Effectiveness of 23-valent pneumococcal polysaccharide vaccine in adults aged 60 years and over in the Region of Madrid, Spain, 2008-2011.

Invasive pneumococcal disease (IPD) is a notifiable disease in the Region of Madrid. The 23-valent pneumococcal polysaccharide vaccine (PPV23) is recommended for children and adults aged two years or over with a high risk of disease, and for all adults aged 60 and over. We describe the evolution of IPD incidence from 2008 to 2011 in people aged 60 years and over and PPV23 vaccine effectiveness (VE). VE is estimated using both the screening method and indirect cohort method. The incidence of IPD varied from 20.0 in 2008 to 15.2 per 100,000 inhabitants in 2011 (RR: 0.8; 95% CI: 0.6­0.9). Adjusted VE estimated with the screening method was 68.2% (95% CI: 56.2­76.9). VE with the Broome method was 44.5% (95% CI: 23.8­59.6) for all PPV23 serotypes, and 64.4% (95% CI: 45.2­76.8) for PPV23 serotypes not included in conjugate vaccines. VE was lower in patients aged 80 years and older (25.5%; 95% CI:-23.2 to 55.0) and those with highrisk medical conditions (31.7%; 95% CI: -2.2 to -54.4). Adjusted VE was 44.5% (95% CI: 19.4-61.8) within 5 years of vaccination and 32.5% (95% CI: -5.6 to 56.9) after 5 years. These results are compatible with current recommendations for PPV23.

[Evaluation of the change in pneumococcal vaccination in 2018 in adults in the Community of Madrid]. / Evaluación del cambio de pauta de vacunación frente al neumococo de 2018 en la población adulta en la Comunidad de Madrid.

BACKGROUND: In the Community of Madrid since 2005 vaccination against pneumococcus in adults from 60 years of age has been carried out with pneumococcal polysaccharide vaccine (PPV23). In January 2018, the guideline changed in favor of pneumococcal conjugate vaccine (PCV13). The objective of this study was to analyze the data of pneumococcal vaccination and to evaluate the implementation of the new guideline of vaccination against pneumococcus in adults in the Community of Madrid. METHODS: Cross-sectional study to estimate vaccine coverage by a retrospective review of the record of vaccination history of people ≥60 years resident in the Community of Madrid. RESULTS: In the Community of Madrid until 2018, 83% of the population were vaccinated with PPV23, 6% with PCV13 and 11% with both vaccines. 96.5% came from Primary Care records. The doses administered of PCV13 surpassed those of PPV23 in ≥60 years in all age groups. 78,660 people ≥60 years were vaccinated with PCV13 (19.5% without risk factors, 67.3% with chronic diseases, 2.5% of the high-risk group and 10.7% belonging to both groups). CONCLUSIONS: In 2018, following Community of Madrid recommendations, 6,639 people were not properly vaccinated with PCV13 and 72,021 (91.6%) were properly vaccinated. The greatest confusion occurred in people ≥60 years without risk factors who had a previous PPV23 and did not require another vaccine but received a PCV13 without complying with the recommended schedule.

Comparison of different advanced oxidation processes (AOPs) in the presence of perovskites.

The efficacy of the oxidation systems: O3, UV radiation, O3/UV radiation, O3/perovskite, UV radiation/perovskite, O3/UV radiation/perovskite, H2O2/UV radiation, H2O2/UV radiation/perovskite, has been investigated by using pyruvic acid as probe compound. Under the operating conditions used, the combination of UV radiation and hydrogen peroxide (with or without perovskites) leads to the fastest pyruvic acid removal while the best results in terms of mineralization degree are obtained when combining O3/UV radiation/perovskite. The effect of the variables: inlet ozone (15-75 mg L(-1)) and initial pyruvic acid (10(-3) to 10(-2)M) concentrations, catalyst load (0.01-1.5 g L(-1)) and pH (2-9) was investigated for the photocatalytic ozonation. The most influencing parameter was the ozone concentration fed to the photoreactor. A zero order was observed for pyruvic acid concentration and close to zero for catalyst load. Some deactivation is observed after reusing the catalyst, likely due to leaching of the active phase.

Photocatalysis of fluorene adsorbed onto TiO2.

