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La Rambla Climate-House funciona como un dispositivo climático y ecológico que forma parte de una serie de iniciativas asociativas, desarrolladas a la escala de los ciudadanos independientes, para contribuir a la reparación del daño medioambiental y climático causado por la sobre-urbanización de Molina de Segura.

Lung cancer screening detects early-stage cancers, but also a large number of benign nodules. Molecular markers can help in the lung cancer screening process by refining inclusion criteria or guiding the management of indeterminate pulmonary nodules. In this study, we developed a diagnostic model based on the quantification in plasma of complement-derived fragment C4c, cytokeratin fragment 21-1 (CYFRA 21-1) and C-reactive protein (CRP). The model was first validated in two independent cohorts, and showed a good diagnostic performance across a range of lung tumor types, emphasizing its high specificity and positive predictive value. We next tested its utility in two clinically relevant contexts: assessment of lung cancer risk and nodule malignancy. The scores derived from the model were associated with a significantly higher risk of having lung cancer in asymptomatic individuals enrolled in a computed tomography (CT)-screening program (OR = 1.89; 95% CI = 1.20–2.97). Our model also served to discriminate between benign and malignant pulmonary nodules (AUC: 0.86; 95% CI = 0.80–0.92) with very good specificity (92%). Moreover, the model performed better in combination with clinical factors, and may be used to reclassify patients with intermediate-risk indeterminate pulmonary nodules into patients who require a more aggressive work-up. In conclusion, we propose a new diagnostic biomarker panel that may dictate which incidental or screening-detected pulmonary nodules require a more active work-up.

BackgroundWhile lung cancer low-dose computed tomography (LDCT) screening is being rolled out in many regions around the world, differentiation of indeterminate pulmonary nodules between malignant and benign remains to a challenge for screening programs. We conducted one of the first systematic investigations of circulating protein markers for their ability to assess the risk of malignancy for screen-detected pulmonary nodules.MethodsBased on four LDCT screening studies in the United States, Canada and Europe, we assayed 1078 unique protein markers in pre-diagnostic samples based on a nested case-control design with a total of 1253 participants. Protein markers were measured using proximity extension assays and the data were analyzed using multivariate logistic regression, random forest, and penalized regressions.ResultsWe identified 36 potentially informative markers differentiating malignant nodules from benign nodules. Pathway analysis revealed a tightly connected network based on the 36 protein-coding genes. We observed a differential mRNA expression profile of the corresponding 36 mRNAs between lung tumors and adjacent normal tissues using data from The Cancer Genomic Atlas. We prioritized a panel of 9 protein markers through 10-fold nested cross-validations. We observed that circulating protein markers can increase sensitivity to 0.80 for nodule malignancy compared to the Brock model (p-valueConclusionsCirculating protein markers can help to differentiate between malignant and benign pulmonary nodules. Validating these results in an independent CT-screening study will be required prior to clinical implementation.

Resumen Objetivo Determinar la precision del analisis visual y el indice de retencion (IR) con el protocolo de imagen tardia 18F-FDG PET/TC para la caracterizacion de los nodulos pulmonares indeterminados (NPI) con baja captacion de FDG. Materiales y metodos Se realizo un analisis retrospectivo en 43 pacientes (28 hombres, 64 ± 11 anos, rango 36-83 anos), remitidos para la caracterizacion de NPI con 18F-FDG-PET/TC y SUVmax ≤ 2,5 a los 60 min postinyeccion (SUVmax1). Los nodulos se analizaron por tamano, puntuacion visual de la captacion de FDG en las reconstrucciones estandar (OSEM 2,8) y de alta definicion (HD), SUVmax1, SUVmax a 180 min postinyeccion (SUVmax2), y se calculo el IR. El diagnostico definitivo se baso en la confirmacion histopatologica (n = 28) o ≥ 2 anos de seguimiento. Resultados Veinticuatro (56%) nodulos eran malignos. El IR ≥ 10% en la reconstruccion estandar detecto 18 nodulos que habrian sido considerados negativos usando el criterio estandar SUVmax ≥ 2,5 para malignidad. El IR ≥ 10% obtuvo una sensibilidad, especificidad, VPP, VPN y una precision del 75, 73,7, 78,3, 70 y 74,4%, respectivamente, mientras que para la captacion de FDG > higado en la HD fueron del 79,1, 63,2, 73,1, 70,6 y 72,1%, respectivamente. SUVmax1 ≥ 2, SUVmax2 > 2,5 y la captacion de FDG > higado en la reconstruccion estandar tuvieron un VPP del 100%. La captacion de FDG > mediastino en la HD obtuvo un VPN del 100%. Conclusiones El IR ≥ 10% fue el criterio mas preciso para la malignidad, seguido de la captacion de FDG > higado en la reconstruccion HD. En la reconstruccion estandar, el SUVmax1 ≥ 2 fue altamente predictivo de malignidad, asi como el SUVmax2 > 2,5 y la captacion de FDG > higado. La captacion de FDG

