Encuesta nacional sobre cambios en las políticas de comunicación, visitas y cuidados al final de la vida en las unidades de cuidados intensivos durante las diferentes olas de la pandemia de COVID-19 (estudio COVIFAUCI) / National survey on changes in visitation, communication and end-of-life care policies in intensive care units through the different COVID-19 pandemic's waves (COVIFAUCI study)

Introducción La pandemia derivada de la infección por SARS-CoV-2 propició cambios en los cuidados tanto a familiares como a pacientes de cuidados intensivos durante las diferentes olas de incidencia del virus. La línea de humanización seguida por la mayoría de los hospitales se vio gravemente afectada por las restricciones aplicadas. Como objetivo, planteamos conocer las modificaciones experimentadas durante las diferentes olas de la pandemia por SARS-CoV-2 en España respecto a la política de visitas a los pacientes en UCI, el acompañamiento al final de la vida, y el uso de las nuevas tecnologías de la comunicación entre familiares, pacientes y profesionales. Métodos Estudio descriptivo transversal multicéntrico mediante encuesta a las UCI españolas desde febrero a abril de 2022. Se realizaron métodos de análisis estadísticos a los resultados según lo apropiado. El estudio fue avalado por la Sociedad Española de Enfermería Intensiva y Unidades Coronarias. Resultados Respondieron un 29% de las unidades contactadas. Los minutos de visita diarios de los familiares se redujeron drásticamente de 135 (87,5-255) a 45 (25-60) en el 21,2% de las unidades que permitían su acceso, mejorando levemente con el paso de las olas. En el caso de duelo, la permisividad fue mayor, aumentando el uso de las nuevas tecnologías para la comunicación paciente-familia en el caso del 96,5% de las unidades. Conclusiones Las familias de los pacientes ingresados en UCI durante las diferentes olas de la pandemia por COVID-19 han experimentado restricciones en las visitas y cambio de la presencialidad por técnicas virtuales de comunicación. Los tiempos de acceso se redujeron a niveles mínimos durante la primera ola, recuperándose con el avance de la pandemia pero sin llegar nunca a los niveles iniciales... (AU)

Introduction The pandemic derived from the SARS-CoV-2 infection led to changes in care for both relatives and intensive care patients during the different waves of incidence of the virus. The line of humanization followed by the majority of the hospitals was seriously affected by the restrictions applied. As an objective, we propose to know the modifications suffered during the different waves of the SARS-CoV-2 pandemic in Spain regarding the policy of visits to patients in the ICU, monitoring at the end of life, and the use of new technologies of communication between family members, patients and professionals. Methods Multicenter cross-sectional descriptive study through a survey of Spanish ICUs from February to April 2022. Statistical analysis methods were performed on the results as appropriate. The study was endorsed by the Spanish Society of Intensive Nursing and Coronary Units. Results Twenty-nine percent of the units contacted responded. The daily visiting minutes of relatives dropped drastically from 135 (87.5-255) to 45 (25-60) in the 21.2% of units that allowed their access, improving slightly with the passing of the waves. In the case of bereavement, the permissiveness was greater, increasing the use of new technologies for patient-family communication in the case of 96.5% of the units. Conclusions The family of patients admitted to the ICU during the different waves of the COVID-19 pandemic have suffered restrictions on visits and a change from face-to-face to virtual communication techniques. Access times were reduced to minimum levels during the first wave, recovering with the advance of the pandemic but never reaching initial levels. Despite the implemented solutions and virtual communication, efforts should be directed towards improving the protocols for the humanization of healthcare that allow caring for families and patients whatever the healthcare context. (AU)

Encuesta nacional sobre cambios en las políticas de comunicación, visitas y cuidados al final de la vida en las unidades de cuidados intensivos durante las diferentes olas de la pandemia de COVID-19 (estudio COVIFAUCI) / National survey on changes in visitation, communication and end-of-life care policies in intensive care units through the different COVID-19 pandemic's waves (COVIFAUCI study)

