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[Resumen] Objetivo. Valorar en individuos con lesión medular traumática (LMT) la relación entre la mortalidad y la necesidad de UCI y las alteraciones objetivadas mediante resonancia magnética (RM) precoz, analizando alteraciones parenquimatosas, disrupción de ligamentos vertebrales (DLV) y compresión del cordón medular (CCM). Diseño. Estudio retrospectivo. Ámbito. Hospital de tercer nivel, unidad de lesionados medulares y UCI. Pacientes. Individuos con LMT aguda entre los años 2010 y 2019. Intervenciones. Análisis de RM realizada en las primeras 72 horas. Variables de interés. Ingreso en UCI y mortalidad. Resultados. Recogidos 269 casos. El patrón que se asoció a una mayor mortalidad fue la hemorragia (16,7%) por 12,5% de los edemas a un nivel y 6,5% de los edemas a múltiples niveles (p = 0,125). Lo mismo aconteció con los ingresos en UCI: 69,0% en hemorragia por 60,2% en edema múltiple y 46,3% en edemas cortos (p = 0,018). Con respecto a la CCM, la mortalidad fue del 13,4% con 59,2% de ingresos en UCI por 2,2% y 42,2% de quienes no presentaban compresión (p = 0,020 y p = 0,003). Las cifras de éxitus e ingreso en UCI en los individuos con DLV fueron del 15,0% y el 67,3%, respectivamente, por un 6,2% y 44,4% de los individuos sin DLV (p < 0,001 y p = 0,013). Conclusiones. La presencia de hemorragia medular, CCM y DLV se asoció a una mayor necesidad de UCI. Existe un significativo aumento de la mortalidad en los casos con CCM y DLV. [Abstract] Objective. To assess in individuals with traumatic spinal cord injury (TSCI) the relationship between mortality and need for ICU and early magnetic resonance imaging (MRI), analyzing spinal parenchymal alterations, disruption of vertebral ligaments (DVL) and spinal cord compression (SCC). Design. Retrospective study. Setting. Third-level hospital, Spinal Cord Injury Unit and ICU. Patients. Individuals with acute TSCI between 2010 and 2019. Intervention. Analysis of MRI performed in the first 72 h. Variables of interest. Admission to ICU and mortality. Results. 269 cases collected. The pattern that demonstrated higher mortality was cord hemorrhage (16.7%) for 12.5% of single-level edema and 6.5% of multilevel edema (p = 0.125). The same happened with ICU admissions: 69.0% in hemorrhage, 60.2% in multilevel edema and 46.3% in short edema (p = 0.018). Analyzing CCM, mortality was 13.4% with 59.2% of ICU admissions, for 2.2% and 42.2% of individuals without cord compression (p = 0.020 and p = 0.003). The figures of death and ICU admission among cord injuries with DVL were 15.0% and 67.3%, for 6.2% and 44.4% of the individuals without DLV (p < 0.001 and p = 0.013). Conclusions. The presence of spinal cord hemorrhage, SCC and DVL was associated with a higher admission in ICU. A significant increase in mortality was observed in cases with SCC and DVL.

Resumen: Objetivo: Determinar el impacto de una intervención educativa en el nivel de conocimientos de los profesores sobre el asma y su manejo. Material y método: Estudio cuasiexperimental, de tipo antes y después, con grupo control, de una intervención educativa (IE) dirigida a mejorar el grado de conocimientos sobre el asma infantil y su manejo en profesores de centros escolares de San Sebastián (Gipuzkoa). Se utilizó como elemento de medida el cuestionario de conocimientos Newcastle Asthma Knowledge Questionnaire (NAKQ) y como intervención educativa, una adaptación del programa Asma, Deporte y Salud. Se utilizó el test de los rangos con signo de Wilcoxon para comparar la puntuación total en el cuestionario antes y después de la intervención, el test de McNemar para comparar el porcentaje de respuestas correctas a cada ítem y el test U de Mann-Whitney para la comparación en la puntuación basal y a los 3 meses entre el grupo de intervención y el grupo control. Se estudiaron el tamaño del efecto y la respuesta media estandarizada. Resultados: Participaron 138 docentes de 6 centros elegidos aleatoriamente (grupo estudio) y 43 en el grupo control. En el grupo estudiado la puntuación media del cuestionario de conocimientos de asma NAKQ antes de la realización de la intervención educativa fue de 16,1 ± 3,4 puntos, con una mediana de 16 (rango 7-23). Tras la intervención educativa, la puntuación ascendió a 22,3 ± 4,1 con una mediana de 23 (rango 6-29), siendo la diferencia media en la puntuación global de conocimientos de 7,0 ± 4,2 puntos, con una mediana de 8 (rango –2; 17), tamaño del efecto de 2,0(> 0,8) siendo la respuesta media estandarizada de 1,7. A los 3 meses de la intervención, la puntuación media del cuestionario fue de 21,4 ± 3,0 puntos, con una mediana de 22 (rango 12-29), significativamente superior al momento previo a la intervención (p 0.8) and the standardised mean response was 1.7. After 3 months of the intervention the mean score of the NAKQ was 21.4 ± 3.0 points, with a median of 22 (range, 12 to 29) which was significantly higher than the score obtained before the intervention (P

