Similar outcomes after newly implemented rats approach compared to standard vats for anatomical lung resection. A propensity-score matched analysis / Resultados similares de un abordaje robótico (RATS) recientemente implementado comparado con un abordaje VATS convencional para resecciones pulmonares anatómicas: análisis de datos emparejados por puntuación de propensión

Introduction Outcomes after the introduction of surgical innovations can be impaired by learning periods. The aim of this study is to compare the short-term outcomes of a recently implemented RATS approach to a standard VATS program for anatomical lung resections. Methods Retrospective review of consecutive patients undergoing pulmonary anatomical resection through a minimally invasive approach since RATS approach was applied in our department (June 01, 2018, to November 30, 2019). Propensity score matching was performed according to patients’ age, gender, ppoFEV1, cardiac comorbidity, type of malignancy, and type of resection. Outcome evaluation includes: overall morbidity, significant complications (cardiac arrhythmia, pneumonia, prolonged air leak, and reoperation), 30-day mortality, and length of hospital stay. Data were compared by two-sided chi-square or Fisher's exact test for categorical and Mann–Whitney U test for continuous variables. Results A total of 273 patients (206 VATS, 67 RATS) were included in the study. After propensity score matching, data of 132 patients were analyzed. The thirty-days mortality was nil. Overall morbidity (RATS: 22.4%, VATS: 29.2%; p=0.369), major complications (RATS: 9% vs VATS: 9.2%; p=0.956) and the rates of specific major complications (cardiac arrhythmia RATS: 4.5%, VATS: 4.6%, p=1; pneumonia RATS:0%, VATS:4.6%, p=0.117; prolonged air leak RATS: 7.5%; VATS: 4.6%, p=0.718) and reoperation (RATS: 3%, VATS: 1.5%, p=1) were comparable between both groups. The median length of stay was 3 days in both groups (p=0.101) (AU)

Introducción La introducción de innovaciones quirúrgicas se asocia con períodos de aprendizaje que pueden afectar a los resultados. El objetivo de este estudio es comparar los resultados postoperatorios de un abordaje RATS para resecciones pulmonares anatómicas implementado recientemente frente a los de un abordaje VATS convencional. Métodos Revisión retrospectiva de los pacientes sometidos a resección pulmonar anatómica mediante un abordaje mínimamente invasivo en nuestro centro desde el inicio del programa de cirugía RATS (junio de 2018) hasta noviembre de 2019. Los pacientes fueron emparejados por puntuación de propensión según variables de riesgo. Los resultados analizados fueron: morbilidad global, complicaciones (mayores, arritmia, neumonía, fuga aérea prolongada y reintervención), mortalidad a los 30 días y estancia hospitalaria. Los datos se compararon mediante la prueba de chi-cuadrado o la exacta de Fisher para variables categóricas y la prueba de U de Mann-Whitney para variables continuas. Resultados Se incluyeron en el estudio 273 pacientes (206 VATS, 67 RATS). Tras el emparejamiento, se analizaron los datos de 132 pacientes. La mortalidad a los 30 días fue nula. La morbilidad global (RATS: 22,4%, VATS: 29,2%; p=0,369), complicaciones mayores (RATS: 9%, VATS: 9,2%; p=0,956), arritmia (RATS: 4,5%, VATS: 4,6%, p=1); neumonía (RATS: 0%, VATS: 4,6%, p=0,117); fuga aérea prolongada (RATS: 7,5%; VATS: 4,6%, p=0,718) y reintervención (RATS: 3%, VATS: 1,5%, p=1) fueron comparables entre ambos grupos. La mediana de la estancia hospitalaria fue de 3 días en ambos grupos (p=0,101). Conclusiones Un programa RATS para resecciones pulmonares anatómicas puede implementarse de manera segura por cirujanos experimentados en VATS sin aumentar los índices de morbilidad (AU)

La Relación médico paciente y algunos aspectos transculturales de salud y enfermedad / Doctor patient comunication and transcultural aspects of health and disease

La orientación científica de la medicina ha sido determinante en el progreso que ha alcanzado, pero la consideración de la persona, la unificación del sujeto en el objeto, es fundamental en la clínica, en el acto médico. Necesitamos una antro-pología médica en la que lo principal es la relación entre ambas, enfermedad y enfermo, que puedan distinguirse, compararse y ser posible, que cada una de las dos funciones relacionadas se unifiquen en un punto medio.El entendimiento entre paciente y médico pueden verse perturbado por malen-tendidos del lenguaje y del bagaje cultural, así como exigimos al paciente que notifique con claridad sobre su enfermedad, el médico quien tiene la mayor res-ponsabilidad en la relación con el enfermo debe preocuparse, a su vez, de notifi-car claramente al paciente de su acontecer, de su diagnóstico y de su pronóstico. Así lo destaca Victor von Weizsacker que expresa claramente la orientación que significa la Antropología Médica, "El hombre es un objeto que contiene un sujeto, y este no está por fuera de los dominios de la ciencia, sino que pertenece a la misma".

