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Abstract Objective To analyze the impact, performance, degree of specialization, and collaboration patterns of the worldwide scientific production on tissue engineering in otorhinolaryngology at the level of countries and institutions. Methods Two different techniques were used, performance and science mapping analyses, using as samples all the available documents regarding tissue engineering focused on otorhinolaryngology applications. The dataset was retrieved from the Core Collection of the Web of Science database from 1900 to 2020. Social structure was analyzed using science mapping analysis with VOSviewer software. Results The United States was the main producer, followed by Germany, and Japan. Malaysia and Germany had the highest Relative Specialization Index, indicating their greater relative interest in this area compared to other countries. The social structure analysis showed that the United States and Germany had significant co‐authorship relationships with other countries. The University of California System, Kyoto University, and Harvard University were the leading institutions producing literature in this field. These latter two institutions showed the largest number of collaborations, although most of them were with institutions within their own country. There was a lack of connections between different communities of research. Conclusion The United States is the main country driving progress in this research area, housing the most notable institutions. However, significant collaborations between these research centers are currently lacking. Encouraging greater cooperation among these institutions and their researchers would promote the exchange of knowledge, ultimately facilitating and accelerating advancements in this field.

Abstract Tissue engineering is a relatively recent research area aimed at developing artificial tissues that can restore, maintain, or even improve the anatomical and/or functional integrity of injured tissues. Otolaryngology, as a leading surgical specialty in head and neck surgery, is a candidate for the use of these advanced therapies and medicinal products developed. Nevertheless, a knowledge-based analysis of both areas together is still needed. The dataset was retrieved from the Web of Science database from 1900 to 2020. SciMAT software was used to perform the science mapping analysis and the data for the biomedical translation identification was obtained from the iCite platform. Regarding the analysis of the cognitive structure, we find consolidated research lines, such as the generation of cartilage for use as a graft in reconstructive surgery, reconstruction of microtia, or the closure of perforations of the tympanic membrane. This last research area occupies the most relevant clinical translation with the rest of the areas presenting a lower translational level. In conclusion, Tissue engineering is still in an early translational stage in otolaryngology, otology being the field where most advances have been achieved. Therefore, although otolaryngologists should play an active role in translational research in tissue engineering, greater multidisciplinary efforts are required to promote and encourage the translation of potential clinical applications of tissue engineering for routine clinical use.

Background: Phenylephrine (PHE) produces higher aortothoracic contractile tension with endothelium (T[ON]) compared to potassium chloride (KCl). Both are exponential triphasic responses (Φ1, Φ2, Φ3) but their kinetics have not been compared with the time constant (τ in s). Goal. To study the triphasic T[On] kinetics (τ: Φ1, Φ2(fundamental) and Φ3) of 1μM PHE vs 40mM KCl. Material and methods: We compared numerical values of τ1, τ2, τ3 of the T[On] of prepubertal male Wistar rats (without established reproductive capacity) with adult male ones. Results: Φ2 showed higher gain (g), shorter delay time (s), and faster kinetics of T[On] at PHE than at KCl. Conclusions: In the time course of T[On] only the fundamental exponential phase was faster with PHE than with KCl.

