The supporting role of the teres major muscle, an additional component in glenohumeral stability? An anatomical and radiological study.

Muscle coordination plays an important role in glenohumeral stability. The rotator cuff and the long head of the biceps are considered the primary dynamic stabilizers muscles. However, the fact that a subgroup of patients with a massive tear in the rotator cuff were able to keep a normal function, should make us question this traditional view. We hypothesize that the teres major which is also a monoarticular scapulohumeral muscle, although it is not part of the conjoined tendon of the rotator cuff, can play a role in glenohumeral stability by a direct support of the humeral head generated by the particular posteroanterior location of this muscle under the humeral head and which, as far as we know, has not been written up previously. This particular effect could appear while the arm is being lifted and the humeral head could be leaning on against the teres major muscle belly underneath it. An anatomical a radiological study was carried out to substantiate our hypothesis. Two cadaver specimens were used for the anatomical study. Frist body was studied through conventional dissection. The second body was analysed through sectional anatomy. Then a radiological study was carried out using magnetic resonance imaging in a healthy male volunteer. Both anatomically and radiologically, the anteroinferior surface of the humeral head was showed firmly resting against the muscle belly of the teres major, to the point of misshaping it from 110 degrees of arm elevation with external rotation. The specific contribution of this effect to the glenohumeral stability needs to be confirmed by further studies and can help us to prevent the high incidence of glenohumeral dislocations.

Long-term Prognosis After Lung Transplantation: A Monocentric Study in 510 Patients.

INTRODUCTION: Lung transplantation is the final treatment option in patients with respiratory failure. Morbidity and mortality rates associated with the management of complications is high despite advances. Postoperative complications include acute transplant rejection, bronchiolitis obliterans, and infections. Because of that, the success of this treatment option depends on the correct choice of donor and candidates to receive a transplant. OBJECTIVE: This study aims to perform a survival analysis of transplanted patients in our center and determine predictive variables of mortality. PATIENTS AND METHODS: This study is a retrospective assessment of data collected from 510 patients at the Hospital University Reina Sofía from October 1993 to December 31, 2016. Patients who were retransplanted were excluded. We collected data regarding basal characteristics of the donors and candidates to receive a transplant. We analyzed the impact in terms of future survival of basal variables from donor and donor recipients. RESULTS: Five hundred ten patients were included (average age 44 ± 17 years, 69% male), with a maximum follow-up period of 21.6 years (average follow-up 4.52 years, interquartile ratio: 0.13 to 6.97 years). Two hundred twenty-seven patients died (54.3% of the total amount). The influence of donor's basal characteristics on mortality was analyzed; moreover, the relationship between basal variables and survival were analyzed using univariate analysis. Available variables were analyzed through multivariate analysis. CONCLUSION: Lung transplantation is a treatment option with an acceptable risk of morbidity and mortality. Increased awareness of features of evolution could help to reduce postoperative complications.

Long-term clinical impact of permanent cardiac pacing after transcatheter aortic valve implantation with the CoreValve prosthesis: a single center experience.

Aims: To determine the impact of permanent cardiac pacing after transcatheter aortic valve implantation (TAVI) with the CoreValveTM prosthesis in terms of all-cause mortality and morbidity [rehospitalizations for heart failure (HF) or stroke] at the long-term follow-up. Methods and results: The prospective analysis comprised 259 patients (138 women, 53.3%, age 78 ± 6 years) treated by a CoreValveTM prosthesis from April 2008 to December 2015. Forty-two patients were excluded for analysis: 9 with pre-existing permanent pacemaker (PPM) implantation, 19 who required a PPM during the follow-up and 14 patients because of hospital mortality during or after the CoreValveTM prosthesis implantation procedure. The remaining 217 patients were divided in two groups: Group-1 included those patients who required a PPM immediately after TAVI, and Group-2 included those patients who did not require permanent cardiac pacing at the long-term follow-up. Patients received follow-up at 1-month, 6-months, 12-months, and yearly thereafter. A total of 39 patients required a PPM immediately after TAVI (15.0%), but 178 patients (68.7%) did not. The mean follow-up was 37 ± 27 months (range 3-99 months) in both groups. There was no difference between the two groups in terms of all-cause mortality (52.6% vs. 56.8%, P = 0.125; HR 1.22 [0.87-1.77, 95% CI]), or stroke (13.3% vs. 15.1% P = 0.842; HR 1.12 [0.37-3.32, 95% CI]). However, patients who underwent PPM implantation developed an increase in readmissions for HF (21.1% vs. 31.9%, P = 0.015; HR 1.82 [1.23-3.92, 95% CI]). Conclusion: Patients requiring a PPM after TAVI did not have an increase in mortality, or an increase in the likelihood of developing a stroke at a long-term follow-up. However, this subgroup of patients showed an increase in rehospitalization due to HF at medium- and long-term follow-up.

