Síntomas óticos y síndrome del dolor miofascial en musculatura temporomandibular y esternocleidomastoideo: Estudio de un caso / Otic symptoms and myofascial pain syndrome in temporomandibular and sternocleidomastoid musculature: A case study

Introducción El dolor de oído y la alteración de la audición son motivos de consulta muy frecuentes. El dolor de oído referido puede deberse a alteraciones temporomandibulares y puntos gatillo en la musculatura cervical. La hipoacusia se relaciona con la presencia de puntos gatillo en musculatura cervical y mandibular. Aunque se han observado efectos beneficiosos sobre esta musculatura tras la utilización de terapia manual y punción seca, la literatura al respecto sigue siendo escasa, motivo por que se realizó el actual estudio. Objetivo Conocer los efectos de un tratamiento basado en la técnica suiza y punción seca en la musculatura temporomandibular y esternocleidomastoideo a corto plazo sobre el dolor de oído e hipoacusia, en una paciente de 24 años. Material y métodos Estudio de un caso. Se realizó una valoración previa al tratamiento y otra al finalizar para valorar sus efectos, mediante audiometría y escala visual analógica. Se programó una sesión de 50 min, semanalmente, durante cuatro semanas. Durante el tratamiento se aplicó la técnica suiza y punción seca en cinco músculos de la región mandibular y cervical. Resultados Tras cuatro sesiones de tratamiento se observó una mejora del dolor de la paciente y se evidenció una recuperación de la audición. Conclusiones Una intervención basada en la técnica suiza y punción seca para el tratamiento del síndrome de dolor miofascial de la musculatura temporomandibular y esternocleidomastoideo puede ser útil para mejorar alteraciones de la audición. Se sugiere la realización de ensayos clínicos aleatorizados que evalúen esta técnica (AU)

Introduction Ear pain and hearing impairment is a frequent medical consultation. Referred ear pain may be due to temporomandibular disorders and the presence of trigger points in the cervical musculature. Hearing loss is related to the presence of trigger points in the cervical and mandibular muscles. Although beneficial effects have been observed on this musculature after the use of manual therapy and dry needling, the literature on the matter is still scarce, which is why the current study was carried out. Objective To know the short-term effects of a treatment based on the Swiss technique and dry needling on the temporomandibular and sternocleidomastoid muscles on ear pain and hearing loss, in a female 24-year-old patient. Material and methods Case study. An assessment was carried out before the treatment and another at the end to evaluate its effects. A 50-minute session was held weekly for 4 weeks. During treatment, the Swiss technique was applied to 5 muscles of the mandibular and cervical region. Results After 4 treatment sessions an improvement in the patient's pain was observed and a hearing recovery was evidenced. Conclusions An intervention based on the Swiss technique and dry needling in the treatment of myofascial pain syndrome of the temporomandibular and sternocleidomastoid muscles may be useful in improving hearing disorders and otalgia. Randomized clinical trials evaluating this technique are suggested (AU)

Abordaje de la hipercolesterolemia en planes y estrategias de saluden España: estado actual y propuestas de futuro / The approach to hypercholesterolemia in health strategies and plans in Spain: present situation and future proposals

Fundamento: Las enfermedades cardiovasculares (ECV)son la principal causa de muerte a nivel mundial y la hipercolesterolemia (HC) es un importante factor de riesgo cardiovascular (FRCV). En España, aproximadamente un25% de los adultos de mediana edad presentan hipercolesterolemia. Nuestro objetivo fue analizar las estrategias y planes de salud existentes en España respecto a las ECVy a la HC, y definir líneas de actuación para su controldesde la gestión y política sanitaria. Material y métodos: Estudio observacional, descriptivo.En la primera fase se revisó la literatura y se realizaronseis entrevistas semiestructuradas; en una segunda fase,12 expertos identificaron las barreras existentes y propusieron estrategias para reducir la mortalidad prematura por las ECV.Resultados: Se identificaron 51 documentos de planificación, el 43% hacían referencia a la HC. Se detectó una altavariabilidad en la implementación de iniciativas a nivel autonómico para el control de la HC. Las barreras identificadas para explicar estos resultados fueron: banalización de la HC, falta de participación activa de agentes clave, desconocimiento del impacto de la HC, el modelo de atención y los circuitos asistenciales existentes, y las políticas sanitarias a corto plazo y con escasa dedicación de recursos a la HC.Conclusiones: A pesar del impacto en salud y socioeconómico de las ECV y de la HC en España, el peso de la HC en las políticas de salud no parece corresponderse con esa relevancia. Faltan medidas para su abordaje, pese a la evidencia de su efectividad. Este estudio propone medidas concretas para avanzar en su control.(AU)

