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Background: We aim to assess whether time of day modified the treatment effect in the RACECAT trial (Direct Transfer to an Endovascular Center Compared to Transfer to the Closest Stroke Center in Acute Stroke Patients With Suspected Large Vessel Occlusion Trial), a cluster-randomized trial that did not demonstrate the benefit of direct transportation to a thrombectomy-capable center versus nearest local stroke center for patients with a suspected large vessel stroke triaged in nonurban Catalonia between March 2017 and June 2020. Methods: We performed a post hoc analysis of RACECAT to evaluate if the association between initial transport routing and functional outcome differed according to trial enrollment time: daytime (8:00 am –8:59 pm ) and nighttime (9:00 pm –7:59 am ). Primary outcome was disability at 90 days, as assessed by the shift analysis on the modified Rankin Scale score, in patients with ischemic stroke. Subgroup analyses according to stroke subtype were evaluated. Results: We included 949 patients with an ischemic stroke, of whom 258 patients(27%) were enrolled during nighttime. Among patients enrolled during nighttime, direct transport to a thrombectomy-capable center was associated with lower degrees of disability at 90 days (adjusted common odds ratio [acOR], 1.620 [95% CI, 1.020–2.551]); no significant difference between trial groups was present during daytime (acOR, 0.890 [95% CI, 0.680–1.163]; P interaction =0.014). Influence of nighttime on the treatment effect was only evident in patients with large vessel occlusion(daytime, acOR 0.766 [95% CI, 0.548–1.072]; nighttime, acOR, 1.785 [95% CI, 1.024–3.112] ; P interaction P interaction >0.1 for all comparisons). We observed longer delays in alteplase administration, interhospital transfers, and mechanical thrombectomy initiation during nighttime in patients allocated to local stroke centers. Conclusions: Among patients evaluated during nighttime for a suspected acute severe stroke in non-urban areas of Catalonia, direct transport to a thrombectomy-capable center was associated with lower degrees of disability at 90 days. This association was only evident in patients with confirmed large vessel occlusion on vascular imaging. Time delays in alteplase administration and interhospital transfers might mediate the observed differences in clinical outcome. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02795962.

Background: We aim to compare the outcome of patients from urban areas, where the referral center is able to perform thrombectomy, with patients from nonurban areas enrolled in the RACECAT trial (Direct Transfer to an Endovascular Center Compared to Transfer to the Closest Stroke Center in Acute Stroke Patients With Suspected Large Vessel Occlusion). Methods: Patients with suspected large vessel occlusion stroke, as evaluated by a Rapid Arterial Occlusion Evaluation score of ≥5, from urban catchment areas of thrombectomy-capable centers during RACECAT trial enrollment period were included in the Stroke Code Registry of Catalonia. Primary outcome was disability at 90 days, as assessed by the shift analysis on the modified Rankin Scale score, in patients with an ischemic stroke. Secondary outcomes included mortality at 90 days, rate of thrombolysis and thrombectomy, time from onset to thrombolysis, and thrombectomy initiation. Propensity score matching was used to assemble a cohort of patients with similar characteristics. Results: The analysis included 1369 patients from nonurban areas and 2502 patients from urban areas. We matched 920 patients with an ischemic stroke from urban areas and nonurban areas based on their propensity scores. Patients with ischemic stroke from nonurban areas had higher degrees of disability at 90 days (median [interquartle range] modified Rankin Scale score, 3 [2–5] versus 3 [1–5], common odds ratio, 1.25 [95% CI, 1.06–1.48]); the observed average effect was only significant in patients with large vessel stroke (common odds ratio, 1.36 [95% CI, 1.08–1.65]). Mortality rate was similar between groups(odds ratio, 1.02 [95% CI, 0.81–1.28]). Patients from nonurban areas had higher odds of receiving thrombolysis (odds ratio, 1.36 [95% CI, 1.16–1.67]), lower odds of receiving thrombectomy(odds ratio, 0.61 [95% CI, 0.51–0.75]), and longer time from stroke onset to thrombolysis (mean difference 38 minutes [95% CI, 25–52]) and thrombectomy(mean difference 66 minutes [95% CI, 37–95]). Conclusions: In Catalonia, Spain, patients with large vessel occlusion stroke triaged in nonurban areas had worse neurological outcomes than patients from urban areas, where the referral center was able to perform thrombectomy. Interventions aimed at improving organizational practices and the development of thrombectomy capabilities in centers located in remote areas should be pursued. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02795962.

The aim of this chapter will be to analyse how the main colonial powers deployed, at the end of the 19th century and the beginning of the 20th, different propaganda strategies with the aim of convincing their populations that the colonial adventure was the solution to their internal problems. In addition, it is intended to deepen the knowledge, on the one hand of the forms and methods used by the different European states to transmit colonial values and disseminate their colonial discourse and, on the other, to analyse how the different populations of the metropolises reacted to the fact that his country had colonies in overseas territories, in his various responses of consent, protest, or resigned acceptance, as well as the attempts to carry out anti-colonial actions by some European leftist parties.

Aims The interplay between aortic stenosis (AS), cardiovascular events, and mortality is poorly understood. In addition, how echocardiographic indices compare for predicting outcomes remains unexplored for the full range of AS severity. Methods and results We prospectively calculated peak jet velocity (Vmax) and aortic valve area (AVA) in 5994 adult subjects with and without AS. We linked ultrasound data to 5-year mortality and clinical events obtained from electronic medical records. Proportional-hazard and negative binomial regression models were adjusted for relevant covariables such as age, sex, comorbidities, stroke-volume, LV ejection fraction, left valve regurgitation, aortic valve sclerosis or calcification, and valve replacement. We observed a strong linear relationship between Vmax and all-cause mortality (hazard ratio: 1.26, 95% confidence interval: 1.19–1.33 per 100 cm/s), cardiovascular events, as well as incidental and recurrent heart failure (HF). Adjusted risks were highly significant even at Vmax values in the range of 150–200 cm/s, risk curves separating very early after the index exam. Vmax was not associated with coronary, arrhythmic, cerebrovascular, or non-cardiovascular events. Although risks were confirmed when AVA was entered in place of Vmax, the risks estimated for categories based on the two indices were mismatched, even in patients with normal flow. An external cohort comprising 112 690 patients confirmed augmented risks of all-cause and cardiovascular mortality starting at values of Vmax and AVA in the range of mild AS. Conclusions Aortic stenosis is strongly associated to all-cause mortality, cardiovascular mortality, and cardiac events, specifically HF. Risks increase in parallel to the degree of outflow obstruction but are apparent very early in patients with mild disease. Criteria for grading AS based on Vmax and AVA are mismatched in terms of outcomes.

Pulmonary thromboembolism (PTE) is a common and potentially serious disorder, characterised by highly variable clinical presentation, which makes it difficult to diagnose. Early estimation of severity is important to adjust the diagnostic process appropriately to manage the condition. In addition, the clinical likelihood of PTE should be considered, and laboratory tests (especially D-dimer) and imaging (echocardiogram, CT angiography) should not delay the start of emergency treatment. Treatment should be supportive, based on resolving vascular obstruction by fibrinolysis or anticoagulation, depending on the patient's clinical profile and situation, and on preventing recurrence.

espanolLa disnea aguda, definida como la sensacion consciente y subjetiva de dificultad respiratoria, es uno de los motivos de consulta mas frecuentes en los Servicios de Urgencias. Este sintoma puede ser secundario a multiples causas, por lo que su manejo debe comenzar con una valoracion precoz de la gravedad del cuadro que permita descartar aquellos procesos que pueden exigir una actuacion rapida, incluso antes de tener un diagnostico etiologico preciso. Excluidas causas emergentes, se procedera a una evaluacion paulatina y estructurada, iniciandose con una anamnesis y una exploracion fisica detalladas, asi como una serie de pruebas complementarias, entre las que no deben faltar el electrocardiograma, la analitica sanguinea y la radiografia de torax, pudiendo orientar el resto en funcion de la sospecha clinica. El presente protocolo describe este manejo inicial, asi como una propuesta de enfoque diagnostico segun los perfiles clinicos. EnglishAcute dyspnoea, defined as a conscious and subjective sensation of shortness of breath, is one of the most frequent reasons for consultation in the emergency department. This symptom may be secondary to multiple causes, and therefore its management should begin with an earky assessment of the severity of the condition, ruling out those processes that may require rapid treatment, even before a precise aetiological diagnosis has been made. Once emergent causes are excluded, a gradual and structured assessment should start with a detailed anamnesis and physical examination, along with a series of complementary tests, including an electrocardiogram, blood analysis and chest X-ray. Other tests should be guided by clinical suspicion. This protocol describes this initial management, and a proposed diagnostic approach according to clinical profiles.

