En este trabajo se realizó un análisis de sensibilidad, calibración y evaluación del desempeño del modelo InVEST para simular la producción de agua media anual en la Cuenca del Río Limay. La ...producción de agua es una servicio ecosistémico hidrológico fundamental que resulta del balance entre la evapotranspiración y la precipitación, dependiendo de las características del suelo y de la cobertura. Las simulaciones permitieron determinar el orden de subcuencas productoras de agua, mostrando que la subcuenca que más produce es la de Aluminé, seguida de la subcuenca Nahuel Huapi. El análisis de sensibilidad a las bases de datos de precipitación evidenció la necesidad de utilizar bases de datos de precipitación con alta resolución espacial y alta densidad de estaciones meteorológicas para este tipo de estudio de modelado a escala de cuenca. La base de datos de precipitación NPCG, generada para Patagonia Norte con alta densidad de estaciones meteorológicas, dio resultados muy satisfactorios y permitió una buena calibración del modelo. Las simulaciones realizadas con diferentes bases de datos globales o cuasi-globales de precipitación mostraron una marcada dispersión en los resultados. La sensibilidad al uso de diferentes bases de datos de uso/cobertura de suelo fue menor que al uso de diferentes bases de precipitación. Sin embargo, se registraron cambios relevantes en la producción de agua en algunas subcuencas cuando las diferencias de uso/cobertura se localizaban en la cabecera de la cuenca. La mejor calibración del modelo (errores menores al 10 %.) se obtuvo con la base de datos de uso/cobertura de suelo SERENA, con la base de precipitación NPCG y con un valor del parámetro ecohidrológico Z=15.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
To evaluate differences in clinical presentation and in surgical outcomes between growth hormone-secreting pituitary adenomas (GH-PAs) and GH and prolactin co-secreting pituitary adenomas ...(GH&PRL-PAs).
Multicenter retrospective study of 604 patients with acromegaly submitted to pituitary surgery. Patients were classified into two groups according to serum PRL levels at diagnosis and immunohistochemistry (IHC) for PRL: a) GH&PRL-PAs when PRL levels were above the upper limit of normal and IHC for GH and PRL was positive or PRL levels were >100ng/and PRL IHC was not available (n=130) and b) GH-PAs who did not meet the previously mentioned criteria (n=474).
GH&PRL-PAs represented 21.5% (n=130) of patients with acromegaly. The mean age at diagnosis was lower in GH&PRL-PAs than in GH-PAs (P<0.001). GH&PRL-PAs were more frequently macroadenomas (90.6% vs. 77.4%, P=0.001) and tended to be more invasive (33.6% vs. 24.7%, P=0.057) than GH-PAs. Furthermore, they had presurgical hypopituitarism more frequently (OR 2.8, 95% CI 1.83-4.38). IGF-1 upper limit of normality (ULN) levels at diagnosis were lower in patients with GH&PRL-PAs (median 2.4 IQR 1.73-3.29 vs. 2.7 IQR 1.91-3.67, P=0.023). There were no differences in the immediate (41.1% vs 43.3%, P=0.659) or long-term post-surgical acromegaly biochemical cure rate (53.5% vs. 53.1%, P=0.936) between groups. However, there was a higher incidence of permanent arginine-vasopressin deficiency (AVP-D) (7.3% vs. 2.4%, P=0.011) in GH&PRL-PAs patients.
GH&PRL-PAs are responsible for 20% of acromegaly cases. These tumors are more invasive, larger and cause hypopituitarism more frequently than GH-PAs and are diagnosed at an earlier age. The biochemical cure rate is similar between both groups, but patients with GH&PRL-PAs tend to develop permanent postsurgical AVP-D more frequently.
