A single dose of dietary nitrate supplementation protects against endothelial ischemia-reperfusion injury in early postmenopausal women.

The onset of menopause and accompanying changes to ovarian hormones often precedes endothelial dysfunction in women. In particular, accelerated impairments in macrovascular and microvascular function coincide with the loss of estrogen, as does impaired endothelial responses to ischemia-reperfusion (IR) injury. In healthy, early postmenopausal women (n = 12; 3.9 ± 1.5 years since menopause) we tested the hypothesis that acute dietary nitrate (NO3-) supplementation would improve endothelial function and attenuate the magnitude of endothelial dysfunction following whole-arm IR in comparison with placebo. In this randomized, double-blind, placebo-controlled, crossover study we tested participants before and after NO3--rich (BRnitrate) and NO3--depleted (BRplacebo) beetroot juice (BR) consumption, as well as following IR injury, and 15 min after IR to assess recovery. Analyses with repeated-measures general linear models revealed a condition × time interaction for brachial artery flow-mediated dilation (FMD; P = 0.04), and no interaction effect was found for the near-infrared spectroscopy-derived reperfusion slope (P = 0.86). Follow-up analysis showed a significant decline in FMD following IR injury with BRplacebo in comparison with all other timepoints (all, P < 0.05), while this decline was not present with BRnitrate (all, P > 0.05). Our findings demonstrate that a single dose of dietary NO3- minimizes IR-induced macrovascular endothelial dysfunction in healthy, early postmenopausal women, but does not improve resting macrovascular and microvascular function. Trial registration number: NCT03644472. Novelty: In healthy, early postmenopausal women, a single dose of NO3--rich BR can protect against IR-induced endothelial dysfunction. This protection may be due to nitric oxide bioactivity during IR rather than improved endothelial function prior to the IR protocol per se.

On the Use of Embedded Fiber Optic Sensors for Measuring Early-Age Strains in Concrete.

Detailed information about concrete behavior in real structures is an important issue in controlling its performance during its service life, and the use of embedded sensors to obtain desired information such as temperature, onset of the cracking process and evolution of strains, has gained the attention of the building concrete industry. Data obtained using this technology can provide valuable information for decision making about the need for corrective interventions that can ensure the integrity and safety of concrete structures for long period of time. This paper presents a review of the current state-of-the-art of embedded fiber optic sensors used to assess concrete information of a wide range of aspects, comprising: existing alternative technologies, characteristics and advantages, practical applications and future developments. Complementarily, the work presents preliminary results of the use of fiber optic sensors to automatically and continuously perform expansion readings of AAR in concrete elements that facilitate both the storage-with elimination of the usual interruptions for manual readings-and the availability of continuous results of expansion data that are not possible to obtain with usual AAR tests code reading recommendations.

Prevention of accidental exposure in radiotherapy: the risk matrix approach.

Knowledge and lessons from past accidental exposures in radiotherapy are very helpful in finding safety provisions to prevent recurrence. Disseminating lessons is necessary but not sufficient. There may be additional latent risks for other accidental exposures, which have not been reported or have not occurred, but are possible and may occur in the future if not identified, analyzed, and prevented by safety provisions. Proactive methods are available for anticipating and quantifying risk from potential event sequences. In this work, proactive methods, successfully used in industry, have been adapted and used in radiotherapy. Risk matrix is a tool that can be used in individual hospitals to classify event sequences in levels of risk. As with any anticipative method, the risk matrix involves a systematic search for potential risks; that is, any situation that can cause an accidental exposure. The method contributes new insights: The application of the risk matrix approach has identified that another group of less catastrophic but still severe single-patient events may have a higher probability, resulting in higher risk. The use of the risk matrix approach for safety assessment in individual hospitals would provide an opportunity for self-evaluation and managing the safety measures that are most suitable to the hospital's own conditions.

A geodesic deformable model for automatic segmentation of image sequences applied to radiation therapy.

