[Primary central nervous system lymphoma: clinical experience in a neurological center]. / Linfoma primario del sistema nervioso central: experiencia clinica en un centro neurologico.

INTRODUCTION: Primary lymphoma of the central nervous system is a variety of non-Hodgkin's lymphoma that accounts for 4-5% of intracranial tumours and 5% of all lymphomas. It has its origin in the brain, the eyes, the leptomeninges and the spinal cord with no systemic evidence of lymphomatoid activity; the subtype of lymphoma is predominantly of B-type cells. PATIENTS AND METHODS: We conducted a descriptive study of the patients diagnosed with primary brain lymphoma who were attended to at third-level centres in Mexico between the years 1980 and 2016. Patients who had been screened for systemic lymphoma were included. The results were analysed by means of simple frequencies, and disease-free and overall survival time was analysed by Kaplan-Meier curves; the differences among curves were analysed by means of log rank. RESULTS: Of a total of 215 patients, there were only 74 cases. By sex, 45% were females and 55% were males. Regarding age, 36.7% were over 60 years old. The most frequent clinical manifestations were motor loss (60%) and cognitive disorders (52%). Most patients received some form of chemotherapy (89%). The only significant factor for radiological response and clinical prognosis was the combined use of radiochemotherapy (p = 0.04493). CONCLUSION: Lymphoma is a tumorous condition with a high clinicoradiological response to treatment, although the response is not long-lasting. Its early identification and multidisciplinary management are essential for a more favourable prognosis in these patients.

TITLE: Linfoma primario del sistema nervioso central: experiencia clinica en un centro neurologico.Introduccion. El linfoma primario del sistema nervioso central es una variedad de linfoma no Hodgkin que representa el 4-5% de los tumores intracraneales y el 5% de todos los linfomas. Se origina en el encefalo, los ojos, la leptomeninge y la medula espinal sin evidencia sistemica de actividad linfomatoide; el subtipo de linfoma mayoritariamente es de celulas de tipo B. Pacientes y metodos. Estudio descriptivo de los pacientes diagnosticados con linfoma cerebral primario que fueron atendidos en centros de tercer nivel en Mexico entre los años 1980 y 2016. Se incluyo a los pacientes que contaran con cribado para busqueda de linfoma sistemico. Los resultados se analizaron mediante frecuencias simples; en el caso del tiempo libre de enfermedad y supervivencia global, mediante curvas de Kaplan-Meier, y las diferencias entre curvas, mediante log rank. Resultados. En un total de 215 pacientes solo hubo 74 casos. El 45% fueron mujeres y el 55%, hombres. El 36,7% eran mayores de 60 años. Las manifestaciones clinicas mas frecuentes fueron deficit motor (60%) y alteraciones cognitivas (52%). La mayoria recibio alguna forma de quimioterapia (89%). El unico factor significativo para respuesta radiologica y pronostico clinico era el uso combinado de radioquimioterapia (p = 0,04493). Conclusion. El linfoma representa una patologia tumoral con alta respuesta clinicorradiologica al tratamiento, aunque la respuesta no es duradera. Es fundamental su identificacion temprana y el tratamiento multidisciplinario para el mejor pronostico de estos pacientes.

Radiotherapy plus temozolomide or PCV in patients with anaplastic oligodendroglioma 1p19q codeleted. / Radioterapia mas temozolomida o PCV en pacientes con oligodendroglioma anaplasico con codelecion 1p19q.

INTRODUCTION: Radiotherapy with procarbazine, lomustine, and vincristine (PCV) improves overall survival in patients with anaplastic oligodendroglioma 1p19q codeleted. PATIENTS AND METHODS: This retrospective analysis investigated outcomes in patients with anaplastic oligodendroglioma 1p19q codeleted compared two different protocols (radiotherapy plus temozolomide or PCV). The primary end points were overall survival and progression-free survival. Secondary endpoint was the radiological response. RESULTS: A total of 48 patients were included. Mean age was 43 years (range: 19-66 years), 26 were male (54.1%). Twenty-one patients received PCV and 27 temozolomide. The baseline characteristics were not difference between the groups. The progression-free survival and overall survival in the PCV group were 7.2 and 10.6 years respectively and temozolomide were 6.1 and 9.2 years, both statistically significant. The radiological response was present in 80.9% in PCV arm and 70.2% in temozolomide arm there was not statistical differences. The multivariate Cox model showed only the significant parameters the use of PCV protocol. The toxicity grade 3 or 4 was present in 42.8% in PCV arm and 11.1% in temozolomide arm. CONCLUSIONS: The most common strategy in the Latin America community is the substitution of the PCV for temozolomide. This retrospective study showed superior efficacy of PCV than temozolomide. The Latin American community effort must be made to be able to have the drugs to available for using as a first line of treatment.

