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Abstract Antibiotic resistance is a global healthcare crisis. Bacteria are highly adaptable and can rapidly acquire mechanisms of resistance towards conventional antibiotics. The permeability barrier conferred by the Gram-negative bacteria cell envelope constitutes a first line of defence against the action of antibiotics. Exposure to extracytoplasmic stresses can negatively affect cell envelope homoeostasis and this causes localised protein misfolding, compromised envelope integrity and impairs barrier function. The CpxA-CpxR two-component regulatory system has evolved to sense extracytoplasmic stresses and to regulate processes that restore homoeostasis of the cell envelope. Hence, controlled Cpx-signalling assists bacteria in adapting, surviving and proliferating in harsh environments, including exposure to antibiotics. Herein, we determined that an intact Cpx-signalling is key to maintaining the Yersinia pseudotuberculosis resistance to colistin and polymyxin B. The susceptibility displayed by Cpx-signalling defective mutants, correlated with cell-envelope deformity and specific modifications of Lipid-A. In vivo transcriptional analysis and in vitro protein-DNA binding studies demonstrated that these modifications were dependent on the direct regulation of Lipid-A biogenesis and modifications of operons by the active phosphorylated CpxR~P isoform. Altogether, our work defines the regulatory mechanism that enables Cpx-signalling to actively control cell envelope remodelling and the permeability of antibiotics in the clinically relevant enteropathogen Y. pseudotuberculosis.

Abstract A lactate/albumin ratio (LAR) greater than 0.5 measured early in the course of pediatric critical illness is associated with greater mortality. Whether the elevated LAR can be explained by microcirculation disorders in children with sepsis is not known. In this longitudinal retrospective study (January 2021-January 2024), serum albumin and lactate were measured on admission to the pediatric intensive care unit (PICU), with sublingual video microscopy performed simultaneously to measure microcirculation. A total of 178 children were included, 37% of whom had septic shock measured with the Phoenix Sepsis Score. Patients with remote sepsis had greater odds of an elevated LAR (aOR 6.87: 95% CI 1.98–23.73; p

The use of Fibre Reinforced Cementitious Matrix (FRCM) for structural retrofitting requires prior assessment of the composite’s mechanical properties, particularly its tensile stress–strain response. This paper presents a LASSO regression model applied to 107 uniaxial tensile tests on Carbon FRCM in order to investigate the impact of both the material and testing parameters on FRCM performance. A highly effective LASSO regression model was trained using k-fold validation, resulting in concise and comprehensible models. Within the testing parameters, both the gripping system and load–speed ratio significantly affected the performance. A substantial impact on ultimate values was found for the load–speed ratio. From the material-related parameters, the most influential was the textile coating in terms of strength and the existence of bilinear or trilinear behaviour. It was also concluded that the combination of textile and matrix properties influenced the stress–strain response at all stages, with high-performance mortars resulting in better textile-to-matrix interaction.

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Abstract Backgrounds In children with sepsis, circulatory shock and multi-organ failure remain major contributors to mortality. Prolonged capillary refill time (PCRT) is a clinical tool associated with disease severity and tissue hypoperfusion. Microcirculation assessment with videomicroscopy represents a promising candidate for assessing and improving hemodynamic management strategies in children with sepsis. Particularly when there is loss of coherence between the macro and microcirculation (hemodynamic incoherence). We sought to evaluate the association between PCRT and microcirculation changes in sepsis. Methods This was a prospective cohort study in children hospitalized with sepsis. Microcirculation was measured using sublingual video microscopy (capillary density and flow and perfused boundary region [PBR]—a parameter inversely proportional to vascular endothelial glycocalyx thickness), phalangeal tissue perfusion, and endothelial activation and glycocalyx injury biomarkers. The primary outcome was the association between PCRT and microcirculation changes. Results A total of 132 children with sepsis were included, with a median age of two years (IQR 0.6–12.2). PCRT was associated with increased glycocalyx degradation (PBR 2.21 vs. 2.08 microns; aOR 2.65, 95% CI 1.09–6.34; p = 0.02) and fewer 4–6 micron capillaries recruited (p = 0.03), with no changes in the percentage of capillary blood volume (p = 0.13). Patients with hemodynamic incoherence had more PBR abnormalities (78.4% vs. 60.8%; aOR 2.58, 95% CI 1.06–6.29; p = 0.03) and the persistence of these abnormalities after six hours was associated with higher mortality (16.5% vs. 6.1%; p

The knowledge of architecture, initially through the direct follow-up of the Vitruvio`s manuscript and later from the intervention of the writers and architects of the Renaissance, has sought to be transmitted over time through the meeting of Its precepts in theoretical works capable of maintaining the principles of shape, style and proportion, guideline and basis for architects and future works. As regards the architect and treatise writer Fray Lorenzo de San Nicolás, we have seen that the theoretical proposals collected in his book “Arte y Uso de Arquitectura” are reflected in their own buildings. Through digital photogrammetric rising techniques we have been able to analyze the degree of approximation or coherence between the theory and the built project.

Summary: Trained immunity (TI) represents a memory-like process of innate immune cells. TI can be initiated with various compounds such as fungal β-glucan or the tuberculosis vaccine, Bacillus Calmette-Guérin. Nevertheless, considering the clinical applications of harnessing TI against infections and cancer, there is a growing need for new, simple, and easy-to-use TI inducers. Here, we demonstrate that heat-killed Mycobacterium tuberculosis (HKMtb) induces TI both in vitro and in vivo. In human monocytes, this effect represents a truly trained process, as HKMtb confers boosted inflammatory responses against various heterologous challenges, such as lipopolysaccharide (Toll-like receptor [TLR] 4 ligand) and R848 (TLR7/8 ligand). Mechanistically, HKMtb-induced TI relies on epigenetic mechanisms in a Syk/HIF-1α-dependent manner. In vivo, HKMtb induced TI when administered both systemically and intranasally, with the latter generating a more robust TI response. Summarizing, our research has demonstrated that HKMtb has the potential to act as a mucosal immunotherapy that can successfully induce trained responses.

