El espacio supracoroideo en pacientes afectados por retinosis pigmentaria / The suprachoroidal space in patients affected by retinitis pigmentosa

Antecedentes y objetivo: El espacio supracoroideo (SCS) es una estructura teórica que se sitúa entre el borde interno de la esclera y el límite externo del coroides. El SCS está siendo estudiado por sus posibles usos como vía para la administración de medicamentos y por técnicas quirúrgicas innovadoras para el tratamiento de muchas enfermedades retinianas. La retinitis pigmentosa (RP) es un grupo de trastornos hereditarios y progresivos caracterizados por el detrimento gradual de fotorreceptores que conduce a una discapacidad visual que se manifiesta típicamente como hemeralopía y pérdida progresiva del campo visual. El objetivo del estudio fue definir la morfología de los márgenes coroideos externos mediante el uso de tomografía de coherencia óptica de barrido (SS-OCT) en la RP.Materiales y métodosEstudio observacional retrospectivo diseñado para evaluar la presencia del ESC en la RP. Realizamos SS-OCT en un grupo de 55 pacientes afectados por RP (26 hombres y 29 mujeres, 110 ojos) con una edad media de 51,8±13,7 años. En el grupo de control incluimos a 28 sujetos sanos (6 hombres y 22 mujeres, 56 ojos) con una edad media de 48,8±16,6 años.ResultadosLas imágenes OCT permitieron delinear de manera precisa el margen coroideo externo y el margen escleral interno en los 110 ojos. En el grupo RP se detectó el ESC en 47 de los 110 ojos (42,7%), en el grupo de control se detectó el ESC en 11 ojos (19,6%).Los sujetos del grupo RP con SCS visibles presentaron un menor grosor retiniano (168,4 micrones) en comparación con aquellos con SCS visibles (211,2 micrones, p=0,007). (AU)

Background and objective: The suprachoroidal space (SCS) is a theoretical structure which can be demonstrated between the inner border of the sclera and the outer boundary of the choroid. SCS is being studied for its potential uses as a route for drug delivery and innovative surgical techniques for the treatment of many retinal diseases. Retinitis pigmentosa (RP) is a group of inherited eye disorders characterized by a gradual loss of photoreceptors, resulting in vision impairment, which typically presents as night blindness and progressive visual field loss. The purpose of the study is to define the morphology of outer choroidal margins by means of SS-OCT in RP.Material and methodThis is a retrospective observational study designed to evaluate the presence of SCS in RP. We performed swept source optical coherence tomography (SS-OCT) in a group of 55 patients affected by RP (26 males and 29 females, 110 eyes) with a mean age of 51.8±13.7 years. In the control group, we included 28 healthy subjects (6 males and 22 females, 56 eyes) with a mean age of 48.8±16.6 years.ResultsOCT scans allowed the outer choroidal margin and inner scleral margin to be delineated with certainty in all 110 eyes. In the RP group SCS was detected in 47 of 110 eyes (42.7%), in the control group SCS was detected in 11 eyes (19.6%).Subjects with SCS visible (RP group) had reduced retinal thickness (168.4μm) compared to those with not visible SCS (211.2μm, p=0.007). (AU)

The suprachoroidal space in patients affected by retinitis pigmentosa.

BACKGROUND AND OBJECTIVE: The Suprachoroidal Space (SCS) is a theoretical structure which can be demonstrated between the inner border of the sclera and the outer boundary of the choroid. SCS is being studied for its potential uses as a route for drug delivery and innovative surgical techniques for the treatment of many retinal diseases. Retinitis pigmentosa (RP) is a group of inherited eye disorders characterized by a gradual loss of photoreceptors, resulting in vision impairment, which typically presents as night blindness and progressive visual field loss. The purpose of the study is to define the morphology of outer choroidal margins by means of SS-OCT in RP. MATERIAL AND METHOD: This is a retrospective observational study designed to evaluate the presence of SCS in RP. We performed Swept Source optical coherence tomography (SS-OCT) in a group of 55 patients affected by RP (26 males and 29 females, 110 eyes) with a mean age of 51.8 ±â€¯13.7 years. In the control group, we included 28 healthy subjects (6 males and 22 females, 56 eyes) with a mean age of 48,8 ±â€¯16,6 years. RESULTS: OCT scans allowed the outer choroidal margin and inner scleral margin to be delineated with certainty in all 110 eyes. In the RP group SCS was detected in 47 of 110 eyes (42,7%), in the control group SCS was detected in 11 eyes (19,6%). Subjects with SCS visible (RP group) had reduced retinal thickness (168.4 µm) compared to those with not visible SCL (211.2 µm, P = .007). CONCLUSIONS: SS-OCT can be successfully applied to assess the presence of SCS in RP and the high rate of SCS found in the RP patients is encouraging when considering future innovative therapies.

