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OBJECTIVE. As health care moves into a new era of increasing information vulnerability, radiologists should understand that they may be using systems that are exposed to altered data or data that contain malicious elements. This article explains the vulnerabilities of DICOM images and discusses requirements to properly secure these images from cyberattacks. CONCLUSION. There is an important need to properly secure DICOM images from attacks and tampering. The solutions described in this article will go a long way to achieving this goal.

Hull soluble polysaccharide (HSPS) is a novel product consisting in a mixture of polysaccharides and proteins extracted from soy hulls by using a methodology based on the extraction of citric pectins. In this work we studied the effect of the addition of two different salts (NaCl and CaCl 2 ) on the emulsifying properties of HSPS at acidic conditions. Low and high homogenization energies were used, obtaining coarse and fine emulsions, respectively. Mean droplet size, the stability against destabilizing processes (creaming, flocculation and coalescence) and the rheological properties of the emulsions were analyzed. Also, the rheology of the O/W interface was studied by using du Noüy ring geometry. Coarse HSPS emulsions were unstable to creaming, being more stable in the presence of salts. In contrast, fine HSPS emulsions showed long-term creaming stability similar to those performed with commercial citric pectin (CCP), although they differ in particle size distribution and flocculation degree. The presence of CaCl 2 reduced the mean size of droplets in fine HSPS emulsions and improved their stability to flocculation and coalescence. Significant differences were observed in the rheological behavior of O/W emulsions and interfaces of HSPS and CCP with respect to the salt addition. Our results indicate that HSPS can be used in the formulation and stabilization of acidic O/W emulsions. Besides, HSPS generates emulsions with different characteristics than those obtained with citric pectins. The use of HSPS provides a suitable alternative in food engineering contributing to the exploitation and valorization of soy hulls, which represents an important waste material in soybean processing., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Study Objective: This trial aimed to compare postoperative analgesia, opioid consumption, duration of ileus and hospital stay, and cytokine levels in patients undergoing laparoscopic cholecystectomies who received intravenous lidocaine in comparison with a control group., Design: Prospective, longitudinal, double-blind, and randomized study., Setting: Operating room and postoperative recovery area., Patients: Forty-four American Society of Anesthesiologists I and II patients older than 17 years, undergoing laparoscopic cholecystectomy, under general anesthesia., Interventions: The first group received intravenous lidocaine during the procedure until 1 hour postoperatively, whereas the second group received saline. Both groups received dipyrone and morphine patient-controlled analgesia., Measurements: Pain was assessed by Visual Numeric Scale at rest and when coughing at different times after the end of the surgery. Blood samples were taken at the end of procedure and 24 hours later. The total morphine patient-controlled analgesia demand, the time for the first flatus, and the length of hospital stay were also recorded., Main Results: Groups were similar in relation to sex (P= .2), age (P= .5), weight (P= .08), and length of surgery (P= .6). No differences were observed regarding the intensity of postoperative pain between the groups, either at rest (P= .76) or when coughing (P= .31), in morphine consumption (P= .9), and in the duration of ileus (P= .5) or length of hospital stay (P= .9). The inflammatory markers interleukin (IL)-1 (P= .02), IL-6 (P< .01), interferon-γ (P< .01), and tumor necrosis factor α (P< .01) showed significant reduction in the lidocaine group against the placebo group, except IL-10 (P= .01), that, because of its anti-inflammatory effects, increased its concentration., Conclusions: Intravenous lidocaine was not able to reduce postoperative pain, opioid consumption, and duration of ileus or length of hospital stay. However, its anti-inflammatory effect was noticeable., (Copyright © 2016 Elsevier Inc. All rights reserved.)

