Reviewing the effect of aggregates in Rhodamine 6G aqueous solution on fluorescence quantum efficiency.

Rhodamines constitute a class of dyes extensively investigated and applied in various contexts, primarily attributed to their high luminescence quantum yield. This study delves into the impact of aggregation on the thermal and optical properties of Rhodamine 6G (R-6G) solutions in distilled water. Examined properties encompass thermal diffusivity (D), temperature coefficient of the refractive index (dn/dT), fluorescence quantum efficiency (η), and energy transfer (ET). These parameters were assessed through thermal lens (TL) and conventional absorption and emission spectroscopic techniques. The dimerization of R-6G solutions was revisited, revealing that an increase in R-6G concentration alters the features of absorption and emission spectra due to dimer formation, resulting in unexpected behavior of η. Consequently, we introduce a novel model for the fraction of absorbed energy converted into heat (φ), which accounts for emissions from both monomers and dimers. Employing this model, we investigate and discuss the concentration-dependent behaviors of η for monomers (ηm) and dimers (ηd). Notably, our findings demonstrate that ηm values necessitate ηd = 0.2, a relatively substantial value that cannot be disregarded. Additionally, applying the Förster theory for dipole-dipole electric ET, we calculate microparameters for ET between monomers (CDD) and monomer-dimer (CDA). Critical ranges for ET in each case are quantified. Microparameter analysis indicates that ET between monomer-monomer and monomer-dimer species of R-6G dissolved in distilled water holds significance, particularly in determining ηm. These results bear significance, especially in scenarios involving high dye concentrations. While applicable to R-6G in water, similar assessments in other media featuring aggregates are encouraged.

Estimation of the post-mortem interval of human skeletal remains using Raman spectroscopy and chemometrics.

An important demand exists in the field of forensic analysis to objectively determine the post-mortem interval (PMI) when human skeletal remains are discovered. It is widely known that bones undergo different chemical and physical processes after death, mainly due to their interaction with the environment in which they are found, although it is not known exactly what these processes consist of. Multiple techniques have been used so far to follow up these and other post-mortem changes and thus establish the time elapsed since the individual's death, but they present important drawbacks in terms of reliability and accuracy. The aim of this research was to propose an analytical methodology capable of determining the PMI by using non-destructive Raman spectroscopy measurements of human skeletal remains. The recorded Raman spectra provided valuable and potentially useful information from which a multivariate study was performed by means of orthogonal partial least squares regression (OPLSR) in order to correlate the PMI with the detected spectral modifications. A collection of 53 real human skeletal remains with known PMI (15 years ≤ PMI ≤ 87 years) was analysed and used for building and validating the OPLS model. The PMI of 10 out of 14 validation samples could be determined with an accuracy error of less than 30%, demonstrating the adequate predictive performance of the OPLS model even in spite of the large inter-individual variability it handled. This opens up the possibility of applying the OPLS model in combination with non-destructive techniques to the determination of the PMI of human skeletal remains that have been buried in conditions similar or equal to those of cemetery niches and in a geographic location with a Mediterranean climate, which is an important achievement for forensic medicine and anthropology.

Hipertensión arterial no controlable en el primer trimestre de la gestación. Hiperparatiroidismo primario, a propósito de un caso / Uncontrollable hypertension in the first trimester of pregnancy. Primary hyperparathyroidism; a case report

Mujer de 28 años. Sin antecedentes médico-quirúrgicos de interés. Gestación actual gemelar bicorial-biamniótica espontánea. Ingresa con 9 semanas por vómitos incoercibles con diagnóstico de hiperemesis gravídica. Las tensiones arteriales se mantienen elevadas. Se inicia estudio de enfermedad hipertensiva y tratamiento, sin mejoría. En las analíticas destacan una calcemia y PTH muy elevada con fosforemia baja. Se completa estudio con ecografía de cuello informada como presencia de lesión hipoecoica inferior al lóbulo tiroideo derecho sugestiva de adenoma paratiroideo. Se confirma diagnóstico de hipercalcemia severa secundaria a hiperparatiroidismo primario por adenoma de paratiroides. Se decide realizar paratiroidectomía en segundo trimestre, tras la cual se produce descenso de la calcemia y control de la tensión arterial y del resto de clínica. Aunque es la causa más frecuente de hipercalcemia en la población general, se trata de una enfermedad poco frecuente en mujeres en edad fértil. Su incidencia aproximada durante el embarazo es de 8/10.000. Durante el embarazo se produce una transferencia de calcio y fósforo materno al feto, lo que provoca la supresión de la secreción de PTH fetal y el incremento de los valores de calcitonina. Se asocia a una alta morbimortalidad materno-fetal, con riesgo de nefrolitiasis, hiperemesis, HTA, gran morbilidad con aumento de riesgo de preeclampsia y de afección renal. Como complicaciones obstétricas destacan el aumento del riesgo de aborto, amenaza de parto pretérmino y el desarrollo de fetos con retraso del crecimiento intrauterino. Entre las medidas conservadoras de tratamiento se recomienda mantener una buena hidratación oral, limitar la ingesta de calcio y tratar los síntomas asociados. La paratiroidectomía es el tratamiento definitivo y se debe realizar en el segundo trimestre

