Science.gov

Sample records for perdas interna subsidiando

  1. Perda de massa em ventos empoeirados de estrelas supergigantes

    NASA Astrophysics Data System (ADS)

    Vidotto, A. A.; Jatenco-Pereira, V.

    2003-08-01

    Em praticamente todas as regiões do diagrama HR, as estrelas apresentam evidências observacionais de perda de massa. Na literatura, pode-se encontrar trabalhos que tratam tanto do diagnóstico da perda de massa como da construção de modelos que visam explicá-la. O amortecimento de ondas Alfvén tem sido utilizado como mecanismo de aceleração de ventos homogêneos. Entretanto, sabe-se que os envelopes de estrelas frias contêm grãos sólidos e moléculas. Com o intuito de estudar a interação entre as ondas Alfvén e a poeira e a sua conseqüência na aceleração do vento estelar, Falceta-Gonçalves & Jatenco-Pereira (2002) desenvolveram um modelo de perda de massa para estrelas supergigantes. Neste trabalho, apresentamos um estudo do modelo acima proposto para avaliar a dependência da taxa de perda de massa com alguns parâmetros iniciais como, por exemplo, a densidade r0, o campo magnético B0, o comprimento de amortecimento da onda L0, seu fluxo f0, entre outros. Sendo assim, aumentando f0 de 10% a partir de valores de referência, vimos que aumenta consideravelmente, enquanto que um aumento de mesmo valor em r0, B0 e L0 acarreta uma diminuição em .

  2. Hyperostosis frontalis interna and androgen suppression.

    PubMed

    May, Hila; Peled, Natan; Dar, Gali; Abbas, Janan; Medlej, Bahaa; Masharawi, Youssef; Hershkovitz, Israel

    2010-08-01

    Although hyperostosis frontalis interna (HFI) has been documented in the medical literature for over 300 years, its etiology remains undetermined. It is generally assumed to be associated with hormonal disturbances of the gonads. The aim of this study was to examine the association between androgen deprivation and development of HFI in males. Two groups of males over 60-years old were compared: a control group that included 180 healthy males, 45 suffering from benign prostatic hypertrophy (BPH) and a study group of 127 males with prostate cancer: 67 who received complete androgen block treatment, and 60 who received different treatments or none at all. CT head scans were used to identify and classify HFI (Brilliance 64, Philips Medical Systems, slice thickness 3 mm x 1.5 mm). It was found that males who received a complete androgen block manifested significantly higher prevalence of HFI compared to healthy males. However, no significant difference in HFI prevalence was found between males suffering from BPH and healthy males or males with prostate cancer who had not received a complete androgen block. A positive association between length of hormonal treatment and manifestation of HFI was shown. It can be concluded that BPH does not promote development of HFI; males who are hormonally treated for prostate cancer are at a higher risk of developing HFI compared to healthy males; the longer the duration of hormonal treatment, the higher the risk of developing HFI.

  3. Hyperostosis frontalis interna: an anthropological perspective.

    PubMed

    Hershkovitz, I; Greenwald, C; Rothschild, B M; Latimer, B; Dutour, O; Jellema, L M; Wish-Baratz, S

    1999-07-01

    Hyperostosis frontalis interna (HFI) is manifested by the accretion of bone on the inner table of the frontal bone. Despite the vast literature on HFI, ambiguity exists as to its etiology, osteogenesis, demography, and history. This stimulated the present broad-scale study of HFI which included the evaluation of 1,706 early 20th century skulls (1,007 males and 699 females) from the Hamann-Todd and Terry human osteological collections, as well as 2,019 pre-19th century East-Mediterranean, Amerindian, and Central European skulls. In addition, 72 cadavers were dissected for gross inspection and histology. Special attention was paid to the relationship of the brain and meninges to endocranial lesions. HFI is an independent condition, not a symptom of a more generalized syndrome as suggested in the past. It can appear in a variety of forms but each is the result of the same process and probably of the same etiology. Investigators' previous failure to recognize the mild stages of HFI (types A and B) as an early form of the general HFI process led to erroneous statistics and interpretations of observations. HFI should also be considered a phenomenon separate from HCI, hyperostosis cranialis diffusa (HCD), and other endostoses, even when it appears in association with them. To avoid ambiguity and facilitate the description of cranial hyperostoses, uniform nomenclature (HFI, HCD) has been recommended. HFI is rarely seen in historic populations, regardless of geographical origin. It is most commonly found among females and is believed to be associated with prolonged estrogen stimulation. While its magnitude of manifestation and frequency are much higher in females, HFI is not a purely female phenomenon. Males with hormonal disturbances such as atrophic testis were found to manifest HFI type D. HFI is associated with age insofar as it is much less frequent in females under 40 years of age. Although advanced cases of HFI (types C and D) have been observed in individuals as

  4. Etiopathogenesis of hyperostosis frontalis interna: a mystery still.

    PubMed

    Raikos, Athanasios; Paraskevas, George K; Yusuf, Faisal; Kordali, Panagiota; Meditskou, Soultana; Al-Haj, Abdulatif; Brand-Saberi, Beate

    2011-10-20

    Hyperostosis frontalis interna is a morphological pattern characterized by single or multiple bony nodules situated on the inner lamina of the frontal bone. It is seldom found in males, but it is a common phenomenon among post-menopausal females in modern societies but relatively rare in antiquity. The etiopathogenesis of the trait is a matter of debate and ranges from genetic predisposition to epigenetic, while endocrine disturbances, aging, and dietary factors are also listed among the causes. We studied the frequency, characteristic features, and etiopathogenesis of the disease in recent cadaveric and dry skull specimens. The frequency of hyperostosis frontalis interna in cadavers and dry skull materials was almost identical, 12.5% and 12.3%, respectively. In cadavers, 87.5% of severe hyperostosis frontalis interna cases were found in females over 65 years-old. Interestingly, in two cadavers we found hyperostotic lesions spreading onto adjacent tissues such as the dura and falx cerebri. We provide some new aspects that may help in better understanding of the etiopathogenesis of hyperostosis frontalis interna. Thereby, we discuss the various etiopathogenesis models found in the literature.

  5. Otitis interna (labyrinthitis) associated with Salmonella enterica arizonae in turkey poults.

    PubMed

    Shivaprasad, H L; Cortes, P; Crespo, R

    2006-03-01

    Otitis interna was diagnosed in five 9-to-21-day-old turkey poults with clinical signs of paralysis, opisthotonus, torticollis, blindness, and increased mortality. Gross and microscopic lesions in the poults included omphalitis, typhlitis, hepatitis, meningoencephalitis, ophthalmitis, neuritis and ganglionitis of the vestibulocochlear nerve, and otitis interna. Salmonella enterica arizonae was isolated from the brains, eyes, intestines, yolk sacs, and livers of poults. Birds with otitis interna also had meningoencephalitis. It is most likely that the S. enterica arizonae infection spread from the brain to the internal ears through the vestibulocochlear nerve. This is the first documentation of otitis interna caused by bacteria in an avian species.

  6. Hyperostosis frontalis interna: criteria for sexing and aging a skeleton.

    PubMed

    May, Hila; Peled, Nathan; Dar, Gali; Cohen, Haim; Abbas, Janan; Medlej, Bahaa; Hershkovitz, Israel

    2011-09-01

    Estimation of sex and age in skeletons is essential in anthropological and forensic medicine investigations. The aim of the current study was to examine the potential of hyperostosis frontalis interna (HFI) as a criterion for determining sex and age in forensic cases. Macroscopic examination of the inner aspect of the frontal bone of 768 skulls (326 males and 442 females) aged 1 to 103, which had undergone a head computerized tomography scan, was carried out using the volume rendering technique. HFI was divided into two categories: minor and major. HFI is a sex- and age-dependent phenomena, with females manifesting significantly higher prevalence than males (p<0.01). In both females and males, prevalence of HFI increases as age increases (p<0.01). We present herein the probabilities of designating an unknown skull to a specific sex and age cohort according to the presence of HFI (standardized to age distribution in an Israeli population). Moreover, we present the probability of an individual belonging to a specific sex or age cohort according to age or sex (respectively) and severity of HFI. We suggest a valid, reliable, and easy method for sex and age identification of unknown skulls.

  7. Identifying and classifying hyperostosis frontalis interna via computerized tomography.

    PubMed

    May, Hila; Peled, Nathan; Dar, Gali; Hay, Ori; Abbas, Janan; Masharawi, Youssef; Hershkovitz, Israel

    2010-12-01

    The aim of this study was to recognize the radiological characteristics of hyperostosis frontalis interna (HFI) and to establish a valid and reliable method for its identification and classification. A reliability test was carried out on 27 individuals who had undergone a head computerized tomography (CT) scan. Intra-observer reliability was obtained by examining the images three times, by the same researcher, with a 2-week interval between each sample ranking. The inter-observer test was performed by three independent researchers. A validity test was carried out using two methods for identifying and classifying HFI: 46 cadaver skullcaps were ranked twice via computerized tomography scans and then by direct observation. Reliability and validity were calculated using Kappa test (SPSS 15.0). Reliability tests of ranking HFI via CT scans demonstrated good results (K > 0.7). As for validity, a very good consensus was obtained between the CT and direct observation, when moderate and advanced types of HFI were present (K = 0.82). The suggested classification method for HFI, using CT, demonstrated a sensitivity of 84%, specificity of 90.5%, and positive predictive value of 91.3%. In conclusion, volume rendering is a reliable and valid tool for identifying HFI. The suggested three-scale classification is most suitable for radiological diagnosis of the phenomena. Considering the increasing awareness of HFI as an early indicator of a developing malady, this study may assist radiologists in identifying and classifying the phenomena.

  8. Bilateral ocular myiasis interna caused by botfly (Oestrus ovis): a case report.

    PubMed

    Parikh, Vatsal; Biswas, Jyotirmay; Vaijayanthi, K; Das, Debmalya; Raval, Vishal

    2011-12-01

    The sheep nasal botfly Oestrus ovis is the commonest of several species of dipteran fly whose larvae are obligatory parasites in the nasal cavities and frontal sinuses of sheep but may cause infestation (myiasis) in man, commonly as external infestations and rarely, involves inner coat of the eye (Ocular myiasis interna). We report an imported case of Bilateral Ocular myiasis interna in an Indian boy.

  9. Hyperostosis frontalis interna in a Neandertal from Marillac (Charente, France).

    PubMed

    Garralda, María Dolores; Maureille, Bruno; Vandermeersch, Bernard

    2014-02-01

    The site of Marillac (Charente, France) has yielded an important stratigraphic sequence containing numerous Neandertal remains (some of them with peri-mortem manipulations) from lithofacies 2 (Quina Mousterian). This level has been correlated with MIS 4 and is associated with a TL date of 57,600 ± 4600 years BP (before present). The study of one of the cranial fragments (Marillac 3) revealed a grade 2 or Type B Hyperostosis frontalis interna (HFI), remodelling and altering the internal table of the thick frontal bone. This pathology has been analysed macroscopically together with radiography and sections made using a microscanner and a scanner. The development of the HFI is compared with published evidence for Sangiran 3 (Homo erectus), two other Neandertals (Forbes' Quarry and Shanidar 5), and several archaeological samples. Forbes' Quarry seems to display more advanced HFI than either Shanidar 5 or Marillac 3. The three Neandertals may be considered mature individuals (≥40 years) and it seems likely that the aetiology of this pathology may be associated with hormonal alterations, as has been suggested for past and extant populations. While the prevalence of HFI in contemporary post-menopausal women is well documented, the identification of HFI amongst males from several archaeological samples (Neanderthals, Ancient Egypt, Syrian Bronze Age or the Anasazi), with different stages of development, confirm that the pathology affected both sexes in past populations. Additional data and research are still needed to elucidate the etiopathogenesis of this illness and to better understand the relationship between environmental factors and their possible influences/consequences for the development of metabolic disorders in prehistoric populations.

  10. [Anales de Medicina Interna: standardization, dissemination and bibliometric indicators. (I) Standards evaluation].

    PubMed

    Ruiz Pérez, R; Delgado López-Cozar, E; Jiménez Contreras, E

    1997-08-01

    The evaluation of scientific journal has become a necessary exercise for a variety of purposes and parties. We evaluated compliance with ISO standards for periodicals by the Spanish biomedical journal An. Med. Interna. Compliance with 136 data items based on different standards was evaluated with the help of a specially developed data sheet, and expressed as overall mean compliance (49.2%) and actual mean compliance (83.4%), i.e., compliance with those items considered necessary for the effective transfer of information via data bases. Items for which standardization was not optimal were examined in detail and specific recommendations for correction were given. We conclude that An. Med. Interna effectively fulfills its mission as an instrument for the communication of research results. In comparison with Spanish journals covering different areas and published by different organizations, compliance with international standards was better in An. Med. Interna.

  11. Transcriptome Profiling of the Theca Interna from Bovine Ovarian Follicles during Atresia

    PubMed Central

    Hatzirodos, Nicholas; Irving-Rodgers, Helen F.; Hummitzsch, Katja; Rodgers, Raymond J.

    2014-01-01

    The theca interna is a specialized stromal layer that envelops each growing ovarian follicle. It contains capillaries, fibroblasts, immune cells and the steroidogenic cells that synthesize androgens for conversion to estradiol by the neighboring granulosa cells. During reproductive life only a small number of follicles will grow to a sufficient size to ovulate, whereas the majority of follicles will undergo regression/atresia and phagocytosis by macrophages. To identify genes which are differentially regulated in the theca interna during follicular atresia, we undertook transcriptome profiling of the theca interna from healthy (n = 10) and antral atretic (n = 5) bovine follicles at early antral stages (<5 mm). Principal Component Analyses and hierarchical classification of the signal intensity plots for the arrays showed primary clustering into two groups, healthy and atretic. A total of 543 probe sets were differentially expressed between the atretic and healthy theca interna. Further analyses of these genes by Ingenuity Pathway Analysis and Gene Ontology Enrichment Analysis Toolkit software found most of the genes being expressed were related to cytokines, hormones and receptors as well as the cell cycle and DNA replication. Cell cycle genes which encode components of the replicating chromosome complex and mitotic spindle were down-regulated in atretic theca interna, whereas stress response and inflammation-related genes such as TP53, IKBKB and TGFB1 were up-regulated. In addition to cell cycle regulators, upstream regulators that were predicted to be inhibited included Retinoblastoma 1, E2 transcription factor 1, and hepatocyte growth factor. Our study suggests that during antral atresia of small follicles in the theca interna, arrest of cell cycle and DNA replication occurs rather than up- regulation of apoptosis-associated genes as occurs in granulosa cells. PMID:24956388

  12. [Arteriovenous fistula of the A. vertebralis after catheterization of V. jugularis interna (author's transl)].

    PubMed

    Beeger, R; Grabbe, E; Vogel, H

    1982-09-01

    The article reports on an arteriovenous fistula between the a. vertebralis and the v. vertebralis with blood flowing off via the v. vertebralis, v. cervicalis profunda and v. brachiocephalica. The fistula occurred after application of a central venous catheter to the v. jugularis interna.

  13. [Anales de Medicina Interna: standardization, dissemination and bibliometric indicators. (II) Bibliometric analysis].

    PubMed

    Jiménez-Contreras, E; Delgado López-Cozar, E; Ruiz Pérez, R

    1997-08-01

    National and international diffusion, composition of the collective of authors who publish in the journal, and cocitation were studies for the journal An. Med. Interna. Diffusion was analyzed by examining the presence of the journal in medical data bases and specialized libraries in Spain. The institutional affiliations and geographical location of authors were determined on the basis of the affiliations given in the article by-lines. The journal is included in the major medical data bases and in approximately 80% of the libraries studied. The predominant professional affiliation among authors was clinical (hospital); the geographical origin of the authors (expressed as a percentage of all authors) approximately paralleled the volume of scientific publications generated by each of Spain's 17 autonomous regions. The cocitation study showed that An. Med. Interna ranked somewhere in the middle of the group' of 38 Spanish medical journals considered representative of research being done in Spain.

  14. Primera aproximación a la estructura interna de Plutón

    NASA Astrophysics Data System (ADS)

    Steren, G. A.; Carranza, G. J.; Hubbard, W. B.

    En el presente trabajo se propuso estudiar la estructura interna actual del planeta Plutón. El modelo que se planteó es del tipo de estructura no-diferenciada. Se incluyó como fuente de calor interna la radioactividad y como único mecanismo de transporte de la energía a la conducción. Se encontró que el planeta estaría compuesto por una mezcla de roca (65% en masa) y hielo de agua (35%). Este simple modelo permite inferir que una estructura más realista para Plutón debería incluir también a la convección como mecanismo de transporte. Ello además permitiría avanzar de modo más firme en el estado de diferenciación del planeta, que casi seguramente sea más complejo que el adoptado.

  15. Presumptive meningoencephalitis secondary to extension of otitis media/interna caused by Streptococcus equi subspecies zooepidemicus in a cat.

    PubMed

    Martin-Vaquero, Paula; da Costa, Ronaldo C; Daniels, Joshua B

    2011-08-01

    A 5-year-old castrated male domestic longhair cat was presented with neurological signs consistent with a central vestibular lesion and left Horner's syndrome. Computed tomography images revealed hyperattenuating, moderately contrast-enhancing material within the left tympanic bulla, most consistent with left otitis media/interna. Marked neutrophilic pleocytosis was identified on cerebrospinal fluid analysis. Streptococcus equi subspecies zooepidemicus (SEZ) was isolated from the cerebrospinal fluid. Intracranial extension of otitis media/interna is relatively infrequent in small animals. There are no reports of otitis media/interna caused by SEZ in dogs or cats. This is the first report of otitis media/interna and presumptive secondary meningoencephalitis caused by SEZ in a cat. Copyright © 2011 ISFM and AAFP. Published by Elsevier Ltd. All rights reserved.

  16. Brief communication: unusual finding at Pueblo Bonito: multiple cases of hyperostosis frontalis interna.

    PubMed

    Mulhern, Dawn M; Wilczak, Cynthia A; Dudar, J Christopher

    2006-08-01

    Hyperostosis frontalis interna (HFI) is a disease characterized by excess bone growth on the internal lamina of the frontal bone and, occasionally, other cranial bones. Although the disease is fairly common in modern populations, its etiology is poorly understood. Hyperostosis frontalis interna has been identified in antiquity, primarily in the Old World, but with a much lower frequency than in modern groups. The purpose of the present study is to report multiple cases of HFI at Pueblo Bonito (Chaco Canyon, New Mexico). Twelve out of 37 adults with observable frontal bones exhibited HFI, ranging from mild to severe, including 11 females and one male. This is the first published case report of HFI in archaeological remains from the New World having a frequency comparable with modern groups. Most archaeological cases of HFI are isolated, so comparative data for multiple cases at one site are rare. The results of this study emphasize the importance of looking for HFI in archaeological remains, although it is rarely observed. Possible genetic and environmental factors for the high frequency of HFI at Chaco Canyon are considered, but additional research is needed to discover the etiology and to better understand why HFI sometimes occurs at modern frequencies in ancient populations.

  17. Bilateral Granulomatous and Fibrinoheterophilic Otitis Interna due to Pseudomonas aeruginosa in a Captive Little Bustard ( Tetrax tetrax ).

    PubMed

    Scala, Christopher; Langlois, Isabelle; Lemberger, Karin

    2015-06-01

    A captive juvenile little bustard ( Tetrax tetrax ) was presented for acute onset of right head tilt and right circling. The bird failed to respond to supportive care and systemic antibiotic therapy. A bilateral granulomatous and fibrinoheterophilic otitis interna due to Pseudomonas aeruginosa was diagnosed postmortem by histopathologic examination and bacterial culture. In bustards, Pseudomonas species have been documented in the normal bacterial flora of the oropharynx and are frequently reported in upper respiratory tract infections. This is the first report of a peripheral vestibular syndrome due to P aeruginosa otitis interna in a bustard species. Pseudomonas aeruginosa should be included as a possible cause of otitis and peripheral vestibular syndrome in bustards.

  18. Ultrastructure of the membrana limitans interna after dye-assisted membrane peeling.

    PubMed

    Brockmann, Tobias; Steger, Claudia; Westermann, Martin; Nietzsche, Sandor; Koenigsdoerffer, Ekkehart; Strobel, Juergen; Dawczynski, Jens

    2011-01-01

    The purpose of this study was to investigate the ultrastructure of the membrana limitans interna (internal limiting membrane, ILM) and to evaluate alterations to the retinal cell layers after membrane peeling with vital dyes. Twenty-five patients (25 eyes) who underwent macular hole surgery were included, whereby 12 indocyanine green (ICG)- and 13 brilliant blue G (BBG)-stained ILM were analyzed using light, transmission electron and scanning electron microscopy. Retinal cell fragments on the ILM were identified in both groups using immunohistochemistry. Comparing ICG- and BBG-stained membranes, larger cellular fragments were observed at a higher frequency in the BBG group. Thereby, the findings indicate that ICG permits an enhanced separation of the ILM from the underlying retina with less mechanical destruction. A possible explanation might be seen in the known photosensitivity of ICG, which induces a stiffening and shrinkage of the ILM but also generates retinal toxic metabolites.

  19. Appearance of hyperostosis frontalis interna in some osteoarcheological series from Hungary.

    PubMed

    Hajdu, T; Fóthi, E; Bernert, Zs; Molnár, E; Lovász, G; Kovári, I; Köhler, K; Marcsik, A

    2009-01-01

    Hyperostosis frontalis interna (HFI) is a generalised pathological condition with an unknown etiology and variable clinical association. It is characterized by excess bone growth and manifested on the inner table of the frontal bone, occasionally extending onto the temporals, parietals and the occipital. The etiology of HFI is uncertain: it may be an unknown genetic predisposition, a common environmental exposure, or special metabolic diseases. The purpose of the present study is to report cases of HFI in some osteoarcheological series from Hungary and to emphasize the importance of the investigation of HFI in ancient populations. Twenty out of 803 adults with observable frontal bones exhibited HFI, ranging from early to mid-type, including 15 females and 5 males. Some overgrowths with edges were blending into the endocranial surface, and some were prominently protruding from the surface. Advanced cases of HFI (type C) were observed after age 40-60 years.

  20. Ophthalmomyiasis interna anterior in a dog: keratotomy and extraction of a Cuterebra sp. larva.

    PubMed

    Edelmann, Michele L; Lucio-Forster, Araceli; Kern, Thomas J; Bowman, Dwight D; Ledbetter, Eric C

    2014-11-01

    A 1-year-old female spayed mixed-breed dog was presented for evaluation of acute onset of lethargy and blepharospasm OD. Slit-lamp biomicroscopy revealed a segmented larva embedded in the inferonasal iris. Moderate anterior uveitis was present. After pharmacologic dilation, mild vitreal hemorrhage and chorioretinal migration tracks were identified. The dog was treated empirically for uveitis for 5 days, after which a keratotomy and larval foreign body extraction was performed. The dog recovered uneventfully from intraocular surgery and remained visual and comfortable. Parasite evaluation confirmed the larva to be a Cuterebra sp. To the authors' knowledge, this is the first report of canine ophthalmomyiasis interna anterior, and the first report of successful surgical removal from the anterior segment in a dog with preservation of vision.

  1. Hyperostosis frontalis interna in postmenopausal women-Possible relation to osteoporosis.

    PubMed

    Djonic, Danijela; Bracanovic, Djurdja; Rakocevic, Zoran; Ivovic, Miomira; Nikolic, Slobodan; Zivkovic, Vladimir; Djuric, Marija

    2016-01-01

    To improve our understanding of hyperostosis frontalis interna (HFI), we investigated whether HFI was accompanied by changes in the postcranial skeleton. Based on head CT scan analyses, 103 postmenopausal women were divided into controls without HFI and those with HFI, in whom we measured the thickness of frontal, occipital, and parietal bones. Women in the study underwent dual energy x-ray absorptiometry to analyze the bone density of the hip and vertebral region and external geometry of the proximal femora. Additionally, all of the women completed a questionnaire about symptoms and conditions that could be related to HFI. Women with HFI had a significantly higher prevalence of headaches, neurological and psychiatric disorders, and a significantly lower prevalence of having given birth. Increased bone thickness and altered bone structure in women with HFI was localized only on the skull, particularly on the frontal bone, probably due to specific properties of its underlying dura. Bone loss in the postcranial skeleton showed the same pattern in postmenopausal women with HFI as in those without HFI. Recording of HFI in medical records can be helpful in distinguishing whether reported disorders occur as a consequence of HFI or are related to other diseases, but does not appear helpful in identifying women at risk of bone loss.

  2. Hyperostosis frontalis interna (HFI) and castration: the case of the famous singer Farinelli (1705-1782).

    PubMed

    Belcastro, Maria Giovanna; Todero, Antonio; Fornaciari, Gino; Mariotti, Valentina

    2011-11-01

    The famous castrato singer Farinelli (1705-1782) was exhumed by our research group in July 2006 for the purpose of gaining some insight into his biological profile through a study of his skeletal remains. Farinelli was castrated before puberty to preserve the treble pitch of the boy's voice into adult life. His powerful and sweet voice became legendary. In spite of its bad preservation state, the skeleton displayed some interesting characteristics that are probably related to the effects of castration, including long limb-bones, persistence of epiphyseal lines and osteoporosis. In particular, the frontal bone was affected by severe hyperostosis frontalis interna (HFI). This condition consists in a symmetrical thickening of the inner table of the bone. The epidemiology of HFI shows that it is relatively common in postmenopausal women but very rare in men. Men affected by this pathology suffer from diseases, syndromes or treatments causing androgen deficiency. In the case of Farinelli, castration was probably responsible for the onset and development of this lesion.

  3. A case of extensive hyperostosis frontalis interna in an 87-year-old female human cadaver.

    PubMed

    Talarico, Ernest F; Prather, Andrew D; Hardt, Kevin D

    2008-04-01

    Hyperostosis frontalis interna (HFI) is a condition that involves thickening of the inner surface of the frontal bone with sparing of the midline. Little is known about the etiology and clinical presentation of HFI. We report unusual findings in a woman with extensive Type D hyperostosis of the frontal bone and a large hyperostotic nodule in the parietal bone with impingement on the precentral gyrus, distinguishing this from the common form of HFI. The scalp was dissected from the cranial vault, and the calvaria and brain were removed and digitally imaged. Bone specimens were embedded in methyl methacrylate plastic, sectioned, and stained using the Von Kossa Method with MacNeal's tetrachrome. Medical records were reviewed, and additional history was obtained through interviews with the donor's family. The calvaria had extensive, bilateral thickening of the frontal bone with irregular topography and clearly demarcated borders. The dura was adherent to all hyperostotic regions. A 3.5-cm nodule was visible on the inner table of the left parietal bone. The dura and cerebrum showed compression in this region, but it was unclear if this resulted in clinical ramifications. Microscopic analysis revealed a larger proportion of cancellous bone was present in regions of macroscopic hyperostosis. Quantitative analysis of sections through areas of gross hyperostosis demonstrated a lower proportion of lamellar bone than in the control. The patient exhibited symptoms that have been correlated to HFI in previous studies. We suggest that the HFI disease process was responsible for the manifestation of these symptoms in this patient.

  4. The Cognitive Role of the Globus Pallidus interna; Insights from Disease States.

    PubMed

    Gillies, M J; Hyam, J A; Weiss, A R; Antoniades, C A; Bogacz, R; Fitzgerald, J J; Aziz, T Z; Whittington, M A; Green, Alexander L

    2017-02-28

    The motor symptoms of both Parkinson's disease and focal dystonia arise from dysfunction of the basal ganglia, and are improved by pallidotomy or deep brain stimulation of the Globus Pallidus interna (GPi). However, Parkinson's disease is associated with a greater degree of basal ganglia-dependent learning impairment than dystonia. We attempt to understand this observation in terms of a comparison of the electrophysiology of the output of the basal ganglia between the two conditions. We use the natural experiment offered by Deep Brain Stimulation to compare GPi local field potential responses in subjects with Parkinson's disease compared to subjects with dystonia performing a forced-choice decision-making task with sensory feedback. In dystonic subjects, we found that auditory feedback was associated with the presence of high gamma oscillations nestled on a negative deflection, morphologically similar to sharp wave ripple complexes described in human rhinal cortex. These were not present in Parkinson's disease subjects. The temporal properties of the high gamma burst were modified by incorrect trial performance compared to correct trial performance. Both groups exhibited a robust low frequency response to 'incorrect' trial performance in dominant GPi but not non-dominant GPi at theta frequency. Our results suggest that cellular processes associated with striatum-dependent memory function may be selectively impaired in Parkinson's disease even if dopaminergic drugs are administered, but that error detection mechanisms are preserved.

  5. Membrana limitans interna and epiretinal membrane lying on macular holes. Some morphological observations.

    PubMed

    Reale, E; Groos, S; Luciano, L; Eckardt, C; Eckardt, U

    2001-01-01

    The structure of the membrana limitans interna (MLI) in the region of the macula has been investigated by electron microscopy in (a) 2 enucleated human adult eyes and (b) 38 surgically removed samples associated with an epiretinal membrane (ERM). In the enucleated eye, the glia cells were vitrad bordered either by the lamina rara or, directly, by the lamina densa. Both extended into a coarse network whereby the lamina densa, through repeated branches and anastomoses, delimited large meshes, the lamina rara formed their contents. High magnification revealed that both meshes and contents of this network were composed by a further, finer network. It is suggested that strips and small openings of the finer network are homologous to the cords and intercordal spaces, respectively, which have been indicated as the common, basic structures of most of the basement membranes. The MLI excised with an ERM had the same structure. In some of the ERM associated with a macular hole, myofibroblasts prevailed among the cells. They showed indented nucleus, stress fibers abuting on the plasma membrane or in apparent continuity with bundles of extracellular filaments (microtendons), gap junctions. The cells lay on or were surrounded by a discontinuous basement membrane.

  6. Hyperostosis frontalis interna (HFI) and castration: the case of the famous singer Farinelli (1705–1782)

    PubMed Central

    Belcastro, Maria Giovanna; Todero, Antonio; Fornaciari, Gino; Mariotti, Valentina

    2011-01-01

    The famous castrato singer Farinelli (1705–1782) was exhumed by our research group in July 2006 for the purpose of gaining some insight into his biological profile through a study of his skeletal remains. Farinelli was castrated before puberty to preserve the treble pitch of the boy's voice into adult life. His powerful and sweet voice became legendary. In spite of its bad preservation state, the skeleton displayed some interesting characteristics that are probably related to the effects of castration, including long limb-bones, persistence of epiphyseal lines and osteoporosis. In particular, the frontal bone was affected by severe hyperostosis frontalis interna (HFI). This condition consists in a symmetrical thickening of the inner table of the bone. The epidemiology of HFI shows that it is relatively common in postmenopausal women but very rare in men. Men affected by this pathology suffer from diseases, syndromes or treatments causing androgen deficiency. In the case of Farinelli, castration was probably responsible for the onset and development of this lesion. PMID:21740437

  7. Globus Pallidus Interna in Tourette Syndrome: Decreased Local Activity and Disrupted Functional Connectivity

    PubMed Central

    Ji, Gong-Jun; Liao, Wei; Yu, Yang; Miao, Huan-Huan; Feng, Yi-Xuan; Wang, Kai; Feng, Jian-Hua; Zang, Yu-Feng

    2016-01-01

    Globus pallidus interna (GPi) is an effective deep brain stimulation site for the treatment of Tourette syndrome (TS), and plays a crucial role in the pathophysiology of TS. To investigate the functional network feature of GPi in TS patients, we retrospectively studied 24 boys with ‘pure’ TS and 32 age-/education-matched healthy boys by resting state functional magnetic resonance images. Amplitude of low-frequency fluctuation (ALFF) and functional connectivity were used to estimate the local activity in GPi and its functional coordinate with the whole brain regions, respectively. We found decreased ALFF in patients’ bilateral GPi, which was also negatively correlated with clinical symptoms. Functional connectivity analysis indicated abnormal regions within motor and motor-control networks in patients (inferior part of sensorimotor area, cerebellum, prefrontal cortex, cingulate gyrus, caudate nucleus, and brain stem). Transcranial magnetic stimulation sites defined by previous studies (“hand knob” area, premotor area, and supplementary motor area) did not show significantly different functional connectivity with GPi between groups. In summary, this study characterized the disrupted functional network of GPi and provided potential regions-of-interest for further basic and clinical studies on TS. PMID:27799898

  8. The pars interna/media anatomy and histology in the human larynx.

    PubMed

    Charpied, George L

    2007-01-01

    The pars interna/media (PIM) is a small muscle found in the human larynx that has not been successfully described in contemporary literature on laryngeal structure. The objective of this study was to describe the PIM's anatomy in detail. Thirteen human larynges obtained from postmortem examination were cleaned and preserved. Exposure of the PIM was through a lateral disarticulation of the cricothyroid joint and reflection of the cricothyroid muscle and the thyroid lamina. In the human, the PIM was found to be strap-like in form and to have two bellies with attachments to the medial surface of the thyroid cartilage at the root of the inferior horn and anteriosuperior cricoid arch. It appears to be innervated by a middle division, vestibular branch, of the internal superior laryngeal nerve. The average fiber diameter is 40 mum. Its type 1-to-type 2 fiber ratio places it within the range of other intrinsic laryngeal muscles. A muscle spindle was identified in medial bundle at the PIM's thyroid attachment. Thyroid medial surface attachment is within few millimeters of the muscular process of the arytenoid cartilage. These data show that the PIM is a robust muscle and deserves attention anatomically. Its orientation within the thyroid and nonrecurrent laryngeal nerve innervations of the human PIM may place it in the vocal fold tensor group rather than the laryngeal sphincter group. It is possible the PIM reports on cricothyroid distance and right versus left cricothyroid joint stresses. Electromyographic examination of the PIM in the Rhesus larynx may help elucidate its physiology to elaborate its human physiology. Copyright 2007 S. Karger AG, Basel.

  9. Glycoprotein from the liver constitutes the inner layer of the egg envelope (zona pellucida interna) of the fish, Oryzias latipes

    SciTech Connect

    Hamazaki, T.S.; Nagahama, Y.; Iuchi, I.; Yamagami, K.

    1989-05-01

    A glycoprotein from the liver, which shares epitopes with chorion (egg envelope or zona pellucida) glycoproteins, is present only in the spawning female fish, Oryzias latipes, under natural conditions. This spawning female-specific (SF) substance is distinct from vitellogenin but closely resembles a major glycoprotein component, ZI-3, of the inner layer (zona radiata interna) of the ovarian egg envelope with respect to some biochemical and immunochemical characteristics. Here we report that the (/sup 125/I)SF substance, injected into the abdominal cavity of the spawning female fish, was rapidly transported by the blood circulation into the ovary and incorporated into the inner layer of egg envelope of the growing oocytes. The result strongly suggests that the SF substance from the liver is a precursor substance of the major component, ZI-3, of the inner layer of egg envelope in the fish.

  10. Transcriptomal profiling of bovine ovarian granulosa and theca interna cells in primary culture in comparison with their in vivo counterparts

    PubMed Central

    Hatzirodos, Nicholas; Glister, Claire; Hummitzsch, Katja; Irving-Rodgers, Helen F.; Knight, Philip G.; Rodgers, Raymond J.

    2017-01-01

    In vitro culture of ovarian granulosa cells and theca cells has been very important for our understanding of their function and regulation. One of the most eagerly sought attributes of cell culture is the use of chemically-defined conditions. However, even under such in vitro conditions cell behaviour could differ from the in vivo situation because of differences in oxygen tension, nutrients, adhesion matrix and other factors. To examine this further we compared the transcriptomes of both granulosa cells and cells from the theca interna that were cultured in what are arguably the best in vitro conditions for maintaining the ‘follicular’ phenotypes of both tissue types, as displayed by their respective freshly-isolated counterparts. The array data analysed are from recently published data and use the same sizes of bovine follicles (small antral 3–6 mm) and the same Affymetrix arrays. We conducted analysis using Partek, Ingenuity Pathway Analysis and GOEAST. Principal Component Analysis (PCA) and hierarchical clustering clearly separated the in vivo from the in vitro groups for both cells types and transcriptomes were more homogeneous upon culture. In both cell cultures behaviours associated with cell adhesion, migration and interaction with matrix or substrate were more abundant. However, the pathways involved generally differed between the two cell types. With the thecal cultures a gene expression signature of an immune response was more abundant, probably by leukocytes amongst the cells cultured from the theca interna. These results indicate differences between in vivo and in vitro that should be considered when interpreting in vitro data. PMID:28282394

  11. Otitis interna, media, and externa with destruction of the left tympanic bulla and subluxation and septic arthritis of the left temporomandibular joint in an alpaca (Vicugna pacos)

    PubMed Central

    Galvan, Noe; Middleton, John R.; Cook, Cristi; Britt, Lisa G.; Kuroki, Keiichi

    2013-01-01

    A 1.5-year-old, 37.7 kg, female alpaca was evaluated for a 2-week history of weight loss, left ear droop, and deviation of the rostral mandible to the right. Antemortem radiography and postmortem examination revealed otitis interna, media, and externa, destruction of the left tympanic bulla, and subluxation and septic arthritis of the left temporomandibular joint. PMID:23997267

  12. Hyperostosis frontalis interna - a marker of social status? Evidence from the Bronze-Age "high society" of Qatna, Syria.

    PubMed

    Flohr, S; Witzel, C

    2011-02-01

    In 1719 Morgagni described a condition, today known as hyperostosis frontalis interna (HFI), as one sign within a triad consisting of HFI, virilism, and obesity. Today, HFI is predominantly found in older women. Although the etiology of HFI has not yet been determined precisely, the condition has been linked to metabolic disorders. HFI is reported to be rare in the archaeological record and the frequency of the condition is thought to have increased during the 19th and 20th centuries. We present preliminary results on the occurrence of HFI in the commingled human bone assemblage from "tomb VII" discovered underneath the Bronze Age royal palace of the ancient city of Qatna, Syria. A preliminary minimal number of individuals of 70 has been estimated for the as yet not fully analyzed skeletal remains. Skull fragments of nine individuals exhibit endocranial bone formations consistent with HFI. Rarity of stress indicators in the skeletons, the rich grave goods, and the burial place within the area of the Royal palace are suggestive of a high social status and an economically favorable situation of the buried individuals. Assuming that their life style included a high calorie diet in combination with little physical activity, acquired metabolic disorders may have been present in many individuals. The comparatively high number of individuals presenting HFI in the studied sample might therefore be viewed as being related to their high social status. Multiple occurrences of HFI in archaeological skeletal assemblages might serve as a proxy for social status.

  13. Comparison of Globus Pallidus Interna and Subthalamic Nucleus in Deep Brain Stimulation for Parkinson Disease: An Institutional Experience and Review

    PubMed Central

    Yazdani, Umar; Dewey III, Richard; Dewey, Richard B.; Miocinovic, Svjetlana

    2017-01-01

    Deep Brain Stimulation (DBS) has revolutionized the lives of patients of Parkinson disease, offering therapeutic options to those not benefiting entirely from medications alone. With its proven track record of outperforming the best medical management, the goal is to unlock the full potential of this therapy. Currently, the Globus Pallidus Interna (GPi) and Subthalamic Nucleus (STN) are both viable targets for DBS, and the choice of site should focus on the constellation of symptoms, both motor and nonmotor, which are key determinants to quality of life. Our article sheds light on the specific advantages and drawbacks of the two sites, highlighting the need for matching the inherent properties of a target with specific desired effects in patients. UT Southwestern Medical Center has a robust and constantly evolving DBS program and the narrative from our center provides invaluable insight into the practical realities of DBS. The ultimate decision in selecting a DBS target is complex, ideally made by a multidisciplinary team, tailored towards each patient's profile and their expectations, by drawing upon scientific evidence coupled with experience. Ongoing research is expanding our knowledge base, which should be dynamically incorporated into an institute's DBS paradigm to ensure that patients receive the optimal therapy. PMID:28706748

  14. Rate of occurrence, gross appearance, and age relation of hyperostosis frontalis interna in females: a prospective autopsy study.

    PubMed

    Nikolić, Slobodan; Djonić, Danijela; Zivković, Vladimir; Babić, Dragan; Juković, Fehim; Djurić, Marija

    2010-09-01

    The aim of our study was to determine rate of occurrence and appearance of hyperostosis frontalis interna (HFI) in females and correlation of this phenomenon with ageing. The sample included 248 deceased females: 45 of them with different types of HFI, and 203 without HFI, average age 68.3 +/- 15.4 years (range, 19-93), and 58.2 +/- 20.2 years (range, 10-101), respectively. According to our results, the rate of HFI was 18.14%. The older the woman was, the higher the possibility of HFI occurring (Pearson correlation 0.211, N=248, P=0.001), but the type of HFI did not correlate with age (Pearson correlation 0.229, N=45, P=0.131). Frontal and temporal bone were significantly thicker in women with than in women without HFI (t= -10.490, DF=246, P=0.000, and t= -5.658, DF=246, P=0.000, respectively). These bones became thicker with ageing (Pearson correlation 0.178, N=248, P=0.005, and 0.303, N=248, P=0.000, respectively). The best predictors of HFI occurrence were respectively, frontal bone thickness, temporal bone thickness, and age(Wald. coeff.=35.487, P=0.000; Wald. coeff.=3.288, P=0.070, and Wald.coeff. =2.727, P =0.099). Diagnosis of HFI depends not only on frontal bone thickness, but also on waviness of internal plate of the frontal bone, as well as-the involvement of the inner bone surface.

  15. 3D-Microarchitectural patterns of Hyperostosis frontalis interna: a micro-computed tomography study in aged women.

    PubMed

    Bracanovic, Djurdja; Djonic, Danijela; Nikolic, Slobodan; Milovanovic, Petar; Rakocevic, Zoran; Zivkovic, Vladimir; Djuric, Marija

    2016-11-01

    Although seen frequently during dissections and autopsies, Hyperostosis frontalis interna (HFI) - a morphological pattern of the frontal bone thickening - is often ignored and its nature and development are not yet understood sufficiently. Current macroscopic classification defines four grades/stages of HFI based on the morphological appearance and size of the affected area; however, it is unclear if these stages also depict the successive phases in the HFI development. Here we assessed 3D-microarchitecture of the frontal bone in women with various degrees of HFI expression and in an age- and sex-matched control group, hypothesizing that the bone microarchitecture bears imprints of the pathogenesis of HFI and may clarify the phases of its development. Frontal bone samples were collected during routine autopsies from 20 women with HFI (age: 69.9 ± 11.1 years) and 14 women without HFI (age: 74.1 ± 9.7 years). We classified the HFI samples into four groups, each group demonstrating different macroscopic type or stage of HFI. All samples were scanned by micro-computed tomography to evaluate 3D bone microarchitecture in the following regions of interest: total sample, outer table, diploe and inner table. Our results revealed that, compared to the control group, the women with HFI showed a significantly increased bone volume fraction in the region of diploe, along with significantly thicker and more plate-like shaped trabeculae and reduced trabecular separation and connectivity density. Moreover, the inner table of the frontal bone in women with HFI displayed significantly increased total porosity and mean pore diameter compared to controls. Microstructural reorganization of the frontal bone in women with HFI was also reflected in significantly higher porosity and lower bone volume fraction in the inner vs. outer table due to an increased number of pores larger than 100 μm. The individual comparisons between the control group and different macroscopic stages of

  16. Propiedades biomecánicas de la membrana limitante interna tras recibir tratamiento intravítreo con ocriplasmina.

    PubMed

    Vielmuth, Franziska; Schumann, Ricarda G; Spindler, Volker; Wolf, Armin; Scheler, Renate; Mayer, Wolfgang J; Henrich, Paul B; Haritoglou, Christos

    2017-01-01

    Objetivo: Evaluar la rigidez de la membrana limitante interna (MLI) humana y evaluar los posibles cambios de las propiedades mecánicas tras administrar una inyección intravítrea de ocriplasmina para tratar la tracción vitreomacular. Métodos: Este estudio se compone de una serie de casos intervencionales y comparativos de 12 muestras de MLI extraídas mediante cirugía y obtenidas de forma consecutiva de 9 ojos de 9 pacientes después de someterse sin éxito a vitreólisis farmacológica con ocriplasmina. Durante el mismo periodo de tiempo, 16 muestras de otros 13 ojos sin tratamiento con ocriplasmina se obtuvieron mediante vitrectomía y sirvieron como controles. Todos los pacientes presentaron agujeros maculares o tracción vitreomacular y se sometieron a vitrectomía con disección de la MLI tanto con tinción con azul brillante (AB) como sin ella. Todas las muestras se analizaron con un microscopio de fuerza atómica con imágenes de las regiones de 25 × 25 μm. En todas las muestras, se analizaron tanto la parte de la retina como la del vítreo de la MLI. Resultados: La microscopia de fuerza atómica no reveló diferencias significativas en cuanto a elasticidad de las muestras de MLI extraídas de ojos con o sin tratamiento con ocriplasmina. Las áreas onduladas de la parte de la retina presentaron una mayor rigidez que la parte del vítreo de la MLI. La cartografía topográfica tanto de la parte del vítreo como de la retina de la MLI no mostró ninguna alteración aparente de la morfología en ojos tratados con ocriplasmina en comparación con los ojos no tratados. La tinción con azul brillante conllevó un aumento de la rigidez tisular. Conclusiones: Las inyecciones intravítreas de ocriplasmina no varían las propiedades biomecánicas de la MLI humana. No existen pruebas de un posible efecto enzimático que interfiera con la rigidez de esta membrana basal. © 2017 S. Karger AG, Basel.

  17. Effect of frozen storage duration and cooking on physical and oxidative changes in M. Gastrocnemius pars interna and M. Iliofiburalis of Rhea americana.

    PubMed

    Filgueras, R S; Gatellier, P; Zambiazi, R C; Santé-Lhoutellier, V

    2011-08-01

    This study was conducted to evaluate the effect of frozen storage time (30, 60, 90 or 180 days) and cooking (100 °C, 30 min) on the physical characteristics and oxidative stability of M. Gastrocnemius pars interna (GN) and M. Iliofiburalis (IF) of rhea americana. Physical parameters measured included thawing and cooking loss, colour parameters (L*a*b*), while oxidation was assessed by determining the TBA-RS, carbonyl and aromatic amino acid content. Prolonged frozen storage of rhea meat decreased lightness (L*), yellowness (b*), and increased the discoloration parameter hue angle and redness a*. During storage, muscle IF was more prone to lipid and myoglobin oxidation than muscle GN. Cooking loss declined with the increase of storage time and was higher in GN than in IF muscle. With cooking, TBA-RS, carbonyl content, and aromatic amino acids (phenylalanine, tyrosine, and tryptophan) were highly affected, but the extent of oxidation ranged according to muscle and duration of frozen storage.

  18. Connectivity of the subthalamic nucleus and globus pallidus pars interna to regions within the speech network: a meta-analytic connectivity study.

    PubMed

    Manes, Jordan L; Parkinson, Amy L; Larson, Charles R; Greenlee, Jeremy D; Eickhoff, Simon B; Corcos, Daniel M; Robin, Donald A

    2014-07-01

    Cortico-basal ganglia connections are involved in a range of behaviors within motor, cognitive, and emotional domains; however, the whole-brain functional connections of individual nuclei are poorly understood in humans. The first aim of this study was to characterize and compare the connectivity of the subthalamic nucleus (STN) and globus pallidus pars interna (GPi) using meta-analytic connectivity modeling. Structure-based activation likelihood estimation meta-analyses were performed for STN and GPi seeds using archived functional imaging coordinates from the BrainMap database. Both regions coactivated with caudate, putamen, thalamus, STN, GPi, and GPe, SMA, IFG, and insula. Contrast analyses also revealed coactivation differences within SMA, IFG, insula, and premotor cortex. The second aim of this study was to examine the degree of overlap between the connectivity maps derived for STN and GPi and a functional activation map representing the speech network. To do this, we examined the intersection of coactivation maps and their respective contrasts (STN > GPi and GPi > STN) with a coordinate-based meta-analysis of speech function. In conjunction with the speech map, both STN and GPi coactivation maps revealed overlap in the anterior insula with GPi map additionally showing overlap in the supplementary motor area (SMA). Among cortical regions activated by speech tasks, STN was found to have stronger connectivity than GPi with regions involved in cognitive linguistic processes (pre-SMA, dorsal anterior insula, and inferior frontal gyrus), while GPi demonstrated stronger connectivity to regions involved in motor speech processes (middle insula, SMA, and premotor cortex).

  19. Clinical-pathological findings of otitis media and media-interna in calves and (clinical) evaluation of a standardized therapeutic protocol.

    PubMed

    Bertone, I; Bellino, C; Alborali, G L; Cagnasso, A; Cagnotti, G; Dappiano, E; Lizzi, M; Miciletta, M; Ramacciotti, A; Gianella, P; D'Angelo, A

    2015-12-03

    The aims of this field trial were to describe the clinical-pathologic findings in calves with otitis media (OM) and media-interna (OMI), to evaluate, through the development of a scoring system, the effectiveness of a standardized therapeutic protocol, and to identify the causative pathogens and their possible correlation with concurrent respiratory disease. All animals underwent physical and neurological examinations at three experimental time points: at diagnosis/beginning of treatment (T0), 1 week (T1) and 2 weeks (T2) after therapy was started, respectively. Follow-up telephone interviews with animal owners were conducted 1 month later. The therapeutic protocol consisted of tulathromycin (Draxxin®; Zoetis), oxytetracycline hydrochloride (Terramicina 100®; Zoetis), and carprofen (Rimadyl®; Zoetis). Twenty-two calves were enrolled. Physical and otoscopic examination at T0 revealed monolateral and bilateral otorrhea in 16 and 6 calves, respectively, with peripheral vestibular system involvement in calves presenting with neurological signs (n = 17; 77 %). A significant improvement of clinical and neurological scores was observed in 20 (90 %) calves, a full recovery in only 1 (5 %). One calf worsened between T0 and T1 and it was removed from the study. None of the other animals showed a worsening of clinical conditions and/or required further treatments at one month follow up. Mycoplasma bovis was isolated in 89 % of the affected ears either alone or together with P. multocida (n = 5), Streptococcus spp. (n = 1), Staphylococcus spp. (n = 1), and Pseudomonas spp. (n = 1). M. bovis either alone or together with these bacteria was also isolated from the upper and/or lower respiratory tract in 19 (86 %) calves. This is the first prospective study to evaluate the effectiveness of a standardized therapeutic protocol for the treatment of OM/OMI in calves. The therapy led to clinical improvement in the majority of the calves. Persistence of mild clinical

  20. Amniotic Fluid Angiopoietin-1, Angiopoietin-2, and Soluble Receptor Tunica Interna Endothelial Cell Kinase-2 Levels and Regulation in Normal Pregnancy and Intraamniotic Inflammation-Induced Preterm Birth

    PubMed Central

    Buhimschi, Catalin S.; Bhandari, Vineet; Dulay, Antonette T.; Thung, Stephen; Razeq, Sonya S. Abdel-; Rosenberg, Victor; Han, Christina S.; Ali, Unzila A.; Zambrano, Eduardo; Zhao, Guomao; Funai, Edmund F.; Buhimschi, Irina A.

    2010-01-01

    Background: Angiopoietin-1 (Ang-1) and Ang-2 act selectively on endothelial cells by engaging the Tunica interna endothelial cell kinase-2 (Tie2) receptor. A soluble form of Tie2 (sTie2) blocks angiopoietin bioactivity. Objective: The aim of the study was to characterize changes and expression patterns of Ang-1, Ang-2, and sTie2 in amniotic fluid (AF) and placenta during human pregnancy and intraamniotic inflammation (IAI)-induced preterm birth. Design and Setting: We conducted a cross-sectional study at a tertiary university hospital. Patients: AF levels of Ang-1, Ang-2, and sTie2 were evaluated in 176 women during second trimester (n = 40), third trimester (n = 37), and preterm labor (positive IAI, n = 50; negative IAI, n = 49). Placenta and cord blood of select women were analyzed. Main Outcome Measures: Ang-1, Ang-2, sTie2, and IL-6 were evaluated by ELISA. Real-time PCR measured Ang-1, Ang-2, and Tie2 placental mRNA levels. Placenta was immunostained for Ang-1 and Ang-2. Placental explant cultures were stimulated with lipopolysaccharide, Pam3Cys, and modulators of protein synthesis/secretion (cycloheximide, monensin, and brefeldin A). Results: In normal pregnancy, the levels and ratios of AF Ang-1, Ang-2, and sTie2 varied with gestational age (GA) (P < 0.001). PCR revealed corresponding changes in placental Ang-1 and Ang-2, but not Tie2, mRNA. IAI raised AF Ang-1, Ang-2, and sTie2 above the expected level for GA without affecting their placental mRNA. Ang-2 immunoreactivity appeared enhanced in areas of villous edema. AF Ang-2/Ang-1 ratio was an important determinant of cord blood IL-6 (P < 0.001). Ex-vivo, sTie2 release was increased by Golgi disrupting but not bacterial mimic agents. Conclusions: Ang-1, Ang-2, and sTie2 are physiological constituents of AF that are GA and IAI regulated. Ang-2/Ang-1 ratio may play a role in modulating the fetal inflammatory response to IAI. Placental sTie2 shedding likely involves a Golgi-mediated mechanism. PMID:20410222

  1. Effect of co-culture with theca interna on nuclear maturation of horse oocytes with low meiotic competence, and subsequent fusion and activation rates after nuclear transfer.

    PubMed

    Choi, Young-Ho; Shin, Taeyoung; Love, Charley C; Johnson, Cindy; Varner, Dickson D; Westhusin, Mark E; Hinrichs, Katrin

    2002-02-01

    We conducted this study to examine whether or not co-culture with theca cells improves the maturation rate of horse oocytes with compact cumuli and to evaluate the cytoplasmic competence of oocytes after maturation by assessing fusion, activation and cleavage rates after nuclear transfer. We collected oocytes by scraping follicles from slaughterhouse-derived ovaries and classified them as having an expanded or a compact cumulus. Expanded oocytes were matured in M199 supplemented with 10% FBS and 5 microU/ml FSH for 24 h: compact oocytes were cultured in the same medium, or they were co-cultured in the same medium with theca interna explants, for 24 or 42 h. Oocytes were held with or without 10 microg/ml cytochalasin B, before washing and micromanipulation. and they were fused with donor fibroblasts by electrical pulse. Fused oocytes were activated with Ca ionophore/cycloheximide, cultured for 5 days, and stained with Hoechst to assess nuclear development. We considered oocytes with an enlarged nucleus, or having cleavage with multiple nuclei, to be activated. There was no significant difference in overall maturation rate between compact oocytes cultured with theca and compact controls. When these two groups were combined, there was a significant increase in the proportion of oocytes in MII between 24 and 42 h (P < 0.05). Expanded oocytes had a significantly higher rate of maturation than did compact oocytes (64% versus 25-30%; P < 0.001). There were no significant differences in rates of successful enucleation, fusion, activation or cleavage between compact control and compact + theca oocytes, nor between compact and expanded oocytes; however, expanded oocytes treated with cytochalasin B had a significantly higher survival rate after enucleation than did untreated expanded oocytes (P < 0.05). Three embryos developed from recombined oocytes, with maximum cleavage to 10 cells. The results of this study indicate that co-culture with theca cells does not increase

  2. Cambios históricos en el aporte terrígeno de la cuenca del Río de la Plata sobre la plataforma interna Uruguaya

    NASA Astrophysics Data System (ADS)

    Marrero, Analía; Tudurí, Adriana; Pérez, Laura; Cuña, Caroline; Muniz, Pablo; Lopes Figueira, Rubens; Michaelovitch de Mahiques, Michel; Alves de Lima Ferreira, Paulo; Pittauerová, Daniela; Hanebuth, Till; García Rodríguez, Felipe

    2014-12-01

    El Río de la Plata (RdlP) presenta significativas variaciones naturales (hidrodinámicas y oceanográficas) asociadas a diferentes condiciones climáticas. El propósito de este trabajo es inferir los cambios de aportes continentales de sedimentos y su relación con las variaciones hidrológicas del Río de la Plata, a través del análisis de proxies sedimentológicos y geoquímicos en testigos de sedimentos de la plataforma interna uruguaya que registran los últimos 100 años, aproximadamente. A partir de la datación por 210Pb de dos testigos de sedimentos (GeoB 13813-4 y BAR1) se reconstruyó la geocronología del ambiente, y se relacionó con datos de las forzantes climáticas Pacific Decadal Oscillation, El Niño/La Niña Southern Oscillation, Atlantic Multidecadal Oscillation, y las anomalías hidrológicas de los ríos Paraná y Uruguay. Los valores más positivos y estables del Southern Oscillation Index, los cuales corresponden a fases La Niña, se observan en el periodo correspondiente entre 1910-1970, respecto al resto de la serie, donde se aprecia una mayor variabilidad y una tendencia hacia valores más negativos (eventos El Niño). Se hicieron dendrogramas (clustering) jerárquicos para ambos testigos. Para el testigo GeoB 13813-4, se utilizó la relación Ca/Ti y la granulometría, mientras que para BAR1 se recurrió a variables granulométricas y la tasa de sedimentación. El mayor aporte continental hacia la región de la plataforma adyacente al Río de la Plata registrado a partir del año 1970, podría ser el factor principal de los agrupamientos observados en los clusters para ambos testigos. Las agrupaciones mostraron una diferenciación en la década de 1970, lo que estaría asociado al aumento de los caudales de los ríos Paraná y Uruguay, durante las últimas tres décadas del siglo XX. Por otra parte se observa que la granulometría del testigo BAR1 presentó un mayor tamaño de grano y más variabilidad que en el caso del testigo Geo

  3. Prevalence and Determinants of the Use of Lipid-Lowering Agents in a Population of Older Hospitalized Patients: the Findings from the REPOSI (REgistro POliterapie Società Italiana di Medicina Interna) Study.

    PubMed

    Bertolotti, Marco; Franchi, Carlotta; Rocchi, Marco B L; Miceli, Andrea; Libbra, M Vittoria; Nobili, Alessandro; Lancellotti, Giulia; Carulli, Lucia; Mussi, Chiara

    2017-04-01

    Older patients are prone to multimorbidity and polypharmacy, with an inherent risk of adverse events and drug interactions. To the best of our knowledge, available information on the appropriateness of lipid-lowering treatment is extremely limited. The aim of the present study was to quantify and characterize lipid-lowering drug use in a population of complex in-hospital older patients. We analyzed data from 87 units of internal medicine or geriatric medicine in the REPOSI (Registro Politerapie della Società Italiana di Medicina Interna) study, with reference to the 2010 and 2012 patient cohorts. Lipid-lowering drug use was closely correlated with the clinical profiles, including multimorbidity markers and polypharmacy. 2171 patients aged >65 years were enrolled (1057 males, 1114 females, mean age 78.6 years). The patients treated with lipid-lowering drugs amounted to 508 subjects (23.4%), with no gender difference. Atorvastatin (39.3%) and simvastatin (34.0%) were the most widely used statin drugs. Likelihood of treatment was associated with polypharmacy (≥5 drugs) and with higher Cumulative Illness Rating Scale (CIRS) score. At logistic regression analysis, the presence of coronary heart disease, peripheral vascular disease, and hypertension were significantly correlated with lipid-lowering drug use, whereas age showed an inverse correlation. Diabetes was not associated with drug treatment. In this in-hospital cohort, the use of lipid-lowering agents was mainly driven by patients' clinical history, most notably the presence of clinically overt manifestations of atherosclerosis. Increasing age seems to be associated with lower prescription rates. This might be indicative of cautious behavior towards a potentially toxic treatment regimen.

  4. Mental Health and the Intern--A Teacher Training Model.

    ERIC Educational Resources Information Center

    Mungo, Samuel J.

    An intern program for teacher trainees at Illinois State University augments the student teaching experience with experience in the surrounding urban community. The urban community experience is used as a vehicle to allow the students to look at their own personal strengths and weaknesses, their willingness to work with others, and their ability…

  5. Comparison of various radiation therapy techniques in breast cancer where target volume includes mammaria interna region.

    PubMed

    Dogan, Mehmet Hakan; Zincircioglu, Seyit Burhanedtin; Zorlu, Faruk

    2009-01-01

    In breast cancer radiotherapy, the internal mammary lymphatic chain is treated in the target volume in a group of patients with high-risk criteria. Because of the variability of the anatomic region and structures in the irradiation field, there are a number of different techniques in breast radiotherapy. While irradiating the target volume, we also consider minimizing the dose to critical structures such as heart, lung, and contralateral breast tissue. In this study, we evaluated the dose distribution of different radiotherapy techniques in patients with left-sided breast cancer who had breast-conserving surgery. A three-dimensional computerized planning system (3DCPS) was used for each patient to compare wide-field, oblique photon-electron, and perpendicular photon-electron techniques in terms of dose homogeneities in the target volume; the doses received by the contralateral breast, heart, and lung; and the coverage of the internal mammary chain. Data from 3DCPS were controlled by the Rando-phantom and thermoluminescence dosimetry. Critical structures were irradiated with acceptable dose percentages in addition to the internal mammary chain with both wide-field and photon-electron techniques. We detected more frequent hot spots in the oblique photon-electron technique than in the other techniques, and this situation necessitated changing the junctions. The wide-field technique was easy to perform and exposed less radiation dose to the heart than photon-electron techniques. In conclusion, we suggest the use of the wide-field technique in breast irradiation when the internal mammary area is in the target volume.

  6. Comparison of Various Radiation Therapy Techniques in Breast Cancer Where Target Volume Includes Mammaria Interna Region

    SciTech Connect

    Dogan, Mehmet Hakan; Zincircioglu, Seyit Burhanedtin Zorlu, Faruk

    2009-04-01

    In breast cancer radiotherapy, the internal mammary lymphatic chain is treated in the target volume in a group of patients with high-risk criteria. Because of the variability of the anatomic region and structures in the irradiation field, there are a number of different techniques in breast radiotherapy. While irradiating the target volume, we also consider minimizing the dose to critical structures such as heart, lung, and contralateral breast tissue. In this study, we evaluated the dose distribution of different radiotherapy techniques in patients with left-sided breast cancer who had breast-conserving surgery. A three-dimensional computerized planning system (3DCPS) was used for each patient to compare wide-field, oblique photon-electron, and perpendicular photon-electron techniques in terms of dose homogeneities in the target volume; the doses received by the contralateral breast, heart, and lung; and the coverage of the internal mammary chain. Data from 3DCPS were controlled by the Rando-phantom and thermoluminescence dosimetry. Critical structures were irradiated with acceptable dose percentages in addition to the internal mammary chain with both wide-field and photon-electron techniques. We detected more frequent hot spots in the oblique photon-electron technique than in the other techniques, and this situation necessitated changing the junctions. The wide-field technique was easy to perform and exposed less radiation dose to the heart than photon-electron techniques. In conclusion, we suggest the use of the wide-field technique in breast irradiation when the internal mammary area is in the target volume.

  7. Local resistance patterns to antimicrobials in internal medicine: a focused report from the REGIMEN (REGistro Infezioni in MEdicina INterna) study.

    PubMed

    Cei, Marco; Pardelli, Riccardo; Sani, Spartaco; Mumoli, Nicola

    2014-02-01

    The treatment for infections in hospitalized patients can be summarized in the timely start of empirical therapy, followed by adjustment on the basis of isolates and microbial susceptibilities. Initial therapy may be based on international guidelines. However, to know local frequencies of bacterial and fungal strains together with patterns of drug resistance should be a better approach to therapy. REGIMEN is a retrospective observational study of all consecutive recorded bacterial and fungal isolates, collected between October 2009 and August 2011 from patients admitted in a 53-bedded ward of internal medicine of a non-teaching Italian hospital. We investigated type of samples and of microorganisms, patterns of susceptibility and resistance to antibiotics, and in-hospital mortality. A total of 504 samples were examined (244 from urine, 189 from blood and 71 from skin and various exudates). Participants were old (mean age, 83 years), and so overall mortality was high (20 %). There were high frequencies of drug resistance; only 27.9 % of urinary gram-negatives and 52.6 % of blood gram-negatives were susceptible to levofloxacin. Susceptibility profiles compatible with the presence of extended-spectrum beta-lactamases were present in 64.2 % of gram-negative strains, and 10.1 % were also resistant to carbapenems. ESKAPE organisms account for a third of all bacterial infections. Local patterns of drug resistance should influence empirical antibiotic therapy for patients admitted in internal medicine wards, where mortality is high.

  8. Learning from the nurses and the paramedics: the experience of a Kenyan medical officer intern-a call for research

    PubMed Central

    Mwenda, Aruyaru Stanley

    2012-01-01

    In the Kenyan medical educations system, one has to go through one year of internship after graduating from medical school in order to be licensed to practise medicine. This internship period is laden with work to the extent of overwhelming and stressing the medical officer interns. Irrespective of what competence interns come with into the field there is still a lot they have to learn from the nurses and the paramedics. Most of the learning takes place during the acute care settings when the intern is on call and is from the nurses. The paramedics most helpful to the intern are the theater assistants who teach interns how to use the various surgical instruments and sometimes direct during minor operations. PMID:22891094

  9. Análise da cinemática interna das regiões HII gigantes e das galáxias HII

    NASA Astrophysics Data System (ADS)

    Plana, H.; Telles, E.; Maíz-Apellániz, J.

    2003-08-01

    Neste trabalho nós mostramos os primeiros resultados de um estudo sobre a cinemática das Regiões HII Gigantes (GHIIRs) em galáxias próximas. Essas regiões HII têm um diâmetro médio entre 100 pc e 1000 pc e uma taxa de formação estelar de 106 M¤ / ano sendo equivalente à observada em galáxias de tipo tardio correspondendo a uma taxa de formação estelar por unidade de volume uma ordem de magnitude maior que a observada em regiões HII normais. Usando espectros de fenda longas em várias posições, nós construímos mapas de velocidades, de dispersão e de intensidade para várias linhas de emissão como Ha, Hb, [NII]6584 Å, [OIII]5007 Å e o doublet de [SII], para cinco regiões gigantes: NGC 2403 II e IV, NGC 595, NGC 5461, NGC 5471, NGC 5455. O estudo da cinemática (mapas de velocidades e da dispersão) mostrou, por exemplo, a presença de cascas em expansão em NGC 595 ou perfis de emissão com várias componentes em NGC 5461. Os perfis de emissão também mostram velocidades supersônicas. Os resultados são discutidos em comparação com os de estudos anteriores realizados.

  10. Comorbidities and short-term prognosis in patients hospitalized for acute exacerbation of COPD: the EPOC en Servicios de medicina interna (ESMI) study.

    PubMed

    Almagro, Pedro; Cabrera, Francisco Javier; Diez, Jesus; Boixeda, Ramon; Alonso Ortiz, M Belen; Murio, Cristina; Soriano, Joan B

    2012-11-01

    Comorbidities are frequent in patients hospitalized for COPD exacerbation, but little is known about their relation with short-term mortality and hospital readmissions. Our hypothesis is that the frequency and type of comorbidities impair the prognosis within 12 weeks after discharge. A longitudinal, observational, multicenter study of patients hospitalized for a COPD exacerbation with spirometric confirmation was performed. Comorbidity information was collected using the Charlson index and a questionnaire that included other common conditions not included in this index. Dyspnea, functional status, and previous hospitalization for COPD or other reasons among other variables were investigated. Information on mortality and readmissions for COPD or other causes was collected up to 3 months after discharge. We studied 606 patients, 594 men (89.9%), with a mean (SD) age of 72.6 (9.9) years and a postbronchodilator FEV1 of 43.2% (21.2). The mean Charlson index score was 3.1 (2.0). On admission, 63.4% of patients had arterial hypertension, 35.8% diabetes mellitus, 32.8% chronic heart failure, 20.8% ischemic heart disease, 19.3% anemia, and 34% dyslipemia. Twenty-seven patients (4.5%) died within 3 months. The Charlson index was an independent predictor of mortality (P < .003; OR,1.23; 95% CI, 1.07-1.40), even after adjustment for age, FEV1, and functional status measured with the Katz index. Comorbidity was also related with the need for hospitalization from the ED, length of stay, and hospital readmissions for COPD or other causes. Comorbidities are common in patients hospitalized for a COPD exacerbation, and they are related to short-term prognosis.

  11. An initial experience with a digital drainage system during the postoperative period of pediatric thoracic surgery.

    PubMed

    Costa, Altair da Silva; Bachichi, Thiago; Holanda, Caio; Rizzo, Luiz Augusto Lucas Martins De

    2016-01-01

    To report an initial experience with a digital drainage system during the postoperative period of pediatric thoracic surgery. This was a prospective observational study involving consecutive patients, ≤ 14 years of age, treated at a pediatric thoracic surgery outpatient clinic, for whom pulmonary resection (lobectomy or segmentectomy via muscle-sparing thoracotomy) was indicated. The parameters evaluated were air leak (as quantified with the digital system), biosafety, duration of drainage, length of hospital stay, and complications. The digital system was used in 11 children (mean age, 5.9 ± 3.3 years). The mean length of hospital stay was 4.9 ± 2.6 days, the mean duration of drainage was 2.5 ± 0.7 days, and the mean drainage volume was 270.4 ± 166.7 mL. The mean maximum air leak flow was 92.78 ± 95.83 mL/min (range, 18-338 mL/min). Two patients developed postoperative complications (atelectasis and pneumonia, respectively). The use of this digital system facilitated the decision-making process during the postoperative period, reducing the risk of errors in the interpretation and management of air leaks. Relatar a experiência inicial com um sistema de drenagem digital no pós-operatório de cirurgia torácica pediátrica. Estudo observacional e prospectivo envolvendo pacientes consecutivos do ambulatório de cirurgia torácica pediátrica da instituição, com idade até 14 anos, e com indicação de ressecção pulmonar (lobectomia e/ou segmentectomia através de toracotomia poupadora muscular). Os parâmetros avaliados foram perda aérea (quantificada com o sistema digital), biossegurança, tempo de drenagem, tempo de internação e complicações. O sistema digital foi utilizado em 11 crianças, com média de idade de 5,9 ± 3,3 anos. A média do tempo de internação foi de 4,9 ± 2,6 dias, a de tempo de drenagem foi de 2,5 ± 0,7 dias, e a de volume de drenagem foi de 270,4 ± 166,7 ml. A média da perda aérea máxima foi de 92,78 ± 95,83 ml

  12. Vestibular system paresis due to emergency endovascular catheterization.

    PubMed

    Simoceli, Lucinda; Sguillar, Danilo Anunciatto; Santos, Henrique Mendes Paiva; Caputti, Camilla

    2012-04-01

    Objetivo: O objetivo deste relato de caso é descrever uma causa incomum de vestibulopatia periférica associada à perda auditiva unilateral em paciente idoso pós- cateterismo de urgência.Relato de caso: Paciente do gênero masculino, 82 anos, submetido à correção de aneurisma roto de aorta abdominal, no intra-operatório sofreu infarto agudo do miocárdio necessitando de angioplastia primária. Após alta hospitalar refere queixa de hipoacusia acentuada à direita e vertigem incapacitante, sem sinais neurológicos focais. Ao exame clínico otorrinolaringológico apresentava: Teste de Weber lateralizado para a esquerda, nistagmo espontâneo para a esquerda , marcha oscilante, leve disbasia e ataxia, índex-nariz e diadococinesia normais, Teste de Romberg com oscilação sem queda e Fukuda com desvio lateral para a direita. O exame audiométrico evidenciava anacusia à direita e perda neurossensorial à esquerda em agudos, arreflexia vestibular à direita na prova calórica e, na tomografia computadorizada dos ossos temporais e tronco-encefálico, presença de haste metálica atravessando o osso temporal direito, a partir da veia jugular interna e bulbo jugular, atravessando os canais semicirculares posterior, superior e vestíbulo, projetando-se em lobo temporal. O diagnóstico radiológico foi lesão traumática por guia endovascular metálico durante cateterismo de urgência e a conduta, considerando que o paciente não havia compensado o equilíbrio, foi reabilitação vestibular.Conclusão: Queixas de tontura no paciente idoso devem ser criteriosamente avaliadas diante do seu histórico clínico patológico pois os antecedentes de doenças e tratamentos prévios, em geral, direcionam as hipóteses diagnósticas porém podem trazer alterações inesperadas.

  13. Analysis of the Economic Impact of Cardiovascular Diseases in the Last Five Years in Brazil.

    PubMed

    Siqueira, Alessandra de Sá Earp; Siqueira-Filho, Aristarco Gonçalves de; Land, Marcelo Gerardin Poirot

    2017-07-01

    ões de reais no ano de 2015, um aumento percentual de 17% no período de 2010 a 2015. Os custos estimados pela morte prematura por DCV representam 61% do total de custo por DCV, os custos diretos com internações e consultas foram de 22% e os custos pela perda da produtividade relacionados à doença foram de 15% do total. Os gastos com saúde no Brasil são estimados em 9,5% do PIB e o custo médio das DCV foi estimado em 0,7% do PIB. Os custos com DCV vêm aumentando significativamente nos últimos cinco anos. Estima-se que os custos por DCV aumentem à medida que a população brasileira envelhece e que a prevalência de DCV aumenta.

  14. Validation of the Portuguese Version of EHP-30 (The Endometriosis Health Profile-30).

    PubMed

    Nogueira-Silva, Cristina; Costa, Patrício; Martins, Carla; Barata, Sónia; Alho, Conceição; Calhaz-Jorge, Carlos; Osório, Filipa

    2015-01-01

    Introdução: O Endometriosis Health Profile Questionnaire-30 é atualmente o questionário mais utilizado para avaliação da qualidade de vida em mulheres com endometriose. O objetivo do presente estudo é avaliar as propriedades psicométricas e validar a versão portuguesa do Endometriosis Health Profile Questionnaire-30.Material e Métodos: Amostra sequencial de conveniência, constituída por 152 doentes com endometriose, de um centro de referência no país, que autopreencheram um questionário sociodemográfico, a versão portuguesa do Endometriosis Health Profile Questionnaire-30 e do Short Form Health Survey 36 Itemâversão 2. Procedeu-se a análise estatística apropriada, com estatística descritiva, análise fatorial, avaliação da consistência interna, correlação item-total e validade convergente (usando o Short Form Health Survey 36 Itemâversão 2).Resultados: A análise fatorial confirmou a validade da estrutura em cinco dimensões do questionário central, explicando uma variância total de 83,2%. A correlação item-total apresentou resultados aceitáveis em todos os itens e a consistência interna foi elevada, com α Cronbach variando de 0,876 a 0,981 nas dimensões do questionário central, e de 0,863 a 0,951 no modular. Demonstrou-se associação negativa significativa entre as dimensões similares do Endometriosis Health Profile Questionnaire-30 e do Short Form Health Survey36 Itemâversão 2. A taxa de preenchimento do questionário foi elevada para todas as dimensões. A perda do bem-estar emocional (no questionário central) e a infertilidade (no modular) apresentaram as pontuações médias mais elevadas e, consequentemente, impacto mais negativo sobre a qualidade de vida.Discussão: São necessários estudos para avaliar a fiabilidade teste-reteste e a sensibilidade à mudança desta versão portuguesa do Endometriosis Health Profile Questionnaire-30.Conclusão: Este estudo demonstra que a versão portuguesa do Endometriosis

  15. [Guidelines for monitoring late-onset Pompe disease.Sociedad Española de Medicina Interna (SEMI), Sociedad Española de Neurología (SEN) y Sociedad Española de Neumología y CirugíaTorácica (SEPAR)].

    PubMed

    Gutiérrez-Rivas, Eduardo; Illa, Isabel; Pascual-Pascual, Samuel I; Pérez-López, Jordi; Vílchez-Padilla, Juan J; Bautista-Lorite, Juan; Barrot, Emilia; López de Munain, Adolfo

    2015-04-01

    Although treatment with alglucosidase alfa has helped improve the prognosis of patients with late-onset Pompe disease, both the development of the disease and the effectiveness of the treatment need to be monitored on a regular basis. This is the reason that has led a committee of Spanish experts to draw up a series of guidelines on how to follow up these patients. The committee proposes a model of follow-up tests for late-onset Pompe disease. First of all, the nutritional status and swallowing function must be evaluated. Second, and due to the variability of the clinical features, the committee recommends the simultaneous use of several scales to measure different functions and parameters. Thus, muscular force is assessed with the Medical Research Council scale; motor functioning, with the six-minute walk test and timed tests; disability, with the Rasch-built Pompe-specific Activity scale; respiratory functioning, with measurement of the forced vital capacity and oxygen saturation; and fatigue, with the fatigue intensity scale. Lastly, the safety and tolerability of enzyme replacement therapy are controlled by registering and treating the potential side effects and measurement of the anti-alglucosidase alfa antibodies. A number of different general recommendations are also included.

  16. Estimated costs of advanced lung cancer care in a public reference hospital.

    PubMed

    Knust, Renata Erthal; Portela, Margareth Crisóstomo; Pereira, Claudia Cristina de Aguiar; Fortes, Guilherme Bastos

    2017-08-17

    coorte de 277 pacientes matriculados no Instituto Nacional do Câncer em 2011. Os custos foram estimados sob a perspectiva do hospital como prestador de serviços de referência para o SUS. Insumos e procedimentos utilizados foram identificados e quantificados, por paciente, sendo a eles atribuídos valores monetários, consolidados por fases da assistência definidas. As análises tiveram caráter descritivo com custos em reais (R$). Em termos globais, a coorte representou um custo de R$2.473.559,91, sendo 71,5% relacionados à atenção ambulatorial e 28,5% as internações. Na atenção ambulatorial, predominaram os custos com radioterapia (34%) e quimioterapia (22%). Os resultados apontaram para custos menores na fase inicial de tratamento (7,2%) e custos muito elevados na fase de manutenção (61,6%). Por fim, identificaram-se diferenças estatisticamente significativas das médias dos custos por faixas etárias, níveis de escolaridade, desempenho físico e tipo histológico. Este estudo fornece um retrato atual, útil e relevante sobre os custos de pacientes com câncer de pulmão não pequenas células assistidos em um hospital público de referência e provê elementos sobre a magnitude do problema do câncer no âmbito da saúde pública. Os resultados ratificam a importância do tratamento radioterápico e das internações como principais componentes de custo do tratamento. Apesar de algumas perdas de seguimento avalia-se que, para cerca de 80% dos pacientes incluídos no estudo, as estimativas aqui apresentadas sejam satisfatoriamente fidedignas ao cuidado da doença, sob a perspectiva de um prestador de referência do SUS, fornecendo elementos para a gestão do serviço, bem como para estudos que redundem em formas mais racionais de alocação de recursos.

  17. Mission Simulators

    NASA Image and Video Library

    Students will use NASA Web-based simulators to follow sequenced directions and complete ordered tasks while learning how the shuttle is made ready for flight, how the shuttle docks with the Interna...

  18. Future of Human Space Exploration

    NASA Image and Video Library

    Now that the Space Shuttle era is over, NASA is writing the next chapters in human Spaceflight with its commercial and international partners. It is advancing research and technology on the Interna...

  19. How the Cultural Contexts of Urban Teaching Affect Novice Science Educators: Implications for School Leaders

    ERIC Educational Resources Information Center

    Duncan, Marlina

    2014-01-01

    While the challenge to retain highly competent teachers affects all schools, the crisis is critical in urban districts, which historically suffer from high teacher turnover (Ingersoll, 2004). This high turnover is especially problematic in the content areas of science (Ingersoll & Perda, 2010). Through ethnographic case studies the first year…

  20. Comprehensive School Reform & Student Achievement in Kentucky Middle Schools

    ERIC Educational Resources Information Center

    Evans-Andris, Melissa; Usui, Wayne M.

    2008-01-01

    This project examines the effects of Comprehensive School Reform (CSR) models on the achievement of students in Kentucky middle schools. Previous studies exploring the effects of CSR on schools and student achievement have rendered mixed results (Berends, 2000; May & Supovitz, 2006; May, Supovitz, & Perda, 2004; RAND, 2002; Zhang,…

  1. Key Issue: Increasing Teacher Retention to Facilitate the Equitable Distribution of Effective Teachers

    ERIC Educational Resources Information Center

    Lasagna, Molly

    2009-01-01

    The term "teacher retention" refers to the ability to keep teachers on the job. In other words, it is the ability to reduce or eliminate teacher turnover. "Turnover" refers to the migration of teachers between schools or districts "and" the attrition of teachers from the profession (Ingersoll & Perda, 2009). From the perspective of a principal,…

  2. Comprehensive School Reform & Student Achievement in Kentucky Middle Schools

    ERIC Educational Resources Information Center

    Evans-Andris, Melissa; Usui, Wayne M.

    2008-01-01

    This project examines the effects of Comprehensive School Reform (CSR) models on the achievement of students in Kentucky middle schools. Previous studies exploring the effects of CSR on schools and student achievement have rendered mixed results (Berends, 2000; May & Supovitz, 2006; May, Supovitz, & Perda, 2004; RAND, 2002; Zhang,…

  3. Topographic characterisation of dental implants for commercial use

    PubMed Central

    Mendoza-Arnau, Amparo; Vallecillo-Capilla, Manuel-Francisco; Cabrerizo-Vílchez, Miguel-Ángel

    2016-01-01

    Background To characterize the surface topography of several dental implants for commercial use. Material and Methods Dental implants analyzed were Certain (Biomet 3i), Tissue Level (Straumann), Interna (BTI), MG-InHex (MozoGrau), SPI (Alphabio) and Hikelt (Bioner). Surface topography was ascertained using a confocal microscope with white light. Roughness parameters obtained were: Ra, Rq, Rv, Rp, Rt, Rsk and Rku. The results were analysed using single-factor ANOVA and Student-Neuman-Keuls(p<0.05) tests. Results Certain and Hikelt obtained the highest Ra and Rq scores, followed by Tissue Level. Interna and SPI obtained lower scores, and MG-InHex obtained the lowest score. Rv scores followed the same trend. Certain obtained the highest Rp score, followed by SPI and Hikelt, then Interna and Tissue Level. MG-InHex obtained the lowest scores. Certain obtained the highest Rt score, followed by Interna and Hikelt, then SPI and Tissue Level. The lowest scores were for MG-InHex. Rsk was negative (punctured surface) in the MG-InHex, SPI and Tissue Level systems, and positive (pointed surface) in the other systems. Rku was higher than 3 (Leptokurtic) in Tissue Level, Interna, MG-InHex and SPI, and lower than 3 (Platykurtic) in Certain and Hikelt. Conclusions The type of implant determines surface topography, and there are differences in the roughness parameters of the various makes of implants for clinical use. Key words:Implants for clinical use, topography, confocal microscopy. PMID:27475680

  4. Brainstem and Cranial Nerve Disorders of Ruminants.

    PubMed

    Boileau, Mélanie J; Gilliam, John

    2017-03-01

    Asymmetrical signs of brainstem disease occur relatively infrequently in ruminants. The most common differential diagnoses include listeriosis, otitis media/interna, and pituitary abscess syndrome. Although these conditions produce signs of brainstem dysfunction, the diseases can usually be differentiated based on historical findings and subtle clinical differences. Basic laboratory diagnostic tests are often not specific in the definitive diagnosis but may be supportive. Advanced imaging techniques have proven to be useful in the diagnosis of otitis media/interna. Presumptive clinical diagnosis is confirmed at necropsy. Treatment involves a prolonged course of antibiotic therapy but is unrewarding in cases of pituitary abscess syndrome.

  5. Modelagem do vento e da fotosfera de AG Carinae

    NASA Astrophysics Data System (ADS)

    Groh, J. H.; Damineli, A.

    2003-08-01

    A trajetória evolutiva das estrelas de alta massa depende fortemente de suas taxas de perda de massa. Apesar do rápido progresso no estudo destas estrelas, a taxa de perda de massa e outros parâmetros físicos básicos, como a temperatura superficial e a velocidade terminal do vento ainda não estão bem determinados. Isto ocorre devido à presença de ventos irregulares, rápidos e fortes ao redor destas estrelas, tornando a interpretação dos seus espectros uma tarefa difícil. Assim, a modelagem do vento e da fotosfera dessas estrelas está sendo cada vez mais usada para obter tais parâmetros a partir dos espectros. O aumento da taxa de perda de massa durante a fase LBV (Variáveis Luminosas Azuis), comparado com outros tipos de estrelas, tem sido atribuído a instabilidades do tipo S Doradus. Dispomos de uma base de dados espectroscópicos cobrindo 22 anos de observações de AG Carinae, incluindo um ciclo S Doradus completo, com espectros CCD em alta resolução na faixa óptica e infravermelha. Utilizamos o programa desenvolvido por Schmutz (1997) para uma análise preliminar desse ciclo, obtendo a taxa de perda de massa a partir da linha do Ha. Não existe uma correlação clara da taxa de perda de massa com mudanças da temperatura efetiva, do raio da estrela e do fluxo na banda V. A estrela atingiu seu mínimo fotométrico (raio mínimo) em 1990 e o máximo fotométrico (raio máximo) em 1995, enquanto que o fluxo máximo da linha do Ha ocorreu em 1996. Além disso a taxa de perda de massa não segue esse ciclo, contrariamente às idéias correntes. Para fazer um modelo mais realista estamos usando o programa CMFGEN (Hillier & Miller), que trata a fotosfera e o vento estelar de forma consistente, considerando a radiação fora do equilíbrio termodinâmico (NLTE) e com blanketting total de linhas. Simulamos o espectro de AG Carinae em duas épocas extremas do ciclo S Dor para testar os resultados obtidos com o modelo mais simplificado.

