Increases in functional connectivity between the default mode network and sensorimotor network correlate with symptomatic improvement after transcranial direct current stimulation for obsessive-compulsive disorder.

BACKGROUND: Non-invasive neuromodulation is a promising intervention for obsessive-compulsive disorder (OCD), although its neurobiological mechanisms of action are still poorly understood. Recent evidence suggests that abnormalities in the connectivity of the default mode network (DMN) and the supplementary motor area (SMA) with other brain regions and networks are involved in OCD pathophysiology. We examined if transcranial direct current stimulation (tDCS) alters these connectivity patterns and if they correlate with symptom improvement in treatment-resistant OCD. METHODS: In 23 patients from a larger clinical trial (comparing active tDCS to sham) who underwent pre- and post-treatment MRI scans, we assessed resting-state functional MRI (rs-fMRI) data. The treatment involved 30-minute daily tDCS sessions for four weeks (weekdays only), with the cathode over the SMA and the anode over the left deltoid. We conducted whole-brain connectivity analysis comparing active tDCS-treated to sham-treated patients. RESULTS: We found that active tDCS, but not sham, led to connectivity increasing between the DMN and the bilateral pre/postcentral gyri (p = 0.004, FDR corrected) and temporal-auditory areas plus the SMA (p = 0.028, FDR corrected). Also, symptom improvement was directly associated with connectivity increasing between the left lateral sensorimotor network and the left precuneus (r = 0.589, p = 0.034). LIMITATIONS: Limited sample size (23 participants with resting-state neuroimaging), inability to analyze specific OCD symptom dimensions (e.g., harm, sexual/religious, symmetry/checking, cleaning/contamination). CONCLUSIONS: These data offer novel information concerning functional connectivity changes associated with non-invasive neuromodulation interventions in OCD and can guide new brain stimulation interventions in the framework of personalized interventions.

External validation of Fetal Medicine Foundation competing-risks model for midgestation prediction of small-for-gestational-age neonates in Spanish population.

OBJECTIVE: To examine the external validity of the new Fetal Medicine Foundation (FMF) competing-risks model for prediction in midgestation of small-for-gestational-age (SGA) neonates. METHODS: This was a single-center prospective cohort study of 25 484 women with a singleton pregnancy undergoing routine ultrasound examination at 19 + 0 to 23 + 6 weeks' gestation. The FMF competing-risks model for the prediction of SGA combining maternal factors and midgestation estimated fetal weight by ultrasound scan (EFW) and uterine artery pulsatility index (UtA-PI) was used to calculate risks for different cut-offs of birth-weight percentile and gestational age at delivery. The predictive performance was evaluated in terms of discrimination and calibration. RESULTS: The validation cohort was significantly different in composition compared with the FMF cohort in which the model was developed. In the validation cohort, at a 10% false-positive rate (FPR), maternal factors, EFW and UtA-PI yielded detection rates of 69.6%, 38.7% and 31.7% for SGA < 10th percentile with delivery at < 32, < 37 and ≥ 37 weeks' gestation, respectively. The respective values for SGA < 3rd percentile were 75.7%, 48.2% and 38.1%. Detection rates in the validation cohort were similar to those reported in the FMF study for SGA with delivery at < 32 weeks but lower for SGA with delivery at < 37 and ≥ 37 weeks. Predictive performance in the validation cohort was similar to that reported in a subgroup of the FMF cohort consisting of nulliparous and Caucasian women. Detection rates in the validation cohort at a 15% FPR were 77.4%, 50.0% and 41.5% for SGA < 10th percentile with delivery at < 32, < 37 and ≥ 37 weeks, respectively, which were similar to the respective values reported in the FMF study at a 10% FPR. The model had satisfactory calibration. CONCLUSION: The new competing-risks model for midgestation prediction of SGA developed by the FMF performs well in a large independent Spanish population. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Mid- to long-term results of SuPerLap single-port treatment in inguinal hernia. / Resultados a medio-largo plazo del tratamiento monopuerto SuPerLap de la hernia inguinal.