Introducción La pandemia derivada de la infección por SARS-CoV-2 propició cambios en los cuidados tanto a familiares como a pacientes de cuidados intensivos durante las diferentes olas de incidencia del virus. La línea de humanización seguida por la mayoría de los hospitales se vio gravemente afectada por las restricciones aplicadas. Como objetivo, planteamos conocer las modificaciones experimentadas durante las diferentes olas de la pandemia por SARS-CoV-2 en España respecto a la política de visitas a los pacientes en UCI, el acompañamiento al final de la vida, y el uso de las nuevas tecnologías de la comunicación entre familiares, pacientes y profesionales. Métodos Estudio descriptivo transversal multicéntrico mediante encuesta a las UCI españolas desde febrero a abril de 2022. Se realizaron métodos de análisis estadísticos a los resultados según lo apropiado. El estudio fue avalado por la Sociedad Española de Enfermería Intensiva y Unidades Coronarias. Resultados Respondieron un 29% de las unidades contactadas. Los minutos de visita diarios de los familiares se redujeron drásticamente de 135 (87,5-255) a 45 (25-60) en el 21,2% de las unidades que permitían su acceso, mejorando levemente con el paso de las olas. En el caso de duelo, la permisividad fue mayor, aumentando el uso de las nuevas tecnologías para la comunicación paciente-familia en el caso del 96,5% de las unidades. Conclusiones Las familias de los pacientes ingresados en UCI durante las diferentes olas de la pandemia por COVID-19 han experimentado restricciones en las visitas y cambio de la presencialidad por técnicas virtuales de comunicación. Los tiempos de acceso se redujeron a niveles mínimos durante la primera ola, recuperándose con el avance de la pandemia pero sin llegar nunca a los niveles iniciales... (AU)

Introduction The pandemic derived from the SARS-CoV-2 infection led to changes in care for both relatives and intensive care patients during the different waves of incidence of the virus. The line of humanization followed by the majority of the hospitals was seriously affected by the restrictions applied. As an objective, we propose to know the modifications suffered during the different waves of the SARS-CoV-2 pandemic in Spain regarding the policy of visits to patients in the ICU, monitoring at the end of life, and the use of new technologies of communication between family members, patients and professionals. Methods Multicenter cross-sectional descriptive study through a survey of Spanish ICUs from February to April 2022. Statistical analysis methods were performed on the results as appropriate. The study was endorsed by the Spanish Society of Intensive Nursing and Coronary Units. Results Twenty-nine percent of the units contacted responded. The daily visiting minutes of relatives dropped drastically from 135 (87.5-255) to 45 (25-60) in the 21.2% of units that allowed their access, improving slightly with the passing of the waves. In the case of bereavement, the permissiveness was greater, increasing the use of new technologies for patient-family communication in the case of 96.5% of the units. Conclusions The family of patients admitted to the ICU during the different waves of the COVID-19 pandemic have suffered restrictions on visits and a change from face-to-face to virtual communication techniques. Access times were reduced to minimum levels during the first wave, recovering with the advance of the pandemic but never reaching initial levels. Despite the implemented solutions and virtual communication, efforts should be directed towards improving the protocols for the humanization of healthcare that allow caring for families and patients whatever the healthcare context. (AU)

National survey on changes in visitation, communication and end-of-life care policies in intensive care units through the different COVID-19 pandemic's waves (COVIFAUCI study).

INTRODUCTION: The pandemic derived from the SARS-CoV-2 infection led to changes in care for both relatives and intensive care patients during the different waves of incidence of the virus. The line of humanization followed by the majority of the hospitals was seriously affected by the restrictions applied. As an objective, we propose to know the modifications suffered during the different waves of the SARS-CoV-2 pandemic in Spain regarding the policy of visits to patients in the ICU, monitoring at the end of life, and the use of new technologies. of communication between family members, patients and professionals. METHODS: Multicenter cross-sectional descriptive study through a survey of Spanish ICUs from February to April 2022. Statistical analysis methods were performed on the results as appropriate. The study was endorsed by the Spanish Society of Intensive Nursing and Coronary Units. RESULTS: 29% of the units contacted responded. The daily visiting minutes of relatives dropped drastically from 135 (87.5-255) to 45 (25-60) in the 21.2% of units that allowed their access, improving slightly with the passing of the waves. In the case of bereavement, the permissiveness was greater, increasing the use of new technologies for patient-family communication in the case of 96.5% of the units. CONCLUSIONS: The family of patients admitted to the ICU during the different waves of the COVID-19 pandemic have suffered restrictions on visits and a change from face-to-face to virtual communication techniques. Access times were reduced to minimum levels during the first wave, recovering with the advance of the pandemic but never reaching initial levels. Despite the implemented solutions and virtual communication, efforts should be directed towards improving the protocols for the humanization of healthcare that allow caring for families and patients whatever the healthcare context.

