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1.
J Neurosci ; 40(40): 7739-7748, 2020 09 30.
Artículo en Inglés | MEDLINE | ID: mdl-32868459

RESUMEN

Accumulating evidence suggests that forgetting is not necessarily a passive process but that we can, to some extent, actively control what we remember and what we forget. Although this intentional control of memory has potentially far-reaching implications, the factors that influence our capacity to intentionally control our memory are largely unknown. Here, we tested whether acute stress may disrupt the intentional control of memory and, if so, through which neural mechanism. We exposed healthy men and women to a stress (n = 27) or control (n = 26) procedure before they aimed repeatedly to retrieve some previously learned cue-target pairs and to actively suppress others. While control participants showed reduced memory for suppressed compared with baseline pairs in a subsequent memory test, this suppression-induced forgetting was completely abolished after stress. Using magnetoencephalography (MEG), we show that the reduced ability to suppress memories after stress is associated with altered theta activity in the inferior temporal cortex when the control process (retrieval or suppression) is triggered and in the lateral parietal cortex when control is exerted, with the latter being directly correlated with the stress hormone cortisol. Moreover, the suppression-induced forgetting was linked to altered connectivity between the hippocampus and right dorsolateral prefrontal cortex (PFC), which in turn was negatively correlated to stress-induced cortisol increases. These findings provide novel insights into conditions under which our capacity to actively control our memory breaks down and may have considerable implications for stress-related psychopathologies, such as posttraumatic stress disorder (PTSD), that are characterized by unwanted memories of distressing events.SIGNIFICANCE STATEMENT It is typically assumed that forgetting is a passive process that can hardly be controlled. There is, however, evidence that we may actively control, to some extent, what we remember and what we forget. This intentional memory control has considerable implications for mental disorders in which patients suffer from unwanted (e.g., traumatic) memories. Here, we demonstrate that the capacity to intentionally control our memory breaks down after stress. Using magnetoencephalography (MEG), we show that this stress-induced memory control deficit is linked to altered activity in the lateral parietal cortex and the connectivity between the hippocampus and right prefrontal cortex (PFC). These findings provide novel insights into conditions under which memory control fails and are highly relevant in the context of stress-related psychopathologies.


Asunto(s)
Memoria , Lóbulo Parietal/fisiología , Estrés Psicológico/fisiopatología , Ritmo Teta , Adolescente , Adulto , Femenino , Humanos , Magnetoencefalografía , Masculino , Lóbulo Parietal/fisiopatología
2.
Acta Psychiatr Scand ; 136(1): 96-107, 2017 07.
Artículo en Inglés | MEDLINE | ID: mdl-28383757

RESUMEN

OBJECTIVE: Alcohol dependence is more prevalent in men than in women. The evidence for how prenatal and adult androgens influence alcohol dependence is limited. We investigated the effects of prenatal and adult androgen activity on alcohol dependence. Moreover, we studied how the behaviours of pregnant women affect their children's prenatal androgen load. METHOD: We quantified prenatal androgen markers (e.g., second-to-fourth finger length ratio [2D : 4D]) and blood androgens in 200 early-abstinent alcohol-dependent in-patients and 240 controls (2013-2015, including a 12-month follow-up). We also surveyed 134 women during pregnancy (2005-2007) and measured the 2D : 4D of their children (2013-2016). RESULTS: The prenatal androgen loads were higher in the male alcohol-dependent patients compared to the controls (lower 2D : 4D, P = 0.004) and correlated positively with the patients' liver transaminase activities (P < 0.001) and alcohol withdrawal severity (P = 0.019). Higher prenatal androgen loads and increasing androgen levels during withdrawal predicted earlier and more frequent 12-month hospital readmission in alcohol-dependent patients (P < 0.005). Moreover, stress levels (P = 0.002), alcohol (P = 0.010) and tobacco consumption (P = 0.017), and lifetime stressors (P = 0.019) of women during pregnancy related positively to their children's prenatal androgen loads (lower 2D : 4D). CONCLUSION: Androgen activities in alcohol-dependent patients and behaviours of pregnant women represent novel preventive and therapeutic targets of alcohol dependence.


