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Objective The “Open Lung Approach” (OLA), that includes high levels of positive end-expiratory pressure coupled with limited tidal volumes, is considered optimal for adult patients with ARDS. However, many previous meta-analyses have shown only marginal benefits of OLA on mortality but with statistical heterogeneity. It is crucial to identify the most likely moderators of this effect. To determine the effect of OLA strategy on mortality of ventilated ARDS patients. We hypothesized that the degree of recruitment achieved in the control group (PaO2/FiO2 ratio on day 3 of ventilation), and the difference in Mechanical Power (MP) or Driving Pressure (DP) between experimental and control groups will be the most likely sources of heterogeneity. Design A Systematic Review and Meta-analysis was performed according to PRISMA statement and registered in PROSPERO database. We searched only for randomized controlled trials (RCTs). GRADE guidelines were used for rating the quality of evidence. Publication bias was assessed. For the Meta-analysis, we used a Random Effects Model. Sources of heterogeneity were explored with Meta-Regression, using a priori proposed set of possible moderators. For model comparison, Akaike's Information Criterion with the finite sample correction (AICc) was used. Setting Not applicable. Patients Fourteen RCTs were included in the study. Interventions Not applicable. Main variables of interest Not applicable. Results Evidence of publication bias was detected, and quality of evidence was downgraded. Pooled analysis did not show a significant difference in the 28-day mortality between OLA strategy and control groups. Overall risk of bias was low. The analysis detected statistical heterogeneity. The two “best” explicative meta-regression models were those that used control PaO2/FiO2 on day 3 and difference in MP between experimental and control groups. The DP and MP models were highly correlated. Conclusions There is no clear benefit of OLA strategy on mortality of ARDS patients, with significant heterogeneity among RCTs. Mortality effect of OLA is mediated by lung recruitment and mechanical power.

We characterized substance use patterns and co-occurring substance use disorders among active cocaine base paste (CBP) users in Santiago, Chile using data from respondent-driven sampling (RDS) in three areas of Metropolitan Santiago. Recruitment began with nine seeds, reaching 398 active CBP users (18% women; mean age 37.7 years), defined as persons consuming CBP at least twice per week in the last three months. Population proportions and uncertainty were estimated accounting for individuals' social network and homophily. The median CBP age of initiation was 21 years, and the median number of years using CBP was 7 for women and 15 for men. The median days of use in the past month was 25 days, with a median of 56 doses per week. The proportion of monthly income spent on CBP was 65%. The prevalence of substance use disorders (SUDs) were: 98% for CBP, 67% for alcohol, 60% for marijuana, and 41% for cocaine hydrochloride. Heavy polydrug use patterns and co-occurring SUDs are frequent among active CBP users in the metropolitan area of Santiago. Traditional surveillance strategies may have underestimated polysubstance use and co-occurring SUDs in active CBP users. RDS proved to be a feasible methodology that could be effectively used for substance use surveillance among hard-to-reach populations.

The congenital deficit of FVII of coagulation it's an anomaly of genetic transmission autosomal recessive type, it can occur with clinical manifestations like hematomas and spontaneous bleeding or not. The normal levels of FVII it's found between 70%-130% of the laboratory reference value. For unknown reasons there is a poor correlation between levels of FVII and bleeding risk. During pregnancy coagulation can be significantly altered, there is a no clear consensus and a very few information about how to act during labor in a patient with a FVII deficit. The case of a 35-year-old patient with 35 weeks of gestation and congenital deficit of the coagulation FVII (36%) is presented, epidural analgesia is performed during labor previously administering activated recombinant FVII (rFVIIa) without complications (Spinal hematoma, postpartum bleeding, thrombosis).

Aim To determine in the adult population the crude and the sex- and age-adjusted prevalence rates of hypertriglyceridaemia (HTG) and to assess its association with cardiovascular risk factors, chronic kidney disease, cardiovascular and cardiometabolic diseases. Methods Cross-sectional observational study conducted in Primary Care, with 6,588 adult study subjects, randomly selected on base-population. Patients had HTG if the triglyceride level was ≥150 mg/dL (≥1.7 mmol/L), or were on lipid-lowering therapy to lower triglyceride. Associations were assessed by univariate and multivariate analysis, and crude and sex- and age-adjusted prevalence rates were determined. Results The arithmetic and geometric means of triglyceride levels were respectively 120.5 and 104.2 mg/dL in global population, 135.7 and 116.0 mg/dL in men, and 108.6 and 95.7 mg/dL in women. The crude HTG prevalence rates were 29.6% in global population, 36.9% in men and 23.8% in women. The sex- and age-adjusted HTG prevalence rates were 27.0% in global population, 34.6% in men and 21.4% in women. The independent variables that were most associated with HTG were hypercholesterolemia (OR: 4.6), low HDL-C (OR: 4.1), hepatic steatosis (OR: 2.8), diabetes (OR: 2.0), and obesity. (OR: 1.9). Conclusions The means of triglyceride levels and HTG prevalence rates are intermediate between those of other national and international studies. A fifth of the female adult population and more than a third of the male population had HTG. The independent factors associated with HTG were hypercholesterolemia and low HDL-C, and the cardiometabolic variables diabetes, hepatic steatosis and obesity.

Sustainable development has its complexity in seeking a balance between the three dimensions, renewable energies require an economic investment and are friendly to the environment; but due to socioeconomic differences, access and widespread use may be limited. Colombia has a subsidy mechanism according to socioeconomic strata, where the lower strata receive a reduction in the price of energy by a set amount of kWh, while the upper strata contribute a 20% of the final price. This research performs an economic evaluation due to the investment made in a photovoltaic system, considering socioeconomic factors; The results will make it possible to identify factors that affect equity and access to these technologies.Keywords: Energy policy, Barriers, Equity, Renewable energy.JEL Classifications: K29, Q48DOI: https://doi.org/10.32479/ijeep.11092

