Combining phytoextraction by Brassica napus and biochar amendment for the remediation of a mining soil in Riotinto (Spain).

Soil contamination in mining areas is an important environmental concern. In these areas, phytoremediation is often impeded because of the low fertility and pH. Assisted phytoremediation is increasingly being used in polluted areas. Biochar could assist plant growth via enhanced soil fertility. An experiment was performed in a mining soil (RIII) from the mining area of Riotinto (Spain) contaminated with Cu, Pb, Zn and As in order to study: (i) The effects of biochar on soil fertility; (ii) Biochar temperature of preparation effect and (iii) Effect of biochar on phytoremediation potential. A mesocosm experiment was designed using Brassica napus as test specie. Soil (RIII) was treated with rabbit manure biochars prepared at 450 °C (BM450) and 600 °C (BM600) at a rate of 10% in mass and incubated for 60 days with or without Brassica napus. Results showed that the combination of BM450 or BM600 with Brassica napus growth decreased the amount of As, Cu, Co, Cr, Se and Pb in the soil. Values of bioaccumulation factor (BAF) for Cd were particularly elevated (>10) in the unamended soil and reached values higher than 1 for other elements, indicating the potential of Brassica napus to accumulate several heavy metals. Translocation Factor (TF) was reduced for Co, Cr, Cd, Cu, Ni, Zn, Pb and As after biochar addition indicating root accumulation of these metals. In all cases, biochar addition increased biomass production. Finally, the addition of BM450 increased GMea index indicating also an improvement on soil quality.

Biochars and hydrochars prepared by pyrolysis and hydrothermal carbonisation of pig manure.

Pyrolysis of organic wastes for biochar preparation has been proved as a useful way of waste management. However, the elevated water content of some organic wastes precludes its use without a drying step before pyrolysis treatment. For this reason, hydrothermal carbonization (HTC) of wet biomass could be an inexpensive alternative management method. The main objective of the present work is to compare the properties of biochars and hydrochars obtained from thermal treatment of pig manure. Biochars were prepared at 300 °C (BPM300), 450 °C (BPM450) and 600 °C (BPM600) and hydrochars were obtained using a pig manure solution (ratio 30:70) that was heated at 200 °C (HPM200), 220 °C (HPM220) and 240 °C (HPM240) during 2 h. Characterization of biochar and hydrochar samples showed that pyrolysis led to chars with more aromatic structures and high thermal stability while HTC process originated chars with more aliphatic structures. HPM220 and HPM240 showed the highest values of field capacity water content and available water probably due to their higher O/C ratios and the macroporosity development in the range from 200 to 30,000 nm. These results suggested that HTC could be an interesting method to obtain soil growing media or green roof materials with adequate hydrophysical properties.

[Healthy sleep: evidence and guidelines for action. Official document of the Spanish Sleep Society]. / Sueño saludable: evidencias y guias de actuacion. Documento oficial de la Sociedad Española de Sueño.

One of the main objectives of the Spanish Sleep Society is to promote healthy sleep in both the general population and in health professionals. This document aims to conduct a review of the current scientific literature on sleep habits that can serve as the basis on which to establish a set of general recommendations, regarding healthy sleep, for use by the general population in Spain as well as to identify the main challenges faced by research into sleep habits. The document has been developed by a multidisciplinary team made up of members of the Spanish Sleep Society who are experts in paediatric sleep medicine, clinical neurophysiology, pulmonology, neurology, chronobiology, physiology and psychology. The existing scientific literature dealing with sleep habits in the general population was reviewed, and the following aspects were addressed: the current state of sleep habits in the Spanish population; a generic review of the optimum number of hours of sleep; the impact of the environmental setting (noise, temperature, illumination, etc.), hours of sleep, diet and sport, together with several specific sections for children and teenagers, shift-workers and drivers of different vehicles. The conclusions from all the aspects addressed in this document have resulted in a set of final general recommendations that will serve as a guide for the general population and health professionals. Likewise, the principal environmental challenges and future lines of research are also discussed.

Effects of adenotonsillectomy on plasma inflammatory biomarkers in obese children with obstructive sleep apnea: A community-based study.