Asunto(s)
Alcoholismo/sangre , Alcoholismo/fisiopatología , Andrógenos/metabolismo , Efectos Tardíos de la Exposición Prenatal/metabolismo , Efectos Tardíos de la Exposición Prenatal/fisiopatología , Síndrome de Abstinencia a Sustancias/sangre , Síndrome de Abstinencia a Sustancias/fisiopatología , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Alcoholismo/epidemiología , Alcoholismo/metabolismo , Estudios Transversales , Dinamarca/epidemiología , Dihidrotestosterona/sangre , Femenino , Dedos/anatomía & histología , Humanos , Estudios Longitudinales , Masculino , Embarazo , Efectos Tardíos de la Exposición Prenatal/epidemiología , Factores Sexuales , Fumar/epidemiología , Estrés Psicológico/epidemiología , Testosterona/sangre
3.
Br J Anaesth ; 118(3): 400-406, 2017 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-28199523

RESUMEN

Background: Cerebral microemboli (ME) are frequently generated during orthopaedic surgery and may impair cerebral integrity. However, the nature of cerebral ME, being either of solid or gaseous origin, is poorly investigated. Our primary aim was to determine both the frequency and nature of cerebral ME in generally anaesthetised patients undergoing major orthopaedic surgery. Methods: Fifty patients (hip/knee/shoulder prosthesis, spine surgery) were enrolled. Cerebral ME and cerebral blood flow velocity (CBFV) were determined in both middle cerebral arteries for 15 min preoperatively and postoperatively, using transcranial Doppler ultrasound. Cerebral tissue oxygen index, determined by near-infrared spectroscopy, was further examined. Statistical analysis was carried out using the Wilcoxon matched-pairs signed-ranks test (median (25 th ; 75 th percentile), P < 0.05). Results: Overall the frequency of postoperative cerebral ME rose to 600% of preoperative values. Primarily gaseous ME occurred preoperatively and postoperatively [19 (6; 63) vs 116 (24; 373), P < 0.001], while the number of solid ME was negligibly small [1 (0; 2) vs 2 (0; 6), P < 0.001]. CBFV and cerebral tissue oxygen index remained unaltered bilaterally before and after surgery. Conclusions: Our findings indicate that cerebral ME considerably increase after major orthopaedic surgery under general anaesthesia. The predominant accumulation of gaseous ME and their preoperative occurrence, suggest that the general anaesthesia and individual patient factors may contribute to the embolic load in addition to orthopaedic surgery. Clinical trial registration: . NCT02340416.


Asunto(s)
Embolia Intracraneal/diagnóstico por imagen , Procedimientos Ortopédicos , Complicaciones Posoperatorias/diagnóstico por imagen , Ultrasonografía Doppler Transcraneal/métodos , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo , Arterias Cerebrales/diagnóstico por imagen , Estudios de Cohortes , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medición de Riesgo , Columna Vertebral/cirugía
4.
Colorectal Dis ; 19(3): 243-250, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-27354302

RESUMEN

AIM: The nonagenarian population is a rapidly growing segment of the Australian population. Surgical resection continues to offer the best chance of long-term survival in colorectal cancer. The primary aims of the present study were to evaluate the 30-day mortality and survival of Australian patients ≥ 90 years of age undergoing surgical resection for colorectal cancer in our health service. The secondary aims were to examine the clinicopathological characteristics of the patients and their tumours. METHOD: All patients ≥ 90 years of age undergoing surgical resection for colorectal cancer from 1998 to 2012 were identified in a centralized multihospital database. Key clinicopathological data, 30-day mortality and long-term overall survival were recorded for each patient. RESULTS: There were 121 patients identified of median age 91 years, 74% of whom were female. The median tumour size was 40 mm, and 51% of operations were carried out as an emergency. The TNM stage was Stage I/II in 57%, Stage III in 40% and Stage IV in 3%. The 30-day mortality was 6.6% (eight of 121) and the 1-, 3- and 5-year overall survival rates were 82.6%, 50.2% and 32.3%, respectively. CONCLUSION: Surgical resection in the nonagenarian patient has an acceptable mortality and offers good overall survival.


