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1.
Eur Phys J C Part Fields ; 84(5): 518, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38784120

RESUMEN

Noble element time projection chambers are a leading technology for rare event detection in physics, such as for dark matter and neutrinoless double beta decay searches. Time projection chambers typically assign event position in the drift direction using the relative timing of prompt scintillation and delayed charge collection signals, allowing for reconstruction of an absolute position in the drift direction. In this paper, alternate methods for assigning event drift distance via quantification of electron diffusion in a pure high pressure xenon gas time projection chamber are explored. Data from the NEXT-White detector demonstrate the ability to achieve good position assignment accuracy for both high- and low-energy events. Using point-like energy deposits from 83mKr calibration electron captures (E∼45 keV), the position of origin of low-energy events is determined to 2 cm precision with bias <1mm. A convolutional neural network approach is then used to quantify diffusion for longer tracks (E≥1.5 MeV), from radiogenic electrons, yielding a precision of 3 cm on the event barycenter. The precision achieved with these methods indicates the feasibility energy calibrations of better than 1% FWHM at Qßß in pure xenon, as well as the potential for event fiducialization in large future detectors using an alternate method that does not rely on primary scintillation.

2.
Rev Neurol ; 69(4): 159-166, 2019 Aug 16.
Artículo en Español | MEDLINE | ID: mdl-31334559

RESUMEN

Interest in the causal relation between consciousness and the underlying neuronal activity has grown in recent decades. Numerous experimental studies have been carried out on the brain structures and networks underlying consciousness in animal models, in patients with brain damage and with very precise functional neuroimaging. In spite of the great multitude of findings, there is no theoretical proposal that integrates this knowledge under a coherent theoretical framework based on the evidence obtained. Existing theories offer a dismembered view of consciousness, since they pose causal explanations that do not include a global functional perspective of the interaction of the different brain networks involved in consciousness. This work offers a theoretical framework that integrates the empirical knowledge, generated in recent decades, into a neurofunctional model of consciousness. This model represents consciousness as an epiphenomenon resulting from the sequential activation of different neural loops that are formed by specific brain structures and networks which receive feedback from their own operations in order to reconfigure their own functional states and the entire system. The ascending reticular activating system, the thalamocortical networks and the cortico-cortical networks sustain cognitive processes that are differentiated, although highly dependent and fundamental for the final experience of consciousness. All these systems form a single physiological space where the individual can deploy different cognitive skills that allow the emergence of complex behaviours such as language, thought and social cognition.


TITLE: Modelo neurofuncional de la conciencia: bases neurofisiologicas y cognitivas.El interes por la relacion causal existente entre la conciencia y la actividad neuronal subyacente ha aumentado en las ultimas decadas. Se han llevado a cabo numerosos estudios experimentales en modelos animales, en pacientes con daño cerebral y con neuroimagen funcional con una excelente precision sobre las estructuras y redes cerebrales que subyacen a la conciencia. A pesar de la gran multitud de hallazgos, no existe una propuesta teorica que integre este conocimiento bajo un marco teorico coherente basado en las evidencias obtenidas. Las teorias existentes ofrecen una vision desmembrada de la conciencia, ya que plantean explicaciones causales que no incluyen una perspectiva funcional global sobre la interaccion del conjunto de redes cerebrales involucradas en la conciencia. Este trabajo ofrece un marco teorico que integra el conocimiento empirico, generado en las ultimas decadas, en un modelo neurofuncional de la conciencia. Este modelo representa la conciencia como un epifenomeno resultante de la activacion secuencial de diferentes bucles neuronales que estan formados por estructuras y redes cerebrales especificas retroalimentadas por sus propias operaciones para poder reconfigurar sus propios estados funcionales y todo el sistema. El sistema reticular activador ascendente, las redes talamocorticales y las redes corticocorticales sostienen procesos cognitivos diferenciados, aunque altamente dependientes y basicos para la experiencia final de conciencia. Todos estos sistemas forman un unico espacio fisiologico en donde el individuo puede desplegar diferentes habilidades cognitivas que permiten la emergencia de conductas complejas como el lenguaje, el pensamiento y la cognicion social.


Asunto(s)
Estado de Conciencia/fisiología , Modelos Neurológicos , Modelos Psicológicos , Corteza Cerebral/fisiología , Emociones/fisiología , Retroalimentación Fisiológica , Actividad Nerviosa Superior/fisiología , Humanos , Memoria/fisiología , Vías Nerviosas/fisiología , Psicofisiología , Tálamo/fisiología
3.
Phys Rev Lett ; 120(13): 132504, 2018 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-29694208

RESUMEN

A new method to tag the barium daughter in the double-beta decay of ^{136}Xe is reported. Using the technique of single molecule fluorescent imaging (SMFI), individual barium dication (Ba^{++}) resolution at a transparent scanning surface is demonstrated. A single-step photobleach confirms the single ion interpretation. Individual ions are localized with superresolution (∼2 nm), and detected with a statistical significance of 12.9σ over backgrounds. This lays the foundation for a new and potentially background-free neutrinoless double-beta decay technology, based on SMFI coupled to high pressure xenon gas time projection chambers.

