Physiotherapy applied to palliative care patients: a descriptive practice-based study.

BACKGROUND: Over the last few years, the presence of physiotherapists in Palliative Care Units (PCU) has considerably grown based on evidence from studies supporting the use of non-pharmacological measures as part of Palliative Care (PC) treatments. However, more accumulated data are needed to definitively establish its added value. The present study describes the type of patients receiving physiotherapy in a PCU and the benefits obtained in relation to their degree of functional dependence. METHODS: An observational, prospective, descriptive, practice-based study was undertaken involving patients admitted to the PCU of Fundación Instituto San José (Madrid, Spain), who according to the PCU´s clinical practice, met the criteria for physiotherapy intervention. Daily clinical practice was unchanged for study reasons. Participants were assessed prior to initiating and at the end of the physiotherapy program using the following standard scales: the Barthel Index, the Functional Ambulation Categories scale, the Palliative Performance Scale, and the Braden scale. A descriptive analysis was performed and scale scores prior to and after treatment were compared using the Wilcoxon signed-rank test. Significance was set at 0.05. RESULTS: A total of 63 patients were included (mean age 71.98 ± 12.72; 61.9% males). Fifty-eight patients (92.1%) were oncological patients; of them, 35 (60.3%) had metastases. Prior to treatment, 28 (44.4%) participants had total dependence according to the Barthel index, and 37 (58.7%) were non-functional ambulator according to the FAC scale. At the end of treatment, the number of patients with total dependence decreased to 15 (23.8%) and those non-functional ambulator to 12 (19.0%). CONCLUSIONS: Patients who benefited from physical therapy during their admission to our PCU were predominantly males with oncological processes, mainly lung cancer. PC including physiotherapy improved their functionality, independence and skills for activities of daily living in this sample of PCU patients.

Sonication did not provide reliability to Maki technique for catheter related bloodstream infection diagnosis.

OBJECTIVE: The aim of our study was to analyze sonication and Maki techniques for diagnosis of catheter tip colonization and catheter-related bloodstream infection (CRBSI) on patients admitted to ICU. METHODS: Observational and prospective study in one Intensive Care Unit. Patients with some central venous catheter (CVC) at least for 7 days and catheter-related infection (CRI) suspicion (new episode of fever or sepsis) were included. We performed Maki technique followed by sonication of catheter tip. We compared area under the curve (AUC) of Maki, sonication, and techniques combination to diagnosis catheter tip colonization and CRBSI. RESULTS: We included 94 CVC from 87 CRI suspicion episodes. We found 14 cases of catheter tip colonization and 10 cases of CRBSI. Of the 14 catheter tip colonization cases, 7 (50.0%) were detected by Maki and sonication techniques, 6 (42.9%) were detected only by Maki technique, and 1 (7.1%) was detected only by sonication technique. Of the 10 CRBSI, 6 (60.0%) were detected by Maki and sonication techniques, 4 (40.0%) were detected only by Maki technique, and any only by sonication technique. We found higher AUC in Maki technique than in sonication technique to diagnosis of CRBSI (p=0.02) and to diagnosis of catheter tip colonization (p=0.03). No significant differences were found in AUC between Maki technique and combination techniques for diagnosis of catheter tip colonization (p=0.32) and of CRBSI (p=0.32). CONCLUSIONS: Sonication did not provide reliability to Maki technique for diagnosis of catheter tip colonization and CRBSI.

Evolution of genetic networks for human creativity.