TITLE: Radioterapia mas temozolomida o PCV en pacientes con oligodendroglioma anaplasico con codelecion 1p19q.Introduccion. La radioterapia con procarbacina, lomustina y vincristina (PCV) mejora la supervivencia global en pacientes con oligodendroglioma anaplasico con codelecion 1p19q, pero no esta disponible en America Latina. Pacientes y metodos. Analisis retrospectivo comparando dos protocolos diferentes, radioterapia mas temozolomida o PCV, en pacientes con oligodendroglioma anaplasico con codelecion 1p19q. Los objetivos primarios fueron la supervivencia global y la supervivencia libre de progresion, y el objetivo secundario, la respuesta radiologica. Resultados. Se incluyo a 48 pacientes, 26 de ellos varones (54,1%), con una edad media de 43 años (rango: 19-66 años). Veintiun pacientes recibieron PCV, y 27, temozolomida. Las caracteristicas iniciales no tuvieron diferencias entre los grupos. La supervivencia libre de progresion y la supervivencia global en el grupo con PCV fueron de 7,2 y 10,6 años, y en el grupo de temozolomida, de 6,1 y 9,2 años, respectivamente, unos resultados estadisticamente significativos. Hubo respuesta radiologica en el 80,9% en el brazo de PCV y el 70,2% en el brazo de temozolomida. El analisis multivariado de Cox mostro como unico parametro significativo el uso del protocolo PCV. El grado de toxicidad 3-4 estuvo presente en el 42,8% en el brazo de PCV y en el 11,1% en el brazo de temozolomida. Conclusiones. La estrategia mas comun en America Latina es la sustitucion de PCV por temozolomida. Este estudio retrospectivo mostro una eficacia superior de PCV que de la temozolomida. La diferencia obliga a la comunidad latinoamericana a hacer un esfuerzo colectivo para poder tener acceso a los medicamentos para su uso como primera linea de tratamiento.

Automated speech analysis tools for children's speech production: A systematic literature review.

PURPOSE: A systematic search and review of published studies was conducted on the use of automated speech analysis (ASA) tools for analysing and modifying speech of typically-developing children learning a foreign language and children with speech sound disorders to determine (i) types, attributes, and purposes of ASA tools being used; (ii) accuracy against human judgment; and (iii) performance as therapeutic tools. METHOD: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied. Across nine databases, 32 articles published between January 2007 and December 2016 met inclusion criteria: (i) focussed on children's speech; (ii) tools used for speech analysis or modification; and (iii) reporting quantitative data on accuracy. RESULT: Eighteen ASA tools were identified. These met the clinical threshold of 80% agreement with human judgment when used as predictors of intelligibility, impairment severity, or error category. Tool accuracy was typically <80% accuracy for words containing mispronunciations. ASA tools have been used effectively to improve to children's foreign language pronunciation. CONCLUSION: ASA tools show promise for automated analysis and modification of children's speech production within assessment and therapeutic applications. Further work is needed to train automated systems with larger samples of speech to increase accuracy for assessment and therapeutic feedback.

Determinants of renal and patient outcomes in a Spanish cohort of patients with ANCA-associated vasculitis and renal involvement.

The classification of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) remains controversial. The main objective of this study was to define the respective values of ANCA serotype-based classification, clinicopathological classification, and histopathological classification in predicting patient and renal outcomes in a Spanish cohort of patients with ANCA with specificity for myeloperoxidase, MPO-ANCA, versus ANCA with specificity for proteinase 3, PR3-ANCA. Two hundred and forty-five patients with ANCA-AAV and biopsy-proven renal involvement diagnosed between 2000 and 2104 were recruited in 12 nephrology services. Clinical and histologic data, renal outcomes, and mortality were analyzed. We applied the Chapel Hill Consensus Conference definition with categories for granulomatosis with the polyangiitis (GPA) and microscopic polyangiitis (MPA), the classification based on ANCA specificity, and the histopathological classification proposed in 2010. Eighty-two percent were MPO-ANCA positive and 18.0% PR3-ANCA positive. Altogether, 82.9% had MPA and 17.1% GPA. The median follow-up was 43.2 months (0.1-169.3). Neither ANCA-based serological nor clinical classification was predictive of renal outcomes or patient survival on bivariate or multivariate Cox regression analysis. Histopathological classification was found to predict development of end-stage renal disease (p = 0.005) in Kaplan-Meier analysis. ANCA specificity was more predictive of relapse than clinicopathological classification in multivariate analysis (HR 2.086; 95% CI 1.046-4.158; p = 0.037). In our Spanish cohort, a majority of patients had an MPO-ANCA-AAV. A classification based on ANCA specificity has a higher predictive value for relapse occurrence and could be used for decision-making with respect to induction treatment and maintenance therapies.

