New tools for calibrating diffraction setups.

New calibration tools in the pyFAI suite for processing scattering experiments acquired with area detectors are presented. These include a new graphical user interface for calibrating the detector position in a scattering experiment performed with a fixed large area detector, as well as a library to be used in Jupyter notebooks for calibrating the motion of a detector on a goniometer arm (or any other moving table) to perform diffraction experiments.

Vigilancia y control de la bacteriemia asociada a catéter venoso central / No disponible

La bacteriemia asociada a catéter es un evento adverso grave prevenible que implica un daño inaceptable para los pacientes y para las organizaciones sanitarias. Cinco medidas –la barrera estéril máxima, el lavado de manos, la limpieza del sitio de inserción con clorhexidina, evitar la utilización de la vena femoral para la inserción, así como la retirada precoz de los catéteres innecesarios– han disminuido significativamente la incidencia de BRC en pacientes críticos y constituyen el paquete de mejores prácticas recomendadas por el CDC, el IHI y la AHQR, como componente principal de cualquier enfoque de prevención. En 2006, una intervención desarrollada en más de cien unidades de cuidados intensivos de Michigan (EE.UU.) logró tasas de 0 BRC por 1.000 días de uso de catéter. Los componentes de esta intervención fueron: implementación de las mejores prácticas y la mejora de la cultura y el trabajo en equipo. Un programa, llamado “En la cúspide: Detener la BRC”, formulado a partir del proyecto de Michigan, se está aplicando en España e Inglaterra. En nuestro país, el proyecto denominado “Bacteriemia zero” es coordinado por el grupo ENVIN-HELICS y está financiado por el Ministerio de Sanidad y Política Social. Este artículo revisa las evidencias y los defectos de las estrategias de prevención que se proponen actualmente (AU)

Catheter-related bacteremia (CRB) are frequent and costly life-threatening but preventable infections. Five measures – maximal sterile barrier precautions, hand washing, and cleaning of the skin insertion site with chlorhexidine as well as the avoidance of femoral vein insertion sites and the removal of unnecessary catheters- significantly reduced the incidence of CRB in critically patients and, integrate the bundle of best practices recommended by the CDC, the IHI and the AHQR as a main component of any prevention approach. More recently, an intervention developed in more than a hundred Michigan (USA) intensive care units achieved rates of 0 CRB per a 1000 catheterization-days. The components of this intervention included translating evidence into practice and improving culture and teamwork. A program, called “On the CUSP: Stop BSI”, formulated from the Michigan project, is being implemented in Spain. In our country, the project named“Bacteremia zero” is coordinated by the group ENVINHELICS and is funded by the Ministry of Health and Social Policy. This paper reviews evidences and flaws of the prevention strategies currently proposed (AU)

Evidence-based consensus recommendations to improve the quality of life in prostate cancer treatment

INTRODUCTION: Prostate cancer (PC) is one of the tumours with the highest incidence in recent years. PC therapies have several adverse effects. A panel consensus recommendation has been made to prevent or ameliorate complications in PC treatment to improve quality of life. MATERIAL AND METHODS: Fifteen specialists have met to analyse the different toxicities associated with PC treatment. Each medical specialist performed a National Library of Medicine PubMed search citations searching about these secondary effects and his specialty from 1999 to 2009 to propose measures for their prevention/amelioration. RESULTS: Surgery is associated with incontinence and impotence. Radiotherapy can produce acute, late urological and gastrointestinal toxicity. Brachytherapy can produce acute urinary retention. Chemotherapy is associated with haematotoxicity, peripheral neuropathy and diarrhoea, and hormone therapy can produce osteoporosis, metabolic syndrome, cognitive and muscular alterations, cardiotoxicity, etc. CONCLUSIONS: Improvement in surgical techniques and technology (IMRT/IGRT) can prevent surgical and radiotherapeutic toxicity, respectively. Brachytherapy toxicity can be prevented with precise techniques to preserve the urethra. Chemotherapy toxicity can be prevented with personalized schedules of treatment and close follow-up of iatrogenia and hormone therapy toxicity can be prevented with close follow-up of possible secondary effects (AU)

Evaluation of left ventricular function and mitral regurgitation during left ventricular-based pacing in patients with heart failure.