4.
J Viral Hepat ; 25(7): 811-817, 2018 07.
Artículo en Inglés | MEDLINE | ID: mdl-29476572

RESUMEN

Hepatitis C virus (HCV) infection is a systemic disease associated with both hepatic and extrahepatic manifestations. The burden associated with the hepatic manifestation of HCV infection has been well documented in Europe, although that of HCV extrahepatic manifestations remains unknown. In this study, we estimated the annual direct medical costs associated with HCV extrahepatic manifestations in five European countries. A previously validated economic model was used to estimate the annual direct medical cost associated with HCV extrahepatic manifestations. Global excess prevalence of extrahepatic manifestations in HCV patients relative to that in non-HCV patients was obtained from a recent meta-analysis. Per-patient per-year inpatient, outpatient and medication costs to treat each extrahepatic manifestation were from the literature, national databases or expert opinion if unavailable otherwise. All costs were adjusted to 2016 euros (€). The overall direct medical costs associated with HCV extrahepatic manifestations were calculated by multiplying the total per-patient per-year costs of each by the respective excess prevalence rates and then by the size of the HCV-infected population in each country. Treatment impact with direct-acting antivirals (DAAs) was explored using HCV extrahepatic manifestations excess prevalence rates among cured patients compared to untreated HCV patients, as sourced from a meta-analysis. The total annual direct medical cost associated with HCV extrahepatic manifestations was estimated to be 2.17 billion euro (€), with a per-HCV-patient cost ranging from €899 to €1647 annually. DAA treatment was projected to result in cost savings of €316 million per year. We find that the annual economic burden of extrahepatic manifestations is significant and may be partly mitigated by treatment with DAAs.


Asunto(s)
Costos de la Atención en Salud , Hepatitis C Crónica/terapia , Europa (Continente) , Humanos
6.
Aliment Pharmacol Ther ; 45(8): 1156-1161, 2017 04.
Artículo en Inglés | MEDLINE | ID: mdl-28206681

RESUMEN

BACKGROUND: A few cases of hepatitis B virus (HBV) reactivation during anti-viral therapy against hepatitis C (HCV) have been reported. However, the information regarding the real impact of this phenomenon is scarce. AIM: To evaluate the risk of HBV reactivation during anti-viral therapy against HCV with an interferon-free regimen with direct-acting anti-virals (DAAs). METHODS: Observational and prospective study of 352 patients receiving DAAs therapy between September 2015 and May 2016. HBV-DNA and ALT levels were monitored at baseline, at week 4 of anti-viral therapy, at end of treatment and 12 weeks after treatment discontinuation in patients with HBV surface antigen (HBsAg) positive or HBV core antibody (anti-HBc) positive before starting anti-viral therapy. RESULTS: Ten (2.8%) and 64 (18%) patients were HBsAg and anti-HBc positive at baseline, respectively. Five (50%) of 10 HBsAg positive and one (1.6%) of 64 anti-HBc positive patients presented HBV virological reactivation (>1log increase in HBV-DNA levels). None of these patients presented clinical reactivation (increase in ALT levels). CONCLUSIONS: HBV virological reactivation is frequent in HBsAg+ patients receiving anti-viral therapy against HCV. However, HBV-DNA elevations were modest (<20 000 IU/mL) and without clinical impact (no ALT elevation).


Asunto(s)
Antivirales/efectos adversos , Virus de la Hepatitis B/efectos de los fármacos , Virus de la Hepatitis B/fisiología , Hepatitis B/tratamiento farmacológico , Hepatitis C Crónica/tratamiento farmacológico , Activación Viral/efectos de los fármacos , Adulto , Anciano , Anciano de 80 o más Años , Antivirales/uso terapéutico , Femenino , Hepatitis B/complicaciones , Hepatitis B/virología , Anticuerpos contra la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/sangre , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/virología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
7.
Rev Esp Sanid Penit ; 19(3): 87-97, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-29364334

RESUMEN

Chronic hepatitis C virus (HCV) infection has been associated with both organ-specific and systemic autoimmune diseases, with cryoglobulinemia being the most frequent associated disease. Experimental, virologic, and clinical evidence have demon-strated a close association between HCV infection and some systemic autoimmune diseases, especially Sjögren's syndrome, but also rheumatoid arthritis and lupus. A higher prevalence of hematological processes has also been described in patients with HCV infection, including cytopenias and lymphoproliferative disorders (B-cell lymphoma). In addition, patients with chronic HCV infection have a higher frequency of other extrahepatic manifestations including endocrine, metabolic and cardiovascular disorders that may worse the prognosis of patients, along with neuropsychiatric manifestations and general symptoms that have a significant influence on the quality of life of the patient. Direct-acting antiviral therapies (DAAs) that have recently begun to be used are providing the opportunity to effectively cure chronic HCV infection and reduce the burden of both hepatic and extrahepatic complications.


