Integrability-to-chaos transition through the Krylov approach for state evolution.

The complexity of quantum evolutions can be understood by examining their spread in a chosen basis. Recent research has stressed the fact that the Krylov basis is particularly adept at minimizing this spread [Balasubramanian et al., Phys. Rev. D 106, 046007 (2022)2470-001010.1103/PhysRevD.106.046007]. This property assigns a central role to the Krylov basis in the investigation of quantum chaos. Here, we delve into the transition from integrability to chaos using the Krylov approach, employing an Ising spin chain and a banded random matrix model as our testing models. Our findings indicate that both the saturation of Krylov complexity and the spread of the Lanczos coefficients can exhibit a significant dependence on the initial condition. However, both quantities can gauge dynamical quantum chaos with a proper choice of the initial state.

Fetal programming effect of rumen-protected methionine on primiparous Angus × Simmental offspring's performance and skeletal muscle gene expression.

Primiparous Angus × Simmental dams (n = 22) with an average body weight (BW) of 449 ±â€…32 kg of BW were divided based on two nutritional treatments: control (CTRL) and rumen-protected methionine (RPM). The control group received bermudagrass hay, corn gluten, and soybean hulls pellets supplementation (base diet); whereas the RPM group received the base diet in addition to 0.07% of DM of RPM at a fixed rate during the last trimester of gestation and the first ~80 d of lactation, in which calves (n = 17) were early weaned. Only male calves were included in this study. After weaning, calves born to RPM dams also received RPM from weaning (day 1) to day 100. Blood sampling and skeletal muscle biopsies for subsequent quantitative polymerase chain reaction (PCR) analysis were conducted on days 1, 25, 50, and 100 on calves. Quantitative PCR data were analyzed using GLIMMIX, and blood metabolites concentrations, BW, and body condition score (BCS) were analyzed using the MIXED procedure of SAS. There was no difference in maternal BW and BCS between treatments. Glucose and blood metabolites that served as biomarkers for liver health (e.g., aspartate transaminase, albumin, alkaline phosphatase, and alanine transaminase) were in the normal levels for all calves (P > 0.40). Calves in the RPM group had a greater expression of adipogenic genes (e.g., PPARG, LPL, and CEBPD) at day 100 compared with CTRL (P < 0.01). In addition, DNA methylation (DNMT1) and oxidative stress-related genes (SOD2 and NOS3) in the RPM group were upregulated at day 100 compared with CTRL (P < 0.01). These results may suggest that calves born to primiparous dams exposed to RPM supplementation are more prone to develop greater adipose tissue than CTRL calves. Furthermore, RPM supplementation may improve methylation processes, as shown by the upregulation of DNMT1. The results shown in our study aim at expanding the knowledge on fetal programming and early-life growth and development of beef cattle under supplementation with RPM.

Plane of nutrition plays a critical role in fetal and postnatal growth in beef cattle offspring. Methionine, a limiting amino acid in ruminants, is also involved in DNA methylation due to its role as S-adenosyl methionine precursor. A complete randomized design experiment was conducted to assess the fetal programming effect of rumen-protected methionine (RPM) supplementation on beef cattle. Calves born to primiparous beef heifers, that individually received RPM during the last trimester of gestation and lactation, had a greater expression of genes related to adipose tissue development, oxidative stress, and DNA methylation compared with those born to dams that did not receive rumen-protected supplementation. No difference in animal performance or blood parameters that serve as biomarkers for liver health status was detected. Our results suggest that maternal supplementation with RPM during the last trimester of gestation and lactation, and supplementation to the offspring after early weaning, could potentially increase adipose tissue development on male calves.

Hepatic transcript profiling in beef cattle: Effects of rumen-protected niacin supplementation.

