Nursing Roles in the Quality of Information in Informed Consent Forms of a Spanish County Hospital.

(1) Background: Because of their direct and continuous contact with the patient, nurses play a relevant role in ensuring that informed consent forms are complete and easy to read and comprehend. The objective of this study was to analyze the legibility and formal quality of informed consent forms for non-surgical procedures in a county hospital. (2) Methods: The readability of these forms was analyzed using the INFLESZ scale and the information they provided according to the formal quality criteria established for these forms. (3) Results: Readability was difficult in 78.08% of the forms analyzed. No form fulfilled all the criteria, the most non-compliant being the non-appearance of the verification of delivery of a copy to the patient (100%), the contraindications (94.59%), and the alternatives (83.78%) of the procedure. Statistically significant differences were observed between disciplines with respect to the INFLESZ readability score and the formal quality score, but no statistically significant correlation was found between the two scores. (4) Conclusions: The informed consent forms for non-surgical procedures analyzed presented mostly difficult readability and poor formal quality, making it difficult for patients to have understandable and complete information. Nursing professionals should be actively involved in their improvement to facilitate patient decision making.

Proteome and Interactome Linked to Metabolism, Genetic Information Processing, and Abiotic Stress in Gametophytes of Two Woodferns.

Ferns and lycophytes have received scant molecular attention in comparison to angiosperms. The advent of high-throughput technologies allowed an advance towards a greater knowledge of their elusive genomes. In this work, proteomic analyses of heart-shaped gametophytes of two ferns were performed: the apomictic Dryopteris affinis ssp. affinis and its sexual relative Dryopteris oreades. In total, a set of 218 proteins shared by these two gametophytes were analyzed using the STRING database, and their proteome associated with metabolism, genetic information processing, and responses to abiotic stress is discussed. Specifically, we report proteins involved in the metabolism of carbohydrates, lipids, and nucleotides, the biosynthesis of amino acids and secondary compounds, energy, oxide-reduction, transcription, translation, protein folding, sorting and degradation, and responses to abiotic stresses. The interactome of this set of proteins represents a total network composed of 218 nodes and 1792 interactions, obtained mostly from databases and text mining. The interactions among the identified proteins of the ferns D. affinis and D. oreades, together with the description of their biological functions, might contribute to a better understanding of the function and development of ferns as well as fill knowledge gaps in plant evolution.

On the energetic and magnetic stability of neutral and charged lithium clusters doped with one and two yttrium atoms.

DFT calculations were performed to study the effect on energetic and magnetic stability when clusters with up to 24 lithium atoms were doped with one and two atoms of yttrium. In this, the effect of the charge was considered. As a result, some stable structures were identified as possible magnetic superatoms, among them, the YLi12+ cluster with an icosahedron geometry with a spin magnetic moment of 4 bohr magnetons. The participation of yttrium in the electron density of the unpaired electrons providing magnetism in clusters was corroborated at the level of a density of states (DOS) calculation and a spin density calculation. In particular, in the Y2Li12+ superatom, it was found that the encapsulated yttrium atom participates with 35.02% and the second yttrium atom with 15.04%. These percentages, with a contribution from p orbitals, but to a greater extent by d orbitals. The complementation to these percentages is due to the participation of the s and p orbitals of the lithium atoms. In general, doping with a second yttrium atom allowed to obtain a greater amount of high magnetic moments, and considering charged clusters allowed to obtain also high magnetic moments.

Occupational Exposure to Inhalational Anesthetics and Teratogenic Effects: A Systematic Review.

