The Emerging Role of Left Bundle Branch Area Pacing for Cardiac Resynchronisation Therapy.

Cardiac resynchronisation therapy (CRT) reduces the risk of heart failure-related hospitalisations and all-cause mortality, as well as improving quality of life and functional status in patients with persistent heart failure symptoms despite optimal medical treatment and left bundle branch block. CRT has traditionally been delivered by implanting a lead through the coronary sinus to capture the left ventricular epicardium; however, this approach is associated with significant drawbacks, including a high rate of procedural failure, phrenic nerve stimulation, high pacing thresholds and lead dislodgement. Moreover, a significant proportion of patients fail to derive any significant benefit. Left bundle branch area pacing (LBBAP) has recently emerged as a suitable alternative to traditional CRT. By stimulating the cardiac conduction system physiologically, LBBAP can result in a more homogeneous left ventricular contraction and relaxation, thus having the potential to improve outcomes compared with conventional CRT strategies. In this article, the evidence supporting the use of LBBAP in patients with heart failure is reviewed.

Serving Patterns of Women's Badminton Medalists in the Rio 2016 Olympic Games.

The aim of the present study was to describe and identify the serving performance profiles of medalists during an elite women's badminton tournament taking notational and temporal variables into account. The sample was composed of the 14 matches (n = 1,052 rallies) played by the three medalists during the 2016 women's singles Olympic Games badminton event (Rio, Brazil). The independent variable studied was serving player (medalist/opponent); while the dependent variables were related to notational analysis: serve type, set, and point won by the server/receiver; and the time-related variables: number of strokes per rally, rally time, rest time, and frequency of strokes. The main results showed that: (i) temporal parameters were similar for total match duration but shorter for rally time, and longer for rest time and with more strokes per rally than found in previous research; (ii) the serve effectiveness showed neutral values when analyzing serving by all the players, medalists, and opponents (around 50%); (iii) the two-step cluster analysis identified how successful players used the serve when playing short rallies with backhand short and flick serves (cluster 1), and forehand long serves (cluster 2); and during long rallies with the use of the backhand short serve, forehand short serve and forehand long serve (cluster 3). On the other hand, medalists and their opponents used forehand long serves during set 1 with durations of 8.80 s (cluster 5); and the opponents showed an independent performance using the forehand short serve during sets 1 and 2 (cluster 4); and (iv) the classification tree analysis (Exhaustive CHAID) identified the importance of different serving patterns with the gold medal player using more backhand and forehand flick serves, and the main use of backhand short serves during sets 1 and 2 in all the tournament stages. The bronze medalist used more forehand long serves during all sets, and the silver medalist showed a mixed performance of serves using the forehand short serve, the backhand short serve and the forehand long serve. The current findings may help coaches and players to manage different serving and playing patterns during training and matches according to the serve and rally requirements.

Hit-to-Lead Optimization of Benzoxazepinoindazoles As Human African Trypanosomiasis Therapeutics.

Human African trypanosomiasis (HAT) is a neglected tropical disease caused by infection with either of two subspecies of the parasite Trypanosoma brucei. Due to a lack of economic incentive to develop new drugs, current treatments have severe limitations in terms of safety, efficacy, and ease of administration. In an effort to develop new HAT therapeutics, we report the structure-activity relationships around T. brucei for a series of benzoxazepinoindazoles previously identified through a high-throughput screen of human kinase inhibitors, and the subsequent in vivo experiments for HAT. We identified compound 18, which showed an improved kinase selectivity profile and acceptable pharmacokinetic parameters, as a promising lead. Although treatment with 18 cured 60% of mice in a systemic model of HAT, the compound was unable to clear parasitemia in a CNS model of the disease. We also report the results of cross-screening these compounds against T. cruzi, L. donovani, and S. mansoni.

Análisis de la vía intraósea: Una alternativa para enfermería ante casos urgentes / Analysis of the intraosseous route. an alternative for nursing in emergency cases

Introducción: La vía intraósea es la segunda vía de elección ante la imposibilidad de canalizar una vía intravenosa en situaciones de extrema urgencia. Se consigue de forma rápida y sencilla y requiere pocos segundos para su inserción. Objetivos: Conocer la bibliografía escrita sobre la técnica de inserción intraósea, así como conocer cómo se lleva a cabo y sus ventajas. Compararla con la vía intravenosa. También indagar sobre los conocimientos de los enfermeros de diferentes lugares sobre esta vía. Metodología: Se realiza una revisión bibliográfica sobre la vía intraósea utilizando las bases de datos PubMed, Medline y Buscador Gerión. Los artículos considerados para la inclusión en el estudio se publicaron en los últimos seis años, tanto en inglés como en castellano. Resultados: La vía intraósea se inserta en zona tibial proximal en niños menores de seis años y tibial distal en adultos. Requiere un mínimo de entrenamiento para su inserción y una vigilancia constante para evitar la aparición de complicaciones. Dependiendo de las enfermeras estudiadas se obtienen diferentes resultados según el área en la que trabajan. No existe ninguna diferencia de absorción entre la vía intravenosa e intraósea. Discusión y conslusiones: Los profesionales de emergencias extrahospitalarias son los que obtienen mejores conocimientos y más utilizan esta técnica. El resto debe recibir formación para aumentar su habilidad y considerar la vía intraósea como alternativa a la intravenosa en cualquier situación que pueda presentarse

