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Objective: Vocal fold paralysis is an uncommon problem in children. Clinical presentation covers a wide range of signs and symptoms. Our objective is to evaluate de efficacy and security of the Endoscopic Arytenoid Abduction Lateropexy (EAAL) in pediatric patients with vocal cord paralysis and to present the results. Material and method: From January 2011 to September 2018 10 patients with vocal fold paralysis underwent examination and treatment. The mean age at treatment was 4.87 years old (2-16). The parameters considered at the pre-/postsurgical time for the clinical assessment of each patient were as follows: the presence or absence of stridor and respiratory distress, the existence or nonexistence of previous tracheostomy, voice alterations, and feeding aspiration events. The mean follow-up was 49.5 months (5-104). Results: EAAL were realized successfully in 10 patients. There were no complications associated with the surgical procedure. In terms of sequelae, we noted 2 cases of minimal liquid-feeding difficulties that were alleviated within three weeks of the surgery with the help of phoniatrics reeducation, and 5 cases of mild dysphonia. In 4 cases tracheostomy was avoided, in 4 cases patients with prior tracheostomy were successfully decannulated following EAAL. Conclusions: EAAL may be selected as a first-line technique in management of vocal cord paralysis, since it is minimally invasive, easy to perform, and produces satisfactory results.

It is crucial to ensure the safety and integrity of underground gas storage (UGS) infrastructure for energy reliability in California, and many other places around the world. To address the risk management need in UGS industry, we take advantage of recent advances in downhole fiber optic monitoring and coupled well-reservoir simulation to provide unprecedented understanding of gas flow in wells at UGS sites. We have combined advanced monitoring and simulation of UGS operations into a decision-support system called the Integrated Risk Management and Decision Support System (IRMDSS). The IRMDSS framework includes three components: (i) mechanistic models, (ii) continuous and frequent monitoring data, and (iii) a supervisory interface for performing analyses using the models and monitoring data. The goal of the IRMDSS is to equip UGS operators with real-time monitoring data and simulation tools that can alert them to potential failures, detect early leakage, and support mitigation decision-making to prevent otherwise larger failures. We demonstrate an application of the IRMDSS by analyzing the temperature and pressure response to a hypothetical leak. Through a review of distributed temperature sensing (DTS) data collected at an operating UGS facility we show that DTS can uniquely and precisely identify the depth of the gas-water-contact in the well annulus, and that DTS can provide an early warning signal of upward gas flow as would occur in a well blowout scenario. When combined with modeling analysis, a rough leak rate can be roughly estimated to understand the severity of the leakage conditions and to support the mitigation decision needed.

Decannulation is the process of removing the tracheotomy cannula permanently, once the original pathology that led to the tracheotomy has been resolved or significantly improved. The prediction of decannulation success is difficult due to the influence of several factors. There is no universally accepted decannulation protocol. There are several protocols and the choice depends, largely, on each institution and the individual situation of each patient. However, in order to achieve successful decannulation, several essential criteria must be taken into account, which must be fulfilled regardless of the chosen protocol. We indicate the characteristics that the patient must meet for decannulation, and we present recommendations on the necessary steps to achieve the removal of the tracheotomy cannula in a child safely and minimizing the risk of failure.

Tracheobronchomalacia (TBM) is the most common tracheobronchial obstruction. Most cases are mild to moderate; therefore, they do not need surgical treatment. Severe tracheomalacia, however, represents a diagnostic and therapeutic challenge since they are very heterogeneous. In the armamentarium of resources for the treatment of dynamic airway collapse, splints and stents are two underused strategies and yet, they may represent the best alternative in selected cases. Lately, computed tomography 3D reconstruction of the airway has been used for the design of virtual models that can be 3D-printed for the creation of novel devices to address training, simulation, and biotechnological implants for refractory and severe airway malformations. This manuscript examines the role of resorbable stents, splints, and the 3D reconstruction and printing of the pediatric airway in tracheobronchomalacia.

Moving loads such as cars and trains are very useful sources of seismic waves, which can be analyzed to retrieve information on the seismic velocity of subsurface materials using the techniques of ambient noise seismology. This information is valuable for a variety of applications such as geotechnical characterization of the near-surface, seismic hazard evaluation, and groundwater monitoring. However, for such processes to converge quickly, data segments with appropriate noise energy should be selected. Distributed Acoustic Sensing (DAS) is a novel sensing technique that enables acquisition of these data at very high spatial and temporal resolution for tens of kilometers. One major challenge when utilizing the DAS technology is the large volume of data that is produced, thereby presenting a significant Big Data challenge to find regions of useful energy. In this work, we present a highly scalable and efficient approach to process real, complex DAS data by integrating physics knowledge acquired during a data exploration phase followed by deep supervised learning to identify "useful" coherent surface waves generated by anthropogenic activity, a class of seismic waves that is abundant on these recordings and is useful for geophysical imaging. Data exploration and training were done on 130~Gigabytes (GB) of DAS measurements. Using parallel computing, we were able to do inference on an additional 170~GB of data (or the equivalent of 10 days' worth of recordings) in less than 30 minutes. Our method provides interpretable patterns describing the interaction of ground-based human activities with the buried sensors., Accepted at the IEEE BigData 2020 conference

To analyze high and low contrast visual acuity and contrast sensitivity in diabetic patients without clinically significant macular edema associated or not with non-proliferative diabetic retinopathy. Cross-sectional study of 368 eyes of 368 patients classified into three groups: a) disease-free patients, b) patients with diabetes mellitus (DM) without diabetic retinopathy, c) DM patients with non-proliferative diabetic retinopathy. All patients underwent a complete ophthalmological examination that included high and low contrast visual acuity with 1.25%, 2.5% and 5% contrast chart and Pelli–Robson type contrast sensitivity test. We observed no statistically significant differences regarding age, intraocular pressure, duration of diabetes or high contrast visual acuity. The eyes of patients with non-proliferative diabetic retinopathy had worse contrast sensitivity (p = 0.03, in both cases) and low contrast visual acuity at 1.5% (p = 0.03 and p = 0.01), 2.5% (p = 0.01, in both cases) and 5% (p = 0.02 and p = 0.04) than patients free of disease or without diabetic retinopathy. Analysis of contrast sensitivity and low contrast visual acuity could be considered as markers of visual function impairment in the eyes of patients with non-proliferative diabetic retinopathy.