Objetivo: Determinar si la velocidad de antígeno prostático específico (PSAV) se relaciona con los hallazgos histopatológicos de la pieza, la supervivencia libre de recidiva bioquímica (SLRB), la supervivencia cáncer-relacionada (SCR) y la supervivencia global (SG). Material y métodos: Estudio observacional de cohorte retrospectivo y prospectivo formado por 265 pacientes con cáncer de próstata a los que se practicó prostatectomía radical (PR) entre 2000-2008. La PSAV fue calculada de forma aritmética y mediante regresión lineal, utilizando valores de antígeno prostático específico del año previo al diagnóstico. Se realizó un análisis multivariado de regresión logística para detectar variables asociadas a enfermedad extracapsular (EEC). Las variables asociadas a SLRB, SCR y SG fueron estudiadas mediante análisis de Kaplan-Meier (PSAV3ng/ml/año) y multivariado de regresión de Cox. La capacidad de PSAV para predecir SLRB, SCR y SG fue determinada mediante c-index. Resultados: La mediana de seguimiento fue 56,16 meses (9,14-106,75). La mediana de PSAV fue 0,65 y 0,63ng/ml/año con los métodos aritmético y de regresión, respectivamente. Se detectó EEC en 74 casos (27,92%) y recidiva bioquímica en 50 (18,87%). Se observó mortalidad cáncer-relacionada en 4 pacientes (1,52%) y mortalidad global en 16 (6,08%). En el análisis multivariado, la PSAV no se relacionó con EEC, asociándose de forma independiente con la SLRB (RR: 1,06; IC 95%: 1,02-1,13; p:=0,008), SCR (RR: 1,22; IC 95%: 1,00-1,50; p=0,048) y SG (RR: 1,35; IC 95%: 1,18-1,55; p3ng/mL/year) and a multivariate Cox regression analysis. The ability of PSA velociy to predict BRFS, CRS, and OS was evaluated by c-index. Results: Median follow-up was 56.16 months (9.14-106.75). Median PSAV was 0.65 and 0.63ng/ml/year using the arithmetic and regression methods respectively. ECD was detected in 74 specimens (27.92%), and biochemical recurrence in 50 patients (18.87%). Cancer-related mortality was seen in 4 patients (1.52%) and overall mortality in 16 (6.08%). In the multivariate analysis, PSAV was not related to ECD. PSAV was an independent predictor for BRFS (RR: 1.06, 95% CI: 1.02-1.13, p=0.008), CRS (RR: 1.22, 95% CI: 1.00-1.50, p=0.048), and OS (RR: 1.35, 95% CI: 1.18-1.55, p

ObjectiveTo estimate the prevalence of the metabolic syndrome (MS) in a population of patients with overweight and obesity of the A Coruña and Granada health areas, using the definitions of the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (ATP III) and of the International Diabetes Federation (IDF).Patients and methodsDuring a period extending from 1996 to 2003, only those patients attending endocrinology outpatient clinics for whom all the anthropometric and biochemical parameters used to define the MS, both according to the ATP IIII and the IDF, were available were selected. The final study sample consisted of 285 patients, 198 females (69.5%) and 87 males (30.5%).ResultsThe prevalence of the MS was 29.8% when the ATP III definition was applied, and 41.1% according to the IDF criteria. Prevalence by sex was 32.2% in men and 28.8% in women according to the ATP III, and 42.5% and 40.4%, respectively, according to the IDF.ConclusionsIn a patient population with overweight or obesity, the prevalence of the MS is higher when the IDF criteria, instead of the ATP III criteria, are used. These findings may have significant implications when it comes to addressing early diagnosis of cardiovascular disease and diabetes mellitus in these patients, in order to perform therapeutic measures at the initial stages and thereby reduce metabolic and cardiovascular complications.

