Breast tumors in adolescents are very rare and mostly benign. Fibroadenomas are the most frequent, but within the extensive differential diagnosis, the phyllodes tumor must be mentioned, which ...accounts for about 1% of breast tumors and the diagnosis of which is very rare in patients younger than 20 years. There are no specific symptoms or radiological images to distinguish phyllodes tumor from fibroadenoma; therefore, histological examination is mandatory for diagnosis. Histology also allows the classification of phyllodes tumor into benign, borderline, or malignant types for appropriate surgical treatment: freemargin excision in benign tumors and mastectomy in the other two types. Fortunately, the majority of these tumors are benign, and treatment maximizes breast conservation with free infiltration margins surgery, given that this fact is the most important factor to prevent local recurrence. In this article, we describe a rare case of borderline cystosarcoma phyllodes in a 12-year-old girl.
Objective
The aim of this study is to assess Trypanosoma cruzi infection prevalence among pregnant migrants living in Madrid according to the country of origin and to assess screening coverage in ...this at‐risk population.
Methods
Retrospective multicentre cross‐sectional study conducted from January 2011 to December 2016 in eight Madrid hospitals. Each hospital reviewed their microbiology data records to assess the screening coverage and serological diagnosis in all pregnant women coming from endemic areas.
Results
From 2011 to 2016, 149,470 deliveries were attended at the eight hospitals, and 11,048 pregnant women were screened for Chagas disease. Most cases (93.5%) were in women from Bolivia, who also showed the highest prevalence (12.4%, 95% confidence interval: 9.9–15.0). Pooled prevalence amongst the screened women was 2.9% (95% CI: 1.8–4.1). Chagas disease screening coverage varied greatly between centres, with a pooled mean coverage of 47% (95% CI: 37%–57%; 73% 95% CI: 63%–82% for those centres with universal screening vs. 10% 95% CI: 6%–15% for those with a selective screening approach; p < 0.001).
Conclusion
Our study provides useful data for policy makers and epidemiologists in a non‐endemic area without congenital Chagas screening programmes.
Scope
Eating large amounts of fat is usually associated with fat accumulation. However, different types of diets (not only lipids) elicit different metabolic responses.
Methods and results
Male and ...female rats (10 week‐old) are distributed in four groups and fed for 1 month a standard diet (SD), or this diet enriched with either lipid (high‐fat diet, HF) or protein (high‐protein diet, HP), or a cafeteria diet (CAF). Both HF and CAF diets share the percentage of energy from lipids (40%) but these are different. Protein‐derived energy in the HP diet is also 40%. Feeding SD, HF, and HP diets does not result in differences in energy intake, energy expenditure, total body weight, or lipid content. However, the CAF‐fed groups show increases in these parameters, which are more marked in the male rats. The CAF diet increases the mass of adipose tissue while the HF diet does not.
Conclusion
Different diets produce substantial changes in the fate of ingested nutrient energy. Dietary lipids are not essential for sustaining an increase in body lipid (or adipose tissue) content. Body protein accrual is unrelated to dietary lipids and overall energy intake. Both protein and lipid accrual are more efficient in male rats.
Rats fed diets with similar energy content, but varying lipid or protein contents, show substantial changes in energy partitioning. Dietary lipids are not essential for sustaining increase in body lipid content or adipose tissue masses, whereas protein and lipid accrual are independent of each other.
•Imipenem/relebactam and ceftazidime/avibactam resistance was evaluated in K. pneumoniae.•Resistance to imipenem/relebactam and ceftazidime/avibactam develops rapidly in all ...clones.•Imipenem/relebactam resistance involves OmpK36 disruption and KPC modification.•KPC variants selected with imipenem/relebactam show resistance to relebactam inhibition.•Development of imipenem/relebactam resistance imposes high fitness costs.
In order to inform and anticipate potential strategies aimed at combating KPC-producing Klebsiella pneumoniae infections, we analysed imipenem/relebactam and ceftazidime/avibactam single-step mutant frequencies, resistance development trajectories, differentially selected resistance mechanisms and their associated fitness cost using four representative high-risk K. pneumoniae clones.
Mutant frequencies and mutant preventive concentrations were determined using agar plates containing incremental concentrations of β-lactam/β-lactamase inhibitor. Resistance dynamics were determined through incubation for 7 days in 10 mL MH tubes containing incremental concentrations of each antibiotic combination up to their 64 × baseline MIC. Two colonies per strain from each experiment were characterized by antimicrobial susceptibility testing, whole genome sequencing and competitive growth assays (to determine in vitro fitness). KPC variants associated with imipenem/relebactam resistance were characterized by cloning and biochemical experiments, atomic models and molecular dynamics simulation studies.
