Validating and optimizing mismatch tolerance of Doppler backscattering measurements with the beam model (invited).

We use the beam model of Doppler backscattering (DBS), which was previously derived from beam tracing and the reciprocity theorem, to shed light on mismatch attenuation. This attenuation of the backscattered signal occurs when the wavevector of the probe beam's electric field is not in the plane perpendicular to the magnetic field. Correcting for this effect is important for determining the amplitude of the actual density fluctuations. Previous preliminary comparisons between the model and Mega-Ampere Spherical Tokamak (MAST) plasmas were promising. In this work, we quantitatively account for this effect on DIII-D, a conventional tokamak. We compare the predicted and measured mismatch attenuation in various DIII-D, MAST, and MAST-U plasmas, showing that the beam model is applicable in a wide variety of situations. Finally, we performed a preliminary parameter sweep and found that the mismatch tolerance can be improved by optimizing the probe beam's width and curvature at launch. This is potentially a design consideration for new DBS systems.

Efectos sobre el codo de la resección de la cabeza radial por fractura aislada de la cabeza del radio en pacientes jóvenes / Effects on the elbow of radial head resection following isolated radial head fracture in young patients

Fundamento: La resección de la cabeza radial ha sido un tratamiento muy utilizado en casos de fractura no reconstruible de la cabeza del radio; algunos autores impulsan el uso de prótesis de cabeza radial. El propósito de este trabajo fue evaluar el resultado a largo plazo de la exéresis de la cabeza del radio por fractura aislada y su repercusión radiológica y funcional a nivel del codo. Pacientes y método. Se han revisado de forma retrospectiva cuarenta y cuatro historias clínicas de pacientes con resección de la cabeza del radio por fractura aislada, sin lesiones asociadas, en pacientes menores de cuarenta años y con un seguimiento mínimo de quince años. Se ha valorado la presencia de dolor, movilidad, fuerza y estabilidad del codo y se ha comparado con el lado contralateral sano. El estudio radiológico recoge la presencia de artrosis, calcificaciones, acortamiento del muñón proximal y medición del ángulo de carga. Se ha utilizado el cuestionario Dishabilities of the Arm, Shoulder and Hand (DASH) para valorar el grado de discapacidad percibido por el paciente. Resultados: El grupo de estudio se compone de diez mujeres y treinta y cuatro varones, con una edad media en el momento de la fractura de 28,6 años (rango 15-40) y un tiempo de evolución o seguimiento medio de 28,5 años (rango 16-38). La afectación en el lado dominante fue en treinta casos (23 diestros y 7 zurdos). Treinta y nueve pacientes (88,6%) no tenían dolor a nivel del codo y en el resto era leve o moderado. La pérdida de movilidad y fuerza respecto al lado contralateral fue de 1,5% para flexo-extensión, 3,5% para prono-supinación, 7,9% de fuerza de flexión y 3,5% de fuerza de extensión del codo. Se encontraron cuatro casos de inestabilidad en valgo y dos posterolateral rotatoria. La mediana del cuestionario DASH fue de 2,5 puntos (rango 0-30,8). Grados variables de artrosis están presentes en 93,3% de los codos y 54,4% de calcificaciones. El aumento medio del ángulo de carga fue de 7,7º respecto al lado sano (rango de 0,9 a 15,8º). Conclusiones: La resección de la cabeza radial por fractura aislada en pacientes jóvenes presenta unos resultados satisfactorios, con pérdidas muy bajas de movilidad y fuerza a nivel del codo. A pesar de la presencia alta de cambios artrósicos y menor de signos clínicos de inestabilidad, el dolor y discapacidad en el codo son muy bajos. En base a estos resultados, la resección de la cabeza radial es una técnica válida para fracturas aisladas incluso en pacientes jóvenes (AU)

