Markov-modulated model for landing flow dynamics: An ordinal analysis validation.

Air transportation is a complex system characterized by a plethora of interactions at multiple temporal and spatial scales; as a consequence, even simple dynamics like sequencing aircraft for landing can lead to the appearance of emergent behaviors, which are both difficult to control and detrimental to operational efficiency. We propose a model, based on a modulated Markov jitter, to represent ordinal pattern properties of real landing operations in European airports. The parameters of the model are tuned by minimizing the distance between the probability distributions of ordinal patterns generated by the real and synthetic sequences, as estimated by the Permutation Jensen-Shannon Distance. We show that the correlation between consecutive hours in the landing flow changes between airports and that it can be interpreted as a metric of efficiency. We further compare the dynamics pre and post COVID-19, showing how this has changed beyond what can be attributed to a simple reduction of traffic. We finally draw some operational conclusions and discuss the applicability of these findings in a real operational environment.

Role of artificial intelligence in multidisciplinary imaging diagnosis of gastrointestinal diseases.

The use of artificial intelligence-based tools is regarded as a promising approach to increase clinical efficiency in diagnostic imaging, improve the interpretability of results, and support decision-making for the detection and prevention of diseases. Radiology, endoscopy and pathology images are suitable for deep-learning analysis, potentially changing the way care is delivered in gastroenterology. The aim of this review is to examine the key aspects of different neural network architectures used for the evaluation of gastrointestinal conditions, by discussing how different models behave in critical tasks, such as lesion detection or characterization (i.e. the distinction between benign and malignant lesions of the esophagus, the stomach and the colon). To this end, we provide an overview on recent achievements and future prospects in deep learning methods applied to the analysis of radiology, endoscopy and histologic whole-slide images of the gastrointestinal tract.

Contrasting chaotic with stochastic dynamics via ordinal transition networks.

We introduce a representation space to contrast chaotic with stochastic dynamics. Following the complex network representation of a time series through ordinal pattern transitions, we propose to assign each system a position in a two-dimensional plane defined by the permutation entropy of the network (global network quantifier) and the minimum value of the permutation entropy of the nodes (local network quantifier). The numerical analysis of representative chaotic maps and stochastic systems shows that the proposed approach is able to distinguish linear from non-linear dynamical systems by different planar locations. Additionally, we show that this characterization is robust when observational noise is considered. Experimental applications allow us to validate the numerical findings and to conclude that this approach is useful in practical contexts.

Empatía en estudiantes de fisioterapia: tendencia por curso y género. Declinación empática / Empathy in physiotherapy students: Trend by course and gender. Empathy decline

Introducción: La empatía es un concepto importante en la interacción entre el profesional fisioterapeuta y el paciente, y contribuye a una mejor atención del mismo. La formación empática en estudiantes de fisioterapia debe ser asumida por las universidades desde el primer año de estudio por el carácter complejo de este atributo; sin embargo, cualquier intervención debe estar precedida por un diagnóstico empático exhaustivo. Objetivo: Determinar los niveles de empatía y de sus componentes en estudiantes de fisioterapia según los factores curso y género. Material y métodos: Estudio exploratorio y de corte transversal. Se estudió una muestra de 191 estudiantes. Los datos de empatía fueron recogidos mediante la aplicación de la escala de empatía de Jefferson. Fueron estimadas la mediana, los cuartiles 1 y 3, la diferencia intercuartílica y el intervalo de confianza de la mediana. Se estudiaron las posibles diferencias en la empatía y sus componentes mediante pruebas no paramétricas (mediana de Mood). Resultados: Hubo diferencias en la empatía y en el componente cuidado con compasión en el factor curso. Se manifiesta la declinación empática en el componente cuidado con compasión. La empatía y sus componentes no se diferenciaron en el género. Conclusiones: La diferencia encontrada en la empatía y en el componente cuidado con compasión, la ausencia de diferencias de empatía entre los géneros y la manifestación de declinación empática solo en el componente cuidado con compasión constituyen características específicas en los estudiantes examinados y representan un diagnóstico empático concreto y se constituye en la base para elaborar una estrategia de intervención que debe ser coherente con estos resultados

