Sensibilidad y especificidad del ecocardiograma transtorácico para el diagnóstico de enfermedad coronaria

Introducción: La enfermedad coronaria es la principal causa de muerte en Colombia y el mundo en personas mayores de 45 años (1, 2). Con la variación en los perfiles epidemiológicos se espera que aumente su prevalencia y costo, disminuyendo la mortalidad. En el estudio diagnóstico de enfermedad coronaria, se realizan múltiples pruebas paraclínicas, dentro de estas, el ecocardiograma es muy utilizado y sus recomendaciones de uso se basan en estudios de hace más de 10 años (3). Metodología: Se realizó un estudio de prueba diagnóstica para determinar las características operativas del ecocardiograma transtorácico para el diagnóstico de enfermedad coronaria frente al cateterismo cardiaco en pacientes con dolor torácico. Resultados: Se analizaron 290 pacientes con una edad promedio de 67 años y 68% hombres; el 74.1% tenía hipertensión arterial y el 24.5% de diabetes mellitus. En el 61% de los pacientes se evidenció enfermedad coronaria por angiografía. La sensibilidad del ecocardiograma transtorácico para enfermedad coronaria fue del 70%, especificidad del 55%, valor predictivo negativo del 54% y valor predictivo positivo del 71%; con una efectividad del 65% y una capacidad predictora del 60.6% (p=0.02). Discusión: La anatomía coronaria fue similar a la descrita previamente, siendo las lesiones multivaso presente en un 41% y la lesión de un vaso fue del 22% (4, 5). Teniendo en cuenta la sensibilidad del 70% y especificidad del 55%, la facilidad de acceso, características no invasivas y el bajo costo; nos permiten recomendar utilizarlo como guía diagnóstica en el contexto del dolor torácico en el servicio de urgencias.

Hidrolipoclasia con solución salina hipotónica versus isotónica en adiposidad localizada

Introducción: La hidrolipoclasia es una técnica de moldeamiento corporal consistente en la infiltración de una solución en el tejido adiposo con la consiguiente aplicación de ultrasonido para producir lisis en los adipocitos y reducción del tejido adiposo en el área de tratamiento. Sin embargo, existen múltiples variaciones a la técnica, entre ellas el tipo de solución utilizada. El objetivo de este estudio fue comparar los resultados con la técnica de hidrolipoclasia en cuanto a reducción de medidas con el uso de solución salina hipotónica versus isotónica. Metodología: Estudio descriptivo de corte transversal, se analizaron historias clínicas de pacientes a los que se les realizó hidrolipoclasia entre enero de 2013 y febrero 2014 en dos centros médicos estéticos de Bogotá. Se compararon dos técnicas (utilizando solución salina isotónica versus hipotónica) en cuanto a la disminución de medidas antropométricas tomadas antes y después del tratamiento. Los datos fueron analizados mediante la comparación de medias utilizando la prueba t de Student. Resultados: Se analizaron 37 historias clínicas, 19 pacientes sometidos a hidrolipoclasia con solución salina hipotónica y 18 con isotónica. Después de la realización de un procedimiento hubo una disminución estadísticamente significativa (p: 0,000) en todas las medidas antropométricas evaluadas, siendo mayor comparativamente en los pacientes tratados con solución hipotónica en cintura, perímetro abdominal y perímetro a nivel de crestas iliacas. Los efectos secundarios incluyeron equimosis y hematomas. No se presentaron complicaciones. Conclusión: La hidrolipoclasia es segura y eficaz en el manejo de adiposidad localizada, teniendo una mayor efectividad cuando se utiliza solución salina hipotónica.

Efectividad en la canalización yugular guiada por ecografía usando tres diferentes técnicas. Experimento en modelos simulados.