Long-term oncological outcomes of endoscopic full-thickness resection after previous incomplete resection of low-risk T1 CRC (LOCAL-study): study protocol of a national prospective cohort study.

BACKGROUND: T1 colorectal cancer (CRC) without histological high-risk factors for lymph node metastasis (LNM) can potentially be cured by endoscopic resection, which is associated with significantly lower morbidity, mortality and costs compared to radical surgery. An important prerequisite for endoscopic resection as definite treatment is the histological confirmation of tumour-free resection margins. Incomplete resection with involved (R1) or indeterminate (Rx) margins is considered a strong risk factor for residual disease and local recurrence. Therefore, international guidelines recommend additional surgery in case of R1/Rx resection, even in absence of high-risk factors for LNM. Endoscopic full-thickness resection (eFTR) is a relatively new technique that allows transmural resection of colorectal lesions. Local scar excision after prior R1/Rx resection of low-risk T1 CRC could offer an attractive minimal invasive strategy to achieve confirmation about radicality of the previous resection or a second attempt for radical resection of residual luminal cancer. However, oncologic safety has not been established and long-term data are lacking. Besides, surveillance varies widely and requires standardization. METHODS/DESIGN: In this nationwide, multicenter, prospective cohort study we aim to assess feasibility and oncological safety of completion eFTR following incomplete resection of low-risk T1 CRC. The primary endpoint is to assess the 2 and 5 year luminal local tumor recurrence rate. Secondary study endpoints are to assess feasibility, percentage of curative eFTR-resections, presence of scar tissue and/or complete scar excision at histopathology, safety of eFTR compared to surgery, 2 and 5 year nodal and/or distant tumor recurrence rate and 5-year disease-specific and overall-survival rate. DISCUSSION: Since the implementation of CRC screening programs, the diagnostic rate of T1 CRC is steadily increasing. A significant proportion is not recognized as cancer before endoscopic resection and is therefore resected through conventional techniques primarily reserved for benign polyps. As such, precise histological assessment is often hampered due to cauterization and fragmentation and frequently leads to treatment dilemmas. This first prospective trial will potentially demonstrate the effectiveness and oncological safety of completion eFTR for patients who have undergone a previous incomplete T1 CRC resection. Hereby, substantial surgical overtreatment may be avoided, leading to treatment optimization and organ preservation. Trial registration Nederlands Trial Register, NL 7879, 16 July 2019 ( https://trialregister.nl/trial/7879 ).

Amyloid-ß oligomers synaptotoxicity: The emerging role of EphA4/c-Abl signaling in Alzheimer's disease.

Alzheimer's disease (AD) is characterized by progressive memory loss and dementia. The strong correlation between cognitive decline and the loss of synapses supports the idea that synaptic damage is a relevant pathogenic mechanism underlying AD progression. It has been shown that amyloid beta oligomers (AßOs) induce synaptotoxicity ultimately leading to the reduction of dendritic spine density, which underlies cognitive damage. However, the signaling pathways connecting AßOs to synaptic dysfunction have not been completely elucidated. In this review, we have gathered evidence on AßOs receptors and the signaling pathways involved in synaptic damage. We make special emphasis on a new AßOs induced axis that involves the tyrosine kinase ephrin receptor A4 (EphA4) and c-Abl tyrosine kinase activation. EphA4 is a key player in homeostatic plasticity, mediating dendritic spine remodeling and retraction. AßOs aberrantly activate EphA4 leading to dendritic spine elimination. c-Abl is activated in AßOs exposed neurons and in AD patient's brain, and the inhibition of activated c-Abl ameliorates cognitive deficits in AD mouse model. The EphA4 receptor activates c-Abl intracellular signaling. Therefore EphA4 is an emerging AßOs receptor and the activation of the EphA4/c-Abl axis would explain the synaptic spine alterations found in AD.

Pro-inflammatory cytokines involvement in the hesperidin antihyperalgesic effects at peripheral and central levels in a neuropathic pain model.