With the goal of ultimate control over the light propagation, photonic crystals currently represent the primary building blocks for novel nanophotonic devices. Bloch surface waves (BSWs) in periodic dielectric multilayer structures with a surface defect is a well-known phenomenon, which implies new opportunities for controlling the light propagation and has many applications in the physical and biological science. However, most of the reported structures based on BSWs require depositing a large number of alternating layers or exploiting a large refractive index (RI) contrast between the materials constituting the multilayer structure, thereby increasing the complexity and costs of manufacturing. The combination of fiber–optic-based platforms with nanotechnology is opening the opportunity for the development of high-performance photonic devices that enhance the light-matter interaction in a strong way compared to other optical platforms. Here, we report a BSW-supporting platform that uses geometrically modified commercial optical fibers such as D-shaped optical fibers, where a few-layer structure is deposited on its flat surface using metal oxides with a moderate difference in RI. In this novel fiber optic platform, BSWs are excited through the evanescent field of the core-guided fundamental mode, which indicates that the structure proposed here can be used as a sensing probe, along with other intrinsic properties of fiber optic sensors, as lightness, multiplexing capacity and easiness of integration in an optical network. As a demonstration, fiber optic BSW excitation is shown to be suitable for measuring RI variations. The designed structure is easy to manufacture and could be adapted to a wide range of applications in the fields of telecommunications, environment, health, and material characterization. Fundación para la Promoción de la Investigación y la Tecnología-Banco de la República of Colombia (Contract 202103); Universidad Nacional de Colombia (Hermes code 46509); Agencia Estatal de Investigación (AEI) and Fondo Europeo de Desarrollo Regional (TEC2016-78047-R and PID2019-106231RB-I00). E.G.V. acknowledges the support of COLCIENCIAS through the Doctoral Scholarship program.

Passive optical tapping can be implemented by stacking multiple layers of polydimethylsiloxane (PDMS), which is used as planar waveguides for the transmission and capturing of light. Once the main waveguide is installed in the communications system, each additional stacked waveguide represents an optical sniffer where it is possible to intercept the data from an input optical fibre, allowing the information to also flow to the output fibre unnoticeably from the point of view of the transmitter. The waveguides can be stacked or removed, making it a dynamic device that overcomes the limitations of previous designs, and the optical sniffer shows fixed implementation. In addition, it is demonstrated that PDMS is a versatile material that permits the control of the coupling of light among the waveguides, depending on its properties, and the thickness of each waveguide is also critical for the performance of the device. Furthermore, the experimental results are supported with a theoretical analysis that permits better understanding of the performance of the device, whose use can be extended to other applications, such as a passive optical hub or a signal combiner/splitter.

The safety of non-selective β-blockers (NSBBs) has been questioned in refractory ascites (RA). We studied the effects of NSBBs on cardiac systolic function, systemic hemodynamics, and renal perfusion pressure (RPP) and function in patients with diuretic-responsive ascites (DRA) and RA.We performed a prospective pre-post repeated-measures study in cirrhotic patients, 18 with DRA and 20 with RA on NSBBs for variceal bleeding prophylaxis. Systolic function (by ejection intraventricular pressure difference [EIVPD]), hepatic venous pressure gradient (HVPG), cardiopulmonary pressures, RPP, and sympathetic activation were measured at baseline and after 4 weeks of propranolol.EIVPD was elevated at baseline (RA 4.5 [2.8-5.7] and DRA 4.2 [3.1-5.7] mmHg; normal 2.4-3.6 mmHg) and directly related to the severity of vasodilation and sympathetic activation. NSBBs led to similar reductions in heart rate and HVPG in both groups. NSBBs reduced EIPVD in RA but not in DRA (-20% vs. -2%, p0.01). In RA, the NSBB-induced reduction in EIPVD correlated with the severity of vasodilation and with higher plasma nitric oxide, norepinephrine and IL-6 (r0.40, all p 0.05). NSBBs reduced RPP in both groups, but impaired renal function only in patients with RA. Reduced EIPVD correlated with decreases in RPP and estimated glomerular filtration rate (r 0.40, all p0.01). After NSBB treatment, RPP dropped below the threshold of renal flow autoregulation in 11 of the 20 (55%) patients with RA, including the 4 fulfilling the criteria for HRS-AKI.Renal perfusion and function depend critically on systolic function and sympathetic hyperactivation in RA. NSBBs blunt the sympathetic overdrive, hamper cardiac output, lower RPP below the critical threshold and impair renal function. β-blockade should be used cautiously or even avoided in patients with RA.We have identified the mechanisms by which non-selective beta-blockers could impair survival in patients with refractory ascites. We show that peripheral vasodilation and sympathetic activation lead to increased left ventricle systolic function in patients with cirrhosis and ascites, which acts as an adaptive mechanism to maintain renal perfusion. When ascites becomes refractory, this compensatory cardiac response to vasodilation is critically dependent on sympathetic hyperactivation and is hardly able to maintain renal perfusion. In this setting, β-blockade blunts the sympathetic overdrive of cardiac function, hampers cardiac output, lowers renal perfusion pressure below the critical threshold and impairs renal function.

Objective: The aims of our study were to assess the effectiveness and safety of continuous positive airway pressure (CPAP) during the transport of infants with acute respiratory failure (ARF) and to compare the disease course and clinical outcomes of CPAP vs oxygen therapy in the PICU setting. Materials and methods: We conducted a retrospective observational and analytical study by reviewing the health records of infants with ARF aged 0–12 months that required interhospital transfer to the PICU. Results: We included 110 patients: 71 transported with CPAP and 39 with oxygen therapy. The main cause of ARF was acute bronchiolitis (81.8%). The median level of CPAP was 7 cmH2O (interquartile range, 6–7). Controlling for the values prior to transfer in the specific multivariate models, we found that CPAP achieved a significant decrease in the Wood-Downes score (β = –1.08; 95% CI = –1.76 to –0.40; P = .002) and the heart rate ( β = –19.64; 95% CI = –28.46 to –10.81; P

Background: Type 2 diabetes (T2D) is a low-grade inflammatory condition with abnormalities in the immune response mediated by T lymphocytes and macrophages. Drug repositioning for immunomodulatory molecules is an attractive proposal for treating T2D. Nitazoxanide (NTZ) is a broad-spectrum drug with promising immunomodulatory effects. Thus, we investigated the immunomodulatory effect of NTZ on peripheral blood mononuclear cells (PBMCs) from patients with T2D. Methods: Fifty patients with T2D were selected, and the proliferative response of T lymphocytes and the M1/M2 ratio of macrophages post cell culture were evaluated by flow cytometry, as well as measuring the concentration of cytokines by ELISA and the relative expression of microRNAs (miRNAs) related to the immune response by real-time PCR. Results: NTZ exerts an inhibitory effect on the cell proliferation of T lymphocytes stimulated with anti-CD3 and anti-CD28 antibodies without modifying cell viability, and significant decreases in the supernatant concentrations of interleukin (IL)-1β, IL-2, IL-6, IL-10, and IL-12. Furthermore, NTZ negatively regulates the relative expression of miR-155-5p without changes in miR-146a-5p. The M1/M2 ratio of monocytes/macrophages decreased the M1 and increased the M2 subpopulation by NTZ. Conclusions: Our results suggest that NTZ exerts immunomodulatory effects on PBMCs from T2D patients, and shows potential alternative therapeutic benefits.

