Estrategia invasiva precoz ajustada al riesgo en pacientes con síndrome coronario agudo sin elevación de segmento ST en Unidades de Cuidados Intensivos Cardiológicos / Risk-adjusted early invasive strategy in patients with non-ST-segment elevation acute coronary syndrome in Intensive Cardiac Care Units

OBJETIVO: Las guías de práctica clínica recomiendan la estrategia invasiva precoz ajustada al riesgo (EIPAR) en pacientes con síndrome coronario agudo sin elevación del segmento ST (SCASEST). El objetivo fue analizar la aplicación de la EIPAR, sus condicionantes e impacto sobre el pronóstico en pacientes con SCASEST ingresados en Unidades de Cuidados Intensivos Cardiológicos (UCIC). DISEÑO: Estudio de cohortes prospectivo. ÁMBITO: UCIC de 8 hospitales en Cataluña. PACIENTES: Pacientes consecutivos con SCASEST entre octubre del 2017 y marzo del 2018. El perfil de riesgo se definió mediante los criterios de la Sociedad Europea de Cardiología. INTERVENCIONES: Se definió como EIPAR la realización de coronariografía en las primeras 6 h en pacientes de muy alto riesgo o en 24 h en pacientes de alto riesgo. VARIABLES DE INTERÉS: Mortalidad/reingreso a los 6 meses. RESULTADOS: Se incluyó a 629 pacientes (edad media 66,6 años), 225 (35,9%) de muy alto riesgo y 392 (62,6%) de alto riesgo. La estrategia invasiva fue mayoritaria (96,2%). La EIPAR se aplicó en 284 pacientes (45,6%), especialmente pacientes más jóvenes, con menos comorbilidades. Estos pacientes presentaron menor estancia en UCIC y hospitalaria, así como menor incidencia de SCA, revascularizaciones y menor incidencia de muerte/reingreso a 6 meses. Tras ajustar por factores de confusión, la asociación entre adherencia y muerte/reingreso a 6 meses persistió de manera significativa (razón de riesgos: 0,66 [0,45-0,97] p = 0,035). CONCLUSIONES: La EIPAR se aplica en una minoría de SCASEST ingresados en UCIC, asociándose con una menor incidencia de eventos

OBJECTIVE: Current guidelines recommend a risk-adjusted early invasive strategy (EIS) in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). The present study assesses the application if this strategy, the conditioning factors and prognostic impact upon patients with NSTEACS admitted to Intensive Cardiac Care Units (ICCU). DESIGN: A prospective cohort study was carried out. SETTING: The ICCUs of 8 hospitals in Catalonia (Spain). PATIENTS: Consecutive patients with NSTEACS between October 2017 and March 2018. The risk profile was defined by the European Society of Cardiology criteria. INTERVENTIONS: EIS was defined as the performance of coronary angiography within the first 6hours in patients at very high-risk or within 24hours in high-risk patients. OUTCOME VARIABLES: Mortality or readmission at 6 months. RESULTS: A total of 629 patients were included (mean age 66.6 years), of whom 225 (35.9%) were at very high risk, and 392 (62.6%) at high risk. Most patients (96.2%) underwent an invasive strategy. EIS was performed in 284 patients (45.6%), especially younger patients with fewer comorbidities. These patients had a shorter ICCU and hospital stay, as well as a lesser incidence of ACS, revascularization and death or readmission at 6 months. After adjusting for confounders, the association between EIS and death or readmission at 6 months remained significant (hazard ratio: .66, 95% confidence interval .45-.97; P=.035). CONCLUSIONS: The EIS was performed in a minority of NSTEACS admitted to ICCU, being associated with better outcomes

Risk-adjusted early invasive strategy in patients with non-ST-segment elevation acute coronary syndrome in Intensive Cardiac Care Units. / Estrategia invasiva precoz ajustada al riesgo en pacientes con síndrome coronario agudo sin elevación de segmento ST en Unidades de Cuidados Intensivos Cardiológicos.

