Can We Do Anything Else before Removing a Button Battery from the Esophagus?-Hyaluronic Acid.

OBJECTIVE: This article tests the protective effect of a commercially available mixture of hyaluronic acid, chondroitin sulfate, and poloxamer 407 on the damage caused by the exposure of esophageal mucosa to button batteries in an animal model. METHODS: Experimental study. Sixty porcine esophageal samples were distributed in three groups: control (CG), exposure (EG), and exposure-protection (EPG). In EG and EPG, one CR2032 button battery per sample was inserted, both were subdivided into 2-, 4-, 6-, and 24-hour exposure subgroups, with subsequent battery removal. EPG samples were irrigated with the solution 1 hour after battery exposure. Esophageal pH and final voltage of the battery were measured. RESULTS: pH in CG remained stable. No significant differences in pH at 1 hour were found between EG and EPG. In EPG, the pH of the mucosa exposed to the anode was lower than in GE at 2 hours (12.44 vs. 11.89, p = 0.203) and 4 hours (13.78 vs. 11.77, p < 0.0001). In the cathode pH was significantly higher in EG at 2 hours (2.5 vs. 4.11, p < 0.0001), 4 hours (2.33 vs. 4.78, p < 0.0001), and 6 hours (2.17 vs. 2.91, p < 0.0001). Significant voltage reduction at 1 hour was found in EG compared to EPG (0.48 vs. 1.08 V, p = 0.004). CONCLUSION: Exposure to hyaluronic acid solution buffers the acidification on the side exposed to the cathode and basification on the anode. This effect can be maintained up to 3 to 5 hours, even after stopping its application. Our results suggest that a solution containing hyaluronic acid could be used as an esophageal protector after accidental ingestion of button batteries.

The evolution of same-sex sexual behaviour in mammals.

Same-sex sexual behaviour has attracted the attention of many scientists working in disparate areas, from sociology and psychology to behavioural and evolutionary biology. Since it does not contribute directly to reproduction, same-sex sexual behaviour is considered an evolutionary conundrum. Here, using phylogenetic analyses, we explore the evolution of same-sex sexual behaviour in mammals. According to currently available data, this behaviour is not randomly distributed across mammal lineages, but tends to be particularly prevalent in some clades, especially primates. Ancestral reconstruction suggests that same-sex sexual behaviour may have evolved multiple times, with its appearance being a recent phenomenon in most mammalian lineages. Our phylogenetically informed analyses testing for associations between same-sex sexual behaviour and other species characteristics suggest that it may play an adaptive role in maintaining social relationships and mitigating conflict.

Effect of feeding olive pomace acid oil on pork lipid composition, oxidative stability, colour, and sensory acceptance.

One of the targets of the meat industry is to reduce production costs and to increase the sustainability of the food chain, which has driven the attention towards the use of by-products as feed ingredients. Acid oils are fat by-products coming from the chemical refining process of edible oils, with a high energy value and that are approved as feed ingredients in the European Union. However, meat producers are hesitant to utilise them due to their varying composition and the limited understanding of their impact on animal performance and meat quality. The objective of this study was to evaluate the effects of using olive pomace acid oil (OPAO) instead of its corresponding crude olive pomace oil (OPO) or crude palm oil (PO) in pig diets on lipid composition, lipid oxidation and quality of pork loin (longissimus dorsi), fresh and after commercial refrigerated storage for 8 days. The experimental design consisted of feeding pigs with four diets supplemented with a 5% of PO, OPO, OPAO or a blend (B) of PO and OPAO (50:50, w/w). Fresh and refrigerated pork loin samples were assessed for fatty acid profile; tocopherol (T) and tocotrienol (T3) composition; lipid oxidative stability with the ferrous oxidation-xylenol orange method; 2-thiobarbituric acid (TBA) value; volatile compounds; colour; and sensory acceptance. Results showed that refrigeration reduced the total T + T3 levels and increased the TBA values and the volatile compound concentrations. The refrigerated storage also affected the instrumental colour parameters (L*, a* and b*) but not the overall acceptance of pork. Regarding the diet, pork from OPAO diet showed a higher unsaturated-to-saturated fatty acid ratio than pork from PO and B diets. The lowest T + T3 concentration was found in OPO and OPAO fresh pork and in OPAO refrigerated pork. The oxidative stability of fresh pork was lower for OPAO than for PO diet, but no significant effect of the diet was observed for this parameter in refrigerated pork. The TBA values and volatile compound concentrations of fresh pork were not affected by the diet. After refrigeration, OPAO pork had the highest TBA value and volatile compound concentrations. In any case, colour and consumer acceptance of pork were not affected by diet. In conclusion, in order to upcycle acid oils in pig diets, and considering results on the lipid oxidative stability of pork, it would be preferable to add the OPAO used in this study blended with PO.

