Síndrome de Kartagener y artritis reumatoide. Reporte de caso / Kartagener Syndrome and Rheumatoid Arthritis. Case Report

Presentación del caso. Se trata de una mujer de 26 años de edad, en seguimiento por la especialidad de reumatología desde los 17 años, cuando consultó con historia de un año de evolución de síndrome poliarticular de grandes y pequeñas articulaciones, aditivo, simétrico acompañado de fatiga, rigidez matutina mayor de una hora. Se reportó además factor reumatoide positivo. La radiografía de ambas manos presentó erosiones, que confirmó el diagnóstico de artritis reumatoide. Adicionalmente, la paciente tenía el antecedente de procesos sinobronquiales a repetición desde su infancia. En la evaluación médica se identificó dolor en los senos paranasales, dextrocardia y bronquiectasias, confirmados por los estudios de imágenes, que permitió concluir en el diagnóstico de síndrome de Kartagener. Intervención terapéutica. La paciente presentaba actividad clínica severa de la artritis reumatoide, se inició el tratamiento con metotrexato 10 mg vía oral un día a la semana, prednisona 5 mg al día y ácido fólico 5 mg a la semana y citas periódicas, controlando los datos de actividad y efectos adversos de los medicamentos, con pruebas hepáticas, hemograma y transaminasas. La especialidad de neumología recomendó la inclusión de la paciente en un programa de rehabilitación respiratoria, así como el uso de azitromicina 500 mg cada día por tres días en los períodos de agudización. Evolución clínica. El tratamiento logró mantener una actividad leve de la artritis reumatoide y sin exacerbación de los síntomas respiratorios

Case presentation. A 26-year-old woman, under follow-up by the rheumatology specialty since she was 17 years old, when she consulted with a history of one year of evolution of polyarticular disease of large and small joints, additive, symmetrical, accompanied by fatigue and morning stiffness for more than one hour. Positive rheumatoid factor was also reported. Additionally, the patient had a history of repeated sinobronchial processes since childhood. Medical examination revealed sinus pain in the paranasal sinuses, dextrocardia, and bronchiectasis, confirmed by imaging studies, which led to the diagnosis of Kartagener's syndrome. Treatment. The patient presented the severe clinical activity of rheumatoid arthritis. The treatment was started with methotrexate 10 mg orally one day a week, prednisone 5 mg a day, and folic acid 5 mg a week and periodic appointments, controlling the activity data and adverse effects of the drugs, with liver tests, hemogram, and transaminases. The pneumology department recommended the inclusion of the patient in a respiratory rehabilitation program as well as the use of azithromycin 500 mg every day for three days during periods of exacerbation. Outcome. The treatment was successful in maintaining a mild activity of the rheumatoid arthritis and without exacerbation of respiratory symptoms

A new mixed reality tool for training in minimally invasive robotic-assisted surgery.

Robotic-assisted surgery (RAS) is developing an increasing role in surgical practice. Therefore, it is of the utmost importance to introduce this paradigm into surgical training programs. However, the steep learning curve of RAS remains a problem that hinders the development and widespread use of this surgical paradigm. For this reason, it is important to be able to train surgeons in the use of RAS procedures. RAS involves distinctive features that makes its learning different to other minimally invasive surgical procedures. One of these features is that the surgeons operate using a stereoscopic console. Therefore, it is necessary to perform RAS training stereoscopically. This article presents a mixed-reality (MR) tool for the stereoscopic visualization, annotation and collaborative display of RAS surgical procedures. The tool is an MR application because it can display real stereoscopic content and augment it with virtual elements (annotations) properly registered in 3D and tracked over time. This new tool allows the registration of surgical procedures, teachers (experts) and students (trainees), so that the teacher can share a set of videos with their students, annotate them with virtual information and use a shared virtual pointer with the students. The students can visualize the videos within a web environment using their personal mobile phones or a desktop stereo system. The use of the tool has been assessed by a group of 15 surgeons during a robotic-surgery master's course. The results show that surgeons consider that this tool can be very useful in RAS training.

Preparation of Volborthite by a Facile Synthetic Chemical Solvent Extraction Method.

