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This paper presents the development of MASDAN, an integrated platform consisting of a mobile application and a web-GIS interface for monitoring the Manila Bay environment. The MASDAN mobile application uses citizen science and Volunteered Geographic Information (VGI) to collect data on specific environmental issues. It also serves as an information, education, and communication (IEC) tool for its users. The MASDAN Monitoring Interface is a centralized citizen report assessment tool for local authorities and environmental agencies to validate and monitor environmental reports within their area of jurisdiction. These two components create a two-way flow of information between citizens and authorities, ensuring prompt and information-driven actions to environmental issues affecting the Manila Bay and linked environments.

Donation barriers are a crucial factor to consider in the study of blood donor behavior. Since blood donors do not behave homogeneously, the aim of this work is to analyze how the donor profile (i.e. sociodemographic characteristics and donation behavior) influences the prevalence of blood donation barriers. A total of 5,353 active donors in the Canary Islands (Spain) completed an online survey. Given the general lack of agreement concerning the conceptualization and measurement of donation barriers, an integrative 25-item barrier scale, which is the result of grouping all barriers identified in the literature according to the concept of obstacle which they represent, was designed and validated. The results indicate that individuals between 18 and 35 years of age, with university education and higher income are more likely to be affected by donation barriers. At the same time, individuals who donate once or twice a year, and those with shorter experience as donors, are more prone to experience donation barriers. The present study is useful for blood transfusion centers, because it shows that centers must identify which donation barriers are the most prevalent in their donor pool, as well as which donor groups are the most affected by them. Thus, blood transfusion centers will be able to design appropriate marketing actions to reduce or eliminate those barriers that prevent active donors to donate repetively.

This work studies the relative influence of the constructive characteristics of thermosiphon factory made solar heating systems of components such as absorber type, collector area, thermal insulation of both collector(s) and tank, tank volume and volume/area ratio, on the annual energy production, the annual efficiency and the solar fraction. The research has been conducted on 28 systems available in the market, tested according to Standard ISO 9459–5:2007 and simulated fo different European reference locations (Athens, Davos, Wurzburg and Stockholm) according to Standard EN 12976–2:2019. The results show that reduced volume has a marked influence on the energetic and efficiency behaviour of these systems. In particular, for reduced volume values greater than 0.8, the constructive characteristics have high influence on systems behaviour. On the contrary, for reduced volume values lower than 0.8, all tested systems have a similar behaviour at the same location. The results found in this study allow optimizing the design of TSWHS, as well as selecting a specific system according to the location and a daily load volume.

Objective The objective of the study was to determine the trend of variables related to tuberculosis (TB) from the Integrated Tuberculosis Research Program (PII-TB) registry of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), and to evaluate the PII-TB according to indicators related to its scientific objectives. Method Cross-sectional, population-based, multicenter study of new TB cases prospectively registered in the PII-TB between 2006 and 2016. The time trend of quantitative variables was calculated using a lineal regression model, and qualitative variables using the χy test for lineal trend. Results A total of 6,892 cases with an annual median of 531 were analyzed. Overall, a significant down-ward trend was observed in women, immigrants, prisoners, and patients initially treated with 3 drugs. Significant upward trends were observed in patients aged 40−50 and >50 years, first visit conducted by a specialist, hospitalization, diagnostic delay, disseminated disease and single extrapulmonary location, culture(+), drug susceptibility testing performed, drug resistance, directly observed treatment, prolonged treatment, and death from another cause. The scientific objectives of the PII-TB that showed a significant upward trend were publications, which reached a maximum of 8 in 2016 with a total impact factor of 49.664, numbers of projects initiated annually, presentations at conferences, and theses. Conclusions PII-TB provides relevant information on TB and its associated factors in Spain. A large team of researchers has been created; some scientific aspects of the registry were positive, while others could have been improved.

La trombosis asociada al cáncer (TAC) constituye una complicación frecuente en pacientes con esta enfermedad. Existen tres opciones para la tromboprofilaxis: los anticoagulantes orales directos (ACOD), las heparinas de bajo peso molecular (HBPM) y las anti-vitamina K (warfarina). Se realizó una revisión sistemática para comparar las tres alternativas de tratamiento sobre efectividad bajo criterios de no inferioridad. Adicionalmente se analizaron el empleo de los ACOD y las HBPM contra placebo para evidenciar superioridad. El evento primario fue la trombosis venosa profunda recurrente (TVPr) y para seguridad, la hemorragia mayor. Un total de 9353 pacientes fueron clasificados en cuatro categorías: ACOD vs warfarina (4 estudios), ACOD vs HBPM (3 estudios), HBPM vs warfarina (3 estudios) y ACOD o HBPM vs placebo (4 estudios). Los resultados mostraron una superioridad de los ACOD sobre la warfarina en TVPr, RR(IC95%) igual a 0,70 (0,58-0,87), p

This paper discusses the development of a coating made of solid waste and residual biomass and its application as ecological solar absorber coating. This absorbent solar coating is made with a binder that consists of essential grapefruit rind oil and expanded polystyrene, both obtained from waste materials, as well as forest biomass soot (FBS) processed by mechanical grinding and used as a functional photothermal material. This mixture produces a paint that can be applied to metallic substrates to form a solar energy-absorbing surface. The characterization and evaluation is shown in three steps: (a) Characterization of the materials using XRD, SEM, TEM, XPS, Raman spectroscopy and IR; (b) coating evaluation using AFM, optical characterization to measure solar absorption, TG to determine the operating temperature and laser flash analysis to determine thermal conductivity; and (c) a testing with thermosolar technology to determine the thermal parameters of solar cookers. It has been identified that the pseudo-amorphous carbon in FBS has solar energy absorption capacity due to the sp2-sp3 bonds present in this kind of carbon, associated with the material’s graphitic domain. Also, results show that the coating can be used with thermosolar technologies operating above 250 °C with a solar absorption index above 96%, and it has thermally-efficient properties. In addition, the coating, it shows better results with solar cookers than other coatings used with this technology, increasing cooking power, so it can potentially be employed with various thermosolar technologies due to the replicability of its materials, its low environmental impact and low economic cost.

Objectives This study sought to describe, in detail, the angiographic, gross macroscopy, and histological dissection of the conduction axis in humans. Background The recent upsurge of interest in specific pacing of the atrioventricular conduction axis has emphasized the need for precise knowledge of the location of the atrial and penetrating components of the atrioventricular conduction axis. Methods A total of 41 human hearts were studied by serial histological sectioning and an additional 3 hearts by gross dissection. One of the hearts studied histologically was also dissected to show the location of the conduction axis prior to serial sectioning. The anatomical findings were then compared with the results of angiography undertaken in the catheter laboratory in 60 patients undergoing electrophysiological studies. Results Marked variation of the location of the transition from atrioventricular conduction axis to the penetrating atrioventricular bundle, or the bundle of His, relative to the landmarks of the triangle of Koch was observed. In just over one-half of both the specimens and the patients, the site of penetration was on the atrial aspect of the hinge of the septal leaflet of the tricuspid valve, with further variation noted relative to the apex of the triangle of Koch. Based on measurements of the histological sections, marked variation in the dimensions of the axis and its adjacency to the right-sided endocardium were also found. In almost three-fifths of hearts, an interventricular component of the fibrous membranous septum was not able to be identified. The significance of these findings to those who seek to perform selective pacing of the atrioventricular conduction axis are discussed. Conclusions Marked variability of the location of the conduction axis within the triangle of Koch is reported. In three-fifths of hearts, the interventricular component of the fibrous membranous septum is nonexistent.

