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Resumen Introducción. Las anomalías uracales son raras tras el nacimiento presentándose la gran mayoría en niños menores de dos años (0,063% de los adultos). Caso clínico. Varón de 27 años con un quiste uracal infectado sintomático que ha provocado además una fístula colovesical. Discusión. Debido a su baja prevalencia y a la variabilidad de presentación clínica, supone un reto diagnóstico. El tratamiento consiste en una resección quirúrgica dada la posibilidad de malignización.

The RIETE Investigators., [Background] The optimal therapy of patients with acute subsegmental pulmonary embolism (PE) is controversial., [Methods] We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to compare the rate of symptomatic PE recurrences during anticoagulation in patients with subsegmental, segmental, or more central PEs. [Results] Among 15 963 patients with a first episode of symptomatic PE, 834 (5.2%) had subsegmental PE, 3797 (24%) segmental, and 11 332 (71%) more central PE. Most patients in all subgroups received initial therapy with low‐molecular‐weight heparin, and then most switched to vitamin K antagonists. Median duration of therapy was 179, 185, and 204 days, respectively. During anticoagulation, 183 patients developed PE recurrences, 131 developed deep vein thrombosis (DVT), 543 bled, and 1718 died (fatal PE, 135). The rate of PE recurrences was twofold higher in patients with subsegmental PE than in those with segmental (hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.16‐3.85) or more central PE (HR, 1.89; 95% CI, 1.12‐3.13). On multivariable analysis, patients with subsegmental PE had a higher risk for PE recurrences than those with central PE (adjusted HR, 1.75; 95% CI, 1.02‐3.03). After stratifying patients with subsegmental PE according to ultrasound imaging in the lower limbs, the rate of PE recurrences was similar in patients with DVT, in patients without DVT, and in those with no ultrasound imaging. [Conclusions] Our study reveals that the risk for PE recurrences in patients with segmental PE is not lower than in those with more central PE, thus suggesting that the risk of PE recurrences is not influenced by the anatomic location of PE.

[EN] A wheel shape optimization of a railway wheel cross section by means of Genetic Algorithms (GAs) is presented with the aim of minimizing rolling noise radiation. Two different approaches have been implemented with this purpose, one centred on direct Sound poWer Level (SWL) minimization, calculated using TWINS methodology, and another one emphasizing computational efficiency, focused on natural frequencies maximization. Numerical simulations are carried out with a Finite Element Method (FEM) model using general axisymmetric elements. The design space is defined by a geometric parametrization of the wheel cross section with four parameters: wheel radius, a web thickness factor, fillet radius and web offset. For all wheel candidates a high-cycle fatigue analysis has been performed according to actual standards, in order to assure structural feasibility. Rolling noise reductions have been achieved, with a decrease of up to 5 dB(A) when considering the wheel component. Response surfaces have been also computed to study the dependency of the objective functions on the geometric parameters and to test the adequacy of the optimization algorithm applied., This study was financially supported by Ministerio de Ciencia, Innovacion y Universidades - Agencia Estatal de Investigacion, European Regional Development Fund (project TRA2017-84701-R), and Conselleria d'Educacio, Investigacio, Cultura i Esport (Generalitat Valenciana, project Prometeo/2016/007).

Fluoride is highly present in the environment, especially in water and its derivatives. Excessive fluoride contribution to diet poses a health risk. Tea leaves accumulate fluoride and the consumption of tea (Camellia sinensis) could pose a risk to human by the excessive fluoride intake. Ninety tea samples were analyzed by potentiometry using a selective fluoride ion electrode. Mixed tea samples (2.82 ± 1.11 mg/L) and black tea samples (2.28 ± 0.79 mg/L) recorded the highest fluoride levels. The contribution of drinking water is important for increasing fluoride levels in teas. The daily consumption of two cups (250 mL per cup) of mixed and black teas prepared with La Laguna tap water does pose a health risk for children (4–8 years old) because of the high contribution percentages (74.4% and 63.6%, respectively) of the Tolerable Upper Intake Level set in 2.5 mg/day by the EFSA (European Food Safety Authority). A minor consumption in children (4–8 years old) and adults during pregnancy is advisable.

Fluoride has been considered as the single factor most frequently responsible for causing enamel mottling. However, in humans, either endogenous and/or exogenous factors not related to fluoride exposure may also cause enamel mottling. In this sense, various studies in the international literature have reported severe mottling of the teeth that could not be attributed to fluoride exposure. Thus, misdiagnosis of non-fluoride-induced enamel defects may occur frequently. Reports of unexpectedly high population prevalence and individual cases of fluorosis, where such diagnoses are irreconcilable with the identified fluoride history, highlight the necessity for a more precise definition and diagnosis of dental fluorosis. Also, a more discriminating diagnostic procedure is suggested. Particularly, positive identification of environmental fluoride levels to which the communities and individuals are exposed shall be developed before the confirmation of a diagnosis of fluorosis. It is considered that a more critical methodology for the diagnosis of fluorosis will be helpful in the rational use and control of fluorides for dental health, and in the identification of factors that may induce enamel defects.

Background Epilepsy is the most common neurological disease in childhood; depending on the definition of drug-resistant epilepsy, incidence varies from 10% to 23% in the paediatric population. The objective of this study was to account for the decrease in the frequency and/or monthly duration of epileptic seizures in paediatric patients with drug-resistant epilepsy treated with antiepileptic drugs, before and after adding intravenous immunoglobulin G (iIV IgG). Methods This is an analytic, observational, retrospective case–control study. We studied paediatric patients with drug-resistant epilepsy who were treated with IV IgG at the Centro Medico Nacional 20 de Noviembre, in Mexico City, from 2003 to 2013. Results One hundred and sixty seven patients (19.5%) had drug-resistant epilepsy and 44 (5.1%) started adjuvant treatment with IV IgG. The mean age of patients at the beginning of treatment was 6.12 years (5.14); aetiology was structural acquired in 28 patients (73.6%), genetic in 5 (13.1%), immune in 1 (2.6%), and unknown in 4 (10.5%). At 2 months from starting IV IgG, seizure duration had reduced to 66.66%; the frequency of seizures was reduced by 64% at 4 months after starting treatment ( P Conclusions According to the results of this study, intravenous immunoglobulin may be an effective therapy for reducing the frequency and duration of seizures in paediatric patients with drug-resistant epilepsy.

Introduction: Laparoscopic sleeve gastrectomy (LSG) is the most widely performed bariatric surgery worldwide but complications and failed procedures are on the rise. Aims: To determine the reasons for failed LSGs and report the results of conversion to gastric bypass surgery, comparing the outcomes with those of primary gastric bypass surgery. Materials and methods: Patients with failed LSG that underwent conversion to gastric bypass surgery through a robotic-assisted and laparoscopic (hybrid) technique were evaluated. Outcomes and follow-up related to weight loss failure (WLF) were compared with those in patients that underwent primary laparoscopic gastric bypass (pLGB) surgery. Results: Revisional surgery was performed on 13 patients due to WLF, on 3 patients because of refractory gastroesophageal reflux disease, and on 2 patients due to gastric stricture. There were no differences between the preoperative characteristics of the patients with WLF before undergoing conversion to gastric bypass and the patients that underwent pLGB surgery. At postoperative month 36, the percentage of excess weight loss (%EWL) was greater in the patients that underwent pLGB surgery, than in those with WLF that underwent conversion to gastric bypass (69.17 ± 23.73 vs. 54.17 ± 12.48, respectively; p