In this work, the extraction of vanadium (V) ions from an alkaline solution using a commercial quaternary ammonium salt and the production of metal vanadates through precipitation stripping were carried out. The crystallization of copper vanadates from the extracts was performed using a solution containing a copper(II) source in concentrated chloride media as a stripping agent. In an attempt to control growth, a stabilizing polymer (polyvinylpyrrolidone, PVP) was added to the stripping solution. The structural characteristics of the crystallized products, mainly copper pyrovanadate (volborthite, Cu3V2O7(OH)2·(H2O)2) nanoflakes and nanoflowers and the experimental parameter influencing the efficiency of the stripping process were studied. From the results, the synthesis of nanostructured vanadates is a simple and versatile method for the fabrication of valuable three-dimensional structures providing abundant active zones for energy and catalytic applications.

Participação política e potência de agir: a produção de saúde ético-política em ocupações estudantis paulistas / Political participation and power to act: the ethical-political health produced by student occupations in São Paulo / Participation politique et puissance d'agir: la santé éthico-politique produite par les occupations juvéniles à São Paulo / Participación política y potencia del actuar: la producción de salud ético-política en las ocupaciones estudiantiles paulistas

Resumo Os anos de 2015 e 2016 foram marcados politicamente por movimentos de ocupações estudantis pelo Brasil, os quais pautavam a defesa da educação pública e tiveram a autogestão como grande marca organizativa. Este artigo objetiva abordar os processos de produção de potência de agir e saúde ético-política ocorridos durante ocupações estudantis paulistas nos anos de 2015 e 2016. O corpus de pesquisa foi construído por meio de entrevistas, grupos focais e observações participantes com estudantes de quatro cidades: São Paulo, Ribeirão Preto, Catanduva e Barretos. A partir da análise do material, evidencia-se que apesar de os participantes terem sido submetidos a processos de diminuição de potência de agir e a sofrimento ético-político durante os movimentos, lutaram em prol de ideais coletivos, partilha de identidades sociais, humor, espaços lúdicos etc.

Abstract The years 2015 and 2016 were politically marked by student occupation movements throughout Brazil, which focused on the defense of public education and stood out due to their self-organization. This paper investigates the production processes of power to act and ethical-political health that took place during the 2015-2016 student occupations in São Paulo. Data was collected by means of interviews, focus groups and participant observations with students from four municipalities: São Paulo, Ribeirão Preto, Catanduva and Barretos. The corpus analysis highlights that although the students were subjected to processes of decreased power to act and ethical-political suffering during the occupations, they fought for collective ideals, shared social identities, humor, play activities, among others.

Résumé Les années 2015 et 2016 ont été marquées politiquement par des mouvements d'occupation juvénile dans tout le Brésil, concernés par la défense de l'éducation publique et qui se sont distingués par leur l'autogestion. Cet article étudie les processus de puissance d'agir et de la santé éthico-politique qui ont eu lieu lors des occupations juvéniles de 201e-2016 à São Paulo. Le données ont été recueillies au moyen d'entretiens, de groupes de discussion et d'observations participantes avec des étudiants de quatre villes : São Paulo, Ribeirão Preto, Catanduva et Barretos. L'analyse du corpus met en évidence que, bien que les participants aient été soumis à des processus de diminution de la puissance d'agir et de souffrance éthico-politique pendant les occupations, ils se sont battus pour des idéaux collectifs, des identités sociales partagées, l'humour, des espaces ludiques, entre autres.

Resumen Los años 2015 y 2016 estuvieron marcados políticamente por movimientos de ocupación estudiantil en todo Brasil con el objetivo de defender la educación pública, los cuales tenían la autogestión como una marca organizacional importante. Este artículo tiene como objetivo abordar los procesos de producción de potencia del actuar y salud ético-política que ocurrieron durante las ocupaciones estudiantiles paulistas en 2015 y 2016. El corpus de investigación se construyó a través de entrevistas, grupos focales y observaciones participantes con estudiantes de cuatro ciudades: São Paulo, Ribeirão Preto, Catanduva y Barretos. Del análisis del material se observa que a pesar de someterse a procesos de disminución de la potencia del actuar y a sufrimiento ético-político durante los movimientos, los estudiantes lucharon por ideales colectivos, intercambio de identidades sociales, humor, espacios lúdicos, entre otros.

