Efectividad de la tecnología robótica y la realidad virtual para la rehabilitación de la función motora en la parálisis cerebral. Revisión sistemática / Effectiveness of robotic technology and virtual reality for the rehabilitation of motor function in cerebral palsy. Systematic review

Introducción: La parálisis cerebral (PC) es una condición de salud secundaria a daños no progresivos que ocurren durante el desarrollo del cerebro en la etapa fetal o infantil. Evaluar la efectividad de la tecnología robótica y la realidad virtual de la función motora en pacientes con PC en comparación con estrategias convencionales de rehabilitación como fisioterapia, terapia ocupacional, intervención de neurodesarrollo y estimulación transcraneal. Se llevó a cabo una revisión de ensayos controlados aleatorizados de los últimos 5 años. Para la evaluación de la calidad metodológica de los estudios incluidos se utilizó la escala PEDro, con evaluación del nivel de evidencia y grado de recomendación según la clasificación de Oxford. Resultados: Diecisiete artículos cumplieron con los criterios de elegibilidad. La tecnología robótica y la realidad virtual demostraron ser efectivas para la mejora de la función motora, las habilidades manuales y las destrezas perceptivo-visuales de los pacientes con PC, en comparación con el uso de estrategias convencionales de rehabilitación.(AU)

Introduction: Cerebral palsy (CP) is a health condition secondary to non-progressive damage that occurs during brain development in the fetal or infant stage. To evaluate the effectiveness of robotic technology and virtual reality on motor function in patients with CP compared to conventional rehabilitation strategies such as physical therapy, occupational therapy, neurodevelopmental intervention, and transcranial stimulation. A review of randomized controlled trials of the last 5 years was carried out. For the evaluation of the methodological quality of the included studies, the PEDro scale was used, with evaluation of the level of evidence and degree of recommendation according to the Oxford classification. Results: Seventeen articles met the eligibility criteria. Robotic technology and virtual reality proved to be effective in improving motor function, manual skills, and visual–perceptual skills in patients with CP, compared to the use of conventional rehabilitation strategies.(AU)

[Effectiveness of robotic technology and virtual reality for the rehabilitation of motor function in cerebral palsy. Systematic review]. / Efectividad de la tecnología robótica y la realidad virtual para la rehabilitación de la función motora en la parálisis cerebral. Revisión sistemática.

INTRODUCTION: Cerebral palsy (CP) is a health condition secondary to non-progressive damage that occurs during brain development in the fetal or infant stage. To evaluate the effectiveness of robotic technology and virtual reality on motor function in patients with CP compared to conventional rehabilitation strategies such as physical therapy, occupational therapy, neurodevelopmental intervention, and transcranial stimulation. A review of randomized controlled trials of the last 5 years was carried out. For the evaluation of the methodological quality of the included studies, the PEDro scale was used, with evaluation of the level of evidence and degree of recommendation according to the Oxford classification. RESULTS: Seventeen articles met the eligibility criteria. Robotic technology and virtual reality proved to be effective in improving motor function, manual skills, and visual-perceptual skills in patients with CP, compared to the use of conventional rehabilitation strategies.

Eosinophilic cholecystitis in children: Case series.

INTRODUCTION: Eosinophilic cholecystitis (EC) is rarely seen in the pediatric population. Most of the available literature comes from adult patients, while only anecdotal cases have been reported in children. OBJECTIVE: To describe the clinical course, management, and outcomes of all EC cases treated at a children's hospital. MATERIAL AND METHODS: All cholecystectomy specimens obtained between 2011 and 2017 were retrospectively reviewed. EC was diagnosed when more than 90% of the inflammatory cells in the gallbladder wall were eosinophils, whereas lymphoeosinophilic cholecystitis (LEC) was diagnosed when the percentage of eosinophils was between 50 and 90. We analyzed all clinical aspects of patients with EC and LEC. RESULTS: We identified and reviewed 134 cholecystectomy specimens. Of them, 8 (6.0%) were classified as EC, and 3 (2.2%) as LEC. The mean age at presentation was 12.6 (2-17) years. The female-to-male ratio was 1.5/1. One patient had a history of hereditary spherocytosis, and 3 patients had systemic eosinophilia. All patients presented with clinical and radiological signs of acute cholecystitis and underwent cholecystectomy. Acute cholecystitis was confirmed by histopathology in all cases. All cases of EC and LEC had cholelithiasis. None of the patients required additional treatment. All patients recovered uneventfully. CONCLUSIONS: EC is rarely seen in children, it does not have a specific clinical presentation, and it is always associated with cholelithiasis. The diagnosis is made postoperatively by histopathology. All patients in our study presented with acute cholecystitis. TYPE OF STUDY: Retrospective review. LEVEL OF EVIDENCE: Level IV.

