Superiority of the Triple Combination of Bortezomib-Thalidomide-Dexamethasone Over the Dual Combination of Thalidomide-Dexamethasone in Patients With Multiple Myeloma Progressing or Relapsing After Autologous Transplantation: The MMVAR/IFM 2005-04 Randomized Phase III Trial From the Chronic Leukemia Working Party of the European Group for Blood and Marrow Transplantation.

PURPOSE This prospective multicenter phase III study compared the efficacy and safety of a triple combination (bortezomib-thalidomide-dexamethasone [VTD]) versus a dual combination (thalidomide-dexamethasone [TD]) in patients with multiple myeloma (MM) progressing or relapsing after autologous stem-cell transplantation (ASCT). PATIENTS AND METHODS Overall, 269 patients were randomly assigned to receive bortezomib (1.3 mg/m(2) intravenous bolus) or no bortezomib for 1 year, in combination with thalidomide (200 mg per day orally) and dexamethasone (40 mg orally once a day on 4 days once every 3 weeks). Bortezomib was administered on days 1, 4, 8, and 11 with a 10-day rest period (day 12 to day 21) for eight cycles (6 months), and then on days 1, 8, 15, and 22 with a 20-day rest period (day 23 to day 42) for four cycles (6 months). Results Median time to progression (primary end point) was significantly longer with VTD than TD (19.5 v 13.8 months; hazard ratio, 0.59; 95% CI, 0.44 to 0.80; P = .001), the complete response plus near-complete response rate was higher (45% v 25%; P = .001), and the median duration of response was longer (17.2 v 13.4 months; P = .03). The 24-month survival rate was in favor of VTD (71% v 65%; P = .093). Grade 3 peripheral neuropathy was more frequent with VTD (29% v 12%; P = .001) as were the rates of grades 3 and 4 infection and thrombocytopenia. CONCLUSION VTD was more effective than TD in the treatment of patients with MM with progressive or relapsing disease post-ASCT but was associated with a higher incidence of grade 3 neurotoxicity.

Avaluació d’indicadors de qualitat del sòl. Carboni orgànic, salinitat i sodicitat a les Terres de l’Ebre

Aquest PFC s’ha desenvolupat en el si de la Secció d’Avaluació de Recursos Agraris (SARA) de la el Departament d’Agricultura, Alimentació i Acció Rural (DAR) de la Generalitat de Catalunya. Des de la SARA s’ha participat en un projecte iniciat a principis de l’any 2006 des de la Unió Europea, ENVironmental ASessment of SOil for monitoring (ENVASSO), que pretén elaborar protocols basats en criteris i indicadors establerts per a la caracterització del sòls. Aquests protocols han de permetre dissenyar estratègies comunes als diferents Estats Membres per poder informar als encarregats de desenvolupar la política europea de protecció del sòl. D’entre els indicadors contemplats en el projecte europeu s’ha decidit que aquest projecte es centraria en el contingut de carboni orgànic del sòl (COS) i en la salinitat i la sodicitat. Desenvolupar aquest treball en el context de l’avaluació del contingut de COS en les Terres de l’Ebre i del monitoratge de la salinitat i de la sodicitat al Delta de l’Ebre resulta interessant per tenir coneixement d’aquests dos indicadors en una zona on l’agricultura pot patir importants canvis a nivell d’usos del sòl en els propers anys.

Influència dels usos del sòl en l’evolució de la dinàmica hidrològica d’una conca. Estudi de cas a l’Anoia, 1977-2008

L’objectiu d’aquest treball radica en estimar quina és la influència dels usos del sòl en la resposta hidrològica d’una conca. En primer lloc s’analitza la influència estadística dels usos del sòl conjuntament amb variables climàtiques, en la seva relació amb el volum d’escolament generat. Per a aquests càlculs s’empra una aproximació de l’evolució del número de corba durant el període d’estudi. D’altra banda s’estima quines són les diferències en l’hidrograma de sortida d’una conca degudes als usos del sòl per a condicions climàtiques iguals i emprant l’aiguat de disseny per a un període de retorn de 10 anys.

Prevalence of Acute Coronary Syndrome in Patients Suspected for Pulmonary Embolism or Acute Aortic Syndrome: Rationale for the Triple Rule-out Concept.

BACKGROUND: The aims of the study were to evaluate the prevalence of acute coronary syndrome (ACS) among patients presenting with atypical chest pain who are evaluated for acute aortic syndrome (AAS) or pulmonary embolism (PE) with computed tomoangiography (CTA) and discuss the rationale for the use of triple rule-out (TRO) protocol for triaging these patients. METHODS: This study is a retrospective analysis of patients presenting with atypical chest pain and evaluated with thoracic (CTA), for suspicion of AAS/PE. Two physicians reviewed patient files for demographic characteristics, initial CT and final clinical diagnosis. Patients were classified according to CTA finding into AAS, PE and other diagnoses and according to final clinical diagnosis into AAS, PE, ACS and other diagnoses. RESULTS: Four hundred and sixty-seven patients were evaluated: 396 (84.8%) patients for clinical suspicion of PE and 71 (15.2%) patients for suspicion of AAS. The prevalence of ACS and AAS was low among the PE patients: 5.5% and 0.5% respectively (P = 0.0001), while the prevalence of ACS and PE was 18.3% and 5.6% among AAS patients (P = 0.14 and P = 0.34 respectively). CONCLUSION: The prevalence of ACS and AAS among patients suspected clinically of having PE is limited while the prevalence of ACS and PE among patients suspected clinically of having AAS is significant. Accordingly patients suspected for PE could be evaluated with dedicated PE CTA while those suspected for AAS should still be triaged using TRO protocol.