The sequencing of production issue is one of the most complex problems that arise in the automotive industry when producing various assembly line products. The objective of this article is to propose a production sequencing model for automotive components. The aim is to define the process variables that affect the number of units produced, the time of unit completion (from entering the first station until exiting the assembly lines), and the utilization rate of the workstations. Currently, computer simulation is one of the most used tools to analyze, design, and evaluate complex production processes. It is able to make decisions about the real system without affecting it. The experimental design in this research was paramount when generating the combinations of the inputs and how they affect the response variables. For this study, multivariable predictive regression models were used in order to verify the hypotheses described below and to identify which variables' main effects and interactions positively or negatively impact the assembly process.

Recently developed distributed acoustic sensing (DAS) technologies convert fiber-optic cables into large arrays of subsurface sensors, enabling a variety of applications including earthquake detection and environmental characterization. However, DAS systems produce voluminous datasets sampled at high spatial-temporal resolution and consequently, discovering useful geophysical knowledge within these large-scale data becomes a nearly impossible task for geophysicists. It is appealing to use supercomputers for DAS data analysis, as modern supercomputers are capable of performing over a hundred quadrillion FLOPS operations and have access to exabytes of storage space. Unfortunately, the majority of geophysical data processing libraries are not geared towards these supercomputer environments. This paper introduces a parallel DAS Data Storage and Analysis (DASSA) framework to enable easy-to-use and parallel DAS data analysis on modern supercomputers. DASSA uses a hybrid (i.e., MPI and OpenMP) data analysis execution engine that supports a user-defined function (UDF) interface for various operations and automatically parallelizes them for supercomputer execution. DASSA also provides novel data storage and access strategies, such as communication-avoiding parallel I/O, to reduce the cost of retrieving large DAS data for analysis. Compared with existing data analysis pipelines used by the geophysical community, DASSA is 16× faster and can efficiently scale up to 1456 computing nodes with 11648 CPU cores.

Background In recent years anti-TNF therapy has been associated with leishmaniasis in immunocompromised patients from endemic areas. Nevertheless, data on asymptomatic Leishmania infection in such patients is scarce. The aim of this study was to determine the prevalence of asymptomatic infection in inflammatory bowel disease (IBD) patients treated with TNF inhibitors living in an endemic area (Catalonia) and to follow up them to study how the infection evolved. Methods 192 IBD patients (143 Crohn's disease; 49 ulcerative colitis) from Catalonia (Spain), an area endemic for L. infantum, were recruited. Peripheral blood samples were collected and tested for anti-Leishmania antibodies by Western blotting (WB). Leishmania kinetoplast DNA was detected in peripheral blood mononuclear cells (PBMC) by a quantitative PCR. Results Serology was positive in 3.1% and Leishmania DNA was found in 8.8%, with a low parasitic load and humoral response. The prevalence was 10.9%, patients being considered infected if they tested positive by at least one of the techniques. Eight out of the 21 patients with asymptomatic leishmaniasis were monitored for 3–8 months after the first test. None of them showed an increased parasitemia or humoral response, or developed leishmaniasis during the follow-up period. Conclusion The prevalence of Leishmania asymptomatic infection detected in our IBD cohort is similar to that found in healthy population in close endemic areas. Due to the short monitoring period, it is not possible to reach a conclusion about the risk of Leishmania reactivation from this study., Biological sciences; Health sciences; Immunology; Infectious disease; Parasitology; Leishmania; IBD; Anti-TNF.

There is interest in the use of dried blood spots (DBS) to monitor lead (Pb) exposure yet concerns raised about the methods used have yet to be rigorously researched. Here, a systematic review and narrative synthesis of the literature was performed to increase understanding of the current state of methods, their performance against QC benchmarks, and common areas of concern across studies. Through keyword searches in databases (years 1972–2021), 208 articles were found of which 36 were deemed eligible. The included studies hailed from 11 countries, and most used Whatman 903 (31%) or Schleicher and Schuell (33%) filter cards . The studies included a range of DBS subsample sizes with 1/4″ (24%) and 3/16″ (15%) being most common. Most earlier studies used GF-AAS (39%), and since the 2000 s there has been a shift towards ICP-MS (33.3%) and more recently XRF. The mean limit of detection across studies using GF-AAS was 1.0 µg/dL versus 0.6 µg/dL for ICPMS. In synthesizing the results, more research is needed on the limit of detections achieved by the various methods, potential differences in Pb concentrations between capillary and venous blood, the influence of the hematocrit effect, and the potential contamination of samples with Pb.

Bronchogenic cysts are congenital malformations of the tracheobronchial tree that are mainly located in the mediastinum or the pulmonary parenchyma. They often occur in early childhood, compressing the airway or the esophagus or by superinfection. Bronchogenic cysts located in the tracheal wall are relatively rare. They present with recurrent episodes of cyanosis, stridor and progressive respiratory distress. The diagnosis is suspected by clinical observation and endoscopic and radiologic evaluation and confirmed by anatomopathological findings. The treatment of choice is the surgical resection of the lesion. We here report the case of a newborn presenting with cyanosis and stridor due to an intramural tracheal bronchogenic cyst that was successfully treated by tracheal resection with end-to-end anastomosis. We highlight the importance of considering this rare entity in the differential diagnosis of cyanotic spells in this age group.

