Central nervous system involvement at first relapse in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and anthracycline monochemotherapy without intrathecal prophylaxis.

BACKGROUND The prevalence of and risk factors for central nervous system recurrence in patients with acute promyelocytic leukemia are not well established and remain a controversial matter. DESIGN AND METHODS Between 1996 and 2005, 739 patients with newly diagnosed acute promyelocytic leukemia enrolled in two consecutive trials (PETHEMA LPA96 and LPA99) received induction therapy with all-trans retinoic acid and idarubicin. Consolidation therapy comprised three courses of anthracycline monochemotherapy (LPA96), with all-trans retinoic acid and reinforced doses of idarubicin in patients with an intermediate or high risk of relapse (LPA99). Central nervous system prophylaxis was not given. RESULTS Central nervous system relapse was documented in 11 patients. The 5-year cumulative incidence of central nervous system relapse was 1.7% (LPA96 3.2% and LPA99 1.2%; p=0.09). The cumulative incidence was 0%, 0.8%, and 5.5% in low-, intermediate-, and high-risk patients, respectively. Relapse risk score (p=0.0001) and the occurrence of central nervous system hemorrhage during induction (5-year cumulative incidence 18.7%, p=0.006) were independent risk factors for central nervous system relapse. CONCLUSIONS This study shows a low incidence of central nervous system relapse in patients with acute promyelocytic leukemia following therapy with all-trans retinoic acid and anthracycline without specific central nervous system prophylaxis. Central nervous system relapse was significantly associated with high white blood cell counts and prior central nervous system hemorrhage, which emerged as independent prognostic factors.

R-ESHAP as salvage therapy for patients with relapsed or refractory diffuse large B-cell lymphoma: the influence of prior exposure to rituximab on outcome. A GEL/TAMO study.

BACKGROUND The role of re-treatment with rituximab in aggressive B-cell lymphomas still needs to be defined. This study evaluated the influence of prior exposure to rituximab on response rates and survival in patients with diffuse large B-cell lymphoma treated with rituximab plus etoposide, cytarabine, cisplatinum and methylprednisolone (R-ESHAP). DESIGN AND METHODS We retrospectively analyzed 163 patients with relapsed or refractory diffuse large B-cell lymphoma who received R-ESHAP as salvage therapy with a curative purpose. Patients were divided into two groups according to whether rituximab had been administered (n=94, "R+" group) or not (n=69, "R-" group) prior to R-ESHAP. RESULTS Response rates were significantly higher in the R- group in the univariate but not in the multivariate analysis. In the analysis restricted to the R+ group, we observed very low complete remission and overall response rates in patients with primary refractory disease (8% and 33%, respectively), as compared to those in patients who were in first partial remission (41% and 86%) or who had relapsed disease (50% and 75%) (p<0.01 in both cases). Overall, 60% and 65% of patients in the R+ and R- groups, respectively, underwent stem-cell transplantation after the salvage therapy. With a median follow-up of 29 months (range, 6-84), patients in the R+ group had significantly worse progression-free survival (17% vs. 57% at 3 years, p<0.0001) and overall survival (38% v 67% at 3 years, p=0.0005) than patients in the R- group. Prior exposure to rituximab was also an independent adverse prognostic factor for both progression-free survival (RR: 2.0; 95% CI: 1.2-3.3, p=0.008) and overall survival (RR: 2.2; 95% CI: 1.3-3.9, p=0.004). CONCLUSIONS R-ESHAP was associated with a high response rate in patients who were not refractory to upfront rituximab-based chemotherapy. However, the survival outcome was poor for patients previously exposed to rituximab, as compared to in those who had not previously been treated with rituximab.

Diesño de un Framework de Persistencia

Implementación y estudio de un framework de persistencia como solución a una problemática concreta.

Clinical and Virological Efficacy of Etravirine Plus Two Active Nucleos(t)ide Analogs in an Heterogeneous HIV-Infected Population.