Objective To determine the accuracy of visual analysis and the retention index (RI) with dual-time point 18F-FDG PET/CT for the characterization of indeterminate pulmonary nodules (IPN) with low FDG uptake. Materials and methods A retrospective analysis was performed on 43 patients (28 men, 64 ± 11 years old, range 36–83 years) referred for IPN characterization with 18F-FDG-PET/CT and maximum standard uptake value ≤2.5 at 60 min post-injection (SUVmax1). Nodules were analyzed by size, visual score for FDG uptake on standard (OSEM 2,8) and high definition (HD) reconstructions, SUVmax1, SUVmax at 180 min post-injection (SUVmax2), and RI was calculated. The definitive diagnosis was based on histopathological confirmation (n = 28) or ≥2 years of follow-up. Results Twenty-four nodules (56%) were malignant. RI ≥ 10% on standard reconstruction detected 18 nodules that would have been considered negative using the standard SUVmax ≥ 2.5 criterion for malignancy. RI ≥ 10% had a sensitivity, specificity, PPV, NPV and accuracy of 75%, 73.7%, 78.3%, 70%, and 74.4%, respectively, while for FDG uptake > liver on HD these were 79.1%, 63.2%, 73.1%, 70.6%, and 72.1%, respectively. SUVmax1 ≥ 2, SUVmax2 > 2.5 and FDG uptake > liver on standard reconstruction had a PPV of 100%. FDG uptake > mediastinum on HD had a NPV of 100%. Conclusions RI ≥ % was the most accurate criterion for malignancy, followed by FDG uptake > liver on HD reconstruction. On standard reconstruction, SUVmax1 ≥ 2 was highly predictive of malignancy, as well as SUVmax2 > 2.5 and FDG uptake > liver. FDG uptake

Objective Lung cancer (LC) is the leading cause of death from cancer worldwide. More than 27,000 LCs are diagnosed annually in Spain, and most are unresectable. Early detection and treatment reduce LC mortality. This study describes surgical outcomes in a longstanding LC screening cohort in Spain. Methods We conducted a retrospective study of surgical outcomes in a LC screening (LCS) program using low dose computed tomography (LDCT) since the year 2000. A descriptive analysis of clinical and radiological parameters, presence or absence of a preoperative diagnosis, pathological staging, morbidity, mortality, and survival was performed. Results Ninety-seven (2.5%) LC were diagnosed in 3825 screened. Twenty individuals with LC had no surgery due to advanced stage or small cell histology. Eighty-seven surgical procedures were carried out for suspected or biopsy proven LC, detected by LDCT. Most operated patients were male (57[85%]) aged 64 ± 9.1 years. Nine patients underwent a second operation for a metachronous primary lung cancer. Mean tumor size was 15.2 ± 7.6 mm. Eight nodules were benign (9.2%). Lobectomy was performed in 56 cases (83.6%). Adenocarcinoma (n = 39; 58.2%) was the most frequent histological type followed by squamous cell carcinoma (n = 17; 25.4%). Fifty-nine (88%) tumors were in Stage I. Thirteen patients (15.4%) had 16 complications. The estimated survival rates at 5 and 10 years for stage I were 93% (95% CI: 79%–98%) and 83% (95% CI: 65%–92%), respectively. Conclusion Lung cancer screening was associated with excellent surgical outcomes with 5 and 10-year survival rates exceeding 90 and 80%, respectively.

Objectives: To determine the time to reverse transcription-polymerase chain reaction (RT-PCR) negativity after the first positive RT-PCR test, factors associated with longer time to RT-PCR negativity, proportion of children seroconverting after proven severe acute respiratory syndrome coronavirus 2 infection, and factors associated with the lack of seroconversion. Study design: The Epidemiological Study of Coronavirus in Children of the Spanish Society of Pediatrics is a multicenter study conducted in Spanish children to assess the characteristics of coronavirus disease 2019. In a subset of patients, 3 serial RT-PCR tests on nasopharyngeal swab specimens were performed after the first RT-PCR test, and immunoglobulin G serology for severe acute respiratory syndrome coronavirus 2 antibodies was performed in the acute and follow-up (

Instituto de Salud Carlos III (Ministry of Economy, Industry and Competitiveness) (PI20/00095) Fundacion para la Investigacion Biomedica del Hospital Universitario Infanta Sofia y del Hospital del Henares (FIIB HUIS HHEN) SERMAS-Fundacion para la Investigacion Biomedica del Hospital 12 de Octubre Universidad Europea de Madrid (UEM20/01) Spanish Society of Paediatrics (Asociacion Espanola de Pediatria) Covid-19 EPICO-AEP 2020 4.056 JCR (2021) Q1, 22/130 Pediatrics 0.922 SJR (2021) Q1, 539/2489 Medicine (Miscellaneous) No data IDR 2021 UEM

Thoracic disc herniation is one of the most therapeutically challenging spine conditions. A myriad of surgical approaches have been described in the literature, including posterior, anterior, and combined techniques. However, transthoracic and retropleural approaches are currently deemed the most effective techniques to successfully obtain anterior decompression. Herein the authors describe a 65-year-old female patient who underwent a transthoracic endoscopic approach to remove a calcified herniated thoracic disc that caused spinal cord compression. Despite having a long learning curve, the surgical technique described herein can be even used in patients with complex and calcified thoracic disc herniations. The video can be found here: https://stream.cadmore.media/r10.3171/2022.3.FOCVID221

