Synchronous carotid and coronary bypass surgery using minimal extracorporeal circulation does not increase the risk of in-hospital stroke compared to isolated carotid endarterectomy under general anaesthesia

Gebiet: Chirurgie Abstract: Introduction: Carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) could be approached in a combined or a staged fashion. Some crucial studies have shown no significant difference in peri-operative stroke and death rate in combined versus staged CEA/CABG. At present conventional extracorporeal circulation (CECC) is regarded as the gold standard for performing on-pump coronary artery bypass grafting. On contrary, the use of minimized extracorporeal circulation (MECC) for CABG diminishes hemodilution, blood-air contact, foreign surface contact and inflammatory response. At the same time, general anaesthesia (GA) is a potential risk factor for higher perioperative stroke rate after isolated CEA, not only for the ipsilateral but also for the contralateral side especially in case of contralateral high-grade stenosis or occlusion. The aim of the study was to analyze if synchronous CEA/CABG using MECC (CEA/CABG group) allows reducing the perioperative stroke risk to the level of isolated CEA performed under GA (CEA-GA group). – Methods: A retrospective analysis of all patients who underwent CEA at our institution between January 2005 and December 2012 was performed. We compared outcomes between all patients undergoing CEA/CABG to all isolated CEA-GA during the same time period. The CEA/CABG group was additionally compared to a reference group consisting of patients undergoing isolated CEA in local anaesthesia. Primary outcome was in-hospital stroke. – Results: A total of 367 CEAs were performed, from which 46 patients were excluded having either off-pump CABG or other cardiac surgery procedures than CABG combined with CEA. Out of 321 patients, 74 were in the CEA/CABG and 64 in the CEA-GA group. There was a significantly higher rate of symptomatic stenoses among patients in the CEA-GA group (p<0.002). Three (4.1%) strokes in the CEA/CABG group were registered, two ipsilateral (2.7%) and one contralateral (1.4%) to the operated side. In the CEA-GA group 2 ipsilateral strokes (3.1%) occurred. No difference was noticed between the groups (p=1.000). One patient with stroke in each group had a symptomatic stenosis preoperatively. – Conclusions: Outcome with regard to mortality and neurologic injury is very good in both -patients undergoing CEA alone as well as patients undergoing synchronous CEA and CABG using the MECC system. Although the CEA/CABG group showed slightly increased risk of stroke, it can be considered as combined treatment in particular clinical situations.

Manifestation of depression symptoms among Mexican American adolescents

Background. Previous findings reported more depression among Mexican American adolescents than among adolescents from other groups. There has been minimal research published on distribution of depression symptoms among Mexican American adolescents and practically no data has been published from community samples. ^ Objective. To examine the phenomenology of DSM-IV major depression symptoms across groups defined by ethnic status, by gender and language use focusing on the Mexican American group. ^ Methods. Secondary data from 2624 adolescents (ages 10-17) among three ethnic subgroups, Mexican (26.7%), African (45%) and Anglo Americans (28.3%), was analyzed. Data come from the Teen Life Changes (TLC) Survey conducted in 1994 by Roberts et al. (1997). A self-report questionnaire, which includes the DSD scale to measure depression, was used. ^ Results. Analysis of data showed significant differences among youth in the phenomenology of depression symptoms by ethnicity, by gender and by language use at home. ^ Conclusion. This study adds knowledge to the psychopathology and mental health literature from the identification of depression symptoms profile as well as permits the design of more appropriate policy for prevention and intervention programs among culturally diverse youth. ^

It's your game, keep it real. Sexual education study

Purpose: This study translated and adapted the It's Your Game, Keep It Real study currently being implemented with middle school youth in Southeast Texas for a middle school population in rural western Honduras. The study tested the effects of a sexual health education program focused on human immunodeficiency virus, sexually transmitted infections, and pregnancy prevention. We hypothesized that the number of adolescents in the intervention group who initiate sexual activity will reduce in comparison to the control group and there will be an increase consistent condom use in sexually active adolescents in the intervention group. ^ Methods: The target population included Spanish-speaking Hispanic middle school students from a small, semi-urban city in western Honduras. One school was randomly selected to receive the intervention and one to the comparison condition. The intervention curriculum consisted of 10 seventh-grade lessons that included individual and group classroom-based activities and personal journaling. Follow-up surveys were completed three months after the last lesson with 146 students (79.3% of the defined cohort). ^ Results: In the comparison condition, 21.4% of students initiated sex by the post-test follow-up three months after the intervention compared to 7.8% in the intervention condition. ^ Conclusions: A multi-component, curriculum-based program that is theory driven and culturally relevant can increase knowledge about STIs and HIV, increase self-confidence amongst middle school students, and develop communication skills amongst friends and partners. Further research must be conducted to assess delay in sexual initiation and the generalizability of these results.^

