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Abstract Extraordinary advances in medicine and public health have contributed to increasing life expectancy worldwide. However, health span—“healthy aging”—has paradoxically lagged to parallel this increase. Consequently, aging‐associated illnesses, such as Alzheimer's disease and aging frailty, are having a growing impact on patients, their families, and entire health‐care systems. Typically, such disorders have been treated as isolated disease entities. However, the inextricable links between aging‐associated disorders and the aging process itself have become increasingly recognized, leading to formation of the field of geroscience. The geroscience concept is that treating the aging process itself should lead to treatment and prevention of aging‐related disorders. However, the aging process is complex, dictated by highly interrelated pleiotropic processes. As such, therapeutics with pleiotropic mechanisms of action (either alone, or as part of combinatorial strategies) will be required for preventing and treating both aging and related disorders. Mesenchymal stem cells (MSCs) have multiple mechanisms of action that make these highly promising geroscience therapeutic candidates. These cells have a high safety profile for clinical use, are amenable to allogeneic use since tissue‐type matching is not required, and can have sustained activity after transplantation. Herein, we review preclinical and clinical data supporting the utility of allogeneic MSCs as a geroscience therapeutic candidate.

Abstract Piscine orthoreovirus (PRV) is a virus that is widely distributed among global aquaculture populations of salmonid species. The coho salmon (Oncorhynchus kisutch) is a species of increasing productive and economic importance in Chile. The presence of PRV has generated concern about its impact on the health and welfare of this species. The objective of this study was to comparatively describe the clinical manifestations, pathological changes, and pathogenesis associated with PRV infection in two different farms of farmed coho salmon in Chile through a prospective longitudinal descriptive observational study. The results demonstrated that PRV-1b and PRV-3a are independently associated with the same clinical and pathological presentation in farmed coho salmon. Microscopic pathology of the disease associated with PRV-1b and PRV-3a was primarily characterized by degenerative and inflammatory findings in the heart and liver. Hematological and blood biochemistry biomarkers in fish exhibited alterations, manifesting as hemolytic anemia and prehepatic jaundice likely due to indirect hyperbilirubinemia. Pathogenesis of infection associated with both PRV-1b and PRV-3a would indicate a specific tropism for erythrocytes and cardiomyocytes of the spongy myocardium. It is noteworthy that despite a notable reduction in viral load of both PRV subgroups in tissues, the frequency of macroscopic lesions increased during the final phase of the study. In conclusion, the results indicate a strong correlation between infection by both PRV subgroups and the proposed orthoreoviral cardiomyopathy and hemolytic jaundice (OCHJ) disease. Further research on the pathogenesis and surveillance of PRV-1b and PRV-3a subgroups is pivotal to develop effective strategies for the control of OCHJ in farmed coho salmon.

Abstract Human organ transplantation has begun in the 1960s with donation after circulatory death. At that time this was named non heart beating donation, later donation after cardiac death and nowadays it is named donation after circulatory death. Currently, we are facing a significant shortage of transplant organs in Europe and worldwide. To increase the graft acceptance from donation after controlled or uncontrolled circulatory death, preceding regional normothermic perfusion by an extracorporeal circulation before organ procurement or ex-situ machine perfusion are frequently implemented in clinical practice as organ assessment and reconditioning techniques. Due to these advancements more organs can be potentially transplanted, even after out-of-hospital cardiac arrest (OHCA). First line actors like emergency physicians and pre-hospital paramedics must be aware of such programs to recognize and refer patients for donation in OHCA situations. This review provides an overview of organs transplanted from uncontrolled donation after circulatory death (uDCD) and emphasize the role of the emergency physician in the organ donation cascade. Outcome of uDCD has a lower effectiveness than donation after brain death (DBD) and controlled donation after circulatory death (cDCD) for short term graft survival. However, observational studies illustrate that long term outcome from uDCD is comparable to graft outcome from cDCD and DBD. We summarize the studies reporting the procured organ rate and functional outcome of organs originated from uDCD. European databases indicate a high incidence of OHCA, where resuscitation efforts are initiated but the rate of return of spontaneous circulation (ROSC) remains limited. These patients represent a substantial potential pool of organ donors for uDCD programs. However, these programs tend to overestimate the number of potential donors. While organ procurement from uDCD has yielded favorable outcomes, further research is required to accurately assess the associated costs and benefits and to establish clear donor selection guidelines. Furthermore, the use of new technologies like extracorporeal Cardiopulmonary Resuscitation (E-CPR) for organ donation should be investigated from both medical and economical perspectives. Emergency departments must also explore the feasibility of implementing these programs.

Abstract Background Given the widespread use of Point-of-Care UltraSound (PoCUS) in clinical practice, with ultrasound machines becoming more portable and affordable, recommendations and position statements from ultrasound societies now promote teaching PoCUS in the undergraduate curriculum. Nevertheless, surveys about PoCUS teaching in European medical schools are lacking. This survey aims to overview the current and future undergraduate PoCUS courses in the European Union (EU). Results A questionnaire was sent to medical schools in 26 of the 27 countries of the EU; Luxembourg is the only country without a medical school. The survey was completed by the dean or a member of the medical school with knowledge of the medical curriculum. Of the 58 medical schools from 19 countries that responded to the survey, 18 (31.0%) from 13 (68.4%) EU countries reported the existence of an undergraduate PoCUS curriculum and a further 16 (27.6%) from 12 (41.4%) EU countries intended to offer it in the future. No significant difference was observed between the current and future PoCUS curricula regarding its content and purpose. Less than 40 h of theoretical teaching is provided in all the medical schools and less than 40 h of practical training is provided in 12 (75%) of the 16 medical schools which answered this specific question. Of the 40 (69%) surveyed medical schools that do not currently teach PoCUS, 20 (50%) intend to offer PoCUS courses in the future. Conclusion Although the lack of teaching hours in curricula suggests that most PoCUS courses are introductory in nature and that medical students are possibly not trained to become autonomous in clinical practice, evaluating the feasibility and impact of PoCUS teaching on clinical practice should be promoted. The medical schools that intend to develop this curriculum should be encouraged to implement validated tools to objectively assess their programs and students’ performances.