The scientific direction of the medicine has been determining in the progress that has reached, but the consideration of the person, the unification of the subject in the object, is fundamental in the clinic, the medical act. We needed a medical anthropology in which the main thing is the relation between both, disease and patient, that they can be distinguished, be compared and to be possible, that each one of the two related functions is unified in a midpoint. The understanding between patient and doctor can be seen disturbed by misun-derstanding of the language and the cultural baggage, as well as we demanded the patient who notifies with clarity on his disease, the doctor that has the great-er responsibility in the relation with the patient must worry, as well, to notify clearly to the patient of his to occur, its diagnosis and its prognosis. Thus it honors Victor von Weizsacker that expresses clearly the direction that means the Medical Anthropology, "the man is an object that contains a subject, and this it is not in favor of outside the dominions of science, but that belongs to the same one".

Inbreeding in Southeastern Spain : The Impact of Geography and Demography on Marital Mobility and Marital Distance Patterns (1900-1969).

In this paper, the structure of a southeastern Spanish population was studied for the first time with respect to its inbreeding patterns and its relationship with demographic and geographic factors. Data on consanguineous marriages (up to second cousins) from 1900 to 1969 were taken from ecclesiastic dispensations. Our results confirm that the patterns and trends of inbreeding in the study area are consistent with those previously observed in most non-Cantabrian Spanish populations. The rate of consanguineous marriages was apparently stable between 1900 and 1935 and then sharply decreased since 1940, which coincides with industrialization in Spain. A marked departure from Hardy-Weinberg expectations (0.25) in the ratio of first cousin (M22) to second cousin (M33) marriages in the study population (0.88) was observed. The high levels of endogamy (>80%) and its significant steadiness throughout the twentieth century is noteworthy. Accordingly, our results show that exogamous marriages were not only poorly represented but also that this reduced mobility (<6 km) suggests that the choice of a mate was preferentially local. We found higher mobility in M22 with respect to M33 cousin mating. The relationships between population size and consanguinity rates and inbreeding fit power-law distributions. A significant positive correlation was observed between inbreeding and elevation. Many Spanish populations have experienced a prolonged and considerable isolation across generations, which has led to high proportions of historical and local endogamy that is associated, in general, with high [Formula: see text] values. Thus, assessing genomic inbreeding using runs of homozygosity (ROH) in current Spanish populations could be an additional pertinent strategy for obtaining a more refined perspective regarding the population history inferred from the extent and frequency of ROH regions.

A new genus and species of Delphacini (Hemiptera: Fulgoroidea: Delphacidae) from Argentina.

A new genus of Delphacini is described from Argentina, Pyrophagus Remes Lenicov gen. n., with one new species, P. tigrinus Remes Lenicov & Varela sp. n. The new species, distributing over a wide cultivated area of Northwestern and Central Argentina and recently confirmed as a vector of MRCV (Rio Cuarto maize virus) in experimental conditions, is one of the most frequently found delphacid species on wheat, oat, maize, triticale, rye, barley and wild Gramineae. The main diagnostic features of the new genus and species are described and illustrated, and information on the host plants, geographical distribution and vector capacity of the new species is provided. 

Empleo de la espirometría incentiva en el análisis de la función pulmonar y la predicción de complicaciones postoperatorias en cirugía torácica / Incentive spirometry in lung function analysisi and prediction of postoperative complications in thoraci surgery

