bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of seasonal upwelling on hydrography and mesozooplankton communities in a Pacific tropical cove off Colombia
Authors: Valencia Bellineth , Giraldo Alan , Rivera-Gómez Marisol , Izquierdo Vanessa , Cuellar-Chacón Andrés 
Published: September 2019

Introduction: The effects of seasonal upwelling on the conditions of the water column and mesozooplankton communities are poorly understood in the coastal zones of the Eastern Tropical Pacific (ETP), despite the important role of upwelling events in the modulation of productivity in these zones. Objective: To evaluate the influence of seasonal upwelling over the Panama Bight on the structure of the water column and mesozooplankton communities in a tropical cove of the ETP. Methods: Hydrographic data and mesozooplankton samples were collected during four field campaigns in Ensenada de Utría (December 2011, February 2012, October 2013, and February 2013), an estuary located in the Northern Pacific coast of Colombia. Non-parametric and multivariate analyses were used to evaluate seasonal differences in the environmental and biotic variables. Results: Surface waters were warm (> 25 °C) and presented low salinities (< 30) throughout the study period. In contrast, subsurface waters were colder (< 20 °C), saltier (> 33), and presented low dissolved oxygen concentrations (< 2.0 ml l-1) during the dry season (January - March), whereas the water column was homogeneous during the rainy season (April - December). Despite the seasonal changes in the environmental conditions, the expected enhancement in the productivity of the system during the dry season (i.e., higher biomass and abundance of the mesozooplankton) only occurred in February 2012. Contrary to expectations, ichthyoplankton abundance was higher during the rainy season, when the assemblage was dominated by the larvae of anchovy (Cetengraulis mysticetus) and an unidentified Gobiidae. Conclusions: The entrance of upwelled waters into Ensenada de Utría is an important factor modulating the seasonal changes observed in the water column. However, there is high interannual variability in the response of mesozooplankton communities to the upwelling events. Because upwelled waters are oxygen-depleted and more acidic, the entrance of upwelled waters into Ensenada de Utría could be causing physiological stress to the benthic and pelagic organisms inhabiting the deepest zones of the cove. This condition may worsen in the future given the predicted increase of deoxygenation and ocean acidification due to climate change.
Óriási, a hátsó mediastinumot és a retroperitoneumot részben kitöltő schwannoma műtéti kezelése
Authors: Baranyai Zsolt , Balázs Ákos 
Published: September 2019

Abstract: A characteristics of mediastinal disorders is that the high anatomical density of vital structures in this region represents a challenge for diagnosis and surgical treatment. Space-occupying lesions can grow without causing overt manifestations – or can progress symptom-free – hence they can reach an extreme size by the time of surgery. A 58-year-old male patient was hospitalized for pleural effusion and an extensive, space-occupying mediastinal lesion, which had been causing respiratory symptoms for 15 years. Cytology of the pleural effusion did not confirm malignancy. The CT scan depicted progression manifested as an increase in the size of the lesion with a likely site of origin in the left adrenal gland. According to the MRI, by contrast, the lesion might have originated in the region of vertebrae Th9–10, as suggested by the lack of dural continuity. However, its adrenal origin could not be excluded either; endocrine activity was not detected. An operation was performed with a neurosurgeon included in the surgical team. A spinal tumor of the size of 20.2 by 11.1 by 10.8 cm was removed through thoraco-laparotomy, and reconstruction of the diaphragm was performed. Histology confirmed a schwannoma. Postoperatively, the expansion of the lung was only partial, because the patient discontinued respiratory rehabilitation. The follow-up CT scan depicted local recurrence. In the lack of alternative therapeutic modalities, surgical resection is usually the sole option for the management of large, mediastinal space-occupying lesions diagnosed at an advanced stage. Such operations should only be performed in specialist surgical centers and with multidisciplinary collaboration. Orv Hetil. 2019; 160(37): 1476–1479.
A fogászati implantátumok csontbeépülését befolyásoló „klasszikus” tényezők változásai az elmúlt évtizedekben
Authors: Koppány Ferenc , Bérczy Kinga , Körmöczi Kinga , Németh Zsolt 
Published: September 2019

