Search

Background: PD1 and its ligand PD-L1 are related to prognosis in many solid tumors; however, their role in oral squamous cell carcinoma (OSCC) remains unclear. Methods: A retrospective monocentric study including all patients with OSCC diagnosed and treated between January 2020 and May 2022 was performed. PD-L1 expression was assessed per a combined positive score (CPS), considering a CPS of > or equal to 1 as positive (1–20 indicating “low expression” and ≥20 indicating “high”). A descriptive analysis of the patient cohort and tumors was performed, including tumor size, stage, lymph node involvement, recurrence, and survival. Results: In total, 65 patients (65 tumors) were analyzed. A total of 66.15% of the tumors were in advanced stages (III-IV), of which 97.67% expressed PD-L1+, compared with 71.42% in the early stages (I–II). T4 tumors expressed PD-L1 in 100% of cases, compared with 54% in T1 tumors. A total of 50.79% of the tumors showed lymph node involvement (pN+), with 100% of the pN+ showing PD-L1+. The prevalence of pN+ was 59.38% vs. 40.63% for high vs. low PD-L1 expression, respectively. Patients’ follow-ups ranged from 2 to 34.5 months. No significant difference was seen between overall survival (OS) and PD-L1 +/− (CPS ≥ 1 vs. CPS < 1) or high (CPS ≥ 20) and low (CPS < 20) PD-L1 expression (p < 0.97 and 0.64, respectively). Conclusions: The method used to measure PD-L1 (a laboratory test with Dako 22C3 anti-PD-L1 primary antibodies) was reliable and accurate, with a correlation coefficient between PD-L1 expression in the biopsy and the surgical piece of 0.83 (p < 0.0001). A CPS of ≥1 was observed in large tumors (p < 0.001) and was correlated with that of lymph node metastases (p < 0.004). Further analysis of PD-L1 expression in OSCC and studies to determine its relevance in tumor biology and prognosis is needed.

Ficha técnica: Mario-Paul Martínez y Fran Mateu Editores Tirant Humanidades, Valencia, 2023 324 pp. ISBN: 978-84-1183-091-1

Objective To assess organ damage, with emphasis on the cardiovascular system, over the different stages of the disease in a large SLE cohort.Methods Multicentre, longitudinal study of a cohort of 4219 patients with SLE enrolled in the Spanish Society of Rheumatology Lupus Registry. Organ damage was ascertained using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). We longitudinally analysed SDI (globally and for each domain) over time only in the 1274 patients whose dates of damage events had been recorded.Results During the first year after diagnosis of SLE, 20% of the 1274 patients presented with new damage manifestations. At years 2 and 3, new damage was recorded in 11% and 9% of patients. The annual percentage of patients with new damage after year 5 decreased to 5%. In the first year with the disease, most damage was accumulated in the musculoskeletal, neuropsychiatric and renal systems; in later stages, most damage was in the musculoskeletal, ocular and cardiovascular systems. Considering ‘cerebrovascular accident’ and ‘claudication for 6 months’ as cardiovascular items, the cardiovascular system was the second most affected system during the early stages of SLE, with 19% of the patients who presented with damage affected at first year after diagnosis. During the late stages, 20–25% of the patients presenting with new damage did so in this modified cardiovascular domain of the SDI.Conclusions New damage occurs mainly during the first year following diagnosis of SLE. Cardiovascular damage is relevant in both the early and the late stages of the disease. Strategies to prevent cardiovascular damage should be implemented early after diagnosis of SLE.

Summary:. Virtual surgical planning (VSP) and three-dimensional (3D) printing can increase precision and reduce surgical time in craniofacial reconstruction. However, the elevated cost and manufacturing time of outsourced workflows is increasing the development of in-house solutions. One of the main challenges in in-house workflows is to create cutting guides that hold plate position information. This is due to the fact that hospitals usually lack the infrastructure required to design and 3D print custom-made plates. Including plate-positioning information in resection guides is especially relevant in complex reconstructions and when tumor extension limits plate placement before resection. Current in-house workflows revolve around the idea of 3D scanning the bent plate’s shape and to fuse it with the VSP. The goal of this article is to share our technique to transfer plate position information to resection guides. Our protocol uses a 3D model of the reconstruction as an intermediate step to transfer the plate position of a bent stock reconstruction plate to cutting guides. Two patients who required mandibular reconstruction with fibula flap are presented to illustrate the technique. This workflow requires a 3D-printed model of the desired outcome, cutting guides, and a stock plate. Results were satisfactory in terms of cutting location and angulation, plate adaptation and condylar position. This technique allows for a simple, safe, cheap, and quick alternative to add reconstruction plate information to cutting guides.

The experience of the Partido Social Democrata (PSD) during the post-revolutionary period (1976-1982) led to an ideological shift from the original social democratic credo to its current center-right position. In this tortuous path that brought the PSD to power at the beginning of 1980, the “impugnation” of the Carnation Revolution and its legacies, as well as the goal of reforming Portugal’s new democratic system, are key issues that have not been sufficiently explored. This article analyzes these aspects in the context of the so-called “Iberian Ebb” when certain Portuguese social and political sectors were influenced by the experience of the Spanish Transition in order to achieve a major convergence with the EEC model.

Las administraciones públicas reciben anualmente un alumnado en prácticas que viene derivado de una formación dual: formativa en el centro educativo y práctica en la administración. Su demanda ha crecido propiciada por las exigencias de las empresas de personal formado, motivando que no sólo estas, sino también las administraciones públicas se involucren en la creación de planes formativos que acerquen al alumnado a la realidad laboral, chocando frontalmente con aspectos que deben considerarse en el diseño de la acción formativa que debe ser acorde con las necesidades del alumnado y los requisitos exigidos por la administración que lo acoge durante su etapa formativa. Las carencias observadas en los tutores asignados al alumnado en prácticas son un obstáculo inicial, en relación a la formación requerida, supliendo esta falta con su experiencia profesional. Seguido del propio alumnado que precisa adquirir una serie de competencias, lo que conlleva que la formación, lejos de estandarizarse, se individualice, adaptando la misma a los requerimientos y necesidades del propio alumnado. Teniendo todo esto en cuenta, el artículo analizará las acciones formativas que en este sentido se han llevado a cabo en las administraciones públicas a lo largo de los últimos 30 años.