Introduction: The intraosseous (IO) route is the second route of choice in emergency cases, when inserting a venous catheter is extremely difficult. Venous access through the IO route is achieved easily and quickly, requiring few seconds for insertion. Objectives: To review the available literature on intraosseous insertion technique, to determine how it is best performed, its advantages and to compare it with the use of the intravenous route. Furthermore, to inquire on the knowledge that nurses from different geographical locations and services have on the IO route. Methodology: A bibliographic review on articles discussing the IO route was performed using the following search engines: Pubmed, Medline and Buscador Gerion. Articles published in English and Spanish over the last six years were considered for inclusion. Results: The IO route is inserted in the proximal tibial zone in children younger than six years and in the distal tibial zone in adults. Its insertion requires minimum training and a constant vigilance to avoid complications. Depending on the nurses analyzed, different results were obtained based on their area of work. No absorption difference was found between the intravenous and intraosseous route. Discussion and conclusions: Outpatient emergency professionals are those who have enhanced knowledge and are most skilled in the use of IO technique. The remaining staff should receive training to increase their skills in order to consider the intraosseous route as an alternative to the intravenous route in situations where it might be required

Proceso asistencial en el accidente cerebrovascular agudo: Activación del código ictus. Caso clínico / Acute stroke care process. activating the code stroke. Clinical case

El accidente cerebrovascular se ha convertido en uno de los motivos de asistencia más frecuentes y de extrema gravedad en los servicios de Urgencias. Requiere una atención inmediata y coordinada para tratar de restablecer la perfusión cerebral con la mayor rapidez posible y permitir así que el paciente recupere sus funciones reduciendo el tiempo de isquemia cerebral. El Código Ictus (CI) es un protocolo que permite la coordinación intra e interhospitalaria en la que sus profesionales se coordinan y actúan de manera rápida para realizar un diagnóstico adecuado y proporcionar un tratamiento precoz que permita conseguir mayores beneficios para el paciente. En este artículo se expone un caso clínico para verificar cual es el proceso asistencial que sigue el paciente con ictus isquémico desde que se atiende en el domicilio hasta que recibe el tratamiento definitivo

Cerebrovascular accidents, more commonly known as strokes, have become one of the most frequent and extremely serious reasons for attending emergency services. Strokes require immediate and coordinated attention, aimed at restoring cerebral perfusion as quickly as possible, and allowing the patient to regain his functions by reducing the time of cerebral ischemia. The Code Stroke (CS) is a protocol that enables intra and interhospital coordination, facilitating health professionals to coordinate and act quickly, in order to reach an adequate diagnosis and provide early treatment that will result in greater benefits for the patient. The present article presents a clinical case with the aim of monitoring the care process that a patient suffering from acute ischemic stroke undergoes, from the time he/she is seen at home until he/she receives definitive treatment

Novel 1,2-dihydroquinazolin-2-ones: Design, synthesis, and biological evaluation against Trypanosoma brucei.

In 2014, a published report of the high-throughput screen of>42,000 kinase inhibitors from GlaxoSmithKline against T. brucei identified 797 potent and selective hits. From this rich data set, we selected NEU-0001101 (1) for hit-to-lead optimization. Through our preliminary compound synthesis and SAR studies, we have confirmed the previously reported activity of 1 in a T. brucei cell proliferation assay and have identified alternative groups to replace the pyridyl ring in 1. Pyrazole 24 achieves improvements in both potency and lipophilicity relative to 1, while also showing good in vitro metabolic stability. The SAR developed on 24 provides new directions for further optimization of this novel scaffold for anti-trypanosomal drug discovery.

Desarrollo e implementación de un nuevo diseño de stent de nitinol para el manejo de estenosis y fístulas benignas del tracto digestivo / Development and Implementation of a New Nitinol Stent Design for Managing Benign Stenoses and Fistulas of the Digestive Tract

