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BackgroundLiver alterations, especially nonalcoholic fatty liver disease (NAFLD) are associated with Rheumatoid Arthritis (RA). This abnormality appears as asymptomatic and can progress to a severe liver damage rapidly. Chronic inflammation, treatment with methotrexate (MTX) or even autoimmunity are factors that might be involved, however the mechanisms related to this comorbidity in RA are not completely stablished yet.Objectives1) To evaluate the liver disease risk in RA patients through feasible indexes to be used in the daily clinical practice and its relationship with clinical features of the disease; 2) To analyze the impact of antibodies to citrullinated proteins antigens (ACPAs) on hepatic function; 3) To examine the influence of MTX treatment on classical parameters and new indexes of hepatic dysfunction in a cross-sectional and longitudinal cohort.Methods1) Cross-sectional study in 307 body mass index matched subjects: 55 healthy donors (HDs), 190 RA patients and 62 non-RA patients diagnosed with NAFLD through echography. Obese patients were excluded from the study. 2) Longitudinal study with 50 RA patients treated with MTX for 6 months. Clinical and laboratory parameters, subclinical liver disease biomarkers and 4 indexes to evaluate the presence of fibrosis and steatosis (APRI, “AST to platelet ratio index”; FIB-4, “fibrosis 4 score”; HSI, “hepatic steatosis index” and TyG, “triglycerides and glucosa index”) were measured. Association studies of hepatic dysfunction with clinical parameters were performed; A panel of 15 proteins directly involved in hepatic disease was analyzed in serum (C1QTNF1, IL7R, TIE1, CCL5, REG3A, CA3, LCN2, CCL14, NRP1, ICAM3, CD59, TIMP1, CNDP1, GNLY, IGFB6). 3) In vitro experiments were carried out in hepatocyte cell line (HEPG2) treated with ACPAs.ResultsUsing NALFD patients as positive controls for the four liver disease indexes, RA patients showed significantly higher levels of HSI and TyG biomarkers. In fact, a high proportion of these patients (42.7%) were estimated to suffer NALFD. The association studies in RA patients showed that liver disease biomarkers (HSI and TyG) were related to the insulin resistance state, inflammation, complement component 3(C3), disease activity, and the levels of ACPAs. Serum levels of CNDP1, CCL5, GNLY, TIMP-1, CD59 and CCL14 were significantly increased in RA patients and correlated with hepatic damage indexes. Treatment with ACPAs on hepatocytes promoted the secretion of C3 in parallel with a significant alteration of genes related to glucose and lipid metabolisms, inflammation, fibrosis and apoptosis. MTX treatment, from the point of cross-sectional approach, was not associated with an increase of hepatic enzymes, serum proteins nor liver disease indexes. Treatment with MTX for 6 months did not affect those levels either.Conclusion1) A high proportion of RA patients present an alteration in markers of NAFLD, associated with insulin resistance state, disease activity, inflammation, component C3 and ACPAs levels; 2) the autoantibodies could directly impact hepatocyte biology altering the expression of genes related to glucose and lipid metabolisms, inflammation, fibrosis and apoptosis, 3) Treatment with MTX did not promote any alteration in subclinical liver disease biomarkers after 6 months of treatment.Funded by Institute of Health Carlos III (PI20/00079).Disclosure of InterestsNone declared

This study aims to analyze the effects of allergen immunotherapy, used to treat allergic symptoms such as pollen allergy. Mathematical models are used as a methodological approach to simulate from a system of impulsive differential equations the dynamics of the model. Immunotherapy is based of supplying small amounts of pollen to the patient, which leads to minimizing severe allergic symptoms when patients are subsequently exposed to higher amounts of pollen in the environment. Lymphocyte concentrations are considered state variables, allowing the behavior and efficacy of allergen immunotherapy to be identified. The manuscript proposes a method that allows to model mixed systems. Phenomena that present continuous times in some instants and discrete times in others, these are phenomena that are frequently found in the field of physics. Allergen immunotherapy is most effective when a treatment is created with pollen dose increments in a linear form.

Determining the response to the forces applied to an elastic solid containing an ideal fluid with constant density is essential in the engineering and biomedical fields. Therefore this paper aims to present and analyze a mixed finite element method for an interaction problem solid-fluid that contributes to understanding these areas. It is assumed transmission conditions are maintained at the fluid boundary and are given by the balance of forces and the equality of normal displacements. The mixed variational formulation that avoids the locking phenomenon, for the coupled problem is in terms of displacement, stress tensor, and rotation in the solid and by pressure and scalar potential in the fluid, the main contribution of this work. The first transmission condition is imposed in the definition of the space and the rest of the conditions appear naturally, which means Lagrange multipliers are not needed at the coupling border. The unknowns for the fluid and the solid are approximated by finite element subspaces of Lagrange and Arnold-Falk-Winther of order 1, which lead to a Galerkin scheme for the continuous problem. Also, the resulting Galerkin scheme is convergent and derives optimal convergence rates. Finally, the model is illustrated using a numerical example.

