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The indications for expanded endoscopic transnasal approaches continue to increase, with more complex skull base defects needing to be repaired. This study reviews the management of large anterior skull base defects with opening of the sellar diaphragm.
A prospective analysis of endonasal endoscopic surgery carried out at Son Espases University Hospital between January 2013 and December 2018 was performed. The analysis included only the cases with a significative intra-operative cerebrospinal fluid leak. In all cases, reconstruction was performed by combining the gasket seal technique with a pedicled mucosal endonasal flap.
Twenty-eight patients were included. The mucoperiosteal nasoseptal flap, the lateral wall flap and the middle turbinate flap were used in 13, 8 and 7 patients, respectively, combined with the gasket seal technique. One case of post-operative cerebrospinal fluid leak was observed (3.57 per cent).
The combination of a gasket seal with an endonasal mucosal flap is an excellent technique for repairing large anterior skull base defects.
Major depressive disorder (MDD) is common in patients diagnosed with advanced cancer (AC), with a prevalence of 16.5%. It is associated with great disability and worsened quality of life, increased number and intensity of physical symptoms, and lower survival. It is the main factor for the presence of suicidal ideation. Antidepressants show modest efficacy, and response requires several weeks. Ketamine has demonstrated a fast and robust antidepressant effect in subanesthetic doses. This effect may prove useful in patients with AC, MDD, and suicidal risk.
We report a case of a patient with advanced cervical cancer who presented with uncontrollable pain, MDD, and a suicide attempt.
A 39-year-old woman diagnosed with cervical cancer stage IVB presented to the Emergency Department after a suicide attempt by hanging. Upon evaluation by the palliative care psychiatrist, she reported intense pain, unresponsive to analgesics, and had a history of persistent suicidal ideation. Antidepressant treatment was started (sertraline 50mg/d) after a single dose of ketamine hydrochloride IV (0.5 mg/kg) was administered. Treatment response was measured using the Brief Edinburgh Depression Scale before and after the intervention. The depressive symptoms decreased by 17% on day 1, 39% on day 3, and 72% on day 17.
Significance of results
This case report shows ketamine's efficacy as an augmentation agent alongside conventional antidepressant treatment in patients with AC. Moreover, it shows rapid response in suicidal ideation that has not been achieved with treatment as usual. More clinical trials are needed to support the potential benefit and safety of ketamine in patients with AC, MDD, and persisting suicidal ideation.
We used two sunflower genotypes displaying pericarp-imposed dormancy at high incubation temperatures (i.e. 30°C) to investigate the role of the pericarp as a limitation to oxygen availability to the embryo (hypoxia), and its impact on embryo abscisic acid (ABA) content and sensitivity to ABA. Results showed that both genotypes displayed very different oxygen threshold values for inhibition of embryo germination when incubation was performed at 30°C. Expression of dormancy in one genotype was therefore related to exacerbated embryo sensitivity to hypoxia, whereas in the other genotype, the pericarp appeared to act as a more severe restraint to oxygen entry. Increased sensitivity to hypoxia was, in part, related to increased sensitivity to ABA, but not to alterations in ABA metabolism. The activity of pericarp-microbial communities (bacteria and fungi) at high temperatures was also assessed as a potential determinant of hypoxia to the embryo. Oxygen consumption in pericarps incubated at 30°C was attenuated with antibiotics, which concomitantly promoted achene germination. In agreement with the observed more severe oxygen deprivation to the embryo exerted by the pericarp, the bacterial load in the pericarp was significantly higher in the commercial hybrid than in the inbred line; however, the application of antibiotics strongly reduced the bacterial colony counts for each genotype. Different bacterial and fungal communities, assessed through their profiles of carbon-source utilization, were determined between genotypes and after treatment with antibiotics. This work highlights the relationship between enhancement of sensitivity to hypoxia with incubation temperature and seed dormancy expression, and suggests that microbial activity might be part of the mechanism through which hypoxia is imposed.