Background Sepsis is one of the main causes of morbidity and mortality worldwide. Fluid resuscitation is among the most common interventions and is associated with fluid overload (FO) in some patients. The objective of this systematic review and meta-analysis was to summarise the available evidence on the association between FO and morbimortality in children with sepsis.Methods A systematic search was carried out in PubMed/Medline, Embase, Cochrane and Google Scholar up to December 2022 (PROSPERO 408148), including studies in children with sepsis which reported more than 10% FO 24 hours after admission to intensive care. The risk of bias was assessed using the Newcastle-Ottawa scale. Heterogeneity was assessed using I2, considering it absent if 75%. A sensitivity analysis was run to explore the impact of the methodological quality on the size of the effect. Mantel-Haenszel’s model of random effects was used for the analysis. The primary outcome was to determine the risk of mortality associated with FO and the secondary outcomes were the need for mechanical ventilation (MV), multiple organ dysfunction syndrome (MODS) and length of hospital stay associated with FO.Results A total of 9 studies (2312 patients) were included, all of which were observational. Children with FO had a higher mortality than patients without overload (46% vs 26%; OR 5.06; 95% CI 1.77 to 14.48; p

En el presente trabajo se ha investigado con detalle un episodio de crecida en un manantial kárstico destinado al abastecimiento de Ubrique (Serranía de Grazalema, provincia de Cádiz). Para ello se ha aplicado un conjunto de técnicas encaminadas a la caracterización del transporte de sedimento y de la presencia de Escherichia coli como indicador de contaminación fecal. Los resultados muestran las variaciones temporales de parámetros físico-químicos, la distribución de partículas y sus implicaciones directas en el transporte de bacterias en un manantial kárstico durante un episodio de lluvia intensa. Además, se analiza la utilidad del control continuo de dichos parámetros para el desarrollo de un sistema de medida y envío remoto de datos con el fin de prevenir la contaminación en manantiales destinados al consumo humano.

Flow visualization is necessary in fields such as engineering, since it allows us to know what is happening around the element being studied by means of a preliminary method, although it is relatively close to future research and computation methodology. The present project studies the interference at the anemometers of the Mars rover Perseverance, caused by the mast holding one of its cameras. After obtaining the model, manufactured by a 3D printer, it was placed inside a hydrodynamic towing tank, and red dye was added for a visual observation of the interference during the experiment. A comparison was made between the results achieved and those seen in a wind tunnel, realizing the high correlation they have. Finally, this paper promotes the use of the hydrodynamic towing tank in preliminary studies due to its low costs, considering the adequate comparison with other higher precision methodologies.

The globalisation of the labour market creates new challenges for organisations when hiring. This article addresses one such challenge that is rarely in the spotlight: the implications of the choice of a language proficiency test for non-native speakers by the hiring organisation. We use the UK National Health Service (NHS) recruitment practices as an example. With the help of a staged experiment, this practice-based study argues that the current international recruitment procedure to the NHS tends to underestimate some important differences between language as a formalised system of words and grammatical rules and discourse as ‘language in action’, causing the loss of staffing capacity. It follows from our analysis that when setting the requirements and objectives of a language test, the recruiting organisations need to consider more explicitly the social and cultural context in which their employees operate and the impact of this context on the communication demands faced by the staff.

Fluid resuscitation with crystalloids has been used in humans for more than 100 years. In patients with trauma, sepsis or shock of any etiology, they can help modify the clinical course of the illness. However, these solutions are medications which are not side-effect free. Recently, they have been questioned in terms of quantity (fluid overload) and their composition. The most frequently used crystalloids, both in high and low-income countries, are 0.9% normal saline (NS) and Ringer's lactate. The first descriptions of the use of sodium and water solutions in humans date from the cholera epidemic which spread throughout Europe in 1831. The composition of the fluids used by medical pioneers at that time differs greatly from the 0.9% NS used routinely today. The term “physiological solution” referred to fluids which did not cause red blood cell hemolysis in amphibians in in vitro studies years later. 0.9% NS has an acid pH, a more than 40% higher chloride concentration than plasma and a strong ion difference of zero, leading many researchers to consider it an unbalanced solution. In many observational studies and clinical trials, this 0.9% NS composition has been associated with multiple microcirculation and immune response complications, acute kidney injury, and worse clinical outcomes. Ringer’s lactate has less sodium than plasma, as well as other electrolytes which can cause problems in patients with traumatic brain injury. This review provides a brief summary of the most important historical aspects of the origin of the most frequently used intravenous crystalloids today.

The cave's physical environment can be affected by tourism activities but only a few studies evaluated how recreational use may affect the cave fauna, mainly in caves with a low number of visitors per year. To test the hypothesis that recreational use led to changes in habitat structure and invertebrate diversity, distinct scales along a cave were analyzed. Distinct areas with and without human visitation were analyzed and transects (10 x 3 m) and quadrats (1 x 1 m) were used to access the invertebrate communities and environmental traits. Thirty-two invertebrate species were recorded, among which six are troglobitic. The similarity of non- troglobitic species differed between the visited and non-visited areas. Substrate composition inside transects differed between the two areas and the differences were higher in the percentage of matrix rock and fine sediments. The distance from the entrance influenced the similarity of non-troglobitic species while troglobitic fauna responded to the proportion of sandy sediment. Inside quadrats, both matrix rock and fine sediments influenced the similarity of non-troglobitic species. Similarity of non-troglobitic species in the visited area was explained by the proportion of matrix rock in transects and quadrats. The proportion of cobbles influenced the similarity of non-troglobitic species in quadrats in the non-visited area. The non-troglobitic species richness inside quadrants was positively related to the amount of guano, wood, fine sediment, boulders, cobbles, matrix rock, sand sediment, and plant debris. Differentiation in habitat structure and faunal composition between the two areas seems to be an effect of distance from the entrance and spatial heterogeneity, but not recreational activities.

