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Presentamos el caso de una paciente de 35 años con diagnóstico de síndrome de aorta media congénita corregida en la infancia con bypass aórtico con interposición de un conducto de dacrón. Durante el seguimiento fue diagnosticada de hipertensión arterial por lo que se inició tratamiento antihipertensivo y se implantó un stent en el conducto. En un TC de aorta de control se apreció una lesión costal sugestiva de osteocondroma que comprimía el conducto. Se realizó un cateterismo cardiaco que confirmó la estenosis hemodinámica por compresión extrínseca de la lesión costal a nivel del stent implantado previamente. El estudio con imagen con TC ayudó a diagnosticar una complicación a nivel de la aorta que había pasado desapercibida en otras técnicas de imagen.

The aim of this study was to describe the perception of changes that Alzheimer’s disease in grandparents has made to the relationship with their grandchildren of between 6 and 13. Qualitative methodology was used. Semi-structured interviews were carried out with 25 grandchildren living in Catalonia, Spain. Participants reported a change in roles from being the care receiver to being the caregiver, changes in the activities that they did together and a positive impact on the grandparent’s emotional wellbeing. In the physical sphere, sleeping problems were reported in grandchildren that cohabited with their grandparents. The feelings they described include fear of not being recognized by their grandparents and sadness, as well as satisfaction resulting from their affection and participating in caring. These findings suggest the need to provide information and resources for grandchildren and their families to enable them to deal with the disease.

Background Phosphoinositide 3-kinase alpha (PI3Kα) H1047R mutations are activating oncogenic events that occur in ~15% of breast cancers (BC). Early generation PI3Kα inhibitors target both wild-type (WT) and mutant PI3Kα and, as a result, their efficacy may be limited by on-target WT PI3Kα-mediated toxicities, including hyperglycemia, skin rash, and diarrhea. LOXO-783 is an oral, potent and highly mutant-selective, brain-penetrant allosteric PI3Kα H1047R inhibitor that is currently in phase 1 testing. Preclinically, LOXO-783 as a single agent is highly selective for PI3Kα H1047R over WT PI3Kα and other PI3K isoforms, and induces single-agent tumor regressions in ER+, HER2- PI3Kα H1047R-mutant breast cancer models without causing hyperglycemia or increases in plasma insulin/C-peptide. LOXO-783 also demonstrates brain penetration in vivo with dose-dependent tumor growth inhibition in brain metastasis models. Here we report the efficacy of LOXO-783 with SOC treatments in preclinical breast cancer models. Methods Cell proliferation assays and in vivo studies to evaluate combination effects were performed in various PI3Ka H1047R mutant HR+, HER2- and triple negative breast cancer models. For each combination in vitro, a combination index (CI) based on the Loewe Additivity Method was calculated (CI>2 antagonism, 0.5>CI< 2 additivity, CI< 0.5 synergy). For the in vivo studies, the Bliss Independence Method was used to evaluate the statistical significance of the combination effects. Results Combining LOXO-783 with either fulvestrant (FUL; CI at 50% inhibition = 0.28) or imlunestrant (CI at 50% inhibition = 0.43) showed increased efficacy in cell proliferation assays using the HR+, HER2-, PI3Kα H1047R-mutant T47D model. LOXO-783 also demonstrated an additive effect in combination with these endocrine therapies in vivo. Similar results were observed in a T47D model engineered to express ESR1 D538G, as well as in an HR+, HER2- PI3Kα double in-cis mutant model (H1047R/D350G) also harboring ESR1 D538G and derived from a patient who had progressed on prior letrozole plus taselisib. Moreover, LOXO-783 plus abemaciclib demonstrated an additive effect in vitro (CI at 50% inhibition = 0.61), and in T47D xenograft and PDX models in vivo. Combinations of LOXO-783 with abemaciclib plus imlunestrant resulted in a mean tumor regression of –48.1%; LOXO-783 with abemaciclib plus FUL showed mean tumor regression of –43.9% in T47D xenografts. Similar efficacy was not observed in the absence of LOXO-783 (mean tumor regression was –7.3% with abemaciclib plus imlunestrant, and 3.2% with abemaciclib plus FUL). We observed comparable results in PDX models. These data collectively demonstrate the additive effect of LOXO-783 with SOC treatments. Extending these studies to additional treatment settings, LOXO-783 was similarly efficacious as a single agent in abemaciclib-resistant and abemaciclib/FUL double-resistant models, and was additive in combination with paclitaxel in a triple negative breast cancer model in vitro and in vivo. Conclusions LOXO-783 shows additive effects when combined with SOC in breast cancers harboring the PI3Kα H1047R-mutation (as single or double in-cis mutations) in both HR+ and triple negative settings. LOXO-783 is also efficacious in ESR1 mutant as well as in abemaciclib and abemaciclib/FUL double-resistant models. A phase 1 trial of LOXO-783 alone or in combination with anticancer therapies is ongoing (PIKASSO-01; NCT05307705). Citation Format: Loredana Puca, Michele S. Dowless, Carmen M. Perez-Ferreiro, Maria Jesus Ortiz-Ruiz, Gregory P. Donoho, Andrew Capen, Lysiane Huber, Sarah M. Bogner, Dongling Fei, Jason R. Manro, Chun Ping Yu, Wei Guo Xu, Rui Wang, Shuang Chen, Mark A. Hicks, Parisa Zolfaghari, Andrew Faber, Raymond Gilmour, Monica D. Ramstetter, Matthew T. Chang, Maria Jose Lallena, Xuequian Gong, David M. Hyman, Lillian M. Smyth, Barbara J. Brandhuber, Barry S. Taylor, Anke Klippel. LOXO-783: A potent, highly mutant selective and brain-penetrant allosteric PI3Kα H1047R inhibitor in combination with standard of care (SOC) treatments in preclinical PI3Kα H1047R-mutant breast cancer models [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-08-02.

