Crystalloid volume versus catecholamines for management of hemorrhagic shock during esophagectomy - assessment of microcirculatory tissue oxygenation of the gastric conduit in a porcine model using hyperspectral imaging - an experimental study.

INTRODUCTION: Oncologic esophagectomy is a two-cavity procedure with considerable morbidity and mortality. Complex anatomy and the proximity to major vessels constitute a risk for massive intraoperative hemorrhage. Currently, there is no conclusive consensus on the ideal anesthesiologic countermeasure in case of such immense blood loss. The objective of this work was to identify the most promising anesthesiologic management in case of intraoperative hemorrhage with regards to tissue perfusion of the gastric conduit during esophagectomy using hyperspectral imaging (HSI). MATERIAL AND METHODS: An established live porcine model (n=32) for esophagectomy was used with gastric conduit formation and simulation of a linear stapled side-to-side esophagogastrostomy. After a standardized procedure of controlled blood loss of about 1 L per pig, the four experimental groups (n=8 each) differed in anesthesiologic intervention i.e. (I) permissive hypotension, (II) catecholamine therapy using noradrenaline, (III) crystalloid volume supplementation and (IV) combined crystalloid volume supplementation with noradrenaline therapy. HSI tissue oxygenation (StO2) of the gastric conduit was evaluated and correlated with systemic perfusion parameters. Measurements were conducted before (T0) and after (T1) laparotomy, after hemorrhage (T2) and 60 minutes (T3) and 120 minutes (T4) after anesthesiologic intervention. RESULTS: StO2 values of the gastric conduit showed significantly different results between the four experimental groups with 63.3% (±7.6%) after permissive hypotension (I), 45.9% (±6.4%) after catecholamine therapy (II), 70.5% (±6.1%) after crystalloid volume supplementation (III) and 69.0% (±3.7%) after combined therapy (IV). StO2 values correlated strongly with systemic lactate values (r=-0.67; CI -0.77 to -0.54), which is an established prognostic factor. CONCLUSION: Crystalloid volume supplementation (III) yields the highest StO2 values and lowest systemic lactate values and therefore appears to be the superior primary treatment strategy after hemorrhage during esophagectomy with regards to microcirculatory tissue oxygenation of the gastric conduit.

Graft conditioning with fluticasone propionate reduces graft-versus-host disease upon allogeneic hematopoietic cell transplantation in mice.

Hematopoietic cell transplantation (HCT) treats many blood conditions but remains underused due to complications such as graft-versus-host disease (GvHD). In GvHD, donor immune cells attack the patient, requiring powerful immunosuppressive drugs like glucocorticoids (GCs) to prevent death. In this study, we tested the hypothesis that donor cell conditioning with the glucocorticoid fluticasone propionate (FLU) prior to transplantation could increase hematopoietic stem cell (HSC) engraftment and reduce GvHD. Murine HSCs treated with FLU had increased HSC engraftment and reduced severity and incidence of GvHD after transplantation into allogeneic hosts. While most T cells died upon FLU treatment, donor T cells repopulated in the hosts and appeared less inflammatory and alloreactive. Regulatory T cells (Tregs) are immunomodulatory and survived FLU treatment, resulting in an increased ratio of Tregs to conventional T cells. Our results implicate an important role for Tregs in maintaining allogeneic tolerance in FLU-treated grafts and suggest a therapeutic strategy of pre-treating donor cells (and not the patients directly) with GCs to simultaneously enhance engraftment and reduce GvHD upon allogeneic HCT.

Optimization of anastomotic technique and gastric conduit perfusion with hyperspectral imaging and machine learning in an experimental model for minimally invasive esophagectomy.

INTRODUCTION: Esophagectomy is the mainstay of esophageal cancer treatment, but anastomotic insufficiency related morbidity and mortality remain challenging for patient outcome. Therefore, the objective of this work was to optimize anastomotic technique and gastric conduit perfusion with hyperspectral imaging (HSI) for total minimally invasive esophagectomy (MIE) with linear stapled anastomosis. MATERIAL AND METHODS: A live porcine model (n = 58) for MIE was used with gastric conduit formation and simulation of linear stapled side-to-side esophagogastrostomy. Four main experimental groups differed in stapling length (3 vs. 6 cm) and simulation of anastomotic position on the conduit (cranial vs. caudal). Tissue oxygenation around the anastomotic simulation site was evaluated using HSI and was validated with histopathology. RESULTS: The tissue oxygenation (ΔStO2) after the anastomotic simulation remained constant only for the short stapler in caudal position (-0.4 ± 4.4%, n.s.) while it was impaired markedly in the other groups (short-cranial: -15.6 ± 11.5%, p = 0.0002; long-cranial: -20.4 ± 7.6%, p = 0.0126; long-caudal: -16.1 ± 9.4%, p < 0.0001). Tissue samples from avascular stomach as measured by HSI showed correspondent eosinophilic pre-necrotic changes in 35.7 ± 9.7% of the surface area. CONCLUSION: Tissue oxygenation at the site of anastomotic simulation of the gastric conduit during MIE is influenced by stapling technique. Optimal oxygenation was achieved with a short stapler (3 cm) and sufficient distance of the simulated anastomosis to the cranial end of the gastric conduit. HSI tissue deoxygenation corresponded to histopathologic necrotic tissue changes. The experimental model with HSI and ML allow for systematic optimization of gastric conduit perfusion and anastomotic technique while clinical translation will have to be proven.