Emerging evidence proposes a link between immune changes and pain, which is consistent with the inflammation theory and the increased incidence of neurodegenerative diseases. Flavonoids have long been used because of their anti-inflammatory potential activity and they are considered a promising alternative to alleviate neuropathic pain. The aim of this study was to investigate the antihyperalgesic effect of hesperidin and the presence of pro-inflammatory cytokines evaluated at peripheral and central levels in the chronic constriction injury as model of neuropathic pain in rats. Mechanical and thermal hyperalgesia were assessed in the aesthesiometer and plantar tests, respectively, as related to the presence of cytokines concentrations (TNF-α, IL-1ß and IL-6) in sciatic nerve and segments of the spinal cord after 15 days chronic constriction injury model in rats receiving vehicle or hesperidin. Antihyperalgesic response of hesperidin (100 mg/kg) was associated to the presence of cytokines mainly at several sections of the spinal cord suggesting not only peripheral but also its involvement in central sensitization in the experimental neuropathic pain.

Whole body vibration training improves vibration perception threshold in healthy young adults: A randomized clinical trial pilot study.

OBJECTIVES: Loss of foot sensitivity is a relevant parameter to assess and prevent in several diseases. It is crucial to determine the vibro-tactile sensitivity threshold response to acute conditions to explore innovative monitor tools and interventions to prevent and treat this challenge. The aims were: 1) to analyze the acute effects of a single whole body vibration session (4min-18Hz-4mm) on vibro-tactile perception threshold in healthy young adults. 2) to analyze the 48 hours effects of 3 whole body vibration sessions on vibro-tactile perception threshold in healthy young adults. METHODS: A randomized controlled clinical trial over 3 sessions of whole body vibration intervention or 3 sessions of placebo intervention. Twenty-eight healthy young adults were included: 11 experimental group and 12 placebo group. The experimental group performed 3 sessions of WBV while the placebo group performed 3 sessions of placebo intervention. RESULTS: The vibro-tactile threshold increased right after a single WBV session in comparison with placebo. Nevertheless, after 3 whole body vibration sessions and 48 hours, the threshold decreased to values lower than the initial. CONCLUSIONS: The acute response of the vibro-tactile threshold to one whole body vibration session increased, but the 48 hours short-term response of this threshold decreased in healthy young adults.

Treatment of Alzheimer disease using combination therapy with plasma exchange and haemapheresis with albumin and intravenous immunoglobulin: Rationale and treatment approach of the AMBAR (Alzheimer Management By Albumin Replacement) study. / Tratamiento de la enfermedad de Alzheimer mediante terapia combinada de aféresis terapéutica y hemoféresis con albúmina e inmunoglobulina intravenosa: fundamentos y aproximación terapéutica al estudio AMBAR (Alzheimer Management By Albumin Replacement).

INTRODUCTION: There is a growing interest in new therapeutic strategies for the treatment of Alzheimer disease (AD) which focus on reducing the beta-amyloid peptide (Aß) burden in the brain by sequestering plasma Aß, a large proportion of which is bound to albumin and other proteins. This review discusses the concepts of interaction between Aß and albumin that have given rise to AMBAR (Alzheimer's Disease Management by Albumin Replacement) project, a new multicentre, randomised, controlled clinical trial for the treatment of AD. DEVELOPMENT: Results from preliminary research suggest that Albutein(®) (therapeutic albumin, Grifols) contains no quantifiable levels of Aß. Studies also show that Albutein(®) has Aß binding capacity. On the other hand, AD entails a high level of nitro-oxidative stress associated with fibrillar aggregates of Aß that can induce albumin modification, thus affecting its biological functions. Results from the phase ii study confirm that using therapeutic apheresis to replace endogenous albumin with Albutein(®) 5% is feasible and safe in patients with AD. This process resulted in mobilisation of Aß and cognitive improvement in treated patients. The AMBAR study will test combination therapy with therapeutic apheresis and haemopheresis with the possible leverage effect of Albutein(®) with intravenous immunoglobulin replacement (Flebogamma(®) DIF). Cognitive, functional, and behavioural changes in patients with mild to moderate AD will be assessed. CONCLUSIONS: the AMBAR study represents a new therapeutic perspective for AD.

Fear of Falling in Women with Fibromyalgia and Its Relation with Number of Falls and Balance Performance.