Antecedentes: las estenosis benignas, la ruptura del tracto digestivo y las fístulas digestivas son condiciones que ponen en riesgo la vida y que por lo general son tratadas quirúrgicamente. Ahora, ha surgido la colocación de stents metálicos parcial o totalmente cubiertos como una opción de manejo con mínima invasión. Se pretende determinar la efectividad clínica de un nuevo diseño de stent de nitinol totalmente cubierto para el tratamiento de las perforaciones digestivas y las fístulas anastomóticas, con especial énfasis en la evaluación de la hiperplasia reactiva. Métodos: en el período 2012-2013 se colocó un stent de nitinol autoexpandible totalmente cubierto en 15 pacientes con perforaciones benignas de esófago, fístulas anastomóticas, estenosis después de cirugía gastrointestinal alta o baja. Se utilizó un stent de mayor diámetro en su centro (20 mm) y en su porción proximal (28 mm). Se recolectaron datos demográficos, tipo de lesión, ubicación del stent y remoción, éxito clínico y complicaciones. Resultados: a un total de 15 pacientes se les puso 15 nuevos stents por fístulas anastomóticas (n = 8), estenosis esofágica (n = 2), estenosis en anastomosis colorrectal (n = 2), estenosis de anastomosis gastroyeyunal (n = 1), ruptura iatrogénica de esófago (n = 1), y estenosis pilórica (n = 1). La remoción endoscópica del stent fue exitosa en todos los pacientes, y una fue particularmente difícil por hiperplasia reactiva. El éxito clínico se logró en 9 pacientes (73%), con una media de permanencia del stent de 10 semanas (rango 7 a 12 semanas). En total, ocurrieron 7 complicaciones en 15 pacientes (47%): hiperplasia reactiva (n = 1), migración (n = 3), dolor severo (n = 2), ulceración esofágica (n = 1), y solo 1 paciente requirió cirugía después del fallo del stent. Ningún paciente falleció como consecuencia de la colocación del mismo. Conclusiones: un stent totalmente cubierto, con nuevo diseño, dejado por 10 semanas, puede ser una alternativa ...

Background: Benign stenoses, digestive tract ruptures and fistulas are conditions that endanger life and are often treated surgically. Recently, the placement of partially or fully covered metal stents has emerged as a minimally invasive treatment option. This article looks at a new design for stents to determine its clinical effectiveness. The new stent is a completely covered nitinol stent for treatment of gastrointestinal perforations and anastomotic leaks. This article places special emphasis on evaluating reactive hyperplasia. Methods: Fifteen had the new completely covered self-expanding nitinol stent placed for treatment of benign esophageal perforations, anastomotic leaks, and stenoses following upper or lower gastrointestinal surgery during 2012 and 2013. The stents are 20 mm in diameter in the middle and 28 mm in diameter at the proximal end. Information about patient demographics, type of lesion, lesion locations, stent removal, clinical success and complications was collected. Results: A total of 15 stents were placed in 15 patients to treat anastomotic leaks (n = 8), esophageal stenoses (n = 2), colorectal stenoses (n = 2), a gastrojejunostomy stenosis (n = 1), an esophageal iatrogenic rupture (n = 1), and a pyloric stenosis (n = 1). Endoscopic removal of the stent was successful in all patients. Although it was particularly difficult in one case because of reactive hyperplasia. Clinical success was achieved in nine patients (73%). Average duration of time between stent placement and removal was 10 weeks with a range of 7 to 12 weeks. In total, seven complications occurred in 15 patients (47%): reactive hyperplasia (n = 1), migration (n = 3) severe pain (n = 2) esophageal ulceration (n = 1) only one patient required surgery after stent failure. No patients died as the result of stenting. Conclusions: A redesigned completely covered stent kept in place for 10 weeks may be an alternative to surgery for treating gastrointestinal ...

Estudio comparativo del stent colónico versus laparotomía en el tratamiento de la obstrucción intestinal aguda por cáncer colorrectal / Comparative Study of Colonic Stenting against Laparotomy for Treating Acute Intestinal Obstruction Due to Colorectal Cancer

Objetivo: la obstrucción por cáncer colorrectal (CCR) es una entidad frecuente y con importante morbilidad y mortalidad. El uso de stent colónicos aparece como una buena alternativa y pueden utilizarse con carácter paliativo o como una terapia puente para facilitar una única y definitiva cirugía. El objetivo del presente estudio es comparar el uso de los stents con la cirugía en los pacientes con obstrucción maligna colorrectal en términos de necesidad de ostomías, morbimortalidad y sobrevida. Métodos: se realizó un estudio descriptivo donde se analizaron retrospectivamente los datos recogidos de una cohorte de 103 pacientes, desde 2004 al 2012, registrada en una base de datos para tal fin y dividida en 4 grupos: un grupo al que se le colocó stent colónico y luego se llevó a cirugía electiva (SCX, n = 26), otro grupo llevado a cirugía convencional (CXC, n = 30), y los otros dos grupos con pacientes en fase avanzada de la enfermedad, unos en quienes solo se les colocó stent paliativo (SP, n = 24) y otros llevados a cirugía con intención paliativa (CP, n = 23). Se establecieron comparaciones entre los grupos y se realizó una descripción de los hallazgos más relevantes. Resultados: se registró un éxito técnico en 90,0% y éxito clínico en 82,0% en los grupos con stents. Se presentaron dos perforaciones asociadas con el stent (8,3%) en el grupo SP y ninguna en el grupo SCX. Hubo migración del stent en 3 pacientes (11,5%) del grupo SCX y en 3 (12,5%) del grupo SP. Se encontró una sobrevida global del 42,7%, siendo más baja en los grupos SP y CP con 4,2% y 34,8%, respectivamente. Se presentó una menor necesidad de ostomías en el grupo SCX con 5 pacientes (19,2%) versus 8 (26,7%) del grupo CXC, sin relevancia estadística, la cual sí se observó al comparar la necesidad de ostomías entre los grupos de CXC y CP con 8 (26,7%) y 15 (65,2%) pacientes respectivamente (P<0,05). Hubo alivio en el grupo SCX en 22 pacientes (84,6%) y solo en 18 del grupo CXC (60%), con una diferencia estadísticamente significativa (p = 0,042). La estancia hospitalaria fue menor en los grupos manejados con stent (SCX y SP), con promedio de 4 días (0-9 días) para cada uno. En el grupo CXC, 30 pacientes requirieron al menos una reintervención, 9 (39,1%) del grupo CP y 8 en el grupo de los stents. Conclusión: el uso de los stents colorrectales con intención paliativa o como terapia puente preoperatoria tiene baja morbilidad y evita en ocasiones una colostomía temporal o definitiva; también previene cirugías en pacientes con enfermedad avanzada y minimiza las ostomías en comparación con los pacientes operados paliativamente; además de que tienen menor estancia hospitalaria. Sin embargo, se necesitan estudios prospectivos que aclaren cuál es el verdadero papel de los stents en la patología obstructiva colorrectal maligna.

