Application to nonlinear optical properties of the RSX-QIDH double-hybrid range-separated functional.

The effective calculation of static nonlinear optical properties requires a considerably high accuracy at a reasonable computational cost, to tackle challenging organic and inorganic systems acting as precursors and/or active layers of materials in (nano-)devices. That trade-off implies to obtain very accurate electronic energies in the presence of externally applied electric fields to consequently obtain static polarizabilities ( α i j ) and hyper-polarizabilities ( ß i j k and γ i j k l ). Density functional theory is known to provide an excellent compromise between accuracy and computational cost, which is however largely impeded for these properties without introducing range-separation techniques. We thus explore here the ability of a modern (double-hybrid and range-separated) Range-Separated eXchange Quadratic Integrand Double-Hybrid exchange-correlation functional to compete in accuracy with more costly and/or tuned methods, thanks to its robust and parameter-free nature.

Assessment of the nonempirical r2SCAN-QIDH double-hybrid density functional against large and diverse datasets.

We update the Quadratic Integrand Double-Hybrid (QIDH) model [J. Chem. Phys. 141, 031101 (2014)] by incorporating the nonempirical restored-regularized Strongly Constrained and Appropriately Normed (r2SCAN) meta-generalized gradient approximation exchange-correlation functional, thus devising a robust density functional approximation free of any empirical parameter and incorporating all the constraints so far known for the exchange-correlation kernel. We assessed the new r2SCAN-QIDH expression on the GMTKN55 database and further extend its application to various types of non-covalent interactions (e.g., S66 × 8, O24 × 5). The assessment done shows that the model becomes very competitive in accuracy with respect to parent exchange-correlation functionals of any type, but without relying on any fitted parameter or numerical training.

Relativistic effects on electronic pair densities: A perspective from the radial intracule and extracule probability densities.

While the effect of relativity in the electronic density has been widely studied, the effect on the pair probability, intracule, and extracule densities has not been studied before. Thus, in this work, we unveil new insights related to changes in the electronic structure caused by relativistic effects. Our numerical results suggest that the mean inter-electronic distance is reduced (mostly) due to scalar-relativistic effects. As a consequence, an increase in the electron-electron repulsion energy is observed. Preliminary results suggest that this observation is also valid when electronic correlation effects are considered.

Effect of marker dosage frequency and spot fecal sampling frequency in the prediction accuracy of fecal output using chromic oxide and titanium dioxide in grazing BON steers.

This study aimed to evaluate the effect of two marker dosage frequencies and two spot fecal sampling frequencies on the variability of fecal output estimation and fecal recovery rate in grazing Blanco Orejinegro (BON) steers with chromium (Cr) or titanium (Ti) as external markers. Four steers (230.5 ± 14.4 kg BW) were used in a 4 × 4 Latin square design in a split-plot arrangement with two markers: Cr or Ti, two marker dosage frequencies: 10.0 g Cr2O3 or TiO2/steer once daily (DF1) or 5.0 g Cr2O3 or TiO2/steer twice daily (DF2), and two fecal sampling frequencies: spot sampling once daily (SF1) or spot sampling twice daily (SF2). Steers were equipped with fecal collection bags to evaluate the actual fecal output (FOR). Fecal marker concentration (FMC) was affected by marker dosage frequency × fecal sampling frequency interaction (P = 0.032): SF1DF1 allowed higher FMC (2.26 g/kg DM) than SF2DF1 (1.95 g/kg DM). Chromium marker allowed higher estimated fecal output (FOe) values when compared to FOR (P < 0.001). Both Ti mean and SD bias (+ 0.074 ± 0.160 kg) were lower than Cr mean and SD bias (+ 0.312 ± 0.272 kg). The Ti fecal output prediction showed lower both RSR (0.586 vs 1.401) and MSPE (0.029 vs 0.167) than Cr prediction. The titanium external marker allowed fecal output estimation with more accuracy in grazing beef cattle trials. A protocol including a once-daily marker dosage associated with a once-daily fecal sampling is plausible, allowing good fecal recovery rates and accurate fecal output estimation.

[Welcome to reading]. / Bienvenida la lectura.

No Abstract available.

We all want to know.

No Abstract available.