Radiocarbon ages, d13C values and rare earth element content of sediment cores BP00-23/07 and BP00-07/06

Two bottom sediment cores (BP00-23/7 and BP00-7/6) recovered from the Yenisei transect in the southern Kara Sea are described. Data on their grain size composition, clay and heavy mineral assemblages, and distribution of a large group of chemical elements are presented. Radiocarbon dates based on AMS C-14 method suggest the Holocene age of sediments in the cores. Literature data on physical properties and foraminifers have also been analyzed. The facies affiliation of the lithostratigraphic subdivisions has been unraveled. History of the Yenisei River runoff in the Holocene has been reconstructed on the basis of different indicators.

Towards a virtualized Internet for computer networking assignments

By combining virtualization technologies, virtual private network techniques and parameterization of network scenarios it is possible to enhance a networking laboratory, typically carried out in university laboratory premises using equipment located there, by interconnecting it to virtual networks running on the students own personal computers. This paper describes some experiences applying this model to create hands-on assignments for a large group of students in computer networking education.

Emissive Langmuir Probes in the Strong Emission Regime for the Determination of the Plasma Properties

The determination of the plasma potential Vpl of unmagnetized plasmas by using the floating potential of emissive Langmuir probes operated in the strong emission regime is investigated. The experiments evidence that, for most cases, the electron thermionic emission is orders of magnitude larger than the plasma thermal electron current. The temperature-dependent floating potentials of negatively biased Vpmenor queVpl emissive probes are in agreement with the predictions of a simple phenomenological model that considers, in addition to the plasma electrons, an ad-ditional electron group that contributes to the probe current. The latter would be constituted by a fraction of the repelled electron thermionic current, which might return back to the probe with a different energy spectrum. Its origin would be a plasma potential well formed in the plasma sheath around the probe, acting as a virtual cathode or by collisions and electron thermalization pro-cesses. These results suggest that, for probe bias voltages close to the plasma potential Vp?Vpl, two electron populations coexist, i.e., the electrons from the plasma with temperatureTeand a large group of returned thermionic electrons. These results question the theoretical possibility of measuring the electron temperature by using emissive probes biased to potentials Vp about lower equal than ?Vpl.

Quantum communications in optical networks

La posibilidad de utilizar sistemas cuánticos para procesar y transmitir información ha impulsado la aparición de tecnologías de información cuántica, p. ej., distribución cuántica de claves. Aunque prometedoras, su uso fuera del laboratorio es actualmente demasiado costoso y complicado. En este trabajo mostramos como utilizarlas en redes ópticas de telecomunicaciones. Al utilizar una infraestructura existente y pervasiva, y compartirla con otras señales, tanto clásicas como cuánticas, el coste se reduce drásticamente y llega a un mayor público. Comenzamos integrando señales cuánticas en los tipos más utilizados de redes ópticas pasivas, por su simplicidad y alcance a usuarios finales. Luego ampliamos este estudio, proponiendo un diseño de red óptica metropolitana basado en la división en longitud de onda para multiplexar y direccionar las señales. Verificamos su funcionamiento con un prototipo. Posteriormente, estudiamos la distribución de pares de fotones entrelazados entre los usuarios de dicha red con el objetivo de abarcar más tecnologías. Para ampliar la capacidad de usuarios, rediseñamos la red troncal, cambiando tanto la topología como la tecnología utilizada en los nodos. El resultado es una red metropolitana cuántica que escala a cualquier cantidad de usuarios, a costa de una mayor complejidad y coste. Finalmente, tratamos el problema de la limitación en distancia. La solución propuesta está basada en codificación de red y permite, mediante el uso de varios caminos y nodos, modular la cantidad de información que tiene cada nodo, y así, la confianza depositada en él. ABSTRACT The potential use of quantum systems to process and transmit information has impulsed the emergence of quantum information technologies such as quantum key distribution. Despite looking promising, their use out of the laboratory is limited since they are a very delicate technology due to the need of working at the single quantum level. In this work we show how to use them in optical telecommunication networks. Using an existing infrastructure and sharing it with other signals, both quantum and conventional, reduces dramatically the cost and allows to reach a large group of users. In this work, we will first integrate quantum signals in the most common passive optical networks, for their simplicity and reach to final users. Then, we extend this study by proposing a quantum metropolitan optical network based on wavelength-division multiplexing and wavelengthaddressing, verifying its operation mode in a testbed. Later, we study the distribution of entangled photon-pairs between the users of the network with the objective of covering as much different technologies as possible. We further explore other network architectures, changing the topology and the technology used at the nodes. The resulting network scales better at the cost of a more complex and expensive infrastructure. Finally, we tackle the distance limitation problem of quantum communications. The solution offered is based on networkcoding and allows, using multiple paths and nodes, to modulate the information leaked to each node, and thus, the degree of trust placed in them.

