Incidence of T2DM and the role of baseline glycaemic status as a determinant in a metropolitan population in northern Madrid (Spain).

AIM: To estimate the incidence of T2DM and assess the effect of pre-T2DM (isolated impaired fasting glucose [iIFG], isolated impaired glucose tolerance [iIGT] or both) on progress to T2DM in the adult population of Madrid. METHODS: Population-based cohort comprising 1,219 participants (560 normoglycaemic and 659 preT2DM [418 iIFG, 70 iIGT or 171 IFG-IGT]). T2DM was defined based on fasting plasma glucose or HbA1c or use of glucose-lowering medication. We used a Cox model with normoglycaemia as reference category. RESULTS: During 7.26 years of follow-up, the unadjusted incidence of T2DM was 11.21 per 1000 person-years (95 %CI, 9.09-13.68) for the whole population, 5.60 (3.55-8.41) for normoglycaemic participants and 16.28 (12.78-20.43) for pre-T2DM participants. After controlling for potential confounding factors, the baseline glycaemic status was associated with higher primary effect on developing T2DM was iIGT (HR = 3.96 [95 %CI, 1.93-8.10]) and IFG-IGT (3.42 [1.92-6.08]). The HR for iIFG was 1.67 (0.96-2.90). Obesity, as secondary effect, was strongly significantly associated (HR = 2.50 [1.30-4.86]). CONCLUSIONS: Our incidence of T2DM is consistent with that reported elsewhere in Spain. While baseline iIGT and IFG-IGT behaved a primary effect for progression to T2DM, iIFG showed a trend in this direction.

Real-world data in primary care: validation of diagnosis of atrial fibrillation in primary care electronic medical records and estimated prevalence among consulting patients'.

BACKGROUND: Primary care electronic medical records contain clinical-administrative information on a high percentage of the population. Before this information can be used for epidemiological purposes, its quality must be verified. This study aims to validate diagnoses of atrial fibrillation (AF) recorded in primary care electronic medical records and to estimate the prevalence of AF in the population attending primary care consultations. METHODS: We performed a cross-sectional validation study of all diagnoses of AF recorded in primary care electronic medical records in Madrid (Spain). We also performed simple random sampling of diagnoses of AF (ICPC-2 code K78) registered by 55 physicians and random age- and sex-matched sampling of the records that included a diagnosis of AF. Electrocardiograms, echocardiograms, and hospital discharge or cardiology clinic reports were matched. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and overall agreement were calculated using the kappa statistic (κ). The prevalence of AF in the community of Madrid was estimated considering the sensitivity and specificity obtained in the validation. All calculations were performed overall and by sex and age groups. RESULTS: The degree of agreement was very high (κ = 0.952), with a sensitivity of 97.84%, specificity of 97.39%, PPV of 97.37%, and NPV of 97.85%. The prevalence of AF in the population aged over 18 years was 2.41% (95%CI 2.39-2.42% [2.25% in women and 2.58% in men]). This increased progressively with age, reaching 16.95% in those over 80 years of age (15.5% in women and 19.44% in men). CONCLUSIONS: The validation results obtained enable diagnosis of AF recorded in primary care to be used as a tool for epidemiological studies. A high prevalence of AF was found, especially in older patients.

Conocimiento de las tendencias de ataques rivales en el bloqueo de voleibol / Knowledge of Opposition Attacking Tendencies on Volleyball Blocking

El objetivo del estudio fue investigar los efectos de proporcionar información probabilística, obtenida del análisis en vídeo de las tendencias de pase de las colocadoras oponentes, sobre el rendimiento en el bloqueo de una jugadora de alto nivel de voleibol. Se analizó su tiempo de reacción, toma de decisión y calidad de ejecución durante 1117 acciones de bloqueo realizadas en 18 partidos de competición, antes y después de recibir esa información contextual de los ataques rivales. Los resultados revelaron que la bloqueadora reaccionó antes (p < .001) en aquellos partidos que recibió información sobre las tendencias de pase de las colocadoras oponentes. En cambio, esta información contextual no tuvo influencia sobre sus decisiones, ni en la calidad de ejecución de sus movimientos. Estos resultados refuerzan el uso de información probabilística como una estrategia competitiva para iniciar antes una respuesta preparatoria a la acción de bloqueo en voleibol de alto nivel. (AU)