INTRODUCCIÓN: La disminución de la función pulmonar tras la cirugía torácica se involucra en la etiología de las complicaciones respiratorias. Concretamente, el FEV1 y la morbimortalidad postoperatorios se relacionan inversamente. La medición del FEV1 durante el postoperatorio requiere una dotación tecnológica no disponible en la mayoría de las unidades de Cirugía Torácica. La espirometría incentiva es un método sencillo y ampliamente utilizado en este periodo perioperatorio. OBJETIVOS: Cuantificar la correlación entre los resultados del la espirometría incentiva y del FEV1 durante el día preoperatorio y los siguientes días a la intervención, en los pacientes sometidos a intervenciones torácicas. MATERIAL Y MÉTODOS: Estudio prospectivo durante 6 meses de pacientes sometidos a intervenciones programadas mediante técnicas de toracotomía, toracotomía vídeo asistida, videotoracoscopia (VATS) y esternotomía. Recogida de los valores de volumen inspiratorio máximo mediante espirometría incentiva y de FEV1 empleando espirometría forzada durante el día prey postoperatorios hasta el alta. RESULTADOS: De los 74 pacientes estudiados se obtuvieron las mediciones en 56 hombres y 7 mujeres, edad media 58+16 años. El 57% se intervino mediante toracotomías, el 25% con toracotomías vídeo asistidas, 13% VATS y 5% esternotomías. 43 sujetos fueron sometidos a cirugía de resección pulmonar (8 neumonectomías, 19 lobectomías y 16 segmentectomías). La estancia media alcanzó los 5 + 3 días, ingresando todos el día previo a la cirugía. Se obtuvo un coeficiente de correlación de 0,719 (p = 0,0005). CONCLUSIONES: Existe una correlación lineal significativa entre los valores de volumen inspiratorio máximo y de FEV1 en los pacientes sometidos a intervenciones de Cirugía Torácica

INTRODUCTION: Decreased lung function following thoracic surgery is involved in the etiology of respiratory complications. Specifically, FEV1 and postoperative morbidity and mortality are related inversely. Measuring postoperative FEV1 requires technological equipment not available in most units of Thoracic Surgery. The incentive spirometry is a simple and widely method used in the perioperative period. OBJECTIVES: To quantify the correlation between the results of the incentive spirometry and FEV1 during the preoperative day and the days following surgery, in patients undergoing thoracic surgery. MATERIAL AND METHODS. A prospective study of patients undergoing thoracic surgery techniques (video assisted thoracotomy, video-assisted thoracoscopy (VATS) and sternotomy) were included. Collecting values encourages maximum inspiratory volume by using spirometry and spirometry FEV1 during the pre and postoperative day until discharge. Follow-up 6 months. RESULTS: 74 patients were included (56 men and 7 women), mean age 58 +16 years were obtained. 57% were operated by thoracotomy, 25% with video assisted thoracotomy, VATS 13%, and 5 % sternotomy. 43 subjects underwent lung resection surgery (8 pneumonectomies, 19 lobectomies and 16 segmentectomies). The average stay reached 5 +3 days, starting the hospital stay the day before surgery. A correlation coefficient of 0.719 (p = 0.0005) was obtained. CONCLUSIONS: there is a significant linear correlation between the values of maximum inspiratory volume and FEV1 in patients undergoing thoracic surgery interventions

N alpha methyl histamine versus propranolol in migraine prophylaxis.

OBJECTIVES: To compare the efficacy and tolerability of the subcutaneous administration of N alpha methyl histamine versus oral propranolol in the treatment of migraine prophylaxis. BACKGROUND: N alpha methyl histamine has a selective affinity for H3 receptors and could constitute a new therapeutic drug in migraine prophylaxis. METHODS: Sixty patients with migraine were selected and enrolled in a 12-week double-blind controlled clinical trial to evaluate the efficacy of subcutaneous administration of N-alpha methyl histamine (1 to 3 ug twice a week ) n=30, compared to administration of 120 mg/day of oral propranolol n=30. the variables were: headache intensity, frequency of attacks, duration of migraine attacks and analgesic intake. RESULTS: fifty five patients completed the study. the data collected during the 4th week of treatment revealed that N alpha methyl histamine and propranolol caused a significantly (p<0.01) greater reduction between the basal values and final values of every variable studied. CONCLUSIONS: Both N alpha methyl histamine and propranolol are similarly effective in reducing or eliminating the headache in migraine prophylaxis. low doses of N-alpha methyl histamine injected subcutaneously may represent a novel and effective therapeutic alternative in migraine patients and may lay the clinical and pharmacological groundwork for the use of H3 receptor agonist in migraine prophylaxis.

Entomofauna of a buried body: study of the exhumation of a human cadaver in Buenos Aires, Argentina.