Etravirine (ETV) is recommended in combination with a boosted protease inhibitor plus an optimized background regimen for salvage therapy, but there is limited experience with its use in combination with two nucleos(t)ide reverse-transcriptase inhibitors (NRTIs). This multicenter study aimed to assess the efficacy of this combination in two scenarios: group A) subjects without virologic failure on or no experience with non-nucleoside reverse-transcriptase inhibitors (NNRTIs) switched due to adverse events and group B) subjects switched after a virologic failure on an efavirenz- or nevirapine-based regimen. The primary endpoint was efficacy at 52 weeks analysed by intention-to-treat. Virologic failure was defined as the inability to suppress plasma HIV-RNA to <50 copies/mL after 24 weeks on treatment, or a confirmed viral load >200 copies/mL in patients who had previously achieved a viral suppression or had an undetectable viral load at inclusion. Two hundred eighty seven patients were included. Treatment efficacy rates in group A and B were 88.0% (CI95, 83.9-92.1%) and 77.4% (CI95, 65.0-89.7%), respectively; the rates reached 97.2% (CI95, 95.1-99.3%) and 90.5% (CI95, 81.7-99.3), by on-treatment analysis. The once-a-day ETV treatment was as effective as the twice daily dosing regimen. Grade 1-2 adverse events were observed motivating a treatment switch in 4.2% of the subjects. In conclusion, ETV (once- or twice daily) plus two analogs is a suitable, well-tolerated combination both as a switching strategy and after failure with first generation NNRTIs, ensuring full drug activity. TRIAL REGISTRATION ClinicalTrials.gov NCT01437241.

La consulta de terapia antitrombótica: progresando hacia la Enfermería de Práctica Avanzada.

There is currently around one million people receiving oral anticoagulants in Spain. The drug most used is acenocoumarol, which requires coagulation monitoring to ensure that the patient is within its normal therapeutic range. Patients usually start this treatment in a hospital clinic and, when they are stabilised, they are referred to primary care, where they are followed-up by their community nurses. The usual practice is that nurses are responsible for changes in the dose when the patients are outside the range. This practice is not performed by hospital nurses, despite having sufficient experience and knowledge to adequately manage these types of patients. An Advanced Nursing Practice model has been introduced into the Haematology management unit of the Hospital Universitario Virgen de la Victoria, Málaga. This involves various aspects of attention and care of patients on anticoagulant therapy, and includes adjusting the doses of their treatment following a catalogue of therapeutic and diagnostic ranges.

Auditoria energètica i proposta de millores en una fàbrica de portes hermètiques

L’objectiu d’aquest projecte, és estudiar i proposar mesures que permetin millorar l'eficiència energètica i el confort de les instal•lacions, d'una empresa dedicada a l'activitat de fabricació de portes hermètiques ubicada a la comarca de la Garrotxa. Per aconseguir aquest objectiu es realitza una auditoria energètica de l'activitat de l'empresa, la qual permet conèixer i entendre el seu comportament energètic. A partir dels resultats i de les conclusions de l’auditoria, es proposa diverses millores i s’estudia les possibilitats que ofereixen un major estalvi energètic, tant des del punt de vista de consum de matèries primeres (gas propà i electricitat), com d’estalvi d’emissions de CO2 a l’atmosfera i augmentar el confort a l’interior dels tallers. A més a més, s’estudia la viabilitat econòmica d'aquestes millores, calculant-ne l’amortització a partir de la seva inversió inicial i de l’estalvi econòmic que ofereixen. En l’auditoria s’estudia el contracte amb l’empresa distribuïdora i altres empreses d’energia, per tal d’optimitzar la facturació d’electricitat, analitzar els paràmetres i consums d’energia activa, reactiva i potència contractada. També s’estudia i s’avalua el sistema d’il•luminació per la seva optimització energètica. A més a més, s’analitza i s’estudia el consum i el cost de subministrament de gas propà. I finalment es realitza una anàlisi dels sistemes productors d’energia i distribució de calefacció, per tal d’optimitzar el consum i millorar el rendiment de les instal•lacions

Estandardització i sistematització del procés de selecció de vàlvules de bola segons condicions preestablertes