BACKGROUND: Obesity and obstructive sleep apnea syndrome (OSA) are highly prevalent and frequently overlapping conditions in children that lead to systemic inflammation, the latter being implicated in the various end-organ morbidities associated with these conditions. AIM: To examine the effects of adenotonsillectomy (T&A) on plasma levels of inflammatory markers in obese children with polysomnographically diagnosed OSA who were prospectively recruited from the community. METHODS: Obese children prospectively diagnosed with OSA, underwent T&A and a second overnight polysomnogram (PSG) after surgery. Plasma fasting morning samples obtained after each of the two PSGs were assayed for multiple inflammatory and metabolic markers including interleukin (IL)-6, IL-18, plasminogen activator inhibitor-1 (PAI-1), monocyte chemoattractant protein-1 (MCP-1), matrix metalloproteinase-9 (MMP-9), adiponectin, apelin C, leptin and osteocrin. RESULTS: Out of 122 potential candidates, 100 obese children with OSA completed the study with only one-third exhibiting normalization of their PSG after T&A (that is, apnea-hypopnea index (AHI) ≤1/hour total sleep time). However, overall significant decreases in MCP-1, PAI-1, MMP-9, IL-18 and IL-6, and increases in adropin and osteocrin plasma concentrations occurred after T&A. Several of the T&A-responsive biomarkers exhibited excellent sensitivity and moderate specificity to predict residual OSA (that is, AHI⩾5/hTST). CONCLUSIONS: A defined subset of systemic inflammatory and metabolic biomarkers is reversibly altered in the context of OSA among community-based obese children, further reinforcing the concept on the interactive pro-inflammatory effects of sleep disorders such as OSA and obesity contributing to downstream end-organ morbidities.

Switching from zidovudine/lamivudine to tenofovir/emtricitabine improves fat distribution as measured by fat mass ratio.

OBJECTIVES: Fat mass ratio (FMR) has been suggested as an objective indicator of abnormal body fat distribution in HIV infection. Although it could provide more comprehensive information on body fat changes than limb fat mass, FMR has scarcely been used in clinical trials examining body fat distribution in HIV-infected patients. METHODS: A subanalysis of a controlled, randomized clinical trial in virologically suppressed HIV-1-infected men switching from zidovudine (ZDV)/lamivudine (3TC) to emtricitabine (FTC)/tenofovir (TDF) versus continuing on ZDV/3TC was carried out. FMR was assessed by dual X-ray absorptiometry (DEXA) for a period of 72 weeks. Lipoatrophy was defined as FMR ≥ 1.5. Multivariate linear regression models for the change in FMR from baseline were fitted. RESULTS: Sixty-five men were randomized and treated (28 in the FTC/TDF arm and 37 in the ZDV/3TC arm), and 57 completed the study (25 and 32 in each arm, respectively). In the FTC/TDF arm, adjusted mean FMR decreased by 0.52 at week 72 (P = 0.014), and in the ZDV/3TC arm it increased by 0.13 (P = 0.491; P between arms = 0.023). Among subjects with lipoatrophy (baseline FMR ≥ 1.5), adjusted FMR decreased by 0.76 (P = 0.003) in the FTC/TDF arm and increased by 0.21 (P = 0.411; P between arms = 0.009) in the ZDV/3TC arm. Baseline FMR and treatment group were significant predictors (P < 0.05) of post-baseline changes in FMR. CONCLUSIONS: Switching from ZDV/3TC to FTC/TDF led to an improvement in FMR, compared with progressive worsening of FMR in subjects receiving ZDV/3TC, showing that fat mass not only increased but was also distributed in a healthier way after the switch.

Determinants of birth size in Northeast Spain.