Asunto(s)
Adenocarcinoma Mucinoso/cirugía , Adenocarcinoma/cirugía , Neoplasias Colorrectales/cirugía , Adenocarcinoma/patología , Adenocarcinoma Mucinoso/patología , Anciano de 80 o más Años , Australia , Colectomía , Neoplasias Colorrectales/patología , Procedimientos Quirúrgicos del Sistema Digestivo , Procedimientos Quirúrgicos Electivos , Urgencias Médicas , Femenino , Humanos , Masculino , Mortalidad , Estadificación de Neoplasias , Estudios Retrospectivos , Tasa de Supervivencia , Carga Tumoral
5.
Nano Lett ; 15(7): 4541-5, 2015 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-26087352

RESUMEN

We probe the local detection efficiency in a nanowire superconducting single-photon detector along the cross-section of the wire with a far subwavelength resolution. We experimentally find a strong variation in the local detection efficiency of the device. We demonstrate that this effect explains previously observed variations in NbN detector efficiency as a function of device geometry.

6.
Cytometry A ; 87(3): 254-61, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25655377

RESUMEN

This report focuses on the characterization of CD4 expression level in terms of equivalent number of reference fluorophores (ERF). Twelve different flow cytometer platforms across sixteen laboratories were utilized in this study. As a first step the participants were asked to calibrate the fluorescein isothiocyanate (FITC) channel of each flow cytometer using commercially available calibration standard consisting of five populations of microspheres. Each population had an assigned value of equivalent fluorescein fluorophores (EFF denotes a special case of the generic term ERF with FITC as the reference fluorophore). The EFF values were assigned at the National Institute of Standards and Technology (NIST). A surface-labelled lyophilized cell preparation was provided by the National Institute of Biological Standards and Control (NIBSC), using human peripheral blood mononuclear cells (PBMC) pre-labeled with a FITC conjugated anti-CD4 monoclonal antibody. Three PBMC sample vials, provided to each participant, were used for the CD4 expression analysis. The PBMC are purported to have a fixed number of surface CD4 receptors. On the basis of the microsphere calibration, the EFF value of the PBMC samples was measured to characterize the population average CD4 expression level of the PBMC preparations. Both the results of data analysis performed by each participant and the results of centralized analysis of all participants' raw data are reported. Centralized analysis gave a mean EFF value of 22,300 and an uncertainty of 750, corresponding to 3.3% (level of confidence 68%) of the mean EFF value. The next step will entail the measurement of the ERF values of the lyophilized PBMC stained with labels for other fluorescence channels. The ultimate goal is to show that lyophilized PBMC is a suitable biological reference cell material for multicolor flow cytometry and that it can be used to present multicolor flow cytometry measurements in terms of ABC (antibodies bound per cell) units.


Asunto(s)
Antígenos CD4/biosíntesis , Fluoresceína-5-Isotiocianato , Leucocitos Mononucleares/metabolismo , Fenotipo , Anticuerpos/análisis , Anticuerpos/metabolismo , Antígenos CD4/análisis , Recuento de Linfocito CD4/métodos , Recuento de Linfocito CD4/normas , Fluoresceína-5-Isotiocianato/análisis , Liofilización/métodos , Regulación de la Expresión Génica , Humanos , Leucocitos Mononucleares/química
7.
Colorectal Dis ; 17(7): 600-11, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-25546572

