Uso del contenido de fluido torácico para la predicción del balance hídrico y las complicaciones pulmonares postoperatorias tras cirugía abdominal mayor / Use of thoracic fluid content for prediction of fluid balance and postoperative pulmonary complications after major abdominal surgery: An observational study

Antecedentes y objetivos: Los efectos nocivos del exceso de líquidos se manifiestan frecuentemente en los pulmones. El contenido de fluido torácico (thoracic fluid content [TFC]) es una variable que proporciona el monitor por biorreactancia STARLING™, que representa el volumen total de líquido en el tórax. El objetivo es analizar la asociación entre la variación de los valores del TFC (TFCd0%) a las 24horas postoperatorias, el balance hídrico postoperatorio y las complicaciones pulmonares postoperatorias. Material y métodos: Estudio observacional prospectivo y analítico. Se incluyeron pacientes programados para cirugía abdominal mayor en un hospital universitario de tercer nivel. Fueron monitorizados durante la intervención y las 24 primeras horas postoperatorias con el monitor STARLING™, midiendo el TFC y su variación en distintas etapas del perioperatorio. Se realizaron ecografías pulmonares seriadas y se recogieron las complicaciones pulmonares postoperatorias. Se realizó una regresión logística para predecir la aparición de atelectasias y congestión pulmonar. Se calculó el coeficiente de correlación de Pearson para comprobar la asociación entre TFC y balance hídrico. Resultados: Se analizaron 50 pacientes. El TFCd0% medido en la mañana del primer día postoperatorio aumentó una mediana del 27,1% [IQR: 20,3-37,5] y se correlacionó con una r=0,44 con el balance postoperatorio de 677ml [IQR: 125,5-1.412]. El aumento del TFC se relacionó con un mayor riesgo de sufrir atelectasias (OR=1,24) y congestión pulmonar (OR=1,3). Conclusiones: El TFCd0% medido a las 24horas de la cirugía presenta una correlación moderada con el balance hídrico postoperatorio. Su incremento es un factor de riesgo para la aparición de complicaciones pulmonares postoperatorias.(AU)

Background and objectives: The harmful effects of excess fluids frequently manifest in the lungs. Thoracic fluid content (TFC) is a variable provided by the STARLINGTM bioreactance monitor, which represents the total volume of fluid in the chest. The objective is to analyze the association between the variation in TFC values (TFCd0%) at 24 hours postoperatively, postoperative fluid balance, and postoperative pulmonary complications. Material and methods: Prospective and analytical observational study. Patients scheduled for major abdominal surgery at a tertiary teaching hospital were included. They were monitored during the intervention and the first 24 postoperative hours with the monitor. STARLINGTM, measuring TFC and its variation in different stages of the perioperative period. Serial lung ultrasounds were performed and postoperative pulmonary complications were recorded. Logistic regression was performed to predict the occurrence of atelectasis and pulmonary congestion. The Pearson correlation coefficient was calculated to verify the association between TFC and water balance. Results: 50 patients were analyzed. TFCd0% measured on the morning of the first postoperative day increased by a median of 27.1% [IQR: 20.3-37.5] and was correlated at r=0.44 with the postoperative balance of 677 ml [IQR: 125.5-1,412]. Increased TFC was related to a higher risk of atelectasis (OR=1.24) and pulmonary congestion (OR=1.3). Conclusions: TFCd0% measured 24 hours after surgery presents a moderate correlation with postoperative fluid balance. Its increase is a risk factor for the appearance of postoperative pulmonary complications.(AU)

Efectividad analgésica del tapentadol en el dolor neuropático secundario al síndrome postlaminectomía / Analgesic effectiveness of tapentadol in neuropathic pain secondary to post-laminectomy syndrome

Objetivo: El objetivo del presente estudio es evaluar la eficacia y seguridad de tapentadol de liberación a 100 o 200 mg vía oral cada 24 horas, de acción prolongada, para el tratamiento del síndrome postlaminectomía (SPL) en una serie de pacientes con dolor neuropático en tratamiento analgésico inefectivo. Material y métodos: Se realizó un estudio unicéntrico, longitudinal, prospectivo y observacional, en el que se reclutaron 30 pacientes a la clínica de dolor de un centro de referencia de tercer nivel que sufrían de SPL y que cumplían con todos los criterios de inclusión; a quienes se les aplicó el cuestionario Brief Pain Inventory en su versión en español y el test de Lanss antes y después de iniciar tratamiento con tapentadol, y se aplicó una t de Student para comparar la efectividad global del tratamiento del dolor neuropático. Resultado: Se analizaron datos de 30 pacientes, de los cuales 19 fueron mujeres (63,3 %) y 11 hombres (36,6 %) con diagnóstico de SPL confirmado y con características de dolor de tipo neuropático, quienes fueron divididos en dos grupos: el primer grupo de 13 pacientes (43,3 %) recibió tapentadol a 100 mg vía oral cada 24 horas y el segundo de 17 pacientes (56,6 %) recibió 200 mg vía oral cada 24 horas por cuatro semanas. Se les dio un seguimiento de 4 semanas y se encontró una disminución estadísticamente significativa (valor de p = 0,05) del dolor neuropático en la consulta subsecuente de la clínica del SPL.(AU)

