Índice de pulsatilidad de arteria cerebral media como predictor para desenlaces desfavorables en fetos pequeños para la edad gestacional

Introducción: La aparición de vasodilatación aislada de la arteria cerebral media en fetos pequeños para la edad gestacional sin otros cambios en el doppler puede interpretarse como fisiológica o podría ser la manifestación inicial de una restricción de crecimiento intrauterino de inicio tardío. Se pretende evaluar la asociación de la disminución del índice de pulsatibilidad de la arteria cerebral media, como predictor de desenlaces perinatales adversos, en fetos con bajo peso para edad gestacional. Metodología: Se realizó un estudio de cohorte analítica de temporalidad histórica para determinar si el hallazgo de disminución de la pulsatibilidad en el doppler de arteria cerebral media se asocia con el pronóstico perinatal adverso, en fetos pequeños para edad gestacional mediante un muestreo no probabilístico. Resultados: Se recolectaron un total de 325 flujometría doppler de fetos pequeños para edad gestacional. El riesgo de parto pretérmino fue RR 2.6 IC95% 1.6-4.1, de hospitalización fue RR 1.4 IC95%1.1-1.9 y de muerte fue 2.1 IC95%1.5-3.2 cuando hay índice de pulsatilidad alterada en la arteria cerebral media. La regresión logística mostró que el riesgo de desenlaces desfavorables con alteraciones en la arteria cerebral media fue de RR 4.2 IC95% 2.5-7.1 ajustado por edad materna, edad gestacional y bajo peso al nacer. Discusión Los pacientes expuestos presentan mayor riesgo de desenlaces desfavorables con diferencias significativas, no así en otros estudios publicados. El presente estudio muestra asociaciones significativas que debe ser evaluada con estudios más amplios.

Tratamiento quirúrgico de las fracturas intertrocantéricas del fémur con placa tornillo dinámico convencional comparado con tornillo dinámico helicoidal

Introducción: Las fracturas intertrocantéricas han llegado a nuestros días con una mayor incidencia dado el envejecimiento de la población, con fracturas más complejas, menos estables y asociadas a osteoporosis, se estima que representan aproximadamente 1,75 millones de años de vida perdidos ajustados a discapacidad es decir 0,1% de la carga de morbilidad a nivel mundial. Existe consenso en el tratamiento quirúrgico de este tipo de fracturas, presentando una incidencia variable de fallos, principalmente cuando son inestables, entre estos el denominado “cuto ut”. La utilización de un método de fijación con placa y tornillo helicoidal (DHHS) aparentemente disminuye la incidencia de dichos fallos con respecto a otras técnicas. Metodología: Por medio de una muestra calculada en 128 de pacientes con fracturas intertrocantéricas operados con DHS y DHHS entre el 2007 y el 2012 en La Clínica San Rafael de la ciudad de Bogotá, Colombia, se realizó un análisis multivariado para determinar si existe o no diferencias significativas en los índices de fallo entre estas dos técnicas. Resultados: Los pacientes incluidos en el estudio 54 (42,1%) fueron hombres y 74 (57,8%) fueron mujeres. 75 fueron operados con DHHS y 53 con DHS; en cuanto a las comorbilidades las principales fueron Hipertensión con 40 pacientes para DHS y 30 para DHHS, para el caso de Diabetes Mellitus fueron 13 y 9 para DHS y DHHS, respectivamente; en cuanto al tipo de fractura más común la principal fue la clasificación Tronzo II con 9 pacientes para DHS y 13 para DHHS. Conclusión. Para el estudios se evidencia que para los 3 desenlaces principales evaluados, 1. El porcentaje de re intervención (p=0,282), 2. La supervivencia en el primer año (p=0,499) y 3. El desempeño funcional con la escala de Oxford (p=0,06); no hubo diferencias estadísticamente significativas entre los grupos.