The availability of models constitutes a key factor when selecting a decision support tool aimed at improving the production and environmental aspects of farms. There is a need for robust models that are user-friendly, facilitating the estimation of farm emissions and the analysis of their temporal fluctuations. The objectives of this study were i) to calculate both the partial (PCF) and total carbon (TCF) footprints of 212 dairy farms, distinguishing those with and without maize cultivation; ii) to identify critical variables related to feed, nutrition, productivity and environmental efficiency; and iii) to formulate and validate prediction equations based on available data from dairy farms. The database encompasses information from 212 dairy cattle farms situated in the temperate-humid zone of northern Spain, spanning the period from 2014 to 2018. Farm classification was based on the presence (CcMz) or absence (ScCMz) of maize cultivation for silage production, resulting in 96 farms in the CcMz category and 116 farms in the ScCMz category.Among the variables considered, the variable herd N-use efficiency (NUECR) for (PCF) showed the lowest root mean square error of prediction at 0.39% and the correspondingly lowest root men. The root mean squared percentage error (RMSPE): standard deviation ratio (RSR) at 0.52. In the case of total carbon footprint (TCF), herd N-use efficiency (NUECR) again showed the lowest root mean square error of prediction at 0.52%. Regarding TCF, herd feed efficiency (EACR) was the variable with the lowest both RMSPE and RSR, with 0.65 and 0.64, respectively. Consequently, the estimation of the PCF and TCF of 1 ​kg of milk from the temperate-humid zone of northern Spain at the farm gate can be feasibly accomplished utilizing NUECR and EACR, respectively.

The main contribution of this paper is the assets of the current and voltage ripples in a buck converter with an LED load. The results indicate that the ripples are different and that it is possible to reduce the passive filter concerning the model of the LED as a simple resistance. The paper presents the design and simulation of a buck converter as a power supply for an LED lamp. Modeling the LED as a resistor and a voltage source (SVRM), the equations to calculate the components of the circuit using the SVRM model are presented, where the Fourier series and phasors are used to calculate the output filter. The equations are validated with SPICE simulations. The results indicate that the SVRM model for the LED load affects the calculation of the output filter of the buck converter as well as the voltage and current ripples, making it a more precise design alternative to the proposed development.

España ha vivido en el último siglo dos grandes períodos de cambios educativos. El primero de ellos vinculado a leyes reguladoras de la educación, donde todo giraba en torno al docente, el cual desempeñaba su función a través de un aprendizaje memorístico. El segundo surge tras el acercamiento a instituciones internacionales como la Organización para la Cooperación y el Desarrollo Económicos y la Unión Europea. La firma del tratado de adhesión en 1986 trajo consigo un cambio de corte social y a nivel metodológico con un cambio del rol del docente, cada vez más considerado como una guía en los procesos de enseñanza-aprendizaje del alumnado. La alternancia política en casi medio siglo ha promovido diversas leyes educativas. La última de ellas, la LOMLOE, que ha reforzado la tendencia de un cambio donde la educación significativa cobra relevancia. A esto hay que sumar una división administrativa, que ajusta el currículo más que a su idiosincrasia al color político, lo que ha provocado una deriva educativa marcada por una brecha entre comunidades del norte y del sur, reflejada en informes como el PISA o estadística acerca del abandono escolar. Todo esto motiva este estudio relacionado con el complejo en el escenario educativo español.

A new category of fruit style beer resulting from the addition of grape matrices is named Italian Grape Ale (IGA). In this paper, we report data on an experimental work to produce IGA beers, adding macerated (CO2 or N2) red Gamay grape must or Aleatico grape pomace resulting from a grape dehydration process. Our hypothesis, that these wine processes can produce volatile organic compounds (VOCs) to characterize these IGA beers which was confirmed by chemical, sensory and aromatic results. IGA beers especially the one with gas-macerated grape musts (IGA-C and IGA-N) showed higher alcohol content than ALE beer (Control) and a higher polyphenol content and antioxidant activity. As regards VOCS, IGA beers increased the concentration of some classes (i.e., alcohols, esters, norisoprenoids) and IGA-N was better characterized by specific compounds such as isobutyric acid, phenylacetate, tyrosol, ethyl hydrogen succinate. Finally, E-nose and sensory evaluation discriminated significantly all the IGA beers.

En los últimos años, los actores intervinientes en los procesos de enseñanza-aprendizaje han visto cómo se han introducido en los mismos, unas herramientas que han complementado a las ya existentes. Estas, catalogadas como de realidad aumentada, favorecen la transmisión y adquisición del conocimiento, a la par que mejoran y potencian las competencias que el alumnado debe adquirir en la etapa formativa de educación secundaria. La implantación de estas herramientas choca frontalmente con los progenitores y el profesorado, reacios en todo momento a que estos instrumentos pueden o deben ser ejecutados y manejados desde dispositivos tales como un Smartphone. Y es que estos dispositivos son percibidos como elementos de distracción y no colaborativos, educativamente hablando. A esto hay que añadir la existencia de una brecha tecnológica, profundizada tras la última crisis socio-económica y agudizada por la pandemia que inició en 2019 y en La Palma-Canarias (España), por la erupción del volcán de Cumbre Vieja, con consecuencias en materia educativa. En este artículo se analizan las consecuencias de introducir, puntualmente en el aula, el Smartphone y software RA, con la intención de mejora en los procesos de enseñanza-aprendizaje y en los actores intervinientes en dichas acciones. La implantación de estas herramientas choca frontalmente con los progenitores y el profesorado reacios en todo momento a que estas herramientas pueden o deben ser ejecutadas y manejadas desde dispositivos tales como un Smartphone. Y es que estos dispositivos son percibidos como elementos de distracción y no colaborativos, educativamente hablando. A esto hay que añadir la existencia de una brecha tecnológica, profundizada tras la última crisis socio-económica (2005) agudizada por la pandemia (2019) y en La Palma-Canarias (España) por la erupción del volcán de Cumbre Vieja, con consecuencias en materia educativa. En este artículo, analizaremos las consecuencias de introducir, puntualmente en el aula Smartphone, y software RA y lo que esto supuso en materia de mejora de los procesos de enseñanza-aprendizaje y en los actores intervinientes en dichas acciones.