Background: We aimed to identify the spectrum of disease in children with COVID-19, and the risk factors for admission in paediatric intensive care units (PICUs).Methods: We conducted a multicentre, prospective study of children with SARS-CoV-2 infection in 76 Spanish hospitals. We included children with COVID-19 or multi-inflammatory syndrome (MIS-C) younger than 18 years old, attended during the first year of the pandemic.Results: We enrolled 1 200 children. A total of 666 (55.5%) were hospitalized, and 123 (18.4%) required admission to PICU. Most frequent major clinical syndromes in the cohort were: mild syndrome (including upper respiratory tract infection and flu-like syndrome, skin or mucosae problems and asymptomatic), 44.8%; bronchopulmonary syndrome (including pneumonia, bronchitis and asthma flare), 18.5%; fever without a source, 16.2%; MIS-C, 10.6%; and gastrointestinal syndrome, 10%. In hospitalized children, the proportions were: 28.5%, 25.7%, 16.5%, 19.1% and 10.2%, respectively. Risk factors associated with PICU admission were MIS-C (odds ratio [OR]: 37.5,95% CI 22.7 to 57.8), moderate or severe liver disease (OR: 9,95% CI 1.6 to 47.6), chronic cardiac disease (OR: 4.8,95% CI 1.8 to 13) and asthma or recurrent wheezing (OR: 2.8,95% CI 1.3 to 5.8). However, asthmatic children were admitted into the PICU due to MIS-C or pneumonia, not due to asthma flare. Conclusion: Hospitalized children with COVID-19 usually present as one of five major clinical phenotypes of decreasing severity. Risk factors for PICU include MIS-C, elevation of inflammation biomarkers, asthma, moderate or severe liver disease and cardiac disease.

Bio-oil produced by fast pyrolysis of eucalyptus sawdust in a bubbling fluidised bed reactor with temperature between 450 and 550 °C was divided into two fractions: heavy bio-oil (HBO) and light bio-oil (LBO). These fractions were mixed with ethanol (EtOH) in order to obtain seven ternary mixtures. These mixtures were characterised according to the following properties: viscosity, lower heating value (LHV), higher heating value (HHV), water content, solids content, acidity, flash point, pour point, density and ultimate analysis. Fractions also had their properties determined. Viscosity, due to its peculiarity, was monitored until 90 days and each mixture had its viscosity profile as a function of time and temperature. Ultimate analysis, heating values, acidity and water content were determined at two different moments to provide an understanding into mixtures ageing. Some properties were analysed through the ternary diagram. Overall, mixtures presented good fuel characteristics with lower water content and acidity and higher heating values and carbon content than typical bio-oil. Nevertheless, choosing HBO as the main component had its drawbacks like viscosities unexpectedly high. Except for viscosity, ageing promoted beneficial changes like lowering water content to a minimum of 0.93% and raising HHV to a maximum of 24.6 MJ kg−1.

This paper refers to the birth of the recycling and domestic collection of electronic waste in Barcelona as a process of both urban innovation and social transformation. It is explained as an event that reveals the vital transformative capacity of matter in our societies and in our cities. With this goal, it makes use of Graham Harman’s critique of Sociology of Associations to advance towards the proposal of New Materialisms. Innovation is expressed as a production made by heterogeneous entities within an improvised process. In it, human and non-human entities interact and produce differential transformations, linked by a sort of “corporal commitment”. The intrinsic qualities of the material show themselves as creative resistances. These materials become intuitive actors in intra-action with elements of the social, giving rise -from 2015- to a new sensibility of the city towards electronic household waste.

Background: Scarce evidence exists about the best treatment for multi-system inflammatory syndrome (MIS-C). We analysed the effects of steroids, intravenous immunoglobulin (IVig), and their combination on the probability of discharge over time, probability of switching to second-line treatment over time, and persistent fever after 2 days of treatment. Methods: We did a retrospective study to investigate the effect of treatments (IVig plus steroids, steroids alone or IVig alone) on children with MIS-C from 1 March to 1 June 2021. We estimated the time-to-event probability using a Cox model weighted by propensity score to balance the baseline characteristics. Findings: 30/132 (22·7%) patients were initially treated with steroids alone, 29/132 (21·9%) with IVig alone, and 73/132 (55%) with IVIG plus steroids. The probability of early discharge was higher with IVig than with IVig plus steroids (hazard ratio [HR] 1·65, 95% CI 1·11–2·45, p=0·013), but with a higher probability of needing second-line therapy versus IVig plus steroids (HR 3·05, 95% CI 1·12-8·25, p=0·028). Patients on steroids had a lower probability of persistent fever after 2 days of treatment (odds ratio [OR] 0·55, 95% CI, 0·28–1·05, p=0·081) versus patients on IVig plus steroids, and those on the combination had a lower probability versus IVig alone (OR 0·21, 95% CI, 0·09–0·46, p=0·0001). Interpretation: The benefits of each approach may vary depending on the outcome assessed. IVig seemed to increase the probability of earlier discharge over time but also of needing second-line treatment over time. Steroids seemed to reduce persistent fever after 2 days of treatment, and combination therapy reduced the need for escalating treatment. Funding Information: Instituto Salud Carlos III, PI20/00095, SERMAS-Fundacion para la Investigacion Biomedica Hospital 12 de Octubre, Spanish Society of Paediatrics, SERMAS-Fundacion para la Investigacion Biomedica Hospitales Infanta Sofia y Henares, Fundacion Universidad Europea de Madrid. Declaration of Interests: No conflicts of interest. Ethics Approval Statement: The study was approved by the Ethics Committee of Hospital 12 de Octubre, Madrid (code 20/101), and other participating hospitals. Participants were enrolled after signed or verbal consent from parents/guardians and by the consent of patients older than 12 years.

