Acute Suppurative Thyroiditis in Childhood: An Atypical Presentation

Neck stiffness is a common clinical sign in children presenting to the emergency department that may indicate a wide variety of diagnoses. Acute suppurative thyroiditis (AST) is an infection of the thyroid gland caused by a bacterium, virus, or, less commonly, fungus. It presents as an acute or subacute development of an anterior cervical mass, with associated inflammatory signs. The pressure upon neck muscles may be reflected as a limitation of cervical mobility. AST is often preceded by an upper respiratory tract infection, and pyriform sinus fistula is the most common predisposing factor. It is particularly uncommon in the pediatric age, with limited cases reported in the literature. Therefore, a heightened suspicion is required for proper diagnosis and timely intervention, due to its high mortality. Prompt treatment with broad-spectrum parenteral antibiotic therapy and drainage is mandatory to prevent the numerous complications associated, namely, mediastinitis and sepsis. We report the case of a two-year-old female child admitted with a two-week history of intermittent high-grade fever and sore throat, followed by prostration and limitation in neck movement on admission. Examination revealed neck stiffness with positive Kernig and Brudzinski signs. The laboratory tests showed elevated inflammatory parameters. Cranial computed tomography (CT) scan and lumbar puncture were normal. On day 2 after admission, an anterior cervical mass with slight signs of fluctuation was detected. Ultrasound was compatible with a hemorrhagic/overinfected thyroid nodule, and the patient was started on broad-spectrum antibiotics. Due to clinical worsening, a cervical CT scan was performed, which documented a thyroid abscess with extension into the retropharyngeal space. She underwent surgical drainage, and Streptococcus anginosus and mixed anaerobes were isolated, sensitive to ongoing antibiotherapy. On multidisciplinary follow-up, an esophageal barium study, laryngoscopy, and cervical magnetic resonance imaging (MRI) were performed, revealing no anatomical defects. AST is a rare disease in children, but potentially fatal, so its early recognition and treatment are essential. We aim to draw attention to this disease and its differential diagnosis to reduce the associated morbimortality.

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children.

Kitul, a food plant with antidiabetic-like effects: Reduction of intracellular reactive species in glucose-stimulated RIN-5F pancreatic β-cells and mitigation of pro-inflammatory mediators in activated RAW 264.7 macrophages

Kitul (Caryota urens L.) inflorescences are broadly used for sweet sap production in Asian countries and Kitul food products are known as being suitable for diabetic patients. Considering the strong ability to inhibit α-glucosidase, we hypothesize that kitul antidiabetic properties might also involve the modulation of inflammatory pathways and hyperglycaemia-induced oxidative damage. Hence, the effects of an inflorescence's methanol extract were investigated in glucose-stimulated pancreatic cells (RIN-5F) and LPS-stimulated RAW 264.7 macrophages. The extract reduced the overproduction of intracellular reactive species in pancreatic cells and also NO, L-citrulline and IL-6 levels in LPS-stimulated RAW 264.7 macrophages. Inhibition of 5-lipoxygenase (IC₅₀ = 166.1 µg/mL) through an uncompetitive manner was also recorded upon treatment with C. urens inflorescences extract. The phenolic profile of the inflorescences was characterized by HPLC-DAD, six hydroxycinnamic acids being identified and quantified. Overall, our data provide additional evidence on the pleiotropic mechanisms of Kitul inflorescences as an antidiabetic agent.

Impact of local and systemic antimicrobials on leukocyte- and platelet rich fibrin: an in vitro study

