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ABSTRACTThis study evaluates the relationship between solution heat treatment and hot plastic deformation before aging treatment and its effect on A356 alloys’ mechanical properties and microstructural features. The study employed tensile tests, Vickers microhardness tests, and electron microscopy analysis. The results show that hot plastic deformation before the solution treatment leads to higher elongation, ultimate tensile stress, and yield strength values, which can be attributed to modifications in eutectic Si particles (spheroidisation, aspect ratio and roundness). On the other hand, hot plastic deformation after the solution treatment mainly affects the elongation of the alloy. This effect is due to the fracture of eutectic Si particles and the formation of cracks and voids between these particles, which facilitate crack nucleation. Thus, the combination of hot plastic deformation and subsequent solution treatment significantly improves the mechanical properties of the A356 alloy. The observed changes in microstructure and mechanical behaviour provide valuable insights for optimising the material's properties and refining an established process in the automotive wheel industry.

El adecuado control del dolor posquirúrgico en pacientes intervenidos de artroscopia de rodilla resulta de suma importancia para permitir una movilización precoz, y con ello, el inicio de la rehabilitación.

This paper delves into the application of Digital Twin Technology (DTT) in the digitalization of assets, processes, and services to improve maintenance performance in railway applications in the context of European Regulation EU 779/2019. Digitalization plays a pivotal role in certifying the suitability of rolling stock in the railway sector. The primary objective of this study is to meticulously examine the fundamental tasks required to build a digital twin in this specific context. The process involves the contributions of key entities fulfilling specific roles: the maintenance and asset certification service provider ensures the integrity and compliance of rolling stock; specialists in IoT and process automation, along with experts in software platforms and services, are tasked with implementing the technological aspects of the digital twin. As a result, a methodology is proposed for the integration of digital design that combines three approaches: Service approach, platform architecture, and model-based asset digitalization. This paper delineates critical stages, from data acquisition and management to model creation and information integration, highlighting the crucial role of DTT in this process. Furthermore, the challenge of digitalization in situations where assets and processes are in an initial state of low or non-existent digitalization is underscored. A profound understanding of digital assets, information layers, and underlying models becomes crucial in the context of the current challenges of railway digitalization.

Land abandonment and rural depopulation are escalating worldwide, presenting sustainability dilemmas for both rural and urban regions. However, there remains a dearth of research on the sociocultural dimensions of abandonment from a local standpoint. This investigation focuses on a case study conducted in southeastern Spain, wherein a social survey was used to evaluate the perspectives of local communities concerning human–nature interconnectedness, land abandonment, and their impacts on quality of life. A survey campaign was administered in the case study region during the spring of 2021, and 122 surveys were collected. The findings identify, in the context of the progressive abandonment of rural lands in Spain, key factors that explain the desire of local people to inhabit and not abandon rural regions in southeastern Spain. Our results also show a strong connection between people and nature in rural Spain, which is explained by the capacity of locals to form relational values in rural environments and the existence of philosophical worldviews and emotional attachments to rural lifestyles. However, barriers to not abandoning rural environments were also identified, including a lack of professional and economic opportunities. Our results suggest that the mitigation of depopulation in rural areas in Spain requires actions to foster land stewardship and address socioeconomic imbalances.

Desde hace años se realizan consultas y seguimiento de pacientes de forma no presencial. Durante la pandemia de COVID-19 diferentes sociedades han recomendado potenciar las consultas telemáticas. La consulta preanestésica no presencial es un acto médico que debe incluir los objetivos básicos de evaluación, preparación, información y obtención del consentimiento. Se debe disponer de medios y tiempo para realizarla. Al comienzo de la consulta debe identificarse el médico y el o los progenitores. La consulta preoperatoria no presencial es especialmente útil en niños ASA I y II que van a someterse a cirugías de bajo riesgo, a una reintervención o a procedimientos diagnósticos. Aquellos pacientes que requieran una exploración física, más allá de la posible de manera telemática, deberán citarse en la consulta presencial. El personal de enfermería puede participar de forma activa en este proceso siempre y cuando el anestesiólogo supervise todo el proceso, tome todas las decisiones sobre el procedimiento y sea el responsable de la información que se da a los padres y al niño, aclarando personalmente cualquier duda. El anestesiólogo debe informar del procedimiento, sus riesgos, incluidos los personalizados, y alternativas. Se registrará en la historia clínica que se ha informado, cuándo y a quién. EL anestesiólogo firmará el Consentimiento Informado haciendo figurar la fecha que da la información y los padres deberán firmarlo antes de la intervención.