Resumen: Introducción: La simulación clínica es una estrategia eficaz para mejorar la seguridad del paciente. La simulación in situ puede tener beneficios al utilizar las instalaciones de cuidados intensivos, el equipo, los suministros clínicos habituales y ser realizado durante la jornada laboral.El objetivo de este estudio fue evaluar la percepción de los participantes de un programa de simulación in situ de alta fidelidad en el Centro de Paciente Crítico Adulto. Métodos: Posterior a los debriefing de las simulaciones in situ realizadas en la Unidad de Paciente Crítico Adulto de Clínica Las Condes, se aplicó una encuesta anónima semiestructurada a modo de evaluar la percepción del personal de salud que participó de la simulación. Resultados: A lo largo de 25 sesiones de simulación realizadas se obtuvieron 144 encuestas. La mayoría de las variables evaluadas tuvieron una puntuación superior a 9, lo que significa excelente o muy relevante, excepto la pregunta “¿Se siente más seguro de sus habilidades en un escenario de caso real similar después de esta actividad?”, que presentó una puntuación de 8,65 ± 1,5. Al analizar las variables según el rol del profesional, solo hubo diferencias entre los enfermeros y técnicos de enfermería. No hubo diferencias entre los equipos de cuidados intensivos y de cuidados intermedios en ninguna de las variables. Conclusiones: Las percepciones de los participantes, relacionadas a la simulación in situ como un proceso formativo fue interpretado como efectivo generando un alto grado de satisfacción. Abstract: Introduction: Clinical simulation is an effective strategy to improve patient safety. In Situ simulation may accrue benefits by utilizing the intensive care facility, routine clinical supplies and equipment, as well as being performed during the workday.The objective of this study was to evaluate participants’ perception of a high-fidelity in situ simulation program in an adult critical patient center. Methods: A semi-structured anonymous survey was applied after the debriefing of the in situ simulation that evaluated the reaction of the health personnel of the adult critical patient unit of Clinica Las Condes. Results: A total of 144 surveys were obtained during 25 simulation sessions. Most of the variables evaluated had a score above 9, interpreted as excellent or very relevant, except for the question “After this activity, do you feel more confident of your skills in a similar real case scenario?”, which presented a score of 8.65 ± 1.5. When analyzing the variables according to the role of the professional, there were only differences between nurses and nursing technicians. There were no differences between intensive care and intermediate care teams in any of the variables. Conclusions: The participants’ perceptions with regards to in situ simulation as a training process were interpreted as effective, generating a high degree of satisfaction.

Marbella has a wide range of luxury property rentals, which are the subject of study within the framework of the collaborative economy, where the Airbnb platform stands out as the most used channel. This research focuses on the analysis of the total number of luxury villas offered in Marbella by Airbnb Luxe and Luxury Retreats. The methodology was carried out in four phases: the first phase involved a review of the literature on tourism and luxury and a study of Marbella as a luxury destination. The second phase focused on the analysis of the types of accommodation that Marbella offers. The third phase focused on the collection of data from the analyzed platform: Airbnb Luxe and Luxury Retreats. Finally, qualitative research consisting of in-depth interviews with owners and real estate agents focused on the luxury sector in Marbella was carried out. The results obtained yield relevant conclusions: Marbella is one of the main luxury holiday destinations in Spain, and the most demanded type of luxe accommodation in Marbella is large luxury villas. The term ‘luxury’ can be subjective, referring to such things as the visible and non-visible aspects that determine the category of a luxury property, hence the need to carry out a study on the luxury segment to establish a precise definition.

Abstract Background Point-of-care ultrasound (PoCUS) is increasingly used in clinical practice and is now included in many undergraduate curricula. Here, we aimed to determine whether medical students who participated in a PoCUS teaching program with several practical training sessions involving healthy volunteers could achieve a good level of diagnostic accuracy in identifying gallbladder pathologies. The intervention group (IG) was trained exclusively on volunteers with a healthy gallbladder, whereas the control group (CG) had access to volunteers with a pathological gallbladder as recommended in most PoCUS curricula. Materials and methods Twenty medical students were randomly assigned to the IG and CG. After completing the training program over 2 months, students were evaluated by three independent examiners. Students and examiners were blind to group allocation and study outcome. Sensitivity and specificity of students’ PoCUS gallstone diagnosis were assessed. Secondary outcomes were students’ confidence, image quality, acquisition time, and PoCUS skills. Results Sensitivity and specificity for gallstone diagnosis were, respectively, 0.85 and 0.97 in the IG and 0.80 and 0.83 in the CG. Areas under the curve (AUC) based on the receiver operating characteristic curve analysis were 0.91 and 0.82 in the IG and CG, respectively, with no significant difference (p = 0.271) and an AUC difference of -0.092. No significant between-group difference was found for the secondary outcomes. Conclusions Our pilot study showed that medical students can develop PoCUS diagnostic accuracy after training on healthy volunteers. If these findings are confirmed in a larger sample, this could favor the delivery of large practical teaching sessions without the need to include patients with pathology, thus facilitating PoCUS training for students.

