Vitamin C and thiamine for the treatment of refractory septic shock in surgical critically ill patients: a retrospective before-and-after study.

OBJECTIVE: This study aimed to evaluate whether early vitamin C and thiamine administration was associated with a lower 28-day and in-hospital mortality in surgical critically ill patients with refractory septic shock. METHODS: We performed a retrospective before-and-after study on patients with refractory septic shock. According to local protocol, hydrocortisone is initiated in case of refractory septic shock. In January 2017, the protocol was changed and vitamin C and thiamine were included. Patients who were admitted in 2015-2016 and 2017-2018 were included in the control and treatment groups, respectively. The primary end point was 28-day and in-hospital mortality. Secondary end points were ICU mortality, ICU and hospital length of stay, duration of vasopressors and mechanical ventilation, use of renal replacement therapy (RRT), and the modification in serum procalcitonin and SOFA score during the first 72 h. RESULTS: A total of 120 patients were included (58 in the treatment group and 62 in the control group). Log-rank test in Kaplan-Meier curves showed lower 28-day and in-hospital mortality over time in the treatment group (p=0.021 and p=0.035, respectively) but it not reached statistical significance in ICU mortality over time (p=0.100). The need of RRT was less frequent in treatment group (17.2% vs. 37.1%, p=0.024). There were no differences in other secondary outcomes. CONCLUSIONS: Intravenous vitamin C and thiamine administration in surgical patients with refractory septic shock may be associated with a lower 28-day and in-hospital mortality. Further prospective studies are needed in refractory septic shock.

Time-resolved structural dynamics of the out-of-equilibrium charge density wave phase transition in GdTe3.

We use ultrafast electron diffraction to study the out-of-equilibrium dynamics of the charge density wave (CDW) phase transition in GdTe3, a quasi-two-dimensional compound displaying a unidirectional CDW state. Experiments were conducted at different incident fluences and different initial sample temperatures below Tc. We find that following photo-excitation, the system undergoes a non-thermal ultrafast phase transition that occurs in out-of-equilibrium conditions. The intrinsic crystal temperature was estimated at each time delay from the atomic thermal motion, which affects each Bragg peak intensity via the Debye Waller factor. We find that the crystal temperature stabilizes with a 6 ps timescale in a quasi-equilibrium state at temperature Tq.e.. We then relate the recovery time of the CDW and its correlation lengths as a function of Tq.e.. The charge density wave is suppressed in less than a picosecond while its recovery time increases linearly with incident fluence and initial temperature. Our results highlight that the dynamics is strongly determined by the initial sample temperature. In addition, the transient CDW phase recently observed along the transverse direction in LaTe3 and CeTe3 is not observed in GdTe3.

El hospital del futuro en 10 puntos / The hospital of the future in 10 points

La Sociedad Española de Medicina Interna ha desarrollado a lo largo de 2018-2019 el proyecto «El hospital del futuro». El hospital del futuro pretende trasladar al contexto del sistema sanitario español la reflexión que abordó el Royal College of Physicians en el Reino Unido sobre la organización de la asistencia en los hospitales del futuro, desde el conocimiento acumulado sobre el Sistema Nacional de Salud. En el proyecto participaron asimismo numerosas sociedades científico-médicas y entidades profesionales del sector salud y asociaciones de pacientes. Este artículo tiene por objeto destacar en 10 puntos las previsiones que consideramos más relevantes derivadas de este proyecto, dedicando el último a los retos que para la Medicina Interna se deducen de estas propuestas

Over the course of 2018 and 2019, the Spanish Society of Internal Medicine carried out a project called "The Future Hospital." Based on cumulative knowledge on the Spanish National Health System, this project seeks to transfer the observations on the organization of healthcare in future hospitals made by the Royal College of Physicians in the United Kingdom to the context of the Spanish healthcare system. The project's participants included numerous scientific and medical societies, professional associations in the health sector, and patient associations. This aim of this article is to highlight, in 10 points, predictions that arose from this project that we consider to be the most relevant, reserving the last point for the challenges for the field of internal medicine that can be surmised from these proposals

The Hospital of the Future in 10 points. / El hospital del futuro en 10 puntos.

