Clinical report: Virtual reality enables comparable contrast sensitivity measurements to in-office testing (pilot study).

SIGNIFICANCE: Vision health disparities largely stem from inaccessibility to vision specialists. To improve patient access to vision tests and to expedite clinical workflows, it is important to assess the viability of virtual reality (VR) as a modality for evaluating contrast sensitivity. PURPOSE: This study aimed to assess the validity of a VR version of the Pelli-Robson contrast sensitivity test by comparing its results with those of the corresponding in-office test. METHODS: Twenty-eight participants (mean ± standard deviation age, 37.3 ± 20.5 years) with corrected vision were recruited for testing on a voluntary basis with randomized administration of the in-office test followed by the VR analog or vice versa. Nineteen participants took each test twice to assess test-retest consistency in each modality. Virtual reality tests were conducted on a commercial Pico Neo Eye 2 VR headset, which has a 4K screen resolution. The environment for both tests was controlled by the participant for location and lighting. RESULTS: Similar sensitivity scores were obtained between testing modalities in both the right (n = 28 participants; Wilcoxon match-paired signed rank [SR], p=0.7) and left eyes (n = 28 participants; Wilcoxon match-paired SR, p=0.7). In addition, similar test-retest scores were found for VR (n = 19 participants; Wilcoxon match-paired SR, p=1.0) or in-office (n = 19 participants; Wilcoxon match-paired SR, p=1.0) tests. Virtual reality Pelli-Robson results correlated well with in-office test results in variably diseased participants (n = 14 eyes from 7 participants, R2 = 0.93, p<0.0001). CONCLUSIONS: In this pilot trial, we demonstrated that VR Pelli-Robson measurements of corrected vision align with those of in-office modalities, suggesting that this may be a reliable method of implementing this test in a more interactive and accessible manner.

Transverse colon volvulus in a young patient with wandering liver.

We present the case of a 26-year-old male patient with no history of interest who consulted the emergency department due to occlusive symptoms. Urgent CT showed the presence of a transverse colonic volvulus in the context of a heterotopic liver, located in the left hypochondrium. There were no clinical or radiological signs of perforation or ischemia, so urgent endoscopic decompression was performed with subsequent elective surgery with a favorable resolution of the condition. Transverse colonic volvulus is rare (<1%) and wandering liver is an exceptional predisposing factor, with less than a hundred published cases. In these patients, endoscopic decompression carries a risk of perforation with high recurrence rates, and surgical treatment should be considered. However, in this case, in the absence of severity criteria, decompressive colonoscopy was considered an urgent treatment and subsequent elective surgery with favorable results.

Geotechnical behaviour of low-permeability soils in surfactant-enhanced electrokinetic remediation.

Electrokinetic processes provide the basis of a range of very interesting techniques for the remediation of polluted soils. These techniques consist of the application of a current field in the soil that develops different transport mechanisms capable of mobilizing several types of pollutants. However, the use of these techniques could generate nondesirable effects related to the geomechanical behavior of the soil, reducing the effectiveness of the processes. In the case of the remediation of polluted soils with plasticity index higher than 35, an excessive shrinkage can be observed in remediation test. For this reason, the continued evaporation that takes place in the sample top can lead to the development of cracks, distorting the electrokinetic transport regime, and consequently, the development of the operation. On the other hand, when analyzing silty soils, in the surroundings of injection surfactant wells, high seepages can be generated that give rise to the development of piping processes. In this article methods are described to allow a reduction, or to even eliminate, both problems.

PAGES OF HISTORY.

The International Journal of Health Services is glad to publish a brief note about the origins of what is now known as the International Association of Health Policy, a worldwide association of professionals working on how to improve the health and well-being of the populations. The International Journal of Health Services was part of that history as well.

The fallacies in arguing that current high unemployment in Spain (27%) is a consequence of supposed labor market rigidities.