Calpain-10 gene polymorphisms and risk of type 2 diabetes mellitus in Mexican mestizos.

The calpain-10 gene is expressed primarily in tissues important in glucose metabolism; thus, some of its polymorphisms have been associated with type 2 diabetes. In this study, we examined the association between the calpain-10 single-nucleotide polymorphism (SNP)-43, SNP-19, and SNP-63 and type 2 diabetes in Mexican mestizos. We included 211 patients and 152 non-diabetic subjects. Polymerase chain reaction was used to identify alleles. We compared allele, genotype, haplotype, and diplotype frequencies between both groups and used the chi-square test to calculate the risk. The allele frequency of SNP-43 allele 1 was 70% in controls and 72% in patients; the GG, GA, and AA genotype frequencies were 48.7, 42.8, and 8.5% in controls and 51.2, 41.7, and 7.1% in patients, respectively. For SNP- 19, the prevalence of allele 1 (2R) was 32% in controls and 39% in patients. In controls, homozygosity (2R/2R) was 10.5%, heterozygosity was 42.8%, and 3R/3R was 46.7%; in cases, these values were 13.3, 50.7, and 36.0%, respectively. For SNP-63, the frequency of allele 1 was 87% in controls and 83% in patients; genotype frequencies in controls were 75.7% (CC), 23% (CT), and 1.3% (TT), and were 69.7, 27.5, and 2.8%, respectively for the cases. Genotype distributions were consistent with Hardy-Weinberg equilibrium. No significant intergroup differences for allele, genotype, haplotype, or diplotype frequencies were observed. We found no association between these polymorphisms and diabetes. However, our sample size was small, so the role of calpain-10 risk alleles should be further examined.

Perfil metabólico y estado nutricional en adolescentes de una comunidad del norte de México / Metabolic profile and nutritional status in adolescents in a community in northern Mexico

Introducción: Desde la infancia y la adolescencia pueden aparecer alteraciones en el metabolismo de los lípidos e hidratos de carbono junto con alteraciones en la nutrición, y servir como marcadores cuya identificación en etapas tempranas de la vida puede menguar el desarrollo de episodios patológicos (diabetes mellitus tipo 2, cardiopatías, nefropatías). Sonora (México) es uno de los Estados con mayor prevalencia nacional de obesidad en edades tempranas y de enfermedades crónico-degenerativas y sus complicaciones. Por tal motivo nos propusimos determinar el perfil metabólico y el estado de nutrición en adolescentes de 15-18 años de una comunidad de Sonora. Pacientes y métodos: Estudio transversal analítico, de 56 adolescentes de 15-18 años de edad, en quienes se determinó el peso, la talla, el índice de masa corporal, la glucemia, el perfil lipídico, los valores de insulina y el índice de resistencia a la insulina (HOMA-IR), tomando como punto de corte 3,16 para considerar resistencia a la insulina (RI). Resultados: De los 56 adolescentes, 25 (44,6%) eran de sexo masculino y 31 (55,4%) de sexo femenino. La prevalencia de sobrepeso-obesidad era del 32,1%. Un 17,9% presentaba RI, un 33,3% un índice cintura de cadera elevado, un 8,9% colesterol elevado, un 16,1% triglicéridos elevados, un 25% una disminución de HDL, un 12,3% insulina elevada y solamente el 1,6% glucosa elevada. El 44,4% de los pacientes con sobrepeso-obesidad presentó RI. Conclusión: Uno de cada 4 adolescentes presenta, por lo menos, alguna alteración en el perfil metabólico, y 1 de cada 3 en el estado de nutrición (AU)

Introduction: Alterations in lipid and carbohydrate metabolism coupled with changes in nutrition, may appear in childhood and adolescence and which serve as markers to identify early in life may reduce the development of pathological events (type 2 diabetes, heart disease, nephropathy). Sonora, Mexico, is one of the states with the highest national prevalence of obesity at an early age, and chronic degenerative diseases and their complications. Therefore we decided to determine the metabolic profile and nutritional status in adolescents 15 to 18 years in a community of Sonora, Mexico. Patients and methods: A cross-sectional survey of 56 adolescents aged 15 to 18 years who were weight, height, body mass index, glycemia, lipid profile, insulin, HOMA-IR (resistance index insulin) taking as cutoff consider 3.16 for IR (insulin resistance). Results: Of the 56 teenagers got 25 (44.6%) males and 31 (55.4%) female; prevalence of overweight-obesity 32.1%, 17.9% had IR; 33.3% waist hip ratio high, 8.9% high cholesterol, 16.1% triglycerides, 25% decrease in HDL, high insulin 12.3% and only 1.6% high glucose. The 44.4% of patients with overweight-obesity presents IR. Conclusion: 1 in 4 teens has at least some alteration in the metabolic profile and 1 in 3 in the state of nutrition (AU)