En la historia de España, los años sesenta del siglo XX son los años del desarrollismo y del crecimiento de las ciudades. Nuestro propósito con este artículo ha sido mirar al desarrollismo franquista, pero no desde la ciudad. Lo hemos hecho desde el mundo rural, desde el fenómeno de la emigración y desde la historia de las mujeres, pero no de las que se fueron, sino de las mujeres que se quedaron. El artículo, posándose en testimonios inéditos y en documentación novedosa procedente de los archivos locales, sostiene que la realidad de la emigración masculina contribuyó a modificar los roles y responsabilidades asumidas por las mujeres del mundo rural andaluz y extremeño. La ausencia de sus maridos, aunque no acabó con la jerarquía de género y con la desigualdad que caracterizaba la relación entre hombres y mujeres, sí las llevó a asumir nuevos deberes adicionales e hizo que su faceta adquiriera muchas veces la imagen de jefa de familia o de sostenedoras de hogares. Lo que asumieron, lo que aprendieron, lo que hablaron, lo que leyeron y hasta lo que compraron esas mujeres del rural, caracterizadas como viudas blancas, desafía las suposiciones de su pasividad y aislamiento que siempre las han caracterizado.

Abstract Background To assess the usefulness of pre-operative contrast-enhanced transthoracic echocardiography (CE-TTE) and post-operative chest-x-ray (CXR) for evaluating central venous catheter (CVC) tip placements, with trans-esophageal echocardiography (TEE) as gold standard. Methods A prospective single-center, observational study was performed in 111 patients requiring CVC positioning into the internal jugular vein for elective cardiac surgery. At the end of CVC insertion by landmark technique, a contrast-enhanced TTE was performed by both the apical four-chambers and epigastric bicaval acoustic view to assess catheter tip position; then, a TEE was performed and considered as a reference technique. A postoperative CXR was obtained for all patients. Results As per TEE, 74 (67%) catheter tips were correctly placed and 37 (33%) misplaced. Considering intravascular and intracardiac misplacements together, they were detected in 8 patients by CE-TTE via apical four-chamber view, 36 patients by CE-TTE via epigastric bicaval acoustic view, and 12 patients by CXR. For the detection of catheter tip misplacement, CE-TTE via epigastric bicaval acoustic view was the most accurate method providing 97% sensitivity, 90% specificity, and 92% diagnostic accuracy if compared with either CE-TTE via apical four-chamber view or CXR. Concordance with TEE was 79% (p

In this work, the applicability of a Firefly Algorithm (FA) to the real problem of the minimum cost of a detailed design for steel frames is studied. To reduce the calculation time, which is a common problem of meta-heuristic algorithms when they are used to solve real design cases, and to better suit the characteristics of the algorithm, a parallel migration strategy has been implemented and tested. As it is well known that the performance of any metaheuristic algorithm depends on the chosen value of its parameters, an extensive sensitivity analysis has been carried out. This not only serves to improve performance but also provides information on how it depends on the values of these parameters. With the information obtained from this analysis, and in order to achieve the robust behavior of the algorithm, a parameter control strategy has also been implemented and tested. Finally, a study demonstrating the close dependence between one of the parameters and the number of variables considered in the examples has been carried out. As a result of this final study, a simple expression is proposed that provides the minimum necessary population based on the number of variables in the problem.

In this article we examine the intertwined relationship between taste and mining culture in early modern Spanish worlds, highlighting descriptions of metals and minerals through which taste appears as an epistemic marker with symbolic dimensions. Drawing on different documents regarding mining practices, mineral vocabulary and metal appreciation in Spain, New Spain, Peru and the New Kingdom of Granada (c.1550–1640), our article contends that knowing minerals through taste in the Spanish worlds was part of a practice engaged with the senses, the body politic and its cosmological order.

Background In a preliminary study during the first COVID-19 pandemic wave, we reported a high rate of success with continuous positive airway pressure (CPAP) in preventing death and invasive mechanical ventilation (IMV). That study, however, was too small to identify risk factors for mortality, barotrauma and impact on subsequent IMV. Thus, we re-evaluated the efficacy of the same CPAP protocol in a larger series of patients during second and third pandemic waves. Methods 281 COVID-19 patients with moderate-to-severe acute hypoxaemic respiratory failure (158 full-code and 123 do-not-intubate (DNI)), were managed with high-flow CPAP early in their hospitalisation. IMV was considered after 4 days of unsuccessful CPAP. Results The overall recovery rate from respiratory failure was 50% in the DNI and 89% in the full-code group. Among the latter, 71% recovered with CPAP-only, 3% died under CPAP and 26% were intubated after a median CPAP time of 7 days (IQR: 5–12 days). Of the patients who were intubated, 68% recovered and were discharged from the hospital within 28 days. Barotrauma occurred during CPAP in

Hospital bed shortage is a worldwide concern. Their unavailability has caused elective surgery cancellations at our hospital peaking in spring 2016 at over 50%. This is often due to difficult patient step-down from intensive care (ICU) and high-dependency units (HDU). In our general/digestive surgery service admitting approximately 1000 patients yearly, ward rounds were run on a consultant firm basis.We report quality improvement (ISRCTN13976096) after we introduced a structured daily multidisciplinary board round framework (SAFER Surgery R2G) adapted from the ‘SAFER patient flow bundle’ and the ‘Red to Green days’ approaches to enhance flow. We compare 2016–2017, when our framework was applied for 12 months.We used a Plan–Do–Study–Act (PDSA) methodology. Our intervention consisted in (1) systematically communicating the key care plan after the afternoon ward rounds to the nurse in charge; (2) 30’ 10:00 hours Monday-to-Friday multidisciplinary board rounds, attended daily by the senior team and weekly by hospital and site managers, revising the key care plan to aim at safe, early discharges, assessing the appropriateness of each inpatient day and tackling any cause of delay. We measured patient flow by average length of stay (LOS), ICU/HDU step-downs and operation cancellations count, monitoring safety through early 30-day readmissions. Compliance was assessed by board round attendance and staff satisfaction rate surveys.After 12 months of intervention (PDSA-1-2, N=1032), compared with baseline (PDSA-0, N=954) average LOS significantly decreased from 7.2 (8.9) to 6.3 (7.4) days (p=0.003); ICU/HDU bed step-down flow increased by 9.3% from 345 to 375 (p=0.197), surgery cancellations dropped from 38 to 15 (p=0.100). 30-day readmissions increased from 0.9% (N=9) to 1.3% (N=14)(p=0.390). Average cross-specialty attendance was 80%. Satisfaction rates were >75%, regarding enhanced teamwork and faster decisions.The SAFER Surgery R2G framework has increased patient flow in the context of an enhanced multidisciplinary approach, requiring senior staff commitment to remain sustainable.