Incorporación del Counseling a la Gestión Integral de la Medicación para gestionar emociones que afectan enfermedades crónicas / Counseling integrated with Comprehensive Medication Management. Emotion management of chronic diseases

Se presenta un caso de una paciente que recibe Gestión Integral de la Medicación integrada con counseling debido a las dificultades para controlar la presión arterial tras haberse tratado con diferentes antihipertensivos y porque refiere que este descontrol está relacionado con su estado emocional. La paciente se presenta con una fuerte carga de ansiedad y anímicamente alterada. Asocia su dificultad para controlar su presión arterial a circunstancias emocionales. Se considera que puede beneficiarse de estrategias de counseling para gestionar emociones integradas con la Gestión Integral de la Medicación. Tras evaluar las intervenciones realizadas interdisciplinariamente, la presión arterial se normaliza, se reduce medicación antihipertensiva, se resuelvan otros problemas de salud y percibe mayor control y capacidad de autogestión. Incorporando la gestión de emociones a la Gestión Integral de la Medicación potenciamos los propios recursos de los pacientes, promovemos su autoconocimiento, mejoramos la toma de decisiones y fomentamos actitudes satisfactorias para reducir su sufrimiento e incrementar su bienestar pudiendo repercutir positivamente en la farmacoterapia.(AU)

A case of a patient who receives Comprehensive Medication Management-CMM- integrated with counseling is presented. The patient shows difficul-ties in controlling blood pressure after having been treated with different antihypertensives and she refers this lack of control is related with her emo-tional status. This patient was highly anxious and emotionally affected. She associates her difficulty in controlling her blood pressure to emotional circumstances. The care team considers that she can benefit from counseling strategies to manage emotions integrated with CMM. After evaluating the interdisciplinary interventions, blood pressure normalizes, antihypertensive medication is reduced, other health problems are resolved and greater control and capacity for self-management are perceived. By incorporating emotion management into CMM, we enhance the patients' own resources, promote their self-knowledge, improve the deci-sion-making process, and promote satisfactory atti-tudes. For these reasons, their suffering is reduced and their well-being increased, allowing a positive effect on pharmacotherapy.(AU)

Influence of Genetic Polymorphisms on Response to Biologics in Moderate-to-Severe Psoriasis.

Psoriasis is a chronic inflammatory skin pathology of autoimmune origin and unknown etiology. There are various therapies for treating it, including a wide range of biopharmaceuticals indicated in moderate-to-severe psoriasis. Depending on their therapeutic target, they are classified as tumor necrosis factor inhibitors (anti-TNF) or cytokine inhibitors (interleukin-12, 23, and 17 antagonists). Although they have proved effective and safe, in clinical practice, many patients show a short- and long-term suboptimal response and even varying degrees of toxicity. This variability in response may be influenced by genetic factors, such as polymorphisms in the genes involved in the pathological environment, metabolism or mechanism of action of the drug that could affect the effectiveness and toxicity of biological therapies. This review assesses pharmacogenetic studies of the impact of genetic factors on response to biopharmaceuticals and toxicity in patients diagnosed with moderate-to-severe psoriasis. The results suggest that polymorphisms detected in the HLA genes, in genes that encode cytokines (TNF, IL genes, TNFAIP3), transporters (PDE3A-SLCO1C1, SLC12A8), receptors (TNFRSF1B, CD84, FCGR2A and FCGR3A, IL17RA, IL23R, TLR genes, PGLYRP4) and associated proteins (TNFAIP3, LY96, TIRAP, FBXL19), as well as other genes implicated in the pathogenesis of psoriasis (CDKAL1, CARD14, PTTG1, MAP3K1, ZNF816A, GBP6, CTNNA2, HTR2A, CTLA4, TAP1) can be used in the future as predictive markers of treatment response and/or toxicity with biological therapies in patients diagnosed with moderate-to-severe psoriasis, tailoring treatment to the individual patient.

Campo de potência: pistas para a produção de uma arma conceitual / Campo de potencia: pistas para la producción de un arma conceptual / Field of power: clues to the production of a conceptual weapon

Resumo O artigo objetiva apresentar a proposta teórica denominada campo de potência. O conceito foi elaborado a partir de pesquisa junto a jovens que participaram de ocupações escolares no estado de São Paulo em 2015 e/ou 2016. A pesquisa teve como fundamento teórico a articulação entre a psicologia histórico-cultural e o pensamento político gramsciano. O campo de potência se configura como um instrumento psicossocial composto por três dimensões entrelaçadas e indissociáveis: potência de agir; aprendizado e desenvolvimento; práxis política. O campo de potência se caracteriza como um ambiente físico e social que favorece a produção de potência de agir; subjetividades e relações democráticas e democratizantes; e práxis política reflexiva e criativa - com caraterísticas multitudinárias. Entende-se que a ação psicossocial pautada no campo de potência possa contribuir com o fortalecimento de movimentos de luta por direitos, bem como com a atuação junto a espaços diversos como: saúde, educação e assistência social.