Introduction: Empathy is an important concept in the interaction between the physiotherapist and the patient, and contributes to a better care of the patient. Empathy training in physiotherapy students must be taught by the universities from the first year of study because of the complex character of this attribute. However, any intervention must be preceded by a comprehensive empathy diagnosis. Objective: To determine the levels of empathy and its components in physiotherapy students according to course and gender factors. Material and methods: Exploratory and cross-sectional study conducted on a sample of 191 students. The empathy data was collected by applying the Jefferson Empathy Scale. The median, 1st and 3rd quartile, interquartile difference and confidence interval of the median were estimated. The possible differences in Empathy and its components were analysed using of non-parametric tests (Mood's median). Results: There were differences in empathy and in the compassionate care component in the course factor. The empathy decline in the compassionate component was observed. Empathy and its components did not differ by gender. Conclusions: The differences found in empathy and in the compassionate care component, the absence of empathy differences in empathy between the genders, and observation of a decline in empathy only in the compassionate care component, were specific characteristics in the students examined. These represent a specific empathy diagnosis, and are the basis for developing an intervention strategy consistent with these results

Methodology to assess quality of estimated disturbances in active disturbance rejection control structure for mechanical system.

A methodology to assess the quality of estimation of disturbances in mechanical systems, by state observers, in the control structure with active compensation of disturbances (ADRC) is presented. Evaluation is carried out by four performance indices that depend on the steady-state error between reference signals and output of the plant. These indices are related with the accuracy and precision of the closed loop system in the sense of norms L2 and L∞, for a set of reference signals representing the typical operating conditions of the mechanism. The effectiveness of the methodology is illustrated with the quality assessment of the estimated disturbance of five state observers to control of a simple pendulum and validated on a SCARA robot arm.

Perfil clínico radiológico de 18 pacientes con síndrome antisintetasas atendidos en Policlínico de Pulmón Reumatológico, Instituto Nacional del Tórax / Clinic and radiologic profile of 18 patients with antisynthetase syndrome, treated in a Rheumatologic Lung Disease Clinic, Instituto Nacional del Torax

Connective Tissue Diseases (CTD) can manifest as Interstitial lung disease (ILD). ILD is a common manifestation of Anti-synthetase syndrome (AS). The main pattern of ILD in AS is nonspecific interstitial pneumonia (NSIP) with or without elements of organizing pneumonia (OP). Other less common forms include usual interstitial pneumonia (UIP) and nonspecific forms. Objectives: Describe radiological and clinical profile of 18 patients with ILD due to AS, evaluated in Instituto Nacional del Torax (INT) between 2013 and 2015. Highlighting the importance of Myositis Panel in patients being evaluated for ILD. Methods: Review of clinical records and lung CT of 76 patients with ILD and suspected AS, seen at INT between august 2013 and July 2015. Results: The diagnosis of AS was made in 18 of 76 patients, with female predominance and mean age of 46.5 years . In most patients the diagnosis of AS and ILD was simultaneous. The most frequent AS antibody was Jo-1, followed by PL-12. Less than half had ANA (+). The predominant radiographic pattern was NSIP / OP. Half of the patients had myositis. Conclusions: AS should be suspected in patients under study for ILD, especially NSIP / OP, and may occur without myositis and with negative ANA. It is essential to have new immunological tests such as a Myositis Panel, which will allow us to diagnose AS with subtle clinical features and negative or inconclusive serology...

Las Enfermedades del tejido conectivo (ETC) se pueden manifestar como Enfermedad Pulmonar Difusa (EPD). El Síndrome Antisintetasas (SAS) con mucha frecuencia presenta EPD. La forma de expresión más frecuente en SAS es la neumonía intersticial no específica (NSIP) con o sin elementos de neumonía en organización (OP). Otras formas menos frecuentes son la neumonía intersticial usual (UIP) y formas inespecíficas. Objetivos: Describir el perfil clínico radiológico de 18 pacientes con EPD secundaria a SAS, atendidos en el Instituto Nacional del Tórax (INT) entre los años 2013 y 2015. Destacar la importancia del Panel de Miositis en pacientes con EPD en estudio. Métodos: Revisión de ficha clínica y TAC pulmonar de 76 pacientes con EPD y sospecha de SAS, atendidos en INT entre agosto 2013 y julio 2015. Resultados: En 18 de 76 pacientes se hizo el diagnóstico de SAS, predominio femenino, edad promedio 46,5 años. En la mayoría el diagnóstico reumatológico y pulmonar fue simultáneo, el anticuerpo antisintetasa más frecuente fue Jo-1, seguido de PL 12. Menos de la mitad tuvo ANA (+). El patrón radiológico predominante fue NSIP/OP. La mitad de los pacientes no presentaron miositis. Conclusiones: El SAS debe ser sospechado en el estudio de pacientes con EPD, especialmente NSIP/OP y se puede presentar sin miositis y ANA (-). Es indispensable contar con nuevos exámenes inmunológicos como el Panel de Miositis, que permite diagnosticar SAS con clínica sutil y serología habitual negativa o no concluyente...

