Feasibility of Cerebellar Measurements with Phased Array Sonography through the Anterior Fontanelle in Comparison to MRI.

OBJECTIVE: Cerebral sonography (CS) through the anterior fontanelle is a neonatal brain imaging method that has become an integral part of modern neonatal bedside care for both screening and diagnostic purposes. Premature infants with cognitive delay have a reduction in cerebellar size at term corrected age on magnetic resonance imaging (MRI). We aimed to determine the level of agreement between postnatal MRI and CS for cerebellar biometry and to determine the level of agreement within one and between different examiners. STUDY DESIGN: Cerebellar sonography and MRI measurements of the cerebellum from 30 term infants was assessed by Bland-Altman plots. Measurements between both modalities were compared using Wilcoxon's signed rank test. A p-value < 0.01 was considered statistically significant. Intraclass correlation coefficients (ICC) for intra- and interrater reliabilities of CS measurements were calculated. RESULTS: There was no statistically significant difference between CS and MRI for linear measurements, but the measurements of perimeter and surface area differed significantly between the two techniques. There was a systematic bias between both modalities for most measurements except for anterior-posterior (AP) width and vermis height (VH). For measurements that were not statistically different from MRI, we found excellent intrarater ICC for the AP width, VH, and cerebellar width. The interrater ICC was excellent for the AP width and VH, but poor for the transverse cerebellar width. CONCLUSION: With a strict imaging protocol, cerebellar measurements of the AP width and the VH can be used as an alternative to MRI for diagnostic-screening purposes in a neonatal department where multiple clinicians perform bedside CS. KEY POINTS: · Abnormal cerebellar growth and injuries affect neurodevelopmental outcome.. · Cerebral sonography through the anterior fontanelle is used for bedside imaging.. · Postnatal sonographic cerebellar measurements are not validated against MRI.. · Measuring vermis height and anterior-posterior width are reliable.. · Measuring transverse cerebellar width through anterior fontanelle is unreliable..

Design and implementation of an online tool for managing the availability of high-cost perishable medicines.

Introduction: Due to their impact on healthcare systems, the sustainability and optimization of high-cost drugs is an issue of concern for several countries. Different strategies have been implemented such as centralized purchasing to optimize budgetary resources. However, there is still a need for a mechanism to optimize these drugs further. Methods: We conducted this prospective multicenter intervention study in five hospitals in the Andalusian Public Health System of Cádiz (Spain) between July 2019 and September 2021. We developed an online website (Farmastock) and implemented it to determine the availability of high-cost, low-use, and near-expiry medicines in each hospital. We used a simple analysis using operational variables to assess the project intervention's savings impact on managing these high-cost drugs. Results: The implementation of Farmastock in Cádiz resulted in savings of 675,757.52 € for the Andalusian Public Health System, with 238 medicines transferred out of the 373 available. Of these medicines offered, the most considerable percentage were medicines used for pathologies with high clinical instability and accounted for nearly 80% of the medicines optimized by the tool. Conclusions: Farmastock allowed the Andalusian Public Health System to make substantial financial savings by not making new purchases of high-cost drugs available in other centers of this health network that were not being used. Therefore, this tool is a very efficient measure to contribute to the sustainability of the APHS and could be implemented in more hospitals soon.

A prospective cohort study using non-invasive methods of cardiovascular assessment to compare postnatal adaptation in well late preterm and term infants.

Echocardiography was combined with pulse oximetry plethysmography to investigate postnatal cardiovascular adaptation in late preterm and term infants. Median (IQR) pleth variability decreased over three days and similar, day2 15%(12-18%) preterm versus 16%(15-18%) term infants. Median (IQR) pulse transit time heart rate normalised was lower in term babies, day2 0.55(0.51-0.63) versus 0.64(0.62-0.68).

Quick Spreading of Populations of an Exotic Firefly throughout Spain and Their Recent Arrival in the French Pyrenees.