This paper presents a study based on wind tunnel research on biplane configurations. The objective of this research is to establish an experimental basis for relationships between the main geometrical parameters that define a biplane configuration (stagger, decalage, gap, and sweep angle) and the aerodynamic characteristics (CL, CD). This experimental study focuses on a 2D approach. This method is the first step towards dealing with the issue, and it allows the variables involved in the tests to be reduced. The biplane configuration has been compared with the monoplane configuration to analyze the viability for implementing the biplane configuration in the field of application for micro air vehicles (MAV). At present, the biplane and other unusual configurations have not been a common design for MAV; however, they do have unlimited future potential. A set of experimental tests were carried out on various biplane configurations at low Reynolds numbers, which allowed the criteria for selecting the best wing configuration to be defined. The results obtained here show that the biplane configuration provides a higher maximum lift coefficient (CLmax) than the planar wing (monoplane). Furthermore, it has a larger wetted surface than the planar configuration, so the parasitic drag increases for the biplane configuration. This research is focused on a drone flight regime (low Reynolds number), and in this case, the parasitic drag (profile drag) has an important role in the total drag of the airplane. This study considers whether the reduction in the induced drag due to three–dimensional configuration (biplanes, box–wings, and joined–wings) can reduce the total drag or if the increase in the parasitic drag is bigger. Additionally, the increase in lift and the decrease in parasitic drag (profile drag) will be studied to determine if they have a greater influence on the performance of the airplane than the increase in structural weight. Further research is planned to be performed on 3D prototypes, with the selected configurations, and applied to nonconventional wing planforms.

IntroductionPediatric and neonatal sepsis is one of the main causes of mortality and morbidity in these age groups. Accurate and early etiological identification is essential for guiding antibiotic treatment, improving survival, and reducing complications and sequelae. Currently, the identification is based on culture-dependent methods, which has many limitations for its use in clinical practice, and obtaining its results is delayed. Next-generation sequencing enables rapid, accurate, and unbiased identification of multiple microorganisms in biological samples at the same time. The objective of this study was to characterize the etiology of neonatal and pediatric sepsis by metagenomic techniques.MethodsA systematic review of the literature was carried out using the PRISMA-2020 guide. Observational, descriptive, and case report studies on pediatric patients were included, with a diagnostic evaluation by clinical criteria of sepsis based on the systemic inflammatory response, in sterile and non-sterile biofluid samples. The risk of bias assessment of the observational studies was carried out with the STROBE-metagenomics instrument and the CARE checklist for case reports.Results and DiscussionFive studies with a total of 462 patients were included. Due to the data obtained from the studies, it was not possible to perform a quantitative synthesis (meta-analysis). Based on the data from the included studies, the result identified that mNGS improves the etiological identification in neonatal and pediatric sepsis, especially in the context of negative cultures and in the identification of unusual microorganisms (bacteria that are difficult to grow in culture, viruses, fungi, and parasites). The number of investigations is currently limited, and the studies are at high risk of bias. Further research using this technology would have the potential to improve the rational use of antibiotics.

Abstract Background The clinical presentation and severity of Multisystem Inflammatory Syndrome in Children associated with COVID-19 (MIS-C) is widespread and presents a very low mortality rate in high-income countries. This research describes the clinical characteristics of MIS-C in critically ill children in middle-income countries and the factors associated with the rate of mortality and patients with critical outcomes. Methods An observational cohort study was conducted in 14 pediatric intensive care units (PICUs) in Colombia between April 01, 2020, and January 31, 2021. Patient age ranged between one month and 18 years, and each patient met the requirements set forth by the World Health Organization (WHO) for MIS-C. Results There were seventy-eight children in this study. The median age was seven years (IQR 1-11), 18 % (14/78) were under one year old, and 56 % were male. 35 % of patients (29/78) were obese or overweight. The PICU stay per individual was six days (IQR 4-7), and 100 % had a fever upon arrival to the clinic lasting at least five days (IQR 3.7-6). 70 % (55/78) of patients had diarrhea, and 87 % (68/78) had shock or systolic myocardial dysfunction (78 %). Coronary aneurysms were found in 35 % (27/78) of cases, and pericardial effusion was found in 36 %. When compared to existing data in high-income countries, there was a higher mortality rate observed (9 % vs. 1.8 %; p=0.001). When assessing the group of patients that did not survive, a higher frequency of ferritin levels was found, above 500 ngr/mL (100 % vs. 45 %; p=0.012), as well as more cardiovascular complications (100 % vs. 54 %; p = 0.019) when compared to the group that survived. The main treatments received were immunoglobulin (91 %), vasoactive support (76 %), steroids (70.5 %) and antiplatelets (44 %). Conclusions Multisystem Inflammatory Syndrome in Children due to SARS-CoV-2 in critically ill children living in a middle-income country has some clinical, laboratory, and echocardiographic characteristics similar to those described in high-income countries. The observed inflammatory response and cardiovascular involvement were conditions that, added to the later presentation, may explain the higher mortality seen in these children.