Patients with metabolic syndrome (MS) have above-average risk of developing atherosclerosis and cardiovascular disease. Inflammation plays a key role in the development of atherosclerosis. High levels of the acute phase reactants C-reactive protein (CRP) and ferritin have been reported to correlate with various components of MS. The serum CRP, ferritin, glucose, insulin, triglycerides, HDL-cholesterol and total cholesterol concentrations of 598 obese or overweight patients were determined, together with relevant anthropometric parameters. Insulin resistance was evaluated by the HOMA method. MS was diagnosed using the ATP III criteria. CRP levels were higher among patients with central obesity than in those without (5.8 vs 3.9 mg/l; P=0.003), and higher among those with fasting plasma glucose concentrations ⩾110 mg/dl than in those with lower concentrations (7.4 vs 4.1 mg/l; P=0.01). Serum ferritin levels were higher among patients with triglyceride concentrations ⩾150 mg/dl than in those with lower levels (76.8 vs 40.1 ng/ml; P

ObjetivoDescribir las características de los procesos de incapacidad temporal (IT), su duración y los factores determinantes en la población activa asegurada de un centro de salud.DiseñoEstudio observacional de prevalencia, descriptivo.EmplazamientoCentro de salud de Ribadeo (Lugo).ParticipantesSe incluyó el total de partes de baja de IT registrados durante el período 2000-2002 (n = 1.714).Mediciones principalesSe recogieron la edad de cada paciente, el sexo, la duración de la IT, el núcleo de residencia (rural/urbano), la actividad económica (según CNAE-93), el régimen de la seguridad social y la causa de la incapacidad (según CIE-9).ResultadosLa tasa de IT fue de 14,79 por 100 personas-año. La media de edad fue de 40,13 ± 12,08 años y 936 (54,6%) procesos correspondieron a varones. Un 85,7% de las bajas se debió a enfermedades comunes, un 12,2% a accidentes no laborales y un 2,1% a accidentes laborales. Los principales grupos de enfermedades asociadas fueron las enfermedades del sistema osteomuscular (25,7%), del aparato respiratorio (16,4%) y los traumatismos (16,2%). El total de episodios supuso la pérdida de 114.355 jornadas laborales. La media de días perdidos por trabajador fue de 99,79 ± 136,37. La media de días perdidos por episodio fue de 66,72 ± 98,79. Según los resultados del análisis multivariable, los episodios de IT de mayor duración se asociaron a pacientes de mayor edad, mujeres y a los regímenes de autónomos o empleados del hogar. Las bajas más largas fueron las causadas por tumores y trastornos mentales.ConclusionesLa edad, el sexo, la profesión y la enfermedad son variables relacionadas con los procesos de IT.ObjectiveTo describe short-term time off work procedures, its duration and the determining factors in an active population covered by health insurance at a health centre.DesignDescriptive and observational study of prevalence.SettingRibadeo Health Centre, Lugo, Spain.ParticipantsAll sickness certificates issued in 2000-2002 were included (n=1714).Main measurementsThe age and sex of each patient, amount of time off, place of residence (rural/urban), job (according to CNAE-93), type of social security cover, and cause of illness (according to CIE-9) were all recorded.ResultsThe short-term time off rate ran at 14.79 per 100 persons a year. Mean age was 40.13 (SD, 12.08); 936 (54.6%) were male. 85.7% of time-off periods were due to chronic illness, 12.2% to accidents not at work and 2.1% to accidents at work. Main associated pathologies were bone and muscular problems (25.7%), respiratory system problems (16.4%), and traumatisms (16.2%). All episodes accounted for the loss of 114 355 working days. Mean days lost per worker were 99.79 (SD, 136.37). Mean days lost per episode were 66.72 (SD, 98.79). Multivariate analysis showed that longer episodes were associated with older patients, women and the self-employed or workers at home. The longest periods off work were caused by cancer and mental disorders.ConclusionsAge, sex, job, and pathology are variables related to short-term time off work.