Introduction The attitude toward living liver donation (LLD) among the Spanish population is mostly positive; however, the reality is that liver transplants from live donations are currently minimal. Given this situation, studies that analyze these discrepancies should be carried out. Objective Analyze the attitude toward LLD among family members of patients on the waiting list for liver transplantation. Method Population under study. First-degree relatives of the patients included in the waiting list for liver transplantation. Inclusion criteria. 1. Have the patient's authorization for family members to participate; 2. Accept, the relative, to participate in this investigation; and 3. Be over 18 years old. Opinion survey. The attitude toward LLD is assessed through a questionnaire on psychosocial aspects. Results Patients who accepted family members’ participation in the study were 21 of 112, of which 9 placed restrictions on family access, and 12 authorized family members without restrictions. The participants were 1. children: 52.2% (n = 24); 2. brothers: 30.5% (n = 14); and 3. partners: 17.3% (n = 14). Finally, the authorized relatives and participants in the study were 45. Of these, only 44% (n = 20) would accept to be donors. Conclusions The access to the LLD of the relatives starts from the restriction and initial rejection of the patients themselves on the waiting list. The promotion of LDD is to initially sensitize patients.

The articles in this special section focus on data driven optimization for transportation and smart mobility applications. We live in an era of major societal and technological changes. Transportation de-carbonization and postindustrial demographic trends, such as massive migrations and an aging society, generate new challenges for cities, making the efficient and sustainable management of services and resources more necessary than ever. Cities must evolve, transform, and become smart to cope with these realities. According to the literature, a city can be referred to as smart when investments in human and social capital and traditional (transportation) and modern [information and communications technology (ICT)] communication infrastructure fuel sustainable economic growth and high quality of life, with a wise management of natural resources, through participatory government.

Products and outputs for water quality monitoring are made available in the IM4ManilaBay MapABLE Web Portal, a web-based GIS platform that serves as a repository of processed maps for Manila Bay and linked systems. The Portal is also linked with the MASDAN mobile application that has been developed to allow the public to report different environmental issues. The web development involved the utilization of geospatial content management system, spatial database system, operating systems, programming, and style language. Services included frontend and backend development. The Web Portal serves as a repository for all outputs derived for water quality monitoring. It contains processed results, technical overview on the developed models and tools, historical data viewing and use of basic geoprocessing tools, and viewing of reported incidents from the MASDAN app. It is expected that the Web Portal will contribute significantly in the efforts of communities and environmental agencies to implement policies for sustainable development and management of Manila Bay and its watershed.

Summary Background Although COVID-19 has greatly affected many low-income and middle-income countries, detailed information about patients admitted to the intensive care unit (ICU) is still scarce. Our aim was to examine ventilation characteristics and outcomes in invasively ventilated patients with COVID-19 in Argentina, an upper middle-income country. Methods In this prospective, multicentre cohort study (SATICOVID), we enrolled patients aged 18 years or older with RT-PCR-confirmed COVID-19 who were on invasive mechanical ventilation and admitted to one of 63 ICUs in Argentina. Patient demographics and clinical, laboratory, and general management variables were collected on day 1 (ICU admission); physiological respiratory and ventilation variables were collected on days 1, 3, and 7. The primary outcome was all-cause in-hospital mortality. All patients were followed until death in hospital or hospital discharge, whichever occurred first. Secondary outcomes were ICU mortality, identification of independent predictors of mortality, duration of invasive mechanical ventilation, and patterns of change in physiological respiratory and mechanical ventilation variables. The study is registered with ClinicalTrials.gov, NCT04611269, and is complete. Findings Between March 20, 2020, and Oct 31, 2020, we enrolled 1909 invasively ventilated patients with COVID-19, with a median age of 62 years [IQR 52–70]. 1294 (67·8%) were men, hypertension and obesity were the main comorbidities, and 939 (49·2%) patients required vasopressors. Lung-protective ventilation was widely used and median duration of ventilation was 13 days (IQR 7–22). Median tidal volume was 6·1 mL/kg predicted bodyweight (IQR 6·0–7·0) on day 1, and the value increased significantly up to day 7; positive end-expiratory pressure was 10 cm H2O (8–12) on day 1, with a slight but significant decrease to day 7. Ratio of partial pressure of arterial oxygen (PaO2) to fractional inspired oxygen (FiO2) was 160 (IQR 111–218), respiratory system compliance 36 mL/cm H2O (29–44), driving pressure 12 cm H2O (10–14), and FiO2 0·60 (0·45–0·80) on day 1. Acute respiratory distress syndrome developed in 1672 (87·6%) of patients; 1176 (61·6%) received prone positioning. In-hospital mortality was 57·7% (1101/1909 patients) and ICU mortality was 57·0% (1088/1909 patients); 462 (43·8%) patients died of refractory hypoxaemia, frequently overlapping with septic shock (n=174). Cox regression identified age (hazard ratio 1·02 [95% CI 1·01–1·03]), Charlson score (1·16 [1·11–1·23]), endotracheal intubation outside of the ICU (ie, before ICU admission; 1·37 [1·10–1·71]), vasopressor use on day 1 (1·29 [1·07–1·55]), D-dimer concentration (1·02 [1·01–1·03]), PaO2/FiO2 on day 1 (0·998 [0·997–0·999]), arterial pH on day 1 (1·01 [1·00–1·01]), driving pressure on day 1 (1·05 [1·03–1·08]), acute kidney injury (1·66 [1·36–2·03]), and month of admission (1·10 [1·03–1·18]) as independent predictors of mortality. Interpretation In patients with COVID-19 who required invasive mechanical ventilation, lung-protective ventilation was widely used but mortality was high. Predictors of mortality in our study broadly agreed with those identified in studies of invasively ventilated patients in high-income countries. The sustained burden of COVID-19 on scarce health-care personnel might have contributed to high mortality over the course of our study in Argentina. These data might help to identify points for improvement in the management of patients in middle-income countries and elsewhere. Funding None. Translation For the Spanish translation of the Summary see Supplementary Materials section.

Ecuadorians are the largest immigrant group in Spain. In countries with preclinical programs of xenotransplantation (XenoTx), it is important to know the population attitude toward them; however, in the Ecuadorian population it is not known.To analyze the attitude toward XenoTx of organs among the Ecuadorian population residing in Spain.Population under study. Ecuadorians residing in Spain.Sample of population over 15 years stratified by age and sex. Instrument valuation. Validated questionnaire of attitude towards xenotransplantation PCID-XenoTx-Ríos. Setting for the study. Random selection of people to survey based on stratification.Of the 461 respondents, 36% are in favor of XenoTx if the results were similar to those obtained with humans, 15% against, and 49% undecided. If the results were worse than with human organs, 11% would be in favor, 26% against, and 63% undecided. The variables associated with this attitude are age (P = .018), marital status (P = .026), studies (P .001), comment with family (P = .001), couple attitude (P = .039), attitude toward cadaveric donation (P .001), previous experience with donation (P = .001), consider the possibility of needing a transplant in the future (P .001), and attitude toward related living donation (P .001). In the multivariate analysis, these data persist: university studies (odds ratio [OR] = 3.875; P = .007); in favor of cadaveric organ donation (OR = 2.840; P .001); previous relationship with donation and organ transplantation (OR = 1.901; P = .026); and consider the possibility of needing a transplant in the future (OR = 4.329; P = .002).The attitude toward XenoTx among Ecuadorian residents in Spain is unfavorable and is conditioned by different psychosocial variables.

