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Resumen Objetivos Determinar las propiedades metricas de la escala COMFORT Behavior Scale desarrollada por van Dijk et al. (2000) en el contexto del paciente critico pediatrico. Diseno Estudio observacional, psicometrico y prospectivo. Lugar de estudio Unidad de Cuidados Intensivos de un hospital pediatrico y universitario de tercer nivel asistencial. Pacientes Un total de 311 ninos con una mediana de edad de 5,07 anos (0,9-11,7). Intervenciones Ninguna. Principales variables y resultados La escala fue administrada de forma simultanea por 2 enfermeros a 311 pacientes ingresados en una unidad de criticos de 18 camas de un hospital pediatrico de tercer nivel asistencial. La version espanola de la COMFORT Behavior Scale obtuvo un alfa de Cronbach de 0,715 y esta compuesta por 3 factores, con 2 items cada uno: 1) alerta y movimiento fisico; 2) calma/agitacion y respuesta respiratoria/llanto, y 3) tono muscular y tension facial. Conclusiones La escala COMFORT B logro ser adaptada al idioma espanol y mostro ser valida para determinar y cuantificar el grado de confort en un grupo de ninos ingresados en una unidad de cuidados pediatricos espanola.

Objectives To determine the measurement properties of the Spanish version of the COMFORT Behavior Scale developed by van Dijk et al (2000) in paediatric critical care patients. Design Prospective observational and psychometric study. Setting Level III Intensive Care Area at a university’s children hospital. Patients A total of 311 children with median age of 5.07 years (IQR = 0.9-11.7). Interventions None. Principal variables and results To determine the measurement properties the Spanish version of the COMFORT Behavior Scale was simultaneous administered by two nurses to 311 patients admitted to an eighteen-bed critical care unit of a third level paediatric hospital. The Spanish version of the COMFORT Behavior Scale obtained a Cronbach alpha coefficient of 0.715 and it is a tool made up of three factors with two items in each domain: i) alertness and physical movement; ii) calmness/agitation and respiratory response/crying, and iii) muscle tone and facial tension. Conclusions The COMFORT B was adapted to Spanish and it has shown to be a valid an reliable tool to assess comfort in a group of children admitted to an Spanish Intensive Care Unit.

The LHC collimation system must adopt materials with excellent thermal shock resistance, high electrical conductivity, geometrical stability, and radiation hardness. Two novel composites, Molybdenum–Carbide–Graphite and Copper–Diamond, are proposed for the LHC collimation upgrade. A postirradiation examination was performed to assess the status of the composites, tested under intense proton beam impacts at the CERN HiRadMat facility. Metrology measurements, computed tomography, and 3D topography allowed to evaluate the localized spallation induced by the beam. This article provides an overview of the thermophysical characterization of the two composites before irradiation and nondestructive postirradiation results.

The High-Luminosity LHC Project aims to increase the integrated luminosity that will be collected by the Large Hadron Collider for the needs of the high energy physics frontier by the end of its Run 3 by more than a factor ten. This will require doubling the beam intensity, and in order to ensure coherent stability until the brighter beams are put in collision, the transverse impedance of the machine has to be reduced. As the major portion of the ring impedance is generated by its collimation system, several low resistivity jaw materials have been considered to lower the collimator impedance and a special collimator has been built and installed in the machine to study their effect. In order to assess the performance of each material we performed a series of tune shift measurements with LHC beams. The results show a significant reduction of the resistive wall tune shift with novel materials, in good agreement with the impedance model and the bench impedance and resistivity measurements. The largest improvement is obtained with a molybdenum coating of a molybdenum-graphite jaw. This coating, applied to the most critical collimators, is estimated to lower the machine impedance by up to 30% and the stabilizing Landau octupole threshold by up to 240 A after accounting for uncertainties of the model and other destabilising effects. A half of the overall improvement can be obtained by coating the jaws of a subset of 4 out of 11 collimators identified as the highest contributors to machine impedance. This subset of low-impedance collimators is being installed during the Long Shutdown 2 in 2019-2020. The High-Luminosity upgrade of the Large Hadron Collider (HL-LHC) will double its beam intensity for the needs of High Energy Physics frontier. In order to ensure coherent stability until the beams are put in collision, the transverse impedance has to be reduced. As the major portion of the ring impedance is sup