Serological and molecular survey of canine distemper virus in red foxes (Vulpes vulpes): Exploring cut-off values and the use of protein A in ELISA tests.

The wide distribution and ecological plasticity of the red fox (Vulpes vulpes) make it a potential reservoir for many infectious diseases shared with domestic and wild carnivores. One of such diseases is canine distemper, which is caused by an RNA virus and its main domestic reservoir is the dog. However, other carnivores can also participate in its maintenance, as shown by the recent upsurge of reported cases in wildlife in many parts of the world, and by the fact that red foxes may act as true reservoirs for canine distemper virus (CDV). The lack of validated serological tests for wildlife or other non-target species may be a handicap for monitoring this virus. In this study, serological assays were compared in 147 red fox sera using a commercial ELISA validated for its use in dogs and a non-specific modified ELISA with Protein A peroxidase conjugate to detect bound antibodies. In addition, the presence of CDV RNA in brain, spleen, lung, and liver samples from 144 foxes was investigated by a RT-qPCR. Through the comparison of the results of both ELISAs and the use of a finite mixture model of the optical density values obtained by both techniques, we adjusted the cut-off point of the commercial ELISA to obtain the seroprevalence in foxes. The overall seroprevalence detected was 53.7% (79/147) and 57.1% (84/147) by the commercial and modified ELISA, respectively, with a moderate agreement according to Cohen's Kappa statistic (κ = 0.491, z = 5.97, p < 0.0001). CDV RNA was detected in 30 out of 144 foxes, which resulted in 20.8% of CDV-infected foxes. At individual level, the results obtained by relating the serological status and the presence/absence of RNA in different organs were explained in terms of the pathogenesis of the infection. Our results highlight the convenience of adjusting the cut-off point when using an ELISA assay developed in domestic dogs for its use in foxes. Moreover, Protein A is confirmed to be a good alternative to be used in red foxes, presenting a good reactivity towards its IgG.

Aggregation of European storm-petrel (Hydrobates pelagicus ssp. melitensis) around cage fish farms. Do they benefit from the farms resources?

Cage aquaculture aggregates wild fauna due to food provision. Several seabirds frequent fish farms, including the European storm-petrel (Hydrobates pelagicus melitensis). This work investigates the presence of storm-petrels around two aquaculture areas interspersed between breeding colonies in western Mediterranean Sea. Contribution of aquaculture-derived resources to their diet was assessed. Storm-petrels were mist-netted at the colonies and marked by bleaching feathers. Density around aquaculture areas was estimated through visual counts. Marks recognition was conducted visually and by photo-capture. Storm-petrel regurgitates were used as target tissue to estimate diet sources contribution. Contribution of surface zooplankton, ichthyoplankton and aquaculture wastes was estimated through Bayesian mixing modelling combining carbon and nitrogen stable isotopes and fatty acids as biomarkers. Storm-petrel density was high in open-sea aquaculture area, but not observed around near shore farms. Temporal variability of storm-petrels density during the breeding season was linked to their reproductive phenology. Within the open-sea aquaculture area, bluefin tuna farm was more attractive for storm-petrels than seabream/seabass farms. Visual identification of bleaching marks was not useful. Photo-capture showed that 8.3% of the storm-petrels watched around farms were firstly trapped in some of the nearby colonies, and 91.7% were unmarked. Qualitative evidence of aquaculture-derived wastes utilization was obtained. However, its estimated contribution was low (4.3%) when compared to ichthyoplankton (61.1%) or zooplankton (34.6%). The studied open-sea farms significantly aggregated storm-petrels along their entire breeding season. Storm-petrels got a slight profit from aquaculture resources. Nevertheless, some concerns arise regarding the cost/benefit balance of the interaction.

Treatment of the pancreatic stump after DCP.