Microwave radiation-assisted synthesis of levulinic acid from microcrystalline cellulose: Application to a melon rind residue.

The circular economy considers waste to be a new raw material for the development of value-added products. In this context, agroindustrial lignocellulosic waste represents an outstanding source of new materials and platform chemicals, such as levulinic acid (LA). Herein we study the microwave (MW)-assisted acidic conversion of microcrystalline cellulose (MCC) into LA. The influence of acidic catalysts, inorganic salt addition and ball-milling pre-treatment of MCC on LA yield was assessed. Depolymerization and disruption of cellulose was monitored by FTIR, TGA and SEM, whereas the products formed were analyzed by HPLC and NMR spectroscopy. The parameters that afforded the highest LA yield (48 %, 100 % selectivity) were: ball-milling pre-treatment of MCC for 16 min at 600 rpm, followed by MW-assisted thermochemical treatment for 20 min at 190 °C, aqueous p-toluenesulfonic acid (p-TSA) 0.25 M as catalyst and saturation with KBr. These optimal conditions were further applied to a lignocellulosic feedstock, namely melon rind, to afford a 51 % yield of LA. These results corroborate the suitability of this method to obtain LA from agroindustrial wastes, in line with a circular economy-based approach.

Drinking water chlorination in dairy beef fattening bulls: water quality, potential hazards, apparent total tract digestibility, and growth performance.

The first study aimed to evaluate the effect of drinking water disinfection (chlorination: NaClO 15%) and conditioning (acidification: H3PO4 diluted 1:5 in water) on water quality, water and feed consumption, apparent total tract digestibility, and its potential hazardous effects on Holstein bulls fed high-concentrate diets. Twenty-four animals (221 ±â€¯20.9 kg of BW, and 184 ±â€¯9.9 days of age) were individually assigned to one of four treatments according to a 2 × 2 factorial arrangement: conditioning (with or without acidification) and disinfection (with or without chlorination). The entire study lasted 210 days. Physicochemical and microbiological water quality, water and feed consumption, haematological and biochemical blood parameters, and apparent total tract digestibility were measured; data were analysed via a mixed-effects model. Chlorination and acidification increased (P = 0.02) free residual chlorine in water, and chlorination reduced (P = 0.01) total coliform and Clostridium perfringens counts in water. Treatment did not affect water consumption, total DM intake, or blood parameters. At the beginning of the study, NDF digestibility decreased (P = 0.04) with acidification, however, this was restored at the end of the study. The second study evaluated the potential benefit of drinking water chlorination and acidification on the performance of crossbred Holstein bulls fed high-concentrate diets under commercial conditions. Ninety-six animals (322 ±â€¯35.0 kg of BW, and 220 ±â€¯14.2 days of age) were allocated into six pens assigned to one of the two treatments: untreated drinking water or drinking water treated with chlorination and acidification for a total of 112 days. Physicochemical and microbiological water quality, water and concentrate consumption, eating behaviour, growth performance, and carcass quality were analysed via a mixed-effects model. Water conditioning and disinfection increased (P = 0.01) free residual chlorine concentration and reduced (P = 0.04) total coliform count in water. Although water consumption and eating behaviour were similar between treatments, water conditioning and disinfection increased average daily weight gain (P = 0.03), BW before slaughter (P = 0.01), and hot carcass weight (P = 0.01). In conclusion, drinking water chlorination and acidification in fattening dairy beef bulls is recommended as it improves growth performance without any detrimental side effects on health or nutrient digestibility.

Olive pomace oil and acid oil as alternative fat sources in growing-finishing broiler chicken diets.

The aim of the present study was to investigate the effect of dietary supplementation of olive pomace oil and olive pomace acid oil, which are rich in monounsaturated fatty acids (FA) but differ in free FA content, on growth performance, digestibility and FA profile of abdominal fat and breast meat. A total of 3,048 one-day-old mixed-sex broiler chickens (Ross 308) were randomly distributed into 24 pens and 3 dietary treatments (8 replicates per treatment). Experimental diets were administered for growing (from 22 to 29 d) and finishing (from 30 to 39 d) periods, consisting of a basal diet supplemented with 6% (as-fed basis) palm oil (PO), olive pomace oil (O), or olive pomace acid oil (OA). Animals fed O achieved the lowest feed conversion ratio (P < 0.01), together with the highest AME value (P = 0.003), but no differences were observed between OA and PO. Regarding FA digestibility, O and OA showed higher values than PO for all FA in both apparent ileal digestibility (AID) and apparent total tract digestibility. Comparing the AID between O and OA, no differences were observed for total FA, monounsaturated FA, or polyunsaturated FA, but animals fed OA showed lower AID values for saturated FA than those fed O (P < 0.001). The FA profile of abdominal fat and breast meat reflected that of the diet, with higher monounsaturated FA and lower saturated FA in animals fed O and OA compared to those fed PO. In sum, the inclusion of both olive pomace oil and acid oil in growing-finishing broiler chicken diets led to great performance parameters and high FA digestibility values, together with an enrichment with monounsaturated FA in abdominal fat and breast meat compared to the use of palm oil. However, a better AID of saturated FA and feed conversion ratio is achieved with O compared to OA.

