Progressive plasticity during colorectal cancer metastasis.

Metastasis is the principal cause of cancer death, yet we lack an understanding of metastatic cell states, their relationship to primary tumor states, and the mechanisms by which they transition. In a cohort of biospecimen trios from same-patient normal colon, primary and metastatic colorectal cancer, we show that while primary tumors largely adopt LGR5 + intestinal stem-like states, metastases display progressive plasticity. Loss of intestinal cell states is accompanied by reprogramming into a highly conserved fetal progenitor state, followed by non-canonical differentiation into divergent squamous and neuroendocrine-like states, which is exacerbated by chemotherapy and associated with poor patient survival. Using matched patient-derived organoids, we demonstrate that metastatic cancer cells exhibit greater cell-autonomous multilineage differentiation potential in response to microenvironment cues than their intestinal lineage-restricted primary tumor counterparts. We identify PROX1 as a stabilizer of intestinal lineage in the fetal progenitor state, whose downregulation licenses non-canonical reprogramming.

The 2021 SIIM-FISABIO-RSNA Machine Learning COVID-19 Challenge: Annotation and Standard Exam Classification of COVID-19 Chest Radiographs.

We describe the curation, annotation methodology, and characteristics of the dataset used in an artificial intelligence challenge for detection and localization of COVID-19 on chest radiographs. The chest radiographs were annotated by an international group of radiologists into four mutually exclusive categories, including "typical," "indeterminate," and "atypical appearance" for COVID-19, or "negative for pneumonia," adapted from previously published guidelines, and bounding boxes were placed on airspace opacities. This dataset and respective annotations are available to researchers for academic and noncommercial use.

Influence of high power ultrasound on natural microflora, pathogen and lactic acid bacteria in a raw meat emulsion.

Raw meat emulsions may have natural, spoilage and pathogenic microorganisms due to the origin and characteristics of this food matrix. All of these microorganisms must be minimized during industrial processing to make food consumption safe and meet quality regulations. Therefore, in this research, the effect of probe ultrasound on the inactivation of three kinds of microorganisms in a raw meat emulsion is evaluated. The microorganisms are: natural microflora NAM, Listeria monocytogenes LIS, and Lactobacillus delbrueckii LAC. A high-intensity probe ultrasound system was used, during 1.0, 2.5, 5.0, 7.5 and 10 min, with pulsed waves of 0.0, 10, 20 and 30 seg, and 200, 250, 300, 350 and 400 W of power. The interrelation between time, wave pulse cycle, and power factors was assessed. The results showed a positive linear independence effect in the treatments without wave pulse for each microorganism, and a quadratic interaction with the time and the ultrasound power for the inactivation of the three kinds of microorganisms. Besides, the desirability function for the inactivation reached up to 60% of the microbial population with the probe ultrasound treatment, with 10 min, a 7.56 s wave pulse and 400 W of power. Thus, these results could be useful to decide the incorporation of mild and emerging technologies in a meat industry line process.

Surgical treatment of periprosthetic humerus fractures and algorithm. / Tratamiento quirúrgico de las fracturas periprotésicas de húmero y algoritmo de actuación.

INTRODUCTION: Periprosthetic humerus fractures are infrequent and sometimes difficult to treat. There is limited literature and no consensus on the handling of these fractures. The objective of this study was to compare our results with those published in the literature, in order to improve our care and propose a management algorithm. MATERIAL AND METHOD: Observational study of 10cases of periprosthetic humerus fractures with a mean follow-up of the patients of 23months. An analysis of sociodemographic, radiological and surgical variables was performed. They were reviewed clinically and by telephone using the UCLA Shoulder Score and Quick-DASH scales. A systematic search was made in Pubmed for periprosthetic humerus fractures, for a literature review with which to compare our series. RESULTS: We analysed 10patients with an average age of 69.4years (37-91). Of the patients, 90% underwent surgery through open reduction and internal fixation. Nine of the ten patients consolidated in a mean time of 6.2months (range 5-12), the remaining suffered a new fracture 5months after the intervention, who were reoperated and a new osteosynthesis performed with bone allograft. In the UCLA scale there was a decrease of 10.66points, and an increase of 27.3points in the Quick-DASH, at the end of the follow-up. CONCLUSIONS: In our series of cases we found similarities in the literature, in relation to demographic aspects and obtaining good radiographic results, which do not correspond to the functional outcome of patients.