Aim and objectives: To assess the adherence of a nursing care model in a multidisciplinary breast cancer unit in a tertiary hospital to the recommended competencies and quality indicators.Background: Aligning the competencies of the breast care nurse with international recommendations for this role helps better fulfil patient needs, increases satisfaction and ensures continuity of care.Design: Cohort study.Methods: Breast care nursing was assessed in all patients treated at the Functional Breast Unit from 1 July 2016 to 30 June 2017. Patients were followed for 1 year. Sociodemographic, clinical and pathological data, treatments performed and nursing interventions were collected. The strobe checklist has been used to report this study. Results: We analysed nursing interventions carried out in 382 patients attended over 1 year in a multidisciplinary breast cancer unit. All patients with early disease had contact with the nurse at different times during their primary treatment. Only 58% of patients with advanced disease had contact with the nurse during their first year of illness. Moreover, first contact with the nurse was delayed by more than a week from diagnosis, the interval recommended by international guidelines.Conclusion: The nursing care model meets the core competencies defined for the breast care nurse in patients with early breast cancer, but the first visit should be organised earlier, and follow-up should extend beyond the completion of primary treatment.Relevance to clinical practice: This study evaluated the breast care nurse model in one breast cancer unit according to international guidelines. Nursing care adhered to most guideline requirements in patients with early breast cancer, but not in those with advanced disease. New models of care need to be developed for women with advanced breast cancer in order to achieve true patient-centred care.

A síndrome de Burnout é um esgotamento físico e mental relacionado ao trabalho que pode ser oriundo de sobrecarga ou excesso de trabalho. A detecção da síndrome de Burnout na prática clínica dos profissionais da equipe de enfermagem é de suma importância, pois previne agravos à saúde física, mental, bem como afastamentos do trabalho. Devido à complexidade do agravo é fundamental a adoção de medidas preventivas no cotidiano dos profissionais de enfermagem. Este estudo tem como objetivo realizar o levantamento de dados relacionados à prevalência da síndrome de Burnout na equipe de enfermagem na clínica médica do referido hospital, visando demonstrar a influência do trabalho no surgimento da síndrome. Trata-se de um estudo observacional do tipo transversal, descritivo de abordagem quantitativa que foi realizado com 48 profissionais membros da equipe de enfermagem da unidade de clínica médica no período de setembro a outubro de 2022, através da aplicação de questionários. Os dados coletados serão transformados em gráficos e os resultados obtidos serão descritos.