OBJECTIVE: To evaluate fear of falling, number of falls, and balance performance in women with FM and to examine the relationship between these variables and others, such as balance performance, quality of life, age, pain, and impact of fibromyalgia. METHODS: A total of 240 women participated in this cross-sectional study. Of these, 125 had fibromyalgia. Several variables were assessed: age, fear of falling from 0 to 100, number of falls, body composition, balance performance, lower limb strength, health-related quality of life, and impact of fibromyalgia. RESULTS: Women with fibromyalgia reported more falls and more fear of falling. Fear of falling was associated with number of falls in the last year, stiffness, perceived balance problems, impact of FM, and HRQoL whereas the number of falls was related to fear of falling, balance performance with eyes closed, pain, tenderness to touch level, anxiety, self-reported balance problems, impact of FM, and HRQoL. CONCLUSION: FM has an impact on fear of falling, balance performance, and number of falls. Perceived balance problems seem to be more closely associated with fear of falling than objective balance performance.

Everolimus plus mycophenolate mofetil as initial immunosuppression in liver transplantation.

BACKGROUND: The purpose of this study was to assess the efficacy and safety of a de novo immunosuppressive regimen with everolimus (EVL) plus mycophenolate mofetil (MMF) without calcineurin inhibitors (CNI) for liver transplantation. The secondary purpose was to compare the renal function with a control group of patients treated with tacrolimus plus MMF. METHODS: Sixteen male and 4 female liver transplant patients received immunosuppression with EVL plus MMF without CNI, with induction with steroids and 16 with basiliximab also. In 10 cases it was indicated as induction immunosuppression without CNI as prevention against nephrotoxicity and neurotoxicity or recurrence of hepatocarcinoma in predisposed patients and in another 10 after withdrawing CNI during the immediate post-transplant period, before hospital discharge, as the result of toxicity, mainly nephrotoxicity and neurotoxicity or the presence of hepatocarcinoma with a high risk of recurrence. A control group comprising 31 patients taking tacrolimus plus MMF was included to compare the renal function. RESULTS: The mean follow-up time was 24 months. One patient had a recurrence of hepatocarcinoma at 8 months after transplant. The cases of nephrotoxicity and neurotoxicity resolved favorably. There were 7 rejections (35%); 2 evolved to chronic rejection with both needing retransplantation, 2 resolved with dose adjustment, and 3 required conversion to CNI. The side effects were hyperlipidemia (25%), wound dehiscence (10%), lymphedema (10%), cytomegalovirus infection (25%), myelotoxicity (25%) and proteinuria >1 g in 1 case (5%). No differences were found in renal function between the two groups. CONCLUSIONS: This regimen was proven to be efficient to prevent and treat nephrotoxicity and neurotoxicity with an acceptable tolerability profile. However, the high associated rejection rate indicates that great caution is required in its use during the immediate post-transplant period. It is advisable to associate the regimen with low doses of CNI and to have agile methods available to monitor EVL to enable rapid dose adjustment.

Evidence of mechanism of action of anti-inflammatory/antinociceptive activities of acacetin.

BACKGROUND: Acacetin is a bioflavonoid with pharmacological properties such as antinociceptive/anti-inflammatory activities. However, scientific evidence of its spectrum activity and mechanisms of action is unknown. METHODS: Acacetin administered via i.p. was assessed using several nociceptive experimental models such as the writhing test, the formalin test and carrageenan paw oedema in the thermal plantar tests (Hargreaves method) in mice, as well as the pain-induced functional impairment model in rat (PIFIR model). RESULTS: Acacetin produced a significant and dose-dependent inhibition of the writhes with an ED50 = 20 mg/kg. Furthermore, acacetin inhibited licking and shaking associated with nociceptive behaviour mainly in the inflammatory phase of the formalin test. No significant differences were observed in the plantar test in mice, but a minor response was obtained in the PIFIR model. Animals receiving pre-treatment of WAY100635 (0.1 mg/kg, s.c.), flumazenil (3 mg/kg, i.p.) or naloxone (1 mg/kg, i.p.) partially reduced the antinociceptive response of acacetin in the writhing test. Presence of the inhibitors in the NO-cGMP-K(+) channel pathway did not modify the antinociceptive effect of acacetin in the writhing or the formalin test. CONCLUSIONS: Our data showed that systemic administration of acacetin decreased visceral and inflammatory nociception and prevented the formalin-induced oedema. In the mechanism of the acacetin antinociceptive effect, 5-HT1A, GABA/BDZs and opioid receptors but not the NO-cGMP-K(+) channel pathway seem to be involved. The data presented prove acacetin to be potentially useful in the therapy of pain-related diseases.