Background: Cardiovascular diseases (CVD) are a major cause of death worldwide and Hypercholesterolemia (HC) is an important cardiovascular risk factor. In Spain,approximately 25% of middle-aged adults suffer from HC.Our objective was to analyse current health strategiesand plans in Spain related to CVD and HC in order todefine possible future courses of action to bring aboutbetter control from a health management and policy perspective.Methods: The study was observational and descriptive.In the first step, a literature review was carried out, followed by six semi structured interviews. In the second step, a group of 12 experts in the field identified existing barriers to HC control and suggested ways to reduce premature mortality due to CVD. Results: A total of 51 documents were identified, of which 43% referred to HC. There was a high variability at the regional level in the implementation of measures and initiatives for the control of HC. Barriers that were identified were : trivialization of HC, lack of active participation bykey stakeholders, lack of understanding of the impact ofHC, existing care models and pathways, and short-termhealth policies that limit the provision of resources forHC care and control. Conclusion: Despite the considerable medical and socioeconomic burden of CVD and HC in Spain, the importance of HC is not reflected in health policies. There is a lack of HC control measures, even when they are shown to be highly feasible and beneficial. This article proposes specific measures to improve control of this issue.(AU)

[The approach to hypercholesterolemia in health strategies and plans in Spain: present situation and future proposals].

BACKGROUND: Cardiovascular diseases (CVD) are a major cause of death worldwide and Hypercholesterolemia (HC) is an important cardiovascular risk factor. In Spain, approximately 25% of middle-aged adults suffer from HC. Our objective was to analyse current health strategies and plans in Spain related to CVD and HC in order to define possible future courses of action to bring about better control from a health management and policy perspective. METHODS: The study was observational and descriptive. In the first step, a literature review was carried out, followed by six semi structured interviews. In the second step, a group of 12 experts in the field identified existing barriers to HC control and suggested ways to reduce premature mortality due to CVD. RESULTS: A total of 51 documents were identified, of which 43% referred to HC. There was a high variability at the regional level in the implementation of measures and initiatives for the control of HC. Barriers that were identified were : trivialization of HC, lack of active participation by key stakeholders, lack of understanding of the impact of HC, existing care models and pathways, and short-term health policies that limit the provision of resources for HC care and control. CONCLUSION: Despite the considerable medical and socioeconomic burden of CVD and HC in Spain, the importance of HC is not reflected in health policies. There is a lack of HC control measures, even when they are shown to be highly feasible and beneficial. This article proposes specific measures to improve control of this issue.

Altitude healing effect in severe asthmatic children.