Pyriform sinus fistulas are rare anomalies of the branchial arches. Most of them are located on the left side. They extend from the apex of the pyriform sinus of the hypopharynx to the thyroid gland or adjacent tissues. The diagnosis is suspected in the presence of acute suppurative thyroiditis or recurrent cervical abscesses, and is confirmed by endoscopic visualization of the fistula hole. The traditional treatment consists of excision of the fistulous tract, with or without thyroid lobectomy, by cervical approach. However, less invasive alternatives that obliterate the path of the fistula have been developed, such as endoscopic electrocautery. We describe our experience with 7 patients with this condition, who were treated with endoscopic cauterization using radiofrequency electrocautery, and we evaluate the effectiveness and safety of the treatment performed.

Pyriform sinus fistulas are rare anomalies of the branchial arches. Most of them are located on the left side. They extend from the apex of the pyriform sinus of the hypopharynx to the thyroid gland or adjacent tissues. The diagnosis is suspected in the presence of acute suppurative thyroiditis or recurrent cervical abscesses, and is confirmed by endoscopic visualisation of the fistula hole. The traditional treatment consists of excision of the fistulous tract, with or without thyroid lobectomy, by cervical approach. However, less invasive alternatives that obliterate the path of the fistula have been developed, such as endoscopic electrocautery. We describe our experience with 7 patients with this condition, who were treated with endoscopic cauterization using radiofrequency electrocautery, and we evaluate the effectiveness and safety of the treatment performed.

Pyriform sinus fistulas are rare anomalies of the branchial arches. The most common form of presentation in children and adolescents is acute suppurative thyroiditis and/or recurrent lateral cervical abscesses. However, fistulas can manifest atypically. The rarity of this pathology and the atypical clinical presentation can delay the diagnosis increasing the risk of recurrent infections and complications. We present the unusual case of a 13-year-old teenager with retropharyngeal abscess due to a congenital pyriform sinus fistula successfully treated by endoscopic electrocautery.

Acquired tracheal stenosis is a very infrequent lesion in the pediatric age group and may be due to diverse causes, being post-intubation stenosis and stenosis secondary to tracheostomy the most common ones. The management of acquired tracheal stenosis remains controversial. Endoscopic treatment provides immediate relief of symptoms but it is associated with a high recurrence rate, and the use of endoluminal prostheses can increase the length of the stricture complicating future surgery. Conversely, good long-term results have been documented with tracheal resection and primary anastomosis. We describe our experience with tracheal resection followed by end-to-end anastomosis for the treatment of post-intubation tracheal stenosis in 8 patients.

Pulmonary aspiration is the passage of food, gastroesophageal reflux and/or saliva to the airway in a manner sufficient to cause chronic or recurrent respiratory symptoms. It is an important cause of recurrent pneumonia, progressive lung disease, bronchiectasis and even death. Aspiration is intermittent and often occurs in children with underlying medical conditions or syndromes that cause respiratory symptoms similar to chronic pulmonary aspiration, so diagnosis of aspiration is often delayed until there is a significant lung injury. The available diagnostic methods and their limitations, and treatment options of chronic pulmonary aspiration in the pediatric population are described.

Congenital tracheoesophageal fistula not associated with esophageal atresia, known as H-type fistula, is an uncommon anomaly. It presents with cough, choking, and cyanosis during feeding and/or recurrent pneumonia. Although symptoms are usually present from birth, diagnosis is difficult. The rarity of this disease, non-specific symptoms, and the limitations of radiological and endoscopic confirmation of the fistula often result in a delay between presentation and diagnosis confirmation. Here we describe the clinical manifestations, assessment methods, and management of 3 newborn infants with H-type tracheoesophageal fistula, together with diagnosis recommendations to prevent unnecessary delays in the management of this condition.La fístula traqueoesofágica congénita sin atresia esofágica asociada, conocida como tipo H, es una anomalía infrecuente. Se manifiesta con episodios de tos, ahogo y cianosis durante la alimentación y/o neumonía recurrente. Si bien los síntomas están usualmente presentes desde el nacimiento, el diagnóstico es difícil. La rareza de esta patología, los síntomas no específicos y las limitaciones en la demostración radiológica y endoscópica de la fístula contribuyen, a menudo, a la demora entre la presentación y la confirmación del diagnóstico. Se describen las manifestaciones clínicas, los métodos de evaluación y el tratamiento de 3 neonatos con esta patología, y se presentan recomendaciones para el diagnóstico a fin de evitar demoras innecesarias en el manejo de las fístulas en H.

Carbon-fibre reinforced polymers (CFRPs) present outstanding mechanical performance per unit of mass; however, they also fail in a brittle manner, with little or no warning of their forthcoming catastrophic failure. In this study, a ‘brick-and-mortar’ design inspired by the structure of nacre was implemented by automated tape lay-up for the first time with the aim of changing the failure response of CFRPs. Standard procedures and materials already implemented in the aerospace industry have been used to produce bio-inspired CFRPs laminates, providing the first example of bio-inspired concepts scaled-up to industrial level. The effects of the proposed automated manufacturing process on the morphology and tensile properties of the laminates were investigated. A non-linear response was observed when the bio-inspired laminates were subjected to tensile forces. This type of response agrees with those of previous studies on lab-scale manufactured aligned discontinuous CFRPs.

