Preoperative nutritional screening by the specialist instead of the nutritional risk score might prevent excess nutrition: a multivariate analysis of nutritional risk factors.

BACKGROUND: The aim of the current study was to assess whether widely used nutritional parameters are correlated with the nutritional risk score (NRS-2002) to identify postoperative morbidity and to evaluate the role of nutritionists in nutritional assessment. METHODS: A randomized trial on preoperative nutritional interventions (NCT00512213) provided the study cohort of 152 patients at nutritional risk (NRS-2002 ≥3) with a comprehensive phenotyping including diverse nutritional parameters (n=17), elaborated by nutritional specialists, and potential demographic and surgical (n=5) confounders. Risk factors for overall, severe (Dindo-Clavien 3-5) and infectious complications were identified by univariate analysis; parameters with P<0.20 were then entered in a multiple logistic regression model. RESULTS: Final analysis included 140 patients with complete datasets. Of these, 61 patients (43.6%) were overweight, and 72 patients (51.4%) experienced at least one complication of any degree of severity. Univariate analysis identified a correlation between few (≤3) active co-morbidities (OR=4.94; 95% CI: 1.47-16.56, p=0.01) and overall complications. Patients screened as being malnourished by nutritional specialists presented less overall complications compared to the not malnourished (OR=0.47; 95% CI: 0.22-0.97, p=0.043). Severe postoperative complications occurred more often in patients with low lean body mass (OR=1.06; 95% CI: 1-1.12, p=0.028). Few (≤3) active co-morbidities (OR=8.8; 95% CI: 1.12-68.99, p=0.008) were related with postoperative infections. Patients screened as being malnourished by nutritional specialists presented less infectious complications (OR=0.28; 95% CI: 0.1-0.78), p=0.014) as compared to the not malnourished. Multivariate analysis identified few co-morbidities (OR=6.33; 95% CI: 1.75-22.84, p=0.005), low weight loss (OR=1.08; 95% CI: 1.02-1.14, p=0.006) and low hemoglobin concentration (OR=2.84; 95% CI: 1.22-6.59, p=0.021) as independent risk factors for overall postoperative complications. Compliance with nutritional supplements (OR=0.37; 95% CI: 0.14-0.97, p=0.041) and supplementation of malnourished patients as assessed by nutritional specialists (OR=0.24; 95% CI: 0.08-0.69, p=0.009) were independently associated with decreased infectious complications. CONCLUSIONS: Nutritional support based upon NRS-2002 screening might result in overnutrition, with potentially deleterious clinical consequences. We emphasize the importance of detailed assessment of the nutritional status by a dedicated specialist before deciding on early nutritional intervention for patients with an initial NRS-2002 score of ≥3.

Clinical features for diagnosis of pneumonia in children younger than 5 years: a systematic review and meta-analysis.

BACKGROUND: Pneumonia is the biggest cause of deaths in young children in developing countries, but early diagnosis and intervention can effectively reduce mortality. We aimed to assess the diagnostic value of clinical signs and symptoms to identify radiological pneumonia in children younger than 5 years and to review the accuracy of WHO criteria for diagnosis of clinical pneumonia. METHODS: We searched Medline (PubMed), Embase (Ovid), the Cochrane Database of Systematic Reviews, and reference lists of relevant studies, without date restrictions, to identify articles assessing clinical predictors of radiological pneumonia in children. Selection was based on: design (diagnostic accuracy studies), target disease (pneumonia), participants (children aged <5 years), setting (ambulatory or hospital care), index test (clinical features), and reference standard (chest radiography). Quality assessment was based on the 2011 Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria. For each index test, we calculated sensitivity and specificity and, when the tests were assessed in four or more studies, calculated pooled estimates with use of bivariate model and hierarchical summary receiver operation characteristics plots for meta-analysis. FINDINGS: We included 18 articles in our analysis. WHO-approved signs age-related fast breathing (six studies; pooled sensitivity 0·62, 95% CI 0·26-0·89; specificity 0·59, 0·29-0·84) and lower chest wall indrawing (four studies; 0·48, 0·16-0·82; 0·72, 0·47-0·89) showed poor diagnostic performance in the meta-analysis. Features with the highest pooled positive likelihood ratios were respiratory rate higher than 50 breaths per min (1·90, 1·45-2·48), grunting (1·78, 1·10-2·88), chest indrawing (1·76, 0·86-3·58), and nasal flaring (1·75, 1·20-2·56). Features with the lowest pooled negative likelihood ratio were cough (0·30, 0·09-0·96), history of fever (0·53, 0·41-0·69), and respiratory rate higher than 40 breaths per min (0·43, 0·23-0·83). INTERPRETATION: Not one clinical feature was sufficient to diagnose pneumonia definitively. Combination of clinical features in a decision tree might improve diagnostic performance, but the addition of new point-of-care tests for diagnosis of bacterial pneumonia would help to attain an acceptable level of accuracy. FUNDING: Swiss National Science Foundation.

