145 research outputs found
Production of He-4 and (4) in Pb-Pb collisions at root(NN)-N-S=2.76 TeV at the LHC
Results on the production of He-4 and (4) nuclei in Pb-Pb collisions at root(NN)-N-S = 2.76 TeV in the rapidity range vertical bar y vertical bar <1, using the ALICE detector, are presented in this paper. The rapidity densities corresponding to 0-10% central events are found to be dN/dy4(He) = (0.8 +/- 0.4 (stat) +/- 0.3 (syst)) x 10(-6) and dN/dy4 = (1.1 +/- 0.4 (stat) +/- 0.2 (syst)) x 10(-6), respectively. This is in agreement with the statistical thermal model expectation assuming the same chemical freeze-out temperature (T-chem = 156 MeV) as for light hadrons. The measured ratio of (4)/He-4 is 1.4 +/- 0.8 (stat) +/- 0.5 (syst). (C) 2018 Published by Elsevier B.V.Peer reviewe
Robust estimation of bacterial cell count from optical density
Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data
Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study
Summary
Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally.
Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies
have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of
the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income
countries globally, and identified factors associated with mortality.
Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to
hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis,
exomphalos, anorectal malformation, and Hirschsprungâs disease. Recruitment was of consecutive patients for a
minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical
status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary
intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause,
in-hospital mortality for all conditions combined and each condition individually, stratified by country income status.
We did a complete case analysis.
Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital
diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal
malformation, and 517 with Hirschsprungâs disease) from 264 hospitals (89 in high-income countries, 166 in middleincome
countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male.
Median gestational age at birth was 38 weeks (IQR 36â39) and median bodyweight at presentation was 2·8 kg (2·3â3·3).
Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income
countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups).
Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome
countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries;
pâ€0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients
combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88â4·11],
p<0·0001; middle-income vs high-income countries, 2·11 [1·59â2·79], p<0·0001), sepsis at presentation (1·20
[1·04â1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention
(ASA 4â5 vs ASA 1â2, 1·82 [1·40â2·35], p<0·0001; ASA 3 vs ASA 1â2, 1·58, [1·30â1·92], p<0·0001]), surgical safety
checklist not used (1·39 [1·02â1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed
(ventilation 1·96, [1·41â2·71], p=0·0001; parenteral nutrition 1·35, [1·05â1·74], p=0·018). Administration of
parenteral nutrition (0·61, [0·47â0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65
[0·50â0·86], p=0·0024) or percutaneous central line (0·69 [0·48â1·00], p=0·049) were associated with lower mortality.
Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome,
middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will
be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger
than 5 years by 2030
Coagulation disorders in liver cirrhosis: a review article
Los eventos fisiopatolĂłgicos de la cirrosis hepĂĄtica alteran drĂĄsticamente los procesos de hemostasia
primaria, secundaria y fibrinĂłlisis. Antiguamente se conceptuaba que dichas alteraciones predisponĂan exclusivamente a un estado de hipocoagulabilidad, debido a la baja producciĂłn hepĂĄtica
de factores procoagulantes y a la trombocitopenia caracterĂstica. Actualmente existe evidencia de
mecanismos de compensaciĂłn que llevan a un reequilibrio hemostĂĄtico, que es inestable y fĂĄcilmente desregulado ante comorbilidades, complicaciones y progresiĂłn de la enfermedad, conduciendo
a fenĂłmenos prohemorrĂĄgicos o protrombĂłticos, como trombosis venosa portal, tromboembolismo
venoso, etc. Para determinar eficazmente si un paciente cirrĂłtico tiene riesgo de sangrado, no son
de utilidad las pruebas de coagulaciĂłn convencionales. El tratamiento dependerĂĄ del estado hipo
o hipercoagulable del paciente. Para ello desarrollamos una revisiĂłn de los fenĂłmenos hemostĂĄticos
en la cirrosis, con el fin de dar a conocer sus caracterĂsticas, el mĂ©todo de diagnĂłstico mĂĄs eficaz
y los tratamientos disponiblesThe pathophysiological events of liver cirrhosis drastically alter the processes of primary and secondary hemostasis and fibrinolysis. Previously, it was conceptualized that these alterations exclusively
predisposed to hypocoagulation, due to the low hepatic production of procoagulant factors and the characteristic thrombocytopenia. Currently, there is evidence of compensation mechanisms that lead
to a hemostatic rebalancing, which is unstable and easily dysregulated in the presence of comorbidities, complications and progression of the disease, leading to prohemorrhagic or prothrombotic
phenomena, such as portal vein thrombosis, venous thromboembolism, etc. To effectively determine
whether a cirrhotic patient is at risk for bleeding, conventional coagulation tests are not helpful.