Behavioral changes, used and benefits of a community program for the promotion in physical activity

Objective: To determine the change of behavior in physical activity and the characteristics associated with the use and benefits of Local Physical Activity Center (CLAF) in the population of the town of Santa Fe de Bogota. Materials and methods: We conducted a longitudinal study before and after, which was assessed at admission and 3 months in the intervention program CLAF physical activity, behavior change compared to the physical activity of users. Inclusion criteria: were being active user of CLAF, aged between 15 and 65 years and voluntarily express their participation in the study. Exclusion criteria: Fill incomplete measurement instruments used. The sampling frame of CLAF users, we selected n=55 subjects. To gather information, a questionnaire, which contained the behavioral stages of change, also conducted a survey which determined semistructured features about the benefits and use of CLAF. Results: The total study participants was n = 55, mean age was 40.4 ± 15.3 years, with a minimum 15 and maximum of 64 years, 83.6% were women. 78.2% do not know the purpose of the Local Centre for Physical Activity. The outreach strategy that most came to the group was 58.2 with a verbal type. The time for links to CLAF more frequently in the group evaluated was 1 to 6 months 36.4. The motivation to regularly attend the CLAF in the majority was to improve the physical and / or a 74.5% mental. 89.1% would be willing to recommend to others the use of CLAF. A 81.8% of the population physical activity performed by more than 150 min / wk at moderate intensity; Post CLAF intervention in the subjects showed positive changes in the level of physical activity (p<0.001, Test de Wilcoxon) and behavioral state (p<0.001, Test de Wilcoxon).

Osteomielitis esternal: utilidad de las pruebas de diagnóstico por imágenes con enfoque en medicina nuclear

Introducción: El diagnóstico de osteomielitis esternal post-esternotomía resulta difícil empleando síntomas clínicos o de laboratorio y las imágenes morfológicas orientan a sospecha más que al diagnóstico. Un diagnóstico precoz ofrece calidad de vida y el mejor tratamiento para reducir una mortalidad que oscila entre 14% y 47%. La gammagrafía con leucocitos marcados ofrece el mejor rendimiento diagnóstico para infecciones y se destaca como el patrón de oro diagnóstico. Objetivo: Identificar el desempeño y utilidad de la gammagrafía con leucocitos autólogos marcados con 99mTc-HMPAO en los estudios realizados para la evaluación de osteomielitis esternal. Materiales y métodos: Se realizó un estudio descriptivo, retrospectivo de prueba diagnóstica en la Fundación Cardioinfantil de Bogotá entre enero/2010 y mayo/2015 evaluando gammagrafías con leucocitos marcados ante la sospecha de osteomielitis posterior a esternotomía. Resultados: Se evaluaron 52 pacientes, en los que la gammagrafía con leucocitos mostró 23 pacientes (44,2%) con osteomielitis esternal, logrando una sensibilidad y especificidad del 88,46% y 100% respectivamente. El valor predictivo positivo fue de 100%, y el valor predictivo negativo fue de 89,66%. El impacto de una prueba negativa no modificó el manejo médico inicial en el 93% de los casos mientras que una prueba positiva lo modificó en el 83%. Conclusiones: La gammagrafía con leucocitos autólogos radiomarcados con 99mTc-HMPAO continúa siendo el patrón de oro de referencia no invasiva para el diagnóstico de osteomielitis, y en el caso de osteomielitis esternal se convierte en la prueba de elección pertinente en la selección de pacientes que ameritan una re-intervención quirúrgica.

Efectividad y seguridad de la quetiapina en la disminución de los síntomas depresivos, en pacientes con esquizofrenia

Introducción: La depresión se presenta frecuentemente en pacientes con esquizofrenia, en las diferentes fases de esta y, dada su similitud con diferentes síntomas propios de la esquizofrenia, su identificación resulta difícil. El objetivo del presente estudio es determinar la efectividad y seguridad de la Quetiapina en la disminución de síntomas depresivos comparada con otros antipsicóticos de segunda generación en pacientes con esquizofrenia. Metodología: se realizó una revisión sistemática de la literatura en 6 bases de datos de acuerdo con la metodología PRISMA, que incluyó estudios de efectividad y seguridad de la Quetiapina (Seroquel®) en pacientes con esquizofrenia y depresión. Los desenlaces fueron medidos mediante escalas para depresión, tasas de suicidio y efectos adversos. Resultados: Se incluyeron dos estudios. El estudio de Di Fiorino en 2014, reportó efectividad de Quetiapina en el tratamiento de pacientes psicóticos con depresión con una diferencia de las reducciones de mínimos cuadrados de la escala CDSS de 2.2 IC 95% (0.8 -3.7) frente a risperidona, y de 3.3 (p<0.0001) en la escala HAM-D frente a risperidona. Los efectos adversos presentados con quetiapina fueron: somnolencia, boca seca, hipotensión. No se reportaron muertes por quetiapina. Discusión: La quetiapina demostró ser efectiva y segura en el manejo de los síntomas depresivos en pacientes con esquizofrenia frente a risperidona al valorar la población con escala CDSS. No fueron reportados desenlaces de suicidio en ninguno de los estudios. La calidad de la evidencia es moderada con sesgos metodológicos importantes. Es necesaria la realización de más estudios clínicos aleatorizados y con cegamiento y estudios de metaanálisis en población homogénea