Reconstrucción con colgajo de músculo temporal en defecto del tercio medio de la región facial. Nuestra experiencia en un hospital de mediana complejidad / TEMPORALIS MUSCLE FLAP RECONSTRUCTION IN FACIAL REGION DEFECTS. OUR EXPERIENCE IN MEDIUM COMPLEXITY HOSPITAL

Introducción: El colgajo pediculado realizado con músculo temporal es una opción terapéutica válida para la reconstrucción de defectos de la región facial posterior a una resección quirúrgica, es una alternativa aceptable a los colgajos libres cuando estos no pueden ser utilizados ya sea por el performance status o patología de base de los pacientes a tratar o por no contar con cirujano microvascular. Objetivo: Describir nuestra experiencia en el uso de este colgajo para la reconstrucción de 7 pacientes con defectos de órbita, paladar y mucosa yugal tras la cirugía ablativa de diversas patologías. Materiales y métodos: Revisión retrospectiva de los pacientes del Servicio de Cirugía General del Hospital José Ramon Vidal, Corrientes-Argentina operados en el periodo comprendido desde enero del 2019 hasta enero del 2021.En este lapso, 7 pacientes fueron sometidos a cirugía reconstructiva inmediata con colgajo de músculo temporal en defectos del tercio medio de la región facial. Resultados: Un total de siete pacientes, (4 masculino- 3 femenino), sometidos a cirugía ablativa por presentar patología maligna (6) y patología benigna (1), con una edad media de 60 años. Dos colgajos se utilizaron para defectos de región orbitaria y partes blandas, seis para defectos en la cavidadoral­ en un paciente se emplearon los 2 músculos temporales-. El colgajo fue exitoso en todos los casos, se presentaron complicaciones menores como: dolor postoperatorio, hematoma, trismus, depresión de la zona dadora. Se obtuvo márgenes libres en el total de los procedimientos. Discusión: La cirugía reconstructiva con colgajo pediculado de musculo temporal es una excelente alternativa de colgajo regional con buenos resultados, posee alta tasa de éxito justificada por su buena vascularización. Además, la proximidad del músculo temporal con la región maxilofacial y su inserción contribuyen a obtener un arco de rotación hasta 180° sin comprometersu vitalidad. Es útil para la reconstrucción en un acto quirúrgico, acortando el tiempo intraoperatorio y sin cambios posicionales. Conclusiones: El colgajo de músculo temporal resulta una opción válida a los colgajos libres osteo-mio-cutáneos para defectos mixtos (óseos y de partes blandas) del tercio medio facial luego de la cirugía ablativa, cuando estos últimos no pueden ser implementados teniendo en cuenta varios aspectos como performance estatus de los pacientes, patología de base y necesidad de contar con un cirujano microvascular

Introduction: temporalis muscle vascularized flaps is a valid therapeutic option for reconstruction of defects in facial region after surgical resections. It is an acceptable alternative to free transfer flaps when these cannot be used because of the patient's performance state and base pathologies. Or because of the lack of a microvascular surgeon. Objectives: To describe on experience applying this kind of flaps for the reconstruction or 7 patients, with defects in palate orbit and yugal mucose after resective surgeries for various pathologies. Materials and methods: retrospective revision of patients in the general department, of Jose R Vidal Hospital (Corrientes - Argentina) into underwent surgery during the period between January 2019 ad January 2021. A total of 7 patients underwent immediate reconstructive surgery using a temporalis muscle flap. Results: 7 patients (4 males y 3 female) underwent resective surgery for different malignant (6) and benign (1) with a median age of 60. Two flaps were used for defects of the orbitary region and soft tissue, six for defects of the oral cavity (in one patient both temporalis muscle were used. Te procedure was successful in all cases, and minor complication were present, (post operatory pain, hematoma, trismus, excavation of the donor region) all procedures resulted un surgical margins of lesion of malignancy. Discussion: reconstructive surgery using a vascularized flap of temporalis muscle is an excellent alternative for regional flaps with good results and a high success justified because of its a good irrigation. Besides the proximity between temporalis muscle and the maxillofacial region, possibilities a flap rotation of up to 180 grades without compromising its vitality it is also useful for reconstruction in a single surgery shortening intra-operatory time while avoiding repositioning of the patients during the procedure. Conclusions: Temporalis muscle flaps are valid option to free osteo- mayo- cutaneal flaps for mixed defects (involving bone and soft tissue) of the medium third of facial region after resective surgeries when the latter cannot be carried and because of various aspects little performance status base pathologies and lack of microvascular margin.

[Surgery 4.0-are we ready?] / Wie weit ist Chirugie 4.0?

The increasing networking of data systems in medicine is not only leading to modern interdisciplinarity in the sense of cooperation between different medical departments, but also poses new challenges regarding the building and room infrastructure. The surgical operating room of the future expands or augments its reality, away from the pure building characteristics, towards an intelligent and communicative space platform. The building infrastructure (operating theatre) serves as sensor and actuator. Thus, it is possible to inform about missing diagnostics as well as to register them directly in the contextualization of the planned surgical intervention or to integrate them into the processes. Integrated operating theatres represent a comprehensive computer platform based on a corresponding system architecture with software-based protocols. An underlying modular system consisting of various modules for image acquisition and analysis, interaction and visualization supports the integration and merging of heterogeneous data that are generated in a hospital operation. Integral building data (e.g., air conditioning, lighting control, device registration) are merged with patient-related data (age, type of illness, concomitant diseases, existing diagnostic CT and MRI images). New systems coming onto the market, as well as already existing systems will have to be measured by the extent to which they will be able to guarantee this integration of information-similar to the development from mobile phone to smartphone. Cost reduction should not be the only legitimizing argument for the market launch, but the vision of a new quality of surgical perception and action.