Re-interventions following appendectomy in children: a multicenter study. / Reintervenciones tras apendicectomía en niños. Estudio multicéntrico.

INTRODUCTION: Acute appendicitis is the most frequent cause of acute abdomen in children. The objective of this study was to analyze the causes, approach, and results of complications requiring surgery following appendectomy. MATERIAL AND METHODS: A retrospective study of the appendectomies conducted in three third-level institutions from 2015 to 2019 was carried out. Complications, causes, and number of re-interventions, time from one surgery to another, surgical technique used, operative findings at baseline appendectomy according to the American Association for the Surgery of Trauma (AAST) classification, and hospital stay were collected. RESULTS: 3,698 appendicitis cases underwent surgery, 76.7% of which laparoscopically, with 37.2% being advanced (grades II-V of the AAST classification). Mean operating time was 50.4 minutes (49.8 ± 20.1 for laparoscopy vs. 49.9 ± 20.1 for open surgery, p > 0.05), and longer in patients requiring re-intervention (68.6 ± 27.2 vs. 49.1 ± 19.3, p < 0.001). 76 re-interventions (2.05%) were carried out. The causes included postoperative infection (n = 46), intestinal obstruction (n = 20), dehiscence (n = 4), and others (n = 6). Re-intervention risk was not impacted by the baseline approach used (open surgery or laparoscopy, OR: 1.044, 95% CI: 0.57-1.9), but it was by appendicitis progression (7.8% advanced vs. 0.7% incipient, OR: 12.52, 95% CI: 6.18-25.3). There was a tendency to use the same approach both at baseline appendectomy and re-intervention. This occurred in 72.2% of laparoscopic appendectomies, and in 67.7% of open appendectomies. The minimally invasive approach (50/76) was more frequent than the open one (27 laparoscopies and 23 ultrasound-guided drainages vs. 26 open surgeries) (p < 0.05). 55% of obstruction patients underwent re-intervention through open surgery (p > 0.05). CONCLUSION: Re-intervention rate was higher in advanced appendicitis cases. In this series, the minimally invasive approach (laparoscopic or ultrasound-guided drainage) was the technique of choice for re-interventions.

INTRODUCCION: La apendicitis aguda es la causa más frecuente de abdomen agudo en niños. El objetivo de este trabajo es estudiar las causas, abordaje y resultados de las complicaciones que requieren intervención quirúrgica después de la apendicectomía. MATERIAL Y METODOS: Estudio retrospectivo de las apendicectomías realizadas en 3 centros de tercer nivel entre 2015-2019. Se recogieron las complicaciones, causas y número de reintervenciones, intervalo entre ambas cirugías, técnica empleada, hallazgos operatorios según la Clasificación de la American Association for the Surgery of Trauma (AAST) en la apendicectomía inicial y tiempo de ingreso. RESULTADOS: Se intervinieron 3.698 apendicitis, un 76,7% por vía laparoscópica, encontrando un 37,2% evolucionadas (grado II-V de la clasificación AAST). El tiempo medio quirúrgico fue de 50,4 minutos (laparoscopia 49,8 ± 20,1 vs. laparotomía 49,9 ± 20,1, p > 0,05), superior en aquellos pacientes que requirieron reintervención (68,6 ± 27,2 vs. 49,1 ± 19,3, p < 0,001). Se realizaron 76 reintervenciones (2,05%). Las causas fueron: infección postoperatoria (n = 46), obstrucción intestinal (n = 20), dehiscencia (n = 4) y otras (n = 6). El abordaje inicial no influyó en el riesgo de reintervención (laparotomía o laparoscopia, OR 1,044, IC 95% 0,57-1,9), pero sí el grado de evolución de la apendicitis (7,8% evolucionadas vs. 0,7% incipientes, OR 12,52, IC 95% 6,18-25,3). Hubo una tendencia a reintervenir por el mismo abordaje que la apendicectomía, esto ocurrió en un 72,2% de las apendicectomías laparoscópicas y en un 67,7% de las apendicectomías abiertas. El abordaje mínimamente invasivo (50/76) fue más frecuente que la laparotomía (27 laparoscopias y 23 drenajes ecoguiados frente a 26 laparotomías) (p < 0,05). El 55% de los pacientes obstruidos se reintervinieron por vía abierta (p > 0,05). CONCLUSION: El índice de reintervención fue superior en las apendicitis evolucionadas. En esta serie, el abordaje mínimamente invasivo (laparoscópico o drenaje ecoguiado) fue la técnica de elección en las reintervenciones.