RESUMEN

AIM: The aim of this study was to compare the methodological quality and input paper characteristics of systematic reviews and meta-analyses reported in the medical and surgical literature by performing a systematic 'overview of reviews'. Ulcerative colitis (UC) and Crohn's disease (CD) were used as the framework for this comparison as they are relatively common serious conditions, with both medical and surgical options for therapy. METHOD: Medline, Embase, CINHAL and the Cochrane Database were searched to November 2013. Eligible papers were systematic reviews or meta-analyses that considered a question of therapy in CD or UC. Two independent reviewers selected the papers, extracted the data and scored their methodology using the AMSTAR scoring system. The papers were categorized into medical therapy (M), surgical therapy (S) or medical and surgical therapy (MS) groups. Following retrieval of the sample of meta-evidence papers, the original input studies used in their creation were identified and a search of Medline, Embase, CINHAL and the Cochrane Database was performed. A team of researchers then examined the collection of papers for bibliographic and financial information. RESULTS: Five hundred papers were identified in the meta-evidence search, of which 118 were deemed eligible. There was a difference in the AMSTAR-rated average quality of the papers between the S and M group (S 7.36 vs M 8.75, P = 0.01). On average S papers were published in journals with a lower impact factor (S 3.26, M 5.04, MS 5.30, P < 0.001). S papers also showed more heterogeneity (I(2) ; S 37%, M 24%, MS 10%, P < 0.001). Some 25% of S meta-analyses used data-sets with significant heterogeneity (I(2) > 75%), compared with 8% of M meta-analyses and 3% of the MS meta-analyses. Some 5% of S papers were done on data sets that had I(2) values > 90%. There was no difference in the average number of papers assessed in each group, the average number of patients per meta-paper, the average time covered by the reviews, the average number of papers considered within each meta-analysis, or the average number of patients considered within each meta-analysis. Considering the conclusions of each meta-analysis, S meta-evidence was 50% more likely than M meta-evidence to be unable to make recommendations for practice. A total of 1499 original input papers were identified, of which 283 were used in more than one review. Within the non-repeated papers (n = 1023) the average impact factor within the S group was lower than that of the M and the MS groups (3.720 vs 11.230 vs 7.563, respectively; ANOVAP < 0.001). M papers had higher rates of pharmaceutical sponsorship than S papers (M 56% vs S 1%) and twice the level of government support (M 16% vs S 8%). Of note, 21% of M papers had corporate sponsorship but did not list any conflict of interest. CONCLUSION: Compared with M meta-analyses, S meta-analyses in the UC and CD domain are more likely to be of poorer methodological quality, are of a greater degree of heterogeneity and less often offer a positive conclusion. The papers used to generate meta-evidence in M papers have a greater degree of corporate and government sponsorship, and are more likely to come from journals with higher impact factors.


Asunto(s)
Investigación Biomédica , Gastroenterología , Enfermedades Inflamatorias del Intestino , Metaanálisis como Asunto , Literatura de Revisión como Asunto , Humanos , Factor de Impacto de la Revista , Investigación Cualitativa , Apoyo a la Investigación como Asunto
8.
Bratisl Lek Listy ; 116(4): 222-6, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25773948

RESUMEN

OBJECTIVE: To assess the reliability of the cervical vertebrae maturation method (CVM). BACKGROUND: Skeletal maturity estimation can influence the manner and time of orthodontic treatment. The CVM method evaluates skeletal growth on the basis of the changes in the morphology of cervical vertebrae C2, C3, C4 during growth. These vertebrae are visible on a lateral cephalogram, so the method does not require an additional radiograph. METHODS: In this website based study, 10 orthodontists with a long clinical practice (3 routinely using the method - "Routine user - RU" and 7 with less experience in the CVM method - "Non-Routine user - nonRU") rated twice cervical vertebrae maturation with the CVM method on 50 cropped scans of lateral cephalograms of children in circumpubertal age (for boys: 11.5 to 15.5 years; for girls: 10 to 14 years). Kappa statistics (with lower limits of 95% confidence intervals (CI)) and proportion of complete agreement on staging was used to evaluate intra- and inter-assessor agreement. RESULTS: The mean weighted kappa for intra-assessor agreement was 0.44 (range: 0.30-0.64; range of lower limits of 95% CI: 0.12-0.48) and for inter-assessor agreement was 0.28 (range: -0.01-0.58; range of lower limits of 95% CI: -0.14-0.42). The mean proportion of identical scores assigned by the same assessor was 55.2 %(range: 44-74 %) and for different pairs of assessors was 42 % (range: 16-68 %). CONCLUSIONS: The reliability of the CVM method is questionable and if orthodontic treatment should be initiated relative to the maximum growth, the use of additional biologic indicators should be considered (Tab. 4, Fig. 1, Ref. 24).


Asunto(s)
Determinación de la Edad por el Esqueleto/métodos , Cefalometría/métodos , Vértebras Cervicales/anatomía & histología , Vértebras Cervicales/crecimiento & desarrollo , Adolescente , Niño , Femenino , Humanos , Masculino , Curva ROC , Reproducibilidad de los Resultados
9.
Br J Surg ; 101(9): 1153-9, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24977342