[Argentinean consensus guidelines on the use of monoclonal antibodies in patients with migraine]. / Consenso sobre el uso de anticuerpos monoclonales en la migraña en Argentina.

INTRODUCTION: Migraine is a very prevalent disorder that is estimated to affect about 15% of adult subjects. Recently, the efficacy and safety of monoclonal antibodies that act on the calcitonin gene-related peptide pathway (MA-CGRP) has been evaluated in migraine. Several groups around the world have developed consensus guidelines about the use of monoclonal antibodies, however, in some regions is difficult to extrapolate the recommendations. AIM: To provide recommendations for the use of MA-CGRP in migraine in Argentina. DEVELOPMENT: A group of neurology experts from Argentina, by using the online surveys methodology as well as face to face meetings developed the intended consensus for the use of MA-CGRP in migraine in Argentina. Recommendations were established based on published evidence and the expert opinion. Recommendations focused on how, when, treatment duration and patients follow up. CONCLUSION: The recommendations of this consensus guidelines attempt to optimize the use of MA-CGRP in migraine in Argentina.

TITLE: Consenso sobre el uso de anticuerpos monoclonales en la migraña en Argentina.Introducción. La migraña es un trastorno muy prevalente que se estima que afecta a alrededor del 15% de los sujetos adultos. Durante los últimos años, se ha evaluado la eficacia y la seguridad de los anticuerpos monoclonales que actúan sobre la vía del péptido relacionado con el gen de la calcitonina (AM-PRGC) en la migraña. Diversos grupos de trabajo internacionales han intentado clarificar y normatizar el uso de estos medicamentos en la migraña. Sin embargo, en muchas ocasiones se extrapolan datos de otras regiones que no contemplan la realidad de cada lugar o son difíciles de implementar. Objetivo. Proveer recomendaciones sobre el uso de AM-PRGC en pacientes con migraña en Argentina. Desarrollo. Un grupo de expertos de Argentina conformado por neurólogos, mediante metodología de ronda de encuestas en la distancia y reuniones presenciales, llevó adelante la elaboración del consenso pretendido para el uso de AM-PRGC en pacientes con migraña en Argentina. Se establecieron las recomendaciones basadas en la evidencia publicada y en el criterio de los expertos que participaron. Las recomendaciones se enfocaron en el momento de usar los AM-PRGC en la migraña tanto crónica como episódica, la duración, los cuidados y el entorno para hacerlo. Conclusión. Las recomendaciones establecidas en el presente consenso permitirán optimizar el manejo de los AM-PRGC en pacientes con migraña en Argentina.

Autoimmune associations in a Mexican cohort with primary biliary cholangitis. / Asociaciones autoinmunes en una cohorte mexicana con colangitis biliar primaria.

INTRODUCTION: Several groups have reported associations of primary biliary cholangitis with other autoimmune entities, particularly Sjögren's syndrome and hypothyroidism. Its prevalence and characteristics in Mexican patients is unknown. AIM: To determine the frequency and characteristics of autoimmune diseases in a Mexican cohort of patients with primary biliary cholangitis. MATERIALS AND METHODS: The medical records of patients that presented with primary biliary cholangitis within the time frame of 2005 and 2012 were reviewed and assessed for other autoimmune diseases. RESULTS: Seventy-eight patients, 75 women and 3 men, were included. Their mean age was 55.8 years. Seventy-three cases had positive antimitochondrial antibodies (94.8%) and disease was confirmed in 5 through liver biopsy. Five patients (8%) had anti-smooth muscle antibodies and 55/78 (70.5%) had antinuclear antibodies by indirect immunofluorescence. Forty-nine patients (62.8%) were positive for an autoimmune disease other than primary biliary cholangitis. Among those, 20 patients had one associated disease, 14 had 2, and 15 patients had 3 concomitant diseases. They included: Sjögren's syndrome in 23/78 patients (29.5%), dysthyroidism in 21/78 cases (26.9%), Raynaud syndrome in 11/78 (14.1%), CREST syndrome in 9/78 patients (11.4%), rheumatoid arthritis in 6/78 patients (7.7%), vitiligo in 5/78 (6.4%), scleroderma in 4/78 patients (5.1%), and other diseases in 8 patients. In 12/78 patients (15.4%), there was a documented family background of autoimmune disease. CONCLUSIONS: The presence of autoimmune associations in our cohort was frequent, and similar in characteristics to the information reported by other groups. The clinical implications of those findings remain to be determined.

