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Objective To determine the predictive value of the inotropic score (IS) and vasoactive-inotropic score (VIS) in low cardiac output syndrome (LCOS) in children after congenital heart disease surgery involving cardiopulmonary bypass (CPB), and to establish whether mid-regional pro-adrenomedullin (MR-proADM) and cardiac troponin I (cTn-I), associated to the IS and VIS scores, increases the predictive capacity in LCOS. Design A prospective observational study was carried out. Setting A Paediatric Intensive Care Unit. Patients A total of 117children with congenital heart disease underwent CPB. Patients were divided into two groups: LCOS and non-LCOS. Interventions The clinical and analytical data were recorded at 2, 12, 24 and 48 h post-CPB. Logistic regression was used to develop a risk prediction model using LCOS as dependent variable. Main outcome measures LCOS, IS, VIS, MR-proADM, cTn-I, age, sex, CPB time, PIM-2, Aristotle score. Results While statistical significance was not recorded for IS in the multivariate analysis, VIS was seen to be independently associated to LCOS. On the other hand, VIS > 15.5 at 2 h post-CPB, adjusted for age and CPB timepoints, showed high specificity (92.87%; 95%CI: 86.75–98.96) and increased negative predictive value (75.59%, 95%CI: 71.1–88.08) for the diagnosis of LCOS at 48 h post-CPB. The predictive power for LCOS did not increase when VIS was combined with cTn-I >14 ng/ml at 2 h and MR-proADM >1.5 nmol/l at 24 h post-CPB. Conclusions The VIS score at 2 h post-CPB was identified as an independent early predictor of LCOS. This predictive value was not increased when associated with LCOS cardiac biomarkers. The VIS score was more useful than IS post-CPB in making early therapeutic decisions in clinical practice post-CPB.

It is challenging to establish the mechanisms involved in the variety of well-defined clinical phenotypes in autism spectrum disorder (ASD) and the pathways involved in their pathogeneses. The aim of the present study was to evaluate the metabolomic profiles of children with ASD subclassified by mental regression (AR) phenotype and with no regression (ANR). The present study was a cross-sectional case–control study. Thirty children aged 2–6 years with ASD were included: 15 with ANR and 15 with AR. In addition, a control group of 30 normally developing children was selected and matched to the ASD group by sex and age. Plasma samples were analyzed with a metabolomics single platform methodology based on liquid chromatography-mass spectrometry. Univariate and multivariate analysis, including orthogonal partial least squares-discriminant analysis modeling and Shared-and-Unique-Structures plots, were performed using MetaboAnalyst 4.0 and SIMCA-P 15. The primary endpoint was the metabolic signature profiling among healthy children and autistic children and their subgroups. Metabolomic profiles of 30 healthy children, 15 ANR and 15 AR were compared. Several differences between healthy children and children with ASD were detected, involving mainly amino acid, lipid and nicotinamide metabolism. Furthermore, we report subtle differences between the ANR and AR groups. In this study, we report, for the first time, the plasmatic metabolomic profiles of children with ASD, including two different phenotypes based on mental regression status. The use of a liquid chromatography-mass spectrometry platform approach for metabolomics in ASD children using plasma appears to be very efficient and adds further support to previous findings in urine. Furthermore, the present study documents several changes related to amino acid, NAD+ and lipid metabolism that, in some cases, such as arginine and glutamate pathway alterations, seem to be associated with the AR phenotype. Further targeted analyses are needed in a larger cohort to validate the results presented herein.

Resumen Objetivos Evaluar la calidad, la accesibilidad y la presencia de herramientas 2.0 de las paginas webs de los hospitales del Sistema Sanitario Publico de Andalucia. Metodos Estudio observacional descriptivo durante el periodo 2010-2012. Las variables analizadas fueron: calidad, accesibilidad y presencia de herramientas 2.0. La calidad se evaluo mediante el cuestionario de Bermudez-Tamayo, la accesibilidad con la herramienta Test de Accesibilidad Web y las herramientas 2.0 por observacion directa. Resultados Disponian de pagina web en 2010, 31 de los 45 hospitales (68,9%), incrementandose hasta 34 (75,5%) en 2012. La puntuacion media + desviacion estandar (DE) del cuestionario de calidad Bermudez Tamayo fue de 11,1 + 3,8 puntos en 2010 y de 12,3 + 3,9 puntos en el ano 2012, observandose una diferencia entre las medias de 0,25 (IC del 95%, 0,00 a 0,50) estadisticamente significativa (p = 0,007). En la evaluacion de la accesibilidad, solo 7 paginas webs (n = 31) en 2010 y 10 (n = 34) en 2012 cumplian criterios legales de accesibilidad. El uso de herramientas 2.0 se incremento a lo largo del estudio. En 2010 disponian de este tipo de herramientas el 19,4% (n = 6) de las paginas webs de los hospitales y en 2012 el 58,8% (n = 20). Conclusiones La calidad evaluada con el cuestionario Bermudez-Tamayo, en general, fue buena. Sin embargo, se observo un incumplimiento de la legislacion en materia de accesibilidad, que debe ser revisada y adaptada a la normativa legal vigente. Se constato la incipiente utilizacion de los recursos web 2.0 como estrategias de educacion y comunicacion en materia de salud.