The adsorption of fluorene onto TiO2 has been investigated by conducting equilibrium and kinetic experiments. Adsorption isotherms have been evaluated at two different pHs in the range of temperatures 296-325 K. The type III isotherm shapes obtained were modelled by considering several expressions taken from the literature. Temperature exerted a positive influence in fluorene uptake. Addition of phosphates involved a negative effect when computing the final equilibrium fluorene removal. The kinetic experiments carried out at 296 K corroborated the competitiveness of phosphates to occupy the active sites on the titania surface. Nevertheless, equilibrium conditions are faster achieved at pH 2 than at pH 5. The photocatalysis of fluorene at different initial concentrations of the parent compound revealed a slight improvement of the process at pH 5 if compared to the results obtained at pH 2. A Langmuir-Hinselwood representation of the data confirms the previous statement. Catalyst load shows an optimum, concentration values of the photocatalyst above the optimum provoke a decrease in the fluorene abatement rate. Reutilisation of the catalyst indicates that fluorene is completely eliminated from the solid, i.e. it is suggested that fluorene and intermediates are surface oxidised.

Gastric pouch carcinoma after gastric bypass for morbid obesity.

The relationship between bariatric surgery and gastric cancer is conjectural. We present a 52-year-old woman with BMI 45 operated initially by a Lap-Band procedure complicated by gastric wall erosion of the band 9 months later. She was re-operated and the band was removed. She subsequently underwent a Roux-en-Y gastric bypass. 5 years after, gastric carcinoma was discovered in the gastric pouch. Because of varied symptoms following bariatric surgery, patients may not present promptly with symptoms related to a gastric carcinoma.

Synthesis of ordered macroporous SiO2 in supercritical CO2 using 3D-latex array templates.

Ordered macroporous SiO(2) membranes were produced by the decomposition of silicon alkoxides in supercritical carbon dioxide (scCO(2)) using 3D-latex arrays as templates.

Characterization of latex particle arrays by gas adsorption.

Assemblies of colloidal particles are frequently used in novel applications, and this requires nondestructive methods allowing overall characterization of the sample and collection of information about the quality of the arrays. From suspensions of polystyrene, poly[styrene-co-(2-hydroxyethylmethacrylate)], poly[styrene-co-acrylic acid], and poly[styrene-co-methacrylic acid], assemblies of spherical particles were obtained by elimination of the solvent in different ways-evaporation, gravity deposition, and filtration. These latex particle packings were characterized by scanning and transmission electron microscopy and by gas adsorption to determine the efficiency of packing. The surface area, total pore volume, and pore size distributions obtained from the adsorption and desorption data were related to characteristic parameters calculated for cubic close-packed spherical particles.

Mast cells in the Harderian gland of female Syrian hamsters during the estrous cycle and pregnancy: effects of the light/dark cycle.

The number of identifiable mast cells and the intraluminal area occupied by porphyrin deposits was studied on semithin sections from female hamster Harderian glands during the estrous cycle and pregnancy. Although the serum levels of estradiol, progesterone, luteinizing hormone and follicle stimulating hormone exhibited significant changes throughout the cycle, no correlation between these changes and the variations in the number of recognizable mast cells was observed. However both during diestrous 1 and proestrous cycles, the number of identifiable mast cells was higher at midnight than at noon (in 14 h light:10 h dark photoperiod with lights on at 07:00 h). A more exhaustive study revealed the presence of 'degranulated mast cells' which were not stained with toluidine blue. Thus, a diurnal cycle in degranulation might occur in the Harderian glands from female hamsters. No significant variations were observed in the area occupied by intraluminal porphyrin deposits during the estrous cycle. However, both the relative number of mast cells and the area occupied by intraluminal porphyrins decreased from day 4 of pregnancy to day 14 showing a strong correlation. The Harderian glands from female Syrian hamsters might provide a useful model for the study of mast cell degranulation during porphyria.

Orbital cup. A device to facilitate ultrasound biomicroscopic examination of pars plana and peripheral retina.

Ultrasound biomicroscopy is a useful technique for anterior segment evaluation; however, examination of the pars plana and the peripheral retina is difficult. We describe a method that facilitates ultrasound biomicroscopic examination of these areas using using a modified swimming goggle(orbital cup) and an eyelid speculum. With this method, not only the pars plana but also structures up to 15 mm from the temporal limbus can be readily imaged.