Resumen Introducción Las fracturas del fémur proximal pediátricas son infrecuentes, se asocian a traumas de alta energía, y presentan complicaciones devastadoras. La mayoría de los casos se tratan en forma quirúrgica utilizando diversos tipos de fijación. El objetivo de este estudio es reportar los resultados de una serie de casos de pacientes quirúrgicos en dos hospitales de referencia en Chile. Materiales y métodos Serie de casos tratados entre el 2004y el 2018, en la que se incluyeron pacientes pediátricos con diagnóstico de fractura de fémur proximal que fueron operados. Se realizó estadística descriptiva de las variables demográficas, la energía del accidente, la clasificación según Delbet, el tipo de tratamiento, la técnica de osteosíntesis, la aparición de complicaciones, y la evaluación clínico-radiológica. Resultados Se evaluaron 17 casos, de los cuales un 76,5% fueron secundarios a accidentes de alta energía. La mediana de edad de la muestra fue de 7 años, y había un 58,8% de niñas. Hubo 3 casos de tipo II en la clasificación de Delbet, 9 de tipo III, y 5 de tipo IV. Como método de fijación, se utilizaron tornillos canulados (9 casos), placa de compresión de bloqueo (locking compression plate, LCP, en inglés; 5 casos), tornillo dinámico de cadera (dynamic hip screw, DHS, en inglés; 2 casos), y placa de compresión dinámica (dynamic compression plate, DCP, en inglés; 1 caso). La mediana de seguimiento fue de 2,3 años (rango: 0,5 a 12,8 años). Se presentaron complicaciones: coxa vara en un caso, y discrepancia de longitud de extremidades inferiores en otro caso, y no hubo osteonecrosis. Se realizó retiro de osteosíntesis en siete pacientes. Se obtuvieron buenos resultados en todos los pacientes según los criterios de Ratliff. Conclusiones La mayoría de las fracturas se asociaron a traumas de alta energía, siendo el tipo más frecuente el III de Delbet. Todos los pacientes fueron tratados en forma quirúrgica, con buenos resultados, sin observar osteonecrosis.Nivel de evidencia: 4.

Debate is ongoing regarding the best service model for achieving a prompt recanalization in LVO ischemic stroke with an indication for thrombectomy. We aim to assess differences between two of the existing models within our region.We work in a cluster of three public hospitals (one hub and two spokes) forming a single functional neurology service in Madrid (Spain). Upon a LVO case out of regular hours, the interventional neuroradiologist drives to the hub hospital following the drive-the-doctor paradigm (DD). For any of the spokes, the patient is transferred to the nearest endovascular-capable hospital (drip-and-ship-DS) following the Madrid Stroke Plan. We compared times to endovascular procedures between cases managed under each model.Thirty-eight patients in the period April 2014-March 2021 meet the inclusion criteria (DD 27; DS 11). While baseline characteristics are comparable between groups, we observed a notable difference in the time delays favoring those managed under the DD model; with differences between median times of 105 min for hospital arrival-groin puncture (DD 140 [110-181]; DS 245 [222-310], p 0.0004); 122 min for CT-groin puncture (DD 100 [85-144]; DS 222 [200-255], p = 0.0001); and 98 min for hospital arrival-recanalization (DD 180 [140-209]; DS 278 [241-360], p = 0.0014). No differences were observed for NIHSS or mRS on discharge.Compared to the drip-and-ship, the drive-the-doctor triage model for patients with LVO ischemic stroke in primary centers seems to guarantee a shorter time to the start of the endovascular procedure and to recanalization in our region.

This action research aims at exploring the contribution of self-assessment checklists on improving oral presentations of two participants that were taking an initial-level English as a second language course at a technician professional institute in Talcahuano, Chile. The intervention was carried out in four weekly sessions in which the participants were trained on the different criteria to assess their oral presentations. The participants self-assessed their work with a checklist and performed a second presentation based on their first self-assessment. Analytic rubrics were also used as an external assessment to compare results from the checklists. At the end of the intervention, a semi-structured interview was conducted to obtain the participants’ perceptions about the process. Findings reveal that by developing autonomy, language awareness, and self-reflective skills, the use of the self-assessment checklist supported the participants not only to improve their oral presentation in overall aspects, mainly in fluency and pronunciation aspects, but also to make positive changes in their confidence and expectations about their performance.

