Blend design tools for Medium Combustion Plants (MCP) firing biomass wastes.

A feasible alternative for agricultural or forestry waste management is the operation of a distributed network of sustainable Medium Combustion Plants (MCPs). However, one of the main factors that hinder its development is the propensity to operational problems derived from corrosion, slagging and fouling characteristics of both bottom and fly ashes. Therefore, a cost-effective approach for these multi-product MCP could be based on predictive tools for an optimal formulation of a fuel blend. This work focuses on the assessment of the ability of these methods to provide guidance for preventing ash-related operational problems and to provide fuel-blending rules. The more widespread tools pertain to two types: compositional classification based on chemical analysis of laboratory ashes, and thermodynamic prediction of the most likely species and phases. Both criterion numbers and compositional maps are ranking methods based on the chemical analysis at a given ashing temperature. Thermodynamic equilibrium modeling is not constrained by any difference in the physical conditions of the MCP compared to those in the laboratory. Both kind of prediction tools have been validated in an MCP firing olive tree pruning residues as well as its typical blends in order to mimic a plausible pattern of fuels along a full year operating campaign. An intensive experimental campaign encompasses plant monitoring and off-line analysis of the ashes along the process line. Interpretation of compositional plots has revealed to be potentially sensitive to ashing temperature. Here are presented examples showing how this variable could lead to either insignificant differences or to a substantial disparity in the a priori fuel diagnosis. Some inconsistencies have been observed between the predictions based on criterion numbers, even for the same fuel and for ranking rules specifically formulated for biomasses. Moreover, it does not match consistently with the information obtained from phase diagrams. Therefore, their use should be limited to the case of a well-established selection of a fuel index for a well-defined fuel provided empirical evidence of an enough good description of the ash behavior, which is not the most frequent case. Thermodynamic equilibrium calculations allow a more precise prediction of the main species in the condensed phase, without the constraint of the ashing temperature. Elemental closure of main ash-forming elements with the chemical analysis of the process ashes presents small differences, and their proximity localization on the phase diagrams denote similar prediction between predicted and process ashes.

La procalcitonina en el diagnóstico de infección postoperatoria en las artroplastias de rodilla / Procalcitonin in the diagnosis of postoperative infection in knee arthroplasty

Objetivo. La procalcitonina (PCT) es un polipéptido de 116 aminoácidos sintetizado en las células C del tiroides cuyas concentraciones se elevan en presencia de una infección bacteriana. El objetivo del trabajo es estudiar el comportamiento de las concentraciones de PCT en el postoperatorio de las artroplastias de rodilla y valorar su utilidad en el diagnóstico de procesos infecciosos y su relación con la velocidad de sedimentación globular (VSG) y la proteína C reactiva (PCR). Material y métodos. Se estudiaron las concentraciones de PCT, PCR y valores de VSG en 128 pacientes intervenidos para una artroplastia primaria de rodilla desde el preoperatorio y los tres primeros días tras la intervención para relacionar los cambios en los niveles de estos marcadores con la aparición de complicaciones. Se estudió la variación en el número de leucocitos, el número de transfusiones, la utilización de diferentes implantes y el tiempo de isquemia buscando correlación con la aparición de concentraciones de PCT > 0,5 ng/mL. Resultados. Concentraciones de PCT < 0,5 ng/mL se correspondieron con ausencia de complicaciones clínicas en el 95% de los casos mientras que concentraciones de PCT > 0,5 ng/mL se correspondieron con aparición de complicaciones clínicas en el 75% de los casos. La PCR y la VSG se incrementaron en todos los casos. Conclusiones. La dificultad para hacer el diagnóstico incuestionable de infección no permite afirmar categóricamente que una concentración de PCT > 0,5 ng/mL sea marcador exclusivo de complicación infecciosa pero su determinación parece de mayor utilidad que la de VSG y PCR (AU)

Purpose of the study: Procalcitonin (PCT) is a 116 aminoacid polipeptyde synthesized in the thyroid C-cells. Its levels rise in the presence of bacterial infection. The aim of this work was to study the evolution of PCT levels in the postoperative period of knee arthroplasty and to assess its usefulness in the diagnosis of the infection process and its relationship to Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP). Material and methods: Blood samples from 128 patients undergoing total knee arthroplasty surgery were taken one hour before surgery and 24, 48 and 72 hours after. PCT, ESR and CRP levels were measured and related to clinical complications. The number of leukocytes, blood transfusions, type of implant and minutes of ischaemia were studied and correlated to PCT concentrations above 0.5 ng/mL. Results: PCT < 0.5 ng/mL correlated with absence of clinical complications in 95% of the cases, and levels of PCT>0.5 ng/mL correlated to clinical complications in 75% of the cases. ESR and CRP increased in all of the patients in the postoperative period. Conclusions: Difficulties in establishing an unquestionable diagnosis of infection do not allow us to firmly assert that PCT levels higher than 0.5 ng/mL are exclusive of bacterial infection, but it does seem to be more useful than ESR and CRP in the management of these patients (AU)

Effect of vitamin D and calcium supplementation on bone turnover in institutionalized adults with Down's Syndrome.

