Relación del machismo con la aceptación de la diabetes mellitus tipo 2 en hombres adultos / Machismo relationship with type 2 diabetes mellitus acceptance among adult men / Relação do machismo com a aceitação do diabetes mellitus tipo 2 em homens adultos

RESUMEN Introducción La aceptación de la diabetes mellitus tipo 2 contribuye al apego del tratamiento y al control de la enfermedad. Pero se ha reportado que los hombres tienen menor aceptación al diagnóstico de este padecimiento. En los hombres mexicanos la no aceptación puede estar relacionada con el machismo. Objetivo Identificar la relación del machismo con la aceptación de la diabetes mellitus tipo 2. Metodología Se realizó un estudio transversal y correlacional. La población de interés fue de hombres con diabetes mellitus tipo 2 entre 20 y 59 años de edad registrados en centros de atención primaria del área metropolitana de Monterrey, Nuevo León, México. Se obtuvo una muestra de 121 participantes a través de un muestreo por conveniencia. Los instrumentos utilizados fueron el Inventario de Conformidad de las Normas Masculinas y la Escala Aceptación en DMT2. Para el análisis estadístico se empleó el programa SPSS versión 25; se realizó un modelo de regresión lineal múltiple. Resultados Los resultados señalan que los hombres con percepción de mayor machismo, jornadas laborales extensas y consumo elevado de cigarrillos aceptan menos el diagnóstico y la enfermedad de la diabetes mellitus tipo 2. Para las subdimensiones del machismo, la homofobia fue el mejor predictor de la aceptación o no de la diabetes mellitus tipo 2. Conclusiones El profesional de salud debe desarrollar programas para la aceptación de la diabetes mellitus tipo 2 en hombres de reciente diagnóstico que contribuyan a aceptar su enfermedad, y así, permitan mejorar el autocuidado, control glucémico y prevención de complicaciones.

ABSTRACT Introduction Accepting a diagnosis of type 2 diabetes mellitus contributes to the adher- ence to the treatment and control of the illness; however, it has been reported that men tend to have a lower acceptance of this diagnosis. Among Mexican men, in particular, this low acceptance could be related to their machismo. Objective To identify the relationship of machismo with the acceptance of a type 2 diabetes mellitus diagnosis. Methodology This is a transversal and correlational study. The population of interest were Mexican men diagnosed with type 2 diabetes mellitus between 20 and 59 years registered in centers of primary attention in the city of Monterrey, Mexico. The sample was constituted of 121 participants chosen by convenience. The instruments used were the Conformity to Masculine Norms Inventory and the Acceptance Scale for DM2. The statistical analysis and the multiple linear regression model were carried out using SPSS v25. Results Findings suggest that men who show machismo, who have long labor shifts, and who consume large quantities of cigarettes tend not to accept a diagnosis of type 2 diabetes mellitus. Regarding the subdimensions of the machismo construct, homophobia was the best predictor of accepting or not a diagnosis of type 2 diabetes mellitus. Conclusions Healthcare professionals should develop programs aimed at improving the acceptance attitude of a type 2 diabetes mellitus diagnosis among men, including those with machismo, in order to better manage self-care, glucose control, and also prevent complications.

RESUMO Introdução A aceitação do diabetes mellitus tipo 2 contribui para a adesão ao tratamento e controle da doença. Mas, tem sido relatado que os homens têm menos aceitação do diagnóstico desta doença. Nos homens mexicanos, a não aceitação pode estar relacionada ao machismo. Objetivo Identificar a relação do machismo com a aceitação do diabetes mellitus tipo 2. Metodologia Foi realizado um estudo transversal e correlacional. A população de interesse foram homens com diabetes mellitus tipo 2 entre 20 e 59 anos registrados em centros de atenção primária na área metropolitana de Monterrey, Nuevo León, México. Foi obtida uma amostra de 121 participantes por amostragem de conveniência. Os instrumentos utilizados foram o Inventário de Conformidade com Normas Masculinas e a Escala de Aceitação DMT2. Para a análise estatística utilizou-se o programa SPSS versão 25; um modelo de regressão linear múltipla foi realizado. Resultados Os resultados indicam que homens com percepção de maior machismo, longas jornadas de trabalho e alto consumo de cigarro aceitam menos o diagnóstico e a doença de diabetes mellitus tipo 2. Para as subdimensões do machismo, a homofobia foi o melhor preditor de aceitação ou não de diabetes melito tipo 2. Conclusões O profissional de saúde deve desenvolver programas de aceitação da diabetes mellitus tipo 2 em homens recém-diagnosticados que contribuam para a aceitação da sua doença e, assim, permitam melhorar o autocuidado, o controlo glicémico e a prevenção de complicações.

