Preliminary study of elastic-tension digital neoprene orthoses for proximal interphalangeal joint flexion contracture.

Flexion contracture of the proximal interphalangeal joint (PIPJ) is one of the most frequent complications in finger trauma. Orthoses are the most widely used method to optimize total end-range time (TERT). No previous studies showed that an elastic tension orthosis could be applied for longer than 12 h. We aimed to demonstrate that the elastic-tension digital neoprene orthosis (ETDNO) can achieve higher TERT and therefore better range of motion than other elastic-tension orthoses (ETO) described in the literature. A prospective study of treatment of PIPJ flexion contracture included 10 PIP joints in 8 patients who met the selection criteria. They were instructed to use the ETDNO for around 23 h per day as far as possible, during a period of 3 weeks. Patients reported a mean TERT of 20.6 h a day. PIPJ contracture improved by a mean Torque Range of Motion (TROM) of 23.5° at 500 g and 22.9° at 800 g of passive extension force during the 3-week treatment. Based on the results of this study, the ETDNO appears to offer a highly effective approach for improving PIPJ flexion contracture, increasing range of motion in extension. ETDNO's efficacy probably lies in the significantly improved comfort and low-profile design, enabling excellent compliance and thus optimizing TERT. LEVEL OF EVIDENCE: Level III.

Extremely long-range, high-temperature Josephson coupling across a half-metallic ferromagnet.

The Josephson effect results from the coupling of two superconductors across a spacer such as an insulator, a normal metal or a ferromagnet to yield a phase coherent quantum state. However, in junctions with ferromagnetic spacers, very long-range Josephson effects have remained elusive. Here we demonstrate extremely long-range (micrometric) high-temperature (tens of kelvins) Josephson coupling across the half-metallic manganite La0.7Sr0.3MnO3 combined with the superconducting cuprate YBa2Cu3O7. These planar junctions, in addition to large critical currents, display the hallmarks of Josephson physics, such as critical current oscillations driven by magnetic flux quantization and quantum phase locking effects under microwave excitation (Shapiro steps). The latter display an anomalous doubling of the Josephson frequency predicted by several theories. In addition to its fundamental interest, the marriage between high-temperature, dissipationless quantum coherent transport and full spin polarization brings opportunities for the practical realization of superconducting spintronics, and opens new perspectives for quantum computing.

Superconducting imprint of magnetic textures in ferromagnets with perpendicular magnetic anisotropy.

Research on proximity effects in superconductor/ferromagnetic hybrids has most often focused on how superconducting properties are affected-and can be controlled-by the effects of the ferromagnet's exchange or magnetic fringe fields. The opposite, namely the possibility to craft, tailor and stabilize the magnetic texture in a ferromagnet by exploiting superconducting effects, has been more seldom explored. Here we show that the magnetic flux trapped in high-temperature superconducting YBa2Cu3O7-δ microstructures can be used to modify the magnetic reversal of a hard ferromagnet-a cobalt/platinum multilayer with perpendicular magnetic anisotropy-and to imprint unusual magnetic domain distributions in a controlled manner via the magnetic field history. The domain distributions imprinted in the superconducting state remain stable, in absence of an external magnetic field, even after increasing the temperature well above the superconducting critical temperature, at variance to what has been observed for soft ferromagnets with in-plane magnetic anisotropy. This opens the possibility of having non-trivial magnetic configuration textures at room temperature after being tailored below the superconducting transition temperature. The observed effects are well explained by micromagnetic simulations that demonstrate the role played by the magnetic field from the superconductor on the nucleation, propagation, and stabilization of magnetic domains.

Ferroelectric Control of Interface Spin Filtering in Multiferroic Tunnel Junctions.

The electronic reconstruction occurring at oxide interfaces may be the source of interesting device concepts for future oxide electronics. Among oxide devices, multiferroic tunnel junctions are being actively investigated as they offer the possibility to modulate the junction current by independently controlling the switching of the magnetization of the electrodes and of the ferroelectric polarization of the barrier. In this Letter, we show that the spin reconstruction at the interfaces of a La_{0.7}Sr_{0.3}MnO_{3}/BaTiO_{3}/La_{0.7}Sr_{0.3}MnO_{3} multiferroic tunnel junction is the origin of a spin filtering functionality that can be turned on and off by reversing the ferroelectric polarization. The ferroelectrically controlled interface spin filter enables a giant electrical modulation of the tunneling magnetoresistance between values of 10% and 1000%, which could inspire device concepts in oxides-based low dissipation spintronics.