The aim of the study was to investigate the effects of providing probabilistic information, obtained from video-performance analytics on passing direction tendencies in opposing volleyball setters, on blocking performance in a high skilled female volleyballer. Data on reaction times, decision-making and quality of movement execution of the skilled blocker were analyzed during 1117 blocking actions in 18 competitive matches, before and after receiving information from the passing tendencies of opposition setters. Results revealed that the blocker reacted significantly earlier in those matches when she received information about opposition pass direction tendencies. No effects of contextual information were found for the blocker´s decisions and quality of movement execution. These results reinforced the use of probabilistic information as a competitive strategy for initiating an early preparatory response to the blocking action in high-skill levels of volleyball. (AU)

Paronychia argentea Lam. protects renal endothelial cells against oxidative injury.

ETHNOPHARMACOLOGICAL RELEVANCE: Paronychia argentea Lam. (Arabic tea), a species spontaneously growing in the Mediterranean area, has been used in folk medicine for renal diseases. AIM OF THE STUDY: To assess the antioxidant and protective potentials of different extracts from P. argentea in the renal endothelial NRK-52E cell line by several in vitro models, including a H2O2-induced oxidative stress model. MATERIAL AND METHODS: Aerial parts of P. argentea were collected in Algeria and ethanolic, chloroform and aqueous-chloroform extracts were obtained from dried plant. The antioxidant capacity was first evaluated by the Oxygen Radical Absorbance Capacity (ORAC) and the free radical scavenging activity (DPPH) methods. Cellular viability was assessed by MTT method assay after 24 h pretreatment with each extract concentration in order to measure protection from H2O2 in NRK-52E cells. Furthermore, the intracellular ROS formation (DCFH-DA method), was determined. RESULTS: P. argentea showed in vitro antioxidant activity as evidenced by the ORAC and DPPH assays. No cell toxicity was observed for concentrations ranging from 0.1 to 100 µg/mL of each extract. These extracts also exerted a protective effect on renal endothelial cells simultaneously treated with 1 mM H2O2. Chemical composition for the aqueous-chloroform extract was assessed by HPLC, as it showed the strongest antioxidant ability, revealing three quercetin derivatives as the main phenolic compounds. CONCLUSION: P. argentea is endorsed with antioxidant activity and protects renal endothelial cells against oxidative damage which indicate this plant constitutes a potential treatment for renal diseases.

Approximate expression for the ground-state energy of the two- and three-dimensional Hubbard model at arbitrary filling obtained from dimensional scaling.

We generalize the linear discrete dimensional scaling approach for the repulsive Hubbard model to obtain a nonlinear scaling relation that yields accurate approximations to the ground-state energy in both two and three dimensions, as judged by comparison to auxiliary-field quantum Monte Carlo (QMC) data. Predictions are made for the per-site ground-state energies in two and three dimensions for n (filling factor) and U (Coulomb interaction) values for which QMC data are currently unavailable.

Influencia de la perspectiva de visionado en el comportamiento motor de tenistas noveles / Influência da perspectiva de visualização no comportamento motor de jogadores novatos / The influence of the viewing perspective on the novel tennis players´ motor behavior

El objetivo del estudio fue analizar la influencia de la perspectiva de visionado (egocéntrica o alocéntrica) sobre el comportamiento motor de una muestra reducida de tenistas noveles cuando percibieron servicios de tenis video-proyectados en laboratorio. Específicamente, un grupo de tenistas (n=6) percibió la secuencia de ensayos con una perspectiva egocéntrica. En cambio, el otro grupo de tenistas (n=6) percibió la misma secuencia de servicios con una perspectiva alocéntrica. Los participantes debían de iniciar su movimiento, rápida y precisamente, cuando identificaran la dirección final la pelota. Los resultados mostraron que los tenistas que percibieron los servicios con una perspectiva alocéntrica consiguieron tiempos de reacción significativamente menores y una precisión de la respuesta mayor en relación a la perspectiva egocéntrica. Se recomienda incluir proyecciones alocéntricas de visionado en el diseño de los entrenamientos perceptivos en el deporte ya que favorecen el rendimiento de los deportistas en la tarea, mediante la producción de inicios rápidos y precisos de la respuesta (AU)