Reconstrucción microquirúrgica de cabeza y cuello en paciente pediátrico / Micro-surgical reconstruction of the head and neck in a pediatric patient

OBJETIVO: Realizar un análisis retrospectivo de pacientes pediátricos sometidos a reconstrucciones con injertos libres microvasculares del territorio maxilofacial en el Hospital Luis Calvo Mackenna entre los años 2014 y 2018. MATERIALES Y MÉTODO: Se realizó un análisis de los casos reconstruidos entre los años indicados. RESULTADOS: Un total de 11 pacientes fueron incluidos en la muestra, 7 hombres y 4 mujeres. El rango de edad de los pacientes fue entre 3 a 17 años (media 10,1). Siete colgajos de fíbula, 3 dorsales y 1 anterolateral de muslo fueron utilizados para reconstrucción. La tasa de éxito de los colgajos fue de un 100%. Discusión: Se realizó una discusión de los colgajos y sus principales indicaciones en pediatría y se compararon los resultados de la revisión con los casos reportados. CONCLUSIÓN: El estudio preoperatorio, una adecuada planificación, la rehabilitación de la oclusión dentaria, la reconstrucción simétrica y mantener el contorno facial deben ser objetivos de la reconstrucción.

AIM: Carry out a retrospective analysis of pediatric patients undergoing reconstructions with free micro-vascular grafts of the maxillofacial territory at the Luis Calvo Mackenna Hospital during the years 2014 and 2018. MATERIALS AND METHOD: Retrospective analysis of the cases reconstructed during the years 2014 and 2018 was made. RESULTS: A total of 11 patients were included in the sample, 7 men and 4 women. The age range of the patients was between 3 to 17 years (mean 10.1 years) . Seven Fibula flaps, 3 dorsal and 1 anterolateral thigh flaps were used for reconstruction. The success rate of the flaps was 100%. DISCUSSION: A discussion of the flaps and their main indications in pediatrics was made and the results of the review were compared with the cases reported. CONCLUSION: The pre-operative study, adequate planning, the rehabilitation of the dental occlusion, the symmetry reconstruction and maintaining the facial contour must be objective of the reconstruction.

Non-cellulosic polysaccharide content in feed ingredients and ileal and total tract non-cellulosic polysaccharide digestibility in 21- and 42-day-old broilers fed diets with and without added composite enzymes.

An initial study profiled non-cellulosic polysaccharide (NCP) levels in feed ingredient samples-corn, soybean meal (SBM), whole soybean, and distillers dried grains with solubles (DDGS). A separate NCP digestibility assay was performed in broilers at day 21 (grower phase) and day 42 (finisher phase) fed corn-soy based diets with and without composite enzymes (phytases, multi-carbohydrases, and proteases). Negative control (NC), NC + composite enzymes (NC+E), and positive control (PC) diets were tested. Negative control and NC + E diets were isocaloric, 3,020 kcal/kg ME at grower phase and 3,026 kcal/kg ME at finisher phase. Positive control diet was formulated to meet the Cobb standard nutrient specifications. Diets, pooled digesta, and excreta samples from all treatment diets were collected from 21- and 42-day-old birds and NCP content analyzed as soluble NCP (S-NCP) and insoluble NCP (I-NCP) fractions. Digestibility coefficient (DC) values were determined for all dietary treatments for both the feeding periods. Results from the ingredient analysis showed NCP levels of ∼7 to 10% in corn samples, ∼8 to 11% in SBM samples, ∼11 to 14% (including pectin level) in whole soybean, and ∼12 to 17% in DDGS samples, suggesting variation (P < 0.05) in NCP levels existed within ingredient samples. Digestibility assays showed that enzyme treated (NC + E) diet improved DC values at day 21 from 6 to 10 units and 6 to 9 units for ileal and total tract collection, respectively, for I-NCP fraction (P < 0.05) compared to DC values for NC or PC diets. The ileal DC values at day 42 were not different between treatment diets (∼0.6) but total tract DC values improved 9 to 11 units for broilers fed NC + E diet compared to NC or PC diets. Higher DC values for S-NCP were observed for all treatments for both feeding periods (∼0.7-ileal and ∼0.8-total tract) compared to DC values for I-NCP. Overall, the use of supplemental enzymes in corn-soy-based diets showed improvement in total NCP digestion.

Role of the water-drinking test in medically treated primary open angle glaucoma patients.