BACKGROUND: Beneficial effects of left ventricular (LV)-based pacing on acute hemodynamic parameters were reported in several series, but only a few studies examined the long-term effects of this new pacing procedure. AIMS: To assess long-term effects of permanent LV-based pacing on LV function and mitral regurgitation (MR) in patients with refractory congestive heart failure (CHF). METHODS: A prospective evaluation of LV function and MR was performed in 23 patients with severe but stable CHF and left bundle branch block (mean QRS: 186+/-31 ms) by radionuclide and echocardiographic techniques at baseline and 6 months after implantation of a permanent LV-based (LV alone: 13 patients; biventricular: 10 patients) pacemaker programmed either in a DDD mode (sinus rhythm; n=14) or in a VVIR mode (atrial fibrillation; n=9). RESULTS: Compared to baseline, the 6 months follow-up visit demonstrated a significant increase in radionuclide derived LV ejection fraction from 23.3+/-7 to 26.2+/-7% (P<0.01) and in echocardiographic LV fractional shortening from 13+/-4 to 16+/-6% (P<0.05), without any change in cardiac index, a significant decrease in LV end-diastolic diameter (from 73.2+/-6 to 71.2+/-7 mm; P<0.05), end-systolic diameter (from 63.6+/-6 to 60.2+/-8 mm; P<0.05) and color Doppler MR jet area (from 11.5+/-6 to 6.6+/-4 cm(1); P<0.001). A comparison of patients with LV pacing alone and patients with biventricular pacing showed similar beneficial effects of pacing on MR severity in the two subgroups and a non-significant trend for a better improvement of LV function during biventricular pacing. CONCLUSION: Thus, in patients with severe CHF and left bundle branch block, permanent LV-based pacing may significantly improve LV systolic function and decrease MR.

Radiofrequency ablation of a posteroseptal atrioventricular accessory pathway in a left-sided tricuspid ring with Ebsteinlike anomaly in a patient with congenitally corrected transposition of the great arteries.

Radiofrequency ablation successfully eliminated a posteroseptal accessory pathway in a left-sided tricuspid ring with Ebsteinlike anomaly in a patient with a congenitally corrected transposition of the great arteries.

Usefulness of pp65 antigenemia for the early diagnosis of cytomegalovirus disease in patients with AIDS.

An observational cohort study was performed to assess the effectiveness of a cytomegalovirus antigenemia (CMV-Ag) assay designed to predict clinical CMV disease in patients with AIDS. Eighty-six HIV-infected patients with CD4+ cell counts of < 100/mm3, positive CMV IgG, and no previous CMV disease were enrolled. Thirty-eight (44%) patients had at least one positive CMV antigenemia test, ten of whom eventually developed CMV focal disease. CMV disease was diagnosed in 13 (15%) patients. The CMV antigenemia assay was positive in ten of these 13 patients. Using a cut-off value of five positive cells in every 150,000 leukocytes sampled, the CMV antigenemia assay had a positive predictive value of 89% and a negative predictive value of 94%. The median time from the first positive CMV antigenemia test to the onset of CMV disease was 102 days. CMV disease probability at 6 months in patients with a CMV antigenemia value > or = 5 was 77.8% versus 6% in patients with CMV antigenemia value < 5 (log-rank test = 48.345; P < 0.001). Several independent factors were associated with the development of CMV disease: CMV antigenemia > or = 5 cells (hazard ratio: 20.44), CD4+ count < or = 25/mm3 (HR: 3.12), and sexual transmission of HIV infection (hazard ratio, 3.15). CMV antigenemia seems to be a good predictor of CMV disease in patients with AIDS.

Evaluation of the SENIC risk index in a Spanish university hospital.

OBJECTIVE: To assess the performance of the Study of the Efficacy of Nosocomial Infection Control (SENIC) risk index for the evaluation of the risk of surgical-site infection (SSI) in a country other than the United States, having a different health system. SETTING: 350-bed university hospital in Spain belonging to the National Health System (Insalud). DESIGN: Observational cohort study of 1,019 patients who underwent consecutive surgery from January to December 1992. Surgical-infection risk factors assessed by the traditional wound-classification system (clean, clean-contaminated, contaminated, and dirty-infected wound) and by the SENIC risk index (length of intervention more than 2 hours, more than three discharge diagnoses, abdominal surgery, and contaminated or dirty-infected wound) were compared by forward logistic regression. RESULTS: The SENIC risk index showed a greater ability to predict SSI than the traditional wound-classification system. The study carried out in our institution reproduced the estimators provided by the SENIC study in the United States. The SENIC risk index provided a stepwise increase in SSI rates, according to the number of factors present, for every traditional wound-classification group. In the case of clean wounds, the incidence of surgical infection (per 100 interventions) increased (1.5, 2.4, 5.3, and 50; P<.001) for patients having from zero to three risk factors of the SENIC risk index. CONCLUSIONS: This study shows that the SENIC risk index results are reproducible, and the index can be used to compare rates of wound infection across countries with different health systems than the United States.