The aim of the study was to address the influence of the viewing perspective (egocentric or alocentric one) in the motor behavior of a reduced sample of novel tennis players when they perceived video-projected services in a laboratory setting. Specifically, a group of tennis players (n = 6) perceived the sequence of rallies with an egocentric perspective. In contrast, another group of players (n = 6) perceived the same sequence with an alocentric perspective. Participants were required to initiate the movement, quickly and precisely, when they identify the final direction of the ball. The results showed that the players, who perceived the rallies with an alocentric viewing, achieved significantly lower reaction times and higher response accuracy than an egocentric perspective. It is recommended to include alocentric viewing projections in the design of perceptual trainings in the sport as they enhance the performance of athletes in the task by producing fast movements and accurate responses (AU)

O objetivo do estudo foi analise a influência da perspectiva de (egocêntrico ou alocêntrica) de visão sobre o comportamento motor de uma pequena amostra de jogadores novatos quando perceberam serviços de vídeo de tênis projetado por laboratório. Especificamente, um grupo de jogadores (n = 6), viu a sequência do ensaio com uma perspectiva autocentrada. Em vez disso, outro grupo de jogadores (n = 6), viu a mesma sequência de serviços com uma perspectiva alocêntrica. Os participantes foram obrigados a iniciar o movimento, de forma rápida e identificar com precisão quando a direcção final da bola. Os resultados mostraram que os jogadores que perceberam uma alocêntrica perspectiva serviços alcançado significativamente menores tempos de reação e precisão do maior resposta em relação à perspectiva egocêntrica. Recomenda-se incluem projeções alocêntrica visualização no projeto de formação perceptual no esporte uma vez que aumentam o desempenho dos atletas na tarefa de produzir resposta inicial rápida e precisa (AU)

Comparing in vivo biodistribution with radiolabeling and Franz cell permeation assay to validate the efficacy of both methodologies in the evaluation of nanoemulsions: a safety approach.

The Franz cells permeation assay has been performed for over 25 years. However, the advent of nanotechnology created a whole new world, especially with regard to topical products. In this new global scenario an increasing number of nanostructure-based delivery systems (NDSs) have emerged and a global warning relating to the safety of these NDSs is arising. This work studied the efficacy of the Franz cells assay, comparing it with the radiolabeling biodistribution test. For this purpose a formulation of sunscreen based on an NDS was developed and characterized. The results demonstrated both that the NDS did not present in vitro cytotoxicity and that the radiolabeling biodistribution test is more precise for the evaluation of NDS cosmetics than the Franz cells assay, since it detected the permeation of the NDS at a picogram order. Due to this fact, and considering all the concerns related to NDSs and nanoparticles in general, more precise methods must be used in order to guarantee the safe use of these new classes of products.

Analysis of disease activity and response to treatment in a large Spanish cohort of patients with systemic lupus erythematosus.

OBJECTIVES: The objectives of this paper are to study the impact of disease activity in a large cohort of patients with systemic lupus erythematosus (SLE) and estimate the rate of response to therapies. METHODS: We conducted a nationwide, retrospective, multicenter, cross-sectional cohort study of 3658 SLE patients. Data on demographics, disease characteristics: activity (SELENA-SLEDAI), damage, severity, hospitalizations and therapies were collected. Factors associated with refractory disease were identified by logistic regression. RESULTS: A total of 3658 patients (90% female; median SLE duration (interquartile range): 10.4 years (5.3-17.1)) were included. At the time of their last evaluation, 14.7% of the patients had moderate-severe SLE (SELENA-SLEDAI score ≥6). There were 1954 (53.4%) patients who were hospitalized for activity at least once over the course of the disease. At some stage, 84.6% and 78.8% of the patients received glucocorticoids and antimalarials, respectively, and 51.3% of the patients received at least one immunosuppressant. Owing to either toxicity or ineffectiveness, cyclophosphamide was withdrawn in 21.5% of the cases, mycophenolate mofetil in 24.9%, azathioprine in 40.2% and methotrexate in 46.8%. At some stage, 7.3% of the patients received at least one biologic. A total of 898 (24.5%) patients had refractory SLE at some stage. Renal, neuropsychiatric, vasculitic, hematological and musculoskeletal involvement, a younger age at diagnosis and male gender were associated with refractory disease. CONCLUSIONS: A significant percentage of patients have moderately-to-severely active SLE at some stage. Disease activity has a big impact in terms of need for treatment and cause of hospitalization. The effectiveness of the standard therapies for reducing disease activity is clearly insufficient. Some clinical features are associated with refractory SLE.