Autism spectrum disorder is characterized by a qualitative alteration in social interaction and communication associated with restricted interests and stereotyped behaviors. This condition will accompany people throughout their lives, with variations in their evolution. Our objectives were to know the evolutionary characteristics of people with autistic spectrum disorder, analyzing cognitive, behavioral, health, mortality and their needs in the aging stage, which will guide the planning of specific support resources. We analyze studies related to the evolution in adult life in people with this disorder, with or without identified entities, and socio-health conditions that should be considered in the aging process. The knowledge about aging in people with autism is still scarce and it is difficult to define a specific pattern because this will depend, among other factors, on the etiology, the degree, the presence of intellectual disability and/or epilepsy, and the scope in where live, which can even condition the life expectancy. Aging has been associated with mood disorders, depression, deterioration in executive functions and episodic memory, although it is difficult to differentiate it from natural aging in people with typical development. The identification of a specific entity will allow to know the possible evolution and prevent complications in syndromes that may be associated with autism: fragile X, Down, Angelman, Rett and Williams, for that reason we rank the genetic and neurological consultation.

Stroke is the most important medical condition leading to permanent disability in adults. The aim of this study is to evaluate the efficacy of dynamic orthoses in the rehabilitation of the upper limbs in patients who have had a stroke.We conducted a longitudinal case-control study. The sample used in the study consisted of patients from rehabilitation centres who presented hemiparesis secondary to an ischaemic or haemorrhagic stroke. The patients were randomly distributed into a study group, whose members received a dynamic orthosis on an upper limb for a six-month period, and a control group. Appraisals were performed pre- and post-treatment with the orthosis with Fugl-Meyer Assessment Scale and with Wolf Motor Function to measure their command over body functions and activities. Differences between pre- and post-test were compared using ANCOVA and Student's t.The sample included 40 patients (65% males) who presented chronic hemiparesis secondary to ischaemic (n = 28) or haemorrhagic stroke (n = 12), with a mean age of 58.43 ± 8.67 years. After the six-month follow-up, improved motor function was observed in both groups, according to both scales. The use of a dynamic orthosis was associated with a tendency towards improved strength in the upper limb.Rehabilitation following a stroke improves strength and body activities in the upper limb. The use of a dynamic orthosis can further improve the strength in this limb, but additional research is needed to confirm our results.Eficacia de la ortesis dinamica del miembro superior en la fase cronica del ictus. Estudio longitudinal.Objetivo. El ictus es la condicion medica mas importante que origina discapacidad permanente en el adulto. El objetivo es valorar la eficacia de ortesis dinamicas en la rehabilitacion del miembro superior en pacientes que han presentado un ictus. Pacientes y metodos. Estudio longitudinal de casos y controles. Se incluyo una muestra de pacientes procedentes de centros de rehabilitacion que presentaban hemiparesia secundaria a ictus isquemico o hemorragico. De forma aleatoria, los pacientes fueron distribuidos en un grupo de estudio, cuyos miembros recibieron una ortesis dinamica en el miembro superior durante seis meses, y un grupo control. Se realizaron valoraciones pre y postratamiento con la ortesis con la Fugl-Meyer Assessment Scale y con la Wolf Motor Function para medir los dominios de las funciones y actividades corporales. Se compararon las diferencias entre pre y postest usando ANCOVA y t de Student. Resultados. Se incluyo a 40 pacientes (65% hombres) que presentaban una hemiparesia cronica secundaria a ictus isquemico (n = 28) o hemorragico (n = 12), con una edad media de 58,43 ± 8,67 años. Tras el seguimiento de seis meses, se observo una mejoria en ambos grupos en la funcion motora segun ambas escalas. El uso de la ortesis dinamica se asocio a una tendencia hacia la mejoria en la fuerza de la extremidad superior. Conclusiones. La rehabilitacion tras el ictus mejora la fuerza y las actividades corporales en el miembro superior. El uso de una ortesis dinamica puede adicionalmente mejorar la fuerza en este miembro, pero se necesitan mas estudios para confirmar nuestros resultados.

Deficits in the perception of time and processing of changes across time are commonly observed in individuals with autism. This pilot study evaluated the efficacy of the use of the software tool Tic-Tac, designed to make time visual, in three adults with autism and learning difficulties. This research focused on applying the tool in waiting situations where the participants exhibited anxiety-related behaviour. The intervention followed a baseline and intervention (AB) design, and a partial interval recording procedure was used to code the presence of stereotypes, nervous utterances, wandering or other examples of nervousness during the selected waiting situations. The results showed that the use of Tic-Tac resulted in lower levels of anxiety-related behaviour in all three participants, compared to the baseline, suggesting that this software may be an effective technology for helping people with autism with organisation and predictability during waiting periods. The results are discussed in terms of limitations and implications for further study.