Introduction The population of Nicaraguan immigrants is growing in North America; however, they have been little analyzed concerning their attitude toward donation and organ transplantation. Objective To analyze the attitude toward the different types of organ donation among the Nicaraguan population residing in Florida. Methods Study population. Nicaraguan population residing in Florida (USA). Inclusion criteria. Population sample over 15 years stratified by age and sex. Instrument valuation. Attitude questionnaires toward organ donation for transplantation “PCID-DTO-Rios,” “PCID–DVR-Rios,” and “PCID–XenoTx-Rios.” Setting for the study. Random selection of people to be surveyed according to stratification. The assistance of immigrant support associations in Florida was required to locate respondents. Results Sample composed of 89 participants. In the attitude toward donation of one’s own organs after death, 22% (n = 20) were in favor, 41% (n = 36) were against, and 37% (n = 33) were undecided. Regarding the donation of living related organs, 76% were in favor (n = 68), 10% were against (n = 9), and 14% were undecided (n = 12). Finally, regarding attitudes toward the acceptance of organ xenotransplantation, if the results were similar to those obtained with human organs, they were not in favor, with 72% (n = 64) against and 28% (n = 25) doubtful. Conclusions The attitude of the Nicaraguan population residing in Florida toward different types of organ donation is unfavorable.

Although blood is essential in healthcare systems for medical and surgical use, it is still a scarce resource. Given that blood cannot be produced artificially, donors are the backbone of the syste...

To analyze the differences in toxicity and biochemical relapse-free survival with hypofractionated radiotherapy with three-dimensional radiotherapy (3D-CRT) or volumetric arc therapy (VMAT) for prostate cancer taking into account comorbidity measured using the Charlson Comorbidity Index (CCI). From January 2011 to June 2016, 451 patients with prostate cancer were treated with 60 Gy (20 daily fractions). VMAT or 3D-CRT was used. Distribution by stage: 17% low-risk, 27.2% intermediate-risk; 39.2% high-risk, 16.6% very high-risk. Mean CCI was 3.4. With a median follow up of 51 months, most patients did not experience any degree of acute GI toxicity (80.9%) compared to 19.1%, who experienced some degree, mainly G-I /II. In the multivariate analysis, only technique was associated with acute GI toxicity ≥ G2. Patients treated with VMAT had greater acute GI toxicity compared with those who received 3D-CRT (23.9% vs. 13.5%, p = 0.005). With respect to acute GU toxicity, 72.7% of patients experienced some degree, fundamentally G-I/II. Neither age, CCI, nor androgen deprivation therapy (ADT) were associated with greater toxicity. Overall survival at 2, 5 and 7 years was 97%, 88% and 83% respectively. The only factor with statistical significance was CCI, with a greater number of events in individuals with a CCI ≥ 4 (p

Evaluate the safety, toxicity and efficacy of an institutional-simplified SBRT protocol with two short SBRT regimens (three or five fractions) for the treatment of lung cancer and oligometastases, according to the volume and localization of tumours. Patients with stage I (T1 or T2) non-small cell lung cancer or lung oligometastases were treated from August 2011 to October 2015. Patients were required to be considered medically inoperable and were discussed in a multidisciplinary team. 100 patients were analysed, 59 had a peripheral location (P), and 41 a central location (C).All patients finished their SBRT course without interruptions related to acute toxicity. The most frequent acute toxicity was grade 1 asthenia, only one patient developed grade 3 toxicity (pneumonitis) and there were no grade 4 or 5 acute toxicities. Three asymptomatic radiation-induced rib fractures were identified, the 1 and 2-year rib fracture-free survival were 97% and 94%, respectively. Two-year progression-free survival and 2-year overall survival of all patients were 52% and 70%, respectively, with a median PFS and OS of 26 and 43 months. Survival free of local progression (SFLP) at 2 years was 89%. A higher PFS in primary lung cancer compared with metastatic tumours was observed, with a median of 35 months with 19 months (p = 0.01). However, no statistical difference was observed in terms of OS between both diseases. SBRT in lung cancer with three sessions for peripheral tumours and five sessions for central tumours may be safely delivered, with low morbidity.

The utilization of solar energy based technologies has attracted increased interest in recent times in order to satisfy the energy demands in buildings. This research work presents a comparative analysis of the energy production and costs of factory made solar heating systems, Thermosiphon Solar Water Heaters Systems (TSWHS) and Forced-circulation Solar Water Heaters Systems (FSWHS), as a function of profile type (high and low) and collector absorber treatment (selective and black painting). We observe that the energy performance and the Levelized Cost of Energy (LCOE) is similar in TSWHS and FSWHS for load volumes below tank nominal volume, black painting absorbers and locations with high solar irradiation. In the case of load volumes greater than nominal, climates with low irradiation and collectors with selective absorbers, the differences in their energy performance can reach a 7% and the LCOE can increase up to 9%. The LCOE is lower for TSWHS systems for all the evaluated scenarios. We have also found that for cold climates, the FSWHS systems present higher net annual energy produced, however, for warm climates TSWHS systems present greater net annual energy production.

In metastatic or locally advanced head and neck tumors that present in frail patients or after chemotherapy progression, radiotherapy is normally used as a palliative treatment, with a high rate of symptom palliation and improvement in quality of life. However, there is controversy about what the optimal regimen is. Moreover, despite the poor prognosis of metastatic head and neck cancer, different retrospective studies have shown that a minority of patients with oligometastatic disease experience prolonged disease-free survival after adding curative radiotherapy treatment to the metastatic disease and/or primary tumor. Different retrospective studies have identified clinical prognostic factors that may be used to select candidate patients with metastatic head and neck cancer for a radical approach with radiotherapy. The purpose of this manuscript is to review the role of radiotherapy in metastatic and locally advanced head and neck tumors.

At the present time, many sings seem to indicate that we live a global energy and environmental crisis. The scientific community argues that the global warming process is, at least in some degree, a consequence of modern societies unsustainable development. A key area in that situation is the citizens mobility. World economies seem to require fast and efficient transportation infrastructures for a significant fraction of the population. The non-stopping overload process that traffic networks are suffering calls for new solutions. In the vast majority of cases it is not viable to extend that infrastructures due to costs, lack of available space, and environmental impacts. Thus, traffic departments all around the world are very interested in optimizing the existing infrastructures to obtain the very best service they can provide. In the last decade many initiatives have been developed to give the traffic network new management facilities for its better exploitation. They are grouped in the so called Intelligent Transportation Systems. Examples of these approaches are the Advanced Traveler Information Systems (ATIS) and Advanced Traffic Management Systems (ATMS). Most of them provide drivers or traffic engineers the current traffic real/simulated situation or traffic forecasts. They may even suggest actions to improve the traffic flow. To do so, researchers have done a lot of work improving traffic simulations, specially through the development of accurate microscopic simulators. In the last decades the application of that family of simulators was restricted to small test cases due to its high computing requirements. Currently, the availability of cheap faster computers has changed this situation. Some famous microsimulators are MITSIM(Yang, Q., 1997), INTEGRATION (Rakha, H., et al., 1998), AIMSUN2 (Barcelo, J., et al., 1996), TRANSIMS (Nagel, K. & Barrett, C., 1997), etc. They will be briefly explained in the following section. Although traffic research is mainly targeted at obtaining accurate simulations there are few groups focused at the optimization or improvement of traffic in an automatic manner — not dependent on traffic engineers experience and “art”. O pe n A cc es s D at ab as e w w w .ite ch on lin e. co m

