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Our aim was to investigate the oviduct environment by studying oviduct gene expression after undernutrition in day-5 pregnant ewes with different initial (i) BCS, and its association with the number of embryos recovered. Thirty-six ewes were divided into 2 groups with different iBCS: iBCS ≥2.75 (n = 19; high, H) and iBCS ≤2.25 (n = 17; low, L), and were randomly assigned to two nutritional treatments for 20 days: 1.5 (control, C) or 0.5 (underfed, U) times the daily maintenance requirements. Thus, the final four groups were: high-iBCS control (HC, n = 9), high-iBCS underfed (HU, n = 10), low-iBCS control (LC, n = 9) and low-iBCS underfed (LU, n = 8). Samples of oviduct were collected and the expression of target genes was quantified using real-time PCR. While high-iBCS control ewes presented more ADIPOR1 mRNA than the high-iBCS underfed group (P 0.05) and low-iBCS control ewes (P = 0.01), high-iBCS underfed group presented higher ADIPOR2 gene expression than low-iBCS underfed ewes (P 0.01) evidencing a differential oviductal gene expression for these receptors. In high-iBCS ewes, control animals presented higher IGFBP2 gene expression than underfed ewes (P 0.05), associated these results with a poor oviductal environment. High-iBCS underfed ewes presented higher IGFBP4 gene expression than high-iBCS control ewes (P 0.05). Stepwise regression models, using various combinations of data on metabolic and reproductive hormones, and oviduct gene expression as independent variables, identified a set of variables that accounted for 75% of the variation in the number of embryos recovered. In conclusion, the oviductal gene expression depends on body reserves and nutritional treatment, and the effect is gene-specific.

Background: A dysregulated inflammatory response contributes to decline in patients with COVID-19. This cross-sectional study evaluated biomarkers of unvaccinated patients admitted to the intensive care unit of a hospital in Fortaleza, Brazil. Methods: Twenty cytokines were quantified upon hospital admission; clinical and laboratory data were analyzed, as well as sociodemographic data, to search for an association with clinical outcomes, including fatal (n = 40) or recovered cases (n = 38). Results: Fatal cases exhibited significantly higher levels of IL-18 (p = 0.009); deceased patients were older (p = 0.0001), had a lower number of platelets (p = 0.0063) and higher neutrophil–lymphocyte ratio (p = 0.0230) than those who recovered. Conclusion: These findings indicate that IL-18 is a possible marker to predict poor prognosis in critically ill patients with COVID-19.

With the recent advances in the object detection research field, tracking-by-detection has become the leading paradigm adopted by multi-object tracking algorithms. By extracting different features from detected objects, those algorithms can estimate the similarities and association patterns of objects along with successive frames. However, since similarity functions applied by tracking algorithms are handcrafted, it is difficult to use them in new contexts. In this study, it is investigated the use of artificial neural networks to learning a similarity function that can be used among detections. During training, multilayer perceptron (MLP) neural networks were introduced to correct and incorrect association patterns, sampled from a pedestrian tracking data set. For such, different motion and appearance feature combinations have been explored. Finally, a trained MLP has been inserted into a multiple-object tracking framework, which has been assessed on the MOT Challenge benchmark. Throughout the experiments, the proposed tracker matched the results obtained by state-of-the-art methods by scoring a tracking accuracy of 60.4%, while running 58% faster than DeepSORT, a recent and similar method used as a baseline. After all, this work demonstrates its method can be automatically trained for different tracking contexts and it has highly competitive cost-effectiveness for online real-time tracking applications.

Aim: To evaluate the prediction capacity of urinary biomarkers for death in critically ill patients with COVID-19. Methods: This is a prospective study with critically ill patients due to COVID-19 infection. The urinary biomarkers NGAL, KIM-1, MCP-1 and nephrin were quantified on ICU admission. Results: There was 40% of death. Urinary nephrin and MCP-1 had no association with death. Tubular biomarkers (proteinuria, NGAL and KIM-1) were predictors of death and cut-off values of them for death were useful in stratify patients with worse prognosis. In a multivariate cox regression analysis, only NGAL remains associated with a two-mount survival chance. Conclusion: Kidney tubular biomarkers, mostly urinary NGAL, had useful capacity to predict death in critically ill COVID-19 patients.