Deficiencia e insuficiencia de vitamina D en mujeres post cirugía bariátrica Roux en Y / Vitamin D deficiency and insufficiency among women with Roux-en-Y bariatric surgery / Deficiência e Insuficiência de vitamina D em mulheres post cirurgia bariátrica Roux em Y

Objetivo Determinar la relación entre la falta de seguimiento, adherencia al tratamiento con multivitamínicos y niveles séricos de 25-OH vitamina D (Vit-D) en mujeres post-cirugía BPRY, en la UNEME de la ciudad de Tijuana, Baja California, México. Métodos Estudio Transversal analítico que incluyó mujeres post-cirugía BPRY (GCa, n=13), con Obesidad Mórbida (GOM, n=13) y mujeres aparentemente sanas (GCo, n=13). Posterior a la autorización mediante consentimiento informado escrito, se realizó una historia clínica, valoración antropométrica, aplicación del instrumento de medición y en una segunda cita se tomó una muestra sanguínea para la cuantificación de Vit-D. El instrumento de medición fue validado mediante Kappa de Cohen mayor al 80% y alfa de Cronbach de 1. El análisis estadístico de los datos se realizó mediante pruebas de diferencia de medias t de Student y ANOVA donde se consideró una p < 0.05 en una prueba a dos colas. Se determinó prevalencia, significancia estadística de la falta de adherencia y seguimiento en relación a los niveles de Vit-D. Resultados La prevalencia de falta de adherencia al tratamiento multivitamínico en estas mujeres con post-cirugía BPRY fue de 85% y la falta de seguimiento post quirúrgico que incluye pruebas de laboratorio de micronutrientes fue del 100%. Se encontró una diferencia estadísticamente significativa entre las medias de los niveles de Vit-D entre las mujeres con y sin adherencia al multivitamínico p < 0.05, IC 95%. Conclusiones Se demostró que la falta de adherencia y seguimiento al tratamiento con multivitamínicos son factores de riesgo para la insuficiencia y deficiencia de Vit-D en pacientes con post-cirugía BPRY.

Objective To determine the interrelationships among lack of compliance, multi-vitamin treatment adherence, and serum levels of 25-OH vitamin D among women with Roux-en-Y bariatric surgery in the UNEME of Tijuana, Baja California, Mexico. Methods This is an analytical and transversal study on women with Roux-en-Y bariatric surgery (GCa, n=13) with morbid obesity (GOM, n=13), and apparently healthy women (GCo, n=13). After the corresponding written informed consents, in a first appointment, the medical record, the anthropometric assessment, and the administration of the instrument were performed, while in a second appointment, blood samples were taken in order to measure the vitamin D levels. The assessment instrument was validated through a Cohen Kappa greater than 80% and a Cronbach Alpha of 1. Student's t test and two-tailed, p < 0.05 ANOVAS were calculated. Results While a lack of adherence to multi-vitamin treatment was found in 85% of the women, a lack of post-surgical follow-up, including micro-nutrients lab tests, was found in 100%. A statistically significant difference between the mean vitamin D levels of women with and without multi-vitamin treatment adherence was found (p < 0.05, CI 95%). Conclusions It was demonstrated that the lack of adherence to multi-vitamin treatments is a vitamin D deficiency risk factor among patients with Roux-en-Y bariatric surgery.

Objetivo Determinar a relação entre a falta de seguimento, aderência ao tratamento com multivitamínicos e niveis séricos de 25-OH vitamina D (Vit-D) em mulheres post-cirurgia BPRY, na UNEME da cidade de Tijuana, Baja California, México. Métodos. Estudo Transversal analítico que incluiu mulheres post-cirurgia BPRY (GCa, n=13), com Obesidade Mórbida (GOM, n=13) e mulheres aparentemente saudáveis (GCo, n=13). Posterior à autorização mediante consentimento informado escrito, realizou-se uma história clínica, avaliação antropométrica, aplicação do instrumento de medição e em uma segunda consulta tomou-se uma amostra sanguínea para a quantificação de Vit-D. O instrumento de medição foi validado mediante Kappa de Cohen maior a 80% e alfa de Cronbach de 1. A análise estatística dos dados realizou-se mediante probas de diferencia de média t de Student e ANOVA onde se considerou uma p < 0.05 em um teste bilateral. Determinou-se prevalência, significância estatística da falta de aderência e seguimento em relação aos níveis de Vit-D. Resultados A falta de aderência ao tratamento multivitamínico nestas mulheres bariátricas foi de 85% e a falta de seguimento post cirúrgico que inclui testes de laboratório de micronutrientes foi de 100%. Encontrou-se uma diferença estatisticamente significativa entre a média dos níveis de Vit-D entre as mulheres com e sem aderência no multivitamínico p < 0.05, IC 95%. Conclusões . Demostrou-se que a falta de aderência e seguimento no tratamento com multivitamínicos são fatores de risco para a insuficiência e deficiência de Vit-D em pacientes bariátricos.

Prevalence and Clinical Correlators of Undiagnosed Significant Depressive Symptoms Among Individuals with Type 2 Diabetes In A Mediterranean Population.

Objective: To determine the frequency and clinical parameters, of clinically significant depressive symptoms among a type 2 diabetes (T2DM) sample from a Mediterranean area without an established diagnosis of depressive disorder (DD). Methods: 320 subjects with T2DM were recruited randomly from Primary-Care settings and the Endocrine Department from a tertiary center in Mallorca (Spain). 91 healthy individuals matched by age, gender and BMI were used as controls. All participating patients graded by the presence of DD by using the "Beck Depression Inventory" (BDI), considering pathological a cut-off score equal or greater than 16. Results: 27.2% T2DM subjects had significant symptoms of DD compared with 12.1% in the control group (p<0.01). BDI score was higher among T2DM when compared with controls (12±9.6 vs. 7.4±5, p<0.0001). The proportion of females (68% vs. 37%, p<0.0001), subjects without an active job (68% vs. 45%, p=0.01) and singles (38% vs. 18%, p=0.007) was greater among T2DM with a BDI≥16. Subjects with criteria for DD had a higher BMI (31.99±5.96 vs. 30.53±5.62, p=0.03). Fasting plasma glucose was higher among T2DM with a BDI≥16 (162±70 vs. 147±45 mg/dl, p=0.02) as well as HbA1c levels (7.9±1.8% vs. 7.4±1.4%, p=0.01), triglycerides (203±183 vs. 161±103 mg/dl; p=0.03) and LDL-cholesterol (112±31 vs. 104±35 mg/dl; p=0.03). Gender, marital status, BMI and triglycerides were independently related to the presence of DD after a logistic regression model. Conclusions: Relevant depressive symptoms are more prevalent among Mediterranean T2DM subjects than in general population. Main clinical correlators of significant depressive symptoms are gender, marital status and BMI.

