Pharmacokinetics of ceftiofur crystalline-free acid in plasma and seminal plasma in beef bulls.

The objective of this study was to compare the plasma (PL) and seminal plasma (SP) pharmacokinetic profile of ceftiofur (CEFT) and desuroylceftiofur acetamide (DFCA) after administration of CEFT crystalline-free acid (CCFA) by SC route in two sites of the ear in beef bulls. Four clinically healthy Hereford bulls received a comprehensive physical exam and subsequently a breeding-soundness examination, CBC, and chemistry profile panel. All bulls were diagnosed healthy and satisfactory potential breeders. In one group (n = 2), a single dose of CCFA was administered SC route at the base of the ear (BOE) at a dose of 6.6 mg/kg of body weight. The second group (n = 2) was also administered by SC route in the middle third of the posterior aspect of the ear (MTE). The concentrations of CEFT and DFCA in PL and SP were determined by a high-performance liquid chromatography mass spectrometry (HPLC-MS). Blood and semen samples were collected before the administration of CCFA and at 12, 24, 36, 48, 72, 96, 120, 144, and 168 h after injection. No levels of CEFT were detected in PL and only in 20 of the 40 SP samples (P = 0.0001). The mean level of CEFT in SP was 0.11 % in comparison with the DFCA level. DFCA was found in all PL and SP samples. Therefore, DFCA was chosen to be utilized in the study of the pharmacokinetics parameters both in PL and SP. There were no differences in the mean PL levels of DFCA for the two sites of SC administration between the BOE (102.9 ± 78.9 ng/mL; X ± SD) and to MTE (116.1 ± 70.2 ng/mL; P = 0.58). The mean SP levels of DFCA after administration in the BOE was 857 ± 747 ng/mL, and for the MTE was 549 ± 488 ng/mL without differences between both sites (P = 0.15). The mean level of DFCA in PL was 109.5 ± 74.0 ng/mL, which was lower than the mean SP levels of 695 ± 103 ng/mL (P = 0.001). Moreover, the PL peak DFCA concentration (Cmax) was 229 ± 46 ng/mL at 36.0 ± 29.4 h (Tmax) post-administration. The SP Cmax was 1851 ± 533 ng/mL at 30.0 ± 28.6 h (Tmax) post-administration. The Cmax between PL and SP were distinctive (P = 0.004) without any differences in Tmax between PL and SP (P = 0.60). The terminal half-life for PL DFCA (47.4 ± 29.3 h) was not different than in SP (53.1 ± 23.6 h; P = 0.77). The PL area under the curve concentration time from the first to the last sample (AUC0-last) was 18,984 ± 4841 ng/mL/h, which was significatively smaller compared with 125,677 ± 59,445 ng/mL/h for SP AUC0-last (P = 0.04). The PL mean residence time from the first to the last sample (MRT0-last) was 69.7 ± 15.1 h, and it was similar than for SP of 66.5 ± 7.7 h (P = 0.69). From the present investigation, based in its pharmacokinetic features, it was concluded that CCFA should be an appropriate antibiotic that could be used for the treatment of bull genital infections when its indication is properly outlined. To study the pharmacokinetics of CCFA in SP, DFCA metabolite was appropriated.

Pharmacokinetics of florfenicol in serum and seminal plasma in beef bulls.

The objectives of this study were to compare the serum and seminal plasma pharmacokinetic profiles of florfenicol (FLO) and florfenicol amine (FLA) after the administration of FLO either by IM or SC routes in beef bulls. Four clinically healthy Hereford bulls underwent a comprehensive physical exam, including breeding soundness examination, CBC, and chemistry profile panel. Bulls were healthy and classified satisfactory potential breeders. In one group (n = 2), a single dose of FLO was administered SC in the middle of the neck at a dose of 40 mg/kg of body weight. In the second group (n = 2), a single dose was administered IM in the muscles of the neck at a dose of 20 mg/kg. Concentrations of FLO and FLA in serum and seminal plasma were determined by ultra-high-performance liquid chromatography coupled to tandem mass spectrometry (UHPLC-MS/MS). Blood and semen samples were collected before the administration of FLO and at 12, 24, 36, 48, 72, 96, 120, 144, and 168 h after injection. The blood was collected from the coccygeal vessels, and semen was collected by electroejaculation. All samples were immediately refrigerated, processed within the first hour after collection, and finally stored at -80 °C. The mean level of total FLO in serum was higher when administered by the SC route (1,415.5 ng/mL) than by the IM route (752.4 ng/mL; P = 0.001). Differences were observed between the percentage of FLA in serum (1.8%; ranging from 1.3 to 2.9) and in seminal plasma (27.5%; ranging from 15.9 to 34.2; P = 0.0001). The mean level (±SD) of FLA was higher in seminal plasma compared to serum (467 ± 466 ng/mL and 18 ± 16 ng/mL, respectively; P = 0.001). The mean level of total FLO in seminal plasma was 1,454.8 ng/mL for the SC route and 1,872.9 ng/mL for the IM route without differences between the two routes (P = 0.51). Differences in the mean level of total FLO between serum and seminal plasma were detected (1,187 ± 2,069 ng/mL and 1,748 ± 1,906 ng/mL, respectively; P = 0.04). From the present investigation, it was concluded that FLO is a suitable antibiotic based on its pharmacokinetic attributes and may be employed for the treatment of bull genital infections when its use is indicated. To study the pharmacokinetics of FLO in seminal plasma, the analysis of FLA should be incorporated.

