Acute toxicity of total ammonia to Macrobrachium rosenbergii postlarvae at different salinity levels.

Nitrogen compounds, particularly ammonium, nitrite and nitrate, are a major problem in shrimp production systems. These compounds can accumulate in the aquatic environment and reach harmful or even lethal levels. Thus, monitoring the levels of nitrogenous compounds such as ammonia and studying their effects on the animals are essential. One tool used for this purpose is acute toxicity testing based on the evaluation of LC50 values. Furthermore, tools that can help improve the performance of aquatic organisms in culture are needed. The present study aimed to evaluate the effect of salinity on the toxicity of total ammonia to postlarvae of the freshwater prawn Macrobrachium rosenbergii. For this purpose, acute toxicity testing (LC50-96h) was performed using 540 postlarvae with a mean weight of 0.13 g and a mean total length of 2.47 cm, divided into 54 experimental units of two liters each. A completely randomized design in a 3×6 factorial scheme was used, combining three salinities (0, 5, and 10 g.L-1) and six total ammonia concentrations (0, 8, 16, 32, 64, and 128 mg.L-1), with three replicates per combination. The LC50 values for M. rosenbergii postlarvae at 24, 48, 72, and 96 h and their respective confidence intervals (95%) were estimated using the trimmed Spearman-Karber method. The results showed that salinities of 5 or 10 g.L-1 did not reduce the acute toxicity of total ammonia.

Growth differentiation factor 11 (GDF11) - a promising anti-ageing factor - is highly concentrated in platelets.

Recent research suggests that growth differentiation factor 11 (GDF11) could reverse age-related diseases and that its blood concentration decreases with age. This poses plasma from young donors as a therapeutic GDF11 source to treat age-related diseases. In addition, the tissue source of circulating GDF11 remains unknown. We analysed GDF11 levels in paired samples of serum, plasma and platelet lysate (PL) from 23 volunteers. Plasma and PL were collected by plateletpheresis. Here, we show that GDF11 is highly concentrated in platelets and that the circulating levels reported in previous studies could be biased as a result of serum sample manipulation.

Multi-site reproducibility of prefrontal-hippocampal connectivity estimates by stochastic DCM.

This study examined the reproducibility of prefrontal-hippocampal connectivity estimates obtained by stochastic dynamic causal modeling (sDCM). 180 healthy subjects were measured by functional magnetic resonance imaging (fMRI) during a standard working memory N-Back task at three different sites (Mannheim, Bonn, Berlin; each with 60 participants). The reproducibility of regional activations in key regions for working memory (dorsolateral prefrontal cortex, DLPFC; hippocampal formation, HF) was evaluated using conjunction analyses across locations. These analyses showed consistent activation of right DLPFC and deactivation of left HF across all three different sites. The effective connectivity between DLPFC and HF was analyzed using a simple two-region sDCM. For each subject, we evaluated sixty-seven alternative sDCMs and compared their relative plausibility using Bayesian model selection (BMS). Across all locations, BMS consistently revealed the same winning model, with the 2-Back working memory condition as driving input to both DLPFC and HF and with a connection from DLPFC to HF. Statistical tests on the sDCM parameter estimates did not show any significant differences across the three sites. The consistency of both the BMS results and model parameter estimates indicates the reliability of sDCM in our paradigm. This provides a basis for future genetic and clinical studies using this approach.

Bronchiectasis in primary Sjögren's syndrome: prevalence and clinical significance.