Funder: Università degli Studi di Milano, OBJECTIVES: Interventional procedures around the knee are widely adopted for treating different musculoskeletal conditions. A panel of experts from the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the existing literature to assess the evidence on image-guided musculoskeletal interventional procedures around the knee, with the goal of highlighting some controversies associated with these procedures, specifically the role of imaging guidance, as well as the efficacy of the medications routinely injected. METHODS: We report the results of a Delphi-based consensus of 53 experts in musculoskeletal radiology, who reviewed the published literature for evidence on image-guided interventional procedures around the knee to derive a list of pertinent clinical indications. RESULTS: A list of 10 statements about clinical indications of image-guided procedures around the knee was created by a Delphi-based consensus. Only two of them had the highest level of evidence; all of them received 100% consensus. CONCLUSIONS: Ultrasonography guidance is strongly recommended for intra-articular and patellar tendinopathy procedures to ensure the precision and efficacy of these treatments. Prospective randomized studies remain warranted to better understand the role of imaging guidance and assess some of the medications used for interventional procedures around the knee. KEY POINTS: • A list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the knee was produced by an expert panel of the ESSR. • Strong consensus with 100% agreement was obtained for all statements. • Two statements reached the highest level of evidence, allowing us to strongly recommend the use of ultrasonography to guide intra-articular and patellar tendon procedures to ensure higher accuracy and efficacy of these treatments.

Background/Introduction Exertional dyspnea is a common finding in patients with Hypertrophic Cardiomyopathy (HCM), yet little data is available regarding the hemodynamic disturbances that lead to symptom development in this population. Purpose To investigate the mechanisms involved in the functional limitation of patients with HCM. Methods We prospectively studied 20 symptomatic patients with confirmed diagnosis of HCM. Assessment included NT-pro BNP levels, echocardiogram, and invasive characterization, where subjects also underwent invasive cardiopulmonary exercise testing. Results Median patient age was 57 (48–66) years old and 15 (75%) were male. Basal NT-pro BNP was elevated (748 pg/mL [406–1082]) and 8 (40%) subjects had NYHA functional Class III despite optimal medical treatment. Sarcomeric abnormal mutations were identified in 12 subjects (60%), most frequently in MYBPC3. Ultrasound imaging showed marked left ventricle (LV) hypertrophy (LV Mass Index 140 g/m2 [109–161]), with signs of LV outflow obstruction in 13 (65%) subjects. All patients displayed preserved ejection fraction (68% [61–73]). Significant mitral regurgitation was present in 5 subjects and median E/e' was 9.87 [6.43–13.14]. At rest, biventricular filling pressures were relatively normal, with upper limit mean Pulmonary Pressure (Table). Patients exercised for 6.4 (95% CI: 5.6–7.2) min, achieving a respiratory exchange ratio of 1.11 (1.02–1.17). All subjects displayed normal cardiac output at rest (5.6 L/min (3.7–7.5)), that increased during exertion, due mostly to a rise in heart rate (p Remarkably, although arterial hemodynamics were relatively normal at baseline, exercise induced significant increases both in the continuous (systemic vascular resistance) and pulsatile components of vascular load (Impedances, p Conclusion Exercise unmasks adverse hemodynamics in HCM, severely increasing LV filling pressures and showing systemic arterial dysfunction. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III, Spain.

Funder: Università degli Studi di Milano, OBJECTIVES: To perform a Delphi-based consensus on published evidence on image-guided interventional procedures for peripheral nerves of the lower limb (excluding Morton's neuroma) and provide clinical indications. METHODS: We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around peripheral nerves in the lower limb (excluding Morton's neuroma) to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper. RESULTS: Nine statements on image-guided interventional procedures for peripheral nerves of the lower limb have been drafted. All of them received strong consensus. Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. CONCLUSION: Despite the promising results reported by published papers on image-guided interventional procedures for peripheral nerves of the lower limb, there is still a lack of evidence on the efficacy of most procedures. KEY POINTS: • Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. • US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. • US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. The volume of local anesthetic affects the size of the blocked sensory area.

Background: Radiomics is an emerging field that translates medical images into quantitative data to enable phenotypic profiling of human disease. In this retrospective study, we asked whether it is possible to use image-based phenotyping to describe and determine prognostic factors in the aging population.Methods: A radiomic frailty cohort with 101 patients was included in the analysis (65 ± 15 years, 55 men). A total of 44 texture features were extracted from the segmented muscle area of the ultrasound images of the anterior thigh. Univariate and multivariate analyses were performed to assess the image data sets and clinical data.Results: Our results showed that the heterogeneity of muscle was associated with an increased incidence of hearing impairment, stroke, myocardial infarction, dementia/memory loss, and falls in the following two years. Regression analysis revealed a muscle radiomic model with 87.1% correct predictive value with good sensitivity and moderate specificity (p = 0.001).Conclusion: It is possible to develop and identify image-based phenotypes in the elderly population. The muscle radiomic model needs to further be validated. Future studies correlated with biological data (genomics, transcriptomics, metabolomics, etc.) will give further insights into the biological basis and molecular processes of the developed radiomic model.

To assess severity markers and outcomes of patients with systemic sclerosis (SSc) with or without pulmonary arterial hypertension (PAH-SSc/non-PAH-SSc), and the impact of interstitial lung disease (ILD) on PAH-SSc. Non-PAH-SSc patients from the Spanish SSc registry and PAH-SSc patients from the Spanish PAH registry were included. A total of 364 PAH-SSc and 1589 non-PAH-SSc patients were included. PAH-SSc patients had worse NYHA-functional class (NYHA-FC), worse forced vital capacity (FVC) (81.2 ± 20.6% vs 93.6 ± 20.6%, P

Background The determinants and consequences of pulmonary hypertension after successfully corrected valvular heart disease remain poorly understood. We aim to clarify the hemodynamic bases and risk factors for mortality in patients with this condition. Methods and Results We analyzed long‐term follow‐up data of 222 patients with pulmonary hypertension and valvular heart disease successfully corrected at least 1 year before enrollment who had undergone comprehensive hemodynamic and imaging characterization as per the SIOVAC (Sildenafil for Improving Outcomes After Valvular Correction) clinical trial. Median (interquartile range) mean pulmonary pressure was 37 mm Hg (32–44 mm Hg) and pulmonary artery wedge pressure was 23 mm Hg (18–26 mm Hg). Most patients were classified either as having combined precapillary and postcapillary or isolated postcapillary pulmonary hypertension. After a median follow‐up of 4.5 years, 91 deaths accounted for 4.21 higher‐than‐expected mortality in the age‐matched population. Risk factors for mortality were male sex, older age, diabetes mellitus, World Health Organization functional class III and higher pulmonary vascular resistance—either measured by catheterization or approximated from ultrasound data. Higher pulmonary vascular resistance was related to diabetes mellitus and smaller residual aortic and mitral valve areas. In turn, the latter correlated with prosthetic nominal size. Six‐month changes in the composite clinical score and in the 6‐minute walk test distance were related to survival. Conclusions Persistent valvular heart disease–pulmonary hypertension is an ominous disease that is almost universally associated with elevated pulmonary artery wedge pressure. Pulmonary vascular resistance is a major determinant of mortality in this condition and is related to diabetes mellitus and the residual effective area of the corrected valve. These findings have important implications for individualizing valve correction procedures. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00862043.