PURPOSE: Organ motion should be taken into account for image-guided fractionated radiotherapy. A deformable segmentation and registration method was developed for inter-and intra-fraction organ motion planning and evaluation. METHODS: Energy minimizing active models were synthesized for tracking a set of organs delineated by regions of interest (ROI) in radiotherapy treatment. The initial model consists of a surface deformed to match the ROI contour by geometrical properties, following a heat flow model. The deformable segmentation model was tested using a Shepp-Logan head CT simulation, and different quantitative metrics were applied such as ROC analysis, Jaccard index, Dice coefficient and Hausdorff distance. RESULTS: Experimental evaluation of automated versus manual segmentation was done for the cardiac, thoracic and pelvic regions. The method has been quantitatively validated, obtaining an average of 93.3 and 99.2% for the sensitivity and specificity, respectively, 90.79% for the Jaccard index, 95.15% for the Dice coefficient and 0.96% mm for the Hausdorff distance. CONCLUSIONS: Model-based deformable segmentation was developed and tested for image-guided radiotherapy treatment planning. The method is efficient, robust and has sufficient accuracy for 2D CT data without markers.

Fast Monte Carlo simulation on a voxelized human phantom deformed to a patient.

PURPOSE: A method for performing fast simulations of absorbed dose using a patient's computerized tomography (CT) scan without explicitly relying on a calibration curve is presented. METHODS: The method is based on geometrical deformations performed on a standard voxelized human phantom. This involves spatially transforming the human phantom to align it with the patient CT image. Since the chemical composition and density of each voxel are given in the phantom data, a calibration curve is not used in the proposed method. For this study, the Monte Carlo (MC) code PENELOPE has been used as the simulation of reference. The results obtained with PENELOPE simulations are compared to those obtained with PENFAST and with the collapsed cone convolution algorithm implemented in a commercial treatment planning system. RESULTS: The comparisons of the absorbed doses calculated with the different algorithms on two patient CTs and the corresponding deformed phantoms show a maximum distance to agreement of 2 mm, and in general, the obtained absorbed dose distributions are compatible within the reached statistical uncertainty. The validity of the deformation method for a broad range of patients is shown using MC simulations in random density phantoms. A PENFAST simulation of a 6 MV photon beam impinging on a patient CT reaches 2% statistical uncertainty in the absorbed dose, in a 0.1 cm3 voxel along the central axis, in 10 min running on a single core of a 2.8 GHz CPU. CONCLUSIONS: The proposed method of the absorbed dose calculation in a deformed voxelized phantom allows for dosimetric studies in the geometry of a patient CT scan. This is due to the fact that the chemical composition and material density of the phantom are known. Furthermore, simulation using the phantom geometry can provide dosimetric information for each organ. The method can be used for quality assurance procedures. In relation to PENFAST, it is shown that a purely condensed-history algorithm (class I) can be used for absorbed dose estimation in patient CTs.

Vesical instillations of hyaluronic acid to reduce the acute vesical toxicity caused by high-dose brachytherapy do not affect the survival: a five-year follow-up study

OBJECTIVE: To determine whether the intravesical use of hyaluronic acid (HA) reduces acute and late vesical toxicity induced by radiotherapy. METHODS: Single-centre retrospective study of patients diagnosed with cervical and endometrial cancer treated with brachytherapy (BT) with or without intravesical instillation of HA. Patients were assigned consecutively to the two treatment groups. Forty milligrams of HA was instilled intravesically for approximately 30 min prior to each BT session. Rates of acute and late vesical toxicity were recorded using the RTOG criteria. RESULTS: Ninety-five clinical histories were reviewed (48 with HA instillation and 47 without). Surgery had been performed in 85.3% of cases, external radiotherapy in 76.8% and chemotherapy in 25.3%. There were no significant differences between groups with regard to the total number of BT sessions, dose per session, total dose or biological equivalent dose. In all the sessions the percentage of patients presenting acute vesical toxicity was lower in the HA group, the differences being statistically significant (p<0.05) after the 2nd (20.8% vs. 40.4%) and 4th sessions (10.9% vs. 31.9%). No patients in the HA group presented vesical toxicity after six months of follow-up. Over the whole study period, the percentage of patients presenting vesical toxicity of degree 2 or more was significantly lower in the HA group (2.08% vs. 12.8%; p<0.05). CONCLUSION: Vesical instillations of HA decrease the incidence and the degree of acute vesical toxicity induced by high-dose BT, and reduce the percentage of patients that develop toxicity of degree 2 or more (AU)

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Decreased nitric oxide markers and morphological changes in the brain of arsenic-exposed rats.

