The space paradox in graphic representation.

The negative space drawing technique refers to drawing the transparent space around and between objects, rather than drawing the objects themselves. This space-based instruction is thought to attenuate object-specific visual attention and to enhance perception of a spatial expanse. Developmentally, it is equivalent to the Piagetian dichotomic space concept of filled and empty space. A sample of 96 children from 5 to 12 years of age and 24 adults (N = 120) drew on a computer tablet a real-life model spacebox placed in front of the participant, with three cubes placed inside the model. Children followed two instructions, a Visual Realism (VR) Instruction "Please draw the three cubes and the box as you can see them" and a Negative Space (NSp) Instruction "Please draw the space around the objects," with the sequence counterbalanced. NSp outline drawings began to show from 9 years onwards. A positive effect of the NSp technique showed for occlusion drawing because of the depiction of common contour of objects which could create a cohesive scene feature such as a horizon. The VR instruction focused attention toward the space box and enhanced 3D drawing of both the spacebox and the cubes. Thus, it could be concluded-rather paradoxically-that drawing in 3D is better based on object- than on space-based attention, while drawing occlusion is better based on space-based than object-based attention. We suggest, however, that a better definition of VR as attention to object appearances is that VR unifies objects and spatial context into one global plane.

Familial hypertriglyceridemia: an entity with distinguishable features from other causes of hypertriglyceridemia.

BACKGROUND: Familial hypertriglyceridemia (FHTG) is a partially characterized primary dyslipidemia which is frequently confused with other forms hypertriglyceridemia. The aim of this work is to search for specific features that can help physicians recognize this disease. METHODS: This study included 84 FHTG cases, 728 subjects with common mild-to-moderate hypertriglyceridemia (CHTG) and 609 normotriglyceridemic controls. All subjects underwent genetic, clinical and biochemical assessments. A set of 53 single nucleotide polymorphisms (SNPs) previously associated with triglycerides levels, as well as 37 rare variants within the five main genes associated with hypertriglyceridemia (i.e. LPL, APOC2, APOA5, LMF1 and GPIHBP1) were analyzed. A panel of endocrine regulatory proteins associated with triglycerides homeostasis were compared between the FHTG and CHTG groups. RESULTS: Apolipoprotein B, fibroblast growth factor 21(FGF-21), angiopoietin-like proteins 3 (ANGPTL3) and apolipoprotein A-II concentrations, were independent components of a model to detect FHTG compared with CHTG (AUC 0.948, 95%CI 0.901-0.970, 98.5% sensitivity, 92.2% specificity, P < 0.001). The polygenic set of SNPs, accounted for 1.78% of the variance in triglyceride levels in FHTG and 6.73% in CHTG. CONCLUSIONS: The clinical and genetic differences observed between FHTG and CHTG supports the notion that FHTG is a unique entity, distinguishable from other causes of hypertriglyceridemia by the higher concentrations of insulin, FGF-21, ANGPTL3, apo A-II and lower levels of apo B. We propose the inclusion of these parameters as useful markers for differentiating FHTG from other causes of hypertriglyceridemia.

Longitud cervical en la predicción de parto prematuro espontáneo y resultados perinatales en población de gemelos (dobles) en Hospital Provincial, Chile / Cervix measurement in spontaneous labor prediction and perinatal results in twins from a provincial hospital, Chile

RESUMEN Diversas publicaciones han demostrado que el acortamiento cervical es un elemento predictor de parto prematuro en embarazo gemelar. Los objetivos del presente trabajo fueron comparar los resultados perinatales de gestantes con longitud cervical (LC), entre las 20-24 semanas, ≤ 25mm y aquellas con LC > 25mm; y evaluar la capacidad predictiva para parto prematuro ≤ 32 semanas. Estudio analítico observacional, retrospectivo de cohorte, se recogieron los datos de las gestantes con embarazo gemelar doble, atendidas en el servicio de Obstetricia y Ginecología Hospital Las Higueras Talcahuano, durante los años 2010 al 2018; quienes se les había realizado al menos una evaluación cervical entre las 20 y 24 semanas; recolectando desde base de datos y ficha clínica sus datos perinatales. Se obtuvo los datos de 186 pacientes, la edad promedio de las pacientes fue 29 años, longitud cervical promedio fue 40,8 mm, parto promedio fue a las 35,6 semanas. El 71% de las gestantes fue gemelar Bicorial-Biamniótico y 29% Monocorial-Biamniótico. El 3,2% de los casos (n=6) tuvo longitud cervical ≤ 25mm en el segundo trimestre. En el grupo con longitud cervical ≤ 25 mm la EG al parto fue 30,7 semanas, con peso promedio de 1.555 gramos y una talla de 41,1 cm; mientras que estos mismos valores en el grupo con cérvix > 25 mm fueron 35,8 semanas, 2,527 gramos y 45,8 cm. La longitud cervical en relación a parto ≤ 32 semanas tuvo una sensibilidad de un 27,8%; especificidad de un 99,4%; VPP de 83,3% y un VPN de 92,8%. CONCLUSIÓN: Nuestros resultados muestran que la longitud cervical logra tener una gran especificidad, VPP y VPN en relación del parto prematuro ≤ 32 semanas, pero con una sensibilidad limitada. Pudiendo ser un buen método para identificar al embarazo gemelar en riesgo de parto prematuro ≤ 32 semanas.

