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INTRODUCTION In the treatment of patients with acute bronchiolitis there is great variability in clinical practice. Treatments whose efficacy has not been demonstrated are frequently used despite the recommendations contained in the Clinical Practice Guidelines. MATERIAL AND METHODS A quality improvement strategy is implemented in the care of patients with acute bronchiolitis in the Emergency Department, which is maintained for five years and is periodically updated to be increasingly restrictive regarding the use of bronchodilators. To evaluate the impact of the intervention, a retrospective study of the rates of prescription of bronchodilators in children diagnosed with acute bronchiolitis in the month of December of four epidemic periods (2012, 2014, 2016 and 2018) was carried out. RESULTS 1767 children are included. There were no differences regarding age, respiratory rate, oxygen saturation or the estimated severity in each of the study seasons. The use of salbutamol in the Emergency Department decreased from 51.2% (95% CI: 46.6%-55.8%) in 2012 to 7.8% (95% CI: 5.7%-10.5%) in 2018 (P

Parasites can manipulate their hosts to increase their transmission success. Avian malaria parasites (Plasmodium) are thought to alter the cues such as host odour, used by host-seeking mosquitoes. Bird odour is affected by secretions from the uropygial gland and may play a role in modulating vector-host interactions. We tested the hypothesis that mosquitoes are more attracted to the uropygial secretions and/or whole-body odour (headspace) of Plasmodium-infected house sparrows (Passer domesticus) than to those of uninfected birds. We tested the attraction of nulliparous (e.g. uninfected mosquitoes without previous access to blood) Culex pipiens females towards these stimuli in a dual-choice olfactometer. We used Gas Chromatography-Mass Spectrometry (GC-MS) analyses to assess whether Plasmodium infection is associated with differences in the chemical composition of uropygial secretions. Mosquitoes were more attracted to the odours of infected than uninfected birds, regardless of sex. However, the significant interaction between infection status and the stimuli (uropygial secretion or headspace) showed that mosquitoes were more attracted to the headspace of infected birds; no differences were found in the case of uropygial secretions. The compounds in the volatile lipophilic fraction of the uropygial secretion did not differ between infected and uninfected birds. These results support the host manipulation hypothesis since avian Plasmodium parasites may be capable of altering their host's body odour, thereby making infected individuals more attractive to mosquitoes.

Polluted soil is an important source of exposure to potentially toxic elements (PTEs) for humans, especially in urban areas. We studied the fate of PTEs in the total (

Puntos para una lectura rapida • El infradiagnostico de la EPOC ha aumentado y se situa actualmente en torno al 81%. • El factor de riesgo principal para desarrollar EPOC es el tabaco, pero tambien hay que considerar otros, como la combustion de biomasa y ocupacionales. • Una prueba broncodilatadora positiva nos obliga a descartar asma y/o a valorar el solapamiento EPOC-asma (ACO, Asthma-COPD Overlap). Los pacientes con ACO deben ser valorados de forma diferente. • Se ha de hacer una valoracion multidimensional (sintomas, gravedad de la obstruccion y riesgo futuro, exacerbaciones y comorbilidades), segun la cual clasificaremos y trataremos la EPOC. • Se recomienda generalmente comenzar el tratamiento farmacologico con un broncodilatador de larga duracion, y si no hay mejoria, asociar la doble broncodilatacion. Si persiste, valorar segun fenotipos o clinica predominante. • La mayor utilidad de los corticoides inhalados es en pacientes con alto riesgo de exacerbar y eosinofilia ≥ 300 cel/μl. • En pacientes no exacerbadores que no responden a la doble broncodilatacion se puede valorar anadir teofilinas. • En pacientes exacerbadores con bronquitis cronica que no responden a la doble broncodilatacion se puede valorar anadir corticoides inhalados, roflumilast, mucoliticos o macrolidos. • En pacientes exacerbadores con enfisema que no responden a la doble broncodilatacion se puede valorar anadir corticoides inhalados, mucoliticos o macrolidos. • El fenotipo EPOC-asma debe comenzar siempre el tratamiento con un corticoide inhalado asociado a un LABA.