Association between nutritional risk based on the NRS-2002 test and hospital morbidity and mortality.

OBJECTIVE: To analyse the relationship between the presence of malnutrition (MN), as measured by the NRS-2002 nutritional evaluation, and the rate of morbidity and mortality. DESIGN: Cross-sectional study. SETTING: Patients admitted to Mateu Orfila Hospital, the regional hospital for the island of Menorca, Spain. SUBJECTS: 1,075 patients who were admitted to Mateu Orfila Hospital (Menorca) who had laboratory studies and a nutritional risk (NR) evaluation available were studied. Those who had a clinical suspicion of MN or those at risk were studied. INTERVENTION: Demographic (age, gender) and clinical (current weight, normal weight, body mass index, weight loss, oral intake, presence of intestinal failure, fistula, renal failure, respiratory infection, urinary infection, hyperglycaemia, admission to the ICU, hospital stay, days of parenteral nutrition treatment and reason for admission) were collected during hospitalisation, as well as hospital mortality and mortality at 6 months following discharge. All underwent the NRS-2002 test. RESULTS: The mean patient age was 67.9 years and 58.3% were men. 62% of patients met the criteria for manutrition according to the NRS-2002 test. A statistically significant association was seen between malnutrition according to the NRS-2002 and intestinal failure, fistula, renal failure, respiratory infection, hyperglycemia, hospital mortality and mortality at 6 months. CONCLUSION: Malnutrition affects more than half of the patients who are admitted to a medium-long admission hospital and it is associated with increased morbidity and mortality. The results underscore the need to establish an update plan and preventative and therapeutic nutritional follow-up. These measures reduce the rate of avoidable complications and save the costs associated with them.

[Retrospective assessment of effective and safety of cinacalcet for the treatment of secondary hyperparathyroidism depending on basal iPTH level]. / Evaluación retrospectiva de la efectividad y seguridad de cinacalcet para el tratamiento de hiperparatiroidismo secundario dependiendo del valor basal de paratohormona intacta.

OBJECTIVE: Cinacalcet is a calcimimetic agent, recommended for treating refractory secondary hyperparathyroidism in patients undergoing dialysis. The aim of this study was to evaluate the efficacy and safety of cinacalcet, comparing patients with baseline iPTH > 300 pg/ml with those with iPTH < 300 pg/ml. METHOD: Observational retrospective study of patients being treated with cinacalcet 30 mg/day from January 2008 to January 2009. We studied 26 patients, 15 with iPTH > 300 pg/ml and 11 with iPTH < 300 pg/ml. The primary efficacy outcome was that there was a reduction between baseline and final iPTH (4 month). The secondary efficacy outcome were the reduction between basal and final calcium, phosphorus, Ca x P, and the percentage of patients with an iPTH decrease > 30%. The safety was evaluated based on the most frequent adverse effects and the levels of serum calcium < 8.6 mg/dl. RESULTS: Patients with initial iPTH > 300 had significant differences before and after cinacalcet treatment in iPTH (563.49+286.88 pg/ml vs 315.15+201.948 pg/ml; P=.017) and serum calcium (9.1+1.77 mg/dl vs 8.15+1.2mg/dl; P=.02). There were no significant differences in patients with initial iPTH < 300 pg/ml. A decrease greater than 30% from baseline iPTH was observed in 60% of patients with baseline iPTH > 300 pg/ml, and only in 27.3% of those with basal iPTH < 300 pg/ml (P=.098). Patients did not show gastric intolerance. CONCLUSIONS: Cinacalcet is an effective and safe drug for controlling secondary hyperparathyroidism in dialysis, mainly when it is used in patients with baseline iPTH > 300 pg/ml.

Effectiveness of perioperative glutamine in parenteral nutrition in patients at risk of moderate to severe malnutrition.

BACKGROUND & AIMS: To determine whether perioperative glutamine supplementation of parenteral nutrition (PN) has an impact on morbidity and mortality of patients with previous moderate to severe risk of malnutrition. METHODS: A quasi-experimental study was conducted comparing the following groups: Control group 1: without glutamine dipeptide supplementation of PN during the perioperative period. Control group 2: PN was supplemented with glutamine dipeptide (0.4 g/kg/day) after surgery only. Group 3 (follow-up group): PN was supplemented with glutamine dipeptide (0.4 g/kg/day) in the perioperative period. Postoperative morbidity and mortality was recorded. RESULTS: Sixty-seven patients matched for baseline and surgical characteristics were recruited into the study. Univariate analysis showed a lower incidence of hyperglycemia and ICU admission in group 3, and a trend to significance (P = 0.078) in terms of a lower incidence of infection. In the multivariate analysis, only group 3 met the models of ICU admission (OR = 0.28), hyperglycemia (OR = 0.11), and renal failure (OR = 0.19). CONCLUSIONS: The results show that perioperative use of glutamine dipeptide in patients at risk of moderate to severe malnutrition before surgery is an effective option for decreasing the morbidity associated with malnutrition, as it improves blood glucose modulation and reduces infection and ICU stay.

