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Objetivo El objetivo de la presente revisión fue analizar y comparar la efectividad de distintos tipos de ejercicio terapéutico en personas con dolor crónico del raquis. Método La búsqueda de datos se realizó utilizando la base de datos electrónica MEDLINE. Se incluyeron ensayos clínicos aleatorizados, realizados en pacientes entre 18 y 65 años con dolor crónico en la región del raquis. Resultados Dos revisores independientes realizaron el análisis de la calidad metodológica utilizando la escala PEDro, siendo 13 los artículos finalmente seleccionados. Los diferentes tipos de ejercicio terapéutico tuvieron efectos significativos en la reducción del dolor, disminución de la discapacidad y mejora de la calidad de vida de los pacientes. Conclusiones Los resultados muestran que no hay una modalidad de ejercicio terapéutico superior a otras. La combinación de diferentes modalidades de ejercicio terapéutico podría resultar una herramienta completa para el manejo del dolor crónico en la columna (AU)
Objective The objective of the present review was to analyze and compare the effectiveness of different types of therapeutic exercise in people with chronic spinal pain. Methods Data search was conducted using the electronic database MEDLINE. Randomized clinical trials, conducted in patients between 18 and 65 years old with chronic pain in the spine region, were included. Results Two independent reviewers performed the analysis of methodological quality using the PEDro scale, with 13 studies finally selected. The different types of therapeutic exercise had significant effects on pain reduction, decrease of disability and improvement of the quality of life of the patients. Conclusions The results show that there is no modality of therapeutic exercise superior to others. The combination of different therapeutic exercise modalities could be a complete tool for the management of chronic pain in the spine (AU)
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Humanos , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Terapia por Ejercicio , Dolor de Cuello/terapia , Dolor Crónico/terapia , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
OBJECTIVE: The objective of the present review was to analyze and compare the effectiveness of different types of therapeutic exercise in people with chronic spinal pain. METHODS: Data search was conducted using the electronic database MEDLINE. Randomized clinical trials, conducted in patients between 18 and 65 years old with chronic pain in the spine region, were included. RESULTS: Two independent reviewers performed the analysis of methodological quality using the PEDro scale, with 13 studies finally selected. The different types of therapeutic exercise had significant effects on pain reduction, decrease of disability and improvement of the quality of life of the patients. CONCLUSIONS: The results show that there is no modality of therapeutic exercise superior to others. The combination of different therapeutic exercise modalities could be a complete tool for the management of chronic pain in the spine.
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Dolor Crónico , Dolor de la Región Lumbar , Adolescente , Adulto , Anciano , Dolor Crónico/terapia , Terapia por Ejercicio , Humanos , Persona de Mediana Edad , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Adulto JovenRESUMEN
No disponible
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Humanos , Encuestas de Atención de la Salud , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Pandemias , Necesidades y Demandas de Servicios de Salud , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Cuidados Críticos/estadística & datos numéricos , Servicio de Anestesia en Hospital/provisión & distribución , EspañaAsunto(s)
Anestesiología/organización & administración , COVID-19/epidemiología , Encuestas de Atención de la Salud/estadística & datos numéricos , Pandemias , SARS-CoV-2 , Anestesiólogos/organización & administración , Anestesiología/estadística & datos numéricos , Reconversión de Camas/estadística & datos numéricos , COVID-19/terapia , Análisis Costo-Beneficio , Cuidados Críticos/estadística & datos numéricos , Capacidad de Camas en Hospitales/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos , Admisión y Programación de Personal , España/epidemiologíaRESUMEN
A literature screening on computational fluid dynamics (CFD) modelling in water treatment applications showed a vast range of validation ranging from no validation at all, over residence time distribution (RTD) and tracer testing, to velocity field, species concentration and, finally, turbulence properties measurements. The validation level also differs depending on process scale (laboratory, pilot, full) and type of system (rheology, single phase vs. multiphase). Given the fact that CFD is in more widespread use, a discussion on the extent and need of validation needs to be initiated. This paper serves as a discussion starter on the topic.
