Aspectos epidemiológicos del traumatismo múltiple en un hospital de referencia: experiencia de 1 año

Se ha realizado un estudio epidemiológico de los traumatismos múltiples (TM) atendidos en el Servicio de Traumatología del Hospital Clínico de Valencia en 1992. De los 285 casos ingresados en el centro, 180 tuvieron su ingreso final en el Servicio de Traumatología. Ciento treinta y tres casos fueron varones y 47 mujeres, con edad media de 33 años. Se analizaron las variables edad, sexo, mecanismo lesional, días de ingreso, tipos de lesión, asociación de lesiones y tratamiento realizado. Por edad, la mayor incidencia fue de los l1 a los 40 años. La causa principal fue el accidente de tráfico. El Injury Severity Score (ISS) medio para toda la serie fue de 12,5 (rango: 3-48). El 75% de los pacientes tenían lesiones musculoesqueléticas en forma aislada. Las lesiones asociadas fueron traumatismo craneoencefálico (76 casos), traumatismo torácico (7 casos), traumatismo abdominal (6 casos) y combinaciones de ellos (16 casos). Se contabilizaron 345 fracturas (1,9 por paciente). La mayor frecuencia se observó en la extremidad inferior (48%), siendo la tibia el hueso más frecuentemente afectado. En total de 166 fracturas fueron tratadas en forma ortopédica, mientras que en 183 de ellas se realizó tratamiento quirúrgico (1,1 intervenciones por paciente). La estancia media hospitalaria fue de 14 días, con un tiempo de hospitalización significativamente mayor en los pacientes con un ISS mayor de 9.The cases of multiple trauma admitted in the University Clinic Hospital of Valencia during 1992 were epidemiologically assessed. A group of 180 patients were finally admitted in the Trauma Unit from a total of 285 hospital admittances. There were 133 men and 47 women, with mean age of 33 years. Age, sex, etiology, period of hospital discharge, type of injury, associated lesions and treatment were recorded from clinical charts. The age group between 11 and 40 years was the most frequently affected. Traffic accident was the most important cause of injury. The mean Injury Severity Score (ISS) for the hole series was 12,4 (3-48). Isolated musculoskeletal injury was found in 75% of the cases. Associated lesions were head trauma (76 cases), thoracic trauma (seven cases) and abdominal trauma (six cases). More than two combinations were found in 16 cases. A total of 345 fractures were recorded (1.9 fractures per patient). The highest frequency was observed in the lower extremity (48%). The tibia was the most affected bone. Conservative treatment was applied in 166 cases, while 183 cases were treated surgically (1.1 surgeries per patient). The mean hospital discharge was 14 days. Patients with ISS > 9 showed a significant higher hospital stay as compared to those with ISS < 9

Multicolour photometry and Coravel observations of stars in the southern open cluster IC 2488

We preseent new UBV photoelectric observations of 119 stars in the field of the southern open cluster IC 2488, supplemented by DDO and Washington photometry and Coravel radial velocities for a sample of red giant candidates. Nearly 50% of the stars sampled - including three red giants and one blue straggler - are found to be probable cluster members. Photometric membership probabilities of the red giant candidates show good agreement with those obtained from Coravel data. A mean radial velocity of (-2.63 +/- 0.06) km/s is derived for the cluster giants. The reddening across the cluster is found to be E(B-V) = 0.24 +/- 0.04. IC 2488, located at a distance of (1250 +/- 120) pc from the Sun and 96 below the Galactic plane, is most probably not related to the planetary nebulae ESO 166-PN21. A metal abundance 0.10 +/- 0.06 relative to the Sun is determined from DDO data of the red giant members, in good agreement with the metallicity values derived from five independent Washington abundance indices. An age of 180 Myr is determined from the fitting of isochrones computed with convective overshooting for Z = 0.019. The isochrone for log t = 8.25 reproduces remarkably well not only the morphology of the upper main sequence but also the observed red giant pattern.Fil: Claria Olmedo, Juan Jose. Universidad Nacional de Cordoba. Observatorio Astronomico de Cordoba; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Piatti, Andres Eduardo. Consejo Nacional de Investigaciónes Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; ArgentinaFil: Lapasset Gomar, Emilio. Universidad Nacional de Cordoba. Observatorio Astronomico de Cordoba; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Mermilliod, J. C.. Universite de Lausanne; Suiz

Functional connectome of arousal and motor brainstem nuclei in living humans by 7 Tesla resting-state fMRI