An established method for the cryopreservation of human femoral arteries for subsequent transplantation as allografts has been studied with particular attention to preservation of smooth muscle and endothelium. Human femoral arteries (HFAs) were harvested from multi-organ donors. Two groups were established; a control group of unfrozen HFAs and a group of cryopreserved HFAs. Cryopreservation was performed using RPMI solution containing dimethyl sulfoxide and the rate of cooling was 1 degrees C/min to -40 degrees C and faster thereafter until -150 degrees C was reached. The contraction and relaxation responses of unfrozen and frozen/thawed arteries were assessed by measurement of the isometric force generated by the HFAs in an organ bath. After thawing (warming was at 15 degrees C/min) the maximal contractile response to noradrenaline was 43% of the response of unfrozen HFAs. The endothelium-independent response to sodium nitroprusside was not altered, whereas the endothelium-dependent relaxation response to acetylcholine was slightly altered. The cryopreservation method used provided limited preservation of the contractility of human femoral arteries, and good preservation of both endothelium-independent and endothelium-dependent relaxation responses.

We evaluated the impact of standard cryopreservation on functional properties of human aortic homografts. From seven human donors, the thoracic descending aorta was obtained. Effects of cryopreservation on contractibility and endothelium function were tested. After cryopreservation no endothelium-dependent or endothelium-independent relaxation was found and the contractibility was strongly affected. Arteries showed no function and loss of endothelial integrity after cryopreservation and thawing.

An established method for cryopreservation that might preserve the vascular and endothelial responses of human femoral arteries (HFAs) to be transplanted as allografts was studied. HFAs were harvested from multiorgan donors and stored at 4 degrees C in saline solution before cryostorage. Thirty HFA rings were isolated and randomly assigned to one control group of unfrozen HFAs (eight rings) and one group of cryopreserved HFAs (22 rings). Cryopreservation was performed in RPMI solution containing dimethylsulfoxide (DMSO) and the rate of cooling was -1 degrees C/min until -40 degrees C and faster rates until -150 degrees C was reached. The contractile and relaxant responses of unfrozen and frozen/thawed arteries were assessed in organ bath by measurement of isometric force generated by the HFAs. After thawing, the maximal contractile responses to the contracting agonist tested (noradrenaline) were in the range of 43% of the responses in unfrozen HFAs. The endothelium-independent responses to sodium nitroprusside were not altered whereas the endothelium-dependent relaxant responses to acetylcholine were weakly altered. The cryopreservation method used provided a limited preservation of contractility of HFAs, a good preservation of the endothelium-independent relaxant responses, and a good preservation of endothelium-dependent relaxation. It is possible that further refinements of the cryopreservation protocol, such as a slower rate of cooling and a more controlled stepwise addition of DMSO, might allow better post-thaw functional recovery.

Resumen Objetivos Analizar las consecuencias del protocolo de congelacion y del metodo de almacenamiento utilizado sobre la actividad funcional, la estructura anatomo-patologica y el grado de apoptosis de las aortas abdominales de cerdo criopreserva-das durante seis meses, tras la descongelacion. Materiales y metodos Se obtuvieron injertos arteriales de cerdos y cada aorta se dividio en dos fragmentos. Grupo 1: segmentos en fresco o bien fijados en formaldehido tras la toma de la muestra (grupo control). Grupo 2: segmentos fijados tras incubacion antibiotica y criopreservacion durante seis meses para un estudio anatomopatologico y de apoptosis, o bien utilizados directamente tras su descongelacion para un estudio funcional. La incubacion antibiotica se realizo en medio de un cultivo RPMI suplementado con antibioticos. Despues de la incubacion antibiotica, la criopreservacion se llevo a cabo en medio RPMI con 10% de dimetilsul-foxido (DMSO). La tasa de enfriamiento fue de 1 °C/min, y el posterior almacenamiento se realizo en fase gaseosa. Resultados No hay diferencia en cuanto al grado de apoptosis en los dos grupos, ni diferencias significativas en el grado de fragmentacion de las elasticas (algo mayor en el grupo 2). Se observa un aumento tanto del grado de despegamiento como del desprendimiento endotelial en el grupo congelado con respecto al grupo control. Despues de la descongelacion, las maximas respuestas a los vasoconstrictores probados (KCl y noradrenalina) fueron del 13 y el 24% de las respuestas de las aortas que se obtuvieron en fresco. Las respuestas relajantes independientes del endotelio al nitroprusiato sodico estaban reducidas y se produjo una importante reduccion de las respuestas de relajacion dependientes del endotelio a la acetilcolina. Conclusiones El metodo de criopreservacion que se empleo disminuyo las respuestas de contraccion y relajacion a los seis meses y produjo cambios morfologicos importantes en cuanto a la conservacion del endotelio y de las elasticas, pero no altero el grado de apoptosis.