OBJECTIVE: Current guidelines recommend a risk-adjusted early invasive strategy (EIS) in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). The present study assesses the application if this strategy, the conditioning factors and prognostic impact upon patients with NSTEACS admitted to Intensive Cardiac Care Units (ICCU). DESIGN: A prospective cohort study was carried out. SETTING: The ICCUs of 8 hospitals in Catalonia (Spain). PATIENTS: Consecutive patients with NSTEACS between October 2017 and March 2018. The risk profile was defined by the European Society of Cardiology criteria. INTERVENTIONS: EIS was defined as the performance of coronary angiography within the first 6hours in patients at very high-risk or within 24hours in high-risk patients. OUTCOME VARIABLES: Mortality or readmission at 6 months. RESULTS: A total of 629 patients were included (mean age 66.6 years), of whom 225 (35.9%) were at very high risk, and 392 (62.6%) at high risk. Most patients (96.2%) underwent an invasive strategy. EIS was performed in 284 patients (45.6%), especially younger patients with fewer comorbidities. These patients had a shorter ICCU and hospital stay, as well as a lesser incidence of ACS, revascularization and death or readmission at 6 months. After adjusting for confounders, the association between EIS and death or readmission at 6 months remained significant (hazard ratio: .66, 95% confidence interval .45-.97; P=.035). CONCLUSIONS: The EIS was performed in a minority of NSTEACS admitted to ICCU, being associated with better outcomes.

Cost-effectiveness of hydrogel plugs in CT-guided lung biopsies. / Estudio de coste-efectividad sobre la utilización de un tapón de hidrogel en las biopsias pulmonares guiadas por tomografía computarizada.

OBJECTIVE: Using a hydrogel plug decreases the number of cases of pneumothorax and reduces the need for pleural drainage tubes in CT-guided lung biopsies. We aimed to analyze the cost-effectiveness of using hydrogel plugs. MATERIAL AND METHODS: We analyzed 171 lung biopsies divided into three groups: Group 1 (n=22): fine-needle aspiration cytology (FNAC) without hydrogel plugs; Group 2 (n=89): FNAC with hydrogel plugs; and Group 3 (n=60): FNAC plus core-needle biopsy (CNB) with hydrogel plugs. We calculated the total costs (direct and indirect) in the three groups. We analyzed the percentage of correct diagnoses, the average and incremental rations, and the most cost-effective option. RESULTS: Total costs: Group 1 = 1,261.28 + 52.65 = € 1,313.93; Group 2 = 1,201.36 + 67.25 = € 1,268.61; Group 3 = 1,220.22 + 47.20 = € 1,267.42. Percentage of correct diagnoses: Group 1 = 77.3%, Group 2 = 85.4%, and Group 3 = 95% (p = 0.04). Average cost-effectiveness ratio: Group 1 = 16.99; Group 2 = 14.85; and Group 3 = 13.34. CONCLUSIONS: Group 3 was the best option, with the lowest average cost-effectiveness ratio; therefore, the most cost-effective approach is to do FNAC and CNB using a dehydrated hydrogel plug at the end of the procedure.

The cost effectiveness of vacuum-assisted versus core-needle versus surgical biopsy of breast lesions. / Estudio de costo-efectividad de la biopsia mamaria asistida por vacío versus biopsia con aguja gruesa o arpón.

OBJECTIVES: To determine the cost effectiveness of breast biopsy by 9G vacuum-assisted guided by vertical stereotaxy or ultrasonography in comparison with breast biopsy by 14G core-needle biopsy and surgical biopsy. MATERIAL AND METHODS: We analyzed a total of 997 biopsies (181 vacuum-assisted, 626 core, and 190 surgical biopsies). We calculated the total costs (indirect and direct) of the three types of biopsy. We did not calculate intangible costs. We measured the percentage of correct diagnoses obtained with each technique. To identify the most cost-effective option, we calculated the mean ratios for the three types of biopsies. RESULTS: Total costs were €225.09 for core biopsy, €638.90 for vacuum-assisted biopsy, and €1780.01 for surgical biopsy. The overall percentage of correct diagnoses was 91.81% for core biopsy, 94.03% for vacuum-assisted biopsy, and 100% for surgical biopsy; however, these differences did not reach statistical significance (p=0.3485). For microcalcifications, the percentage of correct diagnoses was 50% for core biopsy and 96.77% for vacuum-assisted biopsy (p<0.0001). For nodules, there were no significant differences among techniques. The mean cost-effectiveness ratio considering all lesions was 2.45 for core biopsy, 6.79 for vacuum-assisted biopsy, and 17.80 for surgical biopsy. CONCLUSION: Core biopsy was the dominant option for the diagnosis of suspicious breast lesions in general. However, in cases with microcalcifications, the low percentage of correct diagnoses achieved by core biopsy (50%) advises against its use in this context, where vacuum-assisted biopsy would be the technique of choice because it is more cost-effective than surgical biopsy, the other technique indicated for biopsying microcalcifications.