PURPOSE: The water-drinking test (WDT) has recently re-emerged as a possible way to determine the competency of the trabecular meshwork. We performed a prospective interventional study to test the hypothesis that the WDT could be useful in assessing fluctuations in patients undergoing treatment for primary open angle glaucoma (POAG). METHODS: We included 122 patients; 62 on medical treatment for POAG (n=123 eyes) and 60 controls (n=120 eyes). The study group had been on intraocular pressures (IOP) lowering treatment continuously for at least 3months with stable IOP. The WDT was performed during fasting and was considered positive if it fluctuated ≥6mmHg. RESULTS: The patients on medical treatment had a mean age of 50.56±18.45 years vs. 51.35±11.22 for the controls (P=0.34); with 71% being female in the study group and 77% in the control group. In the study group; 52% were on beta blockers (n=64), 27% combination of two or more medications (n=33), 19% prostaglandin analogues (n=24) and 2% alpha agonists (n=2). The WDT was positive in 17.07% (n=21) in the study group and 2.5% (n=3) in the control group (P=0.0001). The mean fluctuation was 7.14±2.15mmHg in the study group and 6.00±0mmHg in the controls (P=0.33). A positive WDT was found in 33.33% (n=11) of those on combination therapy; 12.5% (n=3) prostaglandin analogues and 10.94% (n=7) beta blockers (P=0.03). Combination therapy had the highest positive WDT fluctuation (7.54±2.87) followed by prostaglandin analogues (7.00±1.00) and beta blockers (6.57±0.78) with a P value of 0.44. CONCLUSIONS: The WDT can identify significant fluctuations in eyes with POAG that are medically treated.

Lipid changes and tolerability in a cohort of adult HIV-infected patients who switched to rilpivirine/emtricitabine/tenofovir due to intolerance to previous combination ART: the PRO-STR study.

Objectives: To analyse lipid changes and tolerability in a cohort of HIV-infected patients who switched their antiretroviral regimens to rilpivirine/emtricitabine/tenofovir (RPV/FTC/TDF) in a real-world setting. Methods: PRO-STR is a 48 week prospective observational post-authorization study in 25 hospitals. Patients with a viral load <1000 copies/mL, receiving at least 12 months of combination ART (cART), with constant posology for at least the prior 3 months, were categorized according to previous treatment [NNRTI or ritonavir-boosted PI (PI/r)]. Analytical tests were performed at the baseline visit, between week 16 and week 32, and at week 48. Results: A total of 303 patients were included (mean age 46.6 years; male 74.0%; previous treatment 74.7% NNRTI and 25.3% PI/r). Both groups exhibited significantly reduced lipid profiles, except for HDL cholesterol, for which a non-significant increase was observed. [NNRTI patients: total cholesterol (baseline: 195.5 ±âŸ38.4 mg/dL; week 48: 171.0 ±âŸ35.5 mg/dL), total cholesterol/HDL ratio (baseline: 4.2 ±âŸ1.2; week 48: 4.0 ±âŸ1.2), HDL (baseline: 49.1 ±âŸ12.0 mg/dL; week 48: 49.2 ±âŸ45.8 mg/dL), LDL (baseline: 119.2 ±âŸ30.2 mg/dL; week 48: 114.2 ±âŸ110.7 mg/dL), and triglycerides (baseline: 136.6 ±âŸ86.8 mg/dL; week 48: 113.4 ±âŸ67.8 mg/dL); PI/r patients: total cholesterol (baseline: 203.2 ±âŸ48.8 mg/dL; week 48: 173.4 ±âŸ36.9 mg/dL), total cholesterol/HDL ratio (baseline: 4.7 ±âŸ1.6; week 48: 4.0 ±âŸ1.2), HDL (baseline: 46.4 ±âŸ12.5 mg/dL; week 48: 52.1 ±âŸ54.4 mg/dL), LDL (baseline: 127.0 ±âŸ36.3 mg/dL; week 48: 111.4 ±âŸ35.8 mg/dL), and triglycerides (baseline: 167.6 ±âŸ107.7 mg/dL; week 48: 122.7 ±âŸ72.1 mg/dL)]. The most common intolerances were neuropsychiatric in the NNRTI patients and gastrointestinal and metabolic in the PI/r patients, and these intolerances were significantly reduced in both groups at week 48 [NNRTI: neuropsychiatric (baseline: 81.3%; week 48: 0.0%); PI/r: gastrointestinal (baseline: 48.7%; week 48: 0.0%) and metabolic (baseline: 42.1%; week 48: 0.0%)]. Conclusions: RPV/FTC/TDF improved the lipid profiles and reduced the intolerances after switching from NNRTI or PI-based regimens, in a cohort of HIV-infected patients.