Produção de morangueiro da cv. Camino Real em sistema de túnel

O objetivo deste trabalho foi avaliar a produção da cultivar de morangueiro Camino Real, recentemente introduzida da Califórnia, comparando-a com a das cultivares Aromas e Camarosa, nas condições climáticas do Rio Grande do Sul. O experimento foi realizado em Pelotas, utilizando-se do sistema de produção sob túnel e mudas importadas do Chile. A irrigação foi feita por gotejamento, e a adubação, fornecida via água de irrigação. Em maio de 2006, foi feito o transplantio das mudas no espaçamento de 35 cm entre linhas e entre plantas. Semanalmente, de agosto a dezembro, foram analisadas as variáveis massa fresca e número médio de frutos produzidos. O delineamento experimental foi de blocos casualizados com parcelas subdivididas no tempo, com quatro repetições. As unidades experimentais foram constituídas por 21 plantas. Verificou-se que a produção da cultivar Camino Real (1.121,2 g de frutos comerciais por planta por ano) é semelhante à da 'Aromas' (1.043,3 g) e à da 'Camarosa' (1.038,3 g). Os frutos da 'Camino Real' são maiores e de maior massa (24,6 g) em relação aos da 'Camarosa' (19,5 g) e da 'Aromas' (17,9 g), sendo, no entanto, produzidos em menor número. A máxima massa fresca obtida da cv. Camino Real é de 30,7 g, na 12ª semana de colheita.

Sagittal abdominal diameter is a better predictor than body mass index for duration of laparoscopic left colectomy.

BACKGROUND: Visceral obesity (VO) increases technical difficulty in laparoscopic surgery. The body mass index (BMI) does not always correlate to intra-abdominal fat distribution. Our hypothesis was that simple anthropometric measures that reflect VO, could predict technical difficulty in laparoscopic colorectal surgery, as reflected by the operative time, more accurately than the BMI. METHODS: Charts of all consecutive patients who underwent laparoscopic left colon resection in our institution between 2007 and 2010 were reviewed retrospectively. On a preoperative CT scan, anthropometric measures were taken on an axial plane at the L4-L5 level. Demographic, operative and anthropometric CT measures were correlated with the operative time. Logistic regression analysis was performed to assess the value of anthropometric CT measures or BMI to predict the duration of the colectomy. RESULTS: 121 patients with elective left colon resection for benign (56%) or malignant disease (44%) were included. There were 74 sigmoid resections (61%), 21 left hemicolectomies (17%) and 26 low anterior resections (22%). A longer sagittal abdominal diameter (≥24.8 cm) was significantly associated with longer corrected operative time (248 vs. 228 min, p = 0.043). In multivariate analysis, greater sagittal abdominal diameter, sagittal internal diameter and abdominal perimeter were significantly associated with longer operative time. No significant association was found for the BMI neither in univariate nor in multivariate analysis. CONCLUSIONS: This study suggests that simple linear measures taken on a CT scan, such as sagittal abdominal diameter, sagittal internal diameter and abdominal perimeter, may predict longer operative time in laparoscopic left colonic resections more accurately than BMI.