Este artículo se encuentra disponible en la siguiente URL: https://www.sciencedirect.com/science/article/abs/pii/S0034935620302632?via%3Dihub This is the peer reviewed version of the following article: Viscasillas, J., Alonso-Iñigo, J.M., Gutiérrez-Bautista, A., Casañ-Pallardó, M. & Redondo, J.I. (2020). Descripción de un modelo ovino para la prueba de ventiladores de urgencia en la pandemia de COVID-19, In Press (23 oct.), which has been published in final form at https://doi.org/10.1016/j.redar.2020.10.002 Este es el post-print del siguiente artículo: Viscasillas, J., Alonso-Iñigo, J.M., Gutiérrez-Bautista, A., Casañ-Pallardó, M. & Redondo, J.I. (2020). Descripción de un modelo ovino para la prueba de ventiladores de urgencia en la pandemia de COVID-19, In Press (23 oct.), que se ha publicado de forma definitiva en https://doi.org/10.1016/j.redar.2020.10.002 La pandemia COVID-19 ha puesto de manifiesto un déficit de ventiladores en el sistema sanitario para estas situaciones. Por ello, varios proyectos nacionales e internacionales se han desarrollado en pocas semanas para producir prototipos de ventiladores de fácil y rápida fabricación. Una de las exigencias de la AEMPS para la realización de estudios clínicos con nuevos prototipos pasa por la validación en un modelo animal. Para ello es importante poder utilizar un modelo animal en el que reproducir diferentes situaciones clínicas de forma fácil. En este artículo describimos el uso de la oveja como modelo animal para evaluar un prototipo de ventilador. El animal estuvo anestesiado durante 10 horas en las que el prototipo fue utilizado hasta en 6 escenarios. Este modelo pareció eficaz y es fácilmente reproducible, por lo que es una excelente opción para este tipo de investigación. / The COVID-19 pandemic has revealed a ventilator deficit in the global health system for this scenario. For this reason, several national and international projects have been developed to get done prototypes of ventilators which could be easy and fast to manufacture. One of the requirements of the AEMPS for conducting clinical studies with new prototypes is through the validation of these new prototypes in an animal model. Therefore, it is important to achieve an animal model which allows us to easily reproduce different clinical scenarios. In this article, we describe the use of a sheep as a research model to assess a prototype ventilator. The animal was anesthetized for 10 hours in which the prototype was tested in up to 6 different scenarios. This model is effective and easy to reproduce, making it an excellent choice for this kind of research.

Resumen Las lesiones perianales son unas de las patologías más frecuentes y con mayor variedad de espectros clínicos en cirugía. El quiste ciliado del rafé medio es una lesión congénita benigna muy rara que se presenta principalmente en el pene, pero puede desarrollarse en cualquier lugar de la línea media entre el meato uretral y el ano. Se presenta un caso de quiste ciliado del rafé medio de localización perianal dada su escasa incidencia y descripciones en la literatura, reseñando sus características principales y diagnósticos diferenciales.

Blockchain technology promises to spark a real revolution. One of most important concepts associated with this technology is smart contracts, which enable the automatic execution of agreements and augur a world without intermediaries. The conditions and rules of “contracts” are established in a computer codes and trust is enforced by consensus among the participants. One relevant feature associated with smart contract is the immutability property, which establishes the non-alteration of blockchain network data after the clauses of the contract are been approved by all parties or entities involved. For this reason, smart contract development requires more effort and care than the development of other common programs. They require systematic mechanisms to collect requirements and functional specifications. In addition, it is necessary to verify and validate the agreed functionality and the implemented code before they are deployed in the blockchain platform. This article presents a systematic literature review of primary studies in the field of Software Development Life Cycle, focusing on model-based software design and testing in the blockchain domain of smart contracts. This research aims to identify gaps and/or opportunities for further research. After carried out this review, it was observed that no clear methodology exists for evaluating and validating the quality either of this software or the overall development process. This means that software developers may implement smart contract code in which bugs and serious security vulnerabilities appear when the software is delivered to their customers.

Chronic kidney disease of unknown cause (CKDu) is relatively common in low- and middle-income countries. A high prevalence of CKDu has been reported among the inhabitants of Poncitlan, Mexico. We did a cross-sectional study to compare the characteristics of residents in Poncitlan, a very poor municipality, with those from other municipalities in Jalisco state. We also estimated the prevalence of renal replacement therapy (RRT) in this region. We assessed 51,789 individuals in Jalisco: 16,351 (32.1%) were men, mean age 51.8 ± 15.3 years; 650 (1.3%) were agedlt; 18 years. Overall the prevalence of CKD (10.5%) and proteinuria (11.5%), were similar to the overall Mexican population. There were 283 adult and 144 child participants who resided in Poncitlan: adults were more likely to be female (78.0 vs. 67.9%, p = 0.000) but were of similar age as compared to those from other municipalities; children were younger (8.78 ± 3.97 vs. 15.03 ± 2.57 years, p = 0.000) but had a similar proportion of females compared to children from other municipalities. In Poncitlan, the prevalence of CKD and proteinuria were both higher in adults compared to those from other municipalities (CKD: 20.1 vs. 10.4%, p = 0.002; proteinuria: 36.1 vs. 11.0%, p = 0.000), and the prevalence of proteinuria in children was also higher (44.4 vs. 4.8%, p = 0.000). However, the prevalence of diabetes mellitus and obesity were lower in Poncitlan than elsewhere. The prevalence of RRT in Poncitlan was 2,228 pmp, twice as high as the prevalence for Jalisco state as a whole. In conclusion, CKD and proteinuria were detected frequently in residents of the Poncitlan community. Future studies should consider the possibility that CKDu is due to multifactorial causes, especially in poor communities. .

Hydroxyapatite (HAp) is the most commonly used biomaterial in modern bone regeneration studies because of its chemical similarity to bone, biocompatibility with different polymers, osteoconductivity, low cost, and lack of immune response. However, to overcome the disadvantages of HAp, which include fragility and low mechanical strength, current studies typically focus on property modification through the addition of other materials. Objective. To develop and evaluate the biocompatibility of a HAp material extracted from eggshells and modified with silicon (Si) and poly(lactic-co-glycolic) acid (PLGA). Materials and Methods. An in vitro experimental study in which a HAp material prepared from eggshells was synthesized by wet chemical and conventional chemical precipitation. Subsequently, this material was reinforced with Si/PLGA using the freezing/lyophilization method, and then osteoblast cells were seeded on the experimental material (HAp/Si/PLGA). To analyse the biocompatibility of this composite material, scanning electron microscopy (SEM) and fluorescence confocal microscopy (FCM) techniques were used. PLGA, bovine bone/PLGA (BB/PLGA), and HAp/PLGA were used as controls. Results. A cellular viability of 96% was observed for the experimental HAp/Si/PLGA material as well as for the PLGA. The viability for the BB/PLGA material was 90%, and the viability for the HAp/PLGA was 86%. Cell adhesion was observed on the exterior surface of all materials. However, a continuous monolayer and the presence of filopodia were observed over both external and internal surface of the experimental materials. Conclusions. The HAp/Si/PLGA material is highly biocompatible with osteoblastic cells and can be considered promising for the construction of three-dimensional scaffolds for bone regeneration in dentistry.