Objective: The objective of this study is to eva­luate the efficacy and safety of long-acting tapentadol 100 or 200 mg orally every 24 hours for the treatment of Postlaminectomy Syndrome (SPL) in a series of patients with pain neuropathic in ineffective analgesic treatment. Material and methods: A single-center, longitudinal, prospective and observational study was conducted, in which 30 patients were recruited to the pain clinic of a third-level reference center who suffered from SPL and who met all the inclusion criteria; To whom the Brief Pain Inventory questionnaire in its Spanish version and the Lanss Test were applied before and after starting treatment with tapentadol and a student's t was applied to compare the overall effectiveness of the treatment of neuropathic pain. Results: Data from 30 patients were analyzed, of which 19 were women (63.3 %) and 11 were men (36.6 %) with a diagnosis of confirmed SPL and the presentation of neuropathic pain, who were divided into two groups. The first group of 13 patients (43.3 %) received tapentadol at 100 mg orally every 24 hours, and the second group of 17 patients (56.6 %) received 200 mg orally every 24 hours for four weeks. They were followed up for 4 weeks and statistically significant improvement (p value = 0.05) was found in the SPL clinic.(AU)

Complications related to the insertion and maintenance of peripheral venous access central venous catheter. / Complicaciones relacionadas con la inserción y el mantenimiento del catéter venoso central de acceso periférico.

OBJECTIVE: To evaluate the rates and nature of the complications related to the Central Peripheral Access Catheter (CVCAP or PICC) from its insertion to its withdrawal. METHODS: Prospective observational study. All patients older than 14 years of age with a PICC inserted in the polyvalent intensive care unit (ICU) during the period between May 1, 2015 and April 30, 2016 were included. Data collected included: demographic data, insertion details, reason for insertion and removal, maintenance unit, total dwell time, incidence of complications and related factors and infection rate. RESULTS: 144 PICCs were inserted, of which 94 corresponded to the ICU group (65.28%) and 50 (34.72%) to the non-ICU group. The most important complication was the suspicion of infection: 17.36% (rate of 15.2 per 1000 days of PICC). The total number of confirmed infections was 6.25% (5.5 per 1000 days of PICC), 1.39% (1.2 per 1000 days) being in the ICU group and 4.86% (4.2 per 1000 days) in the non-ICU group. There were 5 bacteraemias, all in the non-ICU group (3 per 1000 days). The most frequent germ was Staphylococcus epidermidis (6 cases). Phlebitis had an incidence of 9.03% (7.9 per 1000 days of PICC). CONCLUSIONS: PICC, effective device for central venous access due to the minimal incidence of risks in implantation and to its advantages with regard to the classic central venous catheters, is a further nursing technique.

Effect of meat enhancement solutions with hydroxypropyl methylcellulose and konjac flour on texture and quality attributes of pale, soft, and exudative pork.

The objective of this study was to determine whether addition of hydrocolloids, buffer ingredients, salt, and sodium phosphate improve the color, texture, and pH of normal and pale, soft, and exudative (PSE) meat. Specific solutions include potassium bicarbonate (KHCO), ammonium bicarbonate (NHHCO), hydroxypropyl methylcellulose (HPMC), and konjac flour (KF). Three studies were carried out. First, the stability and viscoelastic properties of the different solutions was determined. Second, fresh normal (pH 5.6-5.9) and PSE (pHu < 5.4) Longissimus dorsi muscles were ground and assigned a treatment solution: control (fresh normal), water, NaCl/SP, KHCO, NHHCO, KF, HPMC, KHCO/KF, KHCO/KF/NaCl/SP (sodium phosphate), NHHCO/HPMC, and NHHCO/HPMC/NaCl/SP. Third, treatment solutions with suitable viscoelastic properties and stability, were added, homogenized, stuffed into tubes, and cooked to an internal temperature of 75C to form gels, and torsion and texture profile analysis performed. The PSE treated samples containing bicarbonate/hydrocolloid treatments had similar hardness-first bite, hardness-second bite, and gumminess values to the normal-control samples while the NHHCO treated samples had air pockets in the cooked gel. Third, consumers (n = 92) evaluated control and PSE beef/pork frankfurters produced with the following treatments: KHCO, KHCO/HPMC, and KHCO/KF. Treatment had no effect (p > .05) on overall like/dislike of flavor, but PSE frankfurters were preferred (p < .05) to the controls. The use of KHCO with hydrocolloids, salt and SP improved the color, pH and texture properties of PSE ground pork; further research to examine the effectiveness in whole PSE pork muscle systems is needed. PRACTICAL APPLICATIONS: Meat processors could use KHCO with HPMC or KF as ingredients to improve color, texture, and pH of PSE meat. The reduction of variation between PSE and normal pork muscle would improve pork quality and add value to PSE meat products.