Les indústries proveïdores de vàlvules de bola han adaptat, durant els últims 25 anys, els seus productes a les necessitats de la indústria química, sobretot plantes petrolíferes, petroquímiques i indústries farmacèutiques. L’estudi de les propietats físico-químiques dels materials, sobretot elastòmers i termoplàstics, i el perfeccionament de les eines per produir boles en sèrie fan possible la fabricació de vàlvules adequades per a una àmplia gama d’aplicacions. La gran majoria de les indústries proveïdores de vàlvules treballen a partir de dissenys i materials estandarditzats. El procés de producció segons necessitats especials definides és llarg i costós. L’enginyer és el responsable d’escollir el disseny i materials òptims per a cadascuna de les peces del producte, tant de metall, elastòmer o termoplàstic. En molts casos es requereix un producte absolutament òptim, amb l’assegurança de la reduïda provabilitat de fallida i de l’adequació total d’acord amb una necessitat concreta. Aquesta demanda de requisits comporta l’estudi exhaustiu del fluid, de la futura localització del producte i de l’ambient al qual estarà sotmès. Per tant, el fet d’estandarditzar i sistematitzar el procés de selecció de vàlvules de bola segons condicions preestablertes és una tasca important i útil per a la indústria del disseny i fabricació vàlvules de bola. L’objectiu d’aquest projecte és la creació d’una eina que sistematitzi i estandarditzi el procés de selecció d’una vàlvula de bola segons condicions preestablertes

Mean intrinsic tensile properties of stone groundwood fibers from softwood

Stone groundwood (SGW) is a fibrous matter commonly prepared in a high yield process, and mainly used for papermaking applications. In this work, the use of SGW fibers is explored as reinforcing element of polypropylene (PP) composites. Due to its chemical and superficial features, the use of coupling agents is needed for a good adhesion and stress transfer across the fiber-matrix interface. The intrinsic strength of the reinforcement is a key parameter to predict the mechanical properties of the composite and to perform an interface analysis. The main objective of the present work was the determination of the intrinsic tensile strength of stone groundwood fibers. Coupled and non-coupled PP composites from stone groundwood fibers were prepared. The influence of the surface morphology and the quality at interface on the final properties of the composite was analyzed and compared to that of fiberglass PP composites. The intrinsic tensile properties of stone groundwood fibers, as well as the fiber orientation factor and the interfacial shear strength of the current composites were determined

Anàlisi d'accessibilitat en entorns cms

El treball consisteix en l'avaluació d'accessibilitat de dos cms i la configuració dels mateixos perquè arribin a una versió el més accessible possible.

Stone-ground wood pulp-reinforced polypropylene composites: water uptake and thermal properties

Two of the drawbacks of using natural-based composites in industrial applications are thermal instability and water uptake capacity. In this work, mechanical wood pulp was used to reinforce polypropylene at a level of 20 to 50 wt. %. Composites were mixed by means of a Brabender internal mixer for both non-coupled and coupled formulations. Differential scanning calorimetry (DSC) and thermogravimetric analysis (TGA) were used to determine the thermal properties of the composites. The water uptake behavior was evaluated by immersion of the composites in water until an equilibrium state was reached. Results of water absorption tests revealed that the amount of water absorption was clearly dependent upon the fiber content. The coupled composites showed lower water absorption compared to the uncoupled composites. The incorporation of mechanical wood pulp into the polypropylene matrix produced a clear nucleating effect by increasing the crystallinity degree of the polymer and also increasing the temperature of polymer degradation. The maximum degradation temperature for stone ground wood pulp–reinforced composites was in the range of 330 to 345 ºC

Tensile strength characteristics of polypropylene composites reinforced with stone groundwood fibers from softwood

