Challenges in quantification of photocatalytic NO2 abatement effectiveness under real world exposure conditions illustrated by a case study.

Health risks due to NO2 exposure commonly exceed acceptable levels in modern societies. Among the measures to reduce such risks, photocatalytic materials present a promising technology. However, while the pollutant remediation of such materials has been extensively validated in laboratory studies, the performance under real world environmental exposure conditions is still subject to controversy. Indeed, a comparison of available in-situ monitoring studies manifests non-conclusive and highly scattered results regarding the photocatalytic effectiveness observed. The reasons for this behaviour must be carefully explored in order to prevent non-efficient photocatalytic applications from being put into practice on a larger scale. This paper presents a comprehensive large-scale study for assessing the photocatalytic NO2 remediation by active pavements in a street of Madrid (Spain), comprising different in-situ monitoring techniques. The discussion is enriched by relating the obtained results to those of other large-scale studies. The discrepancies between these results may be traced back to different circumstances, among them the distance between the active pavement and the pollutant concentration sampling inlet, as well as to significant site-specific and time-dependent variations of pollutant concentrations and climatic parameters. Under due consideration of these influences, for materials with relatively high initial effectiveness, it was concluded that in most such applications, the average NO2 removal effectiveness, if evaluated at a typical inlet height of Air Quality Stations (3 m), will not exceed a value of 4% (averaged over a sufficiently large number of measurement points in the area of application and a sustained amount of time, i.e. several months). When considering more realistic human exposure conditions (lower heights and daytime), it might be justified to assume somewhat higher average effectiveness.

Sequence analysis suggests positive selection on the bovine prodynorphin gene / Análisis de secuencias genómicas sugieren que el gen de la prodinorfina está bajo selección positiva en bovinos

ABSTRACT Dynorphin A is an endogenous opioid peptide that is part of the KNDy system in the hypothalamus of mammals. This peptide acts as an inhibitor of the GnRH pulse generation, thus regulating the onset of puberty and reproductive cycles. The PDYN gene encodes the propeptide Prodynorphin, the precursor of Dynorphin A. Despite its physiological relevance, PDYN has not emerged as a candidate gene associated with puberty in genomic association studies conducted in cattle. The present work aimed to search for signatures of selection on the PDYN gene among cattle breeds. To this, the whole genome sequences from 57 samples of ten cattle breeds were used. The samples were grouped based on breed selection history and their productive differences, particularly in terms of sexual precocity. The population structure was analyzed using Principal Component Analyses. To evidence recent selection processes, neutrality tests, such as Tajima's D and Fu & Li's F* and D* were performed in defined functional regions of PDYN. The putative promoter of PDYN showed a population structure that is in agreement with the criteria considered to make the groups. In that region, neutrality tests were consistently negative and resulted in statistically significant for the dairy breeds. Also, these breeds exhibited less variability in the haplotype analyses than the others. The results presented here suggest that regulatory regions of PDYN could be under positive selection, particularly in dairy breeds.

RESUMEN Dinorfina A es un péptido opioide endógeno que forma parte del sistema KNDy en el hipotálamo de mamíferos. Este péptido actúa como inhibidor de la generación de los pulsos de GnRH, regulando así el inicio de la pubertad y los ciclos reproductivos. El gen PDYN codifica el propéptido Prodinorfina, precursor de Dinorfina A. A pesar de su relevancia fisiológica, PDYN no ha surgido como gen candidato asociado a pubertad en estudios de asociación genómicos en bovinos. El presente trabajo tuvo como objetivo buscar huellas de selección en el gen PDYN entre diferentes razas bovinas. Para alcanzarlo se utilizaron secuencias genómicas de 57 muestras de diez razas bovinas. Las muestras fueron agrupadas considerando la historia de selección y las diferencias productivas entre razas, particularmente en términos de precocidad sexual. La estructura poblacional fue analizada usando análisis de componentes principales. Para evidenciar procesos de selección recientes se realizaron pruebas de neutralidad, tales como D de Tajima y F* y D* de Fu & Li, en diferentes regiones funcionales de PDYN. El promotor putativo de PDYN mostró una estructura poblacional que es consistente con los criterios usados para agrupar las razas. En esa región, las pruebas de neutralidad fueron consistentemente negativas y estadísticamente significativas en las razas lecheras. Además, estas razas también exhibieron menor variabilidad en los análisis de haplotipos que las demás razas. Los resultados presentados aquí sugieren que regiones regulatorias de PDYN estarían bajo selección positiva, particularmente en razas bovinas lecheras.