Streamlined computational pipeline for genetic background characterization of genetically engineered mice based on next generation sequencing data.

BACKGROUND: Genetically engineered mice (GEM) are essential tools for understanding gene function and disease modeling. Historically, gene targeting was first done in embryonic stem cells (ESCs) derived from the 129 family of inbred strains, leading to a mixed background or congenic mice when crossed with C57BL/6 mice. Depending on the number of backcrosses and breeding strategies, genomic segments from 129-derived ESCs can be introgressed into the C57BL/6 genome, establishing a unique genetic makeup that needs characterization in order to obtain valid conclusions from experiments using GEM lines. Currently, SNP genotyping is used to detect the extent of 129-derived ESC genome introgression into C57BL/6 recipients; however, it fails to detect novel/rare variants. RESULTS: Here, we present a computational pipeline implemented in the Galaxy platform and in BASH/R script to determine genetic introgression of GEM using next generation sequencing data (NGS), such as whole genome sequencing (WGS), whole exome sequencing (WES) and RNA-Seq. The pipeline includes strategies to uncover variants linked to a targeted locus, genome-wide variant visualization, and the identification of potential modifier genes. Although these methods apply to congenic mice, they can also be used to describe variants fixed by genetic drift. As a proof of principle, we analyzed publicly available RNA-Seq data from five congenic knockout (KO) lines and our own RNA-Seq data from the Sall2 KO line. Additionally, we performed target validation using several genetics approaches. CONCLUSIONS: We revealed the impact of the 129-derived ESC genome introgression on gene expression, predicted potential modifier genes, and identified potential phenotypic interference in KO lines. Our results demonstrate that our new approach is an effective method to determine genetic introgression of GEM.

Sistema de Apoyo Experimental para el Reconocimiento Visual y el Nombrado de Objetos / Experimental support system for visual recognition and object nomination

Resumen: En la práctica clínica relacionada con la rehabilitación cognitiva, perceptual y del lenguaje, es habitual emplear como estímulos representaciones de objetos en dos dimensiones como dibujos o fotografías para que sean identificados por los pacientes. Ello supone una limitación, puesto que la presentación de objetos en tres dimensiones, dada su mayor riqueza visual, facilita su identificación y podría apoyar procesos de rehabilitación. Objetivo: Diseñar una configuración experimental para conocer el grado en que las modalidades de presentación de estímulos afectan el reconocimiento visual de objetos. Materiales y Métodos: Se diseñó un sistema de bajo costo para mostrar estímulos en tres modalidades: imágenes, videos y objetos reales. Fueron seleccionados 80 objetos, controlando las variables de manipulabilidad, edad de adquisición, familiaridad, complejidad visual y frecuencia léxica. Se realizó una prueba piloto utilizando el sistema con cinco personas sanas y se midieron los tiempos de reacción en la nominación de los objetos. Resultados: Las diferencias en los tiempos de reacción entre las modalidades observadas apoyan la influencia de la modalidad de presentación en el reconocimiento de objetos. Conclusiones: Las propiedades de volumen de los objetos permitirían la exploración de características que las fotografías no tendrían; razón por la cual, los tiempos de reacción para los objetos reales y los videos fueron menores. Son valiosos los aportes que ofrecen una alternativa de bajo costo para la visualización y el reconocimiento de objetos.

