Weight loss and quality of life in patients surviving 2 years after gastric cancer resection.

BACKGROUND: Malnutrition is common in patients undergoing gastric cancer resection, leading to weight loss, although little is known about how this impacts on health-related quality of life (HRQL). This study aimed to explore the association between HRQL and weight loss in patients 2 years after curative gastric cancer resection. METHODS: Consecutive patients undergoing curative gastric cancer resection and surviving at least 2 years without disease recurrence were recruited. Patients completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the specific module for gastric cancer (STO22) before and 2 years postoperatively and associations between HRQL scores and patients with and without ≥ 10% body weight loss (BWL) were examined. RESULTS: A total of 76 patients were included, of whom 51 (67%) had BWL ≥10%. At 2 years postoperatively, BWL ≥10% was associated with deterioration of all functional aspects of quality of life, with persistent pain (21.6%), diarrhoea (13.7%) and nausea/vomiting (13.7%). By contrast, none of the patients with BWL <10% experienced severe nausea/vomiting, pain or diarrhoea. CONCLUSIONS: Disabling symptoms occurred more frequently in patients with ≥10% BWL than in those with <10% BWL, with a relevant negative impact on HRQL. A cause-effect relationship between weight loss and postoperative outcome remains unsolved.

Postoperative complications do not impact on recurrence and survival after curative resection of gastric cancer.

BACKGROUND: We assessed the impact of complications on recurrence and survival after curative gastric cancer resection. METHODS: Patients undergoing R0 resections between 1990 and 2009 were identified in a prospectively maintained database and were categorized by presence of any complication Clavien-Dindo (CD) ≥ II, sepsis or intra-abdominal sepsis. Cox regression analyses to relate complications and clinico-pathological variables to time to recurrence (TTR) and overall survival (OS) were performed. RESULTS: A total of 271 patients were included with a median follow-up of 149.9 months (range 140.1-159.9). Complications CD ≥ II occurred in 162 (59.8%) patients, sepsis in 66 (22.5%), and intra-abdominal sepsis in 37 (13.6%). Recurrence developed in 88 (32.4%) patients. Independent predictors of short TTR were pTNM stage (IIIB-IIIC vs. IA-IIA) (hazard ratio [HR] = 37.55, 95% confidence interval [CI] 17.57-80.24; p < 0.001), D1 lymphadenectomy (HR = 3.14, 95% CI 1.94-5.07; p < 0.001), and male gender (HR = 1.65, 95% CI 1.06-2.57; p = 0.026). pTNM stage (IIIB-IIIC vs. IA-IIA, HR = 10.28, 95% CI 6.51-16.23; p < 0.001), male gender (HR = 1.64, 95% CI 1.17-2.31; p = 0.005), age (HR = 1.03, 95% CI 1.02-1.05; p < 0.001), and adjuvant therapy (HR = 0.55, 95% CI 0.37-0.83; p = 0.004) were identified as independent predictors of OS.. CONCLUSIONS: Evidence provided by this study does not support a negative impact of postoperative complications CD ≥ II, sepsis, and intra-abdominal sepsis on the oncologic outcome after curative gastric cancer resection.

Electronic effects of substituents on the stability of the iridanaphthalene compound [Ir[upper bond 1 start]Cp*{=C(OMe)CH=C(o-C6[upper bond 1 end]H4)(Ph)}(PMe3)]PF6.

Iridanaphthalene complexes are synthesized from the corresponding methoxy(alkenyl)carbeneiridium compounds. The electronic character of the substituents on the 6-position of the metallanaphthalene ring is crucial from the point of view of the stability of the iridanaphthalene, [Ir[upper bond 1 start]Cp*{=C(OMe)CH=C(o-C[upper bond 1 end]6H4)(Ph)}(PMe3)]PF6, vs. its transformation to the corresponding indanone derivatives. Stability studies of the iridanaphthalene compounds revealed that strong electron donor substituents (-OMe) stabilize the iridanaphthalene, while weak electron donor (-Me) and electron withdrawing (-NO2) groups favor the formation of indanone derivatives. Two possible indanone isomers can be obtained in the conversion of the unstable iridanaphthalene complexes and a mechanism for the formation of these isomers is proposed.

