Search

Resumen: La Sociedad Española de Cirugía Cardiovascular y Endovascular, conjuntamente con el registro general de actividad 2022, muestra sus datos de actividad en pacientes con cardiopatía congénita (CC) del período temporal 2012-2022, basado en un registro voluntario y anónimo de los centros participantes. En 2022 ha aumentado significativamente la actividad de cirugía de CC en España, alcanzando cifras similares a las del año 2019, pre-pandemia. Presentamos agrupados los datos de actividad de los últimos 11 años para reflejar mejor nuestros resultados con estas patologías relativamente infrecuentes. En este tiempo se realizaron 22.056 cirugías de CC, que suponen un 9,5% de la cirugía cardiovascular mayor de nuestro país durante ese tiempo. El 82% de las cirugías congénitas se hicieron con circulación extracorpórea y el 18% restante, sin ella. Destacamos las intervenciones neonatales y en adultos con CC que asocian elevada complejidad, y suponen respectivamente el 18% y el 22% de la actividad total. Las CC operadas más prevalentes continúan siendo los defectos septales en los casos que requieren circulación extracorpórea y los ductus en pacientes operados sin circulación extracorpórea. Los datos se presentan ajustados a la escala Aristóteles básico de riesgo quirúrgico preoperatorio. La mortalidad observada en cirugías con circulación extracorpórea fue del 3% (Aristóteles: 6,39), y en cirugías sin circulación extracorpórea, del 2,34% (Aristóteles: 4,89).Nuestro registro nacional de actividad quirúrgica en CC muestra buenos resultados, permite establecer comparaciones a nivel nacional e internacional, para diseñar estrategias de mejora, fijar objetivos y aumentar la calidad de nuestras actuaciones. Abstract: The Spanish Society of Cardiovascular & Endovascular Surgery presents the 2012-2022 report of the activity in congenital cardiovascular surgery, based on a voluntary and anonymous registration involving most of Spanish centres. This article is complementary to the 2022 cardiovascular surgery annual report, and they are published together. In 2022 we observe an increase in congenital cardiovascular surgery, reaching numbers similar to pre-pandemic activity in year 2019. We included data from the previous 11 years, in order to obtain real information related to our activity with these relatively scarce pathologies. From year 2012 to 2022, 22,056 congenital heart surgeries were performed, accounting for 9.5% of all major surgery (congenital + acquired) performed in Spain during that period. Of these surgeries, 82% of them required extracorporeal circulation and 18% not. We highlight the interventions in neonates and adult patients, which mean respectively 18% and 22% of our whole activity and are a real challenge. The most prevalent congenital heart pathologies operated on were: septal defects in cases requiring extracorporeal circulation, and ductus in patients without extracorporeal circulation. The presented data are adjusted to the basic Aristotle score of preoperative surgical risk. The observed mortality of surgeries with extracorporeal circulation was 3% (Aristotle-6.39), and without cardiopulmonary bypass 2.34% (Aristotle-4.89).Our national registry of surgical activity in congenital heart disease shows good results, allows us to compare ourselves within a national and international framework, design improvement strategies, set objectives and improve the quality of our actions.

Resumen: El presente artículo resume los datos correspondientes a la actividad de cirugía cardiovascular realizada en España en el año 2022. Se elabora a partir de un registro anónimo y voluntario de datos agregados de hospitales de todo el país, quienes transfieren sus datos a la Sociedad Española de Cirugía Cardiovascular y Endovascular. Este es el 34.° año consecutivo en el que se reportan los datos de la actividad nacional. El análisis de la información del año 2022 servirá para evaluar la actividad en España después del fin de la pandemia por COVID-19 y sus estragos en el Sistema Nacional de Salud.En el año 2022 comunicaron su actividad 58 centros. Se realizaron 28.998 intervenciones, con 20.127 procedimientos de cirugía cardiaca mayor. De estos, 17.923 procedimientos fueron realizados con circulación extracorpórea, 18.210 fueron de enfermedad adquirida y 1.917 de enfermedad congénita. Además, se registraron 2.828 intervenciones de cirugía vascular periférica. En cuanto a los diferentes tipos de cirugía cardiaca mayor se realizaron: 7.596 procedimientos de cirugía valvular aislada, 1.621 de cirugía valvular combinada, 4.701 procedimientos de revascularización, 2.432 de cirugía de aorta y 579 procedimientos de válvulas transcatéter.En comparación con el año 2021, observamos un aumento de la cirugía cardiaca mayor adquirida, pero sin llegar a recuperar el nivel de actividad previo a la pandemia. Así mismo, se observó una reducción significativa de la mortalidad con respecto del año 2021, con índices de mortalidad ajustada al riesgo por debajo de 1 en todos los tipos de intervenciones salvo en cirugía polivalvular, combinada valvular y coronaria y en las complicaciones mecánicas del infarto. Abstract: This manuscript summarizes the data corresponding to the cardiovascular surgery activity carried out in Spain in 2022. It has been written based on an anonymous and voluntary registry of aggregated data from hospitals throughout the country, who transfer their data to the Spanish Society of Cardiovascular and Endovascular Surgery. This is the 34th consecutive year in which national activity data has been reported. The analysis of the information collected in 2022 will serve to evaluate the activity in Spain after the end of the COVID-19 pandemic and its impact to the National Health System.In 2022, 58 centers reported their activity. 28,998 interventions were performed, with 20,127 major cardiac surgery procedures. Of these, 17,923 procedures were performed with cardiopulmonary bypass, 18,210 were for acquired disease and 1,917 were for congenital disease. In addition, 2,828 peripheral vascular surgery interventions were recorded. Regarding the different types of major cardiac surgery, the following were performed: 7,596 isolated valve surgery procedures, 1,621 combined valve surgery, 4,701 revascularization procedures, 2,432 aortic surgery, and 579 transcatheter valve procedures.Compared to 2021, we observed an increase in acquired major cardiac surgery, but without recovering the level of activity prior to the pandemic. Likewise, a significant reduction in mortality was observed compared to 2021, with risk-adjusted mortality rates below 1 in all types of interventions except for multiple valve, combined valve and coronary procedures, and repair of mechanical complications of infarction.

El presente estudio busca contribuir a la caracterización del perfil longitudinal de la lámina libre en resaltos hidráulicos que tienen lugar en un cuenco amortiguador. Para ello, se desarrolla un modelo físico de cuenco amortiguador tipificado del United States Bureau of Reclamation (USBR II), sobre el cual se mide la superficie libre de un resalto con números de Froude y Reynolds Fr1=9 y Re1=14.7·104, empleando técnicas LIDAR (LIght Detection And Ranging). Junto con el perfil de la lámina libre se obtienen una serie de parámetros relacionados con el mismo y de relevancia para el funcionamiento del cuenco amortiguador. Los resultados obtenidos y su comparación con datos y expresiones procedentes de la bibliografía muestran que las técnicas empleadas son capaces de caracterizar de forma adecuada la superficie libre del resalto, lo cual resulta indicativo del potencial de esta novedosa instrumentación. Los resultados también apuntan a la capacidad del cuenco analizado para reducir las dimensiones del resalto manteniendo su capacidad disipadora de energía.