BACKGROUND: The beneficial effect of a climatic treatment in children with asthma was established quite some time ago, but the mechanism of this beneficial effect has not been fully elucidated. We investigated the role of the cytokines of the TH2 pathway, reactive oxygen species (ROS) and reactive nitrogen species (RNS) over the course of a high-altitude climatic therapy. METHODS: A group of 67 children originating from various French towns suffering from uncontrolled severe asthma was sent via their medical specialists, to the Briançon climatic area. They were monitored over the course of an entire school year. During this time, they returned home for 15 days during the Christmas holidays. At each stage, assessment of asthma control, lung function examination (peak flow meter and spirometry), and measurement of exhaled NO, ROS and RNS in exhaled breath condensate (EBC), and the level of cytokines in the plasma of the TH2 pathway were carried out. RESULTS: The degree of asthma control improved at high altitude and worsened upon returning home. The average value of the peak expiratory flow also improved during the first 3 months but then worsened upon returning home, while the other spirometric parameters did not change. The level of expired NO and the scores for quality of life underwent a similar change. The level of RNS and ROS in the EBC did not change significantly. Besides, a marked and statistically significant decrease in the level of IL-13 and IL-10 was noted. CONCLUSION: The beneficial effect of a climatic stay of children suffering from allergic asthma at altitude appears to be linked with less allergenic stimulation.

Immune cell arrival kinetics to peritoneum and role during murine-experimental trichomoniasis.

Trichomonas vaginalis causes trichomoniasis, an inflammatory process related to an increased rate of HIV transmission. In order to study T. vaginalis infection response in a microorganism-free environment, an infection model was established providing a host­parasite interaction system useful to study the interplay between immune cells and the parasite. Infected mice peritoneal cells were immunophenotyped at different times after infection using flow cytometry. Neutrophils and macrophages showed the most relevant increase from third to 12th day post-infection. A high number of B lymphocytes were present on 15th day post-infection, and an increase in memory T cells was observed on sixth day post-infection. The levels of NO increased at day 10 post-infection; no significant influence was observed on T. vaginalis clearance. Increased viability of T. vaginalis was observed when the NETs inhibitors, metformin and Cl− amidine, were administrated, highlighting the importance of this mechanism to control parasite infection (43 and 86%, respectively). This report presents a comprehensive cell count of the immune cells participating against trichomoniasis in an in vivo interaction system. These data highlight the relevance of innate mechanisms such as specific population changes of innate immune cells and their impact on the T. vaginalis viability.

Trichomonas vaginalis exosome-like vesicles modify the cytokine profile and reduce inflammation in parasite-infected mice.

Trichomonas vaginalis (Tv) is a flagellated parasite commonly spread through sexual transmission. This protozoan initiates a severe inflammatory process, inducing nitric oxide, interleukin-6 (IL-6), IL-8, IL-10, IL-17 and IL-22 production by host immune cells. The parasites elicit these responses by releasing surface lipophosphoglycan, small extracellular vesicles (exosomes) and other factors. Tv exosomes are similar to mammalian exosomes and have been implicated in the modulation of IL-8 secretion by epithelial cells. Here, we report that exosome-like vesicles from T. vaginalis (Tv-ELVs) induced a more than 15-fold increase in IL-10 expression in RAW264.7 macrophages but only a two fold increase in IL-6 and TNF-α expression levels measured by RT-PCR. Because Tv-ELVs modulated the macrophage response, we also explored the effect of Tv-ELVs in a murine model of infection. Pretreatment with Tv-ELVs significantly increased IL-10 production as measured in vaginal washes by days 8 and 16 post-infection. Remarkably, Tv-ELVs-pretreated mice exhibited a decrease in IL-17 production and a significant decrease in vulvar inflammation. In addition, IL-6 and IL-13 were decreased during infection. Our results suggest that Tv-ELVs have an immunomodulatory role on the cytokine profile induced by the parasite and promote a decrease in the inflammatory process in mice infected with T. vaginalis.

Antimicrobial peptides (AMPs): Ancient compounds that represent novel weapons in the fight against bacteria.