Creutzfeldt-Jakob disease cluster in the health area of Meixoeiro Hospital.

OBJECTIVE: Galicia is the Spanish region in which most bovine spongiform encephalopathy cases have been registered. Meixoeiro Hospital is included in the Galician Health Service (SERGAS). The aim of the study was to analyze the clinical and epidemiological characteristics of Creutzfeldt-Jakob disease (CJD) in the health area of Meixoeiro Hospital and to identify possible specific risk factors to the general public. METHODS: All incident cases of CJD were identified in the health area of Meixoeiro Hospital (187,877 inhabitants) over a 14-year period, 1997-2010, and classified according to WHO diagnostic criteria. We obtained clinical detail and epidemiological information on all cases. Crude and age-specific incidence rates were calculated. A review of surgical or invasive medical procedures was undertaken. RESULTS: We diagnosed 12 patients with CJD, 10 sporadic CJD (sCJD), and two genetic CJD (gCJD). No iatrogenic or variant CJD was detected. According to Poisson distribution, 3.9 CJD cases would be expected for our area over the 14 years researched. The average yearly mortality rate from CJD was 4.6 cases per million (3.8 from sCJD and 0.8 from gCJD). Eight patients (67%) underwent at least one surgical or invasive medical procedure. Sixteen of twenty-seven (59%) of these procedures were undertaken in Meixoeiro Hospital. CONCLUSIONS: The incidence of CJD in the health area of Meixoeiro Hospital is three times higher than expected. The hypothesis that at least some cases of sCJD are apparently because of covert transmission or zoonosis events should not be formally refuted and might explain the high rate found.

Teoría de los cuidados de Swanson y sus fundamentos, una teoría de mediano rango para la enfermería profesional en Chile / Swanson's care theory and her fundamental ideas, a mid-range theory for professional nursing in Chile

La estructura del conocimiento es fundamentado en teorías que permiten el actuar del profesional de enfermería. Objetivo: Analizar la teoría de Los Cuidados de Kristen Swanson para sustentar los cuidados profesionales de enfermería en Chile. Metodología: Se realizó revisión de bibliografía en bases de datos Scielo, Lilacs, Pubmed. Resultados: Las teorías permiten la generación del conocimiento, perfeccionan las prácticas y fundamentan el cuidado profesional en enfermería. Conclusión: El rol gestor del cuidado que se atribuye a los profesionales de enfermería en Chile puede y debe ser respaldado por conocimientos teóricos que aseguren la calidad de los cuidados hacia el usuario (AU)

The structure of knowledge is based on theories that allow the work of a Nursing Professional. Objective: To analyze Kristen Swanson’s Care Theory to support Nursing’s professional health care in Chile. Methodology: A revision of the bibliography was performed on the databases scielo, lilacs and pubmed. Results: The theories encourage the creation of knowledge, they perfect the health care practices and provide the fundamentals for Nursing’s professional care. Conclusion: The Care Management Role given to the nursing professionals in Chile can and should be backed up by theoretical knowledge that will insure quality care towards the patient (AU)

Aharonov-Bohm interference in neutral excitons: effects of built-in electric fields.

We report a comprehensive discussion of quantum interference effects due to the finite structure of neutral excitons in quantum rings and their first experimental corroboration observed in the optical recombinations. The signatures of built-in electric fields and temperature on quantum interference are demonstrated by theoretical models that describe the modulation of the interference pattern and confirmed by complementary experimental procedures.

A comparative study of two histological techniques for the identification of cytomegalovirus infection in colorectal biopsies from patients with chronic inflammatory bowel disease.