Diagnosing neuroleukemiosis: Is there a role for 18F-FDG-PET/CT?

An imaging case is presented on a patient referred to our department for an 18F-FDG-PET/CT, as a paraneoplastic syndrome was suspected due to his clinical situation. He had a history of acute myeloid leukemia (AML) treated two years earlier, with sustained complete remission to date. 18F-FDG-PET/CT findings revealed hypermetabolism in almost all nerve roots, suggesting meningeal spread, consistent with the subsequent MRI findings. Cerebrospinal fluid (CSF) findings confirmed a leptomeningeal reactivation of AML. Although not many studies have evaluated the role of 18F-FDG-PET/CT in leukemia, it is a noninvasive tool for detecting extramedullary sites of disease and a good imaging alternative for those patients on whom an MRI cannot be performed.

Rheumatic diseases of the spine: imaging diagnosis. / Enfermedades reumatológicas en la columna vertebral: diagnóstico radiológico.

Spinal involvement is common both in the spondyloarthritides and in rheumatoid arthritis, in which the cervical segment is selectively affected. Rheumatoid involvement of the cervical spine has characteristic radiologic manifestations, fundamentally different patterns of atlantoaxial instability. Magnetic resonance imaging (MRI) is the technique of choice for evaluating the possible repercussions of atlantoaxial instability on the spinal cord and/or nerve roots in patients with rheumatoid arthritis as well as for evaluating parameters indicative of active inflammation, such as bone edema and synovitis. Axial involvement is characteristic in the spondyloarthritides and has distinctive manifestations on plain-film X-rays, which reflect destructive and reparative phenomena. The use of MRI has changed the conception of spondyloarthritis because it is able to directly detect the inflammatory changes that form part of the disease, making it possible to establish the diagnosis early in the disease process, when plain-film X-ray findings are normal (non-radiographic axial spondyloarthritis), to assess the prognosis of the disease, and to contribute to treatment planning.

La evaluación de competencias quirúrgicas como complemento al método formativo. Revisión / The assessment of surgical skills as a complement to the training method. Revision

Contexto y objetivo: La adquisición y mejora de las habilidades quirúrgicas son un elemento fundamental en la formación de cualquier profesional. Si bien, la propia evaluación de estas constituye, por ahora, un campo con escaso desarrollado. El objetivo de este trabajo es analizar las particularidades de los diferentes sistemas de evaluación y establecer los criterios mínimos que debe reunir un sistema de evaluación de habilidades y conocimientos, como método de evaluación de competencias quirúrgicas en cirugía urológica. Adquisición de evidencias: Revisión de la literatura científica orientada a los diferentes sistemas de evaluación de habilidades y competencias, técnicas y no técnicas, disponibles en la actualidad, con especial atención a las revisiones sistemáticas realizadas y a los estudios prospectivos. Síntesis de evidencias: Tras la revisión efectuada, encontramos que los diferentes sistemas de evaluación de competencias quirúrgicas presentan, a nuestro juicio, una serie de carencias: existe cierto grado de subjetividad en la evaluación de un cirujano por parte del evaluador; no se recoge formalmente la evaluación de competencias no técnicas.; no se describe un seguimiento de la evaluación ni unos parámetros básicos asociados a calidad sanitaria y no existe un registro de competencias asociadas a las diferentes técnicas quirúrgicas, como tampoco se describe la graduación de las mismas y las particularidades específicas para su aplicación. Conclusiones: Entendemos necesario el desarrollo de un nuevo sistema de evaluación de competencias quirúrgicas, técnicas y no técnicas, orientado a la evaluación de urólogos en diferentes técnicas quirúrgicas. Para ello, nuestro equipo ha trabajado en el desarrollo del sistema Evaluation System for Surgical Competencies on Laparoscopy, fundamentado en la definición, graduación y evaluación de aquellas competencias que demuestra un cirujano

Context and objective: The acquisition and improvement of surgical skills constitute a fundamental element in the training of any practitioner. At present, however, the assessment of these skills is a scarcely developed area of research. The aim of this study was to analyse the peculiarities of the various assessment systems and establish the minimum criteria that a skills and knowledge assessment system should meet as a method for assessing surgical skills in urological surgery. Acquisition of evidence: Scientific literature review aimed at the various currently available assessment systems for skills and competencies (technical and nontechnical), with a special focus on the systematic reviews and prospective studies. Summary of the evidence: After conducting the review, we found that the various assessment systems for surgical competence have, in our opinion, a number of shortcomings. There is a certain degree of subjectivity in the assessment of surgeons by the evaluators. The assessment of nontechnical competencies is not formally recorded. There is no description of a follow-up assessment or any basic parameters associated with healthcare quality. There is no registration of associated competencies associated with the various surgical techniques. There is also no ranking of these competencies and the specific peculiarities for their application. Conclusions: We believe that the development of a new assessment system for surgical competencies (technical and nontechnical) aimed at assessing urologists in the various surgical techniques is necessary. To this end, our team has worked on developing the Evaluation System for Surgical Competencies on Laparoscopy, which is based on the definition, ranking and assessment of competencies demonstrated by surgeons

The assessment of surgical skills as a complement to the training method. Revision.