The purpose of this study was to evaluate and to compare the fracture load and the fracture pattern of monolithic and veneered zirconia posterior fixed dental prostheses (FDPs). Twenty standardized steel dies were prepared to receive posterior 3-unit FDPs. Specimens were randomly divided into 2 groups (n=10): (1) Lava Zirconia, and (2) Lava Plus. All FDPs were cemented using glass ionomer cement and subjected to thermal and mechanical cycling at 5-55ºC with a 30-s dwell time for 120,000 masticatory cycles. All specimens were subjected to a three-point bending test until fracture. Data were statistically analyzed using Student's t test, paired t-test and Weibull statistics (α=0.05). No differences were observed in fracture load between the groups. Veneering ceramic fractured before than framework in veneered zirconia group. The fracture pattern was different. The tested groups demonstrated clinically acceptable fracture load values. Monolithic zirconia solves the chipping problem.

Se realizo un estudio experimental en 30 perros con dermatopatias generalizadas en el consultorio veterinario Bocca de Cannes en la ciudad de Guayaquil. El objetivo fue evaluar la rapidez de la ozonoterapia en la remision de las dermatopatias generalizadas asi como tambien caracterizar las dermatopatias en funcion de la causa y severidad en perros. Se evaluo la eficacia de dicho tratamiento segun tres esquemas de ozonoterapia para asi relacionar con las variables independientes edad, sexo, raza y tipo de lesion. El tiempo promedio para evaluar la remision es a los 21 dias. Se pudo determinar que con la ozonoterapia se logro aumentar la velocidad de remision de las lesiones, reduciendo el numero de dias de curacion. Por los resultados de esta experiencia nos permitimos recomendar el uso de ozonoterapia para dermatopatias generalizadas en perros, sean estas superficiales o profundas. An experimental study was performed on 30 dogs with generalized dermatopathies at the Bocca Veterinary Clinic of Cannes in the city of Guayaquil. This paper focuses on evaluating the rapidity of ozone therapy in the remission of generalized dermatopathies. The dermatopathies which is based on the function of the cause and severity in dogs was characterized. It was used to evaluate the effectiveness according to three ozone therapy schemes that are related to the independent variables: age, sex, race and type of injury. The average time to evaluate remission is 21 days. Hence, we were able to establish the fact that with the ozone therapy, the rate of remission of the lesions increases, thereby reducing the number of days of healing. From the results of this study, we hereby recommend the use of ozone therapy for generalized dermatopathies in dogs, whether superficial or deep.

Recurrent respiratory papillomatosis is an infrequent benign neoplasm that commonly affects the upper airway with a predilection for the larynx. Isolated tracheobronchial involvement is very rare. Diagnosis and treatment of this disease is a challenge due to its non-specific clinical manifestation and its recurrent nature. We present a 6-year-old male with a diagnosis of asthma refractory to treatment, without history or evidence of laryngeal papillomatosis. The endoscopic examination revealed extensive tracheobronchial papillomatosis and the computed tomography, pulmonary involvement. He received adjuvant therapy with intravenous Bevacizumab with very good response. We alert pediatricians to consider this rare tracheobronchial neoplasm in all children with atypical asthma symptoms or in those who do not improve with conventional medical treatment.

Juvenile laryngeal papillomatosis is an uncommon disease caused by human papilloma virus, mainly types 6 and 11. It is the most common benign laryngeal tumor in children. This condition should be suspected in any children with persistent and progressive dysphonia with or without stridor and respiratory distress. Flexible laryngoscopy under local anesthesia allows to visualize the typical wart-like lesions. The diagnosis is confirmed by pathological anatomy. Existing treatment is palliative and consists mainly of the surgical excision of the papillomas to maintain the airway without obstruction and to improve the quality of the voice, but it has a high rate of relapse. We present 20 patients with juvenile laryngeal papillomatosis. We describe the clinical manifestations, the diagnostic methods and the treatment of this pathology.

Purpose To evaluate the fracture load of 3-unit zirconia-based posterior fixed dental prostheses (FDPs) before and after veneering the frameworks. Materials and Methods Forty standardized stainless-steel master dies were fabricated (height: 5 mm, convergence: 6o, chamfer: 1 mm) and randomly screwed in pairs onto metal bases. The bases were randomly divided into two groups (n = 20 each) according to the zirconia CAD/CAM system used for constructing 3-unit structures for FDPs: group 1 (L): Lava All-ceramic, group 2 (Z): IPS e.max ZirCAD. Half of the zirconia structures per group were randomly selected and veneered, while the remaining half was left unveneered. The specimens were luted in standard fashion onto the stainless steel master dies using conventional glass ionomer cement. All specimens were tested for fracture load (FL). Specimens were subjected to a three-point bending test until fracture by applying an axial compressive load at the central fossa of the pontics with a universal testing machine at a 0.5 mm/min crosshead speed. Wilcoxon's rank-sum test and Weibull statistics were used for statistical analysis (α = 0.05). Results L structures recorded significantly higher values of load to fracture than the Z group both before and after veneering. Within each ceramic group, no differences were found between unveneered and veneered frameworks. Conclusions Although further studies are necessary to corroborate these findings, both zirconia systems could be recommended for restoring posterior teeth on the basis of the fracture load values recorded in this experiment (>1000 N). The veneering procedure did not affect the overall load to fracture in any group.

Laryngeal tumors are uncommon in children, accounting only for 2% of the laryngeal anomalies. Ninety-eight percent are benign; the most frequent ones are recurrent respiratory papillomatosis and haemangioma. Granular cell tumor, also called Abrikossoff tumor, is an unusual benign neoplasm, especially in the larynx. Clinical manifestations depend on the size and location of the tumor. Dysphonia is the main presenting symptom. The diagnosis is confirmed by the biopsy. The treatment of choice is surgery. We present a 9-year-old girl with dysphonia and exertion dyspnea due to a granular cell tumor of the larynx, and we emphasize the importance of considering the endoscopic evaluation of the airway in every child with progressive or persistent dysphonia in order to determine the etiology.