Estimating SIT-driven population reduction in the Mediterranean fruit fly, Ceratitis capitata, from sterile mating.

Area-wide sterile insect technique (SIT) programs assume that offspring reduction of the target population correlates with the mating success of the sterile males released. However, there is a lack of monitoring tools to prove the success of these programs in real-time. Field-cage tests were conducted under the environmental conditions of the Mediterranean coast of Spain to estimate: (a) the mating success of sterile Vienna-8 (V8) Ceratitis capitata males using molecular markers and (b) their efficacy to reduce C. capitata populations under six release ratios of wild females to wild males to V8 males (1:0:0, 1:1:0, 1:1:1, 1:1:5, 1:1:10, and 1:1:20). Statistical models were developed to predict: (a) the number of females captured in traps, (b) sperm ID (sterile or not) in spermathecae of the trapped females, and (c) the viable offspring produced, using release ratio and temperature as predictors. The number of females captured was affected by relative humidity. However, its influence in the model was low. Female captures were significantly higher in ratios 1:0:0 compared to ratios where V8 males were released. The proportion of V8 sperm in spermathecae increased with temperature and with the number of V8 males released, but leveled off between ratios 1:1:10 and 1:1:20. In all seasons, except winter (no offspring), viable offspring increased with temperature and was lowest for ratio 1:1:20. For the first time, a strong negative relationship between proportion of V8 sperm detected by molecular tools and C. capitata offspring was established. The models obtained should contribute to enhance the efficacy of SIT programs against this pest.

Breakpoint chlorination curves of greywater.

A study on chlorination of raw greywater with hypochlorite is reported in this paper. Samples were chlorinated in a variety of conditions, and residual chlorine (Cl2) was measured spectrophotometrically. For each sample, the chlorination curve (chlorine residuals versus chlorine dose) was obtained. Curves showed the typical hump-and-dip profile attributable to the formation and destruction of chloramines. It was observed that, after reactions with strong reductants and chloramines-forming compounds, the remaining organic matter exerted a certain demand of chlorine. The evolution of chlorination curves with addition of ammonia and dodecylbencene sulfonate sodium salt and with dilution of the greywater sample were studied. In addition, chlorination curves at several contact times have been obtained, resulting in slower chlorine decay in the hump zone than in the dip zone. In addition, the decay of coliforms in chlorinated samples was also investigated. It was found that, for a chlorination dosage corresponding to the maximum of the hump zone (average 8.9 mg Cl2/ L), samples were negative in coliforms after 10 to 30 minutes of contact time. After-growth was not observed within 3 days after chlorination. Implications in chlorination treatments of raw greywater can be derived from these results.

In vitro effects of gamma radiation from 60Co and 137Cs on plasmid DNA.

The effects of gamma radiation from (60)Co and (137)Cs on DNA in aqueous solution are studied experimentally. Using an improved plasmid purification protocol and improved electrophoretic gel analysis techniques provided results with relatively small uncertainties. The results are compared with both theoretical and experimental results. In particular, the results obtained here are discussed in the light of recent discussion on supposed differences of the effects induced by gamma radiation from (60)Co and (137)Cs. We find that the effects of both types of gamma radiation are similar.

[Analysis of the Educational Program for Self-Care in the Elderly (PECA) for improving the quality of life of the elderly]. / Análisis del programa educativo PECA para mejorar la calidad de vida de las personas mayores.