The concept of quality of life is of great importance for interventions directed at people living with disabilities. It is undeniable that the achievement of a satisfactory quality of life should be the objective of clinical interventions that are directed at the group of people with autism spectrum disorder (ASD) and should be a key element in the design of the treatments that are needed to improve the prognosis of future development. Nevertheless, knowledge of both the objective and the subjective conditions that predict greater quality of life satisfaction in people with ASD is still very limited.To explore the perception of the quality of life experienced by a group of children and adolescents with ASD without intellectual disability.A sample of 12 children and 11 adolescents with ASD without intellectual disability. In accordance with their age, they were administered the corresponding quality of life questionnaires.Both groups reported positively on their quality of life, without any differences in the basic dimensions. Nevertheless, in the case of adolescents, very low scores were obtained in the area of self-determination in comparison with their scores in other areas.The discussion centers on the identification of the most relevant dimensions for quality of life, the implications for intervention, and the need to adapt the methodologies in use for the subjective evaluation of those factors, due to the characteristics of ASD that can affect the capabilities necessary for the evaluation of personal experience, and may require the adaptation of the procedures that are employed.Calidad de vida en niños y adolescentes con trastorno del espectro autista sin discapacidad intelectual.Introduccion. El concepto de calidad de vida tiene gran importancia en la intervencion dirigida a las personas con discapacidad. Resulta indiscutible que el alcance de una calidad de vida satisfactoria debe ser el objetivo de las intervenciones clinicas dirigidas al colectivo de personas con trastorno del espectro autista (TEA), y un elemento clave para diseñar los tratamientos necesarios que mejoren el pronostico de desarrollo futuro. A pesar de ello, el conocimiento sobre las condiciones objetivas y subjetivas que predicen una mayor satisfaccion en las personas con TEA es aun muy limitado. Objetivo. Explorar la percepcion de la calidad de vida que experimenta un grupo de niños y adolescentes con TEA sin discapacidad intelectual asociada. Pacientes y metodos. Muestra de 12 niños y 11 adolescentes con TEA sin discapacidad intelectual asociada. Dependiendo de la edad, se les aplico el cuestionario de calidad de vida especifico. Resultados. Ambos grupos informan positivamente sobre su calidad, sin que existan diferencias en las dimensiones basicas. No obstante, en el caso de los adolescentes se obtienen puntuaciones mas bajas en el area de autodeterminacion en comparacion con las demas. Conclusiones. La discusion se centra en la identificacion de las dimensiones mas relevantes para la calidad de vida, las implicaciones para la intervencion y la necesidad de adecuar las metodologias empleadas para la evaluacion subjetiva de estos factores, debido a que las caracteristicas de los TEA pueden alterar las habilidades necesarias para la valoracion de la experiencia personal y requerir la adaptacion de los procedimientos empleados.

We investigate the variations in the transit parameters of WASP-3 over a period of time spanning more than 3 yr. Most of the works published about this planetary system after its discovery concentrate on variations in transit time analysis, whereas long-term variations in transit duration (TDV) have not been explored yet. Apart from providing complementary information on the geometrical configuration of the system, the investigation of TDV can also provide indirect evidence of the presence of additional planets. We find evidence of long-term TDV with an amplitude of 4–5 min. The analysis of periodicity suggests that a modulation may be present but we could not identify a clearly dominant period. We caution that due to the small size of the sample and the effects of the sampling window, additional observations are required to be able to determine true periods.

Extramammary Paget's disease is an uncommon intraepithelial adenocarcinoma which occurs in areas rich in apocrine glands. Although surgery is the treatment of choice, numerous noninvasive treatments have been tried. There are studies that have demonstrated the efficacy of imiquimod to treat Extramammary Paget's disease, but we found no mention in the literature of its use as neoadjuvant therapy previous to surgery excision. We present a case of a large plaque of extramammary Paget's disease successfully treated with imiquimod and minor surgery of the residual disease.

Diabet. Med. 28, 1319–1322 (2011) Abstract Aims To analyse the differences in the prevalence of diabetes and dysglycaemia using fasting plasma glucose and HbA1c criteria. Methods Analytical cross-sectional study undertaken in a random sample of 2144 individuals (age 18–80 years) without known diabetes from the primary care setting in Malaga (Spain). Dysglycaemia was defined as fasting plasma glucose 5.6–6.9 mmol/l or HbA1c 39–46 mmol/mol (5.7–6.4%) and diabetes as fasting plasma glucose ≥ 7.0 mmol/l or HbA1c≥ 48 mmol/mol (≥ 6.5%). Results The proportion of subjects who were normoglycaemic was significantly higher using fasting plasma glucose than HbA1c (83.5 vs. 65%) (P

Psoriasis is an autoimmune chronic inflammatory skin disease that is common in Spain. Connective tissue diseases are a heterogeneous group of conditions characterized by the abnormal function or structure of one or more of the elements that make up connective tissue. These diseases are also autoimmune in origin. In spite of the high prevalence of psoriasis in the general population, its association with a connective tissue disease such as systemic lupus erythematosus, dermatomyositis, scleroderma, or rheumatoid arthritis has only occasionally been reported. It is nevertheless important to have an understanding of such associations, given their significant clinical and therapeutic implications. The association between psoriasis and systemic lupus erythematosus is the one most often described, although the few reports available in the literature have mostly involved single cases. This review will also look at the characteristics of patients with psoriasis and dermatomyositis, mainly focusing on clinical features. The associations between psoriasis and either rheumatoid arthritis or systemic sclerosis will be examined more briefly. The review therefore aims to reflect the literature on psoriasis in association with rheumatic diseases, including coverage of etiologic, pathogenic, clinical, and therapeutic aspects. We emphasize that such cases should be managed by a multidisciplinary team in which care will usually be shared by a rheumatologist and a dermatologist.