Could land cover influence Aedes aegypti mosquito populations?

Aedes aegypti is mainly found in urban environments, where human activity guarantees the permanent availability of potential larval habitats. The present study aimed to test for a possible association between Ae. aegypti infestation and land cover classes. From 23 February to 22 May 2015, immature mosquitoes (except eggs) were sampled in artificial containers identified in dwellings in Córdoba city, Argentina. The proportion of each land cover class was determined by SPOT-5 (Satellites Pour 1'Observation de la Terre or Earth-observing Satellites) image classification. Generalized linear models were developed to assess a suite of predetermined hypotheses and identified cover class variables associated with Ae. aegypti infestation. Arboreal vegetation was identified as the land cover with the greatest relative importance, negatively associated with Ae. aegypti mosquitoes. More infestation was find in areas with less arboreal vegetation, which corresponds to more urbanized areas.

Structure and evolution of magnetohydrodynamic solitary waves with Hall and finite Larmor radius effects.

Nonlinear and low-frequency solitary waves are investigated in the framework of the one-dimensional Hall-magnetohydrodynamic model with finite Larmor effects and two different closure models for the pressures. For a double adiabatic pressure model, the organization of these localized structures in terms of the propagation angle with respect to the ambient magnetic field θ and the propagation velocity C is discussed. There are three types of regions in the θ-C plane that correspond to domains where either solitary waves cannot exist, are organized in branches, or have a continuous spectrum. A numerical method valid for the two latter cases, which rigorously proves the existence of the waves, is presented and used to locate many waves, including bright and dark structures. Some of them belong to parametric domains where solitary waves were not found in previous works. The stability of the structures has been investigated by performing a linear analysis of the background plasma state and by means of numerical simulations. They show that the cores of some waves can be robust, but, for the parameters considered in the analysis, the tails are unstable. The substitution of the double adiabatic model by evolution equations for the plasma pressures appears to suppress the instability in some cases and to allow the propagation of the solitary waves during long times.

Evaluación in Vitro de la Biocompatibilidad de Cuatro Cementos Selladores con Osteoblastos Humanos / In vitro Evaluation of Four Sealer Cements Biocompatibility with Human Osteoblasts

RESUMEN: El correcto sellado apical es un paso importante durante el tratamiento de conductos, para esto, se utilizan puntas de gutapercha y cemento sellador, de este último existen diversas formulaciones químicas en el mercado, por lo cual es importante tomar en cuenta los efectos que estas pueden tener en el proceso de cicatrización periapical. El propósito de este estudio fue evaluar la biocompatibilidad de cuatro cementos selladores con diferente composición química con osteoblastos humanos. Se prepararon extractos de cementos selladores a con dos concentraciones (10 mg/mL y 40 mg/mL) y dos tiempos de exposición (10 min y 8 h), estos fueron colocados en contacto con osteoblastos humanos para evaluar la proliferación y citotoxicidad a 24, 72 y 96 h con sus respectivos controles y blancos. Se realizó un análisis estadístico con ANOVA de un factor y la prueba de comparaciones múltiple de Bonferroni. Los resultados obtenidos, tanto en el ensayo de citotoxicidad como en el de proliferación, indicaron que el cemento a base de resina no es biocompatible con osteoblastos. El cemento a base de poli-dimetilxilosano fue el único que no mostró citotoxicidad a ningún de tiempo de exposición y concentración examinadas en este estudio.

ABSTRACT: Correct apical sealing is an important step during root canal treatment, hence, gutta-percha points and sealant are used. There are several chemical compositions on the market, so it is important to evaluate the effects of these in the periapical healing process. The aim of this study was to evaluate the biocompatibility of four sealer cements with different chemical composition placed in contact with human osteoblast. Different extracts were prepared at two concentrations (10 mg/mL and 40 mg/mL) and two exposure times (10 min and 8 h) these were placed in contact with human osteoblast to evaluate cytotoxicity and proliferation at 24, 48 and 72 h with their respective controls and blanks. A statistical analysis was performed with ANOVA of one factor and Bonferroni post hoc. Results obtained in cytotoxicity and proliferation assays, indicated that the resinbased cement is not biocompatible with osteoblast. The poly-dimethylxilosanbased cement was the only that did not show cytotoxicity at any time of exposure and concentration examined in this study.

