Outcome measures and biomarkers in chronic inflammatory demyelinating polyradiculoneuropathy : from research to clinical practice

Introduction: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an immune-mediated syndrome characterized clinically by weakness and/or numbness that evolves over 2 months or more. The heterogeneity of clinical features necessitates an individualized approach to disease monitoring that takes lessons learned from clinical trials and applies them to clinical practice. Areas covered: This review discusses the importance of clinimetrics and biomarkers in CIDP diagnosis and disease monitoring. Highlighted are the challenges of defining responses to immunotherapy, the usefulness, and limitations of utilizing evidence-based clinical outcome measures during routine clinical care, and the evolving understanding of how diagnostic and disease activity biomarkers may reshape our treatment and disease monitoring paradigms. Expert opinion: Although disability and impairment outcome measures are commonly used in CIDP to indicate disease status, the nonspecific nature of these metrics limits the ability to attribute a change in any given metric to a change in CIDP. This interpretive challenge may be magnified by inconsistencies in the direction of change as well as a strong placebo effect. There is a need to improve our understanding of minimally important changes in existing outcome measures as a means to personalize treatment and to better assess disease activity status with biomarker discovery

Quantitative Assessment of Mycoplasma Hemadsorption Activity by Flow Cytometry

A number of adherent mycoplasmas have developed highly complex polar structures that are involved in diverse aspects of the biology of these microorganisms and play a key role as virulence factors by promoting adhesion to host cells in the first stages of infection. Attachment activity of mycoplasma cells has been traditionally investigated by determining their hemadsorption ability to red blood cells and it is a distinctive trait widely examined when characterizing the different mycoplasma species. Despite the fact that protocols to qualitatively determine the hemadsorption or hemagglutination of mycoplasmas are straightforward, current methods when investigating hemadsorption at the quantitative level are expensive and poorly reproducible. By using flow cytometry, we have developed a procedure to quantify rapidly and accurately the hemadsorption activity of mycoplasmas in the presence of SYBR Green I, a vital fluorochrome that stains nucleic acids, allowing to resolve erythrocyte and mycoplasma cells by their different size and fluorescence. This method is very reproducible and permits the kinetic analysis of the obtained data and a precise hemadsorption quantification based on standard binding parameters such as the dissociation constant Kd. The procedure we developed could be easily implemented in a standardized assay to test the hemadsorption activity of the growing number of clinical isolates and mutant strains of different mycoplasma species, providing valuable data about the virulence of these microorganisms

Diseño de estructura metálica de grandes luces

El presente informe propone el diseño de una nave industrial como estructura básica para una estación de ferrocarril de alta velocidad situada en Badajoz. En este estudio, se incluyen los requisitos básicos para el desarrollo de un proyecto estructural; situación actual del lugar geográfico, normativa aplicable, parámetros de diseño, herramientas informáticas y la aplicación de los conceptos básicos de la mecánica de las estructuras y construcciones industriales. Para ello, se comienza con una breve introducción de la iniciación del ferrocarril en España, la creación de las grandes empresas ferroviarias RENFE y ADIF, y la historia de las primeras líneas férreas en Extremadura. Además, se complementa con el estudio del impacto socioeconómico que tendría sobre la comunidad extremeña gracias a los documentos facilitados por la Junta de Extremadura. En dicho estudio, se incluyen datos reales del turismo, la empleabilidad y el mercado de exportación e importación, principales motores de la economía en Extremadura. Con el avance de la tecnología y la construcción, los efectos de la contaminación química y pasajística son cada vez, más notables. Para ello, todo ingeniero debe presentar un estudio debidamente detallado, donde se adjunta el impacto ambiental del proyecto y las medidas preventivas en beneficio de la naturaleza. Cabe mencionar que, en esta guía, se explica el impacto ambiental específicamente de este proyecto, gracias a la publicación del Boletín Oficial del Estado, además de una breve introducción a los conceptos necesarios del desarrollo sostenible que todo ingeniero debe conocer para causar el menor daño posible a la naturaleza. Finalmente, se planteará el caso práctico del diseño estructural con la herramienta informática de CYPE3D. Para ello, se justificará cada uno de los parámetros de diseño, como las dimensiones de la estructura, la situación geográfica, la normativa a aplicar y los cálculos realizados en el CYPE3D (coeficientes de pandeo, perfiles adecuados, combinación de acciones…). Seguidamente, se adjuntará el presupuesto económico para llevar a cabo dicho proyecto, debidamente desglosado.This research relates the specific design of heavy steel structure wich will become Badajoz´s High Speed Train Station. This report also includes the basic requirements for the structural project development; geographic situation, current regulations, design parameters, software tools, and basic concepts of mechanical of structures and industrial constructions. This guide begins with railway history of Spain, discusses the two most important railway companies established of Spain and gives a brief mention of Extremadura´s first railway line. In addition, you can find a shortly summary about the main engines of the Extremadura´s economy affecting; tourism, employment and exportation/importation market. Thanks to Junta de Extremadura´s document, which shows the tourism, employment and exportation/importation market rates during last few years, this report represents the growing trend and the effects of the project in those elements. With the technological and civil construction progress, the environmental impact is increasing more and more and nowdays, it´s even more remarkable. Due to this, every engineer must attach an elaboratel environmental report and the corrective measures to benefit the nature in each designed project. Also, in this guide, you will be faced with the real environmental impact specific of this project published on Boletín Oficial del Estado, and a brief introduction of the main concepts that every engineer must keep in mind to produce as little damage to nature as possible. Finally, the report presents the real layout design and all appropriate calculations with CYPE3D. For this reason, all design paramenters, structure dimensions, geographic situacion, current regulations and mathematical calculations with CYPE3D (buckling factor, proper profiles for beams, actions combination...) will be explained in detail.Ingeniería Mecánica (Plan 2008

