Manejo perioperatorio de fármacos anticoagulantes y antiagregantes en el paciente con fractura de cadera

La fractura de cadera eleva de manera significativa en los estudios publicados la morbilidad y la mortalidad en los pacientes ancianos que la padecen. La participación en el proceso de fármacos que alteran la hemostasia se ha convertido en uno de los aspectos más importantes y controvertidos del manejo perioperatorio del paciente con fractura de cadera. La anticoagulación o antiagregación plaquetaria de estos pacientes tiene unas implicaciones tanto en la práctica anestésica como quirúrgica que hacen necesaria la búsqueda de un equilibrio entre el riesgo hemorrágico y trombótico de los mismos. Con la elaboración del presente protocolo, en línea con las últimas evidencias científicas publicadas, se sientan las bases para avanzar en el tratamiento de este grupo de pacientes. Una atención multidisciplinar especializada, una fijación precoz de la fractura antes de las 48 horas, y un efectivo programa de rehabilitación pueden disminuir las complicaciones del proceso.Hip fracture rises significantly in published studies morbidity and mortality in elderly patients. Participation in the process of hemostasis-altering drugs has become one of the most important and controversial perioperative management of patients with hip fracture aspects. Anticoagulation or antiplatelet of these patients have some implications as a surgical anesthetic practice that make it necessary to seek a balance between bleeding and thrombotic risk thereof. With the development of this protocol, in line with the latest scientific evidence published, the stage is set to advance the treatment of this patient group. A specialized multidisciplinary care, early fracture fixation within 48 hours and an effective rehabilitation program can reduce complications of that process

Small-Scale Process for the Production of Kefiran through Culture Optimization by Use of Central Composite Design from Whey and Kefir Granules

Cheese is one of the most demanded dairy products worldwide. However, during the conversion of milk to cheese, about 10 liters of milk are employed and about 9 liters of whey are generated for each 1 kg of cheese produced. The whey has traditionally been used for animal feed and as starting material for obtaining whey proteins. Furthermore, whey has the significant values of BOD and COD, becoming the most important contaminant in the dairy industry. For this reason, further growth of cheese sector is being limited by the surplus of whey as a by-product of the production of the cheeses. One of the many possibilities offered by the whey is its use as a starting material to produce many biotech products with a higher added value. The kefiran is a degradable biopolymer and is formed by galactose and glucose units, in almost similar proportions, which have been found with numerous benefits for human health. It is produced by a consortium of acid-lactic bacteria and yeasts, which coexist within the kefir granules, which are able to grow and multiply using the lactose present in the whey. The objective of the present study is to establish a small-scale process that allows the obtaining of kefiran

Abundance estimation and distribution of sardine in Northern Spain (north of IXa and VIIIc divisions)

Since 1986, an acoustic survey programme have been carried out for assessment of sardine: stock in Atlantic waters of the Iberian Peninsula. Sardine abundance estimated by length and age groups and oceanographic conditions in Galician and Cantabrian waters from 1986 to 1993 were studied. The biomass decreased after 1986 despite the occurrence of two very good year classes 1983 (the strongest ever recorded since 1976) and in 1987. The 1991 recruiting year c1ass seems to be a good one in the 1993 survey.Depuis 1986, un programme de sondage acoustique a été fait pour l'evaluation du stock de sardines dans les eaux atlantiques de la Peninsule Iberique. L'abondance de sardines, estimée par des groupes de taille et d'age, et les conditions oceanographiques dans les eaux de la Galicie et de la mer Cantabrique a été étududiée depuis 1986 jusqu'à 1993. La biomasse a diminué après 1986, malgre la presence de deux bonnes années 1983 (la plus forte jamais registrée depuis 1976) et 1987

From downbuilding to contractional reactivation of salt-sediment systems: insights from analog modeling.

This work studies salt-detached fold-and-thrust belts involving minibasins by means of physical analogue modeling. The experimental set up consist of a series of minibasins and diapirs built by downbuilding into a regular polygonal framework. The minibasins-diapir framework were then submitted to contraction, and for some examples accompanied by different rates of syncontractional sedimentation. We aimed at evaluating the influence of an initial salt basin geometry (i.e. equal thickness vs. along-strike tapered) on the development of the salt-sediment system, and how this influences the geometries and kinematics of fold-and-thrust belts. We also tested how these are influenced by different syncontractional sedimentation rates. Results show that major differences on the early salt structures occur during downbuilding as a result of original salt budget (i.e. from pillows to diapirs), with a positive correlation between amount of original salt and salt structure development. Initial contractional deformation is localized on the weaker salt bodies, favoring salt extrusion. Shortening is then transferred forwards once vertical salt feeders are welded (i.e. secondary welds), while basal (primary) welds are sheared, rolled or delaminated. Changes on structural styles occur abruptly along-strike as controlled by degree of development of the precontractional salt structures. Relatively low syncontractional sedimentation rate delays forward propagation of deformation and promotes minibasins tilting. With larger sedimentation rates, a thicker cover inhibits minibasins deformation and secondary welding and, promotes a more coherent mechanical beam detached on the basal weld. Our modeling is compared to natural fold-and-thrust belts such as the Zagros and the European Alps

