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Background: PD1 and its ligand PD-L1 are related to prognosis in many solid tumors; however, their role in oral squamous cell carcinoma (OSCC) remains unclear. Methods: A retrospective monocentric study including all patients with OSCC diagnosed and treated between January 2020 and May 2022 was performed. PD-L1 expression was assessed per a combined positive score (CPS), considering a CPS of > or equal to 1 as positive (1–20 indicating “low expression” and ≥20 indicating “high”). A descriptive analysis of the patient cohort and tumors was performed, including tumor size, stage, lymph node involvement, recurrence, and survival. Results: In total, 65 patients (65 tumors) were analyzed. A total of 66.15% of the tumors were in advanced stages (III-IV), of which 97.67% expressed PD-L1+, compared with 71.42% in the early stages (I–II). T4 tumors expressed PD-L1 in 100% of cases, compared with 54% in T1 tumors. A total of 50.79% of the tumors showed lymph node involvement (pN+), with 100% of the pN+ showing PD-L1+. The prevalence of pN+ was 59.38% vs. 40.63% for high vs. low PD-L1 expression, respectively. Patients’ follow-ups ranged from 2 to 34.5 months. No significant difference was seen between overall survival (OS) and PD-L1 +/− (CPS ≥ 1 vs. CPS < 1) or high (CPS ≥ 20) and low (CPS < 20) PD-L1 expression (p < 0.97 and 0.64, respectively). Conclusions: The method used to measure PD-L1 (a laboratory test with Dako 22C3 anti-PD-L1 primary antibodies) was reliable and accurate, with a correlation coefficient between PD-L1 expression in the biopsy and the surgical piece of 0.83 (p < 0.0001). A CPS of ≥1 was observed in large tumors (p < 0.001) and was correlated with that of lymph node metastases (p < 0.004). Further analysis of PD-L1 expression in OSCC and studies to determine its relevance in tumor biology and prognosis is needed.

Ficha técnica: Mario-Paul Martínez y Fran Mateu Editores Tirant Humanidades, Valencia, 2023 324 pp. ISBN: 978-84-1183-091-1

Objective To assess organ damage, with emphasis on the cardiovascular system, over the different stages of the disease in a large SLE cohort.Methods Multicentre, longitudinal study of a cohort of 4219 patients with SLE enrolled in the Spanish Society of Rheumatology Lupus Registry. Organ damage was ascertained using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). We longitudinally analysed SDI (globally and for each domain) over time only in the 1274 patients whose dates of damage events had been recorded.Results During the first year after diagnosis of SLE, 20% of the 1274 patients presented with new damage manifestations. At years 2 and 3, new damage was recorded in 11% and 9% of patients. The annual percentage of patients with new damage after year 5 decreased to 5%. In the first year with the disease, most damage was accumulated in the musculoskeletal, neuropsychiatric and renal systems; in later stages, most damage was in the musculoskeletal, ocular and cardiovascular systems. Considering ‘cerebrovascular accident’ and ‘claudication for 6 months’ as cardiovascular items, the cardiovascular system was the second most affected system during the early stages of SLE, with 19% of the patients who presented with damage affected at first year after diagnosis. During the late stages, 20–25% of the patients presenting with new damage did so in this modified cardiovascular domain of the SDI.Conclusions New damage occurs mainly during the first year following diagnosis of SLE. Cardiovascular damage is relevant in both the early and the late stages of the disease. Strategies to prevent cardiovascular damage should be implemented early after diagnosis of SLE.

Summary:. Virtual surgical planning (VSP) and three-dimensional (3D) printing can increase precision and reduce surgical time in craniofacial reconstruction. However, the elevated cost and manufacturing time of outsourced workflows is increasing the development of in-house solutions. One of the main challenges in in-house workflows is to create cutting guides that hold plate position information. This is due to the fact that hospitals usually lack the infrastructure required to design and 3D print custom-made plates. Including plate-positioning information in resection guides is especially relevant in complex reconstructions and when tumor extension limits plate placement before resection. Current in-house workflows revolve around the idea of 3D scanning the bent plate’s shape and to fuse it with the VSP. The goal of this article is to share our technique to transfer plate position information to resection guides. Our protocol uses a 3D model of the reconstruction as an intermediate step to transfer the plate position of a bent stock reconstruction plate to cutting guides. Two patients who required mandibular reconstruction with fibula flap are presented to illustrate the technique. This workflow requires a 3D-printed model of the desired outcome, cutting guides, and a stock plate. Results were satisfactory in terms of cutting location and angulation, plate adaptation and condylar position. This technique allows for a simple, safe, cheap, and quick alternative to add reconstruction plate information to cutting guides.

