Láser Excimer en Vitiligo. ¿Tratamiento efectivo y seguro para esta enfermedad? Revisión sistemática de la literatura

Introducción: El vitíligo es una enfermedad prevalente en nuestro medio con una prevalencia del 2% de la población mundial. Los síntomas de esta enfermedad son principalmente estéticos al manifestarse como máculas acrómicas, simétricas en las extremidades y en rostro donde genera la mayor estigmatización de los pacientes. Actualmente ningún tratamiento provee mejoría pronta y permanente de los síntomas. Objetivo: Determinar la efectividad del Láser Excimer 308 nm en el tratamiento del vitíligo por medio de una revisión sistemática de la literatura. Métodos: Búsqueda sistemática de ensayos clínicos y estudios cuasiexperimentales en las bases de datos más importantes acerca de la efectividad del Láser Excimer 308 nm en la repigmentación de los pacientes adultos con vitíligo. Se evaluó su calidad metodológica. Resultados: De 862 artículos encontrados se escogieron 40 artículos potenciales de los cuales dos fueron incluidos en esta revisión. El láser Excimer 308 nm como monoterapia presenta una pigmentación efectiva (≥50%) en 28.03% de las áreas tratadas, de los cuales 72.9% se localizaron en áreas sensibles a radiación ultravioleta y 27.02% en zonas no sensibles. Inicio de pigmentación a la sesión número 13 (un mes post inicio del tratamiento). El láser fue seguro y bien tolerado. Conclusión: La evidencia sugiere que el tratamiento con Láser Excimer 308 nm, como monoterapia, es una alternativa terapéutica para lograr repigmentación pronta de las máculas acrómicas del vitíligo en áreas sensibles a radiación ultravioleta. Deben considerarse estudios que evalúen combinaciones de fármacos y Láser en el tratamiento de vitíligo.

A comparison of the hazard perception ability of matched groups of healthy drivers aged 35 to 55, 65 to 74, and 75 to 84 years

We examined differences in response latencies obtained during a validated video-based hazard perception driving test between three healthy, community-dwelling groups: 22 mid-aged (35-55 years), 34 young-old (65-74 years), and 23 old-old (75-84 years) current drivers, matched for gender, education level, and vocabulary. We found no significant difference in performance between mid-aged and young-old groups, but the old-old group was significantly slower than the other two groups. The differences between the old-old group and the other groups combined were independently mediated by useful field of view (UFOV), contrast sensitivity, and simple reaction time measures. Given that hazard perception latency has been linked with increased crash risk, these results are consistent with the idea that increased crash risk in older adults could be a function of poorer hazard perception, though this decline does not appear to manifest until age 75+ in healthy drivers.

Reliability and validity of physical fitness field tests for adults aged 55 to 70 years

The aim of this study was to examine the reliability and validity of field tests for assessing physical function in mid-aged and young-old people (55-70 y). Tests were selected that required minimal space and equipment and could be implemented in multiple field settings such as a general practitioner's office. Nineteen participants completed 2 field and I laboratory testing sessions. Intra-class correlations showed good reliability for the tests of upper body strength (lift and reach, R=.66), lower body strength (sit to stand, R=.80) and functional capacity (Canadian Step Test, R=.92), but not for leg power (single timed chair rise, R=.28). There was also good reliability for the balance test during 3 stances: parallel (94.7% agreement), semi-tandem (73.7%), and tandem (52.6%). Comparison of field test results with objective laboratory measures found good validity for the sit to stand (cf 1RM leg press, Pearson r=.68, p <.05), and for the step test (cf PWC140, r = -.60, p <.001), but not for the lift and reach (cf 1RM bench press, r=.43, p >.05), balance (r=-.13, -.18, .23) and rate of force development tests (r=-.28). It was concluded that the lower body strength and cardiovascular function tests were appropriate for use in field settings with mid-aged and young-old adults.

Hospital infection control units: Staffing, costs, and priorities

Background: This article describes infection prevention and control professionals’ (ICPs’) staffing levels, patient outcomes, and costs associated with the provision of infection prevention and control services in Australian hospitals. A secondary objective was to determine the priorities for infection control units. Methods: A cross-sectional study design was used. Infection control units in Australian public and private hospitals completed a Web-based anonymous survey. Data collected included details about the respondent; hospital demographics; details and services of the infection control unit; and a description of infection prevention and control-related outputs, patient outcomes, and infection control priorities. Results: Forty-nine surveys were undertaken, accounting for 152 Australian hospitals. The mean number of ICPs was 0.66 per 100 overnight beds (95% confidence interval, 0.55-0.77). Privately funded hospitals have significantly fewer ICPs per 100 overnight beds compared with publicly funded hospitals (P < .01). Staffing costs for nursing staff in infection control units in this study totaled $16,364,392 (mean, $380,566). Infection control units managing smaller hospitals (<270 beds) identified the need for increased access to infectious diseases or microbiology support. Conclusion: This study provides valuable information to support future decisions by funders, hospital administrators, and ICPs on service delivery models for infection prevention and control. Further, it is the first to provide estimates of the resourcing and cost of staffing infection control in hospitals at a national level. Copyright