The aim of the present research was to investigate the influence of the application of a novel cold-pressing system in olive oil manufacturing on the characteristics of olive pomace (OP) and on its valorization by anaerobic digestion (AD). Green olives and olives in veraison, both from the Picual variety, were used with the objective of assessing the effect of ripening level on the performance of the AD processes. The AD processes of these OPs were assessed in biochemical methane potential (BMP) tests. The maximum methane yield (327 ± 5 mL CH4/g VS) and biodegradability value (90.8%) were found for the OP derived from green olives without cold-pressing, which showed the highest soluble COD (113 g O2/L) and the lowest total phenolic concentration (9 g gallic acid/L). The first-order and Transference Function (TF) kinetic models were employed to evaluate the variation in methane production with time and to obtain the kinetic parameters of the anaerobic processes of the four OPs tested. The kinetic constant from the first-order model, k, did not show significant differences for the four OPs tested and ranged between 0.23 and 0.27 day−1. The TF revealed that the values for the maximum methane production rate (Rmax) were slightly higher for the OPs derived from green olives compared to those obtained from olives in veraison. For the green olives, the cold-pressing system caused a decrease in the value of Rmaxfrom 87 ± 7 to 73 ± 6 mL CH4/(g VS·d).

This research was carried out with the aim to evaluate the anaerobic digestion (AD) of llama and dromedary dungs (both untreated and trampled) in batch mode at mesophilic temperature (35 °C). The biochemical methane potential (BMP) tests with an inoculum to substrate ratio of 2:1 (as volatile solids (VS)) were carried out. The methane yield from trampled llama dung (333.0 mL CH4g−1VSadded) was considerably higher than for raw llama, raw and trampled dromedary dungs (185.9, 228.4, 222.9 mL CH4g−1VSadded, respectively). Therefore, trampled llama dung was found to be the best substrate for methane production due to its high content of volatile solids as well as its high nitrogen content (2.1%) and more appropriate C/N ratio (23.6) for AD. The experimental data was found to be in accordance with both first-order kinetic and transference function mathematical models, when evaluating the experimental methane production against time. By applying the first-order kinetic model, the hydrolysis rate constants, kh, were found to be 19% and 11% higher for trampled dungs in comparison with the raw dung of dromedary and llama, respectively. In addition, the maximum methane production rate (Rm) derived from the transference function model for trampled llama dung (22.0 mL CH4g−1VS d−1) was 83.3%, 24.4% and 22.9% higher than those obtained for raw llama manure and for raw and trampled dromedary dungs, respectively.

La infección por SARS-CoV2 ha impactado de forma importante en los pacientes con trasplante renal causando una elevada mortalidad en los primeros meses de la pandemia. La reducción intencionada de la inmunosupresión se ha postulado como uno de los pilares en el manejo de la infección ante la falta de un tratamiento antiviral dirigido. Esta se ha modificado de acuerdo con la situación clínica de los pacientes, y su efecto sobre la función renal o los anticuerpos anti-HLA a medio plazo no ha sido evaluado.

La cirugía reciente es un factor de riesgo transitorio mayor y conocido de tromboembolia venosa (TEV) debido al bajo riesgo de recurrencia de la TEV una vez suspendida la anticoagulación. Por otro lado, se desconoce el riesgo de recurrencia de la TEV en los pacientes con TEV asociada a COVID-19. El objetivo de este estudio consistió en comparar el riesgo de recurrencia de la TEV entre pacientes con TEV asociada a COVID-19 y a cirugía.

L’exercice international de médecine de catastrophe de Madrid a rassemblé, dans le cadre d’une simulation d’attentats terroristes multisite de grande ampleur, plus de 500 participants provenant de 45 services médicaux d’urgence, de services de secours, et des forces de l’ordre. Les services médicaux d’urgence déployés provenaient de 16 régions d’Espagne et de 9 pays. Cette simulation a montré qu’il était possible à des équipes internationales et espagnoles de partager les mêmes protocoles au cours d’un attentat terroriste. Cet exercice a été très réaliste par la simulation avec des décors des effets pyrotechniques, des poursuites de véhicules et la présence de plus de 100 plastrons pris en charge au cours de fusillades, explosion, prise d’otages. Les évacuations par des convois d’ambulances médicalisées ont été effectuées en temps réel et couplées avec des exercices d’accueil massif de victimes dans les hôpitaux. Cet exercice a plusieurs particularités: les équipes engagées sur le terrain n’avaient aucune information préalable sur le scénario pour lequel ils étaient mobilisés; l’exercice s’est déroulé en temps réel, pendant une heure 15, devant plus de 3500 spectateurs rassemblés sur des gradins en face du théâtre des opérations. Cette représentation publique destinée à informer la population sur la réponse des services publics aux attentats terroristes a eu un fort impact médiatique.

