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Resumen: España es el país europeo donde se realizan más técnicas de reproducción asistida (TRA), alcanzando el 9% de los nacidos. El objetivo de este artículo es introducir el marco legal y analizar algunos aspectos éticos, no exentos de controversia, en relación con el anonimato de los donantes de gametos y la ocultación del origen mediante TRA a los hijos. La legislación española establece el anonimato relativo de los donantes: tanto las receptoras de gametos como los hijos nacidos tienen derecho a obtener información general de los mismos siempre que no incluya su identidad, pero ante situaciones de riesgo para la vida y la salud de los hijos permite su quiebra. Asimismo, se determina un inequívoco derecho a la intimidad y confidencialidad del sometimiento a las TRA. El movimiento tendente a introducir en nuestro país una modificación legislativa que acabe con el anonimato de los donantes de gametos se basa en el derecho de los nacidos a conocer su filiación biológica. Junto con los cambios jurídicos, la actitud de padres y profesionales debe ir modificándose hacia una comunicación más transparente y responsable, en función de las experiencias de los adultos concebidos por estas técnicas, y de los adoptados. Construir valores como la confianza y la verdad en el ámbito de las relaciones familiares desde la responsabilidad requiere colocar a los hijos, grandes olvidados y parte más vulnerable, en el centro del debate. Abstract: Spain is the European country where more assisted reproduction techniques (ART) are performed, reaching 9% of newborns. The objective of this article is to introduce the legal framework and to analyze some ethical questions, not without controversy, in relation to the anonymity of gamete donors and the concealment of origin by ART from their children. Spanish legislation establishes the relative anonymity of donors: both gamete recipients and born children have the right to obtain general information about them as long as their identity is not included, but in situations of risk to the life and health of the children allows your bankruptcy. Likewise, an unequivocal right to privacy and confidentiality of submission to the ART is established. The movement aimed at introducing in our country a legislative amendment that ends the anonymity of gamete donors is based on the right of those children to know their biological origin. Along with legal changes, the attitude of parents and professionals must gradually change towards more transparent and responsible communication, based on the experiences of adults conceived by these techniques, and those adopted. Building values such as trust and truth in the family relationships from responsibility requires placing the children, largely forgotten and the most vulnerable part, at the center of the debate.

Spain is the European country where more assisted reproduction techniques (ART) are performed, reaching 9% of newborns. The objective of this article is to introduce the legal framework and to analyze some ethical questions, not without controversy, in relation to the anonymity of gamete donors and the concealment of origin by ART from their children. Spanish legislation establishes the relative anonymity of donors: both gamete recipients and born children have the right to obtain general information about them as long as their identity is not included, but in situations of risk to the life and health of the children allows your bankruptcy. Likewise, an unequivocal right to privacy and confidentiality of submission to the TRA is established. The movement aimed at introducing in our country a legislative amendment that ends the anonymity of gamete donors is based on the right of those children to know their biological origin. Along with legal changes, the attitude of parents and professionals must gradually change towards more transparent and responsible communication, based on the experiences of adults conceived by these techniques, and those adopted. Building values such as trust and truth in the family relationships from responsibility requires placing the children, largely forgotten and the most vulnerable part, at the center of the debate. Resumen: España es el país europeo donde se realizan más técnicas de reproducción asistida (TRA), alcanzando el 9% de los nacidos. El objetivo de este artículo es introducir el marco legal y analizar algunos aspectos éticos, no exentos de controversia, en relación con el anonimato de los donantes de gametos y la ocultación del origen mediante TRA a los hijos. La legislación española establece el anonimato relativo de los donantes: tanto las receptoras de gametos como los hijos nacidos tienen derecho a obtener información general de los mismos siempre que no incluya su identidad, pero ante situaciones de riesgo para la vida y la salud de los hijos permite su quiebra. Asimismo, se determina un inequívoco derecho a la intimidad y confidencialidad del sometimiento a las TRA. El movimiento tendente a introducir en nuestro país una modificación legislativa que acabe con el anonimato de los donantes de gametos, se basa en el derecho de los nacidos a conocer su filiación biológica. Junto a los cambios jurídicos, la actitud de padres y profesionales debe ir modificándose hacia una comunicación más transparente y responsable, en función de las experiencias de los adultos concebidos por estas técnicas, y de los adoptados. Construir valores como la confianza y la verdad en el ámbito de las relaciones familiares desde la responsabilidad, requiere colocar a los hijos, grandes olvidados y parte más vulnerable, en el centro del debate.