Epidermoid carcinoma of the lung in stage I: factors of prognostic interest.

Factors affecting stage I epidermoid cancer of the lung were studied in a series of 29 patients treated only by surgery and followed up for ten years. A set of 13 variables with a possible influence on prognosis were investigated. The application of the Cox Univariate Analysis to the different variables showed the grade of cell differentiation and the mitotic index to be predictors. In the Cox Multivariate Analysis, the proportional regression equation revealed two independently significant variables (p < 0.01), which were the Mitotic Index and Nuclear Area. Grouping patients on the basis of the prognostic variables indicated allows a better prediction for survival to be made for this series of patients.

Ultrasound biomicroscopy in pars planitis.

PURPOSE: To report the diagnosis of pars planitis on the basis of ultrasound biomicroscopy images. METHODS: The Humphrey ultrasound biomicroscope was used for examination of the right eye of a 17-year-old boy, referred to our clinic because of blurred vision. The lens showed a posterior subcapsular cataract precluding fundus visualization. RESULTS: Ultrasound biomicroscopy showed a homogeneous mass of medium reflectivity over the pars plana. Lensectomy and vitrectomy confirmed the diagnosis. CONCLUSION: This brief case report points out the utility of ultrasound biomicroscopy in diagnosing pars planitis in cases of media opacities.

Laparoscopic approach to incisional hernia.

BACKGROUND: After more than 8 years of working in the field, we thought it would be interesting to evaluate our experience in the laparoscopic repair of abdominal wall hernias, focusing attention on the lessons learned with time. METHODS: From January 1994 to November of 2000, a total of 270 patients with abdominal wall hernias were treated in our center using the laparoscopic approach. The data collected and analyzed were preoperative evaluation, operative findings, early and long-term complications, and recurrences. RESULTS: The mean follow-up time was 44 months, mean surgical time was 85 min, and mean hospital stay was 1.5 days. The average number of abdominal wall defects was 4.8 per patient. There were 9 (3.3%) small bowel perforations. Conversion to open surgery was required in 1 case (0.3%). Minor early postoperative complications occurred in 38 patients (14.07%). Twenty patients (7.4%) developed persistent postoperative abdominal pain. There was 1 case (0.3%) of small bowel incarceration through the mesh border and another case (0.3%) of small bowel leakage due to ischemia and subsequent peritonitis. The relapse rate was 4.4% (12 cases). CONCLUSION: The laparoscopic approach is a valuable option in the management of abdominal wall hernias, but it requires experience in laparoscopic surgery and there is a specific learning curve for the technique.

Influence of preservation solution on early lung function (Euro-Collins vs Perfadex).

BACKGROUND: This clinical study was performed to evaluate the efficiency of 2 different preservation solutions (Euro-Collins [EC] vs Perfadex [P]) on organ function in human lung transplantation. METHODS: The donor lungs for 46 patients were flushed either with EC solution (25 cases, EC group) or Perfadex (21 cases, P group). Transplant function was assayed using PaO2/FiO2 ratio after transplantation upon intensive care unit (ICU) arrival and at 12 and 24 hours later (T1, T2, and T3, respectively). We also compared the duration of mechanical ventilatory support and ICU stay. RESULTS: The PO2/FiO2 ratio was significantly better in the P than EC group at T1, T2, and T3. The duration of mechanical ventilatory support and ICU stay were lower also in P group, whereas age, sex, aetiology of lung disease, donor, PaO2/FiO2 ratio, and ischemia time did not show differences between the 2 groups. CONCLUSIONS: Our data on graft function tend to confirm better graft preservation using the P preservation solution.

Treatment of swine summer infertility syndrome by means of oxytocin under field conditions.