This paper proposes an algorithm to design ship power systems in the preliminary design phase. As a case study, an embedded control is integrated into the preliminary design of the ship power system, at the level of Energy Management System (EMS). The embedded control developed for the algorithm aims for cost, availability, safety and emissions optimization from the top layer. At the power system level, a few alternatives are considered such as full electric propulsion and fuel-based energy producers. Different Key Performance Indicators (KPIs), Key Exception Indicators (KEIs) and Key Improvement Indicators (KIIs) for design are evaluated for cost optimization purposes. Power plant sizing results of an Offshore Supply Vessel based on batteries or Generating Sets (GENSETs) power contribution are extracted with the proposed pro-clean power plant design algorithm structure. The result of this first simplified simulation not just include a comparative evaluation between 7 different types of batteries for an all electric ship sizing but also a maximum and instantaneous Depth of Discharge (DoD) of the batteries among the OSV load profile register which could be used as a control bandwidth to consider at the EMS level. The presented algorithm structure is a preface for later hybrid systems power plant sizing generalization.

The prevalence and management of coronary artery disease (CAD) in liver transplantation (LT) candidates are not well characterized. The aims of this study were to evaluate the impact on clinical outcomes of a specifically designed protocol for the management of asymptomatic CAD in LT candidates and to investigate noninvasive risk profiles for obstructive and nonobstructive CAD for 202 LT candidates. Those with high baseline cardiovascular risk (CVR; defined by the presence of classic CVR factors and/or decreased ejection fraction) received coronary angiography and significant arterial stenosis and were treated with percutaneous stents. Patients were followed up after LT until death or coronary event (CE). There were 78 patients who received coronary evaluation (62 direct angiography, 14 computed tomography coronary angiography, and 2 both). Of them, 39 (50%) patients had CAD of any severity, and 6 (7.7%) had significant lesions (5 were amenable to be treated with stents, whereas 1 patient had diffuse lesions which contraindicated the LT). Insulin-dependent diabetes was the only factor related to CAD of any severity (odds ratio, 3.44; 95% confidence interval [CI], 1.00-11.97). A total of 69 patients (46 with coronary evaluation) received LT. The incidence of CEs and overall survival after LT were similar between patients with and without coronary evaluation. Furthermore, no differences occurred between these groups in a multivariate competing risk model (subhazard ratio, 0.84; 95% CI, 0.27-2.61; P = 0.76). In conclusion, the application of an angiographic screening protocol of CAD in a selected high-risk Mediterranean population is safe and effective. The short- and medium-term incidence rates of CEs and death after LT in this population are similar to that observed in low-risk patients.

(1) Background: Radiogenomics is motivated by the concept that biomedical images contain information that reflects underlying pathophysiology. This review focused on papers that used genetics to validate their radiomics models and outcomes and assess their contribution to this emerging field. (2) Methods: All original research with the words radiomics and genomics in English and performed in humans up to 31 January 2022, were identified on Medline and Embase. The quality of the studies was assessed with Radiomic Quality Score (RQS) and the Cochrane recommendation for diagnostic accuracy study Quality Assessment 2. (3) Results: 45 studies were included in our systematic review, and more than 50% were published in the last two years. The studies had a mean RQS of 12, and the studied tumors were very diverse. Up to 83% investigated the prognosis as the main outcome, with the rest focusing on response to treatment and risk assessment. Most applied either transcriptomics (54%) and/or genetics (35%) for genetic validation. (4) Conclusions: There is enough evidence to state that new science has emerged, focusing on establishing an association between radiological features and genomic/molecular expression to explain underlying disease mechanisms and enhance prognostic, risk assessment, and treatment response radiomics models in cancer patients.

Background Patients with pulmonary hypertension (PH) have progressive and disabling symptoms, as well as a burden of treatments and a difficult clinical evaluation that make health-related quality of life a particularly relevant endpoint in this disease. The objective of the study was to evaluate patient-reported outcomes of patients receiving specific treatment for PH in a tertiary hospital using a specific questionnaire (Cambridge Pulmonary Hypertension Outcome Review-CAMPHOR) in the pharmacy consultation. Methods A cross-sectional, observational, descriptive study was conducted. It included all patients receiving specific treatment for PH in a tertiary hospital in Madrid, Spain. The inclusion period comprised between August to December 2019. CAMPHOR questionnaires containing three domains: symptoms, activities and quality of life were completed by the patients at the pharmacy consultation. Demographic and clinical variables, including WHO Functional Class (WHO FC), PH-specific tests and hemodynamic parameters, were recorded. Non-parametric analyses to assess relations between variables and CAMPHOR domains were performed. Results Thirty-six patients consented to participate in the study and completed the questionnaire. Median scores for symptoms, activities, and quality of life domains were 5.5 (2.5–10), 8.0 (4.5–10.5) and 3.5 (1–7.5), respectively. Statistically significant differences were found in the three domains when comparing by WHO FC, in the activities domain for 6-m walking test and in the quality of life domain for patients who had emergency visits or hospitalizations in the last year. Conclusions The CAMPHOR questionnaire could be useful as a complementary test to achieve an integrated evaluation of PH patients, who could complete it easily during their routine pharmacy visits.

Supplemental material, sj-docx-1-uix-10.1177_01617346211029656 for Diagnostic Performance of Muscle Echo Intensity and Fractal Dimension for the Detection of Frailty Phenotype by Rebeca Mirón Mombiela, Jelena Vucetic, Paloma Monllor, Jenny S. Cárdenas-Herrán, Paloma Taltavull de La Paz and Consuelo Borrás in Ultrasonic Imaging

En aquest quadern us presentem una serie de reflexions realitzades per un grup de professionals de diferents ambits com l’academic, el tecnic i el social. En aquesta ocasio el tema que tractem i analitzem es el de l’habitatge des de la perspectiva social. Portem anys que les problematiques en l’acces i en les condicions d’habitabilitat s’estan convertint en un dels principals eixos de l’exclusio social. Ja fa temps que s’utilitza el terme d’exclusio residencial com a dimensio amb identitat propia dins de les analisi de la pobresa i l’exclusio social. L’exclusio residencial i la social formen part d’un mateix entramat social. L’informe del Relator Especial sobre l’extrema pobresa i els drets humans, amb data 21 d’abril de l’any 2020, declara que a Espanya tot i que el govern ha reconegut que l’habitatge es fonamental per a combatre la pobresa, s’ha fet molt poc per a garantir el dret a l’habitatge de forma universal. En aquest context l’arribada de la pandemia del coronavirus ha suposat l’adopcio d’una serie de mesures amb l’objectiu de reduir en lo possible els efectes negatius que aquesta pot suposar per a les persones i families mes vulnerables l’acces i les condicions d’habitatge. El quadern que teniu a mans esta format per una serie d’articles escrits des de la interdisciplinarietat que representen els seus autors i autores i que tracten sobre diferents questions relacionades amb l’habitatge i que ens preocupen des de la perspectiva social. Amb l’objectiu de donar una visio amplia del tema el quadern comenca amb dos escrits de professors del Departament d’Economia Aplicada de la Universitat de Lleida en els que es posen de manifest la problematica de l’habitatge tant des d’una perspectiva individual com col·lectiva. Persones, grups de poblacio i societat en general son victimes d’una dinamica excessivament mercantilista de l’anomenat mercat de l’habitatge amb les repercussions corresponents en les condicions de vida. A continuacio dos escrits vinculats amb el paper que els Serveis Socials desenvolupen, o haurien de desenvolupar, en l’atencio a les necessitats d’habitatge per part de la poblacio mes vulnerable. Se’ns planteja la dificil gestio de la problematica de l’habitatge des de l’atencio primaria basica. A aquests dos escrits acompanya un tercer en el que es reflexiona sobre la manca de voluntat politica per afavorir la resolucio de la problematica de l’habitatge a la ciutat de Lleida. Segueixen dos escrits de l’ambit juridic en els que es valoren algunes de les mesures adoptades durant la pandemia per facilitar l’acces de la poblacio a habitatges de lloguer, fent una aportacio critica de les mateixes. Tot i la voluntat de les mesures, han estat insuficients. El darrer bloc esta format per quatre escrits en els que es plantegen accions dutes a terme per iniciatives privades per afavorir als col·lectius de poblacio mes vulnerable l’acces a un habitatge digne des de diferents formes de tinenca o no tinenca. El primer d’aquests escrits fa una breu reflexio sobre les propostes alternatives en un marc de dificil acces a l’habitatge. Esperem que aquestes reflexions siguin utils i il·lustratives per a les persones que les llegeixin. Aquesta, i no altra, es la nostra voluntat. Creiem que des de la nostra atalaia universitaria podem fer una aportacio d’interes i enriquir el debat social, amb l’objectiu de millorar les possibles analisis que es puguin fer i de donar pistes i orientacions a aquelles persones que, en moments molt complicats, han de prendre decisions.