Abstract The article aims to present the theoretical proposal called the field of power. The concept was developed based on a research with young people who participated in school occupations in the state of São Paulo in 2015 and / or 2016. The research had as theoretical framework the articulation between historical-cultural psychology and Gramscian political theory. The field of power is configured as a psychosocial instrument composed of three intertwined and inseparable dimensions: power to act; learning and development; political praxis. The field of power is characterized as a physical and social environment that favors the production of power to act; democratic and democratizing subjectivities and relations; and reflective and creative political praxis - with multitudinous characteristics. It is understood that the psychosocial action based on the field of power can contribute to the strengthening of movements of fight for rights, as well as with actions in different areas such as: health, education and social assistance.

Resumen El artículo tiene como objetivo presentar la propuesta teórica denominada campo de potencia. El concepto se desarrolló a partir de una investigación con jóvenes que participaron en ocupaciones escolares en el estado de São Paulo en 2015 y/o 2016. La investigación tuvo como base teórica la articulación entre la psicología histórico-cultural y el pensamiento político Gramsciano. El campo de potencia se configura como un instrumento psicosocial compuesto por tres dimensiones entrelazadas e inseparables: potencia de actuar; aprendizaje y desarrollo; praxis política. El campo de potencia se caracteriza como un entorno físico y social que favorece la producción de potencia para actuar; subjetividades y relaciones democráticas y democratizadoras; y praxis política reflexiva y creativa, con características multitudinarias. Se entiende que la acción psicosocial basada en el campo de potencia puede contribuir al fortalecimiento de los movimientos de lucha por derechos, así como con acciones en diferentes áreas como: salud, educación y asistencia social.

Microtornillos como método de control vertical en desprogramación muscular / Vertical control with miniscrews in muscular deprogramming treatment

Una de las consecuencias de la desprogramación neuromuscular es la rotación mandibular en sentido horario, evidenciando el punto prematuro de contacto y aumentando la dimensión vertical del paciente. En pacientes clase II con componente vertical, es un problema realizar este tipo de tratamiento, ya que por lo general este efecto de posterorrotación mandibular hace el perfil más convexo, y en algunos casos genera mordida abierta anterior, la cual se debe corregir posteriormente con el tratamiento de ortodoncia, cirugía o prótesis, lo que alarga el tiempo total de tratamiento por la necesidad de control vertical. El presente caso se trata de una mujer de 45 años de edad, dolicofacial, con tendencia a mordida abierta, mordida dual, sobremordida vertical y horizontal disminuidas, motivo de consulta dolor articular, el cual no le permite continuar con sus labores diarias, el tratamiento realizado fue desprogramación neuromuscular con un guarda oclusal inferior con el propósito de aliviar sintomatología articular y control vertical con microtornillos palatinos previo a tratamiento ortodóncico (AU)

One of the effects of the neuromuscular deprogramming treatment is the mandibular clockwise rotation, making the light premature occlusal contact more evident and increasing the patient vertical dimension. In Class II patients with vertical component is difficult to treat them due to profile worsening as an effect of the clockwise rotation creating in some patient's anterior open bite, this has to be corrected later in treatment with orthodontic intrusion, surgery or prosthodontic treatment, increasing the total time of treatment with the vertical control necessity. This case report is a 45 years old patient, dolichofacial, with anterior open bite tendency, dual bite, decreased overjet and overbite, her chief complaint was temporomandibular joint dysfunction which dont allow her to do her daily duties, the treatment for her was neuromuscular deprogramming splint for the temporomandibular joint pain, and vertical control with temporary anchorage devices (miniscrews) before the orthodontic treatment (AU)

Ameloplastia positiva en relación céntrica como método auxiliar durante la finalización en el tratamiento de ortodoncia en un paciente bruxista / Positive ameloplasty in centric relationship as an auxiliary method during finalization in the orthodontic treatment in a bruxist patient

A continuación se presenta un caso de un paciente de 12 años de edad, con antecedente de bruxismo, con biotipo mesofacial, tercio inferior dolicofacial, hipertonicidad muscular en maseteros, cierre labial forzado con incompetencia labial de 4 milímetros con dolor en sinoviales anteriores inferiores. Los objetivos de tratamiento consistieron en lograr relajación muscular y promover un posicionamiento condilar ortopédicamente funcional y estable, realizar control vertical para disminuir gap interlabial, alinear líneas medias, mantener clase I molar bilateral, clase I canina bilateral y clase I incisiva, crear overjet y overbite adecuados, con recuperación estética y función del segmento anterior. Debido a eventos adversos durante la etapa de cierre de espacios, la clase molar y canina I no se logró, pero se aseguró mediante ameloplastias positivas la función y estética adecuadas para tener un tratamiento de ortodoncia estable a largo plazo (AU)