Over the course of 2018 and 2019, the Spanish Society of Internal Medicine carried out a project called "The Future Hospital." Based on cumulative knowledge on the Spanish National Health System, this project seeks to transfer the observations on the organization of healthcare in future hospitals made by the Royal College of Physicians in the United Kingdom to the context of the Spanish healthcare system. The project's participants included numerous scientific and medical societies, professional associations in the health sector, and patient associations. This aim of this article is to highlight, in 10 points, predictions that arose from this project that we consider to be the most relevant, reserving the last point for the challenges for the field of internal medicine that can be surmised from these proposals.

Antlers of Cervus elaphus as biomonitors of 9°Sr in the environment.

Adequate radioprotection of the environment requires the identification of biomonitors sensitive to the variation of its radionuclide content. Due to the chemical similarities between calcium and strontium, calcified tissues of mammals are considered to be good 9°Sr biomonitors. This work considered Cervus elaphus antlers which, being shed annually, can give information about the importance of radiostrontium contamination in an ecosystem in the time period required for the growth of the antler. The samples were collected at various points of W and SW Spain. The mean value of their 9°Sr content was (70 ± 43 (S.D.)) Bq/kg d.w., range (16-218) Bq/kg d.w., and the radionuclide was evenly distributed in the different parts of the antler. There was a good correlation between the antlers' 9°Sr content and the 9°Sr deposited in the soil. The antlers' content of ²²6Ra (from the natural uranium series) and the contents of some stable elements (Ca, Mg, Sr, and K) were also determined. The values for these stable elements were practically constant in the analyzed samples, and the concentrations measured decreased in the following order: Ca ¼ Mg > K > Sr ¼ 9°Sr > ²²6Ra.

[Diagnostic variability in a cohort of patients with multiple admissions in the last two decades]. / Variabilidad en los diagnósticos de una cohorte de reingresadores en las dos últimas décadas.

OBJECTIVE: To investigate possible changes in the admission pattern correlated with improvement in psychiatric attention and if there is variability in the diagnosis of patients previously identified as having multiple admissions during the study period. MATERIAL AND METHODS: Our study is based on fifty-nine patients who were admitted on at least ten occasions between 1983-2000. The medical records of the frequent users were reviewed and data were extracted on several variables: principal psychiatric diagnosis (DSM-IV TR criteria) and diagnostic changes as main variables and period, admissions density, admission interval and period between last admission and the end of study, as related variables. STATISTICAL ANALYSES: Friedman's variance non-parametric analysis for related samples, Pearson's chi-squared test and sequence graphing. RESULTS AND DISCUSSION: Improved psychiatric care in our city would seem to correlate with the decreasing number of patients with multiple admissions to the point where there have been no admissions in the past year. Diagnosis (DSM-IV axis I and II) variables showed important variations from one admissions to the next. The psychosocial and adaptation problems that became manifest during the successive admissions tended to improve over time as did the overall functioning of the patients. Our findings suggest that this population is composed of three distinct subgroups. Identification of the subgroups may have important implications for the management and treatment modality.

The Ishiguro extension block technique for the treatment of mallet finger fracture: indications and clinical results.

The results of extension block Kirschner wire fixation for the treatment of mallet fractures of the distal phalanx were retrospectively assessed in 65 consecutive patients. The indications for this technique were the presence of a large bone fragment, and palmar subluxation or the loss of joint congruity of the distal interphalangeal joint. Using the Wehbé and Scheider classification there were 27 type IB, 19 type IIB, 17 type IA, and 2 type IIA fractures. According to the Crawford rating system there were 46% excellent, 32% good, 20% fair and 2% poor results. We believe that this technique, when properly applied, produces satisfactory results.

