Physical Activity and Features of Knee Osteoarthritis on Magnetic Resonance Imaging in Individuals Without Osteoarthritis: A Systematic Review.

OBJECTIVE: To systematically review all studies that have evaluated the association between physical activity (PA) levels and features of knee osteoarthritis (OA) on magnetic resonance imaging (MRI) for subjects without OA. METHODS: The inclusion criteria for prospective studies were as follows: 1) subjects without OA; 2) average age 35-80 years; and 3) any self-reported PA or objective measurement of PA. The eligible MRI outcomes were OA-related measures of intraarticular knee joint structures. Exclusion criteria were evaluations of instant associations with transient structural changes after PA. RESULTS: Two randomized controlled trials and 16 observational studies were included. One of 11 studies found that PA was harmfully related to cartilage volume or thickness, but 4 studies found a significant protective association. Four of 10 studies found that PA was harmfully related to cartilage defects, while others showed no significant associations. Two of 3 studies reported a significantly increased cartilage T2 value in individuals with more PA. All 3 studies reported no significant association between PA and bone marrow lesions. Two studies assessed the association between PA and meniscus pathology, in which only occupational PA involving knee bending was associated with a greater risk of progression. CONCLUSION: Within the sparse and diverse evidence available, no strong evidence was found for the presence or absence of an association between PA and the presence or progression of features of OA on MRI among subjects without OA. Therefore, more research is required before PA in general and also specific forms of PA can be deemed safe for knee joint structures.

Effects of land use and climate on carbon and nitrogen pool partitioning in European mountain grasslands.

European mountain grasslands are increasingly affected by land-use changes and climate, which have been suggested to exert important controls on grassland carbon (C) and nitrogen (N) pools. However, so far there has been no synthetic study on whether and how land-use changes and climate interactively affect the partitioning of these pools amongst the different grassland compartments. We analyzed the partitioning of C and N pools of 36 European mountain grasslands differing in land-use and climate with respect to above- and belowground phytomass, litter and topsoil (top 23 cm). We found that a reduction of management intensity and the abandonment of hay meadows and pastures increased above-ground phytomass, root mass and litter as well as their respective C and N pools, concurrently decreasing the fractional contribution of the topsoil to the total organic carbon pool. These changes were strongly driven by the cessation of cutting and grazing, a shift in plant functional groups and a related reduction in litter quality. Across all grasslands studied, variation in the impact of land management on the topsoil N pool and C/N-ratio were mainly explained by soil clay content combined with pH. Across the grasslands, below-ground phytomass as well as phytomass- and litter C concentrations were inversely related to the mean annual temperature; furthermore, C/N-ratios of phytomass and litter increased with decreasing mean annual precipitation. Within the topsoil compartment, C concentrations decreased from colder to warmer sites, and increased with increasing precipitation. Climate generally influenced effects of land use on C and N pools mainly through mean annual temperature and less through mean annual precipitation. We conclude that site-specific conditions need to be considered for understanding the effects of land use and of current and future climate changes on grassland C and N pools.

CT differentiation of fat-poor angiomyolipomas from papillary renal cell carcinomas: development of a predictive model.

PURPOSE: To identify specific contrast-enhanced CT (CECT) findings and develop a predictive model with logistic regression to differentiate fat-poor angiomyolipomas (fpAML) from papillary renal cell carcinomas (pRCC). METHODS: This is a single-institution retrospective study that assess CT features of histologically proven 67 pRCC and 13 fpAML. CECT variables were studied by means of univariate logistic regression. Variables included patients' demographics, tumor attenuation (unenhanced and at arterial, venous and excretory post-contrast phases), type of enhancement, morphological features (axial long and short diameters, long-short axis ratio (LSR) and tumor to kidney angle interface) and presence of visible calcifications or vessels. Those variables with a p ≤ 0.05 underwent standard stepwise logistic regression to find predictive combinations of clinical variables. Best models were evaluated by AUROC curves and were subjected to Leave-one-out cross validation to assess their robustness. RESULTS: Odds ratio (OR) between pRCC and fpAML was statistically significant for patient's gender, tumor attenuation in arterial, venous and excretory phases, tumor's long diameter, short diameter, LSR, type of enhancement, presence of intratumoral vessels and tumor-kidney angle interface. The best predictive model resulted in an area under the curve (AUC) of 0.971 and included gender, tumor-kidney angle interface and venous attenuation with the following equation: Log(p/1 - p) = - 2.834 + 4.052 * gender + - 0.066 * AngleInterface + 0.074 * VenousphaseHU. CONCLUSIONS: The combination of patients' gender, tumor to kidney angle interface and venous enhancement helps to distinguish fpAML from pRCC.

Association between meniscal volume and development of knee osteoarthritis.

OBJECTIVE: To assess the association between meniscal volume, its change over time and the development of knee OA after 30 months in overweight/obese women. METHODS: Data from the PRevention of knee Osteoarthritis in Overweight Females study were used. This cohort included 407 women with a BMI ≥ 27 kg/m2, free of OA-related symptoms. The primary outcome measure was incident OA after 30 months, defined by one out of the following criteria: medial or lateral joint space narrowing (JSN) ≥ 1.0 mm, incident radiographic OA [Kellgren and Lawrence (K&L) ≥ 2], or incident clinical OA. The secondary outcomes were either of these items separately. Menisci at both baseline and follow-up were automatically segmented to obtain meniscal volume and delta-volumes. Generalized estimating equations were used to evaluate associations between the volume measures and the outcomes. RESULTS: Medial and lateral baseline and delta-volumes were not significantly associated to the primary outcome. Lateral meniscal baseline volume was significantly associated to lateral JSN [odds ratio (OR) = 0.87; 95% CI: 0.75, 0.99], while other measures were not. Medial and lateral baseline volume were positively associated to K&L incidence (OR = 1.32 and 1.22; 95% CI: 1.15, 1.50 and 1.03, 1.45, respectively), while medial and lateral delta-volume were negatively associated to K&L incidence (OR = 0.998 and 0.997; 95% CI: 0.997, 1.000 and 0.996, 0.999, respectively). None of the meniscal measures were significantly associated to incident clinical OA. CONCLUSION: Larger baseline meniscal volume and the decrease of meniscal volume over time were associated to the development of structural OA after 30 months in overweight and obese women.

Biochar application and summer temperatures reduce N2O and enhance CH4 emissions in a Mediterranean agroecosystem: Role of biologically-induced anoxic microsites.

Biochar applications have been proposed for mitigating some soil greenhouse gas (GHG) emissions. However, results can range from mitigation to no effects. To explain these differences, mechanisms have been proposed but their reliability depends on biochar type, soil and climatic conditions. Furthermore, it is found that the mitigation capacity is dependent on how the biochar is aging under field conditions. The effects on N2O, CH4 and CO2 emission rates of a gasification pine biochar (applied as 0, 5, and 30 t ha-1) were studied between 8 and 21 months of the application in an alkaline soil cropped to barley under Mediterranean climate. Together with GHG, soil chemical and biological properties were assessed, namely, changes in labile organic matter content and nutrient status, and pH, as well as microbial abundance, activity, and functional composition. During the 2 years of the application, significant changes were observed at the highest rate of biochar application such as higher contents of water, K+, Mg2+, SO42-, higher basal respiration, and with non-significant changes in microbial community, though with some temporal effects. Regarding GHG, N2O decreases coupled with CH4 increases in the summer sampling were measured, although only for the highest application rate scenario. Such effects were unrelated to pH, bioavailable nitrogen status, or bulk soil microbial community shifts. We hypothesized that the key is the porous structure of our wood biochar, which is able to provide more and diversified microbial microhabitats in comparison to bulk soil. At higher temperatures in summer, biologically-induced anoxic conditions in biochar pores acting as microsites may be promoted, where total denitrification to N2 occurs which leads to N2O uptake, while CH4 production is promoted.

Use of Web 2.0 tools by hospital pharmacists.