This study focuses on insects and other arthropods sampled on the exhumation of an infant skeleton belonging to 'Prof. Dr. Rómulo Lambre' skeletal collection. The body was buried in soil inside a wooden coffin in a grave 40cm deep, in autumn, and stored in the cemetery deposit after exhumation. Death records were obtained from the cemetery archive. Samples of faunal remains were recovered from wrappings, clothes, bones and soil samples, and were identified at different taxonomic levels depending on the stage of conservation. The dominant taxon was the muscid fly Ophyra aenescens (Wiedemann). The relationships among the identified taxa and the moving of the corpse, from the burial context to the cemetery deposit, are discussed and used to create a hypothetical colonization sequence after death. The application of entomological data to anthropological research can provide valuable information for the interpretation of taphonomic processes and burial contexts.

Caregivers of Alzheimer's patients and factors influencing institutionalization of loved ones: some considerations on existing literature.

BACKGROUND: Informal caring or caregiving is very common in our postindustrial society. Caregiving burden grows with the worsening of cognitive impairment of the patient and is one of the factors influencing institutionalization. Alzheimer's disease (AD) is a type of dementia that is chronic and deteriorative. The symptoms of this neuropsychiatric disorder generally begin to manifest after the age of sixty and currently 8.9 million family caregivers provide assistance to someone with AD or a related dementia. As the patient's condition worsens, it increases the burden on the caregivers, due to the physical, psychological, and emotional stresses that result from caring for the patient. METHODS: A search of the literature was conducted on electronic database: PubMed, Google Scholar, Science direct, CINAHL in a exploratory way. Inclusion criteria were: articles in English and Italian published between 1999-2011 which mentioned Alzheimer's caregivers, burden, stressors, and institutionalization. The exclusion criterion was failure to mention the word "caregivers". About 100 titles were found and 30 articles abstracts with key words in the title were reviewed. Of the 30 articles selected for further review based on the relevance to the study purpose, 17 articles were finally selected for inclusion in this literature review. RESULTS: Results display that caregiver burden is influenced by patient behavioral and cognitive status, hours involved in care, stress, social isolation, gender, relationship to the patient, availability of support resources, and caregiver characteristics. Assessment tools available to assess and recognize risk factors and burden in caregivers are useful both in terms of caregivers health and decision on istitutionalization. CONCLUSION: Literature suggests to provide information for health care providers to reduce burden and support caregiver health and well-being. Assessment tools available to assess and recognize risk factors and burden in caregivers should be used more often to contribute to reducing caregiver stress and the impact of institutionalization.

Influencia de la formación impartida en las Facultades de Medicina en las aptitudes y actitudes de sus alumnos en tabaquismo / Influence of training given in the medical schools in the appitudes and attitudes of their students regarding the smoking habit

Objetivo. Conocer aptitudes y actitudes sobre el tabaquismo en alumnos de Medicina y valorar la formación adquirida. Métodos. Estudio transversal realizado a estudiantes de medicina durante el curso 2010-2011 utilizando un cuestionario validado, anónimo y autoaplicado. Resultados. El 36% fuman: el 18,7% los fines de semana y el 17,3% a diario, con un consumo medio de 2,08 cigarrillos/día. Han intentado dejar de fumar el 29,3% de los fumadores y desean hacerlo el 28,3% de los alumnos fumadores. Existen diferencias significativas entre los alumnos de primero y sexto en la valoración del tabaquismo como drogodependencia y enfermedad crónica y también en el conocimiento de las enfermedades relacionadas con el tabaco (p< 0,005). El análisis bivariante y multivariante indican que la mayor formación de los alumnos de sexto se relaciona significativamente con un mayor conocimiento de las enfermedades asociadas al tabaco. En relación con el diagnóstico y tratamiento, existen diferencias significativas entre los alumnos de primero y sexto en todos los ítems (p< 0,005). Las tres variables asociadas con los conocimientos adquiridos son la capacidad de recoger en la historia el consumo de tabaco, el conocimiento de los métodos de diagnóstico y del tratamiento multicomponente. Conclusiones. Los resultados muestran que a mayor conocimiento, se asocia mayor competencia profesional en la cumplimentación de la historia clínica y mayor capacidad de intervención (AU)

Objective. To study aptitudes and attitudes with regard to smoking in medical students and evaluate the education received throughout the course of the academic studies. Methods. A cross-sectional study of medical students during the academic year of 2010-2011 using a validated questionnaire, anonymous and completed individually. Results. 36% smoke: 18.7% on weekends and 17.3% daily, with an average consumption of 2.08 cigarettes/ day. 29.3% of smokers have tried to quit smoking and 28.3% of students wish to quit smoking. There are significant differences between students ofthe first and the sixth year in the valuation of smoking and the related drug dependence and also in the knowledge of diseases related to tobacco (p <0.005). The bivariate and multivariate analyses indicate that the higher level of professional education of the 6th year students is significantly related to greater knowledge of the diseases associated with smoking. With regard to diagnosis and treatment there are significant differences between students of the first and the sixth year on all items (p <0.005). The three variables associated with the acquired knowledge consist of the ability to collect data related to smoking in the anamnesis, knowledge of methods of diagnosis and tobacco treatment. Conclusions. The results show that the greater knowledge is associated with greater professional expertise in the completion of the clinical history and greater knowledge of medical intervention (AU)

Feasibility, safety, and preliminary proof of principles of autologous neural stem cell treatment combined with T-cell vaccination for ALS patients.