INTRODUCTION: Laparoscopic treatment of inguinal hernia is gaining popularity in many hospitals, but the use of working channel scopes is not as widely extended. We present our long-term experience with the SuPerLap (laparoscopic-assisted percutaneous suture) technique described by Rosell et al.(1) for epigastric hernia repair in the percutaneous, single-port treatment of inguinal hernia using working channel scopes. MATERIALS AND METHODS: A retrospective analysis of a series of male patients with congenital inguinal hernia undergoing surgery from February 2017 to December 2020 was carried out. A 5 mm-0º pleuroscope with a 3.5 mm working channel, a 20 G epidural needle, a 36 cm/3.5 mm laparoscopic Maryland dissector, and 3-0 polypropylene and polyester sutures were used. RESULTS: 384 inguinal hernia repairs using the SuPerLap technique were performed in 295 male patients - 206 unilateral repairs and 89 bilateral repairs. In 24 bilateral cases (26.95%), preoperative diagnosis had been unilateral. Mean age was two years (2 weeks-13 years). Mean operating time was 14 minutes (6-50 min) for unilateral repair, and 27 minutes (14-80 min) for bilateral repair. There were two cases of epigastric vessel damage, and one case of early recurrence in a newborn, who successfully underwent re-intervention using the SuPerLap technique. No late complications were recorded after a mean follow-up of 1-36 months. CONCLUSIONS: Working channel scopes using the SuPerLap technique avoid additional ports in inguinal hernia repair. They allow for excellent functional results, without visible scars, and minimize spermatic cord manipulation. Laparoscopy allows previously undiagnosed defects to be concomitantly treated.

INTRODUCCION: La laparoscopia en el tratamiento de la hernia inguinal está cada vez más presente en muchos hospitales. El uso de ópticas con canal de trabajo no está tan extendido. Se presenta la experiencia a largo plazo en la aplicación de la técnica SuPerLap (sutura percutánea laparoasistida) propuesta por Rosell y cols.(1) para la reparación de hernias epigástricas en el tratamiento monopuerto, percutáneo de las hernias inguinales mediante el uso de ópticas con canal de trabajo. MATERIAL Y METODO: Serie quirúrgica de hernia inguinal congénita en varones (febrero de 2017-diciembre de 2020). Se utilizó: pleuroscopio de 5 mm-0º con canal de trabajo de 3,5 mm; aguja epidural 20 G; suturas de polipropileno y poliéster 3/0; disector Maryland laparoscópico (36 cm-3,5 mm). RESULTADOS: Se realizaron 384 herniorrafias inguinales según técnica SuPerLap en 295 varones (206 unilaterales, 89 bilaterales). En 24 casos bilaterales (26,95%) el diagnóstico preoperatorio fue unilateral. La edad media fue de dos años (2 semanas-13 años). El tiempo medio quirúrgico fue 14 minutos (6-50 min) en unilaterales, 27 (14-80 min) en bilaterales. Hubo dos casos de lesión de vasos epigástricos y una recidiva precoz en un neonato, reintervenido satisfactoriamente mediante técnica SuPerLap. En un seguimiento de 1-36 meses no hubo complicaciones tardías. CONCLUSIONES: El uso de ópticas con canal de trabajo según técnica SuPerLap posibilita prescindir de puertos adicionales en el tratamiento de la hernia inguinal. Permite resultados funcionales comparables y cirugía sin cicatrices visibles. Minimiza la manipulación del cordón espermático. La laparoscopia permite el tratamiento concomitante de defectos no diagnosticados previamente.

Relevance of early diagnosis in polycythemia vera and essential thrombocythemia: A single center's experience.

OBJECTIVES: This work aims to describe the proportion of patients with polycythemia vera (PV) or essential thrombocythemia (ET) and thrombosis prior to the diagnosis who had erythrocytosis or thrombocytosis prior to the thrombosis. PATIENTS AND METHODS: This is a retrospective review of 63 patients with PV and 130 with ET. RESULTS: In regard to PV, we found prior erythrocytosis in 7 (11.1%) of the 17 cases (27%) with thrombosis prior to diagnosis. In ET, we found prior thrombocytosis in 10 (7.7%) of the 25 cases (19.2%) with thrombosis prior to diagnosis. The median time between the laboratory finding and thrombosis was 8.2 months and 11.8 months for PV and TE, respectively. In both entities, patients with thrombosis prior to diagnosis had significantly lower survival. CONCLUSION: A significant proportion of patients with thrombosis prior to the diagnosis of PV and ET present with erythrocytosis or thrombocytosis prior to the episode of thrombosis. This could allow for anticipating diagnosis and treatment.

