Uretero-uretero anastomosis: una alternativa para pacientes con patología asociada a doble sistema colector

Introducción El doble sistema colector es la alteración renal más frecuente y presenta una incidencia 1/500 individuos. Hay varias opciones de tratamiento para el uréter con reflujo o severamente dilatado cuando se asocia a un sistema duplicado, entre ellas la uretero-uretero anastomosis. El objetivo es dar a conocer nuestra experiencia en la realización de este procedimiento para pacientes pediátricos. Materiales y métodos: Se presenta una serie de casos entre Enero 2010 y Abril 2014, se revisaron 214 historias clínicas de pacientes con doble sistema colector y patologías asociadas; 10 fueron sometidos a uretero-uretero anastomosis. El Seguimiento posopertorio fue de 12 meses promedio. Resultados: Se incluyeron 10 pacientes. El 70% fueron género femenino, la edad promedio al momento de la cirugía fue 5 años . Todos cursaban con infección urinaria y 10% presentaban incontinencia urinaria. En el postoperatorio, en 40% se encontró uréter ectópico, 30% ureterocele intravesical y 30% reflujo vesicoureteral al sistema inferior. Se realizaron siete anastomosis del sistema superior al inferior y tres del inferior al superior, todos por una incisión de 2cm a nivel inguinal y fueron derivados con catéter doble J sin complicaciones postoperatorias. Al tiempo de seguimiento la totalidad de los pacientes se encontraron sin profilaxis antibiótica, con dilatación resuelta, sin infecciones urinarias ni incontinencia. Conclusión: La uretero-uretero anastomosis es una alternativa fiable, segura y con mínima morbilidad para el tratamiento de pacientes con patología asociada a doble sistema colector. Estudios adicionales, con mayor número de pacientes y seguimiento serán necesarios para ver evolución a largo plazo.

Tratamiento de Artritis reumatoide con antagonistas del factor de necrosis tumoral alfa y su asociación con el desarrollo de melanoma cutáneo: revisión sistemática de la literatura y meta-análisis.

Introducción: El tratamiento con antagonistas del factor de necrosis tumoral alfa (anti TNF) ha impactado el pronóstico y la calidad de vida de los pacientes con artritis reumatoide (AR) positivamente, sin embargo, se interroga un incremento en el riesgo de desarrollar melanoma. Objetivo: Conocer la asociación entre el uso de anti TNF y el desarrollo de melanoma maligno en pacientes con AR. Metodología: Se realizó una búsqueda sistemática en MEDLINE, EMBASE, COCHRANE LIBRARY y LILACS para ensayos clínicos, estudios observacionales, revisiones y meta-análisis en pacientes adultos con diagnóstico de AR y manejo con anti TNF (Certolizumab pegol, Adalimumab, Etanercept, Infliximab y Golimumab). Resultados: 37 estudios clínicos cumplieron los criterios de inclusión para el meta-análisis, con una población de 16567 pacientes. El análisis de heterogeneidad no fue significativo (p=1), no se encontró diferencia en el riesgo entre los grupos comparados DR -0.00 (IC 95% -0.001; -0.001). Un análisis adicional de los estudios en los que se reportó al menos 1 caso de melanoma (4222 pacientes) tampoco mostró diferencia en el riesgo DR -0.00 (IC 95% -0.004 ; -0.003). Conclusión: En la evidencia disponible a la fecha no encontramos asociación significativa entre el tratamiento con anti TNF en pacientes con diagnóstico de AR y el desarrollo de melanoma cutáneo.

Texte de présentation sur les concepts muséologiques dans leurs rapports avec les systèmes muséologiques actuels responsables de bouleversements: une double hystérie ?

