Task force IV: Clinical use of ambulatory blood pressure monitoring. Participants of the 1999 Consensus Conference on Ambulatory Blood Pressure Monitoring

OBJECTIVE: To reach a consensus on the clinical use of ambulatory blood pressure monitoring (ABPM). METHODS: A task force on the clinical use of ABPM wrote this overview in preparation for the Seventh International Consensus Conference (23-25 September 1999, Leuven, Belgium). This article was amended to account for opinions aired at the conference and to reflect the common ground reached in the discussions. POINTS OF CONSENSUS: The Riva Rocci/Korotkoff technique, although it is prone to error, is easy and cheap to perform and remains worldwide the standard procedure for measuring blood pressure. ABPM should be performed only with properly validated devices as an accessory to conventional measurement of blood pressure. Ambulatory recording of blood pressure requires considerable investment in equipment and training and its use for screening purposes cannot be recommended. ABPM is most useful for identifying patients with white-coat hypertension (WCH), also known as isolated clinic hypertension, which is arbitrarily defined as a clinic blood pressure of more than 140 mmHg systolic or 90 mmHg diastolic in a patient with daytime ambulatory blood pressure below 135 mmHg systolic and 85 mmHg diastolic. Some experts consider a daytime blood pressure below 130 mmHg systolic and 80 mmHg diastolic optimal. Whether WCH predisposes subjects to sustained hypertension remains debated. However, outcome is better correlated to the ambulatory blood pressure than it is to the conventional blood pressure. Antihypertensive drugs lower the clinic blood pressure in patients with WCH but not the ambulatory blood pressure, and also do not improve prognosis. Nevertheless, WCH should not be left unattended. If no previous cardiovascular complications are present, treatment could be limited to follow-up and hygienic measures, which should also account for risk factors other than hypertension. ABPM is superior to conventional measurement of blood pressure not only for selecting patients for antihypertensive drug treatment but also for assessing the effects both of non-pharmacological and of pharmacological therapy. The ambulatory blood pressure should be reduced by treatment to below the thresholds applied for diagnosing sustained hypertension. ABPM makes the diagnosis and treatment of nocturnal hypertension possible and is especially indicated for patients with borderline hypertension, the elderly, pregnant women, patients with treatment-resistant hypertension and patients with symptoms suggestive of hypotension. In centres with sufficient financial resources, ABPM could become part of the routine assessment of patients with clinic hypertension. For patients with WCH, it should be repeated at annual or 6-monthly intervals. Variation of blood pressure throughout the day can be monitored only by ABPM, but several advantages of the latter technique can also be obtained by self-measurement of blood pressure, a less expensive method that is probably better suited to primary practice and use in developing countries. CONCLUSIONS: ABPM or equivalent methods for tracing the white-coat effect should become part of the routine diagnostic and therapeutic procedures applied to treated and untreated patients with elevated clinic blood pressures. Results of long-term outcome trials should better establish the advantage of further integrating ABPM as an accessory to conventional sphygmomanometry into the routine care of hypertensive patients and should provide more definite information on the long-term cost-effectiveness. Because such trials are not likely to be funded by the pharmaceutical industry, governments and health insurance companies should take responsibility in this regard.

EUROMODUL Gestión

Aplicación que proporciona herramientas de control de las operaciones diarias a una empresa concreta. Las funciones más destacables son: Gestión de proveedores y facturas. Gestión de presupuestos y estado de las obras. Control de clientes. Control de tareas de los operarios autónomos. Se ha diseñado una arquitectura en la que conviven varias tecnologías y varios lenguajes de codificación y programación: HTML, PHP, MySQL, JavaScript, AJAX, JQUERY y CSS.

Hypertension: which aspects of hypertension should we impact on and how?

Cardiovascular complications may, to a large extent, be prevented by lowering blood pressure in hypertensive patients. International recommendations currently stress the importance of reaching values of below 140/90 mmHg in each patient or even lower in the case of concomitant diabetes or renal impairment. It is currently considered crucial to control the systolic pressure as well as the diastolic pressure, in particular because the relationship between cardiovascular risk and blood pressure is closer for the systolic than the diastolic value. An increase in systolic pressure is in itself a sign of the stiffening of the arterial tree. In most patients, the target pressure may only be reached by combining several different antihypertensive agents. In the STRATHE Study, a greater antihypertensive efficacy, in particular on systolic pressure, was obtained by instituting treatment with a fixed low-dose combination of an angiotensin-converting enzyme inhibitor (perindopril) and a diuretic (indapamide), in comparison with other therapeutic strategies based on single-agent therapy. Fixed-dose antihypertensive combinations have now become a validated option for initiating antihypertensive treatment.