Self-Compacting Recycled Concrete Using Biomass Bottom Ash.

In recent years, the use of self-compacting concrete has been a great advantage and garnered undoubted interest in construction. Due to the environmental impact caused by the consumption of natural aggregates in the manufacture of concrete, a more sustainable approach is needed. An approach for more sustainable construction is to use industrial waste such as bottom ash from the combustion of biomass as a replacement for natural aggregates. This research aims to use biomass bottom ash as a replacement for natural sand (10%, 20% and 30% replacement); in addition, by utilizing a crushing process of the bottom ash, the ash has been used as a filler replacement (replacement 20%, 40% and 60%). The fresh and hardened properties have been evaluated according to the standard. The results show the feasibility of using biomass bottom ash in self-compacting concrete, providing a sustainable alternative in order to minimise environmental impacts related to the extraction and depletion of natural resources.

Resultados y complicaciones de la enfermedad del segmento adyacente tratada mediante artrodesis intersomática lateral mínimamente invasiva / Results and complications of adjacent segment disease treated by minimally invasive lateral intersomatic arthrodesis

Resumen: Introducción: Se ha realizado un estudio clínico comparativo sobre los pacientes intervenidos mediante artrodesis intersomática lateral para tratamiento de la enfermedad del segmento adyacente utilizando dispositivos intersomáticos de titanio y de PEEK. Material y métodos: Se han analizado y comparado los resultados clínicos (EVA y oswestry disability index ODI) y radiológicos (alineamiento y fusión), las complicaciones (mayores y menores) y la calidad de vida (EQ5D) de 32 pacientes intervenidos desde Septiembre de 2015 hasta Septiembre de 2018, con un seguimiento medio de 25 meses (46-18). La edad media en la cirugía fue de 66 años (39-89) y 68% de los pacientes fueron mujeres. El segmento intervenido con más frecuencia fue L3-L4 (62%) abordaje retroperitoneal derecho 86%. La EVA lumbar mejoró de 6.2 ± 2.12 a 4.1 ± 1.71 (p = 0.028). La EVA de la pierna descendió de 5.3 ± 2.26 a 1.9 ± 1.58 (p = 0.02). La escala ODI mejoró de 50.2 ± 18.9 a 33.3 ± 10.2 (p = 0.025) y la EQ5D pasó de 0.52 a 0.73 (p = 0.039) sin diferencias estadísticamente significativas entre los grupos (ODI p = 0.18, EQ5D p = 0.293). Radiológicamente aumentó la altura intervertebral, la lordosis lumbar y segmentaria, disminuyó el ángulo de Cobb y la tasa de fusión global fue de 84.3% (88% Ti/82% PEEK), sin diferencias entre los grupos. Conclusiones: La artrodesis intersomática lumbar lateral Lateral Lumbar Interbody Fusion es un método eficaz para el tratamiento de la enfermedad del segmento adyacente con resultados clínicos-radiológicos y complicaciones similares a la literatura. No se han encontrado diferencias entre los implantes de Ti y de PEEK.

Abstract: Introduction: A comparative clinical study has been conducted on patients involved using lateral intersomatic arthrodesis for the treatment of adjacent segment disease using titanium and PEEK intersomatic devices. Material and methods: Clinical (EVA and oswestry disability index ODI) and radiological (alignment and fusion), complications (major and minor) and quality of life (EQ5D) of 32 patients intervened from September 2015 to September 2018 have been analyzed and compared, with an average follow-up of 25 months (46-18). The average age in surgery was 66 years (39-89) and 68% of patients were women. Results: The most common segment involved was L3-L4 (62%) right retroperitoneal approach 86%. Lumbar EVA improved from 6.2 ± 2.12 to 4.1 ± 1.71 (p = 0.028). The LEG EVA descended from 5.3 ± 2.26 to 1.9 ± 1.58 (p = 0.02). The ODI scales improved from 50.2 ± 18.9 to 33.3 ± 10.2 (p = 0.025) and the EQ5D went from 0.52 to 0.73 (p = 0.039) with no statistically significant differences between the groups (ODI p = 0.18, EQ5D p = 0.293). Radiologically increased intervertebral height, lumbar and segmental lordosis, decreased Cobb's angle and the overall melting rate was 84.3% (88% Ti/82% PEEK), with no differences between the groups. Conclusion: Lateral lumbar interbody fusion is an effective method for treating adjacent segment disease with clinical-radiological results and literature-like complications. No differences have been found between Ti and PEEK implants.

