Characteristics, incidence and temporal trends of sepsis in elderly patients undergoing surgery.

BACKGROUND: Despite increasing rates of surgery in the elderly, there is limited population-based information on sepsis in this age group. This study aimed to characterize the epidemiology and national trends of sepsis among elderly patients undergoing surgery in Spain. METHODS: This population-based longitudinal study of patients aged 65 years or older, undergoing surgery between 2006 and 2011, used data from the national hospital discharge database. Patients were identified by ICD coding. Primary endpoints were incidence and case-fatality rates of sepsis. Predefined age groups were examined. In-hospital mortality-related factors were assessed by means of exploratory logistic regression. Trends were assessed for annual percentage change in rates using Joinpoint regression analysis. RESULTS: A total of 44 342 episodes of sepsis were identified, representing 1·5 per cent of all 2 871 199 surgical hospital admissions of patients aged 65 years or older. The rates varied with age and sex. The in-hospital case-fatality rate was 43·9 per cent (19 482 patients), and associated with age, co-morbidity and organ dysfunction. Standardized rates of sepsis increased over time, with an annual change of 4·7 (95 per cent c.i. 1·4 to 8·5) per cent, whereas the case-fatality rate declined, with an overall annual change of -3·6 (-4·3 to -2·8) per cent. The decrease in mortality was more limited in patients with organ dysfunction and in the oldest age group. CONCLUSION: Rates of sepsis are increasing among elderly patients undergoing surgery, whereas in-hospital case fatality, although common, is showing a decreasing trend.

Use of explicit ICD9-CM codes to identify adult severe sepsis: impacts on epidemiological estimates.

BACKGROUND: Severe sepsis is a challenge for healthcare systems, and epidemiological studies are essential to assess its burden and trends. However, there is no consensus on which coding strategy should be used to reliably identify severe sepsis. This study assesses the use of explicit codes to define severe sepsis and the impacts of this on the incidence and in-hospital mortality rates. METHODS: We examined episodes of severe sepsis in adults aged ≥18 years registered in the 2006-2011 national hospital discharge database, identified in an exclusive manner by two ICD-9-CM coding strategies: (1) those assigned explicit ICD-9-CM codes (995.92, 785.52); and (2) those assigned combined ICD-9-CM infection and organ dysfunction codes according to modified Martin criteria. The coding strategies were compared in terms of the populations they defined and their relative implementation. Trends were assessed using Joinpoint regression models and expressed as annual percentage change (APC). RESULTS: Of 222 846 episodes of severe sepsis identified, 138 517 (62.2 %) were assigned explicit codes and 84 329 (37.8 %) combination codes; incidence rates were 60.6 and 36.9 cases per 100 000 inhabitants, respectively. Despite similar demographic characteristics, cases identified by explicit codes involved fewer comorbidities, fewer registered pathogens, greater extent of organ dysfunction (two or more organs affected in 60 % versus 26 % of cases) and higher in-hospital mortality (54.5 % versus 29 %; risk ratio 1.86, 95 % CI 1.83, 1.88). Between 2006 and 2011, explicit codes were increasingly implemented. Standardised incidence rates in this cohort increased over time with an APC of 12.3 % (95 % CI 4.4, 20.8); in the combination code cohort, rates increased by 3.8 % (95 % CI 1.3, 6.3). A decreasing trend in mortality was observed in both cohorts though the APC was -8.1 % (95 % CI -10.4, -5.7) in the combination code cohort and -3.5 % (95 % CI -3.9, -3.2) in the explicit code cohort. CONCLUSIONS: Our findings suggest greater and increasing use of explicit codes for adult severe sepsis in Spain. This trend will have substantial impacts on epidemiological estimates, because these codes capture cases featuring greater organ dysfunction and in-hospital mortality.

Biological characterization of the skin of shortfin mako shark Isurus oxyrinchus and preliminary study of the hydrodynamic behaviour through computational fluid dynamics.

This study characterized the morphology, density and orientation of the dermal denticles along the body of a shortfin mako shark Isurus oxyrinchus and identified the hydrodynamic parameters of its body through a computational fluid-dynamics model. The study showed a great variability in the morphology, size, shape, orientation and density of dermal denticles along the body of I. oxyrinchus. There was a significant higher density in dorsal and ventral areas of the body and their highest angular deviations were found in the lower part of the mouth and in the areas between the pre-caudal pit and the second dorsal and pelvic fins. A detailed three-dimensional geometry from a scanned body of a shark was carried out to evaluate the hydrodynamic properties such as drag coefficient, lift coefficient and superficial (skin) friction coefficient of the skin together with flow velocity field, according to different roughness coefficients simulating the effect of the dermal denticles. This preliminary approach contributed to detailed information of the denticle interactions. As the height of the denticles was increased, flow velocity and the effect of lift decreased whereas drag increased. The highest peaks of skin friction coefficient were observed around the pectoral fins.

