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Venous thromboembolism (VTE) is a frequent complication in patients with cancer and a leading cause of morbidity and death. The objective of the RIETECAT study was to compare the long-term effectiveness and safety of enoxaparin versus dalteparin or tinzaparin for the secondary prevention of VTE in adults with active cancer. We used the data from the multicenter, multinational RIETE registry to compare the rates of VTE recurrences, major bleeding, or death over 6 months in patients with active cancer and acute VTE using full doses of enoxaparin versus dalteparin or tinzaparin, and a multivariable Cox proportional hazard model was used to analyze the primary end point. From January 2009 to June 2018, 4451 patients with active cancer received full doses of the study drugs: enoxaparin, 3526 patients; and dalteparin or tinzaparin, 925 (754 + 171) patients. There was limited difference in VTE recurrences (2.0% vs 2.5%) and mortality rate (19% vs 17%) between the enoxaparin and dalteparin or tinzaparin subgroups. However, there was a slight numerical increase in major bleeding (3.1% vs 1.9%). Propensity score matching confirmed that there were no differences in the risk for VTE recurrences (adjusted hazard ratio [aHR], 0.81; 95% confidence interval [CI], 0.48-1.38), major bleeding (aHR, 1.40; 95% CI, 0.80-2.46), or death (aHR, 1.07; 95% CI, 0.88-1.30) between subgroups. In RIETECAT, in patients with cancer and VTE receiving full-dose enoxaparin or dalteparin or tinzaparin, no statistically significant differences were observed regarding effectiveness and safety outcomes over a 6-month period.

The RIETE Investigators., [Background] The optimal therapy of patients with acute subsegmental pulmonary embolism (PE) is controversial., [Methods] We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to compare the rate of symptomatic PE recurrences during anticoagulation in patients with subsegmental, segmental, or more central PEs. [Results] Among 15 963 patients with a first episode of symptomatic PE, 834 (5.2%) had subsegmental PE, 3797 (24%) segmental, and 11 332 (71%) more central PE. Most patients in all subgroups received initial therapy with low‐molecular‐weight heparin, and then most switched to vitamin K antagonists. Median duration of therapy was 179, 185, and 204 days, respectively. During anticoagulation, 183 patients developed PE recurrences, 131 developed deep vein thrombosis (DVT), 543 bled, and 1718 died (fatal PE, 135). The rate of PE recurrences was twofold higher in patients with subsegmental PE than in those with segmental (hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.16‐3.85) or more central PE (HR, 1.89; 95% CI, 1.12‐3.13). On multivariable analysis, patients with subsegmental PE had a higher risk for PE recurrences than those with central PE (adjusted HR, 1.75; 95% CI, 1.02‐3.03). After stratifying patients with subsegmental PE according to ultrasound imaging in the lower limbs, the rate of PE recurrences was similar in patients with DVT, in patients without DVT, and in those with no ultrasound imaging. [Conclusions] Our study reveals that the risk for PE recurrences in patients with segmental PE is not lower than in those with more central PE, thus suggesting that the risk of PE recurrences is not influenced by the anatomic location of PE.

Background Venous thromboembolism (VTE) is a major cause of morbidity and mortality postoperatively. The use of pharmacologic prophylaxis is effective in reducing the incidence of VTE. However, the prophylaxis is often discontinued at hospital discharge, especially for those with benign disease. The implications of this practice are not known. We assessed the data from a large, ongoing registry regarding the time course of VTE and outcomes after noncancer surgery. Methods We analyzed the RIETE (Computerized Registry on Venous Thromboembolism) registry, which includes data from consecutive patients with symptomatic confirmed VTE. In the present study, we focused on general surgical patients who had developed symptomatic postoperative VTE in the first 8 weeks after noncancer surgery. The main objective was to assess the interval between surgery and the occurrence of VTE. Additional variables included the clinical presentation associated with the event, the use of thrombosis prophylaxis, and unfavorable outcomes. Results The data from 3296 patients were analyzed. The median time from surgery to the detection of VTE was 16 days (interquartile range, 8-30 days). Of the VTE events, 77% were detected after the first postoperative week and 27% after 4 weeks. Overall, 43.9% of the patients with VTE had received pharmacologic prophylaxis after surgery for a median of 8 days (interquartile range, 5-14 days), and three quarters of the VTE events were detected after pharmacologic prophylaxis had been discontinued. Overall, 54% of the patients with VTE had presented with pulmonary embolism. For 15% of the patients, the clinical outcome was unfavorable, including 4% who had died within 90 days. Conclusions The risk of VTE after noncancer general surgery remains high for ≤2 months. More than one half of the patients had presented with symptomatic PE as the VTE event, and 15% had had unfavorable outcomes. Only 44% of these patients had received pharmacologic prophylaxis for around 1 week.

