Survival and death of seeds during liquid nitrogen storage: a case study on seeds with short lifespans.

BACKGROUND: The low temperature of liquid nitrogen is assumed to stop ageing and preserve viability indefinitely, however there are few validating data sets. The use of seeds to test these assumptions is important because other cryopreserved systems lack quantitative measures of viability to allow comparisons among timed points. OBJECTIVE: To evaluate survival of a collection of seeds with short lifespans stored 12-20 years in liquid nitrogen. MATERIALS AND METHODS: Seeds from 11 species (26 accessions) were removed from cryostorage and evaluated for germination and normal growth. RESULTS: Germination of Plantago cordata and Betula spp. seeds did not decrease significantly during cryostorage. However, Populus deltoides and most Salix spp. accessions showed a significant decrease in germination, with further loss observed when P. deltoides seedlings were followed to the young plant stage. Seeds of initial low quality showed greater deterioration during cryostorage. CONCLUSION: Cryostorage maintained viability of Salix and Populus seeds longer than other temperatures. However, ageing was not completely stopped and seed longevity was shorter than that predicted for many other species. A high initial seed quality is important in order to obtain the maximum benefit of cryostorage.

Risk factors for candidemia in non-neutropenic critical patients in Colombia.

OBJECTIVES: Due to the increase in isolation of Candida spp. in critically ill patients, and the high mortality and economic costs which this infection entails, a study was made of the risk factors associated to candidemia in critically ill patients from 7 intensive care units in Colombia. MATERIALS AND METHODS: A multicenter matched case-control study was conducted in 7 intensive care units of 3 university hospitals. Data on overall length of hospital stay (including both general wards and the intensive care unit) were recorded. RESULTS: A total of 243 subjects (81 cases and 162 controls) between January 2008 and December 2012 were included. In order of frequency, C. albicans, C. tropicalis and C. parapsilosis were isolated. The main identified risk factors were: overall length of hospital stay>25 days (OR 5.33, 95% CI 2.6-10.9), use of meropenem (OR 3.75, 95% CI 1.86-7.5), abdominal surgery (OR 2.9, 95% CI 1.39-6.06) and hemodialysis (OR 3.35, 95% CI 1.5-7.7). No differences in mortality between patients with candidemia and controls were found (39.5 vs. 36.5%, respectively, P=.66) were found. CONCLUSIONS: In Colombia, a long hospital stay, abdominal surgery, the use of meropenem and hemodialysis were identified as risk factors for candidemia.

Continuous tissue glucose monitoring correlates with measurement of intermittent capillary glucose in patients with distributive shock.

BACKGROUND: Intermittent glycemic measurements in patients admitted to the intensive care unit (ICU) can result in episodes of severe hypoglycemia or in a poor control of glycemia range. We designed a study to assess accuracy and reliability of continuous monitoring of tissue glucose for patients with distributive shock. METHODS: Consecutive patients admitted to the ICU with a diagnosis of distributive shock and the need of insulin infusion for glycemic control were included in the study. These patients were implanted a Continuous Glucose Control Monitoring System (CGMS) with the sensor inserted subcutaneously into the abdominal wall. CGMS values were recorded every 5min. Capillary glucose (CG) was monitored for adjusting insulin perfusion according to the ICU protocol. Correlation between both methods was assessed. RESULTS: A total of 11,673 CGMS and 348 CG values were recorded. In five patients, CGMS failed to detect tissue glucose. A glucose value <3.33mmol/l (<60mg/dl) was observed in 3.6% of CGMS and in 0.29% CG values. 295 pairs of measurements were included in the statistical analysis for correlation assessment. The intraclass correlation coefficient was 0.706. The Pearson correlation coefficient was 0.71 (p<0.0001, 95% CI 0.65-0.76). The mean of differences between both measurement methods was 0.22mmol/l (3.98mg/dl) (95% CI 0.66-7.31). CONCLUSIONS: When the Continuous Glucose Control Monitoring System (CGMS) is able to obtain data (75% of the patients), there is correlation between the values obtained by this method and capillary blood glucose in patients with distributive shock. CGMS can detect more episodes of glycemic excursions outside the normal range than intermittent capillary glucose monitoring. Variables that may impair glucose metabolism and peripheral soft tissues perfusion could impair CGMS measurements.

