Long-term effectiveness of cinacalcet in non-dialysis patients with chronic kidney disease and seconday hyperparathyroidism

Background: secondary hyperparathyroidism (SHPT) is a common complication of chronic kidney disease (CKD). Cinacalcet use is controversial in non-dialysis patients. Methods: this retrospective observational study recruited patients receiving cinacalcet (off-label use) in 2010 and 2011. Patients were followed for three years from the beginning of treatment using an intention-to-treat approach. Results: forty-one patients were studied: 14 CKD stage 3 (34.1%), 21 CKD stage 4 (51.2%), and 6 CKD stage 5 (14.6%). Median baseline parathyroid hormone (PTH) was 396 (101-1,300) pg/mL. Upon cinacalcet treatment (22 ± 12 months), PTH levels decreased by ≥ 30% in 73.2% of patients (P < 0.001; 95% confidence interval [CI], 59-87%), with a mean time for response of 18.7 months (95% CI, 15.4-22.1). Sixteen patients were followed for 36 months and treated for 32 ± 9 months. Mean reduction in their PTH levels was 50.1% (P < 0.001; 95% CI, 33.8-66.4%) at 36 months, with 62.5% of patients (P < 0.001; 95% CI, 35.9-89.1%) presenting reductions of ≥ 30%. Serum calcium levels decreased from 9.95 ± 0.62 mg/dL to 9.21 ± 0.83 and 9.12 ± 0.78 mg/dL at 12 and 36 months, respectively (P < 0.001). Serum phosphorus levels increased from 3.59 ± 0.43 to 3.82 ± 0.84 at 12 months (P = 0.180), remaining so at 36 months (P = 0.324). At 12 and 36 months, 2 (12.5%) patients experienced hypocalcemia. Meanwhile, 1 (6.3%) and 4 (25.0%) patients reported hyperphosphatemia at 12 and 36 months, respectively. Conclusion: Cinacalcet remained effective for at least 36 months in non-dialysis patients with SHPT. Electrolytic disturbances were managed with concurrent use of vitamin D and its analogs or phosphate binders

Predicting the onset and persistence of episodes of depression in primary health care. The predictD-Spain study: Methodology

Background: The effects of putative risk factors on the onset and/or persistence of depression remain unclear. We aim to develop comprehensive models to predict the onset and persistence of episodes of depression in primary care. Here we explain the general methodology of the predictD-Spain study and evaluate the reliability of the questionnaires used. Methods: This is a prospective cohort study. A systematic random sample of general practice attendees aged 18 to 75 has been recruited in seven Spanish provinces. Depression is being measured with the CIDI at baseline, and at 6, 12, 24 and 36 months. A set of individual, environmental, genetic, professional and organizational risk factors are to be assessed at each follow-up point. In a separate reliability study, a proportional random sample of 401 participants completed the test-retest (251 researcher-administered and 150 self-administered) between October 2005 and February 2006. We have also checked 118,398 items for data entry from a random sample of 480 patients stratified by province. Results: All items and questionnaires had good test-retest reliability for both methods of administration, except for the use of recreational drugs over the previous six months. Cronbach's alphas were good and their factorial analyses coherent for the three scales evaluated (social support from family and friends, dissatisfaction with paid work, and dissatisfaction with unpaid work). There were 191 (0.16%) data entry errors. Conclusion: The items and questionnaires were reliable and data quality control was excellent. When we eventually obtain our risk index for the onset and persistence of depression, we will be able to determine the individual risk of each patient evaluated in primary health car

Intersections of quadrics, moment-angle manifolds, and Hamiltonian-minimal Lagrangian embeddings

We study the topology of Hamiltonian-minimal Lagrangian submanifolds N in C^m constructed from intersections of real quadrics in a work of the first author. This construction is linked via an embedding criterion to the well-known Delzant construction of Hamiltonian toric manifolds. We establish the following topological properties of N: every N embeds as a submanifold in the corresponding moment-angle manifold Z, and every N is the total space of two different fibrations, one over the torus T^{m-n} with fibre a real moment-angle manifold R, and another over a quotient of R by a finite group with fibre a torus. These properties are used to produce new examples of Hamiltonian-minimal Lagrangian submanifolds with quite complicated topology.Comment: 14 pages, published version (minor changes