El tomate de arbol es un frutal de importancia en Colombia, con una productividad limitada por la presencia de problemas sanitarios que se transmiten a traves de los metodos tradicionales de propagacion, que obligan a buscar metodos mas eficientes para la obtencion de plantas sanas. Este trabajo pretendio evaluar diferentes alternativas de micropropagacion para determinar la opcion mas eficiente de multiplicacion masiva de plantulas de tomate de arbol ( Solanum. betaceum ); se evaluaron tres auxinas, acido indolacetico (AIA), acido naftalenacetico (ANA) y acido 2,4-diclorofenoxiacetico (2,4-D) en diferentes dosis, combinadas con 6-bencilaminopurina (BAP) (1,0 mg L -1 y 3,0 mg L -1 ), en un medio de cultivo Murashige Skoog (1962), utilizando hipocotilos como explantes. El mayor promedio de brotes por explante (11,6 brotes) se obtuvo con AIA 0,5 mg L -1 + BAP 3,0 mg L -1 ; el porcentaje de enraizamiento del explante fue mayor en el testigo sin fitorreguladores y con la inclusion de AIA. La variable formacion de plantas completas tuvo mejor comportamiento con AIA 0,5 mg L -1 con el 36,9%. El mejor porcentaje de enraizamiento de brotes obtenidos a partir de hipocotilos, se obtuvo con AIA 1,0 mg L -1 + BAP 3,0 mg L -1 , con un porcentaje de 96,23% y con AIA 1 mg L -1 + BAP 1,5 mgL -1 con 88,83% respectivamente. Las plantas enraizadas fueron exitosamente trasferidas a campo con un 96,6% de supervivencia para hipocotilos.

This research focused on the greenhouse gas (GHG) emissions and potential sinks associated with conventional and sustainable fruit production systems in the Highlands region of Pasto, Narino, Colombia. Based on the IPCC (2006) methodologies, the annual emission balance for a 6-year production cycle included agricultural sources and gasoline consumption related to the main agricultural activities and the potential for soil C accumulation and biomass C fixation in all of the studied systems. The multivariate analysis showed that positive GHG balance emissions would be achieved in all sustainable fruit production systems, as compared to conventional fruit production systems with greater impact on (SS1): Rubus glaucus Benth. Associated with Acacia decurrens trees and live coverage of kikuyu Pennisetum clandestinum grass. According to the results of this study, (SS1) showed the beneficial total GHG balance emission accounting for -21,079 kg of atmospheric CO 2 eq ha -1 yr -1 divided into -4,587 kg CO 2 eq ha -1 yr -1 and -17,102 kg CO 2 eq ha -1 yr -1 due an annual soil and biomass C sequestration potential that could help offset its emissions (610 kg CO 2 eq ha -1 yr -1 ).

Cystic parathyroid adenoma is a rare disease (

Resumen El adenoma quistico paratiroideo es una entidad poco frecuente ( Se presenta el caso de una mujer de 64 anos diagnosticada de hiperparatiroidismo con adenoma quistico paratiroideo y gammagrafia negativa.

