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1.
Artigo em Inglês | MEDLINE | ID: mdl-33829233

RESUMO

BACKGROUND: Intrarenal venous flow (IRVF) measured by Doppler ultrasound has gained interest as a potential surrogate marker of renal congestion and adverse outcomes in heart failure. In this work, we aimed to determine if antigen carbohydrate 125 (CA125) and plasma amino-terminal pro-B-type natriuretic peptide (NT-proBNP) are associated with congestive IRVF patterns (i.e., biphasic and monophasic) in acute heart failure (AHF). METHODS AND RESULTS: We prospectively enrolled a consecutive cohort of 70 patients hospitalized for AHF. Renal Doppler ultrasound was assessed within the first 24-h of hospital admission. The mean age of the sample was 73.5 ± 12.3 years; 47.1% were female, and 42.9% exhibited heart failure with preserved ejection fraction. The median (interquartile range) for NT-proBNP and CA125 were 6149 (3604-12 330) pg/mL and 64 (37-122) U/mL, respectively. The diagnostic performance of both exposures for identifying congestive IRVF patterns was tested using the receiving operating curve (ROC). The cut-off for CA125 of 63.5 U/mL showed a sensibility and specificity of 67% and 74% and an area under the ROC curve of 0.71. After multivariate adjustment, CA125 remained non-linearly and positively associated with congestive IRVF (P-value = 0.008) and emerged as the most important covariate explaining the variability of the model (R2: 47.5%). Under the same multivariate setting, NT-proBNP did not show to be associated with congestive IRVF patterns (P-value = 0.847). CONCLUSIONS: CA125 and not NT-proBNP is a useful marker for identifying patients with AHF and congestive IRVF patterns.

2.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33745912

RESUMO

INTRODUCTION AND OBJECTIVES: Carbohydrate antigen 125 (CA125) has been shown to be useful for risk stratification in patients admitted with acute heart failure (AHF). We sought to determine a CA125 cutpoint for identifying patients at low risk of 1-month death or the composite of death/HF readmission following admission for AHF. METHODS: The derivation cohort included 3231 consecutive patients with AHF. CA125 cutoff values with 90% negative predictive value (NPV) and sensitivity up to 85% were identified. The adequacy of these cutpoints and the risk of 1-month death/HF readmission was then tested using the Royston-Parmar method. The best cutpoint was selected and externally validated in a cohort of patients hospitalized from BIOSTAT-CHF (n=1583). RESULTS: In the derivation cohort, the median [IQR] CA125 was 57 [25.3-157] U/mL. The optimal cutoff value was <23 U/mL (21.5% of patients), with NPVs of 99.3% and 94.1% for death and the composite endpoint, respectively. On multivariate survival analyses, CA125 <23 U/mL was independently associated with a lower risk of death (HR, 0.20; 95%CI, 0.08-0.50; P <.001), and the combined endpoint (HR, 0.63; 95%CI, 950.45-0.90; P=.009). The ability of this cutpoint to discriminate patients at a low 1-month risk was confirmed in the validation cohort (NPVs of 98.6% and 96.6% for death and the composite endpoint). The predicted ability of this cutoff remained significant at 6 months of follow-up. CONCLUSIONS: In patients admitted with AHF, CA125 <23 U/mL identified a subgroup at low risk of short-term adverse events, a population that may not require intense postdischarge monitoring.

3.
Comput Methods Programs Biomed ; 195: 105634, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32645627

RESUMO

BACKGROUND AND OBJECTIVE: In this paper we propose to include an intelligent tutoring system (ITS) within a magnetic resonance (MR) simulator that has been developed in house. With this, we intend to measure the impact, in terms of user experience, of including an ITS in our simulator. METHODS: We thoroughly describe the integration procedure and we have tested the benefits of this integration by means of two actual educational experiences, with one of them using the simulator as a standalone tool, and the other with the joint use of simulator+ITS. The experiences have consisted of two online courses with a number of students around 180 in both of them, where measurements of usability, perceived utility and likelihood to recommend were collected. RESULTS: We have observed that the three measurements improved noticeably in the second course with respect to the first one; specifically, overall usability improved by 22.3%, perceived utility by an average of 55.1% and likelihood to recommend by 13.7%. In addition, quantitative measurements are complemented with comments in free text format directly provided by the students. Results show evidence on the benefits of integrating an ITS in terms of quantitative user experience, as well as qualitative comparative comments directly by students of both courses. CONCLUSIONS: This is the first time that an ITS is used within the scope of MR simulation for training purposes. Benefits of integrating an ITS within an MR simulator have been evaluated in terms of user experience, with satisfactory comparative results.