[Glutamine use for parenteral nutrition in the critically ill patient: effects on morbimortality]. / Utilización de glutamina en nutrición parenteral en paciente crítico: efectos sobre la morbi-mortalidad.

OBJECTIVE: To determine the relationship between adding glutamine dipeptides to parenteral nutrition (PN) and morbimortality in the critically ill patient. MATERIAL AND METHODS: Case-control retrospective study. The cases were patients to whom PN supplemented with 2 g of nitrogen (glutamine) was administered during the period 2001-2004. Controls were patients with PN without glutamine, collected during the year 2000. All included patients had infection defined as the presence of an infectious site plus more than two of the following criteria: leucocytes > 12.000 x 10(6)/L, fever > 38 degrees C, heart rate > 90 bmp, or PCO2 < 31 mmHg. Besides, they had to have prealbumin plasma levels < 15 g/L or albumin levels < 25 g/L, and CRP > 100 mg/L or a fistula. Patients with renal failure, previous dialysis, hepatic encephalopathy, or mixed diet were excluded from the study. Morbimortality variables collected were: hyperglycemia, renal failure, days on PN, days in the ICU, hospitalization days, and mortality. RESULTS: Two hundred and two patients (75 cases and 127 controls) were included. In the previous univariate analysis no significant differences appeared for independent variables between both groups. In the multivariate analysis, glutamine addition was significantly associated to lower renal failure incidence (OR: 0.28; CI: 0.081.00), lower hyperglycemia (OR: 0.38; CI: 0.19-0.75), less hospitalization days (OR: 0.64; CI: 0.44-0.92), and fewer days in the ICU (OR: 0.64; CI: 0.45-0.93). For the variable "exitus", glutamine addition showed a trend towards inclusion into the model (p = 0.097). About the days on PN, the variable glutamine was not included into the model. CONCLUSIONS: In critically ill patients, adding glutamine to PN leads to quicker recovery and lower incidence of hyperglycemia and renal failure. In view of these results, adding glutamine to PN of particular patients is an effective measure to speed up their recovery and avoid certain complications.

[Automation of parenteral nutrition elaboration: adaptation to in force legislation]. / Automatización de la elaboración de nutrición parenteral: adecuación a la legislación actual.

INTRODUCTION: Quality and efficiency criteria of allowances associated to technological procedures are developing in a setting that values quality, and from there the Real Decree RD175/2001 has been issued by which the rules of correct elaboration and quality control of formulations and pharmacy preparations. Parenteral nutrition (PN) is a formulation and, as such, its elaboration and control have to agree with the in force regulations. With this aim, at the Bellvitge University Hospital we have developed a project for automation of elaboration of PN mixtures with the MicroMacro Pump 23 Baxa Compounder. OBJECTIVES: To assess the impact of implementing an automated system of volumetric control in PN elaboration. MATERIAL AND METHODS: The project development may be divided into two differentiated aspects. The first one consisted in the implementation and optimization of the automated system of volumetric control (ASVC). The second aspect comprehends the comparative control performed between the new system and the previous one, and which consisted of a gravimetric system with visual control. For that, real weights were gathered and were compared to predicted weights, and the time of elaboration per bag before and at two times after the implementation of the automated system was registered; the first time just after implementation of the system, and the second time within one year. RESULTS: For the comparison study between both systems used, 141 preparations in total, corresponding to individualized PN, were analyzed: 47 elaborated by means of the gravimetric system (GS), 47 with the ASVC during the implementation period (PN ASVC period 1), 47 PN elaborated with the ASVC within one year of implementation (PN ASVC period 2). The average variation between real weight and predicted weight at the three periods (pre-ASVC, NP ASVC period 1, NP ASVC period 2) was 2.41%, 1.35% and 1.25% respectively (table I). This decrease was statistically significant (p = 0.014). When analyzing the percentage of preparations out of the 3% variation range, we observed a significant reduction (p = 0.00001) by comparing the three periods (Table II). The average elaboration time with the ASVC increased approximately in 4 minutes by bag (3 min 58 sec) during the first studied period, and 3 min 10 sec during the second period, as compared with the study period with the GS. CONCLUSIONS: The new bag-filling system by means of volumetric control represents an improvement in accuracy control and a decrease in the risk for surpassing the acceptable limits. The implementation of a new technological procedure is a difficult task that implies the change of many aspects of the daily practice and that requires a "cultural" change in the PN Unit with the aim of optimizing the process. However, these issues allow for an adaptation to legal requisites in force regarding the regulations of proper elaboration and quality control of formulations as well as an improvement in the integral quality of care.