[Characteristics of deep sedation in gastrointestinal endoscopic procedures performed by intensivists]. / Características de la sedación profunda en procesos endoscópicos gastrointestinales, realizada por médicos intensivistas.

OBJECTIVE: To determine tolerance, pain intensity, percentage of tests completed successfully and complications of deep sedation controlled by intensivists during gastrointestinal endoscopic procedures. DESIGN: A one-year, prospective observational study was carried out. SETTING: Department of Intensive Care intervention in the Endoscopy Unit of Hospital Universitario del Tajo (Spain). PATIENTS: Subjects over 15 years of age subjected to endoscopic procedures under deep sedation. RESULTS: A total of 868 patients were sedated during the study period, with the conduction of 1010 endoscopic procedures. The degree of tolerance was considered adequate («Very good¼/«Good¼) in 96.9% of the patients (95%CI: 95.7-98.1%), with a median score of 0 on the pain visual analog scale. A total of 988 endoscopic procedures were successfully completed (97.8%; 95%CI: 96.9-98.8%): 675 colonoscopies (97.1%) and 305 endoscopies (99.7%). Complications were recorded in 106 patients (12.2%; 95%CI: 10.0-14.5%). The most frequent being desaturation (6.1%), rhythm disturbances (5.1%) and hypotension (2.4%). CONCLUSION: Gastrointestinal endoscopic procedures under sedation controlled by intensivists are well tolerated and satisfactory for the patient, and are successfully completed in a very large percentage of cases. The procedures are associated with frequent minor complications that are resolved successfully.

Rapid AST: Possibility of inferring resistance mechanisms with complex phenotypes.

The new automated systems designed for rapid performance of AST have significantly reduced the response time for susceptibility testing of microorganisms causing bacteremia and sepsis. The Accelerate Pheno® system (AAC) is one such system. Our objective for this study was to determine whether the AAC system is capable of providing an accurate susceptibility profile to infer resistance mechanisms in different carbapenemase-producing isolates when compared to the MicroScan WalkAway System (MWS). Disk diffusion method was also performed on all isolates as a reference method. Additionally, we compared the results obtained with the routine AST production system. We selected 19 isolates from the cryobank of the Microbiology department, all of which were carbapenemase-producing gram-negative bacilli. AAC was able to identify and infer the resistance of a total of 10 isolates, with an EA and CA of 84.2% for meropenem and 88.2% and 64.7% for ertapenem EA and CA, respectively. If we consider the disk diffusion technique, the CA was 57.9% and 76.5% for meropenem and ertapenem. However, in the presence of carbapenemases, AAC was not able to provide adequate MICs or infer the resistance mechanisms of the isolates accurately. Further studies with a larger number of isolates, including the new antibiotics ceftolozane/tazobactam and ceftazidime/avibactam, are needed for a more comprehensive comparison.

Ageing kinetics of fern chlorophyllous spores during dry storage is determined by its antioxidant potential and likely induced by photosynthetic machinery.

Ageing in dry chlorophyllous propagules is leaded by photooxidation through the photosynthetic machinery, but why species differ in longevity and the ageing mechanisms of when light and oxygen are absent are unknown. We hypothesize that the cellular antioxidant capacity is key for the inter- and intra-specific differences in the ageing process. We have tested this hypothesis in chlorophyllous spores of two ferns. They were subjected to four different storage regimes resulting from light/dark and normoxia/hypoxia combinations. Lipophilic and hydrophilic antioxidants, reactive oxygen species (ROS), and photosynthetic pigments were analysed in parallel to germination and the recovery of Fv/Fm over a storage period of up to 22-months. We show that light and oxygen accelerate the ageing process, but their mechanisms (ROS, increase, antioxidant capacity decrease, loss of efficiency of the photosystem II, pigment degradation) appear the same under all conditions tested. The end of the asymptomatic phase of longevity, when a sudden drop of germination occurs, seems to be determined by a threshold in the depletion of antioxidants. Our results support the hypothesis that ageing kinetics in dry plant propagules is determined by the antioxidant system, but also suggests an active role of the photosynthetic machinery during ageing, even in darkness and hypoxia.