Resección transuretral de próstata, comparación de técnica bipolar versus monopolar / Transurethral resection of prostate: comparing bipolar versus monopolar technique

La resección transuretral de próstata (RTUP) es el tratamiento estándar de los síntomas del tracto urinario inferior (STUI), secundarios a obstrucción por crecimiento prostático benigno. El avance tecnológico hace necesario realizar estudios para determinar si todas las técnicas disponibles son igualmente efectivas y seguras que la estándar. Objetivo comparar la RTUP bipolar con la RTUP monopolar, analizando resultados sintomáticos, uroflujométricos y las complicaciones asociadas. Se analizaron pacientes sometidos a RTUP mono y bipolar entre los años 2009 y 2011. El análisis se realizo con Stata 11.2. Resultados: Se analizaron 63 pacientes, un 55 por ciento de ellos fueron sometidos a RTU monopolar y el 45 por ciento a bipolar. El promedio de edad de ambos grupos fue de 66 años. El volumen prostático promedio del grupo monopolar fue de 58.65cc, y del grupo bipolar 67.44 .La mediana del Score IPSS pre-operatorio del grupo monopolar y bipolar fue de 20 y 22 respectivamente, y el post operatorio fue de 4 y 3, siendo la diferencia pre y post operatoria estadisticamente significativa (p=0.006) pero no es significativa al comparar ambos grupos. El Q max promedio pre y post-operatorio en el grupo monopolar fue de 9.08 y 16.8 ml/seg y en el grupo bipolar fue de 6.8 y 16.2 ml/seg. respectivamente. Las diferencias entre los Q máx pre y post quirúrgicos en ambos grupos fue significativa (p<0.001) , pero no al comparar las dos técnicas. El tiempo quirúrgico promedio fue de 58 min para el grupo monopolar y de 64.5 min para el bipolar, siendo esta diferencia significativa (p=0.01). El promedio de tejido resecado para el grupo monopolar fue de 24.9g. y de 29.6g para el grupo bipolar siendo significativa esta diferencia (p=0.04). No hubo diferencias entre ambos grupos al analizar hematocrito y sodio pre y post quirúrgico, días de hospitalización, días de sonda y proporción de complicaciones: síndrome post RTU, hematuria, infecciones, retención aguda de...

Transurethral resection of Prostate (TURP) is the Standard treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction growth. Technological advancement is necessary to conduct studies to determine whether all available techniques are equally effective and safe as standart.To compare bipolar TURP with monopolar TURP, analyzing results symptomatics uroflujometics and associated complications. Patients undergoing monopolar and bipolar TURP between 2009 and 2011. The analysis was perfomed using Stata 11.2. Results: We analyzed 63 patients, 55 percent of them underwent monopolar TURP and 45 percent for bipolard. The average age of both group was 66 years. The group mean prostate volume was 58.65 cc monopolard and bipolar group 67.44 . The median preoperative IPSS Score of monopolardand bipolar group was 20 and 22 respectively, an postoperatively was 4 and , the difference before and after surgery stadisticament significant (p=0.006) but not significant when comparing both groups. The average Q max pre and postoperative in the monopolar group was 9.08 and 8.16 ml/sec and in the bipolar group was 6.8 and 16.2 ml/sec respectively. The differences between pre and post surgical Q max in both groups was significant (p< 0.001), but not to compare the two techniques. Mean operative time was 58 min for the monopolar group and 64.5 min for bipolar, this difference was significant (p=0.01). The average for the group resected tissue was 24.9 gr for the monopolar, and 29.6 gr for the bipolar group this difference was significant (p=0.04). There were no difference between the two groups to analyze hematocrit and sodium pre and post surgical, hospital days, days of probe and rate of complications: post TURP syndrome, hematuria, infection, acute urinary retention...

Thermodynamics in a complete description of Landau diamagnetism.

In the present study we analyze some consequences that come from revised measures as the Wehrl entropy and the Fisher information for the problem of a particle in a magnetic field starting from a complete description of the Husimi function. We discuss in the most complete form (three dimensions) some results related to measures in contrast with the incomplete form (two dimensions) shown in previous contributions. Some limiting cases as high and low temperatures are discussed. From the present reasoning, it is suggested that the formulation in two dimensions is sufficient unto itself to explain the problem whenever the length of the cylindrical geometry of the system is large enough. Otherwise, it is not possible to work in all finite temperatures, a natural lower temperature bound emerges from the analysis when three dimensions are considered.