Resumen: Objetivo: Revisar la literatura científica disponible para resumir la evidencia epidemiológica al respecto del impacto de la hostelería en la incidencia y la mortalidad de la COVID-19. Método: Se incluyeron estudios en cualquier población, que describieran tanto el impacto del cierre o la reapertura de la hostelería como la exposición a negocios de hostelería sobre la incidencia y la mortalidad de la COVID-19. Se empleó el método de búsqueda en bola de nieve, con búsqueda retrospectiva y prospectiva de citas y cocitaciones. Resultados: Se encontraron 20 estudios que investigaron el papel de la hostelería en la epidemiología de la COVID-19. Los estudios de modelaje evidencian que las intervenciones relacionadas con la disminución de los contactos sociales en el interior de los negocios tienen la capacidad para disminuir la velocidad de transmisión. Los estudios de inferencia estadística mostraron resultados similares, afirmando que el cierre de la hostelería es una de las medidas más efectivas para disminuir la incidencia y la mortalidad. Los estudios de brotes muestran la capacidad de los establecimientos de hostelería y restauración para generar eventos de supercontagio, a la vez que enfatizan la importancia de controlar las corrientes de aire y la correcta ventilación del interior de los establecimientos. Conclusiones: Se encuentra una gran consistencia en la literatura al señalar que el cierre de los locales de hostelería es una de las medidas más efectivas para disminuir la incidencia y la mortalidad de la COVID-19. Además, se señalan algunas medidas, como la limitación de aforos y la ventilación, como aspectos a monitorizar en los procesos de reapertura de estos locales. Abstract: Objective: To review the scientific epidemiologic evidence on the role of hospitality venues in the incidence or mortality from COVID-19. Method: We included studies conducted in any population, describing either the impact of the closure or reopening of hospitality venues, or exposure to these venues, on the incidence or mortality from COVID-19. We used a snowball sampling approach with backward and forward citation search along with co-citations. Results: We found 20 articles examining the role of hospitality venues in the epidemiology of COVID-19. Modeling studies showed that interventions reducing social contacts in indoor venues can reduce COVID-19 transmission. Studies using statistical models showed similar results, including that the closure of hospitality venues is amongst the most effective measures in reducing incidence or mortality. Case studies highlighted the role of hospitality venues in generating super-spreading events, along with the importance of airflow and ventilation inside these venues. Conclusions: We found consistent results across studies showing that the closure of hospitality venues is amongst the most effective measures to reduce the impact of COVID-19. We also found support for measures limiting capacity and improving ventilation to consider during the re-opening of these venues.

Resumen: Objetivo: Elaborar una herramienta de apoyo que ayude a tomar decisiones en el marco de la pandemia de COVID-19. Método: Se parte de una búsqueda de diferentes recomendaciones éticas surgidas en España sobre priorización de recursos sanitarios escasos en la pandemia de COVID-19, así como de una revisión narrativa de modelos teóricos sobre distribución en pandemias para definir una fundamentación ética. Finalmente, se extraen recomendaciones para su posible aplicación en distintos ámbitos asistenciales. Resultados: Se identifican tres principios, igualdad estricta, equidad y eficiencia, que se sustancian en criterios de distribución específicos. Conclusiones: Se propone un modelo de distribución de recursos sanitarios escasos en situación de pandemia que parte de un procedimiento de toma de decisiones y adapta los criterios de distribución a los escenarios de la atención sanitaria: atención primaria, residencias sociosanitarias y atención hospitalaria. Abstract: Objective: To develop a support tool to decision-making in the framework of the COVID-19 pandemic. Method: Different ethical recommendations that emerged in Spain on prioritizing scarce health resources in the COVID-19 pandemic first wave were searched; it was conducted a narrative review of theoretical models on distribution in pandemics to define an ethical foundation. Finally, recommendations are drawn to be applied in different healthcare settings. Results: Three principles are identified; strict equality, equity and efficiency, which are substantiated in specific distribution criteria. Conclusions: A model for the distribution of scarce health resources in a pandemic situation is proposed, starting with a decision-making procedure and adapting the distribution criteria to different healthcare scenarios: primary care settings, nursing homes and hospitals.

In this study, we propose the symbiotic integration of photovoltaic (PV) systems into previously built vineyards structures, so as to reduce land intervention, visual impact and costs while suppressing impact over crop production and quality. For this purpose, we have identified grape trellises as an ideal crop type to implement this concept based on a simulation study that analyzes the shading patterns and the PV energy generation of different PV design configurations using Photovoltaic Geographical Information System’s solar radiation data and system performance tool. Our proposal consists in the vertical integration of photovoltaic surfaces over the vines, using the same trellis structure, therefore minimizing cost and land building. We found that a ratio between row distance and trellis height equal or greater than 1.5 allows for the PV integration without generating significant shadowing between consecutive lines, while vertical orientation of the panels allows complete irradiation to the plants below. Different module configurations have been proposed and evaluated, resulting in a range of 40–60% installable capacity (compared to a ground mounted installation) with negligible shadowing over the leaves and grapes. Land equivalent ratio for the proposed architectures ranges between 1.27–1.50, therefore confirming the viability of this proposed agrivoltaic solution.