CONTEXT AND OBJECTIVE: The acquisition and improvement of surgical skills constitute a fundamental element in the training of any practitioner. At present, however, the assessment of these skills is a scarcely developed area of research. The aim of this study was to analyse the peculiarities of the various assessment systems and establish the minimum criteria that a skills and knowledge assessment system should meet as a method for assessing surgical skills in urological surgery. ACQUISITION OF EVIDENCE: Scientific literature review aimed at the various currently available assessment systems for skills and competencies (technical and nontechnical), with a special focus on the systematic reviews and prospective studies. SUMMARY OF THE EVIDENCE: After conducting the review, we found that the various assessment systems for surgical competence have, in our opinion, a number of shortcomings. There is a certain degree of subjectivity in the assessment of surgeons by the evaluators. The assessment of nontechnical competencies is not formally recorded. There is no description of a follow-up assessment or any basic parameters associated with healthcare quality. There is no registration of associated competencies associated with the various surgical techniques. There is also no ranking of these competencies and the specific peculiarities for their application. CONCLUSIONS: We believe that the development of a new assessment system for surgical competencies (technical and nontechnical) aimed at assessing urologists in the various surgical techniques is necessary. To this end, our team has worked on developing the Evaluation System for Surgical Competencies on Laparoscopy, which is based on the definition, ranking and assessment of competencies demonstrated by surgeons.

Slow femoral venous flow and venous thromboembolism following inguinal hernioplasty in patients without or with low molecular weight heparin prophylaxis.

BACKGROUND: Prosthetic material (mesh) is commonly used to repair inguinal hernias. Its implantation close to the common femoral vein (CFV) can induce slow flow and favor the appearance of venous thromboembolism (VTE) events. AIM: To investigate the speed of flow, diameter and area of the CFV after inguinal hernioplasty. METHODS: Two hundred and fifty patients receiving open hernioplasty with a non-resorbable mesh for the repair of a unilateral, primary, simple inguinal hernia were prospectively investigated. Patients were stratified, by consensus, into a low or a moderate risk of VTE group. The moderate-risk group (n = 163) received low molecular weight heparin. On day 10 post-operation a blinded Echo-Doppler was carried out, and repeated 7 days later in patients with a venous flow of <15 cm/s. The speed of flow (cm/s), diameter (cm), and area (cm(2)) of the ipsilateral and contralateral CFV of the groin operated upon were measured. RESULTS: No event symptomatic of VTE was documented. One case of asymptomatic deep vein thrombosis (1/163, 0.6%) was found in the moderate-risk group. In 29 patients (2 and 27 in the low- and moderate-risk groups, respectively; p < 0.001) a maximum blood flow velocity of <15 cm/s was found in the ipsilateral CFV; these flows were close to normal in the second measurement. Taking the entire sample into account, the maximum venous blood flow found in the ipsilateral CFV of the operated groin was less than that measured in the contralateral CFV (20.88 vs. 24.01 cm/s; p < 0.001); this difference was significant in both VTE risk groups. The diameter and area of the CFV were both greater in the ipsilateral than the contralateral CFV (p < 0.01); this finding proved to be significant only in hernias of the left groin (p < 0.001). CONCLUSIONS: In the immediate postoperative period, inguinal hernioplasty with mesh induces a temporarily slow venous flow in the ipsilateral CFV. However, this does not lead to an increase in the incidence of VTE.

Celedonio Calatayud Costa y el nacimiento de la especialidad, la Sociedad Española de Radiología Médica y la revista: el comienzo de un siglo de Radiología española / Celedonio Calatayud-Costa and the birth of the specialty, the Spanish Society of Medical Radiology, and the journal: the beginning of a century of Spanish Radiology

El Dr. Celedonio Calatayud Costa, eminente radiólogo español, electrotécnico, investigador y cofundador de la Sociedad Española de Electrología y Radiología Médica, fue también el fundador de la Revista Española de Electrología y Radiología Médica. La revista, la primera específicamente dedicada a la incipiente especialidad de la electrología, de la que después se desarrollará la radiología, fue la publicación oficial de aquella Sociedad primordial y, por lo tanto, la primera antecesora de Radiología, hoy revista oficial de la Sociedad Española de Radiología Médica. Este artículo analiza la figura del Dr. Calatayud, partiendo de la escasa información que de él se dispone, en el centenario de la edición de su revista. Criticado por algunos, destacada su figura y labor por otros, se trata de una figura controvertida sin la que es imposible entender los comienzos de la especialidad y su publicación científica en España(AU)