Increasing evidence indicates that the Trypanosoma brucei flagellum (synonymous with cilium) plays important roles in host-parasite interactions. Several studies have identified virulence factors and signaling proteins in the flagellar membrane of bloodstream-stage T. brucei, but less is known about flagellar membrane proteins in procyclic, insect-stage parasites. Here we report on the identification of several receptor-type flagellar adenylate cyclases (ACs) that are specifically upregulated in procyclic T. brucei parasites. Identification of insect stage-specific ACs is novel, as previously studied ACs were constitutively expressed or confined to bloodstream-stage parasites. We show that procyclic stage-specific ACs are glycosylated, surface-exposed proteins that dimerize and possess catalytic activity. We used gene-specific tags to examine the distribution of individual AC isoforms. All ACs examined localized to the flagellum. Notably, however, while some ACs were distributed along the length of the flagellum, others specifically localized to the flagellum tip. These are the first transmembrane domain proteins to be localized specifically at the flagellum tip in T. brucei, emphasizing that the flagellum membrane is organized into specific subdomains. Deletion analysis reveals that C-terminal sequences are critical for targeting ACs to the flagellum, and sequence comparisons suggest that differential subflagellar localization might be specified by isoform-specific C termini. Our combined results suggest insect stage-specific roles for a subset of flagellar adenylate cyclases and support a microdomain model for flagellar cyclic AMP (cAMP) signaling in T. brucei. In this model, cAMP production is compartmentalized through differential localization of individual ACs, thereby allowing diverse cellular responses to be controlled by a common signaling molecule.

Digital image correlation (DIC) and finite element analysis (FEA) are used to assess the cylindrical spool-shaped ASTM D7291 and I-beam-shaped specimens for through-thickness (TT) mechanical characterization of thick (25 mm) fiber reinforced polymer matrix composites. The composites are made of E-glass woven fabrics reinforcing a vinyl ester matrix. DIC full-field measurements and FEA showed a rather uniform strain distribution within the gage section of the ASTM D7291 specimen. However, strain concentrations are revealed at the bondlines between the end-tabs and the test specimen, in addition to strain gradients at the curved section of the specimen. DICmeasured and FEA-predicted strain fields of the I-beam specimens exhibited a region of uniform strain distribution within the gage section larger than that of the ASTM D7291 specimen. Nevertheless, high stress concentrations at the fillet (curved flange-to-web transition) regions and some amount of web bending occur in the I-beam specimen. Beyond providing the TT mechanical properties of the E-glass woven/vinyl ester composites, the current work discusses advantages and caveats of both promising specimens, providing quantifications of stress concentration factors and length of zones were strains and stresses may be considered uniform. Highlights • Stress/strain distributions of through-thickness tensile specimens are evaluated. • The main drawback of the spool-shaped specimen is adhesive failure. • The modified I-beam specimen shows acceptable stress concentration factors. • The modified I-beam is adequate for strength and Poisson ratio characterization. • I-beam specimens are easier to manufacture and do not require adhesive joints. [ABSTRACT FROM AUTHOR]

