proving to be an important resource in helping to meet those needs. The goal of this study is to describe the initial results of our experience with Type II asystolic donation. An observational retrospective study was conducted to analyze the variables of four cases in this type of donation. After the analysis we conclude that, despite the limited number of cases in our series, the results are compatible with larger series and permit us to continue to value this method as a resource for broadening the donor pool. [Copyright &y& Elsevier]

Abstract: We studied 81 cirrhotic patients who were candidates for liver transplantation to evaluate frequently detected cardiac alterations by echocardiographic study. Patients were distributed into three groups: group 1 comprised alcoholic cirrhotic patients (n = 40); group 2, viral cirrhotic patients (hepatitis C or B virus) (n = 35); and group 3, patients with primary biliary cirrhosis (n = 6). Cardiac chambers and diastolic functions were estimated by two-dimensional transthoracic echocardiography in M mode and Doppler. The most frequently detected cardiac structural alterations were left atrial diameter enlargement in 100% of the women and 40% of the men in group 1; 87.5% of the women and 15.4% of the men in group 2; and 33.3% of the women in group 3. Interventricular wall thickness enlargement in 50% of the women and 27.8% of the men in group 1, 25% of the women and 30.8% of the men in group 2, and 16.4% of the women in group 3. The prevalence of diastolic dysfunction was 45% in group 1, 32.3% in group 2, and 16.4% in group 3 (P > .05). There were no significant differences between the groups in cardiac chamber dimensions, left ventricular wall thickness, or prevalence of diastolic dysfunction. [Copyright &y& Elsevier]

Abstract: This study assess of hepatopulmonary syndrome (HPS) prevalence and the influence of etiology among cirrhotic patients due to an alcoholic or viral etiology. We examined the records of patients were distributed as Group 1, alcoholic (n = 40) and Group 2, hepatic cirrhosis of viral etiology (n = 35). Hepatic cirrhosis status was estimated by CHILD and MELD scores. Presence of clinical ascites spell out was noted as well as size and diastolic functions of the cardiac chambers using two-dimensional transthoracic echocardiography in M mode and by Doppler. HPS was studied with agitated saline serum and intravenous contrast administration. HPS was considered to be present when serum or contrast passed to the left chamber before the 5th cardiac cycle. There was no significant differences among related to sex, age, cirrhosis status or ascites. HPS frequency was 35% in Group 1 versus 64.7% among Group 2-Patients (P = .01). Taking into account the results, we concluded that HPS frequency was related to cirrhotic etiology. Upon multivariate analysis a patients with cirrhosis from viral etiology showed significantly increased HPS frequency compared with those displaying cirrhosis of an alcoholic etiology. [Copyright &y& Elsevier]

Objective: To assess the trend in hepatitis A, hepatitis B, pneumococcal, tetanus and seasonal influenza vaccination in people with HIV infection and to analyse associated factors., Methods: The Hospital Survey of Patients with HIV, an annual cross-sectional study conducted on a fixed day (2006-2021), was used. Inpatients and outpatients were included. Trends in vaccination and associated factors were analysed using logistic regression., Results: A total of 8643 participants were included. Vaccination rates increased to 65.3% for hepatitis A, 83.7% for hepatitis B, 49.3% for tetanus, 68.9% for pneumococcal and 74.5% for seasonal influenza in 2021. Factors positively associated with vaccination were older age for pneumococcal and influenza vaccination; higher educational level for hepatitis A and tetanus; living in a closed institutions or prison for tetanus, pneumococcal and influenza; and having acquired HIV through sex between men for hepatitis A, B and pneumococcal. In addition, being on antiretroviral treatment and having a high CD4 count were positively associated with vaccination for all these diseases. Factors inversely associated with vaccination were being older (hepatitis A, B and tetanus), being an immigrant (tetanus and seasonal influenza) and being an injection drug user/ex-user for hepatitis A and B., Conclusions: Vaccination in people with HIV has increased in the study period. The results are in line with the recommendations in this population, although there is still room to reach the established vaccination indicators., (Copyright © 2023 Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Published by Elsevier España, S.L.U. All rights reserved.)

