The influence of thermal pressure gradients and ionization (im)balance on the ambipolar diffusion and charge-neutral drifts.

Solar partially ionized plasma is frequently modelled using single-fluid (1F) or two-fluid (2F) approaches. In the 1F case, charge-neutral interactions are often described through ambipolar diffusion, while the 2F model fully considers charge-neutral drifts. Here, we expand the definition of the ambipolar diffusion coefficient to include inelastic collisions (ion/rec) in two cases: a VAL3C one-dimensional model and a 2F simulation of the Rayleigh-Taylor instability (RTI) in a solar prominence thread based on [Lukin et al. 2024 Phil. Trans. R. Soc. A 382, 20230417. (doi:10.1098/rsta.2023.0417)]. On one side, we evaluate the relative importance of the inelastic contribution, compared to elastic and charge-exchange collisions. On the other side, we compare the contributions of ion/rec, thermal pressure, viscosity and magnetic forces to the charge-neutral drift velocity of the turbulent flow of the RTI. Our analysis reveals that the contribution of inelastic collisions to the ambipolar diffusion coefficient is negligible across the chromosphere, allowing the classical definition of this coefficient to be safely used in 1F modelling. However, in the transition region, the contribution of inelastic collisions can become as significant as that of elastic collisions. Furthermore, we ascertain that the thermal pressure force predominantly influences the charge-neutral drifts in the RTI model, surpassing the impact of the magnetic force. This article is part of the theme issue 'Partially ionized plasma of the solar atmosphere: recent advances and future pathways'.

Mancha3D Code: Multipurpose Advanced Nonideal MHD Code for High-Resolution Simulations in Astrophysics.

The Mancha3D code is a versatile tool for numerical simulations of magnetohydrodynamic (MHD) processes in solar/stellar atmospheres. The code includes nonideal physics derived from plasma partial ionization, a realistic equation of state and radiative transfer, which allows performing high-quality realistic simulations of magnetoconvection, as well as idealized simulations of particular processes, such as wave propagation, instabilities or energetic events. The paper summarizes the equations and methods used in the Mancha3D (Multifluid (-purpose -physics -dimensional) Advanced Non-ideal MHD Code for High resolution simulations in Astrophysics 3D) code. It also describes its numerical stability and parallel performance and efficiency. The code is based on a finite difference discretization and a memory-saving Runge-Kutta (RK) scheme. It handles nonideal effects through super-time-stepping and Hall diffusion schemes, and takes into account thermal conduction by solving an additional hyperbolic equation for the heat flux. The code is easily configurable to perform different kinds of simulations. Several examples of the code usage are given. It is demonstrated that splitting variables into equilibrium and perturbation parts is essential for simulations of wave propagation in a static background. A perfectly matched layer (PML) boundary condition built into the code greatly facilitates a nonreflective open boundary implementation. Spatial filtering is an important numerical remedy to eliminate grid-size perturbations enhancing the code stability. Parallel performance analysis reveals that the code is strongly memory bound, which is a natural consequence of the numerical techniques used, such as split variables and PML boundary conditions. Both strong and weak scalings show adequate performance up to several thousands of processors (CPUs).

Identification of antimicrobial resistance genes in intestinal content from Coyote (Canis latrans).

Antibiotic resistance has become a global public health concern in the last few years. Given the widespread rate of recurrence, increasing attention is being turned toward environmental pathways that potentially contribute to antibiotic resistance genes (ARGs) dissemination outside the clinical realm. In this study, a metagenome analysis of intestinal virus-like particle fraction (VLPs) from a wild coyote ( Canis latrans) revealed for the first time, multiple ARGs, such as B-lactamases and multidrug efflux pumps. Description of ARGs presence in natural environments is critical to understand the emergence of resistant strains.