The aim of this study was to evaluate the effect of local and systemic administration of antimicrobials to leukocyte- and platelet-rich fibrin (L-PRF). For part A, 16 tubes of venous blood were collected from each of eight systemically healthy subjects. Prior to blood centrifugation, 12 of the 16 tubes were injected with 0.125 ml, 0.25 ml or 0.50 ml metronidazole solution. One set of L-PRF membranes was used to assess the release of vascular endothelial growth factor AB, platelet-derived growth factor, transforming growth factor beta 1, and bone morphogenetic protein 2 at indicated time points. The metronidazole release over time by L-PRF membranes was also evaluated. The remaining L-PRF membranes were placed on the surface of agar plates inoculated with three different periodontal pathogens to determine their antibacterial activity. For part B, another six subjects were enrolled with three subjects taking 2 g amoxicillin and three subjects 500 mg metronidazole as prophylaxis prior to a periodontal treatment. Before and 2 h after consuming one of the prescribed antimicrobials, three tubes of blood were collected for preparing L-PRF membranes. These membranes were used to measure the antibacterial activity against periodontal pathogens. No statistically significant difference could be found in the release of growth factors between L-PRF membranes with and without incorporation of metronidazole solution. The release of metronidazole could be detected up to day 3, however with the highest concentration during the first 4 h. This concentration was dose dependent. The antibacterial capacity of L-PRF membranes increased significantly for both the systemic intake, and after the addition of metronidazole solution to the blood tubes before centrifugation, the latter again dose dependent. The antibacterial capacity of L-PRF against the periodontal pathogens tested can significantly be enhanced by the addition of antimicrobials, without disadvantage for the release of growth factors.

Integrating Domain Knowledge into Deep Learning for Skin Lesion Risk Prioritization to Assist Teledermatology Referral

Teledermatology has developed rapidly in recent years and is nowadays an essential tool for early diagnosis. In this work, we aim to improve existing Teledermatology processes for skin lesion diagnosis by developing a deep learning approach for risk prioritization with a dataset of retrospective data from referral requests of the Portuguese National Health System. Given the high complexity of this task, we propose a new prioritization pipeline guided and inspired by domain knowledge. We explored automatic lesion segmentation and tested different learning schemes, namely hierarchical classification and curriculum learning approaches, optionally including additional patient metadata. The final priority level prediction can then be obtained by combining predicted diagnosis and a baseline priority level accounting for explicit expert knowledge. In both the differential diagnosis and prioritization branches, lesion segmentation with 30% tolerance for contextual information was shown to improve classification when compared with a flat baseline model trained on original images; furthermore, the addition of patient information was not beneficial for most experiments. Curriculum learning delivered better results than a flat or hierarchical approach. The combination of diagnosis information and a knowledge map, created in collaboration with dermatologists, together with the priority achieved interesting results (best macro F1 of 43.93% for a validated test set), paving the way for new data-centric and knowledge-driven approaches.

Prospective international validation of the predisposition, infection, response and organ dysfunction (PIRO) clinical staging system among intensive care and general ward patients

Background

Stratifying patients with sepsis was the basis of the predisposition, infection, response and organ dysfunction (PIRO) concept, an attempt to resolve the heterogeneity in treatment response. The purpose of this study is to perform an independent validation of the PIRO staging system in an international cohort and explore its utility in the identification of patients in whom time to antibiotic treatment is particularly important.

Methods

Prospective international cohort study, conducted over a 6-month period in five Portuguese hospitals and one Australian institution. All consecutive adult patients admitted to selected wards or the intensive care, with infections that met the CDC criteria for lower respiratory tract, urinary, intra-abdominal and bloodstream infections were included.

Results

There were 1638 patients included in the study. Patients who died in hospital presented with a higher PIRO score (10 ± 3 vs 8 ± 4, p < 0.001). The observed mortality was 3%, 15%, 24% and 34% in stage I, II, III and IV, respectively, which was within the predicted intervals of the original model, except for stage IV patients that presented a lower mortality. The hospital survival rate was 84%. The application of the PIRO staging system to the validation cohort resulted in a positive predictive value of 97% for stage I, 91% for stage II, 85% for stage III and 66% for stage IV. The area under the receiver operating characteristics curve (AUROC) was 0.75 for the all cohort and 0.70 if only patients with bacteremia were considered. Patients in stage III and IV who did not have antibiotic therapy administered within the desired time frame had higher mortality rate than those who have timely administration of antibiotic.

Conclusions

To our knowledge, this is the first external validation of this PIRO staging system and it performed well on different patient wards within the hospital and in different types of hospitals. Future studies could apply the PIRO system to decision-making about specific therapeutic interventions and enrollment in clinical trials based on disease stage.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13613-021-00966-7.