  6. [PRAdA intervention: effects on weight of dietary intervention among treated hypertensive Portuguese natives and African immigrants].

    PubMed

    Peixoto, Catarina; Carrilho, Gisela; Alarcão, Violeta; Guerra, Filipa; Simões, Rui; Fernandes, Milene; Nicola, Paulo; Guiomar, Sofia; Nogueira, Paulo; Rocha, Evangelista

    2014-01-01

    Introdução: Perdas de peso melhoram o controlo da tensão arterial em indivíduos hipertensos. As intervenções comportamentais para a perda de peso parecem ser menos eficazes nos imigrantes de origem africana (IOA). Os principais objetivos foram avaliar os efeitos no peso de uma intervenção alimentar em hipertensos nativos de origem portugueses (NOP) e IOA; identificar fatores de sucesso na perda de peso; avaliar a evolução dos conhecimentos e adesão às recomendações alimentares. Material e Métodos: Foram selecionados aleatoriamente hipertensos medicados seguidos nos cuidados de saúde primários para um estudo de duas fases, observacional (15 meses) e de intervenção comportamental (seis meses). Os participantes foram divididos em dois grupos: IOA e NOP. Foram dadas recomendações alimentares e de estilos de vida em sessões individuais presenciais e telefónicas. Resultados: Dos 110 participantes, com IMC médio de 31,6 ± 3,7 kg/m2 e idade média 61,3 ± 10,0 anos, 60 eram imigrantes. Durante a intervenção os NOP perderam 1,4 ± 2,7% do peso e os IOA 0,8 ± 3,6%, sendo a perda superior comparativamente com a fase observacional. Ser do sexo masculino e consumir pelo menos duas porções de lacticínios magros por dia associou-se a maior perda de peso durante a intervenção, independentemente da idade e origem. Houve um aumento significativo no número de recomendações dietéticas conhecidas e cumpridas, com os NOP a cumprirem em média mais recomendações. Discussão: A intervenção foi bem sucedida relativamente à perda de peso, especialmente no grupo dos NOP, confirmando outros estudos. Conclusão: A intervenção aumentou os conhecimentos e adesão às recomendações, realçando a pertinência da educação alimentar, culturalmente adaptada, nos cuidados de saúde primários.

  7. Human Factors and Safety Considerations of Night Vision Systems Flight Using Thermal Imaging Systems

    DTIC Science & Technology

    1990-04-01

    divides the Sensor pack- result in nonuniform solar h ing. The tank also age into scparviely fimnctional asemblies. This has a major interna source of...Duke) Fort Sam Houston, TX 78234-6200 26 Director of Professional Services U.S. Air Force School AFMSC/GSP of Aerospace Medicina Brooks Air Force Base

  8. Forging an American Grand Strategy: Securing a Path Through a Complex Future

    DTIC Science & Technology

    2013-10-01

    world. • We have to fix our infrastructure. It is more im- portant than buying our beer , our lawn furni- ture, and our cosmetics; it is even more impor...President Jennifer Landon prepares for counsel on a brewing interna- tional situation. The crisis centers around the country of Pacifica. From President

  9. COLLABORATIVE RESEARCH: IN SITU MITIGATION OF MERCURY CONTAMINATED GROUNDWATER IN KAZAKHSTAN

    EPA Science Inventory

    Abstract for EPA Science Forum.

    The EPA Office of International Affairs is managing a U.S. State Department -funded project to redirect former Soviet Union biological weapons scientists. Scientists in countries of the former Soviet Union receive funding through the Interna...

  10. A comparison of internal and external lipids of nondiapausing and diapause initiation phase adult Colorado potato beetles, Leptinotarsa decemlineata

    USDA-ARS?s Scientific Manuscript database

    The Colorado potato beetle, Leptinotarsa decemlineata, reared under diapause inducing conditions will emerge from the soil as an adult and enter the diapause initiation phase, a period where metabolic reserves are stockpiled before the beetles enter the nonfeeding diapause maintenance phase. Interna...

  11. In-Transit Visibility Systems for an Expeditionary Force

    DTIC Science & Technology

    2015-11-01

    November–December 2015 Army Sustainment42 In September 2014, the outbreak of Ebola virus disease in West Africa overwhelmed the region’s...achievements contributed to the suc- cess of the U.S. Agency for Interna- tional Development in its mission to control the outbreak of Ebola

  12. Security Assistance International Logistics, Training, and Technical Assistance Support Policy and Responsibilities

    DTIC Science & Technology

    2000-01-24

    66 Financial Management ...........................................................................66 Section I Preparing the Letter of Offer ...telephone number of the preparer. AR 12-1 • 24 January 2000 66 Chapter 13 Financial Management Section I Preparing the Letter of Offer and Acceptance...regulations. Summary. This regulation provides pol- icy for the management and execution of Army Security Assistance and Interna- tional Logistics Support

  13. Essays on War: 1. The Inconsequence of Superpower War, 2. Quarantine, 3. The Quagmire of Self-Defense,

    DTIC Science & Technology

    1981-01-01

    published a Berlin decree hinting that a concept of limited blockades should be recognized. This would have allowed merchant trade to flourish "pacifically...LEGAL ENTITY? There is, among all mankind, the burden of the valley of vision. Isaiah The need for progressive and creative reappraisal of interna- tional

  14. Agrarian Structure and Labor Migration in Rural Mexico: The Case of Circular Migration of Undocumented Workers to the U.S.

    DTIC Science & Technology

    1980-07-01

    34 Migraciones en el Desarrollo Capitalista." Migraci6n y Desarrollo 3: AnAlisis Hist6ricos y Aspectos Relacionados a la Estructura Agraria y al Proceso de...Portfolio Theory and Capital Markets. New York: McGraw Hill. Singer, Paul I. 1972 " Migraciones Internas: Consideraciones Te6ricas sobre el Estudio

  15. Pi: A Parallel Architecture Interface for Multi-Model Execution

    DTIC Science & Technology

    1990-07-01

    Directory Schemes for Cache Coherence. In The 15th Annual Interna- tional Symposium on Computer Architecture. IEEE Computer Society and ACM, June 1988. [3...Annual International Symposium on Computer Architecture. IEEE Computer Society and ACM, June 1986. [5] Arvind and Rishiyur S. Nikhil. A Dataflow...Overview, 1987. [9] Roberto Bisiani and Alessandro Forin. Multilanguage Parallel Programming of Heterogeneous Machines. IEEE Transactions on Computers

  16. Privatisation, Decentralisation and Education in the United Kingdom: The Role of the State

    ERIC Educational Resources Information Center

    Turner, David

    2004-01-01

    Since the early 1950s, the axis "centralisation-decentralisation", especially as thematised in the work of Isaac Kandel, has represented a major focus of comparative studies in education. Kandel argued that issues relating to the internal conduct of the classroom (interna) should, so far as possible, be decentralised, while issues…

  17. Prolog for VLSI Layout: Experiences in the Design and Implementation of Topolog, A Prolog Based Module Generation and Layout System

    DTIC Science & Technology

    1987-07-01

    Herve Touati , Wayne Citrin, and Bill Bush read early drafts of this paper and made many helpful suggestions. This research was sponsored by the Defense...Lisp and Prolog Programs", Proc. Third Interna-V tional Conference on Logic Programming, Springer-Verlag, 1986. ITouati86l Touati , H., private

  18. Report of the Defense Science Board on Use of Commercial Components in Military Equipment

    DTIC Science & Technology

    1989-06-01

    services adopt the open systems architecture concept, endorse the interna - tional ISO/OSI standards and protocols, comply with GOSIP, and make optimum...and logistica support that uws short. concise. easy to understand and streamlined. A-33 CHS RFP OVERVIEW THE CHS SOLICITATION IS: * UNIQUE

  19. Nonstandard Support Concepts in USAF Managed Security Assistance Program

    DTIC Science & Technology

    1977-06-01

    the sale of nonstandard weapon systems and subsystems emphasize3 the fact that foreign customers are actively participating as buyers in the interna ...sufficient integrated logistica ] system must be fully considered. Programs such as Peace Hawk and Peace Log must be utilized to permit and insure a fully

  20. COLLABORATIVE RESEARCH: IN SITU MITIGATION OF MERCURY CONTAMINATED GROUNDWATER IN KAZAKHSTAN

    EPA Science Inventory

    Abstract for EPA Science Forum.

    The EPA Office of International Affairs is managing a U.S. State Department -funded project to redirect former Soviet Union biological weapons scientists. Scientists in countries of the former Soviet Union receive funding through the Interna...

  1. Expression of orexins and their precursor in the porcine ovary and the influence of orexins on ovarian steroidogenesis in pigs.

    PubMed

    Nitkiewicz, Anna; Smolinska, Nina; Maleszka, Anna; Chojnowska, Katarzyna; Kaminski, Tadeusz

    2014-07-01

    Orexins A and B are hypothalamic neuropeptides associated with homeostasis and the reproductive system. The aim of the study was to compare the expression of the prepro-orexin gene and the intensity of orexins immunoreactivity in the porcine ovary (corpora lutea, granulosa and theca interna cells) during four different stages of the oestrous cycle (days: 2-3, 10-12, 14-16 and 17-19) and to examine the in vitro effect of orexins on the secretion of steroid hormones by porcine luteal, granulosa and theca interna cells. The highest expression of prepro-orexin mRNA was observed in theca interna cells on days 17-19 of the oestrous cycle. The highest content of immunoreactive orexin A was noted in corpora lutea on days 10-12 and the highest level of immunoreactive orexin B on days 14-16 of the cycle. Immunoreactive orexin A concentrations were higher in theca interna cells than in granulosa cells, whereas similar levels of immunoreactive orexin B were observed in both cell types. Under in vitro conditions, at the concentration of 10 nM, orexins A and B inhibited FSH-induced oestradiol secretion by granulosa cells. The obtained results suggest that the pattern of orexin peptide expression in the porcine ovary is related to the animals' hormonal status. Our findings imply that orexins can affect porcine reproductive functions through modulation of ovarian steroidogenesis.

  2. Defense Standardization Program Journal. October/December 2012

    DTIC Science & Technology

    2012-10-01

    Barriers to Trade ( TBT ).The WTO TBT agreement establishes principles for interna- tional standardization processes using attributes similar to those...WTO TBT agreement, the proposed standardization regulation states that public authorities should make best use of the full range of relevant

  3. The Age of Irregular Warfare: So What?

    DTIC Science & Technology

    2010-01-01

    Lynne Rienner, 2002), and Michael Vlahos, Fighting Identity: Sacred War and World Change (Westport, CT: Praeger Security Interna- tional, 2009). 7...Clausewitz’s Trinity since the word trinity implies much more than three-sided geometry . How to represent the threesome picto- graphically in a more

  4. Participative Budgeting as a Communication Process: A Model and Experiment.

    DTIC Science & Technology

    1978-01-01

    evaluations are the products of so many kinds of m di- v idual exper iences , they are unlikely to be changed very much by communicatio n alone. Accuracy...Management Dec ision Laboratory . Whi te Plains , N.Y .: Interna- tional Business Machines Corporation , 1963. Ryan , Thomas A. Jr.; Joiner , Brian L. ; and

  5. Microphone-Independent Robust Signal Processing Using Probabilistic Optimum Filtering

    DTIC Science & Technology

    1994-01-01

    11. A. Acero , "Acoustical and Environmental Robustness in Automatic Speech Recognition," Ph.D. Thesis, Carnegie-MeLton University, Sep- tember 1990...12. R.M. Stem, FJ-I. Leu, Y. Ohshima, T.M. Sullivan, and A. Acero , "Multiple Approaches to Robust Speech Recognition," 1992 Interna- tional

  6. Privatisation, Decentralisation and Education in the United Kingdom: The Role of the State

    ERIC Educational Resources Information Center

    Turner, David

    2004-01-01

    Since the early 1950s, the axis "centralisation-decentralisation", especially as thematised in the work of Isaac Kandel, has represented a major focus of comparative studies in education. Kandel argued that issues relating to the internal conduct of the classroom (interna) should, so far as possible, be decentralised, while issues…

  7. How to: applying and interpreting the SWAT autocalibration tools

    USDA-ARS?s Scientific Manuscript database

    Watershed-level modelers have expressed a need, through ongoing discussions within the USDA-ARS Conservation Effects Assessment Program and the broader international research community, for a better understanding of uncertainty related to hard-to-measure input parameters and to the remaining interna...

  8. Posterior occipitocervical instrumented fusion for dropped head syndrome after deep brain stimulation.

    PubMed

    Pereira, E A C; Wilson-MacDonald, J; Green, A L; Aziz, T Z; Cadoux-Hudson, T A D

    2010-04-01

    We describe dropped head syndrome in a patient with Parkinson's disease receiving subthalamic nucleus deep brain stimulation (DBS). Posterior occipitocervical instrumented fusion after transarticular screw fixation of an odontoid fracture is shown and its rationale explained. Pedunculopontine nucleus DBS as treatment for fall-predominant Parkinson's disease, and globus pallidus interna DBS for dystonia-predominant Parkinson's disease, are discussed.

  9. Taxonomy of the Rhizopogon vinicolor species complex based on analysis of ITS sequences and microsatellite loci.

    Treesearch

    Annette M. Kretzer; Daniel L. Luoma; Randy Molina; Joseph W. Spatafora

    2003-01-01

    We are re-addressing species concepts in the Rhizopogon vinicolor species complex (Boletales, Basidiomycota) using sequence data from the interna transcribed spacer (ITS) region of the nuclear ribosomal repeat, as well as genoLypic data from five microsatellite loci. The R. vinicolor species complex by our definition includes,...

  10. Feature Quantization and Pooling for Videos

    DTIC Science & Technology

    2014-05-01

    segmentation, Brendel and Todorovic [8] attempt to segment the video into spatiotemporal tubes, which represent spatiotemporal extents of moving objects...W. Brendel and S. Todorovic . Video object segmentation by tracking regions. In Interna- tional Conference on Computer Vision, pages 833–840, 2009. 3

  11. Oxidation of Silicon, Silicon Carbide (SiC) and Silicon Nitride (Si3N4)

    DTIC Science & Technology

    1986-06-04

    stability diagram for the Si-N-0 system at 1600K, as given by Singhal (4), which is based an the thermodynamic data of Blegen (5). in this diagram any...eds. TMS-AIME 1373. 4. S.C. Singhal, Cerumurgia InternaUi. 2, 122 (1976). 5. K. Blegen , "Special Ceramics", P. Popper, ed., British Ceramic Research

  12. Cost of nursing most frequent procedures performed on severely burned patients.

    PubMed

    Melo, Talita de Oliveira; Lima, Antônio Fernandes Costa

    2017-01-01

    to identify the mean direct cost (MDC) of the most frequent procedures performed by nursing professionals on severely burned patients in an Intensive Care Unit. exploratory-descriptive quantitative single-case study. The MDC was calculated by multiplying time (timed) spent by nursing professionals in the performance of the procedures by the unit cost of direct labor, and adding the costs of material and medicine/solutions. a MDC of US$ 0.65 (SD=0.36) was obtained for "vital signs monitoring"; US$ 10.00 (SD=24.23) for "intravenous drug administration"; US$ 5.90 (SD=2.75) for "measurement of diuresis"; US$ 0.93 (SD=0.42) for "capillary blood glucose monitoring"; and US$ 99.75 (SD=129.55) for "bandaging". the knowledge developed can support managerial decision-making, contribute to the efficiency distribution of the resources involved and, when possible, provide cost-containment or cost-minimization strategies without impairing the quality of nursing care. identificar o custo direto médio (CDM) dos procedimentos realizados, com maior frequência, por profissionais de enfermagem, em uma Unidade de Terapia Intensiva, aos pacientes grandes queimados. pesquisa quantitativa, exploratório-descritiva, do tipo estudo de caso único. O CDM foi calculado multiplicando-se o tempo (cronometrado) despendido por profissionais de enfermagem na execução dos procedimentos, objeto de estudo, pelo custo unitário da mão de obra direta, somando-se ao custo dos materiais e soluções/medicamentos. obteve-se o CDM de US$ 0.65 (SD=0.36) para "controle dos sinais vitais"; US$ 10.00 (SD=24.23) para "administração de medicamentos via intravenosa"; US$ 5.90 (SD=2.75) para "mensuração de diurese"; US$ 0.93 (SD=0.42) para "verificação de glicemia capilar"; e US$ 99.75 (SD=129.55) para "curativo". o conhecimento desenvolvido pode fundamentar as tomadas de decisão gerenciais subsidiando a eficiência alocativa dos recursos envolvidos e, quando possível, indicar estratégias de conten

  13. Impact of promoting self-care in nursing workload.

    PubMed

    Trettene, Armando Dos Santos; Fontes, Cassiana Mendes Bertoncelo; Razera, Ana Paula Ribeiro; Gomide, Marcia Ribeiro

    2016-01-01

    To assess the impact of promoting self-care in nursing workload and associate it to the variables: age, gender, socioeconomic status, education, marital status and number of children of caregivers. Prospective study with 31 children and their caregivers. Participants were assessed at two moments, 1st and 2nd hospitalization, the nursing workload was measured by the Nursing Activities Score (NAS). The mean NAS in the 1st hospitalization was 60.9% and in the 2nd hospitalization was 41.6%, that is, 14.6 and 9.9 hours of nursing, respectively. The nursing workload on the first day of hospitalization was higher compared to the last day, both for the 1st (p<0.001) and for the 2nd hospitalization (p<0.001), and higher in the first (p<0.001) and in the last day (p=0.025) in the 1st hospitalization. Comparing the 1st hospitalization to the 2nd hospitalization, the first was higher (p<0.001), and NAS items related to the training of self-care was influenced (p<0.001). The nursing workload associated to self-care promotion corresponded to 14.6 hours and was higher than determined by the existing legislation. Verificar o impacto da promoção do autocuidado na carga de trabalho de enfermagem e associá-la às variáveis: idade, gênero, classificação socioeconômica, escolaridade, estado civil e número de filhos dos cuidadores. Estudo prospectivo, onde participaram 31 crianças e seus respectivos cuidadores. Os participantes foram avaliados em dois momentos, 1ª e 2ª internação, quanto à carga de trabalho de enfermagem mensurada por meio do Nursing Activities Score (NAS). A média NAS na 1ª internação foi de 60,9%, e na 2ª internação foi de 41,6%, ou seja, 14,6 e 9,9 horas de enfermagem, respectivamente. A carga de trabalho de enfermagem no primeiro dia de internação foi maior quando comparada ao último dia, tanto na 1ª (p<0,001) como na 2ª internação (p<0,001), e maior no primeiro (p<0,001) e último dia (p=0,025) na 1ª internação. Ainda, na 1ª interna

  14. First 3D reconstruction of the rhizocephalan root system using MicroCT

    NASA Astrophysics Data System (ADS)

    Noever, Christoph; Keiler, Jonas; Glenner, Henrik

    2016-07-01

    Parasitic barnacles (Cirripedia: Rhizocephala) are highly specialized parasites of crustaceans. Instead of an alimentary tract for feeding they utilize a system of roots, which infiltrates the body of their hosts to absorb nutrients. Using X-ray micro computer tomography (MicroCT) and computer-aided 3D-reconstruction, we document the spatial organization of this root system, the interna, inside the intact host and also demonstrate its use for morphological examinations of the parasites reproductive part, the externa. This is the first 3D visualization of the unique root system of the Rhizocephala in situ, showing how it is related to the inner organs of the host. We investigated the interna from different parasitic barnacles of the family Peltogastridae, which are parasitic on anomuran crustaceans. Rhizocephalan parasites of pagurid hermit crabs and lithodid crabs were analysed in this study.

  15. Robust Behavior-Based Control for Distributed Multi-Robot Collection Tasks

    DTIC Science & Technology

    2000-01-01

    Press: New York. [18] Henrik Hautop Lund and Luigi Pagliarini, \\Robocup jr. with lego mindstorms," in Proceedings of the 2000 IEEE Interna- tional...Conference on Robotics and Automation, San Francisco, CA, April 2000, IEEE. [19] Mattias Lindstrom, Anders Oreback, and Henrik I. Christensen, \\Berra: A...ior Fusion using Voting, Ph.D. thesis, Institute of Electronic Systems, Alborg University, Denmark, 1998. [23] Paolo Pirjanian, Henrik I. Christensen

  16. JPRS Report China

    DTIC Science & Technology

    2007-11-02

    cab- inet adopted the following central policies: 1. Increase the openness of politics and reduce corrup- tion and its root causes. This measure ...opinion world- wide. The measures the Chinese Government took to put down the rebellion were entirely consistent with interna- tionally recognized... early 1980’s, it is quite difficult to bring about a peaceful solution to the conflicts in the Central Amer- ican region. Another opinion holds that

  17. Democracy in Afghanistan: The 2014 Election and Beyond

    DTIC Science & Technology

    2014-01-01

    R P O R A T I O N Afghanistan’s upcoming presidential election—set for April 5, 2014—is the most important political event in that country’s decade...long transition to democracy. While the overthrow of the Taliban, the Bonn Process of political reconstruction, and the initial rounds of elections...interna- tional donors and observers have withdrawn, after the mundane reality of democratic politics sets in—and, crucially, after the first set of

  18. U.S. Airline Transport Pilot International Flight Language Experiences, Report 6: Native English-Speaking Controllers Communicating With Non-Native English-Speaking Pilots

    DTIC Science & Technology

    2011-03-01

    English - speaking pilot and you are on the same flight path and you suspect that pilot is low in English language proficiency skills ...native speaker of English (or English dialect). 2. Controllers need to develop greater patience with non-native English - speaking pilots. Once interna...when a non-native English - speaking pilot and you are on the same flight path and you suspect that pilot is low in English language proficiency skills

  19. Legality in Cyberspace: An Adversary View

    DTIC Science & Technology

    2014-03-01

    Sweden as a case study. According to Swedish Ministry of Foreign Affairs officials from the Interna- tional Law and Human Rights Department: We analyze...Article 51) in cases of self- defense against an armed attack (also undefined). The lack of clarity over what constitutes an armed attack in cyberspace...in the case of Russia) are also pro- vided for by existing legal obligations. According to one analysis: Since it is not realistic to expect states to

  20. JPRS Report, West Europe.

    DTIC Science & Technology

    1988-03-10

    some months now people have been talking about the EEC Presidency as a period that will work miracles for the governing party and significantly...nary— pollutes the political atmosphere with mistrust toward the parties and towards politics. The disillusion- ment does not change into hope. With...Norwegian economic policy. In an interview with AFTENPOSTEN last Saturday, Prime Minister Gro Harlem Brundtland said: "The way the interna- tional

  1. Modeling and Prediction of Internal Waves in the South China Sea

    DTIC Science & Technology

    2011-12-01

    numerous interna- tional groups, in partnership with the National Science Council of Taiwan, have sponsored a series of programs to collect...in this issue). The main experiment was conducted in summer 2011. Presently, analysis is underway, with numerous modeling groups having offered...Process Jackson 20 plan view Jackson (2009) Kinematic/empirical Predictive KHIM I 3D Alfordetal.(2011) 3D primitive equation , isopycnal coordinates

  2. From the Sierra to the Cities: The Urban Campaign of the Shining Path

    DTIC Science & Technology

    1992-01-01

    en El Peru: El pensamiento Gonzalo, Brussels, 1989, pp. 43-58, 61-91. See also Carlos Ivan Degregori, "Sendero Luminoso: Los hondos y mortales...desencuentos," in Eduardo Bailon (ed.), Movimientos sociales y crisis: El caso Peruano, Lima, Centro de Estudies y Promoci6n del Desarrollo (DESCO), 1980...Interna- tional Terrorism, the Centro de Estudios y Promoci6n del Desarrollo through its weekly and monthly publications Resumen Semanal and lnformatiuo

  3. Defense AT and L. Volume 41, Number 1, January-February 2012: Effects Through Acquisition Leveraging the Power of Contingency Contracting

    DTIC Science & Technology

    2012-01-01

    are several organizational process standards available. But the most popular one is ISO 9001 , which is the interna- tionally recognized series of...as independent confirmation that the organization meets the requirements of these standards. Since 1998, ISO - 9001 has been used at CAAA. Even...the Acquisition Knowledge Sharing System. You can use the Defense Acquisition Portal to: • Meet your training , education, and on-the-job support

  4. Problems In Nonlinear Acoustics: pulsed finite amplitude sound beams, nonlinear acoustic wave propagation in a liquid layer, nonlinear effects in asymmetric cylindrical sound beams, effects of absorption on the interaction of sound beams and parametric receiving arrays

    DTIC Science & Technology

    1990-12-07

    Proceedings of the 13th Interna- tional Congress on Acoustics, Belgrade, Yugoslavia, August 1989, edited by P. Pravica and G. Drakulic (Sava Centar...Congress on Acoustics (Sava Centar, Belgrade, 1989), edited by P. Pravica and G. Drakulic , Vol. 1, pp. 145-148. [11] K.-E. Froysa, "Weakly nonlinear...Congress on Acoustics (Sava Centar, Belgrade, 1989), edited by P. Pravica and G. Drakulic , Vol. 1, pp. 283-286. [41] C. M. Darvennes, M. F. Hamilton, J

  5. Peripheral venous catheter, a dangerous weapon. Key points to improve its use.

    PubMed

    Capdevila-Reniu, A; Capdevila, J A

    2017-05-30

    Catheter-related bacteremia is one of the most important causes of nosocomial infection. Is associated to high rates of morbidity and mortality, including an economic burden. Peripheral venous catheter bacteremia is a leading cause of nosocomial infection in internal medicine departments. In this article, we review some important key points to improve its use and avoid infections. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  6. Research on Nonlinear and Stochastic Dynamics with Defense Applications

    DTIC Science & Technology

    2009-03-30

    can result in attractors that are nonchaotic but are geometrically strange in the sense that they possess no positive Lyapunov exponent but their...systems," Physical Review E 77, 026208(1-5) (2008). • Y.-C. Lai, "Extreme fluctuations of finite-time Lyapunov exponents in chaotic systems," Interna...fractal properties of the system. By defining the Lyapunov exponents and the fractal dimension based on a proper probability measure from the

  7. Maritime Safety Information in the Year 2000: Listen Up, Navy, the Times they are a Changin

    DTIC Science & Technology

    1990-04-02

    System (GMDSS) assures effective distress and safety communications by a number of measures. Basic among these is the requirement by interna- tional...addresses the subject of maritime safety information (MSI). It stresses simplicity and dependability through automation. Radio navigational warnings...Montivideo Republic of Korea Finisterre Punta del Este Canary Islands Salto United States Tarif a Kodiak Cabo La Nao India Adak Madras Cameroon Bombay USSR

  8. Finding Stable Orientations of Assemblies with Linear Programming

    DTIC Science & Technology

    1993-06-01

    AD-A266 990 Finding Stable Orientations of Assemblies with Linear Programming David Baraff Raju Mattikalli Bruno Repetto Pradeep Khosla CMU-RI-TR-93...Mattikalli, Bruno Repetto and Pradeep Khosla 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION REPORT NUMBER The Robotics... Repetto , and D. Baraff. Stability of assemblies. In Interna- tional Conference on Intelligent Robots and Systems, page (to appear). IEEE/RSJ, July 1993

  9. Inventario mundial de la calidad del carbon mineral (WoCQI) [The world coal quality inventory (WoCQI)

    USGS Publications Warehouse

    Finkelman, R.B.; Lovern, V.S.

    2001-01-01

    Los oficiales encargados de la politica comercial de cada pais requieren informacion clara y precisa sobre el recurso del carbon mineral, particularmente sobre sus propiedades y caracteristicas, para tomar decisiones bien fundamentadas con respecto al mejor uso de los recursos naturales, necesidades de importacion y oportunidades de exportacion, objetivos de politica interna y externa, oportunidades de transferencia tecnologica, posibilidades de inversion externa, estudios ambientales y de salud, y asuntos relacionados con el uso de productos secundarios y su disposicion.

  10. Responding to Strategic and Organizational Uncertainty: Developing Army Leaders after Iraq and Afghanistan

    DTIC Science & Technology

    2013-04-01

    new and broader paradigm...change? 6. Will the U.S., as the leading actor on the world stage, be able to reinvent the interna onal system, carving out poten al new roles in an...expanded world order ? • Individual Empowerment • Diffu s i on of P ower • Demography • Growing Nexus Among Energy, Water, and Food B re ad th

  11. Military Engagement and Forward Presence: Down But Not Out as Tools to Shape and Win

    DTIC Science & Technology

    2016-01-01

    and carefully targeted military engagement can be highly effective, cost-efficient methods for safeguarding vital and important U.S. interests...More specifically, Dr. Deni’s work should benefit those seeking a better un- derstanding of how political leaders at both ends of Pennsylvania Avenue...He is also an adjunct lec- turer at the American University’s School of Interna- tional Service. Previously, he worked for 8 years as a political

  12. [Morgagni-Stewart-Morel syndrome. Case report and review of the literature].

    PubMed

    Gracia-Ramos, Abraham Edgar

    2016-01-01

    Introducción: La hiperostosis frontal interna (HFI) es un sobrecrecimiento óseo en la parte interna del hueso frontal. Dicha alteración puede ocurrir de forma aislada o acompañada de síntomas neuropsiquiátricos, manifestaciones metabólicas y endocrinológicas que en conjunto forman el síndrome de Morgagni-Stewart-Morel. A este respecto, se presenta el caso de una paciente que cumple criterios para tal síndrome y se realiza una revisión de la literatura médica con especial atención en su fisiopatología. Caso clínico: Mujer de 74 años con historia de exposición a humo de leña, vitíligo, diabetes mellitus tipo 2, hipertensión arterial sistémica y deterioro cognitivo, quien ingresa al hospital por malestar general, mareo, ansiedad, confusión, desorientación y dificultad para la marcha. Se realizaron estudios de imagen de cráneo donde se observó la presencia de hiperostosis frontal interna extensa, atrofia cortical y un infarto lacunar talámico izquierdo. Durante su estancia hospitalaria se documentó la presencia de obesidad grado I, hiperglucemia, hipertrigliceridemia e hiperuricemia. Conclusiones: La paciente cumplió con los criterios del síndrome de Morgagni-Stewart-Morel al manifestar la presencia de hiperostosis frontal interna con manifestaciones metabólicas, endocrinológicas y neuropsiquiátricas. El origen fisiopatológico del síndrome se desconoce, aunque se ha postulado que un desbalance endocrinológico motivado por factores genéticos y ambientales puede ser la causa.

  13. Marine Mammal Behavioral Response Studies in Southern California: Advances in Technology and Experimental Methods

    DTIC Science & Technology

    2012-08-01

    andNorwegian Navies. The first phase of this project (2006–2009) studied the behavioral effects of naval sonar on killer whales (Orcinus orca), sperm ...any abnormal behav- iors indicating a potential for injury or clear separation of mothers and de- pendent offspring. Following CEEs, post-exposure...fin whales, sperm whales, Risso’s dolphin, and Cuvier’s beaked whale. In: The 4th Interna- tional Science Symposium on Biologging. Hobart, Tasmania

  14. Pleural ultrasound for clinicians.

    PubMed

    Porcel, J M

    2016-11-01

    Pleural ultrasonography is useful for identifying and characterising pleural effusions, solid pleural lesions (nodules, masses, swellings) and pneumothorax. Pleural ultrasonography is also considered the standard care for guiding interventionist procedures on the pleura at the patient's bedside (thoracentesis, drainage tubes, pleural biopsies and pleuroscopy). Hospitals should promote the acquisition of portable ultrasound equipment to increase the patient's safety. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  15. From Cooperation to Competition - The Future of U.S.-Russian Relations

    DTIC Science & Technology

    2015-05-01

    5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) U.S. Army War College,Strategic Studies Institute,47...Ashburn Drive,Carlilse,PA,17013-5010 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR...Reframe – Over the next three months, the team engaged think tanks, Department of Defense entities, academic institutions, and interna- tional

  16. Tests and Evaluation of Upgraded Flat-Plate and Waffle-Slab Floor Systems

    DTIC Science & Technology

    1983-12-01

    slab floor center portion. Therefore, in the case of Crisis Relocation Planning implementation involving the upgrading of floor systems, allowances...L. Huff managed the project. Mr. M. K. McVay planned and supervised the experiments and Mr. S. C. Woodson analyzed the test results and prepared this...Relocation Planning (CRP). CRP would call for the following actions by FEMA during a time of developing interna- tional crisis when a nuclear war is imminent

  17. Great Lakes Simulation Studies. Volume 2. Lake Erie-Lake Ontario Navigation: A Simulation Study of Alternative Subsystems.

    DTIC Science & Technology

    1972-11-01

    improvements Isuper locks 1200’ x 110’ 80’ 40 min. (expected) Eisenhower-Snell 860’ x 80’ 38’-49’ 37 min. (for large vessels) 44 x .4 0 00 0 Q coJ Iq- _00 U0...H., and Blok, S.I.E., (Untitled), XXII Interna- tional Navigation Congress, Paris , 1969, Permanent International Association of Navigation Congresses

  18. European Conference on Organized Thin Films (4th) Held in Bangor on September 10 - 12, 1992

    DTIC Science & Technology

    1992-09-12

    groups and two by methyl ester groups , all formed good quality Y-layers if deposited on cooled substrates. In the case of the acids it was possible to...the examined lipids here is a mixture of different iso and anti-iso fatty acids with a chain length between 14 and 20 methyl groups . A simija...been to improve the interaction between European research groups . Judgingfrom the large number of presentations from groups collaborating across interna

  19. Prism. Volume 3, Number 1

    DTIC Science & Technology

    2011-12-01

    West Africa every year. This is a startling figure when compared with the gross domestic product ( GDP ) of countries within the region. Guinea-Bissau...one of the coun- tries most deeply affected by drug trafficking, has a GDP of just $304 million.1 The UN notes that the problem is so severe that...interna- tional community, through the UNHCR and UNDP, deliberately created camps and invited Rwandan refugees to Zaire and Burundi , where they had

  20. NATO after Iraq: Out of Sector, or Out of Business?

    DTIC Science & Technology

    1991-04-05

    12-19. 28 Il. See, for example, Marco Bentinck, "NArO’s Out-OF-Area Problem’, Adelphi Papers, No. 211, (London: Interna- tional Institute for...Schweitzer Verlag, 1989, pp. 187-189. 27. See, Guenther Gillessen, FrankFurter Allgemeine, (Frankfurt), January 1i, 19I, in FBIS-WEU-9l-O06, January Ii, 1991

  1. Study of the Capability of the United States Textile and Apparel Industries to Support National Defense. Volume 1

    DTIC Science & Technology

    1983-06-01

    which was geophysically and interna- tionally limited, and yet today might yield greater risk for global confrontation and full mobilization. E. Full...converting other producers in an emergency situation. In addition, this approach toward industry involvement would increase the exposure which both NLABS and...developed responses to handle the potential risk of loss of supply. These responses range from backward integration by du Pont into controlling a

  2. Exploring the Effect of Illumination on Automatic Expression Recognition using the ICT-3DRFE Database

    DTIC Science & Technology

    2011-11-04

    expres- sion recognition with illumination-corrected image sequences,” Auto- matic Face and Gesture Recognition , 2008. FG ’08. 8th IEEE Interna...Wu, Movellan, J., Computer Expres- sion Recognition Toolbox, Univ. of California, San Diego, CA, Automatic Face and Gesture Recognition , 2008 [8] Peers...and Gesture Recognition (FG’00), 2000 [17] Lyons, M., Akamatsu, S., Kamachi, M., Gyoba, J. (1998), Coding fa- cial expressions with Gabor wavelets

  3. Improved UT1 Predictions through Low-Latency VLBI Observations

    DTIC Science & Technology

    2010-03-14

    predictions of Earth orientation parameters (EOPs) in general, and of Universal Time (UT1) in particular, depends strongly on the time delay between the...reduced latency of the obser- vations has improved the accuracy of the combined Interna- tional Earth Rotation and Reference Systems Service (IERS... Earth orientation parameters (EOPs) in general, and of Universal Time (UT1) in particular, depends strongly on the time delay between the last

  4. Progesterone Receptor and Prostaglandins Mediate Luteinizing Hormone-Induced Changes in Messenger RNAs for ADAMTS Proteases in Theca Cells of Bovine Periovulatory Follicles

    PubMed Central

    WILLIS, ERIN L.; BRIDGES, PHILLIP J.; FORTUNE, JOANNE E.

    2017-01-01

    SUMMARY Little is known about the ADAMTS (a disintegrin and metalloproteinase with thrombospondin motifs) family of extracellular proteases in ovarian follicles of non-rodent species, particularly in theca cells. In the present study, temporal changes in the abundance of mRNA encoding four ADAMTS subtypes and hormonal regulation of mRNA encoding two subtypes were investigated in theca interna cells during the periovulatory period in cattle. Gonadotropin-releasing hormone (GnRH) was injected into animals to induce a luteinizing hormone (LH)/follicle-stimulating hormone (FSH) surge, and follicles were obtained at 0 hr post-GnRH (preovulatory) or at 6, 12, 18, or 24 hr (periovulatory). ADAMTS1, -2, -7, and -9 transcript abundance was then determined in the isolated theca interna. ADAMTS1 and -9 mRNA levels were up-regulated at 24 hr post-GnRH, whereas ADAMTS2 mRNA was higher at r12–24 hr post-GnRH and ADAMTS7 mRNA increased transiently at 12 hr post-GnRH compared to other time points. Subsequent in vitro experiments using preovulatory theca interna (0 hr post-GnRH) showed that application of LH in vitro can mimic the effects of the gonadotropin surge on mRNAs encoding ADAMTS1 and -9 and that progesterone/progesterone receptor and/or prostaglandins may regulate the levels of mRNA encoding ADAMTS1 and -9 in theca interna, downstream of the LH surge. Time- and subtype-specific changes in ADAMTS mRNA abundance in vivo, and their regulation in vitro by hormones, indicate that ADAMTS family members produced by theca cells may play important roles in follicle rupture and the accompanying tissue remodeling in cattle. PMID:27879029

  5. Cloud-Induced Uncertainty for Visual Navigation

    DTIC Science & Technology

    2014-12-26

    5003. 22. G. Casella and R. Berger, Statistical Inference, 2nd ed. Stamford: Cengage Learning , 2002. 23. G. Terejanu, “Tutorial on Monte Carlo... learning process, a cascade of weak classifiers is trained. If the sub-window fails to pass any of the classifiers at any stage, it is immediately... learning and detection of natural landmarks for autonomous aerial robots,” in IEEE Interna- tional Conference on Robotics & Automation, 2014, pp. 4996

  6. [Diagnostic references in osteo-archeology. The contribution of historical medical data].

    PubMed

    Charon, Pierre

    2011-01-01

    Some examples of anatomo-radio-clinical (or medico-historical) collation, studied in the Dupuytren Museum of Paris, among osteoplastic conditions, including hyperostosis frontalis interna, fibrous dysplasia of bone, osteochondromas, angioma of bone and osteosarcomas, demonstrate how that triad allows to constitute more secure guidelines for the archaeologist who have not clinical data at his disposal. So, they encourage to support the defence and maintenance actions of such anatomico-pathological museums.

  7. A U.N. Treaty We All Can Support

    DTIC Science & Technology

    2003-03-01

    conduct of nations in the oceans environment.’ To the international straits, archipelagic sea lanes, and interna- majority of the community of nations, it...in t7/s. In contraventmon of thre AcnenIon. I Ciarecently has contended that it has the right to restrict the operations of other na- community , Senate...enae Frein RlatonsCom itte ’Richard I. Grimnawalt, "~fire 1982 lnited Nations Convention on tile law of ithethistrety ut f te Snat ForignReltios

  8. [Hypoplasia of internal carotid artery associated with carotid paraganglioma. A case report and review of the literature].

    PubMed

    Ruiz-Mercado, Héctor; Maldonado-Hernández, Héctor; Cruz-González, Juan Antonio

    2014-01-01

    Antecedentes: la hipoplasia de la arteria carótida interna es una rara malformación congénita. Se le ha relacionado principalmente con aneurismas y otros padecimientos, pero no con paraganglioma. Su incidencia es menor de 0.01% de todas las anomalías de los vasos carotídeos. Aunque su origen exacto no se conoce, se cree que es una secuela de una lesión provocada por causas mecánicas o por estrés hemodinámico; sin embargo, también pudieran estar implicados aspectos de biología molecular del desarrollo embrionario. Caso clínico: se describe un caso raro de una mujer de 37 años de edad con paraganglioma concomitante con hipoplasia de la arteria carótida interna. En estudios angiográficos y análisis rutinarios previos no se había detectado alteración de la arteria carótida interna. En la intervención se extirpó el tumor y se ligó la arteria carótida externa dado que estaba involucrada en la lesión; se dejó intacta la arteria carótida interna hipoplásica. Conclusión: es importante realizar estudios angiográficos de la base del cráneo, así como análisis hemodinámicos para no pasar por alto estas anomalías. La evolución fue satisfactoria y sin secuelas.

  9. Case report: ophthalmomyiasis externa in Dallas County, Texas.

    PubMed

    Sigauke, Ellen; Beebe, Walter E; Gander, Rita M; Cavuoti, Dominick; Southern, Paul M

    2003-01-01

    Ophthalmomyiasis externa is an uncommon condition in North America. If not recognized and managed accordingly, it can be complicated by the potentially fatal condition ophthalmomyiasis interna. Ophthalmomyiasis externa is mainly caused by the sheep bot fly Oestrus ovis; thus, it is more common in farming communities. We report a case of ophthalmomyiasis externa in a young woman from Dallas County, Texas, who had no known history of contact with farm animals.

  10. Case-Based Behavior Adaptation Using an Inverse Trust Metric

    DTIC Science & Technology

    2014-06-01

    NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING...wheeled unmanned ground vehicle (UGV) and uses eBotwork’s built-in natural language processing (for interpreting user commands), locomo- tion, and path...Karray, F.; and Morckos, M. 2012. Mod- elling of robot attention demand in human-robot inter- action using finite fuzzy state automata . In Interna

  11. Persistent benign pleural effusion.

    PubMed

    Porcel, J M

    In this narrative review we describe the main aetiologies, clinical characteristics and treatment for patients with benign pleural effusion that characteristically persists over time: chylothorax and cholesterol effusions, nonexpansible lung, rheumatoid pleural effusion, tuberculous empyema, benign asbestos pleural effusion and yellow nail syndrome. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  12. Venous Thromboembolism during Combat Operations: A 10-y Review

    DTIC Science & Technology

    2014-01-01

    Introduction Tissue injury in conjunction with both the inflammatory response and the delayed inhibition of fibrinolysis places the trauma patient at...Classification of Disease , ninth edition, and Abbreviated Injury Scale (AIS) 2005 injury codes. Complications at all facilities were identified using Interna...tional Classification of Disease , ninth edition codes. The domi nant injury mechanism was categorized as explosive device, gunshot wound, motor vehicle

  13. Cyanine dyes as optical contrast agents for ophthalmological surgery.

    PubMed

    Langhals, Heinz; Varja, Ana; Laubichler, Peter; Kernt, Marcus; Eibl, Kirsten; Haritoglou, Christos

    2011-06-09

    Cyanine dyes were prepared as optical contrast media for supporting the surgery of the lamina limitans interna (LLI) of the retina and other structures of the human eye. Their absorption spectra were adapted both to the spectral sensitivity of the human eye and to standard illumination. The contrast could be further amplified by the application of the strong fluorescence of the dyes used. The binding of the dyes to various surfaces was studied. No toxic effects could be detected for the applied dyes.

  14. [Type 2 Diabetes Mellitus, Depression and Eating Disorders in Patients Submitted to Bariatric Surgery].

    PubMed

    Brandão, Isabel; Marques Pinho, Ana; Arrojado, Filipa; Pinto-Bastos, Ana; Maia da Costa, José; Coelho, Rui; Calhau, Conceição; Conceição, Eva

    2016-03-01

    Introdução: A obesidade associa-se a um elevado número de comorbilidades, entre as quais a diabetes mellitus tipo 2 e a patologia psiquiátrica. A cirurgia bariátrica tem demonstrado ser a melhor solução para a perda de peso e a melhoria das complicações nos casos de obesidade mórbida. O objetivo deste estudo é o de analisar a evolução da diabetes mellitus tipo 2 e de variáveis psicopatológicas antes e depois da cirurgia bariátrica e verificar o seu impacto na perda de peso. Material e Métodos: É um estudo longitudinal, que avalia 75 indivíduos antes e depois de serem submetidos a cirurgia bariátrica (47 - banda gástrica; 19 - bypass Roux-en-Y gástrico; 9 - sleeve gástrico), com tempo de follow-up entre 18 e 46 meses. Os instrumentos de avaliação foram a entrevista clínica e os questionários Eating Disorder Examination questionnaire - EDE-Q e Beck Depression Inventory - BDI. Resultados: Verificou-se melhoria relativamente à variável dicotómica diabetes mellitus tipo 2 após a cirurgia (X(1) = 26,132, p < 0,001). Não ocorreu melhoria significativa em termos de patologia psiquiátrica quando a análise foi controlada para o tipo de cirurgia. Encontrámos uma associação significativa entre as variáveis em estudo no pós-cirúrgico e a perda de peso. Este modelo explica 27% da variação do peso após a cirurgia (R2 = 0,265) e é significativo F (3,33) = 2,981, p = 0,038. Discussão: A diabetes mellitus tipo 2, patologia depressiva ou do comportamento alimentar mostraram estar relacionados com a perda de peso. Não ficou esclarecido em que sentido esta relação é estabelecida, nem a relação que estas variáveis metabólicas e psicológicas possam ter entre si ao longo do período pós cirurgia bariátrica. Conclusão: A diabetes mellitus tipo 2 evoluiu favoravelmente após a cirurgia. Diabetes mellitus tipo 2, depressão e patologia alimentar no período pós-cirúrgico associaram-se a menor perda de peso. As variáveis estudadas no

  15. The basal ganglia in Parkinson's disease: current concepts and unexplained observations.

    PubMed

    Obeso, Jose A; Marin, Concepcio; Rodriguez-Oroz, C; Blesa, Javier; Benitez-Temiño, B; Mena-Segovia, Juan; Rodríguez, Manuel; Olanow, C Warren

    2008-12-01

    The pathophysiology of Parkinson's disease is reviewed in light of recent advances in the understanding of the functional organization of the basal ganglia (BG). Current emphasis is placed on the parallel interactions between corticostriatal and corticosubthalamic afferents on the one hand, and internal feedback circuits modulating BG output through the globus pallidus pars interna and substantia nigra pars reticulata on the other. In the normal BG network, the globus pallidus pars externa emerges as a main regulatory station of output activity. In the parkinsonian state, dopamine depletion shifts the BG toward inhibiting cortically generated movements by increasing the gain in the globus pallidus pars externa-subthalamic nucleus-globus pallidus pars interna network and reducing activity in "direct" cortico-putaminal-globus pallidus pars interna projections. Standard pharmacological treatments do not mimic the normal physiology of the dopaminergic system and, therefore, fail to restore a functional balance between corticostriatal afferents in the so-called direct and indirect pathways, leading to the development of motor complications. This review emphasizes the concept that the BG can no longer be understood as a "go-through" station in the control of movement, behavior, and emotions. The growing understanding of the complexity of the normal BG and the changes induced by DA depletion should guide the development of more efficacious therapies for Parkinson's disease.

  16. The bigger, the better? Volume measurements of parasites and hosts: Parasitic barnacles (Cirripedia, Rhizocephala) and their decapod hosts

    PubMed Central

    Hörnig, Marie K.; Haug, Joachim T.; Noever, Christoph; Høeg, Jens T.; Glenner, Henrik

    2017-01-01

    Rhizocephala, a group of parasitic castrators of other crustaceans, shows remarkable morphological adaptations to their lifestyle. The adult female parasite consists of a body that can be differentiated into two distinct regions: a sac-like structure containing the reproductive organs (the externa), and a trophic, root like system situated inside the hosts body (the interna). Parasitism results in the castration of their hosts, achieved by absorbing the entire reproductive energy of the host. Thus, the ratio of the host and parasite sizes is crucial for the understanding of the parasite’s energetic cost. Using advanced imaging methods (micro-CT in conjunction with 3D modeling), we measured the volume of parasitic structures (externa, interna, egg mass, egg number, visceral mass) and the volume of the entire host. Our results show positive correlations between the volume of (1) entire rhizocephalan (externa + interna) and host body, (2) rhizocephalan externa and host body, (3) rhizocephalan visceral mass and rhizocephalan body, (4) egg mass and rhizocephalan externa, (5) rhizocephalan egg mass and their egg number. Comparing the rhizocephalan Sylon hippolytes, a parasite of caridean shrimps, and representatives of Peltogaster, parasites of hermit crabs, we could match their different traits on a reconstructed relationship. With this study we add new and significant information to our global understanding of the evolution of parasitic castrators, of interactions between a parasitic castrator and its host and of different parasitic strategies within parasitic castrators exemplified by rhizocephalans. PMID:28678878

  17. [Validazione del Gambling Disorder Screening Questionnaire, un questionario diagnostico autosomministrato per il gioco d'azzardo patologico basato sui criteri del DSM-5].

    PubMed

    Villella, Corrado; Pascucci, Marco; de Waure, Chiara; Bellomo, Antonello; Conte, Gianluigi

    2016-01-01

    RIASSUNTO. Scopo. Il DSM-5 presenta delle modifiche nei criteri diagnostici per il gioco d'azzardo patologico, rispetto alla precedente edizione del manuale; è pertanto necessario sviluppare nuovi strumenti diagnostici. Questo studio ha valutato le caratteristiche psicometriche del Gambling Disorder Screening Questionnaire (GDSQ), un questionario sviluppato per l'autosomministrazione, basato sui criteri diagnostici del DSM-IV e del DSM-5 per il gioco d'azzardo patologico, misurandone la validità e la consistenza interna e sottoponendo il questionario all'analisi delle componenti principali. Metodi. 71 pazienti reclutati da un ambulatorio dedicato al gioco d'azzardo patologico e 70 controlli sono stati valutati con il GDSQ, con il South Oaks Gambling Screen (SOGS) e con valutazione psichiatrica. Risultati. Il test ha mostrato una buona sensibilità, specificità, consistenza interna, correlazione con il SOGS. L'esclusione del criterio degli atti illeciti e l'abbassamento del punteggio di cut-off a quattro criteri positivi, come suggerito dal DSM-5, migliora la sensibilità e consistenza interna del test. Discussione e conclusioni. Il GDSQ può essere considerato un utile test di screening per il gioco d'azzardo patologico. Inoltre, questo studio conferma il miglioramento nell'accuratezza diagnostica dei criteri elencati nella quinta edizione del Manuale Diagnostico e Statistico dei Disturbi Mentali rispetto alla precedente edizione.

  18. Cranial arterial pattern of the Sri Lankan spotted chevrotain, Moschiola memmina, and comparative basicranial osteology of the Tragulidae

    PubMed Central

    2015-01-01

    The cranial arterial pattern of artiodactyls deviates significantly from the typical mammalian pattern. One of the most striking atypical features is the rete mirabile epidurale: a subdural arterial meshwork that functionally and anatomically replaces the arteria carotis interna. This meshwork facilitates an exceptional ability to cool the brain, and was thought to be present in all artiodactyls. Recent research, however, has found that species of mouse deer (Artiodactyla: Tragulidae) endemic to the Malay Archipelago possess a complete a. carotis interna instead of a rete mirabile epidurale. As tragulids are the sister group to pecoran ruminants, the lack of a rete mirabile epidurale in these species raises intriguing evolutionary questions about the origin and nature of artiodactyl thermoregulatory cranial vasculature. In this study, cranial arterial patterns are documented for the remaining species within the Tragulidae. Radiopaque latex vascular injection, computed tomography (CT-scanning), and digital 3-dimensional anatomical reconstruction are used to image the cranial arteries of a Sri Lankan spotted chevrotain, Moschiola meminna. Sites of hard and soft tissue interaction were identified, and these osteological correlates were then sought in nine skulls representative of the remaining tragulid species. Both hard and soft tissue surveys confirm that the presence of an a. carotis interna is the common condition for tragulids. Moreover, the use of a 3-D, radiographic anatomical imaging technique enabled identification of a carotico-maxillary anastomosis that may have implications for the evolution of the artiodactyl rete mirabile epidurale. PMID:26644983

  19. HOSPITALIZATIONS FOR CHOLECYSTITIS AND CHOLELITHIASIS IN THE STATE OF RIO GRANDE DO SUL, BRAZIL.

    PubMed

    Nunes, Emeline Caldana; Rosa, Roger Dos Santos; Bordin, Ronaldo

    2016-01-01

    The cholelithiasis is disease of surgical resolution with about 60,000 hospitalizations per year in the Sistema Único de Saúde (SUS - Brazilian National Health System) of the Rio Grande do Sul state. To describe the profile of hospitalizations for cholecystitis and cholelithiasis performed by the SUS of Rio Grande do Sul state, 2011-2013. Hospital Information System data from the National Health System through morbidity list for cholelithiasis and cholecystitis (ICD-10 K80-K81). Variables studied were sex, age, number of hospitalizations and approved Hospitalization Authorizations (AIH), total amount and value of hospital services generated, days and average length of stay, mortality, mortality and case fatality ratio, from health regions of the Rio Grande do Sul. During 2011-2013 there were 60,517 hospitalizations for cholecystitis and cholelithiasis, representing 18.86 hospitalizations per 10,000 inhabitants/year, most often in the age group from 60 to 69 years (41.34 admissions per 10,000 inhabitants/year) and female (27.72 hospitalizations per 10,000 inhabitants/year). The fatality rate presented an inverse characteristic: 13.52 deaths per 1,000 admissions/year for males, compared with 7.12 deaths per 1,000 admissions/year in females. The state had an average total amount spent and value of hospital services of R$ 16,244,050.60 and R$ 10,890,461.31, respectively. The health region "Capital/Gravataí Valley" exhibit the highest total expenditure and hospital services, and the largest number of deaths, and average length of stay. The hospitalization and lethality coefficients, the deaths, the length of stay and spending related to admissions increased from 50 years old. Females had a higher frequency and higher values ​​spent on hospitalization, while the male higher coefficient of mortality and mean hospital stay. A colelitíase é doença de resolução cirúrgica com cerca de 60.000 internações por ano no Sistema Único de Saúde no estado do Rio

  20. Effects of hearing aids in the balance, quality of life and fear to fall in elderly people with sensorineural hearing loss.

    PubMed

    Lacerda, Clara Fonseca; Silva, Luciana Oliveira E; de Tavares Canto, Roberto Sérgio; Cheik, Nadia Carla

    2012-04-01

    Introdução: O processo de envelhecimento provoca modificações estruturais e funcionais à saude, comprometendo o controle postural e processamento central. Estudos têm abordado a necessidade de identificar os fatores de risco prejudiciais à saúde auditiva e segurança em idosos acometidos por déficits auditivos e com alterações de equilíbrio.Objetivo: Avaliar o efeito da prótese auditiva na qualidade de vida, no equilíbrio e no medo de queda em idosos com perda auditiva bilateral.Método: Estudo clínico e experimental realizado com 56 idosos com perda auditiva neurossensorial, submetidos ao uso da prótese auditiva de amplificação sonora individual (AASI). Os idosos responderam aos questionários de qualidade de vida Short Form Health Survery (SF-36), Falls Efficacy Scale- Internacional (FES-I) e o teste de Berg Balance Scale (BBS). Após 4 meses, os idosos que adaptaram ao uso da AASI foram reavaliados.Resultados: Houve 50% de adaptação dos idosos ao AASI. Foi observado que o sexo masculino teve maior dificuldade em adaptar ao aparelho auditivo e que as variáveis idade, grau de perda, presença de zumbido e vertigem não interferiram na adaptação à prótese auditiva. Houve melhora da qualidade de vida nos domínios Estado da Saúde Geral (EGS) e Capacidade Funcional (CF) e do zumbido, assim como o aumento da auto-confiança após adaptação da prótese auditiva.Conclusão: O uso de prótese auditiva propiciou a melhora dos domínios da qualidade de vida, o que refletiu em uma melhor auto-confiança e consequentemente a longo prazo na redução do medo de queda em idosos com perda auditiva neurossensorial.

  1. Translation, cultural adaptation and validation of Kidney Disease Loss Scale to the Brazilian context.

    PubMed

    Ottaviani, Ana Carolina; Orlandi, Fabiana de Souza

    2016-01-01

    Losses can be conceptualized as cognitive and affective responses to individual sorrows, characterized by brooding, yearning, disbelief and stunned feelings, being clinically significant in chronic diseases. The aim of the study was to translate, culturally adapt and validate the Kidney Disease Loss Scale into Portuguese. Validation study involving the steps recommended in the literature for healthcare instruments: initial translation, synthesis of translations, back translation, review by a committee of judges and pretest. The scale was translated and adapted to the Portuguese language, being quick and easy to application. The reliability and reproducibility showed satisfactory values. Factor analysis indicated a factor that explains 59.7% of the losses construct. The Kidney Disease Loss Scale was translated, adapted and validated for the Brazilian context, allowing future studies of losses and providing tools for the professionals working in dialysis centers for assistance to people with chronic kidney disease. As perdas podem ser conceituadas como respostas cognitivas e afetivas para tristezas individuais, caracterizadas pelo remoer, anseio, descrença e sentimentos atordoados, sendo clinicamente significativa em doenças crônicas. O objetivo do estudo foi traduzir, adaptar culturalmente e validar o Kidney Disease Loss Scale para a língua portuguesa. Estudo de validação envolveu as etapas preconizadas na literatura internacional para instrumentos da área de saúde: tradução inicial, síntese das traduções, retrotradução, revisão por um comitê de juízes, pré-teste e avaliação das propriedades psicométricas. A escala foi traduzida e adaptada para o idioma português, sendo de fácil e rápida aplicação. A confiabilidade e a reprodutibilidade apresentaram valores satisfatórios. A análise fatorial indicou um fator que explica 59,7% do constructo de perdas. A Escala de Perdas referente à Doença Renal foi traduzida, adaptada e validada para o

  2. Fuzzy model to estimate the number of hospitalizations for asthma and pneumonia under the effects of air pollution.

    PubMed

    Chaves, Luciano Eustáquio; Nascimento, Luiz Fernando Costa; Rizol, Paloma Maria Silva Rocha

    2017-06-22

    Predict the number of hospitalizations for asthma and pneumonia associated with exposure to air pollutants in the city of São José dos Campos, São Paulo State. This is a computational model using fuzzy logic based on Mamdani's inference method. For the fuzzification of the input variables of particulate matter, ozone, sulfur dioxide and apparent temperature, we considered two relevancy functions for each variable with the linguistic approach: good and bad. For the output variable number of hospitalizations for asthma and pneumonia, we considered five relevancy functions: very low, low, medium, high and very high. DATASUS was our source for the number of hospitalizations in the year 2007 and the result provided by the model was correlated with the actual data of hospitalization with lag from zero to two days. The accuracy of the model was estimated by the ROC curve for each pollutant and in those lags. In the year of 2007, 1,710 hospitalizations by pneumonia and asthma were recorded in São José dos Campos, State of São Paulo, with a daily average of 4.9 hospitalizations (SD = 2.9). The model output data showed positive and significant correlation (r = 0.38) with the actual data; the accuracies evaluated for the model were higher for sulfur dioxide in lag 0 and 2 and for particulate matter in lag 1. Fuzzy modeling proved accurate for the pollutant exposure effects and hospitalization for pneumonia and asthma approach. Prever o número de internações por asma e pneumonia associadas à exposição a poluentes do ar no município em São José dos Campos, estado de São Paulo. Trata-se de um modelo computacional que utiliza a lógica fuzzy baseado na técnica de inferência de Mamdani. Para a fuzzificação das variáveis de entrada material particulado, ozônio, dióxido de enxofre e temperatura aparente foram consideradas duas funções de pertinência para cada variável com abordagem linguísticas: bom e ruim. Para a variável de saída número interna

  3. Public-private settlement and hospital mortality per sources of payment.

    PubMed

    Machado, Juliana Pires; Martins, Mônica; Leite, Iuri da Costa

    2016-07-21

    To analyze if the adjusted hospital mortality varies according to source of payment of hospital admissions, legal nature, and financing settlement of hospitals. Cros-ssectional study with information source in administrative databases. Specific hospital admission reasons were selected considering the volume of hospital admissions and the list of quality indicators proposed by the North-American Agency for Healthcare Research and Quality (AHRQ). Were analyzed 852,864 hospital admissions of adults, occurred in 789 hospitals between 2008 and 2010, in Sao Paulo and Rio Grande do Sul, applying multilevel logistic regression. At hospital admission level, showed higher chances of death male patients in more advanced age groups, with comorbidity, who used intensive care unit, and had the Brazilian Unified Health System as source of payment. At the level of hospitals, in those located in the mean of the distribution, the adjusted probability of death in hospital admissions financed by plan or private was 5.0%, against 9.0% when reimbursed by the Brazilian Unified Health System. This probability increased in hospital admissions financed by the Brazilian Unified Health System in hospitals to two standard deviations above the mean, reaching 29.0%. In addition to structural characteristics of the hospitals and the profile of the patients, interventions aimed at improving care should also consider the coverage of the population by health plans, the network shared between beneficiaries of plans and users of the Brazilian Unified Health System, the standard of care to the various sources of payment by hospitals and, most importantly, how these factors influence the clinical performance. Analisar se a mortalidade hospitalar ajustada varia segundo fonte de pagamento das internações, natureza jurídica e arranjo de financiamento dos hospitais. Estudo observacional transversal com fonte de informações em bases de dados administrativos. Motivos de internação específicos foram

  4. One map policy (OMP) implementation strategy to accelerate mapping of regional spatial planing (RTRW) in Indonesia

    NASA Astrophysics Data System (ADS)

    Hasyim, Fuad; Subagio, Habib; Darmawan, Mulyanto

    2016-06-01

    A preparation of spatial planning documents require basic geospatial information and thematic accuracies. Recently these issues become important because spatial planning maps are impartial attachment of the regional act draft on spatial planning (PERDA). The needs of geospatial information in the preparation of spatial planning maps preparation can be divided into two major groups: (i). basic geospatial information (IGD), consist of of Indonesia Topographic maps (RBI), coastal and marine environmental maps (LPI), and geodetic control network and (ii). Thematic Geospatial Information (IGT). Currently, mostly local goverment in Indonesia have not finished their regulation draft on spatial planning due to some constrain including technical aspect. Some constrain in mapping of spatial planning are as follows: the availability of large scale ofbasic geospatial information, the availability of mapping guidelines, and human resources. Ideal conditions to be achieved for spatial planning maps are: (i) the availability of updated geospatial information in accordance with the scale needed for spatial planning maps, (ii) the guideline of mapping for spatial planning to support local government in completion their PERDA, and (iii) capacity building of local goverment human resources to completed spatial planning maps. The OMP strategies formulated to achieve these conditions are: (i) accelerating of IGD at scale of 1:50,000, 1: 25,000 and 1: 5,000, (ii) to accelerate mapping and integration of Thematic Geospatial Information (IGT) through stocktaking availability and mapping guidelines, (iii) the development of mapping guidelines and dissemination of spatial utilization and (iv) training of human resource on mapping technology.

  5. CORRELATION BETWEEN PRE AND POSTOPERATIVE LEVELS OF GLP-1/GLP-2 AND WEIGHT LOSS AFTER ROUX-EN-Y GASTRIC BYPASS: A PROSPECTIVE STUDY.

    PubMed

    Cazzo, Everton; Gestic, Martinho Antonio; Utrini, Murillo Pimentel; Pareja, José Carlos; Chaim, Elinton Adami; Geloneze, Bruno; Barreto, Maria Rita Lazzarini; Magro, Daniéla Oliveira

    2016-01-01

    The role of gut hormones in glucose homeostasis and weight loss achievement and maintenance after bariatric surgery appears to be a key point in the understanding of the beneficial effects observed following these procedures. To determine whether there is a correlation between the pre and postoperative levels of both GLP-1 and GLP-2 and the excess weight loss after Roux-en-Y gastric bypass (RYGB). An exploratory prospective study which enrolled 11 individuals who underwent RYGB and were followed-up for 12 months. GLP-1 and GLP-2 after standard meal tolerance test (MTT) were determined before and after surgery and then correlated with the percentage of excess loss (%EWL). GLP-2 AUC presented a significant postoperative increase (945.3±449.1 vs.1787.9±602.7; p=0.0037); GLP-1 AUC presented a non-significant trend towards increase after RYGB (709.6±320.4 vs. 1026.5±714.3; p=0.3808). Mean %EWL was 66.7±12.2%. There was not any significant correlation between both the pre and postoperative GLP-1 AUCs and GLP-2 AUCs and the %EWL achieved after one year. There was no significant correlation between the pre and postoperative levels of the areas under the GLP-1 and GLP-2 curves with the percentage of weight loss reached after one year. O papel de hormônios gastrointestinais sobre a homeostase glicêmica e a obtenção e manutenção da perda de peso após a cirurgia bariátrica parece ser elemento fundamental na compreensão dos benefícios observados após estes procedimentos. Determinar se há correlação entre os níveis pré e pós-operatórios de GLP-1 e GLP-2 com a perda do excesso de peso após o bypass gástrico em Y-de-Roux. Estudo prospectivo exploratório que envolveu 11 indivíduos submetidos ao bypass gástrico, acompanhados por 12 meses. Os níveis GLP-1 e GLP-2 após um teste de refeição padrão foram determinados antes e 12 meses após a operação e então foram correlacionados com o percentual de perda do excesso de peso. Houve aumento

  6. Effects of Air Pollutant Exposure on Acute Myocardial Infarction, According to Gender.

    PubMed

    Tuan, Tássia Soldi; Venâncio, Taís Siqueira; Nascimento, Luiz Fernando Costa

    2016-09-01

    There is evidence of the effects of air pollution on hospital admissions due to cardiovascular diseases, including myocardial infarction. To estimate the association between exposure to air pollutants and hospital admissions due to myocardial infarction according to gender, between January 1st 2012 and December 31st 2013, in São Jose dos Campos-SP. An ecological time series study was carried out with daily data of admissions due to AMI, pollutants CO, O3, PM10, SO2, and NO2, according to gender. We used the Poisson regression generalized linear model to estimate the relative risks of hospital admissions with lags of 0-5 days, adjusted for temperature, humidity, seasonality and days of the week. There were 1837 admissions for ischemic heart diseases, with 636 women and 1201 men. For females, the risks were significant for CO in lag 0 (RR = 1,09), lag1 (RR = 1,08) and lag 5 (RR = 1,10) and SO2 in lag 0 (RR = 1,10) and 3 (RR = 1,09). For men there was significance of the CO in, lag 3 and lag 5 (RR = 1,05). There was significance, regardless of gender, for CO at lag 1 (RR = 1,05) and lag 5 (RR = 1,07) and lag 0 for SO2 (RR = 1,06). The data presented show the important role of CO and SO2 in the genesis of myocardial infarction admissions, and responses to pollutant exposure are different if analyzed by gender and together - hence the importance of a stratified analyses. Existem evidências sobre os efeitos da poluição do ar nas internações por doenças cardiovasculares, entre elas o infarto do miocárdio. Estimar a associação entre exposição a poluentes do ar e internações por infarto segundo gêneros, entre 01 de Janeiro de 2012 e 31 de Dezembro de 2013, em São José dos Campos - SP. Estudo ecológico de série temporal com dados diários de internações por IAM dos poluentes CO, O3, PM10, SO2, NO2, segundo gêneros. Utilizou-se modelo linear generalizado da Regressão de Poisson para estimar os riscos relativos para internações com defasagens de 0 a 5

  7. Natural Gas as an Instrument of Russian State Power (Letort Paper)

    DTIC Science & Technology

    2011-10-01

    to affect a policy change by the target,”9 and will complement that definition with that of Ivan Eland, who sees the purpose of sanctions “to have...Chan and Drury, p. 2. 10. Ivan Eland, “Economic Sanctions as Tools of Foreign Poli- cy,” in Lopez and Cortright, p. 37. 11. Edward D. Mansfield...Larrabee, p. 47. 41. Nikolai Pavlov , “Twenty Years of German Unity,” Interna- tional Affairs, Vol. 57, No. 1, 2011, p. 84. 42. Matthew Clements, ed., Country

  8. Canine deafness.

    PubMed

    Strain, George M

    2012-11-01

    Conductive deafness, caused by outer or middle ear obstruction, may be corrected, whereas sensorineural deafness cannot. Most deafness in dogs is congenital sensorineural hereditary deafness, associated with the genes for white pigment: piebald or merle. The genetic cause has not yet been identified. Dogs with blue eyes have a greater likelihood of hereditary deafness than brown-eyed dogs. Other common forms of sensorineural deafness include presbycusis, ototoxicity, noise-induced hearing loss, otitis interna, and anesthesia. Definitive diagnosis of deafness requires brainstem auditory evoked response testing.

  9. Regime and Periphery in Northern Yemen: The Huthi Phenomenon

    DTIC Science & Technology

    2010-01-01

    guidelines of the Interna- tional Journal of Middle East Studies, though we omit macrons for long vowels . The letter ‘ayin ( ع ) is represented by “ ‘ ” and...noted that, in Yemen, the short vowels in names of places and people are often pronounced in locally specific ways or vary according to local...encounter these terms in the Modern Standard Arabic (MSA) of Arabic books and media, we assimilated the short vowel pronunciations to the voweling suggested

  10. Conceptos Basicos Sobre el Gas Natural

    SciTech Connect

    2016-08-01

    El gas natural abastece cerca de 150.000 vehiculos en los Estados Unidos y aproximadamente 22 millones de vehiculos en todo el mundo. Los vehiculos de gas natural (NGV, por sus siglas en ingles) son una buena opcion para las flotas de vehiculos de alto kilometraje, tales como autobuses, taxis, vehiculos de recoleccion de basura, los cuales son alimentados centralmente u operan dentro de un area limitada o a lo largo de una ruta con estaciones de servicio de gas natural. Las ventajas del gas natural como combustible alternativo incluyen su disponibilidad interna, la red de distribucion establecida, un costo relativamente bajo, y los beneficios de las emisiones.

  11. The case against performing pleural biopsies for the aetiological diagnosis of exudates.

    PubMed

    Porcel, J M

    2017-04-19

    In most cases, the etiological diagnosis of pleural exudates does not require a pleural biopsy. However, when it is considered necessary, the biopsy should seldom be conducted using invasive methods such as thoracoscopy. Two paradigmatic examples are pleural tuberculosis and malignant effusions. In many centres, pleural fluid adenosine deaminase measurement has replaced closed pleural biopsies in the diagnosis of tuberculosis. Similarly, pathological and molecular studies on pleural fluid cell blocks or alternatively, image-guided pleural biopsies have drastically reduced the need for thoracoscopy. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  12. Micro-mechanics of fiber reinforced bounded and unbounded solids: effective local and non-local thermo-elastic properties, stress concentration factors, and edge effect

    DTIC Science & Technology

    2005-07-01

    in finite elasticity and applications to black- filled elastomers // Ibid.-2000.-48.-pp. 1389-1411. 4. Guz A.N. Two-level model of meso-mechanics... polyamide . J. Polym. Sci. Part. B: Polyme. Phys. 40, 272—283. Meisner, M.J. and Kouris, D.A., 1995. Interaction of two elliptic inclusions. Interna...of Young’s modulus of layered silicate- elastomer nanocomposites. Polym Composite, 19, 608–617. Stevenson, A.C., 1942. On the equilibrium of plates

  13. Renal function assessment in heart failure.

    PubMed

    Pérez Calvo, J I; Josa Laorden, C; Giménez López, I

    Renal function is one of the most consistent prognostic determinants in heart failure. The prognostic information it provides is independent of the ejection fraction and functional status. This article reviews the various renal function assessment measures, with special emphasis on the fact that the patient's clinical situation and response to the heart failure treatment should be considered for the correct interpretation of the results. Finally, we review the literature on the performance of tubular damage biomarkers. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  14. [Chronic subdural hematoma: historical studies].

    PubMed

    Guénot, M

    2001-11-01

    The first description of a chronic subdural hematoma was made in 1658 by J.J. Wepfer, followed in 1761 by Morgagni. A possible case was described by Honoré de Balzac in 1840 including its traumatic origin and surgical treatment. Virchow, in 1857, denied a traumatic origin, and gave the name of "pachymeningitis hemorrhagica interna" to this pathology which he explained by inflammatory processes. The traumatic etiology of chronic subdural hematoma was recognized in the XXth century, especially by Trotter in 1914. Pathophysiology was considered later on in the XXth century.

  15. [Validation of an instrument to measure food practices in Chilean families of school children aged 4-7 years].

    PubMed

    Lera, Lydia; Salinas, Judith; Fretes, Gabriela; Vio, Fernando

    2013-11-01

    Introducción: Para enfrentar el problema de la obesidad infantil, es necesario evaluar prácticas alimentarias en familias de escolares. Objetivo: Elaborar y validar un instrumento para medir actitudes, conocimientos y hábitos alimentarios en familias chilenas de escolares de prebásica y básica basado en las guías alimentarias. Métodos: Se realizó un estudio piloto en 30 padres de escolares de prebásica y básica. Se diseñó un cuestionario por los investigadores del estudio considerando la opinión de un grupo de expertos, para medir actitudes, conocimientos hábitos alimentarios en los padres de los escolares. Para la validación del cuestionario, se aplicó en 2 ocasiones, con 15 días de intervalo y se evaluó estabilidad temporal, consistencia interna y concordancia inter-observadores. Posteriormente se aplicó a una muestra de 59 padres y se calculó la consistencia interna del instrumento. Resultados: El cuestionario quedó conformado por 55 preguntas, agrupadas en 4 secciones. Se encontró una buena concordancia inter-observadores para casi todas las preguntas de la sección conocimientos en alimentación y hábitos alimentarios (0,5-1,0). La correlación entre la primera aplicación y la segunda (test-retest) fue elevada (0,6-1,0), así como la consistencia interna (0,75). En la sección frecuencia de consumo del padre y en la de alimentación del niño en el hogar y colegio, la consistencia interna para los dos observadores fue elevada (0,85-0,87; 0,92-0,90; respectivamente). Conclusiones: El instrumento es útil y válido para ser aplicado en familias de escolares de prebásica y básica intervenidas con educación nutricional y esta metodología puede ser replicada en estudios similares.

  16. Designing a Practical System for Spectral Imaging of Skylight

    DTIC Science & Technology

    2005-09-20

    Commission Interna- tionale de l’Éclairage), include CIELUV , CIELAB , CIE94, and CIEDE2000.21,22 These metrics quantify distances in their respective...thresholds for RMSE and CIEDE2000 metrics when searching for optimum sensors; Hernández-Andrés et al.1 used GFC, CIELUV , and IIE(%) in a similar way. As...once. We use GFC as a spectral metric, CIELAB as a col- orimetric cost function (denoted by E*ab, the dis- tance between two colors in the CIE’s uniform

  17. The pathophysiology of Fabry disease.

    PubMed

    Olivera-González, S; Josa-Laorden, C; Torralba-Cabeza, M A

    2017-08-23

    Fabry disease is a lysosomal condition with systemic clinical expression, caused by the tissue deposit of globotriaosylceramide, due to a deficit in its degradation. As with most lysosomal diseases, the presence of a mutation in a gene does not explain the pathophysiological disorders shown by patients. We conducted a comprehensive review of the pathogenic mechanisms that occur in Fabry disease. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  18. Randomized trial of deep brain stimulation for Parkinson disease: thirty-six-month outcomes; turning tables: should GPi become the preferred DBS target for Parkinson disease?

    PubMed

    Montgomery, Erwin B

    2013-01-08

    Weaver et al. and Tagliati mistakenly infer clinical equivalence between globus pallidus interna vs subthalamic nucleus deep brain stimulation based on failure to demonstrate statistically significant differences. A clinically meaningful-not statistically significant-difference in outcome should be decided a priori, after which the sample size necessary to have a reasonable probability of detecting the difference could be determined. (4) Fortunately, the study by Weaver et al. had sufficient sample size to demonstrate a 1-point difference in motor outcomes. However, such comparisons presume optimal management so as not to produce a "ceiling effect" that would obscure differences.

  19. [Urinary tract infections in a cohort of kidney transplant recipients].

    PubMed

    Bispo, Ana; Fernandes, Milene; Toscano, Cristina; Marques, Teresa; Machado, Domingos; Weigert, André

    2014-01-01

    Introdução: A infeção do trato urinário é a complicação infeciosa mais comum no período pós transplante renal, estando a sua frequência pouco caracterizada na população portuguesa. Este trabalho teve como objetivo determinar a incidência de infeções do trato urinário e infeções do trato urinário recorrentes em transplantados renais. Material e Métodos: Tratou-se de um estudo observacional de coorte retrospetiva, com consulta dos processos clínicos de doentes transplantados entre Janeiro de 2004 e Dezembro de 2005, no Hospital de Santa Cruz, com seguimento durante cinco anos ou até à data de perda de enxerto, morte ou perda de follow-up. Após uma análise descritiva da população, utilizámos testes bivariados para identificação de fatores associados a infeções do trato urinário. Resultados: Em 127 doentes incluídos com seguimento de 593 doentes/ ano, 53 (41,7%) tiveram pelo menos um episódio de infeção do trato urinário e 21 (16,5%) tiveram infeções do trato urinário recorrentes. O género feminino foi o único fator associado com ocorrência de infeções do trato urinário (p < 0,001, OR = 7,08, RR = 2,95) e infeções do trato urinário recorrentes (p < 0,001, OR = 4,66, RR = 2,83). Os agentes etiológicos mais frequentes foram Escherichia coli (51,6%), Klebsiella pneumoniae (15,5%) e Enterobacter spp (9,9%). As infeções do trato urinário não causaram aumento de mortalidade ou perda de enxerto, mas foram a principal causa de internamentos hospitalares. Discussão: Na nossa população, apenas o género feminino foi identificado como fator de risco para o desenvolvimento de infeções do trato urinário, recorrentes ou não. Escherichia coli foi o agente etiológico mais frequente. Conclusão: Apesar das medidas preventivas adotadas, as infeções do trato urinário continuam a ser uma importante causa de morbilidade e de internamentos hospitalares.

  20. Audition and exhibition to toluene - a contribution for the theme.

    PubMed

    Augusto, Lívia Sanches Calvi; Kulay, Luiz Alexandre; Franco, Eloisa Sartori

    2012-04-01

    Introdução: Com os avanços tecnológicos e as mudanças nos processos produtivos, os trabalhadores estão expostos a diferentes agentes físicos e químicos em seu ambiente laboral. O tolueno é um solvente orgânico presente em colas, tintas, óleos, dentre outros.Objetivo: Comparar os achados literários que evidenciam que trabalhadores expostos simultaneamente a ruído e solventes têm maior probabilidade de desenvolverem uma perda auditiva de origem periférica.Método: Revisão de literatura a respeito da perda auditiva ocupacional em trabalhadores expostos a ruído e tolueno.Resultados: A exposição isolada ao tolueno também pode desencadear uma alteração dos limiares auditivos. Estes achados audiométricos, por ototoxicidade a exposição ao tolueno, apresentam audiogramas semelhantes ao por exposição ao ruído, o que torna dificultoso diferenciar um resultado audiométrico de exposição combinada - ruído e tolueno - e exposição apenas ao ruído.Conclusão: A maioria dos estudos foi projetado para gerar hipóteses e deveria ser considerado como passos preliminares de uma pesquisa adicional. Até hoje os agentes no ambiente de trabalho e seus efeitos têm sido estudados de maneira isolada e os limites de tolerância destes, não consideram as exposições combinadas. Considerando que os trabalhadores estão expostos a múltiplos agentes e que a perda auditiva é irreversível, os testes implementados devem ser mais completos e todos os trabalhadores devem fazer parte do programa de prevenção auditiva, mesmo expostos a baixas doses do limite de exposição recomendado.

  1. Uma grade de perfis teóricos para estrelas massivas em transição

    NASA Astrophysics Data System (ADS)

    Nascimento, C. M. P.; Machado, M. A.

    2003-08-01

    Na XXVIII Reunião Anual da Sociedade Astronômica Brasileira (2002) apresentamos uma grade de perfis calculados de acordo com os pontos da trajetória evolutiva de metalicidade solar, Z = 0.02 e taxa de perda de massa () padrão, para estrelas com massa inicial de 25, 40, 60, 85 e 120 massas solares. Estes perfis foram calculados com o auxílio de um código numérico adequado para descrever os ventos de objetos massivos, supondo simetria esférica, estacionaridade e homogeneidade. No presente trabalho, apresentamos a complementação da grade com os perfis teóricos relativos às trajetórias de Z = 0.02 com taxa de perda de massa dobrada em relação a padrão (2´), e de metalicidade Z = 0.008. Para cada ponto das três trajetórias obtemos os perfis teóricos de Ha, Hb, Hg e Hd, e como esperado eles se apresentam em pura emissão, pura absorção ou em P-Cygni. Para valores de taxa de perda de massa muito baixos (~10-7) não há formação de linhas, o que é visto nos primeiros pontos em todas as trajetórias. Em geral, para um mesmo ponto a componente de emissão diminui e a absorção aumenta de Ha para Hd. É verificado que as trajetórias com Z = 0.02 e padrão possuem menos circuitos (loops) do que as com metalicidade Z = 0.02 e 2´ padrão, e seus perfis são, em geral, menos intensos. Em relação a trajetória de Z = 0.008, verifica-se menos circuitos e maior variação em luminosidade, e seus perfis mostram-se em, algumas trajetórias, mais intensos. Verificamos também que, pontos distintos em uma mesma trajetória, apresentam perfis diferentes para valores similares de luminosidade e temperatura efetiva. Sendo assim, uma grade de perfis teóricos parece ser útil para fornecer uma informação preliminar sobre o estágio evolutivo de uma estrela massiva.

  2. M S MOLECULARES Rumo aos limites da miniaturiza o - (Molecular Magnets - towards the limits of miniaturization)

    SciTech Connect

    Reis, Mario S; Moreira Dos Santos, Antonio F

    2010-01-01

    Por s culos, acreditou-se que o magnetismo s se manifestava em metais, como aqueles contendo ferro; hoje, a imagem mais comum de um m talvez seja a daquelas plaquinhas flex veis coladas geladeira com propagandas dos mais diversos tipos. O leitor conseguiria imaginar um material puramente org nico daqueles que formam os seres vivos como magn tico? E m s do tamanho de mol culas? fato: ambos existem. Esses novos materiais, conhecidos como magnetos moleculares, descobertos e desenvolvidos em v rios laborat rios do mundo, j re nem longa lista de aplica es, do tratamento do c ncer a refrigeradores ecol gicos, passando pela transmiss o de eletricidade sem perda de calor e a fabrica o de computadores extremamente velozes.

  3. Nutcracker syndrome in a child with familial Mediterranean fever (FMF) disease: renal ultrastructural features.

    PubMed

    Ozcan, Ayhan; Gonul, Ipek Isik; Sakallioglu, Onur; Oztas, Emin

    2009-12-01

    Renal nutcracker syndrome is an uncommon clinical condition caused by compression of the left renal vein. It is usually accompanied by hematuria and/or orthostatic proteinuria. To date, the pathogenic mechanism of proteinuria and its ultrastructural features have not been clearly identified. Here, we present the glomerular ultrastructural features of nutcracker syndrome and our attempt to analyze the relationship between proteinuria and ultrastructural features. Two months prior to admission, a 11-year-old girl with familial Mediterranean fever who was treated with colchicine was found to have proteinuria. Accompanying hematuria was not identified, and laboratory findings were otherwise normal. Doppler ultrasonography and computerized tomography angiography revealed an entrapment of the left renal vein. A kidney biopsy was performed due to the persistent proteinuria. Light microscopy revealed segmental, minimal increases in the mesangial cells and matrix. No amyloid deposition was present. Neither immunofluorescence nor electron microscopy showed immunoglobulin deposition. Increased thickness of the glomerular basement membrane due to the unequivocal radiolucent widening of the lamina rara interna was the most striking ultrastructural finding. At high magnification, there were no amyloidal fibrils. It has been proposed that hemodynamic alterations and structural changes in glomerular basement membrane glycosaminoglycans may play a role in the pathogenesis of proteinuria. Radiolucent expansion of the lamina rara interna of the glomerular basement membrane in the presenting case would seem to support these data.