Impact of different criteria on type 2 diabetes remission rate after bariatric surgery.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) achieve similar type 2 diabetes mellitus (T2DM) remission rates. Since a great variability exists in defining T2DM remission, an expert panel proposed partial and complete remission criteria that include the maintenance of fasting plasma glucose (FPG) and glycosylated hemoglobin (A1c) objectives for at least 1 year. The 2-year T2DM remission rate and time needed to reach it after LSG or LRYGB were compared using different remission criteria. METHODS: This was a prospective cohort study of 55 T2DM subjects operated on with LSG (n = 21) or LRYGB (n = 34). Four models for defining remission were used: Buchwald criteria (FPG <100 mg/dl or A1c <6 %), American Diabetes Association (ADA) complete (FPG <100 mg/dl plus A1c <6 % maintained for at least 1 year), ADA partial (FPG <125 mg/dl with A1c <6.5 % maintained for at least 1 year), and ADA complete without time requirement. RESULTS: Both groups were comparable, except for higher A1c levels in the LSG group. The remission rate ranged from 43.6 % using ADA complete remission to 92.7 % with Buchwald criteria, with no differences between surgical procedures. Differences were found in the time to achieve remission only when ADA complete remission criteria (5.1 ± 2.9 months LRYGB and 9.0 ± 3.8 months LSG, p = 0.014) and ADA without time requirement criteria (4.9 ± 2.7 months LRYGB and 8.4 ± 3.9 months LSG, p = 0.005) were used. CONCLUSIONS: T2DM remission rate varies widely depending on the criteria used for its definition. Remission occurred sooner after LRYGB when the strictest criteria to define remission were used.

Estudio descriptivo de la mejora de la calidad percibida en los pacientes sometidos a cirugía bariátrica tras la implantación de una vía clínica / Descriptive study on the improvement of quality perceived after the introduction of a clinical pathway by patients subjected to bariatric surgery

Objetivo. Evaluar el grado de satisfacción de los pacientes incluidos en una vía clínica de cirugía laparoscópica de la obesidad y analizar los factores relacionados con la satisfacción. Material y métodos. A una cohorte consecutiva de pacientes se les invitó a cumplimentar, de forma anónima y voluntaria, la encuesta SERVQHOS el penúltimo día de su alta hospitalaria. Resultados. De un total de 103 pacientes (53 mujeres), 71 (70%) respondieron la encuesta. Un 97,3% respondió «como se esperaba» o «por encima de las expectativas» a las cuestiones planteadas. El 98,6% se mostró «muy satisfecho» o «satisfecho» con la atención recibida y el 97,2% recomendaría el hospital a otras personas. Las cuestiones mejor relacionadas con la satisfacción global fueron la tecnología empleada (p=0,008), la apariencia del personal (p=0,019), el interés del personal sanitario por cumplir lo que promete (p=0,002) y para solucionar los problemas del enfermo (p=0,021), la información prestada por el equipo médico (p=0,039) y el tiempo de espera para ser atendido por el médico (p=0,002). En el estudio multivariante, la única variable con capacidad predictiva, en relación con la satisfacción global, fue el trato personalizado (r=0,52). La mediana de estancia hospitalaria fue de 3 días, y el 76% de los encuestados la consideró suficiente. El porcentaje de máxima satisfacción fue significativamente inferior en las mujeres, los solteros, aquellos sin ocupación profesional y con estudios universitarios. Conclusiones. Los pacientes obesos mórbidos incluidos en una vía clínica de cirugía bariátrica tienen una buena percepción de la asistencia sanitaria recibida(AU)

Objectives. To evaluate the level of perceived satisfaction in patients undergoing bariatric procedures after implementing a clinical pathway, and to analyse factors related to a high degree of satisfaction. Material and methods. A cohort of patients was invited to fulfil, anonymously and voluntarily, a SERVQHOS survey the day before hospital discharge. Results. Seventy-one (53 female) out of 103 patients (70%) responded to the questionnaire. A total of 97.3% of patients who completed the survey answered to the questions "as expected" or "above expectations". Most (98.6%) of the patients were "very satisfied" or "satisfied" with the care received, and 97.2% would recommend the hospital to others. Questions better related to overall satisfaction were technology used (P=.008), staff appearance (P=.019), the interest of staff to fulfil a promise (P=.002), and to solve the problems of the patient (P=.021), information provided by the medical staff (P=.039) and waiting time until being seen by the doctor (P=.002). In the multivariate study, only the "personalized care" achieved the category of a predictive variable (r=0.52). Median hospital stay was 3 days, and 76% of patients considered it adequate. The percentage of highest satisfaction was significantly lower in female, singles, unemployed, and those with academic studies. Conclusions. Morbid obese patients included in a clinical pathway of bariatric surgery had a good perception with the care received(AU)

Impact of restrictive (sleeve gastrectomy) vs hybrid bariatric surgery (Roux-en-Y gastric bypass) on lipid profile.

