Assessment of the effects of dredging on metal levels in port waters using DGT passive samplers and spot sampling.

Aiming at assessing the effect of dredging activities on the levels of metals in Bilbao Port (northern Spain), dissolved and labile metal concentrations in the water were concurrently measured, before, during, and after dredging activities by spot sampling and Diffusive Gradients in Thin-films (DGTs) passive samplers, respectively. Most of the dissolved metal results were below the quantification limits (Cd, <0.06-0.26 µg/L; Co, <5 µg/L; Cu, <5-15 µg/L; Fe, <10-48 µg/L; Mn, <10-22 µg/L; Ni, <2.6-7 µg/L; Pb, <0.39-0.8 µg/L; Zn, <9-24 µg/L). In contrast, DGT results for all sampling times and stations were obtained (Cd, 0.02-0.12 µg/L; Co, 0.08-0.15 µg/L; Cu, 0.5-2.8 µg/L; Fe, 1.0-3.6 µg/L; Mn, 4.7-23.5 µg/L; Ni, 0.5-0.9 µg/L; Pb, 0.15-0.28 µg/L; Zn, 2.6-7.2 µg/L), enabling to determine those metals affected by dredging. Only labile-Pb concentration surpassed momentarily the DGT-Environmental Quality Standard, enabling to rule out biological effects on biota. DGTs are a promising technique for facilitating decision-making during dredging operations.

Evidence mapping based on systematic reviews of therapeutic interventions for soft tissue sarcomas.

PURPOSE: Soft tissue sarcomas are a heterogeneous group of rare tumours of mesenchymal origin. Evidence mapping is one of the most didactic and friendly approaches to organise and summarise the range of research activity in broad topic fields. The objective of this evidence mapping is to identify, describe and organise the current available evidence about therapeutic interventions on soft tissues sarcomas. METHODS: We followed the methodology of global evidence mapping. We performed a search of the PubMed, EMBASE, The Cochrane Library and Epistemonikos to identify systematic reviews (SRs) with or without meta-analyses published between 1990 and March 2016. Two independent literature reviewers assessed eligibility and extracted data. Methodological quality of the included systematic reviews was assessed using AMSTAR. We organised the results according to identified PICO questions and used tables and a bubble plot to display the results. RESULTS: The map is based on 24 SRs that met eligibility criteria and included 66 individual studies. Three-quarters were either observational or uncontrolled clinical trials. The quality of the included SRs was in general moderate or high. We identified 64 PICO questions from them. The corresponding results mostly favoured the intervention arm. CONCLUSIONS: This evidence mapping was built on the basis of SRs, which mostly included non-experimental studies and were qualified by the AMSTAR tool as of moderate quality. The evidence mapping created from PICO questions is a useful approach to describe complex and huge clinical topics through graphical media and orientate further research to fulfil the existing gaps. However, it is important to delimitate the steps of the evidence mapping in a pre-established protocol.

[Multiple cranial neuropathy: a case report of three paediatric patients]. / Neuropatia craneal multiple: descripcion de tres pacientes pediatricos.

TITLE: Neuropatia craneal multiple: descripcion de tres pacientes pediatricos.

Metal measurement in aquatic environments by passive sampling methods: Lessons learning from an in situ intercomparison exercise.

Passive sampling devices (PS) are widely used for pollutant monitoring in water, but estimation of measurement uncertainties by PS has seldom been undertaken. The aim of this work was to identify key parameters governing PS measurements of metals and their dispersion. We report the results of an in situ intercomparison exercise on diffusive gradient in thin films (DGT) in surface waters. Interlaboratory uncertainties of time-weighted average (TWA) concentrations were satisfactory (from 28% to 112%) given the number of participating laboratories (10) and ultra-trace metal concentrations involved. Data dispersion of TWA concentrations was mainly explained by uncertainties generated during DGT handling and analytical procedure steps. We highlight that DGT handling is critical for metals such as Cd, Cr and Zn, implying that DGT assembly/dismantling should be performed in very clean conditions. Using a unique dataset, we demonstrated that DGT markedly lowered the LOQ in comparison to spot sampling and stressed the need for accurate data calculation.