Resumen La psoriasis es una enfermedad cutanea inflamatoria cronica de etiologia autoinmune muy frecuente en nuestro medio. Las enfermedades del tejido conectivo constituyen un grupo heterogeneo de enfermedades que se caracterizan por la anormal funcion o estructura de uno o varios elementos del tejido conectivo, de origen autoinmune. Pese a la alta frecuencia de la psoriasis en la poblacion general, son pocos los casos publicados en los que coexistan psoriasis y enfermedades del tejido conectivo, como lupus eritematoso sistemico, dermatomiositis, esclerodermia o artritis reumatoide. Sin embargo, dadas las implicaciones clinicas y, principalmente, terapeuticas que presentan estos pacientes, resulta importante conocer estas asociaciones. La mas frecuentemente descrita es la de psoriasis y lupus eritematoso sistemico, aunque son pocos los estudios publicados y la mayoria se basan en casos unicos. Tambien trataremos las caracteristicas especificas de los pacientes con dermatomiositis y psoriasis, principalmente de tipo clinico. Abordaremos de forma mas breve la coexistencia de esclerosis sistemica y psoriasis, y de artritis reumatoide y psoriasis. Se pretende, por tanto, realizar una revision de la literatura sobre psoriasis y su coexistencia con enfermedades reumatologicas, que comprende aspectos etiopatogenicos, clinicos y terapeuticos. Ademas queremos resaltar el manejo multidisciplinar que requieren estos pacientes, generalmente entre el reumatologo y el dermatologo.

Background Hand eczema is not uncommon in children but it is rarely studied using skin-prick tests. Few reports have addressed their usefulness in children and none has specifically analyzed their use in children with hand eczema. Material and methods We performed a retrospective study of all children up to 16 years of age with hand eczema who were assessed in the Department of Dermatology at Hospital General Universitario in Alicante, Spain with the standard GEIDAC panel over a 5-year period. We compared the epidemiologic data and results of skin-prick tests in this group with those obtained in children with eczema at any site and in adults with hand eczema. Results The study included a total of 1695 patients: 141 (8.3%) children and 1533 (91.7%) adults. Hand eczema was diagnosed in 496 (31.9%) adults and 32 (22.7%) children. Positive results were obtained in skin-prick tests in 50% of children with hand eczema compared with 37.6% of children with eczema at any site and 50.6% of adults with hand eczema. The current relevance of the positive allergens found in children with hand eczema (76.2%) was greater than that observed in children with eczema at any site (61%) or in adults with hand eczema (43%). The most common allergens in children with hand eczema were kathon CG and fragrance mix I, whereas in the other 2 groups metals were the most common. The most common final diagnosis in children with hand eczema was allergic contact dermatitis (34.3%), which proved to be more common than atopic dermatitis. Conclusions We recommend the use of skin-prick tests in all children with chronic hand eczema.

Resumen Introduccion El eczema de manos en la edad infantil no es infrecuente, pero raramente es estudiado mediante pruebas epicutaneas. Existen pocos trabajos que estudien la utilidad de las mismas en los ninos, pero no existe ninguno que aborde su utilidad en el eczema de manos en la poblacion infantil. Material y metodos Realizamos un estudio retrospectivo con todos los ninos (0-16 anos) con eczema de manos estudiados en la Seccion de Dermatologia del Hospital General Universitario de Alicante con la bateria estandar del GEIDAC durante los ultimos 5 anos. Comparamos los datos epidemiologicos y los resultados de las pruebas epicutaneas de este grupo con los obtenidos en la poblacion infantil con eczema de cualquier localizacion y en los adultos con eczema de manos. Resultados Estudiamos 1.695 pacientes, 141 (8,3%) ninos y 1.553 (91,7%) adultos. 496/1.553 (31,9%) adultos y 32/141 (22,7%) ninos presentaban eczema de manos. El 50% de los ninos con eczema de manos, frente al 37,6% de los ninos con eczema y el 50,6% de los adultos con eczema de manos presentaron algun alergeno positivo en las pruebas epicutaneas. La relevancia presente de los alergenos positivos encontrados en los ninos con eczema de manos (76,2%) fue mayor que las obtenidas en los ninos con eczema (61%) y los adultos con eczema de manos (43%). Los alergenos mas frecuentes en los ninos con eczema de manos fueron el kathon CG y la mezcla de fragancias I, mientras que en los otros dos grupos fueron los metales. El diagnostico final mas frecuente en ninos con eczema de manos fue el eczema de contacto alergico (34,3%) por delante de la dermatitis atopica. Conclusion Recomendamos la realizacion de pruebas epicutaneas a todo nino con eczema cronico de manos.