Asunto(s)
Hepatitis C Crónica/complicaciones , Antivirales/uso terapéutico , Enfermedades Autoinmunes/diagnóstico , Enfermedades Autoinmunes/terapia , Enfermedades Autoinmunes/virología , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/terapia , Enfermedades Cardiovasculares/virología , Enfermedades del Sistema Nervioso Central/diagnóstico , Enfermedades del Sistema Nervioso Central/terapia , Enfermedades del Sistema Nervioso Central/virología , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/terapia , Diabetes Mellitus/virología , Hígado Graso/diagnóstico , Hígado Graso/terapia , Hígado Graso/virología , Enfermedades Hematológicas/diagnóstico , Enfermedades Hematológicas/terapia , Enfermedades Hematológicas/virología , Hepatitis C Crónica/tratamiento farmacológico , Humanos
8.
J Viral Hepat ; 24(4): 304-311, 2017 04.
Artículo en Inglés | MEDLINE | ID: mdl-27935168

RESUMEN

Patients with HCV genotype 3 (GT3) infection and cirrhosis are currently the most difficult to cure. We report our experience with sofosbuvir+daclatasvir (SOF+DCV) or sofosbuvir/ledipasvir (SOF/LDV), with or without ribavirin (RBV) in clinical practice in this population. This was a multicenter observational study including cirrhotic patients infected by HCV GT3, treated with sofosbuvir plus an NS5A inhibitor (May 2014-October 2015). In total, 208 patients were included: 98 (47%) treatment-experienced, 42 (20%) decompensated and 55 (27%) MELD score >10. In 131 (63%), treatment was SOF+DCV and in 77 (37%), SOF/LDV. Overall, 86% received RBV. RBV addition and extension to 24 weeks was higher in the SOF/LDV group (95% vs 80%, P=.002 and 83% vs 72%, P=.044, respectively). A higher percentage of decompensated patients were treated with DCV than LDV (25% vs 12%, P=.013). Overall, SVR12 was 93.8% (195/208): 94% with SOF+DCV and 93.5% with SOF/LDV. SVR12 was achieved in 90.5% of decompensated patients. Eleven treatment failures: 10 relapses and one breakthrough. RBV addition did not improve SVR (RR: 1.08; P=.919). The single factor associated with failure to achieve SVR was platelet count <75×10E9/mL (RR: 3.50, P=.019). In patients with MELD <10, type of NS5A inhibitor did not impact on SVR12 (94% vs 97%; adjusted RR: 0.49). Thirteen patients (6.3%) had serious adverse events, including three deaths (1.4%) and one therapy discontinuation (0.5%), higher in decompensated patients (16.7% vs 3.6%, P<.006). In patients with GT3 infection and cirrhosis, SVR12 rates were high with both SOF+DCV and SOF/LDV, with few serious adverse events.


Asunto(s)
Antivirales/uso terapéutico , Genotipo , Hepacivirus/clasificación , Hepatitis C Crónica/tratamiento farmacológico , Cirrosis Hepática/tratamiento farmacológico , Ribavirina/uso terapéutico , Sofosbuvir/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Antivirales/efectos adversos , Femenino , Hepacivirus/genética , Hepacivirus/aislamiento & purificación , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/virología , Humanos , Cirrosis Hepática/etiología , Cirrosis Hepática/virología , Masculino , Persona de Mediana Edad , Ribavirina/efectos adversos , Sofosbuvir/efectos adversos , Resultado del Tratamiento , Proteínas no Estructurales Virales/antagonistas & inhibidores , Adulto Joven
9.
J Viral Hepat ; 24(3): 226-237, 2017 03.
Artículo en Inglés | MEDLINE | ID: mdl-27976491

RESUMEN

Over the last 5 years, therapies for hepatitis C virus (HCV) infection have improved significantly, achieving sustained virologic response (SVR) rates of up to 100% in clinical trials in patients with HCV genotype 1. We investigated the effectiveness and safety of ombitasvir/paritaprevir/ritonavir±dasabuvir in an early access programme. This was a retrospective, multicentre, national study that included 291 treatment-naïve and treatment-experienced patients with genotype 1 or 4 HCV infection. Most patients (65.3%) were male, and the mean age was 57.5 years. The mean baseline viral load was 6.1 log, 69.8% had HCV 1b genotype, 72.9% had cirrhosis and 34.7% were treatment-naïve. SVR at 12 weeks posttreatment was 96.2%. Four patients had virological failure (1.4%), one leading to discontinuation. There were no statistical differences in virological response according to genotype or liver fibrosis. Thirty patients experienced serious adverse events (SAEs) (10.3%), leading to discontinuation in six cases. Hepatic decompensation was observed in five patients. Four patients died during treatment or follow-up, three of them directly related to liver failure. Multivariate analyses showed a decreased probability of achieving SVR associated with baseline albumin, bilirubin and Child-Pugh score B, and a greater probability of developing SAEs related to age and albumin. This combined therapy was highly effective in clinical practice with an acceptable safety profile and low rates of treatment discontinuation.