(1) Background: In the current healthcare environment, there is a large proportion of female staff of childbearing age, so, according to existing conflicting studies, the teratogenic effects that inhalational anesthetics may have on exposed pregnant workers should be assessed. This investigation aims to analyze the teratogenic effects of inhalational anesthetics in conditions of actual use, determining any association with spontaneous abortion or congenital malformations. (2) Methods: A systematic review was carried out according to the PRISMA statement based on PICO (problem of interest-intervention to be considered-intervention compared-outcome) (Do inhalational anesthetics have teratogenic effects in current clinical practice?). The level of evidence of the selected articles was evaluated using the SIGN scale. The databases used were PubMed, Embase, Scopus, Web of Science, Google academic and Opengrey. Primary studies conducted in professionals exposed to inhalational anesthetics that evaluate spontaneous abortions or congenital malformations, conducted in any country and language and published within the last ten years were selected. (3) Results: Of the 541 studies identified, 6 met all inclusion criteria in answering the research question. Since many methodological differences were found in estimating exposure to inhalational anesthetics, a qualitative systematic review was performed. The selected studies have a retrospective cohort design and mostly present a low level of evidence and a low grade of recommendation. Studies with the highest level of evidence do not find an association between the use of inhalational anesthetics and the occurrence of miscarriage or congenital malformations. (4) Conclusions: The administration of inhalational anesthetics, especially with gas extraction systems (scavenging systems) and the adequate ventilation of operating rooms, is not associated with the occurrence of spontaneous abortions or congenital malformations.

The Shared Proteome of the Apomictic Fern Dryopteris affinis ssp. affinis and Its Sexual Relative Dryopteris oreades.

Ferns are a diverse evolutionary lineage, sister to the seed plants, which is of great ecological importance and has a high biotechnological potential. Fern gametophytes represent one of the simplest autotrophic, multicellular plant forms and show several experimental advantages, including a simple and space-efficient in vitro culture system. However, the molecular basis of fern growth and development has hardly been studied. Here, we report on a proteomic study that identified 417 proteins shared by gametophytes of the apogamous fern Dryopteris affinis ssp. affinis and its sexual relative Dryopteris oreades. Most proteins are predicted to localize to the cytoplasm, the chloroplast, or the nucleus, and are linked to enzymatic, binding, and structural activities. A subset of 145 proteins are involved in growth, reproduction, phytohormone signaling and biosynthesis, and gene expression, including homologs of SHEPHERD (SHD), HEAT SHOCK PROTEIN 90-5 (CR88), TRP4, BOBBER 1 (BOB1), FLAVONE 3'-O-METHYLTRANSFERASE 1 (OMT1), ZEAXANTHIN EPOXIDASE (ABA1), GLUTAMATE DESCARBOXYLASE 1 (GAD), and dsRNA-BINDING DOMAIN-LIKE SUPERFAMILY PROTEIN (HLY1). Nearly 25% of the annotated proteins are associated with responses to biotic and abiotic stimuli. As for biotic stress, the proteins PROTEIN SGT1 HOMOLOG B (SGT1B), SUPPRESSOR OF SA INSENSITIVE2 (SSI2), PHOSPHOLIPASE D ALPHA 1 (PLDALPHA1), SERINE/THREONINE-PROTEIN KINASE SRK2E (OST1), ACYL CARRIER PROTEIN 4 (ACP4), and NONHOST RESISTANCE TO P. S. PHASEOLICOLA1 (GLPK) are worth mentioning. Regarding abiotic stimuli, we found proteins associated with oxidative stress: SUPEROXIDE DISMUTASE[CU-ZN] 1 (CSD1), and GLUTATHIONE S-TRANSFERASE U19 (GSTU19), light intensity SERINE HYDROXYMETHYLTRANSFERASE 1 (SHM1) and UBIQUITIN-CONJUGATING ENZYME E2 35 (UBC35), salt and heavy metal stress included MITOCHONDRIAL PHOSPHATE CARRIER PROTEIN 3 (PHT3;1), as well as drought and thermotolerance: LEA7, DEAD-BOX ATP-DEPENDENT RNA HELICASE 38 (LOS4), and abundant heat-shock proteins and other chaperones. In addition, we identified interactomes using the STRING platform, revealing protein-protein associations obtained from co-expression, co-occurrence, text mining, homology, databases, and experimental datasets. By focusing on ferns, this proteomic study increases our knowledge on plant development and evolution, and may inspire future applications in crop species.

Controlled cycles in spontaneous-timed noninvasive ventilation: Incidence and associated factors.