Spontaneous dichorionic-diamniotic twin pregnancy. Patient is admitted at 9weeks pregnant due to uncontrollable vomiting and is diagnosed with hyperemesis gravidarum. Blood pressure remains high. Study of hypertensive disease and treatment initiated without improvement. Blood tests showed a very high serum calcium and PTH with low phosphoremia. Study is completed with neck ultrasound revealing a lower hypoechoic lesion of the right thyroid lobe suggestive of parathyroid adenoma. Diagnosis of severe hypercalcemia secondary to primary hyperparathyroidism due to parathyroid adenoma was confirmed. It was decided to perform a parathyroidectomy in the second trimester after which a decrease in serum calcium, control blood pressure and other symptoms was found. Although it is the most common cause of hypercalcemia in the general population, it is a rare condition in women of childbearing age. Its approximate incidence during pregnancy is 8/10,000. During pregnancy, maternal calcium and phosphorus is transferred to the fetus, which results in suppression of fetal PTH secretion and increased fetal calcitonin values. It is associated with high maternal and fetal morbidity and mortality and risk of nephrolithiasis, hyperemesis, hypertension, high morbidity with increased risk of preeclampsia and kidney disease. In the fetus, there is an increased risk of spontaneous abortion, intrauterine growth retardation and preterm birth. Among conservative treatment measures, it is recommended to maintain good oral hydration, limit calcium intake and treat associated symptoms. Parathyroidectomy is the definitive treatment and should be performed in the second trimester

Influence of gold nanoholes and nanoslits arrays on Raman spectra and optical reflectance of graphene oxide.

We report the effect of gold nanostructured substrates, fabricated by interference lithography technique (IL), on the Raman spectra and optical reflectance of graphene oxide (GO) layers. For purposes of comparison two gold nanostructured substrates, nanoslits (AuNSs) and circular nanoholes (AuNHs) were compared with a non-nanostructured gold substrate. Effects induced by the gold nanostructured substrates are discussed in terms of the ID/IG ratio and the FWHM of the G band (FWHM(G)) as a function of the G band intensity (IG), showing that both ID/IG and FWHM(G) parameters are highly sensitive to the number of GO layers (nGO), which would allow to identify the number of GO layers in a reliable way. Optical reflectance spectra (R(λ)) reveal that plasmons are generated on the surface of nanostructured substrates by the incident radiation. Dips in R(λ) are ascribed as coupling by surface plasmon polaritons described by Bloch waves (BW-SPP). A peak in R(λ) is also observed and it is ascribed to visible radiation produced by Förster resonance energy transfer and Purcell effect. The relevance of these results lies in the possibility of designing colorimetric plasmonic sensors, based on few layers of GO with an excellent control of nGO and with potential in detection of molecules by fluorescent absorption.

La rehabilitación con implantes en el paciente edéntulo maxilar mediante cirugía guiada y carga inmediata / Implant rehabilitation of maxillary edentulous patient by guided surgery and immediate loading

INTRODUCCIÓN: La cirugía guiada y la carga inmediata de los implantes constituye un nuevo enfoque integral de la rehabilitación de los pacientes edéntulos. El objetivo del presente trabajo era presentar el protocolo diagnóstico, quirúrgico y protésico del tratamiento con implantes mediante la técnica de cirugía guiada y carga inmediata en el tratamiento del maxilar edéntulo. CASO CLÍNICO: Paciente varón de 70 años que acude a consulta para tratamiento con implantes del maxilar edéntulo. La tomografía computarizada de haz cónico (TCHC) muestra que el paciente presenta un adecuado volumen óseo para la inserción de implantes. La información obtenida por la TCHC es utilizada para la evaluación y el plan de tratamiento. Se planificaron diez implantes. Los datos digitales de imagen tomográfica fueron enviados a un centro especializado (Galimplant 3.D(R)) para la realización de la férula quirúrgica y la prótesis provisional. De acuerdo a la férula guiada se insertaron los implantes sin colgajo con un fresado preciso. La prótesis fija inmediata provisional fue realizada y ajustada sobre los pilares, evaluando su oclusión. La prótesis fija definitiva se realizó después de un periodo de 6 meses. CONCLUSIONES: Este caso clínico indica que la implantología oral guiada puede constituir una terapéutica exitosa en el tratamiento del paciente edéntulo maxilar

