Eficacia del aceite de oliva en la prevención de úlceras por presión en pacientes inmovilizados en atención primaria. Ensayo clínico aleatorizado, multicéntrico, paralelo, triple ciego, de no inferioridad

Las úlceras por presión representan un importante problema de salud pública y tienen un importante impacto económico en los sistemas de salud. La mayoría de los estudios para prevenir las úlceras por presión se han llevado a cabo en contextos hospitalarios, usando ácidos grasos hiperoxigenados (AGHO) y hasta la fecha, no se ha realizado ningún estudio específico con aceite de oliva virgen extra (AOVE) en el entorno domiciliario. Material y método Objetivo principal: evaluar si la utilización de AOVE no es inferior a los AGHO en la prevención de úlceras por presión (UPP) en pacientes inmovilizados en el entorno domiciliario. Diseño: Ensayo clínico aleatorizado multicéntrico, paralelo, a triple ciego, de no inferioridad. Ámbito: Población consultante de centros de salud andaluces. Muestra: 831 pacientes inmovilizados en riesgo de padecer UPP. Resultados El período de seguimiento fue de 16 semanas. En el análisis por protocolo, ninguna de las zonas evaluadas presentó diferencias de riesgo de incidencia de las úlceras por presión que superasen el valor delta establecido (10%). Sacro: AOVE 8 (2,55%) vs AGHO 8 (3,08%), RAR 0,53 (-2,2 a 3,26). Talón derecho: AOVE 4 (1,27%) vs AGHO 5 (1,92)%, RAR 0,65 (-1,43 a 2,73). Talón izquierdo: AOVE 3 (0,96%) vs AGHO 3 (1,15%), RAR 0.2 (-1,49 a 1,88). Trocánter Derecho: AOVE 0 (0%) vs AGHO 4 (1,54%), RAR 1,54 (0,04-3,03). Trocánter izquierdo: AOVE 1 (0,32%) vs AGHO 1 (0,38%), RAR 0.07 (-0,91 a 1,04). Discusión Este ensayo clínico pretendía evaluar si la prevención de las UPP usando una fórmula de AOVE no era inferior a la prevención de UPP con el uso AGHO, en el entorno domiciliario y con pacientes inmovilizados de alto riesgo. Los resultados han mostrado esta no inferioridad al no observarse diferencias que hayan superado el límite inferior del intervalo de confianza y convierte al aceite de oliva en un producto eficaz para la prevención de UPP en este tipo de pacientes. Se necesitan más estudios para investigar el mecanismo de acción del AOVE en la prevención de las UPP y relacionarlo con la etiopatogenia de éstas. Bibliografía 1. Gorecki C, Brown JM, Nelson EA, Briggs M, Schoonhoven L, Dealey C, et al. Impact of pressure ulcers on quality of life in older patients: a systematic review. J Am Geriatr Soc. 2009 Jul;57(7):1175–83. 2. Yamamoto Y, Hayashino Y, Higashi T, Matsui M, Yamazaki S, Takegami M, et al. Keeping vulnerable elderly patients free from pressure ulcer is associated with high caregiver burden in informal caregivers. J Eval Clin Pract. 2010 Jun;16(3):585–9. 3. Hanson D, Langemo DK, Anderson J, Thompson P, Hunter S. Friction and shear considerations in pressure ulcer development. Adv Skin Wound Care. 2010 Jan;23(1):21–4. 4. Soldevilla Agreda JJ, Torra i Bou J-E, Verdú Soriano J, López Casanova P. 3.er Estudio Nacional de Prevalencia de Úlceras por Presión en España, 2009: Epidemiología y variables definitorias de las lesiones y pacientes. Gerokomos. 2011 Jun;22(2):77–90. 5. Kottner J, Lahmann N, Dassen T. [Pressure ulcer prevalence: comparison between nursing homes and hospitals]. Pflege Z. 2010 Apr;63(4):228–31. 6. Wilborn D, Halfens R, Dassen T, Tannen A. [Pressure ulcer prevalence in German nursing homes and hospitals: what role does the National Nursing Expert Standard Prevention of Pressure Ulcer play?]. Gesundheitswesen Bundesverb Ärzte Öffentl Gesundheitsdienstes Ger. 2010 Apr;72(4):240–5. 7. Tubaishat A, Anthony D, Saleh M. Pressure ulcers in Jordan: a point prevalence study. J Tissue Viability. 2011 Feb;20(1):14–9. 8. James J, Evans JA, Young T, Clark M. Pressure ulcer prevalence across Welsh orthopaedic units and community hospitals: surveys based on the European Pressure Ulcer Advisory Panel minimum data set. Int Wound J. 2010 Jun;7(3):147–52. 9. Defloor T, Schoonhoven L, Katrien V, Weststrate J, Myny D. Reliability of the European Pressure Ulcer Advisory Panel classification system. J Adv Nurs. 2006 Apr;54(2):189–98