Reintervenciones tras apendicectomía en niños. Estudio multicéntrico / Re-interventions following appendectomy in children: a multicenter study

Introducción: La apendicitis aguda es la causa más frecuente deabdomen agudo en niños. El objetivo de este trabajo es estudiar lascausas, abordaje y resultados de las complicaciones que requieren in-tervención quirúrgica después de la apendicectomía.Material y métodos: Estudio retrospectivo de las apendicectomíasrealizadas en 3 centros de tercer nivel entre 2015-2019. Se recogieronlas complicaciones, causas y número de reintervenciones, intervalo entreambas cirugías, técnica empleada, hallazgos operatorios según la Clasi-ficación de la American Association for the Surgery of Trauma (AAST)en la apendicectomía inicial y tiempo de ingreso.Resultados: Se intervinieron 3.698 apendicitis, un 76,7% por víalaparoscópica, encontrando un 37,2% evolucionadas (grado II-V de laclasificación AAST). El tiempo medio quirúrgico fue de 50,4 minutos(laparoscopia 49,8 ± 20,1 vs. laparotomía 49,9 ± 20,1, p > 0,05), superioren aquellos pacientes que requirieron reintervención (68,6 ± 27,2 vs.49,1 ± 19,3, p < 0,001).Se realizaron 76 reintervenciones (2,05%). Las causas fueron: infec-ción postoperatoria (n = 46), obstrucción intestinal (n = 20), dehiscencia(n = 4) y otras (n = 6). El abordaje inicial no influyó en el riesgo dereintervención (laparotomía o laparoscopia, OR 1,044, IC 95% 0,57-1,9),pero sí el grado de evolución de la apendicitis (7,8% evolucionadas vs.0,7% incipientes, OR 12,52, IC 95% 6,18-25,3).Hubo una tendencia a reintervenir por el mismo abordaje que laapendicectomía, esto ocurrió en un 72,2% de las apendicectomías lapa-roscópicas y en un 67,7% de las apendicectomías abiertas. El abordajemínimamente invasivo (50/76) fue más frecuente que la laparotomía(27 laparoscopias y 23 drenajes ecoguiados frente a 26 laparotomías)(p < 0,05). El 55% de los pacientes obstruidos se reintervinieron porvía abierta (p > 0,05).

Introduction: Acute appendicitis is the most frequent cause ofacute abdomen in children. The objective of this study was to analyzethe causes, approach, and results of complications requiring surgeryfollowing appendectomy.Materials and methods: A retrospective study of the appendecto-mies conducted in three third-level institutions from 2015 to 2019 wascarried out. Complications, causes, and number of re-interventions, timefrom one surgery to another, surgical technique used, operative findingsat baseline appendectomy according to the American Association forthe Surgery of Trauma (AAST) classification, and hospital stay werecollected.Results: 3,698 appendicitis cases underwent surgery, 76.7%of which laparoscopically, with 37.2% being advanced (grades II-Vof the AAST classification). Mean operating time was 50.4 min-utes (49.8 ± 20.1 for laparoscopy vs. 49.9 ± 20.1 for open surgery,p > 0.05), and longer in patients requiring re-intervention (68.6 ± 27.2vs. 49.1 ± 19.3, p < 0.001).76 re-interventions (2.05%) were carried out. The causes includedpostoperative infection (n = 46), intestinal obstruction (n = 20), dehis-cence (n = 4), and others (n = 6). Re-intervention risk was not impactedby the baseline approach used (open surgery or laparoscopy, OR: 1.044,95% CI: 0.57-1.9), but it was by appendicitis progression (7.8% ad-vanced vs. 0.7% incipient, OR: 12.52, 95% CI: 6.18-25.3).There was a tendency to use the same approach both at baseline ap-pendectomy and re-intervention. This occurred in 72.2% of laparoscopicappendectomies, and in 67.7% of open appendectomies. The minimallyinvasive approach (50/76) was more frequent than the open one (27laparoscopies and 23 ultrasound-guided drainages vs. 26 open surger-ies) (p < 0.05). 55% of obstruction patients underwent re-interventionthrough open surgery (p > 0.05).

Valorization of Wastewater from Table Olives: NMR Identification of Antioxidant Phenolic Fraction and Microwave Single-Phase Reaction of Sugary Fraction.