Abstract Background Cardiac arrest (CA) following CO poisoning (CO-induced CA) exposes patients to an extremely high risk of mortality and remains challenging to treat effectively. Terminal carboxyhemoglobin elimination half-life (COHbt1/2) is critically affected by ventilation, oxygen therapy, and cardiac output, which are severely affected conditions in cases of CA. Case presentation Asystole occurred in an 18-year-old woman after unintentional exposure to CO in her bathroom. Cardiopulmonary resuscitation (CPR) was started immediately, including mechanical ventilation with a fraction of inspired oxygen (FiO2) of 1.0 and external chest compressions with a LUCAS® device. CPR was stopped after 101 min, as it was unsuccessful. During this period, we calculated a COHbt1/2 of 40.3 min using a single compartmental model. Conclusions This result suggests that prolongation of CPR time needed to back COHb at 10%, a level more compatible with successful return of spontaneous circulation (ROSC), could be compatible with a realistic CPR time. Calculating COHbt1/2 during CPR may help with decision-making regarding the optimal duration of resuscitation efforts and further with HBO2 or ECLS. Further evidence-based data are needed to confirm this result.

The demography and behaviour of Teinopodagrion oscillans was studied in a protected area in the Andean region of Colombia. Adult damselflies were individually marked, and using their recapture histories, we estimated survival, longevity, sex ratio, and population size using Cormack-Jolly-Seber models. Other aspects of their behaviour were recorded. Survival, recapture, and lifespan (14.1 ± 0.59 days) were similar for both sexes and all age groups. Mature males were larger, and the distance from the water was similar for all individuals. The most supported model was the time-dependent model for survival and recapture. This suggests that weather variations affect the demography of this population in a significant way. Individuals exhibited high fidelity to their site perch, perching with open wings near water on a variety of perches. Mature males make short flights from the perch to intercept conspecific and interspecific males and to hunt prey. The tandem position was formed on macrophytes, and then the pair flew away. Oviposition lasted for 11.23 min on average, with the females ovipositing by abdomen submersion. Our results offer insights into the demographic characteristics and behaviour of this species, providing crucial information for the short- and long-term, from the demography of one species to the conservation of ecosystems of the Andean region.

La presente investigación tiene como objetivo indagar sobre las percepciones que los docentes formadores de enfermeros(as) tienen al momento de acompañar el desarrollo de la escritura en la disciplina. La relevancia de las percepciones radica en que, a pesar de que las universidades han formulado planes de acompañamiento para los estudiantes novatos y acciones de capacitación para sus académicos(as), no siempre quienes dictan clase son conscientes de este relevante aspecto en la educación universitaria, además de que, a pesar de la relativa consciencia que tienen sobre la importancia de dicho acompañamiento, hay vacíos conceptuales que deben revisarse. Para tal efecto, a partir de un diseño cualitativo etnográfico, se aplicó un cuestionario a un grupo de 17 profesionales que dictan clase en la carrera de enfermería de una universidad privada chilena de acceso abierto. El resultado arrojó que, a pesar de la formación en posgrado y los años de experiencia en la docencia universitaria, la mayoría de los profesionales no desarrolla acciones constantes en su ejercicio docente, lo que deriva en acompañamientos superficiales en la tarea de escritura de los aprendientes. La principal conclusión que se deriva de lo anterior es que las universidades deben desarrollar acciones de capacitación permanente a sus académicos(as) que deriven en un acompañamiento consistente en el desarrollo de habilidades de escritura académica.

Los purines de tambo (excretas mezcladas con agua de las instalaciones de ordeñe) se puedenreutilizar en la producción agrícola como reemplazo de los fertilizantes sintéticos. Sin embargo, su altaconcentración nitrogenada podría estimular la volatilización de amoníaco (NH3) y laemisión de óxido nitroso(N2O), con consecuencias sobre el calentamiento global. Nuestros objetivos fueron cuantificar las salidas deNH3 y N2O en un cultivo de maíz fertilizado con purín o urea aplicados superficialmente y relacionar lasemisiones de N2O con los cambios en el contenido de amonio, nitrato y agua del suelo. Se realizó un experimentomanipulativo a campo en el que se midieron ambas salidas gaseosas durante una campaña agrícola. El purínestimuló la volatilización de NH3 al día siguiente de la aplicación (2.7±0.25 vs. 1.1±0.25 y 0.6±0.25 kg N-NH3.ha-1.dia-1 para purín, urea y control, respectivamente), y la emisión directa de N2O durante los tres díassiguientes a la aplicación (75±13 vs. 28±5 y 26±6 µg N-N2O m-2.h-1 para purín, urea y control, respectivamente). A partir del cuarto día, la volatilización de NH3 fue mayor con urea y las emisiones de N2O se equipararonentre tratamientos. La volatilización acumulada durante el ciclo de maíz fue mayor con urea, y la emisióndirecta de N2O acumulada fue similar para ambos fertilizantes. Las emisiones de N2O estuvieron asociadas ala humedad del suelo, que aumentó inicialmente por el agua del purín y luego por las lluvias. Las salidas de NH3 + N2O de los fertilizantes luego de descontar el control fueron mayores con urea que con purín (10.8±1.2y 3.1±0.7 kg N/ha o 0.53±0.06 y 0.18±0.04 kg N/t MS), y el rendimiento de maíz fue similar entre tratamientos(19.0±0.7 t MS/ha). Estos resultados muestran que el uso de purines es una práctica promisoria para reducirel impacto ambiental de los fertilizantes sintéticos.