[Results and complications of adjacent segment disease treated by minimally invasive lateral intersomatic arthrodesis]. / Resultados y complicaciones de la enfermedad del segmento adyacente tratada mediante artrodesis intersomática lateral mínimamente invasiva.

INTRODUCTION: A comparative clinical study has been conducted on patients involved using lateral intersomatic arthrodesis for the treatment of adjacent segment disease using titanium and PEEK intersomatic devices. MATERIAL AND METHODS: Clinical (EVA and oswestry disability index ODI) and radiological (alignment and fusion), complications (major and minor) and quality of life (EQ5D) of 32 patients intervened from September 2015 to September 2018 have been analyzed and compared, with an average follow-up of 25 months (46-18). The average age in surgery was 66 years (39-89) and 68% of patients were women. RESULTS: The most common segment involved was L3-L4 (62%) right retroperitoneal approach 86%. Lumbar EVA improved from 6.2 ± 2.12 to 4.1 ± 1.71 (p = 0.028). The LEG EVA descended from 5.3 ± 2.26 to 1.9 ± 1.58 (p = 0.02). The ODI scales improved from 50.2 ± 18.9 to 33.3 ± 10.2 (p = 0.025) and the EQ5D went from 0.52 to 0.73 (p = 0.039) with no statistically significant differences between the groups (ODI p = 0.18, EQ5D p = 0.293). Radiologically increased intervertebral height, lumbar and segmental lordosis, decreased Cobb's angle and the overall melting rate was 84.3% (88% Ti/82% PEEK), with no differences between the groups. CONCLUSION: Lateral lumbar interbody fusion is an effective method for treating adjacent segment disease with clinical-radiological results and literature-like complications. No differences have been found between Ti and PEEK implants.

INTRODUCCIÓN: Se ha realizado un estudio clínico comparativo sobre los pacientes intervenidos mediante artrodesis intersomática lateral para tratamiento de la enfermedad del segmento adyacente utilizando dispositivos intersomáticos de titanio y de PEEK. MATERIAL Y MÉTODOS: Se han analizado y comparado los resultados clínicos (EVA y. CONCLUSIONES: oswestry disability index ODI) y radiológicos (alineamiento y fusión), las complicaciones (mayores y menores) y la calidad de vida (EQ5D) de 32 pacientes intervenidos desde Septiembre de 2015 hasta Septiembre de 2018, con un seguimiento medio de 25 meses (46-18). La edad media en la cirugía fue de 66 años (39-89) y 68% de los pacientes fueron mujeres. El segmento intervenido con más frecuencia fue L3-L4 (62%) abordaje retroperitoneal derecho 86%. La EVA lumbar mejoró de 6.2 ± 2.12 a 4.1 ± 1.71 (p = 0.028). La EVA de la pierna descendió de 5.3 ± 2.26 a 1.9 ± 1.58 (p = 0.02). La escala ODI mejoró de 50.2 ± 18.9 a 33.3 ± 10.2 (p = 0.025) y la EQ5D pasó de 0.52 a 0.73 (p = 0.039) sin diferencias estadísticamente significativas entre los grupos (ODI p = 0.18, EQ5D p = 0.293). Radiológicamente aumentó la altura intervertebral, la lordosis lumbar y segmentaria, disminuyó el ángulo de Cobb y la tasa de fusión global fue de 84.3% (88% Ti/82% PEEK), sin diferencias entre los grupos. La artrodesis intersomática lumbar lateral.

