Docteur, j'ai un ganglion [Doctor, I have a lymph node]

To investigate a recently developed lymphadenopathy can be simple or complex. The medical history, presence or not of symptoms, the general physical examination, and the localization and characteristics of the adenopathy, most often lead to a diagnosis and therapy when indicated. Among young adults, the etiology is either infectious or reactive, rarely tumoral, as opposed to elderly persons. The most important step is to look at signs of severity (or non banality) such as an increased size, hard consistency, supra-clavicular location, an immunocompromised host, a history of Tb exposition. If present, these signs will trigger a biopsy with cyto- or histopathological examination mostly to rule out a malignant tumor. This article reviews the practical steps of an investigation of an isolated adenopathy in an adult patient.

Les Estratègies d'accés a la universitat via cicle formatiu de grau superior

Les inèrcies de la institució educativa avancen a un ritme més pausat que els reptes socials que es plantegen, donant com a una de les conseqüències el fet que l'origen social continua sent un factor explicatiu de l'èxit educatiu.Són moltes les teories que apunten que l'economia global en la qual estem immersos requereix d'un augment dels requeriments educatius col•lectius. És en aquest context en el qual analitzarem l'accés a la Universitat des dels Cicles Formatius de Grau Superior partint de la hipòtesi que aquesta és una via que afavoreix la consecució del'objectiu d'augmentar els titulats superiors, sota un prisma d'equitat d'oportunitats.

La competència emocional i autoestima al cicle superior d'educació primària

Podeu consultar les jornades completes a: http://hdl.handle.net/2445/46286

La competència emocional i autoestima al cicle superior d'educació primària

Podeu consultar les jornades completes a: http://hdl.handle.net/2445/46286

Bortezomib(Velcade®)-Thalidomide-Dexamethasone (VTD) Is Superior to Thalidomide-Dexamethasone (TD) In Patients with Multiple Myeloma (MM) Progressing or Relapsing After Autologous Transplantation

Introduction: The Thalidomide-Dexamethasone (TD) regimen has provided encouraging results in relapsed MM. To improve results, bortezomib (Velcade) has been added to the combination in previous phase II studies, the so called VTD regimen. In January 2006, the European Group for Blood and Marrow Transplantation (EBMT) and the Intergroupe Francophone du Myélome (IFM) initiated a prospective, randomized, parallel-group, open-label phase III, multicenter study, comparing VTD (arm A) with TD (arm B) for MM patients progressing or relapsing after autologous transplantation. Patients and Methods: Inclusion criteria: patients in first progression or relapse after at least one autologous transplantation, including those who had received bortezomib or thalidomide before transplant. Exclusion criteria: subjects with neuropathy above grade 1 or non secretory MM. Primary study end point was time to progression (TTP). Secondary end points included safety, response rate, progression-free survival (PFS) and overall survival (OS). Treatment was scheduled as follows: bortezomib 1.3 mg/m2 was given as an i.v bolus on Days 1, 4, 8 and 11 followed by a 10-Day rest period (days 12 to 21) for 8 cycles (6 months) and then on Days 1, 8, 15, 22 followed by a 20-Day rest period (days 23 to 42) for 4 cycles (6 months). In both arms, thalidomide was scheduled at 200 mg/Day orally for one year and dexamethasone 40 mg/Day orally four days every three weeks for one year. Patients reaching remission could proceed to a new stem cell harvest. However, transplantation, either autologous or allogeneic, could only be performed in patients who completed the planned one year treatment period. Response was assessed by EBMT criteria, with additional category of near complete remission (nCR). Adverse events were graded by the NCI-CTCAE, Version 3.0.The trial was based on a group sequential design, with 4 planned interim analyses and one final analysis that allowed stopping for efficacy as well as futility. The overall alpha and power were set equal to 0.025 and 0.90 respectively. The test for decision making was based on the comparison in terms of the ratio of the cause-specific hazards of relapse/progression, estimated in a Cox model stratified on the number of previous autologous transplantations. Relapse/progression cumulative incidence was estimated using the proper nonparametric estimator, the comparison was done by the Gray test. PFS and OS probabilities were estimated by the Kaplan-Meier curves, the comparison was performed by the Log-Rank test. An interim safety analysis was performed when the first hundred patients had been included. The safety committee recommended to continue the trial. Results: As of 1st July 2010, 269 patients had been enrolled in the study, 139 in France (IFM 2005-04 study), 21 in Italy, 38 in Germany, 19 in Switzerland (a SAKK study), 23 in Belgium, 8 in Austria, 8 in the Czech republic, 11 in Hungary, 1 in the UK and 1 in Israel. One hundred and sixty nine patients were males and 100 females; the median age was 61 yrs (range 29-76). One hundred and thirty six patients were randomized to receive VTD and 133 to receive TD. The current analysis is based on 246 patients (124 in arm A, 122 in arm B) included in the second interim analysis, carried out when 134 events were observed. Following this analysis, the trial was stopped because of significant superiority of VTD over TD. The remaining patients were too premature to contribute to the analysis. The number of previous autologous transplants was one in 63 vs 60 and two or more in 61 vs 62 patients in arm A vs B respectively. The median follow-up was 25 months. The median TTP was 20 months vs 15 months respectively in arm A and B, with cumulative incidence of relapse/progression at 2 years equal to 52% (95% CI: 42%-64%) vs 70% (95% CI: 61%-81%) (p=0.0004, Gray test). The same superiority of arm A was also observed when stratifying on the number of previous autologous transplantations. At 2 years, PFS was 39% (95% CI: 30%-51%) vs 23% (95% CI: 16%-34%) (A vs B, p=0.0006, Log-Rank test). OS in the first two years was comparable in the two groups. Conclusion: VTD resulted in significantly longer TTP and PFS in patients relapsing after ASCT. Analysis of response and safety data are on going and results will be presented at the meeting.