La ateroesclerosis es una enfermedad sistémica que afecta múltiples lechos vasculares. Después de períodos prolongados de progresión comienzan las manifestaciones clínicas, de forma aguda o crónica (infarto agudo de miocardio, angina estable, claudicación intermitente, enfermedad cerebrovascular, entre otras); por lo que puede cursar de manera subclínica en pacientes con enfermedad arterial coronaria. Lo interesante de esta forma de presentación es que dentro de una serie de casos con enfermedad multivaso, asociado a un índice tobillo-brazo (ITB) < 0,9, después de un síndrome coronario agudo, hemos encontrado, como hallazgo angiográfico, la presencia de una fístula coronaria a ventrículo derecho en un paciente con ITB muy bajo y clínica de claudicación intermitente. Esta fístula es la causa de los síntomas que interrumpieron la rehabilitación cardiovascular; es una enfermedad poco frecuente y causa de dolor torácico, que se informa solo de 0,3 a 0,8%, como hallazgo incidental en angiografías coronarias.

La calidad del aire de interiores (CAI) es determinante cuando se trata de la salud respiratoria y del confort de las personas. El objetivo de esta investigación se centró en evaluar el nivel de calidad del aire interior (CAI) a través de encuestas de percepción a usuarios y mediciones de temperatura, humedad relativa, PM10, PM2.5, CO2, CO, y HCHO en aulas de clase de una Institución de Educación Superior. Las encuestas a los ocupantes mostraron que la principal inconformidad percibida fue la alta temperatura del lugar, la cual osciló entre 19.9°C y 29 °C. La humedad relativa presentó valores entre 64.3 % y 93 %, superando el rango sugerido (30 - 60 %). La concentración máxima de PM10 (41 µg/m3) no superó el límite establecido por la ASHRAE (50 µg/m3), mientras que la concentración máxima de PM2.5 (21 µg/m3) sobrepaso el límite sugerido (15 µg/m3). Las concentraciones de los gases CO2 (998 ppm), CO (21 ppm), y HCHO (0.04 mg/m3) mostraron siempre valores inferiores a los límites estipulados por las diferentes entidades regulatorias.

One of the most outstanding plant species during the blooming of the Atacama Desert is the annual plant Cistanthe longiscapa. This plant can perform CAM photosynthesis, but the ecophysiological and molecular mechanisms that this plant uses to withstand the extreme conditions it inhabits in the field are unknown.Morphological and ecophysiological traits were studied and leaf samples at dawn/dusk times were collected from three sites distributed across an increasing south to north arid gradient, to evaluate CAM expression and transcriptomic differences, and search for links between photosynthetic path and abiotic response.Plants from the different sites presented significant differences in nocturnal leaf acid accumulation, isotopic carbon ratio (δ13C), succulence and other four traits that clearly indicated a spectrum of CAM photosynthesis intensity that correlated with aridity intensity. The differential gene expression analysis among Dawn vs Dusk between sampling sites showed higher gene expression in the arid northern site (3991 v/s 2293) with activation of regulatory processes associated with abscisic acid and circadian rhythm.The analysis highlights clear ecophysiological differences and the requirement of a strong rewiring of the gene expression to allow a transition from a weak into a strong CAM in C. longiscapa.

BackgroundA rapid transcriptional response under an acute stimulus is common in all cellular systems and is an adaptation that allows tolerance to environmental changes. A gene group that has been studied because of its fast response and cytoprotective effects are the hsp genes (encodingHeat Shock Proteins(HSPs), conserved chaperones).. Under normal conditions, the mRNA and protein levels of the main hsp genes are low but they increase rapidly upon heat shock (HS). This is achieved due to the presence of an RNA Polymerase II pausing complex located +30-50 bp from TSS. This complex maintains a partially synthesized RNA strand of said length, poised to resume synthesis, and undergoes subsequent transcriptional inactivation to restore transcript levels after environmental stabilization.MethodsThe Gal4/UAS system was used to modify dAxud1 expression in a tissue specific manner. A DAxud1-GFP fusion was expressed in salivary glands to perform polytene chromosome immunofluorescence and chromatin immunoprecipitation. DAxud1 genome occupancy data was achieved expressing Dam-DAxud1 in imaginal wing discs using Gal4/UAS (TaDa-seq).ResultsUsing TaDa-seq, we demonstrate that DAxud1 protein is present mainly near the TSS of significant occupied genes, most frequently in the first intron. This results also revealed DAxud1 is present in hsp genes, mainly in promoter zone. Following these results, we found that, under dAxud knockdown, larvae and adults flies have a diminished thermotolerance, despite showing an increase in hsp transcripts in larval tissues. We performed polytene chromosome immunofluorescence for DAxud1-GFP, revealing extensive, but dynamic localization on chromatin in hsp70 loci. This was confirmed with chromatin immunoprecipitation. We also found that DAxud1 overexpression leads to an enrichment of RNA Polymerase II at the 5’ end of the hsp70 gene, with a decrease in its transcripts. Importantly, we show interaction of DAxud1 with NELF-B, a component of the transcriptional pausing complex, and knockdown of both genes individually has similar effects on hsp70 transcription.ConclusionDAxud1 protein is a component of chromatin, that relocates under stress conditions such as heat shock, playing a role in maintaining RNA Polymerase II stalled at the 5’ of hsp70, possibly through a pausing mechanism based on its interaction with NELF-B.