Este artículo se encuentra disponible en la página web de la revista en la siguiente URL: https://journals.physiology.org/doi/full/10.1152/japplphysiol.00303.2019?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org This is the pre-peer reviewed version of the following article: Almendros, I., Martínez-Ros, P., Farré, N., Rubio-Zaragoza, M., Torres, M., Gutiérrez-Bautista, A.J. et al. (2019). Placental oxygen transfer reduces hypoxia-reoxygenation swings in fetal blood in a sheep model of gestational sleep apnea. Journal of Applied Physiology, vol. 127, i. 3 (13 sep.), pp. 745-752, which has been published in final form at https://doi.org/10.1152/japplphysiol.00303.2019. Este es el pre-print del siguiente artículo: Almendros, I., Martínez-Ros, P., Farré, N., Rubio-Zaragoza, M., Torres, M., Gutiérrez-Bautista, A.J. et al. (2019). Placental oxygen transfer reduces hypoxia-reoxygenation swings in fetal blood in a sheep model of gestational sleep apnea. Journal of Applied Physiology, vol. 127, i. 3 (13 sep.), pp. 745-752, que se ha publicado de forma definitiva en https://doi.org/10.1152/japplphysiol.00303.2019. AIM: Obstructive sleep apnea (OSA), characterized by events of hypoxia reoxygenation, is highly prevalent in pregnancy, negatively affecting the gestation process and particularly the fetus. Whether the consequences of OSA on the fetus and offspring are mainly caused by systemic alterations in the mother or by direct effect of intermittent hypoxia in the fetus is unknown. In fact, how apnea-induced hypoxemic swings in OSA are transmitted across the placenta remains to be investigated. The aim of this study was to test the hypothesis, based on a theoretical background on the dampening effect of oxygen transfer in the placenta, that oxygen partial pressure (PO2) swings resulting from obstructive apneas mimicking OSA are mitigated in the fetal circulation. METHODS: To this end, 4 anesthetized ewes close to term pregnancy were subjected to obstructive apneas consisting of 25-s airway obstructions. Real time PO2 was measured in the maternal carotid artery and in the umbilical vein using fast-response fiberoptic oxygen sensors. RESULTS: The amplitude of PO2 swings in the umbilical vein were considerably smaller (3.1±1.0 vs. 21.0±6.1 mmHg (m±SE); p

Background Urinary tract infections (UTIs) are the leading cause of infection in hospitalised patients. In this study, we describe the most common pathogens involved in the development of UTIs in hospitalised patients, their antibiotic-sensitivity profile and the activity evolution of antibiotics in standard use for treating these infections. Methods We retrospectively assessed the results of cultures and antibiograms from urine samples from adult patients hospitalised in the Hospital Complex Virgen de la Nieves (Granada, Spain) with a microbiological confirmation of UTI between January 2013 and December 2016. Results We identified 4347 microorganisms (3969 bacteria and 378 yeasts). During the 4 years of the study, Escherichia coli was the most common species isolated in both sexes; however, 62.9% of the UTIs were caused by other microorganisms. The presence of multiresistant microorganisms such as Acinetobacter spp. (1.2%) and extended-spectrum beta-lactamase-producing enterobacteria (10.0%) and carbapenemase-producing enterobacteria (0.3%) were also relevant findings. Imipenem, piperacillin–tazobactam and fosfomycin presented activity rates above 80%, considering all causal microorganisms of UTI, while the other tested antibiotics presented activity rates below 70%. Conclusion Imipenem and piperacillin–tazobactam were the most active antibiotics in hospital use, which makes them first-line antibiotics in the empiric treatment of UTIs in this healthcare setting. The use of other antibiotics should be limited to conditions of demonstrated or highly probable sensitivity.

Resumen Antecedentes La infeccion del tracto urinario (ITU) es la primera causa de infeccion en pacientes con ingreso hospitalario. En este trabajo describimos los patogenos mas frecuentemente implicados en el desarrollo de ITU en pacientes hospitalizados, su perfil de sensibilidad antibiotica y la evolucion de la actividad de los antibioticos de uso habitual en el tratamiento de estas infecciones. Metodos Se evaluaron retrospectivamente los resultados de los cultivos y antibiogramas de las muestras de orina procedentes de pacientes adultos ingresados en el Complejo Hospitalario Virgen de las Nieves (Granada, Espana) con confirmacion microbiologica de ITU entre enero de 2013 y diciembre de 2016. Resultados Se identificaron 4.347 microorganismos (3.969 bacterias y 378 levaduras). Durante los 4 anos de estudio, y en ambos sexos, Escherichia coli fue la especie mas frecuentemente aislada; sin embargo, el 62,9% de las ITU estuvieron causadas por microorganismos diferentes a este. La presencia de microorganismos multirresistentes como Acinetobacter spp. (1,2%) y de enterobacterias productoras de betalactamasas de espectro extendido (10,0%) y de carbapenemasas (0,3%) fueron tambien hallazgos relevantes. Imipenem, piperacilina-tazobactam y fosfomicina presentaron tasas de actividad por encima del 80%, considerando todos los microorganismos causantes de ITU, mientras que el resto de antibioticos ensayados presentaron porcentajes de actividad inferiores al 70%. Conclusion Imipenem y piperacilina-tazobactam fueron los antibioticos de uso hospitalario mas activos, lo que los convierte en antibioticos de primera linea en el tratamiento empirico de la ITU en este ambito sanitario. El uso de otros antibioticos deberia estar limitado a situaciones de sensibilidad demostrada o muy probable.

Peripheral neuropathy is one of the main complications of diabetes. The pathogenesis of this affectation is not completely understood. Several studies refer to hyperglycemia as the principal cause of diabetic neuropathy. Nonetheless, there are changes in the expression of insulin receptor during the progress of diabetic neuropathy, suggesting that this disorder begins before high glucose blood levels are established. In this study, we investigated fructose-induced insulin resistance as a model of neuropathic pain. Insulin resistance was induced by 15% fructose in drinking water for 16 weeks. Fructose slightly enhanced blood glucose levels. In contrast, chronic fructose increased insulin plasma levels and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index. Moreover, fructose induced hyperalgesia (to 0.5% formalin) and tactile allodynia. Interestingly, gabapentin and metformin, but not diclofenac, reversed in a dose-dependent manner fructose-induced tactile allodynia. Fructose enhanced activating factor transcription 3 (ATF3), but not caspase-3 and α2δ-1 subunit, in individual L4 and L5 dorsal root ganglia (DRG) and sciatic nerve. Chronic fructose also increased anoctamin-1 and ASIC3 whereas it reduced insulin receptor-β, α5GABAA receptors and TASK-3 channels protein expression in DRG and sciatic nerve. In contrast, fructose did not change TRPV1 channel protein expression. Treatment with metformin for 4 weeks reversed some of the fructose-induced changes in protein expression. Taken together, these data suggest that insulin resistance induced by fructose reproduces several aspects of neuropathic-like pain. Our data also suggest that nociceptive hypersensitivity in this model is due to the modulation of several ionic channels at the primary afferent neurons.