Dr. Celedonio Calatayud-Costa, an eminent Spanish radiologist, electrical engineer, researcher, and co-founder of the Spanish Society of Electrical Engineering and Medical Radiology, was also the founder of the Spanish Journal of Electrical Engineering and Medical Radiology. The journal, the first journal dedicated specifically to the incipient specialty of electrology, from which radiology would later develop, was the official publication of that primordial Society, and was thus the first antecessor of Radiología, which is today the official journal of the Spanish Society of Medical Radiology. This article analyzes the figure of Dr. Calatayud, based on the scant information available about him, in the centennial of the publication of his journal. Criticized by some and eulogized by others, knowledge about this controversial figure is essential to any understanding of the beginnings of the specialty and its scientific publication in Spain(AU)

[Celedonio Calatayud-Costa and the birth of the specialty, the Spanish Society of Medical Radiology, and the journal: the beginning of a century of Spanish radiology]. / Celedonio Calatayud Costa y el nacimiento de la especialidad, la Sociedad Española de Radiología Médica y la revista: el comienzo de un siglo de Radiología española.

Dr. Celedonio Calatayud-Costa, an eminent Spanish radiologist, electrical engineer, researcher, and co-founder of the Spanish Society of Electrical Engineering and Medical Radiology, was also the founder of the Spanish Journal of Electrical Engineering and Medical Radiology. The journal, the first journal dedicated specifically to the incipient specialty of electrology, from which radiology would later develop, was the official publication of that primordial Society, and was thus the first antecessor of Radiología, which is today the official journal of the Spanish Society of Medical Radiology. This article analyzes the figure of Dr. Calatayud, based on the scant information available about him, in the centennial of the publication of his journal. Criticized by some and eulogized by others, knowledge about this controversial figure is essential to any understanding of the beginnings of the specialty and its scientific publication in Spain.

Estratificación del riesgo de enfermedad tromboembólica venosa y tromboprofilaxis con heparina de bajo peso molecular en pacientes sometidos a cirugía mayor ambulatoria. Estudio prospectivo observacional / Venous thromboembolism risk stratification and thromboprophylaxis with low molecular weight heparin in patients undergoing major ambulatory surgery: an observational prospective study

Introducción: el riesgo de enfermedad tromboembólica venosa (ETV) después de cirugía mayor ambulatoria (CMA), aunque supuestamente es bajo, continua siendo desconocido. Esta cirugía, que cada vez es más frecuente y extensiva a pacientes de mayor edad y comorbilidad, nos obliga a buscar pacientes de riesgo. El objetivo es validar de forma prospectiva una estratificación del riesgo de ETV, en pacientes de CMA, lo que determina el tipo de tromboprofilaxis a realizar. Pacientes y métodos: estudio prospectivo en 402 pacientes consecutivos (45,1 ± 16,0 años) sometidos a diversos procedimientos de CMA, fundamentalmente de pared abdominal (82%) y bajo anestesia regional (60,5%). Los pacientes son estratificados según un consenso español en: a) sin riesgo ETV (n = 141 pacientes); b) con riesgo moderado (n = 228), o c) alto (n = 33). Los grupos de riesgo moderado y alto recibieron heparina de bajo peso molecular (bemiparina 2500 o 3500 UI), comenzando 6 horas después de la operación durante siete días. Al décimo día del postoperatorio se realizo eco-doppler color (de forma ciega), el cual se repitió a la semana en caso necesario; a los 10 y 30 días se midieron diversos parámetros de eficacia y seguridad. Se realizo un estudio trombofílico preoperatoriamente a un tercio de la muestra con la intención de conocer cómo modificaría a posteriori la estratificación realizada. Resultados: completaron el estudio 357 pacientes (88,8%). No se observó ningún evento sintomático; en el grupo de riesgo moderado se detectó una (..) (AU)

Although supposedly low, the risk of venous thromboembolism (VTE) after major ambulatory surgery (MAS) remains to be established. We have carried out a prospective validation of the risk stratification of VTE in MAS patients. Methods: 402 consecutive patients were stratified according to a Spanish consensus as: a) no risk of VTE (n = 141), b) moderate risk (n = 228), and c) high risk (n = 33). The moderate and high risk groups received thromboprophylaxis with low molecular weight heparin. On post-operative day 10, a colour Echo-Doppler was obtained; on days 10 and 30 different parameters of efficacy and safety were measured. Results: 357 patients completed the study. No symptomatic events were observed; one case of asymptomatic deep vein thrombosis was observed. Overall, in 39 patients (three from the low risk group and 36 in the moderate and high risk groups; p<0.001) a decrease to 15 cm/s was observed in interior femoral blood flow. Haemorrhagic complications, all of them minor, in the surgical wound accounted for 2%. The study of thrombophilia revealed a high number of patients with hidden thrombophilia (28.1%). Conclusion: MAS patients are not free of VTE events and require risk stratification. Thromboprophylaxis with LMWH in moderate and high risk of VTE is safe and effective (..)(AU)

[Evaluation of needle exchange program at Pereiro de Aguiar prison (Ourense, Spain): ten years of experience]. / Evaluación del Programa de Intercambio de Jeringuillas en el Centro Penitenciario de Pereiro de Aguiar (Ourense): diez años de experiencia.