Análisis de usabilidad y aplicación de los resultados en el desarrollo de plataformas web

Este trabajo trata cómo se pueden aplicar las técnicas de análisis de usabilidad al desarrollo de plataformas web. Actualmente es común que los servicios sean ofrecidos mediante plataformas web para un grupo muy heterogéneo de personas. Por otra parte, los análisis de usabilidad son una herramienta muy útil para conocer cómo interactúan las personas con los ordenadores y mejorar el diseño de las aplicaciones. Realizar un buen diseño permite mejorar la experiencia de usuario, factor fundamental para el éxito de cualquier producto que requiera interacción con el usuario. A continuación se describen las diferentes fases de los test de usabilidad y se detalla cómo han sido aplicadas durante el desarrollo del proyecto. Finalmente, se presentarán los resultados obtenidos durante la evaluación de la plataforma y el análisis de los mismos indicando cómo han afectado al diseño de la plataforma. ---ABSTRACT---This document discusses how to apply usability test techniques over web platform development. Nowadays, it is common that services are offered through web platforms for a large group of heterogeneous people. Moreover, usability tests are a very useful tool to understand human-computer interaction and improve the design of the applications. A good design can improve user experience, which is essential for the success of any product that requires user interaction. The following pages describes the different phases of usability testing and detail how these have been applied during the development of the project. Finally, the results obtained during the platform evaluation are presented and analysed, explaining how they have affected the design of the platform.

Vivienda y fondo edificatorio: análisis de las consecuencias del parámetro fondo en el edificio de vivienda colectiva

