Osteocondrosis en equinos: un problema latente de la industria hípica

This review is focused on osteochondrosis (OC) in horses. OC is a disturbance in endochondral ossification of mutifactorial etiology affecting equines and other animal species. There is no agreement about the classification of OC, since some researchers defined it as a metabolic disease while others classify it within the group of Developmental Orthopedic Disease (DOD). In horses, OC mainly affects fetlock, hock and stifle joints. Lesions may appear in several locations in a single animal, and sometimes occurs in bilaterally symmetrical sites. Clinical signs are mainly joint distension and differing degrees of lameness. Pathogenesis of the OC is unknown, but many etiologic factors have been proposed such as, dietary imbalance, growth rate, trauma, anatomic conformation and genetics. In veterinary clinics, the diagnosis is carried out mainly by radiological joints evaluation. However, other diagnostic methods have been developed (ultrasound scan, magnetic resonance imaging and computed tomography). Finally, the treatment of OC is aimed to remove free fragments and to repair other lesions by arthroscopic surgery. However treatment may be conservative, depending on horse age. Some researchers believe in the dynamic character of early OC and the eventual disappearance of small lesions.Esta revisión esta centrada en la Osteocondrosis (OC) en equinos. La osteocondrosis es un disturbio en la osificación endocondral de etiología multifactorial que afecta a equinos y otras especies animales. No hay un acuerdo entre los investigadores en la clasificación de la OC; algunos sostienen que se trata de una enfermedad metabólica mientras que otros la incluyen dentro de las Enfermedades Ortopédicas del Desarrollo (DOD). En los caballos la OC afecta principalmente a las articulaciones de nudos, tarsos y babillas. Las lesiones pueden aparecer en varias localizaciones en un mismo animal, a veces ocurren en sitios bilaterales y simétricos. Los signos clínicos son principalmente la distensión articular y diferentes grados de claudicación. La etiopatogenia de OC es desconocida, habiendo sido propuestos varios factores etiológicos como, desbalances en la dieta y/o tasa de crecimiento, traumas, conformación anatómica y factores genéticos. En la clínica veterinaria el diagnóstico se realiza por a través de la evaluación radiológica de las articulaciones. Sin embargo, se han desarrollado otros métodos diagnósticos (ecografía, resonancia magnética y tomografía computada). El tratamiento clásico de OC consiste en remover el fragmento óseo y reparar las lesiones por artroscopia. Sin embargo, el tratamiento puede ser conservador dependiendo la edad del equino; basado en el carácter dinámico de la enfermedad temprana, pequeñas lesiones pueden desaparecer eventualmente

Intensity-Modulated Radiotherapy in Patients with Cervical Cancer. An intra-individual Comparison of Prone and Supine Positioning

<p>Abstract</p> <p>Background</p> <p>Chemoradiation for cervical cancer patients is associated with considerable gastrointestinal toxicity. Intensity-modulated radiotherapy (IMRT) has demonstrated superiority in terms of target coverage and normal tissue sparing in comparison to conventional 3D planning in gynaecological malignancies. Whether IMRT in prone (PP) or supine position (SP) might be beneficial for cervical cancer patients remains partially unanswered.</p> <p>Methods</p> <p>10 patients on FIGO stage IB-III cervical cancer, 6 patients for definitive and 4 patients for adjuvant external beam pelvic RT, were planned in PP and SP using a 7-field IMRT technique. IMRT plans for PP and SP (mean dose, D_mean50.4 Gy) were optimized in terms of PTV coverage (1^stpriority) and small bowel sparing (2^ndpriority). A comparison of DVH parameters for PTV, small bowel, bladder, and rectum was performed.</p> <p>Results</p> <p>The comparison showed a similar PTV coverage of 95% of the prescribed dose and for target conformity in IMRT plans (PP, SP). PTV, rectum and bladder volumes were comparable for PP and SP. Significantly larger volumes of small bowel were found in PP (436 cc, + 35%, p = 0.01). PP decreased the volume of small bowel at 20-50.4 Gy (p < 0.05) and increased the rectum volumes covered by doses from 10-40 Gy (p < 0.01), the V50.4 was < 5% in both treatment positions. Bladder sparing was significant better at 50.4 Gy (p = 0.03) for PP.</p> <p>Conclusion</p> <p>In this dosimetric study, we demonstrated that pelvic IMRT in prone position for patients with cervical cancer seems to be beneficial in reducing small bowel volume at doses ≥20 Gy while providing similar target coverage and target conformity. The use of frequent image guidance with KV (kilovolt) or MV (megavolt) computertomography can reduce set-up deviations, and treatment in prone position can be done with a higher set-up accuracy. Clinical outcome studies are needed to affirm lower toxicity.</p