Transformation of Conjuntival intraepithelial neoplasia into Squamous Cell Carcinoma despite topical treatment with Interferon α2b

Presentamos el caso de una mujer de 69 años de edad que acude por aparición de una tumoración en ojo derecho (OD) de 3 meses de evolución. En la exploración se observó una lesión en conjuntiva nasal de 3x8mm. El estudio de citología por impresión de la lesión, mostró una neoplasia intraepitelial conjuntival (CIN). Se inició tratamiento con interferón α2B tópico (IFN-α2b) 1 MUI/ml. A pesar de una disminución inicial de su tamaño (2x5mm), posteriormente se observó un nuevo crecimiento, por lo que se decidió tratamiento quirúrgico. El estudio histopatológico de la lesión confirmó el diagnóstico de carcinoma de células escamosas (CCE) moderadamente diferenciado con márgenes afectos. El tratamiento de la CIN con IFN-α2b ha impuesto como tratamiento de elección frente a la resección quirúrgica, dados los buenos resultados obtenidos, escasa recurrencia y pocos.Clinical case: A 69 year old woman presented with a conjunctival mass in her right eye (OD) for the previous 3 months. It was observed a mass of 3x8mm involving the nasal conjunctiva. Citolology study was performed showing a conjunctival intraepithelial neoplasia (NIC). Initially the lesion decreased in size (2x5mm) after topical interferon α2b (IFN-α2b) 1 MUI/ml treatment was prescribed. However, 6 months later, a new growth of the NIC was observed, so we decided surgical treatment. Histopathological study confirmed the diagnosis of conjunctival squamous cell carcinoma (SCC). Conclusions : Treatment with IFN-α2b is being preferred to surgical excision for NIC, due to its good results obtained, low recurrence and its few adverse effects. However, ineffective cases and progression to SCC of conjunctiva have been reported

Catalytic steam gasification of biomass for a sustainable hydrogen future: influence of catalyst composition

Hydrogen is regarded as a clean energy for fuelling the future. Hydrogen will be the energy carrier from other resources such as hydropower, wind, solar and biomass. Producing hydrogen from gasification of biomass wastes, particularly in the presence of steam, represents a promising route to produce this clean and CO2-neutral fuel. The steam pyrolysis-gasification ofbiomass (wood sawdust) was carried out with various nickel-based catalysts for hydrogen production in a two-stage fixed bed reaction system. The wood sawdust was pyrolysed in the first reactor and the derived products were gasified in the second reactor in the presence of the catalyst and steam. The synthesised Ni-Ca-Al and Ni-Zn-Al catalysts were preparedbyco-precipitation method with different Ni loadings of 20 mol% and various Zn/Al or Ca/Al ratios, which were characterized with scanning electron microscopy (SEM), transmission electron microscopy (TEM) and temperature-programmed oxidation (TPO). The results showed that the Ni/Zn-Al (1:9) catalyst resulted in higher hydrogenproduction(23.9 mmol H2 g-1biomass)compared with the Ni/Ca-Al (1:9) catalyst (12.7 23.9 mmol H2 g-1 biomass) and in addition, the increase of Ca or Zn content in the catalyst slightly increased the hydrogen production. The TPO results showed that the catalyst suffered negligible coke deposition from the catalytic steam pyrolysis/gasification of wood sawdust. Additionally, Na2CO3 basic solution was also found toproduce a catalyst with better performance and lower coke deposition, compared with NH4OH catalyst preparation agent, as observed by TPO, SEM and TEM analysis

Metabolomics demonstrates divergent responses of two Eucalyptus species to water stress