The experience of the Partido Social Democrata (PSD) during the post-revolutionary period (1976-1982) led to an ideological shift from the original social democratic credo to its current center-right position. In this tortuous path that brought the PSD to power at the beginning of 1980, the “impugnation” of the Carnation Revolution and its legacies, as well as the goal of reforming Portugal’s new democratic system, are key issues that have not been sufficiently explored. This article analyzes these aspects in the context of the so-called “Iberian Ebb” when certain Portuguese social and political sectors were influenced by the experience of the Spanish Transition in order to achieve a major convergence with the EEC model.

Las administraciones públicas reciben anualmente un alumnado en prácticas que viene derivado de una formación dual: formativa en el centro educativo y práctica en la administración. Su demanda ha crecido propiciada por las exigencias de las empresas de personal formado, motivando que no sólo estas, sino también las administraciones públicas se involucren en la creación de planes formativos que acerquen al alumnado a la realidad laboral, chocando frontalmente con aspectos que deben considerarse en el diseño de la acción formativa que debe ser acorde con las necesidades del alumnado y los requisitos exigidos por la administración que lo acoge durante su etapa formativa. Las carencias observadas en los tutores asignados al alumnado en prácticas son un obstáculo inicial, en relación a la formación requerida, supliendo esta falta con su experiencia profesional. Seguido del propio alumnado que precisa adquirir una serie de competencias, lo que conlleva que la formación, lejos de estandarizarse, se individualice, adaptando la misma a los requerimientos y necesidades del propio alumnado. Teniendo todo esto en cuenta, el artículo analizará las acciones formativas que en este sentido se han llevado a cabo en las administraciones públicas a lo largo de los últimos 30 años.

The availability of models constitutes a key factor when selecting a decision support tool aimed at improving the production and environmental aspects of farms. There is a need for robust models that are user-friendly, facilitating the estimation of farm emissions and the analysis of their temporal fluctuations. The objectives of this study were i) to calculate both the partial (PCF) and total carbon (TCF) footprints of 212 dairy farms, distinguishing those with and without maize cultivation; ii) to identify critical variables related to feed, nutrition, productivity and environmental efficiency; and iii) to formulate and validate prediction equations based on available data from dairy farms. The database encompasses information from 212 dairy cattle farms situated in the temperate-humid zone of northern Spain, spanning the period from 2014 to 2018. Farm classification was based on the presence (CcMz) or absence (ScCMz) of maize cultivation for silage production, resulting in 96 farms in the CcMz category and 116 farms in the ScCMz category.Among the variables considered, the variable herd N-use efficiency (NUECR) for (PCF) showed the lowest root mean square error of prediction at 0.39% and the correspondingly lowest root men. The root mean squared percentage error (RMSPE): standard deviation ratio (RSR) at 0.52. In the case of total carbon footprint (TCF), herd N-use efficiency (NUECR) again showed the lowest root mean square error of prediction at 0.52%. Regarding TCF, herd feed efficiency (EACR) was the variable with the lowest both RMSPE and RSR, with 0.65 and 0.64, respectively. Consequently, the estimation of the PCF and TCF of 1 ​kg of milk from the temperate-humid zone of northern Spain at the farm gate can be feasibly accomplished utilizing NUECR and EACR, respectively.

The main contribution of this paper is the assets of the current and voltage ripples in a buck converter with an LED load. The results indicate that the ripples are different and that it is possible to reduce the passive filter concerning the model of the LED as a simple resistance. The paper presents the design and simulation of a buck converter as a power supply for an LED lamp. Modeling the LED as a resistor and a voltage source (SVRM), the equations to calculate the components of the circuit using the SVRM model are presented, where the Fourier series and phasors are used to calculate the output filter. The equations are validated with SPICE simulations. The results indicate that the SVRM model for the LED load affects the calculation of the output filter of the buck converter as well as the voltage and current ripples, making it a more precise design alternative to the proposed development.