In countries where cervical cancer screening programmes are conducted on an opportunistic basis, an active search for women at risk should be made to increase coverage. The objective of our study was to assess the effectiveness of three primary care interventions consisting of providing written, telephone and face-to-face information to increase screening participation among women over the age of 25 years. A randomized experimental study with only one post-test control group was conducted on women aged 25-70 years. A total of 1676 women were randomly distributed into four groups and the following interventions were implemented: written briefing; telephone briefing; an invitation to attend a group meeting and no briefing (control group). The women were evaluated 2 years after the intervention. The outcome variable was participation or nonparticipation in cervical cancer screening. It proved possible to interview a total of 1122 women. Among the groups, homogeneity was tested in terms of sociodemographic characteristics and health-related variables. Women who had undergone cytological testing in the 2 years preceding evaluation had a lower mean age (P<0.001) than women who had not done so (45.5±11.0 vs. 48.8±13.0 years). The proportion of women who had participated in screening was as follows: 35.3% in the written information group [95% confidence interval (CI) 29.8-40.9]; 38.4% in the telephone information group (95% CI 32.5-44.2); 29.3% in the face-to-face information group (95% CI 22.8-35.7) and 26.1% in the control group (95% CI 21.2-30.9), with this difference proving statistically significant (P=0.005). Logistic regression showed that only the interventions based on written or telephone briefing were effective vis-à-vis the control group. In conclusion, both written and telephone information can serve to improve women's participation in opportunistic cervical cancer screening. Current preventive strategies could be optimized by means of simple interventions within the scope of health professionals.

Urea cycle defects and acute or chronic liver failure are linked to systemic hyperammonemia and often result in cerebral dysfunction and encephalopathy. Although an important role of the liver in ammonia metabolism is widely accepted, the role of ammonia metabolizing pathways in the liver for maintenance of whole-body ammonia homeostasis in vivo remains ill-defined. Here, we show by generation of liver-specific Gln synthetase (GS)-deficient mice that GS in the liver is critically involved in systemic ammonia homeostasis in vivo. Hepatic deletion of GS triggered systemic hyperammonemia, which was associated with cerebral oxidative stress as indicated by increased levels of oxidized RNA and enhanced protein Tyr nitration. Liver-specific GS-deficient mice showed increased locomotion, impaired fear memory, and a slightly reduced life span. In conclusion, the present observations highlight the importance of hepatic GS for maintenance of ammonia homeostasis and establish the liver-specific GS KO mouse as a model with which to study effects of chronic hyperammonemia.

Reports of emerging resistance to first-line artemisinin antimalarials make it critical to define resistance mechanisms and identify in vitro correlates of resistance. Here we combine unique in vitro experimental and analytical approaches to mimic in vivo drug exposure in an effort to provide insight into mechanisms of drug resistance. Tightly synchronized parasites exposed to short drug pulses exhibit large stage-dependent differences in their drug response that correlate with hemoglobin digestion throughout most of the asexual cycle. As a result, ring-stage parasites can exhibit >100-fold lower sensitivity to short drug pulses than trophozoites, although we identify a subpopulation of rings (2-4 h postinvasion) that exhibits hypersensitivity. We find that laboratory strains that show little differences in drug sensitivity in standard in vitro assays exhibit substantial (>95-fold) difference in sensitivity when exposed to short drug pulses. These stage- and strain-dependent differences in drug sensitivity reflect differential response lag times with rings exhibiting lag times of up to 4 h. A simple model that assumes that the parasite experiences a saturable effective drug dose describes the complex dependence of parasite viability on both drug concentration and exposure time and is used to demonstrate that small changes in the parasite's drug response profile can dramatically alter the sensitivity to artemisinins. This work demonstrates that effective resistance can arise from the interplay between the short in vivo half-life of the drug and the stage-specific lag time and provides the framework for understanding the mechanisms of drug action and parasite resistance.

Improvement of quality of life and survival of cancer patients will be greatly enhanced by the development of highly effective drugs to selectively kill malignant cells. Artemisinin and its analogs are naturally occurring antimalarials which have shown potent anticancer activity. In primary cancer cultures and cell lines, their antitumor actions were by inhibiting cancer proliferation, metastasis, and angiogenesis. In xenograft models, exposure to artemisinins substantially reduces tumor volume and progression. However, the rationale for the use of artemisinins in anticancer therapy must be addressed by a greater understanding of the underlying mechanisms involved in their cytotoxic effects. The primary targets for artemisinin and the chemical base for its preferential effects on heterologous tumor cells need yet to be elucidated. The aim of this paper is to provide an overview of the recent advances and new development of this class of drugs as potential anticancer agents.