Safety and Efficacy of Dolutegravir Plus Rilpivirine in Treatment-Experienced HIV-Infected Patients: The DORIVIR Study.

OBJECTIVES: To analyze the efficacy and safety of dolutegravir/rilpivirine (DTG/RPV) in HIV-infected patients who switched from any other antiretroviral therapy (ART). METHODS: Open-label, multicenter study including patients who switched to DTG/RPV between February 2015 and February 2016. Efficacy (HIV RNA <50 copies/mL), adverse events, and metabolic changes at 24 weeks were analyzed. RESULTS: A total of 104 participants were included, who switched for the following reasons: toxicity/intolerance (42.3%), convenience (27.8%), and drug interactions (17.3%). Prior regimens are protease inhibitor (56.7%), integrase strand transfer inhibitor (26.9%), and non-nucleoside reverse transcriptase inhibitor (16.3%). Efficacy at 24 weeks was 88.4% (intention to treat) and 96.8% (per protocol). Triglyceride levels were reduced, on average, by 12.7% and a mean decrease of 9.0% in the glomerular filtration rate was observed as well ( P values of .003 and .002, respectively), whereas total cholesterol, HDL cholesterol, LDL cholesterol, creatinine, and glutamic-pyruvic transaminase remained unchanged. No patient discontinued due to adverse events. CONCLUSIONS: Dolutegravir/RPV is effective and safe in long-term HIV-infected patients under any prior ART. Toxicity, convenience, and interactions were the main reasons for changing. At 24 weeks, the lipid profile improved with a decrease in triglycerides.

Electron-Pair Distribution in Chemical Bond Formation.

The chemical formation process has been studied from relaxation holes, Δh(u), resulting from the difference between the radial intracule density and the nonrelaxed counterpart, which is obtained from atomic radial intracule densities and the pair density constructed from the overlap of the atomic densities. Δh(u) plots show that the internal reorganization of electron pairs prior to bond formation and the covalent bond formation from electrons in separate atoms are completely recognizable processes from the shape of the relaxation hole, Δh(u). The magnitude of Δh(u), the shape of Δh(u) ∀ u < Req, and the distance between the minimum and the maximum in Δh(u) provide further information about the nature of the chemical bond formed. A computational affordable approach to calculate the radial intracule density from approximate pair densities has been also suggested, paving the way to study electron-pair distributions in larger systems.

On the performance of natural orbital functional approximations in the Hubbard model.

Strongly correlated materials are now under intense development, and natural orbital functional (NOF) methods seem to be able to capture the physics of these systems. We present a benchmark based on the Hubbard model for a class of commonly used NOF approximations (also known as reduced density matrix functional approximations). Our findings highlight the importance of imposing ensemble N-representability conditions in order to obtain consistent results in systems with either weak or strong electronic correlation, such as the Hubbard system with a varying two-particle interaction parameter. Based on the accuracy of the results obtained using PNOF7, which retrieves a large amount of the total strong nondynamic correlation, the Hubbard model points out that N-representability gives solid foundations for NOF development.

Comparison of plasma pigment epithelium-derived factor (PEDF), retinol binding protein 4 (RBP-4), chitinase-3-like protein 1 (YKL-40) and brain-derived neurotrophic factor (BDNF) for the identification of insulin resistance.

AIMS: To evaluate and compare the association of four potential insulin resistance (IR) biomarkers (pigment-epithelium-derived factor [PEDF], retinol-binding-protein-4 [RBP-4], chitinase-3-like protein 1 [YKL-40] and brain-derived neurotrophic factor [BDNF]) with objective measures of IR. METHODS: We studied 81 subjects with different metabolic profiles. All participants underwent a 5-point OGTT with calculation of multiple IR indexes. A subgroup of 21 participants additionally underwent a hyperinsulinemic-euglycemic clamp. IR was defined as belonging to the highest quartile of incremental area under the insulin curve (iAUCins), or to the lowest quartile of the insulin sensitivity index (ISI). RESULTS: PEDF was associated with adiposity variables. PEDF and RBP4 increased linearly across quartiles of iAUCins (for PEDF p-trend=0.029; for RBP-4 p-trend=0.053). YKL-40 and BDNF were not associated with any adiposity or IR variable. PEDF and RBP-4 levels identified individuals with IR by the iAUCins definition: A PEDF cutoff of 11.9ng/mL had 60% sensitivity and 68% specificity, while a RBP-4 cutoff of 71.6ng/mL had 70% sensitivity and 57% specificity. In multiple regression analyses simultaneously including clinical variables and the studied biomarkers, only BMI, PEDF and RBP-4 remained significant predictors of IR. CONCLUSIONS: Plasma PEDF and RBP4 identified IR in subjects with no prior diagnosis of diabetes.