Economic performance of the EU ETS: Three points of view: policy makers, companies and investors

Un análisis del European Union Emissions Trading Scheme (EU ETS) es importante para tres tipos de agentes: instituciones públicas (consideran este mercado como pieza clave de la política climática de la UE), empresas (deben acudir a este mercado con el fin de cumplir con sus restricciones ambientales) e inversores (ven este mercado como una nueva oportunidad de inversión). Basándonos en las necesidades particulares de cada uno de estos tres grupos de interés, la tesis está integrada por tres capítulos empíricos que tienen como objetivo analizar la performance económica, con vistas a obtener cada uno, implicaciones adaptadas a las necesidades de cada uno de los citados grupos. El primero, tiene como objetivo analizar la relación existente entre la performance económica y la medioambiental de la totalidad de empresas españolas pertenecientes al EU ETS con el fin de proporcionar más información a las instituciones encargadas de elaborar políticas relacionadas con el EU ETS nacional, teniendo en cuenta la importancia de conseguir un balance entre las metas económicas y medioambientales. El objetivo del segundo es doble. En primer lugar, calculamos la eficiencia técnica y medioambiental de cada una de las empresas del sector energético español pertenecientes al EU ETS. En segundo lugar, examinamos hasta qué punto la eficiencia medioambiental determina el número de derechos de emisión que una empresa debe comprar o se puede permitir vender, y por tanto, los gastos o ingresos derivados de un bajo o alto grado de eficiencia. Esta investigación es considerablemente relevante para el management empresarial ya que permite conocer hasta qué punto mejoras en la eficiencia medioambiental influyen en el dinero que una empresa debe gastar en el EU ETS. En el tercer capítulo empírico, tomamos el punto de vista del inversor. Teniendo en cuenta que la mayor parte de las emisiones del EU ETS proceden del sector energético, nuestro objetivo es analizar la relación existente entre los derechos de emisión (EUAs) y los títulos bursátiles de empresas del sector energético, en concreto empresas del sector del petróleo & gas y de energías limpias

Chemical composition and minerals in pyrite ash of an abandoned sulphuric acid production plant

The extraction of sulphur produces a hematite-rich waste, known as roasted pyrite ash, which contains significant amounts of environmentally sensitive elements in variable concentrations and modes of occurrence. Whilst the mineralogy of roasted pyrite ash associated with iron or copper mining has been studied, as this is the main source of sulphur worldwide, the mineralogy, and more importantly, the characterization of submicron, ultrafine and nanoparticles, in coal-derived roasted pyrite ash remain to be resolved. In this work we provide essential data on the chemical composition and nanomineralogical assemblage of roasted pyrite ash. XRD, HR-TEM and FE-SEM were used to identify a large variety of minerals of anthropogenic origin. These phases result from highly complex chemical reactions occurring during the processing of coal pyrite of southern Brazil for sulphur extraction and further manufacture of sulphuric acid. Iron-rich submicron, ultrafine and nanoparticles within the ash may contain high proportions of toxic elements such as As, Se, U, among others. A number of elements, such as As, Cr, Cu, Co, La, Mn, Ni, Pb, Sb, Se, Sr, Ti, Zn, and Zr, were found to be present in individual nanoparticles and submicron, ultrafine and nanominerals (e.g. oxides, sulphates, clays) in concentrations of up to 5%. The study of nanominerals in roasted pyrite ash from coal rejects is important to develop an understanding on the nature of this by-product, and to assess the interaction between emitted nanominerals, ultra-fine particles, and atmospheric gases, rain or body fluids, and thus to evaluate the environmental and health impacts of pyrite ash materials

