Utilidad de la electromiografía de esfínter anal en el diagnóstico diferencial de la atrofia multisistémica: una revisión de la literatura

La atrofia multisistémica (AMS) es una enfermedad degenerativa caracterizada por disautonomías y síntomas extrapiramidales. El diagnóstico diferencial con otros parkinsonismos es difícil, por lo cual se requiere una ayuda paraclínica para soportar el diagnóstico clínico. La degeneración del núcleo de Onuf, exclusiva en esta enfermedad, podría sugerir que la presencia de denervación en el esfínter anal podría ser tomada en cuenta como criterio diagnóstico de AMS. Se realizó una revisión sistemática con el fin de determinar la utilidad de la electromiografía de esfínter anal (EMG-EA) en el diagnóstico diferencial de AMS contra otros parkinsonismos. Se incluyeron 17 estudios que analizaron los resultados de EMG-EA en pacientes con AMS. De éstos, 11 de estudios fueron analíticos y compararon pacientes con AMS y otros parkinsonismos. Los 6 estudios restantes fueron descriptivos. La duración de los potenciales de unidad motora (PUM) es significativamente mayor en pacientes con AMS comparados con otros parkinsonismos, y utilizando un punto de corte > 13 ms muestra características operativas que hacen a este parámetro potencialmente útil. Solo un estudio encontró diferencias significativas en el porcentaje de PUM polifásicos, el cual tuvo una sensibilidad y especificidad clínicamente útil cuando el punto de corte es mayor a 60%. El resto de los estudios no reportan diferencias estadísticamente significativas entre parkinsonismos. La literatura disponible apunta a la potencial utilidad de la EMG-EA en el diagnóstico diferencial de la AMS de otros parkinsonismos; sin embargo es necesario conducir más estudios para solventar las limitaciones metodológicas existentes.

Descripción del comportamiento basal y transoperatorio de los nivels de NIRS cerebral en pacientes con cardiopatias congenitas cianosantes sometidos a cirugia paliativa o correctiva y su correlación con las variables fisiologicas determinantes del flujo sanguineo cerebral

La lesión neurológica es un riesgo latente en pacientes sometidos a cirugía cardiaca, en cirugía para corrección de cardiopatías congénitas puede tener una incidencia tan alta como del 26%, por lo cual es necesario contar con herramientas cada vez más acertadas y que puedan ayudar a disminuir esta incidencia; la saturación regional cerebral medida por NIRS constituye una herramienta válida, que permite una evaluación continua y de forma no invasiva, que puede servir para este fin. El presente estudio pretende determinar una asociación entre los niveles de saturación regional de oxígeno cerebral en los pacientes con cardiopatías congénitas cianosantes y las variables fisiológicas determinantes del aporte de oxígeno, asumiendo una hipoxemia crónica para estos pacientes. Se realizó un estudio de correlación para estas variables, para lo cual se evaluaron de forma sistemática estas en pacientes sometidos a cirugía cardiaca en la Fundación Cardioinfantil Instituto de Cardiología, que cumplían con los criterios de inclusión, hasta completar una muestra de 31 pacientes, en los cuales no se realizó ninguna intervención, catalogándolo como riesgo menor que el mínimo, cumpliendo con los criterios de Helsinki.Se encontró una correlación significativa entre los valores de NIRS cerebral con los contenidos arteriales, capilares y venoso de oxígeno en el análisis bivariado, encontrándose para estos pacientes niveles más bajos de estos contenidos como también para el consumo de oxígeno, no se encontró asociación significativa con la saturación arterial ni venosa de oxígeno, parece existir una relación significativa entre los niveles más bajos de NIRS con el resultado neurológico, estos hallazgos sin embargo no fueron significativos en el análisis multivariado.

Soft budget constraints in a dynamic general equilibrium model

This paper considers an overlapping generations model in which capital investment is financed in a credit market with adverse selection. Lenders’ inability to commit ex-ante not to bailout ex-post, together with a wealthy position of entrepreneurs gives rise to the soft budget constraint syndrome, i.e. the absence of liquidation of poor performing firms on a regular basis. This problem arises endogenously as a result of the interaction between the economic behavior of agents, without relying on political economy explanations. We found the problem more binding along the business cycle, providing an explanation to creditors leniency during booms in some LatinAmerican countries in the late seventies and early nineties.