Several in vitro studies have demonstrated diminished post-thaw functional activity. Therefore, the aim of this study was to investigate the consequences of thawing and storage method used on the post-thaw functional activity of cryopreserved pig aortas with the aim of adjusting the freezing and thawing protocol so that the vascular segments are preserved in the best possible state, maintaining structure and functionality so that they can later be transplanted with success. In vitro responses of frozen, thawed pig aortas were used to investigate the functional activity after thawing at 15 degrees C and 100 degrees C/min and after storage in gas or liquid phase of liquid nitrogen. Cryopreservation was performed in RPMI 1640 medium + 10% dimethylsulfoxide and the rate of cooling was -1 degrees C/min, until -150 degrees C was reached. After thawing the maximal contractile responses to all the contracting agonists tested (KCl, noradrenaline) were in the ranges of 13-27% compared with the responses in unfrozen pig aortas. Contractile responses were slightly better when thawing was performed at 15 degrees C/min compared with 100 degrees C/min. The endothelium independent relaxant responses to sodium nitroprusside were reduced ( P0.05). Cryostorage of pig arteries also resulted in a loss of the endothelium-dependent relaxant response to acetylcholine. The cryopreservation method used provided a limited preservation of pig aorta contractibility, a reduction of the endothelium independent relaxant responses, and no apparent preservation of the endothelium-dependent relaxation. It is possible that further refinements of the cryopreservation protocol might allow better post-thaw functional recovery of pig aortas.

Background. Increased awareness of the limitations of current cardiac valve substitutes has generated a renewed interest in the use of allograft valves. The effects of currently used preservation techniques on the viability of the valve leaflets and the longevity of the implantation however remain controversial. The objective of this study is to analyze the influence of ischemic time, sterilization methods with or without fungicides, and storage procedures on the viability of the valve leaflets and on the histologic structure of the arterial wall, valve leaflet, and myocardium. Methods. The tissue sources were hearts from 40 pigs with 1 hour of warm ischemic time. The aortic and pulmonary valves were dissected after 2 or 24 hours of cold ischemic time. They were stored in antibiotic solution for 20 hours at 4°C with or without an antifungal agent. The samples were cryopreserved using a programed temperature decrease method. After 1 week of storage in a liquid nitrogen tank, either in a gas or a liquid phase, the cardiac valves were slowly thawed and examined. Results. Pulmonary valves showed greater viability than aortic valves. Decreased cellular viability was observed independent of cold ischemic time, treatment with amphotericin B, or the storage method used. Treatment with or without amphotericin B had no influence on cellular viability. Conversely it was observed that there was greater cellular viability among those valves stored in a liquid phase. As far as the histologic structure of the valve is concerned we did not observe any influence either in the treatment with amphotericin B or the storage method used although it was observed that reduction of the cold ischemic time minimized histologic injury. Conclusions. Optimization of preservation methods may decrease the negative effects of cryopreservation on cell viability and histologic structure of the valve.

Resumen Introduccion La creciente demanda de injertos vasculares ha provocado una busqueda continua del metodo ‘ideal’ para minimizar los danos vasculares durante el proceso de conservacion. Objetivo Estudiar la repercusion sobre la histologia arterial del proceso de preservacion del tejido en sus distintas fases. Pacientes y metodos Hemos analizado 86 segmentos arteriales (iliaca y femoral superficial) procedentes de 50 donantes. De cada segmento se obtuvieron tres muestras en distintas fases del proceso, y se establecieron otros tantos grupos de estudio: arterias frescas, postisquemia fria y poscrio-preservacion. El tiempo maximo de isquemia fria fue de 20 horas y las muestras se mantuvieron en solucion antibiotica a 4 °C. La criopreservacion se realizo en una solucion con dimetil sulfoxido (DMSO) con descenso termico programado de 1 °C/min con almacenamiento en fase gas (–150 °C a –190 °C). Se valoraron parametros como la preservacion del endotelio, la intensidad de cambios degenerativos (degeneracion mixoide, apoptosis) en la pared arterial y la presencia de fracturas, comparando los resultados entre los distintos grupos. Se estudiaron igualmente las causas que llevaron al fracaso de algunos injertos. Resultados El 81,4% de las arterias criopreservadas mostro una perdida practicamente total del endotelio (3,5% en los otros dos grupos) y mas del 50%, importantes cambios degenerativos en su pared frente al 3,5 y 8,1% de los grupos 1 y 2. Conclusiones El proceso de criopreservacion provoca una importante perdida endotelial y cambios degenerativos en la pared arterial. El tiempo de isquemia fria que se empleo en nuestro estudio no tiene repercusion en la estructura arterial.

