EURADOS ISO/IEC 17025 guidance for IMS: suggestions on how to interpret and implement the requirements including examples from accredited laboratories.

Individual monitoring of external radiation is an activity usually regulated by national regulatory bodies in most countries. Regulations generally contain technical requirements to be met by the individual monitoring services (IMS), in order to ensure that the measurements are correct and therefore the dosimetry results are reliable. In some countries, the requirements include or even consist of the accreditation of the service according to the standard ISO/IEC 17025: 'General requirements for the competence of testing and calibration laboratories.' It is a fact that accreditation is a growing trend among European IMS as a way to guarantee confidence in their technical competence. The acceptance of the dosimetry results between countries and their indentation in the respective National Dose Registries is facilitated if laboratories conform to the ISO/IEC 17025 standard. In the framework of the activities of EURADOS (European Radiation Dosimetry Group) working group 2 'Harmonization of Individual Monitoring in Europe' and attending to the concern of many European IMS in the process of accreditation, a guide has been prepared. The purpose was to assist and encourage IMS to apply for accreditation and to share the authors' own experience with the process. The guide intends to be a practical reference for IMS on how to interpret and implement the ISO/IEC 17025 requirements to the specific activity of a personal dosimetry service for external radiation, emphasizing those aspects of special interest. It includes examples from dosimetry laboratories already accredited. The major novelties from a new edition of ISO/IEC 17025: 2017 are also identified in the guide. Finally, the guide aims to assist the auditing process, giving examples of auditor's questions and how to show evidence of compliance. The main findings are presented.

Opiniones sobre el tratamiento no farmacológico de la hipertensión arterial en pacientes de Atención Primaria / Opinions on non-drug treatment of arterial hypertension in Primary Health Care patients

Introducción. El objetivo del estudio es comparar los conocimientos y opiniones sobre las medidas del tratamiento no farmacológico (TnoF) de la hipertensión arterial (HTA) en una muestra de pacientes hipertensos (HT) respecto a una muestra de normotensos (NT) que acudieron a consultas de Atención Primaria entre junio y octubre de 2005. Material y métodos. Se realizó un estudio descriptivo transversal en cinco Áreas Básicas de Salud de L'Hospitalet de Llobregat (Barcelona). Se estudió una muestra de 124 pacientes (60 NT y 64 HT) mayores de 60 años, siendo excluidos los que presentaran alguna enfermedad cardiovascular, renal, diabetes o dislipemia. Mediante una encuesta autoadministrada se obtuvo la opinión sobre la influencia en la presión arterial de la obesidad, el colesterol, la actividad física, el estrés y los consumos de tabaco, alcohol, café y sal. Resultados. De los 124 pacientes, el 41,23 % eran hombres y el 58,87 % mujeres. No se observaron diferencias estadísticamente significativas en las opiniones de ambos grupos respecto a la relación de la HTA con la obesidad, el colesterol, el ejercicio físico, los consumos de alcohol, café y sal. Se apreciaron diferencias estadísticamente significativas al comparar la importancia que ambos grupos asignaron al tabaco (p = 0,031) y al estrés (p = 0,039). El 87,50 % de los HT afirma haber recibido recomendaciones sobre la importancia de las medidas del TnoF. Conclusiones. Aunque no se hallaron diferencias estadísticamente significativas, los pacientes HT consideran que el colesterol, el ejercicio físico y los consumos de alcohol, café y sal tienen mayor repercusión en la HTA que los NT. Más del 20 % de los HT se considera libre de cualquier problema de salud, lo que debe alertar a los profesionales en el sentido de la importancia de la educación de estos pacientes