Resumen: Objetivo: Describir los modos de muerte de los niños en las Unidades de Cuidados Intensivos Pediátricos (UCIP) en España y analizar las características de aquellos que fallecen tras decidir una limitación del esfuerzo terapéutico (LET). Métodos: Estudio retrospectivo multicéntrico mediante revisión de informes de alta de los pacientes fallecidos en 8 UCIPs españolas entre 2011 y 2017. Resultados: Se recogieron 337 fallecimientos, de los cuales 151 (50,7%) ocurrieron durante una decisión de LET, mientras que 114 (33,8%) fueron por reanimación cardiopulmonar indicada pero fallida (FRCP) y 52 (15,4%) por muerte cerebral. Los motivos más frecuentes de ingreso en los niños que luego fallecieron fueron cardíacos (32,6%) y respiratorios (22,6%). El 25,5% (86 casos) habían tenido ingresos previos, 253 (75.1%) padecían enfermedades crónicas y 78 (23,2%) presentaban al ingreso una discapacidad grave. La LET fue más frecuente en estos niños y en aquellos con cáncer. La LET consistió fundamentalmente en no iniciar la RCP en caso de parada cardíaca (45%), retirada de la ventilación mecánica (31.6%) y retirada de fármacos vasoactivos (21.6%). Conclusiones: En el momento actual al menos la mitad de los niños que fallecen en una UCIP en España lo hacen tras una decisión de LET, que es más frecuente en aquellos con ingresos previos, discapacidad grave, enfermedad crónica u oncológica. Los profesionales debemos ser conscientes de esta realidad y prepararnos para compartir las decisiones con las familias y ofrecer la mejor calidad asistencial posible a los niños al final de su vida. Abstract: Objective: To describe the different types of child deaths in Paediatric Intensive Care Units (PICU) in Spain, and to analyse the characteristics of those dying from a limitation of therapeutic efforts (LET). Method: A multicentre retrospective study by conducted by reviewing the hospital discharge reports corresponding to deceased patients in 8 Spanish PICUs between 2011 and 2017. Results: A total of 337 deaths were recorded, of which 151 (50’7%) occurred after a decision of LET, while 114 (33’8%) were due to an indicated, but failed, cardiopulmonary resuscitation, and 52 (15.4%) were due to brain death. The most common causes of hospital admission for those children that finally died were a heart-related problem (32.6%) or a respiratory problem (22.6%).A total of 86 cases (25.5%) had a previous hospital admission, with 253 cases (75%) suffering from some type of chronical illness, and 78 (23%) had a serious disability at the time of the admission.LET cases were more frequent among these children and those suffering from cancer. The predominant LET type consisted in: not starting the CPR in the event of a cardiac arrest (45%), withdrawal of the respiratory support (31.6%), and withdrawal of vasoactive drugs (21.6%). Conclusions: At the present time, at least half of the children dying in a PICU in Spain die after a LET decision, which is more frequent in those patients with previous hospital admissions, with a serious incapacity, and chronic or oncological disease. Health professionals should be aware of this situation, and be prepared to share decisions with the families, and to offer children at the end of their life the best possible caring quality.