INTRODUCTION: Guided surgery and immediate functional loading of dental implants constitute a new comprehensive approach for rehabilitation of edentulous patients. The aim of this paper was to present the diagnosis, surgical and prosthetic protocol of implants by guided technique and immediate loading in the treatment of edentulous maxilla. CASE REPORT: A 70-year-old-man, requested an evaluation regarding implant treatment for the edentulous maxilla. The cone beam computarized tomography (CBCT) showed that the patient have an adequate bone volume for maxillary implant placement. The data from CBCT were used for evaluation and treatment planning. Ten implants were treatment planned. Digital data were sent to a software manufacturer (Galimplant.3D(R)) and surgical template and fixed provisional prosthesis according clinical examination were received. According surgical template implants were inserted for a flapless surgical technique with an accuraced drilling. Immediate transitional fixed prosthesis were realized and adjusted with the abutment and finally, occlusion is evaluated. Definitive fixed prosthesis was realized after a 6 month-period of time. CONCLUSIONS: This paper indicated that guided implant dentistry may constitute a successful treatment of edentulous maxillary patients

Anti-ENA profiles related with anti-SS-A/Ro. The detection of Ro52 and Ro60 according to the presence of SS-B/La, and ANA pattern and titer.

Anti-Ro52 (Ro52) and anti-Ro60 (Ro60) antibodies are associated with different clinical entities. We investigated their relationship with the presence of anti-SS-B/La (SSB) antibody, the pattern and titer of antinuclear antibody (ANA), and the variations in antibody profiles related with anti-SS-A/Ro (SSA) positivity. Our aim was to develop a strategy to increase the efficiency of anti-extractable nuclear antigen (ENA) determinations. Statistical analyses were based on the Chi-squared test for categorical variables, the Mann-Whitney U test to compare profiles, and the odds ratio (OR) and 95% confidence interval (95% CI) to estimate the risk of variability. We analyzed 800 SSA-positive samples with Ro52 or Ro60 reactivity. The most frequent profiles were Ro52+Ro60+SSB (n=349, 43.6%); Ro52+Ro60 (n=126, 15.8%); Ro52 (n=121, 15.1%) and Ro60 (n=71, 8.9%). In samples positive only for SSA and an ANA titer ≤1:640, the most likely profile was positivity for either Ro52 or Ro60, whereas when the ANA titer was >1:640, positivity for both Ro52 and Ro60 simultaneously was more likely (p<0.001). In samples positive for both SSA and SSB, the most likely profile was Ro52+Ro60+SSB regardless of the ANA titer (p=0.001). When only SSA was positive and the ANA staining pattern was nucleolar, centromeric or cytoplasmic, Ro52 positivity was most likely (p<0.001). When both SSA and SSB were positive, both Ro52 and Ro60 were likely to be positive regardless of the ANA staining pattern. In 28.7% of the patients the profile was variable. Variability was significantly greater in those with the SSA profile (23/67) than with the SSA+SSB profile (15/105; OR=1.9, 95% CI=1.1-3.3; p=0.025), and the difference in variability was greatest between the Ro52+Ro60 profile (8/23) and the Ro52+Ro60+SSB profile (8/68; OR=4.2, 95% CI=1.9-9.5; p<0.001). We conclude that to increase efficiency in the immunology laboratory, positivity for Ro52 and Ro60 individually or simultaneously can be deduced from SSB status and the ANA pattern and titer. In general, for the most frequent anti-ENA findings, priority should be given to retesting autoantibodies not detected in the initial analysis.

Validez de un método fotométrico de medición de partículas en aire para el control de quirófanos y otras salas de ambiente controlado en los hospitales / Validity of a photometric method of counting particles in air for control of operating rooms and clean rooms in hospitals