OBJECTIVE: Web 2.0 tools are transforming the pathways health professionals use to communicate among themselves and with their patients so this situation forces a change of mind to implement them. The aim of our study is to assess the state of knowledge of the main Web 2.0 applications and how are used in a sample of hospital pharmacists. METHOD: The study was carried out through an anonymous survey to all members of the Spanish Society of Hospital Pharmacy (SEFH) by means of a questionnaire sent by the Google Drive® application. After the 3-month study period was completed, collected data were compiled and then analyzed using SPPS v15.0. RESULTS: The response rate was 7.3%, being 70.5% female and 76.3% specialists. The majority of respondents (54.2%) were aged 20 to 35. Pubmed was the main way of accessing published articles. 65.2% of pharmacists knew the term "Web 2.0". 45.3% pharmacists were Twitter users and over 58.9% mainly for professional purposes. Most pharmacists believed that Twitter was a good tool to interact with professionals and patients. 78.7% do not use an agregator, but when used, Google Reader was the most common. CONCLUSION: Although Web 2.0 applications are gaining mainstream popularity some health professionals may resist using them. In fact, more than a half of surveyed pharmacists referred a lack of knowledge about Web 2.0 tools. It would be positive for pharmacists to use them properly during their professional practice to get the best out of them.

Objetivo: Las herramientas de la Web 2.0 están transformando los canales que los profesionales sanitarios emplean para comunicarse entre sí y con los pacientes por lo que esta situación obliga a un cambio de mentalidad para implementarlas. El objetivo de este estudio fue evaluar el grado de conocimiento y aplicación de las principales herramientas Web 2.0 por parte de farmacéuticos hospitalarios. Método: El estudio se llevó a cabo mediante una encuesta anómina dirigida a todos los miembros de la Sociedad Española de Farmacia Hospitalaria (SEFH) a través de la aplicación Google Drive®. Después de completarse los 3 meses del período de estudio, los datos recogidos se analizaron usando SPPS v15.0. Resultados: La tasa de respuesta fue del 7,3%, siendo el 70,5% mujeres y el 76,3 % especialistas. La mayoría de los que respondieron (54,2%) estaban en el rango de edad de 20 a 35 años. Pubmed fue el medio principal de acceder a los artículos publicados. El 65,2% de los farmacéuticos conocía el término "Web 2.0". El 45,3% eran usuarios de Twitter, de los cuales un 58,9% principalmente para uso profesional. La mayoría creía que Twitter era una buena herramienta para interactuar entre los profesionales y los pacientes. El 78,7% no usaba un agregador, pero cuando lo hacían, Google Reader era el más habitual. Conclusión: Aunque las aplicaciones de la Web 2.0 están ganando popularidad, algunos profesionales sanitarios se resisten a utilizarlas. De hecho, más de la mitad de los farmacéuticos entrevistados manifestaba un nulo conocimiento de las herramientas de la Web 2.0. Sería positivo que los farmacéuticos las usasen adecuadamente durante su práctica profesional para sacarles el máximo partido.

Nutrient and phytoplankton analysis of a Mediterranean coastal area.

Identifying and quantifying the key anthropogenic nutrient input sources are essential to adopting management measures that can target input for maximum effect in controlling the phytoplankton biomass. In this study, three systems characterized by distinctive main nutrient sources were sampled along a Mediterranean coast transect. These sources were groundwater discharge in the Ahuir area, the Serpis river discharge in the Venecia area, and a submarine wastewater outfall 1,900 m from the coast. The study area includes factors considered important in determining a coastal area as a sensitive area: it has significant nutrient sources, tourism is a major source of income in the region, and it includes an area of high water residence time (Venecia area) which is affected by the harbor facilities and by wastewater discharges. We found that in the Ahuir and the submarine wastewater outfall areas, the effects of freshwater inputs were reduced because of a greater water exchange with the oligotrophic Mediterranean waters. On the other hand, in the Venecia area, the highest levels of nutrient concentration and phytoplankton biomass were attributed to the greatest water residence time. In this enclosed area, harmful dinoflagellates were detected (Alexandrium sp. and Dinophysis caudata). If the planned enlargement of the Gandia Harbor proceeds, it may increase the vulnerability of this system and provide the proper conditions of confinement for the dinoflagellate blooms' development. Management measures should first target phosphorus inputs as this is the most potential-limiting nutrient in the Venecia area and comes from a point source that is easier to control. Finally, we recommend that harbor environmental management plans include regular monitoring of water quality in adjacent waters to identify adverse phytoplankton community changes.