Mortality Associated With Proportionality of Secondary Mitral Regurgitation After Transcatheter Mitral Valve Repair: North American Mitraclip for Functional Mitral Regurgitation Registry.

The association, if any, between the effective regurgitant orifice area (EROA) to left ventricular end-diastolic volume (LVEDV) ratio and 1-year mortality is controversial in patients who undergo mitral transcatheter edge-to-edge repair (m-TEER) with the MitraClip system (Abbott Vascular, Santa Clara, CA). This study's objective was to determine the association between EROA/LVEDV and 1-year mortality in patients who undergo m-TEER with MitraClip. In patients with severe secondary (functional) mitral regurgitation (MR), we analyzed registry data from 11 centers using generalized linear models with the generalized estimating equations approach. We studied 525 patients with secondary MR who underwent m-TEER. Most patients were male (63%) and were New York Heart Association class III (61%) or IV (21%). Mitral regurgitation was caused by ischemic cardiomyopathy in 51% of patients. EROA/LVEDV values varied widely, with median = 0.19 mm2/ml, interquartile range [0.12,0.28] mm2/ml, and 187 patients (36%) had values <0.15 mm2/ml. Postprocedural mitral regurgitation severity was substantially alleviated, being 1+ or less in 74%, 2+ in 20%, 3+ in 4%, and 4+ in 2%; 1-year mortality was 22%. After adjustment for confounders, the logarithmic transformation (Ln) of EROA/LVEDV was associated with 1-year mortality (odds ratio 0.600, 95% confidence interval 0.386 to 0.933, p = 0.023). A higher Society of Thoracic Surgeons risk score was also associated with increased mortality. In conclusion, lower values of Ln(EROA/LVEDV) were associated with increased 1-year mortality in this multicenter registry. The slope of the association is steep at low values but gradually flattens as Ln(EROA/LVEDV) increases.

Smoke emissions from biomass burning in Central Mexico and their impact on air quality in Mexico City: May 2019 case study.

Smoke emissions from biomass burning considerably influence regional and local air quality. Many natural wildfires and agricultural burns occur annually in Central Mexico during the hot, dry season (March to May), potentially leading to air quality problems. Nevertheless, the impact of these biomass burning emissions on Mexico City's air quality has not been investigated in depth. This study examines a severely deteriorated air quality case from 11 to 16 May 2019, during which fine particle concentrations (PM2.5) exceeded the 99th percentile of the available official dataset (2005-2019). Specifically, this work aims to highlight the role of fires and regional pollution in the severe episode observed in Mexico City, identifying the fires that were the sources of regional pollution, the type of fuel burned in those fires, and the dominant atmospheric transport pattern. Biomass burning emissions were calculated for different land cover types using satellite data from the Visible Infrared Imaging Radiometer Suite (VIIRS) and the Moderate-Resolution Imaging Spectroradiometer (MODIS). PM2.5 increased by a factor of 2 at some monitoring sites, and ozone concentration increased to 40 % in Mexico City during the poor air quality episode. Our results indicate that over 50 % of the fire activity observed during the 2019 fire season was concentrated in May in Central Mexico. The burning activity was mainly seen over shrubland and forest between 10 and 15 May. Moreover, the fire radiative power analysis indicates that most energy was associated with burning shrubland and forests. Organic carbon emissions were estimated highest on 14 and 15 May, coinciding with the largest number of fires. Back trajectory analysis indicates that enhanced concentration of air pollutants in Mexico City originated from biomass burning detected in neighboring states: Guerrero, Michoacán, and the State of Mexico. Smoke from fires on the specific vegetation cover was advected into Mexico City and contributed to the bad air quality episode. Further meteorological analysis evidenced that the fire intensity and emissions were worsened by low humidity and the late onset of the rainy season in Central Mexico.