The Institution of Transmission Easement in Poland

The text presents an analysis of the institution of transmission easement, which is featured from the perspective of civil-law and public-law relations. The text does not address all the issues related to the institution of transmission easement, that is, no comprehensive analysis of the issues of the grounds for easement establishment, expiry, or remuneration and compensation for easement was conducted. The text presents a general description of the establishment of transmission easement against the backdrop of the Polish Civil Code and the Bill on Transmission Corridors of 18 July 2013, which is currently being drafted. The analysis of the easement institution, apart from the synthetic approach to legal provisions, features a functional and teleological interpretation. It is worth pointing out the aim that the legislator wished to achieve with respect to the work on new considerations both in the domain of the private and public law: 1. the legislator aimed to regulate the disorderly legal status of civil-law relations, but also to avoid dispute in the future, 2. with the aid of new regulations, the legislator wished to respond to the public interest.

Modeled and observed atmospheric radiation balance during the West African dry season: role of mineral dust, biomass burning aerosol, and surface albedo

The global radiation balance of the atmosphere is still poorly observed, particularly at the surface. We investigate the observed radiation balance at (1) the surface using the ARM Mobile Facility in Niamey, Niger, and (2) the top of the atmosphere (TOA) over West Africa using data from the Geostationary Earth Radiation Budget (GERB) instrument on board Meteosat-8. Observed radiative fluxes are compared with predictions from the global numerical weather prediction (NWP) version of the Met Office Unified Model (MetUM). The evaluation points to major shortcomings in the NWP model's radiative fluxes during the dry season (December 2005 to April 2006) arising from (1) a lack of absorbing aerosol in the model (mineral dust and biomass burning aerosol) and (2) a poor specification of the surface albedo. A case study of the major Saharan dust outbreak of 6–12 March 2006 is used to evaluate a parameterization of mineral dust for use in the NWP models. The model shows good predictability of the large-scale flow out to 4–5 days with the dust parameterization providing reasonable dust uplift, spatial distribution, and temporal evolution for this strongly forced dust event. The direct radiative impact of the dust reduces net downward shortwave (SW) flux at the surface (TOA) by a maximum of 200 W m−2 (150 W m−2), with a SW heating of the atmospheric column. The impacts of dust on terrestrial radiation are smaller. Comparisons of TOA (surface) radiation balance with GERB (ARM) show the “dusty” forecasts reduce biases in the radiative fluxes and improve surface temperatures and vertical thermodynamic structure.

Beurling zeta functions, generalised primes, and fractal membranes

We study generalised prime systems P (1 < p(1) <= p(2) <= ..., with p(j) is an element of R tending to infinity) and the associated Beurling zeta function zeta p(s) = Pi(infinity)(j=1)(1 - p(j)(-s))(-1). Under appropriate assumptions, we establish various analytic properties of zeta p(s), including its analytic continuation, and we characterise the existence of a suitable generalised functional equation. In particular, we examine the relationship between a counterpart of the Prime Number Theorem (with error term) and the properties of the analytic continuation of zeta p(s). Further we study 'well-behaved' g-prime systems, namely, systems for which both the prime and integer counting function are asymptotically well-behaved. Finally, we show that there exists a natural correspondence between generalised prime systems and suitable orders on N-2. Some of the above results are relevant to the second author's theory of 'fractal membranes', whose spectral partition functions are given by Beurling-type zeta functions, as well as to joint work of that author and R. Nest on zeta functions attached to quasicrystals.