Uncontrolled activation of the innate immune system promotes the deterioration of neurons in different neurodegenerative diseases, including amyotrophic lateral sclerosis (ALS). T-cell vaccination (TCV) was developed by Irun Cohen and coworkers at the Weizmann Institute of Science (Israel) during the late 1970s and has been demonstrated to be an effective treatment for human autoimmune diseases and a regulator of macrophage activation in animal models. We treated seven ALS patients with this cell therapy and were able to slow or stop disease progression in the affected individuals. The median survival, which is 3.5 years, was extended to 6 years. They were also treated with autologous adult neural stem cells associated with effector T cells. The observed neurologic improvements after treatment lasted for at least 1 year. Clinical recovery in the treated ALS patients was confirmed by an independent, skilled neurologist using the ALS Functional Rating Scale-Revised (ALSFRS-R). TCV in conjunction with an autologous neural stem cell treatment might be a feasible, minimally invasive, safe, and effective approach to obtain enduring therapeutic effects in ALS patients.

Radiotherapy issues in non-small cell lung cancer: radiotherapy versus surgery in the treatment of early stage.

We discussed in this article about the role of surgery, in a broad sense, and radiotherapy for the treatment of early stage of non-small cell lung cancer (NSCLC), and we also examined if patients' outcomes after radiation therapy are comparable to the ones after surgery. Radiotherapy is at present a less attractive alternative to surgery in operable patients with early stage of NSCLC. Indeed, radiotherapy is frequently reserved for patients who are deemed unfit for surgery due to poor pulmonary function or other comorbidities. This introduces a large patient selection bias compared to surgery, rendering overall survival less suitable for comparison. When we compare patients who are deemed operable but refuse surgery, the 5-year overall survival rate observed, after a high effective dose, is equivalent to the outcome after surgery. On the other hand, it is difficult to enroll patients in randomized clinical trials for this purpose, propensity matched analysis allows to compares the effectiveness of radiotherapy and surgery using comparable series of patients, using this methodology two studies obtained similar results. This data support the need of continuous investigation for non-surgical alternatives in this disease, radiotherapy can be a good option. Until then, surgery remains the treatment of choice for early stage of NSCLC.

Efecto del consumo de harina de maíz fortificada con acido fólico sobre los niveles de folatos sanguíneos en mujeres de edad fértil / Effect of fortified flour consumption on blood folate levels in women of childbearing age

Fortification of foods is now widely used to prevent folate deficiency. Folic acid has been added to corn flour and its efficacy in the prevention of NTD has been proved. The aim of this study was to compare the effect of the intake of fortified corn-flour versus non fortified flour and to folic acid supplement, on blood folate levels in women of childbearing age. Forty-five women were randomized into three groups according to: (A) use of fortified flour (n=18), (B) non-fortified flour (n=17); (C) supplementation with 5 mg of oralfolic acid (n=10). All females answer a dietary and anthropometric questionnaire applied once a month during three months. Blood red cell (IE) and plasmatic (P) folate were measured at the beginning and at the end of the study; also the DNA analysis for the 677T mutation was performed. The corn flour was provided to groups A and B during three months, to be consumed as eight tortillas daily. Group C received 5.0 mg tablet of folic acid (Valdecasas®), once per week, during three months. IE and P folate and hematocrito were significantly increased in women from group C (p<0.05). Only plasmatic folic acid levels were significantly increased in women from groups A and B. Genotype distribution was: 15.6 percent homozygous TT, 42.2 percent C/C and 42.2 percent CT. Weekly administration of 5.0 mg of folic acid is an effective way to increase blood folate levels and shows to be more efficient than fortified corn flour.