OBJECTIVE: To assess the status of vitamin D and the effects of calcium and vitamin D3 supplementation on the bone metabolism in a group of adults with Down's syndrome (DS). DESIGN: Randomized, parallel, controlled and open clinical trial. SETTING: Institution for mentally handicapped: Fundación Uliazpi, Diputación Foral de Guipúzcoa, San Sebastián, Spain. SUBJECTS: A total of 23 persons with DS, residents at the Uliazpi Foundation were recruited and all completed the study. INTERVENTION: In all, 12 participants were randomly allocated to receive 1 g of calcium and 800 IU of vitamin D once daily for 1 year while 11 were assigned to the control group, receiving no supplementation. RESULTS: We found no differences between groups regarding serum calcium and phosphorous levels. The remaining parameters showed differences between the two groups consistent with a beneficial effect of the intervention: serum levels of parathyroid hormone, osteocalcin and crosslaps diminished while serum 25 OH vitamin D3 level increased. CONCLUSIONS: The results obtained allow to include people with DS as a risk group with regards to vitamin D deficit, which that can be corrected with vitamin D and calcium supplementation, and giving rise to an improvement of the biochemical markers related to the phospho-calcium metabolism and bone remodelling.

Mano en espejo en anciana / Mirror hand in an elderly woman

Objetivo y caso clínico. Se expone el caso de una paciente anciana ingresada por fractura de cadera que presenta polidactilia sin pulgar en su mano derecha. Conclusiones. El diagnóstico es de mano en espejo, un trastorno de la diferenciación de la extremidad superior muy infrecuente que es diagnosticada y tratada en la infancia, por lo que la deformidad en un adulto es aún más extraordinaria

Aim and case report. The case of an elderly woman admitted for hip fracture who had right polydactyly without a thumb is reported. Conclusions. Mirror hand is a rare disorder of upper-limb differentiation that is generally diagnosed and treated in childhood; adult cases are unusual

[Digital computerized absorptiometry in the diagnosis of osteoporosis in a group of the severely mentally retarded]. / La absorciometría digital computarizada en el diagnóstico de la osteoporosis en un grupo de deficientes mentales graves.

BACKGROUND: The loss of bone mass after a certain age is a physiological fact that, in certain circumstances, is capable of inducing osteoporosis. In the diagnostic strategies for this condition, densitometry is a well-accepted technique now widely used. On patients with severe mental retardation, a number of circumstances come into play and may foster a greater frequency of osteoporosis. GOAL AND SCOPE OF STUDY: The goal of the study is to identify the bone mineral density values in a group of severe mentally retarded individuals using a digital densitometry technique in order to compare these with the general population and investigate the possible influence on these values of certain clinical variables and therapeutic regimens. VOLUNTEERS: One hundred and ninety-two patients of both sexes and treated at an institution devoted to the study and care of severely mentally retarded individuals. ACTIONS TAKEN: In all cases, the bone mineral density value has been obtained by means of digital densitometry using a compact desktop system using dual X-ray absorption measurement technology The data obtained have been contrasted with sex, age, degree of mobility and anti-epilepsy or sedative medication. RESULTS: In the population under study, the bone mineral density is significantly lower than that of the general population: 25% present osteopenia and 22% osteoporosis. These results are associated with the fact that they move little and are regularly taking phenobarbital medication. The population with Down's syndrome is also seen to be a group at risk. CONCLUSIONS: Osteoporosis is frequent among severe mentally retarded patients. The greatest risk is associated with insufficient mobility, Down's syndrome and regular medication with phenobarbital. Digital densitometry is a simple procedure that may be useful to identify the true dimension of this problem and the efficacy of the various preventive or curative procedures put forward.

Artrosis: patogenia y desarrollo / Arthrosis: pathogenesis and development

La alteración degenerativa del cartílago articular de la rodilla es un proceso frecuente, que se ve acompañado de afectación de otras estructuras de la articulación, como son el hueso subcondral, la cápsula articular, la membrana sinovial, etc. Es motivada por diversos factores, tanto locales como generales. El cartílago sufre una disminución de mucopolisacáridos ácidos de la sustancia fundamental, que desprotege a las fibras colágenas y no es capaz de absorber la sobrecarga mecánica que actúa sobre él. En los estadios finales disminuye la síntesis de prostaglandinas, y la concentración de colagenasa, con lo que el cartílago pierde altura y desarrolla una artrosis terminal. Al mismo tiempo los condrocitos reaccionan estimulando las enzimas y desarrollando una respuesta reparadora inadecuada. En condiciones normales, al cargar sobre una articulación se produce una deformación del cartílago y del hueso subcondral, que facilita el máximo contacto y un reparto de presiones en las superficies articulares. Si éstas no son elásticas, se produce una sobrecarga articular y el desarrollo de su degeneración (AU)