Introduction. This study aims to compare knowledge and opinions on non-drug treatment (non-DT) measures of ATH in a sample of hypertensive patients (HT) compared to a sample of normotensive patients (NT) who came to Primary Health Care consultations between June and October 2005. Material and methods. A descriptive, cross-sectional study was conducted in five Basic Health Areas of L'Hospitalet de Llobregat (Barcelona). A sample of 124 patients (60 NT and 64 HT), older than 60 years, was studied. Those patients who had any cardiovascular, renal, diabetes or dyslipidemia disease were excluded. The opinion on the influence of obesity, cholesterol, physical activity, stress and use of tobacco, alcohol, coffee and salt on blood pressure was obtained with a self-administered survey. Results. A total of 41.23 % and 58.87 % out of 124 patients were men and women, respectively. No statistically significant differences were observed in the opinions of both groups regarding the relationship of AHT with obesity, cholesterol, physical exercise, use of alcohol, coffee and salt. Statistically significant differences were observed when the importance that each group gave to tobacco (p = 0.031) and stress (p = 0.039) was compared. A total of 87.50 % of the HT state that they had been given recommendations on the importance of non-DT. Conclusions. Although no statistically significant differences were found, HT patients consider that cholesterol, physical exercise and use of alcohol, coffee and salt have a greater repercussion on the ATH than the NT. More than 20 % of the HT consider they have no health problem, which should alert the professionals about the importance of educating these patients

[Having diabetes without knowing it]. / Tener diabetes y no saberlo. Cribaje de diabetes desconocida en una muestra oportunista de población residente en Cataluña.

As part of the activities on the World Day for Diabetes in 2002, nine professors, one nurse who teaches about diabetes and 126 nursing students at University Schools of Nursing in Barcelona, Lleida, Tarragona, Tortosa and Girona, in collaboration with the Association of Diabetics in Catalonia and with the help of the Advisory Council for Diabetes in Catalonia participated in a diabetes screening campaign on the population residing in Catalonia. This campaign studied the prevalence of type two diabetes in a random sample of the Catalan population. This campaign also proposed to raise the awareness among the general population and among nursing students about the important health consequences diabetes has and to increase investigation and social support measures by nurses related to diabetes. This study checked 4083 persons and discovered 77 cases of altered blood-sugar levels among people who did not know they had diabetes. This finding means that there is a 2.2% prevalence of altered blood-sugar levels in the population who are not diagnosed diabetics. Professors and student participants all gave this experience positive marks and the students' degree of satisfaction was very high.

Tener diabetes y no saberlo / Having diabetes without knowing it

Con motivo del Día Mundial de la Diabetes de 2002, nueve profesoras, una enfermera educadora en diabetes y 126 estudiantes de enfermería de Escuelas Universitarias de Enfermería de Barcelona, Tarragona, Tortosa y Girona, en colaboración con la Asociación de Diabéticos de Cataluña y con el soporte del "Consell Asesor de la Diabetis a Catalunya", participan en una campaña de cribado de diabetes en la población residente en Cataluña. Esta campaña estudia la prevalencia de diabetes tipo 2 en una muetra oportunista de la población catalana. También pretende sensibilizar a la población general y a los estudiantes de enfermería de la importancia sanitaria de esta enfermedad y potentar el rol investigador y social de la enfermera. Se estudian 4.083 personas y se encuentran 77 glucemias alteradas entre la población sin diabetes conocida. Esto supone una prevalencia de glucemias alteradas del 2,2% en la población no diagnosticada de diabetes. Tanto los profesores como los alumnos participantes valoran positivamente esta experiencia y el ni vel de satisfacción de los estudiantes es muy elevado

As part of the activities on the World Day for Diabetes in 2002, nine professors, one nurse who teaches about diabetes and 126 nursing students at University Schools of Nursing in Barcelona, Lleida, Tarragona, Tortosa and Girona, in collaboration with the Association of Diabetics in Catalonia and with the help of the Advisory Council for Diabetes in Catalonia participated in a diabetes screening campaign on the population residing in Catalonia. This campaign studied the prevalence of type two diabetes in a random sample of the Catalan population. This campaign also proposed to raise the awareness among the general population and among nursing students about the important health consequences diabetes has and to increase investigation and social support measures by nurses related to diabetes. This study checked 4083 persons and discovered 77 cases of altered blood-sugar levels among people who did not know they had diabetes. This finding means that there is a 2.2% prevalence of altered blood-sugar levels in the population who are not diagnosed diabetics. Professors and student participants all gave this experience positive marks and the students' degree of satisfaction was very high

[Histopathological changes in sympathetic ganglia of patients treated surgically for palmar-axillary hyperhidrosis. A study of 55 biopsies]. / Cambios anatomopatológicos observados en los ganglios simpáticos de pacientes intervenidos de hiperhidrosis palmar-axilar. Estudio de 55 muestras.

