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In this article, we have carried out a case study to optimize the classification of the maliciousness of cybersecurity events by IP addresses using machine learning techniques. The optimization is studied focusing on time complexity. Firstly, we have used the extreme gradient boosting model, and secondly, we have parallelized the machine learning algorithm to study the effect of using a different number of cores for the problem. We have classified the cybersecurity events’ maliciousness in a biclass and a multiclass scenario. All the experiments have been carried out with a well-known optimal set of features: the geolocation information of the IP address. However, the geolocation features of an IP address can change over time. Also, the relation between the IP address and its label of maliciousness can be modified if we test the address several times. Then, the models’ performance could degrade because the information acquired from training on past samples may not generalize well to new samples. This situation is known as concept drift. For this reason, it is necessary to study if the optimization proposed works in a concept drift scenario. The results show that the concept drift does not degrade the models. Also, boosting algorithms achieving competitive or better performance compared to similar research works for the biclass scenario and an effective categorization for the multiclass case. The best efficient setting is reached using five nodes regarding high-performance computation resources.

Intensive care to facilitate organ donation (ICOD) is defined as the initiation or continuation of life-sustaining measures, such as mechanical ventilation, in patients with a devastating brain injury with high probability of evolving to brain death and in whom curative treatment has been completely dismissed and considered futile. ICOD incorporates the option to organ donation allowing a holistic approach to end-of-life care, consistent with the patients wills and values. Should the patient not evolve to brain death, life-supportive treatment must be withdrawal and controlled asystolia donation could be evaluated. ICOD is a legitimate practice, within the ethical and legal regulations that contributes increasing the accessibility of patients to transplantation, promoting health by increasing deceased donation by 24%, and with a mean of 2.3 organs transplanted per donor, and collaborating with the sustainability of health-care system. This ONT-SEMICYUC recommendations provide a guide to facilitate an ICOD harmonized practice in spanish ICUs.

Resumen Los cuidados intensivos orientados a la donacion (CIOD) se definen como el inicio o la continuacion de medidas de soporte vital, incluyendo la ventilacion mecanica, en pacientes con lesion cerebral catastrofica y alta probabilidad de evolucionar a muerte encefalica, en los que se ha descartado cualquier tipo de tratamiento. Los CIOD incorporan la opcion de la donacion de organos permitiendo un enfoque holistico en los cuidados al final de la vida coherente con los deseos y valores del paciente. Si el paciente no evoluciona a muerte encefalica, se deben retirar las medidas de soporte vital valorando la donacion en asistolia controlada. Los CIOD respetan el marco etico y legal y contribuyen a aumentar las probabilidades de los pacientes de acceder a la terapia de trasplante, generando salud, incrementando la donacion en un 24% con una media de 2,3 organos trasplantados por donante y contribuyendo a la sostenibilidad del sistema sanitario. Estas recomendaciones ONT-SEMICYUC proporcionan una guia para facilitar una practica armonizada de los CIOD en las UCI espanolas.

Objective To know the real clinical practice of Spanish ICUs in relation to analgesia, sedation and delirium, with a view to assessing adherence to current recommendations. Design A descriptive cross-sectional study was carried out based on a national survey on analgesia, sedation and delirium practices in patients admitted to intensive care on 16 November, 2013 and 16 October, 2014. An on-line questionnaire was sent with the endorsement of the SEMICYUC. Setting Spanish ICUs in public and private hospitals. Results A total of 166 ICUs participated, with the inclusion of 1567 patients. The results showed that 61.4% of the ICUs had a sedation protocol, and 75% regularly monitored sedation and agitation – the RASS being the most frequently used scale. Pain was monitored in about half of the ICUs, but the behavioral scales were very little used. Delirium monitoring was implemented in few ICUs. Among the patients on mechanical ventilation, midazolam remained a very commonly used agent. Conclusions This survey is the first conducted in Spain on the practices of analgesia, sedation and delirium. We identified specific targets for quality improvement, particularly concerning the management of sedation and the assessment of delirium.

