Evaluation of high frequency jet ventilation in patients undergoing percutaneous thermal ablation

Purpose: To evaluate the use of high frequency jet ventilation (HFJV) in patients undergoing percutanous thermal ablation procedures.Materials: From may to september 2011 patients with lung, liver or kidney tumors suitable for percutanous thermal ablation were prospectively enrolled to be treated under general anesthesia using HFJV instead of conventional positive pressure ventilation (PPV). Our primary endpoint was feasability of HFJV during percutanous ablation, our secondary endpoints were assessment of breathing related movements by image fusion (CT/US), precision and ease of needle placement by number of CT aquisition/needle reposition and procedure related complications.Results: Twenty-nine patients (21 males, 8 females mean age 66.2 years) with 30 liver tumors, 1 kidney tumors and 6 lung tumors were included. Tumor ablation was performed by radiofrequency (RFA) in 26 cases, microwaves ( MWA) in 2 and cryoablation (CRA) in 1. The ablation procedure could be completed under HFJV in 22 patients. In 2 patients HFVJ had to be stopped in favor of PPV because the tumor was better seen under PPV. HFJV was not performed in 5. Breathing related movements of the target lesion in the cranio-caudal direction as estimated by image fusion were always inferior to 5mm compared to 20mm when patients are under PPV. Needle placement was straightforward under CT as well as US. No patient needed needle repositionning before ablation. We did not observe any HFJV related complications.Conclusions: HFJV significantly reduces breathing movements of target lesion during percutaneous ablation procedures. It does not seem to cause any particular complication. However in some cases such as tumors located at the base of the lungs or in the dome of the liver, the target may be best seen under PPV.

Com conduir sessions de lectura fàcil : directrius d'organització, planificació i dinamització dels clubs de lectura fàcil

Aquest treball pretén millorar la comprensió lectora dels assistents als clubs de Lectura Fàcil existents a Catalunya a través de la presentació d'una guia de conducció de clubs que presenta un model d'estratègies a seguir en les sessions de lectura. Aquestes orientacions seran útils als conductors novells que no són ni especialistes en didàctica de la llengua ni en literatura i que necessiten resoldre els dubtes de dinamització lectora en els col·lectius amb dificultats lectores. Les estratègies d'aprenentatge proposades provenen de la teoria constructivista en educació que aposta per una actitud molt més activa del lector i aprenent adult d'una L2. De la valoració organitzativa i estratègica de les sessions d'alguns dels clubs i, més concretament, de la tasca duta a terme durant tres anys al Club de Lectura Fàcil de la Biblioteca Mestre Martí Tauler de Rubí, del "com es llegeix" i del si "es comprèn allò llegit", sorgeix la necessitat que el conductor planifiqui acuradament les sessions de treball atenent uns objectius de lectura i el treball d'unes habilitats lectores concretes. Així, doncs, en aquest treball s'ofereixen algunes eines per a la planificació d'aquestes sessions de lectura.

Les faules mitològiques burlesques catalanes dins de la modernitat barroca : una particular apropiació de la mitologia clàssica

Estudi comparatiu de les faules mitològiques burlesques catalanes barroques i les produccions del mateix gènere en diferents literatures romàniques. Mitjançant aquest plantejament, es vol reivindicar la participació activa dels autors catalans en la modernitat de l'època barroca.

Action Research : the first steps to start up a pilot experiment in heritage education

Peer-reviewed

Análisis de contenido de la lista dedistribución IweTel (1998-2000)

La llista de distribució s'ha mostrat durant l'última dècada com una eina eficaç a l'hora de vertebrar la comunicació professional. De fet, és un primer pas cap a les comunitats virtuals. En aquest article s'estudia l'evolució d'un cas concret, IweTel, i de l'ús que els subscriptors van fer -ne, a partir de l'anàlisi de contingut dels missatges que van ser enviats entre 1998 i 2000. De l'estudi es desprèn que es tracta d'una llista utilitzada fonamentalment per a la comunicació professional i l'intercanvi d'informació, encara que pateix d'una falta notòria d'implicació activa per part dels seus subscriptors. Per altra banda, encara que han estat notables les millores fruit de la moderació, hi ha una absència viciosa de contingut científic o acadèmic en els debats desenvolupats.

