Eficacia de una estrategia para mejorar los indicadores de calidad del Proceso Asistencial Integrado Diabetes Mellitus 2 en el Centro Avanzado de Diabetes Macarena

Introduction

The assessment of the Diabetes Mellitus 2 Care Process (PAI-DM2) through the assessment tool for the chronic illness’ care models (IEMAC-Diabetes) allows the design of health interventions for the improvement of medical care.

Management of positive margins after initial lumpectomy in elderly women with breast cancer

Introduction

It is unknown whether the treatment disparity observed between young and elderly women extends to the management of positive margins after initial lumpectomy. The primary aim was to evaluate the management of positive margins after initial lumpectomy in elderly women.

Effects of excitatory amino acids and neuropeptide Y on the discharge activity of suprachiasmatic neurons in rat brain slices

Effects of

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-glutamate, AMPA, NMDA and NPY on the discharge activity of neurons located in the ventral subdivision of the suprachiasmatic nucleus were examined in submerged coronal slices of the rat hypothalamus. All substances were bath applied. Application of

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-glutamate (14 neurons examined) induced an excitatory response in 8 suprachiasmatic neurons (+248.9±122.24%, mean±S.E.M.; P<0.001). A biphasic response, i.e. an initial transient excitation (+54.3±8.21%; P<0.001) succeeded by an inhibition (−66.2±9.31%; P<0.001), was observed in 6 neurons. Application of AMPA (36 neurons examined) resulted in an excitation of 31 neurons (+209.2±58.58%; P<0.0001). Application of NMDA (57 neurons examined) induced an excitation in 34 neurons (+253.8±91.18%; P<0.0001), but an inhibition in 8 neurons (−75.7±6.52; P<0.0001). Biphasic effects of NMDA with an excitatory component (+58.7±9.94%; P<0.0001) succeeded by an inhibitory component (−62.0±8.07%; P<0.0001) were observed in 13 neurons. In 5 of 13 examined cases, the inhibitory component of neuronal responses to NMDA was significantly attenuated by the simultaneous application of strychnine (attenuation was 56%; P<0.05). The application of NPY (40 neurons examined) induced significant effects on the discharge rate of 29 suprachiasmatic neurons. 18 of these neurons were inhibited (−59.3±6.39%; P<0.0001) whereas 11 neurons were excited (+156.6±107.22%; P<0.001) by NPY. In 8 of 11 neurons examined, the NPY-induced inhibition was significantly attenuated by 92% during simultaneous application of strychnine (P<0.001). In 23 NPY-sensitive neurons, the discharge activity was also affected by NMDA. Neurons excited by NPY were also excited by NMDA (8 cells). In neurons inhibited by NPY, application of NMDA induced either an inhibition (3 cells) an excitation (5 cells) or a biphasic effect (7 cells). Results suggest a direct excitatory effect of AMPA, NMDA and NPY on suprachiasmatic neurons. In contrast, inhibitory actions of NMDA and NPY are considered induced by an activation of inhibitory interneurons. Antagonistic effects of strychnine suggest an involvement of glycinergic interneurons in a subpopulation of neurons inhibited by NMDA and in most neurons inhibited by NPY. The involvement of inhibitory mechanisms in photic entrainment of the circadian system is discussed. An integrative model of excitatory and inhibitory actions of EAA and NPY on suprachiasmatic neurons is proposed.     

Variability of interferon-γ release assays in people at high risk of tuberculosis infection or progression to tuberculosis disease living in the United States

ObjectivesInterferon-γ release assays, including T-SPOT.TB (TSPOT) and QuantiFERON Gold In-Tube (QFT), are important diagnostic tools for tuberculosis infection, but little work has been done to study the performance of these tests in populations prioritized for tuberculosis testing in the United States, especially those other than health care personnel.MethodsParticipants were enrolled as part of a large, prospective cohort of people at high risk of tuberculosis infection or progression to tuberculosis disease. All participants were administered a tuberculin skin test, TSPOT, and QFT test. A subset of participants had their QFT (n = 919) and TSPOT (n = 885) tests repeated when they returned to get their tuberculin skin test read 2 to 3 days later (repeat study). A total of 531 participants had a TSPOT performed twice on the same sample taken at the same time (split study).ResultsThe QFT repeat test interpretations were discordant (one test positive and the other negative) for 6.4% of participants (59 of 919), and the TSPOT tests were discordant for 60 of 885 participants in the repeat study (6.8%) and 41 of 531 participants in the split study (7.7%). There was a high degree of variability in the quantitative test results for both QFT and TSPOT, and discordance was not associated with both test results being near the established cut-offs. Furthermore, the proportion of discordance was similar when comparing participants in both the TSPOT repeat and TSPOT split studies.DiscussionBoth QFT and TSPOT were 6% to 8% discordant. The results should be interpreted with caution, particularly when seeing a conversion or reversion in serial testing.     

上颌神经阻滞麻醉的应用解剖学基础

目的　为临床口腔颌面外科提供解剖学依据。方法　观察 3 0例干性颅骨标本的翼腭窝及其通道的形态、大小 ,并进行相关数据的测量。结果　 (1)上颌神经阻滞点至颧弓下缘中点的距离 ,左侧为41 0 4± 2 43mm ,右侧为 41 63± 2 19mm ;(2 )圆孔至腭大孔的距离 ,左侧为 3 1 98± 2 2 4mm ,右侧为 3 1 73± 4 2 9mm ;(3 )硬腭至腭大孔的距离 ,左侧为 3 46± 1 12mm ,右侧为 3 54± 1 12mm ;(4)硬腭后缘可作为进针的解剖学标志。结论　本研究可为经颧弓下缘中点和经翼腭管上颌神经阻滞入路提供重要的解剖学参数。     

Suicidal behaviours in male and female users of illicit drugs recruited in drug treatment facilities

Objective

We assessed prevalence of suicidal ideation and plans among illicit drug users and their association with contextual factors, by gender.

Adaptación española de las guías europeas de 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica

The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don’t recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.     

Changes and mechanisms of FFA/H-FABP in right ventricular lipotoxicity injury of pulmonary arterial hypertension rats induced by monocrotaline北大核心CSCD

肺动脉高压(pulmonary artery hypertension,PAH)是一类复杂的、多因素导致的恶性进展性疾病。PAH患者死亡的主要原因是右心室功能衰竭。在正常生理状态下,心脏60%~90%的能量主要来自于脂肪酸的氧化。研究发现,PAH患者出现明显的右心室代谢紊乱,能量代谢特点转变为糖利用增加而脂肪酸利用减少[1-2]。因此,深入探讨PAH时脂质代谢病理机制及特点,寻找PAH右室损伤的脂毒性靶点具有重要意义。