The objective of this study was to examine the interactions between comorbidity and five lifestyle single habits concerning different subscales of quality of life (QoL). For the study, 302 patients were consecutively recruited at the internal medicine department of a tertiary teaching hospital. Lifestyle habits, comorbidities and QoL were recorded according to validated questionnaires. Five single unhealthy habits, such as tobacco consumption, dietary intake of ultra-processed pastries, raw nuts or carbonated drinks, sleep time and physical activity patterns were selected according to previously published data. The main outcomes of the study were the scores of the eight subscales of the SF-36 QoL survey. The aggregate of unhealthy habits showed statistically significant association to every category in the SF-36 questionnaire, both in the univariate and the multivariate analysis when adjusting by age, sex and comorbidity. An interaction was found between comorbidity and unhealthy habits in both physical and mental summaries of SF-36. In conclusion, the lifestyle assessment according to five unhealthy habits is associated with a worse QoL. The interaction between comorbidity and unhealthy habits is especially clear in diseased patients due to the interplay between illness and lifestyle in the prediction of QoL.

This Letter presents the fabrication of dual lossy mode resonance (LMR) refractometers based on titanium dioxide ( T i O 2 ) and tin oxide ( S n O 2 ) thin films deposited on a single side-polished D-shaped optical fiber. For the first time, to the best of our knowledge, two independent LMRs are obtained in the same D-shaped optical fiber, by using a step-shaped nanostructure consisting of a first section of T i O 2 with a thickness of 120 nm and a second section with a thickness of 140 nm (120 nm of T i O 2 and 20 nm of S n O 2 ). Each section is responsible for generating a first-order LMR with TM-polarized light ( L M R T M ). T i O 2 is deposited by atomic layer deposition and S n O 2 by electron-beam deposition. The theoretical results show that the depth of each of the resonances of the dual LMR depends on the length of the corresponding section. Two experimental devices were fabricated with sections of different lengths, and their sensitivities were studied, achieving values ∼ 4000 n m / r e f r a c t i v e i n d e x u n i t (RIU) with a maximum of 4506 nm/RIU for values of the SRI between 1.3327 and 1.3485.

Multi-parameter detection is key in the domain of sensors. Here it is demonstrated that an indium tin oxide (ITO) nanocoating can be used to generate multiple lossy mode resonances (LMRs) in the optical spectrum. To achieve this, a nanocoating with a gradient in thickness is generated on the surface of a planar waveguide, permitting broadening of the LMR because the position of an LMR in the optical spectrum is directly related to the nanocoating thickness. The nanocoating with a gradient in thickness contributes multiple LMRs, each one centred at a different wavelength. With a further etching or deposition using a mask, a pattern of deposited and non-deposited regions can be created, resulting in isolation of the LMRs by preventing LMR overlap. This enables tracking of each central wavelength separately, which can be tuned through control of the gradient or nanocoating pattern. The array of LMR-based sensors is a photonics analogue to the interdigital concept in electronics, enabling multiple resonances to be used for multiparameter sensing. The authors would like to acknowledge the partial support to the Spanish Ministry of Economy and Competitiveness TEC2016-79367-C2-2-R and PID2019-106231RB-I00 research fund, the STARDUST project (European Commission) and the pre-doctoral research grants of the Public University of Navarra.

Florencia Feldman : Residente de la Clínica Ginecotocológica B. Facultad de Medicina, Universidad de la República. Uruguay. Correo electrónico: flofel_0236@hotmail.com Correspondencia: Pedro Francisco Berro 1115 apto 601. Montevideo, Uruguay. ORCID: 0000-0002-2394-6937-- Gina Del Villar: Residente de la Clínica Ginecotocológica C. Facultad de Medicina, Universidad de la República. Uruguay. dra.gina.del.villar.comboni@gmail.com-- Pamela Grimaldi: Asistente de la de la Clínica Ginecotocológica C. Facultad de Medicina, Universidad de la República. Uruguay. pameuru@hotmail.com-- Santiago Scasso : Profesor Adjunto de la Clínica Ginecotocológica C. Facultad de Medicina, Universidad de la República. Uruguay. sscasso@gmail.com ORCID: 0000-0002-0149-6752-- Grazzia Rey: Profesora Agregada de la Clínica Ginecotocológica B. Facultad de Medicina, Universidad de la República. Uruguay. grazziarey@gmail.com. ORCID: 0000-0002-5970-6302 Nota de contribución: Dra. Florencia Feldman: Concepción y diseño del estudio, Análisis e interpretación de los datos o resultados, Análisis estadísticos de los datos o resultados. -- Dra. Gina Del Villar: Recolección de los datos, Elaboración de un borrador del manuscrito, Concepción y diseño del estudio, Análisis e interpretación de los datos o resultados.-- Dra. Pamela Grimaldi: Elaboración de un borrador del manuscrito.-- Dr. Santiago Scasso: Supervisión del trabajo.-- Dra. Grazzia Rey: Supervisión del trabajo. Se realizó un análisis de la tasa de cesáreas en dos maternidades públicas de referencia de Uruguay (Hospital de Clínicas y Centro Hospitalario Pereira Rossell) utilizando la clasificación de Robson para compararlas entre sí, mediante un estudio observacional, descriptivo, retrospectivo y transversal en un periodo de 10 años y 10 meses (2009-2019). Se analizaron 85.526 nacimientos (7.685 (8,9%) en el Clínicas vs 77.841 (91.1%) Pereira Rossell). El porcentaje de cesáreas por año en el Clínicas fue 49,2% ± 5 vs 29,3% ± 3 en Pereira Rossell. Los grupos de Robson más prevalentes fueron 1, 5A y 10 en el Clínicas vs 3, 1 y 5A en Pereira Rossell. En ambos centros los grupos con mayor contribución relativa a la tasa global de cesáreas fueron: 5A, 10 y 1. Ambos centros presentan un aumento en la tasa de cesárea en la última década, pese a que se asisten poblaciones dispares entre cada uno de ellos. Se debe seguir buscando estrategias que ayuden a reducir la tasa de cesáreas principalmente en pacientes sin cesáreas anteriores o con una única cesárea previa, en caso de no presentan contraindicaciones para el parto vaginal. An analysis of the caesarean section rate was carried out in two reference public maternity wards in Uruguay (Hospital de Clínicas and Centro Hospitalario Pereira Rossell) using Robson’s classification to compare them with each other, through an observational, descriptive, retrospective and cross-sectional study in a period 10 years and 10 months (2009-2019). 85,526 births were analyzed (7,685 (8.9%) in the Clinics vs 77,841 (91.1%) Pereira Rossell). The percentage of caesarean sections per year in the Clinics was 49.2% ± 5 vs 29.3% ± 3 in Pereira Rossell. The most prevalent Robson groups were 1, 5A and 10 in the Clinicas vs 3, 1 and 5A in Pereira Rossell. In both centers, the groups with the highest relative contribution to the overall rate of cesarean sections were: 5A, 10 and 1. Both centers show an increase in the rate of cesarean section in the last decade, despite the fact that different populations are attended between each of them. Strategies should continue to be sought to help reduce the rate of cesarean sections, mainly in patients without previous cesarean sections or with a single previous cesarean section, if they do not present contraindications for vaginal delivery. Foi realizada análise da taxa de cesárea em duas maternidades públicas de referência do Uruguai (Hospital de Clínicas e Centro Hospitalario Pereira Rossell), utilizando a classificação de Robson para compará-las, por meio de estudo observacional, descritivo, retrospectivo e transversal. em um período de 10 anos e 10 meses (2009-2019). Foram analisados 85.526 partos (7.685 (8,9%) nas Clínicas vs 77.841 (91,1%) Pereira Rossell). A porcentagem de cesarianas por ano nas Clínicas foi de 49,2% ± 5 vs 29,3% ± 3 em Pereira Rossell. Os grupos de Robson mais prevalentes foram 1, 5A e 10 nas Clínicas vs 3, 1 e 5A em Pereira Rossell. Em ambos os centros, os grupos com maior contribuição relativa para a taxa global de cesárea foram: 5A, 10 e 1. Ambos os centros apresentam aumento da taxa de cesárea na última década, apesar de diferentes populações serem atendidas entre cada um deles. Estratégias devem continuar a ser buscadas para ajudar a reduzir a taxa de cesárea, principalmente em pacientes sem cesárea anterior ou com cesárea única, se não apresentarem contra-indicações para parto normal.