The following is a case of a 12-year-old patient, with a history of bruxism, with a mesofacial biotype, lower third of the facial area, muscular hypertonicity in the masseters, a forced labial closure with a 4-millimeter labial incompetence with pain in inferior anterior synoviums. Treatment objectives consisted of achieving muscle relaxation and promoting orthopedically functional and stable condylar positioning, perform vertical control to decrease interlabial gap, align midlines, maintain bilateral molar class I, bilateral canine class I and incisive class I, create adequate overjet and overbite, with aesthetic recovery and function of the anterior segment. Due to adverse events during the closing phase of spaces, the molar and canine I class was not achieved, but positive function and aesthetics were ensured by positive ameloplasties in order to have a long-term stable orthodontic treatment (AU)

Control vertical mediante bite block en relación céntrica / Vertical control through bite block in centric relation

Paciente femenina de ocho años y cuatro meses, con patrón esquelético de clase II severa y overjet de 10 mm, fue tratada con Bite-Block Céntrico como método de control vertical. Después de cinco meses de terapia con aparatología fija de primera fase se logró control vertical y reducción de las desviaciones de la clase esquelética. Posteriormente se continuó con tratamiento activo durante 18 meses, se dio de alta de la primera fase cuando los objetivos del tratamiento como alineación, nivelación, overbite y overjet fueron adecuados. Los registros postratamiento demostraron una buena estabilidad articular, oclusión funcional y una mejora en la estética facial. El montaje en céntrica postratamiento demuestra estabilidad condilar con el uso de Bite-Block Céntrico como método de control vertical (AU)

Female patient of eight years and four months, with skeletal pattern of severe class II and 10 mm overjet, was treated with Bite-Block Centric as a vertical control method. After five months of therapy with fixed appliances of the first phase, vertical control and reduction of the deviations of the skeletal class were achieved. Subsequently continued with active treatment for 18 months, was discharged from the first phase when the treatment objectives such as alignment, leveling, overbite and overjet appropriate. Post-treatment records showed good joint stability, functional occlusion and an improvement in facial aesthetics. The posttreatment centric assembly demonstrates condylar stability with the use of Centric Bite-Block as a vertical control method (AU)

Advanced systemic amyloidosis secondary to metastatic renal cell carcinoma.

Secondary amyloidosis is a rare complex complication related to chronic inflammatory disease. This complication is sparsely associated to malignant neoplasms. Renal cell carcinoma (RCC) is the most common solid organ malignancy related with this paraneoplastic syndrome. Some case reports have described stabilisation or even remission of amyloidosis with cytoreductive nephrectomy. Majority of those reports were based on locally advanced RCC. We report the first case of early aggressive systemic secondary amyloidosis in high-volume metastatic RCC. The subject was diagnosed with metastatic RCC within 6 months of secondary amyloidosis; on month 5 of initiation of targeted therapy (pazopanib) developed nephrotic syndrome with a heavy proteinuria (>18 g/day), severe hypoalbuminaemia (1.53 g/dL), intense and progressive oedema, severe pancolitis and mild dyspnoea with hypotension. A colon biopsy and the immunohistochemistry confirmed the histological diagnosis of a secondary amyloidosis. The multidisciplinary tumour board decided to perform cytoreductive nephrectomy in order to reduce the pro-inflammatory status. Pathology report showed a complete resection of clear cell RCC plus renal amyloid deposits. The patient died within 4 days of surgery due to multiorgan failure.

Ocupação Estudantil no Instituto Federal de Catanduva (SP): potência, desenvolvimento e práxis / Student Occupation at the Instituto Federal de Catanduva (SP): potency, deve-lopment and práxis / Ocupación Estudiantil en el Instituto Federal de Catanduva (SP): potencia, de-sarrollo y práxis / L'occupation des Élèves à L'institut Fédéral de Catanduva (SP): pouvoirs, dé-veloppement et praxis

As ocupações estudantis paulistas de 2015 marcaram significativamente o cenário político brasileiro e influenciaram diversos outros movimentos estudantis. É abordada no texto uma ocupação ocorrida em 2016 no Instituto Federal de Catanduva (SP). O corpus empírico foi produzido por meio de grupo focal, entrevistas e observações participantes. A partir do tratamento do material, a análise foi dividida em três momentos: potência de agir; aprendizado e desenvolvimento; práxis política. Esses três momentos se identificam com as três dimensões de nossa proposta teórica: campo de potência. Tal campo se caracteriza como um espaço/tempo no qual se favorece a) o acontecimento de bons encontros; b) a produção de subjetividades e relações democráticas e democratizantes; c) a realização de práxis política criativa e reflexiva.