Introduction Total pancreatectomy (TP) is an uncommon operation, with indications that have not been clearly defined and non-standardized postoperative results. We present a national multicentric study on TP and a comparison with the existing literature. Methods A prospective observational study using data from the national registry of patients after pancreaticoduodenectomy and TP performed for any indication during the study period: January 1–December 31, 2015. Results 1016 patients were included from 73 hospitals, 112 of whom had undergone TP. The percentage of TP from the total number of cases was 11%. The mean age was 63.5 years, and 57.2% were males. The most frequently suspected radiological diagnosis was pancreatic cancer (58/112 cases). The most common TP technique was “mesentery artery first” (43/112 cases). Venous resections were performed in 23 patients (20.5%). The percentage of postoperative complications within 90 days was 50%, but major complications (>IIIA) were only 20.7%. The overall 90-day mortality was 8% (9 patients). The average stay was 20.7 days. The 3 most frequent definitive histological diagnoses were: adenocarcinoma of the pancreas, intraductal papillary mucinous neoplasm and chronic pancreatitis. The R0 rate was 67.8%. Conclusions This study shows that the morbidity and mortality results of TP in Spain are similar or superior to previous publications. More precise TP studies are necessary, focused on specific complications such as endocrine insufficiency.

Resumen Introduccion La pancreatectomia total (PT) es una intervencion infrecuente, con unas indicaciones no claramente definidas y unos resultados postoperatorios no estandarizados. Presentamos un estudio multicentrico nacional sobre PT y una comparacion con la literatura existente. Metodos Estudio prospectivo observacional realizado mediante el registro nacional de pacientes operados de duodenopancreatectomia cefalica y PT realizadas por cualquier indicacion durante el periodo comprendido entre el 1 enero y el 31 diciembre del 2015. Resultados Se incluyo a 1.016 pacientes, pertenecientes a 73 centros; de ellos, 112 correspondian a PT. El porcentaje de PT/numero total de casos es del 11%. La edad media fue 63,5 anos y eran varones un 57,2%. El diagnostico radiologico de sospecha mas frecuente fue cancer de pancreas (58/112 casos). La tecnica de la PT mas habitual fue «arteria mesenterica primero» (43/112 casos). Se efectuaron resecciones venosas en 23 pacientes (20,5%). El porcentaje de complicaciones postoperatorias a 90 dias fue 50%, pero las complicaciones mayores (> IIIA) solo el 20,7%. La mortalidad global a 90 dias fue del 8% (9 pacientes). La estancia media fue 20,7 dias. Los 3 diagnosticos histologicos definitivos mas frecuentes fueron: adenocarcinoma de pancreas, neoplasia mucinosa papilar intraductal y pancreatitis cronica. La tasa de R0 fue del 67,8%. Conclusiones Este estudio demuestra que los resultados de morbimortalidad de la PT en Espana son similares o superiores a los publicados previamente. Es necesario un estudio mas especifico sobre PT centrado en complicaciones especificas, como la insuficiencia endocrina.

We thank Ms. I. Martinez Segura and Mr. M.J. Roman Alpiste for their assistance in laboratory work. Additionally, Dr. A. Parviainen acknowledges the `Juan de la Cierva-Incorporaci ' on' fellowship (grant number IJCI-2016-27412); and Dr. J.P. Arrebola acknowledges the Ram ' on y Cajal program (grant number RYC-2016-20155) from the Spanish Ministry of Science, Innovation and Universities. Research performed at the UGR was supported by the Project RTI 2018-094327-B-I00, funded by the Ministry of Science, Innovation and Universities. The European Regional Development Fund (ERFD) and the European Social Fund (ESF) of the European Commission (co)funded the fellowships, research and infrastructure endeavors involved in this research performed at the Instituto Andaluz de Ciencias de la Tierra (UGR-CSIC)., We studied the chemical composition of As and Pb in total (, 'Juan de la Cierva-Incorporacion' fellowship IJCI-2016-27412, Spanish Government RYC-2016-20155, Ministry of Science, Innovation and Universities RTI 2018-094327-B-I00, European Regional Development Fund (ERFD) of the European Commission European Social Fund (ESF) of the European Commission

Mutations in the POMT1 gene, encoding a protein O-mannosyltransferase essential for alpha-dystroglycan (α-DG) glycosylation, are frequently observed in a group of rare congenital muscular dystrophies, collectively known as dystroglycanopathies. However, it is hitherto unclear whether the effects seen in affected patients can be fully ascribed to α-DG hypoglycosylation. To study this, we here used comparative mass spectrometry-based proteomics and immunofluorescence microscopy, in order to investigate the changes in retina of mice in which Pomt1 is specifically knocked out in photoreceptor cells. Our results demonstrate significant proteomic changes and associated structural alteration in photoreceptor cells of Pomt1 cKO mice. In addition to effects related to impaired α-DG O-mannosylation, we observed morphological impairments that are associated with downregulation of a relatively understudied POMT1 substrate, KIAA1549, and with retinal stress. In conclusion, our study provides new hypotheses to explain the phenotypic changes that are observed in the retina of patients with dystroglycanopathies.