En la actualidad existen diversas aplicaciones de la iluminación LED, sin embargo, algunas de estas requieren regular la iluminación con precisión y en un amplio rango de operación, principalmente en tareas de seguimiento. Es en estos casos en donde es necesario considerar la no linealidad del LED para el diseño de esquemas de control, además, se necesita de una fuente de alimentación eficiente ante los cambios de tensión y corriente requeridos por la lámpara. En este trabajo se presenta el diseño de un convertidor DC-DC capaz de realizar y soportar estas variaciones, así como el diseño, simulación y comparación de esquemas de control PI clásico, PI difuso y ganancias programadas para estas aplicaciones. Con el fin de validar los esquemas de control descritos, y con el propósito de cumplir las recomendaciones de la Organización Mundial de la Salud, se toma el control de la iluminancia producida por una lámpara de protección ocular como caso de estudio, en donde el controlador varía el ciclo de trabajo del convertidor, ajustando de esta manera la tensión de la lámpara, y en consecuencia regulando la intensidad luminosa. Comparando los esquemas de control, el desempeño del sistema con el control por ganancias programadas tiene mejores características para el caso de estudio descrito con anterioridad, presentándose un error en estado estable de 0 % y menor sobretiro en comparación con los otros esquemas de control desarrollados.

Abstract Background Adiposity is a major component of the metabolic syndrome (MetS), low muscle strength has also been identified as a risk factor for MetS and for cardiovascular disease. We describe the prevalence of MetS and evaluate the relationship between muscle strength, anthropometric measures of adiposity, and associations with the cluster of the components of MetS, in a middle-income country. Methods MetS was defined by the International Diabetes Federation criteria. To assess the association between anthropometric variables (waist circumference (WC), waist-to-hip ratio (W/H), body mass index (BMI)), strength (handgrip/kg bodyweight (HGS/BW)) and the cluster of MetS, we created a MetS score. For each alteration (high triglycerides, low HDLc, dysglycemia, or high blood pressure) one point was conferred. To evaluate the association an index of fat:muscle and MetS score, participants were divided into 9 groups based on combinations of sex-specific tertiles of WC and HGS/BW. Results The overall prevalence of MetS in the 5,026 participants (64% women; mean age 51.2 years) was 42%. Lower HGS/BW, and higher WC, BMI, and W/H were associated with a higher MetS score. Amongst the 9 HGS/BW:WC groups, participants in the lowest tertile of HGS/BW and the highest tertile of WC had a higher MetS score (OR = 4.69 in women and OR = 8.25 in men;p

Aim: The SAMe-TT2R2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores >2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT2R2 scores >2 than to patients with lower scores. Methods and results: We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and ≥1 stroke risk factor. We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT2R2 score >2 and ≤ 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMe-TT2R2 scores 0-2 and 5,581 (32.0%) patients had scores >2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT2R2 scores >2 and 27.5% in those with scores ≤2. Conclusions: The lack of a clear association between the SAMe-TT2R2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT2R2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial. Clinical trial registration: URL: https://www.clinicaltrials.gov//Unique identifier: NCT01937377, NCT01468701, and NCT01671007.

Recent studies show that the use of self-assessment activities is a key learning mechanism, since they provide an important feedback that increases students’ motivation promoting greater responsibility on their own learning. Similarly, the evidence indicates that the use of gamification tools improves students’ extrinsic and intrinsic motivation. Combining these two approaches, this paper analyzes the role played by self-assessments activities performed using the Kahoot gamification tool and its impact on students’ learning process and outcomes –considering academic’s success and performance rates. Additionally, the gender has been considered in terms of its moderating effect on these relationships. Our findings indicate that students who have carried out self-assessment activities through Kahoot achieve higher success and performance rates compared to those students who have not. Moreover, we find that students' gender moderates the relationship between the use of Kahoot and their academic performance. Resumen Recientes investigaciones han puesto de manifiesto que el uso de autoevaluaciones constituye una importante estrategia de aprendizaje ya que, además de responsabilizar al estudiante de su propio aprendizaje, el feedback que le proporciona constituye un factor de gran relevancia motivacional. Asimismo, se han obtenido evidencias de que el uso de la gamificación puede introducir mejoras en la motivación, tanto extrínseca como intrínseca, del estudiante. Aunando ambos planteamientos, este trabajo analiza la influencia que tiene la realización de autoevaluaciones periódicas a través de un instrumento de gamificación –Kahoot– sobre los resultados del proceso de aprendizaje; resultados que se han estimado a partir de las tasas de éxito y rendimiento de los estudiantes. Adicionalmente, se ha analizado el género del estudiante con el fin de conocer si tiene un efecto moderador sobre las relaciones estudiadas. Los resultados muestran que los estudiantes que han realizado autoevaluaciones mediante Kahoot consiguen mayores tasas de éxito y rendimiento respecto de aquéllos que no las han realizado. Por otra parte, se observa que el género del estudiante modera la relación existente entre el uso de Kahoot y su rendimiento académico.

En los años ochenta, del pasado siglo, se puso en marcha una concepción educativa dual en España, las Escuelas Taller. Esta se dirigió a un público con unos requisitos especiales: parados de larga duración con problemas de inclusión laboral en sus respectivas especialidades, unido a su carencia educativa. Veinte años después de haberlas puesto en marcha, se incorporó al currículo de las mismas el módulo de Alfabetización Digital, cuyo fin era acercar al alumnado a las TIC y a su aplicación en la familia profesional sobre la que se desempeñó la acción formativa. Este estudio, analiza los contenidos recogidos en el currículo del módulo de Alfabetización Digital de la Escuela Taller de Cambados-Pontevedra (ESPAÑA) “Caminos Jacobeos” y ”Cambados Medioambiental”, su contextualizados a la formación del alumnado al que va dirigido, el cual ha sufrido, en los últimos años, una serie de crisis económicas que han provocado la aparición de brechas socioeconómicas. Los resultados, reflejan las inquietudes del alumnado en materia TIC, la adquisición de habilidades y competencias contextualizadas en su formación, y las exigencias de nuevos módulos de formación requeridos y no contemplados en su currículo, pero que la sociedad en la que van a dirigir sus actuaciones les demandan.