Epidemiological studies demonstrate an association between chronic consumption of arsenic contaminated water and cognitive deficits, especially when the exposure takes place during childhood. This study documents structural changes and nitrergic deficits in the striatum of adult female Wistar rats exposed to arsenic in drinking water (3 ppm, approximately 0.4 mg/kg per day) from gestation, throughout lactation and development until the age of 4 months. Kainic acid injected animals (10mg/kg, i.p.) were also analyzed as positive controls of neural cell damage. Morphological characteristics of cells, fiber tracts and axons were analyzed by means of light microscopy as well as immunoreactivity to neuronal nitric oxide synthase (nNOS). As nitrergic markers, nitrite/nitrate concentrations, nNOS levels and expression of nNOS-mRNA were quantified in striatal tissue. Reactive oxygen species (ROS) and lipid peroxidation (LPx) were determined as oxidative stress markers. Arsenic exposure resulted in moderate to severe alterations of thickness, organization, surrounding space and shape of fiber tracts and axons, while cell bodies remained healthy. These anomalies were not accompanied by ROS and/or LPx increases. By contrast, except the expression of nNOS-mRNA, all nitrergic markers including striatal nNOS immunoreactivity presented a significant decrease. These results indicate that arsenic targets the central nitrergic system and disturbs brain structural organization at low exposure levels.

Desgaste profesional y entorno laboral de los pediatras de Atención Primaria / Professional burn-out and work setting of Primary Health Care pediatricians

Objetivo: Identificar la posible asociación entre el grado de desgaste profesional y percepción de problemas laborales, en el ejercicio asistencial de los pediatras de Atención Primaria de Tenerife. Material y Método: Estudio transversal mediante cuestionario Maslach Burnout Inventory (MBI) para valorar el desgaste profesional o Burnout (BO), y preguntas relativas a la percepción de los problemas profesionales. Encuesta anónima a los 102 pediatras de Atención Primaria (AP) de Tenerife. Se describen las distribuciones conjuntas de las dimensiones del MBI, sexo, edad, integración en Equipo, demanda asistencial, confianza en la dirección del Centro y Gerencia. Las comparaciones se realizan mediante la prueba U de Mann-Whitney para variables ordinales o la Chi (2) de Pearson para categóricas a un nivel p¡Ü0,05. Resultados: Tasa de > participación: 66%. Presentaron alto nivel de agotamiento emocional 55%, alto nivel de despersonalización 33% y baja realización personal 47%. El 8% presentan un desgaste profesional total. No se encontró diferencia significativa en el BO por sexo, ni edad. Los pediatras integrados en Equipos presentaban mayor despersonalización (p=0.03).A mayor duración del ejercicio profesional, mayor porcentaje con nivel medio-alto de agotamiento (p=0.04). La elevada demanda asistencial se asocia de forma negativa con el estado de ánimo, arrojando un nivel medio-alto de agotamiento (p=0.006). Encontramos niveles medio-altos de despersonalización entre quienes no se consideran apoyados por la Administración de su Centro (p=0,005), no confían en la Dirección de su Centro (p=0,04) y no confían en la Gerencia para solucionar los problemas de trabajo (p=0,02). Conclusiones: Los pediatras de Atención Primaria de Tenerife, presentan niveles altos de Síndrome de Burnout asociados a una percepción negativa hacia la Administración (AU)