NOx removal efficiency of urban photocatalytic pavements at pilot scale.

Photocatalytic technology implemented in construction materials is a promising solution to contribute to alleviate air quality issues found in big cities. Photocatalysis has been proved able to mineralise most harmful contaminants. However, important problems associated with monitoring the efficiency of these solutions under real conditions still remain, including the lack of affordable analytical tools to measure NOx concentrations with enough accuracy. In this work, two pilot scale demonstration platforms were built at two different locations to assess the photocatalytic NOX removal efficiency of ten selected materials exposed outdoors for AQmesh low-cost sensor PODs were used to measure ground-level to measure NO and NO2 concentrations during nearly one year. The pollutant removal efficiency of the materials was then calculated based on a comparison with simultaneously concentration measurements carried-out on reference, non-active materials. It was found that the NO2 removal efficiency presented large variations across the seasons, with maxima during the warmer months, while NO efficiencies were comparatively steadier. Statistical analysis delivered evidence that the efficiencies significantly depend on different meteorological variables (irradiance and relative humidity) besides NO, NO2 ambient concentrations. Lower efficiencies were observed for higher concentration levels and vice versa. The influence of water vapour could be related to two different effects: a short-term contribution by the instantaneous air humidity and a long-term component associated with the hygroscopic state of the material. The contribution of wind to the pollutant removal efficiencies was principally related to the humidity of air masses moving above the location and to the advection of pollutants from specific emission sources.

Characterization of a deletion in the Hsp70 cluster in the bovine reference genome.

The 70 kilodalton heat shock proteins (Hsp70) are highly conserved molecular chaperones which have a crucial role in the stress response of the cell. In mammals, the Hsp70 proteins are encoded by a cluster of three genes: HSPA1A, HSPA1B and HSPA1L. In bovines, this cluster is located on chromosome 23 downstream of the major histocompatibility complex (BoLA). We detected inconsistencies in the location of markers on the Hsp70 genes reported in the literature that pointed to a potential deletion in the bovine reference genome UMD 3.1.1. An in silico analysis of the bovine genomic region of the Hsp70 cluster, using available information from public databases, confirmed the existence of a deletion of 11.1-kb spanning the HSPA1B gene and the intergenic region between HSPA1B and HSPA1A. Although we originally considered this an assembly error, it is most likely a particular condition of L1 Dominette 01449, the cow sequenced in the Bovine Genome Project. Moreover, we suggest a new classification of bovine Hsp70 sequences reported in NCBI and a reassignment of the location of SNPs from dbSNP that map to the deletion on BTA23. We also compared the location of selected transcription factor binding sites on the promoters of HSPA1A and HSPA1B. The results generated in the present work could be helpful to refine the reference genome of an important livestock species and also to understand the role and the regulation of the bovine Hsp70 genes.