In the Gulf of Mexico (GoM), the upper 300 m of the water column contains a mixture of water types derived from water masses from the North Atlantic and the Caribbean Sea, namely Caribbean Surface Water (CSW), Subtropical Underwater (SUW), Gulf Common Water (GCW), and Tropical Atlantic Central Water (TACW). These are mainly altered by mesoscale processes and local evaporation, which modulate biogeochemical cycles. In this study, we improve our understanding of water mass dynamics by including biogeochemical data when evaluating the T-S relationship to define water-mass boundaries, particularly when the observed thermohaline characteristics overlap. The variables considered were apparent oxygen utilization (AOU), nitrate, and dissolved inorganic carbon (DIC). The data were obtained from eight cruises carried out in the central and southern regions of the GoM and an additional cruise that covered the entire coastal-ocean region. The new proposed boundaries were instrumental in clarifying the dynamics of surface waters. Of note, GCW on the western side of the GoM is not formed from the mixing of CSW and SUW but by the mixing of remnant CSW with TACW. In winter, a remnant of CSW mixed with GCW, and the biogeochemical composition of surface waters was affected, as observed from an increase in nitrate and DIC concentrations and positive AOU values. CSW was mainly detected at the surface during summer with negative AOU values, low DIC values, and almost undetectable nitrate concentrations. The presence or absence of CSW modulated the depth of the nitracline and likely influenced primary productivity.

Objective Acute interstitial pneumonia (AIP) is a severe disease of unknown etiology. Pneumocystis jirovecii is an atypical opportunistic fungus able to colonize patients with chronic pulmonary disease and inducing alveolar macrophage activation. The aim of this study was to evaluate the possible association between Pneumocystis jirovecii and AIP. Subjects and methods The presence of P. jirovecii in bronchoalveolar lavage fluid in the four confirmed cases of AIP identified in a tertiary-care hospital over a period of 9 years was studied using a 2-step nested-PCR protocol assay. Results P. jirovecii was identified in the four cases. None of them had HIV infection. Two of the patients were treated empirically with trimethoprim-sulfamethoxazole, the only survivor was being one of them. Conclusions Our data suggest that Pneumocystis could trigger or favor the development of AIP. Further studies are needed to evaluate the role of the pathogen in the physiopathology of this disease.

This empirical study aims to minimize the travel time of motor vehicles on one of the most important avenues in Celaya City, Guanajuato, Mexico, by means of the optimal synchronization of existing traffic lights. In the optimization process, the following three factors are considered with 3 evaluation levels each: traffic light cycle times; the synchrony defined as staggered, parallel and actual; and the speed limit. The response variables to consider were the average time in the system, the fuel consumption and the greenhouse effect gas (CO2) emissions. Different experiments were performed using the simulation model developed in the PTV-VISSIM software, which represents the vehicle traffic system. The obtained results for the different proposed scenarios allow proper levels to be determined for vehicle traffic system operation to improve mobility, reduce contamination rates and decrease fuel consumption for different motor vehicles using the avenue. As a result, it was possible to establish a methodology that combines microsimulation and design of experiments to program traffic lights and define the operating conditions of a complex vehicular flow system.

Characterization of clay-drug hybrid materials for antibacterial applications using montmorillonite (MMT) and chlorhexidine diacetate (CA) has been reported; however, antibacterial clays based on palygorskite (PLG) have not been explored. Organoclays based on MMT (a laminar clay) and palygorskite (a microfibrous clay), are expected to differ in their chlorhexidine release profiles as the relevance of a specific mechanism depends on several factors. Therefore, CA was incorporated at various concentrations (50, 100 and 200% of Cation Exchange Capacity, CEC) and the resulting organoclays were characterized by Energy-dispersive X-ray spectroscopy (EDS), Fourier transform infrared spectroscopy (FTIR), X-Ray Diffraction (XRD), and Thermogravimetric Analysis (TGA). In addition, in vitro release studies of CA from organoclays were carried out in phosphate buffered saline (PBS) media. EDS FTIR and TGA results confirmed that CA was successful incorporated into these nanoclays. XRD patterns of CA/MMT show an increase in d-spacing of MMT as CA concentration was increased suggesting CA intercalation within the MMT galleries; in contrast, the diffraction peak of CA/PLG remained unchanged upon the CA modification. The drug release studies showed an initial burst release within the first 5 h and then a sustained release of CA up 24 h. CA released from MMT system was higher that observed for PLG ones.