Resumen Objetivo Conocer la practica clinica real de las UCI espanolas en relacion con la analgosedacion y delirium, y valorar como se ajusta a las recomendaciones actuales. Diseno Estudio transversal descriptivo elaborado mediante encuesta nacional sobre practicas de analgosedacion y delirium de los pacientes ingresados en UCI los dias 16 de noviembre de 2013 y 16 de octubre de 2014. Se envio un cuestionario a traves de Internet con el aval de la SEMICYUC. Ambito UCI tanto publicas como privadas de todo el territorio nacional. Resultados Se incluyeron un total de 166 UCI y a 1.567 pacientes. El 61,4% de las UCI contaban con un protocolo de sedacion. El 75% de las UCI monitorizaban la sedacion y agitacion, con RASS como la escala empleada con mayor frecuencia. El dolor se monitorizaba en algo mas de la mitad de las UCI, pero las escalas conductuales eran de muy baja implantacion. El delirium tambien presentaba un bajo nivel diagnostico. Entre los pacientes en ventilacion mecanica el midazolam continuaba siendo un sedante de muy amplio uso. Conclusiones Esta encuesta es la primera realizada en Espana sobre analgosedacion y delirium y nos muestra una fotografia sobre estas practicas, senala algunos aspectos como los relacionados con la monitorizacion y usos de escalas, junto con el manejo del delirium, en los que los resultados del estudio animan a desarrollar proyectos docentes que acerquen la practica clinica real a las recomendaciones nacionales e internacionales.

Resumen Objetivo Valorar si la tecnica de embolizacion urgente del aneurisma cerebral y posterior cirugia del hematoma es segura y eficaz en pacientes con hematoma y signos de hipertension intracraneal por rotura de aneurisma cerebral. Metodos Se incluyeron 23 pacientes consecutivos con aneurisma cerebral roto y mal estado clinico debido a un hematoma intracraneal, ambos tratamientos completados en las primeras 4 horas del inicio de la clinica. Todos los pacientes presentaban signos clinicos de hipertension intracraneal y/o alteracion del nivel conciencia, incluido coma por deterioro rostrocaudal. Se valoro la eficacia de la tecnica mediante el grado de cierre de los aneurismas y el pronostico de los pacientes un mes despues, y la seguridad, mediante el analisis de las complicaciones de los tratamientos. Resultados El 91,3% de los pacientes tenia un aneurisma localizado en la arteria cerebral media (ACM). Todos los pacientes presentaban un valor de 4 en la escala de Fisher y de IV-V en la escala de Hunt y Hess. El tiempo medio desde la identificacion del aneurisma en la tomografia computarizada hasta la embolizacion del aneurisma fue de 115 minutos. Se uso balon de remodeling en el 78% de los casos, con el que se logro un cierre adecuado en el 82,6% de los pacientes. Durante la cirugia se coloco un drenaje ventricular en 9 (39,1%) pacientes. Al mes, 13 (56,5%) pacientes eran independientes, con una mortalidad del 13%. No existieron resangrados. Conclusion En nuestra experiencia, el tratamiento combinado mediante embolizacion del aneurisma y descompresion quirurgica con evacuacion del hematoma es segura y efectiva, y es una alternativa al tratamiento quirurgico aislado.

Resumen Objetivo Estudiar los resultados y las complicaciones del tratamiento endovascular (TEV) en pacientes con ictus isquemico agudo ingresados en una unidad de cuidados intensivos (UCI). Analizar los factores que podrian influir en la mortalidad y en el grado de discapacidad al alta y un ano despues del ictus. Diseno Estudio prospectivo observacional. Ambito UCI polivalente. Hospital de tercer nivel. Pacientes Sesenta pacientes adultos. Muestra consecutiva. Intervenciones Ninguna. Variables de interes Datos epidemiologicos, tiempo desde la clinica inicial hasta el TEV, resultado angiografico, tiempo de estancia en UCI, dias de ventilacion mecanica, complicaciones neurologicas, National Institutes of Health Stroke Scale (NIHSS) al ingreso y al alta de UCI, escala de Rankin modificada (mRS) al ano de evolucion. Resultados Edad media 68,90 ± 8,84 anos. Mediana de tiempo hasta el TEV: 180 min. Mediana NIHSS al ingreso: 17,5; al alta: 3. Flujo distal en el 90% de los casos. Mediana estancia en UCI: 3 dias. Ventilacion mecanica: 81,7%. Independencia funcional (mRS ≤ 2) 50% al ano del ictus. Fallecimientos: 22 (36,6%); 8 (13,3%) en la UCI y el resto durante el primer ano. Conclusiones Las variables asociadas a un peor estado funcional fueron la transformacion hemorragica sintomatica, la ausencia de recanalizacion y las complicaciones durante el procedimiento. La transformacion hemorragica y la hidrocefalia se asociaron a mayor mortalidad. Se consiguio flujo distal en la mayoria de los casos, con una baja tasa de complicaciones. La mitad de los pacientes alcanza independencia funcional al ano del ictus.

