Nonlinear coupling of Alfvén and magnetoacoustic waves in partially ionized plasmas: the effect of thermal misbalance on propagating waves.

Partially ionized plasmas constitute an essential ingredient of the solar atmosphere, and ground- and space-based observations have pointed out the presence of oscillations in partially ionized solar plasmas such as chromosphere, photosphere, prominences or spicules, which have been interpreted in terms of magnetohydrodynamic waves. Our aim is to study the spatial behaviour of propagating weakly and fully nonlinear Alfvén waves, and the subsequent excitation of field-aligned motions and perturbations, when dissipative mechanisms, such as ambipolar diffusion and radiative losses, together with parametrized heating mechanisms, are taken into account. When only ambipolar diffusion is taken into account, first-order Alfvén waves as well as ponderomotive-driven perturbations are spatially damped, while field-aligned motions and perturbations representing propagating slow waves are undamped. These perturbations are damped when thermal effects are also considered and their damping lengths can be longer or shorter than those of ponderomotive-driven perturbations. Therefore, after the initial excitation, Alfvén waves and ponderomotive-driven perturbations could be quickly damped while slow waves still remain in the plasma, and vice versa. This article is part of the theme issue 'Partially ionized plasma of the solar atmosphere: recent advances and future pathways'.

Large scale coherent magnetohydrodynamic oscillations in a sunspot.

Although theoretically predicted, the simultaneous excitation of several resonant modes in sunspots has not been observed. Like any harmonic oscillator, a solar magnetic flux tube can support a variety of resonances, which constitute the natural response of the system to external forcing. Apart from a few single low order eigenmodes in small scale magnetic structures, several simultaneous resonant modes were not found in extremely large sunspots. Here we report the detection of the largest-scale coherent oscillations observed in a sunspot, with a spectrum significantly different from the Sun's global acoustic oscillations, incorporating a superposition of many resonant wave modes. Magnetohydrodynamic numerical modeling agrees with the observations. Our findings not only demonstrate the possible excitation of coherent oscillations over spatial scales as large as 30-40 Mm in extreme magnetic flux regions in the solar atmosphere, but also paves the way for their diagnostic applications in other astrophysical contexts.

Trastornos neuropsiquiátricos y estrategias de afrontamiento emocionales en pacientes postictus. Estudio longitudinal / Neuropsychiatric disorders and emotional coping strategies in post-stroke patients. A longitudinal study

Introducción: Entre un tercio y la mitad de la población que ha padecido un ictus presenta un trastorno neuropsiquiátrico (TNp), el cual suele estar infradiagnosticado. Objetivo: Estudiar la asociación entre la presencia de TNp y las estrategias de afrontamiento en pacientes con ictus. Sujetos y métodos: Estudio prospectivo, longitudinal y comparativo en una muestra de pacientes con ictus isquémico con y sin presencia de TNp. Se recogieron variables sociodemográficas y clínicas. Se evaluó la afectación neurológica (National Institute of Health Stroke Scale) y el afrontamiento (Brief Coping Orientation to Problems Experienced) a los tres y a los 12 meses. El período de estudio fue de 2013 a 2017. Resultados: Se analizó a 82 pacientes, con una edad media de 67,6 ± 10,4 años, y eran hombres el 52,4%. De ellos, 14 con TNp y 36 sin TNp respondieron a la escala de afrontamiento Brief Coping Orientation to Problems Experienced, y los 32 restantes fueron excluidos por afasia/disfasia. A los tres meses se observaron dimensiones de afrontamiento activo, apoyo social, negación y desconexión conductual en el grupo TNp, y a los 12 meses persistió la negación y la desconexión conductual, y aparecieron dimensiones de planificación, autodistracción y autoinculpación. Conclusiones: Los resultados muestran la necesidad de motivar a los pacientes a buscar estrategias más eficaces, identificando los problemas cuando aparecen, de considerarlos superables y de inhibir respuestas impulsivas o inadecuadas, sustituyéndolas por respuestas emocionales y conductas adecuadas.(AU)

Introduction: Between one third and one half of the population that has suffered a stroke present with a neuropsychiatric disorder (NPD), which often goes underdiagnosed. Aim: To study the association between the presence of NPDs and coping strategies in stroke patients. Subjects and methods. Prospective, longitudinal and comparative study in a sample of patients with ischaemic stroke with and without the presence of NPDs. Both sociodemographic and clinical variables were collected. Neurological impairment (National Institute of Health Stroke Scale) and coping (Brief Coping Orientation to Problems Experienced) were assessed at three and 12 months. The period studied was from 2013 to 2017. Results: A total of 82 patients were analysed, with a mean age of 67.6 ± 10.4 years, 52.4% of whom were male. Of them, 14 with NPD and 36 without NPD answered the Brief Coping Orientation to Problems Experienced coping scale, and the remaining 32 were excluded because of aphasia/dysphasia. At three months, dimensions of active coping, social support, denial and behavioural disengagement were observed in the NPD group, and at 12 months, denial and behavioural disengagement persisted, and planning, self-distraction and self-incrimination dimensions appeared. Conclusions: Results show the need to motivate patients to seek more effective strategies, to identify problems when they arise, to consider them as surmountable and to inhibit impulsive or inappropriate responses, replacing them with emotional responses and appropriate behaviours.(AU)

[Neuropsychiatric disorders and emotional coping strategies in post-stroke patients. A longitudinal study]. / Trastornos neuropsiquiátricos y estrategias de afrontamiento emocionales en pacientes postictus. Estudio longitudinal.