Magnetoelastic contribution in domain wall propagation of micrometric wires.

We report on studies of domain wall propagation of magnetically-bistable Fe-Co-rich microwires paying attention on the effect of applied and internal stresses. We measured magnetic domain propagation in various magnetic Fe-Co-rich amorphous microwires with metallic nucleus diameters (from 2.8 microm to 18 microm) using Sixtus Tonks-like experiments. We found that application of applied stresses and increasing of internal stresses result in decreasing of domain wall (DW) velocity. We assume that in order to achieve higher DW propagation velocity at the same magnetic field and enhanced DW mobility, special attention should be paid to the decrease of magnetoelastic energy.

Implementing artificial insemination as an effective tool for ex situ conservation of endangered avian species.

Approximately 503 of the known species of birds are classified as 'endangered' or 'critical'. Captive propagation programs have proven useful in maintaining genetic diversity and restoring wild populations of certain species, including the Peregrine falcon, California condor and Whooping crane. Artificial insemination (AI) has the potential of solving problems inherent to reproductive management of small, closed populations of endangered birds, including dealing with demographic instability, physical and behavioral disabilities, sexual incompatibility, lack of synchrony, and need to maintain gene diversity. In this review, we address the necessary methods and factors that allow AI to be applied effectively to manage rare bird populations. It is clear that semen availability and quality are the greatest limiting factors to implementing consistently successful AI for birds. Behavioral sensitivity to animal handling and the ability to minimize stress in individual birds also are keys to success. Multiple, deep vaginal inseminations can improve fertility, particularly when semen quality is marginal. Laparoscopic methods of semen transfer also have produced fertile eggs. All of these practices leading to successful AI remain dependent on having adequate basic knowledge on female reproductive status, copulatory behavior, endocrine profiles and duration of fertility, especially as related to oviposition. The overall greatest challenge and highest priority is defining these normative traits, which are highly species-specific.

Engineering of Magnetic Softness and Domain Wall Dynamics of Fe-rich Amorphous Microwires by Stress- induced Magnetic Anisotropy.

We observed a remarkable improvement of domain wall (DW) mobility, DW velocity, giant magnetoimpedance (GMI) effect and magnetic softening at appropriate stress-annealing conditions. Beneficial effect of stress-annealing on GMI effect and DW dynamics is associated with the induced transverse magnetic anisotropy. An improvement of the circumferential permeability in the nearly surface area of metallic nucleus is evidenced from observed magnetic softening and remarkable GMI effect rising. We assumed that the outer domain shell with transverse magnetic anisotropy associated to stress-annealing induced transverse magnetic anisotropy affects the travelling DW in a similar way as application of transversal bias magnetic field allowing enhancement the DW velocity. Observed decreasing of the half-width of the EMF peak in stress-annealed microwires can be associated to the decreasing of the characteristic DW width. Consequently, stress annealing enabled us to design the magnetic anisotropy distribution beneficial for optimization of either GMI effect or DW dynamics.

Influence of antiretroviral treatment on quality of life in seropositive inmates.

The aim of the study is to evaluate the influence of antiretroviral treatment on health-related quality of life (HRQOL) of three groups of HIV-positive inmates: those who are taking antiretroviral treatment, those who are not on treatment as it has not yet been indicated, and those who refuse to take treatment even though it has been recommended. A cross-sectional study was conducted on 585 HIV+ inmates in three prisons. The response variable was HRQOL. Independent variables were: sociodemographic variables, psychosocial and drug-related variables. Two multivariate linear regression models were constructed in order to determine the HRQOL, physical health score (PHS) and mental health score (MHS), for each of the three groups identified, using patients who refused treatment as the reference category. Patients who refused therapy had a lower MHS compared with patients in whom treatment was not indicated (P = 0.038). With regard to PHS, patients refusing therapy had a lower score than patients who were not indicated therapy (P = 0.005), and than patients receiving therapy (P = 0.010).

Tailoring of magnetoimpedance effect and magnetic softness of Fe-rich glass-coated microwires by stress- annealing.