Purpose To study the results and complications of endovascular treatment (EVT) in acute ischemic stroke patients admitted to intensive care unit (ICU). To analyse the possible factors related to mortality and level of disability at ICU discharge and one year after stroke. Design Observational prospective study. Setting Mixed ICU. Third level hospital. Patients Sixty adult patients. Consecutive sample. Interventions None. Variables of interest Epidemiological data, time from symptom onset to EVT, angiographic result, length of stay, days on mechanical ventilation, neurological complications, National Institutes of Health Stroke Scale (NIHSS) at ICU admission and discharge, modified Rankin scale score (mRS) at one year. Results Mean age 68.90 ± 8.84 years. Median time from symptom onset to EVT: 180 min. Median NIHSS at admission: 17.5; at discharge: 3. Distal flow was achieved in 90% of cases. Median ICU stay: 3 days. Mechanical ventilation: 81.7%. Functional independence (mRS ≤ 2) 50% at one year. Deaths: 22 (36,6%) of which 8 (13.3%) died during UCI stay and the rest during the first year. Conclusions The factors relating to a worse functional outcome were symptomatic hemorrhage transformation, lack of recanalization and complications during EVT. The factors relating to mortality were symptomatic hemorrhage and hydrocephalus. Distal flow was achieve in most cases with a low complication rate. Half of the patients presented functional independence one year after the stroke.

Intensive care to facilitate organ donation (ICOD) is defined as the initiation or continuation of life-sustaining measures, such as mechanical ventilation, in patients with a devastating brain injury with high probability of evolving to brain death and in whom curative treatment has been completely dismissed and considered futile. ICOD incorporates the option to organ donation allowing a holistic approach to end-of-life care, consistent with the patients wills and values. Should the patient not evolve to brain death, life-supportive treatment must be withdrawal and controlled asystolia donation could be evaluated. ICOD is a legitimate practice, within the ethical and legal regulations that contributes increasing the accessibility of patients to transplantation, promoting health by increasing deceased donation by 24%, and with a mean of 2.3 organs transplanted per donor, and collaborating with the sustainability of health-care system. This ONT-SEMICYUC recommendations provide a guide to facilitate an ICOD harmonized practice in spanish ICUs.

Muerte encefalica por neumoencefalo y fistula dural en el postoperatorio de hernia discal lumbar.

The agronomic performance and nutritive value of Mucuna legume (Stilozobium deeringianum (Bort) Merr.) in five stages were evaluated under climatic conditions of Peruvian central coast to estimate optimum stage of use. Five cutting ages were: 21, 42, 63, 84 and 105 days. Crop growing, forage yield, chemical composition, vitro dry matter digestibility and net energy for lactation of Mucuna were evaluated. The optimum cutting age was 84 days with 25633.3 kg. Ha-1 of fresh matter and 6422.6 kg-1 ha-1 of dry matter. In this age crude protein, neutral detergent fiber and acid detergent fiber and in vitro dry matter digestibility contents were 14.94%, 44.80%, 33.15% and 66.12 %. Net energy for lactation was 1.43 Mcal.kg-1. These results show that Mucuna was well adapted to Peruvian Central Coast with high forage yield and nutritive value.

To know the real clinical practice of Spanish ICUs in relation to analgesia, sedation and delirium, with a view to assessing adherence to current recommendations.A descriptive cross-sectional study was carried out based on a national survey on analgesia, sedation and delirium practices in patients admitted to intensive care on 16 November, 2013 and 16 October, 2014. An on-line questionnaire was sent with the endorsement of the SEMICYUC.Spanish ICUs in public and private hospitals.A total of 166 ICUs participated, with the inclusion of 1567 patients. The results showed that 61.4% of the ICUs had a sedation protocol, and 75% regularly monitored sedation and agitation - the RASS being the most frequently used scale. Pain was monitored in about half of the ICUs, but the behavioral scales were very little used. Delirium monitoring was implemented in few ICUs. Among the patients on mechanical ventilation, midazolam remained a very commonly used agent.This survey is the first conducted in Spain on the practices of analgesia, sedation and delirium. We identified specific targets for quality improvement, particularly concerning the management of sedation and the assessment of delirium.