A plethora of temperature-induced phase transitions have been observed in (CH3NH3)[M(HCOO)3] compounds, where M is Co(II) or Ni(II). Among them, the nickel compound exhibits a combination of magnetic and nuclear incommensurability below Néel temperature. Despite the fact that the zero-field behavior has been previously addressed, here we study in depth the macroscopic magnetic behavior of this compound to unveil the origin of the atypical magnetic response found in it and in its parent family of formate perovskites. In particular, they show a puzzling magnetization reversal in the curves measured starting from low temperatures, after cooling under zero field. The first atypical phenomenon is the impossibility of reaching zero magnetization, even by nullifying the applied external field and even compensating it for the influence of the Earth’s magnetic field. Relatively large magnetic fields are needed to switch the magnetization from negative to positive values or vice versa, which is compatible with a soft ferromagnetic system. The atypical path found in its first magnetization curve and hysteresis loop at low temperatures is the most noticeable feature. The magnetization curve switches from more than 1200 Oe from the first magnetization loop to the subsequent magnetization loops. A feature that cannot be explained using a model based on unbalanced pair of domains. As a result, we decipher this behavior in light of the incommensurate structure of this material. We propose, in particular, that the applied magnetic field induces a magnetic phase transition from a magnetically incommensurate structure to a magnetically modulated collinear structure.

Plastics are widely used for various applications. Once discarded, it is commonly known that they represent a high environmental threat due to their slow degradation; for this reason, there is an imminent need to replace these products with eco-friendlier ones. In the present work, four bacterial polyhydroxybutyrate (PHB) producers, two consortia, and two isolated strains were successfully recovered from the facilities of a paper-manufacturing industry. Spectroscopic studies of the biopolymers obtained from these bacteria corroborated their PHB production capabilities, ranging from 4.04 ± 0.16 to 23.82 ± 3.39 g/L. The characterization of the isolate that presented the highest production yield initially coded as E22 led to the identification of a Klebsiella pneumoniaestrain, which, compared with other PHA bacterial producers reported to date, could be considered with high production potential. The strain E22 was grown in 5 different media prepared from fruit peel residues of banana, orange, papaya, watermelon, and melon, to determine its growth and PHA production capabilities in these low-cost media. The results obtained show different bacterial growth yields among the media tested, although PHB production yields and productivities were similar in all these low-cost media. Cellular accumulation of the biopolymer was higher in watermelon peel medium (8.4 × 10−10g/CFU). These results reveal the potential of K. pneumoniaeE22 for PHB production applications and establish encouraging alternatives to be broader explored regarding low-cost media that could enhance the scale-up of bacterial PHA production processes.

El objetivo de este estudio es presentar una nueva aplicación de realidad virtual (RV) de bajo coste basada en el dispositivo Leap Motion Controller(LMC) desarrollada para la rehabilitación motora de miembros superiores tras patología neurológica y mostrar su viabilidad clínica realizando una experiencia piloto.

The aim of this study was to investigate the effect of a soft hydrothermal pre-treatment (SHP) on olive mill solid waste (OMSW) and its subsequent anaerobic digestion (AD). OMSW was pre-treated in an autoclave at temperatures of 121 °C and 133 °C and excess pressures of 1.1 and 2.1 bars, respectively at heating times of 15, 20, and 30 min. The digestibility of pre-treated and untreated OMSW was determined in terms of methane potential through using biochemical methane potentials tests (BMP). Important solubilization of high-valuable compounds such as hydroxytyrosol and 3,4-dihydroxyphenylglycol was observed after pre-treatments. SHP showed a significant reduction in fiber length and width (p< 0.05). A higher polysaccharides solubilization was observed in treatment at 121 °C compared with that observed at 133 °C. SHP carried out at 121 °C, 1.1 bar (30 min) (pre-treatment A1), allowed obtaining the highest methane yield (380 ± 5 mL CH4/g VS), which was 12.3% higher than that obtained for untreated OMSW. Pearson correlation (PEC) and principal component analysis (PCA) were carried out. PEC showed a positive correlation with phenol vanillic acid and PCA grouped pre-treatment A1 with polysaccharides solubilization. The influence of the SHP conditions on the AD of OMSW was assessed through the monitoring of process performance and calculation of kinetic parameters by using the transference function model.

Conocer las repercusiones del confinamiento por la pandemia de COVID-19 en los autocuidados de personas con enfermedades crónicas y en su salud percibida, e identificar factores para el manejo y la gestión de su enfermedad en situaciones de emergencia.

Tunneled island flaps that transfer skin from a site adjacent to the wound are an effective way to reconstruct defects. These flaps provide good aesthetic and functional results and can be completed during a single surgical session, thus reducing complications. The procedure consists of taking an island of skin about the size of the surgical defect and moving it through a subcutaneous tunnel to cover the wound. We aimed to exemplify the use of these flaps in different regions of the face.