The table olive industry is producing a huge amount of wastewater, which is a post-processing cost and an environmental concern. The present study aims to valorize this processing by-product to obtain a value-added product, thereby enhancing resource efficiency and contributing to achieving sustainable development goals (SDGs). In this sense, a chemical reaction-based platform was developed to obtain valuable components, such as levulinic acid (LA) and 5-hydromethylfurfural (HMF). The products were then analyzed using NMR identification of the antioxidant phenolic fraction and microwave single-phase reaction of the sugary fraction. According to the results, the highest concentration of phenolic compounds does not correspond to the sample directly obtained from NaOH treatment (S1), indicating that water washing steps (S2-S5) are fundamental to recover phenolic substances. Moreover, glucose was presented in the sugary fraction that can be transformed into levulinic acid by a single-phase reaction under microwave irradiation. The information provided in this manuscript suggests that the wastewater from the olive processing industry can be valorized to obtain valuable products.

Crude and acid oils from olive pomace as alternative fat sources in growing-finishing pigs.

The inclusion of crude and acid oils from olive pomace can lead to more unsaturated meat products and, especially in the case of olive pomace acid oil, achieve a more economically and environmentally sustainable swine production. The objective of this trial was to study the effect of dietary supplementation with crude and acid oils from olive pomace, which are rich in monounsaturated fatty acids (FAs) and have differing free FA content, on growth performance, digestibility, carcass parameters and FA profile of Longissimus muscle (LM) and backfat in growing-finishing pigs compared to the conventional crude palm oil. A total of 224 male and female pigs [(Landrace × Large White) × Duroc] were randomly distributed into 48 pens according to initial BW (58.7 ± 9.71 kg, mean ± SD) and sex. Four experimental treatments were randomly assigned (n = 12 pens/treatment; 4-5 pigs/pen) for the growing (0-42 days) and finishing (40-62 days) phases. Treatments consisted of a basal diet supplemented with 5% (as-fed basis) palm oil (PO), olive pomace oil (O), olive pomace acid oil (OA) or a mixture (M) of PO and OA at 50/50. No differences were found in the growth performance results between PO, O or M, but animals fed OA showed a lower gain to feed ratio than M (P = 0.008). No differences were found in apparent ileal digestibility among treatments, however, animals fed O and OA showed the highest values of total FA apparent total tract digestibility, while those fed PO had the lowest values, and M had intermediate values (P < 0.001). No differences were observed in carcass composition among treatments. In relation to backfat and the LM FA profile, O and OA treatments led to a higher unsaturated FA to saturated FA ratio and a lower content in saturated FA than PO. Moreover, O showed a higher intramuscular fat (IMF) content in LM than PO (P = 0.037). It is concluded that olive pomace oil is an interesting alternative fat source that can be included at 5% in growing-finishing pig diets, leading to meat products with more IMF, rich in monounsaturated FA, reaching high FA digestibility values and good pig performance parameters. Alternatively, olive pomace acid oil blended with conventional palm oil did not negatively impact fat utilisation nor performance. Including these fat by-products reduced feeding costs and led to a more efficient and environmentally sustainable production.

Predictors of attrition among adults in a rural HIV clinic in southern Mozambique: 18-year retrospective study.

HIV remains a major cause of morbidity and mortality for people living in many low-income countries. With an HIV prevalence of 12.4% among people aged over 15 years, Mozambique was ranked in 2019 as one of eight countries with the highest HIV rates in the world. We analyzed routinely collected data from electronical medical records in HIV-infected patients aged 15 years or older and enrolled at Carmelo Hospital of Chokwe in Chokwe from 2002 to 2019. Attrition was defined as individuals who were either reported dead or lost to follow-up (LTFU) (≥ 90 days since the last clinic visit with missed medical pick-up after 3 days of failed calls). Kaplan-Meier survival curves and Cox regression analyses were used to model the incidence and predictors of time to attrition. From January 2002 to December 2019, 16,321 patients were enrolled on antiretroviral therapy (ART): 59.2% were women, and 37.9% were aged 25-34 years old. At the time of the analysis, 7279 (44.6%) were active and on ART. Overall, the 16,321 adults on ART contributed a total of 72,987 person-years of observation. The overall attrition rate was 9.46 per 100 person-years. Cox regression showed a higher risk of attrition in those following an inpatient regimen (hazard ratio [HR] 3.18, 95% confidence interval [CI] 2.89-3.50; p < 0.001), having CD4 counts under 50 cells/µL (HR 1.91, 95% CI 1.63-2.24, p < 0.001), receiving anti-TB treatment within 90 days of ART initiation (HR 6.53, 95% CI 5.72-7.45; p < 0.001), classified as WHO clinical stage III (HR 3.75, 95% CI 3.21-4.37; p < 0.001), and having Kaposi's sarcoma (HR 1.99, 95% CI 1.65-2.39, p < 0.001). Kaplan-Meier analysis showed that patients with CD4 counts of less than 50 cells/µL on ART initiation had a 40% lower chance of survival at 18 years. Low CD4 cell counts, ART initiation as an inpatient, WHO clinical stage III, and anti-tuberculosis treatment within 90 days of ART initiation were strongly associated with attrition. Strengthening HIV testing and ART treatment, improving the diagnosis of tuberculosis before ART initiation, and guaranteed psychosocial support systems are the best tools to reduce patient attrition after starting ART.