This article refutes the argument that high unemployment in Spain is due to labor market rigidities, questioning the premises on which this theory is based. It then goes on to explain how those advancing this argument are the very same forces responsible for the macroeconomic decisions that are currently causing unemployment.

Capital-labor struggle: the unspoken causes of the crises.

The literature on the causes of the current financial and economic crises often fails to consider both the causal role of the conflict between capital and labor, and this conflict's continued effect. This article analyzes the evolution of the conflict and its implications for the distribution of income during the post-World War II period. Especially emphasizing the relationship between the U.S. and European economies, it examines the genesis and development of the governing structures of the Eurozone as determining factors in the increasing gap between capital and labor. The history of the European economic trajectory and the current German financial leadership provide important context for the analysis. Evidence is provided that this conflict between capital and labor is at the roots of the current financial and economic crisis, a thesis has been dramatically underexposed in the current scientific literature.

Reactive transport model for bentonites in COMSOL multiphysics: Benchmark and validation exercise.

At present, the deep geological repository concept for spent nuclear fuel is considered the most reliable and safe technique for the permanent disposal of this type of waste. One of the many safety elements used is an engineered barrier made of compacted bentonite. This material allows the encapsulated waste to be isolated from the host rock. Therefore, there is great interest in a detailed study of the behavior of bentonites to different changes in the composition of the surrounding groundwater. In this context, this work presents a new reactive transport model for bentonites implemented in the COMSOL Multiphysics platform. The model contemplates a non-simplistic geochemical system composed of 42 species and 4 minerals. Reactive transport involves the diffusive-dispersive-advective processes defined by the Nernst Planck equations for two overlapping modeling levels (macro- and microstructural) to simulate the behavior of double-porosity media. The uniqueness of this model is that the system of equations used to calculate the chemical speciation problem and the advective-diffusive-dispersive transport can be integrally solved in COMSOL. The model has been satisfactorily verified and validated using the benchmark exercise consisting of the simulation of the multicomponent advective-diffusive column experiment conducted on a compacted bentonite core extracted from a field experiment (LOT project) in the Äspö Hardrock laboratory (Sweden).

Resistance to apoptosis in complicated Crohn's disease: Relevance in ileal fibrosis.

BACKGROUND AND AIMS: The stiffening of the extracellular matrix, and changes in its cellular and molecular composition, have been reported in the pathogenesis of fibrosis. We analyze the mechanisms that perpetuate ileal fibrosis in surgical resections of complicated Crohn's disease patients. METHODS: Ileal resections were obtained from affected and non-affected tissue of stenotic or penetrating Crohn's disease behavior. Ilea from non-IBD patients were used as control tissue. All samples underwent RNA sequencing. Human small intestinal fibroblasts were treated for 48 h with IL-1ß, TFGß1, PDGFB or TNF-α. Resistance to apoptosis was analysed by RT-PCR, western blot and immunohistochemistry in ileal tissue and by RT-PCR and FACS in cultured cells. RESULTS: Growth factor-driven signaling pathways and increased RAS GTPase activity were up-regulated in affected ilea in which we found expression of both the antiapoptotic molecule MCL1 and the transcription factor ETS1 in submucosal fibroblasts, and a senescence-associated secretory phenotype. In cultured intestinal fibroblasts, PDGFB induced an ETS1-mediated resistance to apoptosis that was associated with the induction of both of TGFB1 and IL1B, a cytokine that replicated the expression of SASP detected in ileal tissue. ETS1 drove fibroblast polarization between inflammatory and fibrogenic phenotypes in IL1ß-treated cells. CONCLUSIONS: Our data show resistance to apoptosis in complicated ileal CD, and demonstrate that PDGFB induce an ETS1-mediated resistance to apoptosis associated with an inflammatory and fibrogenic pattern of expression in intestinal fibroblasts. Results point to PDGFRB, IL1R1 or MCL1 as potential targets against ileal fibrosis.

A disturbed metabolite-gpcr axis is associated with microbial dysbiosis in ibd patients: Potential role of gpr109a in macrophages.