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Study question The detection of metals in semen offers a new field in the study of male infertility. Summary answer Normozoospermia is associated with higher amounts of Fe. In males with pathological spermiogram, the percentage of men with Fe in semen was lower than expected. What is known already Increased levels of Fe in human semen appear to have a significant correlation with male fertility, suggesting that Fe in human seminal plasma has an important factor in male reproductive function. Fe acts as an antioxidant being a co-factor of catalasa, which protects sperm. On the other hand, elevated Fe levels are associated with sperm damage and continues to increase the lipid peroxidation that will affect the plasma membrane and the sperm motility. Most authors associate Fe with sperm motility and higher estimated fertility potential, based on standard semen parameters in fertile men, which are associated with lower levels of Fe. Study design, size, duration A prospective study was carried out in 102 men in a Reproduction unit in Tenerife, from February to April 2018 as a part on an epidemiologic study of environmental contaminants and male reproduction. The participant were categorized into two groups, according to the results of semen analysis following the World Health Organization guidelines: the pathological and the normal semen group that constituted the control group. The metal was determined in semen samples. Participants/materials, setting, methods Semen quality and levels of Fe were measured in seminal plasma on a total of 102 men attended successively, for the initial infertility evaluation, The collected samples were used for both semen analysis following the World Health Organization (WHO) guidelines and metal detection and carried out using a Makler® counting chamber (Irvine Scientific, CA) and for metals, were determined by ICP-OES (Inductively Coupled Plasma-Optical Emission Spectrometry) in semen samples. Main results and the role of chance The percentage of males with the presence of Fe was 97.1% and the average level were 0.6283 mg/Kg. When analyzing the relationship between the spermiogram parameters with the levels of Fe in the semen, significant differences were found. All men with a normal sperm analysis presented Fe in semen, but among men diagnosed with altered spermiogram, the percentage of men with Fe in semen (92.7%) was lower than expected (97%) (χ2 128 1 =4.59; p = 0.032). As for the concentration of Fe in spermiogram in the first quartile (25% lower), measuring 0.33 mg/Kg, more pathological samples were found than expected (X2 133 2 =6.921; p = 0.031) having a higher probability of being more pathological (52% vs 31.4%). On the other hand, men with pathological sperm concentration, have higher levels of Fe, in the fourth quartile (0.61 mg/kg), with more frequency than expected (90.6% vs 97%) (χ2 136 1 =6.48; p = 0.011). The association between BMI and the presence of Fe was statistically significant. In obese males (BMI ≥30.0 kg/m2), the percentage of men with Fe in semen (80%) was lower than expected (97%) (χ2 42 2 =11.302; p = 0.001). Limitations, reasons for caution The limitation of this study was the volume of semen that could be obtained for metal detection, only 0.8 mL. because the collected samples were used for both semen analysis and metal detection. Wider implications of the findings: The determination of metals in semen opens a new field in the study of male infertility and many cases of unknown infertility could be due to metal presence or absence in semen, with the option of performing treatments. Trial registration number Not applicable

Background: Periprosthetic infection is commonly caused by Staphylococcus aureus and, if resistant to methicillin (MRSA), is associated with increase in severity and costs to patient and healthcare systems. MRSA colonizes 1–5% of the population, therefore using a screening and decolonisation protocol the risk of periprosthetic infection could be reduced. The objective of our study is to report the results of a preoperative MRSA screening and management protocol utilised at our hospital. Methods: All patients undergoing a total joint arthroplasty at our hospital were preoperatively screened for MRSA colonization with swab samples of five different locations. Exposure to risk factors were investigated in colonised patients and they were treated for 5 days prior surgery with nasal mupirocin, chlorhexidine sponges and oral tablets. Results: During the 48 months of the study, MRSA colonisation was identified in 22 (1.01%) of 2188 patients operated. The culture was positive only in the nasal swab in 55 patients. In five patients the nasal culture was negative, but they had another positive swab culture (three in the groin and two perianal). None of the patients reported a history of recent antibiotic treatment or hospitalization. Conclusion: At our institution, the prevalence of MRSA colonisation is 1.01% in patients undergoing hip and knee arthroplasty. Interestingly, our screening protocol included samples from five different anatomic locations, and it is important to highlight that we found patients with negative nares culture and positive cultures in other locations. Therefore, the number of carriers may be underdiagnosed if only nasal samples are obtained. Level of evidence: IV

Closure of holes caused by unintentional puncture of the dural sac with a relatively large-bore Tuohy needle is thought to be a linear process over a relatively short time. Scientists believe that cerebrospinal fluid (CSF) leakage through the puncture hole is responsible for intracranial hypotension

Cereals and their derivatives are the basis of human nutrition. However, cereals also contribute to the dietary exposure to toxic metals that may pose a risk. Strengthening food security and nutrition information is a high priority challenge for the Cape Verde Government. The toxic metals content (Cr, Ni, Sr, Al, Cd, Pb) has been determined in 126 samples of cereals and derivatives (rice, corn gofio, corn flour, wheat flour, corn, wheat) consumed in Cape Verde. Wheat flour samples stand out for registering the highest Sr (1.60 mg/kg), Ni (0.25 mg/kg) and Cr (0.13 mg/kg). The results show relevant Al levels (1.17 – 13.4 mg/kg) with its highest levels in corn gofio. The mean Pb average content in the cereals is 0.03 – 0.08 mg/kg with the highest level observed in corn gofio. The Al and Pb levels are lower in cereals without husks. A consumption of 100 g/day of corn gofio provide an intake of 1.34 mg Al/day (13.7% of the tolerable weekly intake established at 1 mg/kg bw/week) and 8 µg Pb/day (20% of the BMDL set at 0.63 µg/kg bw/day for nephrotoxic effects). The minimization of the dietary exposure of the Cape Verdean population to toxic metals is through the importation of higher quality cereals.

Aims Little is known about the prognosis of patients with massive pulmonary embolism (PE) and its risk of recurrent venous thromboembolism (VTE) compared with non-massive PE, which may inform clinical decisions. Our aim was to compare the risk of recurrent VTE, bleeding, and mortality after massive and non-massive PE during anticoagulation and after its discontinuation. Methods and results We included all participants in the RIETE registry who suffered a symptomatic, objectively confirmed segmental or more central PE. Massive PE was defined by a systolic hypotension at clinical presentation (

3D printing is the best way to the computerized manufacture of complex geometries for advanced technologies. Because of precise dimension and shape of 3D-printed objects, design criteria are meticulously optimized in 3D printing processes. Nevertheless, achieving 3D printable polymers has always been associated with the consequence of poor mechanical properties, which necessitated the use of reinforcing agents. Typically, neat polymers cannot fulfill the final application requirements. The use of nanomaterials enhances polymer properties. Based on final application, materials should be selected carefully to achieve a printable material along with appropriate properties. 3D-printed nanocomposites have been considered in various applications from electronic to biomedical industry. Designing 3D-printed nanocomposites as biomaterials, mainly for medical applications, was the subject of numerous scientific reports. It was recognized that designing appropriate nanocomposites for 3D printing necessitates collecting profound knowledge about materials’ structure and their rheological properties. However, classification of reports on 3D-printed biomaterials for medical application was the subject of a few reports. In this chapter, 3D-printed nanocomposites are reviewed in view of mechanical and rheological properties for biomaterials applications.

Resumen: La vía clínica de recuperación intensificada en cirugía cardiaca (RICC) pretende identificar, difundir y favorecer la implementación de las mejores actuaciones basadas en la evidencia científica para disminuir la variabilidad en la práctica clínica. La puesta en marcha de estas prácticas en el proceso clínico global favorecerá la obtención de mejores resultados, acortamiento de estancias hospitalarias y en la Unidad de Cuidados Críticos, lo que permitirá una reducción de costes y una mayor eficiencia. Tras realizar una revisión sistemática en cada uno de los puntos del proceso perioperatorio en cirugía cardiaca, se han redactado recomendaciones basadas en la mejor evidencia científica disponible en la actualidad con el consenso de las sociedades científicas implicadas. Abstract: The ERAS guidelines are intended to identify, disseminate and promote the implementation of the best, scientific evidence-based actions to decrease variability in clinical practice. The implementation of these practices in the global clinical process will promote better outcomes and the shortening of hospital and critical care unit stays, thereby resulting in a reduction in costs and in greater efficiency. After completing a systematic review at each of the points of the perioperative process in cardiac surgery, recommendations have been developed based on the best scientific evidence currently available with the consensus of the scientific societies involved.