Los desastres se presentan cada vez con mayor frecuencia en todo el mundo y como resultado ha crecido de forma considerable la pérdida de vidas humanas. En sentido estricto, los desastres no son naturales, sino que se deben a la presencia de un fenómeno natural combinado con la presencia humana en su entorno. Los fenómenos atmosféricos o climáticos pueden generar un desastre cuando la sociedad y los ecosistemas son incapaces de enfrentarse a ellos con eficiencia; tal es el caso de las ondas cálidas, que, en múltiples ocasiones, en muchos países se han convertido en desastres de salud pública. Las ondas cálidas son períodos de tiempo inusualmente cálido y seco o cálido y húmedo, con un sutil inicio y cese, duración de al menos dos o tres días, responsables de una alta tasa de mortalidad y morbilidad y que varían en carácter e impacto aún en una misma localidad, es decir, son relativas al clima de un lugar. La capacidad de adaptación climática, sumada a características demográficas y socioeconómicas, puede determinar un nivel individual de riesgo; las ondas cálidas tienen mayor probabilidad de impactar a las siguientes poblaciones vulnerables: personas mayores y niños, individuos con condiciones de enfermedad preexistentes, que viven socialmente aislados, sin aire acondicionado, sin hogar, sin acceso a información oportuna de las temperaturas y afectaciones en la salud, incapacitados para moverse, propensos a sufrir alguna enfermedad mental, que no ser capaces de cuidarse y se encuentran en condiciones de pobreza en zonas urbanas. Vale destacar que las ondas cálidas incrementarán su intensidad, duración y frecuencia de acuerdo con los escenarios climáticos globales y regionales. Por lo anterior, en este texto se propuso cuantificar, para el período 2002-2023, el papel que las ondas cálidas han tenido en la salud de los habitantes y evaluar mediante la estimación de un índice de riesgo físico la vulnerabilidad humana al calor. Se eligió a Mexicali, Baja California, México, porque es la ciudad que durante el verano registra las temperaturas más altas de todo el país y anualmente se presentan afectaciones a la salud, producto de esas temperaturas extremas. Para tal fin se utilizaron dos enfoques. El primero se orientó a cuantificar las afectaciones a la salud ocasionadas por las temperaturas cálidas extremas, mediante los boletines epidemiológicos semanales que la Secretaría de Salud, dependiente del gobierno de México, pone a disposición de cualquier usuario interesado. Esta información se complementó con estudios locales, respaldados por instituciones de salud locales y el servicio médico forense. El segundo enfoque se orientó a estimar el riesgo físico por las temperaturas cálidas extremas mediante criterios de vulnerabilidad física y social por áreas geoestadísticas básicas. Se encontró que, debido a las ondas cálidas, el número total de personas afectadas fue de 1054, de las cuales 418 (39.7%) fueron por golpe de calor, 627 (59.5%) de agotamiento por calor y 9 (0.8%) por quemadura solar. Por la forma que la Secretaría de Salud agrupa los datos sobre golpes de calor, que incluye insolación, no fallecen todos los que se reportan en esta clasificación. Las defunciones, certificadas por el médico legista, alcanzaron un total de 332, con un valor máximo de 45 en el año 2023. Con el índice de riesgo físico se ratificó que las zonas más vulnerables al calor se ubican en zonas de la ciudad de Mexicali donde el nivel socioeconómico es bajo, los servicios públicos básicos son deficientes y los ingresos reducidos. Se concluye que las ondas cálidas en Mexicali son un problema de salud pública y que una posible solución para su mitigación es la de una planeación estratégica en la que participen gobierno, academia y empresas, vinculada a una red de comunicación, tanto de difusión gubernamental, como por el uso de redes sociales. También, se propone la creación de más áreas verdes o realizar reforestación urbana en las zonas más vulnerables, lo que podría servir como un recurso para disminuir la intensidad de la isla de calor urbano y de las ondas cálidas, y con ello generar zonas confortables al interior de la ciudad.

Antecedentes: Los mapas de bosques perturbados son útiles para identificar afectaciones sobre la biodiversidad y los servicios ecosistémicos. Los métodos que emplean únicamente datos espectrales para detectar las perturbaciones a nivel regional tienen limitaciones. El conocimiento de expertos y el análisis de fragmentación puede mejorar la estimación. Preguntas: ¿Cuál es la distribución de los bosques perturbados en una región de alta biodiversidad? ¿Qué tipos de vegetación y regiones son las más afectadas? Descripción de los datos: imágenes satelitales SPOT 2015, Sentinel-2 de 2019. Se colectó información de la vegetación en 653 sitios. Además, se usaron datos de herbario, censos agrícolas y del Inventario Nacional Forestal. Lugar y fecha del estudio: Estado de Chiapas, durante 2018-2022. Métodos: Se elaboró un mapa híbrido de los tipos de vegetación enfatizando la identificación de bosques secundarios, también se realizó un análisis de fragmentación y se calculó la biomasa leñosa por tipo de bosque. Resultados: El 40 % de la superficie del Estado mantiene una cobertura arbórea; pero solo en el 12 % no se aprecia perturbación; la mayor parte de los bosques no perturbados se encuentran en tres regiones: Selva Lacandona, Sierra Madre y Planicie del Golfo. En general la biomasa de los bosques perturbados es significativamente menor que la de su contraparte madura. Conclusiones: En Chiapas la distribución de los bosques en buen estado de conservación está restringida; casi la mitad de ellos se encuentran fuera de las ANP, por lo que es imperativo promover estrategias adicionales para su manejo y conservación.

El objetivo de este artículo es explicar un esquema orientador para el proceso de enseñanza y aprendizaje de la física general, que permita el desarrollo del pensamiento teórico en los estudiantes de ingeniería. La fundamentación teórica se basa en la Teoría Histórico-Cultural y utiliza, en particular, autores como Vygotski (1996), Davidov (1981, 1988, 1999) y Galperin (1973) para comprender el desarrollo del pensamiento teórico y los principios para que la enseñanza sea desarrolladora. El esquema orientador, propuesto a partir de estudios teóricos-bibliográficos, se traduce en un instrumento eficaz con la participación activa de los alumnos y del grupo en la construcción del conocimiento de la Física, apropiándose de los conceptos esenciales y comprendiendo los diferentes objetos de esta ciencia, lo que posibilita la construcción de nuevos significados y del pensamiento teórico.

En general, hay dos formas de dar cuenta de la realidad: trágica o épicamente. Platón criticó la primera y aplaudió la segunda. A esas formas corresponden dos modos de representación en perspectiva: cónica o ilusionista, y axonométrica o reflexiva. Nos proponemos reseñar que, a diferencia de algunos autores ilusionistas del Renacimiento y Barroco, ciertos artistas de la Modernidad del siglo XX optaron por la representación épica de la realidad, cuya objetividad plurifocal garantiza la axonometría.

Sexism during adolescence may hinder the attainment of gender equality and the eradication of violence against women. The aim of this research was to analyze the relationship between an individual’s view on gender equality and the internalization of ambivalent sexism, as well as to study the impact of different types of egalitarian attitudes (sociocultural, relational, and personal) on the levels of hostile and benevolent sexism among the adolescent population. A quantitative approach with a cross-sectional design was employed in this research. The sample group consisted of 1840 students (50.1% female and 49.9% male) in Compulsory Secondary Education in Castilla-La Mancha, Spain. The results show that adolescents who endorse pro-gender-inequality attitudes exhibit greater levels of hostile and benevolent sexism than their counterparts. Conversely, adolescents adopting pro-equality attitudes leads to lower levels of ambivalent sexism. In both male and female adolescents, egalitarian attitudes at the sociocultural, relational, and individual levels have a negative impact on the internalization of sexism. It is therefore crucial for both schools and families to prioritize the instruction of egalitarian values from early childhood, as this will aid in advancing a fairer and more equal society whilst eradicating sexist biases and violence against women.

BackgroundOur aim was to analyze the effects of a multicomponent exercise program (MEP) on frailty and physical performance in older adults with HIV (OAWH) since exercise can reverse frailty in the older population overall, but there is no data for OAWH.MethodsA prospective longitudinal study with intervention and control group was designed. Sedentary adults 50 or over with and without HIV were included. The intervention was a 12-week home-based MEP. Dependent variables were frailty (frailty phenotype), physical performance (Senior Fitness Test), muscle mass (ASMI) by bioimpedance. Pre- and postintervention measurements were analyzed using McNemar’s test for categorical variables and the Wilcoxon signed-rank test for quantitative variables.Results40 OAWH and 20 OA without HIV. The median age was 56.5 years. 23.3% were women. The prevalence of frailty was 6.6% with no frail HIV-negative participants. Three of the four frail HIV-participants transitioned two (50%) from frail to prefrail and one (25%) to robust after the MEP. In participants with an adherence ≥50%, physical performance was significantly improved [basal vs. 12 week]: upper extremity strength [13 (13–15) vs. 16 (15–19), p = 0.0001], lower extremity strength [13 (11–16) vs. 15 (13–16), p = 0.004], aerobic endurance [62 (55–71) vs. 66 (58–80), p = 0.005]. Participants with low adherence experienced a significant worsening in ASMI [8.35 (7.44–9.26) vs. 7.09 (6.08–8.62), p = 0.03].ConclusionA 12-week MEP enhances frailty by increasing robustness in OAWH, and improves physical performance, and preserves muscle mass in older adults with good adherence to the MEP independently of HIV status.Clinical trial number: NCT 05435521