There is a pressing need for improving of the high-frequency magneto-impedance effect of cost-effective soft magnetic materials for use in high-performance sensing devices. The impact of the stress-annealing on magnetic properties and high frequency impedance of Fe-rich glass-coated microwires was studied. Hysteresis loops of Fe-rich microwires have been considerably affected by stress- annealing. In stress-annealed Fe- rich microwire we obtained drastic decreasing of coercivity and change of character of hysteresis loop from rectangular to linear. By controlling stress-annealing conditions (temperature and time) we achieved drastic increasing (by order of magnitude) of giant magnetoimpedance ratio. Coercivity, remanent magnetization, diagonal and of-diagonal magnetoimpedance effect of Fe-rich microwires can be tuned by stress-annealing conditions: annealing temperature and time. Observed experimental results are discussed considering relaxation of internal stresses, compressive "back-stresses" arising after stress annealing and topological short range ordering.

Marine protected area design patterns in the Mediterranean Sea: Implications for conservation.

Mediterranean marine protected area (MPA) design patterns regarding geographic distribution, size, spacing and shape were analysed as a proxy of the region's MPA's ecological effectiveness and a first step towards an ecologically coherent MPA network. Results for legally designated MPAs and ecologically functional MPAs accounting for overlaps are presented. Geographically, Mediterranean MPA area is very unevenly distributed, with four-fifths concentrated in just three countries of the north-western part of the basin. Average distance between functional MPAs lies within recommended ecological thresholds, which suggests adequate potential connectivity of the Mediterranean MPA system. Mediterranean designated MPAs are larger than MPAs worldwide on average, although they are generally smaller than international guidance suggests at different levels: ecoregion, country and designation category. On average, Mediterranean designated and functional MPAs have relatively high compactness, which makes them prone to spillover and adequate viability, and less vulnerable to edge effects.

Seroprevalence of avian paramyxovirus 1, 2, and 3 in captive and free-living birds of prey in Spain (preliminary results): implications for management of wild and captive populations.

Since December 1997, 700 blood plasma samples from 31 different species of captive and free-living birds of prey from Spain were analyzed by hemagglutination inhibition (HI) test for the presence of antibodies to avian paramyxovirus (aPMV) 1,2, and 3. Out of 700 birds, 120 tested positive for aPMV-1, 10 birds had antibodies to aPMV-2, and 4 birds tested positive against aPMV-3. Prevalence of antibodies against aPMV-1 was significantly higher in captive than in free-living birds of prey and in Falconiformes than in Strigidae and Accipitridae. Infection or exposure in captive birds may be due to the use of avian-derived food in rehabilitation and captive-breeding centers. This may be of concern at the time of reintroduction of these birds into free-living populations.

Fractionation and amino acid composition of an aspartic acid-containing thermal proteinoid population.

The heterogeneity of an aspartic acid-containing thermal polymer population has been studied by anion exchange chromatography, amino acid analysis of the resulting fractions and data processing by the principal components method. By using stepwise or continuous gradients of ionic strength both saw-toothed or bell-shaped elution profiles were obtained. This behaviour and the amino acid composition of analyzed fractions suggest a relatively high degree of heterogeneity in the polymer population although less than theoretically expected. This conclusion is compared with the findings reported in proteinoids made by similar procedures.

Chaunocephalus ferox in free-living white storks in central Spain.

Ten out of 42 (23.8%) white storks (Ciconia ciconia) admitted to two rehabilitation centers in central Spain had lesions caused by the trematode Chaunocephalus ferox in the small intestinal wall. Fourteen of the examined birds were adults, five were subadults, and 23 were chicks of various ages. Parasitation was 32% (n = 8) in chicks and 13% (n = 2) in adult birds, whereas no juvenile bird was affected. Among dead birds, stork chicks affected by C. ferox lesions had a lower body weight (2196.1 g, SD = 814.2) than storks without lesions (2965.8 g, SD = 742.9, P < 0.05). Two chicks were additionally infected with Salmonella subspecies I serotype enteritidis 1,9,12: g, m:1, 7. Prevalence of the parasite in the examined birds was lower than in a population of Asian open-billed storks (Anastomus oscitans), in which it was pathogenic due to the destruction of the tunica muscularis and formation of large granulomatous lesions in the wall of the postduodenal portion of the small intestine. Pathogenic alterations caused by C. ferox are presumed to be related to numbers of adults present. Because storks admitted to rehabilitation centers suffer stress due to various reasons that may lower their immune response and exacerbate existing infections, the analysis of fecal sediments of white storks admitted for rehabilitation is recommended.

A cyclobutane carbonucleoside with marked selectivity against TK+ and TK- varicella zoster virus.

