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Objetivos: determinar la asociación entre estilo de vida y el control de la hipertensión arterial sistémica (has) en una unidad medicina familiar. Métodos: entre el 1 de enero y el 31 de mayo del 2017 se realizó un estudio transversal analítico en la Unidad de Medicina Familiar no. 57 en Puebla, México. La muestra estuvo conformada por 306 pacientes de ambos sexos, mayores de 18 años con diagnóstico de has bajo tratamiento médico. Mediante un muestreo no probabilístico por conveniencia se aplicó el instrumento fantastic para medir estilos de vida. Los datos fueron analizados mediante estadística descriptiva y analítica. Resultados: se determinó que cuatro pacientes (1.3%) presentaban un estilo de vida peligroso, 58 (19%) tenían un bajo estilo de vida, 84 (27.4%) regular, 142 (46.4%) bueno y solo 18 (5.9%) tenían un estilo de vida excelente. Los dominios con evidencia estadísticamente significativa fueron: comunicación, actividad física, nutrición, horas de sueño y estrés. 207 pacientes (67.6%) estaban en control de has. Se observó una asociación significativa entre el estilo de vida y el control de has (p= Conclusiones: el estilo de vida es una variable determinante para el control de la has, identificar estilos de vida en los pacientes puede permitir a los profesionales de la salud determinar, de forma rápida y objetiva, factores de riesgo que pueden ser modificados con el propósito de evitar complicaciones derivadas de enfermedades crónicas.

The hydrodeoxygenation of 2-ethylphenol was carried out under 7 MPa of total pressure and at 340 °C in a fixed-bed reactor over unpromoted Mo/Al2O3 catalyst and over two promoted catalysts (CoMo/Al2O3 and NiMo/Al2O3). For all experiments, dimethyldisulfide was added to the feed to maintain the sulfidation state of the catalysts. On these sulfided catalysts, the transformation of 2-ethylphenol is considered to proceed by three pathways: (1) prehydrogenation of the aromatic ring followed by a dehydration reaction leading to a mixture of alkenes (1-ethylcyclohexene and 3-ethylcyclohexene) and after hydrogenation leading to ethylcyclohexane (HYD pathway); (2) direct cleavage of the Csp2–O bond leading to ethylbenzene (DDO pathway); (3) disproportionation and isomerization reactions leading to oxygenated products (phenol, isomers of 2-ethylphenol and diethylphenols) and their deoxygenated products (ACI pathway). The production of those oxygenated compounds mainly involved the support acidity. The presence of nickel and cobalt allowed an increase of the deoxygenation rate. Nickel only promoted the HYD pathway whereas cobalt promoted both the HYD and DDO pathways. Consequently, the DDO/HYD selectivity was very dependent on the catalyst used. The highest DDO/HYD selectivity was obtained for CoMo/Al2O3. Sulfur vacancies are proposed as active sites for both deoxygenation pathways of 2-ethylphenol, although other active sites (e.g. brim sites) could be involved to explain that the HYD pathway was always predominant. For both deoxygenation pathways, two probable mechanisms are described. The adsorption mode of the molecule most likely determines the deoxygenation route.

We analyse the one-dimensional Coulomb problem (1DCP) pointing out some mistaken beliefs on it. We show that no eigenstates of even or odd parity can represent states of the system. The 1DCP exhibits a sort of spontaneous breaking of parity. We also show that a superselection rule operates in the system. Such rule explains some of its peculiarities. We build the superpotential associated to the 1DCP.

Resumen Introduccion La administracion precoz de antibiotico en pacientes diagnosticados de una neumonia adquirida en comunidad (NAC) condiciona una disminucion de la mortalidad. En EE. UU. Se ha implantado como estandar de calidad su administracion en las primeras cuatro horas. El objetivo de este trabajo ha sido analizar retrospectivamente en un Servicio de Urgencias hospitalario (SUH) de nuestro medio la actuacion con estos pacientes en lo que respecta a la administracion de la primera dosis de antibiotico. Pacientes y metodo Se han analizado aspectos clinicos, asistenciales y organizativos en 93 pacientes diagnosticados de NAC en un SUH para identificar su influencia en la administracion de antibiotico en un plazo inferior a 4 horas. Resultados El 46,2% de los pacientes recibio el antibiotico en las primeras cuatro horas. La asistencia en el area de mayor complejidad se asocio de forma positiva con la administracion del antibiotico en las cuatro primeras horas. Por el contrario, la presencia de un mayor numero de pacientes pendientes de ingreso en el SUH condiciono un menor cumplimiento de esta medida. Conclusiones La administracion precoz de antibiotico en la NAC es posible. El incremento en el cumplimiento de esta medida debe contemplar la mejora de la calidad asistencial tanto en aspectos organizativos propios del SUH (por ejemplo, con una adecuada clasificacion inicial que garantice la atencion de los pacientes acorde a su nivel de complejidad) como ajenos a el (gestion de camas hospitalarias que evite la demora en el ingreso desde el servicio)

Early maternal deprivation (MD) in rats (24 h, postnatal day 9-10) is a model for neurodevelopmental stress. There are some data proving that MD affects the endocannabinoid system (ECS) in a gender-dependent manner, and that these changes may account for the proposed schizophrenia-like phenotype of MD rats. The impact of MD on cannabinoid receptor distribution in the hippocampus is unknown. The aim of this study is to evaluate the expression of CB(1) and CB(2) receptors in diverse relevant subregions (DG, CA1, and CA3) of the hippocampus in 13-day-old rats by immunohistochemistry and densitometry. MD induced a significant decrease in CB(1) immunoreactivity (more marked in males than in females), which was mainly associated with fibers in the strata pyramidale and radiatum of CA1 and in the strata oriens, pyramidale, and radiatum of CA3. In contrast, MD males and females showed a significant increase in CB(2) immunoreactivity in the three hippocampal areas analyzed that was detected in neuropil and puncta in the stratum oriens of CA1 and CA3, and in the polymorphic cell layer of the dentate gyrus. A marked sex dimorphism was observed in CA3, with females exhibiting higher CB(1) immunoreactivity than males, and in dentate gyrus, with females exhibiting lower CB(2) immunoreactivity than males. These results point to a clear association between developmental stress and dysregulation of the ECS. The present MD procedure may provide an interesting experimental model to further address the role of the ECS in neurodevelopmental mental illnesses such as schizophrenia.