  4. [Inhibin, activin, follistatin, and transforming growth factor beta (TGF-beta): presence in the ovary and possible role in the regulation of folliculogenesis in primates].

    PubMed

    Gougeon, A

    1994-09-01

    The aim of this review is to provide recent data concerning the ovarian production of the inhibin-related peptides and their possible role in the regulation of ovarian folliculogenesis in primates. Activin is mainly produced by recruitable follicles, whereas inhibin, FSP and TGF-beta are mainly produced by preovulatory follicles. Activin could play a key role in the selection of the follicle destined to ovulate by enhancing the responsiveness of granulosa cells to FSH. Activin inhibits production of aromatizable androgens by theca interna cells but, by stimulating the FSH-induced aromatase at the level of granulosa cells, it prepares the early selected follicle to play its further endocrine function. The full endocrine function of the preovulatory follicle is triggered, among others, by inhibin which strongly stimulates the production of aromatizable androgens by theca interna cells, by TGF-beta which may favour cytodifferentiation of granulosa cells, and by FSP which, by binding activin, suppresses the negative actions of activin on preovulatory maturation.

  5. [Spanish version of Adonis Complex Questionnaire. A questionnaire to test the muscle dimorphism and vigorexy].

    PubMed

    Latorre-Román, Pedro Ángel; Garrido-Ruiz, Antonio; García-Pinillos, Felipe

    2014-11-08

    Objetivo: Validar la versión española del cuestionario del complejo de Adonis en deportistas de musculación. Método: La muestra está compuesta por 99 deportistas de musculación que entrenan regularmente (Edad: 25.45±5.19 años; IMC=24.53±1.89 kg/m2). Los instrumentos utilizados para valorar la validez discriminante y convergente son la escala revisada de dependencia del ejercicio (Exercise Dependence Scale-Revised, EDS-R) y la escala de autoinformes de actitudes y síntomas de los trastornos alimenticios (Eating Attitudes Test, EAT-26). Las propiedades psicométricas de la escala se obtuvieron mediante un proceso de validez convergente, análisis factorial de los componentes principales, consistencia interna y fiabilidad test-retest. Resultados: La consistencia interna del instrumento muestra un alfa de Cronbach de 0.880 en la escala total. El coeficiente de correlación intraclase (CCI) para valorar la consistencia temporal del instrumento fue de CCI= 0.707, (95% intervalo de confianza=0.336-0.871). El instrumento muestra validez convergente con la escala EDS-R (r=0.613, p.

  6. TOTAL COST OF HOSPITALIZATION OF PATIENTS UNDERGOING ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY RELATED TO NUTRITIONAL STATUS.

    PubMed

    Menezes, Francisco Julimar Correia de; Menezes, Lara Gadelha Luna de; Silva, Guilherme Pinheiro Ferreira da; Melo-Filho, Antônio Aldo; Melo, Daniel Hardy; Silva, Carlos Antonio Bruno da

    2016-01-01

    internação de colecistectomias videolaparoscópicas. Coleta de dados dos prontuários sobre: avaliação de risco nutricional, estado nutricional e custo de internação de pacientes submetidos à colecistectomia videolaparoscópica eletiva no período de janeiro de 2012 a dezembro de 2014. Foram analisados 814 procedimentos. A idade média foi de 39,15 (±12,16) anos; 47 (78,3%) eram mulheres. O custo de internação foi, em média, de R$ 6.167,32 (±1.830,85) para 4,06 (±2,76) dias de internação. Quarenta e um (68,4%) pacientes apresentavam algum grau de sobrepeso; o IMC médio foi 28,07 (±5,41) kg/m²; seis (10%) indivíduos apresentavam risco nutricional ≥3. Houve correlação fraca (r=0,2) e não significativa (p<0,08) entre o custo de hospitalização e o tempo de permanência. No entanto, em indivíduos com IMC normal, a correlação foi forte (r=0,57) e significante (p<0,01). Sobrepeso não demonstrou correlação entre custo e tempo de internação. Entretanto, os indivíduos com sobrepeso apresentaram custo maior de internação em relação aos que não tiveram intercorrência, mas sem correlação com o estado nutricional. Em relação aos com IMC normal, houve correlação forte e estatisticamente significante com o custo para tempo de internação, reforçando que há provável distribuição normal envolvendo estado nutricional adequado e sucesso do procedimento cirúrgico com consequente impacto no custo de internação.

  7. Immunocytochemical localization of nonluteal ovarian relaxin.

    PubMed

    Blankenship, T; Stewart, D R; Benirschke, K; King, B; Lasley, B L

    1994-04-01

    Relaxin has been demonstrated to be produced by the corpus luteum of the menstrual cycle and pregnancy and is also produced by the endometrium and decidua, although these nonluteal sources may not contribute to circulating relaxin concentrations. The reports of luteal production of relaxin have failed to consider nonluteal ovarian sources. To look for sources of nonluteal ovarian relaxin, human ovaries were collected from patients who underwent removal of the ovary for a variety of reasons. Tissues were fixed in formalin and embedded in paraffin. Two monoclonal antibodies were used for immunocytochemical staining, one directed against human relaxin and the other against the C peptide of prorelaxin. In addition to the expected staining of corpora lutea, the luteinized theca interna but not granulosa of developing follicles from ovaries with an active corpus luteum of the cycle also stained positive for both relaxin and prorelaxin. Ovaries from term pregnant women with luteinized theca also demonstrated staining for relaxin and prorelaxin. In addition to luteal and thecal cell staining, small clusters of pseudodecidual cells in the periphery of the ovary stained positive for relaxin and prorelaxin. These data indicate that the ovary contains theca interna-derived structural elements in addition to the corpus luteum that produce relaxin when a corpus luteum is active, while granulosa-derived elements do not. This suggests that luteal production of relaxin is from theca-derived elements and may explain instances of independent relaxin and progesterone secretion.

  8. Horner's syndrome in dogs and cats: 100 cases (1975-1985).

    PubMed

    Kern, T J; Aromando, M C; Erb, H N

    1989-08-01

    The medical records of 74 dogs and 26 cats with Horner's syndrome (HS) that were admitted to the New York State College of Veterinary Medicine between January 1975 and October 1985 were reviewed. In dogs, but not cats, HS was associated significantly (P less than 0.01) with increasing age. Dogs with hypothyroidism (defined liberally but not rigorously), intracranial neoplasia, or thoracic neoplasia, cats with otitis media/interna (defined liberally), and dogs and cats with brachial plexus root avulsion were at greater risk for developing HS than were animals that were hit by a car. Dogs and cats with otitis externa were at less risk of developing HS than were animals that were hit by a car. The cause of HS could not be determined in 50% of dogs and 42.3% of cats. The results of topical adrenergic drug testing in dogs were inconclusive in localizing lesion site. In dogs and cats, HS appeared to be unassociated with gender, breed, or right vs left side. The important causes of HS in dogs and cats were trauma (hit by car), brachial plexus root avulsion, intracranial and thoracic neoplasia, and otitis media/interna.

  9. A Dynamical Study of the Formation of Peculiar Galaxies

    NASA Astrophysics Data System (ADS)

    Chatterjee, T. K.

    1990-11-01

    RESUMEN. Un estudlo de la formaci6n de diferentes tipos de galaxias peculiares (interactuantes) es conducido en base de la dina'mioa de la colisi6n lievando a su formaci6n usando la aproximaci6n impulsiva. Los resultados indican la existencia de una relaci6n caracteristica en base del camblo de la energia interna durante la colisi6n, cual determina el tipo de la galaxia peculiar formado. La relacion es analisada y valores criticos del camblo de Ia energia interna, ilevando a la interacci6n entre galaxias de varias intensidades y la formaci6n consecuente de varios tipos de sistemas peculiares es discutido. ABSTRACT. A study of the formation of different types of peculiar (interacting) galaxies is conducted based on the dynamics of the collision leading to their formation, using the impulsive approximation. Results indicate the existance of a characteristic relationship, based on the internal energy changes during the collision, governing the type of peculiar galaxy formed. The relationship is analysed and critical values of internal energy changes, leading to galaxy interaction of varying intensities and consequent formation of different types of peculiar galaxies is discussed. Key words: GALAXIES-DYNAMICS -- GALAXIES-FORMATION

  10. Privatisation, Decentralisation and Education in the United Kingdom: The Role of the State

    NASA Astrophysics Data System (ADS)

    Turner, David

    2004-07-01

    Since the early 1950s, the axis `centralisation-decentralisation', especially as thematised in the work of Isaac Kandel, has represented a major focus of comparative studies in education. Kandel argued that issues relating to the internal conduct of the classroom (interna) should, so far as possible, be decentralised, while issues relating to administration, school structure and organisation of the educational system (externa) might safely be centralised. After 1988, successive governments in the United Kingdom have undertaken reforms which have placed more central control on the curriculum and even methods of teaching (interna), while school finance and administration (externa) have been devolved to the school level. The present essay argues that a simplistic approach to centralisation and decentralisation is not likely to be fruitful. Instead, we should acknowledge the role of the State in creating a `permissive framework' for educational systems. Local action can then be seen as part of a policy accommodating or resisting the implications of that framework.

  11. [Part of the vertebral artery in patients with sudden deafness].

    PubMed

    Song, Yisa; Lv, Fengquan; Cai, Huixiau; Wu, Hao

    2013-08-01

    To explore the characteristics of vertebral artery system in the patients with sudden deafness by using digital subtraction angiography (DSA). Thirty-four cases of sudden deafness with vertebrobasilar artery ischemia confirmed by the color doppler ultrasound were undergone DSA in both side. The characteristics of vertebral artery, basal artery and before-cerebellum artery were analysis before specific therapy. There is no related complication were occurred among 34 cases. Side vertebral artery was blocked in 2 cases, atherosclerosis was found in 5 cases. The right cerebellar artery anterior and the left cerebellar artery posterior were found filling defect or minor change in 29.4% (10/34) and 35.3% (12/34) of the patients, respectively. The right and the left arteria auditiva interna were found filling defect or minor change in 64.7% (22/34) and 73.5% (25/34) of the patients, respectively. After specific therapy, 8 cases were cured, the hearing of 9 cases were markedly improved, the hearing of 12 cases were improved efficient and 5 patients have no hearing improvement, the total effective rate was 85.3%. The arteria auditiva interna and inferior anterior arteria cerebelli caused inner ear ischemia were found in the patients with sudden deafness. The using of vasodilator may have satisfactory and positive curative effect in the therapy of sudden deafness.

  12. [Chronic subdural haematomas. The internal architecture of the haematoma as a predictor of recurrence].

    PubMed

    García-Pallero, M Ángeles; Pulido-Rivas, Paloma; Pascual-Garvi, José M; Sola, Rafael G

    2014-10-01

    Introduccion. La arquitectura interna del hematoma subdural cronico (HSDC) es un factor muy importante que se debe tener en cuenta como predictor de recidiva. Objetivo. Analizar los factores posiblemente asociados a la recidiva de los HSDC, prestando especial atencion a dicha arquitectura. Pacientes y metodos. Hemos revisado 147 pacientes tratados desde 2010 hasta 2013. Dividimos los HSDC en cuatro tipos de acuerdo con la clasificacion de Nakaguchi de 2001. Ademas, hemos recogido diferentes caracteristicas clinicas y las hemos sometido a analisis estadistico para evaluar su posible asociacion con la tasa de recidiva de los HSDC. Resultados. La tasa de recidiva fue del 14,75% y la de mortalidad, del 4,76%. El tratamiento con anticoagulantes, el tipo de hematoma y el no usar drenaje subdural fueron factores de riesgo estadisticamente significativos para la recurrencia del HSDC. Segun la arquitectura interna, la tasa de recidiva fue del 36,36% para el tipo separado, del 15,90% para el laminar, del 8,82% para el homogeneo y del 0% para el trabecular. Dicha tasa fue significativamente mayor en el tipo separado respecto al homogeneo y trabecular. Conclusiones. El tratamiento con anticoagulantes y el no usar drenaje subdural son factores de riesgo de recurrencia de HSDC. Ademas, la division de los HSDC de acuerdo con la clasificacion de Nakaguchi puede ser util para predecir el riesgo de recurrencia, ya que la tasa de recidiva del tipo separado fue significativamente mayor que la del resto de tipos.

  13. An imbalance between apoptosis and proliferation contributes to follicular persistence in polycystic ovaries in rats

    PubMed Central

    Salvetti, Natalia R; Panzani, Carolina G; Gimeno, Eduardo J; Neme, Leandro G; Alfaro, Natalia S; Ortega, Hugo H

    2009-01-01

    Background Cystic ovarian disease is an important cause of infertility that affects bovine, ovine, caprine and porcine species and even human beings. Alterations in the ovarian micro-environment of females with follicular cysts could alter the normal processes of proliferation and programmed cell death in ovarian cells. Thus, our objective was to evaluate apoptosis and proliferation in ovarian cystic follicles in rats in order to investigate the cause of cystic follicle formation and persistence. Methods We compared the number of in situ apoptotic cells by TUNEL assay, expression of active caspase-3 and members of Bcl-2 family by immunohistochemistry; and cell proliferation by the expression of the proliferation markers: PCNA and Ki-67. Results The proliferation index was low in granulosa of tertiary and cystic follicles of light exposed rats when compared with tertiary follicles of control animals, while in theca interna only cystic follicles presented low proliferation index when compared with tertiary follicles (p < 0.05). The granulosa of cysts exhibited a similar cell DNA fragmentation to early atretic follicles. In the granulosa and theca interna, active caspase-3 shown similar immunostaining levels in tertiary and cystic follicles (p < 0.05). The granulosa cells presented high expression of Bcl-2, Bcl-xL and Bcl-w in the tertiary and cystic follicles with diminishing intensity in the atretic follicles, except with Bcl-w where the intensity was maintained in the atretic follicles (p < 0.05). The expression of Bax was weak in the healthy and cystic follicles. In the theca interna, Bcl-2 expression was the same as the pattern found in the granulosa; no differences were found between tertiary and cystic follicles from both groups for Bcl-xL and Bcl-w. The expression of Bax in this layer was higher in the tertiary follicles of the treated animals (p < 0.05) while the values for cystic follicles were similar to those in the tertiary follicles of controls. The

  14. Cross-cultural adaptation of the EMIC Stigma Scale for people with leprosy in Brazil.

    PubMed

    Morgado, Fabiane Frota da Rocha; Silveira, Erika Maria Kopp Xavier da; Sales, Anna Maria; Nascimento, Lilian Pinheiro Rodrigues do; Sarno, Euzenir Nunes; Nery, José Augusto da Costa; Oliveira, Aldair J; Illarramendi, Ximena

    2017-09-04

    Describe the process of cross-cultural adaptation of the "Explanatory Model Interview Catalog - Stigma Scale" for people affected by leprosy in Brazil. After being authorized by the author of the scale to use it in the national context, we initiated the five steps process of cross-cultural adaptation: (1) translation, (2) synthesis meeting, (3) back-translation, (4) committee of experts and (5) pre-test. The internal consistency of the scale was evaluated using Cronbach's alpha coefficient. The 15 items of the scale's original version were translated into Brazilian Portuguese. The adapted scale showed evidence of a good understanding of its content, attested both by experts and members of the target population. Its internal consistency was 0.64. The adapted instrument shows satisfactory internal consistency. It may be useful in future studies that intend to provide broad situational analysis that supports solid public health programs with a focus on effective stigma reduction. In a later study, the construct's validity, criterion, and reproducibility will be evaluated. Descrever o processo de adaptação transcultural da "Explanatory Model Interview Catalogue - Stigma Scale" para pessoas afetadas por hanseníase no Brasil. Após a autorização do autor da escala para seu uso no contexto nacional, deu-se início aos cinco passos do processo de adaptação transcultural: (1) tradução, (2) reunião de síntese, (3) retrotradução, (4) comitê de peritos e (5) pré-teste. A consistência interna da escala foi avaliada utilizando o coeficiente alfa de Cronbach. Os 15 itens da versão original da escala foram traduzidos para a língua portuguesa do Brasil. A escala adaptada apresentou evidência de boa compreensão de seu conteúdo, atestada tanto por peritos como por membros da população alvo. Sua consistência interna foi de 0,64. O instrumento adaptado apresenta consistência interna satisfatória. Pode ser útil em estudos futuros que intencionem viabilizar

  15. Ovarian hyperstimulation syndrome in a spontaneous singleton pregnancy.

    PubMed

    Cabar, Fábio Roberto

    2016-05-24

    The ovarian hyperstimulation syndrome is the combination of increased ovarian volume, due to the presence of multiple cysts and vascular hyperpermeability, with subsequent hypovolemia and hemoconcentration. We report a case of spontaneous syndrome in a singleton pregnancy. This was a spontaneous pregnancy with 12 weeks of gestational age. The pregnancy was uneventful until 11 weeks of gestational age. After that, the pregnant woman complained of progressive abdominal distention associated with abdominal discomfort. She did not report other symptoms. In the first trimester, a routine ultrasonography showed enlarged ovaries, multiples cysts and ascites. Upon admission, the patient was hemodynamically stable, her serum β-hCG was 24,487mIU/mL, thyroid-stimulating hormone was 2.2µUI/mL and free T4 was 1.8ng/dL. All results were within normal parameters. However, levels of estradiol were high (10,562pg/mL). During hospitalization, she received albumin, furosemide and prophylactic dose of enoxaparin. The patient was discharged on the sixth hospital day. RESUMO A síndrome de hiperestimulação ovariana é a combinação do aumento dos ovários, devido à presença de múltiplos cistos e de hiperpermeabilidade vascular, com subsequente hipovolemia e hemoconcentração. Relata-se um caso de síndrome espontânea em uma gestação única. Trata-se de gravidez espontânea com 12 semanas de idade gestacional. A gravidez ocorreu sem intercorrências até 11 semanas de idade gestacional. Após, a gestante passou a se queixar de distensão abdominal progressiva, associada com desconforto abdominal. A paciente não relatava outros sintomas. A ultrassonografia de rotina no primeiro trimestre mostrou ovários aumentados com múltiplos cistos e ascite. No momento da internação, a paciente apresentava-se hemodinamicamente estável, com β-hCG sérico de 24.487mUI/mL, hormônio estimulante da tireoide de 2,2µUI/m e T4 livre de 1,8ng/dL, ou seja, valores dentro dos par

  16. Looking for the Perfect Mentor.

    PubMed

    Sá, Ana Pinheiro; Teixeira-Pinto, Cristina; Veríssimo, Rafaela; Vilas-Boas, Andreia; Firmino-Machado, João

    2015-01-01

    Introdução: A formação médica pós-graduada consiste num processo complexo no qual os orientadores assumem um papel fundamental. Apesar da sua importância, pouco se sabe sobre os orientadores dos internos portugueses. O presente estudo pretende caracterizar os orientadores de formação em Medicina Interna em Portugal. Material e Métodos: Realizado um estudo observacional, transversal e de carácter analítico, através um questionário online anónimo onde foram avaliadas as características demográficas dos orientadores, o seu percurso na Medicina Interna e envolvimento com o processo formativo. Resultados: Dos 213 questionários válidos (taxa de resposta estimada de 28,4%), a média global da satisfação com o orientador encontra-se nos 4,52 pontos (± 1,33), sendo a relação entre interno e orientador classificada nos 4,86 ± 1,04 pontos. O orientador âidealâfoi caracterizado como dedicado e responsável (4,9 ± 1,37 pontos), com domínio de competências práticas (4,8 ± 1,12 pontos) e teóricas (4,8 ± 1,07 pontos). Foram identificados como preditores da satisfação dos internos com o orientador a relação estabelecidaentre ambos, o envolvimento do orientador na formação, o seu dinamismo, inovação e disponibilidade [modelo explicativo de 82,5% da satisfação (R2 = 0,83; R2 a = 0,82)]. Discussão: O orientador desempenha um papel preponderante no sucesso da formação pós-graduada. Os internos de Medicina Interna em Portugal encontram-se globalmente satisfeitos com os seus orientadores e valorizam preferencialmente as suas capacidades pedagógicas. Conclusão: Este estudo aponta para a importância do orientador de formação na satisfação do interno com o seu internato, alertando para a necessidade de investir nos orientadores como forma de investimento na formação médica pós-graduada.

  17. Methodological proposal for validation of the disinfecting efficacy of an automated flexible endoscope reprocessor.

    PubMed

    Graziano, Kazuko Uchikawa; Pereira, Marta Elisa Auler; Koda, Elaine

    2016-08-08

    ífico, comercialmente disponível, utilizando desinfetante de alto nível à base de ácido peracético 0,2%. o método de avaliação proposto mostrou-se robusto, à medida que as recomendações das legislações pertinentes ao equipamento avaliado foram incorporadas, com algumas adaptações para sua exequibilidade. A aplicação do método proposto permitiu atestar a eficácia do equipamento utilizado na desinfecção de alto nível de endoscópios. o método pode servir de referência para a avaliação de reprocessadoras de endoscópios flexíveis, subsidiando a aquisição dessa categoria de produtos para a saúde. elaborar y aplicar un método para evaluar la eficacia de reprocesadores automatizados de endoscopios flexibles en un momento en el que no hay un método oficial o laboratorios capacitados para cumplir con los requisitos descritos en las normas específicas para este tipo de producto para la salud en Brasil. el presente estudio metodológico fue desarrollado en base a las siguientes referencias teóricas: Organización Internacional de Normalización (International Organization for Standardization - ISO) norma ISO 15883-4/2008 y Agencia Nacional de Vigilancia de la Salud de Brasil (Agência Nacional de Vigilância Sanitária - ANVISA) Resolución del Directorio Colegiado (Resolução de Diretoria Colegiada - RDC) № 35/2010 y 15/2012. El método propuesto se aplicó a un dispositivo comercialmente disponible usando un desinfectante al 0,2% a base de ácido peracético de alto nivel. el método de evaluación propuesto se evaluó como fuerte después de que las recomendaciones formuladas en la legislación pertinente se incorporaron con algunos ajustes para garantizar su factibilidad. La aplicación del método propuesto proporciona evidencia de la eficacia de los equipos de prueba para la desinfección de alto nivel de endoscopios. el método propuesto puede servir de referencia para la evaluación de reprocesadores de endoscopios flexibles, proporcionando de este

  18. Prevalence of and factors associated with self-reported high blood pressure in Brazilian adults.

    PubMed

    Malta, Deborah Carvalho; Bernal, Regina Tomie Ivata; Andrade, Silvânia Suely Caribé de Araújo; Silva, Marta Maria Alves da; Velasquez-Melendez, Gustavo

    2017-06-01

    ) coletados no ano de 2013. Foram estimadas as prevalências e seus respectivos intervalos de confiança 95% por sexo segundo variáveis sociodemográficas, estilos de vida, doenças crônicas relatadas e avaliação do estado de saúde. Modelagem de regressão logística multivariada foi utilizada para identificar as variáveis associadas à hipertensão arterial autorreferida com α < 0,05. A prevalência de hipertensão arterial autorreferida entre os adultos residentes nas capitais brasileiras e Distrito Federal foi de 24,1%. Foram identificadas as seguintes associações com hipertensão arterial autorreferida: faixa etária, tomando 18 a 24 anos como referência, todas as faixas etárias apresentaram maior chance - de 25 a 34 anos (RC = 2,6; IC95% 2,0-3,4) até 65 anos ou mais (RC = 28,1; IC95% 21,7-36,4); baixa escolaridade (9 a 11 anos de estudo - RC = 0,8; IC95% 0,7-0,9; e 12 anos ou mais - RC = 0,6; IC95% 0,6-0,7); raça/cor da pele preta (RC = 1,3; IC95% 1,1-1,5); ser ex-fumante (RC = 1,2; IC95% 1,1-1,3); obesidade (RC = 2,7; IC95% 2,4-3,0); diabetes (RC = 2,9; IC95% 2,5-3,5); e colesterol elevado (RC = 1,9; IC95% 1,8-2,2). Cerca de um quarto da população adulta residente nas capitais brasileiras refere ter hipertensão arterial. As informações do Vigitel são úteis para o monitoramento da hipertensão arterial e identificação de seus fatores associados, subsidiando políticas públicas de promoção, vigilância e atenção à saúde.

  19. Hearing thresholds in patients with drug-resistant tuberculosis: baseline audiogram configurations and associations.

    PubMed

    Sogebi, Olusola Ayodele; Fadeyi, Muse Olatunbosun; Adefuye, Bolanle Olufunlola; Soyinka, Festus Olukayode

    2017-01-01

    parâmetros do audiograma basal para verificar se a tuberculose resistente (TB-R) tem efeitos na audição, descrever as configurações dos audiogramas e determinar se há parâmetros que possam ser associados a essas configurações. Estudo prospectivo com pacientes diagnosticados com TB-R em um centro de tratamento de tuberculose no estado de Ogun, Nigéria. Os pacientes incluídos no estudo foram submetidos à audiometria de tons puros em até duas semanas após o início do tratamento (audiometria basal). Características demográficas e clínicas foram coletadas dos prontuários médicos dos pacientes para análises comparativas. A amostra final envolveu 132 pacientes. A média de idade dos pacientes foi de 34,5 ± 12,6 anos (variação, 8-82 anos), e a razão homem:mulher foi de 2:1. A maioria dos pacientes (n = 103; 78,0%) residia nos estados vizinhos e tinha história de falha de tratamento antituberculose (n = 125; 94.7%); 18 (13.6%) apresentavam status retroviral positivo. Doze pacientes (9,1%) apresentaram audiogramas normais, e 104 (78,8%) apresentaram perda auditiva neurossensorial, sendo as configurações mais comuns do tipo ascendente, em 54 (40,9%), e descendente, em 26 (19,7%). As médias de tons puros em frequências baixas (0,25-1,0 kHz) e altas (2,0-8,0 kHz) foram de 33,0 dB e 40,0 dB, respectivamente. Quanto ao grau de perda auditiva no melhor ouvido, 36 pacientes (27,3%) apresentaram audição normal, e 67 (50,8%) apresentaram perda auditiva leve (26-40 dB), enquanto 29 (21,9%) mostraram perda auditiva moderada ou grave. Entre as variáveis estudadas (idade, gênero, status retroviral, desfecho de tratamento anterior e peso na admissão), somente o gênero masculino foi associado às configurações audiométricas. Nesta amostra de pacientes com TB-R, a maioria apresentou perda auditiva neurossensorial leve e subótima bilateralmente, com configurações audiométricas ascendentes/descendentes associadas ao gênero masculino.

  20. Clinical Outcome and Characterization of Local Field Potentials in Holmes Tremor Treated with Pallidal Deep Brain Stimulation

    PubMed Central

    Ramirez-Zamora, Adolfo; Kaszuba, Brian C.; Gee, Lucy; Prusik, Julia; Danisi, Fabio; Shin, Damian; Pilitsis, Julie G

    2016-01-01

    Background Holmes tremor (HT) is an irregular, low-frequency rest tremor associated with prominent action and postural tremors. Currently, the most effective stereotactic target and neurophysiologic characterization of HT, specifically local field potentials (LFPs) are uncertain. We present the outcome, intraoperative neurophysiologic analysis with characterization of LFPs in a patient managed with left globus pallidus interna deep brain stimulation (Gpi DBS). Case Report A 24-year-old male underwent left Gpi DBS for medically refractory HT. LFPs demonstrated highest powers in the delta range in Gpi. At the 6-month follow-up, a 90% reduction in tremor was observed. Discussion Pallidal DBS should be considered as an alternative target for management of refractory HT. LFP demonstrated neuronal activity associated with higher power in the delta region, similarly seen in patients with generalized dystonia. PMID:27441097

  1. Clinical considerations on the posology of direct oral anticoagulants.

    PubMed

    Sáez-Peñataro, J; Avendaño-Solá, C; González-Juanatey, J R

    2016-10-01

    The efficacy of dicoumarin anticoagulants has been shown in patients with nonvalvular atrial fibrillation. However, they have drawbacks such as the need to adjust the dosage and the interaction with drugs and food. Direct oral anticoagulants are an effective and safe alternative and have a less complicated clinical management. There is considerable debate on the selection criteria for the posology regimens of direct oral anticoagulants. The differences among them and their administration regimens have raised questions about the clinical, pharmacokinetic and pharmacodynamic selection criteria that support the posology. This review critically analyses the available evidence and its impact on the final selection of the dosage regimen. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  2. [Influence of armed conflict on mortality due to traumatic brain injury in children and adolescents].

    PubMed

    Alcalá-Cerra, Gabriel; Paternina-Caicedo, Ángel; Palacio-Babilonia, Betty; Moscote-Salazar, Luis Rafael; Niño-Hernández, Lucía M; Gutiérrez-Paternina, Juan José

    2014-01-01

    INTRODUCCIÓN: ante un conflicto bélico es de esperar que el comportamiento de la mortalidad de un país se vea afectado. El objetivo de esta investigación fue evaluar en un país en guerra interna, la tendencia de la mortalidad por trauma craneoencefálico en niños y adolescentes, que aún en condiciones de paz social constituye una de las causas más frecuentes de muerte y discapacidad en esos grupos poblacionales. MÉTODOS: se llevó a cabo un estudio poblacional y retrospectivo en el que se evaluó la tendencia de la mortalidad por trauma craneoencefálico durante el periodo de 1999 a 2008. Se realizó una regresión lineal para determinar su correlación con la mortalidad relacionada con los eventos bélicos del conflicto armado.

  3. Nutritional value and digestion rate of rhea meat proteins in association with storage and cooking processes.

    PubMed

    Filgueras, Renata S; Gatellier, Philippe; Ferreira, Claude; Zambiazi, Rui C; Santé-Lhoutellier, Véronique

    2011-09-01

    The nutritional value of proteins was investigated after the storage and cooking of rhea M. Gastrocnemius pars interna. Oxidation of basic and aromatic amino acids, surface hydrophobicity and aggregation state of proteins, were determined in raw and cooked meat. In addition, myofibrillar proteins were exposed in vitro to proteases of the digestive tract. Cooking markedly affected the protein surface hydrophobicity. The BBP bound content was three times greater in cooked than in fresh rhea meat. A small increment in tryptophan content after cooking was observed. Storage influenced Schiff bases formation indicating the presence of protein-aldehyde adducts after cooking. High content of Schiff bases was found after cooking of samples stored for 5 days, demonstrating a probable implication of free amino groups, most likely from lysine. Cooking decreased the myofibrillar protein susceptibility to pepsin activity. After cooking, the proteolysis rate by pancreatic enzymes increased. Our findings support the importance of protein aggregation in the nutritional value of meat proteins.

  4. [Bilateral blood pressure measurement before and after coronary bypass surgery: an absolute necessity].

    PubMed

    Ernst, J M; van Bergen, P F; Schepens, M A; Brutel de la Rivière, A; Plokker, H W

    1999-09-11

    Anginous symptoms and a difference in blood pressure between the two arms prompted angiography in two patients, men aged 66 and 50 years. The examination revealed coronary sclerosis and a stenosis in the left subclavian artery. The symptoms disappeared after percutaneous dilatation of the subclavian artery, followed by a coronary bypass operation (CABG) using an internal thoracic artery (a branch of the subclavian artery). In two other patients, men aged 61 and 71 years, who had undergone an arterial CABG 12 years previously, anginous symptoms were the manifestation of a narrowed subclavian artery. The symptoms disappeared after balloon dilatation of the subclavian artery and revascularization of the anterior interventricular branch (left artery descendens) and embolization of the internal thoracic artery graft (internal mammarian artery graft), respectively. Stenosis or occlusion of the proximal subclavian artery may attenuate the blood flow in the ipsilateral A. thoracica interna graft. The diagnosis can simply be made by bilateral blood pressure measurement.

  5. Development and validation of the Hospitality Axiological Scale for Humanization of Nursing Care.

    PubMed

    Galán González-Serna, José María; Ferreras-Mencia, Soledad; Arribas-Marín, Juan Manuel

    2017-08-03

    to develop and validate a scale to evaluate nursing attitudes in relation to hospitality for the humanization of nursing care. Participants: the sample consisted of 499 nursing professionals and undergraduate students of the final two years of the Bachelor of Science in Nursing program. the instrument has been developed and validated to evaluate the ethical values related to hospitality using a methodological approach. Subsequently, a model was developed to measure the dimensions forming the construct hospitality. the Axiological Hospitality Scale showed a high internal consistency, with Cronbach's Alpha=0.901. The validation of the measuring instrument was performed using factorial, exploratory and confirmatory analysis techniques with high goodness of fit measures. the developed instrument showed an adequate validity and a high internal consistency. Based on the consistency of its psychometric properties, it is possible to affirm that the scale provides a reliable measurement of the hospitality. It was also possible to determine the dimensions or sources that embrace it: respect, responsibility, quality and transpersonal care. desenvolver e validar uma escala que permita avaliar a atitude dos enfermeiros em termos de hospitalidade, visando a humanização da enfermagem.Participantes: a amostra foi constituída por 499 profissionais e estudantes de enfermagem dos dois últimos anos do curso de graduação em Enfermagem. utilizando-seuma abordagem metodológica, foi desenvolvido e validado um instrumento para avaliar os valores éticos relacionados com a hospitalidade. Subsequentemente, foi formulado um modelo para mediras dimensões que constituem o construto hospitalidade. a Escala Axiológica de Hospitalidade mostrou uma consistência interna elevada, com Alfa de Cronbach=0,901. A validação do instrumento de medição foi realizada usando-se métodos de análise fatorial, exploratória e confirmatória, que apresentaram bons índices de qualidade de ajuste. o

  6. Nonmotor outcomes in Parkinson’s disease: is deep brain stimulation better than dopamine replacement therapy?

    PubMed Central

    Kandadai, Rukmini Mridula; Jabeen, Afshan; Kannikannan, Meena A.

    2012-01-01

    Nonmotor symptoms are an integral part of Parkinson’s disease and cause significant morbidity. Pharmacological therapy helps alleviate the disease but produces nonmotor manifestations. While deep brain stimulation (DBS) has emerged as the treatment of choice for motor dysfunction, the effect on nonmotor symptoms is not well known. Compared with pharmacological therapy, bilateral subthalamic nucleus (STN)-DBS or globus pallidum interna (GPi)-DBS has significant beneficial effects on pain, sleep, gastrointestinal and urological symptoms. STN-DBS is associated with a mild worsening in verbal fluency while GPi-DBS has no effect on cognition. STN-DBS may improve cardiovascular autonomic disturbances by reducing the dose of dopaminergic drugs. Because the motor effects of STN-DBS and GPi-DBS appear to be similar, nonmotor symptoms may determine the target choice in surgery of future patients. PMID:22276074

  7. Angio-OCT de la zona avascular foveal en ojos con oclusión venosa de la retina.

    PubMed

    Wons, Juliana; Pfau, Maximilian; Wirth, Magdalena A; Freiberg, Florentina J; Becker, Matthias D; Michels, Stephan

    2017-07-11

    Objetivo: El objetivo del estudio comprendía visualizar y cuantificar las alteraciones patológicas de la zona avascular foveal (ZAF) mediante angio-OCT en ojos con oclusión venosa de la retina (OVR) en comparación con el ojo contralateral sano. Procedimientos: La angio-OCT se llevó a cabo mediante el sistema Avanti® RTVue 100 XR (Optovue Inc., Fremont, Calif., EE. UU.). Los bordes de la capa vascular superficial (CVS) se definieron como 3 μm por debajo de la membrana limitante interna y 15 μm por debajo de la capa plexiforme interna y, para la capa vascular profunda (CVP), como 15 y 70 μm por debajo de la membrana limitante interna y de la capa plexiforme interna, respectivamente. La longitud de la ZAF horizontal, vertical y máxima de la CVS y la CVP en cada ojo se midió de forma manual. Además, se midió el ángulo entre el diámetro máximo de la ZAF y el plano papilomacular. Resultados: La angio-OCT representó los defectos dentro de la vasculatura en el área perifoveal en ojos con oclusión de rama venosa de la retina (ORVR; n = 11) y con oclusión de la vena central de la retina (OVCR; n = 8). Esto resultó en un crecimiento del diámetro máximo de la ZAF en ojos con OVR (n = 19) en comparación con el ojo contralateral (n = 19; 921 ± 213 frente a 724 ± 145 µm; p = 0,008). Además, se observó una correlación significativa entre la mejor agudeza visual corregida (MAVC) y el diámetro máximo de la ZAF en la CVP (ρ de Spearman = -0,423, p < 0,01). Por último, en los ojos con OVR, el ángulo entre el plano papilomacular y el diámetro máximo de la ZAF se dio tan solo en el 21,05% (CVS) y en el 15,79% (CVP) de los casos a 0 ± 15 ó 90 ± 15°, respectivamente. En ojos sanos, estos ángulos (que supuestamente representan una configuración de la ZAF regular) fueron más prevalentes (CVS 68,42 frente a 21,05%, p = 0,003; CVP 73,68 frente a 15,79%, p < 0,001). Conclusiones: La angio-OCT muestra alteraciones morfológicas de la ZAF en ojos con

  8. Ultrasound in the diagnosis of asymptomatic hyperuricaemia and gout.

    PubMed

    García Puig, J; Beltrán, L; Mejía Chew, C; Torres, R; Tebar Márquez, D; Pose Reino, A

    2016-11-01

    The increase in serum urate concentrations (hyperuricaemia, ≥7.0mg/dL) creates crystals, which promote inflammation and joint lesions. Ultrasonography can reveal these urate deposits. The presence of crystals suggests that a patient with hyperuricaemia is actually experiencing asymptomatic gout, and that a patient with gout without subcutaneous tophi could experience tophaceous gout. The information offered by ultrasound (double contour sign and hyperechoic concretions mimicking clouds) enables a more specific classification of hyperuricaemia and gout. Additionally, this information can lead to relevant changes in terms of the diagnosis and therapeutic approach for patients with hyperuricaemia and gout. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  9. Reinforcing concomitants of electrically elicited vocalizations.

    PubMed

    Jürgens, U

    1976-09-24

    In 38 squirrel monkeys 251 vocalization-producing electrode positions were tested for their positive and negative reinforcing properties. Two groups of vocalization-producing brain areas could be distinguished: One group in which the electrically elicited vocalization was independent of the accompanying reinforcement effect, and a second group in which vocalization and reinforcement effect were correlated. The first group included the anterior cingulate gyrus, the adjacent supplementary motor area, gyrus rectus, ventromedial edge of the capsula interna, caudal periaqueductal gray and adjacent parabrachial region. The second group consited of the caudatum, septum, substantia innominata, amygdala, inferior thalamic peduncle, stria terminalis, midline thalamus, ventral and periventricular hypothalamus, substantia nigra, rostral periaqueductal gray, dorsolateral midbrain tegmentum and lateral medulla. It is hypothesized that the first group contains predominantly or exclusively "primary" vocalization substrates; the second group is thought to be composed mainly of structures whose stimulation yields vocalization secondarily due to stimulus induced motivational changes.

  10. Why dedicate yourself to bioethics? Seven reasons to get you started.

    PubMed

    Real de Asúa, D; Herreros, B

    2016-01-01

    The aim of clinical bioethics is to promote rational clinical decisions that take into account the clinical facts and the preferences and values of individuals involved in a situation that entails a moral problem. The objective of the present study is to list the reasons why we consider bioethics knowledge and skills to be essential in daily practice and to promote a proactive mindset in clinical bioethics research. The arguments set forth include the need to adapt to changes in the clinical relationship in recent decades, the importance of an ethical approach both for the physician and the patient, the role of bioethics in preventing professional burnout, the ability of ethics to promote a more equitable distribution of resources and the possibility of conducting clinical research in bioethics, a field that has scarcely been explored in Spain. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  11. Conceptos Basicos Sobre el Propano

    SciTech Connect

    2016-08-01

    El propano provee energia a mas de 143.000 vehiculos en los Estados Unidos y 23 millones en todo el mundo. Flotas de todos los Estados Unidos han implementado con exito el uso de vehiculos que funcionan con gas propano, y en la actualidad varios funcionan gracias a este gas, incluyendo autobuses escolares, lanzaderas y autobuses publicos, asi como tambien furgonetas, taxis, vehiculos utilizados por las fuerzas del orden, barredoras de calles y camiones para uso profesional. El propano tambien se utiliza con frecuencia en aplicaciones fuera de la carretera, tales como montacargas, podadoras y equipos de uso profesional y otros equipos agricolas. Las ventajas del propano incluyen la disponibilidad interna, su rendimiento y el hecho de que genera menos emisiones de gases contaminantes que otras alternativas energeticas.

  12. Current diagnosis and treatment of Castleman's disease.

    PubMed

    González García, A; Moreno Cobo, M Á; Patier de la Peña, J L

    2016-04-01

    Castleman's disease is not just a single disease but rather an uncommon, heterogeneous group of nonclonal lymphoproliferative disorders, which have a broad spectrum of clinical expression. Three histological types have been reported, along with several clinical forms according to clinical presentation, histological substrate and associated diseases. Interleukin-6, its receptor polymorphisms, the human immunodeficiency virus and the human herpes virus 8 are involved in the etiopathogenesis of Castleman's disease. The study of this disease has shed light on a syndrome whose incidence is unknown. Despite recent significant advances in our understanding of this disease and the increasing therapeutic experience with rituximab, tocilizumab and siltuximab, there are still difficult questions concerning its aetiology, prognosis and optimal treatment. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  13. Target organ damage in acute heart failure.

    PubMed

    Casado Cerrada, J; Zabaleta Camino, J P; Fontecha Ortega, M

    2016-03-01

    Acute heart failure is a prognostic factor due to its high mortality during the acute phase and the increased frequency of medium to long-term adverse events. The pathophysiological mechanisms triggered during these exacerbations can persist after reaching clinical stability, remaining even after the acute episode has ended. A certain degree of neurohormonal activation, oxidative stress, apoptosis and inflammation (among other conditions) can therefore persist, resulting in organ damage, not just of the myocardium but likely the entire cardiovascular apparatus. This new insight into the persistence of harmful mechanisms that last beyond the exacerbations could be the start of a change in perspective for developing new therapeutic strategies that seek an overall control of hemodynamic and congestive changes that occur during acute decompensated heart failure and changes that remain after achieving clinical stability. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  14. Functional anatomy of the ovaries of pregnant and lactating Cape porcupines, Hystrix africaeaustralis.

    PubMed

    van Aarde, R J; Skinner, J D

    1986-03-01

    The constituent cell types of the ovary of the porcupine were similar to those of New World hystricomorph rodents and accessory corpora lutea and luteal bodies were formed through the luteinization of the membrana granulosa or theca interna of antral follicles. All luteal bodies were histologically similar. The total volume of luteal tissue per female was not affected by fetal age and was unrelated to circulating concentrations of maternal plasma progesterone. Maternal plasma progesterone concentrations were correlated with fetal age. Follicular activity occurred throughout pregnancy but was not affected by fetal age or related to circulating values of oestradiol-17 beta. The formation of accessory corpora lutea during pregnancy is regarded as important in supplementing progesterone during pregnancy.

  15. Wave Coupling in the Earth's Atmosphere: TIME-GCM Simulations of Variable Tidal Effects

    NASA Astrophysics Data System (ADS)

    Hagan, Maura; Maute, Astrid; Zhang, Xiaoli; Forbes, Jeffrey M.; Roble, Raymond; Oberheide, Jens

    We report on the tidal characteristics and their impact on the Earth's atmosphere as determined from a series of National Center for Atmospheric Research (NCAR) thermosphere-ionosphere-mesosphere-electrodynamics general circulation model (TIME-GCM) simulations. We assess the TIME-GCM performance by comparing the model results with extant observational tidal diagnostics. We also investigate the sensitivity of TIME-GCM performance to variable tro-pospheric forcing schemes with particular attention to their impact on upper atmospheric tidal signatures. Toward this end, we introduce tidal perturbations associated with Interna-tional Satellite Cloud Climatology Project (ISCCP) and Tropical Rainfall Measuring Mission (TRMM) data, as well as tidal components inferred from Thermosphere Ionosphere Mesosphere Energetics and Dynamics (TIMED) satellite observations, at the model lower boundary (ca. 30 km). Finally, we investigate the role of mean winds and wave-wave interactions on the tidal components that propagate into the upper atmosphere by contrasting them with linear tidal model results.

  16. Confirming Hypoderma tarandi (Diptera: Oestridae) human ophthalmomyiasis by larval DNA barcoding.

    PubMed

    Rukke, Bjørn Arne; Cholidis, Symira; Johnsen, Arild; Ottesen, Preben

    2014-06-01

    DNA barcoding is a practical tool for species identification, when morphological classification of an organism is difficult. Herein we describe the utilisation of this technique in a case of ophthalmomyiasis interna. A 12-year-old boy was infested during a summer holiday in northern Norway, while visiting an area populated with reindeer. Following medical examination, a Diptera larva was surgically removed from the boy's eye and tentatively identified from its morphological traits as Hypoderma tarandi (L.) (Diptera: Oestridae). Ultimately, DNA barcoding confirmed this impression. The larval cytochrome c oxidase subunit 1 (COI) DNA sequence was matched with both profiles of five adult H. tarandi from the same region where the boy was infested, and other established profiles of H. tarandi in the Barcode of Life Data Systems (BOLD) identification engine.

  17. HIV/AIDS infection: The beginning of the end for today's greatest pandemic?

    PubMed

    Gutiérrez, F

    2017-06-01

    Recently, there have been significant advances in the fight against human immunodeficiency virus, which have increased the hopes of definitively halting its dissemination and of starting the decline of the epidemic it has caused. Transmission of the infection was drastically reduced when infected patients were given antiretroviral treatments, which boosted the diffusion of treatments to middle- and low-income countries. Global therapy coverage has doubled in recent years; meanwhile the incidence of new infections has decreased. Various curative strategies are also actively being investigated, including those aiming to induce cell resistance to the infection through gene therapy and the elimination of latent virus reservoirs. This article reviews the current situation and future developments in terms of controlling the pandemic and, eventually, curing the infection. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  18. L'eliosismologia: onde sismiche per studiare l'interno del Sole

    NASA Astrophysics Data System (ADS)

    Di Mauro, M. P.

    2014-12-01

    Negli ultimi cinquanta anni siamo stati testimoni di una straordinaria rivoluzione della conoscenza e comprensione della nostra stella grazie alla nascita dell'Eliosismologia, lo studio delle oscillazioni solari. Analogamente a ciò che accade nella Terra durante i terremoti, anche l'interno del Sole è pervaso continuamente da onde sismiche che provocano piccole oscillazioni, ovvero deformazioni della fotosfera. Le oscillazioni sono la manifestazione di diversi processi che avvengono all'interno della struttura del Sole e le frequenze sismiche dei modi osservati e misurati sulla superficie sono legate direttamente ai parametri fisici degli strati interni attraversati dalle onde sismiche. Lo studio delle oscillazioni rappresenta, quindi, l'unico metodo diretto per studiare la struttura e la dinamica interna del Sole. In questo articolo verranno illustrate le caratteristiche generali delle oscillazioni solari e verranno presentati i risultati importanti e i progressi notevoli raggiunti grazie all'Eliosismologia.

  19. The case for performing pleural biopsies for the aetiological diagnosis of exudates. Yes.

    PubMed

    Rodriguez-Panadero, F

    2017-10-01

    Pleural biopsies are especially indicated in the following circumstances: a) inconclusive pleural fluid analysis and negative sputum study, if adenosine deaminase (ADA) levels are unavailable; b) suspected multi-resistant tuberculosis; c) a need for differentiating tuberculous pleurisy (if it progresses with neutrophilia) and complicated parapneumonic effusion; d) malignant pleural effusion coexisting with very high ADA levels; e) effusion coexisting with lung cancer and negative pleural cytology; f) suspected mesothelioma; and g) need for implementing re-treatment for patients with relapse after chemotherapy. Image-guided needle biopsy is recommended for cases a and b, while thoracoscopy is preferable for the other cases. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  20. High-frequency pallidal stimulation for camptocormia in Parkinson disease: case report.

    PubMed

    Thani, Nova B; Bala, Arul; Kimber, Thomas E; Lind, Christopher R P

    2011-05-01

    Camptocormia is characterized by abnormal flexion of the thoracolumbar spine that increases during upright posture and abates in the recumbent position and has been reported to occur in patients with Parkinson disease. Camptocormia causes significant spinal and abdominal pain, impairment of balance, and social stigma. A 57-year-old woman with Parkinson disease developed severe camptocormia, which did not improve with trials of antiparkinsonian and muscle relaxant medications. The patient was successfully treated with bilateral globus pallidus interna deep brain stimulation surgery under general anesthesia. High-frequency neuromodulation afforded relief of camptocormia and improvement in Parkinson disease symptoms. Camptocormia in Parkinson disease may represent a form of dystonia and can be treated effectively with chronic pallidal neuromodulation.

  1. Antithrombotic treatment in elderly patients with atrial fibrillation.

    PubMed

    Suárez Fernández, C; Camafort, M; Cepeda Rodrigo, J M; Díez-Manglano, J; Formiga, F; Pose Reino, A; Tiberio, G; Mostaza, J M

    2015-04-01

    Atrial fibrillation (AF) in the elderly is a complex condition due to the high number of frequently associated comorbidities, such as cardiovascular and kidney disease, cognitive disorders, falls and polypharmacy. Except when contraindicated, anticoagulation is necessary for preventing thromboembolic events in this population. Both vitamin K antagonists and direct oral anticoagulants (dabigatran, rivaroxaban and apixaban) are indicated in this context. Renal function should be closely monitored for this age group when these drugs are used. In recent years, various clinical practice guidelines have been published on patients with AF. The majority of these guidelines make specific recommendations on the clinical characteristics and treatment of elderly patients. In this update, we review the specific comments on the recommendations concerning antithrombotic treatment in elderly patients with nonvalvular AF. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  2. Nasopharyngeal polyps in cats.

    PubMed

    Kudnig, Simon T

    2002-11-01

    Nasopharyngeal polyps are non-neoplastic, inflammatory growths that arise from the middle ear or the eustachian tube and extend into the pharynx. The exact etiology of nasopharyngeal polyps is unclear; proposed etiologies include a response to chronic upper respiratory tract infection, chronic otitis media, ascending infection from the nasopharynx, or a congenital origin. Clinical signs usually relate to obstruction of the nasopharynx, with Horner's syndrome and head tilt being consistent with otitis media and otitis interna, respectively. Diagnostic tools include digital or visual examination above the soft palate, flexible fiberoptic caudal rhinoscopy, radiography, computed tomography, and magnetic resonance imaging. Ventral bulla osteotomy combined with traction removal of the polyp is the recommended treatment, although traction only followed by prednisolone therapy can be considered in some cases, especially when there is no evidence of otitis media.

  3. Zika virus infection during the Olympic Games in Rio: A fear or an actual risk?

    PubMed

    Díaz-Menéndez, M; Trigo, E; de la Calle-Prieto, F; Arsuaga, M

    2017-04-01

    The recent outbreak of Zika virus infection in Brazil has aroused considerable media interest due to its association with neurological malformations in children born from mothers infected by the virus and to its association with Guillain-Barre syndrome in adults. This relationship has led to the World Health Organisation declaring the current epidemic as a "Public Health Emergency of International Concern". Controversy also emerged on the advisability of delaying or changing the location of the Olympic and Paralympic Games, which were held in August at various locations in Brazil. In this article, we review the available evidence on the risk of Zika and dengue virus infection in individuals who travel to endemic countries, especially for multitudinous events. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  4. Deep Brain Stimulation in Parkinson's Disease: New and Emerging Targets for Refractory Motor and Nonmotor Symptoms

    PubMed Central

    Beecher, Grayson

    2017-01-01

    Parkinson's disease (PD) is a progressive neurodegenerative condition characterized by bradykinesia, tremor, rigidity, and postural instability (PI), in addition to numerous nonmotor manifestations. Many pharmacological therapies now exist to successfully treat PD motor symptoms; however, as the disease progresses, it often becomes challenging to treat with medications alone. Deep brain stimulation (DBS) has become a crucial player in PD treatment, particularly for patients who have disabling motor complications from medical treatment. Well-established DBS targets include the subthalamic nucleus (STN), the globus pallidus pars interna (GPi), and to a lesser degree the ventral intermediate nucleus (VIM) of the thalamus. Studies of alternative DBS targets for PD are ongoing, the majority of which have shown some clinical benefit; however, more carefully designed and controlled studies are needed. In the present review, we discuss the role of these new and emerging DBS targets in treating refractory axial motor symptoms and other motor and nonmotor symptoms (NMS). PMID:28761773

  5. Hyponatraemia and congestive heart failure refractory to diuretic treatment. Utility of tolvaptan.

    PubMed

    Pose, A; Almenar, L; Manzano, L; Gavira, J J; López Granados, A; Delgado, J; Aramburu, O; Arévalo, J C; Méndez, M; Comín, J; Manito, N

    2017-10-01

    Heart failure (HF) is currently one of the most significant healthcare problems in Spain and has a continuously increasing prevalence. Advances in our understanding of the various biological responses that promote cardiac remodelling and pulmonary venous congestion constitute the basis of current treatment. This article, prepared by members of the HF groups of the Spanish Society of Cardiology and the Spanish Society of Internal Medicine, discusses the current therapeutic strategies for patients with congestion refractory to diuretic treatment. The article includes our clinical experience with the use of tolvaptan as an additional treatment for congestion associated with hyponatraemia. To this end, we propose an algorithm for the use of tolvaptan in patients with congestive HF, natraemia <130mEq/l and poor response to conventional diuretic treatment. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  6. Cardiovascular safety of noninsulin antidiabetic drugs: facts and promises.

    PubMed

    García-Lledó, A; de Santiago-Nocito, A M; de Abajo, F J

    2017-03-15

    Non insulin antidiabetic drugs are widely used in patients with type 2 diabetes. However, the drugs' effect in terms of reducing cardiovascular risk has been the subject of controversy. In 2008, based on the evidence of cardiovascular risk resulting from the use of a number of non insulin antidiabetic drugs, the US Food and Drug Administration published directives on the need to perform cardiovascular safety studies. These directives have helped obtain more evidence, such that at present there are 2 families of drugs that can reduce cardiovascular risk. These recent data have helped us add the reduction of cardiovascular morbidity and mortality to the objective of controlling blood glucose. Nevertheless, research continues with the development of new long-term studies. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  7. Fifty years since the nuclear accident in Palomares (Almeria). Medical repercussions.

    PubMed

    Laynez-Bretones, F; Lozano-Padilla, C

    In January 1966, 2 US military aircraft collided over the skies of Palomares (Almeria). One of them carried thermonuclear bombs, which released plutonium and other radioactive materials upon striking the ground. The most contaminated earth and plants were immediately removed. The Indalo Project was launched to study the effects of nuclear material on the inhabitants and environment of Palomares. A total of 1,077 inhabitants have been monitored since then, and the official version is that the ionising radiation has not been related to any type of disease. However, secrecy has surrounded much of the investigations, and no trustworthy epidemiological study has been conducted in the area. Approximately 500g of plutonium and americium remains in Palomares. Although the risk for the population appears to be low, this radioactive material should be removed as soon as possible. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  8. Space weather models and their validation and verification at the CCMC

    NASA Astrophysics Data System (ADS)

    Hesse, Michael; Berrios Lutz Rastaetter, Masha Kuznetsova Marlo Maddox Antti Pulkkinen Ja Soon Shim David; MacNeice, Peter; Taktakishvili, Sandro; Chulaki, Anna; Moiseev, Larisa; Bakshi, Sarabjit; Patel, Kiran

    The Community Coordinated Modeling Center (CCMC) is a US multi-agency activity with a dual mission. With equal emphasis, CCMC strives to provide science support to the interna-tional space research community through the execution of advanced space plasma simulations, and it endeavors to support the space weather needs of the US and partners. Space weather support involves a broad spectrum, from designing robust forecasting systems and transitioning them to forecasters, to providing space weather updates and forecasts to NASA's robotic mis-sion operators. All of these activities have to rely on validation and verification of models and their products, so users and forecasters have the means to assign confidence levels to the space weather information. In this presentation, we provide an overview of space weather models resident at CCMC, as well as of validation and verification activities undertaken at CCMC or through the use of CCMC services.

  9. [Acute hemiplegia in childhood and alternating hemiconvulsions secondary to Moya-Moya disease. Report of a case associated with Down's syndrome].

    PubMed

    Cornelio-Nieto, J O; Dávila-Gutiérrez, G; Ferreyro-Irigoyen, R; Alcalá, H

    1990-01-01

    Moya-Moya disease has been associated to a number of disease entities including Down syndrome. Initial clinical manifestations in our patient were alternating lateralizing seizures with sudden onset hemiparesis. Ct scan demonstrated several infarcts in different stages of evolution, in the territory of left middle cerebral artery. Single digital subtraction angiography showed bilateral occlusion, predominantly on the left side of the supraclinoid portion of the interna carotid arteries with formation of collateral circulation in the diencephalic territory. The association of Moya-Moya disease and Down syndrome is not fortuitous and it is probably due to a congenital vascular dysplasia. It should be suspected in children with trisomy 21 (with or without congenital heart disease) who presents with alternating hemiplegia and convulsions or acute hemiplegia.

  10. Transition from paediatric care to adult care for patients with mucopolysaccharidosis.

    PubMed

    Couce, M L; Del Toro, M; García-Jiménez, M C; Gutierrez-Solana, L; Hermida-Ameijeiras, Á; López-Rodríguez, M; Pérez-López, J; Torralba, M Á

    2017-07-18

    Mucopolysaccharidosis are multisystem diseases that require large multidisciplinary teams for their care. Specific recommendations are therefore needed for the transition from childhood to adulthood in this patient group. To overcome the barriers that might arise during the transition, the authors consider it essential to implement a flexible plan with a coordinator for the entire process, systematising the information through a standardised paediatric discharge report and educating the patient and their family about the disease, showing the characteristics of the healthcare system in this new stage. The final objective is that, once the transition to adulthood has been completed, the patient's autonomy and potential development are maximised and that the patient receives appropriate healthcare during this transition. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  11. Why teaching empathy is important for the medical degree.

    PubMed

    Díez-Goñi, N; Rodríguez-Díez, M C

    Empathy is a basic skill in the exercise of medicine and increases patient and physician satisfaction and improves clinical results. However, the teaching of empathy is poorly covered in the teaching plans. A number of studies have observed a reduction in empathy during the final training courses. The reasons for this decline include, the students' excessive academic workload, the prioritisation of acquiring medical expertise over humanistic knowledge, the patient load in hospitals and health centres and the physicians' need to distance themselves from their patients. Nevertheless, intervention studies through simulation with standardised patients have shown an increase in empathy in students, which can be evaluated through the Jefferson scales: JSE-S and JSPPPE. The teaching of empathy to medical students is an important commitment in the curricular programs of medical schools. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  12. Automatic trajectory planning of DBS neurosurgery from multi-modal MRI datasets.

    PubMed

    Bériault, Silvain; Al Subaie, Fahd; Mok, Kelvin; Sadikot, Abbas F; Pike, G Bruce

    2011-01-01

    We propose an automated method for preoperative trajectory planning of deep brain stimulation image-guided neurosurgery. Our framework integrates multi-modal MRI analysis (T1w, SWI, TOF-MRA) to determine an optimal trajectory to DBS targets (subthalamic nuclei and globus pallidus interna) while avoiding critical brain structures for prevention of hemorrhages, loss of function and other complications. Results show that our method is well suited to aggregate many surgical constraints and allows the analysis of thousands of trajectories in less than 1/10th of the time for manual planning. Finally, a qualitative evaluation of computed trajectories resulted in the identification of potential new constraints, which are not addressed in the current literature, to better mimic the decision-making of the neurosurgeon during DBS planning.

  13. Fahr syndrome unknown complication: overactive bladder.

    PubMed

    Tuglu, Devrim; Yuvanç, Ercan; Bal, Fatih; Türkel, Yakup; Dağ, Ersel; Yılmaz, Erdal; Batislam, Ertan

    2014-01-01

    A 38-year-old male patient was admitted to our outpatient department because of frequency and urgency incontinence. During evaluation it was detected that the patient was suffering from frequency which was progressive for one year, feeling of incontinence, and urgency incontinence. There was no urologic pathology detected in patient's medical and family history. Neurologic consultation was requested due to his history of boredom, reluctance to do business, balance disorders, and recession for about 3 years. Brain computerized tomography (CT) scan revealed that amorphous calcifications were detected in the bilaterally centrum semiovale, basal ganglia, capsula interna, thalami, mesencephalon, pons and bulbus, and the bilateral cerebellar hemispheres. We have detected spontaneous neurogenic detrusor overactivity without sphincter dyssynergia after evaluating the voiding diary, cystometry, and pressure flow study. We consider the detrusor overactivity which occurred one year after the start of the neurological symptoms as the suprapontine inhibition and damage in the axonal pathways in the Fahr syndrome.

  14. The Internal Medicine of the 21st century: Organizational and operational standards.

    PubMed

    Casariego-Vales, E; Zapatero-Gaviria, A; Elola-Somoza, F J

    2017-07-19

    The Spanish Society of Internal Medicine has developed a consensus document on the standards and recommendations that they consider essential to the organisation of internal medicine units for conducting their activities efficiently and with high quality. We defined 3 groups of key processes: the care of acutely ill adult patients, the comprehensive care of complex chronic patients and the examination of a patient with a difficult diagnosis and no organ-specific disease. As support processes, we identified the structure and operation of the Internal Medicine units. As strategic processes, we identified training and research. The main subprocesses are structured below, and we established the standards and recommendations for each of them. Lastly, we proposed resulting workloads. The prepared standards must be reviewed within a maximum of 4 years. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  15. Determination of diclazuril in animal feed by liquid chromatography.

    PubMed

    De Kock, J; De Smet, M; Sneyers, R

    1992-07-31

    A method is described for the determination of diclazuril (Janssen Research Compound R64433; trademark Clinacox) in chicken feed at the mg kg(-1) level. Compound R062646, a structure analogous to diclazuril, was used as the interna standard. The drug was extracted from food with acidified methanol. Diclazuril was then isolated by means of solid-phase extraction with a cartridge containing a C18 phase. The eluate was evaporated and the residue redissolved in dimethylformamide. An aliquot was injected onto a reversed-phase high-performance liquid chromatographic column and the drug substance quantified at 280 nm by an ultraviolet detector. Extraction (absolute) recoveries of 85% for both internal standard and diclazuril were obtained. The method is suitable for diclazuril concentrations ranging from 0.1 to 1.5 mg kg(-1). Method validation data are presented.

  16. Development of the Anxiety Scale for Natural Disaster: Examination of its Reliability

    NASA Astrophysics Data System (ADS)

    Matsumoto, Miki; Yatabe, Ryuichi

    The objective of present study was to develop the a nxiety scale for natural disaster, and to examineits reliability. We developed the 14 items for the anxiety scale based on anticipated damage of Nankai earthquake in Ehime prefecture. The subjects consist of 391 people in Yawatahama city, Ehime prefecture. Firstly, we analyzed the latent factors which influenced the anxiety for natural disaster by using the factor analysis method. Secondly, we cal culated Cronbach's coefficient alpha. The result of the factor analysis confirmed the three factors such as "anxiety for lifeline damage", "anxiety for second ary disaster" and "fear for others". Cronbach's coefficient alpha for each factor showed the high interna l consistency reliability. We considered that each factor could prove to be a valuable tool for researc h about the person's anxiety for natural disaster.

  17. Lack of association between viral load and severity of acute bronchiolitis in infants.

    PubMed

    Souza, Ana Paula Duarte de; Leitão, Lidiane Alves de Azeredo; Luisi, Fernanda; Souza, Rodrigo Godinho; Coutinho, Sandra Eugênia; Silva, Jaqueline Ramos da; Mattiello, Rita; Pitrez, Paulo Márcio Condessa; Stein, Renato Tetelbom; Pinto, Leonardo Araújo

    2016-01-01

    To investigate the correlation between respiratory syncytial viral load and length of hospitalization in infants with acute wheezing episodes. This was a two-year, cross-sectional study of infants ≤ 12 months of age with bronchiolitis at the time of admission to a tertiary hospital. For the identification of respiratory viruses, nasopharyngeal secretions were collected. Samples were analyzed (throughout the study period) by direct immunofluorescence and (in the second year of the study) by quantitative real-time PCR. We screened for three human viruses: rhinovirus, respiratory syncytial virus, and metapneumovirus. Of 110 samples evaluated by direct immunofluorescence, 56 (50.9%) were positive for a single virus, and 16 (14.5%) were positive for two or more viruses. Among those 72 samples, the most prevalent virus was respiratory syncytial virus, followed by influenza. Of 56 samples evaluated by quantitative real-time PCR, 24 (42.8%) were positive for a single virus, and 1 (1.7%) was positive for two viruses. Among those 25 samples, the most prevalent virus was again respiratory syncytial virus, followed by human rhinovirus. Coinfection did not influence the length of the hospital stay or other outcome s. In addition, there was no association between respiratory syncytial virus load and the length of hospitalization. Neither coinfection nor respiratory syncytial viral load appears to influence the outcomes of acute bronchiolitis in infants. Investigar a correlação entre a carga viral do vírus sincicial respiratório e o tempo de internação hospitalar em lactentes com episódios de sibilância aguda. Este foi um estudo transversal de dois anos envolvendo lactentes de até 12 meses de idade com bronquiolite no momento da internação em um hospital terciário. Para a identificação dos vírus respiratórios foram coletadas secreções nasofaríngeas. As amostras foram analisadas (por todo o período do estudo) por imunofluorescência direta e (no segundo ano

  18. Pernicious anemia. From past to present.

    PubMed

    Rodríguez de Santiago, E; Ferre Aracil, C; García García de Paredes, A; Moreira Vicente, V F

    2015-01-01

    Pernicious anemia is currently the most common cause of vitamin B12 deficiency in Western countries. The histological lesion upon which this condition is based is autoimmune chronic atrophic gastritis. The destruction of parietal cells causes a deficiency in intrinsic factor, an essential protein for vitamin B12 absorption in the terminal ileum. Advances in the last two decades have reopened the debate on a disease that seemed to have been forgotten due to its apparent simplicity. The new role of H. pylori, the value of parietal cell antibodies and intrinsic factor antibodies, the true usefulness of serum vitamin B12 levels, the risk of adenocarcinoma and gastric carcinoids and oral vitamin B12 treatment are just some of the current issues analyzed in depth in this review. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  19. Treatment of Superior Vena Cava (SVC) Syndrome and Inferior Vena Cava (IVC) Thrombosis in a Patient with Colorectal Cancer: Combination of SVC Stenting and IVC Filter Placement to Palliate Symptoms and Pave the Way for Port Implantation

    SciTech Connect

    Sauter, Alexander; Triller, Juergen; Schmidt, Felix; Kickuth, Ralph

    2008-07-15

    Thrombosis of the inferior vena cava is a life-threatening complication in cancer patients leading to pulmonary embolism. These patients can also be affected by superior vena cava syndrome causing dyspnea followed by trunk or extremity swelling. We report the case of a 61-year-old female suffering from an extended colorectal tumor who became affected by both of the mentioned complications. Due to thrombus formation within the right vena jugularis interna, thrombosis of the inferior vena cava, and superior vena cava syndrome, a combined interventional procedure via a left jugular access with stenting of the superior vena cava and filter placement into the inferior vena cava was performed As a consequence, relief of the patient's symptoms, prevention of pulmonary embolism, and paving of the way for further venous chemotherapy were achieved.

  20. Working group 4 of International Standardization Organization -experience of developing the standards of space environment: status of 2010 and roadmap for the future

    NASA Astrophysics Data System (ADS)

    Panasyuk, Mikhail; Tobiska, W. Kent

    Since the beginning of 90's space environment international standards have been developed within the scope of ISO WG4 activities. This has been the first attempt to develop interna-tional standards of physical phenomena of natural environment such as galactic cosmic rays (GCR), solar energetic particles (SEP), the Earth's magnetic field, the ionosphere, the plasma-sphere, etc. The main difficulty faced when developing the international standards is the lack of common methods for characterizing many natural phenomena. However, if methods have been successfully developed, such standards can play an outstanding role in the engineering requirements for spacecraft designs. This report is a survey of the current status of the inter-national standards under development within the scope of the WG4 activity plan and roadmap for the future.

  1. Behavioral and neuronal changes during treatment of mixed transcortical aphasia: a case study.

    PubMed

    Pulvermüller, F; Schönle, P W

    1993-08-01

    The development of language mechanisms outside the traditional language regions is evidenced by the case of K.S., a patient with chronic mixed transcortical aphasia, that is, good repetition performance compared to all other language abilities. The aphasia was caused by an infarction of the left a. carotis interna that completely destroyed the left perisylvian language region and adjacent structures. Five years post onset the patient underwent intensive aphasia therapy. In the treatment setting chosen, both speech production and comprehension abilities improved as demonstrated by adequacy and reaction time scores. It is argued that the behavioral changes observed are likely to be due to (a) newly acquired communicative strategies and (b) neuronal changes within K.S.'s brain. The behavioral changes are explained in terms of strengthening of synaptic connections and formation of Hebbian cell assemblies corresponding to words.

  2. Polypathology, an emerging phenomenon and a challenge for healthcare systems.

    PubMed

    Román, P; Ruiz-Cantero, A

    2017-05-01

    Improvements in living conditions and scientific advances have led to an unprecedented demographic change. The curing of numerous acute diseases and the growing adoption of unhealthy lifestyles have caused a pandemic of cumulative chronic diseases that constitute the leading cause of death worldwide. Currently, the most common situation is the coexistence of multiple chronic diseases (or polypathology). This situation undermines socio-economic development and increases inequality. This results in an overriding need to change the way in which health and disease are addressed. Healthcare systems are not prepared to meet the needs of complex polypathological patients. In this article, we summarise the challenges facing healthcare systems and states, as well as the main recommendations from the organisations responsible for healthcare. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  3. Production and immunohistochemical characterization of monoclonal antibodies against ovarian antigen of the common tree shrew (Tupaia glis).

    PubMed

    Kimura, J; Mukawa, H; Endo, H; Rerkamnuaychoke, W; Kurohmaru, M; Yamada, J; Tsukise, A; Nishida, T

    1998-02-01

    To study the ovarian function of the common tree shrew (Tupaia glis), monoclonal antibodies (MAb) against its ovarian antigen were produced. Several positive hybridomas were cloned and MAb-T2C9 (IgG) was examined for reactivity. Strong immunoreactivity of MAb-T2C9 was localized within the cytoplasm of luteal cells and in the theca interna cells of Graafian follicles. MAb-T2C9 reacted also with testicular interstitial cells and adrenocortical cells, except those of the zona glomerulosa. Similar reactions were seen in the goat and sheep. Western blotting analysis of the ovine corpus luteum after reaction with MAb-T2C9 revealed a single positive band of approximately 60 kDa. These findings suggest that MAb-T2C9 recognized protein molecules related to steroid synthesis.

  4. Red eye: Rule out Ophthalmomyiasis too

    PubMed Central

    Choudhary, Pankaj; Rathore, Mahesh Kumar; Dwivedi, Premchand; Lakhtakia, Sujata; Chalisgaonkar, Charudatt; Dwivedi, Anamika

    2013-01-01

    Ophthalmomyiasis is the infestation of human eye by the larvae of certain flies. Sheep botfly commonly manifests as Ophthalmomyiasis externa when there is conjunctival involvement or rarely as Opthalmomyiasis interna when there is larval penetration into the eyeball. It appears to be more common than what has been indicated by previously published reports. We present a report of seven cases of Ophthalmomyiasis by Oestrus ovis, from central India who presented with features of conjunctivitis varying between mild to severe. The larvae were seen in bulbar and palpebral conjunctiva and also entangled in lashes with discharge. Since the larvae are photophobic, it is prudent to look for them in the fornices and also in discharge. Prompt removal of the larvae from the conjunctiva helps in relieving the symptoms and also prevents serious complications. Taxonomic identification of the species is important to estimate the risk of globe penetration by the larvae. PMID:23803482

  5. A Stepwise Approach: Decreasing Infection in Deep Brain Stimulation for Childhood Dystonic Cerebral Palsy.

    PubMed

    Johans, Stephen J; Swong, Kevin N; Hofler, Ryan C; Anderson, Douglas E

    2017-09-01

    Dystonia is a movement disorder characterized by involuntary muscle contractions, which cause twisting movements or abnormal postures. Deep brain stimulation has been used to improve the quality of life for secondary dystonia caused by cerebral palsy. Despite being a viable treatment option for childhood dystonic cerebral palsy, deep brain stimulation is associated with a high rate of infection in children. The authors present a small series of patients with dystonic cerebral palsy who underwent a stepwise approach for bilateral globus pallidus interna deep brain stimulation placement in order to decrease the rate of infection. Four children with dystonic cerebral palsy who underwent a total of 13 surgical procedures (electrode and battery placement) were identified via a retrospective review. There were zero postoperative infections. Using a multistaged surgical plan for pediatric patients with dystonic cerebral palsy undergoing deep brain stimulation may help to reduce the risk of infection.

  6. Pathophysiology of acute heart failure: a world to know.

    PubMed

    Sánchez-Marteles, M; Rubio Gracia, J; Giménez López, I

    2016-01-01

    Our understanding of the pathophysiological mechanisms of heart failure (HF) has changed considerably in recent years, progressing from a merely haemodynamic viewpoint to a concept of systemic and multifactorial involvement in which numerous mechanisms interact and concatenate. The effects of these mechanisms go beyond the heart itself, to other organs of vital importance such as the kidneys, liver and lungs. Despite this, the pathophysiology of acute HF still has aspects that elude our deeper understanding. Haemodynamic overload, venous congestion, neurohormonal systems, natriuretic peptides, inflammation, oxidative stress and its repercussion on cardiac and vascular remodelling are currently considered the main players in acute HF. Starting with the concept of acute HF, this review provides updates on the various mechanisms involved in this disease. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  7. Involvement of systemic venous congestion in heart failure.

    PubMed

    Rubio Gracia, J; Sánchez Marteles, M; Pérez Calvo, J I

    2017-04-01

    Systemic venous congestion has gained significant importance in the interpretation of the pathophysiology of acute heart failure, especially in the development of renal function impairment during exacerbations. In this study, we review the concept, clinical characterisation and identification of venous congestion. We update current knowledge on its importance in the pathophysiology of acute heart failure and its involvement in the prognosis. We pay special attention to the relationship between abdominal congestion, the pulmonary interstitium as filtering membrane, inflammatory phenomena and renal function impairment in acute heart failure. Lastly, we review decongestion as a new therapeutic objective and the measures available for its assessment. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  8. Safety of diabetes drugs in patients with heart failure.

    PubMed

    Carrasco-Sánchez, F J; Ostos-Ruiz, A I; Soto-Martín, M

    2017-08-28

    Heart failure (HF) and diabetes mellitus are 2 clinical conditions that often coexist, particularly in patients older than 65 years. Diabetes mellitus promotes the development of HF and confers a poorer prognosis. Hypoglycaemic agents (either by their mechanism of action, hypoglycaemic action or adverse effects) can be potentially dangerous for patients with HF. In this study, we performed a review of the available evidence on the safety of diabetes drugs in HF, focused on the main observational and experimental studies. Recent studies on cardiovascular safety have evaluated, although as a secondary objective, the impact of new hypoglycaemic agents on HF, helping us understand the neutrality, risks and potential benefits of these agents. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  9. Thoracic ultrasonography: A new method for the work-up of patients with dyspnea().

    PubMed

    Vitturi, N; Soattin, M; Allemand, E; Simoni, F; Realdi, G

    2011-09-01

    SommarioLa diagnosi differenziale di dispnea è fondamentale per la gestione dell’insufficienza respiratoria in cui, ai parametri routinari, può essere ora affiancata l’ecografia toracica. L’obiettivo di questo studio è stato valutare la validità e l’accuratezza di questa metodica anche in un reparto di medicina interna. MATERIALI E METODI: 152 pazienti ricoverati conseguentemente con diagnosi di dispnea sono stati esaminati dopo valutazione clinica, radiografia del torace, dosaggi bioumorali (NT-proBNP) e terapia d’emergenza. L’esame ecografico polmonare è stato considerato positivo qualora il numero totale di linee B fosse superiore ad 8. L’esame ecografico e il dosaggio dell’NT-proBNP sono stati ripetuti dopo 48 ore. Il gold standard di riferimento è stato la diagnosi clinica di scompenso cardiaco fatta da medici esperti secondo le linee guida dell’AHA. RISULTATI: Il gruppo di pazienti che mostrava un esame ecografico positivo riceveva in percentuale maggiore la diagnosi finale di insufficienza cardiaca (X 92.5; p < 0.005) e valori significativamente più elevati di NT-proBNP (10,384 ng/l vs 3889 ng/l; p < 0.05). Inoltre la diminuzione delle linee B a 48 ore era significativamente maggiore (p < 0.005) nel gruppo di pazienti trattati per scompenso cardiaco mentre non vi erano cambiamenti significativi nei valori di NT-proBNP (p = 0.37). DISCUSSIONE: In conclusione abbiamo dimostrato che anche in un reparto di medicina interna l’ecografia polmonare è uno strumento diagnostico utile per le gestione dell’insufficienza respiratoria e il suo monitoraggio durante la terapia.

  10. Clinical signs, magnetic resonance imaging features, and outcome after surgical and medical treatment of otogenic intracranial infection in 11 cats and 4 dogs.

    PubMed

    Sturges, Beverly K; Dickinson, Peter J; Kortz, Gregg D; Berry, Wayne L; Vernau, Karen M; Wisner, Erik R; LeCouteur, Richard A

    2006-01-01

    Brainstem dysfunction resulting from central extension of infection is a life-threatening complication of otitis media/interna (OMI) that has been described infrequently in dogs and cats. We review the clinical signs of disease, diagnostic findings, and results of surgical and medical treatments of brainstem disease attributable to otogenic intracranial infection in cats and dogs. Eleven cats and 4 dogs were examined because of acute, subacute, or chronic clinical signs of brain disease including central vestibular signs, altered mentation, abnormal posture/gait, cranial nerve deficits, and seizures. Results of a minimal database (CBC, serum biochemical panel, urinalysis, thoracic radiographs, and abdominal ultrasonographic images or radiographs) were within reference intervals in all animals. Magnetic resonance (MR) images of the head were acquired for all animals, and cisternal cerebrospinal fluid (CSF) from 9 of 11 cats and 3 of 4 dogs was examined. Surgical exploration and ventral bulla osteotomy were done for 12 of 15 animals, followed by 1-3 months of antibiotic therapy; the remaining animals were euthanized before treatment. In all animals, MR imaging was effective in characterizing the location and extent of the pathologic changes intracranially as well as within middle/inner ear structures. Results of CSF analysis were characteristic of bacterial infection in most of the animals with acute or subacute disease. Since long-term outcome in all treated animals was very good to excellent, it was concluded that dogs and cats with intracranial disease secondary to extension of otitis media/interna have a good-to-excellent prognosis when the condition was diagnosed and was treated by surgical exploration and appropriate antibiotic therapy.

  11. Management of the Axilla in T1-2 Breast Cancer Patients with Macrometastatic Sentinel Node Involvement Who Underwent Breast-Conserving Therapy.

    PubMed

    Kuru, Bekir; Yuruker, Savas; Sullu, Yurdanur; Gursel, Bilge; Ozen, Necati

    2017-09-25

    The aims of our study were to determine the incidence of axillary recurrence and arm morbidity in T1-2 invasive breast cancer patients with macrometastases on the sentinel lymph node (SLN) who underwent breast-conserving therapy (BCT), with or without axillary lymph node dissection (ALND). One hundred and nine T1-2 invasive breast cancer patients with macrometastases on the SLN who underwent BCT in our institution were included in the study. Patients with 1-2 positive SLN and without extra nodal extension (ENE) on the SLN did not undergo ALND (SLN-only group) and patients with ENE or patients who had >2 metastatic nodes underwent level I, II ALND (ALND group). The SLN-only group received radiotherapy to three axillary levels, the supraclavicular fossa, and ± mammaria interna. ALND group received radiotherapy to axillary level III, the supraclavicular fossa, and ± mammaria interna. The incidence of axillary recurrence and arm morbidity were investigated. Of the 109 patients, 18 patients with >2 metastatic SLNs and 10 with ENE on the SLN underwent ALND and 81 patients underwent SLN only. Median follow-up time was 37 months (3-77). There was no axillary recurrence in SLN-only group. However, in the ALND group 1 patient had developed axillary metastasis. There were 2 objective lymphoedema and 3 arm-shoulder restriction cases in the SLN-only group, and 2 and 3 in the ALND group, respectively. Axillary dissection could safely be omitted in patients with 1-2 macrometastatic SLN and without ENE who undergo BCT and axillary radiotherapy.

  12. [A pilot study on the living with a chronic process scale in patients with Parkinson's disease].

    PubMed

    Ambrosio, Leire; Portillo, M Carmen; Rodríguez-Blázquez, Carmen; Carvajal, Ana; Martínez-Martín, Pablo

    2015-11-16

    Introduccion. Para proporcionar un cuidado individualizado e integral a los pacientes con una enfermedad cronica es necesario conocer como conviven con su trastorno. En la actualidad, no existe una escala validada que evalue este aspecto. Objetivo. Presentar el estudio piloto de la version preliminar de la escala de convivencia con un proceso cronico (EC-PC) realizado en pacientes con enfermedad de Parkinson (EP) en España. Pacientes y metodos. Se elaboro una version preliminar de la escala a partir de una revision bibliografica y la participacion de expertos en procesos cronicos y en EP. Quince pacientes, en todos los estadios de la EP, cumplimentaron la version preliminar de la EC-PC (39 items) y un cuestionario sobre la EC-PC. Se analizaron la viabilidad/aceptabilidad y aspectos preliminares de consistencia interna. Resultados. Ningun dominio presento efecto suelo o techo, pero un 43,6% de los items tenia efecto techo. La correlacion item-total corregida fue satisfactoria, excepto en cinco items. La consistencia interna de los cinco dominios resulto satisfactoria, con indices alfa de 0,81-0,92 y coeficientes de homogeneidad de los items de 0,19-0,43. Los pacientes identificaron tres items como ambiguos y dificiles de responder. A partir de estos resultados, se eliminaron 12 items y se elaboro la version final de la EC-PC, cuyo contenido fue considerado satisfactorio tras su evaluacion por profesionales expertos. Conclusiones. La EC-PC, pendiente de validacion, es una escala viable, de interes potencial en el ambito clinico y sociosanitario para evaluar la convivencia con un proceso cronico como la EP.

  13. [Translation and validation of the Individualised Neuromuscular Quality of Life scale for the Spanish population: quality of life assessment for persons with neuromuscular diseases].

    PubMed

    Fagoaga, J; Girabent-Farres, M; Bagur-Calafat, C

    2017-03-01

    Introduccion. La escala Individualized Neuromuscular Quality of Life (INQoL) es un cuestionario que valora la calidad de vida relacionada con la salud de personas adultas con enfermedades neuromusculares. Objetivo. Validar y analizar la fiabilidad de la version española de la INQoL, como instrumento de medicion de la calidad de vida relacionada con la salud en individuos con enfermedades neuromusculares. Pacientes y metodos. Se realiza una traduccion-retrotraduccion de la INQoL en la poblacion española y, posteriormente, para el analisis de fiabilidad se llevan a cabo dos mediciones, test-retest, a 50 pacientes de 19 a 67 años. De este modo se evalua la concordancia intraobservador y se evalua la consistencia interna de la escala. Resultados. El estudio de la fiabilidad del indice de concordancia intraobservador tiene un valor de excelente en siete de las diez subdimensiones y en la puntuacion total de la calidad de vida; de buena, en dos; y de moderada, en una. El analisis del alfa de Cronbach para las subdimensiones de la INQoL tiene un valor de excelente (> 0,818) en siete de ellas, asi como en la puntuacion total de la calidad de vida relacionada con la salud (0,928), un valor de buena consistencia interna en tres de las subdimensiones y de moderada en una. Conclusiones. La version española de la INQoL es un instrumento valido y fiable como herramienta de medicion de la calidad de vida en individuos adultos con enfermedades neuromusculares.