Introduction: Pediatric hydrocephalus is highly prevalent and therefore a major neurosurgical problem in Africa. In addition to ventriculoperitoneal shunts, which have high cost and potential complications, endoscopic third ventriculostomy is becoming an increasingly popular technique especially in this part of the world. However, performing this procedure requires trained neurosurgeons with an optimal learning curve. For this reason, we have developed a 3D printed training model of hydrocephalus so that neurosurgeons without previous experience with endoscopic techniques can acquire these skills, especially in low-income countries, where specific techniques training as this, are relatively absent. Research Question: Our research question was about the possibility to develop and produce a low-cost endoscopic training model and to evaluate the usefulness and the skills acquired after training with it. Material and Methods: A neuroendoscopy simulation model was developed. A sample of last year medical students and junior neurosurgery residents without prior experience in neuroendoscopy were involved in the study. The model was evaluated by measuring several parameters, as procedure time, number of fenestration attempts, diameter of the fenestration, and number of contacts with critical structures. Results: An improvement of the average score on the ETV-Training-Scale was noticed between the first and last attempt (11.6, compared to 27.5 points; p

The international sepsis guidelines emphasize the importance of early identification along with the combined administration of fluids, antibiotics and vasopressors as essential steps in the treatment of septic shock in childhood. However, despite these recommendations, septic shock mortality continues to be very high, especially in countries with limited resources. Cardiovascular involvement is common and, in most cases, determines the outcomes. Early recognition of hemodynamic dysfunction, both in the macro and microcirculation, can help improve outcomes. Capillary refill time (CRT) is a useful, available and easily accessible tool at all levels of care. It is a clinical sign of capillary vasoconstriction due to an excessive sympathetic response which seeks to improve blood redistribution from the micro- to the macrocirculation. An important reason for functionally evaluating the microcirculation is that, in septic shock, the correction of macrocirculation variables is assumed to result in improved tissue perfusion. This has been termed “hemodynamic coherence.” However, this coherence often does not occur in advanced stages of the disease. Capillary refill time is useful in guiding fluid resuscitation and identifying more seriously affected sepsis patients. Several factors can affect its measurement, which should preferably be standardized and performed on the upper extremities. In this review, we seek to clarify a few common questions regarding CRT and guide its correct use in patients with sepsis.

The paper outlines an algorithm for the rapid aerodynamic evaluation of winglet geometries using the TORNADO Vortex Lattice Method. It is a very useful tool to obtain a first approximation of the aerodynamic properties and for performing an optimization of the geometry design. The TORNADO tool is used to systematically calculate the aerodynamic characteristics of various wings with wingtip devices. The fast response of the aerodynamic models allows obtaining a set of results in a remarkably short time. Therefore, the development of an algorithm to generate wing geometries with great ease and complex shapes is of vital importance for the mentioned optimization process. The basic outline of the algorithm, the equations defining the wing geometries, and the results for unconventional wingtip devices, such as blended winglets and spiroid winglets, are presented. Finally, this algorithm allows designing a procedure to study the improvement of aerodynamic properties (lift, induced drag, and moment). Some examples are included to illustrate the capabilities of the algorithm.

Abstract Moving towards a sustainable society implies constant improvement in the way energy is supplied and consumed, with wider implementation of solar and wind energy facilities in stand‐alone or hybrid configurations. The goal of this work is to evaluate the lifecycle performance (construction and operation‐related impact) of large‐scale solar and wind energy systems and to compare it with conventional coal and natural gas fossil fuel plants under similar conditions. Environmental analyses of energy conversion systems today usually neglect the construction‐related environmental impact of fossil fuel plants, because it is significantly smaller than the impact related to the operation of the plant. However, the construction of large‐scale renewable plants implies the use of rare materials, transport‐related emissions, and other environmentally impactful activities. The plants evaluated here are configured and compared for similar emissions and similar power output. It is found that the life‐cycle environmental impact of the renewable plants could, in some specific cases, exceed that of the fossil fuel plants. Understanding the reasons behind this and the possible limitations of the different technologies can help plan for sustainable energy systems in the future. Finally, solutions to minimize the impact of renewable energy are proposed for more environmentally friendly implementation and future research.

This article aims to highlight the importance of utilizing flow visualization techniques in the preliminary analysis of streamlined and bluff bodies, especially the potential use of visualization with ink in a water channel as a tool for a preliminary approach during fluid mechanics analysis. According to this, the study compares the results obtained using a classical flow visualization technique, ink injection in water, with those obtained through the employment of a laser-based measurement and visualization technique, called PIV, in a low-speed wind tunnel. The article briefly presents both techniques and highlights the importance of flow visualization in the analysis of aerodynamic bodies. This study focuses on flow over NACA airfoils at extremely low Reynolds numbers, which is of great interest for application in extraterrestrial atmospheres, such as on Mars. After obtaining images of the flow streamlines over the NACA 0018 airfoil, the results of both techniques were compared. The results indicated that there was good agreement between the visualization with the water channel and the PIV results, suggesting that the results obtained in the water channel represented a scientifically valid approximation and an essential complement to computational models that require experimental validation.