El aprendizaje de estrategias de resolución de problemas con una hoja de cálculo

Este artículo presenta, en primer lugar, las características educativas del programa informático de una hoja de cálculo y que pueden facilitar el aprendizaje de estrategias de resolución de problemas en la enseñanza secundaria obligatoria. En segundo lugar, se describe las principales características de una propuesta didáctica que incorpora este programa informático para la enseñanza/aprendizaje de estrategias de resolución de problemas numéricos de proporcionalidad. Y, en tercer lugar, se presentan algunos de los resultados obtenidos por los alumnos y que confirman las posibilidades educativas de la hoja de cálculo en la clase de matemáticas.

El método BAPNE y su repercusión en las capacidades cognitivas

Los ejercicios de percusión corporal propuestos por el método BAPNE pretenden estimular a través del juego nuestras dimensiones corporal, emocional y cognitiva. Ello requiere, en primer lugar, focalizar la atención para el aprendizaje y coordinación de todas las actividades involucradas (canto, movimiento, percusión extremidades superiores e inferiores) lo cual demanda una buena disposición de nuestras funciones cognitivas. El movimiento es vital para nuestra salud, y la música está íntimamente relacionada con el movimiento. Es conocido que incluso en estados de escucha pasiva de música, el área cerebral que planifica los mecanismos necesarios para los movimientos está activa, aunque externamente no lo manifestemos. Se ha constatado la existencia de conexiones neuronales entre las áreas auditiva y motora, y de ahí nuestra tendencia a imitar con movimientos corporales la música que percibimos y escuchamos. Por otra parte, son conocidos muchos de los beneficios terapéuticos que las actividades musicales pueden aportarnos en todas sus modalidades, desde el aprendizaje hasta la interpretación (ya sea vocal o instrumental) pasando por la simple escucha activa o pasiva. Todo pa rece indicar, pues, que el movimiento es básico para nuestra salud y que la música, íntimamente ligada a él, es una fuente placentera y agradable para experimentarlo.

BAPNE method and N eurorehabilitation in patients with severe acquired brain injury

The use of body percussion through BAPNE method in neurorehabilitation offers the possibility of studying the development of motor skills, attention, coordination, memory and social interaction of patients with neurological diseases. The experimental protocol was carried out on 52 patients with severe acquired brain injury. Patients were selected for the cut - off scores in the standard neuropsychologic al tests of sustained attention , divided and alert ; at least one emisoma intact, cut -off scores in the standard for procedural and semantic memory ; eye sight , hearing and speech intact. The first group of patients has supported the protocol BAPNE tougher with the traditional rehabilitation activities . The control group continued to perform exclusively the cognitive and neuromotor rehabilitation according to traditional protocols. At 6 months after administration of the protocol is expected to re-test to assess if present , the maintenance of the effects of rehabilitation obtained. Experimentation is carried out for 10 weeks following the protocol of BAPNE method in the Roboris Foundation of Rome.

La percusión corporal como estímulo para alumnos con déficit de atención y concentración

El objetivo de este estudio es desarrollar un protocolo de actividades a través del Método BAPNE con alumnos con dificultades de aprendizaje para la estimulación de la atención, concentración y memoria. Con ello queremos demostrar los beneficios que posee la percusión corporal a través de esta metodología y su relación con la creatividad y aprendizaje por proyectos. Con actividades muy específicas elaboradas por un grupo de investigación organizado por neurólogos y docentes ofrecemos nuevas vías de innovación docente para aplicar a diferentes colectivos educativos. El estudio se articula bajo unos objetivos centrados en la mejora de la capacidad de abstracción, percepción, atención, observación, concentración y aprendizaje. De forma paralela realizamos especial énfasis en la estimulación de la memoria sensorial (a través de los sentidos), memoria a cortoplazo (inmediata y de trabajo) y en la memoria a largo plazo (episódica, semántica y procedimental). La batería de actividades sugeridas se combina para trabajar asociaciones, secuencias, actividades sensomotrices, repeticiones y descripciones corporales, combinaciones motoras a nivel biomecánico, capacidad de atención y de observación, lenguaje, relajaciones, visualizaciones y percepciones espacio - temporales. Así , sugerimos un modo de trabajo lo más holístico posible para ayudar a personas con problemas de atención y memoria.