La fortificación de alimentos con ácido fólico puede ser efectiva en la prevención de los defectos del tubo neural, aunque no existen estudios que demuestren la eficacia de esta medida en la harina de maíz. El objetivo del estudio fue evaluar el efecto del consumo de harina de maíz vitaminada sobre los niveles de folatos sanguíneos, en comparación con la suplementación oral. Se incluyeron 45 mujeres en edad fértil aleatorizadas en tres grupos; grupo A (n=18) harina vitaminada, grupo B (n=17) harina sin vitaminas, grupo C (n=10) suplemento oral 5.0 mg de ácido fólico una vez por semana, durante tres meses. A las participantes se les aplicó una encuesta nutricional y se les midió por radioinmunoensayo el folato intraeritrocitario (FIE) y plasmático (FP) al inicio y final del estudio y se determinó la presencia del polimorfismo C677T del gen MTHFR. En las mujeres con suplemento oral los niveles FIE y FP y el hematocrito se incrementaron significativamente (p< 0.05), mientras que en los grupos A y B se registró un incremento significativo en los valores de FP pero no IE ni hematocrito. La ingesta de otras fuentes de ácido fólico se incrementó significativamente en los grupos A y B. El 15.6 por ciento de las mujeres fueron homocigotas TT, 42.2 por ciento homocigotas CC y 42.2 por ciento heterocigotas CT. La administración de 5 mg de ácido fólico por semana es una medida más eficiente que la ingesta de harina de maíz vitaminada para elevar los niveles de folatos.

Bacterial pathogens associated with bloody diarrhea in Uruguayan children.

Diarrheal disease continues to be a serious health problem, especially in developing countries. Bloody diarrhea represents approximately 20-30% of all cases and has higher morbidity and mortality. Treatment with antibiotics is beneficial in cases of Shigella, Campylobacter, Yersinia and Salmonella infection, principally in those children with a higher risk of invasive disease. The aims of this study were to detect the bacterial agents associated with bloody diarrhea in children and to determine their antimicrobial susceptibility patterns. Between June 2001 and January 2008, 249 children with bloody diarrhea were studied. Shigella and Shiga toxin-producing Escherichia coli (STEC) were recovered from 48 (19.3%) and 3 (1.2%) of the total of cases, respectively. In 49 out of 249 children, in whom other enteropathogens were investigated, we recovered Campylobacter jejuni from 7 children (14.3%), Salmonella spp. from 2 (4.1%) and Aeromonas spp. from 1 (2%) in addition to Shigella from 7 children (14.3%). Thirty-four (70%) Shigella isolates showed resistance to ampicillin and 13 (27%) to trimethoprim-sulfamethoxazole. All Shigella isolates were susceptible to nalidixic acid, ciprofloxacin and ceftriaxone. Salmonella and STEC isolates were susceptible to all antibiotics assayed. Thus, the use of trimethoprim-sulfamethoxazole or ampicillin would not be appropriate for the empirical treatment of Shigella - associated diarrhea.

Lessons learned from the European thoracic surgery database: the Composite Performance Score.

BACKGROUND: This study reports the methods used to review the Composite Performance Score (CPS) along with a reference table, which will be used in the upcoming ESTS Quality Certification Program. METHODS: Data from 4303 patients who underwent pulmonary resection (July 2007-January 2010) were captured in the ESTS database and used for the present analysis. Only patients submitted from units contributing at least 100 consecutive lung resections were used for developing the score. According to the best available evidence the following measures were selected for each surgical domain: preoperative care (1. % of DLCO measurement in patients submitted to major anatomic resections; 2. % of preoperative invasive mediastinal staging in patients with clinically suspicious N2 disease), operative care (% of systematic lymph node dissection), outcomes (risk-adjusted cardiopulmonary morbidity and mortality rates). Morbidity and mortality risk-models were developed by logistic regression and validated by bootstrap analyses. Individual processes and outcomes scores were rescaled according to their standard deviations and summed to generate the CPS. Units were rated accordingly and a percentile reference table was produced. RESULTS: Risk-adjusted survival and absence of morbidity rates varied from 91.5% to 100%, and from 50.2% to 97.5%, respectively. CPS ranged from -4.038 to 1.24. The 50% percentile of CPS corresponded to 0.404. CONCLUSIONS: A revised Composite Performance Score was developed and a reference table presented to be used as a benchmark for the ESTS Quality Certification program.