Hunger affected 278 million people in Africa in 2021, and in Kenya, the proportion of the population unable to afford a healthy diet is 81%. To combat hunger and increase resilience throughout the food system, spirulina (Arthrospira platensis) has been shown to have remarkable properties. The main aim of this study is to investigate whether protein from spirulina is a suitable alternative to protein sourced from fish meal in fish feed for juvenile Nile tilapia (Oreochromis niloticus). In a trial investigating the use of spirulina biomass for fish feed on juvenile Nile tilapia, it has been proven that tilapia fingerlings fed diets with spirulina, replacing up to 30% of fish meal protein, were not affected in terms of growth performance compared to the fish fed the commercial diet. This shows that, nutritionally, protein from spirulina can replace fish meal protein fed to juvenile Nile tilapia. This offers promising opportunities for enhanced food and nutrition security. If produced affordably, spirulina can have a significant impact on the income level of low-income fish farmers in Kenya, who often spend more than 50% of their income on commercial fish feed. Affordability can be made possible if small-scale farmers can produce spirulina using animal manure that is available on the farm instead of using highly priced commercial fertilizer. The additional environmental benefits of spirulina include carbon dioxide sequestration and the removal of nitrogenous and phosphorous waste from the wastewater. Spirulina can therefore increase the sustainability of a whole food system.

BackgroundFrailty resulting from the loss of muscle quality can potentially be delayed through early detection and physical exercise interventions. There is a demand for cost-effective tools for the objective evaluation of muscle quality, in both cross-sectional and longitudinal assessments. Literature suggests that quantitative analysis of ultrasound data captures morphometric, compositional, and microstructural muscle properties, while biological assays derived from blood samples are associated with functional information. ObjectiveThis study aims to assess multiparametric combinations of ultrasound and blood-based biomarkers to offer a cross-sectional evaluation of the patient frailty phenotype and to track changes in muscle quality associated with supervised exercise programs. MethodsThis prospective observational multicenter study will include patients aged 70 years and older who are capable of providing informed consent. We aim to recruit 100 patients from hospital environments and 100 from primary care facilities. Each patient will undergo at least two examinations (baseline and follow-up), totaling a minimum of 400 examinations. In hospital environments, 50 patients will be measured before/after a 16-week individualized and supervised exercise program, while another 50 patients will be followed up after the same period without intervention. Primary care patients will undergo a 1-year follow-up evaluation. The primary objective is to compare cross-sectional evaluations of physical performance, functional capacity, body composition, and derived scales of sarcopenia and frailty with biomarker combinations obtained from muscle ultrasound and blood-based assays. We will analyze ultrasound raw data obtained with a point-of-care device, along with a set of biomarkers previously associated with frailty, using quantitative real-time polymerase chain reaction and enzyme-linked immunosorbent assay. Additionally, we will examine the sensitivity of these biomarkers to detect short-term muscle quality changes and functional improvement after a supervised exercise intervention compared with usual care. ResultsAt the time of manuscript submission, the enrollment of volunteers is ongoing. Recruitment started on March 1, 2022, and ends on June 30, 2024. ConclusionsThe outlined study protocol will integrate portable technologies, using quantitative muscle ultrasound and blood biomarkers, to facilitate an objective cross-sectional assessment of muscle quality in both hospital and primary care settings. The primary objective is to generate data that can be used to explore associations between biomarker combinations and the cross-sectional clinical assessment of frailty and sarcopenia. Additionally, the study aims to investigate musculoskeletal changes following multicomponent physical exercise programs. Trial RegistrationClinicalTrials.gov NCT05294757; https://clinicaltrials.gov/ct2/show/NCT05294757 International Registered Report Identifier (IRRID)DERR1-10.2196/50325

Abstract Background/Objectives Several studies have shown a relationship between vitamin D and migraine, including the association between decreased serum 25‐hydroxyvitamin D in patients with migraine and the positive effects of vitamin D supplementations in the therapy of this disease. Two single‐nucleotide variants (SNVs) vitamin D receptor (VDR) gene, VDR rs2228570, and VDR rs731236 have shown an association with migraine risk in a previous case–control association study, while an exome sequencing study identified a rare variant in GC vitamin D binding protein gene. This study aims to look for the association between several common variants in these two genes and the risk for migraine. Methods We genotyped 290 patients diagnosed with migraine and 300 age‐matched controls using specific TaqMan assays for VDR rs2228570, VDR rs731236, VDR rs7975232, VDR rs739837, VDR rs78783628, GC rs7041, and GC rs4588 SNVs. Results We did not find an association between these SNVs and the risk for migraine. None of these SNVs were related to the positivity of a family history of migraine or with the presence of aura. The VDR rs731236A allele showed a significant association with the triggering of migraine attacks by ethanol (Pc = 0.007). Conclusions In summary, the results of the current study suggest a lack of association between common SNVs in the VDR and GC gene and the risk of developing migraine. The possible relationship between VDR rs731236 and the triggering of migraine episodes with ethanol deserves future studies.

Reseñas de libros

En el presente artículo trataremos de definir el icono en contraste con la obra de arte en el sentido más moderno del término. A lo largo del texto daremos cuenta de la densidad teológica y de la originalidad que el icono posee, de su peculiar penetración en el sentido de lo real, así como de la relación ontológica que mantiene con el modelo que epifánicamente representa. Al mismo tiempo pretendemos aglutinar las constantes metodológicas y formales que el iconógrafo muestra en su hacer, muchas de las cuales, aunque parcialmente conocidas y analizadas, se hallan dispersas en la bibliografía más especializada.

Abstract The performance of stilling basins including a negative step was analyzed addressing its effect on the energy dissipation efficiency, dimensions and structural properties of the hydraulic jump, streambed pressures and pressure fluctuations. Six different cases were simulated, considering two possible relative heights for the step and three possible Froude numbers. The results show that the step yields to lower subcritical depths, allowing smaller basin dimensions. Nevertheless, it tends to slightly increase the roller length of the jump. Concerning the relative energy dissipation, results confirm the improvement derived from the step presence. The internal flow occurring in the jump was also analyzed, and more specifically the subzones generated upstream and downstream the impingement point. The results prove the contribution of the negative step in the stabilization of hydraulic jumps in the stilling basin. In particular, a general decrease of the streambed pressure is observed. In addition, pressure fluctuations are significantly reduced due to the negative step size influence on the hydraulic jump. Furthermore, the effectiveness of the computational fluid dynamics (CFD) techniques to simulate stilling basin flows and to adequately characterize the hydraulic jump performance was confirmed.

Mg-Zn co-doped GaN films were deposited by radio-frequency magnetron sputtering in an N2-Ar2 environment at room temperature, using a target prepared with Mg-Zn co-doped GaN powders. X-ray diffraction patterns showed broad peaks with an average crystal size of 13.65 nm and lattice constants for a hexagonal structure of a = 3.1 Å and c = 5.1 Å. Scanning electron microscopy micrographs and atomic force microscopy images demonstrated homogeneity in the deposition of the films and good surface morphology with a mean roughness of 1.1 nm. Energy-dispersive spectroscopy and X-ray photoelectron spectroscopy characterizations showed the presence of gallium and nitrogen as elemental contributions as well as of zinc and magnesium as co-doping elements. Profilometry showed a value of 260.2 nm in thickness in the Mg-Zn co-doped GaN films. Finally, photoluminescence demonstrated fundamental energy emission located at 2.8 eV (430.5 nm), which might be related to the incorporation of magnesium and zinc atoms.