espanolObjetivo Evaluar la reproductibilidad de la tecnica del ganglio centinela (GC) en el cancer de mama en el varon. Material y metodos Analizamos retrospectivamente a 21 pacientes varones diagnosticados de cancer de mama en nuestro hospital desde 2008 hasta 2016, con un seguimiento de al menos 18 meses. A 15 pacientes se les realizo la biopsia selectiva de ganglio centinela (BSGC) siguiendo los protocolos habituales con inyeccion de 74-111 MBq de 99mTc-nanocoloides peritumoral y adquisicion de imagenes planares a las 2 h. En 2 casos fue necesaria la realizacion de SPECT/TC para la localizacion del GC. Para su analisis se usaron tecnicas anatomopatologicas de inmunohistoquimica o tecnicas moleculares (OSNA). Seis pacientes no se sometieron a la BSGC por presentar ganglios patologicos o enfermedad a distancia en el momento del diagnostico. Resultados La BSGC se practico en 15 pacientes. El GC fue negativo en 6 de estos, siendo positivo en los 9 restantes. Hubo 3 pacientes con BSGC positiva, pero dado el bajo numero de copias de ADN (OSNA) no se realizo linfadenectomia axilar. Si se llevo a cabo vaciamiento axilar en los 6 pacientes restantes, con resultado de 4 vaciamientos positivos y 2 que no mostraban extension de la enfermedad. Conclusiones Segun nuestra experiencia, la BSGC en los varones es una tecnica reproducible, util, segura y fiable, que evita la realizacion de linfadenectomias axilares innecesarias y previene la aparicion de efectos no deseados. EnglishObjective To evaluate the reproducibility of the sentinel lymph node (SLN) technique in male breast cancer. Material and methods We retrospectively analysed 21 male patients diagnosed with breast cancer in our hospital from 2008 to 2016 with, at least, 18 months follow-up. Fifteen patients underwent selective sentinel lymph node biopsy (SLNB) following the usual protocols with peritumoral injection of 18.5-111 MBq of 99mTc-nanocoloides and acquisition of planar images 2 hours after the injection. In 2 cases it was necessary to perform a SPECT/CT to locate the SLN. Immunohistochemistry and molecular techniques (OSNA) were used for their analysis. Six patients did not undergo SLNB because they had pathological nodes or distant disease at the time of diagnosis. Results SLNB was performed in 15 patients. The SLN was negative in 6 patients and positive in the remaining 9. Three patients with positive SLNB did not need axillary lymphadenectomy because of the low number of copies by molecular analysis OSNA. Axillary lymphadenectomy was performed in the remaining 6 patients with the result of 4 positive axillary lymphadenectomies and 2 that did not show further extension of the disease. Conclusions According to our experience, SLNB in males is a reproducible, useful, safe and reliable technique which avoids unnecessary axillary lymphadenectomy and prevents the appearance of undesirable effects.

Resumen La patologia del pie y tobillo es una de las mas frecuentes del sistema musculoesqueletico y de gran repercusion en la calidad de vida de los pacientes. El diagnostico preciso supone un desafio clinico importante debido a que la compleja anatomia y la funcion del pie dificultan la localizacion del origen del dolor por un examen clinico de rutina. En el estudio de la patologia del pie se han utilizado tecnicas anatomicas (radiografia, resonancia magnetica [RM], ultrasonido y tomografia computarizada [TC]) y funcionales (gammagrafia osea [GO], tomografia de emision de positrones [PET] y RM). La imagen hibrida combina las ventajas de los estudios morfologicos y funcionales de forma sinergica, ayudando al clinico en la gestion de problemas complejos. En este articulo profundizamos en la anatomia y en la biomecanica del pie y tobillo y describimos las indicaciones potenciales de las tecnicas hibridas actuales disponibles para el estudio de la patologia del pie y tobillo.

