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Resumen Introduccion Aunque la edad en el ictus no condiciona los tratamientos de reperfusion, lleva implicitamente una fragilidad que condiciona el estado funcional y probablemente el pronostico y la evolucion. Objetivos Estudiar la fragilidad en pacientes con ictus isquemico tratados con trombectomia mecanica y de ≥ 80 anos de edad. Metodo Estudio observacional en poblacion ≥ 80 anos tras sufrir un ictus isquemico y tratarse con trombectomia mecanica, entre febrero y octubre de 2018. Se recogieron variables sobre factores de riesgo cardiovascular, tratamiento concomitante, datos correspondientes al episodio del ictus (gravedad neurologica y funcional con las escalas NIHS y Rankin modificada) y fragilidad (entrevista telefonica, enero-febrero 2019). Resultados La muestra fue de 65 personas. El 72% padecian hipertension arterial y el 43%, fibrilacion auricular. El 75% no estaban a tratamiento anticoagulante. El 78% fueron tratados antes de 6 h. El 82% no sufrieron complicaciones neurologicas. Se consiguio una reperfusion arterial completa en el 83%. El 27,69% puntuaron como no fragil (n = 28). Se observo relacion estadistica entre la fragilidad y la edad (p = 0,003). Discusion A nivel neurologico y funcional los ictus presentaban puntuaciones mayores (mas graves) en las escalas NIHS y Rankin modificada respecto a otros estudios de investigacion. Los pacientes mas mayores que sobrevivieron al ictus son en su mayoria no fragiles, por lo que la recuperacion deberia medirse en terminos de funcionalidad y calidad de vida y no tanto en base a la edad cronologica.

Objective: To describe the heterogeneity of electrodiagnostic (EDx) studies in Guillain-Barre syndrome (GBS) patients collected as part of the International GBS Outcome Study (IGOS). Methods: Prospectively collected clinical and EDx data were available in 957 IGOS patients from 115 centers. Only the first EDx study was included in the current analysis. Results: Median timing of the EDx study was 7 days (interquartile range 4-11) from symptom onset. Methodology varied between centers, countries and regions. Reference values from the responding 103 centers were derived locally in 49%, from publications in 37% and from a combination of these in the remaining 15%. Amplitude measurement in the EDx studies (baseline-to-peak or peak-to-peak) differed from the way this was done in the reference values, in 22% of motor and 39% of sensory conduction. There was marked variability in both motor and sensory reference values, although only a few outliers accounted for this. Conclusions: Our study showed extensive variation in the clinical practice of EDx in GBS patients among IGOS centers across the regions. Significance: Besides EDx variation in GBS patients participating in IGOS, this diversity is likely to be present in other neuromuscular disorders and centers. This underlines the need for standardization of EDx in future multinational GBS studies.(c) 2022 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

This work aims to analyze the prognosis and mortality of patients hospitalized for acute coronary syndrome before and after the implementation of a coronary care unit, hemodynamics room, and the Código Corazón [Infarction Code] primary angioplasty program.We conducted an observational, retrospective study that analyzed the epidemiological characteristics, reperfusion strategies, adverse cardiovascular events, and mortality over a follow-up period of five years. The results from the post-code period (March 1 - December 31, 2012; n=471) were compared with those from the pre-code period (March 1 - December 31, 2009; n=432).There were no differences in the baseline characteristics of the two groups. However, an increase in ST-elevation acute coronary syndrome (STE-ACS) from 17.6% to 34.8% (p.001) was observed during the postcode phase. The use of percutaneous coronary intervention was made widespread at the hospital and was used in 64.8% of non-ST-elevation acute coronary syndrome (NSTE-ACS) cases and in 95.5% of STE-ACS cases. A reduction was observed in readmissions (from 38.2% to 25.1% for NSTE-ACS (p=.001) and from 23.7% to 11.0% for STE-ACS (p=.018)), the composite prognostic variable of adverse cardiovascular events and 5-year mortality (from 58.7% to 45% (p=.001) for NSTE-ACS and from 40.8% to 23.8% (p=.009) for STE-ACS), and a decrease in 30-day mortality in STE-ACS (from 11.8% to 3.7%; p=.021).With the structural changes in the hospital, the use of percutaneous coronary intervention was made widespread and improved the prognosis of patients with acute coronary syndrome, decreasing admissions, adverse cardiovascular events, and mortality.

Resumen Objetivo Analizar el pronostico y mortalidad de los pacientes ingresados en un hospital por sindrome coronario agudo antes y despues de la implantacion de la unidad coronaria, la sala de hemodinamica y el programa de angioplastia primaria (Codigo corazon). Metodos Estudio observacional y retrospectivo. Se analizaron las caracteristicas epidemiologicas, las estrategias de reperfusion, los eventos adversos cardiovasculares y la mortalidad durante 5 anos de seguimiento. Los resultados del periodo post-codigo (1 marzo 2012-31 diciembre 2012; n = 471) se compararon con la etapa precodigo (1 marzo 2009-31 diciembre 2009; n = 432). Resultados No hubo diferencias en las caracteristicas basales de ambos grupos, pero en la fase poscodigo se observo un incremento del sindrome coronario agudo con elevacion del ST (SCACEST) del 17,6 al 34,8% (p Conclusiones Con los cambios estructurales realizados en el hospital se ha generalizado el intervencionismo coronario percutaneo y ha mejorado el pronostico de los pacientes con sindrome coronario agudo, disminuyendo los ingresos, los eventos adversos cardiovasculares y la mortalidad.