The genetic basis for the emergence of creativity in modern humans remains a mystery despite sequencing the genomes of chimpanzees and Neanderthals, our closest hominid relatives. Data-driven methods allowed us to uncover networks of genes distinguishing the three major systems of modern human personality and adaptability: emotional reactivity, self-control, and self-awareness. Now we have identified which of these genes are present in chimpanzees and Neanderthals. We replicated our findings in separate analyses of three high-coverage genomes of Neanderthals. We found that Neanderthals had nearly the same genes for emotional reactivity as chimpanzees, and they were intermediate between modern humans and chimpanzees in their numbers of genes for both self-control and self-awareness. 95% of the 267 genes we found only in modern humans were not protein-coding, including many long-non-coding RNAs in the self-awareness network. These genes may have arisen by positive selection for the characteristics of human well-being and behavioral modernity, including creativity, prosocial behavior, and healthy longevity. The genes that cluster in association with those found only in modern humans are over-expressed in brain regions involved in human self-awareness and creativity, including late-myelinating and phylogenetically recent regions of neocortex for autobiographical memory in frontal, parietal, and temporal regions, as well as related components of cortico-thalamo-ponto-cerebellar-cortical and cortico-striato-cortical loops. We conclude that modern humans have more than 200 unique non-protein-coding genes regulating co-expression of many more protein-coding genes in coordinated networks that underlie their capacities for self-awareness, creativity, prosocial behavior, and healthy longevity, which are not found in chimpanzees or Neanderthals.

Photoexcited energy relaxation and vibronic couplings in π-conjugated carbon nanorings.

Conjugated carbon nanorings exhibit unique photophysical properties that, combined with their tunable sizes and conformations, make them suitable for a variety of practical applications. These properties are intimately associated to their strained, bent and sterically hindered cyclic structures. Herein we perform a comparative analysis of the photoinduced dynamics in carbon nanorings composed of nine phenyl units([9]CPP) and nine naphthyl units ([9]CN) respectively. The sterically demanding naphthyl units lead to large dihedral angles between neighboring units. Nevertheless, the ultrafast electronic and vibrational energy relaxation and redistribution is found to be similar for both systems. We observe that vibronic couplings, introduced by nonadiabatic energy transfer between electronic excited states, ensure the intramolecular vibrational energy redistribution through specific vibrational modes. The comparative impact of the internal conversion process on the exciton spatial localization and intra-ring migration indicates that naphthyl units in [9]CN achieve more efficient but less dynamical self-trapping compared to that of phenyl units in [9]CPP. That is, during the photoinduced process, the exciton in [9]CN is more static and localized than the exciton in [9]CPP. The internal conversion processes take place through a specific set of middle- to high-frequency normal modes, which directly influence the spatial exciton redistribution during the internal conversion, self-trapping and intra-ring migration.

90Y-Radioembolization After Failed Portal Vein Embolization for Colorectal Liver Metastases: A Case Report.

The main limiting factor for liver resection is insufficient future liver remnant (FLR). Portal vein embolization (PVE) is a standard of care treatment to induce FLR hypertrophy, but it is not always efficient. Radioembolization (RE) has a potential to induce liver hypertrophy for PVE-refractory patients. However, this was reported only for the patients with hepatocellular carcinoma. We described two cases of lobar RE after PVE failure for the patients with colorectal liver metastases. This enabled to reach sufficient FLR, provide good local disease control and bridge the patients to extended hepatectomy.

Función del profesional en enfermería en la atención del acoso escolar en niños, niñas y adolescentes / Role of the nursing professional in the attention of bullying in children and adolescents / Papel do profissional de enfermagem na atenção do bullying em crianças e adolescentes

Actualmente se ha incrementado y visualizado el fenómeno del acoso escolar o bullying (por su traducción al inglés); sin embargo,\r\nllama la atención que esta práctica ha existido durante mucho tiempo, pero solo ahora se evidencian las consecuencias que genera\r\nen los niños, niñas y adolescentes; además, según diversos estudios, puede conducir a suicidios en esta población. Diversas profesiones\r\nhan profundizado en el tema; a pesar de ello, no se ha visto avance en el manejo y prevención del acoso, y ha aumentado\r\nel número de casos que llegan a instituciones de salud relacionados con los daños físicos y psicológicos en quienes lo padecen.\r\nPara la enfermería es un reto poder abordar esta situación y proponer estrategias de intervención para su manejo y prevención no\r\nsolo en la víctima y victimario, sino también en la familia, las escuelas e instituciones de salud en los diferentes niveles de atención,\r\nya que cuenta con las herramientas para diseñar intervenciones en el manejo de la comunidad y del paciente institucionalizado.