Background: Radial head resection has been a widely used procedure in cases of non-reconstructable radial head fracture. Some authors propose the use of radial head arthroplasty. The purpose of this study was to evaluate the long-term outcome of radial head resection for isolated fracture, without instability at the time of the fracture, and its radiological and functional repercussions at the elbow level. Methods: We reviewed 44 clinical records with acute resection of the radial head following isolated radial head fracture, with absence of associated injuries, younger than forty, with a minimum follow-up of 15 years. Information was collected on elbow pain, biomechanical function, flexion and extension elbow strength and elbow instability compared with the non-affected side. A radiological study was conducted on all patients to determine the presence of degenerative changes, calcifications and measurement of the carrying angle. Outcomes were evaluated with Disabilities of the Arm, Shoulder and Hand score as an instrument to measure the patient’s perceived disability. Results: The group under study is made up of ten women and thirty-four men, with an average age at the time of fracture of 28.6 years (ranging from 15-40) and an average time since the fracture or follow-up time of 28.5 years (ranging from 16-38). The affectation was on the dominant side in thirty cases (23 right-handed and 7 left-handed). Thirty-nine patients (88.6%) had no elbow pain, and in all other cases was mild or moderate. Loss of mobility and strength was 1.5% for flexo-extension, 3.5% for prono-supination, 7.9% for flexion strength and 3.5% for extension strength. We appreciated four cases of valgus instability and two of postero-lateral instability. The average DASH score was 6.9 points. Radiographic changes of arthritis were present in 93.3% and 54.4% f calcifications. The mean increase of carrying angle was 7.7º compared with non-affected gide (ranking from 0.9-15.8º). Conclusion: Radial head resection for isolated fracture in young patients presents satisfactory results, with very low losses of elbow mobility and strength. Despite the high presence of osteoarthritic changes or lower clinical signs of instability, elbow pain and disability are very low. Our conclusion, based in these results, is that radial head resection is still a useful surgical procedure for isolated fractures even in young patients (AU)

[Effects on the elbow of radial head resection following isolated radial head fracture in young patients]. / Efectos sobre el codo de la resección de la cabeza radial por fractura aislada de la cabeza del radio en pacientes jóvenes.

BACKGROUND: Radial head resection has been a widely used procedure in cases of non-reconstructable radial head fracture. Some authors propose the use of radial head arthroplasty. The purpose of this study was to evaluate the long-term outcome of radial head resection for isolated fracture, without instability at the time of the fracture, and its radiological and functional repercussions at the elbow level. METHODS: We reviewed 44 clinical records with acute resection of the radial head following isolated radial head fracture, with absence of associated injuries, younger than forty, with a minimum follow-up of 15 years. Information was collected on elbow pain, biomechanical function, flexion and extension elbow strength and elbow instability compared with the non-affected side. A radiological study was conducted on all patients to determine the presence of degenerative changes, calcifications and measurement of the carrying angle. Outcomes were evaluated with Disabilities of the Arm, Shoulder and Hand score as an instrument to measure the patient's perceived disability. RESULTS: The group under study is made up of ten women and thirty-four men, with an average age at the time of fracture of 28.6 years (ranging from 15-40) and an average time since the fracture or follow-up time of 28.5 years (ranging from 16-38). The affectation was on the dominant side in thirty cases (23 right-handed and 7 left-handed). Thirty-nine patients (88.6%) had no elbow pain, and in all other cases was mild or moderate. Loss of mobility and strength was 1.5% for flexo-extension, 3.5% for prono-supination, 7.9% for flexion strength and 3.5% for extension strength. We appreciated four cases of valgus instability and two of postero-lateral instability. The average DASH score was 6.9 points. Radiographic changes of arthritis were present in 93.3% and 54.4% of calcifications. The mean increase of carrying angle was 7.7º compared with non-affected gide (ranking from 0.9-15.8º). CONCLUSION: Radial head resection for isolated fracture in young patients presents satisfactory results, with very low losses of elbow mobility and strength. Despite the high presence of osteoarthritic changes or lower clinical signs of instability, elbow pain and disability are very low. Our conclusion, based in these results, is that radial head resection is still a useful surgical procedure for isolated fractures even in young patients.