OBJECTIVE: With improvement in methods, mortality after duodeno-cefalo pancreatectomy (DCP) has decreased to 5% even if complication rate is still high (30-50%). The pancreatic fistula still occurs in 25-50% of cases. Various methods of treating pancreatic stump have been proposed aimed to improve this rate. PATIENTS AND METHODS: The AA, surgeons of suburban hospital, have performed in five years, 2009-2013, 12 DCP. The pancreatic anastomosis has been in all cases an end-to-end duct-to-mucosa pancreatic-jejunostomy. RESULTS: The prevalence of fistula has been 33% (4 cases, 3 grade A and 1 grade B according with ISGPF score). CONCLUSIONS: Soft pancreas and small size of pancreatic duct are recognized as the mayor factor of risk for pancreatic fistula. In these cases are usually preferred pancreatic-jejunostomy (PJ) and pancreatic-gastro-anastomosis (PG). Both techniques show advantages and disadvantages: some randomized and prospective studies have demonstrated the absence of significative differences respect to the prevalence of pancreatic fistulas. Whipple method has been the most often used reconstructive method: a single loop with bile-pancreatic anastomosis and gastro-pancreatic anastomosis in sequence. A careful evaluation of pancretic tissue and Wirsung size with the aim of choosing the most suitable technique and an accurate execution are the most effective methods to prevent pancreatic fistula,even considering particular setting as elderly patient or HIV infection.

Laparoscopic cholecystectomy: ultrasonic energy versus monopolar electrosurgical energy.

OBJECTIVE: Nowadays, laparoscopic cholecystectomy (LC) is undoubtedly considered the "gold standard" in the surgical treatment of symptomatic gallstones, gallbladder adenomas and acute cholecystitis. Among the alternative energy sources proposed (monopolar, bipolar electric scalpel, radiofrequency sealers) with the aim to dissect and/or seal, the ultrasonic energy has been frequently adopted, however without a widespread acceptance among surgeons for routine or emergency laparoscopic cholecystectomy. This study investigates the possible beneficial aspects of ultrasonic dissection and its efficacy in the closure of the cystic artery and duct. PATIENTS AND METHODS: Patients were retrospectively divided into 2 groups according to the instruments used for division of the cystic artery and duct as well as for dissection of the liver bed: 121 patients in whom dissection and coagulation were performed using monopolar coagulation and 43 patients who were all treated with the ultrasonically activated scalpel harmonic ACE (Ethicon Endo-Surgery) as the sole instrument used in the whole procedure. RESULTS: The mean operative time, was significantly shorter in the harmonic group than in the traditional group (35.36 + 10.15 min vs. 55.6+12.10 vs. respectively; p < 0.0001). The rate of gallbladder perforation was significantly higher in the traditional group than in the harmonic group 20.66% (25 patients) vs. 6.98% (3 patients), respectively; p < 0.05). Intraoperative volume blood loss was significantly more in the traditional group than in the HS group (29.32+14.21 vs. 12.41+8.22; p < 0.0001). The mean amount of postoperative drainage was not significantly different among the two group (18.41+6.54 vs. 15.96+8.69 ml, p > 0.05). No considerable visceral injury has been recorded in either group. The postoperative parameters observed included postoperative hospital stay and morbidity for each group. The hospital stay was not significantly shorter in harmonic group (48.15+4.29 vs. 49.06+2.94 h, p > 0.05). The overall morbidity rate was 14.02 % (not significant). CONCLUSIONS: The use of the harmonic scalpel shows some statistically significant advantages limited to a few intraoperative parameters. We conclude that a wider use of harmonic scalpel not offers such advantages to make it the reference technique.

The liposome-protein corona in mice and humans and its implications for in vivo delivery.

As soon as nanomaterials, such as nanoparticles (NPs), are injected into a physiological environment a rich coating of biomolecules known as the "protein corona" rapidly covers them. This protein dress is the main factor, which affects the interaction of NPs with living systems. While the relationship between NP features and the biomolecule corona has been extensively investigated, whether and how changes in the physiological environment affect the NP-protein corona remains under-investigated. This is one of the most important steps in translating results in animal models to the clinic. Here we investigated thoroughly the biological identity of lipid NPs (size, charge, aggregation state and composition of the corona) after incubation with human plasma (HP) and mouse plasma (MP) by dynamic light scattering, micro-electrophoresis and nano-liquid chromatography tandem mass spectrometry (nanoLC/MS-MS). Specifically, we used two different liposomal formulations: the first one was made of polyethyleneglycol (PEG)-coated 1,2-dioleoyl-3-trimethylammonium-propane (DOTAP), while the second one was made of 30% of DOTAP, 50% of neutral saturated 1,2-distearoyl-sn-glycero-3-phosphocholine (DSPC) and 20% cholesterol. The temporal evolution and complexity of the NP-protein corona was found to be strongly dependent on the biological environment. In MP, liposomes were more negatively charged, less enriched in opsonins and appreciably more enriched in apolipoproteins than their counterparts in HP. Collectively, our results suggest that the biological identities of NPs in mice and humans can be markedly different from each other. Relevance of results to in vivo applications is discussed.