Motivos de derivación a una consulta ambulatoria de Traumatología Infantil / A Paediatric Orthopaedic outpatient clinic referral patterns

INTRODUCCIÓN: El objetivo de este estudio fue conocer los motivos de consulta más frecuentes en una consulta de Traumatología Infantil de un Centro de Especialidades y así poder mejorar el programa de formación de los residentes de Pediatría en el manejo de problemas músculo-esqueléticos. MATERIAL Y MÉTODOS: Se recogieron prospectivamente los motivos de consulta, la edad, el sexo y el diagnostico final de todos los pacientes menores de 15 años derivados a una consulta específica de Traumatología Infantil de un Centro de Especialidades. RESULTADOS: Los motivos de consulta más frecuentes fueron el dolor músculo-esquelético (37%), valorar una posible deformidad de los pies (20%), una posible deformidad de la columna (15%), el patrón de marcha (11%), la alineación de los miembros inferiores (4%) y el desarrollo de la cadera (4%). El 42% de los pacientes presentaron una exploración normal o una variante de la normalidad. El 17% de los pacientes presentaron una patología que únicamente requiere ser valorada por parte de Traumatología Infantil si un tratamiento previo con antiinflamatorios no esteroideos o rehabilitación no resuelve la sintomatología. El 8% presentaba una deformidad que solo requiere tratamiento si es sintomática. CONCLUSIONES: La mayoría de las consultas correspondieron a variantes de la normalidad o a condiciones leves que solo precisan tratamiento sintomático. El programa de formación de la residencia de Pediatría no refleja la prevalencia de los problemas músculo-esqueléticos en la práctica clínica diaria

INTRODUCTION: The aim of this study was to identify the commonest referrals to a paediatric orthopaedic outpatient clinic and, therefore, to be able to improve the paediatric residency program in managing musculoskeletal problems. MATERIAL AND METHODS: Demographic data, referrals and final diagnosis were collected prospectively on all patients that were evaluated in a paediatric orthopaedic outpatient clinic. RESULTS: The majority of referrals were to evaluate musculoskeletal pain (37%), foot deformity (20%), spine deformity (15%), walking pattern (11%), alignment of the lower limbs (4%), and development of the hip (4%). A normal physical examination or a normal variation was observed in 42% of patients. A mild condition was observed in 17% of patients that should have only been referred to a paediatric orthopaedic clinic after failing to resolve pain with anti-inflammatories or physiotherapy. A mild deformity that only needed treatment if it became symptomatic was seen in 8% of patients. CONCLUSIONS: The majority of referrals were due to a normal variation or mild conditions that only required symptomatic treatment. Paediatric residency programs do not reflect the prevalence of musculoskeletal conditions in clinical practice

Selecting enhancing solutions for electrokinetic remediation of dredged sediments polluted with fuel.

In this paper a procedure for selecting the enhancing solutions in electrokinetic remediation experiments is proposed. For this purpose, dredged marine sediment was contaminated with fuel, and a total of 22 different experimental conditions were tested, analysing the influence of different enhancing solutions by using three commercial non-ionic surfactants, one bio-surfactant, one chelating agent, and one weak acid. Characterisation, microelectrophoretic and electrokinetic remediation trials were carried out. The results are explained on the basis of the interactions between the fuel, the enhancing electrolytes and the matrix. For one specific system, the electrophoretic zeta potential, (ζ), of the contaminated matrix in the solution was found to be related to the electroosmotic averaged ζ in the experiment and not to the efficiency in the extraction. This later was correlated to a parameter accounting for both contributions, the contaminant and the enhancing solution, calculated on the basis of differences in the electrophoretic ζ in different conditions which has allowed to propose a methodology for selection of enhancing solutions.

[A Paediatric Orthopaedic outpatient clinic referral patterns]. / Motivos de derivación a una consulta ambulatoria de Traumatología Infantil.

INTRODUCTION: The aim of this study was to identify the commonest referrals to a paediatric orthopaedic outpatient clinic and, therefore, to be able to improve the paediatric residency program in managing musculoskeletal problems. MATERIAL AND METHODS: Demographic data, referrals and final diagnosis were collected prospectively on all patients that were evaluated in a paediatric orthopaedic outpatient clinic. RESULTS: The majority of referrals were to evaluate musculoskeletal pain (37%), foot deformity (20%), spine deformity (15%), walking pattern (11%), alignment of the lower limbs (4%), and development of the hip (4%). A normal physical examination or a normal variation was observed in 42% of patients. A mild condition was observed in 17% of patients that should have only been referred to a paediatric orthopaedic clinic after failing to resolve pain with anti-inflammatories or physiotherapy. A mild deformity that only needed treatment if it became symptomatic was seen in 8% of patients. CONCLUSIONS: The majority of referrals were due to a normal variation or mild conditions that only required symptomatic treatment. Paediatric residency programs do not reflect the prevalence of musculoskeletal conditions in clinical practice.