Effect of light and sweeteners on color in an amaretto-type liqueur.

Studies on the color loss in an amaretto-type liqueur under controlled light conditions showed a clear dependence of the decoloration rate on the light intensity, and complete color stability in the absence of light. The principal sweetener used in the preparation of the liqueur strongly affected the rate of color loss under irradiation, color stability being much greater for the formulations containing sucrose or no added sweetener instead of fructose 42. These differences were more pronounced in experiments conducted with chemically well-defined mixtures that contained either of the 2 azo dyes used in the coloration of the amaretto, tartrazine, and Allura Red, and various alternative sweeteners, in 28% (v/v) ethanol solution: D-fructose and, to a lesser extent, D-glucose, at concentrations of 14% (w/v), were effective in bringing about photodecoloration, while no color loss was detected in the presence of sucrose, or in the absence of any added sugar. The results are interpreted in terms of a redox reaction of reducing sugars with the diarylazo compounds, the function of the light being the conversion of the azo compound from the predominant trans configuration to the cis configuration, which on geometric grounds lends itself better to a concerted, cyclical redox reaction with the reducing sugar.

A gamma-ray burst at a redshift of z approximately 8.2.

Long-duration gamma-ray bursts (GRBs) are thought to result from the explosions of certain massive stars, and some are bright enough that they should be observable out to redshifts of z > 20 using current technology. Hitherto, the highest redshift measured for any object was z = 6.96, for a Lyman-alpha emitting galaxy. Here we report that GRB 090423 lies at a redshift of z approximately 8.2, implying that massive stars were being produced and dying as GRBs approximately 630 Myr after the Big Bang. The burst also pinpoints the location of its host galaxy.

[Health surveillance of workers exposed to asbestos: an example of cooperation between the occupational prevention system and the national health system]. / La Vigilancia de la Salud de los trabajadores expuestos al amianto: ejemplo de colaboracion entre el sistema de prevencion de riesgos laborales y el sistema nacional de salud.

The Ministry of Health and Consumer Affairs and the Autonomous Governments of Spain have designed and agreed by consensus with the sanitary professionals and major employer's organizations and Unions a Integral Health Surveillance Programme of asbestos-exposed workers, in order to assure appropriate, uniform and harmonized action throughout the national territory with relation to these workers. PROGRAM DESCRIPTION: This initiative started from the Occupational Health Working group of the Interterritorial Council, with inputs from the Asbestos Working Group of the National Occupational Safety and Health Commission. It was agreed with occupational medicine and infirmary professionals and was approved by the Health and Labour authorities. The program is organised in seven main activities. CURRENT PROGRAM STATUS: two years after the Programme approval a total of 5778 workers are included in the Registry of asbestos-exposed workers. 208 workers have COPD, 198 benign pleural disease, 8 lung cancer, 10 mesothelioma and 7 workers have other cancers possibly related to asbestos (gastric, larynx and colon cancer). REMARKS: the agreement and participation reached in this Programme allow achieving much higher coverage of occupational prevention policies than those obtained with a mere law approval, as we could see during the second year of implementation of the Programme in which the number of attended workers has doubled.

La vigilancia de la salud de los trabajadores expuestos al amianto: ejemplo de colaboración entre el sistema de prevención de riesgos laborales y el sistema nacional de salud / Health surveillance of workers exposed to asbestos: an example of co-operation between the occupational prevention system and the national health system

El Ministerio de Sanidad y Consumo y las Comunidades Autónomashan diseñado y consensuado con los profesionales sanitariosy las organizaciones empresariales y sindicales representativas unPlan Integral de Vigilancia de la Salud de los Trabajadores que hanestado expuestos a Amianto, con el objetivo de garantizar una intervenciónadecuada, uniforme y armonizada de estos trabajadores entodo el territorio nacional. La elaboración del Programa partió delGrupo de Trabajo de Salud Laboral del Consejo Interterritorial, seenriqueció con las aportaciones del Grupo de Trabajo Amianto de laComisión Nacional de Seguridad y Salud en el Trabajo, fue consensuadocon los profesionales de la medicina y enfermería del trabajo,y fue aprobado por las autoridades sanitarias y laborales. El Programaconsta de siete grandes bloques de actividades. Dos años despuésde aprobado el Programa, el estado de implantación en las ComunidadesAutónomas es desigual. Las principales dificultades para supuesta en marcha se encuentran en la elaboración del Registro deexpuestos. Un total de 5.778 trabajadores están incluidos en el Registro.208 trabajadores tienen EPOC, 198 alteraciones pleurales benignas,8 cáncer de pulmón, 10 mesotelioma y 7 presentan otros cáncerescon posible relación con el amianto (gástrico, de laringe y colon). El consenso y la participación alcanzados alrededor de este Programaestán permitiendo lograr coberturas de las políticas de prevenciónde riesgos laborales muy superiores a las que se consiguen conla mera actuación institucional y elaboración de normativa, ya que ensólo los dos primeros años de implantación del Programa se ha duplicadoel número de trabajadores atendidos