BACKGROUND: The most-used ventilation mode in home mechanical ventilation (HMV) is spontaneous-timed, designed to be essentially spontaneous with a programmed backup rate. RESEARCH QUESTION: We do not know the real frequency of activation of controlled cycles, nor its associated factors. STUDY DESIGN: and Methods: We conducted a single-center cohort study of patients with chronic hypoventilation who were started on HMV. We collected the clinical variables, the ventilator programming parameters and the ventilation efficacy data obtained from the built-in software. We analyzed the percentage of controlled cycles (PCC) and the potentially associated clinical variables. RESULTS: Overall, the PCC was very high (median 44%), with little change during the HMV adaptation period. Individuals with a higher PCC (captured patients) had a lower respiratory rate with ventilation, a higher level of ventilatory assistance, and were not associated with a specific clinical profile. INTERPRETATION: Controlled cycles are very common during spontaneous-timed ventilation and depend on the patient's ventilatory pattern and the level of ventilatory assistance.

Estilos de vida relacionados con la salud en estudiantes de Enfermería / Lifestyles health related in Nursing students

Introducción: los cambios de conductas saludables a las no saludables ponen en riesgo la salud, los universitarios son una población muy vulnerable para adoptar estilos de vida que puedan favorecer su calidad de vida. El consumo de alcohol y tabaco como conducta es un tema importante en esta etapa de formación profesional. Objetivo: determinar las conductas de estilo de vida relacionados con la salud como el consumo de cigarrillos, alcohol y drogas, hábitos alimentarios, forma física, control del estrés y seguridad que realizan los estudiantes de la Licenciatura en Enfermería de la Universidad Juárez Autónoma de Tabasco, México. Metodología: estudio de tipo cuantitativo, descriptivo, transversal en una muestra de 666 estudiantes de la Licenciatura en Enfermería seleccionados por muestreo no probabilístico. Resultados: predominó el género femenino con 83%, el 62.8% presenta un buen estilo de vida, seguido del 30.3% que tiene un excelente estilo de vida; el 79.1% corresponde a los estudiantes que no fuman y el 37.8% de los estudiantes tiene una buena alimentación. Los estudiantes calificaron su forma física como regular en el 41% de los casos, seguida de mala con el 34.5%. En cuanto a la práctica de control del estrés calificaron como buena con un 50.8% y excelente con 26.1%. Conclusión: los estudiantes de Enfermería tienen un nivel de estilo de vida bueno relacionado con la salud, los más practicados corresponden a las dimensiones de consumo de alcohol, hábitos alimentarios, control de estrés y seguridad. Es importante considerar la dimensión relacionada con la forma física (práctica de ejercicio físico), ya que se practica ocasionalmente, lo que demuestra que los estudiantes llevan un estilo de vida sedentario.

Introduction: Changes from healthy to unhealthy behaviors put health at risk, so university students are a very vulnerable population to adopt lifestyles that can favor their quality of life. The consumption of alcohol and tobacco as conduct is an important issue at this stage of professional training. Objective: To determine the lifestyle behaviors related to health such as the consumption of cigarettes, alcohol and drugs, eating habits, physical fitness, stress control and safety carried out by the students of the Bachelor of Nursing at the Universidad Juárez Autónoma de Tabasco, in Mexico. Methodology: Quantitative, descriptive, cross-sectional study in a sample of 666 Nursing undergraduate students selected by non-probabilistic sampling. Results: The female gender predominated with 83%, 62.8% have a good lifestyle, followed by 30.3% who have an excellent lifestyle; 79.1% corresponds to students who do not smoke and 37.8% of students have a good diet. The students rated their physical fitness as fair in 41% of the cases, followed by poor with 34.5%. Regarding the practice of stress control, they qualified as good with 50.8% and excellent with 26.1%. Conclusion: Nursing students have a good level of lifestyle related to health, the most practiced correspond to the dimensions of alcohol consumption, eating habits, stress control and safety. It is important to consider the dimension related to physical fitness (practice of physical exercise), since it is only practiced occasionally, which shows that students lead a sedentary lifestyle.

Ultrasound-guided pediatric vascular cannulation by inexperienced operators: outcomes in a training model.