Agri-food wastes are inherently generated along the food production chain. In this sense, a significant reduction or better management of them could improve food security and also reduce hunger. It should be noted that several global organizations have estimated that food wastes could reach 126 million tons by 2020. Normally, agricultural wastes have been used as animal feeds and fertilizers. Nonetheless, most agricultural wastes have macro- and micronutrients, as well as bioactive compounds that could have a high added value after agricultural waste valorization processes, e.g., the latter can be extracted and incorporated as food additives for the manufacture of active and intelligent packaging, while macromolecules such as carbohydrates, proteins and lipids can lead to obtaining biosurfactants and single cell oils of high added value to be used in food sector. This chapter aims to provide some perspectives and advances in the valuation of agri-food wastes.

The increase of mental illness cases around the world can be described as an urgent and serious global health threat. Around 500 million people suffer from mental disorders, among which depression, schizophrenia, and dementia are the most prevalent. Revolutionary technological paradigms such as the Internet of Things (IoT) provide us with new capabilities to detect, assess, and care for patients early. This paper comprehensively survey works done at the intersection between IoT and mental health disorders. We evaluate multiple computational platforms, methods and devices, as well as study results and potential open issues for the effective use of IoT systems in mental health. We particularly elaborate on relevant open challenges in the use of existing IoT solutions for mental health care, which can be relevant given the potential impairments in some mental health patients such as data acquisition issues, lack of self-organization of devices and service level agreement, and security, privacy and consent issues, among others. We aim at opening the conversation for future research in this rather emerging area by outlining possible new paths based on the results and conclusions of this work., Consejo Nacional de Ciencia y Tecnologia (CONACyT), Sonora Institute of Technology (ITSON) via the PROFAPI program PROFAPI_2020_0055, Spanish Ministry of Science, Innovation and Universities (MICINN) project "Advanced Computing Architectures and Machine Learning-Based Solutions for Complex Problems in Bioinformatics, Biotechnology and Biomedicine" RTI2018-101674-B-I00

BackgroundWe designed a device to close accidental dural puncture via the offending puncturing epidural needle directly after diagnosis of the puncture and before removing the needle. The aim of this study was to quantify this device’s ability to seal cerebrospinal fluid leakage.MethodsForty-six anesthetized adult sheep were studied in a single-blind randomized controlled fashion in two equal groups.An intentional dural puncture was performed with an 18-gage Tuohy needle on all the sheep between L6 and S1 levels. Contrast medium was injected through the needle. Twenty-three animals receive treatment with the sealing device. Two minutes after device placement, or dural puncture in the control group, a CT scan was performed on the animals to estimate contrast material leakage. A region of interest (ROI) was defined as the region that enclosed the subarachnoid space, epidural space, and neuroforaminal canal (the vertebral body above and half of its equivalent height in sacrum below the puncture site). In this region, the total contrast volume and the volumes in the epidural space (EPIDURAL) were measured. The primary outcome measure was the EPIDURAL/ROI ratio to ascertain the proportion of intrathecally injected fluid that passed into the epidural space in both groups. The secondary outcomes were the total amount of contrast in the ROI and the EPIDURAL.ResultsThe device was deployed successfully in all but two instances, where it suffered from manufacturing defects.Leakage was less in the study group (1.0 vs 1.4 mL, p=0.008). The median EPIDURAL/ROI ratio was likewise less in the study group (29 vs 46; p=0.013; 95% CI (−27 to –3.5)).ConclusionThis novel dural puncture-sealing device, also envisaged to be used in other comparable iatrogenic leakage scenarios to be identified in the future, was able to reduce the volume of cerebrospinal fluid that leaked into the epidural space after dural puncture. The device is possibly a valuable way of preventing fluid leakage immediately after the recognition of membrane puncture.

La pandemia COVID-19 ha puesto de manifiesto un déficit de ventiladores en el sistema sanitario para estas situaciones. Por ello, varios proyectos a nivel nacional e internacional se han desarrollado en pocas semanas para producir prototipos de ventiladores de fácil y rápida fabricación. Una de las exigencias de la AEMPS para la realización de estudios clínicos con nuevos prototipos pasa por la validación en un modelo animal. Para ello es importante poder utilizar un modelo animal que permita reproducir diferentes situaciones clínicas de forma fácil. En este artículo describimos el uso de la oveja como modelo animal para evaluar un prototipo de ventilador. El animal estuvo anestesiado durante diez horas en las que el prototipo fue utilizado hasta en seis escenarios. Este modelo pareció eficaz y es fácilmente reproducible, por lo que es una excelente opción para este tipo de investigación.

[EN] Rolling noise emitted by railway wheels is a problem that affects human health and limits the expansion of the railway network. It is caused by the wheel vibration due to the wheelrail contact force, and it is important in almost all the vehicle velocity range. The minimization of noise radiation associated with changes on the wheel web is discussed in this work, focusing on potential shape modifications in existing wheels in the form of a perforation distribution over the web. Such a post-manufacturing technique is a cost-effective solution that can be performed in a relatively short term. The implemented objective function is directly related to the overall radiated sound power, which is minimized using a genetic algorithmbased optimizer. In the acoustic model, radiation efficiencies are approximated to unity, the accuracy of this assumption being also studied in the work. The results reflect that an optimized distribution of perforations on the web of a railway wheel can reduce the total sound power level, by about 5 dB(A) and 2 dB(A) for curved and straight web, respectively. The mitigation of the radiated sound power is due to the fact that certain wheel vibration modes are modified and shifted to other frequencies where they are less excited. Finally, the relevance of the cross-sectional curvature of the web is explored by studying two different web geometries, suggesting that it can strongly influence the noise mitigation effects of the perforation pattern., The authors gratefully acknowledge the financial support of Ministerio de Ciencia, Innovacion y Universidades - Agencia Estatal de Investigacion, European Regional Development Fund (project TRA2017-84701-R), and Conselleria d'Educacio, Investigacio, Cultura i Esport (Generalitat Valenciana, project Prometeo/2016/007).

The use of smart contract augurs a world without intermediaries because the code and the agreements contained therein exist across a distributed, decentralized blockchain network. In software engineering, this collaboration is usually represented by using business process models and smart contracts can be used to implement business collaborations in general and inter-organizational business processes. The validation of this contract and the assurance of its quality are critical for its right application. Early testing in smart contract definition is the fact of this paper. The paper discusses the possibility to use transformation protocols to obtain derived artefacts like test case definitions and smart contract code scaffolds. Generation of derived artefacts significantly reduces the number of defects before deploying the smart contract code in the blockchain network. Transformations protocols are created using model-based software development and modelling techniques. This approach allows to simplify and improve the management and execution of collaborative business processes. This would allow, in addition, the application of systematic mechanisms to evaluate and validate the smart contract and, particularly, the application of early testing techniques which would help to reduce the number of defects and, ultimately, the cost of the final review.