Innovative collimators are being investigated to handle the high energy particle beams foreseen in future upgrades of CERN Large Hadron Collider (LHC). This calls for the development of novel advanced materials, as no existing metal- or carbon-based material possesses the combination of physical, thermal, electrical and mechanical properties, imposed by extreme collimator's working conditions. An ambitious research program has been undertaken at CERN and collaborating partners to investigate, process and characterize novel composite materials. A promising new family of materials has been identified in metal/ceramiccarbon composites: these are intended to combine optimum mechanical, thermal and electrical properties, such as mechanical strength, melting temperature, thermal shock resistance, electrical conductivity, and energy absorption. Besides High Energy Physics equipment, these materials are of particular interest for thermal management applications such as high power density electronic packaging, aerospace, automotive, nuclear fusion and solar energy. With that in mind, this paper aims at discussing the properties of investigated materials with respect to their relevance for the various application domains.

Concepto. La hepatitis virica se define como la inflamacion difusa del parenquima hepatico secundaria a la infeccion por un virus hepatotropo. Clasificacion. Existen cinco virus hepatotropos denominados por las letras A-E, de los que los VHA y VHE se transmiten por via oro-fecal, y los VHB, VHC y VHD por via parenteral y/o sexual y con frecuencia evolucionan a la cronicidad. Clinica. El sindrome general de la hepatitis aguda virica es comun a los distintos tipos con algunas manifestaciones diferenciales * La hepatitis por VHA puede ser autolimitada, aunque a veces se comporta de forma colestasica y recurrente * La hepatitis por VHB puede debutar con manifestaciones diversas extrahepaticas * La infeccion por VHD puede presentarse en el curso de una infeccion aguda o cronica por VHB * La hepatitis aguda por VHC es asintomatica en la mayoria de los casos. Evolucion. Las hepatitis por VHA y VHE nunca cronifican. La hepatitis aguda por VHB pasa a la cronicidad en un porcentaje del 1%-5%. Tanto la hepatitis cronica por VHB como por VHC se han relacionado con el desarrollo de hepatocarcinoma. Tratamiento. La mayoria de las hepatitis agudas pueden ser vigiladas en domicilio. En la hepatitis aguda por VHB con ictericia importante, lamivudina podria disminuir la mortalidad. En la hepatitis por VHA y VHB existen diversas pautas de profilaxis pasiva y activa segun condiciones clinicas.

Mammalian cells are widely used in the production of viral vaccines and therapeutic proteins. Most of those processes employ cells growing in suspension; however, some, especially those in vaccine production, use adherent cells. Stirred-tank bioreactors are most widely used for mammalian cell culture processes. When a stirred-tank bioreactor is used for growing adherent cells, a supporting surface for cell attachment is provided by the use of microcarriers or macroporous microcarriers. Alternatively, adherent cells are grown as aggregates in suspension. Fed-batch culture is commonly practised since it reaches high cell and product concentrations. When a stirred-tank bioreactor is operated in a continuous mode, it is a common practice to employ a cell retention device for perfusion in order to increase cell and product concentrations. As mammalian cell culture processes are increasingly being used in the manufacturing, one also witnesses an increasing adoption of disposable (or single-use) cell culture devices. Traditional roller bottles are still often seen. Additionally, multiple flat plates or parallel trays, along with bag type cell growth chambers and even plastic stirred tanks, are used in moderate-scale production and in the seed culture propagation for large-scale bioreactors. Those disposable devices offer simplicity in operations and ease process validation in the production of biopharmaceuticals. Recently, some innovative bioreactors developed nearly two decades ago are finding applications in tissue engineering. Furthermore, the demand for high throughput operations in cell culture processing will continue to drive the innovations in bioreactor technology. Keywords: cell culture; bioreactor; single-use bioreactor; scale-down

In recent years, approaches to control performance optimization for resource-constrained systems (e.g., networked embedded systems) have been receiving increased attention. Most of them focus on theory, whereas practical aspects are omitted. We present a Controller Area Network (CAN) application profile that permits implementing networked embedded systems with control performance optimization quickly. First, the paper justifies the selection of the network, CAN. Afterwards, the specific application profile is presented. The paper ends showing simulation results, which validate the applicability of the presented profile.

