[Gastrostomy tubes in patients with amyotrophic lateral sclerosis: indications, safety and experience in a tertiary care centre]. / Sondas de gastrostomía en pacientes con esclerosis lateral amiotrófica: indicaciones, seguridad y experiencia en un centro de tercer nivel.

AIM: The aim of this study is the clinical characterisation of patients diagnosed with amyotrophic lateral sclerosis (ALS), who were indicated for the placement of a gastrostomy tube (G-Tube) in the period 2007-2017 in the Complejo Asistencial Universitario de Salamanca, and to find possible associated prognostic factors. MATERIAL AND METHODS: It is a descriptive study of clinical cases. RESULTS: Between 2007 and 2017, 139 cases of ALS were assessed and a G-Tube was indicated in 29 of them. Of these 29, on two occasions it was not performed, one due to the patient refusing and the other because of clinical deterioration. Of the total number of G-Tubes, 21 were placed by endoscopy, four by interventional radiology and two by surgery. The main indications were: in 10 cases, for severe dysphagia; in eight cases, for weight loss >10%; and in nine cases, for reduced forced vital capacity <50%. Immediate complications (first 24 hours) included: two intraprocedural desaturations, one ostomy infection, one abdominal pain, one paralytic ileus and one respiratory failure resulting in death. Late complications (first month) include pneumonia, intestinal ischaemia, cellulitis and poor control of secretions. The main cause of death was respiratory failure. The median time elapsed between G-Tube placement and death was 7.89 months. An improvement in analytical nutritional parameters was observed, without showing statistical significance, as a prognostic factor. CONCLUSION: G-Tube placement is an effective and safe procedure to ensure enteral nutrition in ALS patients.

TITLE: Sondas de gastrostomía en pacientes con esclerosis lateral amiotrófica: indicaciones, seguridad y experiencia en un centro de tercer nivel.Objetivo. El objetivo es la caracterización clínica de los pacientes diagnosticados de esclerosis lateral amiotrófica (ELA) a los que se les indicó la colocación de una sonda de gastrostomía (SG) en el período 2007-2017 en el Complejo Asistencial Universitario de Salamanca, y encontrar posibles factores pronósticos asociados. Material y métodos. Es un estudio descriptivo de casos clínicos. Resultados. Entre 2007 y 2017 se evaluaron 139 ELA y se indicó SG en 29 casos. De esos 29, en dos ocasiones no se llevó a cabo, en una ocasión por negativa del paciente y en otra por deterioro clínico. Del total de SG, 21 se colocaron por endoscopia; cuatro, por radiología intervencionista; y dos, por cirugía. Las principales indicaciones fueron: en 10 casos, por disfagia grave; en ocho, por pérdida ponderal > 10%; y en nueve, por disminución de la capacidad vital forzada menor de 50%. Entre las complicaciones inmediatas (primeras 24 horas) se observaron: dos desaturaciones intraprocedimiento, una infección de la ostomía, un dolor abdominal, un íleo paralítico y una insuficiencia respiratoria con fallecimiento. Entre las complicaciones tardías (primer mes): una neumonía, una isquemia intestinal, una celulitis y un mal control de las secreciones. La principal causa de fallecimiento fue la insuficiencia respiratoria. La mediana de tiempo desde la colocación de la SG hasta el fallecimiento fue de 7,89 meses. Se constató mejoría de los parámetros analíticos nutricionales, sin demostrarse significación estadística, como factor pronóstico. Conclusión. La colocación de una SG es un procedimiento eficaz y seguro para asegurar la nutrición enteral en los pacientes con ELA.

