Multicenter Retrospective Registry of Anterior Communicating Artery Aneurysms with Endovascular Therapy (MACAARET): safety and efficacy study according to morphological considerations and spatial orientations.

AIM: To analyse the safety and efficacy parameters of endovascular treatment of anterior communicating artery (ACoA) aneurysms, according to their morphological considerations and three-dimensional orientation in a multicentric registry. MATERIALS AND METHODS: A retrospective analysis was undertaken of a prospective database of consecutive patients that underwent endovascular embolisation for ACoA aneurysm in four high-volume neuroradiology interventional departments. The study has been registered in ClinicalTrial.gov. Data were collected regarding the clinico-demographic variables of the patients, anatomical variations of the circle of Willis, morphological considerations and spatial orientation of ACoA aneurysms were recorded. Safety and efficacy variables were also recorded. Associations between anatomical variations of the circle of Willis, morphological considerations, and spatial orientation of the ACoA aneurysms and safety and efficacy variables were assessed. RESULTS: Data from 122 consecutive patients were collected in the MACAARET study (mean age (±SD) was 55 (±14) and 50.8% (62/122) were male). One hundred and five patients (86.1%) presented with subarachnoid haemorrhage (SAH). ACoA aneurysms with a neck size of >4 mm had less chance of having successful endovascular treatment than those of ≤4 mm (19.8% versus 46.7%; p=0.002) and were also more likely to recanalise during follow-up (61.5% versus 19.5%; p=0.003). Moreover, ACoA aneurysms with an aspect ratio of >1.7 had more chance of having immediate therapeutic success than those with a ratio of ≤1.7 (70.7% versus 44.8%; p=0.012). There were no other associations between the anatomical variables of the ACoA aneurysms and the safety-efficacy variables. CONCLUSION: ACoA aneurysms are suitable for both endovascular and microsurgical approaches, but more data are required to determine which is the best approach regarding the morphological and spatial orientation of the aneurysm and the anatomical variations of the circle of Willis.

[Improve of efficiency of patients management admitted in an Intermediate Respiratory Care Unit by means of an integrated delivery of health care]. / Mejora en la eficiencia del manejo del paciente ingresado en una unidad de cuidados respiratorios intermedios tras la introducción de un proceso asistencial integrado.

INTRODUCTION: Patients admitted to Intermediate Respiratory Care Units are common sharpeners. We describe their overall improvement by the introduction of an Integrated Care Process. METHODS: We conducted an observational descriptive study based on an Intermediate Respiratory Care Unit during 2015-2017. We considered 2 groups: those in-patients during 2016-2017, who took profit from the Integrated Care Process (group A), and those other ones admitted before 2015 when the Integrated Care Process didn't exist yet (group B). We collected sociodemographic variables, clinical ones, those related to care process and economic index. We described them according their type and distribution. RESULTS: The readmission rate within B was 23.65% vs 10.20% within A. These last ones had a mean length of hospital stay of 7.19 days (0.12-14.08), a rate reduction of face-to-face specialized consultations of 45.8% and 28.8% at Emergency Department admissions when compared to B. Prior to the introduction of the Integrated Care Process, 64.9% would have been admitted to the Intensive Care Unit (according to Global Diagnostics Group). We saved 735.1 days of stay at the Intensive Care Unit and therefore over 135,118.204 and 214,649 euros. CONCLUSION: The Integrated Care Process for severe respiratory patients allows a direct and safe relationship with them at home through the Primary Care Teams, so we can save readmissions at hospital, face-to-face consultations at the Emergency Departments and Specialized Consultations and we save money.

Effects of supplementation during late gestation on goat performance and behavior under rangeland conditions.

This study evaluated the effects of peripartum feed supplementation on doe and kid BW and BCS, milk yield and composition, serum metabolites, and maternal-neonatal behavior under rangeland conditions in northern Mexico. Adult does ( = 23) were randomly assigned to 3 nutritional plane groups: 1) goats supplemented (500 g of concentrate [18% CP/kg DM, 2.7 Mcal/kg DM, and 2% salt]) from 15 d prepartum to 7 d postpartum (G15; = 8), 2) the same supplementation as G15 but from 35 d before until 7 d after kidding (G35; = 8), and 3) nonsupplemented does (GC; = 7). Supplemented goats differed from GC goats in BW (48 ± 1.8, 46.1 ± 2.5, and 44.9 ± 2.3 kg; < 0.05), milk yield (1.8 ± 0.1, 1.9 ± 0.2, and 1.2 ± 0.1 kg at d 15 postpartum; < 0.01), kid birth weights (3.8 ± 0.2, 3.6 ± 0.2, and 3.4 ± 0.2 kg; < 0.05), and kid BW at 15 d after birth (6.9 ± 0.2, 6.6 ± 0.2, and 5.6 ± 0.2 kg; < 0.05) for the G35, G15, and GC, respectively. Serum concentrations for total protein, glucose, and cholesterol were not affected ( > 0.05) by treatments. Milk of GC goats showed increased ( < 0.05) percentages for fat, protein, lactose, and nonfat milk solids, whereas total quantities of these variables where higher ( < 0.05) in the G15 and G35 groups. Furthermore, GC dams spent more time seeking their offspring and emitted more low-pitched bleats 4 h postpartum ( < 0.05) in a 2-choice test compared with the G15 and G35 groups. In general, peripartum supplementation promoted a closer dam-kid relationship at 8 h postpartum. Goat performance may be improved in this semiarid region of Mexico with marginal production through supplementation in late gestation.