OBJECTIVES: To evaluate the effectiveness of NEPs in prison to reduce the prevalence of infections associated with intravenous drug use and to know more about acceptance of the program by inmates and staff. MATERIAL AND METHODS: cross-sectional observational study at baseline, 6 and 12 months and 10 years of program development. Interviews were conducted with program users, as well as random sample surveys of officials at the various cuts, and a random sample of inmates from the centre after10 years. Activity indicators of the program were recorded continuously, and the prevalence of HIV, HBV and HCV at baseline and after 10 years was evaluated. For the statistical analysis, the chi-square test was used with the Yates correction when necessary. RESULTS: In ten years we have supplied a total of 15,962 syringes to 429 users, (average 20.2 users/month), and 11,327 (70.9%) were returned. The prevalence of HIV infection decreased from 21% in 1999 to 8.5% in 2009, HCV prevalence from 40% to 26.1% (p <0.01), finding no significant differences in the prevalence of HBsAg +. Most of the inmates and civil servants believe that the program did not increase intravenous drug use and improves hygienic living conditions in prison. CONCLUSIONS: After ten years of development of the NEP, there was a significant decrease in the prevalence of HIV and HCV in the prison population at the centre, and the program is accepted as beneficial by most of the inmates and staff participating in the survey.

Utilization of Anabaena sp. in CO2 removal processes: modelling of biomass, exopolysaccharides productivities and CO2 fixation rate.

This paper focuses on modelling the growth rate and exopolysaccharides production of Anabaena sp. ATCC 33047, to be used in carbon dioxide removal and biofuels production. For this, the influence of dilution rate, irradiance and aeration rate on the biomass and exopolysaccharides productivity, as well as on the CO(2) fixation rate, have been studied. The productivity of the cultures was maximum at the highest irradiance and dilution rate assayed, resulting to 0.5 g(bio) l(-1) day(-1) and 0.2 g(eps) l(-1) day(-1), and the CO(2) fixation rate measured was 1.0 gCO(2) l(-1) day(-1). The results showed that although Anabaena sp. was partially photo-inhibited at irradiances higher than 1,300 µE m(-2) s(-1), its growth rate increases hyperbolically with the average irradiance inside the culture, and so does the specific exopolysaccharides production rate. The latter, on the other hand, decreases under high external irradiances, indicating that the exopolysaccharides metabolism hindered by photo-damage. Mathematical models that consider these phenomena have been proposed. Regarding aeration, the yield of the cultures decreased at rates over 0.5 v/v/min or when shear rates were higher than 60 s(-1), demonstrating the existence of thus existence of stress damage by aeration. The behaviour of the cultures has been verified outdoors in a pilot-scale airlift tubular photobioreactor. From this study it is concluded that Anabaena sp. is highly recommended to transform CO(2) into valuable products as has been proved capable of metabolizing carbon dioxide at rates of 1.2 gCO(2) l(-1) day(-1) outdoors. The adequacy of the proposed equations is demonstrated, resulting to a useful tool in the design and operation of photobioreactors using this strain.

Development of a process for efficient use of CO2 from flue gases in the production of photosynthetic microorganisms.

A new methodology to use efficiently flue gases as CO(2) source in the production of photosynthetic microorganisms is proposed. The CO(2) is absorbed in an aqueous phase that is then regenerated by microalgae. Carbonated solutions could absorb up to 80% of the CO(2) from diluted gas reaching total inorganic carbon (TIC) concentrations up to 2.0 g/L. The pH of the solution was maintained at 8.0-10.0 by the bicarbonate/carbonate buffer, so it is compatible with biological regeneration. The absorption process was modeled and the kinetic parameters were determined. Anabaena sp. demonstrated to tolerate pH (8.0-10.0) and TIC (up to 2.0 g/L) conditions imposed by the absorption step. Experiments of regeneration of the liquid phase demonstrated the feasibility of the overall process, converting CO(2) into organic matter. The developed process avoids heating to regenerate the liquid whereas maximizing the efficiency of CO(2) use, which is relevant to achieve the commercial production of biofuels from microalgae.