Sugarcane agriculture contributes to the greenhouse effect by the polluting action of residue disposal, given that most sugarcane bagasse (SB) is burned. Because it is a low-cost fiber and ...

Resumen Objetivo Analizar una serie de cirugias de catarata realizadas en un hospital docente de tercer-cuarto nivel aportando datos complementarios al numero de cirugias que puedan servir como referencia a analisis posteriores y contrastar los resultados con los publicados en otros sistemas sanitarios publicos, fundamentalmente el britanico. Metodos Estudio retrospectivo sobre 1052 ojos intervenidos de catarata en el Hospital Clinico Universitario de Valladolid desde enero de 2016 a julio de 2016. Variables recogidas: edad, sexo, agudeza visual pre- y posquirurgica, grado de complejidad de la catarata, tiempo quirurgico, tasa y tipo de complicaciones quirurgicas. Resultados La edad media de los pacientes fue de 74,1±9,5 anos. El 81,61% partio de una AV Conclusiones Los resultados de la serie muestran diferencias importantes respecto a los aportados por la auditoria del Sistema de Salud Nacional Ingles siendo en general nuestros pacientes mas complejos y nuestras complicaciones menos frecuentes. Hay carencias en la recogida de datos importantes tales como la refraccion posquirurgica o los tiempos reales de la cirugia, a pesar de lo cual este trabajo puede ser una buena referencia.

Objective To analyse a series of cataract surgeries performed in a third-fourth level teaching hospital, providing complementary data to the number of surgeries that can be used as a further reference, and to compare them with those published by other Public Health Systems, mainly the British one. Methods Retrospective study of 1052 cataract procedures at the University Hospital of Valladolid from January 2016 to July 2016. Collected variables: age, gender, pre- and postsurgical visual acuity, degree of complexity of the cataract, duration of the surgery, and surgical complications. Results The mean age of the patients was 74.1 ± 9.5 years, and 81.61% started from a VA Conclusions The results of the series show significant differences from those from the audit of the English National Healthcare System, with our patients being more complex and having less complications. There are missing-data in the collection of important variables such as post-surgical refraction or the duration of the surgery, which despite this, this work can be a good reference.

Many lesbian, gay, bisexual and transgender people (LGBT), and people living with HIV (PLHIV) feel estranged from and misunderstood by their Christian communities. Churches, in turn, continue to wrestle with issues of theology and pastoral care pertaining to LGBT and PHIV. In response, this article aims to construct an ecclesiological praxis of inclusivity toward LGBT and PLHIV. Framed by Elisabeth Schüsler Fiorenza’s notion of Jesus’ basileia vision as the praxis of inclusive wholeness, we analyze, interpret and theologize narratives from elite interviews with three community leader-practitioners in Singapore and the Philippines who shared on their ministerial struggles, practices and visions. We suggest that churches can take the lead to engender an ecclesiological praxis of inclusivity by being (i) spaces of support, belonging and dignity for LGBT and PLHIV; and (ii) avenues for fostering dialogue with LGBT and PLHIV to articulate God’s inclusive love.