Abstract: Nowadays, it is almost naturally taken among dentists that seemed unimaginable a few decades ago, namely that an inorganic material (titanium) inserted in an organic environment (bone) can be integrated and become a permanent pillar of prosthetics. Bone integration – meaning a structural and functional connection between the implant and the bone – itself was discovered and described in the late 1960s. This provides the basis of dental implantology. In those days, the conditions affecting the positive or negative course of bone integration have been formulated. This process is investigated at the level of basic research and rarely mentioned in the daily clinical practice. The material, form, and surface of the implant all contribute to success if we design well and apply the correct surgical technique. Our goal is to present the changes that have taken place over the past decades, which have resulted in an increasingly perfect integration and clinical success of implants. Orv Hetil. 2019; 160(37): 1455–1463.
Modern fixed combinations of antihypertensive drugs in the treatment of arterial hypertension and obesity: can this comorbid pathology be effectively controlled?
Authors: Vasyuk Yu. A. , Shupenina E. Yu. , Yuschuk E. N. , Namazova G. A. 
Published: September 2019

Aim. To assess the effect of azilsartan/chlortalidone and irbesartan/hydrochlorothiazide fixed combinations on office, daily peripheral and central blood pressure (BP), daily parameters of aortic stiffness and structural and functional state of the left ventricle in patients with arterial hypertension (AH) and obesity.Material and methods. The study included 46 patients with hypertension and obesity aged 35 to 55 years. In the beginning of the study and after 6 months of treatment with azilsartan/chlortalidone (AZL/C) or irbesartan/hydrochlorothiazide (IRB/H) all patients underwent a comprehensive clinical and instrumental and laboratory examination, including a general examination with anthropometric measurements, office measurement of BP, electrocardiography, echocardiography, 24-hour BP monitoring with analysis of central BP and the main parameters of aortic stiffness, biochemical blood tests.Results. Long-term use of two fixed combinations of sartan and diuretic was accompanied by a significant decrease of office and daily BP. However, in the AZL/С use, this change was more pronounced than in the IRB/H. Also, in the AZL/H group, a significantly larger number of patients reach a normalization of 24-hour BP profile. Both studied drugs significantly reduced central BP, which indicates their positive effect on aortic stiffness. However, a significant change in the daily pulse wave velocity determined by the Vasotens system was not detected. During therapy, in both groups, a decrease in left ventricular myocardial mass indexed by body surface area was revealed. It was more noticeable in the AZL/H group and when height indexed2,7. In both groups, an insignificant decrease in creatinine level and an increase in glomerular filtration rate, more noticeable with the administration of AZL/H, were noted. There were no significant fluctuations in the level of uric acid and patients with AH and obesity.Conclusion. According to studies, AH in obese patients is less well controlled than in patients with normal body weight. AZL/H and IRB/H are effective and safe drugs for the treatment of AH in obese patients. However, long-term treatment of AZL/H allows reaching a more pronounced decrease in peripheral and central BP, improving the structural and functional state of the left ventricular myocardium in comparison with IRB/H.
Association of stress with cardiovascular diseases and risk factors in a population (ESSE-RF in Kemerovo region)
Authors: Shapovalova E. B. , Maksimov S. A. , Indukaeva E. V. , Artamonova G. V. 
Published: September 2019

Aim. To assess the prevalence of stress and its association with socio-demographic characteristics, cardiovascular risk factors and cardiovascular diseases (CVD) in the Siberian population.Material and methods. A cross-sectional study was performed in the framework of the Russian multicenter epidemiological study ESSE-RF in the Kemerovo Region in 2013. The presented study included 1628 individuals aged 25 to 64 years. Information was assessed on the presence of stress, some socio-demographic and economic characteristics, a history of CVD, as well as behavioral habits and quality of life. To eliminate the modifying effect of socio-demographic characteristics, a logistic regression analysis was used. The odds ratio (OR) and the 95% confidence interval (CI) were calculated.Results. The prevalence of stress was 22,6%; stress was statistically significantly more often recorded in women (28,1%) than in men (11,7%). After adjusting for sociodemographic characteristics, stress was statistically significantly more often recorded in people with secondary and primary education compared with those with higher education (24,9% and 19,1%, p=0,006), as well as in people with middle and high financial affluence compared with low affluence (24,5% and 11,3%, p<0,001). This association is observed only at the expense of women. For unemployed participants, the stress rate is higher only among males — 18,8% versus 11,4% among workers (p=0,015). Stress was also statistically significantly more often recorded in groups with arterial hypertension, lack of sleep, quality of life on the EQ-VAS scale and on the EuroQol scale. Smokers are more likely to have stress (23,8% vs 22,0%) and have a history of stroke (35,3% vs 22,2%). Among all CVDs and their risk factors, an inverse association of stress with obesity was revealed only in men.Conclusion. Study showed that people with stress are under large load of some cardiovascular risk factors. At the same time, ambiguous associations between stress and arterial hypertension and quality of life were obtained. This confirms the need for further study of the association of stress with other factors of cardiovascular risk, taking into account age and gender and socio-economic characteristics of the population.
Workup and Management of Immune-Mediated Hepatobiliary Pancreatic Toxicities That Develop During Immune Checkpoint Inhibitor Treatment
Authors: Hsu Christine , Marshall John L. , He Aiwu Ruth 
Published: September 2019