OBJECTIVE: To determine the efficacy over 12 months of the educational programme on self-care of the elderly (PECA), which covers quality of life, nutritional status, and perceived social support of people over 65 living in their own homes. DESIGN: Pre-test/post-test experimental study with control group. SETTING: Urban population in the Manso Health District (Example, Barcelona), Spain. PARTICIPANTS: Persons over 65 living in their own homes, healthy or with chronic illnesses characteristic of their age, who had a normal score in the Pfeiffer test. A total of 70 subjects (35 per group) were selected and 5 of the control group left the study. INTERVENTION: Programme on self-care of the elderly, including education on physical activity, nutrition, and social support. MEASUREMENTS: Dependent variables were quality of life, measured by the Nottingham Health Profile; nutritional status, measured by the Mini-Nutritional Assessment (MNA); and social support, measured by the Duke-Unk Functional Social Support Scale. RESULTS: The study sample had an average age of 70.9 (SD, 3.1); 88.2% had self-perception of good health; and 21% lived alone. We only found statistically significant differences between pre- and post-intervention observations in nutritional status (P=.001). CONCLUSION: Despite a statistically significant difference in the variable of nutritional status, the difference was not "clinically" relevant. The ineffectiveness of the intervention is due to our starting from a very homogeneous sample, which had good health status and well-established social networks.

Análisis del programa educativo PECA para mejorar la calidad de vida de las personas mayores

Objetivo. Determinar la eficacia, a lo largo de 12 meses, del programa Educativo de Autocuidado del Anciano (PECA) sobre la calidad de vida, el estado nutricional y el apoyo social percibido de personas mayores de 65 años que viven en su propio domicilio. Diseño. Ensayo clínico aleatorizado. Emplazamiento. Área básica de salud (ABS) de Manso. Barcelona. Participantes. Personas mayories de 65 años que viven en sus propios domicilios, sanas o con enfermedades crónicas propias de la edad y que obtienen una puntuación normal en el test de Pfeiffer. Se seleccionó a un total de 70 sujetos (35 por grupo) y abandonaron 5 del grupo control. Intervención. Programa PECA que incluyeeducación sobre la actividad física, la nutrición y el apoyo social. Mediciones. Las variables dependientes son la calidad de vida, medida con el Perfil de Salud de Nottinham (PSN); el estado nutricional, medido con el Mini Nutritional Assessment (MNA), y el apoyo social, medido con la escala de Apoyo Social Funcional Duke-UnK. Resultados. La muestra tenía una edad media ± desviación estándar de 70,9 ± 3,1 años, tenía una buena percepción de su salud (88,2 por ciento) y el 21 por ciento vivía solo. Únicamente se observaron diferencias estadísticamente significativa s entre las observaciones preinterveción y postintervención en la variable estado nutricional (p = 0,001). Conclusión. La diferencia observada en la variable estado nutricional no es clinicamente relevante. La ausencia de efecto de la intervención podría deberse a que la muestra es muy homogénea, con un buen estado de salud y con una red social bien estabelecida.(AU)

Análisis del programa educativo PECA para mejorar la calidad de vida de las personas mayores / Analysis of the PECA educational programme for improving the quality of life of the elderly

Objetivo. Determinar la eficacia, a lo largo de 12 meses, del programa Educativo de Autocuidado del Anciano (PECA) sobre la calidad de vida, el estado nutricional y el apoyo social percibido de personas mayores de 65 años que viven en su propio domicilio. Diseño. Ensayo clínico aleatorizado. Emplazamiento. Área básica de salud (ABS) de Manso. Barcelona. Participantes. Personas mayores de 65 años que viven en sus propios domicilios, sanas o con enfermedades crónicas propias de la edad y que obtienen una puntuación normal en el test de Pfeiffer. Se seleccionó a un total de 70 sujetos (35 por grupo) y abandonaron 5 del grupo control. Intervención. Programa PECA que incluye educación sobre la actividad física, la nutrición y el apoyo social. Mediciones. Las variables dependientes son la calidad de vida, medida con el Perfil de Salud de Nottingham (PSN); el estado nutricional, medido con el Mini Nutritional Assessment (MNA), y el apoyo social, medido con la escala de Apoyo Social Funcional Duke-UnK. Resultados. La muestra tenía una edad media ± desviación estándar de 70,9 ± 3,1 años, tenía una buena percepción de su salud (88,2%) y el 21% vivía solo. Únicamente se observaron diferencias estadísticamente significativas entre las observaciones preintervención y postintervención en la variable estado nutricional (p = 0,001). Conclusión. La diferencia observada en la variable estado nutricional no es «clínicamente» relevante. La ausencia de efecto de la intervención podría deberse a que la muestra es muy homogénea, con un buen estado de salud y con una red social bien establecida