Angiotensin II for the Treatment of Refractory Shock: A Matched Analysis.

OBJECTIVES: To determine if angiotensin II is associated with improved outcomes as measured by 30- and 90-day mortality as well as other secondary outcomes such as organ dysfunction and adverse events. DESIGN: Retrospective, matched analysis of patients receiving angiotensin II compared with both historical and concurrent controls receiving equivalent doses of nonangiotensin II vasopressors. SETTING: Multiple ICUs in a large, university-based hospital. PATIENTS: Eight hundred thirteen adult patients with shock admitted to an ICU and requiring vasopressor support. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Angiotensin II use had no association with the primary outcome of 30-day mortality (60% vs 56%; p = 0.292). The secondary outcome of 90-day mortality was also similar (65% vs 63%; p = 0.440) as were changes in Sequential Organ Failure Assessment scores over a 5-day monitoring period after enrollment. Angiotensin II was not associated with increased rates of kidney replacement therapy (odds ratio [OR], 1.39; 95% CI, 0.88-2.19; p = 0.158) or receipt of mechanical ventilation (OR, 1.50; 95% CI, 0.41-5.51; p = 0.539) after enrollment, and the rate of thrombotic events was similar between angiotensin II and control patients (OR, 1.02; 95% CI, 0.71-1.48; p = 0.912). CONCLUSIONS: In patients with severe shock, angiotensin II was not associated with improved mortality or organ dysfunction and was not associated with an increased rate of adverse events.

Patient-, Clinician-, and Institution-level Variation in Inotrope Use for Cardiac Surgery: A Multicenter Observational Analysis.

BACKGROUND: Conflicting evidence exists regarding the risks and benefits of inotropic therapies during cardiac surgery, and the extent of variation in clinical practice remains understudied. Therefore, the authors sought to quantify patient-, anesthesiologist-, and hospital-related contributions to variation in inotrope use. METHODS: In this observational study, nonemergent adult cardiac surgeries using cardiopulmonary bypass were reviewed across a multicenter cohort of academic and community hospitals from 2014 to 2019. Patients who were moribund, receiving mechanical circulatory support, or receiving preoperative or home inotropes were excluded. The primary outcome was an inotrope infusion (epinephrine, dobutamine, milrinone, dopamine) administered for greater than 60 consecutive min intraoperatively or ongoing upon transport from the operating room. Institution-, clinician-, and patient-level variance components were studied. RESULTS: Among 51,085 cases across 611 attending anesthesiologists and 29 hospitals, 27,033 (52.9%) cases received at least one intraoperative inotrope, including 21,796 (42.7%) epinephrine, 6,360 (12.4%) milrinone, 2,000 (3.9%) dobutamine, and 602 (1.2%) dopamine (non-mutually exclusive). Variation in inotrope use was 22.6% attributable to the institution, 6.8% attributable to the primary attending anesthesiologist, and 70.6% attributable to the patient. The adjusted median odds ratio for the same patient receiving inotropes was 1.73 between 2 randomly selected clinicians and 3.55 between 2 randomly selected institutions. Factors most strongly associated with increased likelihood of inotrope use were institutional medical school affiliation (adjusted odds ratio, 6.2; 95% CI, 1.39 to 27.8), heart failure (adjusted odds ratio, 2.60; 95% CI, 2.46 to 2.76), pulmonary circulation disorder (adjusted odds ratio, 1.72; 95% CI, 1.58 to 1.87), loop diuretic home medication (adjusted odds ratio, 1.55; 95% CI, 1.42 to 1.69), Black race (adjusted odds ratio, 1.49; 95% CI, 1.32 to 1.68), and digoxin home medication (adjusted odds ratio, 1.48; 95% CI, 1.18 to 1.86). CONCLUSIONS: Variation in inotrope use during cardiac surgery is attributable to the institution and to the clinician, in addition to the patient. Variation across institutions and clinicians suggests a need for future quantitative and qualitative research to understand variation in inotrope use affecting outcomes and develop evidence-based, patient-centered inotrope therapies.

Identification of intraoperative management strategies that have a differential effect on patients with reduced left ventricular ejection fraction: a retrospective cohort study.