Treatment will depend on the hypo or hypercoagulable state of the patient. In this manuscript, we review the hemostatic phenomena in cirrhosis, to reveal its characteristics, effective diagnostic methods
and treatmen
CardiomiopatĂa en el paciente con cirrosis hepĂĄtica: artĂculo de revisiĂłn
La cardiomiopatĂa cirrĂłtica se trata de una complicaciĂłn en el paciente cirrĂłtico, con una pre-valencia superior al 40%. Es una entidad subclĂnica, pero ante el ejercicio o estrĂ©s circulatorio, desencadena su sintomatologĂa. Su fisiopatologĂa se explica por la hipertensiĂłn portal que lleva a vasodilataciĂłn esplĂĄcnica, con posterior liberaciĂłn de vasodilatadores y factores cardiosupreso-res, lo cual conduce a una circulaciĂłn hiperdinĂĄmica y disfunciĂłn circulatoria, con elevaciĂłn del gasto cardĂaco, disminuciĂłn de la resistencia vascular y presiĂłn arterial baja. Sus caracterĂsticas principales son disfunciĂłn cardiaca sistĂłlica y diastĂłlica, circulaciĂłn hiperdinĂĄmica y alteraciones electrofisiolĂłgicas, especialmente prolongaciĂłn del intervalo QT. Para su diagnĂłstico se usa la ecocardiografĂa y pruebas de estrĂ©s fĂsico o farmacolĂłgico. No existe un protocolo de tratamiento estandarizado, sin embargo, el trasplante hepĂĄtico puede ser un procedimiento efectivo para revertir la disfunciĂłn cardiaca en algunos pacientes. En el presente artĂculo se describen tanto las caracterĂsticas de la cardiomiopatĂa cirrĂłtica, como su papel en la morbilidad y mortalidad del paciente con cirrosis.Cirrhotic cardiomyopathy is a complication in cirrhotic patients, with a prevalence of more than 40%. During the resting state, it is a subclinical entity, which triggers symptoms upon exercise or circulatory Cirrhotic cardiomyopathy is a complication in cirrhotic patients, with a prevalence of more than 40%. During the resting state, it is a subclinical entity, which triggers symptoms upon exercise or circulator
Evaluation of the diagnostic value of fecal calprotectin in dyspepsia patients
El diagnĂłstico de pacientes con dispepsia representa un desafĂo ya que en la mayorĂa de los casos se requieren observaciones endoscĂłpicas complejas y costosas. En este estudio, evaluamos el rol del diagnĂłstico de la calprotectina fecal en pacientes con dispepsia. Para ello, en el año 2019 se realizĂł un estudio observacional en 149 pacientes con dispepsia registrados en el Centro de Especialistas en GastroenterologĂa de la entidad privada Cuenca, Ecuador. Los datos disponibles abarcaron edad, sexo, signos de alarma, valores de calprotectina fecal (CF) y hallazgos endoscĂłpicos. Los pacientes en el grupo de edad >65 años fueron los mĂĄs representados, el 56.4% de la poblaciĂłn eran del sexo femenino, el 48.57% eran CF positivos de los cuales el 86.8% poseĂan valores significativos de CF. CF+ se asociĂł significativamente con los hallazgos por EDA/colonoscopia (p65 years were most represented, 56.4% of the population were female, 48.57% were FC positive of whom 86.8% possessed significant values of FC. FC+ was significantly associated with findings by EDA/colonoscopy (p<0.001). The most diagnostic pathologies in patients with FC+ were congestive gastropathy, intestinal metaplasia, giardiasis, and polyposis. FC correlated positively with the presence of pathological findings in the invasive diagnostic tests (r=0.298) and is a useful, noninvasive biomarker correlating positively with endoscopic findings in the gastrointestinal tract of dyspepsia patients
Frequency of lactose intolerance and bacterial overgrowth syndrome in patients with dyspepsia without warning signs. Descriptive observational study
IntroducciĂłn
La prevalencia e incidencia de pacientes en consulta privada, que
presentan sĂntomas dispĂ©pticos como queja principal, cada vez
aumenta, por lo que proponemos determinar la etiologĂa en cada
paciente, determinando, la intolerancia a la lactosa (IL) y el sĂndrome
de sobrecrecimiento bacteriano intestinal (SIBO), como las mĂĄs altas
en prevalencia. La prueba de H2 espirado, es un método pråctico
y accesible, no invasivo, y estĂĄ validada en numerosos estudios,
como método diagnóstico para la Intolerancia a la Lactosa y el
Sobrecrecimiento Bacteriano.