Introduction Few studies conducted in primary care setting report about age-adjusted prevalence rates of erectile dysfunction (ED). Aims of SIMETAP-ED study were to determine crude and age-adjusted prevalence rates of ED diagnosis, to compare these rates with other similar studies, and to compare prevalence rates of cardiovascular risk factors (CVRF), cardiovascular diseases (CVD), metabolic diseases and chronic kidney disease (CKD) between populations with and without ED. Methods Cross-sectional observational study conducted in primary care setting. Population-based random sample: 2934 adult men. Response rate: 66%. A clinical interview was conducted to diagnose ED using a question derived from ED definition. The medical records of patients were reviewed to identify their CVRF and diseases associated with ED. The age-adjustments were standardized to Spanish population. Results The prevalence rates of metabolic diseases, CVD, CVRF, and CKD in population with ED were higher than population without ED, highlighting the CVD. The crude prevalence of ED was 17.2% (95% confidence interval: 15.8•18.6). The age-adjusted prevalence rates of ED were 0.71% in men under 40 years, 12.4% in men over 18 years, 10.8% in men aged 40•69 years, 18.9% in men over 40 years, and 48.6% in men over 70 years. Conclusions SIMETAP-ED study showed association of ED with metabolic diseases, CKD, CVRF, and highlighting CVD. The age-adjusted prevalence of ED was 12.4% in adult men, 19% in men over 40 years, and almost 50% in men over 70 years.

Resumen Fundamento El objetivo del presente estudio es evaluar la seguridad y efectividad del dispositivo de generación de presión positiva continua en la vía aérea de Boussignac® (CPAPB) durante su uso en el transporte en lactantes menores de tres meses con bronquiolitis. Material y métodos Estudio observacional analítico transversal de cuatro años de duración. Se recogieron datos de 25 lactantes que precisaron trasladado interhospitalario a la Unidad de Cuidados Intensivos Pediátrica (UCIP) de referencia con CPAPB e interfase tipo Helmet. Se registraron las caracteristicas epidemiológicas, del traslado y de la evolución en UCIP, además de los parámetros cardiorrespiratorios y gasométricos previos al traslado y a su llegada a UCIP. Resultados La mediana del nivel de presión continua en la vía aérea (CPAP) utilizada durante el traslado fue de 7 cm H2O (6-7,25). Ningún paciente precisó de intubación endotraqueal durante el traslado y un paciente la precisó durante las primeras seis horas de ingreso en UCIP. Los siguientes parámetros cardiorrespiratorios presentaron una mejoría estadisticamente significativa a su llegada a UCIP: score de Wood-Downes modificado [8,40 (2,1)vs5,29 (1,68)], frecuencia respiratoria [60,72 (12,73)vs47,28 (10,31)], frecuencia cardiaca [167,28 (22,60)vs154,48 (24,83)] y saturación de oxígeno [92,08 (5,63)vs97,64 (2,27)]. Conclusiones La aplicación de CPAPB resultó ser un método de soporte respiratorio seguro en lactantes menores de tres meses. Su uso durante el transporte suposo una mejoría en los parámetros cardiorrespiratorios. Abstract Background The present study aims to evaluate the safety and effectiveness of the Boussignac continuous positive airway pressure device (CPAPB) when used during the transportation of infants under three months of age with bronchiolitis. Methods Transversal analytical observational study of four years duration. Data was collected on 25 infants who needed inter-hospital transportation to the reference Paediatric Intensive Care Unit (PICU), with CPAPB and Helmet interface. The epidemiological characteristics of the transportation and evolution in the PICU were registered, as well as the cardiorespiratory gastronomic parameters prior to transfer and on arrival at the PICU. Results The median level of continuous airway pressure (CPAP) used during the transfer was 7 cm H2O (6-7.25). No patient required endotracheal intubation during transportation, while one patient required this during the first six hours of admission in the PICU. The following cardiorespiratory parameters presented a statistically significant improvement on arrival at the PICU: modified Wood-Downes score [8.40 (2.1)vs5.29 (1.68)], respiratory frequency [60.72 (12.73)vs47.28 (10.31)], cardiac frequency [167.28 (22.60)vs154.48 (24.83)] and oxygen saturation [92.08 (5.63)vs97.64 (2.27)]. Conclusions Application of CPAPB proved to be a safe method of respiratory support in infants under three months of age. Its use during transportation brought an improvement in cardiorespiratory parameters.