Abstract Background Encrustation of ureteral double J stents is a common complication that may affect its removal. The aim of the proposed study is to evaluate the efficacy and safety of a new oral composition to prevent double J stent encrustation in indwelling times up to 8 weeks. Methods A double-blinded, multicenter, placebo-controlled trial was conducted with 105 patients with indwelling double J stents enrolled across 9 public hospitals in Spain. The patients were randomly assigned (1:1) into intervention (53 patients) or placebo (52 patients) groups for 3 to 8 weeks and both groups self-monitored daily their morning urine pH levels. The primary outcome of analysis was the degree of stent ends encrustation, defined by a 4-point score (0 – none; 3 – global encrustation) using macroscopic and electron microscopy analysis of crystals, after 3 to 8-w indwelling period. Score was exponentially transformed according to calcium levels. Secondary endpoints included urine pH decrease, stent removal, and incidence of adverse events. Results The intervention group benefits from a lower global encrustation rate of stent ends than placebo group (1% vs 8.2%; p

The early diagnosis and appropriate stratification of sepsis continues to be one of the most important challenges in modern medicine. Single isolated biomarkers have not been enough to improve diagnostic and prognostic strategies and to progress toward therapeutic goals. The information generated by the human genome project has allowed a more holistic approach to the problem. The integration of genomics, transcriptomics, proteomics and metabolomics in sepsis has allowed us to progress in the knowledge of new pathways which are pathophysiologically involved in this disease. Thus, we have understood the importance of and complex interaction between the inflammatory response and the endothelium. Understanding the role of important parts of the microcirculation, such as the endothelial glycocalyx and its interaction with the inflammatory response, has provided early recognition elements for clinical practice that allow the rational use of traditional medical interventions in sepsis. This comprehensive approach, which differs from the classical mechanistic approach, uses systems biology to increase the diagnostic and prognostic spectrum of endothelial damage biomarkers in sepsis, and to provide information on new pathways involved in the pathophysiology of the disease. This, in turn, provides tools for perfecting traditional medical interventions, using them at the appropriate times according to the disease's pathophysiological context, while at the same time discovering new and improved therapeutic alternatives. We have the challenge of transferring this ideal scenario to our daily clinical practice to improve our patients' care. The purpose of this article is to provide a general description of the importance of systems biology in integrating the complex interaction between the endothelium and the inflammatory response in sepsis.

ObjectivesSerum lactate is a useful biomarker of tissue perfusion in critically ill patients. We evaluated the behavior of serum lactate in children in the pediatric intensive care unit (PICU) immediately after liver transplantation and its association with surgical complications, graft dysfunction and 90-day mortality.Materials and MethodsA prospective observational study carried out between November 2009 and December 2019. Multidisciplinary PICU at the University Children's Hospital, Fundación Cardioinfantil-IC, Bogotá, Colombia.Measurements and Main ResultsPatients between 1 month and 18 years of age who were in the immediate post-operative period following living-donor or cadaveric liver transplantation were included. A total of 145 patients with a median age of 14 months (IQR 8–60) met the inclusion criteria. Biliary atresia was the main diagnosis in 56.5% of the cases. A serum lactate level > 3.0 mmol/L on admission to the PICU was associated with biliary complications (AUC 0.73 95% CI 0.54–0.93; p = 0.05) and mortality (AUC 0.72 95% CI 0.63–0.8; p = 0.01). A lactate level > 2 mmol/L after 6 h in the PICU was associated with mortality (AUC 0.70 95% CI 0.54–0.83; p = 0.02). Higher lactate levels and lack of clearance were associated with the presence of tardus et parvus waveforms (p = 0.001) on liver Doppler, primary dysfunction (p < 0.001), arterial thrombosis (p < 0.001) and neurological complications (p = 0.04). There was an inverse correlation between admission lactate and the volume of fluids administered during surgery (rho = 0.36; p < 0.001). A total procedure time > 350 min, along with a vasopressor score > 7 and elevated lactate, were associated with worse outcomes (p < 0.001).ConclusionsIn post-operative pediatric liver transplant patients, the level of serum lactate is associated with post-operative surgical complications and mortality.

Background In this review, we discuss some important aspects of paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS), a new syndrome that is temporally related to previous exposure to SARS-CoV-2 infection. This virus has a broad spectrum of presentation that may overlap with Kawasaki disease in terms of presenting symptoms and laboratory and cardiac findings. Our objective was to review and summarise published evidence regarding the most important aspects of PIMS-TS, with special emphasis on the treatment strategies suggested for middle-income and low-income countries.Methods A systematic review of the literature was performed in the principal medical databases including PubMed, Embase (OVID) and Google Scholar between December 2019 and August 2020.Results A total of 69 articles were identified in the described databases. Altogether, 13 articles met the inclusion criteria and were eligible. The most frequently described symptoms of PIMS-TS include fever (82%), shock (67%) and gastrointestinal (87%), skin (71%) and cardiac disorders (75%). In most series, it has been observed between 4 and 6 weeks after the pandemic appears in the general population. Multisystem inflammatory syndrome in children is presented as a great systemic inflammatory response syndrome, which sometimes presents as shock requiring fluid resuscitation and vasoactive drug support (26%). Several treatment strategies have been used, including immunoglobulin, steroids, aspirin, anakinra and anticoagulation among others. These general and specific interventions should be guided by an interdisciplinary and multidisciplinary team, especially in settings with limited resources.Conclusions PIMS-TS COVID-19 is a new type of presentation of SARS-CoV-2 infection, with an exaggerated inflammatory response and frequent—but not exclusive—digestive and myocardial involvement. It is important to describe the clinical course and outcomes in countries with limited resources as well as establish the role of biomarkers for early diagnosis, effective therapeutic strategies and outpatient follow-up schemes.

Endothelial insult and damage is one of the reported consequences of SARS-CoV-2 infection. It has been associated with severe inflammation, thrombotic phenomena and profound hypoxemia in critically ill patients. Endothelial activation leads to a loss of the endothelium's antithrombotic properties which, under normal conditions, are maintained by the endothelial glycocalyx, a carbohydrate-rich layer that covers the luminal surface of endothelial cells. In children, one of the serious forms of SARS-CoV-2 virus disease (COVID-19) is multisystem inflammatory syndrome (MIS-C). This new disease is characterized by a large inflammatory response and frequent cardiovascular, cutaneous and gastrointestinal disorders. We describe the first two cases of critically ill children with MIS-C who evidenced a large inflammatory response associated with elevated plasma and imaging biomarkers of endothelial activation and endothelial glycocalyx degradation. This microcirculation involvement in MIS-C could, at least partially, explain some of the clinical manifestations and laboratory and imaging alterations found in these patients. These findings contribute to a better understanding of this disease and suggest that medications to modulate the inflammatory response and protect or restore the endothelial glycocalyx should be considered in future studies.