Abstract: A wide variety of stimuli or objects such as drawings or photographs are used in cognitive perceptual and language rehabilitation. However, the presentation of objects in three dimensions, due to the visual richness, facilitates the identification and could support the rehabilitation process. Objective: Design an experimental setup to determine the extent to which the modality of presentation of objects affects the visual recognition of objects. Materials and methods: A low-cost experimental system was designed in order to show the stimulus in three ways: images, videos and real objects. Eighty objects were selected and variables as manipulability, age of acquisition, familiarity, visual complexity, agreement on the label and lexical frequency were controlled. A pilot study was conducted using the system in five healthy participants and the reaction time to identify objects was measured. Results: The findings reveal that the differences in reaction times between the modalities of presentation support the influence of the mode of presentation in object recognition. Conclusions: The volume object properties could allow the exploration of characteristics that the photographs would not have. This may be why the reaction time to identify real objects or videos was lower. Low-cost alternatives for the visualization and object recognition are valuable in cognitive perceptual and language rehabilitation.

Sera from early-onset, severely preeclamptic women directly modulate HLA-E expression in the EA.hy296 endothelial cell line.

The expression of endothelial HLA-E in the context of the systemic inflammatory response observed in preeclampsia has not been established. An experimental study was designed to determine the effect of the sera of pregnant women on the expression of HLA-E in EA.hy296 endothelial cells. First, measurements of protein fractions were performed in sera from early-onset, severely preeclamptic women without HELLP syndrome, in which there was no significant difference in total proteins between the groups, but a reduced level of plasma albumin and an increase in α1-globulin were observed in both groups of pregnant women compared with non-pregnant women. Measurements of colloid osmotic pressure (COP) using a recalculated albumin/globulin ratio formula determined only a significant decrease in COP in all pregnant groups compared with non-pregnant women. The expression of membrane HLA-E was increased in EA.hy296 endothelial cells stimulated with sera of early-onset, severely preeclamptic women, while recombinant interferon-γ (IFN-γ) significantly reduced the expression of membrane HLA-E. Pro-inflammatory cytokines were measured by Luminex in the serum samples, and increased levels of tumor necrosis factor (TNF) and decreased levels of IFN-γ were observed in early-onset, severe preeclampsia compared with normal pregnancy. Moreover, soluble HLA-E was detected in these serum samples by Western blot and ELISA, but no significant difference was found. This raises the possibility that a systemic inflammatory response promotes a compensatory mechanism of COP balance in severe preeclampsia by release of inflammation-induced factors, including endothelial HLA-E. Evidence is now provided regarding HLA-E expression by EA.hy296 cells.

Cytokine production by non-stimulated peripheral blood NK cells and lymphocytes in early-onset severe pre-eclampsia without HELLP.

Preeclampsia involves an exacerbated maternal inflammatory response that suggests a possible role of innate immunity. NK cells can promote this kind of response through cytokine production and the expression of activating or inhibitory receptors. The aims of the present study were to explore cytokine production by peripheral blood mononuclear cells, as well as cytotoxic ability and receptor expression for HLA-E and HLA-G molecules in peripheral natural killer (NK) cells of women with early-onset severe preeclampsia without HELLP (hemolysis, elevated liver enzyme levels and a low platelet count) syndrome. The expression of the ILT2, KIRDL4, NKG2A, and NKG2C receptors and of cytotoxic activity was measured in non-stimulated NK cells, whereas the intracellular expression of IL-4, IL-10, IL-13, IL-12, IFNγ, TNF and VEGF, was assessed in non-stimulated peripheral blood mononuclear cells subsets using flow cytometry. Circulating soluble HLA-G was also determined by ELISA. The intracellular cytokines tested were significantly higher in NK cell subsets from severely preeclamptic women compared with the control group. On the other hand, the percentage of NK cells expressing NKG2A or NKG2C and the cytotoxic activity of NK cells were significantly higher in severely preeclamptic women. Furthermore, there was a significant correlation between urine protein concentration and soluble human leukocyte antigen G (soluble HLA-G) in serum. We conclude that patients with early-onset severe preeclampsia without HELLP syndrome have increased NK cell function related to cytokine production, cytotoxicity and expression of lectin-like receptors such as NKG2.

