Generalized Structure Functions and Multifractal Detrended Fluctuation Analysis Applied to Vegetation Index Time Series: An Arid Rangeland Study.

Estimates suggest that more than 70% of the world's rangelands are degraded. The Normalized Difference Vegetation Index (NDVI) is commonly used by ecologists and agriculturalists to monitor vegetation and contribute to more sustainable rangeland management. This paper aims to explore the scaling character of NDVI and NDVI anomaly (NDVIa) time series by applying three fractal analyses: generalized structure function (GSF), multifractal detrended fluctuation analysis (MF-DFA), and Hurst index (HI). The study was conducted in four study areas in Southeastern Spain. Results suggest a multifractal character influenced by different land uses and spatial diversity. MF-DFA indicated an antipersistent character in study areas, while GSF and HI results indicated a persistent character. Different behaviors of generalized Hurst and scaling exponents were found between herbaceous and tree dominated areas. MF-DFA and surrogate and shuffle series allow us to study multifractal sources, reflecting the importance of long-range correlations in these areas. Two types of long-range correlation appear to be in place due to short-term memory reflecting seasonality and longer-term memory based on a time scale of a year or longer. The comparison of these series also provides us with a differentiating profile to distinguish among our four study areas that can improve land use and risk management in arid rangelands.

[Non-oropharyngeal dysphagia with frequent Emergency Room attendance]. / Disfagia no orofaríngea con alta frecuentación en Urgencias.

BACKGROUND: avoidant/restrictive food intake disorder (ARFID) is a new eating disorder category among eating disorders. Its recent incorporation explains the lack of studies evaluating the optimal treatment and follow-up of patients with this disorder. CASE REPORT: we present the case of a 20-year-old patient with 3-week dysphagia and 20% weight loss. After ruling out organic disorders, he was diagnosed with ARFID and required parenteral and tube feeding until the improvement of the eating disorder. DISCUSSION: in this patient, severe caloric malnutrition secondary to the eating disorder made it necessary to turn to the parenteral and enteral approach until the behavioral modification and progressive food exposure were effective. The absence of etiological treatment makes cognitive behavioral intervention, along with the correction of nutritional deficiencies, the preferred approach.

Introducción: el trastorno de evitación/restricción de la ingesta alimentaria es una nueva categoría diagnóstica en el espectro de trastornos de la alimentación. Su reciente aparición explica la falta de estudios que evalúen el tratamiento y seguimiento de pacientes con esta patología.Caso clínico: presentamos el caso de un paciente de 20 años con disfagia de tres semanas de evolución y pérdida del 20% de peso, diagnosticado de trastorno de evitación/restricción de la ingesta alimentaria tras descartar organicidad del proceso, con necesidad de nutrición parenteral y enteral como tratamiento nutricional hasta mejoría clínica.Discusión: en este paciente, la desnutrición calórica grave secundaria al trastorno alimentario hizo necesario recurrir al aporte parenteral y enteral hasta la modificación conductual y la reintroducción paulatina de la alimentación por vía oral. La ausencia de tratamiento etiológico hace que la terapia conductual junto con la corrección de los déficits nutricionales sean la base del manejo.

Disfagia no orofaríngea con alta frecuentación en urgencias / Non-oropharyngeal dysphagia with frequent Emergency Room attendance

Introducción: el trastorno de evitación/restricción de la ingesta alimentaria es una nueva categoría diagnóstica en el espectro de trastornos de la alimentación. Su reciente aparición explica la falta de estudios que evalúen el tratamiento y seguimiento de pacientes con esta patología. Caso clínico: presentamos el caso de un paciente de 20 años con disfagia de tres semanas de evolución y pérdida del 20% de peso, diagnosticado de trastorno de evitación/restricción de la ingesta alimentaria tras descartar organicidad del proceso, con necesidad de nutrición parenteral y enteral como tratamiento nutricional hasta mejoría clínica. Discusión: en este paciente, la desnutrición calórica grave secundaria al trastorno alimentario hizo necesario recurrir al aporte parenteral y enteral hasta la modificación conductual y la reintroducción paulatina de la alimentación por vía oral. La ausencia de tratamiento etiológico hace que la terapia conductual junto con la corrección de los déficits nutricionales sean la base del manejo

Background: avoidant/restrictive food intake disorder (ARFID) is a new eating disorder category among eating disorders. Its recent incorporation explains the lack of studies evaluating the optimal treatment and follow-up of patients with this disorder. Case report: we present the case of a 20-year-old patient with 3-week dysphagia and 20% weight loss. After ruling out organic disorders, he was diagnosed with ARFID and required parenteral and tube feeding until the improvement of the eating disorder. Discussion: in this patient, severe caloric malnutrition secondary to the eating disorder made it necessary to turn to the parenteral and enteral approach until the behavioral modification and progressive food exposure were effective. The absence of etiological treatment makes cognitive behavioral intervention, along with the correction of nutritional deficiencies, the preferred approach

Esophagus histological analysis after hyperthermia-induced injury: implications for cardiac ablation.