Objetivo: Validar un sistema de medici¨®n fotom¨¦trica de part¨ªculas en aire para realizar los controles de bioseguridad ambiental de quir¨®fanos y otras salas de ambiente controlado en los hospitales. Material y m¨¦todos: Se realizaron un total de 144 mediciones pareadas de aire, 88 en ocho quir¨®fanos con sistemas de ventilaci¨®n convencional y tres niveles de filtraci¨®n y 56 en nueve habitaciones sin instalaciones de ventilaci¨®n. Se midieron part¨ªculas de entre 0,1 a 10 ¦Ìm en mg/m3 por m¨¦todo fotom¨¦trico. Simult¨¢neamente, en cada sala se realiz¨® impacto de aire en placas de Petri con medio de cultivo mediante aparato aspirador de cabezal perforado, obteniendo tras cinco d¨ªas de incubaci¨®n recuento de unidades formadoras de colonias (UFC)/1000L. Finalmente se realiz¨® el c¨¢lculo de los puntos de corte ¨®ptimos para la medici¨®n de part¨ªculas mediante Curvas ROC para discriminar tres niveles de contaminaci¨®n. Resultados: El coeficiente de correlaci¨®n entre las dos mediciones fue 0,779 (p<0,001). Los puntos de corte fueron para 0 UFC. 0,015, para >=10 UFC, 0,037, y para >=100 UFC, 0,053. La sensibilidad para estos puntos fue de 95,83%,100% y 100%, y los ¨ªndices Kappa registraron 0,51, 0,88 y 0,75 respectivamente. Conclusi¨®n: En nuestro estudio la correlaci¨®n entre las medidas es notable; la medici¨®n fotom¨¦trica de part¨ªculas puede ser una alternativa para llevar a cabo alguno de los controles rutinarios de bioseguridad (AU)

Objective: Validate a photometric on-air particle measurement system in order to perform ambient bio-security checks in operating rooms and other clean rooms within hospitals. Material and methods: A total of 144 coupled air samples were performed, 88 in 8 different operating rooms with conventional ventilation systems and 3-level filtering and 56 in 9 different rooms without specific ventilation systems. Particles were measured in size between 0,1 to 10 ¦Ìm with the photometric system in mg/m3. Simultaneously in the rooms are performed the sampling air method with impact on culture media. Incubation period is 5 days and count is performed in colony-forming units (CFU/1000L). Finally, optimal cut-points in particles measure were calculated using ROC curves in order to discriminate the three different contamination levels. Results: Spearma´s correlation coefficient was 0,779 p<0,001. Sensitivity for cut-points in particle counting for the different contamination levels was 95,83% ,100% and 100% respectively, and the corresponding Kappa indexes were 0,51; 0,88 and 0,75. Conclusion: Correlation among measurements is notable. Particle measurement can be a worthy alternative for some of the routine bio-security checks (AU)

Perforin-2 restricts growth of Chlamydia trachomatis in macrophages.

Chlamydia trachomatis is a Gram-negative obligate intracellular bacterium that preferentially infects epithelial cells. Professional phagocytes provide C. trachomatis only a limited ability to survive and are proficient killers of chlamydiae. We present evidence herein that identifies a novel host defense protein, perforin-2, that plays a significant role in the eradication of C. trachomatis during the infection of macrophages. Knockdown of perforin-2 in macrophages did not alter the invasion of host cells but did result in chlamydial growth that closely mirrored that detected in HeLa cells. C trachomatis L2, serovar B, and serovar D and C. muridarum were all equally susceptible to perforin-2-mediated killing. Interestingly, induction of perforin-2 expression in epithelial cells is blocked during productive chlamydial growth, thereby protecting chlamydiae from bactericidal attack. Ectopic expression of perforin-2 in HeLa cells, however, does result in killing. Overall, our data implicate a new innate resistance protein in the control of chlamydial infection and may help explain why the macrophage environment is hostile to chlamydial growth.

Chronic dietary fiber supplementation with wheat dextrin does not inhibit calcium and magnesium absorption in premenopausal and postmenopausal women.

This placebo-controlled, randomized, crossover clinical study examined the effect of chronic wheat dextrin intake on calcium and magnesium absorption. Forty premenopausal and post menopausal women (mean ± SD age 49.9 ± 9.8 years) consumed wheat dextrin or placebo (15 g/day) for 2 weeks prior to (45)calcium ((45)Ca) and (26)magnesium ((26)Mg) absorption testing. After a standardized breakfast, serial blood and urine samples were obtained. The mean ± SD area under the curve from 0 to 9 h for (45)Ca specific activity was 0.81 ± 0.21 for wheat dextrin and 0.82 ± 0.22 for placebo, showing that wheat dextrin had no effect on calcium absorption. The mean ± SD percentage excess of (26)Mg/(24)Mg was 7.8% ± 2.1% for wheat dextrin and 7.9% ± 2.6% for placebo, showing that wheat dextrin had no effect on magnesium absorption. In conclusion, chronic wheat dextrin consumption did not inhibit calcium or magnesium absorption from the gastrointestinal tract in women.