Evaluation of a lateral flow immunoassay to detect CTX-M extended-spectrum ß-lactamases (ESBL) directly from positive blood cultures for its potential use in Antimicrobial Stewardship programs.

OBJECTIVE: Bloodstream infections (BSI) caused by extended-spectrum beta-lactamases Enterobacteriaceae (ESBL-E) are associated with high rates of treatment failure and increased mortality, especially when appropriate antimicrobial therapy is delayed. Our aim was to evaluate the anticipation of ESBLs detection and the potential improvement of the time response of the Vitek 2 System (BioMérieux; France). METHODS: We compared this lateral flow immunoassay when used directly on fluid from positive blood cultures to the VITEK2 AST system. We evaluated 80 isolates, 61 tested directly on fluid from positive blood cultures and 19 tested on fluid from blood cultures spiked with known ESBL positive and negative organisms. RESULTS: The concordance between the CTX-LFIA and the reference method (Vitek 2) had a Cohen´s Kappa coefficient of 0.97, indicating a particularly good correlation between both compared methods. CONCLUSIONS: This lateral flow immunoassay can be more rapid than the Vitek 2 for earlier presumptive identification of CTX-M ESBLs and can be useful to anticipate results and the adjustment of antimicrobial therapy.

ADENI-UCI study: Analysis of non-income decisions in ICU as a measure of limitation of life support treatments.

OBJECTIVE: To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure. DESIGN: Prospective, multicentrico. SCOPE: 62 ICU from Spain between February 2018 and March 2019. PATIENTS: Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure. INTERVENTIONS: None. MAIN INTEREST VARIABLES: Patient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge. RESULTS: A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62-3.99). CONCLUSIONS: Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death.

Effect of storage temperature on green spore longevity for the ferns Equisetum ramosissimum and Osmunda regalis.

Green spores of ferns lose viability quickly, and need specialized treatment for long-term conservation in germplasm banks. Dry storage at different temperatures was studied in green spores of Osmunda regalis and Equisetum ramosissimum. Changes in germination percentage, time to 50 percent of maximum germination (T50) and tendency for normal growth of the gametophyte were assayed during 24 months of storage. Spores stored at 25 degree C died within 1 month. Spores stored at 4 degree C maintained high viability for about 3 months, and then aging was evident by a decrease of final germination percentage, an increase in T50, and abnormal development of the gametophyte. Germination of spores stored at -25 degree C was highly variable during the storage period. Spores cryopreserved at -80 degree C and -196 degree C maintained high viability, rapid germination and normal growth throughout the study period. Cryopreservation of green spores is a feasible method to preserve viability and ensure normal gametophyte development for several years.

ADENI-UCI Study: Analysis of non-income decisions in ICU as a measure of limitation of life support treatments. / Estudio ADENI-UCI: Análisis de las decisiones de no ingreso en UCI como medida de limitación de los tratamientos de soporte vital.

OBJECTIVE: To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure. DESIGN: Prospective, multicentrico SCOPE: 62 ICU from Spain between February 2018 and March 2019. PATIENTS: Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure. INTERVENTIONS: None. MAIN INTEREST VARIABLES: Patient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge. RESULTS: A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62-3.99). CONCLUSIONS: Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death.

Accessory head of the flexor pollicis longus muscle: anatomical study and clinical significance.