Clinical presentation of HIV infection in patients aged 50 years or older.

OBJECTIVES: To describe the clinical presentation of HIV disease in older patients. METHODS: In the period 1989-1996 we reviewed the medical records of 100 patients with human immunodeficiency virus (HIV) infection aged 50 years or older and, 197 controls among HIV-infected patients aged 15-40 years, who attended six institutions in the autonomous community of Valencia (Spain). RESULTS: Older patients were mostly males (86%), men who have sex with men (42%) or unknown (20%) as exposure categories. Older patients had lower CD4 cell counts/mm3 (163+/-136 vs. 450+/-373, P= 0.008), and had AIDS at first evaluation (49% vs. 29%, P = 0.0006) compared with younger patients. For patients presenting with AIDS at HIV infection diagnosis, type and frequency of AIDS indicator diseases did not differ between older and younger patients. CONCLUSION: Studies on clues for early detection of HIV infection in patients aged 50 years or older are urgently needed to improve the health care in this population.

[Oxygen metabolism in isolated rat hepatocytes in obesity. Influence of vitamin C]. / Metabolismo oxigénico en hepatocitos aislados de rata en la obesidad. Influencia de la vitamina C.

Nutritional obesity induced by the ingestion of hyperlipidic diet implies a high consume of lipids, which might be involved in oxygen metabolism. Double bound, in the fatty-acid molecules are a vulnerable point to undergo oxidation reactions-generating lipid peroxidation, that are potentially toxic and can produce serious cell injury (alteration in cell permeability and prostaglandins...). To prevent this oxidative injury the aerobic organisms have intracellular mechanisms of defense, the antioxidant systems, that may be classified as enzymatic and nonenzymatic. Vitamin C belongs to the second group and acts as scavenger of free radicals and other species. The purpose of this study was to evaluate the oxygen metabolism in isolated hepatocytes of rats which obesity has been reached by the ingestion of an hyperenergetic olive-oil rich controlled liquid diet and evaluate the effect of ascorbic acid. Cellular oxidative injury in isolated hepatocytes was induced through a lipid peroxidative and cytotoxic molecule tert-butyl-hydroperoxide (t-BOOH). Results show higher levels of lactate dehydrogenase (LDH) leakage and malondialdehyde (MDA) production in obese rats as compared with controls. Otherwise, when these groups are supplemented with ascorbic acid these changes decrease significantly. ATP levels decrease in hepatocytes of obese rats incubated in the presence of 1 mM tert-butylhydroperoxide. While it is maintained in ascorbic acid supplemented animals. GSH values were lower in hepatocytes from obese and control rats, incubated with tert-butyl-hydroperoxide. Supplementation with ascorbic acid also maintained GSH levels thus indicating that ascorbic acid is acting as an efficient antioxidant.

Genetic alterations and oxidative metabolism in sporadic colorectal tumors from a Spanish community.

