15-Lipoxygenase promotes resolution of inflammation in lymphedema by controlling Treg cell function through IFN-ß.

Lymphedema (LD) is characterized by the accumulation of interstitial fluid, lipids and inflammatory cell infiltrate in the limb. Here, we find that LD tissues from women who developed LD after breast cancer exhibit an inflamed gene expression profile. Lipidomic analysis reveals decrease in specialized pro-resolving mediators (SPM) generated by the 15-lipoxygenase (15-LO) in LD. In mice, the loss of SPM is associated with an increase in apoptotic regulatory T (Treg) cell number. In addition, the selective depletion of 15-LO in the lymphatic endothelium induces an aggravation of LD that can be rescued by Treg cell adoptive transfer or ALOX15-expressing lentivector injections. Mechanistically, exogenous injections of the pro-resolving cytokine IFN-ß restores both 15-LO expression and Treg cell number in a mouse model of LD. These results provide evidence that lymphatic 15-LO may represent a therapeutic target for LD by serving as a mediator of Treg cell populations to resolve inflammation.

[Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention]. / Comentario del CEIPV a las nuevas Guías Europeas de Prevención Cardiovascular 2021.

Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention. We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease (CVD) prevention in clinical practice. The current guidelines besides the individual approach greatly emphasize on the importance of population level approaches to the prevention of cardiovascular diseases. Systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. Regarding LDL-Cholesterol, blood pressure, and glycemic control in patients with diabetes mellitus, goals and targets remain as recommended in previous guidelines. However, it is proposed a new, stepwise approach (Step 1 and 2) to treatment intensification as a tool to help physicians and patients pursue these targets in a way that fits patient profile. After Step 1, considering proceeding to the intensified goals of Step 2 is mandatory, and this intensification will be based on 10-year CVD risk, lifetime CVD risk and treatment benefit, comorbidities and patient preferences. The updated SCORE algorithm-SCORE2, SCORE-OP- is recommended in these guidelines, which estimates an individual's 10-year risk of fatal and non-fatal CVD events (myocardial infarction, stroke) in healthy men and women aged 40-89 years. Another new and important recommendation is the use of different categories of risk according different age groups (< 50, 50-69 ≥ 70 years). Different flow charts of CVD risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic CVD, and in diabetic patients are recommended. Patients with chronic kidney disease are considered high risk or very high-risk patients according to the levels of glomerular filtration rate and albumin-to-creatinine ratio. New lifestyle recommendations adapted to the ones published by the Spanish Ministry of Health as well as recommendations focused on the management of lipids, blood pressure, diabetes and chronic renal failure are included.

Association between infliximab concentrations and clinical response in psoriasis: a prospective cohort study.

BACKGROUND: Infliximab (IFX) trough concentrations (Cmin) have been linked to treatment efficacy in psoriatic patients. Inter-individual IFX Cmin variability and factors influencing IFX pharmacokinetics could explain differences in treatment response. OBJECTIVE: To evaluate the association between IFX Cmin and clinical outcomes in psoriatic patients. METHODS: Prospective study of 33 patients with moderate to severe psoriasis receiving IFX at Bellvitge University Hospital, between October 2013 and November 2016. IFX Cmin and antibodies toward infliximab (ATI) were measured. RESULTS: We collected 155 IFX Cmin and ATI values (mean age, 46 (14) years; 11 (33.3%) women). Mean IFX Cmin was 2.5 (2.4) mg/L and ATIs were detected in six patients, resulting in undetectable IFX Cmin. IFX Cmin was significantly associated with ATI and body mass index (BMI) (ß -2.51, 95% CI -3.56 to -1.4 and ß -0.05, 95% CI -0.09 to -0.01). PASI score and PASI 90/100 response were significantly associated with IFX Cmin (IRR 0.80, 95% CI 0.70 to 0.92; OR 1.79, 95% CI 1.18 to 2.71 and OR 1.79, 95% CI 1.14 to 2.81). CONCLUSION: IFX Cmin significantly influences PASI 90/100 response rates. IFX Cmin wa significantly associated with ATI and BMI. The observed inter-individual variability in IFX Cmin supports the need for IFX drug monitoring.