BACKGROUND: The accessory head of the flexor pollicis longus (AHFPL) has an oblique trajectory from medial to lateral aspect of the forearm below the flexor digitorum superficialis muscle and then joins the flexor pollicis longus muscle. When the anterior interosseous nerve (AIN) courses underneath the muscle belly of the AHFPL an entrapment neuropathy may occur, known as anterior interosseous nerve syndrome (AINS). MATERIALS AND METHODS: This descriptive cross-sectional study evaluated 106 fresh upper extremities. When the AHFPL was present, its fascicle was traced up to evaluate the origin site. The morphometric variables were measured using a digital micrometre (Mitutoyo, Japan). The relationship between the AHFLP and the AIN was evaluated. RESULTS: The AHFPL was found in 34 (32.1%) of the 106 forearms. The AHFPL arose from the flexor digitorum superficialis muscle in 16 (47.1%) forearms, the medial epicondyle of the humerus in 10 (29.4%) forearms and the coronoid process of ulna in 8 (23.5%) forearms. The average total length of the AHFPL was 94.11 ± ± 10.33 mm. The AIN was located lateral to the AHFPL in 3 (8.8%) forearms, posterolateral in 7 (20.6%) forearms and posterior in 24 (70.6%) forearms. CONCLUSIONS: This study performed in a South American population sample revealed a prevalence of the AHFPL in a lower range compared to previous studies in North Americans and Asians. The AIN coursed more frequently underneath the muscle belly of AHFPL. This finding has clinical significance in the onset of the AINS and the subsequent surgical procedure for the AIN decompression.

Lack of correlation between left ventricular outflow tract velocity time integral and stroke volume index in mechanically ventilated patients.

OBJECTIVE: To assess the correlation between left ventricular outflow tract velocity time integral (LVOT VTI) and stroke volume index (SVI) calculated by thermodilution methods in ventilated critically ill patients. DESIGN: A prospective, descriptive, multicenter study was performed. SETTING: Five intensive care units from university hospitals. PATIENTS: Patients older than 17 years needing mechanical ventilation and invasive hemodynamic monitoring were included. INTERVENTIONS: LVOT VTI was measured by pulsatile Doppler echocardiography. Calculations of SVI were performed through a floating pulmonary artery catheter (PAC) or a Pulse index Contour Cardiac Output (PiCCO®) thermodilution methods. MAIN VARIABLES: The relation between LVOT VTI and SVI was tested by linear regression analysis. RESULTS: One hundred and fifty-six paired measurements were compared. Mean LVOT VTI was 20.83±4.86cm and mean SVI was 41.55±9.55mL/m2. Pearson correlation index for these variables was r=0.644, p<0.001; ICC was 0.52 (CI 95% 0.4-0.63). When maximum LVOT VTI was correlated with SVI, Pearson correlation index was r=0.62, p<0.001. Correlation worsened for extreme values, especially for those with higher LVOT VTI. CONCLUSIONS: LVOT VTI could be a complementary hemodynamic evaluation in selected patients, but does not eliminate the need for invasive monitoring at the present time. The weak correlation between LVOT VTI and invasive monitoring deserves additional assessment to identify the factors affecting this disagreement.

Estudio ADENI-UCI: Análisis de las decisiones de no ingreso en UCI como medida de limitación de los tratamientos de soporte vital / ADENI-UCI Study: Analysis of non-income decisions in ICU as a measure of limitation of life support treatments

Objetivo: Analizar las variables asociadas a las decisiones de rechazo al ingreso en una Unidad de Cuidados Intensivos (UCI) como medida de limitación de tratamiento de soporte vital. Diseño: Prospectivo, multicéntrico. Ámbito: Sesenta y dos UCI de España entre febrero de 2018 y marzo de 2019. Pacientes: Mayores de 18 años a los que se les negó el ingreso a una UCI como medida de limitación de tratamiento de soporte vital. Intervenciones: Ninguna. Variables de interés principals: Comorbilidades de los pacientes, situación funcional previa medida por la escala KNAUS y Karnosfky; escalas pronósticas de Lee y Charlson; gravedad del enfermo medida por las escalas APACHE II y SOFA, motivo que justifica la toma de la decisión, persona a la cual es trasmitida la información; fecha de alta o fallecimiento intrahospitalario, destino al alta hospitalaria. Resultados: Se registraron un total de 2.312 decisiones de no ingreso como medida de limitación del tratamiento de soporte vital (LTSV), de las cuales se analizaron 2.284. El principal motivo de consulta fue la insuficiencia respiratoria (1.080 [47,29%]). La pobre calidad de vida estimada de los enfermos (1.417 [62,04%]), la presencia de una enfermedad crónica grave (1.367 [59,85%]) y la limitación funcional previa de los pacientes (1.270 [55,60%]) fueron los principales motivos esgrimidos para denegar el ingreso. La tasa de mortalidad intrahospitalaria fue del 60,33%. La futilidad del tratamiento se constató como factor de riesgo asociado a mortalidad (OR: 3,23; IC 95%: 2,62-3,99). Conclusiones: Las decisiones para limitar el ingreso en UCI como medida de LTSV se basan en los mismos motivos que las decisiones tomadas dentro de la UCI. La futilidad valorada por el intensivista se relaciona adecuadamente con el resultado final de muerte (AU)