Schwannoma of the biliary tract resembling cholangiocarcinoma: A case report and review.

Schwannomas are benign tumours derived from Schwann cells and are extremely rare in the biliary tract. We present the case of a 62-year-old patient with a common bile duct schwannoma that resembled a cholangiocarcinoma. We also review all 17 previously published cases of schwannoma of the biliary tract and discuss the challenges of preoperative diagnosis.

Efecto del masaje terapéutico como cuidado de enfermería en la capacidad funcional del adulto mayor / The effect of therapeutic massage as part of nursing care for the functional capacity of the elderly / Efeito da massagem terapêutica como cuidado da enfermagem na capacidade funcional do idoso

Objetivo: Evaluar el efecto del masaje terapéutico clásico como cuidado de enfermería en la capacidad funcional del adulto mayor en una casa hogar. Métodos: Estudio cuantitativo, longitudinal, cuasiexperimental. Se evaluó la capacidad funcional del adulto mayor antes y después del masaje terapéutico clásico con el índice de Barthel, alfa de Cronbach de 0.95. Muestreo no probabilístico por conveniencia. En total se estudiaron 15 adultos mayores divididos aleatoriamente en grupo de estudio y control, con base en Epidat 3.1. El análisis se realizó con estadística descriptiva y no paramétrica a través de T de Wilcoxon y U de Mann Whitney para lo cual se utilizó el programa SPSS v.19. Resultados: El promedio de edad fue de 84.14 ± 9.68 vs. 80.25 ± 10.49 para el grupo control y de estudio respectivamente; el 73% del género masculino. Previo y posterior al masaje terapéutico en la prueba de Wilcoxon, el resultado fue: grupo control (Z = 0, p = 1) vs. grupo experimental (Z = 2.47, p = 0.01). En la U de Mann Whitney (U = 0.5, p = 0.001). En la posprueba del grupo de estudio se observó un aumento significativo de la capacidad funcional. No existen estudios similares, sin embargo, algunas investigaciones han demostrado que el masaje terapéutico es efectivo para mejorar el dolor, la amplitud de movimiento y la fuerza de agarre en adultos mayores. Conclusiones: El masaje terapéutico clásico es efectivo para incrementar la capacidad funcional del adulto mayor institucionalizado.

Objective: To assess the effect of traditional therapeutic massage on the functional capacity of elderly adults in a residential care facility. Methods: Quasi-experimental, longitudinal and quantitative study. The elderly adults' functional capacity was assessed before and after the classic therapeutic massage using Barthel's index. Cronbach alpha turned out to be 0.95. The sampling was by convenience and not probabilistic. In total, 15 studied elderly adults were randomly assigned to a control group and a study group using Epidat 3.1. Descriptive and not parametric analysis was performed using Wilcoxon T and Mann Whitney U tests with the SPSS v.19 program. Results: The average age was 84.14 ± 9.68 and 80.25 ± 10.49 in the control and study groups respectively. Seventy-three percent were masculine. The Wilcoxon test results were Z = 0, P = 1 in the control group, and Z = 2.47, P = .01 in the experimental group. The Mann Whitney test result was U = 0.5, P = .001. The study group post-test showed a significant increase in the functional capacity. There are not many similar works in the literature; however some research studies have demonstrated that therapeutic massage is effective in improving movement and gripping strength, and also in reducing pain among elderly adults. Conclusions: Traditional therapeutic massage is effective in increasing the functional capacity of institutionalized elderly adults.

Objetivo: Avaliar o efeito da massagem terapêutica clássica como um cuidado de enfermagem na capacidade funcional do idoso no Lar. Métodos: Estudo qualitativo, longitudinal, quase experimental. Avaliou-se a capacidade funcional do idoso antes e depois da massagem terapêutica clássica com o índice de Barthel, alfa de Cronbach de 0.95. Amostragem não probabilística por conveniência. No total estudaram-se 15 idosos divididos aleatoriamente em grupo de estudo e de controle, utilizando Epidat 3.1. A análise realizou-se com estatística descritiva e não paramédica a través de T de Wilcoxon e U de Mann Whitney para o qual se utilizou o programa SPSS v. 19. Resultados: A média de idade foi de 84.14 ± 9.68 vs 80.25 ± 10.49 grupo controle e de estudo respectivamente, 73% gênero masculino. Prévio e posterior à massagem terapêutica na prova de Wilcoxon, o resultado foi: o grupo controle (Z = 0, p = 1) vs grupo experimental (Z = 2.47, p = 0.01). No U de Mann Whitney (U = 0.5, p = 0.001). No pós-teste do grupo de estudo observou-se um aumento significativo da capacidade funcional. Não existem estudos similares, porém, algumas pesquisas têm demonstrado que a massagem terapêutica é efetiva para a melhoria da dor, da amplitude de movimento e da força de preensão em idosos. Conclusões: A massagem terapêutica clássica é efetiva para incrementar a capacidade funcional do idoso numa instituição.