The objective of our study was to assess the effect of rumen-protected niacin supplementation on the transcriptome of liver tissue in growing Angus × Simmental steers and heifers through RNA-seq analysis. Consequently, we wanted to assess the known role of niacin in the physiological processes of vasodilation, detoxification, and immune function in beef hepatic tissue. Normal weaned calves (~8 months old) were provided either a control diet or a diet supplemented with rumen-protected niacin (6 g/hd/d) for a 30-day period, followed by a liver biopsy. We observed a significant list of changes at the transcriptome level due to rumen-protected niacin supplementation. Several metabolic pathways revealed potential positive effects to the animal's liver metabolism due to administration of rumen-protected niacin; for example, a decrease in lipolysis, apoptosis, inflammatory responses, atherosclerosis, oxidative stress, fibrosis, and vasodilation-related pathways. Therefore, results from our study showed that the liver transcriptional machinery switched several metabolic pathways to a condition that could potentially benefit the health status of animals supplemented with rumen-protected niacin. In conclusion, based on the results of our study, we can suggest the utilization of rumen-protected niacin supplementation as a nutritional strategy could improve the health status of growing beef cattle in different beef production stages, such as backgrounding operations or new arrivals to a feedlot.

Tooth and root size as determined from 0.25- and 0.30-mm voxel size cone-beam CT imaging when contrasted to micro-CT scans (0.06 mm): An ex vivo study.

OBJECTIVE: To quantify tooth volume differences from extracted teeth when using three different three-dimensional (3D) computed tomography (CT)-based imaging modalities. DESIGN: Ex vivo study. SETTING: Laboratory and clinics of the University of Alberta. METHODS: Cone-beam CT (CBCT) of 12 extracted teeth were scanned using 0.25- and 0.30-mm voxel size from CBCT and a 0.06-mm voxel size from micro-CT (reference standard). 3D reconstructions for each tooth from each imaging modality were made through the software ITK-SNAP®. The mean volume differences between each pair of scanning modalities were calculated and then compared and analysed through a repeated measures ANOVA. RESULTS: The average overestimations of the teeth volume were 15.2% for the high-resolution CBCT and 28.1% for the low-resolution CBCT compared to micro-CT measurements. The differences in absolute volume were 81.6 mm3 and 152.8 mm3, respectively. All differences were statistically significant (P < 0.05). CONCLUSIONS: Orthodontists and researchers who assess root resorption through CBCT imaging should be aware that the depicted volumes may likely be overestimating tooth volume and camouflaging real root volumetric treatment changes.

Complete Blood Count Analysis on Beef Cattle Exposed to Fescue Toxicity and Rumen-Protected Niacin Supplementation.

Offspring born to dams genetically tested for resistance to fescue toxicity were separated in groups based on their dams' resistance level (tolerant vs. susceptible). Rumen-protected niacin (RPN) is proposed as a potential alleviator for vasoconstriction produced by fescue toxicity. Complete blood count (CBC) analysis was utilized for detection of significant responses to treatments applied. Our objectives were as follows: (a) to analyze changes in CBC due to fescue toxicity, maternal resistance level, and RPN in growing offspring; and (b) to assess the effects of maternal resistance level when consuming endophyte-infected tall fescue seeds in addition to RPN in offspring performance. Body weight, average daily gain, or health status were not improved by RPN or the genetic test to detect fescue toxicity resistance. Typical signs of alkaloids intoxication and heat stress were noticed in offspring. Particularly, rectal temperature was greater for susceptible control heifers. Results showed that susceptible control offspring presented signs of anemia denoted by low mean corpuscular hemoglobin (MCH) and mean corpuscular volume (MCV). High levels of white blood cells (WBC) and basophils in combination to low neutrophils to lymphocytes ratio were the signs of infection or inflammation detected in the CBC analysis, especially in tolerant niacin steers. Furthermore, offspring of control heifers had a greater percentage of reticulocytes and RDW, denoting signs of anemia.

Preconditioning beef cattle for long-duration transportation stress with rumen-protected methionine supplementation: A nutrigenetics study.