Globalización del derecho administrativo colombiano

Esta obra contiene los resultados de la investigación adelantada por la línea de tendencias y perspectivas del derecho administrativo, del Grupo de Investigación en Derecho Público de la Universidad del Rosario, auspiciada por la GTZ, con el objeto de identificar la recepción del fenómeno de la globalización del derecho administrativo en el derecho colombiano. Para ello, la investigación identificó las tendencias que caracterizan la globalización del derecho administrativo: desestatización de funciones administrativas a favor del mercado, cambio en las técnicas de intervención administrativa y adaptación de la administración pública al modelo de la gobernanza, y mediante un análisis matricial aplicado a los componentes más relevantes del Programa de Reforma de la Administración Pública, estableció el grado de su presencia o ausencia en el derecho colombiano.

Para salvar a un niño de las tinieblas.

Título anterior de la publicación : Boletín de la Comisión Española de la UNESCO

Determining the efficacy of summer school on maintaining hearing-impaired children’s language levels

This paper discusses the process of determining the efficacy of summer school on maintaining hearing-impaired children’s language levels.

Catchment-scale modelling of flow and nutrient transport in the Chalk unsaturated zone

The unsaturated zone exerts a major control on the delivery of nutrients to Chalk streams, yet flow and transport processes in this complex, dual-porosity medium have remained controversial. A major challenge arises in characterising these processes, both at the detailed mechanistic level and at an appropriate level for inclusion within catchment-scale models for nutrient management. The lowland catchment research (LOCAR) programme in the UK has provided a unique set of comprehensively instrumented groundwater-dominated catchments. Of these, the Pang and Lambourn, tributaries of the Thames near Reading, have been a particular focus for research into subsurface processes and surface water-groundwater interactions. Data from LOCAR and other sources, along with a new dual permeability numerical model of the Chalk, have been used to explore the relative roles of matrix and fracture flow within the unsaturated zone and resolve conflicting hypotheses of response. From the improved understanding gained through these explorations, a parsimonious conceptualisation of the general response of flow and transport within the Chalk unsaturated zone was formulated. This paper summarises the modelling and data findings of these explorations, and describes the integration of the new simplified unsaturated zone representation with a catchment-scale model of nutrients (INCA), resulting in a new model for catchment-scale flow and transport within Chalk systems: INCA-Chalk. This model is applied to the Lambourn, and results, including hindcast and forecast simulations, are presented. These clearly illustrate the decadal time-scales that need to be considered in the context of nutrient management and the EU Water Framework Directive. (C) 2007 Elsevier B.V. All rights reserved.

Terrestrial ecosystems from space: a review of earth observation products for macroecology applications

Aim Earth observation (EO) products are a valuable alternative to spectral vegetation indices. We discuss the availability of EO products for analysing patterns in macroecology, particularly related to vegetation, on a range of spatial and temporal scales. Location Global. Methods We discuss four groups of EO products: land cover/cover change, vegetation structure and ecosystem productivity, fire detection, and digital elevation models. We address important practical issues arising from their use, such as assumptions underlying product generation, product accuracy and product transferability between spatial scales. We investigate the potential of EO products for analysing terrestrial ecosystems. Results Land cover, productivity and fire products are generated from long-term data using standardized algorithms to improve reliability in detecting change of land surfaces. Their global coverage renders them useful for macroecology. Their spatial resolution (e.g. GLOBCOVER vegetation, 300 m; MODIS vegetation and fire, ≥ 500 m; ASTER digital elevation, 30 m) can be a limiting factor. Canopy structure and productivity products are based on physical approaches and thus are independent of biome-specific calibrations. Active fire locations are provided in near-real time, while burnt area products show actual area burnt by fire. EO products can be assimilated into ecosystem models, and their validation information can be employed to calculate uncertainties during subsequent modelling. Main conclusions Owing to their global coverage and long-term continuity, EO end products can significantly advance the field of macroecology. EO products allow analyses of spatial biodiversity, seasonal dynamics of biomass and productivity, and consequences of disturbances on regional to global scales. Remaining drawbacks include inter-operability between products from different sensors and accuracy issues due to differences between assumptions and models underlying the generation of different EO products. Our review explains the nature of EO products and how they relate to particular ecological variables across scales to encourage their wider use in ecological applications.