Recognition and regionalization of emotions in the arousal-valence plane.

The emotion recognition systems have become important for the diversity of its applications. Several methodologies have been proposed based on how emotions are reflected in biological systems, such as facial expressions, the activity of the nervous system or the prosody of voice. The detection of emotions by voice processing is an approach that involves a noninvasive procedure that produces results with an acceptable rate of detection. In this work an algorithm for features extraction was developed, that efficiently classify different emotional states. Thus, emotions that have not been trained can be associated with a trained emotion both belonging to the same region of the valence-arousal plane.

Phylogenetic placement of Cibicidoides wuellerstorfi (Schwager, 1866) from methane seeps and non-seep habitats on the Pacific margin.

Benthic foraminifera are among the most abundant groups found in deep-sea habitats, including methane seep environments. Unlike many groups, no endemic foraminiferal species have been reported from methane seeps, and to our knowledge, genetic data are currently sparse for Pacific deep-sea foraminifera. In an effort to understand the relationships between seep and non-seep populations of the deep-sea foraminifera Cibicidoides wuellerstorfi, a common paleo-indicator species, specimens from methane seeps in the Pacific were analyzed and compared to one another for genetic similarities of small subunit rDNA (SSU rDNA) sequences. Pacific Ocean C. wuellerstorfi were also compared to those collected from other localities around the world (based on 18S gene available on Genbank, e.g., Schweizer et al., 2009). Results from this study revealed that C. wuellerstorfi living in seeps near Costa Rica and Hydrate Ridge are genetically similar to one another at the species level. Individuals collected from the same location that display opposite coiling directions (dextral and sinstral) had no species level genetic differences. Comparisons of specimens with genetic information available from Genbank (SSU rDNA) showed that Pacific individuals, collected for this study, are genetically similar to those previously analyzed from the North Atlantic and Antarctic. These observations provide strong evidence for the true cosmopolitan nature of C. wuellerstorfi and highlight the importance of understanding how these microscopic organisms are able to maintain sufficient genetic exchange to remain within the same species between seep and non-seep habitats and over global distances.

A novel, fully automated, observer-independent program for semiquantifying striatal ¹²³I-FP-CIT uptake.

OBJECTIVE: To describe and validate a novel, fully automated program specifically designed for the semiquantification of striatal (123)I-FP-CIT uptake using volumes of interest (VOI) analysis. MATERIAL AND METHODS: The proposed algorithm is based on a template that mimics the striatal (123)I-FP-CIT uptake in a healthy subjects, derived from defined anatomical VOIs available from WFU PickAtlas. Four SPECT studies of the anthropomorphic Alderson phantom filled with variable radioactive concentrations were acquired for the experimental validation. Experimental SPECT images were spatially normalized with respect to the previously created template. The binary VOIs corresponding to left caudate and putamen and right caudate and putamen, which were used to construct the template, were projected onto the experimental images to obtain the counts for these regions. To minimize the partial volume effect, a percentage of the voxels in these regions (threshold), rather than all of them, was used. A binary occipital VOI was used to quantify the non-specific uptake. Experimental binding potentials (BPs) were calculated from the counts in these regions. True BPs were calculated from aliquots taken from the solutions used to fill the phantom. RESULTS: There were statistically significant differences in the experimental BP values (p<0.002) according to the percentage of voxels used. A highly significant correlation was achieved between true and experimental BP values, regardless of the percentage of voxels included for quantification. CONCLUSIONS: Our novel, observer-independent program automatically performs the semiquantification of striatal (123)I-FP-CIT uptake in experimental studies.

Sobrecarga del agente de cuidado dependiente y su relación con la dependencia funcional del adulto mayor / Overload in the dependent care agent and its relation to the elder adult functional dependency