Este estudio ofrece una herramienta de aproximación al espacio morfológico-métrico en el que se formula la ciudad de alta densidad desde la vivienda colectiva. La vivienda colectiva es la célula básica de la ciudad. El estudio configurativo y dimensional del tejido urbano muestra la importancia del fondo edificatorio como parámetro clave a mitad de camino entre la vivienda y la ciudad. El fondo edificatorio traza el margen de la arquitectura en la ciudad y desde él se equipa y cuantifica el territorio urbano. Sus dinámicas van caracterizando los distintos entornos, mientras en su interior se formula el tipo en un ajuste de continua verificación y adaptación. La forma de la ciudad y sus distintas posibilidades configurativas —en cuanto masa construida y espacio público, pero sin perder de vista la relación entre ambos— depende en gran medida del fondo edificatorio. Se trata, por tanto, de un parámetro importante de relación entre las distintas configuraciones del espacio exterior e interior. Al proyectar, una vez establecido un fondo, algunas propiedades se adaptan con facilidad mientras que otras requieren un cierto grado de interpretación o deben ser descartadas. Dada una superficie, la especificación del fondo fuerza la dimensión del frente en las configuraciones posibles. Ambas dimensiones son vitales en el valor del factor de forma del continuo edificado y en su relación se produce el complejo rango de posibilidades. Partiendo de la ciudad, un gran fondo encierra y mezcla en su interior todo tipo de usos sin distinción, repercute un menor coste por unidad de superficie edificada y comparte su frente reduciendo los intercambios térmicos y lumínicos. Sin embargo la ciudad de fondo reducido ajusta la forma al uso y se desarrolla linealmente con repetitividad a lo largo de sus frentes exteriores. En ella, el fuerte intercambio energético se opone a las grandes posibilidades del espacio libre. En cambio desde la casa las distintas medidas del fondo se producen bajo determinados condicionantes: clima, compacidad, ocupación, hibridación, tamaño de casa, etc., mientras que el tipo se desarrolla en base a una métrica afín. Este trabajo parte de esta dialéctica. Estudia la relación de dependencia entre las condiciones del edificio de viviendas y su métrica. Jerarquiza edificios en base al parámetro “fondo” para constituir una herramienta que como un ábaco sea capaz de visibilizar las dinámicas relacionales entre configuración y métrica bajo la condición de alta densidad. Para ello en una primera fase se gestiona una extensa muestra de edificios representativos de vivienda colectiva principalmente europea, extraída de tres prestigiosos libros en forma de repertorio. Se ordenan y categorizan extrayendo datos conmensurables y temas principales que ligan la profundidad de la huella a la morfología y posteriormente, esta información se estudia en diagramas que ponen de manifiesto convergencias y divergencias, acumulaciones y vacíos, límites, intervalos característicos, márgenes y ejes, parámetros y atributos... cuya relación trata de factorizar el lugar morfológico y métrico de la casa como metavivienda y ciudad. La herramienta se establece así como un complejo marco relacional en el que posicionar casos concretos y trazar nexos transversales, tanto de tipo morfológico como cultural, climático o técnico, normativo o tecnológico. Cada nuevo caso o traza añadida produce consonancias y disonancias en el marco que requieren interpretación y verificación. De este modo este instrumento de análisis comparativo se tempera, se especializa, se completa y se perfecciona con su uso. La forma de la residencia en la ciudad densa se muestra así sobre un subsistema morfológico unitario y su entendimiento se hace más fácilmente alcanzable y acumulable tanto para investigaciones posteriores como para el aprendizaje o el ejercicio profesional. ABSTRACT This research study offers a tool to approach the morphometric space in which (multi-family) housing defines high-density cities. Multi-family housing is the basic cell of the city. The configuration and dimension studies of the urban fabric render the importance of building depth as a key parameter half way between the dwelling and the city. The building depth traces de limit of architecture in the city. It qualifies and quantifies the urban territory. Its dynamics characterize the different environments while in its essence, an adjustment process of continuous verification and adaption defines type. The shape of the city and its different configuration possibilities —in terms of built fabric and public space, always keeping an eye on the relationship between them— depend majorly on the building depth. Therefore, it is a relevant parameter that relates the diverse configurations between interior and exterior space. When designing, once the depth is established, some properties are easily adpated. However, others require a certain degree of interpretation or have to be left out of the study. Given a ceratin surface, the establishment of the depth forces the dimensions of the facade in the different configurations. Both depth and facade dimensions are crucial for the form factor of the built mass. Its relationship produces a complex range of possibilities. From an urban point of view, great depth means multiple uses (making no distinction whatsoever,) it presents a lower cost per unit of built area and shares its facade optimizing temperature and light exchange. On the contrary, the city of reduced depth adjusts its shape to the use, and develops linearly and repetitively along its facades. The strong energy exchange opposes to the great possibilities of free space. From the perspective of the dwelling, the different dimensions of depth are produced under certain determinants: climate, compactness, occupancy, hybridization, dwelling size, etc. Meanwhile, the type is developed based on a related meter (as in poetry). This work starts from the previous premise. It studies the dependency relation bewteen the conditions of the dwellings and their meter (dimensions). It organizes buildings hierarchically based on the parameter “depth” to create a tool that, as an abacus, is able to visibilise the relational dynamics between configuration and dimension in high density conditions. For this, in the first stage a large group of representative multi-family housing buildings is managed, mostly from Europe, picked from three prestigious books as a repertoir. They are categorized and ordered drawing commensurable data and key issues that link the depth of the fooprint to its morphology. Later, this information is studied deeply with diagrams that bring out connections and discrepancies, voids and accumulations, limits, charasteristic intervals, margins and axii, parameters, attributes, etc. These relationships try to create factors from a morphological and metrical point of view of the house as a metadwelling. This tool is established as a complex relation frame in which case studies are postitioned and cross-cutting nexii are traced. These can deal with morphology, climate, technique, law or technology. Each new case or nexus produces affinities and discrepancies that require interpretation and verification. Thus, this instrument of comparative analysis is fine-tuned, especialized and completed as its use is improved. The way housing is understood in high density cities is shown as a unitary metric subsystem and its understanding is easy to reach and accumulate for future researchers, students or practicing architects.