A randomised controlled trial of triple antiplatelet therapy (Aspirin, Clopidogrel and Dipyridamole) in the secondary prevention of stroke: safety, tolerability and feasibility

Background: Aspirin, dipyridamole and clopidogrel are effective in secondary vascular prevention. Combination therapy with three antiplatelet agents might maximise the benefit of antiplatelet treatment in the secondary prevention of ischaemic stroke. Methodology/Principal Findings: A randomised, parallel group, observer-blinded phase II trial compared the combination of aspirin, clopidogrel and dipyridamole with aspirin alone. Adult patients with ischaemic stroke or transient ischaemic attack (TIA) within 5 years were included. The primary outcome was tolerability to treatment assessed as the number of patients completing randomised treatment. Recruitment was halted prematurely after publication of the ESPRIT trial (which confirmed that combined aspirin and dipyridamole is more effective than aspirin alone). 17 patients were enrolled: male 12 (71%), mean age 62 (SD 13) years, lacunar stroke syndrome 12 (71%), median stroke/TIA onset to randomisation 8 months. Treatment was discontinued in 4 of 9 (44%) patients receiving triple therapy vs. none of 8 taking aspirin (p = 0.08). One recurrent stroke occurred in a patient in the triple group who was noncompliant of all antiplatelet medications. The number of patients with adverse events and bleeding complications, and their severity, were significantly greater in the triple therapy group (p,0.01). Conclusions/Significance: Long term triple antiplatelet therapy was asociated with a significant increase in adverse events and bleeding rates, and their severity, and a trend to increased discontinuations. However, the patients had a low risk of recurrence and future trials should focus on short term therapy in high risk patients characterised by a very recent event or failure of dual antiplatelet therapy.

Eradication of Helicobacter pylori in Children by Triple Therapy Regimens of Amoxicillin, Omeprazole, and Clarithromycin or Azithromycin

Background and Objectives: The present study aimed to evaluate the effect of classical and azithromycin-containing triple therapy eradication regimen against H. pylori in children, and to determine the level of patients’ tolerance. Patients and Methods: This single clinical trial was performed in 2014 on 2 to 15 years old children. All children, in whom H. Pylori infection was confirmed through multiple biopsies of the stomach and required treatment, were enrolled in the study. H. Pylori-positive patients were treated alternately with two different drug regimens; Group OCA received clarithromycin 7.5 mg/kg/day every 12 hours for 10 days, amoxicillin 50 mg/kg/day every 12 hours for 10 days, and omeprazole 1 mg/kg/day every 12 hours for two weeks, and Group OAA received azithromycin 10 mg/kg/day once a day (before meal) for 6 days along with amoxicillin and omeprazole. Four to six weeks after completion of treatment, patients’ stool was tested for H. Pylori through the monoclonal method using the Helicobacter antigen quick kit. Results: There were no significant differences between the two groups regarding gender and age of patients. Based on ITT analysis, the therapeutic response in the OAA and OCA groups were 56.2% and 62.5%, respectively (P = 0.40). Drug adverse effects were 15.6% in the OCA and 3.1% in the OAA group (P = 0.19). Conclusions: The therapeutic response was seen in more than half of the patients treated with triple therapy of H. Pylori eradication regimen including azithromycin or clarithromycin, and there was no significant difference between the two treatment groups. Keywords: Treatment,