Several cyclobutyladenine and analogous carbonucleosides were synthesized from 1R-alpha-pinene and their anti-viral activity was tested. One of them (3e) showed interesting selectivity against both TK+ and TK- VZV.

[Effectiveness of dermatologic minor surgery in the office of the family physician and patient satisfaction in relation with ambulatory surgery]. / Efectividad de la cirugía menor dermatológica en la consulta del médico de familia y satisfacción del paciente en relación con la cirugía ambulatoria.

BACKGROUND: The minor surgery by family physicians increase the primary care competences. The purpose of this work is to prove patients' satisfaction and minor surgery effectiveness practiced by family physicians in health centers with respect to ambulatory's general surgeon. MATERIAL AND METHODS: Case-control retrospective study, comparing dermatological surgical procedures performed by 4 family physicians and 8 3rd-year Family Physician residents with surgical procedures wade made by a surgeon over one a year period. Variables analysed include: descriptive samples homogeneity, surgery effectiveness (waiting time, esthetic results, healing time and number of visits, and histopathologic correlation) and patients' satisfaction (with the waiting time, with the results of surgery and with the physician). RESULTS: Minor surgical procedures carried out by 146 family physicians and 61 general surgeons were compared, in congruence with the analyzed descriptive homogeneity's parameters. Family physicians average waiting time was the lower, with a mean of 45 days less than the surgeon. Patient's satisfaction with the physician was higher when family physician were involved (p < 0.001); the same could be applied for the waiting time (p < 0.001). There were no significant differences over the effectiveness and patients' satisfaction. CONCLUSION: The dermatologic minor surgery by family physician is effective, satisfactory for patients, and has less waiting time. This results justify the introduction of minor surgery in the family physicians office.

[Surgical management of polycystic liver]. / Manejo quirúrgico de la poliquistosis hepática.

Three patients with polycystic liver disease, needing surgical treatment, are reported. In two cases surgical indication was continuous pain and compressive symptoms from an abdominal mass, and in the third case was an infection of the cyst. All patients were treated by fenestration combined with resection of cysts. The postoperative course was uneventful in two patients, but hepatic failure developed in the third case, needing hepatic transplantation. This patient died during this operation. The complications of the disease and its surgical management are revised.

[Biliary ileus: enterolithotomy only or radical surgery?]. / Ileo biliar: sólo enterolitotomía o cirugía definitiva?

Eleven patients, 8 women and 3 men, mean age 69.9 years (range 54-81) were operated with a gallstone ileus during a seven years period. Echography and barium study of small bowel were made in 8 and 2 patients, and gave a diagnostic rate of 37% and 100%, respectively. A preoperative diagnosis was made in 72.2% of cases, simple enterolithotomy was made in 8 cases and in three cases a definitive treatment of biliary pathology was added. There was no mortality and a major complication was observed in 1 patient without biliary surgery (evisceration and recurrence of biliary ileus); no major complications were seen in patients with primary biliary surgery. With a careful, selection, surgery can be made without mortality nor morbidity.

[Diagnostic significance of systematic neonatal urinary echography. Therapeutic implications]. / Valor diagnostico de la ecografia urinaria sistematica neonatal. Implicaciones terapeuticas.

A total of 9,959 ultrasonography studies of the upper excretory urinary system during the first three days of life of all the children born in this centre were carried out over a period of three years. Sonographic abnormalities were found in 125 patients (1.26 per 100) consisting of: Prominent pelvis in 35, pyelic ectasia in 45, hydronephrosis in 16, ureterohydronephrosis in seven, renal agenesis in 14, multicystic kidney in two, renal ectopia en two, other anomalies in four. There had been prenatal sonographic diagnosis of the urinary tract abnormality in 24 patients, all with pyelic ectasia or hydronephrosis. The sonography of the patients with prominent pelvis normalized before three months of age. Intravenous urography was performed on most of the remaining 90 patients, confirming the diagnosis in the greater part, and serial voiding cystourethrography which detected vesicoureteric reflux in 21 of 77 patients. The definitive diagnosis was arrived at in all patients after carrying out the sonography and the uroradiological test. This made prophylactic antibiotic treatment possible in many of the cases and surgical correction of the anomaly in 30, performing pyeloureteroplasty in 11, neo-ureterocystostomy in 10, nephrectomy in five, heminephroureterectomy in three and derivation to the skin in one. Twenty of these patients were operated before three months of age. The number of uropathies operated at early ages at this centre has risen remarkably since introduction of systematic neonatal urinary sonography.