An estimate of the global impact of multiple scattering by clouds on outgoing long-wave radiation

Although the potential importance of scattering of long-wave radiation by clouds has been recognised, most studies have concentrated on the impact of high clouds and few estimates of the global impact of scattering have been presented. This study shows that scattering in low clouds has a significant impact on outgoing long-wave radiation (OLR) in regions of marine stratocumulus (-3.5 W m(-2) for overcast conditions) where the column water vapour is relatively low. This corresponds to an enhancement of the greenhouse effect of such clouds by 10%. The near-global impact of scattering on OLR is estimated to be -3.0 W m(-2), with low clouds contributing -0.9 W m(-2), mid-level cloud -0.7 W m(-2) and high clouds -1.4 W m(-2). Although this effect appears small compared to the global mean OLR of 240 W m(-2), it indicates that neglect of scattering will lead to an error in cloud long-wave forcing of about 10% and an error in net cloud forcing of about 20%.

Effect of hyaluronidase on ocular motility and eyelid function in sub-Tenon's anaesthesia: randomised controlled trial

Purpose: To assess the effect of hyaluronidase on eye and eyelid movements when used as an adjunct in sub-Tenon's anaesthesia. Methods: A total of 60 patients who had sub-Tenon's anaesthesia prior to phacoemulsification surgery were divided into two equal groups in a double-masked randomised controlled fashion. Of these, Group A had 4 ml lignocaine 2%, while Group B had 4ml lignocaine 2% with the addition of sodium hyaluronidase 75 IU/ml. Ocular motility, levator, and orbicularis oculi function were measured in all patients at 5 and 8 min. Levator function was scored from 0 (no function) to 3 (complete function) while orbicularis function was scored from 0 to 2. The score for ocular motility was the sum in four positions of gaze, each position scoring from 0 to 2. Results were compared using a nonparametric test. Results Group B achieved significantly better ocular and lid akinesia than Group A both at 5 and 8 min with P < 0.01. The median scores for levator function at 5 and 8 min were 2 for Group A and 0 for Group B. For orbicularis function, the median scores at both time intervals were 2 for Group A and 1 for Group B. For ocular motility, the median score for Group A at 5 min was 3 and at 8 min was 2.5; for Group B at 5 min was 0.5 and at 8 min was 0. Conclusions: The addition of hyaluronidase in sub-Tenon's anaesthesia has a significant effect in improving ocular and lid (levator and orbicularis) akinesia.

Structure, and thermal, magnetic and chemical properties of copper(II)iodoacetate monohydrate

Reaction of iodoacetic acid with cupric carbonate in water in dimmed light yields green Cu(ICH2COO)(2 center dot)H2O (1). From X-ray crystallography, it is found to be a tetra-acetato bridged copper(II) dimer with the water molecules occupying the apical positions. In thermogravimetry, the coordinated water molecules are lost in the temperature range 50-100 degrees C. From magnetic susceptibility measurements in the temperature range 300-1.8 K, the exchange coupling constant J is found to be -142(1) cm(-1) and g = 2.18(2) with the spin Hamiltonian H = -2J{S-Cu1 center dot S-Cu2}. It reacts with 2,2'-bipyridine (bpy) to yield [Cu(bpy)(2)I]I. It oxidises thiophenol to Ph-S-S-Ph under dry N-2 atmosphere.

Effect of H-bonding on the ambivalence of SCN- towards copper(II)

Condensations of 2-(2-aminoethyl)pyridine with 4-methylimidazole-5-carboxaldehyde and 1-methyl-2-imidazolecarboxaldehyde generate the tridentate N donor ligands L and L' respectively. Reactions of Cu(NCS)(2) with L and L' yield respectively CuL(SCN)(NCS) (1) containing a CuN4S core and CuL'(NCS)(2) (2) having a CuN5 core. Both the cores are square pyramidal with SCN bound in 1 at the axial position through the S end. This differential behaviour of SCN in the two complexes despite the ligands being very similar, is investigated by DFT calculations at the B3LYP/TZV level. It is found that DFT calculations predict isolation of the Cu(ligand)(NCS)(2) species for both the ligands L and L'. Presence of an offsetting intermolecular H-bonding between the N atom of the thiocyanate and the N-H proton of the ligand L of an adjacent molecule makes the binding of SCN via the S end feasible in 1 resulting in the H-bonded-dimer Cu2L2(SCN)(2)(NCS)(2). The strength of the H-bond is estimated as 27.1 kJ mol (1) from the DFT calculations. The question of such H-bonding does not arise with L' as it lacks in a similar H atom. Dimeric 1 represents a case of two non-interacting spins. (C) 2008 Elsevier B. V. All rights reserved.