Unidad multidisciplinar especializada en el tratamiento del pie diabético: evaluación y resultados / Multidisciplinary unit specialized in the treatment of diabetic foot: Evaluation and results

Introducción: En este estudio se realiza la evaluación del proceso asistencial del pie diabético tras la implantación de una vía clínica intrahospitalaria y una consulta multidisciplinar. Objetivos: Evaluar la influencia en factores relacionados con la asistencia, amputaciones y rehabilitación del paciente amputado. Metodología: Estudio retrospectivo en el que se realiza la comparación de tres períodos. Primero (3años): antes de la implantación de la vía. Segundo (5años): posterior a la implantación de la vía. Tercero (10años): posterior a la implantación de la consulta. Resultados: Una consulta especializada en la atención del pie diabético contribuye a una reducción de las amputaciones femorales y menores. Se han optimizado la valoración y el tratamiento por parte de rehabilitación de los pacientes sometidos a amputación mayor. Conclusión: La implantación de vía y consulta contribuye a aumentar la preservación del miembro inferior. Sin embargo, la incidencia sigue siendo alta, sugiriendo que los cuidados del pie diabético permanecen subóptimos.(AU)

Introduction: In this study the evaluation of the care process of the diabetic foot will be carried out after the implementation of an intra-hospital clinical pathway and a multidisciplinary consultation. Objectives: Evaluate the influence on factors related to the care, amputations, and rehabilitation of the amputee patient. Methodology: Retrospective study, in which the comparison of three periods has been made. First (3years): Before the implantation of the pathway. Second (5years): After the implementation of the pathway. Third (10years): After the implementation of the consultation. Results: A specialized consultation in diabetic foot care contributes to a reduction in femoral and minor amputations. The assessment and treatment by rehabilitation of patients undergoing major amputation has been optimized. Conclusion: The implantation of the pathway and consultation contributes to the preservation of the lower limb. However, the incidence remains high, suggesting that diabetic foot care remains suboptimal.(AU)

[Multidisciplinary unit specialized in the treatment of diabetic foot: Evaluation and results]. / Unidad multidisciplinar especializada en el tratamiento del pie diabético: evaluación y resultados.

INTRODUCTION: In this study the evaluation of the care process of the diabetic foot will be carried out after the implementation of an intra-hospital clinical pathway and a multidisciplinary consultation. OBJECTIVES: Evaluate the influence on factors related to the care, amputations, and rehabilitation of the amputee patient. METHODOLOGY: Retrospective study, in which the comparison of three periods has been made. First (3years): Before the implantation of the pathway. Second (5years): After the implementation of the pathway. Third (10years): After the implementation of the consultation. RESULTS: A specialized consultation in diabetic foot care contributes to a reduction in femoral and minor amputations. The assessment and treatment by rehabilitation of patients undergoing major amputation has been optimized. CONCLUSION: The implantation of the pathway and consultation contributes to the preservation of the lower limb. However, the incidence remains high, suggesting that diabetic foot care remains suboptimal.

Participation of interferon type I during canine parvovirus infection.

Canine parvovirus (CPV) is a single-stranded DNA virus that causes severe and fatal gastrointestinal diseases in dogs. CPV has developed several strategies to evade innate immune response mediated by type I interferons (IFN-I) to achieve a successful infection. The aim of this work was to evaluate the capability of CVP-2c to evade the IFN-I mediated response in infected cells. To establish the role of this response, the gene expression of interferon ß (IFNß), IFIT1, IFIT3, MAVS, and STING were estimated in MDCK cells infected with CPV-2c. Viral replication and gene expression was evaluated by quantitative PCR, also, a treatment with IFN-I (interferon omega) was included to confirm the role of IFN-I during CPV infection. The results revealed that CPV-2c infection stimulates the expression of IFNß moderately, in these cells. Due to low IFNß induction, the IFIT1 and IFIT3 expression were also low, and therefore CPV-2c was able to replicate in these cells. However, when the cells were treated with exogenous IFN-I, the IFNß expression was higher, leading to an increased gene expression of IFIT1 and IFIT3, responsible for antiviral control. The overexpression of these proteins reduced the expression of NS1 and VP2 viral genes and hence viral replication. MAVS and STING expression on infected cells showed a mild increase compared to IFNß, suggesting that the viral infection could partially modify its expression. All results obtained in this study showed that during CPV-2c infection in MDCK cells, the IFNß expression was altered since this cytokine is one of the most critical factors for the control and inhibition of viral replication.

Evaluation of intracellular survival of Campylobacter fetus subsp. fetus in bovine endometrial cells by qPCR.