Tailored synthesis of nanostructures by laser irradiation of a precursor microdroplet stream in open-air.

A method to synthesize multicomponent nanostructures in open-air is presented. A microdroplet precursor target is irradiated with a nanosecond laser pulse to induce plasma. At low droplet dispensing rates, the precursor and solvent are fully atomized without debris to produce nanoparticles and nanofilaments during plasma cooling. More complex structures like nanolayers or nanofoams can be synthetised at kilohertz droplet dispensing rates as additional droplets in the vicinity of the target droplet are subjected to the laser-induced plasma and its associated shockwave. Examples of both low- and fast-rate mechanisms are presented for Mn-Fe bi-metal oxide nanoparticles and zinc oxide nanoparticles, nanofilaments and nanofoams. Real-time diagnostics were carried out with time-resolved imaging, atomic emission spectroscopy, light scattering and shadowgraphy. In addition to overcoming some of the difficulties associated with pulsed-laser deposition (PLD), the use of a liquid precursor whose composition can be tailored on a droplet-to-droplet basis opens a number of possibilities.

Viral RNAs are unusually compact.

A majority of viruses are composed of long single-stranded genomic RNA molecules encapsulated by protein shells with diameters of just a few tens of nanometers. We examine the extent to which these viral RNAs have evolved to be physically compact molecules to facilitate encapsulation. Measurements of equal-length viral, non-viral, coding and non-coding RNAs show viral RNAs to have among the smallest sizes in solution, i.e., the highest gel-electrophoretic mobilities and the smallest hydrodynamic radii. Using graph-theoretical analyses we demonstrate that their sizes correlate with the compactness of branching patterns in predicted secondary structure ensembles. The density of branching is determined by the number and relative positions of 3-helix junctions, and is highly sensitive to the presence of rare higher-order junctions with 4 or more helices. Compact branching arises from a preponderance of base pairing between nucleotides close to each other in the primary sequence. The density of branching represents a degree of freedom optimized by viral RNA genomes in response to the evolutionary pressure to be packaged reliably. Several families of viruses are analyzed to delineate the effects of capsid geometry, size and charge stabilization on the selective pressure for RNA compactness. Compact branching has important implications for RNA folding and viral assembly.

Virus-mimicking nano-constructs as a contrast agent for near infrared photoacoustic imaging.

We report the first proof-of-principle demonstration of photoacoustic imaging using a contrast agent composed of a plant virus protein shell, which encapsulates indocyanine green (ICG), the only FDA-approved near infrared chromophore. These nano-constructs can provide higher photoacoustic signals than blood in tissue phantoms, and display superior photostability compared to non-encapsulated ICG. Our preliminary results suggest that the constructs do not elicit an acute immunogenic response in healthy mice.

Análisis coste-utilidad de las estatinas en la prevención primaria de eventos cardiovasculares / No disponible

OBJETIVOS: Evaluar el coste-utilidad de las estatinas en prevención primaria de eventos cardiovasculares en población española con una adherencia similar a estudios observacionales. MÉTODOS: Modelo de simulación determinístico retrospectivo basado en datos de estatinas disponibles en España. Se analizaron varios escenarios de riesgo cardiovascular en una población hipotética de adultos, con adherencia terapéutica del 60%. Los resultados se midieron en costes por años de vida ajustados por calidad (AVACs). Se utilizó el software TreeAge(R).RESULTADOS: En hombres de 40 a 75 años con un riesgo del 10%, los ratios coste-utilidad para simvastatina 10 mg variaron de 33.452 a 4.430 (Euro)/AVAC, respectivamente y en mujeres, de 50.172 a 31.662 (Euro)/AVAC, respectivamente. Para el resto de estatinas los costes fueron superiores. CONCLUSIONES: Con una baja adherencia terapéutica, los costes de las estatinas en prevención primaria fueron muy elevados por AVAC ganado adicional, especialmente en edades tempranas y en mujeres

OBJECTIVES: To evaluate the cost-utility of statins in primary prevention of cardiovascular events in the Spanish population with a similar adherence to observational studies. METHODS: Retrospective deterministic simulation model based on data of available statins in Spain. Various scenarios of cardiovascular risk were analyzed in a hypothetical population of adults with 60% adherence. The results were measured by cost per years of quality-adjusted life (QALYs). The analysis software used was TreeAge (R). RESULTS: With a 10% risk at ages of 40 to 75 years, the cost-utility ratios for simvastatin 10 mg in men ranged from 33,452 to 4,430 (Euro)/QALY, respectively and in women from 50,172 to 31,662 (Euro)QALY, respectively. For other statins the costs were higher. CONCLUSIONS: With low therapeutic adherence, the costs of statins in primary prevention were very high per additional QALY gained, especially at early ages and in women

Effect of a low glycemic load on body composition and Homeostasis Model Assessment (HOMA) in overweight and obese subjects.