Background: Individuals with chronic kidney disease (CKD) often experience reduced muscle strength and diminished health-related quality of life (HRQoL), and engaging in regular exercise may improve them. The aim of this study was to assess the effect of intradialytic exercise using non-immersive virtual reality (VR) on body composition of patients with CKD on hemodialysis (HD). Methods: This was a substudy in a clinical trial of intradialytic exercise intervention using a non-immersive VR game in which the patient interacted by moving the lower limbs. Body composition was determined by BCM Fresenius multifrequency stereoscopic bioimpedance. Body mass index (BMI), fat tissue index (FTI), lean tissue index (LTI), extracellular/intracellular water (EIW), and phase angle (PA) were recorded in 52 patients, 24 in the control group (CG) and 28 in the exercise group (EG). Results: Statistically significant differences were observed between both groups. The LTI increased in the EG while it decreased in the CG. The FTI and the EIW decreased in the EG compared to the increase observed in the CG. Conclusions: Intradialytic exercise using non-immersive VR was associated with an increase in LTI and a decrease in FTI of CKD patients on HD.

The main purpose of the paper is to show how a magnetoresistive (MR) element can work as a current sensor instead of using a Wheatstone bridge composed by four MR elements, defining the concept of a magnetoresistive shunt (MR-shunt). This concept is reached by considering that once the MR element is biased at a constant current, the voltage drop between its terminals offers information, by the MR effect, of the current to be measured, as happens in a conventional shunt resistor. However, an MR-shunt has the advantage of being a non-dissipative shunt since the current of interest does not circulate through the material, preventing its self-heating. Moreover, it provides galvanic isolation. First, we propose an electronic circuitry enabling the utilization of the available MR sensors integrated into a Wheatstone bridge as sensing elements (MR-shunt). This circuitry allows independent characterization of each of the four elements of the bridge. An independently implemented MR element is also analyzed. Secondly, we propose an electronic conditioning circuit for the MR-shunt, which allows both the bridge-integrated element and the single element to function as current sensors in a similar way to the sensing bridge. Third, the thermal variation in the sensitivity of the MR-shunt, and its temperature coefficient, are obtained. An electronic interface is proposed and analyzed for thermal drift compensation of the MR-shunt current sensitivity. With this hardware compensation, temperature coefficients are experimentally reduced from 0.348%/°C without compensation to −0.008%/°C with compensation for an element integrated in a sensor bridge and from 0.474%/°C to −0.0007%/°C for the single element.

Resumen: La Sociedad Española de Cirugía Cardiovascular y Endovascular, de manera conjunta al registro general de actividad 2021, muestra sus datos de actividad en pacientes con cardiopatía congénita del período temporal 2012-2021, basado en un registro voluntario y anónimo de los centros participantes. En 2021, aún marcado por las secuelas de la pandemia COVID-19, persiste el descenso de actividad quirúrgica en cardiopatías congénitas (CC) del 2020 respecto a los años previos. Presentamos agrupados los datos de actividad de la última década, para reflejar mejor nuestros resultados con estas patologías relativamente infrecuentes. En este tiempo se realizaron en España 20.139 cirugías de CC, que suponen el 9,5% de la cirugía cardiovascular mayor realizada en nuestro país durante ese tiempo. El 81,5% de las cirugías congénitas se hicieron con circulación extracorpórea y el 18,5% restante sin ella. Destacamos las intervenciones neonatales y en adultos, que asocian elevada complejidad y suponen, respectivamente, el 18% y el 21% de la actividad total. Las CC operadas más prevalentes continúan siendo los defectos septales en los casos que requieren circulación extracorpórea y los ductus en pacientes operados sin circulación extracorpórea. Los datos se presentan ajustados a la escala Aristóteles básico de riesgo quirúrgico preoperatorio. La mortalidad observada en cirugías con circulación extracorpórea fue del 3,07% (Aristóteles: 6,29), y en cirugías sin circulación extracorpórea, del 2,25% (Aristóteles: 4,82).Nuestro registro nacional de actividad quirúrgica en CC muestra buenos resultados, permite establecer comparaciones a nivel nacional e internacional, para diseñar estrategias de mejora, fijar objetivos y aumentar la calidad de nuestras actuaciones. Abstract: The Spanish Society of Cardiovascular & Endovascular Surgery presents the 2012-2021 report of the activity in congenital cardiovascular surgery, based on a voluntary and anonymous registration involving most of Spanish centres. This article is complementary to the 2021 cardiovascular surgery annual report, and they are published together. In 2021, still marked by the aftermath of the COVID-19 pandemic, the decline in our 2020 congenital activity persists, compared with previous years. We included data from the previous 10 years, in order to obtain real information related to our activity with these relatively scarce pathologies. In the last decade, a total of 20,139 congenital heart surgeries were performed, accounting for 9.5% of all major surgery (congenital + acquired) performed in Spain during that period. Of these surgeries, 81.5% of them required extracorporeal circulation and 18.5% not. We highlight the interventions in neonates and adult patients, which mean respectively 18% and 21% of our whole activity and are a real challenge. The most prevalent congenital heart pathologies operated on were: septal defects in cases requiring extracorporeal circulation, and ductus in patients without extracorporeal circulation. The presented data are adjusted to the basic Aristotle score of preoperative surgical risk. The observed mortality of surgeries with extracorporeal circulation was 3.07% (Aristotle: 6.29), and without cardiopulmonary bypass 2.25% (Aristotle: 4.82).Our national registry of surgical activity in congenital heart disease shows good results, allows us to compare ourselves within a national and international framework, design improvement strategies, set objectives and improve the quality of our actions.

Resumen: El presente registro aporta los datos correspondientes a la actividad de cirugía cardiovascular realizada en España durante el año 2021. Se trata de un registro anónimo y voluntario de datos agregados en el que han participado hospitales del territorio nacional, transfiriendo sus datos a la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE). Se comunican, por trigésimo tercer año consecutivo, los datos de la actividad nacional. El registro de 2021 puede tener valor para analizar la posible recuperación de la actividad en cirugía cardiaca después de la pandemia de SARS-CoV-2 en nuestro país.En el año 2021 comunicaron su actividad 58 hospitales frente a los 60 que compartieron datos en 2020. En total, se realizaron 29.319 intervenciones, con 19.229 procedimientos de cirugía cardiaca mayor. De estos, 16.863 procedimientos fueron realizados con circulación extracorpórea, 17.616 fueron de enfermedad adquirida y 1.613 de enfermedad congénita. Además, se registraron 2.637 intervenciones de cirugía vascular periférica.Como en años previos, tanto la cirugía cardiaca congénita como el trasplante cardiaco disponen de su propio registro. Dentro de los diferentes apartados de cirugía cardiaca mayor se realizaron: 7.673 procedimientos de cirugía valvular aislada, 1.523 de cirugía valvular combinada, 4.287 procedimientos de revascularización, 2.159 de cirugía de aorta y 654 procedimientos de válvulas transcatéter. En comparación con 2020, observamos un aumento generalizado de la actividad, que fue del 7,9% con respecto de dicho año previo, pero con una reducción de más del 12% con respecto de la media de los 9 años anteriores (2012-2020). Abstract: This report provides the data corresponding to the cardiovascular surgery activity performed in Spain during 2021. The Spanish Registry is an anonymous and voluntary registry of aggregated data in which hospitals in the national territory have taken part, transferring their data to the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE). For the thirty-third consecutive year, the national activity data is reported. The 2021 registry may be of some value for analyzing the possible recovery of the cardiac surgery activity after the SARS-CoV-2 pandemic in our country.In 2021, 58 hospitals reported their activity compared to the 60 that shared their data in 2020. In total, 29,319 interventions were performed, with 19,229 major cardiac surgical procedures. Of these, 16,863 procedures were performed with cardiopulmonary bypass, 17,616 were indicated because of acquired disease and 1,613 for congenital disease. In addition, 2,637 peripheral vascular surgical interventions were registered.As in previous years, both congenital heart surgery and heart transplantation activity and outcomes will be reported in separate registries. Within the different types of major cardiac surgical procedures, the following were performed: 7,673 isolated valve procedures, 1,523 combined valve and coronary surgeries, 4,287 coronary revascularization procedures, 2,159 aortic surgeries, and 654 transcatheter valve implantations. Compared to 2020, we observed a general increase in activity, which was 7.9% compared to the previous year, but with a reduction of more than 12% compared to the mean of the previous 9 years (2012-2020).