The pathophysiology of triose phosphate isomerase dysfunction in Alzheimer's disease.

Alzheimer's disease (AD), the most prevalent neurodegenerative disease worldwide, has two main hallmarks: extracellular deposits of amyloid ß-peptide (Aß) and intracellular neurofibrillary tangles composed by tau protein. Most AD cases are sporadic and are not dependent on known genetic causes; aging is the major risk factor for AD. Therefore, the oxidative stress has been proposed to initiate the uncontrolled increase in Aß production and also to mediate the Aß's deleterious effects on brain cells, especially on neurons from the cortex and hippocampus. The production of free radicals in the presence of nitric oxide (NO) yields to the peroxynitrite generation, a very reactive agent that nitrotyrosinates the proteins irreversibly. The nitrotyrosination produces a loss of protein physiological functions, contributing to accelerate AD progression. One of the most nitrotyrosinated proteins in AD is the enzyme triosephosphate isomerase (TPI) that isomerises trioses, regulating glucose consumption by both phosphate pentose and glycolytic pathways and thereby pyruvate production. Hence, any disturbance in the glucose supply could affect the proper brain function, considering that the brain has a high rate of glucose consumption. Besides this directly affecting to the energetic metabolism of the neurons, TPI modifications, such as mutation or nitrotyrosination, increase methylglyoxal production, a toxic precursor of advanced glycated end-products (AGEs) and responsible for protein glycation. Moreover, nitro-TPI aggregates interact with tau protein inducing the intraneuronal aggregation of tau. Here we review the relationship between modified TPI and AD, highlighting the relevance of this protein in AD pathology and the consequences of protein nitro-oxidative modifications.

Fiabilidad interobservador del test de movilidad pasiva accesoria intervertebral lumbar y su correlación con la galvanopalpación en sujetos sanos / Inter-observer reliability of the passive accessory intervertebral motion test and its correlation with the galvanic palpation in healthy subjects

Introducción El diagnóstico de fisioterapia de las disfunciones vertebrales es fundamental para clasificar las alteraciones musculoesqueléticas. La evaluación pasiva de la cantidad y la calidad del movimiento en los diferentes segmentos vertebrales guía la toma de decisiones en relación con el tratamiento de fisioterapia. Los objetivos del presente estudio son determinar la fiabilidad interobservador del test de movilidad pasiva accesoria posteroanterior intervertebral unilateral lumbar como test indicado para identificar sujetos con disfunción articular y analizar la corriente galvánica como herramienta diagnóstica en la identificación de disfunción articular en la columna lumbar con dicho test ortopédico. Material y método Dos fisioterapeutas expertos en fisioterapia manual realizaron el test en una muestra de 30 sujetos asintomáticos en los niveles L1-L5 (lado derecho e izquierdo), realizándose un total de 300 pruebas. Se determinó que un nivel lumbar estaba en disfunción basándose en una sensación final anormal, la calidad de la resistencia anormal y la posible aparición de dolor asociado al movimiento. Para determinar la utilidad diagnóstica de la corriente galvánica, otros dos fisioterapeutas realizaron galvanopalpación consecutivamente al test de movilidad en las articulaciones interapofisarias lumbares de los mismos sujetos asintomáticos. Resultados En el test de movilidad, el porcentaje de acuerdo fue del 86,3%. El índice kappa (k) mostró un acuerdo moderado (k=0,5). El test fue más fiable en los niveles lumbares L3-L4 y L4-L5. En la galvanopalpación el porcentaje de acuerdo fue del 83%. El k mostró un acuerdo moderado en la identificación de disfunción articular (k=0,41). La sensibilidad fue alta en el nivel lumbar L3-L4 y L4-L5 y baja en L1-L2; la especificidad fue elevada (82,7–96,3%) en toda la columna lumbar. Conclusiones La fiabilidad interobservador del test de movilidad es moderada (k=0,5). La galvanopalpación identifica disfunciones articulares, pero en la columna lumbar alta la sensibilidad es baja (AU)