Variable transmission applications for light control or energy saving based on electrochromic materials have been successfully applied in the past in the building, sports, or automotive fields, although lower costs and ease of fabrication, installation, and maintenance are still needed for deeper market integration. In this study, all-printed large area (900 cm2 active area) flexible electrochromic devices were fabricated, and an autoregulating self-power supply was implemented through the use of organic solar cells. A new perspective was applied for automotive light transmission function, where portability and mechanical flexibility added new features for successful market implementation. Special emphasis was placed in applying solution-based scalable deposition techniques and commercially available materials (PEDOT-PSS as an electrochromic material; vanadium oxide, V2O5, as a transparent ion-storage counter electrode; and organic solar modules as the power supply). A straightforward electronic control method was designed and successfully implemented allowing for easy user control. We describe a step-by-step route following the design, materials optimization, electronic control simulation, in-solution fabrication, and scaling-up of fully functional self-powered portable electrochromic devices.

The possibilities of obtaining efficient building thermal control by means of colored envelopes while maintaining broad aesthetic options have been evaluated. The use of colored bilayers, where the inner layer presents strong solar absorbent or reflectance properties, while the outer layer provides visible coloration, represents a feasible way. A representative set of twenty bilayers spanning a broad color palette has been studied in two configurations, static and dynamic. The dynamic configuration allows for the switching of the inner layer between absorptive and reflective states. Simulations have been carried out in a total of nineteen locations around the world, representing the main habitable climates according to Köppen–Geiger climate classification. Comparative results between climate zones where this approach may have a significant impact have been obtained, and identification of feasible climate zones has been carried out. The use of the simpler static configuration is recommended for tropical climates, whereas the dynamic configuration could be effective in moderate climate locations (within arid or temperate climate classification). Possible savings for cold climates are negligible.

Abstract Background Sugar-sweetened beverage consumption is contributing to the obesity epidemic. On 28 March 2017, Catalonia enacted a law levying an excise tax on sugar-sweetened beverages for public health reasons. The purpose of this study is to assess the impact of the tax on the consumption of sugar-sweetened beverages in Catalonia (Spain). Methods Before-and-after study to assess changes in the prevalence of consumption of sugar-sweetened beverages among 1929 persons aged 12 to 40 years residing in low-income neighbourhoods of Barcelona (intervention) and Madrid (control). Beverage consumption frequency was ascertained via a validated questionnaire administered during the month prior to the tax’s introduction (May 2017) and again at 1 year after it had come into force. The effect of the tax was obtained using Poisson regression models with robust variance weighted using propensity scores. Results While the prevalence of regular consumers of taxed beverages fell by 39% in Barcelona as compared to Madrid, the prevalence of consumers of untaxed beverages remained stable. The main reason cited by more than two-thirds of those surveyed for reducing their consumption of sugar-sweetened beverages was the increase in price, followed by a heightened awareness of their health effects. Conclusions The introduction of the Catalonian excise tax on sugar-sweetened beverages was followed by a reduction in the prevalence of regular consumers of taxed beverages.

Two different Zn-based batteries are tested, simultaneously recording the voltage of the negative and positive electrodes during the discharge/charge processes to evidence the advantages of using a three-electrode cell, including a pseudo-reference electrode, with respect to the normally applied two electrodes system. The three-electrode cell allows us to identify in each moment which electrode reveals unexpected events during a battery test and thus to act on it accordingly. In this work, alkaline Zn/Bi2O3 and Zn/air batteries, including a pseudo-reference electrode, are subjected to different galvanostatic discharge/charge tests, highlighting several unforeseen changes and failures in both negative and positive electrodes. Thus, the usefulness of using a three-electrodes system in Zn-based batteries is revealed because it allows us to explain what the cause of the battery failure was and, if necessary, to act immediately. Finally, Spectroscopic Impedance measurements are also applied to a specific case of the Zn/Bi2O3 battery using the same three-electrode cell.