[Improved detection of the pulse oximeter signal with a digital nerve block in patients in poor health status]. / Mejoría en la detección de la onda de pulsioximetría mediante el bloqueo anestésico de los nervios digitales en pacientes en mal estado general.

OBJECTIVE: To demonstrate the efficacy of a digital nerve block for improving pulse oximetry in conditions of low tissue perfusion. METHOD: A randomized single-blind study of adult patients undergoing surgery under general anesthesia for conditions characterized by hypoperfusion. Patients were assigned to a control group or an experimental group. The experimental group received a digital nerve block in the middle finger of the left hand; a sensor was then placed on the finger for between 120 and 300 minutes. Age, sex, diagnosis, total observation time (TOT), percentage of time with no pulse oximeter signal (NoPO), and percentage of time with an unstable pulse oximeter signal (UnstPO) were recorded. Each patient was questioned between 16 and 24 hours after surgery and was examined for flushing, paresthesia, hypoesthesia, pain, and ecchymosis. The chi2 test was used to compare dichotomized or nominal variables and the t test was used to compare age, TOT, NoPO, and UnstPO. Values of P<.05 were considered statistically significant in both cases. RESULTS: Fifty patients were randomized to each group. A total of 82 patients remained in the study (control group=42, experimental group=40). There were no significant between-group differences in diagnoses or TOT. The mean values for NoPO and UnstPO were higher in the control group than in the experimental group (11.1% vs 4.4% and 35.9% vs 15.7%, respectively; P<.001). CONCLUSION: A digital nerve block can be used to prevent pulse oximetry failures in conditions of low peripheral perfusion.

Mejoría en la detección de la onda de pulsioximetría medianteel bloqueo anestésico de los nervios digitales en pacientesen mal estado general / Improved detection of the pulse oximeter signal with a digital nerve block in patients in poor health status

OBJETIVO: Demostrar la eficacia del bloqueo de losnervios digitales (BND) para mejorar la oximetría depulso (OP) en condiciones de baja perfusión hística.MÉTODO: Pacientes adultos operados por afeccionescaracterizadas por hipoperfusión, conducidos con anestesiageneral, de forma aleatoria y con registros a simpleciego. Se asignaron a dos grupos: Grupo C (control) ygrupo B (experimental). El grupo B recibió un BND enel dedo medio de la mano izquierda donde se colocó elsensor con límites de tiempo entre 120 y 300 minutos. Seregistraron: edad, sexo, diagnóstico, tiempo total deobservación (TTO), porcentajes de tiempo con OP nodisponible (OPnodisp) y porcentaje de tiempo con OPinestable (OPinest). Entre 16 y 24 horas después de terminadala intervención se interrogó y examinó a cadapaciente en busca de rubor, parestesias, hipostesia,dolor y equimosis. Para las variables dicotómicas onominales se empleó la prueba χ2 y para comparar lasmedias de edad, TTO, OPnodisp, y OPinest, la prueba tde Student. En ambos casos con un nivel de significaciónde 0,05.RESULTADOS: Se asignaron 50 pacientes a cada grupo.Un total de 82 enfermos permanecieron en el ensayo(C=42 y B=40). No hubo diferencias significativas encuanto a diagnósticos ni TTO. En el grupo C los porcentajesde tiempo promedio con OPnodisp y OPinest fueronsuperiores (11,1% vs. 4,4% y 35,9% vs. 15,7%; respectivamente),p<0,001.CONCLUSIÓN: El BND es una alternativa para evitarlas fallas de OP en condiciones de baja perfusión periférica (AU)

OBJECTIVE: To demonstrate the efficacy of a digitalnerve block for improving pulse oximetry in conditionsof low tissue perfusion.METHOD: A randomized single-blind study of adultpatients undergoing surgery under general anesthesiafor conditions characterized by hypoperfusion. Patientswere assigned to a control group or an experimentalgroup. The experimental group received a digital nerveblock in the middle finger of the left hand; a sensor wasthen placed on the finger for between 120 and 300minutes. Age, sex, diagnosis, total observation time(TOT), percentage of time with no pulse oximeter signal(NoPO), and percentage of time with an unstable pulseoximeter signal (UnstPO) were recorded. Each patientwas questioned between 16 and 24 hours after surgeryand was examined for flushing, paresthesia,hypoesthesia, pain, and ecchymosis. The χ2 test was usedto compare dichotomized or nominal variables and the ttest was used to compare age, TOT, NoPO, and UnstPO.Values of P<.05 were considered statistically significantin both cases.RESULTS: Fifty patients were randomized to eachgroup. A total of 82 patients remained in the study(control group=42, experimental group=40). Therewere no significant between-group differences indiagnoses or TOT. The mean values for NoPO andUnstPO were higher in the control group than in theexperimental group (11.1% vs 4.4% and 35.9% vs15.7%, respectively; P<.001).CONCLUSION: A digital nerve block can be used toprevent pulse oximetry failures in conditions of lowperipheral perfusion (AU)

Could clinical audit improve the diagnosis of pulmonary tuberculosis in Cuba, Peru and Bolivia?

