Metabolomics of Red Wines Aged Traditionally, with Chips or Staves.

Traditionally and alternatively aged wines' odour activity values (OAVs) are investigated to differentiate and highlight the differences between the selected methods. An analysis of the volatile aroma compounds of wines derived from ageing in barrels, oak chips, and staves was performed using stir bar sorptive extraction chromatography-mass spectroscopy (SBSE-GC-MS). The results showed that alcohols, esters, and oak compounds were the main contributors to aroma, and their OAVs were higher in the stave samples after 3 months than in the samples from the other two systems of ageing. Furthermore, wines aged with staves have stronger fruity, spiced, and woody aromas, while samples aged in barrels present more chemistry-driven, floral, caramelly, and creamy aromas. The staves-medium plus toast (SMPT at 3 months > 225) and chips-medium plus toast (CMPT at 3 months > 170) showed the highest levels of aromatic series, suggesting that alternative systems provided more powerful aromas than traditional systems, such as barrels-medium plus toast (BMPT at 3 months > 150). A principal component analysis (PCA), orthogonal partial least squares (OPLS) analysis, and cluster analysis allowed for a clear differentiation to be made between red wines according to ageing systems and ageing times. The odour activity values fingerprint in winemaking is a feasible approach to characterise and distinguish wines. Moreover, OAVs provide important information on the effects of production methods on wine quality and aroma profile.

Risk of Severe Maternal Morbidity Associated with Maternal Comorbidity Burden and Social Vulnerability.

OBJECTIVE: We evaluated the associations of the obstetric comorbidity index (OB-CMI) and social vulnerability index (SVI) with severe maternal morbidity (SMM). STUDY DESIGN: Multicenter retrospective cohort study of all patients who delivered (gestational age > 20 weeks) within a university health system from January 1, 2019, to December 31, 2021. OB-CMI scores were assigned to patients using clinical documentation and diagnosis codes. SVI scores, released by the Centers for Disease Control and Prevention (CDC), were assigned to patients based on census tracts. The primary outcome was SMM, based on the 21 CDC indicators. Mixed-effects logistic regression was used to model the odds of SMM as a function of OB-CMI and SVI while adjusting for maternal race and ethnicity, insurance type, preferred language, and parity. RESULTS: In total, 73,518 deliveries were analyzed. The prevalence of SMM was 4% (n = 2,923). An association between OB-CMI and SMM was observed (p < 0.001), where OB-CMI score categories of 1, 2, 3, and ≥4 were associated with higher odds of SMM compared with an OB-CMI score category of 0. In the adjusted model, there was evidence of an interaction between OB-CMI and maternal race and ethnicity (p = 0.01). After adjusting for potential confounders, including SVI, non-Hispanic Black patients had the highest odds of SMM among patients with an OB-CMI score category of 1 and ≥4 compared with non-Hispanic White patients with an OB-CMI score of 0 (adjusted odds ratio [aOR] 2.76, 95% confidence interval [CI] 2.08-3.66 and aOR 10.07, 95% CI 8.42-12.03, respectively). The association between SVI and SMM was not significant on adjusted analysis. CONCLUSION: OB-CMI was significantly associated with SMM, with higher score categories associated with higher odds of SMM. A significant interaction between OB-CMI and maternal race and ethnicity was identified, revealing racial disparities in the odds of SMM within each higher OB-CMI score category. SVI was not associated with SMM after adjusting for confounders. KEY POINTS: · OB-CMI was significantly associated with SMM.. · Racial disparities were seen within each OB-CMI score group.. · SVI was not associated with SMM on adjusted analysis..

Association of Maternal Comorbidity Burden With Cesarean Birth Rate Among Nulliparous, Term, Singleton, Vertex Pregnancies.