INTRODUCTION: Primary palmar hyperhidrosis (PPH) mainly affects the sympathetic ganglia. This study aims to analyze the histopathological changes in the sympathetic ganglia of patients with PPH. MATERIAL AND METHOD: We studied 55 tissue samples from 35 patients with PPH who underwent T2-T3 gangliectomy for definitive treatment of their disease, analyzing the presence of inflammation, chromatolysis and lipofuscin accumulation. Findings were analyzed in relation to age, compensatory sweating and type of surgery: unilateral, synchronic bilateral or sequential bilateral. RESULTS: We found inflammation in 5.5%, chromatolysis in 61.8% and lipofuscin accumulation in 41.8% of the samples. Chromatolysis and lipofuscin were found without inflammation in 32.1%. Chromatolysis and lipofuscin accumulation were each found in 60% of the samples from synchronic bilateral sympathectomies. However, those percentages decreased between the first and second sympathectomies in sequential procedures, such that chromatolysis was found in 71.4% of first-procedure samples and 42.8% of second-procedure samples; the rates for lipofuscin accumulation changed from 64.2% to 14.2%. Although findings were unrelated to age, they did correlate with compensatory sweating, which was found in 79.7% of patients undergoing synchronic bilateral sympathectomy, 78.5% of sequential bilateral sympathectomy patients and only 56.25% of unilateral sympathectomy patients. CONCLUSIONS: Neuronal death and lipofuscin accumulation unrelated to inflammation are evident in sympathetic ganglia from patients with PPH. Such changes are atypical for a group of patients whose mean age is 29 years, unless such lesions are the result of functional hyperstimulation. Surgery performed sequentially does not lead to overloading of contralateral T2-T3 ganglia; on the contrary, decreased injury is evident.

Cambios anatomopatológicos observados en los ganglios simpáticos de pacientes intervenidos de hiperhidrosis palmar-axilar. Estudio de 55 muestras / Histopathological changes in sympathetic ganglia of patients treated surgically for palmar-axillary hyperhidrosis. A study of 55 biopsies

Fundamento: La hiperhidrosis palmar primaria (HPP) es una enfermedad cuyos órganos de choque son los ganglios simpáticos. Este trabajo tiene por objetivo analizar los cambios anatomopatológicos observados en los ganglios simpáticos de los pacientes con dicha enfermedad. Material y método: 55 muestras procedentes de 35 pacientes afectados de HPP, que fueron sometidos a una gangliectomía T2-T3 como tratamiento definitivo de la enfermedad. Se analizó la presencia de inflamación, cromatólisis y depósitos de lipofuscina. Se correlacionaron los hallazgos con edad, sudación compensatoria y tipo de intervención: unilateral, bilateral simultánea o bilateral secuencial. Resultados: En el total del grupo se registró el 5,5 per cent de inflamación, el 61,8 per cent de cromatólisis y el 41,8 per cent de depósitos de lipofuscina. La presencia de cromatólisis y lipofuscina en ausencia de inflamación fue del 32,1 per cent. En las gangliectomías bilaterales se observó que en la simpatectomía bilateral (SB) simultánea había un grado de coincidencia lesional del 60 per cent tanto de la cromatólisis como de los depósitos de lipofuscina. Por el contrario, en la SB secuencial se detectó un decremento en los valores medios de las muestras de la primera intervención respecto a la segunda, pasando en cromatólisis del 71,4 al 42,8 per cent, y en lipofuscina del 64,2 al 14,2 per cent. Estos hallazgos no se correlacionaron con la edad, aunque sí con la sudación compensatoria, del 79,7 per cent en la SB sincrónica, el 78,5 per cent en la SB secuencial y el 56,25 per cent en la simpatectomía unilateral. Conclusiones: Se demuestra la muerte neuronal en los ganglios simpáticos de los pacientes afectados de HPP, así como depósitos de lipofuscina no asociados a inflamación, lo cual es impropio en pacientes de una edad media de 29 años, salvo que estas lesiones sean resultado de un proceso de hiperestimulación funcional. La cirugía realizada en dos tiempos no comporta una sobrecarga para los ganglios simpáticos T2-T3 contralaterales, sino más bien al contrario, ya que se produce la reducción de la lesión (AU)

