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El objetivo de este trabajo es doble: a) analizar las motivaciones e intereses de un grupo de estudiantes de altas habilidades en comparación con sus compañeros; y, b) analizar las diferencias en intereses y motivaciones en función del sexo y del curso. Participaron 70 estudiantes (18 de altas habilidades) de 2º y 3º de Educación Secundaria Obligatoria (ESO), de dos centros escolares de la Región de Murcia, de entre 13 y 15 años (M = 13.63; DT = .615), habiendo equilibrio en cuanto a género: 35 chicos (50%) y 35 chicas. Se empleó un cuestionario elaborado ad hoc, con ítems extraídos del cuestionario PANA (Pérez y Pro, 2005) y del Cuestionario de Metas Aprendizaje (CMA; Hayamizu et al., 1989). Los resultados mostraron que los alumnos de altas habilidades poseen mayor motivación intrínseca y mayor interés hacia otras asignaturas y contenidos de clase con respecto a sus compañeros/as. Además, existen diferencias significativas en función del género según los intereses de los participantes, los chicos tienen más interés en el área científica y las chicas por el área lingüística. En relación con el curso al que pertenece el alumnado, cuando existen diferencias en cuanto a motivación, estas son a favor del alumnado de 3º con respecto a los de 2º. Este estudio proporciona una descripción general de las diferencias entre los y las adolescentes de altas habilidades y sus iguales en cuanto a intereses y motivaciones, lo cual es un apunte importante de cara a potenciales intervenciones orientadoras.

Our aim was to evaluate the development of new significant mitral regurgitation and long-term survival after mitral repair surgery in functional mitral regurgitation. A retrospective observational analysis of the recurrence of functional mitral regurgitation (ischemic and nonischemic) and global mortality during follow-up of 176 patients who underwent mitral repair surgery between 1999 and 2018 in our center was conducted. The etiology of functional mitral regurgitation was ischemic in 55.7% of cases. After surgery, mitral regurgitation was 0-I in 92.3% of cases. We conducted a long-term clinical follow-up of a mean 42.2 months and an echocardiographic follow-up of a mean 41.8 months. We observed mitral regurgitation of at least grade II in 52 patients (36.9%). Survival at 1, 3, and 5 years was 78.8%, 66.7%, and 52.3%, respectively. Predictive factors for global mortality were age (hazard ratio = 1.038, p = 0.01) and a depressed preoperative ejection fraction. After a competing risk analysis, we found the only predictive factor for the recurrence of mitral regurgitation in our series to be age (sub-hazard ratio = 1.03, 95% confidence interval = 1.01-1.06, p = 0.016). Repair surgery for functional mitral regurgitation shows age as the only independent predictor of recurrence. Age and depressed ejection fraction were predictors of mortality.

Quality of life and patient satisfaction after ministernotomy have never been compared to conventional full sternotomy in randomized trials. The QUALITY-AVR trial is a single-blind, single-center, independent, randomized clinical trial comparing ministernotomy to full sternotomy in patients with isolated severe aortic stenosis scheduled for elective aortic valve replacement. One hundred patients were randomized in a 1:1 computational fashion. The primary endpoint was a difference between intervention groups of ≥0.10 points in change from baseline quality of life Questionnaire EuroQOL-index, measured at 1, 6, or 12 months. Secondary endpoints were differences in change from other baseline EuroQOL-index utilities, cardiac surgery-specific satisfaction questionnaire (SATISCORE), a combined safety endpoint of 4 major adverse complications at 1 month (all-cause mortality, acute myocardial infarction, neurologic events, and acute renal failure), bleeding through drains within the first 24 hours, intubation time, and other minor endpoints. Clinical follow-up was scheduled at baseline, 1, 6, and 12 months after randomization. Change from baseline mean difference EQ-5D-index was +0.20 points (95% confidence interval 0.10–0.30, P

El nuevo modelo de universidad inspirado en los principios del espacio europeo de educación superior ha supuesto un cambio en los roles del profesorado, pasando de transmisor a facilitador de aprendizajes, e incidiendo en el papel del estudiante como protagonista del proceso educativo. Ello supone incorporar el enfoque competencial en la formación universitaria, al considerar que llevar a cabo una enseñanza de calidad implica que el profesorado de enseñanza superior debe tener competencias personales, formativas, de investigación y pedagógicas que le permitan desempeñar su función docente eficazmente. Este trabajo tiene por objetivo la identificación de las competencias pedagógicas más relevantes para favorecer el desarrollo de habilidades, valores y aptitudes profesionales y personales en los estudiantes, con la finalidad de que puedan hacer frente a diferentes situaciones en su labor profesional. Para ello, realizamos una revisión de la literatura a niveles nacional e internacional, a partir de la cual planteamos el diseño de un instrumento en función de las competencias más relevantes: 1) conocer y comprender; 2) saber hacer; y 3) saber ser.