Objective: To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure. Design: Prospective, multicentrico. Scope: 62 ICU from Spain between February 2018 and March 2019. Patients: Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure. Interventions: None. Main interest variables: Patient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge. Results: A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62-3.99). Conclusions: Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death (AU)

Effectiveness and safety of enteral vancomycin to control endemicity of methicillin-resistant Staphylococcus aureus in a medical/surgical intensive care unit.

A prospective trial was undertaken to assess the effectiveness and safety of enteral vancomycin in controlling methicillin-resistant Staphylococcus aureus (MRSA) in an endemic setting. Over the 49 month period patients aged >14 years were enrolled, following admission to a medical/surgical intensive care unit (ICU) and expected to require ventilation for three days or more. A total of 799 patients were included in the trial. Period one, 1 July 1996-30 April 1997, (N=140), was observational. During period two, 1 May 1997-30 September 1998, (N=258), surveillance samples were obtained. MRSA carriers were isolated and received enteral vancomycin. During period three, 1 October 1998-31 July 2000, (N=400), all ventilated patients were given selective digestive decontamination (SDD) with polymyxin E, tobramycin, amphotericin B and vancomycin and four days of intravenous cefotaxime. The primary endpoints were: (1) incidence of patients with diagnostic samples positive for MRSA acquired on the ICU; (2) incidence of patients with vancomycin-resistant enterococci (VRE) in surveillance or diagnostic samples; (3) incidence of patients with samples positive for S. aureus with intermediate sensitivity to glycopeptides (GISA). The incidence of patients with MRSA in diagnostic samples were 31%, 14%, and 2% in periods one, two and three, respectively (P<0.001). There was a VRE outbreak involving 13 patients during period three. VRE disappeared with no change in policy. GISA was not detected. These findings support the effectiveness and safety of enteral vancomycin in the control of MRSA.

Evaluation of a hospital-wide resuscitation team: does it increase survival for in-hospital cardiopulmonary arrest?

OBJECTIVE: To assess the impact (defined not only with regard to patient outcome but also to record keeping for evaluation of care) of a formal, structured resuscitation team for in-hospital cardiopulmonary resuscitation over the year following its creation. METHODS: This is a "before and after" study in which charts of all patients needing resuscitation during the two-year period were reviewed and data arranged in the Utstein Style of in-hospital reporting of cardiac arrests. The review was limited to adults (> or = 18 years of age) in nonICU settings. RESULTS: A total of 220 events were identified. Demographics and presenting rhythms for the two periods under review were similar. For the period of August 1996-August 1997 (group 1), there were 70 resuscitation events recorded with a return of spontaneous circulation (ROSC) rate of 21/70 (30%). For the period of August 1997-August 1998 (group 2), 150 events were recorded and the ROSC rate was significantly higher 87/150 (58%)) (P=0.0002). ROSC after ventricular fibrillation and ventricular tachycardia was similar in both groups (50 vs 57%) (P = 1.00) but an improvement in survival was seen in group 2 from events of bradycardia perfusing rhythm (25% vs 84%) (P = 0.0003). Survival from PEA/Asystole was also improved during period 2 (18 vs 48%) (P = 0.013). Survival to discharge was seen in 3/50 (6%) of patients in period 1 and 18/102 (18%) of patients in period 2 (P = 0.09). CONCLUSIONS: The formation of a structured, formalized hospital resuscitation team was associated with an increase in the number of recorded events, in the number of patients experiencing ROSC and in the percentage of patients who were discharged from the hospital. Facilities with no formal resuscitation team or with no skilled, practiced resuscitator on their current team should consider implementation of a similar strategy.