The behavior of stone groundwood / polypropylene injection-molded composites was evaluated with and without coupling agent. Stone groundwood (SGW) is a fibrous material commonly prepared in a high yield process and mainly used for papermaking applications. In this work, the use of SGW fibers was explored as a reinforcing element of polypropylene (PP) composites. The surface charge density of the composite components was evaluated, as well as the fiber’s length and diameter inside the composite material. Two mixing extrusion processes were evaluated, and the use of a kinetic mixer, instead of an internal mixer, resulted in longer mean fiber lengths of the reinforcing fibers. On the other hand, the accessibility of surface hydroxyl groups of stone groundwood fibers was improved by treating the fibers with 5% of sodium hydroxide, resulting in a noticeable increase of the tensile strength of the composites, for a similar percentage of coupling agent. A new parameter called Fiber Tensile Strength Factor is defined and used as a baseline for the comparison of the properties of the different composite materials. Finally the competitiveness of stone groundwood / polypropylene / polypropylene-co-maleic anhydride system, which compared favorably to sized glass-fiber / polypropylene GF/PP and glass-fiber / polypropylene / polypropylene-co-maleic anhydride composite formulations, was quantified by means of the fiber tensile strength factor

Historia cultural de los cuidados paliativos en las sociedades primitivas: revisión integrativa

Este estudio tiene el objetivo de describir la evolución de los cuidados paliativos, reflexionando sobre la posibilidad de su origen en las culturas primitivas y su relación con el inicio del culto a los muertos. Se describe el cambio producido en las estructuras, las interacciones simbólicas y sociales implicadas en el desempeño de cuidados paliativos durante la prehistoria: unidad funcional, marco funcional y elemento funcional. El marco teórico se fundamenta en la historia cultural, el modelo estructural dialéctico y el interaccionismo simbólico. Se aplicaron técnicas de categorización y análisis de la historia cultural y el estructuralismo dialéctico. Los cuidados paliativos ya existían en las sociedades primitivas vinculados, en gran medida, a los ritos de transición con un alto contenido simbólico. Las estructuras sociales: unidad funcional, marco funcional y elemento funcional; constituyen los pilares sobre los que se sustentaron los cuidados paliativos en las sociedades prehistóricas.

Propuesta para un Proyecto de Evaluación de Stocks de Camarón de Profundidad en aguas de Cabo Verde (2010-2013)

A bibliographic revision on the fisheries research in the Canary, Madeira, and the Azores Islands related to stock assessment of the striped soldier shrimp (Plesionika edwardsii) (Crustacea, Decapoda, Pandalidae) was made. Biological information –reproduction, growth, mortality, recruitment– of the target species, selective technological developments –multiple semi-floating shrimp traps–, and know-how gained by the ICCM can give support to elaborate and execute an ICCM-INDP joint project, in order to explore and assess its insular stocks in the Capeverdian deepwaters (150-300 m). In the frame of the UE Trans-national Cooperation Programme MAC (2007- 2013), the next coming call for proposals seems to be an adequate source to fund it. This project should include some activities for the valorisation and promotion of this new shellfish product, as well as for scientific-technical and social divulgation, and for giving advice to the decision-makers. Lastly, with the aim of developing a new fishing activity in the Cape Verdes on a responsible and sustainable basis, authors have scheduled a second study phase. This should consist of a process of technology transfer, followed by an experimental fishing pilot project including a study on biological and commercial viability with the participation of the Capeverdian fishing sector.

Thermoplastic Starch-based Composites Reinforced with Rape Fibers: Water Uptake and Thermomechanical Properties

Fully biodegradable composite materials were obtained through reinforcement of a commercially available thermoplastic starch (TPS) matrix with rapeseed fibers (RSF). The influence of reinforcement content on the water sorption capacity, as well as thermal and thermo-mechanical properties of composites were evaluated. Even though the hydrophilic character of natural fibers tends to favor the absorption of water, results demonstrated that the incorporation of RSF did not have a significant effect on the water uptake of the composites. DSC experiments showed that fibers restricted the mobility of the starch macromolecules from the TPS matrix, hence reducing their capacity to crystallize. The viscoelastic behaviour of TPS was also affected, and reinforced materials presented lower viscous deformation and recovery capacity. In addition, the elasticity of materials was considerably diminished when increasing fiber content, as evidenced in the TMA and DMTA measurements