Deletions of loci on chromosomes 5q, 17p, 18q, and 22q, together with the incidence of p53 mutations and amplification of the double minute-2 gene were investigated in the sporadic colorectal tumors of 44 patients from a Spanish community. Chromosome deletions were analyzed by means of loss of heterozygosity analysis using a restriction fragment length polymorphism assay. Allelic losses were also detected by polymerase chain reaction (PCR)-single-stranded conformation polymorphism (SSCP) analysis of a polymorphic site in intron 2 of the p53 gene. The percentages of genetic deletions on the screened chromosomes were 39.3% (5q), 58.3% (17p), 40.9% (18q), and 40% (22q). Mutations in p53 exons 2-9 were examined by PCR-SSCP analysis and direct sequencing of the mutated region. Twenty of 44 tumor samples (45.45%) showed mutations at various exons except for exons 2, 3, and 9, the most frequent changes being G-->T transversion and C-->T transition. Because oxygen-free radicals play a role in the carcinogenesis process, we evaluated the oxidative status of the colorectal tumors. Antioxidant activities, lipid peroxidation, and DNA-damaged product concentrations in colon tumors and normal mucosa were compared. In tumor tissues, superoxide dismutase and catalase decreased fourfold and twofold, respectively, whereas glutathione peroxidase and reduced glutathione increased threefold. Malondialdehyde and 8-hydroxy-2-deoxyguanosine (8-OHdG) levels were twofold higher in colorectal tumors than in normal mucosa. Seven of 10 DNA tumor samples (70%) showing higher values of 8-OHdG also had genetic alterations at different chromosomal loci. In these samples, the p53 gene was deleted or mutated in 71.4% of cases. We concluded that the observed changes in the oxidative metabolism of the tumor cells and the consecutive increase in DNA damage may potentiate the genomic instability of different chromosomal regions, leading to further cell malignancy and tumor expansion.

The role of 8-hydroxy-2'-deoxyguanosine in rifamycin-induced DNA damage.

The effect of rifamycin SV on the formation of 8-hydroxy-2'-deoxyguanosine (8-0HdG) has been investigated in vitro and in vivo. Oxidative modification of 2'-deoxyguanosine has been measured as an indication of DNA damage using high-performance liquid chromatography with electrochemical detection. Rifamycin SV in the presence of copper(II) ions induces the formation of 8-0HdG in calf thymus DNA. The effect is enhanced by increasing the antibiotic concentration and inhibited by catalase and hydroxyl radical (.0H) scavengers, such as thiourea and ethanol, in a rifamycin SV concentration-dependent manner. The reduced glutathione (GSH) inhibits DNA damage, and this effect is proportional to the final concentration of the tripeptide in the incubation medium. A significant increase in the formation of 8-0HdG and of malondialdehyde (MDA) in rat liver DNA was observed only in GSH-depleted animals after 5 days of rifamycin SV treatment. These results support the involvement of hydrogen peroxide (H2(0)2) and .0H in the mechanism of the oxidative modification of DNA achieved by rifamycin SV. The role of other reactive species and the antioxidant properties of GSH against oxidative damage is also discussed.

Protective effect of exogenous coenzyme Q against damage by adriamycin in perfused rat liver.

We have investigated the effect of rat liver perfusion with adriamycin on mitochondrial activities. Although the perfusion treatment per se induces some decline of respiratory activities, adriamycin strongly potentiates this effect; moreover the coenzyme Q9 content of the mitochondrial membrane is significantly lowered by the antibiotic. Coaddition of coenzyme Q10 in the perfusate significantly protects the mitochondria, not only from loss of respiratory activities but also of the endogenous CoQ9 content. Exogenous CoQ10 fails to enhance respiratory activities in control rats, not treated with adriamycin, even though CoQ concentration has been proven not to be kinetically saturating in the respiratory chain under physiological conditions. Thus, the beneficial effect of CoQ10 in the perfusate does not appear to be the result of its role in the respiratory chain but is a consequence of its antioxidant action.

Low-dose oral chloroquine in patients with porphyria cutanea tarda and low-moderate iron overload.

OBJECTIVE: to assess the efficacy, tolerance and determinants for relapse in patients with porphyria cutanea tarda treated with low-dose oral chloroquine. DESIGN: open trial with a median follow-up of 3 years. SETTING: outpatient referral unit of a university hospital. PATIENTS: 53 patients with low-moderate iron overload or intolerance to phlebotomies. INTERVENTION: 250 mg twice weekly oral chloroquine diphosphate until remission or failure to respond. MEASUREMENTS: porphyrin excretion, biochemical changes and development of side effects. RESULTS: after administration of a median dose of 23.5 g of chloroquine (limits 12.6-56 g) during a median time of 8 months (limits: 1-26 months), 50 patients (94%) reached a metabolic remission (urinary uroporphyrin excretion < 100 micrograms/l). In 14 of these patients (28%), porphyrin excretion further decreased after finishing chloroquine therapy. Metabolic remission persisted during 24 months (limits 6-97 months). Side-effects (severe pruritus) appeared only in one patient. Twenty-two patients relapsed, the relapses being associated with greater basal values of serum AST, ALT, gammaglobulin, urinary uroporphyrin and to the time needed to achieve remission. One year and three years after finishing therapy the probabilities of relapse were 12% (95% C.I.: 5-27%) and 49% (95% C.I.: 34-67%), respectively. Time to achieve remission was the only independent predictor of relapse (hazard ratio: 1.2, 95% C.I.: 1.05-1.21, P < 0.01). CONCLUSION: low-dose oral chloroquine is a safe therapy that promotes a high proportion of remission and sustained control of porphyria cutanea tarda associated with low-moderate iron overload.