BACKGROUND: There are few data to guide the intraoperative management of patients with reduced left ventricular ejection fraction (LVEF). This study aimed to describe how patients with reduced LVEF are managed differently and to identify and treatments had a different risk profile in this population. METHODS: We performed a retrospective cohort study of adult patients who underwent general anesthesia for non-cardiac surgery. The effect of anesthesia medications and fluid balance was compared between those with and without a reduced preoperative LVEF. The primary outcome was a composite of acute kidney injury, myocardial injury, pulmonary complications, and 30-day mortality. Multivariable logistic regression was used to adjust for confounders. Treatments that affected patients with reduced LVEF differently were defined as those associated with the primary outcome that also had a significant interaction with LVEF. RESULTS: A total of 9420 patients were included. Patients with reduced LVEF tended to have a less positive fluid balance. Etomidate, calcium, and phenylephrine were use more frequently, while propofol and remifentanil were used less frequently. Remifentanil affected patients with reduced LVEF differently than those without (interaction term OR 2.71, 95% CI 1.30-5.68, p = 0.008). While the use of remifentanil was associated with fewer complications in patients with normal systolic function (OR 0.54, 95% CI 0.42-0.68, p < 0.001), it was associated with an increase in complications in patients with reduced LVEF (OR = 3.13, 95% CI 3.06-5.98, p = 0.026). CONCLUSIONS: Patients with a reduced preoperative LVEF are treated differently than those with a normal LVEF when undergoing non-cardiac surgery. An association was found between the use of remifentanil and an increase in postoperative adverse events that was unique to this population. Future research is needed to determine if this relationship is secondary to the medication itself or reflects a difference in how remifentanil is used in patients with reduced LVEF.

Growing location and root maturity impact on the phenolic compounds, antioxidant activity and nutritional profile of different sweet potato genotypes.

This study aimed to analyze the phenolic compounds, antioxidant activity, and the main nutritional components of different colored-fleshed sweet potato genotypes grown in Argentina. Three cultivars of standard size were compared to undersized ones, currently discarded. Furthermore, four genotypes grown in different agroecological locations in Tucuman, Argentina, were evaluated. Chlorogenic and 3,5-dicaffeoylquinic acids were identified as the prevailing phenolic compounds in all samples. Undersized roots had significantly higher phenolics, antioxidant activity and carotenoids than standard. Therefore, they can confer healthy attributes to processed foods and, additionally, reduce waste. Genotypes from Tucuman grown under water stress conditions presented the lowest phenolics, anthocyanins and antioxidant activity, but the highest carotenoid contents. Orange-fleshed cultivars showed the highest protein percentages (6.0-11.7 %) and carotenoid contents ranging between 310 and 1012 µg ß-carotene/g dw, with more than 90 % ß-carotene. These findings could help to promote the cultivation of local genotypes with high added value.

Combined role for YAP-TEAD and YAP-RUNX2 signalling in substrate-stiffness regulation of cardiac fibroblast proliferation.

Cardiac fibrosis is associated with increased stiffness of the myocardial extracellular matrix (ECM) in part mediated by increased cardiac fibroblast proliferation However, our understanding of the mechanisms regulating cardiac fibroblast proliferation are incomplete. Here we characterise a novel mechanism involving a combined activation of Yes-associated protein (YAP) targets RUNX Family Transcription Factor 2 (RUNX2) and TEA Domain Transcription Factor (TEAD). We demonstrate that cardiac fibroblast proliferation is enhanced by interaction with a stiff ECM compared to a soft ECM. This is associated with activation of the transcriptional co-factor, YAP. We demonstrate that this stiffness induced activation of YAP enhances the transcriptional activity of both TEAD and RUNX2 transcription factors. Inhibition of either TEAD or RUNX2, using gene silencing, expression of dominant-negative mutants or pharmacological inhibition, reduces cardiac fibroblast proliferation. Using mutants of YAP, defective in TEAD or RUNX2 activation ability, we demonstrate a dual role of YAP-mediated activation of TEAD and RUNX2 for substrate stiffness induced cardiac fibroblast proliferation. Our data highlights a previously unrecognised role of YAP mediated RUNX2 activation for cardiac fibroblast proliferation in response to increased ECM stiffness.

Pharmacokinetics of oxytetracycline long-acting on plasma and semen of beef bulls.