Currently the phenomenon of bullying has increased and\r\nvisualized, however, it is striking that this practice has existed\r\nfor a long time, but it is up until now where the consequences\r\nthat it generates in the children and adolescents are shown,\r\nwhere, according to various studies, can generate suicides in\r\nthis population. Various professions have deepened the issue;\r\ndespite this, there has not been progress in the management\r\nand prevention of harassment and it has increased\r\nthe number of cases that reach health institutions related to\r\nphysical and psychological damage that are caused in the\r\nchild victim of bullying. It is a challenge for nursing to tackle\r\nthis situation and propose possible intervention strategies for\r\nits management and prevention, not only in the victim and\r\nvictimizer, but also in the family, schools, and health institutions\r\nin the different levels of care, since it has the tools to\r\ndesign interventions in the management of the community\r\nand the institutionalized patient.

Atualmente, o fenômeno do bullying está cada vez maior e\r\nvisível; no entanto, é impressionante que esta prática exista\r\nhá muito tempo, mas só agora que suas consequências em\r\ncrianças e adolescentes que, de acordo com vários estudos\r\npodem gerar suicídios nesta população, estão evidentes. Várias\r\nprofissões se aprofundaram no assunto. Porém, não houve\r\nprogresso na gestão e prevenção de assédio e o número de\r\ncasos que chegam a instituições de saúde relacionados ao\r\ndano físico e psicológico causado à criança vítima de assédio\r\nescolar aumentou. É um desafio para a enfermagem abordar\r\nesta situação e propor possíveis estratégias de intervenção\r\npara a sua gestão e prevenção, não só na vítima e perpetrador,\r\nmas também na família, escolas e instituições de saúde nos\r\ndiferentes níveis de cuidados, uma vez que tem as ferramentas\r\npara conceber intervenções no manejo da comunidade e do\r\npaciente institucionalizado.

Linfoma pleural primario asociado a piotórax / Pyothorax associated primary pleural lymphoma

RESUMEN: presentamos el caso de un paciente varón, exfumador, con antecedentes de empiema crónico de origen tuberculoso, que consultó por dolor torácico. Una tomografía computerizada (TC) demostró una pérdida de volumen en hemitórax derecho, con paquipleuritis calcificada asociada a colección hipodensa pleural, así como una lesión de partes blandas en contigüidad con la referida colección sugestiva de empiema necessitatis. En una tomografía por emisión de positrones (PET) se objetivó masa hipermetabólica de intensa captación en pared torácica derecha con afectación pleural. Se realizó biopsia guiada por TC con diagnóstico de linfoma no Hodgkin. El linfoma pleural primario representa el 7% de los casos de linfoma. Habitualmente afecta a pacientes con antecedentes de infección VIH o piotórax crónico. Los síntomas más frecuentes son disnea y dolor torácico. El diagnóstico se realiza mediante biopsia guiada o videotoracoscopia. El tipo histopatológico de linfoma pleural más descrito es el linfoma de células B grandes difuso

ABSTRACT: We present the case of a male patient, former smoker, with a history of chronic tuberculosis empyema, complaining of thoracic pain. A computerized tomography (CT) scan showed volume loss in the right hemithorax, with calcified pachypleuritis associated with hypodense pleural collection, as well as a soft tissue lesion contiguous with said collection, suggestive of empyema necessitans. A positron emission tomography (PET) scan showed a hypermetabolic mass with intense uptake on the right thoracic wall with pleural involvement. A CT-guided biopsy was done, obtaining a diagnosis of non-Hodgkin lymphoma. Primary pleural lymphoma accounts for 7% of all lymphoma cases. It normally affects patients with a history of HIV infection or chronic pyothorax. The most frequent symptoms are dyspnea and thoracic pain. Diagnosis is made using guided biopsy or videothoracoscopy. The most commonly described histopathological type of pleural lymphoma is diffuse large B-cell lymphoma

Papel de las técnicas de imagen en el diagnóstico y seguimiento del carcinoma vesical músculo invasivo / Role of imaging techniques in the diagnosis and follow-up of muscle-invasive bladder carcinoma