Resumen: Objetivo: Analizar y comprender los discursos reticentes a la vacunación, particularmente los de las personas que han decidido no vacunar a sus hijos/as. Métodos: Estudio cualitativo con cinco entrevistas individuales y dos grupos focales con personas que optaron por no vacunar a su hijos/as en la provincia de Granada. Resultados: Padres y madres manifiestan un sistema de creencias en salud diferente al paradigma biomédico. Desde el punto de vista ético, justifican su posición a partir del derecho a la autonomía y la responsabilidad de sus decisiones. Como argumentos concretos, dudan de la administración de varias vacunas simultáneamente en edades muy tempranas de manera sistemática y sin individualizar cada caso, temen efectos adversos y no entienden la variabilidad en el calendario vacunal. Conclusiones: Los discursos reticentes responden al conflicto de individualidad vs. colectividad: padres y madres, en defensa de su derecho a una crianza sin interferencias del Estado, centran su responsabilidad en el bienestar individual de sus hijos/as independientemente de las consecuencias que su acción u omisión conlleve a la colectividad. En su gestión de los riesgos, elevan los derivados de vacunar por encima de las consecuencias individuales y colectivas de no hacerlo. Las vacunas que más dudas generan son aquellas con mayor controversia en el ámbito científico. La transparencia en la comunicación de efectos adversos, el respeto de las autoridades a otros conceptos de salud/enfermedad, el destierro del término «antivacunas» del lenguaje mediático y científico, y el desarrollo de espacios de diálogo son puentes por construir. Abstract: Objective: To analyse and understand vaccination hesitancy discourses, particularly those of people who have decided not to vaccinate their sons and daughters. Methods: Qualitative study of five individual interviews and two focus groups with people who chose not to vaccinate their children in the province of Granada (Spain). Results: Mothers and fathers manifest a system of health beliefs different to the biomedical paradigm. From an ethical point of view, they justify their position based on the right to autonomy and responsibility for their decisions. Alleged specific reasons: they doubt administration of several vaccines simultaneously at an early age in a systematic way and without individualising each case; they fear adverse effects and do not understand the variations of the vaccination schedule. Conclusions: These vaccination hesitancy discourses respond to the individual vs collective conflict; parents defend their right to bring up their children without any interference from the state and focus their responsibility on the individual welfare of their sons and daughters, regardless of the consequences that their actions might have on the collective. In their management of risks, they consider those derived from vaccination more relevant than the individual or collective consequences of not doing so. The vaccines generating most doubts are the more controversial ones within the scientific world. Transparency in communication of adverse effects; authorities respect for other health/disease concepts; banishment of the term “anti-vaccines” from the media and scientific vocabulary, and developing spaces for dialogue are bridges to be built. Palabras clave: Vacunas, Reticencia vacunal, Ética, Salud pública, Política sanitaria, Investigación cualitativa, Keywords: Vaccines, Vaccination hesitancy, Ethics, Public health, Qualitative research, Health policy, Qualitative research

La llegada de una vacuna contra el SARS-CoV-2 que pueda frenar la expansión de la infección se ha postulado como la respuesta definitiva para frenar la pandemia de COVID-19. Lejos de ser una solución libre de conflictos éticos, la introducción de una nueva vacuna en la práctica de la salud pública, y que se haga en una situación de inestabilidad social, política y económica, vuelve a activar la línea de tensión entre el poder de las instituciones, la autonomía de las personas y las dinámicas de los mercados globales. Esto hace que sea preciso un análisis ético que incluya los conflictos en el ámbito de la investigación y el desarrollo de la vacuna, los elementos de justicia global presentes en la distribución de la vacuna, las decisiones de priorización cuando la oferta de esta no cubra la demanda existente y las posturas que se deberán tomar, desde los poderes públicos, para abordar los casos de reticencia por parte de las personas que no deseen que se les administre la vacuna —o que planteen dudas ante ello.