The precepts followed by Muslim people during the Ramadan season, mainly fasting and abstinence from liquids, as well as changing time habits, can increase occupational risk situations. There is a social perception that can lead to mystify the seriousness of these situations and, therefore, lead to situations of discrimination. This work aims to contribute modestly to the demystification of this incidence in risk prevention, examining the scientific literature and studies on occupational accidents. Additionally, a series of recommendations are made to enable the compatibility of religious practice and safe working during the month of Ramadan regarding occupational health and safety of workers.

Delusional parasitosis is a psychotic disorder where the patient has the delusion of being infested with some insect or parasite. In contrast, shared paranoid disorder or folie à deux is described when the same delusions affect two or more closely related people. It is common for these two situations to cause comorbidity in the family unit. This case report concerns a couple married for 37 years. The husband described that 2 years ago, he began with a tingling sensation throughout his body, related to the presence of parasites coming out from all his body orifices, with no evidence of self-harm. Likewise, the wife reported symptoms of formication and the feeling that there were invisible animals, as mentioned by her husband, and that she felt the parasites running throughout her body. The husband was diagnosed with endoparasitic delusional parasitosis, which caused folie à deux in his wife due to ectoparasitic parasitosis. The patient’s treatment included sertraline and risperidone in oral dosage lasting 3 months reducing delirium, later biperidene was prescribed due to main treatment’s side effects such as akathisia and sialorrhea, however the patient could not take the medication due to economic reasons. The wife was asked to sleep in a separate room, and she reported that the sensory hallucinations disappeared as soon as she slept in a different room. We conclude that the pharmacological approach, the intervention in the family life, and the gradual reintegration of marital habits once the patient improves are crucial in the therapy of delusional disorder.

Background: Preterm newborns require the use of the best and most current strategies to treat and prevent both acute pathology and associated sequelae. This study aimed to compare the differences in the management of preterm newborns over 10 years in a tertiary hospital in Spain and its impact on height, weight, and neurological development in the medium term. Methods: We conducted a retrospective, observational, and analytical study examining the management and clinical variables in preterm newborns under 32 weeks of gestational age who were born in our hospital in 2011 and 2021. Results: Twenty-six newborns were included in the study. Significant differences in magnesium sulfate use, continuous positive airway pressure immediately after birth, and non-invasive mechanical ventilation during hospitalization were observed. Differences were found in the use of parenteral nutrition and the timing of initiation of enteral feeding. We did not observe differences in the neurological or weight evolution in the medium term. Conclusions: Significant differences in managing preterm newborns in these 10 years were observed. Lower mortality and alterations in central nervous system ultrasound and, significantly, less growth retardation during admission in 2021 have been observed; however, it does not manifest with improvement in long-term somatometrics or neurological prognosis.

Spinal metastasis may occur in 40–70% of patients with cancer. Symptoms can vary from pain to spinal cord compression (SCC) and can affect their quality of life (QoL). Stereotactic body radiotherapy (SBRT) allows dose escalation of spinal tumor metastases, minimizing doses to organs at risk and improving pain control. The aim of this study is to retrospectively describe our institution’s experience with robotic SBRT (CyberKnife®, Accuray Incorporated, Sunnyvale, CA, USA) for spinal metastases, in terms of feasibility, oncological results, toxicities, and pain relief observed. In total, 25 patients with 43 lesions were assessed, most of them with dorsal metastases (48.8%). The median total dose was 27 Gy (16–35 Gy), the median number of fractions administered was 3 (1–5), and the median dose per fraction was 9 Gy. Pain was evaluated using the visual analogue scale at baseline and at the end of treatment. The statistically significant reduction in pain (p < 0.01) was associated with the total dose of radiotherapy delivered (p < 0.01). Only one patient developed grade 3 dermatitis. Female gender, adenocarcinoma tumors, and lack of previous surgery were associated with better response to SBRT (p < 0.05). Robotic spine SBRT is feasible, well-tolerated, and improves patients’ QoL through a statistically significant reduction in pain, so it should be offered to patients at an early stage in their process.

Resumen: La gestión de las listas de espera de los diferentes sistemas de salud autonómicos para procedimientos de cirugía cardiaca constituye una importante preocupación entre los profesionales, de la que nuestra Sociedad científica no es ajena. En el año 2000 fue publicada la primera iniciativa de ordenación temporal de los pacientes con patología cardiovascular incluidos en lista de espera quirúrgica. Con los cambios en el manejo y en la concepción de algunas patologías, un nuevo marco normativo vigente y la coyuntura asistencial actual, se hace necesaria una revisión de los mencionados criterios para ofrecer una actualización adecuada al contexto clínico-asistencial presente. Por ello, se ha elaborado un documento basado en la revisión de la literatura científica disponible y en el consenso de un grupo de trabajo dentro de la Sociedad Española de Cirugía Cardiovascular y Endovascular, para actualizar en nuestro país las recomendaciones de prioridad de estas patologías en las listas de espera. Abstract: Waiting list management of cardiac surgical procedures is a main concern for all the Spanish autonomic health systems and for our scientific Society. The first statement for optimal timing of patients waiting for cardiac surgery was published in 2000. Since then, after significant changes in the management of some pathologies, new normative frameworks and the current healthcare situation, a review of the timing criteria to offer an adequate and updated standard of care is needed. In this document we aim to review the available literature in the field and stablish a consensus within a working group of the Spanish Society of Cardiovascular and Endovascular Surgery to optimize the priority recommendations in cardiac surgical waiting lists in our country.

In this article, we study the intensive comparative structures applied to the adjective negro (‘black’) in medieval Spanish, in comparison with the homologous structures in medieval Czech (adjective černý) and Old Norse (adjective svartr). We present and comment numerous examples that contain different second terms of the comparison, from the most frequent (pez ‘pitch’, carbón ‘coal’, cuervo ‘crow’…) to the rarest (olla ‘pot’, diablo ‘devil’…). Numerous convergences are observed, largely due to the existence of deep common cultural bases, such as Christianity and the literary tradition of classical antiquity, but also numerous divergences and even singularities of each of the languages considered.

Abstract Volcanic activity provides a unique opportunity to study the ecological responses of organisms to catastrophic environmental destruction as an essential driver of biodiversity change on islands. However, despite this great scientific interest, no study of the biodiversity at an erupting volcano has yet been undertaken. On La Palma (Canary archipelago), we quantified the main species affected and their fate during the 85-day eruption (September–December 2021). Our main objective consisted of monitoring the biodiversity subjected to critical stress during this volcanic eruption. We found that all biodiversity within a 2.5 km radius was severely affected after the first two weeks. It is challenging to assess whether volcanism can drive evolutionary traits of insular organisms. Examples are the adaptation of an endemic conifer to high temperatures, selection of functional plant types—secondary woodiness—, effects of the disappearance of invertebrates and their influence in trophic nets and vertebrate trophic plasticity. However, our data suggest that such previous evolutionary changes might continue to favour their resilience during this eruption. Lastly, it is a very good opportunity to assess the extent to which these periodic volcanic catastrophes may constitute temporary windows of repeated opportunities for the evolution and speciation of oceanic island biota.

Introduction and objective: Music has been closely linked to medicine since ancient times, and has brought numerous benefits to the health of patients. Patients with chronic kidney disease (CKD) undergoing hemodialysis (HD) generally have a health-related quality of life (HRQL) lower than the reference values ​​of the general population. The objective of the present study is to verify if the intervention of classical music live and “in situ” during the treatment of HD has effects on the HRQoL of the patients. Materials and methods: A prospective, group-randomized intervention study of 4 weeks’ duration was carried out in patients with chronic kidney disease undergoing hemodialysis. Descriptive variables are included for data analysis: age, sex, months in treatment, Kt/V, hemoglobinand albumin. Result variable: HRQL, measured with the Kidney Diseasse health questionnaire Quality of life (KDQOL-SF) before and after the musical intervention. Results: Patients participated in 2 groups, the intervention group and the control group. The analysis of the results shows that the intervention group improved their quality of life compared to the initial measurement. The difference between the pre and post time of the intervention group with respect to the control group increased the mean score (pm) in all the scales significantly, except in the Work situation, Sexual function and Social support scales. The most important results were given on the Symptoms/problems scale with an increase of 15.78 (p

This paper analyses the acoustic behaviour of the Palace of Charles V from a room acoustics perspective but also ponders the uniqueness of the space and its ability to engage and enhance the audience experience. The Palace of Charles V is a relevant part of the historical heritage of Granada. It has an architectural but also an acoustic uniqueness that deserves research. A measurement campaign was made to calculate parameters such as T30, IACC, C80 or Gm, and to explain the behaviour of the Palace. The BQI is quite high, but the late part of the impulse response (t > 80 ms) has strong unwanted reflections causing low clarity (C80) and listener envelopment (LEV). Nevertheless, the Palace is a successful concert venue with good feedback from musicians and the audience.