Objective The study aimed to describe the cases of neurological disease related to the outbreak of enterovirus (EV) in three regions in Northern Spain during 2016. Materials and Methods Multicenter retrospective observational study. Clinical, radiological, and microbiological data were analyzed from patients younger than 15 years with confirmed EV-associated neurological disease admitted to 10 hospitals of Asturias, Cantabria, and Castile and Leon between January 1 and December 31, 2016. Results Fifty-five patients were included. Median age was 24 months (interquartile range = 18.5 months). Fifteen patients were classified as aseptic meningitis (27.3%). In total, 37 cases presented brainstem encephalitis (67.3%), 25 of them due to EV-A71 with excellent prognosis (84.6% asymptomatic 2 months following the onset). Three cases of acute flaccid myelitis (5.5%) by EV-D68 were reported and presented persistent paresis 2 months following the onset. Microbiological diagnosis by reverse transcriptase polymerase chain reaction was performed in all cases, finding EV in cerebrospinal fluid in meningitis, but not in brainstem encephalitis and acute flaccid myelitis, where EV was found in respiratory or rectal samples. Step therapy was administrated with intravenous immunoglobulin (IVIG; 32.7%), methylprednisolone (10%), and plasmapheresis (3.6%). Four patients received fluoxetine (7.3%). Twenty patients needed to be admitted to pediatric intensive care unit (36.4%). Conclusion Clinical, microbiological, and radiological diagnosis is essential in outbreaks of EV neurological disease, taking into account that it can be difficult to identify EV-A71 and EV-D68 in CSF, requiring throat or rectal samples. There is not specific treatment to these conditions and the efficacy and understanding of the mechanism of action of immune-modulatory treatment (IVIG, corticosteroids, and plasmapheresis) is limited.

Esta obra presenta un compendio resumido, claro y conciso, útil para los médicos no especializados en la materia, así como para los estudiantes en su formación de pregrado, sobre las patologías que afectan a los riñones, vías urinarias y aparato genital masculino para el ejercicio médico, puesto que, en lo que no corresponde a nuestra especialización, todos somos médicos generales. Esta obra aborda la Nefrología, la Urología y la Andrología con una concepción actual integradora e interdisciplinar, escrita por especialistas del campo de la Nefrología, la Urología y la Medicina de Familia. Todos ellos atienden diariamente enfermos y por ello han logrado verter en cada uno de los capítulos su proceder clínico habitual y la forma real de abordarlas junto a las actualizaciones de estos temas. Los editores de este manual somos profesores de la asignatura de Nefrología y de Urología en la Facultad de Medicina de Salamanca y en nuestra experiencia asistencial y docente hemos decidido elaborar este manual que se ciñe y glosa el contenido de la Nefrourología.

The incidence of light on the edge of a glass coverslip for a microscope slide, deposited with a thin film on both faces, permits exciting two resonances in each polarisation state of the input light, TE and TM. This dually nanocoated waveguide can be used for detecting simultaneously two different parameters on the basis of a further deposition of suitable materials on each face. As an example, the possibility of detecting temperature and humidity by using polydimethylsiloxane and agarose coatings, respectively, was demonstrated, which opens the path for the development of other dual-parameter sensors, and for even more parameters in cases in which each face of the coverslip is patterned. Moreover, the device was optimised in order to position two resonances in the near infrared (NIR) and two resonances in the visible region, with sensitivities of 0.34 nm/°C and 0.23 nm/%RH in the visible region and 1.16 nm/°C and 0.34 nm/%RH in the NIR, respectively, demonstrating the possibility of using the device in both spectral ranges and opening the path for the development of sensors based on multiple resonances, each one related to a different parameter to be detected.

Simple Summary Dolphin Assisted Therapies (DAT) can be used with any person or group with specific needs and it can be as disparate as people at risk of social exclusion, eating disorders, terminally ill, mental health disorders, among many others. This paper is focused on measuring and analyzing dolphins brain activity when DAT is taking place, in order to identify if there is any differences in female dolphin’s neuronal signal when it is interacting with control or intervention subjects. In addition, we designed a wireless and portable electroencephalographic single-channel signal capture device to monitor the brain activity of a female bottle-nose dolphin. Our findings also validate the evidence that the interaction between a patient with a certain disease or disorder and undergoes to a DAT modifies usual brain activity behavior of a female bottle-nose dolphin. Abstract Dolphin-Assisted Therapies (DAT) are alternative therapies aimed to reduce anxiety levels, stress relief and physical benefits. This paper is focused on measuring and analyzing dolphins brain activity when DAT is taking place in order to identify if there is any differences in female dolphin’s neuronal signal when it is interacting with control or intervention subjects, performing our research in Delfiniti, Ixtapa, Mexico facilities. We designed a wireless and portable electroencephalographic single-channel signal capture sensor to acquire and monitor the brain activity of a female bottle-nose dolphin. This EEG sensor was able to show that dolphin activity at rest is characterized by high spectral power at slow-frequencies bands. When the dolphin participated in DAT, a 23.53% increment in the 12–30 Hz frequency band was observed, but this only occurred for patients with some disease or disorder, given that 0.5–4 Hz band keeps it at 17.91% when there is a control patient. Regarding the fractal or Self-Affine Analysis, we found for all samples studied that at the beginning the dolphin’s brain activity behaved as a self-affine fractal described by a power-law until the fluctuations of voltage reached the crossovers, and after the crossovers these fluctuations left this scaling behavior. Hence, our findings validate the hypothesis that the participation in a DAT of a Patient with a certain disease or disorder modifies the usual behavior of a female bottle-nose dolphin.

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

Copper oxide (CuO) allows the generation of lossy mode resonance (LMR) in a wide wavelength range of the optical spectrum, both in the visible and the near-infrared (NIR). For this, it is necessary to use a configuration based on the lateral incidence of light on the edge of a planar waveguide structure. On the other hand, the use of additional coatings of tin oxide (SnO2) and agarose allows an increase in the sensitivity of the sensor, in response to the breathing monitoring. The sensors were characterized, both in intensity and wavelength. In both cases their behavior depends on the position of the LMR in the optical spectrum. Therefore, it is convenient to extract the design rules that allow an optimal behavior of the sensor. In this sense, sensors located in the NIR presented a better behavior in terms of sensitivity and quality of the signal. In addition, the devices were tested in different conditions: repetitive tests at different distances, oral and nasal breathing, and breathing after doing physical exercise. The authors would to acknowledge the partial support to the Agencia Estatal de Investigacion (AEI) from the Spanish Ministry of Economy and Competitiveness (PID2019-106231RB-I00 and PID2019-106070RB-I00 research funds) and the predoctoral research grant of the Public University of Navarra.