The effect of agricultural intensification and water-locking on the world's largest coastal lagoonal system

The palaeolimnological conditions of Mirim Lagoon, a large coastal shallow lagoon under the influence of historical human impacts related to the development of the primary sector of the economy were reconstructed. The first significant human impact consisted of locking the estuarine system to induce the transition from brackish to freshwater conditions. During this transition, the sedimentation rate consistently increased from pre-disturbance values of 0.25 cm yr^-1 to >1 cm yr^-1. A concomitant increase in nitrogen and carbon values was recorded indicating a related eutrophication process. The highest nutrient levels were achieved during the 1990s after the incorporation of cutting-edge technologies for agricultural production such as high-yielding varieties of rice resistant to climate variability and pests, and the use of inorganic fertilisers, pesticides and water supply controlled by irrigation. After 2011, the soybean production boosted and the area cultivated with this oilseed equalled the area of rice paddies, i.e., 2 × 10⁵ ha. A sharp decrease in δ¹³C from -19 to -24‰ and in δ¹⁵N from 6 to 2‰ were observed in the sedimentary record, indicating a major shift in the composition of the organic matter after the agricultural intensification. Trace elements Cr, Cu, Ni and Zn showed a high positive correlation with Al and Fe, and enrichment factors near 1, indicating a natural and terrigenous source of these elements and also unpolluted conditions. However, the increase of As after 1990 and the positive correlation with Pb was associated with agricultural practices. All elemental ratios (K/Al, Ti/Al and V/Cr) showed constant pre-disturbance trends and a turning point ca. the 1990s. Microplastics were detected from the beginning of the 1990s and increased towards recent sediments, thus corroborating an anthropogenically impacted scenario. Therefore, the development of the primary sector of the economy exerted clear impacts on the environmental quality of the system.

Incremental Learning for Dermatological Imaging Modality Classification

With the increasing adoption of teledermatology, there is a need to improve the automatic organization of medical records, being dermatological image modality a key filter in this process. Although there has been considerable effort in the classification of medical imaging modalities, this has not been in the field of dermatology. Moreover, as various devices are used in teledermatological consultations, image acquisition conditions may differ. In this work, two models (VGG-16 and MobileNetV2) were used to classify dermatological images from the Portuguese National Health System according to their modality. Afterwards, four incremental learning strategies were applied to these models, namely naive, elastic weight consolidation, averaged gradient episodic memory, and experience replay, enabling their adaptation to new conditions while preserving previously acquired knowledge. The evaluation considered catastrophic forgetting, accuracy, and computational cost. The MobileNetV2 trained with the experience replay strategy, with 500 images in memory, achieved a global accuracy of 86.04% with only 0.0344 of forgetting, which is 6.98% less than the second-best strategy. Regarding efficiency, this strategy took 56 s per epoch longer than the baseline and required, on average, 4554 megabytes of RAM during training. Promising results were achieved, proving the effectiveness of the proposed approach.

Impact of g force and timing on the characteristics of platelet-rich fibrin matrices

Recently, new centrifugation protocols for the preparation of platelet-rich fibrin (PRF) have been introduced in an attempt to further improve the beneficial impact of these 2nd generation platelet concentrate membranes. This in-vitro study aimed to compare the biological and physical characteristics of three types of PRF membranes using two different centrifuges with adapted relative centrifugal forces (RCF): leucocyte- and platelet-rich fibrin, advanced platelet-rich fibrin, and advanced platelet-rich fibrin⁺. Release of growth factors, macroscopic dimensions, cellular content and mechanical properties of the respective membranes, prepared from blood of the same individual were explored. Furthermore, the impact of timing (blood draw-centrifugation and centrifugation-membrane preparation) was assessed morphologically as well as by electron microscopy scanning. No statistically significant differences amongst the three PRF modifications could be observed, neither in their release of growth factors or the cellular content, nor in clot/membrane dimensions. The difference between both centrifuges were negligible when the same g-force was used. A lower g-force, however, reduced membrane tensile strength. Timing in the preparation process had a significant impact. Adaptation of RCF only had a minimal impact on the final characteristics of PRF membranes.