Análisis de costes asistenciales en los centros comarcales de rehabilitación / Analysis of healthcare costs in regional rehabilitation centers

Análisis realizado en los servicios de rehabilitación de siete centros sanitarios de características diversas sobre la actividad asistencial y sus costes unitarios. Estudio acompañado de un proceso previo y paralelo de desarrollo de un sistema de información para cononer la actividad de la rehabilitación médica. Explicación de la metodología aplicada para comprobar la estructura de la actividad de los servicios y la determinación de los costes unitarios de la actividad realizada en 1996-1997, mediante cálculo de los costes de los diversos recursos utilizados en cada servicio para cada una de las cuatro prestaciones médicas y 25 prestaciones terapéuticas en las que se ha comprendido toda la actividad asistencial. Se detecta una elevada dispersión de los parámetros calculados entre los servicios objeto del estudio, tanto en estructura de la actividad como en costes unitarios y un alto desajuste entre el modelo de financiación para la rehabilitación ambulatoria en los hospitales y sus costes (AU)

New management opportunities and the Kentucky River case.

Physicians and other health care workers seeking to unionize may face an uphill battle as a result of a recent decision by the U.S. Supreme Court that essentially defines nurses and physicians as supervisory personnel who can't engage in collective bargaining. Discover what led to the decision and how it affects health care.

Expression of angiogenic growth factors in paragangliomas.

OBJECTIVE/HYPOTHESIS: To determine if angiogenic growth factors including vascular endothelial growth factor (VEGF) and platelet-derived endothelial cell growth factor (PD-ECGF) are expressed in human paragangliomas. STUDY DESIGN: A histopathologic and molecular examination of paraganglioma specimens obtained from surgical cases or retrieved from the Pathology Department of the Massachusetts Eye and Ear Infirmary. METHODS: Fresh tumor or archival, paraffin-embedded paraganglioma specimens were analyzed by immunohistochemistry, Western blotting, and ELISA. RESULTS: Positive immunohistochemical staining for VEGF was observed in five of nine surgical specimens and in six of eight archival specimens (11/17, or 65%). PD-ECGF immunoreactivity was detected in four of five surgical specimens and six of eight archival specimens (10/13, or 77%). The presence of PD-ECGF was confirmed by Western blot assay and ELISA confirmed the presence of VEGF in tumor extract. CONCLUSIONS: Both VEGF and PD-ECGF are expressed in paragangliomas and may contribute to the extreme vascularity of these tumors. Key Words. Vascular endothelial growth factor, platelet-derived, endothelial cell growth factor, hypoxia, tumor vasculature.

Disruption of CENP antigen function perturbs dynein anchoring to the mitotic kinetochore.

Injection of purified autoantibodies against human centromeric proteins into HeLa cells during interphase disrupts the organization of the kinetochore and interferes with chromosomal movements during the subsequent mitosis even though the chromosomes retain the ability to bind microtubules. We have investigated the hypothesis that this phenotype arises from effects on cytoplasmic dynein, the microtubule motor protein. In previous experiments we found that introduction of anticentromere antibodies into cell nuclei during the G1- or S-phases causes a prometaphase-like arrest, while injections during G2-phase cause a metaphase arrest. We show here that, in both cases, the level of detectable cytoplasmic dynein at kinetochores is significantly decreased. In contrast, when injected cells were permitted to enter mitosis in the absence of microtubules (conditions where trilaminar kinetochores could be detected by electron microscopy), the intensity of dynein labeling on the kinetochores was identical to that seen in uninjected control cells exposed to colcemid. Therefore, the loss of dynein label on mitotic kinetochores was correlated both with the injection of anticentromere antibodies and with the presence of intact spindle microtubules. We suggest that the injection of anticentromere antibodies somehow weakens the association of dynein with the kinetochore, so that when microtubules are present, these motor molecules are pulled away from the kinetochores as they generate force. This model offers an explanation for the failure of chromosomes of injected cells to move normally in mitosis even though they have attached microtubules.