Solid-state behavior of cromolyn sodium hydrates.

Cromolyn sodium (CS, disodium cromoglycate) is an antiasthmatic and antiallergenic drug. The solid-state behavior of CS is still not completely understood. CS forms nonstoichiometric hydrates and sorbs and liberates water in a continuous manner, although with hysteresis. The reported continuous changes in crystal lattice parameters of CS, which are associated with the changes in water stoichiometry, renders CS physically variable, which may complicate formulation and processing. In addition, controversies still remain as to whether CS exists as different stoichiometric hydrates, mainly because of its variable powder X-ray diffraction (PXRD) patterns (Cox, J. S. G. et al. J. Pharm. Sci. 1971, 60, 1458-65), which indicates a variable crystal structure. The objectives of this study are (a) to understand this unusual water uptake in the light of the molecular and crystal structures of CS, (b) to understand the relationship between the crystal structure and the PXRD patterns using Rietveld analysis, and (c) to investigate whether CS exists as different stoichiometric hydrates. The crystal structure of CS containing 6.44 molecules of water per molecule of CS was determined at 295 and 173 K. The packing arrangements in these structures (space group P1) are similar to those in a previous report, in which the water stoichiometry is 5 to 6, but the bond lengths, bond angles, and lattice parameters are different, reflecting the different water stoichiometries. In the crystal structure solved at 295 K, the position of only one of the two sodium ions could be determined. In the crystal structure solved at 173 K, the previously undetermined sodium ion is disordered over three sites, while four of eight water positions are partially occupied. The 2-hydroxy-propane chain that links the two cyclic moieties of CS was found to be flexible, perhaps allowing the CS crystal to accommodate variable amounts of water. The lack of a fixed coordination site for the second sodium ion may contribute to the disorder of the water molecules. The nonstoichiometric water content of CS is mainly attributed to the water molecules that are associated with the two unoccupied sodium sites. From the PXRD patterns of CS powder, equilibrated at various relative humidities, the various lattice parameters, including previously unreported alpha, beta, and gamma values, were calculated using Rietveld analysis. The peak shifts in these PXRD patterns are quantitatively explained by slight changes in the unit cell parameters. The recently described solid forms of CS were prepared and were found to correspond to the original crystalline CS, described by Cox et al. (1971), but with contamination by the known M mesophase in various proportions. The present results support a variable crystal structure and not the existence of different stoichiometric hydrates of CS.

Lack of correlation between left ventricular outflow tract velocity time integral and stroke volume index in mechanically ventilated patients / Ausencia de correlación entre la integral velocidad tiempo en el tracto de salida del ventrículo izquierdo y el índice volumen sistólico en pacientes en ventilación mecánica

Objective: To assess the correlation between left ventricular outflow tract velocity time integral (LVOT VTI) and stroke volume index (SVI) calculated by thermodilution methods in ventilated critically ill patients. Design: A prospective, descriptive, multicenter study was performed. Setting: Five intensive care units from university hospitals. Patients: Patients older than 17 years needing mechanical ventilation and invasive hemodynamic monitoring were included. Interventions: LVOT VTI was measured by pulsatile Doppler echocardiography. Calculations of SVI were performed through a floating pulmonary artery catheter (PAC) or a Pulse index Contour Cardiac Output (PiCCO(R)) thermodilution methods. Main variables: The relation between LVOT VTI and SVI was tested by linear regression analysis. Results: One hundred and fifty-six paired measurements were compared. Mean LVOT VTI was 20.83±4.86cm and mean SVI was 41.55±9.55mL/m2. Pearson correlation index for these variables was r=0.644, p<0.001; ICC was 0.52 (CI 95% 0.4-0.63). When maximum LVOT VTI was correlated with SVI, Pearson correlation index was r=0.62, p<0.001. Correlation worsened for extreme values, especially for those with higher LVOT VTI. Conclusions: LVOT VTI could be a complementary hemodynamic evaluation in selected patients, but does not eliminate the need for invasive monitoring at the present time. The weak correlation between LVOT VTI and invasive monitoring deserves additional assessment to identify the factors affecting this disagreement