Introducción: El desarrollo tecnológico permite efectuar procedimientos eficientes en pacientes críticos de urgencias como canalizar vasos centrales guiados por ecografía. Éste procedimiento comparado con la técnica a ciegas ofrece ventajas como disminución de complicaciones, mejor éxito y menor tiempo de procedimiento. Hay diferentes técnicas de abordaje: transversal, longitudinal y oblicua, lo que supone diferencias en la efectividad y éxito en cada una de ellas. Materiales y métodos: Se realizó un experimento en modelos simulados con especialistas y residentes de último año de medicina de emergencias. Posterior a estandarizar los conceptos y abordajes de cada una de las técnicas, se puncionaron los modelos para determinar cuál técnica presenta mayor éxito y efectividad para canalización yugular con guía ecográfica. Resultados: El procedimiento fue efectivo en 175 réplicas (97.2%) distribuidas así: éxito 133 (73.9%), redirección 37 (20.6%) y requerimiento de segunda punción en 5 (2.8%). En la técnica transversal la efectividad fue 96.7% (n=58), en longitudinal del 100% (n=60) y en oblicua del 95.0% (n=57), (p=0.377). En residentes la efectividad fue 95.6% (n=86) y en especialistas 98.9% (n=89), (p=0.184). La distribución de éxito mostró que en los especialistas fue mayor en un 18.9% que en los residentes (p=0.004), por género los hombres tienen un éxito mayor en un 18.7% que las mujeres (p=0.009, OR=3.12, IC 95%: 1.30, 7.52). Discusión: No se encontró diferencia significativa en el uso de cualquier técnica, pero la tendencia favorece la técnica longitudinal, quien obtuvo mayor porcentaje de efectividad y éxito.

Plotino y Grosseteste: El neoplatonismo en la cosmología medieval

En este trabajo se estudia el caso de la cosmología del filósofo y científico Robert Grosseteste como un ejemplo de la notable influencia del neoplatonismo en la ciencia medieval. Uno de los propósitos de la cosmología de Grosseteste consistió en explicar la secuencia efectiva de la creación del cosmos. Sostengo que la explicación que ofrece Grosseteste acerca de la creación es una expresión renovada de algunas ideas de Plotino a propósito de cómo el Uno engendra lo múltiple. Me interesa resaltar tres aspectos de la estrecha relación entre el sistema cosmológico de Grosseteste y el sistema metafísico de Plotino: (1) Unidad de principio, (2) Mecanismos de generación y (3) Unidad del sistema.

Reconocimiento geofísico del deslizamiento de Rosiana (depresión de Tirajana, Gran Canaria)

The landslide of Rosiana is considered the largest slope movement amongst those known in historical times in Gran Canana, Canary Islands. It has been activated at least 4 times in the last century, and in the movement of 1956, when about 3.106 m3 of materials were involved, 250 people had to be evacuated and many buildings were destroyed. The present geological hazard has lead to specific studies of the phenomenon which, once characterised, can be used as a guide for the scientific and technical works that are to be made in this or similar areas. This paper wants to increase the knowledge about the unstable mass of Rosiana by using geophysical techniques based on the method of seismic by refraction. The geophysical measues have been interpreted with the aid of the available geomorphologic data, thus obtaining a first approximation to the geometry of the slope movements

Investigación geofísica de los paleovalles pleistocenos del NE de Cataluña: el ejemplo de la Riera de Tossa (Costa Brava meridional)

The geometry of Riera de Tossa (Costa Brava, Catalonia) Pleistocene paleovalley has been studied by two geophysical prospecting methods: vertical electric sounding (VES-DC) and seismic refraction. The results show the existence of a sudden slope change of the thalweg that permits to differentiate two sections where erosion processes operated in unequal intensity. Based on geological and geomorphological available data, it can be inferred that this slope rupture is caused by the litological control imposed by the alineation of resistant materials, which limited the headward erosion extend of the creek during the Upper Pleistocene

Distribució espacial i ús de l'hàbitat de la comunitat de peixos a l'estany de Banyoles