Diagnostic delay and outcome in immunocompetent patients with primary central nervous system lymphoma in Spain: a multicentric study.

INTRODUCTION: To assess the management of immunocompetent patients with primary central nervous system lymphomas (PCNSL) in Spain. METHODS: Retrospective analysis of 327 immunocompetent patients with histologically confirmed PCNSL diagnosed between 2005 and 2014 in 27 Spanish hospitals. RESULTS: Median age was 64 years (range: 19-84; 33% ≥ 70 years), 54% were men, and 59% had a performance status (PS) ≥ 2 at diagnosis. Median delay to diagnosis was 47 days (IQR 24-81). Diagnostic delay > 47 days was associated with PS ≥ 2 (OR 1.99; 95% CI 1.13-3.50; p = 0.016) and treatment with corticosteroids (OR 2.47; 95% CI 1.14-5.40; p = 0.023), and it did not improve over the years. Patients treated with corticosteroids (62%) had a higher risk of additional biopsies (11.7% vs 4.0%, p = 0.04) but corticosteroids withdrawal before surgery did not reduce this risk and increased the diagnostic delay (64 vs 40 days, p = 0.04). Median overall survival (OS) was 8.9 months [95% CI 5.9-11.7] for the whole series, including 52 (16%) patients that were not treated, and 14.1 months (95%CI 7.7-20.5) for the 240 (73.4%) patients that received high-dose methotrexate (HD-MTX)-based chemotherapy. Median OS was shorter in patients ≥ 70 years (4.1 vs. 13.4 months; p < 0.0001). Multivariate analysis identified age ≥ 65 years, PS ≥ 2, no treatment, and cognitive/psychiatric symptoms at diagnosis as independent predictors of short survival. CONCLUSIONS: Corticosteroids withdrawal before surgery does not decrease the risk of a negative biopsy but delays diagnosis. In this community-based study, only 73.4% of patients could receive HD-MTX-based chemotherapy and OS remains poor, particularly in elderly patients ≥ 70 years.

Hombres con diabetes mellitus tipo 2: autoeficacia y factores psicológicos que influyen en el autocuidado / Type 2 diabetes mellitus among men: psychological factors influencing self-care efficacy / Homens com diabetes mellitus tipo 2: autoeficácia e fatores psicológicos que influem no autocuidado

Resumen Introducción: La prevalencia global de diabetes mellitus tipo 2 (DMT2) en los hombres es alta. Para el tratamiento de la enfermedad el hombre debe realizar acciones de autocuidado, por lo que es importante conocer factores relacionados con su cumplimiento. Objetivo: Identificar la relación entre variables demográficas, clínicas, la angustia, la depresión, la autoeficacia y su influencia sobre el autocuidado en hombres con DMT2. Métodos: Estudio transversal y correlacional, en una muestra de 96 hombres con DMT2, usuarios de 13 centros de salud. Los instrumentos utilizados fueron el cuestionario de acciones de cuidado en diabetes, la escala Self-Efficacy for Diabetes, la escala depresión (CES-D) y la escala angustia por diabetes (DDS). Resultados: El autocuidado se correlacionó de manera positiva con la autoeficacia y negativamente con la angustia por diabetes. Las variables que explicaron el autocuidado con el 47.7% de varianza fueron: la autoeficacia (β = .39), el consumo de alcohol (β = -.29), las horas sentado/parado (β= -.27), el tiempo de diagnóstico (β= -.22) y la edad (β =.18). Discusión: Los hombres tuvieron un bajo autocuidado y mantienen conductas de riesgo, lo cual puede atribuirse a sus creencias, estilo de vida o al tipo de trabajo que desempeñan. Conclusiones: Los resultados ofrecen evidencia sobre factores que influyen en el autocuidado de hombres con DMT2, que pueden orientar a los profesionales de enfermería en la atención del paciente. Se sugiere realizar investigaciones de enfermería en hombres, que contribuyan a mejorar la autoeficacia y el autocuidado.