To determine whether early graft function after transplantation impacted graft and patient survivals.Between 1981 and 2008, we performed 1308 renal transplantations. Poor early graft function was defined as a Cockroft-Gault glomerular filtration rate60 mL/min or less at 1 and 3 months posttransplant. Patients who lost their kidney or died within the first 12 months after transplantation were excluded from the study. Multivariate statistical analysis used Cox proportional hazards models.Of the 1308 patients 994 (78.8%) displayed poor early graft function at 1 month after transplantation (glomerular filtration rate60 mL/min), while 268 (21.2%) showed normal function (glomerular filtration rate≥60 mL/min). The 2- and 6-year graft survival rates among the poor early graft function group were 96.8% and 85.8%, respectively, while those among the control group were 97.0% and 88.3%, respectively. The 2- and 6-year patient survival rates in the poor early graft function were 98.5% and 89.8% versus 98.9% and 96.3% in the control group. Similar results were observed at 3 months posttransplant. Controlling for patient age, donor age, HLA-AB and -DR mismatches, cold ischemia time, acute rejection episodes, cyclosporine therapy, and waiting time for transplantation, we did not observe early graft function to be a risk factor for graft survival or patient survival. Glomerular filtration rate at 2, 5, and 6 years after kidney transplantation was significantly lower in the poor early graft function than in the control group.This study suggested that the quality of early graft function had no significant effect on graft and patient survival rate, but did have a significant influence on long-term renal function.

Our objective was to measure the impact of an educational intervention program on teacher's knowledge about asthma and its management.Before and after quasi-experimental study, with control group, of an educational intervention, which had as its aim to improve the teacher's knowledge of asthma and its management, was conducted in some schools of San Sebastian (Gipuzkoa), Spain. The Newcastle Asthma knowledge Questionnaire (NAKQ) was used as a measuring tool, and an adaptation of the asthma, sport and health program was used as an educational intervention. The Wilcoxon signed rank test was used to compare the total score of the questionnaire before and after the intervention, and the McNemar test was performed to compare the percentages of correct answers to each item. The Mann-Whitney U test was also performed to compare the baseline score and the score at three months between the intervention group and control group. The size of the effect and the standardised mean response were studied.A total of 138 teachers from 6 schools, which were chosen at random (study group), and 43 teachers in the control group participated in the study. In the study group, the mean score of the NAKQ before the educational intervention was 16.1±3.4 points, with a median of 16 (range 7 to 23). After the intervention the mean score increased to 22.3±4.1, with a median of 23 (range, 6 to 29). The mean difference in the overall score of the NAKQ was 7.0±4.2 points, with a median of 8 (range, -2 to17). Furthermore, the size of the effect was 2.0 (0.8) and the standardised mean response was 1.7. After 3 months of the intervention the mean score of the NAKQ was 21.4±3.0 points, with a median of 22 (range, 12 to 29) which was significantly higher than the score obtained before the intervention (P.001) and slightly lower than the score obtained immediately after the intervention, assuming a size of the effect of 1.6 and a standardised mean response of 1.2. In the control group, the level of knowledge did not change modified and was lower than the level of the intervention group (P.001).An educational intervention program conducted among teachers significantly increases their knowledge of asthma. Moreover, the increase reduces slightly but maintains its higher level for at least 3 months. In spite of the fact that some aspects of knowledge improved with the educational intervention, they were not optimal.