Combination regimens that include artemisinin derivatives are recommended as first line antimalarials in most countries where malaria is endemic. However, the mechanism of action of artemisinin is not fully understood and the usefulness of this drug class is threatened by reports of decreased parasite sensitivity. We treated Plasmodium falciparum for periods of a few hours to mimic clinical exposure to the short half-life artemisinins. We found that drug treatment retards parasite growth and inhibits uptake of hemoglobin, even at sublethal concentrations. We show that potent artemisinin activity is dependent on hemoglobin digestion by the parasite. Inhibition of hemoglobinase activity with cysteine protease inhibitors, knockout of the cysteine protease falcipain-2 by gene deletion, or direct deprivation of host cell lysate, significantly decreases artemisinin sensitivity. Hemoglobin digestion is also required for artemisinin-induced exacerbation of oxidative stress in the parasite cytoplasm. Arrest of hemoglobin digestion by early stage parasites provides a mechanism for surviving short-term artemisinin exposure. These insights will help in the design of new drugs and new treatment strategies to circumvent drug resistance.

Objective: To improve and adapt training rotation periods following the training program (POE) of the Badajoz Family and Community Medicine (MFyC) Training Unit (UDOCBA)., Design: Mixed qualitative (brainstorming and nominal technical group), and quantitative (cross-sectional descriptive), study in 2006 and 2007., Setting: UDOCBA., Participants: The participants include 50 Residents, 31 accredited tutors, a health technician and a UDOCBA coordinator, as well as 93 MFyC Teaching Units in Spain (UUDD)., Interventions and Measurements: A rotations working group was formed in UDOCBA, which met on two occasions to make substantial modifications to adapt the POE. The first meeting was a brainstorming session, and the second using a nominal technical group, whose results were submitted to an Advisory Committee., Materials: Questionnaire aimed at tutors, analysis of residents self-assessment files, a questionnaire delivered to all the UUDD (via e-mail) and nominal resident groups. Descriptive and bivariate statistics on the variables using the SPSS 15 program., Results: The consensus of the second meeting of the UDOCBA rotations group on evaluating the results obtained with the rest of the tools used, were: to shorten the initial rotation of the C.S. to 5 months, increase the cardiology rotation to 3 months, shorten the rural rotation to 2 months and opt out of the elective 1 month stay in palliatives and radiology., Conclusions: Theoretically well prepared and easily to put into practice. All the consensus results of the UDOCBA were accepted by the Advisory Committee, followed by POE directives. Homogeneity was seen in the UUDD rotations. Unanimity of initial and final rotation by the C.S., and less in rural., (Copyright 2009 Elsevier España, S.L. All rights reserved.)

The lack of compliance with treatment is a public health problem that affects the patient's quality of life, avoids an objective assessment of therapeutic effectiveness and may even cause death. Non compliance can be considered an one-dimensional problem that only depends of patients's responsibility. However, Health Psychology has generated theoretical models that allow the prediction and understanding of therapeutic compliance. It also expands the responsibility to other agents involved in the therapeutic process, specifically health care providers and health systems.

Spinal cord injury is a serious complication of aortic cross-clamping during thoracoabdominal aortic surgery. We report the case of a 59-year-old man whose mycotic pseudoaneurysm in the thoracoabdominal aorta was repaired surgically. Cerebrospinal fluid pressure was monitored and the fluid was drained to protect the spinal cord while the aorta was clamped. A 19-G epidural catheter was inserted into the subarachnoid space using a paramedian approach form L2-L3. The aorta was clamped at the thoracic level in the descending distal portion and at the abdominal level above the kidney, for a period of 61 minutes. A total of 65 ml of cerebrospinal fluid was drained. The early postoperative period was uneventful and tubes were removed 40 hours after surgery. The results of neurological examination were normal. One week later the patient developed a respiratory infection, which was followed by multi-organ failure and died 22 days after the operation. We discuss the case and review the various alternatives available for protecting the spinal cord during surgery on the thoracoabdominal aorta.