OBJECTIVE: To present the results of an ultrasound vascular cannulation (UGVC) training program for inexperienced operators using a training model. METHOD: This was a descriptive observational study developed in the paediatric intensive care unit (PICU) of a third-level hospital. Operators received basic theoretical training in the USVC technique, followed by practical training with a model designed for USVC-inexperienced healthcare professionals. RESULTS: The study included 25 healthcare professionals, who carried out a total of 300 ultrasound-guided cannulation procedures (12 per participant) at equidistant sites on the longitudinal axis/in-plane (LA/IP) and the transverse axis/out-of-plane (TA/OP). The mean depth of cannulated vessels was 0.90 (0.34) cm and their mean diameter was 0.41 (0.1) cm. In 41.7% of cases, complete view of the needle (CVN) was accomplished; in 49% of cases, repositioning of the needle/guidewire (RNG) was necessary for successful UGVC. The rate of successful UGVC in the training model was 79.7%. The mean time required for the procedure was 74.70 (73.72) seconds. The time to successful cannulation was 58.72 (56.87) seconds. The mean number of attempts needed until successful UGVC was 1.31 (0.72). Complications were: (a) 26.3% vessel perforation/wrong guidewire positioning (VP/WGP) and (b) 4.3% successful vessel puncture followed by failure to accomplish subsequent cannulation. CONCLUSIONS: Through the present theoretical-practical training program for inexperienced operators using a training model: (a) high success rates and short procedural times were attained; (b) complete view of needle and need for repositioning the needle/guidewire occurred in half of the procedures; and (c) complications occurred in a third of the procedures.

Formal Quality and Compliance of Informed Consent Forms in Critical Care and Surgical Areas in Spain: An Observational Study.

(1) Background: The informed consent form must contain all the relevant information about the procedure to be performed to guarantee the patient's freedom to choose. (2) Objective: To analyze the formal quality of, and compliance with informed consent forms in critical care and surgical areas in a county hospital in Spain. (3) Methods: The formal quality of informed consent forms in critical care and surgical areas from the hospital were analyzed, following the established formal quality criteria for informed consent forms. The compliance with specific criteria for each of the operated patients during the period of study was also evaluated. (4) Results: The formal quality of 224 informed consent forms was analyzed from 8 disciplines observing a median of non-compliances of 4 with a minimum of 1 and a maximum of 5, with the most breaches being in verifying the delivery of a copy to the patient and showing contraindications. The compliance of 376 documents from 188 operated patients were assessed, highlighting that the non-complied items were: the personalized risks and complete identification of the patient and the physician. A significant association was found between disciplines analyzed and the identification of the physician and personalized risks, with anesthesia and critical care showing the best compliance. (4) Conclusions: The informed consent forms in critical care and surgical areas were shown to have a deficient formal quality and an inadequate compliance. These deficiencies should be corrected to improve the information received by the patients and to guarantee their freedom to choose. As nurses have a responsibility to ensure that patients are adequately informed about both nursing interventions and care, as well as the surgical treatments they receive, consideration should be given to the possibility of nursing professionals taking the lead in obtaining informed consent.

Evaluation of Training in Pediatric Ultrasound-guided Vascular Cannulation Using a Model.

BACKGROUND: The study objective was to evaluate a training program and a training model for pediatric ultrasound-guided vascular cannulation (USGVC) by inexperienced operators. METHODS: An observational descriptive study was conducted at the pediatric intensive care unit of a level-III hospital. The study protocol comprised the following parts: (1) pretraining test; (2) theory and practice training session consisting of an explanation of basic vascular ultrasound concepts plus performing vascular cannulation in a model; (3) posttraining test; and (4) evaluation of the training model. RESULTS: A total of 25 health-care professionals participated in the study. All of them possessed the skills to locate vessels and ultrasound planes, and they performed USGVC using the training model. On a 1-5 scale, the model was rated to have 87.6% fidelity with real pediatric patients; the best regarded aspect of it was utility (93%). Differences were found between pre- and post-training scores: 2.72 ± 0.84 versus 4.60 ± 0.50; P < 0.001 (95% confidence interval: -2.28, -1.47). Altogether, 300 ultrasound-guided cannulation procedures were carried out (12 per participant) distributed along the longitudinal axis in plane and the transverse axis out of plane, with 150 punctures in each of them. The success rate for USGVC in the training model was 79.7%, the mean time for the procedure was 115.6 ± 114.9 s, and the mean time for achieving successful cannulation was 87.69 ± 82.81 s. The mean number of trials needed for successful USGVC was 1.49 ± 0.86. CONCLUSION: After undergoing the theory-practice training, participants: (a) improved their knowledge of ultrasound-guided vascular access; (b) positively evaluated the USGVC training model, in particular its utility and fidelity as compared with cannulation in pediatric patients; and (c) achieved a high USGVC success rate in a relatively short time.

