Recomendaciones sobre programas de rehabilitación pulmonar en pacientes con enfermedad pulmonar obstructiva crónica de la Sociedad de Rehabilitación Cardiorrespiratoria / Recommendations of the Spanish Society of Cardiorespiratory Rehabilitation on pulmonary rehabilitation programmes in patients with chronic obstructive pulmonary disease

Introducción. La rehabilitación respiratoria (RR) es un componente primordial en el manejo de pacientes con enfermedades respiratorias crónicas. El objetivo de este documento de recomendaciones es proporcionar al equipo de rehabilitación una puesta al día de las principales intervenciones a realizar dentro de un programa de RR, haciendo especial énfasis en las evaluaciones previas al inicio del programa. Una valoración adecuada permitirá seleccionar las intervenciones según las necesidades individuales de cada paciente y mejorar la eficiencia de la RR. Métodos. Un comité de expertos que incluía a médicos y fisioterapeutas de la Sociedad de Rehabilitación Cardiorrespiratoria, y un reumatólogo especialista en osteoporosis de la Sociedad Española de Reumatología actualizaron la evidencia disponible en RR a partir de estudios de calidad (revisiones, metaanálisis y ensayos clínicos), incorporando nuevas estrategias e intervenciones complementarias al ejercicio físico. El resultado final del documento fue acordado por todos sus miembros. Resultados. Se proporciona información necesaria para realizar un abordaje multidisciplinario del paciente con enfermedad pulmonar obstructiva crónica que permita hacer una adecuada valoración individualizada y seleccionar las intervenciones a realizar dentro del programa de RR. Conclusiones. El entrenamiento físico sigue siendo la piedra angular de la RR. No obstante, existen diferentes intervenciones que pueden implementarse dentro de los programas de RR, de acuerdo con una valoración y selección adecuada de los pacientes (AU)

Introduction. Pulmonary rehabilitation (PR) is one of the key components in the management of patients with chronic respiratory disease. The goal of this guidance document is to provide rehabilitation team members with an update on the main interventions to be carried out within a PR programme, with special emphasis on the assessments that precede the start of the programme. An appropriate assessment will allow the interventions to be tailored to the patient's individual needs and will improve the overall efficiency of PR. Methods. An expert committee, which included physicians and physiotherapists of the Spanish Society of Cardio-Respiratory Rehabilitation, as well as a rheumatologist specialised in osteoporosis from the Spanish Society of Rheumatology updated the available evidence on PR based on high-quality studies (reviews, meta-analyses and clinical trials), incorporating new strategies and interventions that complemented physical exercise. The final draft of the document was agreed on by all of the members. Results. The document provides all the appropriate information to enable a multidisciplinary approach to the treatment of patients with chronic obstructive pulmonary disease, allowing appropriate individualised assessment and selection of interventions to be carried out within the PR programme. Conclusions. Exercise training remains the cornerstone of PR. Nevertheless, different interventions may be implemented within PR programmes, based on appropriate assessment and adequate patient selection (AU)

Magnetic and magnetoelastic properties of epitaxial SmFe2 thin film.

We report on magnetic and magnetoelastic measurements for a 5000 Å (110) SmFe(2) thin film, which was successfully analyzed by means of a point charge model for describing the effect of the epitaxial growth in this kind of system. Some of the main conclusions of the Mössbauer and magnetoelastic results and the new magnetization results up to 5 T allow us to get a full description of the crystal electric field, exchange, and magnetoelastic behavior in this compound. So, new single-ion parameters are obtained for the crystal field interaction of samarium ions, A(4)(r(4)) = +755 K/ion and A(6)(r(6)) = -180 K/ion, and new single-ion magnetoelastic coupling B(γ,2) is approximately equal -200 MPa and B(ε,2) is approximately equal MPa, which represent the tetragonal and the in-plane shear deformations, respectively. Moreover, the new thermal behavior of the samarium magnetic moment, the exchange coupling parameter, and the magnetocrystalline anisotropy of the iron sublattice are obtained too. From these, the softening of the spin reorientation transition with respect to the bulk case could be accounted for.

Magnetoelastic nature of the dodecagonal anisotropy in holmium metal.

We have investigated the magnetoelastic nature of the dodecagonal anisotropy in the magnetic anisotropy energy (MAE) in the basal plane of the hcp crystalline structure in holmium single crystal. We have proved that the origin of the second harmonic of the hexagonal symmetry in MAE clearly lies on a sixth-order magnetoelastic coupling term. The appearance of a 12-fold anisotropy in MAE in a single crystal having hexagonal symmetry provides a new insight on how the magnetic anisotropy can be modified in a magnetic material with giant spin-lattice coupling.

Magnetization process in holmium: easy axis spin reorientation induced by the magnetostrictive basal plane distortion.

We report on the change of the easy axis direction in holmium, from the a to the b axis, under the application of a magnetic field in the basal plane. This spin reorientation is observed by measuring the magnetic torque in Ho(n)/Lu(15) superlattices (n and 15 are the number of atomic planes in the Ho and Lu blocks). We also observe that, at the field H0 and temperature at which the reorientation occurs, both axes are easy directions. Based on the fact that the field H0 depends on n in the same way as the field-induced magnetoelastic distortion does, we propose that this spin reorientation originates from the strong field-induced magnetoelastic deformation within the basal plane. The modulation of the alpha strains with sixfold symmetry originates a 12-fold term in the magnetic anisotropy energy.