Aim: To identify Prediabetes (PreD) as early and serious diabetes step using clinical-biochemical characteristics in the population of the Primary Prevention Diabetes Buenos Aires (PPDBA) study. Methods: PPDBA Study evaluated benefits of adopting healthy lifestyles to prevent T2D. It recruited people 45–75 years of age with PreD (impaired fasting glycaemia [IFG], impaired glucose tolerance [IGT] or both, American Diabetes Association criteria), using an opportunistic approach. They completed a FINDRISC questionnaire, and those with a score ≥13 points were invited to participate. When they accepted, we performed an oral glucose tolerance test (OGTT) with a complete lipid profile and HbA1c while physicians completed a clinical history. We recruited 367 persons, and depending on OGTT results, the sample was divided into normals (NGT), PreD, or with diabetes (last one was excluded in our analysis). Data were statistically analyzed using parametric and nonparametric tests and logistic regression to identify parameters associated with PreD. Results: From the recruited (n= 367) 47.7% have NGT, 48.5% PreD and 3.8% unknown T2D (excluded). People with PreD were significantly older, with a higher percentage of overweight/obesity, BMI, and larger waist circumference than NGT. They also showed significantly higher fasting and 2 h post glucose load, HbA1c, and triglyceride levels. No significant differences were recorded in the blood pressure, lipid profile though both groups had abnormally high LDL-c values. They also had a larger percentage of TG/HDL-c ratios (insulin resistance indicator) (55% vs. 37.5%). Logistic regression analysis showed that PreD was significant associated with age, waist circumference, and triglyceride above target values. Conclusion: Our findings showed that clinical and biochemical parameters were significantly different between people with PreD and those with NGT. This evidence supports the concept that PreD is a serious dysfunction, which should be early diagnosed and treated properly to prevent its transition to T2D and its complications.

There are several therapeutic options for infantile haemangiomas (IH). Propranolol is used according to a pivotal trial. We aimed to describe the characteristics of IH in clinical practice, including the therapies used, and to compare the characteristics of patients treated with propranolol with those of the trial to assess its external validity.

The landscape configuration of socio-ecological land systems results from the interaction between the environmental conditions (relatively homogeneous within ecoregions) and country-level management and land-use decisions. However, social, land-use and sustainability research disciplines often study each independently. We used Euclidean distance analyses of five indicators of land systems functioning to explore the geographical patterns of across-border human-induced asymmetries in transnational ecoregions of South America. The most asymmetric transnational ecoregions occurred in the tropical rainforest biome which also showed the widest range of asymmetry values compared to other biomes. In contrast, transnational ecoregions in montane grasslands showed comparatively little asymmetries, and tropical dry forests showed intermediate asymmetry values. This pattern indicates that major asymmetries occur in land systems located in productive biomes with a comparatively recent history of development, whereas mature socio-ecosystems with a long history of human land use are more homogeneous across borders. In some cases, asymmetries may stabilize as a consequence of reinforcing feedbacks that promote contrasting land-use decisions across borders, including, for example, the establishment of protected areas, or the promotion of agro-industrial activities. Transnational socio-ecological land systems can be used to evaluate alternatives for sustainable development because they highlight the influence of institutions under different governance regimes in defining the spatial configuration and ecological properties of regions. We invite land-use and sustainability scientists to consider political border interactions as valuable “natural experiments” to better understand the interrelations between biophysical and political systems in defining planetary geographical-ecology in the Anthropocene.

El sistema actual de salud debe transformarse para responder a las necesidades reales de la población mayoritaria que atiende, la población mayor: adaptar el hospital a sus necesidades y no al revés. Ese es el objetivo del Hospital Universitario Infanta Leonor: «Hospital amable para la persona mayor». El proyecto se constituyó como un proceso dentro del mapa de gestión por procesos del hospital. Se definieron 4 subprocesos sobre los que se sustentan todas las actividades y tareas: la asistencia sanitaria (prevención del deterioro funcional, prevención del deliriumy detección del anciano frágil), la formación, el entorno y sus estructuras y la implicación del paciente y sus familiares. El liderazgo corresponde al servicio de geriatría que coordina un equipo transversal de referentes del proyecto. Las acciones se sustentan en la evidencia científica, son rigurosas, evaluables y deben auditarse. El objetivo final es cambiar mentalidades, rutinas y hábitos establecidos para hacer del hospital un lugar más amable para la persona mayor.

Purpose: To evaluate the validity and reliability of the Child Perceptions Questionnaire 11–14 (CPQ11-14) for children attending public educational institutions in Floridablanca (Colombia). Methods: An evaluation study of diagnostic technology was conducted. The questionnaire was completed by 500 students aged 11–14 years who were selected by simple random sampling. The test–retest reproducibility was evaluated in 36 students chosen at random from one of the schools; the questionnaire was completed a second time by these students, with an interval of two weeks between administrations. Internal consistency was estimated using the Cronbach’s alpha coefficient, and test–retest reproducibility was determined with the intraclass correlation coefficient (ICC). The Rasch Rating Scale Model was used to perform the validation; the structure of the categories, the quality of the items, the invariance and the one-dimensionality were analyzed; invariance was confirmed using differential item functioning (DIF). Informed consent was obtained from the parents or guardians, and assent was obtained from the minors. Results: The mean age was 12.7 ± 1.1 years, and 210 (42.0%) participants were female. The Cronbach's alpha and ICC values were 0.91 and 0.63, respectively. The 37 items fit the Rasch model, but a uniform DIF was observed for an item that was eliminated. The questionnaire was not one-dimensional, and the proportion of variance explained by the model was poor (26.3%). Conclusion: The CPQ11-14 showed unsatisfactory test–retest reproducibility and excellent internal consistency; no unidimensionality was observed, but the items fit the Rasch model.