Myofascial pain associated to trigger points: A literature review. Part 2: Differential diagnosis and treatment

During the last decades the advance in knowledge of myofascial pain has been constant in the medical and dental community. However, although several aspects have been clarified in relation to its epidemiology, clinical characteristics and etiopathogenesis, many uncertainties remain. Many clinical conditions are included in the differential diagnosis of myofascial pain associated to trigger points. A good anamnesis and clinical exploration is thus required in order to ensure correct diagnosis and treatment. Among the numerous treatments used in application to trigger points, the spray-and-stretch technique and direct injection targeted to such trigger points have been found to be the most effective options. In chronic cases, psychosocial intervention is required, due to the high incidence of mood disorders and/or anxiety observed in these patients, who in turn present a poorer prognosis. This underscores the importance of early diagnosis and treatment.

A Lead-In with Silibinin Prior to Triple-Therapy Translates into Favorable Treatment Outcomes in Difficult-To-Treat HIV/Hepatitis C Coinfected Patients.

BACKGROUND: The efficacy of first-generation protease inhibitor based triple-therapy against hepatitis C virus (HCV) infection is limited in HIV/HCV-coinfected patients with advanced liver fibrosis and non-response to previous peginterferon-ribavirin. These patients have a low chance of achieving a sustained virologic response (SVR) using first generation triple-therapy, with a success rate of only 20%. We investigated the efficacy and safety of lead-in therapy with intravenous silibinin followed by triple-therapy in this difficult-to-treat patient group. METHODOLOGY: Inclusion criteria were HIV/HCV coinfection with advanced liver fibrosis and documented previous treatment failure on peginterferon-ribavirin. The intervention was a lead-in therapy with intravenous silibinin 20 mg/kg/day for 14 days, followed by triple-therapy (peginterferon-ribavirin and telaprevir) for 12 weeks, and peginterferon-ribavirin alone for 36 weeks. Outcome measurements were HCV-RNA after silibinin lead-in and during triple-therapy, SVR data at week 12, and safety and tolerability of silibinin. RESULTS: We examined sixteen HIV/HCV-coinfected patients with previous peginterferon-ribavirin failure, of whom 14 had a fibrosis grade METAVIR ≥F3. All were on successful antiretroviral therapy. Median (IQR) HCV-RNA decline after silibinin therapy was 2.65 (2.1-2.8) log10 copies/mL. Fifteen of sixteen patients (94%) had undetectable HCV RNA at weeks 4 and 12, eleven patients (69%) showed end-of-treatment response (i.e., undetectable HCV-RNA at week 48), and ten patients (63%) reached SVR at week 12 (SVR 12). Six of the sixteen patients (37%) did not reach SVR 12: One patient had rapid virologic response (RVR) (i.e., undetectable HCV-RNA at week 4) but stopped treatment at week 8 due to major depression. Five patients had RVR, but experienced viral breakthroughs at week 21, 22, 25, or 32, or a relapse at week 52. The HIV RNA remained below the limit of detection in all patients during the complete treatment period. No serious adverse events and no significant drug-drug interactions were associated with silibinin. CONCLUSION: A lead-in with silibinin before triple-therapy was safe and highly effective in difficult-to-treat HIV/HCV coinfected patients, with a pronounced HCV-RNA decline during the lead-in phase, which translates into 63% SVR. An add-on of intravenous silibinin to standard of care HCV treatment is worth further exploration in selected difficult-to-treat patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT01816490.

Sonata no. 2 in A major for violin and piano, op. 100 ("Thun")

Soitinnus: Viulu, piano.