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Aguas Residuales , Purificación del Agua , Simulación por Computador , Hidrodinámica , Reología , AguaRESUMEN
To take full advantage of the remarkable applications of carbon nanotubes in different fields, there is a need to develop effective methods to improve their water dispersion and biocompatibility while maintaining their physical properties. In this sense, current approaches suffer from serious drawbacks such as loss of electronic structure together with low surface coverage in the case of covalent functionalizations, or instability of the dynamic hybrids obtained by non-covalent functionalizations. In the present work, we examined the molecular basis of an original strategy that combines the advantages of both functionalizations without their main drawbacks. The hierarchical self-assembly of diacetylenic-based neoglycolipids into highly organized and compacted rings around the nanotubes, followed by photopolymerization leads to the formation of nanotubes covered with glyconanorings with a shish kebab-type topology exposing the carbohydrate ligands to the water phase in a multivalent fashion. The glyconanotubes obtained are fully functional, and able to establish specific interactions with their cognate receptors. In fact, by taking advantage of this selective binding, an easy method to sense lectins as a working model of toxin detection was developed based on a simple analysis of TEM images. Remarkably, different experimental settings to assess cell membrane integrity, cell growth kinetics and cell cycle demonstrated the cellular biocompatibility of the sugar-coated carbon nanotubes compared to pristine single-walled carbon nanotubes.
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Carbohidratos , Lectinas/metabolismo , Nanotubos de Carbono/química , Animales , Carbohidratos/química , Carbohidratos/farmacología , Línea Celular , RatonesRESUMEN
Nanoporous silica microparticles (NSiO(2)-MP) are considered to be potential drug delivery systems and scaffolding platforms in tissue engineering. However, few biocompatibility studies regarding NSiO(2)-MP interaction with the immune system have been reported. Toll-like receptors (TLR) are involved in host defence as well as autoimmune and inflammatory diseases. The results show that NSiO(2)-MP up to 100µgml(-1) do not affect macrophage cell viability after 24h cell culture. Moreover, NSiO(2)-MP do not compromise the cell viability of TLR-activated Raw 264.7 cells, for either cell surface TLR (TLR1/TLR2/TLR4/TLR6) or endocytic compartment TLR (TLR3/TLR7/TLR9). Furthermore, Raw 264.7 cells do not respond to NSiO(2)-MP exposure in terms of IL-6 or IL-10 secretion. NSiO(2)-MP co-treatment in the presence of TLR ligands does not impair or enhance the secretion of the pro-inflammatory cytokine IL-6 or the regulatory cytokine IL-10. Thus, NSiO(2)-MP do not affect macrophage polarization towards a pro-inflammatory or immunosuppressive status, representing added value in terms of biocompatibility compared with other SiO(2)-based micro- and nanoparticles.
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Sistemas de Liberación de Medicamentos , Macrófagos/metabolismo , Nanopartículas , Dióxido de Silicio/farmacología , Receptores Toll-Like/agonistas , Animales , Línea Celular , Interleucina-10/inmunología , Interleucina-10/metabolismo , Interleucina-6/inmunología , Interleucina-6/metabolismo , Ligandos , Macrófagos/citología , Macrófagos/inmunología , Ratones , Tamaño de la Partícula , Porosidad , Dióxido de Silicio/química , Factores de Tiempo , Receptores Toll-Like/inmunología , Receptores Toll-Like/metabolismoRESUMEN
BACKGROUND AND STUDY AIMS: Endoscopic ultrasound (EUS) is a commonly used and fairly sensitive method of assessing changes of chronic pancreatitis (CP) when routine noninvasive imaging has not shown overt features of CP. The aim of this study is to evaluate the interobserver agreement (IOA) for the classic (MSC) and the Rosemont (RC) criteria for the diagnosis of chronic pancreatitis on the basis of clinical practice. PATIENTS AND METHODS: Two experienced endosonographers evaluated on the same day patients referred for EUS in a blinded fashion. Data from the sonographic criteria of both MSC and RC were collected. Agreement was calculated using k statistics. RESULTS: A total of 69 patients were evaluated. The study population included mainly patients without pancreatic diseases, resulting in a low number of sonographic findings. Agreement for the final diagnosis was moderate for both classification systems of chronic pancreatitis (k = 0.53 for conventional and k = 0.46 for Rosemont). CONCLUSIONS: The IOA of EUS in the diagnosis of CP is moderate. The concordance values obtained in clinical practice are similar to those obtained in multicenter studies. The RC does not seem to improve the IOA of MSC.