An unique case of dyspareunia leading to the diagnosis of urachal cyst in a nulliparous 28-year-old woman.

Urachal cysts are usually asymptomatic. Symptoms, when present, are usually acute abdominal pain, fever, midline hypogastric tenderness, palpable mass, evidence of urinary infection or haematuria due to infection of the cyst. We report an unique case of dyspareunia and "abdominal fluid flowing feeling" caused by an urachal cyst in a 28 year-old nulliparous woman. Diagnosis was achieved by US and MRI. Cystography excluded any cyst-bladder communication. Laparoscopic surgery was performed without perioperative complications. Patient obtained immediate relief of symptoms still continuing at a 24 months follow up.

[Prevalence of the metabolic syndrome in patients with transient ischemic attack or non-cardioembolic stroke]. / Prevalencia del síndrome metabólico en pacientes con ataque isquémico transitorio o infarto cerebral no cardioembólico.

INTRODUCTION: The presence of metabolic syndrome (MS) in patients with ischemic stroke has been analyzed in few studies and there is evidence that the coexistence of MS and stroke increases the subsequent risk of vascular recurrences, regardless of the classical risk factors (RF). One of the main objectives of the APICA study (prevalence of peripheral arterial disease and metabolic syndrome in acute cerebral ischemia) is to analyze this prevalence in Spain in patients with acute cerebral ischemia and to identify clinical variables with a higher risk of MS. METHODS: An epidemiologic, observational, longitudinal, multicenter study including patients over 50 with non-cardioembolic transient ischemic attack (TIA) or ischemic stroke, consecutively recruited. The definition criteria of MS are those of the Adult Treatment Panel III-modified (ATP-IIIm) and of the International Diabetes Federation (IDF) 2005. The statistical analysis was made using the SPSS 15.0 program. A multivariate analysis was performed with the logistic regression models to determine factors associated independently with MS by both criteria. RESULTS: In the study, 977 patients were analyzed: 651 (66.7%) were men and mean age was 69.1 years. Approximately two thirds had MS, 66.8% according to the modified ATP-III criteria and 65.1% by the IDF criteria. The factors related with MS by the modified ATP-III were independently associated with gender (OR 5.34 [2.99-9.54], p<0.001). The variables related with MS by IDF were independently associated with female gender (6.39 [3.55-11.5], p<0.001) and a greater concentration of platelets (1.005 [1.002-1.008], p=0.004). CONCLUSIONS: An elevated prevalence of MS is found in patients with transient ischemic attack or non-cardioembolic stroke, it being similar in both criteria used (66.8% and 65.1%). Female gender is a clearly significant risk factor and is related independently of the variable that determine MS.

[Prevalence of asymptomatic peripheral artery disease in patients with non-cardioembolic ischemic stroke]. / Prevalencia de enfermedad arterial periférica asintomática en pacientes con ictus isquémico no cardioembólico.

INTRODUCTION: The prevalence of asymptomatic peripheral arterial disease (PAD) detected by the ankle-brachial index (ABI) measurement in stroke patients and its relation with the risk of vascular events recurrence is unknown. A main objective of the APICA study (prevalence of peripheral arterial disease and metabolic syndrome in acute cerebral ischemia) is to analyse the prevalence in our country and to identify clinical variables associated with higher risk of PAD. METHODS: Epidemiologic, observational, longitudinal, multicenter study including patients older than 50 with non-cardioembolic transient ischemic attack (TIA) or ischemic stroke, consecutively recruited. PAD was determined if ABI = 0.9. Statistical analysis was performed with SPSS 15.0. A logistic regression analysis was performed to find factors independently associated with asymptomatic PAD. RESULTS: 977 patients were included. 651 (66.7 %) were males and mean age was 69.1. 396 (40.5 %) cases had PAD, after excluding patients with previously known PAD, 321 (35.6%) were defined as asymptomatic PAD. The factors independently associated with asymptomatic PAD were: age (OR 1.020 [1.004-1.037], p = 0.017), previous stroke (1.52 [1.05-2.20], p = 0.027), coronary revascularization (1.97 [1.03-3.79], p = 0.041), established stroke (1.86 [1.20-2.88], p = 0.006), atherothrombotic etiology (1.54 [1.13-2.10], p = 0.006), systolic blood pressure (1.009 [1.001-1.017], p = 0.027) and waist perimeter (0.989 [0.978-1.000], p = 0.005). CONCLUSIONS: More than a third of the patients with noncardioembolic ischemic stroke have asymptomatic PAD. Asymptomatic PAD is mainly observed in older patients, with hypertension, multiple vascular territories condition and with atherothrombotic etiology of stroke.