Objective: Obstructions due to colorectal cancer (CRC) are common and carry significant risks of morbidity and mortality. The use of colonic stents appears to be a good alternative and can be used with palliative therapy or as a bridge to facilitate definitive one-time-only surgery. The aim of this study is to compare the use of stents with surgery in patients with malignant colorectal obstructions in terms of morbidity, survival and the need for ostomies. Methods: This is a descriptive study based on data collected from a cohort of 103 patients from 2004 to 2012. Data were recorded in a database designed for this purpose. Patients were retrospectively divided into four groups for purposes of analysis. One group, which was labelled SCX, had had colonic stents placed and later underwent elective surgery (n = 26). A second group labelled CXC had undergone conventional surgery (n = 30). The other two groups consisted of patients in advanced stages of the disease. One of these groups, labelled SP received palliative stents (n = 24). The final group, labelled CP, underwent palliative surgery (n = 23). Comparisons among groups were made and then descriptions of the most important findings were developed. Results: The technical success rate was 90.0% and the clinical success rate was 82.0% in the groups of patients who received stents. There were two perforations in the SP group (8.3%) and none in the other group (SP) which received stents. Stent migration occurred in three patients (11.5%) in the SCX group and three (12.5%) in the SP group. The overall survival rate was 42.7%, but was only 4.2% in the SP group and 34.8% in the CP group. Fewer ostomies were required in the SCX group (five patients, 19.2%) than in the CXC group (eight patients, 26.7%) although the difference was not statistically significant. Similarly eight patients (26.7%) in the CXC group and 15 patients (65.2%) in the CP group required ostomies (P <0.05). Obstructions were ...

Evaluación de la eficacia de la terapia ablativa con argón plasma en el esófago de Barrett con displasia: seguimiento prospectivo no menor a un año / Evaluation of the Efficacy of Argon Plasma Treatment of Barrett’s Esophagus with Dysplasia: Prospective Follow-up Evaluation not less than one year

Introducción: el esófago de Barrett (EB) con displasia tiene un reconocido potencial maligno. Ni la supresión ácida, ni la cirugía antirreflujo producen una regresión consistente o completa del epitelio metaplásico o displásico. La termoablación endoscópica a través de la coagulación con argón plasma (APC) ofrece la posibilidad de su erradicación (ablación), pero los posibles factores que pueden influir en el desenlace de la terapia aún no han sido evaluados consistentemente. Objetivo: evaluar la eficacia de la APC en la erradicación del EB con displasia y los factores que influencian su desenlace inmediato y tras por lo menos un año de seguimiento. Métodos: A 33 pacientes con EB y displasia (19 hombres-58%), con una media de edad de 56,9±6,35 años (rango 45 a 69 años) con una longitud media del EB de 4,1 cm (rango de 2-8 cm), se les practicó terapia con APC a intervalos de cada 4-6 semanas, hasta lograr la erradicación del EB, mientras estaban recibiendo terapia con doble dosis de inhibidores de bomba de protones (IBP). Los pacientes se controlaron por endoscopia a los 3, 6 y 12 meses y en adelante cada año, con biopsias de cuatro cuadrantes en las áreas tratadas. Resultados: la totalidad de los pacientes presentó ablación del EB y la displasia después de una media de 2 sesiones de APC (1 a 4 sesiones). La recurrencia del EB y la displasia se asocian con una mayor longitud inicial del EB circular o de su margen más proximal, a pesar de un mayor número de sesiones de APC (cifras no significativas). A 7 pacientes se les documentó la recaída del Barrett (21,2%) y en 3 (9,1%) se presentó nuevamente displasia (dos de bajo grado y una de alto grado) La complicación más frecuente fue el dolor retroesternal presente en 6 pacientes (18,2%), en 4 hubo estenosis que ameritó dilatación endoscópica (12,1%) y un paciente (3%) presentó sangrado durante el procedimiento que requirió escleroterapia. El seguimiento promedio fue de 43,7±19 meses y no se presentó carcinoma de esófago ni hubo ninguna muerte relacionada con la enfermedad o la terapia. Conclusiones: el tratamiento con APC es un procedimiento seguro y efectivo como terapia ablativa en segmentos cortos del EB con displasia. La recurrencia del EB y la displasia es común luego de un año posterior a la terapia, especialmente en aquellos con segmentos largos de EB.