Objetivo: Evaluar la correlación entre la integral velocidad tiempo del tracto de salida del ventrículo izquierdo (IVT TSVI) y el índice volumen sistólico (IVS) calculado por métodos de termodilución en pacientes ventilados críticamente enfermos. Diseño: Se realizó un estudio prospectivo, descriptivo y multicéntrico. Ámbito: Cinco unidades de cuidados intensivos de hospitales universitarios. Pacientes: Se incluyeron pacientes mayores de 17 años que necesitaron ventilación mecánica y monitorización hemodinámica invasiva. Intervenciones: La IVT TSVI se midió mediante Doppler pulsátil. Los cálculos de SVI se realizaron a través de un catéter de arteria pulmonar (CAP) o un método de Pulse index Contour Cardiac Output (PiCCO(R)), con métodos de termodilución. Variables principales: La relación entre IVT TSVI e IVS se evaluó mediante análisis de regresión lineal. Resultados: Se compararon 156 mediciones pareadas. La IVT TSVI media fue de 20,83±4,86cm y la media de IVS fue de 41,55±9,55ml/m2. El índice de correlación de Pearson para estas variables fue r=0,644, p<0,001; ICC fue 0,52 (IC 95%: 0,4-0,63). Cuando la IVT TSVI máxima se correlacionó con el IVS, el índice de correlación de Pearson fue r=0,62, p<0,001. La correlación empeoró para los valores extremos, especialmente para aquellos con mayor IVT TSVI. Conclusiones: La IVT TSVI podría ser una evaluación hemodinámica complementaria en pacientes seleccionados, pero no elimina la necesidad de un control invasivo en la actualidad. La débil correlación entre la IVT TSVI y la monitorización invasiva requiere estudios adicionales para identificar los factores que afectan a este desacuerdo

Comportamiento morfológico y electroquímico de un recubrimiento Dip Coating policaprolactona-quitosano-colágeno sobre Ti6Al4V / Morphological and electrochemical behavior of polycaprolactone-chitosan-collagen film fabricated by Dip Coating on Ti6Al4V

Resumen: En este trabajo se presenta, la caracterización mediante las técnica de Infrarrojo, Microscopía de Fuerza Atómica, Microscopía Electrónica de Barrido y ángulo de contacto de los recubrimientos poliméricos de la mezcla binaria de policaprolactona-quitosano y su modificación tras la adición de colágeno que fueron depositados mediante la técnica de Dip Coating sobre la aleación de Ti6Al4V; además, se evaluó mediante la técnica de Espectroscopía de Impedancia Electroquímica la aleación Ti6Al4V recubierta por las mezclas de polímeros a cero días de inmersión en Fluido Corporal Simulado y la capacidad de adsorción de calcio a 21 días de inmersión. De esta manera, se encontraron efectos representativos sobre el papel del colágeno para el aumento de la rugosidad superficial, mayores valores en la resistencia a la polarización del Ti6Al4V, mejor comportamiento en los parámetros de energía libre, adsorción atómica de calcio y la consolidación de una nueva interfase asociada a la monocapa de calcio simulada mediante circuitos equivalentes y observada por Microscopía Electrónica de Barrido.

Abstract: This paper presents the characterization by the infrared technique, atomic force microscopy, scanning electron microscopy and contact angle of the polymer coatings of the binary mixture of polycaprolactone-chitosan and its modification after addition of collagen were deposited by the technique of Dip Coating on Ti6Al4V alloy; also by the technique of Electrochemical Impedance Spectroscopy were evaluated the Ti6Al4V alloy coated by polymer blends zero days immersion in Simulate Bode Fluid and of adsorptivity calcium to 21 days immersion. Thus, representative effects on the role of collagen to increase the surface roughness, higher values in the polarization resistance of Ti6Al4V, better behavior parameters free energy, atomic adsorption of calcium and the consolidation of a found new interface associated with the monolayer calcium simulated by equivalent circuits and observed by Scanning Electron Microscopy.

