Dose selection for radioiodine therapy of borderline hyperthyroid patients according to thyroid uptake of 99mTc-pertechnetate: applicability to unifocal thyroid autonomy?

PURPOSE: The aim of this study was to evaluate the feasibility of applying a previously described dose strategy based on (99m)Tc-pertechnetate thyroid uptake under thyrotropin suppression (TcTU(s)) to radioiodine therapy for unifocal thyroid autonomy. METHODS: A total of 425 consecutive patients (302 females, 123 males; age 63.1+/-10.3 years) with unifocal thyroid autonomy were treated at three different centres with (131)I, using Marinelli's formula for calculation of three different absorbed dose schedules: 100-300 Gy to the total thyroid volume according to the pre-treatment TcTU(s) (n=146), 300 Gy to the nodule volume (n=137) and 400 Gy to the nodule volume (n=142). RESULTS: Successful elimination of functional thyroid autonomy with either euthyroidism or hypothyroidism occurred at a mean of 12 months after radioiodine therapy in 94.5% of patients receiving 100-300 Gy to the thyroid volume, in 89.8% of patients receiving 300 Gy to the nodule volume and in 94.4% receiving 400 Gy to the nodule volume. Reduction in thyroid volume was highest for the 100-300 Gy per thyroid and 400 Gy per nodule strategies (36+/-19% and 38+/-20%, respectively) and significantly lower for the 300 Gy per nodule strategy (28+/-16%; p<0.01). CONCLUSION: A dose strategy based on the TcTU(s) can be used independently of the scintigraphic pattern of functional autonomous tissue in the thyroid.

Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis

OBJECTIVES: To synthesize the evidence on the risk of HIV transmission through unprotected sexual intercourse according to viral load and treatment with combination antiretroviral therapy (ART). DESIGN: Systematic review and meta-analysis. METHODS: We searched Medline, Embase and conference abstracts from 1996-2009. We included longitudinal studies of serodiscordant couples reporting on HIV transmission according to plasma viral load or use of ART and used random-effects Poisson regression models to obtain summary transmission rates [with 95% confidence intervals, (CI)]. If there were no transmission events we estimated an upper 97.5% confidence limit. RESULTS: We identified 11 cohorts reporting on 5021 heterosexual couples and 461 HIV-transmission events. The rate of transmission overall from ART-treated patients was 0.46 (95% CI 0.19-1.09) per 100 person-years, based on five events. The transmission rate from a seropositive partner with viral load below 400 copies/ml on ART, based on two studies, was zero with an upper 97.5% confidence limit of 1.27 per 100 person-years, and 0.16 (95% CI 0.02-1.13) per 100 person-years if not on ART, based on five studies and one event. There were insufficient data to calculate rates according to the presence or absence of sexually transmitted infections, condom use, or vaginal or anal intercourse. CONCLUSION: Studies of heterosexual discordant couples observed no transmission in patients treated with ART and with viral load below 400 copies/ml, but data were compatible with one transmission per 79 person-years. Further studies are needed to better define the risk of HIV transmission from patients on ART.

Ranking of tests for pain hypersensitivity according to their discriminative ability in chronic neck pain

BACKGROUND AND OBJECTIVES Quantitative sensory testing (QST) is widely used to investigate peripheral and central sensitization. However, the comparative performance of different QST for diagnostic or prognostic purposes is unclear. We explored the discriminative ability of different quantitative sensory tests in distinguishing between patients with chronic neck pain and pain-free control subjects and ranked these tests according to the extent of their association with pain hypersensitivity. METHODS We performed a case-control study in 40 patients and 300 control subjects. Twenty-six tests, including different modalities of pressure, heat, cold, and electrical stimulation, were used. As measures of discrimination, we estimated receiver operating characteristic curves and likelihood ratios. RESULTS The following quantitative sensory tests displayed the best discriminative value: (1) pressure pain threshold at the site of the most severe neck pain (fitted area under the receiver operating characteristic curve, 0.92), (2) reflex threshold to single electrical stimulation (0.90), (3) pain threshold to single electrical stimulation (0.89), (4) pain threshold to repeated electrical stimulation (0.87), and (5) pressure pain tolerance threshold at the site of the most severe neck pain (0.86). Only the first 3 could be used for both ruling in and out pain hypersensitivity. CONCLUSIONS Pressure stimulation at the site of the most severe pain and parameters of electrical stimulation were the most appropriate QST to distinguish between patients with chronic neck pain and asymptomatic control subjects. These findings may be used to select the tests in future diagnostic and longitudinal prognostic studies on patients with neck pain and to optimize the assessment of localized and spreading sensitization in chronic pain patients.