Prevalencia del síndrome metabólico en pacientes con ataque isquémico transitorio o infarto cerebral no cardioembólico / Prevalence of the metabolic syndrome in patients with transient ischemic attack or non-cardioembolic stroke

Introducción. La prevalencia del síndrome metabólico (SM) en pacientes con ictus isquémico ha sido analizada en pocos estudios, y existen evidencias de que la coexistencia de SM e ictus incrementa el riesgo posterior de recurrencias vasculares independientemente de los factores de riesgo (FR) clásicos. El estudio APICA (prevalencia de Arteriopatía Periférica y síndrome metabólico en Isquemia Cerebral Aguda) tiene como uno de sus objetivos principales analizar dicha prevalencia en España en pacientes con isquemia cerebral aguda e identificar variables clínicas con un mayor riesgo de SM. Métodos. Estudio epidemiológico, observacional, longitudinal y multicéntrico, que incluyó pacientes de edad igual o mayor a 50 años con ataque isquémico transitorio (AIT) o infarto cerebral no cardioembólico, reclutados de manera consecutiva. Los criterios de definición de SM son los del Adult Treatment Panel III modificados (ATP-IIIm) y de la International Diabetes Federation (IDF) 2005. El análisis estadístico se realizó mediante el paquete SPSS 15.0. Se realizó un análisis multivariante mediante modelos de regresión logística para determinar factores asociados independientemente con SM por ambos criterios. Resultados. En el estudio se analizaron 977 pacientes; 651 (66,7%) eran varones y la edad media fue de 69,1 años. Aproximadamente, dos tercios tenían SM, el 66,8% por criterios ATP-III modificada y el 65,1% por criterios IDF. Los factores relacionados con SM por ATP-III modificada se asociaron de forma independiente con el sexo femenino (OR 5,34 [2,99-9,54], p <0,001). Las variables relacionadas con SM por IDF se asociaron independientemente con el sexo femenino (6,39 [3,55-11,5], p < 0,001) y una mayor concentración de plaquetas (1,005 [1,002-1,008], p = 0,004). Conclusiones. Se (..)(AU)

Introduction: The presence of metabolic syndrome (MS) in patients with ischemic stroke has been analyzed in few studies and there is evidence that the coexistence of MS and stroke increases the subsequent risk of vascular recurrences, regardless of the classical risk factors (RF). One of the main objectives of the APICA study (prevalence of peripheral arterial disease and metabolic syndrome in acute cerebral ischemia) is to analyze this prevalence in Spain in patients with acute cerebral ischemia and to identify clinical variables with a higher risk of MS.Methods: An epidemiologic, observational, longitudinal, multicenter study including patients over 50 with non-cardioembolic transient ischemic attack (TIA) or ischemic stroke, consecutively recruited. The definition criteria of MS are those of the Adult Treatment Panel III-modified (ATP-IIIm) and of the International Diabetes Federation (IDF) 2005. The statistical analysis was made using the SPSS 15.0 program. A multivariate analysis was performed with the logistic regression models to determine factors associated independently with MS by both criteria. Results: In the study, 977 patients were analyzed: 651 (66.7%) were men and mean age was 69.1 years. Approximately two thirds had MS, 66.8% according to the modified ATP-III criteria and 65.1% by the IDF criteria. The factors related with MS by the modified ATP-III were independently associated with gender (OR 5.34 [2.99-9.54], p<0.001). The variables related with MS by IDF were independently associated with female gender (6.39 [3.55-11.5], p<0.001) and a greater concentration of platelets (1.005 [1.002-1.008], p=0.004).Conclusions: An elevated prevalence of MS is found in patients with transient ischemic attack or non-cardioembolic stroke, it being similar in both criteria used (66.8% and 65.1%). Female gender is a clearly significant risk factor and is related independently of the variable that determine MS. (AU)

Prevalencia de enfermedad arterial periférica asintomática en pacientes con ictus isquémico no cardioembólico / Prevalence of asymptomatic peripheral artery disease in patients with non-cardioembolic ischemic stroke