La papaya (Carica papaya L.), es uno de los cultivos de mayor importancia en México, por eso es indispensable evaluar variedades que tengan mejores características morfoagronómicas y de calidad. La presente investigación tiene como objetivo evaluar la calidad morfológica, productiva y fisicoquímica de los frutos de los cultivares de papaya Maradona-F1, Bela Nova-F1 y Maradol bajo manejo orgánico en el trópico seco. La investigación se realizó en la Universidad Autónoma de Guerrero, Centro Regional de Educación Superior de la Costa Chica, Florencio Villareal, Guerrero, México. El cultivar Maradona-F1 presentó los valores más altos en diámetro máximo (11.8 cm) sin embargo Maradol fue superior en diámetro mínimo (9.0 cm). En largo máximo, Maradona-F1 y Bela Nova-F1 expresaron valores similares (21.9 cm; 21.9 cm), al igual que en el largo al diámetro máximo (14.7; 14.3 cm). En peso de fruto se observó que Maradona-F1 presentó 1447.0 g. En grosor de pulpa Maradona-F1 fue mayor (27.94 mm). El valor más intenso en L* lo presentó Maradol, sin embargo, Bela Nova-F1 tubo los valores más altos en a* (39.82) y b* (54.17). El porcentaje más alto en acidez titulable lo expresó Bela Nova-F1 (0.14 %). El pH, más elevado lo obtuvo Maradol con un valor de 5.89. En sólidos solubles totales (°Brix) el hibrida Bela Nova-F1 expresó el valor más elevado con 13.0 °Brix. Las variedades Maradona F-1 y Bela Nova-F1 poseen las mejores características morfoagronómicas y fisicoquímicas, lo cual las hace las variedades más aceptables para su producción en el trópico seco.

Abstract Background This pilot study was designed to develop a fully automatic and quantitative scoring system of B-lines (QLUSS: quantitative lung ultrasound score) involving the pleural line and to compare it with previously described semi-quantitative scores in the measurement of extravascular lung water as determined by standard thermo-dilution. Methods This was a prospective observational study of 12 patients admitted in the intensive care unit with acute respiratory distress and each provided with 12 lung ultrasound (LUS) frames. Data collected from each patient consisted in five different scores, four semi-quantitative (nLUSS, cLUSS, qLUSS, %LUSS) and quantitative scores (QLUSS). The association between LUS scores and extravascular lung water (EVLW) was determined by simple linear regression (SLR) and robust linear regression (RLR) methods. A correlation analysis between the LUS scores was performed by using the Spearman rank test. Inter-observer variability was tested by computing intraclass correlation coefficient (ICC) in two-way models for agreement, basing on scores obtained by different raters blinded to patients’ conditions and clinical history. Results In the SLR, QLUSS showed a stronger association with EVLW (R 2 = 0.57) than cLUSS (R 2 = 0.45) and nLUSS (R 2 = 0.000), while a lower association than qLUSS (R 2 = 0.85) and %LUSS (R 2 = 0.72) occurred. By applying RLR, QLUSS showed an association for EVLW (R 2 = 0.86) comparable to qLUSS (R 2 = 0.85) and stronger than %LUSS (R 2 = 0.72). QLUSS was significantly correlated with qLUSS (r = 0.772; p = 0.003) and %LUSS (r = 0.757; p = 0.005), but not with cLUSS (r = 0.561; p = 0.058) and nLUSS (r = 0.105; p = 0.744). Moreover, QLUSS showed the highest ICC (0.998; 95%CI from 0.996 to 0.999) among the LUS scores. Conclusions This study demonstrates that computer-aided scoring of the pleural line percentage affected by B-lines has the potential to assess EVLW. QLUSS may have a significant impact, once validated with a larger dataset composed by multiple real-time frames. This approach has the potentials to be advantageous in terms of faster data analysis and applicability to large sets of data without increased costs. On the contrary, it is not useful in pleural effusion or consolidations.

La gestión de recursos humanos ha sido tradicionalmente estudiada en el ámbito de las grandes empresas. Sin embargo, en los últimos años hay un gran interés en caracterizar a las microempresas, pequeñas y medianas empresas (pyme), en analizar cómo las prácticas de recursos humanos son implementadas en ellas, y en verificar cuál es el impacto de dichas prácticas en los resultados de la empresa. En este sentido, a partir de una muestra de 1136 pyme españolas, nuestro objetivo es verificar cómo es la implementación de prácticas de recursos humanos en este contexto y, en particular, explorar la orientación de dichas políticas hacia el modelo AMO (habilidad, motivación, oportunidad). Los resultados ponen de manifiesto que los factores contingentes que mayor impacto tienen en el desarrollo de las prácticas de recursos humanos son la antigüedad de la empresa, la naturaleza de su control empresarial y la formación del gerente. Además, se evidencia que las empresas tienen mayor rendimiento cuando sus prácticas de recursos humanos se orientan hacia el modelo AMO

Reseña de la obra 'Nuevas fronteras del Derecho de la Discapacidad' (2020) de Rafael de Lorenzo García y Luis Cayo Pérez Bueno (dirs.).

Purpose: The incidence and the clinical presentation of neurological manifestations of coronavirus disease-2019 (COVID-19) remain unclear. No data regarding the use of neuromonitoring tools in this group of patients are available.Methods: This is a retrospective study of prospectively collected data. The primary aim was to assess the incidence and the type of neurological complications in critically ill COVID-19 patients and their effect on survival as well as on hospital and intensive care unit (ICU) length of stay. The secondary aim was to describe cerebral hemodynamic changes detected by noninvasive neuromonitoring modalities such as transcranial Doppler, optic nerve sheath diameter (ONSD), and automated pupillometry.Results: Ninety-four patients with COVID-19 admitted to an ICU from February 28 to June 30, 2020, were included in this study. Fifty-three patients underwent noninvasive neuromonitoring. Neurological complications were detected in 50% of patients, with delirium as the most common manifestation. Patients with neurological complications, compared to those without, had longer hospital (36.8 ± 25.1 vs. 19.4 ± 16.9 days, p < 0.001) and ICU (31.5 ± 22.6 vs. 11.5±10.1 days, p < 0.001) stay. The duration of mechanical ventilation was independently associated with the risk of developing neurological complications (odds ratio 1.100, 95% CI 1.046–1.175, p = 0.001). Patients with increased intracranial pressure measured by ONSD (19% of the overall population) had longer ICU stay.Conclusions: Neurological complications are common in critically ill patients with COVID-19 receiving invasive mechanical ventilation and are associated with prolonged ICU length of stay. Multimodal noninvasive neuromonitoring systems are useful tools for the early detection of variations in cerebrovascular parameters in COVID-19.

ABSTRACT: The present work aims to compare the structural behavior of steel-concrete composite-section beams for three types of shear connectors made of U hot rolled section and cold-formed sections of U and L. Experimental tests were performed with the three types of connectors associated with I section laminated steel beams and reinforced concrete slabs. For each type of connector, three push-out tests were performed, as well as six simple supported beam tests to evaluate the positive bending moment region. The results indicated that the direct shear behavior among the different types of connectors presents significant differences, however they do not significantly influence the average flexural strength of the composite beams. These, however, present considerable differences in deflections and deformations due to the stiffness differences of the connectors.

