The avalanche-like behaviour of large-scale haemodynamic activity from wakefulness to deep sleep.

Increasing evidence suggests that responsiveness is associated with critical or near-critical cortical dynamics, which exhibit scale-free cascades of spatio-temporal activity. These cascades, or 'avalanches', have been detected at multiple scales, from in vitro and in vivo microcircuits to voltage imaging and brain-wide functional magnetic resonance imaging (fMRI) recordings. Criticality endows the cortex with certain information-processing capacities postulated as necessary for conscious wakefulness, yet it remains unknown how unresponsiveness impacts on the avalanche-like behaviour of large-scale human haemodynamic activity. We observed a scale-free hierarchy of co-activated connected clusters by applying a point-process transformation to fMRI data recorded during wakefulness and non-rapid eye movement (NREM) sleep. Maximum-likelihood estimates revealed a significant effect of sleep stage on the scaling parameters of the cluster size power-law distributions. Post hoc statistical tests showed that differences were maximal between wakefulness and N2 sleep. These results were robust against spatial coarse graining, fitting alternative statistical models and different point-process thresholds, and disappeared upon phase shuffling the fMRI time series. Evoked neural bistabilities preventing arousals during N2 sleep do not suffice to explain these differences, which point towards changes in the intrinsic dynamics of the brain that could be necessary to consolidate a state of deep unresponsiveness.

Colorectal cancer survival at an oncologic center in Colombia. A historic cohort study. / Supervivencia de cáncer colorrectal en un centro oncológico de Colombia. Estudio de cohorte histórica.

INTRODUCTION AND AIMS: In Colombia, cancer of the colon is the third most frequent cancer in relation to incidence and mortality. Five-year survival depends on stage at diagnosis, albeit that rate is not known for the country. The aim of the present study was to characterize the overall survival and disease-free survival rates in an adult population with colorectal cancer treated at an oncology center in Medellín, Colombia. MATERIALS AND METHODS: A retrospective cohort study was conducted. The case records of patients with a histologic diagnosis of colorectal cancer, seen within the time frame of 2011 and 2015, were reviewed. The overall survival and disease-free survival curves were calculated using the Kaplan-Meier method. RESULTS: A total of 824 (54.9%) patients with cancer of the colon and 676 (45.1%) with cancer of the rectum were treated. Mean patient age was 63.3 years, female sex predominated (56.3%), and 98.1% of the tumors were adenocarcinomas. The majority of the lesions were stage iii (31.9% in the colon and 35.5% in the rectum) at the time of diagnosis. Surgery was the most frequent treatment in the colon (85.2%) and radiotherapy was the most frequent in the rectum (75.4%). Overall survival at the median follow-up (27.3 months) was 66.7% for cancer of the colon and 63.9% for cancer of the rectum. Disease-free survival at the median follow-up (18.6 months in colon and 14.9 in rectum) was 72.5 and 68.9%, respectively. CONCLUSIONS: The clinical characteristics and treatment of patients were similar to those found in other studies. Two-year survival was higher than in other Colombian reports and 5-year survival was lower than that observed in developed countries.

Comparative Population Plasma and Tissue Pharmacokinetics of Micafungin in Critically Ill Patients with Severe Burn Injuries and Patients with Complicated Intra-Abdominal Infection.

Severely burned patients have altered drug pharmacokinetics (PKs), but it is unclear how different they are from those in other critically ill patient groups. The aim of the present study was to compare the population pharmacokinetics of micafungin in the plasma and burn eschar of severely burned patients with those of micafungin in the plasma and peritoneal fluid of postsurgical critically ill patients with intra-abdominal infection. Fifteen burn patients were compared with 10 patients with intra-abdominal infection; all patients were treated with 100 to 150 mg/day of micafungin. Micafungin concentrations in serial blood, peritoneal fluid, and burn tissue samples were determined and were subjected to a population pharmacokinetic analysis. The probability of target attainment was calculated using area under the concentration-time curve from 0 to 24 h/MIC cutoffs of 285 for Candida parapsilosis and 3,000 for non-parapsilosis Candida spp. by Monte Carlo simulations. Twenty-five patients (18 males; median age, 50 years; age range, 38 to 67 years; median total body surface area burned, 50%; range of total body surface area burned, 35 to 65%) were included. A three-compartment model described the data, and only the rate constant for the drug distribution from the tissue fluid to the central compartment was statistically significantly different between the burn and intra-abdominal infection patients (0.47 ± 0.47 versus 0.15 ± 0.06 h(-1), respectively; P < 0.05). Most patients would achieve plasma PK/pharmacodynamic (PD) targets of 90% for non-parapsilosis Candida spp. and C. parapsilosis with MICs of 0.008 and 0.064 mg/liter, respectively, for doses of 100 mg daily and 150 mg daily. The PKs of micafungin were not significantly different between burn patients and intra-abdominal infection patients. After the first dose, micafungin at 100 mg/day achieved the PK/PD targets in plasma for MIC values of ≤0.008 mg/liter and ≤0.064 mg/liter for non-parapsilosis Candida spp. and Candida parapsilosis species, respectively.

Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: Paciente quemado crítico / Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): Critically- burned patient

La respuesta que se objetiva tras una agresión térmica grave se caracteriza por hipermetabolismo (es el modelo de agresión más hipermetabólica que existe) e hipercatabolismo, con una elevada destrucción de la musculatura esquelética. Los trastornos metabólicos son más evidentes en las 2 primeras semanas tras la quemadura, aunque pueden prolongarse en relación directa con las complicaciones aparecidas. El soporte nutrometabólico forma parte indiscutible del tratamiento de estos pacientes y debe ser precoz, utilizando preferentemente la vía enteral y la nutrición parenteral complementaria. Es dificultoso el cálculo exacto de los requerimientos caloricoproteicos, aun empleando calorimetría indirecta, debido a las elevadas pérdidas cutáneas de proteínas y CO2. Cabe destacar la indicación de farmaconutrientes específicos, de dosis elevadas de micronutrientes y, en algunas situaciones, del empleo de medicaciones o fármacos con efectos anabólicos (AU)

The response to severe burns is characterized by hypermetabolism (the most hypermetabolic existing model of aggression) and hypercatabolism, with a high degree of destruction of the skeletal musculature. Metabolic disorders are most evident in the first two weeks after the burn, although they can be prolonged in direct relation to the complications that these patients develop. Nutritional-metabolic support is an essential part of the treatment of these patients and should be started early, preferentially through the enteral route, with parenteral nutrition as complementary support. Exact calculation of calorie-protein requirements in these patients is dificult, even when indirect calorimetry is used, due to the high loss of proteins and CO2 through the skin. Specific pharmaconutrients are indicated, with a high dose of micronutrients. The use of drugs or medications with anabolic effects is also sometimes indicated (AU)

[Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): critically-burned patient]. / Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: paciente quemado crítico.

The response to severe burns is characterized by hypermetabolism (the most hypermetabolic existing model of aggression) and hypercatabolism, with a high degree of destruction of the skeletal musculature. Metabolic disorders are most evident in the first two weeks after the burn, although they can be prolonged in direct relation to the complications that these patients develop. Nutritional-metabolic support is an essential part of the treatment of these patients and should be started early, preferentially through the enteral route, with parenteral nutrition as complementary support. Exact calculation of calorie-protein requirements in these patients is difficult, even when indirect calorimetry is used, due to the high loss of proteins and CO(2) through the skin. Specific pharmaconutrients are indicated, with a high dose of micronutrients. The use of drugs or medications with anabolic effects is also sometimes indicated.

Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SENPE: critically-ill burnt patient.

The response to severe burns is characterized by hypermetabolism (the most hypermetabolic existing model of aggression) and hypercatabolism, with a high degree of destruction of the skeletal musculature. Metabolic disorders are most evident in the first two weeks after the burn, although they can be prolonged in direct relation to the complications that these patients develop. Nutritional-metabolic support is an essential part of the treatment of these patients and should be started early, preferentially through the enteral route, with parenteral nutrition as complementary support. Exact calculation of calorie-protein requirements in these patients is difficult, even when indirect calorimetry is used, due to the high loss of proteins and CO2 through the skin. Specific pharmaconutrients are indicated, with a high dose of micronutrients. The use of drugs or medications with anabolic effects is also sometimes indicated.

