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22 páginas.-- 6 figuras.-- 115 referencias.-- Additional Supporting Information may be found in the online version of this article: http://dx.doi.org/10.1111/sed.12431, Subsurface granitic environments are scarce and poorly investigated. A multi‐disciplinary approach was used to characterize the abundant moonmilk deposits and associated microbial communities coating the granite walls of the 16th Century Paranhos spring water tunnel in Porto city (north‐west Portugal). It is possible that this study is the first record of moonmilk in an urban subsurface granitic environment. The morphology and texture, mineralogical composition, stable isotope composition and microbial diversity of moonmilk deposits have been studied to infer the processes of moonmilk formation. These whitish secondary mineral deposits are composed of very fine needle‐fibre calcite crystals with different morphologies and density. Calcified filaments of fungal hyphae or bacteria were distinguished by field emission scanning electron microscopy. Stable isotope analysis revealed a meteoric origin of the needle‐fibre calcite, with an important contribution of atmospheric CO2, soil respiration and urn:x-wiley:00370746:media:sed12431:sed12431-math-0001 from weathering of Ca‐bearing minerals. The DNA‐based analyses revealed the presence of micro‐organisms related to urban contamination, including Actinobacteria, mainly represented by Pseudonocardia hispaniensis, Thaumarchaeota and Ascomycota, dominated by Cladosporium. This microbial composition is consistent with groundwater pollution and contamination sources of the overlying urban area, including garages, petrol stations and wastewater pipeline leakage, showing that the Paranhos tunnel is greatly perturbed by anthropogenic activities. Whether the identified micro‐organisms are involved in the formation of the needle‐fibre calcite or not is difficult to demonstrate, but this study evidenced both abiotic and biogenic genesis for the calcite moonmilk in this subsurface granitic environment., The authors acknowledge the Spanish Ministry of Economy, Industry and Competitiveness (MINEICO, project CGL2011-2569) and the Portuguese Foundation for Science and Technology, FCT (UID/GEO/04035/2013, UID/ECI/04028/2013, PEst-OE/CTE/UI0098/2011) and the LABCARGA| ISEP re-equipment program (IPP-ISEP|PAD’2007/ 08) for financial support. AZM thanks MINEICO for the ‘Juan de la Cierva – Incorporación’ postdoctoral contract (IJCI-2014-20443). PMMS thanks the Spanish Ministry of Science and Innovation for his contract associated with the ‘Research Programme in Technologies for the Assessment and Conservation of Cultural Heritage’ (TCP CSD2007-0005

15 páginas.- 5 figuras.- 85 referencias.- The following are available online at http://www.mdpi.com/2079-6412/10/11/1134/s1 .- This article belongs to the Special Issue Biofilms on Cultural Heritage, The Galapagos Islands (Ecuador) have a unique ecosystem on Earth due to their outstanding biodiversity and geological features. This also extends to their subterranean heritage, such as volcanic caves, with plenty of secondary mineral deposits, including coralloid-type speleothems and moonmilk deposits. In this study, the bacterial communities associated with speleothems from two lava tubes of Santa Cruz Island were investigated. Field emission scanning electron microscopy (FESEM) was carried out for the morphological characterization and detection of microbial features associated with moonmilk and coralloid speleothems from Bellavista and Royal Palm Caves. Microbial cells, especially filamentous bacteria in close association with extracellular polymeric substances (EPS), were abundant in both types of speleothems. Furthermore, reticulated filaments and Actinobacteria-like cells were observed by FESEM. The analysis of 16S rDNA revealed the presence of different bacterial phylotypes, many of them associated with the carbon, nitrogen, iron and sulfur cycles, and some others with pollutants. This study gives insights into subsurface microbial diversity of the Galapagos Islands and further shows the interest of the conservation of these subterranean geoheritage sites used as show caves, This research was funded by the Ecuadorian Ministry of Environment (Project PC-65-14 National Park Galapagos), by the Spanish project MINECO CGL2016-75590-P with European Regional Development Fund and the Portuguese Foundation for Science and Technology (Fundação para a Ciência e a Tecnologia-FCT) under the project UID/Multi/04449/2019 for HERCULES/UE. AMGS was supported by a FPU fellowship of the Spanish Ministry of Education, Culture and Sport (AP2010-2052). AZM was supported by a Marie Curie Intra-European Fellowship of the European Commission’s 7th Framework Programme (PIEF-GA-2012-328689-DECAVE) and a CEECIND/01147/2017 contract from FCT. MLC was supported by a CEECIND/00349/2017 contract from FCT. FG was financially supported by the “HIPATIA” research program of the University of Almeria.