Background: Isolated tricuspid valve surgery is a rarely performed procedure and traditionally is associated with a bad prognosis, although its clinical outcomes still are little known. The aim of this study was to assess the short- and long-term clinical outcomes obtained at our center after isolated tricuspid valve surgery as treatment for severe tricuspid regurgitation. Methods: This retrospective study included 71 consecutive patients with severe tricuspid regurgitation who underwent isolated tricuspid valve surgery between December 1996 and December 2017. Perioperative and long-term mortality, tricuspid valve reoperation, and functional class were analyzed after follow up. Results: Regarding surgery, 7% of patients received a De Vega annuloplasty, 14.1% an annuloplasty ring, 11.3% a mechanical prosthesis, and 67.6% a biological prosthesis. Perioperative mortality was 12.7% and no variable was shown to be predictive of this event. After a median follow up of 45.5 months, long-term mortality was 36.6%, and the multivariate analysis identified atrial fibrillation as the only predictor (Hazard Ratio 3.014, 95% confidence interval 1.06-8.566; P = 0.038). At the end of follow up, 63.6% of survivors had functional class I. Conclusions: Isolated tricuspid valve surgery was infrequent in our center. Perioperative mortality was high, as was long-term mortality. However, a high percentage of survivors were barely symptomatic after follow up.

espanolIntroduccion. La relevancia de estudiar los rasgos de personalidad en los estudiantes creativos dentro del ambito educativo implica su identificacion y posterior respuesta educativa adecuada a los diferentes perfiles creativos que manifiestan. Por tanto, el objetivo fue analizar la relacion entre los rasgos de la personalidad y las habilidades creativas, asi como profundizar en que rasgos de personalidad son los que definen a los estudiantes con mayor potencial creativo en una muestra de adolescentes, basandonos en el modelo de los Cinco Grandes Factores de la personalidad (Costa & McCrae, 1992). Metodo. Participaron 178 estudiantes de Educacion Secundaria Obligatoria (ESO) de la Re- gion de Murcia (Espana), con edades entre los 12 y los 17 anos (M = 14.59; DT = 1.40). De los cuales un 49.3% eran varones. Los instrumentos utilizados fueron: el TTCT (Torrance, 1974), para valorar la creatividad; el BFQ-NA (Big Five Questionnaire de Personalidad para ninos y adolescentes; Barbaranelli, Caprara y Rabasca, 1998), en concreto, la adaptacion espanola (Del Barrio, Carrasco & Holgado, 2006) y el NEO-FFI (Inventario de Personalidad NEO Revisado, version reducida; Costa & McCrae, 2008), para los rasgos de personalidad. Para valorar las diferencias en personalidad realizamos tres grupos en funcion de su nivel de creatividad (alta, media y baja). Resultados. Los datos sugieren que fueron tres los rasgos de la personalidad relacionados con las dimensiones creativas: la Extraversion, la Conciencia/Responsabilidad y la Apertura. Mien- tras que, las personas mas creativas presentaron puntuaciones significativamente mas elevadas en los siguientes rasgos de personalidad: Extraversion, Conciencia/Responsabilidad y Amabi- lidad. Discusion y conclusiones. A nivel general se observa cierta relacion entre las habilidades crea- tivas y los rasgos de personalidad. Concretante son la Extraversion, la Conciencia/Responsabi- lidad y la Apertura las dimensiones mas relacionadas con la creatividad. De las cuales, la Ex- traversion y la Conciencia/Responsabilidad son las que definen en mayor medida un perfil crea- tivo. Resultados en esta linea son los obtenidos por Chamorro-Premuzic y Reichenbacher (2008), Furnham (2015), y Szobiova (2006). EnglishIntroduction: The relevance to study personality traits in creative students within the educa- tional field implies their identification and then select the right educational response to the dif- ferent creative profiles of the students. The aim was to analyze the relationship between per- sonality and creativity, and to deepen into which personality traits defines the students with the greatest creative potential in a sample of adolescents, based on the model of the Five Factors Model of personality (Costa & McCrae, 1992). Method: Participants were 178 students of Compulsory Secondary Education (ESO) from the Region of Murcia (Spain), aged between 12 and 17 years old (M = 14.59, SD = 1.40). Of which 49.3% were boys. The instruments used in our study have been: to value creativity, the TTCT (Torrance, 1974); and to evaluate personality traits, the BFQ-NA (Big Five Personality Ques- tionnaire for children and teenagers, Barbaranelli, Caprara & Rabasca, 1998), specifically, the adaptation to Spanish (Del Barrio, Carrasco & Holgado, 2006) or the NEO-FFI (Revised NEO Personality Inventory, reduced version, Costa & McCrae, 2008), according to the age of the participants. Results: To assess the differences in personality, we made three groups based on their level of creativity (high, medium and low). The results showed that there were three personality traits were related to creative dimensions: Extraversion, Consciousness and Openness. While, the most creative people present significantly higher scores on the following personality traits: Ex- traversion, Consciousness and Agreeableness. Discussion or Conclusion: In general, there was a moderate relationship between creative skills and personality traits. Extraversion, Consciousness and Openness were the personality traits the most related to creativity. Of which, Extraversion and Consciousness were the most define a creative profile. Similar results were those obtained by Chamorro-Premuzic & Reichenbacher (2008), Furnham (2015), and Szobiova (2006).