The objectives of this investigation were to evaluate the pharmacokinetic parameters of oxytetracycline long-acting in plasma and seminal plasma after a single administration through either subcutaneous or intramuscular route at 10 mg/kg or 20 mg/kg dose. Four Simmental bulls, healthy and satisfactory potential breeders, were used. The route of administration either subcutaneous or intramuscular did not affect the mean values for 10 mg/kg dose in plasma (1,470 ng/mL vs. 1,330 ng/mL; P = 0.82) or seminal plasma (5,710 ng/mL vs. 5,390 ng/mL; P = 0.88), or for 20 mg/kg dose in plasma (2,540 ng/mL vs. 2,590 ng/mL; P = 0.96) or seminal plasma (25,600 ng/mL vs. 19,400 ng/mL; P = 0.58), respectively. Comparison between the 10 mg/kg and 20 mg/kg doses showed a difference in terms of mean plasma levels (1400 ng/mL vs. 2570 ng/mL; P = 0.07) and mean seminal plasma levels (6,480 ng/mL vs. 26,200 ng/mL; P = 0.004), respectively. After the dose of 10 mg/kg, plasma Cmax was 2,841 ng/mL at 12 h (Tmax) with a half-life of 20.1 h; seminal plasma Cmax was 11,515 ng/mL at 24 h (Tmax) with a half-life of 23.7 h. After the dose of 20 mg/kg, plasma Cmax was 5,269 ng/mL at 12 h (Tmax) with a half-life of 18.1 h; seminal plasma Cmax was 55,040 ng/mL at 24 h (Tmax) with a half-life of 15.7 h. Oxytetracycline long-acting may be an appropriate antibiotic, owing to its pharmacokinetic properties, that could be used for treating bulls' genital infections when its usage is indicated.

Nrf2-Keap-1 imbalance under acute shear stress induces inflammatory response in venous endothelial cells.

Vascular endothelial cell stimulation is associated with the activation of different signalling pathways and transcription factors. Acute shear stress is known to induce different pro-inflammatory mediators such as IL-8. Nrf2 is activated by prolonged high shear stress promoting an antiinflammatory and athero-protective environment. However, little is known about the impact of acute shear stress on Nrf2 and Keap1 function and its role in IL-8 regulation. We aimed to examine Nrf2-Keap1 complex activation in-vitro and its role in regulating IL-8 transcripts under acute arterial shear stress (12 dyn/cm2) in venous endothelial cells (ECs). We note that acute high shear stress caused a significant upregulation of Nrf2 target genes, HO-1 and GCLM and an increased IL-8 upregulation at 90 and 120 minutes. Mechanistically, acute high shear did not affect Nrf2 nuclear translocation but resulted in reduced nuclear Keap1, suggesting that the reduction in nuclear Keap1 may result in increased free nuclear nrf2 to induce transcription. Consistently, the suppression of Keap1 using shRNA (shKeap1) resulted in significant upregulation of IL-8 transcripts in response to acute shear stress. Interestingly; the over expression of Nrf2 using Nrf2-Ad-WT or Sulforaphane was also associated with significant upregulation of IL-8 compared to controls. This study highlights the role of Keap1 in Nrf2 activation under shear stress and indicates that activation of Nrf2 may be deleterious in ECs in the context of acute haemodynamic injury.

Pharmacokinetics of tulathromycin on plasma and semen of beef bulls.

The objective of this investigation was to evaluate the pharmacokinetic parameters of tulathromycin in plasma and semen of beef bulls after administering a single sc dose at two different sites in the neck. Four Simmental bulls with excellent temperament received a comprehensive physical exam that included breeding soundness examination. In addition, blood was collected and analyzed for CBC and chemical panel in order to rule out any subclinical liver or kidney disease. All bulls were diagnosed as healthy and satisfactory potential breeders. The mean plasma levels of tulathromycin for the two neck sites of sc administration were not different between posterior aspect of the ear where it attaches to the head (RP; regio parotidea; 77.9 ± 43.3 ng/mL; X ± SD) and to the middle of the neck (RC; regio collis lateralis; 73.7 ± 39.7 ng/mL; P = 0.84). The mean seminal plasma levels of tulathromycin after administration in the RP was 608 ± 374 ng/mL and for RC was 867 ± 599 ng/mL without differences between both sites (P = 0.29). The mean level of tulathromycin in plasma was 75.8 ± 40.2 ng/mL, which was lower than mean seminal plasma levels of 781 ± 482 ng/mL (P = 0.001). The plasma peak tulathromycin concentration (Cmax) was 160 ± 27 ng/mL at 21 ± 6 h (Tmax) post-administration. The seminal plasma Cmax was 1539 ± 44.4 ng/mL at 33.00 ± 18.00 h (Tmax) post-administration. The Cmax between plasma and seminal plasma were different (P = 0.008) without any differences in Tmax between plasma and seminal plasma (P = 0.35). The terminal half-life for plasma tulathromycin (81.4 ± 27.6 h) showed a tendency to be shorter than in seminal plasma (114.7 ± 21.7; P = 0.10). The plasma area under the curve concentration time from the first to the last sample (AUC0-last) was 15,440 ± 1717 ng/mL/h, which was significatively smaller compared with 171,071 ± 58,556 ng/mL/h for seminal plasma AUC0-last (P = 0.01). The plasma means residence time from the first to the last sample (MRT0-last) was 89.3 ± 5.1 h and it was shorter than for seminal plasma of 96.6 ± 5.0 h (P = 0.05). From the present investigation, it was concluded that tulathromycin is a suitable antibiotic based in its pharmacokinetic properties that could be used for treatment of bull genital infections when its application is indicated.

