Implementation of a vascular access team and an intravenous therapy programme: A first-year activity analysis.

BACKGROUND: Creating Vascular Access Teams (VAT) provides an expert nursing role that contributes to the training and continuous improvement of healthcare personnel. They can offer greater clinical safety, reducing complications and costs. Peripherally inserted central catheters (PICCs) and midline catheters (ML) can be safe and cost-effective alternatives to other types of venous access (VA). The aim of the study was to analyse our centre's VAT first 12 months of activity. The primary outcome was reported complications. Secondary outcomes were cause of catheter removal, consultancy activity and economic impact of VAT implantation. METHODOLOGY: A longitudinal, descriptive study was carried out from March 2019 to March 2020. Using consecutive sampling, all VA inserted, and all consults received were included. Patients under 18 years of age were excluded. RESULTS: The VAT inserted 1257 catheters into 1056 patients (291 MLs, 966 PICCs). The mean dwell time was 14.9 days for MLs and 59.07 days for PICCs. The main reason for removing VA was end of treatment (80.7%). During VA follow-up confirmed infection was detected in 1 ML (0.3%) and nine PICCs (0.9%). Symptomatic thrombosis was reported in 2 MLs (0.7%) and 16 PICCs (1.7%). The VAT received 367 consultations, and the main reason for consultation was to resolve doubts regarding the management of VA (80.9%). The insertion of ML and PICC catheters represented annual estimated economic savings of €867,688.44€. CONCLUSIONS: Our study provides a detailed analysis of VAT's activity, its relevance to clinical safety, and to efficient resource management within our hospital. It demonstrates how VAT establishment can be a safe and efficient intervention that enhances care quality.

[Prenatal rescue dose of betamethasone in the preterm infant with intrauterine growth restriction]. / Dosis prenatal de rescate de betametasona en el prematuro con restricción del crecimiento intrauterino.

Antenatal corticosteroids reduce mortality and respiratory distress syndrome (RDS) in preterm newborns. These benefits decrease after a week of administration, recommending a rescue therapy if there is a new threat of premature delivery. Repeated administration of antenatal corticosteroids may have deleterious effects and their benefits are controversial in intrauterine growth restriction (IUGR). OBJECTIVE: to verify the effects in the IUGR population of antenatal betamethasone rescue therapy on neonatal morbidity and mortality, RDS, and neurodevelopment at 2 years. PATIENTS AND METHOD: Retrospective study including ≤ 34 weeks and ≤ 1,500g preterm newborns divided according to antenatal betamethasone exposure: Single-cycle (2 doses) vs Rescue therapy (3 doses). Subgroups were created for those ≥ 30 weeks. Both cohorts were followed up to 24 months of corrected age. The Ages & Stages Questionnaires (ASQ)® was administered to assess neurodevelopment. RESULTS: 62 preterm infants with a diagnosis of IUGR were included. The rescue therapy group compared with the single-dose group showed no differences in morbidity and mortality and less intubation rate at birth (p = 0.02), with no differences in respiratory support at 7 days of life. Preterm newborns ≥ 30 weeks exposed to rescue therapy showed higher morbidity and mortality (p = 0.03) and bronchopulmonary dysplasia (BPD) (p = 0.02), showing no differences in RDS. The rescue therapy group showed worse mean scores on the ASQ-3 scale, with no significant differences in cerebral palsy or sensory deficits. CONCLUSIONS: Rescue therapy reduces intubation at birth but does not reduce morbidity and mortality. However, at > 30 weeks, this benefit is not observed and the IUGR population exposed to rescue therapy presented more BPD and lower scores on the ASQ-3 scale at 2 years. Future studies should be aimed at the individualization of antenatal corticosteroid therapy.