Objetive: We sought to determine the association between maintenance intravenous solutions and the presence of hyponatremia in children in pediatric intensive care (PICU).Materials and Methods: An analytical observational study in children hospitalized in the PICU between January 2015 and December 2018. Patients who received maintenance fluids within the first 48 h after admission and who had at least two serum sodium levels drawn during this time were included.Measurements and Main Results: A total of 1,668 patients were admitted to the PICU during the study period, 503 of whom met the inclusion criteria. The median age was 24 months (IQR 8–96) and 50.9% were female. Altogether, 24.1% of the children developed hyponatremia; it was more frequent in those who received hypotonic solutions (63 vs. 37%; OR 1.41 95% CI 0.92, 2.15 p = 0.106), who also had a longer hospital stay (20 vs. 14 days, difference in means 8 days, 95% CI 2.67, 13.3, p = 0.001). Children who received loop diuretics and those who were post-operative had a greater risk of developing hyponatremia if they received hypotonic solutions (aOR 2.1 95% CI 1.41, 3.0, p = 0.000). Those with balanced isotonic solutions had a lower risk of developing hyponatremia (aOR 0.59 95% CI 0.35, 0.99, p = 0.004) and hyperchloremia (aOR 0.51 95% CI 0.34, 0.77, p = 0.000), adjusted for disease severity. A greater risk of death was found in the group with severe hyponatremia

La falta de adherencia a la práctica de actividad física, el sobrepeso y la obesidad son algunos de los problemas que más preocupan en la actualidad por los problemas de salud que generan. La administración educativa se plantea aumentar a tres horas el horario de Educación Física en toda la Educación Obligatoria. Sin embargo, la falta de acuerdo entre los docentes de Educación Fisica puede hacer peligrar a medio plazo la situación alcanzada por nuestra área en los últimos 30 años. Este artículo tiene dos objetivos: a) establecer un marco de discusión que sirva para generar debate entre los docentes ante la posibilidad de aumento de horas en EF; b) presentar una propuesta, a través de la implementación de modelos pedagógicos, la evaluación formativa y el entrenamiento interválico de alta intensidad, que permita responder a la necesidad educativa de aumentar el número de horas. El resultado de la propuesta podrá servir de pauta a las administraciones educativas para dar el ansiado paso de plantear la tercera hora, sin olvidar la importancia en relación a otros beneficios que proporciona como los afectivomotivacionales, los de inserción social, los cognitivos o los de relaciones interpersonales. Abstract. Lack of adherence to physical activity, overweight and obesity are some of the most worrying health problems they generate today. The educational administration is considering increasing the timetable of Physical Education to three hours in all Compulsory Education. However, the lack of agreement among Physical Education teachers may jeopardize in the medium term the situation reached by our area in the last 30 years. This article has two objectives: a) to establish a framework for discussion that will serve to generate debate among teachers regarding the possibility of increasing the number of hours in PE; b) to present a proposal, through the implementation of pedagogical models, formative assessment and high-intensity intervallic training, that will make it possible to respond to the educational need to increase the number of hours. The result of the proposal may serve as a guideline for educational administrations to take the long awaited step of proposing the third hour, without forgetting the importance in relation to other benefits that it provides such as the affective-motivational ones, those of social insertion, the cognitive ones or those of interpersonal relations.

Disruption of lipolysis has widespread effects on intermediary metabolism and organismal phenotypes. Defects in lipolysis can be modeled in Drosophila melanogaster through genetic manipulations of brummer (bmm), which encodes a triglyceride lipase orthologous to mammalian Adipose Triglyceride Lipase. RNAi-mediated knock-down of bmm in all tissues or metabolic specific tissues results in reduced locomotor activity, altered sleep patterns and reduced lifespan. Metabolomic analysis on flies in which bmm is downregulated reveals a marked reduction in medium chain fatty acids, long chain saturated fatty acids and long chain monounsaturated and polyunsaturated fatty acids, and an increase in diacylglycerol levels. Elevated carbohydrate metabolites and tricarboxylic acid intermediates indicate that impairment of fatty acid mobilization as an energy source may result in upregulation of compensatory carbohydrate catabolism. bmm downregulation also results in elevated levels of serotonin and dopamine neurotransmitters, possibly accounting for the impairment of locomotor activity and sleep patterns. Physiological phenotypes and metabolomic changes upon reduction of bmm expression show extensive sexual dimorphism. Altered metabolic states in the Drosophila model are relevant for understanding human metabolic disorders, since pathways of intermediary metabolism are conserved across phyla.

Summary: The inheritance of the midbody remnant (MBR) breaks the symmetry of the two daughter cells, with functional consequences for lumen and primary cilium formation by polarized epithelial cells, and also for development and differentiation. However, despite its importance, neither the relationship between the plasma membrane and the inherited MBR nor the mechanism of MBR inheritance is well known. Here, the analysis by correlative light and ultra-high-resolution scanning electron microscopy reveals a membranous stalk that physically connects the MBR to the apical membrane of epithelial cells. The stalk, which derives from the uncleaved side of the midbody, concentrates the ESCRT machinery. The ESCRT CHMP4C subunit enables MBR inheritance, and its depletion dramatically reduces the percentage of ciliated cells. We demonstrate (1) that MBRs are physically connected to the plasma membrane, (2) how CHMP4C helps maintain the integrity of the connection, and (3) the functional importance of the connection.