4.
Eur J Intern Med ; 81: 78-82, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32553586

RESUMO

INTRODUCTION: There is scarce information about the clinical profile and prognosis of acute heart failure (AHF) at the extreme ranges of age. We aimed to evaluate the 1-year death (all-cause mortality and HF-death) and HF-rehospitalizations of patients ≥85 years admitted for AHF. METHODS: We prospectively evaluated a cohort of 3054 patients admitted with AHF from 2007 to 2018 in a third-level center. Age was categorized per 10-year categories (<65 years; 65-74 years, 75-84 years, and ≥85 years). The risk of mortality and HF-rehospitalizations across age categories was evaluated with Cox regression analysis and Cox regression adapted for competing events as appropriate. RESULTS: The mean age was 73.6 ± 11.2 years, 48.9% were female, and 52.8% had preserved left ventricular ejection fraction (HFpEF). A total of 414 (13.6%) patients were ≥85 years. Among this group of age, female sex and HFpEF phenotype were more frequent. At 1-year follow-up 667 all-cause deaths (22,1%), 311 HF-deaths (10.1%) and 693 HF-hospitalizations (22,7%) were recorded. After multivariable adjustment, and compared to patients <65 years, a stepwise increased risk of all-cause mortality and HF-death was found for each decade increase in age, especially for patients ≥85 years (HR=3.47; 95% CI: 2.49 - 4.84, p<0.001, HR=3.31; 95% CI: 1.95 - 5.63; p<0.001, respectively). This subgroup of patients also showed an increased risk of HF-rehospitalization (HR=1.58; 95% CI: 1.16 - 2.16, p=0.004). CONCLUSIONS: Super elderly patients admitted with AHF showed a dramatically increased risk of 1-year death. This subset of patients also shown an increased risk of 1-year HF-readmission.

5.
Conserv Biol ; 34(2): 494-504, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31461173

RESUMO

Despite much discussion about the utility of remote sensing for effective conservation, the inclusion of these technologies in species recovery plans remains largely anecdotal. We developed a modeling approach for the integration of local, spatially measured ecosystem functional dynamics into a species distribution modeling (SDM) framework in which other ecologically relevant factors are modeled separately at broad scales. To illustrate the approach, we incorporated intraseasonal water-vegetation dynamics into a cross-scale SDM for the Common Snipe (Gallinago gallinago), which is highly dependent on water and vegetation dynamics. The Common Snipe is an Iberian grassland waterbird characteristic of European agricultural meadows and a member of one of the most threatened bird guilds. The intraseasonal dynamics of water content of vegetation were measured using the standard deviation of the normalized difference water index time series computed from bimonthly images of the Sentinel-2 satellite. The recovery plan for the Common Snipe in Galicia (northwestern Iberian Peninsula) provided an opportunity to apply our modeling framework. Model accuracy in predicting the species' distribution at a regional scale (resulting from integration of downscaled climate projections with regional habitat-topographic suitability models) was very high (area under the curve [AUC] of 0.981 and Boyce's index of 0.971). Local water-vegetation dynamic models, based exclusively on Sentinel-2 imagery, were good predictors (AUC of 0.849 and Boyce's index of 0.976). The predictive power improved (AUC of 0.92 and Boyce's index of 0.98) when local model predictions were restricted to areas identified by the continental and regional models as priorities for conservation. Our models also performed well (AUC of 0.90 and Boyce's index of 0.93) when projected to updated water-vegetation conditions. Our modeling framework enabled incorporation of key ecosystem processes closely related to water and carbon cycles while accounting for other factors ecologically relevant to endangered grassland waterbirds across different scales, allowed identification of priority areas for conservation, and provided an opportunity for cost-effective recovery planning by monitoring management effectiveness from space.