Risk Factors for Sternal Wound Infection After Open Heart Operations Vary According to Type of Operation

BACKGROUND This study evaluated whether risk factors for sternal wound infections vary with the type of surgical procedure in cardiac operations. METHODS This was a university hospital surveillance study of 3,249 consecutive patients (28% women) from 2006 to 2010 (median age, 69 years [interquartile range, 60 to 76]; median additive European System for Cardiac Operative Risk Evaluation score, 5 [interquartile range, 3 to 8]) after (1) isolated coronary artery bypass grafting (CABG), (2) isolated valve repair or replacement, or (3) combined valve procedures and CABG. All other operations were excluded. Univariate and multivariate binary logistic regression were conducted to identify independent predictors for development of sternal wound infections. RESULTS We detected 122 sternal wound infections (3.8%) in 3,249 patients: 74 of 1,857 patients (4.0%) after CABG, 19 of 799 (2.4%) after valve operations, and 29 of 593 (4.9%) after combined procedures. In CABG patients, bilateral internal thoracic artery harvest, procedural duration exceeding 300 minutes, diabetes, obesity, chronic obstructive pulmonary disease, and female sex (model 1) were independent predictors for sternal wound infection. A second model (model 2), using the European System for Cardiac Operative Risk Evaluation, revealed bilateral internal thoracic artery harvest, diabetes, obesity, and the second and third quartiles of the European System for Cardiac Operative Risk Evaluation were independent predictors. In valve patients, model 1 showed only revision for bleeding as an independent predictor for sternal infection, and model 2 yielded both revision for bleeding and diabetes. For combined valve and CABG operations, both regression models demonstrated revision for bleeding and duration of operation exceeding 300 minutes were independent predictors for sternal infection. CONCLUSIONS Risk factors for sternal wound infections after cardiac operations vary with the type of surgical procedure. In patients undergoing valve operations or combined operations, procedure-related risk factors (revision for bleeding, duration of operation) independently predict infection. In patients undergoing CABG, not only procedure-related risk factors but also bilateral internal thoracic artery harvest and patient characteristics (diabetes, chronic obstructive pulmonary disease, obesity, female sex) are predictive of sternal wound infection. Preventive interventions may be justified according to the type of operation.

Comparative Effectiveness and Safety of New-Generation Versus Early-Generation Drug-Eluting Stents According to Complexity of Coronary Artery Disease: A Patient-Level Pooled Analysis of 6,081 Patients.

OBJECTIVES The purpose of this study was to compare the 2-year safety and effectiveness of new- versus early-generation drug-eluting stents (DES) according to the severity of coronary artery disease (CAD) as assessed by the SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score. BACKGROUND New-generation DES are considered the standard-of-care in patients with CAD undergoing percutaneous coronary intervention. However, there are few data investigating the effects of new- over early-generation DES according to the anatomic complexity of CAD. METHODS Patient-level data from 4 contemporary, all-comers trials were pooled. The primary device-oriented clinical endpoint was the composite of cardiac death, myocardial infarction, or ischemia-driven target-lesion revascularization (TLR). The principal effectiveness and safety endpoints were TLR and definite stent thrombosis (ST), respectively. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated at 2 years for overall comparisons, as well as stratified for patients with lower (SYNTAX score ≤11) and higher complexity (SYNTAX score >11). RESULTS A total of 6,081 patients were included in the study. New-generation DES (n = 4,554) compared with early-generation DES (n = 1,527) reduced the primary endpoint (HR: 0.75 [95% CI: 0.63 to 0.89]; p = 0.001) without interaction (p = 0.219) between patients with lower (HR: 0.86 [95% CI: 0.64 to 1.16]; p = 0.322) versus higher CAD complexity (HR: 0.68 [95% CI: 0.54 to 0.85]; p = 0.001). In patients with SYNTAX score >11, new-generation DES significantly reduced TLR (HR: 0.36 [95% CI: 0.26 to 0.51]; p < 0.001) and definite ST (HR: 0.28 [95% CI: 0.15 to 0.55]; p < 0.001) to a greater extent than in the low-complexity group (TLR pint = 0.059; ST pint = 0.013). New-generation DES decreased the risk of cardiac mortality in patients with SYNTAX score >11 (HR: 0.45 [95% CI: 0.27 to 0.76]; p = 0.003) but not in patients with SYNTAX score ≤11 (pint = 0.042). CONCLUSIONS New-generation DES improve clinical outcomes compared with early-generation DES, with a greater safety and effectiveness in patients with SYNTAX score >11.