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Endosonografía/métodos , Pancreatitis Crónica/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Enfermedades Pancreáticas/diagnóstico por imagen , Pancreatitis Crónica/diagnósticoRESUMEN
Objetivos: Evaluar el impacto de la introducción de la ecoendoscopia en la práctica clínica. Métodos: Se analizaron todas las exploraciones realizadas en los primeros 18 meses de implantación de la técnica. Se valoró la concordancia mediante técnicas radiológicas o piezas quirúrgicas en los casos en los que fue posible. Resultados: Se realizaron 277 exploraciones. Sólo se han registrado 2 complicaciones y en ambos casos fue en relación con la sedación. La demanda fue en aumento, alcanzando 70 exploraciones/ 100.000 habitantes. Las indicaciones principales fueron procesos biliares (34,3%) y pancreáticos. No se encontró patología alguna en el 10% de los casos. 29 presentaban coledocolitiasis (93% confirmadas y tratadas endoscópicamente). Se diagnosticaron 19 pancreatitis crónicas (sólo el 15,78% fueron diagnosticadas por tomografía computarizada). Se evaluaron 32 pacientes con pancreatitis aguda idiopática: en 20 de ellos se visualizó microlitiasis (80% fueron colecistectomizados y permanecen asintomáticos tras una media de seguimiento de 21,5 meses), 2 casos de coledocolitiasis, 1 con pancreatitis crónica y 9 casos permanecieron sin filiar la etiología. Hemos realizado 56 punciones: 39 muestras de páncreas en 33 pacientes (fueron diagnósticas en el 81,1%, siendo los diagnósticos más frecuentes el adenocarcinoma y el cistoadenoma seroso), 13 adenopatías y 4 masas abdominales. Conclusiones: La ecoendoscopia es una técnica con una demanda creciente, presenta escasos riesgos y conlleva una mejor toma de decisiones en un importante número de pacientes con enfermedades diversas. Por lo tanto, su inclusión en la práctica clínica rutinaria ha de ser considerado(AU)
Objectives: Evaluation of the impact of EUS in clinical practice. Methods: All exploration performed during the first 18 months of implementation of the technique were analyzed. Agreement was assessed by radiographic techniques or surgical specimens in those cases allowed. Results: 277 exploration were performed. There have been only 2 complications and they were related to sedation in both cases. The demand increased gradually, reaching 70 scans per 100,000 inhabitants. Main indications were bile (34.3%) and pancreatic processes. No pathology was found in 10% of cases; 29 cases had choledocholithiasis (93% confirmed and treated endoscopically). Chronic pancreatitis was diagnosed in 19 cases (only 15.78% of the cases were diagnosed by computed tomography). 32 patients with idiopathic acute pancreatitis were evaluated: 20 of them had evidence of microlithiasis (80% cholecystectomized and asymptomatic after a mean follow-up of 21.5 months), two cases of choledocholithiasis, 1 with chronic pancreatitis and 9 cases remained free of filial etiology. We performed 56 punctures: 39 samples of pancreas in 33 patients (81.1% of the samples were diagnostic; adenocarcinoma and serous cystadenoma were the most common diagnoses), 13 enlarged nodes and 4 abdominal masses. Conclusions: EUS is a growing demand technique that has low risks and leads to better decision-making in a significant number of patients with different diseases. Therefore, its inclusion in routine clinical practice must be considered(AU)
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Humanos , Masculino , Femenino , Endoscopía , Coledocolitiasis , Pancreatitis Crónica/diagnóstico , Adenocarcinoma/complicaciones , Adenocarcinoma/diagnóstico , Cistoadenoma/complicaciones , Cistoadenoma/diagnóstico , Leiomiosarcoma , Endoscopía/métodos , Endoscopía/tendencias , Pancreatitis Crónica , Estudios ProspectivosRESUMEN
OBJECTIVES: Evaluation of the impact of EUS in clinical practice. METHODS: All exploration performed during the first 18 months of implementation of the technique were analyzed. Agreement was assessed by radiographic techniques or surgical specimens in those cases allowed. RESULTS: 277 exploration were performed. There have been only 2 complications and they were related to sedation in both cases. The demand increased gradually, reaching 70 scans per 100,000 inhabitants. Main indications were bile (34.3%) and pancreatic processes. No pathology was found in 10% of cases; 29 cases had choledocholithiasis (93% confirmed and treated endoscopically). Chronic pancreatitis was diagnosed in 19 cases (only 15.78% of the cases were diagnosed by computed tomography). 32 patients with idiopathic acute pancreatitis were evaluated: 20 of them had evidence of microlithiasis (80% cholecystectomized and asymptomatic after a mean follow-up of 21.5 months), two cases of choledocholithiasis, 1 with chronic pancreatitis and 9 cases remained free of filial etiology. We performed 56 punctures: 39 samples of pancreas in 33 patients (81.1% of the samples were diagnostic; adenocarcinoma and serous cystadenoma were the most common diagnoses), 13 enlarged nodes and 4 abdominal masses. CONCLUSIONS: EUS is a growing demand technique that has low risks and leads to better decision-making in a significant number of patients with different diseases. Therefore, its inclusion in routine clinical practice must be considered.