Perfil metabólico y estado nutricional en adolescentes de una comunidad del norte de México / Metabolic profile and nutritional status in adolescents in a community in northern Mexico

Introducción: Las alteraciones en el metabolismo de lípidos e hidratos de carbono asociados a alteraciones en la nutrición pueden aparecer desde la infancia y la adolescencia, y servir como marcadores cuya identificación en etapas tempranas de la vida puede reducir el desarrollo de patologías (diabetes mellitus tipo 2, cardiopatías, nefropatías). Sonora (México) es uno de los estados con mayor prevalencia nacional de obesidad en edades tempranas, así como de enfermedades crónico-degenerativas y sus complicaciones. Por tal motivo, nos propusimos determinar el perfil metabólico y el estado nutricional en adolescentes de 15-18 años de edad de una comunidad de Sonora. Pacientes y métodos: Estudio transversal analítico de 56 adolescentes de 15-18 años de edad, a quienes se les determinó el peso, la talla, el índice de masa corporal, la glucemia, el perfil lipídico, la insulina y el índice de resistencia a la insulina, tomando como punto de corte un valor de 3,16 para considerar la presencia de insulinorresistencia (IR). Resultados: De los 56 adolescentes, 25 (44,6%) eran de sexo masculino y 31 (55,4%) femenino; la prevalencia de sobrepeso-obesidad fue del 32,1%, un 17,9% tenía IR, un 33,3% un índice cintura-cadera elevado, un 8,9% el colesterol elevado, un 16,1% triglicéridos, un 25% disminución de HDL, un 12,3% insulina elevada y solamente el 1,6% una glucosa elevada. El 44,4% de los pacientes con sobrepeso-obesidad presentó IR. Conclusión: Uno de cada 4 adolescentes presenta, por lo menos, alguna alteración en el perfil metabólico, y 1 de cada 3 en el estado de nutrición(AU)

Introduction: Alterations in lipid and carbohydrate metabolism coupled with changes in nutrition, may appear in childhood and adolescence and which serve as markers to identify early in life may reduce the development of pathological events (type 2 diabetes, heart disease, nephropathy). Sonora, Mexico, is one of the states with the highest national prevalence of obesity at an early age, and chronic degenerative diseases and their complications. Therefore we decided to determine the metabolic profile and nutritional status in adolescents 15 to 18 years in a community of Sonora. Patients and methods: A cross-sectional survey of 56 adolescents aged 15 to 18 years who were weight, height, body mass index, glycemia, lipid profile, insulin, resistance index insulin, taking as cutoff consider 3.16 for IR (insulin resistance). Results: Of the 56 teenagers got 25 (44.6%) males and 31 (55.4%) female; prevalence of overweight-obesity 32.1%, 17.9% had IR; 33.3% waist hip ratio high, 8.9% high cholesterol, 16.1% triglycerides, 25% decrease in HDL, high insulin 12.3% and only 1.6% high glucose. The 44.4% of patients with overweight-obesity presents IR. Conclusion: 1 in 4 teens has at least some alteration in the metabolic profile, and 1 in 3 in the state of nutrition(AU)

[Midfemoral nerve block for foot surgery: is there an anatomical-clinical correlation between motor response and latency?]. / Bloqueo mediofemoral para cirugía de pie: existe relación entre la respuesta motora y la latencia? Correlación anatomoclínica.