Inflammatory Bowel Disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract characterized by disrupted immune function. Indeed, gut microbiota dysbiosis and metabolomic profile alterations, are hallmarks of IBD. In this scenario, metabolite-sensing G-protein coupled receptors (GPCRs), involved in several biological processes, have emerged as pivotal players in the pathophysiology of IBD. The aim of this study was to characterize the axis microbiota-metabolite-GPCR in intestinal surgical resections from IBD patients. Results showed that UC patients had a lower microbiota richness and bacterial load, with a higher proportion of the genus Cellulosimicrobium and a reduced proportion of Escherichia, whereas CD patients showed a decreased abundance of Enterococcus. Furthermore, metabolomic analysis revealed alterations in carboxylic acids, fatty acids, and amino acids in UC and CD samples. These patients also exhibited upregulated expression of most metabolite-sensing GPCRs analysed, which positively correlated with pro-inflammatory and pro-fibrotic markers. The role of GPR109A was studied in depth and increased expression of this receptor was detected in epithelial cells and cells from lamina propria, including CD68+ macrophages, in IBD patients. The treatment with ß-hydroxybutyrate increased gene expression of GPR109A, CD86, IL1B and NOS2 in U937-derived macrophages. Besides, when GPR109A was transiently silenced, the mRNA expression and secretion of IL-1ß, IL-6 and TNF-α were impaired in M1 macrophages. Finally, the secretome from siGPR109A M1 macrophages reduced the gene and protein expression of COL1A1 and COL3A1 in intestinal fibroblasts. A better understanding of metabolite-sensing GPCRs, such as GPR109A, could establish their potential as therapeutic targets for managing IBD.

The frontal attack on social Europe.

This article explains the consequences of the way that the establishment of the euro as the currency for the eurozone countries has negatively affected their welfare state. The article analyzes the political events that led to the creation of the euro and its impact on the welfare and well-being of these countries' populations.

The social crisis of the Eurozone: the case of Spain.

This article discusses the consequences of the austerity policies promoted by the European Central Bank, the European Commission, and the International Monetary Fund and applied to the peripheral countries of the Eurozone, including Spain. In addition to deteriorating the economic conditions of these countries, these policies are hurting the social well-being of their populations.

[Evaluation of the gastrointestinal quality of life index as a system to prioritize patients on the waiting list for laparoscopic cholecystectomy]. / Evaluación del gastrointestinal quality of life index como sistema de selección para la priorización de pacientes en lista de espera de colecistectomía laparoscópica.

INTRODUCTION: We prospectively evaluated health-related quality of life (HRQoL) through the gastrointestinal quality of life index (GIQLI) as a system to prioritize patients on the waiting list for laparoscopic cholecystectomy (LC) and its correlation with a linear prioritization system developed in the General and Gastrointestinal Surgery Institute of Clínica Quirón in Valencia. MATERIAL AND METHODS: There were 100 consecutive patients who underwent elective outpatient LC. The main outcome measures consisted of: 1) assessment of the impact of the disease, measured through the GIQLI; 2) evaluation of an objective system based on technical scientific criteria; 3) evaluation of the utility of LC in improving HRQoL through the GIQLI by analyzing expected and obtained utility through the change ratio, and 4) analysis of the correlation between the objective linear system, HRQoL and utility. RESULTS: The GIQLI was useful in evaluating the impact of the disease. LC significantly improved HRQoL in both oligosymptomatic and symptomatic patients. The objective or clinical factors did not allow perceptions of the process to be evaluated or the impact on HRQoL to be measured or inferred. A prioritization system based on GIQLI scores allows patients to be selected according to the expected utility (worsening of HRQoL) and obtained utility (improvement in HRQoL) of CL. CONCLUSIONS: Prioritization systems should include utility to guarantee equity. The GIQLI shows the impact of the disease on the patient while the clinical/objective factors are unrelated to the expectation of prioritization. Prioritization systems should include both elements to maintain the balance between impact and appropriate indication.

