A technique to quantify very low activities in regions of interest with a collimatorless detector.

We present a new method to measure sub-microcurie activities of photon-emitting radionuclides in organs and lesions of small animals in vivo. Our technique, named the collimator-less likelihood fit, combines a very high sensitivity collimatorless detector with a Monte Carlo-based likelihood fit in order to estimate the activities in previously segmented regions of interest along with their uncertainties. This is done directly from the photon projections in our collimatorless detector and from the region of interest segmentation provided by an x-ray computed tomography scan. We have extensively validated our approach with 225Ac experimentally in spherical phantoms and mouse phantoms, and also numerically with simulations of a realistic mouse anatomy. Our method yields statistically unbiased results with uncertainties smaller than 20% for activities as low as ~111 Bq (3 nCi) and for exposures under 30 minutes. We demonstrate that our method yields more robust recovery coefficients when compared to SPECT imaging with a commercial pre-clinical scanner, specially at very low activities. Thus, our technique is complementary to traditional SPECT/CT imaging since it provides a more accurate and precise organ and tumor dosimetry, with a more limited spatial information. Finally, our technique is specially significant in extremely low-activity scenarios when SPECT/CT imaging is simply not viable.

[Initial management of the patients with psychiatric involvement in hospital emergency departments: a systematic review].

This article is a systematic review of studies that have investigated the initial management of patients with psychiatric conditions in hospital emergencies services in order to establish practical recommendations. A systematic review of the literature was carried out, consisting of studies published from 2010 to 2020, available in any language, consulting Cochrane Library Plus, PubMed, IBECS, LILACS and MEDLINE. The quality of the studies included in this review was assessed by the AMSTAR2 tool and the FCL 3.0 platform, together with the PRISMA statement. Results from the eleven papers selected showed that improvements in staff training, available resources, appropriate use of restraint and appropriate choice of medication can help to improve the care of patients with mental pathology in hospital emergency services. The same management for any other patient is recommended. However, if the patient is agitated or uncooperative, verbal, pharmacological and/or mechanical restraint (in this order) may be necessary. Keywords. Psychiatry. Psychomotor agitation. Crisis intervention. Hospital emergency service.

Efficacy and safety of peri-procedural bridging therapy with low molecular weight heparin in atrial fibrillation patients under vitamin K antagonists.

BACKGROUND: The clinical effect of peri-operative bridging therapy in atrial fibrillation (AF) patients remains unclear given that it may increase bleeding risk without providing significant benefits. We aimed to investigate peri-procedural events in relation to peri-operative use of bridging therapy in AF patients under Vitamin K Antagonists (VKAs). METHODS: We included AF patients stable the previous 6 months on VKAs. During a median follow-up of 6.5 years (IQR 4.3-7.9), we recorded all invasive procedures and the peri-operative clinical management. All peri-procedural events (ischaemic stroke/transient ischaemic attack/systemic embolism, clinically relevant non-major bleeding and major bleeding) and severe peri-procedural events (ischaemic stroke/transient ischaemic attack/systemic embolism and major bleeding) suffered until the 30-days post-intervention period were recorded. RESULTS: We included 1361 patients (48.7% male, median age 76 [IQR 71-81] years). There were 1100 (70.9%) procedures performed using bridging therapy. The rate of any (4.5% vs. 0.7%, P < 0.001) and severe (2.3% vs. 0.0%, P = 0.002) peri-procedural events were higher in patients receiving bridging therapy. Adjusted logistic regressions demonstrated that the bleeding risk of the procedure was related with higher risk of severe peri-procedural events (OR 3.51, 95% CI 1.54-8.01) and peri-procedural events (OR 2.77, 95% CI 1.56-4.91). Importantly, the use of bridging therapy was also independently associated with higher risk of any peri-procedural events (OR 4.32, 95% CI 1.28-14.51). CONCLUSIONS: In this study including AF patients under VKA therapy, the use of bridging therapy as part of the clinical management during an invasive procedure was independently associated with higher risk of any peri-procedural event.

Nuclear mobility and mitotic chromosome binding: similarities between pioneer transcription factor FoxA and linker histone H1.

There exists a hierarchy by which transcription factors can engage their target sites in chromatin, in that a subset of factors can bind transcriptionally silent, nucleosomal DNA, whereas most factors cannot, and this hierarchy is reflected, at least in part, in the developmental function of the factors. For example, transcription factors possessing the Forkhead box (Fox) DNA-binding domain contain an overall fold resembling that of linker histone and thus are structured to bind DNA, site specifically, in a nucleosomal context. Where tested, Fox factors bind early in the developmental or physiological activation of target genes, thereby enabling the binding of other factors that cannot engage chromatin on their own. To investigate the basis for early chromatin binding, we have used fluorescence recovery after photobleaching (FRAP) to analyze the mobility, in the live cell nucleus, of FoxA factors in comparison to linker histone and other transcription factors. We have further analyzed the factors for their ability to bind to chromatin in mitosis and thereby serve as epigenetic marks. The results indicate that the "pioneer" features of FoxA factors involve various chromatin-binding parameters seen in linker histones and that distinguish the factors with respect to their regulatory and mechanistic functions.

Embolismo paradójico: ¿una entidad infrecuente o poco diagnosticada? / Parasoxical embolism: is it a rare condition or is it underdiagnosed?

