Influència del context geològic i hidrogeològic en l'eficiència energètica dels sistemes geotèrmics de molt baixa entalpia

L’elevat consum energètic de les societats actuals, així com la impossibilitat de sostenir-lo a llarg termini implica la cerca de noves fonts d’energia. D’aquesta manera, en el camp de la climatització residencial, l’energia geotèrmica de molt baixa entalpia es posiciona com una alternativa als recursos energètics actuals. Així, els primers metres de subsòl presenten una temperatura adequada per al seu aprofitament calorífic, mitjançant els sistemes geotèrmics de bomba de calor. Si bé a nivell energètic, són sistemes, intrínsecament, molt eficients, el seu rendiment pot patir importants variacions davant dels canvis en les condicions del medi geològic i hidrogeològic. Especialment, els col·lectors de calor verticals, treballen, amb freqüència, en el si de les formacions hidrogeològiques. En aquest sentit, els canvis del nivell hidràulic i de la temperatura de l’aigua de l’aqüífer es manifesten amb variacions de la conductivitat tèrmica equivalent i del flux subterrani d’aigua, que alhora, aquestes, es tradueixen en alteracions del flux subterrani de calor. Davant d’aquest fet, l’avaluació quantitativa de l’efecte d’aquestes fluctuacions que es presenta en aquest treball mostra petites variacions del nivell hidràulic i de la temperatura de l’aigua comporten canvis molt notables en l’eficiència dels sistemes verticals de bomba de calor geotèrmica.

Nonvitamin-k-antagonist oral anticoagulants in patients with atrial fibrillation and previous stroke or transient ischemic attack: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND AND PURPOSE: To assess whether the combined analysis of all phase III trials of nonvitamin-K-antagonist (non-VKA) oral anticoagulants in patients with atrial fibrillation and previous stroke or transient ischemic attack shows a significant difference in efficacy or safety compared with warfarin. METHODS: We searched PubMed until May 31, 2012, for randomized clinical trials using the following search items: atrial fibrillation, anticoagulation, warfarin, and previous stroke or transient ischemic attack. Studies had to be phase III trials in atrial fibrillation patients comparing warfarin with a non-VKA currently on the market or with the intention to be brought to the market in North America or Europe. Analysis was performed on intention-to-treat basis. A fixed-effects model was used as more appropriate than a random-effects model when combining a small number of studies. RESULTS: Among 47 potentially eligible articles, 3 were included in the meta-analysis. In 14 527 patients, non-VKAs were associated with a significant reduction of stroke/systemic embolism (odds ratios, 0.85 [95% CI, 074-0.99]; relative risk reduction, 14%; absolute risk reduction, 0.7%; number needed to treat, 134 over 1.8-2.0 years) compared with warfarin. Non-VKAs were also associated with a significant reduction of major bleeding compared with warfarin (odds ratios, 0.86 [95% CI, 075-0.99]; relative risk reduction, 13%; absolute risk reduction, 0.8%; number needed to treat, 125), mainly driven by the significant reduction of hemorrhagic stroke (odds ratios, 0.44 [95% CI, 032-0.62]; relative risk reduction, 57.9%; absolute risk reduction, 0.7%; number needed to treat, 139). CONCLUSIONS: In the context of the significant limitations of combining the results of disparate trials of different agents, non-VKAs seem to be associated with a significant reduction in rates of stroke or systemic embolism, hemorrhagic stroke, and major bleeding when compared with warfarin in patients with previous stroke or transient ischemic attack.

Uncontrollable hypertension in patients on hemodialysis: long-term treatment with captopril and salt subtraction

It has been suggested that an inappropriate relationship between renin and exchangeable sodium is responsible for the hypertension of patients with chronic renal failure. Long-term blockade of the renin system by captopril made it possible to test this hypothesis in 8 patients on maintenance hemodialysis. Captopril was administered orally in 2 daily doses of 25 to 200 mg. Previously, blood pressure averaged 179/105 +/- 6/3 (mean +/- SEM) pre- and 182/103 +/- 7/3 mm HG post-dialysis, despite intensive ultrafiltration and conventional antihypertensive therapy. The 4 patients with the highest plasma renin activity normalized their blood pressure with captopril alone, whereas in the 4 remaining patients, captopril therapy was complemented by salt subtraction which consisted in replacement of 1-2 liters of ultrafiltrate by an equal volume of 5% dextrose until blood pressure was controlled. After an average treatment period of 5 months, blood pressure of all 8 patients was reduced to 134/76 +/- 7/5 mm Hg (P less than 0.001) pre- and 144/81 +/- 9/5 mm Hg (P less than 0.001) post-dialysis without a significant change in body weight. The present data suggest that captopril alone or combined with salt subtraction normalizes blood pressure of patients on chronic hemodialysis with so called uncontrollable hypertension.