Early, conforming antibiotic treatment in elderly patients hospitalised for community-acquired pneumonia (CAP) is a key factor in the prognosis and mortality. The objective was to examine whether empirical antibiotic treatment was conforming according to the Spanish Society of Pulmonology and Thoracic Surgery guidelines in these patients. Multicentre study in patients aged ⩾65 years hospitalised due to CAP in the 2013–14 and 2014–15 influenza seasons. We collected socio-demographic information, comorbidities, influenza/pneumococcal vaccination history and antibiotics administered using a questionnaire and medical records. Bivariate analyses and multilevel logistic regression were made. In total, 1857 hospitalised patients were included, 82 of whom required intensive care unit (ICU) admission. Treatment was conforming in 51.4% (95% confidence interval (CI) 49.1–53.8%) of patients without ICU admission and was associated with absence of renal failure without haemodialysis (odds ratio (OR) 1.49, 95% CI 1.15–1.95) and no cognitive dysfunction (OR 1.71, 95% CI 1.25–2.35), when the effect of the autonomous community was controlled for. In patients with ICU admission, treatment was conforming in 45.1% (95% CI 34.1–56.1%) of patients and was associated with the hospital visits in the last year (<3 vs. ⩾3, OR 2.70, 95% CI 1.03–7.12) and there was some evidence that this was associated with season. Although the reference guidelines are national, wide variability between autonomous communities was found. In patients hospitalised due to CAP, health services should guarantee the administration of antibiotics in a consensual manner that is conforming according to clinical practice guidelines.
To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and the INICC Surveillance Online System (ISOS) on central line-associated bloodstream infection (CLABSI) rates in 14 intensive care units (ICUs) in Argentina from January 2014 to April 2017.
This prospective, pre–post surveillance study of 3,940 ICU patients was conducted in 11 hospitals in 5 cities in Argentina. During our baseline evaluation, we performed outcome and process surveillance of CLABSI applying Centers for Disease Control and Prevention/National Health Safety Network (CDC/NHSN) definitions. During the intervention, we implemented the IMA through ISOS: (1) a bundle of infection prevention practice interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback on CLABSI rates and consequences, and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention on the CLABSI rate.
During the baseline period, 5,118 CL days and 49 CLABSIs were recorded, for a rate of 9.6 CLABSIs per 1,000 central-line (CL) days. During the intervention, 15,659 CL days and 68 CLABSIs were recorded, for a rate of 4.1 CLABSIs per 1,000 CL days. The CLABSI rate was reduced by 57% (incidence density rate: 0.43; 95% confidence interval, 0.34–0.6; P<.001).
Implementing IMA through ISOS was associated with a significant reduction in the CLABSI rate in ICUs in Argentina.
The study of the small magnetic structures of the solar photosphere is of great relevance because of their association with concentrations of magnetic field and their possible contribution to the variations of the Total Solar Irradiance. These structures are known to appear close to active regions and ubiquitously in the quiet Sun areas. Numerous studies about their distribution across all over the solar surface have been done with high-resolution instrumentation. However, since the observations have always been carried out from the ecliptic plane, their distribution near the polar regions is not well known. Future missions, like Solar Orbiter, will certainly provide valuable information on these yet unexplored regions. In this work, and in preparation for that moment, we select favorable periods for the observation of the polar regions of the Sun, and study the fraction of covered surface by small magnetic structures and its variation with the solar activity.
Some key physical processes that impact the evolution of Earth's atmosphere on time-scale from days to millennia, such as the EUV emissions, are determined by the solar magnetic field. However, observations of the solar spectral irradiance are restricted to the last few solar cycles and are subject to large uncertainties. We present a physics-based model to reconstruct short-term solar spectral irradiance (SSI) variability. The coronal magnetic field is estimated to employ the Potential Field Source Surface extrapolation (PFSS) based on observational synoptic charts and magnetic flux transport model. The emission is estimated to employ the CHIANTI atomic database 8.0. The performance of the model is compared to the emission observed by TIMED/SORCE.