This data article contains the data related to the research article entitled “Long-term neurological outcomes in out-of-hospital cardiac arrest patients treated with targeted-temperature management” (Caro-Codón et al., 2018). In this dataset, we report details regarding the flow chart of the included patients and the specific exclusion criteria. We also include information on the difference between the patients who attended the structured personal interview (and therefore were finally included in the study) and those who did not attend. Neuropsychiatric and functional data before and after cardiac arrest are also reported. Finally, we list all the “de novo” focal neurological deficits identified after cardiac arrest in the related population.

Perchloroethylene is used mainly as a solvent in dry cleaning, cleaning of electrical equipment, and degreasing of metal parts. The authors report a case of acute poisoning with perchloroethylene contracted by a maintenance worker when cleaning an electric transformer. Since perchloroethylene may cause severe poisoning and the International Agency for Research on Cancer has classified it as a probable carcinogen for humans, the authors have revised the main substances that may replace perchloroethylene in the workplace. Med Pr. 2019;70(3):393–5

Background Groin injuries are some of the most common injuries tennis players suffer. Several factors (e.g., post-match decrease in hip adductor (ADD) strength) have been proposed as possible mechanisms for increasing the incidence of this type of injury. However, the risk factors of developing groin injuries after a tennis match have not yet been delineated. Objective The aim of this study was to determine the effect of tennis match-play on isometric ADD and abductor (ABD) strength and passive hip range of motion (ROM). Methods Twenty-six male tennis players (20.30 ± 4.98 years) took part in this study. Participants completed an evaluation of strength and flexibility hip measurements before and after a simulated tennis match. Dominant and non-dominant passive hip ROM, ADD and ABD isometric strength, and the ADD/ABD strength ratio were measured before and immediately post-match. A global positioning system (GPS) and a session rating of perceived exertion (RPE) were used to assess the locomotive demands and internal match load. Results Isometric dominant ADD strength (17.8%, p ≤ 0.01) and ADD/ABD strength ratio (11.6%, p = 0.04) were lower post-match compared to the pre-match values. No between-limbs differences were observed for isometric ADD strength, ABD strength, and passive hip ROM tests. RPE showed an expected increase between pre- vs. post-match (pre- vs. post-warming-up, 3.42 ± 2.08 vs. 5.62 ± 2.29, p < 0.01). In addition, a significant relationship between ADD strength and the volume of tennis practice per week was found, stablishing that tennis players with lower volume of training per week suffered a reduction in ADD strength in their dominant limb after match-play (r = 0.420, p = 0.04). Conclusion The assessment of ADD strength and the ADD/ABD strength ratio in the dominant limb may be considered a post-match tool that can be used to identify players who require rest and additional recovery strategies before competing again.

Se trata de un convenio de colaboración entre la Organización Sanitaria Integrada Bilbao Basurto y Bilbao Kirolak- Instituto Municipal de Deportes del Ayuntamiento de Bilbao, que pretende dar respuesta a las necesidades de la población de Bilbao frente a la prevención de enfermedades crónicas, realizando una intervención proactiva para favorecer hábitos de vida saludables. Objetivos: Promover la práctica de actividad física en la población adulta, informando de los beneficios para la salud, desarrollando capacidades de empoderamiento e incorporando la actividad física como hábito, todo ello coordinado por dos instituciones. Material y métodos: Se inicia el pilotaje con cuatro cupos de 2 centros de salud (aprox. 6000 usuarios) de Bilbao el 15 de enero de 2017. Se establece el siguiente protocolo de colaboración: - Captación del paciente por parte del equipo de atención primaria, rellenando formulario específico de indicación actividad física. - Entrega al usuario y firma de hoja derivación para su entrega en el polideportivo y así solicitar cita con el técnico deportivo. Compromiso de cita en 2 semanas. - El equipo de atención primaria envía correo electrónico al polideportivo con los datos del usuario. - Bilbao kirolak asesora de la práctica deportiva más adecuada y le entrega una ficha de actividad física personalizada. - Bilbao kirolak envía bimestralmente información de actividad del usuario. - Desde el centro de atención primaria se conciertan citas trimestrales de seguimiento. Se miden los siguientes indicadores: - Número de usuarios derivados. - Número de paciente que acuden a la primera cita con el técnico deportivo. - Número de pacientes que se inscriben en alguna actividad (tipo y periodicidad). - Meses que realizan la actividad. - Entrevistas cualitativas tanto a usuarios como a profesionales de las dos organizaciones que participan en el proyecto a los seis meses del inicio. - Cuestionarios de percepción de salud a los usuarios a los 3 meses. Resultados: Al año del inicio del pilotaje se habían remitido 69 usuarios, de los cuales 48 contactaron con el técnico deportivo acudiendo a la primera cita. De estos 45 usuarios han comenzado a realizar de forma regular un programa de actividad física dirigido por técnicos deportivos. La media de edad es de 59 años. No hay diferencias por sexos La encuesta de satisfacción del usuario y de los profesionales esta confeccionada y a la espera de realizarse en el último trimestre de este año 2018 Conclusiones: El 65% de los usuarios a los que se les incorporó en el proyecto iniciaron la realización de actividad física mantenida. Buena satisfacción tanto de los usuarios como de los profesionales. A la vista de los resultados se ha decidido extender este acuerdo de forma paulatina a otros centros de salud.