Bronchial obstruction is infrequent in the child. The main cause is malacia or benign stenosis. Management alternatives range from conservative treatment to complex surgical and/or endoscopic techniques. Placement of a stent can play a key role in situations where there is no other therapeutic option. However, the ideal stent is not yet available. In the last few years, progress has been made in the development and characterization of novel biodegradable materials in order to overcome the drawbacks of traditional stents made of silicone or metal. We present our experience with a new type of biodegradable airway stent in the treatment of severe bronchomalacia in a 2-year-old child; we evaluate safety and clinical effectiveness. We describe the indications and potential complications of pediatric endoprosthesis in the airway.

Bronchial tumors are rare in children. Most of them are malignant, being the carcinoid tumor the most common. Less frequently the mucoepidermoid carcinoma is found in the tracheobronchial tree. Mucoepidermoid carcinoma accounts for 0.1 to 0.2% of all malignant bronchopulmonary tumors. It manifests with symptoms of airway obstruction and/or recurrent pneumonias. Early diagnosis and appropriate treatment are of great importance in the prognosis. Bronchoscopy with biopsy of the endobronchial mass is the method of choice to confirm the diagnosis. Treatment consists of surgical resection of the lesion. We present an 11-year-old girl with dyspnea on exertion and cough due to a low malignant mucoepidermoid arcinoma of the ronchi. We describe the clinical manifestations, the diagnostic methods and the treatment of this rare neoplasia in pediatrics.

Wegener's granulomatosis is a necrotizing granulomatous vasculitis of autoimmune origin that primarily affects the upper and lower airways and kidneys. It is very rare in children and adolescents. When started at a young age it is often associated with subglottic stenosis. Subglottic stenosis is a potentially fatal manifestation of Wegener's granulomatosis. Its diagnosis requires a high index of suspicion since it might develop in the absence of other signs of activity. Occasionally, subglottic stenosis may present as the initial manifestation of the disease. Diagnosis is confirmed by endoscopic visualization of the lesion. The treatment is complex, and it often requires repeated interventions due to restenosis. We present a 13-year-old patient with subglottic stenosis secondary to Wegener's granulomatosis. We describe the clinical manifestations, diagnosis and treatment of this rare cause of respiratory distress in the pediatric population.

Foreign bodies in esophagus are avoidable accidents that occur most often in children younger than 3 years. The most common presenting symptoms are dysphagia, drooling and vomiting. Occasionally a foreign body in the esophagus may present with respiratory symptoms such as cough, stridor and respiratory distress. This is more common in young children and when the object remains lodged in the esophagus for a prolonged period. Clinical suspicion is essential for early diagnosis, which allows to avoid potential complications. We describe 3 children with a foreign body impacted in the esophagus who presented mainly respiratory symptoms. We alert pediatricians on symptomatic variation in the presentation of a foreign body ingestion and we underline the importance of early diagnosis and treatment.

This study compares the performance of the soluble fms-like tyrosine kinase 1 to placental growth factor (sFlt-1/PlGF) ratio and the cardiac biomarker N-terminal pro-B type natriuretic peptide (NT-proBNP) in the prediction of adverse outcomes in women with suspicion of PE.A retrospective cohort study was conducted on women admitted at triage with signs and/or symptoms of PE (n=340). Serum levels of sFlt-1, PlGF and NT-proBNP were determined by an electrochemiluminescence immunoassay (Roche Diagnostics). The main outcomes were early- or late-onset PE and development of adverse outcome, defined as delivery within the first week since clinical presentation or fetal/early neonatal death.NT-proBNP concentrations (ng/L) were significantly increased in PE versus non-PE women, both at34 (169 versus 34) and ≥34weeks of gestation (101 versus 49) (p0.001). A cut-point of 70 showed sensitivities/specificities of 78/74% for early-, and 70/62% for late-onset PE; slightly lower than those offered by the sFlt-1/PlGF ratio or uric acid. The respective cut-points of 178 and 219 for sFlt-1/PlGF ratio and NT-proBNP, demonstrated similar performance in the prediction of adverse outcome, with sensitivity/specificity of 95/84% and 94/76%, respectively.NT-proBNP and sFlt-1/PlGF ratio can be used to predict the development of an adverse outcome.

As managers almost exclusive in many worldwide forestry regions, non-industrial private forest (NIPF) owners come to play a key role in balanced integrating the variety of forest uses and functions in policies for promoting and revitalising rural areas. In Galicia, a region in the Spanish Northwest, over 67.5% of forestland and 80% of woodland is managed by NIPF owners. Almost 40% of the Galician NIPF owners are agricultural or livestock farmers who manage a total of 169,755 agrarian holdings with woodlands. Although the number of agricultural holdings has dropped significantly over the last 60 years, farmers still constitute a representative section of the NIPF owner population in Galicia. Starting from an initial population of 31,285 active full-time professional farmers in the region, and based on data collected by a personal questionnaire from a sample comprising 4,383 of these professional farmers for the period 1993–2003, Discriminant Analysis (DA) was used to identify which socioeconomic, territorial and public-political factors were useful in distinguishing, and to what extent, that a certain population of Galician active farmers should opt to own and manage forestland areas within their agrarian holdings. The results suggested that the forestry production capacity for the area in which the agricultural holding is located, the size and the number of plots in the land base, the number of years the farmer has been the owner and the economic yield from the holding over the total family income were key factors in distinguishing between farmers with forestry activity (forestland owners) and farmers with no forestry activity (farmland owners). These findings could be used as a guide for designing, planning, and implementing research and policy measures that could allow NIPF landowners with farming and livestock activity to develop sustainable forestry, as key agents in promoting rural development.

Vogt–Koyanagi–Harada syndrome is an autoimmune multisystem disease, characterized by the association of ocular inflammatory manifestations (uveitis and retinal detachment) and extraocular lesions such as meningismus and tegumentary or auditory findings. We report the case of a Hispanic woman with this syndrome.

Resumen El sindrome de Vogt Koyanagi Harada corresponde a una enfermedad autoinmune multisistemica que se caracteriza por la asociacion de manifestaciones inflamatorias oculares (uveitis, desprendimiento de retina) y lesiones extraoculares como meningismo, afectacion dermica y afectacion del VIII par craneal. Presentamos el caso de una mujer hispana con este sindrome.

OBJECTIVE. This study was a retrospective chart analysis spanning 5 yr that investigated associations between occupational therapy interventions and goal-based positive outcomes in patients with multiple sclerosis (MS) and related disorders at discharge in an urban inpatient rehabilitation setting. METHOD. Using descriptive statistics, we examined demographic characteristics in the first analysis phase. In the second phase, we performed a series of correlational analyses to identify treatment variables associated with positive outcomes. RESULTS. Generally, patients improved in their FIM™ scores at discharge. Increasing occupational therapy intensity had a positive effect on functional performance in all categories except feeding, with significant correlations in upper-extremity dressing (r = .153, p < .05) and memory (r = .204, p < .01). CONCLUSION. Occupational therapy was associated with positive functional outcomes for patients with MS. Future treatment protocols should include cognitive skills training, community reintegration, and self-care, because these treatments were found to be significantly correlated with positive changes in FIM scores.

Resumen Introduccion La enfermedad de Meniere se caracteriza por vertigo, hipoacusia y acufeno. Existen diversos estudios sobre la evolucion del vertigo y la audicion pero son escasos los referidos al comportamiento del acufeno, siendo este el objetivo de nuestro estudio. Metodos Se realiza, en un hospital terciario, un estudio descriptivo transversal sobre el comportamiento del acufeno en 88 pacientes con enfermedad de Meniere que se encontraban en distinta fase de la enfermedad. Analizamos las caracteristicas del mismo: la intensidad con una escala analogico-visual, la tonalidad subjetiva con referencias tonales, la repercusion sobre su calidad de vida con un cuestionario de autoevaluacion, y el nivel de incapacitacion con el test Tinnitus Handicap Inventory. Se valoran tambien factores epidemiologicos, antecedentes personales, umbral de audicion y evolucion de las crisis vertiginosas en los ultimos 6 meses. Resultados El promedio de anos de evolucion de la enfermedad fue 15,4 anos. Se evidencio un acufeno de intensidad moderada (5/10), con una leve repercusion en la calidad de vida y de frecuencia predominantemente grave (46%). Se observo un empeoramiento en la calidad de vida en relacion a la afectacion auditiva y/o estadio de la enfermedad. Factores de mal pronostico fueron la tonalidad aguda, antecedentes de depresion y la corta edad. No encontramos relacion con los anos de evolucion de la enfermedad, ni con las crisis de vertigo. Conclusion En muestras grandes, y con largo tiempo de evolucion, el acufeno no es considerado por los pacientes con enfermedad de Meniere como un problema que repercuta de forma importante en su calidad de vida.

Resumen Introduccion La mastoiditis aguda es una complicacion infecciosa otitica que plantea una problematica especifica en el caso de pacientes implantados. Objetivo Revisar los casos de mastoiditis aguda en el programa de implantes cocleares para valorar su incidencia y los problemas asociados. Materiales y metodos Se realizo un estudio retrospectivo en 248 ninos implantados con edades entre los 8 meses y 14 anos desde 1994 hasta 2009 en nuestro programa de implantes cocleares. Se analizan los datos demograficos, clinicos y su tratamiento. Resultados Cinco pacientes desarrollaron mastoiditis aguda (incidencia de 2,01%), 3 de ellos con absceso subperiostico (incidencia de 1,21%), La edad media de implantacion de estos ninos fue de 2 anos y 4 meses, y la complicacion se presento entre 1 – 33 meses postimplante (media 11,6 meses). Cuatro pacientes habian presentado episodios de otitis media secretora previos al implante. La edad media de presentacion de la mastoiditis fue de 3 anos y 4 meses. Todos eran portadores de implante coclear tipo Nucleus, que es el implante mas frecuentemente utilizado en ninos, en nuestro programa. Conclusiones Tendemos a ser mas conservadores en el manejo de la mastoiditis aguda y del absceso subperiostico en la poblacion infantil con implante coclear. Consideramos que se debe prescindir del tratamiento quirurgico mientras sea posible, para evitar la contaminacion del implante, extremando el tratamiento intravenoso y utilizando el drenaje simple mediante puncion, ya que este procedimiento ha mostrado buenos resultados. En el caso de drenaje quirurgico, debe realizarse un estudio radiologico para delimitar la situacion de los electrodos.

Introduction Meniere's disease is characterised by vertigo, hearing loss and tinnitus. Various studies assess the problem of vertigo and audition deficit in Meniere's disease, but only a few of these relate to the clinical characteristics of tinnitus, the aim of this study. Material and methods A transversal descriptive study of the behaviour of tinnitus in 88 patients in different stages of Meniere's disease treated in a tertiary hospital was carried out. The different characteristics of disease were analysed: intensity was evaluated with an analoguevisual scale, subjective tonality through tonal shade references, the impact on the patient's quality of life was tested by a self-appraisal questionnaire, and competence level was evaluated with the Tinnitus Handicap Inventory. Epidemiologic factors, personal records, hearing thresholds and evolution in the number of vertiginous crises in the previous six months were also taken into account. Results The average time of evolution of the disease was 15.4 years. The results evidence the development of tinnitus of moderate intensity (5/10) and low frequency (46%), with a slight impact on quality of life. Worsening in the quality of life related to hearing affectation and/or advanced stages of the disease was also observed. We identified high frequency tonality, a medical record of depression and youth as unfavourable prognostic factors. There was no relationship found with the years of evolution of the disease or with the number of vertigo crises. Conclusion In large samples of long evolution Meniere's disease, patients do not perceive tinnitus as a problem that produces serious impairment in their quality of life.

Introduction Acute mastoiditis (AM) is a paediatric infectious complication that raises a specific problem in case of implanted patients. Objective To review the cases of AM in a paediatric cochlear implant (CI) programme to study its incidence and associated problems. Materials and methods A retrospective study was conducted on 248 children aged between 8 months and 14 years who underwent CI from 1994 to 2009. The demographics, clinical data and their treatment were analyzed. Results Five patients developed acute mastoiditis (2.01%), three of them with subperiosteal abscess (1.21%). The mean age of implantation was 2 years and 4 months, and the complication presented between 1 and 33 months post-implantation (mean, 11.6 months). Four patients had episodes of serous otitis preimplantation. The mean age of AM patients was of 3 years and 4 months. The CI type was nucleus in all cases. Conclusions Conservative management is suggested for AM and subperiosteal abscess in children with cochlear implants. Surgical treatment should be avoided to prevent CI contamination. The first option is intravenous antibiotics and simple puncture of the abscess. If surgical drainage is needed, radiological study should be performed to locate the CI electrodes.

Explaining and predicting nonindustrial private forest (NIPF) owner land management based on social, economic, and environmental factors is an increasingly important issue in policy arenas and academic research on rural development and planning. This study empirically explores and assesses management behavior by NIPF owners by analyzing attributes of landowner profile (age, educational level, primary occupation, engagement in farming, membership of professional groups, training in forestry, availability of market information, and specific knowledge and use of production criteria for timber harvesting). With the aim of predicting outcomes, a multiple regression model was constructed to investigate and quantify the probabilities of and factors influencing the participation of owners in agricultural and forestry associations. In March 2004, 103 resident forest landowners were interviewed about their commitment to and involvement in land management during 1999–2003 in Marina Oriental, a forest region of Galicia, Northern Spain. Results suggest that professional occupation, particularly farming background, is the main factor affecting, either directly or indirectly, the forest management behavior of NIPF owners in the area. In particular, our logistic regression model for landowner membership of professional groups explained 77.9% of the variability observed in the study population, which suggests that the agricultural background of NIPF owners and their expectations from forests, represented by their future intention to enlarge the forestland base, play an important role in membership. In the region, forestry could be a valuable economic activity but it is not considered as such today. Findings could be used as a guide for design, planning, and implementation of research and policy measures that allow NIPF landowners to promote sustainable forestry for rural development.

Mexican traditional medicine uses Solanum chrysotrichum to treat fungi-associated dermal and mucosal illness; its methanolic extract is active against dermatophytes and yeasts. Different spirostanic saponins (SC-2-SC-6) were identified as the active molecules; SC-2 was the most active in demonstrating a fungicidal effect against Candida albicans and non-albicans strains. The aim of the present study was to compare the clinical (elimination of signs and symptoms) and mycological effectiveness (negative mycological studies) of an S. chrysotrichum herbal medicinal product (Sc-hmp), standardized in 1.89 mg of SC-2, against ketoconazole (400 mg) in the topical treatment of cervical and/or vaginal infection by Candida. Both treatments (vaginal suppositories) were administered daily during 7 continuous nights. The study included 101 women (49 in the experimental group) with a confirmed clinical condition and positive mycological studies (direct examination and/or culture) of Candida infection. Basal conditions did not show differences between the groups; a moderate clinical picture was present in 62% of the cases, direct examination was positive in 69%, and the culture was positive with C. albicans predominating (65%). At the end of the administration period, both treatments demonstrated 100% tolerability, and clinical cure in 57.14% of S. chrysotrichum-treated cases and in 72.5% of ketoconazole-treated cases (p = 0.16), as well as 62.8% and 97.5% of mycological effectiveness, respectively (p = 0.0 001). We conclude that, at the doses used, Sc-hmp exhibits the same clinical effectiveness as ketoconazole, but with lower percentages of mycological eradication. Additional clinical studies with Sc-hmp are necessary, with increasing doses of SC-2, for improving the clinical and mycological effectiveness.

Public field-afforestation schemes have been designed and widely implemented as a measure to alleviate uneven distribution, generate economic growth in rural areas and maintain or improve natural resources. The literature on forest management and planning has improved land-related information systems, allowing policy-makers to design and implement future policies on the allocation of forestland uses, and to forecast the land requirements of the target population more closely. The aim of this article is to empirically examine and validate the temporal and spatial land use changes and the socioeconomic effects linked to field-afforestation on private lands in the province of Lugo (Galicia, Northern Spain) at the municipal, parish and individual farm holding levels. Two main top-down field-afforestation programmes are reviewed in the study area: the national programme of public afforestations started with the implementation of Ley de Patrimonio Forestal del Estado (National Forest Estate Act; NFE) from 1941 to 2000, and the European aid scheme for forestry measures established under European Council Regulation No. 2080/1992 from 1993 to 1997. The results of a survey, targeted at 1355 farmers and conducted through questionnaires in the province of Lugo in 2004, complete the analysis of public intervention in forest management. The results indicate that the specific social, economic and environmental context of an agricultural and forestry area involves a differential heritage of land customs that determines a differential response model to forest programmes of land allocation and planning. Therefore, this must not be underestimated by the quantitative or qualitative general objectives of large-scale policies.

Objective. The purpose of this study was to understand through a quantitative assessment, the views of HPV and HPV vaccination among parents of sons from a FQHC in PR. Methods. A self-administered questionnaire was given to a convenience sample of 200 parents of sons 9–17 years old. Results. Nearly 30% of the parents reported that their sons had initiated the HPV vaccine regimen. Health care provider recommendation was significantly associated with vaccine initiation. Among parents of unvaccinated sons, the main reason for not getting the HPV vaccine was they did not know that boys were allowed to get the vaccine. Conclusions. Future efforts should focus on multilevel interventions aimed to increase knowledge as well as other modified behavioral determinants in parents of young males about HPV and the vaccine. Capacity building efforts should be targeted also to increase health providers’ education and communication skills to promote HPV vaccination effectively.