Abstract Introduction: The global prevalence of type 2 diabetes mellitus among men is high; and these patients need to follow self-care routines. Therefore, knowing the factors which can affect their level of compliance is an important issue for nursing. Objective: To identify the relationship between demographic and clinical variables such as anguish and depression, and self-care efficacy in men suffering from type 2 diabetes mellitus. Methods: This a transversal and correlational study on a sample of 96 men with type 2 diabetes mellitus who were registered in 13 health centers. The instruments used were the Questionnaire of Actions of Care in Diabetes, the Self-Efficacy for Diabetes Scale (SED), the Mexico Center of Epidemiological Studies of Depression Scale (CES-D), and the Diabetes Distress Scale (DDS). Results: Self-care was positively correlated to self-efficacy, and negatively correlated to diabetes-related anguish and depression. Variables which accounted for 47.7% of the self-care variance were: self-efficacy (β = .39), alcohol consumption (β = -.29), number of hours sitting or standing (β= -.27), years of being diagnosed (β= -.22), and age (β =.18). Discussion: The sample demonstrated a low level of diabetes self-care which included risky behaviors. This attitude could be a result of the patients' beliefs, lifestyles, and/or type of job. Conclusions: The findings provide evidence on the factors which can influence self-care among men with type 2 diabetes. These results can orient nursing professionals while providing patient attention. Further related studies are suggested in order to help improve efficacy in type 2 diabetes self-care.

Resumo Introdução: A prevalência global de diabetes mellitus tipo 2 (DMT2) nos homens é alta. Para o tratamento da doença o homem deve realizar ações de autocuidado, pelo que é importante conhecer fatores relacionados com sua conformidade. Objetivo: Identificar a relação entre variáveis demográficas, clínicas, a angustia, a depressão, a autoeficácia e sua influência sobre o autocuidado em homens com DMT2. Métodos: Estudo transversal e correlacional, em uma amostra de 96 homens com DMT2, usuários de 13 centros de saúde. Os instrumentos utilizados foram o questionário de ações de cuidado em diabetes, a escala Self-Efficacy for Diabetes, a escala depressão (CES-D) e a escala angustia por diabetes (DDS). Resultados: O autocuidado correlacionou-se de maneira positiva com a autoeficácia e negativamente com a angustia por diabetes. As variáveis que explicaram o autocuidado com o 47.7% de variância foram: a autoeficácia (β = .39), o consumo de álcool (β = -.29), as horas sentado/parado (β= -.27), o tempo de diagnóstico (β= -.22) e a idade (β =.18). Discussão: Os homens tiveram um baixo autocuidado e mantém condutas de risco, o qual pode atribuir-se a suas crenças, estilo de vida ou ao tipo de trabalho que desempenham. Conclusões: Os resultados oferecem evidência sobre fatores que influem no autocuidado de homens com DMT2, que podem orientar aos profissionais de enfermagem na atenção do paciente. Sugere-se realizar pesquisas de enfermagem em homens, que contribuam a melhorar a autoeficácia e o autocuidado.

Automanejo en diabetes mellitus tipo 2 desde un enfoque de género: revisión integrativa / Diabetes mellitus type 2 self-management from a gender focused perspective: an integrative review / Automanejo em diabetes mellitus tipo 2 desde um enfoque de género: revisão integrativa

Objetivo: Identificar las diferencias en el automanejo de la DMT2 bajo un enfoque de género. Metodología: Se realizó una Revisión Integrativa en diferentes bases de datos de las cuales 24 artículos cumplieron con los criterios de inclusión para esta investigación, 13 artículos cuantitativos y 11 cualitativos, la mayoría de los estudios fueron realizados en Estados Unidos y Canadá. Resultados: De acuerdo a los hallazgos, las mujeres cumplen mejor con la alimentación y la toma de medicamentos, presentan menor apoyo social, mayores problemas psicológicos, y la religión, oración, la fe y la espiritualidad son un mecanismo positivo para el manejo de su enfermedad. Mientras que los hombres, cumplen mejor con la actividad física, presentan menor conocimiento, mayor consumo de alcohol y tabaco, y reciben mayor apoyo social. Sin embargo, el trabajo y la ausencia de síntomas graves son una barrera para el automanejo. Conclusiones Existen diferencias entre hombres y mujeres en relación al automanejo, mismas que permiten al personal de enfermería orientar intervenciones bajo un enfoque de género, basado en las necesidades particulares que presentan los hombres y mujeres. Por una parte, las mujeres requieren mejorar el ejercicio y mayor apoyo social, psicológico y espiritual. Los hombres muestran dificultades para cumplir con la alimentación y la toma de medicamentos.