Cerebral palsy (CP) is a health condition secondary to non-progressive damage that occurs during brain development in the fetal or infant stage. To evaluate the effectiveness of robotic technology and virtual reality on motor function in patients with CP compared to conventional rehabilitation strategies such as physical therapy, occupational therapy, neurodevelopmental intervention, and transcranial stimulation. A review of randomized controlled trials of the last 5 years was carried out. For the evaluation of the methodological quality of the included studies, the PEDro scale was used, with evaluation of the level of evidence and degree of recommendation according to the Oxford classification.Seventeen articles met the eligibility criteria. Robotic technology and virtual reality proved to be effective in improving motor function, manual skills, and visual-perceptual skills in patients with CP, compared to the use of conventional rehabilitation strategies.

The human response to the COVID-19 pandemic set in motion an unprecedented shift in human activity with unknown long-term effects. The impacts in marine systems are expected to be highly dynamic at local and global scales. However, in comparison to terrestrial ecosystems, we are not well-prepared to document these changes in marine and coastal environments. The problems are two-fold: 1) manual and siloed data collection and processing, and 2) reliance on marine professionals for observation and analysis. These problems are relevant beyond the pandemic and are a barrier to understanding rapidly evolving blue economies, the impacts of climate change, and the many other changes our modern-day oceans are undergoing. The “Our Ocean in COVID-19” project, which aims to track human-ocean interactions throughout the pandemic, uses the new eOceans platform (eOceans.app) to overcome these barriers. Working at local scales, a global network of ocean scientists and citizen scientists are collaborating to monitor the ocean in near real-time. The purpose of this paper is to bring this project to the attention of the marine conservation community, researchers, and the public wanting to track changes in their area. As our team continues to grow, this project will provide important baselines and temporal patterns for ocean conservation, policy, and innovation as society transitions towards a new normal. It may also provide a proof-of-concept for real-time, collaborative ocean monitoring that breaks down silos between academia, government, and at-sea stakeholders to create a stronger and more democratic blue economy with communities more resilient to ocean and global change.

Arsenic (As) is a metalloid present in the earth's crust and widely distributed in the environment. Due to its high concentrations in the Andean valleys and its chemical similarity with phosphorus (P), its biological role in Andean Microbial Ecosystems (AMEs) has begun to be studied. The AMEs are home to extremophilic microbial communities that form microbial mats, evaporites, and microbialites inhabiting Andean lakes, puquios, or salt flats. In this work, we characterize the biological role of As and the effect of phosphate in AMEs from the Laguna Tebenquiche (Atacama Desert, Chile). Using micro X-ray fluorescence, the distribution of As in microbial mat samples was mapped. Taxonomic and inferred functional profiles were obtained from enriched cultures of microbial mats incubated under As stress and different phosphate conditions. Additionally, representative microorganisms highly resistant to As and able to grow under low phosphate concentration were isolated and studied physiologically. Finally, the genomes of the isolated Salicola sp. and Halorubrum sp. were sequenced to analyze genes related to both phosphate metabolism and As resistance. The results revealed As as a key component of the microbial mat ecosystem: (i) As was distributed across all sections of the microbial mat and represented a significant weight percentage of the mat (0.17 %) in comparison with P (0.40%); (ii) Low phosphate concentration drastically changed the microbial community in microbial mat samples incubated under high salinity and high As concentrations; (iii) Archaea and Bacteria isolated from the microbial mat were highly resistant to arsenate (up to 500 mM), even under low phosphate concentration; (iv) The genomes of the two isolates were predicted to contain key genes in As metabolism (aioAB and arsC/acr3) and the genes predicted to encode the phosphate-specific transport operon (pstSCAB-phoU) are next to the arsC gene, suggesting a functional relationship between these two elements.