Introduction: Barrett’s esophagus (BE) with dysplasia has a recognized potential for malignancy. Neither acid suppression nor anti-reflux surgery produce consistent or complete regression of metaplasia or dysplasia in the epithelium. Endoscopic argon plasma ablation (APC) offers the possibility of eradication, but factors that may influence the outcome of therapy have not been consistently evaluated. Objective: The objective of this study was to evaluate the efficacy of APC for eradication of BE with dysplasia and to evaluate the factors that influence the immediate outcome and results after one year of follow up. Methods: The study population included thirty-three patients suffering from BE with dysplasia: 19 men (58%), mean age of 56.9 ± 6.35 years (range 45-69 years) and an average length of EB 4.1 cm (range 2 to 8 cm.). All patients had undergone APC at intervals of 4 to 6 weeks to eradicate Barrett’s esophagus. Patients also received double doses of proton pump inhibitors (PPIs). Patients were endoscopically monitored at 3, 6 and 12 months and thereafter every year with four-quadrant biopsies of treated areas. Results: Ablation of BE and dysplasia was achieved in all patients after a median of 2 sessions of APC (1-4 sessions). Recurrence of BE and dysplasia is associated with longer initial lengths affected by BE and larger circumferences of its circular or proximal margin, despite treatment with additional APC sessions (no significant differences). Documented recurrences of Barrett’s esophagus occurred in seven patients (21.2%), documented recurrences of dysplasia occurred in three patients (9.1%). Two of these were low grade and one was high grade. The most frequent complication was chest pain which was experienced by six patients (18.2%), four had stenoses that required endoscopic dilatation (12.1%), and one patient’s (3%) bleeding required sclerotherapy during the procedure. The average follow-up time was 43.7 ± 19 months. No esophageal carcinoma developed nor were there any deaths related to the disease or therapy. Conclusions: Treatment with APC is safe and effective ablative therapy for short segments of BE with dysplasia. Post treatment recurrences of BE and dysplasia are common especially among patients with long segments of BE.

Argón plasma versus mucosectomía con bandas en el manejo endoscópico del esófago de Barrett con displasia o el carcinoma de esófago in situ / Argon Plasma Ablation versus Band Mucosectomy for Endoscopic Management of Barrett’s Esophagus with dysplasia or Esophageal Carcinoma

Introducción: se han descrito diferentes técnicas endoscópicas para la ablación del epitelio metaplásico esofágico manteniendo la integridad de la submucosa, bajo una agresiva terapia supresora de ácido con los bloqueadores de bomba. En lo evaluado hasta la fecha existen muy pocos estudios que comparen las diferentes técnicas endoscópicas que reviertan el esófago de Barrett (EB) con displasia y los factores que pueden influir en el pronóstico con estas terapias no se han evaluado consistentemente. Objetivo: este es un estudio piloto que compara la eficacia en la erradicación completa del EB con displasia, entre la resección endoscópica mucosa (EMR) con bandas y la terapia con argón plasma (APC) con bajo voltaje. Los puntos a evaluar son: a) la completa ablación del EB; b) el número de sesiones requeridas; c) las complicaciones. Métodos: la APC se realizó con un catéter flexible 10 Fr. El voltaje utilizado fue de 50 W y el flujo varió entre 1 y 2 l/min. En el grupo de EMR con bandas, la mucosa con EB con un equipo de ligadura multibandas. Hasta seis bandas fueron colocadas por sesión. La mucosa con el EB fue removida con un asa de polipectomía con corriente mezclada. Los pacientes fueron seguidos con endoscopia, se obtuvieron biopsias de cuatro cuadrantes en las áreas tratadas o no a los tres, seis y doce meses después de terminar el tratamiento. Todos los pacientes recibían dosis altas de bloqueadores de bomba de protones. Resultados: este es un estudio prospectivo y describe nuestros resultados en un grupo de 62 pacientes con Barrett y displasia, 33 pacientes (22 hombres, 67%) tratados con APC y 29 con EMR (19 hombres, 66%). La ablación completa del EB se dio en 86,2% con EMR y 79% en la terapia con APC. El número de sesiones requeridas para lograr el tratamiento completo fue de 1±1 con EMR y de 2±1 con APC. No se presentaron complicaciones mayores como sangrado digestivo con necesidad de transfusión o perforaciones. La única complicación ...