RESUMEN

BACKGROUND: Short-term advantages to laparoscopic surgery are well described. This study compared medium- to long-term outcomes of a randomized clinical trial comparing laparoscopic and open colonic resection for cancer. METHODS: The case notes of patients included in the LAFA study (perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care) were reviewed 2-5 years after randomization for incisional hernia, adhesional small bowel obstruction (SBO), overall survival, cancer recurrence and quality of life (QoL). The laparoscopic and open groups were compared irrespective of fast-track or standard perioperative care. RESULTS: Data on incisional hernias, SBO, survival and recurrence were available for 399 of 400 patients: 208 laparoscopic and 191 open resections. These outcomes were corrected for duration of follow-up. Median follow-up was 3·4 (i.q.r. 2·6-4·4) years. Multivariable regression analysis showed that open resection was a risk factor for incisional hernia (odds ratio (OR) 2·44, 95 per cent confidence interval (c.i.) 1·12 to 5·26; P = 0·022) and SBO (OR 3·70, 1·07 to 12·50; P = 0·039). There were no differences in overall survival (hazard ratio 1·10, 95 per cent c.i. 0·67 to 1·80; P = 0·730) or in cumulative incidence of recurrence (P = 0·514) between the laparoscopic and open groups. There were no measured differences in QoL in 281 respondents (P > 0·350 for all scales). CONCLUSION: Laparoscopic colonic surgery led to fewer incisional hernia and adhesional SBO events. REGISTRATION NUMBER: NTR222 (http://www.trialregister.nl).


Asunto(s)
Colectomía/efectos adversos , Neoplasias del Colon/cirugía , Hernia Abdominal/etiología , Obstrucción Intestinal/etiología , Intestino Delgado , Laparoscopía/efectos adversos , Anciano , Colectomía/métodos , Colectomía/mortalidad , Neoplasias del Colon/mortalidad , Conversión a Cirugía Abierta/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Hernia Abdominal/mortalidad , Humanos , Obstrucción Intestinal/mortalidad , Estimación de Kaplan-Meier , Laparoscopía/métodos , Laparoscopía/mortalidad , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Calidad de Vida
10.
Colorectal Dis ; 16(7): 502-15, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24605870

RESUMEN

AIM: Local excision of early rectal cancer is a less morbid alternative to major abdominal surgery. This review evaluates the role of local excision with neoadjuvant or adjuvant chemoradiotherapy to identify a select group of patients where local excision is appropriate without significantly compromising the oncological outcome. METHOD: MEDLINE, PubMed and the Cochrane Central Register of Controlled Trials databases were searched to identify relevant articles investigating the role of local excision with adjuvant or neoadjuvant chemoradiotherapy in patients with T1/T2N0M0 disease. Eleven studies comprising 455 patients were selected. Oncological end-points included overall survival, disease-free and disease-specific survival, recurrence rates as well as perioperative morbidity and mortality. RESULTS: At a range of 30.5-115.2 months, median overall survival, disease-specific and disease-free survival were 75% (66-80.6%), 89% (75-93.3%) and 74% (64-85.2%), respectively. Median local, distant and overall recurrence rates were 10% (4.8-25%), 4.7% (4-11.8%) and 13.1% (10.7-23.5%), respectively. Mortality was 0% in all studies except one (2.9%). Most reported complications were minor and were treated conservatively. CONCLUSION: This systematic review provides data suggesting that selected patients with T1/T2N0M0 rectal cancer may undergo local excision without compromising the oncological outcome otherwise conferred by total mesorectal excision. It may be a particularly useful option in patients in whom radical surgery is contraindicated. Randomized trials comparing both management strategies to consolidate this finding may lead to a paradigm change in the management of early rectal cancer.


Asunto(s)
Quimioradioterapia , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Neoplasias del Recto/cirugía , Neoplasias del Recto/terapia , Humanos , Terapia Neoadyuvante , Estadificación de Neoplasias , Selección de Paciente , Neoplasias del Recto/mortalidad , Neoplasias del Recto/patología , Resultado del Tratamiento
11.
Colorectal Dis ; 16(8): 631-9, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24506067