Sobrepeso y obesidad infantil. Necesidad de intervención de Enfermería / Childhood overweight and obesity. Nursing need for intervention

Introducción: El sobrepeso y obesidad infantil son un problema complejo que necesita atención prioritaria en los programas de salud pública para rectificarlo; considerando que los factores desencadenantes son susceptibles de modificación, a través de crear entornos que capaciten y motiven a las personas, familias y comunidades a adoptar conductas positivas en relación a una alimentación saludable y la realización de actividades físicas que permitan mejorar su salud. Desarrollo: En general la investigación sobre obesidad y sobrepeso en México se ha enfocado en estudios epidemiológicos que apuntan a la necesidad de intervenciones en el estilo de vida para reducir esta agresiva epidemia. No obstante, muy pocos estudios han sido capaces de demostrar cuales son las aproximaciones más efectivas para promover cambios en el estilo de vida. Ante tal problemática los profesionales de enfermería, tienen el compromiso y responsabilidad, de crear un entorno que capacite y motive a las personas, familias y las comunidades a adoptar decisiones y conductas positivas en sus estilos de vida, integrando para ello modelos conceptuales y teorías de enfermería. El objetivo de este artículo es presentar una revisión de la literatura acerca del sobrepeso y la obesidad infantil, así mismo hacer énfasis en la necesidad de realizar estudios o investigaciones interventivas de enfermería para contribuir en la disminución de esta epidemia; pretendiendo aportar un marco de referencia para futuras investigaciones. Para ello se realizo una búsqueda y revisión del problema en las principales bases de datos en español (Artemisa, Lilacs y Medline). Conclusiones: El fin es el de aportar un marco de referencia que sirva de apoyo a futuras investigaciones para el desarrollo de intervenciones de enfermería que contribuyan de manera específica a disminuir el sobrepeso y la obesidad.

Introduction: Obesity and overweight are global health problems because they increase the rates of illnesses and mortality in the short and long terms .These problems are generated, among other, as the consequence of factors such as: lifestyles, genetic, social and cultural. Because overweight is an important economic burden against health systems, improper nourishment, insufficient physical activity, and metabolic disorders observed in some children are constant motives of concern. Development: This child obesity and overweight is a complex problem which needs primary attention within the public health programs. Therefore, and considering that some of triggering factors related these problems are prone to modification, and because of their professional profile and their philosophy essence, nurses have the commitment and responsibility to help, train, and motivate persons, families, and communities adopt behaviors which reduce the risk associated to those factors and thus augment their probabilities to live healthy lives. Conclusions: In México, few studies have proven successful at positively modifying the life-styles of scholars; therefore, the objective of this study is, based on the revision of articles and databases, including those of Artemisa, Lilacs, and Medline, to provide frameworks of reference to help further initiatives of similar studies.

Estilos de vida en escolares con sobrepeso y obesidad en una escuela primaria de México D. F / Ways of life in students with overweight and obesity in a primary school of Mexico City

Introducción: La nutrición constituye un factor determinante de la salud, desempeño físico, mental y de la productividad, particularmente la niñez constituye una población de riesgo, ya que representa un periodo crítico en el ser humano, caracterizado por el crecimiento físico, el desarrollo psicomotor, social. México es el primer país en Latinoamérica con una alta incidencia de obesidad en escolares, de acuerdo con los criterios de la International Obesity Task Force (iotf), reporta una prevalencia nacional combinada de sobrepeso y obesidad en niños de 5 a 11 años de alrededor del 26%, para ambos sexos. Objetivos: Identificar los estilos de vida de niños en edad escolar con sobrepeso y obesidad en una primaria pública del D.F. Metodología: Estudio descriptivo, correlacional y transversal, conformado por toda la población escolar constituida por 503 alumnos de 6 a 11 años. Para la detección de sobrepeso y obesidad se tomo peso, talla así como medición del Índice de Masa Corporal (imc); se determinaron los estilos de vida a través de la aplicación de un instrumento elaborado por Ponce, Sotomayor, Bernal y Salazar (2007), el cual exploró básicamente tres áreas: alimentación, ejercicio - actividad física y recreación. Resultados: 14% del total de niños presenta problemas de sobrepeso u obesidad (71 niños), el 60% consume alimentos no preparados en casa de manera habitual, 99% refiere que la única actividad física es la que se realiza dentro de la escuela, el 34% ve televisión de 3 a 6 hrs diariamente. Existen diferencias significativas en la incidencia de sobrepeso por sexo (razón de 1.5 varones por cada mujer con sobrepeso u obesidad) y también en niños que incrementan sus horas de sedentarismo (p=<.001). Discusión: Los resultados obtenidos en la etapa descriptiva coinciden con lo reportado en la literatura nacional e internacional 8 y 9 Los ayunos prolongados como se mostró en el estudio son factores importantes para condicionar la obesidad tal como lo muestran Veugelers y Fitzgerald. Conclusiones: Es importante realizar este tipo de estudios para poder proponer estrategias de intervención de corte educativo lo más apegadas a la situación real de las poblaciones de niños escolares a los que se pretenda cambiar a estilos de vida saludable que logren contribuir a controlar el sobrepeso y prevenir la obesidad.