In general, beef cattle long-distance transportation from cow-calf operations to feedlots or from feedlots to abattoirs is a common situation in the beef industry. The aim of this study was to determine the effect of rumen-protected methionine (RPM) supplementation on a proposed gene network for muscle fatigue, creatine synthesis (CKM), and reactive oxygen species (ROS) metabolism after a transportation simulation in a test track. Angus × Simmental heifers (n = 18) were stratified by body weight (408 ± 64 kg; BW) and randomly assigned to dietary treatments: 1) control diet (CTRL) or 2) control diet + 8 gr/hd/day of top-dressed rumen-protected methionine (RPM). After an adaptation period to Calan gates, animals received the mentioned dietary treatment consisting of Bermuda hay ad libitum and a soy hulls and corn gluten feed based supplement. After 45 days of supplementation, animals were loaded onto a trailer and transported for 22 hours (long-term transportation). Longissimus muscle biopsies, BW and blood samples were obtained on day 0 (Baseline), 43 (Pre-transport; PRET), and 46 (Post-transport; POST). Heifers' average daily gain did not differ between baseline and PRET. Control heifer's shrink was 10% of BW while RPM heifers shrink was 8%. Serum cortisol decreased, and glucose and creatine kinase levels increased after transportation, but no differences were observed between treatments. Messenger RNA was extracted from skeletal muscle tissue and gene expression analysis was performed by RT-qPCR. Results showed that AHCY and DNMT3A (DNA methylation), SSPN (Sarcoglycan complex), and SOD2 (Oxidative Stress-ROS) were upregulated in CTRL between baseline and PRET and, decreased between pre and POST while they remained constant for RPM. Furthermore, CKM was not affected by treatments. In conclusion, RPM supplementation may affect ROS production and enhance DNA hypermethylation, after a long-term transportation.

Jersey steer ruminal papillae histology and nutrigenomics with diet changes.

The transition from a high forage to a high concentrate diet is an important milestone for beef cattle moving from a stocker system to the feedlot. However, little is known about how this transition affects the rumen epithelial gene expression. This study assessed the effects of the transition from a high forage to a high concentrate diet as well as the transition from a high concentrate to a high forage diet on a variety of genes as well as ruminal papillae morphology in rumen fistulated Jersey steers. Jersey steers (n = 5) were fed either a high forage diet (80% forage and 20% grain) and transitioned to a high concentrate diet (20% forage and 80% grain) or a high concentrate diet (40% forage and 60% grain) and transitioned to a high forage diet (100% forage). Papillae from the rumen were collected for histology and RT-qPCR analysis. Body weight had a tendency for significant difference (p = .08). Histological analysis did not show changes in papillae length or width in steers transitioning from a high forage to a high concentrate diet or vice versa (p > .05). Genes related to cell membrane structure (CLDN1, CLDN4, DSG1), fatty acid metabolism (CPT1A, ACADSB), glycolysis (PFKL), ketogenesis (HMGCL, HMGCS2, ACAT1), lactate/pyruvate (LDHA), oxidative stress (NQO1), tissue growth (AKT3, EGFR, EREG, IGFBP5, IRS1) and the urea cycle (SLC14A1) were considered in this study. Overall, genes related to fatty acid metabolism (ACADSB) and growth and development (AKT3 and IGFBP5) had a tendency for a treatment × day on trial interaction effect. These profiles may be indicators of rumen epithelial adaptations in response to changes in diet. In conclusion, these results indicate that changes in the composition of the diet can alter the expression of genes with specific functions in rumen epithelial metabolism.

Outcome measures for pediatric laryngotracheal reconstruction: International consensus statement.

OBJECTIVES: Develop multidisciplinary and international consensus on patient, disease, procedural, and perioperative factors, as well as key outcome measures and complications, to be reported for pediatric airway reconstruction studies. METHODS: Standard Delphi methods were applied. Participants proposed items in three categories: 1) patient/disease characteristics, 2) procedural/intraoperative/perioperative factors, and 3) outcome measures and complications. Both general and anatomic site-specific measures were elicited. Participants also suggested specific operations to be encompassed by this project. We then used iterative ranking and review to develop consensus lists via a priori Delphi consensus criteria. RESULTS: Thirty-three pediatric airway experts from eight countries in North and South America, Europe, and Australia participated, representing otolaryngology (including International Pediatric Otolaryngology Group members), pulmonology, general surgery, and cardiothoracic surgery. Consensus led to inclusion of 19 operations comprising open expansion, resection, and slide procedures of the larynx, trachea, and bronchi as well as three endoscopic procedures. Consensus was achieved on multiple patient/comorbidity (10), disease/stenosis (7), perioperative-/intraoperative-/procedure-related (16) factors. Consensus was reached on multiple outcome and complication measures, both general and site-specific (8 general, 13 supraglottic, 15 glottic, 17 subglottic, 8 cervical tracheal, 12 thoracic tracheal). The group was able to clarify how each outcome should be measured, with specific instruments defined where applicable. CONCLUSION: This consensus statement provides a framework to communicate results consistently and reproducibly, facilitating meta-analyses, quality improvement, transfer of information, and surgeon self-assessment. It also clarifies expert opinion on which patient, disease, procedural, and outcome measures may be important to consider in any pediatric airway reconstruction patient. LEVEL OF EVIDENCE: 5 Laryngoscope, 129:244-255, 2019.

