Validez actual del diagnóstico de «estado vegetativo permanente»: estudio longitudinal en una muestra clínica de pacientes en estados alterados de conciencia / Current validity of diagnosis of permanent vegetative state: A longitudinal study in a sample of patients with altered states of consciousness

INTRODUCCIÓN: Los estados alterados de conciencia han sido considerados tradicionalmente como cuadros clínicos de pronóstico infausto. En la actualidad, sabemos que dichos estados engloban distintas entidades clínicas cuyo perfil diferencial empieza a reconocerse. MÉTODO: Se incluyeron 37 pacientes con el diagnóstico de estado vegetativo o síndrome de vigilia sin respuesta (SVSR) y 43 en estado de mínima conciencia (EMC) de acuerdo con la Coma Recovery Scale-Revised (CRS-R). Todos los pacientes fueron evaluados mensualmente con la CRS-R durante al menos 6 meses. Se evaluó el momento de superar cada estado considerando los puntos de corte de «irreversibilidad» (12 meses para los casos de origen traumático y 3 para los no traumáticos), tradicionalmente establecidos por la Multi-Society-Task-Force. Se empleó un modelo de regresión logística para determinar las variables predictoras de superar el EMC. RESULTADOS: Un total de 23 pacientes en SVSR superaron este estado, pero solo 9superaron el EMC. De los 43 pacientes en EMC al ingreso, 26 lograron superarlo. Ocho de los 23 (34,7%) pacientes que superaron el SVSR y 17 de los 35 (48,6%) que superaron el EMC lo hicieron más allá del punto de «irreversibilidad». La etiología (p < 0,01), la cronicidad (p = 0,01) y la puntuación en la CRS-R (p < 0,001) predijeron la salida de EMC en el modelo multivariante con un 77,5% de acierto. CONCLUSIONES: Tanto el SVRS como el EMC son entidades clínicamente diferenciadas en términos diagnósticos y pronósticos. Algunos criterios clásicos relacionados con el mal pronóstico de estos estados en términos de tiempo y posibilidades de recuperación deben ser reevaluados

INTRODUCTION: Altered states of consciousness have traditionally been associated with poor prognosis. At present, clinical differences between these entities are beginning to be established. METHOD: Our study included 37 patients diagnosed with vegetative state/unresponsive wakefulness syndrome (UWS) and 43 in a minimally conscious state (MCS) according to the Coma Recovery Scale-Revised (CRS-R). All patients were followed up each month for at least 6 months using the CRS-R. We recorded the time points when vegetative state progressed from 'persistent' to 'permanent' based on the cut-off points established by the Multi-Society-Task-Force: 12 months in patients with traumatic injury and 3 months in those with non-traumatic injury. A logistic regression model was used to determine the factors potentially predicting which patients will emerge from MCS. RESULTS: In the UWS group, 23 patients emerged from UWS but only 9 emerged from MCS. Of the 43 patients in the MCS group, 26 patients emerged from that state during follow-up. Eight of the 23 patients (34.7%) who emerged from UWS and 17 of the 35 (48.6%) who emerged from MCS recovered after the time points proposed by the Multi-Society-Task-Force. According to the multivariate regression analysis, aetiology (P < .01), chronicity (P = .01), and CRS-R scores at admission (P < .001) correctly predicted emergence from MCS in 77.5% of the cases. CONCLUSIONS: UWS and MCS are different clinical entities in terms of diagnosis and outcomes. Some of the factors traditionally associated with poor prognosis, such as time from injury and likelihood of recovery, should be revaluated

Current validity of diagnosis of permanent vegetative state: A longitudinal study in a sample of patients with altered states of consciousness. / Validez actual del diagnóstico de «estado vegetativo permanente¼: estudio longitudinal en una muestra clínica de pacientes en estados alterados de conciencia.

INTRODUCTION: Altered states of consciousness have traditionally been associated with poor prognosis. At present, clinical differences between these entities are beginning to be established. METHOD: Our study included 37 patients diagnosed with vegetative state/unresponsive wakefulness syndrome (UWS) and 43 in a minimally conscious state (MCS) according to the Coma Recovery Scale-Revised (CRS-R). All patients were followed up each month for at least 6 months using the CRS-R. We recorded the time points when vegetative state progressed from 'persistent' to 'permanent' based on the cut-off points established by the Multi-Society-Task-Force: 12 months in patients with traumatic injury and 3 months in those with non-traumatic injury. A logistic regression model was used to determine the factors potentially predicting which patients will emerge from MCS. RESULTS: In the UWS group, 23 patients emerged from UWS but only 9 emerged from MCS. Of the 43 patients in the MCS group, 26 patients emerged from that state during follow-up. Eight of the 23 patients (34.7%) who emerged from UWS and 17 of the 35 (48.6%) who emerged from MCS recovered after the time points proposed by the Multi-Society-Task-Force. According to the multivariate regression analysis, aetiology (P<.01), chronicity (P=.01), and CRS-R scores at admission (P<.001) correctly predicted emergence from MCS in 77.5% of the cases. CONCLUSIONS: UWS and MCS are different clinical entities in terms of diagnosis and outcomes. Some of the factors traditionally associated with poor prognosis, such as time from injury and likelihood of recovery, should be revaluated.

