Aportación de la radioterapia guiada por la imagen al tratamiento del cáncer de próstata

Objetivo: Demostrar que la verificación mediante Cone Beam CT (CBCT) en una serie de pacientes tratados con radioterapia externa 3D (RTE3D) por su cáncer de próstata (CP) se relaciona con una reducción de los niveles de toxicidad aguda y tardía. Material y Métodos: Se ha realizado un estudio retrospectivo no aleatorizado de 2 grupos homogéneos de pacientes tratados entre 2005 y 2008, 46 pacientes verificados mediante Electronic Portal Devices (EPIC) y 48 verificados mediante CBCT (Electa Synergy), con una mediana de edad de 67 años (42-85 años). Recibieron RTE3D por CP estadio localizado ( T1-T3b N0 M0 ), prescribiéndose las mismas dosis, simulados y planificados con los mismos criterios y en los mismos equipos (Electa Precise plan), con una mediana de seguimiento de 24 meses (12 a 54 m). Los criterios de exclusión fueron: tratamiento con anticoagulantes orales, antecedentes de cirugía rectal o prostática, enfermedad inflamatoria intestinal o conectivopatías. Todos los pacientes siguieron un mismo protocolo (dieta laxante suave, laxantes, vejiga llena) con objetivo de intentar mantener estables el contenido rectal y vesical. Se determinó mediante consultas médicas (semanal, mensual, trimestral, semestral) la toxicidad urinaria y gastro-intestinal según las escalas CTCAE.3 y RTOG . Se realizó un análisis estadístico de los datos estableciendo un nivel de confianza del 95%, p<0.005 ha implicado la significación estadística. Resultados y discusión: Con una mediana de seguimiento global de 24 meses (24 meses en el grupo verificado mediante imagen portal y 18 en el verificado mediante CBCT) los niveles de proctitis G2, sangrado rectal G2, toxicidad GU G2 han sido respectivamente 19,56%, 15,21% y 15,2% en el primer grupo frente a 4,17%, 2,08%, 8,33% en el segundo. Así aparece de manera estadísticamente significativa una menor proctitis total y tardía (p 0.008, p 0.032), menor sangrado rectal tardío (p 0.041), menor fisura anal (p 0.038), menor hematuria total y aguda (p 0.027, p 0.022), menor frecuencia urinaria total y aguda (p 0.027 p 0.022) y menor incontinencia urinaria total (p 0.038). No apareció evidencia estadísticamente significativa de menor toxicidad a nivel de disuria aguda y tardía, en relación al TMN, Gleason, PSA ni en función del grado de estabilidad según el protocolo de nivel de acción del CBCT. Conclusiones: La verificación mediante CBCT en esta serie de pacientes, se asocia a una menor toxicidad de manera estadísticamente significativa, pese a haber empleado un protocolo para mantener estables el contenido vesical y rectal, lo que justifica su empleo. Un seguimiento mayor sería necesario para valorar su impacto a nivel de control bioquímico.Objective: Demonstrate that verification through cone beam CT in a series of patients treated with external 3D radiotherapy (3DRT) for prostate cancer (PC) is related to a reduction in levels of acute and late-onset toxicity. Materials and Methods: Non-randomized, retrospective study of two homogenous groups of patients treated between 2005 and 2008 has been undertaken. 46 patients were verified using EPID, and 48 through CBCT. The median age of these patients was 67 years (42-85). These patients recieved 3DRT for localized stage PC (T1-T3bN0M0), and prescribed the same doses, simulated, planned with the same criteria and with the same equipment. The median monitoring time was 24 months. The exclusion criteria were: treatment with oral anticoagulants, rectal or prostatic surgery, inflammatory intestinal or connective disease. All patients followed the same protocol, with the objective of maintaining rectal and vesical content stable. Urinary and gastro-intestinal toxicity was determined through medical consultations according to the CTCAE.3 and RTOG scales. Statistical analysis of data was undertaken, establishing a confidence level of 95%, p<0.005 being the statistical significance. Results y Discussion: With a median follow up of 24 months the levels G>2 of proctitis, rectal bleeding, and GU toxicity were respectively 19.56%, 15.21% and 15.2% en the first group, compared with 4.17%, 2.08% and 8.33% in the second. Statistically, significantly less total and acute proctitis (p 0.008, p 0.032), late onset rectal bleeding (p 0.041), anal fissure (p 0.038), total and acute haematuria (p 0.027), total and acute urinary frequency (p 0.027, p 0.022) and total urinary incontinence (p 0.038) was observed. There was no statistically significant evidence of a lowering in toxicity in terms of stability according to the protocol of the action level of CBCT. Conclusion: Verification through CBCT in this series of patients is associated with a statistically significant lowering in levels of toxicity, even with use of a protocol to maintain vesical-rectal content stable in both groups. This justifies its use. Greater monitoring would be necessary in order to assess the impact of verification at the level of biochemical control