Migración de catéter ureteral doble-J a vena cava inferior, una complicación inusual / Migration of double-J ureteral catheter into the inferior vena cava, an unusual complication

La colocación de catéteres ureterales doble-J es uno de los procedimientos más realizados en Urología, con bajas tasas de complicaciones graves. No obstante, pueden ocurrir y requieren de una identificación y tratamiento precoz. Presentamos el caso de un varón de 73 años intervenido de una prostatectomía radical, al que se le coloca un catéter doble-J por sospecha de lesión ureteral durante la intervención, con inestabilidad hemodinámica en el postoperatorio inmediato secundaria a la migración del catéter a la vena cava inferior

Double-J ureteral catheter placement is one of the most commonly performed procedures in Urology, with low rates of severe complications. Nevertheless, they can occur and require early identification and treatment. We present the case of a 73-year-old man who underwent radical prostatectomy and placement of a double-J catheter due to suspected ureteral injury during the surgery, with hemodynamic instability in the immediate postoperative period secondary to intracaval migration of the catheter.

Effects of local factors on adaptation to heat in Spain (1983-2018).

The European Union is currently immersed in policy development to address the effects of climate change around the world. Key plans and processes for facilitating adaptation to high temperatures and for reducing the adverse effects on health are among the most urgent measures. Therefore, it is necessary to understand those factors that influence adaptation. The aim of this study was to provide knowledge related to the social, climate and economic factors that are related to the evolution of minimum mortality temperatures (MMT) in Spain in the rural and urban contexts, during the 1983-2018 time period. For this purpose, local factors were studied regarding their relationship to levels of adaptation to heat. MMT is an indicator that allows for establishing a relationship to between mortality and temperature, and is a valid indicator to assess the capacity of adaptation to heat of a certain population. MMT is obtained through the maximum daily temperature and daily mortality of the study period. The evolution of MMT values for Spain was established in a previous paper. An ecological, longitudinal and retrospective study was carried out. Generalized linear models (GLM) were performed to identify the variables that appeared to be related to adaptation. The adaptation was calculated as the difference in variation in MMT based on the average increase in maximum daily temperatures. In terms of adaptation to heat, urban populations have adapted more than non-urban populations. Seventy-nine percent (n = 11) of urban provinces have adapted to heat, compared to twenty-one percent (n = 3) of rural provinces that have not adapted. In terms of urban zones, income level and habituation to heat (values over the 95th percentile) were variables shown to be related to adaptation. In contrast, among non-urban provinces, a greater number of housing rehabilitation licenses and a greater number of health professionals were variables associated with higher increases in MMT, and therefore, with adaptation. These results highlight the need to carry out studies that allow for identifying the local factors that are most relevant and influential in population adaptation. More studies carried out at a small scale are needed.

Análisis de la evolución de los operados mediante cirugía de mínimo acceso en nuestro hospital. ¿Presenta mejores resultados que la convencional? / Analysis of the evolution of those operated on with minimal access surgery in our hospital. Does it present better results than the conventional one?

Resumen La estenosis aórtica severa sintomática es la patología quirúrgica más prevalente en cirugía cardiaca y su sustitución aislada se ha realizado históricamente mediante esternotomía media completa. Sin embargo, se ha producido recientemente una gran revolución, especialmente tras la llegada de las prótesis aórticas sin suturas que, unido a un nuevo impulso por la cirugía cardiaca hacia un rumbo menos invasivo, ha provocado que el reemplazo de dicha válvula se lleve a cabo cada vez más frecuentemente por dichas prótesis y por incisiones de mínimo acceso. Por ello, realizamos una revisión de los casos intervenidos en nuestro servicio desde el inicio del programa de cirugía de mínimo acceso comparándolos con los resultados de los casos intervenidos en la misma época mediante cirugía convencional.

Abstract Symptomatic severe aortic stenosis is the most prevalent surgical pathology in cardiac surgery, and its isolated replacement has historically been performed by means of complete middle sternotomy. However, a great revolution has recently taken place, especially after the arrival of sutureless aortic prostheses that, together with a new impulse by cardiac surgery towards a less invasive course, has caused the replacement of said valve to be carried out more and more frequently due to these prostheses and minor access incisions. For this reason, we carried out a review of the cases operated on in our service from the beginning of the minimum access surgery program, comparing them with the results of the cases operated at the same time using conventional surgery.