Selecting native perennial plants for ecological intensification in Mediterranean greenhouse horticulture.

Natural control by predators and parasitoids provides an important and often unnoticed ecosystem service to agricultural landscapes by reducing pest populations in crops. The current model of horticultural intensification in south-eastern Spain produces high yields but has also resulted in a landscape almost completely covered by plastic. Promoting natural areas among greenhouses could enhance biodiversity, by being beneficial insects, and reduce pest pressure outdoors. The first step is to ascertain how pests and their natural enemies (NEs) use Mediterranean vegetation for selecting the best plants for pest suppression outdoors. The abundance of the two major horticultural pests, the tobacco whitefly, Bemisia tabaci, and the western flower thrips, Frankliniella occidentalis, together with their NEs, were assayed in 22 flowering perennial plants, which were newly planted in an experimental field surrounded by greenhouses. Eight plant species were identified as the most critical species for sustaining pest populations outdoors. A set of five plant species supported a medium level of pests, and another set of ten plant species supported the lowest level of both pests. Tobacco whitefly occurred in a few plants species, whereas western flower thrips occurred on almost all the plant species studied, and was favoured by the presence of flowers in perennial plants. The results suggest that plant diversity may provide relatively few acceptable host plants for tobacco whitefly than for western flower thrips. NEs were generally collected in plants that also supported abundance of pests, indicating that host/prey availability, more than food resources from flowers, was a stronger predictor of NE abundance in perennial plants. Field trials using the plants with the lowest host acceptance by pests are needed in order to ascertain whether pest abundance outdoors is reduced.

Blazar spectral variability as explained by a twisted inhomogeneous jet.

Blazars are active galactic nuclei, which are powerful sources of radiation whose central engine is located in the core of the host galaxy. Blazar emission is dominated by non-thermal radiation from a jet that moves relativistically towards us, and therefore undergoes Doppler beaming. This beaming causes flux enhancement and contraction of the variability timescales, so that most blazars appear as luminous sources characterized by noticeable and fast changes in brightness at all frequencies. The mechanism that produces this unpredictable variability is under debate, but proposed mechanisms include injection, acceleration and cooling of particles, with possible intervention of shock waves or turbulence. Changes in the viewing angle of the observed emitting knots or jet regions have also been suggested as an explanation of flaring events and can also explain specific properties of blazar emission, such as intra-day variability, quasi-periodicity and the delay of radio flux variations relative to optical changes. Such a geometric interpretation, however, is not universally accepted because alternative explanations based on changes in physical conditions-such as the size and speed of the emitting zone, the magnetic field, the number of emitting particles and their energy distribution-can explain snapshots of the spectral behaviour of blazars in many cases. Here we report the results of optical-to-radio-wavelength monitoring of the blazar CTA 102 and show that the observed long-term trends of the flux and spectral variability are best explained by an inhomogeneous, curved jet that undergoes changes in orientation over time. We propose that magnetohydrodynamic instabilities or rotation of the twisted jet cause different jet regions to change their orientation and hence their relative Doppler factors. In particular, the extreme optical outburst of 2016-2017 (brightness increase of six magnitudes) occurred when the corresponding emitting region had a small viewing angle. The agreement between observations and theoretical predictions can be seen as further validation of the relativistic beaming theory.

Relación de la calidad de vida y satisfacción laboral del personal de enfermería de un hospital de alta especialidad / Relation of the quality of life at work with the job satisfaction of the nursing staff in a High Specialty Hospital