Les concepts, les notions, les langages qui en découlent, sont intimement lies aux systèmes et aux contextes qui alimentent la forme et la vie du musée. Depuis que la question se pose, où va la muséologie qui a emprunté la voie du changement dans les années 70, 80 et 90, une réflexion sur les principaux vecteurs de transformation de l’institution dex fois séculaire s’impose. Bien que la plupart des musées et de ses dérivatifs (60%) possédant une crédibilité dans le monde occidental , malgré les réformes de modernisation introduites ( attention aux publics, presentation améliorée ) demeurent attachés à la tradition qui en determine l’image, on peut affirmer, sans se tromper, qu’un pan considerable de la muséologie de la période post-moderne (20% en terme de volume d’activité ) est à peine reconnaissable, si on se réfère à la periode antérieure à la deuxième moitié du 20ème siècle. Le concept de MUSEE, dans deux champs antagonistes ou complémentaires, selon l’angle d’analyse, soit la muséologie entrée de plein pied dans les industries culturelles de l ‘ère des communications, et la muséologie (ou l’anti-musée) ayant adopté le parti-pris de l’intervention sociale, véhicules de systèmes idéologiques et organisationnels rompant radicalement avec un passé recent, se partageant entre la mondialisation globalisante et les aspirations du mouvement alter-mondialiste puissant dans la tradition associative. Tributaires d’une part des luttes libératrices (60/70), de la contestation des valeurs, d’autre part des technologies (80/90), de la globalisation (90. ), ces musólogies ( systéme binaire ) prennent la vedette à l’aide de changements irréversibles dans l’ordre des functions du musée.

How to avoid a double-dip recession in the eurozone. CEPS Commentary, 15 November 2012

This CEPS Commentary argues that the way in which the burden of adjustment to the imbalances in the eurozone is borne almost exclusively by the deficit countries in the periphery produces a deflationary bias in the region as a whole. Against the threat of double-dip recession, Paul De Grauwe asserts that the adjustment could be done differently and calls for implementation of a more symmetric macroeconomic policy that reduces the deflationary bias.

A double-Gerdien instrument for simultaneous bipolar air conductivity measurements on balloon platforms

A bipolar air conductivity instrument is described for use with a standard disposable meteorological radiosonde package. It is intended to provide electrical measurements at cloud boundaries, where the ratio of the bipolar air conductivities is affected by the presence of charged particles. The sensors are two identical Gerdien-type electrodes, which, through a voltage decay method, measure positive and negative air conductivities simultaneously. Voltage decay provides a thermally stable approach and a novel low current leakage electrometer switch is described which initiates the decay sequence. The radiosonde supplies power and telemetry, as well as measuring simultaneous meteorological data. A test flight using a tethered balloon determined positive (σ+) and negative (σ−) conductivities of σ+ = 2.77±0.2 fS m−1 and σ− = 2.82±0.2 fS m−1, respectively, at 400 m aloft, with σ+/σ− = 0.98±0.04.

Subseasonal extremes of precipitation and active-break cycles of the Indian summer monsoon in a climate-change scenario

Changes to the behaviour of subseasonal precipitation extremes and active-break cycles of the Indian summer monsoon are assessed in this study using pre-industrial and 2 × CO2 integrations of the Hadley Centre coupled model HadCM3, which is able to simulate the monsoon seasonal cycle reasonably. At 2 × CO2, mean summer rainfall increases slightly, especially over central and northern India. The mean intensity of daily precipitation during the monsoon is found to increase, consistent with fewer wet days, and there are increases to heavy rain events beyond changes in the mean alone. The chance of reaching particular thresholds of heavy rainfall is found to approximately double over northern India, increasing the likelihood of damaging floods on a seasonal basis. The local distribution of such projections is uncertain, however, given the large spread in mean monsoon rainfall change and associated extremes amongst even the most recent coupled climate models. The measured increase of the heaviest precipitation events over India is found to be broadly in line with the degree of atmospheric warming and associated increases in specific humidity, lending a degree of predictability to changes in rainfall extremes. Active-break cycles of the Indian summer monsoon, important particularly due to their effect on agricultural output, are shown to be reasonably represented in HadCM3, in particular with some degree of northward propagation. We note an intensification of both active and break events, particularly when measured against the annual cycle, although there is no suggestion of any change to the duration or likelihood of monsoon breaks. Copyright © 2009 Royal Meteorological Society

Comparison of ammonium lactate, sodium bicarbonate and double calcium lactate methods for extraction of phosphorus from wetland peat soils