Objective: To describe the different types of child deaths in Paediatric Intensive Care Units (PICU) in Spain, and to analyse the characteristics of those dying from a limitation of therapeutic effort (LET). Method: A multicentre retrospective study by conducted by reviewing the hospital discharge reports corresponding to deceased patients in 8 Spanish PICUs between 2011 and 2017. Results: A total of 337 deaths were recorded, of which 151 (50.7%) occurred after a decision of LET, while 114 (33.8%) were due to an indicated, but failed, cardiopulmonary resuscitation, and 52 (15.4%) were due to brain death. The most common causes of hospital admission for those children that finally died were a heart-related problem (32.6%) or a respiratory problem (22.6%).A total of 86 cases (25.5%) had a previous hospital admission, with 253 cases (75%) suffering from some type of chronical illness, and 78 (23%) had a serious disability at the time of the admission.LET cases were more frequent among these children and those suffering from cancer. The predominant LET type consisted in: not starting the CPR in the event of a cardiac arrest (45%), withdrawal of the respiratory support (31.6%), and withdrawal of vasoactive drugs (21.6%). Conclusions: At the present time, at least half of the children dying in a PICU in Spain die after a LET decision, which is more frequent in those patients with previous hospital admissions, with a serious incapacity, and chronic or oncological disease. Health professionals should be aware of this situation, and be prepared to share decisions with the families, and to offer children at the end of their life the best possible caring quality. Resumen: Objetivo: Describir los modos de muerte de los niños en las Unidades de Cuidados Intensivos Pediátricos (UCIP) en España y analizar las características de aquellos que fallecen tras decidir una limitación del esfuerzo terapéutico (LET). Métodos: Estudio retrospectivo multicéntrico mediante revisión de informes de alta de los pacientes fallecidos en 8 UCIPs españolas entre 2011 y 2017. Resultados: Se recogieron 337 fallecimientos, de los cuales 151 (50,7%) ocurrieron durante una decisión de LET, mientras que 114 (33,8%) fueron por reanimación cardiopulmonar indicada pero fallida (FRCP) y 52 (15,4%) por muerte cerebral. Los motivos más frecuentes de ingreso en los niños que luego fallecieron fueron cardíacos (32,6%) y respiratorios (22,6%). El 25,5% (86 casos) habían tenido ingresos previos, 253 (75.1%) padecían enfermedades crónicas y 78 (23,2%) presentaban al ingreso una discapacidad grave. La LET fue más frecuente en estos niños y en aquellos con cáncer. La LET consistió fundamentalmente en no iniciar la RCP en caso de parada cardíaca (45%), retirada de la ventilación mecánica (31.6%) y retirada de fármacos vasoactivos (21.6%). Conclusiones: En el momento actual al menos la mitad de los niños que fallecen en una UCIP en España lo hacen tras una decisión de LET, que es más frecuente en aquellos con ingresos previos, discapacidad grave, enfermedad crónica u oncológica. Los profesionales debemos ser conscientes de esta realidad y prepararnos para compartir las decisiones con las familias y ofrecer la mejor calidad asistencial posible a los niños al final de su vida.

Presbycusis or Age-related hearing loss (ARHL) is a sensorineural hearing loss that affects communication, leading to depression and social isolation. Currently, there are no effective treatments against ARHL. It is known that cocoa products have high levels of polyphenol content (mainly flavonoids), that are potent anti-inflammatory and antioxidant agents with proven benefits for health. The objective is to determine the protective effect of cocoa at the cellular and molecular levels in Presbycusis. For in vitro study, we used House Ear Institute-Organ of Corti 1 (HEI-OC1), stria vascularis (SV-k1), and organ of Corti (OC-k3) cells (derived from the auditory organ of a transgenic mouse). Each cell line was divided into a control group (CTR) and an H2O2 group (induction of senescence by an oxygen radical). Additionally, every group of every cell line was treated with the cocoa polyphenolic extract (CPE), measuring different markers of apoptosis, viability, the activity of antioxidant enzymes, and oxidative/nitrosative stress. The data show an increase of reactive oxidative and nitrogen species (ROS and RNS, respectively) in senescent cells compared to control ones. CPE treatment effectively reduced these high levels and correlated with a significant reduction in apoptosis cells by inhibiting the mitochondrial-apoptotic pathway. Furthermore, in senescence cells, the activity of antioxidant enzymes (Superoxide dismutase, SOD; Catalase, CAT; and Glutathione peroxidase, GPx) was recovered after CPE treatment. Administration of CPE also decreased oxidative DNA damage in the auditory senescent cells. In conclusion, CPE inhibits the activation of senescence-related apoptotic signaling by decreasing oxidative stress in auditory senescent cells.