RESUMEN

AIM: The aim of this study was to develop and externally validate a clinically, practical and discriminative prediction model designed to estimate in-hospital mortality of patients undergoing colorectal surgery. METHOD: All consecutive patients who underwent elective or emergency colorectal surgery from 1990 to 2005, at the Zaandam Medical Centre, The Netherlands, were included in this study. Multivariate logistic regression analysis was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) linking the explanatory variables to the outcome variable in-hospital mortality, and a simplified Identification of Risk in Colorectal Surgery (IRCS) score was constructed. The model was validated in a population of patients who underwent colorectal surgery from 2005 to 2011 in Barcelona, Spain. Predictive performance was estimated by calculating the area under the receiver operating characteristic curve. RESULTS: The strongest predictors of in-hospital mortality were emergency surgery (OR = 6.7, 95% CI 4.7-9.5), tumour stage (OR = 3.2, 95% CI 2.8-4.6), age (OR = 13.1, 95% CI 6.6-26.0), pulmonary failure (OR = 4.9, 95% CI 3.3-7.1) and cardiac failure (OR = 3.7, 95% CI 2.6-5.3). These parameters were included in the prediction model and simplified scoring system. The IRCS model predicted in-hospital mortality and demonstrated a predictive performance of 0.83 (95% CI 0.79-0.87) in the validation population. In this population the predictive performance of the CR-POSSUM score was 0.76 (95% CI 0.71-0.81). CONCLUSIONS: The results of this study have shown that the IRCS score is a good predictor of in-hospital mortality after colorectal surgery despite the relatively low number of model parameters.


Asunto(s)
Cirugía Colorrectal/mortalidad , Mortalidad Hospitalaria , Factores de Edad , Anciano , Anciano de 80 o más Años , Tratamiento de Urgencia/mortalidad , Femenino , Insuficiencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Países Bajos , Oportunidad Relativa , Periodo Posoperatorio , Insuficiencia Respiratoria , Estudios Retrospectivos , Riesgo , Medición de Riesgo/métodos , España
12.
Nanotechnology ; 24(24): 245402, 2013 Jun 21.
Artículo en Inglés | MEDLINE | ID: mdl-23702912

RESUMEN

New nanostructured electrodes, promising for the production of clean and renewable energy in biofuel cells, were developed with success. For this purpose, carbon nanofibers were produced by the electrospinning of polyacrylonitrile solution followed by convenient thermal treatments (stabilization followed by carbonization at 1000, 1200 and 1400° C), and carbon nanotubes were adsorbed on the surfaces of the fibers by a dipping method. The morphology of the developed electrodes was characterized by several techniques (SEM, Raman spectroscopy, electrical conductivity measurement). The electrochemical properties were evaluated through cyclic voltammetry, where the influence of the carbonization temperature of the fibers and the beneficial contribution of the carbon nanotubes were observed through the reversibility and size of the redox peaks of K3Fe(CN)6 versus Ag/AgCl. Subsequently, redox enzymes were immobilized on the electrodes and the electroreduction of oxygen to water was realized as a test of their efficiency as biocathodes. Due to the fibrous and porous structure of these new electrodes, and to the fact that carbon nanotubes may have the ability to promote electron transfer reactions of redox biomolecules, the new electrodes developed were capable of producing higher current densities than an electrode composed only of electrospun carbon fibers.


Asunto(s)
Fuentes de Energía Bioeléctrica , Carbono/química , Lacasa/metabolismo , Nanotecnología/métodos , Nanotubos de Carbono/química , Resinas Acrílicas/química , Adsorción , Fibra de Carbono , Catálisis , Conductividad Eléctrica , Técnicas Electroquímicas , Electrodos , Nanotubos de Carbono/ultraestructura , Oxígeno/química , Espectrometría Raman , Temperatura , Trametes/enzimología
14.
Colorectal Dis ; 15(9): e528-33, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24199233

RESUMEN

AIM: A standardized postoperative score, the DULK (Dutch leakage) score, has been demonstrated to be a useful clinical tool in the diagnosis of anastomotic leakage. It is complicated, however, and a simplification (the modified DULK score) based on fewer parameters derived from multiple logistic regression analyses has been developed. These include clinical condition, abdominal pain not localized at the wound, C-reactive protein level and respiratory rate. The accuracy of each was compared. METHOD: Data of all patients from five Dutch centres operated on between 16 October 2007 and 1 November 2009 with an anastomosis in the colon or rectum were entered into a prospectively maintained database. RESULTS: In total, 782 patients were included of whom 81 (10.4%) had a clinically relevant anastomotic leakage. The DULK score gave an overall sensitivity of 97% for anastomotic leakage, overall specificity of 53%, a positive predictive value (PPV) of 16% and a negative predictive value (NPV) of 99%. The modified DULK score used clinical condition, abdominal pain not localized at the wound, C-reactive protein level and respiratory rate. With at least one parameter present, overall sensitivity was 97%, overall specificity 57%, PPV 17% and NPV 99.5%. With at least two points PPV was 41% and with three points 57%. CONCLUSION: Both the original and modified DULK scores are useful for the early diagnosis of clinically relevant anastomotic leakage. The modified DULK score offers the benefit of fewer parameters and so can easily be used in a clinical environment to estimate the likelihood of anastomotic leakage. However, the early diagnosis of anastomotic leakage remains difficult.