BACKGROUND: Few studies have evaluated the impact of hybrid versus purely restrictive bariatric surgery on lipid profile, with the results being contradictory. The effect of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) on lipid profile was compared. METHODS: A nonrandomized prospective cohort study was conducted on severely obese patients undergoing bariatric surgery. Indication for the type of surgical procedure was based on clinical criteria. Patients on lipid-lowering drugs and those that could not be matched for age, sex, and body mass index were excluded. Finally, 51 patients who underwent LSG and 51 undergoing LRYGB completed this study. RESULTS: During the first year post-surgery, no differences in percentage of excess weight loss and triglyceride reduction were found between groups. After LRYGR, low-density lipoprotein (LDL) cholesterol concentrations fell significantly (125.9 ± 29.3 to 100.3 ± 26.4 mg/dl, p < 0.001), whereas no significant changes were observed in the LSG group (118.6 ± 30.7 to 114.6 ± 33.5 mg/dl, p = 0.220). High-density lipoprotein (HDL) cholesterol increase was significantly greater after LSG (15.4 ± 13.1 mg/dl) compared with LRYGB (9.4 ± 14.0 mg/dl, p = 0.032). Factors independently associated with LDL cholesterol reduction were higher baseline total cholesterol and undergoing LRYGB. A greater increase in HDL cholesterol was associated with LSG, older age, and baseline HDL cholesterol. CONCLUSIONS: LRYGB produces an overall improvement in lipid profile, with a clear benefit in all lipid fractions. Although LSG does not alter LDL cholesterol levels, its effect on HDL cholesterol is comparable to or greater than that obtained with malabsorptive techniques.

[Descriptive study on the improvement of quality perceived after the introduction of a clinical pathway by patients subjected to bariatric surgery]. / Estudio descriptivo de la mejora de la calidad percibida en los pacientes sometidos a cirugía bariátrica tras la implantación de una vía clínica.

OBJECTIVES: To evaluate the level of perceived satisfaction in patients undergoing bariatric procedures after implementing a clinical pathway, and to analyse factors related to a high degree of satisfaction. MATERIAL AND METHODS: A cohort of patients was invited to fulfil, anonymously and voluntarily, a SERVQHOS survey the day before hospital discharge. RESULTS: Seventy-one (53 female) out of 103 patients (70%) responded to the questionnaire. A total of 97.3% of patients who completed the survey answered to the questions "as expected" or "above expectations". Most (98.6%) of the patients were "very satisfied" or "satisfied" with the care received, and 97.2% would recommend the hospital to others. Questions better related to overall satisfaction were technology used (P=.008), staff appearance (P=.019), the interest of staff to fulfil a promise (P=.002), and to solve the problems of the patient (P=.021), information provided by the medical staff (P=.039) and waiting time until being seen by the doctor (P=.002). In the multivariate study, only the "personalized care" achieved the category of a predictive variable (r=0.52). Median hospital stay was 3 days, and 76% of patients considered it adequate. The percentage of highest satisfaction was significantly lower in female, singles, unemployed, and those with academic studies. CONCLUSIONS: Morbid obese patients included in a clinical pathway of bariatric surgery had a good perception with the care received.

La declaración de Helsinki sobre seguridad del paciente en anestesiología / No disponible