Música y neurociencia: un paso más en el conocimiento del ser humano

Un entrenamiento musical de larga duración durante la infancia y/o adolescencia puede reducir la degeneración neuronal que, inevitablemente, se produce con la edad. Hoy día, gracias a las técnicas de neuroimagen, es posible "ver" que ocurre en el interior de nuestro cerebro cuando estamos sometidos a diversos estímulos, entre ellos los musicales. Si utilizamos marcadores radioactivos, a través de las técnicas denominadas Tomografía por Emisión de Positrones (PET), podremos ver qué ocurre con el metabolismo cerebral. La neurología musical es un estimulante campo para los científicos.

Influence of rootstock on nutrient content in grape petioles

Genetic diversity of rootstocks can affect nutrient uptake and the nutrient status of grapevines. The rootstock influence on nutrient content in grape petioles was evaluated on three rootstocks competition experiments carried out at Vale do Rio do Peixe region, in the state of Santa Catarina, Brazil, with the cultivars Niagara Rosada, Concord, and Isabella, grafted on different rootstocks. Two soil liming depths were also evaluated in the Isabella experiment. The greatest rootstock effect was observed on K and Mg content and K/Mg ratio in the petioles. The Vitis vinifera x V. rotundifolia hybrid rootstocks VR 043-43 and VR 044-4 provided the highest K/Mg values and self rooted Isabella the lowest K/Mg ratio. The other tested rootstocks resulted in intermediate values. There was also significant effect on P content, but only in Niagara Rosada and Concord experiments. The depth of soil liming did not significantly affect K and Mg content in the Isabella experiment. The results indicate that rootstock must be considered for nutritional status evaluation and fertilizer recommendation regarding to K and Mg.

Situação e perspectivas da fruticultura de clima temperado no Brasil

A fruticultura está presente em todos os estados brasileiros e, como atividade econômica, envolve mais de cinco milhões de pessoas que trabalham de forma direta e indireta no setor. O Brasil é o terceiro maior produtor mundial de frutas, com colheita em torno de 40 milhões de toneladas ao ano, mas participa com apenas 2% do comércio global do setor, o que demonstra o forte consumo interno (ANUÁRIO BRASILEIRO DE FRUTICULTURA, 2010). A área plantada com plantas frutíferas no Brasil está distribuída em 1.034.708 ha com frutas tropicais, 928.552 ha com frutas subtropicais e 151.732 ha com espécies de clima temperado. Dentre as frutas de clima temperado, destaca-se a produção de uvas de mesa e viníferas (81.355 ha); maçãs (38.205 ha); pêssegos, ameixas e nectarinas (19.043 ha); caqui (8.638 ha); morango, amora, framboesa, mirtilo (3.560 ha); figo (2.886 ha); pera (1.394 ha) e marmelo (211 ha). Mesmo com uma área inferior em relação às espécies de clima tropical e subtropical, as frutas de clima temperado têm uma importância socioeconômica destacada em diversas regiões do Brasil, principalmente nos Estados do Rio Grande do Sul, Santa Catarina, Paraná, São Paulo, Minas Gerais e o Vale do São Francisco, seja como cultivo in natura, agroindústria e/ou agroturismo. Para que ocorra a produção de frutas de qualidade nas regiões de clima temperado no Brasil, é necessário o desenvolvimento de programas de melhoramento genético e/ou estudos de manejo e controles sobre a fisiologia das plantas para adaptá-las às condições de inverno ameno e com oscilação de temperaturas, muito frequentes nas principais regiões produtoras brasileiras. Os verões longos e excesso de precipitação ocasionam muitas doenças e pragas, obrigando muitas vezes ao excesso de tratamentos fitossanitários. O manejo dos pomares com a produção integrada de frutas está possibilitando a produção de qualidade e, ao mesmo tempo, reduzindo o impacto ambiental da atividade no setor. Os desafios estão relacionados à adaptação das espécies às mudanças climáticas, à necessidade de se reduzir o uso de agrotóxicos e insumos, aos manejo pré e pós-colheita realizados nas frutas, logística para atender aos diferentes mercados, controle de doenças e pragas e aos programas de melhoramento genético para atender às novas demandas de cada uma das espécies de clima temperado.

COMPASS identifies T-cell subsets correlated with clinical outcomes.

