Exantema periflexural asimétrico de la infancia, común e infradiagnosticado / Asymmetric periflexural exanthem of childhood, common and underdiagnosed

El exantema periflexural asimétrico de la infancia es una entidad benigna y autolimitada que se manifiesta típicamente en lactantes y preescolares con predominio del sexo femenino. La etiología es desconocida, aunque se ha relacionado con infecciones virales principalmente, y también bacterianas. El diagnóstico es clínico y el tratamiento sintomático. A pesar de ser una enfermedad común, es infradiagnosticada debido en parte al desconocimiento de esta. Nuestro objetivo es contribuir para mejorar el conocimiento de este trastorno. Se presenta el caso clínico de una paciente diagnosticada de exantema periflexural asimétrico con el antecedente de pielonefritis aguda la semana anterior a la aparición de las lesiones cutáneas

Asymmetric periflexural exanthem of childhood is a benign and self-limited disease that characteristically occurs in infants and preschool children with a female predominance. The aetiology is unknown, although it has been mainly linked to viral infections. Diagnosis is clinical and treatment is mainly symptomatic. Despite being a common disease, it is unknown and consequently underdiagnosed. Our goal is to help improving the knowledge of this disorder. We present a clinical case of a patient diagnosed with asymmetric periflexural exanthema with a history of acute pyelonephritis the previous week of the skin lesion onset

Chemometric characterization of the trace element profile of raw meat from Rubia Gallega x Holstein Friesian calves from an intensive system.

This study was conducted to compare the essential and toxic element content of seven veal cuts: shoulder clod (SC), inside round (IR), eye of round (ER), bottom round (BR), heel of round (HR), knuckle (KK) and tenderloin (TL). Eighty-four meat samples were determined by ICP-MS. Overall, essential trace elements (Co, Cu, Fe, Mn and Zn), except Se, varied significantly between the different meat cuts. By contrast, there were no significant variations for the minor trace elements (Cr, Mo and Ni) or the toxic elements (As, Cd and Pb). Chemometric analysis of the data identified four clusters: (1) the main trace elements, except (2) Se, which was closely related to (3) the toxic elements, and finally (4) the minor trace elements. TL and ER cuts constituted two separated groups; most of the SC and KK samples were associated, and IR and BR samples overlapped. TL and SC contained the highest amounts of trace elements, whereas ER and KK the lowest.

Dairy cow nutrition in organic farming systems. Comparison with the conventional system.

The energy supplied by the high-forage diets used in organic farming may be insufficient to meet the requirements of dairy cattle. However, few studies have considered this problem. The present study aimed to analyze the composition of the diets and the nutritional status (focusing on the energy-protein balance of the diets) of dairy cattle reared on organic farms in northern Spain, which are similar to other organic farming systems in temperate regions. Exhaustive information about diets was obtained from organic (ORG) and representative conventional grazing (GRZ) and conventional no-grazing (CNG) farms. Samples of feed from the respective farms were analyzed to determine the composition. Overall, the diets used on the ORG farms were very different from those used on the CNG farms, although the difference was not as evident for GRZ. The CNG farms were characterized by a higher total dry matter intake with a high proportion of concentrate feed, maize silage and forage silage. By contrast, on ORG and GRZ farms, the forage, pasture and fibre intake were the most important variables. The ration used on ORG farms contained a significantly higher percentage of ADF and lower organic matter (OM) content than the rations used in both of the conventional farming systems, indicating that the diets in the former were less digestible. Although the protein concentration in the diets used on the grazing farms (ORG and GRZ) was higher than those used on CNG farms, the protein intake was similar. The results indicated an imbalance between energy and protein due to the low level of energy provided by the ORG diets, suggesting that more microbial protein could be synthesized from the available rumen-degraded dietary nitrogen if rumen-fermentable OM was not limiting. The imbalance between energy and protein led to a reduced amount of total digestible protein reaching the intestine and a lower milk yield per kilogram of CP intake on the ORG farms. In order to improve the protein use efficiency and consequently to reduce the loss of nitrogen to the environment, organic farming should aim to increase the energy content of cattle diets by improving forage quality and formulating rations with more balanced combinations of forage and grain.

Evaluation of trace element status of organic dairy cattle.