Kibble-Zurek Mechanism in Driven Dissipative Systems Crossing a Nonequilibrium Phase Transition.

The Kibble-Zurek mechanism constitutes one of the most fascinating and universal phenomena in the physics of critical systems. It describes the formation of domains and the spontaneous nucleation of topological defects when a system is driven across a phase transition exhibiting spontaneous symmetry breaking. While a characteristic dependence of the defect density on the speed at which the transition is crossed was observed in a vast range of equilibrium condensed matter systems, its extension to intrinsically driven dissipative systems is a matter of ongoing research. In this Letter, we numerically confirm the Kibble-Zurek mechanism in a paradigmatic family of driven dissipative quantum systems, namely exciton-polaritons in microcavities. Our findings show how the concepts of universality and critical dynamics extend to driven dissipative systems that do not conserve energy or particle number nor satisfy a detailed balance condition.

Impacto del tiempo desde la biopsia a la prostatectomía radical en la infragradación del grado de Gleason y análisis de factores relacionados / The impact of time from biopsy to radical prostatectomy on Gleason score undergrading and other related factors

INTRODUCCIÓN: La infragradación del grado de Gleason de la biopsia (IGGB) puede impactar en el manejo y pronóstico de los pacientes con cáncer de próstata. Se analiza el posible impacto del tiempo y otros factores clínico-analíticos y la aparición de IGBB en nuestra serie. PACIENTES Y MÉTODO: Estudio multicéntrico ambispectivo de 1.955 pacientes con cáncer de próstata localizado intervenidos mediante prostatectomía radical entre 2005 y 2018. Se utiliza estadística descriptiva y pruebas de contraste de hipótesis con análisis uni- y multivariado para comunicar los RESULTADOS: RESULTADOS: Edad media 63,69 años (44-80), mediana de PSA 8,70 ng/ml (1,23-99). Se observa IGGB en el 34,7% de toda la muestra. En el 72,8% de los casos la IGGB fue en un único punto consecutivo del grado de Gleason: el paso de 3 + 3 a 3 + 4 fue el más frecuente (289 pacientes, 47,6%). La realización de prostatectomía radical antes o después de 90-180 días desde la biopsia no impactó en su infragradación en ninguno de los grupos. En los análisis uni- y multivariante, la presencia de tumor o tacto rectal patológico en ambos lóbulos, la carga tumoral ≥ 50% de los cilindros totales y una DPSA ≥ 0,20 mostraron capacidad discriminativa independiente para seleccionar pacientes que presentaron IGGB. CONCLUSIONES: El tiempo desde la biopsia hasta la prostatectomía radical no mostró impacto en IGGB. El número de cilindros afectados, la DPSA y presentar tumor bilateral fueron parámetros de fácil acceso que pueden ayudarnos a seleccionar pacientes con mayor probabilidad de presentar IGGB

INTRODUCTION: Gleason score biopsy undergrading (GSBU) can have an impact on the management and prognosis of patients with prostate cancer. We analyze the possible impact of time and other clinical and analytical factors in the appearance of GSBU in our series. PATIENTS AND METHOD: Ambispective, multicenter study of 1955 patients with localized prostate cancer undergoing radical prostatectomy between 2005 and 2018. Descriptive statistics and hypothesis testing are reported by univariate and multivariate analyses. RESULTS: Mean age 63.69 (44-80) years, median PSA 8.70 ng / ml (1.23-99). GSBU was observed in 34.7% of the entire cohort. In 72.8% of the cases, the GSBU occurred in one consecutive Gleason score, with the progression from 3 + 3 to 3 + 4 being the most frequent (289 patients, 47.6%). Performing radical prostatectomy 90-180 days before or after the biopsy does not have an impact on its undergrading in any of the groups. In the univariate and multivariate analysis, the presence of tumor or pathological rectal examination in both lobes, the tumor load ≥ 50% of cylinders and a DPSA ≥ 0.20, showed independent discriminative capacity to select patients who presented GSBU. CONCLUSIONS: The time from biopsy to radical prostatectomy did not show impact on GSBU. The number of affected cylinders, bilateral tumor and DPSA are easily accessible parameters that can help us select patients with greater probability of presenting GSBU

Vortex Dynamics in a Compact Kardar-Parisi-Zhang System.