Background: A definition of myocardial infarction with non-obstructive coronary arteries (MINOCA) was published by European Society of Cardiology in 2016. The aim of this study is to analyze the clinical profile and prognosis of these patients in a prospective single-center study and compare it with the literature data. Methods: During a 3-year period, information from every consecutive MINOCA patient was gathered (n = 109). It was then compared with 412 contemporaneous patients with myocardial infarction and obstructive coronary arteries (MIOCA). Univariate and multivariate analyses were performed. Prognosis analysis was adjusted by age and cardiovascular risk factors (CVRF). Results: MINOCA represented 16.9% of the total of patients admitted for myocardial infarction. Compared with MIOCA, they had more psychosocial disorders (22.9% vs. 10.7%; p < 0.01) and more pro-inflammatory conditions (34.9% vs. 14.0%; p < 0.01). Atrial fibrillation was twice as frequent in MINOCA (14.7% vs. 7.3%; p = 0.016). Predictors of MINOCA were as follows: female gender, absence of diabetes, absence of tobacco use, tachycardia, troponin above 10 times the 99 th percentile, and pro-inflammatory conditions. Median follow-up was 17.3 ± 9.3 months. Major adverse cardiovascular events (MACE; a composite of a recurrence of acute myocardial infarction, transient ischemic attack/stroke, or death from cardiovascular cause and death from any cause) occurred in 10.8% of the MINOCA group as compared with 10.7% in the MIOCA group (hazard ratio [HR] 1.19, 95% confidence interval [CI] 0.58–2.45; p = 0.645). Cardiovascular re-admission rates were higher in the MINOCA group: 19.8% vs. 13.9% (HR 1.85; CI 1.06–3.21; p = 0.030). Conclusions: The frequency of MINOCA is high, with fewer CVRF, and it is linked to atrial fibrillation, psychosocial disorders, and pro-inflammatory conditions. Mid-term prognosis is worse than previously thought, with a similar proportion of MACE as compared to MIOCA, and even a higher rate of cardiovascular re-admissions.

Clay minerals are used widely in health products both as cosmetic and pharmaceutical ingredients. To optimize use, natural compounds are mixed with clay powder. The aim of the present study was to synthesize new, coloured hybrids based on purified Tunisian clay and powders of natural flowers: Malva sylvestris, Chrysanthemum coronarium, Silene dioica, Anagallis monellin and Pelargonium × hortorum. The floral pigments in Tunisian flowers were studied. The chlorophylls (a and b), total flavonoids (TF), total phenolic compounds (TPC), and carotenoids were analyzed using UV-Vis spectrophotometry and high-performance liquid chromatography (HPLC-DAD). In addition, the antioxidant capacity was determined using the oxygenated radical absorption capacity assay (ORAC) and the antioxidant capacity to reduce ferric ion assay (FRAP). The properties of the studied clay were evaluated by means of pharmaceutical and microbiological tests. The coloured hybrids were prepared by solid–solid reaction and analyzed using X-ray diffraction (XRD) and Fourier transform infrared (FTIR) spectroscopy. Chlorophyll a is present in large quantities in the Malva flower which presents the smallest antioxidant capacity. Chlorophyll b and the TPC are more abundant in the Pelargonium × hortorum. The TF appears in large quantities in the Anagallis flower. The carotenoids are present in the largest amounts in the Chrysanthemum. The results of the clay characterization justify its use as a pharmaceutical and cosmetic agent. The mixture of dried flowers and purified clay is used in the synthesis of new and biocoloured hybrids; these can be used as biocosmetic products without negative side effects on human health or the environment.