Introducción: El conocimiento de la calidad de vida en el trabajo (CVT) y de la satisfacción laboral (SL), así como de los factores que influyen en ambas, resulta significativo para las instituciones de salud. La CVT inadecuada y la insatisfacción laboral originan que el personal con elevado nivel de insatisfacción limite sus habilidades, su disponibilidad y sus conocimientos lo cual pone en peligro el clima de trabajo en una organización. Objetivo: Evaluar la relación de la calidad de vida en el trabajo y la satisfacción laboral del personal de enfermería de un hospital de alta especialidad. Método: Se realizó un estudio observacional, prolectivo, transversal, analítico en una población de enfermeras(os) del área clínica. Previo consentimiento informado, se recolectaron los datos con los cuestionarios validados CVT-GOHISALO con alfa de Cronbach 0.956 y el Cuestionario Font Roja con alfa de Cronbach de 0.751. Se utilizó el programa SPSS v 21.0 para el análisis estadístico de los datos, con pruebas de estadística descriptiva, frecuencias, porcentajes, valores promedio, desviación estándar, pruebas de comparación X2 con una p<0.05 y correlación de Pearson. Para el cálculo de riesgos se utilizó razón de momios con un intervalo de confianza al 95%. Resultados: Se evaluó a 357 enfermeras(os); de las cuales, 323 (91%) son mujeres y 34 (9%) hombres, con un promedio de edad de 41±8 años. El 62% es personal profesional, cuya distribución por turnos es: nocturno, 34%; vespertino, 27%; matutino, 25%, y en la jornada acumulada, 14%. Con una antigüedad laboral media de 18±8.4 años. Por servicios: urgencias, 37%; hospitalización adultos, 35%, y hospitalización pediátrica, 18%. Del total de la población, 86% reportó una satisfacción laboral de buena a muy buena y 14% de mala a regular. El 62% refiere tener una CVT de mala a regular, siendo las dimensiones con mayor insatisfacción la seguridad en el trabajo, 65%; satisfacción por el trabajo, 66%; el bienestar logrado a través del trabajo, 70%, y el desarrollo personal, 60%. En relación con la CVT, se encontró que la monotonía laboral es un factor de riesgo con significancia estadística: p=<0.05 (RM=1.04, IC95%,1.14-3.66). Así mismo, la satisfacción por el trabajo (RM=1.30, IC95% 1.11-4.78) y el bienestar logrado a través del trabajo (RM=1.16, IC95%,1.014-4.63) para la SL siendo estadísticamente significativo: p=<0.05. Conclusiones: Los hallazgos sugieren que la SL del personal de enfermería es un determinante en la CVT. De igual manera, las dimensiones reportadas con mayor insatisfacción repercuten en la adecuada gestión de la calidad del cuidado.

Introduction: The knowledge of the quality of work life (QWL) and job satisfaction (JS), as well as the factors that influence it, is significant for health institutions. Inadequate QWL and job dissatisfaction cause staff with a high level of dissatisfaction by limiting their skills, availability and knowledge, endangering the working climate in an organization. Objective: To evaluate the relationship of work quality of life and job satisfaction of nursing staff of a high specialty hospital. Method: An observational, prolective, transversal, analytical study was carried out in a population of nurses in the clinical area. Prior informed consent, data were collected with validated questionnaires QWL-GOHISALO with Cronbach's alpha 0.956; and the Red Font Questionnaire with Cronbach's alpha 0.751. We used the SPSS v 21.0 program for the statistical analysis of the data, with descriptive statistical tests, frequencies, percentages, mean values, standard deviation, X2 comparison tests with a p <0.05, Pearson correlation. For the calculation of risks, we used the odds ratio with a 95% confidence interval. Results: A total of 357 evaluated nurses, 323 (91%) women, and 34 (9%) men; with a mean age of 41±8 years, and 62% the professional staff. Thirty four percent distributed in the night shift; 27% in the evening; 25% in the morning and 14% in the working day. With an average working period of 18±8.4 years; 37% are in the emergency department, 35% in adult hospitalization and 18% in pediatric hospitalization. Of the total population, 86% reported a job satisfaction from good to very good, and 14% from bad to regular. 62% report having a QWL from bad to regular, being the dimensions with the greatest dissatisfaction. Work safety in (65%), work satisfaction (66%), welfare achieved through work (70%) and personal development (60%). Regarding the QWL, it was found that monotony at work is a risk factor with statistical significance: p=<0.05 (RM=1.04, 95% CI, 1.14-3.66). Likewise, work satisfaction with (RM=1.30, IC95% 1.11-4.78) and well-being achieved through work (RM=1.16, 95% CI, 1014-4.63) were statistically significant for p=0.05. Conclusions: These findings suggest that the JS of the nursing staff is a determinant in the QWL. Likewise, the dimensions reported with greater dissatisfaction have an impact on the adequate management of the quality of care.