Do multiple true-false items beat the commonly used one-best-answers questions regarding to the Ottawa Criteria for Good Assessment? Results of a literature review

Background: Multiple True-False-Items (MTF-Items) might offer some advantages compared to one-best-answer-questions (TypeA) as they allow more than one correct answer and may better represent clinical decisions. However, in medical education assessment MTF-Items are seldom used. Summary of Work: With this literature review existing findings on MTF-items and on TypeA were compared along the Ottawa Criteria for Good Assessment, i.e. (1) reproducibility, (2) feasibility, (3) validity, (4) acceptance, (5) educational effect, (6) catalytic effects, and (7) equivalence. We conducted a literature research on ERIC and Google Scholar including papers from the years 1935 to 2014. We used the search terms “multiple true-false”, “true-false”, “true/false”, and “Kprim” combined with “exam”, “test”, and “assessment”. Summary of Results: We included 29 out of 33 studies. Four of them were carried out in the medical field Compared to TypeA, MTF-Items are associated with (1) higher reproducibility (2) lower feasibility (3) similar validity (4) higher acceptance (5) higher educational effect (6) no studies on catalytic effects or (7) equivalence. Discussion and Conclusions: While studies show overall good characteristics of MTF items according to the Ottawa criteria, this type of question seems to be rather seldom used. One reason might be the reported lower feasibility. Overall the literature base is still weak. Furthermore, only 14 % of literature is from the medical domain. Further studies to better understand the characteristics of MTF-Items in the medical domain are warranted. Take-home messages: Overall the literature base is weak and therefore further studies are needed. Existing studies show that: MTF-Items show higher reliability, acceptance and educational effect; MTF-Items are more difficult to produce

Back to the future to revisit meanings

Tanto en los estudios sincrónicos como en los diacrónicos queda en evidencia que el español posee diferentes formas de expresar el tiempo futuro. Por ejemplo, la desinencia del futuro morfológico (-ré) alterna en el español actual con la perífrasis verbal ir+a+infinitivo tal y como se ve en los siguientes ejemplos de la variedad rioplatense: (1) CFK advirtió que "Vamos a sostener este modelo de crecimiento con todas las decisiones que haya que tomar" (Diario Digital 25-04-2012); (2) Rossi aseguró que votarán a favor de YPF unos doscientos diputados (La Nación 28-04-2012). Este hecho ha sido analizado por innumerables estudios y autores, muchos de los cuales se han aproximado a este tema desde la perspectiva variacionista que relaciona significados y contextos (Martínez 1987, Sedano 1994, Company 1999, Alaniz 2010); esta perspectiva explica dicha alternancia por medio de un continuum de factualidad el cual va desde la mayor factualidad de la perífrasis a la menor factualidad de la forma sintética. El análisis de los datos de acuerdo con dichos significados básicos postulados parecía confirmar la hipótesis, al menos en los contextos relacionados con la comunicación oral cotidiana (Martínez 1987). Sin embargo, un estudio más profundo sobre los usos de dichas formas en otros géneros discursivos (Mailhes 2010) nos lleva a replantearnos los significados básicos. En este sentido, la hipótesis que nos interesa confirmar es que las formas se encuentran vinculadas a la evaluación de los hechos por medio de la posibilidad de ejercer control sobre los mismos . Si existe control, se puede seleccionar la perífrasis; si no existe, la forma sintética será más apropiada. La ausencia de control puede dar lugar a una posibilidad más o menos remota así como a la profecía, dos esferas donde la variación es explotada