Past studies of water stress in Eucalyptus spp. generally highlighted the role of fewer than five “important” metabolites, whereas recent metabolomic studies on other genera have shown tens of compounds are affected. There are currently no metabolite profiling data for responses of stress-tolerant species to water stress. We used GC–MS metabolite profiling to examine the response of leaf metabolites to a long (2 month) and severe (Ψpredawn < −2 MPa) water stress in two species of the perennial tree genus Eucalyptus (the mesic Eucalyptus pauciflora and the semi-arid Eucalyptus dumosa). Polar metabolites in leaves were analysed by GC–MS and inorganic ions by capillary electrophoresis. Pressure–volume curves and metabolite measurements showed that water stress led to more negative osmotic potential and increased total osmotically active solutes in leaves of both species. Water stress affected around 30–40% of measured metabolites in E. dumosa and 10–15% in E. pauciflora. There were many metabolites that were affected in E. dumosa but not E. pauciflora, and some that had opposite responses in the two species. For example, in E. dumosa there were increases in five acyclic sugar alcohols and four low-abundance carbohydrates that were unaffected by water stress in E. pauciflora. Re-watering increased osmotic potential and decreased total osmotically active solutes in E. pauciflora, whereas in E. dumosa re-watering led to further decreases in osmotic potential and increases in total osmotically active solutes. This experiment has added several extra dimensions to previous targeted analyses of water stress responses in Eucalyptus, and highlights that even species that are closely related (e.g. congeners) may respond differently to water stress and re-waterin

Anàlisi del web Sexe Joves: www.sexejoves.gencat.cat

El web Sexe Joves és una eina per resoldre els dubtes dels joves sobre salut sexual i reproductiva. Forma part de la cartera de serveis de les unitats d'atenció a la salut sexual i reproductiva (ASSIR) en atenció als joves. Està coordinat i actualitzat per professionals de les unitats ASSIR d'atenció primària de l'Institut Català de la Salut (ICS), que avaluen la qualitat dels continguts del web, les respostes dels professionals i l'opinió dels joves sobre els serveis utilitzats

Los procesos de socialización de docentes de inglés del Programa Nacional de Inglés para educación básica en las primarias públicas de Baja California

El presente estudio busca conocer los procesos de socialización del personal docente que labora en el Programa Nacional de Inglés a nivel primaria y preescolar en Ensenada Baja California, México, para identificar, por un lado, la construcción de la identidad docente desde un enfoque socio pedagógico y; por otro, dar cuenta del contexto en el cual se encuentra inmerso para así contribuir al diálogo en apoyo a acciones que mejoren su entorno. Nuestro propósito no es solo generalizar sobre la construcción de identidades, sino también profundizar sobre el proceso que experimentan docentes que trabajan en el programa. Para enmarcar esta información se realizó un estudio cualitativo con orientación a estudio de caso. Los datos fueron recolectados a través de entrevistas semiestructuradas a un grupo de sujetos clave utilizando el método de análisis por categorías para organizar y concretar los resultados. La intervención circunscribe dos tipos de docentes; aquel grupo que cuenta con una formación pedagógica base, producto de su paso por programas formales de instrucción a nivel de universidad y, otros grupos que obtuvieron su trabajo como docentes por el manejo del inglés o su pertenencia al sistema educativo. También es significativa la manifestación de una falta de inducción al programa para su ingreso al contexto escolar, la precariedad de las condiciones laborales, la falta de apoyo para la capacitación pedagógica y el poco reconocimiento de la imagen del personal docente de lenguas por la sociedad

Model and Simulation Engines for Distributed Simulation of Discrete Event Systems

The construction of efficient distributed simulation engines for discrete event systems (DES) remains a challenge. The vast majority of simulations that are developed today are based on federation of modular sequential simulations. This paper proposes the steps to fill the gap from specifications based on Petri Nets to an efficient simulation of the net throughout a distributed application devoted to this purpose and exploiting the versatility of cloud infrastructures. The outcomes of the proposed DES distributed simulation are: (1) an adapted execution model of PN that is based in the generation and management of events related to the enabling and occurrence of transitions; (2) simple simulation engines for these adapted PN, each hosting a subset of transitions; (3) an scheme for deployment of a set of connected simulation engines; and (4) a simple mechanism for dynamic load balancing by merging/splitting the subsets of transitions hosted in simulation engines