BACKGROUND AND OBJECTIVE: The latency times of midfemoral sciatic nerve blocks vary greatly. This study investigated the correlation between the type of motor response to nerve stimulation on the one hand and latency and block efficacy on the other. PATIENTS AND METHODS: We enrolled 215 consecutive patients (184 women) undergoing orthopedic foot surgery. A tourniquet was applied above the malleolus. The puncture location was found by palpating to locate the groove between the vastus lateralis and biceps femoris muscles, at the mid-point of the line between the posterior edge of the greater trochanter muscle and the insertion of the biceps femoris muscle in the popliteal fossa. A solution of equal proportions (1:1) of 1.5% mepivacaine (with bicarbonate 1:10) and 0.75% levobupivacaine was injected at a dose of 0.45 mL x kg(-1) (maximum 40 mL) using a 10-cm needle. Nerve stimulation was applied at 100-300 ms, 02-0.4 mA, and 2 Hz. Latency was classified as response in less than 15 minutes, in 15 to 30 minutes, or later than 30 minutes. RESULTS: The evoked motor response was inversion in 30 patients, flexion or extension in 38, plantar flexion in 101, dorsiflexion in 37, and eversion in 9. Shorter latencies (15 minutes) were observed in all patients with inversion or flexion/extension and in 84 (83%) of the 101 patients with plantar flexion. Mid-range latencies were observed in 13% of those with a plantar flexion response and in 29.7% of those with dorsiflexion. All 9 patients with eversion and 17 (45.9%) of the 37 patients with dorsiflexion had the longest latencies. The surgical block was complete for all patients. CONCLUSIONS: This approach provides an effective block with minimum latency in patients who have a flexion or extension motor response in the foot and/or fingers, inversion, or plantar flexion, which assumes that the injection has reached the common trunk of the sciatic or tibial nerve. However, a longer latency is associated with a peroneal motor response, particularly eversion.

Bloqueo mediofemoral para cirugía de pie: ¿existe relación entre la respuesta motora y la latencia? Correlación anatomoclínica / Midfemoral nerve block for foot surgery: is there an anatomical-clinical correlation between motor response and latency?

OBJETIVO: En el bloqueo anestésico mediofemoral delnervio ciático existe gran variabilidad en el tiempo delatencia. El objetivo de este trabajo fue relacionar el tipode respuesta motora a la neuroestimulación con el tiempode latencia y eficacia del bloqueo.PACIENTES Y MÉTODOS: Se incluyeron 215 pacientesconsecutivos (184 mujeres) para cirugía ortopédica delpie. Se empleó torniquete de isquemia supramaleolar. Ellugar de punción fue la depresión palpable entre músculosvasto lateral y bíceps femoral, en el punto medio dela línea que une el borde posterior del trocánter mayory la inserción del bíceps femoral en el pliegue poplíteo.Se inyectaron 0,45 mL.Kg-1 (máximo 40 mL), de unaproporción 1:1 de mepivacaína 1,5% (bicarbonatada1:10) y levobupivacaína 0,75%. Se empleó una aguja de10 cm de longitud. Los parámetros de neuroestimulaciónfueron 100-300 ms, 0,2-0,4 mA, 2 Hz. Según el tiempo delatencia se clasificó la respuesta como de menos de 15min, de 15-30 min ó más de 30 minutos.RESULTADOS: Las respuestas motoras encontradas fueroninversión (30 pacientes), flexo-extensión (38), flexiónplantar (101), flexión dorsal (37) y eversión (9). El tiempode latencia fue el menor (15 min) en todos los pacientescon inversión o flexo-extensión, y en 84/101 (83%) con flexiónplantar. Tuvieron latencia media (15-30 min) en 13%con flexión plantar y 29,7% con flexión dorsal. Tuvieronlatencia prolongada todos los pacientes con eversión (9 de9) y en 17/37 (45,9%) con flexión dorsal. El bloqueo quirúrgicofue completo en todos los pacientes.CONCLUSIONES: Con esta vía de abordaje se consigue unbloqueo eficaz y mínima latencia cuando la respuesta esflexo-extensión de pie y/o dedos, inversión o flexión plantar,que supone inyectar en el tronco común del ciático onervio tibial. Por contra la latencia prolongada se asocia auna respuesta motora peronea, especialmente la eversión(AU)

BACKGROUND AND OBJECTIVE: The latency times ofmidfemoral sciatic nerve blocks vary greatly. This studyinvestigated the correlation between the type of motorresponse to nerve stimulation on the one hand andlatency and block efficacy on the other.PATIENTS AND METHODS: We enrolled 215 consecutivepatients (184 women) undergoing orthopedic foot surgery.Atourniquet was applied above the malleolus. The puncturelocation was found by palpating to locate the groovebetween the vastus lateralis and biceps femoris muscles, atthe mid-point of the line between the posterior edge of thegreater trochanter muscle and the insertion of the bicepsfemoris muscle in the popliteal fossa. A solution of equalproportions (1:1) of 1.5% mepivacaine (with bicarbonate1:10) and 0.75% levobupivacaine was injected at a dose of0.45 mL·kg–1 (maximum 40 mL) using a 10-cm needle.Nerve stimulation was applied at 100-300 ms, 0.2-0.4 mA,and 2 Hz. Latency was classified as response in less than 15minutes, in 15 to 30 minutes, or later than 30 minutes.RESULTS: The evoked motor response was inversion in30 patients, flexion or extension in 38, plantar flexion in101, dorsiflexion in 37, and eversion in 9. Shorter latencies(15 minutes) were observed in all patients with inversion orflexion/extension and in 84 (83%) of the 101 patients withplantar flexion. Mid-range latencies were observed in 13%of those with a plantar flexion response and in 29.7% ofthose with dorsiflexion. All 9 patients with eversion and 17(45.9%) of the 37 patients with dorsiflexion had the longestlatencies. The surgical block was complete for all patients...(AU)