espanolIntroduccion: Las enfermedades cardiovasculares se encuentran entre las primeras causas de muerte a nivel mundial y la evidencia cientifica sugiere que tienen un origen en edades tempranas, por lo que disminuir desde la adolescencia los riesgos que contribuyen a su aparicion es indispensable. Objetivo: Determinar riesgo cardiovascular en la poblacion adolescente de una institucion educativa de Timbio, Cauca, 2015 – 2016. Metodologia: Estudio cuantitativo, descriptivo, observacional y de corte transversal. Muestra: 100 estudiantes (47 mujeres, 53 hombres), de 10 a 19 anos de edad. Se evaluaron variables sociodemograficas, antropometricas, fisiologicas, bioquimicas (glicemia), antecedentes personales, familiares, estilos de vida y uso de anticonceptivos orales. Resultados: Se encontro una mayor prevalencia de riesgo cardiovascular en el grupo etario adolescente (15-18 anos) con 84.6%; el genero femenino presento mas posibilidad de tener riesgo cardiovascular (OR: 2.8, IC 95% 1.17 – 6.87); el 7% afirmo consumir tabaco regularmente y el 12% son fumadores pasivos. Se obtuvo que el 26% ingiere bebidas alcoholicas, con una mayor prevalencia entre las edades de 15 a 18 anos (OR: 19.4, IC 95% 2.45 – 48.11); en cuanto a la actividad fisica el 79% la practicaba de forma extracurricular. Presentar habitos alimenticios no saludables genera mayor riesgo cardiovascular (OR: 5.57, IC 95% 1.95 – 15.90). El 67% (n= 67) tiene riesgo cardiovascular. Conclusiones: El genero femenino, el grupo adolescente (15-18 anos), el consumo de bebidas alcoholicas y habitos alimenticios no saludables, se asocian con una mayor posibilidad de tener riesgo cardiovascular. Se encontro en un gran porcentaje de la poblacion de estudio riesgo cardiovascular. EnglishIntroduction: Cardiovascular diseases are among the leading causes of death worldwide and scientific evidence suggests that they have an origin at early ages, so that diminishing from adolescence the risks that contribute to its emergence is essential. Objective: To determine cardiovascular risk in the adolescent population of a high school of Timbio, Cauca, 2015 - 2016. Methodology: Quantitative, descriptive, observational and cross-sectional study. Sample: 100 students (47 women, 53 men), from 10 to 19 years old. Sociodemographic, anthropometric, physiological, biochemical variables (glycemia), personal history, family history, lifestyles and use of oral contraceptives were evaluated. Results: A higher prevalence of cardiovascular risk was found in the adolescent age group (15-18 years) with 84.6%; female gender was more likely to have cardiovascular risk (OR: 2.8, 95% CI 1.17 - 6.87); 7% said they use tobacco regularly and 12% are passive smokers. It was obtained that 26% ingested alcoholic beverages, with a higher prevalence between the ages of 15 to 18 years (OR: 19.4, 95% CI 2.45-48.11); In terms of physical activity, 79% practiced it extracurricularly. Presenting unhealthy eating habits generates greater cardiovascular risk (OR: 5.57, 95% CI 1.95 - 15.90). 67% (n = 67) have cardiovascular risk. Conclusions: The female gender, the adolescent group (15-18 years), drink alcoholic beverages and unhealthy eating habits, are associated with a greater possibility of having cardiovascular risk. It was found in a large percentage of the study population cardiovascular risk.

Resumen Se presenta una revision sistematica sobre la eficiencia de la terapia robotica para la funcion motora de la mano del adulto con hemiplejia. Se realizo una busqueda sistematica en PubMed, registro Central Cochrane de Ensayos Clinicos Controlados – CENTRAL, LILACS, Scielo, bibliotecas virtuales, ScienceDirect, Proquest, Springerlink, Biomed Central, OTseeker, Physiotherapy Evidence Database (PEDro), de enero a diciembre del 2015. La revision analitica se realizo acorde con los estandares de calidad establecidos para reportar estudios experimentales utilizando la estrategia Consolidated standards of reporting trials group (CONSORT) 2010 y la calidad metodologica se evaluo utilizando la escala de Jadad. Encontrandose heterogeneidad en los estudios y el tipo de participantes, el tiempo de tratamiento oscilo entre 4 y 12 semanas y el numero de personas involucradas en el estudio fue entre 11 y 99. La terapia robotica mostro efectividad en la funcion motora de la mano, aunque no se evidenciaron estudios con suficiente poder estadistico con relacion a la terapia convencional, ni practicas exclusivas del uso de la robotica en Neurorrehabilitacion.