INTRODUCTION There are no strong recommendations regarding the management of percutaneous cholecystostomy (PC). The aim of this study was to assess the safety of early PC removal in terms of complications and recurrent disease. MATERIALS AND METHODS Retrospective observational study of consecutive patients who underwent PC for acute cholecystitis from January 2012 to December 2017. We first evaluated PC-related complications and recurrent disease in patients whose drainage was removed as inpatients (IPR) or as outpatients (OPR). Patients were then divided into 2 groups according to the timing of PC removal: G1 with the PC removed within the first 7 days after its collocation and G2 with the PC removed after 7 days. RESULTS We included 151 patients. Patients in the OPR group had their catheters removed after 52 days (26 to 67 d) while the IPR group after 8 days (6 to 11 d); P

The idea of complexity in the teaching and practice of architectural design is linked to formal processes or their programmatic features, leaving aside relevant aspects of the complete cycle of an emergent building: the relationships with the communities involved, management of financial and material resources, technical designs, environmental qualities, construction, and performance. In this way, too much relevance is given to the production of architectural representations and the student’s individual work, in detriment to the real impact that the student's activities may have on our society. In the Clouds of Wood Design-Build Studio (Medellín, Colombia, 2013–17), complexity was understood as the passage of a team of two professors and thirty students through the stages of design and construction of small-format buildings, made in association with rural communities near Medellín and a local company specializing in building with immunized wood. Constructions with a light program, low cost, and high impact on the communities’ daily lives were agreed on between all parties. Excessive production of drawings, models, and simulations was avoided, and collaboration between students, teachers, community leaders, representatives of municipal governments, and construction instructors was encouraged. In each semester of this course (ten studios in five years), the students worked in an articulated way in five groups with defined roles and responsibilities (fund-raising, drawing, wooden models, budget, construction). They only drew plans after knowing in depth the materials and construction technologies to be implemented; they only designed after visiting the communities involved; and they only built after understanding the budgets and the various constraints in play. If in a traditional design studio the students spend at least 80 percent of their time in activities of representation, often disconnected from everyday reality, in this course, they spent half of their time in meetings with experts and leaders, generating not only a balance in favor of the project but also a limited number of precise drawings. The course ran in four one-month modules: the first one to define in a group the overall aspects of the design (program, size, location, qualities) and evaluate five variants; the second, to develop the chosen design proposal; the third, to plan the construction phase; and the last, to build and inaugurate the building with the community. The result was the creation of a family of permeable buildings that are resistant and adapted to the tropical climate; have minimal geometric, structural, and tectonic variations; and made use of the constructive advantages of immunized wood. In addition, the consolidation of a group of students committed to the particular problems of communities, who can propose necessary, relevant, and unexpected buildings, raised the question about what is significant or even radical, today, in the education of architectural design: (a) the exploration of worlds (not yet seen) through images and models, or (b) the incorporation of design into the (already existing) complex and restrictive dynamics through a built architecture project?

We studied MET alterations in 474 advanced non‐small‐cell lung cancer (NSCLC) patients by nCounter, an RNA‐based technique. We identified 3% with METΔex14 mRNA and 3.5% with very‐high MET mRNA expression, a surrogate of MET amplification. MET alterations identified by nCounter correlated with clinical benefit from MET inhibitors. Quantitative mRNA‐based techniques can improve the selection of patients for MET‐targeted therapies., MET inhibitors have shown activity in non‐small‐cell lung cancer patients (NSCLC) with MET amplification and exon 14 skipping (METΔex14). However, patient stratification is imperfect, and thus, response rates have varied widely. Here, we studied MET alterations in 474 advanced NSCLC patients by nCounter, an RNA‐based technique, together with next‐generation sequencing (NGS), fluorescence in situ hybridization (FISH), immunohistochemistry (IHC), and reverse transcriptase polymerase chain reaction (RT–PCR), exploring correlation with clinical benefit. Of the 474 samples analyzed, 422 (89%) yielded valid results by nCounter, which identified 13 patients (3%) with METΔex14 and 15 patients (3.5%) with very‐high MET mRNA expression. These two subgroups were mutually exclusive, displayed distinct phenotypes and did not generally coexist with other drivers. For METΔex14, 3/8 (37.5%) samples positive by nCounter tested negative by NGS. Regarding patients with very‐high MET mRNA, 92% had MET amplification by FISH and/or NGS. However, FISH failed to identify three patients (30%) with very‐high MET RNA expression, among which one received MET tyrosine kinase inhibitor treatment deriving clinical benefit. Our results indicate that quantitative mRNA‐based techniques can improve the selection of patients for MET‐targeted therapies.