Turning waste into valuable resource: potential of electric arc furnace dust as photocatalytic material.

This paper explores the potential of a hazardous waste of difficult management, electric arc furnace dust (EAFD), as photocatalytic material. Starting from a real waste coming from a Spanish steel factory, chemical, mineralogical, and optical characterizations have been carried out. Direct trials on EAFD and mortar containing this waste have been performed to evaluate its potential as photocatalyst itself and within a cementitious material. The analysis of photocatalytic properties has been done by two different methods: degradation of NO x and degradation of rhodamine (RhB). As a result, it can be said that EAFD exhibited photocatalytic activity for both configurations with UV and visible light, having the mortar enhanced photocatalytic activity for NO x with respect to the EAFD itself. Additionally, in direct trials on the EAFD, it has been able to degrade RhB even in the dark, which has been attributed to transfer of electrons between the adsorbed RhB and the conduction band of some oxides in the dust.

Influence of the inlet air in efficiency of photocatalytic devices for mineralization of VOCs in air-conditioning installations.

Nowadays, a large proportion of photocatalytic oxidation (PCO) devices are being implemented in heating, ventilation and air-conditioning systems. However, no systematic studies have been carried out regarding the influence of inlet air preconditioning. To analyse the impact of the inlet air-conditions into photocatalytic efficiency, a simulated air-conditioning duct with flowing gas through inside was designed. Isobutylene was chosen as the target VOCs. The concentration in the gas phase was monitored using a photoionization detector. The influence of flow rate, relative humidity and temperature on the VOC removal efficiency was analysed. Experimental results were presented in terms of gas-removal efficiency (η) and clean air delivery rate (CADR) and analysed on a kinetic basis. From them, the weight of each parameter in the global process has been determined, from bigger to smaller contribution, flow>>temperature>relative humidity. Also, the relevance of the inlet air conditions has been illustrated in a model room in order to determinate the time necessary to obtain a threshold value accomplishing with enough air quality and the energy consumption of the device. Additionally, the photocatalytic decontamination has been assimilated to the "air exchange rate", a parameter commonly used in indoor air quality studies. The results show that preconditioning of air can improve the efficiency of photocatalytic devices and bring important energy savings.

Controlling the levels of airborne pollen: can heterogeneous photocatalysis help?

Airborne pollen is a worldwide problem because is a very important allergenic agent; it can be altered only by certain microorganisms and by some oxidizers, such as reactive oxygen species (ROS). On the other hand, heterogeneous photocatalysis (HPC) arose as a promising technology for reducing the level of contaminants in the air, based on their degradation by the production of ROS. In this paper, study of the feasibility of HPC to diminish the counts of pollen is undertaken. The research has been carried out at different levels, from solutions to mortar specimens with the evidence that HPC is able to reduce the amount of pollen grains. This is a major breakthrough that opens the door to a whole field of research, already full of gaps, whose implications could be quite controversial.

Heavy ion beam measurement of the hydration of cementitious materials.

The setting and development of strength of Portland cement concrete depends upon the reaction of water with various phases in the Portland cement. Nuclear resonance reaction analysis (NRRA) involving the (1)H((15)N,alpha,gamma)(12)C reaction has been applied to measure the hydrogen depth profile in the few 100 nm thick surface layer that controls the early stage of the reaction. Specific topics that have been investigated include the reactivity of individual cementitious phases and the effects of accelerators and retarders.

Long-term use of different doses of low-molecular-weight heparin versus vitamin K antagonists in the treatment of venous thromboembolism.

