Microscopic fractional anisotropy outperforms multiple sclerosis lesion assessment and clinical outcome associations over standard fractional anisotropy tensor.

We aimed to compare the ability of diffusion tensor imaging and multi-compartment spherical mean technique to detect focal tissue damage and in distinguishing between different connectivity patterns associated with varying clinical outcomes in multiple sclerosis (MS). Seventy-six people diagnosed with MS were scanned using a SIEMENS Prisma Fit 3T magnetic resonance imaging (MRI), employing both conventional (T1w and fluid-attenuated inversion recovery) and advanced diffusion MRI sequences from which fractional anisotropy (FA) and microscopic FA (µFA) maps were generated. Using automated fiber quantification (AFQ), we assessed diffusion profiles across multiple white matter (WM) pathways to measure the sensitivity of anisotropy diffusion metrics in detecting localized tissue damage. In parallel, we analyzed structural brain connectivity in a specific patient cohort to fully grasp its relationships with cognitive and physical clinical outcomes. This evaluation comprehensively considered different patient categories, including cognitively preserved (CP), mild cognitive deficits (MCD), and cognitively impaired (CI) for cognitive assessment, as well as groups distinguished by physical impact: those with mild disability (Expanded Disability Status Scale [EDSS] <=3) and those with moderate-severe disability (EDSS >3). In our initial objective, we employed Ridge regression to forecast the presence of focal MS lesions, comparing the performance of µFA and FA. µFA exhibited a stronger association with tissue damage and a higher predictive precision for focal MS lesions across the tracts, achieving an R-squared value of .57, significantly outperforming the R-squared value of .24 for FA (p-value <.001). In structural connectivity, µFA exhibited more pronounced differences than FA in response to alteration in both cognitive and physical clinical scores in terms of effect size and number of connections. Regarding cognitive groups, FA differences between CP and MCD groups were limited to 0.5% of connections, mainly around the thalamus, while µFA revealed changes in 2.5% of connections. In the CP and CI group comparison, which have noticeable cognitive differences, the disparity was 5.6% for FA values and 32.5% for µFA. Similarly, µFA outperformed FA in detecting WM changes between the MCD and CI groups, with 5% versus 0.3% of connections, respectively. When analyzing structural connectivity between physical disability groups, µFA still demonstrated superior performance over FA, disclosing a 2.1% difference in connectivity between regions closely associated with physical disability in MS. In contrast, FA spotted a few regions, comprising only 0.6% of total connections. In summary, µFA emerged as a more effective tool than FA in predicting MS lesions and identifying structural changes across patients with different degrees of cognitive and global disability, offering deeper insights into the complexities of MS-related impairments.

Diffusion tensor imaging metrics associated with future disability in multiple sclerosis.

The relationship between brain diffusion microstructural changes and disability in multiple sclerosis (MS) remains poorly understood. We aimed to explore the predictive value of microstructural properties in white (WM) and grey matter (GM), and identify areas associated with mid-term disability in MS patients. We studied 185 patients (71% female; 86% RRMS) with the Expanded Disability Status Scale (EDSS), timed 25-foot walk (T25FW), nine-hole peg test (9HPT), and Symbol Digit Modalities Test (SDMT) at two time-points. We used Lasso regression to analyse the predictive value of baseline WM fractional anisotropy and GM mean diffusivity, and to identify areas related to each outcome at 4.1 years follow-up. Motor performance was associated with WM (T25FW: RMSE = 0.524, R2 = 0.304; 9HPT dominant hand: RMSE = 0.662, R2 = 0.062; 9HPT non-dominant hand: RMSE = 0.649, R2 = 0.139), and SDMT with GM diffusion metrics (RMSE = 0.772, R2 = 0.186). Cingulum, longitudinal fasciculus, optic radiation, forceps minor and frontal aslant were the WM tracts most closely linked to motor dysfunction, and temporal and frontal cortex were relevant for cognition. Regional specificity related to clinical outcomes provide valuable information that can be used to develop more accurate predictive models that could improve therapeutic strategies.