OBJECTIVES: To analyse the prevalence and clinical significance of bronchiectasis in a large series of patients with primary Sjögren's syndrome (SS) and evaluate its impact on disease expression and outcomes. METHODS: The study cohort included 507 patients with primary SS. Bronchiectasis were diagnosed according to pulmonary computed tomography (CT). As a control group, we included 37 consecutive SS patients evaluated by pulmonary CT during the same study period without pulmonary involvement. RESULTS: Fifty primary SS patients had bronchiectasis according to the pulmonary CT. Nine patients were excluded due to non-autoimmune processes and 41 were classified as bronchiectasis associated with primary SS (40 women, mean age of 64 years). All cases of bronchiectasis were of the cylindrical type and were located in the inferior lobes in 29 cases (71%). Patients with bronchiectasis were older at diagnosis of SS (60.39 vs. 52.54 years, p=0.022) and had a higher frequency of hiatus hernia (41% vs. 16%, p=0.024) in comparison with controls. Immunologically, patients with bronchiectasis had a lower frequency of anti-Ro/SS-A antibodies (27% vs. 54%, p=0.022) but a higher frequency of anti-smooth muscle--SMAantibodies (82% vs. 60%, p=0.043). During follow-up, patients with bronchiectasis had a higher frequency of respiratory infections (56% vs. 3%, p<0.001) and pneumonia (29% vs. 3%, p=0.002) in comparison with those without. CONCLUSIONS: Patients with primary SS and bronchiectasis are characterised by an older age, a high frequency of hiatus hernia, a specific immunologic pattern (low frequency of anti-Ro/SS-A and high frequency of anti-SMA) and during follow-up a much higher frequency of respiratory infections and pneumonia.

Aplicación de los Ambulatory Patient Groups a un servicio de urgencias hospitalarias / No disponible

Objetivo. Analizar el sistema Ambulatory Patient Groups (APG) es útil como sistema de planificación y gestión de los servicios de urgencias. Estimar el sistema de financiación teórico de acuerdo al peso medio de cada proceso. Material y métodos: Se desarrolló un conjunto mínimo básico de datos específico para la actividad de urgencia. Se aplicó el software APG Finder, que clasifica cada episodio en APGs y calcula su peso medio. Se calculó la financiación teórica en función del peso medio de cada visita. Resultados. Se han codificado y agrupado en APGs un total de 6.628 urgencias. Distribuidas en 66% visitas médicas, 16% de procedimientos y terapias significativas, y 18% de pruebas y procedimientos auxiliares. Quince APGs agrupan un 67,4% de la casuística atendida en urgencias. Conclusiones. Los APGs son válidos como sistema de información para la planificación y la gestión de los servicios de urgencias. Las visitas de urgencias están infrafinanciadas (AU)

Objective. To examine whether the Ambulatory Patient Group (APG) system is useful as a planning and management tool for the emergency departments. Estimating the funding system according to the theroretical average weight of each process. Materials and methods. We developed a minimum discharge data set specific to the emergency activity. Implemented software APG Finder, which lists each episode in APGs and calculates their average weight. We calculated the theoretical funding on the basis of the average weight of each visit. Results. A total of 6.628 emergency visits were coded and grouped into APGs, distributed as follows: 66% doctor visits, 16% procedures and meaningful therapies, and 18% test and auxiliary procedures. 15 APGs grouped a 67,4% of all cases seen the emergency department. APGS are valid as information system for planning and managing the emergency department. The emergency visits are funded below (AU)

The linearity of emergent spectro-temporal receptive fields in a model of auditory cortex.

The responses of cortical neurons are often characterized by measuring their spectro-temporal receptive fields (STRFs). The STRF of a cell can be thought of as a representation of its stimulus 'preference' but it is also a filter or 'kernel' that represents the best linear prediction of the response of that cell to any stimulus. A range of in vivo STRFs with varying properties have been reported in various species, although none in humans. Using a computational model it has been shown that responses of ensembles of artificial STRFs, derived from limited sets of formative stimuli, preserve information about utterance class and prosody as well as the identity and sex of the speaker in a model speech classification system. In this work we help to put this idea on a biologically plausible footing by developing a simple model thalamo-cortical system built of conductance based neurons and synapses some of which exhibit spike-time-dependent plasticity. We show that the neurons in such a model when exposed to formative stimuli develop STRFs with varying temporal properties exhibiting a range of heterotopic integration. These model neurons also, in common with neurons measured in vivo, exhibit a wide range of non-linearities; this deviation from linearity can be exposed by characterizing the difference between the measured response of each neuron to a stimulus, and the response predicted by the STRF estimated for that neuron. The proposed model, with its simple architecture, learning rule, and modest number of neurons (<1000), is suitable for implementation in neuromorphic analogue VLSI hardware and hence could form the basis of a developmental, real time, neuromorphic sound classification system.