Introducción. La prevalencia de enfermedad arterial periférica (EAP) asintomática detectada mediante la medición del índice tobillo-brazo (ITB) en pacientes con ictus está poco estudiada, así como si supone un incremento en el riesgo posterior de recurrencias vasculares. El estudio APICA (prevalencia de Arteriopatía Periférica y síndrome metabólico en Isquemia Cerebral Aguda) tiene como uno de sus objetivos principales analizar dicha prevalencia en nuestro país e identificar las variables clínicas asociadas con un mayor riesgo de EAP. Métodos. Estudio epidemiológico, observacional, longitudinal y multicéntrico que incluyó pacientes de edad igual o superior a 50 años con ataque isquémico transitorio (AIT) o infarto cerebral no cardioembólico, reclutados consecutivamente. La presencia de EAP se determinó para un ITB= 0,9. El análisis estadístico se realizó mediante SPSS 15.0. Se efectuó un análisis de regresión logística para determinar los factores que se asociaron de forma independiente con EAP asintomática. Resultados. En el estudio se incluyeron finalmente 977 pacientes, de los que 651 (66,7%) eran varones; la edad media fue de 69,1 años. Trescientos noventa y seis (40,5%) casos tenían EAP (ITB = 0,9) que, tras excluir aquellos pacientes con EAP previa, resultaron 321 (35,6%) con EAP asintomática. Los factores asociados de forma independiente con EAP asintomática fueron: la edad (OR 1,020 [1,004-1,037], p=0,017), el ictus previo (1,52 [1,05-2,20], p=0,027), la revascularización coronaria (1,97 [1,03-3,79], p=0,041), el ictus actual establecido (1,86 [1,20-2,88], p=0,006), la etiología aterotrombótica (1,54 [1,13-2,10], p=0,006), la presión arterial sistólica (1,009 [1,001-1,017], p=0,027) y el perímetro de cintura (0,989 [0,978-1,000], p=0,05). Conclusiones. Más de una tercera parte de los pacientes conictus isquémico no cardioembólico tienen EAP asintomática. Se observa principalmente en pacientes de mayor edad, con hipertensión arterial, afectación de varios territorios vasculares y etiología aterotrombótica para su ictus isquémico (AU)

Introduction: The prevalence of asymptomatic peripheral arterial disease (PAD) detected by the ankle-brachial index (ABI) measurement in stroke patients and its relation with the risk of vascular events recurrence is unknown. A main objective of the APICA study (prevalence of peripheral arterial disease and metabolic syndrome in acute cerebral ischemia) is to analyse the prevalence in our country and to identify clinical variables associated with higher risk of PAD. Methods: Epidemiologic, observational, longitudinal, multicenter study including patients older than 50 with non-cardioembolic transient ischemic attack (TIA) or ischemic stroke, consecutively recruited. PAD was determined if ABI = 0.9. Statistical analysis was performed with SPSS 15.0. A logistic regression analysis was performed to find factors independently associated with asymptomatic PAD. Results: 977 patients were included. 651 (66.7 %) were males and mean age was 69.1. 396 (40.5 %) cases had PAD, after excluding patients with previously known PAD, 321 (35.6%) were defined as asymptomatic PAD. The factors independently associated with asymptomatic PAD were: age (OR 1.020 [1.004-1.037], p = 0.017), previous stroke (1.52 [1.05-2.20], p = 0.027), coronary revascularization (1.97 [1.03-3.79], p = 0.041), established stroke (1.86 [1.20-2.88], p = 0.006), atherothrombotic etiology (1.54 [1.13-2.10], p = 0.006), systolic blood pressure (1.009 [1.001-1.017], p = 0.027) and waist perimeter (0.989 [0.978-1.000], p = 0.005). Conclusions: More than a third of the patients with noncardioembolic ischemic stroke have asymptomatic PAD. Asymptomatic PAD is mainly observed in older patients, with hypertension, multiple vascular territories condition and with atherothrombotic etiology of stroke (AU)

[Incidence of strokes in Spain: the Iberictus study. Data from the pilot study]. / Incidencia de ictus en España: estudio Iberictus. Datos del estudio piloto.

INTRODUCTION: In a population-based study of the incidence of stroke conducted on a broad denominator, it is wise first to carry out a pilot study. AIM: To present the results of the pilot phase of the study on stroke incidence in Spain, entitled Iberictus. PATIENTS AND METHODS: Population of the study: all cases involving the first episode of acute cerebrovascular disease (stroke or transient ischaemic attack) diagnosed among residents over 17 years of age with their habitual place of abode registered in the areas of study between 15th and 31st October 2005 (total denominator: 1,440,997 inhabitants). SOURCE OF DATA: prospective, hospital records (basic minimum data set, discharge abstracts) and casualty department registers. Standardised definitions: diagnostic categorisation and pathological, topographical and aetiological classification. Inter-observer agreement analysis among researchers (kappa). RESULTS: A total of 128 cases were identified. Age range, 37-103 years; mean age, 75.7 +/- 13.4 years; 54% were females. In all, 71.1% of the cases were collected by means of a basic minimum data set. There were 91 ischaemic events (29.7% atherothrombotic and 29.7% cardioembolic). Of the 15 haemorrhagic strokes, 40% due to arterial hypertension, six were lobar hemispheric, six were deep basal ganglia, and there were three cerebellar haemorrhages. The incidence of stroke was seen to increase exponentially with age. Inter-observer agreement was good for the classifications that were employed (range of kappa indices, 0.57-0.78). Several problems were detected and corrected in the fieldwork. CONCLUSIONS: The Iberictus pilot study yielded data that were consistent with the literature and provided us with the opportunity to detect and correct issues that would hinder us from conducting the main study.