BACKGROUND: the role that cytomegalovirus (CMV) plays in inflammatory bowel disease (IBD) is controversial. The diagnosis of CMV infection in IBD depends on viral identification with hematoxylin-eosin (HE) or immunohistochemistry (IHC). Our aim was to compare the sensitivity of HE and IHC for this diagnosis in IBD patients. PATIENTS AND METHODS: a case-control study. Our database was searched for IBD patients with HE- or IHC-based CMV-positivity from 1997 to 2007. Controls were selected among IBD inpatients matched for age and year of diagnosis with CMV. Their clinical characteristics were analyzed. HE and IHC were performed on biopsies from cases and controls at 6 months before and after inclusion in the study. In the statistical analysis, p values below 0.05 were considered significant. RESULTS: ten IBD patients with CMV infection were identified. IBD-CMV patients were more steroid-resistant or steroid-dependent (p = 0.03), and underwent a higher number of colonic biopsies (p = 0.03). From 97 biopsies analyzed, 12 were HE-negative and IHC-positive, and 3 showed reversed results. The sensitivity of HE was 58.6%, 95% CI (38.9-78.3), and that of IHC was 89.7%, 95% CI (76.8-100). We did not find a good level of agreement between both techniques: kappa value 0.55, 95% CI (0.36-0.75). CMV positivity with IHC was associated with the use of more than one immunosuppressant drug, OR 13.5, 95%CI (1.2-152.2). Antiviral treatment was useful for CMV patients with steroid-dependent and steroid-refractory IBD. CONCLUSIONS: IHC shows a 30% higher sensitivity than HE for the diagnosis of CMV infection in IBD patients. There is no good level of agreement between both histological techniques.

Estudio comparativo entre dos técnicas histológicas para el diagnóstico de infección por citomegalovirus en biopsias colorrectales de pacientes con enfermedad inflamatoria intestinal crónica idiopática / A comparative study of two histological techniques for the identification of cytomegalovirus infection in colorectal biopsies from patients with chronic inflammatory bowel disease

Introducción: el papel que el citomegalovirus (CMV) juega enla enfermedad inflamatoria intestinal (EII) es controvertido. Eldiagnóstico de infección por CMV en estos pacientes reside en suidentificación en el tejido colónico mediante hematoxilina-eosina(HE) o inmunohistoquímica (IHC). Nuestro objetivo fue compararla sensibilidad de ambas técnicas histológicas para establecer estediagnóstico.Pacientes y métodos: estudio caso-control, identificando enel periodo 1997-2007 aquellos pacientes CMV positivos con HEo IHQ. Sus controles fueron apareados por edad y año de diagnósticode CMV en los casos. Se realizaron ambas técnicas en lasbiopsias de casos y controles obtenidas 6 meses antes y tras su inclusiónen el estudio. En el análisis estadístico consideramos significativoslos valores de p < 0,05.Resultados: encontramos infección por CMV en 10 pacientes.Estos sujetos presentaban más frecuentemente una EII resistenteo dependiente de esteroides (p = 0,03) y un mayor númerode biopsias de colon (p = 0,03). De 97 biopsias analizadas, 12fueron HE-negativas e IHC-positivas y 3 mostraron resultados inversos.La sensibilidad de HE fue 58,6% IC95 (38,9-78,3) y paraIHQ 89,7% IC95 (76,8-100). No encontramos una buena concordanciaentre ambas técnicas histológicas: kappa 0,55 IC95(0,36-0,75). La positividad para CMV se asoció al uso de más deun fármaco inmunosupresor, OR 13,5 IC95 (1,2-152,2). El tratamientoantiviral fue útil en la EII refractaria o dependiente de esteroides.Conclusiones: la IHQ posee una sensibilidad superior a HE(30%) para el diagnóstico de infección por CMV en la EII, no existiendobuena concordancia entre ambas técnicas histológicas(AU)