En Junio de 2010, los responsables de las sociedades científicas europeas en la especialidad de Anestesiología aprobaron la declaración sobre seguridad del paciente, denominada Declaración de Helsinki.. No es casual que los líderes de la especialidad acordaran una declaración en esta materia, pues la Anestesiología, a través de su historia, ha estado siempre especialmente concienciada con la gestión de los riesgos y la seguridad del paciente. Por otra parte, la transversalidad y el gran campo de acción en que el anestesiólogo desarrolla su actividad hacen que las prácticas seguras adquieran una especial relevancia en su trabajo y que éstas tengan una repercusión directa en el funcionamiento global de los centros clínicos en general. Junto a las labores tradicionales en el quirófano, los especialistas en Anestesiología y Reanimación también están muy presentes en las áreas médicas y quirúrgicas a través de la atención a los enfermos críticos, el tratamiento del dolor agudo y crónico, el cuidado del paciente durante los procedimientos diagnósticos y terapéuticos, y la atención de los enfermos más graves en las áreas de Urgencias. La declaración de Helsinki reconoce la importancia de la seguridad y la gestión de riesgos en los diferentes contextos de trabajo del anestesiólogo y suscribe los estándares de seguridad de la Federación Mundial de Sociedades de Anestesiología (2008). También reconoce la importancia creciente del propio paciente como sujeto de derechos y protagonista principal en el proceso de toma de decisiones que afecten a su salud. La declaración de Helsinki también confirma la trascendencia de la educación y la formación no sólo de los propios especialistas, sino también del resto de profesionales y proveedores sanitarios(AU)

Esta iniciativa coincide con otros programas auspiciados por otras instituciones en que también se enfatiza la importancia de la seguridad y la gestión de los riesgos en los diferentes contextos clínicos. Así, por ejemplo, la Organización Mundial de la Salud, en su estrategia mundial por la seguridad del paciente y con el lema de “la cirugía segura salva vidas”, formula el reto de sistematizar la cumplimentación de listados de seguridad o “checklists” en todas las intervenciones quirúrgicas (Schlack & Boersmester, 2010). Esta iniciativa se recoge en la declaración de Helsinki y también confluye con las recomendaciones de diferentes sociedades científicas. La mención expresa a la importancia de mantener registros y análisis de morbilidad, mortalidad e incidentes críticos reconoce igualmente la necesidad de aplicar metodologías de gestión de la calidad en el ámbito de la Anestesiología. Otra cuestión relevante es que los servicios de Anestesiología deben disponer de protocolos de trabajo y de guías de actuación ante las situaciones clínicas y cuestiones operativas que más riesgo pueden generar. En definitiva, la declaración de Helsinki constituye un valioso documento que se alinea perfectamente con las recomendaciones que, en materia de prácticas seguras, han sido emitidas por diferentes instituciones nacionales e internacionales. El alto grado de acuerdo entre los líderes de la Anestesiología Europea, dentro de la Unión Europea de Médicos Especialistas (UEMS), demuestra que la seguridad sigue constituyendo un objetivo prioritario en la actividad diaria de los anestesiólogos en todo el mundo. La declaración de Helsinki, junto a los documentos relacionados emanados desde las sociedades científicas europeas, contribuirá a que nuestra especialidad siga estando en la vanguardia de la calidad y la seguridad en la práctica clínica(AU)

La Comisión «Hospital sin Dolor» en la estructura de gestión de la calidad de un hospital universitario / The pain committee within the structure of total quality management in a university hospital

El tratamiento del dolor a nivel hospitalario sigue constituyendo una oportunidad de mejora. La existencia de unidades del dolor y de nuevas terapias y medicamentos, eficaces para el paciente individual, no necesariamente conlleva una disminución en la prevalencia del problema en el conjunto de los pacientes hospitalizados. Las comisiones clínicas son un elemento importante en la estructura de gestión de la calidad hospitalaria y una de sus misiones es establecer prioridades asistenciales y organizativas. Se presenta aquí la experiencia de la implantación de un «Hospital sin Dolor» a través de la labor de una comisión clínica encaminada a la formación y concienciación de todos los profesionales en la importancia del dolor y su correcto tratamiento en todo tipo de pacientes. Entre las actividades desarrolladas, se destaca la distribución de cinco mil escalas de medición del dolor, la institucionalización del registro del dolor como quinta constante, el desarrollo de numerosas actividades formativas y la elaboración y publicación de documentos informativos. La Comisión «Hospital sin Dolor» puede ser una herramienta útil para facilitar la concienciación y la colaboración de todos los profesionales para reconocer el alivio del dolor como un objetivo de calidad institucional. Esta iniciativa puede ser desarrollada en diferentes tipos de centros sanitarios (AU)

Inadequately managed pain is still common in hospitals. The existence of pain units and new therapies and drugs can be effective for the individual patient but do not necessarily improve the prevalence of pain in the majority of hospitalised patients. Clinical committees are an important component of the structure for quality management in hospitals, and they can set clinical and organisational priorities. The project “Hospital sin Dolor” (Hospital without Pain) has been developed by a clinical committee aimed at increasing the awareness of all professionals on the importance of pain and its management in all types of patients. Among the activities developed, five thousand pain scales have been distributed throughout the hospital, pain is now formally registered as a fifth vital sign, a number of educational activities have been organised, and informative leaflets have been designed and distributed. Pain Committees can be a useful quality tool to facilitate the awareness and the collaboration of all professionals towards the institutional goal of pain relief. This experience can be implemented in other clinical centres (AU)

Anticipation of age at onset in multiple sclerosis: methodologic pitfalls.

