La evaluación de la fragilidad puede mejorar la predicción del APACHE II en pacientes ancianos ingresados en UCI tras cirugía digestiva / Evaluating frailty may complement APACHE II in estimating mortality in elderly patients admitted to the ICU after digestive surgery

Objetivo: Analizar si la fragilidad puede mejorar la predicción de mortalidad en los pacientes ingresados en UCI tras una cirugía digestiva. Diseño: Estudio prospectivo, observacional y con seguimiento a 6 meses de una cohorte de pacientes que ingresaron en UCI entre el 1 de junio de 2018 hasta el 1 de junio de 2019. Ámbito: UCI quirúrgica de un hospital de tercer nivel. Pacientes: Serie de pacientes sucesivos mayores de 70 años que ingresaron en UCI inmediatamente después de una intervención quirúrgica sobre el aparato digestivo. Fueron incluidos 92 pacientes y se excluyeron 2 por pérdida de seguimiento a los 6 meses. Intervenciones: Al ingreso en UCI se estimó gravedad y pronóstico mediante el APACHE II, y fragilidad mediante la Clinical Frailty Scale y el modified Frailty Index. Variables de interés principales: Mortalidad en UCI, intrahospitalaria y a los 6 meses. Resultados: El modelo que mejor predice mortalidad en UCI es el APACHE II, con un área bajo la curva ROC (ABC) de 0,89 y una buena calibración. El modelo que combina APACHE II y Clinical Frailty Scale es el que mejor predice mortalidad intrahospitalaria (ABC: 0,82), mejorando significativamente la predicción del APACHE II aislado (ABC: 0,78; Integrated Discrimination Index: 0,04). La fragilidad es un factor predictor de mortalidad a los 6 meses, siendo el modelo que combina la Clinical Frailty Scale y el modified Frailty Index el que ha demostrado mayor discriminación (ABC: 0,84). Conclusiones: La fragilidad puede complementar al APACHE II mejorando su predicción de mortalidad hospitalaria. Además, ofrece una buena predicción de la mortalidad a los 6 meses de la cirugía. Para la mortalidad en UCI, la fragilidad pierde su poder de predicción mientras que el APACHE II aislado muestra una excelente capacidad predictiva (AU)

Objective: To analyze whether frailty can improve the prediction of mortality in patients admitted to the ICU after digestive surgery. Design: Prospective, observational, 6-month follow-up study of a cohort of patients admitted to the ICU between June 1, 2018, and June 1, 2019. Setting: Surgical ICU of a third level hospital. Patients: Series of successive patients older than 70 years who were admitted to the ICU immediately after a surgical intervention on the digestive system. 92 patients were included and 2 were excluded due to loss of follow-up at 6 months. Interventions: Upon admission to the ICU, severity and prognosis were assessed by APACHE II, and fragility by the Clinical Frailty Scale and the modified Frailty Index. Main variables of interest: ICU, in-hospital and 6-month mortality. Results: The model that best predicts mortality in the ICU is the APACHE II, with an area under the ROC curve (AUC) of 0.89 and a good calibration. The model that combines APACHE II and Clinical Frailty Scale is the one that best predicts in-hospital mortality (AUC: 0.82), significantly improving the prediction of isolated APACHE II (AUC: 0.78; Integrated Discrimination Index: 0.04). Frailty is a predictor of mortality at 6 months, being the model that combines Clinical Frailty Scale and Frailty Index the one that has shown the greatest discrimination (AUC: 0.84). Conclusions: Frailty can complement APACHE II by improving its prediction of hospital mortality. Furthermore, it offers a good prediction of mortality 6 months after surgery. For mortality in ICU, frailty loses its predictive power, whereas isolated APACHE II shows excellent predictive capacity (AU)

Evaluating frailty may complement APACHE II in estimating mortality in elderly patients admitted to the ICU after digestive surgery.