Resumen: Objetivo: Identificar y cuantificar factores de riesgo precoces relacionados con la necesidad de transfundir hemoderivados a prematuros de muy bajo peso, en tratamiento profiláctico con eritropoyetina humana recombinante (EPO). Secundariamente, evaluar la incidencia de retinopatía del prematuro (ROP) en relación con la administración precoz o tardía de EPO y con la transfusión de sangre. Material y métodos: Estudio descriptivo prospectivo de los nacidos de enero de 2006 a marzo de 2009 con peso inferior a 1.500 g y edad gestacional (EG) inferior a 32 semanas, incluidos en el estudio de morbimortalidad de los recién nacidos menores de 1.500 g de la Sociedad Española de Neonatología (SEN1500) tratados con EPO subcutánea a dosis de 750 UI/kg/semana/6 semanas.Se utilizaron regresiones logísticas univariables y multivariables con el paquete PASW Statistics. Resultados: Se incluyeron un total de 110 recién nacidos (RN) con peso medio de 1.154 g y EG media de 29,3 semanas. Precisaron transfusión de sangre 59 RN (53,6%) frente a 51 (46,3%) no transfundidos. La incidencia de ROP grave (grado≥III) fue del 2,7%. Los factores de riesgo (odds ratio [OR]; intervalo de confianza [IC] del 95%) para ser transfundido obtenidos en el análisis multivariable fueron: sexo masculino (OR: 4,41; IC del 95%, 1,24–15,66), EG (OR: 1,64; IC del 95%, 1,14–2,36, disminución 1 semana), valores de hemoglobina (Hb) al ingreso (OR: 1,45; IC del 95%, 1,04–2,04; disminución 1 g/dl), sepsis tardía (OR: 7,75; IC del 95%, 2,21–21,11) e inicio tardío del tratamiento con EPO (OR: 6,27; IC del 95%, 1,22–32,35).Todos los RN intervenidos de ductus o enterocolitis necrosante precisaron transfusión. No se ha relacionado la ROP con la administración de EPO precoz o tardía ni con la transfusión sanguínea. Conclusiones: Los requerimientos transfusionales son mayores en varones, en prematuros de menor EG, en los de menor Hb al nacer y en los que tienen sepsis tardía. No se ha demostrado relación entre el momento de la administración de EPO con la ROP. Abstract: Objective: To identify and quantify risk factors related to red blood cell transfusion in premature babies weighing

In this work, we studied the influence of operational variables in the bleaching of soda pulp of Musa textilis nee (abaca) [viz. temperature (55-85 degrees C), bleaching time (30-150 min) and peracetic acid concentration oven dry pulp (0.5-4.5%)] on the kappa number and viscosity of the bleached pulp, as well as on the breaking length, burst index and brightness of paper sheets made from it. For this purpose, we used a central composite factorial design in order to identify the optimum operating conditions. In this way equations relating the dependent variables to the operational variables of the bleaching process were derived. These equations reproduce the dependent variables with errors less than 12% for all, except the viscosity which was predicted with errors less than 18%. Obtaining bleached pulp with the highest possible viscosity (1519 ml/g), and paper sheets with the maximum possible breaking length (6547 m) and burst index (5.00 kN/g), entails using a temperature of 55 degrees C, a peracetic acid concentration of 4.5% and a bleaching time of 150 min. This provides a brightness of 79.90%, which is only 6.53% lower than the maximum possible value (85.48%).

The results of characterization for four different vine shoot varieties, grown using two different methods, revealed no significant differences in composition among vine varieties or between growing methods. The holocellulose content of vine shoots (67.14%) is lower than those of other non-wood raw materials (e.g. wheat straw, sunflower stalks, cotton stalks, etc.), but similar to those of pine and higher to those of olive trimmings. On the other hand, their lignin content (20.27%) is similar to those of eucalyptus and the non-wood raw materials. Also, their contents in cold-water, hot-water and 1% soda solubles, and ethanol–benzene extractables, are higher than for pine and eucalyptus. Soda, kraft, ethanol and ethylene–glycol pulping processes have low yields (29–47%) relative to the pulping processes applied to olive trimmings and wheat straw. Kraft pulp is that exhibiting the best properties, including a higher α-cellulose content (73.74%) than pulp from wheat straw or olive trimmings, but a higher lignin content (17.18%). Also, kraft pulp provides paper with the highest breaking length, burst index and tear index (viz. 1316 m, 1.63 kN/g and 1.59 mN m2/g, respectively); these values, which are intermediate among those for olive trimmings, wheat straw and sunflower seeds, are low and can be substantially improved by appropriate refining of the pulp.