IMPORTANCE: Cesarean birth rate among nulliparous, term, singleton, vertex (NTSV) pregnancies is a standard quality measure in obstetrical care. There are limited data on how the number and type of preexisting conditions affect mode of delivery among primigravidae, and it is also uncertain how maternal comorbidity burden differs across racial and ethnic groups and whether this helps to explain disparities in the NTSV cesarean birth rate. OBJECTIVE: To determine the association between obstetric comorbidity index (OB-CMI) score and cesarean delivery among NTSV pregnancies and to evaluate whether disparities in mode of delivery exist based on race and ethnicity group after adjusting for covariate factors. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of deliveries between January 2019 and December 2021 took place across 7 hospitals within a large academic health system in New York and included all NTSV pregnancies identified in the electronic medical record system. Exclusion criteria were fetal demise and contraindication to labor. EXPOSURE: The OB-CMI score. Covariate factors assessed included race and ethnicity group (American Indian or Alaska Native, Asian or Pacific Islander, Hispanic, non-Hispanic Black, non-Hispanic White, other or multiracial, and declined or unknown), public health insurance, and preferred language. MAIN OUTCOME AND MEASURES: Cesarean delivery. RESULTS: A total of 30 253 patients (mean [SD] age, 29.8 [5.4] years; 100% female) were included. Non-Hispanic White patients constituted the largest race and ethnicity group (43.7%), followed by Hispanic patients (16.2%), Asian or Pacific Islander patients (14.6%), and non-Hispanic Black patients (12.2%). The overall NTSV cesarean birth rate was 28.5% (n = 8632); the rate increased from 22.1% among patients with an OB-CMI score of 0 to greater than 55.0% when OB-CMI scores were 7 or higher. On multivariable mixed-effects logistic regression modeling, there was a statistically significant association between OB-CMI score group and cesarean delivery; each successive OB-CMI score group had an increased risk. Patients with an OB-CMI score of 4 or higher had more than 3 times greater odds of a cesarean birth (adjusted odds ratio, 3.14; 95% CI, 2.90-3.40) than those with an OB-CMI score of 0. Compared with non-Hispanic White patients, nearly all other race and ethnicity groups were at increased risk for cesarean delivery, and non-Hispanic Black patients were at highest risk (adjusted odds ratio, 1.43; 95% CI, 1.31-1.55). CONCLUSIONS AND RELEVANCE: In this cross-sectional study of patients with NTSV pregnancies, OB-CMI score was positively associated with cesarean birth. Racial and ethnic disparities in this metric were observed. Although differences in the prevalence of preexisting conditions were seen across groups, this did not fully explain variation in cesarean delivery rates, suggesting that unmeasured clinical or nonclinical factors may have influenced the outcome.

Numerical Simulation of PFRC Fracture Subjected to High Temperature by Means of a Trilinear Softening Diagram.

Fibre-reinforced concrete (FRC) has been used for decades in certain applications in the construction industry, such as tunnel linings and precast elements, but has experienced important progress in recent times, boosted by the inclusion of guidelines for its use in some national and international standards. Traditional steel fibres have been studied in depth and their performance is well-known, although in recent years new materials have been proposed as possible alternatives. Polyolefin macro-fibres, for instance, have been proven to enhance the mechanical properties of concrete and the parameters that define their behaviour (fibre length, fibre proportion or casting method, for instance) have been identified. These fibres overcome certain traditional problems related to steel fibres, such as corrosion or their interaction with magnetic fields, which can limit the use of steel in some applications. The behaviour of polyolefin fibre-reinforced concrete (PFRC) has been numerically reproduced with success through an embedded cohesive crack formulation that uses a trilinear softening diagram to describe the fracture behaviour of the material. Furthermore, concrete behaves well under high temperatures or fire events, especially when it is compared with other construction materials, but the behaviour of PFRC must be analysed if the use of these fibres is to be extended. To this end, the degradation of PFRC fracture properties has been recently experimentally analysed under a temperature range between 20 °C and 200 °C. As temperature increases, polyolefin fibres modify their mechanical properties and their shape, which reduce their performance as reinforcements of concrete. In this work, those experimental results, which include results of low (3 kg/m3) and high (10 kg/m3) proportion PFRC specimens, are used as reference to study the fracture behaviour of PFRC exposed to high temperatures from a numerical point of view. The experimental load-deflection diagrams are reproduced by modifying the trilinear diagram used in the cohesive model, which helps to understand how the trilinear diagram parameters are affected by high temperature exposure. Finally, some expressions are proposed to adapt the initial trilinear diagram (obtained with specimens not exposed to high temperature) in order to numerically reproduce the fracture behaviour of PFRC affected by high temperature exposure.