The efficacy of moxifloxacin-based triple therapy in treatment of Helicobacter pylori infection: a systematic review and meta-analysis of randomized clinical trials

Recent evidence shows that moxifloxacin could exert an antimicrobial effect against Helicobacter pylori in both in vitroand in vivo models. To systematically evaluate whether moxifloxacin-containing triple therapy could improve eradication rates and reduce side effects in first-line or second-line anti-H. pyloritreatment, eligible articles were identified by searches of electronic databases. We included all randomized trials comparing moxifloxacin-based triple therapy with standard triple or quadruple therapy during H. pylori eradication treatment. Statistical analysis was performed with Review Manager 5.0.10. Subanalysis/sensitivity analysis was also performed. We identified seven randomized trials (n=1263). Pooled H. pylori eradication rates were 79.03% (95%CI: 75.73-82.07) and 68.33% (95%CI: 64.44-72.04) for patients with moxifloxacin-based triple therapy or with standard triple or quadruple therapy, respectively (intention-to-treat analysis). The odds ratio (OR) was 1.82 (95%CI: 1.17-2.81), the occurrence of total side effects was 15.23% (95%CI: 12.58-18.20) and 27.17% (95%CI: 23.64-30.92) for groups with or without moxifloxacin, and the summary OR was 0.45 (95%CI: 0.26-0.77). In subgroup analyses, we noted that the second-line eradication rate in the moxifloxacin group was significantly higher than that in the quadruple therapy group (73.33 vs 60.17%, OR: 1.78, 95%CI: 1.16-2.73, P<0.001). However, there was no difference in first-line eradication treatment. Findings from this meta-analysis suggest that moxifloxacin-based triple therapy is more effective and better tolerated than standard triple or quadruple therapy. Therefore, a moxifloxacin-based triple regimen should be used in the second-line treatment of H. pylori infection.

Tratamiento de un efluente salino proveniente de una papelera, mediante un sistema de evaporación de triple efecto

1Tesis] ( Maestría en Ciencias con Especialidad en Ingeniería Ambiental) U.A.N.L.

Modificación en el orden de los componentes de fuerza en un atleta de salto triple. (un estudio de caso).

Tesis (Maestría en Ciencias del Ejercicio) UANL, 2012.

L'expedition du Mexique : réhabilitée au triple ponit de vue, religieux, politique et commercial.

UANL

L'equilibre europeen a la fin du dix-neuvieme siecle; francais and russes vis-a-vis la triple alliance

UANL

A Triple-mode Sigma-delta Modulator Design for Wireless Standards

This work presents a triple-mode sigma-delta modulator for three wireless standards namely GSM/WCDMA and Bluetooth. A reconfigurable ADC has been used to meet the wide bandwidth and high dynamic range requirements of the multi-standard receivers with less power consumption. A highly linear sigma-delta ADC which has reduced sensitivity to circuit imperfections has been chosen in our design. This is particularly suitable for wide band applications where the oversampling ratio is low. Simulation results indicate that the modulator achieves a peak SNDR of 84/68/68 dB over a bandwidth of 0.2/3.84/1.5 MHz with an oversampling ratio 128/8/8 in GSM/WCDMA/Bluetooth modes respectively

A Triple-Mode Feed-Forward Sigma-Delta Modulator Design For Gsm / Wcdma / Wlan Applications

This paper presents a cascaded 2-2-2 reconfigurable sigma-delta modulator that can handle GSM, WCDMA and WLAN standards. The modulator makes use of a low-distortion swing suppression topology which is highly suitable for wide band applications. In GSM mode, only the first stage (2nd order Σ-Δ ADC) is turned on to achieve 88dB dynamic range with oversampling ratio of 160 for a bandwidth of 200KHz; in WCDMA mode a 2-2 cascaded structure (4th order) is turned on with 1-bit in the first stage and 2-bit in the second stage to achieve 74 dB dynamic range with oversampling ratio of 16 for a bandwidth of 2MHz and a 2-2-2 cascaded MASH architecture with a 4-bit in the last stage to achieve a dynamic range of 58dB for a bandwidth of 20MHz. The novelty lies in the fact that unused blocks of second and third stages can be switched off taking into considerations like power consumption. The modulator is designed in TSMC 0.18um CMOS technology and operates at 1.8 supply voltage.

La Web 2.0 en la enseñanza de introducción a la arquitectura

Introducción a la Arquitectura es una asignatura de primer curso que se imparte en la Escuela de Arquitectura de la Universidad de A Coruña. En ella se pretende iniciar la formación del futuro profesional atendiendo desde el comienzo, al triple soporte reflexivo, proyectivo y constructivo del hecho arquitectónico: Se trata de despertar o acrecentar el interés por la Arquitectura y por su razón de ser, aproximándose a su concepto desde una visión teórica e histórica, y fomentando la capacidad analítica, el sentido crítico y el desarrollo lógico del alumno en el territorio propio de la arquitectura, que va desde el urbanismo hasta el diseño elemental. El camino hacia la inminente implantación del Proceso de Bolonia, donde el nuevo concepto de crédito europeo matiza la necesidad de control y responsabilidad de y hacia el alumno, así como la redefinición del sistema universitario a partir del acceso a la sociedad del Conocimiento, nos conduce a la necesidad de incorporar las nuevas tecnologías como nuevo modo de control y relación profesor-alumno dentro de la asignatura. Dentro de este planteamiento se ha trabajado desde hace dos años utilizando herramientas Web 2.0 tanto como elementos de comunicación y debate entre profesores y alumnos como entre los propios alumnos, lo que nos permite realizar un análisis de experiencias y valorar críticamente los resultados obtenidos