OBJECTIVE: To update knowledge on determinants of newborn body size in Northeast of Spain considering gestational, parental and socio-cultural variables. METHODS: Cross-sectional assessment of 1442 infants from Aragón (Spain), born at term between March 2009 and March 2010. Obstetric, neonatal, socio-demographic and parental anthropometry data were collected during the first infant scheduled health examination. Hierarchical linear regression models were used to explore associations between newborn anthropometry and included variables. RESULTS: Birth weight was significantly higher in males than in females (130.7 g), when mother did not smoke during pregnancy (126.3 g), in immigrant mothers (113.1 g) and when parity increased (67.1 g per additional birth). Body weight at birth was 16.9 g higher per kg of maternal weight gain during pregnancy, 5.4 g higher per kg of maternal pre-pregnancy weight and 5.1 g higher per cm of maternal height. Birth length was also significantly higher in males than in females (0.87 cm), when mother did not smoke (0.48 cm), in immigrant mothers (0.64 cm), and it was positively associated with parity, maternal anthropometry and paternal height. Newborn anthropometry was not associated with maternal age, educational level or living location. CONCLUSIONS: Independently of gestational age and newborn sex, the main predictors of birth weight and length were maternal pre-pregnancy anthropometry and weight gain during gestation, to smoke during pregnancy, parity and maternal origin. Our results identify potential modifiable factors influencing newborn body size.

Impact of switching from zidovudine/lamivudine to tenofovir/emtricitabine on lipoatrophy: the RECOMB study.

OBJECTIVES: Lipoatrophy is a long-term adverse effect of some antiretrovirals that affects quality of life, compromises adherence and may limit the clinical impact of HIV treatments. This paper explores the effect of tenofovir/emtricitabine (TDF/FTC) on the amount of limb fat in patients with virological suppression. METHODS: A randomized, prospective clinical trial was performed to compare continuation on a zidovudine/lamivudine (ZDV/3TC)-based regimen with switching to a TDF/FTC-based regimen in terms of the effect on limb fat mass as assessed by DEXA over a 72-week period. RESULTS: Eighty patients were included (39 in the TDF/FTC arm and 41 in the ZDV/3TC arm) and 73 completed the study (37 and 36, respectively). In the switch arm, limb fat increased by a median of 540 g from baseline (P = 0.022), while in the ZDV/3TC arm it decreased by a median of 379 g (P = 0.112; p between groups = 0.007). Subjects with baseline limb fat ≤ 7200 g, previous time on ZDV > 5 years or a body mass index > 25 kg/m(2) experienced higher limb fat gains than other subjects, and these differences were statistically significant. Haemoglobin increased by a median of 1.0 g/dL in the TDF/FTC arm (P < 0.001) and remained unchanged in the ZDV/3TC arm (p between groups = 0.0002). There were no significant differences between groups in other secondary endpoints (body weight, total body and trunk fat content, total body bone mineral density, laboratory parameters, CD4 cell count and viral load). CONCLUSIONS: Switching from a ZDV/3TC-based to a TDF/FTC-based regimen led to a statistically significant improvement in limb fat, in contrast to the progressive loss of limb fat in subjects continuing ZDV/3TC.

Towards microRNA-based therapeutics for diabetic nephropathy.

There is no cure for diabetic nephropathy and the molecular mechanisms underlying disease aetiology remain poorly understood. While current paradigms for clinical management of diabetic nephropathy are useful in delaying disease onset and preventing its progression, they do not do so for a significant proportion of diabetic individuals, who eventually end up developing renal failure. Thus, novel therapeutic targets are needed for the treatment and prevention of the disease. MicroRNAs (miRNAs), a class of non-coding RNAs that negatively regulate gene expression, have recently been identified as attractive targets for therapeutic intervention. It is widely recognised that dysregulation of miRNA expression or action contributes to the development of a number of different human diseases, and evidence of a role for miRNAs in the aetiology of diabetic nephropathy is emerging. The discovery that modulation of miRNA expression in vivo is feasible, combined with recent results from successful clinical trials using this technology, opens the way for future novel therapeutic applications. For instance, inhibition of miRNAs that are commonly upregulated in diabetic nephropathy decreases albuminuria and mesangial matrix accumulation in animal models, suggesting that a therapeutic agent against these molecules may help to prevent the development of diabetic nephropathy. Certain challenges, including the development of safe and reliable delivery systems, remain to be overcome before miRNA-based therapeutics become a reality. However, the findings accumulated to date, in conjunction with newly emerging results, are expected to yield novel insights into the complex pathogenesis of diabetic nephropathy, and may eventually lead to the identification of improved therapeutic targets for treatment of this disease.