Introduction and objectives Potentially inappropriate prescription (PIP) is common in elderly people. It has become a global public health problem due to its association with adverse drug effects (ADE), increased morbidity and mortality, emergency care visits and resource use. The main aim of this study was to determine whether the use of a notification program of PIP in elderly patients admitted in the hospital led to a reduction of their prescription. Method A quasi-experimental before–after study was conducted. PIP were identified by using Beers (2012 update) and STOPP-START criteria (2008 version). An individualized report on PPI was prepared and the effect of this intervention was evaluated. Results 174 patients were included who presented 284 PIP. 54% (153) of the recommendations were accepted. Barthel index was the only variable that proved to contribute to the presence of PIP modifications. The patients whose PIP drugs were modified were significantly more dependent (p = .005), presented cognitive impairment (p = .001) and were more institutionalized (p = .039) than those without any modifications. There were fewer readmissions, emergency care visits and mortality within six months after intervention comparing patients with and without PIP modifications, but without significant differences. 32 ADE were detected, 29 related with PIP drugs. Adverse events were significantly associated with PIP drugs, versus other medications (p Conclusions Review of medication in elderly patients, along with the use of tools that help in the identification of dangerous drugs, entail a reduction of inadequate prescription and significantly contribute to the continuous improvement of chronic medication in elders.

Resumen Introduccion y objetivos La prescripcion potencialmente inapropiada (PPI) es frecuente en ancianos. Se ha convertido en un problema de salud publica mundial por su relacion con efectos adversos a medicamentos (EAM), aumento de la morbimortalidad, visitas a urgencias y consumo de recursos. El objetivo principal de este estudio fue determinar si el uso de un programa de notificacion de PPI en pacientes ancianos hospitalizados condujo a una reduccion en su prescripcion. Metodo Se realizo un estudio quasi-experimental pre-post. La identificacion de las PPI se llevo a cabo segun los criterios de Beers (actualizacion 2012) y STOPP-START (version 2008). Se elaboro un informe individualizado sobre PPI y se evaluo el efecto de esta intervencion. Resultados Se incluyeron 174 pacientes con 284 PPI. Se aceptaron el 54% (153) de las recomendaciones. La unica variable que demostro contribuir a la presencia de modificaciones en la PPI fue el indice de Barthel. Los pacientes a los que se les modifico la PPI se caracterizaron por ser significativamente mas dependientes (p = 0,005), presentar deterioro cognitivo (p = 0,001) y encontrarse mas institucionalizados (p = 0,039) que aquellos a los que no se les realizo ninguna modificacion. Se produjeron menos reingresos, visitas a urgencias y menor mortalidad al comparar los pacientes con y sin modificaciones de PPI, pero sin diferencias significativas. Se identificaron 32 EAM, 29 relacionados con farmacos inapropiados. Los EAM se asociaron con PPI respecto a otros farmacos de manera significativa (p Conclusiones La revision de la medicacion en pacientes de edad avanzada, junto con el uso de herramientas que ayudan en la identificacion de farmacos inapropiados, conlleva una reduccion de la PPI y contribuye de manera significativa a la mejora continua de la medicacion cronica en los ancianos.

Region-optimal algorithms are local search algorithms for solving Distributed Constraint Optimization Problems (DCOPs). In each iteration of the search in such algorithms, every agent selects a group of agents that comply with some selection criteria (each algorithm specifies different criteria). Then, the agent who selected the group, called the mediator, collects assignment information from the group and neighboring agents outside the group, in order to find an optimal set of assignments for its group's agents. A contest between mediators of adjacent groups determines which groups will replace their assignments in that iteration to the found optimal ones. In this work we present a framework called RODA (Region Optimal DCOP Algorithm) that encompasses the algorithms in the region optimality family, and in particular any method for selecting groups. We devise a secure implementation of RODA, called P-RODA, which preserves constraint privacy and partial decision privacy. Our discussion covers both symmetric and asymmetric DCOPs. The two main cryptographic means that enable this privacy preservation are secret sharing and homomorphic encryption. We estimate the computational overhead of P-RODA with respect to RODA and give an upper bound that depends on the group and domain sizes and on the graph topology, but not on the number of agents. The estimations are substantiated with experimental results, including experiments on a simulator, that compare the performance of P-RODA to that of its competing algorithm, P-Max-Sum.