Alterations in frontal white matter neurochemistry and microstructure in schizophrenia: implications for neuroinflammation.

We investigated in vivo neurochemical markers reflective of neuronal health and glial activation to determine if these could yield clues regarding the reduced fractional anisotropy (FA) of white matter and accelerated decline of FA with age in schizophrenia. Participants with schizophrenia and healthy controls completed diffusion tensor imaging to assess FA and proton magnetic resonance spectroscopy to assess neurochemical metabolites in the same frontal region. Frontal FA was significantly lower in the schizophrenia and declined more rapidly with age compared with the healthy control group. In both groups, N-acetylaspartate (NAA), a putative marker of neuronal integrity, and glutamate declined with age, and this decline was stronger in patients. Myo-inositol, a marker of glial cells, was negatively related to FA in both groups. The relationship between FA and age remained significant in schizophrenia even when controlling for all metabolites. The relationships of FA, NAA and myo-inositol to age appear to be independent of one another. The relationship between FA and myo-inositol was independently present in both patients and controls, even after controlling for age, indicating a potential general effect of neuroinflammation on white matter microstructure. Further studies are warranted to determine the underlying mechanism driving the accelerated FA decline with age in schizophrenia.

Laparoscopic transperitoneal and retroperitoneal nephrectomies in children: a change of practice.

INTRODUCTION: Laparoscopic nephrectomies (LNs) may be performed in children with benign renal disease by the transperitoneal (TP) or retroperitoneal (RP) approach. OBJECTIVES: The aim of this study was to present our early results from using both the laparoscopic transperitoneal and retroperitoneal approach, highlighting the change in the approach to a better, simpler procedure performed by experienced surgeons. MATERIALS AND METHODS: Between February 2002 and June 2006, 30 LNs were performed, with the first 10 patients by TP (group 1) and the remaining patients by RP (group 2). Two patients were not included. Demographic data were compared: mean age (88 vs. 66.6 months), gender (30% female vs. 70% male), and laterality (60% left-handed vs. 40% right-handed). Other factors were assessed, as well: Operating time was compared, as was morbidity, analgesics requirement, postoperative hospital stay, and time to resume oral intake. RESULTS: LN was performed in 28 of the 30 cases. One case in each group was converted. Both groups were similar regarding operating time (TP: 92.2 minutes vs. RP: 121.1), hospital stay (36.5 hours vs. 28.8), postoperative analgesia (2.1 doses of dipyrone and 1.2 doses of nalbuphine vs. 2.3 and 1.4). RP was associated with significantly faster postoperative analgesia tolerance than that of the TP approach (7.8 hours vs. 14.4; P < 0.05). Two (22.2%) patients in group 1 presented with vomiting, whereas no patients in group 2 had postoperative vomiting (P < 0.05). No further postoperative complications appeared. CONCLUSIONS: In our hands, both laparoscopic TP and RP approaches are equally safe and effective, but the operating time was slightly shorter (not significant) and postoperative recovery significantly longer for TP. LN may be performed by both approaches, obtaining equal efficacy. TP may be associated with minimal paralytic ileus within the first 12-24 hours, meanwhile RP is related with better surgical skill and postoperative tolerance.

Advances in noninvasive methods for functional evaluation of renovascular disease.

