Evaluación urodinámica y comparativa de la calidad de vida en pacientes con trastorno de vaciamiento vesical sometidos a terapia InterStim, Medtronic®

ResumenAntecedentesDesde 1980 la terapia de neuroestimulación sacra ha demostrado ser una terapia válida y alternativa en el manejo de los trastornos miccionales por patología del tracto urinario bajo, siendo sus principales indicaciones la retención urinaria idiopática, la incontinencia de urgencia y la incontinencia fecal. En nuestro país sigue siendo una terapia novedosa y no se cuenta aún con estudios que evalúen esta eficacia en términos de calidad de vida o con parámetros cuantitativos.Objetivo del estudioEstablecer la eficacia de la terapia de neuroestimulación sacra tipo InterStim, Medtronic®, en el manejo de los pacientes con trastornos de vaciamiento vesical, efectuando un análisis urodinámico y de la calidad de vida comparativo previo y posterior al tratamiento, determinando los volúmenes miccionales, los períodos de incontinencia, la satisfacción del paciente y la calidad de vida.Material y métodosDesde enero de 2010 hasta junio de 2013, en el Hospital Central Militar se realizó evaluación urodinámica y comparativa de la calidad de vida mediante el empleo del instrumento SF-36 v2 (versión mexicana) e ICIQSF, en los pacientes que presentaron trastorno de vaciamiento vesical de etiología no obstructiva y que fueron refractarios a tratamiento médico.ResultadosSe incluyeron 10 pacientes en el estudio, bajo los siguientes diagnósticos: disinergia detrusor-esfínter, vejiga hiperactiva y retención urinaria no obstructiva, ubicados por género (2 masculinos y 8 femeninos). En la totalidad de los pacientes se presentó mejoría del 50% o superior durante la fase de prueba de la terapia de neuroestimulación, y se colocó fase definitiva con los siguientes resultados: se obtuvieron resultados equivalentes al 50-65% de mejoría en los parámetros cualitativos de función física, función social y rol emocional, así como en las variables cuantitativas de volumen de vaciamiento, eficacia de vaciamiento y disminución de los períodos de incontinencia.DiscusiónComo se ha establecido a nivel de la literatura mundial, nuestros resultados fueron similares en el efecto benéfico y la eficacia en la calidad de vida e incontinencia urinaria, respectivamente, y se reportan porcentajes de éxito mayores al 50% en el cese total de los episodios de incontinencia.ConclusionesLa neuromodulación mediante la estimulación del nervio sacro es una forma exitosa de tratamiento en los trastornos de vaciamiento vesical de etiología no obstructiva y refractaria al tratamiento médico, es segura, mínimamente invasiva y de fácil aplicación, y mejora la calidad de vida de los pacientes. Sin embargo, es necesario realizar estudios aleatorizados y que consideren parámetros objetivos (urodinámicos), así como las complicaciones posibles a mediano y largo plazo en este tipo de terapia.AbstractBackgroundSince 1980, sacral neuromodulation therapy has been shown to be a valid alternative therapy in the management of urinary disorders due to lower urinary tract pathology, and its primary indications are: idiopathic urinary retention, urge incontinence, and fecal incontinence. It is still considered a novel therapy in Mexico and there are no studies using quantitative parameters that evaluate its efficacy in terms of quality of life.AimsTo establish the efficacy of the Medtronic InterStim® sacral neuromodulation therapy in the management of patients with bladder voiding disorders through urodynamic and quality of life analyses before and after treatment. Urine volume, periods of incontinence, patient satisfaction, and quality of life were determined.MethodsA comparative urodynamic and quality of life evaluation was carried out using the SF-36 v2 (Mexican version) and the ICIQSF instruments on patients presenting with nonobstructive bladder voiding disorders that were refractory to medical treatment.ResultsTen patients with the following diagnoses were included in the study: detrusor sphincter dyssynergia, overactive bladder, and nonobstructive urinary retention. Two of the patients were men and 8 were women. There was a 50% or greater improvement in all 10 patients during the test phase of the neuromodulation therapy and the definitive placement phase produced the following results: a 50-65% improvement in the qualitative parameters of physical function, social function, and emotional role, as well as in the quantitative variables of voiding volume, voiding efficacy, and reduced periods of incontinence.DiscussionOur results were similar to those established in the international literature in relation to the beneficial effect on quality of life and efficacy in urinary incontinence management; the literature reports success percentages in the complete cessation of incontinence episodes at above 50%.ConclusionsNeuromodulation through sacral nerve stimulation is a successful form of treatment of nonobstructive and medical treatment-refractory bladder voiding disorders. It is safe, minimally invasive, and easy to apply and it improves patient quality of life. Nevertheless, further randomized studies on this type of therapy need to be conducted that take into account objective parameters (urodynamics) and possible medium and long-term complications