Abstract

Immune checkpoint inhibitor treatment has been approved by the U.S. Food and Drug Administration for the treatment of a wide range of cancer types, including hepatocellular carcinoma. Workup and management of immune-mediated hepatitis, pancreatitis, or cholangitis that develops during immune checkpoint inhibitor treatment can be challenging. Immune-mediated hepatitis can be particularly challenging if patients have underlying viral hepatitis or autoimmune hepatitis. Patients with positive hepatitis B virus DNA should be referred to a hepatologist for antiviral therapy prior to immune checkpoint inhibitor treatment. With untreated hepatitis C virus (HCV) and elevated liver enzymes, a liver biopsy should be obtained to differentiate between HCV infection and immune-mediated hepatitis due to anti-programmed cell death protein 1 (PD-1) therapy. If autoimmune serologies are negative, then this supports a case of immune-mediated hepatitis secondary to anti-PD-1 therapy, rather than autoimmune hepatitis. In this case, an empiric steroid therapy is reasonable; however, if the patient does not respond to steroid therapy in 3–5 days, then liver biopsy should be pursued. The incidence of immune checkpoint-induced pancreatitis is low, but when it does occur, diagnosis is not straightforward. Although routine monitoring of pancreatic enzymes is not generally recommended, when pancreatitis is suspected, serum levels of amylase and lipase should be checked. Once confirmed, a steroid or other immunosuppressant (if steroids are contraindicated) should be administered along with close monitoring, and a slow tapering dosage once the pancreatitis is under control. Patients should then be monitored for recurrent pancreatitis. Finally, immune therapy-related cholangitis involves elevated bilirubin and alkaline phosphatase and, once diagnosed, is managed in the same way as immune-mediated hepatitis.

Key Points
Immune-mediated hepatitis, pancreatitis, and cholangitis are found in patients receiving or who have previously received immune checkpoint inhibitors. To work up immune-mediated hepatitis, viral, and autoimmune serologies, liver imaging will help to differentiate immune-mediated hepatitis from hepatitis of other etiology. Hepatology consult may be considered in patients with a history of chronic liver disease who developed hepatitis during immune checkpoint inhibitor treatment. Liver biopsy should be considered to clarify the diagnosis for case in which the hepatitis is refractory to steroid or immunosuppressant treatment. Immune-mediated pancreatitis is treated with steroid or other immunosuppressant with a slow tapering and should be monitored for recurrence.
Nivolumab for the Treatment of Patients with Metastatic Non-Clear Cell Renal Cell Carcinoma (nccRCC): A Single-Institutional Experience and Literature Meta-Analysis
Authors: Chahoud Jad , Msaouel Pavlos , Campbell Matthew T. , Bathala Tharakeswara , Xiao Lianchun , Gao Jianjun , Zurita Amado J. , Shah Amishi Yogesh , Jonasch Eric , Sharma Padmanee , Tannir Nizar M. 
Published: September 2019

Abstract

Introduction
Nivolumab alone and in combination with ipilimumab is approved for the treatment of patients with metastatic renal cell carcinoma (RCC) who received prior vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKI) and those who are treatment naive, respectively. However, the clinical activity of nivolumab in non-clear cell RCC (nccRCC) is unknown, as these patients were excluded from the trials.

Materials and Methods
We reviewed the records of patients who received nivolumab for nccRCC and ccRCC with &gt;20% rhabdoid with the primary endpoint to assess the objective response rate (ORR). We assessed radiographic response using RECIST, v1.1. Secondary endpoints were progression-free survival (PFS) and overall survival (OS). We also reviewed the literature to identify studies reporting on the clinical activity of immune checkpoint inhibitors in nccRCC, and performed a meta-analysis of proportions for ORR and disease control rate (DCR).