Mitigation of yield-scaled nitrous oxide emissions and global warming potential in an oilseed rape crop through N source management.

Enhanced-efficiency nitrogen (N) fertilizers, such as those containing nitrification or urease inhibitors, can mitigate the carbon (C) footprint linked to the production of bioenergy crops through a reduction in direct nitrous oxide (N2O) emissions and indirect N2O losses. These indirect emissions are derived from ammonia (NH3) volatilization, which also have important environmental and health implications. The evaluation of the global warming potential (GWP) of different N sources using site-specific data of yield and direct and indirect emissions is needed for oilseed rape under rainfed semi-arid conditions, especially when meteorological variability is taken into account. Using urea as a N source, the N2O mitigation efficacy of the urease inhibitor N-(n-butyl) thiophosphoric triamide (NBPT) alone or combined with the nitrification inhibitor 2-(3,4-dimethyl-1H-pyrazol-1-yl) succinic acid isomeric mixture (DMPSA) was evaluated under field conditions in a rainfed oilseed rape (Brassica napus L.) crop. Two additional N sources from calcium ammonium nitrate (CAN), with and without DMPSA, were included. The GWP of the treatments was estimated considering the emissions from inputs, operations and other direct and indirect emissions of greenhouse gases (GHGs), such as methane (CH4) and the volatilization of NH3. We also measured the abundance of key genes involved in nitrification and denitrification to improve the understanding of N2O emissions on a biochemical basis under the conditions of our study. The results show that due to the intense rainfall after fertilization and a rewetting event, N2O losses from fertilizers without inhibitors were greater than those previously reported under Mediterranean conditions, while NH3 losses were low and not affected by the urease inhibitor. The cumulative N2O emissions (which were greatly influenced by a rewetting peak three months after fertilization) from the urea fertilization were significantly higher than those from CAN. The presence of NBPT significantly reduced N2O losses by an average of 71%, with respect to urea. The use of DMPSA with CAN resulted in an abatement of N2O emissions (by 57%) and a significant increase in oil yield in comparison with CAN alone. All inhibitor-based treatments were effective in abating N2O emissions during the rewetting peak. The abundances of the nitrifier and denitrifier communities, especially ammonia-oxidizing bacteria (AOB), significantly decreased relative to the urea or CAN treatments as inhibitors were applied. Under the conditions of our study, the sustainability of a bioenergy crop such as oilseed rape can be improved by using inhibitors because they mitigated N2O emissions and/or enhanced the oil yield.

Characterization of the KNOTTED1-LIKE HOMEOBOX (KNOX) gene family in Pinus pinaster Ait.

KNOTTED1-LIKE HOMEOBOX (KNOX) genes are a family of plant-specific homeobox transcription factors with important roles in plant development that have been classified into two subfamilies with differential expression domains and functions. Studies in angiosperms have shown that class I members are related to the maintenance of meristem homeostasis and leaf development, whereas class II members promote differentiation of tissues and organs. However, little is known about its diversification and function in gymnosperms. By combining PCR-based detection and transcriptome data analysis, we identified four class I and two class II KNOX genes in Pinus pinaster. Expression analyses showed that class I members were mainly expressed in meristematic regions and differentiating tissues, with practically no expression in lateral organs, whereas expression of class II members was restricted to lateral organs. Furthermore, overexpression of P. pinaster KNOX genes in Arabidopsis thaliana caused similar phenotypic effects to those described for their angiosperms counterparts. This is the first time to our knowledge that functional analyses of class II members are reported in a conifer species. These results suggest a high conservation of the KNOX gene family throughout seed plants, as the functional differentiation of both subfamilies observed in angiosperms might be partially conserved in gymnosperms.

B Corps: A Socioeconomic Approach for the COVID-19 Post-crisis.