Influence of Thermal and Magnetic History on Direct DTad Measurements of Ni49+xMn36-xIn15 Heusler Alloys

In the present work, using Heusler Ni49+xMn36-xIn15 (with x = 0 and 0.5) alloys, it is shown that the choice of the appropriate measurement protocol (erasing the prior state of the sample in between experiments) in DTad first shot characterization is crucial for obtaining reliable results. Unlike indirect measurements, for which incorrect protocols produce overestimates of the characteristics of the material, erroneous direct measurements underestimate DTad in the region close to its first order phase transition. The error in DTad is found to be dependent on the temperature step used, being up to ~40% underestimation, including a slight shift in its peak temperature.AEI/FEDER-UE (project MAT-2016-77265-R)US Army Research Laboratory W911NF-19-2-021

Impact of Continuous ICT Training in Secondary School Teachers in Portugal.

This paper focuses on the importance of teacher training in developing the necessary skills in the use of information and communications technology in school classrooms, as an effective and useful set of resources in the context of current teaching. The research was carried out in secondary school teachers in the city of Coimbra (Portugal) through technical survey on the perception of the teacher in a number of related topics.Este documento se centra en la importancia de la Formación continua del Profesorado en el desarrollo de las habilidades necesarias en el uso de las Tecnologías de la Información y la Comunicación en las aulas de secundaria, como un conjunto de recursos eficaces y útiles en los contextos de enseñanza actuales. La investigación se llevó a cabo en la escuela secundaria maestros en el Municipio de Coimbra (Portugal) por medio de la técnica de encuesta sobre la percepción del profesor en una serie de temas relacionados

Analysis and comparison of adolescent athletes' motivation : basketball players vs. football players

The motivation of an athlete is determinant for the athletic engagement of the adolescent. The present study attempts to analyze the motivation of adolescent basketball and football players from the perspectives of Achievement Goal Theory (Nicholls, 1989) and Self-Determination Theory (Deci & Ryan, 1985). The study's sample was composed of 248 athletes from 12 to 17 years of age. Half were from basketball and half were from football. The instruments that were utilized were: the Spanish version of the Sport Motivation Scale (SMS) (Núñez, Martín-Albo, Navarro, & González, 2006), the Spanish version of the Perceived Motivational Climate in Sport Questionnaire-2 (PMSCQ-2) (Balaguer, Mayo, Atienza, & Duda, 1997), and the adapted Spanish translation (Moreno, Moreno, & Cervelló, 2007) of the Intention to be Physically Active Scale (IPAS) by Hein, Müür, and Koka (2004). The comparison of the means of the variables between football and basketball players was done utilizing the student t-test for independent samples. Significant differences were found for variables such as: intrinsic motivation (IM) toward accomplishment, external regulation, amotivation, task, ego, and Self-Determination Index (SDI). Basketball players obtained higher values in the SDI, in task, and in IM toward accomplishment than football players. The search for premature performance in football and coaches' educations can help to explain these differences. The importance of these differences reside in the relationship between these motivational variables and the adherence to athletic practice. In conclusion, basketball demonstrated better values in motivational variables, which demonstrates that training sessions are more oriented toward task than ego, that players have more intrinsic and self-determined motivation, and therefore, the adherence of the young athletes will be greater in this sport

A case study on the transmission of a task climate in sport

El clima motivacional transmitido por el entrenador puede influir de manera determinante en la actitud de los deportistas (Smith, Smoll, y Cumming, 2007). Así, los programas de formación deben facilitar a los entrenadores las estrategias necesarias que permitan mejorar la transmisión de clima-tarea durante sus entrenamientos. El objetivo fundamental del estudio fue evaluar cualitativamente la puesta en práctica del Programa Indagativo de Formación para Entrenadores (PIFE) (Conde, Almagro, Sáenz-López, Domínguez, y Moreno-Murcia, 2010), sobre el clima motivacional transmitido por un entrenador de baloncesto, así como su percepción sobre la motivación de los jugadores. El diseño fue un estudio de casos. Se utilizó la entrevista y el diario para la recogida de datos. El programa PIFE ha conseguido que el entrenador adquiera los conocimientos para la transmisión de un clima tarea. En este sentido, una mejora de la transmisión de clima tarea es necesaria para mejorar la motivación de los deportistas y la adherencia a la práctica deportiva.The motivational climate conveyed by the coach, can exert a decisive influence on the attitude of the athletes (Smith, Smoll, y Cumming, 2007). In this sense the training programs can facilitate the necessary strategies to improve the transmission of climate during their workouts. The main objective was to analyze the Training Programme for Trainers (PIFE) (Conde, Almagro, Sáenz-López, Domínguez, y Moreno-Murcia, 2010), on the motivational climate conveyed by a basketball coach and the perception of this on the motivation of the players. The design was a case study with a basketball coach. We used interview and diary for data collection. The program has managed to acquire the skills coach for the transmission of a mastery climate. In this sense an improvement in the transmission of task climate needed to improve athletes'motivation and adherence to sport.This study was possible thanks to the research Project "Motivational factors related to the adherence to physical activity: Analysis in competitive sport contexts" (Ref. DEP2007-73201-C03-02/ACTI), funded by the Spanish Ministry of Science and Innovation

Caracterización y estado de conservación de vidrios tardorromanos del Museo Arqueológico Regional de Madrid procedentes de las necrópolis de Cubas de la Sagra

Se ha caracterizado un conjunto de vidrios tardorromanos hallado en las necrópolis de Cubas de la Sagra y depositado actualmente en el Museo Arqueológico Regional de Alcalá de Henares (Madrid). Dicho conjunto procede del yacimiento de Camino de Santa Juana, localizado en el Sur de la Comunidad de Madrid. Los objetivos consistieron en determinar, por un lado, la composición química y los cromóforos responsables de la tonalidad de los vidrios; y por otro lado, evaluar su estado de conservación para seleccionar la estrategia de conservación preventiva más adecuada para su depósito o exposición en el museo. En el primer caso se analizaron un total de 14 muestras procedentes de ambas necrópolis; y para evaluar su estado de conservación se analizaron muestras de restos del sedimento que circundaba los vidrios para determinar su pH, sus fases mineralógicas y su influencia en el grado de deterioro de los vidrios. El estudio se ha llevado a cabo mediante técnicas convencionales: lupa binocular, espectrometría de fluorescencia de rayos X, difracción de rayos X, microscopía electrónica de barrido de emisión de campo con microanálisis de dispersión de energía de rayos X y espectrofotometría visible. Los resultados han servido para contextualizar arqueométricamente los vidrios en el conjunto de vidrios tardorromanos de la Península Ibérica analizados hasta el momento.Los autores agradecen la financiación del proyecto ref. HAR2012-30769 (Ministerio de Economía y Competitividad) y del programa Geomateriales 2 ref. S2013/MIT-2914 (Comunidad de Madrid y Unión Europea-Fondos Estructurales)Peer reviewe

Intragastric Endoscopic Assisted Single Incision Surgery for Gastric Leiomyoma of the Esophagogastric Junction

Single port laparoscopic surgery is becoming an alternative to conventional laparoscopic surgery as a new approach where all the conventional ports are gathered in just one multichannel port through only one incision. Appling this technical development, we have developed a new technique based on an intragastric approach using a single port device assisted by endoscopy (I-EASI: intragastric endoscopic assisted single incision surgery) in order to remove benign gastric lesions and GIST tumors placed in the posterior wall of the stomach or close to the esophagogastric junction or the gastroduodenal junction. We present a patient with a submucosal gastric tumor placed near the esophagogastric junction removed with this new approach

Using the Social-Local-Mobile App for Smoking Cessation in the SmokeFreeBrain Project: Protocol for a Randomized Controlled Trial

Background: Smoking is considered the main cause of preventable illness and early deaths worldwide. The treatment usually prescribed to people who wish to quit smoking is a multidisciplinary intervention, combining both psychological advice and pharmacological therapy, since the application of both strategies significantly increases the chance of success in a quit attempt. Objective: We present a study protocol of a 12-month randomized open-label parallel-group trial whose primary objective is to analyze the efficacy and efficiency of usual psychopharmacological therapy plus the Social-Local-Mobile app (intervention group) applied to the smoking cessation process compared with usual psychopharmacological therapy alone (control group). Methods: The target population consists of adult smokers (both male and female) attending the Smoking Cessation Unit at Virgen del Rocío University Hospital, Seville, Spain. Social-Local-Mobile is an innovative intervention based on mobile technologies and their capacity to trigger behavioral changes. The app is a complement to pharmacological therapies to quit smoking by providing personalized motivational messages, physical activity monitoring, lifestyle advice, and distractions (minigames) to help overcome cravings. Usual pharmacological therapy consists of bupropion (Zyntabac 150 mg) or varenicline (Champix 0.5 mg or 1 mg). The main outcomes will be (1) the smoking abstinence rate at 1 year measured by means of exhaled carbon monoxide and urinary cotinine tests, and (2) the result of the cost-effectiveness analysis, which will be expressed in terms of an incremental cost-effectiveness ratio. Secondary outcome measures will be (1) analysis of the safety of pharmacological therapy, (2) analysis of the health-related quality of life of patients, and (3) monitoring of healthy lifestyle and physical exercise habits. Results: Of 548 patients identified using the hospital’s electronic records system, we excluded 308 patients: 188 declined to participate and 120 did not meet the inclusion criteria. A total of 240 patients were enrolled: the control group (n=120) will receive usual psychopharmacological therapy, while the intervention group (n=120) will receive usual psychopharmacological therapy plus the So-Lo-Mo app. The project was approved for funding in June 2015. Enrollment started in October 2016 and was completed in October 2017. Data gathering was completed in November 2018, and data analysis is under way. The first results are expected to be submitted for publication in early 2019. Conclusions: Social networks and mobile technologies influence our daily lives and, therefore, may influence our smoking habits as well. As part of the SmokeFreeBrain H2020 European Commission project, this study aims at elucidating the potential role of these technologies when used as an extra aid to quit smoking

Dermatomiosistis.

P a cie n te de 11 años, p ro ce d e n te de Manabí, que ingresó en la Sala de Escolares y Adolescentes del Hospital del Niño "Dr. Francisco Ycaza Bustamante", con cuadro clinico de debilidad proximal simétrica de los músculos de la cintura escapular y pelviana, fiebre, rash eritematoso en cara y extremidades, disfagia y voz nasal, por lo que fue planteado el diagnóstico de Dermatomiosistis, corroborándose posteriormente con exámenes de Laboratorio que reportaron incremento notable de enzimas séricas musculares y por las alteraciones electromiográficas características. La Corticoterapia se administró en bolos de M e tilp re d n is o lo n a IM y P re d n iso n a oral, apreciándose una notable mejoría. ' Posteriormente se realizaron reducciones graduales de los Corticoides, en relación con los niveles séricos enzimáticos y la evolución clínica. El tratamiento se c o m p le m e n tó con P o ta sio y C alcio , por la Corticoterapia, e Isoniazida, en dosis profiláctica, mientras la dosis total de corticoides fue superior a 20mgs. diarios. Durante la hospitalización se diagnosticó Tifoidea con Widal positivo, que fue tratada con Cloranfenicol. La niña fue dada de alta a los tres meses de su ingreso, podía deam bular sin dificultad y continúa controlándose por Consulta Externa, siendo su evolución satisfactoria