Sondas de gastrostomía en pacientes con esclerosis lateral amiotrófica: indicaciones, seguridad y experiencia en un centro de tercer nivel / Gastrostomy tubes in patients with amyotrophic lateral sclerosis: indications, safety and experience in a tertiary care centre

Objetivo: El objetivo es la caracterización clínica de los pacientes diagnosticados de esclerosis lateral amiotrófica (ELA) a los que se les indicó la colocación de una sonda de gastrostomía (SG) en el período 2007-2017 en el Complejo Asistencial Universitario de Salamanca, y encontrar posibles factores pronósticos asociados. Material y métodos. Es un estudio descriptivo de casos clínicos. Resultados: Entre 2007 y 2017 se evaluaron 139 ELA y se indicó SG en 29 casos. De esos 29, en dos ocasiones no se llevó a cabo, en una ocasión por negativa del paciente y en otra por deterioro clínico. Del total de SG, 21 se colocaron por endoscopia; cuatro, por radiología intervencionista; y dos, por cirugía. Las principales indicaciones fueron: en 10 casos, por disfagia grave; en ocho, por pérdida ponderal > 10%; y en nueve, por disminución de la capacidad vital forzada < 50%. Entre las complicaciones inmediatas (primeras 24 horas) se observaron: dos desaturaciones intraprocedimiento, una infección de la ostomía, un dolor abdominal, un íleo paralítico y una insuficiencia respiratoria con fallecimiento. Entre las complicaciones tardías (primer mes): una neumonía, una isquemia intestinal, una celulitis y un mal control de las secreciones. La principal causa de fallecimiento fue la insuficiencia respiratoria. La mediana de tiempo desde la colocación de la SG hasta el fallecimiento fue de 7,89 meses. Se constató mejoría de los parámetros analíticos nutricionales, sin demostrarse significación estadística, como factor pronóstico. Conclusión: La colocación de una SG es un procedimiento eficaz y seguro para asegurar la nutrición enteral en los pacientes con ELA.(AU)

Aim: The aim of this study is the clinical characterisation of patients diagnosed with amyotrophic lateral sclerosis (ALS), who were indicated for the placement of a gastrostomy tube (G-Tube) in the period 2007-2017 in the Complejo Asistencial Universitario de Salamanca, and to find possible associated prognostic factors. Material and methods: It is a descriptive study of clinical cases. Results: Between 2007 and 2017, 139 cases of ALS were assessed and a G-Tube was indicated in 29 of them. Of these 29, on two occasions it was not performed, one due to the patient refusing and the other because of clinical deterioration. Of the total number of G-Tubes, 21 were placed by endoscopy, four by interventional radiology and two by surgery. The main indications were: in 10 cases, for severe dysphagia; in eight cases, for weight loss >10%; and in nine cases, for reduced forced vital capacity <50%. Immediate complications (first 24 hours) included: two intraprocedural desaturations, one ostomy infection, one abdominal pain, one paralytic ileus and one respiratory failure resulting in death. Late complications (first month) include pneumonia, intestinal ischaemia, cellulitis and poor control of secretions. The main cause of death was respiratory failure. The median time elapsed between G-Tube placement and death was 7.89 months. An improvement in analytical nutritional parameters was observed, without showing statistical significance, as a prognostic factor. Conclusion: G-Tube placement is an effective and safe procedure to ensure enteral nutrition in ALS patients.(AU)

Spreading fronts of wetting liquid droplets: Microscopic simulations and universal fluctuations.

We have used kinetic Monte Carlo (kMC) simulations of a lattice gas to study front fluctuations in the spreading of a nonvolatile liquid droplet onto a solid substrate. Our results are consistent with a diffusive growth law for the radius of the precursor layer, R∼t^{δ}, with δ≈1/2 in all the conditions considered for temperature and substrate wettability, in good agreement with previous studies. The fluctuations of the front exhibit kinetic roughening properties with exponent values which depend on temperature T, but become T independent for sufficiently high T. Moreover, strong evidence of intrinsic anomalous scaling has been found, characterized by different values of the roughness exponent at short and large length scales. Although such a behavior differs from the scaling properties of the one-dimensional Kardar-Parisi-Zhang (KPZ) universality class, the front covariance and the probability distribution function of front fluctuations found in our kMC simulations do display KPZ behavior, agreeing with simulations of a continuum height equation proposed in this context. However, this equation does not feature intrinsic anomalous scaling, at variance with the discrete model.

Numerical spatio-temporal characterization of Listeria monocytogenes biofilms.

