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Currently, international trade evolves showing different trends, such as the expansion of global value chains that have been reinforced to be more efficient achieving integrated into the world economy with lower costs; thanks to technological advances and improved organizational processes increasing product competitiveness in world markets. The objective of this study is to identify the main elements of five key factors in the logistics chain foreign trade port of Lazaro Cardenas and calculate the predicted value for each factor identifying areas of opportunity and propose improvements and adjustments. The methodological tool used are artificial neural networks (ANN) through the Multilayer Perceptron processing. The results show that the five variables are highly significant stressing that the office had the lowest weighting thus showing the need for improvement of customs processes in the port, to make it more efficient., Actualmente, el comercio internacional evoluciona, mostrando una mayor expansión de las cadenas de valor mundiales, que se han reforzado logrando ser más eficientes integrándose a la economía mundial con costos más bajos; gracias a los avances tecnológicos y la mejora de los procesos organizacionales, se ha aumentado la competitividad de los productos en los mercados mundiales. El objetivo de este trabajo es identificar los principales elementos de cinco factores clave de la cadena logística del comercio exterior del puerto de Lázaro Cárdenas y calcular el valor pronosticado para cada factor, identificando las áreas de oportunidad y proponer mejoras y adecuaciones. Para lo cual se utiliza la metodología de redes neuronales artificiales (RNA) a través del procesamiento perceptrón multicapa. Los resultados muestran la existencia de cinco variables, las cuales son altamente significativas, destacando de entre ellas la aduana que, obtuvo la ponderación más baja, lo que indica la necesidad de mejora de los procesos aduanales en el puerto, para hacerlo más eficiente.

Certain host genetic variants, especially in the human leucocyte antigen (HLA) region, are associated with different progression of HIV-1-induced diseases and AIDS. Long term non progressors (LTNP) represent only the 2% of infected patients but are especially relevant because of their efficient HIV control. In this work we present a global analysis of genetic data in the large national multicenter cohort of Spanish LTNP, which is compared with sero-negative individuals and HIV-positive patients. We have analyzed whether several single-nucleotide polymorphisms (SNPs) including in key genes and certain HLA-A and B alleles could be associated with a specific HIV phenotype. A total of 846 individuals, 398 HIV-1positive patients (213 typical progressors, 55 AIDS patients, and 130 LTNPs) and 448 HIV-negative controls, were genotyped for 15 polymorphisms and HLA-A and B alleles. Significant differences in the allele frequencies among the studied populations identified 16 LTNP-associated genetic factors, 5 of which were defined for the first time as related to LTNP phenotype: the protective effect of HLA-B39, and the detrimental impact of HLA-B18, -A24, -B08 and –A29. The remaining eleven polymorphisms confirmed previous publications, including the protective alleles HLA-B57, rs2395029 (HCP5), HLA bw4 homozygosity, HLA-B52, HLA-B27, CCR2 V64I, rs9264942 (HLA-C) and HLA-A03; and the risk allele HLA bw6 homozygosity. Notably, individual Spanish HIV-negative individuals had an average of 0.12 protective HLA alleles and SNPs, compared with an average of 1.43 protective alleles per LTNP patient, strongly suggesting positive selection of LTNP. Finally, stratification of LTNP according to viral load showed a proportional relationship between the frequency of protective alleles with control of viral load. Interestingly, no differences in the frequency of protection/risk polymorphisms were found between elite controllers and LTNPs maintaining viral loads <2.000 copies/mL throughout

[Background] We report a novel surgical technique based on an endonasal free mucosal graft (mucoplasty) for improving clinical results and local healing in chronic rhinosinusitis with nasal polyps (CRSwNP)., [Methods] Patients diagnosed with bilateral CRSwNP scheduled for endoscopic sinus surgery were included. They underwent complete removal of anterior and posterior ethmoid cells, in addition to bilateral type III frontal sinusotomy. An endoscopic mucoplasty was performed in the left nasal cavity, whereas the right nasal cavity served as control. Patients were evaluated before surgery and 6 months after operation, including Sino-Nasal Outcome Test (SNOT-22), Visual Analogue Scale (VAS) for olfaction, endoscopic evaluation using the Modified und-Kennedy (MLK) scoring system and healing evaluation., [Results] Ten patients (mean age 53.6 years) were included. A significa t decrease of SNOT-22 score from 57.0 (21.1) to 20.3 (20.6) (P = 0.024) and a non-significa t decrease of VAS for olfaction score from 9.3 (0.5) to 4.6 (3.9) were found. Preoperative mean MLK score was 4.9 (0.7) in the right nostril and 4.8 (1.0) in the left one. After operation, there was a greater decrease of MLK score in the left nostril than in the right (1.9 [1.0] vs. 1.3 [0.8], P = 0.034). Better healing was proved in the nostril with the mucoplasty., [Conclusion] Endonasal mucoplasty could be an effective, safe and feasible complementary surgical procedure in the treatment of CRSwNP. The reduced local edema associated with lower amount of secretions may confer a better control in the frontal recess, orbital wall and nasal roof.