Objective: To identify, from a gender focused perspective, differences in the self-management of diabetes mellitus type 2. Methodology: An integrative review was conducted on several databases. 24 articles fulfilled the inclusion criteria - 13 quantitative and 11 qualitative. The articles were mainly published in the USA and Canada. Results: On the one hand, women were found to comply better with proper diets and medication prescriptions, but showed having less social support and more psychological problems, a situation which they tended to address through religion, pray, faith, and spirituality. On the other hand, men were found to comply better with proper physical activity programs, but showed having less knowledge and more alcohol and tobacco consumption, but more social support though. Conclusions: Differences between men and women were found in relation to their self-managing of diabetes mellitus type 2. This situation prompts the nursing personnel to orient their interventions with a gender focused perspective. For instance, women need to improve their exercising and also receive more social, psychological and spiritual supports, while men need to improve their diet and medication related habits.

Objetivo: Identificar as diferenças no automanejo da DMT2 sob um enfoque de género. Metodologia: Realizou-se uma Revisão Integrativa em diferentes bases de dados das quais 24 artigos cumpriram com os critérios de inclusão para esta pesquisa, 13 artigos quantitativos e 11 qualitativos, a maioria dos estudos foram realizados nos Estados Unidos e Canadá. Resultados: Conforme os achados, as mulheres cumprem melhor com a alimentação e a toma de medicamentos, apresentam menor apoio social, maiores problemas psicológicos, e a religião, oração, a fé e a espiritualidade são um mecanismo positivo para o manejo de sua doença. Enquanto que os homens, cumprem melhor com a atividade física, apresentam menor conhecimento, maior consumo de álcool e tabaco, e recebem maior apoio social. No entanto, o trabalho e a ausência de sintomas graves são uma barreira para o automanejo. Conclusões: Existem diferenças entre homens e mulheres em relação ao automanejo, mesmas que permitem ao pessoal de enfermagem, orientar intervenções sob um enfoque de género, baseado nas necessidades particulares que apresentam os homens e mulheres. Por um lado, as mulheres requerem melhorar o exercício físico e maior apoio social, psicológico e espiritual. Os homens mostram dificuldades para cumprir com a alimentação e a toma de medicamentos.

Domain wall magnetoresistance in BiFeO3 thin films measured by scanning probe microscopy.

We measure the magnetotransport properties of individual 71° domain walls in multiferroic BiFeO3 by means of conductive-atomic force microscopy (C-AFM) in the presence of magnetic fields up to one Tesla. The results suggest anisotropic magnetoresistance at room temperature, with the sign of the magnetoresistance depending on the relative orientation between the magnetic field and the domain wall plane. A consequence of this finding is that macroscopically averaged magnetoresistance measurements for domain wall bunches are likely to underestimate the magnetoresistance of each individual domain wall.

Flexoelectric MEMS: towards an electromechanical strain diode.

Piezoelectricity and flexoelectricity are two independent but not incompatible forms of electromechanical response exhibited by nanoscale ferroelectrics. Here, we show that flexoelectricity can either enhance or suppress the piezoelectric response of the cantilever depending on the ferroelectric polarity and lead to a diode-like asymmetric (two-state) electromechanical response.

Neuromodulación eléctrica y dolor raquídeo / Electrical neuromodulation and pain of spinal origin

El dolor de origen raquídeo es un cuadro patológico con una importante incidencia y prevalencia y un enorme impacto socio-sanitario. La incorporación de las diferentes técnicas de neuromodulación eléctrica en el tratamiento de estos pacientes se ha mostrado como una alternativa terapéutica novedosa, segura y eficaz. El presente trabajo de revisión pretende profundizar desde el punto de vista etiológico y fisiopatológico en el dolor raquídeo, y sobre todo en el síndrome de cirugía fallida espinal. Se intentará acercar la técnica quirúrgica de implantación, comentar las indicaciones y resultados obtenidos hasta la actualidad, y realizar una aproximación crítica a los posibles mecanismos de acción de las diferentes modalidades de neuroestimulación eléctrica. Finalmente, se comentarán cuáles han sido los problemas e inconvenientes que han impedido la utilización generalizada de esta alternativa quirúrgica en estos procesos (AU)

The pain of spinal origin is a pathological condition with a significant incidence and prevalence and enormous social and health impact. The different electrical neuromodulation techniques can be considered an effective and safe alternative for the treatment of these patients. In the present review, we deep from the etiological and pathophysiological in spinal pain, especially in the syndrome of failed spinal surgery. We describe the surgical implantation technique, its indications and results achieved until now. We will also summarize the possible mechanisms of action of different types of electrical neurostimulation. Finally, we will comment on the dificulties and inconvinients that did not allow this pain surgical alternative to become more widely used (AU)

Mechanical Tuning of LaAlO3/SrTiO3 Interface Conductivity.

