Variabilidad morfológica y nucleotídica en el género "cistus" análisis macro- y microevolutivos

Tesis inédita de la Universidad Complutense de Madrid, Facultad de Ciencias Biológicas, Departamento de Botánica, leída el 23-01-2008Fac. de Ciencias BiológicasTRUEProQuestpu

Complicaciones en la cirugía de las luxaciones acromioclaviculares: Estudio comparativo de dos técnicas quirúrgicas

Se realiza un estudio comparativa, retrospectivo, de 46 pacientes con luxación acromioclavicular grado III tratadas quirúrgicamente por la técnica de Phemister (30 caos) y de Bosworth (16 casos). El análisis preoperatorio de ambos grupos no demostró diferencias estadísticamente significativas exceptuando el seguimiento que fue mayor en el grupo de Phemister. En cuanto a resultados, todos los pacientes evolucionaron a la movilidad completa del hombro, con reincorporación a su actividad habitual. No existieron en este apartado diferencias significativas entre ambos grupos. La incidencia de complicaciones fue mayor en el grupo Phemister (75%) que en el Bosworth (13%), debidas fundamentalmente a problemas relacionados con el material de osteosíntesis empleado y con el abordaje quirúrgico. El tornillo utilizado en la técnica de Bosworth asegura buenos resultados funcionales, con menos agresividad quirúrgica y menor riesgo de complicaciones. En ambas técnicas hay que retirar el material en un segundo acto quirúrgico, por lo que debe tenerse en cuenta la posibilidad de emplear implantes de material biorreabsorbible para estudios posteriores.The study compared the clinical and radiographic outcome of two surgical techniques for acute grade III acromioclavicular dislocation: Phemister (30 patients) and Bosworth (16 patients). There are no significative differences between the two groups related to the preoperative assessment. Only the follow-up period was longer in the Phemister group. Concerning results, all patients recovered complete movility and returned to work. There was no significative differences in this evaluation. The Phemister group shows a higher incidence of complications (75%) than the Bosworth group (13%), mainly problems relative to the implant and the surgical approach. The screw employed in the Bosworth technique assure good functional results with lower risk of complications. In both procedures is necessary to remove the hardware in a second operation. The use of bioabsorbable implants should be considered in further studies

Extensive pollen flow but few pollen donors and high reproductive variance in an extremely fragmented landscape

Analysing pollen movement is a key to understanding the reproductive system of plant species and how it is influenced by the spatial distribution of potential mating partners in fragmented populations. Here we infer parameters related to levels of pollen movement and diversity of the effective pollen cloud for the wind-pollinated shrub Pistacia lentiscus across a highly disturbed landscape using microsatellite loci. Paternity analysis and the indirect KinDist and Mixed Effect Mating models were used to assess mating patterns, the pollen dispersal kernel, the effective number of males (N(ep)) and their relative individual fertility, as well as the existence of fine-scale spatial genetic structure in adult plants. All methods showed extensive pollen movement, with high rates of pollen flow from outside the study site (up to 73-93%), fat-tailed dispersal kernels and large average pollination distances (δ = 229-412 m). However, they also agreed in detecting very few pollen donors (N(ep) = 4.3-10.2) and a large variance in their reproductive success: 70% of males did not sire any offspring among the studied female plants and 5.5% of males were responsible for 50% of pollinations. Although we did not find reduced levels of genetic diversity, the adult population showed high levels of biparental inbreeding (14%) and strong spatial genetic structure (S(p) = 0.012), probably due to restricted seed dispersal and scarce safe sites for recruitment. Overall, limited seed dispersal and the scarcity of successful pollen donors can be contributing to generate local pedigrees and to increase inbreeding, the prelude of genetic impoverishment