Results
Twelve patients (30%) had papillary histology, 11 (27.5%) had unclassified, 8 (20%) had ccRCC with rhabdoid component, 5 (12.5%) had chromophobe, 3 (7.5%) had translocation, and 1 (2.5%) had mucinous tubular and spindle cell carcinoma. Overall, seven patients (21.6%, 95% confidence interval [CI], 8.7%–37.9%) had an objective response, including three patients (8.8%, 95% confidence interval [CI], 1.9%–23.7%) who achieved a complete remission. At a median follow-up of 24.5 monoths (95% CI, 17.7–32.6), median PFS was 4.9 monoths (95% CI, 3.53–10.27) and median OS was 21.7 monoths (95% CI, 7.83 mo to not reached). There were no treatment-related deaths. We also identified two retrospective studies reporting best ORR in patients with nccRCC receiving PD-1/PD-L1 checkpoint blockade. The ORR and DCR for the total cohort were, respectively, 18.6% (95% CI, 11.9%–26.4%) and 53.4% (95% CI, 44.2%–62.5%).

Conclusion
Nivolumab demonstrated activity in unclassified nccRCC and ccRCC with &gt;20% rhabdoid; further randomized clinical trials are warranted.
Piperacillin/Tazobactam and Antibiotic-Associated Acute Kidney Injury in Critically Ill Children
Authors: Joyce Emily L. , Kane-Gill Sandra L. , Priyanka Priyanka , Fuhrman Dana Y. , Kellum John A. 
Published: September 2019

Significance Statement
Antibiotic-associated AKI is prevalent and contributes to substantial morbidity and mortality in critically ill pediatric patients. Little is known about how empiric use of broad-spectrum antibiotics affects development of AKI. The authors show that treatment of critically ill children with piperacillin/tazobactam within the first 48 hours of intensive care unit admission is associated with subsequent development of AKI. They demonstrate a weaker, nonsignificant association between AKI and piperacillin/tazobactam used in combination with vancomycin in this population. This second finding adds to uncertainty about the nephrotoxicity of piperacillin/tazobactam in this highly susceptible population. Cefepime, a potential alternative antibiotic, which was not associated with AKI in the study, may be a suitable alternative for some indications.

Background
There continues to be uncertainty about whether piperacillin/tazobactam (TZP) increases the risk of AKI in critically ill pediatric patients. We sought to compare rates of AKI among critically ill children treated with TZP or cefepime, an alternative frequently used in intensive care units, with and without vancomycin.

Methods
We conducted a retrospective cohort study assessing the risk of AKI in pediatric intensive care unit patients after exposure to vancomycin, TZP, and cefepime, alone or in combination, within 48 hours of admission. The primary outcome was development of stage 2 or 3 AKI or an increase in AKI stage from 2 to 3 within the 6 days after the 48-hour exposure window. Secondary outcomes included lengths of stay, need for RRT, and mortality.

Results
Of 5686 patients included, 494 (8.7%) developed stage 2 or 3 AKI. The adjusted odds of developing AKI after medication exposure were 1.56 for TZP (95% confidence interval [95% CI], 1.23 to 1.99), 1.13 for cefepime (95% CI, 0.79 to 1.64), and 0.86 for vancomycin (95% CI, 0.69 to 1.07). The adjusted odds of developing AKI for vancomycin plus TZP versus vancomycin plus cefepime was 1.38 (95% CI, 0.85 to 2.24).

Conclusions
Observational data in critically ill children show that TZP use is associated with increased odds of AKI. A weaker, nonsignificant association between vancomycin plus TZP and AKI compared with vancomycin plus cefepime, creates some uncertainty about the nature of the association between TZP and AKI. However, cefepime is an alternative not associated with AKI.
Regionalización de la precipitación, su agresividad y concentración en la cuenca del río Guayas, Ecuador
Authors: Ilbay Mercy Lucila , Zubieta Barragán Ricardo , Lavado-Casimiro Waldo 
Published: September 2019