Introduction Congenital colour vision deficiencies affect 8% of the male and 0.5% of the female population. The study of colour vision is a complex process due to several factors: the psychophysics of vision itself, the difficulty to establish mathematical models for its analysis, the vague correlation of results between different tests, and the influence of external factors such as lighting, the tests condition, or the experience of the examiner and the patient. In the present document, a simplified review was carried out on the main colour vision tests available in clinical practice. Material and methods Once a filtered preliminary review was made of the bibliography related to the study of colour vision using the PubMed search tool, the most used tests in clinical practice were selected according to their frequency of use and the purpose for which they were applied. A bibliographic study was then carried out on each particular test according to the design of the shown stimuli, its target population, and its sensitivity and specificity. Results From the 95 publications found using the PubMed search tool, in 41 of them, colour tests were used by researchers in their methodology. From the 64 colour tests used, 19 of them were different (with 4 of them being different tests adapted by research groups, and 2 of them carried out online). The most used tests were the following: Ishihara test (10.88%), Farnsworth–Munsell (7.04%), Farnsworth–Munsell 100 Hue (6.4%), Cambridge Colour Test (3.84%), Hardy–Rand–Rittler (3.2%), tests developed by the groups (2.56%), the Anomaloscope (1.28%), the online tests (1.28%) and, finally, Colour Assessment and Diagnosis (0.64%), Pfluger Trident Colour Plates (0.64%), Toothguide Training Box (0.64%), Lanthony Desaturated D-15 (0.64%), City University Test (0.64%), Universal Colour Discrimination Test (0.64%), and Rabin Cone Contrast Test (0.64%). Conclusions The Anomaloscope is the “gold standard” in terms of colour vision testing, despite its incompatibility with daily clinical practice. It is fairly complex to use, difficult to understand for children, and its practice requires having the time available. Nevertheless, it is possible to reach an accurate approximation through the combination of some of the tests listed in this article. The above mentioned tests are a good alternative to determine the presence of dyschromatopsia in settings closer to daily clinical practice or in less controlled settings than a clinical study. The major drawback among the wide range of tests available for the study of colour vision is the difficulty to compare results between tests, since units of the reported data are usually different, and experience is required for its correct interpretation. Currently, there is no consensus on which colour test is the most complete. It is, therefore, advisable to use at least 2 tests in order to ensure diagnoses, and have more extensive information about the visual perception of patients.

Every year thousands of horses from Mexico and the United States of America (USA) are transported to slaughter in Mexico, but little is known about their welfare or pre-slaughter logistics. In this study, we recorded the origin, sex, age and condition of horses (121 journeys, 2648 animals) upon arrival to an abattoir in northern Mexico, including transport details. Horse welfare was measured indirectly via individual scores for body condition, coat quality, lameness, ocular and nasal discharge, as well as reactivity to a chute restraint test, all performed shortly after unloading. The average journey duration was 9.69 (±7.6) hours for horses from Mexico and 16.77 (±4.51) hours for horses from the USA (77 % of all journeys). The prevalence of ocular discharge, nasal discharge, skin wounds, lameness and diarrhoea, were 23 %, 12 %, 11 %, 9 %, 1 % (respectively) of all the horses observed, with no significant differences between Mexican and American horses (P ≥ 0.05). During the chute test the American horses were calmer than the Mexican ones (P < 0.001), who were more restless and aggressive (P = 0.001). Likewise, vocalizations in their three variants during the restraint, neigh/whinny (P = 0.018), nicker (P < 0.001), and snort (P = 0.018), were more common in horses from Mexico. In order to help characterize fitness for transport, a two-step cluster analysis was applied using the welfare indicators, suggesting the existence of four clusters (C) evaluated on arrival at the abattoir (from good to very poor fitness): good (profile C4, n = 769, 29.1 %), average (profile C1, n = 799 horses, 30.2 %), poor (profile C3, n = 586, 22.1 %) and very poor (profile C2, n = 494, 18.6 %). In fact, the C4 best welfare group had 0% lame, 0% nasal discharge, 16.4 % ocular discharge, 7.9 % skin wounds. Instead, the C2 poorest welfare group had 45.8 % lame, 61.1 % nasal discharge, 42.8 % ocular discharge, and 19.9 % skin wounds. Results show potential for using nasal discharge, lameness and ocular discharge as key indicators of horse fitness and welfare on abattoir. The study provides detailed scientific data to help establish strategies regarding optimal days of recovery post-transport and fattening for homogenization of weights between animals of different origins, logistic planning, and optimization of logistic resources to minimize the biological cost of long-distance transport.

Objective To evaluate and compare the analgesic efficacy and adverse effects of dexketoprofen and methadone using a noninferiority trial, during the first 24 postoperative hours in dogs undergoing orthopaedic surgery. Study design Randomized, blinded clinical study. Animals A total of 38 healthy dogs undergoing orthopaedic surgery. Methods Dogs were premedicated with dexmedetomidine [1 μg kg–1 intravenously (IV)] followed by dexketoprofen (1 mg kg–1 IV; group DK) or methadone (0.2 mg kg–1 IV; group M). Anaesthesia was induced with propofol and maintained with isoflurane in 60% oxygen. Postoperatively, dexketoprofen was administered every 8 hours (group DK) and methadone every 4 hours (group M). Analgesia was assessed at baseline and at 1, 2, 4, 6, 18 and 24 hours after extubation using a dynamic and interactive visual analogue scale (DIVAS), the short form of the Glasgow Composite Measure Pain Scale (CMPS-SF), mechanical wound thresholds (MWTs) and plasma cortisol levels. If CMPS-SF score was ≥5, rescue analgesia was administered. Data were analysed using a general linear mixed model, Mann–Whitney U test and chi-squared test as appropriate; a p value Results The CMPS-SF and DIVAS scores were significantly higher in group M compared with group DK and remained higher for a longer period in group M, although the differences were not clinically significant. No significant differences were found in MWT assessment between groups. Plasma cortisol level significantly increased 2 hours after extubation, without significant differences between treatments. Rescue analgesia was administered to three animals (one in group DK; two in group M). Conclusion and clinical relevance We conclude that 1 mg kg–1 IV dexketoprofen administered every 8 hours during the first 24 hours postoperatively is noninferior to methadone in controlling pain after orthopaedic surgery in dog, although frequent pain assessments are recommended to adjust the analgesia plan.

Resumen Antecedentes Hay escasa evidencia sobre el pronostico de la tromboembolia venosa en pacientes sometidos a cirugia ortopedica y en pacientes que sufren un trauma no quirurgico. Metodos Utilizamos la base de datos RIETE (Registro Informatizado de pacientes con Enfermedad TromboEmbolica) para comparar el pronostico del tromboembolismo venoso y el uso de tromboprofilaxis en pacientes sometidos a diferentes procedimientos ortopedicos y en pacientes con traumatismo que no requiere cirugia. Resultados Desde marzo de 2001 a marzo de 2015, se inscribieron un total de 61.789 pacientes en RIETE. De estos, 943 (1.52%) desarrollaron tromboembolismo venoso despues de artroplastia electiva, 445 (0.72%) despues de fractura de cadera, 1.045 (1.69%) despues de cirugia ortopedica no mayor y 2,136 (3.46%) despues de trauma no quirurgico. En general, 2.283 pacientes (50%) presentaron inicialmente embolia pulmonar. En los primeros 90 dias de tratamiento, 30 pacientes (0.66%, IC 95% 0.45-0.93) murieron por embolia pulmonar. La tasa de embolia pulmonar fatal fue significativamente mayor despues de cirugia de fractura de cadera (n = 9 [2.02%]) que despues de la artroplastia electiva (n = 5 [0.53%]), cirugia ortopedica no mayor (n = 5 [0.48%]) o traumatismo no quirurgico (n = 11 [0,48%]). La tromboprofilaxis se utilizo con mayor frecuencia para la fractura de cadera (93%) o la artroplastia electiva (94%) que para la cirugia ortopedica no mayor (71%) o traumatismo no quirurgico (32%). La hemorragia mayor fue significativamente mayor despues de la cirugia de fractura de cadera (4%) que despues de artroplastia electiva (1,6%), cirugia ortopedica no mayor (1,5%) o traumatismo no quirurgico (1,4%). Conclusiones La tromboprofilaxis se utilizo con menos frecuencia en los procedimientos de menor riesgo a pesar del numero absoluto de embolia pulmonar fatal despues de cirugia ortopedica no mayor o traumatismo no quirurgico, excedieron los observados despues de procedimientos de alto riesgo.