The Ministry of Health and Consumer Affairs and the AutonomousGovernments of Spain have designed and agreed by consensuswith the sanitary professionals and major employer's organizationsand Unions a Integral Health Surveillance Programme ofasbestos-exposed workers, in order to assure appropriate, uniformand harmonized action throughout the national territory with relationto these workers. Program description: this initiative startedfrom the Occupational Health Working group of the InterterritorialCouncil, with inputs from the Asbestos Working Group of theNational Occupational Safety and Health Commission. It was agreedwith occupational medicine and infirmary professionals and wasapproved by the Health and Labour authorities. The program isorganised in seven main activities. Current Program status: twoyears after the Programme approval a total of 5,778 workers areincluded in the Registry of asbestos-exposed workers. 208 workershave COPD, 198 benign pleural disease, 8 lung cancer, 10 mesotheliomaand 7 workers have other cancers possibly related toasbestos (gastric, larynx and colon cancer). Remarks: the agreementand participation reached in this Programme allow achievingmuch higher coverage of occupational prevention policies than those obtained with a mere law approval, as we could see duringthe second year of implementation of the Programme in which thenumber of attended workers has doubled

Measuring colonic transit time in chronic idiophatic constipation.

INTRODUCTION AND OBJECTIVES: Colonic transit time can define three types of delay: right colon (colonic inertial), left colon and recto sigmoid. The aim of this study is to compare clinic characteristics and manometric results among the different groups with segmental colonic transit disorder. PATIENTS AND METHODS: 61 subjects were included in our study (5 men and 56 women) with and average age of 47.5 years (range: 17-84 years). We carried our a study of segmental and total colonic transit time, with the use of radio-opaque markers and sequential abdominal X-rays. We considered that transit time was prolonged when it was longer than 72 hours, and segmental transit time, when right colon was longer than 22 hours, left colon 37.2 hours and recto-sigmoid 37.2 hours. We included different clinic data: age, sex, place of residence stool frequency, abdominal pain, painful evacuation, incomplete evacuation, evacuation desire, dietary fibre intake, use of laxatives. We practised anorectal manometry in 20 patients. RESULTS: The average total colonic transit time was 38.2 hours in normal transit and 103 hours with disorder. The frequency in the three colonic segments, when there was a long total colonic transit time, was: 40% in the left colon, 33% in the recto-sigmoid and 27% in the right colon. We analysed the clinical characteristics of these three groups, finding more frequency of painful evacuation and defecation desire and lower dietary fibre intake in recto sigmoid. The most important abnormality in anorectal manometry was the hiposensitivity in the anorectal area, that only appeared in subjects with long segmental transit time in the right colon (colonic inertia), statistically significant. CONCLUSIONS: The measurement of colonic transit time with radio-opaque markers is a simple technique that allows for the objective detection of the different groups of patients with chronic idiopathic constipation. The exact typification of the abnormality is important for the individualization of each treatment.

Relationship between degree of cellular differentiation in colorectal cancer and topographical distribution.