The present study aimed to evaluate trace mineral status of organic dairy herds in northern Spain and the sources of minerals in different types of feed. Blood samples from organic and conventional dairy cattle and feed samples from the respective farms were analysed by inductively coupled plasma mass spectrometry to determine the concentrations of the essential trace elements (cobalt (Co), chromium (Cr), copper (Cu), iron (Fe), iodine (I), manganese (Mn), molybdenum (Mo), nickel (Ni), selenium (Se) and zinc (Zn)) and toxic trace elements (arsenic (As), cadmium (Cd), mercury (Hg) and lead (Pb)). Overall, no differences between organic and conventional farms were detected in serum concentrations of essential and toxic trace elements (except for higher concentrations of Cd on the organic farms), although a high level of inter-farm variation was detected in the organic systems, indicating that organic production greatly depends on the specific local conditions. The dietary concentrations of the essential trace elements I, Cu, Se and Zn were significantly higher in the conventional than in the organic systems, which can be attributed to the high concentration of these minerals in the concentrate feed. No differences in the concentrations of trace minerals were found in the other types of feed. Multivariate chemometric analysis was conducted to determine the contribution of different feed sources to the trace element status of the cattle. Concentrate samples were mainly associated with Co, Cu, I, Se and Zn (i.e. with the elements supplemented in this type of feed). However, pasture and grass silage were associated with soil-derived elements (As, Cr, Fe and Pb) which cattle may thus ingest during grazing.

Chemometric authentication of the organic status of milk on the basis of trace element content.

The objective of this study was to develop a method for authenticating organic milk samples in North Spain on the basis of its trace mineral composition. Fourteen elements in 98 samples were determined by inductively coupled plasma mass spectrometry. Although concentrations of Co, Cr, Cu, I, Se and Zn where statistically higher in conventional milk and As in organic, none of these elements by itself was able to discriminate between organic and conventional milk. The chemical data was examined by principal component analysis and cluster analysis, revealing a natural separation between organic and conventional milk. In a second step, several supervised pattern recognition techniques were used to construct mathematical models for predicting the type of milk (organic or conventional) based on the metal content. The results proved that the model constructed using the artificial neural network is capable of correctly identifying the type of milk in almost 95% of cases.

Assessment of the functional properties of protein extracted from the brown seaweed Himanthalia elongata (Linnaeus) S. F. Gray.

A protein extract from the brown seaweed Himanthalia elongata (Linnaeus) S. F. Gray was prepared and its functional properties, colour and amino acid composition were assessed for its potential future use by the food industry. The total content of amino acids was determined as 54.02±0.46gaminoacids/kg dry weight, with high levels of the essential amino acids lysine and methionine. SDS-PAGE showed 5 protein bands with molecular weights of 71.6, 53.7, 43.3, 36.4 and 27.1kDa. The water holding capacity and oil holding capacity were determined as 10.27±0.09gH2O/g and 8.1±0.07goil/g respectively. Foaming activity and stability were higher at alkaline pH values. The emulsifying capacity and stability of the extract varied depending on the pH and oil used. These results demonstrate the potential use of Himanthalia elongata protein extract in the food industry.

Identifying sources of metal exposure in organic and conventional dairy farming.

In humans the main route of exposure to toxic metals is through the diet, and there is therefore a clear need for this source of contamination to be minimized, particularly in food of animal origin. For this purpose, the various sources of toxic metals in livestock farming (which vary depending on the production system) must be taken into account. The objectives of the present study were to establish the profile of metal exposure in dairy cattle in Spain and to determine, by chemometric (multivariate statistical) analysis, any differences between organic and conventional systems. Blood samples from 522 cows (341 from organic farms and 181 from conventional farms) were analysed by inductively coupled plasma mass spectrometry to determine the concentrations of 14 elements: As, Cd, Co, Cr, Cu, Fe, Hg, I, Mn, Mo, Ni, Pb, Se and Zn. In conventional systems the generally high and balanced trace element concentrations in the mineral-supplemented concentrate feed strongly determined the metal status of the cattle. However, in organic systems, soil ingestion was an important contributing factor. Our results demonstrate that general information about the effects of mineral supplementation in conventional farming cannot be directly extrapolated to organic farming and special attention should be given to the contribution of ingestion of soil during grazing and/or ingestion of soil contaminated forage.

Helminth infections on organic dairy farms in Spain.