[Perioperative management of chronic medications not related with surgical procedures]. / Manejo perioperatorio de la medicación crónica no relacionada con la cirugía.

The correct management of chronic medications not related with surgical procedures in the perioperative period has a relevant place because each year millions of patients around the world undergo surgical procedures. For this reason the assistencial team should be aware of the importance of continuate or discontinuate determinate drugs during perioperative period because some of them are considered an important risk factor in the development of complications. The key is to differentiate necessary from unnecessary medication. This is a complex aspect, little studied, which difficult clinical decisions and favours the coexistence of several trends of clinical practice. The purpose of this review is to describe the factors that determinate the continuity or suspension of chronic medications which are not related with surgery in the perioperative period and to provide practice recommendations in lights of available publications.

[Profhylaxis and treatment of hereditary and acquired angioedema at HUB; use of the C1-esterase inhibitor]. / Profilaxis y tratamiento del angioedema hereditario y adquirido en el HUB; utilización del inhibidor de la C1-esterasa.

INTRODUCTION: Hereditary and acquired angioedema result from a deficiency in first complement component esterase (C1-esterase) inhibitor. It is characterized by transient subcutaneous tissue, intestinal wall, and upper airway swelling, which may lead to asphyxia and death. The pathophysiology, classification, diagnosis, and treatment of this condition are discussed, as is the follow-up of patients diagnosed with angioedema who received 1 vial of concentrated C1-INH (Berinert); the contribution of the Pharmacy Department in the dispensation and control of said drug is also assessed. MATERIAL AND METHODS: PubMed and other relevant sources were searched. Patient, dispensation, and Berinert(R) indication data were collected from controlled prescriptions; follow-up was completed by performing a medical history, collecting laboratory data, and patient interview when needed. RESULTS: Eight out of 9 cases were of hereditary angioedema, and 1 case was of acquired angioedema. Danazol was used as long-term prophylaxis in 8 patients, but side effects forced discontinuation in some of them. The C1-INH concentrate was effective in 6 acute episodes that were detected during the study, as well as in 3 surgical prophylaxis cases (overall use 6,500 U). CONCLUSION: Danazol was effective as prophylactic treatment, but had severe side effects. The C1-INH concentrate was effective both as prophylactic therapy and treatment for acute episodes. An adequate stock of this product will be available at the Pharmacy Department.

Evidence for a dopaminergic involvement in the renal action of centrally administered JA116a, a novel compound with possible dopaminergic activity, in rats.

Intracerebroventricular (i.c.v.) administration of JA116a, induces an increase in urinary volume and sodium excretion in conscious male hydrated rats. The involvement of brain dopaminergic neurons in the JA116a renal action was investigated. Diuretic and natriuretic action of JA116a was blocked by haloperidol pretreatment. The renal effect was prevented by selective dopaminergic neuron, denervation by i.c.v. administration of 6-hydroxydopamine in combination with desmethylimipramine. Our results suggest that JA116a acts centrally, at least in part, via an interaction with endogenous dopamine neurons.

Enfermedad paratrigonica. / Paratrygonic disease

Se presentan dos casos de enfermedad paratrigonica, provocada por emponzonamiento de rayas venenosas de agua dulce (Potamotrygonideae). Se analizan sus caracteristicas clinicas y etiopatogenicas con el objeto de difundir el conocimiento de una enfermedad endemica en una zona de nuestro pais, donde determina serios problemas de incapacidad laboral

Sarna noruega. Asociacion con colagenosis. (Esclerodermia generalizada) y con nocardiosis. / Norwegian scabies.Association with collagenosis (Generalized scleroderma) and with nocardiosis

Se comunican dos casos de sarna noruega.Uno de ellos, variedad eritrodermica-escamosa asociado a colagenopatia (esclerodermia generalizada) y el otro, variedad costrosa asociada a nocardiosis. Se comentan las caracteristicas clinicas e histopatologicas del proceso y se reafirma que se trata de una dermatosis que asienta sobre una condicion patologica previa, la que en nuestros casos no ha sido comunicada anteriormente