Evaluación del Programa de Intercambio de Jeringuillas en el Centro Penitenciario de Pereiro de Aguiar (Ourense): diez años de experiencia / Evaluation of needle exchange program at Pereiro de Aguiar prison (Ourense, Spain): ten years of experience

Objetivos: Evaluar la eficacia de un programa de intercambio de jeringuillas (PIJ) en una prisión para reducir la prevalencia de infecciones asociadas al uso de drogas intravenosas, y conocer la aceptación del programa por internos y funcionarios del centro penitenciario. Material y métodos: Estudio observacional con cortes transversales al inicio, 6 y 12 meses y 10 años de desarrollo del programa. Se realizaron entrevistas a los usuarios del programa y encuestas a muestras accidentales de funcionarios en los distintos cortes, y a una muestra aleatoria de internos a los 10 años. Se registraron diariamente los indicadores de actividad del programa, y se valoró la prevalencia de infección por VIH, hepatitis B y C al inicio y a los 10 años. Para el análisis estadístico utilizamos la prueba ji-cuadrado con la corrección de Yates en caso necesario. Resultados: Durante estos diez años se suministraron 15.962 jeringuillas a 429 usuarios (media de 20,2 usuarios/mes), recuperándose 11.327 (70,9%). La prevalencia de infección por VIH pasó del 21% en 1999 al 8,5% en 2009, la de VHC del 40% al 26,1% (p<0,01). La mayoría de internos y funcionarios consideran que el programa no incrementa el consumo de drogas intravenosas y que mejora las condiciones higiénicas de vida en la prisión. Conclusiones: Tras diez años de PIJ, se observa un significativo descenso en la prevalencia de infección por VIH y por VHC en la población reclusa del centro, y el programa es aceptado como beneficioso por la mayoría de los internos y funcionarios encuestados(AU)

Objectives: To evaluate the effectiveness of NEPs in prison to reduce the prevalence of infections associated with intravenous drug use and to know more about acceptance of the program by inmates and staff. Material and methods: cross-sectional observational study at baseline, 6 and 12 months and 10 years of program development. Interviews were conducted with program users, as well as random sample surveys of officials at the various cuts, and a random sample of inmates from the centre after10 years. Activity indicators of the program were recorded continuously, and the prevalence of HIV, HBV and HCV at baseline and after 10 years was evaluated. For the statistical analysis, the chi-square test was used with the Yates correction when necessary. Results: In ten years we have supplied a total of 15,962 syringes to 429 users, (average 20.2 users/month), and 11,327 (70.9%) were returned. The prevalence of HIV infection decreased from 21% in 1999 to 8.5% in 2009, HCV prevalence from 40% to 26.1% (p <0.01), finding no significant differences in the prevalence of HBsAg +. Most of the inmates and civil servants believe that the program did not increase intravenous drug use and improves hygienic living conditions in prison. Conclusions: After ten years of development of the NEP, there was a significant decrease in the prevalence of HIV and HCV in the prison population at the centre, and the program is accepted as beneficial by most of the inmates and staff participating in the survey(AU)

Utilization of the cyanobacteria Anabaena sp. ATCC 33047 in CO2 removal processes.

In this paper the utilization of the cyanobacteria Anabaena sp. in carbon dioxide removal processes is evaluated. For this, continuous cultures of this strain were performed at different dilution rates; alternatives for the recovery of the organic matter produced being also studied. A maximum CO(2) fixation rate of 1.45 g CO(2) L(-1) day(-1) was measured experimentally, but it can be increased up to 3.0 g CO(2) L(-1) day(-1) outdoors. The CO(2) is mainly transformed into exopolysaccharides, biomass representing one third of the total organic matter produced. Organic matter can be recovered by sedimentation with efficiencies higher than 90%, the velocity of sedimentation being 2.10(-4) s(-1). The major compounds were carbohydrates and proteins with productivities of 0.70 and 0.12 g L(-1) day(-1), respectively. The behaviour of the cultures of Anabaena sp. has been modelized, also the characteristics parameters requested to design separation units being reported. Finally, to valorizate the organic matter as biofertilizers and biofuels is proposed.

Seroprevalencia de anticuerpos contra el virus de hepatitis C (VHC) en trabajadoras sexuales que acuden a un Centro de Referencia de Infecciones de Transmisión Sexual (CERITSS) de la ciudad de Iquitos, Perú / Seroprevalence of antibodies against hepatitis C virus in Female sex workers patients from the sexually transmitted Infections Reference Center in Iquitos, Peru