Patterned growth of nanoscale in clusters on the Si(111)-7×7 and Si(111)-Ge(5×5) reconstructions

Results of a study designed to investigate the possibility of using the Si(111)- Ge(5×5) surface reconstruction as a template for In cluster growth are described. As with Si(111)-7×7, the In adatoms preferentially adsorb in the faulted half-unit cell, but on Si(111)- Ge(5×5) a richer variety of cluster geometries are found. In addition to the clusters that occupy the faulted half-unit cell, clusters that span two and four half-unit cells are found. The latter have a triangular shape spanning one unfaulted and three, nearest neighbor, faulted half-unit cells, Triangular clusters in the opposite orientation were not found. Many of the faulted halfunit cells have a streaked appearance consistent with adatom mobility.

Elastic modulus of Ti-6Al-4V-xB alloys with B up to 0.55 wt.%

An anomalous variation in the experimental elastic modulus, E, of Ti-6Al-4V-xB (with x up to 0.55 wt.%) is reported. Volume fractions and moduli of the constituent phases were measured using microscopy and nanoindentation,respectively. These were used in simple micromechanical models to examine if the E values could be rationalized. Experimental E values higher than the upper bound estimates suggest complex interplay between microstructural modifications, induced by the addition of B, and properties.

Total hip arthroplasty in young patients : with special references to patients under 55 years of age and to patients with developmental dysplasia of the hip

There is an ongoing controversy as to which methods in total hip arthroplasty (THA) could provide young patients with best long-term results. THA is an especially demanding operation in patients with severely dysplastic hips. The optimal surgical treatment for these patients also remains controversial. The aim of this study was to evaluate the long-term survival of THA in young patients (<55 years at the time of the primary operation) on a nation-wide level, and to analyze the long-term clinical and radio-graphical outcome of uncemented THA in patients with severely dysplastic joints. Survival of 4661 primary THAs performed for primary osteoarthritis (OA), 2557 primary THAs per-formed for rheumatoid arthritis (RA), and modern uncemented THA designs performed for primary OA in young patients, were analysed from the Finnish Arthroplasty Register. A total of 68 THAs were per-formed in 56 consecutive patients with high congenital hip dislocation between 1989-1994, and 68 THAs were performed in 59 consecutive patients with severely dysplastic hips and a previous Schanz osteotomy of the femur between 1988-1995 at the Orton Orthopaedic Hospital, Helsinki, Finland. These patients underwent a detailed physical and radiographical evaluation at a mean of 12.3 years and 13.0 years postoperatively, respectively. The risk of stem revision due to aseptic loosening in young patients with primary OA was higher for cemented stems than for proximally porous-coated or HA-coated uncemented stems implanted over the 1991-2001 period. There was no difference in the risk of revision between all-poly cemented-cups and press-fit porous-coated uncemented cups implanted during the same period, when the end point was defined as any revision (including exchange of liner). All uncemented stem designs studied in young patients with primary OA had >90% survival rates at 10 years. The Biomet Bi-Metric stem had a 95% (95% CI 93-97) survival rate even at 15 years. When the end point was defined as any revision, 10 year survival rates of all uncemented cup designs except the Harris-Galante II decreased to <80%. In young patients with RA, the risk of stem revision due to aseptic loosening was higher with cemented stems than with proximally porous-coated uncemented stems. In contrast, the risk of cup revision was higher for all uncemented cup concepts than for all-poly cemented cups with any type of cup revision as the end point. The Harris hip score increased significantly (p<0.001) both in patients with high con-genital hip dislocation and in patients with severely dysplastic hips and a previous Schanz osteotomy, treated with uncemented THA. There was a negative Trendelenburg sign in 92% and in 88% of hips, respectively. There were 12 (18%) and 15 (22%) perioperative complications. The rate of survival for the CDH femoral components, with revision due to aseptic loosening as the end point, was 98% (95% CI 97-100) at 10 years in patients with high hip dislocation and 92% (95% CI, 86-99) at 14 years in patients with a previous Schanz osteotomy. The rate of survival for press-fit, porous-coated acetabular components, with revision due to aseptic loosening as the end point, was 95% (95% CI 89-100) at 10 years in patients with high hip dislocation, and 98% (95% CI 89-100) in patients with a previous Schanz osteotomy. When revision of the cup for any reason was defined as the end point, 10 year sur-vival rates declined to 88% (95% CI 81-95) and to 69% (95% CI, 56-82), respectively. For young patients with primary OA, uncemented proximally circumferentially porous- and HA-coated stems are the implants of choice. However, survival rates of modern uncemented cups are no better than that of all-poly cemented cups. Uncemented proximally circumferentially porous-coated stems and cemented all-poly cups are currently the implants of choice for young patients with RA. Uncemented THA, with placement of the cup at the level of the true acetabulum, distal advancement of the greater trochanter and femoral shortening osteotomy provided patients with high congenital hip dislocation good long-term outcomes. Most of the patients with severely dysplastic hips and a previous Schanz osteotomy can be successfully treated with the same method. However, the subtrochanteric segmental shortening with angular correction gives better leg length correction for the patients with a previous low-seated unilateral Schanz osteotomy.