Presently available data on neutron irradiation damage raise doubts on the feasibility of using EUROFER97 steel for a water-cooled starter blanket in a DEMO reactor, since the ductile-to-brittle transition temperature (DBTT) increases significantly for irradiation temperatures below 350°C. The additional DBTT shift caused by H and He transmutation can only be estimated based on very few results with isotopically tailored EUROFER97 steel. Conservative calculations show that the DBTT of EUROFER97 steel could exceed the operating temperature in water-cooled starter blankets within a relatively short time period. This paper presents results from a EUROfusion funded irradiation campaign that was performed in the High Flux Isotope Reactor at Oak Ridge National Laboratory. The paper compares ten newly developed reduced activation ferritic-martensitic (RAFM) steels irradiated to a nominal dose of 2.5 dpa at 300°C. The post-irradiation experiments using Small Specimen Test Technology included hardness, tensile, and fracture mechanics tests combined with fractography and microstructure analysis are presented. Results show that micro-alloying EUROFER97-type steels influenced the mechanical properties but a dominating impact on irradiation damage resistance could not be identified. In contrast, specific thermo-mechanical treatments lead to better DBTT behavior. Discussion about irradiation response to heat treatment conditions is also given. Despite requiring data also at high dpa values, the results indicate that with these modified materials an increased lifetime and potentially also an increased operating temperature window can be achieved compared to EUROFER97.

Immunosenescence in chronic heart failure (CHF) is characterized by a high frequency of differentiated T-lymphocytes, contributing to an inflammatory status and a deficient ability to generate immunocompetent responses. CMV is the best known inducer of T-lymphocyte differentiation, and is associated with the phenomenon of immunosenescence. In this study, we included 58 elderly chronic heart failure patients (ECHF), 60 healthy elderly controls (HEC), 40 young chronic heart failure patients (YCHF) and 40 healthy young controls (HYC). High differentiation of CD8+ T-lymphocytes was found in CMV-seropositive patients; however, the differentiation of CD4+ T-lymphocytes was increased in CMV-seropositive but also in CHF patients. Anti-CMV antibody titers showed positive correlation with more differentiated CD4+ and CD8+ subsets and inverse correlation with CD4/CD8 ratio. Immunosenescence found in CHF patients is mainly due to the dynamics of CMV-infection, since the differentiation of T-lymphocyte subsets is related not only to CMV-infection, but also to anti-CMV antibody titers.

Merkel cell tumour is a rare skin tumour of high malignancy, poor prognosis and low survival. It is characterized by its tendency to lymph node and vascular invasion and by a high percentage of locoregional recurrence in the year following surgical removal. It affects adults between 60 and 80 years of age and often occurs in the head and neck. We present the case of an 85-year-old man presenting with an ulcerated gluteal mass of 4 months' evolution. Diagnosis was by histopathological and immunohistochemical study. Early diagnosis and appropriate treatment are important to improve the prognosis of these patients.

Resumen El tumor de celulas de Merkel es un tumor cutaneo raro, de elevada malignidad, mal pronostico y baja supervivencia. Se caracteriza por su tendencia a la invasion ganglionar y vascular, y por un alto porcentaje de recurrencia locorregional en el ano siguiente a la extirpacion quirurgica. Afecta a adultos entre los 60 y 80 anos, y se localiza preferentemente en cabeza y cuello. Presentamos el caso de un varon de 85 anos que acude por masa glutea ulcerada de 4 meses de evolucion. El diagnostico se realizo por estudio histopatologico e inmunohistoquimico. Un diagnostico precoz y un tratamiento adecuado son importantes para mejorar el pronostico de estos enfermos.

In recent years, several studies proposed privacy-preserving algorithms for solving Distributed Constraint Optimization Problems (DCOPs). Those studies were based on existing DCOP solving algorithms, which they strengthened by implementing cryptographic weaponry that enabled performing the very same computation while protecting sensitive private data. All of those studies assumed that agents do not collude. In this study we propose the first privacy-preserving DCOP algorithm that is immune to coalitions. Our basic algorithm is secure against any coalition under the assumption of an honest majority (namely, the number of colluding agents is n / 2 , where n is the overall number of agents). We then proceed to describe two variants of that basic algorithm: a more efficient variant that is secure against coalitions of size ≤c, for some constant c ( n − 1 ) / 2 ; and another variant that is immune to agent coalitions of any size, but relies on an external committee of mediators with an honest majority. Our algorithm – PC-SyncBB – is based on the classical Branch and Bound DCOP algorithm. It offers constraint, topology and decision privacy. We evaluate its performance on different benchmarks, problem sizes, and constraint densities. We show that achieving security against coalitions is feasible. Our experiments indicate that PC-SyncBB can run in reasonable time on problems involving up to 19 agents. As all existing privacy-preserving DCOP algorithms base their security on assuming solitary conduct of the agents, we view this study as an essential first step towards lifting this potentially harmful assumption in all those algorithms.

Patients with solid-organ transplants usually present at the emergency department with nonspecific symptoms. The physician should consider a great variety of syndromes and diseases, given the greater risk that solid-organ transplant patients carry because of immunosuppression and transplant-related conditions. Myocardial infarction caused by cardiac allograft vasculopathy must be always suspected and ruled out, even when initial symptoms do not orientate in that direction. We present a case that conjugates signs that can be present in different pathologies. It shows that fever is not always related to infection or rejection but could also appear in acute cardiac allograft vasculopathy. It emphasizes the need of a multi-disciplinary team led by a heart transplant specialist when dealing with this sort of clinical case.