Abstract Introduction Multimodal rehabilitation (MMRH) programmes in surgery have proven to be beneficial in functional recovery of patients. The aim of this study is to evaluate the impact of a MMRH ...programme on hospital costs. Method A comparative study of 2 consecutive cohorts of patients undergoing elective colorectal surgery has been designed. In the first cohort, we analysed 134 patients who received conventional perioperative care (control group). The second cohort included 231 patients treated with a multimodal rehabilitation protocol (fast-track group). Compliance with the protocol and functional recovery after fast-track surgery were analysed. We compared postoperative complications, length of stay and readmission rates in both groups. The cost analysis was performed according to the system “full-costing”. Results There were no differences in clinical features, type of surgical excision and surgical approach. No differences in overall morbidity and mortality rates were found. The mean length of hospital stay was 3 days shorter in the fast-track group. There were no differences in the 30-day readmission rates. The total cost per patient was significantly lower in the fast-track group (fast-track: 8107 ± 4117 euros vs control: 9019 ± 4667 euros; P =.02). The main factor contributing to the cost reduction was a decrease in hospitalisation unit costs. Conclusion The application of a multimodal rehabilitation protocol after elective colorectal surgery decreases not only the length of hospital stay but also the hospitalisation costs without increasing postoperative morbidity or the percentage of readmissions.
Abstract Introduction Rheumatoid arthritis (RA) is a complex polygenic inflammatory disease associated with accelerated atherosclerosis. IL-6 is a key mediator of inflammation in RA. A recent study ...showed an association between IL6 -174 G/C gene polymorphism and cardiovascular (CV) disease in UK individuals with RA. To confirm this association we assessed the influence of three IL6 gene polymorphisms in the risk of CV disease in a large series of patients with RA. Material and methods We studied 1250 Spanish patients with RA. Besides genotyping the traditional single nucleotide polymorphism (SNP) promoter -174G/C (rs1800795), we assessed another two SNPs (rs2069827 and rs2069840) located in the IL6 gene that were selected by SNP-tagging. Results Two-hundred and twenty (17.6%) of the 1250 patients experienced CV events. No significant differences in the genotype, allele and haplotype frequencies between RA patients with and without CV events were observed. Conclusion Our results do not confirm in a Spanish population the association of IL6 gene with CV disease in RA previously reported in the UK.
Management of subclinical hyperthyroidism Santos Palacios, Silvia; Pascual-Corrales, Eider; Galofre, Juan Carlos
International journal of endocrinology and metabolism,
2012, Letnik:
10, Številka:
2
Journal Article
Odprti dostop
The ideal approach for adequate management of subclinical hyperthyroidism (low levels of thyroid-stimulating hormone TSH and normal thyroid hormone level) is a matter of intense debate among ...endocrinologists. The prevalence of low serum TSH levels ranges between 0.5% in children and 15% in the elderly population. Mild subclinical hyperthyroidism is more common than severe subclinical hyperthyroidism. Transient suppression of TSH secretion may occur because of several reasons; thus, corroboration of results from different assessments is essential in such cases. During differential diagnosis of hyperthyroidism, pituitary or hypothalamic disease, euthyroid sick syndrome, and drug-mediated suppression of TSH must be ruled out. A low plasma TSH value is also typically seen in the first trimester of gestation. Factitial or iatrogenic TSH inhibition caused by excessive intake of levothyroxine should be excluded by checking the patient's medication history. If these nonthyroidal causes are ruled out during differential diagnosis, either transient or long-term endogenous thyroid hormone excess, usually caused by Graves' disease or nodular goiter, should be considered as the cause of low circulating TSH levels. We recommend the following 6-step process for the assessment and treatment of this common hormonal disorder: 1) confirmation, 2) evaluation of severity, 3) investigation of the cause, 4) assessment of potential complications, 5) evaluation of the necessity of treatment, and 6) if necessary, selection of the most appropriate treatment. In conclusion, management of subclinical hyperthyroidism merits careful monitoring through regular assessment of thyroid function. Treatment is mandatory in older patients (> 65 years) or in presence of comorbidities (such as osteoporosis and atrial fibrillation).
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