Synthetic MRI in subarachnoid haemorrhage.

AIM: To evaluate the reliability of synthetic magnetic resonance imaging (SyMRI) for detecting complications associated with subarachnoid haemorrhage (SAH), such as ischaemic lesions, hydrocephalus, or bleeding complications. MATERIALS AND METHODS: Twenty patients with SAH, who underwent a conventional brain MRI and a SyMRI on a 3 T MRI machine. Comparable conventional and synthetic T2-weighted fluid attenuated inversion recovery (FLAIR) images were acquired. The presence of ischaemic lesions, hydrocephalus, extra-axial blood collections as well as the volumes of grey matter (GMv), white matter (WMv), and cerebrospinal (CSFv) were compared. The acquisition times of both sequences was also analysed. RESULTS: The concordance between the two techniques was excellent for the detection of ischaemic lesions and extra-axial collections (kappa = 0.80 and 0.88 respectively) and good for the detection of hydrocephalus (kappa = 0.69). No significant differences were detected in the number of ischaemic lesions (p=0.31) or in the Evans index (p=0.11). The WMv and CSFv measures were also similar (p=0.18 and p=0.94, respectively), as well as the volume of ischaemic lesions (p=0.79). Compared to conventional MRI, the SyMRI acquisition time was shorter regardless of the number of sections (32% and 6% time reduction for 4 or 3 mm section thickness, respectively). CONCLUSIONS: SyMRI allows the detection of potential complications of SAH in a similar way to conventional MRI with a shorter acquisition time.

Resultados tras implantación de un protocolo de sedoanalgesia para procedimientos en ámbito hospitalario / Results after implementation of a sedoanalgesia protocol for procedures in hospital environment

INTRODUCCIÓN: Se analiza la efectividad y seguridad de un protocolo específico de sedoanalgesia para procedimien tos, y evalúa la satisfacción del personal sanitario con cada procedimiento. PACIENTES Y MÉTODO: Estudio prospectivo de un protocolo de sedoanalgesia para procedimientos en ámbito hospitalario en menores de 18 años, con una estrategia individualizada según la situación basal del paciente, el tipo de procedimiento y la experiencia del pediatra responsable de la sedación. Se registraron las variables: diagnóstico que motiva el procedimiento, tipo de procedimiento, datos antropométri cos, alergias, medicación, estado ASA y enfermedad de base, tiempo de ayuno, auscultación pul monar, temperatura, saturación de oxígeno, frecuencia respiratoria, frecuencia cardiaca, tensión arterial, lugar de sedación, tipo de fármaco, dosis, tipo de vía, escala de sedación Ramsay, duración de la sedación, tipo y tratamiento de efectos adversos, presencia de familiares durante todo el pro cedimiento y satisfacción del paciente. RESULTADOS: Se realizaron 279 sedaciones. Los fármacos más usados fueron óxido nitroso (62,7%) y midazolam (16,5%); las vías de administración más utili zadas fueron la inhalada (62,4%) y la intravenosa (15,8%). La satisfacción fue alta para el pediatra (92,5%), el enfermero (94,3%), los familiares (96,8%) y los pacientes (93,6%), con una buena correlación entre ellos, y fue significativamente menor al usar midazolam y las vías nasal y bucal. La tasa de efectos adversos fue del 3,2%, y ninguno fue grave. CONCLUSIONES: La implementación de un protocolo específico de sedoanalgesia para procedimientos en el ámbito hospitalario consigue una alta efectividad y seguridad, además de un alto nivel de satisfacción, tanto en familiares como en personal sanitario.