As the number of patients with newly diagnosed renal artery stenosis increases, so has the number of percutaneous transluminal renal-artery angioplasties in the last few years. Deciding the preferred treatment in the clinical setting is fraught with difficulties related to many factors, and there is limited evidence to support angioplasty/stent for any indication. These considerations emphasize the urgent need for improved noninvasive assessment of kidney function in patients with vascular disease. This review will attempt to summarize the available techniques that may potentially be used for measurement of renal function in this context.

Insuficiencia cardíaca: análisis observacional de base de datos / Insuficiência cardíaca: análise observacional de base de dados / Heart failure: observational analysis of database

Introducción. La insuficiencia cardíaca (IC) es la enfermedad con mayor incidencia, que más internaciones y gastos produce a los sistemas de salud en el mundo occidental. Objetivos. Construir una base de datos, buscar en la observación retrospectiva alguna tendencia en la evolución clínica y ecocardiográfica. Analizar la magnitud del problema en nuestro medio aprender del seguimiento realizado y transformar el consultorio de insuficiencia cardíaca en una unidad más compleja con seguimiento telefónico. Material y método. Desde el 24-02-94 a la fecha se han incluido 118 pacientes, cargando de cada uno de ellos en la base de datos: edad, sexo, factores de riesgo, etiología, evolución clínica y ecocardiográfica, drogas utilizadas en el tratamiento médico, tratamientos alternativos. Consumo de O2 pico, fecha de inicio del tratamiento con beta bloqueantes (BB), clase funcional (CF) al comienzo y posterior al mismo, mortalidad, causas de muerte, trasplantes cardíacos (TC), antecedente de cirugía de revascularización, angioplastia percutánea transluminal coronaria y marcapaso definitivo. Internaciones previas al inicio del betabloqueante y posteriores. Na, K, fecha de primera consulta, fecha de última consulta, tiempo de seguimiento en meses. Diabetes (DBT), hipertensión arterial (HTA), dislipidemia, hipotiroidismo. Electrocardiograma e hipertrofia ventricular izquierda. Resultados. La edad media fue de 60,09 ± 11,08 años, el 82% masculino y el 18% femenino. La etiología isquémica fue del 28%, hipertensiva del 24%, idiopática del 22%, chagásica del 17%, y el 9% de valvulopatías. De los 118 pacientes, están actualmente en seguimiento 33 (27%), 5 de ellos están esperando TC, 7 (21%) fueron trasplantados. La media desde el primer síntoma a la última consulta fue de 7,46 años. El síntoma de inicio más frecuente fue disnea (51,51%). La CF media al comienzo del seguimiento fue de 2,63 y a la última consulta de 2,15. Se han constatado 19 muertes (57%). Las causas de muerte fueron: muerte súbita 8 (42%), IC 4 (21%), muerte no cardíaca 2 (10,52%), otras causas cardiovasculares 5 (26%). La media de seguimiento fue de 45,53 meses, se ha perdido en el seguimiento el 52% de los pacientes. Todos ellos tienen seguimiento clínico y ecocardiográfico, al 27% del total se le realizó test de consumo de oxígeno máximo. El 100% fue tratado con BB, el 75% recibió enalapril, el 0,9% inhibidores AT1 y el 60% espironolactona. También recibieron: acenocumarol, digoxina, AAS, furosemida, hidroclorotiazida, amiodarona y mexitilene. Conclusiones. La IC tiene alta incidencia y prevalencia también en nuestro medio, la etiología más frecuente fue la isquémica. La media de seguimiento es alta con una deserción elevada, lo atribuimos principalmente a no tener seguimiento telefónico. La mortalidad es alta, siendo la muerte súbita la causa más frecuente. Es elevado el uso de BB, inhibidores de enzima convertidora de la angiotensina y espironolactona.