We study the dynamics of vortices in a two-dimensional, nonequilibrium system, described by the compact Kardar-Parisi-Zhang equation, after a sudden quench across the critical region. Our exact numerical solution of the phase-ordering kinetics shows that the unique interplay between nonequilibrium and the variable degree of spatial anisotropy leads to different critical regimes. We provide an analytical expression for the vortex evolution, based on scaling arguments, which is in agreement with the numerical results, and confirms the form of the interaction potential between vortices in this system.

The impact of time from biopsy to radical prostatectomy on Gleason score undergrading and other related factors. / Impacto del tiempo desde la biopsia a la prostatectomía radical en la infragradación del grado de Gleason y análisis de factores relacionados.

INTRODUCTION: Gleason score biopsy undergrading (GSBU) can have an impact on the management and prognosis of patients with prostate cancer. We analyze the possible impact of time and other clinical and analytical factors in the appearance of GSBU in our series. PATIENTS AND METHOD: Ambispective, multicenter study of 1955 patients with localized prostate cancer undergoing radical prostatectomy between 2005 and 2018. Descriptive statistics and hypothesis testing are reported by univariate and multivariate analyses. RESULTS: Mean age 63.69 (44-80) years, median PSA 8.70 ng / ml (1.23-99). GSBU was observed in 34.7% of the entire cohort. In 72.8% of the cases, the GSBU occurred in one consecutive Gleason score, with the progression from 3 + 3 to 3 + 4 being the most frequent (289 patients, 47.6%). Performing radical prostatectomy 90-180 days before or after the biopsy does not have an impact on its undergrading in any of the groups. In the univariate and multivariate analysis, the presence of tumor or pathological rectal examination in both lobes, the tumor load ≥50% of cylinders and a DPSA ≥0.20, showed independent discriminative capacity to select patients who presented GSBU. CONCLUSIONS: The time from biopsy to radical prostatectomy did not show impact on GSBU. The number of affected cylinders, bilateral tumor and DPSA are easily accessible parameters that can help us select patients with greater probability of presenting GSBU.

Optimized meropenem dosage regimens using a pharmacokinetic/pharmacodynamic population approach in patients undergoing continuous venovenous haemodiafiltration with high-adsorbent membrane.

BACKGROUND: The pharmacokinetics (PK) of antibiotics change during sepsis and continuous renal replacement therapies in critically ill patients. Limited evidence exists on the use of the oXiris® high-adsorbent membrane. OBJECTIVES: To develop a PK/pharmacodynamic (PD) model for meropenem in critically ill sepsis patients undergoing continuous venovenous haemodiafiltration (CVVHDF) with the oXiris® membrane, and to design an optimal dosing regimen assessed according to the PTA. METHODS: A prospective, open-label, observational PK trial was performed (EUDRACT 2011-005902-30). We conducted PK studies (plasma and ultrafiltrate) for at least 24 h after concomitant administration of CVVHDF and meropenem 1 g q8h. We constructed a PK model using the non-linear mixed-effects approach (NONMEM 7.3). We evaluated the suitability of different dosage regimens using Monte Carlo simulations and calculated the PTA as the percentage of subjects achieving a given percentage of time above the MIC (fT>MIC). RESULTS: The PK of meropenem was best captured by a two-open-compartment model with zero-order input kinetics and first-order elimination. Extracorporeal CL was 7.78 L/h [relative standard error (RSE) 16.45 L/h] and central compartment V (Vc) was 24.9 L (RSE 13.73 L). Simulations showed that, for susceptible Pseudomonas aeruginosa isolates (EUCAST MIC ≤2 mg/L) and attainment of 100%fT>MIC, 500 mg q8h given as extended (EI) or continuous infusion (CI) would be sufficient. For a target of 100%fT>4×MIC, CI of 3000 mg q24h or 2000 mg q8h administered as EI or CI would be required. CONCLUSIONS: We have constructed a PK model of meropenem in sepsis patients undergoing CVVHDF using the oXiris® membrane. This tool will support physicians when calculating the optimal initial dose.

Dynamical Critical Exponents in Driven-Dissipative Quantum Systems.