BACKGROUND: We evaluated whether the incidence of recurrent venous thromboembolic events (VTEs) during and after therapy differs for patients treated with full or reduced doses of low-molecular-weight heparin (LMWH) used long term compared with vitamin K antagonists (VKAs). METHODS: We identified randomized studies of long-term treatment with LMWH or VKA by searching MEDLINE, EMBASE, BIOSIS, and PASCAL. Seventeen studies were included, with 4,002 patients. RESULTS: In the assessment at 12 months of 1,957 patients without cancer, the recurrence rates of VTE in the LMWH/VKA groups were 8.3%/7.6% in the studies using full doses and 12.3%/12.1% in those using prophylactic doses. However, combined analysis after treatment to 1 year showed a nonsignificant (NS) trend to lower recurrent symptomatic VTE in favor of VKA (RR = 1.46, 95% CI 0.96-2.23). In 1,292 patients with cancer the recurrence rates of VTE in the LMWH/VKA groups were 6.5%/17.9% (p = 0.005) in the studies using full doses, 7.1%/13.4% (p = 0.002) in the studies using intermediate doses, and 14.3%/19.1% (p = NS) in the studies using prophylactic doses. Furthermore, the recurrences of VTE after discontinuation of treatment in the LMWH/VKA groups were 1.6%/9.5% (RR = 0.25, 95% CI 0.06-1.1) in 252 patients with full doses and 12%/7.4% (RR = 1.49, 95% CI 0.3-7.48) in 52 patients with prophylactic doses. In this population with cancer, the full-treatment LMWH regimen did not produce more major bleeding events than intermediate or prophylactic doses (5.1% vs. 6.3% or 8.1%, respectively). CONCLUSION: Full-dose LMWH for 3-6 months is as safe as intermediate and prophylactic doses for the long-term treatment of deep vein thrombosis. In patients with cancer it appears that there is an excess of VTE recurrence after treatment with prophylactic doses that does not occur with full therapeutic doses.

Arterial mapping with Duplex ultrasound: diagnostic-therapeutic strategy in patients with critical lower-limb ischemia.

AIM: Arteriography is the gold-standard in decision making in patients with critical lower-limb ischemia. Such method is not bereft of side effects and only gives morphologic information about lesions. Duplex allows to evaluate hemodynamically the arteriosclerotic lesions of ischemic lower limbs non-invasivelly and with the same reliability, in some studies, as angiography. Aim of this study was to determine the value and safety of arterial ultrasonic mapping in decision making for treatment of critical lower-limb ischemia. METHODS: This was a prospective and comparative study in patients with critical lower-limb ischemia recruited from March 2005 to June 2006. Ultrasonic arterial mapping was performed in 130 patients. Arteriography was performed only in those patients with elevated risk of major amputation or if ultrasound was not feasible (44 patients). Patients were randomized into two groups according to decision making criteria: 1) group A based on mapping alone; 2) group B based on arteriography. There was no statistical difference between risk factors in the two groups (P>0.05). Cumulative patency was recorded and compared at one and three months (Log Rank) as well as degree of concordance of decision making using mapping and arteriography in the group with both tests (B); and degree of concordance of the two tests with decision making based on intraoperative findings. RESULTS: The degree of concordance between mapping and arteriography was 84.1% (P<0.0001), and the degree of concordance between mapping and arteriography with respect to final decision according to intraoperative findings was 93.1% and 97.7%, respectively (P<0.0001). There were no statistically significative differences in patency rates at one and three months between the two groups (P>0.05). CONCLUSIONS: Ultrasonic arterial mapping is sufficient and comparable to arteriography for purposes of decision making in patients with critical lower-limb ischemia.