Description of the Occurrence of Canine Dirofilariasis in the State of Rio de Janeiro, Brazil

In order to evaluate the prevalence of canine heartworm in the State of Rio de Janeiro, a multicenter survey was carried out in two phases. The survey involved 1376 dogs from two cities: Rio de Janeiro and Niterói, and its surroundings, including the eastern shore and mountain resorts, which were further divided into sections. In the first phase, 795 dog blood samples were examined by the modified Knott test for the detection of microfilariae. A total of 134 samples (16.85%) were microfilaremic: 8.61% from Rio de Janeiro, 21.76% from Niterói and its surroundings, 33.33% from the eastern shore and 30.43% from the mountain resorts. In the second phase, 595 dog blood samples were examined first by the modified Knott test and the amicrofilaremic samples were subsequently examined by an immunoenzymatic test (ELISA) for antigen detection. In summary, 83 samples (13.95%) were microfilaremic and 44 (7.98%) of the amicrofilaremic samples were positive for heartworm antigen (occult infections). In Rio de Janeiro, 13.68% of the dogs were infected (i.e., antigen-and/or microfilaria-positive) and 8.51% of the dogs had microfilaremic infections. In comparison, Niterói and its surroundings showed values of 24.46% and 17.30% and the eastern shore showed values of 52.46% and 31.15%. In contrast the mountain resorts showed 20% microfilaremic only

Efectividad del tratamiento antirretroviral en pacientes con Diagnóstico de VIH/SIDA de dos ciudades de Colombia

Métodos: Estudio descriptivo en 134 pacientes en tratamiento para VIH/SIDA en Pereira y Manizales entre el 1 de julio de 2008 y el 30 de junio de 2009. Se evaluó la carga viral, conteo de linfocitos CD4, esquemas antirretrovirales, dosis diaria prescrita, tiempo evolución de enfermedad, duración de terapia, antecedentes de enfermedades oportunistas, costos de medicamentos. Resultados: Predominio masculino (91 hombres vs 43 mujeres), promedio de edad de 39 años y 59 meses de evolución de la enfermedad. Todos recibían esquemas a Dosis Diarias Definidas recomendadas. La terapia era efectiva en el 74,5% de los pacientes (carga viral & 400 copias/ml). Se pudo establecer que la falta de adherencia al tratamiento y el antecedente de haber tenido otras 2 infecciones de transmisión sexual se asociaban con mayor riesgo de no controlar la infección por VIH. El valor promedio de los medicamentos por año por paciente fue de € 2.865. Conclusiones. La falta de adherencia al tratamiento sigue siendo uno de los problemas más importantes para garantizar la efectividad, por lo cual los programas de control del VIH/SIDA deben asegurarla.

Symptomatic intracranial hemorrhage after stroke thrombolysis: the SEDAN score.