Introduction The physical therapy diagnosis of a vertebral dysfunction is essential in order to classify musculoskeletal diseases. Passive assessment of quantity and quality of movement on the different vertebral segments guides the decision-making process relative to manual therapy treatment. The aims of this present study have been to determine the interobserver reliability of passive accessory intervertebral postero-anterior unilateral lumbar motion test as a test to identify subjects with joint dysfunction, and to analyze galvanic current as a diagnostic tool to identify joint dysfunction in the lumbar spine with the motion test. Material and methods Two physiotherapists, experts in manual therapy, carried out the test in 30 asymptomatic subjects at L1 to L5 levels (right and left sides), performing a total of 300 tests. To determine the diagnostic value of galvanic current, two other physiotherapists performed galvanic palpation consecutively to the motion test in lumbar zygapophysial joints in the same asymptomatic subjects. Results Percentage agreement was 86.3% for the motion test. The Kappa index showed substantial agreement (according to Landis and Koch, 1977) (k=0.5). PA accessory motion test was more reliable to identify symptomatic spinal L4-L5 and L5-S1 level. Regarding galvanic palpation, the agreement percentage was 83%. Kappa coefficient (k) showed moderate agreement for identification of joint dysfunction (k=0.41). Sensitivity was high in the lumbar level L3-L4 and L4-L5 and was low in L1-L2 level; specificity was high (82.7–96.3%) throughout the lumbar spine. Conclusions Interobserver reliability of the passive motion test is moderate (k=0.5). Galvanic palpation identifies joint dysfunction, however sensitivity is low in the upper lumbar spine (AU)

Valoración de la utilidad del test detector de la proteínatransportadora de ácidos grasos específica del miocardio(h-FABP) en los infartos agudos de miocardio (IAM)diagnosticados en el medio extrahospitalario / Assessment of a heart-type fatty acid-binding protein test in the prehospital diagnosis of acute myocardial infarction

Objetivo: Valorar el test de la proteína cardiaca citoplasmática transportadora de ácidos grasos (h-FABP) como prueba complementaria para el diagnóstico del infarto agudo de miocardio (IAM) en el medio prehospitalario, y especialmente para aquellos pacientes con una clínica de menos de 3 horas de evolución. Método: Estudio prospectivo transversal en pacientes con sospecha de IAM atendidos por 3 unidades de soporte vital avanzado del Servicio de Salud de Castilla-La Mancha(SESCAM). Se recogieron datos clínico-epidemiológicos, un registro electrocardiográfico y se les realizó un test rápido de determinación de h-FABP. Se realizó un seguimiento hospitalario del caso y se consideró su diagnóstico final en el hospital como el patrón oro. Se calcularon los índices de rendimiento diagnóstico de la prueba. Resultados: Se incluyeron 73 pacientes. En 21 casos se repitió la determinación de h-FABP, ya que se detectó cierta dificultad en la lectura y conservación del test, y en 7 casos(9,6%) fue considerado finalmente nulo. En 50 se los 66 casos restantes con resultado legible de h-FABP dicha prueba se realizó durante las primeras 3 horas del inicio de los síntomas. En estos casos, la h-FABP obtuvo una sensibilidad del 91% (intervalo de confianza del 95%: 76%-98%), una especificidad del 37% (15%-65%), una eficiencia del 74% (64%-85%), un valor predictivo positivo del 76% (60%-88%) y un valor predictivo negativo del 67% (30%-93%). Cuando se consideró a la totalidad de pacientes sin tener en cuenta el tiempo transcurrido desde el inicio de la clínica, la h-FABP incrementó (..) (AU)

Objective: To assess the usefulness of testing for heart-type fatty acid-binding protein (h-FABP) to obtain complementary information for the diagnosis of acute myocardial infarction (AMI) in the prehospital setting, particularly in patients whose symptoms began less than 3 hours earlier. Methods: Prospective cross-sectional study in patients with probable AMI attended by 3 advanced life support units belonging to the health service of Castile-La Mancha, Spain. The recorded variables were clinical and epidemiologic data, electrocardiograms, and the results of a rapid h-FABP test. The patients were followed while in hospital, and the definitive diagnosis was considered to be the one eventually made in hospital. Indices reflecting the diagnostic yield of the test were calculated. Results: Seventy-three patients were tested. The h-FABP test had to be repeated for 21 patients because of problems related to storage of the strips or interpreting the results, and in 7 cases (9.6%) test results were judged unusable. In 50of the 66 patients for whom readable h-FABP results were obtained, the test was done within 3 hours of the onset of symptoms. In this group, the h-FABP test achieved a sensitivity of 91% (95% confidence interval [CI]), 76%-98%),specificity of 37% (95% CI, 15%-65%), efficiency of 74% (95% CI, 64%-85%), positive predictive value of 76% (95%CI, 60%-88%), and negative predictive value of 67% (95% CI, 30%-93%). The specificity of the h-FABP test was higher when calculated for the entire patient sample regardless of time elapsed since the onset of symptoms, but the other indices were similar. The diagnostic yield of the test was lower in patients with atypical clinical pictures and/or electrocardiograms than in those with more characteristic signs and (..) (AU)

¿Qué opinan los fisioterapeutas sobre el actual plan de estudios en Fisioterapia y el futuro título de grado? / What is the opinion of Spanish physical therapists on the present and future degree program?