España ha vivido en el último siglo dos grandes períodos de cambios educativos. El primero de ellos vinculado a leyes reguladoras de la educación, donde todo giraba en torno al docente, el cual desempeñaba su función a través de un aprendizaje memorístico. El segundo surge tras el acercamiento a instituciones internacionales como la Organización para la Cooperación y el Desarrollo Económicos y la Unión Europea. La firma del tratado de adhesión en 1986 trajo consigo un cambio de corte social y a nivel metodológico con un cambio del rol del docente, cada vez más considerado como una guía en los procesos de enseñanza-aprendizaje del alumnado. La alternancia política en casi medio siglo ha promovido diversas leyes educativas. La última de ellas, la LOMLOE, que ha reforzado la tendencia de un cambio donde la educación significativa cobra relevancia. A esto hay que sumar una división administrativa, que ajusta el currículo más que a su idiosincrasia al color político, lo que ha provocado una deriva educativa marcada por una brecha entre comunidades del norte y del sur, reflejada en informes como el PISA o estadística acerca del abandono escolar. Todo esto motiva este estudio relacionado con el complejo en el escenario educativo español.

A new category of fruit style beer resulting from the addition of grape matrices is named Italian Grape Ale (IGA). In this paper, we report data on an experimental work to produce IGA beers, adding macerated (CO2 or N2) red Gamay grape must or Aleatico grape pomace resulting from a grape dehydration process. Our hypothesis, that these wine processes can produce volatile organic compounds (VOCs) to characterize these IGA beers which was confirmed by chemical, sensory and aromatic results. IGA beers especially the one with gas-macerated grape musts (IGA-C and IGA-N) showed higher alcohol content than ALE beer (Control) and a higher polyphenol content and antioxidant activity. As regards VOCS, IGA beers increased the concentration of some classes (i.e., alcohols, esters, norisoprenoids) and IGA-N was better characterized by specific compounds such as isobutyric acid, phenylacetate, tyrosol, ethyl hydrogen succinate. Finally, E-nose and sensory evaluation discriminated significantly all the IGA beers.

En los últimos años, los actores intervinientes en los procesos de enseñanza-aprendizaje han visto cómo se han introducido en los mismos, unas herramientas que han complementado a las ya existentes. Estas, catalogadas como de realidad aumentada, favorecen la transmisión y adquisición del conocimiento, a la par que mejoran y potencian las competencias que el alumnado debe adquirir en la etapa formativa de educación secundaria. La implantación de estas herramientas choca frontalmente con los progenitores y el profesorado, reacios en todo momento a que estos instrumentos pueden o deben ser ejecutados y manejados desde dispositivos tales como un Smartphone. Y es que estos dispositivos son percibidos como elementos de distracción y no colaborativos, educativamente hablando. A esto hay que añadir la existencia de una brecha tecnológica, profundizada tras la última crisis socio-económica y agudizada por la pandemia que inició en 2019 y en La Palma-Canarias (España), por la erupción del volcán de Cumbre Vieja, con consecuencias en materia educativa. En este artículo se analizan las consecuencias de introducir, puntualmente en el aula, el Smartphone y software RA, con la intención de mejora en los procesos de enseñanza-aprendizaje y en los actores intervinientes en dichas acciones. La implantación de estas herramientas choca frontalmente con los progenitores y el profesorado reacios en todo momento a que estas herramientas pueden o deben ser ejecutadas y manejadas desde dispositivos tales como un Smartphone. Y es que estos dispositivos son percibidos como elementos de distracción y no colaborativos, educativamente hablando. A esto hay que añadir la existencia de una brecha tecnológica, profundizada tras la última crisis socio-económica (2005) agudizada por la pandemia (2019) y en La Palma-Canarias (España) por la erupción del volcán de Cumbre Vieja, con consecuencias en materia educativa. En este artículo, analizaremos las consecuencias de introducir, puntualmente en el aula Smartphone, y software RA y lo que esto supuso en materia de mejora de los procesos de enseñanza-aprendizaje y en los actores intervinientes en dichas acciones.