We have undertaken visual spectroscopy of the highly evolved planetary nebulae (PNe) A8, A13, A62, A72, A78 and A83 over a wavelength range 4330 < λ < 6830 A. This permits us to specify relative line intensities in various sectors of the nebular shells, and to investigate the variation of emission as a function of radius. We determine that the spectrum of the central star of A78 has varied appreciably over a period of 25 yr. There is now evidence for strong P Cygni absorption in the λ4589 and λ5412 transitions of He II, implying terminal velocities of the order of V∞ 3.83 x 10 3 km s -1 . We also note that the emission-line profiles of the sources can be used to investigate their intrinsic emission structures. We find that most PNe show appreciable levels of emission throughout their volumes; only one source (A13) possesses a thin-shell structure. Such results are in conformity with evolutionary theory, and probably reflect the consequences of adiabatic cooling in highly evolved outflows.

To investigate the role of the monounsaturated n-9 fatty acids (MUFA) in the lipolytic activity of adipocytes, a study was carried out in which an increase in MUFA was produced in the tissues by two different methods; by the dietary enrichment of oleic acid or by producing an essential fatty acid deficiency syndrome. For this, forty-five male Sprague–Dawley rats were fed with a normal-energy diet and were subdivided into three groups. The diets varied in the type of dietary fat; palmitic acid, olive oil, or soyabean oil+palmitic acid. At the end of the study measurements were taken of weight, plasma leptin, tissue concentration of fatty acids, fat-cell size in the epididymal and the omental adipose tissues, adipocyte lipolytic activity of both tissues after stimulation with adrenaline, and the capacity of insulin to inhibit lipolysis. The baseline and adrenaline-stimulated lipolytic activity were greater and the anti-lipolytic capacity of insulin lower in the animals undergoing an increase in MUFA in the tissues (palmitic-acid and olive-oil diets). The area under the curve of glycerol, used as an indicator of lipolytic activity, was positively correlated with the concentration of MUFA and negatively with polyunsaturated fatty acids in the adipose tissues. It is concluded that an increase in tissue MUFA, however obtained, induces an increase in lipolytic activity.

Fundamento y objetivo Evaluar en un estudio poblacional la asociacion entre la actividad fisica diaria y diferentes factores de riesgo metabolico y cardiovascular. Pacientes y Metodo En 1.226 personas (edad: 18–65 anos) aleatoriamente seleccionadas en una poblacion del sudeste espanol se ha evaluado la asociacion entre el nivel de actividad fisica diaria laboral y extralaboral con las siguientes variables: indice de masa corporal, lipidos plasmaticos, presencia de hipertension arterial, obesidad, glucemia basal alterada y tolerancia anormal de la glucosa. Resultados La intensidad de la actividad fisica en el trabajo se correlaciono de manera negativa con las concentraciones de colesterol ligado a lipoproteinas de baja densidad y positivamente con las de colesterol ligado a lipoproteinas de alta densidad. La probabilidad de presentar hipertension arterial, glucemia basal alterada o tolerancia anormal de la glucosa fue mayor en aquellos que tuvieron una menor actividad fisica diaria. Conclusiones La actividad fisica diaria, considerada como uno de los componentes del estilo de vida, se asocia con la presencia de los componentes del sindrome metabolico. Un aumento de la actividad fisica diaria debe contribuir a mejorar los patrones favorables a la prevencion de los factores de riesgo cardiovascular.

The low excitation properties of the planetary nebula (PN) NGC 6720 are known to be unusual, and to imply large ring/core emission ratios. We point out that such characteristics are by no means confined to this source alone, and that high ratios may occur in a large fraction of elliptical and circular PNe. Such trends may arise because of the presence of thin low-excitation emission sheets ‘wrapped’ within and around the primary outflows. The widths of such shells are required to be exceedingly small, and may (for certain cases) be of order ≪10−2 pc. Such a mechanism appears capable of explaining most of the observed emission properties, and may arise through shock interaction between differing envelopes. Alternative explanations in terms of bipolar or cylindrical outflows are shown to be implausible.

Introduccion La psicologia medica ha ayudado a pro-fundizar en el conocimiento y mejor evolucion de diversas enfermedades en su mayoria medicas. En el presente traba-jo se pretende profundizar en una afeccion quirurgica como el neumotorax espontaneo Objetivos El objetivo de este estudio ha sido comparar la personalidad, la patologia afectiva, la ansiedad y el pa-tron de conducta tipo A de un grupo de 34 pacientes con neumotorax espontaneo con un grupo control de 33 pacien-tes hospitalizados por afecciones quirurgicas menores Material y metodos Se han aplicado a los sujetos prue-bas objetivas de valoracion: Trait Anxiety Inventory, Beck Depression Inventory, Jenkins Activity Inventory, Eysenck Personality Questionary. Los cuestionarios se administraron antes de la intervencion quirurgica y tras una entrevista in-formativa Resultados Se han encontrado diferencias estadistica-mente significativas entre los grupos en patron de conducta tipo A, no siendo asi en rasgos de personalidad, estado de animo y ansiedad Conclusiones Podemos concluir que para la mejor evolu-cion de los pacientes con neumotorax espontaneo seria necesa-rio reducir sus caracteristicas del patron de conducta tipo A

In this paper, we present a procedure to estimate the error in elliptic equations using the element-free Galerkin (EFG) method, whose evaluation is computationally simple and can be readily implemented in existing EFG codes. The estimation of the error works very well in all numerical examples for 2-D potential problems that are presented here, for regular and irregular clouds of points. Moreover, it was demonstrated that this method is very simple in terms of economy and gives a good performance. The results show that the error in EFG approximation may be estimated via the error estimator described in this paper. The quality of the estimation of the error is demonstrated by numerical examples. The implemented procedure of error approximation allows the global energy norm error to be estimated and also gives a good evaluation of local errors. It can, thus, be combined with a full adaptive process of refinement or, more simply, provide guidance for redesign of cloud of points. Copyright © 2001 John Wiley & Sons, Ltd.

