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A numerical study of magnetohydrodynamics (MHD) and tracer-particle evolution investigates the effects of resonant magnetic perturbations (RMPs) on the confinement of runaway electrons (REs) in tokamak discharges conducted in the Madison Symmetric Torus. In computational results of applying RMPs having a broad toroidal spectrum but a single poloidal harmonic, m = 1 RMP does not suppress REs, whereas m = 3 RMP achieves significant deconfinement but not the complete suppression obtained in the experiment [Munaretto et al., Nuclear Fusion 60, 046024 (2020)]. MHD simulations with the NIMROD code produce sawtooth oscillations, and the associated magnetic reconnection can affect the trajectory of REs starting in the core region. Simulations with m = 3 RMP produce chaotic magnetic topology over the outer region, but the m = 1 RMP produces negligible changes in field topology, relative to applying no RMP. Using snapshots of the MHD simulation fields, full-orbit relativistic electron test particle computations with KORC show ≈50% loss from the m = 3 RMP compared to the 10%–15% loss from the m = 1 RMP. Test particle computations of the m = 3 RMP in the time-evolving MHD simulation fields show correlation between MHD activity and late-time particle losses, but total electron confinement is similar to computations using magnetic-field snapshots.

Relativistic electron (RE) beams at high current density (low safety factor, q ( a )) yet very low free-electron density accessed with D-2 secondary injection in the DIII-D and JET tokamak are found to exhibit large-scale MHD instabilities that benignly terminate the RE beam. In JET, this technique has enabled termination of MA-level RE currents without measurable first-wall heating. This scenario thus offers an unexpected alternate pathway to achieve RE mitigation without collisional dissipation. Benign termination is explained by two synergistic effects. First, during the MHD-driven RE loss events both experiment and MHD orbit-loss modeling supports a significant increase in the wetted area of the RE loss. Second, as previously identified at JET and DIII-D, the fast kink loss timescale precludes RE beam regeneration and the resulting dangerous conversion of magnetic to RE kinetic energy. During the termination, the RE kinetic energy is lost to the wall, but the current fully transfers to the cold bulk thus enabling benign Ohmic dissipation of the magnetic energy on longer timescales via a conventional current quench. Hydrogenic (D-2) secondary injection is found to be the only injected species that enables access to the benign termination. D-2 injection: (1) facilitates access to low q ( a ) in existing devices (via reduced collisionality & resistivity), (2) minimizes the RE avalanche by 'purging' the high-Z atoms from the RE beam, (3) drives recombination of the background plasma, reducing the density and Alfven time, thus accelerating the MHD growth. This phenomenon is found to be accessible when crossing the low q ( a ) stability boundary with rising current, falling toroidal field, or contracting minor radius-the latter being the expected scenario for vertically unstable RE beams in ITER. While unexpected, this path scales favorably to fusion-grade tokamaks and offers a novel RE mitigation scenario in principle accessible with the day-one disruption mitigation system of ITER.

The search for new alternatives for soil stabilization by means of wasted materials promoted the development of this exploratory research to perform a preliminary evaluation of the geotechnical properties of a fine subgrade soil stabilized with different percentage (4 %, 8 %, 12 % y 16 %) of Used Engine Oil (UEO). In the development of this research, tests of Atterberg limits, permeability coefficient (k), unconfined compression stress (qu), and water-density ratio were performed on a soil classified as MH. The tests were performed both on the unstabilized soil and on UEO stabilized soil. Results show that the liquid and plastic limits tend to lower as the percent of UEO increases, the maximum dry density lightly increase, the optimal water content lower significantly, the unconfined compression stress (qu) stays constant with up to 8 % of UEO and permeability (k) does not show significant variation., La búsqueda de nuevas alternativas para estabilizar suelos con desechos motivó la realización de esta investigación exploratoria para evaluar en forma preliminar las propiedades geotécnicas de un suelo fino de subrasante mezclado con diferentes porcentajes (4 %, 8 %, 12 % y 16 %) de Aceite de Motor Usado (AMU). En el desarrollo de esta investigación se realizaron ensayos de límites de Atterberg, coeficiente de permeabilidad (k), compresión inconfinada (qu), y relación humedad-densidad de un suelo clasificado como MH. Los ensayos se realizaron tanto para el suelo sin estabilizar como para el suelo estabilizado con AMU. Los resultados muestran que los limites líquido y plástico tienden a disminuir con el incremento de AMU, la densidad seca máxima se incrementa ligeramente, el contenido de humedad optima disminuye significativamente, la resistencia a la compresión inconfinada (qu) se mantiene constante para contenidos de AMU hasta el 8 % y la permeabilidad (k) no muestra variación significativa.