Estrategia invasiva de rutina en el síndrome coronario agudo sin elevación del segmento ST con disfunción renal. Resultados del registro ARIAM-SEMICYUC / Routine invasive strategy in acute coronary syndrome patients with renal dysfunction. Results of the ARIAM-SEMICYUC registry

OBJETIVO: Evaluar la utilización y efectividad de la estrategia invasiva de rutina (EIR) en pacientes con síndrome coronario agudo sin elevación de ST con disfunción renal en el mundo real. MÉTODOS: Estudio de cohortes retrospectivo basado en el registro ARIAM-SEMICYUC (años 2011-2014). Se consideró que había disfunción renal cuando el GFR (Cockroft-Gault) era menor de 60 ml/min (disfunción moderada) o de 30 ml/min (disfunción grave). Se excluyeron los pacientes en los que la coronariografía precoz (< 72 h) se debió a shock cardiogénico o isquemia recurrente. El desenlace primario fue la mortalidad hospitalaria. El control del confounding se realizó mediante un análisis de propensión. RESULTADOS: Se analizan 4.279 pacientes, de los cuales un 26% tenía disfunción renal moderada y un 5% disfunción grave. Los pacientes con disfunción renal presentaron una mayor gravedad y comorbilidad, una mayor mortalidad hospitalaria (8,6 frente a 1,8%) y una menor utilización de la EIR (40 frente a 52%). Las OR ajustadas mediante emparejamiento para pacientes sin/con disfunción renal fueron de 0,38 (intervalo de confianza al 95% [IC 95%] de 0,17 a 0,81) y 0,52 (IC 95% de 0,32 a 0,87), respectivamente (p de interacción 0,4779). El impacto de la EIR (diferencia de riesgos ajustada) fue mayor en el grupo con disfunción renal (-5,1%, IC 95% entre -8,1 y -2,1, frente a --1,6%, IC 95% entre -2,6 y -0,6, p de interacción = 0,0335). Tampoco se detectó interacción significativa respecto a los demás enlaces considerados (mortalidad en UCI o a los 30 días, riesgo combinado de muerte o infarto, fracaso renal agudo o hemorragias moderadas/graves) . CONCLUSIONES: Los resultados evidencian que la efectividad de la EIR es similar en pacientes con función renal normal o reducida y alertan sobre una infrautilización de esta estrategia en estos últimos

OBJECTIVE: To evaluate the use and effectiveness of a routine invasive strategy (RIS) in patients with acute coronary syndrome without persistent ST-segment elevation with renal dysfunction in the real world scenario. METHODS: A retrospective cohort study based on the ARIAM-SEMICYUC Registry (2011-2014) was carried out. Renal dysfunction was defined as GFR (Cockroft-Gault) < 60 ml/min (moderate dysfunction) or < 30 ml/min (severe dysfunction). Patients in which early angiography (< 72h) was performed due to cardiogenic shock or recurrent myocardial ischemia were excluded. The primary endpoint was hospital mortality. Confounding factors were controlled using propensity score analysis. RESULTS: A total of 4,279 patients were analyzed, of which 26% had moderate renal dysfunction and 5% severe dysfunction. Patients with renal dysfunction had greater severity and comorbidity, higher hospital mortality (8.6 vs. 1.8%), and lesser use of the RIS (40 vs. 52%). The adjusted OR for mortality in patients without/with renal dysfunction were 0.38 (95% confidence interval [95% CI] 0.17 to 0.81) and 0.52 (95% CI 0.32 to 0.87), respectively (interaction P-value = .4779). The impact (adjusted risk difference) of RIS was higher in the group with renal dysfunction (-5.1%, 95% CI -8.1 to -2.1 vs. -1.6%, 95% CI -2.6 to -0.6; interaction P-value = .0335). No significant interaction was detected for the other endpoints considered (ICU mortality, 30-day mortality, myocardial infarction, acute renal failure or moderate/severe bleeding). CONCLUSIONS: The results suggest that the effectiveness of IRS is similar in patients with normal or abnormal renal function, and alert to the under-utilization of this strategy in such patients

Routine invasive strategy in acute coronary syndrome patients with renal dysfunction. Results of the ARIAM-SEMICYUC registry. / Estrategia invasiva de rutina en el síndrome coronario agudo sin elevación del segmento ST con disfunción renal. Resultados del registro ARIAM-SEMICYUC.