OBJECTIVES: To demonstrate the relationship between degree of cellular differentiation in colorectal cancer and topographical distribution in 215 patients diagnosed with colorectal cancer from 1997 to 2000. MATERIAL AND METHODS: 215 patients (129 men and 86 women) were studied prospectively with a mean age of 64 years (range: 23-84 years). In all patients we performed a full colonoscopy with several biopsies (in patients with colon stenosis we used barium enema), radiographic studies (CT, abdominal ultrasounds), and laboratory tests for serum tumour markers (CEA, Ca 19-9, alpha-fetoprotein). The topographic location of colorectal cancer was: rectum 35%, sigmoid colon 31%, descending colon 10%, transverse colon 6%, ascending colon 9%, caecum 5%, and we included anorectal cancer 4%. RESULTS: According to histological differentiation we found: A) well-differentiated tumours 101/215 (47%); B) moderately-differentiated tumours 98/215 (45.5%), and C) poorly-differentiated tumours 16/215 (7.5%). We found no significant association among histological differentiation, topographic location, stage according to the Astler-Coller classification, sex or age (p = ns). The prevalence of well-differentiated tumours in men was 49% and 43% in women; of moderately-differentiated cancers in men was 43%, and 49% in women; for poorly-differentiated tumours in men was 7.5%, and 7.2% in women. Regarding tumour location, 165 cancers were found in the left colon: 80 were well differentiated, 77 moderately differentiated and 8 poorly differentiated. In the transverse colon we found 12 tumours: 7 well differentiated, 3 moderately differentiated and 2 poorly differentiated. 30 cancers were localized in the right colon: 11 well differentiated, 15 moderately differentiated and 4 poorly differentiated. In the anorectum 8 tumours were found: 3 well differentiated, 3 moderately differentiated and 2 poorly differentiated. According to staging classification, well differentiated tumours (101/215) were more common in Dukes' C2 (20.7%) and B1 (32.6%), moderately differentiated cancers (98/215) were in B1 (28.5%) and C2 (20.4%), and poorly differentiated tumours (16) were more common in Dukes' C2 (25%), without differences among other stages (p = ns). CONCLUSIONS: According to our results we have found that histological differentiation of colorectal cancer has no association with topographic location, and it is independent of sex or age. We have not found any relationship either between histological differentiation and stage in the Astler-Coller classification, but well differentiated cancers were more common at any location, age or sex.

Ranitidine bismuth citrate in the treatment of Helicobacter pylori infection.

OBJECTIVE: Examine the effectiveness of treatments that include ranitidine bismuth citrate (RBC) for Helicobacter pylori infection. DESIGN: Prospective and randomised study. PATIENTS AND METHOD: 137 patients were included (62 women, 75 males, average age 46.9 +/- 13) diagnosed with peptic ulcer and infection by Helicobacter pylori. None had received treatment previously. 67 patients were treated with RBC 400 mg bd and clarithromycin 500 mg bd for 14 days, and 70 patients with RBC 400 mg bd, clarithromycin 500 mg bd and amoxycillin 1 g bd for 7 days. The infection eradication was proven eight weeks after treatment end. The efficacy of treatment was evaluated using the intention-to-treat method. The Chisquare test (chi 2) was used for the statistical analysis of data. RESULTS: Infection in 48 out of 67 patients (71.64%) treated with RBC-clarithromycin for 14 days was eradicated, versus 88.57% (62 out of 70) among those treated with RBC-clarithromycin-amoxycillin for 7 days, with a significant difference between both regimens (p < 0.05). CONCLUSIONS: 7-day treatment with RBC-clarithromycin-amoxycillin has a good eradication rate (88.57%) and represents a valid alternative to regimens including a PPI and two antibiotics, as both regimens have a similar efficacy. Results obtained with the double therapy of RBC-clarithromycin for 14 days were not satisfactory, the rate of eradication being 71.64%. The use of an RBC treatment for Helicobacter pylori infection should always be accompanied by two antibiotics in a triple therapy.

Effectiveness of hemorrhoidal treatment by rubber band ligation and infrared photocoagulation.

OBJECTIVES: To demonstrate the effectiveness of the treatment of internal hemorrhoids with rubber band ligation (RBL) and infrared photocoagulation (IRC). PATIENTS AND METHODS: From march 1996 to december 1999, we prospectively studied 358 patients with a total of 817 hemorrhoid groups and a follow-up period of 36 months. Distribution according to gender and age was: 210 men with a mean age of 46 years and 148 women with a mean age 45.8 years. The mean number of hemorrhoids treated per patients was 2.3. All of them had complete a follow-up protocol at 15, 30, 60 and 180 days and at 12, 24 and 36 months. Rubber band ligation was performed with McGown ligator and suction pump, placing the band at the base of the hemorrhoid. For the infrared coagulation we used a Lumatec coagulation system, applying at least four shoots around each hemorrhoid, with an exposition time ranging between 1 and 1.5 seconds. Treatment was considered effective when patients became asymptomatic (relief of pain, bleeding or anal itching) and the obliteration of hemorrhoids after the treatment was confirmed by anal inspection and anoscopy. RESULTS: Two hundred ninety five of 358 patients were treated with RBL (82.4%), this treatment being effective in 98% of the patients after 180 days and very good after 36 months. There were 6/295 relapses at 36 months (2%). All minor and major complications were observed within the first 15 days of treatment: rectal tenesmus in 96/295 patients (32.5%), mild anal pain in 115/295 (38.9%), self-limited and mild bleeding after the detachment of the bands in 30/295 (10%), and febricula in one patient. Sixty three of 358 patients were treated with IRC (17.6%). In this group, relapses were observed in 6/63 patients (9.5%) at 36 months, all of them with grade III hemorrhoids that required additional treatment with RBL. All the complications (inherent to the technique) were observed within the first days: mild anal pain in 40/63 patients (63.4%) and mild bleeding in 1/63 (1.6%). The treatment with RBL or IRC depended on the number of hemorrhoids and the hemorrhoidal grade. No significant differences were found regarding the effectiveness between RBL and IRC for the treatment of grade I-II hemorrhoids, while RBL was more effective for grade III and IV hemorrhoids (p < 0.05). CONCLUSION: RBL and IRC should be considered as a good treatment for all grades of hemorrhoids, due to its effectiveness, its cost-benefit and its small short and long-term morbidity.