Roux-en-y Gastric Bypass is Superior to Gastric Banding in Non-superobese Patients. a Matched-case Study with Five-year Follow-up

Background: Roux-en-Y gastric bypass (RYGBP) and gastric banding (GB) are the two most popular bariatric procedures. Only few studies have compared their results and follow-up duration is usually limited to <3 years. Patients and Methods: Using our prospective bariatric database, we matched non-superobese GB to RYGBP patients for sex, age and BMI to RYGBP. Follow-up considered up to five years. Results: 442 patients were matched in 221 pairs. Mean age (38,6) and mean BMI (43) were identical. Overall operative morbidity was higher after RYGBP (17,2 versus 5,4 %, p<0,001), but major morbidity was similar (3,6 versus 2,2 %, p=0,57). More patients developed long-term complications after GB (43,9 % versus 19 %, p<0,001), and more required reoperations (24,4 % versus 12 %, p=0,001). After RYGBP, reoperations were mainly due to internal hernias (87 %), with no reversal, whereas 18,5 % of the GB patients required band removal. Even including only patients who retained their band, weight loss after RYGBP was better throughout the study period, with 5-year EBMIL of 77,6 % and 61,7 % (p<0,001) after RYGBP and GB respectively. RYGBP was associated with better food tolerance and greater improvement of the lipid profile. Conclusions: GB is associated with a smaller overall operative morbidity and similar major morbidity, but with more long-term complications, more reoperations, a significant number of reversal or conversion procedures, and reduced weight loss when compared with RYGBP. Five-year results of RYGBP are superior to GB and patients should be informed accordingly.

The value of intraoperative ultrasound in oblique corpectomy for cervical spondylotic myelopathy and ossified posterior longitudinal ligament.

Intraoperative ultrasound (IOUS) has been described to be useful during central corpectomy for compressive cervical myelopathy. This study aimed at documenting the utility of IOUS in oblique cervical corpectomy (OCC). Prospective data from 24 patients undergoing OCC for cervical spondylotic myelopathy and ossified posterior longitudinal ligament (OPLL) were collected. Patients had a preoperative cervical spine magnetic resonance (MR) image, IOUS and a postoperative cervical CT scan. Retrospective data from 16 historical controls that underwent OCC without IOUS were analysed to compare the incidence of residual compression between the two groups. IOUS identified the vertebral artery in all cases, detected residual cord compression in six (27%) and missed compression in two cases (9%). In another two cases with OPLL, IOUS was sub-optimal due to shadowing. IOUS measurement of the corpectomy width correlated well with these measurements on the postoperative CT. The extent of cord expansion noted on IOUS after decompression showed no correlation with immediate or 6-month postoperative neurological recovery. No significant difference in residual compression was noted in the retrospective and prospective groups of the study. Craniocaudal spinal cord motion was noted after the completion of the corpectomy. IOUS is an inexpensive and simple real-time imaging modality that may be used during OCC for cervical spondylotic myelopathy. It is helpful in identifying the vertebral artery and determining the trajectory of approach, however, it has limited utility in patients with OPLL due to artifacts from residual ossification.