To determine whether the urgent embolization of a cerebral aneurysms and posterior surgery on cerebral hematomas is safe and efficacious in patients with hematomas and signs of intracranial hypertension due to the rupture of cerebral aneurysms.We included 23 consecutive patients in poor clinical condition due to an intracranial hematoma caused by a ruptured cerebral aneurysm who were treated with both embolization and surgery within 4hours of the onset of symptoms. All patients had clinical signs of intracranial hypertension and / or altered levels of consciousness, including coma due to rostrocaudal deterioration. We evaluated the efficacy of the combined technique by determining the degree of closure of the aneurysms and the patients' prognosis one month after the procedures; we evaluated safety by analyzing the complications of the treatments.All but two of the patients (21/23; 91.3%) had an aneurysm of the middle cerebral artery. All patients scored 4 on the Fisher scale and were classified as Hunt and Hess IV or V. The mean time from the identification of the aneurysm on computed tomography to embolization was 115minutes. A balloon remodeling technique was used in 18 (78%) patients; embolization achieved adequate closure in 19 (82.6%) patients. During surgery, a ventricular drain was placed in 9 (39.1%) patients. One month after treatment, 13 (56.5%) patients were functionally independent and 3 (13%) had died. No episodes of rebleeding were observed.In our experience, combined treatment including embolization of the aneurysm and surgical decompression with evacuation of the hematoma is a safe and effective alternative to surgical treatment alone.

Infectious complications related to external ventricular shunt (ICREVS) are a main problem in neurocritical intensive care units (ICU). The aim of the review is to assess the incidence of ICREVS and to analyse factors involved.Retrospective analysis, adult polyvalent ICU in a third level reference hospital. Patients carrying external ventricular shunt (DVE) were included. Those patients with central nervous system infection diagnosed prior DVE placement were excluded.87 patients were included with 106 DVE. Most common admittance diagnosis was subarachnoid haemorrhage (49.4%). 31 patients with 32 DVE developed an ICREVS. Infection rate is 19.5 per 1000 days of shunt for ICREVS and 14 per 1000 days for ventriculitis. 31.6% of the patients developed ICREVS and 25.3% ventriculitis. Patients who developed ICREVS presented higher shunt manipulations (2.0 ± 0.6 vs. 3.26 ± 1.02, p=0.02), shunt repositioning (0.1 ± 0.1 vs. 0.2 ± 0.1) and ICU and hospital stay (29.8 ± 4.9 vs 49.8 ± 5.2, p0.01 y 67.4 ± 18.8 vs. 108.9 ± 30.2, p=0.02. Those DVE with ICREVS were placed for longer not only at infection diagnosis but also at removal (12.6 ± 2.1 vs. 18.3 ± 3.6 and 12.6 ± 2.1 vs. 30.4 ± 7.3 days, p0.01). No difference in mortality was found.One out of three patients with a DVE develops an infection. The risk factors are the number of manipulations, repositioning and the permanency days. Patients with ICREVS had a longer ICU and hospital average stay without an increase in mortality.

Multidrug resistant (MDR) microorganisms represent a threat for patients admitted in Intensive Care Units (ICUs). The objective of the present study is to analyse the results of epidemiological surveillance cultures for these microorganisms in one of these units.General ICU. Retrospective analysis, descriptive statistics. Analysis of epidemiological surveillance cultures for MDR microorganisms in 2015. Studied microorganisms: Methicillin-resistant Staphylococcus aureus (MRSA), ESBL-and/or carbapenemase-producing Klebsiella pneumoniae (CESBL-KP) and MDR Acinetobacter baumannii (MDRAB).One thousand, two hundred and fifty nine patients admitted. A total of 2,234 specimens from 384 patients were analysed (690, 634, 62 and 286 were rectal, throat, nasal and skin swabs respectively). Global APACHE II was 18.3 ± 8 versus 21.7 ± 7.8 in patients colonized/infected on admission. Global mortality was 19.7% versus 22.3% in patients colonized/infected on admission. The higher sensitivities achieved with the different samples for the different microorganism detection were as follows. MRSA: 79% and 90% for nasal and nasal + throat swabs, respectively. MDRAB: 80% and 95% for throat and throat + rectal swabs, respectively. CESBL-KP: 95% and 98% for rectal and rectal + throat swabs, respectively. 94 out of the 384 patients (24.4%) were colonized/infected with MDR at admission. 134 patients (10.6% of the total patients admitted) were colonized/infected with a total of 169 MMR during the hospital stay. MRSA has the earliest colonization/infection (9.2 ± 6.4days) and ESBL-producing Enterobacteriaceae, the latest (18.7± 16.4 days).24.4% of patients were colonized/infected by MDR at admission. Nasal, throat and rectal swabs were the most effective specimens for recovering MRSA, MDRAB and CESBL-KP, respectively. The combination of two specimens improves MDR detection except for CESBL-KP. Skin swabs are worthless. The most prevalent MDR at admission were ESBL-producing Enterobacteriaceae while the most frequent hospital acquired MDR was MDRAB..