[Evaluation of the efficacy of adenotonsillectomy for the treatment of obstructive sleep apnea hypopnea syndrome in children using respiratory polygraphy]. / Eficacia de la adenoamigdalectomía en el síndrome de apneas-hipopneas durante el sueño valorada mediante poligrafía respiratoria.

OBJECTIVE: To evaluate the effectiveness of adenotonsillectomy for the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) in children by respiratory polygraphy (RP). MATERIAL AND METHODS: Prospective study was conducted on children referred with clinical suspicion of OSAHS. A clinical history was taken and a general physical and ENT examination was performed on all patients. RP was performed before adenotonsillectomy and six months afterwards. Patients with craniofacial syndromes, neuromuscular disorders, and severe concomitant disease were excluded. RESULTS: We studied 150 children (67. 8% male), with a mean age of 3.74±1.80 years and a BMI of 41.70±31.75. A diagnosis of OSAHS was made if the total number of respiratory events, apneas and hypopneas, divided by the total study time (RDI) was > 4.6, using RP before undergoing adenotonsillectomy. The mean respiratory disturbance index (RDI) was 15.18±11.11, with 58.7% (88) of with severe OSAHS (RDI>10). There was a significant improvement in all clinical and polygraphic variables six months after adenotonsillectomy. The residual OSAHS was 14%. The preoperative RDI was significantly associated with persistent disease (P=.042). CONCLUSIONS: Respiratory polygraphy is useful for monitoring the efficacy of surgical treatment by adenotonsillectomy in children with OSAHS.

Novedades en el consenso español. Visión desde el experto en sueño / No disponible

El síndrome de apneas-hipopneas del sueño (SAHS) está presente en el 2-4niños de 2 a 6 años de edad(1). Afecta por igual a ambos sexos. De los niños que roncan y presentan sospecha de apnea obstructiva, sólo la mitad precisan la realización de una polisomnografía (PSG). El diagnóstico de sospecha de los trastornos respiratorios del sueño (TRS) se debería iniciar desde los primeros controles de salud incluidos en el programa del niño sano. Así, la Academia Americana de Pediatría(1) recomienda que en los controles de salud se investigue el sueño en todos los niños. Si el niño presenta ronquido y síntomas o hallazgos clínicos sugestivos de SAHS, se iniciará la escalada diagnóstica específica de TRS (AU)

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[Assembly and management of helmet-CPAP in infants and children with acute respiratory insufficiency]. / Montaje y manejo del sistema helmet-CPAP en lactantes y niños con insuficiencia respiratoria aguda.

Application of continuous positive airway pressure (CPAP) during respiratory insufficiency through a helmet interface is not well known in the Pediatric practice. The objective of this paper is to describe the necessary elements for it assembly, management and nursing care. The advantages and disadvantages of helmet compared to other interfaces are also discussed.

[Pathogenesis of endometriosis]. / Pathogenèse de l'endométriose.

Endometriosis, defined by the development of endometrial tissue outside the uterus, is a benign disease responsible for infertility and pelvic pain. The diagnosis based on a detailed gynecological history and a careful clinical examination should be done as early as possible in order to treat patients correctly. Medical treatment is not appropriate in all cases and surgical treatment should be proposed but morbidity is related to the severity of the lesion. Ectopic implantation of endometrial cells needs complex interactions between host tissue and epithelial endometrial cells. The conditions for the development of endometriosis are estrogeno-dependent growth of endometrial cells, induction of angiogenesis and lymphangiogenesis. Principal cellular and molecular factors of angiogenesis, lymphangiogenesis and fibrosis should be identified in order to develop new therapeutic strategies of endometriosis.

[Endometriosis: from research to clinical practice]. / L'endométriose: de la recherche a la pratique clinique.