Resumen: Introducción y objetivo: La música ha estado estrechamente unida a la medicina desde la antigüedad, y ha aportado numerosos beneficios a la salud de los pacientes. El paciente con enfermedad renal crónica en tratamiento de hemodiálisis (HD), generalmente, presenta una calidad de vida relacionada con la salud (CVRS) inferior a los valores de referencia de la población general. El objetivo del presente estudio es verificar si la intervención de música clásica en directo e in situ’ durante el tratamiento de HD tiene efectos sobre la CVRS de los pacientes. Materiales y métodos: Se realizó un estudio de intervención, prospectivo y aleatorizado por grupos, en pacientes con enfermedad renal crónica en tratamiento con HD. Durante 4 semanas un grupo de pacientes recibía la intervención con música clásica en directo 30 o 40 min durante las sesiones de HD, mientras el grupo control realizaba el tratamiento habitual. Variables descriptivas: edad, sexo, meses en tratamiento, Kt/V, hemoglobina y albúmina. Variable resultado: CVRS, se midió con el cuestionario de salud Kidney Diseasse Quality of life (KDQOL-SF) antes y después de la intervención musical. Resultados: Participaron 90 pacientes distribuidos en 2 grupos, el grupo intervención y el grupo control. El análisis de los resultados muestra que el grupo con intervención mejoró su calidad de vida respecto a la medición inicial. La diferencia entre el momento pre- y post- del grupo intervención respecto al grupo control aumentó la puntuación media (pm) en todas las escalas de forma significativa, excepto en las escalas Situación laboral, Función sexual y Apoyo social. Los resultados más importantes se dieron en escala Síntomas/problemas con un aumento de 15,78 (p

En general, la mímesis puede ser de orden ritual, visual o cognitiva. La mímesis más antigua tiene lugar en el marco de los ritos, pero en tiempos de empobrecimiento simbólico, muchos de ellos han perdido su antiguo vigor y, a veces, han quedado reducidos a mero folclore. La mímesis visual fue abordada por Platón de la que afirmó que no permitía conocer la realidad con la profundidad ni con la perfección con que era posible hacerlo mediante el rito o la reflexión. Aristóteles profundizó en una mímesis de índole cognitiva, señalando que a partir de ella podían conocerse las leyes de la naturaleza, sus fines y el modo en que opera para conseguirlos. Al analizar estos tipos de mímesis trataremos de poner de relieve que una forma legítima y eficaz de reconectar al hombre con el mundo y con la realidad es la puesta en valor del rito.

Resumen: La Sociedad Española de Cirugía Cardiovascular y Endovascular muestra sus datos de actividad en pacientes con cardiopatía congénita (CC) del período temporal 2012-2020, basado en un registro voluntario y anónimo de los centros participantes. Este manuscrito complementa al registro general de actividad 2020 y ambos se publican conjuntamente. En 2020, marcado por la pandemia COVID-19 en todos los ámbitos sanitarios, observamos un descenso de actividad quirúrgica en CC del 14% respecto al año previo. Agrupamos los datos de actividad de los últimos 9 años, porque reflejan mejor nuestros resultados con estas enfermedades relativamente infrecuentes. En este período se realizaron en España 18.526 cirugías de CC, que suponen un 9,6% de la cirugía mayor (congénita + adquirida) realizada en nuestro país durante ese tiempo. El 81% de las cirugías congénitas se hicieron con circulación extracorpórea y el 19% restante sin ella. Destacamos las intervenciones en neonatos y en adultos que asocian elevada complejidad, suponiendo respectivamente un 19 y 21% de la actividad total. Las CC operadas más prevalentes continúan siendo los defectos septales dentro de los casos que requieren circulación extracorpórea, y los ductus en pacientes operados sin circulación extracorpórea. Los datos se presentan ajustados a la escala Aristóteles básico de riesgo quirúrgico preoperatorio. La mortalidad observada en cirugías con circulación extracorpórea fue del 3,1% (Aristóteles-6,48), y en cirugías sin circulación extracorpórea del 2,41% (Aristóteles-4,81). Este registro muestra detalladamente nuestros datos de actividad quirúrgica en CC, y permite comparaciones tanto a nivel nacional como internacional, para establecer estrategias de mejora de nuestros resultados. Abstract: The Spanish Society of Cardiovascular & Endovascular Surgery presents the 2012-2020 report of the activity in congenital cardiovascular surgery, based on a voluntary and anonymous registration involving the most of Spanish centres. This article is complementary to the 2020 cardiovascular surgery annual report, and they are published together. In 2020, seriously damaged by the COVID-19 pandemic related to all sanitary fields, we observe a 14% drop in our congenital activity compared with 2019. Data from the previous 9 years are included, in order to obtain real information related to our activity in these relatively scarce pathologies. In the last nine years, a total of 18526 congenital heart surgeries were performed, accounting for 9.6% of major surgery (congenital + acquired) performed in Spain during that period. Of these surgeries, 81% of them required extracorporeal circulation and 19% not. We highlight the interventions in neonates and adult patients, which represent respectively 19% and 21% of the whole activity and are a real challenge. The most prevalent congenital heart pathologies operated on were septal defects in cases requiring extracorporeal circulation, and ductus in patients not requiring extracorporeal circulation. The presented data are adjusted to the basic Aristotle score of preoperative surgical risk. The observed mortality of surgeries with extracorporeal circulation was 3.1% (Aristotle-6.48), and without cardiopulmonary bypass 2.41% (Aristotle-4.81). This data analysis shows accurate and reliable information about our surgery for congenital heart disease and allow us to compare ourselves within an international framework, and to organize strategies directed to improve our results.

Resumen: El presente registro aporta los datos correspondientes a la actividad de cirugía cardiovascular realizada en España durante el año 2020. Se trata de un registro anónimo y voluntario de datos agregados en el que han participado 60 hospitales del territorio nacional, transfiriendo sus datos a la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE). Se comunican, por trigésimo segundo año consecutivo los datos de la actividad nacional.El de este año es, sin duda, un registro singular e importante para valorar el impacto que tuvo la pandemia de SARS-CoV-2 sobre la actividad en cirugía cardiaca en nuestro país, más allá de los datos que han sido ya comunicados en este sentido en diversos estudios comunicados por la SECCE.En el año 2020 comunicaron su actividad 60 hospitales frente a los 57 que compartieron datos en 2019. En total, se realizaron 27.017 intervenciones totales, con 17.880 procedimientos de cirugía cardiaca mayor. De estas, 15.534 procedimientos fueron realizados con circulación extracorpórea (CEC). Los 17.880 procedimientos de cirugía cardiaca mayor se pueden desglosar en 16.271 de enfermedad adquirida y 1.609 de enfermedad congénita. Además, se registraron 2.462 intervenciones de cirugía vascular periférica en los diferentes servicios de cirugía cardiovascular.Como en registros previos, tanto la cirugía cardiaca congénita como el trasplante cardiaco disponen de su propio registro. Dentro de los diferentes apartados de cirugía cardiaca mayor se realizaron: 6.766 procedimientos de cirugía univalvular aislada, 1.609 de cirugía valvular combinada, 4.219 procedimientos de revascularización, 1.912 de cirugía de aorta y 502 procedimientos de válvulas transcatéter (TAVI). En comparación con 2019, observamos un descenso generalizado de la actividad, siendo más marcado para la cirugía valvular (−21% para univalvular, −52% para TAVI transapical) y menos para cirugía coronaria (−11%). Además, informamos de diversos datos de distribución geográfica de la actividad quirúrgica a nivel nacional. Abstract: The Spanish Society of Cardiovascular and Endovascular Surgery (SECCE) reports the results of the 2020 registry of the surgical activity in our country. This year represents the 33rd consecutive year in which this report is published. The participation in this registry is anonymous and voluntary, and it is based on the analysis of the information gathered from 60 centers with activity in cardiovascular surgery in our country, and the confidentiality of the individual data of each center is warranted. It is certainly an important issue in which COVID-19 impact on cardiac surgical activity is analysed.The registry reports the global activity in our country, the observed mortality and the estimated mortality risk, stratified in different types of procedures.In 2020, 27.017 interventions were performed, with 17.880 of major heart surgery. Among these, 16.271 procedures were adult cardiac surgery and 1.609 of congenital heart surgery. Congenital heart surgery and cardiac transplant registries are specifically analysed in their corresponding reports.Among the 17.311 procedures of acquired major cardiac surgery, isolated valve surgery was predominant (6.766 procedures), followed by coronary by-pass surgery (4.239), aorta surgery (1.902). TAVI procedures were performed in 502 cases. Coronary surgery showed a 11% decrease in activity.The information derived from this national registry allows to know the state-of-the-art of the surgical specialty in our country, through the knowledge of the surgical activity, the risk profile and the observed results, which is a keystone for an adequate evaluation of the quality of the health care that we deliver to the patients affected with cardiovascular pathologies. Risk adjusted mortality seems adequately adjusted, though important local differences are observed.