This study analyses the impact of various types of innovation (product, process, organisational, and marketing innovation) on the business efficiency of small- and medium-sized hotel enterprises (SMHEs). Innovation in new products/services, support activities for the internal processes, sales channels or new positioning techniques for the product in the market, and methods for the establishment of prices all exert positive effects on the business efficiency of SMHEs in terms of sales growth and/or reduction of operating costs. These findings provide significant information for the design of effective innovation strategies in SMHEs.

Supplemental material, sj-docx-1-uix-10.1177_01617346211029656 for Diagnostic Performance of Muscle Echo Intensity and Fractal Dimension for the Detection of Frailty Phenotype by Rebeca Mirón Mombiela, Jelena Vucetic, Paloma Monllor, Jenny S. Cárdenas-Herrán, Paloma Taltavull de La Paz and Consuelo Borrás in Ultrasonic Imaging

Funder: Università degli Studi di Milano, OBJECTIVES: Image-guided musculoskeletal interventional procedures around the hip are widely used in daily clinical practice. The need for clarity concerning the actual added value of imaging guidance and types of medications to be offered led the Ultrasound and the Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) to promote, with the support of its Research Committee, a collaborative project to review the published literature on image-guided musculoskeletal interventional procedures in the lower limb in order to derive a list of clinical indications. METHODS: In this article, we report the results of a Delphi-based consensus of 53 experts who reviewed the published literature for evidence on image-guided interventional procedures offered in the joint and soft tissues around the hip in order of their clinical indications. RESULTS: Ten statements concerning image-guided treatment procedures around the hip have been collected by the panel of ESSR experts. CONCLUSIONS: This work highlighted that there is still low evidence in the existing literature on some of these interventional procedures. Further large prospective randomized trials are essential to better confirm the benefits and objectively clarify the role of imaging to guide musculoskeletal interventional procedures around the hip. KEY POINTS: • Expert consensus produced a list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the hip. • The highest level of evidence was only reached for one statement. • Strong consensus was obtained for all statements.

To determine the relationship between muscle echo intensity (EI) and fractal dimension (FD), and the diagnostic performance of both ultrasound parameters for the identification of frailty phenotype. A retrospective interpretation of ultrasound scans from a previous cohort (November 2014-February 2015) was performed. The sample included healthy participants = 60 divided into robust, pre-frail, and frail groups according to Fried frailty criteria. A region of interest of the rectus femoris from the ultrasound scan was segmented, and histogram function was applied to obtain EI. For fractal analysis, images were processed using two-dimensional box-counting techniques to calculate FD. Statistical analyses were performed with diagnostic performance tests. A total of 102 participants (mean age 63 +/- 16, 57 men) were evaluated. Muscle fractal dimension correlated with EI (r = .38, p < .01) and showed different pattern in the scatter plots when participants were grouped by non-frail (control + robust) and frail (pre-frail + frail). The diagnostic accuracy for EI to categorize frailty was of 0.69 (95%CI: 0.59-0.78, p = .001), with high intra-rater (ICC: 0.98, 95%CI: 0.98-0.99); p < .001) and inter-rater (ICC: 0.89, 95%CI: 0.75-0.95; p < .001) reliability and low measurement error for both parameters (EI: -0.18, LOA95%: -10.8 to 10.5; FD: 0.00, LOA95%: -0.09 to 0.10) in arbitrary units. The ROC curve combining both parameters was not better than EI alone (p = .18). Muscle FD correlated with EI and showed different patterns according to frailty phenotype, with EI outperforming FD as a possible diagnostic tool for frailty.

Glenohumeral osteoarthritis leads to a functional loss and a decrease in the quality of life of many patients that suffers it. Currently there is no agreement on the use of hemiarthroplasty or total arthroplasty as definitive treatment. The objective is to show the results of the treatment of primary glenohumeral osteoarthritis through hemiarthroplasty in our service.We reviewed 14 patients (19 hemiarthroplasties) performed between 2004 and 2013 in patients diagnosed with primary glenohumeral osteoarthritis without glenoid morphological anomaly. We managed to collect data from eight patients (11 hemiarthroplasties), assessing functional status, pain, and performing activities of daily living using the Constant, ASES and DASH scores preoperatively and at five years of minimum follow-up (range 5-11 years), as well as related complications. The preoperative status was compared to the end of the follow-up.A significant improvement was found in all the parameters analyzed in the study (p.0.05). The average pain in EVA score decreased from 8.89 to 2.67. The ASES improved from 13.51 to 63. 51 half point. The Constant increase of 20.11 points to 65.11 points. The mean preoperative score in the DASH score was 73.68 and 28.30 postoperatively. The average survival of the implant was 81.82% in the seven years of average follow-up. Shoulder hemiarthroplasty obtains good functional results in the treatment of primary glenohumeral osteoarthritis with few complications. The cause of the failure were glenoid erosion in all the cases.La artrosis glenohumeral conlleva a una pérdida funcional y a una disminución de la calidad de vida de muchos pacientes. Actualmente, no existe consenso en cuanto al uso de la hemiartroplastía o la artroplastía total como tratamiento definitivo para este padecimiento. El objetivo es mostrar los resultados del tratamiento de la artrosis glenohumeral primaria mediante hemiartroplastía en nuestro servicio.Revisamos 19 hemiartroplastías (14 pacientes) realizadas entre 2004 y 2013 en pacientes con artrosis glenohumeral primaria sin alteración morfológica glenoidea. Se recabaron los datos de ocho pacientes (11 hemiartroplastías), valorándose el estado funcional, el dolor y la realización de actividades de la vida diaria mediante las escalas Constant, ASES y DASH preoperatorias, a los cinco años de seguimiento mínimo (rango 5-11 años), así como las complicaciones presentadas. Se comparó el estado preoperatorio y al final del seguimiento.Se encontró una mejoría estadísticamente significativa (p.0.05) en todos los parámetros analizados en el estudio. La media del dolor en la escala EVA disminuyó de 8.89 a 2.67. La escala ASES mejoró de 13.51 a 63.51 puntos de media. El Constant aumentó de 20.11 a 65.11 puntos. La puntuación media preoperatoria en la escala DASH fue de 73.68 y la postoperatoria de 28.30 puntos. La supervivencia media del implante fue de 81.82% a los siete años de seguimiento medio. Obtuvimos buenos resultados funcionales con la artrosis glenohumeral primaria, presentándose pocas complicaciones. La causa del fracaso fue la erosión glenoidea.