DNA ploidy and S + G2M fraction (proliferative index) as prognostic determinants in human periampullary cancer.

BACKGROUND/AIMS: The aim of the present study was to investigate the relationship between pathological factors, DNA ploidy patterns, proliferative index and survival in a population of patients undergoing resection for adenocarcinoma of periampullary region. MATERIALS AND METHODS: DNA ploidy and proliferative index of periampullary cancer tissue was measured by flow cytometry in 73 patients who had undergone pancreatoduodenectomy. RESULTS: Seventy-four percent (n = 54) of cancers were diploid and 26% (n = 19) were aneuploid. The median survival time of patients with diploid cancers was 30.1 (s.d. 5.1) months and with aneuploid cancers was 16.0 (s.d. 2.9) months (p = 0.02). Kaplan-Meier survival curves showed that the patients with aneuploid cancers succumbed to recurrent disease within 40 months after surgery whereas 20% of patients with diploid cancers survived longer than 40 months. In patients with long survival (3 years) there was a significant difference between aneuploid and diploid cancers (p < 0.001). In the multivariate analysis, tumor location and tumor size are independent prognostic variables for the length of survival after resection of periampullary cancer. CONCLUSIONS: DNA ploidy pattern appears to be one important prognostic predictor in patients with "long term" survival after successful pancreatoduodenectomy for periampullary cancers.

CENP-C is required for maintaining proper kinetochore size and for a timely transition to anaphase.

The human autoantigen CENP-C has been demonstrated by immunoelectron microscopy to be a component of the inner kinetochore plate. Here we have used antibodies raised against various portions of CENP-C to probe its function in mitosis. We show that nuclear microinjection of anti-CENP-C antibodies during interphase causes a transient arrest at the following metaphase. Injection of the same antibodies after the initiation of prophase, however, does not disrupt mitosis. Correspondingly, indirect immunofluorescence using affinity-purified human anti-CENP-C antibodies reveals that levels of CENP-C staining are reduced at centromeres in cells that were injected during interphase, but appear unaffected in cells which were injected during mitosis. Thus, we suggest that the injected antibodies cause metaphase arrest by reducing the amount of CENP-C at centromeres. Examination of kinetochores in metaphase-arrested cells by electron microscopy reveals that the number of trilaminar structures is reduced. More surprisingly, the few remaining kinetochores in these cells retain a normal trilaminar morphology but are significantly reduced in diameter. In cells arrested for extended periods, these small kinetochores become disrupted and apparently no longer bind microtubules. These observations are consistent with an involvement of CENP-C in kinetochore assembly, and suggest that CENP-C plays a critical role in both establishing and/or maintaining proper kinetochore size and stabilizing microtubule attachments. These findings also support the idea that proper assembly of kinetochores may be monitored by the cell cycle checkpoint preceding the transition to anaphase.

Disruption of centromere assembly during interphase inhibits kinetochore morphogenesis and function in mitosis.

The relationship between the kinetochore and the centromeric heterochromatin that surrounds it is unknown. Anti-centromere autoantibodies (ACAs) that recognize antigens found in the heterochromatin beneath the kinetochore disrupt mitotic events when microinjected into human cells. We show here that ACAs interfere with two different stages of centromere assembly during interphase, resulting in abnormal kinetochore structures during mitosis. Antibody injection prior to late G2 results in the subsequent failure to assemble a trilaminar kinetochore. Such chromosomes bind microtubules but are incapable of movement. Antibody disruption of events during G2 produces unstable kinetochores that prevent the normal transition into anaphase. These experiments present a novel way to examine events in the pathway of kinetochore assembly that occur during interphase, at a time when this structure cannot be visualized directly.