INTRODUCTION: Between one third and one half of the population that has suffered a stroke present with a neuropsychiatric disorder (NPD), which often goes underdiagnosed. AIM: To study the association between the presence of NPDs and coping strategies in stroke patients. SUBJECTS AND METHODS: Prospective, longitudinal and comparative study in a sample of patients with ischaemic stroke with and without the presence of NPDs. Both sociodemographic and clinical variables were collected. Neurological impairment (National Institute of Health Stroke Scale) and coping (Brief Coping Orientation to Problems Experienced) were assessed at three and 12 months. The period studied was from 2013 to 2017. RESULTS: A total of 82 patients were analysed, with a mean age of 67.6 ± 10.4 years, 52.4% of whom were male. Of them, 14 with NPD and 36 without NPD answered the Brief Coping Orientation to Problems Experienced coping scale, and the remaining 32 were excluded because of aphasia/dysphasia. At three months, dimensions of active coping, social support, denial and behavioural disengagement were observed in the NPD group, and at 12 months, denial and behavioural disengagement persisted, and planning, self-distraction and self-incrimination dimensions appeared. CONCLUSIONS: Results show the need to motivate patients to seek more effective strategies, to identify problems when they arise, to consider them as surmountable and to inhibit impulsive or inappropriate responses, replacing them with emotional responses and appropriate behaviours.

TITLE: Trastornos neuropsiquiátricos y estrategias de afrontamiento emocionales en pacientes postictus. Estudio longitudinal.Introducción. Entre un tercio y la mitad de la población que ha padecido un ictus presenta un trastorno neuropsiquiátrico (TNp), el cual suele estar infradiagnosticado. Objetivo. Estudiar la asociación entre la presencia de TNp y las estrategias de afrontamiento en pacientes con ictus. Sujetos y métodos. Estudio prospectivo, longitudinal y comparativo en una muestra de pacientes con ictus isquémico con y sin presencia de TNp. Se recogieron variables sociodemográficas y clínicas. Se evaluó la afectación neurológica (National Institute of Health Stroke Scale) y el afrontamiento (Brief Coping Orientation to Problems Experienced) a los tres y a los 12 meses. El período de estudio fue de 2013 a 2017. Resultados. Se analizó a 82 pacientes, con una edad media de 67,6 ± 10,4 años, y eran hombres el 52,4%. De ellos, 14 con TNp y 36 sin TNp respondieron a la escala de afrontamiento Brief Coping Orientation to Problems Experienced, y los 32 restantes fueron excluidos por afasia/disfasia. A los tres meses se observaron dimensiones de afrontamiento activo, apoyo social, negación y desconexión conductual en el grupo TNp, y a los 12 meses persistió la negación y la desconexión conductual, y aparecieron dimensiones de planificación, autodistracción y autoinculpación. Conclusiones. Los resultados muestran la necesidad de motivar a los pacientes a buscar estrategias más eficaces, identificando los problemas cuando aparecen, de considerarlos superables y de inhibir respuestas impulsivas o inadecuadas, sustituyéndolas por respuestas emocionales y conductas adecuadas.

Ultrasound arterial anomalies in patients exposed to nilotinib therapy for chronic myeloid leukemia.

INTRODUCTION: Patients exposed to nilotinib for chronic myeloid leukemia (CML) appear to be at risk of arterial complication. The prevalence and aspect of ultrasound asymptomatic arterial lesions are unknown. OBJECTIVE: To describe prevalence and characteristics of ultrasound arterial anomalies in patients treated with nilotinib for CML. METHODS: Patients treated with nilotinib from 2006 to 2015 in the department of the Paoli-Calmettes Institute, Marseille, were included retrospectively. A vascular ultrasound screening was carried out from 2010. The arterial lesions at the first examination were described: plaque and its echogenicity, stenosis or occlusion. A vascular arterial anomaly (VAA) was defined by the presence of a clinical and/or ultrasound anomaly. Patients with or without VAA at initial vascular examination were compared using bivariate and multivariate analysis. RESULTS: 74 patients were included (51.4% men, mean age 54.5 years); 25 patients had ultrasound arterial anomalies (33.8%). Carotid bulb was the most involved territory (44%). Arterial anomalies were: 88% plaques, 44%>50% stenosis and 12% occlusion. 72.7% plaques were echolucent or hypoechogenic. A VAA was present in 25 patients with initial vascular evaluation (33.8%). Patients with VAA at baseline were significantly older (64.9 vs 49.3, P<0.001), older at nilotinib initiation (60.8 vs 46.5, P<0.001), with more arterial hypertension (40% vs 12.2%, P=0.01), with more cardiovascular risk factors (P=0.03). In patient with no cardiovascular risk factor 12.5% had VAA (n=24). CONCLUSION: Nilotinib seems to be associated to arterial lesions of unstable lipid-like appearance. The most involved arterial territory was the carotid bulb and the most common lesion was echolucent or hypoechogenic plaque. VAA can occur in patients without cardiovascular risk factors. This result encourages us to systematically screen and follow all patients exposed to nilotinib even those without cardiovascular risk factors.