OBJECTIVE: The aim of this study was to compare the effects of different glycemic load diets on biochemical data and body composition, in overweight and obese subjects, during a 6-month period. RESEARCH DESIGN AND METHODS: This study was an experimental, randomized, parallel design. Anthropometric measurements and biochemical data were measured at baseline at 3 and at 6 months. All subjects completed 3-day dietary intake diaries at the baseline period and during the third and the sixth months. At the sixth month, LGL group had a mean intake of 1,360 ± 300 kcal/day and the high glycemic load group (HGL) had a mean intake of 1,544 ± 595 kcal/day. RESULTS: LGL group obtained a weight reduction of 4.5% (p = 0.006) and the HGL group of 3.0% (p = 0.18). Significant reductions in waist circumference (5%, p = 0.001) of the LGL group were observed, 10% of body fat percentage (p = 0.001), 4.3 kg (13%) of body fat (p = 0.001), 14% of total cholesterol (p=0.007), 35% of high-density lipoproteins (HDL) (p = 0.001), and 10% of HOMA (p = 0.009). In the HGL group, reductions of 4.5% of waist circumference (p = 0.02), 37% of HDL (p = 0.002), and an increase of 8 % of LDL (p = 0.04) were observed. CONCLUSIONS: These results suggest that long term LGL diets are more effective for reducing body mass index, body fat, waist circumference and HOMA and, therefore, may contribute in the prevention of diabetes.

Effect of a low glycemic load on body composition and Homeostasis Model Assessment (HOMA) in overweight and obese subjects / Efecto de la baja carga clucémica en la composición corporal y el HOMA en sujetos con sobrepeso y obesidad

Objective: The aim of this study was to compare the effects of different glycemic load diets on biochemicaldata and body composition, in overweight and obese subjects,during a 6-month period.Research design and methods: This study was an experimental, randomized, parallel design. Anthropometric measurements and biochemical data were measuredat baseline at 3 and at 6 months. All subjects completed 3-day dietary intake diaries at the baseline period and during the third and the sixth months. At the sixthmonth, LGL group had a mean intake of 1,360 ± 300kcal/day and the high glycemic load group (HGL) had amean intake of 1,544 ± 595 kcal/day.Results: LGL group obtained a weight reduction of4.5% (p = 0.006) and the HGL group of 3.0% (p = 0.18). Significant reductions in waist circumference (5%, p =0.001) of the LGL group were observed, 10% of body fat percentage (p = 0.001), 4.3 kg (13%) of body fat (p =0.001), 14% of total cholesterol (p=0.007), 35% of highdensity lipoproteins (HDL) (p = 0.001), and 10% ofHOMA (p = 0.009). In the HGL group, reductions of4.5% of waist circumference (p = 0.02), 37% of HDL (p =0.002), and an increase of 8 % of LDL (p = 0.04) were observed.Conclusions: These results suggest that long term LGL diets are more effective for reducing body mass index, body fat, waist circumference and HOMA and, therefore,may contribute in the prevention of diabetes (AU)

Objetivo: Comparar el efecto de dietas con diferente carga glucémica en la composición corporal y los marcadores bioquímicos, en sujetos con sobrepeso u obesidad, durante un periodo de seis meses.Metodología: Estudio experimental, aleatorio, paralelo.Se realizaron mediciones antropométricas y bioquímicasal inicio, a los tres y a los seis meses. Todos los sujetos realizaron un registro de alimentos de tres días, al inicio, a los tres y a los seis meses. A los seis meses, el grupo de dieta de baja carga glucémica (DBCG) tuvo una ingesta energética promedio de 1.360 ± 300 kcal/día, y el grupo con alta carga glucémica (DACG) de 1.544 ± 595kcal/día. Resultados: El grupo con DBCG obtuvo una reducción de peso del 4,5% (p = 0,006) y el grupo con DACG del3,0% (p = 0,18). En el grupo con DBCG se observaron reducciones significativas en la circunferencia de cintura(CC) (5%, p = 0,001), 10% en el porcentaje de grasa corporal(p = 0,001), 4,3 kg (13%) de masa grasa (p = 0,001),14% en el colesterol total (p = 0,007), 35% en las lipoproteínasde alta densidad (HDL) (p = 0,001), y un 10% en el HOMA (p = 0,009). En el grupo con DACG se observaron reducciones del 4,5% en la CC (p = 0,02), 37% en las HDL(p = 0,002), y un incremento en las lipoproteínas de alta densidad (LDL) del 8% (p = 0,04).Conclusiones: Estos resultados sugieren que a largo plazo las DBCG son más efectivas en la reducción del índice de masa corporal, la grasa corporal, la CC y la sensibilidad a la insulina (HOMA), lo que puede contribuir en la prevención de la diabetes (AU)

Optical nano-constructs composed of genome-depleted brome mosaic virus doped with a near infrared chromophore for potential biomedical applications.