Evaluation of electrical properties of Cr/CrN nano-multilayers for electronic applications.

The electrical properties of Cr/CrN nano-multilayers produced by Unbalanced Magnetron Sputtering have been studied as a function of bilayer period and total thickness. Two groups of multilayers were produced: in the first group the bilayer period varied between 20 nm, 100 nm and 200 nm with total thickness of 1 microm, and in the second group the bilayer period varied between 25 nm, 50 nm and 100 nm and a total thickness of 100 nm. X-ray Diffraction (XRD), Scanning Electron Microscopy (SEM) and Transmission Electron Microscopy (TEM) were used in order to investigate the microstructure characteristics of the multilayers, and the Four Point Probe (FPP) method was used to evaluate in-plane and transverse electrical resistivity. XRD results show (111) and (200) orientations for all the CrN coatings and the presence of a multilayer structure was confirmed through SEM studies. Transverse electrical resistivity results show that this property is strongly dependent on the bilayer period.

Unbalanced magnetic field configuration: plasma and film properties.

Coatings of CrN, TiN, ZrN, TaN and NbN were deposited using an unbalanced magnetron sputtering system with two different degrees of unbalancing to investigate the effect of the degree of unbalancing on both plasma characteristics and film properties. The degree of unbalancing was determined by an extensive characterization of the magnetic field fluxes in the X-Z plane perpendicular to the target. Then, the plasma parameters, such as electron temperature, plasma potential, plasma density and ion current density, were obtained for each target and as a function of the unbalance coefficient. The film microstructure, hardness, corrosion and wear resistant were measured to determine the effect of the degree of unbalancing on these properties. The results suggested that the degree of unbalancing, through the variations induced in the ion bombardment and plasma ionization, had a strong influence on the film hardness, microstructure and preferred orientation.

[Seroepidemiology of Herpes simplex virus type 2 in the Amerindian Yukpa population of Zulia state, Venezuela]. / Seroepidemiología del virus Herpes simplex 2 en una población indígena Yukpa. Estado Zulia. Venezuela.

BACKGROUND: Yukpa aborigines start early in life their sexual activity and promiscuity with native and foreign individuals is common among women. This behavior allows the installation and propagation of Herpes simplex virus type 2 (HSV-2). AIM: To determine the presence of antibodies to HSV-2 in a Yukpa Amerindian community at Zulia State, Venezuela. SUBJECTS AND METHODS: We studied 96 natives, between 13 and 49 years old (62.3% of the whole population, 100% of individuals in fertile age). Control population consisted of 76 individuals, with similar sex and age range distribution, of the urban population from Maracaibo, Zulia State, Venezuela. HSV-2 serologic status was determined by an indirect fluorescent antibody test. RESULTS: Antibodies to HSV-2 were detected in 53.1% of Yukpa population and 21.1% of urban population. Aboriginal women aged 21 to 40 years old had a prevalence of antibodies against HSV-2 of 66.7%. Among pregnant native women, the prevalence of antibodies against HSV-2 was 54.6%. CONCLUSIONS: There is a high prevalence of antibodies against HSV-2 among Yukpa natives in Venezuela.

Lipopolysaccharide of Escherichia coli, polyamines, and acetic acid stimulate cell proliferation in intestinal epithelial cells.

Our aim was to examine whether lipopolysaccharide of Escherichia coli, polyamines of dietetic and/or bacterial origin, and products of the bacterial metabolism influence cell proliferation in epithelial cells from the colon and small intestine. Lipopolysaccharide of Escherichia coli 0111:B4 was incubated with cultures from human colonic mucosa. The mitoses were arrested with Vincristine and the total number of metaphases per crypt was counted. In addition, lipopolysaccharide was incubated with a human colonic epithelial cell line from adenocarcinoma (LS-123 cells) and with a nontransformed small intestinal cell line from germ-free rats (IEC-6 cells) for 24 h. In the last 4 h, the cells were labeled with tritiated thymidine. The cells were incubated with putrescine, cadaverine, and spermidine at 10(-11)-10(-3) M and with acetic acid (10(-5)-10(-1) M), acetaldehyde (10(-10)-10(-4) M) and ammonium chloride (1-20 mM). Lipopolysaccharide of Escherichia coli increased the number of arrested metaphases in human colonic crypts and DNA synthesis in L-123 and IEC-6 cells (P < 0.001). All polyamines increased DNA synthesis in the colonic and small intestinal cell lines, the effects being more marked for putrescine (P < 0.001). The higher concentrations of acetic acid increased DNA synthesis in both epithelial cell lines (P < 0.001). Acetaldehyde slightly decreased DNA synthesis in LS-123 cells at cytotoxic concentrations. Ammonium chloride did not significantly affect DNA synthesis. The final concentration of nonionized ammonia was less than 3%. It is concluded that lipopolysaccharides of Escherichia coli and intraluminal factors derived from microorganisms increase cell proliferation in human colonic crypts and intestinal epithelial cell lines.