Back to the future to revisit meanings

Tanto en los estudios sincrónicos como en los diacrónicos queda en evidencia que el español posee diferentes formas de expresar el tiempo futuro. Por ejemplo, la desinencia del futuro morfológico (-ré) alterna en el español actual con la perífrasis verbal ir+a+infinitivo tal y como se ve en los siguientes ejemplos de la variedad rioplatense: (1) CFK advirtió que "Vamos a sostener este modelo de crecimiento con todas las decisiones que haya que tomar" (Diario Digital 25-04-2012); (2) Rossi aseguró que votarán a favor de YPF unos doscientos diputados (La Nación 28-04-2012). Este hecho ha sido analizado por innumerables estudios y autores, muchos de los cuales se han aproximado a este tema desde la perspectiva variacionista que relaciona significados y contextos (Martínez 1987, Sedano 1994, Company 1999, Alaniz 2010); esta perspectiva explica dicha alternancia por medio de un continuum de factualidad el cual va desde la mayor factualidad de la perífrasis a la menor factualidad de la forma sintética. El análisis de los datos de acuerdo con dichos significados básicos postulados parecía confirmar la hipótesis, al menos en los contextos relacionados con la comunicación oral cotidiana (Martínez 1987). Sin embargo, un estudio más profundo sobre los usos de dichas formas en otros géneros discursivos (Mailhes 2010) nos lleva a replantearnos los significados básicos. En este sentido, la hipótesis que nos interesa confirmar es que las formas se encuentran vinculadas a la evaluación de los hechos por medio de la posibilidad de ejercer control sobre los mismos . Si existe control, se puede seleccionar la perífrasis; si no existe, la forma sintética será más apropiada. La ausencia de control puede dar lugar a una posibilidad más o menos remota así como a la profecía, dos esferas donde la variación es explotada

Back to the future to revisit meanings

Tanto en los estudios sincrónicos como en los diacrónicos queda en evidencia que el español posee diferentes formas de expresar el tiempo futuro. Por ejemplo, la desinencia del futuro morfológico (-ré) alterna en el español actual con la perífrasis verbal ir+a+infinitivo tal y como se ve en los siguientes ejemplos de la variedad rioplatense: (1) CFK advirtió que "Vamos a sostener este modelo de crecimiento con todas las decisiones que haya que tomar" (Diario Digital 25-04-2012); (2) Rossi aseguró que votarán a favor de YPF unos doscientos diputados (La Nación 28-04-2012). Este hecho ha sido analizado por innumerables estudios y autores, muchos de los cuales se han aproximado a este tema desde la perspectiva variacionista que relaciona significados y contextos (Martínez 1987, Sedano 1994, Company 1999, Alaniz 2010); esta perspectiva explica dicha alternancia por medio de un continuum de factualidad el cual va desde la mayor factualidad de la perífrasis a la menor factualidad de la forma sintética. El análisis de los datos de acuerdo con dichos significados básicos postulados parecía confirmar la hipótesis, al menos en los contextos relacionados con la comunicación oral cotidiana (Martínez 1987). Sin embargo, un estudio más profundo sobre los usos de dichas formas en otros géneros discursivos (Mailhes 2010) nos lleva a replantearnos los significados básicos. En este sentido, la hipótesis que nos interesa confirmar es que las formas se encuentran vinculadas a la evaluación de los hechos por medio de la posibilidad de ejercer control sobre los mismos . Si existe control, se puede seleccionar la perífrasis; si no existe, la forma sintética será más apropiada. La ausencia de control puede dar lugar a una posibilidad más o menos remota así como a la profecía, dos esferas donde la variación es explotada

Visual grading of large cross section structural timber of Pinus sylvestris L. according to UNE 56544:2007 standard