Sistemas de Clasificación de Pacientes. Revisión conjunta. Parte II / No disponible

Los Sistemas de Clasificación de Pacientes (SCP) surgen ante la necesidad de disponer de una herramienta que permitiera medir la casuística o tipología de pacientes atendidos, así como el consumo de recursos en los centros sanitarios. Los Grupos Relacionados con el Diagnóstico (GRD) es el SCP cuyo uso está más extendido en España y el empleado en la actualidad. Su aplicación se limita a la actividad de hospitalización, no siendo valido para medir la actividad ambulatoria. Por ello, surge la necesidad de aplicar sistemas de clasificación específicos para la actividad ambulatoria, que nos permitan conocer en profundidad la actividad efectuada, la casuística atendida, el consumo de recursos, controlar l calidad de los resultados, así como utilizar sistemas de financiación específicos según la complejidad clínica de cada caso y del consumo de recursos ocasionado. Destacan como SCO ambulatorios, los Ambulatory Patient Groups y los Ambulatory Care Groups, cuya unidad de análisis es la visita y el paciente, respectivamente (AU)

Patient Classifications Systems (PCS) to the emerging need for a tool that would enable measurement of casuistry or typology of patients, and the consumption of resources in health centres. The Diagnosis Related Groups (DRGs) in the PCS whose use is more widespread in Spain, and the employee at present. Its application is limited to the activity of hospitalization are not valid for measuring ambulatory activity. Therefore, the need arises to apply classification systems specific to the outpatient activity, which will enable us to dig deeper into the activity performed, the casuistry met, the consumption of resources, control the quality of the results, as well as systems using specific funding depending on the complexity of each case and clinical resource consumption caused. Emphasize as SCP outpatient Ambulatory Patient Groups and Ambulatory Care Groups, as the unit of analysis is the visit and the patient (AU)

Sistemas de Clasificación de Pacientes. Revisión conjunta. Parte I / No disponible

Los Sistemas de Clasificación de Pacientes (SCP) surgen en la década de los setenta como consecuencia de la necesidad de medir la casuística de pacientes atendidos, controlar el gasto sanitario y explicar la diversidad de la práctica clínica. Se basan en la agrupación de pacientes y son los que ofrecen la mejor expresión del producto final hospitalario. Su utilidad varía en función de la finalidad para la cual fueron concebidos y a la aplicación que de ellos se vaya a hacer, así, unos son homogéneos en cuanto a consumo de recursos, otros miden la severidad de los procesos, otros representan patrones deseables de manejo clínico, etc. Se han desarrollado distintos sistemas de clasificación de pacientes en función de su finalidad. Los Sistemas de Severidad, los SCP de Media y Larga estancia, los SCP Ambulatorios, SCP para hospitalización, siendo el más utilizado en España en pacientes hospitalizados los Grupos Relacionados con el Diagnóstico (AU)

The Patient Classifications systems, emerge in the seventies, as a result of the need to measure the series of patients, controlling health spending and explain the diversity of clinical practice. They are based on the grouping of patients, and they offer the best expression of the final product hospital. Their usefulness varies depending on the purpose for which they were conceived and the implementation of them is going to do, so some are homogeneous in terms of resource consumption, others measure the severity of the process, others represent desirable patterns of clinical management, and so on. Have developed various systems of classifying patients according to their purpose. Systems Severity, PCS Medium and Long-term stay, the Ambulatory PCS, PCS for hospitalization. Being the most widely used in Spain in hospitalized patients with the Diagnosis Related Groups (AU)

[Pulmonary varix inside a bulla]. / Variz pulmonar en el interior de una bulla.

Pulmonary varices are uncommon vascular abnormalities that are usually asymptomatic and so they are normally diagnosed by chance from a chest x-ray. They often present as a pulmonary nodule and can be either congenital or acquired. If acquired, they are associated with pulmonary venous hypertension, usually as a result of mitral valve disease. Pulmonary arteriography provides a definitive diagnosis, although the use of new noninvasive imaging techniques is spreading. Treatment is not normally required unless serious complications arise. We present the case of a pulmonary varix located within a pulmonary bulla. This form of presentation has not been previously reported.