Title Equivalente migranoso de inicio tardio con aura prolongada y alteracion de la perfusion cerebral.

Bisphosphonates are the first choice therapy for the pharmaco logical treatment of osteoporosis. Following reports of cases of bisphosphonaterelated osteonecrosis of the jaw and atypical femur fracture, the safety of longterm use of bisphosphonates has been evaluated, resulting in the proposal of strontium as an alternative drug. No experimental study using a sequential administration design has been reported to date. Hence, the aim of this study was to evaluate the effect on bone tissue of ovariectomized rats of administration of alendronate followed by strontium ranelate. Fortyeight female Wistar rats were ovariectomized on day 1 of the experiment. Beginning on day 30, they were administered 0.3 mg/kg/week of alendronate (ALN) or vehicle (VEH) for 8 weeks. Two groups (ALN and corresponding control) were euthanized at this time, and the remaining animals were divided into 4 groups and given 290 mg/kg/day of strontium ranelate (SR) in their drinking water (TW) or only water for 4 months. Experimental groups were: ALN+SR, ALN+TW, VEH+SR, VEH+TW, ALN and VEH. The tibiae and hemimandibles were resected for histomorphometric evaluation, and the right femur was used to perform biomechanical studies. ANOVA and Bonferroni test were applied. Diaphyseal stiffness, maximum elastic load and fracture load increased in animals that received alendronate, regardless of whether or not they received subsequent SR treatment. Fracture load also increased in VEH+ SR versus control (VEH+TW). Subchondral and interradicular bone volumes were significantly higher in animals that received ALN than in those that received vehicle. No difference was observed in cortical area or thickness of the tibia among treatments. The results obtained with the model presented here, evaluating tibial and mandibular interradicular bone, showed that the combination of ALN and SR and administration of ALN alone are equally effective in preventing bone loss associated with ovariectomyinduced estrogen depletion.Si bien la primera opción terapéutica para el tratamiento farmacológico de la osteoporosis son los bisfosfonatos (BPs), luego de los primeros reportes en 2003 de los casos de osteone crosis de mandíbula asociada al uso de dichas drogas y las fracturas atípicas de fémur, se ha evaluado su seguridad a largo plazo. Además, en aquellos pacientes que no responden al tratamiento con BPs y mantienen elevado el riesgo de fractura, es necesario suspender su administración y alternar con otras drogas. Una de las que se ha utilizado en la clínica luego del tratamiento con BPs es el ranelato de estroncio (SR). Existen varios trabajos clínicos que reportan los efectos de la administra ción secuencial de ambas drogas, aunque estudios experi men tales con un diseño secuencial aun no se han reportado. Por ello el objetivo de este trabajo ha sido evaluar el efecto de la administración secuencial de alendronato, seguido de ranelato de estroncio sobre el tejido óseo de ratas ovariectomizadas. Se utilizaron 48 ratas Wistar hembras de dos meses de edad divididas en 6 grupos de 8 animales cada uno. El día 1 de experiencia todas fueron ovariectomizadas. El día 30 se comenzó con la administración de alendronato (ALN) en una dosis de 0.3 mg/kg/semana o vehículo (VEH) durante 8 semanas. Luego de este período se sacrificaron dos grupos (uno que recibió ALN y su correspondiente control (sólo vehículo). Los cuatro grupos restantes continuaron con ranelato de estroncio (SR) en el agua de bebida durante 4 meses en una dosis de 290 mg/kg/día o sólo agua corriente( TW) Luego de ese período fueron eutanasiados. Así, los grupos experimentales conformados fueron: ALN+SR, ALN+TW, VEH+SR, VEH+TW, ALN y VEH. Para los estudios histomorfométricos se extrajeron ambas tibias y hemimandíbulas; para el estudio biomecánico se utilizó el fémur derecho. Los resultados fueron analizados mediante el test de ANOVA y el test de Bonferroni. Incrementaron significativamente la rigidez diafisaria, la carga elástica límite y la carga de fractura aquellos grupos que recibieron alendronato versus aquellos que no lo recibieron, independientemente del tratamiento posterior con SR. La carga de fractura además fue mayor en el grupo VEH+SR versus el control (VEH+TW). En cuanto al volumen óseo subcondral e interradicular evaluado histomorfométricamente fue significativamente mayor en aquellos animales que recibieron ALN versus aquellos que recibieron vehículo. No se detectaron diferencias entre aquellos grupos que recibieron SR y sus controles. El área y espesor cortical de la tibia no mostraron diferencias entre grupos. Los resultados obtenidos en el modelo estudiado tanto a nivel del volumen óseo subcondral y cortical de la tibia como a nivel del hueso interradicular del maxilar inferior, mostraron que la combinación de ALN con SR y la administración aislada de ALN son igualmente efectivas para prevenir la pérdida ósea causada por la depleción estrogénica de la ovariectomía.