The aim of this study was to assess the prevalence of the major helminth infections affecting organic dairy cattle in northern Spain. Milk and faecal samples were obtained from 443 milking cows. Ostertagia ostertargi and Fasciola hepatica exposure was assessed by detection of specific antibodies in milk samples and F. hepatica infection was diagnosed by the detection of coproantigens in faecal samples. Dictyocaulus viviparus and Calicophoron daubneyi infections were diagnosed by conventional coprological techniques. The prevalence of infections caused by F. hepatica was considerable low, but similar to data reported from conventional farming in the same area. The prevalence rate of C. daubneyi infection was higher than previous data mirroring an increase of the prevalence that was also reported in other European countries in recent years. Specific antibodies against O. ostertargi were detected in all herds and the median levels of antibodies, determined by ELISA, exceeded the thresholds indicating milk production losses. The prevalence of D. viviparus was almost negligible. For each parasite, an ordinal logistic-regression analysis was used to assess the risk of infection by taking into account the administration of effective anthelmintics and the number of lactations. Treatment of cows with fasciolicides decreased the risk of F. hepatica infection in multiparous cows, whereas treatment with oxiclozanide or albendazol did not decrease the risk of C. daubneyi infection or O. ostertargi exposure, respectively. The study findings demonstrate that helminth infection in organic dairy farming is similar or even lower than previous data reported from conventional farming. Special attention should be paid to the impact of these infections on milk production.

[Home training as a treatment of faecal incontinence and sphincter dyssynergia]. / Entrenamiento anorrectal domiciliario como tratamiento de la encopresis y disinergia esfinteriana.

OBJECTIVE: The defecation disorders represents the 3% of consultations in pediatrics patients. Our goal was to demonstrate the effectiveness and efficiency of the reeducation of the defecation maneuver through home training in patients with encopresis and sphincter dyssynergia. MATERIAL AND METHODS: Study of patients with fecal incontinence treated with home training at our center between 2014-2015. Anorectal manometry was performed and was valued defecation maneuver by expulsion of rectal probe with or without the ball. Daily sessions were performed using a Foley catheter (18-20Fr.) with progressive filling of the balloon, maximum 20cc. The response to the treatment was assessed in terms of episodes of soiling. RESULTS: Seven patients (6 males and 1 female) with a mean age of 9.7 years (range, 5-15) were included; two patients with anorectal malformation history, 1 Hirschsprung disease, 1 sacrococcygeal teratoma and 3 functional encopresis. Three patients had soiling episodes daily and 4 patients frequently. The mean basal pressure of anal channel was 32.34mmHg (range, 11.74-50.75) with negative defecation maneuver in 2 cases, deficient in 3 and dyssynergic in 2 patients. The mean time of biofeedback therapy to be asymptomatic was 5.14 months (range, 2-11), with a mean of 16.14 months (range, 3-24), with the 7 patients currently maintained clean. CONCLUSIONS: The present study suggests that re-education of defecation maneuver through home training, seems to be an effective and efficient therapy, achieving excellent results in medium term.

OBJETIVO: Los trastornos de la defecación representan el 3% de las consultas en pediatría. Nuestro objetivo fue demostrar la eficacia y eficiencia de la reeducación en la maniobra defecatoria mediante el entrenamiento domiciliario en los pacientes con encopresis y disinergia esfinteriana. MATERIAL Y METODOS: Estudio de los pacientes con encopresis tratados mediante entrenamiento domiciliario en nuestro centro entre 2014-2015. Se realizó manometría anorrectal y fue valorada la maniobra defecatoria mediante la expulsión o no de la sonda rectal con o sin balón. Se realizaron sesiones diarias de forma domiciliaria empleando una sonda de Foley (18-20 Fr.) con llenado progresivo del balón, máximo 20 cc. Se evaluó la respuesta al tratamiento en función de la presencia de manchado. RESULTADOS: Se incluyeron 7 pacientes (6 varones y 1 mujer) con edad media de 9.7 años (rango, 5-15); dos con antecedente de malformación anorrectal, una enfermedad de Hirschsprung, 1 teratoma sacrococcígeo y 3 encopresis funcionales. Tres pacientes presentaban manchado diario y 4 de forma frecuente. La media de presión basal del canal fue de 32,34 mmHg (rango, 11,74-50,75) con maniobra defecatoria negativa en 2 casos, deficiente en 3 y disinérgica en 2. La media de tiempo realizando el entrenamiento intestinal hasta lograr estar asintomáticos fue 5.14 meses (rango, 2-11), con un seguimiento medio de 16,14 meses (rango, 3-24), manteniéndose limpios actualmente los 7 pacientes. CONCLUSIONES: El presente estudio sugiere que la reeducación de la maniobra defecatoria mediante entrenamiento domiciliario parece ser una terapia eficaz y eficiente, logrando excelentes resultados a medio plazo.