Variz pulmonar en el interior de una bulla / Pulmonary varix incide a bulla

Las varices pulmonares son anomalías vasculares pulmonares infrecuentes. Suelen ser asintomáticas, por lo que normalmente se diagnostican como hallazgo casual en la radiografía de tórax, y con frecuencia se presentan como un nódulo pulmonar. Su origen puede ser congénito o adquirido; en este último caso se relaciona con una hipertensión pulmonar venosa, frecuentemente asociada a valvulopatía mitral. Su diagnóstico definitivo se realiza mediante arteriografía pulmonar, aunque cada vez más se están usando nuevas técnicas de imagen no invasivas. Normalmente no requieren tratamiento, a menos que presenten complicaciones graves. Exponemos un caso con una forma de presentación de variz pulmonar no descrita con anterioridad, ya que dicha anomalía se encontraba en el interior de una bulla pulmonar

Pulmonary varices are uncommon vascular abnormalities that are usually asymptomatic and so they are normally diagnosed by chance from a chest x-ray. They often present as a pulmonary nodule and can be either congenital or acquired. If acquired, they are associated with pulmonary venous hypertension, usually as a result of mitral valve disease. Pulmonary arteriography provides a definitive diagnosis, although the use of new noninvasive imaging techniques is spreading. Treatment is not normally required unless serious complications arise. We present the case of a pulmonary varix located within a pulmonary bulla. This form of presentation has not been previously reported

Late detection of a shigellosis outbreak in a school in Madrid.

Even though shigellosis in Spain is rare, an indigenous outbreak is occasionally detected. We describe an outbreak in a school in Madrid caused by person-to-person transmission of Shigella sonnei. After the detection of Shigella sonnei in a stool sample from a 3 year old girl, an investigation at her school was initiated. Questionnaires were distributed to the parents of 520 pupils attending the school. A case was defined as a school case if it was the first case in a child's household, and as a household case if other members of the household had fallen ill first. We identified 88 cases (60 pupils and 28 of their family members). The attack rate (AR) was 12% in the school and 32% in the families. There was a significant association between higher AR and lower age. The outbreak lasted for two months. The length and the shape of the epidemic curve of the 60 cases in pupils suggests person-to-person transmission. Shigella sonnei isolated from 5 different cases were typed by pulsed field gel electrophoresis (PFGE) and was found to be an identical strain. The prolonged duration of the outbreak was probably due to delayed detection, and stopped as soon as control measures were introduced.

Mortality in Spain during the heat waves of summer 2003.

The effect of the elevated temperatures on mortality experienced in Europe during the summer of 2003 was observed in several countries. This study, carried out in Spain, describes mortality between 1 June and 31 August and evaluates the effect of the heat wave on mortality. Observed deaths were obtained from official death registers from 50 provincial capitals. Observed deaths were compared with the expected number, estimated by applying a Poisson regression model to historical mortality series and adjusting for the upward trend and seasonality observed. Meteorological information was provided by the Instituto Nacional de Meteorologia (National Institute of Meteorology). Spain experienced three heat waves in 2003. The total associated excess deaths were 8% (43 212 observed deaths compared with 40 046 expected deaths). Excess deaths were only observed in those aged 75 years and over (15% more deaths than expected for the age group 75 to 84 and 29% for those aged 85 or over). This phenomenon (heat-associated excess mortality) is an emerging public health problem because of its increasing attributable risk, the aging of the Spanish population and its forecasted increasing frequency due to global warming. The implementation of alert and response systems based on monitoring of climate-related risks, emergency room activity and mortality, and strengthening the response capacity of the social and health services should be considered.

Late detection of a shigellosis outbreak in a school in Madrid.

Even though shigellosis in Spain is rare, an indigenous outbreak is occasionally detected. We describe an outbreak in a school in Madrid caused by person-to-person transmission of Shigella sonnei. After the detection of Shigella sonnei in a stool sample from a 3 year old girl, an investigation at her school was initiated. Questionnaires were distributed to the parents of 520 pupils attending the school. A case was defined as a school case if it was the first case in a child's household, and as a household case if other members of the household had fallen ill first. We identified 88 cases (60 pupils and 28 of their family members). The attack rate (AR) was 12% in the school and 32% in the families. There was a significant association between higher AR and lower age. The outbreak lasted for two months. The length and the shape of the epidemic curve of the 60 cases in pupils suggests person-to-person transmission. Shigella sonnei isolated from 5 different cases were typed by pulsed field gel electrophoresis (PFGE) and was found to be an identical strain. The prolonged duration of the outbreak was probably due to delayed detection, and stopped as soon as control measures were introduced.