Efficacy and safety of switching to abacavir/lamivudine (ABC/3TC) plus rilpivirine (RPV) in virologically suppressed HIV-infected patients on HAART.

We analysed the efficacy and safety of switching from a regimen based on nonnucleoside reverse transcriptase inhibitors (NNRTI) or integrase inhibitors (INI) to ABC/3TC + RPV in virologically suppressed HIV-infected patients. This multicentre, retrospective study comprised asymptomatic HIV-infected patients who switched from 2 NRTI + NNRTI or 2 NRTI + INI to ABC/3TC + RPV between February 2013 and December 2013; all had undetectable HIV viral load prior to switching. Efficacy and safety, and changes in lipids and cardiovascular risk (CVR) were analysed at 48 weeks. Of 85 patients (74.1 % men, mean age 49.5 years), 83 (97.6 %) switched from a regimen based on NNRTI (EFV 74, RPV 5, ETV 2, NVP 2), and 45 (53 %) switched from TDF/FTC to ABC/3TC. The main reasons for switching were toxicity (58.8 %) and convenience (29.4 %). At 48 weeks, 78 (91.8 %) patients continued taking the same regimen; efficacy was 88 % by intention to treat, and 96 % by per protocol. Two patients were lost to follow-up and five ceased the new regimen (4 due to adverse effects and 1 virologic failure). Mean CD4 cell counts increased (744 vs. 885 cells/µL; p = 0.0001), and there were mean decreases in fasting total cholesterol (-15.9 mg/dL; p < 0.0001) and LDL-cholesterol (-11.0 mg/dL; p < 0.004), with no changes in HDL-cholesterol, triglycerides, total cholesterol:HDL-cholesterol ratio, and CVR. ABC/3TC + RPV is effective and safe in virologically-suppressed patients on antiretroviral therapy (ART). Forty-eight weeks after switching the lipid profile improved with decreases in total and LDL cholesterol.

Malignant epithelial tumors observed in hernia sacs.

INTRODUCTION: The study of a hernia sac rarely provides the evidence of a primary or metastatic malignant epithelial tumor. METHODS: We have reviewed our institutional experience with malignant epithelial tumors found in a hernia sac with the purpose of evaluating cases present/manifesting in the sac, gross appearance, histologic type, primary tumor sites, staging, and patient outcome. RESULTS: A total of 8,435 adult patients underwent inguinal, femoral, umbilical or abdominal hernia repair in our hospitals. Twelve (0.14 %) patients had a malignant epithelial tumor in the hernia sac. Only one of these tumors was primary and the rest metastatic. Six out of twelve tumors (50.0 %), all of them metastatic, were discovered after hernia repair (0.07 %). The mean age of the 12 patients was 68.7 ± 15.2 years (range 43-90 years). Eight patients were male (66.7 %). Six tumors were located in inguinal (50.0 %), five in umbilical (41.7 %), and one in abdominal (8.3 %) hernia sacs. Gastrointestinal cases comprised 50.0 % and gynaecologic cases 25 % of tumors. In three cases (25.0 %) the hernia sac showed no gross abnormalities. All tumors were found in an advanced stage of development and ten patients died. Mean survival of these patients after hernia repair was 275.1 ± 376.4 days (range 6-1,095 days; median 68 days). CONCLUSIONS: Gravity, inflammatory oncotaxis, and chemotactic agents are probably operative phenomena in the development of metastatic lesions in hernia sacs. Routine microscopic evaluation of hernia sacs is not justified by the high cost. It should be reserved for selected cases based on the gross findings. Since subtle lesions may be overlooked on gross examination, particular caution should be taken with the examination of hernia sacs from older patients.