Entrenamiento anorrectal domiciliario como tratamiento de la encopresis y disinergia esfinteriana / Home anorectal training, as a treatment of faecal incontinence and sphincter dyssynergia

Objetivo. Los trastornos de la defecación representan el 3% de las consultas en pediatría. Nuestro objetivo fue demostrar la eficacia y eficiencia de la reeducación en la maniobra defecatoria mediante el entrenamiento domiciliario en los pacientes con encopresis y disinergia esfinteriana. Material y métodos. Estudio de los pacientes con encopresis tratados mediante entrenamiento domiciliario en nuestro centro entre 2014-2015. Se realizó manometría anorrectal y fue valorada la maniobra defecatoria mediante la expulsión o no de la sonda rectal con o sin balón. Se realizaron sesiones diarias de forma domiciliaria empleando una sonda de Foley (18-20 Fr.) con llenado progresivo del balón, máximo 20 cc. Se evaluó la respuesta al tratamiento en función de la presencia de manchado. Resultados. Se incluyeron 7 pacientes (6 varones y 1 mujer) con edad media de 9.7 años (rango, 5-15); dos con antecedente de malformación anorrectal, una enfermedad de Hirschsprung, 1 teratoma sacrococcígeo y 3 encopresis funcionales. Tres pacientes presentaban manchado diario y 4 de forma frecuente. La media de presión basal del canal fue de 32,34 mmHg (rango, 11,74-50,75) con maniobra defecatoria negativa en 2 casos, deficiente en 3 y disinérgica en 2. La media de tiempo realizando el entrenamiento intestinal hasta lograr estar asintomáticos fue 5.14 meses (rango, 2-11), con un seguimiento medio de 16,14 meses (rango, 3-24), manteniéndose limpios actualmente los 7 pacientes. Conclusiones. El presente estudio sugiere que la reeducación de la maniobra defecatoria mediante entrenamiento domiciliario parece ser una terapia eficaz y eficiente, logrando excelentes resultados a medio plazo (AU)

Objective. the defecation disorders represents the 3% of consultations in pediatrics patients. Our goal was to demonstrate the effectiveness and efficiency of the reeducation of the defecation maneuver through home training in patients with encopresis and sphincter dyssynergia. Material and methods. Study of patients with fecal incontinence treated with home training at our center between 2014-2015. Anorectal manometry was performed and was valued defecation maneuver by expulsion of rectal probe with or without the ball. Daily sessions were performed using a Foley catheter (18-20Fr.) with progressive filling of the balloon, maximum 20cc. The response to the treatment was assessed in terms of episodes of soiling. Results. Seven patients (6 males and 1 female) with a mean age of 9.7 years (range, 5-15) were included; two patients with anorectal malformation history, 1 Hirschsprung disease, 1 sacrococcygeal teratoma and 3 functional encopresis. Three patients had soiling episodes daily and 4 patients frequently. The mean basal pressure of anal channel was 32.34mmHg (range, 11.74-50.75) with negative defecation maneuver in 2 cases, deficient in 3 and dyssynergic in 2 patients. The mean time of biofeedback therapy to be asymptomatic was 5.14 months (range, 2-11), with a mean of 16.14 months (range, 3-24), with the 7 patients currently maintained clean. Conclusions. The present study suggests that re-education of defecation maneuver through home training, seems to be an effective and efficient therapy, achieving excellent results in medium term (AU)

Hepatic concentrations of copper and other metals in dogs with and without chronic hepatitis.

OBJECTIVES: Defects in copper metabolism have been described in several dog breeds, and recently, it has been suggested that changes in other essential trace elements could be involved in the pathogenesis of hepatic disease. This study measured hepatic copper accumulation and its interactions with other essential trace and toxic metals in dogs diagnosed with chronic hepatitis. METHODS: Liver samples of 20 chronic hepatitis and 20 healthy dogs were collected. Samples were acid digested, and essential metals (cobalt, copper, iron, manganese, molibdenum, selenium and zinc) and toxic metals (arsenic, cadmium, mercury and lead) were analysed by inductively-coupled plasma mass spectrometry. RESULTS: Copper concentrations were significantly higher in dogs affected by hepatic disease than in controls. Dogs having chronic hepatitis with liver copper concentration greater than 100 mg/kg wet weight showed statistically higher cobalt, manganese and zinc concentrations than dogs having chronic hepatitis with liver copper concentrations less than 100 mg/kg wet weight and controls. Toxic metal concentrations were low - in all cases below the threshold associated with toxicity in dogs. CLINICAL SIGNIFICANCE: Dogs with chronic hepatitis not only have increased concentrations of copper in the liver but also increased concentrations of cobalt, manganese and zinc; measurement of these elements may perhaps aid in diagnosis of liver disease in dogs.