Each of the pathological stages (I-IIIa) of surgically resected non-small-cell lung cancer has hidden biological heterogeneity, manifested as heterogeneous outcomes within each stage. Thus, the finding of robust and precise molecular classifiers with which to assess individual patient risk is an unmet medical need. Here, we identified and validated the clinical utility of a new prognostic signature based on three proteins (BRCA1, QKI, and SLC2A1) to stratify early-stage lung adenocarcinoma patients according to their risk of recurrence or death. Patients were staged according to the new International Association for the Study of Lung Cancer (IASLC) staging criteria (8th edition, 2018). A test cohort (n = 239) was used to assess the value of this new prognostic index (PI) based on the three proteins. The prognostic signature was developed by Cox regression with the use of stringent statistical criteria (TRIPOD: Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis). The model resulted in a highly significant predictor of 5-year outcome for disease-free survival (p < 0.001) and overall survival (p < 0.001). The prognostic ability of the model was externally validated in an independent multi-institutional cohort of patients (n = 114, p = 0.021). We also demonstrated that this molecular classifier adds relevant information to the gold standard TNM-based pathological staging, with a highly significant improvement of the likelihood ratio. We subsequently developed a combined PI including both the molecular and the pathological data that improved the risk stratification in both cohorts (p ≤ 0.001). Moreover, the signature may help to select stage I-IIA patients who might benefit from adjuvant chemotherapy. In summary, this protein-based signature accurately identifies those patients with a high risk of recurrence and death, and adds further prognostic information to the TNM-based clinical staging, even when the new IASLC 8th edition staging criteria are applied. More importantly, it may be a valuable tool for selecting patients for adjuvant therapy. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Resumen La fascitis eosinofilica es una enfermedad rara del tejido conectivo que se caracteriza por induracion y engrosamiento progresivo y simetrico de la piel y del tejido celular subcutaneo localizado, principalmente, en las extremidades. Ademas de las manifestaciones cutaneas hay compromiso articular, muscular y, en casos excepcionales, compromiso sistemico. Su diagnostico se basa en los hallazgos clinicos, eosinofilia en sangre periferica y la toma de una biopsia profunda de piel, que incluya la fascia donde se evidencia un infiltrado compuesto por linfocitos y eosinofilos. El tratamiento de eleccion son los esteroides sistemicos acompanados de medicamentos inmunosupresores.

Eosinophilic fasciitis is a rare connective tissue disease. It is characterized by a progressive and symmetrical induration and thickening of the skin and soft tissues of the limbs. In addition to the skin manifestations, the joints and muscles are also involved, and in rare cases there can be systemic involvement. The diagnosis of EF is based on clinical findings, the presence of peripheral blood eosinophilia, and a full-thickness biopsy that should include the deep fascia in order to show the inflammatory infiltration that is mostly composed of lymphocytes and eosinophils. Systemic corticosteroids remain the treatment of choice and may be combined with an immunosuppressive drug.

Se reporta el caso de un hombre de 47 arios con intoxicación crónica por plomo, secundaria a exposición laboral de 5 años, con sintomatología típica de saturnismo. Consultó por debilidad muscular generalizada, disfagia y parestesias en extremidades. Se documentaron altos niveles de plomo en sangre, asociados a neuropatía periférica, confirmada por electromiografía, y disminución de la fuerza muscular en cintura escapular y pélvica (deltoides y vasto medial), así como atrofia de músculos del cuello (flexores y extensores) manifestada como cefaloparesia. Adicional al cuadro de saturnismo se diagnosticó miopatía inflamatoria con base en la elevación de enzimas musculares, miositis por resonancia magnética nuclear y biopsia muscular compatible, siendo, hasta donde se sabe, el primer reporte conocido de la coexistencia de estas 2 enfermedades. A case is presented on a 47-year-old man with chronic lead poisoning with typical symptoms after 5 years of occupational exposure. He consulted for generalised muscle weakness, early dysphagia, cephaloparesia, and paresthesias in upper and lower limbs. He also had atrophy and decreased proximal muscle strength (deltoid and medial vast) and in both flexor and extensor muscles of the neck. He had a history of high blood lead levels and peripheral neuropathy documented by electromyography. In addition to the diagnosis of lead poisoning, inflammatory myopathy was confirmed based on muscle enzyme elevation, muscular inflammation in magnetic resonance imaging, and typical findings in a muscle biopsy. To our knowledge, this is the first report where both conditions are documented in one patient.