INTRODUCTION: We analyze the effectiveness and safety of a specific analgosedation protocol for procedures, and eva luate the satisfaction of the health personnel with each procedure. PATIENTS AND METHOD: Prospective study of an analgosedation protocol for hospital procedures in children under 18 years of age, with an individualized strategy based on the patient's baseline situation, the type of procedure and the experience of the pediatrician responsible for the sedation. The following variables were recorded: diagnosis motivating the procedure, type of procedure, anthropometric data, allergies, medication, ASA status and baseline disease, fasting time, lung auscultation, temperature, oxygen saturation, res piratory rate, heart rate, blood pressure, sedation location, type of drug, dose, route of administra tion, Ramsay sedation scale, duration of sedation, type and treatment of adverse effects, presence of family members throughout the procedure, and patient satisfaction. RESULTS: 279 sedations were performed. The most commonly used drugs were nitrous oxide (62.7%) and midazolam (16.5%); the most commonly used routes of administration were the inhaled one (62.4%) and the intravenous one (15.8%). The satisfaction was high for the pediatrician (92.5%), the nurse (94.3%), the family (96.8%), and patients (93.6%), with a good correlation between them, and it was significantly lower when using midazolam and the nasal and oral routes. The adverse effects rate was 3.2%, and none was severe. CONCLUSIONS: The implementation of a specific analgosedation protocol for procedures in the hospital environment achieves high levels of effectiveness and safety, as well as a high level of satisfaction, both in family members and in health personnel.

Utilidad pronóstica de las puntuaciones de fallo multiorgánico y del índice inotrópico en el postoperatorio de trasplante cardiaco en niños / Prognostic utility of the multiorgan failure scores and inotropic index in the postoperative of cardiac transplantation in children

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NPC1 regulates ER contacts with endocytic organelles to mediate cholesterol egress.

Transport of dietary cholesterol from endocytic organelles to the endoplasmic reticulum (ER) is essential for cholesterol homoeostasis, but the mechanism and regulation of this transport remains poorly defined. Membrane contact sites (MCS), microdomains of close membrane apposition, are gaining attention as important platforms for non-vesicular, inter-organellar communication. Here we investigate the impact of ER-endocytic organelle MCS on cholesterol transport. We report a role for Niemann-Pick type C protein 1 (NPC1) in tethering ER-endocytic organelle MCS where it interacts with the ER-localised sterol transport protein Gramd1b to regulate cholesterol egress. We show that artificially tethering MCS rescues the cholesterol accumulation that characterises NPC1-deficient cells, consistent with direct lysosome to ER cholesterol transport across MCS. Finally, we identify an expanded population of lysosome-mitochondria MCS in cells depleted of NPC1 or Gramd1b that is dependent on the late endosomal sterol-binding protein STARD3, likely underlying the mitochondrial cholesterol accumulation in NPC1-deficient cells.

Results after implementation of a sedoanalgesia protocol for procedures in hospital environment. / Resultados tras implantación de un protocolo de sedoanalgesia para procedimientos en ámbito hospitalario.

INTRODUCTION: We analyze the effectiveness and safety of a specific analgosedation protocol for procedures, and eva luate the satisfaction of the health personnel with each procedure. PATIENTS AND METHOD: Prospective study of an analgosedation protocol for hospital procedures in children under 18 years of age, with an individualized strategy based on the patient's baseline situation, the type of procedure and the experience of the pediatrician responsible for the sedation. The following variables were recorded: diagnosis motivating the procedure, type of procedure, anthropometric data, allergies, medication, ASA status and baseline disease, fasting time, lung auscultation, temperature, oxygen saturation, res piratory rate, heart rate, blood pressure, sedation location, type of drug, dose, route of administra tion, Ramsay sedation scale, duration of sedation, type and treatment of adverse effects, presence of family members throughout the procedure, and patient satisfaction. RESULTS: 279 sedations were performed. The most commonly used drugs were nitrous oxide (62.7%) and midazolam (16.5%); the most commonly used routes of administration were the inhaled one (62.4%) and the intravenous one (15.8%). The satisfaction was high for the pediatrician (92.5%), the nurse (94.3%), the family (96.8%), and patients (93.6%), with a good correlation between them, and it was significantly lower when using midazolam and the nasal and oral routes. The adverse effects rate was 3.2%, and none was severe. CONCLUSIONS: The implementation of a specific analgosedation protocol for procedures in the hospital environment achieves high levels of effectiveness and safety, as well as a high level of satisfaction, both in family members and in health personnel.