Assuntos
Conservação dos Recursos Naturais , Ecossistema , Animais , Aves , Clima , Pradaria
6.
Artigo em Inglês | MEDLINE | ID: mdl-33620455

RESUMO

AIMS: Iron deficiency (ID) is a frequent finding in patients with chronic and acute heart failure (AHF) along the full spectrum of left ventricular ejection fraction (LVEF). Iron deficiency has been related to ventricular systolic dysfunction, but its role in right ventricular function has not been evaluated. We sought to evaluate whether ID identifies patients with greater right ventricular dysfunction in the setting of AHF. METHODS AND RESULTS: We prospectively included 903 patients admitted with AHF. Right systolic function was evaluated by tricuspid annular plane systolic excursion (TAPSE) and the ratio TAPSE/pulmonary artery systolic pressure (TAPSE/PASP). Iron deficiency was defined, according to European Society of Cardiology criteria, as serum ferritin <100 mg/dL (absolute ID) or ferritin 100-299 mg/dL and transferrin saturation (TSAT) <20% (functional ID). The relationships among the exposures with right ventricular systolic function were evaluated by multivariate linear regression analyses. The mean age of the sample was 74.3 ± 10.6 years, 441 (48.8%) were female, 471 (52.2%) exhibited heart failure with preserved ejection fraction, and 677 (75.0%) showed ID. The mean LVEF, TAPSE, and TAPSE/PASP were 49 ± 15%, 18.6 ± 3.9 mm, and 0.45 ± 0.18, respectively. The median (interquartile range) amino-terminal pro-brain natriuretic peptide was 4015 (1807-8775) pg/mL. In a multivariable setting, lower TSAT and ferritin were independently associated with lower TAPSE (P < 0.05 for both comparisons). Transferrin saturation (P = 0.017), and not ferritin (P = 0.633), was independently associated with TAPSE/PASP. CONCLUSION: In AHF, proxies of ID were associated with right ventricular dysfunction. Further studies should confirm these findings and evaluate the pathophysiological facts behind this association.

7.
J Med Syst ; 44(1): 9, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31792618

RESUMO

A new web-based education-oriented magnetic resonance (MR) simulator is presented. We have identified the main requirements that this simulator should comply with, so that trainees can face useful practical tasks such as setting the exact slice position and its properties, selecting the correct protocol or fitting the parameters to acquire an image. The tool follows the client-server model. The client contains the interface that mimics the console of a real machine and several of its features. The server stores anatomical models and executes the bulk of the simulation. This cross-platform simulator has been used in two real educational scenarios. The acceptance of the tool has been measured using two criteria, namely, the System Usability Scale and the Likelihood to Recommend, both with satisfactory results. Therefore, we conclude that given the potential of the tool, it may play a relevant role for the training of MRI operators and other involved personnel.


Assuntos
Simulação por Computador/normas , Instrução por Computador/normas , Imagem por Ressonância Magnética/normas , Radiologia/educação , Treinamento por Simulação/normas , Competência Clínica , Humanos , Interface Usuário-Computador
8.
Materials (Basel) ; 10(5)2017 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-28772845

RESUMO

Stress corrosion cracking (SCC) of metals is an issue of major concern in engineering since this phenomenon causes many catastrophic failures of structural components in aggressive environments. SCC is even more harmful under cathodic conditions promoting the phenomenon known as hydrogen assisted cracking (HAC), hydrogen assisted fracture (HAF) or hydrogen embrittlement (HE). A common way to assess the susceptibility of a given material to HAC, HAF or HE is to subject a cracked rod to a constant extension rate tension (CERT) test until it fractures in this harsh environment. This paper analyzes the influence of a residual stress field generated by fatigue precracking on the sample's posterior susceptibility to HAC. To achieve this goal, numerical simulations were carried out of hydrogen diffusion assisted by the stress field. Firstly, a mechanical simulation of the fatigue precracking was developed for revealing the residual stress field after diverse cyclic loading scenarios and posterior stress field evolution during CERT loading. Afterwards, a simulation of hydrogen diffusion assisted by stress was carried out considering the residual stresses after fatigue and the superposed rising stresses caused by CERT loading. Results reveal the key role of the residual stress field after fatigue precracking in the HAC phenomena in cracked steel rods as well as the beneficial effect of compressive residual stress.