BACKGROUND: Campylobacter fetus subsp. fetus is the causal agent of sporadic abortion and infertility in bovines that produces economic losses in livestock. AIMS: This study evaluates the capability of C. fetus subsp. fetus to invade and survive in bovine endometrial epithelial cells and attempts to describe a pathogenic mechanism of this microorganism. METHODS: Primary culture of bovine endometrial epithelial cells was challenged with C. fetus subsp. fetus. Intracellular bacteria, represented by the number of genomic copies (g.c.) were quantified at 0, 2, 4, 10, and 24 hours post-infection (h.p.i.), by quantitative polymerase chain reaction (qPCR). The presence of intracellular bacteria was evaluated by immunofluorescence and immunohistochemistry. RESULTS: The results showed that only viable C. fetus subsp. fetus could invade endometrial cells. The g.c. number in assays with viable C. fetus subsp. fetus reached an average value of 656 g.c., remained constant until 4 h.p.i., then decreased to 100 g.c, at 24 h.p.i. In assays with non-viable microorganisms, the average value of g.c. was less than 1 g.c. and never changed. The intracellular presence of this bacteria was confirmed at 2 h.p.i. by immunofluorescence and immunohistochemistry. CONCLUSION: The results suggest that only C. fetus subsp. fetus viable can invade bovine endometrial epithelial cells but will not replicate in them, indicating that the endometrial cells do not represent a replication niche for this pathogen. Nonetheless, this invasion capability suggests that this type of cell could be employed by the pathogen to spread to other tissues.

Chiggers (Acariformes: Trombiculoidea) do not increase rates of infection by Batrachochytrium dendrobatidis fungus in the endemic Dwarf Mexican Treefrog Tlalocohyla smithii (Anura: Hylidae).

Amphibian populations are globally declining at an alarming rate, and infectious diseases are among the main causes of their decline. Two micro-parasites, the fungus Batrachochytrium dendrobatidis (Bd) and the virus Ranavirus (RV) have caused mass mortality of amphibians and population declines. Other, less understood epizootics are caused by macro-parasites, such as Trombiculoidea chiggers. Infection with chiggers can affect frog behavior and survival. Furthermore, synergistic effects of co-infection with both macro and micro-parasites may lead to higher morbidity. To better understand these potential synergies, we investigated the presence and co-infection by chiggers, Bd and RV in the endemic frog Tlalocohyla smithii (T. smithii). Co-infection of Bd, RV, and/or chiggers is expected in habitats that are suitable for their co-occurrence; and if infection with one parasite facilitates infection with the others. On the other hand, co-infection could decrease if these parasites were to differ in their micro-environmental requirements (i.e. niche apportionment). A total of 116 frogs of T. smithii were studied during 2014 and 2016 in three streams within the Chamela-Cuixmala Biosphere Reserve in Jalisco, Mexico. Our results show that 31% of the frogs were infected with Trombiculoidea chiggers (Hannemania sp. and Eutrombicula alfreddugesi); Hannemania prevalence increased with air temperature and decreased in sites with high canopies and with water pH values above 8.5 and below 6.7. Bd prevalence was 2.6%, RV prevalence was 0%, and none of the frogs infected with chiggers were co-infected with Bd. Together, this study suggests that chiggers do not facilitate infection with Bd, as these are apportioned in different micro-habitats. Nevertheless, the statistical power to assure this is low. We recommend further epidemiological monitoring of multiple parasites in different geographical locations in order to provide insight on the true hazards, risks and conservation options for amphibian populations.

Evaluation of pro- and anti-inflammatory interleukins in the mammary gland of goats experimentally infected with Staphylococcus chromogenes.

The aim of this work was to evaluate the relative gene expression levels of the cytokines IL- 1B, IL-8, IL-12, IFN-γ, IL-4, IL-10 and TGF-ß in somatic milk cells of French Alpine breed, anestrous goats that were experimentally infected in the left mammary gland with Staphylococcus chromogenes during the lactation peak. Milk samples were obtained from both glands for 21 consecutive days post infection. Total RNA was extracted, and real-time PCR was conducted using primers specific to each cytokine. The relative RNA expression of the evaluated cytokines was determined by the comparative method 2-ΔΔCT, using milk from the right gland of the goats as a reference (control) and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) as an endogenous control. According to the Wilcoxon test results, IL-1B and IL-12 expression levels showed significant differences compared to those in the control group (p⟨0.05) from 24 hours post infection until the end of lactation; on day three, IL1ß, IL8, IL12 and TGF-ß had a statistically significant change in expression with respect to those in the control group (p⟨0.05); closer to the end of the lactation period, there is no overexpression of the anti-inflammatory interleukins (IL-4 and TGF-ß) which may reflect the effort of the host immune system to eradicate the microorganism from the mammary gland.