Background and Objectives : Pulmonary hypertension (PH) is a clinical condition with high mortality rates, particularly in patients over 65. Current guidelines recommend assessing the likelihood of pulmonary hypertension (LPH) using advanced echocardiography before proceeding to right heart catheterization. This study proposed using the common femoral vein (CFV), an accessible vein that reflects right atrial pressure, as an alternative method to assess the high likelihood of pulmonary hypertension (H-LPH). Materials and Methods : This prospective observational study included 175 emergency patients from three hospitals. Ultrasound assessed the pulsed wave Doppler (PW-Doppler) morphology of the CFV. This diagnostic yield for H-LPH was evaluated alongside traditional ultrasound parameters (right-to-left ventricular basal diameter ratio greater than 1 (RV > LV), septal flattening, right ventricular outflow acceleration time (RVOT) of less than 105 ms and/or mesosystolic notching, pulmonary artery diameter greater than the aortic root (AR) diameter or over 25 mm, early pulmonary regurgitation maximum velocity > 2.2 m/s; TAPSE/PASP less than 0.55, inferior vena cava (IVC) diameter over 21 mm with decreased inspiratory collapse, and right atrial (RA) area over 18 cm 2 ). Results: The CFV's PW-Doppler cardiac pattern correlated strongly with H-LPH, showing a sensitivity (Sn) of 72% and a specificity (Sp) of 96%. RA dilation and TAPSE/PASP < 0.55 also played significant diagnostic roles. Conclusions: The CFV's PW-Doppler cardiac pattern is an effective indicator of H-LPH, allowing reliable exclusion of this condition when absent. This approach could simplify initial LPH evaluation in emergency settings or where echocardiographic resources are limited.

Introduction: Bone and Joint Infections (BJI) have high morbidity. Methicillin resistant Staphylococcus aureus (MRSA) has increased. Culture-based diagnosis has difficult to recovering fastidious bacteria and detecting polymicrobial infections, molecular methods offer a promising improvement for the diagnosis of BJI with reduced time to result. The aim of the study was to determine the correlation between culture results and the Biofire joint infection panel (BJIP) in a cohort of pediatric patients with BJI., Materials and Methods: Descriptive study. Patients admitted with probable o confirmed BJI between July 1, 2019 and February 28, 2021 at HOMI. Blood cultures, synovial and bone fluid samples were taken. Samples were kept at -70 °C. On September 2022, the panel was performed., Results: 32 patients were included . The average age was 83m (RIQ: 32-145). 23 (71.8%) patients had a positive culture. The most frequent microorganism were S. aureus 19 (83%), 11/19 (57.9%) Staphylococci isolates were MRSA. 24/32 (75%) were positive by panel, 20 positive detections were concordant with culture, there were 6 additional isolates by panel (2 S. aureus , 2 S. pyogenes , 1 K. kingae and 1 C. albicans ), three microorganisms were isolated in culture but not in the panel. (2 S. aureus and 1 S. agalactiae ). Two patients with coinfection were detected. All MRSA were detected by culture and panel. In 26 (81.3%) patients the etiology was documented by any method., Conclusion: These results showed a moderate level of agreement between BJIP and culture ( κ  = 0.47). The panel allowed the detection of fastidious bacteria including K. kingae and polymicrobial samples. There was a very good level of agreement between the panel and culture for the MRSA detection ( κ  = 1)., Competing Interests: The molecular panels were donated by bioMérieux and they did not participate in the design or analysis of the study results. GC-M: Has received support from Pfizer, MSD (Merck Sharp and Dohme) for participation in congresses and paid conferences, has participated in advisory boards and has received support from for research. He has received fees from BiomerieuxTM for lectures. AL-C: Has received support from Pfizer, MSD (Merck Sharp and Dohme) for participation in congresses and paid conferences, has participated in advisory boards and has received support from for research. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Camacho-Moreno, Vergara-Amador, Martínez-Villegas, Aragón-Joya, Romero-Cardozo, Lores-Garcia, Moreno and Leal-Castro.)