Kiwifruit bleeding sap samples, collected in Italian and Chilean orchards from symptomatic and asymptomatic plants, were evaluated for the presence of Pseudomonas syringae pv. actinidiae, the causal agent of bacterial canker. The saps were sampled during the spring in both hemispheres, before the bud sprouting, during the optimal time window for the collection of an adequate volume of sample for the early detection of the pathogen, preliminarily by molecular assays, and then through its direct isolation and identification. The results of molecular analyses showed more effectiveness in the P. syringae pv. actinidiae detection when compared with those of microbiological analyses through the pathogen isolation on the nutritive and semiselective media selected. The bleeding sap analyses allowed the isolation and identification of two hypersensitive response (HR) negative and hypovirulent P. syringae pv. actinidiae strains from different regions in Italy. Moreover, multilocus sequence analysis (MLSA) and whole genome sequence (WGS) were carried out on selected Italian and Chilean P. syringae pv. actinidiae virulent strains to verify the presence of genetic variability compared with the HR negative strains and to compare the variability of selected gene clusters between strains isolated in both countries. All the strains showed the lack of argK and coronatine gene clusters as reported for the biovar 3 P. syringae pv. actinidiae strains. Despite the biologic differences obtained in the tobacco bioassays and in pathogenicity assays, the MLSA and WGS analyses did not show significant differences between the WGS of the HR negative and HR positive strains; the difference, on the other hand, between PAC_ICE sequences of Italian and Chilean P. syringae pv. actinidiae strains was confirmed. The inability of the hypovirulent strains IPVBO 8893 and IPV-BO 9286 to provoke HR in tobacco and the low virulence shown in this host could not be associated with mutations or recombinations in T3SS island.

Resumen La satisfaccion laboral y el capital psicologico contribuyen positivamente al bienestar psicologico de los trabajadores y pueden reducir los niveles de burnout en el contexto laboral. El objetivo de esta investigacion fue evaluar la relacion entre la satisfaccion laboral, el capital psicologico y el sindrome de burnout. Participaron en este estudio 111 trabajadores. Los resultados mostraron una relacion inversa entre las variables predictoras (satisfaccion laboral y capital psicologico) y la variable dependiente (sindrome de burnout). De acuerdo con los analisis, las variables predictoras explican el 24% de la varianza del modelo; ademas, el modelo represento el 35% de la varianza cuando la dimension de agotamiento emocional del sindrome de burnout fue evaluada como variable dependiente (e. g., despues de excluir las otras 2 dimensiones del sindrome). Estos resultados evidencian beneficios potenciales en los programas dirigidos a promover la satisfaccion laboral y el capital psicologico en el contexto organizacional.

To analyse a series of cataract surgeries performed in a third-fourth level teaching hospital, providing complementary data to the number of surgeries that can be used as a further reference, and to compare them with those published by other Public Health Systems, mainly the British one.Retrospective study of 1052 cataract procedures at the University Hospital of Valladolid from January 2016 to July 2016. Collected variables: age, gender, pre- and postsurgical visual acuity, degree of complexity of the cataract, duration of the surgery, and surgical complications.The mean age of the patients was 74.1 ± 9.5 years, and 81.61% started from a VA0.5. The duration of the surgery was collected only in 12% of the procedures. The complications rate was 1.8%, with one case of endophthalmitis. A final postoperative refraction was performed in only 44.7% of the cases. A total of 87.2% of the eyes achieved a VA ≥ 0.5 after surgery.The results of the series show significant differences from those from the audit of the English National Healthcare System, with our patients being more complex and having less complications. There are missing-data in the collection of important variables such as post-surgical refraction or the duration of the surgery, which despite this, this work can be a good reference.

WOS: 000442229500021, PubMed ID: 30101073, Background: In infants with phenylketonuria (PKU), dietary management is based on lowering and titrating phenylalanine (Phe) intake from breast milk or standard infant formula in combination with a Phe-free infant formula in order to maintain blood Phe levels within target range. Professionals use different methods to feed infants with PKU and our survey aimed to document practices across Europe. Methods: We sent a cross sectional, survey monkey (R) questionnaire to European health professionals working in IMD. It contained 31 open and multiple-choice questions. The results were analysed according to different geographical regions. Results: Ninety-five centres from 21 countries responded. Over 60% of centres commenced diet in infants by age 10 days, with 58% of centres implementing newborn screening by day 3 post birth. At diagnosis, infant hospital admission occurred in 61% of metabolic centres, mainly in Eastern, Western and Southern Europe. Breastfeeding fell sharply following diagnosis with only 30% of women still breast feeding at 6 months. 53% of centres gave pre-measured Phe-free infant formula before each breast feed and 23% alternated breast feeds with Phe-free infant formula. With standard infant formula feeds, measured amounts were followed by Phe-free infant formula to satiety in 37% of centres (n = 35/95), whereas 44% (n = 42/95) advised mixing both formulas together. Weaning commenced between 17 and 26 weeks in 85% centres, >= 26 weeks in 12% and < 17 weeks in 3%. Discussion: This is the largest European survey completed on PKU infant feeding practices. It is evident that practices varied widely across Europe, and the practicalities of infant feeding in PKU received little focus in the PKU European Guidelines (2017). There are few reports comparing different feeding techniques with blood Phe control, Phe fluctuations and growth. Controlled prospective studies are necessary to assess how different infant feeding practices may influence longer term feeding development., Vitaflo, We thank Vitaflo for supporting the publication cost of this paper.