La evaluación de la reducción de amenazas en el Parque Natural de la Zona Volcánica de la Garrotxa (Girona)

En este artículo se presenta la metodología y los resultados derivados de la aplicación de una adaptación del denominado modelo de evaluación de reducción de amenazas (Threat Reduction Assesment) en el Parque Natural de la Zona Volcánica de la Garrotxa (PNZVG). Endefinitiva, se pretende valorar la efectividad de la gestión a partir del grado de reducción de amenazas en el PNZVG. El estudio se realizó a partir de la elaboración de una evaluación externa e independiente, que ha contado a la vez con una estrecha colaboración de los órganos gestores y rectores del Parque, así como con una activa participación de distintos agentes sociales clave. Se concluye que, después de veinticinco años de existencia del Parque, muchas de las amenazas iniciales sólo se han reducido de forma modesta e incluso a partir del índice adaptado, considerado un enfoque más realista; con lo cual se llega a la preocupante conclusión de que algunas de las amenazas más importantes se han incrementado

Radiation induced apoptosis and initial DNA damage are inversely related in locally advanced breast cancer patients.

Background. DNA-damage assays, quantifying the initial number of DNA double-strand breaks induced by radiation, have been proposed as a predictive test for radiation-induced toxicity. Determination of radiation-induced apoptosis in peripheral blood lymphocytes by flow cytometry analysis has also been proposed as an approach for predicting normal tissue responses following radiotherapy. The aim of the present study was to explore the association between initial DNA damage, estimated by the number of double-strand breaks induced by a given radiation dose, and the radio-induced apoptosis rates observed. Methods. Peripheral blood lymphocytes were taken from 26 consecutive patients with locally advanced breast carcinoma. Radiosensitivity of lymphocytes was quantified as the initial number of DNA double-strand breaks induced per Gy and per DNA unit (200 Mbp). Radio-induced apoptosis at 1, 2 and 8 Gy was measured by flow cytometry using annexin V/propidium iodide. Results. Radiation-induced apoptosis increased in order to radiation dose and data fitted to a semi logarithmic mathematical model. A positive correlation was found among radio-induced apoptosis values at different radiation doses: 1, 2 and 8 Gy (p < 0.0001 in all cases). Mean DSB/Gy/DNA unit obtained was 1.70 ± 0.83 (range 0.63-4.08; median, 1.46). A statistically significant inverse correlation was found between initial damage to DNA and radio-induced apoptosis at 1 Gy (p = 0.034). A trend toward 2 Gy (p = 0.057) and 8 Gy (p = 0.067) was observed after 24 hours of incubation. Conclusions. An inverse association was observed for the first time between these variables, both considered as predictive factors to radiation toxicity.

Combined low initial DNA damage and high radiation-induced apoptosis confers clinical resistance to long-term toxicity in breast cancer patients treated with high-dose radiotherapy

BACKGROUND. Either higher levels of initial DNA damage or lower levels of radiation-induced apoptosis in peripheral blood lymphocytes have been associated to increased risk for develop late radiation-induced toxicity. It has been recently published that these two predictive tests are inversely related. The aim of the present study was to investigate the combined role of both tests in relation to clinical radiation-induced toxicity in a set of breast cancer patients treated with high dose hyperfractionated radical radiotherapy. METHODS. Peripheral blood lymphocytes were taken from 26 consecutive patients with locally advanced breast carcinoma treated with high-dose hyperfractioned radical radiotherapy. Acute and late cutaneous and subcutaneous toxicity was evaluated using the Radiation Therapy Oncology Group morbidity scoring schema. The mean follow-up of survivors (n = 13) was 197.23 months. Radiosensitivity of lymphocytes was quantified as the initial number of DNA double-strand breaks induced per Gy and per DNA unit (200 Mbp). Radiation-induced apoptosis (RIA) at 1, 2 and 8 Gy was measured by flow cytometry using annexin V/propidium iodide. RESULTS. Mean DSB/Gy/DNA unit obtained was 1.70 ± 0.83 (range 0.63-4.08; median, 1.46). Radiation-induced apoptosis increased with radiation dose (median 12.36, 17.79 and 24.83 for 1, 2, and 8 Gy respectively). We observed that those "expected resistant patients" (DSB values lower than 1.78 DSB/Gy per 200 Mbp and RIA values over 9.58, 14.40 or 24.83 for 1, 2 and 8 Gy respectively) were at low risk of suffer severe subcutaneous late toxicity (HR 0.223, 95%CI 0.073-0.678, P = 0.008; HR 0.206, 95%CI 0.063-0.677, P = 0.009; HR 0.239, 95%CI 0.062-0.929, P = 0.039, for RIA at 1, 2 and 8 Gy respectively) in multivariate analysis. CONCLUSIONS. A radiation-resistant profile is proposed, where those patients who presented lower levels of initial DNA damage and higher levels of radiation induced apoptosis were at low risk of suffer severe subcutaneous late toxicity after clinical treatment at high radiation doses in our series. However, due to the small sample size, other prospective studies with higher number of patients are needed to validate these results.