Asunto(s)
Fuga Anastomótica/diagnóstico , Colon/cirugía , Técnicas de Apoyo para la Decisión , Recto/cirugía , Dolor Abdominal , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica , Proteína C-Reactiva/análisis , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Países Bajos , Estudios Prospectivos , Frecuencia Respiratoria , Sensibilidad y Especificidad
15.
J Cancer Res Clin Oncol ; 149(10): 7717-7728, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-37004598

RESUMEN

AIM: To summarise our centre's experience managing patients with neuroendocrine tumours (NETs) in the first 5 years after the introduction of peptide receptor radionuclide therapy (PRRT) with [177Lu]Lu-DOTA-octreotate (LUTATE). The report emphasises aspects of the patient management related to functional imaging and use of radionuclide therapy. METHODS: We describe the criteria for treatment with LUTATE at our centre, the methodology for patient selection, and the results of an audit of clinical measures, imaging results and patient-reported outcomes. Subjects are treated initially with four cycles of ~ 8 GBq of LUTATE administered as an outpatient every 8 weeks. RESULTS: In the first 5 years offering LUTATE, we treated 143 individuals with a variety of NETs of which approx. 70% were gastroentero-pancreatic in origin (small bowel: 42%, pancreas: 28%). Males and females were equally represented. Mean age at first treatment with LUTATE was 61 ± 13 years with range 28-87 years. The radiation dose to the organs considered most at risk, the kidneys, averaged 10.6 ± 4.0 Gy in total. Median overall survival (OS) from first receiving LUTATE was 72.5 months with a median progression-free survival (PFS) of 32.3 months. No evidence of renal toxicity was seen. The major long-term complication seen was myelodysplastic syndrome (MDS) with a 5% incidence. CONCLUSIONS: LUTATE treatment for NETs is a safe and effective treatment. Our approach relies heavily on functional and morphological imaging informing the multidisciplinary team of NET specialists to guide appropriate therapy, which we suggest has contributed to the favourable outcomes seen.


Asunto(s)
Tumores Neuroendocrinos , Masculino , Femenino , Humanos , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Tumores Neuroendocrinos/patología , Medicina de Precisión , Octreótido/uso terapéutico , Imagen Molecular , Receptores de Péptidos , Radioisótopos
16.
Colorectal Dis ; 14(8): 997-1000, 2012 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-21955514

RESUMEN

AIM: The aim of the study was to determine the long-term outcome, recurrence rate and faecal incontinence score after fissurectomy for chronic anal fissure (CAF) not responding to conservative treatment. METHOD: Fifty-three consecutive patients (29 women) who underwent fissurectomy for a medically resistant CAF between 1998 and 2005 were included in the study. At a minimum follow-up of 5 years a standardized questionnaire was sent to all patients, assessing recurrence, satisfaction with the operation (on a scale of 0-10) and faecal continence (Vaizey score, 0-24). The patients were compared with a control group of 50 healthy volunteers, matched for sex and age, who had never undergone anal surgery. RESULTS: Forty-three (81%) patients (25 women) returned the questionnaire. The mean age was 40 (SD 12.1) years and median follow up was 8.2 (5.5-12.2) years. Five patients had a recurrent CAF (11.6%). Ninety per cent of patients would have consented to the operation again if necessary. The mean Vaizey score at follow-up was 2.5 (SD ± 4.2). The mean Vaizey score of the four patients who had had a previous lateral sphincterotomy was 3.8 and for the eight patients who had reported a continence disturbance before fissurectomy it was 8.3. The mean Vaizey score of the 31 patients who were continent before fissurectomy was 0.8 compared with 0.4 in the control group (P = 0.9). CONCLUSION: At 5 years or more fissurectomy for medically resistant CAF is effective with a low recurrence rate and minimal influence on continence.