Métodos: Estudio descriptivo, correlacional, transversal, muestreo por conveniencia, incluyó a 90 adultos mayores y 90 agentes de cuidado dependiente. Se describió el perfil socio demográfico, se aplicó el índice de Barthel para evaluar el nivel de dependencia del adulto mayor y la entrevista de Zarit para evaluar la sobrecarga subjetiva del agente de cuidado dependiente. Objetivo: Identificar la relación entre el nivel de sobrecarga subjetiva del agente de cuidado dependiente y el nivel de dependencia funcional del adulto mayor con enfermedad crónico degenerativa en el Hospital General de Silao, Guanajuato en México. Resultados: La edad promedio de los adultos mayores fue de 70.9 ±10, en el índice de Barthel presentaron dependencia leve (41.1%) en las actividades de la vida diaria. El perfil del agente de cuidado dependiente correspondió a una mujer de edad media (53.8 ±5.2), casada (88.9%), ama de casa (73.3%), hija de quien cuida (48.9%). En la entrevista de Zarit se encontró a agentes de cuidado dependiente sin sobrecarga (85.6%). Para verificar si existía correlación entre las variables sobrecarga subjetiva y dependencia funcional, se obtuvo el coeficiente de correlación rho de Spearman (-0.46), p<0.05. Discusión: Orem infirió que en situaciones donde se requiera de cuidado, la sobrecarga del agente de cuidado dependiente se relaciona con la dependencia funcional del adulto mayor. Conclusión: A menor grado de dependencia del adulto mayor, menor es el nivel de sobrecarga subjetiva del agente de cuidado dependiente.

Objective: To identify the relationship between the subjective overload level of the dependent care agent and the functional dependency level of the elder adult suffering from chronic degenerative illnesses at the Silao General Hospital in Guanajuato, Mexico. Methods: A descriptive, correlational, transversal and basic study design was used. Sampling was by convenience, and included 90 elder adults and 90 dependent care agents. The social and demographic profile was described. The Barthel index was used to assess the level of dependence of the elder adult, while the Zarit interview was used to assess the subjective overload of the dependent care agent. Results: The elder adult average age was 70.9 ±10; and after using the Barthel index, 41.1% showed dependency in their daily life. The profile of the dependent care agent corresponded to that of a middle aged woman (53.8 ±5.2), married (88.9%), housewife (73.3%), and daughter of the elder (48.9%). From the Zarit interview, it was found that 85.6% were dependent care agents without overload. In order to verify if a correlation existed between the variables subjective overload and functional dependency, the Spearman correlation rho was calculated, and turned out to be -0.46, p<.05. Discussion: Orem inferred that in situations where healthcare is required, the dependent care agent overload is related to the functional dependency of the elder adult. Conclusions: The lower the grade of dependence of the elder adult, the lower the subjective overload of the dependent care agent.

Biological activity of three alkyl cinnamates on young larvae of Tuta absoluta.

The "tomato moth," Tuto absoluta (Meyrick) (Lepidoptera: Gelechiidae), is a neotropical oligophagous insect considered a key pest of tomato crops. It was detected in Europe seven years ago and quickly spread to several regions of Asia and North Africa. In Argentina, its control is done by chemical pesticides mainly. The indiscriminate use of chemical broad spectrum pesticides have caused several problems in the control of this pest due to resistance mechanism involved to several insecticides including pyrethroids, organophosphates and biopesticides. In this context, the searching and evaluation of new compounds- compatible with integrated pest management programs- has become relevant. Within the phenylpropanoids, alkyl cinnamates, whether natural or synthetic, have been reported with biological activity: repellence, antifeedant and insecticide. Therefore, the cinnamates could be a valuable alternative to replace the conventional insecticides. The aim of this work was to study the antifeedant effect of three alkyl cinnamates (methyl, ethyl and propyl cinnamate) on the consumption rate patterns of second instar larvae of T. absoluta. A series of concentrations of each compound (100, 250 and 500 micrograms/milliliter) were prepared using acetone (analytical grade) - distilled water as solvent and a surfactant (Tween 80) was added to each solution to improve the wet of leaves. Tomato leaf disks of 2 cm diameter were treated by immersion in each solution during 15 seconds. Afterward, the treated discs were dried under fume hood and each disk was placed in a plastic capsule. A larva with 6-8 hours of starvation was added to each experimental unit. Each treatment was replicated between 24-30 times. The area consumed by each larva was measured after 24, 48 and 72 hours post-treatment. We also evaluated development time, weight of the pupa, adult emergence, fecundity and fertility as sublethal effects. The results were analyzed using ANOVA test. None of the compounds tested at the aforementioned concentrations exhibited insecticidal effect. However, ethyl cinnamate showed a strong antifeedant effect. The results observed on the leaf consumption and other sublethal effects assessed will be discussed. According to these preliminary results, further studies are needed to complete its toxicological profile by other exposure methods.

Using DNA as a fiducial marker to study SMC complex interactions with the atomic force microscope.