Resumen Se reporta el caso de un hombre de 47 anos con intoxicacion cronica por plomo, secundaria a exposicion laboral de 5 anos, con sintomatologia tipica de saturnismo. Consulto por debilidad muscular generalizada, disfagia y parestesias en extremidades. Se documentaron altos niveles de plomo en sangre, asociados a neuropatia periferica, confirmada por electromiografia, y disminucion de la fuerza muscular en cintura escapular y pelvica (deltoides y vasto medial), asi como atrofia de musculos del cuello (flexores y extensores) manifestada como cefaloparesia. Adicional al cuadro de saturnismo se diagnostico miopatia inflamatoria con base en la elevacion de enzimas musculares, miositis por resonancia magnetica nuclear y biopsia muscular compatible, siendo, hasta donde se sabe, el primer reporte conocido de la coexistencia de estas 2 enfermedades.

INTRODUCTION: Strongyloides stercoralis is an intestinal parasitic nematode that causes hyperinfection and/or a dissemination syndrome in hosts, which is often difficult to diagnose. This study aims to compare the diagnostic efficacy of four conventional methods used to diagnose strongyloidiasis with real-time polymerase chain reaction (qPCR) to detect S. stercoralis in fecal samples. METHODS: We analyzed 143 fecal samples collected from Colombian regions with varying degrees of risk for intestinal infections caused by S. stercoralis to assess the validity, performance, overall efficiency, and concordance of the qPCR using a direct stool test, modified Ritchie concentration technique, agar plate culture, and Harada-Mori technique as reference tests. RESULTS While four fecal samples were positive for S. stercoralis using conventional methods, 32 were positive via qPCR. The diagnostic sensitivity of the qPCR was 75% [95% confidence interval (CI): 20.07-100%], whereas its specificity, negative predictive value, negative likelihood ratio, and Youden’s J index were 78.42% (95% CI: 71.22-85.62%), 99.09% (95% CI: 96.86-100%), 0.32 (95% CI: 0.06-1.74), and 0.53, respectively. In addition, the estimated kappa index between the qPCR and the conventional methods was 0.12 (95% CI: -0.020-0.26). CONCLUSIONS: The diagnostic sensitivity of qPCR to detect strongyloidiasis is analogous to that of conventional parasitology methods, with an additional advantage of being capable of identifying the parasite DNA at low sample concentrations.

Treatment of an infected postpneumonectomy cavity is very difficult. We present a patient with an infection of a postpneumonectomy cavity by Staphylococcus epidermidis treated with local daptomycin for different dwell times, maintaining high antibiotic levels above the MIC. Clinical and microbiological cure were achieved successfully.

This research presents and discusses the results of product yields, higher heating value, proximate and ultimate analyses of the charcoal obtained in the Fast Pyrolysis Plant – PPR-200. It is a fast pyrolysis plant with a biomass feed capacity of 200 kg per hour, owned by Unicamp. Elephant grass with an average particle diameter of 2 mm and 12% of moisture was used as raw material. The PPR-200 facility operated under different conditions. Air was used as fluidization agent. This study tries to increase the knowledge of the PPR-200 plant operation in fast pyrolysis regimen. Experimental tests were carried out considering two independent factors: fluidization air and stoichiometric air ratio and the height of the fixed bed. In the pyrolysis process, a charcoal with a high carbon content is obtained as well as the release of oxygen from the biomass. Experimental results showed that the favorable operating conditions for oxygen release from elephant grass and carbon concentration in the charcoal are a fixed fluidized bed of 207 mm height and 8% of supplied air to the stoichiometric air ratio. Under these optimized conditions, the fluidized bed temperature resulted to be 650 °C on average and the yield production of charcoal in relation to the biomass fed (dry and ash free, d.a.f.) was of 14 wt.%. The charcoal produced under such conditions presented 92.4% of elemental carbon, and 2.85% of elemental oxygen.

This study focuses on the technical viability evaluation of the fast pyrolysis of sugar cane straw for its energy use. By means of this thermochemical process, the sugar cane straw is converted into bio-fuels (biochar, bio-oil) and non-condensable gases. The bio-fuels obtained could be used as fuel or as raw material in the chemical industry. The fast pyrolysis of sugar cane straw has been developed in a fluidized bed reactor. In order to improve this process to obtain high bio-oil yield, the influence of the operational conditions (equivalence ratio and temperature) on the product yields and on their characteristics was evaluated. The product yields of bio-oil and char were up to 35.5 wt.% and 48.2 wt.% respectively. The maximum bio-oil yield was achieved at temperature and equivalence ratio conditions of 470 °C and 0.14. The bio-oil obtained has low oxygen content (38.48 wt.% dry basis), very low water content, and a lower heating value of 22.95 MJ/kg. The gas chromatographic analyses allowed the identification of oxygenated compounds and heterocyclic aromatic hydrocarbons. The bio-oil pH ranged between 3.14 and 3.57 due to the presence of acid organic compounds. The char obtained has a high fixed carbon and volatile matter content. Its HHV value is 13.54 MJ/kg.