In recent years, complex-oxide heterostructures and their interfaces have become the focus of significant research activity, primarily driven by the discovery of emerging states and functionalities that open up opportunities for the development of new oxide-based nanoelectronic devices. The highly conductive state at the interface between insulators LaAlO3 and SrTiO3 is a prime example of such emergent functionality, with potential application in high electron density transistors. In this report, we demonstrate a new paradigm for voltage-free tuning of LaAlO3/SrTiO3 (LAO/STO) interface conductivity, which involves the mechanical gating of interface conductance through stress exerted by the tip of a scanning probe microscope. The mechanical control of channel conductivity and the long retention time of the induced resistance states enable transistor functionality with zero gate voltage.

Nanoscale conductive pattern of the homoepitaxial AlGaN/GaN transistor.

The gallium nitride (GaN)-based buffer/barrier mode of growth and morphology, the transistor electrical response (25-310 °C) and the nanoscale pattern of a homoepitaxial AlGaN/GaN high electron mobility transistor (HEMT) have been investigated at the micro and nanoscale. The low channel sheet resistance and the enhanced heat dissipation allow a highly conductive HEMT transistor (Ids > 1 A mm(-1)) to be defined (0.5 A mm(-1) at 300 °C). The vertical breakdown voltage has been determined to be ∼850 V with the vertical drain-bulk (or gate-bulk) current following the hopping mechanism, with an activation energy of 350 meV. The conductive atomic force microscopy nanoscale current pattern does not unequivocally follow the molecular beam epitaxy AlGaN/GaN morphology but it suggests that the FS-GaN substrate presents a series of preferential conductive spots (conductive patches). Both the estimated patches density and the apparent random distribution appear to correlate with the edge-pit dislocations observed via cathodoluminescence. The sub-surface edge-pit dislocations originating in the FS-GaN substrate result in barrier height inhomogeneity within the HEMT Schottky gate producing a subthreshold current.

Mechanical writing of ferroelectric polarization.

Ferroelectric materials are characterized by a permanent electric dipole that can be reversed through the application of an external voltage, but a strong intrinsic coupling between polarization and deformation also causes all ferroelectrics to be piezoelectric, leading to applications in sensors and high-displacement actuators. A less explored property is flexoelectricity, the coupling between polarization and a strain gradient. We demonstrate that the stress gradient generated by the tip of an atomic force microscope can mechanically switch the polarization in the nanoscale volume of a ferroelectric film. Pure mechanical force can therefore be used as a dynamic tool for polarization control and may enable applications in which memory bits are written mechanically and read electrically.

Magnetotransport at domain walls in BiFeO3.

Domain walls in multiferroics can exhibit intriguing behaviors that are significantly different from the bulk of the material. We investigate strong magnetoresistance in domain walls of the model multiferroic BiFeO3 by probing ordered arrays of 109° domain walls with temperature- and magnetic-field-dependent transport. We observe temperature-dependent variations in the transport mechanism and magnetoresistances as large as 60%. These results suggest that by locally breaking the symmetry of a material, such as at domain walls and structural interfaces, one can induce emergent behavior with properties that deviate significantly from the bulk.

Elastic and anelastic relaxations in the relaxor ferroelectric Pb(Mg1/3Nb2/3)O3: I. Strain analysis and a static order parameter.

The structural evolution of Pb(Mg(1/3)Nb(2/3))O(3) (PMN) has been reviewed in terms of characteristic temperatures, length scales and timescales, with a view to considering the overall relaxor behaviour from the perspectives of strain and elasticity. A conventional analysis of lattice parameter data in terms of spontaneous strain and strain/order parameter coupling shows that even though a normal phase transition does not occur the relaxor ordering process is accompanied by a significant volume strain which follows the pattern of a static order parameter evolving according to that expected for a tricritical phase transition with T(c) ≈ 350 K. This matches the evolution of the intensity of the elastic central peak in neutron scattering spectra, and reflects the development of static (or quasistatic) polar nanoregions (PNRs) as if by a mean-field phase transition. Use of a Landau free energy expansion, which includes Γ4(-) order parameter components to describe ferroelectric contributions and an R1(+) order parameter to describe cation ordering together with their formal coupling with strain, then allows the pattern of elastic softening expected for a cubic → rhombohedral phase transition to be anticipated. The extent to which observed softening differs from this static mean-field pattern serves to highlight the additional roles of local heterogeneity and relaxation dynamics in determining the relaxor properties of PMN.

Elastic and anelastic relaxations in the relaxor ferroelectric Pb(Mg1/3Nb2/3)O3: II. Strain-order parameter coupling and dynamic softening mechanisms.