Age may explain the association of an early dialysis initiation with poor survival.

BACKGROUND: Some studies postulate that early dialysis initiation may increase mortality. AIM: The aim of the present study was to assess to what extent this was due to confounding by age. DESIGN: Observational retrospective cohort study. METHODS: We studied all patients starting dialysis therapy between 1 January 1995 and 31 December 2009 in our center. The following variables at dialysis initiation in end-stage renal disease (ESRD) patients were analysed: estimated glomerular filtration rate (eGFR), age, gender, diabetes mellitus, serum albumin, hemoglobin, period of dialysis initiation, history of ischemic heart disease and stroke. Multivariate Cox model was used to calculate adjusted patient survival. RESULTS: Over the last 15 years, 428 patients initiated dialysis therapy in our reference area. Median eGFR at dialysis initiation was 8.16 ml/min. In the univariate analysis, increased eGFR, age, dialysis initiation 1995-1999/2000-2004, diabetes and history of ischemic heart disease were associated (P < 0.05) with increased mortality in ESRD. Patients that started dialysis program with eGFR > 8.16 were older than those who did it with eGFR < 8.16 (66 vs. 61 years, P < 0.001). The association between mortality and eGFR in the crude multivarite Cox model was lost when the model was adjusted by age. In the multivariate Cox model, dialysis initiation period, serum albumin and history of ischemic heart disease were associated with mortality. CONCLUSION: History of ischemic heart disease, serum albumin and dialysis start before 2005 were risk factors for mortality in ESRD patients. Older age is usually associated with early dialysis initiation, so age adjustment is needed to perform studies aimed to calculate the effect of eGFR at dialysis initiation on survival.

Application of Toxicity Identification Evaluation (TIE) procedures for the characterization and management of dredged harbor sediments.

This study refers to the performance of Phase I Toxicity Identification Evaluation (TIE) procedures to identify the contaminants (i.e. organic compounds, metals and ammonia) exerting toxicity in marine sediments from the Pasaia harbor (Oiartzun estuary, northern Spain). The effectiveness of the manipulations to reduce toxicity was proved with the marine amphipod survival test (whole-sediment) and the sea urchin embryo-larval assay (elutriates). By means of TIEs it was concluded that organic compounds were the major contaminants exerting toxicity, although toxic effects by metals was also demonstrated. Additionally, the combination of Phase I treatments allowed to investigate the toxicity changes associated to the mobility of contaminants during dredging activities. Therefore, the performance of TIE procedures as another line of evidence in the decision-making process is recommended. They show a great potential to be implemented at different steps of the characterization and management of dredged harbor sediments.

Integrative sediment assessment at Atlantic Spanish harbours by means of chemical and ecotoxicological tools.

This study refers to the integrative assessment of sediment quality in three harbour areas at the Spanish Atlantic Coast: Vigo (Northwestern Spain), Bilbao and Pasajes (Northern Spain). At each site, two lines of evidence have been considered: chemical analyses (metal, PAH and PCB concentrations in sediments and ammonia concentration in bioassays) and toxicity tests (Microtox®, Corophium sp. marine amphipod and Paracentrotus lividus sea urchin larvae). Chemical and ecotoxicological results have been integrated by means of a tabular matrix and a multivariate factorial analysis (FA). Highly toxic samples have been characterised in Vigo and Pasajes harbours while Bilbao samples present toxicity levels ranging from non-toxic to moderately toxic. High toxicity is associated with high levels of contaminants whereas confounding factors (ammonia, organic matter and mud) have been identified to be the main cause of low to moderate toxicity. Based on the obtained results, it can be concluded that deriving potential toxicity of sediments based on comparison with Sediment Quality Guidelines (SQGs) is in agreement to toxicity results in areas presenting high levels of contaminants. However, at lower levels of toxicity (low to moderate), the mismatch between the potential toxicity (SQG approach) and the toxicity measured by bioassays is greater, as the former only accounts for chemical concentrations, without considering the interaction between contaminants and the effect of confounding factors. Contrarily, the multivariate analysis seems to be a robust tool for the integration and interpretation of different lines of evidence in areas affected by different sources of contamination.