Facilitation and plant phenotypic evolution.

While antagonistic interactions between plants have been a major topic of eco-evolutionary research, little evidence exists on the evolution of positive plant interactions (i.e., plant facilitation). Here, we first summarize the existing empirical evidence on the role of facilitation as a selection pressure on plants. Then, we develop a theoretical eco-evolutionary framework based on fitness-trait functions and interaction effectiveness that provides predictions for how facilitation-related traits may evolve. As evolution may act at levels beyond the individual (such as groups or species), we discuss the subject of the units of evolutionary selection through facilitation. Finally, we use the proposed formal evolutionary framework for facilitation to identify areas of future research based on the knowledge gaps detected.

Constructed pine log piles facilitate plant establishment in mining drylands.

Ecological facilitation, though accepted as a main mechanism of plant community assembly, is just starting to be utilized in restoration programmes. Constructing nurse objects that mimic the effect of natural nurse species can be an option to trigger plant nucleation processes in disturbed stressful ecosystems. We hypothesized that arranged log piles might imitate plant facilitation by alleviating abiotic stress and expanding the regeneration niche of beneficiary species, eventually promoting plant establishment, fitness and diversity. With this aim, within a pilot restoration programme in abandoned mining structures in SE Spain where climatic and edaphic stresses concur, we constructed 133 pine log piles from natural wastes generated by local silvicultural activities. We monitored 51 of them plus their adjacent open areas for 15 months, measuring soil temperature, radiation and humidity. We recorded natural seedling establishment, plant nutritional status and heavy metal accumulation. We further performed a seed sowing experiment to investigate how log piles affect plant taxonomic and functional diversity based on 11 establishment and phytostabilization traits. Pine log piles significantly softened microclimatic conditions and accelerated plant establishment in unfertile and metal-polluted mining substrates, simultaneously capturing water, providing shade and pine seeds. Plant communities that naturally established beneath the piles were 15 times denser and five times taxonomically more diverse than those in open areas, despite being skewed towards pine recruitment. Experimental communities sown under log piles were also 1.4 times functionally more diverse, as theory predicts for relaxed abiotic conditions. Log piles improved seedling nutritional status, in terms of P and K content, at the cost of increased metal accumulation. At the landscape scale, nurse objects triggered plant establishment promoting taxonomic and functional diversity in extremely stressful environments. This study exemplifies how soft restoration tools can be based on mechanisms that are widely accepted in the ecological theory.

Early graft dysfunction after liver transplant: Comparison of different diagnostic criteria in a single-center prospective cohort.

OBJECTIVE: Comparison of different diagnostic criteria for early liver allograft dysfunction (EAD) and their capability to predict mortality. DESIGN: Single-center, prospective, cohort study. SETTINGS: ICU in a Regional Hospital with a liver transplant program since 1997. PATIENTS: 253 consecutive patients admitted to our ICU immediately after liver transplantation between 2009 and 2015. VARIABLES OF INTEREST: Differences in the incidence of EAD and its relation with ICU, Hospital and 2-year mortality depending on the definition applied using as comparator the UNOS (United Network for Organ Sharing) primary non-function criterion. RESULTS: The incidence of early liver allograft dysfunction according to UNOS was 13.8%, to Makowka 6.3%, to Ardite 10.7%, to Nanashima 20.6%, to Dhillon 30.8% and to MEAF 13.4%. Kappa test did not show a good correlation among these criteria. EAD was related with ICU mortality for all diagnostic criteria except Dhillon but only UNOS, Makowka and MEAF were associated with 2-year mortality. Hospital mortality was poorly predicted by all criteria except for the MEAF score. CONCLUSION: We found a poor agreement between different criteria analyzed for the diagnosis of EAD. In our population, the MEAF score showed the best relationship with short- and long-term mortality.

Tuberculosis Treatment Outcomes Among Children in Rural Southern Mozambique: A 12-year Retrospective Study.