Influencia de las desigualdades sociales en salud en la mortalidad de la población rural y urbana en España, 2007-2013 / Influence of social inequalities in health on the mortality of the rural and urban population in Spain, 2007-2013

OBJETIVO: Describir patrones de causa de muerte por género, edad y territorio. Las causas de mortalidad y sus posibles relaciones con las desigualdades en salud en la población rural y urbana en España. MATERIAL Y MÉTODOS: Se realizó un estudio ecológico de los datos de mortalidad de la población española entre 2007 y 2013. Los datos de mortalidad se obtuvieron del Instituto Nacional de Estadística (INE). Para presentar los datos de forma agrupada y simplificada, se codificó la clasificación CIE-10 utilizada por el INE con la clasificación de Carga de Enfermedad definida por Murray y López en 1996, reducida a 21 categorías de enfermedades. Se ha calculado la variable territorio rural/urbano tomando como referencia el corte que establece que poblaciones superiores a 10.000 habitantes son entornos urbanos y los que están por debajo son entornos rurales. Se utilizó el test de χ2 y de la z corregida por Bonferroni para los factores de carácter cualitativo y el contraste de la t de Student para los factores de carácter cuantitativo. RESULTADOS: Las principales causas de muerte fueron las enfermedades cardiovasculares con el 31% (844.010) y los tumores malignos con el 26,7% (724.889), las neuropsiquiátricas con el 8,8% (238.330) y las respiratorias con el 8,7% (235.448). En el entorno rural, para el género masculino se encontró que fallecieron el 52,7% (366.053) mientras que en el entorno urbano fallecieron el 51,3% (995.470). En cuanto al género femenino, los casos de defunciones fueron el 47,3% (329.063) en el entorno rural y el 48,7% (9545.188) en el urbano. Con respecto a la edad, las medias de las edades que se asocian a un fallecimiento más tardío fueron las condiciones nutricionales (media de 85,62 años). En cuanto a las edades más tempranas, obviando las relacionadas con los fallecimientos de recién nacidos, fueron las anomalías congénitas con 25,37 años de media. CONCLUSIONES: Se encontraron diferencias de mortalidad entre los 3 ejes de desigualdad sociales en salud (edad, género y territorio). Por lo tanto, podemos decir que los determinantes sociales condicionan nuestra esperanza de vida

OBJECTIVE: Describe patterns of cause of death by gender, age and territory. The causes of mortality and their possible relationships with health inequalities in the rural and urban population in Spain. MATERIAL AND METHODS: An ecological study of the mortality data of the Spanish population between 2007 and 2013 was carried out. Mortality data were obtained from the National Statistics Institute (INE). To be able to present the data in the grouped and simplified form, the ICD-10 classification detected by the INE was coded with the classification of Disease Load defined by Murray and López (1996), reduced to 21 categories of diseases. The territory variable has been determined: rural / urban, taking as a reference the cut that establishes that populations over 10,000 inhabitants are urban environments and those that are below rural environments. The chi-square test and the Bonferroni-corrected z test for qualitative factors and the Student's t-test for quantitative factors were considered. RESULTS: The results showed than the main causes of death were cardiovascular diseases with 31% (844,010) and malignant tumors with 26.7% (724,889), neuropsychiatric with 8.8% (238,330) and respiratory with 8.7% (235,448). In the rural setting, for the male gender, 52.7% (366,053) died, while 51.3% (995,470) died in the urban environment. Regarding the female gender, the cases of deaths were 47.3% (329,063) in the rural environment and 48.7% (9545.188) in the urban. Related to age, the means of the ages associated with a later death were nutritional conditions with 85.62 years. As for the earliest ages, obviating those related to the deaths of newborns, were the congenital anomalies with 25.37 years of means. CONCLUSIONS: Mortality differences were found between the 3 axes of social inequality in health-age, gender and territory. Therefore, we can say that social determinants condition our life expectancy

Comparison of the antinociceptive profiles of morphine and oxycodone in two models of inflammatory and osteoarthritic pain in rat.