En la historia de España, los años sesenta del siglo XX son los años del desarrollismo y del crecimiento de las ciudades. Nuestro propósito con este artículo ha sido mirar al desarrollismo franquista, pero no desde la ciudad. Lo hemos hecho desde el mundo rural, desde el fenómeno de la emigración y desde la historia de las mujeres, pero no de las que se fueron, sino de las mujeres que se quedaron. El artículo, posándose en testimonios inéditos y en documentación novedosa procedente de los archivos locales, sostiene que la realidad de la emigración masculina contribuyó a modificar los roles y responsabilidades asumidas por las mujeres del mundo rural andaluz y extremeño. La ausencia de sus maridos, aunque no acabó con la jerarquía de género y con la desigualdad que caracterizaba la relación entre hombres y mujeres, sí las llevó a asumir nuevos deberes adicionales e hizo que su faceta adquiriera muchas veces la imagen de jefa de familia o de sostenedoras de hogares. Lo que asumieron, lo que aprendieron, lo que hablaron, lo que leyeron y hasta lo que compraron esas mujeres del rural, caracterizadas como viudas blancas, desafía las suposiciones de su pasividad y aislamiento que siempre las han caracterizado.

Abstract Background To assess the usefulness of pre-operative contrast-enhanced transthoracic echocardiography (CE-TTE) and post-operative chest-x-ray (CXR) for evaluating central venous catheter (CVC) tip placements, with trans-esophageal echocardiography (TEE) as gold standard. Methods A prospective single-center, observational study was performed in 111 patients requiring CVC positioning into the internal jugular vein for elective cardiac surgery. At the end of CVC insertion by landmark technique, a contrast-enhanced TTE was performed by both the apical four-chambers and epigastric bicaval acoustic view to assess catheter tip position; then, a TEE was performed and considered as a reference technique. A postoperative CXR was obtained for all patients. Results As per TEE, 74 (67%) catheter tips were correctly placed and 37 (33%) misplaced. Considering intravascular and intracardiac misplacements together, they were detected in 8 patients by CE-TTE via apical four-chamber view, 36 patients by CE-TTE via epigastric bicaval acoustic view, and 12 patients by CXR. For the detection of catheter tip misplacement, CE-TTE via epigastric bicaval acoustic view was the most accurate method providing 97% sensitivity, 90% specificity, and 92% diagnostic accuracy if compared with either CE-TTE via apical four-chamber view or CXR. Concordance with TEE was 79% (p

In this work, the applicability of a Firefly Algorithm (FA) to the real problem of the minimum cost of a detailed design for steel frames is studied. To reduce the calculation time, which is a common problem of meta-heuristic algorithms when they are used to solve real design cases, and to better suit the characteristics of the algorithm, a parallel migration strategy has been implemented and tested. As it is well known that the performance of any metaheuristic algorithm depends on the chosen value of its parameters, an extensive sensitivity analysis has been carried out. This not only serves to improve performance but also provides information on how it depends on the values of these parameters. With the information obtained from this analysis, and in order to achieve the robust behavior of the algorithm, a parameter control strategy has also been implemented and tested. Finally, a study demonstrating the close dependence between one of the parameters and the number of variables considered in the examples has been carried out. As a result of this final study, a simple expression is proposed that provides the minimum necessary population based on the number of variables in the problem.

In this article we examine the intertwined relationship between taste and mining culture in early modern Spanish worlds, highlighting descriptions of metals and minerals through which taste appears as an epistemic marker with symbolic dimensions. Drawing on different documents regarding mining practices, mineral vocabulary and metal appreciation in Spain, New Spain, Peru and the New Kingdom of Granada (c.1550–1640), our article contends that knowing minerals through taste in the Spanish worlds was part of a practice engaged with the senses, the body politic and its cosmological order.

