Consumo de betabloqueantes como factor protector para peritonitis bacteriana espontánea en cirróticos con varices esofágicas

Objetivo: Nos propusimos determinar si el consumo de betabloqueantes es factor protector para peritonitis bacteriana espontanea en cirróticos con varices esofágicas en el Hospital Belén de Trujillo en el periodo 2012 - 2015. Material y Métodos: Se llevó a cabo un estudio de casos y controles. La población de estudio estuvo constituida por 126 pacientes adultos con cirrosis hepática descompensada; los cuales fueron divididas en 2 grupos: con peritonitis bacteriana espontanea o sin ella. Resultados: .- La edad promedio en pacientes con Peritonitis bacteriana espontánea fue de 48.3 y la edad promedio de pacientes sin peritonitis bacteriana fue 49.7. La etiología alcohólica y la hipoalbuminemia se observaron con una frecuencia significativamente mayor en los pacientes con peritonitis bacteriana espontanea en comparación con los pacientes sin esta complicación. La frecuencia de consumo de betabloqueadores en pacientes cirróticos con peritonitis bacteriana espontanea fue 52% y de 77% en pacientes cirróticos sin peritonitis bacteriana espontanea. Así mismo, los hallazgos observados en el análisis multivariado identifican la etiología alcohólica (ORa 2.5 IC95%[1.3-4.1]) y la hipoalbuminemia (ORa 2.8 IC95%[1.7-4.2]) como factores de riesgo asociado a Peritonitis bacteriana espontánea. El consumo de betabloqueantes es factor protector para peritonitis bacteriana espontanea con un odds ratio de 0.31. Conclusiones: El consumo de betabloqueadores es factor protector para peritonitis bacteriana espontanea en cirróticos con várices esofágicas en el Hospital Belén de Trujillo.Objective: To determine if the consumption of beta-blockers is a protective factor for spontaneous bacterial peritonitis in cirrhotic patients with esophageal varices in the Belén Hospital of Trujillo in the period 2012 - 2015. Material and Methods: An analytical, observational, retrospective, case and control study was carried out. The study population consisted of 126 adult patients with liver cirrhosis; which were divided into 2 groups: with or without spontaneous bacterial peritonitis. Results: The average age in patients with spontaneous bacterial peritonitis was 48.3 and the average age of patients without bacterial peritonitis was 49.7. The alcoholic etiology and hypoalbuminemia were observed with a significantly higher frequency in patients with spontaneous bacterial peritonitis compared to patients without this complication. The frequency of consumption of beta-blockers in cirrhotic patients with spontaneous bacterial peritonitis was 52% and 77% in cirrhotic patients without spontaneous bacterial peritonitis. Likewise, the findings observed in the multivariate analysis identify the alcoholic etiology (ORa 2.5 IC95% [1.3-4.1]) and hypoalbuminemia (ORa 2.8 IC95% [1.7-4.2]) as risk factors associated with spontaneous bacterial peritonitis.The consumption of beta-blockers is protective factor for spontaneous bacterial peritonitis with an odds ratio of 0.31. Conclusions: The consumption of beta-blockers is a protective factor for spontaneous bacterial peritonitis in cirrhotic patients with esophageal varices in the Belén Hospital of Trujillo.Tesi

A Critical Temporal Window for Selectin-dependent CD4+ Lymphocyte Homing and Initiation of Late-Phase Inflammation in Contact Sensitivity

Contact sensitivity (CS) is an inflammatory disorder characterized by early and late phases of leukocyte recruitment. We used a noninvasive intravital microscopy technique allowing for the direct visualization of leukocyte rolling and adhesion on blood vessel endothelium. By blocking specific adhesion molecules, we elucidated the molecular mechanisms mediating early leukocyte recruitment to be E- and P-selectin and demonstrated that leukocyte recruitment in the late phase had a different adhesive profile (mainly α4-integrin). Complete blockade of E- and P-selectin within the first 2 h of leukocyte–endothelial cell interactions (but not later) eliminated selectin-independent leukocyte recruitment at 24 h. Despite the predominance of neutrophils in the early phase, specific elimination of CD4+ lymphocytes in the early phase eliminated the late response. CD4+ lymphocytes homed to skin via E- and P-selectin within the early phase and induced the late phase response. Addition of these same CD4+ lymphocytes 2 h after antigen challenge was too late for these cells to home to the skin and induce late phase responses. Our data clearly demonstrate that the antigen-challenged microenvironment is only accessible to CD4+ lymphocytes for the first 2 h, and that this process is essential for the subsequent recruitment of other leukocyte populations in late phase responses