As the structure of biofilms plays a key role in their resistance and persistence, this work presents for the first time the numerical characterization of the temporal evolution of biofilm structures formed by three Listeria monocytogenes strains on two types of stainless-steel supports, AISI 304 SS No. 2B and AISI 316 SS No. 2R. Counting methods, motility tests, fluorescence microscopy and image analysis were combined to study the dynamic evolution of biofilm formation and structure. Image analysis was performed with several well-known parameters as well as a newly defined parameter to quantify spatio-temporal distribution. The results confirm the interstrain variability of L. monocytogenes species regarding biofilm structure and structure evolution. Two types of biofilm were observed: homogeneous or flat and heterogeneous or clustered. Differences in clusters and in attachment and detachment processes were due mainly to the topography and composition of the two surfaces although an effect due to motility was also found.

Dynamical approach to the Casimir effect.

Casimir forces can appear between intrusions placed in different media driven by several fluctuation mechanisms, either in equilibrium or out of it. Herein, we develop a general formalism to obtain such forces from the dynamical equations of the fluctuating medium, the statistical properties of the driving noise, and the boundary conditions of the intrusions (which simulate the interaction between the intrusions and the medium). As a result, an explicit formula for the Casimir force over the intrusions is derived. This formalism contains the thermal Casimir effect as a particular limit and generalizes the study of the Casimir effect to such systems through their dynamical equations, with no appeal to their Hamiltonian, if any exists. In particular, we study the Casimir force between two infinite parallel plates with Dirichlet or Neumann boundary conditions, immersed in several media with finite correlation lengths (reaction-diffusion system, liquid crystals, and two coupled fields with non-Hermitian evolution equations). The driving Gaussian noises have vanishing or finite spatial or temporal correlation lengths; in the first case, equilibrium is reobtained and finite correlations produce nonequilibrium dynamics. The results obtained show that, generally, nonequilibrium dynamics leads to Casimir forces, whereas Casimir forces are obtained in equilibrium dynamics if the stress tensor is anisotropic.

Pairwise summation approximation of Casimir energy from first principles.

We obtain the pairwise summation approximation (PSA) of the Casimir energy from first principles in the soft dielectric and soft diamagnetic limit, this analysis let us find that the PSA is an asymptotic approximation of the Casimir energy valid for large distances between the objects. We also obtain the PSA for the electromagnetic coupling part of the Casimir energy, so we are able to complete the PSA limit for the first time for the complete electromagnetic field.

Effects of angiotensin II and atrial natriuretic peptide on LH release are exerted in the preoptic area: possible involvement of gamma-aminobutyric acid (GABA).

The preoptic/anterior hypothalamic area (PO/AH) contains the majority of LHRH neurons of which the function is regulated by a variety of neurotransmitters and peptides. In this area, numerous estrogen-receptive neurons utilize gammaaminobutyric acid (GABA) as neurotransmitter and these neurons communicate directly with LHRH neurons. Angiotensin II (AII) and atrial natriuretic peptide (ANP) are known to be involved in the regulation of LH secretion. The site of action of these peptides and the mechanisms by which they influence LHRH neurons, are largely unknown. Therefore the effects of intrapreoptic application of AII and ANP on serum LH levels of ovariectomized (ovx) and of ovx estrogen-primed rats were investigated. The peptides were applied into the PO/AH by means of push-pull cannula and in the effluent fractions GABA was measured. In the ovx estrogen-primed rat, prominent LH and prolactin surges were observed. At the time of increased LH levels preoptic GABA release was significantly reduced. At this time application of AII or ANP into the PO/AH was without effect on either LH or prolactin levels in the serum or on preoptic GABA release rates. In ovx, not steroid-primed rats intrapreoptic AII application suppressed serum LH levels significantly and this treatment had a slight stimulatory effect on preoptic GABA release rates. This effect of AII could be antagonized by prior preoptic treatment with saralasin, a specific AII receptor blocking peptide. Preoptic treatment with ANP resulted in a slight increase in serum LH levels which was accompanied by a slight, but significant reduction of preoptic GABA release rates.(ABSTRACT TRUNCATED AT 250 WORDS)