Associations of Frailty and Physical Function with a Daily Activities Measured by a Pattern-Recognition Activity Monitor: An Isotemporal Substitution Analysis in the IMPACT65+ Study.

OBJECTIVES: The aims of this study were (i) to examine the independent associations of the time spent in daily activities measured by multi-sensor pattern-recognition with frailty and physical functioning (PF); and (ii) to analyze how relocating time between these daily activities is associated with frailty and PF in a sample of older adults. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: The study sample consists of 436 (287 women) high-functioning community-dwelling older adults, aged 65 to 92 years, who participated in the IMPACT65+ Study. MEASUREMENTS: Frailty was calculated as a continuous measure; based on the five widely recognized Fried's criteria. PF was assessed using the SF-12 questionnaire. The time in daily activities was assessed by the Intelligent Device for Energy expenditure and Activity (IDEEA). Independent associations of daily activities with frailty and PF were examined using linear regression models adjusting for potential confounders. The isotemporal substitution models for estimate the effect of replacing time in one activity with the same amount of time in another activity while holding wake time constant. RESULTS: Time spent lying was directly associated, while time in walk at average and brisk pace was inversely associated with frailty. The independent associations for PF were similar to lying, walk at average pace and walk at brisk pace. Isotemporal substitution analyses revealed a clear beneficial effect of hypothetically replacing 30 min/day of sedentary behaviors or light physical activity by the same amount of moderate-to-vigorous physical activity for frailty and PF. CONCLUSION: This is the first study examining the activity-specific and isotemporal association of daily activities with frailty and PF in older adults. Isotemporal substitution analyses showed that replacing sedentary behaviors (lie, recline, passive sit) by light-intensity activities (active sit, stand and walk at slow pace), as well as light-intensity activities by activities at MVPA such as walk at brisk pace, may produce theoretical improvements in frailty and PF. These findings are important for the development of effective interventions focused on reducing age-related frailty and declines in PF.

Criterion-related validity of self-report walking time from the EPIC questionnaire in older adults.

Tools for measuring walking time make use of objective and subjective methods. One subjective approach is to administer physical activity questionnaires (PAQ), mainly because they are inexpensive and easy to give to large groups. The European Prospective Investigation into Cancer and Nutrition (EPIC) study has a brief PAQ (EPIC-PAQ) and includes one question referencing walking time. The objective of this study was to assess the validity of the question about time spent walking included in the EPIC-PAQ. The sample included 200 older adults (113 women). To assess daily walking time, participants responded to the EPIC-PAQ in an interview and wore a portable gait analysis system and physical activity monitor for 48 consecutive hours in free-living condition. Results indicated that the mean of bias between the EPIC-PAQ and objetive measurement was -64.6 min/day. Also, the correlation was low compared to an objective measurement (rho = 0.196) and was positively correlated with the time spent at speeds below 2.5 mph but the correlation was low (slow walking rho = 0.154 and pace walking rho = 0.163). The EPIC-PAQ shows low correlations with the objective measurement of walking time, that suggests it may be inaccurate and affecting the estimate of the EPIC-PAQ's PA energy expenditure in this age group.

Concurrent Criterion Validity of a Test of Usual Gait Speed in Older Adults.

Usual gait speed has been shown to have very good reliability and convincing predictive validity for evaluating older adults' gait skills, but its criterion validity is unknown. We examined the criterion validity of the 8-feet (i.e., 2.44 meters) test in a laboratory environment to assess usual gait speed by comparing its results with the Intelligent Device for Energy Expenditure and Activity (IDEEA) monitor. Participants were 200 well-functioning community-dwelling adults aged 65 and older (113 women; 87 men; mean [M] age = 71.8, standard deviation [ SD] = 5.6 years). Participants wore the IDEEA monitor for 48 consecutive hours, and we used the participants' average usual gait speed for the analysis. The Spearman correlation of usual gait speed using both the 8-feet test and IDEEA monitor was moderate and statistically significant (ρ = .364, p < .001). The mean difference between both methods was 0.20 ( SD = 0.27) meters/second, and the corresponding limits of agreement were 0.73 and -0.33 meters/second. There was a small systematic bias when the difference between the two methods was correlated with usual gait speed as measured by the IDEEA (ρ = -.20, p = .011). The perfect agreement (weighted kappa) of both instruments for classifying usual gait speed into tertiles, quartiles, and quintiles was 48.3% ( k = 0.17), 30.9% ( k = 0.23), and 25.4% ( k = 0.29), respectively. Our results indicate that the 8-feet test showed moderate criterion-related validity for evaluating and assessing usual gait speed test in older adults.