Síndrome de Erasmus / Erasmus syndrome

La neumoconiosis constituye un grupo de enfermedades asociadas con la exposición e inhalación de polvo mineral, de partículas inorgánicas, sílice, berilio, carbón, cobalto, talco, etc. La exposición al polvo de sílice se asocia no sólo con silicosis, sino también con enfermedad pulmonar obstructiva crónica, cáncer de pulmón, insuficiencia renal y riesgo aumentado de tuberculosis pulmonar y enfermedades autoinmunes. Está bien establecida la asociación entre el contacto con el sílice por vía inhalatoria y enfermedades autoinmunes, particularmente en el contexto de una exposición intensa. La exposición al sílice se ha vinculado con un incremento de la síntesis de anticuerpos y complejos inmunes, aún sin la presencia de características clínicas de enfermedad autoinmune. El riesgo de desarrollar esclerosis sistémica, artritis reumatoidea, lupus eritematoso sistémico, dermatomiositis / polimiositis y anticuerpos anticitoplasmáticos del neutrófilo (ANCA) positivos (vasculitis) esta descripto en varios estudios. En paciente que trabajan en canteras con escasas medidas de prevención el desarrollo de silicosis ha llegado ser tan severo que ha requerido trasplante pulmonar; sobre esta base se recomienda seguirlos con un perfil inmunológico como control o estar atentos a otras manifestaciones de autoinmunidad. La esclerosis sistémica es una enfermedad autoinmune definida como un desorden generalizado de la microvasculatura y del tejido conectivo, con engrosamiento y obliteración de los vasos arteriales de piel, pulmón, tracto gastrointestinal, corazón y riñones. Su etiología es desconocida pero probablemente concurren factores endógenos y exógenos. Entre los factores exógenos, la exposición ocupacional juega un rol importante como causa potencial, incluyendo el polvo de sílice, cloruro de vinilo, resina epoxi, bleomicina, hidrocarburos aromáticos, aceites. Excepto el s-lice todos los otros agentes producen cambios reversibles una vez suspendido el contacto con el agente. El polvo de sílice y su inhalación es un factor de riesgo bien reconocido de esclerosis sistémica. Las partículas de cristal de sílice (cuarzo) que miden menos de un micrometro son las más patogénicas ya que al ser inertes pueden permanecer por tiempo indeterminado en el tejido. El antecedente de exposición al polvo de sílice y esclerosis sistémica se conoce como Síndrome de Erasmus.

Prevalence and distribution of hepatitis C virus genotypes in Spain during the 2000-2015 period (the GEHEP 005 study).

We report the largest study on the prevalence and distribution of HCV genotypes in Spain (2000-2015), and we relate them with clinical, epidemiological and virological factors. Patients from 29 hospitals in 10 autonomous communities (Andalusia, Aragon, Castilla-Leon, Catalonia, Galicia, Canary Islands, Madrid Community, Valencian Community, Murcia Region and Basque Country) have been studied. Annual distribution of HCV genotypes and subtypes, as well as gender, age, transmission route, HIV and/or HBV coinfection, and treatment details were recorded. We included 48595 chronically HCV-infected patients with the following characteristics: median age 51 years (IQR, 44-58), 67.9% male, 19.1% HIV-coinfected, 23.5% HBV-coinfected. Parenteral transmission route was the most frequent (58.7%). Genotype distribution was 66.9% GT1 (24.9% subtype 1a and 37.9% subtype 1b), 2.8% GT2, 17.3% GT3, 11.4% GT4 and 0.1% GT5 and 0.02% GT6. LiPA was the most widely HCV genotyping test used (52.4%). HCV subtype 1a and genotypes 3 and 4 were closely associated with male gender, parenteral route of infection and HIV and HBV coinfection; in contrast, subtype 1b and genotype 2 were associated with female gender, nonparenteral route and mono-infection. Age was related to genotype distribution, and different patterns of distribution and biodiversity index were observed between different geographical areas. Finally, we describe how treatment and changes in transmission routes may have affected HCV genotype prevalence and distribution patterns. We present the most recent data on molecular epidemiology of hepatitis C virus in Spain. This study confirms that genotype distributions vary with age, sex, HIV and HBV coinfection and within geographical areas and epidemiological groups.

Immune modulation by the hepatitis C virus core protein.

Hepatitis C virus (HCV) infection is currently the most important cause of chronic viral hepatitis in the world and one of the most frequent indications for liver transplantation. HCV uses different strategies to evade the innate and adaptive immune response, and this evasion plays a key role in determining viral persistence. Several HCV viral proteins have been described as immune modulators. In this review, we will focus on the effect of HCV nucleocapsid core protein in the function of immune cells and its correlation with the findings observed in HCV chronically infected patients. Effects on immune cell function related to both extracellular and intracellular HCV core localization will be considered. This review provides an updated perspective on the mechanisms involved in HCV evasion related to one single HCV protein, which could become a key tool in the development of new antiviral strategies able to control and/or eradicate HCV infection.