Enfisema lobar congénito asociado con malformación adenomatoide quística tipo I: presentación de caso / Congenital lobar emphysema associated with cystic adenomatoid malformation type I: case report

Las anormalidades congénitas pulmonares constituyen un grupo heterogéneo de alteraciones del desarrollo pulmonar, y muchas de ellas son asintomáticas; sin embargo, es importante conocerlas, pues deben entrar en el diagnóstico diferencial de aquellos pacientes con síndrome de dificultad respiratoria. Algunas de estas lesiones pueden coexistir, al punto de que el secuestro pulmonar puede presentarse con malformación adenomatoide quística tipo II en más del 50 de los casos. Aunque el diagnóstico definitivo para este tipo de lesiones es histológico, las imágenes desempeñan un papel importante para un acercamiento inicial. La historia natural de estas malformaciones pulmonares depende del tamaño de la masa pulmonar y el problema fisiológico que esta cause. La tomografía computarizada de multidetectores ha ampliado el conocimiento de la anatomía pulmonar y mejora la visualización del árbol traqueobronquial en la población pediátrica.

Utilidad de la iiopsia rectal en el diagnósticodel paciente pediátrico con esttreñimiento. experiencia de cinco años en un centro Colombiano de refreencia / The usefulness of rectal biopsy when diagnosing paediatric patients suffering from straining. Five year-experience in a Colombian reference centre (public hospital)

Antecedentes. El estreñimiento en la edad pediátrica es un problema de alta prevalencia que afecta aproximadamente al 8% de los niños. La mayoría de los pacientes no tienen una patología estructural de base y sólo en un pequeño porcentaje se encuentra una causa orgánica como las disganglionosis intestinales también llamadas neuropatías entéricas; es en estos casos donde la biopsia rectal juega un papel primordial para el diagnóstico. Objetivos. Determinar la incidencia de las neuropatías entéricas y las características de las biopsias colorectales realizadas para estudio del paciente con estreñimiento en el laboratorio de patología de la Fundación Hospital de la Misericordia en un periodo de cinco años. Material y métodos. Se revisaron y clasificaron las biopsias rectales remitidas para estudio por estreñimiento. Resultados. Se evaluaron 854 biopsias correspondientes a 272 casos, con un promedio de 3,13 muestras por paciente. En 183 casos se encontró histología normal (67,29%), en cincuenta y seis se estableció el diagnóstico de aganglionosis o enfermedad de Hirschsprung (20,59%), en dos el de displasia neuronal intestinal (DNI) (0.74%), 8 pacientes se consideraron sospechosos de DNI (2.94%) y los 22 restantes (8,1%) fueron informados como material inadecuado para el estudio de neuropatía entérica. Conclusiones. Las biopsias rectales son un método útil para el diagnóstico de las neuropatías entéricas, sin embargo un porcentaje de ellas no permiten una adecuada interpretación. La disganglionosis más frecuente en esta serie fue la enfermedad de Hirschsprung con 56 casos, seguida por la displasia neuronal intestinal con tan sólo dos pacientes.

Background. Straining occurs in around 8% of paediatric aged children. Most patients do not have base structural pathology and an organic cause, such as enteric neuropathy (also called Hirschsprung's disease or intestinal aganglionosis), is only found in a small percentage of them; rectal biopsy plays a vital role in diagnosis in such cases. Objectives. Determining enteric neuropathy prevalence and the characteristics of colorectal biopsies made by the Fundación Hospital de la Misericordia's pathology laboratory for studying patients suffering from straining over a five-year period (2005-2009). Materials and methods. Rectal biopsies sent for study regarding straining were reviewed and classified. Results. 854 biopsies from 272 cases were evaluated, giving an average of 3.13 samples per patient. Normal histology was found in 183 cases (67.29%), a diagnosis of Hirschsprung's disease or aganglionosis was established in 56 patients (20.59%), intestinal neuronal dysplasia (IND) in 2 of them (0.74%), clinical symptoms were considered suspicious for IND in 8 patients (2.94%) and the remaining 22 (8.1%) were reported as having unsuitable material for studying enteric neuropathy. Conclusions. Rectal biopsies are a useful method for diagnosing enteric neuropathy; however, some of them cannot be suitably interpreted. The most frequently occurring aganglionosis in this series of cases was Hirschsprung's disease (56 cases), followed by intestinal neuronal dysplasia with just two patients.