Foram realizados ensaios de pirólise rápida em reator de leito fluidizado com palha de cana-de-açúcar utilizando ar como agente de fluidização, onde foram utilizadas 3 faixas de ajuste para a abertura da válvula de controle de fluxo de ar para o reator. O objetivo foi avaliar os rendimentos de bio-óleo e finos de carvão em função das vazões de ar, que foram medidas com uma placa de orifício. Também foram monitorados os perfis de temperatura e pressão no interior do reator. A planta de pirólise onde foram realizados os testes pertence a Faculdade de Engenharia Agrícola da Universidade Estadual de Campinas (Unicamp), estando instalada no Laboratório de Termodinâmica e Energia. O reator possui uma capacidade nominal de 200 kg.h-1 de biomassa e opera em regime auto-térmico, consumindo entre 10 e 15% da biomassa para fornecimento de calor ao processo. Enquanto os valores de temperatura e pressão sofreram elevação, assim como a quantidade de biomassa queimada para fornecimento de calor, observou-se que a quantidade total biomassa alimentada no reator apresentou comportamento decrescente em relação ao aumento da vazão de ar, assim como os rendimentos gravimétricos de finos de carvão e bio-óleo.

Introduction and objective To evaluate the results of our program of clipping the thoracic sympathetic nervous system (TSNS) for the treatment of facial flush and/or hyperhidrosis (HH), and to compare the methodology-results of the program development phase (A: January 2007–April 2009) and its consolidation phase (B: May 2009–March 2010). Material and methods The program included a total of 44 patients (88 procedures) subjected to video thoracoscopy and clipping of the TSNS in a one day surgery unit. Data were collected and analyzed retrospectively, and a descriptive and comparative statistical analysis was performed between the two periods (A and B). Results The overall morbidity was 5 cases (11.3%). The post-surgical occurrence rate of HH was 4.54% (2 cases), and the incidence of compensatory sweating was 65.9% (minimal in 26 of the 29 cases). On comparing period B with period A, there was a significant decrease in surgical time, disappearance of recurrence of HH, a decrease of 30% in morbidity, reduction by half in the incidence of moderate to severe compensatory sweating, and an increase in the level of satisfaction. The clamps were removed in one of the poorly tolerated compensatory sweating cases, resulting in its disappearance. Conclusions Clipping the TSNS is a safe technique in the one day surgery unit, with a short learning curve (20 cases) after which comparable, or even better, results are obtained than those of sympatholysis. These results, together with their potential reversibility, make it, in our opinion, the technique of choice in the surgery of the TSNS.

Resumen Introduccion y objetivo Evaluar los resultados de nuestro programa de clipaje del sistema nervioso toracico simpatico (SNTS) para el tratamiento del rubor facial y/o hiperhidrosis (HH) y comparar la metodologia-resultados de la fase de desarrollo del programa (A: enero 2007-abril 2009) y la fase de consolidacion del mismo (B: mayo 2009-marzo 2010). Poblacion y metodos Se ha incluido a 44 pacientes (88 procedimientos) sometidos a clipaje videotoracoscopico del SNTS en regimen de cirugia mayor ambulatoria (CMA). Los datos fueron recogidos prospectivamente y analizados retrospectivamente. Se ha realizado estudio estadistico descriptivo y comparativo entre los 2 grupos. Resultados La morbilidad global fue de 5 casos (11,3%). La tasa de recidiva postquirurgica de HH fue del 4,54% (2 casos), la incidencia de sudoracion compensadora (SC) fue del 65,9% (minima en 26 de los 29 casos). Al comparar el periodo B con el A, se aprecia: disminucion significativa del tiempo quirurgico, desaparicion de la recidiva de HH, disminucion de la morbilidad en un 30%, reduccion a la mitad de la incidencia de SC moderada-severa e incremento del grado de satisfaccion. En uno de los casos de SC mal tolerada se retiraron los clips consiguiendose la desaparicion de esta. Conclusiones El clipaje del SNTS es una tecnica segura en regimen de CMA, con una curva de aprendizaje corta (20 casos) tras la cual se obtienen resultados equiparables o, incluso mejores, que los de la simpaticolisis. Estos resultados, junto a su potencial reversibilidad, la convierten, en nuestra opinion, en la tecnica de eleccion en la cirugia del SNTS.