Evaluation of diffusive gradients in thin-films (DGTs) as a monitoring tool for the assessment of the chemical status of transitional waters within the Water Framework Directive.

In this contribution, the potential use of diffusive gradients in thin-films (DGTs) for the chemical evaluation of transitional water bodies within the Water Framework Directive (WFD) has been studied. The water metal concentration has been evaluated in 13 estuaries in the southeastern Bay of Biscay. The DGTs were deployed in triplicate at two stations in each estuary, delimiting the tidal influence. The DGT results were in the ranges of 2-1570 ng L(-1) for cadmium, 66-515 ng L(-1) for copper, 30-3650 ng L(-1) for nickel and 0.8-95.5 µg L(-1) for zinc. The DGTs provided reliable average labile metal concentrations in highly dynamic systems that were comparable with DGT measurements in coastal and estuarine waters worldwide. In addition, it was possible to discriminate those estuaries more susceptible to environmental impacts, being consistent with the historical contamination of each estuary. Based on the obtained results, a sampling strategy for the monitoring of transitional water bodies using DGTs is proposed.

Dietas enriquecidas y suplementos nutricionales en ancianos hospitalizados / Fortified diets and dietary supplements in elderly hospitalized patients

Un diagnóstico adecuado y el tratamiento temprano de la malnutrición comportan unos beneficios clínicos y económicos en los pacientes hospitalizados, especialmente en los ancianos, que son los que con más frecuencia presentan signos y síntomas de malnutrición en el momento de ingresar en un hospital. Una intervención nutricional agresiva mejora su estado nutricional, favorece el pronóstico, disminuye la tasa de reingresos e incluso podría mejorar la calidad de vida. Sin embargo, la prevalencia de malnutrición en los hospitales se mantiene elevada. A pesar de las numerosas publicaciones realizadas, aún no existe un consenso entre los profesionales sanitarios acerca de la indicación de la suplementación habitual en los ancianos hospitalizados. En este artículo se revisan los posibles beneficios de los suplementos nutricionales orales en ancianos hospitalizados, aunque también se comentarán otros aspectos de la suplementación nutricional en este grupo de edad (AU)

[Pulmonary vascular reactivity and the development of edema in the presence of prostaglandin inhibitors in the isolated canine lobe]. / Reactividad vascular pulmonar y formación de edema en presencia de inhibidores de prostaglandinas en el lóbulo canino aislado.

UNLABELLED: Alveolar hypoxia is the most powerful pulmonary vasoconstrictor. In a previous work, we did not demonstrate significant changes in vascular reactivity and edema formation in an isolated canine lobe model during alveolar hypoxia. The purpose of this study is to define vascular pulmonary reactivity and edema formation after induction of pulmonary vasoconstriction using a prostaglandin inhibitor like tiaprofenic acid and alveolar hypoxia. Six isolated canine pulmonary lobules were instrumented and studied, all of them under two conditions (normoxia FIO2 21% and hypoxia FIO2 5%) four starting in normoxia condition and 2 starting in hypoxia condition. RESULTS: No significant changes in filtration rate were found, normoxia 0.42 +/- 0.41, hypoxia 0.37 +/- 0.51 ml/min/100 g pulmonary tissue P = NS. The arterial pressure in basal conditions was 25.1 +/- 6.21, and during hypoxia increased to 37 +/- 7.19 cm H2O (Delta 12.0 +/- 1.2 cm H2O). P < 0.001. CONCLUSION: Hypoxia vascular reactivity was significantly increased in tiaprofenic acid pretreated isolated canine lobes, no changes in pulmonary permeability was found nor increased rate in edema formation.