BACKGROUND/AIM: There are several reports that claim anticipation in complex or polygenic diseases such as multiple sclerosis (MS), Crohn disease or schizophrenia. The aim of the present study was to assess age at onset of MS during the last 60 years in the region of Costa de Ponent (Barcelona, Spain) showing how apparent changes in age at onset between generations can be an artefact of analysis based on cohorts that have not been followed enough time. METHODS: The study comprised 1100 patients diagnosed of MS. The method used to correct for follow-up time bias involves constructing comparison cohorts that had been observed for the same amount of time. To ensure equal follow-up times, we restricted our analysis to patients whose onset was by 37 years of age (percentile 75) and were at least 37 years old. We analysed differences in age at onset using log-rank test to compare survival curves estimated by Kaplan-Meier method. RESULTS: Age at onset decreases progressively from older to younger generations. However, when adjustment to equal follow-up time was done, anticipation in age at onset was not found. CONCLUSION: Anticipation of age at onset is undetectable when adjusted for follow-up time.

Estudio de utilización de analgésicos opiáceos en un hospital general universitario / Study of opioid analgesic use in a general university hospital

Objetivo: El objetivo de este trabajo ha sido realizar un estudio de utilización de analgésicos opiáceos en el Hospital Universitario La Paz (Madrid) en el año 2008 para conocer cómo se está utilizando este grupo de medicamentos y cuál es la tendencia del consumo. Para ello, se presentan los datos de uso de opiáceos en pacientes ingresados de forma global, por hospitales y por servicios clínicos. Se exponen los datos de consumo de los 5 últimos años y se ha cuantificado el uso del resto de principios activos empleados como analgésicos en nuestro hospital. Material y métodos: Haciendo uso de la metodología recomendada por la Organización Mundial de la Salud para los estudios de utilización de medicamentos en hospitales, presentamos nuestros datos en dosis diarias definidas (DDD) por 100 estancias. Los datos de consumo se han obtenido del programa de gestión de medicamentos del Servicio de Farmacia Farma Tools (Dominion®) Resultados: El valor global de utilización de opiáceos en 2008 ha sido de 8,1 DDD/100estancias. Los principios activos más consumidos han sido la morfina parenteral y el fentanilo transdérmico, y entre los 2 representan el 83% del consumo total de opiáceos. En el análisis por hospitales apreciamos que el Hospital General y el de Traumatología son los que presentan un mayor empleo de opiáceos y siguen el mismo patrón de utilización que el global. Los servicios más representativos del consumo de opiáceos han sido las reanimaciones del Hospital General y de Traumatología, los Servicios de Oncología, Cuidados paliativos y Hematología. En estos últimos 5 años se ha producido un incremento global del consumo de aproximadamente el 20%, viéndose implicados todos los principios activos. Con relación al consumo total de analgésicos, los datos reflejan una amplia utilización en el hospital (104 DDD/100 estancias)...(AU)

Objective: The aim of this study was to analyze opioid analgesic use in the La Paz University Hospital in 2008 in order to identify patterns of use and consumption. To that end, data from inpatients were analyzed overall, as well as by hospitals and departments. We analyzed data on consumption in the previous 5 years and quantified the use of there maining active principles administered as analgesics in our hospital. Materials and methods: Following the Wold Health Organization’s guidelines for studies on medication use in hospitals, data are shown as defined daily dose (DDD) per 100hospital stays. Data on drug use were obtained from the drug management program, Farma Tools (Dominion®), which is used by the Pharmacy Service at La Paz Hospital. Results: The overall value of opioid utilization in 2008 was 8.1 DDD per 100 hospital stays. The most widely used active principles were parenteral morphine and transdermal fentanyl. Together, these drugs represented 83% of total opioid consumption. Analysis by hospital revealed that the General and Traumatology Hospitals showed the highest opioiddrug consumption and followed the same utilization pattern as overall use. The services most representative of opioid consumption in inpatients were the Recovery Room in the General and Traumatology Hospitals, Critical Care, Oncology, Hematology and Palliative Care. In the last 5 years of the study, the overall use of these drugs increased by 20%, irrespective of the active principles involved. Analysis of analgesic intake at La Paz Hospital showed widespread use (104 DDD per 100 hospital stays). Opioids represented7.4% of total analgesic consumption, the most frequently used analgesics being acetaminophen and metamizol. Conclusions: The results of our study show an increasing trend in opioid consumption in this hospital...(AU)