Reducing the Visual Signature of the M4A1 Rifle

The Maneuver Center of Excellence (MCoE) presented a directive to reduce the visual signature for small arms weapons by altering the color of the M4A1 rifle from its traditional black color. This research utilizes the Systems Decision Process (SDP) to develop and analyze alternatives to create a feasible and permanent solution to reduce the weapon’s visual signature. The research consisted of an extensive stakeholder and functional analysis to develop a value model and framework that provides a values-based recommendation. The model establishes an optimal color change process that accounts for the design and performance characteristics of the weapon system and the stakeholder’s values. The research also analyzes the potential integration of short wave infrared (SWIR) mitigation into the new color of the weapon. This analysis will establish a baseline methodology for weapon color change for all Army small arms weapons

Factibilidad de la soldadura TIG en ensamblado de aluminio 6063 extruido para fabricación de automóviles

Introduction. One of the most used materials in various industrial processes is aluminum, due to its great versatility and low weight, great malleability and formability, resistance to corrosion, and high electrical conductivity. Its appearance has allowed a boom in the development of new techniques, methods, and applications. Among the joining methods are welding processes, and specifically the TIG (Tungsten Inert Gas) welding process, which uses an atmosphere of Argon gas to protect the formation of the weld seam. Objective. The present study is focused on analyzing the feasibility of TIG welding in the assembly of extruded 6063 aluminum for automobile manufacturing. Methodology. It is based on documentary and bibliographical research. Results. They were based on the analyzes of the characteristics of the 6063 alloy, the extrusion of the metals and the characteristics of the weld. Conclusion. Embrittlement of the base material was obtained due to electric arc heating, as well as a decrease in tensile strength and an increase in the hardness of aluminum before a welding procedure. To minimize and solve the effects described above on the characteristics of aluminum, a heat treatment must be used after the welding process.Introducción. Uno de los materiales más utilizados en los diversos procesos industriales es el aluminio, debido a su gran versatilidad y bajo peso, gran maleabilidad y conformabilidad, resistencia a la corrosión y alta conductividad eléctrica. Su aparición ha permitido un gran auge en el desarrollo de nuevas técnicas, métodos y aplicaciones. Dentro de los métodos de unión se encuentran los procesos de soldadura, y en específico el proceso de soldadura TIG (Tungsten Inert Gas) el cual utiliza una atmósfera de gas Argón para proteger la formación del cordón de soldadura. Objetivo. El presente estudio está enfocado en analizar la factibilidad de la soldadura TIG en el ensamblado de aluminio 6063 extruido para fabricación de automóviles. Metodología. Se basa en investigaciones de tipo documental y bibliográfica. Resultados. Se basaron en los análisis de las características de la aleación 6063, la extrusión de los metales y las características de la soldadura. Conclusión. Se obtuvo fragilización del material base a causa del calentamiento al arco eléctrico, así como, disminución de la resistencia a la tracción y aumento en la dureza del aluminio ante un procedimiento de soldadura.  Para minimizar y solucionar los efectos descritos anteriormente en las características del aluminio, se debe recurrir posterior al proceso de soldadura, a un tratamiento térmico

Le retour de la pièce esquillée !

pdf déposé avec autorisation de l'éditeurNational audienceLes auteurs s'interrogent sur les outillages riches en pièces esquillées, rassemblent des données sur leur situation géographique et passent en revue les différentes hypothèses technologiques et fonctionnelles

Diagnosis of central disorders of hypersomnolence: A reappraisal by European experts

Summary The aim of this European initiative is to facilitate a structured discussion to improve the next edition of the International Classification of Sleep Disorders (ICSD), particularly the chapter on central disorders of hypersomnolence. The ultimate goal for a sleep disorders classification is to be based on the underlying neurobiological causes of the disorders with clear implication for treatment or, ideally, prevention and or healing. The current ICSD classification, published in 2014, inevitably has important shortcomings, largely reflecting the lack of knowledge about the precise neurobiological mechanisms underlying the majority of sleep disorders we currently delineate. Despite a clear rationale for the present structure, there remain important limitations that make it difficult to apply in routine clinical practice. Moreover, there are indications that the current structure may even prevent us from gaining relevant new knowledge to better understand certain sleep disorders and their neurobiological causes. We suggest the creation of a new consistent, complaint driven, hierarchical classification for central disorders of hypersomnolence; containing levels of certainty, and giving diagnostic tests, particularly the MSLT, a weighting based on its specificity and sensitivity in the diagnostic context. We propose and define three diagnostic categories (with levels of certainty): 1/“Narcolepsy” 2/“Idiopathic hypersomnia”, 3/“Idiopathic excessive sleepiness” (with subtypes)Peer reviewe