In August 2018, a firefly (Coleoptera: Lampyridae) of American origin was observed in several localities in Girona (Catalonia, Spain) and was described as Photinus immigrans by Zaragoza-Caballero and Vinolas, 2018. Here, we show that this species dispersed very quickly throughout northeastern Spain and was, in 2020, observed in the French Pyrenees. The animal's quick progress is documented, and part of its biology is described (dispersion speed, land use, phenology, identification of all life stages). An additional population was localized in Extremadura, and its special status is discussed. We were able to determine its Argentinian-Uruguayan origin and propose, therefore, to consider Photinus immigrans as a synonym of Photinus signaticollis (Blanchard, 1846) (=Photinus immigrans Zaragoza-Caballero and Viñolas, 2018, syn. nov.). Our data clearly show that at least the Catalan and French populations are spreading very quickly and are able to settle permanently if adequate ecosystems are found. The species is highly expansive and may well be invasive; our citizen science platforms are ideally suited to monitor their progress throughout Spain and France. This is important for avoiding future ecological problems with diverse native faunas, such as glow-worms, fireflies and earthworms. If no ways are found to stop the species' progression, the animals will quite probably invade substantial areas of France, Spain and the rest of Europe in the years to come.

Less-Invasive Surfactant Administration for Neonatal Respiratory Distress Syndrome: A Consensus Guideline.

INTRODUCTION: Less-invasive surfactant administration (LISA) is a method of surfactant delivery to preterm infants for treating respiratory distress syndrome (RDS), which can reduce the composite risk of death or bronchopulmonary dysplasia and the time on mechanical ventilation. METHODS: A systematic literature search of studies published up to April 2021 on minimally invasive catheter surfactant delivery in preterm infants with RDS was conducted. Based on these studies, with parental feedback sought via an online questionnaire, 9 UK-based specialists in neonatal respiratory disease developed their consensus for implementing LISA. Recommendations were developed following a modified, iterative Delphi process using a questionnaire employing a 9-point Likert scale and an a priori level of agreement/disagreement. RESULTS: Successful implementation of LISA can be achieved by training the multidisciplinary team and following locally agreed guidance. From the time of the decision to administer surfactant, LISA should take <30 min. The comfort of the baby and requirements to maintain non-invasive respiratory support are important. While many infants can be managed without requiring additional sedation/analgesia, fentanyl along with atropine may be considered. Parents should be provided with sufficient information about medication side effects and involved in treatment discussions. CONCLUSION: LISA has the potential to improve outcomes for preterm infants with RDS and can be introduced as a safe and effective part of UK-based neonatal care with appropriate training.

Discovery of 5-{2-[5-Chloro-2-(5-ethoxyquinoline-8-sulfonamido)phenyl]ethynyl}-4-methoxypyridine-2-carboxylic Acid, a Highly Selective in Vivo Useable Chemical Probe to Dissect MCT4 Biology.

Due to increased lactate production during glucose metabolism, tumor cells heavily rely on efficient lactate transport to avoid intracellular lactate accumulation and acidification. Monocarboxylate transporter 4 (MCT4/SLC16A3) is a lactate transporter that plays a central role in tumor pH modulation. The discovery and optimization of a novel class of MCT4 inhibitors (hit 9a), identified by a cellular screening in MDA-MB-231, is described. Direct target interaction of the optimized compound 18n with the cytosolic domain of MCT4 was shown after solubilization of the GFP-tagged transporter by fluorescence cross-correlation spectroscopy and microscopic studies. In vitro treatment with 18n resulted in lactate efflux inhibition and reduction of cellular viability in MCT4 high expressing cells. Moreover, pharmacokinetic properties of 18n allowed assessment of lactate modulation and antitumor activity in a mouse tumor model. Thus, 18n represents a valuable tool for investigating selective MCT4 inhibition and its effect on tumor biology.

Simultaneous encapsulation of trans-resveratrol and vitamin D3 in highly concentrated double emulsions.

BACKGROUND: Encapsulation of biocompounds is essential to protect them from environmental factors that could enhance their oxidation or cause them to lose their beneficial properties due to extreme photosensitivity, among other factors. The main goal of this work was to study the feasibility of preparing concentrated double emulsions with a high loading capacity containing simultaneously trans-resveratrol (RSV) and vitamin D3 (VitD3 ). Such emulsions could be used for food fortification or pharmaceutical formulations or as vehicles for targeted controlled release. RESULTS: In order to achieve large concentrations of the encapsulated compounds, all the double emulsions were formulated using a W1 /O in W2 ratio of 80/20, while the ratios tested for W1 in O where 20/80 and 30/70. All the emulsions were characterized by droplet size, morphology, colloidal stability and encapsulation efficiency (EE) over a period of 6 weeks. VitD3 and RSV concentration were determined by a technique based on reverse-phase high-performance liquid chromatography. The viability of preparing concentrated W1 /O/W2 emulsions containing both biocompounds has been demonstrated with satisfactory results. Initial RSV concentrations in the concentrated double emulsions formulated varied from 5.0 to 8.3 mg L-1 , while for VitD3 values of 28-32 mg L-1 were obtained. The presence of VitD3 retarded RSV release in the formulated emulsions. It was observed that after 1 week of storage RSV EE increased around 10-50% when VitD3 was simultaneously encapsulated. CONCLUSION: Simultaneous encapsulation of RSV and VitD3 was possible in high internal phase emulsions. The emulsions presented high colloidal stability, being suitable for food fortification applications. © 2020 Society of Chemical Industry.