Background: Chronic non-communicable diseases are prevalent conditions in developing countries, such as Colombia. Several socioeconomic and educational factors have been associated with these pathologies. However, there is little country-specific information regarding the self-reported prevalence of chronic diseases and their association with the aforementioned factors in Colombia. Objectives: To evaluate the current situation of chronic non-transmissible diseases in Colombia by self-report and to analyze its potential relationship with sociodemographic, economic and educational factors. Methods: This is a cross-sectional baseline sub-analysis from the prospective, standardized collaborative PURE study in Colombia. Participants were recruited between 2005 to 2009, in 11 departments of the country, and included 7,485 subjects of 35 to 70 years old. Questionnaires of self-reported chronic non-communicable diseases, and demographic, socioeconomic and educational variables were applied. Results: Hypertension was the most prevalent chronic condition reported with a prevalence of 22.2% (21.2%–23.1%, 95% CI), followed by diabetes with a prevalence of 5.7% (5.1%–6.2%, 95% CI), asthma 2.7% (2.2%–3.0%, 95% CI), coronary heart disease 2.4% (2.0%–2.7%, 95% CI), stroke and heart failure 1.5% (1.2%–1.8%, 95% CI) each, chronic obstructive pulmonary disease 1.2% (0.6%–1.5%, 95% CI), and cancer 1.2% (1.0%–1.5%, 95% CI). Among the study sample, 23.3% (22.4%–24.3%, 95% CI) reported having one chronic NCDs, and 6.4% (5.9%–7.0%, 95% CI) reported having multiple chronic NCDs. The prevalence of multiple NCDs increased significantly with age, was more common in those from households with higher income, whereas it was significantly lower in persons with high education. The central and central-east regions of the country are those with the higher prevalence of self-reported NCDs. Conclusion: The results of the current study indicate the presence of socioeconomic and educational inequalities in the distribution of chronic NCDs in the Colombian population.

Background: Preoperative assessment is critical to decide the most adequate surgical strategy for oral squamous cell carcinoma (SCC). Magnetic resonance (MR) and intraoral ultrasonography (US) have been reported to be of great value for preoperative estimation of depth of invasion (DOI) and/or tumor thickness (TT). This review aims to analyze the accuracy of MR and intraoral US in determining DOI/TT in oral SCC, by assuming histological evaluation as the reference method.Methods: The procedure was conducted following the modified 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We performed a systematic search of papers on PubMed, Scopus, Web of Science, and Cochrane Library databases until July 31st, 2019. For quantitative synthesis, we included nine studies (487 patients) focused on MR, and 12 (520 patients) focused on intraoral US. The Pearson correlation coefficient (r) between DOI/TT evaluated with MR or intraoral US was assumed as effect size. A meta-analysis (MA) for each study group (MR and US) was performed by using the random-effects models with the DerSimonian–Laird estimator and r-to-z transformation.Results: In the MA for MR studies, a high heterogeneity was found (I2 = 94.84%; Q = 154.915, P < 0.001). No significant risk of bias occurred by evaluating funnel plot asymmetry (P = 0.563). The pooled (overall) r of the MR studies was 0.87 (95% CI from 0.82 to 0.92), whereas the pooled r-to-z transformed was 1.44 (95% CI from 1.02 to 1.85). In the MA for US studies a high heterogeneity was found (I2 = 93.56%; Q = 170.884, P < 0.001). However, no significant risk of bias occurred (P = 0.779). The pooled r of the US studies was 0.96 (95% CI from 0.94 to 0.97), whereas the pooled r-to-z transformed was 1.76 (95% CI from 1.39 to 2.13). These outputs were confirmed in additional MA performed by enrolling only MR (n = 8) and US (n = 11) studies that evaluated TT.Conclusions: MR and intraoral US seem to be promising approaches for preoperative assessment of DOI/TT in oral SCC. Remarkably, a higher pooled r and r-to-z transformed were observed in the intraoral US studies, suggesting that this approach could be more closely related to histopathological findings.

The first goal of this work was the description of a model addressed to quantify the carbon footprint in Spanish autochthonous dairy sheep farms (Manchega group), foreign dairy sheep farms (foreigners group: Lacaune and Assaf breeds), and Spanish autochthonous dairy goat farms (Florida group). The second objective was to analyze the GHG emission mitigation potential of 17 different livestock farming practices that were implemented by 36 different livestock farms, in terms of CO2e per hectare (ha), CO2e per livestock unit (LU), and CO2e per liter of fat- and protein-corrected milk (FPCM). The study showed the following results: 1.655 kg CO2e per ha, 6.397 kg CO2e per LU, and 3.78 kg CO2e per liter of FPCM in the Manchega group; 12.634 kg CO2e per ha, 7.810 CO2e kg per LU, and 2.77 kg CO2e per liter of FPCM in the Foreigners group and 1.198 kg CO2e per ha, 6.507 kg CO2e per LU, and 3.06 kg CO2e per liter of FPCM in Florida group. In summary, purchasing off-farm animal feed would increase emissions by up to 3.86%. Conversely, forage management, livestock inventory, electrical supply, and animal genetic improvement would reduce emissions by up to 6.29%, 4.3%, 3.52%, and 0.8%, respectively; finally, an average rise of 2 °C in room temperature would increase emissions by up to 0.62%.

This study aimed to investigate psychiatric symptomatology in a sample of patients affected by breast cancer undergoing surgery, evaluating the potential mediators on perceived stress levels, depression and hopelessness. The study was conducted on eighty-five patients with breast cancer, admitted consecutively to the Breast Unit of the IRCCS Ospedale Policlinico San Martino, between May 2018 and December 2019. Sociodemographic (age of diagnosis, gender, marital and occupational status, educational level, having children) and clinical (type and side of surgery, previous breast surgery, neoadjuvant chemotherapy and axillary dissection) characteristics were investigated through a semi-structured interview. The following rating scales were administered: Beck Depression Inventory, Beck Hopelessness Scale, and Perceived Stress Scale. Our findings indicate that the presence of children and of a partner was associated with a lower total score on the clinical dimensions evaluated. Furthermore, we found demolitive surgery to be a mediator between perceived stress and hopelessness, while history of previous breast surgery was found to be a mediator between demolitive surgery and perceived stress. In conclusion, patients affected by breast cancer undergoing more complex and demolitive surgery or with history of previous breast surgery should be mostly monitored from a psychological and psychiatric point of view from the beginning of treatments to evaluate the first manifestations of psychiatric symptomatology.