Oxycodone and morphine are two opioid drugs commonly used for the treatment of moderate to severe pain. However, their use in the management of noncancer pain remains a controversial issue and, in this respect, the evidence on their effectiveness and safety, particularly in osteoarthritis, is being questioned. In order to analyse their analgesic profile, two different pain models in rats were used: the formalin-induced inflammatory pain and the monosodium iodoacetate (MIA)-induced knee osteoarthritic pain. Drugs were administered systemically (i.p.) and their antinociceptive effect and potency were assessed. In the formalin test, both morphine and oxycodone produced a dose-dependent antinociceptive effect, but oxycodone outdid morphine in terms of effectiveness and potency (nearly two times) in the early (acute nociceptive) as in the late phase (inflammatory). In the osteoarthritis model, both drugs reduced movement-evoked pain (knee-bend test), mechanical allodynia (von Frey test) and heat hyperalgesia (Plantar test). Pretreatment with naloxone and naloxone methiodide reduced morphine and oxycodone effects. Peripheral mu-opioid receptors play a crucial role in the antinociceptive effect of both drugs on movement-evoked pain and heat hyperalgesia, but not on tactile allodynia. The main finding of our study is that oxycodone has a better antinociceptive profile in the inflammatory and osteoarthritic pain, being more effective than morphine at 14 days post-MIA injection (phase with neuropathic pain); it overcame the morphine effect by improving the movement-induced pain, tactile allodynia and heat hyperalgesia. Therefore, oxycodone could be an interesting option to treat patients suffering from knee osteoarthritis when opioids are required.

Composición corporal y somatotipo por posición de juego en balonmano profesional masculino / Body composition and somatotype in professional men's handball according to playing positions

Se realizó un estudio descriptivo transversal en 19 jugadores profesionales del Club Balonmano Valladolid. Las mediciones antropométricas fueron realizadas según el protocolo estándar. Se estimaron la masa grasa y ósea, se calculó el somatotipo y se analizaron las diferencias entre las variables en función de la posición. Como resultados, se obtuvo que los pivotes fueron los jugadores más pesados (con mayor porcentaje de masa grasa); los extremos, los más ligeros y los laterales, junto con los pivotes, los más altos. No se observaron diferencias en el IMC en los grupos. En la somatocarta los centrales y laterales se situaron en la zona central; los extremos y los pivotes en la endomorfa-mesomorfa y los porteros en la ecto-endomorfa. Así se evidenció que las variables antropométricas, los datos de composición corporal y la somatocarta de los deportistas confirman las características morfológicas básicas de los jugadores para la posición para la que son más aptos (AU)

A cross-sectional descriptive study was accomplished in 19 professional players from Valladolid Handball Club. Anthropometric measurements were performed according to standard protocol. Body fat and bone mass were estimated, and the somatotype was calculated. As results, the line players were significantly the heaviest players; the wings were lightest and the backs, with the line players, the tallest. Nevertheless, no significant differences in BMI were observed. Regarding the body composition, the line players showed the highest values of fat-mass. No differences in BMI were observed in the groups. With respect to the somatochart, the center backs and backs were in the central area; wings and line players showed an endomorph-mesomorph development, and goalkeepers were in the ecto-endomorph area. As conclusions, anthropometric variables, body composition data and the somatochart of the athletes evaluated confirm the basic morphological characteristics of the players for the position for which they are best suited (AU)

Characterization of Cardiovascular Alterations Induced by Different Chronic Cisplatin Treatments.

In the last years, many clinical studies have revealed that some cisplatin-treated cancer survivors have a significantly increased risk of cardiovascular events, being cisplatin-induced cardiovascular toxicity an increasing concern. The aim of the present work was to evaluate the cardiovascular alterations induced by different chronic cisplatin treatments, and to identify some of the mechanisms involved. Direct blood pressure, basal cardiac (left ventricle and coronary arteries) and vascular (aortic and mesenteric) functions were evaluated in chronic (5 weeks) saline- or cisplatin-treated male Wistar rats. Three different doses of cisplatin were tested (1, 2, and 3 mg/kg/week). Alterations in cardiac and vascular tissues were also investigated by immunohistochemistry, Western Blot, and or quantitative RT-PCR analysis. Cisplatin treatment provoked a significant modification of arterial blood pressure, heart rate, and basal cardiac function at the maximum dose tested. However, vascular endothelial dysfunction occurred at lower doses. The expression of collagen fibers and conexin-43 were increased in cardiac tissue in cisplatin-treated rats with doses of 2 and 3 mg/kg/week. The expression of endothelial nitric oxide synthase was also modified in cardiac and vascular tissues after cisplatin treatment. In conclusion, chronic cisplatin treatment provokes cardiac and vascular toxicity in a dose-dependent manner. Besides, vascular endothelial dysfunction occurs at lower doses than cardiac and systemic cardiovascular toxicity. Moreover, some structural changes in cardiac and vascular tissues are also patent even before any systemic cardiovascular alterations.