Elastic and anelastic behaviour of single crystal and ceramic samples of Pb(Mg(1/3)Nb(2/3))O(3) has been investigated at frequencies of ~0.1-1.2 MHz through the temperature interval 10-800 K by resonant ultrasound spectroscopy (RUS). Comparison with data from the literature shows that softening of the shear modulus between the Burns temperature and the freezing interval is independent of frequency. The softening is attributed to coupling between acoustic modes and the relaxation mode(s) responsible for central peaks in Raman and neutron scattering spectra below the Burns temperature, and can be described with Vogel-Fulcher parameters. Shear elastic compliance and dielectric permittivity show similar patterns of temperature dependence through the freezing interval, demonstrating strong coupling between ferroelectric polarization and strain such that the response to applied stress is more or less the same as the response to an applied electric field, with a frequency dependence consistent with Vogel-Fulcher-like freezing in both cases. Differences in detail show, however, that shearing induces flipping between different twin orientations, in comparison with the influence of an electric field, which induces 180° flipping: the activation energy barrier for the former appears to be higher than for the latter. Below the freezing interval, the anelastic loss also has a similar pattern of evolution to the dielectric loss, signifying again that essentially the same mechanism is involved in the freezing process. Overall softening at low temperatures is attributed to the contributions of strain relaxations due to coupling with the local ferroelectric order parameter and of coupling between acoustic modes and continuing relaxational modes of the polar nanostructure. Dissipation is attributed to movement of boundaries between PNRs or between correlated clusters of PNRs. Overall, strain coupling is fundamental to the development of the characteristic strain, dielectric and elastic properties of relaxors.

Experiencia de trauma renal abierto en el Servicio de Urgencias Hospital Padre Hurtado / Open renal trauma experience in the emergency unit of Hospital Padre Hurtado

El trauma renal se presenta en el 10 por ciento de los pacientes traumatizados y se clasifica en abierto o cerrado de acuerdo a su mecanismo. El trauma renal abierto alcanza en zonas urbanas entre un 15-20 por ciento del total de traumas renales. Es producido principalmente por armas blancas o de fuego; estas últimas son de alta energía y se asocian a /lesiones de otros órganos. Se presenta nuestra experiencia en traumatismo renal abierto en los últimos 18 meses. Se evaluaron un total de 196 pacientes con traumatismo torácico, abdominal y toracoabdominal ingresados entre Julio de 2009 y Diciembre de 2010. Se identificaron 9 pacientes con diagnóstico de trauma renal abierta con confirmación diagnóstica por imágenes o durante el intraoperatorio. Las edades oscilan entre 16 y 30 años con un promedio de 22,7; 8 de 9 son de sexo masculino. El mecanismo de trauma es en un 55,5 por ciento (5/9) por arma de fuego y en un 44,5 por ciento (4/9) por arma blanca. Se clasificó el trauma renal según American Association for the Surgery of Trauma. Encontrándose que 2/9 (22 por ciento) corresponden a grado ll, 3/9 (33 por ciento) a grado a grado ll,3/9 (33 por ciento) a grado IV y 1/9 (11 por ciento) a grado V. La baja de hematocrito varió entre 1 y 23 por ciento, con un promedio de 11,3 por ciento. Se decidió manejo conservador en 5/9 pacientes: dentro de esto no se consideran las cirugías efectuadas por lesión de órgano no urológico. Un total de 3 pacientes (33,3 por ciento) requirió nefrectomía. Lesiones toracoabdominales asociadas se observaron en 7 de 9 pacientes, siendo las más frecuentes el Bazo (2), Hígado (2), Estómago (2), Diafragma (2) y Colon (2). No hubo muertes en el grupo de estudio en seguimiento de 6 /meses. A pesar de la baja incidencia de trauma renal abierto, se observa un gran número de pacientes considerando otras series nacionales. La anterior, probablemente debido a las características socioculturales del centro hospitalario...