Sedation is necessary in the management of critically ill patients, both to alleviate suffering and to cure patients with diseases that require admission to the intensive care unit. Such sedation should be appropriate to the patient needs at each timepoint during clinical evolution, and neither too low (undersedation) nor too high (oversedation). Adequate sedation influences patient comfort, safety, survival, subsequent quality of life, bed rotation of critical care units and costs. Undersedation is detected and quickly corrected. In contrast, oversedation is silent and difficult to prevent in the absence of management guidelines, collective awareness and teamwork. The Zero Oversedation Project of the Sedation, Analgesia and Delirium Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units aims to offer a practical teaching and collective awareness tool for ensuring patient comfort, safety and management with a view to optimizing the clinical outcomes and minimizing the deleterious effects of excessive sedation. The tool is based on a package of measures that include monitoring pain, analgesia, agitation, sedation, delirium and neuromuscular block, keeping patients pain-free, performing dynamic sedation according to clinical objectives, agreeing upon the multidisciplinary protocol to be followed, and avoiding deep sedation where not clinically indicated.

The human flea Pulex irritans Linnaeus, 1758 (Siphonaptera: Pulicidae) is one of the most studied species together with the cat flea Ctenocephalides felis Bouché, 1835, because they have a cosmopolitan distribution and are closely related to humans. The present study aimed to carry out a comparative morphometric and molecular study of two different populations of P. irritans (Spain and Argentina). Accordingly, internal transcribed spacer (ITS)1 and ITS2 of rDNA and the partial cytochrome c oxidase subunit 1 (cox1) and cytochrome b (cytb) mtDNA genes of these taxa were sequenced. Furthermore, the taxonomy, origin, evolution and phylogeny of P. irritans was assessed. The morphometric data obtained did not show significant differences between P. irritans specimens from Spain and Argentina, even when these two populations were collected from different hosts; however, there was a considerable degree of molecular divergence between both populations based on nuclear and mitochondrial markers. Thus, it is proposed that P. irritans, in contrast with other generalist fleas, maintains a certain degree of morphological similarity, at least between Western Palearctic and Neotropical areas. Furthermore, two well defined geographical genetic lineages within the P. irritans species are indicated, suggesting the existence of two cryptic species that could be discriminated by a polymerase chain reaction-linked restriction fragment length polymorphism. Fil: Zurita, A.. Universidad de Sevilla; España Fil: Callejón, R.. Universidad de Sevilla; España Fil: García Sánchez, Ángela María. Universidad de Sevilla; España Fil: Urdapilleta, Mara. Secretaria de Gobierno de Salud. Instituto Nacional de Medicina Tropical. Instituto Nacional de Medicina Tropical - Sede Tucumán; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste; Argentina Fil: Lareschi, Marcela. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Estudios Parasitológicos y de Vectores. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Centro de Estudios Parasitológicos y de Vectores; Argentina Fil: Cutillas, C.. Universidad de Sevilla; España

Technical ceramics are being widely employed in the electric power, medical and engineering industries because of their thermal and mechanical properties, as well as their high resistance qualities. The manufacture of technical ceramic components involves complex processes, including milling and stirring of raw materials in aqueous solutions, spray drying and dry pressing. In general, the spray-dried powders exhibit an important degree of variability in their performance when subjected to dry-pressing, which affects the efficiency of the manufacturing process. Commercial additives, such as deflocculants, biocides, antifoam agents, binders, lubricants and plasticizers are thus applied to ceramic slips. Several bacterial and fungal species naturally occurring in ceramic raw materials, such as Sphingomonas, Aspergillus and Aureobasidium, are known to produce exopolysaccharides. These extracellular polymeric substances (EPS) may confer unique and potentially interesting properties on ceramic slips, including viscosity control, gelation, and flocculation. In this study, the microbial communities present in clay raw materials were identified by both culture methods and DNA-based analyses to select potential EPS producers based on the scientific literature for further assays based on the use of EPS for enhancing the performance of technical ceramics. Potential exopolysaccharide producers were identified in all samples, such as Sphingomonas sp., Pseudomonas xanthomarina, P. stutzeri, P. koreensis, Acinetobacter lwoffi, Bacillus altitudinis and Micrococcus luteus, among bacteria. Five fungi (Penicillium citrinum, Aspergillus niger, Fusarium oxysporum, Acremonium persicinum and Rhodotorula mucilaginosa) were also identified as potential EPS producers., This research was funded by Fundação para a Ciência e a Tecnologia, project EXPL/CTM-CER/0637/2012.