Comparativa de las Ingestas Dietéticas de Referencia (IDR) de los diferentes países de la Unión Europea, de Estados Unidos (EEUU) y de la Organización Mundial de la Salud (OMS) / Comparison of dietary reference intakes (DRI) between different countries of the European Union, The United States and the world health organization

Antecedentes: En España, existen varios organismos y sociedades científicas que han editado sus propios de valores de referencia sobre la ingesta recomendada de nutrientes, que no siempre coinciden en los contenidos y formas presentadas. Objetivo: Revisar los conceptos, datos y la metodología que han seguido otros países o grupos de países para obtener y documentar sus propios Valores de Referencia, con objeto de ofrecer una información básica que facilite el establecimiento de los valores de referencia que mejor puedan adaptarse a la población española, en base a la mejor evidencia científica disponible en la actualidad. Ámbito: Revisión de la información disponible en los distintos países (o grupos de países) de la Unión Europea, Estados Unidos y la Organización Mundial de la Salud. Los datos estudiados corresponden a poblaciones sanas. Conclusiones: Las ingestas de referencia difieren notablemente entre los distintos países estudiados en cuanto a grupos de población, tipo de nutrientes incluidos, metodología y periodicidad de las revisiones publicadas. Sin embargo, la mayoría definen de manera semejante los conceptos más importantes, aunque tengan distintas denominaciones en cada país. Por otro lado, en la mayoría de los casos estudiados existe un único organismo científico encargado de la publicación y actualización de los valores de ingestas dietéticas de referencia, no siendo así en España. En este contexto, parece conveniente alcanzar un acuerdo entre todos los organismos y sociedades científicas españolas implicadas en esta tarea, con objeto de establecer unos valores de referencia únicos para todo el país, con el consenso de todos (AU)

Background: In Spain, there are some organizations and scientific societies that have edited reference values of recommended nutrient intake, but whose data does not always agree in terms of format and content. Aims: To review the definitions, data and methodology that other countries or groups of countries have followed to obtain and document their own reference values in order to offer basic information to facilitate the establishment of the best reference values for the Spanish population. Field: Review of the available information in different countries (or groups of countries) from the European Union, the United States and World Health Organization. The analysed data concerned to healthy populations. Conclusions: Reference intakes differ among the examined countries according to population groups, included nutrients, methodology and frequency of published reviews. However, most of the countries define major concepts in the same way, although with different names in each country. On the other hand, most of the studied cases represent only a scientific organization in charge of the publication and update of the values of dietary reference intakes, but not in Spain. In that context, it looks convenient to reach a consensus among all Spanish organizations and scientific societies that are involved in this task, in order to establish an acceptable reference values (AU)

ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy).

A collaboration of multidisciplinary experts on the functional evaluation of lung cancer patients has been facilitated by the European Respiratory Society (ERS) and the European Society of Thoracic Surgery (ESTS), in order to draw up recommendations and provide clinicians with clear, up-to-date guidelines on fitness for surgery and chemo-radiotherapy. The subject was divided into different topics, which were then assigned to at least two experts. The authors searched the literature according to their own strategies, with no central literature review being performed. The draft reports written by the experts on each topic were reviewed, discussed and voted on by the entire expert panel. The evidence supporting each recommendation was summarised, and graded as described by the Scottish Intercollegiate Guidelines Network Grading Review Group. Clinical practice guidelines were generated and finalized in a functional algorithm for risk stratification of the lung resection candidates, emphasising cardiological evaluation, forced expiratory volume in 1 s, systematic carbon monoxide lung diffusion capacity and exercise testing. Contrary to lung resection, for which the scientific evidences are more robust, we were unable to recommend any specific test, cut-off value, or algorithm before chemo-radiotherapy due to the lack of data. We recommend that lung cancer patients should be managed in specialised settings by multidisciplinary teams.

Nuevos sistemas de drenaje torácico / No disponible

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Case report on the clinical results of a combined cellular therapy for chronic spinal cord injured patients.

OBJECTIVES: With the intention to ameliorate the clinical condition of patients with chronic spinal cord injury (SCI), a program that combines three cell therapies and an appropriate neurorehabilitation program were used to recreate and enhance the natural conditions of SCI repair. METHODS: Vascularization recovery is approached by selective artery infusion of BMMNCs (bone marrow mononuclear cells) to the disrupted area. Eighteen days later, with the aim to restore the specific inflammatory activity, an i.v. infusion of spinal cord specific ETCs (effector T cells) is carried out. With the intention of supplying cellular components for the process of repair, an infusion of autologous neural stem cells (NSCs) through selective feeding artery infusion is carried out, followed by an appropriate neurorehabilitation program. RESULTS: A total of eight ASIA (American Spinal Injury Association) A patients (five with jeopardized brachial plexus and three without) received the treatment. No severe adverse events was observed in any of the receptor patients: five patients evolved from ASIA A to ASIA D and regained the ability to stand up and, with varying effectiveness, to walk; two patients remained in the same condition, but exhibited motor and sensitive improvements; and one patient could not be evaluated. CONCLUSIONS: These reports suggest that the biological characteristics of acute SCI may be recreated in a comprehensive, safe and effective manner.