Background Most clinical data regarding the use of sacubitril-valsartan (SV) in patients with heart failure with reduce EF (HFrEF) come from clinical trials, while observational studies in real life are scarce. Purpose To analyse the efficacy, safety and tolerability of SV in patients with HFrEF in real life. Methods An analysis of the SAVE-RLife (SV Evidence in Real Life) study was performed. This is an observational and ambispective study that included all patients with HFrEF who started SV between SEP2016 and DEC2018. Results A total of 291 patients were included in the study with a median follow-up of 326 (169; 523). Mean age 66.16±11.8, 71 were women (24.4%), 209 patients started treatment at office (71.8%) and 82 during the admission (28.2%). The main aetiologies were ischemic heart disease (51.5%) and idiopathic dilated cardiomyopathy (35.4%). Comorbidities included: 71.5% hypertensive, 55.3% dyslipidemic, 37.1% AF and 44% T2DM. Baseline treatment included 85.9% beta-blockers, 87.2% ACEI or ARA-II, 65.6% MRA and 17.5% iSGLT2. After treatment start with SV, baseline and follow-up analytical parameters such as GFR, K+ levels and NT-BNP, and echo parameters of LV reverse remodeling were evaluated (Table 1). Improvement of the functional NYHA class (Figure 1) and reduction in the incidence of hospital admission or visits to emergency room (ER) were observed. Side effects were 16.2% acute renal failure, 9.3% symptomatic hypotension, 9.7% asymptomatic hypotension and 15.9% hyperkalemia. In 31 patients (11%) the drug was discontinued, one patient due to angioedema. 7.9% of patients died during follow-up, 7 of them due to HF (2.4%). Table 1 Before SV After SV P value Analytical data GFR (ml/min) 70.25±24.95 68.27±24.62 0.008 Serum K+(mEq/L) 4.53±0.50 4.71±0.456 Predictors of clinical improvement Conclusions SV has shown to improve morbidity and mortality in patients with HFrEF by improving functional class, decreasing NT-proBNP levels and reducing admissions due to HF, without significant side effects. In our study SV improved LVEF and reverse remodeling echocardiographic parameters too.

Background: Patients with liver disease associated with alpha-1 antitrypsin deficiency (AATD) are homozygous for the Z mutation, leading to chronic liver damage. Objective: To assess the serum levels of glutamate-oxaloacetate transaminase (GOT), glutamate-pyruvate transaminase (GPT), and gamma-glutamyl transpeptidase (GGT) in patients with different genotypes for the alpha-1 antitrypsin (AAT) gene. Methods: Patients (n = 1494) underwent genotyping of the SERPINA1 gene, together with a determination of AAT and GOT and GPT and GGT transaminase levels. Patients with a deficient allele (n = 476) and with a normal genotype were compared. Results: A statistically significant association was found between deficient genotypes and GOT (p &lt, 0.0003), GPT (p &lt, 0.002), and GGT (p &lt, 0.006). Comparing GOT levels in patients with PI*Z deficient variant versus those with normal genotype, an odds ratio (OR) of 2.72 (CI: 1.5&ndash, 4.87) (p &lt, 0.0005) was obtained. This finding was replicated with the PI*Z allele and the GPT values (OR = 2.31, CI: 1.45&ndash, 3.67, p &lt, 0.0003). In addition, a statistically significant association was found between liver enzymes and AAT values. Conclusion: The PI*Z allele seemed to be a risk factor for the development of liver damage. AAT deficient genotypes were associated with GOT, GPT, and GGT altered values. Low AAT levels were associated with high GPT and GGT levels.

Background The HeartLogic algorithm combines multiple implantable cardioverter-defibrillator (ICD)-based sensors into an index for prediction of impending heart failure (HF) decompensation. In patients with ICD and cardiac resynchronization therapy ICD remotely monitored at 13 Spanish centers, we analyzed the association between clinical events and HeartLogic alerts and we described the use of the algorithm for the remote management of HF. Methods The association between clinical events and HeartLogic alerts was studied in the blinded phase (from ICD implantation to alert activation – no clinical actions taken in response to alerts) and in the following active phase (after alert activation – clinicians automatically notified in case of alert). Results We enrolled a total of 215 patients (67±13 years old, 77% male, 53% with ischemic cardiomyopathy) with ICD (19%) or CRT-D (81%). The median duration of the blinded phase was 8 [3–12] months. In this phase, the HeartLogic index crossed the threshold value (set by default to 16) 34 times in 20 patients. HeartLogic alerts were associated with 6 HF hospitalizations and 5 unplanned in-office visits for HF. Five additional HeartLogic threshold crossings were not associated with overt HF events, but occurred at the time of changes in drug therapy or of other clinical events. The rate of unexplained alerts was 0.25 alert-patient/year. The median time spent in alert was longer in the case of HF hospitalizations than of in-office visits (75 [min-max: 30–155] days versus 39 [min-max: 5–105] days). The maximum HeartLogic index value was 38±15 in the case of hospitalizations and 24±7 in that of minor HF events. The median duration of the following active phase was 5 [2–10] months. After HeartLogic activation, 40 alerts were reported in 26 patients. Twenty-seven (68%) alerts were associated with multiple HF- or non-HF related conditions or changes in prescribed HF therapy. Multiple actions were triggered by these alerts: HF hospitalization (4), unscheduled in-office visits (8), diuretics increase (8), change in other cardiovascular drugs (5), device reprogramming (2), atrial fibrillation ablation (1), patient education on therapy adherence (2). The rate of unexplained alerts not followed by any clinical action was 0.13 alert-patient/year. These alerts were managed remotely (device data review and phone contact), except for one alert that generated an unscheduled in-office visit. Conclusions HeartLogic index was frequently associated with HF-related clinical events. The activation of the associated alert allowed to remotely detect relevant clinical conditions and to implement clinical actions. The rate of unexplained alerts was low, and the work required in order to exclude any impending decompensation did not constitute a significant burden for the centers. Funding Acknowledgement Type of funding source: None

Purpose To identify predictors of palliation for head and neck cancer treated with the "Hypo Trial" hypofractionated radiation therapy regimen in a clinical setting. Design/method We retrospectively assessed 106 consecutive patients with incurable cancer, treated between January 2008 and December 2018. Regimen used was 30-36Gy in 5-6 biweekly fractions of 6Gy. Results The prescription dose was 30Gy in 57 (53.8%) patients and 36Gy in 49 (46.2%) patients. 89.6% patients completed the prescribed treatment. With a median follow-up of 6.92 months, 79.2% of the patients experienced clinical palliation. Palliation was correlated with the radiation therapy dose (P = 0.05). Median overall and progression-free survival (OS, PFS) were 7 and 4.63 months, respectively. Achieving palliation was associated to OS (P = 0.01). Conclusions This short palliative hypofractionated scheme resulted in a high rate of palliation, with excellent compliance and acceptable toxicity. Our results show that radiation dose is a predictive factor for palliation.