Trichuris trichiura is a nematode considered as the whipworm present in humans and primates. The systematics of the genus Trichuris is complex. Morphological studies of Trichuris isolated from primates and humans conclude that the species infecting these hosts is the same. Furthermore, numerous molecular studies have been carried out so far to discriminate parasite species from humans and Non-Human Primates using molecular techniques, but these studies were not performed in combination with a parallel morphological study. The hypothesised existence of more species of Trichuris in primates opens the possibility to revise the zoonotic potential and host specificity of T. trichiura and other putative new species of whipworms. In the present work, a study of Trichuris Roederer, 1761 (Nematoda:Trichuridae) parasitizing C. g. kikuyensis, P. ursinus, Macaca sylvanus, Pan troglodytes, and Sus scrofa domestica has been carried out using modern morphometric techniques in order to differentiate populations of Trichuris isolated from four species of captive NHP from different geographical regions, and swine, respectively. The results obtained revealed strong support for geometrical morphometrics as a useful tool to differentiate male Trichuris populations. Therefore, morphometrics in combination with other techniques, such as molecular biology analyses, ought to be applied to further the differentiation of male populations. On the other hand, morphometrics applied to female Trichuris species does not seem to contribute new information as all the measurements combinations of obtained from females always showed similar results., Graphical abstract Image 1, Highlights - Geometrical morphometrics is an useful tool to differentiate male Trichuris populations. - Geometrical morphometrics results are in agreement with the molecular biology analysis applied to the adult male samples that allow the identification of different species of Trichuris. - The hypothesised existence of different species of Trichuris in primates opens the possibility to revise the zoonotic potential and host specificity of T. trichiura and other putative new species of whipworms.

To know the real clinical practice of Spanish ICUs in relation to analgesia, sedation and delirium, with a view to assessing adherence to current recommendations.A descriptive cross-sectional study was carried out based on a national survey on analgesia, sedation and delirium practices in patients admitted to intensive care on 16 November, 2013 and 16 October, 2014. An on-line questionnaire was sent with the endorsement of the SEMICYUC.Spanish ICUs in public and private hospitals.A total of 166 ICUs participated, with the inclusion of 1567 patients. The results showed that 61.4% of the ICUs had a sedation protocol, and 75% regularly monitored sedation and agitation - the RASS being the most frequently used scale. Pain was monitored in about half of the ICUs, but the behavioral scales were very little used. Delirium monitoring was implemented in few ICUs. Among the patients on mechanical ventilation, midazolam remained a very commonly used agent.This survey is the first conducted in Spain on the practices of analgesia, sedation and delirium. We identified specific targets for quality improvement, particularly concerning the management of sedation and the assessment of delirium.

Vargas Vila, más allá de la hipérbole

Resumen Objetivo Los pacientes ingresados en el Servicio de Oftalmologia (OFT) estan aumentando su edad, comorbilidad y complejidad, induciendo un incremento de interconsultas a Medicina Interna (MI). Una alternativa a las interconsultas es la asistencia compartida (AC). Estudiamos el efecto de la AC con MI sobre la estancia hospitalaria de los enfermos ingresados en OFT. Metodos Estudio observacional retrospectivo de los pacientes ≥14 anos ingresados desde el 1/1/2009 al 30/06/2013 en OFT; desde mayo de 2011 con AC con MI. Analizamos edad, sexo, tipo de ingreso, si fue operado, peso administrativo asociado a GRD, numero total de diagnosticos al alta, indice de comorbilidad de Charlson (ICh), fallecimiento, reingresos y estancia hospitalaria. Resultados Entre ambos grupos, hubo diferencias estadisticamente significativas en el porcentaje de pacientes operados (odds ratio [OR] 2,3, intervalo de confianza del 95% [IC 95%]: 1,5 a 3,6), peso administrativo (0,1160; IC 95%: 0,0738 a 0,1583) y numero de diagnosticos (0,9; IC 95%: 0,5 a 1,3). Al ajustar, observamos que la AC redujo el 27,8% la estancia en OFT, 0,5 dias (IC 95%: 0,1 a 1). Conclusiones Los enfermos ingresados en OFT estan aumentando su comorbilidad y complejidad. La AC se asocia a una disminucion de la estancia y costes en OFT, similares a los observados en otros servicios quirurgicos.