Further observations on the interaction between sugar cane and Gluconacetobacter diazotrophicus under laboratory and greenhouse conditions.

Sugar cane (Saccharum spp.) variety SP 70-1143 was inoculated with Gluconacetobacter diazotrophicus strain PAL5 (ATCC 49037) in two experiments. In experiment 1 the bacteria were inoculated into a modified, low sucrose MS medium within which micropropagated plantlets were rooted. After 10 d there was extensive anatomical evidence of endophytic colonization by G. diazotrophicus, particularly in lower stems, where high numbers of bacteria were visible within some of the xylem vessels. The identity of the bacteria was confirmed by immunogold labelling with an antibody raised against G. diazotrophicus. On the lower stems there were breaks caused by the separation of the plantlets into individuals, and at these 'wounds' bacteria were seen colonizing the xylem and intercellular spaces. Bacteria were also occasionally seen entering leaves via damaged stomata, and subsequently colonizing sub-stomatal cavities and intercellular spaces. A localized host defence response in the form of fibrillar material surrounding the bacteria was associated with both the stem and leaf invasion. In experiment 2, stems of 5-week-old greenhouse-grown plants were inoculated by injection with a suspension of G. diazotrophicus containing 10(8) bacteria ml(-1). No hypersensitive response (HR) was observed, and no symptoms were visible on the leaves and stems for the duration of the experiment (7 d). Close to the point of inoculation, G. diazotrophicus cells were observed within the protoxylem and the xylem parenchyma, where they were surrounded by fibrillar material that stained light-green with toluidine blue. In leaf samples taken up to 4 cm from the inoculation points, G. diazotrophicus cells were mainly found within the metaxylem, where they were surrounded by a light green-staining material. The bacteria were growing in relatively low numbers adjacent to the xylem cell walls, and they were separated from the host-derived material by electron-transparent 'haloes' that contained material that reacted with the G. diazotrophicus antibody.

El uso del miedo en los mensajes de salud / Use of fear in health messages

Gran parte de las intervenciones en promoción de salud y prevención de la enfermedad incluyen mensajes, dirigidos a la población, que se basan en las consecuencias negativas para la salud que acarrea una determinada conducta. De esta forma se pretende conseguir la adherencia del público a las recomendaciones que, habitualmente, son transmitidas en el mismo mensaje. Estas comunicaciones que utilizan la amenaza como elemento persuasivo fundamental han sido llamadas «mensajes de miedo» y, a pesar de la frecuencia con que se utilizan, su eficacia para promover las conductas que recomiendan está sujeta a controversia. Distintos autores han llegado a la conclusión de que el uso de la amenaza en los mensajes de salud parece influir en el desarrollo posterior de actitudes y conductas preventivas. Esto, no significa, sin embargo, que los mensajes amenazadores tengan necesariamente consecuencias positivas. Para ello deben cumplir dos condiciones básicas: provocar la atención del sujeto en lugar de miedo e incluir una recomendación para eliminar la amenaza del mensaje, que sea percibida por el sujeto como eficaz y fácil de realizar. De estas condiciones se derivan una serie de recomendaciones prácticas para el desarrollo de mensajes de promoción de salud (AU)