  14. Differences in brain activation between tremor- and nontremor-dominant Parkinson disease.

    PubMed

    Prodoehl, Janey; Planetta, Peggy J; Kurani, Ajay S; Comella, Cynthia L; Corcos, Daniel M; Vaillancourt, David E

    2013-01-01

    OBJECTIVE To compare differences in functional brain activity between tremor- and nontremor-dominant subtypes of Parkinson disease (PD) using functional magnetic resonance imaging. DESIGN In our study, patients with tremor-dominant PD and those with nontremor-dominant PD performed a grip task, and the results obtained were compared using voxelwise analysis. Areas of the brain that were significantly different were then examined using a region-of-interest analysis to compare these patients with healthy controls. Voxel-based morphometry was used to determine macroscopic differences in gray and white matter volume between patient groups. SETTING University-affiliated research institution. PARTICIPANTS A total of 20 drug-naive patients with PD (10 with tremor-dominant PD and 10 with nontremor-dominant PD) and a total of 20 healthy controls. MAIN OUTCOME MEASURES Blood oxygenation level-dependent activation and percent signal change. RESULTS Robust findings across both voxelwise and region-of-interest analyses showed that, compared with patients with tremor-dominant PD, patients with nontremor-dominant PD had reduced activation in the ipsilateral dorsolateral prefrontal cortex, the globus pallidus interna, and the globus pallidus externa. Region-of-interest analyses confirmed that patients with nontremor-dominant PD had reduced activity in the ipsilateral dorsolateral prefrontal cortex, the globus pallidus interna, and the globus pallidus externa compared with patients with tremor-dominant PD and healthy controls. Patients with tremor-dominant PD had increased activity in the contralateral dorsolateral prefrontal cortex compared with patients with nontremor-dominant PD and healthy controls. These results could not be explained by differences in gray or white matter volume. CONCLUSIONS Reduced brain activity occurs in the prefrontal cortex and globus pallidus of patients with nontremor-dominant PD compared with both patients with tremor-dominant PD and healthy controls

  15. Structure of the ovaries of the Nimba otter shrew, Micropotamogale lamottei, and the Madagascar hedgehog tenrec, Echinops telfairi.

    PubMed

    Enders, A C; Carter, A M; Künzle, H; Vogel, P

    2005-01-01

    The otter shrews are members of the subfamily Potamogalinae within the family Tenrecidae. No description of the ovaries of any member of this subfamily has been published previously. The lesser hedgehog tenrec, Echinops telfairi, is a member of the subfamily Tenrecinae of the same family and, although its ovaries have not been described, other members of this subfamily have been shown to have ovaries with non-antral follicles. Examination of these two species illustrated that non-antral follicles were characteristic of the ovaries of both species, as was clefting and lobulation of the ovaries. Juvenile otter shrews range from those with only small follicles in the cortex to those with 300- to 400-microm follicles similar to those seen in non-pregnant and pregnant adults. As in other species, most of the growth of the oocyte occurred when follicles had one to two layers of granulosa cells. When larger follicles became atretic in the Nimba otter shrew, hypertrophy of the theca interna produced nodules of glandular interstitial tissue. In the tenrec, the hypertrophying theca interna cells in most large follicles appeared to undergo degeneration. Both species had some follicular fluid in the intercellular spaces between the more peripheral granulosa cells. It is suggested that this fluid could aid in separation of the cumulus from the remaining granulosa at ovulation. The protruding follicles in lobules and absence of a tunica albuginea might also facilitate ovulation of non-antral follicles. Ovaries with a thin-absent tunica albuginea and follicles with small-absent antra are widespread within both the Eulipotyphla and in the Afrosoricida, suggesting that such features may represent a primitive condition in ovarian development. Lobulated and deeply crypted ovaries are found in both groups but are not as common in the Eulipotyphla making inclusion of this feature as primitive more speculative. Copyright 2005 S. Karger AG, Basel.

  16. [Cultural adaptation and Argentine validation of the Northwick Park Neck Pain Questionnaire in the hospitals of the Autonomous City of Buenos Aires].

    PubMed

    Aguirre, Mariana V; Rodríguez, Matias G; Clarett, Martín; Iribarne, Juan I; Martínez, Marianela; Battistotti, Romina; López de Arcaute, Ana S; Adarves, Romina; Orsini, Esteban

    2013-01-01

    Objetivo: realizar la adaptación cultural y validación del Cuestionario Northwick Park (NPQ) en Argentina, determinando sus propiedades psicométricas, en pacientes con dolor cervical de origen mecánico derivados al Servicio de Kinesiología del Hospital D. F. Santojanni. Materiales y Métodos: Se solicitó la autorización del autor original del NPQ, luego se realizó la adaptación lingüística y prueba piloto. Las propiedades psicométricas incluyeron: confiabilidad test-retest (coeficiente de correlación intraclase, CCI), validez (coeficiente de correlación de Pearson NPQ-Escala Análoga Visual, EVA), consistencia interna (alfa de Cronbach) y sensibilidad al cambio (prueba T para pruebas pareadas NPQ-EVA). Se incluyeron consecutivamente 60 pacientes de septiembre de 2007 a febrero de 2009 con dolor cervical mecánico. Se midieron las variables porcentaje de discapacidad (NPQ) y dolor (EVA) al día del ingreso, a las 24 horas y al alta. Resultados: Veintiséis pacientes completaron el estudio, 4 fueron eliminados y 30 no completaron la 3° medición. Se obtuvo una buena confiabilidad test-retest (ICC 0.8979) y una alta consistencia interna (alfa de Cronbach 0.86). La validez mostró una buena correlación (r= 0,678). La sensibilidad al cambio fue buena (r=0.661). Conclusión: El NPQ es un instrumento válido, confiable y sensible para evaluar la discapacidad asociada al dolor cervical de origen mecánico en pacientes atendidos en el ámbito hospitalario de la Ciudad Autónoma de Buenos Aires.

  17. [Transcultural translation-adaptation to Spanish of the Infants' Dermatitis Quality of Life questionnaire for children under four years with atopic dermatitis].

    PubMed

    Maza-De Franco, Carmen Alexandra; Morales-Sánchez, Martha Alejandra; Morales-Barrera, María Enriqueta

    2016-01-01

    Antecedentes: La dermatitis atópica se observa hasta en 20% de los niños, de ahí la importancia de instrumentos para apoyo de su evaluación. Objetivo: Determinar la validez y confiabilidad de la adaptación al español del cuestionario IDQOL en pacientes <4 años de edad con dermatitis atópica (DA). Métodos: Traducción y retrotraducción del cuestionario; se hizo una prueba piloto en 30 niños con DA para obtener una versión definitiva. Se midió la confiabilidad interna (alfa de Cronbach) y correlación de puntajes del IDQOL y SCORAD (coeficiente de correlación de Pearson). Resultados: Se incluyeron 102 niños con edad entre dos y 48 meses. El coeficiente de correlación de Pearson (r) de los puntajes del IDQOL y SCORAD fue de 0.697 (p=0.0001), indicativo de una correlación positiva alta. La correlación entre la gravedad medida por el cuidador y el puntaje del SCORAD (r=0.565, p=0.0001) resultó ser positiva baja. La consistencia interna del IDQOL mediante alfa de Cronbach fue de 0.84, indicativa de buena consistencia del instrumento para evaluar calidad de vida. Conclusión: El cuestionario IDQOL en español es un válido para medir la calidad de vida en pacientes <4 años con DA y útil en el seguimiento y en los ensayos clínicos.

  18. Clinical Validation of the Nursing Outcome "Swallowing Status" in People with Stroke: Analysis According to the Classical and Item Response Theories.

    PubMed

    Oliveira-Kumakura, Ana Railka de Souza; de Araujo, Thelma Leite; Costa, Alice Gabrielle de Sousa; Cavalcante, Tahissa Frota; Lopes, Marcos Venícios de Oliveira; Carvalho, Emilia Campos

    2017-09-19

    To validate clinically the nursing outcome "Swallowing status". The adjustment of the nursing outcome was investigated according to the Classical and Item Response Theories. The models were compared regarding information loss, goodness-of-fit, and differential item functioning. Stability and internal consistency were examined. The nursing outcome has the best fit in the generalized partial credit model with different discrimination parameters. Strong correlations among the scores of each indicator were observed. There was no differential item functioning of the outcome indicators. The scale presented high internal consistency (Cronbach's α = .954) and stability (and > .800). This study presents a valid nursing outcome. Most accurate monitoring of sensitivity to an intervention. Validar clinicamente o resultado de enefermagem "Estado da Deglutição". MÉTODOS: O ajustamento do resultado foi investigado de acordo com as teorias Clássica e de Resposta ao Item. Os modelos foram comparados assumindo parâmetros de itens cruzados de igual discriminação. Investigaram-se as propriedades de bondade do ajuste, funcionamento diferencial dos itens, estabilidade e consistência interna. O resultado se ajustou melhor a partir do Modelo de crédito parcial generalizado, o qual demonstrou unidimensionalidade do resultado e forte correlação entre os escores de cada indicador. Não houve funcionamento diferencial dos indicadores. A consistência interna para a escala global (Cronbach's α = .954) e a estabilidade (>.800) mantiveram-se elevadas. CONCLUSÃO: O estudo apresenta um resultado de enfermagem válido. RELEVÂNCIA PARA A PRÁTICA CLÍNICA: Maior acurácia para monitorar a sensibilidade da intervenção. © 2017 NANDA International, Inc.

  19. A fonte ionizante do disco de acreção no núcleo de NGC1097

    NASA Astrophysics Data System (ADS)

    Silva, R. N.; Storchi-Bergmann, T.

    2003-08-01

    Observações em raios-X revelam o "coração" dos núcleos ativos de galáxias, pois esse tipo de radiação provém das suas regiões mais internas, próximas ao buraco negro central. Neste trabalho apresentamos observações em raios-X da região central da galáxia NGC1097, que hospeda um buraco negro supermassivo e um disco de acreção cuja emissão vem sendo observada há dez anos através da linha de emissão Ha larga (10000 km/s) e de duplo pico. As observações em raios-X - que foram obtidas com o Telescópio Chandra - foram combinadas com observações no ultravioleta obtidas com o Telescópio Espacial Hubble e são usadas para estudar as características da fonte central que ioniza o disco de acreção. A distribuição espectral de energia é comparada com a predita por modelos, em particular o de uma estrutura "ADAF" ("advection dominated accretion flow") na parte interna do disco. Tal estrutura produz um espectro de emissão de linhas estreitas tipo LINER, como observado em NGC1097 e em rádio-galáxias que apresentam linhas de Balmer largas de duplo pico. Apresentamos também uma comparação entre outros LINERs com linhas de emissão largas de duplo pico, disponíveis na literatura ou nos arquivos do Chandra e do Telescópio Espacial Hubble e discutimos as correspondentes implicações para modelos da fonte central.

  20. Evaluation of the Psychometric Properties of NOC Outcomes "Anxiety Level" and "Anxiety Self-Control" in a Portuguese Outpatient Sample.

    PubMed

    Sampaio, Francisco Miguel Correia; Araújo, Odete Sofia Silva Lomba; Sequeira, Carlos Alberto da Cruz; Lluch Canut, María Teresa; Martins, Teresa

    2017-01-25

    To adopt the language and to evaluate the psychometric properties of "Anxiety level" and "Anxiety self-control" NOC outcomes in Portuguese adult patients. Methodological design. The final European Portuguese version of the NOC outcome "Anxiety level," composed by 16 indicators, proved excellent internal consistency. Exploratory factor analysis (EFA) was forced to three factors. The NOC outcome "Anxiety self-control," composed of nine indicators, demonstrated a questionable internal consistency. EFA was forced to two factors. European Portuguese versions of the studied NOC outcomes proved to be tools with acceptable psychometric properties for evaluating anxiety in Portuguese patients. This study contributed to the development of NOC language and to the enrichment of nursing's body of knowledge. Adaptar a linguagem e avaliar as propriedades psicométricas dos resultados NOC "Nível de ansiedade" e "Autocontrolo da ansiedade" em utentes portugueses adultos. MÉTODOS: Estudo metodológico. A versão portuguesa do resultado NOC "Nível de ansiedade", composta por 16 indicadores, apresentou uma excelente consistência interna. A análise fatorial exploratória (AFE) foi forçada a três dimensões. O resultado NOC "Autocontrolo da ansiedade", composto por nove indicadores, apresentou uma consistência interna questionável. A AFE foi forçada a duas dimensões. CONCLUSÕES: As versões portuguesas dos resultados NOC estudados são instrumentos com propriedades psicométricas aceitáveis para avaliar a ansiedade em utentes portugueses. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Este estudo contribuiu para o desenvolvimento da linguagem NOC e para enriquecer o corpo de conhecimento de Enfermagem. © 2017 NANDA International, Inc.

  1. Developmental Programming: Does Prenatal Steroid Excess Disrupt the Ovarian VEGF System in Sheep?1

    PubMed Central

    Ortega, Hugo Héctor; Veiga-Lopez, Almudena; Sreedharan, Shilpa; del Luján Velázquez, Melisa María; Salvetti, Natalia Raquel; Padmanabhan, Vasantha

    2015-01-01

    Prenatal testosterone (T), but not dihydrotestosterone (DHT), excess disrupts ovarian cyclicity and increases follicular recruitment and persistence. We hypothesized that the disruption in the vascular endothelial growth factor (VEGF) system contributes to the enhancement of follicular recruitment and persistence in prenatal T-treated sheep. The impact of T/DHT treatments from Days 30 to 90 of gestation on VEGFA, VEGFB, and their receptor (VEGFR-1 [FLT1], VEGFR-2 [KDR], and VEGFR-3 [FLT4]) protein expression was examined by immunohistochemistry on Fetal Days 90 and 140, 22 wk, 10 mo (postpubertal), and 21 mo (adult) of age. Arterial morphometry was performed in Fetal Day 140 and postpubertal ovaries. VEGFA and VEGFB expression were found in granulosa cells at all stages of follicular development with increased expression in antral follicles. VEGFA was present in theca interna, while VEGFB was present in theca interna/externa and stromal cells. All three receptors were expressed in the granulosa, theca, and stromal cells during all stages of follicular development. VEGFR-3 increased with follicular differentiation with the highest level seen in the granulosa cells of antral follicles. None of the members of the VEGF family or their receptor expression were altered by age or prenatal T/DHT treatments. At Fetal Day 140, area, wall thickness, and wall area of arteries from the ovarian hilum were larger in prenatal T- and DHT-treated females, suggestive of early androgenic programming of arterial differentiation. This may facilitate increased delivery of endocrine factors and thus indirectly contribute to the development of the multifollicular phenotype. PMID:26178718

  2. [Association of stress hyperglycemia and in-hospital complications].

    PubMed

    Galindo-García, Gerardo; Galván-Plata, María Eugenia; Nellen-Hummel, Haiko; Almeida-Gutiérrez, Eduardo

    2015-01-01

    Introducción: la hiperglucemia de estrés es la elevación de la glucosa sérica que se encuentra a la admisión hospitalaria de un paciente. El objetivo fue evaluar el impacto de la hiperglucemia de estrés al ingreso en el desenlace de pacientes no críticos hospitalizados en un servicio de Medicina Interna. Métodos: estudio de cohorte prospectivo y analítico realizado en pacientes de Medicina Interna del Hospital de Especialidades del Centro Médico Nacional Siglo XXI del Instituto Mexicano del Seguro Social, de septiembre de 2011 a febrero de 2012. Resultados: se incluyeron 89 pacientes con niveles séricos de glucosa < 110 mg/dL (grupo A) y 90 pacientes con niveles de glucosa > 110 mg/dL (grupo B). La diabetes mellitus fue más frecuente en el grupo B (p < 0.001). La hemoglobina glucosilada mayor a 6.5 % se encontró en el 36.4 % de los pacientes del grupo B y en el 8.7 % del grupo A, (p < 0.001). Los pacientes del grupo B tuvieron mayor puntuación en el APACHE II (p = 0.02) y tendencia a mayor frecuencia de complicaciones. Conclusiones: la hiperglucemia de estrés se asocia a una mayor puntuación de APACHE II, y tiende a una mayor frecuencia de enfermedad crítica, sepsis, infección de vías urinarias, neumonía y uso de aminas vasopresoras. Los predictores independientes de muerte fueron la presencia de hipertensión arterial y el score APACHE II.

  3. Hospitalization of people 50 years old or older living with HIV/AIDS.

    PubMed

    Pio, Daiana Patrícia Marchetti; Reinato, Lilian Andreia Fleck; Lopes, Letícia Pimenta; Caliari, Juliano de Souza; Gir, Elucir

    2017-01-01

    Identify the rate and predictive factors of the hospitalization of people living with HIV/AIDS (PLHA), aged 50 years or older. A quantitative, cross-sectional study was conducted at two inpatient units specialized in infectious diseases in a teaching hospital. Data were gathered through individual interviews between August 2011 and February 2015. All ethical precepts were followed. Of the 532 admitted patients, 95 were PLHA 50 years old or older; 30.5% were admitted 3 to 4 times after being diagnosed with HIV/AIDS. Rate of hospitalization was 17.8%, and being 50 to 60 years old was a protective factor against hospitalization. Identificar a taxa e os fatores preditores para a hospitalização de pessoas vivendo com HIV/Aids (PVHA), com idade igual ou superior a 50 anos. Estudo quantitativo, transversal, realizado em duas unidades de internação especializadas em cuidados às doenças infecciosas, de um hospital universitário. A coleta de dados foi realizada por meio de entrevista individual, no período de agosto de 2011 a fevereiro de 2015. Todos os preceitos éticos foram contemplados. Das 532 internações, 95 eram de PVHA com idade igual ou superior a 50 anos; 56,8% receberam o diagnóstico de HIV/Aids antes de terem completado 50 anos de idade; 30,5% foram hospitalizadas de 3 a 4 vezes após o diagnóstico da infecção pelo HIV/Aids. A taxa de hospitalização foi de 17,8%, e a faixa etária de 50 a 60 anos foi fator de proteção para a hospitalização.

  4. Developmental Programming: Does Prenatal Steroid Excess Disrupt the Ovarian VEGF System in Sheep?

    PubMed

    Ortega, Hugo Héctor; Veiga-Lopez, Almudena; Sreedharan, Shilpa; del Luján Velázquez, Melisa María; Salvetti, Natalia Raquel; Padmanabhan, Vasantha

    2015-09-01

    Prenatal testosterone (T), but not dihydrotestosterone (DHT), excess disrupts ovarian cyclicity and increases follicular recruitment and persistence. We hypothesized that the disruption in the vascular endothelial growth factor (VEGF) system contributes to the enhancement of follicular recruitment and persistence in prenatal T-treated sheep. The impact of T/DHT treatments from Days 30 to 90 of gestation on VEGFA, VEGFB, and their receptor (VEGFR-1 [FLT1], VEGFR-2 [KDR], and VEGFR-3 [FLT4]) protein expression was examined by immunohistochemistry on Fetal Days 90 and 140, 22 wk, 10 mo (postpubertal), and 21 mo (adult) of age. Arterial morphometry was performed in Fetal Day 140 and postpubertal ovaries. VEGFA and VEGFB expression were found in granulosa cells at all stages of follicular development with increased expression in antral follicles. VEGFA was present in theca interna, while VEGFB was present in theca interna/externa and stromal cells. All three receptors were expressed in the granulosa, theca, and stromal cells during all stages of follicular development. VEGFR-3 increased with follicular differentiation with the highest level seen in the granulosa cells of antral follicles. None of the members of the VEGF family or their receptor expression were altered by age or prenatal T/DHT treatments. At Fetal Day 140, area, wall thickness, and wall area of arteries from the ovarian hilum were larger in prenatal T- and DHT-treated females, suggestive of early androgenic programming of arterial differentiation. This may facilitate increased delivery of endocrine factors and thus indirectly contribute to the development of the multifollicular phenotype.

  5. [The validity and reliability of the Spanish version of the Severe Cognitive Impairment Profile (SCIP) for the cognitive assessment of persons with advanced stages of Alzheimer's disease].

    PubMed

    Buiza, C; Montorio-Cerrato, I; Yanguas, J

    2015-10-16

    Introduccion. Existen pocas herramientas validadas al castellano para realizar una evaluacion precisa del funcionamiento cognitivo de personas con demencias avanzadas. Esta poblacion supone un reto por el elevado numero de personas que alcanzan estos estadios y por la complejidad de cuidados que requieren. Este trabajo presenta la validacion al castellano de un instrumento, la escala 'perfil de deterioro cognitivo grave' (SCIP), que permite la evaluacion del funcionamiento cognitivo de personas con enfermedad de Alzheimer avanzada. Pacientes y metodos. Estudio transversal con 133 sujetos (29 hombres y 104 mujeres; edad media: 81,61 ± 7,41 años) con diagnostico de enfermedad de Alzheimer en estadios de moderado a muy grave, segun la escala de deterioro global (GDS 5-7). Se realizaron analisis de discriminacion de los items, estudio de la consistencia interna y fiabilidad interjueces y test-retest, y se contrasto la estructura factorial y la validez del instrumento. Resultados. Solo el 1% de los 160 items de la escala resulto no discriminativo. La consistencia interna de la escala es adecuada, asi como la fiabilidad interjueces y test-retest. Respecto a la validez de constructo, la correlacion con el miniexamen cognitivo es 0,74 (p < 0,01), y se encuentran diferencias significativas entre la escala SCIP y los tres niveles de la GDS analizados. La estructura factorial de la escala muestra la existencia de un solo factor que explica el 66,12% de la varianza. Conclusion. La escala SCIP es un instrumento util, fiable y valido para la evaluacion exhaustiva en castellano de las funciones cognitivas en personas con demencia en estadios de moderado a muy grave.

  6. Ultrastructural observations of previtellogenic ovarian follicles of the caecilians Ichthyophis tricolor and Gegeneophis ramaswamii.

    PubMed

    Beyo, Reston S; Sreejith, Parameswaran; Divya, Lekha; Oommen, Oommen V; Akbarsha, Mohammad A

    2007-04-01

    The ultrastructural organization of the previtellogenic follicles of the caecilians Ichthyophis tricolor and Gegeneophis ramaswamii, of the Western Ghats of India, were observed. Both species follow a similar seasonal reproductive pattern. The ovaries contain primordial follicles throughout the year with previtellogenic, vitellogenic, or postvitellogenic follicles, depending upon the reproductive status. The just-recruited primordial follicle includes an oocyte surrounded by a single layer of follicle and thecal cells. The differentiation of the theca into externa and interna layers, the follicle cells into dark and light variants, and the appearance of primordial yolk platelets and mitochondrial clouds in the ooplasm mark the transition of the primordial follicle into a previtellogenic follicle. During further development of the previtellogenic follicle the following changes occur: i) the theca loses distinction as externa and interna; ii) all the follicle cells become the dark variant and increase in the complexity of ultrastructural organization; iii) the nucleus of the oocyte transforms into the germinal vesicle and there is amplification of the nucleoli; iv) the primordial yolk platelets of the cortical cytoplasm of the oocyte increase in abundance; v) the mitochondrial clouds fragment and the mitochondria move away from the clouds, leaving behind the cementing matrix, which contains membrane-bound vesicles of various sizes, either empty or filled with a lipid material; vi) the perivitelline space appears first as troughs at the junctional points between the follicle cells and oocyte, which subsequently spread all around to become continuous; vii) macrovilli and microvilli develop from the follicle cells and oocyte, respectively; and viii) the precursor material of the vitelline envelop arrives at the perivitelline space. The sequential changes in the previtellogenic follicles of two species of caecilians are described.

  7. Synchronism of naupliar development of Sacculina carcini Thompson, 1836 (Pancrustacea, Rhizocephala) revealed by precise monitoring

    NASA Astrophysics Data System (ADS)

    Trédez, Fabien; Rabet, Nicolas; Bellec, Laure; Audebert, Fabienne

    2017-01-01

    Sacculina carcini is member of a highly-specialized group of parasitic cirripeds (Rhizocephala) that use crabs ( Carcinus maenas) as hosts to carry out the reproductive phase of their life cycle. We describe the naupliar development of S. carcini Thompson, 1836 from a very precise monitoring of three different broods from three specimens. Nauplii were sampled every 4 h, from the release of the larvae until the cypris stage. Larval development, from naupliar instar 1 to the cypris stage, lasts 108 h at 18 °C. A rigorous sampling allowed us to describe an additional intermediate naupliar instar, not described previously. Naupliar instars are renumbered from 1 to 5. Nauplius 1 (N1) larvae hatch in the interna; N2 are released from the interna and last between 12 and 16 h; N3 appear between 12 and 16 h after release; N4 appear between 28 and 32 h; and N5 appear between 44 and 48 h. The cypris stage appears between 108 and 112 h. The redescribed morphologies allowed us to identify new characters. Antennular setation discriminates naupliar instars 3, 4 and 5. Telson and furca morphologies discriminate all naupliar instars. Furthermore, we demonstrate that the speed of larval development is similar within a single brood and between broods from different specimens, suggesting synchronization of larval development. From precise monitoring of broods every 4 h, we demonstrate that the life cycle of S. carcini includes five instars of naupliar larvae instead of four. The morphological characters of the larvae discriminate these naupliar instars and allow the identification of S. carcini from other Rhizocephala species. S. carcini larvae develop synchronously. Consequently, they might be an informative model to study larval development in crustaceans.

  8. ENDOSCOPIC SLEEVE GASTROPLASTY FOR OBESITY TREATMENT: TWO YEARS OF EXPERIENCE.

    PubMed

    Lopez-Nava, Gontrand; Galvão, M P; Bautista-Castaño, I; Fernandez-Corbelle, J P; Trell, M; Lopez, N

    2017-01-01

    Bariatric endoscopic techniques are minimally invasive and induce gastric volume reduction to treat obesity. Aim : To evaluate endoscopic sleeve gastroplasty (Apollo method) using a suturing method directed at the greater curvature, as well as the perioperative care, two year safety and weight loss. Prospective single-center study over 154 patients (108 females) using the endoscopic sleeve gastroplasty procedure under general anesthesia with overnight inpatient observation. Of the154 initial patients, 143 were available for 1-month of follow-up, 133 for 6-month, 64 for 12-month and 28 completed the 24 month assessment. Follow-up was carried out by a multidisciplinary team (nutritionist and psychologist). Outcomes evaluated were: change in BMI; change in body weight (TBWL); % of loss of initial body weight (%TBWL); % of excess body weight loss (%EWL) (segregated in > or <25% and adverse effects. Voluntary oral contrasted radiological examinations were scheduled to assess the gastroplasty at different times post-procedure. Mean age was 44.9 (23-69) years. At 24 months after the procedure baseline mean BMI change from 38.3 to 30.8 kg/m2. TBWL, %TBWL and %EWL were of 21.3 kg, 19.5% and 60.4% respectively. 85.7% of patients achieve the goal of >25% %EWL. There were no mayor adverse events intraprocedure or during the 24 months of follow-up . Endoscopic sleeve gastroplasty with regular monitoring by a multidisciplinary team can be considered an effective, safe and well tolerated procedure for obesity treatment, at least for two years of follow-up. As técnicas de endoscopia bariátrica são minimamente invasivas e induzem à redução do volume gástrico para tratar a obesidade. Avaliar a gastroplastia sleeve endoscópica (método Apollo) usando um método de sutura direcionado para a grande curvatura, bem como os cuidados perioperatórios, segurança em dois anos e perda de peso. Estudo prospectivo em um único centro com 154 pacientes (108 mulheres) usando o

  9. Risk factors for postpartum urinary incontinence.

    PubMed

    Leroy, Lígia da Silva; Lúcio, Adélia; Lopes, Maria Helena Baena de Moraes

    2016-04-01

    To investigate the risk factors for postpartum urinary incontinence (UI) and its characteristics. This was a case-control study with 344 puerperal women (77 cases and 267 controls) with up to 90 days postpartum. In a single session, participants were given a questionnaire with sociodemographic and clinical data and two others that assessed urine leakage, leakage situations, and type of UI. Stress UI was present in 45.5% of the women, incidents of urine leakage several times a day in 44.2%, of which 71.4% were in small amounts and 57.1% when coughing or sneezing. In 70.1% of cases, UI began during pregnancy and remained through the postpartum period. After running a binary logistic regression model, the following factors remained in the final model: UI during pregnancy (OR 12.82, CI 95% 6.94 - 23.81, p<0.0001), multiparity (OR 2.26, CI 95% 1.22 - 4.19, p=0.009), gestational age at birth greater or equal to 37 weeks (OR 2.52, CI 95% 1.16 - 5.46, p=0.02) and constipation (OR 1.94, CI 95% 1.05 - 5.46, p=0.035). Most often, UI first appeared during pregnancy and remained through the postpartum period. Urinary incontinence during pregnancy, multiparity, gestational age at birth greater or equal to 37 weeks, and constipation were presented as risk factors. In the studied group, stress UI was more frequent. Investigar os fatores de risco para a incontinência urinária (IU) no puerpério e as suas características. Trata-se de estudo caso-controle com 344 puérperas (77 casos e 267 controles), com até 90 dias pós-parto. Foi aplicado, em um único momento, um questionário para os dados sociodemográficos e clínicos, e dois outros para avaliar a perda urinária, situações de perda e o tipo de IU. Apresentaram IU de esforço 45,5%, perda urinária diversas vezes ao dia 44,2%, sendo 71,4% em pequena quantidade e 57,1% ao tossir ou espirrar. Em 70,1% dos casos a IU iniciou-se na gestação e permaneceu no puerpério. Ao ajustar-se um modelo de regressão logística bin

  10. Factors associated with mortality in patients undergoing coronary artery bypass grafting.

    PubMed

    Koerich, Cintia; Lanzoni, Gabriela Marcellino de Melo; Erdmann, Alacoque Lorenzini

    2016-08-08

    to investigate the factors associated with mortality in patients undergoing coronary artery bypass grafting in a cardiovascular referral hospital in Santa Catarina. quantitative, exploratory, descriptive and retrospective study. The medical records of 1447 patients, from 2005 to 2013, were analyzed for statistically related variables, these being: profile, hospitalization diagnosis, risk factors for coronary artery disease, complications recorded during the hospitalization, length of hospitalization and cause of death. the mortality rate was 5.3% during the study period. Death was more common in females and those of black skin color, with a mean age of 65 years. Acute myocardial infarction was the most common hospitalization diagnosis. The majority of the complications recorded during hospitalization were characterized by changes in the cardiovascular system, with longer hospitalization periods being directly related to death from septic shock. the data provide subsidies for nursing work with preventive measures and early detection of complications associated with coronary artery bypass grafting. This reinforces the importance of using the data as quality indicators, aiming to guarantee care guided by reliable information to guide managers in planning patient care and high complexity health services. conhecer os fatores associados à mortalidade de pacientes submetidos à cirurgia de revascularização do miocárdio em hospital referência cardiovascular em Santa Catarina. estudo quantitativo, exploratório, descritivo e retrospectivo. Foram analisados os prontuários de 1447 pacientes, entre 2005 e 2013, e as variáveis relacionadas estatisticamente, sendo estas: perfil, diagnóstico da internação, fatores de risco para doença arterial coronariana, intercorrências registradas na internação, tempo de internação e causa do óbito. a taxa de mortalidade foi de 5,3% no período do estudo. Os óbitos foram mais frequentes em negros, do sexo feminino e média de

  11. [Weight control attempts among Portuguese adults: prevalence, motives and behavioral strategies].

    PubMed

    Santos, Inês; Andrade, Ana M; Teixeira, Pedro J

    2015-01-01

    Introdução: Em Portugal não existem dados atuais sobre tentativas de controlo do peso nem sobre estratégias e motivos na base dessas tentativas na população. Este estudo teve como objectivos determinar a prevalência das tentativas de perda/manutenção do peso e identificar as estratégias comportamentais e os motivos associados, numa amostra representativa da população adulta portuguesa. Material e Métodos: Estudo transversal constituído por 1098 indivíduos adultos. A informação sociodemográfica, os dados antropométricos e as estratégias e motivos associados à perda/manutenção do peso foram recolhidos por entrevista telefónica. Resultados: Cerca de 44% dos adultos portugueses (53% de mulheres e 35% dos homens) estão ativamente a tentar controlar o peso. Salienta-se que 22% das mulheres com peso normal tentam perder peso e que 53% dos homens e 34% das mulheres com peso excessivo não o fazem. Entre os homens, 49% com nível educacional superior estão a tentar controlar o peso versus 32% com nível educacional básico. A estratégia mais frequentemente adoptada para gerir o peso é o consumo regular de hortícolas e os motivos mais referenciados são melhorar a saúde/prevenir doenças e melhorar o bem-estar. Discussão e Conclusão: Mais de metade das mulheres e cerca de um terço dos homens em Portugal estão ativamente a tentar gerir o seu peso, utilizando estratégias comportamentais consistentes com as recomendações de saúde pública. Os motivos de saúde e bem-estar predominam sobre os restantes. Este estudo contribui para o conhecimento da gestão do peso em Portugal, alertando para o desenvolvimento de estratégias de prevenção da obesidade adequadas ao perfil da população.

  12. Cometa Hyakutake (C/1996 B2): análise do gás e características físicas das partículas de poeira

    NASA Astrophysics Data System (ADS)

    Sanzovo, G. C.; de Almeida, A. A.; Boczko, R.

    2003-08-01

    A completa caracterização e compreensão do núcleo de um cometa novo é de fundamental importância para a elucidação dos processos físicos e químicos atuantes na época da formação do Sistema Solar. O Cometa Hyakutake, conjuntamente com o Cometa Hale-Bopp representam os objetos mais brilhantes que visitaram o Sistema Solar Interno nos últimos 20 anos. Neste Trabalho, nós aplicamos o Método Semi-Empírico das Magnitudes Visuais (MSEMV) à aproximadamente 4000 dados observacionais que correlacionam a magnitude visual absoluta com a distância heliocêntrica para o Cometa Hyakutake nas fases pré- e pós-periélicas. Como produto da aplicação desse método, conseguimos caracterizar dimensionalmente seu núcleo e área ativa efetiva. As taxas de produção dos radicais CN, C2 e C3, obtidos a partir de dados disponíveis na literatura, revelam que, além de muito brilhante, o Hyakutake é um cometa "normal" no sentido de Cochran (1986). Desse modo, deduzimos as taxas de perdas de água (em moléculas/s) a partir da análise de sua magnitude visual aparente, e as convertemos em taxas de perdas de gás (em g/s), despreendido pelo nucleo cometário. Com o auxílio do modelo fotométrico clássico da poeira, realizamos uma análise sistemática e uniforme dessa componente cometária, a partir dos fluxos observacionais no contínuo, para os comprimentos de onda 365,0 e 484,5 nm, assumindo que esses fluxos são o resultado da radiação solar espalhada por grãos de partículas micrométricos presentes na coma. Com isso, pudemos obter as taxas de produção (em g/s), cores (relativas à cor neutra solar), e as dimensões efetivas médias das partículas de poeira, bem como as razões poeira-gás.

  13. [Prevalence of chromosomal abnormalities in spontaneous abortions or fetal deaths].

    PubMed

    Bastos, Raquel; Ramalho, Carla; Dória, Sofia

    2014-01-01

    Introdução: O abortamento espontâneo é um dos problemas mais frequentes da gravidez, estimando-se que afete, pelo menos, 25% das mulheres que tentam engravidar. O objetivo principal deste trabalho foi o estudo da prevalência das anomalias cromossómicas em perdas gestacionais, analisando a sua relação com a idade materna, idade gestacional e história de abortamentos prévios.Material e Métodos: Realizou-se um estudo retrospetivo em 401 casos de perdas de gravidez que efetuaram análise citogenética e anátomo-patológica, entre janeiro de 2008 e junho de 2012, no Centro Hospitalar de S. João.Resultados: Dos 401 casos enviados para estudo citogenético foi possível obter informação sobre o complemento cromossómico em 333 casos, dos quais 72,7% apresentaram cariótipo normal e 27,3% cariótipo anormal. As aneuploidias representaram 92,3% das cromossomopatias identificadas, sendo as trissomias as mais frequentes, associadas a uma idade materna avançada e a uma idade gestacional precoce. Não se verificou concordância entre os resultados da análise anátomo-patológica e citogenética.Discussão e Conclusão: A prevalência de anomalias cromossómicas, no primeiro trimestre, foi semelhante entre os casos de abortamento esporádico e recorrente. Com o aumento da idade materna observou-se um aumento das trissomias, com um incremento médio de 7,4% no risco de ocorrência por ano. Não foi estabelecida uma correlação cariótipo-patológica significativa. A contaminação materna da amostra foi o principal entrave à determinação exata da prevalência de anomalias cromossómicas. As técnicas de citogenética molecular já disponíveis podem colmatar esta e outras limitações da técnica convencional.

  14. Assessment of the nursing care product (APROCENF): a reliability and construct validity study.

    PubMed

    Cucolo, Danielle Fabiana; Perroca, Márcia Galan

    2017-04-06

    to verify the reliability and construct validity estimates of the "Assessment of nursing care product" scale (APROCENF) and its applicability. this validation study included a sample of 40 (inter-rater reliability) and 172 (construct validity) assessments performed by nurses at the end of the work shift at nine inpatient services of a teaching hospital in the Brazilian Southeast. The data were collected between February and September/2014 with interruptions. Cronbach's alpha and Spearman's correlation coefficients were calculated, as well as the intraclass correlation and the weighted kappa index (inter-rater reliability). Exploratory factor analysis was used with principal component extraction and varimax rotation (construct validity). the internal consistency revealed an alpha coefficient of 0.85, item-item correlation ranging between 0.13 and 0.61 and item-total correlation between 0.43 and 0.69. Inter-rater equivalence was obtained and all items evidenced significant factor loadings. this research evidenced the reliability and construct validity of the scale to assess the nursing care product. Its application in nursing practice permits identifying improvements needed in the production process, contributing to management and care decisions. verificar as estimativas de confiabilidade e validade de construto da escala "Avaliação do produto do cuidar em enfermagem" (APROCENF) e sua aplicabilidade. este estudo de validação incluiu em sua amostra 40 (confiabilidade interavaliadores) e 172 (validade de construto) avaliações realizadas por enfermeiros ao final do turno de trabalho em nove unidades de internação de um hospital universitário do sudeste brasileiro. A coleta de dados ocorreu entre fevereiro e setembro de 2014 de forma interrupta. Foram calculados os coeficientes alfa de Cronbach e correlação de Spearman (consistência interna), a correlação intraclasse e Kappa ponderado (confiabilidade interavaliadores) e a análise fatorial exploratória foi

  15. Sepsis in a university hospital: a prospective study for the cost analysis of patients' hospitalization.

    PubMed

    Barreto, Maynara Fernanda Carvalho; Dellaroza, Mara Solange Gomes; Kerbauy, Gilselena; Grion, Cintia Magalhães Carvalho

    2016-04-01

    To estimate the cost of hospitalization of patients with severe sepsis or septic shock admitted or diagnosed in the Urgent and Emergency sector at a university hospital and followed until the clinical outcome. An epidemiological, prospective, observational study conducted in a public hospital in southern Brazil for the period of one year (August 2013 to August 2014). Sepsis notification forms, medical records and data of the cost sector were used for the collection of clinical and epidemiological data. The sample comprised 95 patients, resulting in a total high cost of hospitalization (R$ 3,692,421.00), and an average of R$ 38,867.60 per patient. Over half of the total value of the treatment of sepsis (R$ 2,215,773.50) was assigned to patients who progressed to death (59.0%). The higher costs were related to discharge, diagnosis of severe sepsis, the pulmonary focus of infection and the age group of up to 59 years. The high cost of the treatment of sepsis justifies investments in training actions and institution of protocols that can direct preventive actions, and optimize diagnosis and treatment in infected and septic patients. Estimar o custo da internação de pacientes com sepse grave ou choque séptico admitidos ou diagnosticados no setor de Urgências e Emergências de um hospital universitário e seguidos até o desfecho clínico. Estudo epidemiológico, prospectivo e observacional, realizado em um hospital público do sul do Brasil, no período de 1 ano (agosto de 2013 a agosto de 2014). A coleta dos dados clínico-epidemiológicos utilizou fichas de notificação de sepse, prontuários e dados do setor de custos. Foi realizada análise de tendência central, dispersão e quartis dos custos das internações. Amostra composta por 95 pacientes que totalizaram elevado custo da internação (R$ 3.692.421,00), com média de R$ 38.867,60 por paciente. Mais da metade do valor total do tratamento da sepse (R$ 2.215.773,50) destinou-se a pacientes que evoluíram a

  16. Hypertension in patients admitted to clinical units at university hospital: post-discharge evaluation rated by telephone.

    PubMed

    Campos, Cássia Lima de; Pierin, Angela Maria Geraldo; Pinho, Natalia Alencar de

    2017-01-01

    To characterize hypertensive patients after admission to hospital considering the current status, compliance to treatment, habits and lifestyle, and knowledge and beliefs about the disease. This was an exploratory study with 265 hypertensive patients admitted to a medical inpatients unit of a university hospital. Data were collected in an interview over the telephone. The level of significance was set as p<0.05. It was found that 32% of hypertensive patients had died. One hundred patients were interviewed, mean age of 64.15 (13.2) years, 51% were women, 56% non-white, 51% with primary education, 52% were retired, 13% were smokers, 38% used alcohol, 80% did not perform physical exercise, and the mean body mass index was 35.9 (15.5) kg/m2. The comorbidities were heart problem (52%), diabetes (49%) and stroke (25%). As to antihypertensive treatment, 75% were on use, 17.3% stopped taking them and 21.3% missed visits. The treatment sites were the primary care unit (49%) and hospital (36%). As for knowledge and beliefs, 25% believed hypertension is curable, 77% that treatment should last for the rest of their lives, and hypertension brings complications (84%). A total of 46.7% were controlled. The lack of control was associated (p<0.05) with non-white ethnicity and absence of heart problems. There were significant deaths occurred after hospitalization and poor control of blood pressure, probably due to inadequate habits and lifestyles and non-compliance to antihypertensive treatment. Caracterizar hipertensos após internação quanto a condição atual, adesão ao tratamento, hábitos e estilos de vida, e conhecimento e crenças sobre a doença. Estudo exploratório, com 265 hipertensos, após internação em clínica médica de hospital universitário. Os dados foram coletados em entrevista por contato telefônico. O nível de significância foi de p<0,05. Verificou-se que 32% dos pacientes faleceram. Foram entrevistados 100 hipertensos, com média de idade de 64,15 (13

  17. [Introducing a mixed nutritional screening tool (CIPA) in a tertiary hospital].

    PubMed

    Suárez Llanos, José Pablo; Benitez Brito, Nestor; Oliva García, José Gregorio; Pereyra-García Castro, Francisca; López Frías, María Alicia; García Hernández, Alberto; Díaz Sirgo, Belarmina; Llorente Gómez de Segura, Ignacio

    2014-05-01

    Introducción: La desnutrición en el paciente hospitalizado es muy prevalente, por lo que es importante incorporar métodos de depistaje. Se ha desarrollado en nuestro centro un método mixto de cribado nutricional (CIPA), que incluye cuatro parámetros: a) control de ingestas 72 h; b) IMC; c) proteínas; y d) albúmina. Objetivos: 1) conocer la prevalencia de desnutrición en pacientes hospitalizados en el servicio de Medicina Interna de nuestro centro; 2) analizar variables asociadas a mayor prevalencia de desnutrición; 3) evaluar su efecto pronóstico clínico. Material y métodos: Se revisaron retrospectivamente los resultados de los test de cribado nutricional efectuados a 305 pacientes ingresados en el servicio de Medicina Interna en el periodo noviembre/2012-octubre/2013. Se analizó la prevalencia de desnutrición hospitalaria y la asociación del resultado positivo en el cribado (al menos un ítem positivo) con las siguientes variables: IMC, edad, sexo, patología subyacente, estancia, reingreso precoz (< de 1 mes) y mortalidad. Resultados: El test fue positivo en un 23% de los pacientes. Los pacientes con cribado positivo presentaban un IMC inferior (24,9 ± 7,2 vs 27,8 ± 6,4 kg/m; p = 0,002). La patología neoplásica e infecciosa se asociaron a mayor positividad (35,3 y 28,9%, respectivamente; p=0,006). El sexo y la edad no se asociaron con el resultado del test de cribado. Los pacientes con cribado positivo presentaban mayor estancia media (26,7 ± 25 vs 19,4 ± 16,5; p = 0,005), tasa de reingresos precoces (18,6 vs 6,8%; p = 0,003) y mortalidad (30 vs 10,3%; p < 0,001). Conclusiones: El test de cribado CIPA es capaz de detectar al paciente malnutrido y predecirle un peor pronóstico clínico (mortalidad, estancia media y reingreso precoz).

  18. [Fever of unknown origin, comparing two series with 26 years of difference].

    PubMed

    Casarrubias-Ramírez, Moisés; Alfaro-Mejía, José Alfredo; De Santiago-Leaños, Juan; Mendoza-Álvarez, Sergio Alberto; Pineda-Galindo, Luis Francisco; Vera-Lastra, Olga Lidia

    2015-01-01

    Introducción: la fiebre de origen oscuro (FOO) es un síndrome de abordaje difícil y espectro cambiante. El objetivo fue comparar dos series de FOO estudiadas en el departamento de Medicina Interna del Hospital de Especialidades del Centro Médico La Raza.Métodos: fue un estudio comparativo de datos secundarios: los datos de la serie 1979-87, que fueron publicados por Frati et al. y los de la serie 2004-14, registrados en la base de datos de FOO del departamento de Medicina Interna. Se compararon datos demográficos, diagnósticos finales y pruebas diagnósticas utilizadas. Se describen mediana y amplitud para las variables numéricas y distribución de frecuencias para las variables nominales. El análisis bivariado se hizo con chi cuadrada o prueba de Fisher con los programas SPSS versión 17.0 para MAC y open epi versión 3.7.Resultados: se incluyeron 127 pacientes en la serie 1979-87, y 118 en la 2004-14. La serie más reciente tuvo menos casos ocasionados por infecciones, (p = 0.024), y más enfermedades inflamatorias no infecciosas (p = 0.0004). Se mantuvieron constantes las enfermedades neoplásicas y los casos con diagnóstico desconocido. Variaron poco las pruebas de laboratorio realizadas y su utilidad diagnóstica; en cambio los estudios de imagen fueron menos útiles en la serie 2004-14 (p = 0.00003). Las biopsias y la laparotomía fueron frecuentemente realizadas y útiles en ambas series.Conclusiones: En la última serie hubo más enfermedades inflamatorias no infecciosas a expensas de un menor número de infecciones. Los estudios invasivos siguen siendo necesarios.

  19. Validation of the Comply with Post-Exposure Management Among Health Care Workers Instrument for Brazil.

    PubMed

    Jansen, Adriane Corrêa; Marziale, Maria Helena Palucci; Santos, Cláudia Benedita Dos; Dantas, Rosana Aparecida Spadotti; Santos, Danielle Maria de Souza Serio Dos

    2016-01-01

    To validate the Comply with post-exposure management among healthcare workersinstrument for Nursing in Brazil. A methodological study carried out with 137 nursing professionals exposed to biological material. The existence of floor and ceiling effects was analyzed, evaluating reliability by the internal consistency of the items and test-retest reproducibility. The construct validity was analyzed by the multitrait-multi method analysis. Ceiling effects were found in two subscales. The result of the internal consistency of four subscales varied between 0.81 and 0.91. The results were considered satisfactory, while two subscales presented an unsatisfactory result (0.50 and 0.37). An evaluation of the measurement stability obtained positive results in relation to the statistical significance, with Intraclass Correlation Coefficient values between the two measurements ranging from 0.301 to 0.727; the validity of a convergent and divergent construct was confirmed by multitrait-multi method analysis, except for the Attitude subscale, which presented unsatisfactory values. The instrument presents satisfactory results for validity and reliability, except for the Attitude dimension. Validar para o Brasil o instrumento Comply with post-exposure management among health care workers para a enfermagem. Estudo metodológico realizado com 137 profissionais de enfermagem expostos a material biológico. Analisou-se a existência dos efeitos floor e ceiling e avaliou-se a fidedignidade pela consistência interna dos itens e estabilidade da medida (teste-reteste). Analisou-se a validade de construto por meio da análise multitraço-multimétodo. Verificaram-se efeitos ceiling em duas subescalas. O resultado da consistência interna, de quatro subescalas, variou entre 0,81 e 0,91, resultados considerados satisfatórios, e duas subescalas apresentaram resultado insatisfatório (0,50 e 0,37). A avaliação da estabilidade da medida obteve resultados positivos em relação à signific

  20. Psychometric properties of the Attitudes Scale facing Alcohol and Alcoholism in nursing students.

    PubMed

    Vargas, Divane de; Rocha, Fernanda Mota

    2016-12-19

    to verify the psychometric properties of the Attitudes Scale facing Alcohol and Alcoholism (EAFAA) and people with disorders related to the use of alcohol in nursing students. a convenience sample (n=420) completed the EAFAA, the data were submitted to Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). the EFA resulted in an instrument composed of 48 items divided into four factors. The CFA has established the validity of the factorial structure. The internal consistency of the scale was considered adequate (α=0.85) presenting a sensitivity of 70% and specificity of 75%. the EAFAA constitutes a reliable instrument to identify the attitudes of nursing students towards alcohol, alcoholism and persons with disorders related to alcohol use. verificar as propriedades psicométricas da Escala de Atitudes Frente ao Álcool, ao Alcoolismo e as pessoas com transtornos relacionados ao uso do Álcool em estudantes de enfermagem. uma amostra de conveniência (n=420) completou a EAFAA, os dados foram submetidos à Análise Fatorial Exploratória (AFE) e Análise Fatorial Confirmatória (AFC). a AFE resultou em um instrumento composto por 48 itens divididos em quatro fatores. A AFC estabeleceu a validade da estrutura fatorial. A consistência interna da escala foi considerada adequada (α=0,85) apresentando sensibilidade de 70% e especificidade de 75%. a EAFAA constitui-se em um instrumento confiável para identificar as atitudes de estudantes de enfermagem frente ao álcool, ao alcoolismo e a pessoa com transtornos relacionados ao uso de álcool. verificar las propiedades psicométricas de la escala de actitudes frente al alcohol, al alcoholismo y a las personas con trastornos por consumo de alcohol en estudiantes de enfermería. una muestra por conveniencia (n=420) completó la EAFAA, cuyos datos se sometieron a un análisis factorial exploratorio (AFE) y un análisis factorial confirmatorio (AFC). el AFE dio como resultado un instrumento compuesto por

  1. [Influence of genetic polymorphisms in UGT1A1, UGT1A7 and UGT1A9 on the pharmacokynetics of irinotecan, SN-38 and SN-38G].

    PubMed

    Valenzuela Jiménez, B; González Sales, M; Escudero Ortiz, V; Martínez Navarro, E; Pérez Ruixo, C; Rebollo Liceaga, J; González Manzano, R; Pérez Ruixo, J J

    2013-01-01

    Objetivo: Evaluar la influencia de los polimorfismos genéticos en UGT1A1, UGT1A7 y UGT1A9 sobre la farmacocinética poblacional de irinotecán y sus metabolitos, SN-38 y SN-38G. Metodología: Las concentraciones plasmáticas de irinotecán, SN-38 y SN-38G determinadas en 72 pacientes se utilizaron para desarrollar un modelo farmacocinético poblacional en el programa NONMEM VII. Se empleó el método M3 para incluir en el análisis las concentraciones por debajo del límite de cuantificación de la técnica analítica. Se evaluó el efecto de la edad, sexo, superficie corporal, bilirrubina total, medicación concomitante, tipo de tumor y polimorfismos genéticos en UGT1A1, UGT1A7 y UGT1A9 sobre los parámetros farmacocineticos del modelo. La validación interna del modelo farmacocinético se realizó mediante normalized visual predictive check (NVPC) y normalized predictive distribution error (NPDE). Resultados: El valor medio (variabilidad interpaciente, %) del aclaramiento de irinotecán, SN-38 y SN-38G ha sido 42,9 (56,4%), 1340 (76,8%) y 188 L/h (70,1%), respectivamente. La presencia de alelos con baja actividad enzimática (UGT1A1*28, UGT1A7*3 y UGT1A9*22) redujo el aclaramiento de SN-38 entre un 20 y un 36%. La validación interna ha confirmado que el modelo farmacocinético poblacional resulta adecuado para describir la evolución temporal de las concentraciones plasmáticas de irinotecán, SN-38 y SN-38G y su variabilidad en pacientes oncológicos. Conclusión: La inclusión de información farmacocinética-farmacogenética puede añadir valor a la personalización de la dosificación de irinotecán por cuanto que permitirá manejar cuantitativamente las reducciones de dosis en pacientes con toxicidad iatrogénica debido a los polimorfismos genéticos en UGT1A1.

  2. A Neurologist's Hard Day's Work: Impact of Inpatient Neurology Consultation in a Tertiary Hospital.

    PubMed

    Rocha, Helena; Monteiro, Ana; Gomes, Tiago; Grilo, Miguel; Carvalho, Marta

    2016-01-01

    Introdução: A consulta de neurologia realizada a doentes hospitalizados sob a responsabilidade de outras especialidades é um trabalho exigente mas muitas vezes sub-valorizado e pouco documentado. Este estudo pretendeu avaliar o impacto das consultas internas de neurologia num hospital português e, consequentemente, a performance do nosso Serviço no que diz respeito a esta matéria. Material e Métodos: Foi conduzido um estudo retrospetivo durante o ano de 2013 através da revisão de dados clínicos e demográficos. Resultados: Ao longo de um ano, os neurologistas no nosso Serviço avaliaram 632 doentes internados. As principais razões para o pedido de consulta foram a alteração do estado mental/comportamental, défice neurológico focal e crises epiléticas. Os pedidos de avaliação provieram principalmente de serviços médicos mas também de Unidades de Cuidados Intensivos e Intermédios. Os neurologistas sugeriram investigação adicional em cerca de 50% dos doentes; alterações terapêuticas foram efetuadas numa proporção semelhante de doentes. No final da consulta foi possível estabelecer um novo diagnóstico em 63% dos casos, sendo os mais frequentes manifestação neurológica de doenças sistémicas, epilepsia e doença vascular cerebral. Tal intervenção teve impacto no cuidado de 68% dos doentes. Discussão e Conclusão: Diferentes estudos na literatura suportam os nossos achados, enfatizando que esta atividade tem benefícios diretos no tratamento dos doentes e que é custo-efetiva. Os nossos resultados sugerem que a atividade de consultadoria interna da Neurologia resulta em intervenções úteis para a gestão clínica dos doentes internados.

  3. Evaluación de la utilidad diagnóstica de la versión española del cuestionario al informador «AD8»☆

    PubMed Central

    Pardo, C. Carnero; de la Vega Cotarelo, R.; Alcalde, S. López; Aparicio, C. Martos; Carrillo, R. Vílchez; Gavilán, E. Mora; Galvin, J.E.

    2012-01-01

    Introducción El AD8 es un cuestionario al informador breve que puede ser autoaplicado y facilita la identificación de deterioro cognitivo (DC); nuestro objetivo es evaluar la utilidad diagnóstica (UD) de una versión española. Material y métodos Estudio transversal en una muestra clínica de díadas paciente/ informador, 330 sujetos con sospecha de DC o demencia (DEM) y 71 controles. Se ha evaluado la consistencia interna (α de Cronbach) y la validez (correlaciones parciales con estadio GDS, Fototest e índice funcional [IF]). La UD se ha evaluado para no DC vs DC (GDS 3–4) por medio del área bajo la curva ROC (aROC) y se ha considerado mejor punto de corte aquel que hacía máximo el índice de Youden. Resultados En la muestra, 105 no tenían DC, 99 tenían DC sin DEM y 203 DEM. La consistencia interna es alta (α 0,90, IC del 95%, 0,89–0,92), al igual que las correlaciones con GDS (r = 0,72, p < 0,001), Fototest (r = −0,61, p < 0,001) e IF (r = 0,59, p < 0,001). El aROC del AD8 es 0,90 (IC del 95%, 0,86–0,93), sin diferencia significativa con la del Fototest (aROC 0,93, IC del 95%, 0,89–0,96); el mejor punto de corte es 3/4 con sensibilidad de 0,93 (IC del 95%, 0,88–0,96), especificidad de 0,81 (IC del 95%, 0,72–0,88) y el 88,8% de las clasificaciones correctas. El uso conjunto de AD8 y Fototest mejora de forma significativa la UD de ambos (aROC 0,96, IC del 95%, 0,93–0,98, p < 0,05). Conclusiones La versión española del AD8 conserva las cualidades psicométricas y la UD de la versión original; su uso combinado con el Fototest mejora de forma significativa la UD de ambos. PMID:22652137

  4. PYOGENIC LIVER ABSCESS: DIAGNOSTIC AND THERAPEUTIC MANAGEMENT.

    PubMed

    Santos-Rosa, Otto Mauro Dos; Lunardelli, Henrique Simonsen; Ribeiro-Junior, Marcelo Augusto Fontenelle

    2016-01-01

    The pyogenic liver abscess has an incidence of 1.1/1,000 habitants. Mortality can reach 100%. The use of less invasive procedures diminish morbidity and hospital stay. Identify risk factors in patients who underwent percutaneous drainage guided by ultrasound as treatment. Were analyzed 10 patients submitted to the method. Epidemiological characteristics, laboratory markers and imaging exams (ultrasound and CT) were evaluated. The majority of the patients were men with mean age of 50 years old. Liver disease, alcoholism and biliary tract disease were the most common prodromes. Abdominal pain (90%), fever (70%) and jaundice (40%) were the most common clinical manifestations. Mortality of 20% was observed in this series. Hypoalbuminemia and days of hospitalization had a statistically significant positive association with death. The pyogenic liver abscess has subacute evolution which makes the diagnosis difficult. Image exams have high sensitivity in diagnosis, particularly computed tomography. Percutaneous drainage associated with antibiotic therapy is safe and effective therapeutic resource. O abscesso hepático piogênico tem incidência de 1,1 por 1.000 habitantes com mortalidade podendo chegar a 100%. O uso de recursos menos invasivos diminuem morbimortalidade e tempo de internação hospitalar. Identificar fatores de risco no abscesso hepático piogênico tratado por drenagem percutânea guiada por ultrassom. Total de 10 pacientes foram submetidos ao procedimento. Foram avaliadas características epidemiológicas, marcadores laboratoriais exames de imagem (ultrassom e tomografia). Na amostra houve predominância do sexo masculino, com média de idade de 50 anos. Hepatopatia, etilismo e doença da via biliar foram os pródromos mais frequentes. Dor abdominal (90%), febre (70%) e icterícia (40%) foram manifestações clínicas mais comuns. Houve mortalidade de 20% nesta série. Hipoalbuminemia e dias de internação hospitalar tiveram associação positiva com

  5. Expression and localization of angiopoietin family in buffalo ovarian follicles during different stages of development and modulatory role of angiopoietins on steroidogenesis and survival of cultured buffalo granulosa cells.

    PubMed

    Mishra, S R; Thakur, N; Somal, A; Parmar, M S; Yadav, V P; Bharati, Jaya; Bharti, M K; Paul, A; Verma, M R; Chouhan, V S; Sharma, G Taru; Singh, G; González, L A; D'Occhio, M J; Sarkar, M

    2016-10-15

    The present study investigated the expression and localization of angiopoietin (ANPT) family members in buffalo ovarian follicles of different size. It also looked at the role of ANPTs in estradiol secretion and mRNA expression of phosphoinositide-3-kinase-protein kinase B signaling pathway cellular proliferation (phosphoinositide-dependant kinase and protein kinase B [AKT]) and proapoptotic (BAD) factors with caspase 3 in cultured buffalo granulosa cells (GCs). The mRNA and protein expression of ANPT-1 was greatest (P < 0.05), whereas ANPT-2 was reduced (P < 0.05) in preovulatory follicles as compared to F1 follicle. Tyrosine kinase with immunoglobulin-like and EGF-like domains 1 transcripts and protein expression did not change in all follicular groups, whereas tyrosine kinase with immunoglobulin-like and EGF-like domains 2 mRNA was highest (P < 0.05) in theca interna but not GC layer of preovulatory follicle. All members of ANPT family were localized in GC and theca interna showing a stage specific immunoreactivity. Cultured GCs were treated with ANPT-1 and ANPT-2 separately at doses of 1, 10, and 100 ng/mL and in combination at 100 ng/mL for three incubation periods (24, 48, and 72 hours). Estradiol secretion was highest (P < 0.05) at 100 ng/mL at 72 hours of incubation when GCs were treated with either protein alone. The mRNA expression of phosphoinositide-dependant kinase and AKT was highest (P < 0.05), and BAD with caspase 3 was lowest (P < 0.05) at 100 ng/mL at 72 hours of incubation, when cultured GCs were treated separately with each protein or in combination. The immuoreactivity of AKT, pAKT, and pBAD were maximal, whereas BAD was minimal with 100 ng/mL at 72 hours when cultured GCs treated with either protein alone. The findings indicate that ANPTs are expressed in a regulated manner in buffalo ovarian follicle during different stages of development where they may promote steroidogenesis and GC survival through autocrine and paracrine

  6. Gradiente radial de [Mg/Fe] em duas galáxias elípticas

    NASA Astrophysics Data System (ADS)

    Milone, A.; Capelato, H.

    2003-08-01

    Basicamente, são propostos dois cenários de evolução quí mio-dinâmico para os sistemas esferoidais: (i) o hierárquico através da fusão e/ou acresção de sub-sistemas com ou sem surtos de formação estelar, e (ii) o colapso monolí tico dissipativo com formação estelar interrompida por um vento galáctico. Ambos, dentro de certos limites, conseguem explicar os gradientes internos de metalicidade estelar presentes nas galáxias elí pticas bem como a relação observada entre a metalicidade central e a massa (Mg20 vs. log sv0). No entanto, nenhum prevê uma variação interna para a razão de abundâncias Mg/Fe que indiretamente define a escala temporal da formação estelar. Empregamos a espectroscopia óptica de fenda longa com a finalidade de recuperar as histórias de formação estelar, de enriquecimento quí mico e da dinâmica dentro de determinadas regiões das galáxias. Os espectros de média resolução (FWHM = 7,1 Å) e escala angular de 1,092 arcsec/pixel foram coletados com o telescópio 1,60m do OPD/LNA. Comparamos nossas medidas de linhas de absorção com resultados espectrofotométricos de modelos de populações estelares simples - mais especificamente os í ndices do Sistema Lick como Mg2, Mg b, < Fe > e Hb - a fim de se investigar as variações internas de [Fe/H], [Mg/Fe] e idade. Para duas galáxias elí pticas, NGC 1052 e NGC 7796, pertencentes a ambientes de baixa densidade, encontramos uma variação radial da razão Mg/Fe decrescente do centro para fora em regiões de 0,6 e 1 raio efetivo respectivamente. Discutimos alguns cenários de enriquecimento quí mico para estas duas galáxias.

  7. [Development and Validation of the National Functionality Table for Chronic Diseases].

    PubMed

    Pereira, Carla Sandra; Banco, Jaime; Lopes, Manuel; Escoval, Ana; Nogueira, Paulo; Diniz, José Alexandre; Guerra, Fernando; Coelho, Anabela

    2016-02-01

    Introdução: A avaliação sistemática e registo da funcionalidade de pessoas adultas com doença crónica permite horizontalizar políticas de saúde, sociais e emprego de acordo com a funcionalidade; dotar os profissionais de saúde e sociais de um instrumento de recolha de informação, que complemente os registos de doença; medindo os ganhos de funcionalidade. O objetivo de estudo foi desenvolver uma Tabela Nacional de Funcionalidade para adultos em idade ativa com doença crónica, de acordo com a Classificação Internacional de Funcionalidade, Incapacidade e Saúde da Organização Mundial de Saúde. Material e Métodos: Recorremos a métodos quantitativos e qualitativos; revisão da literatura (17 artigos), grupo focal (nove peritos), painel de Delphi (16 peritos) e estudo exploratório (309 pessoas com doença crónica). Resultados: Na revisão da literatura, foram identificadas 67 atividades limitadas na população em estudo das quais foram selecionadas 40 atividades pelo grupo focal e 38 validadas pelo painel de Delphi. Discussão: Para testar as propriedades psicométricas comparamos o valor médio de todos os coeficientes possíveis do tipo consistência interna (split-half). Na análise da discriminação dos níveis de funcionalidade em amostras diferentes, verificou-se a igualdade de vari'ncias pelo teste de Levene e a igualdade de média por recurso ao teste t. De acordo com a observação e análise do coeficiente α de Cronbach, verificou-se que a Tabela Nacional de Funcionalidade proposta apresenta bons níveis de fiabilidade. Na análise de componentes principais, identificaram-se cinco dimensões. Conclusão: A referida tabela tem características psicométricas apropriadas no que diz respeito à consistência, fiabilidade e validade interna.

  8. DIFFERENT PROTOCOLS OF POSTCONDITIONING DOES NOT ATTENUATE MESENTERIC ISCHEMIA-REPERFUSION INJURY AFTER SHORT-TERM REPERFUSION.

    PubMed

    Brito, Marcus Vinicius Henriques; Yasojima, Edson Yuzur; Machado, Andressa Abnader; Silveira, Matheus Paiva Pacheco Reis; Teixeira, Renan Kleber Costa; Yamaki, Vitor Nagai; Costa, Felipe Lobato da Silva

    2017-01-01

    Mesenteric ischemia is a challenging diagnosis. Delay in diagnosis can lead to extent bowel necrosis and poor outcomes. Ischemia and reperfusion syndrome plays an important role in this scenario. To access effects of different post-conditioning cycles on mesenteric ischemia-reperfusion syndrome. Twenty-five rats were assigned into five groups: Sham, used to establish normal parameters; control group, submitted to mesenteric ischemia for 30 min; in groups GP3, GP1 and GP30, ischemia was followed by post-conditioning protocol, which consisted of 1 cycle of 3 min (GP3), 3 cycles of 1 min (GP1) or 6 cycles of 30 s (GP30), respectively. Ileum samples were harvested after one hour of reperfusion. Intestinal mucosal injury was evaluated through histopathological analysis. The average of mesenteric injury degree was 0 in the sham group, 3.6 in the control group, 3.4 in GP3, 3.2 in GP1, and 3.0 in GP30; villous length average was 161.59 in sham group, 136.27 in control group, 135.89 in GP3, 129.46 in GP1, and 135.18 in GP30. Was found significant difference between sham and other groups (p<0.05); however, there was no difference among post-conditioning groups. Post-conditioning adopted protocols were not able to protect intestinal mucosa integrity after mesenteric ischemia and short term reperfusion. O desfecho satisfatório na abordagem cirúrgica da obesidade deve contemplar, além da perda de peso, alteração significativa nas comorbidades preexistentes e na qualidade de vida dos pacientes. Avaliar a qualidade de vida no pós-operatório tardio de pacientes submetidos à cirurgia de gastrectomia vertical por videolaparoscopia. Foi aplicado o questionário "Bariatric Analysis and Reporting Outcome System" (BAROS) em pacientes submetidos à gastrectomia vertical por videolaparoscopia. Foram avaliados 47 pacientes, entre 21 e 60 anos de idade. O IMC médio antes da operação era 43,06±5,87 kg/m². A média percentual de redução do excesso de peso após foi de 85,46±23

  9. Bone grafting for alveolar ridge reconstruction. Review of 166 cases.

    PubMed

    Salmen, Fued Samir; Oliveira, Marina Reis; Gabrielli, Marisa Aparecida Cabrini; Piveta, Ana Cláudia Gabrielli; Pereira, Valfrido Antonio; Gabrielli, Mario Francisco Real

    2017-01-01

    to investigate the predictive factors of failure in bone grafts for alveolar ridge augmentation and implant surgery. we reviewed the charts of 166 patients operated between 1995 and 2014. A total of 248 grafting procedures were performed. We submitted the data to the binomial test at 5% significance. grafts to gain width of the alveolar ridge (65.32%) were more frequent than sinus lifting (p<0.0001) and the number of grafts to the posterior maxilla (48.8%) was greater than in other regions (p<0.01); 6.04% of the grafts were lost. The losses in anterior (p<0.0309) and posterior (p<0.0132) maxilla were higher than in the mandible. There were 269 ​​implants installed in the grafted areas, of which only 4.83% were lost. The number of implants lost (4.51%) in areas of onlay grafts was not statistically higher than those placed after sinus lifting (2.63%, p<0.2424). Losses were greater in the anterior (53.85%) and posterior (38.46%) maxilla than in the mandible (p<0.031). Regarding patients' age, 76.92% of the lost grafts (p<0.006) and 80% of the lost implants (p<0.001) were installed in patients over 40 years. failure rate was higher both for grafts and dental implants in the maxilla and in patients over 40 years of age. investigar os fatores preditivos de falhas em enxertos ósseos para aumento do rebordo alveolar e cirurgia de implantes. os prontuários de 166 pacientes, operados entre 1995 e 2014, foram revistos. Um total de 248 enxertos foi realizado. Os dados foram submetidos ao teste binomial a 5% de significância. os enxertos para ganho em espessura do rebordo alveolar (65,32%) foram mais frequentes do que levantamentos de seio maxilar (p<0,0001) e o número de enxertos para a região posterior da maxila (48,8%) foi maior do que em outras regiões (p<0,01). Foram perdidos 6,04% dos enxertos. As perdas em maxila anterior (p<0,0132) e posterior (p<0,0309) foram maiores do que na mandíbula. Foram instalados 269 implantes nas áreas enxertadas e apenas 4

  10. [Prevalence of potentially inappropriate medication in hospitalized elderly patients by using explicit criteria].

    PubMed

    Galán Retamal, C; Garrido Fernández, R; Fernández Espínola, S; Ruiz Serrato, A; García Ordóñez, M A; Padilla Marín, V

    2014-07-01

    INTRODUCCIÓN: En personas mayores la prescripción de medicamentos potencialmente inapropiados (PIM) es muy elevada y se asocia con mayor riesgo de eventos adversos, morbilidad y utilización de recursos sanitarios. El objetivo del presente estudio es conocer la prevalencia y tipo de PIM en pacientes ancianos polimedicados al ingreso y alta hospitalaria, los factores asociados a su prescripción y la aplicabilidad de distintos criterios explícitos seleccionados de la bibliografía y adaptados a nuestro ámbito. MÉTODO: Se realiza estudio observacional transversal durante 12 meses (marzo 2010-febrero 2011), sobre 179 pacientes ancianos polimedicados, ingresados en un servicio de Medicina Interna. Como herramienta para detectar la prescripción inadecuada se seleccionaron 50 PIM a partir de la bibliografía (criterios Beers, Stopp, BMC y Priscus) utilizando una técnica Delphi. A través de entrevista con el paciente, revisión de historias clínicas e informe de conciliación se identificaron los PIM previamente seleccionados. Posteriormente se analizó la relación entre distintos factores y la prescripción de PIM.

  11. [Reflections on the clinical reports «minimum data set»].

    PubMed

    Prieto de Paula, J M; Franco Hidalgo, S

    2012-02-01

    Royal Decree 1093/2010 (3 September 2010) establishes the minimum data set that the clinical reports of discharges and outpatient visits elaborated in the facilities of the National Health System should contain, among others. Until then, the Ministerial Order 221/1984, that only required the drawing up of a discharge report for patients seen in a hospital-regime health care establishment, was in force. In spite of the importance of these documents, their quality is far from that desired, especially that of the reports on visits, which, among other things, are not performed in a high percentage of the cases. Recently the Sociedad Española de Medicina Interna (SEMI) (Spanish Society of Internal Medicine), in collaboration with other scientific societies, issued some recommendations for the drawing up of the discharge reports. In this present work, a series of thoughts are made on the implications of the new decree, especially in the case of the reports of the outpatient clinics.

  12. Use and dependence on opioid drugs in the Spanish population with chronic pain: Prevalence and differences according to sex.

    PubMed

    Coloma-Carmona, A; Carballo, J L; Rodríguez-Marín, J; Pérez-Carbonell, A

    To analyse the prevalence in the use and dependence on opioid drugs in the Spanish population with chronic pain and evaluate the differences according to sex. The demographic variables, opioid treatment characteristics and use of other substances were assessed in 229 users of opioid drugs. A descriptive bivariate analysis of the data was performed. Forty-six percent of the patients met the criteria of dependence on opioid drugs (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition [DSM-IV-TR]). Alcohol and cannabis consumption was greater in the men. The rates of dependence on the use of opioid drugs were significantly higher in the extended treatments. Planning for treatments with opioids and strategies for preventing inappropriate use should not depend on the patient's sex. We need further studies on the medical and psychological variables related to the use of and dependence on opioids. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  13. Modeling and Theories of Pathophysiology and Physiology of the Basal Ganglia–Thalamic–Cortical System: Critical Analysis

    PubMed Central

    Montgomery Jr., Erwin B.

    2016-01-01

    Theories impact the movement disorders clinic, not only affecting the development of new therapies but determining how current therapies are used. Models are theories that are procedural rather than declarative. Theories and models are important because, as argued by Kant, one cannot know the thing-in-itself (das Ding an sich) and only a model is knowable. Further, biological variability forces higher level abstraction relevant for all variants. It is that abstraction that is raison d’être of theories and models. Theories “connect the dots” to move from correlation to causation. The necessity of theory makes theories helpful or counterproductive. Theories and models of the pathophysiology and physiology of the basal ganglia–thalamic–cortical system do not spontaneously arise but have a history and consequently are legacies. Over the last 40 years, numerous theories and models of the basal ganglia have been proposed only to be forgotten or dismissed, rarely critiqued. It is not harsh to say that current popular theories positing increased neuronal activities in the Globus Pallidus Interna (GPi), excessive beta oscillations and increased synchronization not only fail to provide an adequate explication but are inconsistent with many observations. It is likely that their shared intellectual and epistemic inheritance plays a factor in their shared failures. These issues are critically examined. How one is to derive theories and models and have hope these will be better is explored as well. PMID:27708569

  14. Time-course of coherence in the human basal ganglia during voluntary movements

    PubMed Central

    Talakoub, Omid; Neagu, Bogdan; Udupa, Kaviraja; Tsang, Eric; Chen, Robert; Popovic, Milos R.; Wong, Willy

    2016-01-01

    We are interested in characterizing how brain networks interact and communicate with each other during voluntary movements. We recorded electrical activities from the globus pallidus pars interna (GPi), subthalamic nucleus (STN) and the motor cortex during voluntary wrist movements. Seven patients with dystonia and six patients with Parkinson’s disease underwent bilateral deep brain stimulation (DBS) electrode placement. Local field potentials from the DBS electrodes and scalp EEG from the electrodes placed over the motor cortices were recorded while the patients performed externally triggered and self-initiated movements. The coherence calculated between the motor cortex and STN or GPi was found to be coupled to its power in both the beta and the gamma bands. The association of coherence with power suggests that a coupling in neural activity between the basal ganglia and the motor cortex is required for the execution of voluntary movements. Finally, we propose a mathematical model involving coupled neural oscillators which provides a possible explanation for how inter-regional coupling takes place. PMID:27725721

  15. A histological, ultrastructural and immunohistochemical study of superficial temporal arteries and middle meningeal arteries in moyamoya disease.

    PubMed

    Li, B; Wang, C C; Zhao, Z Z; Hu, Y; Aihara, K; Ghazizadeh, M; Sasaki, Y; Yang, S Y; Pan, J

    1991-07-01

    Pathologic changes in superficial temporal arteries (STA) and middle meningeal arteries (MMA) biopsied from 15 patients with moyamoya disease (MD) who had undergone cerebro-temporal arterio-synangiosis were studied histologically, ultrastructurally and immunohistochemically. The main pathologic features were: proliferation of smooth muscle cells (SMCs) and thickening of the intima, degeneration and destruction of SMCs in the media and intima, and the presence of condensed organelles in necrosed SMCs or the interstitium among SMCs, or both outside and within the elastica interna (EI). The EI had become thin, porous, fragmented and was even absent in some segments. These changes are different from those of other forms of angiopathy, but identical with those at the ends of internal carotid arteries (ICA) reported by us previously, being pathognomonic for MD. These changes in the STA and MMA reveal that MD involves not only the ICA but also the intra- and extracranial branches of external carotid arteries. The medial necrosis of SMCs seems to be the primary injury of the arterial wall in MD. STA tissue blocks from two cases of MD were stained immunohistochemically. By electron microscopy, IgG-, IgM-, and C3-positive granules were observed on the ER of endothelial and intimal cells. Further studies on more cases are needed to determine whether an immunoreaction has occurred in these arteries.

  16. Eye ontogeny in Pleurodema bufoninum: A comparison with Pleurodema somuncurense (Anura, Leptodactylidae).

    PubMed

    Volonteri, Clara; Barrasso, Diego A; Cotichelli, Leonardo; Basso, Néstor G; Hermida, Gladys N

    2017-04-02

    Vision is one of the main sensory systems in amphibians, and the eye structure is highly associated with habitat conditions. The ontogeny, as well as the adult structure, of the eye has been studied in only a few species. The life change after metamorphosis is accompanied by changes in the visual environment. The aim of this work is to describe the eye ontogeny of Pleurodema bufoninum and to compare it with that of Pleurodema somuncurense. Specimens of both Pleurodema species were processed for histology analysis at different stages of development, including the tadpole, postmetamorphic, and adult forms. Eyes in both Pleurodema species are composed of the 3 tunics, tunica fibrosa, tunica vasculosa, and tunica interna, and the lens. Additionally, in both, the iris presents a projection on its dorsal and ventral free ends that screens the cornea. This structure has been reported in the eye of several anuran species and is called the umbraculum, meniscus or pupillary nodule. Our results show that the structures related to light capture (retina and lens) appear early in larval life, while the components of the terrestrial-life eye (scleral cartilage, specialized cornea, eyelids, nictitating membrane, and Harderian's gland) do not develop until the metamorphic climax, when the tadpole leaves the water. The adult eyes of P. bufoninum and P. somuncurense are very similar in structure and development.

  17. [Spanish translation and validation of the Postural Assessment Scale for Stroke Patients (PASS) to assess balance and postural control in adult post-stroke patients].

    PubMed

    Cabanas-Valdés, Rosa; Girabent-Farrés, Monserrat; Cánovas-Vergé, David; Caballero-Gómez, Fernanda M; Germán-Romero, Ana; Bagur-Calafat, Caritat

    2015-02-16

    Introduccion. En los ultimos años, la Postural Assessment Scale for Stroke Patients (PASS) se ha convertido en la escala mas utilizada para valorar el equilibrio y el control postural en pacientes adultos que han sufrido un ictus, especialmente en la fase aguda y subaguda. Objetivo. Traducir y validar la PASS para la poblacion española como instrumento de valoracion del equilibrio y el control postural en pacientes adultos postictus. Pacientes y metodos. Se tradujo al español la version original francesa de la PASS; dicha version fue consensuada por un equipo de expertos. Posteriormente se hizo una retrotraduccion al frances y se envio al autor de la escala, el cual aprobo dicha version. Seguidamente se evaluo la fiabilidad intra e interobservador; para ello se llevaron a cabo cuatro mediciones a 60 pacientes postictus, a partir de una videograbacion. Dos de estas mediciones fueron realizadas por el mismo observador, y la tercera y cuarta, por un segundo y tercer observadores. Resultados. Los valores obtenidos referidos a la puntuacion total de la escala reflejan un indice de fiabilidad del 0,999; tambien muestran una fiabilidad superior a 0,90 en cada uno de los items, tanto en las comparaciones intraobservador como interobservador, y una consistencia interna del 0,94. Conclusion. La version española de la PASS es valida y fiable para valorar el equilibrio y el control postural en pacientes adultos postictus.

  18. Viral hepatitis and immigration: A challenge for the healthcare system.

    PubMed

    Cuenca-Gómez, J A; Salas-Coronas, J; Soriano-Pérez, M J; Vázquez-Villegas, J; Lozano-Serrano, A B; Cabezas-Fernández, M T

    2016-01-01

    Viral hepatitis is a significant health problem in African countries. The increase in the immigrant population from this continent represents a challenge for the Spanish healthcare system. A descriptive study was conducted on the prevalence of the serological markers of hepatitis B (HBV), C (HCV) and D (HDV) in African immigrants treated in a specialised doctor's office. The study included 2518 patients (87.7% Sub-Saharan natives), with a mean age of 31.3 years. Some 78.8% of the patients had a positive infection marker for HBV, and 638 patients (25.3%) were diagnosed with active hepatitis B (HBsAg +). In 19 cases, antibodies against HDV were detected (4 cases with detection of the viral genome). Sixty-eight patients had antibodies against HCV, 26 of whom had a positive viral load. The high prevalence of viral hepatitis in immigrants, especially HBV infection, represents a significant change in the profile of patients treated in Spain and requires measures aimed at early diagnosis and transmission prevention. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  19. Children's cranial lesions from Neolithic.

    PubMed

    Shbat, A; Smrcka, V

    2009-01-01

    In skeletal material from the neolithic settlement at Makotrasy, county Kladno, were analysed two children's craniums (identification numbers Ao 8218 and Ao 4184) with pathological cases. Case 1 (Object 127, Ao 8218) is the individual about 4 to 5 years old. There is oval aperture with the diameter 25 x 20 mm in the area of anthropometrical point bregma, with vertical, multiple knurled edges. Bevelled and rounded segment in the left frontal part of the aperture with diameter 10 mm is imitating healing process. We suggest this case is the trephination with the marks of the healing process in the period of 1 to 2 weeks after the surgery took over. Case 2 (Pit 25, Ao 4184) is child with age determined about 4 years old. Cranium was found buried separately. There is oval defect located at os occipitale and os parietale sin and goes through sutura lambdoidea. Caudal part of defect is missing. The edge of the defect is sharp and inward bevelled with exposed diploe. Traces of any vital reaction were not identified. Diameter is around 50 mm. Perimortal trephination leading to death, or postmortal taking of the trephinational amulet must be considered. There were several pathological lesions on the same skull. Defect of oval shape sized 8 x 12 mm is located at the os parietale dex. Defect interferes mostly with lamina externa and less with lamina interna. Exposed diploe is without any vital reaction.

  20. Fibre Dissection and Sectional Study of the Major Porcine Cerebral White Matter Tracts.

    PubMed

    Pascalau, R; Szabo, B

    2017-08-01

    White matter anatomy is the basis for numerous applications in neurology, neurosurgery and fundamental neuroscience. Although the porcine brain is frequently used as experimental model in these fields of research, the description of its white matter is not as thorough as in the human brain or other species. Thus, the aim of this study is to describe the porcine white matter tracts in a complex manner. Two stepwise dissection protocols adapted from human anatomy were performed on six adult pig brain hemispheres prepared according to the Klingler method. Other four hemispheres were sectioned along section planes that were chosen similar to the Talairach coordinate system. As a result, three commissural tracts, seven association tracts and one projection tract were identified: corpus callosum, fornix, commissura rostralis, the short-association tracts, fasciculus longitudinalis superior, fasciculus uncinatus, fasciculus longitudinalis inferior, fasciculus occipitofrontalis inferior, cingulum, tractus mamillothalamicus and capsula interna. They were described and illustrated from multiple points of view, focusing on their trajectory, position, dimensions and anatomical relations. All in all, we achieved a three-dimensional understanding of the major tracts. The results are ready to be applied in future imagistic or experimental studies. © 2017 Blackwell Verlag GmbH.

  1. [Prevalence of nosocomial infections in a secondary care hospital in Mexico].

    PubMed

    Castañeda-Martínez, Fernando Cain; Valdespino-Padilla, María Guadalupe

    2015-01-01

    Introducción: las infecciones nosocomiales son un problema creciente, de gran repercusión social y económica que afecta a las instituciones hospitalarias. El objetivo de este trabajo fue determinar la prevalencia de infecciones nosocomiales en hospital de segundo nivel. Métodos: estudio transversal, observacional, se calculó un tamaño de muestra para una proporción, se incluyeron pacientes hospitalizados con más de 48 horas de internamiento; se obtiene estadística descriptiva y prueba de hipótesis utilizando prueba exacta de Fisher, se utilizó el software SPSS versión 18. Resultados: se encontró una prevalencia de 9.52 %, con una edad media de 46.59 años; 64.3 % de los pacientes fueron del sexo femenino, 35.7 % masculinos, la prevalencia por servicio fue de 16.27 % en Medicina Interna, y 12.5 % en Cirugía. Conclusiones: 10 de cada 100 pacientes hospitalizados presentan infección nosocomial, comportamiento muy similar a lo reportado en la literatura médica.