Renal trauma is present in 10 percent of politraumatized patients. It’s classified into opened or closed renal trauma, according to its mechanism. Opened renal trauma in urban areas reaches 15ta 20 percent of all renal traumas. It’s mainly secondary to gunshot wounds or knifes. Gunshot wounds are classified as hi energy trauma and usually are associated to other organ lesions. We present our experience in opened renal trauma in the last 18 months. Retrospective study where 196 patients with thoracic, abdominal and thoraco-abdominal trauma admitted in the emergency room between July 2009 and December 201 0. Nine patients were identified with opened renal trauma, with diagnostic confirmation y imaging study o during surgery. The ages ranged between 16 and 30 years; with an average of 22, 7 years. Eight out of nine patients were males. The mechanism of injury was in 55.5 percent (5/9) produced by gunshot and 44.5 percent (4/9) by knife. The opened renal traumas were classified according to the American Association for the Surgery of Trauma. We found that 2/9 (22 percent) belonged to grade ll. 3/9 (33 percent) to grade lll. 3/9 (33 percent) to grade IV and 1/9 to grade V (11 percent). The drop in hematocrit ranged between 1percent and 23percent, with an average of 11.3 percent. Five out of nine patients were treated conservatively, excluding surgeries because of neurologic¡ organs. Three patients required nephrectomy. Seven out of nine patients presented association with thoraco-abdominat injuries. The most frequent were spleen (2), liver (2), stomach (2), and diaphragm (2), and colon (2). There was no mortality during a six months follow-up. Despite the low incidence of opened renal trauma, we present a large number of patients according to other national reports, probably due to socio-cultural environment of this hospital...

Clinical and economic analysis of hospital acquired infections in patients diagnosed with brain tumor in a tertiary hospital.

OBJECTIVES: To analyze the relationship between hospital acquired infections and clinical outcomes, duration of stay, and cost per infectious episode in patients diagnosed with brain tumors in our service. MATERIALS AND METHODS: We conducted a retrospective study on patients diagnosed with brain tumors and admitted to the department of neurosurgery in the Cruces Hospital of the University of the Basque Country between January 1st, 2007 and December 31st, 2007. We collected demographics, responsible pathogens, infection location, length of hospitalization, and costs of various medical and surgical procedures performed. RESULTS: We reviewed 139 patients that accumulated 210 hospital visits. We found 34 episodes of hospital acquired infections (16.25% of patients). The most frequent infections were that of the lower respiratory tract, urinary tract, and surgical site. We found that patients with HAIs had a significantly lower final KPS score (sig <0.01), greater mean cost of stay (17097 €, sig<0.01), and longer length of stay (15.45 days, sig<0.01). We did not find a significant difference in mortality. CONCLUSIONS: We found significant association between the presence of HAIs and worse clinical outcomes, higher costs, and longer length of stay. The pathogens responsible and infection locations were similar to existing series in the literature. Although variability in study designs in the literature makes interpretation and comparison of results difficult, measures to prevent these complications.

Clinical and economic analysis of hospital acquired infections in patients diagnosed with brain tumor in a tertiary hospital

Objectives. To analyze the relationship between hospital acquired infections and clinical outcomes, duration of stay, and cost per infectious episode in patients diagnosed with brain tumors in our service.Materials and methods. We conducted a retrospective study on patients diagnosed with brain tumors and admitted to the department of neurosurgery in the Cruces Hospital of the University of the Basque Country between January 1st, 2007 and December 31st, 2007. We collected demographics, responsible pathogens, infection location, length of hospitalization, and costs of various medical and surgical procedures performed.Results. We reviewed 139 patients that accumulated 210 hospital visits. We found 34 episodes of hospital acquired infections (16.25% of patients). The most frequent infections were that of the lower respiratory tract, urinary tract, and surgical site. We found that patients with HAIs had a significantly lower final KPS score (sig <0.01), greater mean cost of stay (17097€, sig.<0.01), and longer length of stay (15.45 days, sig<0.01). We did not find a significant difference in mortality.Conclusions. We found significant association between the presence of HAIs and worse clinical outcomes, higher costs, and longer length of stay. The pathogens responsible and infection locations were similar to existing series in the literature. Although variability in study designs in the literature makes interpretation and comparison of results difficult, measures to prevent these complications can improve quality of care and reduce costs (AU)

Objetivos. Analizar la relación entre la presencia de infección nosocomial y el resultado clínico final, la duración de la estancia y el coste del episodio en los pacientes diagnosticados de tumoración cerebral en nuestro servicio.Material y método. Realizamos un estudio retrospectivo incluyendo los pacientes ingresados en el Servicio de Neurocirugía del Hospital Universitario de Cruces con diagnostico de tumoración cerebral en el periodo comprendido entre el 1-1-2007 y el 31-12 del 2007. Recogimos variables demográficas, los microorganismos responsables y la localización de las distintas infecciones, el tiempo de ingreso y los costes de los distintos procedimientos médicos y quirúrgicos realizados.Resultados. Recogimos 139 pacientes, que acumularon un total de 210 episodios. Encontramos la presencia de infecciones nosocomiales en 34 episodios (16,25%). La localización mas frecuente fue la respiratoria, seguida del tracto urinario y la infección de herida quirúrgica. Encontramos unas diferencias significativas en la situación funcional al alta (sig <0.01), el coste medio de los episodios (17097€, sig.<0.01) y en la estancia media (15.45 días, sig.<0.01). No encontramos diferencias significativas con respecto a la mortalidad.Conclusiones. Encontramos asociaciones significativas entre la presencia de infección nosocomial, un peor resultado clínico, un mayor coste y una mayor estancia. Los gérmenes responsables y localizaciones fueron similares a las series previamente publicadas. A pesar de que la variabilidad en el diseño de los estudios recogidos en la literatura dificulta la interpretación y comparación de los resultados, las medidas destinadas a la prevención de esta complicación permiten simultáneamente mejorar la asistencia prestada, asi como reducir los costes generados por la enfermedad (AU)