Introducción: Las neoplasias vesicales con invasión muscular suponen un 20-30% del total. En estos pacientes se requiere la realización de pruebas de imagen para determinar la estadificación local y a distancia. Objetivo: Describir el papel de las diferentes pruebas de imagen en el diagnóstico, estadificación y seguimiento del cáncer vesical músculo-invasivo. Evaluar los últimos avances en radiología orientados a mejorar la sensibilidad y especificidad de la estadificación local y la respuesta al tratamiento. Adquisición de la evidencia Se ha realizado una revisión actualizada de la bibliografía. Síntesis de la evidencia: La tomografía computarizada y la resonancia magnética son las pruebas de imagen de elección para realizar una adecuada estadificación previa a la cirugía. La tomografía computarizada con fase de urografía es la técnica más empleada actualmente, aunque presenta limitaciones en la estadificación local. La ecografía continúa teniendo un papel limitado. Los últimos avances en resonancia magnética han mejorado su capacidad para la estadificación local y se postula como prueba de elección en el seguimiento, con resultados prometedores en la valoración de respuestas al tratamiento. La tomografía por emisión de positrones podría mejorar la detección de adenopatías y de enfermedad metastásica extrapélvica. Conclusiones: Las pruebas de imagen son fundamentales en el diagnóstico, estadificación y seguimiento del cáncer vesical músculo-invasivo. Los últimos avances técnicos han supuesto una importante mejora en la estadificación local y abren la posibilidad de valorar respuestas al tratamiento

Introduction: Muscle-invasive bladder malignancies represent 20-30% of all bladder cancers. These patients require imaging tests to determine the regional and distant staging. Objective: To describe the role of various imaging tests in the diagnosis, staging and follow-up of muscle-invasive bladder cancer. To assess recent developments in radiology aimed at improving the sensitivity and specificity of local staging and treatment response. Acquisition of evidence: We conducted an updated literature review. Synthesis of the evidence: Computed tomography and magnetic resonance imaging (MRI) are the tests of choice for performing proper staging prior to surgery. Computed tomography urography is currently the most widely used technique, although it has limitations in local staging. Ultrasonography still has a limited role. Recent developments in MRI have improved its capacity for local staging. MRI has been suggested as the test of choice for the follow-up, with promising results in assessing treatment response. Positron emission tomography could improve the detection of adenopathies and extrapelvic metastatic disease. Conclusions: Imaging tests are essential for the diagnosis, staging and follow-up of muscle-invasive bladder cancer. Recent technical developments represent important improvements in local staging and have opened the possibility of assessing treatment response

Role of imaging techniques in the diagnosis and follow-up of muscle-invasive bladder carcinoma. / Papel de las técnicas de imagen en el diagnóstico y seguimiento del carcinoma vesical músculo invasivo.

INTRODUCTION: Muscle-invasive bladder malignancies represent 20-30% of all bladder cancers. These patients require imaging tests to determine the regional and distant staging. OBJECTIVE: To describe the role of various imaging tests in the diagnosis, staging and follow-up of muscle-invasive bladder cancer. To assess recent developments in radiology aimed at improving the sensitivity and specificity of local staging and treatment response. ACQUISITION OF EVIDENCE: We conducted an updated literature review. SYNTHESIS OF THE EVIDENCE: Computed tomography and magnetic resonance imaging (MRI) are the tests of choice for performing proper staging prior to surgery. Computed tomography urography is currently the most widely used technique, although it has limitations in local staging. Ultrasonography still has a limited role. Recent developments in MRI have improved its capacity for local staging. MRI has been suggested as the test of choice for the follow-up, with promising results in assessing treatment response. Positron emission tomography could improve the detection of adenopathies and extrapelvic metastatic disease. CONCLUSIONS: Imaging tests are essential for the diagnosis, staging and follow-up of muscle-invasive bladder cancer. Recent technical developments represent important improvements in local staging and have opened the possibility of assessing treatment response.

Is the Treatment with Biological or Non-biological DMARDS a Modifier of Periodontal Condition in Patients with Rheumatoid Arthritis?