Introduction: The occurrence of pneumomediastinum (PM) and/or pneumothorax (PTX) in patients with severe pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was evaluated., Methods: This was a prospective observational study conducted in patients admitted to the intermediate respiratory care unit (IRCU) of a COVID-19 monographic hospital in Madrid (Spain) between December 14, 2020 and September 28, 2021. All patients had a diagnosis of severe SARS-CoV-2 pneumonia and required noninvasive respiratory support (NIRS): high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP). The incidences of PM and/or PTX, overall and by NIRS, and their impact on the probabilities of invasive mechanical ventilation (IMV) and death were studied., Results: A total of 1306 patients were included. 4.3% (56/1306) developed PM/PTX, 3.8% (50/1306) PM, 1.6% (21/1306) PTX, and 1.1% (15/1306) PM + PTX. 16.1% (9/56) of patients with PM/PTX had HFNC alone, while 83.9% (47/56) had HFNC + CPAP/BiPAP. In comparison, 41.7% (521/1250) of patients without PM and PTX had HFNC alone (odds ratio [OR] 0.27; 95% confidence interval [95% CI] 0.13-0.55; p  < .001), while 58.3% (729/1250) had HFNC + CPAP/BiPAP (OR 3.73; 95% CI 1.81-7.68; p  < .001). The probability of needing IMV among patients with PM/PTX was 67.9% (36/53) (OR 7.46; 95% CI 4.12-13.50; p  < .001), while it was 22.1% (262/1185) among patients without PM and PTX. Mortality among patients with PM/PTX was 33.9% (19/56) (OR 4.39; 95% CI 2.45-7.85; p  < .001), while it was 10.5% (131/1250) among patients without PM and PTX., Conclusions: In patients admitted to the IRCU for severe SARS-CoV-2 pneumonia requiring NIRS, incidences of PM/PTX, PM, PTX, and PM + PTX were observed to be 4.3%, 3.8%, 1.6%, and 1.1%, respectively. Most patients with PM/PTX had HFNC + CPAP/BiPAP as the NIRS device, much more frequently than patients without PM and PTX. The probabilities of IMV and death among patients with PM/PTX were 64.3% and 33.9%, respectively, higher than those observed in patients without PM and PTX, which were 21.0% and 10.5%, respectively., Competing Interests: Declaration of Conflicting InterestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: MLG, JRTT, AZV, PMA, MSO, ECS, MAOF, JHN, EMSL, and PL were medical researchers in the HEEIZ in open-label randomized phase 3 clinical trial NEPTUNO to determine the efficacy and safety of plitidepsin (an antiviral drug) compared to control in adult patients requiring hospitalization for moderate COVID-19. PL was the primary researcher. The rest of the authors mentioned were secondary researchers. PharmaMar payments were made to all the researchers. PL and EMSL are members of PharmaMar's Advisory Board. JRTT, CFM, DL, and PL also were researchers in the HEEIZ in open-label phase 3 clinical trial OSCAR to evaluate the efficacy and safety of otilimab (an anti-GM-CSF monoclonal antibody) in patients ≥70 years requiring admission to IRCU for severe COVID-19. PL was the primary researcher. The rest of the authors mentioned were secondary researchers. GlaxoSmithKline (GSK) payments were made to all the researchers. MLG also declares receipt of payment from Gilead Sciences for impart a session in HEEIZ about the use of remdesivir in adult hospitalized patients diagnosed with COVID-19. PL declares financial and material support for educational activities from Linde Healthcare, Bial, Boehringer Ingelheim, Air Liquide, GSK, FAES Farma, and Novartis. In the same way, JRTT and TVV also disclose to have received financial and material support for educational activities from several pharmaceutical companies and Phillips/Cardiva. PL declares having received funding from Phillips/Cardiva for medical writing at this institution. All authors have received funding from various pharmaceutical companies for registration at medical-scientific congresses in their respective fields. All authors have completed and submitted the International Committee of Medical Journal Editors (ICMJE) form for disclosure of potential conflicts of interest.