Introduction. In the west world the heart failure is the illness that has the most incidence, admissions and costs to the health systems. Objectives. To make a database, look for any tendency in retrospective observation. To analyze the issue in our area, to learn about the follow-up and transform the heart failure office in a more complex unit with phone follow-up. Material and method. Since 02-24-94 until the date, were included 118 patients, storing of each of them in data base: age, sex, risk factors, etiology, clinical and echocardiographic evolution, drugs used in medical treatment, alternatives treatments, transplantations, peak O2 consumption, start of beta bloquers treatment, functional class before and after it, mortality, causes of death, coronary artery by pass graft, cardiac transplantations, pacemakers, percutaneous transluminal coronary angioplasty, admitions before and after beta blockers, Na, K, date of first and last consult, follow up in months. Diabetes, high hypertension arterial, electrokardiogrham and left ventricular hypertrophy. Results. The age media was 60.9 ± 11.09, 82% were male and 18% female. The ischemic etiology was 28%, hypertensive 24%, idiopathic 22%, chagasic 17% and 9% was valvular disease. From 118 patients are in follow-up at date 33 (27%), 5 of them are waiting cardiac transplantation, 7 (21%) were transplanted. The media from the first symptom to last consultation was 7.46 years. The most frequent initial symptom was dyspnea 51.51%. The media functional class at the beginning of the follow-up was 2.63±0.83 and at the end was 2.15±0.97. Nineteen deaths (57%) happened during the follow up. The causes of death were: sudden death 8 (42%), terminal heart failure 4 (21%), others cardiovascular causes 5 (26%), non cardiac death 2 (10.52%). The follow-up media was 45.53 months, were lost in the follow up 52% of the patients. All patients have clinic and echocardiographic follow-up, 27% of total were studied with peak O2 consumption. The 100% were treated with beta blockers, 75% with enalapril, 0.9% inhibitors AT1 and 60% with spironolactone. Acenocumarol, digoxin, AAS, furosemida, hidroclorotiazida, amiodarone y mexitilene too. Conclusions. The heart failure has high incidence and prevalence in our area, the most frequent etiology was the ischemic. The media of follow-up is high with a high lost in it, that we believe is attributable to a non follow-up phone. The mortality is high; the most frequent cause was sudden death. The use of beta blockers, enzyme converter Angiotensin inhibitor and spironolactone was elevated.

Introdução. A insuficiência cardíaca (IC) é a doença com maior incidência, que mais internações e gastos produzem aos sistemas de saúde no mundo ocidental. Objetivos. Construir uma base de dados, buscar na observação retrospectiva alguma tendência na evolução clínica e ecocardiográfica. Analisar a magnitude do problema em nosso meio, aprender do seguimento realizado e transformar o consultório de insuficiência cardíaca em uma unidade mais complexa com seguimento telefônico. Material e método. Desde 24-02-94 até esta data se incluíram 118 pacientes, carregando de cada um deles na base de dados: idade, sexo, fatores de risco, etiologia, evolução clínica e ecocardiográfica, drogas utilizadas no tratamento médico, tratamentos alternativos. Consumo de O2 pico, data de início do tratamento com beta bloqueantes (BB), classe funcional (CF) ao começo e posterior ao mesmo, mortalidade, causas de morte, transplantes cardíacos (TC), antecedente de cirurgia de revascularização, angioplastia percutânea transluminal coronária e marcapasso definitivo. Internações prévias ao início do beta-bloqueante e posteriores. Na, K, data da primeira consulta, data da última consulta, tempo de seguimento em meses. Diabetes (DBT), hipertensão arterial (HTA), dislipidemia, hipotiroidismo. Eletrocardiograma e hipertrofia ventricular esquerda. Resultados. A idade média foi de 60,09±11,08 anos, 82% masculino e 18% feminino. A etiologia isquêmica foi de 28%, hipertensiva de 24%, idiopática de 22%, chagásica de 17%, e 9% de valvulopatias. Dos 118 pacientes, estão atualmente em seguimento 33 (27%), 5 deles estão esperando TC, 7 (21%) foram transplantados. A média desde o primeiro sintoma à última consulta foi de 7,46 anos. O sintoma de início mais freqüente foi dispnéia (51,51%). A CF média ao começo do seguimento foi de 2,63 e à última consulta de 2,15. Constataram-se 19 mortes (57%). As causas de morte foram: morte súbita 8 (42%), IC 4 (21%), morte não cardíaca 2 (10,52%), outras causas cardiovasculares 5 (26%). A média de seguimento foi de 45,53 meses, perderam-se no seguimento 52% dos pacientes. Todos eles com seguimento clínico e ecocardiográfico, ao 27% do total se realizou test de consumo de oxigênio máximo.O 100% foi tratado com BB, 75% recebeu enalapril, 0,9% inibidores AT1 e 60% espironolactona. Também receberam: acenocumarol, digoxina, AAS, furosemida, hidroclorotiazida, amiodarona e mexiletina. Conclusões. A IC tem alta incidência e prevalência também em nosso meio, a etiologia mais freqüente foi a isquêmica. A média de seguimento é alta com uma deserção elevada, que o atribuímos principalmente ao não seguimento telefônico. A mortalidade é alta, sendo a morte súbita a causa mais freqüente. É elevado o uso de BB, inibidores de enzima conversora da angiotensina e espironolactona.