OBJECTIVE: To analyze whether frailty can improve the prediction of mortality in patients admitted to the ICU after digestive surgery. DESIGN: Prospective, observational, 6-month follow-up study of a cohort of patients admitted to the ICU between June 1, 2018, and June 1, 2019. SETTING: Surgical ICU of a third level hospital. PATIENTS: Series of successive patients older than 70 years who were admitted to the ICU immediately after a surgical intervention on the digestive system. 92 patients were included and 2 were excluded due to loss of follow-up at 6 months. INTERVENTIONS: Upon admission to the ICU, severity and prognosis were assessed by APACHE II, and fragility by the Clinical Frailty Scale and the modified Frailty Index. MAIN VARIABLES OF INTEREST: ICU, in-hospital and 6-month mortality. RESULTS: The model that best predicts mortality in the ICU is the APACHE II, with an area under the ROC curve (AUC) of 0.89 and a good calibration. The model that combines APACHE II and Clinical Frailty Scale is the one that best predicts in-hospital mortality (AUC: 0.82), significantly improving the prediction of isolated APACHE II (AUC: 0.78; Integrated Discrimination Index: 0.04). Frailty is a predictor of mortality at 6 months, being the model that combines Clinical Frailty Scale and Frailty Index the one that has shown the greatest discrimination (AUC: 0.84). CONCLUSIONS: Frailty can complement APACHE II by improving its prediction of hospital mortality. Furthermore, it offers a good prediction of mortality 6 months after surgery. For mortality in ICU, frailty loses its predictive power, whereas isolated APACHE II shows excellent predictive capacity.

Unveiling unconventional magnetism at the surface of Sr2RuO4.

Materials with strongly correlated electrons often exhibit interesting physical properties. An example of these materials is the layered oxide perovskite Sr2RuO4, which has been intensively investigated due to its unusual properties. Whilst the debate on the symmetry of the superconducting state in Sr2RuO4 is still ongoing, a deeper understanding of the Sr2RuO4 normal state appears crucial as this is the background in which electron pairing occurs. Here, by using low-energy muon spin spectroscopy we discover the existence of surface magnetism in Sr2RuO4 in its normal state. We detect static weak dipolar fields yet manifesting at an onset temperature higher than 50 K. We ascribe this unconventional magnetism to orbital loop currents forming at the reconstructed Sr2RuO4 surface. Our observations set a reference for the discovery of the same magnetic phase in other materials and unveil an electronic ordering mechanism that can influence electron pairing with broken time reversal symmetry.

Evaluating frailty may complement APACHE II in estimating mortality in elderly patients admitted to the ICU after digestive surgery. / La evaluación de la fragilidad puede mejorar la predicción del APACHE II en pacientes ancianos ingresados en UCI tras cirugía digestiva.

OBJECTIVE: To analyze whether frailty can improve the prediction of mortality in patients admitted to the ICU after digestive surgery. DESIGN: Prospective, observational, 6-month follow-up study of a cohort of patients admitted to the ICU between June 1, 2018, and June 1, 2019. SETTING: Surgical ICU of a third level hospital. PATIENTS: Series of successive patients older than 70 years who were admitted to the ICU immediately after a surgical intervention on the digestive system. 92 patients were included and 2 were excluded due to loss of follow-up at 6 months. INTERVENTIONS: Upon admission to the ICU, severity and prognosis were assessed by APACHE II, and fragility by the Clinical Frailty Scale and the modified Frailty Index. MAIN VARIABLES OF INTEREST: ICU, in-hospital and 6-month mortality. RESULTS: The model that best predicts mortality in the ICU is the APACHE II, with an area under the ROC curve (AUC) of 0.89 and a good calibration. The model that combines APACHE II and Clinical Frailty Scale is the one that best predicts in-hospital mortality (AUC: 0.82), significantly improving the prediction of isolated APACHE II (AUC: 0.78; Integrated Discrimination Index: 0.04). Frailty is a predictor of mortality at 6 months, being the model that combines Clinical Frailty Scale and Frailty Index the one that has shown the greatest discrimination (AUC: 0.84). CONCLUSIONS: Frailty can complement APACHE II by improving its prediction of hospital mortality. Furthermore, it offers a good prediction of mortality 6 months after surgery. For mortality in ICU, frailty loses its predictive power, whereas isolated APACHE II shows excellent predictive capacity.

Homogeneous Diffusion Solid Model as a Realistic Approach to Describe Adsorption onto Materials with Different Geometries.