Vector bioimpedance detects situations of malnutrition not identified by the indicators commonly used in geriatric nutritional assessment: A pilot study.

OBJECTIVE: To compare body composition as assessed by conventional and vector bioelectrical impedance analysis according to the nutritional cataloging using body mass index (BMI) in a group of institutionalized elderly. METHODS: Cross-sectional study in 38 institutionalized elderly. Body composition was estimated by bioimpedance analysis. Differences in body composition were analyzed using t-test and ANOVA, or their corresponding nonparametric tests. Statistical significance was set at p<0.05. RESULTS: Based on BMI, the sample showed overweight (average BMI: 26.4kg/m2), and women had higher BMI values than men (28.9 vs. 25.5kg/m2). Based on waist circumference, abdominal obesity was detected in 60.7% of men and 80% of women. Conventional bioimpedance analysis (BIA) yielded high fat mass values and slightly depleted skeletal muscle mass, compatible with sarcopenic obesity. All individual impedance vectors were located on the right of the major axis of the tolerance ellipses, reflecting body-cell-mass depletion in all subjects, regardless of BMI cataloging. CONCLUSIONS: Bioelectrical impedance vector analysis (BIVA) detects body compartment changes in institutionalized elderly that are not identified by the most widely used clinical practice nutritional indicators, such as BMI, waist circumference, and BIA-estimated body composition.

Injerto aorto-poplíteo directo para el tratamiento de la isquemia crítica de los miembros inferiores / Direct aorto-popliteal arterial bypass for critical limb ischemia

No disponible

Implementation of the agmatine-controlled expression system for inducible gene expression in Lactococcus lactis.

BACKGROUND: Lactococcus lactis has been safely consumed in fermented foods for millennia. This Gram-positive bacterium has now become of industrial importance as an expression host for the overproduction of lipopolysaccharide-free recombinant proteins used as food ingredients, therapeutic proteins and biotechnological enzymes. RESULTS: This paper reports an agmatine-controlled expression (ACE) system for L. lactis, comprising the lactococcal agmatine-sensor/transcriptional activator AguR and its target promoter P(aguB). The usefulness and efficiency of this system was checked via the reporter gene gfp and by producing PEP (Myxococcus xanthus prolyl-endopeptidase), an enzyme of biomedical interest able to degrade the immunotoxic peptides produced during the gastrointestinal breakdown of gluten. CONCLUSION: The ACE system developed in this work was suitable for the efficient expression of the functional recombinant proteins GFP and PEP. The expression system was tightly regulated by the agmatine concentration and allowed high protein production without leakiness.

[PROPOSAL FOR A NEW FORMULA FOR ESTIMATING RESTING ENERGY EXPENDITURE FOR HEALTHY SPANISH POPULATION]. / PROPUESTA DE UNA NUEVA FÓRMULA DE ESTIMACIÓN DEL GASTO ENERGÉTICO EN REPOSO PARA POBLACIÓN SANA ESPAÑOLA.