Objetives: To identify possible association among level of Burnout Syndrome and perception of job problems, on the service of providing care in Paediatricians Primary Care. Methods: Cross-sectional study though Maslach Burnout Inventory (MBI) questionnaire to estimate (BO) Burnout Syndrome and questions about perception of work problems. Anonymous questionnaire to on hundred and two Primary Care Paediatricians in Tenerife. MBI dimension are described in relation with sex, age, outfit integration, assistance demand, director confidence, and management. Comparisons are performed with U Mann-Whiyney or ordinal variables or Chi (2) Pearson for categorical variable (p¡Ü0.05). Result: Participation rate was 66%, high level of emotional exhaustion: 55%, high level of depersonalization: 33%, low personal achievements: 47%. Presents total BO: 8%. There was not found significantly differences between sex or age in BO. Paediatrics inside out fits showed higher depersonalization (p=0.03). For long time of professional care service, higher percentage of quite severe emotional exhaustion (p=0,04). The high assistance demand was found to be related with wood, as negative bringing out in moderate-severe level of emotional exhaustion (p=0.006). We founded moderate-severe levels of depersonalization among people who do not feel support from administration centre (p=0.005), do not have confidence on director ship (p=0,04) and do not have confidence on management to settle work problems (p=0,02).Conclusions: Tenerife´s Primary Care Paediatrics show high level on BO related with negative perception of Administration (AU)

[Up-date of the diagnosis and treatment of vasospastic angina]. / Actualización del diagnóstico y tratamiento de la angina vasoespástica.

Vasospastic or Prinzmetal's variant angina as it is also known is a special type of ischemic heart disease characterized by spontaneous episodes of chest pain accompanied by transitory ST segment elevations during the episodes. These alterations are essential for its diagnosis and it is difficult to diagnose it in their absence. If clinical suspicion is high, it should be confirmed by coronary vasospasm provocation tests, since, on the contrary, there may be cases that are not diagnosed or considered to be other types of diseases. Furthermore, progression of this type of angina to a myocardial infarction due to coronary stenosis is a relatively uncommon event.

Actualización del diagnóstico y tratamiento de la angina vasoespástica / Up-date of the diagnosis and treatment of vasospastic angina

La angina vasoespástica o variante de Printzmetal es una forma particular de cardiopatía isquémica, caracterizada por episodios espontáneos de dolor torácico acompañados de elevaciones transitorias del segmento ST durante dichos episodios, siendo estas alteraciones fundamentales para su diagnóstico, el cual se dificulta mucho en ausencia de las mismas, debiendo ser confirmado, si la sospecha clínica es elevada, mediante tests de provocación de vasoespasmo coronario, ya que de lo contrario puede haber casos infradiagnosticados o catalogados de otro tipo de patologías. La progresión de este tipo de angina hacia un infarto agudo de miocardio (IAM) por placa complicada es un hecho relativamente poco frecuente

Vasospastic or Prinzmetal's variant angina as it is also known is a special type of ischemic heart disease characterized by spontaneous episodes of chest pain accompanied by transitory ST segment elevations during the episodes. These alterations are essential for its diagnosis and it is difficult to diagnose it in their absence. If clinical suspicion is high, it should be confirmed by coronary vasospasm provocation tests, since, on the contrary, there may be cases that are not diagnosed or considered to be other types of diseases. Furthermore, progression of this type of angina to a myocardial infarction due to coronary stenosis is a relatively uncommon event (AU)

[Lung function and exposure to tobacco smoke among adolescents]. / Función pulmonar y exposición al humo del tabaco en adolescentes.

OBJECTIVE: To study lung function in adolescents in relation to smoking (active and passive smokers) and to investigate the repercussion on spirometric parameters. PATIENTS AND METHOD: We studied 301 healthy adolescents with no history of bronchial asthma or colds in the month prior to the study. A questionnaire on tobacco exposure was administered and spirometry (Datospir-92) was performed. RESULTS: There were 165 boys (54.5%) and 136 girls (45.5%) aged between 14 and 20 years old (16.40+/-1.32). A total of 27.2% were non-smokers and were not exposed to tobacco smoke (NS), 31.3% were passive smokers, with household exposure of 10 cigarettes per day during at least the previous year (PS), and 41.5% were current smokers who had been smoking>or=10 cigarettes/day for at least 1 year (CS). Significant differences were found between age and smoking habits (p=0.0001) and between smoking habits and female sex (girls CS: 33.9% vs boys CS: 21.8 %) (p=0.007). A significant association was found between smoking (NS, PS and CS) and spirometric parameters (ANOVA): forced vital capacity (FVC) (p=0.001), forced expiratory volume in 1 second (FEV1) (p=0.0001), FEV1/FVC (p=0.004), peak expiratory flow (PEF) (p=0.0001), midexpiratory flow at 25% of forced vital capacity (MEF25%) (p=0.01), MEF50% (p=0.0001) and MEF25-75% (p=0.0001); CS in relation to NS was as follows: FEV1, PEF, MEF50%, MEF25-50% (p=0.0001) and FVC, FEV1/FVC, MEF25% (p=0.01); CS in relation to PS: FEV1/ FVC (p=0.02), PEF (p=0.004), MEF50% and MEF25-75% (p=0.003), PS in relation to NS: FVC and FEV1 (p=0.02). Significant differences in FVC, FEV1 and MEF25-75% were found in female CS in comparison with boys. CONCLUSIONS: The CS group showed a significant decrease in spirometric parameters in relation to the NS group. The airway was affected sooner in the female group of smokers than in the male group, even though the intensity and time of exposure were the same in both groups.