El propósito de la investigación fue proveer estrategias aplicables en el proceso de solución de problemas que se modelan mediante ecuaciones algebraicas para determinar si hubo diferencia significativa en el rendimiento académico de los grupos bajo investigación. Se realizó un estudio piloto y un análisis de dificultad y discriminación. La muestra de los tres grupos fueron 26 estudiantes matriculados en un curso general de matemáticas como requisito de su programa de estudios. Se le administró una preprueba y una posprueba al grupo de control 1 (C1) y al grupo experimental (E). La posprueba se administró a los grupos C1, C2 y E. Se llevó a cabo el tratamiento en el que los grupos de control recibieron enseñanza tradicional y el grupo experimental, enseñanza basada en la aplicación de estrategias heurísticas. Se realizó una prueba de normalidad y un análisis de discrepancia y dificultad. Se calculó la media de la administración de la preprueba. Se concluyó que C1 y E tenían similar rendimiento y conocimiento en la solución de problemas y ecuaciones algebraicas al inicio de la investigación, y que existió una diferencia significativa después del tratamiento en los grupos C1 y E, se mostró que los grupos C1 y E eran homogéneos, y que existió una diferencia significativa entre los tres grupos participantes en la posprueba de rendimiento académico. Se aportó un instrumento de investigación, un módulo educativo para estudiantes y una guía estratégica para el profesor.

Resumen: La pandemia SARS-CoV-2 ha desafiado el despliegue de todo el equipo de salud, movilizando no solo un recurso humano, también equipamiento, insumos y una infraestructura, que permita responder una alta demanda de pacientes críticos, que requirió abrir más camas críticas, manejada por un personal sanitario sin experiencia en UCI y con equipamiento e insumos limitados. El trabajo en equipo, la comunicación efectiva y el liderazgo en enfermería, son competencias esenciales en la primera ola de la pandemia, por lo que el objetivo de este artículo es describir la innovación de la orgánica estructural de enfermería, especialmente en las áreas de hospitalización de paciente crítico, para velar por el cuidado del paciente, la familia y el equipo de salud. Summary: The SARS-CoV-2 pandemic has challenged the deployment of the entire health team, mobilizing not only a human resource, but also equipment, supplies and an infrastructure, which allows responding to a high demand for critical patients, which required opening more critical beds, managed by health personnel without ICU experience and with limited equipment and supplies. Teamwork, effective communication and leadership in nursing are essential competencies in the first wave of the pandemic, so the objective of this article is to describe the innovation of the structural nursing organization, especially in hospitalization areas. Critical patient, to ensure the care of the patient, the family and the health team.

Resumen: La pandemia en Chile generó un desafío de modernización y gestión de los Cuidados Intensivos, haciendo necesario que las unidades de pacientes críticos realizaran un aumento de su capacidad hospitalaria, lo que requiere preparar una infraestructura, un equipamiento mínimo, protocolos y un equipo humano preparado y alineado, para garantizar la seguridad y calidad de atención a los pacientes. Una forma de lograrlo es la incorporación de la estrategia militar de Sistema de Comando de Incidentes, utilizado para enfrentar distintos tipos de desastres, con una estructura modular de comando y sus seccionales de trabajo, con diferentes equipos y líderes para hacer frentes a los variados desafíos. El objetivo de este artículo es describir la instauración del sistema de comando de incidentes en un hospital privado, detallando su conformación y los resultados logrados. Summary: The pandemic in Chile has been a real challenge in terms of modernization and management of intensive care. Critical care units have been forced to increase their hospital capacity in terms of infrastructure, equipment, protocols and human team, while guaranteeing safety and high-quality patient care.One approach to achieve this objective is to develop the army strategy called incident command system that has been used to face different types of disaster. A modular command structure is developed based on the creation of teams each lead by an expert in different areas in order to cope with a variety of upcoming challenges.The objective of this article is to describe the setting up of a successful incident command system in a private hospital, detailing its formation and results obtained.

Heart and skeletal muscle inflammation (HSMI) caused by Piscine orthoreovirus (PRV) was first described in farmed Atlantic salmon in Chile in 2011. However, as PRV induces long-lasting infections, it is not known when Chilean farmed salmon may have started to show PRV positivity. This study aimed to evaluate the presence/absence of PRV-1 in formalin-fixed, paraffin-embedded Atlantic salmon heart tissues (FFPE) cultured in Chile during 1992 and 1999. The most frequent histopathological findings in the 42 FFPE blocks were mild focal cardiomyocyte degeneration (57.1%) and a mild focal mononuclear inflammatory infiltrate (21.4%) in the ventricular stratum spongiosum of the heart. One of the 42 heart samples analyzed by RT-qPCR was positive for PRV-1 (2.4%). All samples were negative for other viral and bacterial pathogens that can induce similar histological changes in the heart. Taken together, our results show that PRV-1 has been present in Chile—as a low-virulence genogroup—since at least 1994, 17 years before the first HSMI outbreak in 2011. Finally, archaeovirology can be a valid alternative to contribute to the understanding of the epidemiology of diseases in aquaculture.

Piscirickettsiosis (SRS), caused by Piscirickettsia salmonis, is the main infectious disease that affects farmed Atlantic salmon in Chile. Currently, the official surveillance and control plan for SRS in Chile is based only on the detection of P. salmonis, but neither of its genogroups (LF-89-like and EM-90-like) are included. Surveillance at the genogroup level is essential not only for defining and evaluating the vaccination strategy against SRS, but it is also of utmost importance for early diagnosis, clinical prognosis in the field, treatment, and control of the disease. The objectives of this study were to characterize the spatio-temporal distribution of P. salmonis genogroups using genogroup-specific real-time probe-based polymerase chain reaction (qPCR) to discriminate between LF-89-like and EM-90-like within and between seawater farms, individual fish, and tissues/organs during early infection in Atlantic salmon under field conditions. The spatio-temporal distribution of LF-89-like and EM-90-like was shown to be highly variable within and between seawater farms. P. salmonis infection was also proven to be caused by both genogroups at farm, fish, and tissue levels. Our study demonstrated for the first time a complex co-infection by P. salmonis LF-89-like and EM-90-like in Atlantic salmon. Liver nodules (moderate and severe) were strongly associated with EM-90-like infection, but this phenotype was not detected by infection with LF-89-like or co-infection of both genogroups. The detection rate of P. salmonis LF-89-like increased significantly between 2017 and 2021 and was the most prevalent genogroup in Chilean salmon aquaculture during this period. Lastly, a novel strategy to identify P. salmonis genogroups based on novel genogroup-specific qPCR for LF-89-like and EM-90-like genogroups is suggested.