Asunto(s)
Antivirales/uso terapéutico , Genotipo , Hepacivirus/clasificación , Hepatitis C Crónica/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Quimioterapia Combinada/efectos adversos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/patología , Femenino , Hepacivirus/genética , Hepacivirus/aislamiento & purificación , Hepatitis C Crónica/virología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , España , Respuesta Virológica Sostenida , Resultado del Tratamiento
10.
Aliment Pharmacol Ther ; 44(6): 629-37, 2016 09.
Artículo en Inglés | MEDLINE | ID: mdl-27464682

RESUMEN

BACKGROUND: Hospital mortality in patients with spontaneous bacterial peritonitis (SBP) is high despite albumin treatment, particularly in those with worse liver and/or renal function. AIM: To determine the independent predictive factors of in-hospital mortality and to create and validate a predictive model of mortality in patients with SBP. METHODS: We analysed all cirrhotic patients with high-risk SBP (serum urea ≥11 mmol/L and/or serum bilirubin ≥68 µmol/L) between 2001 and 2011. We developed a predictive model of in-hospital mortality and validated this in a different cohort. RESULTS: We included 118 high-risk SBP episodes treated with antibiotics and albumin. In-hospital mortality was 33/118 (28%). The independent predictive factors of in-hospital mortality at SBP diagnosis were serum urea, blood leucocyte count, Child-Pugh score and mean arterial pressure. A predictive model including these four variables showed a discrimination accuracy (AUC) of 0.850, 95% CI 0.777-0.922. A cut-off point of 0.245 showed a sensitivity of 0.85 and specificity of 0.75. The in-hospital mortality was 28/49 (57.1%) in patients with a model value ≥0.245, and 5/69 (7.2%) in patients with a model value <0.245 (P < 0.001). The validation series included 161 patients with an in-hospital mortality of 40/161 (24.8%), 30/77 (39.0%) in patients with a model value ≥0.245, and 10/84 (11.9%) in those with a model value <0.245 (P < 0.001). CONCLUSIONS: We developed and validated a predictive model of mortality that includes serum urea, blood leucocyte count, Child-Pugh score and mean arterial pressure in high-risk patients with spontaneous bacterial peritonitis. These findings may help to identify patients who would benefit from additional therapeutic strategies.


Asunto(s)
Infecciones Bacterianas/mortalidad , Cirrosis Hepática/mortalidad , Modelos Teóricos , Peritonitis/mortalidad , Anciano , Antibacterianos/uso terapéutico , Estudios de Cohortes , Femenino , Mortalidad Hospitalaria , Humanos , Cirrosis Hepática/microbiología , Masculino , Persona de Mediana Edad , Peritonitis/microbiología , Valor Predictivo de las Pruebas , Pronóstico
11.
Exp Clin Endocrinol Diabetes ; 124(1): 39-44, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26575116

RESUMEN

OBJECTIVE: The clinical value of thyrotropin receptor antibodies for the differential diagnosis of thyrotoxicosis induced by pegylated interferon-alpha remains unknown. We analyzed the diagnostic accuracy of thyrotropin receptor antibodies in the differential diagnosis of thyrotoxicosis in patients with chronic hepatitis C (CHC) receiving pegylated interferon-alpha plus ribavirin. METHODS: Retrospective analysis of 274 patients with CHC receiving pegylated interferon-alpha plus ribavirin. Interferon-induced thyrotoxicosis was classified according to clinical guidelines as Graves disease, autoimmune and non- autoimmune destructive thyroiditis. RESULTS: 48 (17.5%) patients developed hypothyroidism, 17 (6.2%) thyrotoxicosis (6 non- autoimmune destructive thyroiditis, 8 autoimmune destructive thyroiditis and 3 Graves disease) and 22 "de novo" thyrotropin receptor antibodies (all Graves disease, 2 of the 8 autoimmune destructive thyroiditis and 17 with normal thyroid function). The sensitivity and specificity of thyrotropin receptor antibodies for Graves disease diagnosis in patients with thyrotoxicosis were 100 and 85%, respectively. Patients with destructive thyroiditis developed hypothyroidism in 87.5% of autoimmune cases and in none of those with a non- autoimmune etiology (p<0.001). CONCLUSION: Thyrotropin receptor antibodies determination cannot replace thyroid scintigraphy for the differential diagnosis of thyrotoxicosis in CHC patients treated with pegylated interferon.