Enhancing trans-Resveratrol loading capacity by forcing W1/O/W2 emulsions up to its colloidal stability limit.

Trans-Resveratrol (3, 5, 4'-trihydroxystilbene) is a naturally occurring polyphenol easily oxidizable and extremely photosensitive with a short biological half-life that must be encapsulated to maintain its beneficial properties on the human body. The aim of this work is to increase the amount of resveratrol encapsulated using concentrated double water-in-oil-in-water (W1/O/W2) emulsions, making these systems more interesting as ingredient for functional food products and/or pharmaceutical formulations. The concentration of the inner emulsion (W1/O) for several external (W1O/W2) ratios was optimized in terms of encapsulation efficiency (EE), colloidal stability and rheological behaviour. W1/O emulsions formulated with ratios of 30/70 and 40/60 were used to obtain double emulsions (with ratios of 20/80 up to 80/20 of W1O/W2). Trans-Resveratrol EE increased up to 90 % when the most concentrated double emulsions were prepared for both W1/O ratios tested. The maximum resveratrol concentrations on double emulsions were 10.8 mg/L and 14.4 mg/L when 30/70 and 40/60 of W1/O ratios were used, respectively. However, longer time stability was found for double high internal phase emulsions (W1O/W2) with a ratio of 30/70 of W1/O. The double emulsion formulated with a 80/20 W1O/W2 volumetric ratio together with 30/70 of W1/O seems suitable to be used as ingredient for pharmaceutical and food devices/products due to its high colloidal stability, clearly pseudoplastic and elastic behaviour, high EE and large trans-Resveratrol carrier capacity.

Comparison of MRI and neurosonogram 1- and 2-dimensional morphological measurements of the newborn corpus callosum.

BACKGROUND: Developmental abnormalities of the corpus callosum (CC) are linked to multiple neuro-developmental disorders, for which neonatal neuroimaging may allow earlier diagnosis and intervention. MRI is often considered the most sensitive imaging modality to white matter changes, while neurosonogram (NS) remains the clinical staple. This study assesses the correlation between MRI and US measurements of the neonatal CC using a protocol derived from established methodologies. METHODS: MR and NS images from an existing cohort of term infants (≥37 weeks gestational age) were studied. Length and area measurements of the CC made with linear (LUS) and phased array US (PUS) data were compared to those from MRI. Intra-observer reliabilities were estimated. RESULTS: Moderate-to-strong correlation strengths were observed for length measurements and the total area of the CC. Sectional area measurements showed poorer correlations. Bland-Altman plots support improved correspondence of length and total area measurements. LUS data appeared to correspond closer to MRI. All three modalities showed comparable repeatability. CONCLUSION: NS correlates well with some MRI measurements of the CC and shows similar levels of repeatability, making them possibly interchangeable. Use of LUS, a technique rarely used for NS, may be preferable to the standard approach for morphological studies.

Cell immobilization of Streptomyces coelicolor: effect on differentiation and actinorhodin production

Streptomycetes are mycelium-forming bacteria that produce two thirds of the clinically relevant secondary metabolites. Despite the fact that secondary metabolite production is activated at specific developmental stages of the Streptomyces spp. life cycle, different streptomycetes show different behaviors, and fermentation conditions need to be optimized for each specific strain and secondary metabolite. Cell-encapsulation constitutes an interesting alternative to classical fermentations, which was demonstrated to be useful in Streptomyces, but development under these conditions remained unexplored. In this work, the influence of cell-encapsulation in hyphae differentiation and actinorhodin production was explored in the model Streptomyces coelicolor strain. Encapsulation led to a delay in growth and to a reduction of mycelium density and cell death. The high proportion of viable hyphae duplicated extracellular actinorhodin production in the encapsulated cultures with respect to the non-encapsulated ones (AU)

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[Application of an obesity treatment protocol for 2 years]. / Aplicación de un protocolo de tratamiento de obesidad durante 2 años.