Variabilidad en los diagnósticos de una cohorte de reingresadores en las dos últimas décadas / Diagnostic variability in a cohort of patients with multiple admissions in the last two decades

Introducción. Investigar posibles cambios en el patrón de ingresos en relación con mejoras en la asistencia psiquiátrica y si existe variabilidad en los diagnósticos en un grupo de pacientes reingresadores durante su período de seguimiento. Material y métodos. Del total de pacientes psiquiátricos hospitalizados entre 1983-2000 se selecciona un grupo de 59 que ingresaron al menos 10 veces. Revisando las historias clínicas analizamos las siguientes variables: diagnóstico psiquiátrico principal (basándonos en el sistema DSM-IV) y cambio diagnóstico como principales variables y período, densidad de ingresos, intervalo sin ingresos y cierre como variables derivadas. Pruebas estadísticas: análisis no paramétrico de la varianza de Friedman para muestras relacionadas, chi2 de Pearson y gráficas secuenciales. Resultados y discusión. La mejoría progresiva de la asistencia psiquiátrica en la provincia probablemente explicaría la disminución del número de pacientes reingresadores hasta su desaparición en el último año. Las variables relacionadas con diagnósticos en los ejes I y II (DSM-IV) presentan variaciones importantes en los sucesivos ingresos. Los problemas psicosociales y ambientales se acumularían a lo largo de los ingresos y el nivel de actividad global tendería a mejorar en función de los años que se lleve ingresando. Encontramos que esta población de pacientes se componía de tres subgrupos susceptibles de un abordaje terapéutico diferente (AU)

Pacientes con ingresos múltiples en una Unidad de Hospitalización Psiquiátrica de Hospital General: variabilidad y relaciones dentro del grupo / Patients with multiple hospitalization in a Psiquiatric Hospitalization Unit in a General Hospital: variability and relationship in the group

Objetivo: En un trabajo previo definimos (1) algunas características de pacientes con múltiples ingresos en nuestra Unidad de Hospitalización Psiquiátrica. Con el presente estudio hemos pretendido ampliar el conocimiento de estos pacientes, analizando en ese mismo grupo la relación entre diversas variables (edad, sexo, diagnóstico, actividad global, etc.) especialmente con el número de ingresos y el tiempo empleado en completarlos. Material y métodos: Cincuenta y nueve pacientes con diez o más ingresos en un periodo de dieciocho años. Pruebas estadísticas básicas de correlación, comparación de medias, frecuencias y porcentajes. Resultados y discusión: El tiempo en completar los ingresos (no el número de éstos) se pudo relacionar con el deterioro de la actividad global y los cambios de diagnósticos. A mayor edad al primer ingreso, mayor frecuencia de reingresos y estancias más largas, pero también evoluciones más favorables. Entre las mujeres se observó una mayor variabilidad en diagnósticos y patología más compleja (AU)

¿Cómo son los pacientes reingresadores? Un estudio descriptivo en Psiquiatría de Hospital General / How are the readmited patients? A psichiatric descriptive study in a General Hospital

Objetivo: Describir las características de los pacientes que reingresan repetidamente en una Unidad de Hospitalización Psiquiátrica de Hospital General.Material y métodos: Del total de pacientes psiquiátricos hospitalizados entre 1983 y 2000, se seleccionan los que ingresaron al menos 10 veces. Se describen algunas variables socio-demográficas y clínicas, comparándolas con las de la muestra total de la que proceden.Resultados y discusión: Cincuenta y nueve pacientes (1,3 por ciento del total) ingresaron diez o más veces en el periodo estudiado, sumando 789 ingresos (9 por ciento del total). Este grupo se caracteriza por una media de edad al primer ingreso mucho menor; sexo predominantemente femenino; cumplimiento de los ingresos en tiempos variables; estancia media más alta; diagnóstico más frecuente de trastornos afectivos y psicóticos; porcentaje más elevado de trastornos de personalidad y de problemas psico-sociales y ambientales, y nivel de funcionamiento o actividad global al ingreso, mucho menor que la muestra general de pacientes psiquiátricos. (AU)

Hepatitis aguda por candesartan / Acute hepatitis induced by candesartan

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[Genetic analysis and relationship to pathogenicity in Botrytis cinerea]. / Análisis genético y relación con patogenicidad en Botrytis cinerea.