Terapia de rescate con micofenolato mofetil en pacientes con nefritis lúpica / Rescue therapy in lupus nephritis patients with micophenolato mofetil

La terapia a largo plazo con ciclofosfamida combinada con esteroides mejora la sobrevida renal en pacientes con Nefritis Lúpica Proliferativa, pero con efectos tóxicos considerables. En años recientes, el Micofenolato Mofetil (MMF) un inmunosupresor usado en trasplante, parece ser efectivo en casos selectos de Nefritis Lúpica. Métodos: Describiremos 6 pacientes con Nefritis Lúpica clase IV y V según OMS que por distintas razones debieron ser tratados con MMF como droga de rescate. El mismo estabilizó la función renal. Controló la actividad del LES y permitió la disminución o suspensión del corticoide. Resultados: En tres casos se logró remisión completa, dos presentaron remisión parcial y tuvimos un fracaso por plaquetopenia y leucopenia severa con sepsis grave a punto de partida de una neumopatía; en este paciente se suspendió el tratamiento. Uno de ellos presentó un herpes zóster que se trató con Aciclovir y la suspensión transitoria de MMF. Conclusión: EL MMF fue efectivo para conseguir remisiones en la NL y mantener inactivo el LES, por lo que se lo debiera considerar como terapia de rescate, o bien para tratamiento de mantenimiento luego de la inducción con ciclofosfamida, o directamente como terapia de inducción en aquellos pacientes donde la fertilidad es un factor importante. Seguimientos a largo plazo de las pacientes son necesarios para evaluar su efectividad en la sobreviva renal, como ya ha sido demostrado con la Ciclofosfamida.

Long term cyclophosfamide combinated steroids therapy improves renal survival in patients with Proliferate Lupus Nephritis, with considerable toxic effects. In lately years MMF, a immune suppressor used in transplant, seems to be effective in selected cases of Lupus Nephritis. Methods: We will describe six patients with Lupus Nephritis class IV and V (OMS Classification). that what different causes they must be treated with MMF like rescue drug. This stabilizes the renal function. controls LES activity and allows reductions or end of corticoids. Results: In tree cases we achievement total remission, two show partial remission and we had a fail because plaquetopenia and severe leucopenia with serious sepsis to give rise to neumopaty; this patient broke off the treatment. One presented Zoster...

[Malaise with sweating induced by eye-drop. A case of iatrogenic pathology caused by diagnostic error]. / Malaises avec sueurs dus à un collyre. Un cas d'errance diagnostique due à une pathologie iatrogène.

INTRODUCTION: Eye-drops can provoke various systemic side effects and diagnosis of an iatrogenic pathology can made difficult. Observation For 4 months, and 80 year-old man had experienced severe recurrent episodes of sweating concomitant with shaking of the legs. Alpha stimulating eye-drops, prescribed for his glaucoma, were at the origin of these problems. On withdrawal of the latter, the symptoms regressed. DISCUSSION: Diagnosis of an iatrogenic pathology was made after 3 months of medical explorations. The delay in diagnosis was prolonged because the patient had not mentioned the use of an active ingredient, since it was in the form of eye-drops. CONCLUSION: The search for drug-induced causes must be systematic when faced with any unexplained symptom and must include all the active ingredients, whatever their form of administration.