The Americas have an elevated number of leishmaniasis cases (accounting for two-thirds of the worldwide disease burden) and circulating Leishmania species, and are therefore of interest in terms of epidemiological surveillance. Here, we present a systematic review of Leishmania parasite species circulating in the countries of the American continent, together with complementary information on epidemiology and geospatial distribution. A database was built from data published between 1980 and 2018 on Leishmania species identified in most of the American countries. A total of 1499 georeferenced points were extracted from published articles and subsequently located to 14 countries in the Americas. This database could be used as a reference when surveilling the occurrence of Leishmania species in the continent., Measurement(s)DistributionTechnology Type(s)digital curationFactor Type(s)reference • political division • type of sample • species • method of identification • geographic coordinatesSample Characteristic - OrganismLeishmaniaSample Characteristic - LocationNorth America • South America Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.11993970

Background: The presence of epicardial connections (ECs) between pulmonary veins (PVs) and other anatomic structures may hinder PV isolation. In this study, we analyzed their prevalence, location, associated factors, and clinical implications. Methods: Five hundred thirty-four consecutive patients with atrial fibrillation undergoing radiofrequency ablation were included. We considered that an EC was present if: (1) the first pass around the PV antrum did not produce PV isolation and (2) subsequent atrial activation during PV pacing showed that the earliest site was located away from the ablation line and later activation sites were observed near the ablation line. Clinical and electrophysiological variables were collected from all patients. Patients were followed during 12.9±9.4 months, and any documented atrial tachyarrhythmia after the 3-month blanking period was classified as a recurrence. Results: Out of the 534 patients included, 72 (13.5%) were found to have 81 ECs. There was a significant association between the presence of ECs and structural heart disease (15.3% in patients without ECs versus 36.5% in patient with ECs; P P =0.002). The presence of a left common trunk was significantly associated with the absence of ECs (29.6% in patients without ECs versus 16.2% in patients with ECs; P =0.014). Patients with ECs had lower acute success in PV isolation compared with patients without ECs (99.1% versus 86.1%; P P =0.04). Conclusions: ECs between PVs and other adjacent structures are frequent in patient with atrial fibrillation (prevalence: 13.5%). Structural heart disease and a patent foramen ovale are strongly associated with the presence of ECs. ECs reduce the acute and chronic success of PV isolation.

The number of people of Nigerian origin in Europe is growing. However, there are no studies that have analyzed their awareness of organ donation and transplantation.To analyze the attitude toward organ donation among Nigerian-born population living in Spain.The sample population was a selection of people born in Nigeria who are now living in Spain. A sample of this cohort older than 15 years was obtained randomly and stratified by age and sex. Attitude was assessed using a validated questionnaire on the psychosocial attitudes toward organ donation (PCID-DTO-Ríos). A random selection of people from this cohort was surveyed.A sample of 183 respondents was included in the study. Of their attitudes toward cadaveric donation, 33% were in favor of it, 34% were against it, and 33% were undecided. The variables associated with having a more favorable attitude (P .001) were: 1. Knowledge related to donation and transplantation; 2. attitude toward the body; 3. religion; and 4. social interaction. In the multivariate analysis, the main independent factor associated with the attitude toward organ donation was the knowledge of the concept of encephalic death. Respondents who are familiar with the concept of brain death are 10 times more likely to be in favor of donation than those who are not.The attitude toward organ donation among the Nigerian-born population living in Spain is not very favorable and is associated with psychosocial factors. A campaign to raise awareness among Nigerian residents in Spain has become a priority.

Awareness about organ donation among the general population is fundamental to organ donation programs. It is important to determine the factors that influence attitudes toward organ donation within the general population in order to carry out cost-effective campaigns.To analyze the attitude toward organ donation among Santiago, Cuba, citizens.The study population encompassed residents in Santiago, Cuba. A sample population of residents older than 15 years was obtained randomly and stratified by age and sex. Attitude was assessed using a validated questionnaire on psychosocial aspects toward organ donation and transplant (PCID-DTO Ríos). Available census data were used. The survey was self-administered and completed anonymously.Of the 455 respondents, 70% of respondents are in favour of cadaveric donation, 16% are against, and 14% were undecided. Several variables were associated with having a more favorable attitude. And in the multivariate analysis, the following variables continue to feature as independent variables: 1. knowledge of the concept of brain death [OR = 2.386 (4.761-1.194); P = .014]; 2. being in favor of donating a family member's organs [OR = 3.067 (5.952-1.584); P = .001]; 3. a partner's favorable attitude [OR = 5.795 (1.477-22.731); P = .012]; 4. being an atheist/agnostic as the religious beliefs [OR = 1.845 (3.289-1.038); P = .037]; 5. not being concerned about the possible mutilation of the body after donation [OR = 7.437 (2.918-18.955); P .001]; 6. not accepting other treatment options after death, such as inhumation [OR = 3.048 (5.714-1.626); P = .001].The attitude toward cadaveric organ donation among the Santiago, Cuba population is favorable and it is associated with several psychosocial factors.

Introduction Head and neck cancer recurrence is a therapeutic challenge due to the anatomical and functional constraints of the head and neck area. Stereotactic body radiotherapy (SBRT) is a high-precision technique of radiotherapy that consists of delivering a high ablative biological dose in 1–5 high-dose fractions, requiring a very high precision of the radiotherapy process with potential application in this clinical setting Methods Different studies that investigate the role of SBRT in the treatment of recurrent head and neck cancer have been reviewed. Indications to properly select patients for this treatment are presented. Results Retrospective studies and phase I–II trials with selected patients have shown low to moderate toxicity, with an efficacy at least similar to that of treatment with combinations of radiotherapy and chemotherapy. In selected patients, SBRT is a treatment option for recurrent head and neck cancer with low toxicity. Discussion New prospective studies should clarify data regarding the efficacy and toxicity of SBRT in head and neck cancer recurrence.

The speech emotion recognition has a huge potential in human computer interaction applications in fields such as psychology, psychiatry and affective computing technology. The great majority of research works on speech emotion recognition have been made based on record repositories consisting of short sentences recorded under laboratory conditions. In this work, we researched the use of the Emotional Temperature strategy for continuous tracking in long-term samples of speech in which there are emotional changes during the speech. Emotional Temperature uses a few prosodic and paralinguistic features set obtained from a temporal segmentation of the speech signal. The simplicity and limitation of the set, previously validated under laboratory conditions, make it appropriate to be used under real conditions, where the spontaneous speech is continuous and the emotions are expressed in certain moments of the dialogue, given emotional turns. This strategy is robust, offers low computational cost, ability to detect emotional changes and improves the performance of a segmentation based on linguistic aspects. The German Corpus EMO-DB (Berlin Database of Emotional Speech), the English Corpus LDC (Emotional Prosody Speech and Transcripts database), the Polish Emotional Speech Database and RECOLA (Remote Collaborative and Affective Interactions) database are used to validate the system of continuous tracking from emotional speech. Two experimentation conditions are analyzed, dependence and independence on language and gender, using acted and spontaneous speech respectively. In acted conditions, the approach obtained accuracies of 67–97% while under spontaneous conditions, compared to annotation performed by human judges, accuracies of 41–50% were obtained. In comparison with previous studies in continuous emotion recognition, the approach improves the existing results with an accuracy of 9% higher on average. Therefore, this approach has a good performance with low complexity to develop real-time applications or continuous tracking emotional speech applications.

To evaluate a new organisational model, “process management” (PM), implemented in the Hospital Universitario Virgen de la Victoria (HUVV) compared with traditional models used in other Radiation Oncology Departments (RODs), in terms of efficacy and efficiency. The study period ranged from September 2011 to August 2012. Efficacy was assessed, comparing the number of patients attended in first consultation and treated per month, average waiting time from referral to first visit and average waiting time from first visit to treatment. Data were collected from two public hospitals in Andalusia: the HUVV and another Public Hospital in Andalusia (PHA1). Efficiency was assessed comparing the costs per patient attended in first visit and treated at HUVV in 2012 compared with those of a second Public Hospital in Andalusia (PHA2) for 2008. The number of sessions saved using hypofractionation versus classical schemes during the year 2012 in HUVV was estimated, and the money saved was calculated. In the efficacy analysis, we found significant differences in the average waiting time for first visit, start of treatment, and the number of patients seen and treated annually. After calculating the total cost generated in the ROD, the efficiency analysis showed a lower cost per patient attended in first visit (EUR 599.17) and per patient treated (EUR 783.50), with a saving of 6035 sessions using hypofractionated schemes. Process management in an ROD reduces time, both to first medical visit and to treatment initiation, allowing an optimisation of linear accelerator (LINAC) capacity.