We have engineered an optical nanoconstruct composed of genome-depleted brome mosaic virus doped with indocyanine green (ICG), an FDA-approved near-infrared (NIR) chromophore. Constructs are highly monodispersed with standard deviation of ±3.8 nm from a mean diameter of 24.3 nm. They are physically stable and exhibit a high degree of optical stability at physiological temperature (37 °C). Using human bronchial epithelial cells, we demonstrate the effectiveness of the constructs for intracellular optical imaging in vitro, with greater than 90% cell viability after 3 h of incubation. These constructs may serve as a potentially nontoxic and multifunctional nanoplatform for site-specific deep-tissue optical imaging, and therapy of disease.

El proceso de integración del alumno al entorno clínico para el aprendizaje reflexivo / The integration process to the student in the clinical environment from the reflective learning

Introducción: Durante la implementación del "Modelo de tutoría clínica reflexiva" se integró el autor a la práctica clínica de un grupo de Fundamentos de Enfermería II como tutor clínico del grupo. De esta experiencia surge el análisis que a continuación se presenta, en donde se identifican las características de la relación entre el tutorado y el entorno clínico, la importancia de su integración en la práctica clínica y los factores que intervienen en este proceso. Desarrollo: El entorno clínico es un concepto cuyo potencial no se limita al espacio físico que enmarca las prácticas clínicas de enfermería, sino el contexto en el cual se desarrollan interacciones sociales que permiten el aprendizaje experiencial en la clínica. La integración del alumno al entorno clínico constituye la base del aprendizaje en la práctica. El proceso de integración es complejo y se requiere la colaboración de diversos factores en la práctica para que se concrete. Conclusiones: la integración es un proceso que requiere una mayor atención en la planeación de las practicas clínicas, del logro de este proceso dependerá la generación de aprendizajes reflexivos, el desarrollo de habilidades orientadas al cuidado y la construcción de la identidad profesional de los alumnos.

Introduction: During the implementation of the "Clinical Reflective Tutorship Model" the author was be incorporated to the clinical practice of "nursing fundamentals II" as a clinical tutor of this group. From this experience develop the present analysis that explains the components to the student-clinical environment relationship, the importance to their integration in the clinical practice and the factors that take part in this process. Development: the clinical environment is a concept that means more than the physical space in the educative practices, it's the context where develop social interactions between the practice actors that let the experiencial learning. The integration to the student in the clinical environment constitutes the base to the practical learning. The integration process is difficult and requires the collaboration of several factors in the practices to be completed. Conclusions: the integration is a process that requires more attention in the planning to the clinical practices. The generation of reflective learning, the develop of care skills and the construct to the student`s professional identity depends of the integration process.

El Proyecto MADAI: un estudio epidemiológico sobre el abordaje y manejo del dolor agudo periquirúrgico / MADAI project: an epidemiologic study about the perioperative pain tnanagetnent and treattnent

Objetivo. Obtener información descriptiva sobre el abordaje y el manejo del paciente con dolor agudo periquirúrgico tratado con analgésicos parenterales en el ámbito hospitalario. Metodología. Estudio epidemiológico, descriptivo, multicéntrico. Pacientes ingresados en los servicios de cirugía general, torácica, cardiovascular, angiología y cirugía vascular, ginecología, traumatología y urología. Resultados. Participaron 76 hospitales distribuidos por las diferentes comunidades autónomas y un total de 439 investigadores. Se evaluaron 1972 pacientes de los que el 43.9% y 25.5%, respectivamente pertenecieron a los servicios de cirugía general y traumatología. El 52.8% de los pacientes tenían más de 60 años, un 31.2 % no presentaron ninguna enfermedad concomitante, el 36.7% padecían hipertensión y un 16.5% diabetes. En el 5.8% de los pacientes se utilizaron escalas para valorar la intensidad del dolor al ingreso. En las sucesivas visitas, este porcentaje oscila entre el 10 % y el 15%. En el postoperatorio, los principales analgésicos administrados son los AINE (sobre todo el metamizol, que utilizan del 63.6% al 40.5% del total de pacientes del estudio) y el paracetamol, que utilizan el 41.3% a las 0-12horas y el 27% el día 4. El porcentaje que recibe medicación de rescate va disminuyendo, desde el primer control (25.7%), al del cuarto día (6%), siendo la medicación más utilizada el paracetamol. Conclusiones. A pesar de que en el ámbito de la cirugía se considera importante el tratamiento del dolor, la utilización de protocolos no es habitual. La elaboración y utilización de guías terapéuticas para el tratamiento del dolor peri quirúrgico podría mejorar el confort del paciente y su recuperación (AU)

Objective. To obtain descriptive information about patient treatment with acute perioperative pain receiving parenteral analgesics in hospital environments. Methodology. Epidetniologic descriptive multicentre study. Patients admitted in the following Surgery services: General, Thoracic, Cardiovascular, Angiology, Gynaecology, Orthopaedic and Urology. Results. Participation of 76 hospitals, distributed along the country; and 439 investigators. 1972 patients were assessed. 43.9% and 25.5% were admitted in General and Orthopaedic surgery services respectively. 52.8% of patients were over 60 years oíd. 31.2% did not present any concomitant illness. 36.78% had arterial hypertension and 16.5% diabetes mellitus. Pain scales to measure pain intensity, were used by 5.8% of patients at admission. In the following visits, these percentages ranged from 10% to 15%. During postoperative period NSAIDs were the most widely used (specially metamizol, administrated from 63.6% to 40.5% of the patients) and acetaminophen which was used by 41.3% of the patients in the first 12 hours and 27% in the 4th day. The percentage of patients that received rescue medication decreases from 25.7 % at first control to 6% at 4th day control; being acetaminophen the most commonly used medication. Conclusions. Despite pain treatment is considered important in surgical environments, treatment protocols are seldom used. The elaboration and the use of therapeutics guidelines for perioperative pain treatment could improve the patient comfort and their recuperation (AU)

