AKI: an increasingly recognized risk factor for CKD development and progression.

Acute kidney injury (AKI) is an increasing health burden with high morbidity and mortality rates worldwide. AKI is a risk factor for chronic kidney disease (CKD) development and progression to end stage renal disease (ESRD). Rapid action is required to find treatment options for AKI, plus to anticipate the development of CKD and other complications. Therefore, it is essential to understand the pathophysiology of AKI to CKD transition. Over the last several years, research has revealed maladaptive repair to be an interplay of cell death, endothelial dysfunction, tubular epithelial cell senescence, inflammatory processes and more-terminating in fibrosis. Various pathological mechanisms have been discovered and reveal targets for potential interventions. Furthermore, there have been clinical efforts measures for AKI prevention and progression including the development of novel biomarkers and prediction models. In this review, we provide an overview of pathophysiological mechanisms involved in kidney fibrosis. Furthermore, we discuss research gaps and promising therapeutic approaches for AKI to CKD progression.

Monitoring game-based motor rehabilitation of patients at home for better plans of care and quality of life.

This paper describes the biomedical, remote monitoring infrastructure developed and currently tested in the EU REHAB@HOME project to support home rehabilitation of the upper extremity of persons post-stroke and in persons with other neurological disorders, such as Multiple Sclerosis patients, in order to track their progress over therapy and improve their Quality of Life. The paper will specifically focus on describing the initial testing of the tele-rehabilitation system's components for patients' biomedical monitoring over therapy, which support the delivery and monitoring of more personalized, engaging plans of care by rehabilitation centers and services.

Nonlinear image labeling for multivalued segmentation.

We describe a framework for multivalued segmentation and demonstrate that some of the problems affecting common region-based algorithms can be overcome by integrating statistical and topological methods in a nonlinear fashion. We address the sensitivity to parameter setting, the difficulty with handling global contextual information, and the dependence of results on analysis order and on initial conditions. We develop our method within a theoretical framework and resort to the definition of image segmentation as an estimation problem. We show that, thanks to an adaptive image scanning mechanism, there is no need of iterations to propagate a global context efficiently. The keyword multivalued refers to a result property, which spans over a set of solutions. The advantage is twofold: first, there is no necessity for setting a priori input thresholds; secondly, we are able to cope successfully with the problem of uncertainties in the signal model. To this end, we adopt a modified version of fuzzy connectedness, which proves particularly useful to account for densitometric and topological information simultaneously. The algorithm was tested on several synthetic and real images. The peculiarities of the method are assessed both qualitatively and quantitatively.

[The application of fractal technics for the enhancement of radiographic images]. / Applicazione di tecniche frattali per la discriminazione di immagini radiografiche.

This paper deals with digital radiological image processing, with a special emphasis on quantitative measurement extraction aimed at discriminating different lung pathologies. Texture analysis of these images, not easily performed by the human eye, can be carried out by means of fractal techniques, which allow different textures to be characterized by a single parameter--i.e. the fractal dimension. To extract the fractal dimension of an image, the so-called "blanket" method is employed, which allows the average fractal dimension of an image area to be evaluated. The result of this processing is a new image whose points are assigned the average fractal dimension value of the area they belong to. The behaviors of fractal dimension histograms related to various simulations of lung pathologies are notably different, which allows such pathologies to be effectively characterized and differentiated on a quantitative basis. The radiographic images the "blanket" method was applied to are related to simulations of both pathological and healthy tissues. The behaviors of fractal dimension histograms and the average fractal dimension values allow the characterization of the different pathologies both for single tissues and in case of superimposition of a healthy tissue on a pathological one. The promising simulation results have encouraged us to carry out the present experimental investigation in the field of lung neoplasms.

Eventraciones: reconstitución plástica de la línea alba mediante doble sutura invaginante isotensional (DSII) / Reconstruction of midline incisional hernias using a double isotensional suture

Background: Incisional hernias of the midline are frequently multisacular and its treatment without a mesh is followed by a high rate of recurrences. Aim: To report a new technique for the treatment of midline incisional hernias, performing an isotensional suture of the midline with Vycril® 2-0, followed by a double invaginant suture of the rectus aponeurosis with Ethybond® 2-0. Material and Methods: Observational prospective study of 90 women and 26 men, aged 54 +/- 13 and 59 +/- 13 years respectively, with a hernia sac smaller than 15 cm and with an aponeurotic defect smaller than 3 cm, operated between January 2002 and December 2005. Results: Surgery was performed under local anesthesia on an ambulatory basis. The surgical procedure consisted in the excision of a skin lozenge which included the scar, dissection and reduction of all sacs and isotensional suture of the midline with Vycryl #1®. This suture was followed by a double invaginating suture of the rectus sheath in the midline with Ethylon® 0. Five superficial infections and two hematomas were observed. Seven recurrences (7 percent) in 99 patients (85 percent of the sample), were found during a mean follow up of 4.6 years (range 2-6). Conclusions: The double invaginating isotensional suture (DIIS) is an acceptable alternative for the treatment of small and middle size incisional hernias of the midline.