Background: the role that cytomegalovirus (CMV) plays in inflammatorybowel disease (IBD) is controversial. The diagnosis ofCMV infection in IBD depends on viral identification with hematoxylin-eosin (HE) or immunohistochemistry (IHC). Our aim wasto compare the sensitivity of HE and IHC for this diagnosis in IBDpatients.Patients and methods: a case-control study. Our databasewas searched for IBD patients with HE- or IHC-based CMV-positivityfrom 1997 to 2007. Controls were selected among IBD inpatientsmatched for age and year of diagnosis with CMV. Theirclinical characteristics were analyzed. HE and IHC were performedon biopsies from cases and controls at 6 months beforeand after inclusion in the study. In the statistical analysis, p valuesbelow 0.05 were considered significant.Results: ten IBD patients with CMV infection were identified.IBD-CMV patients were more steroid-resistant or steroid-dependent(p = 0.03), and underwent a higher number of colonic biopsies(p = 0.03). From 97 biopsies analyzed, 12 were HE-negativeand IHC-positive, and 3 showed reversed results. The sensitivityof HE was 58.6%, 95% CI (38.9-78.3), and that of IHC was89.7%, 95% CI (76.8-100). We did not find a good level of agreementbetween both techniques: kappa value 0.55, 95% CI (0.36-0.75). CMV positivity with IHC was associated with the use ofmore than one immunosuppressant drug, OR 13.5, 95%CI (1.2-152.2). Antiviral treatment was useful for CMV patients withsteroid-dependent and steroid-refractory IBD.Conclusions: IHC shows a 30% higher sensitivity than HEfor the diagnosis of CMV infection in IBD patients. There is nogood level of agreement between both histological techniques(AU)

Análisis factorial y características psicométricas de la Kleinina Psychoanalytic Diagnostic Scale (KPDS) / Factor analysis and psychometric characteristics of the Kleinian Psychoanalytic Diagnostic Scale (KPDS)

El trabajo tiene como objetivo investigar las características psicométricas de la escala Kleinian Psychoanalytic Diagnostic Scale (KPDS) a través del análisis factorial. Además se ha realizado una discusión del sentido conceptual de sus factores a la luz de algunos datos derivados de la capacidad para discriminar pacientes que pertenecen a agrupaciones diagnósticas obtenidas mediante criterios DSM-IV-R, así como de la relación con el test de Rorschach. Los resultados del trabajo sugieren una clara estructura bifactorial con una notable consistencia interna. Los ítems que cargan los dos factores obtenidos parecen tener un sentido clínico conceptualmente coherente con el modelo teórico que ha inspirado la escala (AU)

This paper studies the psychometric properties of the Kleinina Psychoanalytic Diagnostic Scale (KPDS) by using factor analysis. It reviews the scale´s ability to distinguish between DSM IV TR diagnoses, and also examines the relation between the KPDS and the Rorschach Test. The results suggest that the KPDS has a clear bi-factorial structure with a highly significant internal consistency. The items which correspond to each of the obtained factors bear a conceptually coherent clinical sense with the theoretical model inspiring the Scale (AU)

[Prognostic value of the ultrasound and diuretic renogram in the evolution of ureteropelvic junction obstruction]. / Valor pronóstico de la ecografía y el renograma diurético en la evolución de la estenosis pieloureteral.

INTRODUCTION: The congenital obstruction of the pieloureteral junction (UPJ) is the most frequent cause of hydronephrosis in children. Sometimes, establishing the convenience of a surgical procedure is difficult, mainly if we consider the literature published on the spontaneous resolution of the slight, moderate and even severe hydronephrosis in newborns. OBJECTIVE: To determine the prognostic value of ultrasound in the evolution of the unilateral hydronephrosis, by assesing the size of the contralateral kidney. To verify if the "supranormal" renal function (SRF) is real or an artefact. PATIENTS AND METHODS: We have performed a descriptive observational study over a 10 years period (1995-2005). The study included all patients with the only diagnosis of obstructive unilateral hydronephrosis that underwent pieloplasty, and were controlled for 1 year period after the surgical treatment. RESULTS: Of the 66 patients in the study, 42 were boys (63.6%) and 24 girls (36.4%). After the first diuretic renogram (DR), in 57 of the patients (86.4%) the clearance half-time (T1/2) was over 20 minutes, in 6 cases (9.1%) it was 10-20 minutes and only in 3 cases it was shorter than 10 minutes. A similar differential renal function (FRD) was observed in the moderate and severe hydronephrosis. Supranormal function (FRD > 52%) was detected on DR in 11 patients, predominating in left hidronefrosis, and in more than 50% of the cases this value it did not agree with the renal function measured by dimercapto-succinic acid (DMSA), Pearson's correlation coefficient: 0.19. These kidneys experienced a greater reduction of the postoperative renal function. CONCLUSIONS: In the unilateral obstructive hydronephrosis, the healthy contralateral kidney experiences hypertrophy detectable by ultrasound, but these ecographic diameters are within the band of individual confidence of the healthy children of reference. The supranormal function exists, but in most cases it is an artefact.