Granular filters are required to perform two basic functions in embankment dams: (a) prevent the migration of base soil particles, and (b) allow drainage of seepage water. Traditionally, retention function (a) has been evaluated using Particle Size Distribution (PSD) and drainage function (b) using Permeability (kf), but usually permeability have been also correlated with PSD, so the permeability criterion have been expressed in terms of D15b of the base soil and D15f of the granular filter. Only few authors have used filter permeability for the assessment of retention function and there is no general agreement with them, but permeability should be a very important variable because it takes into account not only the whole PSD of the filter, (instead of just several representative diameters), but also other important characteristic such as compaction, porosity, density and particle shape. Based on a literature review and research experience at the University of Granada, this paper analyses the importance of filter permeability in the design and control of granular filters in embankment dams, even with dispersive base soils.

Resumen Objetivo Analizar el diagnostico de muerte encefalica (ME) en Iberoamerica. Fundamento La ME se ha aceptado como la muerte del individuo desde hace decadas, pero existen diferencias legales y gran variabilidad en los criterios diagnosticos de cada pais. Metodo Encuesta sobre el diagnostico medico y legal de la ME en los 21 paises que forman la Red/Consejo Iberoamericano de Donacion y Trasplante. Resultados Todos los paises iberoamericanos, excepto Nicaragua, reconocen legalmente la ME como la muerte de la persona. Para declarar el fallecimiento, en la mayoria se necesitan 2 o 3 medicos. En todos los paises es obligatoria la presencia de un coma arreactivo, ausencia de reflejos de tronco y de respiracion espontanea. Los niveles de presion parcial de dioxido de carbono requerida en el test de apnea oscilan entre 50–60 mmHg. La temperatura minima requerida para la exploracion neurologica oscila entre 32–35° C. El test de atropina es obligatorio en 7 paises (35%). El periodo de observacion mas recomendado es de 6 h, pero hay gran variabilidad, que llega hasta 24 h. En 8 paises (40%) es obligatorio realizar siempre un test instrumental, en el resto solamente en circunstancias especiales. En algunos paises, si no hay donacion de organos para trasplante no se retiran las medidas de soporte, este hecho es mas frecuente en los ninos. Conclusiones Existe uniformidad en los criterios diagnosticos fundamentales, pero se observan diferencias en los prerrequisitos clinicos, la exploracion neurologica, el tiempo de observacion, los test instrumentales y las decisiones clinicas tras la declaracion de ME. Seria recomendable la homogeneizacion de los criterios diagnosticos.

The objective of the Latin American Network/Council of Donation and Transplant is to develop cooperation among its member states in all aspects related to donation and transplant of organs, tissue and cells. Given that diagnosing brain death (BD) is one of the key issues for the procurement of organs for transplant, the Network/Council seeks to contribute to defining the accepted concept of BD and its diagnosis and to disseminate this information among healthcare workers. In this report, we present the general guidelines on brain death and recommendations for clinical decisions after its diagnosis established and approved by the Latin American Network/Council of Donation and Transplant at its sixth meeting held in La Havana, Cuba, in May 2008. Although there are legal differences and variations in the diagnostic criteria used to define BD among its member states, brain death is accepted as the death of an individual for all legal, ethical and scientific effects. The diagnosis of BD should be independent of the decision of whether to donor or not donate organs for transplant. Once a diagnosis of BD has been confirmed, the possibility of organ donation should always be considered and the appropriate organ maintenance measures initiated. If organ donation is contraindicated, all support measures should be withdrawn including mechanical respiration. The decision to withdraw all support measures is consistent with the clinical-legal diagnosis and supported by several scientific and bioethics societies.

The purpose of this paper is the description of an application for the complete automation of a mosaics manufacturing process with irregular random pieces, so called trencad/spl inodot//spl acute/s. An intelligent robotic cell has been implemented by using intelligent methods and pattern recognition techniques to assemble unpredictable objects in an autonomous manner.

An active vision system with two cameras has to be calibrated on-line to perform stereo vision applications. A calibration of a binocular system is possible using a small number of homologous features in both images. The correspondence problem can be resolved by using traditional template matching algorithms but it has a high computational cost. In this paper some dynamic programming aspects are introduced to deal with template matching in order to reduce the execution time. Some experimental results demonstrate their viability and suggest other lines to improve its performance.