Natural short-lived halogens exert an indirect cooling effect on climate.

Observational evidence shows the ubiquitous presence of ocean-emitted short-lived halogens in the global atmosphere1-3. Natural emissions of these chemical compounds have been anthropogenically amplified since pre-industrial times4-6, while, in addition, anthropogenic short-lived halocarbons are currently being emitted to the atmosphere7,8. Despite their widespread distribution in the atmosphere, the combined impact of these species on Earth's radiative balance remains unknown. Here we show that short-lived halogens exert a substantial indirect cooling effect at present (-0.13 ± 0.03 watts per square metre) that arises from halogen-mediated radiative perturbations of ozone (-0.24 ± 0.02 watts per square metre), compensated by those from methane (+0.09 ± 0.01 watts per square metre), aerosols (+0.03 ± 0.01 watts per square metre) and stratospheric water vapour (+0.011 ± 0.001 watts per square metre). Importantly, this substantial cooling effect has increased since 1750 by -0.05 ± 0.03 watts per square metre (61 per cent), driven by the anthropogenic amplification of natural halogen emissions, and is projected to change further (18-31 per cent by 2100) depending on climate warming projections and socioeconomic development. We conclude that the indirect radiative effect due to short-lived halogens should now be incorporated into climate models to provide a more realistic natural baseline of Earth's climate system.

Rectal cytomegalovirus ulcer in an immunocompetent patient: an uncommon cause of lower gastrointestinal bleeding.

We report the case of an 80-years-old male patient who presented with hematochezia without hemodynamic compromise and with a history of laryngeal squamous-cell carcinoma that was operated on 2 weeks before the bleeding episode.

Non-Linear Dimensionality Reduction With a Variational Encoder Decoder to Understand Convective Processes in Climate Models.

Deep learning can accurately represent sub-grid-scale convective processes in climate models, learning from high resolution simulations. However, deep learning methods usually lack interpretability due to large internal dimensionality, resulting in reduced trustworthiness in these methods. Here, we use Variational Encoder Decoder structures (VED), a non-linear dimensionality reduction technique, to learn and understand convective processes in an aquaplanet superparameterized climate model simulation, where deep convective processes are simulated explicitly. We show that similar to previous deep learning studies based on feed-forward neural nets, the VED is capable of learning and accurately reproducing convective processes. In contrast to past work, we show this can be achieved by compressing the original information into only five latent nodes. As a result, the VED can be used to understand convective processes and delineate modes of convection through the exploration of its latent dimensions. A close investigation of the latent space enables the identification of different convective regimes: (a) stable conditions are clearly distinguished from deep convection with low outgoing longwave radiation and strong precipitation; (b) high optically thin cirrus-like clouds are separated from low optically thick cumulus clouds; and (c) shallow convective processes are associated with large-scale moisture content and surface diabatic heating. Our results demonstrate that VEDs can accurately represent convective processes in climate models, while enabling interpretability and better understanding of sub-grid-scale physical processes, paving the way to increasingly interpretable machine learning parameterizations with promising generative properties.

Reactive halogens increase the global methane lifetime and radiative forcing in the 21st century.