En el marc d'un projecte més ampli sobre la comunitat de peixos de la conca lacustre de Banyoles, s'ha estudiat la distribució espacial de les diferents espècies així com l'ús que aquestes fan de l'hàbitat. El poblament piscícola de l'estany de Banyoles és el resultat d'un llarg historial d'introducció d'espècies exòtiques i extinció de les poblacions autòctones locals. S'ha revisat la seva composició actual detectant un total de 18 espècies (4 autòctones i 14 introduïdes) de les quals només 13 presenten una població estable. L'estudi de l'hàbitat s'ha centrat a l'Estany, l'element principal del sistema lacustre, analitzant per separat la zona litoral i la zona limnètica. En el primer cas s'han realitzat les captures d'individus mitjançant pesca elèctrica des d'una embarcació adaptada per aquesta pràctica. La totalitat del litoral ha estat dividida en trams de característiques homogènies on s'han obtingut les captures per unitat d'esforç per cada espècie. El mostreig s'ha desenvolupat entre l'estiu de 1997 i la primavera del 2000 realitzant un total de 10 campanyes de pesca. Les espècies més abundants al litoral són la perca americana (Micropterus salmoides) i el peix sol (Lepomis gibbosus), essent també presents la perca (Perca fluviatilis), carpa (Cyprinus carpio) i el gardí (Scardinius erythrophthalmus). S'han capturat altres espècies com ara anguila (Anguilla anguilla), bagra (Squalius cephalus), sandra (Sander lucioperca), carpí (Carassius auratus) i madrilleta vera (Rutilus rutilus), però són molt menys abundants en nombre. S'ha examinat, per cadascuna de les espècies, si existeix selecció de l'hàbitat i en cas afirmatiu, quin és el preferent en base a la classificació del litoral en sis tipus de vegetació predominant. Les espècies més abundants, perca americana i peix sol, ocupen tots els hàbitats disponibles però amb una densitat diferent. La perca mostra també una clara selecció de l'hàbitat a favor de les zones molt estructurades amb abundant presència de jonca litoral. Carpa i gardí seleccionen els ambients més fondos amb major presència de matèria orgànica d'origen vegetal procedent del bogar. En general els individus ocupen les zones amb una densitat de vegetació intermèdia, majoritàriament zones de jonca a l'estiu i zones amb mansega a l'hivern, on troben refugi i els recursos tròfics necessaris. La perca americana, a més, presenta una elevada fidelitat a un mateix punt del litoral al llarg de la seva vida. La zona limnètica ha estat prospectada mensualment mitjançant ecosondació, realitzant transectes perpendiculars a l'eix principal de l'Estany, cobrint la seva totalitat. La composició d'espècies s'ha obtingut a partir de les captures fetes amb xarxes (tresmalls) amb periodicitat estacional. L'anàlisi geoestadística de la densitat de peixos ha permès descriure l'estructura espacial d'aquesta a partir dels variogrames, així com la seva variabilitat tant espacial com temporal, i obtenir els mapes de densitat. A l'hivern, la densitat de peixos a la zona limnètica assoleix els seus valors mínims i els individus es troben formant agregats dispersos, pels diferents estrats de fondària. A partir de la primavera la densitat augmenta, pel reclutament i la major freqüència d'individus que abandonen el litoral; la densitat esdevé més homogènia a les primer capes de fondària. A l'estiu la densitat és màxima i l'estrat més homogeni coincideix amb la posició de la termoclina. Aquest estructura varia en disminuir la temperatura i barrejar-se la columna d'aigua, tornant a la situació hivernal. La perca i la madrilleta vera són les espècies predominants en aquest ambient, juntament amb la carpa. La seva distribució no és homogènia i respon a les característiques limnològiques de les diferents cubetes de l'Estany. Una particularitat d'aquest, relacionada amb el seu origen càrstic, es la formació d'una ploma hidrotermal que afecta la distribució dels peixos, probablement en augmentar la terbolesa. S'ha integrat l'ús de l'hàbitat de les espècies que ocupen tant la zona limnètica com la litoral a partir del seguiment d'individus, concretament de perca i bagra. S'ha utilitzat un sistema automàtic de posicionament que estima la localització dels individus marcats amb transmissor de telemetria acústica. L'anàlisi dels desplaçaments mostra un rang superior per la bagra en comparació amb la perca. Ambdues espècies mostren una orientació en els seus desplaçaments. La perca ocupa el litoral a la nit i es desplaça a la zona limnètica de dia, amb un ritme d'activitat marcat per dos màxims coincidint amb la sortida i posta de sol; en canvi la bagra mostra una major activitat nocturna amb zones de repòs properes al litoral. S'ha estimat igualment els dominis vital de cada individu marcat.