Background In a preliminary study during the first COVID-19 pandemic wave, we reported a high rate of success with continuous positive airway pressure (CPAP) in preventing death and invasive mechanical ventilation (IMV). That study, however, was too small to identify risk factors for mortality, barotrauma and impact on subsequent IMV. Thus, we re-evaluated the efficacy of the same CPAP protocol in a larger series of patients during second and third pandemic waves. Methods 281 COVID-19 patients with moderate-to-severe acute hypoxaemic respiratory failure (158 full-code and 123 do-not-intubate (DNI)), were managed with high-flow CPAP early in their hospitalisation. IMV was considered after 4 days of unsuccessful CPAP. Results The overall recovery rate from respiratory failure was 50% in the DNI and 89% in the full-code group. Among the latter, 71% recovered with CPAP-only, 3% died under CPAP and 26% were intubated after a median CPAP time of 7 days (IQR: 5–12 days). Of the patients who were intubated, 68% recovered and were discharged from the hospital within 28 days. Barotrauma occurred during CPAP in

Hospital bed shortage is a worldwide concern. Their unavailability has caused elective surgery cancellations at our hospital peaking in spring 2016 at over 50%. This is often due to difficult patient step-down from intensive care (ICU) and high-dependency units (HDU). In our general/digestive surgery service admitting approximately 1000 patients yearly, ward rounds were run on a consultant firm basis.We report quality improvement (ISRCTN13976096) after we introduced a structured daily multidisciplinary board round framework (SAFER Surgery R2G) adapted from the ‘SAFER patient flow bundle’ and the ‘Red to Green days’ approaches to enhance flow. We compare 2016–2017, when our framework was applied for 12 months.We used a Plan–Do–Study–Act (PDSA) methodology. Our intervention consisted in (1) systematically communicating the key care plan after the afternoon ward rounds to the nurse in charge; (2) 30’ 10:00 hours Monday-to-Friday multidisciplinary board rounds, attended daily by the senior team and weekly by hospital and site managers, revising the key care plan to aim at safe, early discharges, assessing the appropriateness of each inpatient day and tackling any cause of delay. We measured patient flow by average length of stay (LOS), ICU/HDU step-downs and operation cancellations count, monitoring safety through early 30-day readmissions. Compliance was assessed by board round attendance and staff satisfaction rate surveys.After 12 months of intervention (PDSA-1-2, N=1032), compared with baseline (PDSA-0, N=954) average LOS significantly decreased from 7.2 (8.9) to 6.3 (7.4) days (p=0.003); ICU/HDU bed step-down flow increased by 9.3% from 345 to 375 (p=0.197), surgery cancellations dropped from 38 to 15 (p=0.100). 30-day readmissions increased from 0.9% (N=9) to 1.3% (N=14)(p=0.390). Average cross-specialty attendance was 80%. Satisfaction rates were >75%, regarding enhanced teamwork and faster decisions.The SAFER Surgery R2G framework has increased patient flow in the context of an enhanced multidisciplinary approach, requiring senior staff commitment to remain sustainable.

En la actualidad existen diversas aplicaciones de la iluminación LED, sin embargo, algunas de estas requieren regular la iluminación con precisión y en un amplio rango de operación, principalmente en tareas de seguimiento. Es en estos casos en donde es necesario considerar la no linealidad del LED para el diseño de esquemas de control, además, se necesita de una fuente de alimentación eficiente ante los cambios de tensión y corriente requeridos por la lámpara. En este trabajo se presenta el diseño de un convertidor DC-DC capaz de realizar y soportar estas variaciones, así como el diseño, simulación y comparación de esquemas de control PI clásico, PI difuso y ganancias programadas para estas aplicaciones. Con el fin de validar los esquemas de control descritos, y con el propósito de cumplir las recomendaciones de la Organización Mundial de la Salud, se toma el control de la iluminancia producida por una lámpara de protección ocular como caso de estudio, en donde el controlador varía el ciclo de trabajo del convertidor, ajustando de esta manera la tensión de la lámpara, y en consecuencia regulando la intensidad luminosa. Comparando los esquemas de control, el desempeño del sistema con el control por ganancias programadas tiene mejores características para el caso de estudio descrito con anterioridad, presentándose un error en estado estable de 0 % y menor sobretiro en comparación con los otros esquemas de control desarrollados.