The exposure of the hybrid detector of the Pierre Auger Observatory

The Pierre Auger Observatory is a detector for ultra-high energy cosmic rays. It consists of a surface array to measure secondary particles at ground level and a fluorescence detector to measure the development of air showers in the atmosphere above the array. The "hybrid" detection mode combines the information from the two subsystems. We describe the determination of the hybrid exposure for events observed by the fluorescence telescopes in coincidence with at least one water-Cherenkov detector of the surface array. A detailed knowledge of the time dependence of the detection operations is crucial for an accurate evaluation of the exposure. We discuss the relevance of monitoring data collected during operations, such as the status of the fluorescence detector, background light and atmospheric conditions, that are used in both simulation and reconstruction.Comment: Paper accepted by Astroparticle Physic

Anisotropic flow of charged hadrons, pions and (anti-)protons measured at high transverse momentum in Pb-Pb collisions at sNN=2.76\sqrt{s_{\rm NN}}=2.76 TeV

The elliptic, $v_2$, triangular, $v_3$, and quadrangular, $v_4$, azimuthal anisotropic flow coefficients are measured for unidentified charged particles, pions and (anti-)protons in Pb-Pb collisions at $\sqrt{s_{\rm NN}} = 2.76$ TeV with the ALICE detector at the Large Hadron Collider. Results obtained with the event plane and four-particle cumulant methods are reported for the pseudo-rapidity range $|\eta|<0.8$ at different collision centralities and as a function of transverse momentum, $p_{\rm T}$, out to $p_{\rm T}=20$ GeV/$c$. The observed non-zero elliptic and triangular flow depends only weakly on transverse momentum for $p_{\rm T}>8$ GeV/$c$. The small $p_{\rm T}$ dependence of the difference between elliptic flow results obtained from the event plane and four-particle cumulant methods suggests a common origin of flow fluctuations up to $p_{\rm T}=8$ GeV/$c$. The magnitude of the (anti-)proton elliptic and triangular flow is larger than that of pions out to at least $p_{\rm T}=8$ GeV/$c$ indicating that the particle type dependence persists out to high $p_{\rm T}$.Comment: 16 pages, 5 captioned figures, authors from page 11, published version, figures at http://aliceinfo.cern.ch/ArtSubmission/node/186

Centrality dependence of charged particle production at large transverse momentum in Pb-Pb collisions at sNN=2.76\sqrt{s_{\rm{NN}}} = 2.76 TeV

The inclusive transverse momentum ($p_{\rm T}$) distributions of primary charged particles are measured in the pseudo-rapidity range $|\eta|<0.8$ as a function of event centrality in Pb-Pb collisions at $\sqrt{s_{\rm{NN}}}=2.76$ TeV with ALICE at the LHC. The data are presented in the $p_{\rm T}$ range $0.15<p_{\rm T}<50$ GeV/$c$ for nine centrality intervals from 70-80% to 0-5%. The Pb-Pb spectra are presented in terms of the nuclear modification factor $R_{\rm{AA}}$ using a pp reference spectrum measured at the same collision energy. We observe that the suppression of high-$p_{\rm T}$ particles strongly depends on event centrality. In central collisions (0-5%) the yield is most suppressed with $R_{\rm{AA}}\approx0.13$ at $p_{\rm T}=6$-7 GeV/$c$. Above $p_{\rm T}=7$ GeV/$c$, there is a significant rise in the nuclear modification factor, which reaches $R_{\rm{AA}} \approx0.4$ for $p_{\rm T}>30$ GeV/$c$. In peripheral collisions (70-80%), the suppression is weaker with $R_{\rm{AA}} \approx 0.7$ almost independently of $p_{\rm T}$. The measured nuclear modification factors are compared to other measurements and model calculations.Comment: 17 pages, 4 captioned figures, 2 tables, authors from page 12, published version, figures at http://aliceinfo.cern.ch/ArtSubmission/node/284

Measurement of charm production at central rapidity in proton-proton collisions at s=2.76\sqrt{s} = 2.76 TeV