OBJECTIVE: To evaluate the use and effectiveness of a routine invasive strategy (RIS) in patients with acute coronary syndrome without persistent ST-segment elevation with renal dysfunction in the real world scenario. METHODS: A retrospective cohort study based on the ARIAM-SEMICYUC Registry (2011-2014) was carried out. Renal dysfunction was defined as GFR (Cockroft-Gault)<60ml/min (moderate dysfunction) or<30ml/min (severe dysfunction). Patients in which early angiography (<72h) was performed due to cardiogenic shock or recurrent myocardial ischemia were excluded. The primary endpoint was hospital mortality. Confounding factors were controlled using propensity score analysis. RESULTS: A total of 4,279 patients were analyzed, of which 26% had moderate renal dysfunction and 5% severe dysfunction. Patients with renal dysfunction had greater severity and comorbidity, higher hospital mortality (8.6 vs. 1.8%), and lesser use of the RIS (40 vs. 52%). The adjusted OR for mortality in patients without/with renal dysfunction were 0.38 (95% confidence interval [95%CI] 0.17 to 0.81) and 0.52 (95%CI 0.32 to 0.87), respectively (interaction P-value=.4779). The impact (adjusted risk difference) of RIS was higher in the group with renal dysfunction (-5.1%, 95%CI -8.1 to -2.1 vs. -1.6%, 95%CI -2.6 to -0.6; interaction P-value=.0335). No significant interaction was detected for the other endpoints considered (ICU mortality, 30-day mortality, myocardial infarction, acute renal failure or moderate/severe bleeding). CONCLUSIONS: The results suggest that the effectiveness of IRS is similar in patients with normal or abnormal renal function, and alert to the under-utilization of this strategy in such patients.

Antidiabetic and antioxidant activity of Stevia rebaudiana extracts (Var. Morita) and their incorporation into a potential functional bread.

In this study a new wheat bread was designed whose sugars were replaced with S. rebaudiana Bertoni aqueous extract. The impact of the S. rebaudiana Bertoni aqueous extract on nutritional and sensory quality, its ability to reduce sugar intake and its antioxidant properties were investigated. Functional bread with 50 % of sugars replaced with S. rebaudiana extract was compared with traditional wheat bread. The extract demonstrated alpha amylase (IC50 = 198.40 µg/mL) glucosidase (596.77 µg/mL) inhibition. The radical scavenging activity exhibited an IC50 value of 335.94 mg/mL. In comparison with the control, the bread with stevia extract was softer and had lower microbial growth during the shelf-life study. The sensory test showed that the substitution of 50 % stevia extract was more acceptable when comparing with all quality characteristics. Regarding the nutritional contribution, the content of dietary fiber and digestible carbohydrates in the bread with stevia extract was higher and lower respectively, so caloric intake was significantly reduced. The results showed that the biological properties of S. rebaudiana extract were retained after the bread making process and that the proposed bread is suitable as functional food in human nutrition.

Markers of pathogenicity islands in strains of Aeromonas species of clinical and environmental origin.

The aim of this study was to investigate the presence of markers of pathogenicity islands that may be informative to detect the virulent PAI carriers of clinical and environmental strains of Aeromonas spp. isolated in Mexico. virB2, virB9 and virB11 genes were found in Aeromonas strains isolated from environmental and clinical sources while cagE and tfc16 genes were only in strains of environmental origin. Having performed the wide screening presented in this study, we now have a set of strains to map and confirm the presence of a pathogenicity island in Aeromonas strains isolated in Mexico.

[Gastrocolocutaneous fistula: an uncommon complication of percutaneous endoscopic gastrostomy]. / Fístula gastrocolocutánea: una infrecuente complicación de la gastrostomía endoscópica percutánea.

Endoscopic percutaneous gastrostomy is a safe technique although with potential complications before which the clinician has to be on alert in order to early detect them even after a long period of normal functioning. Most of them represent minor problems. Gastrocolocutaneous fistula is a rare but severe complication favored by some risk factors such as previous post-surgical adherences, deformities of the spine, or excessive gastric inflation at the time of performing the technique. We present the case of a patient with PEG with this complication that occurred after the first tube replacement. Our goal was in two senses: on the one hand, to analyze the preventive aspects and basic guidelines for a safe PEG placement to minimize the risks; on the other hand, to alert on the possible presence of this entity to prevent a progressive nutritional impairment. This complication ought to be included in the differential diagnosis of the diarrhea syndrome in the patient carrying a PEG. The diagnostic techniques of choice are radiologic tests such as CT scan and contrast media administration through the tube. Surgical therapy should be reserved to patients with acute peritonitis in order to perform a new gastrostomy.