Abstract Background Engagement in exercise by haemodialysis (HD) patients has been shown to generate benefits both in terms of improved functional capacity and in the health-related quality of life. The use of non-immersive virtual reality (VR) games represents a new format for the implementation of intradialysis exercise. Some studies have shown that engaging in exercise for 6 months reduces the consumption of antihypertensive drugs and decreases the time spent admitted to hospital among individuals receiving HD treatments. The objective of this study was to evaluate changes in the consumption of healthcare resources and micro-costing for patients on HD who completed a VR exercise program. Materials and methods Design: This study is a secondary analysis of a clinical trial. The participants performed an intradialysis exercise program with non-immersive virtual reality for 3 months. The variables were recorded in two periods: 12 months before and 12 months after the start of the exercise program. Results The micro-costing analysis showed a significant decrease in the mean cost, in euros, for the consumption of laboratory tests − 330 (95% CI:[− 533, − 126];p = 0.003), outpatient visits − 351 ([− 566, − 135];p = 0.003), and radiology tests − 111 ([− 209, − 10];p = 0.03) in the 12 months after the implementation of the exercise program relative to the 12 months prior to its start. Conclusion The implementation of intradialysis exercise programs decreased the expenditure of some healthcare resources. Future studies could help clarify if longer interventions would have a stronger impact on these cost reductions.

Chronic kidney disease (CKD) is a major public health problem worldwide that affects more than 10% of the Spanish population. CKD is associated with high comorbidity rates, poor prognosis and major consumption of health system resources. Since the publication of the last consensus document on CKD seven years ago, little evidence has emerged and few clinical trials on new diagnostic and treatment strategies in CKD have been conducted, apart from new trials in diabetic kidney disease. Therefore, CKD international guidelines have not been recently updated. The rigidity and conservative attitude of the guidelines should not prevent the publication of updates in knowledge about certain matters that may be key in detecting CKD and managing patients with this disease. This document, also prepared by 10 scientific associations, provides an update on concepts, clarifications, diagnostic criteria, remission strategies and new treatment options.The evidence and the main studies published on these aspects of CKD have been reviewed. This should be considered more as an information document on CKD. It includes an update on CKD detection, risk factors and screening; a definition of renal progression; an update of remission criteria with new suggestions in the older population; CKD monitoring and prevention strategies; management of associated comorbidities, particularly in diabetes mellitus; roles of the Primary Care physician in CKD management; and what not to do in Nephrology.The aim of the document is to serve as an aid in the multidisciplinary management of the patient with CKD based on current recommendations and knowledge. Resumen: La enfermedad renal crónica (ERC) es un importante problema de salud pública a nivel mundial afectando a mas del 10% de la población española. Se asocia a elevada comorbilidad, mal pronóstico, así como a un gran consumo de recursos en el sistema sanitario. Desde la publicación del último documento de consenso sobre ERC publicado hace siete años, han sido escasas las evidencias y los ensayos clínicos que hayan mostrado nuevas estrategias en el diagnóstico y tratamiento de la ERC, con excepción de los nuevos ensayos en la enfermedad renal diabética. Esta situación ha condicionado que no se hayan actualizado las guías internacionales en este aspecto. Esta rigidez y actitud conservadora de las guías no debe impedir la publicación de actualizaciones en el conocimiento en algunos aspectos, que pueden ser clave en la detección y manejo del paciente con ERC. En este documento, elaborado en conjunto con diez sociedades científicas, se muestra una actualización sobre conceptos, aclaraciones, criterios diagnósticos, estrategias de remisión y nuevas opciones terapéuticas.Se han revisado las evidencias y los principales estudios publicados en estos aspectos de la ERC, considerándose más bien un documento de información sobre este padecimiento. El documento incluye una actualización sobre la detección de la ERC, factores de riesgo, cribado, definición de progresión renal, actualización en los criterios de remisión con nuevas sugerencias en la población anciana, monitorización y estrategias de prevención de la ERC, manejo de comorbilidades asociadas, especialmente en diabetes mellitus, funciones del médico de Atención Primaria en el manejo de la ERC y qué no hacer en Nefrología.El objetivo del documento es que sirva de ayuda en el manejo multidisciplinar del paciente con ERC basado en las recomendaciones y conocimientos actuales.

Resumen: La enfermedad renal crónica (ERC) es un importante problema de salud pública a nivel mundial afectando a más del 10% de la población española. Se asocia a elevada comorbilidad, mal pronóstico, así como a un gran consumo de recursos en el sistema sanitario. Desde la publicación del último documento de consenso sobre ERC publicado hace siete años, han sido escasas las evidencias y los ensayos clínicos que hayan mostrado nuevas estrategias en el diagnóstico y tratamiento de la ERC, con excepción de los nuevos ensayos en la enfermedad renal diabética. Esta situación ha condicionado que no se hayan actualizado las guías internacionales específicas de ERC. Esta rigidez y actitud conservadora de las guías no debe impedir la publicación de actualizaciones en el conocimiento en algunos aspectos, que pueden ser clave en la detección y manejo del paciente con ERC. En este documento, elaborado en conjunto por diez sociedades científicas, se muestra una actualización sobre conceptos, aclaraciones, criterios diagnósticos, estrategias de remisión y nuevas opciones terapéuticas.Se han revisado las evidencias y los principales estudios publicados en estos aspectos de la ERC, considerándose más bien un documento de información sobre esta patología. El documento incluye una actualización sobre la detección de la ERC, factores de riesgo, cribado, definición de progresión renal, actualización en los criterios de remisión con nuevas sugerencias en la población anciana, monitorización y estrategias de prevención de la ERC, manejo de comorbilidades asociadas, especialmente en diabetes mellitus, funciones del médico de Atención Primaria en el manejo de la ERC y qué no hacer en Nefrología.El objetivo del documento es que sirva de ayuda en el manejo multidisciplinar del paciente con ERC basado en las recomendaciones y conocimientos actuales. Abstract: Chronic kidney disease (CKD) is a major public health problem worldwide that affects more than 10% of the Spanish population. CKD is associated with high comorbidity rates, poor prognosis and major consumption of health system resources. Since the publication of the last consensus document on CKD seven years ago, little evidence has emerged and few clinical trials on new diagnostic and treatment strategies in CKD have been conducted, apart from new trials in diabetic kidney disease. Therefore, CKD international guidelines have not been recently updated. The rigidity and conservative attitude of the guidelines should not prevent the publication of updates in knowledge about certain matters that may be key in detecting CKD and managing patients with this disease. This document, also prepared by 10 scientific societies, provides an update on concepts, clarifications, diagnostic criteria, remission strategies and new treatment options.The evidence and the main studies published on these aspects of CKD have been reviewed. This should be considered more as an information document on CKD. It includes an update on CKD detection, risk factors and screening; a definition of renal progression; an update of remission criteria with new suggestions in the older population; CKD monitoring and prevention strategies; management of associated comorbidities, particularly in diabetes mellitus; roles of the Primary Care physician in CKD management; and what not to do in Nephrology.The aim of the document is to serve as an aid in the multidisciplinary management of the patient with CKD based on current recommendations and knowledge.