Background Older age has been confirmed as a risk factor for severe clinical presentation of SARS-CoV-2 disease (COVID-19). The prevalence of confirmed SARS-CoV-2 infection in Catalonia among people over 60 years is 6.6%. Biological agents have not been associated with a higher incidence nor a worse prognosis of COVID-19. However, the role of immunosuppressants (IMS) on this issue is still to be elucidated. Moreover, there are scarce data related about COVID-19 in inflammatory bowel disease (IBD) patients under IMS, and none focusing in elderly IBD. Our aim was to describe and to compare the incidence and severity of COVID-19 in patients over 65 years of age with IBD, particularly in relation to the use of IMS. Methods We performed a retrospective cohort study including IBD patients over 65 years since January 2020, from two referral centres in the Barcelona metropolitan area (Catalonia, Spain). Patients were grouped in two cohorts regarding the use or not of IMS (thiopurines or methotrexate). Patients on biological treatment were excluded. We identified those cases with confirmed infection with SARS-CoV-2 (positive PCR) during the period from 1st of March 2020 (the beginning of the pandemic in Catalonia) to 1st March 2021 (the beginning of vaccination in the elderly). Demographic data, IBD comorbidities, concomitant non-IBD related treatments, and SARS-CoV-2 infection outcomes were recorded. Results Four-hundred and eighteen elderly IBD patients were included. The median age was 74 years (IQR 69–78), 52% were male; 70% had ulcerative colitis, 28% Crohn’s disease and 2% IBD unclassified, 62% had arterial hypertension, 22% diabetes mellitus, 22% cardiovascular disease, 15% chronic obstructive pulmonary disease, 10% chronic renal disease, 5% were active smokers. There were no differences regarding comorbidities and non-IBD treatments between the two study groups. From the whole cohort, 89 (21.3%) patients were on IMS (86 with thiopurines, 3 with methotrexate). The median time on IMS was 121 months (IQR 60–162). During the study period, 32 patients (7.7%) had confirmed SARS-CoV-2 infection (7 of whom were on IST; 7.6% not on IMS vs. 7.9% on IMS, P=0.933). Seventeen (53%) patients required hospital admittance (4% not IMS vs. 4.5% on IMS; P=0.818); 4 of them developed COVID-19 related complications (3 patients not on IMS vs. 1 on IMS), and 7 (22%) patients died (6 not on IMS vs. 1 patient on IMS). Conclusion The rate of SARS-CoV-2 infection among elderly IBD patients is quite similar to that reported in the elderly background population. In elderly IBD patients, SARS-CoV-2 infection was associated with a high admission rate and mortality, regardless of the use of IMS.

Rationale, aims and objectives Patients with pulmonary arterial hypertension (PAH) have progressive and disabling symptoms, as well as a burden of treatments and a difficult clinical evaluation that make health-related quality of life a particularly relevant endpoint in this disease. The objective of our study was to evaluate patient-reported outcomes of patients receiving specific treatment for PAH in a tertiary hospital using a specific questionnaire (Cambridge Pulmonary Hypertension Outcome Review-CAMPHOR). Methods A cross-sectional, observational, descriptive study was conducted. It included all patients receiving specific treatment for PAH in a tertiary hospital in Madrid, Spain. The inclusion period comprised between August to December 2019. CAMPHOR questionnaires containing three domains: symptoms, activities and quality of life were completed by the patients at the pharmacy consultation. Demographic and clinical variables, including WHO Functional Class (WHO FC), PAH-specific tests and hemodynamic parameters, were recorded. Non-parametric analyses to assess relations between variables and CAMPHOR domains were performed. Results Thirty-six patients consented to participate in the study and completed the questionnaire. Median scores for symptoms, activities, and quality of life domains were 5.5 (2.5 – 10), 8.0 (4.5 – 10.5) and 3.5 (1 – 7.5), respectively. Statistically significant differences were found in the three domains when comparing by WHO FC, in the activities domain for 6-meters walking test and in the quality of life domain for patients who had emergency visits or hospitalizations in the last year. Conclusions The CAMPHOR questionnaire could be useful as a complementary test to achieve an integrated evaluation of PAH patients, who could complete it easily during their routine pharmacy visits.

Sarcopenia is a disease characterized by decreased skeletal muscle mass, strength, and loss of function that can impair quality of life and increase physical disability, adverse metabolic effects, and mortality. This review familiarizes the reader with ultrasound (US)-based biomarkers for sarcopenia with a discussion of these topics: why assessing sarcopenia is relevant for radiologists, how to evaluate muscle structure with US, the current challenges or pitfalls of these biomarkers, and the implications of all the available evidence. It summarizes the most up-to-date literature on the pathophysiology behind the use of these US-based biomarkers, the biomarkers themselves, and a protocol used for their assessments. The article also describes representative examples that reflect modern practice in the field. Imaging is routinely used in clinical practice, and radiologists can play an important role in the evaluation of geriatric patients, providing an unprecedented opportunity to improve decision support in sarcopenia prevention and treatment.

Megalencephalic leukoencephalopathy with cysts is a leukodystrophy of genetic origin that produces an alteration in the water and ion homeostasis in the brain, generating vacuolar forms and chronic oedema in the white matter with progressive neurological deterioration. It should be suspected in infants who present progressive macrocephaly during the first year of life, motor retardation and characteristic findings in magnetic resonance brain scans.We report the case of a girl who was followed up from the age of 9 months due to progressive macrocephaly and delayed psychomotor development and brain MRI findings consistent with megalencephalic leukoencephalopathy with cysts, and the appearance of epilepsy during its development. The usual genetic studies (new generation sequencing and array) were negative, but as the diagnostic criteria were met, a complementary messenger RNA and DNA study was conducted, which confirmed the presence of two pathogenic variants in MLC1.Megalencephalic leukoencephalopathy with cysts is a rare condition. Progressive macrocephaly in the first year of life, the absence of deterioration or slow deterioration, and the possibility of developing epilepsy, spasticity and ataxia are characteristic signs in its course. It is important for these patients to undergo an imaging test that shows findings that characterise this condition, which, together with the clinical features, makes it possible to differentiate it from other leukodystrophies and to establish a confirmatory diagnosis. Genetic studies can confirm the associated mutation that makes it possible to predict the clinicoradiological phenotype.Leucoencefalopatía megalencefálica con quistes: importancia de la descripción clínica en la era genética.Introducción. La leucoencefalopatía megalencefálica con quistes es una leucodistrofia de origen genético que produce una alteración de la homeostasis del agua e iones en el cerebro, generando formas vacuolares y edema crónico en la sustancia blanca con deterioro neurológico progresivo. Debe sospecharse en los lactantes que presentan macrocefalia progresiva durante el primer año de vida, retraso motor y hallazgos característicos en la resonancia magnética cerebral. Caso clínico. Niña en seguimiento desde los 9 meses por macrocefalia progresiva y retraso del desarrollo psicomotor con presencia en la resonancia magnética cerebral de hallazgos compatibles con leucoencefalopatía megalencefálica con quistes, y aparición de epilepsia en su evolución. Los estudios genéticos habituales (secuenciación de nueva generación y array) fueron negativos, pero, al cumplir los criterios diagnósticos, se procedió al estudio del ARN mensajero y el ADN complementario, que confirmó la presencia de dos variantes patogénicas en MLC1. Conclusiones. La leucoencefalopatía megalencefálica con quistes es una entidad infrecuente. Es característica la macrocefalia progresiva en el primer año de vida, la ausencia de deterioro o deterioro lento, y la posibilidad de desarrollar epilepsia, espasticidad y ataxia en su evolución. Cobra importancia en dichos pacientes la realización de una prueba de imagen que muestre hallazgos propios de la entidad, lo que, junto con la clínica, permite diferenciarla de otras leucodistrofias y establecer un diagnóstico confirmatorio. Los estudios genéticos pueden constatar la mutación asociada que posibilita predecir el fenotipo clinicorradiológico.