The enzymatic hydrolysis of cheese whey was optimised using the enzymes iZyme, Alcalase or Flavourzyme under different conditions. Hydrolysates supplemented with commercial nutrients were evaluated as fermentation broths to produce DL-3-Phenyllactic acid (PLA) from phenylalanine (Phe) by Lactobacillus plantarum CECT-221. Optimised hydrolysates were obtained using Flavourzyme at 50 °C and 100 rpm during 12 h, and assayed in 250 ml Erlenemyer flasks using different proportions of vinasses as economic nutrient. The process was then scaled up using a 2 litres Bioreactor working under the continuous modality. Under the intermediate dilution rate of 0·0207 h−1 0·81 ± 0·026 mM of PLA and 38·8 ± 3·253 g/l of lactic acid were produced. A final evaluation revealed that lactic acid, and bacteriocins exerted the highest inhibitory effect among the extracted components of cell-free supernatants.
In recent decades, we have seen an increase in the use of computers. This presents a crossroads in deciding what to do with the units that become "obsolete". As society, we have created a new type of solid waste that must be handled differently because the diversity of materials composition. In addition, at the end of their life cycle also affects the environment when the materials are disposal in landfill; i.e. plastic substrate (polycarbonate), may lead to chronic problems such as hyperactivity, infertility or even cancer.
The recycling of electronic equipment is from whole parts, such as the electronic cables. Recover substances (plastics) and compounds (metals) from electronic cables could it be possible.
We are looking for a solution to this problem and we created a structure of recycling to reduce the waste at the source and allows that which cannot be reduced is recycled, because computers contain 20% of thermoplastics and 6% of plastic mixtures that are the subject of this investigation.
The recycled chemist hired himself since it provides capabilities that address the limitations of the mechanical recycling; you need large quantities of clean, separate, homogeneous plastic waste to be able to guarantee the quality of the final product. Chemical recycling overcomes these drawbacks, since the classification of the different types of plastic resins from of waste is not necessary.
Based on the data obtained from this research, determines that the recycling of computer waste in conjunction with other plans of reduction at source makes this a viable alternative for the management of the same. Benefits that can be derived by establishing a recycling of the computer waste program is donating units or sell these affordable to low-income people who otherwise would not have access to this technology.
Increasing evidence suggests that the Mediterranean diet can reduce the risk of CVD. Olive oil is the hallmark of this dietary pattern. We conducted a meta-analysis of case–control, prospective cohort studies and a randomised controlled trial investigating the specific association between olive oil consumption and the risk of CHD (101 460 participants) or stroke (38 673 participants). The results of all observational studies were adjusted for total energy intake. The random-effects model assessing CHD as an outcome showed a relative risk (RR) of 0·73 (95 % CI 0·44, 1·21) in case–control studies and 0·96 (95 % CI 0·78, 1·18) in cohort studies for a 25 g increase in olive oil consumption. In cohort studies, the random-effects model assessing stroke showed a RR of 0·74 (95 % CI 0·60, 0·92). The random-effects model combining all cardiovascular events (CHD and stroke) showed a RR of 0·82 (95 % CI 0·70, 0·96). Evidence of heterogeneity was apparent for CHD, but not for stroke. Both the Egger test (P= 0·06) and the funnel plot suggested small-study effects. Available studies support an inverse association of olive oil consumption with stroke (and with stroke and CHD combined), but no significant association with CHD. This finding is in agreement with the recent successful results of the PREDIMED randomised controlled trial.
This study aimed to evaluate the effect of 12 substrates in the seedling growth of chili apple (Capsicum pubescens R. & P.) hybrid Grajales ST. The substrates were prepared with different proportions of five materials: perlite, coconut fiber, loam, Sunshine3 ® and wood dust. The seeds were sown in trays of 50 cavities. For the substrates were determined physical and chemical properties. Significant differences in growth parameters of seedlings are the effect of the substrate. Based on the remarkable accumulation of dry matter of each of the organs of the seedling, and their relative distribution, one can surmise a seedling quality with 47.70 % dry matter in leaves, 35.34 % in stem and 16.95 % in root. The substrate with better features for the production of chile apple seedlings was prepared with 25 % loam and 75 % perlite (v/v), which showed retention of 85.5 % moisture, electrical conductivity of 0.03 dS·m-1 and total porosity of 62.5 %.