Many activities in health promotion and disease prevention address to the target group messages which are based in the negative consequences for health linked to a certain behavior. This infomation is supposed to promote adherence to the recommendations that are usually included in the same message. These kind of communications, which use threat as the basic persuasive strategy, are defined as «fear appeals» and, in spite of being a frequent resource for practicioners their effectiveness to promote the recommended behaviors have caused much controversy. In trying to answer this question several authors have concluded that the use of threat in health messages can influence the subsequent development of preventive attitudes and behaviors. However, this does not mean that fear appeals necessarily have positive consequences. To achieve its objective threat messages must meet two basic conditions: they must induce attention, instead of fear, in the subject; and be accompanied by a recommendation percibed as effective to avoid the threat and easily carried out by the subject. Some practical advices for the developmente of health promotion messages are derived from these two conditions (AU)

¿Son la ocupación y la educación intercambiables como indicadores sociales en salud comunitaria? Un estudio en población ocupada / ¿Are education and occupation interchangeable as social indicators in community health? a study on employed people

Objetivo. Los estudios epidemiológicos y las intervenciones para reducir las desigualdades en salud en la comunidad requieren la asignación de indicadores socioeconómicos exhaustivos y fáciles de obtener. Dos de los más utilizados son la ocupación y la educación. En este estudio pretendemos evaluar la asociación entre educación y ocupación en población adulta ocupada, por si, en ausencia de una variable, fuera posible utilizar la otra con la menor pérdida posible de información sobre nivel socioeconómico. Diseño. A partir de una muestra representativa (n = 3.091) de población general (18-65 años), tomada de una encuesta de prevalencia sobre factores de riesgo de enfermedades crónicas realizada en la Región de Murcia, se ha realizado un análisis (log)lineal entre educación y ocupación en la población ocupada (65,8 por ciento varones y 34,2 por ciento mujeres de la muestra total). Resultados. Los varones presentan una asociación significativa entre las posiciones directivas y la educación universitaria. La asociación se reduce entre la ocupación en tareas administrativas y la categoría de estudios secundarios, para incrementarse en los trabajadores manuales con estudios primarios o sin estudios. En las mujeres, con un menor número de efectivos, la asociación educación-ocupación describe el mismo patrón, incluso con mayor magnitud en las asociaciones entre las clases directivas y el nivel educativo universitario. En varones y mujeres las mayores asociaciones se encuentran en ambas diagonales de las tablas de educación por ocupación, indicando: a mejor ocupación, mayor educación, y lo contrario. Conclusión. La clasificación de la gente con trabajo de acuerdo con la educación y la ocupación presenta: asociación, consistencia interna y gradiente. En ausencia de información exhaustiva sobre ocupación, la educación puede ser una alternativa como indicador de nivel socioeconómico (AU)

Intraepithelial lymphocytes and coeliac disease: permanent changes in CD3-/CD7+ and T cell receptor gammadelta subsets studied by flow cytometry.

UNLABELLED: Permanent changes in intestinal intraepithelial lymphocytes have been observed in coeliac patients. The aim of this investigation was to study small intestinal intraepithelial lymphocytes by using flow cytometry and to evaluate its diagnostic value in coeliac disease. Three-colour flow cytometry analyses were performed on isolated epithelial cells of 117 intestinal biopsies obtained from 113 children (54 coeliac disease, 4 other enteropathies, 18 Helicobacter pylori associated gastritis and 37 normal controls). A multiple logistic regression model was developed to select the best intraepithelial lymphocytes subset predictor of coeliac disease. Coeliac patients had significant higher levels of T cell receptor gammadelta intraepithelial lymphocytes than control patients (p < 0.01), H. pylori patients (p < 0.01) and other enteropathies (p < 0.05). The density of CD3-/CD7+ intraepithelial lymphocytes, a intraepithelial lymphocyte subset poorly characterized by immunohistochemical methods, was significantly lower in coeliac patients than in the control group (p < 0.01). H. pylori group (p < 0.01) and other enteropathies (p < 0.01). Both changes remained altered independent of the coeliac patient's diet. The data were used on a logistic regression analysis in order to calculate sensitivity [94.4%; 95% confidence interval (CI) 83.7-98.6%], specificity (94.9%; 95% CI 84.9-98.7%) and likelihood ratio for a positive test 18.5 (95% CI 6.1-55.8) in the diagnosis of coeliac disease. CONCLUSION: Changes in T cell receptor gammadelta and CD3-/CD7+ intraepithelial lymphocytes subsets are permanently observed in paediatric coeliac disease. Their assessment, by three-colour flow cytometry on routine diagnostic biopsies, permits a better characterization of coeliac enteropathy and represents a valuable procedure to identify coeliac patients with different clinical presentations.