La teoría de las transiciones y la salud de la mujer en el embarazo y en el posparto / Transition Theory and Woman's Health from Pregnancy to Post-Delivery

Esta investigación es realizada con el propósito de explorar qué tanto la teoría de las transiciones soporta los hallazgos de la experiencia del embarazo y el postparto, y ara obtener un aporte de los datos a la teoría.Objetivo general: identificar los elementos que caracterizan las transiciones del embarazo y el posparto a la luz de la teoría de las transiciones.Objetivos específicos: 1) Comprender la experiencia de las mujeres durante la transición del embarazo y el posparto; 2) explorar sobre las habilidades y los recursos con los que cuenta la mujer para afrontar los cambios; 3) establecer las condiciones que se presentan durante las tansiciones del embarazo y el posparto que permiten lograr una tansición saludable.Metodología: en el 2004 se realizó una investigación de estudio de caso. Un caso fue la transición del embarazo y el otro fue la transición del posparto. Las mujeres participantes entraron al estudio en la semana 26 del embarazo y permanecieron en él hasta la octava semana del posparto. Se aplicaron instrumentos para valorar riesgo, sintomatología depresiva, calidad de vida y apoyo social. Se utilizó la visita domiciliaria y la entrevista en profundidad.Resultados: se identificaron la naturaleza, las condiciones y los indicadores de la transición. La noticia del embarazo y la lactancia son momentos críiticos. La participación del compañero es altamente valorada; la planificación; las expectativas reales y la experiencia previa contribuyen a una transición saludable.Conclusiones: la teoría de las tansiciones aporta elementos para guiar el cuidadi. Se encontró replicación literal y teórica, y un elemento adicional a la teoría, elde la dimensión esperitual.Recomendaciones: involucrar al compañero, apoyar a la mujer ante la noticia del embarazo y en la lactancia. Valorar la dimensión espirirtual y realizar investigación respecto a esta dimensión.

[Cardiovascular risk factors in children and teenagers aged 6-18 years old from Medellin (Colombia)]. / Factores de riesgo cardiovascular en niños de 6 a 18 años de Medellín (Colombia).

OBJECTIVE: To evaluate exposure to the major risk factors for cardiovascular disease in children from Medellín according to age, sex, type of school, and socioeconomic status. METHOD: We performed a descriptive study in 2611 children aged 6-18 years old from the city of Medellín in Colombia. Lipid profile, blood pressure, body mass index, diet, exercise, alcohol intake, and smoking were evaluated. RESULTS: Forty-six percent of the children drank alcohol, 8.7 % smoked and 50 % were physically inactive. Fat and carbohydrate intake was high in 48 % and 47 %, respectively. A total of 9.3 % of the children were overweight and 4.6 % were obese. Systolic and diastolic blood pressure were high in 1.3 % and 3.9 %, respectively. Mean high-density lipoprotein cholesterol (HDL-C) values were lower than in other populations, while triglyceride values were higher. Differences in serum lipid concentrations were found according to age and sex. The prevalence of risk factors according to the National Cholesterol Education Program criteria were: 19.1 % for HDL-C, 17.1 % for triglycerides, 17.0 % for low-density lipoprotein cholesterol (LDL-C), 13.5 % for total cholesterol (TC) and 22.9 % for TC/HDL-C. CONCLUSIONS: In children from the city of Medellín, the most prevalent cardiovascular risk factors were related to lifestyle. Mean plasma lipid concentrations varied according to age and sex. The prevalence of overweight was higher than in other populations in Colombia but was lower than that reported for other countries.