  2. Contribution of the spanish agency for medicines and healthcare products to the European committee for the evaluation of medicinal products for human use.

    PubMed

    Alonso-Gutiérrez, A; Díaz-Ramos, P; Sulleiro-Avendaño, E; de Miguel-Marañón, M; Padilla-Gallego, M E; Sancho-López, A; Ruiz-Antúnez, S; Prieto-Yerro, C

    2015-05-01

    The centralized procedure for registering medicinal products involves a joint assessment by all regulatory agencies of European Union member states, which are coordinated by the European Medicines Agency. Since its implementation in 1995, the Spanish Agency for Medicines and Healthcare Products (AEMPS) has actively contributed to the committee on medicinal products for human use. The therapeutic areas in which AEMPS has the greatest presence are cardiovascular, sensory organs (mainly ophthalmology) and genitourinary/sexual hormones. The technical staff of AEMPS contributes their expertise and extensive experience to this task, as do the practitioners of the Spanish healthcare system who act as external experts, providing their clinical vision and bringing the daily clinical practice to the evaluation of medicinal products. As with other European decision spaces, the joint participation of the member states is not homogeneous, with a minority of countries still heading the majority of assessments for the committee on medicinal products for human use, although all member countries take part in the final decision. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  3. Does extracellular matrix of the varicose vein wall change according to clinical stage?

    PubMed

    Demirkıran, Mehmet Ali; Köksoy, Cüneyt; Heper, Aylin Okçu; Bengisun, Uğur

    2014-01-01

    The etiology and pathophysiology of chronic venous disease is not fully understood. This study aimed to determine the variation of the extracellular matrix proteins in varicose vein wall according to clinical stage. Forty varicose and 10 control veins were sampled from the saphenofemoral junction. The Clinical Etiologic Anatomic Pathophysiologic (CEAP) classification was used in patients with varicose veins. Samples were stained with hematoxylin-eosin, Masson's trichrome, EVG (Elastica-van Gieson) stain and with laminin, fibronectin, tenascin antibodies. Stained samples were examined immuno-histochemically. Changes in extracellular matrix were determined semi-quantitatively using light microscopy. It was observed that in the early stages (C2-C3) of chronic venous disease, fibrosis is increased in the intima and media layers, with fragmentation in lamina elastica interna, and increased tenascin expression in the intima layer. In advanced stages (C4-C6), the accumulation of tenascin in the intima continued along with fibrosis in the media layer, the thickness of the media layer increased and fibronectin deposition was observed. This study showed that changes first occur in the intima during the early stages of the disease with addition of alterations in the media layer at later stages.

  4. Does extracellular matrix of the varicose vein wall change according to clinical stage?

    PubMed Central

    Demirkıran, Mehmet Ali; Köksoy, Cüneyt; Heper, Aylin Okçu; Bengisun, Uğur

    2014-01-01

    Objective: The etiology and pathophysiology of chronic venous disease is not fully understood. This study aimed to determine the variation of the extracellular matrix proteins in varicose vein wall according to clinical stage. Material and Methods: Forty varicose and 10 control veins were sampled from the saphenofemoral junction. The Clinical Etiologic Anatomic Pathophysiologic (CEAP) classification was used in patients with varicose veins. Samples were stained with hematoxylin-eosin, Masson’s trichrome, EVG (Elastica-van Gieson) stain and with laminin, fibronectin, tenascin antibodies. Stained samples were examined immuno-histochemically. Changes in extracellular matrix were determined semi-quantitatively using light microscopy. Results: It was observed that in the early stages (C2–C3) of chronic venous disease, fibrosis is increased in the intima and media layers, with fragmentation in lamina elastica interna, and increased tenascin expression in the intima layer. In advanced stages (C4–C6), the accumulation of tenascin in the intima continued along with fibrosis in the media layer, the thickness of the media layer increased and fibronectin deposition was observed. Conclusion: This study showed that changes first occur in the intima during the early stages of the disease with addition of alterations in the media layer at later stages. PMID:25931926

  5. Outcome of Recipients of Hematopoietic Stem Cell Transplants Who Require Intensive Care Unit Support: A Single Institution Experience.

    PubMed

    Galindo-Becerra, Samantha; Labastida-Mercado, Nancy; Rosales-Padrón, Jaime; García-Chavez, Jessica; Soto-Vega, Elena; Rivadeneyra-Espinoza, Liliana; León-Peña, Andres A; Fernández-Lara, Danitza; Dominguez-Cid, Monica; Anthon-Méndez, Javier; Arizpe-Bravo, Daniel; Ruiz-Delgado, Guillermo J; Ruiz-Argüelles, Guillermo J

    2015-01-01

    Admission to the intensive care unit (ICU) of a patient who has been grafted with hematopoietic stem cells is a serious event, but the role of the ICU in this setting remains controversial. Data were analyzed from patients who underwent autologous or allogeneic bone marrow transplantation at the Centro de Hematología y Medicina Interna de Puebla, México, between May 1993 and October 2014. In total, 339 patients were grafted: 150 autografts and 189 allografts; 68 of the grafted patients (20%) were admitted to the ICU after transplantation: 27% of the allografted and 11% of the autografted patients (p = 0.2). Two of 17 autografted patients (12%) and 5 of 51 allografted patients (10%) survived. All patients who required insertion of an endotracheal tube died, whereas 7 of 11 patients without invasive mechanical ventilation survived (p = 0.001). Only 10% of the grafted patients survived their stay in the ICU; this figure is lower than those reported from other centers and may reflect several facts, varying from the quality of the ICU support to ICU admission criteria to the initial management of all the grafts in an outpatient setting, which could somehow delay the arrival of patients to the hospital.

  6. Multiple-time-scale framework for understanding the progression of Parkinson's disease

    NASA Astrophysics Data System (ADS)

    Andres, D. S.; Gomez, F.; Ferrari, F. A. S.; Cerquetti, D.; Merello, M.; Viana, R.; Stoop, R.

    2014-12-01

    Parkinson's disease is marked by neurodegenerative processes that affect the pattern of discharge of basal ganglia neurons. The main features observed in the parkinsonian globus pallidus pars interna (GPi), a subdomain of the basal ganglia that is involved in the regulation of voluntary movement, are pathologically increased and synchronized neuronal activity. How these changes affect the implemented neuronal code is not well understood. Our experimental temporal structure-function analysis shows that in parkinsonian animals the rate-coding window of GPi neurons needed for the proper performance of voluntary actions is reduced. The model of the GPi network that we develop and discuss here reveals indeed that the size of the rate-coding window shrinks as the network activity increases and is expanded if the coupling strength among the neurons is increased. This leads to the novel interpretation that the pathological neuronal synchronization in Parkinson's disease in the GPi is the result of a collective attempt to counterbalance the shrinking of the rate-coding window due to increased activity in GPi neurons.

  7. [Analysis of utilization of information in the journal Medicina Clinica].

    PubMed

    Aleixandre, R; Giménez Sánchez, J V; Terrada, M L; López Piñero, J M

    1994-09-10

    Scientific communication knowledge is specifically based in the analysis of the bibliographic references inside the publications. Pattern and laws determining the information consumption in the items of the journal Medicina Clinica are investigated in the present study as its own aim. An analysis was performed on the 13,286 references downloaded from 618 papers published by the journal in 1990. With dBASE IV was generated a database for the management of the information; data was distributed in several tables through criteria of age, documentary types, countries, journals and Bradford zones. The analysed references belong to 1,241 different journals, 110 from Spain. Being two thirds of the total sum, the publications from United States and United Kingdom have received more citations than those from Spain. The publications from european countries, like France, Germany and Italy, are scarcely present. Bradford core is constituted by the journals Medicina Clinica and The Lancet. The analysis of the bibliographic references available from the articles in this journal is able to produce knowledge on the information consumption by the practitioners; its usefulness as a complementary utility to the Indice de Citas e Indicadores Bibliométricos de Revistas Españolas de Medicina Interna y sus especialidades 1990 must be considered.

  8. RECALMIN II. Eight years of hospitalisation in Internal Medicine Units (2007-2014). What has changed?

    PubMed

    Zapatero-Gaviria, A; Barba-Martín, R; Canora Lebrato, J; Fernández-Pérez, C; Gómez-Huelgas, R; Bernal-Sobrino, J L; Díez-Manglano, J; Marco-Martínez, J; Elola-Somoza, F J

    2017-08-30

    To analyse the evolution of care provided by the internal medicine units (IMU) of the Spanish National Health System from 2007 to 2014. We analysed all discharges from the IMU of the Spanish National Health System in 2007 and 2014, using the Minimum Basic Data Set. We compared the risk factors by episode, mortality and readmissions between the two periods. We prepared specific fits for the risk for mortality and readmissions in heart failure, pneumonia and chronic obstructive pulmonary disease, as well as the Charlson index for all activity. Discharges from the IMU between the two periods increased 14%. The average patient age increased by 2.8 years (71.2±17.1 vs. 74±16.2; p<.001), with a marked increase in comorbidity (Charlson index, 4±3.7 vs. 4.7±3.9; p<.001; 24% increase in risk factors per episode). The adjusted mortality rates decreased slight but significantly, with a slight increase in readmissions. During the analysed period, there was an increase of almost 3 years in the mean age of patients treated in the IMU of the Spanish National Health System, with a marked increase in comorbidity. These results should lead to a more appropriate assignment of nurse workloads and an increased implementation of good practices in clinical management. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  9. Hypomania: a transcultural perspective

    PubMed Central

    ANGST, JULES; MEYER, THOMAS D.; ADOLFSSON, ROLF; SKEPPAR, PETER; CARTA, MAURO; BENAZZI, FRANCO; LU, RU-BAND; WU, YI-HSUAN; YANG, HAI-CHEN; YUAN, CHENG-MEI; MORSELLI, PAOLO; BRIEGER, PETER; KATZMANN, JUDITH; TEIXEIRA LEÃO, INES ALICE; DEL PORTO, JOSÉ ALBERTO; HUPFELD MORENO, DORIS; MORENO, RICARDO A.; SOARES, ODEILTON T.; VIETA, EDUARD; GAMMA, ALEX

    2010-01-01

    This study examined the transcultural robustness of a screening instrument for hypomania, the Hypomania Checklist-32, first revised version (HCL-32 R1). It was carried out in 2606 patients from twelve countries in five geographic regions (Northern, Southern and Eastern Europe, South America and East Asia). In addition, GAMIAN Europe contributed data from its members. Exploratory and confirmatory factor analyses were used to examine the transregional stability of the measurement properties of the HCL-32 R1, including the influence of sex and age as covariates. Across cultures, a two-factor structure was confirmed: the first factor (F1) reflected the more positive aspects of hypomania (being more active, elated, self-confident, and cogni-tively enhanced); the second factor (F2) reflected the more negative aspects (being irritable, impulsive, careless, more substance use). The measurement properties of the HCL-32 R1 were largely invariant across cultures. Only few items showed transcultural differences in their relation to hypomania as measured by the test. F2 was higher among men and in more severe manic syndromes; F1 was highest in North and East Europe and lowest in South America. The scores decreased slightly with age. The frequency of the 32 items showed remarkable similarities across geographic areas, with two excep-tions: South Europeans had lower symptom frequencies in general and East Europeans higher rates of substance use. These findings support the interna-tional applicability of the HCL-32 R1 as a screening instrument for hypomania. PMID:20148160

  10. Examination of cytological smears and cell blocks of pleural fluid: Complementary diagnostic value for malignant effusions.

    PubMed

    Porcel, J M; Quirós, M; Gatius, S; Bielsa, S

    2017-04-01

    To evaluate the independent usefulness of pleural fluid smear and cell block (CB) preparations for the diagnosis of malignant effusions. A total of 632 cytological smears and 554 CBs from 414 consecutive patients with malignant effusions were retrospectively evaluated. The diagnostic yield of a first specimen was 44% regardless of whether a smear or CB cytologic examination was performed. The use of subsequent separated specimens increased the identification of malignancy to 56%. Overall, 11% of samples found to be negative by cytologic smears showed malignant cells on CBs, whereas 15% of negative CBs were reported as positive on smear slides. Pleural fluid specimens with low red and/or white blood cell counts more frequently resulted in the generation of suboptimal CB preparations. If CBs and smears are prepared and examined, the percentage of positive diagnoses will be greater than if only one method is used. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  11. Visibility of healthcare research institutes through the Web of Science database.

    PubMed

    González-Albo, B; Moreno-Solano, L; Aparicio, J; Bordons, M

    2017-06-15

    The strategic importance of healthcare research institutes (HRIs) in health sciences research in Spain has motivated this analysis of the feasibility of studing their contribution to the Spanish scientific output through their presence as a signatory institution in the publications. We identified the output of the HRIs in the Web of Science database, comparing their observed output (the institutes are explicitly listed in the authors' workplace) and potential output (estimated based on the linked hospitals). The studies based on scientific publications do not help us reliably identify the contribution of the HRIs because their observed production is much lower than the potential output, although their visibility tends to increase over time. This article highlights the importance of HRI members including the institute among their work addresses to increase the visibility of these organisations and to facilitate studies aimed at assessing their activity in the national and international context. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  12. [Validity and consistency of the ECAVIPEP and CAVE scales to assess quality of life in paediatric patients with epilepsy].

    PubMed

    García-Galicia, Arturo; García-Carrasco, Mario; Montiel-Jarquín, Álvaro J; García-Cuautitla, Marco A; Barragán-Hervella, Rodolfo G; Romero-Figueroa, M Socorro

    2014-10-01

    Introduccion. La epilepsia tiene un alto impacto en la calidad de vida del niño, por lo que es importante contar con instrumentos validados y consistentes para su evaluacion. Objetivo. Comparar la validez y consistencia de una nueva escala de calidad de vida para pacientes epilepticos pediatricos (ECAVIPEP) de un hospital mexicano con la escala CAVE ampliamente validada. Pacientes y metodos. Estudio comparativo, en el que se analiza la validez y consistencia de una nueva escala para evaluar la epilepsia en niños. Se realizo en niños epilepticos de 4-10 años mediante la aplicacion de una escala de calidad de vida, comparandola con la escala CAVE ampliamente validada. Se utilizo el alfa de Cronbach y la rho de Spearman para la validez y la consistencia. Resultados. Fueron 114 pacientes, 72 (63,1%) niños y 42 (36,8%) niñas. La consistencia interna dio un valor del alfa de Cronbach de 0,673. Para el analisis de validez convergente, comparando las puntuaciones obtenidas por la CAVE y por la ECAVIPEP, se obtuvo una rho de Spearman de 0,670 (p menor que 0). Conclusion. La ECAVIPEP es una escala valida y consistente para la evaluacion en niños de 4-10 años con epilepsia.

  13. [Cognitive Reserve Scale: testing the theoretical model and norms].

    PubMed

    Leon-Estrada, I; Garcia-Garcia, J; Roldan-Tapia, L

    2017-01-01

    Introduccion. La teoria de la reserva cognitiva contribuiria a explicar las diferencias en el rendimiento intelectual en sujetos con deterioro cognitivo similar y en sujetos sanos. Sin embargo, son necesarios mas datos psicometricos que garanticen el uso de los instrumentos de medicion de reserva cognitiva. Objetivo. Aportar evidencias de validez respecto a la estructura interna de la escala de reserva cognitiva (ERC) y establecer un baremo de referencia para la interpretacion de sus puntuaciones. Sujetos y metodos. Un total de 172 sujetos completaron la ERC y fueron distribuidos en dos grupos en funcion de la edad: 36-64 años (n = 110) y 65-88 años (n = 62). Resultados. El analisis factorial mediante modelos de ecuaciones estructurales exploratorios indico un moderado ajuste de los datos al modelo propuesto. En general, los indices de discriminacion fueron correctos (entre 0,21 y 0,50), y se registro congruencia entre los items a lo largo de los periodos de juventud, adultez y madurez para ambos grupos de edad. Se observaron valores adecuados del indice de fiabilidad (alfa de Cronbach: 0,80) y de los errores tipicos de medida (media: 51,40 ± 11,11). Conclusiones. La ERC se enmarcaria dentro del modelo teorico hipotetizado y las puntuaciones podrian interpretarse mediante el baremo ofrecido, lo que avalaria su empleo en la investigacion en este campo.

  14. El sistema ESO 296-IG 11

    NASA Astrophysics Data System (ADS)

    Agüero, E. L.; Paolantonio, S.

    El objeto ESO 296-IG 11 que se presenta en forma de ``V'' y posee destacadas condensaciones a lo largo de cada una de sus dos ramas, las que son de igual extensión (~ 1'), es estudiado en base a material espectroscópico obtenido en el CASLEO. Así se establecen las principales características espectrales, las condiciones físicas y los mecanismos de excitación dominantes de las zonas más notables de su estructura, como así también la distribución de su extinción interna y la variación del grado de excitación de las mismas. Del análisis de las velocidades radiales se determina que se trata de dos galaxias de tipo disco que se están interpenetrando y que conforman un sistema triple junto con una galaxia de contorno elíptico y tamaño considerablemente menor (0.2') que se encuentra a ~ 1.3' del punto de intersección de las dos primeras, ubicada sobre la dirección que contiene a una de éstas y hacia la que se extienden unas débiles y largas prolongaciones de la otra.

  15. National survey on the activity of internists in shared care-interconsultations in spanish hospitals.

    PubMed

    Marco Martínez, J; Montero Ruíz, E; Fernández Pérez, C; Méndez Bailón, M; García Klepzig, J L; Garrachón Vallo, F

    2016-11-01

    To analyse the activity of interconsultations conducted by the departments of internal medicine, communicating their importance to managers and offering information to these departments to improve their organisation. A cross-sectional study was conducted using an interconsultation activity survey (on-demand consulting activity for other departments) and shared care (consulting activity provided in a regulated manner to other departments). We received 120 surveys that corresponded to 108 public and 12 private hospitals. Forty-five percent of the surveyed hospitals had a specialised interconsultation unit, and 31% had shared care. The department most frequently helped by the presence of a stable consultation unit (65% of the cases) was orthopaedic and trauma surgery. Fifty-five percent of the departments of internal medicine surveyed had an interconsultation activity record since the start of their activity. Ninety-two percent of the departments lacked a protocol that regulated interconsultations, and in 74% of the cases, the interconsultation was on demand. The interconsultation activity is generalised in the departments of internal medicine, but only 45% of these departments have interconsultation units, and only 33% provide the shared care modality. The survey reflects the shortcomings of training and some confusion in the concept of interconsultations. The considerable majority of departments lack organisational interconsultation protocols. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  16. [Biodegradable coronary stents: history of application and own experience].

    PubMed

    Furkalo, S N; Khasianov, I V; Vlasenko, E A

    2014-10-01

    Experience of application of a new generation coronary stents--biodegradable stent--platforms--was summarized, in 46 patients, suffering an ischemic heart disease, 60 stents "Absorb" were implanted. Unstable course of the disease was noted in 6 (13.0%) patients, coronary angina of functional class II--III--in 40 (87%). Early stenting was accomplished in 10, aortocoronary shunting--in 4 patients, and abdominal aorta endoprosthesis--in 1. One stent "Absorb" was implanted to 33 patients, two stents--to 11, four biodegradable stents--1. In one observation the stenting of coronary arteries and a. carotis interna was conducted. In all the patients the immediate postoperative period course was uneventful, unfaithful implantation or an acute thrombosis of stent were not observed. The investigation results witnesses the possibility of application of this technology in various clinical and angiographic situations. For wide introduction of biodegradable stents into practice of interventional cardiology departments it is necessary to proceed with the immediate and late follow-up results studying.

  17. Design, Fabrication, Simulation and Characterization of a Novel Dual-Sided Microelectrode Array for Deep Brain Recording and Stimulation.

    PubMed

    Zhao, Zongya; Gong, Ruxue; Huang, Hongen; Wang, Jue

    2016-06-15

    In this paper, a novel dual-sided microelectrode array is specially designed and fabricated for a rat Parkinson's disease (PD) model to study the mechanisms of deep brain stimulation (DBS). The fabricated microelectrode array can stimulate the subthalamic nucleus and simultaneously record electrophysiological information from multiple nuclei of the basal ganglia system. The fabricated microelectrode array has a long shaft of 9 mm and each planar surface is equipped with three stimulating sites (diameter of 100 μm), seven electrophysiological recording sites (diameter of 20 μm) and four sites with diameter of 50 μm used for neurotransmitter measurements in future work. The performances of the fabricated microelectrode array were characterized by scanning electron microscopy (SEM), electrochemical impedance spectroscopy (EIS) and cyclic voltammetry. In addition, the stimulating effects of the fabricated microelectrode were evaluated by finite element modeling (FEM). Preliminary animal experiments demonstrated that the designed microelectrode arrays can record spontaneous discharge signals from the striatum, the subthalamic nucleus and the globus pallidus interna. The designed and fabricated microelectrode arrays provide a powerful research tool for studying the mechanisms of DBS in rat PD models.

  18. Nuevos escenarios de la migración México-Estados Unidos. Las consecuencias de la guerra antiinmigrante

    PubMed Central

    MASSEY, Douglas S.; PREN, Karen A.; DURAND, Jorge

    2010-01-01

    La historia de la migración México-Estados Unidos se caracteriza por una serie de periodos durante los cuales los patrones migratorios se transforman y evolucionan como respuesta a los cambios en la política migratoria de Estados Unidos. En la década de 1990 se dio uno de estos cambios, lo que provocó el paso de la ‘era de la contradicción’ a la ‘era de la marginalización’. Actualmente, un gran número de migrantes indocumentados permanecen al margen de la ley, precisamente en un periodo en el que las penas se han incrementado y la persecución ha alcanzado niveles récord. De manera cada vez más notoria, los migrantes indocumentados, por la represión interna y fronteriza, quedan obligados a romper los lazos que los vinculaban con sus lugares de destino, pero al mismo tiempo se sienten cada vez más extraños en una tierra donde la aplicación de políticas antiinmigrantes es cosa de todos los días, lo que los sitúa en una posición de marginalización y gran vulnerabilidad. PMID:21209790

  19. Multiplexed coding in the human basal ganglia

    NASA Astrophysics Data System (ADS)

    Andres, D. S.; Cerquetti, D.; Merello, M.

    2016-04-01

    A classic controversy in neuroscience is whether information carried by spike trains is encoded by a time averaged measure (e.g. a rate code), or by complex time patterns (i.e. a time code). Here we apply a tool to quantitatively analyze the neural code. We make use of an algorithm based on the calculation of the temporal structure function, which permits to distinguish what scales of a signal are dominated by a complex temporal organization or a randomly generated process. In terms of the neural code, this kind of analysis makes it possible to detect temporal scales at which a time patterns coding scheme or alternatively a rate code are present. Additionally, finding the temporal scale at which the correlation between interspike intervals fades, the length of the basic information unit of the code can be established, and hence the word length of the code can be found. We apply this algorithm to neuronal recordings obtained from the Globus Pallidus pars interna from a human patient with Parkinson’s disease, and show that a time pattern coding and a rate coding scheme co-exist at different temporal scales, offering a new example of multiplexed neuronal coding.

  20. Assessment of the reliability and consistency of the "malnutrition inflammation score" (MIS) in Mexican adults with chronic kidney disease for diagnosis of protein-energy wasting syndrome (PEW).

    PubMed

    González-Ortiz, Ailema Janeth; Arce-Santander, Celene Viridiana; Vega-Vega, Olynka; Correa-Rotter, Ricardo; Espinosa-Cuevas, María de Los Angeles

    2014-10-04

    Antecedentes: El síndrome de desgaste proteínico-energético (DPE) se refiere a una condición de desnutrición, inflamación, anorexia, y emaciación de reservas corporales resultante de las condiciones inflamatorias y no inflamatorias que prevalecen en pacientes con enfermedad renal crónica (ERC).Una forma ampliamente descrita en la literatura para evaluar el DPE es el Malnutrition Inflamation Score (MIS). Objetivo: Valorar la fiabilidad y consistencia del MIS en adultos mexicanos con ERC en Hemodiálisis (HD) para Diagnóstico de DPE. Métodos: Estudio de pruebas diagnósticas. Se analizó una muestra de 45 adultos con ERC en HD, Durante el periodo Junio-Julio 2014. El instrumento se aplicó en 2 ocasiones, la fiabilidad test-retest se calculó mediante el Coeficiente de correlación Intraclase (CCI), la consistencia interna del cuestionario se analizó mediante el Coeficiente de Cronbach. Se calculó una prueba de Kappa ponderada para estimar la validez del instrumento, posteriormente se comparó con el índice nutricional de Bilbrey (IB). Resultados: La fiabilidad entre cuestionarios valorada en la muestra de pacientes fue de CCI = 0.829. La concordancia entre observaciones MIS es considerada como adecuada = 0.585 (p.

  1. Multiple-time-scale framework for understanding the progression of Parkinson's disease.

    PubMed

    Andres, D S; Gomez, F; Ferrari, F A S; Cerquetti, D; Merello, M; Viana, R; Stoop, R

    2014-12-01

    Parkinson's disease is marked by neurodegenerative processes that affect the pattern of discharge of basal ganglia neurons. The main features observed in the parkinsonian globus pallidus pars interna (GPi), a subdomain of the basal ganglia that is involved in the regulation of voluntary movement, are pathologically increased and synchronized neuronal activity. How these changes affect the implemented neuronal code is not well understood. Our experimental temporal structure-function analysis shows that in parkinsonian animals the rate-coding window of GPi neurons needed for the proper performance of voluntary actions is reduced. The model of the GPi network that we develop and discuss here reveals indeed that the size of the rate-coding window shrinks as the network activity increases and is expanded if the coupling strength among the neurons is increased. This leads to the novel interpretation that the pathological neuronal synchronization in Parkinson's disease in the GPi is the result of a collective attempt to counterbalance the shrinking of the rate-coding window due to increased activity in GPi neurons.

  2. [Clinical usefulness and psychometric properties of the Cambridge Behavioural Inventory].

    PubMed

    Fernandez-Martinez, R; Kokoulina, E; Carballido-Araujo, E; Garcia-Fuertes, I; Gutierrez-Martinez, O; Santiago-Lopez, F; Vazquez-Batan, P

    2016-11-16

    Introduccion. Un area importante de la evaluacion neuropsicologica son los sintomas psicologicos y conductuales. El inventario conductual de Cambridge –Cambridge Behavioural Inventory (CBI)– es una medida de autoinforme dirigida a allegados que recoge una amplia variedad de sintomas conductuales que pueden darse en el curso de las enfermedades neurologicas. El principal objetivo del estudio es comprobar la utilidad clinica de su adaptacion al castellano. Sujetos y metodos. El CBI fue cumplimentado por 215 allegados de pacientes remitidos desde los servicios de neurologia y psiquiatria. Se compararon los perfiles del CBI de cuatro grupos de pacientes formados sobre la base de sus principales caracteristicas clinicas, datos psicometricos, pruebas de imagen y juicio clinico del profesional solicitante del estudio neuropsicologico. Resultados. La mayoria de las escalas (10 de 13) del CBI tuvo valores de consistencia interna aceptables, y las escalas de memoria y atencion/orientacion, correlaciones elevadas con medidas objetivas de memoria y orientacion temporal. Los perfiles del CBI de los grupos de pacientes con distintas condiciones (trastorno organico de la memoria, trastorno funcional de la memoria, variante conductual de demencia frontotemporal y enfermedad de Alzheimer) fueron consistentes con sus principales caracteristicas. Conclusiones. El CBI es un instrumento psicometricamente fiable y con adecuada validez convergente y discriminante que puede ser util en el proceso de evaluacion neuropsicologica, aportando informacion relevante no solo sobre el funcionamiento cognitivo y las capacidades funcionales, sino tambien sobre los sintomas conductuales y psicologicos de los pacientes con trastornos cognitivos.

  3. A survey to medical residents on the performance of diagnostic and therapeutic thoracenteses: a training gap?

    PubMed

    Porcel, J M; Cases-Viedma, E; Bielsa, S

    2016-12-01

    Pleural fluid aspiration is a routine procedure for pulmonologists and internists. Our aim was to evaluate technical and methodological aspects of diagnostic and therapeutic thoracenteses performed by last two-year residents of Pulmonology and Internal Medicine. An online 24-item questionnaire was sent to participants, and responses were evaluated according to the medical specialty. The survey was completed by 139 (17.1%) residents (71 internists and 68 pulmonologists). 29.5% and 41% performed one or no diagnostic or therapeutic thoracenteses monthly, respectively. Only 44% used ultrasonography to guide pleural procedures. Less than half of respondents used local anesthesia for diagnostic aspirations. Contrary to current recommendations, 25% of residents employed intramuscular needles for therapeutic aspirations. More than 80% of residents routinely ordered pleural fluid cultures and cytological studies, regardless of the clinical suspicion. About 40% requested imaging studies after a diagnostic thoracentesis. Half or more of the respondents were unaware of pH measurement methodologies, culture type for mycobacteria, and performance of cell blocks. Pulmonologists were more experienced than internists, and also made use of ultrasonography more frequently. This survey highlights gaps of knowledge and skills in conducting diagnostic and therapeutic thoracenteses. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  4. Pallidal stimulation for segmental dystonia: long term follow up of 11 consecutive patients.

    PubMed

    Sensi, Mariachiara; Cavallo, Michele A; Quatrale, Rocco; Sarubbo, Silvio; Biguzzi, Sara; Lettieri, Cristian; Capone, Jay G; Tugnoli, Valeria; Tola, Maria Rosaria; Eleopra, Roberto

    2009-09-15

    Pallidal stimulation is a convincing and valid alternative for primary generalized dystonia refractory to medical therapy or botulinum toxin. However, the clinical outcome reported in literature is variable most likely because of heterogeneity DBS techniques employed and /or to clinical dystonic pattern of the patients who undergo surgery. In this study, we report the long term follow up of a homogeneous group of eleven subjects affected by segmental dystonia who were treated with bilateral stimulation of the Globus Pallidus pars interna (GPi) from the years 2000 to 2008. All the patients were evaluated, before surgery and at 6-12-24-36 months after the treatment, in accordance with the Burke Fahn Marsden Dystonia Rating Scale (BFMDRS). Our study indicates that DBS promotes an early and significant improvement at 6 months with an even and a better outcome later on. The analysis of specific sub items of the BFMDRS revealed an earlier and striking benefit not only as far as segmental motor function of the limbs but also for the complex cranial functions like face, (eyes and mouth), speech and swallowing, differently from results reported in primary generalized dystonia. Deep Brain Stimulation of GPi should be considered a valid indication for both generalized and segmental dystonia when other therapies appear ineffective.

  5. Mice Drawer System: a Long Duration Animal Experiment on the International Space Station

    NASA Astrophysics Data System (ADS)

    Cotronei, Vittorio; Liu, Yi; Pignataro, Salvatore

    Mice represent one of the most important animal models for biomedical research. In the past decade mice have been used as surrogates to understand physiological adaption and its under-lying mechanisms to orbital spaceflight. A breakthrough in this field has been achieved with the launch of MDS experiment inside Shuttle Discovery (mission STS-128) on August 28, 2009 at 23:58 EST, and its re-entry to earth by Shuttle Atlantis (mission STS-129) on November 27 2009 at 9:47 EST, marking this as the first long duration animal experiment on the Interna-tional Space Station (ISS). This presentation will provide the life history and milestones starting from the project brainstorm to the post-ground activities of the recent MDS payload mission. The Italian Space Agency (ASI) initiated and coordinated this multi-disciplinary project by focusing on five areas: the development of a multi-purpose automated payload by industry; bio-compatibility tests of subsystems throughout various critical phases of the payload development by researchers, development of a ground segment to interface with NASA Payload Operations Center and three different geographically distributed Italian Operations Centers; establishment of an international tissue sharing program; specialized bio-specimen intercontinental shipment. With close collaboration with NASA, activities such as pre-flight payload acceptance, animal preparation, in-flight crew intervention and re-entry animal recovery were smoothly and swiftly accomplished.

  6. The optimal pallidal target in deep brain stimulation for dystonia: a study using a functional atlas based on non-linear image registration

    PubMed Central

    Tolleson, Christopher; Pallavaram, Srivatsan; Li, Chen; Fang, John; Phibbs, Fenna; Konrad, Peter; Hedera, Peter; Francois-D'Haese, Pierre; Dawant, Benoit M.; Davis, Thomas L.

    2014-01-01

    Background Deep Brain Stimulation (DBS) of the globus pallidus interna (GPi) is established as efficacious for dystonia yet the optimal target within this structure is not well defined. Published evidence suggests that spatial normalization provides a better estimate of DBS lead location than traditional methods based on standard stereotactic coordinates. Methods We retrospectively reviewed our pallidal implanted dystonia population. Patient imaging scans were morphed into an MRI atlas using a non-linear image registration algorithm. Active contact locations were projected onto the atlas and clusters analyzed for the degree of variance in two groups: 1) good and poor responders and 2) cervical (CD) and generalized dystonia (GD). Results Average active contact location between CD and GD good responders was distinct but not significantly different. Mean active contact for CD poor responders was significantly different from CD responders and GD poor responders in the dorsoventral direction. Conclusions A normalized imaging space is arguably more accurate in visualizing postoperative leads. Despite some separation between groups, this data suggests there was not an optimal pallidal target for common dystonia patients. Degrees of variance overlapped due to a large degree of individual target variation. Patient selection may ultimately be the key to maximizing patient outcomes. PMID:25502118

  7. Middle ear polyps: results of traction avulsion after a lateral approach to the ear canal in 62 cats (2004-2014).

    PubMed

    Janssens, Sara Ds; Haagsman, Annika N; Ter Haar, Gert

    2017-08-01

    Objectives The objective of this study was to report the surgical outcome and complication rate of deep traction avulsion (TA) of feline aural inflammatory polyps after a lateral approach (LA) to the ear canal. Methods This was a retrospective analysis of data retrieved from an electronic database of 62 cats treated with TA after an LA (TALA) for removal of ear canal polyps. Long-term outcome was assessed via a telephone questionnaire survey with the owners. Results Domestic shorthair cats (48%) and Maine Coons (37%) were over-represented. The most common presenting clinical signs were otorrhoea, ear scratching and head shaking. Video-otoscopic examination confirmed a polypous mass in the ear canal in all patients. All 62 cats underwent TALA, with a mean surgical time of 33 mins for experienced surgeons (n = 4) and 48 mins (n = 12) for less experienced surgeons. The recurrence rate of polyp regrowth for experienced surgeons was 14.3% vs 35% for the less experienced surgeons. Postoperative complications included Horner's syndrome (11.5%) and facial nerve paralysis (3%). Otitis interna was not observed. Conclusions and relevance A lateral approach to the ear canal in combination with deep TA of an aural inflammatory polyp is an effective first-line technique that results in a low recurrence and complication rate.

  8. Prevalence of hypoalbuminemia and nutritional issues in hospitalized elders.

    PubMed

    Brock, Felipe; Bettinelli, Luiz Antonio; Dobner, Taise; Stobbe, Júlio César; Pomatti, Gabriela; Telles, Cristina Trevizan

    2016-08-08

    to estimate the prevalence of hypoalbuminemia in hospitalized elders, related to socio-demographic variables, nutritional status and length of stay. crosscutting study with 200 patients hospitalized in a large hospital in the South of Brazil during three months. Evaluations, lab tests and interviews through questionnaires were performed. the average albuminemia was 2,9 ± 0,5g/dL. Hypoalbuminemia was diagnosed in 173 subjects (87%) and was absent in 27 (13%) that have normal albuminemia (p=0,000). After six days of hospitalization, the prevalence of low levels grew significantly to 90% (p=0,002), average 2,7 ± 0,5g/dL. Using the Mini Nutritional Assessment, it was observed that 41 patients were malnourished and from those, 40 had hypoalbuminemia. the prevalence of hypoalbuminemia proved to be high, in approx. nine in ten elders, and the nutritional status and the length of stay proved to be related to the decrease of serum albumin levels. Thus, it is suggested that monitoring albumin levels should be done to evaluate the risk that the patient has to develop malnutrition and other complications during hospital stays. estimar a prevalência de hipoalbuminemia em idosos hospitalizados, em relação às variáveis sociodemográficas, estado nutricional e tempo de internação. estudo transversal, com 200 pacientes internados em hospital de grande porte do sul do Brasil, durante o período de três meses. Foram realizadas avaliações, análise de exames laboratoriais e entrevista através de questionário. a média de albuminemia foi 2,9 ± 0,5g/dL. O diagnóstico de hipoalbuminemia, foi encontrado em 173 sujeitos (87%), e não revelado em 27 (13%), que apresentaram albuminemia normal (p=0,000). Constatou-se que após seis dias de internação a prevalência de níveis baixos aumentou significativamente para 90% (p=0,002), com média de 2,7 ± 0,5g/dL. Utilizando-se a Mini Avaliação Nutricional, observou-se que 41 pacientes estavam desnutridos, e que destes, 40

  9. Clinical outcome and intraoperative neurophysiology for focal limb dystonic tremor without generalized dystonia treated with deep brain stimulation.

    PubMed

    Ramirez-Zamora, Adolfo; Kaszuba, Brian; Gee, Lucy; Prusik, Julia; Molho, Eric; Wilock, Meghan; Shin, Damian; Pilitsis, Julie G

    2016-11-01

    Dystonic tremor (DT) is defined as a postural/kinetic tremor occurring in the body region affected by dystonia. DT is typically characterized by focal tremors with irregular amplitudes and variable frequencies typically below 7Hz. Pharmacological treatment is generally unsuccessful and guidelines for deep brain stimulation (DBS) targeting and indications are scarce. In this article, we present the outcome and neurophysiologic data of two patients with refractory, focal limb DT treated with Globus Pallidus interna (Gpi) DBS and critically review the current literature regarding surgical treatment of DT discussing stereotactic targets and treatment considerations. A search of literature concerning treatment of DT was conducted. Additionally, Gpi DBS was performed in two patients with DT and microelectrode recordings for multi unit analysis (MUAs) and local field potentials (LFPs) were obtained. The mean percentage improvement in tremor severity was 80.5% at 3 years follow up. MUAs and LFPs did not show significant differences in DT patients compared with other forms of dystonia or PD except for higher interspikes bursting indices. LFP recordings in DT demonstrated high power at low frequencies with action (<3.5Hz). Gpi DBS is an effective treatment in patients with focal limb DT without associated generalized dystonia. Intraoperative neurophysiologic findings suggest that DT is part of phenotypic motor manifestations in dystonia. Copyright © 2016 Elsevier B.V. All rights reserved.

  10. [Monoclonal gammopathy of undetermined significance (MGUS) in Mexican mestizos: one institution's experience].

    PubMed

    Ruiz-Delgado, Guillermo J; Gómez Rangel, J David

    2004-01-01

    Monoclonal gammopathy of undetermined significance (MGUS) is defined as presence of serum monoclonal protein at a concentration of 3 g per deciliter or less, no monoclonal protein or only moderate amounts of monoclonal light chains in urine, absence of lytic bone lesions, anemia, hypercalemia, and renal insufficiency related with monoclonal protein, and with a proportion of plasma cells in bone marrow of 10% or less. In Caucasian population, MGUS affects about 3% of individuals > 70 years of age, whereas in Mexican mestizos this figure is substantially lower (0.7%); on the other hand, MGUS represents in Mexico only 2.4% of all monoclonal gammopathies. In a total of 9081 individuals studied prospectively at the Centro de Hematología y Medicina Interna de Puebla throughout a 20-year period, 11 patients with MGUS were identified. Median age was 70 years (range 43-83 years). Patients have been followed in periods ranging from 6 to 3270 days (median, 308 days). Two patients evolved into overt multiple myeloma at 308 and 1687 days after diagnosis of MGUS. Overall median survival (SV) of the group has not been reached, whereas 3270 days overall SV is 91%. After discussing underreporting, biasing, and other confounding factors, it would seem that MGUS, like other monoclonal gammopathies, is less frequent in Mexican mestizos than in Caucasians. Routine screening studies to identify the condition should result in increased numbers of patients.

  11. Clinical trials. A pending subject.

    PubMed

    Gil-Extremera, B; Jiménez-López, P; Mediavilla-García, J D

    2017-07-31

    Clinical trials are essential tools for the progress of clinical medicine in its diagnostic and therapeutic aspects. Since the first trial in 1948, which related tobacco use with lung cancer, there have been more than 150,000 clinical trials to date in various areas (paediatrics, cardiology, oncology, endocrinology, etc.). This article highlights the importance for all physicians to participate, over the course of their professional career, in a clinical trial, due to the inherent benefits for patients, the progress of medicine and for curricular prestige. The authors have created a synthesis of their experience with clinical trials on hypertension, diabetes, dyslipidaemia and ischaemic heart disease over the course of almost 3 decades. Furthermore, a brief reference has been made to the characteristics of a phase I unit, as well as to a number of research studies currently underway. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  12. White Matter Injury and Recovery after Hypertensive Intracerebral Hemorrhage

    PubMed Central

    Zuo, Shilun; Pan, Pengyu; Li, Qiang

    2017-01-01

    Hypertensive intracerebral hemorrhage (ICH) could very probably trigger white matter injury in patients. Through the continuous study of white matter injury after hypertensive ICH, we achieve a more profound understanding of the pathophysiological mechanism of its occurrence and development. At the same time, we found a series of drugs and treatment methods for the white matter repair. In the current reality, the research paradigm of white matter injury after hypertensive ICH is relatively obsolete or incomplete, and there are still lots of deficiencies in the research. In the face of the profound changes of stroke research perspective, we believe that the combination of the lenticulostriate artery, nerve nuclei of the hypothalamus-thalamus-basal ganglia, and the white matter fibers located within the capsula interna will be beneficial to the research of white matter injury and repair. This paper has classified and analyzed the study of white matter injury and repair after hypertensive ICH and also rethought the shortcomings of the current research. We hope that it could help researchers further explore and study white matter injury and repair after hypertensive ICH. PMID:28680884

  13. Cardiovascular risk factors, nonvalvular atrial fibrillation and retinal vein occlusion.

    PubMed

    Lisa Gracia, M; Córdoba Alonso, A; Hernández Hernández, J L; Pérez Montes, R; Napal Lecumberri, J J

    2017-05-01

    To analyse the importance of cardiovascular risk factors, ultrasound findings in the supra-aortic trunk and the presence of anticoagulated nonvalvular atrial fibrillation (NVAF) in patients with retinal vein occlusion (RVO) and in a control group. A cross-sectional study was conducted of all patients with RVO consecutively referred to the office of internal medicine, comparing them with a control group. We analysed clinical, electrocardiographic and ultrasound variables. We studied 212 patients (114 men and 98 women) with RVO and 212 controls (95 men and 117 women) of similar ages. Arterial hypertension, dyslipidaemia and diabetes mellitus were significantly more prevalent in the patients with RVO than in the controls (73.6 vs. 50%, 64.6 vs. 48.6% and 27.8 vs. 12.3%, respectively). We observed arteriosclerotic lesions in the supra-aortic trunk in 55% of the patients with RVO. The patients with RVO and NVAF had a greater burden of cardiovascular risk factors than the controls with NVAF. There were no differences in terms of the international normalised ratio or in the use of direct anticoagulants between the cases and controls with NVAF. Cardiovascular risk factors (especially arterial hypertension) and arteriosclerotic involvement of the supra-aortic trunk are highly prevalent in RVO. Anticoagulation does not appear to be effective in preventing RVO. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  14. Treating epilepsy: a review of Polish historical sources.

    PubMed

    Owczarek, Krzysztof

    2011-10-01

    The first surviving Polish publications on epilepsy were written in the 16th and 17th centuries. Many causes of epileptic seizures are quoted and they are divided into two categories: internal and external. Internal causes (causa interna) include imbalance in the basic bodily humors, that is, yellow bile, black bile, phlegm, and blood. According to medieval writers, the principal cause of epilepsy was vapor, a damp, cold volatile substance originating in the excessive production of one of the basic organismic liquids. Vapor allegedly stuck to the openings leading to the cerebral ventricles or blocked them entirely, resulting in convulsions. External causes (causa externa) include overeating and excessive drinking, teething, spoiled milk, poisons, badly treated spots and fever, cold air, moonlight, and wearing donkey hide. Medical treatments for epilepsy included surgical interventions (bloodletting) and pharmacological interventions. The latter included laxatives, sea onion (scilla maritima, urginea maritima), and ground human skull, all of which were supposed to protect the body from vapors. Medical practitioners of that time also advised that the factors and circumstances conducive to epileptic seizures be observed and identified so that patients could be isolated from these alleged causal factors and their seizures reduced or ended.

  15. The anterior to midaxillary line between the 4th or 5th intercostal space (Buelau position) is safe for the use of thoracostomy tubes in preterm and term infants.

    PubMed

    Eifinger, Frank; Lenze, Miriam; Brisken, Katrin; Welzing, Lars; Roth, Bernhard; Koebke, Jürgen

    2009-06-01

    Thoracostomy tubes are widely used in neonatology. Complications occurred significantly more frequently in infants, especially neonates, than in adults. Principally, the access is the modified Buelau position which takes place in the anterior axillary line at the 4th or 5th intercostal space above the margin of the ribs. This study seeks to determine the characteristics and topographic conditions of the anatomical structures at the ventral and lateral thoracic wall in the preterm and term neonate. Fifteen formalin-fixed stillborns were prepared (nine male, six female, 28-43 weeks gestational age). The anatomical preparation involved the complete thoracic wall region. In all preparations, a venous vessel was detected at the lateral wall and was identified as v. thoracoepigastrica without accompanying artery. Arteria (a.) and vena (v.) thoracica interna were regularly found close to the sternal plate on both sides between rib and fascia. With increasing gestational ages the course of the v. thoracoepigastrica varied significantly between the left and right thoracic wall. It was demonstrated that the v. thoracoepigastrica regularly arose within the abdominal or thoracic subcutaneous fat and drained into the v. subclavia. The variance between its course was almost 5-12 mm to the lateral or medial side. At both thoracic sides, no other organs or organ structures except lung parenchyma could be detected when using the Buelau position. The anterior to midaxillary line between the 4th or 5th intercostal space (Buelau position) is safe for the use of thoracostomy tubes in preterm and term infants.

  16. Post-stroke dyskinesias

    PubMed Central

    Nakawah, Mohammad Obadah; Lai, Eugene C

    2016-01-01

    Strokes, whether ischemic or hemorrhagic, are among the most common causes of secondary movement disorders in elderly patients. Stroke-related (vascular) movement disorders, however, are uncommon complications of this relatively common disease. The spectrum of post-stroke movement disorders is broad and includes both hypo- and hyperkinetic syndromes. Post-stroke dyskinesias are involuntary hyperkinetic movements arising from cerebrovascular insults and often present with mixed phenotypes of hyperkinesia which can sometimes be difficult to classify. Nevertheless, identification of the most relevant motor phenotype, whenever possible, allows for a more specific phenomenological categorization of the dyskinesia and thus helps guide its treatment. Fortunately, post-stroke dyskinesias are usually self-limiting and resolve within 6 to 12 months of onset, but a short-term pharmacotherapy might sometimes be required for symptom control. Functional neurosurgical interventions targeting the motor thalamus or globus pallidus interna might be considered for patients with severe, disabling, and persistent dyskinesias (arbitrarily defined as duration longer than 12 months). PMID:27853372

  17. [Spanish validation of the Iowa Rating Scale for Personality Change (IRSPC) for the appraisal of changes in personality in patients with acquired brain injury].

    PubMed

    Guallart-Balet, María; Jiménez-Cortés, Marta P; Tuquet-Calvo, Helena; Pelegrín-Valero, Carmelo; Olivera-Pueyo, Javier; Benabarre-Ciria, Sergio; Tirapu-Ustárroz, Javier

    2015-01-01

    Introduccion. La Iowa Rating Scale for Personality Change (IRSPC) presenta una serie de caracteristicas (enfasis en las funciones motivacionales y emocionales, evaluacion de las funciones ejecutivas 'cognitivas' en la vida cotidiana, estimacion de la personalidad premorbida, valoracion de la fiabilidad del informador) que hacen muy interesante su utilizacion tanto en la clinica como en la investigacion. Objetivo. Validar en castellano la IRSPC para la evaluacion de los 'cambios de personalidad' secundarios a las lesiones cerebrales de la corteza prefrontal en general y del area ventromedial en particular. Pacientes y metodos. Tras el proceso de traduccion y adaptacion de la guia de la escala al castellano, se realizo un estudio de validacion con 31 pacientes con daño cerebral traumatico y se obtuvieron unos resultados de fiabilidad muy adecuados. Resultados. Los resultados obtenidos al medir la consistencia interna de la IRSPC y los coeficientes de fiabilidad interobservadores y test-retest apoyan dicha afirmacion. La validez del instrumento es confirmada por la validez concurrente (comparandolo con el inventario neuropsiquiatrico) y la validez de constructo (comparando las puntuaciones de los pacientes antes y despues del traumatismo). Conclusiones. La IRSPC es un instrumento fiable y valido para la exploracion clinica, en el contexto de una evaluacion integral de los sintomas derivados de las enfermedades neurologicas en general, y en particular de aquellas en las que se encuentra involucrada la corteza prefrontal ventromedial.

  18. Care models for polypathological patients.

    PubMed

    Fernández Moyano, A; Machín Lázaro, J M; Martín Escalante, M D; Aller Hernandez, M B; Vallejo Maroto, I

    Polypathological patients have specific clinical, functional, psychoaffective, social, family and spiritual characteristics. These patients are generally elderly and frail and have frequent decompensations. They frequently use healthcare resources, have significant functional impairment and have a high index of dependence. This results in a significant social impact, high mortality and a high consumption of resources. The current healthcare models have not answered these needs, which causes problems with accessibility to healthcare services, a lack of coordination among these services, a higher probability of adverse events related to polypharmacy and a high consumption of resources. In the past decade, the healthcare models have changed and are characterized by work in multidisciplinary and interlevel teams, patient self-care, the availability of tools for decision making, information and communication systems and prevention. The goal is to have prepared and proactive health teams and an informed and active patient population. The assessment of health results, processes and the costs for these programs is still based on moderate to low evidence. It is therefore not an easy task to determine the type and intensity of interventions or to determine the patient groups that could gain more benefits. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  19. Analysis of the healthcare process of patients with type 2 diabetes mellitus and associated comorbidity treated in Spain's National Health System: A perspective of medical professionals. IMAGINE study.

    PubMed

    Gómez-Huelgas, R; Artola-Menéndez, S; Menéndez-Torre, E

    2016-04-01

    To analyse the care received by patients with type 2 diabetes mellitus (DM2) and comorbidity in Spain's National Health System. Cross-sectional study using an online survey. A total of 302 family physicians, internists and endocrinologists participated in the study. The participants were recruited voluntarily by their respective scientific societies and received no remuneration. Patients with DM2 and comorbidity are mostly treated in Primary Care (71.8%). Forty percent are referred to hospital care, mainly due to renal failure, poor glycaemic control and for a retinopathy assessment. Only 52% of those surveyed conducted medication reconciliation in the transition between healthcare levels. Fifty-eight percent reported conducting interconsultations, clinical meetings or consultancies between healthcare levels. The 3 main factors identified for improving the follow-up and control of DM2 with comorbidity were the multidisciplinary study (80.8%), the continuing education of health professionals (72.3%) and therapeutic education programmes (72%). A lack of time, a lack of qualified personnel for lifestyle interventions and organisational shortcomings were mentioned as the main obstacles for improving the care of these patients. Most patients with DM2 and comorbidity are treated in Primary Care. Promoting multidisciplinary care and training programmes for practitioners and patients can help improve the quality of care. Therapy reconciliation represents a priority area for improvement in this population. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  20. Long-term increase in coherence between the basal ganglia and motor cortex after asphyxial cardiac arrest and resuscitation in developing rats

    PubMed Central

    Aravamuthan, Bhooma R.; Shoykhet, Michael

    2016-01-01

    BACKGROUND The basal ganglia are vulnerable to injury during cardiac arrest. Movement disorders are a common morbidity in survivors. Yet, neuronal motor network changes post-arrest remain poorly understood. METHODS We compared function of the motor network in adult rats that, during postnatal week 3, underwent 9.5 min of asphyxial cardiac arrest (n = 9) or sham intervention (n = 8). Six months after injury, we simultaneously recorded local field potentials (LFP) from the primary motor cortex (MCx) and single neuron firing and LFP from the rat entopeduncular nucleus (EPN), which corresponds to the primate globus pallidus pars interna. Data were analyzed for firing rates, power, and coherence between MCx and EPN spike and LFP activity. RESULTS Cardiac arrest survivors display chronic motor deficits. EPN firing rate is lower in cardiac arrest survivors (19.5 ± 2.4 Hz) compared with controls (27.4 ± 2.7 Hz; P < 0.05). Cardiac arrest survivors also demonstrate greater coherence between EPN single neurons and MCx LFP (3—100 Hz; P < 0.001). CONCLUSIONS This increased coherence indicates abnormal synchrony in the neuronal motor network after cardiac arrest. Increased motor network synchrony is thought to be antikinetic in primary movement disorders. Characterization of motor network synchrony after cardiac arrest may help guide management of post-hypoxic movement disorders. PMID:26083760

  1. Parapneumonic pleural effusion: early versus late thoracoscopy.

    PubMed

    Pereira, Rodrigo Romualdo; Alvim, Cristina Gonçalves; Andrade, Cláudia Ribeiro de; Ibiapina, Cássio da Cunha

    2017-07-31

    com pacientes com derrame pleural parapneumônico que apresentavam septações ou loculações à ultrassonografia de tórax e que foram submetidos a toracoscopia no período entre janeiro de 2000 e janeiro de 2013. Os pacientes foram divididos em dois grupos: toracoscopia precoce (TP), realizada até o 5º dia da hospitalização; e toracoscopia tardia (TT), realizada após o 5º dia de internação. Foram incluídas 60 pacientes, 30 em cada grupo. A média de idade foi de 3,4 anos, 28 pacientes (46,7%) eram do sexo masculino, e 47 (78,3%) foram submetidos à toracoscopia primária, sem realização de drenagem simples prévia. Os grupos TP e TT foram semelhantes quanto ao sexo, idade, peso e tipo de toracoscopia (p > 0,05 para todos). Observou-se uma diferença significativa quanto à média de duração da internação nos grupos TP e TT (14,5 dias vs. 21,7 dias; p < 0,001). Houve também diferenças significativas entre os grupos quanto ao total de dias com febre, total de dias entre internação e início da drenagem e total de dias com dreno. Oito pacientes (13,6%) apresentaram alguma complicação após a toracoscopia, sem diferença entre os grupos. Não houve óbitos. A TP, realizada até o 5º dia da admissão hospitalar, associou-se a menor duração da internação, menor tempo de drenagem e menor duração da febre, sem estar associada a maior frequência de complicações, necessidade de CTI ou hemotransfusão.

  2. Modeling and Theories of Pathophysiology and Physiology of the Basal Ganglia-Thalamic-Cortical System: Critical Analysis.

    PubMed

    Montgomery, Erwin B

    2016-01-01

    Theories impact the movement disorders clinic, not only affecting the development of new therapies but determining how current therapies are used. Models are theories that are procedural rather than declarative. Theories and models are important because, as argued by Kant, one cannot know the thing-in-itself (das Ding an sich) and only a model is knowable. Further, biological variability forces higher level abstraction relevant for all variants. It is that abstraction that is raison d'être of theories and models. Theories "connect the dots" to move from correlation to causation. The necessity of theory makes theories helpful or counterproductive. Theories and models of the pathophysiology and physiology of the basal ganglia-thalamic-cortical system do not spontaneously arise but have a history and consequently are legacies. Over the last 40 years, numerous theories and models of the basal ganglia have been proposed only to be forgotten or dismissed, rarely critiqued. It is not harsh to say that current popular theories positing increased neuronal activities in the Globus Pallidus Interna (GPi), excessive beta oscillations and increased synchronization not only fail to provide an adequate explication but are inconsistent with many observations. It is likely that their shared intellectual and epistemic inheritance plays a factor in their shared failures. These issues are critically examined. How one is to derive theories and models and have hope these will be better is explored as well.

  3. An addition to geographic hematology: chronic myeloproliferative diseases are infrequent in Mexican Mestizos.

    PubMed

    Ruiz-Argüelles, Guillermo J; López-Martínez, Briceida; Lobato-Mendizábal, Eduardo; Ruiz-Delgado, Guillermo J

    2002-06-01

    The chronic myeloproliferative diseases (CMPDs) include chronic myelogenous leukemia (CML), primary (essential) thrombocythemia (PT), agnogenic myeloid metaplasia (AMM), and polycythemia vera (PV). Certain hematological malignancies have a different prevalence in our country than in countries with Caucasian populations. Data indicate that the prevalence of CML in our country is similar to that found in Caucasians; however, the prevalence of the other CMPDs has not been studied. In a total of 8069 individuals studied between June 1983 and March 2001 in the Centro de Hematologia y Medicina Interna de Puebla, we assessed the prevalence of CML, PT, AMM, and PV. Some of the clinical features of these individuals were also assessed. Forty-nine patients with CML, 14 with PT, 7 with AMM, and 3 with PV were identified. The clinical presentations of these CMPDs were not different from those described in Caucasians. We found that CML was more than 3 times more frequent than PT, that both PV and AMM were exceptional, and that PT, AMM, and PV were significantly less frequent in Mexican than in Caucasian populations (P < .01).

  4. [Primary gastric lymphoma: incidence, prognostic factors and effect of treatment with chemotherapy].

    PubMed

    Lobato-Mendizábal, E; Ruiz Argüelles, G J; Labardini-Méndez, R; Rodríguez-Mejorada, M

    1990-08-01

    This paper deals with the prevalence, clinical features and therapeutic response of 19 patients with primary gastric lymphoma studied and treated at Centro de Hematologia y Medicina Interna de Puebla, Mexico and Instituto Nacional de la Nutricion Salvador Zubiran, Mexico City, Mexico, in a 10 year period (1979-1989). The main findings were as follows: 1) The prevalence of gastric lymphoma has increased in Mexico: Between 1950 and 1980 the prevalence was found at 4.5% of all gastric tumors, whereas between 1980 and 1990 it was found at the 7.6% level (chi square = .0001). 2) The significant prognostic factors for survival were in this series the clinico-pathologic stage and the degree of infiltration of the gastric wall: 80-month disease free survival was 80% and 44% respectively for stages I and III (p less than 0.02); 10-year disease free survival was 100% and 23% respectively for mucosal/submucosal infiltration VS mucosal/serosal infiltration (p less than 0.01). 3) The 10-year disease free survival was 68% for patients treated with chemotherapy and surgery; this figure is similar to those obtained using radiotherapy and surgery, but with a lower relapse rate. Two patients with lymphomatous lesion less than 3 cm. and invading only mucosae/submucosae were treated solely with chemotherapy and both of them remain disease free after 20 months of follow-up.

  5. Molecular monitoring of the treatment of patients with BCR/ABL (+) chronic myelogenous leukemia.

    PubMed

    Ruiz-Argüelles, G J; López-Martínez, B; Ramírez-Cabrera, J M; Reyes-Núñez, V; Rodríguez-Cedeño, H M; Garcés-Eisele, J

    2001-01-01

    The molecular follow-up of patients with chronic myelogenous leukemia (CML) has been described as useful in other countries, but there are not data reported in Mexico. All patients studied at Laboratories Clínicos de Puebla/Centro de Hematología y Medicina Interna de Puebla in which the BCR-ABL hybrid gene was identified by means of polymerase chain reaction were analyzed. In 22 individuals the molecular marker of the disease was studied at diagnosis and in different instances afterwards; these patients were treated with chemotherapy, interferon, autologous or allogeneic bone marrow transplantation. Only the six patients that were allografted from HLA-identical siblings cleared the molecular marker of the disease; the rest of them did not achieve molecular remissions. The median survival (SV) of the whole group has not been reached, whereas the 53-month SV is 68%. One of the allografted patients died as a result of complications of graft versus-host disease. We have found useful the molecular monitoring of the treatment of patients with CML. Using this approach, we found that molecular remissions can be accomplished only with allografting; however, other therapeutic approaches may also result in long-lasting hematologic remissions.

  6. A case report: spontaneous rupture of dissecting aneurysm of the middle colic artery.

    PubMed

    Chino, Osamu; Kijima, Hiroshi; Shibuya, Makoto; Yamamoto, Soichiro; Kashiwagi, Hiroyuki; Kondo, Yasumasa; Makuuchi, Hiroyasu

    2004-12-01

    Aneurysms of the superior mesenteric artery branches are rarely reported, even among them colic artery aneurysms are seldom. We report a case of 78-year-old male with ruptured dissecting aneurysm of middle colic artery. The patient complained abdominal pain and nausea during hospital stay for renal stone. The patient suddenly developed severe abdominal pain, leading to shock. He underwent emergency surgery under a preoperative diagnosis of intraperitoneal hemorrhage. At exploratory laparotomy, a large hematoma involving the mesentery root of the transverse colon was associated with a ruptured aneurysm measuring 15 x 10 mm in size, which was located to the mid-portion of middle colic artery. Right-hemicolectomy was carried out because of ischemic changes in the ascending colon. Histological examination demonstrated a ruptured dissecting aneurysm of the middle colic artery approximately 5 cm in length, associated with destruction of the tunica interna and media. The aneurysm was thought to result from idiopathic segmental arterial mediolysis, because no definitive evidence of atherosclerosis or arteritis was observed.

  7. One View of the Current State of Understanding in Basal Ganglia Pathophysiology and What is Needed for the Future

    PubMed Central

    Montgomery, Erwin B.

    2011-01-01

    Deep Brain Stimulation (DBS), arguably, is the most dramatic development in movement disorders since the levodopa for Parkinson’s disease. Yet, its mechanisms of action of DBS are unknown. However, DBS related research already has demonstrated that current concepts of basal ganglia pathophysiology are wrong. Specifically, the notion that over-activity of the globus pallidus interna causes parkinsonism, the basis for the most current theories, is no longer tenable. The development of any new theory will be aided by an understanding of how current theories are wrong and why have these flawed theories persist. Many of the problems of current theories are more matters of inference, assumptions, presumptions, and the accepted level of ambiguity than they are of fact. Consequently, it is imperative that these issues be addressed. Just as the inappropriate use of a tool or method is grounds for criticism, methods of reasoning are tools that can be used inappropriately and should be subject to discussion just as misuse of any other tool. Thorough criticism can provide very important lesions though the process could be mistaken as harsh or personal; neither is the case here. At the least, such analyzes can point to potential pitfalls that could be avoided in the development of new theories. As will be discussed, theories are important for the development of therapies but perhaps most important, for the acceptance of new therapies, as was the case for the recent resurgence of interest in surgical therapies. PMID:24868387

  8. Dimethoxyethyl phthalate: embryopathy, teratogenicity, fetal metabolism and the role of zinc in the rat.

    PubMed Central

    Parkhie, M R; Webb, M; Norcross, M A

    1982-01-01

    A single intraperitoneal injection (0.6 ml/kg) of dimethoxyethyl phthalate (DMEP) was given to groups of Wistar strain rats on day 10, 11, 12, 13 or 14 of gestation. Control rats received 0.6 ml/kg of physiological saline intraperitoneally. In phthalate-treated rats, embryopathy was manifested by a high incidence (12-79%) of fetal deaths and fetal resorptions. Fetotoxic effects were expressed by a significant reduction in fetal weights. Hydrocephalus interna, a congenital malformation of the brain, was caused by DMEP. Congenital skeletal deformities (66-96%), with multiple skeletal (14-64%) and appendicular malformations (25-57%), were also induced by DMEP. Control rats exhibited no congenital malformations of the brain and no appendicular or multiple skeletal deformities. DMEP caused a significant decrease in the zinc content of the fetus. Fetoplacental metabolism 1 and 4 hr after intravenous administration of 14C-DMEP suggested rapid transfer of the parent compound to the fetus across the placenta and that DMEP is a teratogenic moiety. The possible role of zinc in phthalate-induced teratogenesis in rats is also discussed. PMID:7140701

  9. Zarit Burden Interview Psychometric Indicators Applied in Older People Caregivers of Other Elderly.

    PubMed

    Bianchi, Mariana; Flesch, Leticia Decimo; Alves, Erika Valeska da Costa; Batistoni, Samila Sathler Taveres; Neri, Anita Liberalesso

    2016-11-28

    to derive psychometric indicators of construct validity and internal consistence of the Zarit Burden Interview scale for caregivers, describing associations of the scale with metrics related to care demands, coping strategies and depression in aged caregivers. crosscutting descriptive and correlational study. The convenience sample was composed by a hundred and twenty one senior caregivers (Avg=70.5 ± 7.2 years, 73% women). They answered a questionnaire to check the physical and cognitive demands of care, the Zarit Burden Interview (ZBI), the California Inventory of Coping Strategies and the Geriatric Depression Scale (GDS-15). ZBI showed good internal consistency and also for the three factors emerging from factor analysis, explaining 44% of variability. ZBI is positively related with objective care demands (p < 0.001), depression (p = 0.006) and use of dysfunctional coping strategies (p = 0.0007). ZBI is of interest to be applied to aged caregivers and the association of higher degrees of burden, dysfunctional coping and depression show a vulnerability scenario that may affect to older people taking care of other elderly. derivar indicadores psicométricos de validade de construto e consistência interna da escala de sobrecarga de cuidadores de Zarit Burden Interview e descrever associações desta com medidas referentes às demandas de cuidado, estratégias de enfrentamento e depressão em cuidadores idosos. estudo descritivo, transversal e correlacional. Cento e vinte e um cuidadores idosos (M= 70,5 ± 7,2 anos, 73% feminino) compuseram uma amostra de conveniência e responderam a um protocolo de pesquisa para levantamento de demandas de cuidado de natureza física e cognitiva, à Zarit Burden Interview (ZBI), ao Inventário de Estratégias de Enfrentamento da Califórnia e à Escala de Depressão Geriátrica (GDS-15). a ZBI revelou bons índices de consistência interna e para os três fatores resultantes da análise fatorial, os quais explicaram 44% da

  10. Cultural adaptation and validation of an instrument on barriers for the use of research results.

    PubMed

    Ferreira, Maria Beatriz Guimarães; Haas, Vanderlei José; Dantas, Rosana Aparecida Spadoti; Felix, Márcia Marques Dos Santos; Galvão, Cristina Maria

    2017-03-02

    to culturally adapt The Barriers to Research Utilization Scale and to analyze the metric validity and reliability properties of its Brazilian Portuguese version. methodological research conducted by means of the cultural adaptation process (translation and back-translation), face and content validity, construct validity (dimensionality and known groups) and reliability analysis (internal consistency and test-retest). The sample consisted of 335 nurses, of whom 43 participated in the retest phase. the validity of the adapted version of the instrument was confirmed. The scale investigates the barriers for the use of the research results in clinical practice. Confirmatory factorial analysis demonstrated that the Brazilian Portuguese version of the instrument is adequately adjusted to the dimensional structure the scale authors originally proposed. Statistically significant differences were observed among the nurses holding a Master's or Doctoral degree, with characteristics favorable to Evidence-Based Practice, and working at an institution with an organizational cultural that targets this approach. The reliability showed a strong correlation (r ranging between 0.77 and 0.84, p<0.001) and the internal consistency was adequate (Cronbach's alpha ranging between 0.77 and 0.82). the Brazilian Portuguese version of The Barriers Scale was valid and reliable in the group studied. efectuar la adaptación cultural del instrumento The Barriers to Research Utilization Scale, y analizar propiedades métricas de validez y confiabilidad de su versión para portugués brasileño. investigación metodológica conducida mediante el proceso de adaptación cultural (traducción y retrotraducción), validez de faz y contenido, validez de constructo (dimensionalidad y grupos conocidos) y análisis de fiabilidad (consistencia interna y test-retest). La muestra incluyó 335 enfermeros, de los cuales 43 participaron de la etapa retest. la validez de la versión adaptada del instrumento fue

  11. The assessment of medical competencies.

    PubMed

    Sureda-Demeulemeester, E; Ramis-Palmer, C; Sesé-Abad, A

    2017-06-27

    To describe the most widely used tools in the assessment of medical competencies, analyse their prevalence of use, their advantages and disadvantages and propose an appropriate model for our context. We conducted a narrative review of articles from MEDLINE, following the PRISM protocol, and analysed a total of 62 articles. The assessment of competencies is heterogeneous, especially in the educational and professional settings. The specific and technical competencies acquired during university education are mainly assessed using the objective structured clinical assessment. In the professional setting, core competencies are assessed using the 360° technique. We need a rigorous empiric comparison of the efficiency of the tools according to the type of competency. We propose a competency management model for the «undergraduate/graduate/active professional» continuum, whose goal is to improve training and professional practice and thereby increase the quality of patient care. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  12. Teaching the basics of echocardiography in the undergraduate: Students as mentors.

    PubMed

    Arias Felipe, A; Doménech García, J; Sánchez Los Arcos, I; Luordo, D; García Sánchez, F J; Villanueva Martínez, J; Forero de la Sotilla, A; Villena Garrido, V; Torres Macho, J; García de Casasola Sánchez, G

    To analyse the ability of medical students to incorporate the practical teaching of basic echocardiography planes using a peer mentoring design. Thirty-six medical students previously trained in obtaining echocardiography planes (mentors) taught the other 5th-year students (n=126). The teaching methodology included three stages: theory (online course), basic training (three 15h sessions of practical experience in ultrasound and at least 20 echocardiographic studies per mentor) and objective structured clinical assessment (OSCA), which scored the appropriateness of the basic ultrasound planes and the correct identification of 16 cardiac structures. The students' weighted mean score in the OSCA was 8.66±1.98 points (out of 10). Only 10 students (8.4%) scored less than 5, and 15 (12.6%) scored less than 7. Fifty students (42%) scored 10 points. The most easily identified structure was the left ventricle in the short-axis parasternal plane, with 89.9% of correct answers. The most poorly identified structure was the mitral valve in the subxiphoid plane, with 69.7% of correct answers. Peer mentoring-based teaching achieves an appropriate level of training in obtaining basic echocardiography planes. The training period is relatively short. The peer mentoring system can facilitate the implementation of teaching on basic aspects of ultrasound to a large number of undergraduate students. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  13. Trypanosoma cruzi: histopathology of endocrine system in immunocompromised mice.

    PubMed Central

    Calabrese, K. S.; Lagrange, P. H.; da Costa, S. C.

    1994-01-01

    Naturally immunocompromised athymic mice, neonatal mice and adult outbred OFI mice treated with the immunosuppressive agents cyclophosphamide (CY), dexamethasone (DM) and indomethacin (IM) were infected with trypomastigotes of Trypanosoma cruzi Y and CL strains. 10(4) parasites were used, except in the case of IM treatment, where mice received 10(3) trypomastigotes in one group and 10(5) in another. The course of parasitaemia, tissue distribution of amastigotes and time of mortality were compared with an infected thymus intact control group. Neonate and indomethacin treated mice presented the same pattern of parasitaemia. Death occurred as early as 9-10 days after infection. A single dose of CY 200 mg/kg given 5 days after infection enhanced the parasitaemia and increased the number of parasites in the tissues. All groups were similar in terms of colonization of the endocrine system by parasites and the adrenals showed the highest density of amastigotes nests. The thyroid gland (analysed only in neonates) showed intense amastigote accumulation. Colonization of the ovary was observed with amastigotes in both the theca interna and in the stroma. The testes (also examined only in the neonate) showed that the interstitial cells, the tunica albuginea of the seminiferous tubules and the loose connective tissue were infected. Athymic nude mice showed the most intense parasite colonization of the islets of Langerhans. Images Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 PMID:7734334

  14. Differential characteristics of bacteraemias according to age in a community hospital.

    PubMed

    Toyas, C; Aspiroz, C; Martínez-Álvarez, R M; Ezpeleta, A I; Arazo, P; Ferrando, J C

    To describe the characteristics of bacteraemias, according to age, in a community hospital. A prospective study of bacteraemias was conducted in 2011. The patients were classified into 3 age groups: younger than 65 years, 65 to 79, and 80 or older. The study collected variables on the patients and episodes. The study analysed 233 bacteraemias in 227 patients (23.8% in those younger than 65 years; 38.3% in the 65 to 79 age group; and 37.9% in the 80 years or older group). The most common underlying disease in all the groups was diabetes mellitus. In the most elderly patients, the Charlson index was highest, there was a lower proportion of exogenous factors, and almost 25% were severely dependent (Barthel index<20). Escherichia coli was the most common germ, and the main focus was urological. The patients aged 80 years or older had predominantly healthcare-associated infections, less severe symptoms (sepsis) (66.3%) and higher mortality (29.1%) compared with the younger patients. The very elderly patients with bacteraemia presented fewer exogenous factors, greater comorbidity and a poorer functional situation. The most common focus was urological and the origin was healthcare related. Despite their less severe clinical presentation, these patients' mortality was greater, and their degree of dependence was a highly relevant independent risk factor. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  15. One View of the Current State of Understanding in Basal Ganglia Pathophysiology and What is Needed for the Future.

    PubMed

    Montgomery, Erwin B

    2011-05-01

    Deep Brain Stimulation (DBS), arguably, is the most dramatic development in movement disorders since the levodopa for Parkinson's disease. Yet, its mechanisms of action of DBS are unknown. However, DBS related research already has demonstrated that current concepts of basal ganglia pathophysiology are wrong. Specifically, the notion that over-activity of the globus pallidus interna causes parkinsonism, the basis for the most current theories, is no longer tenable. The development of any new theory will be aided by an understanding of how current theories are wrong and why have these flawed theories persist. Many of the problems of current theories are more matters of inference, assumptions, presumptions, and the accepted level of ambiguity than they are of fact. Consequently, it is imperative that these issues be addressed. Just as the inappropriate use of a tool or method is grounds for criticism, methods of reasoning are tools that can be used inappropriately and should be subject to discussion just as misuse of any other tool. Thorough criticism can provide very important lesions though the process could be mistaken as harsh or personal; neither is the case here. At the least, such analyzes can point to potential pitfalls that could be avoided in the development of new theories. As will be discussed, theories are important for the development of therapies but perhaps most important, for the acceptance of new therapies, as was the case for the recent resurgence of interest in surgical therapies.

  16. In-vivo holmium laser angioplasty

    NASA Astrophysics Data System (ADS)

    Haase, Karl K.; Hassenstein, Stefan; Hanke, Hartmut; Hanke, Sybille; Oberhoff, Martin; Karsch, Karl R.

    1992-08-01

    Holmium laser angioplasty was performed in the atheromatous carotid artery of 10 rabbits to evaluate this mid-infrared laser as an alternative energy source for angioplasty. An additional 10 rabbits served as a control group. The laser emitted light at a wavelength of 2120 nm with pulse durations of 150 microsecond(s) . The energy density was 17.5 J/cm2. Cross sections were analyzed in regard to laser specific injury 7 and 14 days following laser irradiation. Staining of (alpha) -actin was used to identify smooth muscle cells (SMC), and bromodesoxyuridine labeling was carried out to determine the extent of proliferating cells. Integrity of the lamina elastica interna fibers was disrupted in 6 of 10 animals. In all animals, loss of medial SMCs was observed 7 and 14 days after treatment. Quantification of SMCs undergoing DNA synthesis in the intima and media showed a significant increase of labelled cells following laser irradiation. This proliferative response resulted in a significant increase of intimal thickening after laser ablation.

  17. Occurrence of L- and D-crustacean hyperglycemic hormone isoforms in the eyestalk X-organ/sinus gland complex during the ontogeny of the crayfish Astacus leptodactylus.

    PubMed

    Serrano, Laetitia; Grousset, Evelyse; Charmantier, Guy; Spanings-Pierrot, Céline

    2004-09-01

    We studied the ontogeny of the eyestalk structure and of the L-CHH and d-Phe3-CHH synthesis in the X-organ/sinus gland (XO/SG) complex by light microscopy and immunocytochemistry in the freshwater crustacean Astacus leptodactylus. The optic ganglia start to differentiate in embryos at EI 190 microm (EI: eye index; close to 410 microm at hatching). At EI 270 microm, the three medullae (externa, interna, and terminalis) and the lamina ganglionaris are present and are organized as in the adult eyestalk. The L-CHH was localized in perikarya of neuroendocrine cells, in their tracts, and in SG from the metanauplius stage to the adult. The d-Phe3-CHH was visualized in XO perikarya, in their tracts and in SG of embryos from EI 350 microm and in all later studied stages. Co-localization of both CHH stereoisomers always occurred in the d-Phe3-CHH-producing cells. These results show that the synthesis of CHH enantiomers starts during the embryonic life in A. leptodactylus, and that the d-isomer is synthesized later than its L-counterpart. We discuss the post-translational isomerization as a way to generate hormonal diversity and the putative relation between d-Phe3-CHH synthesis and the ability to osmoregulate, occurring late during the embryonic life of Astacus leptodactylus. Copyright The Histochemical Society, Inc.

  18. [Burnout and quality of life in medical residents].

    PubMed

    Prieto-Miranda, Sergio Emilio; Rodríguez-Gallardo, Gisela Bethsabé; Jiménez-Bernardino, Carlos Alberto; Guerrero-Quintero, Laura Guadalupe

    2013-01-01

    Introducción: el burnout y la calidad de vida son fenómenos poco estudiados en estudiantes de posgrado y sus efectos se desconocen. Métodos: estudio descriptivo longitudinal. Se incluyeron residentes que iniciaron su primer año de posgrado en marzo de 2010. Se aplicó, a su ingreso, a los 6 y 12 meses, la versión española del cuestionario PEC VEC de perfil de calidad de vida validado al español y el inventario de burnout de Maslach específico para médicos. Para las variables nominales se utilizó ?2 y para variables numéricas Anova. Resultados: se incluyeron 45 residentes. La edad promedio fue de 26.9 ± 2.93; 18 (40 %) fueron del sexo femenino y 27 (60 %) del masculino. En la encuesta PEC VEC se encontró un descenso significativo en cuatro de las seis escalas valoradas en las tres mediciones realizadas. En el cuestionario de burnout se encontraron niveles altos de agotamiento emocional en las tres pruebas, bajo grado de despersonalización, y logros personales al ingreso, elevándolos a los 6 y 12 meses. La especialidad más afectada fue medicina interna. Conclusiones: hay presencia de burnout y deterioro de calidad de vida en médicos residentes que estudian posgrado y se mantiene durante el primer año de residencia.

  19. Unnecessary overuse. Study of "inadvisable practices" for patients with atrial fibrillation.

    PubMed

    Ortiz, M M; Llamas, P; Sanmartín, M; Egido, J A; Del Toro, J; Egocheaga, M I; Estévez, M S; Navarro, I M; Mira, J J

    2017-05-01

    To identify overuse (diagnostic, therapeutic and self-care practices that represent risks that outweigh the potential benefits) in patients with atrial fibrillation. The study was based on qualitative research techniques. Using the "Metaplan" technique, we identified and ordered potentially inappropriate, ineffective and inefficient practices. By means of a consensus conference, we then established a number of "inadvisable practice" measures (relatively common practices that should be eliminated based on the scientific evidence or clinical experience). Professionals from the specialties of cardiology, haematology, neurology, internal medicine, family medicine and nursing participated in the consensus. We developed a catalogue of 19 "inadvisable practices" related to the diagnosis, treatment and care of anticoagulated patients that were inappropriate, had questionable effectiveness or were ineffective, as well as 13 beliefs or behaviours for anticoagulated patients that could result in injury or were useless or inefficient. The "inadvisable practices" approach helps identify practices that represent greater risks than benefits for patients. It seems appropriate to include algorithms in the clinical decision-making support systems that consider this information for the diagnosis, treatment and for home care. For this last case, recommendations have also been prepared that define specific contents for the healthcare education of these patients. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  20. Diagnostic utility of handheld ultrasonography as an extension of the physical examination of patients with heart failure.

    PubMed

    López-Palmero, S; Bolivar-Herrera, N; López-Lloret, G; Merchán-Ortega, G; Macancela-Quiñones, J J; López-Martínez, G

    2015-05-01

    Conventional echocardiography is the technique of choice for assessing left ventricular function and the presence of structural heart disease in patients with heart failure. The aim of this study was to assess the diagnostic performance of handheld ultrasonography performed by a medical internist on patients with a clinical diagnosis of heart failure. Cross-sectional observational study of 212 patients diagnosed with heart failure in a hospital center. A medical internist with basic training in echocardiography performed an examination using handheld ultrasonography and semiquantitatively assessed several variables. The patients' left ventricular systolic function was assessed, along with the cavity dimensions, significant valvular heart disease, pericardial effusion and the diameter of the inferior vena cava. The examination using handheld ultrasonography was conducted in less than 6minutes. The agreement between the diagnoses of the medical internist and the expert echocardiographist was very good (k>0.81) for the diameter, hypertrophy and left ventricular systolic function, valvular regurgitation, pericardial effusion and diameter of the inferior vena cava. Handheld echocardiography performed by a medical internist, as an extension of the physical examination of patients with heart failure, is a valid and safe test that helps increase the diagnostic performance. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  1. Morphometry and immunohistochemistry of follicles growth and steroidogenesis in saharian wild sand rat, Psammomys obesus, ovary.

    PubMed

    Boubekri, Amina; Gernigon-Spychalowicz, Thérese; Khammar, Farida; Exbrayat, Jean-Marie

    2009-01-01

    The sand rat (Psammomys obesus) constitutes a model to study seasonal changes and several metabolic disorders. In order to perform breeding laboratory conditions, the reproductive function of this species living in North Occidental Algerian Sahara was studied. The aim of this work was to investigate the follicular growth changes and the steroidogenic associated aspects. The study was performed using morphometrical and immunohistochemical methods. From primordial to preantral states, the follicle diameter increased progressively from 17-20 mum to 192-225 mum. The preovulatory follicles reached about 500 mum in diameter. Immunoreactivity to progesterone, androstenediol and estradiol, varied in the different parts of the ovary and follicular cells. The progesterone antibody appeared clearly labelled in the theca interna of the growing follicle and increased in the granulosa; the androgen antibody was continuously weak and diffuses in all follicles; the estradiol labelling appeared weak and diffuse in preantral follicles then increased in antral follicles in both theca and granulosa or only in granulosa. In antral follicles, estradiol label was clearly localized in granulosa cells and totally devoid in theca cells. In Psammomys ovary, labels of hormone were diffuse or localized, weak or intense in the theca and or in the granulosa according to the follicle size.

  2. Distribution of taurine and other free amino acids in the visual pathway of the crayfish procambarus clarkii.

    PubMed

    Picones, A; Escalera, R L; Pasantes-Morales, H

    1992-04-01

    1. Free taurine showed an in homogenous distribution along the neuropiles associated with the visual processing pathway in the eyestalk and brain of the freshwater crayfish Procambarus clarkii.2. Within the eyestalk, taurine was statistically significant (P < 0.001), more Concentrated in the retina(photo reccptor layer) lamina ganglionaris region than in the medulla extema-medulla interna and medulla terminalis regions; 64% of the total content (45% in terms of total concentration) of taurine in the eyestalk was localized in the retina-lamina ganglionaris zone.3. Regarding other free amino acids also identified, and considering the whole eyestalk, taurine concentration was comparable with those of alanine and glycine, but statistically significantly higher than glutamate, GABA and aspartate. In the brain (cerebroid ganglion) taurine, alanine, glycine, glutamate and GABA concentrations, albeit not identical, were not statistically significantly different; only the aspartate concentration was significantly lower (P < 0.001).4. These results show that taurine is a major constituent in the anterior part of the crayfish central nervous system and support the notion that this free amino acid could play a physiologically important role in the crustacean visual pathway.

  3. ADC evaluation of the corticospinal tract in multiple sclerosis.

    PubMed

    Inal, Mikail; Unal, Birsen; Kala, Ibrahim; Turkel, Yakup; Bilgili, Yasemin Karadeniz

    2015-06-01

    Apparent diffusion coefficient (ADC) values derived from diffusion-weighted MR imaging (DWI) provide important information about tissues. The goal of this study was to evaluate the ADC values in the corticospinal tract regions in multiple sclerosis (MS). The ADC values of 42 patients with multiple sclerosis and 46 healthy people were measured. The ADC values in the corticospinal tract at the capsula interna posterior crus from six points and mesencephalon from three points bilaterally in MS patients were compared with those of controls. An ANOVA post hoc test was used to analyse the differences in mean ADC values between the MS and control groups. The mean ADC values of the right (p = 0.008) and left internal capsules (p = 0.000) and right (p = 0.002) and left mesencephalons (p = 0.044) in MS patients were significantly lower than in the control group. There was no significant difference between the right and left side ADC values in MS (p = 0.313 vs. p = 0.223) and control groups (p = 0.756 vs. p = 0.105), respectively. The mean ADC values of the corticospinal tract in MS patients were significantly lower than in the control group. This decreased diffusion may be the result of cellular infiltration due to inflammation, cytotoxic oedema, demyelination or remyelination processes.