Antimicrobial peptides (AMPs) are short peptidic molecules produced by most living creatures. They help unicellular organisms to successfully compete for nutrients with other organisms sharing their biological niche, while AMPs form part of the immune system of multicellular creatures. Thus, these molecules represent biological weapons that have evolved over millions of years as a result of an escalating arms race for survival among living organisms. All AMPs share common features, such as a small size, with cationic and hydrophobic sequences within a linear or cyclic structure. AMPs can inhibit or kill bacteria at micromolar concentrations, often by non-specific mechanisms; hence the appearance of resistance to these antimicrobials is rare. Moreover, AMPs can kill antibiotic-resistant bacteria, including insidious microbes such as Acinetobacter baumannii and the methicillin-resistant Staphylococcus aureus. This review gives a detailed insight into a selection of the most prominent and interesting AMPs with antibacterial activity. In the near future AMPs, due to their properties and despite their ancient origin, should represent a novel alternative to antibiotics in the struggle to control pathogenic microorganisms and maintain the current human life expectancy.

Advanced DNA- and Protein-based Methods for the Detection and Investigation of Food Allergens.

Currently, food allergies are an important health concern worldwide. The presence of undeclared allergenic ingredients or the presence of traces of allergens due to contamination during food processing poses a great health risk to sensitized individuals. Therefore, reliable analytical methods are required to detect and identify allergenic ingredients in food products. The present review addresses the recent developments regarding the application of DNA- and protein-based methods for the detection of allergenic ingredients in foods. The fitness-for-purpose of reviewed methodology will be discussed, and future trends will be highlighted. Special attention will be given to the evaluation of the potential of newly developed and promising technologies that can improve the detection and identification of allergenic ingredients in foods, such as the use of biosensors and/or nanomaterials to improve detection limits, specificity, ease of use, or to reduce the time of analysis. Such rapid food allergen test methods are required to facilitate the reliable detection of allergenic ingredients by control laboratories, to give the food industry the means to easily determine whether its product has been subjected to cross-contamination and, simultaneously, to identify how and when this cross-contamination occurred.

A PCR procedure for the detection of Giardia intestinalis cysts and Escherichia coli in lettuce.

Giardia intestinalis is a pathogen associated with foodborne outbreaks and Escherichia coli is commonly used as a marker of faecal contamination. Implementation of routine identification methods of G. intestinalis is difficult for the analysis of vegetables and the microbiological detection of E. coli requires several days. This study proposes a PCR-based assay for the detection of E. coli and G. intestinalis cysts using crude DNA isolated from artificially contaminated lettuce. The G. intestinalis and E. coli PCR assays targeted the ß-giardin and uidA genes, respectively, and were 100% specific. Forty lettuces from local markets were analysed by both PCR and light microscopy and no cysts were detected, the calculated detection limit was 20 cysts per gram of lettuce; however, by PCR, E. coli was detected in eight of ten randomly selected samples of lettuce. These data highlight the need to validate procedures for routine quality assurance. These PCR-based assays can be employed as alternative methods for the detection of G. intestinalis and E. coli and have the potential to allow for the automation and simultaneous detection of protozoa and bacterial pathogens in multiple samples. Significance and impact of the study: There are few studies for Giardia intestinalis detection in food because methods for its identification are difficult for routine implementation. Here, we developed a PCR-based method as an alternative to the direct observation of cysts in lettuce by light microscopy. Additionally, Escherichia coli was detected by PCR and the sanitary quality of lettuce was evaluated using molecular and standard microbiological methods. Using PCR, the detection probability of Giardia cysts inoculated onto samples of lettuce was improved compared to light microscopy, with the advantage of easy automation. These methods may be employed to perform timely and affordable detection of foodborne pathogens.

Clinically used selective oestrogen receptor modulators increase LDL receptor activity in primary human lymphocytes.