A one-year follow-up study of the Symbol Digit Modalities Test (SDMT) and the Paced Auditory Serial Addition Test (PASAT) in relapsing-remitting multiple sclerosis : an appraisal of comparative longitudinal sensitivity

Altres ajuts: We also thank Ignasi Gich from Department of Epidemiology, Hospital de la Santa Creu i Sant Pau for his advice on statistical analysis.Neuropsychological batteries are infrequently used to assess cognitive impairment in multiple sclerosis because they are time-consuming and require trained personnel. The Symbol Digit Modalities Test (SDMT) is suggested to be a useful screening tool to measure cognitive impairment in multiple sclerosis patients and is more valid and reliable over time than the Paced Auditory Serial Addition Test (PASAT). The purpose of this study was to evaluate which of these tests was more sensitive to cognitive impairment at one-year follow-up. A total of 237 patients with relapsing-remitting multiple sclerosis and 57 healthy controls underwent a complete neuropsychological assessment. One year later, we assessed 196 patients using the Brief Repeatable Battery of Neuropsychological Tests. We also administered other executive function and prospective memory tests, together with fatigue and depression questionnaires. A total of 33.8% of patients were classified as cognitively impaired. The SDMT and the PASAT 3 seconds test (PASAT3) had a sensitivity of 0.809 and 0.783, respectively, thereby classifying patients as cognitively impaired. Analysis of 196 patients one year later showed 31.6% had cognitive impairment compared with 27.6% at the first assessment. The sensitivity to detect cognitive impairment after one year was 0.824 for SDMT and 0.796 for PASAT3. When the predictors were removed from the comparative standard battery, SDMT still showed a slightly higher sensitivity. Both SDMT and PASAT3 correlated significantly with all tests, but SDMT showed higher correlation values. Furthermore, SDMT was completed by all subjects while PASAT3 was completed by 86.9% of patients and 94.7% of controls. SDMT is simpler to administer than PASAT3 and may be slightly more sensitive to MS cognitive impairment. It could thus be a suitable test to assess cognitive impairment routinely in people with relapsing-remitting multiple sclerosis

Gestión eficiente de la evaluación continua del alumnado. La integración del trabajo de escritorio con moodle

Se presenta una aplicación desarrollada en Visual Basic para Microsoft Excel 2010 con el propósito de ofrecer una herramienta que ayude al profesorado en las labores de calificación de pruebas de evaluación continua a lo largo de un curso en conjunción con la plataforma Moodle. Se describe también su aplicación a una asignatura concreta

El Medio Ambiente natural. Los ecosistemas de la Comunidad Valenciana

Trabajo final de máster en profesorado de Educación Secundaria Obligatoria, Bachillerato, Formación Profesional y Enseñanzas de Idiomas, Artísticas y Deportivas especialidad Biología y Geología en el que se trata una secuencia didactica elaborada a partir de un trabajo in situ sobre los ecosistemas de la Comunidad Valenciana, aunque perfectamente sería adaptable a los ecosistemas de Aragón recogido dentro del Bloque 5. El medio ambiente natural del 2ºcurso de la ESO apartado El Medio Natural en Aragón

Diagnostic challenges in chronic inflammatory demyelinating polyradiculoneuropathy

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) consists of a spectrum of autoimmune diseases of the peripheral nerves, causing weakness and sensory symptoms. Diagnosis often is challenging, because of the heterogeneous presentation and both mis- and underdiagnosis are common. Nerve conduction study (NCS) abnormalities suggestive of demyelination are mandatory to fulfil the diagnostic criteria. On the one hand, performance and interpretation of NCS can be difficult and none of these demyelinating findings are specific for CIDP. On the other hand, not all patients will be detected despite the relatively high sensitivity of NCS abnormalities. The electrodiagnostic criteria can be supplemented with additional diagnostic tests such as CSF examination, MRI, nerve biopsy, and somatosensory evoked potentials. However, the evidence for each of these additional diagnostic tests is limited. Studies are often small without the use of a clinically relevant control group. None of the findings are specific for CIDP, meaning that the results of the diagnostic tests should be carefully interpreted. In this update we will discuss the pitfalls in diagnosing CIDP and the value of newly introduced diagnostic tests such as nerve ultrasound and testing for autoantibodies, which are not yet part of the guidelines