Los padres a examen. ¿Cuál es su conocimento de los derechos de sus hijos? / Parents presence at the examination. How much do they know about their children's rights?

La autonomía de las personas es un derecho fundamental indiscutible que tan solo puede verse limitado en las circunstancias que marque la ley. Sin embargo frecuentemente surgen problemas cuando existe incertidumbre sobre esa competencia. Cuando se trata con personas discapacitadas o ancianos, por ejemplo. También con niños y adolescentes. Sobre estos últimos, las diferentes normas legales parecen no ser capaces de determinar el momento en el que deben ser considerados como adultos. Este hecho, corroborado por junto con las experiencia del día a día de una la consulta de pediatría, nos ha conducido a elaborar el trabajo que sigue, en el que se pretende valorar el conocimiento de los padres sobre los derechos de sus hijos como pacientes. Los resultados de este estudio preliminar, muestran un alto grado de desconocimiento de los padres acerca de los derechos de sus hijos a decidir por sí mismos, en lo que respecta a su salud (AU)

Personal freedom is an indisputable fundamental right that can only be limited by Law. However there are problems when there is uncertainty about that responsibility, disabled people or the elderly, for example. This may also include children and adolescents. In this latter case, the different legal standards seem to contradict when it comes to defining when a minor is considered an adult. This fact, corroborated by the daily experiences of a paediatrics clinic, has led to producing this article, in which an attempt is made to find out how much knowledge parents have of their children' rights as patients. Results from this preliminary study, show a high degree of parental ignorance on their children' rights to decide for themselves as regards their health (AU)

Caso de genitourinario presentado en la Sesión General de Lectura de Casos del XXX Congreso Nacional de la SERAM, A Coruña. Mayo 2010 / No disponible

No disponible

Biodiversity differences between managed and unmanaged forests: meta-analysis of species richness in Europe.

Past and present pressures on forest resources have led to a drastic decrease in the surface area of unmanaged forests in Europe. Changes in forest structure, composition, and dynamics inevitably lead to changes in the biodiversity of forest-dwelling species. The possible biodiversity gains and losses due to forest management (i.e., anthropogenic pressures related to direct forest resource use), however, have never been assessed at a pan-European scale. We used meta-analysis to review 49 published papers containing 120 individual comparisons of species richness between unmanaged and managed forests throughout Europe. We explored the response of different taxonomic groups and the variability of their response with respect to time since abandonment and intensity of forest management. Species richness was slightly higher in unmanaged than in managed forests. Species dependent on forest cover continuity, deadwood, and large trees (bryophytes, lichens, fungi, saproxylic beetles) and carabids were negatively affected by forest management. In contrast, vascular plant species were favored. The response for birds was heterogeneous and probably depended more on factors such as landscape patterns. The global difference in species richness between unmanaged and managed forests increased with time since abandonment and indicated a gradual recovery of biodiversity. Clearcut forests in which the composition of tree species changed had the strongest effect on species richness, but the effects of different types of management on taxa could not be assessed in a robust way because of low numbers of replications in the management-intensity classes. Our results show that some taxa are more affected by forestry than others, but there is a need for research into poorly studied species groups in Europe and in particular locations. Our meta-analysis supports the need for a coordinated European research network to study and monitor the biodiversity of different taxa in managed and unmanaged forests.

Diversity-interaction modeling: estimating contributions of species identities and interactions to ecosystem function.