Data Augmentation Using Adversarial Image-to-Image Translation for the Segmentation of Mobile-Acquired Dermatological Images

Dermoscopic images allow the detailed examination of subsurface characteristics of the skin, which led to creating several substantial databases of diverse skin lesions. However, the dermoscope is not an easily accessible tool in some regions. A less expensive alternative could be acquiring medium resolution clinical macroscopic images of skin lesions. However, the limited volume of macroscopic images available, especially mobile-acquired, hinders developing a clinical mobile-based deep learning approach. In this work, we present a technique to efficiently utilize the sizable number of dermoscopic images to improve the segmentation capacity of macroscopic skin lesion images. A Cycle-Consistent Adversarial Network is used to translate the image between the two distinct domains created by the different image acquisition devices. A visual inspection was performed on several databases for qualitative evaluation of the results, based on the disappearance and appearance of intrinsic dermoscopic and macroscopic features. Moreover, the Fréchet Inception Distance was used as a quantitative metric. The quantitative segmentation results are demonstrated on the available macroscopic segmentation databases, SMARTSKINS and Dermofit Image Library, yielding test set thresholded Jaccard Index of 85.13% and 74.30%. These results establish a new state-of-the-art performance in the SMARTSKINS database.

Medicinal plants utilized in Thai Traditional Medicine for diabetes treatment: Ethnobotanical surveys, scientific evidence and phytochemicals

ETHNOPHARMACOLOGICAL RELEVANCE

Diabetes mellitus remains the most lethal metabolic disease of contemporaneous times and despite the therapeutic arsenal currently available, research on new antidiabetic agents remains a priority. In recent years, the revitalization of Thai Traditional Medicine (TTM) became a clear priority for the Thai government, and many efforts have been undertaken to accelerate research on herbal medicines and their use in medical services in various hospitals. Additionally, and particularly in rural areas, treatment of diabetes and associated symptomatology frequently relies on herbal preparations recommended by practitioners of TTM. In the current work, medicinal plants used in Thailand for treating diabetes, as well as their hypoglycaemic pharmacological evidences and potential therapeutic use for diabetes-related complications were reviewed.

MATERIALS AND METHODS

Ethnopharmacological information on the plant materials used in TTM for diabetes treatment was collected through literature search in a range of scientific databases using the search terms: diabetes, folk medicine, Thailand medicinal plants, traditional medicine. Information regarding scientific evidence on the antidiabetic effects of surveyed species was obtained considering not only the most common taxonomic designation, but also taxonomic synonyms, and including the keywords 'diabetes' and 'hypoglycaemic effect'.

RESULTS

A total of 183 species known to be used for diabetes management in TTM were reviewed, with 30% of them still lacking experimental evidences to support claims regarding the mechanisms and phytochemicals underlying their antidiabetic properties. Moreover, a total of 46 bioactives displaying effective antidiabetic effects have been isolated from 24 species, their underlying mechanism(s) of action being fully or partially disclosed.

CONCLUSIONS

We deliver the most extensive survey dealing with the ethnomedicinal knowledge of Thai medicinal plants utilized on diabetes management. We are certain that the current review will spark further research on Thai plants for the development of new standardized phytomedicines through drug discovery programmes.

Gustavia gracillima Miers. flowers effects on enzymatic targets underlying metabolic disorders and characterization of its polyphenolic content by HPLC-DAD-ESI/MSn

Notwithstanding Gustavia gracillima Miers widespread distribution in neotropical regions, its chemical profile and biological properties remain uninvestigated. A methanol extract obtained from the flowers was characterized through HPLC-DAD-ESI/MSⁿ, nine ellagic acid derivatives and twelve kaempferol 3-O-glycosides being identified and quantitated for the first time at the species and genus. Preliminary cytotoxicity screening did not reveal noticeable effects upon gastrointestinal representative cell lines (AGS, Caco-2 and Hep G2), which further prompted us to evaluate the impact in a series of targets involved in metabolic disorders and associated complications. Despite of the moderate inhibition towards 5-lipoxygense activity, G. gracillima methanol extract displayed significant effects on carbohydrates-hydrolysing enzymes. In contrast with the antidiabetic reference drug acarbose, the extract was able to selectively inhibit yeast α-glucosidase activity (IC₅₀ = 4.72 µg/mL), with negligible inhibitory effects upon α-amylase. Kinetic studies pointed to a model of mixed inhibition with a great binding activity, characterized by an inhibitory constant of 2.91 µg/mL. The notable inhibitory activity was also confirmed in α-glucosidase homogenates isolated from human intestinal cells (IC₅₀ = 34.03 µg/mL). Moreover, the extract obtained from the flowers of G. gracillima displayed significant aldose reductase inhibition (IC₅₀ = 61.88 µg/mL), as well as O₂^- and NO scavenging properties. A moderate inhibitory effect was also recorded against pancreatic lipase (IC₅₀ = 362.17 µg/mL) through a mixed inhibition mode. Recorded data supports the potential incorporation of G. gracillima flowers on antidiabetic herbal formulations and/or supplements, with not only straight action on carbohydrates digestion, but also direct interference with targets involved on subsequent diabetes events, such as triglycerides metabolism, inflammation and radical-mediated stress.