Evaluation of Low Intensity Laser Therapy In Myofascial Pain Syndrome

Limited studies have demonstrated that low intensity laser therapy (LILT) may have a therapeutic effect on the treatment of myofascial pain syndrome (MPS). Sixty (60) patients with MPS and having one active trigger point in the anterior masseter and anterior temporal muscles were selected and assigned randomly to six groups (n=10): Groups I to III were treated with GaAIAS (780 nm) laser, applied in continuous mode and in a meticulous way, twice a week, for four weeks. Energy was set to 25 J/cm(2), 60 J/cm2 and 105 J/cm2, respectively. Groups IV to VI were treated with placebo applications, simulating the same parameters as the treated groups. Pain scores were assessed just before, then immediately after the fourth application, immediately after the eighth application, at 15 days and one month following treatment. A significant pain reduction was observed over time (p<0.001). The analgesic effect of the LILT was similar to the placebo groups. Using the parameters described in this experiment, LILT was effective in reducing pain experienced by patients with myofascial pain syndrome. Thus, it was not possible to establish a treatment protocol. Analyzing the analgesic effect of LILT suggests it as a possible treatment of MPS and may help to establish a clinical protocol for this therapeutic modality.

Effect of different bleaching systems on the ultrastructure of bovine dentin

The aim of this study was to evaluate in vitro the effect of different in-office bleaching systems on the surface morphology of bovine dentin. Thirty tooth fragments measuring 4 x 4mm, containing enamel and dentin, were obtained from the crowns of extracted bovine incisors. Samples were subjected to simulated intracoronal bleaching techniques using conventional (Opalescence Endo (R) and Whiteness Super Endo (R)) and light-activated systems (Opalescence Xtra (R) and Whiteness HP Maxx (R)). Controls were treated with either sodium perborate mixed with 10% hydrogen peroxide or no bleaching agent. The samples were observed under SEM and the recorded images were evaluated for topographic alterations. The ultrastructural alterations of dentin observed in this study varied greatly between groups according to the products used. Higher pH products (Whiteness HP Maxx (R) and Opalescence Xtra (R)) associated with in-office techniques yielded better maintenance of dentin ultrastructure. Apparently, both low pH and hydrogen peroxide oxidation play a role in altering the ultrastructure of dentin during internal dental bleaching. The use of alkaline products with reduced time of application (in-office techniques) may decrease such morphological alterations.

MODELLING OF HIGH-PRESSURE PHASE EQUILIBRIUM IN SYSTEMS OF INTEREST IN THE FOOD ENGINEERING FIELD USING THE PENG-ROBINSON EQUATION OF STATE WITH TWO DIFFERENT MIXING RULES

In this work, thermodynamic models for fitting the phase equilibrium of binary systems were applied, aiming to predict the high pressure phase equilibrium of multicomponent systems of interest in the food engineering field, comparing the results generated by the models with new experimental data and with those from the literature. Two mixing rules were used with the Peng-Robinson equation of state, one with the mixing rule of van der Waals and the other with the composition-dependent mixing rule of Mathias et al. The systems chosen are of fundamental importance in food industries, such as the binary systems CO(2)-limonene, CO(2)-citral and CO(2)-linalool, and the ternary systems CO(2)-Limonene-Citral and CO(2)-Limonene-Linalool, where high pressure phase equilibrium knowledge is important to extract and fractionate citrus fruit essential oils. For the CO(2)-limonene system, some experimental data were also measured in this work. The results showed the high capability of the model using the composition-dependent mixing rule to model the phase equilibrium behavior of these systems.