Atomic force microscopy can potentially provide information on protein volumes, shapes, and interactions but is susceptible to variable tip-induced artifacts. In this study, we present an atomic force microscopy approach that can measure volumes of nonglobular polypeptides such as structural maintenance of chromosomes (SMC) proteins, and use it to study the interactions that occur within and between SMC complexes. Together with the protein of interest, we coadsorb a DNA molecule and use it as a fiducial marker to account for tip-induced artifacts that affect both protein and DNA, allowing normalization of protein volumes from images taken on different days and with different tips. This approach significantly reduced the error associated with volume analysis, and allowed determination of the oligomeric states and architecture of the Bacillus subtilis SMC complex, formed by the SMC protein, and by the smaller ScpA and ScpB subunits. This work reveals that SMC and ScpB are dimers and that ScpA is a stable monomer. Moreover, whereas ScpA binds directly to SMC, ScpB only binds to SMC in the presence of ScpA. Notably, the presence of both ScpA and ScpB favored the formation of higher-order structures of SMC complexes, suggesting a role for these subunits in the organization of SMC oligomers.

Temporary morphological changes in plus disease induced during contact digital imaging.

OBJECTIVE: To compare and quantify the retinal vascular changes induced by non-intentional pressure contact by digital handheld camera during retinopathy of prematurity (ROP) imaging by means of a computer-based image analysis system, Retinal Image multiScale Analysis. METHODS: A set of 10 wide-angle retinal pairs of photographs per patient, who underwent routine ROP examinations, was measured. Vascular trees were matched between 'compression artifact' (absence of the vascular column at the optic nerve) and 'not compression artifact' conditions. Parameters were analyzed using a two-level linear model for each individual parameter for arterioles and venules separately: integrated curvature (IC), diameter (d), and tortuosity index (TI). RESULTS: Images affected with compression artifact showed significant vascular d (P<0.01) changes in both arteries and veins, as well as in artery IC (P<0.05). Vascular TI remained unchanged in both groups. CONCLUSIONS: Non-adverted corneal pressure with the RetCam lens could compress and decrease intra-arterial diameter or even collapse retinal vessels. Careful attention to technique is essential to avoid absence of the arterial blood column at the optic nerve head that is indicative of increased pressure during imaging.

[Dermoid cyst in childhood, diagnosed as ptosis]. / Quiste dermoide en la infancia bajo el diagnóstico de ptosis.

CLINICAL CASE: A four year-old boy, diagnosed of palpebral ptosis since he was 2 by his paediatrician. At the initial ophthalmological revies he had asymmetrical upper eyelids. In the follow-up a mild ocular hypotrophy appeared in his left eye and an increasing astigmatism, which made us suspect an orbital disease. The MRI confirmed a mass, compatible with a dermoid cyst. CONCLUSION: Due to the slow growth of these tumours, it is only with clinical follow-up and the aid of imaging techniques that we may achieve the diagnosis and offer a definitive treatment with surgical extirpation.

Plus disease in retinopathy of prematurity: quantitative analysis of vascular change.

PURPOSE: To examine the relationship between rate of vascular change and plus disease diagnosis. DESIGN: Retrospective observational case-control study. METHODS: Wide-angle images were taken bilaterally from 37 infants at 31 to 33 weeks and 35 to 37 weeks postmenstrual age (PMA). The semi-automated Retinal Image multiScale Analysis system was used to measure parameters for all arteries and veins: integrated curvature, diameter, and tortuosity index. A reference standard diagnosis (plus vs not plus) was defined for each eye by consensus of 5 experts at 35 to 37 weeks PMA. Weekly rate of change in parameters was compared in eyes with plus vs not plus disease. Receiver operating characteristic area under the curve (AUC) was calculated for plus disease detection based on 1) weekly rates of parameter change between 31 to 33 weeks and 35 to 37 weeks PMA and 2) parameter values at 35 to 37 weeks only. RESULTS: Weekly rates of change in all venous parameters were significantly different in eyes with plus vs not plus disease, particularly for tortuosity index (P < .0004) and diameter (P = .018). Using weekly rate of change, AUC for plus disease detection was highest for venous tortuosity index (0.819) and venous diameter (0.712). Using the 35 to 37-week PMA image only, AUC was highest for venous integrated curvature (0.952) and diameter (0.789). CONCLUSION: Rate of change in venous, but not arterial, parameters is correlated with plus disease development in this data set. This did not appear to contribute information beyond analysis of an image at 35 to 37 weeks PMA only.

Quiste dermoide en la infancia bajo el diagnóstico de ptosis / Dermoid cyst in chidhood, diagnosed as ptosis

Caso clínicoNiño de 4 años diagnosticado por su pediatra de ptosis congénita en ojo izquierdo a los 2 años. En su valoración oftalmológica inicial, únicamente se aprecia discreta asimetría entre los párpados superiores. Es en consultas posteriores cuando aparece discreta hipotropia del ojo izquierdo, y un astigmatismo creciente que hacen sospechar sobre patología orbitaria. La RMN confirma la presencia de una masa compatible con un quiste dermoide.ConclusiónDebido al crecimiento lento de estos tumores, sólo un seguimiento de la clínica y la ayuda de pruebas de imagen, llevará al diagnóstico y al tratamiento definitivo mediante extirpación quirúrgica(AU)