To assess which type of preoperative dietary strategy is most effective in reducing liver volume and assessing its influence on different biochemical parameters and on surgical complications in individuals undergoing bariatric surgery. Parallel randomized trial comparing the effect of a very low calorie diet (VLCD) and a low calorie diet (LCD) for a period of 21 days before surgery on hepatic volume, anthropometric and biochemical parameters. Compliance and tolerance to the diets, surgical complications, and hospital stay were also determined. Eighty-six morbid obese participants undergoing bariatric surgery were randomized. The hepatic volume was significantly reduced in both intervention groups, but no differences in changes between groups were detected. The reduction in the hepatic volume was higher in those patients with a baseline hepatic volume > 3 L compared to those with

Introducción: El desarrollo de disfunción renal en el contexto de una falla cardíaca aguda se conoce como síndrome cardiorrenal (SCR) tipo 1. El empeoramiento de la función renal (EFR) durante la internación es un predictor de mal pronóstico. La cistatina C ha surgido como un marcador de función renal alternativo a la creatinina. Objetivo: Demostrar la utilidad clínica de la cistatina C como predictor de EFR y factor pronóstico en pacientes con insuficiencia cardíaca aguda y sin disfunción renal evaluada por creatinina al ingreso. Material y métodos: Se llevó a cabo un estudio observacional, prospectivo, de pacientes consecutivos con diagnóstico de insuficiencia cardíaca aguda y sin disfunción renal, definida como un valor de creatinina < 1,3 mg/dl al ingreso. Se realizó un dosaje de cistatina C al ingreso. El punto final primario fue EFR y los secundarios fueron mortalidad hospitalaria, mortalidad total y reinternación por insuficiencia cardíaca. Resultados: Se incluyeron 166 pacientes con una mediana de edad de 85 años (IIC 77,7-89). La incidencia de EFR fue del 29,7%, con una mortalidad hospitalaria del 3,1% y una mortalidad total del 24,4%. La mediana de seguimiento fue de 193 días. El valor de cistatina C fue significativamente mayor en los pacientes que desarrollaron EFR (1,72 ± 0,58 mg/dl vs. 1,51 ± 0,41 mg/dl; p = 0,03) y en los pacientes que murieron en el seguimiento (1,76 ± 0,49 mg/dl vs. 1,51 ± 0,46 mg/dl; p = 0,004). La cistatina C resultó un predictor independiente de mortalidad (OR 3,03, IC 95% 1,22-7,47) y de EFR (OR 2,38, IC 95% 1,02- 5,5) en el análisis multivariado. Se halló un punto de corte óptimo de 1,6 mg/dl de cistatina, con una sensibilidad del 61,22% y una especificidad del 60,34% para el desarrollo de EFR y del 61,54% y 61,98%, respectivamente, para mortalidad total. Conclusión: El valor de cistatina C al ingreso es predictor de desarrollo de EFR durante la internación y de mayor mortalidad en esta población con insuficiencia cardíaca aguda y función renal conservada al ingreso.