Background/Objectives: Radiotherapy (RT) is a component of therapy for head and neck cancer (HNC) with a negative nutritional impact. Our aim was to compare an early versus a conventional nutritional intervention. Subjects and methods: Retrospective study of HNC patients undergoing RT. Evolution before and after the establishment of a fast-track circuit was evaluated. A conventional group (CG) made up of patients submitted to the nutrition unit during RT after nutritional deterioration, was compared to an early group (EG) represented by patients included in a fast-track circuit, starting nutritional follow-up before the beginning of RT. Only patients with preserved oral intake were involved. Demographic, nutritional and clinical variables were analyzed. Data of hospitalizations and deaths were collected up to three months after RT. Results: 135 subjects constituted the EG and 39 the CG. At baseline, the prevalence of malnutrition was lower in the EG (31.9% vs 69.5%, p= 0.0001), as was the need for nutritional supplements (40% vs 79.5%, p= 0.0001) or nasogastric tube (0% vs 12.8%, p= 0.0001) in comparison to the CG. Three months after RT, there were less patients with oral nutritional support in the EG (79.1% vs 96.9%, p= 0.018), and the number of emergency visits (0.75 vs 1.1 episodes per patient, p= 0.021) and hospitalizations was also lower in this group (29% vs 59%, p= 0.044). Conclusions: The fast-track approach made early intervention possible. Therefore, patients maintained a better nutritional status, needed less nutritional support and their evolution improved, with a significant decrease in hospitalizations.

Purpose: To achieve the internal validation of predictive models for recurrence-free survival and risk of recurrence in patients with cervical cancer at any stage. Methods: A retrospective analysis of a prospectively collected data was conducted between January 2010 and January 2019 on 229 women with cervical cancer. We performed a survival analysis using the Kaplan–Meier method and, finally, developed a Cox model. We also elaborated a binomial generalized linear model for the occurrence of recurrence. Results: Median recurrence-free survival was 44.37 months (IQR = 44.81 months; R= 1–252). A reduction in the likelihood of recurrence-free survival of 40% was observed in the first 25 months of follow-up and, from that moment, it continued to decline gradually reaching the value of 9.8% at 6 and a half years, remaining stable from that moment until the end of the follow-up. We employed a Cox model with a predictive capacity of 78% and based on predictors as follow: maximum tumor diameter, PET-CT findings, and weekly dose of cisplatin. Thirteen ninety-seven percent  of patients developed, at least, 1 recurrence during the follow-up time. We employed a binomial generalized linear model with a predictive capacity of 80% and based on predictors as follow: FIGO stage and experience of adverse effects. Conclusions: Thirteen ninety-seven percent of patients with cervical cancer developed, at least, 1 recurrence. The highest reduction in the likelihood of recurrence-free survival was observed in the first 25 months of the follow-up duration. We developed solid models that, once externally validated, might provide useful prognostic information for both patients and oncologists at first consultation.

Purpose: We aimed to perform a longitudinal assessment of the quality of life of cervical cancer survivors comparing statistical significance with minimal clinically important difference. Methods: We conducted a prospective cohort study on the quality of life of 106 cervical cancer survivors between August 1, 2016 and January 31, 2019. The self-reported measures included the FACT-Cx v.4.0 and the WHOQOL-BREF questionnaires. Results: We found no statistically significant changes in the quality of life (p> 0.05), except for a significant worsening in the group that underwent primary surgery and adjuvant radiation therapy and chemotherapy (p= 0.041). However, we observed minimal clinically important differences for all questionnaires regarding the total score (7.81 vs. 23.83 vs. 11.5 vs. 15.5 vs. 26.87 SDs), “physical” (7.28 vs. 4.75 vs. 5.13 vs. 3.79 vs. 4.95 SDs), “functional” (7.87 vs. 4.84 vs. 3.21 vs. 6.93 vs. 12.02 SDs), “emotional” (4.12 vs. 2.34 vs. 1 vs. 1 vs. 3.54 SDs; except for the comparison between the questionnaires at 12–24 months and 24–60 months after the end of the therapy), and “additional concerns” (8.59 vs. 11.13 vs. 8.19 vs. 6.93 vs. 5.66 SDs; except for the comparison between the questionnaires at 0–6 months and 12–24 months after the end of the therapy) domains of the FACT-Cx. The quality of life of long-term cervical cancer survivors was moderate-optimal regarding WHOQOL-BREF questionnaire scores (minimum “psychological healtha”: 48 ± 14.04; maximum “environmentd” 67.46 ± 20.40). Conclusions: The quality of life of long-term cervical cancer survivors was moderate-optimal. No significant changes in the quality of life were found. However, considering minimal clinically important differences, there was an improvement of the quality of life throughout the follow-up.