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Endosonografía , Enfermedades Gastrointestinales/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Endosonografía/estadística & datos numéricos , Femenino , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/patología , Neoplasias Gastrointestinales/diagnóstico , Neoplasias Gastrointestinales/diagnóstico por imagen , Hospitales de Distrito , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
The ontogenesis of the pineal gland of 20 bovine embryos (Bos taurus) has been analysed from 160 days of gestation to birth by means of optical microscopy and immunohistochemical techniques. For this study, the specimens were grouped into two stage in accordance with the most relevant histological characteristics: Stage 1 (160 to 200 days of prenatal development) and Stage 2 (220 days of prenatal development to birth). At 160 days of gestation some rounded structures with a central lumen, which we refer to as glandular rosettes, begin differentiation from the epithelium of the pineal recess, experiencing an extraordinary increase in number and size at 200 days of intrauterine life. In the interior of the pineal parenchyma we observed some morphologically rounded cells with oval euchromatic nuclei and a well-differentiated nucleolus that we refer to as the pinealoblasts. We also observed other cells characterised by the presence of low cytoplasm and rounded and highly stained nuclei that we refer to as the interstitial cells. The glandular stroma is formed from the capsular, trabecular, and perivascular connective tissue as well as from the reticular network that comes from the cellular processes of the interstitial cells. The blood vessels, at 240 of gestation, show well-formed walls where the endothelial cells stand out. At 160 days of gestation we witnessed some cells with small, dense, oval nuclei, positive to the glial fibrillary acidic protein (GFAP). At this age NPY positive fibres were detected, distributed around the blood vessels and among the pinealoblasts. We conclude by clarifying that the changes detected in the morphology as well as in the number and size of glandular rosettes appear to be related to the functional activity of the pineal gland during embryonic development.
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Regulación del Desarrollo de la Expresión Génica , Inmunohistoquímica/métodos , Glándula Pineal/embriología , Glándula Pineal/patología , Animales , Bovinos , Núcleo Celular/metabolismo , Desarrollo Fetal , Proteína Ácida Fibrilar de la Glía/metabolismo , Neuropéptido Y/metabolismo , Factores de TiempoRESUMEN
AIM: To study the clinical characteristics, treatment response and evolution in patients with microscopic colitis. MATERIAL AND METHODS: We performed a retrospective analysis of 24 patients (15 with collagenous colitis and 9 with lymphocytic colitis). Clinical and diagnostic features, treatment response and evolution according to the presence of maintenance therapy were evaluated. RESULTS: The mean age of the patients was 59.7 years and most were male. Nine patients took non-steroidal anti-inflammatory drugs (NSAID). No significant association was found with other drugs. Four patients presented associated rheumatological disease. Most patients presented insidious-onset diarrhea without pathological products, which was frequently associated with other symptoms (abdominal pain, bloating, weight loss, asthenia, tenesmus, and incontinence). Seven patients showed a slight increase in globular sedimentation rate. Fat in stools and radiological investigations (transit and opaque enema) were normal in patients who underwent these tests. Endoscopy revealed non-specific alterations in 42% of the patients while results were normal in the remaining patients. One patient showed clinical improvement on withdrawal of NSAIDs and 4 patients improved spontaneously. Clinical response was achieved in 7 of 13 patients treated with antimotility drugs, in 8 of 9 patients treated with salicylates, in 3 treated with oral corticoids, in 1 treated with cholestyramine and in 1 treated with topical budesonide. Nineteen patients required no maintenance therapy, 4 were administered salicylates and 1 was administered cholestyramine. After a mean follow-up of 42 months, evolution was chronic and intermittent in 14 patients and chronic and continuous in 1; 9 patients presented a single episode. No significant differences were found between patients administered maintenance therapy and those who were not or between collagenous colitis and lymphocytic colitis in the parameters analyzed. CONCLUSIONS: Microscopic colitis constitutes a group of diseases characterized by chronic diarrhea, few systemic effects and minimal radiological and/or endoscopic alterations. Evolution is characterized by recurrent episodes, with good response to treatment with cholestyramine, salicylates or corticoids when required.