High-sensitivity troponin T levels in kidney transplant recipients.

Cardiovascular disease (CVD) is still the leading cause of death among kidney transplant recipients. Validated biomarkers are important to identify patients at high risk for cardiovascular events and mortality. Cardiac troponins are one of the best available prognostic markers in this clinical situation, especially in chronic kidney disease and kidney transplant (KT) patients. The recently appeared high-sensitivity immunoassay to measure troponin T (hsTnT) has not yet been widely studied in the transplant population. We designed a cross-sectional study to evaluate hsTnT levels among 177 stable, asymptomatic patients, including 44.1% (78) males of overall mean age of 56.14 ± 14.25 years. Mean glomerular filtration rate estimated with the MDRD-4 (eGFR MDRD) formula was 48.93 ± 26.46 mL/min/1.73 m(2). Median hsTnT was 11 (interquartile range = 11-26) ng/L. Patients were classified according to their hsTnT levels: normal, below 14 ng/L (57.6%, n = 102 patients), and those with basally elevated levels. Upon univariate analysis, a significant association was found between higher hsTnT levels and several variables, including clinical features, such as age, sex or prior CVD; renal function indicators: creatinine, eGFR MDRD, and proteinuria; nutritional and inflammation markers: albumin, ferritin, and C-reactive protein; and several cardiac enzymes: creatine kinase myocardial band (CKMB), B-type natriuretic peptide, and its N-terminal fragment. A logistic regression model adjusted for age, sex, and variables significantly associated with higher hsTnT levels, showed that male gender, age, CKMB, and lower glomerular filtration rate to show independent relation to basally elevated levels of hsTnT among asymptomatic kidney transplant recipients.

Adaptive methods for growing electronic circuits on an imperfect synthetic matrix.

Living systems can adapt to injuries and even heal themselves, an ability desirable also in synthetic systems. A method is presented for dynamically adapting the construction of an electronic circuit to hardware defects by formulating the process as a series of interactions between identical but specialized structures called supercells. The circuit components, including wires, can occupy any place in the hardware that has been determined to be free of defects. The circuit specification is reduced to a connected graph, with no positional information, and provided as a code repeated in each supercell. Using the code, supercells differentiate into circuit components in a late stage of the process, with highly adaptable physical location and organization; supercells also form the wires between circuit components. The structure and function of the system at three major levels is presented, the lowest cellular level, the supercell, and the target circuit level. Adaptation of circuit construction to defective hardware was observed for this method. Results obtained from this development process on simulated and real hardware with a variety of defect types and defect patterns are presented, as well as higher level simulations of the algorithm and its response to a wider range of defect patterns, amounts of hardware, and hardware to fault ratios.

Prevalencia de presión arterial elevada y otros factores de riesgo de enfermedad cardiovascular en trabajadores de cafetines de la Universidad Central de Venezuela (ciudad universitaria) / Prevalence high blood pressure and others risk factors of cardiovascular disease in workers of cafe the cafeterias the Universidad Central de Venezuela (university city)

Se realizó un estudio transversal en una muestra de 100 sujetos, trabajadores de cafetines de la Universidad Central de Venezuela, en la cual predonimó el sexo masculino con el 62 por ciento y frente a 38 por ciento del femenino, con media 35+6 años de antiguedad en el oficio; el 72 por ciento tenían oficio de cocinero, "lonchero" y personal de limpieza y el 28 por ciento de cajero y personal administrativo o gerencial. En su mayoría el nivel de enseñanza fue de 7° año o menos. La prevalencia de la presión arterial elevada fue de 33 por ciento y presión de pulso elevada 46.7 por ciento. La media de la presión sistólica, ajustada a la edad, en personas con más de 5 años en el oficio (135 Hg./mm) estaba significativamente aumentada

Triphalangeal thumb and psychomotor retardation: a new association?

The triphalangeal thumb (TPT) is a rare malformation in which the thumb is presented as a long digit of three phalanges. We describe two brothers showing TPT and psychomotor retardation, especially in language. Difficulties in language development were also observed in children with TPT in another study. The coexistence of TPT and psychomotor retardation in those patients and in the two patients described here suggests that TPT and psychomotor retardation could be part of a syndromic association not described previously.