Role of rigidity and temperature in the kinetics of photodarkening in Ge(x)As((45-x))Se(55) thin films

We present insightful results on the kinetics of photodarkening (PD) in Ge(x)As(45-x)Se(55) glasses at the ambient and liquid helium temperatures when the network rigidity is increased by varying x from 0 to 16. We observe a many fold change in PD and its kinetics with decreasing network flexibility and temperature. Moreover, temporal evolution of PD shows a dramatic change with increasing x. (C)2011 Optical Society of America

Dissimilar friction stir welding between aluminum alloy and magnesium alloy at a low rotational speed

A sound weld was obtained between 2024-T3 Al alloy and AZ31B-O Mg alloy dissimilar metal plates of 5 mm thickness, at a rotational speed of 300 rev min(-1) and at a welding speed of 50 mm min(-1). One of the parameter studied was, the effect of interface offset variation, on the quality and properties of the welded samples and on the thickness of intermetallic layer formed in the welded samples. The intermetallic layer at the midst of the weld volume contains intermetallic compounds Al12Mg17 and Al3Mg2. Highest tensile strength of 106.86 MPa, corresponding tensile joint efficiency of 44.52% and corresponding elongation 1.33% were obtained for the tensile sample, with interface offset of 0.66 mm from zero interface offset in retreating side and with approximate least intermetallic thickness of 1.2 mu m. Dissimilar friction stir welded joint samples had failed completely in brittle fracture mode; the position of tensile fracture was located at the midst of intermetallic layer, which had maximum hardness and minimum ductility. The nano hardness values fluctuate in the weld nugget owing to dynamic recrystallization of alloy materials and formation of brittle intermetallic compounds of alloy materials in the weld nugget; maximum hardness of 10.74 GPa occurred for the sample with least intermetallic thickness of 1.2 mu m. (C) 2014 Elsevier B.V. All rights reserved.

Influencia de rotación de cultivos y métodos de control sobre la dinámica de las malezas y el crecimiento, desarrollo y rendimiento del sorgo (Sorghum bicolor (L) Moench) var. D-55)

En la Estación Experimental de Las Mercedes municipio de Managua, se inició en la época de postrera en 1991, un experimento de rotación de cultivos bajo diferentes niveles de control de malezas. El presente trabajo evaluó el efecto de los cultivos antecesores sorgo, maíz y pepino con tres niveles de control de malezas : químico, período crítico y limpias periódicas a la dinámica de la cenosis de malezas, crecimiento y rendimiento del cultivo sucesor sorgo. Cuando antecedió el pepino la abundancia de maleza fue mayor con 504 Ind/m2 reduciéndose considerablemente a la cosecha obteniendo una biomasa promedio de 133.9 gr/m2. Sucedió lo contrario con maíz como cultivo antecesor ya que al principio la abundancia fue de 201 Ind/m2 y se obtuvo la mayor biomasa con 259.8 gr/m2 y para sorgo-sorgo tuvo valores de 232 Ind/m2 y a la cosecha en menor valor en biomasa de sorgo 130.0 gr/m2. En el rendimiento se enmarcó una tendencia a favor de maíz como cultivo antecesor con 1878 Kg/ha de sorgo, mientras sorgo-sorgo obtuvo un rendimiento de 1839 Kg/ha comparándose con pepino como antecesor con 1832 Kg/ha de sorgo. Comparando los controles aquí hubo diferencias significativas y en mayor valor le correspondió al control químico con 2048.0 Kg/ha, control período crítico con 1786 Kg/ha y el menor valor le correspondió a limpia periódica con sólo 1715 Kg/ha. En el control período crítico presentó mayor abundancia la maleza al inicio con 444 Ind/m2, teniendo una reducción hasta 62 Ind/m2 en la cosecha. El control químico tuvo un comportamiento similar que el control período crítico con 295 Ind/m2, reduciendo al final del ciclo con 135 Ind/m2. El control limpias periódicas tuvo al inicio la menor abundancia con 200 Ind/m2, reduciendo a la cosecha a 3 Ind/m2.