In situ revascularization with rifampicin-soaked silver polyester graft for aortic infection: Results of a retrospective monocentric series of 18 cases.

OBJECTIVE: To evaluate the short and long-term results of in situ prosthetic graft treatment using rifampicin-soaked silver polyester graft in patients with aortic infection. MATERIAL AND METHOD: All the patients surgically managed in our center for an aortic infection were retrospectively analyzed. The primary endpoint was the intra-hospital mortality, secondary outcomes were limb salvage, persistent or recurrent infection, prosthetic graft patency, and long-term survival. RESULTS: From January 2004 to December 2015, 18 consecutive patients (12 men and 6 women) were operated on for aortic infection. Six mycotic aneurysms and 12 prosthetic infections, including 8 para-entero-prosthetic fistulas, were treated. In 5 cases, surgery was performed in emergency. During the early postoperative period, we performed one major amputation and two aortic infections were persistent. Intra-hospital mortality was 27.7%. The median follow-up among the 13 surviving patients was 26 months. During follow-up, none of the 13 patients presented reinfection or bypass thrombosis. CONCLUSION: This series shows that in situ revascularization with rifampicin-soaked silver polyester graft for aortic infection have results in agreement with the literature in terms of intra-hospital mortality with a low reinfection rate.

Predicción de hemorragia masiva a nivel extrahospitalario: validación de seis escalas / Prediction of massive bleeding in a prehospital setting: validation of six scoring systems

Objetivo: Validar a nivel extrahospitalario la capacidad diagnóstica de seis escalas de predicción para hemorragia masiva. Diseño: Cohorte retrospectiva. Ámbito: Atención extrahospitalaria del paciente con enfermedad traumática grave. Participantes: Pacientes mayores de 15 años, que han sufrido un trauma grave (definido por los criterios de código 15), atendidos en el medio extrahospitalario por un servicio de atención sanitaria de emergencias desde enero de 2010 hasta diciembre de 2015 y trasladados a un centro hospitalario de alta complejidad en Madrid. Variables de interés principales: Se validaron las siguientes escalas: 1. Trauma Associated Severe Haemorrhage score. 2. Assessment of Blood Consumption Score. 3. Emergency Transfusion Score. 4. Índice de Shock. 5. Prince of Wales Hospital/Rainer Score. 6. Larson Score. Resultados: Se estudiaron 548 pacientes, el 76,8% (420) fueron hombres, una edad mediana de 38 (rango intercuartil [RIC]: 27-50). Injury Severity Score de 18 (RIC: 9-29). El trauma cerrado fue el 82,5% (452). La frecuencia global de HM fue de 9,2% (48), días de estancia en UCI de 2,1 (RIC: 0,8 - 6,2) y una mortalidad hospitalaria del 11,2% (59). La escala con mayor precisión fue la Emergency Transfusion Score (AUC 0,85), en segundo lugar se encuentran Trauma Associated Severe Haemorrhage y Prince of Wales Hospital/Rainer (AUC 0,82); la escala con menor precisión Assessment of Blood Consumption (AUC 0,68). Conclusiones: A nivel extrahospitalario la aplicación de cualquiera de las seis escalas predice la presencia de hemorragia masiva y permite la activación de los protocolos de transfusión masiva mientras el paciente es trasladado a un centro hospitalario

Objective: To validate the diagnostic ability of six different scores to predict massive bleeding in a prehospital setting. Design: Retrospective cohort. Setting: Prehospital attention of patients with severe trauma. Subjects: Subjects with more than 15 years, a history of severe trauma (defined by code 15 criteria), that were initially assisted in a prehospital setting by the emergency services between January 2010 and December 2015 and were then transferred to a level one trauma center in Madrid. Variables: To validate: 1. Trauma Associated Severe Haemorrhage Score. 2. Assessment of Blood Consumption Score. 3. Emergency Transfusión Score. 4. Índice de Shock. 5. Prince of Wales Hospital/Rainer Score. 6. Larson Score. Results: 548 subjects were studied, 76,8% (420) were male, median age was 38 (interquartile range [IQR]: 27-50). Injury Severity Score was 18 (IQR: 9-29). Blunt trauma represented 82,5% (452) of the cases. Overall, frequency of MB was 9,2% (48), median intensive care unit admission days was 2,1 (IQR: 0,8 - 6,2) and hospital mortality rate was 11,2% (59). Emergency Transfusión Score had the highest precisions (AUC 0,85), followed by Trauma Associated Severe Haemorrhage score and Prince of Wales Hospital/Rainer Score (AUC 0,82); Assessment of Blood Consumption Score was the less precise (AUC 0,68). Conclusion: In the prehospital setting the application of any the six scoring systems predicts the presence of massive hemorrhage and allows the activation of massive transfusion protocols while the patient is transferred to a hospital

Prediction of massive bleeding in a prehospital setting: validation of six scoring systems. / Predicción de hemorragia masiva a nivel extrahospitalario: validación de seis escalas.