Clinical outcomes of melanoma brain metastases treated with stereotactic radiosurgery and anti-PD-1 therapy, anti-CTLA-4 therapy, BRAF/MEK inhibitors, BRAF inhibitor, or conventional chemotherapy.

BACKGROUND: The effect of immunologic and targeted agents on intracranial response rates in patients with melanoma brain metastases (MBMs) is not yet clearly understood. This report analyzes outcomes of intact MBMs treated with single-session stereotactic radiosurgery (SRS) and anti-PD-1 therapy, anti-CTLA-4 therapy, BRAF/MEK inhibitors(i), BRAFi, or conventional chemotherapy. PATIENTS AND METHODS: Patients were included if MBMs were treated with single-session SRS within 3 months of receiving systemic therapy. The primary end point of this study was distant MBM control. Secondary end points were local MBM control defined as a >20% volume increase on follow-up MRI, systemic progression-free survival, overall survival (OS) from both SRS and cranial metastases diagnosis, and neurotoxicity. Images were reviewed alongside two neuro-radiologists at our institution. RESULTS: Ninety-six patients were treated to 314 MBMs over 119 SRS treatment sessions between January 2007 and August 2015. No significant differences were noted in age (P = 0.27), gender (P = 0.85), treated gross tumor volume (P = 0.26), or the diagnosis-specific graded prognostic assessment (P = 0.51) between the treatment cohorts. Twelve-month Kaplan-Meier (KM) distant MBM control rates were 38%, 21%, 20%, 8%, and 5% (P = 0.008) for SRS with anti-PD-1 therapies, anti-CTLA-4 therapy, BRAF/MEKi, BRAFi, and conventional chemotherapy, respectively. No significant differences were noted in the KM local MBM control rates among treatment groups (P = 0.25). Treatment with anti-PD-1 therapy, anti-CTLA-4 therapy, or BRAF/MEKi significantly improved OS on both univariate and multivariate analyses when compared with conventional chemotherapy. CONCLUSION: In our institutional analysis of patients treated with SRS and various systemic immunologic and targeted melanoma agents, significant differences in distant MBM control and OS are noted. Prospective evaluation of the potential synergistic effect between these agents and SRS is warranted.

[Factors determining patient satisfaction with the pre-anaesthesia consultation]. / Factores determinantes de la satisfacción del paciente con la consulta de anestesia.

OBJECTIVE: To analyse patient satisfaction with care provided in the pre-anaesthetic consultation and its determining factors. MATERIAL AND METHOD: An anonymous questionnaire was randomly distributed to patients attending a pre-anaesthesia clinic, which included 4 questions with 5 possible answers on a (very dissatisfied, dissatisfied, fairly satisfied, satisfied and very satisfied) categorical graduated scale related to punctuality, understanding of the information received, respectful treatment, and overall satisfaction. The fifth question was about the knowledge or the name of the anaesthesiologist who attended them. A binary logistic regression model was used, which identified the predictors of satisfaction, calculated the odds ratios, and their respective 95% confidence intervals. RESULTS: A total of 4006 questionnaires were analysed, in which 99.2% (3966) of users rated as satisfied/very satisfied the question about the respectful treatment, 98.4% (3937) of the information received and understanding, 77.4% (3096) punctuality in attending, and 97, 6% (3909) overall satisfaction. Almost three-quarters (71%, 2844) did not know the name of the anaesthesiologist. Regression analysis associated the more satisfied with their treatment (OR 17.44; P<.0005) and the information received (OR 14.94, P<.0005), while punctuality (OR 5 40; P<.0005) was the factor that contributed less to the result. CONCLUSION: In our population satisfaction in pre-anaesthesia consultation is due mainly to the communication skills of the anaesthesiologist.

Development of chronic pain after episiotomy.