Chromosomal passengers: toward an integrated view of mitosis.

The major events of mitosis have traditionally been considered to represent two distinct pathways and have been studied by two separate groups of workers. The chromosomal events (chromosome condensation and sister chromatid disjunction) have been the principal focus for one group, while the cytoskeletal events (nuclear envelope breakdown, chromosomal movements, cytokinesis) have been the focus for the other. This historical division is epitomized by the view of many cell biologists, which was aptly caught by Mazia's comparison of the role of the chromosome arms in mitosis to that of "the corpse at the funeral" which "provide a reason for the proceedings but do not take an active part in them" (Mazia 1961). More recent studies have demonstrated that the role of the chromosomes in mitotic movements is somewhat more active than this. That the kinetochore may play an important role in chromosome movements has long been suspected (see early references in Mazia 1961) but was only proven rather recently (Brinkley et al. 1988; Gorbsky et al. 1987; Nicklas 1989). This has led to a burst of recent interest in all aspects of kinetochore structure and function. Our studies have led us to ask whether chromosomes may play an even more extensive role in the events of mitosis. We suggest here that in addition to their active role in movements, the chromosome may make important structural contributions to the anaphase spindle and cleavage furrow, which are normally thought of as "cytoskeletal" functions. These structural contributions may be made by members of a new class of "chromosomal passenger" proteins that use the chromosomes as a means of conveyance so that they are correctly positioned at the metaphase plate to carry out their nonchromosomal functions during anaphase and the subsequent mitotic events.

Injection of anticentromere antibodies in interphase disrupts events required for chromosome movement at mitosis.

We have used autoantibodies to probe the function of three human centromere proteins in mitosis. These antibodies recognize three human polypeptides in immunoblots: CENP-A (17 kD), CENP-B (80 kD), and CENP-C (140 kD). Purified anticentromere antibodies (ACA-IgG) disrupt mitosis when introduced into tissue culture cells during interphase. We have identified two execution points for antibody inhibition. Antibodies injected into the nucleus greater than or equal to 3 h before mitosis prevent the chromosomes from undergoing normal prometaphase movements in the subsequent mitosis. Antibodies injected in the nucleus during late G2 cause cells to arrest in metaphase. Surprisingly, antibodies introduced subsequent to the beginning of prophase do not block mitosis. These results suggest that the CENP antigens are involved in two essential interphase events that are required for centromere action in mitosis. These may include centromere assembly coordinate with the replication of alpha-satellite DNA at the end of S phase and the structural maturation of the kinetochore that begins at prophase.

CENP-B: a major human centromere protein located beneath the kinetochore.

The family of three structurally related autoantigens CENP-A (17 kD), CENP-B (80 kD), and CENP-C (140 kD) are the best characterized components of the human centromere, and they have been widely assumed to be components of the kinetochore. Kinetochore components are currently of great interest since this structure, which has long been known to be the site of microtubule attachment to the chromosome, is now believed to be a site of force production for anaphase chromosome movement. In the present study we have mapped the distribution of CENP-B in mitotic chromosomes by immunoelectron microscopy using two monospecific polyclonal antibodies together with a newly developed series of ultra-small 1-nm colloidal gold probes. We were surprised to find that greater than 95% of CENP-B is distributed throughout the centromeric heterochromatin beneath the kinetochore. This strongly supports other emerging evidence that CENP-B is specifically associated with alpha-satellite heterochromatin. Although in certain instances CENP-B can be seen to be concentrated immediately adjacent to the lower surface of the kinetochore, the outer plate remains virtually unlabeled. Similar analysis with a human autoimmune serum that recognizes all three CENP antigens reveals an additional unsuspected feature of kinetochore structure. In addition to recognizing antigens in the centromeric heterochromatin, the autoantiserum recognizes a concentration of antigens lateral to the kinetochore. This difference in staining pattern may reflect the presence of a "collar" of chromatin rich in CENP-C and/or CENP-A encircling the kinetochore plates.