La gestión por procesos en el tratamiento del dolor / Process managetnent in pain treatment

El tratamiento del dolor constituye una oportunidad de mejora. Los principios de la gestión por procesos pueden facilitar el diseño,desarrollo y funcionamiento de las Unidades del Dolor. El requisito fundamental es la orientación al paciente, buscando la satisfacciónde sus necesidades y demandas. La identificación de los distintos procesos -de gestión, clave y de apoyo- que se integran en la Unidaddel Dolor permite la elaboración del mapa de procesos de la Unidad, con sus correspondientes fichas de procesos y diagramas de flujoo flujogramas. Esta metodología, que supone una ruptura con las formas de gestión tradicional, puede contribuir a dar personalidad eidentidad a la Unidad asistencial, facilitando eventualmente su certificación en calidad(AU)

The management of pain still needs to be improved. The principles of process management can be applied to the design, development and daily function of a Pain Unit. The main request is its orientation to meet the needs and demands of patients. The identification of the different processes within the Unit allow for the design of its process mapping and the development of process files and flowcharts. This methodology of work may break away with traditional management schemes, but can contribute to better define the identity of the Pain Unit and eventually facilitate its certification in quality (AU)

Oral health-related quality of life and nutritional status.

OBJECTIVES: This study examines whether oral health-related quality of life (OHRQoL) is associated with malnutrition risk in the elderly. METHODS: A cross-sectional study was designed using a representative sample of Spaniards over 65 years old. Data on sociodemographics and oral health status were gathered by interview and examination. Oral health-related quality of life was evaluated using the Geriatric Oral Health Assessment Index (GOHAI), and malnutrition risk using the Mini Nutritional Assessment (MNA). RESULTS: The final sample included 2,860 elderly, 41.7 percent males and 58.3 percent females, with a mean age of 73.7 +/- 6.8 years. Mean GOHAI score was 52.1 +/- 7.2, with 70.7 percent of the sample needing oral health care according to this index. The mean MNA score was 24.0 +/- 3.31; 3.5 percent of the elderly were malnourished, 31.5 percent were at risk of malnutrition, and 65.0 percent were considered adequately nourished. A strong association was found between mean GOHAI and MNA scores.

Optical coherence tomography analysis of a randomized study combining photodynamic therapy with intravitreal triamcinolone.

BACKGROUND: The objective of the study was to analyze optical coherence tomography (OCT) scan differences between patients with predominantly classic subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) treated with only photodynamic therapy (PDT) and patients treated with PDT combined with intravitreal triamcinolone acetonide (IVTA). METHODS: In this prospective study, 61 patients were randomized to receive PDT (n = 30) or PDT combined with IVTA (n = 31). They were evaluated every 3 months with a refraction protocol for best-corrected visual acuity (VA) measured with Early Treatment Diabetic Retinopathy Study (ETDRS) charts, fluorescein angiography (FA), and OCT. When measuring foveal thickness on OCT scans, neuroretinal foveal thickness (NFT) was differentiated from outer high reflectivity band thickness (OHRBT). The main outcome measures were mean change in OCT measurements and correlation of VA and angiographic area of the lesion with OCT measurements. RESULTS: At the 12-month follow-up, the mean change in NFT was not significantly reduced (P = 0.9), but the mean change in OHRBT was significantly lower (P = 0.004) in the group of patients who received combined therapy. There was no correlation between final VA and NFT in either patient group (P = 0.2). The final VA was significantly worse in eyes with a thicker OHRBT (P = 0.04) in the group of patients treated with only PDT. There was no correlation between angiographic area and NFT and OHRBT in either patient group (P > 0.3). There was a statistically significant difference between the pre-treatment angiographic area of the lesion and VA at the 12-month follow-up in the combined therapy group (P = 0.01), and more eyes treated with only PDT presented with intraretinal fluid at the last follow-up (P = 0.01). CONCLUSION: Combined PDT+IVTA therapy was more effective than PDT alone at reducing OHRBT. This OCT measurement seems to be have a greater effect on VA than NFT.