Un programa de intervención nutricional y actividad física de seis meses produce efectos positivos sobre la composición corporal de adolescentes escolarizados / A six-month program of nutritional intervention and physical activity produces positive effects on the body composition os school adolescent

Introducción. La prevalencia de obesidad y sobrepeso infantil está mostrando un importante aumento a nivel mundial, particularmente en los países desarrollados. Se precisan actuaciones educativas inmediatas para frenar esta situación. Objetivo. Evaluar los efectos de un programa educativo de intervención nutricional y de actividad física sobre el porcentaje graso y distribución de grasa corporal en adolescentes escolarizados. Método. Se aplicó durante 6 meses un programa de intervención nutricional y de actividad física sobre un grupo de 24 adolescentes (12 mujeres y 12 varones), grupo experimental (GE). El grupo control (GC) estuvo compuesto por 13 mujeres y 9 varones. Se evaluaron diversas variables antropométricas antes y después de la intervención: peso, talla, índice de masa corporal (IMC), por ciento de masa grasa, masa libre de grasa, perímetro de cintura y ratio cintura/cadera. Resultados. El por ciento de masa grasa disminuyó significativamente en los niños del GE y aumentó en las niñas del GC tras la intervención. La ratio cintura/cadera disminuyó significativamente en los niños de ambos grupos y sólo en las niñas del GE. Se observó un incremento de la masa libre de grasa en los varones pertenecientes al GE. Conclusiones. La aplicación de un programa educativo de intervención nutricional y de actividad física aplicado desde el área de educación física en un grupo de adolescentes durante seis meses parece haber tenido un efecto positivo sobre la composición corporal, disminuyendo el porcentaje graso en los niños y evitando su aumento en las niñas (AU)

Angina inestable / Unstable angina

La angina inestable es un síndrome clínico, englobado dentro del síndrome coronario agudo, con un amplio espectro de presentaciones clínicas de diferente gravedad y pronóstico. Los datos clínicos, los cambios electrocardiográficos y el uso de determinaciones analíticas (troponinas T e I) permiten un diagnóstico y estratificación pronóstica precoces. De esta forma se facilita el inicio rápido del tratamiento y la elección de la estrategia agresiva o conservadora a seguir que deben adaptarse al nivel de riesgo. El tratamiento pretende controlar los síntomas y prevenir la muerte o el infarto de miocardio. La medicación antianginosa (nitratos, betabloqueantes, calcioantagonistas) permite la estabilización clínica en la gran mayoría de los casos. La medicación antitrombótica (aspirina, ticlopidina, trifusal, antagonistas de la glicoproteína lIb/IIIa y heparina) consigue disminuir la incidencia de muerte e infarto de miocardio. La aspirina es. probablemente, el fármaco más eficaz. Los antagonistas de la glicoproteína IIb/IIIa deberían ser utilizados solamente en casos de alto riesgo. La revascularización coronaria precoz se empleará preferentemente en casos de alto riesgo, a ser posible tras una estabilización médica inicial, y cuando fracase el tratamiento médico (AU)

[Nutrition in the sport practice: adaptation of the food guide pyramid to the characteristics of athletes diet]. / La nutrición en la práctica deportiva: adaptación de la pirámide nutricional a las características de la dieta del deportista.