[Ambulatory laparoscopic cholecystectomy. A cohort study of 1,600 consecutive cases]. / Colecistectomía laparoscópica ambulatoria. Estudio de cohortes de 1.600 casos consecutivos.

OBJECTIVE: A descriptive analysis of day-case laparoscopic cholecystectomy (ALC) in a cohort of 1,600 consecutive patients performed in Instituto de Cirugía y Aparato Digestivo (ICAD), Clínica Quirón de Valencia in the period 1997-2010. PATIENTS AND METHODS: Prospective observational study of 1,601 consecutive patients undergoing elective laparoscopic cholecystectomy (LC) provided by the regional health service and private health companies. MAIN MEASURES: Conversion rate, non-planned admissions, readmissions, surgery duration and demographics. RESULTS: ALC was successfully performed in 80.8% of cases. LC with over-night (ON) stay accounted for 13.4% of patients. Admission was necessary in 4.6%. Mortality was 0.13%, 0.08 in ALC and 0.5% in ON LC. Readmissions occurred in 2.1%, 1.6% in ALC group, 5.4% in ON stay and 4.2% in admission group. CONCLUSIONS: ALC is a reliable and safe procedure. Minimization of admission rates is the key for cost-effective optimization in the management of cholelithiasis. ALC should be considered as the reference standard in gallbladder stone disease treatment.

Usefulness of V˙O2 Kinetics and Biomechanical Parameters as Predictors of Athlete's Performance in 800 m Running Race.

Incremental tests to exhaustion have been usually employed as the "gold standard" to establish the fitness level of athletes. However, during real competition in many sport disciplines, exertion is not characterized by an increasing effort until failure. The purpose of this preliminary study was to add new evidence regarding the usability of parameters obtained from an on-field testing in 800 m running athletes. V˙O2 kinetics (mean, amplitude, phase time, and phase start time) and biomechanical parameters (velocity, stride frequency, and stride length) were analyzed in eight athletes during a maximal 800 m running race test. Our results showed that only the peak of blood lactate concentration after the 800 m test was correlated with the race time (p = 0.047). The race time was positively associated with both the phase duration and phase start time (all p-values < 0.05). Conversely, race time was negatively correlated with velocity, stride frequency, and amplitude (p-values < 0.05). Our results reveal that jointly studying the V˙O2 kinetics and biomechanical parameters during a maximal 800 m running race test is a useful tool to predict the athlete's upcoming performance and improve the planning and control of the training process of 800 m running athletes.

Combining Soil Vapor Extraction and Electrokinetics for the Removal of Hexachlorocyclohexanes from Soil.

This paper focuses on the evaluation of the mobility of four hexachlorocyclohexane (HCH) isomers by soil vapor extraction (SVE) coupled with direct electrokinetic (EK) treatment without adding flushing fluids. SVE was found to be very efficient and remove nearly 70 % of the four HCH in the 15-days of the tests. The application of electrokinetics produced the transport of HCH to the cathode by different electrochemical processes, which were satisfactorily modelled with a 1-D transport equation. The increase in the electric field led to an increase in the transport of pollutants, although 15 days was found to be a very short time for an efficient transportation of the pollutants to the nearness of the cathode. Loss of water content in the vicinity of the cathode warns about the necessity of using electrokinetic flushing technologies instead of simple direct electrokinetics. Thus, results point out that direct electrokinetic treatment without adding flushing fluids produced low current intensities and ohmic heating that contributes negatively to the performance of the SVE process. No relevant differences were found among the removal of the four isomers, neither in SVE nor in EK processes.

Incidence and Risk Factors for Development of Cardiac Toxicity in Adult Patients with Newly Diagnosed Acute Myeloid Leukemia.