Multiresidue determination of pesticides in surface water by SPE-HPLC-ESI and SPE-UPLC-ESI tandem mass spectrometry (MS/MS- triple quadrupole analyser).

2009

L’importation de la littérature française : un triple détournement de capital. Réflexions à partir d’une étude de réception journalistique en Suède

The background material of the study consists of articles about French literature gathered between 2010 and 2014 in the Swedish press. The aim of the article is to isolate the most widely discussed French literature from France in the Swedish press during the period, in order to explore why the transfer of this literature persists over time, how it is perceived, and which type of mediators bring about this transmission. The study raises questions about the image of French literature in Swedish media, Sweden’s impact on the transnational circulation of literature, and the use of French literature to place Sweden on the literary map. The results of the reception study show that French literature is presented as both aesthetically disruptive with innovative features and as a normative and traditional model. It incarnates an image of tradition as well as of modernity. French literature from France is principally mediated by orthodox journalists with a consistent symbolic capital, and the posture of these journalists is analyzed through Sapiro’s model, inspired by Bourdieu. The orthodox journalists manage to redirect the symbolic capital inherent to consecrated French literature at three levels: national, personal, and transnational. Firstly, the importation of French literature increases Swedish literature’s symbolic capital. Secondly, this transfer allows for an auto-consecration of the orthodox journalists themselves. Thirdly, this use of highly valued imported literature engenders a supplementary consecration (surconsecration) of a national literature and its dominating language. In conclusion, these observed bilateral literary exchanges show the often overlooked importance of peripheral countries in transnational literary transmission. The results modify Casanova’s (2002) model, since they display the impact on the market from the margins. The transfer of central national literatures in dominating languages towards peripheral countries allows for dominated languages and minor national literatures to take an active part in the construction and reconstruction of the relations on the global literary map.

Étude et passivation des défauts introduits par la gravure de vias sur cellule photovoltaïque triple jonction

Malgré l'augmentation constante de l'efficacité des cellules photovoltaïques multi-jonctions destinées au photovoltaïque concentré, des pertes de performances subsistent à haute concentration solaire. Elles sont principalement causées par un ombrage excessif dû aux métallisations ou par effet Joule à cause de la résistance série. Une des solutions à ce problème est de reporter le contact métallique en face avant sur la face arrière grâce à des vias métallisés et isolés électriquement. Avec cette architecture, les pertes dues à l'effet Joule et à l'ombrage seront limitées et des gains en efficacité sont attendus. Toutefois, l'intégration de vias sur des cellules photovoltaïques triple jonction favorise la recombinaison électron-trou en surface et peut provoquer une perte de performances de ces dispositifs. Ce mémoire présente les travaux de recherche effectués visant à étudier précisément cette problématique ainsi qu'à proposer des solutions pour limiter ces pertes. L'objectif est d'évaluer les pertes de performances de cellules photovoltaïques triple jonction suite à l'intégration de vias. Dans un second temps, l'objectif secondaire vise à limiter les pertes grâce à des traitements de passivation. Les résultats et solutions qu'apporte ce projet représentent une étape clé dans la réalisation de cette nouvelle architecture de contact électrique pour cellules photovoltaïques. En effet, les conclusions de ce projet de recherche permettent de valider la possibilité d'obtenir des gains en efficacité grâce à cette architecture. De plus, les procédés de microfabrication présentés dans ce projet de recherche proposent des solutions afin d'intégrer des vias sur ces hétérostructures tout en limitant les pertes en performances.