We present evidence of pupil response modification, as well as differential theoretical melatonin suppression through selective and dynamic electrochromic filtering of visible light in the 400-500 nm range to minimize chronodisruptive nocturnal blue light exposure. A lower activation of intrinsically photosensitive retinal ganglion cells (ipRGCs), the first step for light to reach a human's internal clock, is related to melatonin secretion therefore avoiding detrimental effects of excessive blue light exposure. Pupillary Light Reflex and Color Naming were experimentally assessed under light filtered by two different coloration states (transmissive and absorptive) of these novel dynamic filters, plus an uncoated test device, in 16 volunteers. Also, different commercial light sources at illuminances ranging from 1 to 1000 lux were differentially filtered and compared in terms of theoretical melatonin suppression. Representative parameters of the pupil responses reflected lower pupil constriction when the electrochromic filters (ECFs) were switched on (absorptive state, blue light is absorbed by the filter) compared to uncoated filters (control sample), but failed to do so under transmissive state (blue light passes through the filter) indicating less activation of ipRGCs under absorptive state (although no significant differences between states was found). Out of eight colors tested, just one showed significant differences in naming between both filter states. Thus, the ECF would have some protecting effect on ipRGC activation with very limited changes in color perception. While there are some limitations of the theoretical model used, the absorptive state yielded significantly lower theoretical melatonin suppression in all those light sources containing blue wavelengths across the illuminance range tested. This would open the way for further research on biological applications of electrochromic devices.

Perovskite solar cells have progressed very steadily, reaching power conversion efficiencies (PCE) beyond 20% while also improving their lifetimes up to 10,000 h. A large number of cell architecture and materials for active, transporting and electrode layers have been used, either in blends or in nanostructured layers. In this article, a set of perovskite solar cells have been designed, fabricated and characterized with special focus on their lifetime extension. The inclusion of 5-amino-valeric acid iodide (5–AVAI) as interlayer in a methyl-amino lead-iodide (MAPI) perovskite solar cell has provided additional stability in cells with PCE > 10% and T80 = 550 h. Experiments for up to 1000 h with solar cells at maximum power point under continuous illumination with solar simulator have been carried out (1 kW/m2, AM1.5G, equivalent to more than six months of outdoor illumination in locations such as Southeast Spain, with an average irradiation of 1900 kWh/m2/year). The addition of molecular additives in the bulk active layer and ETL and carbon layers not only allows better carrier transport, but also increases the stability of the perovskite solar cell by reducing ion migration within the bulk MAPI and between the different layers. Engineered interfaces with ZrO2 between the TiO2 and carbon layers contribute to reducing degradation.

The integration of photovoltaic technologies into greenhouse envelopes appears to be an innovative and environmentally-friendly way to supply their various energy demands. However, the effect on the inner growing conditions, especially on the temperature, must be assessed in order to effectively implement this solution. In this study, experimental temperature data were obtained over two years for four structures built with different photovoltaic technologies (mono-crystalline silicon, amorphous silicon, cadmium telluride, and an organic polymeric technology) and fitted to a thermal model in order to provide a comprehensive analysis of their potential utilization as a cover material in greenhouses. Additionally, the thermal effect of color in structures composed of several common construction materials (brick, wood, plasterboard and glass) was quantified and modelled, supplementing the thermal analysis of passive solutions for this application. In all cases, inner and ambient temperature differences of up to +20 °C, created by a passive heating effect during the day, and −5 °C, created by a passive cooling effect during the night, have been observed, suggesting the use of the photovoltaic modules with different degrees of structure coverage, complemented with the color tuning of the modules themselves as passive methods to control the temperature and light spectrum of greenhouses.