Fenoldopam use in a burn intensive care unit: a retrospective study

<p>Abstract</p> <p>Background</p> <p>Fenoldopam mesylate is a highly selective dopamine-1 receptor agonist approved for the treatment of hypertensive emergencies that may have a role at low doses in preserving renal function in those at high risk for or with acute kidney injury (AKI). There is no data on low-dose fenoldopam in the burn population. The purpose of our study was to describe our use of low-dose fenoldopam (0.03-0.09 μg/kg/min) infusion in critically ill burn patients with AKI.</p> <p>Methods</p> <p>We performed a retrospective analysis of consecutive patients admitted to our burn intensive care unit (BICU) with severe burns from November 2005 through September 2008 who received low-dose fenoldopam. Data obtained included systolic blood pressure, serum creatinine, vasoactive medication use, urine output, and intravenous fluid. Patients on concomitant continuous renal replacement therapy were excluded. Modified inotrope score and vasopressor dependency index were calculated. One-way analysis of variance with repeated measures, Wilcoxson signed rank, and chi-square tests were used. Differences were deemed significant at p < 0.05.</p> <p>Results</p> <p>Seventy-seven patients were treated with low-dose fenoldopam out of 758 BICU admissions (10%). Twenty (26%) were AKI network (AKIN) stage 1, 14 (18%) were AKIN stage 2, 42 (55%) were AKIN stage 3, and 1 (1%) was AKIN stage 0. Serum creatinine improved over the first 24 hours and continued to improve through 48 hours (<it>p </it>< 0.05). There was an increase in systolic blood pressure in the first 24 hours that was sustained through 48 hours after initiation of fenoldopam (<it>p </it>< 0.05). Urine output increased after initiation of fenoldopam without an increase in intravenous fluid requirement (<it>p </it>< 0.05; <it>p </it>= NS). Modified inotrope score and vasopressor dependency index both decreased over 48 hours (<it>p </it>< 0.0001; <it>p </it>= 0.0012).</p> <p>Conclusions</p> <p>These findings suggest that renal function was preserved and that urine output improved without a decrease in systolic blood pressure, increase in vasoactive medication use, or an increase in resuscitation requirement in patients treated with low-dose fenoldopam. A randomized controlled trial is required to establish the efficacy of low-dose fenoldopam in critically ill burn patients with AKI.</p

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Pan-cancer analysis of whole genomes

Cancer is driven by genetic change, and the advent of massively parallel sequencing has enabled systematic documentation of this variation at the whole-genome scale(1-3). Here we report the integrative analysis of 2,658 whole-cancer genomes and their matching normal tissues across 38 tumour types from the Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium of the International Cancer Genome Consortium (ICGC) and The Cancer Genome Atlas (TCGA). We describe the generation of the PCAWG resource, facilitated by international data sharing using compute clouds. On average, cancer genomes contained 4-5 driver mutations when combining coding and non-coding genomic elements; however, in around 5% of cases no drivers were identified, suggesting that cancer driver discovery is not yet complete. Chromothripsis, in which many clustered structural variants arise in a single catastrophic event, is frequently an early event in tumour evolution; in acral melanoma, for example, these events precede most somatic point mutations and affect several cancer-associated genes simultaneously. Cancers with abnormal telomere maintenance often originate from tissues with low replicative activity and show several mechanisms of preventing telomere attrition to critical levels. Common and rare germline variants affect patterns of somatic mutation, including point mutations, structural variants and somatic retrotransposition. A collection of papers from the PCAWG Consortium describes non-coding mutations that drive cancer beyond those in the TERT promoter(4); identifies new signatures of mutational processes that cause base substitutions, small insertions and deletions and structural variation(5,6); analyses timings and patterns of tumour evolution(7); describes the diverse transcriptional consequences of somatic mutation on splicing, expression levels, fusion genes and promoter activity(8,9); and evaluates a range of more-specialized features of cancer genomes(8,10-18).Peer reviewe

An Optical Overview of Blazars with LAMOST. II. Gamma-Ray Blazar Candidates and Updated Classifications

Blazars represent the dominant class of associated gamma-ray sources detected by the Fermi Large Area Telescope (LAT). However, in the more recent release of the Fourth Fermi-LAT Point Source Catalog (4FGL), similar to 25% of the sources associated with lower-energy counterparts show a multifrequency behavior similar to that of blazars, but lacks an optical spectroscopic confirmation of their nature and are therefore classified as Blazar Candidates of Uncertain Type (BCUs). A particularly challenging task in blazar studies is to classify these BCUs and, when possible to estimate their redshifts, in particular for BL Lac objects, characterized by almost featureless optical spectra with only weak emission lines. Continuing our study of blazars with Large Sky Area Multi-Object Fiber Spectroscopic Telescope (LAMOST) optical spectral data, we perform an extensive search for optical spectra available in the LAMOST Data Release 6 archive. Our aim is confirming the blazar nature of BCUs and to test if new data can allow us to get a redshift estimate for BL Lac objects that lack measurement, as well as to search for and discover changing-look blazars. We selected sources out of the 4FGL catalog, the list of targets from our follow-up spectroscopic campaign of unidentified and/or unassociated gamma-ray sources, and the Roma-BZCAT multifrequency catalog of blazars, finding a total of 42 sources with available LAMOST DR6 spectra. We confirmed the blazar-like nature of four blazar candidates . For the remaining 37 sources we confirm their previous classification