To assess whether PSA velocity (PSV) is related to pathological findings in surgical specimen, biochemical recurrence-free survival (BRFS), cancer-related survival (CRS), and overall survival (OS).A retrospective and prospective observational cohort study on 265 patients with prostate cancer (PCa) who underwent radical prostatectomy (RP) from 2000 to 2008. PSAV was calculated arithmetically and by linear regression analysis, using PSA values in the year prior to diagnosis. A multivariate logistic regression analysis was performed to detect variables associated to extracapsular disease (ECD). Variables related to BRFS, CRS, and OS were analyzed using Kaplan-Meier methodology (PSAVor=3 vs.3 ng/mL/year) and a multivariate Cox regression analysis. The ability of PSA velociy to predict BRFS, CRS, and OS was evaluated by c-index.Median follow-up was 56.16 months (9.14-106.75). Median PSAV was 0.65 and 0.63 ng/ml/year using the arithmetic and regression methods respectively. ECD was detected in 74 specimens (27.92%), and biochemical recurrence in 50 patients (18.87%). Cancer-related mortality was seen in 4 patients (1.52%) and overall mortality in 16 (6.08%). In the multivariate analysis, PSAV was not related to ECD. PSAV was an independent predictor for BRFS (RR: 1.06, 95% CI: 1.02-1.13, p=0.008), CRS (RR: 1.22, 95% CI: 1.00-1.50, p=0.048), and OS (RR: 1.35, 95% CI: 1.18-1.55, p0.001) in the multivariate Cox regression analysis.PSAV is a preoperative parameter that predicts for BFRS, CRS, and OS in patients undergoing RP. No association was found between PSA velocity and presence of ECD.

Resumen Objetivo Determinar si la velocidad de antigeno prostatico especifico (PSAV) se relaciona con los hallazgos histopatologicos de la pieza, la supervivencia libre de recidiva bioquimica (SLRB), la supervivencia cancer-relacionada (SCR) y la supervivencia global (SG). Material y metodos Estudio observacional de cohorte retrospectivo y prospectivo formado por 265 pacientes con cancer de prostata a los que se practico prostatectomia radical (PR) entre 2000–2008. La PSAV fue calculada de forma aritmetica y mediante regresion lineal, utilizando valores de antigeno prostatico especifico del ano previo al diagnostico. Se realizo un analisis multivariado de regresion logistica para detectar variables asociadas a enfermedad extracapsular (EEC). Las variables asociadas a SLRB, SCR y SG fueron estudiadas mediante analisis de Kaplan-Meier (PSAV≤3 vs. >3 ng/ml/ano) y multivariado de regresion de Cox. La capacidad de PSAV para predecir SLRB, SCR y SG fue determinada mediante c-index. Resultados La mediana de seguimiento fue 56,16 meses (9,14–106,75). La mediana de PSAV fue 0,65 y 0,63 ng/ml/ano con los metodos aritmetico y de regresion, respectivamente. Se detecto EEC en 74 casos (27,92%) y recidiva bioquimica en 50 (18,87%). Se observo mortalidad cancer-relacionada en 4 pacientes (1,52%) y mortalidad global en 16 (6,08%). En el analisis multivariado, la PSAV no se relaciono con EEC, asociandose de forma independiente con la SLRB (RR: 1,06; IC 95%: 1,02–1,13; p:=0,008), SCR (RR: 1,22; IC 95%: 1,00–1,50; p=0,048) y SG (RR: 1,35; IC 95%: 1,18–1,55; p Conclusiones La PSAV es una variable preoperatoria que predice SLRB, SCR y SG en los pacientes tratados mediante PR. No se observa asociacion entre PSAV y la presencia de EEC.

Introduction The aims of this study were to quantify the incidence of cardiovascular events and identify the clinical relevance of modifiable variables. Materials and Methods The 1729 patients who underwent renal transplantation from 1981 to 2004 were evaluated in an observational, prospective follow-up study with no exclusions. A cardiovascular event was defined as the presence of ischemic cardiac disease (chest pain-myocardial infarction), cardiac insufficiency, arrhythmia (auricular fibrillation), peripheral vascular disease, or cerebrovascular accident. A survival analysis was performed using the Kaplan-Meier method. A Cox regression analysis was applied. Having identified the predictive variables of cardiovascular events, the population attributable fraction (PAF) and the etiological fraction (EF) were estimated. A risk score was calculated using Cox regression coefficients. Results The accumulated incidence of cardiovascular events was 22.2%, with an incidence rate of 468.6 × 10,000 follow-up years. From the Cox regression model, the variables with an independent effect close to statistical significance to predict cardiovascular events were as follows: recipient age (RR = 1.05), smoking at the time of the transplantation (RR = 2.1), left ventricle hypertrophy during follow-up (RR = 2.4), prior diabetes mellitus, and obesity (body mass index ≥30). At the time of transplantation, 41.7% were smokers. During follow-up, a clear difference was observed in the incidence rates of cardiovascular events between smokers and nonsmokers. Similar phenomena were observed for left ventricle hypertrophy and obesity. The resulting scores ranged between 0 and 5. The area under the ROC curve of the score for the prediction of cardiovascular events was 0.74. Conclusion The incidence of cardiovascular events was consistent with the literature. A series of modifiable variables of major clinical relevance exist to decrease the frequency of cardiovascular events following renal transplantation.