Objetivos
Establecer la frecuencia de la intolerancia a la lactosa y el
sobrecrecimiento bacteriano en pacientes con dispepsia sin signos de
alarma en el centro de especialidades GastroenterologĂa GonzĂĄlez de
la ciudad de Cuenca-Ecuador.
MetodologĂa
Es un estudio observacional descriptivo, de corte transversal, que
recopilĂł los datos mediante el anĂĄlisis documental (historias clĂnicas) y
prueba de H2 espirado aplicadas a 310 individuos de ambos sexos con
un promedio de edad de 50±17 años, en el periodo febrero del 2019 a
febrero del 2020.
Resultados
Se observĂł que la intolerancia a la lactosa se presenta en el 29% de
los casos, mientras que el sobrecrecimiento bacteriano intestinal en el
20.3%, de los pacientes con sĂntomas dispĂ©pticos.
Conclusiones
La intolerancia a la lactosa tanto como el sĂndrome de sobrecrecimiento
bacteriano (SIBO), son sĂndromes frecuentes que se presentan en la
consulta privada, por lo que se debe tener en cuenta, en la investigaciĂłn
de un paciente con sĂntomas dispĂ©pticos, y no se debe descartar antes
de realizar una prueba diagnĂłstica como el test de H2 espiradoIntroduction
The prevalence and incidence of patients in private practice, presenting with dyspeptic
symptoms as a chief complaint, is increasing, so we propose to determine the etiology in each
patient, determining, lactose intolerance (LI) and intestinal bacterial overgrowth syndrome
(SIBO), as the highest in prevalence. The exhaled H2 test is a practical and accessible method
and has been validated in numerous studies as a diagnostic method.
Objectives
To establish the frequency of lactose intolerance and bacterial overgrowth in patients with
dyspepsia without alarm signs in the Gastroenterology GonzĂĄlez specialty center in the city of
Cuenca-Ecuador.
Methodology
This is a descriptive observational study, cross-sectional, which collected data through
documentary analysis (medical records) and H2 exhaled test applied to 310 individuals of both
sexes with an average age of 50±17 years, in the period February 2019 to February 2020.
Results
Lactose intolerance was observed in 29% of cases, while intestinal bacterial overgrowth in 20.3%..
Conclusions
Lactose intolerance as well as bacterial overgrowth syndrome (SIBO), are frequent syndromes
occurring in private practice, and should therefore be taken into account, when investigating a
patient with dyspeptic symptoms, and should not be ruled out before performing a diagnostic
test such as the exhaled H2 test
Immunosuppression protocol in liver transplantation: review article
El trasplante de hĂgado es el Ășltimo recurso para el tratamiento de hepatopatĂas. Para evitar el rechazo del injerto se requieren esquemas de inmunosupresiĂłn que han ido evolucionando a lo largo de los años. Se realizĂł una revisiĂłn bibliogrĂĄfica en la base de datos PubMed sobre las terapias inmunosupresoras disponibles para evitar el rechazo del injerto en el trasplante hepĂĄtico, los esquemas utilizados, efectos adversos, interacciones y sus modificaciones desde la fase de inducciĂłn hasta el seguimiento posterior. Se encontrĂł que la inducciĂłn habitual es con esteroides o terapia inmunolĂłgica clonal. En el mantenimiento, los inhibidores de la calcineurina son los mĂĄs utilizados, las dosis se deben ajustar segĂșn sus niveles sĂ©ricos y la presencia de efectos adversos como nefrotoxicidad o diabetes. Por otra parte, los inhibidores del mTOR han sido considerados como agentes reductores del riesgo de recidiva de cĂĄncer hepatocelular. Las caracterĂsticas del paciente y sus comorbilidades (embarazo, insuficiencia renal, diabetes, sepsis, carcinoma hepatocelular) requieren modificar el tratamiento e individualizarlo.Liver transplantation is the last option for the treatment of liver disease. Immunosuppression schemes
are required to avoid graft rejection, which have evolved over the years. A literature review was
carried out in PubMed on the immunosuppressive therapies available to avoid graft rejection in liver
transplantation, as well as on the schemes used, adverse effects, interactions and their modifications
from the induction phase to subsequent follow-up. The usual induction was found to be with steroids