The current global health and economic crisis caused by COVID-19 has opened the possibility to adopt the B Corp model and focus more on the person. Based on grounded theory, we have examined 147 organizations from 14 countries listed at the B Corp Directory for Latin America. Latin American B Corps have traits linked to family-related issues that are distinct from other B Corps located in different continents. Our main findings are that B Corps develop a more inclusive and sustainable economy to benefit society, go beyond the notion of CSR, and move away from traditional companies, as B Corps combine social development and economic growth.

Magnesium oxide clusters as promising candidates for hydrogen storage.

With the idea of proposing solid state systems that have a high storage capacity of molecular hydrogen, a density functional theory study of magnesium oxide (MgO)n clusters (n = 1-10) was carried out. Hydrogen-magnesium oxide systems presented adsorption energy values in accordance with the previously reported studies of physisorption processes; additionally negative values of ΔGads were found describing adsorption as a favorable process. Here, the (MgO)7 cluster presented the highest adsorption energy. The storage capacity by weight of the magnesium oxide clusters was greater than the recommended percentage (7.5%) by the U.S. Department of Energy. QTAIM analysis and non-covalent index plots highlighted the weak nature of the interaction between the MgO clusters and hydrogen molecules, and the fundamental role of the Mg-O bonds' polarity in the systems' storage capacity.

The effect of nitrification inhibitors on NH3 and N2O emissions in highly N fertilized irrigated Mediterranean cropping systems.

There is an increasing concern about the negative impacts associated to the release of reactive nitrogen (N) from highly fertilized agro-ecosystems. Ammonia (NH3) and nitrous oxide (N2O) are harmful N pollutants that may contribute both directly and indirectly to global warming. Surface applied manure, urea and ammonium (NH4+) based fertilizers are important anthropogenic sources of these emissions. Nitrification inhibitors (NIs) have been proposed as a useful technological approach to reduce N2O emission although they can lead to large NH3 losses due to increasing NH4+ pool in soils. In this context, a field experiment was carried out in a maize field with aiming to simultaneously quantify NH3 volatilization and N2O emission, assessing the effect of two NIs 3,4­dimethilpyrazol phosphate (DMPP) and 3,4­dimethylpyrazole succinic acid (DMPSA). The first treatment was pig slurry (PS) before seeding (50 kg N ha-1) and calcium ammonium nitrate (CAN) at top-dressing (150 kg N ha-1), and the second was DMPP diluted in PS (PS + DMPP) (50 kg N ha-1) and CAN + DMPSA (150 kg N ha-1) also before seeding and at top-dressing, respectively. Ammonia emissions were quantified by a micrometeorological method during 20 days after fertilization and N2O emissions were assessed using manual static chambers during all crop period. The treatment with NIs was effective in reducing c. 30% cumulative N2O losses. However, considering only direct N2O emissions after second fertilization event, a significant reduction was not observed using CAN+DMPSA, probably because high WFPS of soil, driven by irrigation, favored denitrification. Cumulative NH3 losses were not significantly affected by NIs. Indeed, NH3 volatilization accounted 14% and 10% of N applied in PS + DMPP and PS plots, respectively and c. 2% of total N applied in CAN+DMPSA and CAN plots. Since important NH3 losses still exist even although abating strategies are implemented, structural and political initiatives are needed to face this issue.

Topical Vasoconstrictors in Cosmetic Rhinoplasty: Comparative Evaluation of Cocaine Versus Epinephrine Solutions.

BACKGROUND: The use of topical vasoconstrictors is a common practice in nasal surgery. These agents reduce bleeding and enable a good surgical field. Topical cocaine and epinephrine, which are frequently used in cosmetic rhinoplasty, are considered safe and effective, but secondary effects have been described. The aim of the present study was to evaluate and compare the benefits and risks of epinephrine and cocaine employed as topical vasoconstrictive agents in cosmetic rhinoplasty. METHODS: This prospective non-randomised study included 65 consecutive female patients undergoing primary closed rhinoplasty. Patients were treated with topical aqueous solutions of 4 % cocaine (n = 33) or 1:1000 epinephrine (n = 32). Benefits and risks of drug use were compared between groups. Vasoconstriction was assessed by quantitative and qualitative evaluation of bleeding during surgery. Systemic effects were studied in terms of cardiovascular changes during the procedure. The Mann-Whitney test and mixed-effects models were used to compare continuous variables and to assess the effects of vasoconstrictor treatment, respectively. RESULTS: Cocaine exerted a stronger and more predictable vasoconstrictive effect than epinephrine. This difference was linked to better field quality, but did not relate to shorter surgery times. Increased heart rate was detected with both agents and was significantly higher with cocaine (p < 0.05). Blood pressure did not significantly differ between groups. CONCLUSIONS: Both cocaine and epinephrine, at the concentrations used in this study, are suitable as topical vasoconstrictive agents in aesthetic rhinoplasty. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Treatment of severe hypertriglyceridemia with continuous insulin infusion.