Exosome-derived miR-21 was independently associated with CD4 T cell decline in HIV-1-infected elite controllers (OR 0.369, 95% CI 0.137–0.994, p = 0.049). Also, a negative correlation between miR-21 expression and MCP-1 level was found (r = −0.649, p = 0.020), while no correlation between soluble biomarkers or cellular immune activation was found.

[EN]: [Introduction]: Our aims were to investigate the adherence to national guidelines of initial antiretroviral therapy (ART) in the Spanish multicenter CoRIS cohort during the years 2010–2015, to identify the reasons for the prescription of nonrecommended treatments, and to explore the role of institutional constraints to guideline compliance. [Methods]: ART regimens were classified as recommended, alternative or nonrecommended according to the guidelines. Physicians were asked the reasons for prescribing nonrecommended regimens. Factors associated with the prescription of non recommended regimens were assessed using multivariable logistic regression. [Results]: During the study period, 586 (10.7%) of 5479 patients who started ART were given a regimen not recommended in the guidelines. The most frequent reasons for prescribing nonrecommended regimens were: enrolment in clinical trials (43.3%), comorbidities and/or interactions (10.2%), pregnancy (8.7%), and cost (7.7%). Among 37 participating centers, 16 (43%), treating 3561 patients, reported limitations related with the cost of ART, and 20 (54%), treating 1365 patients, reported restrictions for prescribing at least one recommended antiretroviral. In multivariable analysis, a higher risk of receiving nonrecommended regimens was associated with male gender, HIV acquisition by heterosexual transmission, low viral loads, initiation of treatment during the years 2011 to 2015, and initiation of treatment in a center with restricted access to at least one antiretroviral drug. [Conclusions]: Compliance to clinical guidelines was high. A high proportion of centres reported cost limitations for ART or restricted access to at least one recommended antiretroviral drug, with a significant impact on the choice of initial regimens., [ES]: [Introducción]: Nuestros objetivos fueron investigar la adecuación del tratamiento antirretroviral (TAR) inicial a las guías nacionales en la cohorte multicéntrica española CoRIS durante los años 2010-2015, identificar las razones para la prescripción de pautas no recomendadas y estudiar la influencia de limitaciones institucionales en el cumplimiento de las guías. [Métodos]: Se clasificaron las pautas de TAR en recomendadas, alternativas o no recomendadas según las guías de GeSIDA/Plan Nacional sobre el sida. Se preguntaron las razones para haber prescrito pautas no recomendadas a los médicos prescriptores. Se evaluaron los factores asociados a la prescripción de pautas no recomendadas mediante regresión logística multivariable. [Resultados]: Durante el periodo de estudio 586 (10,7%) de 5.479 pacientes que iniciaron TAR recibieron una pauta no recomendada. Las razones más frecuentes para prescribir pautas no recomendadas fueron: participación en ensayo clínico (43,3%), comorbilidades y/o interacciones (10,2%), embarazo (8,7%) y coste (7,7%). Entre los 37 centros participantes 16 (43%), que incluían 3.561 pacientes, referían limitaciones en el coste del TAR y 20 (54%), que incluían 1.365 pacientes, referían restricciones para la prescripción de al menos un fármaco recomendado. En el análisis multivariable el riesgo de recibir una pauta no recomendada se asoció a ser varón, adquisición del VIH por vía heterosexual, carga viral baja, inicio del tratamiento durante los años 2011 a 2015 e inicio del tratamiento en un centro con acceso restringido al menos a un antirretroviral. [Conclusiones]: El cumplimiento de las guías de TAR fue elevado. Una alta proporción de centros refirieron limitaciones de coste para el TAR o acceso restringido al menos a uno de los fármacos antirretrovirales recomendados; esto último influyó en la elección de pautas no recomendadas.

Actualmente, el comercio internacional evoluciona, mostrando una mayor expansión de las cadenas de valor mundiales, que se han reforzado logrando ser más eficientes integrándose a la economía mundial con costos más bajos; gracias a los avances tecnológicos y la mejora de los procesos organizacionales, se ha aumentado la competitividad de los productos en los mercados mundiales. El objetivo de este trabajo es identificar los principales elementos de cinco factores clave de la cadena logística del comercio exterior del puerto de Lázaro Cárdenas y calcular el valor pronosticado para cada factor, identificando las áreas de oportunidad y proponer mejoras y adecuaciones. Para lo cual se utiliza la metodología de redes neuronales artificiales (RNA) a través del procesamiento perceptrón multicapa. Los resultados muestran la existencia de cinco variables, las cuales son altamente significativas, destacando de entre ellas la aduana que, obtuvo la ponderación más baja, lo que indica la necesidad de mejora de los procesos aduanales en el puerto, para hacerlo más eficiente.

El Instituto de Biomecánica (IBV) ha realizado un estudio que cuantifica la precisión y validez de la tecnología de escaneado del pie en 3D con Smartphone, desarrollada por el IBV, en comparación con metodologías tradicionales, como mediciones manuales, y otras soluciones comerciales actuales referentes en el mercado. Los resultados confirman que la tecnología del IBV es tan precisa como la solución de referencia, y mucho más fiable que las mediciones manuales realizadas por un experto, ofreciendo grandes oportunidades de aplicación en sectores económicos donde la posibilidad de escanear en cualquier lugar y a bajo coste son importantes para su implantación y escalabilidad.