OBJECTIVES: To assess the effectiveness of clinical audit in improving the quality of diagnostic care provided to patients suspected of tuberculosis; and to understand the contextual factors which impede or facilitate its success. METHODS: Twenty-six health centres in Cuba, Peru and Bolivia were recruited. Clinical audit was introduced to improve the diagnostic care for patients attending with suspected TB. Standards were based on the WHO and TB programme guidelines relating to the appropriate use of microscopy, culture and radiological investigations. At least two audit cycles were completed over 2 years. Improvement was determined by comparing the performance between two six-month periods pre- and post-intervention. Qualitative methods were used to ascertain facilitating and limiting contextual factors influencing change among healthcare professionals' clinical behaviour after the introduction of clinical audit. RESULTS: We found a significant improvement in 11 of 13 criteria in Cuba, in 2 of 6 criteria in Bolivia and in 2 of 5 criteria in Peru. Twelve out of 24 of the audit criteria in all three countries reached the agreed standards. Barriers to quality improvement included conflicting objectives for clinicians and TB programmes, poor coordination within the health system and patients' attitudes towards illness. CONCLUSIONS: Clinical audit may drive improvements in the quality of clinical care in resource-poor settings. It is likely to be more effective if integrated within and supported by the local TB programmes. We recommend developing and evaluating an integrated model of quality improvement including clinical audit.

Inhibitory effect of voluntary movement preparation on cutaneous heat pain and laser-evoked potentials.

In our study, preparation of voluntary movement was used to physiologically activate the motor cortex areas and the effect of this activation on CO(2) laser-evoked potentials (LEPs) was explored. LEPs were recorded from 31 scalp electrodes in 10 healthy subjects after painful stimulation of the right C6-C7 skin dermatomes. LEP stimuli were delivered in the time interval between a visual warning stimulus followed after 1 s. by an imperative stimulus. The imperative stimulus triggered: (i) no task in the baseline condition (Pain); (ii) flexion-extension movements of the second finger of the right hand in the movement condition (Pain + Movement); (iii) cognitive task (mathematic computation) in the distraction condition (Pain + Cognition). The experimental conditions were also repeated during application of laser stimuli on the left C6-C7 skin dermatomes. Compared with the baseline condition (no task required), during preparation of right-hand voluntary movement there was a significant reduction in LEP amplitude and subjective pain rating after right- but not after left-hand stimulation, which suggests that the observed effect cannot be attributed to a nonspecific reduction in attention toward painful stimulus. During preparation of a cognitive task, LEP amplitude was reduced compared to baseline. Our results represent the first neurophysiological suggestion that physiological activation of the motor cortex, occurring during movement preparation, inhibits cortical pain processing by a centrifugal mechanism.

Progress towards tuberculosis elimination in Cuba.

SETTING: The Cuban National Tuberculosis Control Programme (NTCP) was implemented in 1962, and has included directly observed treatment since 1971 and DOTS since 1982. OBJECTIVE: To assess the short-term trends of major indicators of tuberculosis (TB) elimination. METHODS: A surveillance system has been created on treatment and case finding. Data from the National TB Registry of the Ministry of Public Health were reviewed. RESULTS: The incidence of TB declined from 1965 to 1991 from 65.0 to 4.7 per 100000 population, then reversed in the period 1992-1994. The implementation of a re-intervention package recovered the increase from 1995 to 1998. From 1999 to 2003, 97.5% of TB suspects identified underwent sputum smear microscopy. The incidence rate declined from 10.0 to 7.2/100000. In 2003 the case detection rate was 92.2%; the overall TB cure rate was 92% and TB human immunodeficiency virus (HIV) co-infection was 3%. Two of Cuba's 15 provinces reached incidence rates of <5/100000, eliminating TB as a public health problem. CONCLUSION: Low incidence, high detection and cure rates, along with low rates of TB-HIV co-infection, are evidence of progress towards the elimination of TB as a public health problem in Cuba, using DOTS in a context of good socio-cultural and technological interaction.

Modulation of laser-evoked potentials by experimental cutaneous tonic pain.