PURPOSE: To evaluate and numerically score histological alterations observed in the acute phase in the esophagus after being exposed to a hyperthermic dosage and subsequently to correlate the scores obtained with the hyperthermic treatment parameters (i.e. temperature (T) and time (t)). MATERIAL AND METHODS: Esophagus samples obtained from New Zealand white rabbits were immersed in a temperature-controlled saline bath at 40, 50, 60 and 70 degrees C for 30, 60 and 90 s. Samples were then processed for histological analysis (Masson Trichrome technique), and evaluated by searching for objective heat-damage signs. A numerical value was assigned to each sample for each finding. RESULTS: In general, all the layers were affected by the treatment, however, the greatest alterations were found in the epithelium and deeper muscular layers (circular and longitudinal). We found no damage (i.e. no differences to control) in all of the samples treated at 40 degrees C, and severe damage in treatments at 60 and 70 degrees C, regardless of exposure time. On the other hand, samples treated at 50 degrees C did show different results related to time: no damage for 30 s, light damage for 60 s, and moderate damage for 90 s. We assigned a score value to each hyperthermic dosage, and obtained the fitted equation based on a logarithmic transformation of the Arrhenius equation: Score = 130.7 - 40,851/(T + 273) + log t, (R(2) = 0.9326, P < 0.0001). CONCLUSIONS: Hyperthermic treatment mainly affects the epithelium and deeper muscular layers. The results suggest a damage threshold of 50 degrees C for treatments of 30-90 s. The proposed scoring system provides a good fit with the hyperthermic parameters.

Formation of cartilage in vivo with immobilized autologous rabbit auricular cultured chondrocytes in collagen matrices.

BACKGROUND: The availability of generated cartilage de novo is one of the needs of reconstructive surgery. In this study, the authors constructed a matrix formed by autologous immobilized chondrocytes using collagen gel as a scaffold. Furthermore, the ability of these matrices to engraft and generate new cartilage was examined. METHODS: Biopsy specimens of elastic cartilage were surgically obtained from the ears of eight New Zealand White rabbits. After collagenase II digestion of cartilage, chondrocytes were isolated and propagated in culture medium. Chondrocytes were immobilized into bovine collagen lattices and implanted, replacing pieces of removed native cartilage. Five weeks after implantation, the rabbits were killed and the ears were examined macroscopically and analyzed by means of histochemical methods. RESULTS: The results show the formation of new cartilage from implanted lattices with chondrocytes. Gross analysis of the ears shows similarities in appearance, consistency, texture, and histology between native and new cartilage. Fluorescence of the nucleus from bisbenzimide-labeled chondrocytes was detected in newly formed tissue, pointing out its in vitro culture origin. No signs of an inflammatory reaction attributable to implants were found in either the control or the chondrocyte lattices. CONCLUSION: The authors suggest that this approach is of value for future clinical use.

[Severe cyanosis after total cavopulmonary connection, corrected by surgical ligation of the suprahepatic veins]. / Cianosis severa tras derovación cavopulmonar total, corregida mediante ligadura quirúrgica de las venas suprahepáticas.

We describe a patient with a diagnosis of heterotaxia and independent drainage of the suprahepatic veins into the venous atrium who underwent total extracardiac cavopulmonary connection in which hepatic vein drainage remained directly into the atrium. In the immediate postoperative period she showed increasing cyanosis that suggested substantial right-to-left shunt. Surgical ligation of the suprahepatic veins resolved the complication effectively without signs of hepatic congestion or portal hypertension.

Rapid progression of midventricular obstruction in adults with double-chambered right ventricle.

OBJECTIVE: The purpose of this study was to determine the rate of progression of midventricular obstruction in adolescents and adults with double-chambered right ventricle. METHODS: Clinical and echocardiographic findings in 45 patients (mean age 26 +/- 6 years, range 15-44) diagnosed with double-chambered right ventricle were retrospectively analyzed. Twenty patients underwent surgical repair before the age of 15 years. The relationship between Doppler midventricular pressure gradient and patient age was analyzed in 25 patients without previous repair. Sequential change in midventricular obstruction was determined for patients with 2 or more Doppler echocardiographic examinations performed within at least a 2-year interval. RESULTS: Right midventricular pressure gradient in nonrepaired patients was 70 +/- 38 mm Hg (range 25-150). A significant relationship between midventricular obstruction and patient age (r = 0.64, P <.001) was found. Midventricular pressure gradient at initial evaluation was 32 +/- 27 mm Hg in 16 patients < 25 years and 73 +/- 45 mm Hg in 9 patients >/= 25 years (P <.03). After the initial study, 5 patients underwent surgical repair and 13 patients without repair were followed up for a period of 6.1 +/- 2.7 years (range 2-9), in which midventricular pressure gradient increased from 32 +/- 26 mm Hg to 67 +/- 35 mm Hg (P <.001). The slope of the change in midventricular pressure gradient was 6.2 +/- 3 mm Hg per year of follow-up. Seven more patients underwent surgical repair during follow-up due to progression of the obstruction. There was no mortality nor residual midventricular obstruction in surgically repaired patients. CONCLUSIONS: Mild right midventricular obstruction shows a fast rate of progression in adolescents and young adults. Thus, close clinical and echocardiographic follow-up is advised, and surgical repair should be considered if significant progression of obstruction is detected.