OBJECTIVE: To analyze the incidence of chronic pain 5 months after episiotomy, as well as potential prognostic factors. METHODS: A prospective cohort observational study was conducted on pregnant women age≥18 years who had undergone an episiotomy. The presence of pain was evaluated in the area of episiotomy at 24 and 48 h of delivery using a structured face-to-face questionnaire, and by telephone questionnaire at 5 months. The primary endpoint was the presence of persistent pain at 5 months. A record was made of the presence of pain at delivery, and its intensity, the presence or absence of epidural analgesia, instrumental delivery, perineal tear, and pain when episiotomy was performed, as well as the presence of dyspareunia and urinary incontinence at 5 months post-episiotomy. RESULTS: A total of 87 parturient patients were included, of whom 78 completed the study. Of the patients who completed the study, 12.8% reported chronic episiotomy pain. Epidural analgesia was associated with a higher incidence of instrumental delivery and less pain at the time of episiotomy and expulsion (P<.0005, P<.02, and P<.01, respectively). Chronic pain is associated with operative delivery (P<.017), and with the presence of pain at rest at 24 and 48 h (P<.01), of wound complications (P<.026), and of dyspareunia (P<.001). CONCLUSION: An incidence of 12.8% of women developing chronic pain after delivery with episiotomy suggests a health problem. More studies are needed to confirm our results.

Identification of functional, short-lived isoform of linker for activation of T cells (LAT).

Linker for activation of T cells (LAT) is a transmembrane adaptor protein playing a key role in the development, activation and maintenance of peripheral homeostasis of T cells. In this study we identified a functional isoform of LAT. It originates from an intron 6 retention event generating an in-frame splice variant of LAT mRNA denoted as LATi6. Comparison of LATi6 expression in peripheral blood leukocytes of human and several other mammalian species revealed that it varied from being virtually absent in the mouse to being predominant in the cow. Analysis of LAT isoform frequency expressed from minigene splicing reporters carrying loss- or gain-of-function point mutations within intronic polyguanine sequences showed that these elements are critical for controlling the intron 6 removal. The protein product of LATi6 isoform (LATi6) ectopically expressed in LAT-deficient JCam 2.5 cell line localized correctly to subcellular compartments and supported T-cell receptor signaling but differed from the canonical LAT protein by displaying a shorter half-life and mediating an increased interleukin-2 secretion upon prolonged CD3/CD28 crosslinking. Altogether, our data suggest that the appearance of LATi6 isoform is an evolutionary innovation that may contribute to a more efficient proofreading control of effector T-cell response.

Analysis of quality of nuchal translucency measurements: its role in prenatal diagnosis.

OBJECTIVE: Quantitative analysis of the quality of nuchal translucency (NT) measurements. METHODS: First-trimester combined screening for Down syndrome was performed to all pregnant women attended in our Department from October 2003 to November 2009. NT was measured according to the Fetal Medicine Foundation (FMF) criteria by 20 trained obstetricians. The performance of NT measurements was retrospectively analyzed with regard to several quality control standards. Accuracy according to experience, professional profile, crown rump length (CRL) values, and FMF certification was statistically tested. RESULTS: A total of 14978 NT measurements were assessed. (1) The mean operator-specific median NT-MoM values was 0,98. (2) Mean percentage of cases >95th and <5th centiles were 5,0% and 4,2%, respectively. (3) Logarithmic mean and SD of the NT MoM values were 0,00 and 0,13, respectively. (4) The DR for trisomy 21 at screening time was 90,7% for a FPR of 6,7% for standard screening strategy. (5) According to Cumulative SUM (CUSUM) figures, the performance was more acceptable in FMF-certified operators. CONCLUSION: Overall, quality standards show optimal NT measurements in our unit. Operator experience, a dedicated profile to fetal medicine, CRL over 60 mm, and FMF certification have a significant positive impact on the quality standards.

[Health-care workload and instructional capacity of Spanish hospitals accredited to train residents in anesthesiology]. / Actividad asistencial y capacidad docente de los hospitales españoles acreditados para la formación de residentes de anestesiología.

OBJECTIVES: To describe the health-care workload and instructional capacity of Spanish hospitals accredited to train anesthesiology residents. METHODS: Survey of supervisors of anesthesiology residents in 2008 to determine caseloads in surgery and obstetrics as well as in pain clinics and critical care units. The results are presented for different Spanish autonomous communities. The maximum theoretical capacity for instruction in accordance with European guidelines is calculated. RESULTS: The 100 hospitals surveyed train 325 residents per year and could theoretically increase the training opportunities they offer, within certain limits. Given optimal distribution of resources, the system could train 397 residents per year in pediatric surgery in 3-month rotations, 442 residents in neurosurgery in 2-month rotations, and 479 residents in thoracic surgery in 1-month rotations. Some Spanish communities presently have problems giving training in the settings of pediatric, thoracic, and major outpatient surgery. Furthermore, even though anesthesiologists are presently responsible for 41.6% of available critical care beds, 46 hospitals do not have a sufficient number of beds to give training in this setting. This shortage may have negative repercussions on the accreditation of training programs. CONCLUSIONS: Although certain limitations were found, the survey showed that the training capacity of the system is greater than accreditation suggests. It would therefore be possible to increase the number of residents.