Influence of a halide ion on ribbons of water pentamer

Reactions of CuF2, CuCl2 center dot 2H(2)O and CuBr2 with 2,2'-dipyridylamine (HDPA) in water at room temperature using Cu: HDPA = 2: 1 mol yield [Cu(HDPA) (H2O)(2)F]F center dot 3H(2)O (1), Cu(HDPA) Cl-2 (2) and [Cu(HDPA) Br-2 (3) respectively. The structures of 2 and 3 are isostructural in spacegroup C-2 with cell dimensions; for 2, a = 14.702(8), b = 7.726(2), c = 4.829(6) angstrom, beta = 96.68(8)degrees and for 3, a = 14.2934(8), b = 7.9057(6), c = 5.1982(5) angstrom, beta = 94.049(7)degrees. In the X-ray crystal structure, the complex 1 is found to contain tapes of water pentamers. Our DFT calculations at the B3LYP/LanL2DZ level show that the reaction Cu(HDPA)X-2 + 2H(2)O = [Cu(HDPA)(H2O)(2)X]X is most exothermic in the gas phase when X- = F-, i.e., the tendency of water uptake is maximum for Cu(HDPA) F-2. It seems that the exothermicities of the aquations of Cu(HDPA) Cl-2 and Cu(HDPA) Br-2 are not sufficient to stabilise the type of ribbons of water observed in 1 and consequently water is eschewed when X- = Cl- or Br-.

Use of HNO3 as the source of NO to prepare a nitric oxide complex of ruthenium

Reaction of cis-Ru(bisox)(2)Cl-2, where bisox is 4,4,4',4'-tetramethyl-2,2'-bisoxazoline, with HNO3 in 1 : 4 molar proportion in boiling water under N-2 atmosphere and subsequent addition of an excess of NaClO4 center dot H2O yields [Ru(bisox)(HL)(NO)](ClO4)(NO3) (1). HL is a hydrolysed form of bisox where one of the oxazoline rings opens up. X-Ray crystallography shows that 1 contains an octahedral RuN5O core. HL binds the metal through an imino N, an amide N and an alcoholic O atom. Reaction of cis-Ru(bisox)(2)Cl-2 with an excess of NaNO2 in water gives cis-Ru(bisox)(2)(NO2)(2) (2). On acidification by HClO4 in methanol, 2 is smoothly converted to cis-[Ru(bisox)(2)(NO2)(NO)](ClO4)(2) (3) due to equilibrium (1).

Development of novel brush-type chiral stationary phases based on terpenoid selectors: HPLC evaluation and theoretical investigation of enantioselective binding interactions

The terpenoid chiral selectors dehydroabietic acid, 12,14-dinitrodehydroabietic acid and friedelin have been covalently linked to silica gel yielding three chiral stationary phases CSP 1, CSP 2 and CSP 3, respectively. The enantiodiscriminating capability of each one of these phases was evaluated by HPLC with four families of chiral aromatic compounds composed of alcohols, amines, phenylalanine and tryptophan amino acid derivatives and beta-lactams. The CSP 3 phase, containing a selector with a large friedelane backbone is particularly suitable for resolving free alcohols and their derivatives bearing fluorine substituents, while CSP 2 with a dehydroabietic architecture is the only phase that efficiently discriminates 1, 1'-binaphthol atropisomers. CSP 3 also gives efficient resolution of the free amines. All three phases resolve well the racemates of N-trifluoracetyl and N-3,5-dinitrobenzoyl phenylalanine amino acid ester derivatives. Good enantioseparation of beta-lactams and N-benzoyl tryptophan amino acid derivatives was achieved on CSP 1. In order to understand the structural factors that govern the chiral molecular recognition ability of these phases, molecular dynamics simulations were carried out in the gas phase with binary diastereomeric complexes formed by the selectors of CSP 1 and CSP 2 and several amino acid derivatives. Decomposition of molecular mechanics energies shows that van der Waals interactions dominate the formation of the diastereomeric transient complexes while the electrostatic binding interactions are primarily responsible for the enantioselective binding of the (R)- and (S)-analytes. Analysis of the hydrogen bonds shows that electrostatic interactions are mainly associated with the formation of N-(HO)-O-...=C enantio selective hydrogen bonds between the amide binding sites from the selectors and the carbonyl groups of the analytes. The role of mobile phase polarity, a mixture of n-hexane and propan-2-ol in different ratios, was also evaluated through molecular dynamics simulations in explicit solvent. (c) 2006 Elsevier Ltd. All rights reserved.