The transformation of benzofuran, 2,3-dihydrobenzofuran and 2-ethylphenol, as well as the competitive effect between furanic compounds (benzofuran and 2,3-dihydrobenzofuran) and a phenolic compound (2-propylphenol) over a sulfided NiMoP/Al2O3 catalyst were studied under a total pressure of 7 MPa at 340 °C in a fixed bed reactor. The transformation of each oxygenated compounds was carried out with or without H2S (from dimethyldisulfide). Ethylcyclohexane was already the main deoxygenated product which was obtained by hydrogenation of aromatic ring followed by dehydratation and hydrogenation reactions (HYD pathway). The formation of ethylbenzene by a direct deoxygenation (DDO) pathway was in all cases very limited. Other oxygenated products were obtained by disproportionation and isomerization reactions. A global reaction scheme of the benzofuran transformation over a NiMoP/Al2O3 sulfided catalyst was established. In addition, the inhibiting effect of benzofuran and/or 2,3-dihydrobenzofuran on the transformation of 2-ethylphenol was demonstrated. Moreover, a promoting effect of H2S on the deoxygenating rate of all oxygenated compounds was observed.

Classical motion in an inverse square potential is shown to be equivalent to free motion on a hyperbola. The existence of a classical splitting between the q > 0 and q 0 regions of motion is demonstrated. We show that this last property may be regarded as the classical counterpart of the superselection rule occurring in the corresponding quantum problem. We solve the quantum problem in momentum space finding that there is no way of quantizing its energy but that the eigenfunctions suffice to describe the single renormalized bound state of the system. The dynamical symmetry of the classical problem is found to be O ( 1 , 1 ) . Both this symmetry and the symmetry of inversion through the origin are found to be broken.

We discuss an operator solution for the bound states of the non-relativistic hydrogen atom. The method adds the phase of a state and its associated operator to the set of variables of the system. The augmented set of operators is found to form a closed set of commutation relations thus comprising an operator Lie algebra. From these relations, the energy spectrum and bounded radial eigenfunctions are calculated. Our approach is analogous to the one employed to compute the angular momentum spectrum and eigenfunctions but with operators satisfying an su(1,1) Lie algebra instead of su(2). This method, with the same operator algebra and minor modifications, may be used to solve the Dirac relativistic hydrogen atom.

Background Knowledge about determinants of quality of life (QoL) in eosinophilic oesophagitis (EoO) patients helps to identify patients at risk of experiencing poor QoL and to tailor therapeutic interventions accordingly. Aim To evaluate the impact of symptom severity, endoscopic and histological activity on EoE-specific QoL in adult EoE patients. Methods Ninety-eight adult EoE patients were prospectively included (64% male, median age 39 years). Patients completed two validated instruments to assess EoE-specific QoL (EoO-QoL-A) and symptom severity (adult EoE activity index patient-reported outcome) and then underwent esophagogastroduodenoscopy with biopsy sampling. Physicians reported standardised information on EoE-associated endoscopic and histological alterations. The Spearman's rank correlation coefficient was calculated to determine the relationship between QoL and symptom severity. Linear regression and analysis of variance was used to quantify the extent to which variations in severity of EoE symptoms, endoscopic and histological findings explain variations in QoL. Results Quality of life strongly correlated with symptom severity (r = 0.610, P < 0.001). While the variation in severity of symptoms, endoscopic and histological findings alone explained 38%, 35% and 22% of the variability in EoE-related QoL, respectively, these together explained 60% of variation. Symptom severity explained 18-35% of the variation in each of the five QoL subscale scores. Conclusions Eosinophilic oesophagitis symptom severity and biological disease activity determine QoL in adult patients with eosinophilic oesophagitis. Therefore, reduction in both eosinophilic oesophagitis symptoms as well as biological disease activity is essential for improvement of QoL in adult patients. Clinicaltrials.gov number, NCT00939263.

International audience; Background Leucine supplementation might have therapeutic potential in preventing diet-induced obesity and improving insulin sensitivity. However, the underlying mechanisms are at present unclear. Additionally, it is unclear whether leucine supplementation might be equally efficacious once obesity has developed. Methodology/Principal Findings Male C57BL/6J mice were fed chow or a high-fat diet (HFD), supplemented or not with leucine for 17 weeks. Another group of HFD-fed mice (HFD-pairfat group) was food restricted in order to reach an adiposity level comparable to that of HFD-Leu mice. Finally, a third group of mice was exposed to HFD for 12 weeks before being chronically supplemented with leucine. Leucine supplementation in HFD-fed mice decreased body weight and fat mass by increasing energy expenditure, fatty acid oxidation and locomotor activity in vivo. The decreased adiposity in HFD-Leu mice was associated with increased expression of uncoupling protein 3 (UCP-3) in the brown adipose tissue, better insulin sensitivity, increased intestinal gluconeogenesis and preservation of islets of Langerhans histomorphology and function. HFD-pairfat mice had a comparable improvement in insulin sensitivity, without changes in islets physiology or intestinal gluconeogenesis. Remarkably, both HFD-Leu and HFD-pairfat mice had decreased hepatic lipid content, which likely helped improve insulin sensitivity. In contrast, when leucine was supplemented to already obese animals, no changes in body weight, body composition or glucose metabolism were observed. Conclusions/Significance These findings suggest that leucine improves insulin sensitivity in HFD-fed mice by primarily decreasing adiposity, rather than directly acting on peripheral target organs. However, beneficial effects of leucine on intestinal gluconeogenesis and islets of Langerhans's physiology might help prevent type 2 diabetes development. Differently, metabolic benefit of leucine supplementation is lacking in already obese animals, a phenomenon possibly related to the extent of the obesity before starting the supplementation.