Mortality in Spain during the heat waves of summer 2003.

The effect of the elevated temperatures on mortality experienced in Europe during the summer of 2003 was observed in several countries. This study, carried out in Spain, describes mortality between 1 June and 31 August and evaluates the effect of the heat wave on mortality. Observed deaths were obtained from official death registers from 50 provincial capitals. Observed deaths were compared with the expected number, estimated by applying a Poisson regression model to historical mortality series and adjusting for the upward trend and seasonality observed. Meteorological information was provided by the Instituto Nacional de Meteorología (National Institute of Meteorology). Spain experienced three heat waves in 2003. The total associated excess deaths were 8% (43 212 observed deaths compared with 40 046 expected deaths). Excess deaths were only observed in those aged 75 years and over (15% more deaths than expected for the age group 75 to 84 and 29% for those aged 85 or over). This phenomenon (heat-associated excess mortality) is an emerging public health problem because of its increasing attributable risk, the aging of the Spanish population and its forecasted increasing frequency due to global warming. The implementation of alert and response systems based on monitoring of climate-related risks, emergency room activity and mortality, and strengthening the response capacity of the social and health services should be considered.

Laser-assisted uvulopalatoplasty for snoring: does it meet the expectations?

The high prevalence of habitual snoring (35% of the general population) and the increasing demand for an effective treatment have led, in the last decade, to the generalisation of laser-assisted uvulopalatoplasty (LAUP). However, acceptable studies on its effectiveness are lacking. The present randomised, placebo-controlled study included 25 nonapnoeic and mild obstructive sleep apnoea snorers to evaluate LAUP effectiveness for snoring. Group I received a one-stage LAUP treatment and group II a placebo (simulated snore surgery followed by an oral placebo). Before each treatment and 3 months after, the variables and procedures assessed were: body weight; sleepiness (Epworth sleepiness scale); quality of life (SF-36); subjective snoring intensity (0-10 analogue scale); objective snoring intensity (average decibel intensity); snoring index (number of snores per hour); and apnoea/hypopnea index. No differences were observed in body weight, sleepiness, quality of life, subjective and objective intensity, and frequency of snoring, and apnoea/hypopnea index between the groups before and 3 months after treatment. In conclusion, this study provides evidence of the lack of effectiveness of one-stage laser-assisted uvulopalatoplasty for snoring in nonapnoeic and mild obstructive sleep apnoea patients, with the result that it does not meet the expectations generated by the procedure.

Effectiveness of CPAP treatment in daytime function in sleep apnea syndrome: a randomized controlled study with an optimized placebo.

Application of continuous positive airway pressure (CPAP) as the standard treatment for sleep apnea/hypopnea syndrome (SAHS) is a moot point. Studies on the effectiveness of this treatment have been challenged because of the lack of a suitable placebo. The recent description of a true placebo (sham CPAP) prompted us to conduct a randomized trial of CPAP or placebo to assess the effectiveness of CPAP in improving SAHS-related symptoms and daytime function in patients with moderate to severe SAHS. Forty-eight patients, stratified in four groups according to severity, were randomly allocated into two treatment groups (optimal and sham CPAP) for a 6-wk period. Of these, 45 completed follow-up (91% males; age: 54 +/- 10 yr; body mass index [BMI]: 32 +/- 6 kg/m(2); apnea-hypopnea index [AHI]: 54 +/- 19 events/h; and Epworth Sleepiness Scale [ESS]: 16 +/- 5). The ESS, a questionnaire on SAHS-related symptoms, Functional Outcomes Sleep Questionnaire (FOSQ), and the Short Form Health Survey (SF-36) were completed at inclusion and after treatment. After 10 d of washout, the placebo group was treated with optimal CPAP and reassessed before and after optimal CPAP. The group receiving optimal CPAP when compared with the group with sham CPAP showed considerably greater improvement in the relief of sleepiness (-9.5 versus -2.3, p < 0.001), other SAHS-related symptoms (-18.5 versus -4.5, p < 0.001), vigilance (+8.5 versus +3.4, p = 0.009), and general productivity (+4.0 versus +0.5, p = 0.04) FOSQ scales. Both groups used a similar number of hours for the optimal and the sham CPAP (4.3 versus 4.5, (p = NS). The patients initially treated with placebo CPAP improved significantly more when optimal CPAP was applied for ESS (-2.3 versus -6.7, p < 0.001) and other sleep apnea syndrome (SAS)-related symptoms (-4.5 versus -11.2, p = 0.02). Our study provides strong evidence of the effectiveness of CPAP treatment in improving symptoms and perceived health status in moderate to severe SAHS.