Botrytis cinerea is a plant-pathogenic fungus that produces the disease known as grey mould in a wide variety of agriculturally important hosts in many countries. Ten strains from different locations collected on different years have been isolated and characterized by several methods (morphological, biochemical, genetical and molecular). Results showed that clear morphological differences exist between strains, and showing a relationship between the presence of sclerotia and pathogenicity. The conidial size and the nuclear number were highly variable between different strains. Pulsed-field gel electrophoresis showed a unique karyotype for each strain, highly polymorphic between strains and with a number of bands ranging from 4 to 8. An efficient transformation system has been achieved through the plasmid pAMPF21, containing the region AMA1 of Aspergillus nidulans. Lastly, from a genomic library the gdhA gene has been cloned. This gene produces an RNAm of 1.7 Kb and complements the deficiency on glutamate dehydrogenase activity of A. nidulans.

Astroglial differentiation of cortical precursor cells triggered by activation of the cAMP-dependent signaling pathway.

In the developing brain, differentiation of neural precursors into neurons or glial cells occurs in response to neurotrophic factors acting on the cell surface. Intracellular signaling mechanisms that relay information to initiate differentiative responses of neural precursor cells are poorly understood. To investigate whether stimulation of the cAMP-dependent signaling pathway participates in differentiative responses of cells in the developing CNS, we performed experiments using both conditionally immortalized neural precursor cells (RC2.E10 cells) and primary cultures of cells from developing rat cortex. Initially, we determined that RC2.E10 cells retain phenotypic features of neural precursors after inactivation of the immortalizing oncogene, a temperature-sensitive mutant of the simian virus 40 large-T antigen (SV40T). We found that, once SV40T is inactivated, RC2.E10 cells cease to divide and die. However, RC2. E10 cells can proliferate in the presence of basic fibroblast growth factor. In addition, they express nestin, a marker of neural precursor cells. Both RC2.E10 cells and primary cortical precursor cells undergo astroglial differentiation in response to cAMP stimulation by treatment with 8-bromo-cAMP. In both cases, cAMP-induced astrocyte differentiation is characterized by morphological changes, stimulation of glial fibrillary acidic protein expression, downregulation of nestin expression, and decreased proliferation. No increases in the expression of neuronal or oligodendrocytic markers were observed. Our results support the notion that the developing CNS contains neural precursor cells with the capacity of undergoing astrocyte differentiation in response to increased intracellular cAMP concentrations.

Effects of visnadine on rat isolated vascular smooth muscles.

Visnadine, an active principle extracted from the fruit of Ammi visnaga, exhibits peripheral and coronary vasodilator activities and has been used for the treatment of angina pectoris. The present study was undertaken to further characterize the inhibitory effects of visnadine on the contractile responses in rat isolated aortic rings and portal vein segments. Visnadine (< 10(-5) M) selectively inhibited the contractions induced by depolarization with 80 mM KCl or by CaCl2 in KCl-depolarized aorta and the spontaneous activity of the portal vein. Its inhibitory effects were not increased as the time of depolarization was prolonged and were similar in aorta incubated in 5 or 40 mM KCl. At concentrations higher than 10(-5) M, visnadine also inhibited the contractile responses induced by noradrenaline and phorbol 12-myristate 13-acetate (PMA), being equipotent to inhibit noradrenaline-induced contractions in either Ca(2+)-containing or Ca(2+)-free medium and PMA-induced contractions. In conclusion, the present results suggest that visnadine preferentially inhibited the contractile responses mediated by Ca2+ entry through L-type Ca2+ channels, whereas at high concentrations it may also interfere with other sites involved in vascular smooth muscle contraction.

An autonomously replicating plasmid transforms Botrytis cinerea to phleomycin resistance.

A transformation system has been developed for the pathogen fungus Botrytis cinerea, based on the utilization of the wide host plasmid pUT737 that contains the Sh ble gene, conferring resistance to phleomycin. Transformed protoplasts were regenerated at 10-25 micrograms ml(-1) of phleomycin, at a frequency of 25-40 transformants per microgram of DNA, and they were resistant up to 50 micrograms ml(-1). Southern hybridization using undigested and digested total DNA showed the presence of circular autonomously replicating plasmid pUT737 in the transformants. Reisolated plasmid from transformed fungus transformed E. coli and rescued plasmid was identified as PUT737. Transformants were grown for four generations under non-selective conditions and replicative plasmids were still detected. Plasmids present in all transformants at this stage had been modified from native pUT737 and showed the same size and configuration indicating that selection through stabilizing plasmid forms has happened.