Introduction Globally, firefighting is a highly stressful, physical and mental demanding occupation. In a study carried out by the principal author, Guatemalan firefighters suffered from musculoskeletal disorders and distress, mainly because of physical unfitness, inadequate eating habits and violence exposure. A teaching intervention was planned with a component of training and the elaboration of a book, designed for Central American firefighters, with the aim of teaching firefighters how to take care of their physical and mental health. The book is already having direct impact on more than 5,000 Guatemalan firefighters. Methods The book was planned as a teaching intervention firstly for Guatemalan firefighters and then scope was widened to Central American firefighters. It was conducted using participatory methodology with representatives of firefighters, who designed layout and wrote chapter 1. Collaboration was obtained from toxicology and nutrition experts of Universidad de San Carlos, including senior students, in writing chapters 2, 3 and 4. This University also collaborated in the printing of the first 500 copies. Collaboration was also obtained from Ludwig-Maximillians-Universitat, in writing chapters 5, 6 and 7, as well as the final revision and layout. Results The book was electronically issued in 2016 using Ludwig-Maximillians-Universitat networks and hard copies were delivered to Guatemala´s firefighters authorities in a formal ceremony on 2017. More than 3000 of copies are waiting to be printed at Universidad de San Carlos de Guatemala. Conclusion This is a perfect example of a successful teaching intervention, with multicenter collaboration, including universities in Germany and in Guatemala, as well as the direct participation of the targeted population.

Introduction To know the prevalence of exposures and diseases at workplaces is crucial for the development of intervention strategies and healthcare planning. However, in many low and middle-income countries (LMIC) research is no priority. One reason is a lack of experts able to carry out sound epidemiological research at workplaces. One way of preparing such experts is through project-based training. We therefore implemented a project as training method in our blended learning Master in International Occupational Safety and Health (OSH). Methods Students start by identifying their research interest based on existing worker’s health problems. They develop a study protocol to assess working conditions and health at a self-selected workplace. After ethics approval, they carry out the project during the 2nd term of the program. In term 3, they learn to analyse and interpret data and develop a teaching intervention. In the final term, students write the master thesis in form of a scientific paper. Throughout the process, they are accompanied by a tutor. Results Since its beginning in 2012, the number of participants in the program is stable with 10–12 students/year. All of them are OSH experts with at least 2 years of experience in the field coming from eight Latin American countries. Students evaluate the project-based learning approach as positive. Of the 43 graduating students, 9 research papers were published in journals. More than half of the graduates teach students at local universities and thereby act as multipliers. Few continue to carry out research mainly due to lack of priority in their home countries. Discussion The project-based learning approach contributes to occupational health research in Latin America. The concept might be promising also for other LMIC. However, due to the individual tutoring the program is cost intensive, publication of the results challenging and work opportunities for researchers limited.

The latest terrorist attacks in Europe and in the rest of the world, and the military experience in the most recent conflicts leave us with several lessons learned. The most important is that the fate of the wounded rests in the hands of the one who applies the first dressing, because the victims usually die within the first 10 minutes, before professional care providers or police personnel arrive at the scene. A second lesson is that the primary cause of preventable death in these types of incidents involving explosives and firearms is massive hemorraghe.There is a need to develop a training oriented to citizens so they can identify and use available resources to avoid preventable deaths that occur in this kind of incidents, especially massive hemorrhage.A 7-hour training intervention program was developed and conducted between January and May 2017. Data were collected from participants' answers on a multiple-choice test before and after undertaking the training. Improved mean score for at least 75% of a group's members on the posttraining test was considered reflective of adequate knowledge.A total of 173 participants (n = 74 men [42.8%]; n = 99 women [57.2%]) attended the training. They were classified into three groups: a group of citizens/ first responders with no prior health training, a group of health professionals, and a group of nursing students. Significant differences (ρ.05) between mean pre- and post-training test scores occurred in each of the three groups.There was a clear improvement in the knowledge of the students after the training when pre- and post-training test scores were compared within the three groups. The greatest improvement was seen in the citizens/first responders group.