The $p_{\rm T}$-differential production cross sections of the prompt (B feed-down subtracted) charmed mesons D$^0$, D$^+$, and D$^{*+}$ in the rapidity range $|y|<0.5$, and for transverse momentum $1< p_{\rm T} <12$ GeV/$c$, were measured in proton-proton collisions at $\sqrt{s} = 2.76$ TeV with the ALICE detector at the Large Hadron Collider. The analysis exploited the hadronic decays D$^0 \rightarrow$K$\pi$, D$^+ \rightarrow$K$\pi\pi$, D$^{*+} \rightarrow$D$^0\pi$, and their charge conjugates, and was performed on a $L_{\rm int} = 1.1$ nb$^{-1}$ event sample collected in 2011 with a minimum-bias trigger. The total charm production cross section at $\sqrt{s} = 2.76$ TeV and at 7 TeV was evaluated by extrapolating to the full phase space the $p_{\rm T}$-differential production cross sections at $\sqrt{s} = 2.76$ TeV and our previous measurements at $\sqrt{s} = 7$ TeV. The results were compared to existing measurements and to perturbative-QCD calculations. The fraction of cdbar D mesons produced in a vector state was also determined.Comment: 20 pages, 5 captioned figures, 4 tables, authors from page 15, published version, figures at http://aliceinfo.cern.ch/ArtSubmission/node/307

Avanços recentes em nutrição de larvas de peixes

Os requisitos nutricionais de larvas de peixes são ainda mal compreendidos, o que leva a altas mortalidades e problemas de qualidade no seu cultivo. Este trabalho pretende fazer uma revisão de novas metodologias de investigação, tais como estudos com marcadores, genómica populacional, programação nutricional, génomica e proteómica funcionais, e fornecer ainda alguns exemplos das utilizações presentes e perspectivas futuras em estudos de nutrição de larvas de peixes

Ultrahigh energy neutrinos at the pierre auger observatory

The observation of ultrahigh energy neutrinos (UHEs) has become a priority in experimental astroparticle physics. UHEs can be detected with a variety of techniques. In particular, neutrinos can interact in the atmosphere (downward-going ) or in the Earth crust (Earth-skimming ), producing air showers that can be observed with arrays of detectors at the ground. With the surface detector array of the Pierre Auger Observatory we can detect these types of cascades. The distinguishing signature for neutrino events is the presence of very inclined showers produced close to the ground (i.e., after having traversed a large amount of atmosphere). In this work we review the procedure and criteria established to search for UHEs in the data collected with the ground array of the Pierre Auger Observatory.This includes Earth-skimming as well as downward-going neutrinos. No neutrino candidates have been found, which allows us to place competitive limits to the diffuse flux of UHEs in the EeV range and above

Description of Atmospheric Conditions at the Pierre Auger Observatory using the Global Data Assimilation System (GDAS)

Atmospheric conditions at the site of a cosmic ray observatory must be known for reconstructing observed extensive air showers. The Global Data Assimilation System (GDAS) is a global atmospheric model predicated on meteorological measurements and numerical weather predictions. GDAS provides altitude-dependent profiles of the main state variables of the atmosphere like temperature, pressure, and humidity. The original data and their application to the air shower reconstruction of the Pierre Auger Observatory are described. By comparisons with radiosonde and weather station measurements obtained on-site in Malarg\"ue and averaged monthly models, the utility of the GDAS data is shown

All-sky search for long-duration gravitational wave transients with initial LIGO

We present the results of a search for long-duration gravitational wave transients in two sets of data collected by the LIGO Hanford and LIGO Livingston detectors between November 5, 2005 and September 30, 2007, and July 7, 2009 and October 20, 2010, with a total observational time of 283.0 days and 132.9 days, respectively. The search targets gravitational wave transients of duration 10-500 s in a frequency band of 40-1000 Hz, with minimal assumptions about the signal waveform, polarization, source direction, or time of occurrence. All candidate triggers were consistent with the expected background; as a result we set 90% confidence upper limits on the rate of long-duration gravitational wave transients for different types of gravitational wave signals. For signals from black hole accretion disk instabilities, we set upper limits on the source rate density between 3.4×10-5 and 9.4×10-4 Mpc-3 yr-1 at 90% confidence. These are the first results from an all-sky search for unmodeled long-duration transient gravitational waves. © 2016 American Physical Society