To analyse the influence of cold ischemic time (CIT) (2-24 h) and of cryopreservation (liquid phase) on the viability of the valvular fibroblasts and in the presence of apoptosis. Cardiac valves from 10 pigs were evaluated by anatomo-pathological study of the wall, muscle and leaflet. At the same time, the presence of cellular death due to apoptosis was investigated in two ways; directly on tissue by Apodetec system and by two-colour flow cytometry assay analyzing a suspension of fibroblast from valve leaflets using Anexina V and propidium iodure (PI). We established three groups of samples to compare different experimental conditions: 2 h of ischemia (group 1), 24 h of ischemia (group 2), and a programme of cryopreservation (-1 degrees C/min) after 2 h of ischemia, followed by storage in liquid nitrogen during a week and thawing was performed (group 3). The analysis of viabilities showed slight differences between all three groups. The results indicated CIT of 24 h undergoing more structural affectation than CIT of 2 h. Flow cytometry analysis did not show important differences between groups; however cryopreserved samples (group 3) slightly less viability and a higher percentage of death by apoptosis than group 1 and 2 using flow cytometry. Apoptosis was confirmed on tissue from all valves but mainly in samples of group 2 and group 3. In summary, the viability of the valves in the case of ischemic times of 2 h, 24 h or after cryopreservation/thawing differs slightly. The death of the cells is mainly mediated by necrosis and not by apoptosis.

To determine whether the development of an artificial neural network (ANN) made up of clinical variables allows for the prediction of prostate biopsy (PB) outcome.Patients (n=953) underwent PB at the Arquitecto Marcide Hospital in Ferrol (Spain), between january 2000 and june 2005. The variables studied were age, PSA, digital rectal examination (DRE) and prostate volume, data for all of which were available in 843 cases. In order to determine factors related to prostate cancer (PC) diagnosis, a logistic regression analysis and a feed-forward neural network were developed, including three hidden layer nodes and an output node, representing the probability of PC. Both models were constructed from a random sample of n=643 patients (derivation set). The predictive capacity was assessed with the remaining 200 patients (validation set), by means of ROC curves and the area under the curve (AUC).PC was detected in 500 (59.3%) cases. Adjusting for age, PSA, digital rectal examination and prostate volume, in a multivariate logistic regression model it was observed that all the variables were independent predictors of PC. The AUC were 0.693 for PSA, 0.707 for prostate volume, 0.815 for logistic regression and 0.819 for ANN. The predictive capacity of the ANN was significantly higher than that of the PSA (p=0.002) and prostate volume (p0,001) and similar to that of logistic regression (p=0.760).The ANN shows a PC prediction capacity that is significantly higher than unimodal diagnosis methods, and similar to that of logistic regression.

The analysis of the survival of patients diagnosed with gastricadenocarcinoma and the factors which modify prognosis.Retrospective cohort study of overall patients diagnosed with gastric adenocarcinoma treated in the Xeral-Calde and Juan Canelejo hospitals of Lugo and La Coruña (Spain) between 1975 and 1993. The following variables were studied: age, sex, the year of diagnosis, place of residence, delayed diagnosis, localisation of the primitive tumour, the TNM classification, the Laurén histological type and the type of surgical resection when conducted. The Kaplan-Meier statistical method was employed to determine the probability of survival. Cox regression was used to determine prognosis factors.The diagnosis was established on 2,334 patients: 63,2% were males;the average overall age was 66.5 (11,9 SD) years, the median delayed diagnostic was 3,19 months, the lower third was the most common localisation (46,3%), 30,2% of the cases were diagnosed in the IV stage, and curative surgery was conducted in 46,4% of the cases. The probability of survival for overall numbers was 26% and curative surgery, was conducted in 45% of cases. The most advanced states in the TNM classification and the absence of curative surgery were factors associated with the poorest prognosis.Survival after gastric cancer is low. Initial stage and radical surgical treatment are the main factors for prognosis.

Two methods of donor management were analysed, namely, with and without in situ cooling perfusion of the kidney in an attempt to determine the optimal management and preservation methods for asystolic kidney donors. The group of recipients of in situ cooling perfusion kidneys showed more days of oliguria (P