CH4 is the most abundant reactive greenhouse gas and a complete understanding of its atmospheric fate is needed to formulate mitigation policies. Current chemistry-climate models tend to underestimate the lifetime of CH4, suggesting uncertainties in its sources and sinks. Reactive halogens substantially perturb the budget of tropospheric OH, the main CH4 loss. However, such an effect of atmospheric halogens is not considered in existing climate projections of CH4 burden and radiative forcing. Here, we demonstrate that reactive halogen chemistry increases the global CH4 lifetime by 6-9% during the 21st century. This effect arises from significant halogen-mediated decrease, mainly by iodine and bromine, in OH-driven CH4 loss that surpasses the direct Cl-induced CH4 sink. This increase in CH4 lifetime helps to reduce the gap between models and observations and results in a greater burden and radiative forcing during this century. The increase in CH4 burden due to halogens (up to 700 Tg or 8% by 2100) is equivalent to the observed atmospheric CH4 growth during the last three to four decades. Notably, the halogen-driven enhancement in CH4 radiative forcing is 0.05 W/m2 at present and is projected to increase in the future (0.06 W/m2 by 2100); such enhancement equals ~10% of present-day CH4 radiative forcing and one-third of N2O radiative forcing, the third-largest well-mixed greenhouse gas. Both direct (Cl-driven) and indirect (via OH) impacts of halogens should be included in future CH4 projections.

Prevalencia de fibrilación auricular en Colombia según información del Sistema Integral de Información de la Protección Social (SISPRO) / Prevalence of atrial fibrillation in Colombia according to information from the Comprehensive Information System of the Social Protection (SISPRO)

Resumen Introducción: La fibrilación auricular es la arritmia cardíaca más frecuente, es una de las causas más importantes de eventos cerebrovasculares de origen embólico y se asocia con el desarrollo de insuficiencia cardíaca y muerte súbita. En Colombia, constituye una enfermedad con altos costos para el sistema de salud; sin embargo, su prevalencia es desconocida. Objetivo: Describir la prevalencia de fibrilación auricular reportada a los sistemas oficiales de información en Colombia. Método: Mediante la extracción, el tabulado y el análisis de datos de la herramienta SISPRO, del Ministerio de Salud y Protección Social de Colombia, se calculó la prevalencia de fibrilación auricular estandarizada por edad, global y para las diferentes regiones geográficas del país, entre los años 2013 y 2017. Resultados: Se identificaron 143,656 casos reportados con el código I48X, que corresponde a fibrilación auricular en la CIE-10. La prevalencia de fibrilación auricular se incrementó desde 41 hasta 87 por cada 100,000 habitantes entre 2013 y 2017 (p < 0.001). En Colombia, la fibrilación auricular es más frecuente en las mujeres, con mayor prevalencia en mayores de 60 años (606/100,000 en 2017); hay zonas con prevalencia superior a 150/100,000 en los departamentos de Antioquia, Caldas, Santander y Bogotá D.C. Conclusiones: Este estudio sugiere que la fibrilación auricular tiene una tendencia ascendente en Colombia, es más frecuente en las mujeres y más prevalente en los centros urbanos, posiblemente debido a una mayor proporción de pacientes mayores y al mejor acceso a los sistemas de salud.

Abstract Introduction: Atrial fibrillation is the most frequent cardiac arrhythmia. It is responsible for an important proportion of embolic strokes and is associated with the development of congestive heart failure and sudden cardiac death. In Colombia, atrial fibrillation is highly costly for the healthcare system; however, its true prevalence is unknown. Objective: To describe the prevalence of atrial fibrillation reported to the official information systems in Colombia. Method: We calculated the prevalence of atrial fibrillation through the extraction, tabulation and analysis of data contained in the Integral Information System for Social Protection tool, which was created by the Ministry of Health and Social Protection in Colombia. Global and age-standardized prevalence rates were obtained for the period between years 2013 and 2017. Results: A total of 143,656 cases were identified. These were reported through the ICD-10 code I48X, corresponding to atrial fibrillation. The prevalence of atrial fibrillation increased from 41 to 87 cases per 100,000 inhabitants between years 2013 and 2017 (p < 0.001). In Colombia, atrial fibrillation is more frequent among women, and individuals over the age of 60 (606/100,000 in 2017). The departments of Antioquia, Caldas, Santander and Bogotá D.C had zones with prevalence greater than 150/100,000. Conclusions: This study suggests that atrial fibrillation displays an upward trend in Colombia. Its prevalence is higher in women and urban centers. The latter may be due to the higher proportion of older patients and better access to healthcare in these subgroups.