Introduction: Several strategies have been devised to safely limit the use of thoracic imaging in patients suspected of pulmonary embolism (PE). However, they are based on different rules for clinical probability (CP) assessment, rendering their combination difficult. The four-level pulmonary embolism probability score (4PEPS) allows the combination of all other strategies using a single CP assessment. Methods and analysis: Pragmatic cluster-randomized trial in 20 EDs. Patients with suspected PE will be included and followed for 90 days (number of patients to be included: 2560, 1280 in each arm). Ten centers will be allocated to the control group where physicians will be free to do as they see fit but they will be given the recommendation to apply a validated strategy. Ten centers will be allocated to the interventional group where the physicians will be given the recommendation to apply the 4PEPS strategy. The primary objective will be to demonstrate that the application of the 4PEPS strategy by the emergency physicians, in comparison to current practices, (i) does not increase the risk of serious events related to diagnostic strategies and (ii) significantly reduces the use of thoracic imaging. Ethics and dissemination: The study will be submitted for approval to an institutional ethics review board for all participating centers. If successful, the SPEED&PEPS trial will have an important impact for patients suspected of PE limiting their irradiation and for public health in substantial savings in terms of the direct cost of diagnostic investigations and the indirect cost of hospitalizations due to waiting times or delayed harmful effects. Funding: This work is funded by a French Public Health grant (PREPS-N 2019). The funding source plays no role in the study design, data collection, analysis, interpretation or the writing of the manuscript. Trial registration: ongoing. Trial status: not started.

La ictericia, patología sumamente común en cualquier escenario clínico, la bilirrubina al ser un metabolito de la descomposición del grupo Heme que debe ser metabolizado en el hígado y ser parte de la absorción de ciertos nutrientes en el tracto intestinal, presenta muchos puntos donde su metabolismo o función se puede ver afectado, abriendo una gran gama de posibles etiologías para su aparición, donde la edad del paciente, estilo de vida y comorbilidades deben ser tomados en cuenta, dada la mayor probabilidad de ciertas patologías dependiendo del grupo en el que se encuentre el paciente. Una historia clínica minuciosa de síntomas actuales, antecedentes familiares, medicamentos utilizados, entre otros, es esencial en conjunto con un examen físico detallado, no solo buscando signos directos pero indirectos de alguna patología causante. Los exámenes de gabinete apoyan las sospechas clínicas como las enzimas hepáticas, pruebas de coagulación y anticuerpos virales, además el avance de la tecnología y mayor disponibilidad de ultrasonidos, tomografía y resonancia magnética facilitan el diagnóstico en estos pacientes, así dando mayor facilidad y rapidez al tratar a estos pacientes.

Abstract Aim To illustrate the pre‐hospital management arsenals and protocols in different EMS units, and to estimate the perceived difficulty of diagnosing suspected acute heart failure (AHF) compared with other common pre‐hospital conditions. Methods and results A multinational survey included 104 emergency medical service (EMS) regions from 18 countries. Diagnostic and therapeutic arsenals related to AHF management were reported for each type of EMS unit. The prevalence and contents of management protocols for common medical conditions treated pre‐hospitally was collected. The perceived difficulty of diagnosing AHF and other medical conditions by emergency medical dispatchers and EMS personnel was interrogated. Ultrasound devices and point‐of‐care testing were available in advanced life support and helicopter EMS units in fewer than 25% of EMS regions. AHF protocols were present in 80.8% of regions. Protocols for ST‐elevation myocardial infarction, chest pain, and dyspnoea were present in 95.2, 80.8, and 76.0% of EMS regions, respectively. Protocolized diagnostic actions for AHF management included 12‐lead electrocardiogram (92.1% of regions), ultrasound examination (16.0%), and point‐of‐care testings for troponin and BNP (6.0 and 3.5%). Therapeutic actions included supplementary oxygen (93.2%), non‐invasive ventilation (80.7%), intravenous furosemide, opiates, nitroglycerine (69.0, 68.6, and 57.0%), and intubation 71.5%. Diagnosing suspected AHF was considered easy to moderate by EMS personnel and moderate to difficult by emergency medical dispatchers (without significant differences between de novo and decompensated heart failure). In both settings, diagnosis of suspected AHF was considered easier than pulmonary embolism and more difficult than ST‐elevation myocardial infarction, asthma, and stroke. Conclusions The prevalence of AHF protocols is rather high but the contents seem to vary. Difficulty of diagnosing suspected AHF seems to be moderate compared with other pre‐hospital conditions.

Introduction Patients with lower limb trauma requiring orthopaedic immobilisation may be at risk of venous thromboembolism but opinions differ about who may benefit from thromboprophylactic anticoagulant treatment.The aim of this CASTING study is to demonstrate the safety of thromboprophylaxis based on the Thrombosis Risk Prediction for patients with cast immobilisation (TRiP(cast) score with regards to the 3-month incidence of symptomatic venous thromboembolism events in low-risk patients not receiving thromboprophylaxis, as well as the usefulness of this strategy on the rate of patients receiving anticoagulant treatment in comparison to current practice.Methods and analysis CASTING will be a stepped-wedge cluster randomised controlled clinical trial, performed in 15 emergency departments in France and Belgium. With their informed consent, outpatients admitted to one of the participating emergency departments for a lower limb trauma requiring orthopaedic immobilisation without surgery will be included. All centres will begin the trial with the ‘observational period’ and, every 2 weeks, 1 centre will be randomly assigned to switch to the ‘interventional period’ and to apply the TRiP(cast) score, in which only patients with a score ≥7 will receive thromboprophylactic anticoagulant treatment. The primary endpoint is the rate of clinical thromboembolic events within 90 days following the inclusion of low-risk patients not receiving thromboprophylaxis.Ethics and dissemination The protocol has been approved by the Comité de Protection des Personnes Sud I (Ethics Review ID-RCB: 2019-A01829-48) for France and the Comité d’éthique hôpital-facultaire Saint Luc (N° B403201941338) for Belgium. It is carried out in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. The findings of this study will be disseminated in peer-reviewed journals and at scientific conferences.Trial registration number NCT04064489.