Velocities of compressional and shear waves in limestones

Carbonate rocks are important hydrocarbon reservoir rocks with complex textures and petrophysical properties (porosity and permeability) mainly resulting from various diagenetic processes (compaction, dissolution, precipitation, cementation, etc.). These complexities make prediction of reservoir characteristics (e.g. porosity and permeability) from their seismic properties very difficult. To explore the relationship between the seismic, petrophysical and geological properties, ultrasonic compressional- and shear-wave velocity measurements were made under a simulated in situ condition of pressure (50 MPa hydrostatic effective pressure) at frequencies of approximately 0.85 MHz and 0.7 MHz, respectively, using a pulse-echo method. The measurements were made both in vacuum-dry and fully saturated conditions in oolitic limestones of the Great Oolite Formation of southern England. Some of the rocks were fully saturated with oil. The acoustic measurements were supplemented by porosity and permeability measurements, petrological and pore geometry studies of resin-impregnated polished thin sections, X-ray diffraction analyses and scanning electron microscope studies to investigate submicroscopic textures and micropores. It is shown that the compressional- and shear-wave velocities (V-p and V-s, respectively) decrease with increasing porosity and that V-p decreases approximately twice as fast as V-s. The systematic differences in pore structures (e.g. the aspect ratio) of the limestones produce large residuals in the velocity versus porosity relationship. It is demonstrated that the velocity versus porosity relationship can be improved by removing the pore-structure-dependent variations from the residuals. The introduction of water into the pore space decreases the shear moduli of the rocks by about 2 GPa, suggesting that there exists a fluid/matrix interaction at grain contacts, which reduces the rigidity. The predicted Biot-Gassmann velocity values are greater than the measured velocity values due to the rock-fluid interaction. This is not accounted for in the Biot-Gassmann velocity models and velocity dispersion due to a local flow mechanism. The velocities predicted by the Raymer and time-average relationships overestimated the measured velocities even more than the Biot model.

The acoustic signature of fluid flow in complex porous media

Effective medium approximations for the frequency-dependent and complex-valued effective stiffness tensors of cracked/ porous rocks with multiple solid constituents are developed on the basis of the T-matrix approach (based on integral equation methods for quasi-static composites), the elastic - viscoelastic correspondence principle, and a unified treatment of the local and global flow mechanisms, which is consistent with the principle of fluid mass conservation. The main advantage of using the T-matrix approach, rather than the first-order approach of Eshelby or the second-order approach of Hudson, is that it produces physically plausible results even when the volume concentrations of inclusions or cavities are no longer small. The new formulae, which operates with an arbitrary homogeneous (anisotropic) reference medium and contains terms of all order in the volume concentrations of solid particles and communicating cavities, take explicitly account of inclusion shape and spatial distribution independently. We show analytically that an expansion of the T-matrix formulae to first order in the volume concentration of cavities (in agreement with the dilute estimate of Eshelby) has the correct dependence on the properties of the saturating fluid, in the sense that it is consistent with the Brown-Korringa relation, when the frequency is sufficiently low. We present numerical results for the (anisotropic) effective viscoelastic properties of a cracked permeable medium with finite storage porosity, indicating that the complete T-matrix formulae (including the higher-order terms) are generally consistent with the Brown-Korringa relation, at least if we assume the spatial distribution of cavities to be the same for all cavity pairs. We have found an efficient way to treat statistical correlations in the shapes and orientations of the communicating cavities, and also obtained a reasonable match between theoretical predictions (based on a dual porosity model for quartz-clay mixtures, involving relatively flat clay-related pores and more rounded quartz-related pores) and laboratory results for the ultrasonic velocity and attenuation spectra of a suite of typical reservoir rocks. (C) 2003 Elsevier B.V. All rights reserved.