El primer franquismo (1939-1952) fue un periodo de carestía, miseria, enfermedades y muerte. Considerando el hambre como protagonista, el estudio de la mortalidad de una zona rural de Andalucía Oriental permite relacionar los condicionantes políticos, económicos y sociales con la nutrición. Y también con las condiciones higiénico-sanitarias, las enfermedades y las principales causas de muerte, provocadas tanto directa (enfermedades del aparato digestivo) como indirectamente (enfermedades del aparato respiratorio e infecto-contagiosas) por el hambre.

Extramedullary Plasmacytoma is an uncommon cell dyscrasia, representing 1% of all head and neck tumours. Characteristically, EMP is a slowly growing neoplasm with pattern of growth that delays its diagnosis. Secondary to this evolution, most patients present symptoms related to the location of the mass.We present a case of EMP in the maxillofacial region in a 59 years old male, who was treated by our department.Treatment approach is generally personalized to each case. These tumours often appear in complicated anatomic locations. EMPs are radiosensitive, and radiotherapy is often used as a first-line treatment to avoid disfiguring results and potentially eliminate the need for further invasive surgical procedures, but surgery combined with Radiotherapy has demonstrated good results in preventing local recurrence.

In this work, a study of the variation of the parameters of structures for curved roofs was carried out in order to evaluate changes in the rate of steel consumption. Several models have been designed with different geometries and bonding conditions. At first, these models were divided into three groups or structural systems, in order to determine the most efficient from the mass point of view of the structure. Then, the group that presented the best performance was analyzed with a larger amount of data. Structural design was performed using the STRAP® software and based on the requirements of the technical standard ABNT NBR 8800: 2008. Calculating the models, it has been found that the steel rate can vary greatly from one geometry to another and, in the same system, it varies considerably with respect to span and spacing between porticos. For certain support conditions and a certain span, it was observed that the use of small spacing between porticos in order to decrease the load on each curved frame can lead to high steel rates. It has been found that this phenomenon occurs due to the limitation of the slenderness of compressed members. On the other hand, large spacing results in large surrounding areas that, in turn, require larger sections to resist soliciting stresses. Thus, there is an intermediate or optimal spacing that offers a lower rate of material consumption, allowing for the elaboration of more economical structural projects.

Article 2560, paragraph 2, of the Italian Civil Code sets forth a specific regulation of the trade debts in the context of the transfer of a going concern. Such provision of law seems apparently clear. However, case law and the scholars show that its actual applicability has raised several issues over the years. This paper examines some of these issues, especially focusing on the interpretation followed by the majority of case law, with the specific aim to give, once for all, some guidelines to the practitioners.

In the European Higher Education Area, students assume responsibility for their own learning. Using self-assessment activities (carried out on virtual platforms), students increase their autonomy, responsibility, communication and flexibility in their learning process. This study uses a sample of 356 students during the academic year 2016/2017. The results show a positive impact between student participation in self-assessment activities and their learning outcomes. Individual and academic factors as well as attitude towards the subject influence students’ participation in self-assessment activities.

PURPOSE: The aim of this study was to evaluate the impact of clinical pathway (CP) implementation in laparoscopic radical prostatectomy (LRP) has had on patient care and clinical evolution after discharge. MATERIALS AND METHODS: Eighty-six patients were included in 2 groups: first group was composed of patients operated since the new technique (LRP) was used until the CP was implemented (26 patients operated in 2002) and, second group, with 60 patients, followed the CP during 2004 and 2005. RESULTS: The operative time was reduced from 377.7 to 172.3 minutes after the CP implementation. The duration of bladder catheterization decreased by more than 10 days (from 26.17 to 15.85 days) and that of thromboprophylaxis was reduced from 6.44 to 3.38 days. No difference was found in the rate of complications in the first month after surgery, nor was there any difference in the rate of occurrence of erectile dysfunction, incontinence, and biochemical recurrence during the first year after surgery. CONCLUSION: After the implementation of the CP, there have been better results in patient care, such as reduction in the duration of catheterization and thromboprophylaxis. In comparison with other studies, we observed a clear reduction in length of stay and operative time. However, there is still room for improvement in reducing the duration of catheterization. [ABSTRACT FROM AUTHOR]

Introduction: Mucosa-associated lymphoid tissue (MALT) lymphoma is a non-Hodgkin Lymphoma (NHL) localized all along the aerodigestive tract. The aim of this report is to present the case of a patient with MALT lymphoma in soft palate treated in our department. Case report: Case of a 26-year-old female who visited our department. She presented a tumor in soft palate that she reported a year ago. A biopsy was performed with the diagnosis of a Low-B-grade MALT lymphoma type. Due to the low initial stage of the lesion the haematologist decided to start monotherapy with Rituximab. The therapy was changed to R-Bendamustine. At present and after two years since diagnosed (May, 2015–February, 2017), the patient is disease-free. Discussion: The MALT lymphoma constitute 8% of the NHL. Progression to aggressive lymphoma is rare, occurring in under 10% of cases. Tumors are sensitive to radiotherapy and local treatment, both options can be followed by a prolonged disease-free period. The optimal treatment of MALT Lymphoma has not been agreed yet. Conclusion: MALT lymphoma is a rare disease in maxillofacial area, with tendency to remain in the original location for long periods. The optimal treatment of MALT Lymphoma has not been agreed yet. Due to persistent disease and concomitant Sjögren’s syndrome, in our case it was agreed that combination of Rituximab with other chemotherapy agents was indicated, with a good response.

A simple formulation for the optimal design of reinforced concrete sections under compression and biaxial bending was established in a previous work by the authors. In that work, it was found that the formulation produced satisfactory results when used together with three algorithms that belong to the nature-inspired meta-heuristic algorithm group. However, despite the favorable results obtained, the necessary calculation times were extensive in all the cases. In order to solve this problem, the authors implemented a parallel calculation strategy in the algorithm that gave better results in the previous work. It was possible to verify, through two examples, that this strategy reduces calculation times as more processes are used in parallel, and that the adjustments made in the algorithm favor reaching designs close to the global optimum independently of the number of parallel processes adopted.

Background: Spindle cell carcinoma (SpCC) is an infrequent and aggressive type of squamous cell carcinoma (SCC) characterized by the proliferation of epithelial and mesenchymal components. Oral SCC in children is an extremely rare entity and the SpCC variant has been reported in one case in the paediatric patient literature. Methods: In this paper, we report a case of SpCC of the tongue in an 11-year-old boy treated by on-block surgical resection and microvascular tissue reconstruction. Results: After 14 months the patient is free of disease with easily intelligible speech and normal swallowing. Conclusions: Diagnosis and treatment of this rare tumour in this age group is a challenge because of the overlapping of histopathological features and the complex reconstruction required to achieve adequate aesthetic and functional results.