The student occupations of São Paulo in 2015 marked the Brazilian political scene and influenced several other student movements. It is approached in the text an occupation occurred in 2016 at the Instituto Federal de Catanduva (SP). The empirical corpus was produced through a focus group, interviews and participant observations. From the treatment of the material, the analysis was divided into three moments: power to acting; learning and development; political praxis These three moments identify with the three dimensions of our theoretical proposal: field of potency. The field of potency is characterized as a space / time in which it favors a) the event of good encounters; b) the production of democratic and democratizing subjectivities and relations; and c) the realization of creative and reflexive political praxis.

Las ocupaciones estudiantiles de São Paulo en 2015 marcaron la escena política brasilena e influyeron en muchos otros movimientos estudiantiles. Se aborda en el texto una ocupación ocurrida en 2016 en el Instituto Federal de Catanduva (SP). El corpus empírico se produjo a través de un grupo focal, entrevistas y observaciones participantes. Del tratamiento del material, el análisis se dividió entres momentos: potência de obrar; aprendizaje y desarrollo; praxis política. Estos tres momentos se identifican con las tres dimensiones de nuestra propuesta teórica: el campo de potencia. El campo de potência se caracteriza como un espacio / tiempo en el que favorece a) el evento de buenos encuentros; b) la producción de subjetividades y relaciones democráticas y democratizadoras; c) la realización de la praxis política creativa y reflexiva.

Les occupations des élèves à São Paulo en 2015 ont marqué la scène politique brésilienne et ont influencé plusieurs autres mouvements détudiants. C'est abordé dans le texte l'occupation qui a eu lieu à llnstitut fédéral de Catanduva (SP), en 2016. Le corpus empirique a été produit par un groupe focal, des entretiens et des observations de participants. De le traitement de les données brut disponibles, l'analyse a été divisée en trois étapes: le pouvoir d'agir; apprentissage et développement; praxis politique. Ces trois étapes s'identifient aux trois dimensions de notre proposition théorique: le champ de puissance. Ce domaine est caractérisé comme un espace / temps dans lequel il favorise: a) la manifestation de bonnes rencontres; b) la production de subjectivités et de relations démocratiques et démocratisantes; et c) la réalisation d'une praxis politique créative et réflexive.

Phonon driven charge dynamics in polycrystalline acetylsalicylic acid mapped by ultrafast x-ray diffraction.

The coupled lattice and charge dynamics induced by phonon excitation in polycrystalline acetylsalicylic acid (aspirin) are mapped by femtosecond x-ray powder diffraction. The hybrid-mode character of the 0.9 ± 0.1 THz methyl rotation in the aspirin molecules is evident from collective charge relocations over distances of some 100 pm, much larger than the sub-picometer nuclear displacements. Oscillatory charge relocations around the methyl group generate a torque on the latter, thus coupling electronic and nuclear motions.

Reconstrucción de la continuidad digestiva tras cirugía de la diverticulitis aguda complicada. Estudio retrospectivo multicéntrico / Stoma reversal after surgery for complicated acute diverticulitis: A multicentre retrospective study

INTRODUCCIÓN: El objetivo del estudio es analizar la tasa de reconstrucción del estoma tras cirugía por diverticulitis aguda complicada (DAC), su demora, factibilidad, complicaciones y factores de riesgo de mantenerlo. MÉTODOS: Estudio retrospectivo multicéntrico de pacientes intervenidos mediante cirugía urgente por DAC con realización de un estoma en 10 hospitales durante 6 años. Se analiza la frecuencia de reconstrucción del estoma, fundamentalmente de los terminales, y el tiempo en que se produce, así como los factores relacionados con ella. RESULTADOS: De 385 pacientes intervenidos por DAC, a 312 (81%) se les realizó un estoma: 292 fueron colostomías terminales y 20 estomas derivativos. Durante el seguimiento, en 161 (51,6%), se intentó el cierre a una mediana de 9 meses. Las causas más frecuentes de no efectuarlo fueron la comorbilidad y el fallecimiento del paciente. La edad más avanzada se mostró factor adverso en el análisis multivariante y la tasa actuarial de reconstrucción fue mayor en hombres y en quienes no se realizó un Hartmann. La cirugía pudo completarse en todos menos en un paciente y en 4 se asoció un estoma derivativo. La morbimortalidad fue del 35,7 y 1,9%, respectivamente. Hubo un 8,4% de reintervenciones y un 6% de fallos de sutura, quedando 12 pacientes (7,9%) con un estoma tras el intento de reconstrucción. CONCLUSIONES: La cirugía de la DAC se asocia muy frecuentemente a la construcción de un estoma terminal, que en casi un 50% no se reconstruirá. Además, la intervención de reconstrucción tiene una demora notable y está asociada a una morbimortalidad nada despreciable