Suitability of Constitutive Models of the Structural Concrete Codes When Applied to Polyolefin Fibre Reinforced Concrete.

The use of fibres as structural reinforcement in concrete is included in standards, providing guidelines to reproduce their behaviour, which have been proven adequate when steel fibres are used. Nevertheless, in recent years new materials, such as polyolefin fibres, have undergone significant development as concrete reinforcement. This work gives insight on how suitable the constitutive models proposed by the Model Code 2010 (MC2010) are in the case of such polymer fibres. A set of numerical models has been carried out to reproduce the material behaviour proposed by the MC2010 and the approach based on the softening function proposed by the authors. The results show remarkable differences between the experimental results and the numerical simulations when the constitutive models described in the MC2010 are employed for different polyolefin fibre reinforced concrete mixes, while the material behaviour can be reproduced with greater accuracy if the softening function proposed by the authors is employed when this type of macro-polymer fibres is used. Moreover, the relatively complex behaviour of polyolefin fibre reinforced concrete may be reproduced by using such constitutive model.

Deep Learning Based Cloud Cover Parameterization for ICON.

A promising approach to improve cloud parameterizations within climate models and thus climate projections is to use deep learning in combination with training data from storm-resolving model (SRM) simulations. The ICOsahedral Non-hydrostatic (ICON) modeling framework permits simulations ranging from numerical weather prediction to climate projections, making it an ideal target to develop neural network (NN) based parameterizations for sub-grid scale processes. Within the ICON framework, we train NN based cloud cover parameterizations with coarse-grained data based on realistic regional and global ICON SRM simulations. We set up three different types of NNs that differ in the degree of vertical locality they assume for diagnosing cloud cover from coarse-grained atmospheric state variables. The NNs accurately estimate sub-grid scale cloud cover from coarse-grained data that has similar geographical characteristics as their training data. Additionally, globally trained NNs can reproduce sub-grid scale cloud cover of the regional SRM simulation. Using the game-theory based interpretability library SHapley Additive exPlanations, we identify an overemphasis on specific humidity and cloud ice as the reason why our column-based NN cannot perfectly generalize from the global to the regional coarse-grained SRM data. The interpretability tool also helps visualize similarities and differences in feature importance between regionally and globally trained column-based NNs, and reveals a local relationship between their cloud cover predictions and the thermodynamic environment. Our results show the potential of deep learning to derive accurate yet interpretable cloud cover parameterizations from global SRMs, and suggest that neighborhood-based models may be a good compromise between accuracy and generalizability.

Interpretación medicolegal para el abordaje de individuos con desórdenes del desarrollo sexual en Colombia / Interpretation of medical-legal Colombian legislation to treat individuals with disorders of sexual development

Objetivo Los desórdenes del desarrollo sexual (DDSs) son un grupo de condiciones médicas cuyo manejo implica un enfoque transdisciplinario. En la legislación colombiana, no existe una regulación específica en materia de intervenciones médicas en individuos con DDSs. La Corte Constitucional Colombiana se ha encargado de proferir sentencias, en las cuales se han establecido unos lineamientos y parámetros para el manejo jurídico de los casos de ambigüedad genital. Teniendo en cuenta lo anterior, nos proponemos en este artículo exponer y analizar, desde la visión de un grupo transdisciplinario, las sentencias más relevantes que han sido proferidas por la Corte Constitucional Colombiana. Métodos Se realizó una revisión narrativa en las bases de datos de la Corte Constitucional y de la literatura legal. Se recopilaron todas las sentencias disponibles, y se evaluaron lo casos clínicos identificados por el grupo transdisciplinario de DDSs del Hospital Universitario San Ignacio. Finalmente, los autores generaron por consenso un texto de discusión, como guía para los lectores, luego de analizar cada una de las sentencias y los casos presentados. Resultados Se identificaron 9 sentencias y los antecedentes que llevaron a la elaboración de cada una de ellas. Los nueve casos presentados contienen conceptos importantes para la articulación por parte del grupo transdisciplinario, tales como, autonomía, consentimiento sustituto y asistido, e indicación médica del tratamiento. Se excluyeron las sentencias T-692/99 y la T-918/2012, dado que daban información duplicada con referencia a sentencias incluidas en este documento. Conclusión La Corte Constitucional Colombiana ha proferido sentencias en las cuales no se ha contado con la participación de grupos de expertos. La terminología usada no describe apropiadamente el lenguaje técnico que se aplica al manejo de nuestros pacientes. Para el abordaje de individuos con DDSs, resulta muy importante conocer la relevancia de las sentencias basadas en un análisis individual de cada caso.