El proyecto que vamos a plantear en esta memoria, y que se desarrolla dentro del TFM de GPC de la Universidad de Zaragoza, gira en torno a la figura y obra del escultor aragonés Manuel Arcón (Graus, Huesca, 1928- Zaragoza, 2018). Tras su fallecimiento consideramos oportuno plantear una acción cultural necesaria para que no quede en el olvido una de las figuras de origen aragonés que han dedicado toda su vida a la escultura y cuyo reconocimiento consideramos necesario. Este proyecto, en lo que se refiere a la celebración del homenaje, viene respaldado por otros escultores y artistas como son Alberto GÓMEZ ASCASO, Luis HINOJOSA GALINDO y Alfonso VAL ORTEGO, quienes al conocer la propuesta, que pretendo llevar a cabo, se ofrecieron para participar en el homenaje.La propuesta en la que trabajamos formará parte de las actividades culturales que cada verano se desarrollan en Graus, localidad donde nació el artista y que han manifestado interés para que así sea. Pero desde principio de este año, cuando comenzó a trabajar en el desarrollo del proyecto, hasta la fecha han sucedido algunos acontecimientos que han desvirtuado la actividad que hemos diseñado. Nos hemos encontrado con una serie de restricciones de movilidad, debidas al estado de alarma sanitaria originadas por la pandemia COVID19, que nos ha impedido trabajar interprovincialmente hasta este mes de junio.Dentro de la propuesta que presentamos destacaré la organización de una exposición audiovisual de su producción escultórica, acompañada de obras de escultores que lo conocieron (y cuya invitación a participar ya ha sido enviada) y que en este homenaje propiciarían con sus esculturas un acompañamiento a “el maestro” desaparecido y un diálogo necesario entre diferentes generaciones de artistas. Por las características de la exposición, titulada “Patios de Arte”, creo que es propicio plantear el evento este año ya que la muestra está previsto ubicarla en espacios abiertos, con capacidad de público reducida y que invita al paseo tranquilo. En lo que se refiere a la acogida del evento expositivo, este año se espera gran afluencia de visitantes, tanto de turistas como de quienes tienen su segunda residencia en Graus y que, debido a la incertidumbre de viajar a destinos vacacionales fuera de la península, consideramos que se verá incrementada su afluencia dentro de la comunidad aragonesa.Entre las propuestas que componen el programa que presentamos más adelante, está el compromiso ya cerrado para la instalación de un retrato en escultura que realizará el escultor Alberto Gómez Ascaso, discípulo de Arcón, y que se inauguraría el día en el que se presentan las actividades vinculadas a la conmemoración del escultor. Su ubicación será en la plaza Compañía, delante del espacio Pirineos en el que un día expusiera Manuel, con otros escultores de la Ribagorza. Con una proyección de la obras del artista sobre las fachadas de la plaza mayor, un lugar especial donde el evento toma cuerpo y el particular mundo del artista creador se aprecia en las imágenes-luz proyectadas acompañadas por la música Gymnopédies de Erik Satie como fondo y unas palabras del alcalde de Graus.Este acto esperamos que tenga continuidad en otras manifestaciones artísticas que se realizarán en un futuro próximo en la ciudad de Zaragoza y en Graus (Huesca) donde las Escuelas de arte y Asociaciones de artistas aragoneses tienen un papel fundamental y que con el nombre del escultor podrán programar jornadas en torno a la escultura aragonesa, junto a la participación de la Universidad de Zaragoza, donde los especialistas pueden aportar a la sociedad una parte del conocimiento que junto a los artistas emergentes y contemporáneos será generadora de sinergias para motivar con estas iniciativas una exposición posterior de las esculturas de Manuel Arcón, mediando su familia, para acceder al Espacio Pirineos de Graus.

Background: The assessment of vascular remodeling using optical coherence tomography (OCT) has been previously described in some types of pulmonary hypertension. However, evidence about its feasibility and clinical utility for evaluation of pulmonary arterial vasculopathy in advanced heart failure (HF) is scarce. Optical Coherence Tomography Observation of Pulmonary Ultra-Structural Changes in Heart Failure (OCTOPUS-CHF) study is designed to study the correlation between OCT-morphometric parameters and hemodynamic data measured or derived from right heart catheterization (RHC). Methods: OCTOPUS-CHF is an observational, prospective, multicentre study aiming to recruit 100 patients with advanced HF referred for heart transplantation (HTx) evaluation. As part of such evaluation, all patients will undergo RHC in order to rule out severe pulmonary hypertension. After RHC, a Dragonfly (TM) OPTIS (TM) imaging catheter will be used to perform OCT evaluation of a right-lower-lobe pulmonary artery with a luminal diameter

Background Smoking Habit (SH) is a relevant epidemiological factor in IBD, so it is recommended to quit. We have no data on the persistence of its long-term abandonment. Methods All patients of our hospital registred in the ENEIDA registry (spanish national IBD registry) with active SH at time of diagnosis were identified. Ex-smokers (> 6 months of abstinence) were invited to participate by telephone contact and epidemiological and SH data were recorded using medical records and telephone survey. The Fargeström Test for Nicotine Dependence (FTND) was used to grade the degree of addiction. Results 122 ex-smokers [88 Crohn Disease (CD), 33 Ulcerative Colitis (UC)] were included, the mean age of SH abandonment (SHA) was 41 years (33–48), lower in CD (38 years) compared to UC (46) (p-value 0.002). The mean time from diagnosis to SHA was 72 months in CD and 98 in UC. Patients had a 2-point degree of FTND addiction, higher in CD (p-value 0.063), with 80% of them working. In CD, the main motivation was medical indication as a specific treatment (28%) and for general health advice (23%); in UC were general health advice (45%) followed by associated comorbidities (15%). 90% of the cohort managed to quit smoking on their own and only 11% needed pharmacological help. 60% explained a relapse, on average at 12 months (3–36), with a higher rate in CD (46%) compared with UC (24%) (p-value 0.029) despite a longer mean follow-up of patients with UC (114 VS 168, p-value 0.035). 39% of them referred to be living with a smoker at the time of relapse. The only factor of those assessed that directly impacted the risk of relapse was a higher score on the FTND (p-value 0.027). Conclusion - The overall risk of relapse is 60%, half of which during the first year. Patients with CD have a higher risk, possibly due to a higher degree of addiction. - The only factor associated with relapse in (SH) was a higher FTND score. - SHA is delayed in relation to the diagnosis of IBD.

ObjectivesTo update the 2012 European Society of Musculoskeletal Radiology (ESSR) clinical consensus guidelines for musculoskeletal ultrasound referral in Europe.MethodsTwenty-one musculoskeletal imaging experts from the ESSR participated in a consensus study based on a Delphic process. Two independent (non-voting) authors facilitated the procedure and resolved doubtful issues. Updated musculoskeletal ultrasound literature up to July 2017 was scored for shoulder, elbow, wrist/hand, hip, knee, and ankle/foot. Scoring of ultrasound elastography was included. The strength of the recommendation and level of evidence was scored by consensus greater than 67% or considered uncertain when the consensus was consensus less than 67%.ResultsA total of 123 new papers were reviewed. No evidence change was found regarding the shoulder. There were no new relevant articles for the shoulder, 10 new articles for the elbow, 28 for the hand/wrist, 3 for the hip, 7 for the knee, and 4 for the ankle/foot. Four new evidence levels of A were determined, one for the hip (gluteal tendons tears), one for the knee (meniscal cysts), one for the ankle (ankle joint instability), and one for the foot (plantar plate tear). There was no level A evidence for elastography, although for Achilles tendinopathy and lateral epicondylitis evidence level was B with grade 3 indication.ConclusionsFour new areas of level A evidence were included in the guidelines. Elastography did not reach level A evidence. Whilst ultrasound is of increasing importance in musculoskeletal medical practice, the evidence for elastography remains moderate.Key Points center dot Evidence and expert consensus shows an increase of musculoskeletal ultrasound indications.center dot Four new A evidence levels were found for the hip, knee, ankle, and foot.center dot There was no level A evidence for elastography.