Las eventrorrafias sin malla de la línea media se asocian con una elevada tasa de recidivas. En esta publicación damos cuenta de una técnica fascial utihzable en eventraciones peque±as y medianas de la línea media que hemos llamado doble sutura invaginante isotensional (DSII). El estudio observacional descriptivo es una serie clínica constituida por 90 mujeres con una edad promedio de 54 +/- 12,9 años y 26 varones con una edad promedio de 59 +/- 13,7 años, intervenidos entre el Iº de Enero de 2002 y el 31 de Diciembre de 2005. En 14 casos se trató de una eventración recidivada. Se intervinieron pacientes con un saco de hasta 15 cm, único o múltiple, con un anillo inferior a 3 cm, con una edad fisiológica inferior a los 70 años y ASA 1 y 2. La obesidad y la diabetes mellitus no constituyeron una contraindicación. La operación se efectuó con anestesia local, en forma ambulatoria en 98 y con anestesia raquídea en 18 casos. La técnica incluyó resección de un losanjo de piel, manejo de los sacos y rrafia mediante sutura de la línea alba con Vycryl® 2-0, seguida de doble sutura invaginante del plano aponeurótico con Ethybond® 0. Apreciamos 5 infecciones y 2 hematomas de la herida. Un seguimiento promedio de 4,6 (2 - 6) años se efectuó en 99 pacientes (85 por ciento) de la muestra, apreciándose 7 recidivas (7 por ciento). La DSII es una técnica alternativa en las eventraciones pequeñas y medianas de la línea media.

Por una sexualidad humana responsable / Responsable human sexuality

Objetivos: 1) Conocer la características de la conducta sexual adolescente; 2) evaluar riesgos; 3) generar cambios positivos hacia una sexualidad humana responsable y más segura. Antecedentes: 1) Encuesta sobre población similar 1994. 2) Porcentaje de embarazos adolescentes en 1997/98 en Dolores. Diseño: Se abordaron temas de sexualidad para informar, reflexionar y obtener datos, en talleres y con encuestas estructuradas y no estructuradas. Lugar: Escuelas Medias N 1, 3,4 y Agraria de Dolores. Población: 1er año Polimodal (jóvenes de ambos sexos de 15 a 16 años). Resultados: Se trabajó con 430 jóvenes en grupos de 25 a 32, de junio a noviembre de 1999, realizándose 4 a 6 encuentros por grupo. Se encuestaron muestras representativas, de las que se desprende que el 19.46 por ciento no relaciona el momento de la ovulación con el embarazo, el 32.88 por ciento cree que el coito interrupto es un buen MAC. El 44.54 por ciento de las mujeres (M) y el 64.44 por ciento de los varones (V) se han iniciado sexualmente (en encuestas de 1994, IRS a los 16 años 24 por ciento de las M y 85.5 por ciento de los V). No usaron MAC o sólo lo usaron a veces el 47.12 por ciento de los V y el 75.49 por ciento de la M. De los V el 45.67 por ciento tiene relaciones casuales y el 32.18 por ciento con prostitutas. El 12.24 por ciento de las adolescentes sexualmente activas han quedado embarazadas, de éstas llegaron a término el 42.85 por ciento abortaron el 57.14 por ciento. El 88.97 por ciento de los encuestados consideraron que los talleres los ayudaron y escribieron reflexiones. Conclusión: La disminución de la edad de IRS, el bajo uso del preservativo y el alto indice de embarazos demuestran conductas sexuales de riesgo que hacen necesaria una intervención educativa. La educación sexual parte de la familia, pero la escuela puede hacer un valioso aporte, el mismo necesita generar una relación empática adecuada, que permita una profunda reflexión, esto se puede conseguir, si desde el ámbito salud, se realiza un trabajo con docentes, para generar promotores de salud en sexualidad, el contacto permanente de ellos con los jóvenes puede establecer la continuidad y comunicación necesaria para una adecuada respuesta