Clinical caseA four year-old boy, diagnosed of palpebral ptosis since he was 2 by his paediatrician. At the initial ophthalmological revies he had asymmetrical upper eyelids. In the follow-up a mild ocular hypotrophy appeared in his left eye and an increasing astigmatism, which made us suspect an orbital disease. The MRI confirmed a mass, compatible with a dermoid cyst.ConclusionDue to the slow growth of these tumours, it is only with clinical follow-up and the aid of imaging techniques that we may achieve the diagnosis and offer a definitive treatment with surgical extirpation(AU)

Percepción subjetiva del paso del tiempo en el enfermo y el cuidador primario en Cuidados Paliativos hospitalarios / No disponible

Objetivos: estudiar la percepción subjetiva del paso del tiempo en enfermos hospitalizados en una Unidad de Cuidados Paliativos (UCP) y sus cuidadores primarios. Averiguar el grado de concordancia entre la percepción temporal de ambos. Explorar factores personales, clínicos y psicosociales que pueden estar relacionados con dicha percepción. Método: estudio descriptivo llevado a cabo en la Unidad de Cuidados Paliativos del Hospital Santa Caterina de Girona desde el 1 de mayo de 2005 al 31 de mayo de 2006. Participan 96 pacientes ingresados con enfermedad terminal y sus cuidadores primarios. Resultados: el 41,7% de los enfermos refiere una percepción subjetiva del paso del tiempo «largo» o «muy largo» mientras que un 28,1% lo considera «corto» o «muy corto». La percepción temporal en los enfermos está relacionada con la edad y la valoración de la calidad de la relación con el cuidador primario, siendo las personas mayores y las que refieren una buena relación con el cuidador las que perciben un paso del tiempo más rápido. Por el contrario, la percepción subjetiva del paso del tiempo en enfermos es independiente del sexo, de los días de ingreso en la UCP, del grado de dependencia funcional para las actividades básicas de la vida diaria (ABVD), de la gravedad de la enfermedad y la proximidad a la muerte, y de comunicar experiencias subjetivas positivas y/o negativas durante la jornada. En referencia a los cuidadores primarios, la mayoría encuentran el tiempo «ni corto ni largo» (39,6%). No se observa relación entre la percepción del paso del tiempo del cuidador primario y las horas de estancia en el hospital, los días de ingreso, el grado de dependencia funcional del enfermo para las ABVD, el informar de experiencias subjetivas positivas y/o negativas y la calidad de la relación enfermo-cuidador primario. Contrariamente, la percepción subjetiva del paso del tiempo del cuidador estuvo relacionada con la gravedad de la enfermedad y la proximidad a la muerte, percibiéndose el tiempo más largo a medida que se agrava la situación del enfermo. Las percepciones subjetivas del paso del tiempo del enfermo y del cuidador primario no están relacionadas. Enfermos y cuidadores primarios perciben el paso del tiempo de forma distinta, pasando algo más largo para los enfermos que para sus cuidadores primarios. Conclusiones: en general, los enfermos ingresados en una UCP perciben el paso del tiempo ligeramente más lento que sus cuidadores primarios, quedando pendiente para posteriores análisis valorar aquellos factores que modulan dicha percepción. Las percepciones del paso del tiempo de enfermos y cuidadores primarios no están relacionadas, percibiendo ambos el paso del tiempo en el hospital de forma diferente. A pesar de estas divergencias, otros aspectos psicosociales como una buena relación entre ambos, pueden influir en su percepción de la situación, convirtiendo así los hechos en más agradables y positivos. Es posible que se considere un hecho positivo simplemente la presencia y asistencia de un cuidador primario con el que se tenga una buena relación. En este sentido, integrando en nuestra atención sanitaria, recursos ambientales y técnicas terapéuticas destinadas a mejorar la relación enfermo-cuidador, podríamos facilitar en un futuro un mayor bienestar para el enfermo y para su cuidador primario en esta etapa difícil que es el final de la vida (AU)