Infection by SARS-CoV2 has devastating consequences on health care systems. It is a global health priority to identify patients at risk of fatal outcomes. 1955 patients admitted to HM-Hospitales from 1 March to 10 June 2020 due to COVID-19, were were divided into two groups, 1310 belonged to the training cohort and 645 to validation cohort. Four different models were generated to predict in-hospital mortality. Following variables were included: age, sex, oxygen saturation, level of C-reactive-protein, neutrophil-to-platelet-ratio (NPR), neutrophil-to-lymphocyte-ratio (NLR) and the rate of changes of both hemogram ratios (VNLR and VNPR) during the first week after admission. The accuracy of the models in predicting in-hospital mortality were evaluated using the area under the receiver-operator-characteristic curve (AUC). AUC for models including NLR and NPR performed similarly in both cohorts: NLR 0.873 (95% CI: 0.849-0.898), NPR 0.875 (95% CI: 0.851-0.899) in training cohort and NLR 0.856 (95% CI: 0.818-0.895), NPR 0.863 (95% CI: 0.826-0.901) in validation cohort. AUC was 0.885 (95% CI: 0.885-0.919) for VNLR and 0.891 (95% CI: 0.861-0.922) for VNPR in the validation cohort. According to our results, models are useful in predicting in-hospital mortality risk due to COVID-19. The RIM Score proposed is a simple, widely available tool that can help identify patients at risk of fatal outcomes. This research received no external funding Sí

We present a novel covalent functionalization of a D-shape fiber biosensor based on Lossy Mode Resonances. IgG/anti-IgG model is applied to prove the regeneration of the union and thus the re-usability of the sensor.

This paper seeks to assess the effectiveness of customs policies in increasing the resources devoted to controlling and inspection. Specifically, it seeks to analyze whether an increase in the administrative cost of collecting taxes on foreign trade in Ecuador contributes to reducing customs fraud. To this end, we identify and estimate a transfer function model (ARIMAX), considering information on foreign trade such as official international trade statistics report and tariff rates, as well as the execution of budgetary expenditure and Ecuador’s gross domestic product (GDP). The period under study includes quarterly series from 2006 to 2018. The results obtained by the model indicate that allocating greater material and budgetary resources to combat customs fraud does not always achieve the objective of reducing customs evasion.

Tungsten oxide (WO3) thin-films fabricated on glass slides have been proven to generate lossy mode resonances (LMRs) in the visible region. Obtained devices were characterized in transmission by lateral incidence of light on the edge of glass slides. Resonances at both TE and TM polarizations were analyzed for different thicknesses and in different deposition conditions. Moreover, it was successfully proved that WO3 coated glass slides present a high sensitivity to refractive index, which opens the path to the application of this structure in the domain of optical sensors. This work was supported in part by the Spanish Agencia Estatal de Investigación (AEI) through project PID2019-106231RB-I00 and by Italian Ministry of University and Research (MIUR) through the University Research Project 2017 (prot. RG11715C8213BD81).

In this work a simultaneous refractive index and temperature sensor is presented. The optical structure consists of a soda-lime planar waveguide coated with CuO thin film for the generation of two separated Lossy Mode Resonances (LMRs). One section of the CuO thin film is in contact with the external medium while the other part is coated with a thick layer of PDMS. As result of this, two different resonances are obtained, centered at 600 nm and 1000 nm respectively. The first resonance wavelength is modified by the external medium refractive index, while the second one is only affected by the PDMS refractive index, that due to the thermo-optic effect can be used to measure the ambient temperature. Using this simple structure, a dual sensor has been obtained, showing an RI sensitivity of 1600 nm/RIU and a temperature sensitivity of 1.12 nm/0C.

espanolIntroduccion: la enfermedad renal cronica contribuye a disminuir la fuerza muscular y la funcion fisica a traves de una disminucion de la masa muscular. De acuerdo con la evidencia, la hemodialisis puede acentuar esta complicacion, asi como llevar al paciente a un deterioro del estado general de salud. El objetivo de la investigacion fue comparar la fuerza muscular de pacientes con hemodialisis, evaluada mediante dinamometria en una poblacion mexicana, con los valores de referencia. Material y metodos: se realizo un estudio transversal en pacientes masculinos y femeninos de 20 a 81 anos, con enfermedad renal cronica en estadio 5, del area de consulta externa del Hospital General Regional No 46 del Instituto Mexicano del Seguro Social. La fuerza muscular se evaluo por medio de un dinamometro mecanico. El valor promedio clasificado por rango de edad y genero se comparo con el percentil 50 de un estudio de referencia. Las diferencias intergrupales se calcularon con la prueba no parametrica de la U de Mann-Whitney y la correlacion mediante la prueba de Pearson. Todos los pacientes firmaron la carta de consentimiento informado. Resultados: la muestra del estudio fue de 150 pacientes, 97 (64,7 %) hombres y 53 (35,3 %) mujeres. De acuerdo con la dinamometria, la media fue de 21,5 ± 10,1 kg; se demostro una correlacion significativa entre la edad, el peso y la hemoglobina. Conclusion: se encontro que los pacientes con enfermedad renal cronica sometidos a hemodialisis se encontraban en el percentil 10 de fuerza muscular, medido por dinamometria, lo que demuestra una disminucion marcada de dicha fuerza muscular. Sin embargo, este resultado tambien podria verse afectado por diferentes variables, como la edad del paciente, la altura, el peso, la tasa de filtracion glomerular (TFG), la concentracion de hemoglobina, la creatinina serica, la glucosa serica y la evaluacion global subjetiva, dado que se encontro una asociacion significativa entre estos factores y la fuerza muscular. EnglishIntroduction: chronic kidney disease contributes to decreased muscle strength and physical function through a decrease in muscle mass. Current evidence suggests that hemodialysis can accentuate this complication, as well as lead to deterioration of the patient’s overall health. The aim of this study is to compare muscle strength in a group of Mexican patients undergoing hemodialysis, evaluated by dynamometry, with available reference values. Materials and methods: a cross-sectional study was conducted in male and female patients between 20 and 81 years of age, with stage-5 chronic kidney disease, from the outpatient Hospital General Regional No 46 of the Mexican Social Security Institute. Muscle strength was assessed by means of a mechanical dynamometer. The average value classified by age and gender was compared with the 50th percentile of a reference study. Inter-group differences were calculated with the nonparametric Mann-Whitney U-test, and correlation using Pearson’s test, logistic regression, and chi-squared test. All patients signed an informed consent form. Results: a total of 150 patients, 97 (64.7 %) men and 53 (35.3 %) women, were included in the study. The mean dynamometric value for muscle strength was 21.5 ± 10.1 kg, and a significant correlation was found with age, weight, and hemoglobin concentration. Conclusion: patients undergoing hemodialysis treatment for chronic kidney disease were found to be at the 10th percentile for muscle strength, as measured by dynamometry, thus demonstrating a marked decrease in muscle strength. This result could, however, also have been affected by different variables such as patient age, height, weight, glomerular filtration rate (GFR), hemoglobin concentration, serum creatinine, serum glucose, and the subjective global assessment, given that a significant association was also found between these and muscle strength.