Changes in objectively measured physical activity in adolescents with Down syndrome: the UP&DOWN longitudinal study.

BACKGROUND: It is a priority to understand that physical activity behaviour over time is a priority in Down syndrome population in order to design and promote succesfull interventions to maintain or increase levels of physical activity. We aimed to study 1 and 2-year changes in objectively measured physical activity among a relatively large sample of adolescents with Down syndrome. METHODS: This study comprised a total of 99 adolescents with Down syndrome (38 girls) aged from 11 to 20 years old at baseline. Participants with valid accelerometer data at baseline and at least one of the follow-up visits were included in the analysis. RESULTS: Overall, levels of physical activity observed in adolescents with Down syndrome declined from baseline to follow-ups, but these changes were not significant (all P > 0.05). Moderate-to-moderately high tracking of physical activity was observed in adolescents with Down syndrome (all P < 0.001). Youths who met physical activity guidelines at baseline demonstrated a greater decline in physical activity in 1 and 2-year changes (P < 0.05), although they were also more likely to meet physical activity guidelines at 1 and 2-year follow-ups (P < 0.05). CONCLUSIONS: Adolescents with Down syndrome do not change their levels of physical activity at 2-year follow-ups, but those who met physical activity guidelines presented stronger declines in physical activity over time.

Physical fitness as a mediator between objectively measured physical activity and clustered metabolic syndrome in children and adolescents: The UP&DOWN study.

BACKGROUND AND AIMS: The extent to which physical fitness (PF) attenuates or modifies the association between physical activity (PA) and clustered metabolic syndrome risk factors (CMetSRF) is controversial. We aimed: i) To examine the independent and combined association of objectively measured PA and PF with CMetSRF in children and adolescents; ii) To test the mediating effect of PF in the association of PA with CMetSRF. METHODS AND RESULTS: A total of 226 children and 256 adolescents participated. Levels of PA (light, moderate, vigorous and moderate-to-vigorous [MVPA]) and PF were measured by accelerometry and ALPHA battery, respectively. Cardiorespiratory and muscular fitness values were combined in a global PF variable. A CMetSRF was computed by assessing the following variables: waist circumference, systolic blood pressure, high-density lipoprotein cholesterol, triglycerides and glucose. In children, the highest vigorous PA (ß = -0.193; P = 0.003) and MVPA (ß = -0.149; P = 0.025) were individually associated with lower CMetSRF, but these associations were not independent of global PF. In adolescents, the association of moderate (ß = -0.123; P = 0.046) and MVPA (ß = -0.147; P = 0.024) with CMetSRF was independent of PF. Among unfit adolescents, the higher time they spent in MVPA the lower CMetSRF levels were found (P = 0.032). CONCLUSIONS: The results are suggestive of a full mediation of global PF in the association of MVPA and vigorous PA with CMetSRF in children. In adolescents, the association of higher moderate and MVPA with lower CMetSRF was independent of levels of PF, and mediation analyses suggest only a partial mediation of global PF in the association of MVPA with CMetSRF.

Influence of heat-labile serum components in the presence of OmpA on the outer membrane of Salmonella gallinarum.

Salmonella gallinarum is the causative agent of fowl typhoid. Being a Gram-negative bacteria, its outer membrane proteins (OMP) can be regulated by different microenvironments. S. gallinarum was cultured under the following conditions: nutrient broth (NB), NB supplemented with serum from specific pathogen-free birds (NBS) and NB with serum incubated at 56 °C prior to incubation with the bacteria (NBSD); OMP were subsequently extracted. Several changes were observed in the apparent expression of OMP, mainly a decrease in an OMP with a size of 30 kDa, approximately, under the NBS condition. In contrast, the same event was not observed in NB and NBSD when using one- and two-dimensional polyacrylamide gels (SDS-PAGE). Using the OMP with a size of 30 kDa, approximately, as antigen in indirect ELISA, we were able to differentiate serum from healthy and vaccinated birds, as well as birds infected with S. gallinarum and S. enteritidis. The amino-terminal of this protein was sequenced, showing 100 % identity with OmpA of S. typhimurium. Subsequently, we designed primers to amplify the gene by PCR. The partial sequence of the amplified gene showed 100 % identity with OmpA of S. gallinarum. (1) Heat-labile serum components influence the presence of OmpA in the OM of S. gallinarum; (2) by the way of ELISA, OmpA allows to specifically differentiate healthy from diseased birds.