Concentrations of cadmium (Cd), lead (Pb), copper (Cu), zinc (Zn) and iron (Fe) were measured in three macroalgal species, Codium simulans, Sargassum sinicola and Gracilaria pachydermatica, and in the sea slug Elysia diomedea, living in marine ecosystems dominated by Sargassum species and located near exploited phosphorite deposits. Metal concentrations in macroalgae and sea slugs were significantly different among sites. The highest concentrations of Cd recorded in C. simulans and S. sinicola, as well as in E. diomedea were recorded at the site closest to the phosphorite deposit. In general, Cd and Zn concentrations in E. diomedea were higher than those recorded in specimens of C. simulans, S. sinicola and G. pachydermatica. In contrast, Pb, Cu, and Fe concentrations in E. diomedea were lower than or similar to those in macroalgae from all sampled sites. The information generated contributes to the knowledge about potential mobility and metal bioaccumulation at lower trophic levels in marine eco systems.
In the present work, a comparison study of the Ni catalysts supported on SBA-15 silica support prepared with and without the addition of organic ligands (citric acid and ethylenediaminetetraacetic acid (EDTA) was undertaken. The aim of this study was to inquire on the effect of the addition of organic ligands on the characteristics of the supported NiO and Ni nanoparticles and on their activity and selectivity in hydrogenation (HYD) of aromatics. Catalysts with different metal loadings (5, 10 and 20 wt. % of Ni) were prepared, characterized by nitrogen physisorption, small-angle and powder XRD, TPR, UV-vis DRS, and HRTEM, and tested in HYD of naphthalene (NP). It was found that Ni(II)-Ligand complexes were formed in aqueous solutions of Ni(NO3)2 containing citric acid (CA) or EDTA. Catalysts prepared from impregnation solutions with and without ligands had different textural characteristics and dispersion of NiO particles after calcination at 500 °C for 4 h. As it was shown by XRD, DRS and TPR, dispersion of NiO particles significantly increased when EDTA was used, whereas it noticeably decreased after the addition of CA. Similar trends were observed in the dispersion of metallic Ni particles after reduction of the NiO/SBA-15 precursors (HRTEM). In line with the characterization results, catalytic activity tests revealed strong differences in the activity of the prepared Ni/SBA-15 catalysts in hydrogenation of naphthalene. Catalysts prepared with the addition of EDTA were more active than those prepared without ligands. On the contrary, the HYD activity of a series of the Ni catalysts prepared with citric acid was lower than of other corresponding samples. The reasons of such a different behavior of the catalysts prepared with two organic ligands used are discussed on the basis of the obtained characterization results.
Today the company seeks alternative natural medicine that are compatible
with the body, which does not produce side effects and hang time are easily
accessible and cost of those who currently have. The concern of researchers
and specialists in the development of new materials is to seek, to
experiment and create products that can be useful and compatible with human
beings so as to obtain a curative effect without a side effect
The development of pharmacologically active materials has increased in
recent years. People lack access to most drugs and is therefore a need for
more rapid and less expensive than current, which can be applied to cellular
systems in vitro, in order to evaluate the biocompatibility of new
materials. The current study seeks to experiment in a new line of research
that helps health care and have a better quality of life.
The excipients in the drug are auxiliary substances that help the active
ingredient is the one with the therapeutic action, can be formulated in an
effective and pleasant for the patient. It is one or more substances that
are incorporated into the product to facilitate its preparation, maintenance
or administration. We therefore tested clay known as bentonite to serve as a
vehicle for transport of an active substance (ursolic acid)  and some
scientific studies have shown that it possesses anti-inflammatory,
antibacterial, antifungal and highly cytotoxic capacity. Both materials were
mixed to generate a new biomaterial that has anti-inflammatory activity.
Evaluation of this model was under the inhibition of edema produced by
13-acetate-12-ortho-tetradecanoylphorbol (TPA) in mouse ear.