In recent years, after various scandals, the role of auditors has been called into question, even casting doubt on whether their reports reliably reflect the true financial situation of the auditee, especially when this situation is not good. Normative changes in the way auditors have to rate certain questions provide a good opportunity to study this problem. These changes have acquired great relevance among the factors involved in studying audit quality. Thus, the present study analyzed the effect of the normative change that took place in Spain in December 2010, related to opinions modified for going-concern uncertainties. Until that date, the auditor’s uncertainty about the company’s going-concern status led to a qualified opinion. However, under the new regulation, it became an opinion that included an explanatory paragraph stating the reasons for concern, which was considered less serious. In all, 152 small- and medium-sized enterprises that had begun bankruptcy proceedings were studied. Expert systems were used for their analysis, based on classification trees assembled through boosting and bagging. In addition, the logistic regression was used as baseline to compare previous methods. The main result obtained was that a change in the norm that catalogs the going-concern issue as less serious made auditors more likely to report this situation, thus questioning the audit quality.

BACKGROUND AND OBJECTIVE We examined the prognostic value of obesity and nuclear β-catenin in patients with locally advanced rectal cancer. METHODS We prospectively recruited a total of 98 eligible patients with locally advanced cancer for preoperative radiochemotherapy followed by total mesorectal excision. Patients' height and weight were reaorded before radiochemotherapy, and the immunohistochemical expression of nuclear β-catenin was analyzed. Disease-free survival (DFS) was analyzed using the Kaplan-Meier method and a Cox regression model was employed for the multivariate analysis. RESULTS Obese patients were associated with a lower number of recurrences (3.6% vs. 34.3%, P = 0.001), and a higher DFS (95% vs. 53%; HR, 0.09; 95%CI, 0.01-0.64; P = 0.005) than non-obese patients. In the multivariate analysis, body mass index, nuclear β-catenin expression, and the absence of lymph node metastases showed a significant increase in DFS. CONCLUSIONS Obesity and nuclear β-catenin are independent favorable prognostic factors for DFS in locally advanced cancer treated with preoperative radiochemotherapy. J. Surg. Oncol. 2017;115:301-306. © 2017 Wiley Periodicals, Inc.

Background Blood transfusion is a valuable therapeutic tool for massive bleeding in spite of inherent risks and makes the difference between life and death. Rational use of blood components and particularly of red blood cells concentrates (RBC) request for surgery could minimize the transfusional reactions and financial burden for blood banks. Objective To know the transfusion practice and the relationship between the request and use of RBC in programmed surgeries at the General Hospital of Mexico. Materials and methods A retrospective study was conducted and data analysis based in the number of RBC units required from the blood bank were compared with the number of RBC units transfused. Medical records, surgical notes, anesthesia worksheets, nursing and laboratory reports from a 6 months period, were reviewed. Results During the studied period, 354 RBC were requested from the blood bank from different surgical specialties; with a total of 680 units. From these only 63 (9.2%) were transfused vs 617 (90.7%) that were not used and were returned to the blood bank. Conclusions RBC requests were excessive compared to the real demand; this represents inadequate blood requests and elevated costs for the blood bank and the health system. There is a need to promote strategies through the institutional Transfusion Medicine Committee.

Introduction Roseomonas is rarely involved in pathology but represents an important case of contamination when is associated to hematopoietic stem cells, having intrinsic resistance to multiple classes of antibiotics and the ability to gain new resistance factors. This is a report that follows a previous identification of contamination microorganisms in the cryopreserved Umbilical Cord Blood Units (UCBU) stored in the Cord Blood Bank (CBB) of the National Center of Blood Transfusion (NCBT) at Mexico City. Objective Phenotypic and molecular characterization of Roseomonas genomospecies 5 isolated from UCBU. Materials and methods Phenotypic enzyme diffusion tests in solid phase (proteases, amylases, hemolysins and lipases detection) and antimicrobials (for Gram negative bacteria) resistance tests were performed to determine the potential virulence and resistance of the strain isolated of the Umbilical Cord Blood Unit 2191. Additional PCR assays were performed to determine the presence of genetic elements associated to antimicrobial resistance: bla genes and Class 1 integrons. Also, a 16S rRNA gene sequence analysis was done on microbial strains isolated from UCBU. Results Broad-spectrum penicillins, third generation cephalosporins, and fluoroquinolones did not show inhibitory activity in the 2191 strain. We could only identify extracellular amylase activity. Gene detection by PCR of encoding antimicrobial resistance (β-lactamases) and Class 1 integrons revealed the presence of bla–HSV and bla–TEM variants in the 2191 strain. Phylogenetic analysis revealed the presence of Roseomonas genomospecies 5 in the 2191 UCBU (named 2191 strain). Conclusions This is the first report on the isolation of Roseomonas genomospecies 5 in a UCBU for transplantation, an unusual bacteria isolated from umbilical cord blood, associated with a possible immunosuppression in the donor. Its presence in UCBU can be fatal in immunocompromised patients if it were used for transplantation of Hematopoietic Stem Cells (HSC), due to the potential virulence of the strains and the resistance to antimicrobials commonly used.

The Bolivian population is growing in Spain. Xenotransplantation of organs and/or tissues carries many social and cultural implications. It is important to find out the level of acceptance of xenotransplantation in immigrant populations, especially in populations where there are preclinical trials. The objective of the study is to analyze the attitude toward xenotransplantation of organs and tissues in the Bolivian population residing in Spain and the variables that influence their attitude.We selected a sample of the Bolivian population living in Spain. A sample of the population older than 15 years was obtained randomly and stratified by age and sex. Attitude was assessed using a validated questionnaire on psychosocial aspects toward xenotransplantation (PCID-XENOTX-Ríos).Of the 206 respondents, 26% of respondents are in favor of xenotransplantation of organs if it was assumed that xenotransplanted organs functioned as well as human ones. If the results were worse, only 6% would be in favor. The following factors were associated with this attitude: (1) level of education (P = .008), (2) a favorable attitude toward human donation (P = .004), (3) a partner's favorable attitude toward transplantation (P .001), and (4) a belief that one might need a transplant in the future (P = .01). The following were associated with attitude in the multivariate analysis: (1) having secondary education (odds ratio, 3.690; P = .004) and (2) a partner's favorable attitude toward transplantation (odds ratio, 6.024; P = .003).The attitude of Bolivian residents in Spain toward xenotransplantation is negative and is determined by educational and family factors.

Introduction The Bolivian population is growing in Spain. The knowledge and acceptance of the concept of brain death are fundamental. Objective To analyze the level of understanding of the brain death concept among the population of Bolivians residing in Spain. Methods The study population was Bolivians living in Spain. The inclusion criteria were being older than 15 years, being born in Bolivia, and residing in Spain; participants were selected randomly from this group and stratified by age and sex. Knowledge of the concept of brain death was assessed using a validated questionnaire on psychosocial aspects toward organ donation. A group of people to be surveyed was randomly selected. Assistance from immigration support associations in Spain was needed to advise on the location of potential respondents. The survey was self-administered and completed anonymously. Results Of the 206 respondents, 27% understood brain death (BD) and believed that this was the death of an individual. Of the rest, 18% did not understand it and the remaining 55% believed it did not mean the death of a patient. Those who understood the concept of BD were more in favor of deceased donation than those who did not (52% vs 47%; P = .886). None of the sociopersonal variables analyzed is associated with knowledge of the concept of BD. A high percentage of respondents indicated fear of apparent death during organ donation. Conclusions The majority of the Bolivian population residing in Spain does not understand the concept of BD. Contrary to most psychosocial studies, it is not associated with attitudes toward organ donation or other sociopersonal factors.

Introduction The number of Population of Guinea residents in Spain has increased significantly; however, there are no studies that analyze their awareness of transplantation and especially living kidney donation. Objective To analyze the attitude toward living kidney donation among the Spanish resident population born in Guinea. Methods People born in Guinea and residents in Spain were included in this study. A sample of population older than 15 years was obtained randomly and stratified by age and sex. Attitude was assessed using a validated questionnaire on psychosocial aspects with respect to living kidney donation (PCID-DVR-Rios). Results Of the 170 respondents, 68% of respondents are in favor of related living kidney donation. The remaining 32% were against it or undecided. The results of the multivariable analysis indicated that respondents who were in favor of cadaveric organ donation and transplantation had a probability of being in favor of living kidney donation 10 times greater than those who were not in favor, and that respondents who had collaborated in prosocial activities had a probability of being in favor of living kidney donation that was 10,638 times greater than those who have not collaborated and will not collaborate in the future. Conclusions The attitude toward related living kidney donation among the population born in Guinea and residing in Spain is not very favorable compared with studies of attitude in the European and Spanish population, and it is associated with psychosocial factors.

The modeling and representation in state space of conventional single-phase distributed generation system (in particular PV systems) allow, in the time domain, their analysis under operating conditions in steady state and transient state. The research reported in this article is oriented in particular to the determination of the periodic steady state under conditions of harmonic distortion of single-phase distributed generation systems. The analysis is carried out in the time domain, considering the particular modeling of the components of the PV system, their associated controls and their representation in the frame of reference of the state space. Results are validated against the simulator PSCAD/EMTDC®, widely accepted by the power industry.

Background Atrial myocardial infarction may be a risk for atrial fibrillation. However, the electrophysiological and structural characteristics of the infarcted atrial myocardium are not well known. This study aimed to analyse the changes in local atrial electrograms and myocardial structure in an experimental model of isolated atrial myocardial infarction. Methods Five anesthetized, open-chest pigs were submitted to 4 hours of acute atrial myocardial ischemia induced by direct surgical clamping of atrial coronary branches originating from the right coronary artery. In all cases, we recorded simultaneously the 12-lead surface electrocardiogram (ECG) and the epicardial mapping of local atrial electrograms (17 x 12.5 mm patches containing 128 electrodes, with 1 mm inter-electrode distance) in a region close to the occluded branches and in control non-treated atria. The changes in local atrial QRS-ST segment and the amplitude of the P-wave of the ECG were sequentially analysed (Figure). The hearts were removed and processed for anatomopathological examination. Results Selective atrial coronary branch occlusion induced a patchy atrial myocardial necrosis with an irregular and abrupt border zone (circled areas in the Figure). During the first 15 min of ischemia, the local atrial electrograms showed increasing R waves, widening of QRS complex, and ST segment elevation leading to monophasic potentials (maximal ST segment at 30 min: from 0.2±0.7 mV to 1.9±1.4 mV, ANOVA p Structural and electrical atrial changes Conclusion Selective occlusion of atrial coronary branches induced patchy atrial myocardial necrosis with abrupt anatomical and electrical border zone. The overt QRS and ST segment changes in local atrial electrograms resembled those described in acute ventricular myocardial ischemia, and were associated with widening of the P-wave on the surface ECG. Although acute ischemic arrhythmias were not observed, the atrial structural alterations might set the substrate for re-entrant arrhythmias late after the healing over process. Acknowledgement/Funding Supported by grants from ISCI-MINECO (FISPI17/00069), CIBERCV (CB16/11/00276), FEDER and Fundaciό “La Maratό” TV3 (20150830).

Introduction Permanent and irreversible damage to the conduction tissue is one of the most common complications of TAVI. Detailed knowledge of the anatomy of the atrioventricular (AV) bundle is crucial to minimize the potential for injury to the His bundle branch block or complete AV block. Purpose Preexisting anatomic location and damage of the right bundle branch (RBB) may have important unrecognized clinical implications. Methods The myocardial arrangement and the presence of fibrous and fatty tissue infiltration of the AV conduction axis and right bundle branch were examined by dissection techniques and histological sections in 57 structurally normal human heart specimens (48 males, 77±7 years). Results The AV conduction axis enters the AV component of the membranous septum and is encircled by the fibrous tissue of the central fibrous body. The AV bundle is divided in a non-branching portion and a branching portion. After a short distance of the non-branching component along the septal crest, the RBB arises at the end of the branching portion of the conduction axis and is located superficially in the muscular ventricular septum. The RBB takes off from the bundle at the level of origin of the superior fascicle of the left bundle, passing then through the thickness of the ventricular septum to emerge beneath the medial papillary muscle of the tricuspid valve. In 22 hearts (49%) in which we found to have a relatively left-sided deviation of the AV bundle in relation to the interventricular membranous septum the RBB runs intramyocardial along the muscular interventricular septum. In the remaining 51% of the hearts the RBB runs subendocardially in the crest of the interventricular muscular septum. We found connective tissue and fatty infiltration along the right bundle branch in 23 hearts (40%) from its origin to its distal part. A significant correlation was found between age and the presence of RBB fibrosis (85% of hearts from individuals with age >80 years). These 2 conditions may make the RBB very vulnerable to self-expanding aortic valves during or after TAVI (figure). RBB and its critical region Conclusions The presence of an intramyocardial location of the RBB with a lef-sided deviation and the fibro-fatty infiltration found in the mayority of senescent hearts are relevant anatomic determinants that may increase the risk of complete AV block following a TAVI procedure.

Background Transplanted renal artery stenosis (TRAS) is the main vascular complication of patients undergoing kidney transplantat, with a reported incidence ranging from 1% to 23%. Clinically important TRAS is associated with refractory hypertension, graft dysfunction and increased peak systolic velocity (PSV) above 200 cm/s. Percutaneous intervention (PI) of TRAS with or without stent is widely accepted as a viable and safe treatment option. Purpose To evaluate blood pressure and renal function in patients with TRAS undergoing PI in the following year. Methods Between January 2007 and December 2014, 310 patients with suspected TRAS underwent consecutive angiography. Of these, 173 presented significant stenosis (>60%) and were submitted to PI. Endpoints were systolic blood pressure (SBP), diastolic blood pressure (DBP), serum creatinine (Scr), number of blood pressure medications and PSV with one month and one year post intervention. Results The mean age was 42.89±15.03 years, 78% of the population were male, 84% received kidneys from decesed donors, 94% having received a stent. The angiographic success and complication rates were 98% and 8,4% respectively. 98.7% were on blood pressure medications with 2.13±1.05 drugs/patient. Pre-intervention values of SBP, DBP and Scr were 152.8±25.28 mmHg, 92.67±16.43 mmHg and 3.04±2.75 mg/dL, respectively. After 1 month, there was a significant reduction in SBP (138.34±19.71; p Evolution of Blood Pressure Conclusion PI with stent of TRAS was effective in improving blood pressure and renal function levels on month 1 and on year 1 with a low rate of complications.