The aim of the study was to assess the incidence and the cumulative probability of cytolytic and cholestatic hepatotoxicity during antiretroviral treatment in a group of HIV HCV haemophiliacs. We evaluated 47 patients that received 246 courses of antiretroviral treatment [98 courses of pre-highly active antiretroviral therapy (pre-HAART) and 148 HAART treatments]. Liver function tests were assessed at baseline of each treatment, after 1 month and at least every 4 months thereafter. Cytolytic and cholestatic hepatotoxicity was recorded. Of the 246 treatments, 28 (12.45%) were followed by cytolytic hepatotoxicity and 32 (13%) by cholestatic hepatotoxicity. Cytolytic hepatotoxicity was similar in HAART (16/148; 10.8%) and in pre-HAART treatment (12/98; 12.2%) and cholestatic hepatotoxicity was more frequent in HAART (29/148; 19.6%) than in pre-HAART treatment (3/98; 3.1%) (P < 0.001). The actuarial probability of developing cytolytic and cholestatic hepatotoxicity at 10 years of onset of antiretroviral treatments was 39% and 56%, respectively. Most enzyme elevations were asymptomatic, but in eight cases therapy was discontinued or changed and in one case a cirrhotic patient died of progressive liver failure. In HIV HCV haemophiliacs, the cumulative probability of developing hepatotoxicity during follow-up is high and although in the most cases the toxicity is mild, fatal cases can occur.

Introduction Hepatitis C virus (HCV) infection is one of the leading causes of chronic liver disease and the reason for more than 50% of liver transplantations (OLT). Recurrent HCV infection occurs in almost all transplant recipients and has an unfavorable course. Although immunosuppressive agents are necessary to avoid allograft rejection, these drugs may favor viral replication facilitating viral-mediated graft injury. Methods To predict the evolution of two HCV+ patients who underwent OLT, we studied INF-γ and TNF-α production and the maturation capacity of dendritic cells (DCs) at three time points: before transplantation (Pre-Tx) and at 2 (2M) and 6 (6M) months after transplantation. Cytometric bead assays were used to quantify INF-γ and TNF-α production in the supernates of mixed leukocyte reactions (MLR) between spleen cells from the liver donor and CD4+ cells from the recipients. Immature and mature DCs were generated in vitro from patient monocytes. Results The one patient who experienced recurrent HCV showed loss of CD4+ responses to donor antigens and INF-γ and TNF-α production after OLT. In contrast, the other patient maintained detectable levels of these cytokines after OLT. It was possible to generate mature DCs from monocytes with the aid of CD40L in both cases, but decreased expression of HLA-DR, CD80, and CD86 markers was observed upon posttransplantation analyses in the patient with recurrent HCV. Conclusion Loss of the proliferative response as well as INF-γ and TNF-α production, together with a decreased HLA-DR, CD80, and CD86 (markers of mature DCs), indicated an inadequate immune response to viral progression in the liver transplant recipient with relapsing HCV infection.

The objective of this study was to investigate the presence of nailfold capillary abnormalities and extrahepatic signs of connective tissue disease in patients with primary biliary cirrhosis (PBC), as compared to patients with other chronic liver diseases. We evaluated 22 patients with PBC and 15 patients with other chronic liver diseases as a control group. Nailfold capillaroscopy was performed by two observers blinded to clinical findings using a Wild M3 stereomicroscope with an Intralux 5000 Volpi cold light lamp. We detected nailfold capillary abnormalities in 20 out of 22 (91%) PBC patients. Twelve of these 20 patients (54%) showed capillary alterations characteristic of systemic sclerosis. In the control group only two out of 15 patients (13%) presented alterations and in both cases they were a nonspecific type. The presence of nailfold capillary abnormalities was significantly greater in PBC patients than in the control group (P < 0.001). Eleven out of the 22 PBC patients (50%) had extrahepatic signs of connective tissue disease and most of them were related to systemic sclerosis; patients with other chronic liver diseases did not present rheumatic manifestations (P < 0.001). In PBC patients there was a significant association between systemic sclerosis capillary pattern and rheumatic manifestations (P < 0.03). The high prevalence of nailfold capillary abnormalities characteristic of systemic sclerosis in patients with PBC and the correlation with sclerodermal manifestations suggests that this capillaroscopic finding could be a useful indicator to investigate rheumatic manifestations in these patients.

Tumor necrosis factor-alpha (TNF) causes vasodilatation and a hyperdynamic state by activating nitric oxide (NO) synthesis. Tyrphostins, specific inhibitors of protein tyrosine kinase (PTK), block the signaling events induced by TNF and NO production. A hyperdynamic circulatory syndrome (HCS) is often observed in portal hypertension (PHT). TNF and NO seem to mediate these hemodynamic changes. The aim of this work was to study the effect of PTK inhibition on the systemic and portal hemodynamics, TNF and NO production, in cirrhotic rats with portal hypertension. Rats with liver cirrhosis induced by chronic inhalation of carbon tetrachloride were used. Animals were treated daily with tyrphostin AG 126 (alpha-cyano-(3-hydroxy-4-nitro) cinnamonitrile) or placebo for 5 d. Mean arterial pressure (MAP), heart rate (HR), and portal pressure (PP) were measured by indwelling catheters. Cardiac output (CI) and stroke volume (SV) were estimated by thermodilution, systemic vascular resistance (SVR) was calculated (MAP/CI), and portal systemic shunting (PSS) was quantitated using radioactive microspheres. Serum and mesenteric lymph node (MLN) TNF levels were measured using an immunoassay kit, and serum NOx was determined photometrically by its oxidation products. The AG 126-treated group showed a statistically significant increase in MAP and SVR, and decreases in CI, SV, MLN TNF, and serum NO oxidation products nitrite and nitrate (NOx) in comparison with the placebo-treated rats. No significant differences were noticed in HR, PP, PSS, or serum TNF. Significant correlations were observed between MAP and NOx, MAP and MLN TNF, PSS and NOx, and serum TNF and serum NOx. The HCS observed in PHT seems to be mediated, at least in part, by TNF and NO by the activation of PTKs and their signaling pathways. PTK activity inhibition ameliorates the hyperdynamic abnormalities that characterize animals with cirrhosis and PHT.

The liver has a significant representation of the mononuclear phagocyte system and can, therefore, efficiently remove bacteria from the blood. However it can become involved during systemic infections when local or general conditions favor bacterial colonization. On the other hand it must be borne in mind that increased susceptibility to infection is common in patients with chronic liver disease due to impairment of the immune system and to malnutrition. In this chapter we discuss the involvement of the liver in systemic infections that have not been considered in other sections of the book.

Complications during induction chemotherapy (CT) for AML cause mortality in 5–20% of cases. It is relevant to define the risk of early death in this setting. In patients with a high probability of dying due to toxicity, the intensification of the supportive measures and/or alternative antineoplastic approaches could be appropriate. The aim of this study was to detect the features associated with lethal complications during induction CT for AML. We defined early deaths (ED) as those occurring before 42 days after the start of induction in the absence of evident leukemia. We analyzed all consecutive patients diagnosed with AML between June 1998 and February 2006 in 20 Spanish hospitals. These cases were treated according two multicenter trials CETLAM 99 (n=326) and CETLAM 2003 (n=248). Both schemes included idarubicin 12 mg/m2 days 1,3 and 5, etoposide 100 mg/m2 days 1–3 and cytarabine 500 mg/m2/12 hours days 1, 3, 5 and 7 as front-line treatment. In the CETLAM 2003, G-CSF (150 mg/m2 days 0–7) was added as priming therapy. The series included 574 patients, 248 (43%) female, with a median age of 48 years. Creatinine level was elevated (> 1,2 mg/dL) in 11% of patients. The overall mortality rate during induction (ED) was 12% (n=69). 335 (58%) patients achieved a complete remission with a single course of CT, 108 (19%) a partial remission and 62 (11%) were refractory. The most common causes of death were infection (n= 28, 46%), bleeding (n=7, 11%), pulmonary failure not due to infection (n=6, 10%), and multiorgan failure (n=4, 7%). Univariate analysis showed that age older than 50 years old, male gender, M4 or M5 FAB subtype, leukocyte count higher than 100x109/L, blasts in the marrow >70% and creatinine level above 1,2 mg/dL were associated with more frequent ED. In multivariate analysis, elevated creatinine level [hazard ratio (HR) 2.6 (1.3–5.2); P=0.009], leukocytosis >100x109/L [HR 2.3 (1.1–4.6) P=0.021] and age > 50 years old [HR 2.1 (1.4–3.9) P=0.018] were independent risk factors. The remaining parameters, including among others the use of G-CSF, gender, blasts in the marrow, treatment protocol, cytogenetics at diagnosis and FLT-3 mutational status were not associated with higher incidence of ED. Taking into account the three significant variables identified as risk factors, we developed a scoring system to predict the probability of ED during induction. The probability of ED in the low risk (none risk factor, n=212), intermediate risk (1 risk factor, n=239) and high risk (2 or 3 risk factors, n=57) categories were 3%, 11% and 28% respectively (P

Hereditary multiple exostosis (HME) or diaphysial aclasis is an autosomal dominant condition characterized by multiple exostoses which appear in different parts of the skeleton (Solomon, 1963). Lesions occur in infants and children and usually cease to enlarge at puberty. Complications are uncommon, and haemothorax has occasionally been described (Balatskii et al, 1973; Proper et al, 1980; Tejeira et al, 1989). We report a patient presenting with spontaneous haemothorax as a complication of costal exostoses. A 19-year-old boy known to have multiple exostoses was admitted with sudden pleuritic right-sided pain. There was no history of recent trauma. On examination he was apyrexial and blood pressure was normal. He had pain in the right side of his chest and shortness of breath and there was dullness to percussion and reducedbreath sounds at the right base.