In spite of all the advances in sport nutrition and the importance of an adequate food intake in order to improve sport performance, both recreational and professional athletes forget frequently to include planning an optimum diet and fluid intake in their global strategy for performance. Physiological and metabolic adaptations produced as a consequence of physical exercise lead to the necessity of increasing caloric (in accordance to energy output) and protein (based on the trophic needs of the organism) intake. Likewise, paying major attention to vitamin and mineral intake, specifically B vitamins and zinc and chromium, is required, in order to optimize carbohydrate metabolism, the ultimate limiting factor for sport performance. During the training phase, 60% of calories should come from carbohydrates, protein intake should be 1.2-2 g/kg/day and athletes should follow the recommendations of the food guide pyramid. During the pre-, per- and post-competition phase the healthy aspect of the diet passes to a second level, in order to obtain good sport performance and to guarantee a fast and effective recovery. Again, carbohydrates with a high or medium glycaemic index and water are the nutrients which have to be calculated more thoroughly. In conclusion, athletes have to follow a diet that is adequate to their higher energy output and to their higher metabolic turnover. The food guide pyramid is a graphic expression which facilitates the comprehension and following of a healthy diet. In the present article, the authors introduce the pyramid adapted to the characteristics of sports nutrition, with easy-to-follow practical recommendations regarding the kind and amounts of foodstuffs that should be consumed in order to cover nutrient needs of people who exercise regularly.

[Pneumocystis carinii pneumonia in patients with a solid organ transplant: a report of 5 cases]. / Neumonía por Pneumocystis carinii en pacientes con trasplante de órgano sólido: presentación de cinco casos.

A report is made here of five patients who underwent solid organ transplantation, were not infected with the human immunodeficiency virus, and suffered Pneumocystis carinii pneumonia while receiving immunosuppressive drugs. The figure represents a prevalence of 0.43% among patients with solid organ transplantation at the Clínica Puerta de Hierro. Some features of this infection are reported in patients without AIDS, both transplanted patients and with other clinical conditions, the possible predisposing factors and the necessity to keep a high suspect index when individuals treated with immunosuppressive drugs present with respiratory symptoms. Likewise, a suggestion is made to consider the use of chemoprophylaxis with cotrimoxazole in these cases.

[The impact of hospitalization on drug prescription]. / Impacto de la hospitalización sobre la prescripción de fármacos.

BACKGROUND: The aim of this study was to investigate the influence of hospitalization on drug prescription and identify the proportion of hospital admissions for "pharmacologic causes" and the incidence of side effects during hospital stay. METHODS: Five hundred four patients admitted to the internal medicine department of a community hospital over a consecutive six-month period were studied. Follow up until hospital discharge was carried out with information being collected according to a protocol established from the characteristics of the treatment administered. RESULTS: Most of the patients admitted were elderly males, with low educational and socioeconomic status, presenting multiple chronic diseases. During hospitalization the number of drugs prescribed doubled (6.0) in relation to the mean (3.3) at the time of admission. Upon discharge the mean number of drugs prescribed (4.1) was significantly higher to that at the time of patient admission. This increase in the number of drugs prescribed upon discharge reflected practically all of the therapeutic groups, specially those of antibiotics, hematologic and digestive drugs, including all the patients regardless of age or sex. The number of drugs prescribed during admission was identified as a variable independently associated to the increase in the number of drugs prescribed on discharge. Hospital admissions for pharmacologic causes were due to therapeutic non compliance (15.4%) and the presentation of side effects (7.8%). The presentation of side effects during hospitalization (8.5%), mostly gastrointestinal, cardiovascular or neurologic was related with age, and the number of drugs administered, and was associated with longer hospital stay. CONCLUSIONS: Contrary to what was expected, hospitalization leads to an increase in the number of drugs prescribed in relation with the therapeutic schedules administered prior to admission.

[The prevalence of hepatitis C virus markers in a series of 14 patients with essential mixed cryoglobulinemia]. / Prevalencia de marcadores del virus de la hepatitis C en una serie de catorce pacientes con crioglobulinemia mixta esencial.

This paper studies the prevalence of antibodies against hepatitis B and C virus in 14 patients with essential mixed cryoglobulinemia (EMC), comparing the results with those of 14 systemic erythematosus lupus (SEL) patients and 14 health people. Our results show a very low positivity rate of virus B markers in patients with EMC. In other hand, 10 of 14 patients with EMC have antibodies against hepatitis C virus, both with ELISA and Innolia confirmatory method--and none SEL patient or health people. We conclude, according with other published series, that a very high prevalence of antibodies against hepatitis C is found in patients with EMC.