Introduction In liver transplantation, living donation shows better and better results. However, rates of living liver donation (LLD) are low. Objective To analyze the attitude towards LLD among patients on the waiting list for liver transplantation. Method Study population: Patients included in the waiting list for liver transplantation who are not in code 0 and do not present with encephalopathy above grade I. Protocol: After being included in the waiting list, they are informed of the study and they are cited in the Psychology Consultation. Instruments: attitude questionnaire towards LLD, carried out in the Psychological Care consultation. Results Of the 147 patients included in the waiting list, 112 fulfilled the inclusion criteria in the study. After being cited in the consultation, 100% of respondents are in favor of living liver donation. However, when considering the related LLD, 80% of the respondents indicated that they would not accept a living donation from a family member and therefore did not want to complete the questionnaire. Of the remaining 20% who completed the study, 11% would accept it from any family member, 8% only from some family members (mainly excluding children and grandchildren), and the remaining 1% would accept it but excluded all their family members. Conclusion Currently, there is a disconnect between patients' intentions in favor of living liver donation and the real attitude when they are on the waiting list and related living donation is raised.

Background The Ecuadorian population forms the largest Latin American immigrant group in Spain. However, their knowledge about the brain death (BD) concept and the relationship with the attitude toward organ donation has been little analyzed. The objective of the study is to analyze the knowledge of the BD concept among the Ecuadorian population resident in Spain. Methods The population under study was the population born in Ecuador and resident in Spain. Inclusion criterion was age older than 15 years stratified by age and sex. The assessment instrument was PCID-DTO-Rios, a validated questionnaire of attitude toward donation and organ transplantation. Field work involved random selection of respondents based on stratification. The support of immigration support associations was required to obtain sample locations. The completion was anonymous and self-administered. Results Of the 461 respondents, 22% (n =102) know the BD concept and accept it as the death of the person; 61% (n = 283) do not know it; and for 17% (n = 76) it does not mean the death of the person. The variables related to the correct knowledge of BD are age (P = .007) and marital status (P = .028), with age persisting in the multivariate study (odds ratio, 1.036; P = .008). There is no objective relationship with the attitude toward organ donation. Thus, 60% of those who know the concept are in favor of donating (n = 61), and 59% of those who do not know it are in favor (n = 210; P = .813). Conclusions The BD concept is little known among Ecuadorians residing in Spain, and it is not associated with the attitude toward donation.

The design of this Massive Open Online Courses (MOOC) has been grounded on the competency-based learning model of the National Institute for the evaluation of Education Evaluation (INEE) in Spain. This study is focused on exploring teachers’ perspectives on difficulties in building and developing a health-related MOOC. The role of teachers in the assessment procedures of this course besides is considered. Methodology: We performed qualitative research and an eidetic phenomenological analysis through semi-structured in-depth interviews. The thematic categories have been defining upon assessment tools used in the MOOC, through the experiences and difficulties during the planning and design of this course. The xMOOC topics show the different pathological postural patterns and possible postural and technological adjustments that enable physical motor control. You will learn to design and build with the help of Low-Cost Philosophy. The last module will facilitate the game-based learning where individual adjustments will be made for people with functional diversity. Results: Development of MOOC has demonstrated to be a procedure of enriching collaborative learning, through which it has been possible to transmit knowledge of the different professionals. The first difficulty that we have found was the develop schedule and course planning, because it is very difficult to achieve the dates when you rely on a large group of teachers. Collaborative work is very enriching, during the design of the course you become a facilitator of the content and you are filled with satisfaction when you achieve the expected outcome after many long months of work. However, such development has brought a number of challenges that the teachers have faced in the design of the audiovisual content. The creation of the MOOC was a big challenge because it is a new format in which the theoretical main content of a course has been summarized into small didactic and short videos. Respondents mentioned as an impediment to reduce video time. Because It is essential that the content of the video keeps the interest and motivation of the participants. At the same time, loss of information should be avoided in this process and the import idea should be organized in order to not repeat the content in various modules. One of the main challenges in the MOOC is to reduce the number of dropout rate by providing content that is attractive and stimulating to the student. During the qualitative research, teachers concluded that the assessment was dynamic, active and participatory. A mixed assessment will be used, through engagement with and participation in online discussion forums and to evaluate cumulative achievement at the end of each module. A preliminary assessment will be made before starting the course content. An assessment could be enhanced through learner analytics (LA), analysis of quantitative audience usage data generated by video-sharing platforms. Students that make all cumulative assessments at the end of the modules will receive the certificate of completion of the course. Conclusion: Teachers agreed on the importance of generating discussion and exchange of knowledge among participants to enable and encourage creativity. The most common difficulty was to summarize the content of the video to achieve the motivation of the participant in MOOC.

Specific relationships among reactive oxygen species, activation pathways, and inflammatory mechanisms involved in kidney injury were assessed in a combined model of obesity and hyperoxaluria. Male Wistar rats were divided into four groups: Control, HFD (high fat diet), OX (0.75% ethylene glycol), and HFD + OX (combined model) Changes in basal O2− levels were evaluated by chemiluminescence in renal interlobar arteries and renal cortex. Furthermore, the effect of different inhibitors on NADPH-stimulated O2− generation was assessed in renal cortex. Oxidative stress sources, and local inflammatory mediators, were also determined, in parallel, by RT-PCR, and correlated with measures of renal function, urinary biochemistry, and renal structure. Rats from the HFD group developed overweight without lipid profile alteration. Tubular deposits of crystals were seen in OX and severely enhanced in HFD + OX groups along with a significantly higher impairment of renal function. Basal oxidative stress was increased in renal cortex of OX rats and in renal arteries of HFD rats, while animals from the combined HFD + OX group exhibited the highest levels of oxidative stress in renal cortex, derived from xanthine oxidase and COX-2. NADPH oxidase-dependent O2− generation was elevated in renal cortex of the OX group and markedly enhanced in the HFD + OX rats, and associated to an up-regulation of Nox1 and a down-regulation of Nox4 expression. High levels of oxidative stress in the kidney, of OX and HFD + OX groups were also associated to an inflammatory response mediated by an elevation of TNFα, COX-2, NFκB1 MCP-1, and OPN. Oxidative stress is a key pathogenic factor in renal disease associated to hyperoxaluria and a common link underlying the exacerbated inflammatory response and kidney injury found under conditions of both obesity and hyperoxaluria. Nox1 pathway must be considered as a potential therapeutic target.

Aims To analyze the clinical relevance of O6-methylguanine-DNA methyltransferase in rectal adenocarcinoma treated with chemoradiotherapy followed by surgery. Methods Tissue samples from 29 rectal adenocarcinoma patients were obtained after chemoradiotherapy. O6-methylguanine-DNA methyltransferase promoter methylation status was established by methylation-specific polymerase chain reaction. O6-methylguanine-DNA methyltransferase protein levels were determined by immunohistochemistry. Clinicopathologic variables, including treatment regression grade, recurrence, lymph node invasion, and stage and differentiation grade of the tumor, were determined. Results The O6-methylguanine-DNA methyltransferase gene promoter was methylated in 81.5% of samples. Most patients (88.9%) showed low O6-methylguanine-DNA methyltransferase protein expression. O6-methylguanine-DNA methyltransferase methylation status was not correlated with any of the clinicopathological variables determined in rectal adenocarcinomas selected for chemoradiotherapy. Conclusion O6-methylguanine-DNA methyltransferase methylation status is not correlated with clinicopathologic variables examined in rectal adenocarcinoma selected for chemoradiotherapy, although its role as a biomarker awaits further investigation.