The role of fatness on physical fitness in adolescents with and without Down syndrome: The UP&DOWN study.

BACKGROUND/OBJECTIVES: Adolescents with Down syndrome (DS) exhibit higher levels of fatness and low levels of physical fitness compared with those without DS. In adolescents without DS, fatness is tightly associated with physical fitness, but this association is unclear in adolescents with DS. The aim of this study was to examine the association between several markers of fatness and physical fitness in a relative large sample of adolescents with and without DS. SUBJECTS/METHODS: A total of 111 adolescents with DS (41 females) aged 11-20 years participated in this cross-sectional study. We also included a sex-matched control group (ratio 1:2) of 222 adolescents without DS aged 12-18 years, participating in the UP&DOWN Study. The Assessing Level of Physical Activity (ALPHA) health-related fitness test battery for adolescents was used to assess fatness and physical fitness. RESULTS: Our results show that fatness is not associated with low levels of physical fitness in adolescents with DS (that is, 3 of the 16 analyses identified differences in physical fitness variables by groups of fatness). In contrast, fatness, as expected, is associated with levels of physical fitness in adolescents without DS (that is, 13 of the 16 analyses identified differences in physical fitness variables by groups of fatness). CONCLUSIONS: The present finding contributes to new knowledge by suggesting that the role of fatness on physical fitness is different in adolescents with and without DS, and consequently, the poor levels of physical fitness in adolescents with DS may be due to the syndrome rather than the high prevalence of obesity from this population.

Physical Activity, Sitting Time and Mortality in Older Adults with Diabetes.

The purpose of this study was to examine the independent and combined association of physical activity (PA) and sitting time (ST) with all-cause mortality in older adults with diabetes. A total of 611 individuals representative of the Spanish diabetic population aged ≥ 60 years. Participants were selected in 2000/2001 and were prospectively followed-up through 2011. PA and ST were self-reported at baseline. Study associations were summarized as hazard ratios (HR) and their 95% confidence interval (CI). During a mean follow-up of 8.3 years, 282 deaths occurred. The HR (95% CI) of mortality for very/moderately active individuals compared to those who were inactive/less active was 0.59 (0.45, 0.78). The association between ST and mortality was non-linear (P<0.001 in spline analysis), and mortality was increased only among individuals who reported a ST>8 h/day (HR=1.77, 95% CI 1.25, 2.52). The HR (95% CI) of mortality was 0.50 (0.32, 0.77) in participants who either were very/moderately active or had ST≤8 h/day, and 0.32 (0.20, 0.50) in those with both health behaviors, compared to those with none of these behaviors. In conclusion, among older adults with diabetes, high PA and less ST are independently and jointly associated with lower risk of all-cause mortality.

Reduction in diabetic amputations over 15 years in a defined Spain population. Benefits of a critical pathway approach and multidisciplinary team work.

OBJECTIVE: To assess changes in diabetic lower-extremity amputations (LEA) rates in a defined population over a 15-year period, following a multidisciplinary approach including a critical pathway in an inpatient setting with standardized preoperative and postoperative care, as well as in an outpatient setting through the establishment of a diabetic foot clinic. METHODS: This is a study of the incidence and types of LEAs performed in patients with diabetic foot disease complicated admitted to Morales Meseguer Hospital (Murcia, Spain), a large district general hospital, before (1998-2000) and after (2001-2012) of the introduction of better organized diabetes foot care. Hospital and clinic characteristics to the success of the programme are described. All cases of LEA in diabetic patients (1998-2012) within the area were identified by ICD-9-Clinical modification (CM) diagnostic codes. A chi square test was used to compare the frequency and level of amputations. RESULTS: Over all inpatients with diabetes admitted with foot infections and gangrene, there was a significant decrease in the proportion of total major amputations (47%) and elective major amputations (66%) (p<0.001). The incidence of total major amputations rates per 100.000 of the general population fell with statistical significance (p=0.009). The biggest improvement in LEA incidence was seen in the reduction of major elective amputation with fell 60%, from 7.6 to 3.1 per 100,000 (p<0.001). CONCLUSIONS: Significant reductions in total and major amputations rates occurred over the 15-year period following improvements in foot care services included multidisciplinary teamwork (critical pathway and diabetic foot clinic).