Introducción. A pesar de que tanto la enfermedad tromboembólica venosa (ETEV) como el foramen oval permeableson entidades frecuentes, la isquemia arterial secundaria a un embolismo paradójico constituye una rareza y seestima que se encuentra en la base de aproximadamente un 2% de éstas. Caso clínico. Mujer de 83 años que acudió a urgenciaspor la isquemia arterial aguda del miembro inferior izquierdo, que se produjo tres meses después de una fracturasubcapital del fémur derecho. Durante ese período había presentado un marcado deterioro cognitivo y funcional, yhabía acudido al servicio de urgencias en varias ocasiones por episodios de disnea. Tras la embolectomía realizada deurgencia, se realizaron otras exploraciones complementarias que confirmaron el diagnóstico de sospecha de embolismosparadójicos secundarios a una ETEV con tromboembolismo pulmonar). Conclusiones. Aunque teóricamente más frecuenteen los accidentes cerebrovasculares, el embolismo paradójico es una causa de isquemia arterial aguda probablementeinfradiagnosticada. Un alto índice de sospecha clínica, junto con la utilización razonable de técnicas de cribado,permitiría un mayor número de diagnósticos que ayudarían a conocer mejor la historia natural de la ETEV y la relevanciadel foramen oval permeable como una entidad que la ensombrece

Introduction. Although both venous thromboembolic disease (VTED) and patent foramen ovale are frequentconditions, arterial ischaemia secondary to a paradoxical embolism is rare and is estimated to be at the root of 2% ofall such cases. Case report.We report the case of an 83-year-old female who visited the Emergency department becauseof an acute arterial ischaemia in the lower left limb that was produced three months after a subcapital fracture of theright femur. Throughout that period the patient experienced notable cognitive and functional deterioration and had tovisit the Emergency department several times because of bouts of dyspnea. After a performing an emergency embolectomy, other complementary examinations were carried out that confirmed the suspected diagnosis of paradoxical embolismssecondary to VTED with pulmonary thromboembolism. Conclusions. Although it is theoretically more frequent in cerebrovascularaccidents, paradoxical embolism is a probably underdiagnosed cause of acute arterial ischaemia. A highdegree of clinical suspicion, together with the reasonable utilisation of screening techniques, would make it possible toachieve a greater number of diagnoses that would help to gain a deeper understanding of the natural history of VTEDand the importance of patent foramen ovale as a condition that makes it worse

Endoprótesis fenestrada para tratamiento de aneurisma de aorta yuxtarrenal / Fenestrated stent-grafts to treat juxtarenal aortic aneurysms

Introducción. El uso de prótesis endovasculares ha supuesto una gran aportación para el tratamiento de aneurismas en pacientes de alto riesgo. Presentamos un caso de tratamiento de aneurisma yuxtarrenal mediante endoprótesis con fenestraciones para las arterias renales. Caso clínico. Se trata de un paciente de 60 años de edad, al que se le diagnosticó de aneurisma de aorta durante la realización de cateterismo cardíaco. Como patología asociada destacamos la existencia de cardiopatía isquémica grave con angina inestable sin posibilidades de revascularización miocárdica ni angioplastia. Fue intervenido quirúrgicamente de colectomía total por colitis ulcerosa. Estas dos circunstancias condicionaban un alto riesgo general y local para la cirugía arterial directa del aneurisma. En el estudio preoperatorio mediante tomografía axial computarizada y arteriografía se comprobó que el cuello subrrenal era de tan sólo 3 mm, por lo que se completó el estudio para el tratamiento mediante una endoprótesis fenestrada. Mediante abordaje femoral bilateral se procedió a colocar una prótesis fenestrada Zenith Cook ZFEN-1000 de 28 mm de diámetro proximal, 24 mm de diámetro distal y una longitud de 109 mm, con una escotadura para la arteria mesentérica superior, y dos fenestraciones para las arterias renales. Se concluyó con dos extensores rectos ESLE-55-24 Zenith Cook que se fijan a la bifurcación aórtica. El procedimiento finalizó con éxito, sin que se apreciaran fugas en los controles intra y postoperatorio. Conclusión. El uso de endoprótesis fenestradas para el tratamiento de aneurismas yuxtarrenales es un procedimiento factible y útil, cuyos resultados a largo plazo todavía no se conocen bien (AU)

[A spontaneous pseudoaneurysm of the superficial femoral artery. Apropos a case]. / Falso aneurisma espontáneo de arteria femoral superficial. A propósito de un caso.

A case of pseudoaneurysm of the superficial femoral artery is reported. No relation with traumatisms, septic, agents or others could be proved. Literature was reviewed, looking for the different etiologies of pseudoaneurysms. The extremely rare incidence of the case reported is noted.

Prevention of induced atherosclerosis by peroxidase.

Hepatocatalase peroxidase, an active peroxidase-oxidase subunit isolated from beef-liver catalase, prevents cholesterol deposition and aortic atherosclerosis in cholesterol-fed rabbits and has no apparent toxicity or undesirable de effects. No allergic or immunological reactions have been observed. The participation of this enzymatic subunit in homeostatic control mechanisms and its potential pharmacological value in the control of human atherosclerosis are suggested.