BACKGROUND AND OBJECTIVE: Experimental models suggest the use of different therapy protocols in rheumatoid arthritis (RA) as modulators on periodontal condition. This study evaluated the effects of conventional drug treatment and anti-TNF therapy in patients with RA on microbiological and periodontal condition, establishing the association of markers of periodontal infection with indexes of rheumatic activity. MATERIALS AND METHODS: One hundred seventy nine individuals with RA were evaluated (62 with anti-TNF-. and 115 with only DMARDs). The periodontal evaluation included plaque and gingival indexes, bleeding on probing (BOP), clinical attachment loss (CAL), pocket depth (PD) and subgingival plaque samples for microbiological analysis. Rheumatologic evaluations included a clinical examination, rheumatoid factor (RF), antibodies against cyclic-citrullinated peptides (ACPAs), and activity markers (DAS28-ERS), high sensitive C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR). RESULTS: Anti-TNF-alpha therapy influenced periodontal microbiota with a higher frequency of T. denticola (p=0.01). Methotrexate combined with leflunomide exhibited a higher extension of CAL (p=0.005), and anti-TNF-alpha therapy with methotrexate was associated with a lower extension of CAL (p=0.05). The use of corticosteroids exerted a protective effect on the number of teeth (p=0.027). The type of DMARD affected P. gingivalis, T. forsythia and E. nodatum presence. Elevated ACPAs titers were associated with the presence of red complex periodontal pathogens (p=0.025). Bleeding on probing was associated with elevated CPR levels (p=0.05), and ESR was associated with a greater PD (p=0.044) and presence of red complex (p=0.030). CONCLUSION: Different pharmacological treatments for RA affect the clinical condition and subgingival microbiota.

Can SLE classification rules be effectively applied to diagnose unclear SLE cases?

Objective The objective of this paper is to develop novel classification criteria to distinguish between unclear systemic lupus erythematosus (SLE) and mixed connective tissue disease (MCTD) cases. Methods A total of 205 variables from 111 SLE and 55 MCTD patients were evaluated to uncover unique molecular and clinical markers for each disease. Binomial logistic regressions (BLRs) were performed on currently used SLE and MCTD classification criteria sets to obtain six reduced models with power to discriminate between unclear SLE and MCTD patients that were confirmed by receiving operating characteristic (ROC) curve. Decision trees were employed to delineate novel classification rules to discriminate between unclear SLE and MCTD patients. Results SLE and MCTD patients exhibited contrasting molecular markers and clinical manifestations. Furthermore, reduced models highlighted SLE patients exhibiting prevalence of skin rashes and renal disease while MCTD cases show dominance of myositis and muscle weakness. Additionally decision tree analyses revealed a novel classification rule tailored to differentiate unclear SLE and MCTD patients (Lu-vs-M) with an overall accuracy of 88%. Conclusions Validation of our novel proposed classification rule (Lu-vs-M) includes novel contrasting characteristics (calcinosis, CPK elevated and anti-IgM reactivity for U1-70K, U1A and U1C) between SLE and MCTD patients and showed a 33% improvement in distinguishing these disorders when compared to currently used classification criteria sets. Pending additional validation, our novel classification rule is a promising method to distinguish between patients with unclear SLE and MCTD diagnosis.

Bone marrow trephine biopsy involvement by lymphoma: pattern of involvement and concordance with flow cytometry, in 10 years from a single institution.

PURPOSE: To evaluate the features of bone marrow (BM) biopsy involvement by lymphoma, pattern of infiltration, morphological analysis and flow cytometry were reviewed at all lymphoma patients over a period of 10 years. METHODS/PATIENTS: 413 cases were included in the study if BM biopsy slides were available. Only 356 patients had both BM trephine biopsy and flow cytometry. RESULTS: The most frequent subtype was diffuse large B cell (31.2%), followed by follicular lymphoma (18.9%). The predominant pattern was mixed (nodular-interstitial) (9.2%). Morphological marrow infiltration was found in 138 cases, and flow cytometry identified 117 cases with BM involvement. A concordance between the two methods was detected in 305 cases (85.7%). There was discordance in 51 cases (14.3%): morphology positive/FC negative in 33 cases and morphology negative/FC positive in 18. CONCLUSIONS: Flow cytometry is slightly more useful in detecting involvement when the BM is affected, but this finding is not conclusive.