Endogenous oxytocin is released by the sow at the time of mating in response to stimulation by the boar, which may explain, at least partially, the importance of the relationship between the boar's courting activity and the subsequent reproductive performance of the sow. The aim of this study was to determine the effects on reproductive performance of supplementing AI doses with exogenous oxytocin during the low fertility season. At an intensive piggery in northwest Spain 3 experimental groups were randomly formed and observed throughout the year. Group 1 sows were inseminated with semen supplemented with 4 IU oxytocin. Group 2 sows received 4 IU oxytocin injected through the vulvar lips mucosa at the time of insemination. Group 3 sows were inseminated without oxytocin and served as the controls. During the low fertility season the results for each group were as follows: farrowing rate 77.02, 56.25 and 54.39%, and litter size 10.77 +/- 0.28, 10.45 +/- 0.31 and 8.53 +/- 0.34 respectively. It is concluded that the addition of oxytocin to seminal doses just before AI is an easily applicable, effective method for increasing fertility and litter size during the summer months.

Sheep embryo cryopreservation by vitrification and conventional freezing.

The survival of ovine embryos (morulae and blastocysts) either frozen by a conventional method or vitrified was investigated in culture. In Experiment I, embryos were vitrified using a solution containing 25% propylene glycol and 25% glycerol. A group of embryos (simulated control) was processed without freezing to evaluate the toxicity of the vitrification solution. In Experiment II, embryos were exposed to a solution of PBS containing 10% glycerol and 0.25 M sucrose placed horizontally in a programmable freezer. Automatic seeding was applied at -7 degrees C in 2 positions on straws and cooled at -0.3 degrees C/min to -25 degrees C and then stored in liquid nitrogen. In vitro development rates of vitrified embryos were 12% (morulae) and 19% (blastocysts). Simulated embryos showed a higher rate of survival than embryos cryopreserved by vitrification (67 and 63%, morulae and blastocysts respectively). In conventional cooling, the blastocysts showed the highest viability percentage (67%) of all the experimental groups but these values decreased significantly in morulae (31%). Differences in temperature between straws placed in distinct positions in the freezing chamber and thermic deviation were observed when automatic seeding was applied. Embryo viability differed from 51 to 75% according the relative position of the embryos within the chamber. Survival was higher when automatic seeding was applied on the meniscus of the embryo column versus the central point of this column (65 vs 21%). The damage of both cryopreservation methods on zona pellucida integrity (27 and 35% in vitrified and conventionally frozen embryos, respectively) had no effect on the in vitro survival.

Laparoscopic intraperitoneal onlay polytetrafluoroethylene mesh repair (IPOM) for inguinal hernia during spinal anesthesia in patients with severe medical conditions.

In patients with severe pulmonary disease, laparoscopic techniques are not advised. The authors report their preliminary experience with laparoscopic intraperitoneal onlay polytetrafluoroethylene mesh repair for inguinal hernia during spinal anesthesia in patients with chronic obstructive pulmonary disease. Spinal anesthesia was performed using hyperbaric bupivacaine (3-3.5 mL) injected at L2-L3. If necessary, additive opioid therapy was administered. Under low-pressure pneumoperitoneum (10 mm Hg), polytetrafluoroethylene mesh was stapled securely on the posterior inguinal wall to spare epigastric and iliac vessels. Fifteen patients underwent surgery. Median age was 62 years. All patients were classified American Society of Anesthesiologists physical status III/IV. Mean forced expiratory volume in the first second was 1.1 L/s. Median operating time was 20 minutes. Postoperative recovery was uneventful for all patients. The average duration of hospital stay was 1.5 days. Seroma or hematoma was not noted. Six-month follow-up did not show recurrence or infection. This technique is an effective method of repair of inguinal hernia in patients with severe chronic obstructive pulmonary disease, and it provides a maximum of comfort.

[The prognosis of mediastinal lymph node infiltration (N2) in patients with non-small-cell lung carcinoma (NSCLC) who have undergone curative treatment]. / Pronóstico de la infiltración ganglionar mediastínica (N2) en pacientes con carcinoma de pulmón de células no microcelulares (CPCNM) intervenidos con intenciones curativas.