In this work, the adsorption kinetics of p-nitrophenol (PNP) onto several commercial activated carbons (ACs) with different textural and geometrical characteristics was studied. For this aim, a homogeneous diffusion solid model (HDSM) was used, which does take the adsorbent shape into account. The HDSM was solved by means of the finite element method (FEM) using the commercial software COMSOL. The different kinetic patterns observed in the experiments carried out can be described by the developed model, which shows that the sharp drop of adsorption rate observed in some samples is caused by the formation of a concentration wave. The model allows one to visualize the changes in concentration taking place in both liquid and solid phases, which enables us to link the kinetic behaviour with the main features of the carbon samples.

¿Lo sabes todo sobre epistaxis? / Do you know all about epistaxis?

La epistaxis es un síntoma muy común es muestra práctica diaria, aproximadamente el 60% de la población ha tenido al menos un episodio en algún momento de su vida pero solo 6% precisó atención médica. La mayoría de episodios son limitados y benignos pero, en ocasiones, nos encontramos con casos que pueden resultar fatales.

Nosebleed is a really common symptom, about 60% of the population has had at least one episode at some point in their lives but only 6% required medical attention. Most episodes are limited and benign but in some rare cases, it could be deathly.

Zinc modulation of basal and ß-adrenergically stimulated L-type Ca2+ current in rat ventricular cardiomyocytes: consequences in cardiac diseases.

Zinc exists in biological systems as bound and histochemically reactive free Zn(2+) in the nanomolar range. Zinc is required as either structural or catalytic component for a large number of enzymes. It also modulates current passage through many ion channels. Here, we reinvestigated the effects of extracellular and intracellular Zn(2+) on the L-type Ca(2+) current (I (CaL)) and its modulation by ß-adrenergic stimulation in rat ventricular cardiomyocytes. In the absence of Ca(2+) ions, Zn(2+) could permeate through the L-type channel at much lower concentrations and at a more positive voltage range, but with a lower permeability than Ca(2+). In the presence of Ca(2+), extracellular Zn(2+) demonstrated strong bimodal inhibitory effects on the I (CaL), with half-inhibition occurring around 30 nM, i.e., in the range of concentrations found in the plasma. Intracellular Zn(2+) also significantly inhibited the I (CaL) with a half-inhibitory effect at 12.7 nM. Moreover, ß-adrenergic stimulation was markedly reduced by intracellular Zn(2+) at even lower concentrations (<1 nM) as a consequence of Zn(2+)-induced inhibition of the adenylyl cyclase. All these effects appeared independent of redox variations and were not affected by dithiothreitol. Thus, both basal intracellular and extracellular Zn(2+) modulate transmembrane Ca(2+) movements and their regulation by ß-adrenergic stimulation. Considering that, in many pathological situations, including diabetes, the extracellular Zn(2+) concentration is reduced and the intracellular one is increased, our results help to explain both Ca(2+) overload and marked reduction in the ß-adrenergic stimulation in these diseases.

Toxins from Physalia physalis (Cnidaria) raise the intracellular Ca(2+) of beta-cells and promote insulin secretion.

Physalia physalis is a marine cnidarian from which high molecular weight toxins with hemolytic and neurotoxic effects have been isolated. In the present work, two novel toxins, PpV9.4 and PpV19.3 were purified from P. physalis by bioactive guideline isolation. It involved two steps of column chromatography, gel filtration and RP-HPLC. The molecular weights were 550.7 and 4720.9 Da for PpV9.4 and PpV19.3, respectively. In the light of the Edman sequencing results, the structure of these toxins included the presence of modified amino acids. Both toxins increased the percentage of insulin secreting beta-cells and induced cytosolic Ca2+ elevation. To date, this is the first report of low molecular weight toxins increasing insulin secretion purified from cnidarians, by constituting a new approach to the study of beta-cells physiology.

Comparison of early quality of life outcomes in autologous and allogeneic transplant patients.