Objective. To determine the efficacy over 12 months of the educational programme on self-care of the elderly (PECA), which covers quality of life, nutritional status, and perceived social support of people over 65 living in their own homes. Design. Pre-test/post-test experimental study with control group. Setting. Urban population in the Manso Health District (Eixample, Barcelona), Spain. Participants. Persons over 65 living in their own homes, healthy or with chronic illnesses characteristic of their age, who had a normal score in the Pfeiffer test. A total of 70 subjects (35 per group) were selected and 5 of the control group left the study. Intervention. Programme on self-care of the elderly, including education on physical activity, nutrition, and social support. Measurements. Dependent variables were quality of life, measured by the Nottingham Health Profile; nutritional status, measured by the Mini-Nutritional Assessment (MNA); and social support, measured by the Duke-Unk Functional Social Support Scale. Results. The study sample had an average age of 70.9 (SD, 3.1); 88.2% had self-perception of good health; and 21% lived alone. We only found statistically significant differences between pre- and post-intervention observations in nutritional status (P=.001). Conclusion. Despite a statistically significant difference in the variable of nutritional status, the difference was not "clinically" relevant. The ineffectiveness of the intervention is due to our starting from a very homogeneous sample, which had good health status and well-established social networks

Organ contouring for prostate cancer: interobserver and internal organ motion variability.

The purpose of this study is to assess the uncertainties that arise in locating the boundaries of anatomical structures, such as the prostate and the bladder, due to interobserver variability in the delineation of the structures and to internal organ motion. The variabilities are computed in all the radial directions and this information is used to obtain the margins, following the techniques and limitations imposed by medical practice. The margins obtained from the organ motions are significantly greater than those arising from interobserver variability. The developed tools, allow us to obtain the required margins in an efficient way.

Preliminary results of 3D dose calculations with MCNP-4B code from a SPECT image.

Interface software was developed to generate the input file to run Monte Carlo MCNP-4B code from medical image in Interfile format version 3.3. The software was tested using a spherical phantom of tomography slides with known cumulated activity distribution in Interfile format generated with IMAGAMMA medical image processing system. The 3D dose calculation obtained with Monte Carlo MCNP-4B code was compared with the voxel S factor method. The results show a relative error between both methods less than 1 %.

Preliminary results of 3D dose calculations with MCNP-4B code from a SPECT image / Resultados preliminares de los cálculos de dosis 3D con el código de MCNP-4B de una imagen de SPECT

Interface software was developed to generate the input file to run Monte Carlo MCNP-4B code from medical image in Interfile format version 3.3. The software was tested using a spherical phantom of tomography slides with known cumulated activity distribution in Interfile format generated with IMAGAMMA medical image processing system. The 3D dose calculation obtained with Monte Carlo MCNP-4B code was compared with the voxel S factor method. The results show a relative error between both methods less than 1% (AU)

Se creó un programa de interfaz para generar el archivo de entrada que permitiera procesar el código Monte Carlo MCNP-4B de la imagen médica, en la versión 3.3 del formato Interfile. El programa se probó usando un fantoma esférico de cortes tomográficos con distribución de actividad acumulada uniformemente en formato Interfile generada desde el sistema de procesamiento de imágenes médicas IMAGAMMA. La distribución de dosis fue obtenida con el código de Monte Carlo MCNP-4B y sus resultados fueron comparados con el método de voxel del factor S. Los resultados mostraron un error relativo entre ambos métodos menor del 1% (AU)

Determination of residual chlorine in greywater using o-tolidine.

The determination of chlorine with o-tolidine in greywater has been studied, and a batch method and a sequential injection method have been proposed. It was found that the reaction of o-tolidine with chlorine was slower in a greywater matrix. Grey water samples must be filtered before analysis, or alternatively, a blank of sample must be measured. The samples are very unstable, and after 2 h of storage in dark conditions at 4 degrees C the chlorine concentration can diminish. The standard addition method, in some samples gave unsatisfactory results as a consequence of matrix effects. It was concluded that samples with a total organic carbon (TOC) higher than 60 mgCl(-1) can not be accurately analysed using these methods. However, samples with a TOC lower than 60 mgCl(-1) gave 100+/-3% recoveries. The linear range of the methods was 0-3.0 and 0-5.0 mgCl(2)l(-1), and the limit of quantification 0.2 and 0.5 mgCl(2)l(-1), for the batch method and the sequential injection method, respectively. This is the first paper devoted to grey water from the analytical chemistry point of view.