OBJECTIVE: To validate the diagnostic ability of six different scores to predict massive bleeding in a prehospital setting. DESIGN: Retrospective cohort. SETTING: Prehospital attention of patients with severe trauma. SUBJECTS: Subjects with more than 15 years, a history of severe trauma (defined by code 15 criteria), that were initially assisted in a prehospital setting by the emergency services between January 2010 and December 2015 and were then transferred to a level one trauma center in Madrid. VARIABLES: To validate: 1. Trauma Associated Severe Haemorrhage Score. 2. Assessment of Blood Consumption Score. 3. Emergency Transfusión Score. 4. Índice de Shock. 5. Prince of Wales Hospital/Rainer Score. 6. Larson Score. RESULTS: 548 subjects were studied, 76,8% (420) were male, median age was 38 (interquartile range [IQR]: 27-50). Injury Severity Score was 18 (IQR: 9-29). Blunt trauma represented 82,5% (452) of the cases. Overall, frequency of MB was 9,2% (48), median intensive care unit admission days was 2,1 (IQR: 0,8 - 6,2) and hospital mortality rate was 11,2% (59). Emergency Transfusión Score had the highest precisions (AUC 0,85), followed by Trauma Associated Severe Haemorrhage score and Prince of Wales Hospital/Rainer Score (AUC 0,82); Assessment of Blood Consumption Score was the less precise (AUC 0,68). CONCLUSION: In the prehospital setting the application of any the six scoring systems predicts the presence of massive hemorrhage and allows the activation of massive transfusion protocols while the patient is transferred to a hospital.

Valoración del dolor en el ámbito de las emergencias extrahospitalarias en Cataluña / Assessment of pain in the area of out-of-hospital emergencies in Catalonia

Objetivo: Conocer la valoración y el manejo del dolor que utilizan los profesionales del Sistema de Emergencias Médicas (SEM) en Cataluña. Metodología: Estudio descriptivo, observacional y transversal en el ámbito de la asistencia extrahospitalaria, desde agosto a octubre de 2015 en Cataluña. La muestra ha sido no probabilística de conveniencia como técnica de recogida de datos se utilizó una encuesta on line ad hoc enviada por la empresa SEM SA a todos los trabajadores del SEM. El proyecto fue aprobado por la dirección de la empresa. Se estudiaron variables demográficas, lugar de trabajo: Soporte Vital Avanzado Médico (SVA Mike), Soporte Vital Avanzado Enfermero (SVA India), soporte Vital Básico (SVB); categoría profesional (Médico/a, Enfermero/a, Técnico/a), años de experiencia en el SEM, tipo de paciente a quien se valora el dolor, escalas de dolor utilizadas, percepción de los profesionales sobre el abordaje del dolor y el manejo de la analgesia dentro de la asistencia. El análisis de los datos se realizó con el paquete estadístico SPSS versión 20.0 para IBM. Resultados: A partir de una población total de 932 trabajadores del SEM que pertenecen a las categorías profesionales de médico, enfermera y técnico en emergencias sanitarias (TES), se han analizado 152 respuestas (la tasa de respuesta fue del 16,30 %). El 95,4 % de los participantes manifestaron valorar el dolor en la anamnesis inicial del paciente, el 94,1 % expresaron utilizar escalas para medir el dolor. Los médicos y enfermería usaban la escala EVA (54,6 %) y los técnicos la escala numérica (45,4 %) (p < 0,001). El 46,7 % aplicaban la analgesia que consideraron oportuna y el 96,7 % de médicos y enfermeras explicaron que realizaban revaloración del dolor posterior a la analgesia. Conclusiones: La mayoría de participantes manifestaron valorar el dolor de manera sistemática y mediante una escala. Sería de gran interés unificar criterios de valoración y manejo del dolor, así como disponer de protocolos específicos actualizados en el ámbito prehospitalario