Projecte d'energia solar tèrmica

El proyecto consiste en el diseño de una instalación solar térmica para producción de agua caliente sanitaria (ACS) en un edificio de nueva construcción en la localidad de Mollerussa (Lleida). Se han estudiado las necesidades térmicas de ACS en atención a las características constructivas y funcionales del edificio, dando cumplimiento a la normativa vigente. Conocida la demanda energética esperada, se han analizado los datos climatológicos y de temperatura de red de agua fría propios del emplazamiento, y se ha propuesto un campo de captación compuesto por captadores planos y los distintos subconjuntos que componen la instalación: acumulación, transferencia térmica, trazado hidráulico, regulación y control, y energía auxiliar. Con ello se ha llevado a cabo una simulación energética mediante la herramienta TSOL, software de simulación solar recomendado por entidades de reconocido prestigio, para comprobar que se han alcanzado los objetivos del sistema propuesto. Por último, se ha realizado un estudio del beneficio medioambiental que supone la instalación proyectada, indicando el ahorro energético para el usuario y las toneladas equivalentes de dióxido de carbono evitadas.

Sudden cardiac death in the young (5-39 years) in the canton of Vaud, Switzerland.

BACKGROUND: Sudden cardiac death (SCD) among the young is a rare and devastating event, but its exact incidence in many countries remains unknown. An autopsy is recommended in every case because some of the cardiac pathologies may have a genetic origin, which can have an impact on the living family members. The aims of this retrospective study completed in the canton of Vaud, Switzerland were to determine both the incidence of SCD and the autopsy rate for individuals from 5 to 39 years of age. METHODS: The study was conducted from 2000 to 2007 on the basis of official statistics and analysis of the International Classification of Diseases codes for potential SCDs and other deaths that might have been due to cardiac disease. RESULTS: During the 8 year study period there was an average of 292'546 persons aged 5-39 and there were a total of 1122 deaths, certified as potential SCDs in 3.6% of cases. The calculated incidence is 1.71/100'000 person-years (2.73 for men and 0.69 for women). If all possible cases of SCD (unexplained deaths, drowning, traffic accidents, etc.) are included, the incidence increases to 13.67/100'000 person-years. However, the quality of the officially available data was insufficient to provide an accurate incidence of SCD as well as autopsy rates. The presumed autopsy rate of sudden deaths classified as diseases of the circulatory system is 47.5%. For deaths of unknown cause (11.1% of the deaths), the autopsy was conducted in 13.7% of the cases according to codified data. CONCLUSIONS: The incidence of presumed SCD in the canton of Vaud, Switzerland, is comparable to the data published in the literature for other geographic regions but may be underestimated as it does not take into account other potential SCDs, as unexplained deaths. Increasing the autopsy rate of SCD in the young, better management of information obtained from autopsies as well developing of structured registry could improve the reliability of the statistical data, optimize the diagnostic procedures, and the preventive measures for the family members.

Predicting community and ecosystem outcomes of mycorrhizal responses to global change.

Mycorrhizal symbioses link the biosphere with the lithosphere by mediating nutrient cycles and energy flow though terrestrial ecosystems. A more mechanistic understanding of these plant-fungal associations may help ameliorate anthropogenic changes to C and N cycles and biotic communities. We explore three interacting principles: (1) optimal allocation, (2) biotic context and (3) fungal adaptability that may help predict mycorrhizal responses to carbon dioxide enrichment, nitrogen eutrophication, invasive species and land-use changes. Plant-microbial feedbacks and thresholds are discussed in light of these principles with the goal of generating testable hypotheses. Ideas to develop large-scale collaborative research efforts are presented. It is our hope that mycorrhizal symbioses can be effectively integrated into global change models and eventually their ecology will be understood well enough so that they can be managed to help offset some of the detrimental effects of anthropogenic environmental change.