Variation in dynamic elastic shear modulus of sandstone upon fluid saturation and substitution

Experimental acoustic measurements on sandstone rocks at both sonic and ultrasonic frequencies show that fluid saturation can cause a noticeable change in both the dynamic bulk and shear elastic moduli of sandstones. We observed that the change in dynamic shear modulus upon fluid saturation is highly dependent on the type of saturant, its viscosity, rock microstructure, and applied pressures. Frequency dispersion has some influence on dynamic elastic moduli too, but its effect is limited to the ultrasonic frequency ranges and above. We propose that viscous coupling, reduction in free surface energy, and, to a limited extent, frequency dispersion due to both local and global flow are the main mechanisms responsible for the change in dynamic shear elastic modulus upon fluid saturation and substitution, and we quantify influences.

The role of eddies in driving the tropospheric response to stratospheric heating perturbations

A simplified general circulation model has been used to investigate the chain of causality whereby changes in tropospheric circulation and temperature are produced in response to stratospheric heating perturbations. Spinup ensemble experiments have been performed to examine the evolution of the tropospheric circulation in response to such perturbations. The primary aim of these experiments is to investigate the possible mechanisms whereby a tropospheric response to changing solar activity over the 11-yr solar cycle could be produced in response to heating of the equatorial lower stratosphere. This study therefore focuses on a stratospheric heating perturbation in which the heating is largest in the tropics. For comparison, experiments are also performed in which the stratosphere is heated uniformly at all latitudes and in which it is heated preferentially in the polar region. Thus, the mechanisms discussed have a wider relevance for the impact of stratospheric perturbations on the troposphere. The results demonstrate the importance of changing eddy momentum fluxes in driving the tropospheric response. This is confirmed by the lack of a similar response in a zonally symmetric model with fixed eddy forcing. Furthermore, it is apparent that feedback between the tropospheric eddy fluxes and tropospheric circulation changes is required to produce the full model response. The quasigeostrophic index of refraction is used to diagnose the cause of the changes in eddy behavior. It is demonstrated that the latitudinal extent of stratospheric heating is important in determining the direction of displacement of the tropospheric jet and storm track.

In-street wind direction variability in the vicinity of a busy intersection in central London

We present results from fast-response wind measurements within and above a busy intersection between two street canyons (Marylebone Road and Gloucester Place) in Westminster, London taken as part of the DAPPLE (Dispersion of Air Pollution and Penetration into the Local Environment; www.dapple.org.uk) 2007 field campaign. The data reported here were collected using ultrasonic anemometers on the roof-top of a building adjacent to the intersection and at two heights on a pair of lamp-posts on opposite sides of the intersection. Site characteristics, data analysis and the variation of intersection flow with the above-roof wind direction (θref) are discussed. Evidence of both flow channelling and recirculation was identified within the canyon, only a few metres from the intersection for along-street and across-street roof-top winds respectively. Results also indicate that for oblique rooftop flows, the intersection flow is a complex combination of bifurcated channelled flows, recirculation and corner vortices. Asymmetries in local building geometry around the intersection and small changes in the background wind direction (changes in 15-min mean θref of 5–10 degrees) were also observed to have profound influences on the behaviour of intersection flow patterns. Consequently, short time-scale variability in the background flow direction can lead to highly scattered in-street mean flow angles masking the true multi-modal features of the flow and thus further complicating modelling challenges.