Para el medico intensivista, realizar un diagnosticode muerte encefalica (ME) implica tomar decisiones de gran responsabilidad: retirar las medidas de soporte, o valorar la donacion deorganos para trasplante. En este trabajo, se repasa el diagnostico de ME, centrandose fundamentalmente en sus aspectos clinicos e insistiendo en la necesidad de realizar una exploracion neurologica sistematica, completa y extremadamente rigurosa. Se detallan los prerrequisitos que ha de presenter el paciente antes de iniciar el protocolo diagnostico, y la exploracion neurologica necesariaincluyendo cada uno de los reflejos troncoencefalicosy la prueba de apnea. Tambien, serevisan las caracteristicas y tipos de actividadmotora de origen medular que pueden apareceren situaciones de ME, asi como el periodo de observacion necesario para realizar dicho diagnostico. In this paper, the diagnosis of BD is revised,focusing mainly on its clinical issues and insisting upon the necessity of obtaining a systemic, complete, and extremely accurate neurologic examination. Details are given of the pre-requisites that must be met by the patient before a diagnostic protocol is initiated and the necessary neurologicexamination including each of the brain stem reflexes and theapnea test. Also, the characteristicsand types of spinal cord motor activities are revised which may be present in situations of BD, as well as the required observation period to obtain such diagnosis.

Fundamento Las implicaciones asistenciales y sociales que la muerte encefalica tiene en el quehacer diario de los medicos que trabajan en las Unidades de Cuidados Intensivos justifican la realizacion de esta Conferencia de Consenso, con el objetivo de elaborar unas recomendaciones diagnosticas de muerte encefalica y de unificar los criterios de actuacion y la toma de decisiones clinicas Metodo El modelo de Conferencias de Consenso adoptado por la SEMICYUC se centra en intentar dar respuesta a unas preguntas predefinidas sobre el tema en cuestion, por parte de “expertos” que aportan las “pruebas” disponibles sobre cada pregunta concreta a un jurado no prejuzgado sobre la materia. Finalmente, el jurado elabora las conclusiones relativas a cada una de las preguntas formuladas Conclusiones Se presentan las conclusiones del jurado relativas a las dos preguntas claves: ?cuales son los criterios diagnosticos de muerte encefalica? y ?cuales son las implicaciones eticas del diagnostico de muerte encefalica y que decisiones clinicas debe tomar el medico intensivista tras dicho diagnostico?

To observe the course of pediatric patients with femur shaft fractures managed with elastic titanium nails.A descriptive, longitudinal, ambispective study was conducted at UMAE HTYOLV analyzing femur fractures in patients from one and a half to 16 years of age who were managed with elastic titanium nails during a 5-year period. Bone healing, complications, hip and knee ranges of motion, and gait were assessed.Seventy-one fractures were found in 70 patients. Clinical and radiographic bone healing was observed at a mean of 8.13 weeks, regardless of the type and location of the fracture, and patient age and weight. Two patients had delayed bone healing and one patient progressed to pseudoarthrosis. Among the 70 patients, 54 (77.6%) did not have any complications, and 16 (22.4%) had complications. Sixty-seven patients (95.9%) had full knee and hip mobility without gait alterations; 2 (2.7%) required 3 months of special physical rehabilitation, and one (1.4%) continued having hip and knee stiffness and could not walk.Elastic titanium nails represent an alternative for the management of femur shaft fractures in pediatric patients. Adherence to the technique and indications for their use yields better results and results in fewer complications.

Osteoporosis is a disease in which the microarchitecture of bone tissue deteriorates, with consequent loss of bone mass. Strontium ranelate (SrR) is currently used for treatment of the condition. SrR may have a dual effect: anabolic (stimulating pre-osteoblast replication) and anti-catabolic (reducing osteoclastic activity). However, its mechanism of action has not yet been completely elucidated. The aim of this study is to evaluate the effect of SrR on bone remodeling in healthy Wistar rats. Two-month old female Wistar rats were administered SrR (2 g/L) in drinking water for 30 weeks. Oriented histological sections were prepared from lower jaw and tibia and stained with HE, and the following histomorphometric parameters were evaluated: a) in interradicular bone: bone volume, and percentages of bone-formation, quiescent and bone-resorption surfaces; and b) in tibia: bone volume, total thickness of growth cartilage, thickness of hypertrophic cartilage zone and number of megakaryocytes. No significant difference was found in the parameters between the control animals and those treated with SrR. The results would therefore show that SrR does not alter the bone parameters studied in this experimental design.