There are some nail abnormalities described in systemic lupus erythematosus (SLE).The aim of this study was to evaluate the association between nail dystrophy (ND) and disease activity, accrued organ damage, capillaroscopic abnormalities, autoantibodies, and some markers of endothelial cell activation in patients with SLE.This was a cross-sectional study of SLE patients from a rheumatology clinic in a tertiary care hospital. Patients were allocated in groups, according to the presence or absence of ND. Demographics, clinical data, disease activity, accrued damage, serology, nailfold capillaroscopy characteristics, serum levels of anti-endothelial cell antibodies, and plasma levels of endothelin 1 were compared between groups. Disease activity was assessed by the Systemic Lupus Erythematosus Disease Activity Index 2000 index and accrued organ damage by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index.Sixty-one patients were included; 50 patients (82%) were female. Thirty-two patients (52.5%) showed ND, and 29 did not. Besides a more frequent use of cyclophosphamide (46.9% vs 20.7%; P = 0.03) in the ND group, clinical features were similar. A greater organ damage was found in patients with ND (median Systemic Lupus International Collaborating Clinics/American College of Rheumatology index = 0.5, minimum = 0, maximum = 6) than in patients without ND (0, 0, 3, respectively; P = 0.04); specifically, only the skin domain was associated with ND (P = 0.04). Onycholysis (40.6%) and longitudinal ridging (25%) were the most frequent nail changes. Nailfold capillaroscopy changes were more frequent in ND patients (40.6%) than in control subjects (13.8%) (P = 0.02). The most frequent nailfold capillaroscopy findings in the ND group were enlarged capillaries (40.6%) and microhemorrhages (12.5%). There was no association between ND and the autoantibody profile, plasma endothelin 1, or serum anti-endothelial cell antibodies.Nail dystrophy was associated with higher accrued organ damage and the presence of capillaroscopic abnormalities. This suggests that ND might be related to chronic microvascular damage.

Background Microbiological culture of cerebrospinal fluid is the gold standard to differentiate between aseptic and bacterial meningitis, but this method has low sensitivity. A fast and reliable new marker would be of interest in clinical practice. Objective Interleukin-6, secreted by T cells in response to meningeal pathogens and quickly delivered into cerebrospinal fluid, was evaluated as a marker of acute meningitis. Design and Methods A total of 150 cerebrospinal fluid samples were analysed by an electrochemiluminescence method, selected according to patient diagnosis: (a) bacterial meningitis confirmed by positive culture ( n = 26); (b) bacterial meningitis with negative culture or not performed ( n = 15); (c) viral meningitis confirmed by polymerase chain reaction or immunoglobulin G determination ( n = 23); (d) viral meningitis with polymerase chain reaction negative or not performed ( n = 42); and (e) controls ( n = 44). Results Cerebrospinal fluid interleukin-6 concentration showed significant differences between all pathologic groups and the control group ( P Conclusion Interleukin-6 measured by electrochemiluminescence method is a promising marker for early differentiation between aseptic and bacterial meningitis. More studies are needed to validate clinical implications for future practice in an emergency laboratory.

The purpose of the present investigation was to assess the pharmacological properties of Tournefortia hartwegiana Steud (Boraginaceae), used in traditional medicine for the treatment of diabetes, diarrhea and kidney pain in Morelos, Mexico. Administration of methanol extract from aerial parts of Tournefortia hartwegiana (310 mg/kg body weight/day) for 10 days, to normoglycemic and alloxan-induced diabetic rats, significantly lowered their blood glucose levels (37 and 36%, respectively, p0.05). The anti-diabetic and hypoglycemic activities due to the MeOH extract were similar to those produced by metformin at 120 mg/kg (positive control, p0.05). In contrast, the hexane, dichloromethane and MeOH extracts from the same species showed no significant spasmolytic effect and did not have activity in antibacterial and Artemia salina toxicity bioassays.

Resumen El linfoma anaplasico de celulas grandes es una patologia rara en la infancia. La localizacion mas frecuente es en la piel y nodulos linfaticos, siendo infrecuente la afectacion del pabellon auricular. Presentamos el caso de un nino de 6 anos con tumoracion en el lobulo de la oreja. Se realizo tratamiento quirurgico y el resultado de la anatomia patologica mostro linfoma anaplasico de celulas grandes. Los estudios radiologicos fueron negativos y no hubo afectacion sistemica.

The imbalanced production of placental biomarkers and vitamin D deficiency have been proposed as risk factors for the development of preeclampsia (PE). However, little is known about the relationship between them and their role in early- versus late-onset PE. The objectives were to assess the role of 25-hydroxyvitamin D [25(OH)D] concentrations and the soluble fms-like tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF) ratio in the development of early- and late-onset PE; and to evaluate the relationship between 25(OH)D and the biomarkers.A retrospective, full-blinded cohort study was conducted at the Obstetric Emergency Service of a tertiary care hospital. Pregnant women (n=257) attending obstetric triage with suspicion of PE were included. sFlt-1, PlGF and 25(OH)D concentrations were measured by electrochemoluminescence (ECLIA) immunoassay and pregnancy outcome (development of PE) was registered from patients records.PE women showed lower 25(OH)D concentrations at clinical presentation than non-PE women (median: 35.0 nmol/L and 39.6 nmol/L, respectively; p=0.027). Women with 25(OH)D levels Low vitamin D status in women with suspected late-onset PE increases the risk of imminent development of the disease.