Estudio Observacional sobre el dolor Postoperatorio leve o moderado. Evaluación del tratamiento con Paracetamol. IV. Estudio EOPEP / Observational study about postoperative mild and modérate pain. Evaluation of treattnent with intravenous paracetamol. EOPEP study

Objetivos. Valorar la eficacia y seguridad de la analgesia postoperatoria con paracetamol intravenoso (P-iv). Pacientes y Métodos. Estudio prospectivo, multicéntrico observacional de pacientes sometidos a cirugía de dolor postoperatorio (DPO) leve y moderado que recibieron 4 dosis de P-iv 1 g /4-6h, solo o asociado con otros analgésicos. Se valoró el grado de dolor mediante la escala analógica visual, la afectación de la actividad, los efectos indeseables y la satisfacción del paciente. Periodo de estudio. 24 horas postoperatorias. Se aplicaron tests paramétricos o no paramétricos, o un modelo de regresión logística. Resultados. 725 pacientes evaluables, 56% con DPO previsiblemente leve y 43.3% DPO moderado. La EVA disminuyó significativamente en cada una de las valoraciones sucesivas (p<0,001), pero se mantuvo inferior a 30. El 46.3% de los pacientes recibieron P-iv como única analgesia. Metamizol fue el fármaco más frecuentemente asociado, seguido de opiáceos. Los niveles más altos de EVA se correlacionaron con la administración de analgésicos asociados, más interferencia con la actividad, más nauseas y vómitos y menor grado de satisfacción (p<0.05). El factor que se correlacionó con mayores valores de EVA fue el tipo de cirugía. No se observaron efectos indeseables relacionados con el P-iv. Conclusión. P-iv a dosis de 1 g/4-6 h es eficaz durante las primeras 24 horas del postoperatorio de cirugía que produce DPO leve a moderado, con pocos efectos indeseables. En la práctica anestésica se combina con frecuencia con otros analgésicos, siendo el más frecuente el metamizol seguido de opiáceos (AU)

Objective. Te evalúate the efficacy and safety of post-surgery analgesia with intravenous paracetamol (P-iv). Patient and Methods. Prospective, multicentre-observational study in patients who had surgery associated to mild or modérate postoperative pain (POP) that received 4 doses of P-iv 1 g /4-6h, alone or associated with other analgesics. The degree of pain by the visual analogue scale, effect on the activity, undesirable effects and patient satisfaction were recorded. Period of study: 24 hrs post-surgery. Statistics. Parametric or non-parametric, or a model of regression analysis. Results. 725 patient enrolled, 56% with mild POP and 43,3% modérate POP. EVA decreased significantly through the successive evaluations (p<0,001), but remained below 30. 46,3% received only P-iv as analgesic. Metamizol was the most frequently associated analgesic, followed by opiates. Higher levéis of EVA were correlated with: administration of associated analgesics, more interference with the activity, more nauseas and vomiting and smaller degree of satisfaction (p<0.05). The type of surgery was correlated with greater valúes of EVA. No undesirable effects caused by P-iv were observed. Conclusión. P-iv to 1 g/4-6 h is effective during the 24 first hours post-surgery that produces mild to modérate POP with few undesirable effects, and anaesthesia practice combines frequently P-iv with other analgesics, being the most frequent metamizol followed by opiates (AU)

Citología tiroidea: métodos complementarios / Thyroid cytology: complementary methods

Describir nuestra experiencia en la punción aspiración con aguja fina de tiroides utilizando ultrasonido tiroideo y/o control citológico inmediato para así evaluar la sensibilidad de los mismos en apoyo a este procedimiento. Se revisaron historias clínicas de 242 pacientes entre enero 2005 y abril 2007 en los cuales se realizaron 130 punciones guiadas por ultrasonido, 126 con control citológico inmediato y ambos en 26 pacientes; evaluando el número, tamaño y distribución de los nódulos, caraterísticas ecográficas, número de láminas, diagnóstico citológico y correlación con el diagnóstico definitivo. Se encontró mayor prevalencia de nódulos únicos entre 1 y 4 cm; ubicándose principalmente en el lóbulo derecho siendo más frecuentes las lesiones complejas. Para valorar los diagnósticos citológicos, fueron agrupados como maligno, hipercelular o hipocelular, consiguiendo porcentajes de 12 por ciento, 81 por ciento respectivamente. De las muestras hipocelulares 15 fueron guiadas por ultrasonido y 5 con control citológico inmediatos, en 3 casos se utilizaron ambos métodos. La sensibilidad de las punciones guiadas por ultrasonido fue de 88 por ciento y de los casos en los que se utilizó control citológico inmediato del 96 por ciento. El 20 por ciento de los pacientes fueron llevados a cirugía, siendo compatible el diagnóstico citológico con el definitivo en 88 por ciento de los mismos. La punción aspiración con aguja fina de tiroides es un método adecuado para suministrar información de los nódulos tiroideos, cuya sensibilidad aumenta al utilizar soporte citológico y ultrasonográfico. Estudios posteriores deben realizarse con el objetivo de valorar la relación costo beneficio en cada caso.