Objective To determine whether there was an association between serum total antioxidant capacity (TAC) levels prior to in liver transplantation (LT) for hepatocellular carcinoma (HCC) and 1-year LT mortality. Methods This observational retrospective single-centre study of patients with LT for HCC measured serum levels of TAC and malondialdehyde (as a biomarker of lipid peroxidation) before LT. The study endpoint was 1-year LT mortality. Results This study included 142 patients who underwent LT for HCC. Patients who survived the first year ( n = 127) had significantly lower aged liver donors, significantly higher serum TAC levels, and significantly lower serum malondialdehyde levels compared with the non-survivors ( n = 15). Logistic regression analysis found that serum TAC levels (odds ratio [OR] 0.275; 95% confidence interval [CI] 0.135, 0.562) and the age of the LT donor (OR 1.050; 95% CI 1.009, 1.094) were associated with 1-year LT mortality. There was an inverse association between serum levels of TAC and malondialdehyde levels (rho = –0.22). Conclusions There was an association between low serum TAC levels prior to LT for HCC and mortality during the first year after LT. There was an inverse association between serum TAC levels and lipid peroxidation as measured by malondialdehyde levels.

Melatonin administration has been associated with different benefits in animals and patients suffering from liver diseases. However, there is no published data about circulating melatonin levels in patients with hepatocellular carcinoma (HCC) who underwent liver transplantation (LT). Thus, the objective of this observational and retrospective study was to determine whether patients with HCC with lower serum melatonin levels prior to LT have a higher risk of one-year mortality after LT. We measured serum levels of melatonin, malondialdehyde (to assess lipid peroxidation), and total antioxidant capacity (to assess antioxidant state) before LT. One-year surviving LT patients (n = 129) showed higher serum levels of melatonin (p = 0.001) and total antioxidant capacity (p = 0.001) and lower serum levels of malondialheyde (p = 0.01) than non-surviving LT patients (n = 16). Logistic regression analysis showed that high serum melatonin levels prior to LT were associated with lower one-year LT mortality (odds ratio = 0.525; 95% confidence interval (CI) = 0.331–0.834; p = 0.006). We found an association between serum levels of melatonin with serum levels of malondialheyde (rho = −0.22; p = 0.01) and total antioxidant capacity (rho = 0.21; p = 0.01). Thus, the novel findings of our study were the association between high serum melatonin levels prior to LT and survival at first year after LT and the association between serum levels of melatonin with malondialheyde and total antioxidant capacity.

Diaphragmatic herniation is an uncommon complication in the postquirurgic follow of the liver transplant. The associated symptoms are unspecific and may not suggest the correct diagnosis. It may explain why in many patients the diagnosis remains unmade or it is made only after a long interval of time. We present the case of a fifty-seven-year-old male who required an orthotopic liver transplant in 2010 due to a trifocal hepatocarcinoma. In postoperatory follow-up the patient showed alimentary regurgitation, vomiting, and dyspepsia. The diagnosis was made by an oesophagogastroduodenal transit with barium and an abdominal CT scan that showed a left diaphragmatic herniation with the gastric fundus into the thorax. With these findings we decided to perform a programmed surgery. After takedown of adhesions and replacement of the stomach into the upper abdomen, the palm-sized diaphragmatic opening was closed with a synthetic material. The patient’s condition remained stable throughout the entire operation. The postoperative course was uneventful and he was discharged at the fifth day after surgery with a normal digestive intake. In a 12-month follow-up the patient shows no symptoms.

Cytokeratin (CK)-18 is the major intermediate filament protein in the liver and during hepatocyte apoptosis is cleaved by the action of caspases; the resulting fragments are released into the blood as caspase-cleaved cytokeratin (CCCK)-18. Higher circulating levels of CCCK-18 have been found in patients with hepatocellular carcinoma (HCC) than in healthy controls and than in cirrhotic patients. However, it is unknown whether serum CCCK-18 levels before liver transplantation (LT) in patients with HCC could be used as a prognostic biomarker of one-year survival, and this was the objective of our study with 135 patients. At one year after LT, non-survivors showed higher serum CCCK-18 levels than survivors (p = 0.001). On binary logistic regression analysis, serum CCCK-18 levels >384 U/L were associated with death at one year (odds ratio = 19.801; 95% confidence interval = 5.301–73.972; p < 0.001) after controlling for deceased donor age. The area under the receiver operating characteristic (ROC) curve of serum CCCK-18 levels to predict death at one year was 77% (95% CI = 69%–84%; p < 0.001). The new finding of our study was that serum levels of CCCK-18 before LT in patients with HCC could be used as prognostic biomarker of survival.