Asunto(s)
Autoanticuerpos , Interferón-alfa/efectos adversos , Polietilenglicoles/efectos adversos , Receptores de Tirotropina , Adolescente , Adulto , Anciano , Autoanticuerpos/sangre , Autoanticuerpos/inmunología , Diagnóstico Diferencial , Femenino , Hepatitis C Crónica/sangre , Hepatitis C Crónica/tratamiento farmacológico , Hepatitis C Crónica/inmunología , Humanos , Interferón-alfa/administración & dosificación , Masculino , Persona de Mediana Edad , Polietilenglicoles/administración & dosificación , Receptores de Tirotropina/antagonistas & inhibidores , Receptores de Tirotropina/sangre , Receptores de Tirotropina/inmunología , Proteínas Recombinantes/administración & dosificación , Proteínas Recombinantes/efectos adversos , Tiroiditis Autoinmune/sangre , Tiroiditis Autoinmune/inducido químicamente , Tiroiditis Autoinmune/diagnóstico , Tiroiditis Autoinmune/inmunología
12.
Aliment Pharmacol Ther ; 43(3): 364-74, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26582599

RESUMEN

BACKGROUND: Data are scarce on the natural history of chronic hepatitis C (CHC) in patients with mild hepatitis C who did not respond to anti-viral therapy. AIM: To predict the risk of progression to cirrhosis, identifying patients with the more urgent need for therapy with effective anti-virals. METHODS: A cohort of 1289 noncirrhotic CHC patients treated with interferon-based therapy between 1990 and 2004 in two referral hospitals were followed up for a median of 12 years. RESULTS: Overall, SVR was achieved in 46.6% of patients. Data from a randomly split sample (n = 832) was used to estimate a model to predict outcomes. Among nonresponders (n = 444), cirrhosis developed in 123 (28%) patients. In this group, the 3, 5 and 10-year cumulative probabilities of cirrhosis were 4%, 7% and 22%, respectively, compared to <1% in the SVR-group (P < 0.05). Baseline factors independently associated with progression to cirrhosis in nonresponders were: fibrosis ≥F2, age >40 years, AST >100 IU/L, GGT >40 IU/L. Three logistic regression models that combined these simple variables were highly accurate in predicting the individual risk of developing cirrhosis with areas under the receiving operating characteristic curves (AUC) at 5, 7 and 10 years of ~0.80. The reproducibility of the models in the validation cohort (n = 457, nonresponders = 244), was consistently high. CONCLUSIONS: Modelling based on simple laboratory and clinical data can accurately identify the individual risk of progression to cirrhosis in nonresponder patients with chronic hepatitis C, becoming a very helpful tool to prioritise the start of oral anti-viral therapy in clinical practice.


Asunto(s)
Hepatitis C Crónica/complicaciones , Cirrosis Hepática/etiología , Cirrosis Hepática/fisiopatología , Adulto , Antivirales/uso terapéutico , Biomarcadores , Progresión de la Enfermedad , Femenino , Humanos , Interferones/uso terapéutico , Cirrosis Hepática/tratamiento farmacológico , Modelos Logísticos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Curva ROC , Reproducibilidad de los Resultados
13.
Brain Inj ; 29(12): 1439-44, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26305856

RESUMEN

OBJECTIVE: The main objective of this study is to determine whether gender affects global mortality and functional outcome after severe traumatic brain injury (TBI). METHODS: This retrospective cohort study included 629 patients with severe TBI (14.9% female) admitted to the ICU of a university hospital. Patients were split into gender groups to study potential differences in global mortality and functional outcome at ICU discharge and 6 months post-trauma using the GOS. The following variables were analysed: age, intracranial injury, injury mechanism, injury severity, factors contributing to secondary brain injury, monitoring level, treatment, complications, length of stay in the ICU and cause of death. RESULTS: No differences were found between gender groups in neuromonitoring level or surgical procedures. Women had higher APACHE II scores, a higher incidence of pre-hospital hypotension, anaemia and transfusion and higher mortality rates in the ICU (OR = 1.74; 95% CI = 1.09-2.77) and 6 months post-trauma (OR = 1.65; 95% CI = 1.02-2.67). There were no significant differences in functional outcome at ICU discharge or 6 months post-injury. The multivariate analysis did not show gender as an independent predictive factor in mortality after severe TBI. CONCLUSION: In this study, gender was not found to be an independent predictor for poorer outcome after severe TBI.


Asunto(s)
Lesiones Encefálicas/mortalidad , Factores Sexuales , Adulto , Estudios de Cohortes , Femenino , Predicción , Escala de Coma de Glasgow , Escala de Consecuencias de Glasgow , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , España , Adulto Joven
14.
J Viral Hepat ; 22(3): 297-306, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25164560