Tropical peatlands are a major, but understudied, biophysical feedback factor on the atmospheric greenhouse effect. The largest expanses of tropical peatlands are located in lowland areas of Southeast Asia and the Amazon basin. The Loreto Region of Amazonian Peru contains ~63,000 km2 of peatlands. However, little is known about the biogeochemistry of these peatlands, and in particular, the cycling of carbon dioxide (CO2) and methane (CH4), and their responses to hydrometeorological forcings. To address these knowledge gaps, we established an eddy covariance (EC) flux tower in a natural palm (Mauritia flexuosa L.f.) swamp peatland near Iquitos, Peru. Here, we report ecosystem-scale CO2 and CH4 flux observations for this Amazonian palm swamp peatland over a two-year period in relation to hydrometeorological forcings. Seasonal and short-term variations in hydrometeorological forcing had a strong effect on CO2 and CH4 fluxes. High air temperature and vapor pressure deficit (VPD) exerted an important limitation on photosynthesis during the dry season, while latent heat flux appeared to be insensitive to these climate drivers. Evidence from light-response analyses and flux partitioning support that photosynthetic activity was downregulated during dry conditions, while ecosystem respiration (RE) was either inhibited or enhanced depending on water table position. The cumulative net ecosystem CO2 exchange indicated that the peatland was a significant CO2 sink ranging from −465 (−279 to −651) g C m−2 y−1 in 2018 to −462 (−277 to −647) g C m−2 y−1 in 2019. The forest was a CH4 source of 22 (20 to 24) g C m−2 y−1, similar in magnitude to other tropical peatlands and larger than boreal and arctic peatlands. Thus, the annual carbon budget of this Amazonian palm swamp peatland appears to be a major carbon sink under current hydrometeorological conditions.

To assess which type of preoperative dietary strategy is most effective in reducing liver volume and assessing its influence on different biochemical parameters and on surgical complications in individuals undergoing bariatric surgery.Parallel randomized trial comparing the effect of a very low calorie diet (VLCD) and a low calorie diet (LCD) for a period of 21 days before surgery on hepatic volume, anthropometric and biochemical parameters. Compliance and tolerance to the diets, surgical complications, and hospital stay were also determined.Eighty-six morbid obese participants undergoing bariatric surgery were randomized. The hepatic volume was significantly reduced in both intervention groups, but no differences in changes between groups were detected. The reduction in the hepatic volume was higher in those patients with a baseline hepatic volume 3 L compared to those with 3 L (adjusted P value 0.001). The percentages of total weight lost were 5.8 and 4.2% (adjusted P value = 0.004) for participants on the VLCD and LCD, respectively. There were no differences between groups for any of the biochemical parameters analyzed, nor in the number of surgical complications nor the length of hospital stay. Adherence to the diet was good; nevertheless, participants in the VLCD intervention showed worse tolerance.In subjects with morbid obesity undergoing bariatric surgery, compared to a LCD, a preoperative 21-day intervention with VLCD is more effective in terms of reducing total body weight but not in terms of reducing the liver volume. Both types of preoperative diets have similar effects on clinical biochemical parameters, rate of surgical complications, and hospital length stay.

Large, intact areas of tropical peatland are highly threatened at a global scale by the expansion of commercial agriculture and other forms of economic development. Conserving peatlands on a landscape scale, with their hydrology intact, is of international conservation importance to preserve their distinctive biodiversity and ecosystem services and maintain their resilience to future environmental change. We explored threats to and opportunities for conserving remaining intact tropical peatlands; thus, we excluded peatlands of Indonesia and Malaysia, where extensive deforestation, drainage, and conversion to plantations means conservation in this region can protect only small fragments of the original ecosystem. We focused on a case study, the Pastaza‐Marañón Foreland Basin (PMFB) in Peru, which is among the largest known intact tropical peatland landscapes in the world and is representative of peatland vulnerability. Maintenance of the hydrological conditions critical for carbon storage and ecosystem function of peatlands is, in the PMFB, primarily threatened by expansion of commercial agriculture linked to new transport infrastructure that is facilitating access to remote areas. There remain opportunities in the PMFB and elsewhere to develop alternative, more sustainable land‐use practices. Although some of the peatlands in the PMFB fall within existing legally protected areas, this protection does not include the most carbon‐dense (domed pole forest) areas. New carbon‐based conservation instruments (e.g., REDD+, Green Climate Fund), developing markets for sustainable peatland products, transferring land title to local communities, and expanding protected areas offer pathways to increased protection for intact tropical peatlands in Amazonia and elsewhere, such as those in New Guinea and Central Africa which remain, for the moment, broadly beyond the frontier of commercial development.

Techniques such as equilibrium (DC) and dynamic (AC) magnetic measurements have been used to determine the anisotropy constant of a variety of magnetic nanoparticles, obtaining values that are often an order of magnitude higher than the corresponding bulk material. Unfortunately, the effect of particle-particle interactions is often neglected, hence the reported values are an effective collective parameter , rather than an intrinsic property. In this study we used DC and AC magnetic measurements to determine the anisotropy constant of magnetic nanoparticles fixed in a cross-linked polymer matrix. We used nanoparticle concentrations of 0.1%, 1%, 6%, and 33%(w/w) in order to determine the effect of concentration, and hence interactions, on the value determined for the anisotropy constant. The effect of interaction on determining the magnetocrystalline anisotropy constant was accounted for by using the Ne?el and Vogel-Fulcher relaxation models, the latter with an effective interaction temperature determined from independent measurements. A decrease in the anisotropy constant determined from these measurements was observed with decreasing particle concentration from ~ 6100 kerg/cm3 to ~ 500 kerg/cm3 using the Vogel-Fulcher model and from ~ 9100 kerg/cm3 to ~ 1100 kerg/cm3 using the Ne?el model. The values obtained for the most dilute samples using the Vogel-Fulcher model are of comparable magnitude to bulk values for magnetite. More importantly, the value of ?0 obtained from AC susceptibility decreased from 10-32 to 10-9 s with decreasing particle concentration. As ?0 is expected to be of the order of 10-9 s, these results indicate that the value of magnetic anisotropy determined for the dilute sample represents an intrinsic rather than effective property. These measurements and analysis illustrate the importance of particle concentration/interactions in determining the intrinsic magnetic properties of nanoparticles, particularly the anisotropy constant .

Increasing information suggests that absorption profiling may be superior to trough level monitoring for optimal concentration control of cyclosporine microemulsion (Neoral) therapy, and that CsA exposure early post-transplant may correlate significantly with reduced risk of acute graft rejection. This randomized, prospective, multicenter international concentration-controlled study was conducted in 21 renal transplant centers in 8 countries to test and compare the clinical feasibility, functionality, accuracy, precision and prediction of rejection by cyclosporine microemulsion absorption profiling to conventional trough-level drug monitoring. Primary or second renal allograft recipients treated with basiliximab, cyclosporine microemulsion and prednisone immunosuppression were randomized to two study groups in which cyclosporine microemulsion therapy was monitored using a multipointalgorithm or by trough levels. The two study arms were comparable in terms of baseline characteristics, treatment and clinical outcomes. Treatment failure, consisting of acute rejection, graft loss or death, occurred with equal incidence in the two groups (30% and 33%, respectively). Diagnostic feasibility, measured as the proportion of samples obtained within the designated time window, was marginally lower in area under the time-concentration curve (AUC) than in trough groups, but the therapeutic accuracy and precision were comparable or superior in the AUC group. Cox regression analysis performed across study groups showed a highly significant correlation between the predicted probability of acute rejection and cyclosporine (CsA) exposure measured by AUC over the entire 12-h dosage interval (AUC[0-12]) (p = 0.0068), AUC over the first 4 h of the 12-h dosage interval (AUC[0-4]) (p = 0.0014) or 2h post-dose (C2) CsA level (p = 0.0027). Day 3 dose- and weight-corrected C2 values (EMIT equivalent) separated patients into low (200 microg/L/mg/kg dose), intermediate (200-350 microg/L/mg/kg dose) and high absorber categories (350 microg/L/mg/kg dose), defining those at greatest risk. Within these categories, C2 values above approximately 1500 microg/L by day 3 post-transplant were associated with the lowest predicted probability of rejection. Comparable analysis by Cox regression using C0 levels did notreach statistical significance. Absorption profiling is a feasible, accurate and precise method for monitoring cyclosporine microemulsion therapy in clinical practice and, as shown in the companion article, may be simplified by the use of single-point C2 concentrations which accurately predict individual AUC[0-4] exposure levels. Both cyclosporine microemulsion relative absorption (i.e. dose- and weight-corrected exposure) and CsA exposure (measured by predicted AUC or C2 levels) are closely correlated with the risk of rejection, and define patients at high and low risk of acute graft rejection. Trough (C0) levels are not closely correlated with either CsA exposure or rejection risk, and should not be considered reliable for monitoring cyclosporine microemulsion therapy.

Recent data suggest that optimal cyclosporine (CsA) exposure early post-transplant significantly reduces the risk of acute graft rejection. They indicate that trough level monitoring is inadequate for precise concentration-controlled therapy, and suggest that absorption profiling may offer a superior approach for guiding clinical immunosuppression with Neoral. An international, prospective, multicenter study examined the feasibility, accuracy, precision and clinical utility of cyclosporine microemulsion (Neoral) absorption profiling in de novo renal transplant recipients receiving basiliximab immunoprophylaxis and cyclosporine microemulsion maintenance immunosuppression. The nested pharmacokinetic study reported here was conducted in 4 study centers in which full (11-point) pharmacokinetic profiles were performed on days 3, 7, 14 and 84 post-transplant to examine absorption profile and absorption efficiency, and to determine optimal sparse-sampling pharmacokinetic methods to predict Neoral exposure. Twenty-four patients had complete 12-h pharmacokinetic (PK) data on all 4 sampling days. Area under the time-concentration curve (AUC) over the first 4 h of the 12-h dosage interval (AUC[0-4]) and AUC over the entire 12-h dosage interval (AUC[0-12]) reached 3803 +/- 1033 and 7462 +/- 2120 microg.h/L respectively, by day 3, remained stable throughout the first 2 weeks, and declined to 2310 +/- 698 and 4062 +/- 1158 microg.h/L by day 84 (p0.001). AUC[0-4], capturing the drug absorption phase, represented 52% of the AUC[0-12] values across the four PK study days (mean R20.90). Between-patient variability was highest for C0 and C1 (mean coefficient of variation [c.v.] 36-47%), and lower for C2 (mean c.v. 28%) and subsequent time-points during the dosing interval. Mean relative CsA absorption, measured by dose- and weight-adjusted AUC[0-4] and AUC[0-12], increased significantly over time. The dose- and weight-corrected AUC[0-4h] (DWC.AUC[0-4]) rose by over 100% (p0.001) from 753 +/- 202 at day 3 to 905 +/- 232 at day 7, 1080 +/- 330 at day 14 and 1521 +/- 316 by day 84, while the dose-and weight-corrected AUC[0-12h] (DWC.AUC[0-12]) rose by over 80% (p0.001) from 1477 +/- 390 microg.h/L/ mg/kg on day 3, to 1721 +/- 426 on day 7, 2086 +/- 478 on day 14 and 2690 +/- 602 on day 84 (p0.001). Relative CsA absorption varied over 5-fold between patients at day 3, but patients tended to remain within the same quartiles over time. Sparse-sample modeling identified optimum 3-point, 2-point and 1-point predictors for AUC[0-4] and AUC[0-12]. C2 was the most accurate and robust .1-point predictor for AUC[0-4] (mean R2: 0.80), while C3 was superior for AUC[0-12] (mean R2: 0.75). C0 was not a good predictor of either AUC[0-4] or AUC[0-12] (mean R2: 0.13 and 0.24, respectively).Absorption profiling defines the heterogeneity in CsA exposure and relative absorption post-transplant. A 2-h post-dose blood sample is the most consistent, accurate and robust single-point predictor of the absorption phase measured by AUC[0-4] and should replace trough level monitoring for accurate concentration-control of Neoral therapy in the clinical setting. The use of additional samples at 1 and 3h is more complex and costly, but increases prediction accuracy and may be valuable in selected patients with erratic absorption.

This open, multicenter, randomized, parallel-group study evaluated the efficacy and safety of tacrolimus-based dual and triple therapy regimens. For this 3-month study (with 12-month follow up), 491 adult renal transplant patients were randomized and received either dual therapy (tacrolimus/corticosteroids; 246 patients) or triple therapy (tacrolimus/corticosteroids/azathioprine; 245 patients). Patient survival rates at months 3 and 12 were 99.2 (dual) vs 99.6 % (triple) and 97.8 vs 98.7 %, respectively. Graft survival rates at months 3 and 12 were 94.1 (dual) vs 95.4 % (triple) and 92.8 vs 93.3 %, respectively. After 3 months, the incidences of treated acute rejection were 28.8 (dual) and 29.7 % (triple); and 7.6 (dual) and 5.4 % (triple) for corticosteroid-resistant acute rejections. Between months 4 and 12, three new first rejections were reported, (dual: 2, triple: 1). For leukopenia (1.3 vs 11.7 %; P < 0.001) and anemia (14.8 vs 23.0 %, P = 0.026), significantly higher incidences were reported in the triple therapy group. The incidence of de novo insulin-dependent diabetes was 5.6 (dual) and 4.0 % (triple) at month 3. In terms of efficacy, no difference between the treatment groups was observed.

Between January 1992 and December 1998 we collected clinical, epidemiological and treatment data on all patients diagnosed of tuberculosis in our specialized unit. Five hundred sixty-seven patients (70% male and 30% female) were studied prospectively. The rate of new cases increased until 1995 and decreased during the last three years of study. Mean patient age was 38.8 years, with nearly 64% of patients under 45 years of age. Predisposing disease, mainly chronic alcoholism, was present in 36%. Fifteen percent belonged to a high-risk social group (6.5% were drug addicts and 6.3% lived inside secure institutions). The mean time elapsing from the appearance of symptoms until referral to our service was 80.4 days and the most common clinical picture at presentation was general unwellness with cough and expectoration (46%) followed by hemoptysis (18%). Cavitation was visible in 48.5% of x-rays, while alveolar infiltrates were seen in 33%, pleural effusion in 12% and lymph node involvement in 10%. Adult tuberculosis was diagnosed in 80% of cases, 10% were reactivations and 9% were primary. Bacteriological diagnosis was available for 85%. Therapy usually involved six months with hydrazide, rifampicin and pyrazinamide (81%). Therapy was generally well-tolerated, although analyses revealed some anomalies, such as transaminase alteration (18%) and hyperuricemia (19%). Therapy was changed because of toxicity in only 2.6%. Follow-up after therapy was strict and the rate of successful cure was 97.5%. We conclude that diagnosis was not prompt enough and believe that knowledge of epidemiological, clinical and evolutionary data, as well as monitoring of real rates of cure of treated patients justifies the existence of specialized centers for managing tuberculosis.

Objetivo Estudiar la prevalencia del tabaquismo en escolares de Sevilla y la influencia que el entorno personal y social tiene sobre el consumo. Metodos Este trabajo esta incluido en el marco de una campana de prevencion del tabaquismo efectuada en centros de ensenanza. Los alumnos cumplimentaban de forma anonima una encuesta, basada en el cuestionario de la OMS sobre actitudes y habitos de la poblacion. Resultados Se evaluaron un total de 3.385 jovenes de 10 a 19 anos de edad, pertenecientes a 47 centros escolares de Sevilla y 28 pueblos de la provincia. El 19,1% de los jovenes reconocian ser fumadores activos, con proporcion algo mayor en alumnas (19,8%) que en alumnos (18,3%). Objetivamos que habia conexion del tabaquismo de los jovenes con el habito de sus hermanos mayores y sobre todo con el de sus amigos (odds ratio, 20,5). Los adolescentes reconocian baja permisividad por parte de los padres y mayor tolerancia en el resto del entorno. Los fumadores activos vinculan en mayor medida el tabaco con valores como indepedencia y libertad, y creen que puede causar efectos sobre la salud, aunque menos que los no fumadores. Las expectativas de consumo son altas para los fumadores regulares. Conclusiones Hemos encontrado un elevado porcentaje de fumadores entre los jovenes escolares de ambos sexos. La adquisicion y mantenimiento del tabaquismo en la adolescencia esta influido notablemente por el entorno de amigos, pudiendo incidir tambien mensajes como independencia y libertad transmitidos habitualmente por la industria tabaquera.

Prospective studies focusing on the relationship between diabetic retinopathy and the presence of microalbuminuria are lacking. The objective of the present study was to determine the potential relationship between both forms of diabetic microangiopathy by means of a five-year long prospective study in which 104 patients with type 1 diabetes mellitus and with no retinal involvement at the beginning of the study were included. At the end of the study four groups of patients emerged: group 1, made up of 63 patients without both retinal involvement and microalbuminuria; group 2, made up of 17 patients with both retinopathy and microalbuminuria; group 3, with 16 patients with retinopathy but without microalbuminuria, and group 4, with eight patients with microalbuminuria only. In the statistical study, a direct significance was observed for both increased levels of HbA1c and total cholesterol; and a reverse significance for increased levels of HDL-cholesterol as well as the presence of diastolic arterial hypertension, for group 2 (patients with both retinopathy and microalbuminuria). For group 3, increased levels of triglycerides and evolution time (patients with retinopathy but without microalbuminuria) were significant. In the present study we conclude that microalbuminuria is not a good marker for diabetic microangiopathy defined as renal and retinal involvement, although its presence prompt us to watch more frequently the ocular fundus in diabetic patients.

The aim of this study was to analyze the results of the tuberculosis contact tracing carried out in an outpatient pneumology setting and to assess its performance with regard to the detection of new cases of tuberculosis and infected contacts. One thousand two hundred and twenty-eight contacts of 302 tuberculosis patients were evaluated in the Tuberculosis Unit of the Dr. Fleming Specialities Center between 1992 and 1996. Contacts were categorized into groups with regard to bacteriological status of the index case (Group A, smear-positive; Group B, culture-positive only; Group C, smear- and culture-negative) and intimacy of exposure to the index case (close or casual). The possible association between the existence of infection or disease and the bacteriological status of the index case and degree of intimacy of exposure was analyzed. There were 582 infected contacts (47.4%) and 42 new cases of tuberculosis (3.4%), six of which were smear-positive. The proportion of infected and diseased contacts was significantly higher for those who had contact with smear-positive patients and those who had close contact with the index case. Chemoprophylaxis was completed in 431 (35.1%) of the contacts evaluated. Systematic investigation of contacts represents an efficient means of discovering new cases of tuberculosis and infection, especially among contacts of smear-positive index cases and among those who are closer to the index case. The administration of appropriate treatment to these contacts will contribute to controlling the transmission of tuberculosis within the community.

Introduction. Renal function predicts graft survival in kidney transplant patients. This study compared the 2-year evolution of renal function in patients treated with cyclosporine or tacrolimus in combination with mycophenolate mofetil (MMF) and prednisone. Methods. We studied 1558 cadaveric renal transplant recipients from 14 Spanish hospitals between January 2000 and December 2002. Of these, 1168 were treated with tacrolimus and 390 with cyclosporine. The primary efficacy endpoint was long-term renal function. Renal function was measured by serum creatinine and glomerular filtration rate (GFR) by creatinine clearance calculated from the Cockcroft-Gault formula. This report summarizes the 2-year results. Results. At 24 months the tacrolimus group showed significantly better serum creatinine (1.5 ± 0.7 vs 1.8 ± 0.8 mg/dL, P

The purpose of this study was to investigate the incidence and risk factors for the development of diabetes mellitus after kidney transplantation (PTDM). A total of 1783 nondiabetic renal allograft recipients transplanted from January 2000 to December 2002 were included. Diabetes was diagnosed following American Diabetes Association criteria. While 1276 patients were treated with tacrolimus (Tac), mycophenolate mofetil (MMF), and steroids, 507 patients received cyclosporine-ME (CsA), MMF, and steroids. PTDM incidence at 6, 12, and 24 months was 14.2%, 12.8%, and 13.3%, respectively. Cumulative incidence during the follow-up was 21.6%. Only 121 of the diabetic patients (47.6%) at 6 months remained diabetic at 24 months. Furthermore, 60 patients of 116 patients on insulin at 6 months (51.7%) remained on treatment at 24 months. The cumulative incidence of PTDM was similar in the two immunosuppressive treatments (19.7% on CsA-MMF vs 22.3% on Tac-MMF; P = NS). However, at 24 months, 14 of 50 diabetic patients on CsA-MMF (28%) and 74 of 161 patients on Tac-MMF (45.9%) were on insulin treatment (P.05). By Cox regression analysis, age older than 60 years (RR 1.61; 95%CI 1.28-2.04; P.001), body mass index (BMI)30 kg/m2 at transplantation (RR 1.66; 95%CI 1.27-2.16; P.001), and immunosuppression with Tac (RR 1.30; 95%CI 1.02-1-66; P = .033) were associated with PTDM. In conclusions, the incidence of PTDM at 24 months in immunosuppressive protocols including MMF is about 22%, and it is associated with older age, increased BMI, and immnunosuppression with Tac.

Diabetes mellitus (DM) is a public health problem with a prevalence of 345 million people worldwide that it may double by the year 2030 and have a high costs and mortality. Gastrointestinal surgery is accepted as a form of treatment that was already suggested for obese in 1987 by Pories, confirmed for obese patients by the metaanalysis of Buchwald and the direct comparison of gastric bypass with medical treatment in the study of Schauer that demonstrate a 4 fold greater resolution rate of DM with surgery. Improvement occurs immediately after surgery, before the patients lose weight in with BMI35; but there is doubt if the existent evidence is enough to extrapolate these results to patients with BMI35 and especially with BMI30, in spite that four reviews in patients with this BMI and DM2 demonstrated the same results when stomach, duodenum and part of jejunum is bypassed as happen gastric bypass (better results with this of one anastomosis than of two anastomosis, Roux-en-Y) BPD. For patients with a BMI between 30 and 35 restrictive techniques: LAGB and SGL are good but not better than the mixed: RYGB, BAGUA, or SG-DJB with remission from 60 to 100%, minor in the derivative: BPD and above on the IID with a 81% of remission. There are no differences in the metabolic control in comparison to the obese, It is progressively better with DJB, SDS, IID and BAGUA especially in patients who do not require insulin, have less time with disease, have normal C peptide levels, and not so much relation with the initial BMI that is only important to decide the degree of restriction. Although several mechanisms has been suggested for explaining these results such as caloric intake, hormonal changes, bypass of the anterior or early stimulation of posterior intestine, fundectomy, intestinal gluconeogenesis and others, new ones will appear in the near future.La diabetes mellitus (DM) es un problema de salud pública, con una prevalencia de 345 millones de personas, que puede duplicarse para el año 2030 y con importante repercusión en costes y mortalidad. La cirugía gastrointestinal es aceptada como una forma de tratamiento sugerida en obesos desde 1987 por Pories, y confirmada por el meta-análisis de Buchwald y la comparación directa del bypass gástrico con el mejor tratamiento médico en el estudio de Schauer que pone de manifiesto un índice de remisión 4 veces mayor con la cirugía. La mejoría ocurre inmediatamente después de la cirugía, antes de la pérdida de peso en pacientes con IMC35; pero hay duda si la evidencia existente es suficiente para extrapolar estos resultados a pacientes con IMC35 y especialmente con IMC30, a pesar de existir cuatro revisiones en pacientes con este IMC y DM2 que demuestran los mismos resultados que en obesos cuando se puentea estómago, duodeno y parte del yeyuno como pasa en el bypass gástrico y la DBP. Para pacientes con IMC entre 30 y 35 las técnicas restrictivas: BGAL Y GVL son buenas pero no superiores a las mixtas: BGYR, BAGUA o GV-BDY con remisión desde 60 a 100%, menor en las derivativas: DBP y mayor en la IID con un 81% de remisión. En pacientes con sobrepeso no existen diferencias en el control metabólico respecto a los obesos. Es progresivamente mejor con DBP, CDC, IID y BAGUA sobre todo en pacientes que no requieren insulina, tienen menos tiempo con la enfermedad o con un nivel de peptido C normal, factores determinantes y no así el IMC inicial que sólo influye en el volumen de restricción. Aunque se han sugerido distintos mecanismos para explicar los resultados como ingesta calórica, hormonales, teoría del intestino anterior o posterior, fundectomía , neoglucogénesis intestinal y otros, aparecerán más en un futuro no lejano.

In a subset of dialysis patients, erythropoietin (rHuEpo) treatment exacerbates hypertension. The mechanism of this pressor effect is unknown; however, it has been suggested that decreased endogenous nitric oxide (NO) activity may play a role. To explore this hypothesis, Sprague-Dawley rats were given rHuEpo (150 U/kg s.c. three times per week) or corresponding vehicle. Blood pressure, haematocrit, and urinary excretion of the stable NO metabolites, nitrite (NO2) and nitrate (NO3), were determined at baseline and 3 weeks. After 3 weeks of rHuEpo treatment there was a significant increase in blood pressure and haematocrit, while in vehicle-treated rats blood pressure and haematocrit remained at basal levels. Urinary excretion of NO2+NO3 increased compared to basal in rHuEpo, but not vehicle rats. Thus in normal rats rHuEpo does have a significant pressor effect, but this is not associated with decreased activity of the endogenous NO system. Thus decreased endogenous NO activity is not responsible for rHuEpo-associated hypertension. These data further suggest that endogenous NO activity is increased in rHuEpo-treated rats, perhaps as a counter-regulatory mechanism that limits the pressor effect. Whether this mechanism is active in the setting of rHuEpo-treated chronic renal failure in humans is unknown.