Background Afatinib is a second generation irreversible EGFR tyrosine kinase inhibitor (TKI), indicated as firstline therapy in non-small cell lung cancer (NSCLC). There are two other first generation EGFR TKIs indicated in NSCLC treatment, and no direct comparison of them. Purpose To compare the efficacy of afatinib versus erlotinib or gefitinib in EGFR TKIs naive patients with NSCLC. Material and methods This was an observational retrospective study carried out between January 2015 and April 2016. All patients with NSCLC undergoing firstline treatment with an EGFR TKI were included. Patient data were taken from clinical records. Efficacy endpoints were overall survival (OS), progression free survival (PFS) and response rate, assessed by RECIST criteria. Results 46 patients were included. 76% were men, average age was 71 years. 71.8% had an ECOG performance status of 0–1 and 76% were current or past smokers. NSCLC stage was III/IV in 84.4% of patients and histologic type was adenocarcinoma in 37% of patients. 43.5% were treated with erlotinib, 39.9% with gefitinib and 17.4% with afatinib. EGFR status was determined in only 16 patients, being mutated in 7 (4 treated with erlotinib and the other 3 with afatinib). Median OS for afatinib, gefitinib and erlotinib was 5, 14 and 43 months, respectively (HR (95% CI) gefitinib vs afatinib: 0.25 (0.07–0.81); erlotinib vs afatinib: 0.16 (0.05–0.55)). Median PFS was 2 months for afatinib, 8 months for gefitinib and 16 months for erlotinib (HR (95% CI) gefitinib vs afatinib: 0.18 (0.06–0.59); erlotinib vs afatinib: 0.08 (0.02–0.29)). Response rate by group was 37.5%, 61.1% and 80% for afatinib, gefitinib and erlotinib, respectively. Conclusion According to the main clinical guidelines, EGFR mutation status should be known before the start of treatment, and EGFR TKIs should only be used in patients with a positive EGFR mutation test. Our study suggests that afatinib is less effective than erlotinib or gefitinib, but our population was small. Further studies with more patients are needed to compare afatinib with the other EGFR TKIs. References and/or acknowledgements Sequist LV, Yang JC-HC-H, Yamamoto N, et al. Phase III study of afatinib or cisplatin plus pemetrexed in patients with metastatic lung adenocarcinoma with EGFR mutations. J Clin Oncol2013;31:1–11. No conflict of interest

Background The antiretroviral combination tenofovir disoproxil, emtricitabine, cobicistat and elvitegravir (TDF/FTC/COBI/RVG) has been widely used to treat HIV infection. This regimen is related to the highest risk of kidney disease because of the ability of cobicistat to block creatinine tubular secretion, boosting tenofovir’s nephrotoxic effect because this drug is cleared using the same mechanism. Hence careful monitoring of creatinine clearance, urine glucose and protein levels, and blood phosphate levels at the start and during treatment is key. Purpose To assess the impact of TDF/FTC/COBI/RVG on renal function in our patients, evaluating the extent to which EPAR’s monitoring needs are satisfied at the start and during treatment, and describing measures taken to resolve any incidences encountered. Material and methods We undertook a descriptive retrospective study, involving all patients treated with TDF/FTC/COBI/EVG over 2 years. Data were collected from patients’ digital clinical and analytical histories. We registered demographic data, previous treatments with tenofovir or cobicistat, laboratory monitoring information, adjustment of monitoring to given criteria, use of other nephrotoxic drugs and measures taken if renal function decreased (if ClCr Results 43 patients (81% men, average age 44 years) received TDF/FTC/COBI/RVG during the study period. 53% had previously been treated with tenofovir. Average ClCr was 107 mL/min (only 19% had ClCr Conclusion Despite wide experience with their use, the number of cases of decreased renal function with TDF/FTC/COBI/RVG treatment has increased with time. In our study, we observed a progressive decrease in creatinine clearance, leading to hospital admission in one case. This could be because none of our patients received adequate monitoring. No conflict of interest