Imipenem/relebactam prevented the emergence of single-step resistance mutants at lower concentrations than ceftazidime/avibactam. In three of the four strains evaluated, imipenem/relebactam resistance development emerged more rapidly, and in the ST512/KPC-3 clone reached higher levels compared to baseline MICs than for ceftazidime/avibactam. Lineages evolved in the presence of ceftazidime/avibactam showed KPC substitutions associated with high-level ceftazidime/avibactam resistance, increased imipenem/relebactam susceptibility and low fitness costs. Lineages that evolved in the presence of imipenem/relebactam showed OmpK36 disruption, KPC modifications (S106L, N132S, L167R) and strain-specific substitutions associated with imipenem/relebactam resistance and high fitness costs. Imipenem/relebactam-selected KPC derivatives demonstrated enhanced relebactam resistance through important changes affecting relebactam recognition and positioning.
Our findings anticipate potential resistance mechanisms affecting imipenem/relebactam during treatment of KPC-producing K. pneumoniae infections.
Purpose
Definitions of acute respiratory distress syndrome (ARDS) include radiographic criteria, but there are concerns about reliability and prognostic relevance. This study aimed to evaluate the ...independent relationship between chest imaging and mortality and examine the inter-rater variability of interpretations of chest radiographs (CXR) in pediatric ARDS (PARDS).
Methods
Prospective, international observational study in children meeting Pediatric Acute Lung Injury Consensus Conference (PALICC) criteria for PARDS, which requires new infiltrate(s) consistent with pulmonary parenchymal disease, without mandating bilateral infiltrates. Mortality analysis focused on the entire cohort, whereas inter-observer variability used a subset of patients with blinded, simultaneous interpretation of CXRs by intensivists and radiologists.
Results
Bilateral infiltrates and four quadrants of alveolar consolidation were associated with mortality on a univariable basis, using CXRs from 708 patients with PARDS. For patients on either invasive (IMV) or non-invasive ventilation (NIV) with PaO
2
/FiO
2
(PF) ratios (or SpO
2
/FiO
2
(SF) ratio equivalent) > 100, neither bilateral infiltrates (OR 1.3 (95% CI 0.68, 2.5),
p
= 0.43), nor 4 quadrants of alveolar consolidation (OR 1.6 (0.85, 3),
p
= 0.14) were associated with mortality. For patients with PF ≤ 100, bilateral infiltrates (OR 3.6 (1.4, 9.4),
p
= 0.01) and four quadrants of consolidation (OR 2.0 (1.14, 3.5),
p
= 0.02) were associated with higher mortality. A subset of 702 CXRs from 233 patients had simultaneous interpretations. Interobserver agreement for bilateral infiltrates and quadrants was “slight” (kappa 0.31 and 0.33). Subgroup analysis showed agreement did not differ when stratified by PARDS severity but was slightly higher for children with chronic respiratory support (kappa 0.62), NIV at PARDS diagnosis (kappa 0.53), age > 10 years (kappa 0.43) and fluid balance > 40 ml/kg (kappa 0.48).
Conclusion
Bilateral infiltrates and quadrants of alveolar consolidation are associated with mortality only for those with PF ratio ≤ 100, although there is high- inter-rater variability in these chest-x ray parameters.
The administration of diets with different protein/energy ratios induce variable but distinctive responses in rats; an excessive protein content tends to decrease fat accumulation, but reversion of ...this ratio tends to increase adipose tissue mass. The fate of N derived from amino acid metabolism is not only dependent on energy and dietary protein; the increased excretion of urea elicited by high-protein diets contrasts with the lower urea excretion (despite excess dietary protein and energy) in rats fed a cafeteria diet. After one month of exposure to high-protein (HPD) or cafeteria (CD) diets, we administered a gavage of 15 N-arginine to undisturbed adult male rats, in order to trace the utilization of this not-recyclable-N amino acid under diets with different protein/energy relationships. Rats fed a high-protein diet excreted higher amounts of N in urine and showed much lower gastrointestinal content of the label. The CD rats decreased the excretion of urine N. Both groups' N balance showed a significant proportion of N not-accounted-for (but excreted nevertheless), the proportion being especially large in the HPD group. In conclusion, the process of disposal of amino acid N through the so far unknown pathway for “non-accounted-for N” is, thus essentially dependent on excess amino acid availability; independently of urea cycle operation and diet energy content.