La telangiectasia hemorrágica hereditaria (HHT, por sus siglas en inglés) es una enfermedad minoritaria con herencia autosómica dominante que provoca una afectación vascular sistémica.

El cistoadenoma mucinoso de ovario representa el 15% de las lesiones neoplásicas benignas del ovario, diagnosticándose por lo general entre los 20 y los 60 años de edad. Frecuentemente alcanza un gran tamaño ocasionando clínica compresiva. Presentamos a continuación el caso de una paciente joven que comenzó con clínica digestiva y distensión abdominal, siendo intervenida de un cistoadenoma ovárico gigante.

Abstract: High-frequency induction heating is frequently used to consolidate solid pieces of refractory ceramics. However, this valuable technique has not been deeply evaluated for sample preparation in light metal-based systems as an economical and feasible alternative for rapid sintering routes such as spark plasma sintering. This work deals with the potential use of induction heating to produce highly densified samples with refined microstructure, enhanced mechanical properties, and lower oxygen contamination. Here we demonstrate that induction-sintering can increase the hardness and yield strength in 70 and 80% respectively, compared to a commercial hardened alloy (AA-1350-H19). Theoretical calculations demonstrate that this behavior can be attributed to two main reinforcement mechanisms: dislocations obstruction and grain refinement. The increased mechanical response can be imputed to the effective sub-micron microstructure retention due to its shorter processing time and lower temperature compared to the conventional sintering process. Graphic abstract:

Estudios previos han sugerido que las diferencias en la estructura de los pies podrían afectar el comportamiento de la distribución de la presión plantar, por lo que esto podría aumentar la probabilidad de sufrir una lesión. El objetivo de este trabajo fue determinar el efecto de la morfología de las plantas de los pies sobre la distribución de la presión plantar entre el pie normal, el pie plano, cavo extremo y el pie cavo en condiciones estáticas y dinámicas.

A subset of families with co-dominant or recessive inheritance has been described in several genes previously associated with dominant inheritance. Those recessive families displayed similar, more severe, or even completely different phenotypes to their dominant counterparts. We report the first patients harboring homozygous disease-related variants in three genes that were previously associated with dominant inheritance:a loss-of-function variant in the CACNA1Agene and two missense variants in the RETand SLC20A2genes, respectively. All patients presented with a more severe clinical phenotype than the corresponding typical dominant form. We suggest that co-dominant or recessive inheritance for these three genes could explain the phenotypic differences from those documented in their cognate dominant phenotypes. Our results reinforce that geneticists should be aware of the possible different forms of inheritance in genes when WES variant interpretation is performed. We also evidence the need to refine phenotypes and inheritance patterns associated with genes in order to avoid failures during WES analysis and thus, raising the WES diagnostic capacity in the benefit of patients.

Reconstruction of the tip of the nose following the excision of skin cancer is a cosmetic and surgical challenge. We propose using a crescentic nasojugal flap, also known as a perialar crescentic advancement flap, to repair such defects. We present a series of 13 cases in which cutaneous carcinoma (mostly basal cell carcinoma) was excised from the lateral nasal tip with clear margins and the defect repaired with a crescentic nasojugal flap. The technique was successful in all cases. None of the patients developed notable surgical complications and the postoperative outcomes were satisfactory, with no significant functional or cosmetic problems. The crescentic nasojugal flap is therefore a good option for repairing medium-sized defects on the tip of the nose.

La trombosis venosa profunda y el tromboembolismo pulmonar son dos manifestaciones de un mismo proceso, la enfermedad tromboembólica venosa, que constituye una importante causa de morbimortalidad. Requiere un diagnóstico precoz y una rápida instauración del tratamiento anticoagulante. Se trata de una enfermedad multifactorial en la que intervienen factores genéticos y ambientales. Denominamos trombofilia a la tendencia a desarrollar episodios trombóticos y se suele clasificar en congénita o adquirida. Las trombofilias congénitas más relevantes son los déficits de antitrombina, proteína C y proteína S, la mutación del factor V Leiden y la mutación G20210A del gen de la protrombina. Entre las condiciones adquiridas se debe resaltar el síndrome antifosfolípido. Actualmente no se considera oportuno realizar el estudio de trombofilia a todos los pacientes que hayan presentado una trombosis. Se debe seleccionar cuidadosamente a los pacientes que se benefician de dicho estudio.

El tratamiento anticoagulante en la población anciana es un desafío para los profesionales, ya que este grupo poblacional presenta características que pueden modificar el riesgo trombótico y el riesgo hemorrágico. Se trata de pacientes que suelen tener diversas comorbilidades asociadas, múltiples fármacos que pueden interaccionar con el tratamiento anticoagulante, mayor fragilidad, así como factores personales y sociales que pueden condicionar la adherencia a un tratamiento específico. Actualmente, el abanico de opciones terapéuticas es más amplio que en décadas anteriores, por lo que es preciso realizar una adecuada valoración individual de cada paciente para elegir el fármaco anticoagulante que le aporte más beneficio.