Agreement in metastatic spinal cord compression

Background: Metastatic epidural spinal cord compression (ESCC) is a devastating medical emergency. The purpose of this study was to determine the reliability of the 6-point ESCC scoring system and the identification of the spinal level presenting ESCC. Methods: Clinical data and imaging from 90 patients with biopsy-proven spinal metastases were provided to 83 specialists from 44 hospitals. The spinal levels presenting metastases and the ESCC scores for each case were calculated twice by each clinician, with a minimum of 6 weeks' interval. Clinicians were blinded to assessments made by other specialists and their own previous assessment. Fleiss kappa (κ) statistic was used to assess intraobserver and interobserver agreement. Subgroup analyses were performed according to clinicians' specialty (medical oncology, neurosurgery, radiology, orthopedic surgery, and radiation oncology), years of experience, and type of hospital. Results: Intraobserver and interobserver agreement on the location of ESCC was substantial (κ>0.61). Intraobserver agreement on the ESCC score was 'excellent' (κ=0.82), whereas interobserver agreement was substantial (κ=0.64). Overall agreement with the tumor board classification was substantial (κ=0.71). Results were similar across specialties, years of experience and hospital category. Conclusions: The ESCC score can help improve communication among clinicians involved in oncology care

Early detection of anthracycline- and trastuzumab-induced cardiotoxicity: value and optimal timing of serum biomarkers and echocardiographic parameters.

Aims To evaluate echocardiographic and biomarker changes during chemotherapy, assess their ability to early detect and predict cardiotoxicity and to define the best time for their evaluation. Methods and results Seventy-two women with breast cancer (52 ± 9.8 years) treated with anthracyclines (26 also with trastuzumab), were evaluated for 14 months (6 echocardiograms/12 laboratory tests). We analysed: high-sensitivity cardiac troponin T, NT-proBNP, global longitudinal strain (GLS), left ventricle end-systolic volume (LVESV), left ventricle end-diastolic volume (LVEDV), and left ventricular ejection fraction (LVEF). Cardiotoxicity was defined as a reduction in LVEF>10% compared with baseline with LVEF<53%. High-sensitivity troponin T levels rose gradually reaching a maximum peak at 96 ± 13 days after starting chemotherapy (P < 0.001) and 62.5% of patients presented increased values during treatment. NT-proBNP augmented after each anthracycline cycle (mean pre-cycle levels of 72 ± 68 pg/mL and post-cycle levels of 260 ± 187 pg/mL; P < 0.0001). Cardiotoxicity was detected in 9.7% of patients (mean onset at 5.2 months). In the group with cardiotoxicity, the LVESV was higher compared with those without cardiotoxicity (40 mL vs. 29.5 mL; P = 0.045) at 1 month post-anthracycline treatment and the decline in GLS was more pronounced ( 17.6% vs. 21.4%; P = 0.03). Trastuzumab did not alter serum biomarkers, but it was associated with an increase in LVESV and LVEDV (P < 0.05). While baseline LVEF was an independent predictor of later cardiotoxicity (P = 0.039), LVESV and GLS resulted to be early detectors of cardiotoxicity [odds ratio = 1.12 (1.02–1.24), odds ratio = 0.66 (0.44–0.92), P < 0.05] at 1 month post-anthracycline treatment. Neither high-sensitivity troponin T nor NT-proBNP was capable of predicting subsequent cardiotoxicity. Conclusions One month after completion of anthracycline treatment is the optimal time to detect cardiotoxicity by means of imaging parameters (LVESV and GSL) and to determine maximal troponin rise. Baseline LVEF was a predictor of later cardiotoxicity. Trastuzumab therapy does not affect troponin values hence imaging techniques are recommended to detect trastuzumab-induced cardiotoxicity.post-print3194 K