Presencia de Hezbollah en la triple frontera, un desafío para las políticas de seguridad conjuntas de Argentina, Brasil y Paraguay (2001-2006)

El grupo fundamentalista Hezbollah, nació en el Líbano y propagó su ideología por el mundo a finales del siglo XX y principios del siglo XXI. En el punto más álgido de su expansión, instaló una de sus células en el límite entre Argentina, Brasil y Paraguay, generando un riesgo para la región. Por esto, se hizo necesario crear políticas conjuntas de seguridad en la Triple Frontera con el fin de combatir la amenaza en la zona entre los años 2001 y 2006. Aunque teóricamente es necesario instaurar un Complejo Regional de Seguridad para mitigar los efectos de la amenaza, esto representó una complicación para los actores estatales, principalmente por sus divergencias geopolíticas, sociales, así como, las distintas percepciones sobre el grupo terrorista presente. Esto, resultó por dificultar la respuesta acertada en temas seguridad en la frontera.

Nueva luz sobre el origen de la guerra de la Triple Alianza

Introducción Este trabajo tiene tres objetivos claramente marcados: el primero, recordar el insigne amigo, cuyas paginas esclarecedoras  tanto nos han enseñado respecto al pasado de su patria, el Paraguay. El segundo, dar otro paso mas hacia el conocimiento de la verdad, respecto  de  los hechos coyunturales que dieron origen a la contienda mas cruenta en la historia moderna de la América Latina, que sumió el pueblo paraguayo en una nueva depresión económica, demográfica y social, similar a  la que experimenta durante el  largo régimen de Gaspar Rodríguez de Francia. Por ultimo, nos mueve un afán  propedéutico, dedicado a los alumnos de la cátedra de Metodología de la Universidad Nacional de Costa Rica.

Bidentate N-heterocyclic carbene complex of Manganese as catalyst for hydrosilylation and hydroboration of double and triple bonds

Scopo del presente lavoro di tesi è la sintesi di un complesso di manganese contenente un legante bis N-eterociclico e la sua applicazione come catalizzatore nelle reazioni di idrosililazione e idroborazione di doppi e tripli legami. I composti organici sililati e borilati sono importanti prodotti intermedi in diversi settori della chimica fine grazie alla loro stabilità e alla loro capacità di essere ampiamente funzionalizzati. Idroborazione e idrosililazione, grazie allo sviluppo di catalizzatori appositi, permettono di ottenere questi composti riducendo coprodotti, sottoprodotti e condizioni operative estreme. Generalmente i catalizzatori impiegati industrialmente contengono metalli di transizione costosi, rari e non biocompatibili. Per questo motivo negli ultimi anni la ricerca si è concentrata sullo sviluppo di nuovi catalizzatori a base di metalli della prima serie di transizione tra cui il manganese, noto per essere abbondante sulla crosta terrestre, economico e biocompatibile. I composti N-eterociclici (NHC) sono una classe di leganti tra le più utilizzate poiché oltre a una grossa variabilità di caratteristiche steriche ed elettroniche, consentono di stabilizzare la specie metallica. I complessi N-eterociclici di manganese sono stati scarsamente applicati nelle reazioni di idroborazione e idrosililazione. Per questo motivo, il gruppo dove ho svolto il mio tirocinio si è dedicato a questo tipo di ricerca, sintetizzando e testando un complesso bis-NHC di manganese nell’idrosililazione di carbonili e solfossidi. Il mio lavoro si inserisce all’interno di questo ampio progetto, applicando nuovamente lo stesso complesso su una serie di substrati e reazioni differenti. In particolare, l’idrosililazione è stata applicata su alchini, alcheni e su carbonili (in questo caso attivando il complesso con la luce visibile). Inoltre, si è testata l’attività catalitica del complesso nell’idroborazione di alchini.