Flexoelectric rotation of polarization in ferroelectric thin films.

Strain engineering enables modification of the properties of thin films using the stress from the substrates on which they are grown. Strain may be relaxed, however, and this can also modify the properties thanks to the coupling between strain gradient and polarization known as flexoelectricity. Here we have studied the strain distribution inside epitaxial films of the archetypal ferroelectric PbTiO(3), where the mismatch with the substrate is relaxed through the formation of domains (twins). Synchrotron X-ray diffraction and high-resolution scanning transmission electron microscopy reveal an intricate strain distribution, with gradients in both the vertical and, unexpectedly, the horizontal direction. These gradients generate a horizontal flexoelectricity that forces the spontaneous polarization to rotate away from the normal. Polar rotations are a characteristic of compositionally engineered morphotropic phase boundary ferroelectrics with high piezoelectricity; flexoelectricity provides an alternative route for generating such rotations in standard ferroelectrics using purely physical means.

Rabdomiolisis asociada a torniquete en cirugía de rodilla: importancia del estrés oxidativo y el rol del alopurinol en su prevención / Rhabdomyolysis associated with tourniquet in knee surgery: importance of oxidative stress and the role of allopurinol in the prevention

Orthopedic knee surgery using a tourniquet has allowed surgeons to operate with a bloodless field. Nevertheless, tourniquet application produces an ischemia-reperfusion cycle in the skeletal muscle. As a consequence of the reoxygenation of the muscle, an enhancement on the production of reactive oxygen species leads to cell dysfunction, apoptosis and necrosis. A mild rhabdomyolisis is ascertained from the average 7-fold increase in plasma creatine phosphokinase and myoglobin in these patients, with release of intracellular content such as uric acid and phosphate. Altogether, these factors ascertain a distant response, determined by systemic inflammation and renal involvement by means of glomerular and tubular damage. In contrast, it is likely that acute kidney injury remains under diagnosed due to the recent change in acute kidney failure diagnostic paradigm. As a plausible evidence-based intervention, a diminution on the production of reactive oxygen species seems the pathophysiological treatment. Indeed, allopurinol supplementation constitutes a reasonable, innocuous and cheap alternative for these patients, because of inhibition of xanthine oxidase, the latter being the main source of reactive oxygen species in the setting of ischemia-reperfusion. This review focuses on the pathophysiology of rhabdomyolisis and acute kidney injury in the context of tourniquet knee surgery and therapeutics on allopurinol.

The flexoelectricity of barium and strontium titanates from first principles.

We present ab initio calculations of the longitudinal flexoelectricity for BaTiO(3) and SrTiO(3) using a direct approach. The calculated value for SrTiO(3) agrees with recently reported measurements. For BaTiO(3), however, the theoretical values are smaller than the measured ones; possible reasons for the discrepancy are discussed.

Domains in ferroelectric nanodots.

Almost free-standing single crystal mesoscale and nanoscale dots of ferroelectric BaTiO(3) have been made by direct focused ion beam patterning of bulk single crystal material. The domain structures which appear in these single crystal dots, after cooling through the Curie temperature, were observed to form into quadrants, with each quadrant consisting of fine 90 degrees stripe domains. The reason that these rather complex domain configurations form is uncertain, but we consider and discuss three possibilities for their genesis: first, that the quadrant features initially form to facilitate field-closure, but then develop 90 degrees shape compensating stripe domains in order to accommodate disclination stresses; second, that they are the result of the impingement of domain packets which nucleate at the sidewalls of the dots forming "Forsbergh" patterns (essentially the result of phase transition kinetics); and third, that 90 degrees domains form to conserve the shape of the nanodot as it is cooled through the Curie temperature but arrange into quadrant packets in order to minimize the energy associated with uncompensated surface charges (thus representing an equilibrium state). While the third model is the preferred one, we note that the second and third models are not mutually exclusive.