Introduction: Nutrition is a health, productivity, and physical- mental performance factor, which has a particularly important impact on children. According to the International Obesity Task Force (IOTF), Mexico has a combined overweight-obesity prevalence of 26% among children between 5 and 11 years old. Objectives: Identify life styles of school-age children with overweight or obesity problems in a primary school of the Federal District. Methodology: This was a basic, descriptive, correlational study which included all the 6-11 year old children in a primary school (503 students). Weight, height, and mass indexes were taken. Life styles (nutrition, physical activity, and recreation) were determined through an instrument made by Ponce, Sotomayor, Bernal, and Salazar (2007). Results: 14% (71 children) showed an overweight-obesity problem, 60% do not consume home-made food at school, 99% have physical activity only at school, and 34% watch TV from 3 to 6 hours daily. Overweight-obese male/female ratio was 1.5, and an association was found between overweight-obesity problems and a sedentary life style found (p <= .001). Discussion: Results were similar to those found at the national and international literature (8.9). As demonstrated by Veugelers and Fitzgerald, prolonged fasting is an important obesity conditioning factor. Conclusion: This kind of studies can help design education intervention strategies to modify children's life styles and prevent and control their overweight and obesity.

Role of radiotherapy in organ-sparing treatment of seminoma

Radical orchiectomy is the standard treatment for patients with seminoma. In both bilateral and unilateral testicular cancer, this therapy results in infertility, permanent androgen replacement treatment and significant psychological problems stemming from castration. Given that most patients with germinal cell tumours are long-term survivors, quality of life is becoming more and more relevant in therapeutic decision-making. We present a case of metachronous bilateral seminoma treated with tumour enucleation and adjuvant local radiotherapy. We also provide a review of the literature on the role of radiotherapy in organ sparing (AU)

No disponible

Imitate to integrate: reviewing the pathway for B chromosome integration in Trypoxylon (Trypargilum) albitarse (Hymenoptera, Sphecidae).

B chromosomes are genomic "intruders" normally characterized by their total dispensability counteracted by a variety of drive mechanisms, which assures their presence regardless of their harmful effects on the host genome. From an evolutionary standpoint, the relationship between standard (A) and B chromosomes can go through different pathways, from an everlasting arms race to a cordial B integration. Examples underlying the first situation are fairly common; B integration, however, has been more a theoretical than a practical possibility. The B chromosome in the haplodiploid solitary wasp Trypoxylon albitarse is probably the first example of a "mimetic" B, which is being integrated into the A genome by limiting itself to one B per haploid genome, the same dosage as the A chromosomes. Here we review some of the findings underlying this hypothesis and discuss the T. albitarse B strategy as a possible mechanism for B chromosome integration as a regular member of the chromosome complement in haplodiploid organisms.

The voluntary dissemination of performance information by health care organizations.

This paper examines the factors that influence the voluntary dissemination of performance information by health care organizations. A model of information dissemination is developed and tested using data on Health Maintenance Organizations. The empirical findings suggest that health care organizations disseminate information on their performance because there are collective-good benefits resulting from dissemination, particularly when the product or organizational innovation is unfamiliar to some purchasers. The findings also suggest that the competitive structure of the local health care market influences the dissemination decision, with health care organizations more likely to disseminate information about their performance in relatively competitive markets.

The effects of regulatory tools on organizational populations.

One of the main activities of regulation is the control of market development by influencing the number of firms in an industry, their entry into an industry, and their exit from an industry. Population ecology is used as a framework for explaining both the direct and indirect effects of regulatory activity on entry, exit, and market structure. This framework is then used to derive specific propositions about regulatory effects on entry, exit, and market structure in the health maintenance organization industry.