[Incidence of strokes in Spain. Methodological foundations of the Iberictus study]. / Incidencia de ictus en España. Bases metodológicas del estudio Iberictus.

INTRODUCTION: Epidemiological data on the incidence of cerebrovascular diseases in our country are scarce. A representative population-based study with a large denominator is required. AIM: To present the design of the study on stroke incidence in Spain, entitled Iberictus. SUBJECTS AND METHODS: We conducted a prospective, population-based study on the incidence of strokes and transient ischemic attacks, in which it is possible to distinguish: 1) population with a steady risk, which was well defined and had a broad denominator. We included all the cases in which the first episode of acute cerebrovascular disease was diagnosed among those over the age of 17 years (with no upper age limit) with their habitual residence in the areas of study between the 1st January and 31st December 2006: Lugo, Segovia, Talavera de la Reina, Mallorca and Almeria (total denominator, 1,440,997 inhabitants; minimum denominator per area, 100,000 inhabitants); 2) source of multiple and complementary data: hospital records (minimum basic data set, discharge abstracts), emergency and primary care records for the area with diagnostic codes 430-39 and 674.0 (International Classification of Diseases-9), population-based mortality records; 3) standardised definitions: diagnostic categorisation (MONICA-World Health Organisation, 1987), pathological classification (ischaemia, haemorrhagic), topography and aetiology; 4) presentation of data in suitable age groups, by sex and overall; 5) pilot study and analysis of inter-observer agreement among researchers. CONCLUSIONS: With this design, the Iberictus study satisfies the methodological criteria as an 'ideal' study of the incidence of acute cerebrovascular diseases proposed by Malgrem, Sudlow and Warlow, and represents a unique opportunity to further our knowledge of the epidemiology of strokes in our country.

Long-term effect of a single application of organic refuse on carbon sequestration and soil physical properties.

Restoration of degraded lands could be a way to reverse soil degradation and desertification in semiarid areas and mitigate greenhouse gases (GHG). Our objective was to evaluate the long-term effects of a single addition of organic refuse on soil physical properties and measure its carbon sequestration potential. In 1988, a set of five plots (87 m(2) each) was established in an open desert-like scrubland (2-4% cover) in Murcia, Spain, to which urban solid refuse (USR) was added in a single treatment at different rates. Soil properties were monitored over a 5-yr period. Sixteen years after the addition, three of the plots were monitored again (P0: control, P1: 13 kg m(-2), P2: 26 kg m(-2) of USR added) to assess the lasting effect of the organic addition on the soil organic carbon (SOC) pools and on the physical characteristics of the soil. The SOC content was higher in P2 (16.4 g kg(-1)) and in P1 (11.8 g kg(-1)) than in P0 (7.9 g kg(-1)). Likewise, aerial biomass increased from 0.18 kg m(-2) in P0 up to 0.27 kg m(-2) in P1 and 0.46 kg m(-2) in P2. This represents a total C sequestration of 9.5 Mg ha(-1) in P2 and 3.4 Mg ha(-1) in P1, most of the sequestered C remaining in the recalcitrant soil pool. Additionally, higher saturated hydraulic conductivity, aggregate stability, and available water content values and lower bulk density values were measured in the restored plots. Clearly, a single addition of organic refuse to the degraded soils to increase the potential for C sequestration was effective.

Anthropogenic nutrient sources and loads from a Mediterranean catchment into a coastal lagoon: Mar Menor, Spain.

The Mar Menor is a coastal lagoon increasingly threatened by urban and agricultural pressures. The main watercourse draining into the lagoon is the Rambla del Albujón. A fortnightly campaign carried out over one annual cycle enabled us to characterize the treated urban sewage effluents and agricultural sources which contribute to the nutrient fluxes in the watercourse. Multivariate analysis provided information for establishing chemical signatures and for assessing the relative influence of the various sources on the water quality at the outlet. Mass balances were used to examine net gains and losses, and cross-correlations with rainfall to analyze climatic influence and control factors in the trends of the nutrient flux. The rainfall pattern was significantly cross-correlated with nitrate and phosphorus fluxes from agricultural sources, while fluctuations in the resident population explained the phosphorus flux trend in urban sources. 50% of dissolved inorganic nitrogen was from agricultural sources, while 70% of total phosphate and 91% of total organic carbon were from urban point sources. The net amounts of all the nutrients fell as a result of plant uptake and/or denitrification in the channel. The control of urban point sources (phosphorus-enriched) is suggested as a promptly action for improving the health of the coastal lagoon.