European guideline and expert statements on the management of narcolepsy in adults and children

Background and purpose: Narcolepsy is an uncommon hypothalamic disorder of presumed autoimmune origin that usually requires lifelong treatment. This paper aims to provide evidence-based guidelines for the management of narcolepsy in both adults and children. Methods: The European Academy of Neurology (EAN), European Sleep Research Society (ESRS), and European Narcolepsy Network (EU-NN) nominated a task force of 18 narcolepsy specialists. According to the EAN recommendations, 10 relevant clinical questions were formulated in PICO format. Following a systematic review of the literature (performed in Fall 2018 and updated in July 2020) recommendations were developed according to the GRADE approach. Results: A total of 10,247 references were evaluated, 308 studies were assessed and 155 finally included. The main recommendations can be summarized as follows: (i) excessive daytime sleepiness (EDS) in adults-scheduled naps, modafinil, pitolisant, sodium oxybate (SXB), solriamfetol (all strong); methylphenidate, amphetamine derivatives (both weak); (ii) cataplexy in adults-SXB, venlafaxine, clomipramine (all strong) and pitolisant (weak); (iii) EDS in children-scheduled naps, SXB (both strong), modafinil, methylphenidate, pitolisant, amphetamine derivatives (all weak); (iv) cataplexy in children-SXB (strong), antidepressants (weak). Treatment choices should be tailored to each patient's symptoms, comorbidities, tolerance and risk of potential drug interactions. Conclusion: The management of narcolepsy involves non-pharmacological and pharmacological approaches with an increasing number of symptomatic treatment options for adults and children that have been studied in some detail.Peer reviewe

The evaluation of European criminal law

The role of evaluation has become increasingly important in the context of EU policies in the field of judicial cooperation in criminal matters. This evolution is the result of an increasing number of legally binding instruments adopted in the framework of the third pillar of the European Union and of their growing impact on national legal systems

Building essential biodiversity variables (EBVs) of species distribution and abundance at a global scale

Much biodiversity data is collected worldwide, but it remains challenging to assemble the scattered knowledge for assessing biodiversity status and trends. The concept of Essential Biodiversity Variables (EBVs) was introduced to structure biodiversity monitoring globally, and to harmonize and standardize biodiversity data from disparate sources to capture a minimum set of critical variables required to study, report and manage biodiversity change. Here, we assess the challenges of a 'Big Data' approach to building global EBV data products across taxa and spatiotemporal scales, focusing on species distribution and abundance. The majority of currently available data on species distributions derives from incidentally reported observations or from surveys where presence-only or presence-absence data are sampled repeatedly with standardized protocols. Most abundance data come from opportunistic population counts or from population time series using standardized protocols (e.g. repeated surveys of the same population from single or multiple sites). Enormous complexity exists in integrating these heterogeneous, multi-source data sets across space, time, taxa and different sampling methods. Integration of such data into global EBV data products requires correcting biases introduced by imperfect detection and varying sampling effort, dealing with different spatial resolution and extents, harmonizing measurement units from different data sources or sampling methods, applying statistical tools and models for spatial inter- or extrapolation, and quantifying sources of uncertainty and errors in data and models. To support the development of EBVs by the Group on Earth Observations Biodiversity Observation Network (GEO BON), we identify 11 key workflow steps that will operationalize the process of building EBV data products within and across research infrastructures worldwide. These workflow steps take multiple sequential activities into account, including identification and aggregation of various raw data sources, data quality control, taxonomic name matching and statistical modelling of integrated data. We illustrate these steps with concrete examples from existing citizen science and professional monitoring projects, including eBird, the Tropical Ecology Assessment and Monitoring network, the Living Planet Index and the Baltic Sea zooplankton monitoring. The identified workflow steps are applicable to both terrestrial and aquatic systems and a broad range of spatial, temporal and taxonomic scales. They depend on clear, findable and accessible metadata, and we provide an overview of current data and metadata standards. Several challenges remain to be solved for building global EBV data products: (i) developing tools and models for combining heterogeneous, multi-source data sets and filling data gaps in geographic, temporal and taxonomic coverage, (ii) integrating emerging methods and technologies for data collection such as citizen science, sensor networks, DNA-based techniques and satellite remote sensing, (iii) solving major technical issues related to data product structure, data storage, execution of workflows and the production process/cycle as well as approaching technical interoperability among research infrastructures, (iv) allowing semantic interoperability by developing and adopting standards and tools for capturing consistent data and metadata, and (v) ensuring legal interoperability by endorsing open data or data that are free from restrictions on use, modification and sharing. Addressing these challenges is critical for biodiversity research and for assessing progress towards conservation policy targets and sustainable development goals