[Acetate-free on-line PHF: how to improve hyperacetatemia and haemodynamic tolerance]. / PHF on-line sin acetato: cómo mejorar la hiperacetatemia y la tolerancia hemodinámica.

SUMMARY BACKGROUND: The small quantity of acetate present in the dialysis fluid exposes patient's blood to an acetate concentration 30-40 times the physiological levels. This amount is even greater in hemodiafiltration on-line. Our purpose was to evaluate the clinical-analytical effects using three different dialysis techniques in the same patient. METHODS: 35 patients on hemodialysis were included. All patients were treated with conventional bicarbonate dialysate for 3 months, after randomization were switched to first be treated with PHF online with standard bicarbonate dialysate for 6 months and then switched to PHF on-line acetate-free dialysate for the other 6 months or to invert the two last periods. Blood samples were drawn monthly throughout the study and clinical data were obtained. RESULTS: Postdialysis blood acetate levels were higher in patients treated with conventional bicarbonate dialysate with respect to the period of PHF with free-acetate dialysate. Moreover, the percentage of patients with postdialysis blood acetate levels in the pathologic range was higher in patients treated with conventional bicarbonate dialysate respect to PHF on-line acetate-free dialysate period (61% vs. 30%). Serum concentrations of chloride postdialysis were higher and serum concentrations of bicarbonate pre and posthemodialysis were lower in the PHF free-acetate period. The incidence of hypotensive episodes was significantly lower in the PHF on-line with conventional dialysate. CONCLUSIONS: PHF on-line with free-acetate dialysate allows that most of patients finished hemodialysis with blood acetate levels in the physiologic ranges. PHF on-line is a predilutional hemodiafiltration treatment with better tolerance than hemodialysis with standard bicarbonate dialysate.

PHF on-line sin acetato: cómo mejorar la hiperacetatemia y la tolerancia hemodinámica / No disponible

Antecedentes: la presencia de acético en el Líquido de Diálisis (LD) expone al paciente a una concentración de acetato 30-40 veces superior a la normal. Dicha exposición aumenta en técnicas de Hemodiafiltración (HDF) online. El objetivo de dicho estudio fue evaluar los cambios clínico-analíticos al usar tres técnicas de Hemodiálisis(HD) diferentes. Métodos: se reclutaron 35 pacientes en HD estable. Se dializaron tres meses con HD convencional y luego fueron aleatorizados para pasar a una técnica de PHF on-line con concentrado convencional seis meses, y después pasaron a PHF on-line sin acetato otros seis meses. El otro grupo invertía estos dos períodos. Se obtuvieron análisis de sangre y datos clínicos de HD. Resultados: las medias de los acetatos posdiálisis fueron significativamente superiores durante los períodos de tratamiento con acético respecto al período sin acetato. El porcentaje de valores patológicos de acetato posdiálisis fue significativamente superior durante los períodos de tratamiento con acético (61 respecto al 30%). Las concentraciones de cloro pos-HD fueron superiores y las de bicarbonato pre y pos-HD fueron menores durante el período sin acético. El número de hipotensiones fue significativamente inferior en el período de PHF on-line con LD estándar respecto a los otros períodos. Conclusiones: la técnica de PHF on-line sin acetato disminuye la exposición a concentraciones elevadas de acetato y consigue que la mayoría de pacientes termine la HD con una acetatemia en el rango fisiológico. La PHF on-line es un tratamiento de HDF predilucional con mejor tolerancia que la HD estándar con bicarbonato (AU)