Factores de riesgo cardiovascular en niños de 6 a 18 años de Medellín (Colombia) / Cardiovascular risk factors in children and teenagers aged 6-18years old from Medellín (Colombia)

Objetivo: Evaluar la exposición a los principales factores de riesgo cardiovascular en los niños de Medellín, según edad, sexo, tipo de colegio y estrato socioeconómico. Método: Estudio descriptivo, en 2.611 niños de 6 a 18 años de Medellín (Colombia). Se evaluaron perfil lipídico, presión arterial, índice de masa corporal, consumo de alimentos, actividad física, consumo de bebidas alcohólicas y tabaco. Resultados La prevalencia del consumo de alcohol fue de 46 por ciento, la de tabaco 8,7 por ciento y la de sedentarismo del 50 por ciento. El 48 por ciento de los niños tenían dietas con alto contenido de grasas y el 47 por ciento con exceso de hidratos de carbono. El 9,3 por ciento de los niños presentaron sobrepeso, y el 4,6 por ciento, obesidad. Presentaron presión arterial sistólica (PAS) elevada el 1,3 por ciento de los niños, y la diastólica (PAD), 3,9 por ciento. Los promedios de colesterol de las lipoproteínas de alta densidad (c-HDL) fueron más bajos que en otras poblaciones y los triglicéridos más altos, los lípidos séricos mostraron diferencias según edad y sexo. Las prevalencias de riesgo según los puntos de corte de la National Cholesterol Education Program, fueron para: c-HDL, 19,1 por ciento; triglicéridos, 17,1 por ciento; colesterol de las lipoproteínas de baja densidad (c-LDL), 17,0 por ciento; colesterol total (CT), 13,5 por ciento, y CT/c-HDL, 22,9 por ciento. Conclusiones; En los niños de Medellín la mayor prevalencia de riesgo cardiovascular fue para los factores relacionados con el estilo de vida. Los promedios de las concentraciones de los lípidos plasmáticos presentaron diferencias según edad y sexo. La prevalencia de exceso de peso fue mayor que en otros niños colombianos e inferior a la comunicada por otros países (AU)

Tight junction proteins.

A fundamental function of epithelia and endothelia is to separate different compartments within the organism and to regulate the exchange of substances between them. The tight junction (TJ) constitutes the barrier both to the passage of ions and molecules through the paracellular pathway and to the movement of proteins and lipids between the apical and the basolateral domains of the plasma membrane. In recent years more than 40 different proteins have been discovered to be located at the TJs of epithelia, endothelia and myelinated cells. This unprecedented expansion of information has changed our view of TJs from merely a paracellular barrier to a complex structure involved in signaling cascades that control cell growth and differentiation. Both cortical and transmembrane proteins integrate TJs. Among the former are scaffolding proteins containing PDZ domains, tumor suppressors, transcription factors and proteins involved in vesicle transport. To date two components of the TJ filaments have been identified: occludin and claudin. The latter is a protein family with more than 20 members. Both occludin and claudins are integral proteins capable of interacting adhesively with complementary molecules on adjacent cells and of co-polymerizing laterally. These advancements in the knowledge of the molecular structure of TJ support previous physiological models that exhibited TJ as dynamic structures that present distinct permeability and morphological characteristics in different tissues and in response to changing natural, pathological or experimental conditions.

Confiabilidad de las predeterminaciones cefalométricas en cirugía ortognática / Reliability of cephalometric predeterminations in orthognathic surgery