In this prospective study of 148 surgically treated patients with non-small cell carcinoma of the lung (NSCLC) who were followed for 5 to 7 years, we analyzed the prognostic value of mediastinal lymph node invasion (N2) and survival after 5 years depending on different characteristics. Forty-two (28.4%) patients were N2. Survival in this sample was 9%. Twenty-seven T2N2 patients (among whom survival was 13%) were selected from this group and classified according to whether lymph node invasion was intranodal (survival 39%) or extracapsular (survival 5%) (p < or = 0.05). We also evaluated the prognostic value of different ganglionic areas in accordance to the maps suggested by the American Thoracic Society (ATS). There were no survivors for areas 2, 8 and 9, and no patient with invasion of more than two areas lived more than 18 months. Significant differences in survival were found among patients with invasion of areas 10 and 11. We conclude a) that global analysis of N2 is of such little value in predicting survival that surgery is not justified unless screening criteria are applied; b) that extracapsular invasion rules out surgical treatment; c) that the prognostic value of ganglionic areas is not entirely clear, although the prognosis seems to be poorer for invasion of areas 2, 8 and 9 or invasion of more than 2 areas, and d) that invasion of area 10 would appear to be better classified as N2 than as N1.

[Unilateral diaphragmatic paralysis treated successfully by plication]. / Parálisis diafragmática unilateral tratada con éxito mediante plicatura diafragmática.

Unilateral diaphragmatic paralysis is rare and usually due to interrupted phrenic nerve conduction of impulses. The idiopathic form is the most common and viral infection has been suggested as the cause. Generally, clinical repercussions are few but may be severe in some cases. We report a case of unilateral diaphragmatic paralysis that was successfully treated by plication of the diaphragm affected.

[The role of computed tomography (CT) of the thorax in defining the anatomical extent in bronchogenic carcinoma (BC)]. / Papel de la tomografía computarizada (TC) de tórax en la definición de la extensión anatómica en el carcinoma broncogénico (CB).

A series of 129 carriers of non-small cell bronchogenic carcinoma (BC), in whom computed tomography (CT) of the thorax was performed as part of the preoperative study, are presented. The results of CT were compared with those of thoracotomy in terms of sensitivity (SEN), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV). Thoracic wall (prevalence 0.18): SEN, SP, PPV and NPV were 0.65, 0.92, 0.63 and 0.92, respectively. In peripheral tumors these values were 0.85, 0.90, 0.69 and 0.96, respectively. CT demonstrating invasion of the thoracic wall thus requires confirmation for the purpose of surgical staging. If CT reveals an intact wall, however, surgery may take place immediately. Malignant mediastinal lymph nodes: (prevalence 0.36): SEN, SP, PPV, and NPV were 0.70, 0.89, 0.78 and 0.84, respectively. For peripheral tumors these values were 0.78, 0.93, 0.82 and 0.91, respectively. CT demonstrating malignant mediastinal lymph nodes should be confirmed by mediastinoscopy. If mediastinal malignancy is not observed by CT, thoracotomy may be performed in peripherally located tumors; in centrally located tumors, however, the absence of adenopathy should be confirmed by mediastinoscopy.

[A multivariate prospective study of prognostic factors in non-small-cell lung carcinoma (NSCLC): the results at 5 years]. / Estudio prospectivo multivariante sobre factores pronósticos en el carcinoma de pulmón no microcelular (CPNM): resultados a 5 años.

We present the results of a 5-year prospective study of 153 patients with a diagnosis of bronchogenic carcinoma (BC) who underwent curative surgery. Clinical and anatomical variables were analyzed by multiple regression analysis for prediction of death. Among the anatomical variables, the most significant were the following: stages of anatomical spread (p < or = 0.00000), ganglionic state (p < or = 0.00000), type for surgery (curative or non-curative) (p < or = 0.00000) and state of tumor (p = 0.00012). Significant clinical variables were clinical stage by Feinstein's classification (p = 0.00037), functional capacity (ECOG scale) (p = 0.01196) and tumor size measured conventionally (p = 0.01196). These variables were entered into a multivariate model for prognostic prediction in order to determine the patient's relative risk over time. The best combination of anatomical variables was obtained by associating the stages of spread and ganglionic state (chi 2 = 34.24; p = < 0.00000); the best combination of clinical variables was clinical stage and tumor size (chi 2 = 17.37; p = 0.00023). Thus, although the anatomical variables are more important than clinical ones, the latter have independent prognostic value, are easy to obtain and are available before surgery. They therefore represent an alternative to prognosis based on anatomical spread.