Portuguese cultural adaptation and validation of the European Health Literacy Survey (HLS-EU) for children aged 9 to 10 (HLS-EU-PTc)

Introduction

To measure Health literacy (HL) as proposed in the context of the European Health Literacy Survey/questionnaire (HLS-EU-Q), the Health Literacy for Children and Adolescents (HLCA) Consortium (GE) adapted it for children. A trans-cultural adaptation and validation to Portuguese (HLS-EU-PTc), will supply policy makers, experts and health professionals with information that can promote healthier communities while fighting health disparities.

Methods

After permission was granted from the HLCA Consortium the TRAPD model was used (eg parallel translation, focus groups, two back translations). An assessment and pretesting of HLS-EU-PTc was done with 16 children for cognitive testing. A qualitative explanatory (n = 16) and quantitative, cross-sectional study (n = 82), age mean 13, SD 0.96, from Portugal (mainland) was implemented for proceed with the validation process. A variety of measures were obtained like internal consistency and mean scores.

Results

Preliminary results for evaluation of the psychometric properties of the HLS-EU-PTc show satisfactory internal consistency (Cronbach’s alpha coefficient 0.87). In a scale from 1 (very difficult) to 4 (very easy) for indicators of the HLS-EU-PTc, we have a mean of 3.25 and a SD of .478.

Conclusions

This is the first study to examine the feasibility of a Portuguese version (HLS-EU-PTc) of the HLS-EU-Q adapted for children and it indicates high internal consistency and level of self-reported HL. The usefulness of the HLS-EU-PTc instrument can be further discussed while planning public health policy strategies from the HL standpoint. The validated HLS-EU-PTc version of the HLS-EU-Qc survey, with the user’s manual can be accessed at www.literacia-saude.info.

Background levels of trace elements in brown and red seaweeds from Trindade, a remote island in South Atlantic Ocean

Trace elements in organisms are normally higher in well-developed coastal areas than on oceanic islands. Few studies have used seaweeds as their sentinels on islands. This study established background levels of trace elements (As, Cd, Pb, Zn, Cu and Hg) for four seaweed species (Dictyopteris delicatula and Canistrocarpus cervicornis, brown algae; Ceratodictyon variabile and Palisada perforata, red algae) from Trindade, an oceanic Brazilian island, and verified potential differences associated to distinct environmental conditions. Spatial differences were not detected for As, Hg and Cd in samples, although the highest concentrations of these elements were observed in brown seaweeds. The highest Zn, Pb and Cu concentrations in seaweeds from the only inhabited beach may be a signal of the onset of human footprints on this still pristine, remote island. By comparison with background described in the literature, concentrations of trace elements in seaweeds were low, thus, allowing them to be considered reference levels.

Technical note: Influence of feed on image quality of abdominal ultrasonography in New Zealand white kits

<p class="Body">The aim of this study was to evaluate the influence of feed change on image quality of ultrasound scanning of the gallbladder, kidney and jejunum in New Zealand White kits. Thirty-nine 35-day-old rabbits were used, distributed into 4 diet groups: C, only commercial feed; CH, commercial feed and hay; C24H, only commercial feed, replaced by hay 24 h before examination; and CH24H, commercial feed and hay, with the commercial feed withdrawn 24 h before the exam. The rabbits received the diet for 42 d (from 35 to 77 d of age) and the ultrasound evaluations were performed on days 56 and 77. Ultrasonographic assessment for image quality focused on the possibility of visualisation and an image quality rating (3 scores: unacceptable, acceptable or excellent) for the gallbladder, kidneys and jejunum. The kidneys were visualised in 100% of animals of all diets and ages. There was no difference in visualisation (P&gt;0.05) of the gallbladder among the animals fed different diets on days 56 and 77. The C24H diet had a higher visualisation possibility (P&lt;0.05) of the jejunum compared to the C and CH diets on day 77. For the image quality score, there was no difference in the studied organs on day 56. However, on day 77, there was a difference for the jejunum (P&lt;0.05), and only the C24H and CH24H diets presented images classified as excellent. In conclusion, the image quality of the kidneys and gallbladder was unaffected by feed, and the jejunum had an improved image quality with the inclusion of hay and without the commercial feed 24 h before the test in New Zealand White rabbits at 77 d of age.</p>