11.
Clin Transl Oncol ; 15(2): 117-23, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22855171

RESUMO

INTRODUCTION: Nomograms are used to predict the involvement of non-sentinel nodes (nSN) in breast cancer. This study attempts to externally validate two of the more commonly used nomograms (MSKCC and Stanford University). MATERIALS AND METHODS: Five hundred and one cases of positive SNB with posterior axillary lymphadenectomy from 11 Spanish hospitals with widespread experience of the technique were studied. In all cases, an estimate of the probability of nSN involvement was made using the MSKCC and the Stanford University nomograms. Discrimination was assessed by calculating the area under the receiver operating characteristic curve. To assess the calibration of the nomogram, observed probability was plotted against the nomogram-calculated predicted probability. RESULTS: The overall predictive accuracy of the MSKCC nomogram was 0.684 (95 % confidence interval, 0.635-0.732), while in the case of that from Stanford the predictive accuracy was 0.658 (95 % confidence interval 0.607-0.709). The mean predicted probability of nSN metastases in each group of patients was correlated with the observed probability with an acceptable concordance (r = 0.820; p < 0.004 in MSKCC nomogram and r = 0.888; p < 0.001 in Stanford nomogram). CONCLUSION: These nomograms can be useful tools in the evaluation of patients with breast cancer and positive sentinel nodes but other factors, including a comprehensive clinical assessment, must be used to decide the most appropriate surgical approach for an individual patient, especially with regard to avoiding unnecessary lymphadenectomy.


Assuntos
Neoplasias da Mama/patologia , Metástase Linfática/diagnóstico , Nomogramas , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Feminino , Humanos , Pessoa de Meia-Idade , Curva ROC , Biópsia de Linfonodo Sentinela
12.
Rev. colomb. ortop. traumatol ; 25(3)sept. 2011. ilus
Artigo em Espanhol | LILACS | ID: lil-639101

RESUMO

El nervio obturador (L2-L4) inerva músculos cuya función principal es la aducción del muslo y, en menor grado, su rotación externa, y recoge la sensibilidad de la cara interna del muslo. Su lesión aislada es infrecuente y suele ser compresiva o traumática. Se presenta el caso de un hombre de 37 años con clínica de neuropatía del nervio obturador secundaria a un quiste sinovial de la articulación de la cadera, que por lo infrecuente del caso sufrió un retraso tanto en el diagnóstico como en el tratamiento definitivo.


Assuntos
Nervo Obturador/lesões , Cisto Sinovial
13.
Revista Infociencia ; 15(3)jul-sep.2011. tab
Artigo em Espanhol | CUMED | ID: cum-47821

RESUMO

Existen factores de riesgo social que pueden repercutir negativamente en la capacidad funcional de los adultos mayores ya que se asocian a un incrementode la vulnerabilidad para que estos desarrollen estado de fragilidad ynecesidad. Se realizó una investigación descriptiva, con el objetivo dedeterminar los factores de riesgo social del adulto mayor en el consultoriomédico de la familia 28 del Policlínico 2 Arcelio Suárez Bernal del municipiode Jatibonico, en el período comprendido desde el 1ro de enero al 31 dediciembre del 2009. La muestra estuvo conformada por 103 adultos mayores. Se utilizaron las variables: edad, sexo, estado civil, enfermedades asociadas,componentes básicos de las funciones familiares disminuidos o nulos.Predominaron los grupos de edades de 60-64 y 70-74 (24.3porciento), el sexofemenino (60.2porciento), las mujeres ancianas viudas (20,3 porciento), la hipertensiónarterial (60,2porciento) y la comprensión de la familia de la conducta y puntos de vista de los ancianos (50,4 por ciento). Hubo una incidencia elevada de factoresde riesgo social asociada a la presencia de ancianas solas y viudas,disminución de los recursos económica, la comprensión de los ancianos por lafamilia y la presencia de enfermedades crónicas no transmisibles(AU)