Background: Attempts at dynamic reconstruction of the upper eyelid either by neurotization or direct muscle replacement have been scarce. Substitution of the levator palpebrae superioris muscle requires the use of extremely small and pliable structures. As a proof of concept/pilot study, we present a consecutive series of patients who underwent blepharoptosis correction using the neurotized omohyoid muscle graft., Methods: Retrospective analysis of patients receiving a neurotized omohyoid muscle graft for levator palpebralis substitution between January and December 2019., Results: Five patients were operated (2 male, 3 female); median age was 35.5 years. Median palpebral aperture was 0 mm and levator function was< 1 mm in all cases. Median denervation time for the levator muscle was 9 years. All surgeries were uneventful, and no postoperative complications were seen. Twelve months after the procedure, all patients presented with adequate palpebral aperture on activation of the spinal nerve. Median palpebral aperture was 6.5 mm Postoperative electromyography revealed muscle contraction when stimulation was applied to the spinal nerve., Conclusion: This study introduces the concept of severe blepharoptosis correction using the omohyoid muscle. We believe that with time and further technical refinements it could become an invaluable tool in eyelid reconstruction surgery., Competing Interests: Conflicts of interest None declared., (Copyright © 2023. Published by Elsevier Ltd.)

Aims:  To evaluate the evidence and produce a summary and recommendations for the most common heart and lung applications of point-of-care ultrasound (PoCUS)., Methods:  We reviewed 10 clinical domains/questions related to common heart and lung applications of PoCUS. Following review of the evidence, a summary and recommendation were produced, including assignment of levels of evidence (LoE) and grading of the recommendation, assessment, development, and evaluation (GRADE). 38 international experts, the expert review group (ERG), were invited to review the evidence presented for each question. A level of agreement of over 75 % was required to progress to the next section. The ERG then reviewed and indicated their level of agreement regarding the summary and recommendation for each question (using a 5-point Likert scale), which was approved if a level of agreement of greater than 75 % was reached. A level of agreement was defined as a summary of "strongly agree" and "agree" on the Likert scale responses., Findings and Recommendations:  One question achieved a strong consensus for an assigned LoE of 3 and a weak GRADE recommendation (question 1). The remaining 9 questions achieved broad agreement with one assigned an LoE of 4 and weak GRADE recommendation (question 2), three achieving an LoE of 3 with a weak GRADE recommendation (questions 3-5), three achieved an LoE of 3 with a strong GRADE recommendation (questions 6-8), and the remaining two were assigned an LoE of 2 with a strong GRADE recommendation (questions 9 and 10)., Conclusion:  These consensus-derived recommendations should aid clinical practice and highlight areas of further research for PoCUS in acute settings., Competing Interests: A number of authors have declared potential conflicts of interest from the past three years:Bøetker, M.T. [royalties received from e-learning platform USabcd.org]; Connolly, J. [honoraria received from Sonosite FujiFilm UK, equipment loans from Canon Healthcare, Terason Ultrasound, EchoNous]; Gargani, L. [honoraria received from GE Healthcare, Philips Healthcare & Caption Health]; Jarman, R.D. [honoraria received from Sonosite FujiFilm UK, equipment loans from Canon Healthcare]; Kim, D. [medical advisor for Clarius Mobile Health]; Liu, R. [honoraria received from Philips Healthcare]; Olusanya, O. [honoraria received from GE Healthcare & Sonosite FujiFilm UK]; Peck, M. [honoraria received from GE Healthcare]., (Thieme. All rights reserved.)