Objective Patients admitted to the Department of Ophthalmology (OPH) are of increasing age, comorbidity and complexity, leading to increased consultations/referrals to Internal Medicine (IM). An alternative to consultations/referrals is co-management. The effect of co-management on length of hospital stay was studied in patients admitted to OPH. Methods Retrospective observational study was performed that included patients ≥14 years old discharged from OPH between 1 January 2009 and 30 June 2013, who were co-managed from May 2011. An analysis was made including age, sex, type of admission, whether it was operated on, administrative weight associated with GRD, total number of discharge diagnoses, Charlson comorbidity index (CCI), mortality, readmissions, and LoS. Results There were statistically significant differences between the groups in operated patients (odds ratio [OR] 2.3, 95% confidence interval [95% CI] 1.5 to 3.6), administrative weight (0.1160; 95% CI 0.0738 to 0.1583), and number of diagnoses (0.9, 95% CI 0.5 to 1.3). On adjustment, co-management reduced LoS in OPH by 27.8%, 0.5 days (95% CI 0.1 to 1). Conclusions Patients admitted to OPH have increasing comorbidity and complexity. Co-management is associated with a reduced LoS and costs in OPH, similar to that observed in other surgical services.

Objective An important but understudied activity of the departments of internal medicine (IM) is the in-hospital consultations. We analyzed the requests for in-hospital consultation with IM and the potential differences between the consultations of medical and surgical departments. Patients and methods This was an 8-month observational prospective study that analyzed demographic variables related to the origin of the interconsultation, comorbidity, length of stay and hospital mortality, emergency, admission-consultation request delay, appropriateness (not appropriate if another department was consulted for the same reason or if the pathology behind the consultation was that of the requesting service) and, for patients who underwent surgery, whether it was requested before or after the surgery. Results During the study, 215 in-hospital consultations were conducted (27 consultations/month). The mean age of the patients was 69.8 years (women, 50%). Some 30.7% were requested by medical departments and 69.3% by surgical departments. Thirteen percent of the in-hospital consultations were duplicated. The department of IM was not the appropriate department consulted in 23.3% of cases (13.0% of the cases requested consultations for the same reason with another department; in 14.3% of the cases, the pathology was that of requesting department). More in-hospital consultations were conducted on Mondays and Fridays than on Thursdays (25.1% and 23.7% versus 15.3%, respectively; p = .03). The delay between admission and the request for interconsultation was of 12.6 days. Some 90.7% of the in-hospital consultations for patients undergoing surgery were requested after the intervention. There were no differences in the characteristics of the in-hospital consultations between the medical and surgical departments. Conclusions In-hospital consultations directed at IM are frequently duplicate, are not well directed at the appropriate department and their urgency is incorrectly assessed. These characteristics are similar for the consultations with medical and surgical departments.

Resumen Objetivo Una actividad importante y poco estudiada de los servicios de medicina interna (MI) son las interconsultas. Hemos analizado las solicitudes de interconsulta a MI y posibles diferencias entre las consultas de los servicios medicos y quirurgicos. Pacientes y metodos Estudio observacional prospectivo de 8 meses de duracion. Se analizaron variables demograficas, relacionadas con la procedencia de la interconsulta, comorbilidad, estancia y mortalidad hospitalaria, urgencia, demora ingreso-solicitud, adecuacion (no adecuado si otro servicio habia sido consultado por el mismo motivo o porque la enfermedad motivo de consulta era propia del servicio solicitante) y, en los pacientes intervenidos quirurgicamente, si fue solicitada antes o despues de la intervencion. Resultados En el tiempo de estudio se recibieron 215 interconsultas (27 consultas/mes). La edad media fue de 69,8 anos (mujeres 50%). El 30,7% fueron solicitadas por servicios medicos y el 69,3% por servicios quirurgicos. Un 13% de las interconsultas estuvieron duplicadas. El servicio de MI no era el servicio consultado adecuado en el 23,3% (13,0% solicitadas por el mismo motivo a otro servicio y en el 14,3% la enfermedad era propia del servicio solicitante). Los lunes y viernes se formularon mas interconsultas que los jueves (25,1 y 23,7% versus 15,3%; respectivamente, p = 0,03). La demora entre el ingreso y la solicitud de interconsulta fue de 12,6 dias. El 90,7% de las interconsultas solicitadas a pacientes intervenidos se emitieron despues de la intervencion. No hubo diferencias en las caracteristicas de las interconsultas entre los servicios medicos y quirurgicos. Conclusiones Las interconsultas dirigidas a MI con frecuencia son duplicadas, no estan bien dirigidas al servicio adecuado y se aprecia una incorrecta valoracion de su urgencia. Estas caracteristicas son similares para las consultas de los servicios medicos y quirurgicos.