Objective To evaluate the reproducibility of the sentinel lymph node (SLN) technique in male breast cancer. Material and methods We retrospectively analyzed 21 male patients diagnosed with breast cancer in our hospital from 2008 to 2016 with, at least, 18 months follow-up. Fifteen patients underwent selective sentinel lymph node biopsy (SLNB) following the usual protocols with peritumoral injection of 18.5–111 MBq of 99mTc-nanocoloides and acquisition of planar images 2 h after the injection. In 2 cases it was necessary to perform a SPECT/CT to locate the SLN. Immunohistochemistry and molecular techniques (OSNA) were used for their analysis. Six patients did not undergo SLNB because they had pathological nodes or distant disease at the time of diagnosis. Results SLNB was performed in 15 patients. The SLN was negative in 6 patients and positive in the remaining 9. Three patients with positive SLNB did not need axillary lymphadenectomy because of the low number of copies by molecular analysis OSNA. Axillary lymphadenectomy was performed in the remaining 6 patients with the result of 4 positive axillary lymphadenectomies and 2 that did not show further extension of the disease. Conclusions According to our experience, SLNB in males is a reproducible, useful, safe and reliable technique which avoids unnecessary axillary lymphadenectomy and prevents the appearance of undesirable effects.

The assessment of potential trace metal(loid) contamination in tailing dumps and soils was characterized in the Chadak mining area (Uzbekistan). Concentrations of trace elements (V, Cr, Co, Ni, Cu, Zn, As, Cd, Sb, Pb) were determined by X-ray fluorescence analysis and compared with background and intervention values (IV). The concentrations of As, Zn, Sb, and Pb were higher in the abandoned than in the active tailing dump, ranging from 42–1689 mg/kg for As, 73–332 mg/kg for Zn, 14–1507 mg/kg for Sb, and 27–386 mg/kg for Pb. Selective extractions were applied in order to assess the mobility and availability of trace metal(loid)s in samples. Oxyanion-forming elements such as As and Sb were immobilized by Fe oxides, although to some extent also extractable with acetic acid and soluble-in-water forms were detected, indicating potential bioavailability that can impose a potential toxicity risk for the environment. Selective extractions data also showed that Zn and Pb were relatively immobile, although in higher contamination sites significant amounts of these elements were also extractable with acetic acid. In tailing materials Zn and Pb mobility were negatively correlated by the cation-exchange capacity (CEC) and clay content, indicating the importance of these factors in the reduction of the potential toxicity for these elements. Total concentration of As, Sb, and Pb were also negatively correlated with soil pH, indicating that the oxidation process of sulphide tailings and thus the generation of acidic conditions may lead to release of contaminants over time. However, due to the calcium carbonate content, the acid neutralization capacity of the tailings is not yet exhausted and contaminant concentrations in soil-pore water are still relatively low. The results of our investigation suggest that environmental risk associated with these wastes in semi-arid climate is therefore not a short-term problem but rather requires constant monitoring and additional ecotoxicological studies.

Evidence from previous studies shows that in undergraduate programs, the highest rates of academic failure are in mathematics courses, especially in engineering programs. To reduce the failure rate, professors use several instructional strategies and information technologies. In this paper, a scoping review protocol is presented, based on the framework proposed by Arksey and O’Malley (2005), to answer the following research questions: 1) What are the instructional strategies that have been most successfully used for teaching mathematics at the undergraduate level? and 2) Which information technologies have been used to implement these instructional strategies? The scoping review was performed through three electronic databases: SCOPUS, ERIC and JSTOR.

In the last ten years our knowledge about the formation of traffic jams has changed substantially, so that the idea of "phantom traffic jam" could soon seem naive to us. But transforming traffic flows and eliminating traffic jams requires that each individual driver (human or non-human) understands their role in traffic flows, the genesis of traffic jams, and how to behave to avoid them. Based on previous studies we have termed this adaptive, anti-jam behavior Wavedriving. This paper presents the design and structure of an online WaveDriving course (WDC) conceived to teach to avoid traffic jams, as well as its first pilot tests. Although some improvements have been identified after the pilots, the preliminary results confirm that the WDC manages to transform car-following behavior of participants, from ordinary drivers to WaveDrivers.

The purpose of this study is twofold. First, to adapt and validate a two-factor model of Body Change Inventory to the Spanish context, in order to measure the orientation towards thin body and orientation towards muscular body. The second aim is to analyse the sociocultural stereotypes towards thinness and muscular body according to the sex variable combined with the discrepancy with the current weight. The sample consisted of 1022 students (488 girls and 534 boys) between 9 and 12 years old (female: mean = 10.41, SD = .66, males: mean = 10.47, SD = .68). An analysis was performed on the psychometric properties of the scale using different tests that enabled it to be considered as a valid and reliable tool. The results of variance analysis showed that both girls and boys intend to lose weight in the search for the thin body ideal, while more boys are pursuing a muscular body, regardless of whether they intend to lose, gain, or maintain weight.