or clonal immune therapy. In maintenance, calcineurin inhibitors are the most widely used, and their
doses should be adjusted according to their serum levels and the presence of adverse effects such
as nephrotoxicity or diabetes. On the other hand, mTOR inhibitors have been considered to reduce
the risk of hepatocellular cancer recurrence. The characteristics of the patient and their comorbidities
(pregnancy, kidney failure, diabetes, sepsis, hepatocellular carcinoma) require modification and
individualization of the treatmen
Multiplicity dependence of light (anti-)nuclei production in pâPb collisions at sNN=5.02 TeV
The measurement of the deuteron and anti-deuteron production in the rapidity range â1 < y < 0 as a function of transverse momentum and event multiplicity in pâPb collisions at âsNN = 5.02 TeV is presented. (Anti-)deuterons are identified via their specific energy loss dE/dx and via their time-of- flight. Their production in pâPb collisions is compared to pp and PbâPb collisions and is discussed within the context of thermal and coalescence models. The ratio of integrated yields of deuterons to protons (d/p) shows a significant increase as a function of the charged-particle multiplicity of the event starting from values similar to those observed in pp collisions at low multiplicities and approaching those observed in PbâPb collisions at high multiplicities. The mean transverse particle momenta are extracted from the deuteron spectra and the values are similar to those obtained for p and particles. Thus, deuteron spectra do not follow mass ordering. This behaviour is in contrast to the trend observed for non-composite particles in pâPb collisions. In addition, the production of the rare 3He and 3He nuclei has been studied. The spectrum corresponding to all non-single diffractive p-Pb collisions is obtained in the rapidity window â1 < y < 0 and the pT-integrated yield dN/dy is extracted. It is found that the yields of protons, deuterons, and 3He, normalised by the spin degeneracy factor, follow an exponential decrease with mass number
Development of a prediction model for postoperative pneumonia A multicentre prospective observational study
BACKGROUND Postoperative pneumonia is associated with increased morbidity, mortality and costs. Prediction models of pneumonia that are currently available are based on retrospectively collected data and administrative coding systems. OBJECTIVE To identify independent variables associated with the occurrence of postoperative pneumonia. DESIGN A prospective observational study of a multicentre cohort (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe database). SETTING Sixty-three hospitals in Europe. PATIENTS Patients undergoing surgery under general and/or regional anaesthesia during a 7-day recruitment period. MAIN OUTCOME MEASURE The primary outcome was postoperative pneumonia. Definition: the need for treatment with antibiotics for a respiratory infection and at least one of the following criteria: new or changed sputum; new or changed lung opacities on a clinically indicated chest radiograph; temperature more than 38.3 degrees C; leucocyte count more than 12 000 mu l(-1). RESULTS Postoperative pneumonia occurred in 120 out of 5094 patients (2.4%). Eighty-two of the 120 (68.3%) patients with pneumonia required ICU admission, compared with 399 of the 4974 (8.0%) without pneumonia (P < 0.001). We identified five variables independently associated with postoperative pneumonia: functional status [odds ratio (OR) 2.28, 95% confidence interval (CI) 1.58 to 3.12], pre-operative SpO(2) values while breathing room air (OR 0.83, 95% CI 0.78 to 0.84), intra-operative colloid administration (OR 2.97, 95% CI 1.94 to 3.99), intra-operative blood transfusion (OR 2.19, 95% CI 1.41 to 4.71) and surgical site (open upper abdominal surgery OR 3.98, 95% CI 2.19 to 7.59). The model had good discrimination (c-statistic 0.89) and calibration (Hosmer-Lemeshow P = 0.572). CONCLUSION We identified five variables independently associated with postoperative pneumonia. The model performed well and after external validation may be used for risk stratification and management of patients at risk of postoperative pneumonia
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