Plant extract is an excellent alternative to reduce methane emissions and ameliorate ruminal fermentation due the presence of the secondary metabolites, however, there are many studies with plants used on human's diet that shows a good result but may occur competition and elevate the costs for the system. Plants consumed by animal have secondary metabolites in quantity and diversity, it can be a good strategy. This work aimed to determine the bromatological composition and characterize the Urochloa humidicola methanol extract such as the presence of secondary metabolites. The samples of the leaves of U. humidicola were collected, dried in the shade with temperature below 40°C, ground in a willey mill in 2 mm particles and subjected to cold maceration with methanol. The solution obtained was filtered by filter paper and concentrated in a rotary evaporator and put to finish the process, drying under airflow. The results of bromatological analyses were subjected to ANOVA by comparing averages by Fisher's test using the 9.1 Saeg software and phytochemical prospecting testes were characterized as the intensity of the presence of each class of metabolites and represented via the cross-system where:(+++) implies a large presence, (++) implies a considerable presence, (+) implies a small presence and (0) implies a no presence. The dry crude methanolic extract was subjected to analysis of chemical composition and phytochemical prospecting. The extract showed 10.20% crude protein and 35% ether extract and traces of fibrous constituents, because the methanol extraction extracted only soluble constituents. A phytochemical prospecting was positive for the presence of saponin. tannin, alkaloids, catechins, non-protein amino acids and saccharides and was negative for the presence of flavonoids and purines. The U. humidicola methanol extract can be used as a phytogenic additive in the feeding of ruminants. [ABSTRACT FROM AUTHOR]

The mission of veterinary clinical pathology is to support the diagnostic process by using tests to measure different blood biomarkers to support decision making about farmed fish health and welfare. The objective of this study is to provide reference intervals (RIs) for 44 key hematological, blood biochemistry, blood gasometry and hormones biomarkers for the three most economically important farmed salmonid species in Chile (Atlantic salmon, coho salmon and rainbow trout) during the freshwater (presmolt and smolt age range) and seawater stages (post-smolt and adult age range). Our results confirmed that the concentration or activity of most blood biomarkers depend on the salmonid species, age range and/or the interaction between them, and they are often biologically related to each other. Erythogram and leukogram profiles revealed a similar distribution in rainbow trout and coho salmon, but those in Atlantic salmon were significantly different. While the activity of the most clinically important plasma enzymes demonstrated a similar profile in Atlantic salmon and rainbow trout, coho salmon demonstrated a significantly different distribution. Plasma electrolyte and mineral profiles showed significant differences between salmonid species, especially for rainbow trout, while Atlantic salmon and coho salmon demonstrated a high degree of similarity. Furthermore, electrolytes, minerals and blood gasometry biomarkers were significantly different between age ranges, suggesting a considerably different distribution between freshwater and seawater-farmed fish. The RIs of clinically healthy fish described in this study take into account the high biological variation of farmed fish in Chile, as the 3.059 individuals came from 78 different fish farms, both freshwater and seawater, and blood samples were collected using the same pre-analytical protocol. Likewise, our study provides the Chilean salmon farming industry with standardized protocols that can be used routinely and provides valuable information to improve the preventive vision of aquamedicine through the application of blood biomarkers to support and optimize health, welfare and husbandry management in the salmon farming industry.

Bacterial kidney disease (BKD) is widespread in many areas of the world and can cause substantial economic losses for the salmon aquaculture industry. The objective of this study was to investigate the pathophysiological response and gene expression profiles related to the immune response at different water temperatures and to identify the best immunopathological biomarkers to define a phenotype of resistance to BKD. The abundance of msa transcripts of R. salmoninarum in the head kidney was significantly higher in infected fish at 11°C. R. salmoninarum induced significantly more severe kidney lesions, anemia and impaired renal function at 11°C. In addition, the expression pattern of the genes related to humoral and cell-mediated immune responses in infected fish at 11 and 15°C was very similar, although R. salmoninarum induced a significantly greater downregulation of the adaptive immune response genes at the lower water temperature. These results could be due to a suppressed host response directly related to the lowest water temperature and/or associated with a delayed host response related to the lowest water temperature. Although no significant differences in survival rate were observed, fish infected at the lowest temperature showed a higher probability of death and delayed the mortality curve during the late stage of infection (35 days after infection). Thirty-three immunopathological biomarkers were identified for potential use in the search for a resistance phenotype for BKD, and eight were genes related specifically to the adaptive cell-mediated immune response.