Análisis coste-efectividad del tratamiento del aneurisma de aorta abdominal mediante prótesis endovascular en España / Analysis of the cost-effectiveness of using stents to treat abdominal aortic aneurysms in spain

Objetivos. Determinar si el tratamiento endovascular (TEV) es una opción coste-efectiva en la terapia delaneurisma de aorta abdominal (AAA) respecto a la cirugía abierta, y evaluar el impacto presupuestario de una mayorutilización de estos dispositivos en el Sistema Nacional de Salud. Pacientes y métodos. Realizamos un análisis costeefectividady coste-utilidad del TEV frente a cirugía abierta utilizando un modelo de Markov de ciclos mensuales basadoen datos clínicos de la literatura (esencialmente el estudio EVAR-1) y la opinión de expertos. Tuvimos en consideraciónuna población española hipotética de pacientes con AAA igual o superior a 5 cm y tributarios de cirugía abierta. El análisislo realizamos desde la perspectiva del Sistema Nacional de Salud, y se descontaron costes y efectos futuros al 3,5%.Adicionalmente realizamos el impacto presupuestario y un análisis de sensibilidad probabilístico con la simulación deMonte-Carlo. Resultados. Los resultados mostraron que el TEV se asocia a una mayor efectividad que la cirugía abierta,con ganancias de entre 0,03 y 0,18 años de vida por paciente a uno y cuatro años, respectivamente (resultados similaressi se utilizan años de vida ajustados por calidad). El coste medio por paciente fue mayor en TEV, entre 2.879 y 3.492euros según distintos escenarios, el coste por años de vida ganado con TEV fue de 111.064 a 19.852 euros y el coste poraños de vida ajustados por calidad ganado fue de 137.206 a 27.077 euros (análisis a uno y cuatro años, respectivamente).El impacto presupuestario de aumentar la introducción de la endoprótesis evaluada en España durante los próximoscuatro años representa el 0,5-2,2% del coste total de las AAA. Conclusiones. El TEV es una alternativa coste-efectiva conrespecto a la intervención quirúrgica convencional, ya que a los cuatro años de seguimiento presenta valores por debajodel umbral de eficiencia usualmente aceptado en España(AU)

Aims. To determine whether endovascular treatment (EVT) is a cost-effective option for the treatment ofabdominal aortic aneurysm (AAA) with respect to open surgery, and to evaluate the budget impact of a more widespreadutilisation of these devices in the Spanish National Health Service. Patients and methods. We performed a costeffectivenessand cost-utility analysis of EVT versus open surgery using a Markov model of monthly cycles based onclinical data from the literature (essentially the EVAR-1 study) and the opinion of experts. The sample taken into accountwas a hypothetical Spanish population of patients with AAA equal to or larger than 5 cm and who were candidates foropen surgery. The analysis was performed from the perspective of the National Health Service, and future costs andeffects were discounted at 3.5%. Additionally we also examined the budget impact and performed a probabilisticsensitivity analysis with Monte-Carlo simulation. Results. The results showed that EVT is associated to a higher degreeof effectiveness than open surgery, with gains of between 0.03 and 0.18 years of life per patient at one and four years,respectively (similar results to those obtained if quality adjusted life years are used). The mean cost per patient wasgreater in EVT, between 2879 and 3492 euros, depending on the different scenarios, the cost-life years gained with EVTwas from 111 064 to 19 852 euros and the cost-quality adjusted life years gained was from 137 206 to 27 077 euros(analysis at one and four years, respectively). The budget impact of increasing the introduction of stents evaluated inSpain over the next four years represents 0.5-2.2% of the total cost of AAA. Conclusions. EVT is a cost-effectivealternative with respect to conventional surgical interventions, because at four years of follow-up it offers values thatare below the efficiency threshold that is usually accepted in Spain(AU)

Estudio epidemiológico para valorar la adhesión de los cirujanos vasculares españoles al documento de consenso TASC II para el tratamiento de la enfermedad arterial periférica / Retrospective study to evaluate the adherence to the document TASC II consensus on peripheral arterial disease in Spain