Fluoride plays an important role in the prevention of dental decay and in the reduction of osteoporosis. However, due to the multiple dietary sources of fluoride, the recommended intake can be exceeded on a prolonged basis and may have a harmful effect on health. In particular, high intakes of fluoride can cause dental fluorosis in the child population. For the above reason, the fluoride content was determined in 65 samples of different refreshment drinks and natural juices by potentiometry using a selective ion electrode in order to evaluate the dietary intake of this anion from the consumption of these drinks. The mean concentrations of fluoride obtained were 0.47 and 0.39 mg/L for soft drinks and natural juices, respectively. The major contribution to the recommended daily intake (RDI) of fluoride comes from samples of tea based drinks (8.25% men, 11.0% women, 47.1% children). The largest contribution to the RDI of fluoride in natural juices comes from grape juices (9.5% men, 12.7% women, 54.3% children). The intake of fluoride from the consumption of these drinks is below the RDI. However, in the case of children, more control is needed given the numerous dietary sources of fluoride that can contribute to a high intake, thereby increasing the risk of dental fluorosis.

Background Streptococcus Group B (GBS) colonization in pregnant women is the most important risk factor for newborn disease due to vertical transmission during delivery. GBS colonization during pregnancy has been implicated as a leading cause of perinatal infections. Traditionally, pregnant women are screened for GBS between 35 and 37 weeks of gestation. However, antenatal culture-based screening yields no information on GBS colonization status and offers low predictive value for GBS colonization at delivery. Numerous assays have been evaluated for GBS screening in an attempt to validate a fast and efficient method. The aim of this study was to compare bacteria isolation by culture and two qPCR techniques, targeting sip and cfb genes, respectively, for detecting colonizing GBS. Methods Cultures – the gold-standard technique, a previous qPCR technique targeting the sip gene, and a new proposed qPCR assay targeting the cfb gene were evaluated as diagnostic tools on 320 samples. Results Considering cultures as the gold standard, the evaluated qPCR method detected 75 out of 78 samples, representing a sensitivity of 93.58% (95% confidence interval (CI), 90.89–96.27) and specificity of 94.62% (95% CI, 91.78–97.46). However, an additional analysis was performed for true positives that included not only samples showing positives by culture but samples showing positive for both qPCR assays. The sensitivity and specificity were recalculated including these discrepant samples and a total of 89 samples were considered as positive, giving a prevalence of 27.81%. With this new analysis, the qPCR targeting the cfb gene showed a sensitivity of 95.5% (95% CI, 88.65–98.59) and specificity of 99.13% (95% CI, 96.69–99.97). Conclusions The new qPCR method is a sensitive and specific assay for detecting GBS colonization and represents a valuable tool for identifying candidates for intrapartum antibiotic prophylaxis. Cultures should be retained as the reference and the routine technique because of its specificity and cost analysis ratio, but it would be convenient to introduce PCR techniques to check negative culture samples or when an urgent detection is required to reduce risk of infection among infants.

Resumen La revisión de los últimos meta-análisis que comparan, en la hemicolectomía derecha laparoscópica, la confección de la anastomosis intracorpórea (IC) frente a la extracorpórea (EC), parecen señalar una cierta ventaja de la realización IC aludiendo a una reducción en la morbilidad, sin encontrar diferencias significativas en la tasa de fugas anastomóticas. Sin embargo, todos coinciden en señalar la debilidad de las recomendaciones en base a la heterogeneidad y diseño retrospectivo de los estudios analizados. Es muy probable que los nuevos avances en cirugía mínimamente invasiva, dispositivos robotizados y la mejora en la experiencia de los grupos conviertan en "gold standard" la anastomosis IC, pero a la luz de lo publicado, aún no estamos en ese tiempo. Aunque sea una obviedad: los mensajes lanzados a los cirujanos en formación deben estar cargados de rigor y honestidad. Traducidos en recomendaciones fiables y seguras para nuestros pacientes.

Objetivo: Describir las tendencias en el manejo actual de la litiasis urinaria en el entorno de la Confederación Americana de Urología (CAU) para reconocer patrones de práctica clínica e identificar necesidades educativas. Material y método: Encuesta en línea compuesta por 31 preguntas de respuesta múltiple (español y portugués) a través www.caunet.org revelando datos demográficos, patrones de práctica clínica y actitudes ante situaciones clínicas específicas. Resultados: Cuatrocientos sesenta y tres profesionales procedentes de Brasil, México, Argentina, España, Colombia, Chile y otros (3,96% de la membresía CAU) completaron la encuesta. Todos los participantes practican algún tipo de tratamiento para la litiasis urinaria: 98,5% ureteroscopia (URS) semirrígida, 83,8% nefrolitotomía percutánea (NLP), 78,2% URS flexible y 67,2% litotricia extracorpórea. Los médicos más jóvenes tienden a realizar NLP (p < 0,001) y la proporción de usuarios de URS flexible es mayor en los países de habla portuguesa (p = 0,037). La fuente de energía principal empleada es el láser (60,7%). Practican NLP de calibre reducido 15,3%, más en hospitales universitarios (p < 0,01) y profesionales de mayor edad (p < 0,01). Solo el 3,2% utiliza acceso percutáneo al riñón guiado exclusivamente por ultrasonido (US), especialmente profesionales mayores (p < 0,001). Utiliza posición supina el 40,4%, más en España (p < 0,001) y en entorno universitario (p = 0,017). Practican NLP sin nefrostomía el 3,9%. En URS flexible el 19,2% no usa vaina de acceso ureteral y los profesionales de mayor edad prefieren vainas de calibre más delgado (p < 0,001). Conclusiones: El manejo de litiasis en el entorno CAU sigue un perfil similar al reconocido en las guías clínicas europea y americana, aunque se reconocen interesantes variaciones en función de la edad y de laspreferencias de los profesionales. Se identifican como posibles áreas de mejora NLP de calibre reducido y punción guiada por US. Objective: To describe the trends in the current management of urolithiasis in the Confederación Americana de Urología (CAU) setting to recognise patterns of clinical practice and identify educational needs. Material and method: An online survey was created with 31 multiple-choice questions (Spanish and Portuguese) through www.caunet.org, which revealed demographic data, patterns of clinical practice and approaches for specific clinical conditions. Results: A total of 463 practitioners from Brazil, Mexico, Argentina, Spain, Colombia, Chile and other countries (3.96% of the members of CAU) completed the survey. All participants performed some type of urolithiasis treatment: 98.5% performed semirigid ureteroscopy (URS), 83.8% performed percutaneous nephrolithotomy (PCNL), 78.2% performed flexible URS, and 67.2% performed extracorporeal lithotripsy. The youngest physicians tended to perform PCNL (P < .001), and the proportion of users of flexible URS was greater in the Portuguese countries (P = .037). The main energy source was laser (60.7%). Small-calibre PCNL was performed by 15.3% of the respondents, more often in university hospitals (P < .01) and by older practitioners (P < .01). Only 3.2% of the respondents used percutaneous access to the kidney guided exclusively by ultrasound, especially the older practitioners (P < .001). The supine position was used by 40.4% of the respondents, more often in Spain (P < .001) and in the university setting (P = .017). PCNL without nephrostomy was practiced by 3.9% of the respondents. For flexible URS, 19.2% of the respondents did not use ureteral access sheaths, and the older practitioners preferred thinner calibre sheaths (P < .001). Conclusions: The management of lithiasis in the CAU setting follows a profile similar to that recognised in the European and American clinical guidelines, although there are interesting variations based on the practitioner's age and preferences. We identified potential areas for improvement in small-calibre PCNL and ultrasound-guided puncture. Sin financiación 1.136 JCR (2018) Q4, 68/80 Urology & Nephrology 0.332 SJR (2018) Q3, 66/107 Urology No data IDR 2018 UEM