Endometriosis, defined by the development of endometrial tissue outside the uterus, is a benign disease responsible for infertility and pelvic pain. The diagnosis based on a detailed gynaecological history and a careful clinical examination should be done as early as possible in order to treat patients correctly. Medical treatment is not appropriate in all cases and surgical treatment should be proposed but morbidity is related to the severity of the lesion. Ectopic implantation of endometrial cells needs complex interactions between host tissue and epithelial endometrial cells. The conditions for the development of endometriosis are oestrogeno-dependent growth of endometrial cells, induction of angiogenesis and lymphangiogenesis. Principal cellular and molecular factors of angiogenesis, lymphangiogenesis and fibrosis should be identified in order to develop new therapeutic strategies of endometriosis.

Avances en el diagnóstico y tratamiento del síndrome de apneas del sueño (SAHS) / Advances in the diagnosis and treatment of sleep apnea syndrome (SAS)

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Diagnóstico precoz, seguimiento y control del paciente con síndrome de apneas-hipopneas durante el sueño / Early diagnosis, follow-up and control of patients suffering from sleep apnoea-hipoapnoea syndrome

El síndrome de apneas-hipopneas durante el sueño (SAHS) se define como un cuadro de somnolencia excesiva, trastornos cognitivo-conductuales, respiratorios, cardiacos, metabólicos o inflamatorios secundarios a episodios repetidos de obstrucción de la vía aérea superior (VAS) durante el sueño. Estos episodios se miden con el índice de alteraciones respiratorias (IAR), definido como número de apneas, hipopneas y ERAM (esfuerzos respiratorios asociados a microdespertares). Un IAR# 5 asociado a síntomas relacionados con la enfermedad y no explicados por otras causas, confirma el diagnóstico de SAHS. En la práctica el número de pacientes diagnosticados de SAHS depende de la disponibilidad de medios técnicos adecuados, del número de laboratorios de sueño y de la accesibilidad a los mismos. El papel del médico de atención primaria es fundamental tanto en el diagnóstico de sospecha como en el seguimiento y control de los pacientes con SAHS. El diagnóstico de sospecha de SAHS se realizará a partir de una historia clínica compatible y, aunque no existe ningún síntoma específico de SAHS, tres son los síntomas clave para establecer la sospecha diagnóstica: ronquidos entrecortados, pausas asficticas y excesiva somnolencia diurna o sueño no reparador. Los pacientes identificados en atención primaria con sospecha de SAHS deben ser remitidos a la Unidad de Sueño según unos criterios de derivación de forma preferente, urgente u ordinaria. Los médicos de atención primaria deben desempeñar un papel importante en el seguimiento de los pacientes diagnosticados de SAHS y deberían realizar vigilancia de las medidas higienicodietéticas, evaluar el grado de adhesión y eficacia del tratamiento con presión positiva continua sobre la vía aérea superior (CPAP), y la aparición de efectos secundarios (AU)

Sleep apnoea-hipoapnoea syndrome (SAHS) is defined by excessive daytime sleepiness, and cognitive-behavioural, respiratory, cardiac, metabolic or inflammatory disorders, secondary to repetitive episodes of upper airway collapse during sleep. These episodes are ass essed with the respiratory alteration index (RAI), defined by the number of apnoeas, hipoapnoeas and REAM (respiratory effort associated to microarousals). A RAI<=5, together with disease symptoms not explained by other causes, confirms the diagnosis of SAHS. In practice, the number of patients diagnosed of SAHS depends on appropriate technical resources availability, and on the number and accessibility to sleep laboratories. The role of primary care physicians is fundamental as much for the diagnosis as for the follow-up and control of patients suffering from SAHS. SAHS diagnosis starts with a compatible clinical history and, although there are not specific SAHS symptoms, there are 3 key symptoms to suppose the diagnosis: laboured snoring, asphyxiating breaks and excessive daytime sleepiness or no refreshing sleep. Patients identified in primary care suspicious of a SAHS diagnosis must be sent to a Sleep Unit following specific derivation criteria: preferential, urgent or ordinary. Primary care physicians should play an important role in the follow-up of SAHS patients. They should pay attention to hygienic-dietary measures and assess thedegree of both, performance and efficacy, of the treatment with continuous positive air pressure (CPAP) and the development of side effects (AU)