Sweet potato, in Argentina, is affected by the “encrespamiento amarillo”, a viral disease in which seven viruses are involved, among them two potyvirus (sweet potato feathery mottle virus - SPFMV and sweet potato virus G - SPVG) and a crinivirus (sweet potato chlorotic stunt virus - SPCSV). This research aimed to study the interaction between SPFMV and SPVG with SPCSV in sweet potato. Two sweet potato cultivars (Gem and Arapey INIA) and Ipomoea setosa as an indicator susceptible plant were tested as single (SPFMV or SPVG), double (SPFMV + SPVG, SPFMV + SPCSV or SPVG + SPCSV) or triple (SPFMV + SPVG + SPCSV) grafts. Both potyviruses were purified and the viral concentrations in the plant tissues were quantified by the DAS-Elisa method. The viruses and their severities were evaluated at 7, 15, 21, 30 and 35 days post-inoculation. A synergistic effect was observed with the three viruses in the indicator plant. The viral concentration increase was 50 times for SPFMV (day 35) and two times for SPVG (day 21) in the Gem cultivar, and 1.89 times for SPFMV (day 35) and three times for SPVG (day 7) in the Arapey INIA. For multiple infections, the indicator plant and the Gem cultivar exhibited synergistic symptoms and increase in the viral titers, with a higher severity and variability of the symptoms. Co-infections such as SPFMV + SPVG showed characteristic potyvirus symptoms, without increasing the viral concentrations; triple co-infections exhibited viral complex symptoms, with increase in the potyvirus titers; and the symptoms were mild or imperceptible in the simple infections.

Background: Patients with lower-limb trauma requiring immobilization have an increased risk of venous thromboembolism (VTE). While thromboprophylaxis for all patients seems not effective, targeted thromboprophylaxis in high risk patients may be an appropriate alternative. Therefore, we aimed to develop and validate a risk assessment model for VTE risk: the TRiP(cast) score (Thrombosis Risk Prediction following cast immobilization). Methods: In this prediction model study, for development, data were used from the MEGA study (case-control study into the etiology of VTE) and for validation, data from the POT-CAST trial (randomized trial on the effectiveness of thromboprophylaxis following cast immobilization) were used. Model discrimination was calculated by estimating the Area Under the Curve (AUC). For model calibration, observed and predicted risks were assessed. Findings: The TRiP(cast) score includes 14 items; one item for trauma severity (or type), one for type of immobilization and 12 items related to patients’ characteristics. Validation analyses showed an AUC of 0.74 (95%CI 0.61–0.87) in the complete dataset (n = 1250) and 0.72 (95%CI 0.60–0.84) in the imputed data set (n = 1435). The calibration plot shows the degree of agreement between the observed and predicted risks (intercept 0.0016 and slope 0.933). Using a cut-off score of 7 points in the POT-CAST trial (incidence 1.6%), the sensitivity, specificity, positive and negative predictive values were 76.1%, 51.2%, 2.5%, and 99.2%, respectively. Interpretation: The TRiP(cast) score provides a helpful tool in daily clinical practice to accurately stratify patients in high versus low-risk categories in order to guide thromboprophylaxis prescribing. To accommodate implementation in clinical practice a mobile phone application has been developed. Funding: ZonMW VIMP grant:17110200011. Keywords: Immobilization, Prediction, Risk assessment model, Risk, Trauma, Venous thromboembolism

Abstract  During early seedling development of oil seed plants, the transition from lipid based heterotrophic to photoautotrophic carbohydrate metabolism is accompanied with a biphasic control of the chloroplast antioxidant system. In continuous light, organellar peroxiredoxins (Prx) and thylakoid-bound ascorbate peroxidase (tAPx) are activated early in seedling development, while stromal ascorbate peroxidase (sAPx), Cu/Zn-superoxide dismutase-2 (Csd2) and monodehydroascorbate reductase (MDHAR) and the cytosolic peroxiredoxins PrxIIB, PrxIIC and PrxIID are fully activated between 2.5 and 3 days after radicle emergence (DARE). Discontinuous light synchronized the expression of chloroplast antioxidant enzymes, but defined diurnally specific typeII-Prx-patterns in the cytosol and initiated chloroplast senescence around 2.5 DARE. Carbohydrate feeding uncoupled sAPx expression from the light pattern. In contrast, sucrose-feeding did not significantly impact on Prx transcript amounts. It is concluded that upon post-germination growth Prxs are activated endogenously to provide early antioxidant protection, which is supported by the Halliwell–Asada-Cycle, whose expressional activation depends on metabolic signals provided only later in development or in day-night-cycles. [ABSTRACT FROM AUTHOR]

The diversity of arbuscular mycorrhizal fungi (AMF) communities in agricultural systems depends on biotic and abiotic factors as well as on cultural practices. This research aimed to evaluate the diversity of AMF present in an altitudinal transect cultivated with cape gooseberry (Physalis peruviana L.). A set of 13 soil samples from cape gooseberry plantations located in the Colombian Andean mountains in the provinces of Cundinamarca and Boyaca were collected during dry (0-20 mm/month) and rainy (150-330 mm/month) seasons between 1500 and 3000 m a.s.l., in order to establish the relationship between the altitudinal characteristics and AMF diversity. The evaluation of the abundance of spores and species and diversity indexes showed the presence of 46 AMF species in the dry season and 31 in the rainy season. This shows the high diversity of AMF in the tropical Andes with spore abundance between 20 and 120 spores 10 g-1 of soil in the rainy season and between 127 and 1531 spores 10 g-1 of soil in the dry season.

Inhibitors of DNA methyltransferases (DNMTs) are attractive compounds for epigenetic drug discovery. They are also chemical tools to understand the biochemistry of epigenetic processes. Herein, we report five distinct inhibitors of DNMT1 characterized in enzymatic inhibition assays that did not show activity with DNMT3B. It was concluded that the dietary component theaflavin is an inhibitor of DNMT1. Two additional novel inhibitors of DNMT1 are the approved drugs glyburide and panobinostat. The DNMT1 enzymatic inhibitory activity of panobinostat, a known pan inhibitor of histone deacetylases, agrees with experimental reports of its ability to reduce DNMT1 activity in liver cancer cell lines. Molecular docking of the active compounds with DNMT1, and re-scoring with the recently developed extended connectivity interaction features approach, led to an excellent agreement between the experimental IC50 values and docking scores.