Kinking, coiling, and tortuosity of extracranial internal carotid artery: is it the effect of a metaplasia?

INTRODUCTION: Morphological anomalies of the extracranial internal carotid artery (ICA) cause symptomatic cerebrovascular insufficiency in 4-16% of the cases. The aim of the present study is to evaluate macroscopic and microscopic features of a group of extracranial ICA anomalies, specifically kinking, coiling, and tortuosity, eventually affecting the surgical approach. MATERIALS AND METHODS: From January 2003 to December 2005, 10 out of 169 (6%) revascularized patients (pts) were operated upon because of an ICA anomaly. They were all but two symptomatics. Seven pts were treated by ICA transection and end-to-side reimplantation of the ICA at the level of the carotid bulb; three pts were treated by ICA resection and end-to-end anastomosis. In all the cases a segment of ICA was resected; in three cases one more segment was also obtained from a common carotid artery (CCA) and these specimens were histologically examined. Patients were followed-up through a 3-year period. RESULTS: No pts died and none suffered of neurologic events. Duplex scan and arteriographic postoperative control showed the correct surgical reconstruction. Matching preoperative clinical findings with presence or absence of significant atherosclerotic stenotic lesion, we found out a positive cerebral CT in one pt (20%) in both groups; fluent neurological deficit was preeminent in pts with pure ICA anomalies (40% vs. 0%) (P = 0.2); pts with pure ICA anomalies were significantly younger than 65 years old (80% vs. 0%) (P = 0.03) and males were more involved by pure ICA anomalies (60% vs. 40%) (P = 0.1). The histological examination of ICA specimens showed a reduction of elastic fibers and muscular cells with a compensative increase of connective fibers. CONCLUSIONS: At our knowledge this is the first study focused on ICA anomalies like kinking, coiling, and tortuosity, comparing histologic features of CCA and ICA specimens coming from the same affected carotid axis. Our results, although preliminary, show elastic and muscular tissue substituted by loose connective tissue, configuring a metaplasia of tunica media limited to the ICA. Our hypothesis is that extracranial ICA, being a segment of transition between an elastic vessel (CCA) and a muscular vessel (intracranial ICA), is particularly subject to metaplastic transformation, analogously to other transition zones in human body. Our purpose is now to confirm by ultrastructural and molecular biology techniques, in a wider series, the presence of this metaplasia, since this could condition also the revascularization techniques.

Utilización de las unidades relativas de valor (URVs) como instrumento de gestión en el laboratorio clínico / Usage relative value units (RVUs) as a management tool in clinical laboratory

En este estudio se muestran las pautas seguidas para obtener las Unidades Relativas de Valor (URVs) individuales, globales y medias de los Laboratorios Clínicos. Se parte de la contabilidad analítica que permite asignar a cada prueba un coste total y obtener su Unidad Relativa deValor (URV) en relación al coste total de la creatinina. La relación Nº total de URVs / Nº total de pruebas permite aproximarse a la complejidad media del Laboratorio. En el análisis de costes, se obtiene el coste medio por prueba y por URV. En el análisis de productividad se obtiene el nº de URVs por facultativo , por personal sanitario no facultativo (PSNF), y para el conjunto de ambos colectivos. Todos los parámetros obtenidos se comparan con los valores referenciales propuestos, que constituyen una aproximación a la eficiencia teórica en condiciones previamente establecidas (AU)

[Epidemiology and prevention in dialysis]. / Epidemiologia e prevenzione in emodialisi.

During the last years, prevention of hospital infections assumed the role of primary objective for active interventions and dedicated laws for safety in work areas and for facilities accreditation defined responsibilities and preventive measures to reduce the biological risk. Dialysis centers are areas where the infective risk is high but the strict application of the Universal Measures and of specific recommendations are sufficient to reduce the risk of diffusion and transmission of pathogens. The late referral of the ESRD patient, with or without infectious comorbidity, shows an intervention field, in which a local epidemiological survey gives useful data and stimulates the data management at hospital level (Epidemiologists and nefrologists) and family doctors, to improve the disease management of very complex and high cost patients.