Advances in flow cytometry and other single-cell technologies have enabled high-dimensional, high-throughput measurements of individual cells as well as the interrogation of cell population heterogeneity. However, in many instances, computational tools to analyze the wealth of data generated by these technologies are lacking. Here, we present a computational framework for unbiased combinatorial polyfunctionality analysis of antigen-specific T-cell subsets (COMPASS). COMPASS uses a Bayesian hierarchical framework to model all observed cell subsets and select those most likely to have antigen-specific responses. Cell-subset responses are quantified by posterior probabilities, and human subject-level responses are quantified by two summary statistics that describe the quality of an individual's polyfunctional response and can be correlated directly with clinical outcome. Using three clinical data sets of cytokine production, we demonstrate how COMPASS improves characterization of antigen-specific T cells and reveals cellular 'correlates of protection/immunity' in the RV144 HIV vaccine efficacy trial that are missed by other methods. COMPASS is available as open-source software.

COMPORTAMENTO DA CULTIVAR NIÁGARA ROSADA ENXERTADA SOBRE DIFERENTES PORTA-ENXERTOS NO SUL DE SANTA CATARINA, BRASIL

RESUMO A videira ‘Niagara Rosada’ é a principal cultivar de uva de mesa plantada no Sul do Brasil. Para avaliar a qualidade da uva produzida, foi conduzido um experimento com aNiagara Rosada nos seguintes porta-enxertos: ‘Jales’, ‘Tropical’, ‘Campinas’, ‘VR 043-43’, ‘R-99’, ‘Paulsen 1103’, ‘Schwarzmann’,‘Traviú’, ‘Golias’, ‘Gravesac’, ‘RR 101-14’, ‘Dog Ridge’, ‘VR 044-4’, ‘Kobber5BB’ e ‘SO4’, mais o pé-franco. Foram avaliados a fenologia, o vigor, a sobrevivência das plantas ea produção (produtividade, tamanho do cacho e número de cachos por planta). Os diferentes porta-enxertos não influenciam na fenologia da planta. O maior vigor foi observado para o ‘Dog Ridge’, seguido do‘Campinas’, ‘Paulsen 1103’ e ‘VR 043-43’. As maiores mortalidades de planta ocorreram para pé-franco (56%), ‘Traviú’ (50%) e ‘Schwarzmann’(41%). Os porta-enxertos ‘Paulsen 1103’, ‘Campinas’ e ‘Golias’, além de altaprodutividade, apresentam cachos maiores e mais compactos.

Status epilepticus of inflammatory etiology: A cohort study.

OBJECTIVE: Inflammation-related epilepsy is increasingly recognized; however, studies on status epilepticus (SE) are very infrequent. We therefore aimed to determine the frequency of inflammatory etiologies in adult SE, and to assess related demographic features and outcomes. METHODS: This was a retrospective analysis of a prospective registry of adult patients with SE treated in our center, from January 2008 to June 2014, excluding postanoxic causes. We classified SE episodes into 3 etiologic categories: infectious, autoimmune, and noninflammatory. Demographic and clinical variables were analyzed regarding their relationship to etiologies and functional outcome. RESULTS: Among the 570 SE consecutive episodes, 33 (6%) were inflammatory (2.5% autoimmune; 3.3% infectious), without any change in frequency over the study period. Inflammatory SE episodes involved younger patients (mean age 53 vs 61 years, p = 0.015) and were more often refractory to initial antiepileptic treatment (58% vs 38%, odds ratio = 2.19, 95% confidence interval = 1.07-4.47, p = 0.041), despite similar clinical outcome. Subgroup analysis showed that, compared with infectious SE episodes, autoimmune SE involved younger adults (mean age 44 vs 60 years, p = 0.017) and was associated with lower morbidity (return to baseline conditions in 71% vs 32%, odds ratio = 5.41, 95% confidence interval = 1.19-24.52, p = 0.043) without any difference in mortality. CONCLUSIONS: Despite increasing awareness, inflammatory SE etiologies were relatively rare; their occurrence in younger individuals and higher refractoriness to treatment did not have any effect on outcome. Autoimmune SE episodes also occurred in younger patients, but tended to have better outcomes in survivors than infectious SE.