The influence of temperature (150–170 °C), pulping time (15–45 min) and soda concentration (5–10%) in the pulping of abaca on the yield, kappa, viscosity, breaking length, stretch and tear index of pulp and paper sheets, was studied. Using a factorial design to identify the optimum operating conditions, equations relating the dependent variables to the operational variables of the pulping process were derived that reproduced the former with errors lower than 25%. Using a high temperature, and a medium time and soda concentration, led to pulp that was difficult to bleach (kappa 28.34) but provided acceptable strength-related properties (breaking length 4728 m; stretch 4.76%; tear index 18.25 mN m2/g), with good yield (77.33%) and potential savings on capital equipment costs. Obtaining pulp amenable to bleaching would entail using more drastic conditions than those employed in this work.

Objetivo: Determinar la eficacia del tratamiento con eritropoyetina humana recombinante (rH-EPO) en la profilaxis de la anemia del prematuro. Pacientes y método: Estudio de casos y controles, no aleatorizado, retrospectivo de 108 pretérminos de peso < 1.500 gramos y edad gestacional < 34 semanas. Se excluyeron a los prematuros afectados de enfermedad hemolítica o hemorrágica y/o fallecimiento durante los primeros días de vida. Fueron tratados 54 pacientes con rH-EPO (250 U/kg, subcutánea, 3 veces por semana) durante 6 semanas. Se añadió sulfato ferroso oral (4-6 mg/kg/día) y un complejo polivitamínico. Resultados: Entre ambos grupos no existen diferencias significativas en cuanto a: edad gestacional, peso, ferritina, hemoglobina y hematócrito al ingreso, número de extracciones y días con ventilación mecánica. El número de transfusiones por niño en el grupo sin rH-EPO fue de 1,46 ± 1,38, frente a 0,69 ± 1,19 en el tratado (p < 0,002). Un 63% de los niños tratados no precisaron ser transfundidos frente a un 29% del grupo control (p < 0,001). La hemoglobina media más baja alcanzada fue de 8,72 ± 2,62 g/dl en el grupo sin tratamiento, frente a una hemoglobina de 9,7 ± 2,08 g/dl en el que sí lo recibió. Conclusiones: La a dministración profiláctica de rH-EPO muestra una tendencia a disminuir el número de transfusiones en los prematuros de bajo peso, siendo claramente eficaz en los pretérminos estables con un peso superior a 1.000 gramos. : Objective: To evaluate the effectiveness of recombinant human erythropoietin (rH-EPO) in the prophylactic treatment of anemia of prematurity. Patients and methods: We performed a non-randomised, retrospective case control study of 108 premature babies with birth weights of less than 1500 grams and gestational age of less than 34 weeks. Infants with hemolytic or hemorrhagic disease and those who died in the first days of life were excluded. Fifty-four patients were treated with rHEPO (250 U/kg subcutaneously, 3 times a week) for 6 weeks. A ferrous sulfate supplement was also administered orally (4-6 mg/kg/day) with a multivitamin complex. Results: There were no differences between groups in gestational age, birth weight, ferritin levels, hematocrit and hemoglobin on admission, amount of blood sampled and days with ventilatory support. The number of transfusions per patient were 1.46 ± 1.38 in control group versus 0.69 ± 1.19 in rH-EPO-treated infants (p < 0.002). Sixty-three percent of infants in the treated group did not require blood transfusions compared with only 29.7% in the nontreated group (p < 0.001). The lowest mean hemoglobin was 8.72 ± 2.62 gr/dl in the control group versus 9.70 ± 2.08 gr/dl in the rH-EPO group. Conclusions: Prophylactic treatment with rH-EPO was effective in reducing the number of transfusions, mainly in stable newborn infants with a birth weight greater than 1000 grams.

In this paper, we present a chemical, mineralogical, petrographical and textural study of the wall material in the Muslim Alhambra (XI TH to XV TH centuries). Different types of concretes represent this material. The binder has been charaterized as very pure lime, and the aggregate is mostly composed of metamorphics rock fragments whit erosive morphology. The porosimetric nature of the wall material was charaterized by SEM and the Hg intrusion porosimetry. XRD data and Image Analysis studies have shown the differents proportions of binder, fine aggregate and coarse aggregate in the concretes. The construction technique consisted in putting material to form the wall (clay, aggregate and lime) between two parallel, vertical planks attached to each other by bars of wood. Each layer of material was packed in. One particular type of wall is the “calicostrado”, which is made of two materials: one rich in lime, in the outer part of he wall and a more clayey material in the middle. The schematic cross-section of a “calicostrado” wall and its weathering patterns is presented. The state of preservation of the material in the walls of the study areas is acceptable, despite some zones being macroscopically more eroded.

In this work, we examined the influence of operational variables [viz. Ethyleneglycol concentration (50-70%), temperature (155-185 degrees C), time (30-90 min) and number of PFI beating revolutions (500-1500)] in the ethyleneglycol pulping of tagasaste (Chamaecytisus proliferus) on pulp yield and the breaking length, stretch, burst index, tear index and brightness of paper sheets formed from it. Application of a fuzzy neural network model in combination with an experimental factorial design allowed the results for the dependent variables to be predicted as a function of the operating conditions used with errors less than 15% in all cases. The operating conditions of choice provided pulp with a high yield (56.85%) and a low brightness (22.51%) which may thus be useful to obtain non-white paper.