Objectives To investigate whether muscle quality based on echo intensity (EI) is associated with muscle strength (MS) and correlates with risk of frailty in elderly outpatients. Design Cross-sectional, experimental study. Setting Outpatient clinic. Participants Individuals aged 20 to 90 (N = 112). Individuals aged 20 to 59 participated as controls. Those aged 60 and older participated in the experimental group and were subdivided into robust, prefrail, and frail according to the Fried frailty criteria. Measurements EI, muscle thickness (MT), and subcutaneous fat thickness (SFT) of the anterior compartment of the thigh were measured using ultrasound images. MS was quantified using a hand dynamometer. Participants responded to a questionnaire asking about demographic and physical characteristics, frailty criteria, and quality of life. Results There was a significant negative correlation between EI and MS (Women: correlation coefficient (r) = −.522, P < .001; Men: r = −.355, P < .001). A similar trend was found for MT but not SFT. Statistically significant differences were also found between EI values, MT, MS, and quality of life and the different stages of frailty (P < .01). Conclusions Higher levels of EI were associated with lower levels of strength and greater frailty. These results, although needing to be replicated in larger and more-diverse populations, suggest that EI obtained using ultrasound images might be used as noninvasive imaging biomarker of frailty in elderly adults and opens the possibility of accurately testing interventions performed to prevent it.

Resumen Introduccion La historia clinica electronica y los soportes informaticos en la consulta han modificado la relacion medico-paciente. Este tipo de historia ofrece multiples ventajas, aunque dudamos del protagonismo que ha adquirido el ordenador, que ha pasado de ser una herramienta de trabajo a ser el centro de nuestra atencion durante la entrevista clinica, disminuyendo la interaccion con el paciente. El objetivo del estudio fue estimar el tiempo empleado por el medico de familia en el manejo del soporte informatico frente al dedicado a la comunicacion interpersonal durante cada consulta y si se modifica en funcion de variables como la edad del medico o el motivo de consulta. Material y metodos Realizamos un estudio observacional, descriptivo y transversal, donde participaron 2 centros de salud durante 10 semanas. El investigador asistio a todas las consultas, registrando la hora de entrada y salida del paciente de la consulta. Se cronometro cada vez que el medico fijaba su mirada en los soportes informaticos. Resultados Se recogieron 436 consultas. Los medicos miraron los soportes informaticos una mediana del 38,33% de la duracion total de una consulta. Los mayores de 45 anos dedicaron mas tiempo a fijar su vista en los soportes informaticos (p Conclusion Los medicos de familia utilizaron casi un 40% del tiempo de la consulta en mirar los soportes informaticos, variando segun edad del medico, numero de motivos de consulta y pacientes citados.

Image-guided interventional procedures of the nerves are commonly performed by physicians from different medical specialties, although there is a lack of clinical indications for these types of procedures. This Delphi-based consensus provided a list of indications on image-guided interventional procedures for nerves of the upper limb based on updated published evidence.An expert panel of 45 members of the Ultrasound and Interventional Subcommittees of the ESSR participated in this Delphi-based consensus study. After revision of the published papers on image-guided interventional procedures for nerves of the upper limb updated to September 2018, the experts drafted a list of statements according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus on statements regarding clinical indications was considered as strong when more than 95% of experts agreed, and broad if more than 80% agreed.Ten statements were drafted on procedures for nerves of the upper limb. Only two statements reached the highest level of evidence (ultrasound guidance is a safe and effective method for brachial plexus block; ultrasound-guided non-surgical approaches are safe and effective methods to treat carpal tunnel syndrome in the short term, but there is sparse evidence on the mid- and long-term effectiveness of these interventions). Strong consensus was obtained on 6/10 statements (60%), while 4/10 statements reached broad consensus (40%).This Delphi-based consensus study reported poor evidence on image-guided interventional procedures for nerves of the upper limb. Sixty percent of statements on clinical indications provided by the expert board reached a strong consensus.• An expert panel of the ESSR provided 10 evidence-based statements on clinical indications for image-guided interventional procedures for nerves of the upper limb • Two statements reached the highest level of evidence • Strong consensus was obtained on 6/10 statements (60%), while 4/10 statements reached broad consensus (40%).

BACKGROUND: Image-guided interventional procedures around the shoulder are commonly performed in clinical practice, although evidence regarding their effectiveness is scarce. We report the results of a Delphi method review of evidence on literature published on image-guided interventional procedures around the shoulder with a list of clinical indications. METHODS: Forty-five experts in image-guided musculoskeletal procedures from the ESSR participated in a consensus study using the Delphic method. Peer-reviewed papers regarding interventional procedures around the shoulder up to September 2018 were scored according to the Oxford Centre for Evidence-based Medicine levels of evidence. Statements on clinical indications were constructed. Consensus was considered as strong if more than 95% of experts agreed and as broad if more than 80% agreed. RESULTS: A total of 20 statements were drafted, and 5 reached the highest level of evidence. There were 10 statements about tendon procedures, 6 about intra-articular procedures, and 4 about intrabursal injections. Strong consensus was obtained in 16 of them (80%), while 4 received broad consensus (20%). CONCLUSIONS: Literature evidence on image-guided interventional procedures around the shoulder is limited. A strong consensus has been reached for 80% of statements. The ESSR recommends further research to potentially influence treatment options, patient outcomes, and social impact. KEY POINTS: Expert consensus produced a list of 20 evidence-based statements on clinical indications of image-guided interventional procedures around the shoulder. The highest level of evidence was reached for five statements. Strong consensus was obtained for 16 statements (80%), while 4 received broad consensus (20%).

Background The assessment of vascular remodeling using optical coherence tomography (OCT) has been previously described in some types of pulmonary hypertension. However, evidence about its feasibility and clinical utility for evaluation of pulmonary arterial vasculopathy in advanced heart failure (HF) is scarce. Optical Coherence Tomography Observation of Pulmonary Ultra-Structural Changes in Heart Failure (OCTOPUS-CHF) study is designed to study the correlation between OCT-morphometric parameters and hemodynamic data measured or derived from right heart catheterization (RHC). Methods OCTOPUS-CHF is an observational, prospective, multicentre study aiming to recruit 100 patients with advanced HF referred for heart transplantation (HTx) evaluation. As part of such evaluation, all patients will undergo RHC in order to rule out severe pulmonary hypertension. After RHC, a Dragonfly™ OPTIS™ imaging catheter will be used to perform OCT evaluation of a right-lower-lobe pulmonary artery with a luminal diameter ≤ 5 mm. The primary objective is to study the correlation of OCT parameters with hemodynamic RHC data. The secondary objective is to determine if OCT parameters improve prognostic stratification. Conclusions The OCTOPUS-CHF study will investigate the feasibility and clinical utility of pulmonary arterial vasculopathy evaluation with OCT in advanced HF patients and its correlation with hemodynamic RHC data. The ability of OCT-morphometric parameters to improve prognostic stratification will also be tested. Sin financiación 4.164 JCR (2020) Q2, 56/142 Cardiac & Cardiovascular Systems 1.406 SJR (2020) Q1, 62/349 Cardiology and Cardiovascular Medicine No data IDR 2020 UEM