La absorciometría digital computarizada en el diagnóstico de la osteoporosis en un grupo de deficientes mentales graves / Computerized digital absorption measurement in the diagnosis in the diagnosis of osteoporosis in a group of severly mentally retarded patients

Antecedentes: La pérdida de masa ósea es a partir de cierta edad un hecho fisiológico que en determinadas circunstancias es capaz de producir osteoporosis. En las estrategias de diagnóstico de la enfermedad, la densitometría es una técnica acreditada cuyo empleo se ha generalizado. En los deficientes mentales graves concurren una serie de circunstancias que podrían favorecer una mayor frecuencia de casos de osteoporosis. Objetivo y ámbito de estudio: El objetico del estudio es conocer los valores de la densidad mineral ósea en un grupo de deficientes mentales graves mediante una técnica de densitometría digital, compararlos con la de la población general e investigar la influencia que sobre ellos tienen algunas variables clínicas y pautas terapéuticas. Sujetos: Ciento noventa y dos pacientes de ambos sexos atendidos en una institución dedicada al estudio y cuidados de deficientes mentales graves. Intervenciones: En todos los casos se ha obtenido el valor de la densidad mineral ósea mediante densitometría digital realizada con un equipo compacto de sobremesa que emplea tecnología de absorciometría dual de rayos X. Los datos obtenidos se han puesto en relación con el sexo, la edad, el grado de movilidad y las medicaciones antiepiléptica y sedante. Resultados: La densidad mineral ósea es en la población estudiada significativamente inferior a la de la población general. El 25 por ciento presenta osteopenia y el 22 por ciento osteoporosis. Estos resultados están asociados con el hecho de no moverse y de tomar fenobarbital como medicación habitual. La población con síndrome de Down se perfila también como grupo de riesgo. Conclusiones: La osteoporosis es frecuente entre los deficientes mentales graves. El mayor riesgo se asocia a la movilidad deficiente, al síndrome de Down y al fenobarbital como medicación habitual. La densitometría digital es un procedimiento sencillo que puede ser útil para conocer la dimensión real de este problema y la eficacia de los diferentes procedimientos preventivos o curativos que se propongan (AU)

Background: The loss of bone mass after a certain age is a physiological fact that, in certain circumstances, is capable of inducing osteoporosis. In the diagnostic strategies for this condition, densitometry is a well-accepted technique now widely used. On patients with severe mental retardation, a number of circumstances come into play and may foster a greater frequency of osteoporosis. Goal and scope of study: The goal of the study is to identify the bone mineral density values in a group of severe mentally retarded individuals using a digital densitometry technique in order to compare these with the general population and investigate the possible influence on these values of certain clinical variables and therapeutic regimens. Volunteers: One hundred and ninety-two patients of both sexes and treated at an institution devoted to the study and care of severely mentally retarded individuals. Actions taken: In all cases, the bone mineral density value has been obtained by means of digital densitometry using a compact desktop system using dual X-ray absorption measurement technology The data obtained have been contrasted with sex, age, degree of mobility and anti-epilepsy or sedative medication. Results: In the population under study, the bone mineral density is significantly lower than that of the general population: 25% present osteopenia and 22% osteoporosis. These results are associated with the fact that they move little and are regularly taking phenobarbital medication. The population with Down’s syndrome is also seen to be a group at risk. Conclusions: Osteoporosis is frequent among severe mentally retarded patients. The greatest risk is associated with insufficient mobility, Down’s syndrome and regular medication with phenobarbital. Digital densitometry is a simple procedure that may be useful to identify the true dimension of this problem and the efficacy of the various preventive or curative procedures put forward (AU)

[Bioelectric impedance in the nutritional evaluation of mentally deficient quadriplegic adults]. / La impedanciometría en la valoración nutricional en deficientes mentales cuadripléjicos adultos.

Severely mentally retarded persons with cerebral palsy show a high rate of acute and chronic malnutrition. Without discarging other factors which might be at play, caloric intake deficiency stemming from the difficulties involved in being fed appear to play a crucial role in its etiology. In the assessment of these disorders, anthropometry is limited by the lack of adequate reference values and by the difficulty or impossibility of measuring height using the conventional method. The purpose of this study is to see how changes in body composition brought about by an increase in dietary caloric intake are perceived by both anthropometry and biolectrical impedance analysis. To do so, 13 subjects were selected from a group of 203 severely mentally retarded persons made up of 25% cerebral palsy patients and 13% quadriplegics. The 13 subjects were fed orally without tubes and all had tricipital skinfolds of less than P25. All 13 were given a 25% caloric increase over the regular diets for a period of two months. This increase was provided by means of a polymeric, normoproteic, hypercaloric preparation. Weight and brachial perimeter showed significant increases coinciding with the administration of the supplement. Theses increases were not noticeable two months after discontinuing the supplement. There were no significant changes in tricipital and subescapular skinfolds, muscular circumference of de mid-arm, resistance, reactance, or the total body an extracellular water calculated from the latter two values. From these results we deduce that biolectrical impedance analisys offers no advantages over anthropometry in monitoring the nutritional status of quadriplegics.