Introducción y objetivos: Las áreas silvestres protegidas (ASP) tienen como tarea principal la protección de la biodiversidad de un área determinada, para lo cual es fundamental limitar el ingreso de especies exóticas. El objetivo del presente estudio fue registrar las especies de plantas exóticas que prosperan al interior de ASP de Chile y describir algunos patrones florísticos que determinan la presencia y distribución de las especies. M&M: Se recopilaron antecedentes para 35 ASP, en donde fue reportado el número total y la proporción de especies exóticas. Con estos datos se obtuvo la riqueza y se calculó un índice de invasibilidad para cada ASP. Se realizaron análisis de la composición de especies y se determinaron patrones florísticos a través de análisis de ordenamiento, similitud y regresión. Resultados: Se registró un total de 355 especies de plantas exóticas presentes en las 35 ASP. La Reserva Nacional Río Clarillo presentó la mayor riqueza de especies exóticas, en tanto que la mayor proporción con relación al total de especies y la mayor invasibilidad fueron registradas en el Monumento Natural Cerro Ñielol. La distancia a la ciudad más cercana, la precipitación y la temperatura fueron las variables ambientales de mayor incidencia sobre los diferentes ensambles de especies exóticas que exhiben las ASP. Discusión: La riqueza de plantas exóticas al interior de las ASP es alta, con relación a la flora adventicia total que presenta Chile. La evidencia mostrada sugiere una baja proporción de plantas exóticas compartidas entre las ASP distribuidas en los diferentes bioclimas considerados. Este tipo de estudios constituyen la base para la confección de listas de riesgo y el diseño de programas en la gestión de las especies de plantas exóticas.

Editorial

Hexagonal nanocrystals were obtained from Zn-doped GaN powders and Mg-doped GaN powders, which were synthesized via pyrolysis of a viscous complex compound, followed by its nitridation. XRD showed well-defined peaks for hexagonal GaN with an average crystal size of 21.3 nm. Scanning electron microscopy showed an amorphous and porous appearance in surface morphology, which could be related to the combustion process. Energy-dispersive spectroscopy characterization showed contributions of gallium, nitrogen, and small traces of Zn and Mg in the GaN samples. TEM showed the presence of well-defined hexagonal nanocrystals with an area of 75.9 nm2 for the Zn-doped GaN powders and an area of 67.7 nm2 for the Mg-doped GaN powders. The photoluminescence spectra showed an emission energy of 2.8 eV (431.5 nm) for the Zn-doped GaN powders, while the Mg-doped GaN powders showed energies in the range from 2.7 eV to 2.8 eV (460.3 nm–443.9 nm). The Raman scattering showed spectra where the vibration modes A1(TO), E1(TO), and E2(High) could be observed, which are characteristic of hexagonal GaN.

The Refrigerated Capacitated Vehicle Routing Problem (RCVRP) considers a homogeneous fleet with a refrigerated system to decide the selection of routes to be performed according to customers' requirements. The aim is to keep the energy consumption of the routes as low as possible. We use a thermodynamic model to understand the unloading of products from trucks and the variables' efficiency, such as the temperature during the day influencing energy consumption. By considering various neighborhoods and a shaking procedure, this paper proposes a Granular Tabu Search scheme to solve the RCVRP. Computational tests using adapted benchmark instances from the literature demonstrate that the suggested method delivers high-quality solutions within short computing times, illustrating the refrigeration system's effect on routing decisions.

Resumen: Presentamos una nueva edición de la Guía de Centros de Hemodiálisis. Se enmarca en el programa de actualización de las Guías Clínicas de la Sociedad Española de Nefrología. Es un documento de consenso en el que han colaborado nefrólogos con amplia experiencia en diálisis y expertos de la enfermería nefrológica. La Guía ha sido corregida por un grupo de evaluadores externos. Se ha informado y se ha tomado en consideración la opinión de los pacientes a través de la Asociación de Enfermos Renales (ALCER). Esta Guía incluye en sus diez capítulos aspectos arquitectónicos, logísticos y organizativos. Hace especial énfasis en las necesidades de recursos humanos y su cualificación. Revisa las modalidades actuales de hemodiálisis, su dosificación y adecuación y la monitorización y seguimiento intra e interdiálisis. La hemodiálisis es una de las formas de tratamiento renal sustitutivo, por lo que menciona la necesidad de la inclusión en lista de espera para trasplante y la relación con las unidades de diálisis peritoneal. La calidad de vida del paciente en hemodiálisis comprende la necesidad de relacionarse y viajar por lo que se revisa y estandariza la atención de los pacientes transeúntes. La gestión de calidad es una herramienta necesaria actualmente para lograr la mejora continua de cualquier procedimiento como la hemodiálisis. Esta Guía pretende ser una ayuda para el buen funcionamiento de las Unidades de Diálisis, para los responsables de las mismas, así como para los gestores sanitarios. Abstract: We present a new edition of the Hemodialysis Center Guide. It is part of the program of updating the Clinical Guides of the Spanish Society of Nephrology. It is a consensus document in which nephrologists with extensive experience in dialysis and experts in nephrological nursing have collaborated. The Guide has been corrected by a group of external evaluators. The opinion of the patients through the kidney diseases patient association (ALCER) has been reported and taken into consideration. This Guide includes in its ten chapters architectural, logistical and organizational aspects. It places special emphasis on human resources needs and their qualification. Review current hemodialysis modalities, dosage and adequacy, and intra and interdialysis monitoring. Hemodialysis is one of the forms of renal replacement therapy, so it mentions the need for transplant waiting list inclusion and the relationship with peritoneal dialysis units. The patient's quality of life on hemodialysis understands the need to relate and travel so care of transitory patients is reviewed and standardized. Quality management is a tool currently needed to achieve continuous improvement of any procedure such as hemodialysis. This Guide is intended to be an aid for the proper functioning of the Dialysis Units, for those responsible for them, as well as for health managers.

Abstract Background Engineered stone silicosis is an emerging disease in many countries worldwide produced by the inhalation of respirable dust of engineered stone. This silicosis has a high incidence among young workers, with a short latency period and greater aggressiveness than silicosis caused by natural materials. Although the silica content is very high and this is the key factor, it has been postulated that other constituents in engineered stones can influence the aggressiveness of the disease. Different samples of engineered stone countertops (fabricated by workers during the years prior to their diagnoses), as well as seven lung samples from exposed patients, were analyzed by multiple techniques. Results The different countertops were composed of SiO2 in percentages between 87.9 and 99.6%, with variable relationships of quartz and cristobalite depending on the sample. The most abundant metals were Al, Na, Fe, Ca and Ti. The most frequent volatile organic compounds were styrene, toluene and m-xylene, and among the polycyclic aromatic hydrocarbons, phenanthrene and naphthalene were detected in all samples. Patients were all males, between 26 and 46 years-old (average age: 36) at the moment of the diagnosis. They were exposed to the engineered stone an average time of 14 years. At diagnosis, only one patient had progressive massive fibrosis. After a follow-up period of 8 ± 3 years, four patients presented progressive massive fibrosis. Samples obtained from lung biopsies most frequently showed well or ill-defined nodules, composed of histiocytic cells and fibroblasts without central hyalinization. All tissue samples showed high proportion of Si and Al at the center of the nodules, becoming sparser at the periphery. Al to Si content ratios turned out to be higher than 1 in two of the studied cases. Correlation between Si and Al was very high (r = 0.93). Conclusion Some of the volatile organic compounds, polycyclic aromatic hydrocarbons and metals detected in the studied countertop samples have been described as causative of lung inflammation and respiratory disease. Among inorganic constituents, aluminum has been a relevant component within the silicotic nodule, reaching atomic concentrations even higher than silicon in some cases. Such concentrations, both for silicon and aluminum showed a decreasing tendency from the center of the nodule towards its frontier.