The incidence of cardiac morbimortality in acute myeloid leukemia (AML) is not well known. We aim to estimate the cumulative incidence (CI) of cardiac events in AML patients and to identify risk factors for their occurrence. Among 571 newly diagnosed AML patients, 26 (4.6%) developed fatal cardiac events, and among 525 treated patients, 19 (3.6%) experienced fatal cardiac events (CI: 2% at 6 months; 6.7% at 9 years). Prior heart disease was associated with the development of fatal cardiac events (hazard ratio (HR) = 6.9). The CI of non-fatal cardiac events was 43.7% at 6 months and 56.9% at 9 years. Age ≥ 65 (HR = 2.2), relevant cardiac antecedents (HR = 1.4), and non-intensive chemotherapy (HR = 1.8) were associated with non-fatal cardiac events. The 9-year CI of grade 1-2 QTcF prolongation was 11.2%, grade 3 was 2.7%, and no patient had grade 4-5 events. The 9-year CI of grade 1-2 cardiac failure was 1.3%, grade 3-4 was 15%, and grade 5 was 2.1%; of grade 1-2, arrhythmia was 1.9%, grade 3-4 was 9.1%, and grade 5 was 1%. Among 285 intensive therapy patients, median overall survival decreased in those experiencing grade 3-4 cardiac events (p < 0.001). We observed a high incidence of cardiac toxicity associated with significant mortality in AML.

Impact of empirical treatment in extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella spp. bacteremia. A multicentric cohort study.

BACKGROUND: The objective of this study is to analyze the factors that are associated with the adequacy of empirical antibiotic therapy and its impact in mortality in a large cohort of patients with extended-spectrum ß-lactamase (ESBL)--producing Escherichia coli and Klebsiella spp. bacteremia. METHODS: Cases of ESBL producing Enterobacteriaceae (ESBL-E) bacteremia collected from 2003 through 2008 in 19 hospitals in Spain. Statistical analysis was performed using multivariate logistic regression. RESULTS: We analyzed 387 cases ESBL-E bloodstream infections. The main sources of bacteremia were urinary tract (55.3%), biliary tract (12.7%), intra-abdominal (8.8%) and unknown origin (9.6%). Among all the 387 episodes, E. coli was isolated from blood cultures in 343 and in 45.71% the ESBL-E was multidrug resistant. Empirical antibiotic treatment was adequate in 48.8% of the cases and the in hospital mortality was 20.9%. In a multivariate analysis adequacy was a risk factor for death [adjusted OR (95% CI): 0.39 (0.31-0.97); P = 0.04], but not in patients without severe sepsis or shock. The class of antibiotic used empirically was not associated with prognosis in adequately treated patients. CONCLUSION: ESBL-E bacteremia has a relatively high mortality that is partly related with a low adequacy of empirical antibiotic treatment. In selected subgroups the relevance of the adequacy of empirical therapy is limited.

Prospective evaluation of intraoperative peripheral nerve injury in colorectal surgery.

AIM: Intraoperative peripheral nerve injury can have permanent neurological consequences. Its incidence is not known and varies according to the location and the surgical specialty. This study was a prospective analysis of intraoperative peripheral nerve injury as a complication of abdominal colorectal surgery. METHOD: All patients who underwent major colorectal abdominal surgery in our Colorectal Unit between 1996 and 2009 were analyzed. Data on nerve injury were prospectively collected. RESULTS: There were 2304 patients, of whom eight (0.3%) experienced intraoperative peripheral nerve injury. This occurred in 5/2211 (0.2%) open procedures and in 3/93 (3%) laparoscopic procedures. There was no association between intraoperative peripheral nerve injury and age, gender, body mass index, surgeon, operation time, American Society of Anesthesiology (ASA) score and urgent surgery. The use of Allen-type stirrups and a vacuum bag (in laparoscopic surgery) seemed to be protective for nerve injury in the lower and upper limbs respectively. CONCLUSION: Adequate positioning and the use of pressure-free positioning devices may prevent intraoperative peripheral nerve injury, particularly during laparoscopy.