Vascular Inflammation in Subclinical Atherosclerosis Detected by Hybrid PET/MRI

BACKGROUND: Atherosclerosis is a chronic inflammatory disease, but data on arterial inflammation at early stages is limited. OBJECTIVES: The purpose of this study was to characterize vascular inflammation by hybrid 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/magnetic resonance imaging (PET/MRI). METHODS: Carotid, aortic, and ilio-femoral 18F-FDG PET/MRI was performed in 755 individuals (age 40 to 54 years; 83.7% men) with known plaques detected by 2-/3-dimensional vascular ultrasound and/or coronary calcification in the PESA (Progression of Early Subclinical Atherosclerosis) study. The authors evaluated the presence, distribution, and number of arterial inflammatory foci (increased 18F-FDG uptake) and plaques with or without inflammation (coincident 18F-FDG uptake). RESULTS: Arterial inflammation was present in 48.2% of individuals (24.4% femorals, 19.3% aorta, 15.8% carotids, and 9.3% iliacs) and plaques in 90.1% (73.9% femorals, 55.8% iliacs, and 53.1% carotids). 18F-FDG arterial uptakes and plaques significantly increased with cardiovascular risk factors (p < 0.01). Coincident 18F-FDG uptakes were present in 287 of 2,605 (11%) plaques, and most uptakes were detected in plaque-free arterial segments (459 of 746; 61.5%). Plaque burden, defined by plaque presence, number, and volume, was significantly higher in individuals with arterial inflammation than in those without (p < 0.01). The number of plaques and 18F-FDG uptakes showed a positive albeit weak correlation (r = 0.25; p < 0.001). CONCLUSIONS: Arterial inflammation is highly prevalent in middle-aged individuals with known subclinical atherosclerosis. Large-scale multiterritorial PET/MRI allows characterization of atherosclerosis-related arterial inflammation and demonstrates 18F-FDG uptake in plaque-free arterial segments and, less frequently, within plaques. These findings suggest an arterial inflammatory state at early stages of atherosclerosis. (Progression of Early Subclinical Atherosclerosis [PESA]; NCT01410318).The PESA study is cofunded equally by the Centro Nacional de Investigaciones Cardiovasculares (CNIC) and Banco Santander. The study also receives funding from the Instituto de Salud Carlos III (PI15/02019) and the European Regional Development Fund (ERDF) “A way to make Europe.” The CNIC is supported by the Ministerio de Ciencia, Innovación y Universidades, and the Pro CNIC Foundation, and is a Severo Ochoa Center of Excellence (SEV-2015-0505). Dr. Sanchez-González is an employee of Philips Healthcare. Dr. Bueno has received research funding from the Instituto de Salud Carlos III, Spain (PIE16/00021 & PI17/01799), AstraZeneca, Bristol-Myers Squibb, Janssen, and Novartis; has received consulting fees from AstraZeneca, Bayer, Bristol-Myers Squibb-Pfizer, and Novartis; and has received speaking fees or support for attending scientific meetings from AstraZeneca, Bayer, Bristol-Myers Squibb-Pfizer, Novartis, and MEDSCAPE-the heart.org.S

Entrenamiento en habilidades básicas de gestión de grupos para la mejora de la competencia transversal de hablar en público: protocolo para alumnos de posgrado de Psicología