Characterization and biological activity of a brazilian isolate of Bacillus sphaericus (Neide) highly toxic to mosquito larvae

Primary powders of Bacillus sphaericus strain S2 isolated from soil samples in Brazil, and strain 2362 were produced in a 14 liter fermentor. Growth patterns and sporulation observed in three trials with strains S2 and 2362 in the fermentor were similar. Second-instar larvae of Culex quinquefasciatus, Anopheles albimanus, Anopheles quadrimaculatus, and Aedes aegypti exposed for 48 hr to strain S2 responded with LC50 values of 0.25, 5.95, 12.28 and 140.0 ppb of lyophilized primary powder, respectively. Under the same conditions, strain 2362 resulted in LC50 values of 0.39, 7.16, 16.93 and 307.0 ppb of lyophilized primary powder, respectively, in those mosquito larvae. Statistical analysis of the bioassay data did not show significant differences among LC50 values observed in B. sphaericus strains S2 and 2362, at the 0.05 level. Toxins of strains S2 and 2362 were extracted at pH 12 with NaOH. Electrophoresis of the extracts in polyacrylamide gel under denaturing conditions revealed the 51 and 42 kDa toxins in both S2 and 2362 B. sphaericus strains. The presence of the 42 kDa peptide in the extracts was confirmed by Western blot and Elisa, with anti-42 kDa IgG previously prepared from strain 2362.

Caracterització i conservació d’una població de tortuga de rierol (Mauremys Leprosa) a l’ein del riu Llobregat al terme d’Abrera

S'ha estudiat una població de tortuga de rierol (Mauremys leprosa) present al curs principal del riu Llobregat, al seu pas pel municipi d'Abrera (Baix Llobregat). El tram té una longitud de 4.140 metres de recorregut sinuós, inclòs a l'EIN Riu Llobregat, amb predomini d'albaredes i pollancredes. S'ha caracteritzat el tram de riu segons el tipus de secció que presenta al llarg de l'àrea d'estudi. L'activitat de les tortugues comprèn de mitjans de febrer a mitjans de novembre, sense que s'hagi detectat una disminució a l'estiu. L'ús de l'espai no és uniforme amb una marcada preferència per trams del riu amb una certa fondària i velocitat de l'aigua alentida. S’han capturat 68 tortugues de rierol mitjançant nanses de pesca adaptades i, un cop marcades, s'han alliberat al mateix lloc. Per a cada animal es van obtenir les dades biomètriques i es va determinar el sexe. Mitjançant el mètode de captura-recaptura s'ha estimat la mida de la població en 100 ± 11 individus. La ràtio de sexes de la població és de 2:1 a favor dels mascles. La distribució de classes d'edats permet comprovar que la població està ben estructurada. No s'ha comprovat la reproducció, tot i que el nombre de femelles reproductores és elevat. La falta de captures de nounats i d’individus d'un hivern d’edat, i el baix nombre de juvenils capturats fa pensar que la taxa de reclutament és baixa. La mobilitat dels animals aigües amunt està limitada per la presència de dos assuts a l'àrea d'estudi, la qual cosa compromet la connectivitat de la població dins i fora de l'àrea d'estudi. També s'ha detectat la presència de tortuga de Florida (Trachemys scripta spp.) sense que s'hagi observat cap interacció entre ambdues espècies. Es proposen un seguit de mesures per afavorir la conservació de la tortuga de rierol.

Pharmacovigilance [Pharmacovigilance update]

The observations of pharmacovigilance reported during 2007 reflect an increasing attention towards drug-induced augmentation of the incidence of common disorders. New substances are thus to be added to the list of risk factors susceptible to favour cardiovascular events (tegaserod, rosiglitazone, erythropoïetin, aprotinine) or psychiatric disorders (dopaminergic agonists, rimonabant). The evaluation of the security profile of new medicines remains challenging. Besides biological investigations of questionable relevance and clinical trial of inconstant efficiency towards safety outcomes, the role of pharmacovigilance notifications by practitioners remains of paramount importance.