ObjetivoConocer la opinión de los fisioterapeutas españoles sobre el actual plan de estudios en Fisioterapia y el futuro título de grado.Material y métodoEstudio cualitativo mediante encuesta telefónica.ResultadosCincuenta fisioterapeutas de diferente procedencia geográfica y universidad de origen fueron encuestados. El 53,1% considera que la formación académica recibida no fue la adecuada, el 60% incluiría más asignaturas relacionadas con la terapia manual y el 46% aumentaría los créditos de asignaturas, como Anatomía, Biomecánica y Fisiología. El 94% de los fisioterapeutas considera que el futuro título de grado debería desarrollarse entre 4 y 5 años, y debería incluir la especialización.ConclusionesBajo grado de satisfacción del actual plan de estudios con carencias formativas en técnicas de terapia manual e insuficiente carga lectiva en asignaturas de estructura y función del cuerpo humano. El aspecto más valorado por los fisioterapeutas encuestados es la formación práctica. El futuro título de grado debería desarrollarse en cuatro años e incluir la especialidad.Todo ello haría necesaria una futura revisión del desarrollo curricular(AU)

ObjectiveTo learn the opinion of Spanish Physical Therapists on the present physical therapy curriculum and future degree program.Material and methodQualitative study by telephone survey.Results50 physical therapists from different geographic and university origins were polled. A total of 53.1% consider that they did not receive adequate academic training, 60% would include more subjects related to the manual therapy and 46% would increase the credits for subjects such as anatomy, biomechanics and physiology. A total of 94% of the physical therapists consider that the future degree program should include 4 and 5 years and should include the specialization.ConclusionsThere is a low degree of satisfaction regarding present curriculum with training deficiencies in techniques of manual therapy and insufficient content regarding the subject load for subjects on structure and function of the human body. The feature receiving the highest value by the physical therapists surveyed is practical training. The future degree studies should be carried out in a four year program and include the speciality. Thus, a future review of the curricular development is necessary(AU)

PACS regionales y su gestión / Regional PACS AND THIR MANAGEMENT

La gestión del conocimiento que se lleva a cabo en un RIS-PACS regional puede derivar en un mero intercambio de infrmes radiológicos. Esto es sin duda necesario, pero lo ideal es el trabajo en, red en el intercambio de informes radiológicos. Esto es sin duda necesario, pero lo ideal es el trabajo en, red en el que se acuerdan por cada uno de los interantes de la organizacion regional, las necesidades de apoyo, la manera de realizar estudios y el tipo de studios que se informan (AU)

The knowledge management which is carried out in a regional RIS-PACS can derive into a mere exchange of radiology repors. This is doubtless necessary. But it would be ideal to work in network, in which each of the members of the regional organisation agree on the support needs, the way to condutct the studies and the type of studies which are recorded (AU)

Resolution of binary mixtures of microorganisms using electrochemical impedance spectroscopy and artificial neural networks.

This work describes the resolution of binary mixtures of microorganisms using electrochemical impedance spectroscopy (EIS) and artificial neural networks (ANNs) for the processing of data. Pseudomonas aeruginosa, Staphylococcus aureus and Saccharomyces cerevisiae were chosen as models for Gram-negative bacteria, Gram-positive bacteria and yeasts, respectively. In this study, best results were obtained when entering the imaginary component of the impedance at each frequency (strongly related to the capacitive elements of the electrical equivalent circuit) into backpropagation neural networks made up by two hidden layers. The optimal configuration of these layers respectively used the radbas and the logsig transfer functions with 4 or 6 neurons in the first hidden layer and 10 neurons in the second one. In all cases, good prediction ability was obtained with correlation coefficients better than 0.989 when comparing the predicted and the expected values for a set of six external test samples not used in the training process.