The purpose of this study is the introduction of the Holonic framework for the conceptual design of an "intelligent packaging" in the Sherry Wine´s Industry. This purpose is based on the search for an effective design, that is, a design that produces the desired effect on the user, thus fulfilling their expectations and leaving aside the existing problems in the traditional wine packaging. Due to the lack of specific methodologies, the holonic model has been chosen as an integrating framework for the design and development of conventional products. In addition, this model allows to support the combined use of other classical methodologies such as: AHP, QFD, FAST, TRIZ among other, allowing to use in the model, the advantages provided by each of them separately. The result is the methodological application to the design of an intelligent package that achieves the desired goals while improving the consumer experience. The proposed packaging design allows its direct reuse, being advantageous for obtaining certifications and audit approval. In addition, the use of intelligent technologies allows effective control and correct use of the product. Keywords: Sherry wines; holonic engineering; bottle; smart packaging; sustainable design; industrial design.

Analisar a literatura existente acerca das contribuições da assistência domiciliar na atenção primária à saúde.Métodos:Trata-se de uma revisão integrativa da literatura de caráter qualitativo. A busca dos trabalhos envolvidos na pesquisa foi realizada nas seguintes bases de dados: SCIELO, LILACS, BDENF e MEDLINE, a partir dos descritores em ciências da saúde: “Atenção primária `saúde”, “Visita domiciliar” e “Saúde pública”. Os critérios de inclusão foram: publicados no período entre 2012 e 2022, cujo acesso ao periódico era livre aos textos completos, artigos em idioma português, inglês e espanhol e relacionados à temática. Critérios de exclusão foram: artigos duplicados, incompletos, resumos, resenhas, debates, artigos publicados em anais de eventos e indisponíveis na íntegra.Resultados:O atendimento por meio das visitas consiste em conhecer o paciente, o local em que vive e principalmente orientar a família quanto aos cuidados a serem realizados.Conclusão:Conclui-se que a visita domiciliar é de grande importância para a saúde da população na atenção primária, ela tem um papel essencial na assistência, pois reúne a equipe multiprofissional no domicilio do paciente que não pode ir até a unidade básica de saúde.

Venous thromboembolism (VTE) is a common, multi-causal disease with potentially serious short- and long-term complications. In clinical practice, there is a need for improved plasma biomarker-based tools for VTE diagnosis and risk prediction. Here we show, using proteomics profiling to screen plasma from patients with suspected acute VTE, and several case-control studies for VTE, how Complement Factor H Related 5 protein (CFHR5), a regulator of the alternative pathway of complement activation, is a VTE-associated plasma biomarker. In plasma, higher CFHR5 levels are associated with increased thrombin generation potential and recombinant CFHR5 enhanced platelet activation in vitro. GWAS analysis of ~52,000 participants identifies six loci associated with CFHR5 plasma levels, but Mendelian randomization do not demonstrate causality between CFHR5 and VTE. Our results indicate an important role for the regulation of the alternative pathway of complement activation in VTE and that CFHR5 represents a potential diagnostic and/or risk predictive plasma biomarker.

This paper aims to explore the contributions of research that include gender perspective in analysing the sexual experiences of women diagnosed with serious mental illness and to identify any barriers and systems that impede sexual fulfilment. We have developed a qualitative literature review using the PRISMA statement. The databases SCOPUS, WOS and PsychINFO were used in this review. Studies were included if they were published up to March 15, 2022, and only studies in English were included. An initial database search was preformed; upon screening for eligibility, there remained 16 studies that explored the sexual experiences of women with diagnoses of serious mental illness. The studies were analysed by a thematic synthesis. Data was coded line-by-line which generated descriptive themes, resulting in four synthesised findings. The four synthesised findings that derived from the reviewed studies were stigma and subjectivity, the experience of interpersonal relationships, the socialisation of women and the effects of psychiatric hegemony. A feminist perspective highlights the interrelationship between gender and stigma as it relates to serious mental illness and sexuality. A feminist perspective and an intersectional approach should be adopted at the intersubjective and structural level to account for the complexity of human experience and to subvert the heteropatriarchal system.

Chagas disease, caused by the protozoa parasite Trypanosoma cruzi, is a neglected tropical disease and a major public health problem affecting more than 6 million people worldwide. Many challenges remain in the quest to control Chagas disease: the diagnosis presents several limitations and the two available treatments cause several side effects, presenting limited efficacy during the chronic phase of the disease. In addition, there are no preventive vaccines or biomarkers of therapeutic response or disease outcome. Trypomastigote form and T. cruzi-infected cells release extracellular vesicles (EVs), which are involved in cell-to-cell communication and can modulate the host immune response. Importantly, EVs have been described as promising tools for the development of new therapeutic strategies, such as vaccines, and for the discovery of new biomarkers. Here, we review and discuss the role of EVs secreted during T. cruzi infection and their immunomodulatory properties. Finally, we briefly describe their potential for biomarker discovery and future perspectives as vaccine development tools for Chagas Disease.