We present a linear time-varying Luenberger observer (LTVLO) using compartmental models to estimate the unmeasurable states in patients with type 1 diabetes. The LTVLO proposed is based on the linearization in an operation point of the virtual patient (VP), where a linear time-varying system is obtained. LTVLO gains are obtained by selection of the asymptotic eigenvalues where the observability matrix is assured. The estimation of the unmeasurable variables is done using Ackermann's methodology. Additionally, it is shown the Lyapunov approach to prove the stability of the time-varying proposal. In order to evaluate the proposed methodology, we designed three experiments: A) VP obtained with the Bergman minimal model; B) VP obtained with the compartmental model presented by Hovorka in 2004; and C) real patients data set. For experiments A) and B), it is applied a meal plan to the VP, where the dynamic response of each state model is compared to the response of each variable of the time-varying observer. Once the observer is evaluated in experiment B), the proposal is applied to experiment C) with data extracted from real patients and the unmeasurable state space variables are obtained with the LTVLO. LTVLO methodology has the feature of being updated each instant of time to estimate the states under a known structure. The results are obtained using simulation with MatlabTM and SimulinkTM. The LTVLO estimates the unmeasurable states from in silico patients with high accuracy by means of the update of Luenberger gains at each iteration. The accuracy of the estimated state space variables is validated through fit parameter.

En respuesta a la necesidad de generar alternativas que permitan asegurar la calidad y diferenciación del café de Nariño, se realizó esta investigación con el objetivo de evaluar la calidad física y sensorial del café variedad Colombia, fruto rojo, sembrado a plena exposición solar por caficultores del programa Nespresso AAA 2015, en diferentes altitudes y variaciones en el beneficio, en el Municipio de la Unión, Nariño. En cada finca se cosecharon diez kilos de café maduro con color rojo intenso, se procesaron con beneficio húmedo en la misma finca, se secaron con diferentes tiempos de exposición solar y se llevaron al laboratorio de Almacafé para evaluar sus características físicas y organolépticas como: aroma, fragancia, acidez, cuerpo, sabor, sabor residual, balance, taza limpia, dulzor y puntaje del catador. Igualmente se analizaron las relaciones de los factores climáticos y agronómicos de cada finca con la calidad de taza. Toda la información se analizó mediante análisis multivariado de componentes principales (ACP) y análisis de correspondencias múltiples (ACM). Se concluyó que las condiciones de altitud, no están asociadas particularmente con los parámetros de calidad de la bebida del café; menores contenidos de fósforo en el suelo, menor tiempo de fermentación (16 - 17h) y secado (20 - 25h de sol), se asociaron a mayores puntajes de calidad. La compleja interacción de todas las variables asociadas a la producción del café, es la que define al final, la calidad de taza.

En respuesta a la necesidad de generar alternativas que permitan asegurar la calidad y diferenciación del café de Nariño, se realizó esta investigación con el objetivo de evaluar la calidad física y sensorial del café variedad Colombia, fruto rojo, sembrado a plena exposición solar por caficultores del programa Nespresso AAA 2015, en diferentes altitudes y variaciones en el beneficio, en el Municipio de la Unión, Nariño. En cada finca se cosecharon diez kilos de café maduro con color rojo intenso, se procesaron con beneficio húmedo en la misma finca, se secaron con diferentes tiempos de exposición solar y se llevaron al laboratorio de Almacafé para evaluar sus características físicas y organolépticas como: aroma, fragancia, acidez, cuerpo, sabor, sabor residual, balance, taza limpia, dulzor y puntaje del catador. Igualmente se analizaron las relaciones de los factores climáticos y agronómicos de cada finca con la calidad de taza. Toda la información se analizó mediante análisis multivariado de componentes principales (ACP) y análisis de correspondencias múltiples (ACM). Se concluyó que las condiciones de altitud, no están asociadas particularmente con los parámetros de calidad de la bebida del café; menores contenidos de fósforo en el suelo, menor tiempo de fermentación (16 - 17h) y secado (20 - 25h de sol), se asociaron a mayores puntajes de calidad. La compleja interacción de todas las variables asociadas a la producción del café, es la que define al final, la calidad de taza. In response to the need of generating alternatives to ensure the quality and differentiation of the Nariño coffee, this work was carried out with the objective of evaluating the physical and sensory quality of coffee variety Colombia, red fruit, sown to full sunlight by growers of Nespresso AAA program 2015, growing at different altitudes with variations in the coffee post-harvest, in the municipality of La Union, Nariño. Ten kilos of coffee fruit were harvested per farm; these fruits were processed through wet benefit and dried under different solar exposure times, and then were carried to the Almacafé laboratory to assess their physical and organoleptic characteristics such as: aroma, fragrance, acidity, body, taste, residual flavor, balance, clean cup, sweetness and score of taster. It was also analyzed the relationships between climatic and agronomic factors in each farm with the cup quality. The data were analyzed by multivariate analysis of principal components (PCA) and multiple correspondence analyses (ACM). The altitudes are not particularly associated with the quality parameters of the coffee drink; lower contents of P, less time of fermentation (16 - 17h) and drying (20 - 25h of sun), were associated with higher scores of quality. The complex interaction of all the variables associated to the coffee production of, is what defines, the cup quality.

Circadian clocks organize the metabolism, physiology, and behavior of organisms throughout the day-night cycle by controlling daily rhythms in gene expression at the transcriptional and post-transcriptional levels. While many transcription factors underlying circadian oscillations are known, the splicing factors that modulate these rhythms remain largely unexplored. A genome-wide assessment of the alterations of gene expression in a null mutant of the alternative splicing regulator SR-related matrix protein of 160 kDa (SRm160) revealed the extent to which alternative splicing impacts on behavior-related genes. We show that

En el presente artículo se analizan las principales novedades normativas que se han producido en el Impuesto sobre el Valor Añadido como consecuencia de los cambios introducidos por diferentes normas estatales y comunitarias aprobadas a lo largo del año 2013 y primer trimestre de 2014, haciendo especial hincapié en las modificaciones introducidas en la Ley del Impuesto, por la Ley de Presupuestos Generales del Estado para el año 2014 y en el Reglamento, por el Real Decreto 828/2013, de 25 de octubre.

RESUMEN El tomate de árbol es un frutal de importancia en Colombia, con una productividad limitada por la presencia de problemas sanitarios que se transmiten a través de los métodos tradicionales de propagación, que obligan a buscar métodos más eficientes para la obtención de plantas sanas. Este trabajo pretendió evaluar diferentes alternativas de micropropagación para determinar la opción más eficiente de multiplicación masiva de plántulas de tomate de árbol (Solanum betaceum); se evaluaron tres auxinas: ácido indolacético (AIA), ácido naftalenacético (ANA) y ácido 2,4-diclorofenoxiacético (2,4-D) en diferentes dosis, combinadas con 6-bencilaminopurina (BAP) (1,0 mg L-1 y 3,0 mg L-1), en un medio de cultivo Murashige Skoog (1962), utilizando hipocotilos como explantes. El mayor promedio de brotes por explante (11,6 brotes) se obtuvo con AIA 0,5 mg L-1 + BAP 3,0 mg L-1; el porcentaje de enraizamiento del explante fue mayor en el testigo sin fitorreguladores y con la inclusión de AIA. La variable formación de plantas completas tuvo mejor comportamiento con AIA 0,5 mg L-1 con el 36,9%. El mejor porcentaje de enraizamiento de brotes obtenidos a partir de hipocotilos, se obtuvo con AIA 1,0 mg L-1 + BAP 3,0 mg L-1, con un porcentaje de 96,23% y con AIA 1 mg L-1 + BAP 1,5 mgL-1 con 88,83% respectivamente. Las plantas enraizadas fueron exitosamente trasferidas a campo con un 96,6% de supervivencia para hipocotilos. ABSTRACT The tree tomato is a fruit of importance in Colombia, with a productivity limited by the presence of sanitary problems that are transmitted through the traditional methods of propagation, that force to look for more efficient methods for the obtaining of healthy plants. This study was carried out to evaluate different alternatives of micropropagation that would allow us to determine the most efficient option for the mass production of tamarillo plants (Solanum betaceum). Hypocotyls explants were evaluated under the effect of three auxins: AIA, ANA and 2,4-D in different doses, combined with BAP. The basic medium used was Murashige Skoog (1962). The largest average of number of shoots was obtained when using AIA 0.5 mg L-1 + BAP 3.0 mg L-1 with a value of 11.6 shoots. The best treatment for rooting of hypocotyls was AIA and the control without phytoregulators. Regeneration of complete plants was better to AIA 0.5 mg L-1, with an average of 36.9%. The best average for rooting of shoots obtained was obtained with AIA 1.0 mg L-1 + BAP 3.0 mg L-1 with 96.23% and with AIA 1.0 mg L-1 + BAP 1.5 mg L-1 (88.83%). The rooted plant were successfully transplanted into the soil with a 96.6% survival rate.

RESUMEN El durazno pertenece a la familia Rosaceae; su fruto es una drupa muy apetecida por su agradable sabor, aroma y características nutricionales. Es un fruto climatérico, altamente perecedero con elevada intensidad respiratoria y producción de etileno. Con el fin de realizar la caracterización poscosecha del fruto de durazno cv. Dorado bajo condiciones del trópico alto, se cosecharon frutos en el municipio de Tuta (Boyacá, Colombia) en madurez fisiológica. Se realizaron seis mediciones cada tercer día de parámetros fisicoquímicos como: pérdida de peso, color de epidermis y pulpa, tasa respiratoria, firmeza, extensibilidad, solidos solubles totales (SST) y acidez total titulable (ATT). El fruto de durazno presentó un comportamiento climatérico de acuerdo con su tasa respiratoria; alcanzando el pico climatérico a los 9 días de almacenamiento, la pérdida de peso aumentó linealmente, con un valor de 17,18% en el día 11 de almacenamiento (temperatura de 18±2ºC y humedad relativa de 75±5%), la firmeza disminuyó durante el almacenamiento alcanzando valores de 6,5 N, de igual manera la ATT disminuyó a medida que avanzó la maduración del fruto; pasando de 0,95% en el día 1 a 0,76% en el día 11 de almacenamiento. Por su parte, el índice de color de la epidermis y de la pulpa, los SST, la relación de madurez (RM) y la extensibilidad aumentaron durante la poscosecha. ABSTRACT Peach belongs to the Rosaceae family; its fruit is a drupe highly appreciated for its pleasant flavour, aroma, and nutritional characteristics. It is also a highly perishable climacteric fruit with elevated respiratory rates and ethylene production. In order to characterize postharvest behavior of peach cv. Dorado fruits under high tropic conditions, fruits at physiological maturity were harvested in the municipality of Tuta (Boyacá, Colombia). The following physicochemical parameters were measured six times, every third day: weight loss, skin and pulp color, respiration rate, firmness, extensibility, total soluble solids (TSS), and total titratable acidity (TTA). In accordance with the respiration rate, peach fruits showed a climacteric behavior; reaching a climacteric peak at the ninth day of storage, weight loss increased linear with the time, reaching 17.18% on day 11 of storage (temperature: 18±2ºC, relative humidity: 75±5%). Firmness decreased along the storage period achieving values of 6.5N, in a similar way, TTA declined with the advance of the fruit ripeness stage; falling from 0.95% on day 1 to 0.76% on day 11 of storage. Moreover, skin and pulp color indexes, TSS, maturity ratio and extensibility increased during postharvest.

Cystic parathyroid adenoma is a rare disease (0.01% of all cervical masses) that associates primary hyperparathyroidism in 9% of cases. Parathyroid scintigraphy is essential for its diagnosis with uncommon false negative results. Hybrid SPECT/CT equipments allow a more accurate diagnosis. Functional cystic parathyroid adenomas are surgically treated. A case of a 64-year-old woman with diagnoses of hyperparathyroidism and a cystic parathyroid adenoma without uptake in scintigraphy is described.

Background The benefits of a diagnostic workup for occult cancer in patients with VTE are controversial. Our aim was to provide and validate a risk score for occult cancer in patients with VTE. Methods We designed a nested case-control study in a cohort of patients with VTE included in the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry from 2001 to 2014. Cases included cancer detected beyond the first 30 days and up to 24 months after VTE. Control subjects were defined as patients with VTE with no cancer in the same period. Results Of 5,863 eligible patients, 444 (7.6%; 95% CI, 6.8%-8.2%) were diagnosed with occult cancer. On multivariable analysis, variables selected were male sex, age > 70 years, chronic lung disease, anemia, elevated platelet count, prior VTE, and recent surgery. We built a risk score assigning points to each variable. Internal validity was confirmed using bootstrap analysis. The proportion of patients with cancer who scored ≤ 2 points was 5.8% (241 of 4,150) and that proportion in those who scored ≥ 3 points was 12% (203 of 1,713). We also identified scores divided by sex and age subgroups. Conclusions This is the first risk score that has identified patients with VTE who are at increased risk for occult cancer. Our score needs to be externally validated.

OBJECTIVE: Glioblastoma multiforme is the most frequent primary brain tumor in adults. The major obstacle for successful treatment is the invasive growth pattern. Metabolically, glioblastomas are highly glycolytic, leading to increased levels of lactic acid production. The carbonic anhydrase IX (CAIX) moderates the extrusion of hydrogen ions into the extracellular space, which may enhance tumor invasion by activating proteolytic enzymes. We therefore induced glycolysis in glioblastoma cells and investigated the extracellular pH, cathepsin B expression, and its subcellular distribution and secretion parallel to the invasive behavior of the cells upon CAIX knockdown. METHODS: U251 glioblastoma cells were transfected with a CAIX siRNA construct and cultured in a Biocoat Matrigel invasion chambers with an 8-mm pore size membrane. The chambers were incubated in a humified 5% CO2 modular with either 21% oxygen and 25 mM glucose (control) or 0% oxygen plus 125 mM glucose (glycolysis). Invasion was quantified by counting the cells on the lower membrane surface. Extracellular pH was measured using a pH-meter. Cathepsin B expression and localization was investigated by RT-PCR, Western blot, and immunofluorescence staining, respectively. The cathepsin B secretion into the supernatant was measured using a cathepsin B activity assay. RESULTS: In vitro glycolysis caused a significant increase of cathepsin B expression and secretion combined with massive invasion of glioblastoma cells. In addition, the subcellular distribution of the enzyme was shifted to the cell periphery. The extracellular pH dropped significantly under glycolytic conditions, antagonized by CAIX knockdown. In addition, CAIX knockdown did not influence cathepsin B expression but attenuated the intracellular change of cathepsin B distribution and reduced both the cathepsin B secretion and glioma cell invasion. CONCLUSION: Our data demonstrate that CAIX moderates invasion in glycolytic glioma cells via acidification of the extracellular milieu and enhanced secretion of cathepsin B.

Bladder cancer is one of the most common causes of death in industrialized countries. New tumor markers and therapeutic approaches are still needed to improve the management of bladder cancer patients. Choline kinase-alpha (ChoKalpha) is a metabolic enzyme that has a role in cell proliferation and transformation. Inhibitors of ChoKalpha show antitumoral activity and are expected to be introduced soon in clinical trials. This study aims to assess whether ChoKalpha plays a role in the aggressiveness of bladder tumors and constitutes a new approach for bladder cancer treatment. We show here that ChoKalpha is constitutively altered in human bladder tumor cells. Furthermore, in vivo murine models, including an orthotopic model to mimic as much as possible the physiological conditions, revealed that increased levels of ChoKalpha potentiate both tumor formation (P< or =0.0001) and aggressiveness of the disease on different end points (P=0.011). Accordingly, increased levels of ChoKalpha significantly reduce survival of mice with bladder cancer (P=0.05). Finally, treatment with a ChoKalpha-specific inhibitor resulted in a significant inhibition of tumor growth (P=0.02) and in a relevant increase in survival (P=0.03).

Recent advances in information and communication technology allow the design and testing of new models of diabetes management, which are able to provide assistance to patients regardless of their distance from the health care providers. The M2DM project, funded by the European Commission, has the specific aim to investigate the potential of novel telemedicine services in diabetes management. A multi-access system based on the integration of Web access, telephone access through interactive voice response systems, and the use of palmtops and smart modems for data downloading has been implemented. The system is based on a technological platform that allows a tight integration between the access modalities through a middle layer called the multi-access organizer. Particular attention has been devoted to the design of the evaluation scheme for the system: A randomized controlled study has been defined, with clinical, organizational, economic, usability, and users' satisfaction outcomes. The evaluation of the system started in January 2002. The system is currently used by 67 patients and seven health care providers in five medical centers across Europe. After 6 months of usage of the system no major technical problems have been encountered, and the majority of patients are using the Web and data downloading modalities with a satisfactory frequency. From a clinical viewpoint, the hemoglobin A1c (HbA1c) of both active patients and controls decreased, and the variance of HbA1c in active patients is significantly lower than the control ones. The M2DM system allows for the implementation of an easy-to-use, user-tailored telemedicine system for diabetes management. The first clinical results are encouraging and seem to substantiate the hypothesis of its clinical effectiveness.

Resumen Estudio realizado sobre 17 pacientes que presentaban edema postraumatico no agudo de tobillo y pie. El objetivo es determinar la reduccion de volumen de edema que se obtiene tras la aplicacion de una sola sesion protocolizada de fisioterapia. La terapia consistio en masaje de derivacion circulatoria, movilizaciones activas y ejercicios de derivacion. La variacion del edema se mide mediante el analisis del volumen del agua desplazada, inmediatamente, antes y despues del tratamiento. Los resultados muestran una mejoria media de 2,2 cc, aunque a nivel estadistico, la reduccion no resulta significativa (p = 0,08).

In the context of the EU funded Telematic Management of Insulin-Dependent Diabetes Mellitus (T-IDDM) project, we have designed, developed and evaluated a telemedicine system for insulin dependent diabetic patients management. The system relies on the integration of two modules, a Patient Unit (PU) and a Medical Unit (MU), able to communicate over the Internet and the Public Switched Telephone Network. Using the PU, patients are allowed to automatically download their monitoring data from the blood glucose monitoring device, and to send them to the hospital data-base; moreover, they are supported in their every day self monitoring activity. The MU provides physicians with a set of tools for data visualization, data analysis and decision support, and allows them to send messages and/or therapeutic advice to the patients. The T-IDDM service has been evaluated through the application of a formal methodology, and has been used by European patients and physicians for about 18 months. The results obtained during the project demonstration, even if obtained on a pilot study of 12 subjects, show the feasibility of the T-IDDM telemedicine service, and seem to substantiate the hypothesis that the use of the system could present an advantage in the management of insulin dependent diabetic patients, by improving communications and, potentially, clinical outcomes.

This paper presents a service for the anonymisation of electronic health care record (EHR) extracts for secondary use based on the ISO/EN 13606 norm. The sending of clinical data for secondary use, in accordance with current legislation, must be carried out using anonymised data. The ISO/EN 13606 standard has characteristics which favour the development of an anonymisation service, thanks to a design that separates clinical information from demographic information and allows a semantic interoperability to be achieved in the exchange of information. The developed system, based on ISO/EN 13606, consists of two modules: demographic server and an anonymising module. El demographic server is able to work independently, while the anonymising module must always work with an associated demographic server. The anonymisation is the process through which it is no longer possible to establish the link between the data and the subject to whom it refers. The demographic server is responsible for the permanent storage of the demographic entities. The anonymising module is responsible for eliminating everything linked to the demographic data of a given extract. The anonymisation process consists of four phases: storage of the demographic information included in the extract, substitution of identifiers, elimination of the demographic information of the extract and final validation. The anonymising system has been integrated into Telemedicine projects with favourable results. The sending of anonymised data for a secondary use allows the generation of large clinical databases from which knowledge can be deduced using data-mining techniques.