  4. Alligators, contaminants and steroid hormones.

    PubMed

    Guillette, Louis J; Edwards, Thea M; Moore, Brandon C

    2007-01-01

    Steroids are essential for successful reproduction in all vertebrate species. Over the last several decades, extensive research has indicated that exposure to various environmental pollutants can disrupt steroidogenesis and steroid signaling. Although steroidogenesis is regulated by the hypothalamic-pituitary axis, it is also modified by various paracrine and autocrine factors. Furthermore, the classical two-cell model of steroidogenesis in the developing ovarian follicle, involving the granulosa and theca cells in mammals, may not be universal. Instead, birds and probably reptiles use the two thecal compartments (theca interna and theca externa) as sites of steroid production. We have documented that embryonic or juvenile exposure to a complex mixture of contaminants from agricultural and storm water runoff leads to altered steroid hormone profiles in American alligators. Our observations suggest that alterations in plasma steroid hormone concentrations are due in part to altered gene expression, modified hepatic biotransformation and altered gonadal steroidogenesis. Future studies must examine the interplay between endocrine and paracrine regulation in the development and expression of gonadal steroidogenesis in individuals exposed to endocrine disrupting contaminants at various life stages if we are to fully understand potential detrimental outcomes.

  5. Histological study of the external, middle and inner ear of horses.

    PubMed

    Blanke, A; Aupperle, H; Seeger, J; Kubick, C; Schusser, G F

    2015-12-01

    Clinical, anatomical and histological aspects of the equine acoustic organ have been poorly investigated and illustrated in literature so far. It is understood that an intact acoustic organ and hearing function are of vital importance for the well-being of flight animals like horses. The knowledge of the acoustic organ is usually transferred analogously from other mammals to horses. The purpose of this study was to provide a detailed and complete histological description of the healthy equine auditory organ, and to determine its congruity to other mammalians. Anatomical dissections and histological preparations were carried out on ten cadaver heads. Specimens of various parts of the equine acoustic organ were taken and evaluated histologically. The histological composition of external, middle and inner ear structures are predominantly congruent to those of other mammals, especially to human beings. Unique inwardly directed rete pegs within the osseous ear canal and the prominent tensor tympani muscle are described for the first time. Results obtained in this study can be employed as references for further research on the equine acoustic organ and improve the understanding of the clinical development of hearing loss, otitis externa/media/interna or tympanosclerosis. © 2014 Blackwell Verlag GmbH.

  6. Healthcare resources and needs in anticoagulant therapy for patients with nonvalvular atrial fibrillation. SAMOA Study.

    PubMed

    Barrios, V; Egocheaga-Cabello, M I; Gállego-Culleré, J; Ignacio-García, E; Manzano-Espinosa, L; Martín-Martínez, A; Mateo-Arranz, J; Polo-García, J; Vargas-Ortega, D

    2017-05-01

    To determine, in the various medical specialties, the healthcare process for anticoagulated patients with nonvalvular atrial fibrillation, to determine the available and necessary resources and to identify potential areas of improvement in the care of these patients. We performed a cross-sectional survey of primary care and specialised physicians involved in the care of anticoagulated patients. The questionnaires referred to the healthcare process, the indication and prescription of anticoagulant therapy and the barriers and deficiencies present for these patients. A total of 893 physicians participated in the study, 437 of whom worked in primary care and 456 of whom were specialists (mostly cardiologists). Forty-two percent of the family doctors indicated that they assessed and prescribed anticoagulant therapy, and 66% performed the regular follow-up of these patients. In both healthcare settings, the physicians noted the lack of standardised protocols. There was also a lack of quality control in the treatment. The role of primary care in managing anticoagulated patients has grown compared with previous reports. The responses of the participating physicians suggest marked gaps in the standardisation of the healthcare process and several areas for improvement in these patients' follow-up. The promotion of training in direct-acting anticoagulant drugs remains pivotal. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  7. Malignancies and infection due to the human immunodeficiency virus. Are these emerging diseases?

    PubMed

    Valencia Ortega, M E

    2017-09-02

    Since the start of the human immunodeficiency virus (HIV) epidemic, tumour disease among patients has been significant. The collection of malignancies can be divided primarily into 2 groups: those associated with HIV (all of which are related to viral diseases) and those not associated with HIV (only some of which are associated with viral diseases). The origin of these malignancies is multifactorial, and the main causes that have led to an increase in tumour disease are immunosuppression, coinfection with oncogenic viruses and life prolongation secondary to the use of antiretroviral therapy. Establishing the general characteristics of the undiagnosed AIDS tumours is difficult, mainly because they are a highly heterogeneous group formed by malignancies of a diverse nature. The treatments do not differ from those used in the general population, although the management can be more difficult due to the late diagnosis, drug interactions and associated comorbidities. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  8. Angiostrongylus cantonensis infection in captive Geoffroy's tamarins (Saguinus geoffroyi).

    PubMed

    Kottwitz, Jack J; Perry, Kaylee K; Rose, Heidi H; Hendrix, Charles M

    2014-10-01

    3 Geoffroy's tamarins (Saguinus geoffroyi) in a zoo in east central Alabama developed neurologic signs shortly after a tamarin kept in the same enclosure was found dead. Neurologic abnormalities varied among animals and were progressive. One female tamarin with a head tilt, nystagmus, mild ataxia, and paresis of a thoracic limb had gram-positive cocci present in an ear canal with otitis media and interna suspected. Another female with mild ataxia attributed to previous tail amputation developed seizures, and a male tamarin with tail tip trauma also developed ataxia. The tamarin with suspected otitis received cephalexin and prednisolone, but neurologic signs worsened, and the patient died. Preliminary examination of necropsy samples revealed severe meningoencephalitis in both deceased tamarins. Prednisolone and phenobarbital treatment was initiated for the tamarin with seizures, but rapid neurologic deterioration led to euthanasia. Further histologic examination of the 3 deceased tamarins revealed meningitis and acute perivascular hemorrhage in the meninges. Parasites morphologically consistent with Angiostrongylus (Parastrongylus) cantonensis were present in the lungs of 1 animal and in the meninges of 2. The surviving tamarin received cephalexin for tail tip trauma and prednisolone and albendazole for presumed meningoencephalitis and parasitic infection but had permanent neurologic deficits. To our knowledge, these represent the first cases of A cantonensis infection in Geoffroy's tamarins and the first report of its presence in the United States not associated with a major shipping port. The presence of a mature worm in the lungs of 1 tamarin suggested completion of the parasite life cycle, previously reported only in rats.

  9. Prognostic value of a previous medical or surgical admission in outpatients with symptomatic pulmonary embolism.

    PubMed

    Ruiz-Artacho, P; Rodríguez-López, I; Pérez Peña, C; González Del Castillo, J; Calvo, E; Martín-Sánchez, F J

    2016-03-01

    To determine whether an earlier medical (MA) or surgical (SA) admission in the previous three months is a factor associated with mortality at 30 days in outpatients with acute symptomatic pulmonary embolism. Observational, retrospective cohort study on adult patients diagnosed with acute symptomatic pulmonary embolism in a tertiary hospital over a period of 6 years. The study included 870 patients with a mean age of 72.7 years: 10.6% (92) had a prior MA, 4.9% (43) had a SA and 12.9% (112) died within the first 30 days. The MA group showed a higher frequency of simplified Pulmonary Embolism Severity Index (PESI) of high risk (≥1) (MA 90.2% vs SA 65.1% vs no prior admission 67.0%; p<0.001) and mortality at 30 days (MA 20.7% vs SA 7.0% vs no prior admission 12.9%; p=0.038). The logistic regression analysis demonstrated that a simplified PESI≥1 was the only independent risk factor for mortality at 30 days. The severity of the acute episode, as assessed by the simplified PESI scale, is independently associated with mortality at 30 days in outpatients with acute symptomatic pulmonary embolism. An earlier MA in the previous 3 months usually involves greater severity in the acute episode. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  10. Diagnostic value of a simplified Pfeiffer questionnaire for polypathological patients.

    PubMed

    Bernabeu-Wittel, M; Nieto Martín, D; Moreno-Gaviño, L; Ollero-Baturone, M

    To analyse the correlation, sensitivity, specificity and positive predictive (PPV) and negative predictive (NPV) values of each question on the Pfeiffer questionnaire (SPMSQ) compared with the full questionnaire for polypathological patients (PPPs). Multicentre cross-sectional study. An SPMSQ score is considered pathological if 3 or more errors are recorded. For each question and combination of 2 questions, we calculated the correlation (kappa index), sensitivity, specificity and predictive values compared with the full SPMSQ. Of the 1632 PPPs included (mean age, 77.9±9.8 years, 53% men), 1434 performed the SPMSQ (the remaining presented delirium); 39% of the PPPs were pathological. The question "What day is it today?" and the command "Count backwards by 3s from 20" obtained good correlation and NPV (85 and 89%, respectively); the combination of both increased the NPV to 97%. The question "When were you born?' achieved good correlation and greater PPV (93%). The combination of the question "What day is it today?" and the command "Count backwards by 3s from 20" achieved a high NPV. The question related to the date of birth achieved the highest PPV. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  11. Formation and regression of the corpus luteum of the American alligator

    USGS Publications Warehouse

    Guillette, L.J.; Woodward, A.R.; You-Xiang, Q.; Cox, M.C.; Matter, J.H.; Gross, T.S.

    1995-01-01

    Luteal morphology of the American alligator is unique when compared to other reptiles but is similar to that of its phylogenetic relatives, the birds. The theca is extensively hypertrophied, but the granulosa never fills the cavity formed following the ovulation of the ovum. The formation of the corpus luteum (CL) is correlated with elevated plasma progesterone concentrations, which decline dramatically after oviposition with the onset of luteolysis. Unlike those of most other reptiles, the central luteal cell mass is composed of two cell types; one presumably is derived from the granulosa, whereas the other is from the theca interna. Both cell types are present throughout gravidity but only one cell type is seen during mid to late luteolysis. A significant decline in luteal volume occurs following oviposition and continues throughout the post-oviposition period. The fastest decline in luteal volume occurs in the month immediately after oviposition; this rate then slows. Luteolysis appears to continue for a year or more following oviposition, as distinct structures of luteal origin can still be identified in animals 9 months after oviposition. The size of persistent CL can be used to determine whether a given female oviposited during the previous nesting season. Females with CL having volumes greater than 0.2 cm2 or CL diameters greater than 0.4 cm were active the previous season. 

  12. t(8;21) (q22;q22) acute myelogenous leukemia in Mexico: a single institution experience.

    PubMed

    Ruiz-Argüelles, Guillermo J; Morales-Toquero, Amelia; Manzano, Carlos; Ruiz-Delgado, Guillermo J; Jaramillo, Patricia; Gonzalez-Carrillo, Martha L; Reyes-Núñez, Virginia

    2006-08-01

    We analyze the prevalence and clinical features of a group of patients with t(8;21) (q22;q22) acute myeloblastic leukemia, identified in a single institution in México over a 10-year period. Fifteen patients presented at the Centro de Hematología y Medicina Interna de Puebla from February 1995 to August 2005; only nine were treated and followed in the institution. Median age was 24 years, (range 7-49); there was only one male. According to the French-American-British (FAB) morphological classification of leukemia, the morphology was M2 in four cases, M4 in three cases, M3 in one case and M0 in one. In addition to the myeloid markers, lymphoid markers were identified in 6 patients. Patients were induced to remission with combined chemotherapy and three subsequently underwent bone marrow transplantation (BMT). The median overall and disease-free survival has not been reached, being above 3390 days, the probability of survival at this time was 73%. In this single-center experience in México, we found that the t(8;21) (q22;q22) variant of leukemia was more frequent than in Caucasian populations, that the co-expression of lymphoid markers in the blast cells is very frequent and that this malignancy is associated with a relatively good prognosis.

  13. Morphology of ovarian changes during the reproductive cycle of the house lizard, Hemidactylus flaviviridis.

    PubMed

    Guraya, S S; Varma, S K

    1976-06-01

    Ovarian changes during the reproductive cycle of the oviparous wall lizard (Hemidactylus flaviviridis Rüppel) are described and discussed. It ovulates from mid-March to mid-May with a peak in April. Two eggs, one from each ovary, are ovulated at a time. After the breeding season is over, the ovaries are reduced in size. From June to third week of February they contain small pre-vitellogenic fillicles which start increasing in size with the approach of March when yolk deposition occurs rapidly. The histological details of developing the pre-ovulatory follicles are described. Follicle cell nuclei are taken into the ooplasm of pre-vitellogenic follicles; they are finally absorbed before yolk deposition starts. Pre-ovulatory follicles show highly vascularized thecae and invaginations of the follicular epithelium. Follicular atresia generally occurs in follicles with polymorphic granulosae, in post-ovulatory ovaries. Their granulosa cells give rist to phagocytes which, after removing the ooplasmic contents, degenerate, while the theca interna cells are hypertrophied to form the interstitial gland cells in the walls of degenerated follicles. After ovulation, the granulosa cells hypertrophy to form luteal cell mass filling the follicular cavity. Fibroblasts which appear to arise from the thecal layer, invade the luteal cell mass and form septa. Blood vessels occur in the luteal cell mass. The possible physiological significance of corpora lutea in the wall lizard is discussed.

  14. La dinámica demográfica y la desigualdad educativa en Méxicoa

    PubMed Central

    Giorguli Saucedo, Silvia E.; Vargas Valle, Eunice D.; Ulloa, Viviana Salinas; Hubert, Celia; Potter, Joseph E.

    2015-01-01

    En este trabajo se presenta una investigación sobre el vínculo entre los procesos educativos y la dinámica demográfica en México. La tradición del pensamiento sobre población y desarrollo ha partido de la hipótesis de que el ritmo de crecimiento poblacional, el tamaño de las familias y la migración influyen sobre la acumulación de capital humano entre la población en edades escolares. Se explora aquí la relación del desempeño educativo de los jóvenes entre 14 y 23 años y la razón de dependencia juvenil, la fecundidad adolescente y la migración interna e internacional; para ello se utilizan datos agregados a escala municipal del año 2000. El análisis incluye indicadores de la oferta educativa municipal basados en estadísticas administrativas de la SEP. PMID:26146427

  15. Structure and work process in primary care and hospitalizations for sensitive conditions.

    PubMed

    Araujo, Waleska Regina Machado; Queiroz, Rejane Christine de Sousa; Rocha, Thiago Augusto Hernandes; Silva, Núbia Cristina da; Thumé, Elaine; Tomasi, Elaine; Facchini, Luiz Augusto; Thomaz, Erika Barbara Abreu Fonseca

    2017-08-17

    process of the primary care teams impact the number of hospitalizations for primary care sensitive conditions in Brazilian municipalities. Investigar se características da estrutura das unidades básicas de saúde e do processo de trabalho das equipes de atenção básica estão associadas ao número de internações por condições sensíveis à atenção primária. Neste estudo ecológico, foram analisados dados de municípios brasileiros relativos a características sociodemográficas, de cobertura de programas assistenciais, de estrutura das unidades básicas de saúde e processo de trabalho das equipes de atenção básica. Os dados foram obtidos do primeiro ciclo do Programa de Melhoria do Acesso e Qualidade da Atenção Básica, do Departamento de Informática do Sistema Único de Saúde, do Instituto Brasileiro de Geografia e Estatística e do Programa das Nações Unidas. Estimaram-se as associações por meio de coeficientes de regressão binomial negativa (β) e respectivos intervalos de confiança a 95%, com abordagem hierarquizada em três blocos (alpha = 5%). Na análise ajustada, para o desfecho em 2013, no bloco distal, a cobertura do Programa Bolsa Família (β = -0,001) e de plano privado (β = -0,01) apresentaram associação negativa; e o índice de desenvolvimento humano (β = 1,13), a proporção de pessoa idosa (β = 0,05) e de menor de cinco anos (β = 0,05) e a cobertura da Estratégia de Agentes Comunitários de Saúde (β = 0,002) mostraram associação positiva com internações por condições sensíveis à atenção primária. No bloco intermediário, apresentaram associação negativa o horário mínimo (β = -0,14) e a disponibilidade de vacina (β = -0,16); e associação positiva, a disponibilidade de medicamentos (β = 0,16). No bloco proximal, apenas a variável apoio matricial (β = 0,10) mostrou associação positiva. Na análise ajustada do número de internações por condições sensíveis à atenção primária em 2014, as vari

  16. Leukoencephalopathy Associated with Parvovirus Infection in Cretan Hound Puppies▿

    PubMed Central

    Schaudien, D.; Polizopoulou, Z.; Koutinas, A.; Schwab, S.; Porombka, D.; Baumgärtner, W.; Herden, C.

    2010-01-01

    Leukoencephalopathies in dogs encompass presumably inherited conditions such as leukodystrophies, hypomyelination or spongiform degeneration, but other causes, such as virus infections and toxic or nutritional factors, might also play a contributory role. In this report, we provide evidence of parvovirus infection and replication in the brains of five 6-week-old Cretan hound puppies suffering from a puppy shaker syndrome and leukoencephalopathy. Although these puppies belonged to two different litters, they were closely related, tracing back two generations to the same sire. Histologically, a mild to moderate lymphohistiocytic meningitis, with focal lymphohistiocytic leukoencephalitis in two animals, and a mild to moderate vacuolation with myelin loss, mainly in the white matter of the cerebellum was detected. Vacuolation was also found in the corpus callosum, fimbria hippocampi, mesencephalon, capsula interna, basal ganglia, and hypothalamus. By immunohistology and in situ hybridization, either parvoviral antigen, DNA, mRNA, or replicative intermediate DNA were detected in the cerebellum, hippocampus, periventricular areas, corpus callosum, cerebral cortex, medulla oblongata, and spinal cord. Parvovirus antigen, DNA, and mRNA were present in cells of the outer granular layer of the cerebellum and in periventricular cells, most likely representing spongioblasts, glial cells, neurons, endothelial cells, occasional macrophages, and ependymal cells. Sequencing revealed canine parvovirus type 2 stretches. Thus, an association of parvovirus infection with the leukoencephalopathy seems likely, possibly facilitated by a genetic predisposition due to the mode of inbreeding in this particular dog breed. PMID:20592142

  17. Design, Fabrication, Simulation and Characterization of a Novel Dual-Sided Microelectrode Array for Deep Brain Recording and Stimulation

    PubMed Central

    Zhao, Zongya; Gong, Ruxue; Huang, Hongen; Wang, Jue

    2016-01-01

    In this paper, a novel dual-sided microelectrode array is specially designed and fabricated for a rat Parkinson’s disease (PD) model to study the mechanisms of deep brain stimulation (DBS). The fabricated microelectrode array can stimulate the subthalamic nucleus and simultaneously record electrophysiological information from multiple nuclei of the basal ganglia system. The fabricated microelectrode array has a long shaft of 9 mm and each planar surface is equipped with three stimulating sites (diameter of 100 μm), seven electrophysiological recording sites (diameter of 20 μm) and four sites with diameter of 50 μm used for neurotransmitter measurements in future work. The performances of the fabricated microelectrode array were characterized by scanning electron microscopy (SEM), electrochemical impedance spectroscopy (EIS) and cyclic voltammetry. In addition, the stimulating effects of the fabricated microelectrode were evaluated by finite element modeling (FEM). Preliminary animal experiments demonstrated that the designed microelectrode arrays can record spontaneous discharge signals from the striatum, the subthalamic nucleus and the globus pallidus interna. The designed and fabricated microelectrode arrays provide a powerful research tool for studying the mechanisms of DBS in rat PD models. PMID:27314356

  18. Alternative treatment of ovarian cysts with Tribulus terrestris extract: a rat model.

    PubMed

    Dehghan, A; Esfandiari, A; Bigdeli, S Momeni

    2012-02-01

    Tribulus terrestris has long been used in traditional medicine to treat impotency and improve sexual functions in man. The aim of this study was to evaluate the efficiency of T. terrestris extract in the treatment of polycystic ovary (PCO) in Wistar rat. Estradiol valerate was injected to 15 mature Wistar rats to induce PCO. Rats were randomly divided into three groups (control, low-dose and high-dose groups) of five each and received 0, 5 and 10 mg of T. terrestris extract, respectively.Treatments began on days 50 and 61 after estradiol injection; at the same time, vaginal smear was prepared. The ovaries were removed on day 62, and histological sections were prepared accordingly. The number and diameter of corpora lutea, thickness of the theca interna layer and the number of all follicles were evaluated in both ovaries. In comparison with the control group, the number of corpora lutea and primary and secondary follicles significantly increased following T. terrestris treatment; however, the number of ovarian cysts significantly decreased. It can be concluded that T. terrestris have a luteinizing effect on ovarian cysts, which may relate to its gonadotropin-like activity; also, a high dose of the extract can efficiently remove ovarian cysts and resume ovarian activity.

  19. System Identification of Local Field Potentials under Deep Brain Stimulation in a Healthy Primate

    PubMed Central

    Pedoto, Gilda; Santaniello, Sabato; Montgomery, Erwin B.; Gale, John T.; Fiengo, Giovanni; Glielmo, Luigi; Sarma, Sridevi V.

    2013-01-01

    High frequency (HF) Deep Brain Stimulation (DBS) in the Sub-Thalamic Nucleus (STN) is a clinically recognized therapy for the treatment of motor disorders in Parkinson Disease (PD). The underlying mechanisms of DBS and how it impacts neighboring nuclei, however, are not yet completely understood. Electrophysiological data has been collected in PD patients and primates to better understand the impact of DBS on STN and the entire Basal Ganglia (BG) motor circuit. We use single unit recordings from Globus Pallidus, both pars interna and externa segments (GPi and GPe) in the BG, in a normal primate before and after DBS to reconstruct Local Field Potentials (LFPs) in the region. We then use system identification techniques to understand how GPe LFP activity and the DBS signal applied to STN influence GPi LFP activity. Our models suggest that when no stimulation is applied, the GPe LFPs have an inhibitory effect on GPi LFPs with a 2-3 ms delay, as is the case for single unit neuronal activity. On the other hand, when DBS is ON the models suggest that stimulation has a dominant effect on GPi LFPs which mask the inhibitory effects of GPe. PMID:21096635

  20. Bronchial fistula closure with negative pressure wound therapy: a feasible and cost-effective treatment.

    PubMed

    Nunes, Rodrigo Barboza; Müller, Bruno Francisco; Cipriano, Federico Enrique Garcia; Coltro, Pedro Soler; Farina, Jayme Adriano

    2016-01-01

    Treatment of bronchial fistula (BF) after pulmonary lobectomy is a challenge. Often, patients require long hospital stay, have recurrent empyema and pneumonia, are susceptible to sepsis, often need broad-spectrum antibiotics, as well as various surgical approaches. With the advent and growing evidence of the benefits of negative pressure therapy (NPT), its use in some patients with BF has been reported with encouraging results concerning its feasibility and cost-effectiveness. The aim of this study was to demonstrate the application of NPT as a resource for BF treatment and comparatively analyze the overall cost of treatment. RESUMO O tratamento de fístula brônquica (FB) após lobectomia pulmonar é um desafio. Muitas vezes, o paciente demanda longo tempo de internação, apresenta recidivas de empiema e pneumonia, pode evoluir para sepse, frequentemente necessita de antibioticoterapia de amplo espectro, bem como de várias abordagens cirúrgicas. Com o advento e acúmulo de evidências dos benefícios da terapia por pressão negativa (TPN), seu uso em alguns pacientes com FB tem sido relatado com resultados animadores relativos à sua viabilidade e ao seu custo-efetividade. O objetivo deste estudo foi demonstrar a aplicação de TPN como recurso para tratamento da FB e analisar comparativamente o custo global do seu tratamento.

  1. What basal ganglia changes underlie the parkinsonian state? The significance of neuronal oscillatory activity

    PubMed Central

    Quiroga-Varela, A.; Walters, J.R.; Brazhnik, E.; Marin, C.; Obeso, J.A.

    2014-01-01

    One well accepted functional feature of the parkinsonian state is the recording of enhanced beta oscillatory activity in the basal ganglia. This has been demonstrated in patients with Parkinson's disease (PD) and in animal models such as the rat with 6-hydroxydopamine (6-OHDA)-induced lesion and 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-treated monkeys, all of which are associated with severe striatal dopamine depletion. Neuronal hyper-synchronization in the beta (or any other) band is not present despite the presence of bradykinetic features in the rat and monkey models, suggesting that increased beta band power may arise when nigro-striatal lesion is advanced and that it is not an essential feature of the early parkinsonian state. Similar observations and conclusions have been previously made for increased neuronal firing rate in the subthalamic and globus pallidus pars interna nuclei. Accordingly, it is suggested that early parkinsonism may be associated with dynamic changes in basal ganglia output activity leading to reduced movement facilitation that may be an earlier feature of the parkinsonian state. PMID:23727447

  2. Prevalence of auditory changes in newborns in a teaching hospital.

    PubMed

    Guimarães, Valeriana de Castro; Barbosa, Maria Alves

    2012-04-01

    Introdução: O diagnóstico e a intervenção precoces na surdez são de fundamental importância no desenvolvimento infantil. A perda auditiva e mais prevalente que outros distúrbios encontrados ao nascimento.Objetivo: Estimar a prevalência de alterações auditivas em recém-nascidos em um hospital escola.Método: Estudo transversal prospectivo que avaliou 226 recém-nascidos, nascidos em um hospital público, entre maio de 2008 a maio de 2009.Resultados: Dos 226 triados, 46 (20,4%) apresentaram ausência de emissões, sendo encaminhados para a segunda emissão. Das 26 (56,5%) crianças que compareceram no reteste, 8 (30,8%) permaneceram com ausência e foram encaminhadas ao otorrinolaringologista. Cinco (55,5%) compareceram e foram examinadas pelo médico. Destas, 3 (75,0%) apresentaram otoscopia normal, sendo encaminhadas para avaliação do Potencial Evocado Auditivo de Tronco Encefálico (PEATE). Do total de crianças estudadas, 198 (87,6%) tiveram presença de emissões em um dos testes e, 2 (0,9%) com diagnóstico de surdez.Conclusão: A prevalência de alterações auditivas na população estudada foi de 0,9%. O estudo oferece dados epidemiológicos relevantes e apresenta o primeiro relatório sobre o tema, fornecendo resultados preliminares para futura implantação e desenvolvimento de um programa de triagem auditiva neonatal.

  3. Ventos em supergigantes B[e] das nuvens de Magalhães e da Galáxia

    NASA Astrophysics Data System (ADS)

    de Araújo, F. X.; Pilling, D. A.; Pereira, C. B.; Fernandes, M. B.

    2003-08-01

    As Supergigantes B[e] apresentam as seguintes características: (i) alta luminosidade; (ii) espectro típico de estrelas de tipo B; (iii) linhas permitidas e proibidas em emissão de metais de baixa ionização, especialmente FeII; (iv) linhas de Balmer, e por vêzes também dos ions HeI e FeII, com perfis tipo P Cygni indicativos de altas taxas de perda de massa. Atualmente estamos desenvolvendo um projeto que visa comparar as propriedades fisicas (principalmente e v¥) dos ventos destes objetos nas Nuvens de Magalhães e na Galaxia. O objetivo é estudar a influência da metalicidade. No presente painel apresentamos uma determinação das velocidades terminais de 11 estrelas, sendo 4 na GNM (Hen S111, 66, R126 e Hen S93), 4 na PNM (Hen S18, S23, S65 e R4) e 3 na Galaxia (CPD-529243, MWC 300 e GG Car). Nossos dados são espectros de alta resolução obtidos no telescópio 1.52m do ESO com o espectrógrafo FEROS. Para determinar as velocidades terminais usamos as linhas Hd e HeI 3888 Å cujas componentes em absorção costumam estar livres de "blends" e estruturas. Nossos resultados sugerem que as velocidades de expansão na GNM são maiores (ainda que apenas ligeiramente) do que aquelas da PNM, como esperado. No entanto, os objetos da Galaxia não parecem seguir a mesma tendência.

  4. SAFETY AND EFFECTIVENESS OF SINGLE ANASTOMOSIS DUODENAL SWITCH PROCEDURE: PRELIMINARY RESULT FROM A SINGLE INSTITUTION.

    PubMed

    Nelson, Lars; Moon, Rena C; Teixeira, Andre F; Galvão, Manoel; Ramos, Almino; Jawad, Muhammad A

    Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) was introduced into bariatric surgery by Sanchez-Pernaute et al. as an advancement of the biliopancreatic diversion with duodenal switch. To evaluate the SADI-S procedure with regard to weight loss, comorbidity resolution, and complication rate in the super obese population. A retrospective chart review was performed on initial 72 patients who underwent laparoscopic or robot-assisted laparoscopic SADI-S between December 17th, 2013 and July 29th, 2015. A total of 48 female and 21 male patients were included with a mean age of 42.4±10.0 years (range, 22-67). The mean body mass index (BMI) at the time of procedure was 58.4±8.3 kg/m2 (range, 42.3-91.8). Mean length of hospital stay was 4.3±2.6 days (range, 3-24). Thirty-day readmission rate was 4.3% (n=3), due to tachycardia (n=1), deep venous thrombosis (n=1), and viral gastroenteritis (n=1). Thirty-day reoperation rate was 5.8% (n=4) for perforation of the small bowel (n=1), leakage (n=1), duodenal stump leakage (n=1), and diagnostic laparoscopy (n=1). Percentage of excess weight loss (%EWL) was 28.5±8.8 % (range, 13.3-45.0) at three months (n=28), 41.7±11.1 % (range, 19.6-69.6) at six months (n=50), and 61.6±12.0 % (range, 40.1-91.2) at 12 months (n=23) after the procedure. A total of 18 patients (26.1%) presented with type II diabetes mellitus at the time of surgery. Of these patients, 9 (50.0%) had their diabetes resolved, and six (33.3%) had it improved by 6-12 months after SADI-S. SADI-S is a feasible operation with a promising weight loss and diabetes resolution in the super-obese population. Anastomose única em bypass duodenoileal com gastrectomia vertical (SADI-S) foi introduzida na cirurgia bariátrica por Sanchez-Pernaute et al. como um avanço da derivação biliopancreática com switch duodenal. Avaliar o procedimento SADI-S no que diz respeito à perda de peso, resolução de comorbidades e taxa de complicações na popula

  5. Condições físicas do disco de acréscimo da nova-anã V4140 SGR

    NASA Astrophysics Data System (ADS)

    Borges, B.; Baptista, R.

    2003-08-01

    Discos de acréscimo são aparatos cósmicos que permitem que matéria seja eficientemente acrescida sobre uma fonte compacta pela remoção de momento angular via tensões viscosas enquanto transforma a energia potencial gravitacional em calor e, posteriormente, em radiação. Sistemas binários semi-ligados, como Variáveis Cataclísmicas (VCs) não-magnéticas, são talvez os melhores ambientes encontrados para o estudo da física desses discos de acréscimo. O desenvolvimento de técnicas de imageamento indireto, como o mapeamento por eclipses (MME) e a tomografia Doppler, permitiu avanços importantes na compreensão da física dos processos de acréscimo desses sistemas. V4140 Sagitarii é uma VC eclipsante de curto período orbital (~ 90 min) que não havia sido classificada como nova-anã ou polar. Neste trabalho apresentamos a análise do mapeamento por eclipse feito com dados de fotometria CCD nas bandas B, V e R de V4140 Sgr realizada no LNA. O objeto foi observado no declínio de erupção em julho de 1992 e em erupção em julho de 2001, isso indicou a classificação do sistema como uma nova-anã. A análise, feita sobre os mapas já apresentados em trabalho anterior, apresenta (i) diagrama cor-cor, que indica uma emissão opticamente espessa nas partes internas do disco em quiescência (R < RL1); (ii) diagrama cor-magnitude, usado para inferir uma distância de 600 +/- 10 pc ao sistema; (iii) a distribuição radial de temperatura observada que concorda com a lei de disco espesso em estado estacionário TµR-3/4, com temperaturas em torno de 10000 K e 3000 K ns partes internas e externas do disco em quiescência, respectivamente; (iv) a evolução da distribuição de temperatura no declínio de erupção; (v) estimativa da transferência de massa de 109.9+/-0.1 M¤/ano em quiescência, similar àquelas observadas em novas-like. O sistema é comparado à outras novas-anãs (e.g. OY Car e Z Cha) em quiescência e erupção, mostrando-se tratar um

  6. Economic analysis of costs with enteral and parenteral nutritional therapy according to disease and outcome.

    PubMed

    Hyeda, Adriano; Costa, Élide Sbardellotto Mariano da

    2017-01-01

    foram observados em internações relacionadas a infecções, cânceres e doenças cérebro-cardiovasculares. Os maiores custos com dieta parenteral foram observados nas internações relacionadas aos cânceres (64,52%) e às síndromes demenciais (46,17%). A maior relação entre o custo total com dieta e o custo total da conta foi na síndrome demencial (46,32%) e no câncer (41,2%). Os usuários que foram a óbito consumiram 51,26% dos custos totais das contas, sendo 32,81% com dieta (47,45% do valor total com dieta e 58,81% do custo na modalidade parenteral). As terapias nutricionais enteral e parenteral representaram uma parte importante dos custos no tratamento de indivíduos hospitalizados, principalmente nos casos dos cânceres e nas síndromes demenciais. O custo com dieta parenteral foi maior no grupo de usuários que foram a óbito.

  7. Analysis of the symmetric configuration of the circle of Willis in a series of autopsied corpses.

    PubMed

    Stojanović, Nebojga; Stefanović, Ivica; Kostić, Aleksandar; Radisavejević, Misa; Stojanov, Dragan; Petrović, Sladjana

    2015-04-01

    The forming of the blood vessels network configuration at the base of the brain and interconnecting of blood vessels during the embryogenesis is directly related to the phylogenetic development of the brain and brain structures. A blood vessel configuration at the brain base, in the form of a ring or a hexagon, stands in direct relation to the perfusion needs of certain parts of the brain during its primary differentiation. The aim of this paper was to determine the incidence of certain blood vessel configurations at the base of the brain and understanding their symmetry or asymmetry. Analysis of the blood vessels at the base of the brain was performed on the autopsied subjects. The object of observation was the anterior segment of the circle of Willis consisting of C1- a. carotis interna (ICA), above a. communicaus posterior (PcoA), the segment A1 a. cerebri anterior (ACA) from a. carotis interna bifurcation to the a. communicans anterior (AcoA) and a communicans anterior itself, as well as the posterior segment consisting of PcoA and the segment P1--a. cerebri posterior (PCA) from the a. basilaris bifurcation to the PcoA. For the purpose of grouping the findings, the four basic configuration types of the circle of Willis were identified based on its symmetry or asymmetry. Type-A (symmetric circle of Willis), type-B (asymmetric circle of Willis' due to the unilateral hypoplastic A1-ACA); type-C (symmetric circle of Willis with bilateral symmetric changes on PcoA) and type-D (asymmetric circle of Willis due to the asymmetric changes on PcoA). Autosy was performed on 56 corpses. A total of 41 (73.2%) subjects were recorded with a symmetric configuration of the circle of Willis', of which 27 (48.2%) subjects had type A and 14 (25%) type C. The asymmetric configuration was present in 15 (26.8%) subjects, of whom 9 (16%) had type B and 6 (10.8%) subjects, of whom 9 (16%) had type B and 6 (10.8%) type D. The symmetric Willis group (73.2%) did not have a homogeneous

  8. Translation and cross-cultural adaptation of the Clinical Competence Questionnaire for use in Brazil.

    PubMed

    Kwiatkoski, Danielle Ritter; Mantovani, Maria de Fátima; Pereira, Evani Marques; Bortolato-Major, Carina; Mattei, Ângela Taís; Peres, Aida Maris

    2017-06-05

    Questionnaire foi traduzido e adaptado a estudantes brasileiros, e as propriedades psicométricas da versão em português do questionário apresentaram consistência interna satisfatória quanto à amostra estudada. traducir y adaptar transculturalmente el Clinical Competence Questionnaire para uso de los estudiantes brasileños que concluyen la graduación en enfermería, así como para medir las propiedades psicométricas del cuestionario. estudio metodológico realizado en seis etapas: traducción del instrumento Clinical Competence Questionnaire, obtención de consenso de las traducciones, retrotraducción, análisis por el comité de especialistas, pretest y presentación del proceso de adaptación transcultural para los desarrolladores. Las propiedades psicométricas fueron medidas utilizando el alfa de Cronbach, coeficiente de correlación intraclase e índice de validez de contenido. el instrumento fue traducido, adaptado transculturalmente y su versión final estuvo constituida por 48 ítems. El coeficiente alfa de Cronbach fue de 0,90; el índice de concordancia de los ítems fue de 99% para los estudiantes y de 98% para los evaluadores. el Clinical Competence Questionnaire fue traducido y adaptado para uso de estudiantes brasileños; las propiedades psicométricas, de la versión en portugués del cuestionario, presentaron consistencia interna satisfactoria encontrada en la muestra estudiada.

  9. Quality of Life Score as a Predictor of Death in Dogs with Degenerative Mitral Valve Disease.

    PubMed

    Strunz, Célia M C; Marcondes-Santos, Mário; Takada, Julio Yoshio; Fragata, Fernanda S; Mansur, Antônio de Pádua

    2017-04-01

    sobreviventes ou não sobreviventes. Os valores mais elevados das seguintes variáveis foram obtidos no início do estudo no grupo de não sobreviventes (12 cães): fragmento N-terminal do peptídeo natriurético tipo B (NT-proBNP), norepinefrina plasmática, frequência cardíaca, escore de qualidade de vida, razão da dimensão interna diastólica do ventrículo esquerdo e raiz aórtica, razão da dimensão interna sistólica do ventrículo esquerdo e raiz aórtica e a relação da dimensão do átrio esquerdo e a raiz aórtica. Concentrações de NT-proBNP e o escore de qualidade de vida foram independentemente associados com morte na análise multivariada. O escore de qualidade de vida foi uma variável independente para a morte por doença cardíaca em cães com DDVM. Este resultado é encorajador, pois este escore é de fácil aplicação e não requer o emprego de tecnologia, necessitando apenas de um veterinário e um dono observador.

  10. Cross-Cultural adaptation of the General Functioning Scale of the Family.

    PubMed

    Pires, Thiago; Assis, Simone Gonçalves de; Avanci, Joviana Quintes; Pesce, Renata Pires

    2016-06-27

    fundamental de escolas públicas do município de São Gonçalo, Rio de Janeiro. Os tipos de equivalências investigados foram: conceitual e de itens, semântica, operacional, e mensuração. O estudo envolveu discussão com especialistas, traduções e retraduções do instrumento e avaliação psicométrica. Foi realizado estudo de confiabilidade e validade, por testagem da consistência interna (alpha de Cronbach), da correlação pelo método de split-half de Guttman e do coeficiente de correlação de Pearson, e por análise fatorial confirmatória. Associações entre Funcionamento Geral da Família e variáveis teoricamente associadas ao tema (embriaguez do pai ou da mãe e violência entre os pais) foram analisadas por estimação de razão de chance. A equivalência semântica encontrada foi entre 90,0% e 100%. O alfa de Cronbach variou de 0,79 a 0,81, indicando boa consistência interna do instrumento. O coeficiente de correlação de Pearson oscilou entre 0,303 e 0,549. Encontrou-se associação estatística entre o escore de funcionamento geral da família e as variáveis teoricamente relacionadas e constatou-se boa qualidade dos ajustes do modelo de análise confirmatória. Os resultados obtidos indicam a aplicabilidade do instrumento na população brasileira, que se mostra de fácil compreensão e boa aferição do constructo de interesse.

  11. [Recovery of walk in persons with stroke and heart disease].

    PubMed

    Kapidzić-Duraković, Suada; Karabegović, Azra; Zonić-Imamović, Majda

    2006-01-01

    The goal of this research is to analyze the differences in recovery of walk of two groups of patients who have suffered the stroke--those who have and have not suffered from heart disease prior to the stroke. Test group consisted of patients who have suffered the stroke, and have been rehabilitated in the Clinic for physical medicine and rehabilitation in Tuzla, in 2003. Patients who have had a heart disease before suffering the stroke and have been treated by a cardiologist comprised the first test group (Group I, N=48), while patients without previous heart disease comprised the second test group (Group II, N=69). In relation to their ability to walk, patients have been divided into three groups: those who are able to walk without help, those who are not able to walk and those who are able to walk with a walking aid. Therapies used include kinesiotherapy, paraffin, criotherapy, and electro procedures. Total number of those rehabilitated in the hospital after the stroke is 117, out of which 45 (38.5 %) were women and 72 (61.5 %) men, with average of 68 +/- 9,2 years of age. According to the kind of stroke suffered, 105 patients have had ischemia (89.7 %) and 12 have had hemorrhagia (10.3 %). The highest number of patients have had paralysis of the left side of the body--48 (41.0 %), then paralysis of the right side--43 (36.8 %) and both sides--15 (12.8 %). In relation to the localization of the changes in the brain detected in the CT, the highest number of patients have had multiply lacunar changes--41 (35,0 %), then changes in parietal area--33 (28.2 %) and temporoparietal area--22 (18.8 %), and a bit less had changes in capsula interna--15 (12.8 %), occipital--3 (2.6 %) and cerebellum--3 (2.6 %). In relation to the heart diseases, most of the patients have had compensated weakness of the heart--20 (41.7 %), suffered infarctus myocardii--8 (16.7 %) and atrial fibrillation--8 (16.7 %), with angina pectoris 6 (12,5 %), with arrhitmia--3 (6.3 %) and heart surgery--3

  12. Parameters predicting follicular carcinoma in thyroid nodules with indeterminate cytology.

    PubMed

    Kunt, Mevlüt; Cirit, Erkan; Eray, Ismail Cem; Yalay, Orçun; Parsak, Cem Kaan; Sakmann, Gürham

    2015-01-01

    La finalità dello studio è quella di cercare di determinare i parametri indicativi di malignità paragonando caratteristiche demografiche e aspetti di benignità o malignità dei loro noduli determinati sui referti anatomo-patologici dopo tiroidectomia in pazienti con citologia FNAB sospetta per neoplasia follicolare. Lo studio è stato condotto su 152 casi di sospetto carcinoma follicolare in base ai risultati della FNAB. Sono stati presi in considerazione l’età, l’eventuale esposizione a radiazioni, livelli sierici di TSH ed i dati ecografici riguardo al numero, diametro, struttura interna, ecogenicità, caratteristiche dei margini, eventuale presenza di alone e di micro calcificazioni interne. Sono stati anche considerati i rilievi scintigrafici dei noduli. L’età media dei pazienti era 48,14 anni (da 20 a 71); 25 (16,5%) di sesso maschile e 127 (83,5%) femminile. La natura maligna era prevalente tra i pazienti con TSH di livello superiore al normale, che non ai livelli normali o inferiori. La presenza di calcificazioni intranodulari [rapporto differenziale: 3,1; 95% di intervallo di confidenza: 1,3-7,4], aumento della vascolarizzazione intranodulare [rapporto differenziale: 14,7; 95% di intervallo di confidenza: 1,4-147,7], assenza di segni di alone [rapport differenziale: 0,1; 95% di intervallo di confidenza: 0,04-0,8], e margini non ben definiti [rapport differenziale: 0,1; 95% di intervallo di confidenza: 0,49-0,3] erano i dati statisticamente significativi più comuni nei casi di malignità. Su questi dati si può concludere che su basi cliniche e su parametri ecografici è possibile fare previsioni sulla malignità di noduli tiroidei di natura indeterminata, ricordando che l’indagine ecografica è un mezzo semplice, facile e di scarso costo nella diagnostica dei noduli tiroidei.

  13. Colour, lipid and protein stability of Rhea americana meat during air- and vacuum-packaged storage: influence of muscle on oxidative processes.

    PubMed

    Filgueras, R S; Gatellier, P; Aubry, L; Thomas, A; Bauchart, D; Durand, D; Zambiazi, R C; Santé-Lhoutellier, V

    2010-11-01

    Physicochemical characteristics and oxidative stability during storage were determined in Gastrocnemius pars interna (GN) and Iliofiburalis (IF) muscles of Rhea americana. Glycolytic potential (GP) and pH decline of muscles were measured within the first 24 h post mortem. Colour, lipid and protein stability were determined during storage of meat, i.e. 5 days under air-packaging at 4°C, or 28 days under vacuum-packaging at 4°C. In parallel, anti-oxidant status of muscles was estimated by measuring α-tocopherol content and anti-oxidant enzyme activities (superoxide dismutase and catalase), while pro-oxidant status was evaluated by determining haeminic iron and long chain fatty acids (especially polyunsaturated fatty acids). The ultimate pH was similar in both muscles, but the GP value was significantly higher in IF than in GN muscle. Haeminic iron and alpha-tocopherol content differed between muscles, with 30% more haeminic iron (p<0.05) and 134% more alpha-tocopherol (p<0.001) in IF than GN muscle. The IF muscle presented higher lipid content and lower PUFA/SFA ratio (polyunsaturated fatty acids/saturated fatty acids) than GN muscle. With storage under air-packaging, lipid and protein oxidation of rhea muscles increased up to 275% and 30%, respectively. This increase was more rapidly and marked in IF muscle. The IF also showed high level of metmyoglobin accumulation after 3 days of storage (47%) and was rejected by 1 consumer out of 2 in sensorial analysis. Under vacuum-packaging, both muscles showed a high stability of colour and no oxidation of lipids and proteins.

  14. Transcriptome profiling of granulosa and theca cells during dominant follicle development in the horse.

    PubMed

    Donadeu, F Xavier; Fahiminiya, Somayyeh; Esteves, Cristina L; Nadaf, Javad; Miedzinska, Katarzyna; McNeilly, Alan S; Waddington, David; Gérard, Nadine

    2014-11-01

    Several aspects of equine ovarian physiology are unique among domestic species. Moreover, follicular growth patterns are very similar between horses and humans. This study aimed to characterize, for the first time, global gene expression profiles associated with growth and preovulatory (PO) maturation of equine dominant follicles. Granulosa cells (GCs) and theca interna cells (TCs) were harvested from follicles (n = 5) at different stages of an ovulatory wave in mares corresponding to early dominance (ED; diameter ≥22 mm), late dominance (LD; ≥33 mm) and PO stage (34 h after administration of crude equine gonadotropins at LD stage), and separately analyzed on a horse gene expression microarray, followed by validation using quantitative PCR and immunoblotting/immunohistochemistry. Numbers of differentially expressed transcripts (DETs; ≥2-fold; P < 0.05) during the ED-LD and LD-PO transitions were 546 and 2419 in GCs and 5 and 582 in TCs. The most prominent change in GCs was the down-regulation of transcripts associated with cell division during both ED-LD and LD-PO. In addition, DET sets during LD-PO in GCs were enriched for genes involved in cell communication/adhesion, antioxidation/detoxification, immunity/inflammation, and cholesterol biosynthesis. In contrast, the largest change in TCs during the LD-PO transition was an up-regulation of genes involved in immune activation, with other DET sets mapping to GPCR/cAMP signaling, lipid/amino acid metabolism, and cell proliferation/survival and differentiation. In conclusion, distinct expression profiles were identified between growing and PO follicles and, particularly, between GCs and TCs within each stage. Several DETs were identified that have not been associated with follicle development in other species.

  15. [Physical activity by pregnant women and its influence on maternal and foetal parameters; a systematic review].

    PubMed

    Aguilar Cordero, M J; Sánchez López, A M; Rodríguez Blanque, R; Noack Segovia, J P; Pozo Cano, M D; López-Contreras, G; Mur Villar, N

    2014-10-01

    Introducción: Las múltiples ventajas que aporta a la salud la práctica de una actividad física de forma continuada son conocidas. Aunque es importante en todas las etapas de la vida, cuando llega la gestación aparecen algunas dudas sobre la conveniencia de realizar ejercicio físico, así como del tipo de actividad, de su frecuencia, intensidad y duración. Objetivo: Analizar los principales estudios sobre la influencia de la actividad física sobre los parámetros materno- fetales. Método: Revisión sistemática de programas de actividad física destinados a las mujeres embarazadas y sus resultados durante el embarazo, el parto y el postparto. Se identificaron 45 artículos a través de la búsqueda automatizada en las bases de datos PUBMED, Scopus y Google Scholar; se llevó a cabo entre los meses de octubre de 2013 y marzo de 2014. Para seleccionar los artículos fue preciso considerar la utilidad y la relevancia del tema estudiado y la credibilidad o experiencia de los autores en la temática. Se tuvo en cuenta la validez interna y externa de cada uno de los artículos revisados. Conclusiones: Los resultados de la revisión ponen de manifiesto la importancia de la actividad física durante el periodo gestacional y se constata que la información disponible en la actualidad puede servir de referente inicial para continuar profundizando en los resultados que sobre la salud materno fetal tiene la práctica de actividad física en el medio acuático.

  16. PubMed

    Flores-Peña, Yolanda; Acuña-Blanco, América; Cárdenas-Villarreal, Velia M; Amaro-Hinojosa, Marily D; Pérez-Campa, María E; Elenes-Rodríguez, Jesús R

    2017-02-01

    Introducción: las madres no reconocen cuando su hijo presenta sobrepeso-obesidad (SP-OB) y existe evidencia de relación entre esta percepción (PMPH) no adecuada y el estilo materno de alimentación infantil (EMAI).Objetivos: a) evaluar la confiabilidad del Cuestionario Estilos de Alimentación del Cuidador (CFSQ); b) verificar la asociación entre la PMPH y el estado nutricio del hijo; c) describir el EMAI; d) verificar diferencias entre el EMAI y el IMC del hijo; e) verificar la asociación entre la PMPH y los EMAI.Métodos: participaron 566 diadas (madre/hijo preescolar). Las madres seleccionaron la imagen que representaba el peso del hijo (PMPH) y contestaron el CFSQ. Se calculó coeficiente alpha de Cronbach. Se aplicó V de Cramer, ANOVA y Chi-cuadrado. Resultados: la consistencia interna del CFSQ fue 0,88. El 8,4% (n = 12) de madres de hijos con SP-OB tuvieron PMPH adecuada (V = 0,26, p = 0,001). El EMAI más frecuente fue el autoritario (34,5%, n = 195), el EMAI no involucrado presentó IMC más alto del hijo (F = 3,91, p < 0,05). Cuando las madres perciben el SP-OB de sus hijos ejercen un EMAI no involucrado (χ2 = 15,384, gl = 6, p < 0,05).Conclusiones: las madres de hijos con SP-OB tienen una PMPH no adecuada y presentan con mayor frecuencia EMAI autoritario. Cuando perciben a sus hijos como con SP-OB tienen EMAI no involucrado. Se recomiendan intervenciones para reconocer el SP-OB del hijo y la enseñanza de estrategias que promuevan un EMAI con autoridad.

  17. [Not Available].

    PubMed

    Latorre-Román, Pedro Ángel; Martínez-López, Emilio José; Ruiz-Ariza, Alberto; Izquierdo-Rus, Tomás; Salas-Sánchez, Jesús; García-Pinillos, Felipe

    2016-06-30

    Objetivo: el objetivo de este estudio es evaluar las propiedades psicométricas del cuestionario de disfrute por el ejercicio físico (PACES) en adolescentes con sobrepeso y obesidad.Métodos: participaron 139 adolescentes con sobrepeso y obesidad: 91 niñas (edad = 13,85 ± 1,92 años; índice de masa corporal [IMC] = 26,83 ± 3,16 kg/m2) y 48 niños (edad = 14,29 ± 1,62 años; IMC = 28,31 ± 3,74 kg/m2). Para analizar el disfrute por la actividad física se empleó el cuestionario Physical Activity Enjoyment Scale (PACES).Resultados: los resultados del análisis factorial exploratorio y confirmatorio han mostrado una estructura de dos factores; a su vez el PACES presenta una consistencia interna muy alta (alfa de Cronbach = 0,908). La fiabilidad test-retest indica una buena concordancia temporal (Spearman rho = 0,815, p < 0,001). Por último, el PACES en adolescentes con sobrepeso y obesidad manifiesta una validez convergente adecuada con la intencionalidad de ser activo (MIFA), la atracción por la actividad física (CAPA), la resistencia cardiorrespiratoria y los pliegues suprailiacoy subescapular.Conclusión: los resultados confirman que el PACES es una medida válida y fiable del disfrute por la actividad física en adolescentes con sobrepeso y obesidad. El disfrute por la actividad física puede ser relevante en la participación de los adolescentes con sobrepeso y obesidad en estas actividades.

  18. US in the evaluation of abdominal pain in a department of internal medicine.

    PubMed

    Simoni, F; Vitturi, N; Tagliente, M; Soattin, M; Realdi, G

    2011-09-01

    Sommario INTRODUZIONE: L’ecografia dell’addome sta acquistando un ruolo sempre maggiore nell’iter diagnostico del dolore addominale, tuttavia il suo ruolo nella diagnosi di alcuni importanti quadri di dolore addominale è ancora in corso di studio. Scopo del nostro studio è stato valutare il ruolo dell’ecografia nella diagnosi differenziale di dolore addominale in un reparto di medicina interna. Materiali e metodi: Abbiamo condotto un’analisi retrospettiva di 248 ecografie addominali eseguite per dolore addominale nel nostro centro. Per ogni esame, sono stati registrati i dati inseriti nel modulo di richiesta e i reperti ecografici che potevano essere considerati correlati a dolore addominale. Risultati: In 105 pazienti (42%) l’ecografia dell’addome ha rilevato un reperto ecografico rilevante ed è stata quindi considerata positiva. Un’alta percentuale di pazienti era anziana (>65 anni, 52%) e grande anziana (>80 anni, 24%): questi soggetti avevano percentuale significativamente maggiore di esami ecografici positivi. La percentuale di indagini positive non è risultata significativamente diversa tra quelle eseguite per dolore addominale localizzato e non localizzato. Specifiche localizzazioni di dolore addominale erano associate a determinati reperti ecografici, come masse epatiche, masse ovariche e calcolosi renale, mentre dolore addominale non localizzato era associato a reperti ecografici di versamento liquido addominale e anse intestinali distese da fluido. DISCUSSIONE: Un’alta percentuale di indagini ecografiche ha identificato condizioni che potrebbero causare dolore addominale. Il valore diagnostico dell’ecografia addominale è stato maggiore in pazienti anziani e grandi anziani. Quando viene richiesta un’ecografia addominale, l’esame dovrebbe sempre essere valutato nell’ambito nel contesto clinico. Il clinico dovrebbe essere consapevole della grande potenzialità dell’ecografia addominale nella diagnosi delle diverse cause di

  19. Behaviour of health professionals concerning the recommendations for prophylaxis for infectious endocarditis in our setting: Are the guidelines followed?

    PubMed

    Anguita, P; Castillo, F; Gámez, P; Carrasco, F; Roldán, R; Jurado, B; Castillo, J C; Martín, E; Anguita, M

    2017-03-01

    The prophylaxis regimens for infectious endocarditis recommended by the clinical practice guidelines have recently changed. We do not know whether the current regimens are correctly followed in our setting. Our objective was to describe the approaches of various health professionals concerning these guidelines. We conducted a survey in Cordoba, using a 16-item online questionnaire on this topic. We randomly selected a sample of 180 practitioners (20 cardiologists, 80 dentists and 80 primary care physicians), of whom 173 responded. Half of the participants were men; 52% had more than 20 years of professional experience. Some 88.3% of the participants considered that prophylaxis of endocarditis is effective (77.8% of the cardiologists, 93.7% of the dentist; p=.086). In general, prophylaxis is performed in conditions of clearly established risk (>90% of those surveyed). However, prophylaxis is also performed in a high proportion of cases with no risk of endocarditis, varying between 30 and 60% according to the procedure (mostly the dentists, between 36 and 67%, followed by the primary care physicians, between 28 and 59%). The antibiotic regimens employed varied significantly. The primary care physicians were furthest from the recommended regimen (only 25.8% used the recommended regimen vs. 54.4% of dentists and 72.2% of cardiologists; p=.002). Compliance with the recommendations on prophylaxis for endocarditis should be improved in our setting. We observed a tendency, especially among noncardiologists, to "overindicate" the prophylaxis. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  20. Studies of gonadal sex differentiation

    PubMed Central

    Makiyan, Zograb

    2016-01-01

    ABSTRACT Gonadal differentiation has a determinative influence on sex development in human embryos. Disorders of sexual development (DSD) have been associated with persistent embryonal differentiation stages. Between 1998 and 2015, 139 female patients with various (DSD) underwent operations at the Scientific Center of Obstetrics, Gynaecology and Perynatology in Moscow, Russia. Clinical investigations included karyotyping, ultrasound imaging, hormonal measurement and investigations of gonadal morphology. The male characteristics in the embryo are imposed by testicular hormones. When these are absent or inactive, the fetus may be arrested at between developmental stages, or stay on indifferent stage and become phenotypically female. A systematic analysis of gonadal morphology in DSD patients and a literature review revealed some controversies and led us to formulate a new hypothesis about sex differentiation. Proliferation of the mesonephric system (tubules and corpuscles) in the gonads stimulates the masculinization of gonads to testis. Sustentacular Sertoli cells of the testes are derived from mesonephric excretory tubules, while interstitial Leydig cells are derived from the original mesenchyme of the mesonephros. According of the new hypothesis, the original mesonephric cells (tubules and corpuscles) potentially persist in the ovarian parenchyma. In female gonads, some mesonephric excretory tubules regress and lose the tubular structure, but form ovarian theca interna and externa, becoming analogous to the sustentacular Sertoli cells in the testis. The ovarian interstitial Leydig cells are derived from intertubal mesenchyme of the mesonephros, similar to what occurs in male gonads (testis). Surprisingly, the leading determinative factor in sexual differentiation of the gonads is the mesonephros, represented by the embryonic urinary system. PMID:26950283

  1. Genetic susceptibility to Gilbert's syndrome in a valencian population; efficacy of the fasting test.

    PubMed

    Torres, A K; Escartín, N; Monzó, C; Guzmán, C; Ferrer, I; González-Muñoz, C; Peña, P; Monzó, V; Marcaida, G; Rodríguez-López, R

    To describe the populational distribution of the UGT1A1*28 variant (genetic variant code rs8175347) located in the promotor of the UGT gene and correlate its genotypes with the results of the fasting test, as well as its relationship with the biochemical disorder of Gilbert's syndrome (GS) in a Valencian population. We studied the prevalence of the genotypes (TA)6/6 (TA)6/7 and (TA)7/7 of the deleterious variant rs8175347 in 144 patients with hyperbilirubinemia, 38 of whom had previously undergone the fasting test to diagnose GS, and in 150 control patients. By analysing the genomic region of the TATA box of the UGT1A1 gene promotor using Sanger sequencing, we established the correlation between the rs8175347 genotypes and the fasting test results and with the patients' biochemical disorders. The rate of heterozygosity of allele (TA)7 in the control population was 32% and increased to 87.59% among the patients with suspected GS. The rate of genotype TA7/7 was 81.94% among the patients with hyperbilirubinemia, compared with 11.33% in the control patients. The fasting test showed a 15.79% rate of false negatives and a 5.26% rate of false positives. The high frequency of allele (TA)7 among the Valencian control population, almost double the 5% reported for European control patients, confirms the high rate of GS reported in the Spanish population, without observing significant differences between the geographical ends of the country. The efficacy and reliability of the fasting test for the diagnosis of GS is questionable. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  2. [Spanish scientific research output on tuberculosis indexed in MEDLINE, 1997-2006].

    PubMed

    Ramos, José Manuel; Masiá, Mar; Padilla, Sergio; García-Pachón, Eduardo; Gutiérrez, Félix

    2009-06-01

    To analyze Spanish scientific research output related to tuberculosis during the 10-year period from 1997 through 2006 and to consider it within the context of European Union (EU) productivity. The bibliometric study was based on a search of the MEDLINE database, using the PubMed search interface. Search terms were tuberculosis or tuberculous appearing in any database field. Of 35 735 titles retrieved, 1191 were by Spanish authors. This represented 4.1% of world output. Spain, accounting for 13.5% of EU scientific output in this area, was the third most productive EU country; 610 (51.2%) of the papers were published in English and 581 (48.8%) in Spanish. The number of papers published remained steady over the 10-year period. The first author's specialty was usually microbiology (225 documents, or 20.6%), followed by internal medicine (154, or 14.1%), and respiratory medicine (117, 10.7%). Journals publishing the largest numbers of papers on tuberculosis were Medicina Clínica and Enfermedades Infecciosas y Microbiología Clínica with 78 (6.5%) each, Anales de Medicina Interna with 72, Revista Clínica Española with 64, and Archivos de Bronconeumología with 63. The most productive provinces were Madrid and Barcelona, with 272 (22.8%) and 256 (21.5%) papers, respectively. The most productive institutions were hospitals, with 900 titles (75.6%), followed by universities, with 132 (11.1%). Tuberculosis research in Spain has taken place at a steady rate over the last 10 years and has accounted for a substantial proportion of EU research in this field. Half the papers by Spanish authors were found in international journals published outside Spain. The majority of papers were from authors working in hospitals.

  3. Infectious spondylitis in the Balearic Islands: An analysis of 51 cases.

    PubMed

    Raya Cruz, M; Vilchez Rueda, H H; Marinescu, C I; Sarasíbar Ezcurra, H; Riera Jaume, M; Payeras Cifre, A

    2015-01-01

    Vertebral osteomyelitis (VO) is a rare entity, although its incidence has increased in recent years. The objective is to describe the patients with this infection in our environment and a comparison with other published series. A retrospective review was conducted of epidemiological, clinical, microbiological, treatment, complications and evolution data of patients with VO during 10 years (2004-2014) in two hospitals of Mallorca. 51 cases, median age 66 (range 22-85) years, 37 (72.5%) men with a mean onset of symptoms of 80.1 ± 125.1 days. In thirty-six (70.6%) cases the origin of infection was considered hematogenous, although previous bacteremia was documented in 23 (45%) cases, being of urinary in 10 (43.5%) cases. Clinically at the moment of diagnosis 35 (68.8%) had fever, 32 (62.7%) pain, 14 (27.5%) irradiated nerve pain and 10 (19.6%) paralysis/paresia. MRI was the most performed radiological test 46 (90.2%), being pathological in all cases. S. aureus 23 (52.3%) was the most common microbiological isolates. At the moment of the diagnosis, blood cultures were positive in 27 (65.8%) of 41 cases and 11 (50%) of 22 percutaneous puncture was positive. Paraspinal, epidural or psoas abscesses were observed in 23 (45.1%), neurological deficit in 7 (13.7%) and chronic pain in 6 (11.8%). One patient (1.9%) died in relation with infection. Diagnosis was delayed in most cases. Previous bacteremia being main predisposing factor and hematogenous origin the main source of infection. S. aureus was the most isolated. Percutaneous puncture together with blood cultures increase etiologic diagnosis. A high percentage of patients had complications or sequelae. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  4. Morphological Studies on the Peripheral Circulation of the Ovary in One-Humped Camel (Camelus dromedarius).

    PubMed

    Mokhtar, Doaa M; Abd-Elhafez, Enas A

    2016-08-01

    Histological examination of the peripheral circulation of the ovary of 18 females of the one-humped camel revealed a series of blood vessels with special structures. Throttle or occlusive artery was recorded in the ovarian zona vasculosa and in the cortex, and it showed an intimal cushion-like thickening made up of intimal bolsters that formed of smooth muscle fibres and glomus cells. The smooth muscle cells of the tunica media and the tunica adventitia of throttle artery pursued a circumferential pattern. Anastomosis arteriovenosa included simple bridge-like anastomotic vessels between arteria and venae, and glomus vessels of typical structure were demonstrated. Glomus organs were recorded in the ovary and were comprised of the tortuous glomus vessels and the related afferent and efferent vessels. Glomus cell complexes also were commonly occur at the cortex ovarii that possessed an extremely convoluted course with a hyperplastic wall and a narrow lumen. Atypical glomus vessels were demonstrated within the ovarian zona vasculosa, and the wall of these vessels was relatively thick and consisted of double tunica media with an intimal bolster. Some vessels contained an intimal bolster device of exclusively glomus cell structure (glomus bolster) with a tunica elastic interna demarcated it from the glomus cell media. Some venae represented several layers of longitudinally arranged smooth muscle fibres in the tunica media. Other venae showed wall with variable thickness. Venae with double muscular tunica media were recorded in the medulla. Some venae showed double internal elastic lamina. Also, venae with thick adventitia contained dispersed smooth muscle fibres were determined. Spirally oriented arteriole and venule were demonstrated within the cortex and medulla ovarii. Gestation sclerosis was demonstrated in ovarian zona vasculosa of pregnant females. © 2015 Blackwell Verlag GmbH.

  5. Reduction in hospitalisations and emergency department visits for frail patients with heart failure: Results of the UMIPIC healthcare programme.

    PubMed

    Cerqueiro, J M; González-Franco, A; Montero-Pérez-Barquero, M; Llácer, P; Conde, A; Dávila, M F; Carrera, M; Serrado, A; Suárez, I; Pérez-Silvestre, J; Satué, J A; Arévalo-Lorido, J C; Rodríguez, A; Herrero, A; Jordana, R; Manzano, L

    2016-01-01

    Heart failure (HF) is a disease with high morbidity and mortality. We evaluated the usefulness of the Comprehensive Management Units for Patients with HF (Unidades de Manejo Integral para Pacientes con IC [UMIPIC]) programme. We analysed the patient data from the UMIPIC programme, which was recorded in the HF registry (RICA) of the Spanish Society of Internal Medicine. We compared emergency department visits and hospitalisations for any cause and for HF during the year prior to inclusion in the programme against those that occurred during the subsequent follow-up year, using the chi-squared test. A total of 258 patients (mean age, 80years; 51.9% women) were included in the study. During the previous year, there were 693 hospitalisations for all causes and 174 hospitalisations during the follow-up (75% reduction, P<.001). There were 613 hospitalisations for HF during the previous year and 92 during the follow-up (85% reduction, P<.001); 655 vs. 302 in terms of emergency department visits for any cause (53.9% reduction, P<.001); and 440 vs. 120 for emergency department visits for HF (72% reduction, P<.001). There were no significant differences in the number of hospitalisations or emergency department visits for causes other than HF. The UMIPIC programme based on the comprehensive care of elderly patients with HF and comorbidity reduces the rate of hospital readmissions and emergency department visits during the first year of follow-up. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  6. Diagnostic validity of hand gestures in chest pain of coronary origin.

    PubMed

    Montero-Pérez, F J; Quero-Espinosa, F de Borja; Clemente-Millán, M J; Castro-Giménez, J A; de Burgos-Marín, J; Romero-Moreno, M Á

    To determine the frequency of 3 hand gestures by patients with chest pain and determine the diagnostic validity of the gestures in acute coronary syndrome. A prospective study was conducted on 383 adult patients treated for chest pain in an emergency department. We observed certain hand gestures, previously referred to in the medical literature as characteristic of coronary pain (gesture 1: a clenched fist held over the sternal area or Levine's sign; gesture 2: open hand located over the same area; gesture 3: both hands placed in the centre of the chest), as well as other gestures. We analysed their association with the coronary origin of the pain. We confirmed the coronary origin of the pain in 164 (43%) patients (ACS group). The other 219 patients (57%) did not have a coronary origin for the pain (nonACS group). Eighty-nine percent of the patients identified their pain with one of the 3 classical gestures. The most frequent gesture was number 2, both overall (59%) and by group (60% ACS group; 57.5% nonACS group). There was no significant association between the type of gesture and the final diagnosis (P=.172). The greater specificity corresponded to Levine's sign (90%), followed by other gestures (86%) and gesture 3 (81%). Although 89% of the patients expressed their chest pain with one of the 3 manual gestures classically associated with coronary pain, none achieved sufficient diagnostic accuracy to be used as indicative of this type of pain. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  7. Deep Brain Stimulation for Parkinson Disease

    PubMed Central

    Bronstein, Jeff M.; Tagliati, Michele; Alterman, Ron L.; Lozano, Andres M.; Volkmann, Jens; Stefani, Alessandro; Horak, Fay B.; Okun, Michael S.; Foote, Kelly D.; Krack, Paul; Pahwa, Rajesh; Henderson, Jaimie M.; Hariz, Marwan I.; Bakay, Roy A.; Rezai, Ali; Marks, William J.; Moro, Elena; Vitek, Jerrold L.; Weaver, Frances M.; Gross, Robert E.; DeLong, Mahlon R.

    2015-01-01

    Objective To provide recommendations to patients, physicians, and other health care providers on several issues involving deep brain stimulation (DBS) for Parkinson disease (PD). Data Sources and Study Selection An international consortium of experts organized, reviewed the literature, and attended the workshop. Topics were introduced at the workshop, followed by group discussion. Data Extraction and Synthesis A draft of a consensus statement was presented and further edited after plenary debate. The final statements were agreed on by all members. Conclusions (1) Patients with PD without significant active cognitive or psychiatric problems who have medically intractable motor fluctuations, intractable tremor, or intolerance of medication adverse effects are good candidates for DBS. (2) Deep brain stimulation surgery is best performed by an experienced neurosurgeon with expertise in stereotactic neurosurgery who is working as part of a interprofessional team. (3) Surgical complication rates are extremely variable, with infection being the most commonly reported complication of DBS. (4) Deep brain stimulation programming is best accomplished by a highly trained clinician and can take 3 to 6 months to obtain optimal results. (5) Deep brain stimulation improves levodopa-responsive symptoms, dyskinesia, and tremor; benefits seem to be long-lasting in many motor domains. (6) Subthalamic nuclei DBS may be complicated by increased depression, apathy, impulsivity, worsened verbal fluency, and executive dysfunction in a subset of patients. (7) Both globus pallidus pars interna and subthalamic nuclei DBS have been shown to be effective in addressing the motor symptoms of PD. (8) Ablative therapy is still an effective alternative and should be considered in a select group of appropriate patients. PMID:20937936

  8. CLIPPERS: chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids. Review of an increasingly recognized entity within the spectrum of inflammatory central nervous system disorders

    PubMed Central

    Dudesek, A; Rimmele, F; Tesar, S; Kolbaske, S; Rommer, P S; Benecke, R; Zettl, U K

    2014-01-01

    Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a recently defined inflammatory central nervous system (CNS) disorder, prominently involving the brainstem and in particular the pons. The condition features a combination of clinical symptoms essentially referable to brainstem pathology and a characteristic magnetic resonance imaging (MRI) appearance with punctate and curvilinear gadolinium enhancement ‘peppering’ the pons. The radiological distribution is focused in the pons and adjacent rhombencephalic structures such as the cerebellar peduncles, cerebellum, medulla and the midbrain. While the lesion burden with a perivascular pattern is typically most dense in these pontine and peripontine regions, enhancing lesions may additionally extend into the spinal cord and supratentorial structures such as the thalamus, basal ganglia, capsula interna, corpus callosum and the cerebral white matter. Another core feature is clinical and radiological responsiveness to glucocorticosteroid (GCS)-based immunosuppression. As withdrawal of GCS treatment results commonly in disease exacerbation, long-term immunosuppressive therapy appears to be mandatory for sustained improvement. Diagnosis of CLIPPERS is challenging, and requires careful exclusion of alternative diagnoses. A specific serum or cerebrospinal fluid (CSF) biomarker for the disorder is currently not known. Pathogenesis of CLIPPERS remains poorly understood, and the nosological position of CLIPPERS has still to be established. Whether CLIPPERS represents an independent, actual new disorder or a syndrome that includes aetiologically heterogeneous diseases and/or their prestages remains a debated and not finally clarified issue. Clinicians and radiologists should be aware of this condition and its differential diagnoses, given that CLIPPERS constitutes a treatable condition and that patients may benefit from an early introduction of GCS ensued by long

  9. [New views on the functional morphology of human clitoris].

    PubMed

    Miko, M; Urban, L; Kajanová, M; Polák, S; Varga, I

    2014-04-01

    The clitoris is the female external sexual organ and is composed of erectile bodies. The distal portion of the vagina, clitoris and urethra form an integrated entity sui generis. All these components share a common vasculature and nerve supply and during sexual stimulation they respond as one functional unit. The clitoris is closely linked to the mechanism of sexual arousal in women. Glans has a dense network of receptors, innervated often with a several nerves at the same time - taking care of tactile sensitivity, thus, standing on the beginning of the journey, which culminates in orgasm. Nervus dorsalis clitoridis, which is a branch of n. pudendus, takes care of sensitive innervation. For blood supply is responsible a. clitoridis, which is a branch of a. pudenda interna. The most common congenital developmental anomalies of the clitoris include: clitoromegaly, penis-like clitoris and bifid clitoris. All, however, are among the relatively rare birth defects. Mechanism of orgasm gets attention between both laic and scientific community, although to this date there are speculations about its exact mechanism. There is relevant opinion, influenced by Freuds doctrine, which strictly recognizes two kinds of female orgasms - vaginal and clitoral, and, according to proponents of this theory, only the second mentioned is caused by stimulation of the clitoris. The second school unifies the term orgasm and claims that only clitoral stimulation (digital, penile, cunnilingus) and contraction of striated perineal muscle are responsible for orgasm, whether the glans (external part) or the body of the clitoris from the vaginal approach is stimulated. Therewithal, special term for mythical and still undocumented (despite many attempts and bold claims about its finding) G spot (named after Ernst Gräfenberg, a German doctor who predicted the existence of this place) is redundant. Important role in the regulation of female sexuality and responsiveness play a hormonal influences and

  10. Porcine arteriogenesis based on vasa vasorum in a novel semi-acute occlusion model using high-resolution imaging.

    PubMed

    Harnoss, Jonathan M; Krackhardt, Florian; Ritter, Zully; Granzow, Susanne; Felsenberg, Dieter; Neumann, Konrad; Lerman, Lilach O; Riediger, Fabian; Hillmeister, Philipp; Bramlage, Peter; Buschmann, Ivo R

    2017-08-03

    Bridging collaterals (BC) develop in several chronic total artery occlusion diseases, and can prevent extensive myocardial necrosis. Yet, their origin, growth process, and histo-morphology are still unclear. Since vasa vasorum (VV) may take part in collateralization, we hypothesized that VV are the basis for BCs. To comprehensively investigate this arteriogenesis process, we used high-resolution imaging, including corrosion casts, post-mortem angiography with stereoscopy, micro-CT, and immunohistology, in combination with a novel semi-acute vessel occlusion model. This porcine model was produced by implanting a copper stent minimally invasively into the left anterior descending coronary artery. To define the kinetics of arteriogenesis, pigs (n = 11) were assigned to one of the five euthanasia timepoints: day 0.5 (D0.5, n = 2), D3 (n = 2), D5 (n = 1), D7 (n = 3), or D12 (n = 3) after stent implantation. We found that (1) BCs originate from longitudinally running type 1 VV, mainly VV interna, partially also from VV externa; (2) the growth of VV to BC is rapid, occurring within 7 days; and (3) porcine BCs are likely functionally relevant, considering an observed 102% increase in the number of smooth muscle cell layers in their vascular wall. High-resolution imaging in a minimally invasive non-acute vessel occlusion model is an innovative technique that allowed us to provide direct evidence that porcine BCs develop from the VV. These data may be crucial for further studies on the treatment of angina pectoris and thromboangiitis obliterans through therapeutic stimulation of BC development.

  11. CLIPPERS: chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids. Review of an increasingly recognized entity within the spectrum of inflammatory central nervous system disorders.

    PubMed

    Dudesek, A; Rimmele, F; Tesar, S; Kolbaske, S; Rommer, P S; Benecke, R; Zettl, U K

    2014-03-01

    Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a recently defined inflammatory central nervous system (CNS) disorder, prominently involving the brainstem and in particular the pons. The condition features a combination of clinical symptoms essentially referable to brainstem pathology and a characteristic magnetic resonance imaging (MRI) appearance with punctate and curvilinear gadolinium enhancement 'peppering' the pons. The radiological distribution is focused in the pons and adjacent rhombencephalic structures such as the cerebellar peduncles, cerebellum, medulla and the midbrain. While the lesion burden with a perivascular pattern is typically most dense in these pontine and peripontine regions, enhancing lesions may additionally extend into the spinal cord and supratentorial structures such as the thalamus, basal ganglia, capsula interna, corpus callosum and the cerebral white matter. Another core feature is clinical and radiological responsiveness to glucocorticosteroid (GCS)-based immunosuppression. As withdrawal of GCS treatment results commonly in disease exacerbation, long-term immunosuppressive therapy appears to be mandatory for sustained improvement. Diagnosis of CLIPPERS is challenging, and requires careful exclusion of alternative diagnoses. A specific serum or cerebrospinal fluid (CSF) biomarker for the disorder is currently not known. Pathogenesis of CLIPPERS remains poorly understood, and the nosological position of CLIPPERS has still to be established. Whether CLIPPERS represents an independent, actual new disorder or a syndrome that includes aetiologically heterogeneous diseases and/or their prestages remains a debated and not finally clarified issue. Clinicians and radiologists should be aware of this condition and its differential diagnoses, given that CLIPPERS constitutes a treatable condition and that patients may benefit from an early introduction of GCS ensued by long

  12. [Simplified laparoscopic gastric bypass. Initial experience].

    PubMed

    Hernández-Miguelena, Luis; Maldonado-Vázquez, Angélica; Cortes-Romano, Pablo; Ríos-Cruz, Daniel; Marín-Domínguez, Raúl; Castillo-González, Armando

    2014-01-01

    Antecedentes: la cirugía de la obesidad comprende diversos procedimientos gastrointestinales. El bypass gástrico en Y de Roux es el prototipo de los procedimientos mixtos y el más practicado en el mundo en sus diversas variedades. Una técnica similar y novedosa es la adoptada por Cardoso-Ramos y Galvao denominada "bypass simplificado" que rápidamente se aceptó por la mayor facilidad y resultados muy parecidos a la técnica convencional. Objetivo: describir los resultados a un año del bypass gástrico simplificado para el tratamiento de la obesidad mórbida. Material y métodos: estudio retrospectivo y descriptivo de todos los pacientes a quienes se realizó bypass gástrico de enero de 2008 a julio de 2012, en la clínica de obesidad de un hospital privado de la Ciudad de México. Resultados: se estudiaron 90 pacientes con diagnóstico de obesidad mórbida, con límites de edad de 18 y 65 años, operados para bypass gástrico simplificado. En 10% de los pacientes hubo complicaciones, las más frecuentes fueron: hemorragia y hernia interna. Durante el periodo de estudio la mortalidad fue de 0%. La pérdida de peso promedio a los 12 meses fue de 72.7%. Conclusión: el bypass gástrico simplificado laparoscópico es una cirugía segura, con buenos resultados a mediano plazo, y con una pérdida del exceso de peso adecuada en 71% de los casos.

  13. Cognitive and Psychiatric Effects of STN versus GPi Deep Brain Stimulation in Parkinson's Disease: A Meta-Analysis of Randomized Controlled Trials

    PubMed Central

    Zhang, Xiao-Hua; Wang, Yun-Peng; Li, Ji-Ping; Li, Yong-Jie

    2016-01-01

    Background Deep brain stimulation (DBS) of either the subthalamic nucleus (STN) or the globus pallidus interna (GPi) can reduce motor symptoms in patients with Parkinson’s disease (PD) and improve their quality of life. However, the effects of STN DBS and GPi DBS on cognitive functions and their psychiatric effects remain controversial. The present meta-analysis was therefore performed to clarify these issues. Methods We searched the PUBMED, EMBASE, and the Cochrane Central Register of Controlled Trials databases. Other sources, including internet-based clinical trial registries and grey literature sources, were also searched. After searching the literature, two investigators independently performed literature screens to assess the quality of the included trials and to extract the data. The outcomes included the effects of STN DBS and GPi DBS on multiple cognitive domains, depression, anxiety, and quality of life. Results Seven articles related to four randomized controlled trials that included 521 participants were incorporated into the present meta-analysis. Compared with GPi DBS, STN DBS was associated with declines in selected cognitive domains after surgery, including attention, working memory and processing speed, phonemic fluency, learning and memory, and global cognition. However, there were no significant differences in terms of quality of life or psychiatric effects, such as depression and anxiety, between the two groups. Conclusions A selective decline in frontal-subcortical cognitive functions is observed after STN DBS in comparison with GPi DBS, which should not be ignored in the target selection for DBS treatment in PD patients. In addition, compared to GPi DBS, STN DBS does not affect depression, anxiety, and quality of life. PMID:27248139

  14. Expression and localization of fibroblast growth factor (FGF) family in buffalo ovarian follicle during different stages of development and modulatory role of FGF2 on steroidogenesis and survival of cultured buffalo granulosa cells.

    PubMed

    Mishra, S R; Thakur, N; Somal, A; Parmar, M S; Reshma, R; Rajesh, G; Yadav, V P; Bharti, M K; Bharati, Jaya; Paul, A; Chouhan, V S; Sharma, G T; Singh, G; Sarkar, M

    2016-10-01

    The present study investigated the expression and localization of FGF and its functional receptors in the follicle of buffalo and the treatment of FGF2 on mRNA expression of CYP19A1 (aromatase), PCNA, and BAX (BCL-2 associated X protein) in cultured buffalo granulosa cells (GCs). Follicles were classified into four groups based on size and E2 level in follicular fluid (FF): F1, 4-6mm diameter, E2<0.5ng/ml of FF; F2, 7-9mm, E2=0.5-5ng/ml; F3, 10-13mm, E2=5-40ng/ml; F4, >14mm, E2>180ng/ml. The qPCR studies revealed that the mRNA expression of FGF1, FGF2 and FGF7 were maximum (P<0.05) in theca interna (TI) whereas the transcripts of FGFR1, FGFR2, FGFR2IIIB and FGFR2IIIC were up-regulated (P<0.05) in GCs of F4 follicles. Protein expression of most members were maximum (P<0.05) in F4 follicles except FGFR3 and FGFR4. All members were localized in GC and TI with a stage specific immunoreactivity. Primary culture of GCs with treatment of FGF2 at different dose-time combinations revealed that the mRNA expression and immunoreactivity of CYP19A1 and PCNA were maximum (P<0.05) whereas BAX was minimum (P<0.05) with 200ng/ml at 72h of incubation. The findings indicate that FGF family members are expressed in a regulated manner in buffalo ovarian follicles during different stages of development where FGF2 may promote steroidogenesis and GC survival through autocrine and paracrine manner.

  15. Prevalence of depression in type 2 diabetes mellitus.

    PubMed

    Rodríguez Calvín, J L; Zapatero Gaviria, A; Martín Ríos, M D

    2015-04-01

    The relationship between depression and diabetes has been widely documented but there have been methodological limitations such as the failure to conduct a diagnostic interview of the depressive condition. We have estimated the prevalence of depression in patients with type 2 diabetes mellitus (DM2) and its relationship with sociodemographic, lifestyle and clinical variables. This was a cross-sectional, randomized study (stratified by sex and age) of patients with DM2 treated in a healthcare area with approximately 3000 eligible patients. The depressive symptoms were assessed using the Beck Depression Inventory (depression defined as a BDI score>16) and a psychiatric interview. We used a multivariate logistic regression model to evaluate the association between depression and DM2, after adjusting for known risk factors. We examined 275 patients with DM2 (mean age, 64.5 years; men, 56.4%). The prevalence of depression was calculated at 32.7% (95% CI 27.4-38.5) and increased with age. A greater prevalence of depression was found in women, widowers, patients with obesity, those with poor compliance with the prescription, those with poor glycemic control and those who developed complications from diabetes. Thirty-five percent (95% CI 26.4-45.8) of the patients who scored>16 on the BDI scale had not been diagnosed with depression. Depression is highly prevalent in patients with DM2, especially in women. For approximately one-third of the patients, a diagnosis of depression had not been reached. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  16. Effect of an intervention on quality indicators for improving the treatment of hyperglycemia in patients hospitalized in noncritical areas.