BACKGROUND AND PURPOSE: Treatment with selective oestrogen receptor modulators (SERMs) reduces low-density lipoprotein (LDL) cholesterol levels. We assessed the effect of tamoxifen, raloxifene and toremifene and their combinations with lovastatin on LDL receptor activity in lymphocytes from normolipidaemic and familial hypercholesterolaemic (FH) subjects, and human HepG2 hepatocytes and MOLT-4 lymphoblasts. EXPERIMENTAL APPROACH: Lymphocytes were isolated from peripheral blood, treated with different compounds, and 1,1'-dioctadecyl-3,3,3,3'-tetramethylindocarbocyanine perchlorate (DiI)-labelled LDL uptake was analysed by flow cytometry. KEY RESULTS: Tamoxifen, toremifene and raloxifene, in this order, stimulated DiI-LDL uptake by lymphocytes by inhibiting LDL-derived cholesterol trafficking and subsequent down-regulation of LDL receptor expression. Differently to what occurred in HepG2 and MOLT-4 cells, only tamoxifen consistently displayed a potentiating effect with lovastatin in primary lymphocytes. The SERM-mediated increase in LDL receptor activity was not altered by the anti-oestrogen ICI 182,780 nor was it reproduced by 17ß-oestradiol. However, the tamoxifen-active metabolite endoxifen was equally effective as tamoxifen. The SERMs produced similar effects on LDL receptor activity in heterozygous FH lymphocytes as in normal lymphocytes, although none of them had a potentiating effect with lovastatin in heterozygous FH lymphocytes. The SERMs had no effect in homozygous FH lymphocytes. CONCLUSIONS AND IMPLICATIONS: Clinically used SERMs up-regulate LDL receptors in primary human lymphocytes. There is a mild enhancement between SERMs and lovastatin of lymphocyte LDLR activity, the potentiation being greater in HepG2 and MOLT-4 cells. The effect of SERMs is independent of oestrogen receptors but is preserved in the tamoxifen-active metabolite endoxifen. This mechanism may contribute to the cholesterol-lowering action of SERMs.

Identification of single nucleotide polymorphisms (SNPs) in the 16S rRNA gene of foodborne Bacillus spp.

The main goal of this work was the identification of single nucleotide polymorphisms (SNPs) in the 16S rRNA gene of foodborne Bacillus spp. that may be useful for typing purposes. These species include, among others, Bacillus cereus, an important pathogenic species involved in food poisoning, and Bacillus licheniformis, Bacillus subtilis and Bacillus pumilus, which are causative agents of food spoilage described as responsible for foodborne disease outbreaks. With this purpose in mind, 52 Bacillus strains isolated from culture collections and fresh and processed food were considered. SNP type "Y" at sites 212 and 476 appeared in the majority of B. licheniformis studied strains. SNP type "R" at site 278 was detected in many strains of the B. subtilis/Bacillus amyloliquefaciens group, while polymorphism "Y" at site 173 was characteristic of the majority of strains of B. cereus/Bacillus thuringiensis group. The analysis of SNPs provided more intra-specific information than phylogenetic analysis in the cases of B. cereus and B. subtilis. Moreover, this study describes novel SNPs that should be considered when designing 16S rRNA-based primers and probes for multiplex-PCR, Real-Time PCR and microarray systems for foodborne Bacillus spp.

Genetic discrimination of foodborne pathogenic and spoilage Bacillus spp. based on three housekeeping genes.

Bacillus genus includes foodborne pathogenic and spoilage-associated species, such as Bacillus cereus, Bacillus licheniformis, Bacillus subtilis and Bacillus pumilus. Bacillus is also a heterogeneous genus that includes closely related species that are difficult to discriminate among, especially when well-conserved genes such as 16S rRNA and 23S rRNA are considered. The main goal of the present work was to study the usefulness of three housekeeping genes, the TU elongation factor (tuf), the DNA gyrase ß subunit (gyrB) and the RNA polymerase ß subunit (rpoB) genes, for use in differentiating among the most important foodborne Bacillus spp. sequences from 20 foodborne isolated Bacillus strains, and sequences belonging to different Bacillus spp. retrieved from the GenBank were analysed. In general terms, gyrB, rpoB and tuf gene regions for the strains considered in this study exhibited interspecific similarities of 57.8%, 67.23% and 77.66% respectively. Novel tufGPF and tufGPR universal primers targeted to the tuf gene were designed and proved to be useful for the amplification of all Bacillus spp considered. In conclusion, the tuf gene can be considered to be a good target for the differential characterisation of foodborne Bacillus species, especially for differentiating B. subtilis and B. cereus from other closely related species.