OBJECTIVE: A study was undertaken to develop a score for assessing risk for symptomatic intracranial hemorrhage (sICH) in ischemic stroke patients treated with intravenous (IV) thrombolysis. METHODS: The derivation cohort comprised 974 ischemic stroke patients treated (1995-2008) with IV thrombolysis at the Helsinki University Central Hospital. The predictive value of parameters associated with sICH (European Cooperative Acute Stroke Study II) was evaluated, and we developed our score according to the magnitude of logistic regression coefficients. We calculated absolute risks and likelihood ratios of sICH per increasing score points. The score was validated in 828 patients from 3 Swiss cohorts (Lausanne, Basel, and Geneva). Performance of the score was tested with area under a receiver operating characteristic curve (AUC-ROC). RESULTS: Our SEDAN score (0 to 6 points) comprises baseline blood Sugar (glucose; 8.1-12.0 mmol/l [145-216 mg/dl] = 1; >12.0 mmol/l [>216 mg/dl] = 2), Early infarct signs (yes = 1) and (hyper)Dense cerebral artery sign (yes = 1) on admission computed tomography scan, Age (>75 years = 1), and NIH Stroke Scale on admission (≥10 = 1). Absolute risk for sICH in the derivation cohort was: 1.4%, 2.9%, 8.5%, 12.2%, 21.7%, and 33.3% for 0, 1, 2, 3, 4, and 5 score points, respectively. In the validation cohort, absolute risks were similar (1.0%, 3.5%, 5.1%, 9.2%, 16.9%, and 27.8%, respectively). AUC-ROC was 0.77 (0.71-0.83; p < 0.001). INTERPRETATION: Our SEDAN score reliably assessed risk for sICH in IV thrombolysis-treated patients with anterior- and posterior circulation ischemic stroke, and it can support clinical decision making in high-risk patients. External validation of the score supports its generalization.

Transección pancreática mediante un nuevo dispositivo asistido por radiofrecuencia en un modelo porcino de pancreatectomía distal laparoscópica: estudio de factibilidad

La morbilitat relacionada amb el desenvolupament de la fístula pancreàtica postoperatòria (FP) posteriorment a realitzar una pancreatectomia distal persisteix elevada. Hem realitzat un treball experimental per a avaluar la factibilitat de la realització de la transecció pancreàtica mitjançant un nou dispositiu assistit per radiofreqüència en un model porcí de pancreatectomia distal laparoscòpica (PDL). S’ha realitzat PDL en 10 animals avaluant com a variable principal el desenvolupament de FP i com a variables secundàries paràmetres relacionats amb l’aparició de complicacions intra o postoperatòries. Els resultats obtinguts suggereixen la factibilitat de la realització de la transecció pancreàtica mitjançant el dispositiu assistit per radiofreqüència.

Pharmacokinetic interaction between methotrexate and chloral hydrate.

We report the case of a drug interaction between methotrexate (MTX) and chloral hydrate (CH) observed in a child treated for acute leukemia. Significantly slower MTX clearance and increased MTX exposure occurred on the first three courses of a high-dose chemotherapy when co-administered with CH despite normal renal function, adequate hydration, and alkalinization. Mean MTX area under the curve associated with CH administration was 1,134 µmol hours/L, compared to 608 µmol hours/L after discontinuation of CH. This interaction possibly resulted from a competition between anionic CH metabolites and MTX for renal tubular excretion.

Organometallic cages as vehicles for intracellular release of photosensitizers.

Water-soluble metalla-cages were used to deliver hydrophobic porphin molecules to cancer cells. After internalization, the photosensitizer was photoactivated, significantly increasing the cytotoxicity in cells. During the transport, the photosensitizer remains nonreactive to light, offering a new strategy to tackle overall photosensitization, a limitation often encountered in photodynamic therapy.

Análisis de los factores asociados a la mortalidad de los pacientes ingresados en el servicio de medicina intensiva

Objetivo: Analizar los factores asociados a mortalidad en UCI, en planta y al año. Material y Métodos: Estudio prospectivo observacional de 134 pacientes cuya evolución se sigue hasta el fallecimiento o hasta el año del episodio crítico. Resultados: mortalidad en UCI 20,9%, mortalidad hospitalaria 24,6%, mortalidad al año 34,1%. Conclusiones: La mortalidad en UCI se correlaciona con el APACHE II medio de 22 y SAPS II medio de 60. Los fallecidos en planta tienen una APACHE de 15 y SAPS de 51. Al año, encontramos relación con la edad media de 69 años, APACHE de 20 y SAPS de 57.

The "speech of the 'intelligentsia" as the object of the study of Soviet social linguistics

В статье будут рассмотрены два исследования русского и советского лингвиста Е.Д. Поливанова, посвященные фонетике «интеллигентского языка». В начале 1930-ч гг. Поливанов выдвинул новаторскую теорию языка, основанную на изучении социолектов и групповых диалектов русского языка современности. Язык интеллигенции - один из излюбленных предметов исследований лингвиста. Поливанов доказывает, что изменениям подвержен не только словарный запас, но и фонетика, и приводит конкретные примеры фонетических изменений, вызванных революцией.