El presente proyecto se enmarca en la mejora educativa de dos grandes bloques: 1)La mejora de competencias transversales indispensables en la carrera académica de cualquier alumno universitario. En este proyecto en concreto, se abordará la tarea de hablar en público, que ostenta un papel central en el desempeño de los alumnos en la práctica totalidad de asignaturas y en la potenciación de sus destrezas básicas a ofrecer en su futuro profesional. 2)La mejora educativa de alumnos del Master Oficial en Psicología General Sanitaria, como parte aplicada de su formación. Atendiendo al primer bloque, son múltiples las situaciones en las que los alumnos han de enfrentarse a un público y exponer o defender un trabajo, opinión etc… Ante esta situación, tradicionalmente se ha dado mayor peso a cuestiones de contenido (lo que se expone) y no tanto a cuestiones de forma (cómo se hace). La demanda de servicios que presten atención y ayuda en este ámbito va en aumento. Desde un punto de vista comunitario cada vez son más las asociaciones, fundaciones, escuelas que se dirigen a potenciar esta destreza (p. ej. ToastMaster). En el mismo sentido, desde un contexto clínico, se observa la misma tendencia de demanda de ayuda, en este caso profesional, para hacer frente a este tipo de situaciones, fundamentalmente por parte de alumnos universitarios. La ansiedad a exponer es un fenómeno ampliamente estudiado y relacionados con síndromes clínicos, como por ejemplo la Fobia Social. La carrera universitaria exige a sus alumnos tareas, ejercicios, exámenes… que requieren la puesta en práctica de esta competencia. Además, no es un fenómeno exclusivo de ninguna disciplina concreta, por lo que esta competencia es transversal a diferentes asignaturas y ramas del conocimiento. Un enfoque comunitario (desde la universidad) y focalizado (para universitarios) supondría atender a la competencia transversal de hablar en público de una manera formal y sistematizada, centrándose en el aprendizaje de la forma (cómo se hace) y de aquellos factores que pudieran interferir (ansiedad, timidez…). El segundo bloque que define este proyecto va dirigido a la mejora educativa de los alumnos del Máster Oficial en Psicología General Sanitaria. Parte de su formación práctica supone la confección, planificación y ejecución de planes de psicoeducativos de salud. Todos los miembros de este proyecto guardamos relación, de una u otra manera con la Clínica Universitaria de Psicología de la UCM (CUP-UCM), centro de prácticas del itinerario del citado master. Esto supone una excepcional oportunidad de añadir a su plan formativo de rotación por la CUP-UCM, el diseño y ejecución de estos talleres, siempre bajo estrecha supervisión y acompañamiento de miembros del proyecto

Importancia de los parámetros clínicos analíticos de la sepsis grave en la uropatía obstructiva

INTRODUCTION. Obstructive uropathy (OU) is very prevalent. Its level of bacteremia is high, complicating up to 40% of cases with severe sepsis. &nbsp; OBJECTIVE The purpose of this clinical case report is to describe medical profiles of patients with Obstructive Uropathy at the HCU of Valladolid. MATERIALS AND METHODS All patients of legal age urgently admitted with the diagnosis of UO were included. An observational and descriptive prospective study was designed to classify patients into two groups: severe sepsis patients and non-severe sepsis patients. A descriptive and inferential statistical analysis was carried out, considering a p &lt;0.05 as significant. The quantitative variables were expressed in an interquartile range; medians and the qualitative ones in percentages and absolute numbers. Demographic and clinical data were analysed using Pearson's Chi-square test (Ӽ2) for categorical variables, and the U - Mann - Whitney test was used for continuous variables. OUTCOMES: Our series consists of 65 patients. UO occurred preferentially in men (63.07%).&nbsp; The most frequent comorbidities were HBP and obesity. In the majority of patients, OU was incomplete and secondary to lithiasis. 64.61% of them developed severe sepsis. The urine culture was positive in 20.63% of the cases, being Escherichia coli the most frequent microorganism. Urinary diversion was urgently performed in 40% of the patients. CONCLUSION: There is an analytical profile characteristic of severe sepsis maintained over time, consisting of an increased percentage of neutrophils and procalcitonin and decreased amount of bicarbonate in the bloodINTRODUCCIÓN: La uropatía obstructiva (UO) es muy prevalente. Su nivel de bacteriemia es elevado complicándose hasta en el 40% de los casos con una sepsis grave. OBJETIVO: Describir el perfil clínico del paciente con UO del HCU de Valladolid. MATERIAL Y MÉTODOS: Se diseña un estudio observacional y descriptivo prospectivo. Se incluyó a todo paciente mayor de edad ingresado con carácter de urgencia con el diagnóstico de UO. Los pacientes fueron clasificados en dos grupos en función de si desarrollando sepsis grave (SG) o no (NSG). Se realizó un análisis estadístico descriptivo e inferencial considerándose una p &lt; 0,05 como significativa.&nbsp; Las variables cuantitativas se expresaron en rango intercuartílico y medianas y las cualitativas en porcentajes y números absolutos. Los datos demográficos y clínicos se analizaron mediante el test Chi - cuadrado de Pearson (Ӽ2) para las variables categóricas, y para las variables continuas el test U - Mann - Whitney. RESULTADOS: Nuestra serie consta de 65 pacientes. La UO ocurrió preferentemente en varones (63,07%). La HTA y la obesidad fueron las comorbilidades más frecuentes. La mayoría de la UO eran incompletas y secundarias a litiasis. El 64,61% desarrolló una SG. El Cultivo de orina fue positivo en el 20,63% de los casos siendo el microorganismo más frecuente la E. coli. En el 40% de los pacientes se realizó una derivación urinaria urgente. CONCLUSIÓN: Existe un perfil analítico característico de SG mantenido en el tiempo que consiste en la elevación en sangre del porcentaje de neutrófilos, de procalcitonina y disminución de bicarbonato