We study the phase ordering of parametrically and incoherently driven microcavity polaritons after an infinitely rapid quench across the critical region. We confirm that the system, despite its driven-dissipative nature, satisfies the dynamical scaling hypothesis for both driving schemes by exhibiting self-similar patterns for the two-point correlator at late times of the phase ordering. We show that polaritons are characterized by the dynamical critical exponent z≈2 with topological defects playing a fundamental role in the dynamics, giving logarithmic corrections both to the power-law decay of the number of vortices and to the associated growth of the characteristic length scale.

Subacute intoxication with sodium nitrate induces hematological and biochemical alterations and liver injury in male Wistar rats.

Nitrate pollution has emerged as a problem of great importance because in recent years, the levels of nitrate in soil and groundwater have increased, mainly through anthropogenic activities, such as the use of fertilizers in agriculture, domestic wastewater and septic tanks, industrial waste and deforestation. In animals, nitrate reduction to nitrite (NO2) and nitric oxide (NO) promote the formation of methemoglobin in the blood and the generation of highly reactive intermediates that induce oxidative stress in target organs. Exposition to nitrates has been associated with methemoglobinemia, reproductive toxicity, metabolic and endocrine alterations and cancer. This study analyzed acute intoxication with sodium nitrate (NaNO3) in male Wistar rats, aged 12-16 weeks. Four groups with n = 10 rats each were formed: group 1 was the control, and group 2, group 3 and group 4 were treated for 10 days with intragastric doses of 19, 66 and 150 mg/kg/d NaNO3, respectively. Hematological, metabolic and histological biomarkers in the liver were analyzed. The results showed high percentages of methemoglobin, an increase in NO2 in the plasma and an accumulation in the liver. Moreover, there were high counts of white blood cells and platelets in all treated groups. Additionally, there was an increase in the spleen weight in group 4. High levels of glucose, triglycerides, lactate dehydrogenase (LDH), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were observed and were significantly increased in groups 3 and 4. For oxidative stress biomarkers, there were increases in Thiobarbituric Acid Reactive Substances (TBARS), total GSH and SOD activity, mainly in group 4. Changes in mitochondrial activity were not significant. Histopathological analyses of the liver showed inflammation, infiltration of mononuclear cells, steatosis, ischemia and necrosis, and these findings were more evident at high doses of NaNO3 in which high of S-nitrosylation were found. In conclusion, NaNO3 was reduced to NO2, thereby inducing methemoglobinemia, whereas other reactive species generated oxidative stress, causing hematological and metabolic alterations and injury to the liver.

Microbiological stabilization of tiger nuts' milk beverage using ultra-high pressure homogenization. A preliminary study on microbial shelf-life extension.

Tiger nuts' milk beverages are highly perishable products. For this reason, the interest of food industry for their commercialization makes necessary the application of preservation treatments to prolong their shelf-life. In the current study, the effect of ultra-high pressure homogenization (UHPH) on the microbiological and sensory qualities of tiger nuts' milk beverage was evaluated. Characteristics of UHPH-treated products (at 200 and 300 MPa, with inlet temperature of 40 °C) were compared with those of raw (RP) and conventionally homogenized-pasteurized (H-P) beverages, after treatment and during cold storage at 4 °C. Microbiological quality of beverages was studied by enumerating total counts, psychrotrophic bacteria, lactobacilli, enterobacteria, molds and yeasts, and mesophilic spores. Evolution of color and sensory characteristics of beverages were also determined. Microbiological shelf-life of the tiger nuts' milk beverages was extended from 3 to 25, 30 and 57 days by applying H-P and UHPH treatments at 200 and 300 MPa, respectively. Color of beverages was the only attribute that differentiated UHPH samples from the others, with greater luminosity and whiteness. Hence, UHPH treatments showed to be an alternative to the conventional H-P for obtaining tiger nuts' milk beverages with an improved microbiological shelf-life and good sensorial characteristics.

Potential indications for deep brain stimulation in neurological disorders: an evolving field.