La trombofilia es una predisposición congénita o adquirida a sufrir un evento trombótico. El desarrollo de la trombosis se debe a un proceso multifactorial en el que pueden intervenir tanto causas genéticas como factores ambientales. Ante un paciente que ha presentado una trombosis es fundamental realizar una adecuada investigación de la historia personal y familiar, antes de considerar un análisis específico de trombofilia. El estudio de trombofilia se suele indicar en pacientes que han presentado un episodio trombótico sin un claro factor desencadenante.

La enfermedad tromboembólica venosa es un problema médico de gran magnitud. Afecta a uno de cada 1000 adultos a nivel mundial. El uso rutinario de la tromboprofilaxis ha permitido reducir la morbimortalidad asociada a esta causa. Las estrategias de tromboprofilaxis se deberán basar en los factores de riesgo individual de los pacientes y del contexto clínico en el que se encuentren como operaciones, hospitalización o enfermedades oncológicas. Una herramienta útil son las escalas de riesgo trombótico para cada una de estas situaciones. El tratamiento de elección en la mayoría de las situaciones va a ser el farmacológico, reservando el tratamiento con medidas mecánicas para situaciones de alto riesgo hemorrágico o coadyuvante al tratamiento farmacológico. Los más extendidos en la actualidad son las heparinas de bajo peso molecular.

La presencia de clínica hemorrágica y/o de alteraciones en el estudio básico de coagulación en muchas ocasiones es consecuencia de una coagulopatía subyacente. Es muy importante saber interpretar si una clínica hemorrágica es o no patológica y qué estudios hay que realizar a nivel de laboratorio para el diagnóstico y confirmación de un trastorno de la hemostasia.

Las alteraciones adquiridas en la coagulación suelen ser diagnosticadas en la edad adulta en pacientes sin historia de coagulopatías y, gran parte de ellas, son secundarias a otras patologías subyacentes. La fisiopatología de las coagulopatías adquiridas es muy distinta de unas a otras. La coagulación intravascular diseminada (CID) es secundaria a una activación de la coagulación con un consumo de factores secundario, la hepatopatía crónica produce una hipoproducción tanto de factores de coagulación como de proteínas reguladoras de la hemostasia, la hemofilia A adquirida es secundaria a la producción de un anticuerpo inhibidor del factor VIII y tanto el síndrome de von Willebrand adquirido como el déficit adquirido de factor XIII tienen varias posibles causas. La clínica hemorrágica va a ser muy variable de unas a otras; de una clínica nula o muy leve en ciertos casos de CID o enfermedad hepática hasta sangrados de gravedad vital en la hemofilia A adquirida. Asimismo, a nivel de laboratorio, cada patología presentará unas alteraciones determinadas con las que se confirmará el diagnóstico definitivo. En general, el tratamiento de las causas subyacentes va a ser esencial para el control de estas coagulopatías, siendo de vital importancia el control de la clínica hemorrágica.

Esta actualización aborda el grupo de trastornos que van a afectar a las paredes de los vasos sanguíneos y a las plaquetas, que son parte fundamental de la hemostasia primaria. Se dividen en púrpuras (afectación vascular) o alteraciones cuantitativas o cualitativas de las plaquetas. Pueden ser congénitas o adquiridas. La incidencia de muchas de estas entidades va a ser baja, considerándose algunas como enfermedades raras. Las manifestaciones hemorrágicas típicas van a ser la aparición de sangrados cutaneomucosos con los traumatismos. Algunas de las coagulopatías congénitas van a formar parte de grupos sindrómicos en los que la afectación va a ir más allá de la clínica hemorrágica, requiriendo un abordaje multidisciplinar. En toda coagulopatía es importante realizar una historia clínica personal y familiar minuciosa. En este apartado, son útiles las pruebas de funcionalidad y agregación plaquetaria. Cada vez más se están conociendo las alteraciones genéticas que hay detrás de estos cuadros, cobrando más importancia las técnicas de diagnóstico molecular. En las formas congénitas, el tratamiento va a ser sintomático, dirigido según la localización y acompañado de equipos multidisciplinares. Para los casos con afectación de la función de las plaquetas, además se podrá optar por la transfusión de plaquetas.

La hemostasia es un proceso complejo en el que participan multitud de agentes (endotelio, proteínas, plaquetas, etc.) para conseguir un estado de homeostasis y evitar las hemorragias espontáneas y limitar el sangrado ante una lesión. El conocimiento ha ido evolucionando hacia un modelo en el que las reacciones de la coagulación se producen sobre las superficies celulares. Las coagulopatías congénitas se clasifican en leves, moderadas y graves en función del déficit de factor. Estudiaremos las hemofilias A y B, la enfermedad de von Willebrand y otras coagulopatías menos frecuentes por déficit de otros factores. Se basa en la historia clínica hemorrágica y la determinación del nivel del factor de coagulación. El estudio de la enfermedad de von Willebrand va a ser de los más complejos. El estudio molecular de estos trastornos está cobrando gran importancia, dado que puede ayudar con el diagnóstico, predecir el riesgo de desarrollo de inhibidores (hemofilias) y permitir establecer una correlación entre genotipo y fenotipo hemorrágico. El tratamiento se basa en la reposición del factor que se encuentra deficitario. Se recomienda hacerlo con los preparados comerciales disponibles; individualizar los tratamientos haciendo partícipe al paciente de estos y valorar otros tratamientos coadyuvantes para favorecer el proceso hemostático.