Objective Disorders of sexual development (DSDs) are a group of conditions that require a transdisciplinary approach. In the Colombian legislation, there are no specific regulations regarding medical interventions in individuals with DSDs. The Colombian Constitutional Court has issued sentences establishing some guidelines and parameters for the legal management of cases of genital ambiguity. Considering the aforementioned information, the present manuscript aims to describe and analyze, from the perspective of a transdisciplinary team, the most relevant sentences issued by the Colombian Constitutional Court. Methods We performed a narrative review of the database of the Colombian Constitutional Court and of the legal literature. We compiled all available court sentences and evaluated the clinical cases identified by the transdisciplinary team at Hospital Universitario San Ignacio. Lastly, the authors composed, through consensus, a text for discussion, as a guide to the readers, after the analysis of each of the sentences and cases presented. Results We identified nine sentences and the precedents that led to their development. The nine cases presented contain important concepts for the work of the transdisciplinary team, such as autonomy, substitute and assisted consent, and the medical indication of treatment. Sentences T-692/99 and T-918/2012 were excluded, as they provided duplicate information concerning sentences included in this document. Conclusion The Colombian Constitutional Court has issued sentences without the participation of a team of experts in DSDs. The terminology used does not properly describe the jargon that is applied in the management of our patients. In order to approach individuals with DSDs, awareness regarding the relevance of the sentences based on an individual analysis of each case is of great importance.

Fracture and Size Effect of PFRC Specimens Simulated by Using a Trilinear Softening Diagram: A Predictive Approach.

The size effect on plain concrete specimens is well known and can be correctly captured when performing numerical simulations by using a well characterised softening function. Nevertheless, in the case of polyolefin-fibre-reinforced concrete (PFRC), this is not directly applicable, since using only diagram cannot capture the material behaviour on elements with different sizes due to dependence of the orientation factor of the fibres with the size of the specimen. In previous works, the use of a trilinear softening diagram proved to be very convenient for reproducing fracture of polyolefin-fibre-reinforced concrete elements, but only if it is previously adapted for each specimen size. In this work, a predictive methodology is used to reproduce fracture of polyolefin-fibre-reinforced concrete specimens of different sizes under three-point bending. Fracture is reproduced by means of a well-known embedded cohesive model, with a trilinear softening function that is defined specifically for each specimen size. The fundamental points of these softening functions are defined a priori by using empirical expressions proposed in past works, based on an extensive experimental background. Therefore, the numerical results are obtained in a predictive manner and then compared with a previous experimental campaign in which PFRC notched specimens of different sizes were tested with a three-point bending test setup, showing that this approach properly captures the size effect, although some values of the fundamental points in the trilinear diagram could be defined more accurately.

Homogeneous Fe2O3 coatings on carbon nanotube structures for supercapacitors.