Hypo-accommodation responses in hypermetropic infants and children

Aims: Accommodation to overcome hypermetropia is implicated in emmetropisation. This study recorded accommodation responses in a wide range of emmetropising infants and older children with clinically significant hypermetropia to assess common characteristics and differences. Methods: A PlusoptiXSO4 photorefractor in a laboratory setting was used to collect binocular accommodation data from participants viewing a detailed picture target moving between 33cm and 2m. 38 typically developing infants were studied between 6-26 weeks of age and were compared with cross-sectional data from children 5-9 years of age with clinically significant hypermetropia (n=15), corrected fully accommodative strabismus (n=14) and 27 age-matched controls. Results: Hypermetropes of all ages under-accommodated compared to controls at all distances, whether corrected or not (p<0.00001) and lag related to manifest refraction. Emmetropising infants under-accommodated most in the distance, while the hypermetropic patient groups underaccommodated most for near. Conclusions: Better accommodation for near than distance is demonstrated in those hypermetropic children who go on to emmetropise. This supports the approach of avoiding refractive correction in such children. In contrast, hypermetropic children referred for treatment for reduced distance visual acuity are not likely to habitually accommodate to overcome residual hypermetropia left by an under-correction.

The NAO troposphere–stratosphere connection

Using monthly mean data, daily data, and theoretical arguments, relationships between surface pressure variations associated with the North Atlantic Oscillation (NAO), tropopause height, and the strength of the stratospheric vortex are established. An increase in the NAO index leads to a stronger stratospheric vortex, about 4 days later, as a result of increased equatorward refraction of upward-propagating Rossby waves. At tropopause level the effects of the enhanced NAO index and stratospheric polar vortex are opposite, resulting in a lower tropopause over Iceland and a higher tropopause over the Arctic. The raising of the Arctic tropopause leads to a stretching and spinup of the tropospheric column and is therefore associated with a lowering of the surface pressure near the North Pole. For monthly mean data it is found that a standard deviation increase in the NAO index is associated with a 10% increase in the strength of the stratospheric vortex, as measured by potential vorticity at 500 K. A simple theoretical model predicts that this is associated with about 300-m elevation of the Arctic tropopause, as is observed, and a 5-hPa lowering of the surface pressure at the North Pole. The effects of the spinup of the tropospheric column may project on the NAO pattern so that the stratosphere acts as an integrator of the NAO index.

Interactions of an anionic surfactant with poly(oxyalkylene) copolymers in aqueous solution

The interactions of sodium dodecyl sulfate (SDS) with poly(ethylene oxide)/poly(alkylene oxide) (E/A) block copolymers are explored in this study: With respect to the specific compositional characteristics of the copolymer, introduction of SDS can induce fundamentally different effects to the self-assembly behavior of E/A copolymer solutions. In the case of the E18B10-SDS system (E = poly(ethylene oxide) and B = poly(butylene oxide)) development of large surfactant-polymer aggregates was observed. In the case of B20E610-SDS, B12E227B12-SDS, E40B10E40-SDS, E19P43E19-SDS (P = poly(propylene oxide)), the formation of smaller particles compared to pure polymeric micelles points to micellar suppression induced by the ionic surfactant. This effect can be ascribed to a physical binding between the hydrophobic block of unassociated macromolecules and the non-polar tail of the surfactant. Analysis of critical micelle concentrations (cmc*) of polymer-surfactant aqueous solutions within the framework of regular solution theory for binary surfactants revealed negative deviations from ideal behavior for E40B10E40-SDS and E19P43E19-SDS, but positive deviations for E18B10-SDS. Ultrasonic studies performed for the E19P43E19-SDS system enabled the identification of three distinct regions, corresponding to three main steps of the complexation; SDS absorption to the hydrophobic backbone of polymer, development of polymer-surfactant complexes and gradual breakdown of the mixed aggregates. (C) 2008 Elsevier Inc. All rights reserved.