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Colitis/terapia , Adulto , Anciano , Anciano de 80 o más Años , Antiinflamatorios no Esteroideos/efectos adversos , Artritis/complicaciones , Colitis/complicaciones , Colitis/patología , Enfermedades del Colágeno/complicaciones , Enfermedades del Colágeno/patología , Enfermedades del Colágeno/terapia , Diarrea/etiología , Femenino , Estudios de Seguimiento , Humanos , Linfocitos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
We present the case of a 44-year-old woman who was referred to us for jaundice, choluria and acholia. Review of the patient's clinical history revealed that tests for hepatitis A virus (HAV) IgM antibody had been positive 4 and 2 years previously and continued to be so. The patient showed a score of 16 in the International Autoimmune Hepatitis Group's system when the HAV marker was not taken into account and a score of 13 when this marker was taken into account. The persistence of this viral marker for so many years in such patients is probably associated with polyclonal hypergammaglobulinemia. Consequently, we believe that the inclusion of this antibody as a negative datum in the diagnosis of autoimmune virus should be viewed with caution.
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Virus de la Hepatitis A/inmunología , Anticuerpos Antihepatitis/sangre , Hepatitis Autoinmune/inmunología , Inmunoglobulina M/sangre , Adulto , Biomarcadores/sangre , Femenino , Anticuerpos de Hepatitis A , Hepatitis Autoinmune/diagnóstico , HumanosRESUMEN
La colitis colágena es una enfermedad cuya frecuencia ha aumentado progresivamente en los últimos años debido fundamentalmente a la toma rutinaria de biopsias en el estudio de pacientes con diarrea crónica. Se han comunicado buenas respuestas con numerosos tratamientos, aunque hay pocos ensayos clínicos realizados por el escaso número de pacientes con esta patología. Presentamos dos casos de colitis colágena cuyo interés reside en su manejo terapéutico, revisando las distintas alternativas existentes en el tratamiento de esta entidad de creciente importancia en la práctica clínica diaria (AU)
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Adulto , Anciano , Masculino , Femenino , Humanos , Budesonida , Antiinflamatorios no Esteroideos , Antiinflamatorios , Enfermedades del Colágeno , Colitis , Diarrea , Administración Tópica , Enema , GlucocorticoidesRESUMEN
The report shows that melatonin enhances IL-2 and IL-6 production by two human lymphocytic (Jurkat) and monocytic (U937) cell lines via a nuclear receptor-mediated mechanism. Jurkat cells express nuclear (RZRalpha, RORalpha1 and RORalpha2) and membrane (mt1) melatonin receptors, and melatonin binds to Jurkat nuclei and membranes with the same affinity described for human peripheral blood mononuclear cells (PBMCs). Melatonin enhances IL-2 production by Jurkat cells activated by either phytohemagglutinin (PHA) or phorbol myristate acetate (PMA). PHA activation of Jurkat cells does not change the profile of melatonin receptor expression; on the contrary, PMA activation negatively regulates the mtl receptor. In the absence of the membrane receptor, melatonin still activates IL-2 production. U937 cells express only the mtl receptor. Although melatonin binds to both U937 nuclei and membranes, CGP 52608, a ligand of the nuclear receptor for melatonin, does not inhibit melatonin binding to U937 nuclei, suggesting that a protein other than the RZR/RORalpha receptor was involved in the process. In U937 cells, melatonin did not modify basal production of IL-6 or when activated by PMA plus LPS (lipopolysaccharide), a treatment that downregulates the expression of the mtl receptor. However, in U937 cells activated with IFN-gamma, which induces the expression of the RORgamma1 and RORalpha2 nuclear receptors and represses the expression of the mt1 receptor, melatonin can activate IL-6 production. These results show that the expression of nuclear melatonin receptor is sufficient for melatonin to activate cytokine production in human lymphocytic and monocytic cell lines.