Objective: To know the assessment and pain management used by the professionals of the Medical Emergency System (EMS) in Catalonia. Methodology: Descriptive, observational and transversal study in the field of out-of-hospital care, from August to October 2015 in Catalonia. The sample was non-probabilistic of convenience, as an information collection technique was used an online survey sent by the company SEM SA to all workers of SEM. The project was approved by the management of the company. It was studied demographic variables, workplace (SVA Mike, SVA India, SVB), professional category (Physician, Nurse, Technician), years of experience in the type of patient to whom the pain is assessed, the scales of pain used, the professionals’ perception about the pain approach and the management of the analgesia within the care. Data analysis has been done with the SPSS version 20.0 per IBM statistical package. Results: From a total population of 932 EMS workers belonging to the professional categories of physician, nurse and technician in health emergencies (TES), 152 responses were analyzed (the response rate was 16.30 %). 95.4 % of the participants assessed the pain in the patient's initial anamnesis, 94.1 % used scales. Physicians and nurses used the EVA scale (54.6 %) and medical emergency technicians used the numerical scale (45.4 %) (p < 0.001). The 46.7 % one applied the analgesia they considered opportune and 96.7 % of doctors and nurses did a subsequent revaluation the pain. Conclusions: The majority of participants assessed pain systematically and on a scale. It would be of great interest to unify criteria of evaluation and pain management, as well as to have specific protocols updated in the prehospital setting

Incidence of anaphylaxis recorded during 1 year by the Municipal Emergency Service of Madrid (SAMUR-PC)

No disponible

Emerging treatment using tubulin inhibitors in advanced non-small cell lung cancer.

INTRODUCTION: Tubulin inhibitors including taxanes and vinca alkaloids are important components of chemotherapy regimens used in advanced non-small cell lung cancer (NSCLC). Despite a treatment paradigm shift due to molecularly-targeted therapies and immunotherapy, a majority of patients will receive chemotherapy during their treatment course. Either used alone or in combination, tubulin inhibitors have demonstrated clinical benefits in different settings of lung cancer management. Areas covered: This review first discusses FDA-approved tubulin inhibitors for NSCLC, such as paclitaxel, docetaxel, vinorelbine, and nab-paclitaxel. The article then provides a summary of novel tubulin inhibitors, including cabazitaxel, eribulin, ixabepilone, patupilone, plinabulin, new colchicine analogues and others. It also discusses new tubulin inhibitor combinations with immunotherapy (PD-1/PD-L1 inhibitors) and molecularly-targeted therapies (e.g. anti-angiogenic agents, mTOR inhibitors, heat shock protein 90 inhibitors, MEK inhibitors, and anti-HER3 agents). Lastly, emerging data on potential resistance mechanisms and predictive biomarkers for tubulin inhibitors are explored. Expert opinion: Tubulin inhibitors will likely continue to play important roles in NSCLC management due to the advent of novel agents and combinations. Through further understanding of tumor biology, investigation of drug resistance, and development of predictive biomarkers, we will be better positioned to incorporate microtubule inhibition into patient specific treatment strategies.

[The role of diffusion tensor imaging in the pre-surgical study of temporal lobe epilepsy]. / Papel de la imagen por tensor de difusion en el estudio prequirurgico de la epilepsia del lobulo temporal.

INTRODUCTION: Diffusion tensor imaging (DTI) is a non-invasive technique that can be used to assess the integrity of the white matter in the brain. AIMS: To investigate the usefulness of DTI in patients with temporal lobe epilepsy (TLE) and to observe its relationship with lateralisation of the epileptogenic focus in these patients. PATIENTS AND METHODS: We analysed 11 patients diagnosed with TLE in accordance with the pre-surgical protocol of our epilepsy unit, and who were seizure-free two years after performing a temporal lobectomy plus amygdalohippocampectomy (Spencer technique). As part of their pre-operative study, a 1.5 T magnetic resonance brain scan with diffusion tensor imaging was performed. A voxel-based analysis was then employed to study the differences in connectivity between the hemisphere that underwent surgery and the contralateral hemisphere. RESULTS: Compared with the contralateral hemisphere, a statistically significant reduction in fractional anisotropy (p < 0.05) was observed in the corpus callosum, the cingulate, the superior longitudinal fasciculus, the anterior thalamic radiations, the internal capsule, the ventral lateral and pulvinar nuclei of the thalamus, the inferior frontooccipital fasciculus, the uncinate fasciculus, the inferior longitudinal fasciculus and the parahippocampal gyrus, all ipsilateral to the epileptogenic focus. CONCLUSIONS: The characterisation of the abnormalities in the connectivity of the cerebral white matter, by means of DTI in patients with TLE, can be a valuable aid for the lateralisation of the epileptogenic focus in the pre-surgical evaluation of these patients. Further studies with a higher number of patients would be needed to confirm these results.