OBJECTIVE: To evaluate the effectiveness of a clinic protocol used in the Complexo Hospitalario Universitario de Vigo (CHUVI) for obese outpatients. PATIENTS AND METHODS: The study included 47 obese outpatients. All of them were evaluated in clinical department and applied the obesity protocol for a period of 2 years. Variables as weight, BMI and levels of obesity in the initial and final time were evaluated. RESULTS AND DISCUSSION: In obese patients between 26 and 65 years was observed a tendency to reduce their degree of obesity, with significant differences in 2012 compared to 2010. There are differences in behavior between men and women in terms of change in obesity graduation. CONCLUSIONS: In our study we found differences in behavior between men and women in terms of grade change in obesity, in women there is a greater tendency to reduce.

Objetivo: Evaluar la eficacia de un protocolo clínico para pacientes obesos utilizado en la consulta de obesidad del Complexo Hospitalario Universitario de Vigo (CHUVI). Pacientes y métodos: En el estudio participaron 47 pacientes procedentes de la consulta de obesidad del CHUVI. Todos ellos fueron evaluados en consulta y siguieron el protocolo de obesidad durante un periodo de 2 años. Se evaluaron variables como el peso, el IMC y los grados de obesidad en el momento inicial y final. Resultados y discusión: En pacientes obesos entre 26 y 65 años se observa una tendencia a disminuir su grado de obesidad, con diferencias significativas en el 2012 respecto al 2010. Hay diferencias de comportamiento entre hombres y mujeres en cuanto al cambio de graduación en la obesidad. Conclusiones: En nuestro estudio hemos comprobado diferencias de comportamiento entre hombres y mujeres en cuanto al cambio de graduación en la obesidad; en las mujeres hay una mayor tendencia a reducirlo.

A novel microdeletion involving the 13q31.3-q32.1 region in a patient with normal intelligence.

Microdeletions of the long arm of chromosome 13 lead to a characteristic facial appearance with systemic affection; 13q deletion shows a wide phenotypic spectrum that varies with respect to the location and size of the deletion region. The main clinical features are mental retardation, growth retardation, craniofacial dysmorphy and various congenital defects. In the present study we describe the case of an adult female of Mexican origin with microcephaly, facial dysmorphism, short stature, hand anomalies and normal intelligence associated with a de novo 13q31.3-q32.1 microdeletion that involved several genes including the MIR17HG and the GPC5 genes.

Cell immobilization of Streptomyces coelicolor : effect on differentiation and actinorhodin production.

Streptomycetes are mycelium-forming bacteria that produce two thirds of the clinically relevant secondary metabolites. Despite the fact that secondary metabolite production is activated at specific developmental stages of the Streptomyces spp. life cycle, different streptomycetes show different behaviors, and fermentation conditions need to be optimized for each specific strain and secondary metabolite. Cell-encapsulation constitutes an interesting alternative to classical fermentations, which was demonstrated to be useful in Streptomyces, but development under these conditions remained unexplored. In this work, the influence of cell-encapsulation in hyphae differentiation and actinorhodin production was explored in the model Streptomyces coelicolor strain. Encapsulation led to a delay in growth and to a reduction of mycelium density and cell death. The high proportion of viable hyphae duplicated extracellular actinorhodin production in the encapsulated cultures with respect to the non-encapsulated ones.

Heated humidified high-flow nasal cannula versus low-flow nasal cannula as weaning mode from nasal CPAP in infants ≤28 weeks of gestation.