KEY POINTS The right ventricle of the mammal heart is highly sensitive to the afterload imposed by a combination of the pulmonary circulation and the retrograde contribution of the left heart. Right ventricular afterload can be analysed in terms of pulmonary artery input impedance, which we were able to decompose as the result of the harmonic frequency responses of the pulmonary vessels and the left heart attached in series. Using spectral methods, we found a natural matching between the pulmonary vasculature and the left chambers of the heart. This coupling implies that the upstream transmission of the left heart frequency-response has favourable effects on the pulmonary tree. This physiological mechanism protects the right ventricle against acute changes in preload, and its impairment may be a relevant contribution to right ventricle dysfunction in pulmonary hypertension. ABSTRACT The right ventricle (RV) of the mammal heart is highly sensitive to the afterload imposed by the pulmonary circulation, and the left heart (LH) retrogradely contributes significantly to this vascular load. Transmission-line theory anticipates that the degree of matching between the frequency responses of the pulmonary vasculature and the LH should modulate the global right haemodynamic burden. We measured simultaneous high-fidelity flow (pulmonary artery) and pressure (pulmonary artery and left atrium) in 18 healthy minipigs under acute haemodynamic interventions. From these data, we decomposed the impedance spectra of the total right-circulation system into the impedance of the pulmonary vessels and the harmonic response of the LH. For frequencies above the first harmonic, total impedance was below the pulmonary impedance during all phases (P

Este artículo analiza el impacto de las innovaciones de producto (o servicio), procesos, organizacional y de marketing en el desempeño financiero de las pequeñas y medianas empresas (PYMES) hoteleras. El rendimiento financiero del negocio se refleja en dos indicadores: aumento de ventas y reducción de costes. Utilizando una amplia muestra de PYMES hoteleras españolas recogidas por el estudio INTURPYME (2013), nuestros resultados muestran un impacto positivo de la innovación en estos dos indicadores. Además, nuestros hallazgos indican que la relación entre las diferentes tipologías de innovación y el resultado empresarial presentan implicaciones reveladoras para las políticas y estrategias de innovación para las PYMES hoteleras. This article analyses the impact of product (or service), process, organizational and marketing innovations on financial performance of hospitality small and medium-sized enterprises (SMEs). The financial performance of the business is measured by two indicators: sales increase and cost reduction. Using a large sample of Spanish hospitality SMEs collected by the INTURPYME research project (2013), our results show a positive impact of innovation on these two indicators. In addition, our findings indicate that the relationship between the different types of innovation and financial performance show significant implications for the design of innovation policies and strategies for hospitality SMEs. Universidad de Sevilla. Máster Universitario en Economía y Desarrollo

Se ha realizado una crónica de exploración urbana en Alcorcón mediante unos deliberados recorridos por la ciudad -y uno extra desde una ciudad de otra periferia- en los cuales se han realizado fotografías con el fin de localizar las cuestiones estéticas, sociales o poblacionales que definen la idiosincrasia propia de esta población. Se compara estas sensaciones con las de una periferia ajena, la de una ciudad satélite de Moscú, para apreciar las cuestiones que generan un paisaje y una forma de vida común en las afueras de un espacio metropolitano, pero a su vez, detectar las variaciones y factores propios de la ciudad. El objetivo prioritario es el de reivindicar la necesidad de interpretar estos espacios periféricos de manera profunda y particular, para así realizar operaciones arquitectónicas y urbanísticas conscientes y adecuadas a sus características.

BACKGROUND: Although image-guided interventional procedures of the elbow and wrist are routinely performed, there is poor evidence in the literature concerning such treatments. Our aim was to perform a Delphi-based consensus on published evidence on image-guided interventional procedures around the elbow and wrist and provide clinical indications on this topic. METHODS: A board of 45 experts in image-guided interventional musculoskeletal procedures from the European Society of Musculoskeletal Radiology were involved in this Delphi-based consensus study. All panelists reviewed and scored published papers on image-guided interventional procedures around the elbow and wrist updated to September 2018 according to the Oxford Centre for Evidence-based Medicine levels of evidence. Consensus on statements drafted by the panelists about clinical indications was considered as "strong" when more than 95% of panelists agreed and as "broad" if more than 80% agreed. RESULTS: Eighteen statements were drafted, 12 about tendon procedures and 6 about intra-articular procedures. Only statement #15 reached the highest level of evidence (ultrasound-guided steroid wrist injections result in greater pain reduction and greater likelihood of attaining clinically important improvement). Seventeen statements received strong consensus (94%), while one received broad consensus (6%). CONCLUSIONS: There is still poor evidence in published papers on image-guided interventional procedures around the elbow and wrist. A strong consensus has been achieved in 17/18 (94%) statements provided by the panel on clinical indications. Large prospective randomized trials are needed to better define the role of these procedures in clinical practice. KEY POINTS: The panel provided 18 evidence-based statements on clinical indications of image-guided interventional procedures around the elbow and wrist. Only statement #15 reached the highest level of evidence: ultrasound-guided steroid wrist injections result in greater pain reduction and greater likelihood of attaining clinically important improvement. Seventeen statements received strong consensus (94%), while broad consensus was obtained by 1 statement (6%).

Background Image-guided interventional procedures of the nerves are commonly performed by physicians from different medical specialties, although there is a lack of clinical indications for these types of procedures. This Delphi-based consensus provided a list of indications on image-guided interventional procedures for nerves of the upper limb based on updated published evidence. Methods An expert panel of 45 members of the Ultrasound and Interventional Subcommittees of the ESSR participated in this Delphi-based consensus study. After revision of the published papers on image-guided interventional procedures for nerves of the upper limb updated to September 2018, the experts drafted a list of statements according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus on statements regarding clinical indications was considered as strong when more than 95% of experts agreed, and broad if more than 80% agreed. Results Ten statements were drafted on procedures for nerves of the upper limb. Only two statements reached the highest level of evidence (ultrasound guidance is a safe and effective method for brachial plexus block; ultrasound-guided non-surgical approaches are safe and effective methods to treat carpal tunnel syndrome in the short term, but there is sparse evidence on the mid- and long-term effectiveness of these interventions). Strong consensus was obtained on 6/10 statements (60%), while 4/10 statements reached broad consensus (40%). Conclusions This Delphi-based consensus study reported poor evidence on image-guided interventional procedures for nerves of the upper limb. Sixty percent of statements on clinical indications provided by the expert board reached a strong consensus.

The most common radiological error in examinations of the spine is the failure to diagnose fractures. This is the third most frequent reason for lawsuits brought against radiologists for negligence, after the failure to diagnose breast cancer and the failure to diagnose lung cancer. The thousands of radiological reports of spinal examinations done every year affect not only patients' health, but also their permission to be off work and their compensation. For this reason, it is our responsibility to know why errors are committed and how to detect them in order to avoid their repetition. In this article, we show the spectrum of the most common errors in our experience in double reading spinal examinations, and we try to determine what causes these errors.

Introduction Megalencephalic leukoencephalopathy with cysts is a leukodystrophy of genetic origin that produces an alteration in the water and ion homeostasis in the brain, generating vacuolar forms and chronic oedema in the white matter with progressive neurological deterioration. It should be suspected in infants who present progressive macrocephaly during the first year of life, motor retardation and characteristic findings in magnetic resonance brain scans. Case report We report the case of a girl who was followed up from the age of 9 months due to progressive macrocephaly and delayed psychomotor development and brain MRI findings consistent with megalencephalic leukoencephalopathy with cysts, and the appearance of epilepsy during its development. The usual genetic studies (new generation sequencing and array) were negative, but as the diagnostic criteria were met, a complementary messenger RNA and DNA study was conducted, which confirmed the presence of two pathogenic variants in MLC1. Conclusions Megalencephalic leukoencephalopathy with cysts is a rare condition. Progressive macrocephaly in the first year of life, the absence of deterioration or slow deterioration, and the possibility of developing epilepsy, spasticity and ataxia are characteristic signs in its course. It is important for these patients to undergo an imaging test that shows findings that characterise this condition, which, together with the clinical features, makes it possible to differentiate it from other leukodystrophies and to establish a confirmatory diagnosis. Genetic studies can confirm the associated mutation that makes it possible to predict the clinicoradiological phenotype.