[A study of 234 patients with subarachnoid hemorrhage of aneurysmic and cryptogenic origin]. / Estudio de 234 pacientes con hemorragia subaracnoidea de origen aneurismático y criptogenético.

INTRODUCTION: Subarachnoidal hemorrhage (SAH) is a medical emergency in all the patients. There are some known risk factors and, some complications associated to subarachnoid hemorrhage due to aneurysm rupture, being the rebleeding the main cause of mortality. POPULATION AND METHODS: We performed a retrospective study of 234 patients with non traumatic SAH treated in the Hospital Clínic i Provincial of Barcelona from January 1993 to December 1999. Diagnosis of SAH was done by CT, and ethiological diagnosis by brain angiography. We pay attention to previous pathological history, Hunt-Hess, WFNS and Fisher scales, and we divided our population in two groups depending on the treatment (surgery or embolization). We analyzed SAH complications and GOS at discharge and in a year. RESULTS: Population main age was 53.67 years-old (16-88 years-old). The relationship between male:female was 1:1.4. Almost out of 37% of the patients had previous history of high blood pressure, out of 25.9% were smokers. We saw a bleeding predominance within active hours (from 8:00 to 22:00), mostly during the morning (from 8:00 to 14:00). Between the complications associated to SAH, 45 patients (out of 19.2%) suffered clinical vasospasm, 24 patients (out of 10.25%) rebleeded, 61 patients (out of 26%) had some degree of hydrocephallus post-SAH, and 38 patients (out of 16.23%) had seizures. In 31 cases the bleeding pattern in CT scan was non-perimesencephalic (out of 62% of the 50 patients with negative angiography) and, in 19 cases (out of 38%) was perimesencephalic one. Patients with angiography had 150 aneurysms from anterior circulation and, 12 from posterior circulation. We performed surgery in ninety eight patients, and embolization in 38. We found among embolized patients a worse clinical status and massive hemorrhages than in surgery ones, and, those patients had higher mortality rates and severe sequelae. DISCUSSION: We noticed that sex, pathological history and bleeding timing rates similar than previously published, either than SAH complications. We deeply analyzed those patients with negative angiography and their bleeding pattern, finding that a perimesencephalic bleeding pattern could be caused by an aneurysm, as nowadays publications point out. Due to the above reason we tried to perform a second angiography to every patient with a negative first one. We want to highlight among treated patients, those embolized had a most severe clinical status and then their prognosis and mortality rate was higher. Finally, surgical group, had a high rate of ischemic complications, and most part of this patients group didn't get a control angiography, thus lead us to change our policy, seeing the final results. CONCLUSIONS: This study has been specially self-helpful in order to analyze our medical policy in front of this entity, and in this way, to elaborate a protocol of treatment taking account nowadays tendencies and our experience.

[Langerhans cell histiocytosis of the temporal bone]. / Histiocitosis de células de Langerhans de hueso temporal.

Eosinophilic granuloma (EG) is a localized, benign form of Langerhans' cell histiocytosis. It is the least severe of the histiocytosis syndromes and characterized by lytic lesions of one or more bones. Temporal bone lesions usually occur in association with multifocal disease, but isolated lesions may occur in either the mastoid bone alone or in the entire temporal bone affecting other sites in the body. Two cases of EG of the temporal bone are reported and the literature is reviewed.

An investigation of hybrid III and living human drop tests.

The effect of roof crush on restrained occupants has often been discussed without regard to the headroom available, effectiveness of belts, and location of roof crush. In this article, the question of the ability to protect a simply restrained occupant in an environment in which the roof does not crush is addressed. The subjects were inverted and dropped vertically in noncrushable production vehicle compartments and a specially designed drop fixture. Data collected includes head accelerations, vehicle accelerations, head displacements, belt angles, anchor point location, seat position, and belt tension for a variety of occupant sizes. To our knowledge, these are the first inverted living human vertical studies to be scientifically documented and reported. It was found that no head or neck injuries resulted from drops of up to 91 cm and velocities up to 4.2 m/sec for restrained occupants in the absence of roof crush.