Safety cost management in construction companies: A proposal classification.

BACKGROUND: Estimating health and safety costs in the construction industry presents various difficulties, including the complexity of cost allocation, the inadequacy of data available to managers and the absence of an accounting model designed specifically for safety cost management. Very often, the costs arising from accidents in the workplace are not fully identifiable due to the hidden costs involved. OBJECTIVE: This paper reviews some studies of occupational health and safety cost management and proposes a means of classifying these costs. METHODS: We conducted an empirical study in which the health and safety costs of 40 construction worksites are estimated. RESULTS: A new classification of the health and safety cost and its categories is proposed: Safety and non-safety costs. CONCLUSIONS: The costs of the company's health and safety policy should be included in the information provided by the accounting system, as a starting point for analysis and control. From this perspective, a classification of health and safety costs and its categories is put forward.

Essential and toxic trace element concentrations in different commercial veal cuts in Spain.

The aim of this study was to evaluate essential and toxic element concentration of ten commercially available veal cuts, together with diaphragm, cardiac muscle and liver tissue from 10 animals of "Galician Supreme Veal". Essential trace elements (Co, Cr, Cu, Fe, Mn, Mo, Ni, Se and Zn) and toxic elements (As, Cd, Hg and Pb) were determined by ICP-MS. Essential trace element concentrations ranged from 0.002-55.64mg/kg between muscles. Toxic element concentrations were very low, and high numbers of samples showed unquantifiable residues of Cd and Pb. Veal cuts including muscles with a high proportion of oxidative slow-twitch fibers (diaphragm and cardiac muscle) showed significantly higher essential trace element concentrations, the lower concentrations being found in veal cuts including glycolytic fast-twitch fibers (eye round). Our results suggest that essential and toxic trace element concentration could be used as a new meat quality parameter, or to add further value to certain products (i.e. livestock reared on extensive systems with high physical activity).

Effects of different strategies of mineral supplementation (marine algae alone or combined with rumen boluses) in organic dairy systems.

This study was designed to evaluate the effect of marine algae supplementation alone or in combination with a regular mineral supplement (rumen boluses) to improve the mineral status in organic dairy cattle and their effect on the milk mineral composition, milk production, composition (% of fat and protein) and quality (SCC). Thirty-two Holstein Friesian lactating cows were randomly selected and assigned to the algae (A), boluses (B), algae+boluses (AB) and control group (C). For the algae groups (A, AB), a supplement composed of Sea Lettuce (80%), Japanese Wireweed (17.5%) and Furbelows (2.5%) was formulated to be given to the cows at the rate of 100 g/animal per day (A1) for the length of 4 weeks. In the second half of the experiment (weeks 5-8), the algae mixture was reformulated and the proportion of Furbelows was increased from 2.5% to 5.0% with a subsequent decrease of Lettuce to 77.5% (A2). In the boluses group (B), each cow received 2 boluses after calving. Blood (serum) and milk samples were collected at 2 and 4 week intervals, respectively, and analysed for trace element concentrations by ICP-MS. Information related to the milk composition and SCC during a 305-day lactation for each animal were obtained from the Dairy Records Management System. The supplementation with algae, boluses or the combination of both treatments showed a statistically significant effect on the iodine (algae), selenium (boluses) and cobalt (algae+boluses) status of the animals. In milk, treatments had a statistical significant increase on iodine, and a tendency to increase selenium concentrations. The assayed algae mixture combined with another source of selenium could be an effective tool to improve the mineral status in serum and milk.

Inter-reflux and bolus clearance times in non-pathologic pediatric patients: data support computational models.