Xeroderma pigmentosum and trichothiodystrophy are associated with different mutations in the XPD (ERCC2) repair/transcription gene

The xeroderma pigmentosum group D (XPD) protein has a dual function, both in nucleotide excision repair of DNA damage and in basal transcription. Mutations in the XPD gene can result in three distinct clinical phenotypes, XP, trichothiodystrophy (TTD), and XP with Cockayne syndrome. To determine if the clinical phenotypes of XP and TTD can be attributed to the sites of the mutations, we have identified the mutations in a large group of TTD and XP-D patients. Most sites of mutations differed between XP and TTD, but there are three sites at which the same mutation is found in XP and TTD patients. Since the corresponding patients were all compound heterozygotes with different mutations in the two alleles, the alleles were tested separately in a yeast complementation assay. The mutations which are found in both XP and TTD patients behaved as null alleles, suggesting that the disease phenotype was determined by the other allele. If we eliminate the null mutations, the remaining mutagenic pattern is consistent with the site of the mutation determining the phenotype.

East Gondwana ancestry of the sunflower alliance of families

The sunflower alliance of families comprises nearly 10% of all flowering plant species and includes the largest of all plant families, the sunflower family Asteraceae, which has 23,000 species, and the bellflower family Campanulaceae. Both are worldwide in distribution, but the majority of their species occur in the northern hemisphere. Recently it has been shown that a number of small, woody families from the Australian–Southwest Pacific area also belong in this relationship. Here we add yet another such family and present phylogenetic, biogeographic, and chronological analyses elucidating the origin of this large group of plants. We show that the ancestral lineages are confined to Malesia, Australia, New Guinea, and New Zealand and that the sunflower and bellflower families represent phylogenetically derived lineages within a larger group with a Cretaceous and southern-hemisphere, presumably East Gondwana, ancestry. Their highly derived position in the flowering plant phylogeny makes this significant for understanding the evolution of flowering plants in general.

“Switch I” mutant forms of the bacterial enhancer-binding protein NtrC that perturb the response to DNA

NtrC (nitrogen regulatory protein C) is a bacterial enhancer-binding protein of 469 residues that activates transcription by σ54-holoenzyme. A region of its transcriptional activation (central) domain that is highly conserved among homologous activators of σ54-holoenzyme—residues 206–220—is essential for interaction with this RNA polymerase: it is required for contact with the polymerase and/or for coupling the energy from ATP hydrolysis to a change in the conformation of the polymerase that allows it to form transcriptionally productive open complexes. Several mutant NtrC proteins with amino acid substitutions in this region, including NtrCA216V and NtrCG219K, have normal ATPase activity but fail in transcriptional activation. We now report that other mutant forms carrying amino acid substitutions at these same positions, NtrCA216C and NtrCG219C, are capable of activating transcription when they are not bound to a DNA template (non-DNA-binding derivatives with an altered helix–turn–helix DNA-binding motif at the C terminus of the protein) but are unable to do so when they are bound to a DNA template, whether or not it carries a specific enhancer. Enhancer DNA remains a positive allosteric effector of ATP hydrolysis, as it is for wild-type NtrC but, surprisingly, appears to have become a negative allosteric effector for some aspect of interaction with σ54-holoenzyme. The conserved region in which these amino acid substitutions occur (206–220) is equivalent to the Switch I region of a large group of purine nucleotide-binding proteins. Interesting analogies can be drawn between the Switch I region of NtrC and that of p21ras.