Introduction: Various endoscopic techniques for ablation of metaplastic esophageal epithelia which maintain the integrity of the submucosa have been described. All maintain patients under aggressive acid suppressive therapy with proton pump inhibitors. To date, few studies have compared the different endoscopic techniques for eradicating Barrett’s esophagus (BE) with dysplasia. Similarly the factors that might influence patients’ prognoses after these therapies have not been very consistently evaluated. Objective: This is a pilot study which compares the effectiveness of complete eradication of BE with dysplasia through endoscopic mucosal resection (EMR) with bands and low voltage endoscopic argon plasma coagulation (APC). The three points evaluated are whether complete ablation of BE was achieved, the number of sessions required and whether and what complications occurred. Methods: APC was performed using a flexible 10 French catheter. The voltage used was 50 W and flow timed varied between 1 minute and 2 l/min. In one group BE mucosa was treated with multi-band ligation. Up to six bands were placed per session. The mucosa with BE was removed with a polypectomy loop and a mixed stream of water. Patients were followed up endoscopically and biopsies were obtained from the four quadrants in both treated and untreated areas at three, six and twelve months after treatment ended. All patients received high doses of proton pump inhibitors. Results: This prospective study describes our results in a group of 62 patients with Barrett’s Esophagus and dysplasia. Thirty-three patients (22 men, 67%) were treated with APC and 29 were treated with EMR (19 men, 66%). Complete ablation of BE was achieved in 86.2% of patients treated with EMR and in 79% of those treated with APC. The number of sessions required to achieve complete ablation was 1 ± 1 for EMR and 2 ± 1 for APC. No major complications such as gastrointestinal bleeding requiring transfusion or perforations occurred. The only complications were two cases of esophageal stenosis, one in each group. These were successfully treated with single sessions of dilation. After a mean of 68.7 ± 18.9 months of follow-up in the APC group and 50.2 ± 19.3 months in the EMR group no cases of carcinoma of the esophagus and no deaths due to disease or therapy had occurred. Conclusions: In patients with BE with high or low grade dysplasia, APC and EMR achieve comparably high eradication rates of neoplasia and intestinal metaplasia (79% versus 86%). Both procedures have comparable levels of effectiveness and safety and have low rates of complications. Nevertheless, APC is associated with a greater number of sessions.

Ablación con radiofrecuencia del esófago de Barret con displasia o carcinoma in situ: Experiencia preliminar / Preliminary Experience with Radiofrequency Ablation of Barrett’s Esophagus with in situ Dysplasia or Carcinoma

Introducción: el esófago de Barrett (EB) es el resultado de la injuria crónica del ácido sobre el epitelio esofágico por el RGE. Se define cuando el epitelio metaplásico columnar reemplaza al epitelio escamoso estratificado que normalmente recubre el esófago. El EB representa un factor de riesgo para el adenocarcinoma de esófago. El objetivo de la ablación por radiofrecuencia (RFA) es destruir el epitelio metaplásico con la corriente eléctrica de radiofrecuencia para estimular la reaparición del epitelio plano estratificado del esófago distal. Objetivo: evaluar la eficiencia y seguridad de la técnica de RFA, recientemente introducida en la ciudad de Medellín, Colombia, para el manejo del EB con displasia o carcinoma in situ. Materiales y métodos: diez pacientes fueron tratados con RFA. Pacientes con EB con displasia o carcinoma in situ como hallazgo histológico fueron elegidos para el tratamiento. La técnica de RFA se aplicó usando el equipo BARRX: el sistema circular HALO360 o el HALO90. Los efectos macro o microscópicos de la terapia con RFA, la tolerancia del paciente al tratamiento así como las complicaciones fueron evaluadas. Resultados: un grupo de 10 pacientes recibió la terapia con RFA, todos terminaron la terapia y el seguimiento. En siete pacientes había displasia de bajo grado, en dos de alto grado y un paciente con carcinoma in situ. Dos pacientes tenían resección endoscópica con bandas de nódulos de la mucosa previa a la terapia con RFA. Se realizaron un total de 13 procedimientos: 10 con HALO360, 2 HALO90 y un paciente tratado con argón plasma para un EB residual. En todos los pacientes se logró la erradicación del epitelio esofágico metaplásico y displásico como se confirmó en la evaluación endoscópica e histológica. No se encontraron complicaciones significativas relacionadas con la terapia de RFA, pero en dos pacientes se encontró estenosis del esófago y uno requirió dilataciones endoscópicas tres semanas después de la terapia. Conclusiones: con base en estos resultados preliminares consideramos que este es un método promisorio, sin mayores complicaciones y bien tolerado por el paciente. En la mayoría de pacientes se erradicó exitosamente el epitelio metaplásico y displásico del esófago distal.