Deep brain stimulation (DBS) is an established therapy for appropriately selected patients with movement disorders and neuropsychiatric conditions. Although the exact mechanisms and biology of DBS are not fully understood, it is a safe and well-tolerated therapy for many refractory cases of neuropsychiatric disease. Increasingly, DBS has been explored in other conditions with encouraging results. In this paper, available data is reviewed and new DBS targets, challenges and future directions in neurological disorders are explored. A detailed search of the medical literature discussing the potential use of DBS for neurological disorders excluding accepted indications was conducted. All reports were analyzed individually for content and redundant articles were excluded by examining individual abstracts. The level of evidence for each indication was summarized. Multiple studies report promising preliminary data regarding the safety and efficacy of DBS for a variety of neurological indications including chronic pain, tinnitus, epilepsy, Tourette syndrome, Huntington's disease, tardive dyskinesia and Alzheimer's disease. The initial results of DBS studies for diverse neurological disorders are encouraging but larger, controlled, prospective, homogeneous clinical trials are necessary to establish long-term safety and effectiveness. The field of neuromodulation continues to evolve and advances in DBS technology, stereotactic techniques, neuroimaging and DBS programming capabilities are shaping the present and future of DBS research and use in practice.

Manejo conservador de neumatocele en niños tras neumonía necrotizante / Conservative management of pneumatocele after necrotizing pneumonia in children

El neumatocele es una lesión redondeada de contenido aéreo y pared fina que se produce tras infección, trauma o inflamación pulmonares. Puede ser confundida con otras imágenes quísticas pulmonares (malformación adenomatosa, bronquiectasia). En ausencia de clínica respiratoria importante, el seguimiento radiológico evolutivo podría bastar, evitando procedimientos diagnósticos o terapéuticos lesivos para el paciente (AU)

Pneumatocele is a rounded cystic thin-walled lesion full of air inside the lung due to a lung trauma, infection or inflammation. It can be misdiagnosed with other pulmonary air cyst as bronquiectasia or adenomatous malformation. If there are no severe respiratory symptoms, radiological follow-up will be enough avoiding harmful diagnostic or therapeutic procedures for the patient (AU)

Incidence and risk factors of superficial and deep vein thrombosis associated with peripherally inserted central catheters in children.

Essentials Pediatric studies on peripherally inserted central catheter (PICC)-related thrombosis are scarce. This study analyzes incidence and risk factors for PICC-related venous thrombosis in children. PICC-related thrombosis is a common, and nearly always, asymptomatic complication. Echo-guided insertion and a catheter to vein ratio < 0.33 may notably decrease this complication. SUMMARY: Background Upper-extremity venous thrombosis is associated with the use of peripherally inserted central catheters (PICCs). Few pediatric studies have focused on this issue. Objectives To determine the incidence and risk factors for PICC-related superficial vein thrombosis (SVT) and deep vein thrombosis (DVT) in children. Patients/methods An observational follow-up cohort study was conducted at a single hospital between June 2012 and June 2015. All patients receiving a PICC were enrolled and followed up, with weekly Doppler ultrasound examination of the catheterized limb until PICC removal. Patient, procedural and follow-up data were analyzed. Results In the study period, 265 PICCs were inserted (median age of patients 6.5 years, interquartile range [IQR] 2.4-13 years; median weight 20 kg, IQR 11-38 kg; 54% males; 67.9% chronically ill), and patients were followed up for a total of 9743 days. The median indwelling time was 21 days (IQR 12-37 days). During follow-up, 88 (33.2% of insertions) PICC-related thromboses (incidence rate [IR] 9.03 per 1000 catheter-days) were diagnosed, 66 (24.9%) as isolated SVT, seven (2.6%) as isolated DVT, and 15 (5.7%) as SVT with associated DVT (IR 6.78, 0.71 and 1.54 per 1000 catheter-days, respectively). Only 9.9% of patients with SVT and 18.2% of those with DVT were symptomatic. The main risk factors for PICC-related SVT and DVT were a catheter/vein ratio of > 0.33 and thrombosis of the catheterized superficial vein, respectively. Conclusions PICC-related thrombosis is a common and nearly always asymptomatic complication in children, the SVT rate being approximately three times higher than the DVT rate. Optimal vein and catheter selection, yielding the lowest possible catheter/vein ratio, may decrease the rate of PICC-related thrombosis.

Dietary ß-galactomannans have beneficial effects on the intestinal morphology of chickens challenged with Salmonella enterica serovar Enteritidis.