The present study aimed to investigate whether tonic cutaneous pain exerts any effect on the cortical processing of nociceptive input and if this effect may involve only body parts in pain. Tonic cutaneous pain was obtained in nine healthy human subjects by infusion of a hypertonic saline (5%) in the s.c. tissue over the hypothenar muscles (10 ml/h for 20 min). Nociceptive cutaneous CO2 laser-evoked potentials were recorded after stimulation of the right hand dorsum, which was adjacent to the painful area, and the right perioral region, corresponding to the adjacent cortical sensory area. Laser-evoked potentials were obtained before saline injection, at the peak pain and 20 min after pain disappeared. During saline infusion, the laser-evoked pain to right hand stimulation was reduced and the vertex laser-evoked potentials (N2a-P2, mean latency 181 ms and 319 ms for the N2a and the P2 potentials, respectively), which are generated in the anterior cingulate cortex, were significantly decreased in amplitude compared with the baseline. Moreover, the topography of these potentials was modified by cutaneous pain, shifting from the central toward the parietal region. Dipolar modeling showed that the dipolar source in the anterior cingulate cortex moved backward during saline infusion. This result suggests that cutaneous pain may modify the relative activities of the anterior and posterior anterior cingulate cortex parts, which are thought to be devoted to encode different aspects of pain sensation. No laser-evoked potential change was observed after stimulation of the right perioral region, suggesting that functional changes in the nociceptive system are selective for the painful regions and not for areas with cortical proximity.

Malignant mixed Mullerian tumors.

Malignant mixed Mullerian tumours (MMMTs) are rare neoplasms, highly aggressive and with an extremely poor prognosis, usually arising in elderly postmenopausal women and presenting at an advanced stage. MMMTs derive from the mullerian mesodermus that differentiates in epithelial and stromal elements, both malignant elements. The clinic pathological features of 3 uterine MMMTs are reported here. The patients ranged in age from 25 to 69 years. The initial manifestations were mainly bloody discharge, abdominal pain and increase of the volume of the uterus. Treatment in 2 patients was hysterectomy with double ooforectomy, and resection of the pelvic mass was the treatment in the third case. Adjuvant radio chemotherapy was administrated in 2 of the 3 cases. Follow-up revealed recurrent pelvic tumour in 1 patient at 59 months, and breast metastases at 20 months in the second one. Because of the high incidence of recurrence and poor prognosis of these tumours, they should be studied and managed by a multidisciplinary team composed by surgeons, oncologists, radiotherapists and pathologists.

Malignant mixed mullerian tumors

No disponible

Malignant mixed mullerian tumours (MMMTs) arerare neoplasms, highly aggressive and with an extremelypoor prognosis, usually arising in elderlypostmenopausal women and presenting at an advancedstage. MMMTs derive from the mullerianmesodermus that differentiates in epithelial andstromal elements, both malignant elements.The clinic pathological features of 3 uterine MMMTsare reported here. The patients ranged in age from25 to 69 years. The initial manifestations weremainly bloody discharge, abdominal pain and increaseof the volume of the uterus. Treatment in 2patients was hysterectomy with double ooforectomy,and resection of the pelvic mass was the treatmentin the third case. Adjuvant radio chemotherapywas administrated in 2 of the 3 cases. Follow-uprevealed recurrent pelvic tumour in 1 patient at 59months, and breast metastases at 20 months in thesecond one.Because of the high incidence of recurrence andpoor prognosis of these tumours, they should bestudied and managed by a multidisciplinary teamcomposed by surgeons, oncologists, radiotherapistsand pathologists

Segmental inhibition of cutaneous heat sensation and of laser-evoked potentials by experimental muscle pain.