Rice plays a strategic role in food security in West Africa. However, the region increasingly relies on rice imports due to a growing and structural deficit, and domestic value chains face constraints in technology, finance and coordination. As a result, West Africa is very vulnerable to international and local trade disruptions, such as the ones currently inflicted by the COVID-19 pandemic. We build on evidence of the current state of domestic rice value chain upgrading in West Africa to anticipate the impacts of the COVID-19 pandemic on rice value chains’ resilience and their capacity to sustain food security in the region. Several policy options are proposed to help West African governments mitigate the impacts of the COVID-19 crisis on food security., Highlights • Rice plays a strategic role in food security in West Africa. • Growing reliance on rice imports exposes the region to international trade disruptions. • We assess the resilience of domestic rice value chains to COVID-19. • We anticipate the potential impact of foodborne zoonotic pathogens on food security. • We propose policy options for mitigating impacts of the pandemic in West Africa.

Background: Prescription drug misuse and its related risks are considered a worldwide public health issue. Current trends show that the extent of such phenomenon may not be limited to subjects with psychiatric disorders, as it also spreads to dance party and nightclub attendees, who often consume prescription drugs in combination with alcohol and psychoactive substances. This study aims to report the sociodemographic data and the psychiatric and clinical features of a sample of clubbers reporting prescription drugs use. Methods: Patients admitted to the psychiatry ward of the Can Misses Hospital in Ibiza were recruited for the study during a span of four consecutive years (2015-2018). The inclusion criteria were age 18-75 years old and the intake of psychoactive substances or more than five alcohol units during the previous 24 h. Substance use habits, psychopathological features, and use of unprescribed pharmaceuticals were investigated. Urine samples were collected and analyzed using gas chromatography/mass spectrometry. Results: A total of 110 subjects with psychoactive substance intoxication were recruited for the study. Among these, 37 (40%) disclosed the use of prescription drugs without medical supervision. The most common compounds were benzodiazepines (66%), antiepileptic drugs (8%), antidepressants (6%), opioids (6%), antipsychotics (6%), stimulants (6%), and non-steroidal anti-inflammatory drugs (NSAIDs, 2%). Prescription drug misuse was negatively associated with the use of psychodysleptics (two-tailed Fisher's exact test p = 0.018, rho = -0.262). Conclusions: The use of prescription drugs is also common among clubbers, usually characterized by low propensity to be prescribed benzodiazepines, antipsychotics, or antidepressants. Prescription drugs may be an alternative to classic and novel psychoactive compounds or may be used to tamper and self-medicate the effects determined by the use of substances. Party goers should be adequately informed about possible risks of co-intake of psychoactive substances and prescription drugs to prevent serious medical and psychiatric consequences., This study was partly funded by the European Project entitled Analysis, Knowledge dissemination, Justice implementation and Special Testing of Novel Synthetic Opioids-JUST-2017-AG-DRUG.

Improving cardiorespiratory fitness (CRFit) in cancer patients is crucial to increase survivorship, promote health, and improve quality of life. High-intensity training (HIT) has the potential to increase CRFit, perhaps better than other exercise modalities, but the extant evidence has yet to be fully explored. This systematic review and meta-analysis aimed to evaluate the effects of HIT on CRFit in cancer patients and survivors and to identify the optimal characteristics of the interventions (eg, cancer type, intervention timing, exercise modality, intervention's duration, and the number of minutes of high-intensity exercise in each session). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A total of 31 articles (2515 participants) were included in the systematic review and 25 in the meta-analyses. CRFit significantly improved with HIT in comparison with a control group (P .00001, SMD = 0.44 and a 95% confidence interval from 0.25 to 0.64). The results obtained in the sub-analysis were statistically significant except the comparison with the active group CRFit (P = .13). The results showed that higher effects could be achieved in: patients starting to exercise before treatment, interventions longer than eight weeks, programs including exclusively cardiovascular training and with a high-intensity part of session duration of at least 20 minutes.

One way to address the practical challenges of the current problems of water services is through demand-side measures. These types of measures impact on demand through price changes or on water use control, considering that the impacts of these measures would be extremely useful in order to implement an adequate policy mix. One of the objectives of this paper is to show the possibilities of water management tools, particularly the use of prospective prices and demand models, in order to anticipate scarcity scenarios. This can best be done using better predictive models. Current computer tools provide a good basis for developing applications to perform prospective analysis on water prices and demand. Through simulation, we can try to optimize financial flows of costs and revenues based on the behavior of certain variables. This aims to find a better combination of price levels for urban water uses, making it possible to adjust the chargeback mechanisms, the level of cost recovery of investments, and the allocation between user types. This paper aims to show the advantages of these tools and illustrates its usefulness with a registered model that allows simulations of potential scenarios resulting from certain management measures. This research is partially supported by the Cátedra del Agua of the University of Alicante and the Diputación Provincial de Alicante (https://catedradelaguaua.org/).

Following the food price crisis in 2008, African governments implemented policies aiming at crowding in investment in rice value chain upgrading to help domestic rice compete with imports. We assess the state of rice value chain upgrading in West Africa by reviewing evidence on rice millers’ investment in semi-industrial and industrial milling technologies, contract farming and vertical integration during the post-crisis period 2009–2019. We find that upgrading is more dynamic in countries with high rice production and import bills and limited comparative advantage in demand. However, scaling of upgrading faces several challenges in terms of vertical coordination, technology, finance and policies. Our assessment can help value chain actors and policy makers refine upgrading strategies and policies to increase food security in West Africa., Highlights • Rice value chain upgrading in West Africa is heterogeneous among countries. • Upgrading involves milling technologies, contract farming and vertical integration. • In 2019, 57 industrial and semi-industrial rice mills were operating in West Africa. • Import bill, rice production and cultural heritage jointly explain 89% of heterogeneity. • Challenges include vertical coordination, technology, finance and policies.