Diazoxide enhances excitotoxicity-induced neurogenesis and attenuates neurodegeneration in the rat non-neurogenic hippocampus

Diazoxide, a well-known mitochondrial KATP channel opener with neuroprotective effects, has been proposed for the effective and safe treatment of neuroinflammation. To test whether diazoxide affects the neurogenesis associated with excitotoxicity in brain injury, we induced lesions by injecting excitotoxic N-methyl-d-aspartate (NMDA) into the rat hippocampus and analyzed the effects of a daily oral administration of diazoxide on the induced lesion. Specific glial and neuronal staining showed that NMDA elicited a strong glial reaction associated with progressive neuronal loss in the whole hippocampal formation. Doublecortin immunohistochemistry and bromo-deoxyuridine (BrdU)-NeuN double immunohistochemistry revealed that NMDA also induced cell proliferation and neurogenesis in the lesioned non-neurogenic hippocampus. Furthermore, glial fibrillary acidic protein (GFAP)-positive cells in the injured hippocampus expressed transcription factor Sp8 indicating that the excitotoxic lesion elicited the migration of progenitors from the subventricular zone and/or the reprograming of reactive astrocytes. Diazoxide treatment attenuated the NMDA-induced hippocampal injury in rats, as demonstrated by decreases in the size of the lesion, neuronal loss and microglial reaction. Diazoxide also increased the number of BrdU/NeuN double-stained cells and elevated the number of Sp8-positive cells in the lesioned hippocampus. These results indicate a role for KATP channel activation in regulating excitotoxicity-induced neurogenesis in brain injury.

El desafío de incorporar las redes institucionales y comunitarias en la intervención con adolescentes infractores: una investigación acción en tres regiones del sur de Chile

Se reportan los resultados obtenidos a partir de una investigación acción con componentes participativos, orientada a fortalecer el funcionamiento de redes institucionales y comunitarias para la intervención con adolescentes infractores de ley. El articulo da cuenta de los principales resultados obtenidos a partir de este proceso, centrando su análisis en un conjunto de dimensiones que permiten tener una panorámica acerca de los avances y desafíos que presentan los programas involucrados en el estudio. Los resultados reportan las dificultades de los equipos para incluir de modo eficiente los recursos de las redes inter institucionales dada la fragmentación de la política pública destinada a este grupo de adolescentes, así como las barreras para integrar la dimensión comunitaria en el trabajo con los jóvenes producto del formato de intervención así como las modalidades de financiamiento de los programas. Así también se evidencian mejoras en la comprensión e integración de estos componentes por parte de los equipos de los programas durante el proceso articulándose redes interinstitucionales con mejores grados de continuidad y complementariedad en su quehacer y una incorporación paulatina, aunque parcial de la dimensión comunitaria en la intervención.

Intestinal Alkaline Phosphatase: Potential Roles in Promoting Gut Health in Weanling Piglets and Its Modulation by Feed Additives - A Review

The intestinal environment plays a critical role in maintaining swine health. Many factors such as diet, microbiota, and host intestinal immune response influence the intestinal environment. Intestinal alkaline phosphatase (IAP) is an important apical brush border enzyme that is influenced by these factors. IAP dephosphorylates bacterial lipopolysaccharides (LPS), unmethylated cytosine-guanosine dinucleotides, and flagellin, reducing bacterial toxicity and consequently regulating toll-like receptors (TLRs) activation and inflammation. It also desphosphorylates extracellular nucleotides such as uridine diphosphate and adenosine triphosphate, consequently reducing inflammation, modulating, and preserving the homeostasis of the intestinal microbiota. The apical localization of IAP on the epithelial surface reveals its role on LPS (from luminal bacteria) detoxification. As the expression of IAP is reported to be downregulated in piglets at weaning, LPS from commensal and pathogenic gram-negative bacteria could increase inflammatory processes by TLR-4 activation, increasing diarrhea events during this phase. Although some studies had reported potential IAP roles to promote gut health, investigations about exogenous IAP effects or feed additives modulating IAP expression and activity yet are necessary. However, we discussed in this paper that the critical assessment reported can suggest that exogenous IAP or feed additives that could increase its expression could show beneficial effects to reduce diarrhea events during the post weaning phase. Therefore, the main goals of this review are to discuss IAP’s role in intestinal inflammatory processes and present feed additives used as growth promoters that may modulate IAP expression and activity to promote gut health in piglets.