Two patients are presented with lymphadenopathy, hepatosplenomegaly and infiltration of the bone marrow with plasmocytoid cells in whom an important heterogeneous hyperimmunoglobulinemia was detected (3.18 and 5.85 g/100/ml). Autopsy showed widespread poorly differentiated lymphocytic lymphoma with plasmocytoid differentiation in the first case and a well differentiated lymphocytic lymphoma with plasmocytoid differentiation involving lymph nodes, marrow, spleen, liver and kidney in the second case. High concentrations of IgM and IgG were detected in lymph node and spleen homogenates from this case. After splenectomy and cyclophosphamide the immunoglobulins decreased. It is suggested that both cases had a malignant lymphoma with plasmocytoid differentiation and polyclonal gammopathy.

Obstructive jaundice was cured in a 70-years-old woman after endoscopic removal of a bezoar located in a prepapillary duodenal diverticulum.

The efficacy and safety of famotidine and ranitidine in the treatment of active duodenal ulcer were compared in a multicenter, randomized double-blind study. The study was carried out in 5 centers which included a total of 143 patients with endoscopically documented active duodenal ulcer. The patients received either famotidine (1 tablet of 40 mg at night) or ranitidine (2 tablets of 150 mg at night). Endoscopic examinations were performed at 4 and 6 weeks of active treatment. Day and nocturnal pain were also monitored and the laboratory and clinical profiles evaluated. One hundred and thirty-three patients fulfilled the evaluation criteria (66 patients in the famotidine group and 67 in the ranitidine group). Healing rates at weeks 4 or 6 of treatment showed no significant differences between the famotidine and the ranitidine groups. The healing rates were 79% at week 4 and 96% at week 6 in the famotidine group, and 77% at week 4 and 95% at week 6 in the ranitidine group. Similar results were observed in both treatment groups with regard to pain resolution, decrease in antacid intake and safety profile.

One hundred twenty-eight records of patients with multiple myeloma were reviewed to assess the incidence and manifestations of liver involvement. Histologic study of the liver was available in 21 patients. Diffuse infiltration of the liver by plasma cells was observed in 10 patients, myeloid metaplasia in four, amyloidosis in two, toxic hepatitis in two, and extrahepatic cholestasis secondary to infiltration of the peripancreatic tissue by plasma cells in one. The clinical signs of plasma cell infiltration of the liver consisted of hepatomegaly in seven patients, mild elevation of liver enzymes in five, and portal hypertension in two. Jaundice was only observed in patients with hepatitis or extrahepatic cholestasis. Liver infiltration by plasma cells did not appear to have a major prognostic significance.

A 39-year-old male presented with melena and sideropenic anemia. Gastric barium meal showed multiple feeling defects and gastric endoscopy showed in the antrum several polypoid lesions that histopathologically were consistent with Cronkhite-Canada polyposis. Studies on intestinal absorption were within normal limits.

Aim:To describe the physical health profile of patients with drug use disorders who were included in the study of adaptation-validation of the Addiction Severity Index 6th version (ASI-6) into Spanish.Method:Multicentre, observational, longitudinal, prospective study. A total of 194 substance dependent/abuser individuals were included. Assessments were made with the Spanish ASI-6.Results:Men were 79.9%, mean ages were 41.08 (SD 11.64), 42.3% were single and 87.6% were acute patients. The severity score in the Physical Health area was 44.32 (SD 9.51). The most prevalent diseases were: 25.3% hepatitis, 11.9% had high blood pressure, 8.2% cirrhosis or hepatic disease, 6.7% epilepsy or convulsions and 5.7% tuberculoses. No statistically significant differences were found according to gender. Acute patients had statistically significant higher proportion of pregnant woman (2.3% vs. 0% p< 0.05) and lower proportion of diabetes (3.5% vs. 12.5% p= 0.05).Conclusions:Patients with drug use disorders have a mild-moderate severity of physical health. Physical health is not influenced by gender, but it is by the clinical state.