Background: Most patients with cerebral palsy (CP) do not respond to physical therapy due to deterioration in their nutritional status, secondary to gastrointestinal disorders and the catabolic state of the disease itself. However, basic treatments only contemplate the energy requirements and do not consider supplementation with glutamine, zinc, selenium, colecalciferol, spirulina, omega 3 or even vegetal proteins. Objective: In this study, we determined the effect of using a nutritional support system (NSS): diet and supplements, on the gross motor function in children with CP with spastic diparesic and Gross Motor Function Classification System III (GMFCS III). Methods: An exploratory study was performed. Thirty patients (from 4 to 12 years old) were randomly assigned to: (1) dietary surveillance (FG), (2) deworming and WHO diet (CG), or (3) deworming and the NSS (IG). Gross motor function was evaluated using the gross motor function measure (GMFM) scale. Results: The IG-treated group presented a significant improvement in standing and walking parameters analyzed in the GMFM compared with FG and CG groups. Fifty percent of the IG-treated patients managed to walk, while in the other groups, no patients were able to walk. Conclusions: The NSS used in the present work improves gross motor function and promotes walking in patients with CP.

The intramandibular gland II in Polybia emaciata Lucas is described. This species is among the few that uses mud for nest construction, and their nests persist for a long time following abandonment. The intramandibular gland II has been found in single representatives of the genera Mischocyttarus, Apoica and Leipomeles, and this record is the second for the genus Polybia. Despite expectations derived from the nest characteristics of the species, gland dimensions such as cell diameter were well within the range observed for other species, with the cell number even comparatively small. Gland function remains to be investigated.

En el presente trabajo realizamos una revisión y actualización de las acciones, indicaciones, reacciones adversas y sus tratamientos, interacciones y contraindicaciones de los distintos medios de contrastes.In this review, we revised and updated the actions, indications, interactions and contraindications of the different contrast media, as well as their adverse reactions and how to treat them.

Objective: An early differential diagnosis is mandatory when facing a patient with clinical shock of unclear aetiology, in order to guide proper treatment. We assessed if the expired CO2 measurement and alveolar-arterial CO2 calculation could improve the differential diagnosis of shock during its initial presentation, particularly in separating pulmonary embolism from other causes of shock. Methods: We analysed the charts of 12 patients who presented with clinical shock and had end-tidal CO2 (EtCO2) and arterial CO2 partial pressure (PaCO2) measurements. Results: In cases with pulmonary embolism-related shock (n = 3), the gradient between PaCO2 and EtCO2 was increased (37 vs 0.2 mmHg). There was a similar trend for a higher PaCO2 value (60 vs 32.2 mmHg) and a lower EtCO2 value (23 vs 32 mmHg). Conclusion: An initial CO2 measurement might be an easily available tool for the early diagnostic work-up of clinical shock.

La nutrición de las plantas de uchuva es determinante para obtener un alto rendimiento del cultivo y garantizar el nivel de calidad del producto para exportación. Con el fin de caracterizar la fertilidad química de los suelos de las zonas productoras de uchuva en Cundinamarca, se realizó un muestreo en dos de los principales municipios productores, como son Granada y Silvania. Para tal fin se seleccionaron 30 fincas en las cuales se realizó el muestreo de suelos y la posterior caracterización química y su relación con el contenido de nutrientes disponibles para las plantas. Se hizo la comparación de municipios con el fin de determinar la conveniencia de un manejo similar o, en caso contrario, específico por zona. Se encontraron diferencias significativas entre los dos municipios, relacionadas especialmente con el contenido de materia orgánica en el suelo, pero además se observaron serios problemas de desbalance de cationes y alta acidez, que requieren una planificación adecuada de la fertilización. Además, los altos niveles de micronutrientes Mn y Cu pueden ser limitantes para el cultivo de uchuva. Se analizaron los componentes principales asociados a la fertilidad de los suelos y se hicieron recomendaciones generales por zona que deben ajustarse a nivel de finca.

La transferencia de plántulas de mora de condiciones in vitro a ex vitro es una de las fases más críticas de la técnica de micropropagación debido al alto grado de mortalidad de plántulas (50 a 90%), como consecuencia de una cutícula poco desarrollada, estomas no funcionales y un sistema radical débil que facilita la deshidratación por estrés hídrico. Esta investigación se orientó a la obtención de plántulas limpias procedentes de cultivo de tejidos y endurecidas con micorrizas arbusculares (HMA). La investigación se realizó bajo condiciones controladas; se utilizó un diseño experimental de bloques completos al azar con ocho tratamientos, tres repeticiones y cuatro unidades experimentales, así: tres tratamientos testigo sin inoculación, sin fertilizar (T0), con 50% de fertilización (T50), y con 100% de fertilización (T100), y cinco tratamientos inoculados con HMA (MA1, MA2, MA3, MA4 y Mycobiol) más T50. Los mayores beneficios de la inoculación con HMA se lograron con la cepa MA4 aislada de Silvania (Cundinamarca) y con esporas nativas clasificadas como Glomus sp. y Acaulospora sp. Las plantas inoculadas mostraron mejor adaptación al ambiente, expresada en el porte, la acumulación de biomasa foliar y radical, mayor área foliar y mejor estado nutricional expresado en una mayor absorción de nutrientes esenciales (P, N, Ca y Mg). El uso de la cepa MA4 permitió sustituir el 50% de la fertilización comercial debido a que obtuvo valores similares a T100 en la absorción de P y Ca, y superiores a ésta en la absorción de N y Mg. Este comportamiento vegetal se explicó por los niveles de colonización del hongo en las raíces.