Introducción. La enfermedad arterial periférica (EAP) se considera la arteriopatía no cardíaca de mayor prevalencia.En la guía médica TASC II, publicada en 2007, se describen los procedimientos para el diagnóstico y tratamientode esta enfermedad. Objetivo. Evaluar la adhesión a la guía TASC II por parte de los médicos de los servicios decirugía vascular en los hospitales españoles. Pacientes y métodos. A partir de la historia clínica de pacientes dados dealta en los servicios de cirugía vascular diagnosticados de EAP, se recogieron datos sobre las características del paciente,diagnóstico, seguimiento y tratamiento de la EAP. Estos datos se compararon con las recomendaciones de la guíaTASC II. Resultados. Se incluyeron 1.456 pacientes tratados en 63 hospitales. Se observó un cumplimiento global con laguía TASC II del 62,43%, mientras que la adhesión a la guía en función de sus diferentes bloques varió, y los procesos derevascularización junto con el tratamiento de los factores de riesgo fueron los bloques con una adhesión superior (el 82,4y el 84,96%, respectivamente). El bloque de recomendaciones con el que menos se cumplió correspondió al tratamientode la claudicación intermitente (24,8%). Por último, respecto a los bloques relacionados con el tratamiento de la isquemiacrítica y la isquemia aguda de la extremidad se obtuvieron adhesiones del 78,46 y del 60,1%, respectivamente. Conclusiones.En este estudio se ha obtenido información valiosa sobre la práctica habitual médico-quirúrgica en el tratamientode los pacientes diagnosticados de EAP en España, y se ha observado un mayor cumplimiento con la guía TASCII en los bloques de revascularización y de control de los factores de riesgo(AU)

Introduction. Peripheral arterial disease (PAD) is considered the most prevalent non-cardiac arterial disease.The new TASC II guidelines (Inter-Society Consensus for the Management of Peripheral Arterial Disease) describes theprocedures for a proper diagnosis and treatment of the PAD. Aim. To evaluate the adherence of angiologists andvascular surgeons to the new TASC II guidelines in the main Spanish hospitals. Patients and methods. Each vascularsurgery department contributed their last 20 consecutive patients diagnosed with PAD and discharged from the hospital.The data were collected in to a CRF from the medical records, which included patient characteristics, diagnoses,treatments prescribed and follow-up. These data were compared with the recommendations of TASC II guidelines.Results. A total of 1,456 patients in 80 hospitals were included in the study during the year 2007, of which 60 patientsdid not fulfil with the selection criteria of the study. This is the reason why the statistical analysis has been done on 1,396patients. The global adherence to TASC II was observed in the 62.43%, whereas the adherence to the guideline bySections, varied being the revascularización processes and the management of the risk factors the Sections with greateradherence (82.4% and 84.96 respectively). The Section of recommendations that less adhesion obtained (24.8%)corresponded to management of the intermittent claudication. Finally the Section for the management of critical ischemiaand acute ischemia of the extremities obtained an adhesion of 78.46% and 60.1% respectively. Conclusions. The ENGUÍAstudy provides valuable information on the current medical practice in the management of patients diagnosed with PAD inSpain. A global adhesion of TASC II of 62.43% will help us to develop strategies to improve the management of PADaccording to guidelines(AU)

The importance of a standing position in the diagnosis of Nutcracker phenomenon by duplex sonography.