Variaciones vasculares en cavidad abdominal y de vías urinarias: presentación de caso / Vascular variations in urinary tract and abdominal cavity: case report

Se presenta un raro caso de múltiples variaciones en la cavidad abdominal de un espécimen cadavérico de 50 años de género masculino, del laboratorio de anatomía de la Universidad Industrial de Santander (Bucaramanga-Colombia). Se observó variaciones arteriales (arteria renal adicional derecha y origen de la rama hepática derecha desde la arteria mesentérica superior), venosa (vena renal derecha adicional) y de vía urinaria (doble uréter en el lado derecho). Estas diversas variantes anatómicas además de suscitar interés académico, deben ser consideradas y descritas correctamente por los clínicos durante la realización de procedimientos quirúrgicos, radiológicos y de imágenes diagnósticas en la cavidad abdominal.

Here we present a rare case of multiple abdominal cavity variations in a 50-year-old male cadaveric specimen of the anatomy laboratory of the Universidad Industrial de Santander (Bucaramanga, Colombia). The anatomical dissection revealed arterial variations (right additional renal artery and origin of the right hepatic branch from the superior mesenteric artery), venous (right additional renal vein) and urinary tract (duplicated ureter on the right side). These multiple anatomic variations in addition to raising academic interest, should be considered and described correctly by clinicians while performing surgical, radiological and imaging procedures in the abdominal cavity.

Factores de riesgo asociados a candidemia en pacientes críticos no neutropénicos en Colombia / Risk factors for candidemia in non-neutropenic critical patients in Colombia

OBJETIVOS: Determinar los factores de riesgo asociados a candidemia en pacientes críticos de 7 unidades de cuidados intensivos de Colombia. MATERIALES Y MÉTODOS: Estudio de casos y controles pareado, multicéntrico, retrospectivo, en 7 unidades de cuidados intensivos de 3 hospitales universitarios. Se tomaron datos de duración de la estancia hospitalaria global (incluyendo salas generales) y en la unidad de cuidados intensivos. RESULTADOS: Se incluyeron 243 participantes (81 casos y 162 controles) entre enero de 2008 y diciembre de 2012. Se aislaron en orden de frecuencia C. albicans, C. tropicalis y C. parapsilosis. Los principales factores de riesgo identificados fueron: tiempo de estancia hospitalaria global>25 días (OR 5,33; IC 95% 2,6-10,9), uso de meropenem (OR 3,75; IC 95% 1,86-7,5), cirugía abdominal (OR 2,9; IC 95% 1,39-6,06) y hemodiálisis (OR 3,35; IC 95% 1,5-7,7). No se encontraron diferencias en mortalidad entre los grupos de pacientes con candidemia y el grupo control (39,5 frente a 36,5%; p = 0,66). CONCLUSIONES: Se identificaron como factores de riesgo para candidemia en Colombia la larga estancia hospitalaria, la cirugía abdominal, el uso de meropenem y la hemodiálisis

OBJECTIVES: Due to the increase in isolation of Candida spp. in critically ill patients, and the high mortality and economic costs which this infection entails, a study was made of the risk factors associated to candidemia in critically ill patients from 7 intensive care units in Colombia. MATERIALS AND METHODS: A multicenter matched case-control study was conducted in 7 intensive care units of 3 university hospitals. Data on overall length of hospital stay (including both general wards and the intensive care unit) were recorded. RESULTS: A total of 243 subjects (81 cases and 162 controls) between January 2008 and December 2012 were included. In order of frequency, C. albicans, C. tropicalis and C. parapsilosis were isolated. The main identified risk factors were: overall length of hospital stay>25 days (OR 5.33, 95% CI 2.6-10.9), use of meropenem (OR 3.75, 95% CI 1.86-7.5), abdominal surgery (OR 2.9, 95% CI 1.39-6.06) and hemodialysis (OR 3.35, 95% CI 1.5-7.7). No differences in mortality between patients with candidemia and controls were found (39.5 vs. 36.5%, respectively, P=.66) were found. CONCLUSIONS: In Colombia, a long hospital stay, abdominal surgery, the use of meropenem and hemodialysis were identified as risk factors for candidemia