Large cross section structural timber have been used in many structures over long periods of time and still make up an important part of the market due to its mechanical properties. Furthermore, it is frequent its employment in new construction site. It involves the need for a visual grading standard for timber used in construction according to the quality assessment. The material has to satisfy the requirements according to the currently regulations. UNE 56544 is the Spanish visual grading standard for coniferous structural timber. The 2007 version defined a new visual grade in the standard for large section termed Structural Large Timber (MEG). This research checks the new visual grading and consists of 116 structural size specimens of sawn coniferous timber of Scotch pine (Pinus sylvestris L.) from Segovia, Spain. The pieces had a cross section of 150 by 200 mm. They were visually graded according to UNE 56544:2007. Also, mechanical properties have been obtained according to standard EN 408. The results show very low output with an excessive percentage of rejected pieces (33%). The main reasons for the rejection of pieces are fissures and twist

Applicability of the GP Device to the Circle of Willis Arteries by Using a Mathematical Model

According to the World Health Organization, 15 million people suffer stroke worldwide each year, of these, 5 million die and 5 million are permanently disabled. Stroke is therefore a major cause of mortality world-wide. The majority of strokes are caused by a blood clot that occludes an artery in the brain, and although thrombolytic agents such as Alteplase are used to dissolve clots that arise in the arteries of the brain, there are limitations on the use of these thrombolytic agents. However over the past decade, other methods of treatment have been developed which include Thrombectomy Devices e.g. the 'GP' Thrombus Aspiration Device ('GP' TAD). Such devices may be used as an alternative to thrombolytics or in conjunction with them to extract blood clots in arteries such as the middle cerebral artery of the midbrain brain, and the posterior inferior cerebellar artery (PICA) of the posterior aspect of the brain. In this paper, we mathematically model the removal of blood clots using the 'GP' TAD from selected arteries of the brain where blood clots may arise taking into account factors such as the resistances, compliances and inertances effects. Such mathematical modelling may have potential uses in predicting the pressures necessary to extract blood clots of given lengths, and masses from arteries in the Circle of Willis - posterior circulation of the brain

Ball possession effectiveness in men's and women's elite basketball according to situational variables in different game periods

The aim of the present study was to identify the importance of floorball tactical variables to predict ball possession effectiveness, when controlling quality of opposition and game periods. The sample was composed by 1500 ball possessions, corresponding to 14 games randomly selected from the International Championships played during 2008 and 2010 (World Championship, Four nations tournament and classificatory phases for World Championship) by teams from different competition levels (HIGH, INTERMEDIATE and LOW). The effects of the predictor variables on successful ball possessions according to the three game contexts (HIGH vs. HIGH; HIGH vs. LOW; LOW vs. LOW games) were analyzed using Binomial Logistic Regressions. The results showed no interaction with the game period. In HIGH vs. HIGH games, quality of opposition showed an association with ball possession effectiveness with ending zone, offensive system, possession duration, height of shooting and defensive pressures previous to the shot. In HIGH vs. LOW games the important factors were the starting zone, possession duration, defensive pressure previous to the last pass and to the shot, technique of shooting and the number players involved in each ball possession. Finally, in LOW vs. LOW games, the results emphasized the importance of starting and ending zones, the number of passes used and the technique of shooting. In conclusion, elite floorball performance is mainly affected by quality of opposition showing different game patterns in each context that should be considered by coaches when preparing practices and competitions.

Application of Public Private Partnerships to the Spanish Airport System

The current deficit situation of the Spanish airport system suggests the need to manage this in a more efficient and profitable way. One of the possible options is through private management and being able to do this through Public Private Partnerships (PPP). This study analyzes the situation of the sector and its economic importance and the different possibilities for introducing private management in a public company, specifying the situation in the case of airports, presenting the advantages and disadvantages of these possibilities, and aiming at results obtained in other places where it has been applied. It is proposed that the ideal model for the introduction of private management would be through PPP models tailored to each airport, but having common characteristics according to the group they belong to. Finally, we observe that not all airports are commercially attractive, so that the PPP concept does not apply to all of them. In some cases even the operability itself is not viable at all, and that should be considered separately in order to avoid creating a private monopoly while trying to enhance competition among them.