Triple combination therapy in pulmonary arterial hypertension

Pulmonary arterial hypertension is a severe disease characterized by increasing in pulmonary vascular resistance leading to right ventricular failure and death. Currently available drugs for treatment of PAH act on three different pathways responsible of the pathogenesis of this disease: the endothelin pathway, the nitric oxide pathway and the prostacyclin pathway. The purpose of our study was to reassess our experience on the use of drugs that interact on the pathobiological line of prostacyclin so we retrospectively included all patients, referred to our center from February 1995 to December 2021, who received therapy with i.v. Epoprostenol, s.c. Treprostinil or oral Selexipag. Firstly, we observed that patients treated with Epoprostenol were significantly more compromised at baseline when compared to the two other groups and evaluating the effects of the three different drugs, it emerged that patients treated with Epoprostenol had significantly greater improvements in respect to those treated with Treprostinil and Selexipag. In the second part of our analysis we assessed the effects of these drugs when used as third line strategy in order to limit many confounding factors that could influence demographic, clinical and hemodynamic characteristics of patient populations. The differences emerged in exercise capacity and baseline hemodynamics reflect the fact that in our clinical practice, we add Epoprostenol as third line therapy in more compromised patients, Treprostinil in intermediate situations and Selexipag in less impaired conditions. Comparing the effects of treatments between baseline and first follow-up we noticed smaller benefits with Selexipag when compared with intravenous and subcutaneous strategies but it’s important to weight baseline patient’s differences. Our analysis confirmed clinical and functional benefits for the use of both prostacyclin analogues and prostacyclin receptor agonists in terms of improved functional class, six-minute walking distance and cardiopulmonary hemodynamics.

Core-valence Correlation Effects On Ir Calculations: The Bf3 And Bcl3 Cases.

The first theoretical results of core-valence correlation effects are presented for the infrared wavenumbers and intensities of the BF3 and BCl3 molecules, using (double- and triple-zeta) Dunning core-valence basis sets at the CCSD(T) level. The results are compared with those calculated in the frozen core approximation with standard Dunning basis sets at the same correlation level and with the experimental values. The general conclusion is that the effect of core-valence correlation is, for infrared wavenumbers and intensities, smaller than the effect of adding augmented diffuse functions to the basis set, e.g., cc-pVTZ to aug-cc-pVTZ. Moreover, the trends observed in the data are mainly related to the augmented functions rather than the core-valence functions added to the basis set. The results obtained here confirm previous studies pointing out the large descrepancy between the theoretical and experimental intensities of the stretching mode for BCl3.

Sci1 Is A Component Of The Auxin-dependent Control Of Cell Proliferation In Arabidopsis Upper Pistil.

To characterize the recently described SCI1 (stigma/style cell cycle inhibitor 1) gene relationship with the auxin pathway, we have taken the advantage of the Arabidopsis model system and its available tools. At first, we have analyzed the At1g79200 T-DNA insertion mutants and constructed various transgenic plants. The loss- and gain-of-function plants displayed cell number alterations in upper pistils that were controlled by the amino-terminal domain of the protein. These data also confirmed that this locus holds the functional homolog (AtSCI1) of the Nicotiana tabacum SCI1 gene. Then, we have provided some evidences the auxin synthesis/signaling pathways are required for downstream proper AtSCI1 control of cell number: (a) its expression is downregulated in yuc2yuc6 and npy1 auxin-deficient mutants, (b) triple (yuc2yuc6sci1) and double (npy1sci1) mutants mimicked the auxin-deficient phenotypes, with no synergistic interactions, and (c) the increased upper pistil phenotype in these last mutants, which is a consequence of an increased cell number, was able to be complemented by AtSCI1 overexpression. Taken together, our data strongly suggests SCI1 as a component of the auxin signaling transduction pathway to control cell proliferation/differentiation in stigma/style, representing a molecular effector of this hormone on pistil development.

Characterization Of Cumulative Joint Damage Patterns In Patients With Rheumatoid Arthritis: A Clinical, Serological, And Gene Polymorphism Perspective.