Effects of highly active antiretroviral therapy with nelfinavir in vertically HIV-1 infected children: 3 years of follow-up. Long-term response to nelfinavir in children.

BACKGROUND Antiretroviral treatment (ART) in children has special features and consequently, results obtained from clinical trials with antiretroviral drugs in adults may not be representative of children. Nelfinavir (NFV) is an HIV-1 Protease Inhibitor (PI) which has become as one of the first choices of PI for ART in children. We studied during a 3-year follow-up period the effects of highly active antiretroviral therapy with nelfinavir in vertically HIV-1 infected children. METHODS Forty-two vertically HIV-infected children on HAART with NFV were involved in a multicentre prospective study. The children were monitored at least every 3 months with physical examinations, and blood sample collection to measure viral load (VL) and CD4+ cell count. We performed a logistic regression analysis to determinate the odds ratio of baseline characteristics on therapeutic failure. RESULTS Very important increase in CD4+ was observed and VL decreased quickly and it remained low during the follow-up study. Children with CD4+ <25% at baseline achieved CD4+ >25% at 9 months of follow-up. HIV-infected children who achieved undetectable viral load (uVL) were less than 40% in each visit during follow-up. Nevertheless, HIV-infected children with VL >5000 copies/ml were less than 50% during the follow-up study. Only baseline VL was an important factor to predict VL control during follow-up. Virological failure at defined end-point was confirmed in 30/42 patients. Along the whole of follow-up, 16/42 children stopped HAART with NFV. Baseline characteristics were not associated with therapeutic change. CONCLUSION NFV is a safe drug with a good profile and able to achieve an adequate response in children.

Different profiles of immune reconstitution in children and adults with HIV-infection after highly active antiretroviral therapy.

BACKGROUND Recent advances in characterizing the immune recovery of HIV-1-infected people have highlighted the importance of the thymus for peripheral T-cell diversity and function. The aim of this study was to investigate differences in immune reconstitution profiles after highly active antiretroviral therapy (HAART) between HIV-children and adults. METHODS HIV patients were grouped according to their previous clinical and immunological status: 9 HIV-Reconstituting-adults (HIV-Rec-adults) and 10 HIV-Reconstituting-children (HIV-Rec-children) on HAART with viral load (VL) or=500 cells/microL at least during 6 months before the study and CD4+

Avaluació del consum d'energia eléctrica d'una indústria càrnia

L’objecte d’aquest treball ha estat avaluar el consum d’energia elèctrica de la industria BECSA, situada al municipi de Palol de Revardit i dedicada a l’elaboració de pernil curat preparat per a ser llescat industrialment. En primer lloc es va estudiar el procés productiu de la indústria i la maquinària, per tal de determinar les potencies activa i reactiva de cadascuna de les màquines. Amb les potències per una banda, i l’estudi dels temps de treball de les màquines per l’altra, es van determinar els consums d’energia activa i reactiva que suposava el procés. A partir de l’anàlisi de les dades obtingudes, les factures elèctriques, les tarifes i complements per destinació horària, es van proposar una sèrie de millores per a poder disminuir els costos del consum d’energia elèctrica de la indústria

Status of radiation protection at different hospitals in Nepal.