Mercado de valores, bolsas de valores y el caso boliviano

Contiene: 1. Marco conceptual. 2. Mercado de valores y bolsas de valores en Bolivia. 3. La bolsa boliviana de valores. 4. Perspectivas del mercado de valores. 5. Bolsa boliviana de valores noviembre 89 a noviembre de 1995.

Seis años de mercado de valores

Contiene: 1. Introducción. 2. Caracterización del mercado. 3. Mercado accionario. 4. Consideraciones generales sobre las perpectivas de desarrollo del mercado de valores.

The "split" gluteus maximus musculocutaneous flap.

The "split" gluteus musculocutaneous flap is a useful flap for perineal and ischial reconstruction. The flap uses the superficial 1 to 2 cm of the gluteus muscle, supplied by proximal parasacral perforators. It can be raised simply, quickly, and with minimal blood loss. Importantly, the deep muscle is left in place and remains innervated and well-vascularized. Deep structures are protected, and other flap options are preserved. Anatomic findings based on 16 cadaver dissections (8 cadavers with bilateral dissections) are presented. Representative case reports and our experience with 18 consecutive cases in 17 patients are presented.

Infeccion intrahospitalaria / Hospital infections

En un grupo de pacientes quirurgicos con diagnostico de hipertrofia benigna de prostata, retenciones agudas de orina, lesiones uretrales, de vejiga neurogenica, lesiones uretrales, carcinoma prostatico, hipertrofia de labio posterior de cuello, se hicieron estudios tendientes a investigar infeccion post-operatoria. Para ello se vigilo el retiro de sondas uretrales, tomando muestras en el momento de retirarlas, asimismo se tomaron cultivos de los extremos de las sondas utilizadas en los dias consecutivos a la intervencion quirurgica. De la misma manera se obtuvieron especimenes de liquidos de los drenajes de heridas.

The role of splenorrhaphy in splenic trauma.

Eighty-five cases of splenic trauma that were treated surgically from 1981 to 1983 were reviewed to define the exact role of splenorrhaphy. There were 73 male and 12 female patients with a mean age of 34 years. The mechanism of injury was blunt trauma in 51 and penetrating trauma in 34. The incidence of associated intraabdominal injury was 31 per cent and 79 per cent in blunt and penetrating trauma, respectively. Splenectomy was performed in 43 (51%) and splenorrhaphy in 42 (49%). Splenorrhaphy was performed in 19 (37%) who had blunt trauma and 23 (67%) who had penetrating trauma (P less than 0.01). Overall six patients died, three in the splenorrhaphy group (7.1%). Only one patient who had splenorrhaphy required reoperation for splenic hemorrhage. The authors conclude that about 50 per cent of all injured spleens in the patient population studied can be salvaged during laparotomy for splenic trauma, the splenic salvage rate is higher in penetrating trauma, and splenorrhaphy is a safe operation.

¿Es necesario dejar drenaje después de colecistectomía electiva? / Is it necessary to drain after the elective cholecistectomy?

Se analiza en forma prospectiva y randomizada, la necesidad de drenar o no el espacio subhepático después de colecistectomía electiva, en un grupo de 124 pacientes operados en forma consecutiva en Hospital Regional de Copiapó. Los pacientes drenados presentaron una mayor incidencia de vómitos en el postoperatorio que los sin drenar. Un 4,8% de los pacientes drenados presentó infección de herida operatoria, mientras que el 1,6% de los no drenados, presentó infección (p:n.s.). Complicaciones pulmonares o de otro tipo menores se presentaron con igual frecuencia en ambos grupos. La estadía postoperatoria, así como la analgesia empleada, fue similar en ambos grupos. No hubo mortalidad en esta serie