Resumen Introduccion El sindrome antifosfolipido es una enfermedad autoinmune, caracterizada por trombosis vascular y morbilidad gestacional en presencia de anticuerpos antifosfolipidos. Se han descrito varios factores de riesgo para el desarrollo de trombosis en estos pacientes, pero los estudios son heterogeneos y no discriminan entre eventos arteriales y venosos. Objetivo Describir las manifestaciones clinicas e inmunologicas del sindrome antifosfolipido en una cohorte de pacientes colombianos y establecer los factores de riesgo para el desarrollo de trombosis venosa y arterial. Materiales y metodos Se condujo un estudio analitico de corte transversal. Criterio de inclusion: Consenso de Sydney de 2006 y clasificacion del sindrome antifosfolipido como secundario, segun criterios del American College of Rheumatology. Resultados Se incluyeron 100 pacientes; 84 de ellos mujeres; edad promedio 37.6 anos. El 59% de los pacientes correspondia a sindrome antifosfolipido secundario. La manifestacion clinica mas frecuente inicial y durante el seguimiento fue la trombosis venosa (56.52% y 47%, respectivamente), seguida por “manifestaciones no criterio” (23.91%), especialmente neurologicas. La trombosis venosa profunda fue recurrente en el 46%; 30% de los individuos presento trombocitopenia severa. La ausencia de autoanticuerpos especificos discrimino entre formas primarias y secundarias. La diabetes mellitus fue un factor de riesgo significativo para trombosis venosa (6.4% vs. 0%; OR 2.205, IC 95%: 1.772–2.742) y el tabaquismo para enfermedad cerebrovascular (33.3% vs. 6%, OR 7.9, IC 95%: 1.5–41.324). Conclusiones Esta cohorte de pacientes colombianos con sindrome antifosfolipido presenta alto porcentaje de manifestaciones no incluidas en los criterios clasificatorios, con compromiso organico grave, atipico y recurrente.

The objective of this paper is to report our results on the behavior of an Otto engine working with gasoline blended with a fraction rich in esters of carboxylic acids derived from biomass pyrolysis bio-oil, hereby called as “Bioflex”. Sugarcane trash undergoes a fast pyrolysis process at the PPR-200 pilot plant to produce the bio-oil at Unicamp (Brazil). The process of separating carboxylic acids from bio-oil, the production of esters from these acids, the process of blending these esters with gasoline as well as the results of the use of this blend in an Otto engine of 4 kW capacity – component of a 2 kW e generator – are described. Trial tests determined that it is possible to blend up to 14 vol.% of Bioflex with gasoline type C used in Brazil. The engine performance with this blend compared to the performance of the engine working with pure gasoline resulted in identical power output and fuel consumption. The results showed that it is technically feasible to use blends of carboxylic acid esters derived from the biomass pyrolysis bio-oil with gasoline in conventional Otto engines.

Objective: Despite the use of thoracic epidural analgesia, a constant severe ache occurs in the ipsilateral shoulder of almost 75% of patients after thoracotomy. The aim of this prospective-randomized study was to investigate the effect of phrenic nerve infiltration (PNI) compared with suprascapular nerve block (SNB) on ipsilateral shoulder pain after thoracic surgery. Methods: After Local Research Ethics Committee approval, written informed consent was obtained from 90 adult patients undergoing thoracotomy for pulmonary resection. Patients were excluded if they had preexisting shoulder pain, were unable to understand the visual analog scale (VAS) scoring system or due to failure of epidural analgesia. The phrenic group (PNI) received 10 ml of 2% lidocaine infiltrated into the periphrenic fat pad, 1—2 cm close to the diaphragm, just before chest closure. The suprascapular group (SNB) received 10 ml of 0.5% plain bupivacaine injected into the suprascapular fossa once the surgery was finished.Ablindedobservertothestudygroupassessedthepatient’sshoulderandthoracotomypain,usingtheVASscoreandafive-pointobserver verbal rating score (OVRS), at 0.5, 1, 2, 3, 4,5, 6, 12, 48, and 72 h after surgery and at discharge. The time and dose of any administered analgesic medication were recorded. Results: Finally, 74 patients were included (37 per group). Sixteen patients were excluded (unable to understand scoring system, failure of the epidural technique, and lost data). There were no significant differences in age, gender, body mass index, type/ duration of operation, and pain scores at rest, between the two groups. Shoulder pain intensity was significantly lower in the PNI group compared with the SNB group (median value of VAS area under the curve for the PNI group: 8.1 (0—70.9) cm vs 114.3 (43.8—193.8) cm for the SNB group; p < 0.001). There were no significant differences between the two groups according to postoperative thoracotomy pain. Conclusions: Phrenic nerve block with 2% lidocaine should be performed in all patients undergoing a major thoracic surgery procedure. These results strongly support the hypothesis that irritation of the pericardium and/or mediastinal—diaphragmatic pleural surfaces results in pain that is referred to the shoulder via the phrenic nerve. # 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Neste trabalho são discutidos os principais problemas encontrados durante a operação da planta piloto de pirólise rápida de biomassa, pertencente à Universidade Estadual de Campinas- Unicamp, Brasil. Essa planta foi ajustada para a produção de bio-óleo, a partir de resíduos de biomassa de pequeno tamanho. Durante os testes, os principais problemas identificados foram: escoamento de vapores da pirólise pelo sistema de alimentação de biomassa; travamento da rosca de alimentação de biomassa; segregação da biomassa no leito; sinterização do material inerte; acúmulo de biomassa e de carvão vegetal dentro do reator; dificuldade para o aquecimento do inerte e baixa eficiência de recuperação de bio-óleo. Os resultados dos testes exploratórios permitiram definir condições operacionais para possibilitar o trabalho estável do reator, aumentar o conhecimento sobre os fenômenos que ocorrem durante a pirólise rápida em leito fluidizado, além do estabelecimento de faixas operacionais para vários fatores independentes, visando a futuros trabalhos de otimização experimental.