INTRODUCTION: although there are precise and accurate techniques for estimating resting energy expenditure, like the indirect calorimetry (IC), daily practice needs faster, easier and cheaper methods as the predictive equations. OBJECTIVE: the aim of the study was to develop a new predictive equation for estimating resting energy expenditure (REE) for healthy Spanish population. Méthods: the REE of 95 healthy normal weighted volunteers was determined by indirect calorimetry (IC). The new equation was obtained by multiple lineal regression by using the analytical criteria of the Cp of Mallows and the adjusted R2. Then, the behavior of the new formula was studied in a group of overweight volunteers through the intraclass correlation coefficient (ICC) and Bland-Almand plots. The level of signification was reached at p < 0,05. RESULTS: the average age was 42 years (range: 2.0-63.2). Mean REE determined by IC was 1 589.1 kcal/d (312.0). The selected equation was: [y = 1 376.4 - 308 Sex (M = 0; W = 1) + 11.1 Weigh (kg) - 8 Age (years)] (R2: 0.68; EE: 175.95). The ICC between the new equation and the IC in normal weighted subjects was 0.901 (95%CI: 0.851 - 0.934). The new formula showed a good level of agreement in the overweight group (ICC: 0.880; 95%IC: 0.772 - 0.937). CONCLUSIONS: we propose a new predictive equation for estimating the REE for healthy Spanish population which has an easy application and includes sex, age and weigh. The selected equation shows an adequate behavior in overweight subjects too.

Introducción: aunque se dispone de técnicas precisas y exactas para la estimación del GER, como la calorimetría indirecta (CI), en la práctica diaria se precisan métodos rápidos, fáciles de aplicar y económicos, como los modelos predictivos. Objetivo: desarrollar una nueva ecuación predictiva del gasto energético en reposo (GER) para población española adulta sana. Métodos: se determinó el GER en 95 sujetos sanos con normopeso mediante CI. Se utilizó la regresión lineal múltiple para la obtención del modelo, empleando como criterios analíticos la Cp de Mallows y el R2 ajustado. Se estudió el comportamiento del modelo generado en una muestra de 39 sujetos con IMC ≥ 25 kg/m2 mediante el coeficiente de correlación intraclase (ICC) y la prueba de Bland-Altman. La significación se alcanzó con p < 0,05. Resultados: la edad media fue de 42 años (rango: 23,0­ 63,2). El valor medio del GER estimado fue de 1.589,1 kcal/d (312,0). La ecuación seleccionada fue: [GER (kcal/d) = 1.376,4 ­ 308 Sexo (V = 0; M = 1) + 11,1 Peso (kg) ­ 8 Edad (años)] (R2: 0,68; EE: 175,95). El CCI entre el nuevo modelo predictivo y la CI fue de 0,901 (IC del 95%: 0,851 ­ 0,934) en la muestra con normopeso. La aplicación del modelo en la muestra de sujetos con IMC ≥ 25 kg/m2 alcanzó una buena concordancia (CCI de 0,880; IC del 95%: 0,772 ­ 0,937). Conclusiones: se presenta un nuevo modelo de estimación del GER para población sana española fácilmente aplicable en la práctica diaria, que incluye las variables sexo, edad y peso. La ecuación propuesta presenta un comportamiento adecuado en sujetos con IMC ≥ 25 kg/m2.

[COMPREHENSIVE CARE IN THE LAST DAYS AND HOURS OF LIFE]. / Cuidados integrales de los últimos días y horas de vida.

This article identifies the most significant elements of the process of nurse attention to the last days and hours of life in the context of a disease previously diagnosed like a terminal situation. For this object, we have reviewed the main clinical guidelines on comprehensive care and, especially, the guideline that was designed by the Saint John of God Hospital in Seville. We conclude that it is necessary to know how to identify the phase of agony to apply, therefore a default care plan that, allows to respond customized to the specific needs that occur in the last hours of the life of a terminal patient. A continued and coordinated interprofessional assistance to patient and family following standardized standards allows achieving a peaceful death and free from avoidable suffering.

[AGREEMENT BETWEEN INDIRECT CALORIMETRY AND PREDICTIVE EQUATIONS IN A SAMPLE OF SPANISH HEALTHY ADULTS]. / CONCORDANCIA ENTRE CALORIMETRÍA INDIRECTA Y MODELOS PREDICTIVOS EN UNA POBLACIÓN SANA ESPAÑOLA.