Physical fitness, overweight and the risk of eating disorders in adolescents. The AVENA and AFINOS studies.

UNLABELLED: What is already known about this subject Eating disorders are among the public health issues facing adolescents. An excess of body fat has been associated with an increased risk of these disorders. The association of physical fitness with eating disorders has not yet been analysed in adolescents. What this study adds This study confirms that the overweight and obesity increase the risk of developing eating disorders. The present study shows that there is an inverse association between physical fitness levels and the risk of eating disorders. This study suggests that physical fitness might attenuate the influence of overweight on the development of eating disorders in adolescents. BACKGROUND: Eating disorders together with the overweight and obesity are important health concerns in adolescents. OBJECTIVE: To analyse the individual and combined influence of overweight and physical fitness on the risk of developing eating disorders in Spanish adolescents. METHODS: The sample consisted of 3571 adolescents (1864 females), aged 13 to 18.5 years, from Spain who participated in the AVENA and AFINOS studies. The risk of eating disorders was evaluated using the SCOFF questionnaire. Body mass index was calculated and the adolescents were classified into two groups: overweight (including obesity) and non-overweight according to Cole's cut-off points. Cardiorespiratory fitness in the AVENA Study was assessed by the 20-m shuttle-run test and the overall physical fitness level was self-reported in the AFINOS Study. RESULTS: Overweight adolescents had a higher risk of developing eating disorders than non-overweight adolescents (odds ratio [OR] = 4.91, 95% confidence interval [CI]: 3.63-6.61 in the AVENA Study and OR = 2.45, 95% CI: 1.83-3.22 in the AFINOS Study). Also, adolescents with medium and low levels of physical fitness had a higher risk of developing eating disorders (OR = 1.51, 95% CI: 1.05-2.16, and OR = 2.25, 95% CI: 1.60-3.19, respectively, in the AVENA Study, and OR = 1.73, 95% CI: 1.37-2.17, and OR = 4.11 95% CI: 2.98-5.65, respectively, in the AFINOS Study) than adolescents with high levels of physical fitness. In both studies, the combined influence of overweight and physical fitness showed that adolescents with lower levels of physical fitness had an increased risk of developing eating disorders in both non-overweight and overweight groups. CONCLUSIONS: Physical fitness might attenuate the influence of overweight on the development of eating disorders in adolescents.

Muscular fitness, fatness and inflammatory biomarkers in adolescents.

BACKGROUND: Muscular fitness, cardiorespiratory fitness (CRF) and fatness are mutually related with chronic inflammation. PURPOSE: To examine the independent association of muscular fitness with inflammatory biomarkers in adolescents from nine European countries. METHODS: A total of 639 adolescents (296 boys) aged from 12.5 to 17.5 year were included in this report. Data collection took place in 2006-2007 and analyses in 2012. A muscular fitness score was computed from handgrip strength and standing long jump. CRF was measured using the 20 m shuttle run test. Z-scores of C-reactive protein, complement factors C3 and C4, leptin and white blood cell counts were summed to create a cluster of inflammatory biomarkers. Sex, age, pubertal stage and centre were used as main confounders. Additional models were further adjusted for insulin resistance (HOMA-IR) and sum of four skinfolds. RESULTS: Muscular fitness was negatively associated with single and clustered inflammatory biomarkers (standardized ß from -0.399 to -0.100, all P-values < 0.05). Additional adjustments for CRF and HOMA-IR weakened the associations, but they still remained significant. The association was no longer significant when adjusting for skinfolds. Decreasing values of inflammatory score were observed across incremental levels of muscular fitness in both non-overweight and overweight adolescents (P ≤ 0.05). CONCLUSIONS: Adolescents with higher levels of muscular fitness present a lower chronic inflammation, and this seems to be explained by lower levels of fatness. Yet, overweight and obese adolescents may exhibit a less adverse profile if they maintain appropriate levels of muscular fitness.