Función pulmonar y exposición al humo del tabaco en adolescentes / Lung function and exposure to tobacco smoke among adolescents

Objetivo Estudiar la función pulmonar de adolescentes y relacionarlo con hábito tabáquico (HT) en fumadores activos y pasivos. Investigar la repercusión sobre los parámetros espirométricos. Pacientes y método Un total de 301 adolescentes sanos, no diagnosticados de asma bronquial y sin presentar episodios catarrales en el mes previo. Encuesta de exposición al tabaco y espirometría basal (Datospir-92). Resultados Un total de 165 varones (54,5 %) y 136 mujeres (45,5 %) de las siguientes edades: 14-20 años (16,40 ± 1,32). Distribución: 27,2 %, no fumadores, no expuestos al humo del tabaco (NE); 31,3 %, fumadores pasivos, expuestos en su domicilio a más de 10 cigarrillos/día al menos durante el último año (FP); 41,5 %, fumadores habituales que fumaban 10 o más cigarrillos al día al menos durante un año (FH). Existen diferencias significativas entre edad y HT (p = 0,0001), entre HT y sexo femenino (mujeres FH: 33,9 %; varones FH: 21,8 %) p = 0,007. Obtuvimos relación entre HT (NE, FP y FH) y parámetros espirométricos (ANOVA): capacidad vital forzada (FVC) (p = 0,001), volumen espiratorio forzado en el primer segundo (FEV1) (p = 0,0001), FEV1/FVC (p = 0,004), pico máximo de flujo espiratorio (PEF) (p = 0,0001), MEF25 % (flujo espiratorio máximo cuando queda en el pulmón el 25 % de la FVC) (p = 0,01), MEF50 % (p = 0,0001) y MEF25-75 % (p = 0,0001). El FH en relación con NE: FEV1, PEF, MEF50 %, MEF25-75 % (p = 0,0001), FVC, FEV1/FVC, MEF25 % (p = 0,01). El FH en relación con FP: FEV1/FVC (p = 0,02), PEF (p = 0,004), MEF50 %, MEF25-75 % (p = 0,003). El FP en relación con NE: FVC, FEV1 (p = 0,02). Las mujeres FH presentan diferencias significativas en: FVC, FEV1 y MEF25-75 %, con respecto a los varones. Conclusiones Los adolescentes FH presentan un descenso significativo de los parámetros espirométricos en relación con los NE. Las mujeres fumadoras, con la misma intensidad y tiempo de exposición que los varones, tienen afectada su vía aérea más precozmente