Triagem fitoquímica e avaliação da atividade antibacteriana de extratos das flores de Sambucus nigra L. (Caprifoliaceae) / Phytochemical screening and evaluation of the antibacterial activity of Sambucus nigra L. flower extracts (Caprifoliaceae)

RESUMO O presente trabalho teve como objetivo realizar a triagem fitoquímica e avaliar a atividade antibacteriana de extratos das flores de Sambucus nigraL. Os extratos; aquoso (10 %), etanólico (5 %) e Acetato de etila (5 %) foram submetidos a testes colorimétricos para triagem fitoquímica e a avaliação da atividade antibacteriana foi realizada pelo método de disco-difusão em ágar. Os resultados mostraram que nas concentrações de 6 e 12 mg o extrato aquoso apresentou halos significativos de inibição para Staphylococcus aureus, Pseudomonas aeruginosa e Streptococcus pyogenes, porém, quando comparado aos medicamentos usados como referência a atividade não foi satisfatória, e, ainda, evidenciou a ausência de inibição para todas as cepas testadas com o aumento da concentração para 18 e 24 mg. A análise da triagem fitoquímica evidenciou a presença de flavonoides com intensa reação de cor no extrato aquoso e etanólico, e de fraca intensidade no extrato acetato de etila. Nos mesmos extratos, pelos testes realizados, não foram detectados taninos, saponinas, antraquinonas e alcaloides. Concluiu-se que o extrato aquoso apresentou melhor efeito inibitório para Staphylococcus aureus, Pseudomonas aeruginosa e Streptococcus pyogenes, porém insuficiente para promover a inativação eficiente quando comparado aos controles.

ABSTRACT This study aimed to perform a phytochemical screening and to evaluate the antibacterial activity of the extracts of Sambucusnigra L. flowers. The aqueous (10%), ethanolic (5%) and ethyl acetate (5%) extracts were subjected to colorimetric tests for phytochemical screening and the antibacterial activity evaluation was performed by the disk-diffusion method in agar. The results showed that in the 6 and 12 mg concentrations the aqueous extract presented significant inhibition halos for Staphylococcus aureus, Pseudomonas aeruginosa and Streptococcus pyogenes, but when compared with the medicines used as a reference, the activity was not satisfactory and, besides, it indicated the absence of inhibition for all the tested strains with the concentration increase of 18 and 24mg. The phytochemical screening analysis showed the presence of flavonoids with intense color reaction in the aqueous and ethanol extracts, and of low intensity in the ethyl acetate sample. In the same extracts, the tests did not detect tannins, saponins, alkaloids and anthraquinones. It was concluded that the aqueous extract showed better inhibitory effect on the Staphylococcus aureus, Pseudomonas aeruginosa and Streptococcus pyogenes, but not enough to promote an effective inactivation when compared with the medicine tests.

Detection of food spoilage and pathogenic bacteria based on ligation detection reaction coupled to flow-through hybridization on membranes.

Traditional culturing methods are still commonly applied for bacterial identification in the food control sector, despite being time and labor intensive. Microarray technologies represent an interesting alternative. However, they require higher costs and technical expertise, making them still inappropriate for microbial routine analysis. The present study describes the development of an efficient method for bacterial identification based on flow-through reverse dot-blot (FT-RDB) hybridization on membranes, coupled to the high specific ligation detection reaction (LDR). First, the methodology was optimized by testing different types of ligase enzymes, labeling, and membranes. Furthermore, specific oligonucleotide probes were designed based on the 16S rRNA gene, using the bioinformatic tool Oligonucleotide Retrieving for Molecular Applications (ORMA). Four probes were selected and synthesized, being specific for Aeromonas spp., Pseudomonas spp., Shewanella spp., and Morganella morganii, respectively. For the validation of the probes, 16 reference strains from type culture collections were tested by LDR and FT-RDB hybridization using universal arrays spotted onto membranes. In conclusion, the described methodology could be applied for the rapid, accurate, and cost-effective identification of bacterial species, exhibiting special relevance in food safety and quality.