The Functional Assessment of Cancer Therapy-Bone Marrow Transplant measures quality of life (QOL) in SCT patients. Prior reports found mixed results regarding QOL differences among autologous and allogeneic SCT patients. In addition, there is a paucity of literature examining differences in QOL patterns over time between autologous and allogeneic patients. The present study examines differences in QOL between patients free of clinical depression undergoing autologous (n = 41) and allogeneic (n = 64) SCT during early stages of treatment. Despite clinical differences, autologous and allogeneic patients demonstrated similar changes in QOL. The exception was the Functional subscale which indicated worse QOL for allogeneic patients at discharge (F test = 4.61, df = 1, P < 0.05); allogeneic patients (Mean = 13.06, s.d. = 5.36) indicated they were less able to function at work and were less accepting of their illness than autologous patients (Mean = 16.02, s.d. = 6.73). There was a significant main effect for time on nearly all QOL subscales (P < 0.05) demonstrating decline during treatment and return to baseline by discharge; only the Social Well-Being scale did not significantly change over time. These results help to understand patients' response to SCT in the earliest stages and ultimately help identify patients at risk who could benefit from therapeutic interventions.

Impact of tDCS on performance and learning of target detection: interaction with stimulus characteristics and experimental design.

We have previously found that transcranial direct current stimulation (tDCS) over right inferior frontal cortex (RIFC) enhances performance during learning of a difficult visual target detection task (Clark et al., 2012). In order to examine the cognitive mechanisms of tDCS that lead to enhanced performance, here we analyzed its differential effects on responses to stimuli that varied by repetition and target presence, differences related to expectancy by comparing performance in single- and double-blind task designs, and individual differences in skin stimulation and mood. Participants were trained for 1h to detect target objects hidden in a complex virtual environment, while anodal tDCS was applied over RIFC at 0.1 mA or 2.0 mA for the first 30 min. Participants were tested immediately before and after training and again 1h later. Higher tDCS current was associated with increased performance for all test stimuli, but was greatest for repeated test stimuli with the presence of hidden-targets. This finding was replicated in a second set of subjects using a double-blind task design. Accuracy for target detection discrimination sensitivity (d'; Z(hits)-Z(false alarms)) was greater for 2.0 mA current (1.77) compared with 0.1 mA (0.95), with no differences in response bias (ß). Taken together, these findings indicate that the enhancement of performance with tDCS is sensitive to stimulus repetition and target presence, but not to changes in expectancy, mood, or type of blinded task design. The implications of these findings for understanding the cognitive mechanisms of tDCS are discussed.

Impacto de un modelo de integración docente asistencial en la formación profesional y el campo clínico / Impact of integration teaching healthcare model in the clinical fields and professional formation

Los campos clínicos son un pilar fundamental en la formación de profesionales de la salud. Contar con campos clínicos pertinentes constituye una exigencia para el desarrollo de un proyecto educativo de calidad. Este estudio de corte transversal tiene como propósito evaluar el impacto en la formación y desarrollo profesionales, del modelo de integración docente asistencial desarrollado entre la Escuela de Enfermería de la Pontificia Universidad Católica de Chile y los Servicios de Enfermería de la Red de Salud UC (CIDAE-UC). Resultados: Es un modelo de trabajo que facilita el aprovechamiento de conocimientos y capacidades de enfermeras docentes y clínicas en la asistencia y la docencia, lo que se traduce en un incremento de docencia en las áreas clínicas y una mayor congruencia entre las necesidades de formación y las áreas clínicas identificadas para dar respuesta a ello. Es una estrategia de valor para preparar un personal idóneo en las diversas especialidades e incrementar la disciplina de enfermería, a través del desarrollo profesional y de la investigación colaborativa.

Clinical fields are a fundamental pillar in the training of health professionals. Counting on relevant clinical fields is a requirement for the development of an educational project of quality. This cross-sectional study aims to assess the impact in the training and on professional development of integration teaching healthcare model developed between the School of Nursing, Catholic University of Chile and the nursing services of the network of SALUD UC (CIDAE-UC). Results: working model that facilitates the use of knowledge and skills of teachers and clinical nurses in teaching and assistance, resulting in an increase in teaching in the clinical areas and a greater congruence between the needs of training and clinical areas identified to respond to this. It is a strategy of value to prepare an appropriate personnel in various specialties and increase the discipline of nursing, through professional development and collaborative research.

Transcranial direct current stimulation's effect on novice versus experienced learning.