There are social risk factors that can rebound negatively in the functional capacity of elder people thus they associate to an enchancement of the vulnerability to have them develop a state of fragility and necessity. Adescriptive investigation was done with the objective of determinig the socialrisk factors of elder people in the dispensaries 28 of policlinic ll from Jatibonico municipality from january 1 st to december 31 st, 2009 .The sample wasconformed by 103 older people. Different variables were used like: age, sex,marital status, associated desease and basic components of the family functions disminished or null. It prevailed the 60-64 and 70-74 year old group(24.3percent), female sex (60.2percent), the elder widow women (20,3 percent), thehypertension (60,2percent) and family comprehension about conduct and elderly points of view (50,4 percent). There was a high incidence of the social risk factorsassociated to the presence of old women, alone and widows, the lessen ofeconomic resources, the retirement, the incomprehension of elder people bytheir families and the presence of non transmisible chronic desease(AU)


Assuntos
Humanos , Idoso Fragilizado/psicologia , Fatores de Risco
14.
Revista Infociencia ; 15(3)jul-sep.2011. tab
Artigo em Espanhol | CUMED | ID: cum-47818

RESUMO

El envejecimiento es un proceso universal que al parecer afecta a todos losseres humanos, el mismo está concebido como una sucesión demodificaciones morfológicas, fisiológicas y psicológicas de carácter irreversible.Se realizó una investigación descriptiva con el objetivo de identificar elcomportamiento de algunos factores biosicosociales en los adultos mayores que sobrepasan los 90 años en los consultorios médicos 44, 45 y 49 delPoliclínico 2 Arcelio Suárez Bernal de Jatibonico en el período comprendidodel 1ro de enero del 2007 al 31 de diciembre del 2008. La muestra estuvoconformada por 23 longevos que cumplieron criterio de inclusión. Se utilizaronlas variables: sexo, edad, autovalidismo, alimentos, hábitos tóxicos, problemade salud y principales planes y proyectos. Predominó el sexo femenino(69,6 porciento), el grupo de edades entre 90 - 94 años (69,6 porciento), el café como factor de riesgo (56,5 por ciento), la fractura de cadera (39,1 por ciento) y el autovalidismo en vestirse (86,9 porciento). Se encontró que estos ancianos envejecieron de manera óptima ya que permanecieron activos física y socialmente(AU)


Aging is a universal process that seems to affect all human beings, which isunderstood as a succession of morphological, physiological and phychological modifications with an irreversible character. A descriptive investigation wasdone with the objective of identifying the behaviour of some biopsy chosocial factors in elder people of 90 years old and more in the dispensaries 44,45, and 49 of the policlinic 2 Arcelio Suérez Bernal from Jatibonico municipality from January 1st ,2007 to december 31 st ,2008. The sample was conformed by 23 long lived that fulfilled with the inclusion criteria. Different variables were usedlike: sex, age, autovalidism, food, toxic habits, assossiated deseases andprincipal plans and projects. Female sex prevailed (69,6 percent), the 90-94years oldgroup, coffe as risk factor (56,5 percent), hip break (39,1 percent) and the autovalidism inthe way (86,9) percent.It was found these elderly get old in a best way because theywere physical and social active(AU)


Assuntos
Humanos , Feminino , Idoso , Idoso de 80 Anos ou mais , Idoso/psicologia
15.
Dynamis ; 27: 187-210, 12, 2007.
Artigo em Espanhol | MEDLINE | ID: mdl-18351164

RESUMO

Linguistic mechanisms of 18th century scientific language are studied in the first Natural History text originally drafted in Spanish. William Bowles describes linguistic concerns in science over the definition of terms that refer to realities in the three natural kingdoms. Diatopic and diastratic variants and definition procedures are reported, demonstrating the importance of these texts to the History of Science and the History of the Spanish Language.