[Benign sinusal mucor colonization in association with septal deviation]. / Colonización benigna sinusal por mucor asociada a desviación septal.

Mucormycosis is a well recognised opportunistic infection caused by saprophytic fungi of the Mucoraceae family. Usually, the upper aerodigestive tract is the portal of entry. Patients who are debilitated or inmunosuppressed might present with these infections, although sometimes can happen in patients with good health. We present a case of benign mucor colonitation at the sinus maxillary associated a deviated nasal septum.

Evaluation of a simplified oscillation technique for assessing airway obstruction in sleep apnoea.

The forced oscillation technique (FOT) is a noninvasive method that is useful for assessing airway obstruction and for titrating continuous positive airway pressure (CPAP) in patients with sleep apnoea. The aim was to evaluate the routine applicability of a simplified FOT set-up based on recording pressure and flow at the level of the CPAP device, i.e. obviating the need for connecting the transducers to the nasal mask. A correction to account for the tubing and the exhaust port was applied. This simplified FOT was evaluated on nine patients with moderate or severe sleep apnoea during routine CPAP titration. Patient impedance measured by the simplified FOT ([Z]) was compared with actual patient impedance ([Zrs]) measured simultaneously with a reference FOT based on recording pressure and flow at the nasal mask. An excellent agreement was found between [Z] and [Zrs] over the wide range of airway obstruction explored (4.8-72.1 cmH2O x s x L(-1)): [Z] = [Zrs] x 0.86 + 1.3 cmH2O x s x L(-1) (r = 0.99). Moreover, the simplified and the conventional FOT settings detected the same respiratory events during sleep. These results demonstrate that this simplified FOT is applicable for measuring airway obstruction during routine sleep studies in patients with sleep apnoea.

Development of a new flow-through bulk optode for the determination of manganese(III).

A flow-through bulk optode based on the use of 1-(2-pyridylazo)-2-naphthol (PAN) immobilized in a plasticized poly(vinyl chloride) membrane entrapped in a cellulose support, in conjuntion with the flow injection analysis technique, is proposed for the determination of manganese(II). The calibration graph obtained at 570 nm was linear in the range 0.27-27.5 mg L(-1) (5 x 10(-6)-5 x 10(-4) M) Mn(II) with a detection limit of 0.18 mg L(-1). The coefficients of variation of the sensor response for 5.5 mg L(-1) of Mn(II) were +/-0.22% for consecutive measurements (n = 10), +/-0.48% between days (n = 5) and +/-0.38% between different membranes (n = 6). The sensor was readily regenerated with the carrier acetic acid/acetate buffer of pH 4.5. The method was applied to the determination of manganese in steels, waters and lemon tree leaves.

Colonización benigna sinusal por mucor asociada a desviación septal / Benign sinusal mucor colonisation in association to septal deviation

La mucormicosis es una reconocida infección oportunista causada por hongos saprofitos de la familia Mucoraceae. Generalmente, la vía aero-digestiva superior es la puerta de entrada. Pacientes que están debilitados o inmunosuprimidos pueden presentar estas infecciones, aunque en ocasiones puede aparecer en pacientes con buena salud. Presentamos un caso de colonización por mucor del seno maxilar asociado a una desviación de tabique (AU)

Mucormycosis is a well recognised opportunistic infection caused by saprophytic fungi of the Mucoraceae family. Usually, the upper aerodigestive tract is the portal of entry. Patients who are debilitated or inmunosuppressed might present with these infections, although sometimes can happen in patients with good health. We present a case of benign mucor colonitation at the sinus maxillary associated a deviated nasal septum (AU)