Otorragia en una paciente pediátrica atendida de urgencias / No disponible

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Retirada de implante endosinusal mediante abordaje endoscópico. A propósito de un caso / Endosinusal implant removal by endoscopic approach. A case report

La rehabilitación mediante implantes dentales en pacientes con atrofia ósea en sectores posteriores del maxilar superior supone un reto para el clínico en la práctica diaria. La elevación sinusal, suele ser el procedimiento quirúrgico de elección para el manejo de estas situaciones y posibilita una adecuada rehabilitación implanto soportada. La migración de un implante al espacio antral es una complicación poco común que puede asociarse a la elevación sinusal. Han sido descritas numerosas técnicas para la retirada de implantes desplazados al antromaxilar y, entre ellas, destaca por su reciente incorporación y por su escasa morbilidad el abordaje endoscópico endosinusal. Se presenta el caso clínico de un paciente que fue derivado al servicio de Cirugía Oral y Maxilofacial del Hospital Universitario Madrid-Montepríncipe con diagnóstico de sinusitis aguda producida por un implante (..) (AU)

Rehabilitation with dental implants inpatients with bone atrophy of the posterior maxilla is a challenge that the clinician is faced frequently in daily practice. Sinus lift is a surgical procedure of choice for managing these situations and enables adequate implant rehabilitation. The migration of an implant antral space is a rare complication that may be associated with the technique of lifting the maxillary sinus. Many techniques have been described for removal of implants in the maxillary antrum displaced, among them, is distinguished by its recent incorporation and its low morbidity, the endoscopic approach endosinusal A case report of a patient who was referred (..) (AU)

Pulsed dye laser as an excellent choice of treatment for lupus tumidus: a prospective study.

BACKGROUND: Clinical manifestations of cutaneous lupus erythematosus (CLE) vary widely, and different subtypes of this autoimmune disease exist. Tumidus subtype (LT) has been recently separated from the chronic subtypes and is now considered an independent entity due to its particular clinical and histological features. Different treatments are usually prescribed for CLE. Our group has experience of CLE effectively treated with pulsed dye laser (PDL). It was our impression that better responses were achieved in the LT subtype, but no controlled prospective studies with PDL have been specifically performed. MATERIALS AND METHODS: A prospective study was performed on 10 patients with histologically confirmed LT treated with PDL. All patients were treated with 595 nm PDL using the 10 mm spot size at 0.5 ms pulse width and a fluence of 8 J/cm(2). Biopsies were taken before and 4 weeks after treatment and were stained with haematoxylin-eosin. RESULTS: Evaluation after PDL treatment showed clinical improvement in all of them without side-effects and reduction of the dermal lymphocytic infiltrate in 9/10 of the patients. Epidermal changes were absent in all patients. Mucin deposition persisted only in one patient. However, 50% of the patients developed new lesions nearby or distant to the treated zones. CONCLUSIONS: PDL therapy is an effective and fast treatment option for acute flares of LT; however, it does not prevent recurrences. A histological improvement has been confirmed in this study. Purpura seems to be necessary to achieve a good response.

[Plaque-phase mycosis fungoides treated with photodynamic therapy: results from 12 patients]. / Micosis fungoide en fase de placas tratada con terapia fotodinámica: resultados en 12 pacientes.

BACKGROUND: Recent years have seen an increase in the off-label use of photodynamic therapy for the treatment of a variety of skin diseases. Plaque-phase mycosis fungoides is among the most promising possibilities for the use of this treatment. OBJECTIVES: To evaluate the treatment of plaque-phase mycosis fungoides with photodynamic therapy and compare the results obtained using fluorescence photography. MATERIALS AND METHODS: We performed a prospective, descriptive, observational study. Twelve patients with 24 lesions were treated with topical methyl aminolevulinate (MAL) under an occlusive dressing for 3 h, followed by 8 min of red light (630 nm, 37 J/cm2; Aktilite). RESULTS: Six patients had a complete response, 5 a partial response, and 1 did not respond to treatment. A mean of 5.7 sessions was applied and no side effects were reported. Treatment tolerance was excellent. CONCLUSIONS: Photodynamic therapy with MAL appears to be a good treatment option for patients with plaque-phase mycosis fungoides with a small number of lesions.