We have acquired narrowband imaging of NGC 3587 (the Owl Nebula) in the transitions [O II] λλ3727, 3729, H I λ4861, [O III] λ5007, H I λ6563, [N II] λ6584, [S II] λ6717, and [S II] λ6731. As a result, we are able to evaluate the variation of excitation and electron density over the projected envelope of the source. We propose that the Owl Nebula consists of four primary shells: an internal, tilted, barrel-like component responsible for higher excitation emission; two much more uniform, spherically symmetric structures, CSCI and CSCII. These, finally, are enveloped by a much lower intensity, lower excitation halo, dubbed CSCIII. A large proportion of the low-excitation emission appears to be associated with the periphery of CSCI, and it is conceivable that this is, physically speaking, a relatively thin-shelled structure. [S II] density mapping appears to indicate that ne is preferentially enhanced toward the northern periphery of the shell, in a regime where low-excitation line strengths are also preferentially enhanced. We suggest that such trends may arise through northerly shocking of the shell CSCI. There is, in addition, some evidence for an east-west dichotomy in density structure, which may reflect variable sampling of the higher density, barrel-like component. Mean densities are low, and of the order ne = 590 cm-3.

We have acquired narrowband imaging of NGC 2346 in the transitions H I λ6563 and λ4861 and [O III] λ5007. As a result, we are able to evaluate the variation of both excitation and extinction over the projected central parts of the nebular shell. Extinction appears to be surprisingly uniform, and there is (in particular) little evidence for the reddening asymmetries proposed in previous analyses. Cusplike enhancements in Av at the periphery of the source are attributed to a layer of extincting material at the limits of the H II region, implying a value of major-axis reddening ΔAv < 0.5 mag. Similar extinctions are also deduced from an analysis of infrared and millimeter-wavelength observations. It is unclear what proportion of this reddening may be attributed to the molecular belt, although it seems likely that this feature contributes ~0.3 mag of extinction in the northern lobe and explains the north-south asymmetries noted in optical images. Given that levels of local extinction are quite modest, it seems likely that the larger part of the observed reddening (Av ≈ 2 mag) arises from intervening interstellar material, a conclusion that is again at variance with previous analyses. Such a presumption would explain the relative uniformity in extinction over the face of the nebula, and similarity between distances estimated from extinction and those determined through alternative analyses. If this is accepted, however, then it follows that prior estimates of central star extinction must be greatly in error. One possible origin for this error is noted from Hubble Space Telescope imagery in [N II] λ6584, where it is clear that a secondary star is located close to the presumed A-type central star, a component that was not allowed for in previous analyses. It is unclear whether this star is physically associated with the core binary system.

We have acquired imaging of the bipolar outflow M2-9 in the transitions [O III] λ5007, H I λ6563, [N II] λ6584, and [S II] λλ6717, 6731. As a result, we are able to map both excitation and density over the face of the nebula. We find that underlying densities in the lobes increase to ne ~ 1.6 × 103 cm-3 at distances rp ~ 12''–15'' from the central star, after which they again decrease to ne 27''. Superposed upon this are various density knots, associated with the visual condensations, in which peak values of ne are of order 6.3 × 103 cm-3. These appear to be responsible for low-excitation shadowing of the outer envelope. All of these features (the density peaks, and broad underlying density variation) are shown to be consistent with a particular model of shock excitation, in which an interior wind is shock-interacting with an external neutral envelope. Such a model appears also to be consistent with trends in [O III]/Hα and [S II]/Hα, which (for the northern lobe at least) appear most consistent with shock excitation.

The planetary nebula NGC 2392 possesses an extremely unusual spectrokinematic morphology, characterized by several strange and elusive structures. In this paper, extensive narrowband imaging of the source is used to investigate the shell excitation structure, while [O III] and [S II] images are ratioed to provide fully sampled mapping of electron density and temperature. As a result, we are able to confirm the presence of low densities in the various filamentary structures, an appreciable radial decrease in density in the outer shell, and finally, a probable regime of higher shell densities at the interface of the bright inner shell and lower intensity outer halo. Although temperatures are more uniform, we also find evidence for a significant temperature enhancement close to the inner-outer shell interface, and it is proposed that both anomalies (in density and temperature) arise in a postshock cooling regime. Finally, present imaging and prior spectroscopy are used to construct a revised model of the source, in which it is argued that the outer filamentary structure occupies a disklike regime, congruent with the principal plane of the outer spheroid. Individual filaments arise from low-excitation density contrasts, created through the interaction between the outer shell and a precessing jet.