Objetivo: Evaluar el impacto del ejercicio como una intervención no farmacológica para la prevención primaria y secundaria de eventos cardio y cerebrovasculares asociados a dislipidemia en personas con hipercolesterolemia. Métodos: Se elaboró una guía de práctica clínica siguiendo los lineamientos de la guía metodológica del Ministerio de Salud y Protección Social para recolectar de forma sistemática la evidencia científica y formular las recomendaciones utilizando la metodología GRADE. Se tomó la información específica acerca de ejercicio como medida terapéutica en el tratamiento de dislipidemia. Resultados: Tanto el ejercicio aeróbico como el de resistencia se asocian a disminución en el colesterol con lipoproteínas de baja densidad y los triglicéridos, cambios que fueron estadísticamente significativos; pero estos no son clínicamente relevantes, dado que se trata de una reducción mínima. No se encontró un cambio estadísticamente significativo en los valores de colesterol de alta densidad. Conclusiones: Se presenta evidencia a favor del uso de ejercicio como parte fundamental del tratamiento de hipercolesterolemia. Aunque no se encontraron diferencias clínicamente significativas en los valores de colesterol o triglicéridos, el ejercicio físico es una actividad con amplios beneficios para el paciente en otros dominios clínicos de interés, por lo que al considerar el riesgo y el beneficio de esta práctica, los beneficios son claros y superan ampliamente el bajo riesgo al que se expone una persona al realizar una rutina de ejercicio, como parte de su vida cotidiana.

Objetivo: El tratamiento de la dislipidemia debe ser acorde con el riesgo individual de cada paciente. Existen múltiples ecuaciones de predicción de riesgo cardiovascular, sin embargo, es necesario determinar cuál es la más adecuada para ser utilizada en la población colombiana. Métodos: La alianza CINETS, comisionada por el Ministerio de la Protección Social y Colciencias, revisó la evidencia disponible con respecto a qué métodos de evaluación de riesgo cardiovascular son válidos en la población colombiana. Se generaron recomendaciones utilizando la metodología GRADE. Población: Población adulta con diagnóstico de dislipidemia o en riesgo de desarrollarla. Recomendaciones: En la población de prevención primaria o sin enfermedad cardiovascular clínicamente manifiesta se recomienda utilizar la escala de Framingham recalibrada para Colombia para clasificar el riesgo (Recomendación fuerte a favor de la intervención). Existen personas con condiciones que por sí mismas implican un riesgo mayor y ameritan manejo farmacológico directo.

Objetivo: Evaluar el impacto sobre la incidencia y recurrencia de eventos cardiovasculares y cerebrovasculares (prevención primaria y secundaria), los niveles de las fracciones lipídicas y la incidencia de efectos secundarios en personas con hipercolesterolemia intolerantes al tratamiento con las estatinas. Métodos: Se elaboró una guía de práctica clínica siguiendo los lineamientos de la guía metodológica del Ministerio de Salud y Protección Social para recolectar de forma sistemática la evidencia científica y formular las recomendaciones utilizando la metodología GRADE. Población: Población adulta, con diagnóstico de dislipidemia, o en riesgo de desarrollarla, intolerantes al manejo con las estatinas. Recomendaciones: Se formulan recomendaciones a favor del uso de diferentes medicamentos (los fibratos, la niacina, los ácidos omega 3, las resinas secuestradoras de ácidos biliares, el ezetimibe), según su efectividad hipolipemiante y reducción de eventos cardiovasculares, como propuesta adaptada al contexto social colombiano.

Objetivo: Evaluar el impacto del tratamiento con estatinas sobre la incidencia y la recurrencia de los eventos cardiovasculares y los cerebrovasculares (prevención primaria y secundaria), los niveles de las fracciones lipídicas y la incidencia de efectos secundarios (el cáncer y la diabetes mellitus) en personas con hipercolesterolemia. Métodos: Se elaboró una guía de práctica clínica siguiendo los lineamientos de la guía metodológica del Ministerio de Salud y Protección Social para recolectar de forma sistemática la evidencia científica y formular las recomendaciones utilizando la metodología GRADE. Resultados: Se evidenció un efecto benéfico del tratamiento farmacológico con estatinas tanto en población de prevención primaria como en prevención secundaria, logrando reducciones clínica y estadísticamente significativas en la mortalidad y en los eventos cardiovasculares y cerebrovasculares. Adicionalmente, el tratamiento intensivo con estatinas mostró mayor reducción en los eventos cardiovasculares y cerebrovasculares ateroscleróticos al compararlo con el tratamiento de intensidad moderada. No se encontraron diferencias significativas en el riesgo de desarrollar cáncer al comparar estatinas frente a placebo pero sí se encontró un incremento de nueve por ciento en el riesgo de presentar diabetes mellitus asociado al tratamiento con estatinas. Conclusiones: Se formulan recomendaciones a favor del uso de estatinas como primera línea de tratamiento de hipercolesterolemia, y se establecen criterios para definir la intensidad de la terapia (alta o moderada respuesta) según el riesgo cardiovascular a 10 años, el nivel de colesterol LDL (cLDL), la edad y los antecedentes personales y los familiares.

Background: The aim of this study was to compare the effectiveness of laparoscopic liver resection (LLR) and laparoscopic radiofrequency ablation (LRFA) in the treatment of small nodular hepatocellular carcinoma (HCC). Patients and Methods: We enrolled 50 cirrhotic patients with similar baseline characteristics that underwent LLR (n = 26) or LRFA (n = 24), in both cases with intraoperative ultrasonography. Operative and peri-operative data were retrospectively evaluated. Results: LLR included anatomic resection in eight cases and non-anatomic resection in 18. In LRFA patients, a thermoablation of 62 nodules was achieved. Between LLR and LRFA groups, a significant difference was found both for median diameters of treated HCC nodules (30 vs. 17.1 mm; P < 0.001) and the number of treated nodules/patient (1.29 ± 0.62 vs. 2.65 ± 1.55; P < 0.001). A conversion to laparotomy occurred in two LLR patient (7.7%) for bleeding. No deaths occurred in both groups. Morbidity rates were 26.9% in the LLR group versus 16.6% in the LRFA group (P = 0.501). Hospital stay in the LLR and LRFA group was 8.30 ± 6.52 and 6.52 ± 2.69 days, respectively (P = 0.022). The surgical margin was free of tumour cells in all LLR patients, with a margin