    PubMed

    Ena, J; Gómez-Huelgas, R; Zapatero-Gaviria, A; Vázquez-Rodriguez, P; González-Becerra, C; Romero-Sánchez, M; Igúzquiza-Pellejero, M J; Artero-Mora, A; Varela-Aguilar, J M

    2016-10-01

    We evaluated the effect of an intervention on certain quality indicators employed for improving the treatment of hospital hyperglycemia. A multicenter cross-sectional study was conducted on patients with hyperglycemia hospitalized in the internal medicine departments of 44 hospitals evaluated in 2 time periods: 2014 (baseline period) and 2015 (postintervention period). The intervention consisted of the dissemination of the indicators obtained in 2014 and the objectives for improvement. As indicators, we assessed the frequency of glucose monitoring adapted to the patient's dietary intake or medication, the use of basal-bolus or basal-bolus-correction insulin therapy as the preferred control method of hyperglycemia and the recent availability of HbA1c prior to hospital discharge. A total of 506 and 562 patients were assessed in 2014 and 2015, respectively. The results of the indicators in the baseline and postintervention periods were as follows: blood glucose monitoring adapted to the dietary intake or the medication (71.5 vs. 74.1%, P=.33), use of insulin in basal-correction regimen (32 vs. 32.6%, P=.61) or basal-bolo-correction (20.7 vs. 24, P=.20) and recent HbA1c value (54.1 vs. 66.3%, P<.001). The mean glucose values in the 24h prior to the study were similar in the 2 periods. The rate of hypoglycemia was also similar in both periods (3.3 vs. 2.3%, P=.31). There is a need to implement multimodal interventions to improve the treatment of hyperglycemia in patients hospitalized in noncritical areas. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  17. Echinococcosis: A 15-year epidemiological, clinical and outcome overview.

    PubMed

    Amado-Diago, C A; Gutiérrez-Cuadra, M; Armiñanzas, C; Arnaíz de Las Revillas, F; Gómez-Fleitas, M; Fariñas, M C

    2015-10-01

    To analyze the epidemiological and clinical characteristics and mortality of patients with cystic echinococcosis (CE) in northern Spain. A retrospective study of the medical records of patients diagnosed with CE and hospitalized from 1997 to 2011 in a University Hospital. A total of 76 patients (44 men) were diagnosed with CE. The mean age was 57.8 years (SD: 19.1 years; range: 14.9-92.7). The yearly average incidence was 1.08 cases/100,000 inhabitants. The highest incidence was registered in patients aged 70-79 years (22.7% of all cases). Liver was the main organ involved (92.1%), followed by lung (6.6%) and peritoneum (1.3%). Fifty-five patients (72%) received treatment: 2 (3.6%) medical treatment with albendazole, 27 (49%) surgical treatment, 3 (5.4%) medical treatment combined with cyst drainage, and 23 (42%) combined medical and surgical treatment. Eight patients had a recurrence. Twenty-four (31.2%) patients died. No patient's death was attributed directly to hydatidosis, though mortality was significantly higher in the untreated vs. the treated patient group (57% vs. 22%, p=0.003). Hydatidosis treatment and diagnostic approaches remain heterogeneous. The liver continues being the main organ affected. Mortality was higher in patients who did not receive treatment. However, this result might have been influenced by other factors, mainly age. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  18. Characterization of steroidogenic factor 1 during sexual differentiation in a marsupial.

    PubMed

    Whitworth, D J; Pask, A J; Shaw, G; Marshall Graves, J A; Behringer, R R; Renfree, M B

    2001-10-17

    In eutherian mammals, such as mice and humans, steroidogenic factor 1 (SF1) plays important roles in the development of the gonad and in its steroidogenic activity. Marsupial and eutherian mammals have been evolving independently for at least 100 million years and so we were interested in comparing SF1 of a marsupial with that of eutherians. To this end, we have cloned SF1 from an Australian marsupial, the tammar wallaby. Although the amino acid sequence of SF1 is highly conserved among vertebrate species, tammar SF1 appears to have diverged less from the ancestral SF1 than have eutherian SF1 proteins. Tammar SF1 is expressed by both ovaries and testes on the day of birth, just prior to the onset of testicular differentiation, until at least 8 days after birth by which time the ovary also has begun to sexually differentiate. SF1 transcripts are localized predominantly to the pre-granulosa and Sertoli cells of the ovary and testis, respectively. In the testis SF1 transcripts are also present in the interstitial cells, although at a lower level than that which is observed in the Sertoli cells. SF1 is also transcribed in adult testis and ovary. In the adult ovary SF1 is expressed in the interstitial gland, and in the granulosa cells and theca interna of small to medium-sized antral follicles, but is not expressed in large antral follicles. Thus, although the structure of tammar SF1 is divergent from that of eutherians, its expression profile is similar, supporting a conserved role in gonadal development and steroidogenesis.

  19. Luteinizing hormone, progesterone and the morphological development of normal and superovulated corpora lutea in sheep.

    PubMed

    McClellan, M C; Dieckman, M A; Abel, J H; Niswender, G D

    1975-12-10

    The development of granulosa-lutein cells was studied in 27 normal and 32 superovulated ewes between days 0-4(day 0 began with the preovulatory LH peak in normal animals and the HCG injection in superovulated ewes). The pattern of differentiation was similar in both groups. Following initial hormonal stimulation (0-12 hours after LH or HCG), granulosa cells were approximately 100 mu2 and contained small, pleomorphic nuclei with large amounts of clumped chromatin. Elongate cells lining the basement membrane possessed large, heterogeneous dense bodies, and a well-developed Golgi apparatus. Mitotic figures were observed up to 6 hours prior to ovulation. Sixteen to 20 hours following the LH surge or HCG injection, hypertrophy of granulosa cells was evident. Nuclei contained definitive nucleoli. Blood vessels in the theca interna were abundant and highly dilated. Ovulation occurred approximately 24 hours after the LH peak or HCG injection. Visible signs of luteinization were evident 6-12 hours after ovulation. A slight increase in serum progesterone levels was detected. The second post-ovulatory day was characterized by continuing hypertrophy of granulosa cells and extensive proliferation of smooth endoplasmic reticulum and mitochondria. Nuclei of granulosa cells were larger and possessed extremely large nucleoli. Numerous mitotic figures were apparent within the corpus luteum. Serum progesterone concentrations began increasing at 60-72 hours after hormone stimulation. By the end of the third post-ovulatory day, the corpus luteum consisted of large, pleomorphic, parenchymal cells, interspersed between capillaries and connective tissue elements. Only an occasional mitotic figure was apparent within the corpus luteum at 100 hours. Light microscopic autoradiography of 5, 10, and 15 day corpora lutea taken from ewes pulsed with 3H thymidine at specific times before and after ovulation revealed that granulosa cells did not undergo secondary mitoses following ovulation. In

  20. Compound gravity receptor polarization vectors evidenced by linear vestibular evoked potentials

    NASA Technical Reports Server (NTRS)

    Jones, S. M.; Jones, T. A.; Bell, P. L.; Taylor, M. J.

    2001-01-01

    The utricle and saccule are gravity receptor organs of the vestibular system. These receptors rely on a high-density otoconial membrane to detect linear acceleration and the position of the cranium relative to Earth's gravitational vector. The linear vestibular evoked potential (VsEP) has been shown to be an effective non-invasive functional test specifically for otoconial gravity receptors (Jones et al., 1999). Moreover, there is some evidence that the VsEP can be used to independently test utricular and saccular function (Taylor et al., 1997; Jones et al., 1998). Here we characterize compound macular polarization vectors for the utricle and saccule in hatchling chickens. Pulsed linear acceleration stimuli were presented in two axes, the dorsoventral (DV, +/- Z axis) to isolate the saccule, and the interaural (IA, +/- Y axis) to isolate the utricle. Traditional signal averaging was used to resolve responses recorded from the surface of the skull. Latency and amplitude of eighth nerve components of the linear VsEP were measured. Gravity receptor responses exhibited clear preferences for one stimulus direction in each axis. With respect to each utricular macula, lateral translation in the IA axis produced maximum ipsilateral response amplitudes with substantially greater amplitude intensity (AI) slopes than medially directed movement. Downward caudal motions in the DV axis produced substantially larger response amplitudes and AI slopes. The results show that the macula lagena does not contribute to the VsEP compound polarization vectors of the sacculus and utricle. The findings suggest further that preferred compound vectors for the utricle depend on the pars externa (i.e. lateral hair cell field) whereas for the saccule they depend on pars interna (i.e. superior hair cell fields). These data provide evidence that maculae saccule and utricle can be selectively evaluated using the linear VsEP.

  1. [Reliability and validity of the Severe Impairment Battery, short form (SIB-s), in patients with dementia in Spain].

    PubMed

    Cruz-Orduña, Isabel; Agüera-Ortiz, Luis F; Montorio-Cerrato, Ignacio; León-Salas, Beatriz; Valle de Juan, M Cristina; Martínez-Martín, Pablo

    2015-01-01

    Introduccion. Las personas con demencia progresiva evolucionan hacia un estado donde los tests neuropsicologicos tradicionales dejan de ser eficaces. La bateria de evaluacion del deterioro grave, en su forma completa (SIB) y abreviada (SIB-s), se desarrollo para evaluar el estado cognitivo de pacientes con demencia avanzada. Objetivo. Evaluar los atributos psicometricos de la SIB-s en poblacion española. Pacientes y metodos. Estudio transversal de 127 pacientes con demencia (86,6%, mujeres; edad media: 82,6 ± 7,5 años) evaluados con la SIB-s y las siguientes medidas: escala de deterioro global, miniexamen cognitivo (MEC), miniexamen del estado mental grave (sMMSE), indice de Barthel y escala del estado funcional. Resultados. La puntuacion media total de la SIB-s fue de 19,1 ± 15,34 (rango: 0-48). Efectos suelo y techo < 20%. El analisis factorial identifico un unico factor que explica el 68% de la varianza total de la escala. La consistencia interna fue alta (alfa de Cronbach: 0,96). La correlacion item-total corregida oscilo entre 0,27 y 0,83, y la homogeneidad de los items fue de 0,43. La fiabilidad test-retest e interevaluador fue satisfactoria (coeficiente de correlacion intraclase: 0,96 y 0,95, respectivamente), asi como la validez de constructo convergente con otras medidas cognitivas (MEC: 0,83; sMMSE: 0,9). La SIB-s mostro una correlacion moderada con escalas cognitivas de dependencia funcional (indice de Barthel: 0,48; FAST: –0,74). El error estandar de la medida fue de 3,07 para el total de la escala. Conclusiones. La SIB-s es un instrumento fiable y valido, relativamente breve, para evaluar a pacientes con demencia avanzada en la poblacion española.

  2. Neurovascular ultrasound in emergency settings: diagnostic and therapeutic aspects.

    PubMed

    Santos, T; Veloso, M; Barros, P

    2017-04-16

    Introduccion. La ecografia neurovascular es una tecnica de diagnostico por imagenes rapida, portatil e incruenta que en manos de un ecografista experimentado aporta informacion reproducible y fiable acerca del estado hemodinamico y morfologico de los vasos craneales y cervicales. Objetivo. Revisar los datos disponibles sobre el uso de esta herramienta en el abordaje del ictus isquemico agudo. Desarrollo. La ecografia neurovascular se divide en dos modalidades de uso: diagnostica y terapeutica. A la luz de los bajos porcentajes de recanalizacion de las oclusiones de la arteria carotida interna y del segmento proximal de la arteria cerebral media logradas por el activador del plasminogeno tisular recombinante (r-tPA) por via intravenosa, el uso diligente de la ecografia neurovascular en el servicio de urgencias ayuda a dirimir que pacientes son susceptibles de beneficiarse del tratamiento endovascular. Asimismo, la vigilancia ecografica durante el curso del tratamiento con el r-tPA permite analizar la evolucion de la recanalizacion arterial. La ecografia cervical permite valorar el grado de estenosis y la composicion o la superficie de la placa arterial, extremos que, por ejemplo, pueden indicar la idoneidad de una intervencion carotidea. Por ultimo, tambien se esta investigando el potencial terapeutico de la ecografia. La sonotrombolisis y la sonolisis, la primera combinando el r-tPA con las ondas ultrasonicas y la segunda sirviendose unicamente de ellas como medio para lisar el trombo, han evidenciado hasta el momento resultados alentadores. Conclusion. La ecografia neurovascular ha progresado enormemente hasta adquirir un protagonismo destacado en el estudio de los trastornos cerebrovasculares.

  3. "Asleep" Deep Brain Stimulation Surgery: A Critical Review of the Literature.

    PubMed

    Chen, Tsinsue; Mirzadeh, Zaman; Ponce, Francisco A

    2017-09-01

    Although performing deep brain stimulation (DBS) with the patient under general anesthesia without microelectrode recording (MER) or intraoperative test stimulation (ITS) for movement disorders ("asleep" DBS) has become increasingly popular, its feasibility is based on the untested assumption that stereotactic accuracy correlates with positive clinical outcomes. To investigate outcomes after asleep DBS without MER or neurophysiological testing, we reviewed the medical literature on the topic. We searched PubMed to identify all studies reporting clinical outcomes for patients who underwent DBS without MER or ITS for Parkinson disease (PD) or essential tremor (ET). We identified 9 studies with level 3b (n = 3) or level 4 evidence (n = 6). Eight PD studies (220 patients) reported asleep placement of 431 electrodes (341 subthalamic nucleus, 90 globus pallidus interna). Unified Parkinson Disease Rating Scale motor examination-III scores for 208 patients demonstrated significant improvement (40.2%-65%) at 6-12 months. The levodopa equivalent daily dose for 115 patients was significantly reduced (14%-49.3%) at 6-12 months in 103 patients. Two studies with a comparison cohort undergoing "awake" DBS with MER found no differences in postoperative Unified Parkinson Disease Rating Scale-III improvement or levodopa equivalent daily dose reduction. One study of asleep DBS for ET found no difference in functional outcomes between 17 patients undergoing asleep ventral intermediate nucleus DBS and 40 patients undergoing awake placement with ITS. Initial evidence suggests that asleep DBS can be performed safely for PD and ET with good clinical outcomes. Long-term follow-up, larger cohorts, and double-armed studies are needed to validate these initial results. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. [Clinical profile of persistent generalized muscle contraction following the insult of developing brain].

    PubMed

    Maruyama, Koichi; Iai, Mizue; Arai, Hiroshi; Yokochi, Kenji

    2014-01-01

    Persons with severe motor and intellectual disabilities (SMID) caused by injury to the developing brain sometimes present generalized hypertonia in a specific position with extreme muscle overactivity persisting for most of the time during wakefulness. This "persistent generalized muscle contraction" is often associated with bad humor, sleep disturbance, hyperhidrosis, wasting, elevation of serum creatine kinase levels, regular daytime use of hypnotic or sedative medication, and the necessity to maintain the neck or hip in a flexed position manually. The aim of this study is to elucidate the clinical profile of this condition. We retrospectively examined the medical records and brain imaging data of 66 SMID patients in the state of persistent generalized muscle contraction. Most patients could be classified into 2 major categories on the basis of clinical presentation and brain imaging: (A) those with premature birth and bilateral lesion of globus pallidus interna (kernicterus) (n = 16), and (B) those with various widespread bilateral basal ganglia/thalamic and/or cerebral lesions such as hypoxia-ischemia, acute encephalopathy, malformation, etc (n = 50). Group A assumed an asymmetrical tonic-neck-reflex-like position, torsion of the trunk, fluctuation of hypertonia, and better mental development. Three of them exhibited extreme hypertonia resembling status dystonicus. Group B often exhibited persistent and fixed retroflexion of the neck and trunk or opisthotonus. Drugs such as oral muscular relaxants were ineffective in both groups. Injection of botulinum toxin into the cervical and paravertebral muscles partially alleviated symptoms. Persistent generalized muscle contraction in SMID has at least two different types. Group A has characteristics of severe dystonic hypertonia that could lead to status dystonicus. Group B might have peculiar characteristics of muscle overactivity triggered by wakefulness or discomfort, which probably results from inability to achieve

  5. [Burden of hospitalization for pneumonia in a Spanish tertiary hospital. Period 2009-2014].

    PubMed

    López-Gobernado, Miguel; Pérez-Rubio, Alberto; López-García, Eva; Mayo-Iscar, Agustín; Eiros, José María

    2017-01-01

    Introducción: el objetivo de este trabajo es estimar la carga de hospitalización por neumonía adquirida en la comunidad y neumonía neumocócica en un hospital de nivel terciario del Sistema Nacional de Salud Español. Métodos: estudio retrospectivo en el que se recogen los datos del Conjunto Mínimo de Datos Básicos que usa códigos clínicos del Código Internacional de Enfermedades, asi como el índice de hospitalización por mil habitantes, la tasa de hospitalización por mil habitantes, el índice de mortalidad y la tasa de letalidad, usando como denominador los datos demográficos de la población del Área de Salud. Resultados: la descarga de 5758 episodios codificados con los códigos CIE 480 a 486 relativos a neumonía, señalan un índice de hospitalización de 3.54 personas hospitalizadas por cada 1000 habitantes, 65.34% del total de ingresos hospitalarios se produce en los Servicios de Medicina Interna y de Neumología. La estancia media hospitalaria por año es de 16.63 días. La tasa bruta de mortalidad es de 69.15 cada 100 000 y la tasa de letalidad de 19.56%, siendo más elevadas en adultos mayores de 65 años. Conclusiones: a pesar de las medidas terapéuticas y preventivas actuales, la incidencia y la mortalidad por neumonía adquirida en la comunidad en adultos se mantienen elevadas, lo que justifica fortalecer y abordar nuevas estrategias de concienciación y prevención.

  6. Incidence of cancer in outpatients with chronic obstructive pulmonary disease.

    PubMed

    Figueira Gonçalves, J M; Dorta Sánchez, R; Pérez Méndez, L I; Pérez Negrín, L; García-Talavera, I; Pérez Rodríguez, A; Díaz Pérez, D; Viña Manrique, P; Guzmán Sáenz, C

    2017-10-01

    The relationship between chronic obstructive pulmonary disease (COPD) and the overall incidence of cancer is poorly understood. The aim of this study was to analyse the incidence of cancer (pulmonary or extrapulmonary) in patients with COPD during follow-up in a specialised outpatient unit, as well as to assess its relationship with the degree of airflow obstruction. A prospective observational study was conducted with a cohort of 308 patients with COPD in pulmonology outpatient follow-up consultations from January 2012 to December 2015. The diagnosed malignancies during this period were divided into pulmonary and extrapulmonary. The overall incidence rate of cancer, lung cancer and extrapulmonary cancer were 10.3, 3.4 and 7.3 cases per 1,000 patients with COPD per year, respectively. The most common cancers were lung cancer (31%), genitourinary tract cancer (29%) and gastrointestinal cancer (21%). Mild-moderate stages (gradeI-II of the 2009 GOLD classification) and the increase in the pack-year index (PYI) were related to an increase in the onset of malignancies, with an odds ratio (OR) of 2.16 (95% confidence interval [95% CI]: 1.087-4.309; P=.026) and 1.01 (95% CI: 1.002-1.031; P=.023), respectively. The incidence of extrapulmonary cancer in patients with COPD was twice that of lung cancer; stagesI-II of the 2009 GOLD classification and the PYI were significantly related to the onset of malignancies. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  7. Gene control of tyrosine kinase TIE2 and vascular manifestations of infections

    PubMed Central

    Ghosh, Chandra C.; David, Sascha; Zhang, Ruyang; Berghelli, Anthony; Milam, Katelyn; Higgins, Sarah J.; Hunter, Jon; Mukherjee, Aditi; Wei, Yongyue; Tran, Mei; Suber, Freeman; Kobzik, Lester; Kain, Kevin C.; Lu, Shulin; Santel, Ansgar; Yano, Kiichiro; Guha, Prajna; Dumont, Daniel J.; Christiani, David C.; Parikh, Samir M.

    2016-01-01

    Ligands of the endothelial-enriched tunica interna endothelial cell kinase 2 (Tie2) are markedly imbalanced in severe infections associated with vascular leakage, yet regulation of the receptor itself has been understudied in this context. Here, we show that TIE2 gene expression may constitute a novel vascular barrier control mechanism in diverse infections. Tie2 expression declined rapidly in wide-ranging models of leak-associated infections, including anthrax, influenza, malaria, and sepsis. Forced Tie2 suppression sufficed to attenuate barrier function and sensitize endothelium to permeability mediators. Rapid reduction of pulmonary Tie2 in otherwise healthy animals attenuated downstream kinase signaling to the barrier effector vascular endothelial (VE)-cadherin and induced vascular leakage. Compared with wild-type littermates, mice possessing one allele of Tie2 suffered more severe vascular leakage and higher mortality in two different sepsis models. Common genetic variants that influence TIE2 expression were then sought in the HapMap3 cohort. Remarkably, each of the three strongest predicted cis-acting SNPs in HapMap3 was also associated with the risk of acute respiratory distress syndrome (ARDS) in an intensive care unit cohort of 1,614 subjects. The haplotype associated with the highest TIE2 expression conferred a 28% reduction in the risk of ARDS independent of other major clinical variables, including disease severity. In contrast, the most common haplotype was associated with both the lowest TIE2 expression and 31% higher ARDS risk. Together, the results implicate common genetic variation at the TIE2 locus as a determinant of vascular leak-related clinical outcomes from common infections, suggesting new tools to identify individuals at unusual risk for deleterious complications of infection. PMID:26884170

  8. [Consensus on the detection and management of prediabetes. Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society].

    PubMed

    Mata-Cases, M; Artola, S; Escalada, J; Ezkurra-Loyola, P; Ferrer-García, J C; Fornos, J A; Girbés, J; Rica, I

    2015-01-01

    In Spain, according to the Di@bet.es study, 13.8% of the adult population suffers from diabetes and 14.8% from some form of prediabetes (impaired glucose tolerance, impaired fasting glucose or both). Since early detection of prediabetes can facilitate the implementation of therapeutic measures to prevent its progression to diabetes, we believe that preventive strategies in primary care and specialized clinical settings should be agreed. Screening for diabetes and prediabetes using a specific questionnaire (FINDRISC) and/or the measurement of fasting plasma glucose in high risk patients leads to detecting patients at risk of developing diabetes and it is necessary to consider how they should be managed. The intervention in lifestyle can reduce the progression to diabetes and reverse a prediabetic state to normal and is a cost-effective intervention. Some drugs, such as metformin, have also been shown effective in reducing the progression to diabetes but are not superior to non-pharmacological interventions. Finally, an improvement in some cardiovascular risk factors has been observed although there is no strong evidence supporting the effectiveness of screening in terms of morbility and mortality. The Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society has issued some recommendations that have been agreed by the Sociedad Española de Endocrinología y Nutrición, Sociedad Española de Endocrinología Pediátrica, Sociedad Española de Farmacia Comunitaria, Sociedad Española de Medicina Familiar y Comunitaria, Sociedad Española de Médicos Generales, Sociedad Española de Médicos de Atención Primaria, Sociedad Española de Medicina Interna, Asociación de Enfermería Comunitaria and Red de Grupos de Estudio de la Diabetes en Atención Primaria. Copyright © 2015. Publicado por Elsevier España, S.L.U.

  9. Consensus on the detection and management of prediabetes. Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society.

    PubMed

    Mata-Cases, M; Artola, S; Escalada, J; Ezkurra-Loyola, P; Ferrer-García, J C; Fornos, J A; Girbés, J; Rica, I

    2015-03-01

    In Spain, according to the Di@bet.es study, 13.8% of the adult population suffers from diabetes and 14.8% from some form of prediabetes (impaired glucose tolerance, impaired fasting glucose or both). Since early detection of prediabetes can facilitate the implementation of therapeutic measures to prevent its progression to diabetes, we believe that preventive strategies in primary care and specialized clinical settings should be agreed. Screening for diabetes and prediabetes using a specific questionnaire (FINDRISC) and/or the measurement of fasting plasma glucose in high risk patients leads to detecting patients at risk of developing diabetes and it is necessary to consider how they should be managed. The intervention in lifestyle can reduce the progression to diabetes and reverse a prediabetic state to normal and is a cost-effective intervention. Some drugs, such as metformin, have also been shown effective in reducing the progression to diabetes but are not superior to non-pharmacological interventions. Finally, an improvement in some cardiovascular risk factors has been observed although there is no strong evidence supporting the effectiveness of screening in terms of morbility and mortality. The Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society has issued some recommendations that have been agreed by the Sociedad Española de Endocrinología y Nutrición, Sociedad Española de Endocrinología Pediátrica, Sociedad Española de Farmacia Comunitaria, Sociedad Española de Medicina Familiar y Comunitaria, Sociedad Española de Médicos Generales, Sociedad Española de Médicos de Atención Primaria, Sociedad Española de Medicina Interna, Asociación de Enfermería Comunitaria and Red de Grupos de Estudio de la Diabetes en Atención Primaria. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  10. Trouble in the aquatic world: How wildlife professionals are battling amphibian declines

    USGS Publications Warehouse

    Olson, Deanna H.; Chestnut, Tara E.

    2014-01-01

    A parasitic fungus, similar to the one that caused the extinction of numerous tropical frog and toad species, is killing salaman-ders in Europe. Scientists first identified the fungus, Batrachochytrium salamandrivorans, in 2013 as the culprit behind the death of fire salamanders (Salamandra salamandra) in the Netherlands (Martel et al. 2013) and are now exploring its potential impact to other species. Although the fungus, which kills the amphibians by infecting their skin, has not yet spread to the United States, researchers believe it's only a mat-ter of time before it does and, when that happens, the impact on salamander populations could be devastating (Martel et al. 2014). Reports of worldwide declines of amphibians began a quarter of a century ago (Blaustein & Wake 1990). Globally, some amphibian popula-tion declines occurred in the late 1950s and early 1960s, and declining trends continued in North America (Houlahan et al. 2000). In the earlier years, population declines were attributed primar-ily to overharvest due to unregulated supply of species such as the northern leopard frog (Litho-bates pipiens) for educational use (Dodd 2013). In later years, however, causes of declines were less evident. In 1989, herpetologists at the First World Congress of Herpetology traded alarming stories of losses across continents and in seemingly pro-tected landscapes, making it clear that amphibian population declines were a "global phenomenon." In response to these reports, in 1991, the Interna-tional Union for Conservation of Nature (IUCN) established the Declining Amphibian Populations Task Force to better understand the scale and scope of global amphibian declines. Unfortunate-ly, the absence of long-term monitoring data and targeted studies made it difficult for the task force to compile information.

  11. [The effect of a dimenhydrinate combination of the cardiovascular system and cerebral blood circulation in the anaesthetized dog].

    PubMed

    Hahn, N; Felix, R; Sonnenfeld, A; Babour, A; Heidari, S

    1975-02-01

    The influence of Vertigo-Vomex (VV) and Vertigo-Vomex Retard (VVR) on the perfusion rate of the a. carotis interna and on the peripheral circulation was tested in 30 anaesthetized dogs. These drugs represent beta-dimethylamino-ethyl-benzhydrylether-1,3-dimethyl-8-chloroxanthine (dimenhydrinate, Vomex A) with the addition of pyridine-3-carbonic acid (nicotinic acid, niacin) and pyridoxine-HCl (vitamin B6) and its retard preparation. A) Angiographic researches of the brain vessels after i.v. injection of VV. B) Perfusion rate in the a. carotis int. by electromagnetic flowmeter; measurements of blood pressure, heart rate, and acid-base balance; reactions after injection of niacin, dimenhydrinate, and pyridoxine-HCl as well as after a combination of both. C) Same measurements as in B but after oral application. In one out of four cases there was a dilation of the brain vessels, in two cases there was a small one, in one case there was none. Niacin induces a short-lasting augmentation of the perfusion rate in the a. carotis int. simultaneously with rising aortic blood pressure. Dimenhydrinate with pyridoxine-HCl slightly increases the heart rate. Combined with niacin the perfusion rate shortly increases immediately after injection of niacin without any rise of blood pressure but combined with a fall in blood pH and standard bicarbonate. After oral application of VVR there was a slight but not significant augmentation of the perfusion rate in the a. carotis int. combined with rising blood pressure but with no change of the blood pH. Therefore the certain intivertigineous effect of VV and VVR cannot be explained by a rise of the perfusion rate in the inner ear or in the brain. In view of our results the central effect of dimenhydrinate combined with niacin and pyridoxine-HCl hypothetically may be improved by metabolic influences on the cells and their membranes.

  12. Randomized clinical trial of nutritional counseling for malnourished hospital patients.

    PubMed

    Casals, C; García-Agua-Soler, N; Vázquez-Sánchez, M Á; Requena-Toro, M V; Padilla-Romero, L; Casals-Sánchez, J L

    2015-01-01

    Malnutrition is associated with an increased risk of mortality and morbidity, longer hospital stays and general loss of quality of life. The aim of this study is to assess the impact of dietary counseling for malnourished hospital patients. Prospective, randomized, open-label study of 106 hospital patients with malnutrition (54 in the control group and 52 in the intervention group). The intervention group received dietary counseling, and the control group underwent standard treatment. We determined the patients' nutritional state (body mass index, laboratory parameters, malnutrition universal screening tool), degree of dependence (Barthel index), quality of life (SF-12), degree of satisfaction (CSQ-8), the number and length of readmissions and mortality. The patients who underwent the "intervention" increased their weight at 6 months, while the controls lost weight (difference in body mass index, 2.14kg/m(2); p<.001). The intervention group had better results when compared with the control group in the Malnutrition Universal Screening Tool scores (difference, -1.29; p<.001), Barthel index (difference, 7.49; p=.025), SF-12 (difference, 13.72; p<.001) and CSQ-8 (difference, 4.34, p<.001) and required fewer readmissions (difference, -0.37; p=.04) and shorter stays for readmissions (difference, -6.75; p=.035). Mortality and laboratory parameters were similar for the 2 groups. Nutritional counseling improved the patients' nutritional state, quality of life and degree of dependence and decreased the number of hospital readmissions. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  13. In vivo Exploration of the Connectivity between the Subthalamic Nucleus and the Globus Pallidus in the Human Brain Using Multi-Fiber Tractography

    PubMed Central

    Pujol, Sonia; Cabeen, Ryan; Sébille, Sophie B.; Yelnik, Jérôme; François, Chantal; Fernandez Vidal, Sara; Karachi, Carine; Zhao, Yulong; Cosgrove, G. Rees; Jannin, Pierre; Kikinis, Ron; Bardinet, Eric

    2017-01-01

    The basal ganglia is part of a complex system of neuronal circuits that play a key role in the integration and execution of motor, cognitive and emotional function in the human brain. Parkinson’s disease is a progressive neurological disorder of the motor circuit characterized by tremor, rigidity, and slowness of movement. Deep brain stimulation (DBS) of the subthalamic nucleus and the globus pallidus pars interna provides an efficient treatment to reduce symptoms and levodopa-induced side effects in Parkinson’s disease patients. While the underlying mechanism of action of DBS is still unknown, the potential modulation of white matter tracts connecting the surgical targets has become an active area of research. With the introduction of advanced diffusion MRI acquisition sequences and sophisticated post-processing techniques, the architecture of the human brain white matter can be explored in vivo. The goal of this study is to investigate the white matter connectivity between the subthalamic nucleus and the globus pallidus. Two multi-fiber tractography methods were used to reconstruct pallido-subthalamic, subthalamo-pallidal and pyramidal fibers in five healthy subjects datasets of the Human Connectome Project. The anatomical accuracy of the tracts was assessed by four judges with expertise in neuroanatomy, functional neurosurgery, and diffusion MRI. The variability among subjects was evaluated based on the fractional anisotropy and mean diffusivity of the tracts. Both multi-fiber approaches enabled the detection of complex fiber architecture in the basal ganglia. The qualitative evaluation by experts showed that the identified tracts were in agreement with the expected anatomy. Tract-derived measurements demonstrated relatively low variability among subjects. False-negative tracts demonstrated the current limitations of both methods for clinical decision-making. Multi-fiber tractography methods combined with state-of-the-art diffusion MRI data have the

  14. [Validation of cold chain during distribution of parenteral nutrition].

    PubMed

    Tuan, Federico; Perone, Virginia; Verdini, Rocio; Pell, Maria Betina; Traverso, Maria Luz

    2015-09-01

    Objetivo: el presente estudio tiene la finalidad de demostrar la aptitud del proceso empleado para acondicionar las mezclas de nutrición parenteral extemporáneas para su distribución, considerando el objetivo de conservar la cadena de frío durante el traslado hasta que llega al paciente, necesario para asegurar la estabilidad, efectividad y seguridad de estas mezclas. Método: validación concurrente; diseño e implementación de un protocolo de evaluación del proceso de acondicionamiento y distribución de MNPE elaboradas por un laboratorio farmacéutico. Ejecución de test, según criterios de aceptación predefinidos. Se efectúa en dos oportunidades, en verano y en las rutas que requieren un tiempo de traslado más prolongado. Evaluación de la conservación de la temperatura mediante supervisión de los valores de temperatura interna de cada tipo de empaquetado, registrados por equipos data loggers calibrados. Resultados: los diferentes test cumplen con los criterios preestablecidos. Los valores obtenidos permiten asegurar el mantenimiento de la cadena de frío durante un tiempo superior al traslado hasta los puntos más distantes. Conclusiones: este estudio permite mostrar la aptitud del proceso de acondicionamiento de MNPE para su distribución, manteniendo la cadena de frío durante todo el traslado desde el Laboratorio farmacéutico hasta el paciente. Considerando que la rotura de la cadena de frío puede ocasionar alteraciones de la compatibilidad y estabilidad de las nutriciones parenterales, así como fallas en el soporte nutricional, este estudio contribuye a la seguridad del paciente, una de las dimensiones relevantes de la calidad de la atención de la salud.

  15. Conceptuaciones de los estudiantes de las facultades de educacion y ciencias naturales de la Universidad de Puerto Rico, recinto de Rio Piedras, acerca de la ciencia y la pseudociencia

    NASA Astrophysics Data System (ADS)

    Reyes Medina, Hector A.

    Esta investigacion describe las conceptuaciones de los estudiantes de tercer ano o mas a nivel de bachillerato de los programas de Educacion en Ciencia y Ciencias Naturales de la Universidad de Puerto Rico, Recinto de Rio Piedras, acerca de lo establecido en la literatura para distinguir el conocimiento cientifico de las creencias pseudocientificas. Este estudio se guio por un diseno tipo encuesta transversal que permitio conocer de manera consistente las conceptuaciones de los estudiantes encuestados acerca de la Ciencia y la Pseudociencia. Ademas, permitio desarrollar inferencias estadisticas relacionadas a la poblacion de estudio, sus conceptuaciones y su inclinacion teorica en torno al Realismo y al Racionalismo cientifico moderados. El instrumento utilizado fue el Cuestionario acerca de las concepciones de la ciencia y la pseudocienca en estudiantes universitarios, Reyes (2015). Este cuestionario fue validado mediante la recopilacion de diversas fuentes de evidencias, entre estas se encuentran las evidencias basadas en el contenido, el proceso de respuesta, la estructura interna y de constructo. Tambien, se calculo el Alfa de Crombach para la escala total y para cada componente y se realizo un analisis de factores que demostro la presencia de seis componentes claramente definidos de acuerdo a lo esperado sobre las caracteristicas originales del instrumento. Las estadisticas utilizadas fueron descriptivas. Participaron 302 alumnos, de las facultades de educacion y ciencias naturales. Se encontro que las conceptuaciones de los estudiantes de ambas facultades se inclinan en un 66.2% a favor con lo establecido en el modelo teorico en torno al Realismo y al Racionalismo cientifico moderados. Sin embargo, aun hay un 33.8% de los estudiantes de ambas facultades que poseen conceptuaciones distintas al modelo teorico propuesto.

  16. Comportamiento dinámico de asteroides en la región 23 < a < 26 UA

    NASA Astrophysics Data System (ADS)

    López García, F.

    Los Kuiper Belt Objects (KBOs) pueden ser una fuente de origen de los cometas de corto período. Muchos de los KBOs observados parecen provenir, al igual que el sistema Pluton-Charonte, de órbitas resonantes con Neptuno. Los Centauros son objetos que dinámicamente provienen de órbitas inestables cuyo semieje mayor se encuentra entre las órbitas de Júpiter y Neptuno. Pudiera ser que estos cuerpos fueron expulsados desde la región del cinturón de Kuiper y se encuentran en un proceso de ``scattering" debido a los efectos gravitacionales de los planetas gigantes. Su tiempo de vida dinámico es de algunos millones de años. La evolución orbital de los objetos trans-Neptunianos nos permite conocer su comportamiento anterior, por eso, es importante su relación dinámica con la evolución orbital de Neptuno. El objeto de este trabajo es estudiar el comportamiento dinámico de partículas test que se encuentran entre las resonancias 3:2 con Neptuno y 2:3 con Urano, las cuales comprenden una región de 2 UA aproximadamente. Los primeros resultados indican que la mayoría de los objetos ficticios son eyectados hacia la parte externa del Sistema Solar, mientras que sólo una parte pequeña del total de objetos estudiados, aproximadamente un 7%, son eyectados hacia la parte interna del Sistema Solar, y en algunos casos sus órbitas pueden cruzar la órbita de los planetas terrestres.

  17. Relationship between renal function and renal volume in autosomal dominant polycystic kidney disease: cross-sectional study.

    PubMed

    Torres-Sánchez, M J; Ávila-Barranco, E; Esteban de la Rosa, R J; Fernández-Castillo, R; Esteban, M A; Carrero, J J; García-Valverde, M; Bravo-Soto, J A

    2016-03-01

    To determine in patients with autosomal dominant polycystic kidney disease the relationship between total renal volume (the sum of both kidneys, TRV) as measured by magnetic resonance and renal function; and its behaviour according to sex and the presence of arterial hypertension, hypercholesterolaemia and hyperglycemia. Cross-sectional study including patients with autosomal dominant polycystic kidney disease who underwent periodic reviews at Nephrology external consultations at Hospital de las Nieves de Granada, and who underwent an magnetic resonance to estimate renal volume between January 2008 and March 2011. We evaluated 67 patients (59.7% women, average age of 48±14.4 years) and found a significant positive association between TRV and serum creatinine or urea, which was reversed compared with estimated glomerular filtration by MDRD-4 and Cockcroft-Gault. Women showed an average serum creatinine level and a significantly lower TRV level compared with males. Subgroups affected by arterial hypertension and hyperuricemia presented average values for serum creatinine and urea, higher for TRV and lower for estimated glomerular filtration. The hypercholesterolaemia subgroup showed higher average values for urea and lower for estimated glomerular filtration, without detecting significant differences compared with TRV. The volume of polycystic kidneys measured by magnetic resonance is associated with renal function, and can be useful as a complementary study to monitor disease progression. The presence of arterial hypertension, hyperuricemia or hypercholesterolaemia is associated with a poorer renal function. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  18. Topography of dyskinesias and torticollis evoked by inhibition of substantia nigra pars reticulata.

    PubMed

    Dybdal, David; Forcelli, Patrick A; Dubach, Mark; Oppedisano, Michael; Holmes, Angela; Malkova, Ludise; Gale, Karen

    2013-04-01

    GABAergic neurons of the substantia nigra pars reticulata (SNpr) and globus pallidus pars interna (GPi) constitute the output pathways of the basal ganglia. In monkeys, choreiform limb dyskinesias have been described after inhibition of the GPi, but not the SNpr. Given the anatomical and functional similarities between these structures, we hypothesized that choreiform dyskinesias could be evoked by inhibition of an appropriate region within the SNpr. The GABAA receptor agonist, muscimol, was infused into various sites within the SNpr and the adjacent STN of freely moving macaques. The effect of the GABAA antagonist, bicuculline (BIC), was also examined. Muscimol (MUS) in SNpr evoked the following: (1) choreiform dyskinesias of the contralateral arm and/or leg from central and lateral sites; (2) contralaterally directed torticollis from central and posterior sites; and (3) contraversive quadrupedal rotation from anterior and lateral sites. MUS infusions into the adjacent SN pars compacta or STN were without effect, ruling out a contribution of drug spread to adjacent structures. BIC in SNpr induced ipsiversive postures without choreiform dyskinesia or torticollis, whereas in the STN, it evoked ballistic movements. This is the first report of choreiform dyskinesia evoked by inhibition of the SNpr. This highly site-specific effect was obtained from a restricted region within the SNpr distinct from that responsible for inducing torticollis. These results suggest that overactivity of different SNpr outputs mediates choreiform dyskinesia and torticollis. These abnormalities are symptoms of dystonia, Huntington's disease, and iatrogenic dyskinesias, suggesting that these conditions may result, in part, from a loss of function in SNpr efferent projections.

  19. Generation and evaluation of an ultra-high-field atlas with applications in DBS planning

    NASA Astrophysics Data System (ADS)

    Wang, Brian T.; Poirier, Stefan; Guo, Ting; Parrent, Andrew G.; Peters, Terry M.; Khan, Ali R.

    2016-03-01

    Purpose Deep brain stimulation (DBS) is a common treatment for Parkinson's disease (PD) and involves the use of brain atlases or intrinsic landmarks to estimate the location of target deep brain structures, such as the subthalamic nucleus (STN) and the globus pallidus pars interna (GPi). However, these structures can be difficult to localize with conventional clinical magnetic resonance imaging (MRI), and thus targeting can be prone to error. Ultra-high-field imaging at 7T has the ability to clearly resolve these structures and thus atlases built with these data have the potential to improve targeting accuracy. Methods T1 and T2-weighted images of 12 healthy control subjects were acquired using a 7T MR scanner. These images were then used with groupwise registration to generate an unbiased average template with T1w and T2w contrast. Deep brain structures were manually labelled in each subject by two raters and rater reliability was assessed. We compared the use of this unbiased atlas with two other methods of atlas-based segmentation (single-template and multi-template) for subthalamic nucleus (STN) segmentation on 7T MRI data. We also applied this atlas to clinical DBS data acquired at 1.5T to evaluate its efficacy for DBS target localization as compared to using a standard atlas. Results The unbiased templates provide superb detail of subcortical structures. Through one-way ANOVA tests, the unbiased template is significantly (p <0.05) more accurate than a single-template in atlas-based segmentation and DBS target localization tasks. Conclusion The generated unbiased averaged templates provide better visualization of deep brain nuclei and an increase in accuracy over single-template and lower field strength atlases.

  20. [Validation of eating habits subscale in children (sehan: spanish version) from 10 to 12 years].

    PubMed

    Nebot, Vicente; Pablos, Ana; Elvira, Laura; Guzmán, José Francisco; Drehmer, Eraci; Pablos, Carlos

    2015-04-01

    Introducción: La vulnerabilidad de los niños y la actual situación epidemiológica, hace necesarioel uso de instrumentos validados para estudiar sus hábitos alimenticios tanto en contextos familiares como en escolares. Objetivo: Validar una Subescala de Hábitos Alimentarios en Niños (SEHAN), de 10 a 12 años. Método: Se validó el instrumento y sus ítems por cinco expertos y apartir de estas valoraciones se calculó el coeficiente de concordancia canónica (CCC). Para la fiabilidad y consistencia interna, 134 estudiantes completaron dos veces la subescala y se calculó el Coeficiente de Correlación Intraclase (CCI), el Coeficiente de Correlación de Spearman (CCS) y el test Wilcoxon. Para la validez criterial se halló el CCS de 187 alumnos. Se valoró la correlación entre IMC y pliegue tricipital (PLT) con la puntuación final de la SEHAN. Resultado: La SEHANquedó compuesta por 27 ítems. La puntuación de los expertos fue de 3.94 (sobre 4 puntos posibles). El CCC fue del 83.04%. El resultado del test de Wilcoxon, fue (p< .05). Para el 81.86% de la subescalase obtuvo un CCI>.06. El CCI rango fue .467 - .914 para 25 de los 27 ítems. El CCS rango fue .350 - .777 (p< .01) en 25 de las 27 variables. El CCS para la validez criterial de la SEHAN con IMCy PLT en ambos casos fue (p< .05). Conclusiones: La SEHAN demostró ser un instrumento válido, fiable, sencillo, de rápida administración y fácil compresión.

  1. Quantifying the Neural Elements Activated and Inhibited by Globus Pallidus Deep Brain Stimulation

    PubMed Central

    Johnson, Matthew D.; McIntyre, Cameron C.

    2008-01-01

    Deep brain stimulation (DBS) of the globus pallidus pars interna (GPi) is an effective therapy option for controlling the motor symptoms of medication-refractory Parkinson's disease and dystonia. Despite the clinical successes of GPi DBS, the precise therapeutic mechanisms are unclear and questions remain on the optimal electrode placement and stimulation parameter selection strategies. In this study, we developed a three-dimensional computational model of GPi-DBS in nonhuman primates to investigate how membrane channel dynamics, synaptic inputs, and axonal collateralization contribute to the neural responses generated during stimulation. We focused our analysis on three general neural elements that surround GPi-DBS electrodes: GPi somatodendritic segments, GPi efferent axons, and globus pallidus pars externa (GPe) fibers of passage. During high-frequency electrical stimulation (136 Hz), somatic activity in the GPi showed interpulse excitatory phases at 1–3 and 4–5.5 ms. When including stimulation-induced GABAA and AMPA receptor dynamics into the model, the somatic firing patterns continued to be entrained to the stimulation, but the overall firing rate was reduced (78.7 to 25.0 Hz, P < 0.001). In contrast, axonal output from GPi neurons remained largely time-locked to each pulse of the stimulation train. Similar entrainment was also observed in GPe efferents, a majority of which have been shown to project through GPi en route to the subthalamic nucleus. The models suggest that pallidal DBS may have broader network effects than previously realized and the modes of therapy may depend on the relative proportion of GPi and/or GPe efferents that are directly affected by the stimulation. PMID:18768645

  2. Destruction of the germinal disc region of an immature preovulatory chicken follicle induces atresia and apoptosis.

    PubMed

    Yao, H H; Volentine, K K; Bahr, J M

    1998-09-01

    The germinal disc region (GDR), which contains the germinal disc and overlying granulosa cells, is essential for completion of maturation of the preovulatory chicken follicle. The current study was conducted to test the hypothesis that destruction of the GDR (GDRX) of an immature preovulatory chicken follicle blocks ovulation, induces apoptosis, and causes atresia. The GDR of immature preovulatory follicles (F2) were destroyed by freezing with dry ice (3 mm in diameter) 48-50 h before ovulation. As a control for the effect of freezing, a nonGDR portion (a portion of the follicular wall opposite to the GDR relative to the follicular stalk) of other F2 follicles were destroyed (nonGDRX). Treatment of F2 follicles by GDRX caused atresia and blocked ovulation of all treated follicles (6 of 6), whereas none of the nonGDRX follicles (0 of 5) underwent atresia. Treatment of follicles by GDRX induced apoptotic DNA fragmentation (laddering) in theca and granulosa layers obtained from the frozen area and in the theca layer obtained from the follicular wall distal to the frozen area. In contrast, apoptosis was only present in theca and granulosa layers in the frozen area of the nonGDRX follicle. Furthermore, the in situ DNA end-labeling technique demonstrated that in the GDRX follicle 24 h after treatment, cells in the theca interna, endothelial cells in blood vessels of the theca externa, and a few granulosa cells underwent apoptosis. These results indicate that destruction of the GDR of an immature preovulatory follicle causes atresia and apoptosis and blocks ovulation. These novel findings suggest that the GDR maintains development of the chicken preovulatory follicle by producing one or more survival factors. Without the GDR, chicken follicles cannot develop further and they eventually die.

  3. Behaviour of nucleated cells in various types of pleural effusion.

    PubMed

    Ferreiro, L; Pereiro, T; San José, E; Toubes, M E; Suárez-Antelo, J; Álvarez Dobaño, J M; González Barcala, F J; Rodríguez Núñez, N; Lama, A; Valdés, L

    2017-04-01

    To know the behavior of cellular components of pleural fluid can help focus the differential diagnosis of a pleural effusion. Our objective was to assess their composition in different types of pleural effusions and assess whether it provides relevant clinical information. Observational, cross-sectional and retrospective study in which the cellular components of pleural effusions of different etiology were analyzed. Pleural effusions were classified as neutrophilic, lymphocytic (≥50% of each one of them), eosinophilic (≥10%) or mesothelial (>5%) and were grouped into six diagnostic categories RESULTS: 1.467 patients were studied (354 heart failure; 59 other transudates; 349 paraneumonic; 133 tuberculous; 397 malignant and 175 other exudates). The predominance cell was lymphocytic in heart failure (44,4%), uncomplicated parapneumonic (29,2%), tuberculosis (88%) and malignant (49,6%); neutrophilic in parapneumonic (57%) and malignant (9,6%); eosinophilic in malignant (6,3%) and mesotelial in tuberculosis (12%). The most frequent etiologies with lymphocyte count ≥80% were tuberculosis (35,1%) and malignant (23,3%). Parameters with higher discriminating accuracy were: leukocytes (transudates: AUC 0,835) and percentage of neutrophils (empyemas: AUC 0,906 and complicated parapneumonic+empyemas: AUC 0,907). Nucleated cell counts will help focus the etiology of pleural effusions, since each etiology often have a characteristic cell predominance. The percentage of nucleated cells in pleural fluid not ruled out tuberculosis if there is a high count of mesothelial cells, nor a parapneumonic effusion with lymphocytic predominance, or malignancy with ≥80% lymphocytes. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  4. Factors influencing pleural drainage in parapneumonic effusions.

    PubMed

    Porcel, J M; Valencia, H; Bielsa, S

    2016-10-01

    The identification of parapneumonic effusions (PPE) requiring pleural drainage is challenging. We aimed to determine the diagnostic accuracy of radiological and pleural fluid findings in discriminating between PPE that need drainage (complicated PPE (CPPE)) and those that could be resolved with antibiotics only (uncomplicated PPE (UPPE)). A retrospective review of 641 consecutive PPE, of which 393 were categorized as CPPE and 248 as UPPE. Demographics, radiological (size and laterality on a chest radiograph) and pleural fluid parameters (pus, bacterial cultures, biochemistries) were compared among groups. Logistic regression was performed to determine variables useful for predicting chest drainage, and receiver-operating characteristic curves assisted in the selection of the best cutoff values. According to the likelihood ratios (LR), findings increasing the probability of chest tube usage the most were: effusions occupying ≥1/2 of the hemithorax (LR 13.5), pleural fluid pH ≤7.15 (LR 6.2), pleural fluid glucose ≤40mg/dL (LR 5.6), pus (LR 4.8), positive pleural fluid cultures (LR 3.6), and pleural fluid lactate dehydrogenase >2000U/L (LR 3.4). In the logistic regression analysis only the first two were selected as significant predictors of CPPE. In non-purulent effusions, the effusion's size and pleural fluid pH retained their discriminatory properties, in addition to a pleural fluid C-reactive protein (CRP) level >100mg/L. Large radiological effusions and a pleural fluid pH ≤7.15 were the best predictors for chest drainage in patients with PPE. In the subgroup of patients with non-purulent effusions, pleural fluid CRP also contributed to CPPE identification. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  5. Sonographic examination of epiaortic vessels in patients with peripheral vertigo.

    PubMed

    Salvaggio, G; Gargano, R; Campisi, A; Cantisani, V; Ricci, P; Gallina, S; Midiri, M; Caruso, G

    2010-09-01

    Sommario INTRODUZIONE: Valutare l’utilità dell’eco-color Doppler (CDU) dei vasi epiaortici nei pazienti con vertigine periferica da causa sconosciuta. MATERAILI E METODI: Centocinquantasei pazienti (gruppo studio; 42 uomini e 114 donne; età media 61,86 ± 14,14) e 161 pazienti (gruppo controllo; 80 uomini e 81 donne; età media 62,31 ± 13,69) sono stati sottoposti a CDU dei vasi epiaortici. Sono stati valutati i seguenti parametri: presenza di placche ateromasiche a livello dell’arteria carotide (CA) comune e/o interna; spessore medio intimale (IMT) della CA comune; picco di velocità sistolica (PSV) e indice di resistenza (RI) a livello delle arterie vertebrali (VA).Sono stati utilizzati test parametrici (T-test) e non parametrici (Mann–Whitney U-test e Kolmogorov–Smirnov test). È stata eseguita un’analisi di regressione logistica per fornire un odds ratio indice di grandezza del rischio di vertigine. Sono state considerate variabili indipendenti (età, sesso), fattori di rischio vascolare (ipercolesterolemia, diabete, ipertensione) e variabili CDU (IMT, placche, PSV e RI). RISULTATI: Placche ed IMT > 1 mm sono stati trovati in 31 (19,8%) e 98 (62,8%) pazienti del gruppo di studio e in 43 (26,7%) e 125 (77,6%) pazienti del gruppo controllo. I test statistici, applicati a PSV e RI, non hanno dimostrato differenze significative (p-valore > 0,05). Alla regressione logistica le vertigini sono risultate associate ad età, sesso, ipercolesterolemia, diabete, ipertensione e IMT (p < 0,01), mentre placche, PSV ed RI non erano fattori significativi (p > 0,05). DISCUSSIONE: IMT è la sola variabile CDU significativamente associata alla vertigine, specialmente nelle classi di età inferiore (35-45 e 45-55) del gruppo studio.

  6. Does Dietary Deoxynivalenol Modulate the Acute Phase Reaction in Endotoxaemic Pigs?--Lessons from Clinical Signs, White Blood Cell Counts, and TNF-Alpha.

    PubMed

    Tesch, Tanja; Bannert, Erik; Kluess, Jeannette; Frahm, Jana; Kersten, Susanne; Breves, Gerhard; Renner, Lydia; Kahlert, Stefan; Rothkötter, Hermann-Josef; Dänicke, Sven

    2015-12-23

    We studied the interaction between deoxynivalenol (DON)-feeding and a subsequent pre- and post-hepatic immune stimulus with the hypothesis that the liver differently mediates the acute phase reaction (APR) in pigs. Barrows (n = 44) were divided into a DON-(4.59 mg DON/kg feed) and a control-diet group, surgically equipped with permanent catheters pre- (V. portae hepatis) and post-hepatic (V. jugularis interna) and infused either with 0.9% NaCl or LPS (7.5 µg/kg BW). Thus, combination of diet (CON vs. DON) and infusion (CON vs. LPS, jugular vs. portal) created six groups: CON_CON(jug.)-CON(por.), CON_CON(jug.)-LPS(por.), CON_LPS(jug.)-CON(por.), DON_CON(jug.)-CON(por.), DON_CON(jug.)-LPS(por.), DON_LPS(jug.)-CON(por.). Blood samples were taken at -30, 15, 30, 45, 60, 75, 90, 120, 150, 180 min relative to infusion and analyzed for leukocytes and TNF-alpha. Concurrently, clinical signs were scored and body temperature measured during the same period. LPS as such induced a dramatic rise in TNF-alpha (p < 0.001), hyperthermia (p < 0.01), and severe leukopenia (p < 0.001). In CON-fed pigs, an earlier return to physiological base levels was observed for the clinical complex, starting at 120 min post infusionem (p < 0.05) and persisting until 180 min. DON_LPS(jug.)-CON(por.) resulted in a lower temperature rise (p = 0.08) compared to CON_LPS(jug.)-CON(por.). In conclusion, APR resulting from a post-hepatic immune stimulus was altered by chronic DON-feeding.

  7. Exaggerated hypertensive response to exercise and myocardial ischaemia in patients with known or suspected coronary artery disease.

    PubMed

    Bouzas-Mosquera, C; Bouzas-Mosquera, A; Peteiro, J

    2017-08-21

    The association between an exaggerated hypertensive response to exercise (EHRE) and the probability of ischaemia in stress tests is controversial. Our purpose was to determine the possible association between an EHRE and the development of chest pain and electrocardiographic or echocardiographic ischaemia with exercise. A retrospective observational study was conducted of 10,047 patients with known or suspected coronary artery disease referred for exercise echocardiography. A logistic regression analysis assessed the effect of developing an EHRE (defined as a maximum systolic blood pressure with exercise ≥220mmHg) and the onset of chest pain and electrocardiographic and echocardiographic changes suggestive of ischaemia. A total of 402 patients developed an EHRE. The rates of angina, electrocardiographic ischaemia and echocardiographic ischaemia among the patients with an EHRE were 8.2, 16.2 and 22.6% versus 13.8, 14.7 and 27.5%, respectively, for patients without an EHRE (p=.001, p=.4, p=.032). After a multivariate fit, EHRE was associated with a lower probability of exercise-induced angina (OR, 0.44; 95% CI 0.30-0.65; p<.001) and echocardiographic ischaemia (OR, 0.63; 95% CI 0.48-0.83; p=.001) but not with the onset of electrocardiographic ischaemia. EHRE is associated with a lower prevalence of angina and echocardiographic ischaemia in patients with known or suspected coronary artery disease. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  8. Is deep brain stimulation a treatment option for anorexia nervosa?

    PubMed Central

    2013-01-01

    Anorexia nervosa (AN) is a severe psychiatric disorder with high rates of morbidity, comorbidity and mortality, which in a subset of patients (21%) takes on a chronic course. Since an evidence based treatment for AN is scarce, it is crucial to investigate new treatment options, preferably focused on influencing the underlying neurobiological mechanisms of AN. The objective of the present paper was to review the evidence for possible neurobiological correlates of AN, and to hypothesize about potential targets for Deep brain stimulation (DBS) as a treatment for chronic, therapy-refractory AN. One avenue for exploring new treatment options based on the neurobiological correlates of AN, is the search for symptomatologic and neurobiologic parallels between AN and other compulsivity- or reward-related disorders. As in other compulsive disorders, the fronto-striatal circuitry, in particular the insula, the ventral striatum (VS) and the prefrontal, orbitofrontal, temporal, parietal and anterior cingulate cortices, are likely to be implicated in the neuropathogenesis of AN. In this paper we will review the few available cases in which DBS has been performed in patients with AN (either as primary diagnosis or as comorbid condition). Given the overlap in symptomatology and neurocircuitry between reward-related disorders such as obsessive compulsive disorder (OCD) and AN, and the established efficacy of accumbal DBS in OCD, we hypothesize that DBS of the nucleus accumbens (NAc) and other areas associated with reward, e.g. the anterior cingulated cortex (ACC), might be an effective treatment for patients with chronic, treatment refractory AN, providing not only weight restoration, but also significant and sustained improvement in AN core symptoms and associated comorbidities and complications. Possible targets for DBS in AN are the ACC, the ventral anterior limb of the capsula interna (vALIC) and the VS. We suggest conducting larger efficacy studies that also explore the

  9. High-sensitivity troponin T and the risk of recurrent readmissions after hospitalisation for acute heart failure.

    PubMed

    Escribano, D; Santas, E; Miñana, G; Mollar, A; García-Blas, S; Valero, E; Payá, A; Chorro, F J; Sanchis, J; Núñez, J

    2017-03-01

    High-sensitivity troponin is a biomarker of myocardial damage and is associated with a greater risk of mortality and disease progression in patients with acute heart failure (AHF). However, its relationship with the risk of future readmissions is less known. The aim of this study was to assess the association between ultrasensitive troponin T (TnT-us) values in patients with AHF and the risk of recurrent readmissions in the follow-up. We prospectively included a cohort of 621 consecutive patients with AHF, excluding those patients with acute coronary syndrome. We measured the TnT-us levels obtained during the first medical contact in the emergency department. The risk of cumulative readmissions was assessed using negative binomial regression. The mean age of the participants was 73.6±10.8 years, 54.6% were men, and 52% had a left ventricular systolic function ≥50%. The median TnT-us level was 35.5pg/ml (interquartile range [IQR], 22-67). After a median follow-up of 1.2 years (IQR, 0.4-2.4), a total of 153 deaths (24.6%) were recorded, as well as 689 readmissions for all causes in 303 patients (48.8%) and 286 readmissions for HF in 163 patients (26.3%). In the multivariate analysis, the high TnT-us values were associated with an increased risk of readmission, both for all causes and for HF (incidence rate ratio [IRR], 1.16; 95% confidence interval, 1.02-1.36; p=.029 and IRR, 1.23; 95% confidence interval, 1.04-1.46; p=.018, respectively). For patients with AHF, the increase in TnT-us levels was independently associated with a risk of recurrent readmissions during the follow-up. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  10. Uncommon Applications of Deep Brain Stimulation in Hyperkinetic Movement Disorders

    PubMed Central

    Smith, Kara M.; Spindler, Meredith A.

    2015-01-01

    Background In addition to the established indications of tremor and dystonia, deep brain stimulation (DBS) has been utilized less commonly for several hyperkinetic movement disorders, including medication-refractory myoclonus, ballism, chorea, and Gilles de la Tourette (GTS) and tardive syndromes. Given the lack of adequate controlled trials, it is difficult to translate published reports into clinical use. We summarize the literature, draw conclusions regarding efficacy when possible, and highlight concerns and areas for future study. Methods A Pubmed search was performed for English-language articles between January 1980 and June 2014. Studies were selected if they focused primarily on DBS to treat the conditions of focus. Results We identified 49 cases of DBS for myoclonus-dystonia, 21 for Huntington's disease, 15 for choreacanthocytosis, 129 for GTS, and 73 for tardive syndromes. Bilateral globus pallidus interna (GPi) DBS was the most frequently utilized procedure for all conditions except GTS, in which medial thalamic DBS was more common. While the majority of cases demonstrate some improvement, there are also reports of no improvement or even worsening of symptoms in each condition. The few studies including functional or quality of life outcomes suggest benefit. A limited number of studies included blinded on/off testing. There have been two double-blind controlled trials performed in GTS and a single prospective double-blind, uncontrolled trial in tardive syndromes. Patient characteristics, surgical target, stimulation parameters, and duration of follow-up varied among studies. Discussion Despite these extensive limitations, the literature overall supports the efficacy of DBS in these conditions, in particular GTS and tardive syndromes. For other conditions, the preliminary evidence from small studies is promising and encourages further study. PMID:25713746

  11. Changes in Motor-Related Cortical Activity Following Deep Brain Stimulation for Parkinson’s Disease Detected by Functional Near Infrared Spectroscopy: A Pilot Study

    PubMed Central

    Morishita, Takashi; Higuchi, Masa-aki; Saita, Kazuya; Tsuboi, Yoshio; Abe, Hiroshi; Inoue, Tooru

    2016-01-01

    It remains unclear how deep brain stimulation (DBS) modulates the global neuronal network involving cortical activity. We aimed to evaluate changes in cortical activity in six (two men; four women) patients with Parkinson’s disease (PD) who underwent unilateral globus pallidus interna (GPI) DBS surgery using a multi-channel near infrared spectroscopy (NIRS) system. As five of the patients were right-handed, DBS was performed on the left in these five cases. The mean age was 66.8 ± 4.0 years. The unified Parkinson’s disease rating scale (UPDRS) motor scores were evaluated at baseline and 1- and 6-month follow-up. Task-related NIRS experiments applying the block design were performed at baseline and 1-month follow-up. The mean of the total UPDRS motor score was 48.5 ± 11.1 in the off-medication state preoperatively. Postoperatively, total UPDRS motor scores improved to 26.8 ± 16.6 (p < 0.05) and 22.2 ± 8.6 (p < 0.05) at 1- and 6-month follow-up, respectively. A task-related NIRS experiment showed a postoperative increase in the cortical activity of the prefrontal cortex comparable to the preoperative state. To our knowledge, this is the first study to use a multi-channel NIRS system for PD patients treated with DBS. In this pilot study, we showed changes in motor-associated cortical activities following DBS surgery. Therapeutic DBS was concluded to have promoted the underlying neuronal network remodeling. PMID:28018196

  12. Modeling plaque fissuring and dissection during balloon angioplasty intervention.

    PubMed

    Gasser, T Christian; Holzapfel, Gerhard A

    2007-05-01

    Balloon angioplasty intervention is traumatic to arterial tissue. Fracture mechanisms such as plaque fissuring and/or dissection occur and constitute major contributions to the lumen enlargement. However, these types of mechanically-based traumatization of arterial tissue are also contributing factors to both acute procedural complications and chronic restenosis of the treatment site. We propose physical and finite element models, which are generally useable to trace fissuring and/or dissection in atherosclerotic plaques during balloon angioplasty interventions. The arterial wall is described as an anisotropic, heterogeneous, highly deformable, nearly incompressible body, whereas tissue failure is captured by a strong discontinuity kinematics and a novel cohesive zone model. The numerical implementation is based on the partition of unity finite element method and the interface element method. The later is used to link together meshes of the different tissue components. The balloon angioplasty-based failure mechanisms are numerically studied in 3D by means of an atherosclerotic-prone human external iliac artery, with a type V lesion. Image-based 3D geometry is generated and tissue-specific material properties are considered. Numerical results show that in a primary phase the plaque fissures at both shoulders of the fibrous cap and stops at the lamina elastica interna. In a secondary phase, local dissections between the intima and the media develop at the fibrous cap location with the smallest thickness. The predicted results indicate that plaque fissuring and dissection cause localized mechanical trauma, but prevent the main portion of the stenosis from high stress, and hence from continuous tissue damage.

  13. Cerebral multifrequency MR elastography by remote excitation of intracranial shear waves.

    PubMed

    Fehlner, Andreas; Papazoglou, Sebastian; McGarry, Matthew D; Paulsen, Keith D; Guo, Jing; Streitberger, Kaspar-Josche; Hirsch, Sebastian; Braun, Jürgen; Sack, Ingolf

    2015-11-01

    The aim of this study was to introduce remote wave excitation for high-resolution cerebral multifrequency MR elastography (mMRE). mMRE of 25-45-Hz drive frequencies by head rocker stimulation was compared with mMRE by remote wave excitation based on a thorax mat in 12 healthy volunteers. Maps of the magnitude |G*| and phase φ of the complex shear modulus were reconstructed using multifrequency dual elasto-visco (MDEV) inversion. After the scan, the subjects and three operators assessed the comfort and convenience of cerebral mMRE using two methods of stimulating the brain. Images were acquired in a coronal view in order to identify anatomical regions along the spinothalamic pathway. In mMRE by remote actuation, all subjects and operators appreciated an increased comfort and simplified procedural set-up. The resulting strain amplitudes in the brain were sufficiently large to analyze using MDEV inversion, and yielded high-resolution viscoelasticity maps which revealed specific anatomical details of brain mechanical properties: |G*| was lowest in the pons (0.97 ± 0.08 kPa) and decreased within the corticospinal tract in the caudal-cranial direction from the crus cerebri (1.64 ± 0.26 kPa) to the capsula interna (1.29 ± 0.14 kPa). By avoiding onerous mechanical stimulation of the head, remote excitation of intracranial shear waves can be used to measure viscoelastic parameters of the brain with high spatial resolution. Therewith, the new mMRE method is suitable for neuroradiological examinations in the clinic. Copyright © 2015 John Wiley & Sons, Ltd.

  14. The clinical profile of women with stable ischaemic heart disease in Spain. More effort is needed in secondary prevention. SIRENA study.

    PubMed

    Gámez, J M; Ripoll, T; Barrios, V; Anguita, M; Pedreira, M; Madariaga, I

    2016-01-01

    Cardiovascular diseases are the leading cause of death for women, especially ischaemic heart disease, which is still considered a man's disease. In Spain, there are various registries on ischaemic heart disease, although none are exclusively for women. The objectives of the SIRENA study were to describe the clinical profile of women with ischaemic heart disease treated in cardiology consultations, to estimate its prevalence of cardiovascular risk factors and understand its clinical management. A multicentre observational study was conducted with a sample of 631 women with stable ischaemic heart disease, consecutively included during cardiology consultations. Forty-one researchers from all over Spain participated in the study. The mean age was 68.5 years. The clinical presentation was in the form of acute coronary syndrome in up to 67.2% of the patients. The prevalence of cardiovascular risk factors was high (77.7% of the patients had hypertension, 40.7% had diabetes and 68% had dyslipidaemia), with 30.7% having uncontrolled hypertension, 78.4% having LDL-cholesterol levels higher than 70mg/dL and 49.2% having HbA1c levels greater than 7%. The considerable majority of the patients underwent optimal medical treatment with antiplatelet agents, beta-blockers, renin-angiotensin-aldosterone system blockers and hypolipidaemic agents. Coronary angiography was performed for 88.3% of the patients, and 63.4% underwent percutaneous coronary intervention. Women with stable ischaemic heart disease in Spain initially present some form of acute coronary syndrome and a high prevalence of inadequately controlled cardiovascular risk factors, despite undergoing optimal medical therapy. A high percentage of these women undergo coronary revascularisation. Increased efforts are required for secondary prevention in women with stable ischaemic heart disease. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  15. Relative contributions of local cell and passing fiber activation and silencing to changes in thalamic fidelity during deep brain stimulation and lesioning: a computational modeling study.

    PubMed

    So, Rosa Q; Kent, Alexander R; Grill, Warren M

    2012-06-01

    Deep brain stimulation (DBS) and lesioning are two surgical techniques used in the treatment of advanced Parkinson's disease (PD) in patients whose symptoms are not well controlled by drugs, or who experience dyskinesias as a side effect of medications. Although these treatments have been widely practiced, the mechanisms behind DBS and lesioning are still not well understood. The subthalamic nucleus (STN) and globus pallidus pars interna (GPi) are two common targets for both DBS and lesioning. Previous studies have indicated that DBS not only affects local cells within the target, but also passing axons within neighboring regions. Using a computational model of the basal ganglia-thalamic network, we studied the relative contributions of activation and silencing of local cells (LCs) and fibers of passage (FOPs) to changes in the accuracy of information transmission through the thalamus (thalamic fidelity), which is correlated with the effectiveness of DBS. Activation of both LCs and FOPs during STN and GPi-DBS were beneficial to the outcome of stimulation. During STN and GPi lesioning, effects of silencing LCs and FOPs were different between the two types of lesioning. For STN lesioning, silencing GPi FOPs mainly contributed to its effectiveness, while silencing only STN LCs did not improve thalamic fidelity. In contrast, silencing both GPi LCs and GPe FOPs during GPi lesioning contributed to improvements in thalamic fidelity. Thus, two distinct mechanisms produced comparable improvements in thalamic function: driving the output of the basal ganglia to produce tonic inhibition and silencing the output of the basal ganglia to produce tonic disinhibition. These results show the importance of considering effects of activating or silencing fibers passing close to the nucleus when deciding upon a target location for DBS or lesioning.

  16. Expression and localization of members of the thrombospondin family during final follicle maturation and corpus luteum formation and function in the bovine ovary

    PubMed Central

    BERISHA, Bajram; SCHAMS, Dieter; RODLER, Daniela; SINOWATZ, Fred; PFAFFL, Michael W.

    2016-01-01

    The aim of this study was to characterize the expression patterns and localization of the thrombospondin family members (THBS1, THBS2) and their receptors (CD36 and CD47) in bovine ovaries. First, the antral follicles were classified into 5 groups based on the follicle size and estradiol-17beta (E2) concentration in the follicular fluid (< 0.5, 0.5–5, 5–40, 40–180 and >180 E2 ng/ml). Second, the corpus luteum (CL) was assigned to the following stages: days 1–2, 3–4, 5–7, 8–12, 13–16 and >18 of the estrous cycle and of pregnancy (month 1–2, 3–4, 6–7 and > 8). Third, the corpora lutea were collected by transvaginal ovariectomy before and 0.5, 2, 4, 12, 24, 48 and 64 h after inducing luteolysis by injecting a prostaglandin F2alpha analog. The mRNA expression of examined factors was measured by RT-qPCR, steroid hormone concentration by EIA, and localization by immunohistochemistry. The mRNA expression of THBS1, THBS2, CD36, and CD47 in the granulosa cells and theca interna was high in the small follicles and reduced in the preovulatory follicles. The mRNA expression of THBS1, THBS2, and CD47 in the CL during the estrous cycle was high, but decreased significantly during pregnancy. After induced luteolysis, thrombospondins increased significantly to reach the maximum level at 12 h for THBS1, 24 h for THBS2, and 48 h for CD36. The temporal expression and localization pattern of the thrombospondins and their specific receptors in the antral follicles and corpora lutea during the different physiological phases of the estrous cycle and induced luteolysis appear to be compatible with their inhibitory role in the control of ovarian angiogenesis. PMID:27396384

  17. Chemical composition and fatty acid profile of rhea (Rhea americana) meat.

    PubMed

    Romanelli, Pedro Fernando; Trabuco, Elizeu; Scriboni, Andréia Borges; Visentainer, Jesuí Vergílio; Souza, Nilson Evelázio de

    2008-06-01

    The purpose of this work was to determine the proximate composition and fatty acid profiles of the Gastrocnemius pars interna intramuscular fat (IMF) of rhea (Rhea americana) thighs. The birds were bred in captivity, fed with balanced feed (Nutriavestruz Crescimento - Purina) and kept in a pen with grass ad lib. The birds of both sexes used in the research weighed 23 kg on average and were aged about twelve (12) months old. They were subjected to hydric diet (12 h) before slaughtering by electric shock. The rhea meat showed an average moisture, protein, ash and total lipid contents of 74.1%, 22.8%, 1.5% and 1.6%, respectively. It was noticed the predominance of monounsaturated fatty acids (MUFA) in intramuscular fat (IMF), 42.3% and a high percentage of polyunsaturated fatty acids (PUFA), 29.7%. The fatty acids found in higher proportion in rhea IMF were: 18:2n-6 (24.33%), 18: ln-9 (19.25%), 16:0 (13.70%), 22: ln9 (11.40%), 18:0 (10.66%), 15: ln-10 (8.62%), 24: ln-9 (2.90%) and 20:4n-6 (1.72%). The PUFA/SFA and n-6/n-3 ratios were 1.06 and 31.30, respectively. The consumption of rhea meat is a healthy alternative to red meat as it points to a lower susceptibility to cardiovascular diseases caused by the high consumption of fat comparatively to the consumption of meat from most domesticated animals.

  18. Atlas-based functional radiosurgery: Early results

    SciTech Connect

    Stancanello, J.; Romanelli, P.; Pantelis, E.; Sebastiano, F.; Modugno, N.

    2009-02-15

    Functional disorders of the brain, such as dystonia and neuropathic pain, may respond poorly to medical therapy. Deep brain stimulation (DBS) of the globus pallidus pars interna (GPi) and the centromedian nucleus of the thalamus (CMN) may alleviate dystonia and neuropathic pain, respectively. A noninvasive alternative to DBS is radiosurgical ablation [internal pallidotomy (IP) and medial thalamotomy (MT)]. The main technical limitation of radiosurgery is that targets are selected only on the basis of MRI anatomy, without electrophysiological confirmation. This means that, to be feasible, image-based targeting must be highly accurate and reproducible. Here, we report on the feasibility of an atlas-based approach to targeting for functional radiosurgery. In this method, masks of the GPi, CMN, and medio-dorsal nucleus were nonrigidly registered to patients' T1-weighted MRI (T1w-MRI) and superimposed on patients' T2-weighted MRI (T2w-MRI). Radiosurgical targets were identified on the T2w-MRI registered to the planning CT by an expert functional neurosurgeon. To assess its feasibility, two patients were treated with the CyberKnife using this method of targeting; a patient with dystonia received an IP (120 Gy prescribed to the 65% isodose) and a patient with neuropathic pain received a MT (120 Gy to the 77% isodose). Six months after treatment, T2w-MRIs and contrast-enhanced T1w-MRIs showed edematous regions around the lesions; target placements were reevaluated by DW-MRIs. At 12 months post-treatment steroids for radiation-induced edema and medications for dystonia and neuropathic pain were suppressed. Both patients experienced significant relief from pain and dystonia-related problems. Fifteen months after treatment edema had disappeared. Thus, this work shows promising feasibility of atlas-based functional radiosurgery to improve patient condition. Further investigations are indicated for optimizing treatment dose.

  19. The tobacco paradox in acute coronary syndrome. The prior cessation of smoking as a marker of a better short-term prognosis.

    PubMed

    Bastos-Amador, P; Almendro-Delia, M; Muñoz-Calero, B; Blanco-Ponce, E; Recio-Mayoral, A; Reina-Toral, A; Cruz-Fernandez, J M; García-Alcántara, A; Hidalgo-Urbano, R; García-Rubira, J C

    2016-01-01

    The tobacco paradox is a phenomenon insufficiently explained by previous studies. This study analyses the prognostic role of prior or active smoking in patients with acute coronary syndrome. We obtained data from the ARIAM registry, between 2001 and 2012. The study included 42,827 patients with acute coronary syndrome (mean age, 65±13 years; 26.4% women). The influence of smoking and that of being an ex-smoker on mortality was analysed using a multivariate analysis. The smokers were younger, were more often men, had less diabetes, hypertension and prior history of heart failure, stroke, arrhythmia and renal failure and more frequently had ST-elevation and a family history of smoking. The ex-smokers had more dyslipidaemia and history of angina, myocardial infarction, ischemic heart disease, peripheral vasculopathy and chronic bronchial disease. Smokers and ex-smokers less frequently developed cardiogenic shock (smokers 4.2%, ex-smokers 4.7% and nonsmokers 6.9%, P<.001). Hospital mortality was 7.8% for the nonsmokers, 4.9% for the ex-smokers and 3.1% for the smokers (P<.001). In the multivariate analysis, the smoker factor lost its influence in the prognosis (-0.26%, p=.52 using an inverse probability calculation; and+0.26%, P=.691 using a propensity analysis). However, the exsmoker factor showed a significant reduction in mortality in both tests (-2.4% in the inverse probability analysis, P<.001; and -1.5% in the propensity analysis, P=.005). The tobacco paradox is a finding that could be explained by other prognostic factors. Smoking cessation prior to hospitalization for acute coronary syndrome is associated with a better prognosis. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  20. Aortic valve surgery in octogenarians: Risk factors and long-term impact.

    PubMed

    Carrascal, Y; Valenzuela, H; Laguna, G; Pareja, P; Blanco, M; Ortega, C

    2015-04-01

    To understand the risk factors and long-term impact and results of aortic valve surgery in patients over age 80. We consecutively evaluated 255 octogenarians who were operated on between 2000 and 2013 and referred for aortic valve disease (isolated or combined with coronary artery disease), which, even when associated with other diseases, was the primary cause of the patient's functional limitation. The mortality rate decreased from 14.08% (2000-2004) to 7.7% (isolated valve surgery, 4.4%; with coronary bypass, 3.3%) (2010-2013). The independent risk factors associated with mortality were urgent surgery, combined procedures, peripheral vascular disease, a postsurgery hematocrit level <24% and the need for transfusion. More than 50% of the patients experienced a postoperative complication. Blood product transfusions were associated with renal and respiratory failure, and preoperative anemia was associated with an increased rate of myocardial infarction and stroke. Survival at 1, 3, 5 and 10 years was 79.5, 74.3, 63.6 and 30.5%, respectively, with 91.5% of patients in NYHA functional class I-II. Long-term survival was lower for cases of preoperative left ventricular dysfunction. The EuroSCORE I logistics score was not useful for our population as a predictor of mortality or of medium to long-term survival. The morbidity and mortality of aortic valve surgery for patients over age 80 has decreased in recent years, although it remains higher when valve surgery is combined with coronary surgery. The presence of preoperative left ventricular dysfunction decreases long-term survival. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  1. Absence of cystatin C involvement in ventricular remodelling and heart failure.

    PubMed

    Pérez-Calvo, J I; Castiella Muruzábal, T; Búcar Barjud, M; Josa Laorden, C; Sánchez Marteles, M; Lacambra Blasco, I; Asensio López, M C; Pascual Figal, D A

    2016-03-01

    Cystatin C (CysC) is a protease encoded by housekeeping genes. Although its prognostic value in heart failure (HF) is well known, it is debatable whether this value is due to the greater accuracy of CysC in calculating the glomerular filtration rate or to its involvement in pathological ventricular remodelling. The aim of this study was to determine whether CysC expression changes in the myocardium of foetuses of different ages and in the myocardium of adults with various cardiovascular diseases, as well as to analyse the correlation between its serum concentrations and cardiac structure and morphology in a patient group with HF. We analysed the correlations (Pearson's r and Spearman's test) between the serum CysC levels and echocardiographic parameters of 351 patients with HF. We also performed immunohistochemical staining for CysC, metalloproteinase-9 (MMP-9) and desmin in 9 cardiac tissue samples from autopsies of 4 foetuses of different gestational ages and 5 healthy adults or adults with cardiovascular disease. For the patients with HF, there was no correlation between the CysC concentrations and the cardiac parameters measured by 2D echocardiography. The immunohistochemistry showed a weak background staining for CysC in all samples, regardless of age and the presence or absence of cardiovascular diseases. Our results suggest that CysC does not have a significant role in the pathological remodelling of the left ventricle in HF. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  2. Neural code alterations and abnormal time patterns in Parkinson's disease.

    PubMed

    Andres, Daniela Sabrina; Cerquetti, Daniel; Merello, Marcelo

    2015-04-01

    The neural code used by the basal ganglia is a current question in neuroscience, relevant for the understanding of the pathophysiology of Parkinson's disease. While a rate code is known to participate in the communication between the basal ganglia and the motor thalamus/cortex, different lines of evidence have also favored the presence of complex time patterns in the discharge of the basal ganglia. To gain insight into the way the basal ganglia code information, we studied the activity of the globus pallidus pars interna (GPi), an output node of the circuit. We implemented the 6-hydroxydopamine model of Parkinsonism in Sprague-Dawley rats, and recorded the spontaneous discharge of single GPi neurons, in head-restrained conditions at full alertness. Analyzing the temporal structure function, we looked for characteristic scales in the neuronal discharge of the GPi. At a low-scale, we observed the presence of dynamic processes, which allow the transmission of time patterns. Conversely, at a middle-scale, stochastic processes force the use of a rate code. Regarding the time patterns transmitted, we measured the word length and found that it is increased in Parkinson's disease. Furthermore, it showed a positive correlation with the frequency of discharge, indicating that an exacerbation of this abnormal time pattern length can be expected, as the dopamine depletion progresses. We conclude that a rate code and a time pattern code can co-exist in the basal ganglia at different temporal scales. However, their normal balance is progressively altered and replaced by pathological time patterns in Parkinson's disease.

  3. Prediction of a neuropeptidome for the eyestalk ganglia of the lobster Homarus americanus using a tissue-specific de novo assembled transcriptome.

    PubMed

    Christie, Andrew E; Roncalli, Vittoria; Cieslak, Matthew C; Pascual, Micah G; Yu, Andy; Lameyer, Tess J; Stanhope, Meredith E; Dickinson, Patsy S

    2017-03-01

    In silico transcriptome mining is a powerful tool for crustacean peptidome prediction. Using homology-based BLAST searches and a simple bioinformatics workflow, large peptidomes have recently been predicted for a variety of crustaceans, including the lobster, Homarus americanus. Interestingly, no in silico studies have been conducted on the eyestalk ganglia (lamina ganglionaris, medulla externa, medulla interna and medulla terminalis) of the lobster, although the eyestalk is the location of a major neuroendocrine complex, i.e., the X-organ-sinus gland system. Here, an H. americanus eyestalk ganglia-specific transcriptome was produced using the de novo assembler Trinity. This transcriptome was generated from 130,973,220 Illumina reads and consists of 147,542 unique contigs. Eighty-nine neuropeptide-encoding transcripts were identified from this dataset, allowing for the deduction of 62 distinct pre/preprohormones. Two hundred sixty-two neuropeptides were predicted from this set of precursors; the peptides include members of the adipokinetic hormone-corazonin-like peptide, allatostatin A, allatostatin B, allatostatin C, bursicon α, CCHamide, corazonin, crustacean cardioactive peptide, crustacean hyperglycemic hormone (CHH), CHH precursor-related peptide, diuretic hormone 31, diuretic hormone 44, eclosion hormone, elevenin, FMRFamide-like peptide, glycoprotein hormone α2, glycoprotein hormone β5, GSEFLamide, intocin, leucokinin, molt-inhibiting hormone, myosuppressin, neuroparsin, neuropeptide F, orcokinin, orcomyotropin, pigment dispersing hormone, proctolin, pyrokinin, red pigment concentrating hormone, RYamide, short neuropeptide F, SIFamide, sulfakinin, tachykinin-related peptide and trissin families. The predicted peptides expand the H. americanus eyestalk ganglia neuropeptidome approximately 7-fold, and include 78 peptides new to the lobster. The transcriptome and predicted neuropeptidome described here provide new resources for investigating peptidergic

  4. Long-term animal implantation study of biotube-autologous small-caliber vascular graft fabricated by in-body tissue architecture.