Brainstem nuclei play a pivotal role in many functions, such as arousal and motor control. Nevertheless, the connectivity of arousal and motor brainstem nuclei is understudied in living humans due to the limited sensitivity and spatial resolution of conventional imaging, and to the lack of atlases of these deep tiny regions of the brain. For a holistic comprehension of sleep, arousal and associated motor processes, we investigated in 20 healthy subjects the resting-state functional connectivity of 18 arousal and motor brainstem nuclei in living humans. To do so, we used high spatial-resolution 7 Tesla resting-state fMRI, as well as a recently developed in-vivo probabilistic atlas of these nuclei in stereotactic space. Further, we verified the translatability of our brainstem connectome approach to conventional (e.g. 3 Tesla) fMRI. Arousal brainstem nuclei displayed high interconnectivity, as well as connectivity to the thalamus, hypothalamus, basal forebrain and frontal cortex, in line with animal studies and as expected for arousal regions. Motor brainstem nuclei showed expected connectivity to the cerebellum, basal ganglia and motor cortex, as well as high interconnectivity. Comparison of 3 Tesla to 7 Tesla connectivity results indicated good translatability of our brainstem connectome approach to conventional fMRI, especially for cortical and subcortical (non-brainstem) targets and to a lesser extent for brainstem targets. The functional connectome of 18 arousal and motor brainstem nuclei with the rest of the brain might provide a better understanding of arousal, sleep and accompanying motor functions in living humans in health and disease

Extension and refinement of the predictive value of different classes of markers in ADNI: Four-year follow-up data

Background: This study examined the predictive value of different classes of markers in the progression from mild cognitive impairment (MCI) to Alzheimer\u27s disease (AD) over an extended 4-year follow-up in the Alzheimer\u27s Disease Neuroimaging Initiative (ADNI) database. Methods: MCI patients were assessed for clinical, cognitive, magnetic resonance imaging (MRI), positron emission tomography-fluorodeoxyglucose (PET-FDG), and cerebrospinal fluid (CSF). markers at baseline and were followed on a yearly basis for 4 years to ascertain progression to AD. Logistic regression models were fitted in clusters, including demographics, APOE genotype, cognitive markers, and biomarkers (morphometric, PET-FDG, CSF, amyloid-beta, and tau). Results: The predictive model at 4 years revealed that two cognitive measures, an episodic memory measure and a Clock Drawing screening test, were the best predictors of conversion (area under the curve = 0.78). Conclusions: This model of prediction is consistent with the previous model at 2 years, thus highlighting the importance of cognitive measures in progression from MCI to AD. Cognitive markers were more robust predictors than biomarkers. (C) 2014 The Alzheimer\u27s Association. All rights reserved

Strenuous exercise worse than sedentarism?

Schnohr et al. (1) reported a U-shaped association between all-cause mortality and exercise dose in a Danish cohort. Jogging 1 to 2.4 h/week was associated with the lowest mortality, whereas jogging >3 times/week was no better than being inactive and was worse than light jogging (adjusted hazard ratio [HR]: 9.08; 95% confidence interval [CI]: 1.87 to 44.01). Furthermore, older (61.3 16.2 years) sedentary nonjoggers with cardiovascular disease (CVD) risk factors...

The Era of Smartphones: Back to Our Biological Makeup?

Physical inactivity is a major modifiable cardiovascular risk factor that has become a growing health problem in the 21st century: 83% of adolescents aged 13-15 years and approximately 1/3 of adults worldwide are inactive, that is, not meeting the minimum international physical activity (PA) recommendations (=150 minutes/week of moderate to vigorous PA) [1, 2]. Thus, the PA levels of the general population, especially of individuals at cardiovascular risk, should be routinely assessed by health care professionals, as it has been recently recommended by the American Heart Association [3]. To this end, accelerometers (usually attached to an elastic belt around the waist) allow objective quantification of PA by providing continuous recordings. At least 3 to 5 days of accelerometer monitoring (including weekend days) are required to determine habitual PA, and it is generally accepted that the device should be worn for =10 hours/day [4]. For this reason, the simple and inexpensive method of PA questionnaires is more widely used and generally better accepted. Unfortunately, the validity of self-reported PA is questionable..

Delayed Effect of Dendritic Cells Vaccination on Survival in Glioblastoma: A Systematic Review and Meta‐Analysis

Background: Dendritic cell vaccination (DCV) strategies, thanks to a complex immune response, may flare tumor regression and improve patients’ long‐term survival. This meta‐analysis aims to assess the efficacy of DCV for newly diagnosed glioblastoma patients in clinical trials. Meth-ods: The study databases, including PubMed, Web of Knowledge, Google Scholar, Scopus, and Cochrane, were searched by two blinded investigators considering eligible studies based on the following keywords: “glioblastoma multiforme”, “dendritic cell”, “vaccination”, “immunother-apy”, “immune system”, “immune response”, “chemotherapy”, “recurrence”, and “te-mozolomide”. Among the 157 screened, only 15 articles were eligible for the final analysis. Results: Regimens including DCV showed no effect on 6‐month progression‐free survival (PFS, HR = 1.385, 95% CI: 0.822–2.335, p = 0.673) or on 6‐month overall survival (OS, HR = 1.408, 95% CI: 0.882–2.248, p = 0.754). In contrast, DCV led to significantly longer 1‐year OS (HR = 1.936, 95% CI: 1.396–2.85, p = 0.001) and longer 2‐year OS (HR = 3.670, 95% CI: 2.291–5.879, p = 0.001) versus control groups. Hence, introducing DCV could lead to increased 1 and 2‐year survival of patients by 1.9 and 3.6 times, respectively. Conclusion: Antitumor regimens including DCV can effectively improve mid-term survival in patients suffering glioblastoma multiforme (GBM), but its impact emerges only after one year from vaccination. These data indicate the need for more time to achieve an anti‐GBM immune response and suggest additional therapeutics, such as checkpoint inhibitors, to empower an earlier DCV action in patients affected by a very poor prognosis