Alveolar hemorrhage in systemic lupus erythematosus: a cohort review

Diffuse alveolar hemorrhage (DAH) is a rare but potentially catastrophic manifestation with a high mortality. Among rheumatologic diseases, it occurs most frequently in patients with systemic lupus erythematosus (SLE) and systemic vasculitis. Despite new diagnostic tools and therapies, it remains a diagnostic and therapeutic challenge. The aim of this work was to characterize the SLE patients with an episode of alveolar hemorrhage followed in our Clinical Immunology Unit (CIU). A retrospective chart review was carried out for all patients with SLE followed in CIU between 1984 and the end of 2013. We reviewed the following data: demographic characteristics, clinical and laboratory data, radiologic investigations, histologic studies, treatment, and outcome. We identified 10 episodes of DAH, corresponding to seven patients, all female. These represent 1.6% of SLE patients followed in our Unit. The age at DAH attack was 42.75 ± 18.9 years. The average time between diagnosis of SLE and the onset of DAH was 7.1 years. Three patients had the diagnosis of SLE and the DAH attack at the same time. Disease activity according to SLEDAI was high, ranging from 15 to 41. All patients were treated with methylprednisolone, 37.5% cyclophosphamide and 28.6% plasmapheresis. The overall mortality rate was 28.6%.

Natural background groundwater composition in the Azores archipelago (Portugal): a hydrogeochemical study and threshold value determination

Groundwater discharges were sampled in selected springs from São Miguel (Furnas and Fogo trachytic central volcanoes) and Santa Maria islands (Azores, Portugal), in order to characterize natural background levels (NBLs) and proceed to the determination of threshold values (TVs). Besides being a key issue in order to fully assess the anthropogenic pressures, NBLs are also instrumental to derive TVs, therefore complying with requirements from the European Union Groundwater Directive. The composition of groundwater corresponds mainly to low mineralized Na-HCO3 to Na-Cl water types, the latter dominant in Santa Maria island, with a decreasing order of Na>Ca>Mg>K and Cl>HCO3>SO4>NO3 for cations and anion respectively. The majority of the samples are slightly acid to slightly alkaline (pH range of 5.45-7.43), and the electrical conductivity range between 180 and 1458 μS/cm. Groundwater composition is controlled by two major drivers, addition of sea salts and dissolution of silicate minerals. Results shown that TVs established along the present study are in general in the lower rank when compared to the range of values proposed by the several EU member states, with the main exception of NO3, reflecting the impact of agriculture activities over water quality in the Azores, and lower than the national ones. The comparison between the estimated NBL and TV with values derived with another dataset from the Azores, usually higher, depicts the effect of a larger and diverse number of groundwater sources over calculations. On the other hand, all samples which show a contribution from volcanic/hydrothermal systems were excluded from the dataset, which explains why the derived NBLs and TVs are lower comparing to other active volcanic areas, which is also a conservative approach on a subject that has regulatory implications.

Spring geochemistry in an active volcanic environment (São Miguel, Azores): source and fluxes of inorganic solutes