Shoulder pain has been associated with glenohumeral internal rotation deficit (GIRD) and a reduction in external rotation (ER) strength; however, in tennis players, there is scarce evidence regarding the impact of a single match on shoulder range of motion (ROM), strength and serve speed. The aim of this study was to determine the acute effect of a single tennis match on shoulder rotation ROM, isometric strength and serve speed. Twenty-six professional tennis players participated in the study (20.4±4.4 years; 10.5±3.2 years tennis expertise; 20.5±5.4 h/week training). Passive shoulder external (ER-ROM) and internal rotation ROM (IR-ROM), ER and IR isometric strength were measured before and after a single tennis match (80.3±21.3 min) in both shoulder´s. Moreover, the total arc of motion (TAM) and ER/IR strength ratio were calculated. Video analysis was used to assess the number of serves and groundstrokes, while a radar gun was utilized to measure maximal ball speed. In the dominant shoulder, compared to pre-match levels, IR-ROM was significantly reduced (-1.3%; p = 0.042), while ER-ROM (5.3%; p = 0.037) and TAM (3.1%; p = 0.050) were significantly increased. In the non-dominant shoulder, ER-ROM (3.7%; p = 0.006) was increased. Furthermore, in the dominant shoulder, the isometric ER strength was significantly reduced after the match (-4.8%; p = 0.012), whereas serve speed was not significantly reduced after match (-1.16%; p = 0.197). A single tennis match leads to significant reductions in shoulder ROM (e.g., IR of the dominant shoulder) and isometric strength (e.g., ER of the dominant shoulder). This study reveals the importance of recovery strategies prescription aiming at minimize post-match alteration in the shoulders.

Strength training is crucial for soccer players' long-term development at early ages and the biological maturation may influence specific strength-training adaptations. The aim of this study was to propose a strength-training programme for the strength development of pre-pubertal players and to analyse the adaptations to this training programme in players with different maturity status. One hundred and thirty young male soccer players participated in an 8-week strength-training programme consisting of two sessions per week (20-minutes of a combination of plyometric and resistance exercises) which was conducted prior to their normal soccer training. Three maturity groups were defined according to the years from/to their peak height velocity (PHV) as Pre-, Mid- and Post-PHV. Initial differences between the maturity groups were found in anthropometrical (weight and height) and physical performance variables (One Repetition Maximum (RM), Peak Power output (PP), 30-m sprint and T-test). The strength-training programme was beneficial for the three maturity groups (p< 0.05) with general greater improvements for the Pre- and Mid-PHV groups, with large effects in RM, PP and T-test, than for the Post-PHV group (moderate effects). The strength-training programme proposed in the present study seems to be positive for the strength-related development in young soccer players especially for Pre- and Mid-PHV players. The differences in the training adaptations for players with different maturity status suggest the individualization of the training stimulus for the correct long-term development of the players.

El Atlas presenta de forma sistemática y completa las elecciones generales celebradas en España entre 1977 y 2016, dedicando un capítulo a cada comicio, analizando diversas variables y ofrenciendo un panorama general preelectoral y postelectoral. Se destacan asimismo algunos aspectos susceptibles de posible mejora, como la clarificación del criterio para considerar unas elecciones como adelantadas o no, o la utilización de un modelo diferente de uno de los mapas que se elaboran.

Mitral stenosis (MS) is frequently associated with the development of atrial fibrillation (AF) as a consequence of hemodynamic and inflammatory changes in the left atrium. Both conditions predispose to thrombus formation, with frequent involvement of the left atrial appendage (LAA), and consequent increase in the incidence of systemic thromboembolic events. Percutaneous mitral valvuloplasty (PMV) reduces the risk of thromboembolism in patients with significant mitral stenosis. Percutaneous LAA closure is also associated with a reduction in thromboembolic risk in patients with AF, but there are no data regarding the use of this technique in patients with significant mitral valve disease. We report the case of a 57-year-old-woman with significant MS and permanent AF, in New York Heart Association functional class II, who despite adequate oral anticoagulation with acenocoumarol, presented several clinical episodes of systemic thromboembolism in the last four years. It was decided to perform a combined percutaneous procedure, including both PMV and percutaneous LAA closure with the Amplatzer Cardiac Plug device. No significant acute complications occurred and the patient was discharged on indefinite treatment with acenocoumarol associated with aspirin 100 mg/d for three months. After a one-year follow-up, there have been no new embolic episodes or other complications. Resumo: A estenose mitral (EM) é frequentemente associada ao desenvolvimento de fibrilhação auricular (FA) como consequência de alterações hemodinâmicas e inflamatórias na aurícula esquerda. Ambas as condições predispõem à formação de trombos, com frequente envolvimento do apêndice auricular, e consequente aumento da incidência de eventos tromboembólicos sistémicos. A valvuloplastia mitral percutânea (VMP) reduz o risco de tromboembolismo em doentes com EM significativa. O encerramento percutâneo do apêndice auricular esquerdo (PCLAA) na FA também está associado a uma redução de risco de tromboembolismo em pacientes com FA, mas não existem dados sobre a utilização desta técnica em doentes com MS. Relatamos o caso de uma mulher de 57 anos de idade com significativa EM e FA permanente, em classe funcional II, que, apesar de anticoagulação oral adequada com acenocumarol, apresentou nos últimos quatro anos vários episódios clínicos de tromboembolismo sistémico. Foi decidido realizar um procedimento percutâneo combinado de PMV e PCLAA com dispositivo Amplatzer Cardiac Plug. Não se verificaram complicações agudas significativas e o paciente recebeu alta com acenocumarol de forma indefinida, associado com aspirina 100 mg/d durante três meses. Depois de um ano de follow-up, não houve novos episódios embólicos ou outras complicações. Keywords: Percutaneous left atrial appendage closure, Percutaneous mitral valvuloplasty, Mitral stenosis, Atrial fibrillation, Palavras-chave: Encerramento percutâneo do apêndice arterial esquerdo, Valvuloplastia mitral percutânea, Estenose mitral, Fibrilhação auricular