Els jocs cooperatius desenvolupats a l'àrea d'educació física milloren les relaciones que s'estableixen entre alumnes de cicle superior de primària

Introducció: Teodorico (2004) ens diu que amb el joc cooperatiu els alumnes poden valorar, compartir i reflexionar sobre la relació que estableixen amb els altres companys. Per això, l’objectiu de la meva investigació és avaluar l’efecte que pot tenir l’aplicació d’una unitat de programació, centrada en el joc cooperatiu, en la relació que s’estableix entre els alumnes de 5è de primària, focalitzant l’atenció amb el líder i el menys acceptat del grup-classe. Mètodes: La intervenció s’avalua amb un disseny quasi-experimental pre-post amb grup control. I des del punt de vista dels dissenys observacionals podem parlar d’un disseny de seguiment, idiogràfic i multidimensional. El total de la mostra d’aquesta investigació era de 48 alumnes, dividit en el grup experimental (25) i en el grup control (23). La durada de la intervenció va ser de 8 setmanes i es va utilitzar un qüestionari ad hoc per la confecció dels sociograma i un instrument observacional ad hoc de les relacions de grup-classe. Resultats: El grup experimental estava format per 4 grups d’alumnes, al final de la unitat només se’n formaven 2, en canvi, el grup control, tan abans com després, estava format pels mateixos grups d’alumnes. Un dels menys acceptats del grup experimental ha millorat la relació amb alguns dels companys, en canvi els menys acceptat del grup control no ha millorat cap tipus de relació. Conclusions: Crec que els jocs cooperatius són una bona eina educativa per intentar millorar les relacions, ja que amb més temps crec que els resultats d’aquesta investigació haguessin sigut més positius.

El principio del Universal Design. Concepto y desarrollos en la enseñanza superior

Los principios, las prácticas y la investigación sobre diseño universal han sidoimplantados progresivamente en diferentes ámbitos, respecto al diseño y la preparación de entornos para la atención a las necesidades de las personas con discapacidad. En el contexto internacional, este desarrollo ha estado vinculado al avance en derechos sobre igualdad de oportunidades. En el contexto legislativo español, en la Ley 51/2003 se introducen definiciones sobre «accesibilidad universal» y «diseño para todos», con lo que se genera un marco que posibilita el análisis de fuentes conceptuales y de aplicación en nuestro contexto, de las aportaciones del diseño universal, así como su consideración para la fundamentación de prácticas de innovación e investigación en nuestros ámbitos universitarios. En este trabajo, a partir de una amplia revisión de fuentes y aportaciones de gran trayectoria en este campo, se presentan y analizan distintos enfoques, a través de los cuales se están desarrollando y aplicando prácticas de diseño universal en el ámbito de la enseñanza universitaria, y se plantean sus implicaciones educativas. Este análisis permite concluir que las aplicaciones del diseño universal parecen más prometedoras para el progreso hacia metas de inclusión en el entorno universitario que una perspectiva de «adaptación curricular»; aunque se pone de manifiesto la necesidad de que la investigación que se desarrolle en nuestros contextos aporte pruebas y elementos que favorezcan su implementa- ción. Aplicar prácticas docentes y de planificación en la enseñanza universitaria con bases en el diseño universal podría contribuir a superar, eliminar o evitar en un futuro barreras en el aprendizaje, no solo limitadoras del progreso de las personas con discapacidad, sino también del conjunto del alumnado. Asimismo, las conclusiones de este trabajo plantean aplicaciones y estimaciones de nuevas muestras empíricas como puntos de partida para futuras y posibles determinaciones de enfoques conceptuales.

Triiodothyronine and nerve growth factor are required to induce cytoplasmic dynein expression in rat dorsal root ganglion cultures.