Natural abundance of stable nitrogen isotopes reflect changes in pelagic food webs and mobility of size classes of the north Iberian sardine (Sardina pilchardus)

The natural abundance of stable nitrogen isotopes (δ15N) in sardine (Sardina pilchardus) and plankton was determined from samples collected between 1998 and 2003 in the northwestern shelf of the Iberian Peninsula with the purpose of studying the variability in the trophic position of sardine. Sardines were grouped in three size-length classes (small: 20 cm). Plankton samples were size-fractionated between ca. 0.7 and 2000 μm of individual length. The plankton at the base of the pelagic food web in the western shelf region (Galicia) was more enriched in δ15N than plankton in the northern and eastern region (Mar Cantábrico), likely because of upwelling. Variability in δ15N in sardine was related both to changes in feeding strategies during growth and to the mobility of size classes between adjacent shelf regions. Large sardines showed regional differences in δ15N similar to those of small plankton, suggesting that old specimens remained for long periods in the same region. In contrast, small and medium-sized sardines have similar δ15N values in all regions. We hypothesize that interannual differences in δ15N of sardine are caused mainly by variations in the mobility of large size classes, as the isotopic signature of the small sardines was relatively less variable and suggests low variability in the plankton food web. In turn, such variations would be related to changes in the size of the sardine population in the north Iberian shelf

Influence on preexisting salt diapirs during thrust wedge evolution and secondary welding: insights from analogue modeling

Salt lithologies are mechanically weaker than other sedimentary rocks. Salt horizons usually act as décollements and precursor salt bodies preferentially deform early during contraction, concentrate deformation, and impact the structural style and kinematics during mountain building. Focusing on shortened isolated-diapir provinces, our analog modeling program investigates the influence of two salt walls on folding and thrusting. High resolution topographic scans and particle image analysis show that the presence of precursor diapirs impacts the layer parallel shortening patterns and presumably the stress field at the onset of contraction. Shortening concentrates on diapirs, leading to roof arching, crestal extension and salt extrusion. This sequence of events occurs earlier on thinner salt- sediment sequences including diapirs having well-developed pedestals, particularly when proximal to the deformation front. Folds and thrusts nucleate at salt walls if they feature a well-developed pedestal. Further shortening results in secondary welding as evidenced by the collapse of uplifted roof domes, cessation of indentation and reverse faulting nucleated at the secondary welds. Meanwhile, and depending upon the processes occurring on the diapir closer to the backstop, the deformation of the distal salt wall is discontinuous. Our modeling results are compared with experimental works and natural examples from the Fars (Zagros Mountains)

Clinical and Dermoscopic Evaluation of Melanocytic Lesions in Patients with Chronic Graft Versus Host Disease

Patients treated with haematopoietic stem cell transplantation are at increased risk of cutaneous malignant neoplasms. There are no reports on the characteristics of melanocytic lesions in patients with chronic graft versus host disease and the value of recognizing these difficult lesions in high-risk patients. The objective of this study is to describe the clinical and dermo scopic characteristics of melanocytic lesions in patients with chronic graft versus host disease in order to understand their morphology. A prospective cross-sectional study was performed; 10 melanocytic lesions on the trunk and extremities were selected from each patient. A statistically significant association was found between regression and high total dermoscopic score and 7-point checklist score. Lesions were excised or included in short-term digital follow-up. Melanocytic lesions in patients with chronic graft versus host disease developing after allogeneic-haematopoietic stem cell transplantation exhibit marked structural and colour changes similar to melanoma. This is believed to result from the inflammatory process associated with graft versus host disease

HeIse Wheels: a Family of Mechanisms for Implementing Variable Geometry Hybrid Wheels

This paper presents a family of mechanisms of two degrees of freedom for implementing variable geometry hybrid wheels. These mechanisms are capable of transforming a circular wheel into a hybrid wheel with multiple legs. In this paper we describe the main attributes and advantages of these mechanisms, which we named HeIse Wheels. In addition, various terms and concepts related to the mathematical modeling of these devices are defined. The family of mechanisms consists of 14 original designs, which represent a sound solution to the problem of wheel-hybrid wheel transformation