Transcranial direct current stimulation (TDCS) is a non-invasive form of brain stimulation applied via a weak electrical current passed between electrodes on the scalp. In recent studies, TDCS has been shown to improve learning when applied to the prefrontal cortex (e.g., Kincses et al. in Neuropsychologia 42:113-117, 2003; Clark et al. Neuroimage in 2010). The present study examined the effects of TDCS delivered at the beginning of training (novice) or after an hour of training (experienced) on participants' ability to detect cues indicative of covert threats. Participants completed two 1-h training sessions. During the first 30 min of each training session, either 0.1 mA or 2.0 mA of anodal TDCS was delivered to the participant. The anode was positioned near F8, and the cathode was placed on the upper left arm. Testing trials immediately followed training. Accuracy in classification of images containing and not-containing threat stimuli during the testing sessions indicated: (1) that mastery of threat detection significantly increased with training, (2) that anodal TDCS at 2 mA significantly enhanced learning, and (3) TDCS was significantly more effective in enhancing test performance when applied in novice learners than in experienced learners. The enhanced performance following training with TDCS persisted into the second session when TDCS was delivered early in training.

Isolation of retro-transcribed RNA from in vitro Mycosphaerella fijiensis-infected banana leaves.

High polyphenol and polysaccharide levels in plant tissues such as banana fruit and leaves constitute a significant challenge to the extraction of sufficient amounts of high-quality RNA required for cDNA library synthesis and molecular analysis. To determine their comparative effectiveness at eliminating polyphenols, polysaccharides and proteins, three protocols for RNA extraction from in vitro banana plantlet leaves were tested: Concert(TM) Plant RNA isolation kit, a small-scale protocol based on Valderrama-Cháirez, and a modified version of the Valderrama-Cháirez protocol. RNA quantity and purity were evaluated by UV-spectrophotometry using DEPC-treated water and Tris-HCl, pH 7.5. Purity was greater using Tris-HCl. The Concert(TM) Plant protocol produced the poorest quality RNA. Reverse transcription into cDNAs from RNA isolated from in vitro banana plantlet leaves infected with Mycosphaerella fijiensis using the modified Valderrama-Cháirez protocol, followed by PCR using primers designed against gamma-actin from banana and M. fijiensis, yielded products of the anticipated size. In addition, this protocol reduced the processing time, lowered costs, used less expensive equipment, and could be used for other plants that have the same problems with high polyphenol and polysaccharide levels.

The effects of familiarity and group size on mating preferences in the guppy, Poecilia reticulata.

In recent years, it has become evident that frequency dependence in the attractiveness of a particular phenotype to mates can contribute to the maintenance of polymorphism. However, these preferences for rare and unfamiliar male phenotypes have only been demonstrated in small, controlled experiments. Here, we tested the preference for unfamiliar mates in groups of six to 96 individuals over 13 days, in the guppy (Poecilia reticulata). We observed individual behaviour in situ to test whether fish discriminate two unfamiliar individuals among many familiar ones. We found that unfamiliar males and females were preferred over the familiar fishes in all groups and that this effect decayed over time. Increasing group sizes and levels of sexual activity did not hamper the preference for unfamiliar mates, providing further support for the role of frequency dependent mate choice in the maintenance of trait polymorphism in natural populations.

Efficacy and economic benefits of prophylactic treatments of newly felled bamboo.

Bamboo (Bambusa spp.) users in Laguna and Rizal, Philippines, were surveyed regarding their willingness to accept varying degrees of bamboo powderpost beetle, Dinoderus minutus (F.) (Coleoptera: Bostrichidae), damage. The efficacy of deltamethrin, permethrin, or disodium octaborate tetrahydrate in water or in kerosene was then assessed against beetles on freshly cut bamboo (Bambusa vulgaris Schrader ex Wendland). Adult D. minutus in groups of 100 were capable of inflicting 50% cross-sectional damage on 30-cm-long bamboo samples within a 4-wk test period. Deltamethrin (0.01% [AI]). in water or kerosene provided significantly better protection against D. minutus attack on bamboo for 5 wk than did all other treatments. The results from a survey were then used to assess the cost/benefit ratio for each prophylactic treatment. Successful prophylactic treatment provided up to a 12:1 return, illustrating the benefits of such treatments.

Frequency and factors associated with recurrences of ocular toxoplasmosis in a referral centre in Colombia.