Characterisation and profiling of Bacillus subtilis, Bacillus cereus and Bacillus licheniformis by MALDI-TOF mass fingerprinting.

The Bacillus genus includes species such as Bacillus cereus, Bacillus licheniformis and Bacillus subtilis, some of which may be pathogenic or causative agents in the spoilage of food products. The main goal of this work was to apply matrix-assisted laser desorption ionisation-time of flight (MALDI-TOF) mass fingerprinting to the classification of these Bacillus species. Genetic analyses were also compared to phyloproteomic analyses. A collection of 57 Bacillus strains isolated from fresh and processed food and from culture collections were studied and their mass spectra compiled. The resulting mass fingerprints were compared and characteristic peaks at the strain and species levels were assigned. The results showed that MALDI-TOF was a good complementary approach to 16S rRNA sequencing and even a more powerful tool in the accurate classification of Bacillus species, especially for differentiating B. subtilis and B. cereus from Bacillus amyloliquefaciens and Bacillus thuringiensis, respectively. MALDI-TOF was also found to provide valuable information at both intra- and interspecies levels in the Bacillus species studied.

Respuesta inmediata ante grandes emergencias: modelo matemático basado en redes neuronales y árboles de decisión / Rapid response to large-scale emergencies: a neural network model and a decision-tree algorithm

Objetivo: En la gestión de recursos ante incidentes con múltiples víctimas (IMV), el factor incertidumbre en un entorno de caos inicial se convierte en el peor enemigo del decisor. El objetivo fue diseñar un modelo matemático predictivo en este entorno de decisiones para mejorar la fase inicial de la gestión de recursos ante una gran emergencia. Método: Se partió de una base de datos de incidentes reales con múltiples víctimas en Castilla-La Mancha en los últimos cinco años, sobre la que se trabajó con 10 variables categorizadas en función de su peso en la gravedad de la emergencia. Se diseñó una red neuronal, que aprende sobre los casos reales, y por otro lado se generó un árbol de decisión con el fin de buscar la mejor respuesta entre ambos modelos. Se ha encontrado una importante limitación metodológica, ya que prácticamente todos los IMV analizados son accidentes de tráfico. Resultados: El modelo basado en árboles de decisión da más información y mayor variabilidad que la red neuronal e identifica 6 grupos homogéneos en función del "número de afectados iniciales", "tipología del incidente" y "entorno" (p < 0,05).Conclusiones: Es posible crear un modelo matemático predictivo con las variables consideradas que permite una mejor gestión de recursos ante un IMV, pero se necesita un mayor número de casos reales pasados y con tipología más diversa, para ser aplicadas a casos reales futuros con la metodología propuesta (AU)

Objective: The greatest challenge to decision-making during the management of emergencies with multiple victims is uncertainty in an initially chaotic environment. Our objective was to develop a predictive model to improve response and early resource management in the early-phase environment of chaotic uncertainty during large-scale emergencies. Methods: A database of information on real incidents with multiple victims in Castile-La Mancha, Spain, in the last 5 years was used to study the weight of 10 categorical variables and their effect on the seriousness of the emergencies. A neural network was designed to learn about these real cases, and a decision tree was generated, to study which of the 2 approaches gave the best results. An important design limitation was that nearly all the incidents analyzed involved traffic accidents. Results: The model based on decision-tree analysis gave more information and greater variability. It proved superior to the neural network, identifying 6 homogeneous groups according to the following factors: number of initial victims, type of incident, and environment (P<.05).Conclusions: A predictive model can be based on the considered variables in the interest of improving resource management during a large-scale emergency. However, development based on a larger number of real incidents of different types would be needed before such a model could be applied during real future incidents (AU)

Isolation and characterization of Streptococcus parauberis from vacuum-packaging refrigerated seafood products.