Introduction: Barrett’s esophagus (BE) is the result of chronic damage to the esophageal epithelium caused by the acid of gastrointestinal reflux diseases (GERD). It is defined as replacement of the by stratified squamous epithelium that normally lines the esophagus with metaplastic columnar epithelium. BE represents a risk factor for esophageal adenocarcinoma. The aim of radiofrequency ablation (RFA) is to destroy the metaplastic epithelium with the electric current of a radiofrequency to stimulate the reappearance of stratified squamous epithelium in the distal esophagus. Objective: The objective of this study was to evaluate the efficiency and safety of RFA which has recently been introduced in the city of Medellin, Colombia for management of BE with in situ dysplasia or carcinoma. Materials and Methods: Ten patients were treated with RFA. BE patients with in situ dysplasia or carcinoma and histological diagnoses were chosen for treatment. RFA procedures were done with BARRX equipment, the circular HALO360 system or the HALO90 system. Macroscopic and microscopic effects of RFA, patient tolerance to treatment and complications were evaluated. Results: A group of 10 patients received treatment with RFA. All ten finished treatment and follow-up. Seven patients had low-grade dysplasia, two had high-grade dysplasia, and one patient had in situ carcinoma. Two patients had undergone endoscopic resections of nodules and treatments of mucosa with bands prior to therapy with RFA. A total of 13 procedures were performed: 10 RFAs with the HALO360, 2 RFAs with the HALO90 and one argon plasma treatment for residual BE in one patient. Eradication of metaplastic and dysplastic esophageal epithelium was achieved in all patients and confirmed by endoscopic and histologic evaluation. No significant complications related to RFA were found, but in two patients esophageal stenoses were found. One required endoscopic dilatation three weeks after therapy. Conclusions: Based on these preliminary results we believe that this is a promising method that is well-tolerated by patients and which has no major complications. Metaplastic and dysplastic epithelium of the distal esophagus were successfully eradicated in most patients.

Percepción de competencia, estado de ánimo y tolerancia al estrés en jóvenes deportistas de alto rendimiento / Perception of competence, mood state and stress tolerance in young high performance athletes

Este estudio aborda el papel que juega la competencia percibida en el estado de ánimo y la tolerancia al estrés de jóvenes deportistas orientados hacia el alto rendimiento. En este estudio participaron 30 jóvenes deportistas pertenecientes a 10 modalidades deportivas diferentes, considerados como promesas en sus respectivos deportes. Los resultados de este estudio mostraron que altos valores de competencia percibida ofrecían altas correlaciones negativas con las dimensiones generadoras de estrés, así como positivas con las dimensiones recuperadoras de estrés. Asimismo, la competencia percibida mostraba una correlación elevada y negativa con la fatiga. Todo ello indica que la competencia percibida funciona como un elemento nuclear y mediador de variables psicológicas que juegan un papel importante en el rendimiento de los jóvenes deportistas (AU)

This study analyzed the role that perceived competence played in the mood state and the stress tolerance of young athletes. Thirty young athletes belonging to 10 different types of sports participated in this study. The results evidenced that high perceived competence had high negative correlations related to the dimension of stress generators, and positive correlations with the dimensions of stress recovery. Furthermore, perceived competence showed negative correlation with fatigue. These data indicates that perceived competence works as a nuclear element and mediator of psychological variables that play an important role in the performance of young athletes (AU)

Antígeno carcinoembrionario versus dímero D en la determinación del pronóstico y la recurrencia en el paciente con cáncer colorrectal / Carcinoembryonic antigen vs. D-dimer in the evaluation of colorectal cancer patients’ prognoses and potential recurrence

Antecedentes: El antígeno carcinoembrionario (ACE) es el marcador tumoral más usado en el cáncer colorrectal (CCR). Recientes estudios sugieren que el dímero D (DD) puede ser un mejor marcador tumoral que el ACE. Se pretende evaluar, en este estudio prospectivo, el valor pronóstico de ambos marcadores en pacientes con CCR. Materiales y métodos: La población de estudio son 166 pacientes (media 60,7 ± 12,1 años, 85 hombres) que fueron intervenidos con intención curativa por cáncer colorrectal (estados I a III) entre enero de 2003 y diciembre de 2007 a quienes se les comprobó en el preoperatorio el ACE y el DD, así como en el seguimiento hasta su recaída y/o muerte. Se evaluaron las características clínico-patológicas y el estado del tumor se determinó de acuerdo al sistema de la AJCC. Se estableció un valor anormal para ACE superior a 5 ng/mL y mayor a 0,5 µg/mL para el DD. Se determinaron los valores de ambos marcadores al momento de la recurrencia o del último control en los que sobrevivieron, lo que se hizo hasta junio de 2008. Resultados: En el prequirúrgico se encontraron valores anormales en el 81,3% para el DD y de 51,2% para el ACE. Valores elevados de DD y ACE se relacionan con un estado más avanzado. El valor pronóstico del ACE y el DD preoperatorios favorece al ACE como predictor de recurrencia y de mortalidad. Las curvas de sobrevida son similares para ambos marcadores. Conclusiones: Podemos afirmar que un ACE anormal tiene una mayor correlación con el estado tumoral y un mejor valor pronóstico de recaída y de mortalidad que la elevación del DD.