Embarazo molar con feto vivo y éxito perinatal. Reporte de un caso y revisión bibliográfica / Molar pregnancy with live fetus, and perinatal success. Case report and bibliographical review

Resumen ANTECEDENTES: la mola parcial o incompleta representa 30% de las enfermedades trofoblásticas gestacionales; sin embargo, la incidencia de mola parcial con feto vivo es una manifestación poco frecuente, que ocurre en 1 de cada 100,000 embarazos. CASO CLÍNICO: paciente de 27 años de edad, con antecedentes ginecoobstétricos de 3 embarazos y 2 partos, sin comorbilidades ni alteraciones de importancia para el padecimiento actual; embarazo de 30.1 semanas según la fecha de la última menstruación y diagnóstico de enfermedad trofoblástica gestacional (mola parcial), placenta previa y útero arcuato. El ultrasonido evidenció vesículas hidrópicas, compatibles con enfermedad trofoblástica gestacional (mola parcial), por lo que se realizó amniocentesis a las 16.3 semanas del embarazo, sin incidentes ni complicaciones. Se encontró el cariotipo 46,XX. Se decidió la interrupción del embarazo por cesárea de urgencia. Puesto que se trataba de un embarazo con alta morbilidad y mortalidad, y la paciente tenía paridad satisfecha, se decidió realizar cesárea-histerectomía con la técnica de Esperanza-Bautista. Nació una niña de 1416 g, Capurro de 3 semanas y Apgar 7/9. El reporte de patología fue: proliferación anormal del trofoblasto, vesículas y vellosidades hidrópicas. La paciente continuó en seguimiento semanal sin complicaciones aparentes. CONCLUSIONES: el embarazo molar con feto vivo es una alteración poco frecuente. El diagnóstico temprano, seguimiento prenatal estrecho y tratamiento multidisciplinario representan factores importantes para la viabilidad del recién nacido.

Abstract BACKGROUND: The partial or incomplete mole represents 30% of gestational trophoblastic diseases. However, the incidence of partial mole with a viable fetus is an uncommon presentation, with an incidence of 1 per 100,000 pregnancies. CASE REPORT: a 27-year-old female with a gyneco-obstetric history of 3 pregnancies and 2 births, without comorbidities or alterations of importance for the current condition; pregnancy of 30.1 weeks according to the date of last menstruation and diagnosis of gestational trophoblastic disease (partial spring), placenta previa and arcuate uterus. The ultrasound evidenced hydropic vesicles, compatible with gestational trophoblastic disease (incomplete mole). The amniocentesis was performed at 16.3 weeks of pregnancy. The karyotype 46, XX was found. It was decided to terminate the pregnancy by emergency cesarean section. Since it was a pregnancy with high morbidity and mortality, and the patient had parity satisfied, it was decided to perform a cesarean-hysterectomy using the Esperanza-Bautista technique. A female newborn was born, weighing 1416 g, Capurro 3 weeks and APGAR 7/9. The pathology report was abnormal proliferation of the trophoblast, vesicles and villi. At the moment the patient remains in weekly follow-up with no apparent complications. CONCLUSIONS: Molar pregnancy with a viable fetus has an infrequent presentation. Early diagnosis, close prenatal follow-up, and multidisciplinary management condition perinatal success.

Fractal dimension and mechanism of aggregation of apple juice particles.

Turbidity of freshly squeezed apple juice is produced by a polydisperse suspension of particles coming from the cellular tissue. After precipitation of coarse particles by gravity, only fine-colloidal particles remain in suspension. Aggregation of colloidal particles leads to the formation of fractal structures. The fractal dimension is a measure of the internal density of these aggregates and depends on their mechanism of aggregation. Digitized images of primary particles and aggregates of depectinized, diafiltered cloudy apple juice were obtained by scanning electron microscopy (SEM). Average radius of the primary particles was found to be a = 40 ± 11 nm. Maximum radius of the aggregates, R(L), ranged between 250 and 7750 nm. Fractal dimension of the aggregates was determined by analyzing SEM images with the variogram method, obtaining an average value of D(f) = 2.3 ± 0.1. This value is typical of aggregates formed by rapid flocculation or diffusion limited aggregation. Diafiltration process was found to reduce the average size and polydispersity of the aggregates, determined by photon correlation spectroscopy. Average gyration radius of the aggregates before juice diafiltration was found to be R(g) = 629 ± 87 nm. Average number of primary particles per aggregate was calculated to be N = 1174.