Previous contributions suggested that gastroesophageal reflux can be modeled in terms of a Poisson process. This study aims to provide empirical data to validate this statement in pediatric patients so that computational models can be broadly used as an alternative for research. A retrospective review of 63 pediatric patients who underwent 24-hour impedance-pH monitoring to discard gastroesophageal reflux disease was conducted in this study. Patients were grouped by age as preterm (21), infants (21), and children (21). All the tracings were analyzed by a trained physician who identified the reflux entry and the bolus clearance time of each episode. The time between reflux episodes was tested against three probability distributions (gamma, exponential and inverse Gaussian) whereas the bolus clearance time was tested against a normal probability distribution. Parameters were estimated using the maximum likelihood method. The Kolmogorov-Smirnov test and the Kullback-Leibler divergence were computed to evaluate the goodness of fit. One-way analysis of variance was applied to compare results along the three groups. Exponential fitting for inter-reflux time was successful in 90.48% of children older than 1 year. The overall reflux rate was 57.58 reflux episodes per day whereas the mean bolus clearance time ranged between 10.87 in preterm subjects and 12.05 in children, showing a good Gaussian fitting. The time between reflux episodes can be modeled in terms of a Poisson process in non tube-fed patients, whereas the bolus clearance time follows a normal distribution in all cases.

The use of seaweed from the Galician coast as a mineral supplement in organic dairy cattle.

This study was designed to assess the value of seaweeds from the Galician coast as a source of minerals (especially iodine (I) but also other micro-minerals) in organic dairy cattle. It was conducted in an organic dairy farm in the Lugo province that typically represents the organic milk production in NW Spain. The animal's diet consisted mainly of local forage (at pasture or as hay and silage in the winter) and 5 kg of purchased concentrate/day per animal (representing 23.5% of feed intake). Based on the mineral composition of the diet, the physiological requirements and the EU maximum authorised levels in feed, a supplement composed by Sea Lettuce (Ulva rigida) (as flakes, 80%), Japanese Wireweed (Sargasum muticum) (flakes, 17.5%) and Furbelows (Saccorhiza polyschides) (powder, 2.5%) was formulated to give 100 g/animal per day. Sixteen Holstein Friesian lactating cows were randomly selected and assigned to the control (n=8) and algae-supplemented groups (n=8). Both groups had exactly the same feeding and management with the exception of the algae supplement, which was mixed with the concentrate feed and given to the animals at their morning milking for 10 weeks. Heparinised blood (for plasma analysis) and milk samples were collected at 2-week intervals and analysed for toxic and trace element concentrations by inductively coupled plasma-mass spectrometry or inductively coupled plasma-optical emission spectrometry. The algae supplement significantly improved the animals' mineral status, particularly I and selenium that were low on the farm. However, the effect of the algae supplement on the molybdenum status in cattle needs further investigation because of its great relevance on copper metabolism in ruminants. The I supply deserves special attention, since this element is at a very high concentration in brown-algae species and it is excreted in the milk proportionally to its concentration in plasma concentrations (mean ± s.e. in the algae-supplemented and control groups were 268 ± 54 and 180 ± 42 µg/l, respectively).

Monte Carlo method for the evaluation of symptom association.

Gastroesophageal monitoring is limited to 96 hours by the current technology. This work presents a computational model to investigate symptom association in gastroesophageal reflux disease with larger data samples proving important deficiencies of the current methodology that must be taking into account in clinical evaluation. A computational model based on Monte Carlo analysis was implemented to simulate patients with known statistical characteristics Thus, sets of 2000 10-day-long recordings were simulated and analyzed using the symptom index (SI), the symptom sensitivity index (SSI), and the symptom association probability (SAP). Afterwards, linear regression was applied to define the dependency of these indexes with the number of reflux, the number of symptoms, the duration of the monitoring, and the probability of association. All the indexes were biased estimators of symptom association and therefore they do not consider the effect of chance: when symptom and reflux were completely uncorrelated, the values of the indexes under study were greater than zero. On the other hand, longer recording reduced variability in the estimation of the SI and the SSI while increasing the value of the SAP. Furthermore, if the number of symptoms remains below one-tenth of the number of reflux episodes, it is not possible to achieve a positive value of the SSI. A limitation of this computational model is that it does not consider feeding and sleeping periods, differences between reflux episodes or causation. However, the conclusions are not affected by these limitations. These facts represent important limitations in symptom association analysis, and therefore, invasive treatments must not be considered based on the value of these indexes only until a new methodology provides a more reliable assessment.