OBJECTIVE: the aim of this study was to analyze the agreement between the resting energy expenditure (REE) obtained by indirect calorimetry (IC) and that obtained by prediction equations in a sample of healthy adults from Spain. Méthods: a descriptive cross-sectional study was conducted in 95 healthy, normal-weight adults. REE was determined by IC and 45 population-specific prediction equations which were based on weight, height, sex and/or body composition (BC). The Intraclass Correlation Coefficient (ICC) and Bland-Alman plots were used to analyze the agreement between the REE obtained by IC and that obtained by prediction equations. The level of signification was reached at p < 0,05. RESULTS: mean age was 42 years (range: 23.0-63.2). Mean REE determined by CI was 1589 (312) kcal/d [1822.3 (224.3) kcal/d in men and 1379.3 (216.1) kcal/d in women; p < 0.05]. The De-Lorenzo, Harris-Benedict, Schofield, and especially the Korth equations showed the greatest level of agreement with respect to IC. CONCLUSIONS: there is high variability in the estimates of REE depending on the prediction equation used. The De Lorenzo, Harris-Benedict, and the Schofield equations showed a good level of agreement in our sample; however, the Korth equation was the most appropriate. Equations based on weight and/or height were more accurate than those which included body composition variables.

Objetivo: estudiar la concordancia entre el gasto energético en reposo (GER) obtenido mediante calorimetría indirecta (CI), y las ecuaciones de estimación más utilizadas en población adulta sana española. Métodos: estudio transversal en el que se determinó el GER en 95 sujetos sanos con normopeso mediante calorimetría indirecta y modelos predictivos (se seleccionaron 45 fórmulas desarrolladas en adultos de características similares a la muestra estudiada que incluían peso, talla, sexo y/o composición corporal). La concordancia entre ambos métodos se analizó mediante el Coeficiente de Correlación Intraclase (CCI) y la prueba de Bland-Altman. La significación se alcanzó con p < 0,05. Resultados: la edad media fue de 42 años (rango: 23,0­ 63,2). El GER medio estimado por CI en la muestra fue de 1589 (312) kcal/día [1822,3 (224,3) kcal/día en varones y 1379,3 (216,1) kcal/día en mujeres; p < 0,05]. Las fórmulas que mejor se ajustaron a la muestra fueron las de De-Lorenzo, Harris-Benedict, Schofield y, especialmente, Korth. Conclusiones: existen grandes variaciones en la estimación del gasto energético en reposo en función de la ecuación predictiva utilizada. Las fórmulas de De-Lorenzo, Harris-Benedic y Schofield se comportan adecuadamente en la muestra evaluada; sin embargo, la de Korth demostró ser la más apta. Los modelos que incluyen peso y/o talla obtuvieron mejores resultados que los que contienen variables de composición corporal.

Mixture optimization of anaerobic co-digestion of tomato and cucumber waste.

Greenhouse cultivation has significantly increased the production of vegetables and reduced dependence on environmental conditions. In Mediterranean areas, vegetable crops are nowadays one of the most important sources of organic waste generation. Anaerobic digestion is among the methods used to treat this type of biodegradable waste. However, the selection of the organic wastes to be subjected to this microbial treatment is a crucial aspect due to seasonality and simultaneity of the original crops. In this sense, as waste does not have frequently the proper nutrient balance, co-digestion with other substrates generated in the same geographical area is recommended to ensure the correct development of the process. This work studies the mesophilic co-digestion of tomato waste (TW) and cucumber waste (CW), which are common greenhouse wastes that do not contain an adequate ratio among nutrients (C/N/P) and are generated simultaneously. The influence of the percentage of both wastes in the mixture on the overall performance of the process was evaluated. The combination of TW and CW was found to be feasible in terms of stability, biodegradability and methane yield, which reached a value of 292 mLSTP CH4/g VS (STP: standard temperature and pressure, 0°C and 760 mmHg) for the percentage of tomato in the mixture, which is considered optimal at 55-75%. The most suitable organic load rate was determined for a percentage of 65% of TW, reaching a value of 1562 kg(waste) m(-3) month(-1).

"Core out" or "curettage" in rectal advancement flap for cryptoglandular anal fistula.