(1) Aims: Patients receiving antitumor necrosis factor (anti-TNF) therapy are at risk of developing tuberculosis (TB), usually due to the reactivation of a latent TB infection (LTBI). LTBI screening and treatment decreases the risk of TB. This study evaluated the diagnostic performance of different LTBI screening strategies in patients with inflammatory bowel disease (IBD). (2) Methods: Patients in the Spanish ENEIDA registry with IBD screened for LTBI between January 2003 and January 2018 were included. The diagnostic yield of different strategies (dual screening with tuberculin skin test [TST] and interferon-ץ-release assay [IGRA], two-step TST, and early screening performed at least 12 months before starting biological treatment) was analyzed. (3) Results: Out of 7594 screened patients, 1445 (19%; 95% CI 18–20%) had LTBI. Immunomodulator (IMM) treatment at screening decreased the probability of detecting LTBI (20% vs. 17%, p = 0.001). Regarding screening strategies, LTBI was more frequently diagnosed by dual screening than by a single screening strategy (IGRA, OR 0.60; 95% CI 0.50–0.73, p < 0.001; TST, OR 0.76; 95% CI 0.66–0.88, p < 0.001). Two-step TST increased the diagnostic yield of a single TST by 24%. More cases of LTBI were diagnosed by early screening than by routine screening before starting anti-TNF agents (21% [95% CI 20–22%] vs. 14% [95% CI 13–16%], p < 0.001). The highest diagnostic performance for LTBI (29%) was obtained by combining early and TST/IGRA dual screening strategies in patients without IMM. (4): Conclusions: Both early screening and TST/IGRA dual screening strategies significantly increased diagnostic performance for LTBI in patients with IBD, with optimal performance achieved when they are used together in the absence of IMM.

Abstract Background Composition of the vaginal microbiota has significant influence on female urogenital health and control of infectious disease. Murine models are widely utilized to characterize host-pathogen interactions within the vaginal tract, however, the composition of endogenous vaginal flora remains largely undefined with modern microbiome analyses. Here, we employ 16S rRNA amplicon sequencing to establish the native microbial composition of the vaginal tract in adult C57Bl/6 J mice. We further interrogate the impact of estrous cycle and introduction of the human vaginal pathobiont, group B Streptococcus (GBS) on community state type and stability, and conversely, the impact of the vaginal microbiota on GBS persistence. Results Sequencing analysis revealed five distinctive community states of the vaginal microbiota dominated largely by Staphylococcus and/or Enterococcus, Lactobacillus, or a mixed population. Stage of estrus did not impact microbial composition. Introduction of GBS decreased community stability at early timepoints; and in some mice, GBS became the dominant bacterium by day 21. Endogenous Staphylococcus abundance correlated with GBS ascension into the uterus, and increased community stability in GBS-challenged mice. Conclusions The murine vaginal flora is diverse and fluctuates independently of the estrous cycle. Endogenous flora may impact pathogen colonization and dissemination and should be considered in urogenital infection models.

Uruguay ha registrado un incremento del 40 % en los suicidios durante los últimos 15 años; el 17 % de quienes cometen estas conductas son adolescentes. Ante la importancia de contar con instrumentos adecuados para valorar y manejar el riesgo suicida en esta etapa, el presente estudio analiza algunas propiedades psicométricas del Inventario de Riesgo Suicida para Adolescentes (IRISA). A una muestra de 447 estudiantes uruguayos, con un rango de edad de entre 12 y 18 años (M=15.06; DE=1.84), se les administró un cuestionario sociodemográfico y el IRISA. El análisis factorial confirmatorio corroboró la dimensionalidad de la escala, los adecuados índices de fiabilidad y las correlaciones esperables intra-subescalas. Se concluye que el IRISA muestra propiedades psicométricas adecuadas, por lo que constituye una herramienta útil para la identificación de aquellos adolescentes en riesgo suicida y su uso extensivo en los servicios de atención primaria de la salud podría resultar prometedor.

Histoplasmosis is one of the most common endemic mycoses affecting immunocompromised individuals in the United States and Latin America. Involvement of the central nervous system carries higher mortality rates and worse prognosis, given its resemblance to stroke, vasculitis, and meningitis of other etiologies. The diagnosis is challenging, due to its subtle clinical presentation and the poor sensitivity of the cerebrospinal fluid culture. Herein the authors present a case of a middle-aged man with HIV, who presented with intermittent headaches exacerbated by an oculomotor nerve palsy, concerning for acute stroke. A diagnosis of central nervous system histoplasmosis was made, and his neurological deficits subsided after initiation of treatment. The stroke-like syndrome in this scenario may be secondary to granulomatous vasculitis of small caliber cerebral blood vessels. Histoplasmosis of the central nervous system remains a challenging diagnosis, which requires a high index of suspicion by the clinician for an early institution of therapy in order to improve outcomes.