    PubMed

    Watanabe, Taiji; Kanda, Keiichi; Yamanami, Masashi; Ishibashi-Ueda, Hatsue; Yaku, Hitoshi; Nakayama, Yasuhide

    2011-07-01

    A mold for the preparation of an in-body tissue architecture-induced autologous vascular graft, termed "biotube," was prepared by covering a main silicone rod (outer diameter, 3 mm; length, 30 mm) with two pieces of polyurethane sponge tubes (internal diameter, 3 mm; length, 3 mm) at both ends. The molds were embedded into the dorsal subcutaneous pouch of rabbits (weighing ca. 2 kg) for 2 months. After harvesting the rods with the formed surrounding tissues, the rods were removed to create biotubes impregnated with anastomotic reinforcement cuffs at both ends. The biotubes had homogeneous, thin connective tissue wall (thickness, 76 ± 37 μm) that was primarily composed of collagen and fibroblasts. One biotube was loaded with argatroban and autoimplanted in the carotid artery for 26 months. Neither antiplatelet nor anticoagulant agents were administered, except for an intraoperative heparin injection. Follow-up angiography showed no aneurysm formation, rupturing, or stenosis during implantation. At the end of implantation, the wall thickness of biotube (212 ± 24 μm at the anastomosis portion and 150 ± 14 μm at the midportion) was similar to that of native artery (189 ± 23 μm). The luminal surface was completely covered with endothelial cells on the formed lamina elastica interna-like layer. The regenerated vascular walls comprised multilayered smooth muscle cells and dense collagen fibers with regular circumferential orientation. A remarkable multilayered elastin fiber network was observed near the anastomosis portion. Biotubes could thus be used as small-caliber vascular prostheses that greatly facilitate the healing process and exhibit excellent biocompatibility. Copyright © 2011 Wiley Periodicals, Inc.

  5. Gender related differences in clinical profile and outcome of patients with heart failure. Results of the RICA Registry.

    PubMed

    Conde-Martel, A; Arkuch, M E; Formiga, F; Manzano-Espinosa, L; Aramburu-Bodas, O; González-Franco, Á; Dávila-Ramos, M F; Suárez-Pedreira, I; Herrero-Domingo, A; Montero-Pérez-Barquero, M

    2015-10-01

    To analyze the differential clinical characteristics according to gender of patients with heart failure in terms of etiology, comorbidity, triggers, treatment, hospital stay and overall mortality at one year. We employed data from the RICA registry, a multicenter prospective cohort of patients hospitalized in internal medicine departments for heart failure, with a follow-up of one year. We analyzed the differences between the gender in terms of the etiology of the heart disease, comorbidity, triggers, left ventricle ejection fraction, functional state, mental condition, treatment, length of stay and mortality at 1 year. A total of 1772 patients (47.2% men) were included. The women were older than the men (p<.001) and had a higher prevalence of hypertension, obesity, chronic kidney disease, atrial fibrillation and preserved left ventricle ejection fraction (p<.001). The men's medical history had a predominance of myocardial infarction, chronic obstructive pulmonary disease, peripheral arteriopathy (p<.001) and anemia (p=.02). In the women, a hypertensive etiology was predominant, followed by valvular. The main triggers were hypertension and atrial fibrillation. Treatment with beta-blockers, ACEIs and/or ARBs did not differ by sex. The women had poorer functional capacity (p<.001), according to the Barthel index. After adjusting for age and other prognostic factors, the mortality at one year was lower among the women (RR: 0.69; 95% CI 0.53-0.89; p=.004). HF in women occurs at a later age and with different comorbidities. The hypertensive and valvular etiology is predominant, with preserved left ventricle ejection fraction, and the age-adjusted mortality is lower than in men. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  6. [Pulse wave velocity of the leg minus that of the arm measured with a custom device correlates to the coronary calcium quantification].

    PubMed

    Rico Martín, S; de Nicolás Jiménez, J M; Moyano Calvente, S L; Mogollón Jiménez, M V; Vega Fernández, J; Calderón García, J F; Bacaicoa Lopez de Sabando, M A; Tardio, M; Sánchez Muñoz-Torrero, J F

    2016-05-01

    The pulse wave velocity (PWV) in the great arteries is an indicator of vascular risk. Our objective was to identify the PWV index between the arms and legs that best correlates with the coronary calcium quantification (CCQ) and to compare it with other methods. Eight-one patients without vascular disease underwent the following measurements: CCQ; carotid intima-media thickness (IMT); carotid-femoral PWV (cfPWV), using COMPLIOR; and PWV in the arms and legs, with our own device (abiPWV, ankle brachial index PWV). The difference in PWVs between the leg and arm (l-a PWV) measured with abiPWV was the index that best correlated with CCQ (r=0.401, P<.001). The correlation between IMT and CCQ and between CF-PWV and CCQ were r=0.366, P=.001; and r=0.385, P=.001, respectively. For a CCQ score higher than 100 as a marker of significant coronary arteriosclerosis, the areas under the curve for l-a PWV, IMT and cfPWV were 0.721 (P=.002), 0.758 (P<.001) and 0.636 (P=.058), respectively. For patients without vascular disease, the l-a PWV measured with abiPWV appears to be the index that best correlates with the CCQ. This association is comparable to that between IMT and CCQ and between cfPWV and CCQ. The abiPWV is an easy-to-use device that can help improve vascular risk stratification. Copyright © 2016 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  7. Strange Stars, Neutron Stars and Pulsar Emission

    NASA Astrophysics Data System (ADS)

    Benvenuto, O. G.; Horvath, J. E.

    1990-11-01

    RESUMEN. Se ha conjeturado que una partlecula de dieciocho quarks, sin Carga, sin espi'n y sin colar (quark-alfa) podri'a ser estable a ba5as tern peraturas y presiones aiTh COfl respecto a materia extrafla. Presentamos en este trabajo la estmctura de estrellas extraflas incluyendo los efectos y apariencia de parti'culas uark-alfa en las capas exteriores. La estruc tura interna ya no es hoinogenea del centro a la superficie, sino que muestra un centro de materia extrafla, capas s6lidas y una costra delgada de materia normal en la superficie. La superficie de materia nonnal permite la fornaci6n de una magnetosfera, la que se piensa sea el sitlo en donde ocurre la emisi6n del pulsar. La superficie de superflui'do ayuda a explicar el fen6rneno de `glitch', el cual ba sido observado en muchos pulsares. Se discute la ecuaci6n de estado para rnateria quark-alfa relevante en este regimen. ABSTIZACT:It has been conjectured that an quark, uncharged, spinless and colorless particle Cquark-alpha) could be stable at low pressures and temperatures even with respect to strange matter. We present in work tlie structure of stars including the effects of the appearance of quark-alpi' particles ii their outer layers. The internal structure is no longer from tlie center to the surface, but show a strange matter core, a solid and superfluid layers and a thin crust of normal matter at the surface. The normal matter surface allows tlie fon tion of a magnetosphere, whicl is to be tl place where pulsar emission occurs. A superfluid layer helps to explain tlie glitch , wlflch has been observed in . equation of state for quark-alpha matter relevant in regime is also discussed. Keq LA)OtL : ARY S - OF STATF - ?.ACT

  8. Prevalence of obesity according to Edmonton staging in the Internal Medicine consultations. Results of the OBEMI study.

    PubMed

    Carretero Gómez, J; Arévalo Lorido, J C; Gómez Huelgas, R; Sánchez Vidal, M T; Suárez Tembra, M; Varela Aguilar, J M; Munielo Voces, I; Fernández Pérez, E; Fernández Rodríguez, J M; Ena Muñoz, J

    2017-03-01

    To estimate the prevalence of obesity in patients treated by departments of Internal Medicine and to classify the patients according to the Edmonton Obesity Staging System (EOSS). An observational, descriptive cross-sectional study included outpatients older than 18 years, with a body mass index (BMI)>30, from 38 hospitals between the 1st and 14th of February, 2016. We classified the patients according to the EOSS and analysed their clinical, laboratory and demographic variables. A value of P<.05 was considered statistically significant. Of the 1,262 patients treated in consultations, we recruited 298 and analysed 265. The prevalence of obesity was 23.6%, the mean age was 62.47±15.27 years, and the mean BMI was 36.1±5.3kg/m(2). According to EOSS stage (0, 1, 2, 3 and 4), the prevalence was 4.9, 14.7, 62.3, 15.5 and 2.64%, respectively. Those patients with EOSS>2 were significantly older and had significantly more comorbidities. The multivariate analysis related age (OR 1.06; P<.0003), blood glucose (OR 1.04; P<.0006), total cholesterol (OR 0.98; P<.02) and uric acid (OR 1.32; P<.02) levels with an EOSS>2. An analysis of correspondence grouped, with an explanatory percentage of 78.2%, the patients according to their EOSS, comorbidity, education level, employment status and functional capacity. The prevalence of obesity in the patients treated by Internal Medicine departments is similar to that of the general population, although the patients are older and have a higher BMI. EOSS is useful for implementing a comprehensive approach for patients with obesity, regardless of the BMI, which can help achieve better health and quality-of-life results. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  9. Expression of wilms' tumor gene and protein localization during ovarian formation and follicular development in sheep.

    PubMed

    Logan, Kathleen A; McNatty, Kenneth P; Juengel, Jennifer L

    2003-02-01

    Wilms' tumor protein (WT1) is a transcriptional repressor essential for the development of mammalian kidneys and gonads. To gain insight into possible roles of WT1 in ovarian formation and follicular function, we studied patterns of mRNA and protein localization throughout fetal gonadal development and in ovaries of 4-wk-old and adult sheep. At Day 24 after conception, strong expression of WT1 mRNA and protein was observed in the coelomic epithelial region of the mesonephros where the gonad was forming. By Day 30, expression was observed in the surface epithelium and in many mesenchymal and endothelial cells of the gonad. Epithelial cells continued to express WT1 throughout gonadal development, as did pregranulosa cells during the process of follicular formation. However, WT1 expression was not observed in germ cells. During follicular growth, granulosa cells expressed WT1 from the type 1 (primordial) to the type 4 stages, but thereafter expression was reduced in type 5 (antral) follicles, consistent with the differentiation of granulosa cells into steroid-producing cells. The possible progenitor cells for the theca interna (i.e., the cell streams in the ovarian interstitium) expressed WT1 heterogeneously. However, differentiated theca cells in antral follicles did not express WT1. Strong expression of WT1 was observed during gonadal development, which is consistent with a role for WT1 in ovarian and follicular formation in the ewe. WT1 was identified in many cells of the neonatal and adult ovaries, including granulosa cells, suggesting that this factor is important for preantral follicular growth. However, the decline in WT1 expression in antral follicles suggests that WT1 may prevent premature differentiation of somatic cells of the follicle during early follicular growth.

  10. Effects of methoxychlor on IGF-I signaling pathway in rat ovary.

    PubMed

    Ozden-Akkaya, O; Altunbas, K; Yagcı, A

    2017-01-01

    Follicular development and other ovarian functions are regulated by growth factors that can be affected by exogenous agents. Methoxychlor (MXC) is an organochloride pesticide that causes female infertility. We investigated how MXC affects the distribution of developing ovarian follicles in adult rats after treatment between embryonic day (E) 18 and postnatal day (PND) 7. We also measured insulin-like growth factor-I (IGF-I) and its receptor, IGF-IR, expressions in ovarian follicles and investigated whether MXC changed the levels of IGF-I and IGF-IR in the ovary. Using immunohistochemical (IHC) staining, we detected IGF-I expression in oocytes and granulosa cells of the follicles, luteal cells, interstitial cells, theca externa and theca interna, and the smooth muscle of ovarian vessels. IGF-IR was co-localized with IGF-I in the ovary except for the theca externa. IGF-I expression was decreased in granulosa cells of preantral and antral follicles after treatment with MXC compared to granulosa cells of preantral and antral follicles of the control group. We also observed that oocytes of secondary follicles and granulosa cells of secondary and preantral follicles of the MXC treated groups showed increased IGF-IR expression compared to oocytes of secondary follicles and granulosa cells of secondary and preantral follicles of the control group. We also detected more secondary and preantral follicles, and fewer primordial and antral follicles after MXC administration compared to controls. Therefore, the IGF signaling pathway may participate in MXC induced ovary dysfunction and female infertility.

  11. Reliability of nutritional assessment in patients with gastrointestinal tumors.

    PubMed

    Poziomyck, Aline Kirjner; Fruchtenicht, Ana Valeria Gonçalves; Kabke, Georgia Brum; Volkweis, Bernardo Silveira; Antoniazzi, Jorge Luiz; Moreira, Luis Fernando

    2016-01-01

    Patients with gastrointestinal cancer and malnutrition are less likely to tolerate major surgical procedures, radiotherapy or chemotherapy. In general, they display a higher incidence of complications such as infection, dehiscence and sepsis, which increases the length of stay and risk of death, and reduces quality of life. The aim of this review is to discuss the pros and cons of different points of view to assess nutritional risk in patients with gastrointestinal tract (GIT) tumors and their viability, considering the current understanding and screening approaches in the field. A better combination of anthropometric, laboratory and subjective evaluations is needed in patients with GIT cancer, since malnutrition in these patients is usually much more severe than in those patients with tumors at sites other than the GIT. RESUMO Pacientes com neoplasia gastrointestinal e desnutridos são menos propensos a tolerar procedimentos cirúrgicos de grande porte, radioterapia ou quimioterapia. Em geral, apresentam maior incidência de complicações, como infecção, deiscência e sepse, o que aumenta o tempo de internação e o risco de morte, e reduz a qualidade de vida. O objetivo desta revisão é abordar os prós e contras de diferentes pontos de vista que avaliam risco nutricional em pacientes com tumores do Trato Gastrointestinal (TGI) e sua viabilidade, considerando o atual entendimento e abordagens de triagem neste campo. Melhor combinação de avaliações antropométricas, laboratoriais e subjetivas se faz necessária em pacientes com câncer do TGI, uma vez que a desnutrição nestes pacientes costuma ser muito mais grave do que naqueles indivíduos com tumores em outros sítios que não o TGI.

  12. [The role of diffusion tensor imaging in the pre-surgical study of temporal lobe epilepsy].

    PubMed

    Garcia-Pallero, M A; Torres, C V; Manzanares-Soler, R; Camara, E; Sola, R G

    2016-12-16

    Introduccion. La imagen por tensor de difusion (DTI) es una tecnica no invasiva que puede ser utilizada para evaluar la integridad de la sustancia blanca cerebral. Objetivo. Investigar la utilidad de la DTI en pacientes con epilepsia del lobulo temporal (ELT) y ver su relacion con la lateralizacion del foco epileptogeno en estos pacientes. Pacientes y metodos. Se analizan 11 pacientes diagnosticados de ELT segun el protocolo de evaluacion prequirurgica de nuestra unidad de epilepsia, y libres de crisis a los dos años de la realizacion de una lobectomia temporal mas amigdalohipocampectomia (tecnica de Spencer). Como parte de su estudio preoperatorio, se realiza una resonancia magnetica cerebral de 1,5 T con secuencia de tensor de difusion y se estudian, mediante un analisis basado en voxel, las diferencias en la conectividad entre el hemisferio intervenido y el contralateral. Resultados. Comparado con el hemisferio contralateral, se observo una reduccion de la anisotropia fraccional estadisticamente significativa (p < 0,05) en el cuerpo calloso, el cingulo, el fasciculo longitudinal superior, las radiaciones talamicas anteriores, la capsula interna, los nucleos ventral lateral y pulvinar del talamo, el fasciculo frontooccipital inferior, el fasciculo uncinado, el fasciculo longitudinal inferior y el giro parahipocampal ipsilaterales al foco epileptogeno. Conclusiones. La caracterizacion de las anormalidades en la conectividad de la sustancia blanca cerebral, a traves de la DTI en pacientes con ELT, puede tener un valor importante para la lateralizacion del foco epileptogeno en la evaluacion prequirurgica. Serian necesarios estudios con un numero mas elevado de pacientes para confirmar estos resultados.

  13. Chronic myeloid leukaemia in Spain: Its presentation characteristics have changed. Spanish section of the EUTOS population-based registry.

    PubMed

    Osorio, S; Casado, L F; Giraldo, P; Maestro, B; Andrade, M; Redondo, S; García-Gutiérrez, V; Ayala, R; Garcia, N; Steegmann, J L

    2016-01-01

    To provide more reliable data on the epidemiology of chronic myeloid leukaemia (CML) in Spain than are currently available. The EUTOS population-based project of European LeukemiaNet is a population registry of new CML cases in patients 18 years of age or older from 22 European areas. The Spanish section included the autonomous communities of Madrid, Castilla-La Mancha and Aragon, from 1-2-2010 to 31-12-2012. A total of 250 cases were recorded in 35 months. The overall incidence was 1.08 cases/10(5) inhabitants-year, with a predominance of men (58%) and clear differences among the communities. The incidence standardised by age was similar (overall, 1.04; men, 1.31; women, 0.81). The median age was 54 years. The incidence increased with age, reaching a peak at>65 years, although 31.7% of cases appeared between the ages of 20 and 44 years. Four percent of cases were diagnosed in advanced stages (2.4% in accelerated phase, 1.6% in blast crisis), 56% were asymptomatic, 38% had splenomegaly, and the Sokal score was high in 11% (lower than what was previously reflected in the literature). The current incidence of CML in Spain is higher than previously reported and similar to that of the European studies. Unlike the classical descriptions, CML presented mostly in asymptomatic form, with no splenomegaly, less leucocytosis and in stages with better prognosis. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  14. High doses of systemic corticosteroids in patients hospitalised for exacerbation of chronic obstructive pulmonary disease. A cohort study.

    PubMed

    Rueda-Camino, J A; Bernal-Bello, D; Canora-Lebrato, J; Velázquez-Ríos, L; García de Viedma-García, V; Guerrero-Santillán, M; Duarte-Millán, M A; Cristóbal-Bilbao, R; Zapatero-Gaviria, A

    2017-08-30

    To assess the effect of high doses of corticosteroids in patients hospitalised for exacerbation of chronic obstructive pulmonary disease (COPD). A prospective cohort study was conducted on patients hospitalized with COPD between January and March 2015, grouped according to the glucocorticoid dosage administered (cutoff, 40mg of prednisone/day). We compared the results of hospital stay, readmission and mortality at 3 months of discharge. We analysed 87 patients. The median daily dose was 60mg of prednisone (interquartile range, 46.67-82.33mg/day), and the administration route was intravenous in 96.6% of the cases. We established a relative risk (RR) for hospital stays longer than 8 days of 1.095 (95% CI 0.597-2.007; P=.765) when steroid dosages greater than 40mg/day were employed. In these patients, the hazard ratio (HR) for readmission in the 3 months after discharge was 0.903 (95% CI 0.392-2.082; P=.811), and the mortality was 1.832 (95% CI 0.229-16.645; P=.568). Neither the RR nor the HR varied in a statistically significant manner after adjusting for confounding factors. A daily dose greater than 40mg of prednisone in patients hospitalised for COPD exacerbation was not associated with a shorter hospital stay or a reduction in readmissions or mortality at 3 months. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  15. Clinical and financial implications of disease-related malnutrition in a department of Internal Medicine: prospective cohort study.

    PubMed

    Ballesteros-Pomar, M D; Calleja-Fernández, A; González-Valdés, M; Pintor-de la Maza, B; Villar Taibo, R; Vidal-Casariego, A; Urioste-Fondo, A; Torres-Torres, B; de Luis-Román, D; Cano-Rodríguez, I

    2016-12-01

    Disease-related malnutrition is a challenge for Spanish hospitals. Our objective was to assess the feasibility and importance of establishing a nutritional screening strategy in our community. A prospective cohort study was conducted in a department of internal medicine for 3 months. The nutritional screening was conducted at admission and was repeated weekly using the Malnutrition Universal Screening Tool. We analysed the clinical data, mean stay and expenses. The study included 330 patients (53.9% men), with a mean age of 77.8 years. The mean stay was 7 days, and the Charlson comorbidity index was 5.4. At admission, the Malnutrition Universal Screening Tool detected 26.9% of patients with a risk of malnutrition. Eighteen percent of the patients with a good nutritional state developed malnutrition during the hospitalisation. The patients with initially severe malnutrition had a longer mean stay. The patients whose nutritional state worsened during the hospitalisation had a significantly longer stay (2.5 days) compared with those whose state did not worsen. These cases of malnutrition caused a cost overrun of €767 per hospitalisation (35% greater), which entailed a malnutrition-related excess expenditure of €646,419.93 annually in the studied department. The appropriate coding resulted in an increase in mean weight from 2.11 to 2.81, which represented €82,568.52 and has not been previously quantified. The high prevalence and clinical and financial implications of Disease-related malnutrition in patients hospitalised in internal medicine warrants establishing protocols for its early detection and treatment. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  16. Pulmonary vascular changes in extremely preterm sheep after intra-amniotic exposure to Ureaplasma parvum and lipopolysaccharide.

    PubMed

    Willems, Monique G M; Kemp, Matthew W; Fast, Laura A; Wagemaker, Nick M M; Janssen, Leon E W; Newnham, John P; Payne, Matt S; Spiller, Owen B; Kallapur, Suhas G; Jobe, Alan H; Delhaas, Tammo; Kramer, Boris W; Wolfs, Tim G A M

    2017-01-01

    Chorioamnionitis can induce pulmonary inflammation and promote bronchopulmonary dysplasia development, distinguished by alveolar simplification and impaired vascular growth. Chorioamnionitis is more common during the extremely preterm canalicular lung stage (crucial for vascular development); and increases the risk for subsequent sepsis. We hypothesized that single/combined exposure to chronic and/or acute inflammation induces pulmonary inflammatory responses and vascular changes. Ovine fetuses were intra-amniotically exposed to chronic Ureaplasma parvum (UP) at 24 days (d) before extreme preterm delivery at 94d (term 147d) and/or to lipopolysaccharide (LPS) 7 or 2d before delivery. Pulmonary inflammation, vascular remodeling and angiogenic factors were assessed. LPS exposure increased CD3-positive and myeloperoxidase-positive cells. Combined UP-LPS exposure increased pulmonary inflammation compared with 2d LPS or UP groups. The UP+2d LPS group had an increased adventitial fibrosis score when compared with UP-treated animals. A reduced wall-to-lumen ratio was found in the 7d LPS animals when compared to the 2d LPS-treated animals. Exposure to UP+2d LPS reduced VEGF and VEGFR-2 levels compared with 2d LPS-treated animals. Angiopoietin-1 (Ang1) and tunica interna endothelial cell kinase 2 (Tie-2) levels were decreased after UP+7d LPS as well as after 7d LPS, but not with UP alone. Chronic UP and subsequent LPS exposure increased pulmonary inflammation and decreased expression of angiogenic growth factors and receptors when compared to single hit-exposed animals.

  17. Pulmonary vascular changes in extremely preterm sheep after intra-amniotic exposure to Ureaplasma parvum and lipopolysaccharide

    PubMed Central

    Kemp, Matthew W.; Fast, Laura A.; Wagemaker, Nick M. M.; Janssen, Leon E. W.; Newnham, John P.; Payne, Matt S.; Spiller, Owen B.; Kallapur, Suhas G.; Jobe, Alan H.; Delhaas, Tammo; Kramer, Boris W.; Wolfs, Tim G. A. M.

    2017-01-01

    Background Chorioamnionitis can induce pulmonary inflammation and promote bronchopulmonary dysplasia development, distinguished by alveolar simplification and impaired vascular growth. Chorioamnionitis is more common during the extremely preterm canalicular lung stage (crucial for vascular development); and increases the risk for subsequent sepsis. We hypothesized that single/combined exposure to chronic and/or acute inflammation induces pulmonary inflammatory responses and vascular changes. Methods Ovine fetuses were intra-amniotically exposed to chronic Ureaplasma parvum (UP) at 24 days (d) before extreme preterm delivery at 94d (term 147d) and/or to lipopolysaccharide (LPS) 7 or 2d before delivery. Pulmonary inflammation, vascular remodeling and angiogenic factors were assessed. Results LPS exposure increased CD3-positive and myeloperoxidase-positive cells. Combined UP-LPS exposure increased pulmonary inflammation compared with 2d LPS or UP groups. The UP+2d LPS group had an increased adventitial fibrosis score when compared with UP-treated animals. A reduced wall-to-lumen ratio was found in the 7d LPS animals when compared to the 2d LPS-treated animals. Exposure to UP+2d LPS reduced VEGF and VEGFR-2 levels compared with 2d LPS-treated animals. Angiopoietin-1 (Ang1) and tunica interna endothelial cell kinase 2 (Tie-2) levels were decreased after UP+7d LPS as well as after 7d LPS, but not with UP alone. Conclusion Chronic UP and subsequent LPS exposure increased pulmonary inflammation and decreased expression of angiogenic growth factors and receptors when compared to single hit-exposed animals. PMID:28666032

  18. [RECALMIN. Patient care in the internal medicine units of the Spanish national health system].

    PubMed

    Zapatero Gaviria, A; Barba Martín, R; Román Sánchez, P; Casariego Vales, E; Diez Manglano, J; García Cors, M; Jusdado Ruiz-Capillas, J J; Suárez Fernández, C; Bernal, J L; Elola Somoza, F J

    2016-05-01

    To perform a situation analysis of the care provided by internal medicine units (IMUs) in Spain and to develop, based on this analysis, proposals for improving the quality of care in these units. A descriptive, cross-sectional study of the IMUs of general acute care hospitals of the Spanish National Health System (SNHS), with data referring to 2013. The study variables were collected via an ad hoc questionnaire. Of the total 260hospitals identified in the SNHS, 142responses were obtained from 139hospitals throughout Spain, which represents 53.5% of the IMUs in the SNHS. The mean number of internists per IMU was 14±8, with a mean rate of 7.2±3.3 internists per 100,000 inhabitants. In 2013, the average number of hospital discharges from the IMU was 2,987±2,066, and those discharged by internists was 232±107. Sixty-one percent of the IMUs had implemented an interconsultation unit, and 41% had implemented a systematic care program for complex chronic patients. Thirty-three percent of the IMUs conducted multidisciplinary rounds, and 60% of these IMUs planned the discharge. The 2013 RECALMIN survey revealed a number of important aspects of the organisation, structure and management of IMUs. The remarkable variability in the indicators of structure, activity and management probably reflect significant differences in efficiency and productivity, which therefore provide significant room for improvement. Copyright © 2016 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  19. Pressure ulcers in patients hospitalized in Internal Medicine: associated factors and mortality.

    PubMed

    Díez-Manglano, J; Fernández-Jiménez, C; Lambán-Aranda, M P; Landa-Santesteban, M C; Isasi de Isasmendi-Pérez, S; Moreno-García, P; Bejarano-Tello, E; Barranco-Usón, J; Munilla-López, E; Del Corral-Beamonte, E

    2016-12-01

    To determine the prevalence of pressure ulcers in patients hospitalized in internal medicine and the clinical factors and risk of death associated with its presence. Prospective cohort study with patients hospitalized in internal medicine. We recorded the age, sex, presence of pressure ulcers, degree of ulceration, Barthel index, Norton scale, major diagnostic category, length of hospital stay and weight of the diagnosis-related groups. We compared the clinical characteristics of the patients with or without ulcers and analysed the mortality after 3 years based on the presence of ulcers. The study included 699 patients, 100 of whom (14.3%) had pressure ulcers (27 with grade I, 17 with grade II, 21 with grade III, 25 with grade IV and 10 with unknown grade). The Barthel index (OR 0.985; 95% CI 0.972-0.998; p=.022) and Norton scale (OR 0.873; 95% CI 0.780-0.997; p=.018) are independently associated with ulcers. Twenty-three percent of the patients with ulcers died during hospitalization, 68% died within a year, and 83% died within 3 years. The presence of pressure ulcers was independently associated with mortality (HR, 1.531; 95% CI 1.140-2.056; p=.005). Pressure ulcers are common in patients hospitalized in internal medicine, and their presence is associated with higher short, medium and long-term mortality. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  20. Does Dietary Deoxynivalenol Modulate the Acute Phase Reaction in Endotoxaemic Pigs?—Lessons from Clinical Signs, White Blood Cell Counts, and TNF-Alpha

    PubMed Central

    Tesch, Tanja; Bannert, Erik; Kluess, Jeannette; Frahm, Jana; Kersten, Susanne; Breves, Gerhard; Renner, Lydia; Kahlert, Stefan; Rothkötter, Hermann-Josef; Dänicke, Sven

    2015-01-01

    We studied the interaction between deoxynivalenol (DON)-feeding and a subsequent pre- and post-hepatic immune stimulus with the hypothesis that the liver differently mediates the acute phase reaction (APR) in pigs. Barrows (n = 44) were divided into a DON-(4.59 mg DON/kg feed) and a control-diet group, surgically equipped with permanent catheters pre- (V. portae hepatis) and post-hepatic (V. jugularis interna) and infused either with 0.9% NaCl or LPS (7.5 µg/kg BW). Thus, combination of diet (CON vs. DON) and infusion (CON vs. LPS, jugular vs. portal) created six groups: CON_CONjug.-CONpor., CON_CONjug.-LPSpor., CON_LPSjug.-CONpor., DON_CONjug.-CONpor., DON_CONjug.-LPSpor., DON_LPSjug.-CONpor.. Blood samples were taken at −30, 15, 30, 45, 60, 75, 90, 120, 150, 180 min relative to infusion and analyzed for leukocytes and TNF-alpha. Concurrently, clinical signs were scored and body temperature measured during the same period. LPS as such induced a dramatic rise in TNF-alpha (p < 0.001), hyperthermia (p < 0.01), and severe leukopenia (p < 0.001). In CON-fed pigs, an earlier return to physiological base levels was observed for the clinical complex, starting at 120 min post infusionem (p < 0.05) and persisting until 180 min. DON_LPSjug.-CONpor. resulted in a lower temperature rise (p = 0.08) compared to CON_LPSjug.-CONpor.. In conclusion, APR resulting from a post-hepatic immune stimulus was altered by chronic DON-feeding. PMID:26703732

  1. [Bibliometric analysis of scientific output on influenza in Mexico, 2000-2012].

    PubMed

    Castillo-Pérez, José Juan; Muñoz-Valera, Luz; García-Gómez, Francisco; Mejía-Aranguré, Juan Manuel

    2015-01-01

    Introducción: la influenza H1N1 se convirtió en la primera pandemia del siglo XXI en 2009-2010. En México no hay estudios bibliométricos que hayan analizado este tema en relación con la generación del conocimiento mexicano. El objetivo es determinar el volumen e impacto de la producción científica mexicana publicada en revistas del Science Citation Index (SCI) sobre influenza en el periodo 2000-octubre de 2012. Métodos: se incluyeron todos los documentos vertidos en SCI cuyo tema de abordaje fuera influenza; para esto se emplearon los descriptores influenza o swine flu H1N1. El análisis incluyó autoría, patrón de colaboración internacional, revistas, tipo de documento, citaciones y dirección de correspondencia. Resultados: en 2000-2012 se publicaron 241 artículos relacionados con influenza. Los años con el número más alto de artículos publicados fueron 2009 (n = 53) y 2010 (n = 62). Las revistas con más publicaciones fueron Salud Pública de México (n = 16), PLOS ONE (n = 13), Archives of Medical Research (n = 13) y Vaccine (n = 10). El área más investigada fue enfermedades infecciosas (18.9 %), seguida de medicina interna (14 %) e inmunología (14 %), salud ocupacional (13 %) y medicina experimental (12.3 %). Conclusión: la producción científica sobre la influenza supone cerca del 1 % del total de la producción médico-científica con un decremento posterior a la pandemia de influenza en 2009.

  2. Acute and Chronic Changes in Aquaporin 4 Expression After Spinal Cord Injury

    PubMed Central

    Nesic, Olivera; Lee, Julieann; Ye, Zaiming; Unabia, Geda C.; Rafati, Danny; Hulsebosch, Claire E.; Perez-Polo, J. Regino

    2007-01-01

    The effect of spinal cord injury (SCI) on the expression levels and distribution of water channel aquaporin 4 (AQP4) has not been studied. We have found AQP4 in gray and white matter astrocytes in both uninjured and injured rat spinal cords. AQP4 was detected in astrocytic processes that were tightly surrounding neurons and blood vessels, but more robustly in glia limitans externa and interna, which were forming an interface between spinal cord parenchyma and cerebrospinal fluid (CSF). Such spatial distribution of AQP4 suggests a critical role that astrocytes expressing AQP4 play in the transport of water from blood/CSF to spinal cord parenchyma and vice versa. SCI induced biphasic changes in astrocytic AQP4 levels, including its early down-regulation and subsequent persistent up-regulation. However, changes in AQP4 expression did not correlate well with the onset and magnitude of astrocytic activation, when measured as changes in GFAP expression levels. It appears that reactive astrocytes began expressing increased levels of AQP4 after migrating to the wound area (thoracic region) two weeks after SCI, and AQP4 remained significantly elevated for months after SCI. We also showed that increased levels of AQP4 spread away from the lesion site to cervical and lumbar segments, but only in chronically injured spinal cords. Although overall AQP4 expression levels increased in chronically-injured spinal cords, AQP4 immunolabeling in astrocytic processes forming glia limitans externa was decreased, which may indicate impaired water transport through glia limitans externa. Finally, we also showed that SCI-induced changes in AQP4 protein levels correlate, both temporally and spatially, with persistent increases in water content in acutely and chronically injured spinal cords. Although correlative, this finding suggests a possible link between AQP4 and impaired water transport/edema/syringomyelia in contused spinal cords. PMID:17074445

  3. Turning a Negative into a Positive: Ascending GABAergic Control of Cortical Activation and Arousal

    PubMed Central

    Brown, Ritchie E.; McKenna, James T.

    2015-01-01

    Gamma-aminobutyric acid (GABA) is the main inhibitory neurotransmitter in the brain. Recent technological advances have illuminated the role of GABAergic neurons in control of cortical arousal and sleep. Sleep-promoting GABAergic neurons in the preoptic hypothalamus are well-known. Less well-appreciated are GABAergic projection neurons in the brainstem, midbrain, hypothalamus, and basal forebrain, which paradoxically promote arousal and fast electroencephalographic (EEG) rhythms. Thus, GABA is not purely a sleep-promoting neurotransmitter. GABAergic projection neurons in the brainstem nucleus incertus and ventral tegmental nucleus of Gudden promote theta (4–8 Hz) rhythms. Ventral tegmental area GABAergic neurons, neighboring midbrain dopamine neurons, project to the frontal cortex and nucleus accumbens. They discharge faster during cortical arousal and regulate reward. Thalamic reticular nucleus GABAergic neurons initiate sleep spindles in non-REM sleep. In addition, however, during wakefulness, they tonically regulate the activity of thalamocortical neurons. Other GABAergic inputs to the thalamus arising in the globus pallidus pars interna, substantia nigra pars reticulata, zona incerta, and basal forebrain regulate motor activity, arousal, attention, and sensory transmission. Several subpopulations of cortically projecting GABAergic neurons in the basal forebrain project to the thalamus and neocortex and preferentially promote cortical gamma-band (30–80 Hz) activity and wakefulness. Unlike sleep-active GABAergic neurons, these ascending GABAergic neurons are fast-firing neurons which disinhibit and synchronize the activity of their forebrain targets, promoting the fast EEG rhythms typical of conscious states. They are prominent targets of GABAergic hypnotic agents. Understanding the properties of ascending GABAergic neurons may lead to novel treatments for diseases involving disorders of cortical activation and wakefulness. PMID:26124745

  4. Computed tomography evaluation of patients with chronic headache.

    PubMed Central

    Dumas, M D; Pexman, J H; Kreeft, J H

    1994-01-01

    OBJECTIVE: To determine whether the rate of detecting a tumour, arteriovenous malformation (AVM) or aneurysm with the use of enhanced or unenhanced computed tomography (CT) is significant in patients with chronic headache and to calculate the cost. DESIGN: Case series. SETTING: Chronic headache clinic at a tertiary care referral centre. PATIENTS: All 373 consecutive patients with chronic headache (284 women, 89 men) referred for CT scanning from May 1987 to October 1992 who met one or more of the following criteria: increased severity of symptoms or resistance to appropriate drug therapy (287 patients [76.9%]), change in characteristics or pattern of headache (78 [20.9%]) or family history of intracranial structural lesion (8 [2.1%]). INTERVENTIONS: CT scans of the head were enhanced with nonionic contrast medium (292 scans), were unenhanced (70) or involved both methods (40). OUTCOME MEASURES: Number and nature of minor and major findings, and total price per scan. RESULTS: Of the 402 CT scans 14 (95% confidence interval [CI] 7 to 21) revealed minor findings that did not alter patient management: infarct (9 scans), cerebral atrophy (2), cavum vergae (1), hyperostosis frontalis interna (1) and communicating hydrocephalus (1). Four scans (95% CI 0 to 8) showed significant lesions: osteoma (2), low-grade glioma (1) and aneurysm (1); only the aneurysm was treated. There were no cases of AVM. An unenhanced scan cost $82.63 and an enhanced scan $204.05. The cost per significant finding was over $18,000. In all, it cost $74,243 to find one treatable vascular lesion. CONCLUSIONS: The detection rate of CT scanning in patients with chronic headache is similar to that expected in the general population, provided the neurologic findings are normal. The cost of detecting intracranial lesions in this patient population is high [corrected]. PMID:7954139

  5. The evolution of amphibian metamorphosis: insights based on the transformation of the aortic arches of Pelobates fuscus (Anura)

    PubMed Central

    Kolesová, Hana; Lametschwandtner, Alois; Roček, Zbyněk

    2007-01-01

    In order to gain insights into how the aortic arches changed during the transition of vertebrates to land, transformations of the aortic arches during the metamorphosis of Pelobates fuscus were investigated and compared with data from the early development of a recent ganoid fish Amia calva and a primitive caudate amphibian Salamandrella keyserlingi. Although in larval Pelobates, as in other non-pipid anurans, the gill arches serve partly as a filter-feeding device, their aortic arches maintain the original piscine-like arrangement, except for the mandibular and hyoid aortic arches which were lost. As important pre-adaptations for breathing of atmospheric oxygen occur in larval Pelobates (which have well-developed, though non-respiratory lungs and pulmonary artery), transformation of aortic arches during metamorphosis is fast. The transformation involves disappearance of the ductus Botalli, which results in a complete shunting of blood into the lungs and skin, disappearance of the ductus caroticus, which results in shunting of blood into the head through the arteria carotis interna, and disappearance of arch V, which results in shunting blood to the body through arch IV (systemic arch). It is supposed that the branching pattern of the aortic arches of permanently water-dwelling piscine ancestors, of intermediate forms which occasionally left the water and of primitive tetrapods capable of spending longer periods of time on land had been the same as in the prematamorphic anuran larvae or in some metamorphosed caudates in which the ductus caroticus and ductus Botalli were not interrupted, and arch V was still complete. PMID:17367494

  6. Compensatory stepping in Parkinson's disease is still a problem after deep brain stimulation randomized to STN or GPi

    PubMed Central

    St George, R. J.; Carlson-Kuhta, P.; King, L. A.; Burchiel, K. J.

    2015-01-01

    The effects of deep brain stimulation (DBS) on balance in people with Parkinson's disease (PD) are not well established. This study examined whether DBS randomized to the subthalamic nucleus (STN; n = 11) or globus pallidus interna (GPi; n = 10) improved compensatory stepping to recover balance after a perturbation. The standing surface translated backward, forcing subjects to take compensatory steps forward. Kinematic and kinetic responses were recorded. PD-DBS subjects were tested off and on their levodopa medication before bilateral DBS surgery and retested 6 mo later off and on DBS, combined with off and on levodopa medication. Responses were compared with PD-control subjects (n = 8) tested over the same timescale and 17 healthy control subjects. Neither DBS nor levodopa improved the stepping response. Compensatory stepping in the best-treated state after surgery (DBS+DOPA) was similar to the best-treated state before surgery (DOPA) for the PD-GPi group and the PD-control group. For the PD-STN group, there were more lateral weight shifts, a delayed foot-off, and a greater number of steps required to recover balance in DBS+DOPA after surgery compared with DOPA before surgery. Within the STN group five subjects who did not fall during the experiment before surgery fell at least once after surgery, whereas the number of falls in the GPi and PD-control groups were unchanged. DBS did not improve the compensatory step response needed to recover from balance perturbations in the GPi group and caused delays in the preparation phase of the step in the STN group. PMID:26108960

  7. Assessment of thromboprophylaxis in medical patients hospitalized in Andalusia. A multicenter study.

    PubMed

    Navarro Puerto, M A; Medrano Ortega, F J; Izquierdo Guerrero, R; Calderón Sandubete, E; Buzón-Barrera, M L; Marín-León, I

    2015-04-01

    Hospitalized patients are a population at risk for venous thromboembolism (VTE). The PRETEMED-2007 clinical practice guidelines help identify high-risk medical patients who are suited to thromboprophylaxis. These guidelines therefore provide a standard for prophylaxis in such patients. We evaluated the risk of VTE and the adjustment of thromboprophylaxis to the standards of the PRETEMED-2007 guidelines in patients hospitalized in internal medicine departments. An observational, cross-sectional multicenter study was performed in 2010 in 16 hospitals in Andalusia and included 20 consecutive patients per center. The study variables were age, sex, risk factors for VTE and hemorrhage, the risk-adjusted PRETEMED of VTE, adjustment of thromboembolic prophylaxis at admission and at discharge and hospital mortality. The study included 293 patients (57.8% men) with a mean age of 69 (±15) years. The most common triggers for VTE were acute severe infection (27.3%) and neoplasia (16.4%). Some 43.4% of the patients presented a risk of hemorrhage. The risk of VTE at admission and discharge was high in 47.8% and 31% and moderate in 8.2% and 10.6%, respectively. A total of 91.7% and 17.3% of the patients underwent prophylaxis with low-molecular-weight heparin on admission and at discharge, respectively. The prescription was appropriate for 59.9% of the patients at admission (overutilization 38.4%, underutilization 1.7%) and for 74.7% at discharge (overutilization 5.4%, underutilization 19.9%). The adjustment was greater in patients older than 60 years and with greater hemorrhagic risk. For 60% of the patients admitted to the departments of internal medicine in Andalusia, the thromboprophylaxis was appropriate. The inadequacy of thromboprophylaxis (40%) is mostly due to overutilization. These results suggest significant space for improvement. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  8. Scientific production and bibliometric impact of a representative group of Spanish internists with established research careers.

    PubMed

    Burbano Santos, P; Miró, Ò; Martín-Sánchez, F J; Fernández Pérez, C; Casademont, J

    2015-10-01

    To study the temporal evolution of the bibliometric indices of internists with established research experience in order to predict the future behavior of researchers and to assess whether output focused on a specific area of internal medicine helps obtain greater visibility than in general internal medicine. We analyzed a representative group of members of the Spanish Society of Internal Medicine (SEMI) based on data obtained from the Web of Science. As an indicator of productivity, we analyzed the number of articles published. As impact indicators, we studied the impact factor (IF), the number of citations and the h-index. We analyzed 42 internists, with a mean experience of 30 years and a total of 6655 publications. The mean (SD) number of studies was 158 (96), the number of citations was 2,850 (2,865), the IF was 711 (549) and the h-index was 25 (11). These figures were higher for the specialist internists than for the general internists. There was a good relationship between the impact and productivity indicators (R(2)=.61-.89) and a poor relationship between these indicators and the years of experience (R(2)=.13-.19). The temporal evolution of these indicators for each individual researcher and for all researchers as a whole was adjusted to a second-degree polynomial model, with the h-index having the highest R(2) values. The h-index is the factor that had the best adjustment and least variability and could therefore help predict the future scientific output and impact of internists. The specialist researchers achieved greater visibility than the general internists. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  9. Stroke in young adults: Incidence rate, risk factors, treatment and prognosis.

    PubMed

    González-Gómez, F J; Pérez-Torre, P; DeFelipe, A; Vera, R; Matute, C; Cruz-Culebras, A; Álvarez-Velasco, R; Masjuan, J

    2016-10-01

    To analyse the incidence, risk factors, aetiology, treatment and clinical evolution of young patients with stroke. Retrospective registry of patients aged 55 years or younger hospitalised in a stroke unit during 2014. We recorded the incidence rate for all strokes and analysed demographic data, risk factors, degree of stress, stroke type and aetiology, reperfusion treatments and clinical evolution. The study included 110 patients, the majority of whom were men (60.9%, 1.6:1 ratio). The incidence rate was 13.3% (110 of 830 strokes). Most of the patients had cardiovascular risk factors. Smoking was the most common risk factor (56.4%), followed by arterial hypertension (50%), dyslipidaemia (42.7%), obesity (33%), diabetes (18.2%) and emboligenic heart disease (12.7%). Some 64.3% of the heart disease cases and 51.1% of the dyslipidaemia cases were discovered during hospitalisation. Some 57.2% of the patients experienced psychosocial stress in the stage prior to the stroke. Some 83.6% of the stroke cases were ischaemic, 12.7% were haemorrhagic and 3.6% were venous sinus thrombosis. Of the ischaemic stroke cases, 30.4% were cryptogenic, 23.9% were lacunar, 16.3% were from uncommon causes, 15.2% were atherothrombotic and 14.1% were cardioembolic. Some 78.6% of the cerebral haemorrhage cases were hypertensive. Some 23.3% of the ischaemic stroke cases underwent reperfusion treatments in the acute phase, achieving levels of functional independence at 3 months of 62.5%. The majority of stroke events in patients 55 years of age or younger appear to be related to a high prevalence of classical cardiovascular risk factors and possibly to psychosocial stress. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  10. Red wine intake but not other alcoholic beverages increases total antioxidant capacity and improves pro-inflammatory profile after an oral fat diet in healthy volunteers.

    PubMed

    Torres, A; Cachofeiro, V; Millán, J; Lahera, V; Nieto, M L; Martín, R; Bello, E; Alvarez-Sala, L A

    2015-12-01

    Different alcoholic beverages exert different effects on inflammation and oxidative stress but these results are controversial and scanty in some aspects. We analyze the effect of different alcoholic beverages after a fat-enriched diet on lipid profile, inflammatory factors and oxidative stress in healthy people in a controlled environment. We have performed a cross-over design in five different weeks. Sixteen healthy volunteers have received the same oral fat-enriched diet (1486kcal/m(2)) and a daily total amount of 16g/m(2) of alcohol, of different beverages (red wine, vodka, brandy or rum) and equivalent caloric intakes as sugar with water in the control group. We have measured the levels of serum lipids, high sensitivity C-reactive protein (hsCRP), tumor necrosis factor α (TNFα), interleukin 6 (IL-6), soluble phospholipase A2 (sPLA2), lipid peroxidation (LPO) and total antioxidant capacity (TAC). Red wine intake was associated with decreased of mean concentrations of hsCRP, TNFα and IL-6 induced by fat-enriched diet (p<0.05); nevertheless, sPLA2 concentrations were not significantly modified. After a fat-enriched diet added with red wine, TAC increased as compared to the same diet supplemented with rum, brandy, vodka or the control (water with sugar) (p<0.05). Moderate red wine intake, but not other alcoholic beverages, decreased pro-inflammatory factors and increased total antioxidant capacity despite a fat-enriched diet intake in healthy young volunteers. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  11. Deep Brain Stimulation for Parkinson’s Disease: Recent Trends and Future Direction

    PubMed Central

    FUKAYA, Chikashi; YAMAMOTO, Takamitsu

    2015-01-01

    To date, deep brain stimulation (DBS) has already been performed on more than 120,000 patients worldwide and in more than 7,000 patients in Japan. However, fundamental understanding of DBS effects on the pathological neural circuitry remains insufficient. Recent studies have specifically shown the importance of cortico-striato-thalamo-cortical (CSTC) loops, which were identified as functionally and anatomically discrete units. Three main circuits exist in the CSTC loops, namely, the motor, associative, and limbic circuits. From these theoretical backgrounds, it is determined that DBS sometimes influences not only motor functions but also the cognitive and affective functions of Parkinson’s disease (PD) patients. The main targets of DBS for PD are subthalamic nucleus (STN) and globus pallidus interna (GPi). Ventralis intermedius (Vim)-DBS was found to be effective in improving tremor. However, Vim-DBS cannot sufficiently improve akinesia and rigidity. Therefore, Vim-DBS is seldom carried out for the treatment of PD. In this article, we review the present state of DBS, mainly STN-DBS and GPi-DBS, for PD. In the first part of the article, appropriate indications and practical effects established in previous studies are discussed. The findings of previous investigations on the complications caused by the surgical procedure and on the adverse events induced by DBS itself are reviewed. In the second part, we discuss target selection (GPi vs. STN) and the effect of DBS on nonmotor symptoms. In the final part, as issues that should be resolved, the suitable timing of surgery, symptoms unresponsive to DBS such as on-period axial symptoms, and the related postoperative programing of stimulation parameters, are discussed. PMID:25925761

  12. Cranial reconstruction using allogeneic mesenchymal stromal cells: A phase 1 first-in-human trial.

    PubMed

    Morrison, David Anthony; Kop, Alan Matthew; Nilasaroya, Anastasia; Sturm, Marian; Shaw, Kathryn; Honeybul, Stephen

    2017-05-09

    Cranioplasty is necessary for patients that have undergone craniectomy following trauma, stroke or other causes of elevated intracranial pressure. This study assessed the effectiveness of treating cranial defects with allogeneic mesenchymal stromal cells (MSC) on a ceramic carrier and polymer scaffold, to produce viable bone and healing of a cranial void. Patients underwent a baseline computed tomography (CT) scan for construct design. Two sets of interlocking moulds were three-dimensional printed to enable shaping of two polymer meshes, which formed the boundaries of the construct corresponding to restoration of the skull interna and externa. In vitro expanded donor MSC were seeded onto ceramic granules in a good manufacturing practices facility. The inner mesh was placed in theatre, followed by the cell-loaded granules, and the outer mesh. Patients were followed-up at 3, 6 and 12 months and cosmesis assessed visually, while bone formation was assessed by CT scans at 1 day, 3 months and 12 months. Manufacture of the construct and surgery was uneventful for all three patients. Initial cosmesis was excellent with no complications. New bone formation was demonstrated by analysis of CT data; however, bone resorption was noted in all 3 cases on the 12-month CT scan. The lack of rigidity of the construct in an environment with continuous pulsatile movement may be preventing the formation of solid bone. It is possible to produce a customized allogeneic MSC construct for cranial reconstruction to replace cranial bone with good cosmesis, using a combination of medical computer modelling, rapid-prototyping and tissue engineering. Copyright © 2017 John Wiley & Sons, Ltd.

  13. A systematic review of the clinical validity of the Cologuard™ genetic test for screening colorectal cancer.

    PubMed

    Onieva-García, M Á; Llanos-Méndez, A; Baños-Álvarez, E; Isabel-Gómez, R

    2015-12-01

    The aim of this study was to assess the available evidence on the validity, diagnostic accuracy and clinical utility of the multitarget DNA test in faeces (Cologuard™) for screening for colorectal cancer (CRC). A systematic review was performed by consulting MedLine, EMBASE and Web of Science to July 2014. Studies on diagnostic tests were selected that evaluated the test in asymptomatic adults who underwent CRC screening. The quality and risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. The level of evidence was defined according to the National Institute for Health and Clinical Excellence. A qualitative synthesis was conducted. A total of 299 literature references were identified, including 1 synthesis report and 5 diagnostic test studies. Three of the 5 studies had a case-control design in Sackett phase II and were of moderate quality, and 2 had a prospective design in Sacket phase III and were of high quality. The sensitivity for detecting CRC was greater than 90%, but only 40% for detecting advanced adenomas. The test provided conclusive diagnostic evidence to rule out CRC (negative likelihood ratio, LR-: 0.02-0.09), although it was not useful for ruling out advanced adenoma (LR-: 0.5-0.7). The Cologuard™ test is a valid screening test for ruling out cancerous lesions but is suboptimal for ruling out precancerous lesions. There is no evidence in terms of mortality, survival or cost-effectiveness. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  14. Concepts of neurosurgical management of chronic subdural haematoma: historical perspectives.

    PubMed

    Weigel, R; Krauss, J K; Schmiedek, P

    2004-02-01

    The history of chronic subdural haematoma (CSH), spanning from its possibly earliest beginnings throughout the centuries until the early 1980s, was investigated within the context of four different epochs. In the 'era of uncertainty', successful trephination, the modem method of choice for the treatment of CSH, was developed by neolithic men. Various historical sources indicate that patients with CSH might have undergone surgery at that time. CSH might have been one of the ailments that had spectacular courses of salvation after trephination. The entity of CSH was first described in the 'era of pioneers' in the seventeenth century by Johann Jacob Wepfer. The misconception of 'pachymeningitis hemorrhagica interna' was introduced by Rudolf Virchow in 1857. By the end of the nineteenth century it became more widely accepted that trauma was a possible cause of CSH. Successful neurosurgical treatment of CSH was first reported by Hulke in 1883. Putnam and Cushing, in 1925, focused on surgery as the treatment of choice for CSH. In the 'era of diagnostic refinement', the introduction of pneumencephalography and angiography allowed the diagnosis of CSH much earlier. Subsequently, the typical signs and symptoms of patients suffering from CSH changed from apathy and coma to headaches and discrete focal neurological symptoms. In the 'era of surgical routine', neurosurgical approaches became smaller and less invasive. Removal of the haematoma was identified as the primary goal of surgery. The use of closed system drainage markedly improved reexpansion of the brain after surgery. Burr hole craniostomy and twist drill craniostomy became the surgical treatment of first choice because of their low morbidity and mortality. There is growing evidence, however, that the neurosurgical learning curve has reached a plateau.

  15. Neural code alterations and abnormal time patterns in Parkinson’s disease

    NASA Astrophysics Data System (ADS)

    Andres, Daniela Sabrina; Cerquetti, Daniel; Merello, Marcelo

    2015-04-01

    Objective. The neural code used by the basal ganglia is a current question in neuroscience, relevant for the understanding of the pathophysiology of Parkinson’s disease. While a rate code is known to participate in the communication between the basal ganglia and the motor thalamus/cortex, different lines of evidence have also favored the presence of complex time patterns in the discharge of the basal ganglia. To gain insight into the way the basal ganglia code information, we studied the activity of the globus pallidus pars interna (GPi), an output node of the circuit. Approach. We implemented the 6-hydroxydopamine model of Parkinsonism in Sprague-Dawley rats, and recorded the spontaneous discharge of single GPi neurons, in head-restrained conditions at full alertness. Analyzing the temporal structure function, we looked for characteristic scales in the neuronal discharge of the GPi. Main results. At a low-scale, we observed the presence of dynamic processes, which allow the transmission of time patterns. Conversely, at a middle-scale, stochastic processes force the use of a rate code. Regarding the time patterns transmitted, we measured the word length and found that it is increased in Parkinson’s disease. Furthermore, it showed a positive correlation with the frequency of discharge, indicating that an exacerbation of this abnormal time pattern length can be expected, as the dopamine depletion progresses. Significance. We conclude that a rate code and a time pattern code can co-exist in the basal ganglia at different temporal scales. However, their normal balance is progressively altered and replaced by pathological time patterns in Parkinson’s disease.

  16. Dabigatran: Experience in standard clinical practice.

    PubMed

    Álvarez-Otero, J; de la Fuente-Aguado, J; Arias-Castaño, J C; González-González, L; Puerta-Louro, R; Araújo-Fernández, S

    2015-10-01

    Dabigatran is an anticoagulant drug and a direct thrombin inhibitor and has been approved for the prevention of ischaemic stroke secondary to nonvalvularauricular auricular fibrillation. The aim of this study was to determine the efficacy of dabigatran in clinical practice for preventing cerebral ischaemic events associated with nonvalvularauricular auricular fibrillation, as well as its tolerance and safety profile. A descriptive and retrospective study was conducted, which included all patients who started anticoagulant treatment with dabigatran between November 2011 and September 2012. Follow-up was performed from the start of treatment until June 2013. The incidence of ischaemic events of cerebral, cardiac and peripheral origin was recorded, as was the onset of adverse effects and haemorrhagic complications, whose location and severity were determined. We analysed 316 patients, with a mean age of 76.46±8.37 years, of whom 53.5% were men. Two patients (0.55/100 patient-years) presented ischaemic stroke (including one amaurosis fugax). Eight (2.18/100 patient-years) patients had an adverse ischaemic event, whose origin was cardiac in 5 (1.36/100 patient-years) cases and peripheral in 3 (0.81/100 patient-years). Forty (10.91/100 patient-years) patients had a haemorrhagic complication: 32 minor (8.73/100 patient-years) and 8 major (2.18/100 patient-years) haemorrhages. Dabigatran is effective in standard clinical practice in preventing stroke and has a safety profile similar to that reported in the clinical trials. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  17. Epidemiological and sociodemographic factors associated with complicated alcohol withdrawal syndrome.

    PubMed

    Monte-Secades, R; Blanco-Soto, M; Díaz-Peromingo, J A; Sanvisens-Bergé, A; Martín-González, M C; Barbosa, A; Rosón-Hernández, B; Tejero-Delgado, M A; Puerta-Louro, R; Rabuñal-Rey, R

    2017-10-01

    To analyse the influence of epidemiological and sociodemographic factors in complicated alcohol withdrawal syndrome (AWS). A multicentre, observational prospective study was conducted on consecutively added patients with AWS hospitalised in internal medicine departments. We recorded sociodemographic, epidemiological, clinical and progression data. Complicated AWS was defined as that which progressed with seizures or delirium tremens. We studied 228 episodes of AWS in 219 patients. The mean age was 54.5 years (SD, 11.5), and 90.8% were men. AWS was the cause for hospitalisation in 39.9% of the patients. Some 27.1% of the cases presented seizures, and 32.4% presented delirium tremens. The daily quantity of alcohol ingested was 17.8 standard drink units (SD, 21.4), with 16.6 years of dependence (SD, 11.3). The pattern of alcohol abuse was regular in 82.8% of the patients. Some 38.4% of the patients were married or had a partner, and 45.6% had children. Some 72.7% of the patients were unemployed or retired. Some 68.5% had only completed primary studies. Some 4.8% consumed cannabis, 5.2% consumed cocaine and 3% consumed opioids. The independent variables related to complicated AWS were consumption of a drug other than alcohol (OR, 5.3; 95% CI 1.5-18.7), low education level (OR, 3.4; 95% CI 1.6-7.3) and hospitalisation for AWS (OR, 2.9; 95% CI 1.5-5.6). The model's receiver operating characteristic area was 0.718 (95% CI 0.643-0.793). Concomitant drug abuse and a low educational level could help identify patients at risk of complicated AWS. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  18. Mass carbon monoxide poisoning among television viewers of a football match.

    PubMed

    Godoy, P; Pont, C; Artigues, A; Alsedà, M

    2016-11-01

    The objective was to study a mass carbon monoxide (CO) poisoning and the characteristics of the asymptomatic cases. On the 2nd of February, 2015, a group of more than 30 television viewers of a football match contacted the emergency department due to suspected CO poisoning from a butane stove. A visual inspection of the location of the exposure and a descriptive epidemiological study were conducted. Based on the type of variable, the presence of a statistical association was studied with Fisher's exact test or the Kruskal-Wallis test. Thirty-four of the 39 individuals were affected (87.2%). The exposed individuals had a mean age of 43.8 years (SD, 22.1), and 28.2% (11/39) were women. The time of exposure was 52.4min (SD, 21.0), and the mean distance from the oven was 4.2m (SD, 2.5). The most common symptoms were headache (50%), nausea (20.6%), weakness (20.6%) and dizziness (14.7%). The carboxyhaemoglobin (COHb) levels were very high (13.8% ±5.8%). Some 97.1% of the individuals required oxygen therapy, and 39.4% required hyperbaric chamber treatment. Some 29.5% of the cases had no symptoms but showed COHb levels similar to those that did have symptoms (13.6% vs. 15.3%, nonsignificant difference). The asymptomatic cases had a shorter exposure time (38.3min vs. 53.3min; P<.036). Almost a third of the exposed individuals were asymptomatic, even with COHb levels similar to those of the symptomatic patients, and the majority of these asymptomatic patients even required oxygen treatment in a hyperbaric chamber. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  19. [Development and validation of an instrument designed to measure the impact of networks of support for breastfeeding].

    PubMed

    Baño Piñero, Isabel; Canteras Jordana, Manuel; Carrillo García, Cesar; López Araez, Alicia; Martínez Roche, María Emilia

    2015-04-01

    Antecedentes: partimos de la hipótesis de que no existen suficientes cuestionarios validados que midan el impacto de las redes de apoyo a la lactancia materna para población hispano hablante. Objetivo: Por ese motivo, nos planteamos como objetivo general de este trabajo, elaborar y validar (a nivel de contenido y constructo) un instrumento de medida cuantitativa. Método: Se evaluó la validez de contenido sometiendo el cuestionario a un juicio de expertos en lactancia materna de la Región de Murcia. La prueba piloto se llevó a cabo entre los meses de marzo y abril de 2014. Las encuestas fueron realizadas directamente por las usuarias que acudían al grupo de apoyo a la lactancia “Lactando”. Para la validez de constructo se realizó un análisis factorial con el que se determinaron las distintas dimensiones que el cuestionario podría medir. Se realizó una estadística descriptiva de cada uno de los ítems. A través del análisis de componentes principales, se obtuvo la varianza total explicada, determinando así, los factores con los elementos que los definían. Resultados: A través del análisis factorial, el cuestionario obtuvo una alta consistencia interna para sus cinco componentes (satisfacción, consultas, experiencia, problemas y apoyo), consiguiendo valores de 0,942 a 0,632. Y un porcentaje de varianza total explicada elevado (11,157% - 5,093%). Conclusión: Este estudio ha servido para crear un instrumento pertinente y válido a nivel de contenido y de constructo, capaz de medir el impacto de las redes de apoyo a la lactancia a través de 5 dimensiones.

  20. Brainstem auditory evoked responses in an equine patient population: part I--adult horses.

    PubMed

    Aleman, M; Holliday, T A; Nieto, J E; Williams, D C

    2014-01-01

    Brainstem auditory evoked response has been an underused diagnostic modality in horses as evidenced by few reports on the subject. To describe BAER findings, common clinical signs, and causes of hearing loss in adult horses. Study group, 76 horses; control group, 8 horses. Retrospective. BAER records from the Clinical Neurophysiology Laboratory were reviewed from the years of 1982 to 2013. Peak latencies, amplitudes, and interpeak intervals were measured when visible. Horses were grouped under disease categories. Descriptive statistics and a posthoc Bonferroni test were performed. Fifty-seven of 76 horses had BAER deficits. There was no breed or sex predisposition, with the exception of American Paint horses diagnosed with congenital sensorineural deafness. Eighty-six percent (n = 49/57) of the horses were younger than 16 years of age. The most common causes of BAER abnormalities were temporohyoid osteoarthropathy (THO, n = 20/20; abnormalities/total), congenital sensorineural deafness in Paint horses (17/17), multifocal brain disease (13/16), and otitis media/interna (4/4). Auditory loss was bilateral and unilateral in 74% (n = 42/57) and 26% (n = 15/57) of the horses, respectively. The most common causes of bilateral auditory loss were sensorineural deafness, THO, and multifocal brain disease whereas THO and otitis were the most common causes of unilateral deficits. Auditory deficits should be investigated in horses with altered behavior, THO, multifocal brain disease, otitis, and in horses with certain coat and eye color patterns. BAER testing is an objective and noninvasive diagnostic modality to assess auditory function in horses. Copyright © 2014 by the American College of Veterinary Internal Medicine.

  1. The stigma of low opioid prescription in the hospitalized multimorbid elderly in Italy.

    PubMed

    Marengoni, Alessandra; Nobili, Alessandro; Corli, Oscar; Djade, Codjo Djignefa; Bertoni, Diana; Tettamanti, Mauro; Pasina, Luca; Corrao, Salvatore; Salerno, Francesco; Marcucci, Maura; Mannucci, Pier Mannuccio

    2015-04-01

    The primary aim of this study was to evaluate the prevalence of opioid prescriptions in hospitalized geriatric patients. Other aims were to evaluate factors associated with opioid prescription, and whether or not there was consistency between the presence of pain and prescription. Opioid prescriptions were gathered from the REgistro POliterapie Societa` Italiana di Medicina Interna (REPOSI) data for the years 2008, 2010 and 2012. 1,380 in-patients, 65+ years old, were enrolled in the first registry run, 1,332 in the second and 1,340 in the third. The prevalence of opioid prescription was calculated at hospital admission and discharge. In the third run of the registry, the degree of pain was assessed by means of a numerical scale. The prevalence of patients prescribed with opioids at admission was 3.8% in the first run, 3.6% in the second and 4.1% in the third, whereas at discharge rates were slightly higher (5.8, 5.3, and 6.6%). The most frequently prescribed agents were mild opioids such as codeine and tramadol. The number of total prescribed drugs was positively associated with opioid prescription in the three runs; in the third, dementia and a better functional status were inversely associated with opioid prescription. Finally, as many as 58% of patients with significant pain at discharge were prescribed no analgesic at all. The conservative attitude of Italian physicians to prescribe opioids in elderly patients changed very little between hospital admission and discharge through a period of 5 years. Reasons for such a low opioid prescription should be sought in physicians' and patients' concerns and prejudices.

  2. [Surgical management of paraclinoid aneurysms].

    PubMed

    Magallón-Barajas, Eduardo; Abdo-Toro, Miguel; Flores-Robles, Claudia

    2016-01-01

    Introducción: los aneurismas paraclinoideos se originan en los segmentos clinoideo C5 y oftálmico C6 de la arteria carótida interna. Su frecuencia aproximada es del 5 al 11 %. Para su manejo microquirúrgico se requiere de un conocimiento anatómico de la región y del aneurisma. El objetivo es mostrar el manejo neuroquirúrgico de los aneurismas paraclinoideos. Métodos: se hizo un estudio retrospectivo en un servicio de neurocirugía, de enero de 2009 a enero de 2015. Se incluyeron 66 pacientes con aneurisma paraclinoideo. Se obtuvieron las características clínicas, la evolución, las complicaciones y los resultados de los pacientes al revisar los expedientes clínicos y radiológicos. Resultados: 61 pacientes (92.4 %) pertenecieron al sexo femenino; a 65 se les realizó clipaje neuroquirúrgico y a uno se le realizó bypass cerebral con exclusión del aneurisma. Tuvieron ruptura del aneurisma con hemorragia subaracnoidea 46 pacientes. Por su localización 35 aneurismas paraclinoideos (53 %) fueron superiores, 20 mediales (30.3 %) y cuatro inferiores (6 %). Tuvieron aneurismas pequeños 33 pacientes (50 %), 23 grandes (34.8 %) y 10 gigantes (15.5 %). Presentaron buenos resultados 51 pacientes después del manejo quirúrgico, dado que sacaron calificaciones de 4 y 5 según el Glasgow Outcome Score (GOS). La amaurosis fue la complicación funcional más seria atribuible a la cirugía (tres pacientes). Conclusión: la microcirugía sigue siendo el tratamiento para estos aneurismas debido a su capacidad de excluirlos totalmente, además de que es el mejor método para descomprimir el nervio óptico.

  3. The climate change and energy security nexus

    SciTech Connect

    King, Marcus Dubois; Gulledge, Jay

    2013-01-01

    The study of the impacts of climate change on national and interna-tional security has grown as a research field, particularly in the last five years. Within this broad field, academic scholarship has concentrated primarily on whether climate change is, or may become, a driver of violent conflict. This relationship remains highly contested. However, national security policy and many non-governmental organizations have identified climate change as a threat multiplier in conflict situations. The U.S. Department of Defense and the United Kingdom's Ministry of Defense have incorporated these findings into strategic planning documents such as the Quadrennial Defense Review and the Strategic Defence and Security Review. In contrast to the climate-conflict nexus, our analysis found that academic scholarship on the climate change and energy security nexus is small and more disciplinarily focused. In fact, a search of social science litera-ture found few sources, with a significant percentage of these works attribut-able to a single journal. Assuming that policymakers are more likely to rely on broader social science literature than technical or scientific journals, this leaves a limited foundation. This then begged the question: what are these sources? We identified a body of grey literature on the nexus of climate change and energy security of a greater size than the body of peer-reviewed social science literature. We reviewed fifty-eight recent reports, issue briefs, and transcripts to better understand the nexus of climate change and energy security, as well as to gain insight about the questions policymakers need answered by those undertaking the research. In this article, we describe the nature of the sources reviewed, highlight possible climate change and energy security linkages found within those sources, identify emerging risks, and offer conclusions that can guide further research.

  4. [Infraorbital schwannoma. Case report].

    PubMed

    Mora-Ríos, Laura Evelyn; Ríos Y Valles-Valles, Dolores; Flores-Estrada, José Javier; Rodríguez-Reyes, Abelardo Antonio

    2014-01-01

    Antecedentes: el schwannoma infraorbitario es un tumor benigno de la vaina nerviosa periférica compuesto por células de Schwann. Suele aparecer entre los 20 y 70 años de edad, asintomático y producir proptosis progresiva e indolora durante su crecimiento. Caso clínico: paciente masculino de 32 años de edad que ingresó al hospital debido a un tumor no doloroso de crecimiento lentamente progresivo sobre el saco lagrimal izquierdo. A la exploración oftalmológica el tumor era de consistencia ahulada y estaba firmemente adherido a las estructuras vecinas. La transiluminación resultó negativa. El ultrasonido modo B mostró un ojo fáquico y un tumor infraorbitario homogéneo, bien circunstrito, con diámetro mayor de 19.7 mm, sin afectación de la vía lagrimal. El ultrasonido modo A mostró una reflectividad media-alta, con escasa vascularidad interna. La tomografía computada mostró un tumor de densidad homogénea, bien circunscrito a la región anterior y por debajo del globo ocular, sin erosión ósea. El tumor se extirpó mediante una incisión subdérmica. El diagnóstico histopatológico fue: schwannoma infraorbitario. Conclusiones: el schwannoma es un tumor benigno, poco frecuente en la órbita. Su diagnóstico definitivo se establece con base en los hallazgos histopatológicos, como: cápsula verdadera, áreas hiper e hipocelulares, engrosamiento y hialinización de las paredes vasculares. Sin esos hallazgos puede confundirse con tumores fusocelulares benignos. Se informa un nuevo caso de schwannoma infraorbitario y se compara con los casos previamente reportados.

  5. Magnetic resonance-transcranial ultrasound fusion imaging: A novel tool for brain electrode location.

    PubMed

    Walter, Uwe; Müller, Jan-Uwe; Rösche, Johannes; Kirsch, Michael; Grossmann, Annette; Benecke, Reiner; Wittstock, Matthias; Wolters, Alexander

    2016-03-01

    A combination of preoperative magnetic resonance imaging (MRI) with real-time transcranial ultrasound, known as fusion imaging, may improve postoperative control of deep brain stimulation (DBS) electrode location. Fusion imaging, however, employs a weak magnetic field for tracking the position of the ultrasound transducer and the patient's head. Here we assessed its feasibility, safety, and clinical relevance in patients with DBS. Eighteen imaging sessions were conducted in 15 patients (7 women; aged 52.4 ± 14.4 y) with DBS of subthalamic nucleus (n = 6), globus pallidus interna (n = 5), ventro-intermediate (n = 3), or anterior (n = 1) thalamic nucleus and clinically suspected lead displacement. Minimum distance between DBS generator and magnetic field transmitter was kept at 65 cm. The pre-implantation MRI dataset was loaded into the ultrasound system for the fusion imaging examination. The DBS lead position was rated using validated criteria. Generator DBS parameters and neurological state of patients were monitored. Magnetic resonance-ultrasound fusion imaging and volume navigation were feasible in all cases and provided with real-time imaging capabilities of DBS lead and its location within the superimposed magnetic resonance images. Of 35 assessed lead locations, 30 were rated optimal, three suboptimal, and two displaced. In two cases, electrodes were re-implanted after confirming their inappropriate location on computed tomography (CT) scan. No influence of fusion imaging on clinical state of patients, or on DBS implantable pulse generator function, was found. Magnetic resonance-ultrasound real-time fusion imaging of DBS electrodes is safe with distinct precautions and improves assessment of electrode location. It may lower the need for repeated CT or MRI scans in DBS patients. © 2015 International Parkinson and Movement Disorder Society.

  6. Early deep brain stimulation in patients with myoclonus-dystonia syndrome.

    PubMed

    Rocha, Helena; Linhares, Paulo; Chamadoira, Clara; Rosas, Maria José; Vaz, Rui

    2016-05-01

    Myoclonus-dystonia (MD) is a rare movement disorder which is disabling and frequently refractory to medical treatment. Deep brain stimulation (DBS) of the globus pallidus interna (GPi) has been used to treat some patients. Although there is significant motor improvement with DBS, the impact on disability and on quality of life has been infrequently reported. Also, the benefit of the procedure is not established in patients without ε-sarcoglycan gene (SGCE) mutations. We present two patients with severe MD treated with GPi-DBS, one of the patients without a SGCE mutation. Motor improvements (rest/action/total subscores of the Unified Myoclonus Rating Scale and movement subscore of the Burke-Fahn-Marsden Dystonia Rating Scale [BFMRS]) and disability (BFMRS disability subscore) were carefully evaluated preoperatively and at 6 and 12months after surgery. Quality of life (addressed using the Portuguese version of the Medical Outcomes Study 36-item Short-Form General Health Survey, version 2.0 [SF-36v2]) was tested preoperatively and 12months after DBS. At 12-month follow-up, myoclonus improved 78.6% in Patient 1 and 80.7% in Patient 2, while dystonia improved 37% and 86.7%, respectively. Improvements in disability ranged from 71.4% to 75%. With regard to quality of life, all parameters addressed by the SF-36v2 improved or stabilized in both patients. No major adverse effects were noticed. Improvements in motor symptoms are consistent with reports in the literature and were obtained regardless of the identification of a SGCE gene mutation. There were also significant benefits on disability and quality of life. DBS should be considered for MD.

  7. Induction of endothelin-2 expression by luteinizing hormone and hypoxia: possible role in bovine corpus luteum formation.

    PubMed

    Klipper, Eyal; Levit, Anat; Mastich, Yonit; Berisha, Bajram; Schams, Dieter; Meidan, Rina

    2010-04-01

    The pattern and regulation of endothlin-2 (EDN2) expression and its putative roles in bovine ovaries were investigated. EDN2 mRNA was determined in corpus luteum (CL) and during folliculoluteal transition induced by GnRH in vivo. EDN2 was elevated only in the early CL and was not present in older CL. In the young CL, EDN2 mRNA was identified mainly in luteal cells but not endothelial cells that expressed the EDN1 gene. Similarly, in preovulatory follicles, EDN2 was expressed in the granulosa cells (GCs) and not in the vascular theca interna. LH and hypoxia are two major stimulants of CL formation. Therefore, GCs were cultured with bovine LH, under hypoxic conditions. GCs incubated with bovine LH resulted in increased EDN2 mRNA 42 h later. CoCl2, a hypoxia-mimicking agent, elevated EDN2 in GCs in a dose-dependent manner. Incubation of the human GC line (Simian virus 40 large T antigen) under low oxygen tension (1%) augmented EDN2 6 and 24 h later. In these two cell types, along with EDN2, hypoxia augmented VEGF. EDN2 induced in GCs changes that characterize the developing CL: cell proliferation as well as up-regulation of vascular endothelial growth factor and cyclooxygenase-2 (mRNA and protein levels). Human chorionic gonadotropin also up-regulated these two genes. Small interfering RNA targeting EDN-converting enzyme-1 effectively reduced its mRNA levels. This treatment, expected to lower the mature EDN2 peptide production, inhibited VEGF mRNA levels and GC numbers. Together these data suggest that elevated EDN2 in the early bovine CL, triggered by LH surge and hypoxia, may facilitate CL formation by promoting angiogenesis, cell proliferation, and differentiation.

  8. Localization of Basal Ganglia and Thalamic Damage in Dyskinetic Cerebral Palsy.

    PubMed

    Aravamuthan, Bhooma R; Waugh, Jeff L

    2016-01-01

    Dyskinetic cerebral palsy affects 15%-20% of patients with cerebral palsy. Basal ganglia injury is associated with dyskinetic cerebral palsy, but the patterns of injury within the basal ganglia predisposing to dyskinetic cerebral palsy are unknown, making treatment difficult. For example, deep brain stimulation of the globus pallidus interna improves dystonia in only 40% of patients with dyskinetic cerebral palsy. Basal ganglia injury heterogeneity may explain this variability. To investigate this, we conducted a qualitative systematic review of basal ganglia and thalamic damage in dyskinetic cerebral palsy. Reviews and articles primarily addressing genetic or toxic causes of cerebral palsy were excluded yielding 22 studies (304 subjects). Thirteen studies specified the involved basal ganglia nuclei (subthalamic nucleus, caudate, putamen, globus pallidus, or lentiform nuclei, comprised by the putamen and globus pallidus). Studies investigating the lentiform nuclei (without distinguishing between the putamen and globus pallidus) showed that all subjects (19 of 19) had lentiform nuclei damage. Studies simultaneously but independently investigating the putamen and globus pallidus also showed that all subjects (35 of 35) had lentiform nuclei damage (i.e., putamen or globus pallidus damage); this was followed in frequency by damage to the putamen alone (70 of 101, 69%), the subthalamic nucleus (17 of 25, 68%), the thalamus (88 of 142, 62%), the globus pallidus (7/35, 20%), and the caudate (6 of 47, 13%). Globus pallidus damage was almost always coincident with putaminal damage. Noting consistent involvement of the lentiform nuclei in dyskinetic cerebral palsy, these results could suggest two groups of patients with dyskinetic cerebral palsy: those with putamen-predominant damage and those with panlenticular damage involving both the putamen and the globus pallidus. Differentiating between these groups could help predict response to therapies such as deep brain

  9. [Prognostic value of measuring the diameter and inspiratory collapse of the inferior vena cava in acute heart failure].

    PubMed

    Josa-Laorden, C; Giménez-López, I; Rubio-Gracia, J; Ruiz-Laiglesia, F; Garcés-Horna, V; Pérez-Calvo, J I

    2016-05-01

    To assess the utility of measuring the diameter and collapse of the inferior vena cava (IVC) in acute heart failure (AHF), its relationship with the prognosis and serum biomarkers of congestion. An observational prospective study was conducted that included 85 patients with AHF, classifying them into 4 groups according to IVC diameter (≤ or >20mm) and inspiratory collapse (< or ≥50%) at admission. The endpoints were mortality due to HF and the combined event of mortality and readmission for HF at 180 days. Some 24.7% of the patients had an undilated IVC and ≥50% collapse (group 1); 20% had an undilated IVC and <50% collapse (group 2), 5.9% had a dilated IVC and ≥50% collapse (group 3); and 49.4% had a dilated IVC and <50% collapse (group 4). The lack of inspiratory collapse but not IVC dilation was related to higher concentrations of urea (P=.007), creatinine (P=.004), uric acid (P=.008), NT-proBNP (P=.009) and CA125 (P=.005). Survival free of the combined event at 180 days was lower in those patients with no IVC collapse. Dilation and the absence of the inspiratory collapse of the IVC are common in the context of AHF. The lack of inspiratory collapse of the IVC during the decompensation phase identifies a subgroup of patients with poorer prognosis at 6 months. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  10. Impact of a do-not-do intervention on 12 laboratory measurements.

    PubMed

    Zambrana-García, J L; Macías Blanco, C; Fernández-Suárez, A; Peñacoba Masa, A; Olivares Durán, M J; Aguilar Benítez, J M; Zambrana-Luque, J L

    2017-08-19

    In recent years, various scientific societies and healthcare organisations have created recommendations aimed at decreasing the use of healthcare interventions that have shown no efficacy or effectiveness. The aim of this study was to assess the impact of an intervention on 12 do-not-do recommendations regarding the laboratory in 7 hospital centres. Before-after study conducted in 7 hospital centres of Cordoba and Jaen during 2015 and 2016. Based on the recommendations of existing scientific societies, a consensus was reached on various actions regarding laboratory measurements. We analysed the number and cost of measuring 6 tumour markers (carcinoembryonic antigen, prostate-specific antigen, carbohydrate antigen [CA] 15.3, CA125, CA19.9 and alpha-fetoprotein), thyrotropin, T3, T4, glycated haemoglobin, urea, ferritin and antigliadin antibodies, before and after implementing the consensus. Compared with the previous year, there were 55,902 fewer laboratory measurements (-19%) in 2016, with an overall savings of €82,100. The reduction in the number of measurements occurred mainly in plasma urea (-50.3%) and in the tumour markers CA125 (-16%), CA19.9 (-11.6%) and CA15.3 (-10.5%). The most pronounced savings were achieved in the measurements of urea (-€21,002), thyroid hormones (-€12,716) and thyrotropin (-€7,638). The adoption and consensus of do-not-do recommendations among healthcare levels resulted in a significant reduction in unnecessary measurements. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  11. Effects that passive cycling exercise have on muscle strength, duration of mechanical ventilation, and length of hospital stay in critically ill patients: a randomized clinical trial.

    PubMed

    Machado, Aline Dos Santos; Pires-Neto, Ruy Camargo; Carvalho, Maurício Tatsch Ximenes; Soares, Janice Cristina; Cardoso, Dannuey Machado; Albuquerque, Isabella Martins de

    2017-01-01

    To evaluate the effects that passive cycling exercise, in combination with conventional physical therapy, have on peripheral muscle strength, duration of mechanical ventilation, and length of hospital stay in critically ill patients admitted to the ICU of a tertiary care university hospital. This was a randomized clinical trial involving 38 patients (≥ 18 years of age) on mechanical ventilation who were randomly divided into two groups: control (n = 16), receiving conventional physical therapy; and intervention (n = 22), receiving conventional physical therapy and engaging in passive cycling exercise five days per week. The mean age of the patients was 46.42 ± 16.25 years, and 23 were male. The outcomes studied were peripheral muscle strength, as measured by the Medical Research Council scale, duration of mechanical ventilation, and length of hospital stay. There was a significant increase in peripheral muscle strength (baseline vs. final) in both groups (control: 40.81 ± 7.68 vs. 45.00 ± 6.89; and intervention: 38.73 ± 11.11 vs. 47.18 ± 8.75; p < 0.001 for both). However, the range of increase in strength was higher in the intervention group than in the control group (8.45 ± 5.20 vs. 4.18 ± 2.63; p = 0.005). There were no significant differences between the groups in terms of duration of mechanical ventilation or length of hospital stay. The results suggest that the performance of continuous passive mobilization on a cyclical basis helps to recover peripheral muscle strength in ICU patients. (ClinicalTrials.gov Identifier: NCT01769846 [http://www.clinicaltrials.gov/]). Avaliar os efeitos da realização de exercícios passivos com um cicloergômetro, associada à fisioterapia convencional, na força muscular periférica, no tempo de ventilação mecânica e no tempo de internação hospitalar em pacientes críticos internados em UTI de um hospital universitário terciário. Ensaio clínico randomizado envolvendo 38 pacientes (idade > 18 anos) em ventila

  12. NEW TECHNIQUE FOR OBESITY SURGERY: INTERNAL GASTRIC PLICATION TECHNIQUE USING INTRAGASTRIC SINGLE-PORT (IGS-IGP) IN EXPERIMENTAL MODEL.

    PubMed

    Müller, Verena; Fikatas, Panagiotis; Gül, Safak; Noesser, Maximilian; Fuehrer, Kirs Ten; Sauer, Igor; Pratschke, Johann; Zorron, Ricardo

    2017-01-01

    Bariatric surgery is currently the most effective method to ameliorate co-morbidities as consequence of morbidly obese patients with BMI over 35 kg/m2. Endoscopic techniques have been developed to treat patients with mild obesity and ameliorate comorbidities, but endoscopic skills are needed, beside the costs of the devices. To report a new technique for internal gastric plication using an intragastric single port device in an experimental swine model. Twenty experiments using fresh pig cadaver stomachs in a laparoscopic trainer were performed. The procedure was performed as follow in ten pigs: 1) volume measure; 2) insufflation of the stomach with CO2; 3) extroversion of the stomach through the simulator and installation of the single port device (Gelpoint Applied Mini) through a gastrotomy close to the pylorus; 4) performance of four intragastric handsewn 4-point sutures with Prolene 2-0, from the gastric fundus to the antrum; 5) after the performance, the residual volume was measured. Sleeve gastrectomy was also performed in further ten pigs and pre- and post-procedure gastric volume were measured. The internal gastric plication technique was performed successfully in the ten swine experiments. The mean procedure time was 27±4 min. It produced a reduction of gastric volume of a mean of 51%, and sleeve gastrectomy, a mean of 90% in this swine model. The internal gastric plication technique using an intragastric single port device required few skills to perform, had low operative time and achieved good reduction (51%) of gastric volume in an in vitro experimental model. A cirurgia bariátrica é atualmente o método mais efetivo para melhorar as co-morbidades decorrentes da