TITLE: Papel de la imagen por tensor de difusion en el estudio prequirurgico de la epilepsia del lobulo temporal.Introduccion. La imagen por tensor de difusion (DTI) es una tecnica no invasiva que puede ser utilizada para evaluar la integridad de la sustancia blanca cerebral. Objetivo. Investigar la utilidad de la DTI en pacientes con epilepsia del lobulo temporal (ELT) y ver su relacion con la lateralizacion del foco epileptogeno en estos pacientes. Pacientes y metodos. Se analizan 11 pacientes diagnosticados de ELT segun el protocolo de evaluacion prequirurgica de nuestra unidad de epilepsia, y libres de crisis a los dos años de la realizacion de una lobectomia temporal mas amigdalohipocampectomia (tecnica de Spencer). Como parte de su estudio preoperatorio, se realiza una resonancia magnetica cerebral de 1,5 T con secuencia de tensor de difusion y se estudian, mediante un analisis basado en voxel, las diferencias en la conectividad entre el hemisferio intervenido y el contralateral. Resultados. Comparado con el hemisferio contralateral, se observo una reduccion de la anisotropia fraccional estadisticamente significativa (p < 0,05) en el cuerpo calloso, el cingulo, el fasciculo longitudinal superior, las radiaciones talamicas anteriores, la capsula interna, los nucleos ventral lateral y pulvinar del talamo, el fasciculo frontooccipital inferior, el fasciculo uncinado, el fasciculo longitudinal inferior y el giro parahipocampal ipsilaterales al foco epileptogeno. Conclusiones. La caracterizacion de las anormalidades en la conectividad de la sustancia blanca cerebral, a traves de la DTI en pacientes con ELT, puede tener un valor importante para la lateralizacion del foco epileptogeno en la evaluacion prequirurgica. Serian necesarios estudios con un numero mas elevado de pacientes para confirmar estos resultados.

[Identification of gaps in the clinical patient care of asthma in Spain. Results of the OPTIMA-GEMA survey]. / Identificación de las carencias asistenciales en la atención clínica del asma en España. Resultados de la encuesta OPTIMA-GEMA.

BACKGROUND: Based on the GEMA 2009 guidelines (Spanish Asthma Management Guidelines), this project identified and assessed the main deficiencies in the implementation of the guidelines and proposed initiatives for improvement. METHODS: The study gathered and evaluated the opinions of a multidisciplinary group of asthma experts (allergists, pulmonologists, pediatricians, and primary care physicians). The first step identified health care aspects of GEMA 2009 that could be improved (Phase I). Subsequently, the issues were prioritized, using a 9-point Likert scale (Phase II). RESULTS: In Phase I, 134 physicians participated, and 107 of them took part in Phase II. High priority was assigned to 81% and 49.2% of the limitations identified in health care for adults and children respectively. The most important deficiency in adult care was improving treatment for pregnant women; in pediatric care, it was the use of high doses of beta-2 adrenergic antagonists in asthma deterioration. Other relevant needs were the limited use of spirometry, symptom questionnaires, and written action plans for the patients, as well as the lack of involvement of nursing staff in asthma care and the need to adjust treatment according to levels of control in follow-ups. CONCLUSIONS: The priority areas for improvement were those related to asthma treatment. Future programs for implementation of asthma guidelines should prioritize the use of symptom questionnaires, nursing staff involvement, and attention to pregnant women with asthma.

Anti-vimentin Antibodies Present at the Time of Transplantation May Predict Early Development of Interstitial Fibrosis/Tubular Atrophy.

BACKGROUND: Anti-vimentin (a cytoskeletal protein) autoantibodies in renal transplant recipients have been correlated with interstitial fibrosis/tubular atrophy (IFTA). In this study, we examine the association between pretransplantation anti-vimentin antibodies and the subsequent development of IFTA. METHODS: Sera obtained before renal transplantation from 97 transplant recipients were analyzed for the presence of anti-vimentin antibodies via Luminex assays to determine the concentration of anti-vimentin antibodies. Results were correlated with findings of IFTA on biopsy as well as graft function and patient and graft survival. RESULTS: In our patient population, 56 of 97 patients were diagnosed by biopsy with IFTA 2.9 (±2.1) years after renal transplantation. Patients with IFTA on biopsy had higher mean concentration of anti-vimentin antibodies when compared to patients without IFTA (32.2 µg/mL [3.97-269.12 µg/mL] vs 14.57 µg/mL [4.71-87.81 µg/mL]). The risk of developing IFTA with a concentration of anti-vimentin antibody >15 µg/mL before transplantation was 1.96 (95% CI = 1.38-2.79, P = .011). Patients with elevated anti-vimentin antibody concentrations (>15 µg/mL) at the time of transplantation also had a higher risk of developing IFTA (81.4% vs 41.2%; P < .05). In addition, graft function was worse at 1, 3, and 5 years posttransplantation in patients with elevated concentrations of pretransplantation anti-vimentin antibody. Although there were more graft losses in the IFTA groups (49.12% vs 25.64%, P = .021) and the IFTA patients loss their grafts earlier (4.3 years vs 3.6 years), there was no statistical difference in graft loss rates. CONCLUSIONS: Pretransplantation anti-vimentin antibody concentrations >15 µg/mL may be a risk factor for IFTA.