Objectives: to study the subjective perception of the passing of time among patients hospitalized in a Palliative Care Unit (PCU) and their primary caregivers. To find out agreement extent between perceived time in both. To explore personal, clinical, and psychosocial factors that may be related to this perception. Method: a descriptive study carried out in the Palliative Care Unit at Hospital Santa Caterina in Girona from May 1st 2005 to May 31st 2006. Ninety-six terminally ill patients and their primary caregivers took part in the survey. Results: in 41.7% of patients the subjective perception of the passage of time was described as «long» or «very long», while 28.1% considered it «short» or «very short». Time perception in patients was related to age and quality of the relationship with primary caregivers, with older people and those having a good relationship with their caregiver experiencing a faster passage of time. In contrast, the subjective perception of the passage of time in patients is unrelated to sex, days in a PCU, functional dependence for basic activities of daily living (BADL), seriousness of illness, and proximity of death, as well as the communication of positive and/or negative events during the day. Regarding primary caregivers, most of them find that time is «neither short nor long» (39.6%). No connection was observed between perceived passage of time in primary caregivers and hours in the hospital, days in the PCU, extent of functional dependence for BADL, communication of positive and/or negative events, and quality of patient-caregiver relationship. On the contrary, the subjective perception of the passage of time in caregivers was related to seriousness of illness and proximity of death, with time being perceived as longer with patient worsening. The subjective perceptions of the passage of time in patients and primary caregivers are unrelated. Patients and primary caregivers perceive the passage of time in a different way - time is longer for patients versus primary caregivers. Conclusions: in general, patients in a PCU perceive the passage of time as slightly slower when compared to their primary caregivers, leaving for a later analysis an evaluation of factors modulating this perception. The perceptions of the passage of time in patients and primary caregivers are unrelated, and both perceive the passage of time in hospital in a different way. In spite of these divergences other psychosocial aspects, such as a good relationship between both, may influence their perception. Thus, everything may become more pleasant and positive. It is possible that the simple fact of having a good relationship with the caregiver can be positively considered. In this sense, integrating in our healthcare system environmental resources and therapeutical techniques aimed at improving the relationship between patients and caregivers may improve wellbeing for both patients and primary caregivers at the end of life (AU)

Effect of food characteristics, storage conditions, and electron beam irradiation on active agent release from polyamide-coated LDPE films.

We investigated the effect of electron beam irradiation, storage conditions, and model food pH on the release characteristics of trans-cinnamaldehyde incorporated into polyamide-coated low-density polyethylene (LDPE) films. Active agent release rate on irradiated films (up to 20.0 kGy) decreased by 69% compared with the nonirradiated controls, from 0.252 to 0.086 microg/mL/h. Storage temperature (4, 21, and 35 degrees C) and pH (4, 7, and 10) of the food simulant solutions (10% aqueous ethanol) affected the release rate of trans-cinnamaldehyde. As expected, antimicrobial release rate decreased to 0.013 microg/mL/h at the refrigerated temperature (4 degrees C) compared to the higher temperatures (0.029 and 0.035 microg/mL/h at 21 and 35 degrees C). The fastest release rate occurred when exposed to the acidic food simulant solution (pH 4). In aqueous solution, trans-cinnamaldehyde was highly unstable to ionizing radiation, with loss in concentration from 24.50 to 1.36 microg/mL after exposure to 2.0 kGy. Fourier transform infrared (FTIR) analysis revealed that exposure to ionizing radiation up to 10.0 kGy did not affect the structural conformation of LDPE/polyamide films and the trans-cinnamaldehyde in the films, though it induced changes in the functional group of trans-cinnamaldehyde when dose increased up to 20.0 kGy. Studies with a radiation-stable compound (naphthalene) showed that ionizing radiation induced the crosslinking in polymer networks of LDPE/polyamide film and caused slow and gradual release of the compound. This study demonstrated that irradiation serves as a controlling factor for release of active compounds, with potential applications in the development of antimicrobial packaging systems.

E-Beam irradiation of bagged, ready-to-eat spinach leaves (Spinacea oleracea): an engineering approach.

We experimentally assessed the efficacy of electron beam irradiation to ensure the safety and quality of ready-to-eat spinach leaves using a 2-MeV Van de Graff accelerator. Spinach leaves (approximately 8 g) inside petri dishes were irradiated up to 1 kGy and stored at 4 degrees C for 15 d. Nonirradiated samples served as controls. Color, texture, vitamin C, total carotenoids, and chlorophyll content were measured using standard methods. Sensory analysis was performed by 15 untrained panelists using a 9-point hedonic scale. Color of control and irradiated samples showed slight variation throughout storage. Firmness of all samples changed significantly (P < 0.05) by half the storage time; however, exposure to radiation did not cause significant differences by the end of shelf life. Irradiation did not affect the chlorophyll and total carotenoid content, though it produced samples with significantly lower (P < 0.05) vitamin C content. For all treatments, chlorophyll content decreased by day 15 while total carotenoids remained constant. Although, by the end of refrigerated storage, all the irradiated samples received slightly lower odor scores, sensory analysis revealed that irradiation had little or no effect on the overall quality of spinach leaves. We also simulated the dose distribution within a bag of spinach leaves irradiated using a 10-MeV linear accelerator (0.3 to 1 kGy) to quantify the problem of nonuniform dose absorbed at different parts of the bag and predict death of a pathogen such as Escherichia coli O157:H7. The simulation results confirmed that it is feasible to irradiate baby spinach leaves (up to 1 kGy) to eliminate E. coli 0157:H7 while maintaining the overall quality of the produce.