AIM: To determine the frequency and clinically related factors for recurrences in toxoplasmic retinochoroiditis in Colombian patients. METHODS: Cross-sectional analysis based on clinical charts of patients examined during the period of September 2005 to July 2008 at the University medical centre in Quindio (Colombia). Patients with retinochoroidal lesions consistent with Toxoplasma infection were included. Comparisons were made with an index of recurrences adjusted for months of follow-up or of the available data of periods with and without recurrences RESULTS: The clinical charts of 56 patients were analysed. In total, 25 patients (44%) were seen during an active episode, and 31 patients during inactive periods. There were 25 patients (44%) without episodes of recurrence. The total number of recurrences was 80 episodes. The mean number of recurrences was of two recurrences each 11 years. Adjusted recurrences index indicated that the most important factors associated with recurrence were previous therapy with steroids without antibiotics and previous subconjunctival injection of steroids. CONCLUSIONS: The use of systemic steroids without antibiotics and subconjunctival injection of steroids were identified as the main factors related to recurrence in this group of patients.

Development of the powderpost beetle (coleoptera: bostrichidae) at constant temperatures.

Development of Dinoderus minutus was studied under laboratory conditions at five constant temperatures (15, 18, 25, 28, and 30 degrees C) to estimate developmental thresholds and thermal requirements of the egg, larva, pupa, and egg-to-adult stages. Adults began to burrow along the grain into bamboo pieces within 24 h after cutting and continued across the grain. Female beetle oviposited an average of 9.1 eggs in the ensuing 24 h, all in the metaxylem. The average period for development of eggs, larva, and pupa were 5.4, 43.8, and 4.6 d at 30 degrees C, respectively. The development rate data were regressed through the x-axis to derive the thermal constants of 4.3, 6.8, and 4.5 degrees C and thermal requirements of 113.6, 909.1, and 96.2 DD to predict D. minutus egg oviposition to hatch, larva-to-pupa development, and adult emergence from pupa, respectively. The thermal threshold for egg-to-adult development was 6.4 degrees C, with total thermal requirements of 1,111.1 DD. Oviposition, emergence, and thermal requirements for development of the various stages of D. minutus may be used for postharvest pest management of bamboo.

Adsorption of p-nitrophenol on activated carbon fixed-bed.

Carbon fixed-beds are usually used to remove organic contaminants. Adsorption in a carbon filter is a dynamic, non-steady process which is not yet completely understood. The objective of this paper is to establish a methodology to simplify the study of this process based on the wave theory, rapid small-scale column test and experimental design/surface response analysis. The constant pattern wave hypothesis was confirmed by the experimental data. The influence of the inlet concentration of p-nitrophenol and the flow rate on dynamic adsorption was studied at 20 degrees C following a central composite design using a second-order model. Both parameters have an important influence on the response variables studied. The methodology used is a useful tool for studying the dynamic process and shows interactions that are difficult to verify by the classical step-by-step method.

Importance of lipids in the nutritional treatment of inflammatory diseases.

Over the last decades, scientific advances in the knowledge of anti-inflammatory properties of lipids have lead to the development of new formulas for enteral and parenteral nutrition. These products have been utilised as a treatment for a variety of inflammatory diseases. In this review we expose the effects of lipids used in enteral nutriton on different inflammatory pathologies such as inflammatory bowel disease, atherosclerosis, lung fibrosis, rheumatoid arthritis, and others. During inflammatory diseases, eicosanoids are produced from polyunsaturated fatty acids present in cellular membranes. Inflammatory activity of these molecules depends on the nature of their precursors: when arachidonic acid (n-6) is present, pro-inflammatory molecules are released, whereas eicosapentaenoic acid (n-3)-derived eicosanoids are weakly inflammatory. In this way, fish oils, rich in n-3 polyunsaturated fatty acids, increase the content of eicosapentaenoic-eicosanoids and decrease arachidonic acid in immune and endothelial cells leading to a lower inflammatory activity. Likewise, oleic acid exhibits anti-inflammatory effects by preventing the release of particular chemotactic molecules. In summary, enteral diets supplemented with n-3 polyunsaturated fatty acids and oleic acid benefits the treatment of patients with inflammatory pathologies, leading to better outcomes, and decreasing the doses of anti-inflammatory drugs, which exhibit important secondary effects.