[Surgical closure of atrial septal defect before or after the age of 25 years. Comparison with the natural history of unoperated patients]. / Cierro quirúrgico de la comunicación interauricular antes o después de los 25 años de edad. Comparación con la evolución natural en pacientes no operados.

INTRODUCTION: Surgical closure of an atrial septal defect (ASD) before the age of 25 years has been demonstrated to reduce complications during adulthood. However, the outcome for patients operated after the age of 25 is still debated. METHODS: In a retrospective study we examined the outcome of early and late surgical repair of ASD in adults, as compared with the natural evolution of unoperated patients. The study population was 280 patients (mean age 40 18 years) with non-restrictive ASD: 102 patients (group 1) underwent surgery before the age of 25 years, 90 patients (group 2) underwent surgery after the age of 25 years, and 88 unoperated patients were older than 25 years at the time of study (group 3). The variables analyzed were left ventricular systolic function, left atrial dimensions, systolic pulmonary pressure, right ventricular dimensions, the degree of mitral and tricuspid regurgitation, and the prevalence of late atrial fibrillation. RESULTS: Left ventricular systolic function and the degree of mitral regurgitation were not statistically different between groups. Compared with the patients in group 2, the patients in group 1 had a significantly lower systolic pulmonary arterial pressure (p < 0.001) and less dilated right ventricle (p < 0.001) and left atrium (p < 0.001). The degree of tricuspid regurgitation (p < 0.001) and prevalence of atrial fibrillation (p < 0.001) were significantly higher in the patients of group 2. Compared with group 3, the patients in group 2 had a significantly lower systolic pulmonary arterial pressure (p < 0.001) and less dilated right ventricle (p < 0.001). However, the left atrial dimensions, degree of tricuspid regurgitation, and prevalence of atrial fibrillation did not differ in a statistically significant way between the two groups. CONCLUSIONS: Surgical repair of an atrial septal defect in patients over 25 years of age does not fully prevent hemodynamic deterioration and the development of atrial arrhythmias. Therefore it seems that the surgical closure of ASD before adulthood should be strongly recommended.

Cierre quirúrgico de la comunicación interauricular antes o después de los 25 años de edad. Comparación con la evolución natural en pacientes no operados / Surgical closure of atrial septal defect before or after the age of 25 years. Comparison with the natural history of unoperated patients

Introducción. El cierre quirúrgico de la comunicación interauricular (CIA) antes de los 25 años de edad disminuye las complicaciones durante la vida adulta, pero las consecuencias de la intervención en pacientes mayores de 25 años siguen siendo motivo de controversia. Métodos. Para comparar los efectos de la cirugía precoz y/o tardía con la evolución natural se ha estudiado, de forma retrospectiva, a 280 adultos (edad media 40 ñ 18 años) con CIA no restrictiva. Ciento dos pacientes (grupo 1) habían sido operados antes de los 25 años, 90 (grupo 2) habían sido operados después de los 25 años y 88 (grupo 3) no habían sido operados previamente. Se comparó la presión pulmonar sistólica, el tamaño del ventrículo derecho y la aurícula izquierda, el grado de insuficiencia mitral y tricúspide, la función sistólica del ventrículo izquierdo y la prevalencia de fibrilación auricular. Resultados. No había diferencia en la función sistólica del ventrículo izquierdo o en el grado de insuficiencia mitral entre los tres grupos. Comparado con el grupo 2, el grupo 1 tenía menores presión sistólica pulmonar (p < 0,001), tamaño del ventrículo derecho (p < 0,001), grado de insuficiencia tricúspide (p < 0,001), tamaño de aurícula izquierda (p < 0,001) y prevalencia de fibrilación auricular (p < 0,001). Comparado con el grupo 3, el grupo 2 presentaba menores presión sistólica pulmonar (p < 0,001) y tamaño del ventrículo derecho (p < 0,001), pero no existía diferencia en el grado de insuficiencia tricúspide, el tamaño de la aurícula izquierda o la prevalencia de fibrilación auricular. Conclusiones. El cierre quirúrgico de la CIA después de los 25 años no previene el deterioro hemodinámico o el desarrollo de arritmias auriculares, por lo que se debería concentrar esfuerzos en corregir el defecto antes de la edad adulta (AU)