La predeterminación cefalométrica en cirugía ortognática es una aproximación al resultado final que hacen el cirujano maxilofacial y el ortodoncista en la radiografía cefálica lateral prequirúrgica, con el fin de prever la dimensión de los movimientos en los tejidos duros y blandos que se realizarán en el paciente durante la cirugía. Esta técnica se ha utilizado como una herramienta diagnóstica valiosa, permitiendo al cirujano, al ortodoncista y al paciente tener una visión de los resultados que se van a obtener. En esta investigación se calculó el porcentaje de confiabilidad de las predeterminaciones cefalométricas hechas manualmente en treinta pacinetes sometidos a cirugía ortognática, comparando el número de variables que se aproximaban a lo esperado en un 95 por ciento. Se usaron las radiografías prequirúrgicas (T1) sobre las cuales se hizo el trazado cefalométrico, la predicción de los movimientos de los maxilares necesarios para cada paciente (T2) y la comparación con el trazado cefalométrico sobre las radiografías postquirúrgicas. Para determinar el porcentaje de confiabilidad se midió la distancia en punto cefalométricos de tejidos duros y blandos entre ambos trazos superpuestos (T2-T3). Estas medidas se compararon tanto sen sentido horizontal (plano de Frankfort) como en sentido vertical (plano de McNamara). Los resultados muestran cómo las predeterminaciones hechas sobre acetatos tienen alto porcentaje de confiabilidad en los movimientos del maxilar superior y la mandíbula, poer más en el plano vertical que horizontal. Por el contrario, la predeterminacion del mentón se comporta de una manera menos confiable, siendo menor la confiabilidad en el plano anteroposterior que en el vertical. Los resultados obtenidos están en concordancia con los reportados por otros autores, quienes consideran la predeterminación cefalométrica como una herramienta vital previa a la realización del plan de tratamiento ortodóntico-quirúrgico

Prepubertal boys' sexual behavior and behavior problems.

The increasingly early initiation of penetrative sexual practices and the implication for prevention of HIV and sexually transmitted diseases requires the study of childhood sexual behavior and its determinants. In adolescence, early sexual initiation is associated with other "problem behaviors" (Jessor & Jessor, 1977). To explore an analogous association for the middle childhood years, we studied 126 boys aged 5 to 11 years at increased risk for the development of conduct-disorder-related behavior with the Child Behavior Checklist (CBCL)/4-18 (Achenbach, 1991) and reevaluated 112 of them 15 months later. At both time points, the boys scored higher on the Sex Problems scale as well as on the nonsexual CBCL scales than Achenbach's nonclinical norm sample. Within the at-risk sample, the Sex Problems scale was significantly related to externalizing problem behaviors, but also to the other CBCL scales of behavioral/emotional problems. These data point to childhood precursors of the association observed by Jessor and Jessor (1977) in adolescence.

TQI in the Albuquerque Veterans Affairs Medical Center's long-term oxygen therapy program.

BACKGROUND: Long-term oxygen therapy (LTOT) is the only treatment demonstrated to prolong the life of patients with chronic obstructive pulmonary disease. In November 1994, a multidisciplinary total quality improvement (TQI) team composed of the involved hospital services was established to reorganize and improve the LTOT program at the Albuquerque Veterans Affairs Medical Center (AVAMC), Albuquerque. FROM THE OLD TO THE NEW PROCESS: The LTOT team used a process map to analyze the current process and gather information from patients and staff regarding their satisfaction with the program. It then began working on the identified problems and streamlining the LTOT referral process. A respiratory therapy position with the specific responsibility of serving as the home oxygen (O2) coordinator (HOC) was established and filled. The evaluation process was to be initiated by the AVAMC physicians, following which the HOC would perform a newly standardized evaluation that would establish the patient's need for O2 and result in a specific prescription. RESULTS: Quality indicators were selected to monitor changes in the program. Data from chart reviews, the Veterans Affairs National Cost Containment Center, and patient surveys were used to evaluate the indicators. Timeliness of referral to the program before inpatient discharge improved, O2 prescriptions in the new program more frequently addressed activity, and the cost per patient was reduced by 37.1%. Patient satisfaction rates also improved. DISCUSSION: A motivated team with representatives of the services involved was able to analyze and dramatically improve an important but complicated program.

The effect of lead exposure on behavior problems in preschool children.