RESUMEN

Transient elastography (TE) is the reference method to obtain liver stiffness measurements (LSM), but no results are obtained in 3.1% and unreliable in 15.8%. We assessed the applicability and diagnostic accuracy of TE re-evaluation using M and XL probes. From March 2011 to April 2012 868 LSM were performed with the M probe by trained operators (50-500 studies) (LSM1). Measurements were categorized as inadequate (no values or ratio <60% and/or IQR/LSM >30%) or adequate. Inadequate LSM1 were re-evaluated by experienced operators (>500 explorations) (LSM2) and inadequate LSM2 using XL probe (LSMXL). Inadequate LSM1 were obtained in 187 (21.5%) patients, IQR/LSM >30% in 97 (51%), ratio <60% in 24 (13%) and TE failed to obtain a measurement in 67 (36%). LSM2 achieved adequate registers in 123 (70%) of 175 registers previously considered as inadequate. Independent variables (OR, 95%CI) related to inadequate LSM1 were body mass index (1.11, 1.04-1.18), abdominal circumference (1.03, 1.01-1.06) and age (1.03, 1.01-1.04) and to inadequate LSM2 were skin-capsule distance (1.21, 1.09-1.34) and abdominal circumference (1.05, 1.01-1.10). The diagnostic accuracy (AUROC) to identify significant fibrosis improved from 0.89 (LSM1) to 0.91 (LSM2) (P = 0.046) in 334 patients with liver biopsy or clinically significant portal hypertension. A third evaluation (LSMXL) obtained adequate registers in 41 (93%) of 44 patients with inadequate LSM2. Operator experience increases the applicability and diagnostic accuracy of TE. The XL probe may be recommended for patients with inadequate values obtained by experienced operators using the M probe. http://clinicaltrials.gov (NCT01900808).


Asunto(s)
Diagnóstico por Imagen de Elasticidad/métodos , Diagnóstico por Imagen de Elasticidad/normas , Hígado/diagnóstico por imagen , Hígado/patología , Competencia Profesional , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Femenino , Humanos , Hepatopatías/diagnóstico por imagen , Hepatopatías/patología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Curva ROC , Reproducibilidad de los Resultados , Factores de Riesgo , Adulto Joven
15.
Rev Neurol ; 58(7): 296-302, 2014 Apr 01.
Artículo en Español | MEDLINE | ID: mdl-24677152

RESUMEN

INTRODUCTION: After a traumatic brain injury (TBI), cognitive functionality may be severely altered. Some studies have aimed at identifying the best predictive variables for cognitive recovery, however, results still remain unclear. AIMS: To assess the recovery of cognitive functionality in TBI patients after a rehabilitation programme, and to identify the variables that best predict the cognitive recovery. PATIENTS AND METHODS: We conducted a retrospective pre-post study with 58 adult TBI patients that underwent an intensive rehabilitation programme. All of them were assessed using the cognitive functions sub-scale from the FIM+FAM scale, at admission and discharge. Both scores were compared using non-parametric test Wilcoxon. Cognitive functionality gain percentage was calculated and correlated with all the collected data. A multiple linear regression analysis was carried out to identify the best predictors of cognitive functionality gain percentage by introducing all clinical, demographic and cognitive information. RESULTS: The group's cognitive functionality increased significantly from 33,6% to 85% (p < 0,01). Patients with higher cognitive functionality gain percentage were those with younger age, shorter time post-TBI, and higher scores on cognitive functions sub-scale, conditional attention and Luria's memory word tests. The best predictors for cognitive functionality gain percentage were time post-TBI and cognitive functions at admission (adjusted R(2) = 55,8%). CONCLUSIONS: Patients who started rehabilitation sooner and had a higher cognitive functionality at admission, showed the greatest increase in cognitive functionality gain percentage. Other variables like age, or scores on cognitive tests must also be considered in future studies.


TITLE: Predictores de la recuperacion funcional cognitiva en pacientes con traumatismo craneoencefalico.Introduccion. Tras un traumatismo craneoencefalico (TCE), el funcionamiento cognitivo de los pacientes puede resultar gravemente alterado. Diversos estudios han tratado de identificar las variables que mejor predicen su recuperacion. Objetivos. Evaluar la recuperacion funcional cognitiva de pacientes con TCE tras un programa de neurorrehabilitacion e identificar las variables predictoras de dicha recuperacion. Pacientes y metodos. Estudio pre-post retrospectivo de 58 pacientes adultos con TCE que realizaron un programa de rehabilitacion intensivo. Todos fueron evaluados mediante la subescala de funcionalidad cognitiva de la medida de la independencia funcional + medida de la evaluacion de la funcionalidad (FIM+FAM), al inicio y al final de la rehabilitacion. Ambas puntuaciones fueron comparadas mediante la prueba no parametrica de Wilcoxon. Se calculo el porcentaje de ganancia funcional cognitiva y se correlaciono con todas las variables recogidas. A partir de toda la informacion clinica, demografica y cognitiva recogida, realizamos un analisis de regresion lineal multiple para identificar los mejores predictores de dicha ganancia. Resultados. La funcionalidad cognitiva aumento significativamente del 33,6% al 85% (p < 0,01). Los pacientes con mayor porcentaje de ganancia funcional cognitiva fueron aquellos con menor edad y periodo post-TCE, y mayores puntuaciones en la subescala cognitiva de la FIM+FAM y en las pruebas de atencion condicional y curva de aprendizaje de Luria. Los mejores predictores de la recuperacion funcional fueron el periodo post-TCE y la funcionalidad cognitiva al inicio (R2 ajustado = 55,8%). Conclusiones. El comienzo temprano de la rehabilitacion y la mayor funcionalidad cognitiva al inicio resultaron ser los mejores predictores de la recuperacion funcional cognitiva. Otras variables, como la edad o puntuaciones en pruebas cognitivas, tambien deben considerarse en futuros estudios.