INTRODUCTION: The aim was to analyse the stoma reversal rate after surgery for complicated acute diverticulitis (CAD), and more specifically the end-stoma-reversal, as well as the delay, feasibility, complications and risk factors for stoma maintenance. METHODS: A multicentre retrospective study of patients who had undergone urgent surgery for CAD with stoma formation in ten hospitals during a period of 6 years. The frequency of reversal over time and the factors affecting the decision for reversal were analysed. RESULTS: Out of 385 patients operated for CAD, 312 underwent stoma creation: 292 end colostomies and 20 diverting stomas. During follow-up, stoma reversal surgery was performed in 161 patients (51.6%) after a median of 9 months. The main causes for not performing stoma reversal were comorbidities and the death of the patient. Advanced age was an adverse factor in the multivariate analysis, and the actuarial rate of reversal was higher in men and in patients with no previous Hartmann's operation. Stoma reversal surgery was completed in all but one patient, and a loop ileostomy was associated in four. Morbidity and mortality rates were 35.7% and 1.9%, respectively. A total of 8.4% of patients underwent re-operation, and 6% experienced an anastomotic leak. Twelve patients remained with a stoma after the attempted reconstruction surgery. CONCLUSIONS: Surgery for CAD is frequently associated with an end stoma, which will ultimately not be reversed in almost 50% of patients. Moreover, reversal surgery is frequently delayed and is associated with significant morbidity and mortality

Soft-mode driven polarity reversal in ferroelectrics mapped by ultrafast x-ray diffraction.

Quantum theory has linked microscopic currents and macroscopic polarizations of ferroelectrics, but the interplay of lattice excitations and charge dynamics on atomic length and time scales is an open problem. Upon phonon excitation in the prototypical ferroelectric ammonium sulfate [(NH4)2SO4], we determine transient charge density maps by femtosecond x-ray diffraction. A newly discovered low frequency-mode with a 3 ps period and sub-picometer amplitudes induces periodic charge relocations over some 100 pm, a hallmark of soft-mode behavior. The transient charge density allows for deriving the macroscopic polarization, showing a periodic reversal of polarity.

Stoma reversal after surgery for complicated acute diverticulitis: A multicentre retrospective study. / Reconstrucción de la continuidad digestiva tras cirugía de la diverticulitis aguda complicada. Estudio retrospectivo multicéntrico.

INTRODUCTION THE AIM: was to analyse the stoma reversal rate after surgery for complicated acute diverticulitis (CAD), and more specifically the end-stoma-reversal, as well as the delay, feasibility, complications and risk factors for stoma maintenance. METHODS: A multicentre retrospective study of patients who had undergone urgent surgery for CAD with stoma formation in ten hospitals during a period of 6 years. The frequency of reversal over time and the factors affecting the decision for reversal were analysed. RESULTS: Out of 385 patients operated for CAD, 312 underwent stoma creation: 292 end colostomies and 20 diverting stomas. During follow-up, stoma reversal surgery was performed in 161 patients (51.6%) after a median of 9 months. The main causes for not performing stoma reversal were comorbidities and the death of the patient. Advanced age was an adverse factor in the multivariate analysis, and the actuarial rate of reversal was higher in men and in patients with no previous Hartmann's operation. Stoma reversal surgery was completed in all but one patient, and a loop ileostomy was associated in four. Morbidity and mortality rates were 35.7% and 1.9%, respectively. A total of 8.4% of patients underwent re-operation, and 6% experienced an anastomotic leak. Twelve patients remained with a stoma after the attempted reconstruction surgery. CONCLUSIONS: Surgery for CAD is frequently associated with an end stoma, which will ultimately not be reversed in almost 50% of patients. Moreover, reversal surgery is frequently delayed and is associated with significant morbidity and mortality.