Importancia de los parámetros clínicos analíticos de la sepsis grave en la uropatía obstructiva

INTRODUCCIÓN: La uropatía obstructiva (UO) es muy prevalente. Su nivel de bacteriemia es elevado complicándose hasta en el 40% de los casos con una sepsis grave. OBJETIVO: Describir el perfil clínico del paciente con UO del HCU de Valladolid. MATERIAL Y MÉTODOS: Se diseña un estudio observacional y descriptivo prospectivo. Se incluyó a todo paciente mayor de edad ingresado con carácter de urgencia con el diagnóstico de UO. Los pacientes fueron clasificados en dos grupos en función de si desarrollando sepsis grave (SG) o no (NSG). Se realizó un análisis estadístico descriptivo e inferencial considerándose una p 0,05 como significativa.  Las variables cuantitativas se expresaron en rango intercuartílico y medianas y las cualitativas en porcentajes y números absolutos. Los datos demográficos y clínicos se analizaron mediante el test Chi - cuadrado de Pearson (Ӽ2) para las variables categóricas, y para las variables continuas el test U - Mann - Whitney. RESULTADOS: Nuestra serie consta de 65 pacientes. La UO ocurrió preferentemente en varones (63,07%). La HTA y la obesidad fueron las comorbilidades más frecuentes. La mayoría de la UO eran incompletas y secundarias a litiasis. El 64,61% desarrolló una SG. El Cultivo de orina fue positivo en el 20,63% de los casos siendo el microorganismo más frecuente la E. coli. En el 40% de los pacientes se realizó una derivación urinaria urgente. CONCLUSIÓN: Existe un perfil analítico característico de SG mantenido en el tiempo que consiste en la elevación en sangre del porcentaje de neutrófilos, de procalcitonina y disminución de bicarbonato

Tumour heterogeneity in glioblastoma assessed by MRI texture analysis: a potential marker of survival

Objective: The main objective of this retrospective work was the study of three-dimensional (3D) heterogeneity measures of post-contrast pre-operative MR images acquired with T1 weighted sequences of patients with glioblastoma (GBM) as predictors of clinical outcome. Methods: 79 patients from 3 hospitals were included in the study. 16 3D textural heterogeneity measures were computed including run-length matrix (RLM) features (regional heterogeneity) and co-occurrence matrix (CM) features (local heterogeneity). The significance of the results was studied using Kaplan?Meier curves and Cox proportional hazards analysis. Correlation between the variables of the study was assessed using the Spearman?s correlation coefficient. Results: Kaplan?Meyer survival analysis showed that 4 of the 11 RLM features and 4 of the 5 CM features considered were robust predictors of survival. The median survival differences in the most significant cases were of over 6 months. Conclusion: Heterogeneity measures computed on the post-contrast pre-operative T1 weighted MR images of patients with GBM are predictors of survival. Advances in knowledge: Texture analysis to assess tumour heterogeneity has been widely studied. However, most works develop a two-dimensional analysis, focusing only on one MRI slice to state tumour heterogeneity. The study of fully 3D heterogeneity textural features as predictors of clinical outcome is more robust and is not dependent on the selected slice of the tumour