Summary Background: the small quantity of acetate present in the dialysis fluid exposes patient’s blood to an acetate concentration 30-40 times the physiological levels. This amountis even greater in hemodiafiltration on-line. Our purpose was to evaluate the clinical-analytical effects using three different dialysis techniques in the same patient. Methods: 35 patients on hemodialysis were included. All patients were treated with conventional bicarbonate dialysate for 3 months, after randomization were switched to first be treated with PHF online with standard bicarbonate dialysate for 6 months and then switched to PHF on-line acetate-free dialysate for the other 6months or to invert the two last periods. Blood samples were drawn monthly throughout the study and clinical data were obtained. Results: Posdialysis blood acetate levels were higher in patients treated with conventional bicarbonate dialysate with respect to the period of PHF with free-acetate dialysate. Moreover, the percentage of patients with posdialysis blood acetate levels in the pathologic range was higher in patients treated with conventional bicarbonate dialysate respect to PHF on-line acetate-free dialysate period (61% vs. 30%). Serum concentrations of chloride posdialysis were higher and serum concentrations of bicarbonate pre and poshemodialysis were lower in the PHF free-acetate period. The incidence of hypotensive episodes was significantly lower in the PHF on-line with conventional dialysate. Conclusions: PHF on-line with free-acetate dialysate allows that most of patients finished hemodialysis with blood acetate levels in the physiologic ranges. PHF on-line is a predilutional hemodiafiltration treatment with better tolerance than hemodialysis with standard bicarbonate dialysate (AU)

Radiation doses in the surroundings of patients undergoing nuclear medicine diagnostic studies.

Dose rate measurements were performed at 0, 0.5, and 1 m from the external surface of 79 patients corresponding to the most frequent studies: 99mTc-cardiac with reinjection, 99mTc-cardiac single injection, 99mTc-bone scan, 99mTc-lung studies, and cardiac studies using 201Tl. Doses to staff, nearby patients, and the collective effective doses were estimated for the different working shifts and hospital areas. The estimated dose for nurses for 1 y was 518 microSv in the cardiology section and 338 microSv in the short stay section. For patients, the mean dose per stay was calculated to be 8.5 microSv in the cardiology section. The maximum dose that a patient could receive from a radioactive patient is 499 microSv for a double injection cardiac patient study. The maximum collective effective dose for the whole hospital was calculated to be 0.063 person-Sv. The probability of staff receiving doses higher than the limits for a working day is negligible. Maximum doses for staff and patients are far below dose limits for the public and therefore no additional radiological protection is needed.

Pattern completion through phase coding in population neurodynamics.

This article presents an alternative phase coding mechanism for Freeman's KIII model of population neurodynamics. Motivated by experimental evidence that supports the existence of a neural code based on synchronous oscillations, we propose an analogy between synchronization in neural populations and phase locking in KIII channels. An efficient method is proposed to extract phase differences across granule channels from their state-space trajectories. First, the scale invariance of the KIII model with respect to phase information is established. The phase code is then compared against the conventional amplitude code in terms of their bit-wise and across-fiber pattern recovery capabilities using decision-theoretic principles and a Hamming-distance classifier. Graph isomorphism in the Hebbian connections is exploited to perform an exhaustive evaluation of patterns on an 8-channel KIII model. Simulation results show that phase information outperforms amplitude information in the recovery of incomplete or corrupted stimuli.

Habituation in the KIII olfactory model with chemical sensor arrays.

This paper presents a novel combination of chemical sensors and the KIII model for simulating mixture perception with a habituation process triggered by local activity. Stimuli are generated by partitioning feature space with labeled lines. Pattern completion is demonstrated through coherent oscillations across granule populations using experimental odor mixtures.

Clavo femoral proximal de AO/ASIF(PFN)) en el tratamiento de las fracturas de la región trocantérea y subtrocantérea del fémur / AO/ASIF proximal femoral nail (PFN) in the treatment of the trochanteric and subtrochanteric fractures of the femur

Objetivo: Descripción de los resultados obtenidos con el clavo femoral proximal (PFN, AO) para el tratamiento de las fracturas de la región trocantérea y subtrocatéreadel fémur.Material y Método: Se realizó un estudio observacional descriptivo prospectivo de los pacientes intervenidos en el servicio de Traumatología y Cirugía Ortopédica del Hospital Universitario Virgen de las Nieves de Granada por fractura extracapsular con el implante PFN (AO) durante el primer año de su utilización en nuestro centro (1998).Durante dicho periodo se intervinieron un total de 505 fracturas de cadera colocándose 120 clavos femorales proximales.Resultados: La media de edad de los pacientes intervenidos fue de 73 años, con un 62 por ciento de mujeres. El 54 por ciento de los pacientes tenía más de un antecedente patológico previo aunque el 69 por ciento llevaba una vida social independiente, sin precisar apoyo para la marcha en el 76 por ciento de los casos. El tiempo hasta la intervención fue de 1,99 días tras el ingreso, con un tiempo quirúrgico medio de 50 minutos de incisión a cierre y una anestesia general en el 75 por ciento de los casos; el tiempo de ingreso fue de 8,55 días y la mortalidad durante el primer año del 15 por ciento. En el seguimiento, un 19 por ciento presentó dolor residual, un 11,5 por ciento presentó algún grado de acortamiento y un 1,6 por ciento de rotación externa. La tasa de reintervención fue del 5 por ciento.Conclusiones: El clavo femoral proximal de AO/ASIF aporta una gran estabilidad en las fracturas del tercio proximal femoral, incluso en aquellas muy inestables; permitiendo movilidad y carga precoz, factor pronóstico decisivo en los pacientes con este tipo de fractura (AU)