Steady-state creep and joining of alumina/zirconia composites containing alumina volume fractions of 20, 60, and 85% have been investigated between 1250 and 1350°C. Superplasticity of these compounds is controlled by grain-boundary sliding and the creep rate is a function of alumina volume fraction, not grain size. Using the principles of superplasticity, pieces of the composite have been joined by applying the stress required to achieve 5 to 10% strain to form a strong interface at temperatures as low as 1200°C
In the last fifteen years, there have been significant changes in the production of medicines, mainly in the addition of new components to the formulation of solid dosage forms. The current trend of “back to nature” to lead to a healthier life has led those who are engaged in the pharmaceutical field to develop new formulations that allow the use of natural products of plant origin
For example, excipient ingredients, used as carriers for a drug's active ingredients, are now being used. These are incorporated into a drug in order to facilitate the drug's preparation, maintenance, or administration. The excipient is beneficial to the patient because it allows the drug to be easily administered and absorbed by the human body 
There is evidence that the clays have great potential for both absorption and adsorption due to its tiny particles. In addition, it has been reported that some clays have an effective antiseptic and healing ability [5–8]
In the present work, a clay called bentonite was tested as a support vehicle of an inflammatory agent derived from a Mexican native plant called Distictis buccinatoria, commonly named “Tonacaxóchitl”. Studies carried out by Rojas et al. have shown that the organic extract of this plant has important antibacterial, antifungal, cytotoxic and anti-inflammatory properties 
A biomaterial is a non-biological material used in a medical device in order to interact with biological systems. Many different types of materials such as metals, ceramic or natural and synthetic polymers can be included in this definition. Most of the time they are used as mixed materials where the combination of two or more substances with their own characteristics results in a new material whose features will be superior to the ones of its components for the achievement of the objectives preset . According to the length and characteristics of the contact with an organism, biomaterials can be classified as temporal and permanent and of intra or extra corporal location. According to their functions they can be used as support, diagnostic or treatment . Some biomaterials contain drugs and they are considered as medicines, others may include living cells and become the so called “hybrid biomaterials”.
Elaboration of a biomaterial from a medicinal plant called Tonacaxochitl (Distictis buccinatoria (D.C.)) is presented in this work. The Tonacaxochitl is an endemic plant from Morelos state in Mexico. By means of solvents, active principles were extracted from the plant in an integral way. Obtained product (plant extract) was mixed with materials like clay and toncil. The biomaterial obtained from clay and toncil has shown anti-inflammatory activity, what makes it a useful tool for topic treatment of inflammation. Tests are being carried out with different extract concentrations to specify suitable concentrations to get effects on specific parts of the human body.
Mycobacterium avium subsp. hominissuis (MAH) infection in swine may cause granulomatous lesions in lymph nodes that must undergo differential diagnosis with those caused by M. tuberculosis complex members. Moreover, MAH outbreaks can lead to severe economic losses due to condemnation of carcasses. A number of potential sources of infection for animals can usually be identified in contaminated farms. This report describes the application of several molecular characterization techniques in order to identify the possible environmental sources of MAH infection in an outbreak involving four breeding farms and six fattening farms. Molecular profiles obtained from MAH strains suggested a likely epidemiological link between clinical and environmental isolates cultured from sawdust and cooling systems from one breeding farm. These results highlight the potential risk posed by these environmental elements in the spread of infection and the need for implementation of adequate management practices in order to minimize this risk.
Heroes play collectivist or individualist roles in imagination and self-development. Representations of heroic figures in questionnaires given to French (n = 241) and Spanish (n = 227) samples of 10 and 15-year-olds were examined to assess the extent that heroes originated in digital media, and whether they were proximal or distal personalities. There is strong evidence that heroes in this sample were largely learned about in digital media (France 45%, Spain 50%): family and community heroes were a minority (France 11%, Spain 9%). Male heroes were more important to Spanish participants compared to their French peers. The acquisition sequence for hero type reported in the pre-television era, proximal (family and community) to distal (beyond the neighbourhood), is reversed in this study. Generally, 10-year-olds preferred heroes with collectivist qualities and 15 year olds with individualised qualities. Findings are discussed in terms of the emergence of social capital.