Asunto(s)
Lesiones Encefálicas/psicología , Trastornos del Conocimiento/etiología , Adolescente , Adulto , Factores de Edad , Daño Encefálico Crónico/etiología , Daño Encefálico Crónico/psicología , Lesiones Encefálicas/rehabilitación , Trastornos del Conocimiento/epidemiología , Escolaridad , Femenino , Escala de Coma de Glasgow , Humanos , Curva de Aprendizaje , Discapacidades para el Aprendizaje/epidemiología , Discapacidades para el Aprendizaje/etiología , Masculino , Pruebas Neuropsicológicas , Pronóstico , Recuperación de la Función , Estudios Retrospectivos , Factores de Tiempo , Adulto Joven
16.
Am J Transplant ; 14(2): 375-83, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24410892

RESUMEN

The value of transient elastography (TE) to assess clinical outcomes in hepatitis C recurrence after liver transplantation (LT) has not been explored so far. We studied 144 hepatitis C-infected and 48 non-hepatitis C virus (HCV)-infected LT recipients and evaluated the prognostic value of TE 1 year after transplantation to predict clinical decompensations and graft and patient survival. In HCV patients, cumulative probabilities of liver decompensation 5 years after LT were 8% for patients with liver stiffness measurement (LSM) <8.7 kilopascals (kPa) versus 47% for patients with LSM ≥ 8.7 kPa (p<0.001). Five-year graft and patient cumulative survival were 90% and 92% in patients with LSM<8.7 kPa (p<0.001) and 63% and 64% in patients with LSM ≥ 8.7 kPa, respectively (p<0.001). Patients with low LSM 1 year after LT had excellent outcomes independently from receiving antiviral treatment or achieving sustained virological response (SVR). In contrast, graft survival significantly improved in patients with LSM ≥ 8.7 kPa who achieved SVR. No association between outcomes and LSM at 12 months was observed in non-HCV patients. In conclusion, LSM 1 year after LT is a valuable tool to predict hepatitis C-related outcomes in recurrent hepatitis C and can be used in clinical practice to identify the best candidates for antiviral therapy.


Asunto(s)
Antivirales/uso terapéutico , Supervivencia de Injerto , Hepatitis C/tratamiento farmacológico , Hepatitis C/cirugía , Trasplante de Hígado/efectos adversos , Hígado/patología , Complicaciones Posoperatorias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico por Imagen de Elasticidad , Femenino , Estudios de Seguimiento , Hepacivirus/patogenicidad , Hepatitis C/virología , Humanos , Hígado/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Pronóstico , Recurrencia , Adulto Joven
17.
J Dairy Sci ; 95(11): 6320-31, 2012 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-22981571

RESUMEN

The applicability of a light backscatter sensor with a large field of view was tested for on-line monitoring of coagulation and syneresis in a goat cheese (Murcia al Vino) manufactured under industrial conditions. Cheesemaking was carried out concurrently in a 12-L pilot vat and a 10,000-L industrial vat following the normal cheesemaking protocol. Cheese moisture, whey fat content, hardness, springiness, and adhesiveness were measured during syneresis. The results obtained show that cutting time is best predicted by considering the coagulation ratio at the inflection point and the percentage increase in the ratio during coagulation, with no need for the first derivative. The large field of view reflectance ratio provided good results for the prediction of moisture content, yield, hardness, springiness, and adhesiveness of the final cheese.


Asunto(s)
Queso , Tecnología de Alimentos/métodos , Algoritmos , Animales , Queso/análisis , Queso/normas , Calidad de los Alimentos , Cabras , Agua/análisis
18.
Brain Inj ; 26(1): 76-82, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22149446

RESUMEN

INTRODUCTION: This study tested the hypothesis that S100ß is a useful screening tool for detecting intracranial lesion (IL) in patients with a normal level of consciousness after traumatic brain injury (TBI). METHODS: One hundred and forty-three post-TBI patients without a decrease in consciousness (GCS = 15) and with at least one neurological symptom (e.g. transitory loss of consciousness, amnesia, headache, dizziness or vomiting) were prospectively included. A blood sample was drawn at 6-hours post-TBI. A routine CT scan was obtained within 24 hours post-injury. Diagnostic properties of S100ß for IL prediction in CT scan findings were tested using ROC-analysis. RESULTS: A total of 15 patients (10.5%) had IL. Serum levels were significantly higher in these patients. Significant differences were found between S100ß levels and CT scan findings (p = 0.007). ROC-analysis showed that S100ß is a useful tool for detecting the presence of IL in CT scans (p = 0.007). In this series, the best cut-off for S100ß is 0.130 µg L(-1), with 100% sensitivity and 32.81% specificity. CONCLUSION: Within the first 6 hours post-TBI, serum S100ß seems to be an effective biochemical indicator of IL in patients without a decrease in consciousness. These results indicate that higher S100ß cut-off values substantially improve the clinical relevance of this protein.