Valor pronóstico de la ecografía y el renograma diurético en la evolución de la estenosis pieloureteral / Prognostic value of the ultrasound and diuretic renogram in the evolution of ureteropelvic junction obstruction

Introducción. La obstrucción congénita de la unión pieloureteral(EPU) es la causa más frecuente de hidronefrosis en el niño. A veces, establecer la indicación quirúrgica es difícil, sobre todo si tenemos en cuenta la literatura publicada sobre la resolución espontánea de la hidronefrosis leve, moderada e incluso grave en el periodo neonatal. Objetivo. Determinar el valor pronóstico de la ecografía en la evolución de la hidronefrosis unilateral, monitorizando el tamaño del riñón contralateral. Comprobar si la función renal “supranormal” (FRS) es real o un artefacto. Pacientes y métodos. Realizamos un estudio observacional descriptivo que abarca 10 años (1995-2005). Se han considerado a efectos del estudio a todos los pacientes pediátricos con diagnóstico de hidronefrosis obstructiva que fueron sometidos a una pieloplastia, y controlados durante un período mínimo de 1 año tras el tratamiento quirúrgico. Resultados. De los 66 pacientes revisados 42 eran niños (63,6%)y 24 niñas (36,4%). Tras el primer renograma diurético (RD), en 57pacientes (86,4%) el tiempo medio de eliminación (T1/2) estaba por encima de los 20 minutos, en 6 casos (9,1%) estaba entre 10-20 minutos y sólo en 3 casos era menor de 10 minutos. Se observó una función renal diferencial (FRD) similar en las hidronefrosis moderadas y graves. En 11 pacientes encontramos una FRS (FRD>52%) renográfica, predominando en las hidronefrosis izquierdas, y en más del 50% de los casos este valor no coincidía con la FRD gammagráfica con ácido dimercaptosuccínico (DMSA), coeficiente de correlación de Pearson: 0,19. Estos riñones con FRS preoperatoria experimentaron un mayor descenso de la función renal postoperatoria. Conclusiones. En las hidronefrosis obstructivas el riñón contralateral sano experimenta una hipertrofia apreciable en la ecografía, pero estos diámetros ecográficos están dentro de la banda de confianza individual de la población sana de referencia. La función supranormal existe, pero en la mayoría de los casos es un artefacto (AU)

Introduction. The congenital obstruction of the pieloureteral junction(UPJ) is the most frequent cause of hydronephrosis in children. Sometimes, establishing the convenience of a surgical procedure is difficult, mainly if we consider the literature published on the spontaneous resolution of the slight, moderate and even severe hydronephrosis in newborns. Objective. To determine the prognostic value of ultrasound in the evolution of the unilateral hydronephrosis, by assessing the size of the contralateral kidney. To verify if the “supranormal” renal function(SRF) is a real or an artefact. Patients and methods. We have performed a descriptive observational study over a 10 years period (1995-2005). The study included all patients with the only diagnosis of obstructive unilateral hydronephrosis that underwent pieloplasty, and were controlled for 1 year period after the surgical treatment. Results. Of the 66 patients in the study, 42 were boys (63.6%) and24 girls (36.4%). After the first diuretic renogram (DR), in 57 of the patients (86.4%) the clearance half-time (T1/2) was over 20 minutes, in6 cases (9.1%) it was 10-20 minutes and only in 3 cases it was shorter than 10 minutes. A similar differential renal function (FRD) was observed in the moderate and severe hydronephrosis. Supranormal function (FRD>52%)was detected on DR in 11 patients, predominating in left hidronefrosis, and in more than 50% of the cases this value it did not agree with the renal function measured by dimercapto-succinic acid (DMSA), Pearson’s correlation coefficient: 0.19. These kidneys experienced a greater reduction of the postoperative renal function. Conclusions. In the unilateral obstructive hydronephrosis, the healthy contralateral kidney experiences hypertrophy detectable by ultrasound, but these ecographic diameters are within the band of individual confidence of the healthy children of reference. The supranormal function exists, but in most cases it is an artefact (AU)

Epiperitoneal vessels: more resources to perform DIEP flaps.