Long-term efficacy of a program to control methicillin-resistant Staphylococcus aureus.

The long-term efficacy of a program to control methicillin-resistant Staphylococcus aureus (MRSA) was evaluated in a 350-bed university hospital. Three periods were monitored: pre-epidemic (January 1989-November 1989), outbreak (December 1989-June 1990) and control program (July 1990-December 1992) periods. Control measures included cohort isolation, patient care measures and therapy (oral cotrimoxazole plus fusidic acid ointment) of MRSA carriage in patients, roommates and personnel. A total of 117 MRSA-infected patients were detected. For each period respectively, MRSA incidence (number of cases per 1,000 patient-days) was 3.2, 8.2 and 2.0 in the intensive care unit (ICU) and 0.08, 0.23 and 0.26 in the general wards. During the outbreak there was a 2.7-fold overall increase of baseline MRSA incidence (p < 0.02). The crude mortality was 68% and the attributable mortality was estimated to be 50%. The program was estimated to have prevented 76% (CI95 28-91, p < 0.0001) of expected MRSA cases and 85% (CI95 62-94, p < 0.0001) of expected fatalities due to MRSA in the ICU, but it had no significant effect in the general wards. The program did not control vancomycin consumption.

Progestin challenge test in postmenopausal patients.

OBJECTIVES: The purpose of this study is to analyze the characteristics of patients identified with the progestin test. METHODS: We administered the progestin challenge test to 157 postmenopausal women and compared the characteristics of the patients who bled, with those who did not. RESULTS: Bleeding occurred in 14.01% of cases and we found that the number of patients who bled were significantly and independently more overweight, had higher levels of plasma estradiol, had a clear presence of superficial cells in the vaginal epithelium and had been menopausal for fewer years than those who did not bleed. CONCLUSIONS: We concluded that the test identifies women at risk from hormone-related endometrial cancer.

Erythrocyte ion fluxes in essential hypertensive patients with left ventricular hypertrophy.

BACKGROUND: Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular morbidity and mortality in essential hypertension (EH). Several hemodynamic and nonhemodynamic factors have been involved in the development of LVH in hypertension, including abnormalities in cellular ion mobilization. METHODS AND RESULTS: We measured different ion transport systems in erythrocytes from 50 patients with EH classified as having or not having LVH measured by M-mode echocardiography. Thirty-two EH patients (64%) exhibited criteria of LVH, and 18 (36%) did not. When the two groups were compared, patients with LVH were older (44.7 +/- 7.4 versus 37.6 +/- 9.2 years; P < .01) and exhibited higher rates of erythrocyte Na(+)-H+ exchange (9.8 +/- 4.1 versus 7.1 +/- 2.6 mmol.[L.cells.h]-1; P < .05) and higher intraerythrocyte Na+ content (8.5 +/- 1.3 versus 7.5 +/- 0.8 mmol/L per cell; P < .01). Systolic and diastolic blood pressure values, as well as biochemical, hormonal, and other erythrocyte ion transport systems studied did not differ between EH with or without LVH. The results of a multiple linear regression analysis using left ventricular mass index (LVMI) as the dependent variable showed that Na(+)-H+ exchange and the maximal rate of the Na(+)-K(+)-Cl- cotransport were the only two independently significant parameters associated with an increased LVMI. CONCLUSIONS: The increased rate of the erythrocyte Na(+)-H+ exchange and the decreased maximal rate of the Na(+)-K(+)-Cl- cotransport system are both associated with the presence of LVH in EH patients. These abnormalities of ion transport pathways tend to increase the intracellular Na+ content and may be involved in the pathogenesis of LVH in EH.