BACKGROUND: Globally, tuberculosis (TB) remains a serious cause of morbidity and mortality for children. Mozambique is 1 of 30 high TB and TB/HIV burden countries. This study aimed to assess treatment outcomes of childhood TB in Chókwè District, Mozambique. METHODS: A retrospective cohort study of children <15-years-old treated for TB from 2006 to 2017 was conducted at Carmelo Hospital of Chókwè. Descriptive statistics were used to summarize patient characteristics. Treatment outcomes stratified by HIV status were compared with χ. Multivariable logistic regression was used to estimate the odds of a favorable TB treatment outcome. Kaplan-Meier curves were used to estimate the cumulative incidence of death. RESULTS: Nine hundred thirty-three cases of childhood TB were enrolled, 45.9% of which were female and 49.6% were <5-years-old. Five hundred sixty-five (62%) children were HIV positive. Seven hundred sixty-two (83.6%) cases had a favorable TB treatment outcome. In comparison to children 0-4 years, the 5-14 age group had a higher odds of a favorable outcome [odds ratio: 2.02, 95% confidence interval: 1.42-3.05]. Being 5-14 years was associated with lower risk of death (hazard ratio: 0.435; 95% confidence interval: 0.299-0.632). Those starting anti-TB treatment ≤3 months after antiretroviral therapy initiation had a survival probability of approximately 75% at 1 year compared with 95% for those who were HIV negative. CONCLUSIONS: Most children in this cohort had favorable TB treatment outcomes. Worse outcomes were observed for younger children and if anti-TB treatment started ≤3 months after initiation of antiretroviral therapy. Rigorous screening for TB and isoniazid preventative therapy may reduce the burden of TB in this population and lead to better outcomes.

[Efficacy of virtual reality on balance and gait in multiple sclerosis. Systematic review of randomized controlled trials]. / Eficacia de la realidad virtual sobre el equilibrio y la marcha en esclerosis multiple. Revision sistematica de ensayos controlados aleatorizados.

INTRODUCTION: Multiple sclerosis (MS) is a neurodegenerative disease that causes gait abnormalities and a deficit in balance control in the vast majority of people affected by it. Virtual reality has been proposed as a complementary approach to conventional physiotherapeutic treatment as a way of improving these variables. AIM: To assess the real efficacy of this approach compared to other neurorehabilitation therapies, or no intervention, in MS. PATIENTS AND METHODS: A systematic review of randomized controlled trials was conducted. Studies of the last five years that compare virtual reality with conventional treatment or no intervention, on balance and/or gait, in adults with MS, were included. PEDro scale was used to assess methodological quality and the Oxford scale to determine the level of evidence and grades of recommendations. RESULTS: Eight studies met the eligibility criteria. For balance, the efficacy of virtual reality is, at least, comparable as conventional training. For gait, virtual reality seems not to be superior in improving the speed, compared with the other types of interventions assessed. Methodological quality of studies was low-moderate. CONCLUSIONS: Virtual reality is as effective as conventional training for improving balance in people with MS. No data suggests that virtual reality is superior to other interventions in improving gait speed. For other gait parameters, virtual reality's efficacy remains unknown.

TITLE: Eficacia de la realidad virtual sobre el equilibrio y la marcha en esclerosis multiple. Revision sistematica de ensayos controlados aleatorizados.Introduccion. La esclerosis multiple (EM) es una enfermedad neurodegenerativa que produce alteraciones en el equilibrio y la marcha en la mayoria de los pacientes. La realidad virtual se ha propuesto como un abordaje complementario al tratamiento rehabilitador convencional como medio para mejorar dichas alteraciones. Objetivo. Evaluar la eficacia del abordaje mediante realidad virtual, en comparacion con otras intervenciones de neurorrehabilitacion o la no intervencion, en la EM. Pacientes y metodos. Se realiza una revision sistematica de ensayos controlados aleatorizados. Se incluyeron estudios de los ultimos cinco años que comparasen la intervencion de realidad virtual frente al tratamiento convencional o la no intervencion sobre el equilibrio y la marcha en personas adultas con EM. Se utilizo la escala PEDro para evaluar la calidad metodologica de los estudios incluidos y la escala de Oxford para evaluar el nivel de evidencia y el grado de recomendacion. Resultados. Ocho estudios cumplieron los criterios de elegibilidad. Para el equilibrio, la eficacia de la realidad virtual es, al menos, comparable a la del entrenamiento convencional. Para la marcha, la realidad virtual parece no ser superior en el parametro velocidad, en comparacion con el resto de intervenciones evaluadas. La calidad metodologica de los estudios fue moderada-baja. Conclusiones. La realidad virtual es igual de eficaz que el entrenamiento rehabilitador convencional para mejorar el equilibrio en personas con EM. No se han hallado datos que sugieran que la realidad virtual sea superior a otras intervenciones en la mejora de la velocidad de la marcha, y su eficacia sobre otros parametros de la marcha es aun incierta.