We have acquired [O III] λ5007, H I λλ6563 and 4861, and [S II] λλ6717 and 6731 imaging of the bipolar outflow source NGC 6445. As a result, we find that density is preferentially enhanced within an interior optical/radio emission annulus and takes a maximum value ~1.1 × 103 cm-3. Visual extinction appears also to be enhanced within this regime, taking values ~0.8 mag greater than for the enveloping shell, a result that is shown to imply ratios Av/N(H2) comparable to that of NGC 7027 and at least 4 times greater than for the interstellar medium. Finally, we investigate the variation of excitation through the projected nebular envelope. While the nucleus possesses excitation properties consistent with normal (radiatively excited) sources, it appears that line ratios toward the source periphery may indicate the presence of appreciable shock activity.

The aim of this study was to test the hypothesis of an association between the -30GA polymorphism of the promoter of the glucokinase gene and the prevalence and incidence of obesity. We studied the -30GA polymorphism of the glucokinase gene promoter in 981 persons, of whom 866 were seen again 6 years later. All the persons underwent an oral glucose-tolerance test and the BMI (weight/height(2)) was recorded. The -30GA polymorphism of the glucokinase gene promoter was studied using RFLP-PCR. At the initial study, the probability of having a BMIor =25 in carriers of the A allele was significantly lower than expected by chance (odds ratio (OR) = 0.63; 95% confidence interval (CI) = 0.456-0.885). In those persons with a BMIor =30 at the first study, the probability at 6 years of losing weight (reaching a BMI30) was greater in carriers of the A allele (OR = 0.22; 95% CI = 0.087-0.576). The increase in weight over these 6 years, taken as a continuous variable, was significantly less only in those persons who were originally obese (P = 0.018). In conclusion, in a population from southern Spain, carriers of the A allele of the -30GA polymorphism in the promoter of the glucokinase gene had a lower risk for obesity and the likelihood of losing weight was greater in those obese persons who had the A allele (GA or AA).

We report the results of narrow band imaging of the bipolar outflow source NGC 2818 in transitions of [NII], [OIII], [SII], and HI. As a consequence, we are able to assess the overall excitation properties of the shell, and determine that line ratios towards the nebular periphery are anomalous, and characteristic of planar shocks with velocity km s-1 . Pre-shock densities are likely to be modest, and of order cm-3 . The [SII] imaging is further used to derive a fully-sampled map of electron density, whence it is clear that the density structure is rather complex and related to various features within the excitation maps. Peak values cm-3 occur close to the nucleus, although densities subsequently decline for major axis displacements arcsec. The minor axis distribution, on the other hand, appears to be somewhat more extended and bilobal. It is probable that complexities in the density mapping reflect the presence of condensations and filaments within the primary shell structure, and that these are also responsible for apparent variations in density as a function of forbidden and permitted line transition.

To study the prevalence and correlates of body size phenotypes in an adult Spanish population.We undertook a cross-sectional analysis in a random sample of 2,270 individuals. We defined six body size phenotypes based on body mass index category (normal-weight, 18.5 to 24.9 kg/m2; overweight, 25 to 29.9 kg/m2; obese, ≥30.0 kg/m2) and the presence of ≤1 (metabolically healthy) or ≥2 (metabolically abnormal) cardiometabolic abnormalities: metabolically healthy normal-weight (MHNW), metabolically abnormal normal-weight (MANW), metabolically healthy overweight (MHOW), metabolically abnormal overweight (MAOW), metabolically healthy obese (MHO), and metabolically abnormal obese (MAO). We considered four cardiometabolic abnormalities: systolic and/or diastolic blood pressure ≥130/85 mm Hg, triglycerides ≥150 mg/dL, high-density-lipoprotein cholesterol levels40/50 mg/dL in men/women, and elevated glucose (fasting plasma glucose ≥100 mg/dL or previous diabetes).The prevalence of the MHO, MHOW, and MANW phenotypes was 2.2, 13.9, and 7.9%, respectively. Whereas 9.6% of obese and 32.6% of overweight individuals were metabolically healthy, 21.3% of the normal-weight subjects were metabolically abnormal. A multivariate regression model (adjusted for age, sex, and waist circumference) showed that age40 years, male sex, and higher waist circumference were independently associated with the metabolically abnormal phenotype MANW, whereas younger age, female sex, and lower waist circumference were independently associated with the metabolically healthy phenotypes.The prevalence of MHO in our population is low and is more common in women and younger people. In contrast, a high proportion of normal-weight individuals (mainly over 40 years of age) in our population show cardiometabolic abnormalities.

The kinematics of Planetary Nebulae are analyzed in terms of the solutions to the equations of hydrodynamic equilibrium developed by J. Canto. We apply our analysis to the Planetary Nebulae NGC 6905 and NGC 6537. A detailed spectroscopic study of these objects reveals the existence of high nuclear velocities, together with complex kinematic structures and unusual emission line intensities. Shock ionization clearly plays a key role in these nebulae. Remarkably good agreement is obtained when comparing the synthetic maps and spectra resulting from the shock solutions with the observational data.