Resumen La aparicion de lesiones cutaneas es una de las principales causas de atencion en las consultas al regreso de un viaje, asi como de atencion en pacientes inmigrantes. El cambio en las condiciones medioambientales, asi como la exposicion a diferentes factores de riesgo durante el viaje (diferentes microorganismos, realizacion de actividades de aventura, etc.) condicionan en ocasiones la aparicion de dichas lesiones cutaneas. El espectro etiologico de dichas lesiones es muy amplio, por ello su estudio ha de ser protocolizado, conociendo la epidemiologia y distribucion de dichas enfermedades, asi como el reconocimiento de las lesiones dermatologicas elementales para poder hacer un adecuado diagnostico diferencial. Hay que tener especial atencion a la hora de estudiar pacientes con caracteristicas especiales por ejemplo el VIH, o pacientes con diferentes fototipos de piel, donde las lesiones cutaneas pueden presentar una morfologia diferente.

ResumenNoventa por ciento de las fístulas vesicovaginales (FVV) son producidas después de una histerectomía, con una frecuencia de uno en 1,800 casos. Nezhat et al. fue uno de los primeros en publicar el tratamiento laparoscópico de una FVV. Con respecto a los abordajes laparoscópicos de las FVV complejas, pocos son los reportes que existen en este tema.El objetivo es mostrar la técnica de O’Conor realizada vía laparoscópica, y el resultado exitoso en fístulas complejas.Se presenta paciente femenino de 35 años, con historia de histerectomía secundaria a hemorragia uterina posparto en el año 2010, en el posoperatorio mediato se le diagnosticó FVV, siendo sometida a plastia de fístula vía vaginal en marzo de 2010, con recurrencia de la misma. Nuevamente es sometida a plastia de fístula, en noviembre de 2010 con abordaje transabdominal abierto con técnica O’Conor, siendo fallida. En junio de 2011 es sometida por nuestro equipo a una plastia de FVV con abordaje laparoscópico. Tiempo quirúrgico laparoscópico: 150 minutos. Sangrado transoperatorio: 50 cc. Tiempo de estancia hospitalaria: 3 días. Tiempo de uso de sonda transuretral y cateterización ureteral bilateral: 4 semanas. Vigilancia por 13 meses, sin recidiva de la fístula.En el caso de esta paciente llamamos “FVV compleja”, a una fístula que cumple con uno de los siguientes criterios: FVV mayor de 2cm, fístula que involucra un meato ureteral, fístula secundaria a radiación, fístula rectovaginal asociada, fístula con una reparación quirúrgica fallida. La laparoscopía aplicada al tratamiento de las FVV complejas, tiene resultados similares a la cirugía abierta.AbstractNinety percent of the vesicovaginal fistulas (VVF) are produced after a hysterectomy, with a frequency of one in 1,800 cases. Nezhat et al. were one of the first to publish an article on laparoscopic treatment of a VVF.There are very few reports with respect to the laparoscopic approaches of complex VVF. The aim of this report was to demonstrate the successful result of the O’Conor technique in complex fistula treatment.A 35-year-old woman had a past history of hysterectomy secondary to postpartum uterine hemorrhage in 2010. A VVF was diagnosed in the mid postoperative period and she underwent fistula repair through the vagina in March 2010. The fistula recurred and she underwent fistula repair in November 2010 with the open transabdominal approach using the O’Conor technique. The surgery failed. In June 2011 our team operated on her, performing vesicovaginal fistula repair with the laparoscopic approach. Laparoscopic surgery duration: 150 min. Intraoperative blood loss: 50 cc. Hospital stay: 3 days. Time with transurethral catheter and bilateral ureteral catheterization: 4 weeks. The patient has been under active surveillance for 13 months and there has been no fistula recurrence.In the case of this patient, we call “complex VVF” a fistula that meets one of the following criteria: VVF larger than 2cm, fistula that involves one ureteral meatus, fistula secondary to radiation, associated rectovaginal fistula, or fistula with failed surgical repair. The laparoscopic treatment of complex vesicovaginal fistulas has similar results to those of open surgery.