Background: Carcinoembryonic antigen (CEA) is the most common marker used for diagnosis of colorectal cancer (CRC). Recent studies suggest that D-dimer (DD) can be a better tumor marker than CEA. This prospective study evaluates the value for prognosis of both markers in patients with CRC. Materials and Methods: 166 colorectal cancer patients were studied. There were 85 male patients and 81 female patients. Their mean age was 60.7±12.1 years. All had undergone surgery with curative intent for stages I and II CRC between January 2003 and December 2007. During the preoperative phase both CEA and DD were used to establish prognoses for these patients. They were monitored until relapse and/or death. Clinical pathological characteristics were evaluated and the tumor stage was determined according to the AJCC system. 5 ng/mL was determined as an abnormal value for CEA and 0.5 µg/mL as abnormal for DD. The values for both markers were determined for the recurrent cases or at the final check up of patients who survived. These studies were continued until June 2008. Results: During the preoperative phase, abnormal DD values were found in 81.3% of these patients, while abnormal values for CEA were found in 51.2%. Elevated values of DD and CEA were related to how far the cancer had advanced. Preoperative prognoses as determined by CEA and DD favor CEA as a marker for predicting both recurrence and mortality. Survival curves were similar for both markers. Conclusion: Abnormal CEA values have a higher correlation with tumor stages and have greater value for determining prognoses of relapse and mortality than does DD value elevation.

Perceptions of motivational climate and teachers’ strategies to sustain discipline as predictors of intrinsic motivation in physical education

This study examined the relationship among pupils’ perceptions of the motivational climate, pupils’ perceptions of teachers’ strategies to maintain discipline and pupils’ intrinsic motivation in physical education. A sample of 2189 Spanish adolescents, ages 13 to 17 years, completed Spanish versions of the EPCM, SSDS, and IMI. Confirmatory factor analyses were carried out to confirm the factorial validity of the scales. Then, the relationship among the variables was explored through Structural Equation Modelling. The most important predictors of pupils’ intrinsic motivation were the perceived mastery climate, and perceived teachers’ emphasis on intrinsic reasons to maintain discipline. Perceived performance climate and perceived teachers’ strategies to maintain discipline based on introjected reasons and indifference, predicted pupils’ tension-pressure. Results are discussed in the context of theoretical propositions of self-determination theory and practical issues of enhancing adolescents’ motivation in physical education (AU)

Se han analizado las relaciones entre las percepciones del alumnado del clima motivacional, las estrategias del profesorado para mantener la disciplina, y la motivación intrínseca en educación física. Una muestra de 2189 adolescentes españoles de 13 a 17 años, completaron versiones españolas de la EPCM, SSDS e IMI. Mediante Análisis Factoriales Confirmatorios y Modelos de Ecuaciones Estructurales se ha verificado la validez de las escalas y la relación entre variables. Los predictores más importantes de la motivación intrínseca han sido la percepción del clima de maestría y el énfasis del profesorado en razones intrínsecas para la disciplina. El clima de ejecución y las estrategias basadas en razones introyectadas e indiferentes ante la disciplina, han predicho la tensión-presión del alumnado. Se han discutido los resultados en el marco de la auto-determinación de cara a potenciar la motivación de los adolescentes en educación física (AU)

Perceptions of motivational climate and teachers' strategies to sustain discipline as predictors of intrinsic motivation in physical education.

This study examined the relationship among pupils' perceptions of the motivational climate, pupils' perceptions of teachers' strategies to maintain discipline and pupils' intrinsic motivation in physical education. A sample of 2189 Spanish adolescents, ages 13 to 17 years, completed Spanish versions of the EPCM, SSDS, and IMI. Confirmatory factor analyses were carried out to confirm the factorial validity of the scales. Then, the relationship among the variables was explored through Structural Equation Modelling. The most important predictors of pupils' intrinsic motivation were the perceived mastery climate, and perceived teachers' emphasis on intrinsic reasons to maintain discipline. Perceived performance climate and perceived teachers' strategies to maintain discipline based on introjected reasons and indifference, predicted pupils' tension-pressure. Results are discussed in the context of theoretical propositions of self-determination theory and practical issues of enhancing adolescents' motivation in physical education.

Perceived motivational climate, sportsmanship, and students' attitudes toward physical education classes and teachers.

The purpose of this study was to examine the relations among students' perceptions of motivational climate, sportsmanship attitudes, and attitudes toward content and teachers in physical education. 910 secondary school students ages 13 to 16 years (M=14.3, SD=1.1) completed Spanish translations of L'Echelle de Perception du Climat Motivational by Biddle, et al., the Multidimensional Sportspersonship Orientations Scale by Vallerand, et al., and the Student Attitudes toward Teacher and Program in Physical Education by Luke and Cope. Structural equation modeling showed that perceived mastery climate is a predictor of students' attitudes toward teacher and content and positive sportsmanship attitudes. In contrast, perceived performance climate was not a predictor or mainly predicted negatively the students' attitudes toward the physical education teacher, content, and sportsmanship attitudes. These findings are discussed with regard to the implications for physical educators.