The combination of carbon nanotubes with transition metal oxides can exhibit complementary charge storage properties for use as electrode materials for next generation energy storage devices. One of the biggest challenges so far is to synthesize homogeneous oxide coatings on carbon nanotube structures preserving their integrity. Here we present the formation of conformal coatings of Fe2O3 on vertically aligned carbon nanotubes obtained by atomic layer deposition. We investigate the effect of pristine, nitrogen plasma and water plasma treated carbon nanotube surfaces on the ALD-growth of Fe2O3 using ferrocene and ozone precursors. The surface morphology, coating thickness, microstructure and surface chemistry of iron oxide-carbon nanotube composites and their ultimate influence on the electrochemical behavior of the composites are evaluated. The most effective surface functionalization is that achieved by H2O plasma treatment, whereas untreated carbon nanotubes, despite the lack of active sites in the starting pristine surface, can be coated with an inhomogeneous Fe2O3 film.

Disorders of Sexual Development: Current Status and Progress in the Diagnostic Approach.

Disorders of sexual development (DSD) are conditions with an atypical chromosomal, gonadal or phenotypic sex, which leads to differences in the development of the urogenital tract and different clinical phenotypes. Some genes have been implicated in the sex development during gonadal and functional differentiation where the maintenance of the somatic sex of the gonad as either male or female is achieved by suppression of the alternate route. The diagnosis of DSD requires a structured approach, involving a multidisciplinary team and different molecular techniques. We discuss the dimorphic genes and the specific pathways involved in gonadal differentiation, as well as new techniques for genetic analysis and their diagnostic value including epigenetic mechanisms, expanding the evidence in the diagnostic approach of individuals with DSD to increase knowledge of the etiology.

Phenotypic Characteristics and Copy Number Variants in a Cohort of Colombian Patients with VACTERL Association.

VACTERL association (OMIM 192350) is a heterogeneous clinical condition characterized by congenital structural defects that include at least 3 of the following features: vertebral abnormalities, anal atresia, heart defects, tracheoesophageal fistula, renal malformations, and limb defects. The nonrandom occurrence of these malformations and some familial cases suggest a possible association with genetic factors such as chromosomal alterations, gene mutations, and inherited syndromes such as Fanconi anemia (FA). In this study, the clinical phenotype and its relationship with the presence of chromosomal abnormalities and FA were evaluated in 18 patients with VACTERL association. For this, a G-banded karyotype, array-comparative genomic hybridization, and chromosomal fragility test for FA were performed. All patients (10 female and 8 male) showed a broad clinical spectrum: 13 (72.2%) had vertebral abnormalities, 8 (44.4%) had anal atresia, 14 (77.8%) had heart defects, 8 (44.4%) had esophageal atresia, 10 (55.6%) had renal abnormalities, and 10 (55.6%) had limb defects. Chromosomal abnormalities and FA were ruled out. In 2 cases, the finding of microalterations, namely del(15)(q11.2) and dup(17)(q12), explained the phenotype; in 8 cases, copy number variations were classified as variants of unknown significance and as not yet described in VACTERL. These variants comprise genes related to important cellular functions and embryonic development.

[Proctocolitis by cryptococcus in an immunocompetent patient: first report in Peru]. / Proctocolitis por criptococo en inmunocompetente: primer reporte de caso en Per ú.

Cryptococcosis is a typical opportunistic fungal infection in immunocompromised patients especially those with HIV (human immunodeficiency virus). We report a case of primary intestinal criptococosis in a 57 year old women HIV negative with one year of abdominal pain and hematochezia. Colonoscopy reveals nodular and friable mucosa from rectum to distal descending colon. We report the first case of gastrointestinal criptococosis in Peru in an immunocompetent patient.

Un ensayo clínico piloto de la efectividad clínica de dos presentaciones de esomeprazol / Clinical effectiveness of two esomeprazole presentations in a pilot trial