Assuntos
Idioma , História Natural/história , História do Século XVIII , Linguística , Espanha , Terminologia como Assunto , Livros de Texto como Assunto/história
16.
Cancer Causes Control ; 15(6): 591-600, 2004 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15280638

RESUMO

OBJECTIVE: The present study aimed to determine whether the combined effects of environmental estrogens measured as the total effective xenoestrogen burden (TEXB-alpha) are a risk factor for breast cancer over and above the risk potentially linked to specific pesticides. METHODS: We measured the levels of 16 organochlorine pesticides as well as TEXB in adipose tissue of 198 women at the time of breast cancer diagnosis. These were compared with findings in 260 age and hospital matched control women without breast cancer. RESULTS: The median levels of p,p'-DDE (1,1-dichloro-2,2-bis( p -chlorophenyl)ethylene), aldrin, endosulfan ether and lindane (the pesticides detected in > 40% of the study population) were higher in cases than controls, although the differences did not reach statistical significance. After adjusting for potential confounders, the odds ratio (OR) for breast cancer in women with detectable levels of aldrin was 1.55 (95% confidence interval (CI) 1.00-2.40). Among the postmenopausal women, the OR for aldrin and lindane was 1.84 (95% CI 1.06-3.18) and 1.76 (95% CI 1.04-2.98), respectively. Among cases with body mass index (BMI) below the median (28.6 kg/m2), the OR was 3.42 (95% CI 1.22-9.58) for women in the highest quartile of TEXB-alpha versus those in the lowest. The subgroup of leaner postmenopausal women showed an increased risk (OR: 5.67; 95% CI 1.59-20.21) for those in the highest tertile versus those in the lowest. CONCLUSIONS: We found an increased risk for breast cancer in the leaner women, especially in the leaner postmenopausal subgroup, related to the TEXB-alpha. The pesticides aldrin and lindane are also individually associated with risk.


Assuntos
Neoplasias da Mama/epidemiologia , Neoplasias da Mama/etiologia , Estrogênios/farmacocinética , Estrogênios/envenenamento , Hidrocarbonetos Clorados , Inseticidas/farmacocinética , Inseticidas/envenenamento , Tecido Adiposo/química , Adulto , Idoso , Índice de Massa Corporal , Estudos de Casos e Controles , Feminino , Humanos , Pessoa de Meia-Idade , Pós-Menopausa , Fatores de Risco , Xenobióticos/farmacocinética , Xenobióticos/envenenamento
17.
Rev. mex. pediatr ; 61(1): 31-4, ene.-feb. 1994. ilus
Artigo em Espanhol | LILACS | ID: lil-139993

RESUMO

Se informa de un lactante que después de haber tenido un periodo neonatal normal presentó una pobre ganancia de peso, fatiga al ser alimentado, infecciones de repetición. A la radiografía del tórax mostró cardiomegalia, con flujo pulmonar aumentado; y en el ecocardiograma, dilatación de la aurícula izquierda, con la válvula mitral con pendiente EF disminuida (12 m/seg), con un sólo músculo papilar y flujo diastólico transmitral turbulento, con área valvular estenótica (0.7 cm²). Con estos datos se hizo el diagnóstico de estenosis mitral por válvula mitral en "paracaídas". Fue llevado a cirugía a los 11 meses de edad y, ante la imposibilidad de hacerle la plastía, se le colocó una prótesis mitral mecánica. La evolución ha sido satisfactoria, con tratamiento médico a base de coumadin, dipiridamol y furosemida. Se resaltan las ventajas de la valoración no invasiva y el éxito de la cirugía


Assuntos
Humanos , Masculino , Lactente , Bioprótese , Estenose da Valva Mitral/cirurgia , Estenose da Valva Mitral/congênito , Próteses Valvulares Cardíacas/reabilitação , Próteses Valvulares Cardíacas , Valva Mitral/anormalidades , Valva Mitral/cirurgia , Ponte Cardiopulmonar/reabilitação
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