Streptococcus parauberis is known as an etiological agent of mastitis in cows and for producing streptococcosis in farmed fish, although its presence in foods has seldom been reported. In this work, two bacterial isolates were recovered from a spoiled vacuum-packaged refrigerated seafood product. Both isolates were identified by 16S rRNA gene sequencing, exhibiting 99% homology with respect to S. parauberis. Both isolates were also characterized by Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS). Genetic analysis revealed the clonal homogeneity of the isolates and their grouping together with other S. parauberis strains in a different cluster with respect to Streptococcus uberis strains. Proteomic analysis by MALDI-TOF MS allowed for the identification of five mass peaks in the range of 2200-6000 m/z that resulted to be specific to the species S. parauberis and allowed its rapid and direct identification with respect to other pathogenic and spoilage bacteria potentially present in seafood and other food products. This study represents, to our knowledge, the first report of S. parauberis in seafood in general and in vacuum-packed food products in particular. Moreover, it provides a rapid method based on MALDI-TOF MS for the identification of S. parauberis.

Validation of a food frequency questionnaire in Spanish patients with familial hypercholesterolaemia.

BACKGROUND AND AIMS: The aim of this study is to validate a semi-quantitative Food Frequency Questionnaire (FFQ) used for general population in Spain, in patients with familial hypercholesterolaemia (FH). SUBJECTS AND METHODS: Subjects with genetic diagnosis of FH were randomly selected from the Spanish FH Registry. They completed an FFQ based in 113 food items at inclusion (FFQ1) and after 1 year (FFQ2), and a 3-day dietary records (DR) every 3 months. Detailed instruction about how to register foods and beverages was given by a trained nutritionist. Each DR and FFQ was systematically coded, and the daily nutrients intake in absolute, percentage and nutrient density terms were estimated using a software system based on food composition tables. Pearson correlation coefficient was calculated with correction-repeated measurements to assess the reproducibility of both FFQ and the four 3-day DRs, as well as the validity of FFQ comparing to the mean of 3 days' DR. RESULTS: A total of 112 subjects (58 females and 54 males, aged 43 ± 16 years) finished the study. There were no differences between FFQ1, FFQ2 and mean FFQ (FFQa) in mean absolute and percentage values of selected daily nutrients' intake. Comparison between FFQ1, FFQ2, FFQa and the mean of four 3-day DRs was statistically significant in all absolute values, but not in percentage or nutrient density terms. Corrected Pearson correlation coefficient ranged from 0.470 to 0.952 for mean values of all nutrients, except alcohol. CONCLUSION: This study demonstrated that FFQ is a reliable tool to assess the dietary pattern in FH patients.

Airways changes related to air pollution exposure in wheezing children.

In this study, we aimed to evaluate the relationship between individual total exposure to air pollution and airway changes in a group of 51 wheezing children. Respiratory status was assessed four times (January 2006, June 2006, January 2007 and June 2007) during a 1-week period through a standardised questionnaire, spirometry, exhaled nitric oxide fraction and pH in exhaled breath condensate (EBC). Concentrations of particles with a 50% cut-off aerodynamic diameter of 10 µm (PM(10)), O(3), NO(2) and volatile organic compounds were estimated through direct measurements with an ad hoc device or air pollution modelling in the children's schools and at their homes in the same 4 weeks of the study. For each child, total exposure to the different air pollutants was estimated as a function of pollutant concentrations and daily activity patterns. Increasing total exposure to PM(10), NO(2), benzene, toluene and ethylbenzene was significantly associated with a decrease of forced expiratory volume in 1 s (FEV(1)) and with an increase of change in FEV(1). Increasing exposure to NO(2) and benzene was also related to a significant decrease of FEV(1)/forced vital capacity. Increasing exposure to PM(10), NO(2), benzene and ethylbenzene was associated with acidity of EBC. This study suggests an association in wheezing children between airway changes and total exposure to air pollutants, as estimated by taking into account the concentration in the various microenvironments attended by the children.