Characterization of aerosol particles during a high pollution episode over Mexico City.

More than 7 thousand wildfires were recorded over Mexico in 2019, affecting almost 640 thousand hectares. Most of these fires occurred during the spring season generating dense smoke plumes, impacting urban areas in the central part of the Mexican plateau. From May 10 to 17, 2019, biomass burning (BB) plumes affected Mexico City (MC) and diffused across the basin, producing PM2.5 levels ~ 2 times higher than the nation's air quality standards. Average PM2.5 concentrations increased sharply from 29.4 ± 7.2 µg m-3 to 65.1 ± 13.6 µg m-3 when the dense smoke plumes were detected. The higher particle concentration impacted the aerosol optical depth (AOD) as values ~ 3 times greater than the annual mean (0.32 ± 0.12) were measured, which resulted in a 17% loss of global horizontal irradiation (GHI). Under these severe pollution conditions, the visibility (Va) was reduced by ~ 80%. The high incidence of strong absorbent particles, such as soot and tarballs was revealed through electron microscopy and X-ray fluorescence (XRF) analysis. These techniques show chemical similarities between MC aerosols and those from the high-altitude (~ 4010 m. a. g. l.) Altzomoni Atmospheric Observatory, evidencing a strong influence of the BB emissions, suggesting a regional transport of these pollutants.

Psychodynamic Psychiatry in Argentina at a Crossroads.

The authors provide an overview of the history of psychoanalysis and psychodynamic psychiatry in Argentina. They describe the evolving practice patterns of psychodynamic psychiatrists in this vibrant South American country, highlighting socio-political influences and challenges.

Comportamiento del consumo de oxígeno durante una sesión de rehabilitación cardíaca / Behavior of Oxygen Consumption During a Cardiac Rehabilitation Session

RESUMEN Objetivo: estudiar el comportamiento del consumo de oxígeno en pacientes con miocardiopatía dilatada durante una sesión de rehabilitación cardíaca. Material y métodos: diseño observacional, transversal, analítico relacional. Muestra: 10 pacientes masculinos con miocardiopatía dilatada, con deterioro de moderado a grave de la función ventricular. Se evaluó a los pacientes en laboratorio y en una sesión de rehabilitación mediante un analizador de gases portátil Medgraphics® VO 2000. La sesión de rehabilitación consistió en ejercicios en bicicleta fija de 10 minutos, step, escalera coordinativa, fuerza con mancuerna para bíceps y hombros, cuádriceps en camilla y dorsales en máquina. Resultados: Edad (años) 57,4 ± 14,6. Peso (kg) 91,4 ± 22,2. Talla (cm) 168,1 ± 6,2. Laboratorio: VO2max relativo (ml/kg/min) 21,8 ± 7,3. Tasa de intercambio respiratorio, RER (VCO2/VO2)1,05 ± 0,09. Volumen ventilado (L/min) 65,7 ± 18,5. Frecuencia cardíaca (lat./min) en VO2max 127,8 ± 23,8. Sesión: Duración (min) 37,5 ± 10. VO2pico (ml/kg/min) 14,6 ± 3 (69,9 ± 16,7% del VO2max). Coeficiente de correlación entre VO2max y tiempo con VO2 < 50% del VO2max (min) 0,662 (p = 0,037) y entre VO2pico en rehabilitación y tiempo en RER entre 0,85-1(min) 0,787 (p = 0,007). Los pacientes con mejor aptitud ejercitaron en zona de baja intensidad. Al aumentar el esfuerzo, aumentaron los minutos en intensidad moderada. Conclusión: Se constató en este estudio que los pacientes alcanzaron un VO2pico en las sesiones inferiores a sus máximos obtenidos en laboratorio. Si bien cualquier dosis de entrenamiento en estos pacientes es más beneficiosa que la inactividad física, el diseño y la planificación de las sesiones de RHC, valorando las intensidades de trabajo intrasesión, podrían generar mayor impacto en la mortalidad, las reinternaciones y en la calidad de vida.