Bonding study in all-metal clusters containing Al4 units.

The nature of the bonding of a series of gas-phase all-metal clusters containing the Al4 unit attached to an alkaline, alkaline earth, or transition metal is investigated at the DFT level using Mulliken, quantum theory of atoms in molecules (QTAIM), and Hirshfeld iterative (Hirshfeld-I) atomic partitionings. The characterization of ionic, covalent, and metallic bonds is done by means of charge polarization and multicenter electron delocalization. This Article uses for the first time Hirshfeld-I multicenter indices as well as Hirshfeld-I based atomic energy calculations. The QTAIM charges are in line with the electronegativity scale, whereas Hirshfeld-I calculations display deviations for transition metal clusters. The Mulliken charges fail to represent the charge polarization in alkaline metal clusters. The large ionic character of Li-Al and Na-Al bonds results in weak covalent bonds. On the contrary, scarcely ionic bonds (Be-Al, Cu-Al and Zn-Al) display stronger covalent bonds. These findings are in line with the topology of the electron density. The metallic character of these clusters is reflected in large 3-, 4- and 5-center electron delocalization, which is found for all the molecular fragments using the three atomic definitions. The previously reported magnetic inactivity (based on means of magnetic ring currents) of the pi system in the Al42- cluster contrasts with its large pi electron delocalization. However, it is shown that the different results not necessary contradict each other.

Prevalence of dementia subtypes in El Prat de Llobregat, Catalonia, Spain: the PRATICON study.

BACKGROUND: Studies on dementia subtypes show a wide variation in the prevalence of Alzheimer's disease (AD) and vascular dementia (VD) worldwide. However, studies reporting on Lewy body dementia (LBD) and frontotemporal dementia (FTD) are sparse. AIMS: To describe the prevalence of dementia and subtypes. METHOD: A 34% sample of 5,150 subjects aged 70 years and over in El Prat de Llobregat (Barcelona) were screened by the Mini-Mental State Examination. When scoring <24, participants were assessed to establish a diagnosis. RESULTS: There were 165 subjects diagnosed with dementia (prevalence of 9.4%). Subtypes of dementia were: AD 69.1%, VD 12.7%, LBD 9.1%, FTD 3% and secondary dementia 1.8%. Prevalences were: AD 6.5%, VD 1.2%, LBD 0.9% and FTD 0.3%. CONCLUSIONS: AD and VD were the most common type of dementia. Prevalence of dementia, AD and FTD were similar to those reported, while prevalence of VD and LBD were lower.

[Postoperative pain management in a tertiary care hospital: initial situation prior to starting a quality assurance program]. / Atención del dolor postoperatorio en un hospital de tercer nivel: situación inicial previa a la implantación de un programa de calidad.

OBJECTIVE: To characterize the initial situation in postoperative pain management among the services General and Vascular surgery as the first step in developing a program to improve postoperative analgesia. METHODS: An anonymous questionnaire with 14 items covered the characteristics of postoperative pain, information received about analgesic treatments and requesting medication, and degree of satisfaction. The questionnaire was filled in during an early postoperative interview with all patients undergoing surgery in the aforementioned departments. RESULTS: A total of 158 patients were interviewed; 89% were from the general surgery department and 11% from vascular surgery. At 24 hours after surgery, 18% were free of pain, 35% had mild pain, and 47% had moderate or intense pain. Nonsteroidal anti-inflammatory drugs were the most frequently used postoperative analgesics, in 94% of patients, and the dosage and timing had been prescribed for 74%. Thirty-six percent of the patients asked for an analgesic to be administered. The correlation between degree of greatest pain and request for an analgesic was statistically significant (P < 0.001). CONCLUSIONS: Postoperative pain is an area in which improvements can be implemented to provide better care and treatment of surgical patients, particularly since there are efficacious analgesic treatments for pain control that are presently not being used. The custom of prescribing pain medication on demand should be avoided in all surgical procedures that are known to produce postoperative pain.