Beside the several growth factors which play a crucial role in the development and regeneration of the nervous system, thyroid hormones also contribute to the normal development of the central and peripheral nervous system. In our previous work, we demonstrated that triiodothyronine (T3) in physiological concentration enhances neurite outgrowth of primary sensory neurons in cultures. Neurite outgrowth requires microtubules and microtubule associated proteins (MAPs). Therefore the effects of exogenous T3 or/and nerve growth factors (NGF) were tested on the expression of cytoskeletal proteins in primary sensory neurons. Dorsal root ganglia (DRG) from 19 day old rat embryos were cultured under four conditions: (1) control cultures in which explants were grown in the absence of T3 and NGF, (2) cultures grown in the presence of NGF alone, (3) in the presence of T3 alone or (4) in the presence of NGF and T3 together. Analysis of proteins by SDS-polyacrylamide gel electrophoresis revealed the presence of several proteins in the molecular weight region around 240 kDa. NGF and T3 together induced the expression of one protein, in particular, with a molecular weight above 240 kDa, which was identified by an antibody against MAP1c, a protein also known as cytoplasmic dynein. The immunocytochemical detection confirmed that this protein was expressed only in DRG explants grown in the presence of NGF and T3 together. Neither control explants nor explants treated with either NGF or T3 alone expressed dynein. In conclusion, a combination of nerve growth factor and thyroid hormone is necessary to regulate the expression of cytoplasmic dynein, a protein that is involved in retrograde axonal transport.

Fonts d'informació sobre l'Ensenyament Superior

Este artículo da a conocer algunas fuentes de información sobre estudios y otros trabajos referentes al ámbito universitario. Se pretende con ello contribuir a una mejor formación del profesorado universitario, ayudando a localizar aquellos estudios ya realizados que pueden ofrecer ideas y conocimientos sobre el mundo universitario. Se mencionan bibliografías (libros y revistas), boletines, sumarios, bases de datos y otros servicios.

L'alimentació humana del Paleolític Superior al Neolític. Canvis i efectes de la Revolució Neolítica en la salut

Dieta Flash, Dieta Dukan, Dieta Mediterrània, Dieta Vegetariana o Dieta Paleolítica són només alguns exemples de les setanta-dos diferents dietes que es practiquen en l’actualitat (Dukan, 2011). Tanmateix, tot i convergir a l’hora d’autoproclamer-se com a baluard d’una “forma de vida sana” que portarà als seus seguidors a la “felicitat” i a evitar les anomenades “malalties de la civilització”1 (Milton, 2000; Cordain, 2011; Pérez, 2012; Campos, 2012), alhora, el tret comú de totes aquestes dietes és la manca de quòrum –àdhuc posicions antagòniques− en llur concepció del que hauria de ser una “dieta sana”.

Desempenho agronômico das videiras 'Crimson Seedless' e 'Superior Seedless' no norte de Minas Gerais

O objetivo deste trabalho foi avaliar a influência do vigor dos porta-enxertos '1103 Paulsen' e 'IAC-572 Jales', no desempenho agronômico das cultivares Crimson Seedless e Superior Seedless. O experimento foi realizado na Fazenda Experimental da Epamig, em Mocambinho, distrito de Jaíba, MG, em delineamento inteiramente casualizado com sete repetições em esquema fatorial 2x2. Foram analisadas a fertilidade de gemas, o número e a massa de cachos e a massa de ramos. O porta-enxerto '1103 Paulsen' proporcionou os melhores resultados nas cultivares Crimson Seedless e Superior Seedless quanto à massa e número de cachos por planta e fertilidade de gemas, com produtividade média de 31,9 e 22,4 t ha-1 ano-1 , respectivamente. O porta-enxerto 'IAC-572 Jales' proporcionou maior vigor, com maior massa de ramos por planta nas duas cultivares. O porta-enxerto '1103 Paulsen' induziu a maiores fertilidade de gemas e produtividades em 'Crimson Seedless' e 'Superior Seedless' e pode ser indicado para o cultivo na região de Jaíba, MG.

Inserció laboral i empleabilitat en el marc de l'Espai Europeu d'Educació Superior: el cas de la Facultat de Pedagogia de la Universitat de Barcelona

La inserció laboral és l'accés al mercat laboral, al món del treball, entenent per tal la consecució d'un treball. Des d"aquesta perspectiva s'entendria la inserció laboral com un fet puntual (Fernández, 1988; Figuera i Bisquerra, 1992; Pérez Escoda, 1996), en referència al «fet d'aconseguir una ocupació en un moment determinat, és a dir, un contracte laboral. La inserció laboral inclou tant la incorporació de la persona a un lloc de treball com el seu manteniment. Actualment, dintre de la problemàtica de l'atur i de la inserció, cal tenir en compte ambdós factors, ja que, a més de la dificultat per trobar un treball, l'altre gran problema resideix en la capacitat per mantenir-ho» (Romero et al., 2004).