OBJECTIVES: Interpreting associations between lead exposure and child behavior problems is difficult because studies have not controlled for sociodemographic confounders or have used shed teeth to mark exposure. This study explored associations between blood lead and preschool behavior. METHODS: Children from a smelter town and a non-lead-exposed town in Yugoslavia were followed up prospectively from pregnancy through age 3. The Child Behavior Checklist was used to assess behavior problems in 379 3-year-olds, controlling for sociodemographic factors and difficult infant temperament. RESULTS: Multiple regression revealed the expected significant associations between checklist subscales and sociodemographic factors, which explained 7% to 18% of the variance on the subscales. Concurrent blood lead explained a significant 1% to 4% of the variance on the Destructive and Withdrawn subscales. Earlier difficult temperament explained an additional 2% to 5% of the checklist variance. Scores on the Destructive subscale were consistently associated with blood lead. As blood lead increased from 10 to 20 micrograms/dL, subscale scores increased by approximately 0.5 points. CONCLUSIONS: Lead/behavior associations are significant but small compared with the effects of social factors.

Anatomía ecográfica de la próstata normal / Ultrasonography anatomy of the normal prostate

Después de la aparición de los trabajos de Mc Neal, la anatomía de la próstata se estudia en tres zonas que se articulan alrededor de dos estructuras canalares: la uretra prostática y los canales eyaculadores. El perfeccionamiento de los transductores en ecografía endocavitaria, permite reproducir parcialmente este modelo anatómico. La siguiente descripción en imagenología de la anatomía por zonas de la próstata es fundamental para entender mejor la morfología prostática cuyo estudio se orienta actulamente hacia la detección precoz y la extensión local de cáncer de próstata. La excelente resolución en contraste de la ecografía la hace el examen de elección para detectar una anomalía de la zona periférica de la próstata. La ecogra debe realizarsee por vía endocavitaria con transductores de 7-5 MHz. El doppler color contribuye al estudio de la vascularización de la próstata. La excelente resolución en contraste de la ecografía la hace el examen de elección para detectar una anomalía de la zona periférica de la próstata. La ecografía debe estar precedida de un tacto rectal por cuanto la información obtenida por la ecografía es de mayor utilidad cuando el tacto rectal es normal

Parenting predictors of early conduct problems in urban, high-risk boys.

OBJECTIVE: As part of a larger, prospective study, the authors examined concurrent and prospective relations among parenting and child antisocial behavior in inner-city boys at high risk for delinquent behavior. METHOD: One hundred twenty-six younger brothers (aged 6 to 10 years) of convicted delinquents in New York City and their parents were assessed; 15 months later 112 boys were reassessed. Demographics, parenting, and child diagnosis were examined as they relate to child externalizing behavior problems. Hierarchical multiple regression analyses predicted changes in Externalizing scores from year I parenting. RESULTS: At years I and II, 22% and 27% of boys, respectively, scored above the clinical cutoff for Externalizing. Controlling for earlier Externalizing, each of three domains of parenting still made significant independent contributions to later Externalizing scores, explaining 17% of the variance. Altogether this model explained 51% of the variance in year II Externalizing scores. CONCLUSIONS: Data support a cumulative risk model, whereby each of several adverse parenting factors further compounds the likelihood of child conduct problems.

Cardiac profile and disruptive behavior in boys at risk for delinquency.

The objective of this study was to examine associations in youth between antisocial behavior and cardiovascular profile. Younger brothers of adjudicated delinquents (N = 120) received a standardized psychiatric assessment and an assessment of three factors often studied in behavioral cardiology research: family history of hypertension, resting blood pressure, and obesity. As a group, relative to population norms, these youth exhibited signs of obesity and elevated blood pressure, with 30% of the sample appearing clinically obese and 24% having a blood pressure above the 90th percentile for national norms in their age cohort. Within the sample, score on the Child Behavior Checklist (CBCL) Delinquency scale correlated with blood pressure (r = .29-.34) and an index of obesity, weight/height3 (r = .20). Further, scores on the CBCL Delinquency, Aggression, and Externalizing scales were elevated in boys with a positive family history of hypertension. Among boys at risk for delinquency, disruptive psychopathology relates to factors often studied in behavioral cardiology research. Relationships between risk factors for ischemic cardiovascular disease and hostile behavior may be manifested with measures of disruptive psychopathology.