Asunto(s)
Fisura Anal/cirugía , Adulto , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Incontinencia Fecal/cirugía , Femenino , Humanos , Masculino , Satisfacción del Paciente , Recurrencia , Encuestas y Cuestionarios
17.
Colorectal Dis ; 19(6): 589-590, 2017 06.
Artículo en Inglés | MEDLINE | ID: mdl-28494522
18.
Colorectal Dis ; 14(4): e187-90, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-21955545

RESUMEN

AIM: The aetiology of colonoscopic perforation and factors related to poor outcome of surgical treatment were studied. METHOD: A single-centre review was conducted of all patients who underwent surgical treatment of a colonoscopic perforation, identified from a prospective registry of 21,981 consecutive colonoscopies carried out between 1993 and 2009. RESULTS: There were 29 (eight women) patients of mean age 73 years including 10 who had a nonelective colonoscopy. The perforation was not immediately recognized in 12 patients and in the remaining 17, seven were initially managed conservatively. The causes of perforation were barotrauma (11), mechanical force (14) and polypectomy-related (3). Barotrauma was more frequent in emergency colonoscopy and mechanical force in elective colonoscopy. The outcome of surgery was as follows: mortality 10%, complications 34.5%, reoperation 14%, secondary surgery 23% and permanent colostomy 3%. The only factor related to in-hospital mortality was an increased American Society of Anesthesiologists (ASA) score. CONCLUSION: Colonoscopic perforation requiring surgery is a catastrophic event with high mortality, morbidity and reoperation rates.


Asunto(s)
Colon/cirugía , Enfermedades del Colon/cirugía , Colonoscopía/efectos adversos , Perforación Intestinal/cirugía , Anciano , Barotrauma/complicaciones , Enfermedades del Colon/diagnóstico , Enfermedades del Colon/etiología , Enfermedades del Colon/mortalidad , Pólipos del Colon/cirugía , Femenino , Humanos , Perforación Intestinal/diagnóstico , Perforación Intestinal/etiología , Perforación Intestinal/mortalidad , Masculino , Complicaciones Posoperatorias/epidemiología , Sistema de Registros , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
19.
Andrologia ; 44 Suppl 1: 471-3, 2012 May.
Artículo en Inglés | MEDLINE | ID: mdl-21806664

RESUMEN

The aim of this study was to ascertain the variations in the reproductive sex ratio (number of men to number of women) among male professional basketball players in Spain. This retrospective, cross-sectional study is based on a survey conducted in the Spanish professional basketball leagues during the season 2009-2010. A total of 172 professional basketball players completed an anonymous survey. Forty-seven of the respondents had offspring, with a total of 61 children: 70% girls and 30% boys, with a sex ratio value of 0.42. Thirty-three basketball players were Caucasian (CAU), with 44 children, nine boys and 35 girls (sex ratio = 0.26). Fourteen were black, of African heritage (AFR), with 17 children, nine boys and eight girls, (sex ratio = 1.12). Differences (P < 0.01) were found in offspring sex ratio values for all basketball players (sex ratio = 0.42) and for CAU group (sex ratio = 0.26) when compared with the general Spanish population (sex ratio = 1.06). Moreover, a significant seasonal variation was observed in CAU offspring sex ratio during the first quarter compared with the rest of the year (0.66 versus 0.12) (P < 0.03). In conclusion, a significant increase in the sex ratio value in favour of female offspring was observed in the group of CAU professional basketball players.


Asunto(s)
Baloncesto , Razón de Masculinidad , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Estudios Retrospectivos , España , Encuestas y Cuestionarios
20.
J Microencapsul ; 29(2): 138-46, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22329480

RESUMEN

Nanoparticles prepared of human serum albumin (HSA) represent promising carriers for drug delivery. Desolvating procedure is a common method to obtain protein-based particles. However process parameters have a great influence on size, size distribution and particle yield of the resulting formulation. Therefore, it is crucial to investigate their effects on particle preparation. This study is focused on the influence of different desolvating agents on the resulting particle characteristics and cytotoxicity in cell culture. Another aspect of the study was the influence of different stirring rates, pre-stirring of the HSA solution and the continuous addition of desolvating agent during the preparation process. The results indicate that it is possible to predict the particle size depending on dielectric constant of the desolvation medium. Remarkably, combination of methanol and ethanol used as desolvating agent was able to produce very small spherical HSA nanoparticles in a size range between 50 and 80 nm.


Asunto(s)
Sistemas de Liberación de Medicamentos , Nanopartículas/administración & dosificación , Albúmina Sérica/administración & dosificación , Tamaño de la Partícula , Solubilidad
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