To analyse the differences in the prevalence of diabetes and dysglycaemia using fasting plasma glucose and HbA(1c) criteria.Analytical cross-sectional study undertaken in a random sample of 2144 individuals (age 18-80 years) without known diabetes from the primary care setting in Malaga (Spain). Dysglycaemia was defined as fasting plasma glucose 5.6-6.9 mmol/l or HbA(1c) 39-46 mmol/mol (5.7-6.4%) and diabetes as fasting plasma glucose ≥ 7.0 mmol/l or HbA(1c)≥ 48 mmol/mol (≥ 6.5%).The proportion of subjects who were normoglycaemic was significantly higher using fasting plasma glucose than HbA(1c) (83.5 vs. 65%) (P0.0001). Compared with fasting plasma glucose, HbA(1c) detects more cases of dysglycaemia (32 vs. 14.8%) (P0.0001) and diabetes (3 vs. 1.7%) (P0.0001).In our environment, using HbA(1c) for the diagnosis of pre-diabetes and diabetes could increase the target population for preventive and therapeutic measures. Further cost-effectiveness studies are needed before the widespread diagnostic use of HbA(1c) can be recommended.

Resumen Los tumores vesicales benignos de origen mesenquimal tienen una incidencia de aparicion muy baja, de ellos el mas frecuente es el leiomioma Aportamos un nuevo caso, planteando una discusion en cuanto a las pruebas complementarias necesarias para su diagnostico

Psoriasis is an autoimmune chronic inflammatory skin disease that is common in Spain. Connective tissue diseases are a heterogeneous group of conditions characterized by the abnormal function or structure of one or more of the elements that make up connective tissue. These diseases are also autoimmune in origin. In spite of the high prevalence of psoriasis in the general population, its association with a connective tissue disease such as systemic lupus erythematosus, dermatomyositis, scleroderma, or rheumatoid arthritis has only occasionally been reported. It is nevertheless important to have an understanding of such associations, given their significant clinical and therapeutic implications. The association between psoriasis and systemic lupus erythematosus is the one most often described, although the few reports available in the literature have mostly involved single cases. This review will also look at the characteristics of patients with psoriasis and dermatomyositis, mainly focusing on clinical features. The associations between psoriasis and either rheumatoid arthritis or systemic sclerosis will be examined more briefly. The review therefore aims to reflect the literature on psoriasis in association with rheumatic diseases, including coverage of etiologic, pathogenic, clinical, and therapeutic aspects. We emphasize that such cases should be managed by a multidisciplinary team in which care will usually be shared by a rheumatologist and a dermatologist.

We present the first results from long-term photometric observations carried out with the INTA-CAB 50-cm telescope in a fully robotic mode. The data belong to an ongoing programme for the photometric follow up of known transiting close-in giant planets. We describe the techniques used to generate differential light curves of the programme stars and discuss the photometric performance obtained over the first year of operation.

Hand eczema is not uncommon in children but it is rarely studied using skin-prick tests. Few reports have addressed their usefulness in children and none has specifically analyzed their use in children with hand eczema.We performed a retrospective study of all children up to 16years of age with hand eczema who were assessed in the Department of Dermatology at Hospital General Universitario in Alicante, Spain with the standard GEIDAC panel over a 5-year period. We compared the epidemiologic data and results of skin-prick tests in this group with those obtained in children with eczema at any site and in adults with hand eczema.The study included a total of 1695 patients: 141 (8.3%) children and 1533 (91.7%) adults. Hand eczema was diagnosed in 496 (31.9%) adults and 32 (22.7%) children. Positive results were obtained in skin-prick tests in 50% of children with hand eczema compared with 37.6% of children with eczema at any site and 50.6% of adults with hand eczema. The current relevance of the positive allergens found in children with hand eczema (76.2%) was greater than that observed in children with eczema at any site (61%) or in adults with hand eczema (43%). The most common allergens in children with hand eczema were kathon CG and fragrance mix I, whereas in the other 2 groups metals were the most common. The most common final diagnosis in children with hand eczema was allergic contact dermatitis (34.3%), which proved to be more common than atopic dermatitis.We recommend the use of skin-prick tests in all children with chronic hand eczema.

gastrointestinal stromal tumors (GISTs) are rare (10 to 20/million). They exist in the whole digestive system and its surroundings, and are most common in the stomach (70%), followed by the small intestine (20-25%), colon and rectum (5%), and esophagus (5%). Their clinical presentation varies from small, incidentally found nodules to large and aggressive tumors. Nowadays GISTs are classified according to Fletcher s classification.to review the features of our GIST population.a retrospective study of GIST patients identified by immunohistochemical criteria, from 1997 to December 2007, and classified according to Fletcher s criteria.43 patients were included (24 men, 19 women) with a mean age of 62.7 years. Gastric GISTs (20 cases, 46.5%), small intestine GISTs (18 cases, 41.9%); in 5 cases metastases of occult tumors were found. Eighteen cases had no symptoms. Tumors were classified according to Fletcher s criteria as high-risk (n = 19), intermediate-risk (n = 7), low-risk (n = 12), and indeterminate-risk (n = 5). Death occurred in 10 patients, and 13 patients had metastatic disease.our results are in accordance with the world literature, in which a majority of cases are men with gastric tumors. The 5-year survival rate was 42%. Fletcher s criteria were easily applicable criteria and could predict tumor behavior.