Assessing the impact of composting and vermicomposting on bacterial community size and structure, and microbial functional diversity of an olive-mill waste.

The aim of this study was to couple biochemical and molecular methodologies for evaluating the impact of two recycling technologies (composting and vermicomposting) on a toxic organic waste. To do this, six enzyme activities controlling the key metabolic pathways of the breakdown of organic matter, real-time PCR assays targeting 16S rRNA genes, and denaturing gradient gel electrophoresis (DGGE) profiling-sequence analysis of PCR-amplified 16S rRNA fragments have been used to determine the functional diversity, bacterial number, and bacterial community structure, respectively, in a mixture of olive waste and sheep manure, and in the derived compost and vermicompost. Both the recycling technologies were effective in activating the microbial parameters of the toxic waste, the vermicomposting being the best process to produce greater bacterial diversity, greater bacterial numbers and greater functional diversity. Although several identical populations were detected in the processed and non-processed materials, each technology modified the original microbial communities of the waste in a diverse way, indicating the different roles of each one in the bacterial selection.

Clinical and radiological features of posterior communicating artery aneurysms.

SUMMARY: Treatment of unruptured intracranial aneurysms based on critical size and predictive risk factors is generally accepted, but several factors contribute to the clinical outcome in a patient with subarachnoid hemorrhage (SAH) secondary to a ruptured aneurysm. We decided to evaluate other parameters that might contribute to the clinical outcome of patients with a ruptured posterior communicating artery aneurysm. A retrospective review of the medical records of patients diagnosed and/or treated of cerebral aneurysms at our institution was carried out. We selected patients with Pcom aneurysms that presented with SAH and reviewed conventional and tridimensional angiographic images to determine its anatomical orientation and correlated the data with amount of SAH and clinical presentation and outcome. A total of 112 Pcom aneurysms presented with SAH and were included in this study. 92 patients were women and 20 were men, with a mean age of 57 years (range 25-81). According to anatomical orientation, 43 were inferolateral, 30 lateral, 13 superolateral, three inferomedial, two in medial location, two superomedial, 11 inferoposterior, five posterior and three superoposterior. Aneurysms in superolateral location are to be watched carefully, it is likely that this location joins several conditions for these aneurysms to grow faster or have a higher hemodynamic stress which makes them more at risk of rupture and contribute to a worse clinical outcome.

Organic matter humification by vermicomposting of cattle manure alone and mixed with two-phase olive pomace.

The chemical changes occurring in a cattle manure (CM) and a mixture of two-phase olive pomace and CM (OP+CM) after vermicomposting with Eisenia andrei for eight months were evaluated. Further, humic acid (HA)-like fractions were isolated from the two substrates before and after the vermicomposting process, and analyzed for elemental and acidic functional group composition, and by ultraviolet/visible, Fourier transform infrared and fluorescence spectroscopies. Before vermicomposting, the HA-like fractions featured a prevalent aliphatic character, large C contents, small O and acidic functional group contents, a marked presence of proteinaceous materials and polysaccharide-like structures, extended molecular heterogeneity and small degrees of aromatic ring polycondensation, polymerisation and humification. After vermicomposting, the total extractable C and HA-C contents in the bulk substrates increased, and the C and H contents, aliphatic structures, polypeptidic components and carbohydrates decreased in the HA-like fractions, whereas O and acidic functional group contents increased. Further, an adequate degree of maturity and stability was achieved after vermincomposting, and the HA-like fractions, especially that from OP+CM, approached the characteristics typical of native soil HA. Vermicomposting was thus able to promote organic matter humification in both CM alone and in the mixture OP+CM, thus enhancing the quality of these materials as soil organic amendments.

[Renal failure and insulin resistance: effect of the dialysis dose]. / Insuficiencia renal y resistencia insulínica: efecto de la dosis de diálisis.