Micosis fungoide en fase de placas tratada con terapia fotodinámica: resultados en 12 pacientes / Plaque-Phase Mycosis Fungoides Treated with Photodynamic Therapy: Results from 12 Patients

Introducción: La terapia fotodinámica (TFD) está siendo desarrollada en los últimos años en dermatosis diferentes de las aprobadas para su uso. Entre todas ellas, la micosis fungoide (MF) en estadio de placas es una de las más prometedoras. Objetivos: Evaluar los resultados en el tratamiento de la MF en placas con TFD y correlacionarlos con la fotografía de fluorescencia. Material y métodos: Llevamos a cabo un estudio prospectivo, descriptivo y observacional. Se seleccionaron un total de 12 pacientes con 24 lesiones que fueron tratados con metilaminolevulinato (MAL) tópico ocluido tres horas y luz roja (630nm, 37J/cm2, 8min, Aktilite®). Resultados: Un total de 6 pacientes obtuvo respuesta completa, 5 pacientes alcanzaron respuesta parcial y uno no respondió al tratamiento. La media de sesiones aplicadas fue de 5,7 y no se recopilaron efectos secundarios. La tolerancia fue excelente. Conclusiones: La TFD con MAL parece una buena alternativa terapéutica para los pacientes con MF en placas con escaso número de lesiones (AU)

Background: Recent years have seen an increase in the off-label use of photodynamic therapy for the treatment of a variety of skin diseases. Plaque-phase mycosis fungoides is among the most promising possibilities for the use of this treatment. Objectives: To evaluate the treatment of plaque-phase mycosis fungoides with photodynamic therapy and compare the results obtained using fluorescence photography. Materials and methods: We performed a prospective, descriptive, observational study. Twelve patients with 24 lesions were treated with topical methyl aminolevulinate (MAL) under an occlusive dressing for 3h, followed by 8min of red light (630nm, 37J/cm2; Aktilite). Results: Six patients had a complete response, 5 a partial response, and 1 did not respond to treatment. A mean of 5.7 sessions was applied and no side effects were reported. Treatment tolerance was excellent. Conclusions: Photodynamic therapy with MAL appears to be a good treatment option for patients with plaque-phase mycosis fungoides with a small number of lesions (AU)

Lymphogranuloma venereum proctocolitis: a silent endemic disease in men who have sex with men in industrialised countries.

Lymphogranuloma venereum (LGV) is a sexually transmitted disease (STD) caused by serovars L1-L3 of Chlamydia trachomatis. Rare in the western world prior to 2003, different outbreaks or clusters of LGV have been reported in Europe, North America and Australia among men who have sex with men (MSM) over the past few years. The majority were HIV infected MSM with high-risk sexual behaviour and a high rate of concomitant STD, including hepatitis C. Most of them presented with a proctitis syndrome and only a few with the classical bubonic form. A previously non-described serovar, L2b, has been identified as the main causative agent of the epidemic. A delay in diagnosis has been the rule because of the misleading symptomatology of LGV proctitis, the unfamiliarity of the disease to physicians, and the lack of a routine diagnostic test for LGV serovars. It is crucial to increase the awareness of the disease among physicians for prompt diagnosis and treatment, to avoid complications, and to stop ongoing transmission. It has additional public health implications since LGV may facilitate the transmission and acquisition of HIV and other STD.