ResumenIntroducciónMúltiples abordajes han sido descritos para la reparación quirúrgica de las fístulas ureterovaginales, incluyendo psoas Hitch y Boari flap. Con el continuo refinamiento de las técnicas laparoscópicas, los abordajes reconstructivos han pasado de un terreno prácticamente experimental, incluso anecdótico a la práctica habitual.ObjetivoPresentamos nuestra experiencia inicial con ureteroneocistostomía con psoas Hitch laparoscópico, en pacientes que han sido referidos con fístula ureterovaginal.Material y métodosRetrospectivamente, identificamos 5 casos de fístula ureterovaginal tratada mediante reimplante ureteral tipo Lich Gregoir y psoas Hitch en nuestra Institución, de septiembre de 2010 a julio de 2012. La indicación de la cirugía fue: presencia de fístula ureterovaginal con o sin estenosis de uréter de tercio distal.ResultadosLas 5 pacientes tuvieron fístula secundaria a histerectomía por enfermedad benigna. La edad promedio fue de 37.2 (rango 34–43) años. A 2 pacientes se les colocó nefrostomía percutánea, previo a la cirugía. A 3 pacientes se les logró colocar catéter doble J. Involucro de la fístula: uréter derecho 2 y uréter izquierdo 3. La media de la longitud de las estenosis fue de: 1.9 (rango 1.4–2.2)cm. Tiempo quirúrgico promedio fue de 174 (rango 160–180) minutos. Sangrado transoperatorio promedio 130 (rango 50–200)mL.DiscusiónEl primer reimplante ureteral laparoscópico fue realizado en 1994 por Erlich et al., en un paciente pediátrico. Reddy y Evans publicaron la primera ureteroneocistostomía en 1994, en la población adulta.ConclusionesLa ureteroneocistostomía laparoscópica es un procedimiento seguro, reproducible, que muestra las ventajas de la cirugía de mínima invasión: rápida recuperación, poca convalecencia, corta estancia hospitalaria, con resultados equiparables a la cirugía abierta.AbstractBackgroundNumerous approaches have been described for the surgical repair of ureterovaginal fistulas, including the psoas hitch and Boari flap. With the continual refinement of laparoscopic techniques, reconstructive approaches have gone from being practically experimental, to becoming common practice.AimsWe present herein our preliminary experience in ureteroneocystostomy with laparoscopic psoas hitch in referred patients presenting with ureterovaginal fistula.MethodsFive cases of ureterovaginal fistula were retrospectively identified that were treated with LichGregoir ureteral reimplantation and psoas hitch within the time frame of September 2010 to July 2012 at our institution. Indication for surgery was: ureterovaginal fistula with or without stricture in the distal third of the ureter.ResultsThe 5 patients presented with fistula secondary to hysterectomy for benign disease. Mean age was 37.2 (range: 34–43) years. Percutaneous nephrostomy was placed in 2 patients prior to surgery and double-J catheter placement was achieved in 3 patients. The fistula invol-ved the right ureter in 2 patients and the left ureter in 3. Mean stricture length was 1.9 (range: 1.4–2.2)cm, mean surgery duration was 174 (range: 160–180) min, and estimated blood loss was 130 (range: 50–200)mL.DiscussionThe first laparoscopic ureteral reimplantation was performed in 1994 by Erlich et al. in a pediatric patient. Also in 1994, Reddy and Evans published a report on the first ureteroneocystostomy in the adult population.ConclusionsLaparoscopic ureteroneocystostomy is a safe procedure with the advantages of minimally invasive surgery: rapid recovery and short convalescence, with similar results to those of open surgery.