Metaanálisis de fracturas de cadera, vertebrales y de muñeca en mujeres posmenopáusicas con indicaciones preventivas o de tratamiento para osteoporosis con risedronato o raloxifeno / Meta-analysis of hip, vertebral and wrist fractures in postmenopausal women undergoing preventive therapy or treatment for osteoporosis with risedronate and raloxifene

Fundamento: Se presenta una revisión sistemática con metaanálisis de los efectos del uso de risedronato y raloxifeno en las fracturas y en la densidad mineral ósea (DMO), de cadera, vértebra y muñeca en las mujeres con osteoporosis posmenopáusica. Material y método: Se revisaron los ensayos clínicos publicados desde 1966 hasta septiembre de 2002 en MEDLINE, Cochrane Library, EMBASE, Pascal Biomed y publicaciones de la Sociedad Española de Reumatología, Sociedad Española de la Investigación Ósea y del Metabolismo Mineral y Fundación Hispana de Osteoporosis y Enfermedades Metabólicas Óseas. Resultados y discusión: Se incluyeron 8 ensayos clínicos con risedronato y 6 con raloxifeno. A las dosis recomendadas (5 mg de risedronato y 60 mg de raloxifeno) con seguimiento de 2 o más años, el riesgo relativo (RR) de fracturas de cadera fue de 0,74 (intervalo de confianza [IC] del 95 por ciento, 0,59-0,94) y 1,13 (IC del 95 por ciento, 0,66-1,96) con risedronato y raloxifeno, respectivamente; en fracturas vertebrales fue de 0,61 (IC del 95, por ciento 0,50-0,75) y 0,65 (IC del 95 por ciento, 0,53-0,79), respectivamente, y en fracturas de muñeca de 0,67 (IC del 95 por ciento, 0,42-1,07) y 0,88 (IC del 95 por ciento, 0,67-1,14), respectivamente. El incremento de la DMO para risedronato y raloxifeno vertebral fue del 4,32 por ciento (IC del 95 por ciento, 3,78-4,88) y del 2,62 por ciento (IC del 95 por ciento, 2,40-2,82); femoral del 2,77 por ciento (IC del 95 por ciento, 2,37-3,17) y 1,39 por ciento (IC del 95 por ciento, 1,03-1,75), y en el trocánter del 3,94 por ciento (IC del 95 por ciento, 3,29-4,58) y 1,72 por ciento (IC del 95 por ciento, 0,602,85), respectivamente. Risedronato disminuyó el riesgo de fractura en cadera, no así en muñeca, mientras raloxifeno no mostró un efecto reductor de fracturas ni en cadera ni en muñeca. La reducción del riesgo de fractura vertebral se produjo en ambos fármacos. En trocánter, fémur y vértebra, ambos fármacos produjeron aumentos en la DMO (AU)

Calcificaciones subcutáneas y periostitis en extremidades inferiores en imágenes / Subcutaneus calcifications and periostitis in the lower extremities radiology

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Excitability relationships between lower limb myotatic arcs in spasticity.

The excitability of a lower limb myotatic reflex arc is modulated by the antecedent activation of another myotatic arc in the same limb; the changes can be represented by heteronymous excitability curves. This work compares heteronymous excitability curves in spastic and normal subjects. Eighteen patients who showed clear signs of pyramidal tract lesions at a chronic stage were studied. Three myotatic arcs of the lower limb (soleus, quadriceps, and short biceps) were activated either by mechanical percussion (T Sol-T Quad-TSBi) or by electrical stimulation of the afferent nerve (H Sol-H Quad). They were used as conditioning and test responses in six different combinations, and the results compared to those obtained previously in normal volunteers. In spastic patients, heteronymous excitability curves are more obviously modified than homonymous ones. The changes are most prominent in the thigh muscles and less marked when the soleus reflex is conditioned by activation of quadriceps and biceps femoris myotatic reflex arcs.

Analogies and differences between reserpine PGO wave discharges and oculomotor phasic activity during paradoxical sleep in the cat.

In the present study the analogies and differences between phasic PGO activity of parodoxical sleep and the reserpine induced PGO waves were investigated. The oculomotor phasic activities in chronic cats were studied. It appeared that the intrinsic organisation of latencies and the appearance of phasic waves in the four structures studied were common to both experimental situations. However the sequential patterns of discharges were different in PS and under reserpine treatment.

Sequential discharges of phasic waves in the pontine oculomotor system during paradoxical sleep in chronic mesencephalic and decorticate cats.

The temporal organization of sequences of phasic activity (PGO) in the pontine oculomotor system during paradoxical sleep was compared in normal cats, in "mesencephalic" preparations, and in completely decorticated animals. After both types of operation, PGO discharges lost their random character, becoming grouped in bursts separated by long intervals. These observations suggest that the cerebral cortex is involved in the regulation of patterns of PGO sequences.

Behavioural and electroencephalographic effects of intracerebral microinjections of sodium pentobarbital.

The effects of intracerebral microinjections of Nembutal into different brain areas, with the purpose of reproducing the behavioural and EEG signs of barbiturate narcosis, have been studied and analyzed. Cats were implanted for polygraphic study of the sleep-wakefulness cycle and bilateral brain canulae were also placed in strategic brain areas. The most striking results was the controlateral turning after unilateral injections of Nembutal in the nigra, suggesting a loss of balance among the actions of the nigro-striatal-cortical pathways on both sides. The sequence of events produced by intravestibular injections of Nembutal suggests that the drug, when injected intraperitoneally, acts also upon the vestibular system. This data stresses the importance of localized intracerebral microinjections of drugs to determine and differentiate their action mechanisms when injected in an intraperitoneal or intravenous way.