Socio-ecological systems maintain reciprocal interactions between biophysical and socioeconomic structures. As a result of these interactions key essential services for society emerge. Urban expansion is a direct driver of land change and cause serious shifts in socio-ecological relationships and the associated lifestyles. The framework of rural-urban gradients has proved to be a powerful tool for ecological research about urban influences on ecosystems and on sociological issues related to social welfare. However, to date there has not been an attempt to achieve a classification of municipalities in rural-urban gradients based on socio-ecological interactions. In this paper, we developed a methodological approach that allows identifying and classifying a set of socio-ecological network configurations in the Region of Madrid, a highly dynamic cultural landscape considered one of the European hotspots in urban development. According to their socio-ecological links, the integrated model detects four groups of municipalities, ordered along a rural-urban gradient, characterized by their degree of biophysical and socioeconomic coupling and different indicators of landscape structure and social welfare. We propose the developed model as a useful tool to improve environmental management schemes and land planning from a socio-ecological perspective, especially in territories subject to intense urban transformations and loss of rurality.

Resumen Objetivo La membrana de oxigenacion extracorporea (ECMO) es un tipo de asistencia circulatoria que asocia elevada mortalidad. Sin embargo, superar la fase inicial de soporte mecanico no implica supervivencia ni a corto ni a largo plazo. Objetivo: describir las caracteristicas y evolucion de los pacientes con shock cardiogenico refractario (SCR) asistidos con ECMO veno-arterial (ECMO-VA) en un hospital con programa de trasplante cardiaco. Diseno Estudio de cohortes y retrospectivo de centro unico. Ambito UCI cardiologica de un hospital terciario. Pacientes Un total de 46 pacientes asistidos consecutivamente con una ECMO-VA durante 6 anos. Intervenciones Analisis de la mortalidad hospitalaria tras la retirada del soporte mecanico, de la supervivencia global (SG) y de los factores asociados. Resultados Quince pacientes (33%) fallecieron con la ECMO-VA y 31 (67%) sobrevivieron a su retirada tras un soporte de 8 dias (RIC: 5-15); 14 pacientes fueron trasplantados. La mortalidad hospitalaria en estos pacientes fue del 32% (10/31) y se relaciono con: edad (p = 0,001), SAPS-II (p = 0,009), sangrado de canulas (p = 0,01), indicacion de SCR post-IAM (p = 0,001). Con una mediana de seguimiento de 27 meses (RIC: 11-49), seguian vivos el 91% de los pacientes que fueron dados de alta del hospital. La SG tras la retirada de la ECMO-VA se relaciono con el tipo de indicacion (p = 0,002), teniendo peor pronostico los pacientes con SCR postinfarto. Conclusiones En nuestra experiencia, la ECMO-VA es un tipo de asistencia mecanica que puede utilizarse en el manejo del SCR. Asocia una mortalidad precoz elevada, pero tras superar la fase hospitalaria la supervivencia de los pacientes es buena.

Objective Extracorporeal membrane oxygenation (ECMO) affords mechanical circulatory assistance associated to high mortality. However, weaning from such mechanical support may not imply improved short- or long-term survival. This study describes the characteristics and evolution of patients with refractory cardiogenic shock (RCS) subjected to venoarterial ECMO (VA-ECMO) in a hospital with a heart transplant program. Design A single-center, retrospective cohort study was carried out. Setting The cardiovascular ICU of a tertiary hospital. Patients Forty-six patients consecutively subjected to VA-ECMO over 6 years. Interventions Hospital mortality after weaning from ECMO and overall survival (OS) were analyzed. Results Fifteen patients (33%) died with VA-ECMO and 31 (67%) were weaned after 8 days of support (IQR: 5–15). Fourteen patients under went transplantation. Hospital mortality in these patients was 32% (10/31), and was associated to age ( p = 0.001), SAPS II score ( p = 0.009), cannulation bleeding ( p = 0.01) and post-acute myocardial infarction RCS ( p = 0.001). After a median follow-up of 27 months (IQR: 11–49), 91% of the patients discharged from hospital were still alive. Overall survival after weaning from assistance was associated to the type of cardiac disease ( p = 0.002). Patients with RCS after acute myocardial infarction had a poorer prognosis. Conclusions In our experience, VA-ECMO can be used as mechanical assistance in the management of RCS. The technique is associated to high early mortality, though the long-term survival rate after hospital discharge is good.

Resumen Introduccion La progresiva reduccion del calibre del tracto en cirugia percutanea renal, hasta alcanzar la miniaturizacion, ha expandido su utilizacion a litiasis de menor tamano que hasta ahora se trataban mediante litotricia extracorporea por ondas de choque (LEOCH) y cirugia retrograda intrarrenal (CRIR). Objetivo Realizar una puesta al dia de las diferentes tecnicas de nefrolitectomia de calibre reducido (NLP-CR) analizando su eficacia, seguridad e indicaciones, asi como su grado de implantacion en la actualidad. Material y metodos Realizamos una revision en PubMed de la literatura en castellano e ingles sobre las diferentes tecnicas de NLP-CR. Resultados La NLP-CR ha disminuido la morbilidad asociada a la NLP estandar, particularmente el sangrado, y ha posibilitado la nefrolitectomia tubeless con mayor seguridad. Existen diferentes tecnicas con confusa terminologia (miniperc, microperc, mini-microperc, ultraminiperc) que se diferencian en el calibre que emplean y en determinados aspectos tecnicos que hacen que sus indicaciones deban ser precisadas. Actualmente, la NLPCR compite con tecnicas menos invasoras que la NLP estandar, como la LEOCH y la CRIR en el tratamiento de las litiasis de pequeno tamano, pero todavia su papel no esta suficientemente esclarecido y es aun motivo de debate. Conclusiones Las indicaciones de la NLP se estan expandiendo a tamanos litiasicos mas pequenos debido a la miniaturizacion de la tecnica, compitiendo en este campo con LEOCH y CRIR. Precisamos mayores estudios para establecer sus indicaciones precisas en el tratamiento de la litiasis renal.

Introduction The progressive reduction in the caliber of the tract in percutaneous kidney surgery to the point of miniaturization has expanded its use to smaller stones that until now have been treated with extracorporeal shock wave lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS).