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El presente estudio tiene como objetivo analizar los motivos para practicar AF de los estudiantes universitarios en el contexto ecuatoriano, determinar las diferencias en función del sexo y la compatibilización estudio-trabajo, establecer la asociación entre los motivos para practicar AF y estimar el valor predictor del sexo, la edad y la compatibilización estudio-trabajo sobre los motivos para realizar AF. La muestra estuvo compuesta por 1412 estudiantes universitarios (21.2 ± 3.5 años), 513 hombres (36.3%) y 899 mujeres (63.7%). El instrumento utilizado para la recolección de los datos fue el Cuestionario de Contenido de los Objetivos en el Ejercicio. Para el análisis de resultados se empleó la prueba U de Mann-Whitney, el coeficiente de correlación de Spearman y un análisis de regresión lineal. Los principales hallazgos demuestran que hay diferencias estadísticamente significativas entre hombres y mujeres en los motivos de afiliación social, dirección de la salud, reconocimiento social y desarrollo de la habilidad. También, se observan diferencias estadísticas entre las mujeres que compatibilizan o no el estudio y el trabajo en los motivos de afiliación social, reconocimiento social y desarrollo de la habilidad. Por otro lado, se identifica que la principal motivación para realizar AF está direccionada a la salud, mientras que el motivo que menos incentiva la práctica de AF es el reconocimiento social. Por último, en el análisis de regresión el sexo presenta un valor predictor significativo en los motivos analizados. Por lo cual, se ponen de manifiesto los intereses de los estudiantes ecuatorianos y se obtiene información clave para mejorar e incrementar los niveles y la adherencia a la AF con el fin de contribuir a una vida físicamente más activa en la población universitaria. Palabras clave: motivos, actividad física, universitarios, motivación, Ecuador Abstract. The aim of the present study was to analyze the reasons for practicing PA among university students in the Ecuadorian context, determine the differences according to sex and work-study compatibility, establish the association between the reasons for practicing PA, and estimate the predictive value of sex, age, and work-study compatibility on the reasons for practicing PA. The sample consisted of 1412 university students (21.2 ± 3.5 years), 513 men (36.3%) and 899 women (63.7%). The instrument used for data collection was the Goals in Exercise Content Questionnaire. The Mann-Whitney U test, Spearman's correlation coefficient and a linear regression analysis were used to analyze the results. The main findings show that there are statistically significant differences between men and women in the reasons of social affiliation, health direction, social recognition and skill development. Also, statistical differences are observed between women who do or do not combine study and work in the reasons of social affiliation, social recognition and skill development. On the other hand, the main motivation for PA is health, while the motive that least encourages the practice of PA is social recognition. Finally, in the regression analysis, sex presented a significant predictive value in the motives analyzed. Therefore, the interests of Ecuadorian students are revealed, and key information is obtained to improve and increase the levels and adherence to PA in order to contribute to a more physically active life in the university population. Keywords: Reasons, physical activity, university students, motivation, Ecuador

Abstract Introduction Papillary renal cell carcinoma (pRCC) is the second most common histology of renal cell carcinoma (RCC), accounting for 10–15% of cases. Traditionally, pRCC is divided into type 1 and type 2, although this division is currently debated as a prognostic factor of survival. Our aim was to investigate the epidemiology and survival of the pRCC subtypes in a whole nation cohort of patients during a 50-year period. Materials and methods A Population based retrospective study including consecutive cases of RCC in Iceland from 1971–2020. Comparisons were made between histological classifications of RCC, with emphasis on pRCC subtypes (type 1 vs. 2) for outcome estimation. Changes in RCC incidence were analyzed in 5-year intervals after age standardization. The Kaplan–Meier method and Cox regression were used for outcome analysis. Results A total of 1.725 cases were identified, with 74.4%, 2.1% and 9.2% having clear cell (ccRCC), chromophobe (chRCC), and pRCC, respectively. The age standardized incidence (ASI) of pRCC was 1.97/100.000 for males and 0.5/100.000 for females, and the proportion of pRCC increased from 3.7% to 11.5% between the first and last intervals of the study (p

The Social and Solidarity Economy (SSE) is a unique economic model that addresses contemporary community problems by democratising the economy through activities that promote sustainability, solidarity, and collective prosperity. Research on the SSE has increased in recent years, showing its potential as an alternative to dominant economic schemes. This article aims to analyse how the SSE can contribute to sustainability in rural sector associations in Ecuador through the Participatory Action Research (PAR) method. This method empowers various stakeholders, including the community, associations, and the university, to be actively involved in designing, developing, and implementing solutions to alleviate their problems. The results show that in the context of a developing country, this active participation, interaction, and commitment can identify the various problems that the rural sector and its associations are experiencing. This situation allows for possible joint action solutions, involving people who usually do not have decision-making power or are vulnerable, by diagnosing their socio-economic conditions and establishing a training programme where knowledge production is democratic, thus combining theoretical and practical elements according to the needs detected.

Abstract Introduction Non-infectious sternal dehiscence (NISD) is a known complication following coronary artery bypass grafting (CABG), with previous studies estimating an incidence of 0.4–1% of surgeries. We aimed to study the incidence of NISD together with short- and long-term outcomes in a whole-nation cohort of patients. Materials and methods A retrospective study on consecutive CABG patients diagnosed with NISD at Landspitali from 2001 to 2020. Patients diagnosed with infectious mediastinitis (n = 20) were excluded. NISD patients were compared to patients with an intact sternum regarding patient demographics, cardiovascular risk factors, intra- and postoperative data, and estimated overall survival. The median follow-up was 9.5 years. Results Twenty out of 2280 eligible patients (0.88%) developed NISD, and the incidence did not change over the study period (p = 0.98). The median time of diagnosis was 12 days postoperatively (range, 4–240). All patients were re-operated using a Robicsek-rewiring technique, with two cases requiring a titanium plate for fixation. Patients with NISD were older, had a higher BMI and EuroSCORE II, lower LVEF, and more often had a history of COPD, MI, and diabetes compared to those without NISD. Length of stay was extended by 15 days for NISD patients, but short and long-term survival was not statistically different between the groups. Conclusions The incidence of NISD was low and in line with previous studies. Although the length of hospital stay was extended, both short- and long-term survival of NISD patients was not significantly different from patients with an intact sternum.

La existencia del desplazamiento forzado como consecuencia del conflicto armado interno en Colombia, es una constante en casi todas sus regiones, pero este escrito se concentrará en una consecuencia, la inclusión laboral en el departamento de Sucre-Colombia, por tanto, pretende analizar los determinantes de inclusión laboral de la población víctima del desplazamiento forzado por la violencia en el departamento de Sucre para los años 2011 y 2016. La investigación es de tipo deductiva con un enfoque descriptivo y cuantitativo, con estimaciones de modelos Logit y Probit, utilizando como fuente de información datos de la Encuesta Nacional de Calidad de Vida para los años referidos con resultados no concluyentes, en referencia de evidenciar una desventaja en participación, empleabilidad y rentabilidad de la población desplazada en el departamento de Sucre, Colombia.

Fired bricks are on high demand in building constructions because of their cheapness, appearance, robustness, isolation achievement and sustainability. To make fired bricks, Constructions and eco-friendly sector used clay materials. However, the major challenge in their utilization is their thermal and mechanical behavior after exposure. Problems occur mainly when permanently subjected to increased temperature which severely influence its durability, and in this case an overall failure mode calculation is essential. In this work a simple approach based on the Unified Strength Theory (UST) criterion was used to estimate the thermomechanical damage. Results of thermomechanical damage values are shown.

On the rise request for long-lasting materials, clay materials are in between the well-nigh minerals exploited by production and ecological fields in the making of fired bricks. Clay incessantly expounded to high temperature reacts differently at ambient temperature which critically touches its longevity.In present study, a coupled thermo-mechanical damage model of clay is established. In this model, the Unified Strength Theory (UST) criterion is used as the failure criterion based on the Weibull distribution and the continuous damage theory. The proposed model is validated by uniaxial compression experiment of high-temperature clay. The variation of the two distribution factors (m and W0) in the combined TM damage relationship with temperature is analysed. The results show that the damage evolvement speed of the clay shows a curving form getting closed to one as the temperature rises, indicating that the temperature can delay the development of cumulative damage. The damage fundamental modelling discussed is in accord with the testings curves at the various phases of yielding and pre-apex force. This study leads to an enhanced understanding of high temperature clay mechanics and affords the fundament to heighten clay bricks resourcefulness lastingness.

Humankind experience in the world corresponds to the appropriation of its external environment and to its own self-conformation. The link of human collectives with what is called “atmospheric phenomena” in Occidental society is mainly expressed as climatic and meteorologic knowledge. In this article, this is examined through the analysis of the inscribed knowledge concerning the deity called Tláloc which was produced by the pre-Cortesian people from Anáhuac and through the study of the episteme that may have supported it. To inquire into the atmospheric knowledge inscribed in the deity and gain a glimpse into the atmospheric experience of pre-Cortesian people as well as their later epistemic and cognitive conquest and destruction by Spanish conquerors, we have selected a set of ancient iconographic inscriptions of Tláloc as our central object of study. The text begins with an interpretative framework of Tláloc’s pre-Cortesian images; then, we demonstrate the heterogenous constitution of an intellectual device clustered around Tláloc, the deified expression of its atmospheric and human capacities, and its posterior desacralization and dehumanization by Spanish conquerors; we conclude with a reflection on the study of the inscribed knowledge produced by the peoples of ancient Mexico.

Ischaemic Hepatitis (IH) or Hypoxic Hepatitis (HH) also known as centrilobular liver cell necrosis is an acute liver injury characterized by a rapid increase in serum aminotransferase. The liver injury typically results from different underlying medical conditions such as cardiac failure, respiratory failure and septic shock in which the liver becomes damaged due to deprivation of either blood or oxygen. IH is a potentially lethal condition that is often preventable if diagnosed timely. The role of mechanisms that cause IH is often not well understood, making it difficult to diagnose or accurately quantify the patterns of related biomarkers. In most patients, currently, the only way to determine a case of IH is to rule out all other possible conditions for liver injuries. A better understanding of the liver's response to IH is necessary to aid in its diagnosis, measurement, and improve outcomes. The goal of this study is to identify mechanisms that can alter associated biomarkers for reducing the density of damaged hepatocytes, and thus reduce the chances of IH. We develop a mathematical model capturing dynamics of hepatocytes in the liver through the rise and fall of associated liver enzymes aspartate transaminase (AST), alanine transaminase (ALT) and lactate dehydrogenase (LDH) related to the condition of IH. The model analysis provides a novel approach to predict the level of biomarkers given variations in the systemic oxygen in the body. Using IH patient data in the US, novel model parameters are described and then estimated for the first time to capture real-time dynamics of hepatocytes in the presence and absence of IH condition. The results may allow physicians to estimate the extent of liver damage in an IH patient based on their enzyme levels and receive faster treatment on a real-time basis.

Se presenta en el documento una crítica a los modelos IS – LM y de Solow, El modelo IS – LM tiene como sustento la epistemología Keynesiana, el cual considera el argumento de que a mayor gasto público el nivel de crecimiento económico de un país aumenta, argumento rebatido por la Escuela Austriaca. Con relación al modelo de Solow, se critica la utilización de una función microeconómica para explicar fenómenos macroeconómicos mucho más complejos. Además de su utilidad para analizar y comprender no sólo la era industrial, sino la era del conocimiento; sin dejar de lado su aplicación para el caso de países desarrollados, y no necesariamente para aquellos en vías de desarrollo.

Históricamente el grado de intervención del Estado en los asuntos económicos depende de la estructura, del modelo vigente y del interés del mismo en ser agente activo o pasivo de las actividades económicas. Para el caso concreto de la articulación de los sectores agropecuario e industrial para definir el sistema Agroindustrial el Estado pasó de un alto nivel de intervención a una mínima expresión, destacándose el modelo proteccionista a través de la Industrialización por Sustitución de Importaciones hasta finales de la década de los años ochenta, adoptando a partir de los noventa un proceso de apertura económica que generó cambios en el sector agropecuario dadas las medidas arancelarias y las políticas comerciales impuestas a lo largo de los periodos de gobiernos liberales.

La valoración de bienes ambientales es un frente de desarrollo en investigación aplicada en economía. En este caso se valora la disponibilidad a pagar de los visitantes de la cuenca del rio Cali – Colombia a partir del método de costo del viaje con la contrastación econométrica de frecuencia multinomial ordenada. En ese sentido, se tiene en cuenta la importancia de la fauna silvestre local y su afectación por la frecuencia de las visitas. Se abordará en este estudio la valoración económica ambiental, definición metodológica, como también una descripción de las variables relevantes para valoración de la cuenca y estimación definiendo la forma funcional más adecuada. Se llega a la conclusión que existe una disponibilidad a pagar por uso de los habitantes de actividades recreativas de US 53 dólares, lo cual infiere que la cuenca presenta uso y valor monetarios para sus usuarios.

Control of the 2002–2003 severe acute respiratory syndrome (SARS) outbreak was based on rapid diagnosis coupled with effective patient isolation. We used uncertainty and sensitivity analysis of the basic reproductive number R0 to assess the role that model parameters play in outbreak control. The transmission rate and isolation effectiveness have the largest fractional effect on R0. We estimated the distribution of the reproductive number R0 under perfect isolation conditions. The distribution lies in the interquartile range 0.19–1.08, with a median of 0.49. Even though the median of R0 is 1, even with perfect isolation. This implies the need to simultaneously apply more than one method of control.

Background: Large-sized clinical trials have failed to show an overall benefit of surgery over medical treatment in managing spontaneous intracerebral hemorrhages (ICH); less invasive techniques have shown to decrease brain injury caused by surgical manipulation in the standard open approach improving the clinical outcomes of patients. Thereby, we propose a low-cost 3D-printed endoport for a less invasive ICH evacuation. In this study, the authors compare the clinical outcomes of early surgical evacuation using a 3D-printed endoport vs. a standard open surgery (OS)., Methods: A retrospective analysis was conducted comparing patients who underwent early evacuation of a deep hypertensive ICH through an endoport vs. OS at a single center from August 2017 to March 2019. Demographic, clinical, and radiologic data were reviewed. The primary outcomes were the 90-day post-stroke functional outcome and mortality., Results: A total of 36 patients were included. The two cohorts (18 endoport; 18 OS) showed no statistically significant differences in demographic, clinical, and radiologic characteristics, including median admission hemorrhage volume, Glasgow Coma Scale, and ICH scores. At 90-day post-stroke, 44% of patients in the endoport group and 17% in the OS group had a favorable functional outcome (mRS 0-3) ( p = 0.039); moreover, the endoport group showed lower mortality (33% vs. 72%, p = 0.019)., Conclusions: This study suggests that an endoport-assisted ICH evacuation may have better functional outcomes and lower mortality than OS. The proposed device could provide a safe, low-cost alternative for ICH's surgical treatment. More rigorous research is hence needed to assess the potential benefits of this technique.

A family of dioxidovanadium(V) complexes (1-4) of the type [Na(H 2 O) x ] + [V V O 2 (HL 1-4 )] - (x = 4, 4.5 and 7) where HL 2- represents the dianionic form of 2-hydroxybenzoylhydrazone of 2-hydroxyacetophenone (H 2 L 1 , complex 1), 2-hydroxy-5-methylacetophenone (H 2 L 2 , complex 2), 2-hydroxy-5-methoxyacetophenone (H 2 L 3 , complex 3) and 2-hydroxy-5-chloroacetophenone (H 2 L 4 , complex 4), have been synthesized and characterized by analytical and spectral methods. These complexes exhibited the potential abilities to suppress the erythrocytes carbonic anhydrase enzymatic activity in type 1 and type 2 diabetic patients (in vitro), promising antidiabetic activity against T2 diabetic mice (in vivo). They also exhibited significant cytotoxic activity against cervical cancer (SiHa) cells (in vitro) as the IC 50 value of complexes 1, 2 and 4 is substantially lower than the value found for cisplatin while that of 3 is comparable and follow the order: 4 < 1 < 2 < 3 and can kill the cells by apoptosis via the generation of reactive oxygen species (ROS). The complexes are soluble both in water and octanol media and also non-toxic at working concentrations. The antidiabetic activity of these four complexes follows the order: 4 > 2 > 1 > 3 while both the carbonic anhydrase and cytotoxic activity follow the order: 4 > 1 > 2 > 3 suggesting that complex 4, containing electron withdrawing Cl atom is the most reactive while 3 with electron donating OCH 3 group is the least reactive species. The molecular docking study on hCA-I and hCA-II demonstrates that complexes interact via hydrogen bonding as well as different types of π-stacking., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Introduction: Grading dysphagia is crucial for clinical management of patients. The Eckardt score (ES) is the most commonly used for this purpose. We aimed to compare the ES with the recently developed Brief Esophageal Dysphagia Questionnaire (BEDQ) in terms of their correlation and discriminative capacity for clinical and manometric findings and evaluate the effect of gastroesophageal reflux symptoms on both., Methods: Symptomatic patients referred for high-resolution manometry (HRM) were prospectively recruited from seven centers in Spain and Latin America. Clinical data and several scores (ES, BEDQ, GERDQ) were collected and contrasted to HRM findings. Standard statistical analysis was performed., Key Results: 426 patients were recruited, 31.2% and 41.5% being referred exclusively for dysphagia and GERD symptoms, respectively. Both BEDQ and ES were independently associated with achalasia. Only BEDQ was independently associated with being referred for dysphagia and with relevant HRM findings. ROC curve analysis for achalasia diagnosis showed AUC of 0.809 for BEDQ and 0.765 for ES, with the main difference being higher BEDQ sensitivity (80.0% vs 70.8% for ES). GERDQ independently predicted ES but not BEDQ. In the absence of dysphagia (BEDQ = 0), GERD symptoms significantly determine ES., Conclusions and Inferences: Our study suggests both the BEDQ and ES can complementarily describe symptomatic burden in achalasia. BEDQ has several advantages over the ES in the dysphagia evaluation, basically due to its higher sensitivity for manometric diagnosis and independence of GERD symptoms. ES should be used as an achalasia-specific metric, while BEDQ is a better symptom-generic evaluating tool., (© 2021 John Wiley & Sons Ltd.)

Background: Stroke is a worldwide leading cause of mortality and disability, and there are substantial economic costs for poststroke care. Disadvantaged populations show increased incidence, severity, and unfavorable outcomes. This study aimed to report the survival, functional outcome, and caregiver satisfaction of low-income patients diagnosed with a large hemispheric infarction (LHI) who underwent decompressive craniectomy (DC)., Methods: A retrospective analysis was conducted in consecutive adult patients with an LHI who underwent DC at a single center between October 2015 and September 2019. Demographic, clinical, and radiologic data were reviewed. The primary outcomes were 1-year survival and favorable functional outcome., Results: Forty-nine patients were included; those <60 years of age showed a higher proportion of favorable functional outcomes (76% vs. 33%; P = 0.031) but similar survival (52% vs. 56%; P = 0.645) than older patients, respectively. Performing the craniectomy in <48 hours from stroke onset compared with ≥48 hours showed no statistically significant differences in survival (59% vs. 46%; P = 0.352) and favorable functional outcomes (56% vs. 70%; P = 0.683), respectively. In retrospective thinking, 79% of caregivers would decide to perform the surgery again., Conclusions: Age group and time from stroke onset to craniectomy were not associated with survival; notwithstanding, a higher proportion of patients <60 years of age were associated with a favorable functional outcome compared with older patients. Additionally, if given the option, most caregivers would decide to perform the surgery again, independently of the grade of disability of the patient., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction: This case report illustrates a new variant in the anterior cerebral artery complex, identified during carotid angioplasty., Clinical Case: A 50-year-old male patient diagnosed with left carotid stenosis was diagnosed and treated by a cerebral angiography. During the procedure, crossed circulation in the anterior cerebral artery was identified. The presence of this variation demanded to discard distal emboli or artery dissection. Angioplasty was performed and the patient followed up without neurological deficit., Discussion: Among the most possible and prevalent variations in anterior circulation, none of them explain the phenomenon we observed. Therefore, a new variant is established. The knowledge about variants in cerebral circulation is important to rule out pathology., Conclusion: Cerebral diagnostic angiography has become more available and frequent because of the rising in endovascular tools to treat stroke patients. Considering this new variation and others is important to discard pathology., (© 2021. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

A novel mathematical procedure to codify chiral features of organic molecules in the QuBiLS-MIDAS framework is introduced. This procedure constitutes a generalization to that commonly used to date, where the values 1 and -1 (correction factor) are employed to weight the molecular vectors when each atom is labelled as R (rectus) or S (sinister) according to the Cahn-Ingold-Prelog rules. Therefore, values in the range [Formula: see text] with steps equal to 0.25 may be accounted for. The atoms labelled R or S can have negative and positive values assigned (e.g. -3 for an R atom and 1 for an S atom, or vice versa), opposed values (e.g. -3 for an R atom and 3 for an S atom, or vice versa), positive values (e.g. 3 for an R atom and 1 for an S atom) or negative values (e.g. -3 for an R atom and -1 for an S atom). These proposed Chiral QuBiLS-MIDAS 3D-MDs are real numbers, non-symmetric and reduced to 'classical' (non-chiral) QuBiLS-MIDAS 3D-MDs when symmetry is not codified (correction factor equal to zero). In this report, only the factors with opposed values were considered with the purpose of demonstrating the feasibility of this proposal. From QSAR modelling carried out on four chemical datasets (Cramer's steroids, fenoterol stereoisomer derivatives, N-alkylated 3-(3-hydroxyphenyl)-piperidines, and perindoprilat stereoisomers), it was demonstrated that the use of several correction factors contributes to the building of models with greater robustness and predictive ability than those reported in the literature, as well as with respect to the models exclusively developed with QuBiLS-MIDAS 3D-MDs based on the factor 1 | -1. In conclusion, it can be stated that this novel strategy constitutes a suitable alternative to computed chirality-based descriptors, contributing to the development of good models to predict properties depending on symmetry.

Idiopathic achalasia is a severe motility disorder of the esophagus and is characterized by a failure of the lower esophageal sphincter to relax due to a loss of neurons in the myenteric plexus. Most recently, we identified an eight-amino-acid insertion in the cytoplasmic tail of HLA-DQβ1 as strong achalasia risk factor in a sample set from Central Europe, Italy and Spain. Here, we tested whether the HLA-DQβ1 insertion also confers achalasia risk in the Polish and Swedish population. We could replicate the initial findings and the insertion shows strong achalasia association in both samples (Poland P=1.84 × 10(-04), Sweden P=7.44 × 10(-05)). Combining all five European data sets - Central Europe, Italy, Spain, Poland and Sweden - the insertion is achalasia associated with Pcombined=1.67 × 10(-35). In addition, we observe that the frequency of the insertion shows a geospatial north-south gradient. The insertion is less common in northern (around 6-7% in patients and 2% in controls from Sweden and Poland) compared with southern Europeans (~16% in patients and 8% in controls from Italy) and shows a stronger attributable risk in the southern European population. Our study provides evidence that the prevalence of achalasia may differ between populations.

Animal models of cerebral ischemia have typically been established and performed using young animals, even though cerebral ischemia (CI) affects primarily elderly patients. This situation represents a discrepancy that complicates the translation of novel therapeutic strategies for CI. Models of transient global CI using aged animals have demonstrated an apparent neuroprotective effect on CA1 hippocampal neurons; however, this effect is not completely understood. Our study used a model in which young (3-6 months) and aged (18-21 months) male Wistar rats were subjected to 15 min of transient global CI using the four-vessel occlusion (4 VO) model. We determined that the 4 VO model can be performed on aged rats with a slight increase in mortality rate. In aged rats, the morphological damage was completely established by the 4th day after reperfusion, displaying no difference from their younger counterparts. These results demonstrated the lack of a neuroprotective effect of aging on CA1 hippocampal neurons in aged male Wistar rats. This study determined and characterized the morphological damage to the CA1 area after 15 min of 4 VO in aged male Wistar rats, validating the use of this model in CI and aging research.

Idiopathic achalasia is characterized by a failure of the lower esophageal sphincter to relax due to a loss of neurons in the myenteric plexus. This ultimately leads to massive dilatation and an irreversibly impaired megaesophagus. We performed a genetic association study in 1,068 achalasia cases and 4,242 controls and fine-mapped a strong MHC association signal by imputing classical HLA haplotypes and amino acid polymorphisms. An eight-residue insertion at position 227-234 in the cytoplasmic tail of HLA-DQβ1 (encoded by HLA-DQB1*05:03 and HLA-DQB1*06:01) confers the strongest risk for achalasia (P=1.73×10(-19)). In addition, two amino acid substitutions in the extracellular domain of HLA-DQα1 at position 41 (lysine encoded by HLA-DQA1*01:03; P=5.60×10(-10)) and of HLA-DQβ1 at position 45 (glutamic acid encoded by HLA-DQB1*03:01 and HLA-DQB1*03:04; P=1.20×10(-9)) independently confer achalasia risk. Our study implies that immune-mediated processes are involved in the pathophysiology of achalasia.

The number of patients with spine conditions has grown exponentially in recent years leading to an increase in the number of cases requiring surgical treatment. Currently vertebral fusion surgery with a transpedicular approach represents the most commonly used technique to treat any type of vertebral disorder. The morphometric characteristics of vertebrae, particularly the pedicle, determine the size of pedicular implants, including width and length, as well as the shape and direction of the screw and its ideal angulation at the time of introduction. Knowing these characteristics is important to prevent injuring important adjacent structures and to decrease the postoperative complication rate. In recent decades numerous studies on the morphometric characteristics of the vertebral pedicle have been conducted in different populations to determine its real dimensions by means of direct measurement and imaging methods. These studies have concluded that there are significant differences in these measurements among the different ethnic groups, races, genders, ages and the vertebral regions studied. This paper analyzes the different morphometric studies of the pedicle and all the other vertebral elements studied in Mexico and the rest of the world and explain the importance of their knowledge and surgical application for the correct development of vertebral fusion surgery with a transpedicular approach.

A functional polymorphism (rs6554199) located in the c-kit gene was associated with achalasia in a Turkish cohort. Our aim was to replicate this result in a large cohort of Spanish patients and controls. A case-control study was performed with 282 Spanish white unrelated patients and 687 healthy controls. All were genotyped for SNP rs6554199 using a TaqMan Assay. No association was found in our study (T allele frequency in patients and controls: 47.3% vs. 49.4%; OR=0.92, p=0.41). The finding that the T allele of the c-kit rs6554199 polymorphism could be associated with achalasia as reported in a Turkish population could not be replicated in a Spanish cohort. Although ethnic differences might explain these data, the sample size that compromised the statistical power in the Turkish cohort and is higher in our study, led us to suggest that the reported association seems to be a false positive., (Copyright © 2012 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.)

Background: Cardiac resynchronization therapy (CRT) reduces morbidity and mortality and improves symptoms in patients with systolic heart failure (HF) and ventricular dyssynchrony. This randomized, double-blind, controlled study evaluated whether optimizing the interventricular stimulating interval (V-V) to sequentially activate the ventricles is clinically better than simultaneous V-V stimulation during CRT., Methods: Patients with New York Heart Association (NYHA) III or IV HF, meeting both CRT and implantable cardioverter-defibrillator indications, randomly received either simultaneous CRT or CRT with optimized V-V settings for 6 months. Patients also underwent echocardiography-guided atrioventricular delay optimization to maximize left ventricular filling. The V-V optimization involved minimizing the left ventricular septal to posterior wall motion delay during CRT. The primary objective was to demonstrate noninferiority using a clinical composite end point that included mortality, HF hospitalization, NYHA functional class, and patient global assessment. Secondary end points included changes in NYHA classification, 6-minute hall walk distance, quality of life, peak VO(2), and event-free survival., Results: The composite score improved in 75 (64.7%) of 116 simultaneous patients and in 92 (75.4%) of 122 optimized patients (P < .001, for noninferiority). A prespecified test of superiority showed that more optimized patients improved (P = .03). New York Heart Association functional class improved in 58.0% of simultaneous patients versus 75.0% of optimized patients (P = .01). No significant differences in exercise capacity, quality of life, peak VO(2), or HF-related event rate between the 2 groups were observed., Conclusions: These findings demonstrate modest clinical benefit with optimized sequential V-V stimulation during CRT in patients with NYHA class III and IV HF. Optimizing V-V timing may provide an additional tool for increasing the proportion of patients who respond to CRT., (Copyright © 2012 Mosby, Inc. All rights reserved.)

Idiopathic achalasia is an esophageal motor disorder of unknown etiology. A wealth of evidence supports the concept that achalasia is an immune-mediated disease. According to this evidence, achalasia has been significantly associated with specific alleles of the human leukocyte antigen class II, PTPN22 and IL23R. Several studies have demonstrated association of the IL10 gene with different inflammatory disorders. Our aim was to evaluate the role of functional IL10 promoter polymorphisms in susceptibility to idiopathic achalasia. A case-control study was performed with the -1082, -819, and -592 IL10 promoter polymorphisms in 282 patients and 529 controls and in an independent replication set of 75 patients and 575 controls. The GCC haplotype of the IL10 promoter was reported to be associated with a lower risk of achalasia in the discovery sample (odds ratio [OR] = 0.79, 95% confidence interval [CI] = 0.64-0.98, p = 0.029). This association was validated in a replication set (OR = 0.69, 95% CI = 0.48-1.00, p = 0.04). In the combined analysis no heterogeneity was observed between the 2 sample sets and the GCC haplotype was significantly associated with the disease (OR(MH) = 0.76, 95% CI = 0.63-0.91, p = 0.003). Our results provide the first evidence for an association between IL10 promoter polymorphisms and idiopathic achalasia, suggesting that the interleukin-10 cytokine may contribute to the pathogenesis of this disease., (Copyright © 2011 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.)

Background: Idiopathic achalasia is a primary esophageal motor disorder of unknown etiology. Different evidences have been reported in support of achalasia as the result of an autoimmune and inflammatory process leading to neuronal cell loss. According to this, idiopathic achalasia has been significantly associated with specific alleles of the human leukocyte antigen system class II, although few reports studying association with other loci can be found in the literature. Recent studies have shown association of a non-synonymous polymorphism within the IL23R gene with different chronic inflammatory disorders, including Barrett's esophagus. The purpose of this study was to assess whether the IL23R coding variant Arg381Gln polymorphism is involved in susceptibility to idiopathic achalasia., Methods: We performed a case-control study including 262 patients with idiopathic achalasia and 802 healthy subjects, all of them white Spaniards. Achalasia patients were diagnosed on the basis of clinical, radiographic, endoscopic, and manometric criteria. All samples were genotyped for the IL23R Arg381Gln polymorphism using TaqMan technology., Key Results: The minor allele of the Arg381Gln polymorphism was significantly increased in patients compared with healthy controls (OR = 1.46, 95% CI = 1.01-2.11, P = 0.036). This association seems to be specific to male patients with disease onset after 40 years (OR = 2.33, 95% CI = 1.29-4.16, P = 0.002)., Conclusions & Inferences: Our results suggest a role of IL23R in idiopathic achalasia predisposition and extend the evidence of the general influence of this gene in autoimmune and inflammatory diseases.

Background: Numerous criteria believed to define a positive response to cardiac resynchronization therapy have been used in the literature. No study has investigated agreement among these response criteria. We hypothesized that the agreement among the various response criteria would be poor., Methods and Results: A literature search was conducted with the keywords "cardiac resynchronization" and "response." The 50 publications with the most citations were reviewed. After the exclusion of editorials and reviews, 17 different primary response criteria were identified from 26 relevant articles. The agreement among 15 of these 17 response criteria was assessed in 426 patients from the Predictors of Response to Cardiac Resynchronization Therapy (PROSPECT) study with Cohen's kappa-coefficient (2 response criteria were not calculable from PROSPECT data). The overall response rate ranged from 32% to 91% for the 15 response criteria. Ninety-nine percent of patients showed a positive response according to at least 1 of the 15 criteria, whereas 94% were classified as a nonresponder by at least 1 criterion. kappa-Values were calculated for all 105 possible comparisons among the 15 response criteria and classified into standard ranges: Poor agreement (kappa< or =0.4), moderate agreement (0.4 or =0.75). Seventy-five percent of the comparisons showed poor agreement, 21% showed moderate agreement, and only 4% showed strong agreement., Conclusions: The 26 most-cited publications on predicting response to cardiac resynchronization therapy define response using 17 different criteria. Agreement between different methods to define response to cardiac resynchronization therapy is poor 75% of the time and strong only 4% of the time, which severely limits the ability to generalize results over multiple studies.

Background: Doppler tissue imaging (DTI)-based dyssynchrony parameters failed to predict response to cardiac resynchronization therapy (CRT) in the multicenter Predictors of Response to Cardiac Resynchronization Therapy (PROSPECT) trial. Large variability during the interpretation of DTI data was one of several factors thought to contribute to this failure. In this study, the authors hypothesized that using larger regions of interest (ROIs) to generate velocity curves from Doppler tissue images would significantly reduce the variability of DTI dyssynchrony parameters., Methods: The variability of 3 ROI sizes (6 x 6, 18 x 6, and 30 x 6 mm) was compared in 30 patients undergoing CRT. Variability due to manual ROI placement was determined for each ROI size by placing 3 ROIs in each myocardial segment, 6mm apart from one another. Thus, 3 velocity curves were generated for each segment and each ROI size. Four published dyssynchrony parameters were calculated from all permutations of the 3 ROI positions per segment. A mean modified coefficient of variation was calculated for each parameter and ROI size., Results: The 6 x 6 mm ROI had a mean coefficient of variation of 27%. The 18 x 6 and 30 x 6 mm ROIs had significantly lower coefficients of variation (17% and 14%, respectively) than the 6 x 6 mm ROI (P < .01 for both). The 30 x 6 mm ROI also reduced the diagnostic inconsistency of dyssynchrony parameters by 44% (P = .024) compared with the 6 x 6 mm ROI., Conclusion: Using a 30 x 6 mm ROI instead of a 6 x 6 mm ROI to quantify tissue Doppler dyssynchrony reduces variability by 47% and diagnostic inconsistency by 44%. The authors recommend using a 30 x 6 mm ROI in future trials to minimize variability.

Background: Perforation of the esophagus after pneumatic dilation for achalasia is a severe complication which should be treated accurately in order to obtain a successful immediate outcome and a satisfactory result for the underlying condition., Methods: Five consecutive patients presenting with distal esophageal perforation after pneumatic dilation for achalasia were included in this study. All patients had gastrografin swallow performed to confirm the perforation, and one patient was also submitted to flexible esophagoscopy. Laparoscopic approach was performed in all patients with five portals. The phrenoesophageal membrane was opened on its anterior aspect. The distal esophagus was dissected free, and perforations were identified with the help of methylene blue or milk administration through the esophageal tube. All perforations were sutured with interrupted absorbable sutures. Contralateral myotomy and partial anterior Dor fundoplication completed the operation. Endoscopic control of length of myotomy and watertightness of mucosal closure was performed in all cases., Results: There were no intraoperative complications. After surgery all patients were maintained with nil per os until a barium swallow showed no leakage. One patient had a radiologic leakage sustained for 1 week. All patients were dismissed uneventfully. At 6 months after surgery, esophageal manometry was performed. Mean lower esophageal sphincter resting pressure had fallen from 30 to 8.7 mmHg., Conclusions: Laparoscopy offers an excellent approach to treat distal esophageal instrumental perforations, perhaps even better than open surgery. Suture of the perforation, contralateral myotomy and partial anterior fundoplication is a good option in the treatment of perforated achalasia after pneumatic dilation.

Purpose: To develop a method for quantifying left ventricular (LV) internal flow as a measure of dyssynchrony using standard cine cardiac magnetic resonance (CMR) images., Materials and Methods: CMR images were obtained from 10 healthy controls and 10 patients with dyssynchronous heart failure (class III/IV, LV ejection fraction <35%, pattern seen in an electrocardiogram QRS duration > 150 msec). The LV volume was reconstructed and divided into 16 regions. Internal flow was defined as the sum of the regional volume changes minus the global volume change during each time step in the cardiac cycle. Internal flow fraction (IFF) was defined as the total internal flow as a percentage of stroke volume during systole (IFF(systole)), diastole (IFF(diastole)), or the whole cycle (IFF(whole))., Results: IFF(whole) was significantly increased in the patients (9.9 +/- 5.0% vs. 1.5 +/- 0.5% in the controls, P < 0.001). An IFF(whole) threshold of 4% discriminated between patients and controls with 90% sensitivity and 100% specificity. IFF(diastole) (2.3 +/- 0.8%) was greater than IFF(systole) (0.8 +/- 0.5%) in the normal controls (P < 0.001) while the patients had similar IFF(diastole) (7.8 +/- 4.2%) and IFF(systole) (12.0 +/- 7.8%)., Conclusion: Left ventricular internal flow fraction can be quantified from standard CMR images. In this preliminary study, Left ventricular internal flow fraction discriminated patients with dyssynchronous heart failure from normal controls with 95% accuracy., ((c) 2008 Wiley-Liss, Inc.)

Background: Left ventricular dyssynchrony is often diagnosed by comparing velocity curves from Doppler tissue images of two or more myocardial regions. Velocity curves are generated by placing sample volumes or regions of interest (ROIs) within the myocardium. ROIs need to be manually relocated to maintain a midmyocardial location as the heart moves, but are frequently left in a stationary position. The error caused by use of a stationary ROI may affect the diagnosis of dyssynchrony, but this has not been quantified., Objective: We hypothesized that using a stationary ROI to quantify dyssynchrony from Doppler tissue images would affect the diagnosis of dyssynchrony in patients with heart failure., Methods: We quantified dyssynchrony in 18 patients with heart failure using 4 published dyssynchrony parameters: septal-to-lateral delay, maximum difference in the basal 2- or 4-chamber times to peak, SD of the 12 basal and midwall times to peak, and cross-correlation delay (XCD). Each dyssynchrony parameter was measured using both tracked and stationary ROIs., Results: Use of a stationary ROI did not change the diagnosis of dyssynchrony when using XCD. However, ROI tracking changed the diagnosis of dyssynchrony in 17%, 11%, and 17% of patients when using septal-to-lateral delay, maximum difference in the basal 2- or 4-chamber times to peak, and SD of the 12 basal and midwall times to peak, respectively. XCD showed the lowest percent difference between tracked and stationary ROIs (4 +/- 9% vs 22 +/- 53%, 50 +/- 167%, and 12 +/- 30%, respectively, for septal-to-lateral delay, maximum difference in the basal 2- or 4-chamber times to peak, and SD of the 12 basal and midwall times to peak)., Conclusion: Manual ROI tracking is required when using conventional time-to-peak parameters to diagnose dyssynchrony. XCD diagnosis of dyssynchrony can be performed accurately with a stationary ROI.

Background: Quantification of left ventricular dyssynchrony using Doppler tissue imaging may improve selection of patients who will benefit from cardiac resynchronization therapy. Most methods used to quantify dyssynchrony use a time-to-peak analysis, which is quantitatively simplistic and requires manual identification of systole and selection of peak velocities., Methods: We developed and tested a new, highly automatable dyssynchrony parameter, cross-correlation delay (XCD), that does not require identification of systole or manual selection of peak systolic velocities. XCD uses all velocity data points from 3 consecutive beats (approximately 420 points). We tested XCD on 11 members of a positive control group (responders to cardiac resynchronization therapy with a >or=15% reduction in left ventricular end-systolic volume) and 12 members of a negative control group (normal 12-lead electrocardiogram and 2-dimensional echocardiogram findings). We compared XCD to septal-to-lateral delay in time-to-peak (SLD), maximum difference in the basal 2- or 4-chamber times to peak (MaxDiff), and SD of the 12 basal and midwall times-to-peak (Ts-SD)., Results: XCD and Ts-SD were significantly different between the positive and negative control groups (both P

Dynamic kinetic resolution (DKR) of a series of sterically hindered allylic alcohols has been conducted with Candida antarctica lipase B (CALB) and ruthenium catalyst 1. The optically pure allylic acetates obtained were subjected to oxidative cleavage to give the corresponding acylated acyloins in high yields without loss of chiral information.

Objectives: The purpose of this study was to evaluate the safety of implanting a cardiac resynchronization therapy (CRT) system., Background: Clinicians and patients require data on the safety of the CRT implant procedure to estimate procedural risk., Methods: We evaluated outcomes of transvenous CRT system implantation in 2,078 patients from the Multicenter InSync Randomized Clinical Evaluation (MIRACLE) study, the MIRACLE Implantable Cardioverter-Defibrillator (ICD) study, and the InSync III study. We compared the MIRACLE study to the InSync III study and the MIRACLE ICD study randomized phase to its general phase to evaluate the effect of new technologies., Results: The implant attempt succeeded in 1,903 of 2,078 (91.6%) patients. Implant time decreased from 2.7 h in the MIRACLE study to 2.3 h in the InSync III study (p < 0.001), and from 2.8 h in the MIRACLE ICD study randomized phase to 2.4 h in the general phase (p < 0.001). The implant procedure produced 62 perioperative complications in 53 (9.3%) MIRACLE trial patients; 159 in 135 (21.1%) MIRACLE ICD study randomized phase patients and 71 in 62 (13.9%) general phase patients (p < 0.05 vs. randomized); and 41 in 37 (8.8%) InSync III study patients (p = NS vs. the MIRACLE study). We observed 73 postoperative complications in 62 (11.7%) MIRACLE trial patients, 77 in 68 (11.9%) MIRACLE ICD study randomized phase patients and 56 in 45 (11.0%) general phase patients (p = NS), and 37 in 34 (8.6%) InSync III study patients (p = NS). A total of 8% of patients required reoperation to treat lead dislodgement, extracardiac stimulation, or infection during follow-up., Conclusions: Transvenous CRT system implantation appears safe, well-tolerated, has a high success rate, and improves with operator experience and the addition of new technologies.

Objectives: The InSync III study evaluated sequential cardiac resynchronization therapy (CRT) in patients with moderate-to-severe heart failure and prolonged QRS., Background: Simultaneous CRT improves hemodynamic and clinical performance in patients with moderate-to-severe heart failure (HF) and a wide QRS. Recent evidence suggests that sequentially stimulating the ventricles might provide additional benefit., Methods: This multicenter, prospective, nonrandomized, six-month trial enrolled a total of 422 patients to determine the effectiveness of sequential CRT in patients with New York Heart Association (NYHA) functional class III or IV HF and a prolonged QRS. The study evaluated: whether patients receiving sequential CRT for six months experienced improvement in 6-min hall walk (6MHW) distance, NYHA functional class, and quality of life (QoL) over control group patients from the reported Multicenter InSync Randomized Clinical Evaluation (MIRACLE) trial; whether sequential CRT increased stroke volume compared to simultaneous CRT; and whether an increase in stroke volume translated into greater clinical improvements compared to patients receiving simultaneous CRT., Results: InSync III patients experienced greater improvement in 6MHW, NYHA functional class, and QoL at six months compared to control (all p < 0.0001). Optimization of the sequential pacing increased (median 7.3%) stroke volume in 77% of patients. No additional improvement in NYHA functional class or QoL was seen compared to the simultaneous CRT group; however, InSync III patients demonstrated greater exercise capacity., Conclusions: Sequential CRT provided most patients with a modest increase in stroke volume above that achieved during simultaneous CRT. Patients receiving sequential CRT had improved exercise capacity, but no change in functional status or QoL.

Objectives: To determine the potential influence of cardiac resynchronization therapy (CRT) on the frequency and types of ventricular arrhythmia (VA) in patients with an indication for the implantable cardioverter-defibrillator (ICD), we performed a retrospective electrogram (EGM) analysis of stored VA events from the two largest CRT-ICD trials., Background: Previous reports suggest that CRT might promote polymorphic VT (PVT), while a beneficial effect of CRT on ventricular function might reduce the frequency of monomorphic VT (MVT). Theoretically, a balanced effect produces no change in overall VA., Methods: We analyzed stored EGMs from patients in the Contak-CD and Insync-ICD studies receiving appropriate therapy for VA. EGM inspection distinguishes MVT and PVT using morphologic criteria rather than cycle length classification alone., Results: Of 1,041 subjects entering the two trials, 880 were randomized CRT (N = 439) or control (N = 441). We were able to analyze 840 EGMs in 150 patients with VA, including 678 MVT episodes and 162 PVT episodes. These events were distributed among 68 patients with active CRT (390 MVT vs 111 PVT) and 82 patients assigned to control (288 MVT compared to 51 PVT). The apparent increase in PVT episodes in the CRT group is not significant and can be explained by a disproportionate number of episodes in a few patients. We were unable to identify clinical variables predictive of PVT during CRT., Conclusions: CRT is not associated with a measurable increase in the incidence of PVT, or in a reduction in MVT in the combined InSync-ICD and Contak-CD populations.

Cardiac resynchronization therapy (CRT) has been shown to provide symptom relief to many patients who have congestive heart failure (CHF). Still, there are technical concerns with implanting CRT systems, and these range from inadequate venous anatomy to a variety of left ventricular (LV) lead problems. Fortunately, there are several new implant tools to help physicians achieve a stable and adequate LV pacing site. There are a number of guiding catheter shapes to tailor the choice to specific anatomic abnormalities that may be encountered during implants. Key to success was the development of over-the-wire LV leads that are capable of maneuvering within complex venous anatomy. Improvements in LV leads have included increasing lead diameter and bipolar design. In some cases, epicardial LV lead placement may be necessary at surgery. The latest systems have begun to integrate disease management modalities, which hopefully will reduce the need for CHF hospitalizations.

Cardiac resynchronization therapy (CRT) addresses abnormal left ventricular (LV) activation that produces detrimental effects on cardiac systolic and diastolic function. CRT improves symptoms and ventricular performance, promotes reverse remodeling, and decreases mortality and hospitalization in patients with congestive heart failure (CHF). Atrial-synchronized biventricular stimulation reverses many of the temporal delays in mechanical activation associated with LV dysfunction and conduction system disease. The therapy evolved from anecdotal application through surgical implantation of LV pacing leads to transvenous delivery of LV pacing leads for use with dedicated CRT devices. The controlled clinical trials included specific patient groups, and provided data leading to widely adopted indications for the therapy. Current indications exclude the use of CRT in patients with permanent atrial fibrillation, although small series suggest a benefit of the therapy in these patients. The role of cardiac imaging with echocardiography to detect cardiac dyssynchrony promises to improve patient selection by not only excluding likely nonresponders, but also extending the therapy to those with dyssynchrony in the absence of QRS prolongation. Expanded indications under evaluation include the role of CRT in patients with mildly symptomatic CHF, mild to moderate LV dysfunction, dyssynchrony in the absence of QRS prolongation, and dyssynchrony induced by right ventricular pacing.

Cardiac resynchronization therapy (CRT) improves symptoms, exercise performance, ventricular function, and survival in patients with left ventricular dysfunction, prolonged QRS, and drug-refractory moderate to severe CHF. The growing application of CRT has created a large number of patients with complicated devices that need follow-up care from general practitioners, cardiologists, heart failure specialists and electro-physiologists. Optimal care of the CRT patient includes recognition and management of peri-implantation complications, optimal programming of atrio-ventricular and sequential ventricular timing, and troubleshooting device-related problems during long-term follow-up. A basic awareness of fundamental device features, the techniques to maximize the response to CRT, and an understanding of stored device data to track the response to therapy provide clinicians the ability to maximize clinical outcomes in the CHF patient. As evolving technology continues to increase the complexity of device therapies, clinicians must understand these therapies in order to properly treat heart failure patients. This work summarizes many of the issues involving early complications of CRT device implant, the strategies to optimize device function, and suggests a scheme for follow-up care of patients with CRT devices.

Background: Cardiac resynchronization therapy (CRT) is currently indicated in patients with moderate to severe heart failure, a wide QRS complex and significant left ventricular dysfunction despite optimal medical therapy. Adoption of these criteria for CRT results in a favorable response in only two thirds of candidates., Methods: "Predictors of response to cardiac resynchronization therapy (PROSPECT)," a prospective, multicenter, nonrandomized study, aims to identify echocardiographic measures of dyssynchrony and evaluate their ability to predict response to CRT. PROSPECT will enroll approximately 300 patients in up to 75 centers in the United States, Asia, and Europe with clinical follow-up for 6 months. We will prospectively and individually test a variety of conventional echocardiographic and tissue Doppler imaging parameters against measures of clinical response. The primary response criteria are improvement in the heart failure Clinical Composite Score and left ventricular reverse remodeling. Enrollment began in March 2004 and is expected to conclude early 2005.

Cardiac resynchronization therapy (CRT) improves symptoms and functional status in heart failure patients; however, current selection criteria need improvement. A novel tissue Doppler imaging parameter, the peak velocity difference (PVD), defined as the greatest difference in time to peak velocity between any of 6 left ventricular regions, may better select responders to CRT. Subjects were divided into 2 groups based on the PVD. Clinical and echocardiographic parameters significantly improved in subjects with dyssynchrony by the baseline PVD and had a better overall response to CRT.

Objective: To determine the extent and importance of unmet health needs of type 2 diabetic patients seen at primary care services., Material and Methods: A cross-sectional study was conducted in 1999, among rural and urban patients of the Mexican Institute of Social Security, in Nuevo Leon, Mexico. The study population consisted of 256 subjects selected at random, diagnosed with type-II diabetes for at least two years. Data were obtained by interview and complemented with medical charts and provider interviews. Five health areas and four health determinants were evaluated, through Mexican Official Standards and American Diabetes Association standards of medical care for diabetic patients. Analysis consisted of descriptive statistics and estimation of z scores., Results: Health needs were met in 49% of cases. A lower mean of health need satisfaction was found in rural regions as compared to urban regions (36.8% vs. 53.3%, p < .01). Nutrition was the most affected health area (z score = -6), followed by the physical exercise (z score = -1), the metabolic health area (z score = +1), the non-smoking health area (z score = +2), the prevention and early detection of complications health area (z score = +2), and the cognitive health area (z score = +3). The health determinant with the highest requirement corresponded to utilization (z score = -5), followed by resource availability (z score = -4), perceived health need (z score = +4), and access barriers (z score = +6)., Conclusions: Health need measurement allows evaluating the effectiveness of existing interventions, in addition to identifying areas with higher unmet health needs. These findings facilitate analysis and decision-making to devise specific health policies and actions directed at improving the quality of care for diabetic patients. The English version of this paper is available at: http://www.insp.mx/salud/index.html

This study compares LV performance during high right ventricular septal (RVS) and apical (RVA) pacing in patients with LV dysfunction who underwent His-bundle ablation for chronic AF. We inserted a passive fixation pacing electrode into the RVA and an active fixation electrode in the RVS. A dual chamber, rate responsive pulse generator stimulated the RVA through the ventricular port and the RVS via the atrial port. Patients were randomized to initial RVA (VVIR) or RVS (AAIR) pacing for 2 months. The pacing site was reversed during the next 2 months. At the 2 and 4 month follow-up visit, each patient underwent a transthoracic echocardiographical study and a rest/exercise first pass radionuclide ventriculogram. We studied nine men and three women (mean age of 68 +/- 7 years) with congestive heart failure functional Class (NYHA Classification): I (3 patients), II (7 patients), and III (2 patients). The QRS duration was shorter during RVS stimulation (158 +/- 10 vs 170 +/- 11 ms, P < 0.001). Chronic capture threshold and lead impedance did not significantly differ. LV fractional shortening improved during RVS pacing (0.31 +/- 0.05 vs 0.26 +/- 0.07, P < 0.01). RVS activation increased the resting first pass LV ejection fraction (0.51 +/- 0.14 vs 0.43 +/- 0.10, P < 0.01). No significant difference was observed during RVS and RVA pacing in the exercise time (5.6 +/- 3.2 vs 5.4 +/- 3.1, P = 0.6) or the exercise first pass LV ejection fraction (0.58 +/- 0.15 vs 0.55 +/- 0.16, P = 0.2). The relative changes in QRS duration and LV ejection fraction at both pacing sites showed a significant correlation (P < 0.01). We conclude that RVS pacing produces shorter QRS duration and better chronic LV function than RVA pacing in patients with mild to moderate LV dysfunction and chronic AF after His-bundle ablation.

Objective: The purpose of this study was to determine the prevalence of nosocomial infections, associated risk factors, microbiology, use of antibiotics, and associated mortality among hospitalized children., Material and Methods: A 1-day prevalence survey was conducted among 1,183 children hospitalized in a nationwide network of 21 public hospitals caring for children. To attain consistency between hospitals, CDC nosocomial infection definitions were used. Adjusted relative odds of bacteremia were estimated using logistic regression analysis., Results: The prevalence of nosocomial acquired infection was 9.8% (CI 95%, 8.1-11.6). The more prevalent infections were pneumonia (25%), sepsis/bacteremia (19%), and urinary tract infection (5%). The main microorganism isolated in blood cultures drown from patients with nosocomial infection was K. pneumoniae (31%). The prevalence of antibiotics use was 49% with substantial variation between hospitals (range 3-83%). Using logistic regression analysis, four factors were independently associated with the risk of nosocomial infection: central venous catheters (OR 3.3; CI 95% 1.0-5.9), total parenteral nutrition (OR 2.1; CI 95% 1.0-4.5) mechanical ventilation (OR 2.3; CI 95% 1.2-4.1), and low birth weight (OR 2.6; CI 95% 1.0-6.8). The overall mortality was 4.8%; however, patients with nosocomial infection had two times greater risk to die as compared to non-infected children (OR 2.6; CI 95% 1.3-5.1)., Conclusions: This rapid assessment survey using a standard methodology allows to document the prevalence of nosocomial infections in children. The results were used to develop targeted programs on central catheters and mechanical ventilation aimed to reduce bacteremia/sepsis and pneumonia, two nosocomial infections characterized by high prevalence and mortality.