ABSTRACT Several publications have shown that cervical shortening is a predictive element of premature delivery in twin pregnancy. The objectives of the present study were to compare the perinatal results of pregnant women with cervical length, between 20-24 weeks, ≤ 25mm and those with> 25mm; and evaluate the predictive capacity for premature delivery ≤ 32 weeks. An observational, cohort, retrospective, analytical study collected the data of pregnant women with double twin pregnancy treated at the Obstetrics and Gynecology Service Hospital Las Higueras Talcahuano during the years 2010 to 2018; who had at least one cervical measurement between 20 and 24 weeks of pregnancy; collecting perinatal data from database and clinical record. Data were obtained from 186 patients, the average age of the patients was 29 years, average cervical measurement was 40.8 mm, average delivery was 35.6 weeks. The 71% of pregnant women were twin BcBa and 29% McBa. The 3.2% (n = 6) had cervical measurement ≤ 25mm in the second trimester. In the group with cervical length ≤ 25 mm, the GA at delivery was 30.7 weeks, with an average weight of 1555 grams and a height of 41.1 cm; while these same values in the group with cervix > 25 mm were 35.8 weeks, 2527 grams and 45.8 cm. Cervical measurement in relation to childbirth ≤ 32 weeks had a sensitivity of 27.8%; specificity of 99.4%; PPV of 83.3% and a NPV of 92.8%. CONCLUSION: Our results show that cervical length has great specificity, PPV and NPV in relation to premature labor ≤ 32 weeks, but with limited sensitivity. It can be a good method to identify the twin pregnancy at risk of preterm birth ≤ 32 weeks.

Tracheostomy in pediatric critically ill patients.

The indications for and timing of tracheostomy in children have changed significantly over recent years, and no consensus has been gathered in that regard. The purpose of this study is to present a series of critically ill patients who required a tracheostomy. All critically ill patients required a tracheostomy between 1 June 2009 and 31 March 2012. It is a retrospective, observational, descriptive study. A total of 18 patients underwent tracheostomy during the period under study. The most common indication was neuromuscular compromise. The average duration of mechanical ventilation before placement of a tracheostomy was 23.8 days (0-58 days). The complications observed were minor, and no patients died from tracheostomy-related causes. All parents were trained in airway management and cardiopulmonary resuscitation. There were no serious tracheostomy-related complications in critically ill pediatric patients. The procedure was effective in the management of patients with respiratory failure, patients with neuromuscular compromise and children with upper airway obstruction.

Relación entre la intervención de enfermería y la prevención de complicaciones en pacientes con nutrición parenteral total / Relation between the intervention of nursing and the prevention of complications in patients with total parenteral nutrition

En el presente trabajo se estudiaron las intervenciones de 20 enfermeras del servicio de Cirugía General del Hospital Nacional Edgardo Rebagliati Martins-IPSS durante el mes de octubre de 1996 que brindaron atención a pacientes diagnosticados de fístula intestinal que recibían Nutrición Parenteral Total (N.P.T.), a fín de reconocer los problemas existentes y establecer estrategias que mejoren la atención de Enfermería. El método que se utilizó fue analítico de corte transversal, extrayendo los datos através de una Guía de Observación. El análisis estadístico se realizó empleando la prueba de Chi-Cuadrado con la significancia de p < 0.05. Se concluyó que el 59 por ciento siempre realizan intervenciones para valorar el estado de salud para lo cual utilizaron la información obtenida durante la visita diaria a los pacientes y reporte de enfermería. Las enfermeras en un 56 por ciento no realizaron el control de la administración de N.P.T., pero se destaca que un 50 por ciento verifica el contenido de las bolsas antes de su administración; y un 50 por ciento verifica el buen funcionamiento de la bomba de infusión. Un 47 por ciento de enfermeras realizaron la valoración física, pero descuidaron el aspecto psicoemocional. Un 46 por ciento de enfermeras realizaron intervenciones para identificar signos y síntomas de complicaciones durante la N.P.T.; entre éstas intervenciones tenemos: control de funciones vitales, valoración física, control de glucosa en sangre por Haemoglucotest y orina en 24 horas, así como la observación de características de piel y estomas, el 36 por ciento aplican medidas de asepsia para el manejo de la Bomba de Infusión. Solamente una de ellas a veces controla peso y talla diariamente de los pacientes sometidos a N.P.T.