This paper investigates inequality persistence in a group of 21 OECD countries using linear and non-linear fractionally integrated methods. Using linear models, the results show that the series are strongly persistent which implies lack of average reversal and permanency of shocks. Mean reversion is only found in the case of Finland and partial evidence of mean reversion is detected for Belgium, Greece, Austria and the Netherlands. The results are similar using non-linear methods. Mean reversion is only found in the case of Finland, Belgium, Greece and Spain. Although, most countries show no evidence of non-linear structures except for four countries, namely, Finland, Spain, the United Kingdom and the United States. The implications of the empirical findings are reported at the end of the manuscript. post-print 910 KB

Este estudio está dirigido a la e-evaluación de la competencia de presentación oral utilizando recursos tecnológicos en un modelo activo que combina aprendizaje basado en proyectos y aula invertida. Este estudio aplica el uso de una rúbrica digital para la evaluación de la competencia en presentación oral en diferentes situaciones de evaluación activa y progresiva de 99 futuros docentes en las que la participación es opcional u obligatoria. Los resultados muestran que la rúbrica digital empleada en varios momentos es una metodología y una tecnología que facilita el proceso de retroalimentación y diálogo entre docentes y estudiantes sobre los criterios de evaluación. Los resultados apoyan futuras decisiones de diseño metodológico de evaluación formativa apropiadas en entornos de aprendizaje online., This study focuses on e-assessment of oral presentation competence using technology resources in a model that combines project-based learning and fl ipped learning. This study uses a digital rubric to assess oral presentation competence in different situations of progressive assessment for 99 preservice teachers, situations in which participation was either optional or compulsory. Findings show that the digital rubric used at various times is a methodology and a technology that facilitates the feedback process and dialogue between teachers and students about the assessment criteria. The results support future decisions for methodological design of formative assessment appropriate to online learning environments.

Funding Acknowledgements Type of funding sources: None. Introduction Cardiac Rehabilitation Programs (CRP) still do not reach all patients with this indication. In the context of COVID-19 pandemic, the new home-CRP model has been introduced. Purpose To evaluate the results in terms of improvement of psychosocial outcomes and changes in employment situation with home-CRP. Methods Cross-Sectional Observational study that included patients of both sexes, ≥ 18 years, after acute coronary syndrome or after coronary revascularization, included in home CRP. Information was collected from the computerized clinical history of the patients (diseased vessels, degree and type of revascularization, risk stratification). Data was collected at the beginning and in the end after 2 months of the home CRP: smoking habit, weight, abdominal perimeter, anxiety/ depression (measured by HADS: Hospital Anxiety and Depression scale) and employment status. Results A total of 173 patients has been studied. Mean age was 51.6 (SD: 7.94), 15.6% women. Indication for home CRP was non ST elevation myocardial infarction (NSTEMI) in 45.7%, 31.8% had STEMI, 17.9% after elective coronary interventions ,3.5% after cardiac arrest, and 1.2% corresponded to other causes. Patients were at low risk in 50%, 48% moderate and 2% high risk. With 1, 2, or 3 vessels disease in 38.1%, 28.3%, and 33.5% respectively. Coronary revascularization was obtained by percutaneous interventions in 80.9%, by surgery in 14.5% and 4.6% of patients received only medical treatment. At baseline, 33.5% obese and 55% smoked at index admission. After two months of home PRHC we obtained a reduction of 85.5% in smoking (p Conclusions The present study indicates that home- cardiac rehabilitation programs reduce anxiety, depression and improve return to work after acute coronary syndrome.