Gene discovery and gene function assignment in filamentous fungi

Filamentous fungi are a large group of diverse and economically important microorganisms. Large-scale gene disruption strategies developed in budding yeast are not applicable to these organisms because of their larger genomes and lower rate of targeted integration (TI) during transformation. We developed transposon-arrayed gene knockouts (TAGKO) to discover genes and simultaneously create gene disruption cassettes for subsequent transformation and mutant analysis. Transposons carrying a bacterial and fungal drug resistance marker are used to mutagenize individual cosmids or entire libraries in vitro. Cosmids are annotated by DNA sequence analysis at the transposon insertion sites, and cosmid inserts are liberated to direct insertional mutagenesis events in the genome. Based on saturation analysis of a cosmid insert and insertions in a fungal cosmid library, we show that TAGKO can be used to rapidly identify and mutate genes. We further show that insertions can create alterations in gene expression, and we have used this approach to investigate an amino acid oxidation pathway in two important fungal phytopathogens.

Impacto no sistema imunológico da utilização prolongada de morfina para tratamento da dor

Introdução. Apesar das evidências dos efeitos imunomodulatórios da morfina, não há na literatura estudos que tenham comparado a interação entre citocinas, imunidade celular (linfócitos T, B e NK) e a administração prolongada de morfina administrada pelas vias oral ou intratecal em doentes com dor crônica neuropática não relacionada ao câncer. Foram avaliados de forma transversal e comparativa 50 doentes com diagnóstico de dor lombar crônica e com presença de radiculopatia (dor neuropática) previamente operados para tratar hérnia discal lombar (Síndrome Dolorosa Pós- Laminectomia), sendo 18 doentes tratados prolongadamente com infusão de morfina pela via intratecal com uso de sistema implantável no compartimento subaracnóideo (grupo intratecal); 17 doentes tratados prolongadamente com morfina pela via oral (n=17) e 15 doentes tratados com fármacos mas sem opióides (grupo sem opioide). Foram analisadas as concentração das citocinas IL-2, IL-4, IL-8, TNFalfa, IFNy, IL-5, GM-CSF, IL-6, IL-10 e IL-1beta no plasma e no líquido cefalorraquidiano; imunofenotipagem de linfócitos T, B e células NK e avaliados os Índice de Escalonamento de Opióide (em percentagem de opióide utilizada e em mg), dose cumulativa de morfina (mg), duração do tratamento em meses, dose final de morfina utilizada (em mg), e equivalente de morfina por via oral (em mg). Resultados. Não houve diferença estatisticamente significativa entre o número de linfócitos T, B e NK nos doentes com morfina administrada pelas vias IT, VO e os não usuários de morfina. Houve correlação positiva entre as concentrações de linfócitos T CD4 e o Índice de Escalonamento de Opióide (em % e mg) nos doentes tratados com morfina por via intratecal. Houve correlação negativa entre as concentrações de células NK (CD56+) e o Índice de Escalonamento de Opióide (em % e mg) nos doentes tratados com morfina por via intratecal. Houve correlação positiva entre o número de células NK (CD56+) e a dose cumulativa de morfina (em mg) administrada pelas vias intratecal e oral. Houve correlação positiva entre as concentrações de linfócitos T CD8 e a duração do tratamento em meses nos doentes tratados com morfina pela via oral. As concentrações de IL-8 e IL-1beta foram maiores no LCR do que no plasma em todos os doentes da amostra analisada. As concentrações de IFNy no LCR foram maiores nos doentes que utilizavam morfina pela via oral e nos não usuários de morfina do que nos que a utilizavam pela via intratecal. As concentrações de plasmáticas de IL-5 foram maiores nos doentes utilizavam morfina pela via oral ou intratecal do que nos que não a utilizavam. A concentração de IL-5 no LCR correlacionou-se negativamente com a magnitude da dor de acordo com a EVA nos doentes tratados com morfina pelas via oral ou intratecal. Nos doentes tratados com morfina pelas via oral ou intratecal, a concentração de IL-2 no LCR correlacionou-se positivamente com a magnitude da dor de acordo com a EVA e negativamente com o Índice de Escalonamento de Opióide (em % e mg) e a dose cumulativa de morfina (em mg). As concentrações plasmáticas de GMCSF foram maiores nos doentes utilizavam morfina pela via oral ou intratecal do que nos não a utilizavam. A concentração de TNFalfa no LCR nos doentes tratados com morfina pela via intratecal correlacionou-se negativamente com o Índice de Escalonamento de Opióide (em % e mg), a dose cumulativa de morfina (em mg) e dose equivalente por via oral (em mg) de morfina. A concentração plasmática das citocinas IL-6 e IL-10 correlacionou-se negativamente com a duração do tratamento (em meses) nos doentes tratados com morfina administrada pela via oral. O Índice de Escalonamento de Opióide (em mg e %) correlacionou-se negativamente com as concentrações no LCR de IL-2 e TNFalfa nos doentes tratados com morfina administrada pela via intratecal. O Índice de Escalonamento de Opióide (em mg e %) correlacionou-se negativamente com as concentrações no LCR de IL-2 e IL-5 nos doentes tratados com morfina administrada pela via oral. Houve correlação negativa entre a intensidade da dor de acordo com a EVA e as concentrações de IL-5 e IL-2 no LCR nos doentes tratados com morfina administrada pelas vias oral e intratecal. Houve correlação negativa entre a intensidade da dor de acordo com a EVA e as concentrações plasmáticas de IL-4 nos doentes tratados com morfina administrada pela via intratecal. Houve correlação negativa entre a intensidade da dor de acordo com a EVA e as concentrações plasmáticas de IL-1beta nos doentes tratados com morfina administrada pela via intratecal. Conclusões: Os resultados sugerem associações entre citocinas e imunidade celular (células T , B e NK) e o tratamento prolongado com morfina administrada pela via oral ou intratecal. Estes resultados podem contribuir para a compreensão da imunomodulação da morfina administrada por diferentes vias em doentes com dor neuropática crônica não oncológica . São necessários mais estudos sobre os efeitos da morfina sobre o sistema imunológico