Pielonefritis aguda. Estudio de 153 casos / Acute puelonephritis. A 153 cases study

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Functional determinants of the Escherichia coli fis promoter: roles of -35, -10, and transcription initiation regions in the response to stringent control and growth phase-dependent regulation.

Escherichia coli Fis is a small DNA binding and bending protein that has been implicated in a variety of biological processes. A minimal promoter sequence consisting of 43 bp is sufficient to generate its characteristic growth phase-dependent expression pattern and is also subject to negative regulation by stringent control. However, information about the precise identification of nucleotides contributing to basal promoter activity and its regulation has been scant. In this work, 72 independent mutations were generated in the fis promoter (fis P) region from -108 to +78 using both random and site-directed PCR mutagenesis. beta-Galactosidase activities from mutant promoters fused to the (trp-lac)W200 fusion on a plasmid were used to conclusively identify the sequences TTTCAT and TAATAT as the -35 and -10 regions, respectively, which are optimally separated by 17 bp. We found that four consecutive substitutions within the GC-rich sequence just upstream of +1 and mutations in the -35 region, but not in the -10 region, significantly reduced the response to stringent control. Analysis of the effects of mutations on growth phase-dependent regulation showed that replacing the predominant transcription initiation nucleotide +1C with a preferred nucleotide (A or G) profoundly altered expression such that high levels of fis P mRNA were detected during late logarithmic and early stationary phases. A less dramatic effect was seen with improvements in the -10 and -35 consensus sequences. These results suggest that the acute growth phase-dependent regulation pattern observed with this promoter requires an inefficient transcription initiation process that is achieved with promoter sequences deviating from the -10 and -35 consensus sequences and, more importantly, a dependence upon the availability of the least favored transcription initiation nucleotide, CTP.

A method for evaluating data-preprocessing techniques for odour classification with an array of gas sensors.

The performance of a pattern recognition system is dependent on, among other things, an appropriate data-preprocessing technique, In this paper, we describe a method to evaluate the performance of a variety of these techniques for the problem of odour classification using an array of gas sensors, also referred to as an electronic nose. Four experimental odour databases with different complexities are used to score the data-preprocessing techniques. The performance measure used is the cross-validation estimate of the classification rate of a K nearest neighbor voting rule operating on Fisher's linear discriminant projection subspace.

Identification and characterization of the fis operon in enteric bacteria.

The small DNA binding protein Fis is involved in several different biological processes in Escherichia coli. It has been shown to stimulate DNA inversion reactions mediated by the Hin family of recombinases, stimulate integration and excision of phage lambda genome, regulate the transcription of several different genes including those of stable RNA operons, and regulate the initiation of DNA replication at oriC. fis has also been isolated from Salmonella typhimurium, and the genomic sequence of Haemophilus influenzae reveals its presence in this bacteria. This work extends the characterization of fis to other organisms. Very similar fis operon structures were identified in the enteric bacteria Klebsiella pneumoniae, Serratia marcescens, Erwinia carotovora, and Proteus vulgaris but not in several nonenteric bacteria. We found that the deduced amino acid sequences for Fis are 100% identical in K. pneumoniae, S. marcescens, E. coli, and S. typhimurium and 96 to 98% identical when E. carotovora and P. vulgaris Fis are considered. The deduced amino acid sequence for H. influenzae Fis is about 80% identical and 90% similar to Fis in enteric bacteria. However, in spite of these similarities, the E. carotovora, P. vulgaris, and H. influenzae Fis proteins are not functionally identical. An open reading frame (ORF1) preceding fis in E. coli is also found in all these bacteria, and their deduced amino acid sequences are also very similar. The sequence preceding ORF1 in the enteric bacteria showed a very strong similarity to the E. coli fis P region from -53 to +27 and the region around -116 containing an ihf binding site. Both beta-galactosidase assays and primer extension assays showed that these regions function as promoters in vivo and are subject to growth phase-dependent regulation. However, their promoter strengths vary, as do their responses to Fis autoregulation and integration host factor stimulation.