Identificación de las carencias asistenciales en la atención clínica del asma en España. Resultados de la encuesta OPTIMA-GEMA / Identification of gaps in the clinical patient care of asthma in Spain. Results of the OPTIMA-GEMA survey

Fundamento: En línea con el lanzamiento de la guía GEMA2009, el objetivo del estudio fue identificar y evaluar las carencias en la implementación de las recomendaciones de la misma y proponer iniciativas de mejora. Material y métodos: Estudio descriptivo-comparativo, transversal, cualitativo. Inicialmente se identificaron los aspectos mejorables refrendándolos con la GEMA2009 (Fase I), para posteriormente priorizar su necesidad de abordaje puntuando los aspectos mejorables utilizando una escala Likert de 9 puntos (Fase II). Resultados: Participaron 134 médicos en la Fase I, y de estos, 107 en la Fase II. El estudio recogió y evaluó las opiniones de un grupo multidisciplinar de expertos en asma (neumólogos, alergólogos, pediatras y médicos de atención primaria). El 81% de las limitaciones identificadas en la atención a adultos y el 49,2% en los niños se consideraron de prioridad alta. Las más importantes fueron: en adultos, mejorar el tratamiento de las embarazadas; en niños, el empleo de los b2-adrenérgicos a dosis elevadas en la exacerbación de asma. Otras carencias relevantes fueron: la escasa utilización de la espirometría, de cuestionarios de síntomas y de planes de acción por escrito para los pacientes, la falta de implicación del personal de enfermería y no ajustar el tratamiento según el grado de control en revisiones. Conclusiones: Las áreas de mejora prioritaria son las relacionadas con el tratamiento. Los futuros programas de implementación de las guías deberían priorizar el uso de los cuestionarios de síntomas, la implicación de enfermería y la atención de la asmática embarazada (AU)

Background: Based on the GEMA 2009 guidelines (Spanish Asthma Management Guidelines), this project identified and assessed the main deficiencies in the implementation of the guidelines and proposed initiatives for improvement. Methods: The study gathered and evaluated the opinions of a multidisciplinary group of asthma experts (allergists, pulmonologists, pediatricians, and primary care physicians). The first step identified health care aspects of GEMA 2009 that could be improved (Phase I). Subsequently, the issues were prioritized, using a 9-point Likert scale (Phase II). Results: In Phase I, 134 physicians participated, and 107 of them took part in Phase II. High priority was assigned to 81% and 49.2% of the limitations identified in health care for adults and children respectively. The most important deficiency in adult care was improving treatment for pregnant women; in pediatric care, it was the use of high doses of beta-2 adrenergic antagonists in asthma deterioration. Other relevant needs were the limited use of spirometry, symptom questionnaires, and written action plans for the patients, as well as the lack of involvement of nursing staff in asthma care and the need to adjust treatment according to levels of control in follow-ups. Conclusions: The priority areas for improvement were those related to asthma treatment. Future programs for implementation of asthma guidelines should prioritize the use of symptom questionnaires, nursing staff involvement, and attention to pregnant women with asthma (AU)

[Influence of waiting time on patient and companion satisfaction]. / Influencia del tiempo de espera en la satisfacción de pacientes y acompañantes.

OBJECTIVE: To evaluate patient and companion satisfaction of a hospital Emergency Department and its relationship with waiting time. METHODOLOGY: Prospective, observational study. SETTING: Hospital de Figueres Emergency Department (Girona, Spain). STUDY VARIABLES: sociodemographic characteristics, satisfaction level, real and perceived waiting time for triage and being seen by a physician. RESULTS: A total of 285 responses were received from patients and companions. The mean age of the patients and companions (n=257) was 54.6years (SD=18.3). The mean overall satisfaction (n=273) was 7.6 (SD=2.2). Lower perceived waiting time until nurse triage was related to higher overall satisfaction (Spearman rho (ρ)=-0.242, P<.001), and lower perceived waiting time until being seen by physician, with a higher overall satisfaction (ρ=-0.304; P<.001). Users who were informed about estimated waiting time showed higher satisfaction than those who were not informed (P=.001). CONCLUSIONS: Perceived waiting time and the information about estimated waiting time determined overall satisfaction.

Influencia del tiempo de espera en la satisfacción de pacientes y acompañantes / Influence of waiting time on patient and companion satisfaction

Objetivo: Evaluar la satisfacción de pacientes y acompañantes de un servicio de urgencias hospitalario y su relación con el tiempo de espera. Método: Estudio observacional transversal. Ámbito de estudio: Servicio de Urgencias del Hospital de Figueres (Girona). Variables estudiadas: características sociodemográficas, nivel de satisfacción, tiempo de espera real y percibido hasta el triaje y la visita médica. Resultados: Se recibieron 285 respuestas. La edad media (n = 257) fue de 54,6 años (DE = 18,3). La puntuación media de la satisfacción global con la visita (n = 273) fue de 7,6 (DE = 2,2) y la mediana, de 8 (rango intercuartílico [RIC] = 2). Se observó, a menor tiempo de espera percibido hasta ser atendidos por la enfermera de triaje, mayor satisfacción global (ρ = −0,242, p < 0,001), y a menor tiempo de espera percibido hasta la visita médica, mayor satisfacción global (ρ = −0,304; p < 0,001). Los usuarios que fueron informados sobre el tiempo de espera hasta la visita médica mostraron mayor satisfacción que los que no fueron informados (p = 0,001). Conclusiones: La satisfacción de los usuarios del servicio de urgencias es elevada. La percepción del tiempo de espera y la información sobre este tiempo influyó en la satisfacción de los usuarios (AU)