La agresividad de la lluvia contribuye a la erosividad del suelo en regiones de alta montaña, y por tal a la sedimentación en la parte baja de la cuenca. La reducción de incertidumbre acerca de la agresividad de la lluvia en regiones costeras y andinas contribuye a la formulación de medidas de mitigación que contribuyan a la reducción de erosión y pérdida de nutrientes. Este estudio presenta un análisis espacial y temporal de la agresividad climática en la cuenca del río Guayas ubicada en la costa y Andes ecuatoriales. Se seleccionó datos mensuales registrados de 30 estaciones pluviométricas para el periodo de 1968-2014. Se determinó zonas homogéneas de precipitación mediante el método k-means. Los resultados indicaron dos regiones homogeneas predominantes, la primera ubicada al oeste en la zona costera y andina (85.2% del área de la Cuenca), con un índice de agresividad alto y muy alto, mientras que la distribución de la precipitación en la segunda región (Alta montaña) resultó de muy baja a baja agresividad. La mayor agresividad potencial de la lluvia le corresponde una mayor acumulación de precipitación promedio anual, lo que indica una alta influencia estacional de las lluvias, i.e, una mayor cantidad de lluvia puede precipitar en un número reducido de meses consecutivos. Los valores de concentración revelan una gradiente regional en dirección este-oeste, que va de moderadamente a fuertemente estacional. El análisis de tendencias de la concentración de lluvia mensual no muestra cambios significativos en el periodo de estudio. No obstante, nuestros hallazgos explican el porqué la región oeste y sur de la cuenca del río Guayas está expuesta a problemas de sedimentación en la parte baja, producto de la capacidad erosiva de la lluvia en la parte alta y media de la cuenca.
Detección de antibióticos betalactámicos, tetraciclinas y sulfamidas como contaminantes emergentes en los ríos San Pedro y Pita del cantón Rumiñahui.
Authors: Ramirez-Cando Lenin Javier , Chicaiza Ramírez Sabrina Estefania , Ramos López Allan David , Álvarez César Iván 
Published: September 2019

Las actividades que se realizan en el diario vivir, como la higiene personal o el cuidado de la salud, pueden provocar efectos negativos en el ecosistema, generando alteraciones sobre el medio ambiente, dado que se consumen varias sustancias de diferente origen y composición química, de estas sustancias se conoce relativamente poco con respecto al impacto que tendrá en el ambiente y en el ser humano, sustancias que son reconocidas con el nombre de contaminantes emergentes. El presente trabajo experimental fue desarrollado en las parroquias de Uyumbicho, Amaguaña, dos localidades ubicadas a 1km de la orilla del río San Pedro y la parroquia de Sangolqui cerca al río Pita, se evaluó la probable existencia de residuos de antibióticos betalactámicos y sulfamidas, en los 13 puntos de muestreo distribuidos de la siguiente manera: 9 en el río San Pedro y 4 en el río Pita, se realizaron 6 muestreos de agua, para ser analizadas mediante la utilización de un kit de detección para antibióticos, las muestras fueron analizadas 2 veces cada mes, por 3 meses, se procesó las imágenes con técnica fotogramétricas y estadísticas para cuantificar los antibióticos, de manera rápida y sencilla. Los resultados obtenidos son claros con un total del 41 de 78 muestras que representa el 52% de casos positivos con presencia de residuos de antibióticos betalactámicos y sulfamidas en los afluentes de los ríos San Pedro y Pita.
Participación ciudadana en la radio comunitaria en la región central de Ecuador
Authors: Mullo-López Alex Hernan , Toro Bravo Juan P. , Álvarez Garzón Lorena C. 
Published: September 2019

La radio comunitaria se expone como una propuesta emancipadora de los pueblos, que apertura canales comunicacionales en la esfera pública, hacia el diálogo intercultural. La presente investigación utiliza metodologías cualitativas para analizar la labor que cumplen las radios comunitarias de la región central de Ecuador a fin de promover el progreso social, mediante el fomento de procesos participativos que garanticen contenidos que satisfagan las demandas sociales. Finalmente, se determina que sumado al conocido problema económico se evidencia que no existen estrategias de comunicación horizontal que faciliten el empoderamiento de los ciudadanos alrededor del medio de comunicación. La Ley Orgánica de Comunicación no diversifica a las radios comunitarias para que en función de sus diferencias se impulse una intervención equitativa en el espectro radioeléctrico. Así mismo no impulsa el empoderamiento de la gente como voluntarios. El tema de capacitación es una necesidad que puede ser satisfecha desde la academia.