Morbilidad, mortalidad y costes sanitarios evitables medianteuna estrategia de tratamiento del tabaquismo en España / The effects of implementing a smoking cessation intervention in Spain on morbidity, mortality and health care costs

Objetivo: Se valoran los efectos que tendría una intervención destinada a reducir el uso de tabaco en la población española de fumadores sobre la morbilidad, la mortalidad y los costes asociados al consumo de tabaco. Método: Se ha adaptado el modelo Health and Economic Consequences of Smoking patrocinado por la OMS y desarrollado por The Lewin Group. La intervención propuesta incluye el acceso a asistencia farmacológica de un 35% de los fumadores que intentan dejar de fumar, y obtienen una tasa global de cesación al año del 7,2%. Las enfermedades estudiadas son: cáncer de pulmón, enfermedad coronaria, enfermedad cerebrovascular, EPOC, asma y bajo peso al nacer. Se estiman los casos de enfermedad y muerte atribuibles al consumo de tabaco evitados y la reducción en el coste sanitario debidos a la intervención, proyectados a 20 años. Resultados: Sin intervención, en el año 1 del modelo 2.136.094 fumadores padecen alguna de las condiciones clínicas atribuibles al consumo de tabaco, el coste asistencial es de 4.286 millones de euros y las muertes atribuibles son 26.537. La intervención propuesta evita 2.613, 9.192, 17.415 y 23.837 casos de enfermedad atribuible al consumo de tabaco en los años 2, 5, 10 y 20 del modelo, respectivamente. Los costes asistenciales acumulados evitados son 3,5 millones de euros en el año 2 y 386 millones de (..) (AU)

Objective: We estimated the effect that a smoking cessation intervention in the Spanish population of smokers would have on smoking-related morbidity, mortality and healthcare costs. Methods: We adopted the model Health and Economic Consequences of Smoking sponsored by the WHO Health Organization and developed by the The Lewin Group. The smoking cessation intervention proposed incluides pharmacological treatment to 35% of smokers who are trying to quit smoking and obtains a quit rate of 7.2%. The diseases studied are: lung cancer, heart disease, stroke, chronic obstructive pulmonary disease, asthma exacerbation, and low birth weight. The smoking-related cases of disease and of averted death and the reduction in healthcare expenditure due to the intervention were estimated. Results: Without intervention, at year 1 of the model, 2,136,094 smokers would be affected by some smoking-related disease; healthcare expenditure would be 4,286 million € and deaths attributable to smoking would total 26,537. The proposed intervention (..) (AU)

[The effects of implementing a smoking cessation intervention in Spain on morbidity, mortality and health care costs]. / Morbilidad, mortalidad y costes sanitarios evitables mediante una estrategia de tratamiento del tabaquismo en España.

OBJECTIVE: We estimated the effect that a smoking cessation intervention in the Spanish population of smokers would have on smoking-related morbidity, mortality and health care costs. METHODS: We adopted the model Health and Economic Consequences of Smoking sponsored by the WHO Health Organization and developed by the The Lewin Group. The smoking cessation intervention proposed includes pharmacological treatment to 35% of smokers who are trying to quit smoking and obtains a quit rate of 7.2%. The diseases studied are: lung cancer, heart disease, stroke, chronic obstructive pulmonary disease, asthma exacerbation, and low birth weight. The smoking-related cases of disease and of averted death and the reduction in health care expenditure due to the intervention were estimated. RESULTS: Without intervention, at year 1 of the model, 2,136,094 smokers would be affected by some smoking-related disease; health care expenditure would be 4,286 million e and deaths attributable to smoking would total 26,537. The proposed intervention would prevent 2,613, 9,192, 17,415 and 23,837 cases of smoking-related disease at years 2, 5, 10 and 20 of the model, respectively. The saving in accumulated health care costs would amount to 3.5 million e at year 2 and 386 million e over 20 years. The accumulated prevented deaths are 284 at year 2 and 9,205 over 20 years. The intervention would save a total of 78,173 life-years by the end of the period considered. CONCLUSIONS: The availability of new effective smoking cessation interventions and the increase in accessibility to such interventions may contribute significantly to reducing morbidity, mortality and health care costs associated with smoking in Spain.