Objective: To evaluate patient and companion satisfaction of a hospital Emergency Department and its relationship with waiting time. Methodology: Prospective, observational study. Setting: Hospital de Figueres Emergency Department (Girona, Spain). Study variables: sociodemographic characteristics, satisfaction level, real and perceived waiting time for triage and being seen by a physician. Results: A total of 285 responses were received from patients and companions. The mean age of the patients and companions (n = 257) was 54.6 years (SD = 18.3). The mean overall satisfaction (n = 273) was 7.6 (SD = 2.2). Lower perceived waiting time until nurse triage was related to higher overall satisfaction (Spearman rho (ρ) = −0.242, P < .001), and lower perceived waiting time until being seen by physician, with a higher overall satisfaction (ρ = −0.304; P < .001). Users who were informed about estimated waiting time showed higher satisfaction than those who were not informed (P = .001). Conclusions: Perceived waiting time and the information about estimated waiting time determined overall satisfaction (AU)

Reduction of obstruction related bladder overactivity by the guanylyl cyclase modulators BAY 41-2272 and BAY 60-2770 alone or in combination with a phosphodiesterase type 5 inhibitor.

AIMS: To assess the urodynamic effects of soluble guanylyl cyclase (sGC) stimulator, BAY 41-2272, and activator, BAY 60-2770, (which both are able to induce cGMP synthesis even in the absence of nitric oxide (NO)) alone or in combination with a phosphodiesterase type 5 (PDE5) inhibitor, vardenafil, in a model of partial urethral obstruction (PUO) induced bladder overactivity (BO). METHODS: Fifty-six male Sprague-Dawley rats were used, 31 of them underwent PUO. Fourteen rats were used for Western blots to assess PDE5 and sGC expression. For drug evaluation cystometry without anesthesia was performed three days following bladder catheterization. RESULTS: Obstructed rats showed higher micturition frequency and bladder pressures than non-obstructed animals (Intermicturition Interval, IMI, 2.28 ± 0.55 vs. 3.60 ± 0.60 min (± standard deviation, SD); maximum micturition pressure, MMP, 70.1 ± 8.0 vs. 48.8 ± 7.2 cmH2O; both P < 0.05). In obstructed rats vardenafil, BAY 41-2272, and BAY 60-2770 increased IMI (2.77 ± 1.12, 2.62 ± 0.52, and 3.22 ± 1.04 min; all P < 0.05) and decreased MMP (54.4 ± 2.8, 61.5 ± 11.3, and 51.2 ± 6.3 cmH2O; all P < 0.05). When vardenafil was given following BAY 41-2272 or BAY 60-2770 no further urodynamic effects were observed. PDE5 as well as sGC protein expression was reduced in obstructed bladder tissue. CONCLUSIONS: Targeting sGC via stimulators or activators, which increase the levels of cGMP independent of endogenous NO, is as effective as vardenafil to reduce urodynamic signs of BO. Targeting the NO/cGMP pathway via compounds acting on sGC might become a new approach to treat BO.

Impacts on particles and ozone by transport processes recorded at urban and high-altitude monitoring stations.

In order to evaluate the influence of particle transport episodes on particle number concentration temporal trends at both urban and high-altitude (Aitana peak-1558 m a.s.l.) stations, a simultaneous sampling campaign from October 2011 to September 2012 was performed. The monitoring stations are located in southeastern Spain, close to the Mediterranean coast. The annual average value of particle concentration obtained in the larger accumulation mode (size range 0.25-1 µm) at the mountain site, 55.0 ± 3.0 cm(-3), was practically half that of the value obtained at the urban station (112.0 ± 4.0 cm(-3)). The largest difference between both stations was recorded during December 2011 and January 2012, when particles at the mountain station registered the lowest values. It was observed that during urban stagnant episodes, particle transport from urban sites to the mountain station could take place under specific atmospheric conditions. During these transports, the major particle transfer is produced in the 0.5-2 µm size range. The minimum difference between stations was recorded in summer, particularly in July 2012, which is most likely due to several particle transport events that affected only the mountain station. The particle concentration in the coarse mode was very similar at both monitoring sites, with the biggest difference being recorded during the summer months, 0.4 ± 0.1cm(-3) at the urban site and 0.9 ± 0.1cm(-3) at the Aitana peak in August 2012. Saharan dust outbreaks were the main factor responsible for these values during summer time. The regional station was affected more by these outbreaks, recording values of >4.0 cm(-3), than the urban site. This long-range particle transport from the Sahara desert also had an effect upon O3 levels measured at the mountain station. During periods affected by Saharan dust outbreaks, ozone levels underwent a significant decrease (3-17%) with respect to its mean value.