Genetic diversity of heat-labile toxin expressed by enterotoxigenic Escherichia coli strains isolated from humans

The natural diversity of the eft operons, encoding the heat-labile toxin LT-I (LT), carried by enterotoxigenic Escherichia coli (ETEC) strains isolated from humans was investigated. For many years, LT was supposed to be represented by a rather conserved toxin, and one derivative, produced by the reference H10407 strain, was intensively studied either as a virulence factor or as a vaccine adjuvant. Amplicons encompassing the two LT-encoding genes (eltA and eltB) of 51 human-derived ETEC strains, either LT+ (25 strains) only or LT+/ST+ (26 strains), isolated from asymptomatic (24 strains) or diarrheic (27 strains) subjects, were subjected to restriction fragment length polymorphism (RFLP) analysis and DNA sequencing. Seven polymorphic RFLP types of the H10407 strain were detected with six (BsaI, DdeI, HhaI, HincII, HphI, and MspI) restriction enzymes. Additionally, the single-nucleotide polymorphic analysis revealed 50 base changes in the eft operon, including 21 polymorphic sites at eltA and 9 at eltB. Based on the deduced amino acid sequences, 16 LT types were identified, including LT1, expressed by the H10407 strain and 23 other strains belonging to seven different serotypes, and LT2, expressed by 11 strains of six different serotypes. In vitro experiments carried out with purified toxins indicated that no significant differences in GM1-binding affinity could be detected among LT1, LT2, and LT4. However, LT4, but not other toxin types, showed reduced toxic activities measured either in vitro with cultured cells (Y-1 cells) or in vivo in rabbit ligated ileal loops. Collectively, these results indicate that the natural diversity of LTs produced by wild-type ETEC strains isolated from human hosts is considerably larger than previously assumed and may impact the pathogeneses of the strains and the epidemiology of the disease.

Some factors associated with dental caries in the primary dentition of children with Down syndrome

Aim It is well reported in the scientific literature that there is a high level of periodontal disease and lower caries prevalence in Down Syndrome (DS) individuals, when compared with age-matched non DS individuals. This study was conducted to investigate the process of dental caries in DS children. Materials and methods In this study the following parameters were considered: oral hygiene habits, levels of Streptococcus mutans (SM) and Lactobacillus spp. (LB), Modified Gingival Index (MGI), and Simplified Oral Hygiene Index (OHI-S). A case group with DS children (n=69) and a control group of non DS children (n=69) were formed to perform this study Dental caries severity was determined using the DMFT index. Samples of non-stimulated saliva were collected to determine the Lactobacillus spp levels. For SM levels, MSB agar plates were used. Results The findings revealed that the case group attended, dental check-ups more frequently brushed their teeth more times per day, flossed less, and also more frequently had SM levels classified as ""high count"". The MGI was higher and the OHI-S was lower than the control group (p<0.001). Conclusion No significant differences were found between the DMFT indexes of children from the two groups (p=0.345). The logistic regression analysis showed that in the case group, age, MGI, and SM count were positively related to dental caries (p<0.05).

Functional Diversity of Heat-labile Toxins (LT) Produced by Enterotoxigenic Escherichia coli

Heat-labile toxins (LTs) have ADP-ribosylation activity and induce the secretory diarrhea caused by enterotoxigenic Escherichia coli (ETEC) strains in different mammalian hosts. LTs also act as adjuvants following delivery via mucosal, parenteral, or transcutaneous routes. Previously we have shown that LT produced by human-derived ETEC strains encompass a group of 16 polymorphic variants, including the reference toxin (LT1 or hLT) produced by the H10407 strain and one variant that is found mainly among bacterial strains isolated from pigs (LT4 or pLT). Herein, we show that LT4 ( with six polymorphic sites in the A (K4R, K213E, and N238D) and B (S4T, A46E, and E102K) subunits) displays differential in vitro toxicity and in vivo adjuvant activities compared with LT1. One in vitro generated LT mutant (LTK4R), in which the lysine at position 4 of the A subunit was replaced by arginine, showed most of the LT4 features with an similar to 10-fold reduction of the cytotonic effects, ADP-ribosylation activity, and accumulation of intracellular cAMP in Y1 cells. Molecular dynamic studies of the A subunit showed that the K4R replacement reduces the N-terminal region flexibility and decreases the catalytic site crevice. Noticeably, LT4 showed a stronger Th1-biased adjuvant activity with regard to LT1, particularly concerning activation of cytotoxic CD8(+) T lymphocytes when delivered via the intranasal route. Our results further emphasize the relevance of LT polymorphism among human-derived ETEC strains that may impact both the pathogenicity of the bacterial strain and the use of these toxins as potential vaccine adjuvants.