[In-hospital mortality in surgical patients. Predictive factors]. / Mortalidad intrahospitalaria en cirugía con ingreso. Análisis de factores predictores.

OBJECTIVE: To analyze the value of patient and surgical variables as predictors of the survival until discharge of hospitalized surgical patients in a tertiary care hospital over the course of 1 year. MATERIAL AND METHODS: The hospital records for patients admitted for surgery between January 1 and December 31, 2007, were consulted to extract age, sex, ASA physical status classification of the patient, type of admission and surgery (scheduled or emergency), surgical department assigned, and date of discharge or exitus. The data were subjected to multivariate survival analysis using the Cox regression model. RESULTS: A total of 4184 patients underwent surgery in 2007; the median (25th-75th percentile) patient age was 56 (39-71) years. In 77.5% of the cases (3244 patients) surgery was scheduled; 23.1% of those patients had been admitted by the emergency department. The ASA classification was 1 for 21.8%, 2 for 44.2%, 3 for 28%, and 4 for 6%. Of patients classified as ASA 1-3, a total of 33.2% were aged 65 years or older; in contrast, 78.7% of ASA 4 patients were in that age bracket. Eighty-nine (2.1%) surgical patients died. Cox regression survival analysis showed that variables related to a lower likelihood of survival to discharge were a physical status classification of ASA 4, age 65 years or older, and emergency surgery (P < .0005 for all comparisons). CONCLUSIONS: Patients over the age of 65 years, in an ASA 4 anesthetic risk category, admitted on an emergency basis for emergency surgery were at higher risk of death. Greater vigilance in the perioperative care of patients with these risk factors is advisable in the interest of reducing mortality.

Aportes de la terapia ocupacional al contexto educacional inclusivo: interrelación entre el enfoque psicosocial, la teoría de integración sensorial y acciones de atención temprana / Contributions of the occupational therapy to the inclusive educational context: interrelation of the psychosocial approaches, the theory of sensory integration and early attention actions

En contextos sociales vulnerados se observan condiciones que interfieren el desarrollo de habilidades y destrezas académicas, relacionales y emocionales. Esto, ligado a una respuesta inadecuada a los estímulos ambientales o necesidades individuales, puede convertir el proceso de adaptación del niño al contexto escolar en una tarea que requiere coordinación y gestión en red. Esta sistematización tiene como objetivo presentar un tipo de intervención que facilita los procesos de autonomía de niños en situación de vulnerabilidad escolar en escuelas municipales de la comuna de Huechuraba, entre los años 2006 y 2009. La estrategia central consiste en fomentar las interacciones de todos los sistemas a través de intervenciones ya sea individuales y/o grupales a niños, familiares, profesores, comunidad educativa, centros de salud y especialistas de salud y educación. Con ello se promueve el respeto por los derechos del niño y por las particularidades individuales del desarrollo, incorporando acciones relevantes en la convivencia diaria. Esto permite reconstruir y resignificar relaciones y símbolos vinculares desde la cotidianeidad, abarcando los contextos ocupacionales y el campo relacional del niño, permitiendo así el surgimiento de la autonomía del niño.

In social harmed contexts, it’s common to observe conditions that interfere with the development of social, emotional and academic skills. This, bound to an inadequate answer to the environmental stimuli and individual necessities, can turn the process of adaptation to the school context a complex task, that requires preventive actions, coordination and management in network. The present document has as objective to present a type of intervention that facilitates the processes of autonomy and participation of children in situation of vulnerability in municipal schools of district Huechuraba, between years 2006 and 2009. The central strategy is to foment the interactions of all the systems, it is used individual and group interventions to children, relatives, professors and educative community, specialists of education and health. With it, the respect for the child’s rights as well as the individual particularitities of development are promoted, incorporating complementary methodologies and educative practices in the daily coexistence. This makes it possible to reconstruct and to resignificate relations and symbols from the daily activities, promoting with it the upcoming of child`s autonomy.