Introducción: los principales factores de riesgo descritos para contraer la infección por el virus de la hepatitis C (VHC) son antecedentes de transfusión sanguínea y uso de droga endovenosa; el riesgo por transmisión sexual es controversial. Existen pocos estudios de VHC en trabajadoras sexuales (TS) en el Perú, encontrando bajas prevalencias de VHC (0-1%). El presente estudio se ha realizado en Iquitos, una ciudad en la selva peruana, en donde existe gran comercio sexual y la prevalencia de HIV/SIDA y otras Infecciones de Transmisión Sexual (ITS) es alta. Objetivo: determinar la seroprevalencia de anticuerpos contra el VHC en TS de la ciudad de Iquitos atendidas en un Centro Especializado de Referencia de Infecciones de transmisión sexual (CERITSS) e identificar los factores de riesgo asociados a esta. Material y métodos: es un estudio de corte transversal en TS quienes acudieron a su control periódico al CERITSS San Juan entre mayo 2003 a enero 2004. Una encuesta clínica-epidemiológica fue utilizada para determinar la frecuencia de factores de riesgo para adquirir la infección por VHC. Para determinar la presencia de anticuerpos contra el VHC, se utilizó la prueba de enzima inmunoensayo (EIA); todos los resultados positivos fueron confirmados con la prueba inmunoblot recombinante (RIBA). Resultados: cuatro de las 200 TS enroladas en el estudio fueron positivos para la prueba EIA, todas ellas tuvieron resultados positivos de RIBA (prevalencia de 2%, IC95% 0,06-3,94%). Estas 4 TS reportaron ser naturales de Iquitos, tener mas de 5 años de trabajo sexual, reportaron un bajo uso de condón (<50%). Tres de ellas reportaron haber tenido mas de 9 parejas/ día, realizar trabajo sexual bajo efecto del alcohol y tener sexo anal frecuentemente. Ninguna refirió transfusiones sanguíneas, antecedente de tatuajes o uso de drogas endovenosas. Solo una de las 4 VHC positivas tuvo serología positiva para sífilis co-existentemente y ninguna para VIH. Una de las 200 TS enroladas tuvo infección por VIH. Conclusiones: la seroprevalencia de anticuerpos contra el VHC en TS es mayor que la reportada en poblaciones similares en otras ciudades del Perú. Esta población se caracterizó por tener una conducta sexual de alto riesgo y no tener antecedentes de transfusión sanguínea ni consumo de droga endovenosa.

Introducction: the principal described risk factors to contract the hepatitis C virus (HCV) are blood transfusion antecedents and intravenous drug use; sexual transmission risk is controversial. In Peru there exist few studies whose female sex worker (FSW) HCV prevalence oscillates between 0-1%. The present study is based in Iquitos, a Peruvian jungle city with high sexual commerce and HIV/AIDS prevalence. Objetive: determine the HCV serological prevalence in Iquitos FSWs attending the STI/ HIV specialist center (CERITSS) and identify associated risk factors. Material and methods: cross-sectional study in FSWs who attended periodic San Juan CERITSS examinations from May 2003 to January 2004. Epidemical questionnaires where used to evaluate the risk factors. To determine HCV antibodies presence, the immunoassay enzyme (EIA) positive results were confirmed by the recombinant immunoblot assay (RIBA) test. Results: 4/200 FSWs enrolled in the study were EIA test positive; all had confirmed positive RIBA results, representing 2%(95%IC 0,06%-3,94%) prevalence. the 4 FSWs referred to be were born in Iquitos, to having been a sex worker for five years and stated condom use was <50%. Three to having had 9 sexual clients daily; to heavy alcohol consumption and to frequent anal sex . None declared intravenous drug use; having had tattoos and blood transfusions. Only one of 4 HCV positives had syphilis serology and none had HIV infections. 1/200 was diagnosed with HIV. Conclusion: the antibody against HCV seroprevalence in Iquitos FSWs is greater than reported in similar populations or the general population of other Peruvian cities. This population was characterized by having high risk sexual behavior and no blood transfusion antecedent nor intravenous drug user.

Nutrición enteral con dieta inmunomoduladora perioperatoria / Enteral nutrition with peri-surgery immunomodulating diet

Objetivo: Valorar el estado nutricional en el perioperatorio, de pacientes afectos de cáncer esofágico o gástrico, tratados mediante esofaguectomía y gastrectomía total respectivamente, y analizar la repercusión de la dieta enteral inmunomoduladora con las complicaciones postquirúrgicas. Ámbito: Pacientes ingresados en el Servicio de Cirugía del Hospital Clínico Universitario de Salamanca. Pacientes y métodos: Pacientes sometidos a esofaguectomía yo gastrectomía total a los que se le aporta nutrición enteral (NE) precoz con una dieta inmunomoduladora. Intervenciones: A todos los pacientes se les pautaba una dieta inmunomoduladora de 1000 kcal/día por vía oral más dieta normal por turmix que iniciaban en el 5º día preoperatorio y continuando en el postoperatorio inmediato (en las primeras 24 h) con NE por catéter de yeyunostomía, de forma progresiva hasta conseguir 25Kcal/Kg/día al 4º-5º día. La NE se mantuvo al menos los primeros diez días del postoperatorio y se realizaron controles analíticos en el preoperatorio en el quinto y décimo días postoperatorios. También realizamos una ecuación de predicción con la variable dependiente morbi-mortalidad y como independientes con el resto de las variables. Resultados: Se estudiaron 68 pacientes de los cuales 36 (35 varones y 1 mujer) padecían cáncer esofágico y 32 (21 varones y 11 mujeres) que padecían cáncer gástrico. La media de edad de los pacientes con cáncer esofágico era de 60 ± 9,68 años con una estancia media postoperatoria de 36,97 ± 62,37 días y las cifras de pacientes con cáncer gástrico eran 69,41 ± 11,53 años y 24,41 ± 13,77 días respectivamente. La comparación de medias de los parámetros nutricionales bioquímicos, puso de manifiesto una disminución de las cifras de casi todas las variables, en la determinación del 5º día postoperatorio respecto de la determinación preoperatoria y posterior aumento en la determinación del 10º día postoperatorio respecto del 5º día. Las diferencias son en la mayoría de los casos estadísticamente significativas. Resultaron ser partícipes en la ecuación de predicción de la morbimortalidad las variables, colesterol, enfermedades asociadas, PCR, IgM y sexo varón. Conclusiones: Las variables analizadas, excepto el sexo, parecen ser indicadores adecuados para el estudio de la respuesta a la agresión quirúrgica y así mismo a la nutrición enteral. La nutrición perioperatoria inmunomoduladora creemos que recupera las cifras de parámetros nutricionales postoperatorios.La nutrición enteral por yeyunostomía es bien tolerada y con morbilidad baja y poco severa (AU)