To characterize cumulative joint damage (CJD) patterns in rheumatoid arthritis (RA) and determine their associations with demographic/clinical features and HLA-DRB1 gene polymorphism. Hand and foot radiographs were obtained from 404 patients with RA. CJD patterns were determined by 3 derivations from Sharp/van der Heijde scores, obtained by the mathematical division of scores for hands/feet (Sharp-h/f score), fingers/wrists (Sharp-f/w score), and erosion/space narrowing (Sharp-e/sn score), respectively. DNA and serum were obtained for determination of HLA-DRB1 polymorphism, rheumatoid factor (RF), and anticitrullinated protein antibodies (ACPA). Patients with wrist-dominant CJD pattern were more likely to have severe RA than those with finger-dominant pattern (68.4% vs 46.0%; p = 0.036) as were those with foot-dominant vs hand-dominant CJD pattern (76.5% vs 56.4%; p = 0.044). HLA-DRB1 shared epitope (SE) alleles were associated with erosion-dominant CJD pattern (p = 0.021). Patients with erosion-dominant CJD pattern had higher levels of RF and ACPA than those with space-narrowing-dominant CJD pattern (median RF 71.35 U/ml vs 22.05 U/ml, respectively; p = 0.003; median ACPA 187.9 U/ml vs 143.2 U/ml, respectively; p < 0.001). The majority of triple-positive patients (SE+, RF+, ACPA+) had erosion-dominant CJD pattern (62.3%) while the majority of triple-negative patients (SE-, FR-, ACPA-) had space narrowing-dominant CJD pattern (75%; p = 0.017). ACPA was associated with HLA-DRB1 SE alleles (p < 0.05). Patients with foot-dominant CJD pattern were taller than those with hand-dominant CJD pattern (p = 0.002); those with erosion-dominant CJD pattern had higher weight and body mass index than those with space narrowing-dominant CJD pattern (p = 0.014, p = 0.001). CJD patterns were associated with disease severity, HLA-DRB1 SE status, presence and titer of ACPA and RF, and morphometric features.

Chronic Continuous Exenatide Infusion Does Not Cause Pancreatic Inflammation And Ductal Hyperplasia In Non-human Primates.

In this study, we aimed to evaluate the effects of exenatide (EXE) treatment on exocrine pancreas of nonhuman primates. To this end, 52 baboons (Papio hamadryas) underwent partial pancreatectomy, followed by continuous infusion of EXE or saline (SAL) for 14 weeks. Histological analysis, immunohistochemistry, Computer Assisted Stereology Toolbox morphometry, and immunofluorescence staining were performed at baseline and after treatment. The EXE treatment did not induce pancreatitis, parenchymal or periductal inflammatory cell accumulation, ductal hyperplasia, or dysplastic lesions/pancreatic intraepithelial neoplasia. At study end, Ki-67-positive (proliferating) acinar cell number did not change, compared with baseline, in either group. Ki-67-positive ductal cells increased after EXE treatment (P = 0.04). However, the change in Ki-67-positive ductal cell number did not differ significantly between the EXE and SAL groups (P = 0.13). M-30-positive (apoptotic) acinar and ductal cell number did not change after SAL or EXE treatment. No changes in ductal density and volume were observed after EXE or SAL. Interestingly, by triple-immunofluorescence staining, we detected c-kit (a marker of cell transdifferentiation) positive ductal cells co-expressing insulin in ducts only in the EXE group at study end, suggesting that EXE may promote the differentiation of ductal cells toward a β-cell phenotype. In conclusion, 14 weeks of EXE treatment did not exert any negative effect on exocrine pancreas, by inducing either pancreatic inflammation or hyperplasia/dysplasia in nonhuman primates.

A eficacia e a heterocronia das respostas de adaptação de basquetebolistas submetidos a diferentes modelos de estruturação da carga de treinamento e competição

Universidade Estadual de Campinas . Faculdade de Educação Física