Impact of maternal diabetes on birthweight is greater in non-Hispanic blacks than in non-Hispanic whites.

AIMS/HYPOTHESIS: To determine the impact of maternal diabetes during pregnancy on racial disparities in fetal growth. METHODS: Using linked birth certificate, inpatient hospital and prenatal claims data we examined live singleton births of mothers resident in South Carolina who self-reported their race as non-Hispanic white (NHW; n = 140,128) or non-Hispanic black (NHB; n = 82,492) and delivered at 28-42 weeks' gestation between 2004 and 2008. RESULTS: Prepregnancy diabetes prevalence was higher in NHB (3.0%) than in NHW (1.7%), while the prevalence of gestational diabetes mellitus (GDM) was similar in NHB (6.1%) and NHW (6.3%). At a delivery BMI of 35 kg/m(2), GDM exposure was associated with an average birthweight only 17 g (95% CI 4, 30) higher in NHW, but 78 g (95% CI 61, 95) higher in NHB (controlling for gestational age, maternal age, infant sex and availability of information on prenatal care). Figures for prepregnancy diabetes were 58 g (95% CI 34, 81) in NHW and 60 g (95% CI 37, 84) in NHB. GDM had a greater impact on birthweight in NHB than in NHW (60 g racial difference [95% CI 39, 82]), while prepregnancy diabetes had a large but similar impact. Similarly, the RR for GDM of having a large- relative to a normal-weight-for-gestational-age infant was lower in NHW (RR 1.41 [95% CI 1.34, 1.49]) than in NHB (RR 2.24 [95% CI 2.05, 2.46]). CONCLUSIONS/INTERPRETATION: These data suggest that the negative effects of GDM combined with obesity during pregnancy may be greater in NHB than in NHW individuals.

Stem cells for myocardial regeneration.

The field of cardiovascular regenerative medicine has made significant strides over the past decade. Clinical trials have demonstrated benefit in acute myocardial infarction (AMI) and chronic heart failure (CHF). As the field has matured, it has defined novel biology and invented an array of therapeutic strategies that are currently under development. In this brief review, we attempt to conceptualize the knowledge to date as well as examine how this knowledge has been translated to various therapeutic strategies.

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

OBJETIVO: Analizar qué variables relacionadas con el paciente y con la cirugía, predicen la supervivencia al alta en los pacientes intervenidos en cirugía con ingreso en un hospital terciario durante el periodo de un año. MATERIAL Y MÉTODO: Se analizaron en la base de datos oficial del hospital, los pacientes intervenidos en régimen de ingreso hospitalario desde el 1 de enero hasta el 31 de diciembre del año 2007, en la que se incluye la edad, sexo, estado físico del paciente-ASA, tipo de ingreso y de cirugía (programado/urgente), servicio quirúrgico asignado y fecha de alta del paciente o fallecimiento. El estudio estadístico se realizó mediante análisis multivariante de Cox. RESULTADOS: En este periodo de tiempo se intervinieron 4.184 pacientes, siendo la mediana de la edad de 56 (P25-P75: 39-71) años. En el 77,5% de los casos (3.244 pacientes) se realizó la cirugía de forma programada, de los cuales el 23,1% habían ingresado de urgencias. El 21,8% fue valorado como ASA I, el 44,2% ASA II, el 28% ASA III y el 6% como ASA IV. El 33,2% de los pacientes clasificados como ASA I, II ó III tenían una edad igual o superior a 65 años, mientras que de los pacientes incluidos en el riesgo anestésico ASA IV el 78,7% reunían dicha condición. Se registraron 89 fallecimiento (2,1% del total de pacientes). El análisis multivariante de regresión de Cox permitió relacionar a los pacientes ASA IV (p<0,0005), con edad igual o superior a 65 años (p<0,0005) e intervenidos con carácter urgente (p<0,0005), con una menor probabilidad de supervivencia al alta frente a cualquier otro tipo de pacientes. CONCLUSIONES: La población con edad igual o superior a 65 años, con riesgo anestésico ASA IV, que ingresa con carácter urgente e intervenida con carácter urgente, presenta un mayor riesgo de mortalidad al ingreso frente al resto de pacientes. Potenciar los cuidados perioperatorios en este grupo de riesgo debe prevalecer con el objetivo de reducir su mortalidad(AU)