The binomial symptom index: toward an optimal method for the evaluation of symptom association in gastroesophageal reflux.

BACKGROUND: The evaluation of symptom association in gastroesophageal reflux is an open problem. The scientific literature reports important deficiencies and clinicians are claiming a new methodology. This article provides an optimal method for the evaluation of symptom association, the binomial symptom index (BSI). METHODS: A mathematical description of the BSI was presented for the study of association and causality. A total of n = 850,000 patients were simulated using a Monte Carlo model to perform a two-way sensitivity analysis. The average and the standard deviation of the BSI were evaluated in groups of 5000 patients with the same values of the reflux rate, symptom rate, association ratio, window of association, and monitoring time in order to contrast their influence on the estimator. KEY RESULTS: The BSI decreased with the number of reflux episodes when there was association, and remained constant and below 40% when there was not. The standard deviation was no higher than 40% and decreased with the reflux or symptom rates, and more sharply with the monitoring time, reaching approximately 0% for 50 days. A window length matching the characteristic reflux-symptom lag maximized the overall BSI and minimized its dispersion. Twenty-four hour and 96-h monitorings allowed detecting association ratios of 50% and 25%, respectively. CONCLUSIONS & INFERENCES: The BSI is a simple and reliable index for the evaluation of symptom association that considers all the parameters under analysis. Defining an appropriate cut-off value, the BSI can provide a measure of probability and strength of association simultaneously.

Essential trace and toxic element concentrations in organic and conventional milk in NW Spain.

Dietary composition and husbandry practices largely determine essential trace element status and toxic element exposure of livestock, and consequently their concentrations in animal products. This study evaluates the main essential trace (Co, Cr, Cu, Fe, I, Mn, Mo, Ni, Se and Zn) and toxic (As, Cd, Hg and Pb) element concentrations in milk from organic and conventional farms in NW Spain (n=50). Milk samples were acid digested and analyzed by ICP-MS. Essential trace element concentrations in organic milk were significantly lower compared to conventional milk, this was especially evident for elements that are routinely supplemented at high concentrations in the conventional concentrate feed: Cu (41.0 and 68.9µg/L in organic and conventional milk, respectively), Zn (3326 and 3933µg/L), I (78 and 265µg/L) and Se (9.4 and 19.2µg/L). Toxic metal concentrations in milk were in general very low and no statistically significant differences were observed between organic and conventional milk. In addition, the mineral content of organic milk showed a seasonal pattern, the significantly higher As (65%) and Fe (13%) concentrations found in the winter sampling possibly being related to a higher consumption of concentration feed and soil ingestion when grazing.

Histochemistry evaluation of the oxidative stress and the antioxidant status in Cu-supplemented cattle.

The aim of this paper is to evaluate at a histopathological level the effect of the most commonly used copper (Cu) supplementation (15 mg/kg dry matter (DM)) in the liver of intensively reared beef cattle. This was done by a histochemistry evaluation of (i) the antioxidant capacity in the liver - by the determination of metallothioneins (MT) and superoxide dismutase (SOD) expression - as well as (ii) the possible induction of oxidative damage - by the determination of inducible nitric oxide synthase (iNOS), nitrotyrosine (NITT), malondialdehyde (MDA) and 8-oxoguanine (8-oxo) - that (iii) could increase apoptotic cell death - determined by cytochrome-c (cyto-c), caspase 1 (casp1) and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL). Liver samples from Cu-supplemented (15 mg Cu sulphate/kg DM, n = 5) and non-supplemented calves (n = 5) that form part of other experiments to evaluate Cu status were collected at slaughter and processed for immunohistochemistry and TUNEL. MT expression was diffuse and SOD showed slight changes although without statistical significance. iNOS and NITT positive (+) cells significantly increased, mainly around the central veins in the animals from the Cu-supplemented group, whereas no differences were appreciated for the rest of the oxidative stress and apoptosis markers. Under the conditions of this study, which are the conditions of the cattle raised in intensive systems in NW Spain and also many European countries, routinely Cu supplementation increased the risk of the animals to undergo subclinical Cu toxicity, with no significant changes in the Cu storage capacity and the antioxidant defensive system evaluated by MT and SOD expression, but with a significant and important increase of oxidative damage measured by iNOS and NITT. The results of this study indicated that iNOS and NITT could be used as early markers of initial pathological changes in the liver caused by Cu supplementation in cattle, although more studies in cattle under different levels of Cu supplementation are needed.