The aim of the study was to evaluate the effect of tonic muscle pain evoked by injection of 5% hypertonic saline in the right brachioradialis muscle on the somatosensory sensation of laser-evoked heat pain and laser-evoked potentials. The heat pain pathways were studied in 9 healthy human subjects by recording the scalp potentials evoked by CO(2) laser stimuli delivered on four sites: the skin above the right brachioradialis muscle (ipsilateral local pain), the wrist area where muscle pain was referred in all subjects (ipsilateral referred pain), and two areas on the left arm symmetrical to both local and referred pain (contralateral local pain and contralateral referred pain). Laser-evoked potentials were obtained from 31 scalp electrodes before saline injection, during saline infusion (bolus injection with 0.3 ml saline infused over 20 s, followed by a steady infusion rate of 30 ml/h for the next 25 min), and 20 min after muscle pain had disappeared. While the early N1/P1 component (around 130 ms and 145 ms of latency after stimulation of the skin over the brachioradialis muscle and the wrist, respectively) was not affected by muscle pain, the amplitudes of the later vertex laser-evoked potentials (N2 latency of around 175 ms and 210 ms after stimulation of the skin over the brachioradialis muscle and the wrist, respectively; P2 latency of around 305 ms and 335 ms after stimulation of the skin over the brachioradialis muscle and the wrist, respectively) evoked from ipsilateral local pain, ipsilateral referred pain, and contralateral local pain sites were significantly decreased during muscle pain compared with the baseline recording, while they recovered after pain had disappeared. At the same stimulation sites, the rating of the laser-evoked pain sensation was reduced significantly during muscle pain as compared with the baseline and it recovered after pain had disappeared. On the contrary, muscle pain did not show any effect on both laser-evoked pain and laser-evoked potential amplitude when the contralateral referred pain site was stimulated. The muscle pain inhibitory effect on both heat pain sensation and laser-evoked potential amplitude is probably mediated by an ipsilateral and contralateral segmental mechanism which acts also on the referred pain area, while more general inhibitory mechanisms, such as a distraction effect or a diffuse noxious inhibitory control, are excluded by the absence of any effect of muscle pain on laser-evoked pain and laser-evoked potentials obtained from a remote site, such as the contralateral referred pain area. Since muscle pain induced by hypertonic saline injection is very similar to clinical pain, our results can be useful in understanding the pathophysiology of the somatosensory modifications which can be observed in patients with musculoskeletal pain syndromes.

Unmyelinated trigeminal pathways as assessed by laser stimuli in humans.

Laser pulses excite superficial free nerve endings innervated by small-myelinated (Adelta) and unmyelinated (C) fibres. Whereas laser-evoked scalp potentials (LEPs) are now reliably used to assess function of the Adelta-fibre nociceptive pathways in patients with peripheral or central lesions, the selective activation of C-fibre receptors and recording of the related brain potentials remain difficult. To investigate trigeminal C-fibre function, we directed laser pulses to the facial skin and studied sensory perception and scalp evoked potentials related to Adelta- or C-fibre activation in healthy humans and patients--one having a bilateral facial palsy, two a trigeminal neuropathy, and two a Wallenberg syndrome. We also measured afferent conduction velocity and, with source analysis, studied the brain generators. Whereas laser pulses of low intensity and small irradiated area elicited pinprick sensations and standard Adelta-LEPs, laser pulses of very-low intensity and large irradiated area elicited warmth sensations and scalp potentials with a latency compatible with C-fibre conduction (negative wave 280 ms, positive wave 380 ms); the estimated conduction velocity was 1.2 m/s. The main waves of the scalp potentials originated from the anterior cingulate gyrus; they were preceded by activity in the opercular region and followed by activity in the insular region. The patient with bilateral facial palsy, who had absent trigeminal-facial reflexes, had normal Adelta- and C-related scalp potentials; the patients with trigeminal neuropathy, characterized by loss of myelinated and sparing of unmyelinated fibres, had absent Adelta- but normal C-related potentials; and the patients with Wallenberg syndrome had absent Adelta- and C-related potentials. We conclude that laser pulses with appropriate characteristics evoke brain potentials related to the selective activation of trigeminal nociceptive Adelta or thermal C fibres. The trigeminal territory yields rewarding LEP findings owing to the high density of thermal receptors and, because the short conduction distance, minimizes the problem of signal dispersion along slow-conducting unmyelinated afferents. The opercular-insular region and the cingulate gyrus are involved in the processing of C-fibre trigeminal inputs. The method we describe may prove useful in patients with lesions affecting the trigeminal thermal pain pathways.

[Economic and social impact of the National Tuberculosis Control Program (NTCP) on the Cuban population]. / Impacto económico-social del Programa Nacional de Control de la Tuberculosis (PNCT) en la población Cubana.

Tuberculosis (TB) control strategies provide one of the greatest cost/effectiveness results. To assess the impact of the national TB control program on the Cuban population, the time series of new TB cases and death reports, potential years of life lost, and the numbers of beds for TB case hospitalization in the entire country during 1964-91 and 1992-96 were described by common simple calculation on the basis of estimated expected values. The reduction in new TB cases and deaths, potential years of life saved, and savings in expenditures for treatment, hospitalization, and unemployment compensation were estimated. From 1965 to 1991 new case reports were reduced by 94.6% (4% per year); 86,500 cases were avoided; 166,439 potential years of life were saved; 2,831,625 million pesos were saved on tuberculostatic drugs; 82.7 million pesos were saved on unemployment compensation under the social security system for workers with active TB. Estimated savings totaled 494,919,631.3 pesos. Nationwide intervention for TB control produced an important impact on the basis of the sociopolitical status making it possible to approach complete elimination of the disease in the future.