Funding Acknowledgements Type of funding sources: None. Introduction Cardiac rehabilitation programs (CRP) still do not reach all patients with this indication. In the context of COVID-19 pandemic, the new home CRP model has been introduced. Purpose To evaluate the results in terms of control of cardiovascular risk factors (CVRF) and changes in functional capacity with home CRP. Methods Cross-sectional observational study that included 173 patients, ≥ 18 years, after acute coronary syndrome or after coronary revascularization, included in home PRHC. Electronic medical records were analyzed to collect data on baseline clinical variables at the entrance and exit after 2 months of the home CRP: smoking habit, weight, abdominal perimeter, total cholesterol, LDLc, HDLc, triglycerides, HBA1c, METS in stress test and employment status. Results A total of 173 patients has been studied. Mean age was 51.6 (SD: 7.94), 15.6% women. Indication for home CRP was non-ST-elevation myocardial infarction (NSTEMI) in 45.7% of patients, 31.8% had STEMI, 17.9% after elective coronary interventions, 3.5% after cardiac arrest, and 1.2% corresponded to other causes. Patients were at low risk in 50%, 48% moderate and 2% high risk. With 1, 2, or 3 vessels disease in 38.1%, 28.3%, and 33.5% respectively. Coronary revascularization was obtained by percutaneous interventions in 80.9% while 14.5% by surgery. Baseline 45.7% of patients were hypertensive, 71.7% dyslipidemic, 33.5% obese, 15.7% diabetic, and 14 % smoked at index admission. After two months of home CRP we obtained a reduction of 85.5% in smoking (p Conclusions The present study indicates that home cardiac rehabilitation programs are a valid alternative in low- and moderate-risk patients after acute coronary syndrome.

IntroductionLegionnaires’ Disease is a pneumonia caused by Legionella spp., currently treated empirically with fluoroquinolones and macrolides. In this study, we aim to describe the antibiotic susceptibility pattern of environmental Legionella recovered in the south of Portugal.MethodsMinimal inhibitory concentration (MIC) determination of 57 Legionella isolates (10 Lp sg 1, 32, Lp sg 2-14 15 L. spp) was achieved by broth microdilution, as described by EUCAST, for azithromycin, clarithromycin, ciprofloxacin, levofloxacin, and doxycycline. ResultsFluoroquinolones were the most active antibiotic, displaying the lowest MIC values in contrast to doxycycline which had the highest. MIC90 and epidemiological cut-off (ECOFF) values were, respectively, 0.5/1 mg/L for azithromycin, 0.125/0.25 mg/L for clarithromycin, 0.064/0.125 mg/L for ciprofloxacin, 0.125/0.125 mg/L for levofloxacin and 16/32 mg/L for doxycycline.DiscussionMIC distributions were higher than reported by EUCAST for all antibiotics. Interestingly, two phenotypically resistant isolates with high-level quinolone resistance were identified. This is the first time that MIC distributions, lpeAB and tet56 genes have been investigated in Portuguese environmental isolates of Legionella.

Nontuberculous mycobacteria (NTM) are gaining interest with the increased number of infected patients. NTM Elite agar is designed specifically for the isolation of NTM without the decontamination step.

Introduction: This study aimed to develop an individualized artificial intelligence model to help radiologists assess the severity of COVID-19’s effects on patients’ lung health.Methods: Data was collected from medical records of 1103 patients diagnosed with COVID-19 using RT- qPCR between March and June 2020, in Hospital Madrid-Group (HM-Group, Spain). By using Convolutional Neural Networks, we determine the effects of COVID-19 in terms of lung area, opacities, and pulmonary air density. We then combine these variables with age and sex in a regression model to assess the severity of these conditions with respect to fatality risk (death or ICU).Results: Our model can predict high effect with an AUC of 0.736. Finally, we compare the performance of the model with respect to six physicians’ diagnosis, and test for improvements on physicians’ performance when using the prediction algorithm.Discussion: We find that the algorithm outperforms physicians (39.5% less error), and thus, physicians can significantly benefit from the information provided by the algorithm by reducing error by almost 30%.