Salmonella enterica serovar Enteritidis is one of the leading causes of food-borne salmonellosis in humans. Poultry is the single largest reservoir, and the consumption of incorrectly processed chicken meat and egg products is the major source of infection. Since 2006, the use of antibiotics as growth promoters has been banned in the European Union, and the dietary inclusion of ß-galactomannans (ßGM) has become a promising strategy to control and prevent intestinal infections. The aim of this study was to investigate the effect of various ßGM-rich products on intestinal morphology in chickens challenged with Salmonella Enteritidis. To assess this effect, a total of 280 male Ross 308 chickens were studied (40 animals per treatment housed in 5 cages). There were 7 treatments, including controls: uninoculated birds fed the basal diet (negative control) and inoculated birds fed the basal diet (positive control) or the basal diet supplemented with Salmosan (1 g/kg), Duraió gum (1 g/kg), Cassia gum (1 g/kg), the cell walls of Saccharomyces cerevisiae (0.5 g/kg), or the antibiotic colistine (0.8 g/kg). The birds were fed these diets from the d 1 to 23, except the animals in the colistine group, which were fed the diet containing the antibiotic only from d 5 to 11. The inoculated animals were orally infected on d 7 with 10(8) cfu of Salmonella Enteritidis. Bird performance per replicate was determined for the whole study period (23 d), and the distal ileum and cecal tonsil of 5 animals per treatment (1 animal per replicate) were observed at different magnification levels (scanning electron, light, and laser confocal microscopy). In the images corresponding to the treatments containing ßGM we observed more mucus, an effect that can be associated with the observation of more goblet cells. Moreover, the images also show fewer M cells, which are characteristic of infected animals. Regarding the morphometric parameters, the animals that received Duraió and Cassia gums show greater (P = 0.001 and P = 0.016, respectively) villus length compared with the animals in the positive control, thus indicating the capacity of these products to increase epithelial surface area. However, no effect (P > 0.05) on microvillus dimensions was detected. In conclusion, the results obtained indicating the beneficial effects of these ßGM on intestinal morphology give more evidence of the positive effects of these supplements in poultry nutrition.

Compositional and biochemical changes during cold storage of starter-free fresh cheeses made from ultra-high-pressure homogenised milk.

The aim of the present study was to evaluate the effects of using ultra-high pressure homogenisation (UHPH) on the composition and biochemistry of starter-free fresh cheeses and to monitor their evolution during cold storage as an alternative to conventional treatments applied in the production of fresh cheese such as conventional pasteurisation and homogenisation-pasteurisation. Although both homogenisation treatments increased cheese moisture content, cheeses from UHPH-treated milk showed lower moisture loss during storage than those from conventionally homogenised-pasteurised milk. Lipolysis and proteolysis levels in cheeses from UHPH-treated milk were lower than those from conventionally treated milk samples. Although, oxidation was found to be the major drawback, in general terms, high quality starter-free fresh cheeses were obtained from UHPH-treated milk.

Acanthamoeba encephalitis: A Case Report and Review of Therapy.

BACKGROUND: Acanthamoeba is a rare cause of encephalitis yet is associated with high mortality. Treatment protocols vary greatly and generally include combination therapy across a wide spectrum of antiinfective classes. CASE DESCRIPTION: A 63-year-old male who underwent renal transplantation presented 6 months after transplantation with depressed level of consciousness. Imaging of the head with computerized tomography showed an enhancing lesion suspicious for brain abscess. Biopsy of the lesion showed Acanthamoeba cysts. The patient was treated with sulfadiazine, fluconazole, flucytosine, azithromycin, and miltefosine but without success. We review recently published cases of Acanthamoeba encephalitis with an emphasis on treatment protocols and outcomes. CONCLUSION: Free-living protozoans such as Acanthamoeba are ubiquitous in the environment and should be suspected in immunosuppressed persons who present with central nervous system findings and brain abscess. Biopsy is critical to establish the etiology so that appropriate combination therapy can be deployed.

Pilot study to validate a computer-based clinical decision support system for dyslipidemia treatment (HTE-DLP).