BACKGROUND: The main cause of death in patients undergoing hemodialysis are cardiovascular events. We have analyzed the association between intradialysis fractional clearance of urea or Kt/V index in patients with chronic renal failure in hemodialysis as an indicator of adequate dialysis and the classical factors of cardiovascular risk. PATIENTS AND METHODS: A total of 47 patients with chronic renal failure on hemodialysis were included. Diabetes mellitus was considered an exclusion criteria. Optimization of dialysis was analyzed by Kt/v index in accordance with the Daugirdas formula. The cardiovascular risk factors evaluated were: insulin resistance, calculated according to the HOMA method, total cholesterol, LDL-cholesterol, triglycerides, arterial hypertension, obesity and metabolic syndrome. The relationship between cardiovascular risk factors and Kt/V index was analyzed with the variant and multivariant analysis. RESULTS: The HOMA median (interquartile range) of the patients was 1.16 (0.53-5.77). HOMA was correlated with triglycerides and HDL-cholesterol levels. HOMA was significantly greater in those who had less adapted dialysis (Kt/V < 1.4) (1.9 +/- 1.3 vs 1.0 +/- 0.3, p = 0.02). Furthermore, a negative correlation was found between HOMA and Kt/V. The multivariant analysis of the factors associated to HOMA demonstrated that the only associated parameters were Kt/V greater than 1.4, body mass index and age. CONCLUSIONS: In patients with chronic renal failure, adapted dialysis, determined by the Kt/V index, correlated negatively with insulin resistance. Based on these data, we suggest the need for longitudinal studies that consider this index as a predictive variable of cardiovascular events in this type of patients.

Enterobacterias productoras de beta lactamasa de espectro expandido en pacientes críticos de la Maternidad Concepción Palacios / Expanded spectrum beta lactamase producting enterobacterias in crtical patients from Maternity Hospital

Dentro de los mecanismos de resistencia bacteriana encontrados en los miembros de las Enterobacteriaceae, las Beta Lactamasas de Espectro Expandido (BLEE), juegan un papel importante ya que debido a su naturaleza plasmídica pueden diseminarse a otros géneros diferentes a E. coli, K. pneumoniae y K. oxytoca, de donde principalmente se han descrito y confieren resistencia a cefalosporinas de tercera y cuarta generación y a aztreonam. Dado que en la Maternidad “Concepción Palacios” (MCP) la mayor parte de los pacientes constituyen neonatos y el tratamiento empleado principalmente son cefalosporinas, se evaluó la frecuencia en este centro de Enterobacterias productoras de BLEE aislados en áreas críticas de muestras de hemocultivos, puntas de catéter, orina y secreciones en el período comprendido de Enero a Junio de 2006. La identificación y sensibilidad se realizaron con las galerías ID32GN y ATBGN-5 respectivamente, utilizando el equipo semiautomatizado Mini API (BioMérieux). Para la detección fenotípica de producción de BLEE se empleó el método de doble difusión con discos y el método recomendado por el Clínical and Laboratory Standard Institute (CLSI) (1). La mayor frecuencia se obtuvo para Pantoea agglomerans, seguida de Klebsiella pneumoniae, y Enterobacter cloacae. El 80 % de las enterobacterias aisladas, fueron productoras de BLEE.

Inside the mechanisms of bacterial resistance found in members of the Enterobacteriaceae family, the Expanded Spectrum Beta Lactamasas (ESBL), play an important role due to its plasmid nature it can be spread to other different genera to E. coli, K.pneumoniae, and K. oxytoca, wherefrom principally they have been described, and award resistance to cephalosporin of third and fourth generation and to aztreonam. In view of the Maternity “Concepción Palacios” (MCP) most of the patients constitutes newborn, and the principally used treatment are cephalosporin, the frequency of ESBL producting enterobacteria was evaluated in this center, isolated in critical areas from samples of blood cultures, tops of catheter, urine and secretions from January to June, 2006. The identification and sensibility were realized by the galleries ID32GN and ATBGN-5 respectively, using the semi automated Mini API (BioMérieux) equipment. For the phenotypical detection of ESBL production there were used the double diffusion of disc method and the method recommended by the Clinical and Laboratory Standard Institute (CLSI) (1). The major frequency was to Pantoea agglomerans followed by Klebsiella pneumoniae, and Enterobacter cloacae. 80% of the isolated enterobacteria, were producer of ESBL.