OBJETIVE: 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(AU)

La población fibromiálgica ante la cirugía. Estudio descriptivo y análisis del dolor posoperatorio en histerectomías / Fibromyalgia population before surgery: A descriptive study and analysis of post-hysterectomy pain

Objetivos. Este trabajo pretende determinar en primer lugar, la prevalencia, y el perfil clínico y demográfico de la población fibromiálgica de nuestra área sanitaria sometida a cirugía mayor; y en segundo lugar, analizar las características del dolor postoperatorio de las pacientes con fibromialgia intervenidas de Histerectomía abdominal, comparándolas con un grupo control. Materiales y método. Estudio retrospectivo realizado durante el periodo de enero de 2006 y mayo de 2008, seleccionando los casos con diagnóstico previamente establecido de fibromialgia reflejados en la historia de anestesia, para la realización a continuación de una entrevista telefónica sistematizada, en la que se completaron datos demográficos, clínicos, médicos, con especial atención al tratamiento y seguimiento de su enfermedad fibromiálgica, así como del recuerdo del dolor postoperatorio. Materiales y método. Estudio comparativo de la efectividad del tratamiento del dolor postoperatorio, mediante un sistema de PCA (Analgesia Controlada por el Paciente) intravenosa (iv) con Tramadol y Metamizol, de las pacientes con fibromialgia sometidas a Histerectomía abdominal frente a un grupo control. Resultados. Revisadas 11.814 historias de anestesia, se estimó una prevalencia de la enfermedad de un 0,86% durante el periodo de estudio. El perfil clínico medio fue: mujer de mediana edad, con sobrepeso, patología musculoesquelética y psiquiátrica acompañante, valorada generalmente con riesgo anestésico ASA II, en seguimiento para su patología fibromiálgica por su médico de atención primaria, polimedicada con AINES (antiinflamatorios no esteroideos), ansiolíticos y relajantes musculares, y sin un buen control del dolor. El estudio comparativo del dolor posoperatorio en las histerectomías demostró una efectividad similar en el tratamiento de ambos grupos; sin embargo las pacientes con fibromialgia solicitaron un 45% más de analgesia a la PCA que el grupo control. Conclusiones. Las pacientes fibromiálgicas podrían necesitar mayor cantidad de analgésicos que la población general tras una histerectomía abdominal. El sistema de PCA permite optar a un tratamiento más individualizado, ya que los pacientes pueden controlar la cantidad de analgesia que necesiten en función del dolor que presenten, sin incrementar los efectos secundarios (AU)

Objective. This study attempts to determine, firstly, the prevalence, and clinical and demographic profile of the fibromyalgia population in our health area subjected to major surgery, and secondly, to analyse the characteristics of the pain of fibromyalgia patients after abdominal hysterectomy, and comparing them with a control group. Material and method. A retrospective study conducted over the period January 2006 to May 2008, selecting cases with a previously established diagnose of fibromyalgia recorded in the Anaesthesia medical records. A standardised telephone interview was then carried out, in which the demographic, clinical and medical data was collected, paying particular attention to the treatment and follow-up of their fibromyalgia, as well as noting the post-surgical pain. Material and method. A comparative study on the efficacy of the treatment of post-surgical pain, using a an intravenous (iv) PCA (Patient Controlled Analgesia) system with Tramadol and Metamizole, of patients with fibromyalgia who had an abdominal hysterectomy versus a control group. Results. Out of a total of 11,814 anaesthesia medical records were reviewed, there was a prevalence of 0.86% of the disease during the study period. The average clinical profile was: middle-aged woman, overweight, musculoskeletal and accompanying psychiatric disease, generally assessed as anaesthetic risk ASA II, on follow-up due to her fibromyalgia disease by her primary care doctor, multiple medication with NSAIDs (non-steroidal anti-inflammatory drugs), tranquillisers and muscle relaxants, and poorly controlled pain. The comparative study of post-operative pain in hysterectomies showed a similar efficacy in the treatment of both groups. However the patients with fibromyalgia requested 45% more analgesia by PCA than the control group. Conclusions. Patients with fibromyalgias could need a greater amount of analgesics than the general population after an abdominal hysterectomy. The PCA system enables a more individualised treatment to be chosen, since the patients can control the amount of analgesia they need depending on their pain, without increasing secondary effects (AU)