An algebraic solution for the hydrogen atom analogous to the one recently proposed to solve the relativistic version of the system is presented. We add to the usual radial description of the problem an additional angular variable and an associated operator which can be considered as part of an su(1, 1) Lie algebra. The operators of the algebra define radial ladder operator relating the eigenfunctions of the system in unit steps of the principal quantum number. We conclude that the radial bound states of the hydrogen atom in our extended configuration space can be regarded as spanning the minimal M representation of the su(1, 1) Lie algebra. The method can also be extended to solve the s-wave Morse problem and the three-dimensional harmonic oscillator.

The bound eigenfunctions and spectrum of a Dirac hydrogen atom are found taking advantage of the SU ( 1 , 1 ) Lie algebra in which the radial part of the problem can be expressed. For defining the algebra we need to add to the description an additional angular variable playing essentially the role of a phase. The operators spanning the algebra are used for defining ladder operators for the radial eigenfunctions of the relativistic hydrogen atom and for evaluating its energy spectrum. The status of the Johnson–Lippman operator in this algebra is also investigated.

Background Recent evidence indicates that the slowly expanding population of CD5+ B cells that characterizes B-cell chronic lymphocytic leukemia (B-CLL) could be related to defects in the response to cytokine produced by T cells that regulate apoptosis. We studied the intracellular expressions of interleukin-2 (IL-2), tumor necrosis factor-α (TNF-α), and interferon-γ (IFN-γ) in T-helper 1 cells (Th1 response) of B-CLL. Methods Peripheral blood mononuclear cells from 21 healthy individuals and purified T cells from 21 early-stage and 15 late-stage B-CLL patients were activated with phorbol myristate acetate and ionomycin. The Th1 cytoplasmic cytokines were evaluated in CD4+ and CD8+ T cells by flow cytometry. Results The percentages of CD4+ and CD8+ T cells positive for IL-2 were significantly lower in B-CLL patients than in healthy individuals (P = 0.030 and 0.049, respectively). No significant differences in TNF-α or IFN-γ intracellular expressions were found between patients and healthy individuals. TNF-α- and IFN-γ–expressing CD8 T cells were disease stage dependent, being significantly higher in late-stage patients (P < 0.001 for both cytokines). Conclusions Our present observations suggested that Th1 cytokines may be of major importance in the pathogenesis of B-CLL. Cytometry Part B (Clin. Cytometry) 56B:23–29, 2003. © 2003 Wiley-Liss, Inc.

For many decades, simplification of traditionally shaded coffee-production systems has been an idealised model for increasing yields. In Mexico, coffee producers have been interested in replacing diverse natural shade with Inga species monocultures due to this practice having the supposed advantages of producing higher coffee yields than diverse shade. However, the effect of different shade systems on yields is little known. The purpose of this study was to evaluate the effect of two types of shaded-coffee systems on coffee yields and soil nutrient content; the first shade system is mainly dominated by Inga latibracteata Harms and the other composed of species-rich natural vegetation. The investigation took place in producer plots in the Francisco I. Madero Community, Municipality of Jitotol, Chiapas, Mexico. Collected data included species richness, shade-tree density, number of strata, tree diameter, tree height, shade-cover percentage, direct and diffused light, coffee yields, soil-nutrient concentrations (N, P, K, Ca and Mg), soil-organic matter and pH. Evaluated shade type did not have an effect on grain yield or soil nutrients. The perceived advantage of the Inga shade system is reduced weed emergence, saving farmers one annual weed-clearing. There was no significant correlation between total N and organic matter. The presence of fewer products and services in comparison to the multiple shade system was thought to be an additional disadvantage to the Inga dominated system. Organic matter in the multiple shade system correlated positively with total N. Due to its complex structure and diversity, the multiple shade system could be certified as shade or bird-friendly coffee.

Employing a relativistic version of a hypervirial result, recurrence relations for arbitrary nondiagonal radial hydrogenic matrix elements have recently been obtained in Dirac relativistic quantum mechanics. In this contribution honoring Professor Lowdin, we report on a new relation we have recently discovered between the matrix elements 〈2∣rλ∣1〉 and 〈2∣βrλ∣1〉—where β is a Dirac matrix and the numbers distiguish between different radial eigenstates—that allow for a simplification and hence for a more convenient way of expressing the recurrence relations. We additionally derive another relation that can be employed for simplifying two-center matrix element calculations in relativistic atomic or molecular calculations. © 2002 John Wiley & Sons, Inc. Int J Quantum Chem, 2002

CONTEXT: Tyrosine kinase inhibitors (TKIs) are used in different types of cancers due to their good profile of adverse reactions and their convenience in the oral administration. Some studies describe that certain TKIs are associated with changes in the glycemic profile of the patients. AIMS: This study aims to determine if treatment with ITK affects to serum glucose levels in clinical practice. SETTINGS AND DESIGN: A retrospective study was carried out in 136 episodes (112 patients treated with sorafenib, sunitinib, imatinib, dasatinib, or nilotinib). SUBJECTS AND METHODS: The serum glucose levels were analyzed before treatment and after months 1, 2, 3, 6, 9, and 12 of treatment. STATISTICAL ANALYSIS USED: Statistical analysis was completed with SPSS version 20 for Windows. RESULTS: There were significant differences in the serum glucose levels before treatment between diabetic and nondiabetic patients, but not between the average blood glucose readings before treatment and the average of the subsequent readings, once their treatment had begun. CONCLUSIONS: The results of this study do not reproduce the results of the literature since changes in the serum glucose levels have not been found in this sample of patients.

The ways for improving on techniques for finding new solvable potentials based on supersymmetry and shape invariance has been discussed by Morales et al. [1] In doing so they address the peculiar system known as the one-dimensional hydrogen atom. In this paper we show that their remarks on such problem are mistaken. We do this by explicitly constructing both the one-dimensional Coulomb potential and the superpotential associated with the problem, objects whose existence are denied in the mentioned paper.

The hydrogen atom is solved using a simple method. We show that this system has an exact solution that can be written in terms of Laguerre polynomials of noninteger index, instead of the hypergeometric series. This point is important because Laguerre polynomials of integer index appear in the solution of the nonrelativistic hydrogen atom, giving students a more unified point of view for this system.

B-cell chronic lymphocytic leukemia (B-CLL) is characterized by the slow and progressive accumulation of monoclonal apparently mature, CD5+ B lymphocytes. The majority of circulating cells appear to be nondividing, and it has been suggested that a prolonged life span is mainly responsible for the accumulation of the leukemic cells. However, spontaneous programmed cell death by apoptosis occurs when B chronic lymphocytic leukemia cells are cultured in vitro. This may be because of the lack of an unidentified essential cytokine present in vivo. Thus, we investigate interleukin-2 (IL-2), IL-4, IL-6 and IL-10 in vitro effects on apoptosis of B cells from 32 previously untreated patients with B-CLL in initial clinical stages. B cells were isolated from peripheral blood, and apoptosis was measured in these cells immediately after isolation and following incubation in vitro, without and with the different cytokines, for 24 and 48 h. Distribution of cellular DNA content and quantitative analysis of apoptosis were determined by standard propidium iodide staining and flow cytometry. Spontaneous apoptosis occurred in B-CLL cells incubated in vitro in the absence of cytokines. Our results indicate that both IL-2 and IL-4, but not IL-6, inhibit in vitro apoptosis in a large percentage of B-CLL patients. IL-10 increases in vitro apoptotic cell number in stage 0 patients, but not in stage I and II. These data support the hypothesis that IL-2 or IL-4, may be cell survival factors in vivo and that IL-10 might be a candidate for immune therapy of early B-CLL. Cytometry (Comm. Clin. Cytometry) 38:224–230, 1999. © 1999 Wiley-Liss, Inc.

A novel realization of the classical SU(2) algebra is introduced for the Dirac relativistic hydrogen atom defining a set of operators that, besides, allow the factorization of the problem. An extra phase is needed as a new variable in order to define the algebra. We take advantage of the operators to solve the Dirac equation using algebraic methods. To acomplish this, a similar path to the one used in the angular momentum case is employed; hence, the radial eigenfuntions calculated comprise non unitary representations of the algebra. One of the interesting properties of such non unitary representations is that they are not labeled by integer nor by half-integer numbers as happens in the usual angular momentum representation., Comment: 20 pages 1 eps figure in a single zipped file, submitted to J. Math. Phys

We discuss the existence of ambiguities, or anomalies of fermionic nature as we call them, in the quantization of relativistic systems with odd Grassmann degrees of freedom. We propose in this work a way of avoiding such ambiguities in the case of relativistic quantum mechanics, by including the odd degrees of freedom into a generalization of the momentum, in a similar manner to the minimal coupling. We illustrate our results with some examples, including the Dirac oscillator as a typical case of the problems we are dealing with.

Superintegrable Hamiltonians in three degrees of freedom posses more than three functionally independent globally defined and single-valued constants of motion. In this contribution and under the assumption of the existence of only periodic and plane bounded orbits in a classical system we are able to establish the superintegrability of the Hamiltonian. Then, using basic algebraic ideas, we obtain a contemporary proof of Bertrand's theorem. That is, we are able to show that the harmonic oscillator and the Newtonian gravitational potentials are the only 3D potentials whose bounded orbits are all plane and periodic.

Soon after the discovery of cannabis by western societies, its psychotropic effects overshadowed its medical benefits. However, investigation into the molecular action of the main constituents of cannabis has led to the discovery of an intercellular signalling system, called the endocannabinoid system (ECS). The ECS comprises a set of molecular components, including enzymes, signalling lipids and G-protein coupled receptors, which has an outstanding role in modulating eating behaviour and energy homeostasis. Interestingly, evidence has shown that the ECS is present at the central and peripheral nervous system, modulating the function of the hypothalamus, the brain reward system and the brainstem, and coordinating the crosstalk between these brain structures and peripheral organs. Indeed, the ECS is present and functional in metabolically relevant peripheral tissues, directly modulating their physiology. In the context of a global obesity pandemic, these discoveries are highly suggestive in order to design novel pharmaceutical tools to fight obesity and related morbidities. In fact, a cannabinoid-based first generation of drugs was developed and marketed. Their failure, due to central side-effects, is leading to a second generation of these drugs unable to cross the blood-brain barrier, as well as other ECS-focused strategies that are still in the pipeline. In the next few years we will hopefully know whether such an important player in energy homeostasis can be successfully targeted without significantly affecting other vital processes related to mood and sense of well-being.

International audience; The hydrodeoxygenation of model phenol compounds (phenol and 2-ethylphenol) was carried over unpromoted Mo/Al2O3 and promoted CoMo/Al2O3 catalysts. Hydrodeoxygenation proceeds by two pathways:– hydrogenation of the aromatic ring followed by Csp3-O bond cleavage (HYD pathway, (hydrogenation of the aromatic ring followed by Csp3-O bond cleavage));– direct cleavage of the Csp2-O bond (DDO Pathway).Both routes were favored by the presence of Co on the catalyst, while the presence of the alkyl substituent on the phenolic ring favors the DDO route but inhibits the HYD pathway. IR (InfraRed) spectroscopy shows that while phenol mostly dissociates on these catalysts, a significant fraction of 2-ethylphenol remains non dissociated. The adsorption energies of both reactants and possible reaction intermediates on promoted and non-promoted sulfide phases as computed by DFT (Density-Functional Theory) confirm these findings and allow rationalizing the catalytic activity trends observed experimentally.

We discuss the existence of ambiguities in the quantization of systems with odd Grassmann degrees of freedom, or anomalies of fermionic nature as we call them, which could lead us to an incorrect quantum counterpart. We propose in this work a way of avoiding such ambiguities in the case of relativistic mechanics, which consists in including the odd degrees of freedom into a generalization of the momentum, that fully contains the anomalies. We consider this generalized momentum as the relevant variable to quantize, mentioning their gauge transformation properties. We illustrate our results with some examples. In particular, we discuss the Dirac oscillator as a typical case of the problems we are dealing with.

CANDIPOP Project from GEIH-GEMICOMED (SEIMC) and REIPI., We compared the clinical efficacy of fluconazole and echinocandins in the treatment of candidemia in real practice. The CANDIPOP study is a prospective, population-based cohort study on candidemia carried out between May 2010 and April 2011 in 29 Spanish hospitals. Using strict inclusion criteria, we separately compared the impact of empirical and targeted therapy with fluconazole or echinocandins on 30-day mortality. Cox regression, including a propensity score (PS) for receiving echinocandins, stratified analysis on the PS quartiles and PS-based matched analyses, were performed. The empirical and targeted therapy cohorts comprised 316 and 421 cases, respectively; 30-day mortality was 18.7% with fluconazole and 33.9% with echinocandins (p 0.02) in the empirical therapy group and 19.8% with fluconazole and 27.7% with echinocandins (p 0.06) in the targeted therapy group. Multivariate Cox regression analysis including PS showed that empirical therapy with fluconazole was associated with better prognosis (adjusted hazard ratio 0.38; 95% confidence interval 0.17–0.81; p 0.01); no differences were found within each PS quartile or in cases matched according to PS. Targeted therapy with fluconazole did not show a significant association with mortality in the Cox regression analysis (adjusted hazard ratio 0.77; 95% confidence interval 0.41–1.46; p 0.63), in the PS quartiles or in PS-matched cases. The results were similar among patients with severe sepsis and septic shock. Empirical or targeted treatment with fluconazole was not associated with increased 30-day mortality compared to echinocandins among adults with candidemia., BA has received grant support from Gilead Sciences, Pfizer and the Instituto de Salud Carlos III, and he has received honoraria for talks on behalf of Gilead Sciences, Merck Sharp and Dohme, Pfizer, Astellas and Novartis. MCE has received grant support from Astellas Pharma, bioMerieux, Gilead Sciences, Merck Sharp and Dohme, Pfizer, Schering Plough, Soria Melguizo SA, Ferrer International, the European Union, the ALBAN programme, the Spanish Agency for International Cooperation, the Spanish Ministry of Culture and Education, the Spanish Health Research Fund, the Instituto de Salud Carlos III, the Ramon Areces Foundation and the Mutua Madrileña Foundation. MCE has received grant support from Astellas Pharma, bioMerieux, Gilead Sciences, Merck Sharp and Dohme, Pfizer, Schering Plough, Soria Melguizo SA, Ferrer International, the European Union, the ALBAN programme, the Spanish Agency for International Cooperation, the Spanish Ministry of Culture and Education, the Spanish Health Research Fund, the Instituto de Salud Carlos III, the Ramon Areces Foundation and the Mutua Madrileña Foundation.

The endocannabinoid (eCB) system is a widespread intercellular signalling mechanism that plays a critical role in body homoeostasis. It is located in key points involved in food intake and energy expenditure, coordinating all the players involved in energy balance. As such, it has come to be seen as an interesting target for the management of diseases characterized by an imbalanced energy homoeostasis, such as obesity and eating disorders. The aetiology of eating disorders and the molecular systems involved are still largely a mystery. Research has focused on brain circuits where the eCB system plays an important role, such as those related to feeding behaviour and the rewarding properties of food. Accordingly, recent findings have suggested a deregulation of the eCB system in eating disorders. At present, cannabinoid agonists are safe and effective tools in the management of diseases in which weight gain is needed, for example cachexia in AIDS patients. However, studies on the potential therapeutic validity of cannabinoids in eating disorders are scarce and inconclusive. Taken together, all these considerations warrant more preclinical and clinical investigations in the role of the eCB system in eating disorders. Eventually, they may provide novel pharmacological approaches for the treatment of these diseases.

A prospective cohort study was conducted to analyze whether self-reported fatigue predicts overall survival in patients with esophageal cancer.Patients enrolled in the Mayo Clinic Esophageal Adenocarcinoma and Barrett's Esophagus Registry between September 2001 and January 2009 who completed a baseline quality of life instrument were eligible for evaluation. The fatigue component was scored on a 0-10 scale, with 0 as extreme fatigue. Patients were categorized as having a decreased energy level if they reported a score of ≤ 5. Fatigue scores ≥ 6 reflect normal levels of energy.Data from a total of 659 enrolled patients were analyzed. A total of 392 (59 %) and 267 (41 %) patients reported decreased and normal energy, respectively. Univariate analysis indicates patients with normal energy had improved 5-year survival compared to patients with decreased energy (37 vs 28 %, hazard ratio (HR) 0.74, p = 0.006). Among the patients with locally advanced disease, the same relationship was seen (28 vs 17 %, HR = 0.67, p = 0.003); this remained significant on multivariate analysis (HR = 0.71, p = 0.015).A decreased energy level is associated with poor survival in patients with esophageal cancer. Thus, patients with high levels of fatigue should be referred for psychological support and be considered for therapy aimed at amelioration of fatigue symptoms.

The consensus statements for eosinophilic oesophagitis recommend that ambulatory pH monitoring is one means of determining if gastro-oesophageal reflux is the cause of oesophageal eosinophilia and should guide pharmacological therapy.To evaluate prospectively the accuracy of pH monitoring as a predictor of endoscopic, histological and symptomatic response in patients with oesophageal eosinophilia.We conducted a prospective trial in which patients with oesophageal eosinophilic infiltration with ≥15 eos/hpf underwent a 24-h pH study and were placed in one of two treatment arms for 6 weeks based on positive or negative results. Patients with abnormal acid exposure were treated with esomeprazole 40 mg twice daily and others were treated with oral viscous budesonide 1 g twice daily. Response to treatment was assessed by oesophageal histology (5 eos/hpf) and symptoms.A total of 51 patients were enrolled in the study. The average patient age was 39 years and 31 patients (61%) were male. The average number of eosinophils per hpf, prior to study enrolment was 41.2 (range 15-140, s.d. 27.7). Nineteen (37%) had positive pH studies and 32 (63%) had negative pH studies. Eighteen patients completed treatment with esomeprazole. Only eleven (61%) had histological response and, of these eleven, five (46%) had symptomatic improvement. A total of 28 patients with normal acid exposure completed treatment with budesonide. Only 16 (57%) had histological and 11 (69%) had symptomatic improvement.In this prospective trial of pH-guided treatment, neither positive nor negative results of initial pH monitoring accurately predicted response to therapy.

We present a case of recurrent subdural post-surgical empyema by Proprionibacterium acnes after a first drained empyema in which no microbiological diagnosis was reached. P. acnes is a gram-positive anaerobic organism which is part of the saprophytic flora of the skin and others parts of the body. However, it can cause infections, as in the central nervous system, especially post-surgical infections in which can be the second more frequent organism after Staphylococcus aureus. P. acnes grows slowly and shows better growth in liquid anaerobic media. It is usually resistant to metronidazol and sensitive to penicillin. In postoperative central nervous system infections we must take into account the possibility of this organism, process the sample properly and keep touch with the Microbiology Department.

The neuroactive steroid estradiol reduces reactive astroglia after brain injury by mechanisms similar to those involved in the regulation of reactive gliosis by endocannabinoids. In this study, we have explored whether cannabinoid receptors are involved in the effects of estradiol on reactive astroglia. To test this hypothesis, the effects of estradiol, the cannabinoid CB1 antagonist/inverse agonist AM251, and the cannabinoid CB2 antagonist/inverse agonist AM630 were assessed in the cerebral cortex of male rats after a stab wound brain injury. Estradiol reduced the number of vimentin immunoreactive astrocytes and the number of glial fibrillary acidic protein immunoreactive astrocytes in the proximity of the wound. The effect of estradiol was significantly inhibited by the administration of either CB1 or CB2 receptor antagonists. The effect of estradiol may be in part mediated by alterations in endocannabinoid signaling because the hormone increased in the injured cerebral cortex the messenger RNA levels of CB2 receptors and of some of the enzymes involved in the synthesis and metabolism of endocannabinoids. These findings suggest that estradiol may decrease reactive astroglia in the injured brain by regulating the activity of the endocannabinoid system. © 2011 The Author.

Se presenta un caso de recidiva de infección postquirúrgica en forma de empiema subdural por Proprionibacterium acnes tras un primer empiema drenado en el que no se llegó al diagnóstico microbiológico. P acnes es un microorganismo gram positivo, anaerobio, que forma parte de la flora saprófita de la piel y de otras zonas del organismo. Sin embargo puede producir infecciones, entre otras localizaciones, en el sistema nervioso central (SNC), especialmente infecciones postquirúrgicas en las que puede llegar a ser el segundo germen en frecuencia después de Staphylococcus aureus. Es de crecimiento lento y suele crecer mejor en medios anaeróbicos líquidos. Suele ser resistente al metronidazol y sensible a penicilinas. En las infecciones postquirúrgicas del sistema nervioso central hay que tener en cuenta la posibilidad de este microorganismo, procesar las muestras de forma adecuada y mantenernos en contacto con el Servicio de Microbiología.

International audience; We report the study of the impact of water on the stability of Mo and CoMo sulfide catalysts in hydrodeoxygenation of phenolic compounds. The presence of water at reaction temperature leads to an additional deactivation of the catalyst, which is fully reversible on the CoMo catalyst, but partly irreversible on non-promoted Mo catalyst. IR and HRTEM characterizations as well as DFf simulations confirm the higher sensitivity of unpromoted MoS(2) toward water and show that large amounts of water at reaction temperature lead to the exchange of an important fraction of edge sulfur atoms on non-promoted MoS(2) catalysts, hence changing the nature of the active sites. For Co-promoted catalyst, the extent of water poisoning is much lower and reversible because Co atoms prevent sulfur-oxygen exchanges. Hence, in HDO conditions, Co does not only increase the intrinsic activity of the catalyst (promotion effect) but also stabilizes the active phase in the presence of water (passivation effect). (C) 2011 Elsevier Inc. All rights reserved.

To evaluate the efficacy and toxicity of erlotinib in patients with non-small cell lung cancer.Patients were selected from an outpatients' dispensing database. The time period selected was from January 2008 to January 2010. Data was collected from patient's medical history - electronic and paper based. We used Response Evaluation Criteria in Solid Tumours (RECIST) to measure response and measured time to progression and overall survival. Toxicity was evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE).We found partial response in 5/46 patients and stable disease in 14/46 patients. Time to disease progression was 4.01 months (median 2.33 months) and overall survival was 5.63 months (median 4.67). The most common toxicities were rash, anorexia, asthenia, infection and gastrointestinal side effects. Patients who developed skin toxicity had a (statistically significant) greater time to progression and overall survival rate than the group that did not develop this toxicity (mean time to progression: 2.76 vs. 7.87 months; mean overall survival: 10.74 months vs. 3.98).Survival analysis findings suggest lower efficacy in our patient population in comparison with data seen in other publications, and adverse events followed the expected pattern. Although our greatest limitation was sample size, which must be kept in mind, this therapy could be an alternative for patients with non-small cell lung cancer.

Endocannabinoids (ECs) are important neuromodulators involved in a plethora of physiological processes such as modulation of synaptic transmission, neuroprotection, immune function, and neurodevelopment, among others. However, still lacking is a detailed study on the presence of this system in the circumventricular areas, brain structures controlling the interaction between cerebrospinal fluid and brain parenchyma. The aim of this work was to provide the anatomical basis supporting a functional role of ECs in the activity of circumventricular areas. To this end, an immunohistochemical study of the EC system in rat brain was performed. Receptors and synthesizing and degrading enzymes for ECs were widely distributed in rat ependyma and subependyma, marginal glia, and circumventricular organs (CVOs) such as the choroid plexus, subfornical organ, subcommissural organ, median eminence, and area postrema. These zones constitute barrier systems between the brain parenchyma and the ventricular or subarachnoid cerebrospinal fluid (CSF) and between the extracellular hemal milieu of CVOs and the brain parenchyma or the CSF. By immunohistochemistry and real-time polymerase chain reaction we found DAGLα, DAGLβ, NAPE-PLD, MAGL, and FAAH in the ependyma. These finding suggest that the ependyma can release and clear ECs from the ventricular CSF. Subependymal astrocytes and tanycytes displayed DAGLα immunoreactivity but parenchymal astrocytes did not express EC-synthesizing enzymes, thus establishing a sharp distinction between these two astrocyte populations. CB1 was located in fibers innervating discrete subventricular zones such as the neurogenic striatal subventricular zone and the fourth ventricle. CB1 fibers also innervated some CVOs. J. Comp. Neurol. 518:3065–3085, 2010. © 2010 Wiley-Liss, Inc.

Maternal deprivation (MD) has numerous outcomes, including modulation of neuroendocrine functions. We previously reported that circulating leptin levels are reduced and hypothalamic cell-turnover is affected during MD, with some of these effects being sexually dimorphic. As leptin modulates the development of hypothalamic circuits involved in metabolic control, we asked whether MD has long-term consequences on body weight, leptin levels and the expression of neuropeptides involved in metabolism. Rats were separated from their mother for 24 h starting on postnatal day (PND) 9 and sacrificed at PNDs 13, 35 and 75. In both sexes MD reduced body weight, but only until puberty, while leptin levels were unchanged at PND 35 and significantly reduced at PND 75. Adiponectin levels were also reduced at PND 75 in females, while testosterone levels were reduced in males. At PND 13, MD modulated cell-turnover markers in the hypothalamus of males, but not females and increased nestin, a marker of immature neurons, in both sexes, with males having higher levels than females and a significantly greater rise in response to MD. There was no effect of MD on hypothalamic mRNA levels of the leptin receptor or metabolic neuropeptides or the mRNA levels of leptin and adiponectin in adipose tissue. Thus, MD has long-term effects on the levels of circulating hormones that are not correlated with changes in body weight. Furthermore, these endocrine outcomes are different between males and females, which could be due to the fact that MD may have sexually dimorphic effects on hypothalamic development.

Rationale: Idiopathic Pulmonary Fibrosis (IPF) is a disease characterized by the accumulation of fibroblasts, deposition of extracellular matrix proteins, and distortion of normal tissue architecture. The key histopathological feature is the formation of fibroblasts foci (FF) composed of fibroblasts or fibroblast-like cells clustered together and relatively well-demarcated from surrounding cells. There is evidence suggesting that FF have different stable phenotypes, each of them contributing to a profibrotic environment. Recently, Achayra et al (2006) revealed that FAP, a cell surface serine protease with collagenase, gelatinase, and dipeptidyl peptidase (DPP) activity is expressed in FF in patients with IPF and is not expressed in normal or emphysematous tissue. To see if this pattern of expression is kept after isolating the cells from the lung tissue, we aimed to evaluate FAP expression in primary cultures of normal (NHLF) and IPF derived fibroblasts, in basal conditions and when stimulated with TGF-b1. Methods: Fibroblast cultures from NHLF (three cell lines) or IPF lungs (5 cell lines) between passages 4-9 were grown to confluence in F-12 medium. FAP expression was measured with qRT-PCR, after being incubated for 24 hrs in serum free medium, with or without TGF-b1 10 ng/ml. Number of copies were normalized with the 18s ribosome subunit. Results are expressed as mean ± SE of triplicates of at least two separate experiments. Student T- test was used for statistical Results: Three IPF cell lines showed clearly an increased FAP expression (p < 0.5) (259.93 ± 1.3; 215 ± 9.6; 38.2 ± 7.2); when compared with the NHLF cell lines (0.77 ± 0.57; 0.58 ± 0.23; .31 ± 0.13). In the other two cell lines, number of copies tended to be higher than controls (1.7±0.4; 1.7±0.3), but the differences were not statistically significant. Additionally, TGF-b1 10 ng/ml increased FAP expression in NHLF 4.4±2.6 fold vs.1.4±0.33; 2.2±0.29; 22.4±1.7 in IPF. Conclusions: FAP expression was increased in three out of five lung fibroblast cell lines derived from IPF patients. The response to TGFb-1 on FAP expression was variable, but a net increase with regard to basal expression was observed in both normal and IPF fibroblasts. These results suggest that FAP expression could be part of a stable lung fibroblast phenotype.

"In this paper we study a simple analytic continuation of the Riemann≥function, using Bernoulli numbers and an analytic continuation of the°function in the complex plane. We use our results to study the critical condition in bosonic string theory. The approach is simple and givesthe student an alternative point of view of the subject. We also show that the mathematical basis needed to understand the critical condition isbased on well known properties of the Dirichlet series and the theory of entire functions, and is within reach of the average graduate student."

The conformal invariance properties of a Dirac oscillator are established. A set of operators is constructed whose algebra shows that it can be considered as a conformal system. The operators are then used to solve the problem using algebraic techniques. The superconformal generalization of the algebra is also worked out, and some consequences of these invariances for the properties of the model are mentioned.

The implications of the existence of only closed and bounded plane orbits in classical mechanics are investigated. The authors show that these are such restrictive conditions as to allow for the existence of 'extra' constants of the motion. They also determine the functional form of the potentials producing them; these potentials can only be the Newtonian and the harmonic oscillator potential (Bertrand's theorem). They mention how these findings relate to the existence of hidden symmetries and superintegrability on such systems. Various points of their discussion are commented on or explained at the end.

Early maternal deprivation (MD) in rats (24h, PND 9-10) is a model for neurodevelopmental stress. Our previous data showed that MD altered the hippocampal levels of the endocannabinoid 2-AG and the expression of hippocampal cannabinoid receptors in 13-day-old rats, with males being more markedly affected. The aim of this study was to analyze the impact of MD on the enzymes involved in 2-AG biosynthesis (DAGLalpha and DAGLbeta) and degradation (MAGL) in relevant areas (DG, CA1, CA3) of the hippocampus in 13-day-old neonatal rats. The expression of the enzymes was evaluated by quantitative RT-PCR, immunohistochemistry, and densitometry. MD induced a significant increase in DAGLalpha immunoreactivity in both males and females, which was mainly associated with fibers in the polymorphic cell layer of the dentate gyrus and in the stratum pyramidale of CA3. In contrast, the molecular layer of the dentate gyrus showed a significant decrease in DAGLalpha immunoreactivity in MD males and females. No changes were observed in DAGLbeta immunoreactivity. MD induced a significant decrease in MAGL immunoreactivity in hippocampal CA3 and CA1 areas, more marked in males than in females, and that was mainly associated with fibers in all strata of CA3 and CA1. The results also showed a significant decrease of MAGL mRNA levels in MD males. These data support a clear association between neurodevelopmental stress and dysregulation of the endocannabinoid system. This association may be relevant for schizophrenia and other neurodevelopmental psychiatric disorders.

Early antibiotic administration to patients diagnosed of community-acquired pneumonia (CAP) has been associated with a lower mortality. In the USA, its administration within four hours has been implanted as a quality standard. The objective of this work was to analyze, in a Spanish emergency department, the performance with patients with CAP, focusing on the administration of the first dose of antibiotic.Clinics, welfare and organizational aspects have been analysed on 93 patients diagnosed of CAP in an emergency department in order to identify their influence on antibiotic administration within 4 hours.46.2% of patients received antibiotics within 4 hours. The fact that patients were assisted in the higher complexity level showed a positive association with the antibiotic administration within 4 hours. On the contrary, presence of more than 10 patients waiting to be admitted showed a negative association.Early antibiotic administration in the CAP is possible. On order to guarantee a higher number of patients taking antibiotics within 4 hours we have to improve quality of care in both the emergency department (to guarantee correct classification according to the level of complexity) and in the hospital (management of beds to avoid delay in the admission of the patients).

This study aims to evaluate the prognosis of urinary tract infections (UTI) treated empirically with inadequate antibiotic treatment.Prospective cohort study of patients over 18 years of age, attended in the hospital emergency service between 01/02 and 31/05 of 2007, due to micturation symptoms, accompanied by pyuria (10 leukocytes/mm(3) of uncentrifuged urine) or positive reactive strip for nitrites-leukocytes and urine culture with10(3) colony forming units. It was considered that the antibiotic treatment prescribed empirically was adequate if the bacteria isolated was sensitive and had been prescribed for the correct time. It was considered that there was therapeutic failure when the symptoms persisted after 5 days of treatment. Age, gender, presence of indwelling bladder catheter, type of UTI, hospitalization in the previous 3 months, origin of the patient and associated diseases were recorded.A total of 177 bacteria were isolated in 168 patients. In 29 cases (17.3%), the microorganism isolated was resistant to the antibiotic prescribed. There was thereaputic failure in only 6 patients, although they did not required hospital admission. The patients who lived in a residential home for the elderly (13.7% vs 2.2%, P = 0.015) or who had been hospitalized during the previous 3 months (20.6% vs 4.3%, p = 0.039) had a greater risk of receiving inadequate treatment.The prognosis of the patients attended in the emergency hospital service due to UTI with discordant antibiotic treatment is favorable in most of the cases. Performing urine culture in patients with greater risk of suffering UTI due to a resistant microorganism would be recommendable.