Trends in mortality due to motor vehicle traffic accident injuries between 1987 and 2011 in a Spanish region (Comunitat Valenciana)

Objective: To analyse the time evolution of the rates of mortality due to motor vehicle traffic accidents (MVTA) injuries that occurred among the general population of Comunitat Valenciana between 1987 and 2011, as well as to identify trend changes by sex and age group. Methods: An observational study of annual mortality trends between 1987 and 2011. We studied all deaths due to MVTA injuries that occurred during this period of time among the non-institutionalised population residing in Comunitat Valenciana (a Spanish Mediterranean region that had a population of 5,117,190 inhabitants in 2011). The rates of mortality due to MVTA injuries were calculated for each sex and year studied. These rates were standardised by age for the total population and for specific age groups using the direct method (age-standardised rate – ASR). Joinpoint regression models were used in order to detect significant trend changes. Additionally, the annual percentage change (APC) of the ASRs was calculated for each trend segment, which is reflected in statistically significant joinpoints. Results: For all ages, ASRs decrease greatly in both men and women (70% decrease between 1990 and 2011). In 1990 and 2011, men have rates of 36.5 and 5.2 per 100,000 men/year, respectively. In the same years, women have rates of 8.0 and 0.9 per 100,000 women/year, respectively. This decrease reaches up to 90% in the age group 15–34 years in both men and women. ASR ratios for men and women increased over time for all ages: this ratio was 3.9 in 1987; 4.6 in 1990; and 5.8 in 2011. For both men and women, there is a first significant segment (p < 0.05) with an increasing trend between 1987 and 1989–1990. After 1990, there are 3 segments with a significant decreasing APC (1990–1993, 1993–2005 and 2005–2011, in the case of men; and 1989–1996, 1999–2007 and 2007–2011, in the case of women). Conclusion: The risk of death due to motor vehicle traffic accidents injuries has decreased significantly, especially in the case of women, for the last 25 years in Comunitat Valenciana, mainly as of 2006. This may be a consequence of the road-safety measures that have been implemented in Spain and in Comunitat Valenciana since 2004. The economic crisis that this country has undergone since 2008 may have also been a contributing factor to this decrease. Despite the decrease, ASR ratios for men and women increased over time and it is still a high-risk cause of death among young men. It is thus important that the measures that helped decrease the risk of death are maintained and improved over time.