ABSTRACT Objective: The aim of this study was to analyze the response of oxygen consumption in patients with dilated cardiomyopathy during a cardiac rehabilitation session. Methods: This was an observational, cross-sectional, relational analytical study. Ten male patients with dilated cardiomyopathy and moderate to severe ventricular dysfunction were included in the study. Patients were evaluated in the laboratory and during a rehabilitation session using a Medgraphics VO 2000 portable gas analyzer. The rehabilitation session consisted in 10 minutes of stationary bike exercises, step, coordinaton stairs, and muscle strength using dumbbells for biceps and shoulder, a quadriceps stretcher and a dorsal muscle machine. Results: Mean age was 57.4 ± 14.6 years, weight 91.4 ± 22.2 kg and height 168.1 ± 6.2 cm. In the laboratory, VO2max was 21.8 ± 7.3 ml/kg/min, respiratory exchange rate (RER) (VCO2/VO2) 1.05 ± 0.09, ventilated volume 65.7 ± 18.5 L/min and heart rate in VO2max 127.8 ± 23.8 beats/min. Rehabilitation session duration was 37.5 ± 10 min with peakVO2 14.6 ± 3 ml kg/min (69.9 ± 16.7 % VO2max). The correlation coefficient between VO2max and time with VO2 <50% VO2max(min) was 0.662 (p = 0.037) and between peakVO2 in rehabilitation and time in RER between 0.85-1 (min) was 0.787 (p = 0.007). Patients with better fitness exercised in the low-intensity zone. As exercise increased, the minutes in moderate intensity also increased. Conclusion: The study showed that patients reached peakVO2 in sessions below the maximum values obtained in the laboratory. Even though any dose of training in these patients was more beneficial than physical inactivity, cardiac rehabilitation session design and planning, taking into account intrasession exercise intensities, could generate greater impact on mortality, rehospitalizations and quality of life.

Ichthyosis follicularis, atrichia and photophobia (IFAP) and hereditary mucoepithelial dysplasia: Two syndromes that share a common clinical spectrum.

Ichthyosis follicularis, atrichia and photophobia syndrome (IFAP) is an X-linked inherited disease caused by pathogenic variants in the gene encoding the membrane-bound transcription factor peptidase, site 2 (MBTPS2). Clinical presentation includes ichthyosis follicularis, alopecia, photophobia and developmental delay. Hereditary mucoepithelial dysplasia (HMD) is a dominantly inherited disease characterized by keratitis, non-scarring alopecia, skin lesions including follicular keratosis, perineal erythema, and mucosal involvement. Recently, variants in SREBF1, a gene coding for a transcription factor related to cholesterol and fatty acid synthesis, have been associated with the disease. These two syndromes share a common clinical spectrum. Here, we describe an IFAP syndrome patient with a novel variant in the MBTPS2 gene and an HMD patient with a previously reported variant in the SREBF1 gene. In addition, we present a review of the literature describing the triad characterized by non-scarring alopecia, keratosis follicularis, and ocular symptoms common in both IFAP and HMD patients to raise awareness of these underdiagnosed diseases. We also highlight the subtle differences in clinical presentation between the two disorders to better enable differentiation.

The impact of biomass burning emissions on protected natural areas in central and southern Mexico.

Biomass burning from grassland, forests, and agricultural waste results in large amounts of gases and particles emitted to the atmosphere, which affect air quality, population health, crop development, and natural vegetation. Regional atmospheric circulations can transport those plumes of pollutants over hundreds of kilometers, affecting vulnerable environments such as those considered protected natural areas (PNAs). This study evaluates the spatiotemporal distribution of active fires detected, and associated emissions, in central and southern Mexico from satellite data between March and June 2017, to assess the impact of the smoke plumes on protected ecosystems. The arrival of smoke plumes to selected PNAs (both near large urban centers and in remote areas) is assessed using airmass forward trajectories from selected emission sources. The spatial distribution of the remotely derived aerosol optical depth confirms the regional impact of particle emissions from the observed fires on PNAs, particularly in central Mexico. The identified areas of high fire density are also associated with large coarse particle concentrations at the surface. Moreover, there is a significant contribution of organic carbon to the total coarse particle mass, 60% on average. Finally, while most of the impact in ambient pollution is observed in PNAs located close to the regions with active fires in southern Mexico and Central America, the long-range transport of smoke plumes reaching the USA was also confirmed.