UNLABELLED: Despite the paucity of evidence, the practice of weaning nasal continuous positive airway pressure (NCPAP) is widespread. However, the most clinically effective non-invasive ventilatory support strategy remains to be determined. We compared the outcome of very premature infants with respiratory distress syndrome treated with a combination of NCPAP and heated humidified high-flow nasal cannula (HHFNC) versus NCPAP and low-flow nasal cannula (LFNC). Between 2004 and 2008, patients ≤28 weeks of gestation and <1,250 g of birth weight were treated with NCPAP + HHFNC or NCPAP + LFNC. Their respiratory and non-respiratory outcome including cost-effectiveness was compared after matching for antenatal steroid doses, mode of delivery, birth plurality, gestational age, birth weight, gender, surfactant doses, length of mechanical ventilation and clinical risk index for babies-II (CRIB-II) score. Thirty-nine infants received HHFNC + NCPAP, and 40 received NCPAP + LFNC. Median gestational age and birth weight were 27 weeks and 930 g and 27 weeks and 980 g, respectively. The total number of NCPAP days was significantly reduced by 50 % in the HHFNC group. Thirteen percent of the patients on NCPAP suffered from nasal bridge lesions compared to none on HHFNC. Respiratory and non-respiratory outcome was not significantly different otherwise. Combination of NCPAP and HHFNC reduced costs by 33 %. CONCLUSIONS: HHFNC shortens NCPAP time without increasing overall length of non-invasive respiratory support in very preterm infants. Unlike NCPAP, HHFNC does not seem to increase the risk of nasal trauma and appears to improve cost-effectiveness whilst producing otherwise equal respiratory and non-respiratory outcomes.

Aplicación de un protocolo de tratamiento de obesidad durante 2 años / Application of an obesity treatment protocol for 2 years

Objetivo: Evaluar la eficacia de un protocolo clínico para pacientes obesos utilizado en la consulta de obesidad del Complexo Hospitalario Universitario de Vigo (CHUVI). Pacientes y métodos: En el estudio participaron 47 pacientes procedentes de la consulta de obesidad del CHUVI. Todos ellos fueron evaluados en consulta y siguieron el protocolo de obesidad durante un periodo de 2 años. Se evaluaron variables como el peso, el IMC y los grados de obesidad en el momento inicial y final. Resultados y discusión: En pacientes obesos entre 26 y 65 años se observa una tendencia a disminuir su grado de obesidad, con diferencias significativas en el 2012 respecto al 2010. Hay diferencias de comportamiento entre hombres y mujeres en cuanto al cambio de graduación en la obesidad. Conclusiones: En nuestro estudio hemos comprobado diferencias de comportamiento entre hombres y mujeres en cuanto al cambio de graduación en la obesidad; en las mujeres hay una mayor tendencia a reducirlo (AU)

Objective: To evaluate the effectiveness of a clinic protocol used in the Complexo Hospitalario Universitario de Vigo (CHUVI) for obese outpatients. Patients and methods: The study included 47 obese outpatients. All of them were evaluated in clinical department and applied the obesity protocol for a period of 2 years. Variables as weight, BMI and levels of obesity in the initial and final time were evaluated. Results and discussion: In obese patients between 26 and 65 years was observed a tendency to reduce their degree of obesity, with significant differences in 2012 compared to 2010. There are differences in behavior between men and women in terms of change in obesity graduation. Conclusions: In our study we found differences in behavior between men and women in terms of grade change in obesity, in women there is a greater tendency to reduce (AU)

Prevalence of Essential Tremor on Arosa Island, Spain: a Community-based, Door-to-Door Survey.

BACKGROUND: The prevalence of essential tremor (ET) is still not well understood and the various studies performed to date have generated highly variable results. Few epidemiologic studies on the prevalence of ET have been reported from Spain. METHODS: A one-stage door-to-door survey was conducted on Arosa Island, northwestern Spain, to determine the prevalence of ET in the population aged 65 years and older. The diagnostic criteria for ET were the presence of non-dystonic head tremor or moderate- to severe-amplitude tremor on at least four tests of the revised Washington Heights-Inwood Genetic Study of Essential Tremor (WHIGET) Scale. RESULTS: A total of 65 individuals with ET (28 males, 37 females) were identified, resulting in a crude prevalence of 8.63% (adjusted rate 8.42%). Prevalence increased with advancing age. There were no significant differences in prevalence between sexes in any of the age groups. Among the prevalent cases, 12.3% (n = 8) had been previously diagnosed. Only 29.2% (n = 19) reported functional disability caused by tremor. A family history of tremor was reported in 35.4% (n = 23). DISCUSSION: The prevalence of ET was higher than that seen in similar populations in Spain and other countries. A high proportion of those with ET were previously undiagnosed. Since Arosa Island has been a relatively isolated area, these results might indicate a predominant role, at least in the elderly, for genetic factors in the development of ET.