Context: Pressure ulcers are especially difficult to treat in patients with spinal cord injury (SCI) and recurrence rates are high. Prompted by encouraging results obtained using bone marrow stem cells to treat several diseases including chronic wounds, this study examines the use of autologous stem cells from bone marrow to promote the healing of pressure ulcers in patients with SCI. Objective: To obtain preliminary data on the use of bone marrow mononuclear cells (BM-MNCs) to treat pressure ulcers in terms of clinical outcome, procedure safety, and treatment time. Participants: Twenty-two patients with SCI (19 men, 3 women; mean age 56.41 years) with single type IV pressure ulcers of more than 4 months duration. Interventions: By minimally invasive surgery, the ulcers were debrided and treated with BM-MNCs obtained by Ficoll density gradient separation of autologous bone marrow aspirates drawn from the iliac crest. Results: In 19 patients (86.36%), the pressure ulcers treated with BM-MNCs had fully healed after a mean time of 21 days. The number of MNCs isolated was patient dependent, although similar clinical outcomes were observed in each case. Compared to conventional surgical treatment, mean intra-hospital stay was reduced from 85.16 to 43.06 days. Following treatment, 5 minutes of daily wound care was required per patient compared to 20 minutes for conventional surgery. During a mean follow-up of 19 months, none of the resolved ulcers recurred. Conclusions: Our data indicate that cell therapy using autologous BM-MNCs could be an option to treat type IV pressure ulcers in patients with SCI, avoiding major surgical intervention.

Vascular endothelial growth factor (VEGF) is a protein that increases vascular permeability and induces the proliferation, migration and survival of endothelial cells. Bisphosphonates (BPs) are antiresorptive drugs that are widely used in the treatment of bone metabolism diseases and bone metastases. Since 2003, cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ) have been reported. Few papers explain the mechanisms that induce BRONJ; some authors mention alterations in bone remodelling and a certain antiangiogenic effect of BPs. The aim of this study is to evaluate the expression of VEGF in bone marrow cells and the number of blood vessels and area occupied by them in animals treated with the BP sodium olpadronate (OPD). We used 16 Wistar rats, 60 days old, divided into two groups, experimental (OPD) and control. The OPD group received 0.3 mg/kg/week intraperitoneal OPD for 5 weeks. The control group received an equivalent intraperitoneal volume of physiological saline solution. After euthanasia, hemimandibles were processed and mesio-distal histological sections of the first molar were prepared. Sections were stained with hematoxylin-eosin (HE), immunohistochemical detection of VEGF was performed (sc-7269) and the following histomorphometric parameters were evaluated: In HE-stained sections--number of blood vessels per sq. mm. and percentage (%) of area occupied by blood vessels in relation to total area evaluated; in sections with immunohistochemical detection of VEGF--number of VEGF+ bone marrow cells per sq. mm. Data underwent statistical analysis. Number of blood vessels/mm2 was significantly lower in the OPD group (OPD: 92 +/- 16;140 +/- 31; p0.05) and % vascular area/total area evaluated showed no significant difference (OPD: 15.6 +/- 6.1;10.2 +/- 4.2). Number of VEGF+ cells/mm2 was lower in the OPD group than in the control group, with statistically significant differences (OPD: 7804.8 +/- 597;13187.6 +/- 894; p.001). The results of this study suggest that monosodium olpadronate has an antiangiogenic effect. Further studies are needed to reveal its potential as an antitumor agent and its connection with the onset of BRONJ.

The aim of this study was to determine the progression of cognitive dysfunction in primary Sjögren Syndrome (SS).Twelve subjects with SS were compared with ten subjects with migraine and ten healthy controls on neuropsychological, mood and fatigue tests at baseline and 8 years later.At follow-up, SS subjects performed below subjects with migraine on the Continuous Performance Test (CPT) but did not differ on other tasks. Compared with controls, both clinical groups obtained lower scores on simple reaction time, patients with SS obtained lower scores on the Wisconsin Card Sorting Test (WCST) and patients with migraine performed below controls on the Benton's Judgment of Line Orientation Test (JOLO). Clinical groups did not differ on cognitive changes over time, except that migraine subjects improved on verbal fluency. Compared with baseline, both SS and migraine patients were more impaired on simple reaction time, Trail Making Test part B, Stroop and JOLO. However, they showed higher scores on verbal and visual memory, WCST and CPT reaction time. SS also showed higher levels of depression and fatigue than migraine and controls, with no significant changes over time.Preliminary evidence indicates some cognitive deficits in both SS and migraine following a pattern of fronto-subcortical dysfunction without a significant cognitive decline over time.