Mineral waters were monthly sampled in selected springs from Furnas and Fogo trachytic central volcanoes (São Miguel, Azores, Portugal). Water temperatures between 15.1 °C and 90.2 °C, characterize poorly mineralized waters of Na-HCO₃ and Na-HCO₃-Cl types. According to the spring location, two watersheds were selected in each volcano to evaluate solute fluxes and chemical weathering rates (Fogo volcano: Ribeira Grande river - RRG; Furnas volcano: Ribeira Quente river - RRQ). Na, Mg, K and Ca fluxes in groundwater represented 43%, 60%, 46% and 57% of the total (subsurface plus surface fluxes) in RRG, and respectively 43%, 53%, 46% and 49% in RRQ. Average HCO₃ flux is ten times higher in RRQ (130.1 × 10(6) mol/yr) compared to RRG (13.8 × 10(6) mol/yr), reflecting the volcano degassing and the lower ratio between groundwater and river water fluxes. Based on these values, total CO₂-consumption by weathering ranged from 1.5 × 10(6)mol/km(2)/yr (RRG) to 4 × 10(6)mol/km(2)/yr (RRQ). TDS load varied between 3772 t/yr (RRG) and 15388 t/yr (RRQ), and the ratio between values in groundwater and in surface water is respectively equal to 0.72 and 2.04. The associated chemical weathering rates in groundwater were 206 t/km(2)/yr (RRG) and 399 t/km(2)/yr (RRQ). Coupled to river water, these values indicate that total chemical weathering rates are respectively equal to 493 t/km(2)/yr and 594 t/km(2)/yr. A similar approach developed for the entire archipelago showed that the chemical weathering rates due to groundwater are in the range from 33 to 321 t/km(2)/yr, being partially controlled by the age of the islands. Results of the present study point out to the need to consider groundwater solute fluxes due to weathering when establishing geochemical budgets.

Fluvial geochemistry in São Miguel Island (Azores, Portugal): source and fluxes of inorganic solutes in an active volcanic environment

River water chemistry in two of the major rivers in São Miguel Island (Azores archipelago, Portugal) has been characterized monthly between June 2010 and October 2011 in order to estimate the main geochemical processes that explain water composition and to estimate solute fluxes and the thermal water input to rivers. Both rivers (Ribeira Grande - RRG, and Ribeira Quente - RRQ) drain active trachytic central volcanoes. The number of sampling stations is seven in RRG and six in RRQ. Rivers are mainly slightly acid to basic in nature (pH in the range 5.41-8.70 in RRG and 5.90-8.10 in RRQ) and from the Na-HCO3 and Na-HCO3-Cl water types. In both cases water temperature increases towards the river mouth and median values are slightly higher in Ribeira Quente (15.5-22.4°C) comparing to Ribeira Grande river (15.2-19.7°C). Electrical conductivity suggests poorly mineralized waters (139-456 μS/cm in RRG and 209-402 μS/cm in RRQ, and values increase downstream. Higher solute fluxes are associated to HCO3 and Na, and the total CO2 flux is equal to 3647 t/yr in RRQ and 7546 t/yr in RRG. Mixture with thermal water discharges also influences river water chemistry and in RRQ the contribution to the annual average discharge rate was estimated in 2.96×10(6)m(3)/yr (12.8% of overall discharge rate in the watershed). In RRG thermal water discharges were estimated in 2.4×10(6)m(3)/yr (14.9% of the discharge rate). The minimum total CO2-consumption associated with low-temperature weathering is equal to 0.58×10(6)mol/km(2)/yr in Ribeira Quente river and equal to 0.78×10(6)mol/km(2)/yr in Ribeira Grande river.

Especificaciones de cálculo de la vida útil y estado límite de corrosión

RESUMENLos cálculos de vida útil de las estructuras de hormigón están pasando rápidamente de los laboratorios a las normativas y a ser especificados en la licitación de grandes infraestructuras. Así vidas útiles de 100 años o más se han requerido en puentes como Oresund o en el nuevo canal de Panamá. Sin embargo la especificación se realiza de forma resumida sin que se defina la forma de demostrar esa durabilidad y en algunos casos, sin siquiera mencionar los ensayos y sus valores limites que se deben utilizar. En la presente comunicación se describen los aspectos más importantes que se deben especificar en los modelos que deben ser además de los coeficientes de difusión, la concentración superficial, los factores de envejecimiento y el límite de cloruros así como la probabilidad de corrosión que se considera inaceptable.Palabras Clave: hormigón; cloruros; resistividad; difusión.ABSTRACTEstimates of service life of concrete structures are rapidly moving from laboratories to the standards and to be specified in the construction for large infrastructures. So service life of 100 years or more were required to Oresund bridge or the new Panama Canal. However, the specification is made without defining how to prove the specified durability and in some cases, without even mentioning the tests and limit values to be used. Present communication describes the most important aspects to be specified in the chloride prediction models in addition to the diffusion coefficients, which are the surface concentration, the aging factor, the limit of chlorides and the acceptable probability of corrosion.Keywords: concrete; chlorides; resistivity; diffusion.