Objective To study lung function in adolescents in relation to smoking (active and passive smokers) and to investigate the repercussion on spirometric parameters. Patients and method We studied 301 healthy adolescents with no history of bronchial asthma or colds in the month prior to the study. A questionnaire on tobacco exposure was administered and spirometry (Datospir-92) was performed. Results There were 165 boys (54.5 %) and 136 girls (45.5 %) aged between 14 and 20 years old (16.40 ± 1.32). A total of 27.2 % were non-smokers and were not exposed to tobacco smoke (NS), 31.3 % were passive smokers, with household exposure of 10 cigarettes per day during at least the previous year (PS), and 41.5 % were current smokers who had been smoking >= 10 cigarettes/day for at least 1 year (CS). Significant differences were found between age and smoking habits (p = 0.0001) and between smoking habits and female sex (girls CS: 33.9 % vs boys CS: 21.8 %) (p = 0.007). A significant association was found between smoking (NS, PS and CS) and spirometric parameters (ANOVA): forced vital capacity (FVC) (p = 0.001), forced expiratory volume in 1 second (FEV1) (p = 0.0001), FEV1/FVC (p = 0.004), peak expiratory flow (PEF) (p = 0.0001), midexpiratory flow at 25 % of forced vital capacity (MEF25 %) (p = 0.01), MEF50 % (p = 0.0001) and MEF25-75 % (p = 0.0001); CS in relation to NS was as follows: FEV1, PEF, MEF50 %, MEF25-50 % (p = 0.0001) and FVC, FEV1/FVC, MEF25 % (p = 0.01); CS in relation to PS: FEV1/ FVC (p = 0.02), PEF (p = 0.004), MEF50 % and MEF25-75 % (p = 0.003), PS in relation to NS: FVC and FEV1 (p =0.02). Significant differences in FVC, FEV1 and MEF25-75 % were found in female CS in comparison with boys. Conclusions The CS group showed a significant decrease in spirometric parameters in relation to the NS group. The airway was affected sooner in the female group of smokers than in the male group, even though the intensity and time of exposure were the same in both groups

Epidemiología del déficit en glucose-6-fosfato deshidrogenasa eritrocitaria en España / No disponible

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Troponina: Interpretación Clínica / No disponible

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Metrorragia masiva en una paciente anticoagulada con warfarina. Reversión rápida con concentrado de complejo protrombínico (Prothromplex Immuno TIM 4 600 UI) / Massive metrorrhagia in a patient under warfarin anticoagulation. Rapid reversal with a concentrated prothrombin complex (Prothromplex Immuno TIM 4 600 IU)

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Tomoterapia helicoidal: IMRT adaptada guiada por imagen / Helical tomotherapy: image CT-guided IMRT

El Tomo-Therapy HI-ART es un nuevo sistema de radioterapia que integra la planificación del tratamiento,la verificación de la posición del paciente, del target y de los órganos a riesgo (OAR) y la ejecución de la administraciónde la radiación. Mediante un colimador multiláminas binario es posible modular la intensidad deun haz de radiación helicoidal, rotatorio y continuo, generado en un Acelerador Lineal instalado en un gantryde morfología anular, obteniendo altos índices de conformabilidad en el target, distribuciones de dosis homogéneasy altos gradientes dosimétricos, optimizando el rango terapéutico.Además, proporciona imágenes volumétricas de TAC (tomoimagen) de los volúmenes de interés (target,OAR) inmediatamente antes del tratamiento, permitiendo en tiempo real certificar la posición del paciente,precisar con exactitud la localización del target y de los OAR, y adaptar el tratamiento de radioterapia deacuerdo a las posibles modificaciones que ocurren durante el tiempo de tratamiento en la morfología, tamaño ymovilidad del tumor.En conclusión, Tomo-Therapy HI-ART integra en una única unidad funcional tratamiento e imagen utilizandoun Acelerador Lineal instalado en un gantry anular helicoidal, siendo una modalidad de alta precisión de radioterapiade intensidad modulada (IMRT) guiada por imagen tomográfica

The Tomo-Therapy HI-ART System delivers intensity-modulated radiotherapy (IMRT) using a multileafcollimator (MLC). This binary MLC is made up of interlaced leaves, where each leaf can open and closequickly to permit or block the radiation throughout it, dividing the radiation beam into many smaller beams(beamlets).The Tomo-Therapy System also includes a computed tomography (CT) which can verify the size, shape andlocation of the patient’s anatomy, target and organs at risk just prior to the time of treatments.This integrated system allows to optimize the planification, CT verification and fusion images, set-upmodifications on line, and finally to deliver the dose, verify the dose delivered and made a dose reconstruction,a whole process called adaptive radiotherapy.The Tomo-Therapy is the first system of image CT-guided IMRT