Objective: To assess the nutritional peri-surgical status of patients suffering from esophageal or gastric cancer, treated with esophagectomy and total gastrectomy, respectively, and to analyze the impact of an enteral immunomodulating diet on postsurgical complications. Setting: Patients admitted to the Surgery Department of Hospital Clínico Universitario of Salamanca. Patients and methods: Patients submitted to esophagectomy and/or total gastrectomy to whom early enteral nutrition (EN) is provided with an immunomodulating diet. Interventions: All patients were prescribed an immunomodulating diet of 1000 Kcal/day p.o. plus a normal grinded diet that they started on the 5th presurgical day and pursued during the immediate postsurgical period (within the first 24 hours) with EN through a jejunostomy catheter, in a progressive way until reaching 25 kcal/kg/day at days 4-5. EN was kept in place for at least the first 10 days after surgery and laboratory checkups were done before surgery and at days 5 and 10 after surgery. We also performed a prediction equation, with morbidity as the dependent variable and the remaining as independent variables. Results: Sixty-eight patients were studied of whom 36 (35 men and 1 women) suffered from esophageal cancer and 32 (21 men and 11 women) from gastric cancer. Mean age of patients with esophageal cancer was 60 ± 9.68 years, with a mean postsurgical stay of 36.97 ± 62.37 days, and for gastric cancer patients mean age was 69.41 ± 11.53 years and mean stay 24.41 ± 13.77 days. The comparison of the means of the biochemical nutrition parameters showed a decrease in almostall values at the 5ht post-surgery day in relation to the presurgical determination, and an increase in the measurement at the 10th postsurgical day as compared to the 5th day values. In most of the cases, the differences are statistically significant. For morbimortality prediction, the variables cholesterol, related diseases, CRP, IgM, and male gender, were contributors. Conclusions: All the analyzed variables, but gender, seem to be appropriate indicators for the study of response to surgical aggression as well as of enteral nutrition. We believe that peri-surgical immunomodulating nutrition recovers the values of postsurgical nutrition parameters. Enteral nutrition through jejunostomy is well tolerated, and has a low and mild morbidity (AU)

Auditory function recovery following acoustic overstimulation.

OBJECTIVE: To examine electrophysiological data from auditory brainstem responses (ABRs) and distortion product otoacoustic emissions (DPOAEs) in chickens following acoustic overstimulation. MATERIAL AND METHODS: A total of 15 white 15-day-old Leghorn chickens were used. The animals were anesthetized with Equithensin, and placed with their heads in a special holder. Click stimuli were generated by a Nicolet CA1000 device and ABRs were recorded subcutaneously using three stainless-steel electrodes. An ILO 92/DP analyzer was used to determine DPOAEs. The noise was generated by a Promax GB 212 device. The acoustic exposure was provoked with a 2-kHz pure tone at 120 dB SPL for 24 h. ABRs and DPOAEs were determined before and immediately post-exposure and 5, 15, 21 and 30 days after the traumatic exposure. RESULTS: In our control DPgram response, the maximum amplitudes (dB SPL) occurred at 1, 1.5, 2, 3 and 4 kHz and the minimum amplitudes at 0.7, 5 and 6 kHz. Immediately following acoustic overstimulation an amplitude loss in all frequencies was detected (p < 0.001). Five days after noise exposure only the amplitude loss at 3 kHz remained. Three waves with positive and negative peaks appeared in our control ABR recordings. An important threshold shift was detected in the ABR response immediately after acoustic overstimulation. Its complete recovery occurred 15 days after the acoustic trauma. CONCLUSION: Recovery of the DPgram response was detected 5 days after acoustic overstimulation, whereas the normal ABR threshold appeared on the 15th day.