Brown Blotch Caused by Pseudomonas tolaasii on Cultivated Pleurotus eryngii in Spain.

In 2006, symptoms of brown blotch were observed on cultivated Pleurotus eryngii (king oyster mushroom) in Castilla-La Mancha (Spain). Subsequently, between January and May of 2008, brown blotch affected 39.75% of the blocks of substrate cultivated, resulting in a considerable loss of production. Symptoms observed were principally characterized by a yellowish brown-to-orangish color, first of the cap and then of the stalk. Some samples also showed a slightly concave cap. From samples collected from four different king oyster mushroom farms, a fluorescent gram-negative bacterium was recovered on King's B medium and identified as Pseudomonas tolaasii by the LOPAT scheme and other tests (2). The bacterium isolated had the following characteristics: oxidative, positive for oxidase and arginine dihydrolase, negative for levan production, pectinolitic activity on potato slices, and tobacco hypersensitivity. Results from other tests were as follows: negative for esculin hydrolysis and positive for gelatine, casein, and Tween 80 hydrolysis; mannitol, erythritol, sorbitol, m-inositol, and adonitol were used as a sole carbon source, but not sucrose, d-tartrate, or trigonelline. The white line test was performed (4) using P. reactans LPPA 540 and the presumptive isolates of P. tolaasii were positive. The gene encoding the 16S rRNA from two isolates (LPPA532 and LPPA533) was sequenced after PCR amplification (2) and their nucleotide sequences (1,400 bp; EMBL Accession No. FM864215 for LPPA 532) proved to be identical. The amplified sequences were compared with DNA sequences available in databases (GenBank, EMBL, DDBJ, and PDB) by using BLAST. An identity of 99% was obtained with 16S rDNA of three P. tolaasii strains (GenBank Accession Nos. AF320990, AF094750, and AF255336). Four isolates were selected for pathogenicity tests. Bacterial suspensions were grown for 16 h in yeast peptone glucose broth (approximately 108 CFU/ml) and were inoculated by puncture into 10 mushroom caps using sterilized wooden toothpicks (4). Sterilized distilled water was used as a control. These were then incubated at room temperature in glass dishes. Assays were conducted twice and the results were recorded after 10 days. The symptoms that developed after infection were similar to those observed in the crop, while the control mushrooms remained symptomless. Bacteria sharing the characteristics of the inoculated isolates were recovered from symptomatic caps. P. tolaasii has been described as causing brown blotch on Pleurotus eryngii (1,3), but to our knowledge, this is the first report of P. tolaasii causing brown blotch on Pleurotus eryngii in Spain. References: (1) J. F. Bradbury. No. 891 in: Descriptions of Pathogenic Fungi and Bacteria. CMI, Kew, Surrey, UK, 1987. (2) A. J. González et al. Appl. Environ. Microbiol. 69:2936, 2003. (3) A. Russo et al. Microbiol. Res. 158:265, 2003. (4) J. M. Wells et al. Phytopathology 86:1098, 1996.

Ascitis fetal transitoria: alerta al ultrasonografista / Prenatal diagnosis of isolated fetal ascites

We review our experience with the management and perinatal outcome in three cases of isolated fetal ascites detected prenatally at the San Camilo Hospital, San Felipe, Chile, in a period of seven years. Two cases were confirmed as being the result of meconium peritonitis and the remaining to a Klippel-Feil syndrome. We conclude that the detection of transient isolated fetal ascites warrants a close surveillance of the neonate looking for signs associated with intestinal rupture and non-chromosomal genetic syndromes.

Se presenta nuestra experiencia con el manejo y resultados perinatales de 3 casos de ascitis fetal aislados diagnosticados prenatalmente en el Hospital “San Camilo”, San Felipe, durante un período de 7 años. Dos casos correspondieron a peritonitis meconial y uno a un síndrome de Klippel-Feil. Se concluye que la detección de ascitis fetal aislada, aunque sea transitoria, obliga a realizar una observación acuciosa de la evolución neonatal, ya que puede ser el único indicio prenatal de una perforación intestinal o algún síndrome genético no cromosómico.