[Auxological study of contemporary and historical samples of the population of madrid]. / Estudio auxológico de muestras contemporáneas e históricas de la población madrileña: aplicación del modelo 1 de Preece-Baines.

OBJECTIVES: To describe statural growth in a sample of both sexes using the Preece-Baines model 1 (PB1) in order to obtain smoothed percentiles for use in reference growth charts. To apply the PB1to several historical samples, with different age ranges, obtained from the literature (1896-1983) in order to study secular changes in stature. MATERIAL AND METHODS: The sample consisted of 1,525 schoolchildren, aged 6-18 years. The PB1was fitted to the percentile curves, which were corrected for deviation from normal distribution by the LMS model. The PB1was applied to the historical samples and the variables describing growth spurt and adult height were compared. RESULTS: The age of peak height velocity (PHV) was 13.73 years in males and 11.02 years in females. Estimated adult height, in this model, was 176.22 cm for males and 163.53 cm for females. Mean velocity of secular change in males was estimated as 1.2 cm/decade. The age at PHV increased by 0.2 years/decade. CONCLUSIONS: The PB1did not achieve smoothed percentile curves for use in reference growth charts. Right skewness of the distribution was corrected by application of the LMS method. However, the PB1is useful for studying secular trends in statural growth.

Estudio auxológico de muestras contemporáneas e históricas de la población madrileña: aplicación del modelo 1 de Preece-Baines / Auxological study of contemporary and historical samples of the population of madrid (spain): application of the preece-baines growth model 1

Objetivos: Describir el crecimiento estatural de una muestra de niños y jóvenes de ambos sexos mediante el modelo 1 de Preece-Baines (PB1) para obtener valores percentilares suavizados que sirvan de referencia. Asimismo, aplicar el PB 1 a una serie de muestras históricas, con rangos de edad variables, recopiladas de la bibliografía entre 1896 y 1983, para estimar los cambios seculares. Material y métodos: La muestra constaba de 1.525 escolares entre 6 y 18 años. El PB1 se ajustó a las curvas percentilares que se corrigieron para las desviaciones de la normalidad mediante el modelo LMS. Después de aplicar el PB 1 a las muestras históricas se han comparado los parámetros que describen el estirón y la talla adulta. Resultados: La edad del pico del estirón ha resultado de 13,73 años en varones y de 11,02 años en mujeres y la estatura adulta estimada, según el modelo, de 176,22 cm en varones y de 163,53 cm en mujeres. La velocidad promedio de cambio secular en la talla adulta de los varones resultó de 1,2 cm/década. La edad del pico del estirón presenta un adelanto de 0,2 años/década. Conclusiones: Al elaborar referencias poblacionales de talla para la edad, el PB1 por sí mismo no logra suavizar los percentiles finales. Pero la aplicación del LMS consigue eliminar la asimetría derecha de la distribución. Sin embargo, el PB1 se adapta al estudio del secular trend para la talla (AU)

[Chylothorax as a late complication of pacemaker endocarditis]. / Quilotórax como una complicación a largo plazo de la endocarditis sobre marcapasos.

The mortality observed in pacemaker endocarditis may be high when all the components of the device are not withdrawn. Few studies have reported the posterior morbidity once the acute disease is resolved. Herein we present a patient who developed superior vena cava thrombosis, obstruction of thoracic duct and chylothorax after the initial episode of endocarditis. The evolution of the patient illustrates the late complications of isolated antibiotic treatment of pacemaker endocarditis, the poor results obtained with temporal oral anticoagulation in the management of superior vena cava thrombosis in the presence of retained intravascular foreign material, the excellent, prolonged initial response of chylothorax to conservative measures with anticoagulation and diet, relapse of chylothorax related to the increase in arterial pulmonary pressure, the absence of response at this time to the dietary measures and the successful treatment with video-assisted thoracic surgery to treat chylothorax without the morbidity of the large surgical procedures.