Background The axillary web syndrome (AWS) is a surgical breast cancer sequel that limits the functionality of the patient and delays the protocol times of application of cancer treatments. This implies a long period of discomfort and limitations for the user. Objective To investigate the different physiotherapy treatments for the AWS and how effective they are. Methods A systematic review based on PRISMA protocol and registered in PROSPERO (CRD42021281354) was conducted. The research was performed using PubMed, Scopus, CINAHL, PEDro, and Web of Science databases during January 2022 and March 2022. All randomized controlled trials and controlled clinical trials were included in this review. Results A total of 188 articles were identified, with 9 studies selected for the systematic review. These studies basically propose treatments based on exercises and stretching, manual therapy, and the combination of manual therapy and exercises. Conclusions Exercise and stretching are the most effective therapies within the field of physiotherapy for the rehabilitation of axillary web syndrome. They restore range of motion faster, reduce pain, improve quality of life, and reduce disabilities. Manual therapy, scar massage, and myofascial release could help improve outcomes but with worse results. The meta-analysis conclusion is that pain is the only outcome with a significant reduction after the application of physiotherapy treatments − 0.82 [− 1.67; 0.03]. This conclusion is drawn from the only three studies with small sample sizes.

Magnetorheological elastomers (MREs) have been developed as a new class of smart materials for such diverse applications as adaptive vibration control of systems and energy dissipation. The linear viscoelastic (LVE) behavior of MREs is expected to play a significant role in determining filler morphology (structure, size, and aspect ratio) and working conditions. The LVE behavior of pre-structures, especially anisotropic structures, has not been clearly explained. To this end, this study aimed to analyze the LVE behavior and dynamic properties according to different pre-structures of magnetic particles. This is based on MRE pre-structures oriented at 0°, 30°, 45°, and 90° using oscillatory shear excitation as a function of frequency and amplitude sweep tests. For the latter, the excitation frequency and magnetic field intensity were analyzed. These analyses were performed for both storage modulus and loss factor corresponding to 10% strain amplitude from the roughly level linear line of the LVE region. The results showed that increasing the frequency or magnetic field intensity to increase anisotropy reduced the LVE limit. For every oriented pre-structure and analyzed frequency tested, the magnetic field decreased the LVE limit. Thus, the orientation of the carbonyl iron particles in the matrix enhanced the viscoelastic properties.

Society, industry, and particularly engineering are currently immersed in a profound technological change, oriented towards the optimization of processes and the improvement in the management of existing resources. From this point of view, it is interesting to incorporate systems capable of improving the operation and efficiency of the built environment. The study aims to address the current state of development of the different methodologies that make it possible to solve the need to move the focus away from the city to the territory that arose after the COVID-19 pandemic; with the consequent evolution of the concept of Smart City to Smart Territory. Methodologically, a review of the state of the art of the different currents is carried out, within the reference framework of Industry 4.0, which focuses on implementing intelligent systems for sensorisation and monitoring of infrastructures that enable more sophisticated, efficient, and optimal maintenance strategies. As a result, it should be noted that the current trend is obligatory since it is not so imperative to build new infrastructures in developed countries but rather to explore the possible extension of their useful life and to advocate a new approach to engineering based on sustainability criteria. Key Words: Smart-territory, maintenance, intelligent infrastructure, monitoring, Smart-city.

In this study, the newly synthesized TiO2 and N doped TiO2 clusters were added to silica sol to synthesize N-TiO2/SiO2 composites via the sol–gel method. Afterwards, the prepared sols were applied by brushing on portland cement. Doping with nitrogen significantly increased the absorption of TiO2 towards the visible region, thus, increasing the photocatalytic activity. SEM characterization of the treated samples showed that the clusters were distributed in form of aggregates on the samples’ surface. The self-cleaning and air de-polluting performances were assessed through methylene blue degradation and the oxidation of nitrogen oxide, resulting in methylene blue (MB) removal of 85% and 78% after 60 min of irradiation for SN10TiO2 and STiO2, respectively. Regarding air de-pollution performance, the newly synthesized photocatalysts showed the ability of NOx reduction. However, their efficiency was somewhat lower, in which 23.81% of NO has been oxidized by the sample SN10TiO2, while SP25 showed a total NO conversion of 38.98%. The powdered xerogels of the newly synthesized nanoparticles revealed high photocatalytic efficiency concerning NO oxidation, resulting in a higher performance compared to those obtained by the xerogel containing P25. Graphical abstract