Project Panther LIFE is an inclusive postsecondary transition program for students with intellectual disabilities providing university access and participation with the primary goal of employment at program completion. Students in the program receive support from their academic mentors and peer coaches during the academic year. This study examines the skills and activities mentors use during their weekly sessions with students with intellectual disabilities and identifies areas in which mentors may require further support or training. Data analysis revealed major themes related to inclusion, self-determination, and adaptive behavior skills. Upon review of the data, we suggest that mentors need ongoing support from transition programs especially in areas related to encouraging self-advocacy and supporting time management.

En el campo de la literatura juvenil deportiva, Breathe, Annie, Breathe (2014), de la autora estadounidense Miranda Kenneally, aborda la transición a la universidad de su protagonista, Annie, quien experimenta importantes cambios vitales y corporales al comenzar la vida en el campus e introducirse en el atletismo. Siguiendo la estructura de una novela de iniciación, Breathe, Annie, Breathe se centra en el reconocimiento del cuerpo a través de una maratón para la que la protagonista se entrena con la intención de honrar a su pareja, recientemente fallecida. Inicialmente caracterizada como una joven pasiva y sin conciencia sobre su potencial físico y afectivo, Annie va evolucionando hacia la madurez adulta, al tiempo que descubre su cuerpo y deseos sexuales y centra sus aspiraciones académicas. Este proceso, al final, la llevará a recuperar un sentido de afectividad más allá de su primer amor. A medida que avanza en sus entrenamientos, Annie no concede importancia a su pérdida de peso y se enorgullece, por el contrario, de la fuerza y resistencia conseguidas. En este sentido, desde una perspectiva de género la obra de Kenneally desmitifica la feminidad de la pérdida de peso al equiparar el cambio físico con el bienestar, más que con la belleza, al contrario de lo que ocurría con novelas juveniles anteriores. Ello indica una evolución en la novela juvenil deportiva que requiere de atención académica con el fin de evaluar el impacto positivo que puede tener sobre los cánones de belleza corpórea de las lectoras jóvenes. Palabras clave: novela deportiva juvenil; novela norteamericana contemporánea; cuerpo femenino; sexualidad; empoderamiento; desórdenes alimenticios In the context of Young Adult Sports Fiction, Miranda Kenneally's Breathe, Annie, Breathe (2014) addresses some crucial problematics that her protagonist, Annie, experiences through her body changes as she enters the world of athletics and campus life. Structured as a coming-of-age novel, Breathe, Annie, Breathe depicts Annie's progressive acknowledgement of her body as she trains for a marathon so as to honor her recently deceased boyfriend. First characterized as a rather passive young woman with no awareness of her physical and emotional potential, Annie starts to become a mature adult with a burgeoning sense of self, able to understand her body, academic goals and sexual desires, ultimately leading her to recover her affectivity beyond her first love. As her training progresses, Annie focuses increasingly on her growing endurance and prowess rather than her weight loss. Thus, from a gender perspective, Kenneally's novel demystifies the weight-loss process as an intrinsically feminine one, aligning it with wellbeing rather than beauty, in contrast to previous young adult novels. This points to an evolution in the Young Adult Sports Fiction genre which should be addressed in order to evaluate the positive impact it may have on young female readers' canons of corporeal beauty. Keywords: Young Adult Sports Fiction; contemporary North American fiction; female body; sexuality; empowerment; eating disorders, Body Awakening through Athletics: A Gender Analysis of Corporealities in Breathe, Annie, Breathe I. The Development of Young Adult Sports Fiction in North American Literature Young Adult Sports Fiction (henceforth [...]