Bloch surface wave (BSW) platforms are particularly interesting for light confinement and surface sensitivity, as an alternative to the metal-based surface plasmon polaritons (SPP). However, most of the reported BSW platforms require depositing a large number of alternating dielectric layers to realize the excitation of the surface waves. In this Letter, we demonstrate an experimentally feasible D-shaped photonic crystal fiber (PCF) platform consisting of only a single dielectric layer on its flat surface, which can sustain Bloch waves at the boundary between the dielectric layer and the PCF cladding. The presence of the dielectric layer modifies the local effective refractive index, enabling a direct manipulation of the BSWs. In addition, the D-shaped structure provides direct contact with the external medium for sensing applications with an ultrahigh sensing figure of merit ( 2451 R I U − 1 ) and has the potential to be used over a wide range of analyte refractive indices.

espanolAntecedentes: varios estudios sugieren que las concentraciones perioperatorias de troponinas de alta sensibilidad son factores incrementales y predictivos de un evento cardiaco adverso mayor (MACE) y mortalidad por todas las causas. Objetivo: El objetivo del estudio fue evaluar el valor predictivo de la troponina I cardiaca de alta sensibilidad (hs-cTnI) en el desarrollo de MACE y mortalidad por todas las causas, dentro de los 30 dias y 1 ano de seguimiento despues de la cirugia no cardiaca. . Metodos: En este estudio de cohorte prospectivo, se incluyeron hombres ≥ 45 anos y mujeres ≥ 55 anos con ≥ 2 factores de riesgo cardiovascular y sometidos a cirugia no cardiaca de riesgo intermedio o alto. La informacion demografica y clinica se recopilo a partir de historias clinicas. Se midio la hs-cTnI basal 24 h antes de la cirugia y su concentracion postoperatoria 24 h despues de la cirugia. Resultados: En toda la muestra, 8 pacientes (8,6%) desarrollaron MACE a los 30 dias de seguimiento (4 muertes), 12 (12,9%) en el primer ano (7 muertes) y 17 (18,2%) despues de completar el seguimiento. -seguimiento quirurgico (10 muertes). Observamos concentraciones basales y postoperatorias mas elevadas en los pacientes que presentaban MACE (12 pg / ml frente a 3,5 pg / ml; p = 0,001 y 18,3 pg / ml frente a 5,45 pg / ml; p = 0,009, respectivamente). Los cocientes de riesgo (HR) calculados mediante el analisis de regresion de Cox entre la concentracion basal de hs-cTnI y el desarrollo posoperatorio de MACE a los 30 dias y 1 ano fueron 5,70 (intervalo de confianza [IC] del 95%, 1,10-29,40) con hs-cTnI> 6,2 pg / ml y 12,86 (IC del 95%, 1,42-116,34) con hs-cTnI> 3,3 pg / ml, respectivamente. El riesgo estimado de muerte por HR postoperatorio a 1 ano fue de 14,43 (IC del 95%, 1,37-151,61) con hs-cTnI> 4,5 pg / ml. Conclusiones: La hs-cTnI preoperatoria fue un factor de riesgo predictivo independiente para MACE a los 30 dias y 1 ano despues de la cirugia no cardiaca y para la mortalidad por todas las causas 1 ano despues de la cirugia no cardiaca. EnglishBackground: Various studies suggest that perioperative concentrations of high-sensitivity troponins are incremental and predictive factors of a major adverse cardiac event (MACE) and all-cause mortality. Objective: The objective of the study was to evaluate the predictive value of high-sensitivity cardiac troponin I (hs-cTnI) in the development of MACE and all-cause mortality, within 30-days and 1-year follow-up after noncardiac surgery. Methods: In this prospective cohort study, we in- cluded men ≥ 45 years and women ≥ 55 years with ≥ 2 cardiovascular risk factors and undergoing intermediate or high-risk noncardiac surgery. Demographic and clinical information was collected from clinical charts. We measured baseline hs-cTnI 24 h before surgery, and its post-operative concentration 24 h after surgery. Results: In the entire sample, 8 patients (8.6%) developed MACE at 30-days follow-up (4 deaths), 12 (12.9%) within the 1st year (7 deaths), and 17 (18.2%) after complete post-surgical follow-up (10 deaths). We observed higher baseline and post-operative concentrations in patients who pre- sented MACE (12 pg/ml vs. 3.5 pg/ml; p = 0.001 and 18.3 pg/ml vs. 5.45 pg/ml; p = 0.009, respectively). The hazard ratios (HRs) calculated by Cox regression analysis between the hs-cTnI baseline concentration and the post-operative development of MACE at 30-days and 1-year were 5.70 (95% confidence interval [CI], 1.10-29.40) with hs-cTnI > 6.2 pg/ml and 12.86 (95% CI, 1.42-116.34) with hs-cTnI > 3.3 pg/ml, respectively. The estimated post-operative HR death risk at 1-year was 14.43 (95% CI, 1.37-151.61) with hs-cTnI > 4.5 pg/ml. Conclusions: Pre-operative hs-cTnI was an independent predictive risk factor for MACE at 30-days and 1-year after noncardiac surgery and for all-cause mortality at 1-year after noncardiac surgery. (REV INVEST CLIN. 2020;72(2):110-8)

Many different communication protocols are used in the industry for automation activities. Here it is shown the experience of the last years related to how to prepare students towards facing this challenge, by teaching some widely used protocols and programming tools integrated in a final project that the students must solve in pairs. In addition, the assessment of the subject has been optimized towards increasing the implication of students in the different parts, something that has been studied by analyzing the evolution of the marks.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

The generation of lossy mode resonances (LMRs) with a setup based on lateral incidence of light in coverslips is a simple platform that can be used for sensing. Here the versatility of this platform is proved by studying the deposition of different coating materials. The devices were characterized with both SEM and AFM microscopy, as well as ellipsometry, which allowed obtaining the main parameters of the coatings (thickness, refractive index and extinction coefficient) and relating them with the different sensitivities to refractive index attained with each material. In this way it was possible to confirm and complete the basic rules observed with lossy mode resonance based optical fiber sensors towards the design of simpler and more compact applications in domains such as chemical sensors or biosensors. Agencia Estatal de Investigación; European Regional Development Fund (TEC2016-78047-R).