AIM: To determine the clinical usefulness of Doppler ultrasonography in the diagnosis of the Nutcracker phenomenon, as an alternative to computed tomographic scans (CT). METHODS: This study consisted of 52 patients that presented with intermittent hematuria of unknown origin between January 2006 to April 2008. Doppler ultrasonography was used to assess the left renal vein (LRV) by measuring the anteroposterior (AP) diameter and peak systolic velocity (PSV) in supine and standing positions, at the hilar and interaortomesenteric portions of the LRV. These data were compared with CT scans. The sensitivity and specificity of duplex sonography was determined using the AP diameter and PSV ratios to assess the cut-off levels. Kappa (k) statistic was also evaluated. RESULTS: mean AP diameters of the LRV measured by Doppler sonography were 8.38 mm at the hilar and 3.17 mm under the SMA, compared to 9.3 mm (hilar) and 3.2 mm (SMA) in the supine and standing position respectively. The PSV in the supine position was 25.77 cm/s and 115.48 cm/s, respectively, compared to 25.54 cm/s and 125.96 cm/s in the standing position. The cut-off levels were 3.85 (sensitivity: 61.5%, specificity: 80.8%, k:0.42) for the supine and 4.12 (sensitivity:61.5%, specificity: 65.4%, k: 0.27) for the standing AP diameter, 2.99 (sensitivity: 92.3%, specificity: 73.1%, k: 0.65) for the supine and 3.73 (sensitivity: 96.4%, specificity: 79.2%, k: 0.76) for the standing PSV. CONCLUSIONS: Our data show that the standing PSV ratio is the best parameter for to detecting entrapment of the LRV.

Early mobilisation in patients with acute deep vein thrombosis does not increase the risk of a symptomatic pulmonary embolism.

AIM: The purpose of the study was to determine if early mobilisation in patients with acute lower limb deep vein thrombosis (DVT) increases the incidence of symptomatic pulmonary embolism (PE) and to evaluate the predisposing factors for PE such as location of the thrombus and duration of symptoms. METHODS: The current study was a prospective randomised clinical trial. Between January 2005 and December 2007, 219 patients with acute lower limb DVT were enrolled in the study (118 males and 101 females); the mean age was 64.2 years. INCLUSION CRITERIA: <15 days of initial symptoms, life expectancy >1 year, no life-threatening clinical conditions, and signed informed consent. The patients were randomised into two groups. Group A, 105 patients (47.9%) were hospitalized and received 5 days of bed rest; Group B, 114 patients (52.1%) received care at home with early walking and compression stockings. The primary end point was the presence of symptomatic PE during the first 10 days of treatment. The relationships between the duration of symptoms, location of the thrombus, and symptomatic PE were also analysed. RESULTS: Five cases of symptomatic PE were detected (2.3%), three in Group B and two in Group A. There was no significant difference in the occurrence of new PE between the two groups (P=0.54). Likewise, no difference was detected based on the duration of symptoms (P=0.62) and the location of the thrombus (P=0.43). CONCLUSIONS: In acute DVT , early walking, thrombus location, and duration of the symptoms did not influence the incidence of symptomatic PE.

Non-cardiac arterial disease in Catalonia: patient profiles and quality of clinical records by characteristics of the Vascular Surgery Unit.

AIM: Non-cardiac arterial disease (NCAD) is a frequent cause of hospital admission. The aim of this study was to investigate differences in patient profiles and clinical records as a function of the size of the Vascular Surgery Unit (VSU). METHODS: Retrospective observational study. Stratified cluster sampling and selection of patients hospitalized for NCAD. ANALYSIS: 1) description of patient profiles, quality of clinical records, and VSU [availability of diagnostic (DR) and therapeutic (TR) resources, and of written protocols (WP)]; 2) association between these variables and size of VSU. RESULTS: The sample consisted of 14 hospitals, 6 with a VSU of 15 or fewer beds (VSU < or = 15B) and 8 with >15 beds (VSU >15B). The mean number of DRs, TRs and WPs was 9, 2.8 and 2 in VSUs < or = 15B, and 11.5, 6.5 and 3.3 in VSUs >15B. The proportion of patients older than 70, female, with ischemic disease, or with coexisting diabetes was significantly higher in VSUs < or = 15B (67%, 31%, 95% and 57%, respectively) than in VSUs >15B (58%, 22%, 69% and 48%). Comorbid conditions and treatment during admission and at discharge were documented significantly less frequently in the clinical records in VSUs < or = 15B. Risk factors were under-reported in the clinical records of both types of VSU. CONCLUSION: Patient profiles and the quality of clinical records vary by size of VSU. Under-reporting of risk factors may hinder the implementation of prevention and treatment measures.