In this paper, I examine cultural citizenship not as a stable fact but as the product of everyday practice. The analysis focuses on educational discourses and classroom interactions in the school of a rural town in Spain and in relation to Moroccan immigrant children’s membership and identity. I show how teachers engage in distinction, authentication, and authorization practices, playing on essentialist notions of children’s ethnolinguistic identities and upholding notions of belonging to the nation that are predicated on homogeneity. This paper also examines how Moroccan immigrant children contest teachers’ essentialist formulations by asserting multiple, hybrid forms of membership and belonging.

Purpose The purpose of this chapter is to examine everyday multilingual peer play interactions through their implications for the development of friendships among immigrant children. Methodology/approach Bringing together linguistic anthropology and conversation analysis as methodological approaches, this chapter explores friendship processes among Moroccan immigrant girls in Spain, specifically by analyzing the structure and composition of one such peer group, as well as their multilingual and multimodal interactions. Findings The main findings are that the multi-age, mixed-expertise composition of this peer group, as well as the semiotically flexible forms of participation and interaction that it encourages, are conducive to remarkably inclusive groups and strong friendships among a diverse group of Moroccan immigrant girls (including, younger and older girls, girls with disabilities and girls with very different immigration histories). Solid inclusive friendships are cemented in this peer interactional environment first because being able to interchangeably negotiate expert/novice participation roles in game interactions affirms feelings of social competence among all the girls, and second because achieving shared understandings in play entails successfully negotiating rules and expectations, which promotes trust and collaboration, while minimizing conflict. The inclusive nature of these girls’ peer-groups contrasts with the exclusion they encounter in other social settings and relationships. Research Implications In this sense, this chapter has important implications for understanding immigrant children’s abilities to respond to forms of social exclusion by forming diverse peer groups and strong friendships of their own. These friendships offer them a path to combat the marginalization they experience in other domains of social life.

Maria was a fifth grade student when the authors met her in a study of immigrant child-language brokers. Her family immigrated from a farming community in Mexico to a Chicago suburb where there wer...

This paper focuses on issues of reproduction and the manufacturing of national/ethnic and religious identities in the deterritorialized space of the Moroccan immigrant diaspora. More specifically, this paper examines Moroccan immigrant children's language socialization into pan-Arabic and Islamic identities in relation to the teaching of the Arabic language to these younger generations of Moroccans, who have either already been born in Spain, or who immigrated to Spain with their parents when they were toddlers. Moroccan immigrant children in this study attend Arabic language classes in a Spanish public school—a relatively new program jointly funded by the Spanish and Moroccan Ministries of Education—and in after-school religious classes in a small oratory-mosque run by a local Islamic cultural organization. In this paper, I address similarities and differences in linguistic and literacy practices between these two contexts, paying particular attention to how the internal dynamism of the Moroccan community itself organizes adults’ socializing efforts in relation to language education, especially where there may be some conflicting interests in achieving literacy by religious and secular elements of the children's communities of origin. Comparing language and literacy practices in the fields of Arabic language classes at the school and in the mosque allows us to trace homologies, or similarity of organization in linguistic and cultural (re)production, across these two settings, but also to uncover different kinds of strategies teachers engage in and the differential effect pursued by putting these strategies to use in the classroom. Outlining both, processes of homology and heterogeneity, is particularly important to understand the degree of redundancy in language socialization practices, as well as the possible areas of disjuncture that may impinge upon children's ability to negotiate commonality of belonging in their multiple communities.

Objetivo Describir el perfil de los pacientes con sindrome coronario agudo sin elevacion del segmento ST (SCASEST) por lesion aguda del tronco comun de la arteria coronaria izquierda (TCI). Diseno Serie de casos consecutivos (enero 2002 a febrero 2003) con seguimiento hasta el alta hospitalaria. Ambito Unidad Coronaria y Unidad de Hemodinamica y Cardiologia Intervencionista de un hospital general. Pacientes y metodo Se estudio a 6 pacientes con SCASEST y lesion aguda del TCI en la coronariografia. Se analizan la clinica, el electrocardiograma (ECG) basal y con dolor, los marcadores cardiacos, el ecocardiograma y los hallazgos del cateterismo cardiaco. Resultados De los 6 enfermos (varones; 43-76 anos), 2 presentaban angina inestable y 4 infarto agudo de miocardio sin onda Q (IAMNQ) con shock cardiogenico (n = 2), edema pulmonar (n = 1) o fibrilacion ventricular (n = 1). El ECG con dolor mostro cambios del segmento ST en ≥7 derivaciones con descenso en DI (1-4 mm), DII (1-2 mm), V4-V6 (1-4 mm) y ascenso en aVR (0,5-2,5 mm), y un sumatorio en valor absoluto (∑ST [DI, DII, aVR, V4-V6]) ≥10 mm. La coronariografia (1-48 h) evidencio una estenosis ≥70% del TCI, por lo que en 2 pacientes se procedio a cirugia y en 4 a angioplastia e implante de stent, con buen resultado final. Conclusiones En los pacientes con SCASEST y disfuncion ventricular izquierda severa, arritmias ventriculares graves o ECG con cambios marcados del segmento ST en ≥7 derivaciones que incluyan DI, DII, aVR, V4, V5, V6, se debe sospechar una lesion aguda del TCI y plantear una estrategia invasiva urgente o incluso de emergencia.