We develop a modeling framework that estimates the effects of species identity and diversity on ecosystem function and permits prediction of the diversity-function relationship across different types of community composition. Rather than just measure an overall effect of diversity, we separately estimate the contributions of different species interactions. This is especially important when both positive and negative interactions occur or where there are patterns in the interactions. Based on different biological assumptions, we can test for different patterns of interaction that correspond to the roles of evenness, functional groups, and functional redundancy. These more parsimonious descriptions can be especially useful in identifying general diversity-function relationships in communities with large numbers of species. We provide an example of the application of the modeling framework. These models describe community-level performance and thus do not require separate measurement of the performance of individual species. This flexible modeling approach can be tailored to test many hypotheses in biodiversity research and can suggest the interaction mechanisms that may be acting.

[Analyzing the evolution of a Pharmacy Department using a relative value unit system]. / Análisis de la evolución de un Servicio de Farmacia a través del sitema de unidades relativas de valor.

INTRODUCTION: This study proposes the use of relative value units (RVU) as a clinical management tool to evaluate departmental services. OBJECTIVES: To measure productivity from 2000 to 2002 by estimating RVU. To determine RVU cost in constant Euros and evaluate system efficiency during this period of time. METHODS: Retrospective, observational study of a pharmacy department s production. RVU assigned to each activity have been obtained from a standardized document drawn up by the Sociedad Española de Farmacia Hospitalaria. Cost of each RVU was determined based on total cost assigned to the pharmacy department and the total number of RVUs produced. RESULTS: Drug dispensation activities account for 76% of the total production, followed by elaboration activities (21%). CONCLUSIONS: Productivity in our department has increased 46.48% in this period of time, while efficiency has increased by 23.8%.

Groove pancreatitis: hallazgos con TC helicoidal / Groove Pancreatitis: Spiral CT Findings

Objetivos: Describir los hallazgos por TC helicoidal de una entidad poco conocida: la groove pancreatitis o pancreatitis del surco pancreaticoduodenal (SPD), y revisar el diagnóstico diferencial de dicha entidad.Material y métodos: Presentamos ocho casos de pancreatitis del surco, todos estudiados con TC helicoidal. Se dispone de correlación anatomopatológica en dos casos a los que se les realizó duodenopancreatectomía cefálica y en los otros seis casos se dispone de un seguimiento radiológico que abarca de cinco a 36 meses.Resultados: En todos los casos la TC helicoidal mostró ensanchamiento y aumento de la densidad de la grasa del SPD, con escasa captación de contraste que refleja el componente fibroso de esta afección, asociada a áreas quísticas en su interior y/o en la pared duodenal. La cabeza pancreática estaba respetada en las formas "puras" de la pancreatitis del surco y se visualizaban zonas hipodensas en las formas "segmentarias cefálicas".Conclusión: El conocimiento de esta forma poco frecuente de pancreatitis crónica y los hallazgos radiológicos que permiten su diagnóstico son importantes para el radiólogo, ya que su diagnóstico diferencial incluye las neoplasias de la región periampular (AU)

Complications of orthotopic liver transplantation: spectrum of findings with helical CT.

Orthotopic liver transplantation has become the treatment of choice for patients with end-stage nonmalignant liver disease. The surgical techniques and immunosuppressive therapy for this procedure have improved considerably. Nevertheless, there are still significant complications, particularly those of vascular origin, which can lead to graft failure and require retransplantation unless prompt treatment is instituted. These complications include arterial and venous thrombosis and stenosis; arterial pseudoaneurysm; biliary leakage, stricture, and obstruction; liver ischemia, infarction, and abscess; fluid collections and hematomas; lymphoproliferative disorders; recurrent tumors; hepatitis C virus infection; and splenic infarction. Since the clinical presentation of posttransplantation complications is frequently nonspecific and varies widely, imaging studies are critical for early diagnosis. Helical computed tomography (CT) is a valuable complement to ultrasonography (US) in the postoperative period and is a safe, accurate, and noninvasive method of demonstrating hepatic vessels (hepatic artery, portal vein, hepatic veins, and inferior vena cava) and evaluating nonvascular complications (in the hepatic parenchyma and bile duct abnormalities) and extrahepatic tissues. Knowledge and early recognition of these complications is essential for graft salvage, and CT can provide valuable information, particularly for patients with indeterminate US results or in whom US examination is difficult.