Técnicas de ahorro de sangre en cirugía ortopédica

La cirugía ortopédica está asociada con frecuencia a la necesidad de transfusión de sangre homóloga, con los consiguientes riesgos que ello conlleva. En la actualidad se resalta la importancia de la disminución tanto de la transfusión como de la sobretransfusión en este tipo de cirugía. Dicho objetivo se puede alcanzar con el empleo de diversas técnicas de ahorro de sangre, que incluyan la potenciación del uso de sangre antóloga de métodos para disminuir el sangrado perioperatorio. La máxima eficacia para disminuir la necesidad de transfusión de sangre homóloga se deriva de la combinación de varias técnicas de ahorro, como son los programas de autotransfusión, la hipotensión controlada y el empleo de nuevos fármacos como eritropoyetina o aprotinina; todo ello sin olvidar la importancia de establecer unos criterios restrictivos, en consonancia con las directrices más actuales en este sentido, en el momento de indicar la necesidad de una transfusión sanguínea.Technique in orthopaedic surgery requires frequently transfusion of homologous blood which entails several risks. Nowadays, the importance of the decrease of both transfusion and overtransfusion has been proposed for this type of surgery. This aim can be reached by using different blood saving techniques including either the use of antologous blood or methods to minimize perioperative bleeding. The highest efficacy in order to diminish homologous blood transfusion combines several savings techniques as autotransfusion programs, controlled hypotension, and the use of new drugs such as erytropoyetin and aproinin. Restrictive criteria have to be established according to the more recent guidelines for blood transfusion

Evaluación mediante simulación de las competencias clínicas de los alumnos del máster en Enfermería de Anestesia, Reanimación y Terapia del Dolor de la UB.

Podeu consultar la Vuitena trobada de professorat de Ciències de la Salut completa a: http://hdl.handle.net/2445/66524Introduccion: EL MARTD es actualmente semipresencial con considerable contenido en prácticas clínicas que se desarrollan individualmente con tutores clínicos de varios centros asistenciales. La dispersión y posible variabilidad de esta organización debe garantizar el contenido y calidad del aprendizaje. En el curso 2013-14 planteamos evaluar los resultados de las prácticas con un doble objetivo: valorar las competencias de los alumnos y si nuestra organización conseguía los objetivos prácticos. El instrumento fue la observación de la actuación del alumno en un entorno simulado al final del periodo práctico. Metodologia: - Participaron los 60 alumnos matriculados, 30 evaluadores (15 enfermeras y 15 anestesiólogos) y 12 coordinadores de rotaciones y de estaciones. - Diseño de 6 estaciones con contenido relevante para la formación, ejecución en 10 min seguido de 15 min de “debriefing”, plantillas de evaluación de habilidades clínicas y no clínicas y criterios acordados por los evaluadores. Las estaciones fueron valoración preanestésica, bloqueo de plexo, anestesia general, preparación de perfusiones electrónicas de fármacos, depresión respiratoria y shock anafiláctico. - Se entrenó a los instructores sobre contenido y finalidad de la prueba, con 2 reuniones prácticas..

Estudio biomecánico in vivo del grupo muscular flexor del codo en condiciones basales y su respuesta a la fatiga.

El objetivo del presente trabajo es establecer una aproximación al patrón de referencia habitual de la biomecánica del bíceps braquial y su respuesta a la fatiga. Sobre 37 voluntarios varones sanos se determinó una capacidad de contracción voluntaria máxima de flexión del codo de 266,8 ± 58,7N en el brazo dominante y de 258,2 ± 59,4N en el no dominante, que descendió a 211,5 ± 53N y 205,3 ± 56,5N respectivamente al someter a los voluntarios al test de fatiga (p<0,001 en ambos). El tiempo de fatiga se objetivó en 160,7 ± 72,8 s en el brazo dominante y en 156,7 ± 68,7 s en el no dominante. La supinación voluntaria máxima disminuyó de 208,7 ± 54N y 207 ± 54,8N hasta 194,1 ± 66,6N y 192,8 ± 66N respectivamente en el estudio postfatiga (p<0,001 en ambas). No se apreciaron diferencias significativas en el estudio de subgrupos por edades