The development of the DIEP flap established an accepted concept of reconstructive surgery, but in patients who demonstrate inadequate in vivo flap perfusion, alternative surgical options to improve vascularisation are limited. We present a 42-year-old patient, with a left mastectomy whose breast was reconstructed with a DIEP flap. After anastomosis to the internal mammary vessels there was insufficient arterial perfusion of the flap. The situation was resolved by using an independent medial perforator artery emerging from the peritoneal layer (epiperitoneal vessels). This new pedicle was anastomosed end-to-end to the distal portion of the inferior epigastric artery. We consider that epiperitoneal vessels can be an emergency pedicle when needed and a possible alternative to the main pedicle of the DIEP flap.

[Hysteroscopy requirements and complications]. / Requisiti e complicanze dell'isteroscopia.

With this study, possible complications of diagnostic and surgical hysteroscopy were identified in order to define minimum safety requirements for the technique in three different healthcare settings: the physician's office, the outpatient clinic and the operating room. A literature review was conducted to compare the results in terms of feasibility and simplicity, as well as complications associated with the use of various instruments and techniques. Thanks to advances in technologies and procedures, diagnostic hysteroscopy has an excellent safety profile and is widely accepted. With the aid of minioptics (lens or fiber <4 mm in diameter), success rates have increased and hysteroscopy-associated pain has been considerably reduced. Published studies report low complication rates with minioptic hysterectomy. Surgical interventions conventionally performed on an inpatient basis (polypectomy, myoma removal) can be carried out under an outpatient or day surgery regime without the need for cervical canal dilation or anesthesia. The complications rate following hysteroscopy depends on the diameter and type of the instrument, the duration of the intervention, the extent and type of the disorder and the patient's clinical condition. Based on the study findings, the following recommendations for procedures and services can be made: diagnostic hysteroscopy with or without anesthesia performed as a simple ambulatory or gynaecologist's office procedure; surgical hysteroscopy for polypectomy, removal of myomas G0 <1 cm, synechiae and metroplasty as an ambulatory surgical procedure; surgical hysteroscopy for polypectomy, removal of myomas G0 <1 cm, synechiae and metroplasty as a safe ambulatory surgical procedure (in at-risk patients); surgical hysterectomy for myomectomy, voluminous polyps, metroplasty as a surgical procedure in day surgery.

Luther-Emery phase and atomic-density waves in a trapped fermion gas.

The Luther-Emery liquid is a state of matter that is predicted to occur in one-dimensional systems of interacting fermions and is characterized by a gapless charge spectrum and a gapped spin spectrum. In this Letter we discuss a realization of the Luther-Emery phase in a trapped cold-atom gas. We study by means of the density-matrix renormalization-group technique a two-component atomic Fermi gas with attractive interactions subject to parabolic trapping inside an optical lattice. We demonstrate how this system exhibits compound phases characterized by the coexistence of spin pairing and atomic-density waves. A smooth crossover occurs with increasing magnitude of the atom-atom attraction to a state in which tightly bound spin-singlet dimers occupy the center of the trap. The existence of atomic-density waves could be detected in the elastic contribution to the light-scattering diffraction pattern.

Quantitative determination of the hubbard model phase diagram from optical lattice experiments by two-parameter scaling.

We propose an experiment to obtain the phase diagram of the fermionic Hubbard model, for any dimensionality, using cold atoms in optical lattices. It is based on measuring the total energy for a sequence of trap profiles. It combines finite-size scaling with an additional "finite-curvature scaling" necessary to reach the homogeneous limit. We illustrate its viability in the 1D case, simulating experimental data in the Bethe-ansatz local-density approximation. Including experimental errors, the filling corresponding to the Mott transition can be determined with better than 3% accuracy.