Induction of Glutathione S-transferase Activity in Triatoma infestans

Several synthetic pesticides and allelochemicals used to treat Triatoma infestans adults by topic application showed some degree of cytosolic glutathione S-transferase (GST) induction. General inducers of detoxication systems such as phenobarbital and 3-methylcholantrene topically applied on T. infestans resulted in no GST induction. Meanwhile, general insecticide synergist such as piperonyl butoxide (160 mg/insect) increased the GST-activity in the range of 120-140%. Insects injected with reduced glutathione (300 mg/insect) presented at the forth day elevated GST activity

Urologie [Trends in urology]

The systemic treatment of kidney cancers is promising regarding the first results of the inhibiting molecules of the angiogenesis. Projections in research are encouraging for more specific and sensitive markers of the prostate cancer. For this last the intermittent hormonotherapy improves the quality of life of the patients. The overweight control in infertility allows greater chances of giving birth. The morbidity of the kidney percutaneous surgery is decreased by the use of smaller tools. Reduction rate of reobstruction thanks to new manufactoring stents. The botulinic toxin for the hyperactive bladder refunded by the health insurances.

Estudi per la implantació d'un ERP de codi obert en una empresa de fabricació de mobles

Un sistema ERP és una aplicació informàtica que permet gestionar tots els processos de negoci d’una empresa de forma integrada. Aquest projecte tracta sobre l’estudi previ que s’ha de realitzar en una empresa abans de la implantació d’un sistema ERP. L’empresa escollida per l’estudi és una pyme de fabricació de mobles. En primer lloc, s’inclou una base teòrica sobre els sistemes ERP. Després, s’analitza el funcionament i requeriments de l’empresa escollida. Finalment, s’estudien tres sistemes ERP de codi obert, es selecciona el que millor s’adapta i es fa una proposta de la seva futura implantació.

Teaching foreign languages through translation: considering multiple intelligences

Aquest treball de recerca tracta de la relació existent entre pedagogia, traducció, llengües estrangeres i intel•ligències múltiples. El debat sobre si la traducció és una eina útil a la classe de llengües estrangeres és un tema actual sobre el qual molts investigadors encara indaguen. Estudis recents, però, han demostrat que qualsevol tasca de traducció -en la qual s’hi poden incloure treballs amb les diferents habilitats- és profitosa si la considerem un mitjà, no una finalitat en ella mateixa. Evidentment, l’ús de la traducció dins l’aula és avantatjosa, però també hem de tenir presents certs desavantatges d’aquesta aplicació. Un possible desavantatge podria ser la creença que, al principi, molta gent té referent a l’equivalència, paraula per paraula, d’una llengua vers una altra. Però després de presentar vàries tasques de traducció als estudiants, aquests poden arribar a controlar, fins i tot, les traduccions inconscients i poden assolir un cert nivell de precisió i flexibilitat que val la pena mencionar. Però l’avantatge principal és que s’enfronten a una activitat molt estesa dins la societat actual que combina dues llengües, la llengua materna i la llengua objecte d’estudi, per exemple. De tot això en podem deduir que utilitzar la llengua materna a la classe no s’ha de considerar un crim, com fins ara, sinó una virtut, evidentment si és emprada correctament. En aquest treball de recerca s’hi pot trobar una síntesi tant de les principals teories d’adquisició i aprenentatge de llengües com de les teories de traducció. A la pregunta de si les teories, tant de traducció com de llengües estrangeres, s’haurien d’ensenyar implícita o explícitament, es pot inferir que segons el nivell d’estudis on estiguin els aprenents els convindrà aprendre les teories explícitament o les aprendran, de totes maneres, implícitament. Com que qualsevol grup d’estudiants és heterogeni -és a dir que cada individu té un ritme i un nivell d’aprenentatge concret i sobretot cadascú té diferents estils de percepció (visual, auditiu, gustatiu, olfactiu, de moviment) i per tant diferents intel•ligències-, els professors ho han de tenir en compte a l’hora de planificar qualsevol programa d’actuació vers els alumnes. Per tant, podem concloure que les tasques o projectes de traducció poden ajudar als alumnes a aprendre millor, més eficaçment i a aconseguir un aprenentatge més significatiu.

Als Marie Bonaparte sich taub stellte ...

Between 1927 and 1931 Marie Bonaparte had herself operated upon her clitoris three times. She did so against Freud's advice with whom she was in analysis. Among psychoanalysts these operations are still often regarded as "errors" or aberrations. But for Marie Bonaparte, who was in various ways familiar with physics and a somatic approach, surgery was the first choice, psychoanalysis only a possible alternative. She was not impressed by the skepticism of her colleagues, and adhered even more emphatically to her own strategy