Asunto(s)
Encefalopatías/sangre , Lesiones Encefálicas/sangre , Factores de Crecimiento Nervioso/sangre , Proteínas S100/sangre , Tomografía Computarizada por Rayos X , Biomarcadores/sangre , Encefalopatías/diagnóstico por imagen , Encefalopatías/fisiopatología , Lesiones Encefálicas/diagnóstico por imagen , Lesiones Encefálicas/fisiopatología , Progresión de la Enfermedad , Femenino , Escala de Coma de Glasgow , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Subunidad beta de la Proteína de Unión al Calcio S100 , Índices de Gravedad del Trauma
19.
Ortod. esp. (Ed. impr.) ; 51(4): 166-172, oct.-dic. 2011. ilus, tab
Artículo en Español | IBECS | ID: ibc-121694

RESUMEN

Introducción: El anclaje esquelético temporal es una incorporación relativamente reciente en los tratamientos de ortodoncia. El objetivo de este estudio fue comparar retrospectivamente el tiempo que tarda en asomar un canino maxilar incluido comparando el uso de minitornillos con el anclaje dentario convencional. Material y métodos: Se estudiaron un total de 31 pacientes con caninos maxilares incluidos, tratados en una clínica privada durante los últimos 15 años. El grupo test estaba formado por 15pacientes en los que se traccionó del canino incluido utilizando un minitornillo, y el grupo control estaba formado por 16 pacientes en los que se utilizó anclaje dentario. Resultados: A pesar de la reducción del tiempo de tracción utilizando minitornillos detectada clínicamente, no se encontraron diferencias estadísticamente significativas en el tiempo de erupción forzada en el grupo test comparado con el grupo control. Conclusiones: En este estudio retrospectivo comparativo no existe diferencia estadísticamente significativa entre los dos grupos, sugiriendo que dentro de los límites de este estudio, el tiempo de erupción forzada de un canino incluido no depende del sistema de tracción (AU)


Introduction: Temporal osseous anchorage is a recent technique that clinicians have incorporated to orthodontic treatments. The aim of this study was to compare retrospectively the time required to complete the canine forced eruption phase by using two different orthodontic devices. Subjects and methods: A total of 31 patients treated in a private office during the last 15 years were studied. Test group comprised15 patients on whom traction of the impacted canine was performed with a mini-screw, and control group comprised 16patients on whom traction of the impacted canine was performed from teeth. Results: In spite of a shorter time of traction detected in the mini-screw group there were no statistically significant differences between groups. Conclusions: In this retrospective comparative study no statistically significant differences could be observed between groups, suggesting that within the limits of this study, forced eruption time does not depend on the traction system (AU)


Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Diente no Erupcionado/epidemiología , Erupción Dental , Diente Canino/fisiopatología , Aparatos Ortodóncicos , Aparatos de Tracción Extraoral , Estudios Retrospectivos , Tornillos Óseos , Anclas para Sutura
20.
Am J Transplant ; 11(5): 1051-7, 2011 May.
Artículo en Inglés | MEDLINE | ID: mdl-21466653

RESUMEN

IL28B gene polymorphisms are associated with the response to antiviral therapy in hepatitis C patients. We investigated the influence of IL28B polymorphisms on the response to therapy before and after liver transplantation (LT). Genotyping of SNPs rs8099917 and rs12979860 was performed in 128 HCV-infected liver transplant recipients and in their donors; all patients underwent antiviral treatment after LT. The prevalence of genotypes rs12979860CC and rs8099917TT was higher in donors than in recipients (50% vs.19%, p < 0.001 and 67% vs. 38%, p < 0.001, respectively). Response to antiviral therapy was significantly higher for recipient genotype rs12979860CC as compared to rs12979860CT/TT both before (100% vs. 48% p = 0.013) and after LT (59% vs. 25% p = 0.002). The figures were almost identical for SNP rs8099917. Sustained virological response after LT was particularly high in patients with favorable recipient and donor genotypes (p < 0.01 for both SNPs). In a subgroup of 34 patients treated while awaiting LT, a favorable donor IL28B genotype was associated with an improved virological response after LT. Our results support a major role of recipient IL28B genotype in the response to antiviral treatment for hepatitis C recurrence. Interestingly, donor genotype also seems to influence the response pattern, especially in recipients who have a favorable IL28B genotype.


Asunto(s)
Hepacivirus/metabolismo , Hepatitis C/genética , Interleucinas/genética , Polimorfismo de Nucleótido Simple , Adulto , Anciano , Antivirales/uso terapéutico , Femenino , Genotipo , Hepatitis C/tratamiento farmacológico , Humanos , Interferones , Fallo Hepático/cirugía , Fallo Hepático/terapia , Trasplante de Hígado/métodos , Donadores Vivos , Masculino , Persona de Mediana Edad , Prevalencia , Recurrencia , Obtención de Tejidos y Órganos
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