Independent and joint contributions of economic, social and physical environmental characteristics to mortality in the Detroit Metropolitan Area: A study of cumulative effects and pathways.

OBJECTIVE: Previous studies have demonstrated associations between race-based residential segregation, neighborhood socioeconomic and physical environmental characteristics, and mortality. Relatively few studies have examined independent and joint effects of these multiple neighborhood characteristics and mortality, including potential mediating pathways. In this study we examine the extent to which associations between race-based residential segregation and all-cause mortality may be explained by multiple socioeconomic indicators and exposure to air pollutants. METHODS: Drawing on data from multiple sources, we assessed bivariate associations between race-based residential segregation (operationalized as percent non-Hispanic Black), education (percent with graduate equivalency degree), poverty (percent below poverty), income inequality (GINI coefficient) and air pollution (ambient PM2.5) and age adjusted all-cause, all race mortality (henceforth all cause mortality) at the census tract level in the Detroit Metropolitan Area. We used inequality curves to assess the (in)equitable distribution of economic and environmental characteristics by census tract racial composition. Finally, we used generalized estimating equations (GEE) to examine independent and joint associations among percent NHB, education, income inequality, and air pollution to all-cause mortality, and test for mediating effects. RESULTS: Bivariate associations between racial composition, education, poverty, income inequality, PM2.5 and all-cause mortality were statistically significant. Census tracts with higher concentrations of NHB residents had significantly lower educational attainment, higher poverty, and greater exposure to PM2.5. In multivariate models, education, income inequality and PM2.5 fully attenuated associations between racial composition and all-cause mortality. CONCLUSIONS: Results are consistent with the hypothesis that race-based residential segregation is associated with heightened all-cause mortality, and that those effects are mediated by education, income inequality, and exposure to air pollution at the census tract level. Public health and cross-sector interventions to eliminate race-based residential segregation or to eliminate the maldistribution of educational and economic resources, and environmental exposures, across census tracts could substantially reduce regional inequities in all-cause mortality.

Susceptibility of agricultural pests of regional importance in South America to a Bacillus thuringiensis Cry1Ia protein.

Bacillus thuringiensis toxins of the Cry1I class have dual specificity for insects in the orders Coleoptera and Lepidoptera. We assessed the toxicity of a Cry1Ia protein from an Argentinian B. thuringiensis strain against agricultural pests in the families Tenebrionidae, Curculionidae, Noctuidae and Tortricidae. Three recombinant protein variants were produced that differed in length and fusion tag position to rule out artifactual results. The protein was toxic to Cydia pomonella and Rachiplusia nu. In contrast, Alphitobius diaperinus, Anthonomus grandis and Spodoptera frugiperda were not susceptible. The results are discussed with respect to previous studies and the prospective use of Cry1Ia in strategies to control major cotton pests in the region.

Influence of Menopausal Hormone Therapy on Body Composition and Metabolic Parameters.

The loss of estrogen with menopause is associated with an increase in central fat. The objective of this study was to evaluate the effects of menopause hormone therapy (HT) on body composition and metabolic parameters in postmenopausal women. A prospective study was conducted among postmenopausal women from the Climacteric clinic, Universidade Federal de São Paulo. Thirty-two participants, median age 51 years, were included. Sixteen women were eligible to receive a low-dose continuous combined HT, containing 1 mg of E2 plus 0.125 mg of trimegestone for 6 months. The other 16 women remained in the control group. In the HT group, significant decreases from baseline were evident for the total cholesterol (TC) (p < 0.05) and LDL levels (p < 0.05). The HDL significantly decreased (p < 0.05). However, the TC/HDL ratio also decreased (p = 0.05). The parameters of body composition, after 6 months of HT, were maintained. In the control group, body mass index levels increased from baseline, however, with nonstatistically significant differences (p = 0.06). Analyzing the body composition showed a significant increase in the trunk body fat (p = 0.04), trunk region fat (p = 0.04), and total region fat (p = 0.03) after 6 months. In conclusion, the present study provides evidence that HT can stunt the increase in total body fat and prevent the shift from a more central fat distribution observed in early postmenopausal period.