En los años ochenta, del pasado siglo, se puso en marcha una concepción educativa dual en España, las Escuelas Taller. Esta se dirigió a un público con unos requisitos especiales: parados de larga duración con problemas de inclusión laboral en sus respectivas especialidades, unido a su carencia educativa. Veinte años después de haberlas puesto en marcha, se incorporó al currículo de las mismas el módulo de Alfabetización Digital, cuyo fin era acercar al alumnado a las TIC y a su aplicación en la familia profesional sobre la que se desempeñó la acción formativa. Este estudio, analiza los contenidos recogidos en el currículo del módulo de Alfabetización Digital de la Escuela Taller de Cambados-Pontevedra (ESPAÑA) “Caminos Jacobeos” y ”Cambados Medioambiental”, su contextualizados a la formación del alumnado al que va dirigido, el cual ha sufrido, en los últimos años, una serie de crisis económicas que han provocado la aparición de brechas socioeconómicas. Los resultados, reflejan las inquietudes del alumnado en materia TIC, la adquisición de habilidades y competencias contextualizadas en su formación, y las exigencias de nuevos módulos de formación requeridos y no contemplados en su currículo, pero que la sociedad en la que van a dirigir sus actuaciones les demandan.

The first goal of this work was the description of a model addressed to quantify the carbon footprint in Spanish autochthonous dairy sheep farms (Manchega group), foreign dairy sheep farms (foreigners group: Lacaune and Assaf breeds), and Spanish autochthonous dairy goat farms (Florida group). The second objective was to analyze the GHG emission mitigation potential of 17 different livestock farming practices that were implemented by 36 different livestock farms, in terms of CO2e per hectare (ha), CO2e per livestock unit (LU), and CO2e per liter of fat- and protein-corrected milk (FPCM). The study showed the following results: 1.655 kg CO2e per ha, 6.397 kg CO2e per LU, and 3.78 kg CO2e per liter of FPCM in the Manchega group; 12.634 kg CO2e per ha, 7.810 CO2e kg per LU, and 2.77 kg CO2e per liter of FPCM in the Foreigners group and 1.198 kg CO2e per ha, 6.507 kg CO2e per LU, and 3.06 kg CO2e per liter of FPCM in Florida group. In summary, purchasing off-farm animal feed would increase emissions by up to 3.86%. Conversely, forage management, livestock inventory, electrical supply, and animal genetic improvement would reduce emissions by up to 6.29%, 4.3%, 3.52%, and 0.8%, respectively; finally, an average rise of 2 °C in room temperature would increase emissions by up to 0.62%.

This study aimed to investigate psychiatric symptomatology in a sample of patients affected by breast cancer undergoing surgery, evaluating the potential mediators on perceived stress levels, depression and hopelessness. The study was conducted on eighty-five patients with breast cancer, admitted consecutively to the Breast Unit of the IRCCS Ospedale Policlinico San Martino, between May 2018 and December 2019. Sociodemographic (age of diagnosis, gender, marital and occupational status, educational level, having children) and clinical (type and side of surgery, previous breast surgery, neoadjuvant chemotherapy and axillary dissection) characteristics were investigated through a semi-structured interview. The following rating scales were administered: Beck Depression Inventory, Beck Hopelessness Scale, and Perceived Stress Scale. Our findings indicate that the presence of children and of a partner was associated with a lower total score on the clinical dimensions evaluated. Furthermore, we found demolitive surgery to be a mediator between perceived stress and hopelessness, while history of previous breast surgery was found to be a mediator between demolitive surgery and perceived stress. In conclusion, patients affected by breast cancer undergoing more complex and demolitive surgery or with history of previous breast surgery should be mostly monitored from a psychological and psychiatric point of view from the beginning of treatments to evaluate the first manifestations of psychiatric symptomatology.

El primer franquismo (1939-1952) fue un periodo de carestía, miseria, enfermedades y muerte. Considerando el hambre como protagonista, el estudio de la mortalidad de una zona rural de Andalucía Oriental permite relacionar los condicionantes políticos, económicos y sociales con la nutrición. Y también con las condiciones higiénico-sanitarias, las enfermedades y las principales causas de muerte, provocadas tanto directa (enfermedades del aparato digestivo) como indirectamente (enfermedades del aparato respiratorio e infecto-contagiosas) por el hambre.