AIM: Transanal advancement flap is a recognized technique for complex fistula. Management of the tract is open to discussion. Excision of the tract by the "core out" technique is difficult and could increase the risk of sphincter damage. Curettage is easier but it could increase the risk of recurrence. The aim of the present study was to assess the effect of both techniques on sphincter function and to study the clinical results. METHOD: This is a retrospective analysis from a prospective database. One hundred nineteen consecutive patients with high cryptoglandular anal fistula were included. "Core out" technique was performed in 78 patients (group I) and "curettage" in 41 (group II). In both, a full-thickness rectal flap was advanced over the closed internal defect. Anorectal manometry was performed to assess sphincter function. Continence was assessed using the Wexner Scale. Recurrence was defined as the presence of an abscess or fistulization. RESULTS: Manometric results showed a significant decrease in the maximum resting pressure after surgery in both groups. The maximum squeeze pressure was significantly reduced only in group I (p < 0.001). No significant changes in Wexner score were observed. The overall recurrence rate was 5.88%, five of group I (6.4%) and two of group II (4.9%), without statistical significance (p = 0.74). CONCLUSIONS: The core-out technique causes a significant decrease in squeeze pressures, which reflects damage to the external anal sphincter. This could lead to incontinence in high-risk patients. Curettage is a simple technique that preserves the values of squeeze pressures without increasing recurrence rates.

Long bone development requires a threshold of Hox function.

The Hoxd(Del(11-13)) mutant is one of the animal models for human synpolydactyly, characterized by short and syndactylous digits. Here we have characterized in detail the cartilage and bone defects in these mutants. We report two distinct phenotypes: (i) a delay and change in pattern of chondrocyte maturation of metacarpals/metatarsals and (ii) formation of a poor and not centrally positioned primary ossification center in the proximal-intermediate phalanx. In the metacarpals of Hoxd(Del(11-13)) mutants, ossification occurs postnataly, in the absence of significant Ihh expression and without the establishment of growth plates, following patterns similar to those of short bones. The strong downregulation in Ihh expression is associated with a corresponding increase of the repressor form of Gli3. To evaluate the contribution of this alteration to the phenotype, we generated double Hoxd(Del(11-13));Gli3 homozygous mutants. Intriguingly, these double mutants showed a complete rescue of the phenotype in metatarsals but only partial phenotypic rescue in metacarpals. Our results support Hox genes being required in a dose-dependent manner for long bone cartilage maturation and suggest that and excess of Gli3R mediates a significant part of the Hoxd(Del(11-13)) chondrogenic phenotype.

Surgical outcomes of craniocervial junction meningiomas: a series of 22 consecutive patients.

OBJECTIVE: We present our experience in managing craniocervical junction meningiomas and discuss various surgical approaches and outcomes. METHODS: We retrospectively reviewed 22 consecutive cases of craniocervical junction meningiomas operated on between August 1995 and May 2012. RESULTS: There were 15 female and 7 male patients (mean age: 54 years). Meningiomas were classified based on origin as spinocranial (7 cases) or craniospinal (15 cases). Additionally, the tumors were divided into anatomical location relative to the brainstem or spinal cord: there were 2 anterior tumors, 7 anterolateral, 12 lateral, and 1 posterolateral. Surgical approaches included the posterior midline suboccipital approach (9 cases), the far lateral approach (12 cases) and the lateral retrosigmoid approach (1 case). Gross-total resection was achieved in 45% of patients and subtotal in 55%. The most common post-operative complications were cranial nerve (CN) IX and X deficits. The mortality rate was 4.5%. There have been no recurrences to date with a mean follow-up was 46.5 months and the mean Karnofsky score at the last follow-up of 82.3. In this series, spinocranial tumors were detected at a smaller size (p=0.0724) and treated earlier (p=0.1398) than craniospinal tumors. They were associated with a higher rate of total resection (p=0.0007), fewer post-operative CN IX or X deficits (p=0.0053), and shorter hospitalizations (p=0.08). CONCLUSION: Our experience suggests that posterior midline suboccipital or far-lateral approaches with minimal condylar drilling and vertebral artery mobilization were suitable for most cases in this series.