Metabolic syndrome (MetS) is a combination of various cardiovascular risk factors with a major impact on morbidity and premature mortality. However, the impact of MetS on self-reported health-related quality of life (HRQoL) is unknown.

Se ha comunicado la asociación de ictus isquémico y COVID-19, con mayor frecuencia en aquellos pacientes más graves. Sin embargo, se desconoce en qué medida podría estar en relación con la inflamación sistémica y la hipercoagulabilidad producidas en el contexto de la infección.

Background: Health professionals commonly use gait speed in the evaluation of functional status in older people. However, only a limited number of studies have assessed gait speed in the absence of disorders of gait, using confounding factors and exclusion criteria coming from studies conducted in younger people. Our study aims to analyse which factors are associated with gait speed in older people with normal clinical gait. Methods: An observational cross-sectional study was conducted in 119 community-dwelling residents without relevant comorbidities (Charlson index &lt; 2), preserved function (Barthel > 85) and normal gait by visual exploration. Exclusion criteria included suffering from any illness that could modify the characteristics of gait, terminal status or the presence of an acute medical illness in the past 3 months. We used a stepwise linear regression of several variables (sociodemographic characteristics, cognition, body composition, drugs, falls, sarcopenia, frailty and physical activity) on 6-metre gait speed. Results: The mean age was 78 years (range 70–96 years) and 71.4% were women. Variables that remained associated with gait speed in the multivariate final model were age (B= − 0.020, p&lt; 0.001); gender (B= − 0.184, p&lt; 0.001); waist-to-height ratio (B= − 0.834, p= 0.002); number of falls (B= − 0.049, p= 0.003) and the number of Fried’s frailty criteria (B= − 0.064, p= 0.019). Conclusion: Falls, frailty and the waist-to-height ratio modify gait speed in older people with normal gait. Studies analysing the potential effect of several factors on gait speed should consider them as confounding factors.

Pure K0.5Na0.5NbO3(KNN) and KNN doped with Li+(6% mole), La3+(1.66%, 5%, 6% mole), and Ti4+(10% mole) were prepared by mixture of oxides using high-energy milling and conventional solid-state reaction. The effects of the dopant on the physical properties of pure KNN have been evaluated based on the structural, ferroelectric, pyroelectric, and dielectric measurements. The XRD measurements show that KNN pure sample contains a mixture of monoclinic and orthorhombic crystalline phases, with a slightly higher concentration of monoclinic phase. In contrast, all doped samples show a higher concentration of the orthorhombic phase, as well as the presence of a secondary phase (K6Nb10.8O30), also detected by Raman measurements. The samples with a higher concentration of this secondary phase, also present greater dielectric losses and lower values of remnant polarization. The dielectric measurements allowed us to detect temperatures of structural transitions (orthorhombic-tetragonal, O-T) previous to the ferroelectric-paraelectric transition (tetragonal-cubic, T-C), and also in this set of samples, a direct correlation was found between the values of remnant polarization and the corresponding pyroelectric signal response.

The relationship between parasites and glomerulonephritis (GN) is well documented in certain parasitoses, but not in cases of Strongyloides stercolaris(S. stercolaris) where there are few cases described being the majority GN of minimal changes. We report a case of hyperinfestation by S. stercolarisin a patient affected by a membranous GN treated with oral corticosteroids with fatal outcome for the patient. This case provides a double teaching: first about a rare association of strongyloid and membranous GN and second about the importance of establishing a diagnosis of suspected and appropriate treatment for certain infections or diseases with little clinical expression before starting any immunosuppressive treatment.

La relación entre parásitos y glomerulonefritis (GN) está bien documentada en determinadas parasitosis, no así en casos de Strongyloides stercolaris (S. stercolaris), donde hay pocos casos descritos, siendo la mayoría GN de cambios mínimos. Reportamos un caso de hiperinfestación por S. stercolaris en un paciente afectado de una GN membranosa tratado con corticoides por vía oral con resultado fatal para el paciente. Este caso nos aporta una doble enseñanza: en primer lugar, acerca de una asociación rara de estrongiloidiasis y GN membranosa, y en segundo lugar, sobre la importancia de establecer un diagnóstico de sospecha y tratamiento adecuados ante determinadas infecciones o enfermedades con poca expresividad clínica antes de iniciar cualquier tratamiento inmunosupresor.