Procedures for routine analysis of soil phosphorus (P) have been used for assessment of P status, distribution and P losses from cultivated mineral soils. No similar studies have been carried out on wetland peat soils. The objective was to compare extraction efficiency of ammonium lactate (PAL), sodium bicarbonate (P-Olsen), and double calcium lactate (P-DCaL) and P distribution in the soil profile of wetland peat soils. For this purpose, 34 samples of the 0-30, 30-60 and 60-90 cm layers were collected from peat soils in Germany, Israel, Poland, Slovenia, Sweden and the United Kingdom and analysed for P. Mean soil pH (CaCl2, 0.01 M) was 5.84, 5.51 and 5.47 in the 0-30, 30-60 and 60-90 cm layers, respectively. The P-DCaL was consistently about half the magnitude of either P-AL or P-Olsen. The efficiency of P extraction increased in the order P-DCaL < P-AL &LE; P-Olsen, with corresponding means (mg kg(-1)) for all soils (34 samples) of 15.32, 33.49 and 34.27 in 0-30 cm; 8.87, 17.30 and 21.46 in 30-60 cm; and 5.69, 14.00 and 21.40 in 60-90 cm. The means decreased with depth. When examining soils for each country separately, P-Olsen was relatively evenly distributed in the German, UK and Slovenian soils. P-Olsen was linearly correlated (r = 0.594, P = 0.0002) with pH, whereas the three P tests (except P-Olsen vs P-DCaL) significantly correlated with each other (P = 0.017850.0001). The strongest correlation (r = 0.617, P = 0.0001) was recorded for P-AL vs P-DCaL) and the two methods were inter-convertible using a regression equation: P-AL = -22.593 + 5.353 pH + 1.423 P-DCaL, R-2 = 0.550.

A double data rate (DDR) architecture for OFDM based wireless consumer devices

The creation of OFDM based Wireless Personal Area Networks (WPANs) has allowed the development of high bit-rate wireless communication devices suitable for streaming High Definition video between consumer products, as demonstrated in Wireless-USB and Wireless-HDMI. However, these devices need high frequency clock rates, particularly for the OFDM, FFT and symbol processing sections resulting in high silicon cost and high electrical power. The high clock rates make hardware prototyping difficult and verification is therefore very important but costly. Acknowledging that electrical power in wireless consumer devices is more critical than the number of implemented logic gates, this paper presents a Double Data Rate (DDR) architecture for implementation inside a OFDM baseband codec in order to reduce the high frequency clock rates by a complete factor of 2. The presented architecture has been implemented and tested for ECMA-368 (Wireless- USB context) resulting in a maximum clock rate of 264MHz instead of the expected 528MHz clock rate existing anywhere on the baseband codec die.

A double data rate (DDR) architecture for OFDM based wireless consumer devices

The creation of OFDM based Wireless Personal Area Networks (WPANs) has allowed high bit-rate wireless communication devices suitable for streaming High Definition video between consumer products as demonstrated in Wireless- USB. However, these devices need high clock rates, particularly for the OFDM sections resulting in high silicon cost and high electrical power. Acknowledging that electrical power in wireless consumer devices is more critical than the number of implemented logic gates, this paper presents a Double Data Rate (DDR) architecture to reduce the OFDM input and output clock rate by a factor of 2. The architecture has been implemented and tested for Wireless-USB (ECMA-368) resulting in a maximum clock of 264MHz instead of 528MHz existing anywhere on the die.

An application of the DEA double bootstrap to examine sources of efficiency in Bangladesh rice farming

In this article we examine sources of technical efficiency for rice farming in Bangladesh. The motivation for the analysis is the need to close the rice yield gap to enable food security. We employ the DEA double bootstrap of Simar and Wilson (2007) to estimate and explain technical efficiency. This technique overcomes severe limitations inherent in using the two-stage DEA approach commonly employed in the efficiency literature. From a policy perspective our results show that potential efficiency gains to reduce the yield gap are greater than previously found. Statistically positive influences on technical efficiency are education, extension and credit, with age being a negative influence.

Application of a double bootstrap to investigation of determinants of technical efficiency of farms in Central Europe

The paper provides one of the first applications of the double bootstrap procedure (Simar and Wilson 2007) in a two-stage estimation of the effect of environmental variables on non-parametric estimates of technical efficiency. This procedure enables consistent inference within models explaining efficiency scores, while simultaneously producing standard errors and confidence intervals for these efficiency scores. The application is to 88 livestock and 256 crop farms in the Czech Republic, split into individual and corporate.

Application of a double bootstrap to investigation of determinants of technical efficiency of farms in Central Europe

The paper provides one of the first applications of the double bootstrap procedure (Simar and Wilson 2007) in a two-stage estimation of the effect of environmental variables on non-parametric estimates of technical efficiency. This procedure enables consistent inference within models explaining efficiency scores, while simultaneously producing standard errors and confidence intervals for these efficiency scores. The application is to 88 livestock and 256 crop farms in the Czech Republic, split into individual and corporate.