Objective:  To evaluate the evidence and produce a summary and recommendations for the most common heart and lung point-of-care ultrasound (PoCUS)., Methods:  We reviewed 10 clinical domains/questions related to common heart and lung applications of PoCUS. Following review of the evidence, a summary and recommendations were produced, including assigning levels of evidence (LoE) and grading of recommendation, assessment, development, and evaluation (GRADE). 38 international experts, the expert review group (ERG), were invited to review the evidence presented for each question. A level of agreement of over 75 % was required to progress to the next section. The ERG then reviewed and indicated their level of agreement of the summary and recommendation for each question (using a 5-point Likert scale), which was approved in the case of a level of agreement of greater than 75 %. A level of agreement was defined as a summary of "strongly agree" and "agree" on the Likert scale responses., Findings and Recommendations:  One question achieved a strong consensus for an assigned LoE of 3 and a weak GRADE recommendation (question 1), the remaining 9 questions achieved broad agreement with an assigned LoE of 4 and a weak GRADE recommendation (question 2), three achieved an LoE of 3 with a weak GRADE recommendation (questions 3-5), three achieved an LoE of 3 with a strong GRADE recommendation (questions 6-8) and the remaining two were assigned an LoE of 2 with a strong GRADE recommendation (questions 9 and 10)., Conclusion:  These consensus-derived recommendations should aid clinical practice and highlight areas of further research for PoCUS in acute settings., Competing Interests: A number of authors have declared potential conflicts of interest from the past three years.Bøetker, M.T. [royalties received from e-learning platform USabcd.org];Connolly, J. [honoraria received from Sonosite FujiFilm UK, equipment loans from Canon Healthcare, Terason Ultrasound, EchoNous]; Gargani, L. [honoraria received from GE Healthcare, Philips Healthcare & Caption Health]; Jarman, R.D. [honoraria received from Sonosite FujiFilm UK, equipment loans from Canon Healthcare];Kim, D. [medical advisor for Clarius Mobile Health]; Liu, R. [honoraria received from Philips Healthcare];Olusanya, O. [honoraria received from GE Healthcare & Sonosite FujiFilm UK];Peck, M. [honoraria received from GE Healthcare]., (Thieme. All rights reserved.)

Background: Many patients with COVID-19 require respiratory support and close monitoring. Intermediate respiratory care units (IRCU) may be valuable to optimally and adequately implement noninvasive respiratory support (NRS) to decrease clinical failure. We aimed at describing intubation and mortality in a novel facility entirely dedicated to COVID-19 and to establish their outcomes., Methods: This was a retrospective, observational study performed at one hospital in Spain. We included consecutive subjects age > 18 y, admitted to IRCU with COVID-19 pneumonia, and requiring NRS between December 2020-September 2021. Data collected included mode and usage of NRS, laboratory findings, endotracheal intubation, and mortality at day 30. A multivariable Cox model was used to assess risk factors associated with clinical failure and mortality., Results: A total of 1,306 subjects were included; 64.6% were male with mean age of 54.7 y. During the IRCU stay, 345 subjects clinically failed NRS (85.5% intubated; 14.5% died). Cox model showed a higher clinical failure in IRCU upon onset of symptoms and hospitalization was < 10 d (hazard ratio [HR] 1.59 [95% CI 1.24-2.03], P < .001) and P aO 2 /F IO 2 < 100 mm Hg (HR 1.59 [95% CI 1.27-1.98], P < .001). These variables were not associated with increased 30-d mortality., Conclusions: The IRCU was a valuable option to manage subjects with COVID-19 requiring NRS, thus reducing ICU overload. Male sex, gas exchange, and blood chemistry at admission were associated with worse prognosis, whereas older age, gas exchange, and blood chemistry were associated with 30-d mortality. These findings may provide a basis for better understanding outcomes and to improve management of noninvasively ventilated patients with COVID-19., Competing Interests: Mr Martínez-Alejos is part-time employee at Philips France. The remaining authors have disclosed no conflicts of interests., (Copyright © 2023 by Daedalus Enterprises.)

Text: Recent years have seen great advances in the use of clinical ultrasound imaging in both hospital emergency departments and out-of-hospital settings. However, all new techniques require up-to-date definitions of competencies relevant to the clinical realities of different specialties and the geographic settings in which specialists work. To that end, a group of experts in clinical ultrasound reviewed the evidence available in the literature and strictly applied the Delphi method to define the competencies relevant to emergency physicians. The group worked with the starting premise that clinical ultrasound imaging should be a common competency across the specialty.