The effects of transdermal rotigotine on non-motor symptoms of Parkinson's disease: a multicentre, observational, retrospective, post-marketing study.

AIM: This study evaluated the effect of ≥6 months of transdermal rotigotine on non-motor and motor symptoms of patients with advanced Parkinson's disease. MATERIALS AND METHODS: The study was conducted in Spain between September 2011 and December 2012 (ClinicalTrials.gov: NCT01504529). The primary efficacy variable was the change from baseline in non-motor symptoms, as assessed by changes in Parkinson's Disease Non-Motor Symptoms Questionnaire total scores at 6 months. Secondary endpoints included the assessment of motor symptoms by Unified Parkinson's Disease Rating Scale III scores. RESULTS: Data from 378 patients (mean age: 70.2 years; 56.9% male) with Parkinson's disease receiving rotigotine from were collected. Mean disease duration was 6.1 years, and mean rotigotine treatment duration was 45.6 months. Rotigotine reduced non-motor symptoms by 14.6% (mean change from baseline in Parkinson's Disease Non-Motor Symptoms Questionnaire: -1.5 ± 3.4; p < 0.0001). The majority of patients (58.2%) had improved non-motor symptoms at 6 months. Comparing the baseline versus study end, fewer patients experienced events in the urinary (78.6% vs. 73.3%; p = 0.0066), sleep (82.8% vs. 72.8%; p < 0.0001) and mood/cognition (77.3% vs. 66.4%; p < 0.0001) domains of the Parkinson's Disease Non-Motor Symptoms Questionnaire. Mean motor symptoms were reduced from baseline by 8.0% (mean change from baseline in Unified Parkinson's Disease Rating Scale III: -2.6 ± 8.0; p < 0.0001). CONCLUSIONS: In clinical practice in Spain, rotigotine may be an effective treatment to reduce the non-motor and motor symptoms in patients with advanced Parkinson's disease.

Towards shot-noise limited diffraction experiments with table-top femtosecond hard x-ray sources.

Table-top laser-driven hard x-ray sources with kilohertz repetition rates are an attractive alternative to large-scale accelerator-based systems and have found widespread applications in x-ray studies of ultrafast structural dynamics. Hard x-ray pulses of 100 fs duration have been generated at the Cu K α wavelength with a photon flux of up to 109 photons per pulse into the full solid angle, perfectly synchronized to the sub-100-fs optical pulses from the driving laser system. Based on spontaneous x-ray emission, such sources display a particular noise behavior which impacts the sensitivity of x-ray diffraction experiments. We present a detailed analysis of the photon statistics and temporal fluctuations of the x-ray flux, together with experimental strategies to optimize the sensitivity of optical pump/x-ray probe experiments. We demonstrate measurements close to the shot-noise limit of the x-ray source.

Assessment of late cardiomyopathy by magnetic resonance imaging in patients with acute promyelocytic leukaemia treated with all-trans retinoic acid and idarubicin.

Late cardiomyopathy CMP is regarded as a potential severe long-term complication after anthracycline-based regimens for acute promyelocitic leukaemia (APL). We assess by MRI the incidence and severity of clinical and subclinical long-term CMP in a cohort of adult APL patients in first complete remission with PETHEMA trials. Adult patients diagnosed with APL in first complete remission lasting ≥2 years underwent anamnesis and physical examination and were asked to perform a cardiac MRI. Clinical CMP was defined as radiographic and physical signs of heart failure accompanied by symptoms or by left ventricle ejection fraction (LVEF) <45% by MRI with or without symptoms. Subclinical CMP was defined as the following MRI abnormalities: LVEF 45-50% or late gadolinium enhancement or two or more of LVEF ≤55%, left ventricle end-diastolic volume index ≥98 ml/m2, left ventricle end-systolic volume index ≥38 ml/m2, right ventricle end-diastolic volume index ≥106 ml/m2 and regional wall motion abnormalities. Of the 82 patients enrolled in the study, median cumulative dose of anthracyclines (doxorubicin equivalence) was 650 mg/m2, and median time from APL diagnosis to the study was 87 months (range, 24-195). Seven out of 57 patients with available MRI (12%) had subclinical CMP (all of them showed late gadolinium enhancement in MRI), and none had clinical CMP. Among the 25 patients without MRI, none had CMP by chest X-ray and physical assessment. In summary, we found 12% of subclinical and no clinical late CMP assessed by MRI in APL patients treated with PETHEMA protocols. Due to the low number of patients, we must interpret our results cautiously.