RESUMEN Este trabajo tiene como objetivo identificar cuáles son las variables a través de los cuales se puede medir la calidad del proceso de enseñanza-aprendizaje de la Estadística en las carreras ...universitarias donde se imparte esta asignatura a partir de la dificultades que se presentan en la actualidad, mediante un análisis estructural prospectivo que permita determinar las variables determinantes, claves, autónomas y de resultado, variables esenciales para la determinación de la evolución del sistema.
La vía clínica de recuperación intensificada en cirugía cardiaca (RICC) pretende identificar, difundir y favorecer la implementación de las mejores actuaciones basadas en la evidencia científica para ...disminuir la variabilidad en la práctica clínica. La puesta en marcha de estas prácticas en el proceso clínico global favorecerá la obtención de mejores resultados, acortamiento de estancias hospitalarias y en la Unidad de Cuidados Críticos, lo que permitirá una reducción de costes y una mayor eficiencia. Tras realizar una revisión sistemática en cada uno de los puntos del proceso perioperatorio en cirugía cardiaca, se han redactado recomendaciones basadas en la mejor evidencia científica disponible en la actualidad con el consenso de las sociedades científicas implicadas.
The ERAS guidelines are intended to identify, disseminate and promote the implementation of the best, scientific evidence-based actions to decrease variability in clinical practice. The implementation of these practices in the global clinical process will promote better outcomes and the shortening of hospital and critical care unit stays, thereby resulting in a reduction in costs and in greater efficiency. After completing a systematic review at each of the points of the perioperative process in cardiac surgery, recommendations have been developed based on the best scientific evidence currently available with the consensus of the scientific societies involved.
A participación no mercado bolsista é un tema de estudo con varias décadas de historia, aínda hoxe en discusión, como resposta á persistencia de baixas taxas de participción. Neste traballo ...analízanse os determinantes da participación no devandito mercado mediante modelos probit, onde a variable dependente recolle a tenza directa de accións e/ou a participación indirecta a través de fondos de investimento. Os resultados amosan que a idade, educación, preferencias de risco e uso de internet resultan ser variables chaves á hora de explicar a participación dos fogares no mercado de valores na España.
El objetivo fue evaluar las propiedades físicas del suelo bajo diferentes sistemas de labranzas y secuencias de cultivos en un Argiudol Ácuico de Corrientes, a fin de obtener indicadores de calidad. ...El diseño fue de parcelas completamente aleatorizadas en arreglo factorial (3x4), donde los factores fueron: • Sistemas de labranzas, con tres niveles: convencional (LC), reducida (LR) y siembra directa (SD); y • Secuencias de cultivos, con cuatro niveles: maíz-avena (M-Av), maíz-descanso (M-D), algodón-avena (A-Av) y algodón-descanso (A-D). Los tratamientos fueron 12, con 4 repeticiones y 48 unidades experimentales. En la siembra de maíz y algodón, del cuarto ciclo productivo, se determinó densidad aparente (Da), estabilidad de agregados (EA), Infiltración (Ib) y resistencia mecánica a la penetración (RMP), en condiciones de capacidad de campo (CC). Se aplicó análisis de la varianza con la prueba de Duncan. La RMP fue 0,27 MPa en superficie para SD respecto de LR y LC (0,18 MPa), en cambio en profundidad se revirtió la situación, 0,9 MPa en SD y 1,17 MPa para LC (α ≤ 0,05). La EA fue 68,3% en SD; 54,8% en LR y 49,5% en LC (α ≤ 0,05). También aumentó la infiltración bajo SD (2,9 cm h-1), seguidos por LR y LC (α ≤ 0,05). Los atributos que podrían indicar calidad de suelo serían: a) La RMP disminuyó por el laboreo del suelo en superficie, con LC y LR, pero presentó la mejores condiciones bajo SD en profundidad; b) Las rotaciones que finalizaron con algodón tuvieron menor RMP (7-20 cm) que con cultivos de maíz; c) La EA y la Ib presentaron los mayores valores en SD. Las prácticas que favorecieron la EA colaboraron a una mayor Ib e implicaría una menor escorrentía y erosión hídrica; d) La SD presentó las variaciones más favorables para mantener la calidad del suelo.
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