Nepal has a long history of medical radiology since1923 but unfortunately, we still do not have any Radiation Protection Infrastructure to control the use of ionizing radiations in the various fields. The objective of this study was an assessment of the radiation protection in medical uses of ionizing radiation. Twenty-eight hospitals with diagnostic radiology facility were chosen for this study according to patient loads, equipment and working staffs. Radiation surveys were also done at five different radiotherapy centers. Questionnaire for radiation workers were used; radiation dose levels were measured and an inventory of availability of radiation equipment made. A corollary objective of the study was to create awareness in among workers on possible radiation health hazard and risk. It was also deemed important to know the level of understanding of the radiation workers in order to initiate steps towards the establishment of Nepalese laws, regulation and code of radiological practice in this field. Altogether, 203 Radiation workers entertained the questionnaire, out of which 41 are from the Radiotherapy and 162 are from diagnostic radiology. The radiation workers who have participated in the questionnaire represent more than 50% of the radiation workers working in this field in Nepal. Almost all X-ray, CT and Mammogram installations were built according to protection criteria and hence found safe. Radiation dose level at the reference points for all the five Radiotherapy centers are within safe limit. Around 65% of the radiation workers have never been monitored for radiation. There is no quality control program in any of the surveyed hospitals except radiotherapy facilities.

A woman with reddish nodule on the skin of the breast.

A 54-year-old woman presented a peri-areolar nodule located in the skin of the right breast. Clinical examination showed a 6 x 5 cm exophytic, lobed, ulcerated, and bleeding nodule. The patient reported that the tumor had grown gradually over a period of 3 months. The patient had been diagnosed 8 years prior to presentation with infiltrating ductal carcinoma of the right breast (pT2NO). This tumor was treated with partial mastectomy (conservative surgery) and lymph node dissection, then subsequently received 30 tangent field radiotherapy sessions to the breast for a total dose of 45 Gy. The rest of her cutaneous exam was normal. There was no family history of any similar tumor.

Transparencia y organizaciones no lucrativas

Tota organització no lucrativa te la finalitat de prestar un servei que millori o mantingui la qualitat de vida de la societat. Per a aconseguir aquest objectiu, aquestes organitzacions es caracteritzen per estar formades per grups de persones voluntàries que no busquen el lucre personal, sinó que a través d’uns valors que es remunten a èpoques de l’antic Egipte com son el respecte, la solidaritat o la confiança, tracten de millorar la societat en la que vivim. Les organitzacions del anomenat tercer sector tindran que ser transparents per a aconseguir generar confiança a l’exterior, però al mateix temps, tindran que fer front al seu major problema per a subsistir, la captació de fons. La situació econòmica actual ha accentuat encara més aquesta problemàtica de finançament, solucionada tradicionalment mitjançant fons procedents de particulars, de l’administració pública, d’empreses o d’altres organitzacions del mateix sector. A l’actualitat s’han tingut que buscar noves solucions com són la innovació o una correcta gestió de la comunicació que permeti generar transparència. La correcta gestió de la comunicació estarà basada a l’escolta activa i en adoptar una postura assertiva a l’hora d’intercanviar una informació, el que finalment permetrà difondre el valor de la transparència de l’organització no lucrativa, aconseguint així millorar la imatge, augmentar la confiança i reforçar la reputació. Per a poder realitzar aquest procés, prèviament es deurà aconseguir un liderat directiu capaç de guiar el procés de comunicació, la implantació de una cultura holística per a la transparència en la organització i la formació del membres del treball. Cal mencionar que a l’actualitat existeixen noves vies tecnològiques que han facilitat molt la gestió de la comunicació. Encara això, aquestes vies deurien ser explotades a major proporció, doncs com queda comprovat, quant millor sigui aquesta gestió, major serà la transparència.

Àgora : Aprendre és cosa de tots

La idea general d¿aquest projecte consisteix en implementar una xarxa (social) entre tots els membres que participen en el procés educatiu, obrint la participació, a més dels membres clàssics (professors) a altres rols (terapeutes, logopedes, professors de reforç, etc.) i implicar de manera més activa a les famílies en les tasques diàries de l¿escola, proporcionant-los informació al moment.