UNLABELLED: Pilot study to validate a Computerized Decision Support Systems (CDS) (HTE-DLP) for improving treatment of hyperlipidemia. METHODS: HTE-DLP was programmed to offer automatic specific reminders for lipid treatment. Seventy-seven patients with high cardiovascular risk were randomized. 10 expert physicians in cardiovascular-risk management were recruited. We assessed number of patients at LDL <70 mg/dl after 12 weeks of treatment. RESULTS: A greater proportion of intervention group reached the LDL-C <70 mg/ml [55.0% vs 12.5%, p = 0.003; OR: 3.26 IC (1.16-9.15)]. "High potency statins" and combined therapy were used more frequently in the intervention group than the control group (p = 0.001). Seven adverse effects were documented in the intervention group and two in the control group. An acceptable relationship was observed with regard to costeffectiveness in the intervention group. Physicians expressed good agreement with HTE-DLP (86.1%) and comfortable ease-of-use (85%). CONCLUSIONS: Use of a CDSS in high-risk cardiovascular patients resulted in a significant reduction in LDL-C levels.

Pseudoartrosis humeral en fractura obstétrica tras osteomielitis aguda hematógena / Humeral pseudoarthrosis in obstetric fracture after acute hematogenic osteomyelitis

Introducción: La infección neonatal es una causa importante de morbimortalidad en la primera semana de vida a consecuencia de la exposición a microorganismos genitales maternos durante el parto. La sepsis neonatal se presenta como enfermedad fulminante y multisistémica, destacando la infección por klebsiella pneumoniae, con una mortalidad aproximada del 60%. Su asociación con un cuadro de osteomielitis aguda hematógena (OAH) es de difícil diagnóstico, con posibles complicaciones severas. Este cuadro de OAH asociado a fractura obstétrica precisa de intervención quirúrgica, tanto por su entidad infecciosa como por su posible evolución a pseudoartrosis. Caso clínico: Recién nacido a término con pérdida de bienestar fetal e ingreso en UCI por sepsis neonatal, con absceso en brazo izquierdo que drena espontáneamente y toma de cultivo positiva para klebsiella pneumoniae. Se comienza tratamiento antibiótico con cefotaxima y vancomicina sin mejoría tras 20 días, decidiéndose tratamiento quirúrgico con limpieza y estabilización mediante fijador externo con evolución favorable de su cuadro sistémico. A nivel de la fractura obstétrica se apreció falta de unión ósea con evolución a pseudoartrosis atrófica, por lo que se decidió reintervención con aporte de injerto óseo autólogo de cresta ilíaca y nueva fijación externa, con unión completa del foco a los dos meses y resolución del caso. Conclusión: La fractura obstétrica asociada a OAH es un cuadro poco frecuente que debe ser diagnosticado y tratado quirúrgicamente, con posibles complicaciones como la pseudoartrosis del foco fracturario (AU)

Introduction: Neonatal infection is an important morbimortality cause that occurs in the first week of life and it is a consequence to maternal genital microorganisms during partus. Neonatal sepsis is a sudden and multisystemic disease, standing out the infection by klebsiella pneumoniae, with an approximate mortality of 60%. Its association with acute hematogenic osteomyelitis has a difficult diagnose with severe income complications. Acute hematogenic osteomyelitis associated with an obstetric fracture needs surgical treatment because of its infectious importance and its possible evolution to pseudoarthrosis. Case report: Newborn with a loss of fetal wellness and entrance to intensivity care unit because of neonatal sepsis, with an abscess in his left arm that drains spontaneously and a positive biopsy to klebsiella pneumoniae. Antibiotic treatment with cefotaxime and vancomycin is started without any improvement after 20 days. Surgical treatment is decided with a cleaning procedure and stabilisation with external fixator, with a proper evolution of his sistemic clinic. Related to the obstetric fracture, non-union is appreciated with an evolution to atrophic pseudoarthrosis. A new surgical intervention is decided with the contribution of autologous bone graft from iliac crest and a new external fixator, with a complete bone union in two months and the clinical case solution. Conclusion: Obstetric fracture associated to acute hematogenic osteomyelitis is a low frequency episode that must be diagnosed and surgically treated with external fixation and autologous bone graft, with possible complications as pseudoarthrosis (AU)