Severe hypertriglyceridemia (SH) represents a therapeutic emergency because of the possibility of developing cardiovascular events and hyperlipemic acute pancreatitis (PA). Most patients with SH suffer primary or genetic abnormality in lipid metabolism in combination with a precipitating factor such as uncontrolled diabetes mellitus, alcoholism, and drug intake. The standard treatment of hypertriglyceridemia (HTG) with omega 3 fatty acids and fibrates, along with dietary changes, has no effect on an emergency situation. There are no clinical guidelines to SH, but therapy with insulin, heparin, a combination of both, plasmapheresis, or octreotide have been tested succesfully. We report the case of a 10-year-old girl with clinical acute pancreatitis and diabetic ketoacidosis debut, along with incidental finding of an SH, who had a good outcome after treatment with insulin intravenous infusion.

The origins of apicomplexan sequence innovation.

The Apicomplexa are a group of phylogenetically related parasitic protists that include Plasmodium, Cryptosporidium, and Toxoplasma. Together they are a major global burden on human health and economics. To meet this challenge, several international consortia have generated vast amounts of sequence data for many of these parasites. Here, we exploit these data to perform a systematic analysis of protein family and domain incidence across the phylum. A total of 87,736 protein sequences were collected from 15 apicomplexan species. These were compared with three protein databases, including the partial genome database, PartiGeneDB, which increases the breadth of taxonomic coverage. From these searches we constructed taxonomic profiles that reveal the extent of apicomplexan sequence diversity. Sequences without a significant match outside the phylum were denoted as apicomplexan specialized. These were collated into 9134 discrete protein families and placed in the context of the apicomplexan phylogeny, identifying the putative origin of each family. Most apicomplexan families were associated with an individual genus or species. Interestingly, many genera-specific innovations were associated with specialized host cell invasion and/or parasite survival processes. Contrastingly, those families reflecting more ancestral relationships were enriched in generalized housekeeping functions such as translation and transcription, which have diverged within the apicomplexan lineage. Protein domain searches revealed 192 domains not previously reported in apicomplexans together with a number of novel domain combinations. We highlight domains that may be important to parasite survival.

The global landscape of sequence diversity.

BACKGROUND: Systematic comparisons between genomic sequence datasets have revealed a wide spectrum of sequence specificity from sequences that are highly conserved to those that are specific to individual species. Due to the limited number of fully sequenced eukaryotic genomes, analyses of this spectrum have largely focused on prokaryotes. Combining existing genomic datasets with the partial genomes of 193 eukaryotes derived from collections of expressed sequence tags, we performed a quantitative analysis of the sequence specificity spectrum to provide a global view of the origins and extent of sequence diversity across the three domains of life. RESULTS: Comparisons with prokaryotic datasets reveal a greater genetic diversity within eukaryotes that may be related to differences in modes of genetic inheritance. Mapping this diversity within a phylogenetic framework revealed that the majority of sequences are either highly conserved or specific to the species or taxon from which they derive. Between these two extremes, several evolutionary landmarks consisting of large numbers of sequences conserved within specific taxonomic groups were identified. For example, 8% of sequences derived from metazoan species are specific and conserved within the metazoan lineage. Many of these sequences likely mediate metazoan specific functions, such as cell-cell communication and differentiation. CONCLUSION: Through the use of partial genome datasets, this study provides a unique perspective of sequence conservation across the three domains of life. The provision of taxon restricted sequences should prove valuable for future computational and biochemical analyses aimed at understanding evolutionary and functional relationships.