8 p.- Papers presented at the International Workshop "The Conservation of Subterranean Cultural Heritage", held 25-27 March 2014, in Seville, Spain., Subsurface engineering environments, such a mines, tunnels and water galleries, may have cultural significance, in addition to their inherent geological characteristics. The 16th century Paranhos spring water tunnel located in Porto city (NW Portugal) was excavated throughout the ganitic bedrock to supply water for the public fountains for more than five centuries. Nowadays, due to groundwater quality degradation and high deterioration level of the granite tunnel. The water is no longer used for public purposes. This subsurface granite heritage represents a favourable habitat for a wide variety of microorganisms, which participate in the formation processes of secondary minerals and dissolution of rock components…, Financiado con el Proyecto (HAR-2010-11432-E) Red de Ciencia y Tecnología para la Conservación del Patrimonio Cultural

Patients admitted to the Department of Ophthalmology (OPH) are of increasing age, comorbidity and complexity, leading to increased consultations/referrals to Internal Medicine (IM). An alternative to consultations/referrals is co-management. The effect of co-management on length of hospital stay was studied in patients admitted to OPH.Retrospective observational study was performed that included patients ≥14 years old discharged from OPH between 1 January 2009 and 30 June 2013, who were co-managed from May 2011. An analysis was made including age, sex, type of admission, whether it was operated on, administrative weight associated with GRD, total number of discharge diagnoses, Charlson comorbidity index (CCI), mortality, readmissions, and LoS.There were statistically significant differences between the groups in operated patients (odds ratio [OR] 2.3, 95% confidence interval [95% CI] 1.5 to 3.6), administrative weight (0.1160; 95% CI 0.0738 to 0.1583), and number of diagnoses (0.9, 95% CI 0.5 to 1.3). On adjustment, co-management reduced LoS in OPH by 27.8%, 0.5 days (95% CI 0.1 to 1).Patients admitted to OPH have increasing comorbidity and complexity. Co-management is associated with a reduced LoS and costs in OPH, similar to that observed in other surgical services.

An important but understudied activity of the departments of internal medicine (IM) is the in-hospital consultations. We analyzed the requests for in-hospital consultation with IM and the potential differences between the consultations of medical and surgical departments.This was an 8-month observational prospective study that analyzed demographic variables related to the origin of the interconsultation, comorbidity, length of stay and hospital mortality, emergency, admission-consultation request delay, appropriateness (not appropriate if another department was consulted for the same reason or if the pathology behind the consultation was that of the requesting service) and, for patients who underwent surgery, whether it was requested before or after the surgery.During the study, 215 in-hospital consultations were conducted (27 consultations/month). The mean age of the patients was 69.8 years (women, 50%). Some 30.7% were requested by medical departments and 69.3% by surgical departments. Thirteen percent of the in-hospital consultations were duplicated. The department of IM was not the appropriate department consulted in 23.3% of cases (13.0% of the cases requested consultations for the same reason with another department; in 14.3% of the cases, the pathology was that of requesting department). More in-hospital consultations were conducted on Mondays and Fridays than on Thursdays (25.1% and 23.7% versus 15.3%, respectively; p=.03). The delay between admission and the request for interconsultation was of 12.6 days. Some 90.7% of the in-hospital consultations for patients undergoing surgery were requested after the intervention. There were no differences in the characteristics of the in-hospital consultations between the medical and surgical departments.In-hospital consultations directed at IM are frequently duplicate, are not well directed at the appropriate department and their urgency is incorrectly assessed. These characteristics are similar for the consultations with medical and surgical departments.