Lateral rectus muscle biopsy as diagnosis of unknown metastatic breast cancer. / Biopsia del músculo recto lateral orbitario como diagnóstico de cáncer de mama metastásico no conocido.

The case concerns a 58 year-old female with no medical history of interest who consulted due to binocular diplopia of one week onset. It was associated with costal pain, dyspnoea, intense asthenia and weight loss of 2 months onset. In the blood analysis in the Emergency Department it showed hypercalcaemia, renal failure, and bicytopenia. The chest x-ray showed lytic bone lesions that initially lead to multiple myeloma with extra-osseous involvement. In addition to the corresponding study, in case of horizontal diplopia, a cranial CT scan without contrast was performed where an adjacent lesion to the lateral wall of the left orbit is observed. This was of soft tissue density, and included the external rectus muscle that exerts a mass effect on the optic nerve by displacing it medially. Many lytic bone diffuse lesions with salt and pepper pattern were found in the calotte. A rectus lateral muscle and bone biopsy of the sacral wing was performed, resulting in metastasis of carcinoma compatible with mammary origin. An atypical case is presented of horizontal diplopia in the context of a patient with a severe constitutional picture with no established diagnosis, in which the biopsy of the lateral rectum was key to the confirmation diagnosis.

A nurse plant benefits from facilitative interactions through mycorrhizae.

Plant facilitation promotes coexistence by maintaining differences in the regeneration niche because some nurse species recruit under arid conditions, whereas facilitated species recruit under more mesic conditions. In one Mexican community, 95% of species recruit through facilitation; Mimosa luisana being a keystone nurse for many of them. M. luisana individuals manifest greater fitness when growing in association with their facilitated plants than when growing in isolation. This observation suggests that nurses also benefit from their facilitated plants, a benefit thought to be mediated by mycorrhizal fungi. Under field conditions, we experimentally tested whether mycorrhizal fungi mediate the increased fitness that M. luisana experiences when growing in association with its facilitated plants. We applied fungicide to the soil for nurse plants growing alone and growing in association with their facilitated plants in order to reduce the mycorrhizal colonisation of roots. We then assessed the quantity and quality of seed production of M. luisana in four treatments (isolated-control, isolated-fungicide, associated-control and associated-fungicide). Fungicide application reduced the percentage root length colonised by mycorrhizae and reduced fitness of M. luisana when growing in association with their facilitated plants but not when growing in isolation. This reduction was reflected in the total number of seeds, number of seeds per pod, seed mass and seed viability. These results suggest that nurses benefit from the presence of their facilitated plants through links established by mycorrhizae, indicating that both plants and belowground mutualistic communities are all part of one system, coexisting by means of intrinsically linked interactions.

Aqueous humor misdirection syndrome after glaucoma filtering surgery in patient with bilateral acute iris transillumination (BAIT) syndrome. / Síndrome de misdirección del humor acuoso tras cirugía filtrante de glaucoma en paciente con síndrome de transiluminación aguda iridiana bilateral (BAIT).

CASE REPORT: Bilateral Acute Iris Transillumination (BAIT) is a disease characterised by bilateral acute, severe pigment dispersion of the iris, and pupil sphincter paralysis. The case is reported of a 51-year-old female who was diagnosed with BAIT syndrome, with refractory ocular hypertension in the left eye, and who needed filtering surgery. Aqueous misdirection was developed a week after surgery, then pars plana vitrectomy was performed and the complication was solved. CONCLUSION: This is the first case described in literature of aqueous humor misdirection syndrome secondary to glaucoma filtering surgery in a patient diagnosed of BAIT syndrome. This is a recently defined disease with a few cases currently described.

Peripapillar retinal hamartoma associated with tuberous sclerosis. Case report. / A propósito de un caso de hamartoma retiniano adyacente a cabeza de nervio óptico en un caso de esclerosis tuberosa.

INTRODUCTION: Tuberous sclerosis is a rare multisystemic disease with an autosomal dominant inheritance pattern. There are few documented cases in the literature of retinal hamartomas (astrocytomas) with aggressive progression in the context of this disease. CASE REPORT: A report is presented on a case of a 31 year-old male with unknown history of ophthalmic or systemic conditions, who referred to a history of 6 months of blurred vision in his right eye. This was caused by a unilateral retinal hamartoma due to an undiagnosed tuberous sclerosis. DISCUSSION: Multidisciplinary management, with the cooperation of Internal Medicine and the Oncology Department, is needed in these cases, as well as genetic counselling for affected patients. Complications are directly related to increased tumour size. Treatment does not seem to have any influence on the natural history of the disease.