L-Arginine supplementation 0.5% of diet during the last 90 days of gestation and 14 days postpartum reduced uterine fluid accumulation in the broodmare.

L-Arginine is an essential amino acid in many species that has been shown to influence reproduction. However, in horses a dose of 1% L-arginine of total dietary intake impaired absorption of other amino acids, whereas a dose of 0.5% did not. The objectives of this experiment were to evaluate postpartum parameters on mares supplemented with 0.5% L-arginine through the last 90d of gestation and 14d postpartum. Sixteen light-horse mares were randomly divided in two groups: 8 mares supplemented with 0.5% L-arginine and 8 mares fed an isonitrogenous equivalent. Gestation length, days to uterine clearance and days to first ovulation were compared. Uterine body depth, diameter of uterine horns, and length of largest pocket of uterine fluid were recorded daily via transrectal ultrasound. Measurements of foal weight, height, and cannon bone circumference were recorded for 9 weeks. Arginine treatment had no effect on gestation length (P=0.58). Supplemented mares cleared fluid quicker postpartum (6.8±0.53d; P=0.026) compared to control (9.0±0.38d). Mares supplemented with L-arginine had smaller diameter of fluid present in the postpartum uterus (P≤0.05). Days to first postpartum ovulation were not affected by treatment nor any influence on uterine involution. Finally, treatment had no effect on any foal's measured parameters. L-Arginine supplementation fed at 0.5% of daily intake during the last 90d of gestation and early postpartum in mares decreased uterine fluid accumulation, yet did not appear to have any effect on any other parameters measured.

Differential immunoglobulin class-mediated responses to components of the U1 small nuclear ribonucleoprotein particle in systemic lupus erythematosus and mixed connective tissue disease.

OBJECTIVE: The objective of this paper is to determine whether patients with systemic lupus erythematosus (SLE) and mixed connective tissue disease (MCTD) possess differential IgM- and IgG-specific reactivity against peptides from the U1 small nuclear ribonucleoprotein particle (U1 snRNP). METHODS: The IgM- and IgG-mediated responses against 15 peptides from subunits of the U1 snRNP were assessed by indirect enzyme linked immunosorbent assays (ELISAs) in sera from patients with SLE and MCTD and healthy individuals (n = 81, 41, and 31, respectively). Additionally, 42 laboratory tests and 40 clinical symptoms were evaluated to uncover potential differences. Binomial logistic regression analyses (BLR) were performed to construct models to support the independent nature of SLE and MCTD. Receiver operating characteristic (ROC) curves corroborated the classification power of the models. RESULTS: We analyzed IgM and IgG anti-U1 snRNP titers to classify SLE and MCTD patients. IgG anti-U1 snRNP reactivity segregates SLE and MCTD from nondisease controls with an accuracy of 94.1% while IgM-specific anti-U1 snRNP responses distinguish SLE from MCTD patients with an accuracy of 71.3%. Comparison of the IgG and IgM anti-U1 snRNP approach with clinical tests used for diagnosing SLE and MCTD revealed that our method is the best classification tool of those analyzed (p ≤ 0.0001). CONCLUSIONS: Our IgM anti-U1 snRNP system along with lab tests and symptoms provide additional molecular and clinical evidence to support the hypothesis that SLE and MCTD may be distinct syndromes.

First feeding regimes for long-snout seahorse Hippocampus reidi larvae.

Seahorses are endangered species included in Appendix II of CITES from 2002 due to the progressive regression of wild populations. This study focused in Hippocampus reidi, one of the species with highest interest in trade, showing an increasing demand in the last decades. This study was conducted during 28 days to compare the effects of different time enrichment (0, 24, and 48h) for Artemia using a commercial product (Easy-Selco DHA INVE Aquaculture, Dendermonde, Belgium). Results showed no significant differences in growth between treatments until 21DAB, after which animals fed for 48h one enriched Artemia showed significantly better growth. Cumulative average survival during the first 14DAB was significantly higher in Oh treatment, while from 15DAB to the end of the experiment, no significantly differences were observed.