Resumen Introducción: el presente estudio tuvo como fin investigar la efectividad clínica de dos presentaciones de esomeprazol en pacientes con dispepsia de causa no estudiada. Métodos: se realizó un ensayo clínico piloto de dos presentaciones de esomeprazol de 40 mg recibidos diariamente por 28 días. Se eligieron pacientes con diagnóstico de dispepsia no estudiada que asistieron a consulta de gastroenterología en un hospital de referencia. Se evaluaron a los pacientes inicialmente con endoscopia y biopsia, el seguimiento a 2 y 4 semanas con escalas clínicas de síntomas y calidad de vida con cuestionarios validados en español (SODA y QoL-PEI) y eventos adversos. Además, se midieron los niveles de pH gástrico con pH-metrías en 24 horas al día 14 de tratamiento. Se tomaron niveles séricos del medicamento al momento de la evaluación de la pH-metría. Para las escalas clínicas se aplicó un análisis de varianza (ANOVA) de dos factores con medidas repetidas y al encontrar diferencias significativas en los tiempos se realizó una corrección de Bonferroni. Resultados: se aleatorizó un total de 33 pacientes, 16 y 17 pacientes en cada grupo. No hubo diferencias en el porcentaje de inhibición del pH gástrico al día 14 de tratamiento (p = 0,9795). No hubo diferencias en concentraciones de niveles séricos el día 14 (p = 0,2199). No se encontraron diferencias significativas en las escalas de gravedad y calidad de vida en las dos primeras semanas de tratamiento, pero sí en las últimas dos semanas, en las cuales el producto de prueba demostró mayor disminución del dolor (p = 0,0048) y superioridad en conformidad (p = 0,01) en la subescala SODA. No se presentaron eventos adversos serios y no hubo diferencias estadísticas entre la presentación eventos adversos no serios. Conclusiones: los productos de prueba y el de referencia mostraron efectos similares en variables clínicamente relevantes.

Abstract Introduction: This pilot studied the clinical effectiveness of two presentations of esomeprazole in patients with dyspepsia with undiagnosed causes. Methods: We conducted a pilot clinical trial of two 40 mg Esomeprazole presentations. Patients with dyspepsia of unknown cause at a gastroenterology clinic in a referral hospital were included. They received one or the other presentation daily for 28 days. Patients were initially evaluated with endoscopy and biopsy and received follow-up examinations at two and four weeks. Adverse events were recorded, and clinical symptom scales and quality of life questionnaires validated in Spanish (SODA and QoL-PEI) were used. In addition, gastric pH levels were measured continuously for 24 hours on day 14 of treatment. Serum levels of the medication administered were also measured on day 14 of treatment. A two-way repeated measures ANOVA was used to compare mean differences between the two groups. When significant differences in times were found, a Bonferroni correction was made. Results: A total of 33 patients were randomized into two groups: 16 patients in one group and 17 in the other. There were no differences in the percentages of gastric pH inhibition at day 14 of treatment (p = 0.9795). There were no differences in serum level concentrations on day 14 (p = 0.2199). No significant differences were found in severity and quality of life scales in the first two weeks of treatment. However, in the last two weeks of treatment the test product showed a larger decrease in pain (p = 0.0048) and superiority in compliance (p = 0.01) on the SODA subscale. There were no serious adverse events, and there were no statistical differences between the presentations of non-serious adverse events. Conclusions: The Test product and the Reference product showed similar effects on clinically relevant variables.

Influence of Temperature on the Longitudinal Cracking in Multipurpose Precast Concrete Sleepers Prior to Their Installation.

Prestressed monoblock railway sleepers are concrete elements with almost no reinforcement apart from the prestressing wires, which makes them very sensitive to any stress variation that can induce tensile stresses. In recent years, severe longitudinal cracking has been observed in a number of sleepers in hot regions of Spain, even before these elements were put in service. This work studies the problem while considering the thermal variation as the main factor affecting this cracking phenomenon. A non-linear static load-step analysis is applied on a non-linear finite element model to reproduce the problem and, after its experimental validation, the influence of three design parameters of the sleepers are studied: the nature of concrete aggregates, the dowel thickness, and the dowel material. The results show that all these three parameters may have significant influence on the problem, with the dowel material being the most important parameter. When the dowels are made of a material with a high elastic modulus and a high thermal expansion coefficient, the crack opening induced by a realistic thermal variation can reach significant values and result in longitudinal crack propagation. The changes of humidity are not considered in this study because they are beyond the scope of this work.