Background: Currently, studies are underway to determine whether coronary stent implantation with percutaneous transluminal coronary angioplasty before a coronary artery bypass graft (CABG) influences the prognosis of surgery. This study aimed to assess the need for future revascularisation or all-cause mortality as a composite endpoint after CABG surgery among patients with previous stent implantation. Methods: A retrospective, non-randomised study was performed on 721 patients who underwent CABGin our centre between 2012 and 2017. This single-centre study compared two groups: 1) the previous stent group, patients with previous stent implantation (n=144), and 2) the non-previous stent group, patients without previous stent implantation (n=577). Results: After a median follow-up of 36 months, the previous stent group presented a decreased combined event-free survival at 1, 3 and 5 years compared with the non-previous stent group (67.4, 43.5 and 23.0% vs. 91.0, 80.3 and 63.0%, respectively; p Conclusions: Patients with percutaneous coronary intervention before CABG present higher comorbidities and clinical events during follow-up than those who do not undergo stenting.

The individual influence of a variety of comorbidities on COVID-19 patient outcomes has already been analyzed in previous works in an isolated way. We aim to determine if different associations of diseases influence the outcomes of inpatients with COVID-19. Retrospective cohort multicenter study based on clinical practice. Data were taken from the SEMI-COVID-19 Registry, which includes most consecutive patients with confirmed COVID-19 hospitalized and discharged in Spain. Two machine learning algorithms were applied in order to classify comorbidities and patients (Random Forest -RF algorithm, and Gaussian mixed model by clustering -GMM-). The primary endpoint was a composite of either, all-cause death or intensive care unit admission during the period of hospitalization. The sample was randomly divided into training and test sets to determine the most important comorbidities related to the primary endpoint, grow several clusters with these comorbidities based on discriminant analysis and GMM, and compare these clusters. A total of 16,455 inpatients (57.4% women and 42.6% men) were analyzed. According to the RF algorithm, the most important comorbidities were heart failure/atrial fibrillation (HF/AF), vascular diseases, and neurodegenerative diseases. There were six clusters: three included patients who met the primary endpoint (clusters 4, 5, and 6) and three included patients who did not (clusters 1, 2, and 3). Patients with HF/AF, vascular diseases, and neurodegenerative diseases were distributed among clusters 3, 4 and 5. Patients in cluster 5 also had kidney, liver, and acid peptic diseases as well as a chronic obstructive pulmonary disease; it was the cluster with the worst prognosis. The interplay of several comorbidities may affect the outcome and complications of inpatients with COVID-19.

Resumen: La comunicación interventricular postinfarto es la complicación mecánica del síndrome coronario agudo con mayor mortalidad. En la mayoría de ocasiones obtenemos el diagnóstico mediante la historia clínica y una prueba de imagen que suele ser la ecocardiografía. Pese a ello, las pruebas de imagen pueden ir sujetas a un error diagnóstico que ocasiona una demora en el tratamiento. Todas las pruebas tienen suma importancia para el diagnóstico de la enfermedad. Abstract: Post-infarction ventricular septal defect has the highest mortality of the mechanical complications in acute coronary syndrome. Most of the time a diagnosis is obtained with the medical history and imaging tests, usually cardiac ultrasound. Nonetheless, imaging tests can be subject to diagnosis errors that cause delays in treatment. All tests are very important for the diagnosis of the disorder.

Resumen: Introducción: La minitoracotomía anterior derecha es un abordaje alternativo a la esternotomía media para tratar dolencias mitrales, tricúspides y defectos interauriculares. Además de evitar las complicaciones asociadas a la esternotomía, este abordaje aporta ventajas estéticas y una recuperación precoz. Métodos: Realizamos un estudio observacional retrospectivo de toda nuestra serie de 106 pacientes intervenidos con una minitoracotomía anterior derecha entre enero de 2013 y junio de 2019. En los primeros 55 casos el procedimiento se realizó con visión directa y desde octubre de 2017 la cirugía fue videoasistida. Comparamos los datos perioperatorios de ambos grupos. Resultados: Los procedimientos fueron: 46 reparaciones mitrales, 30 recambios mitrales, 15 recambios tricúspides y 15 cierres de comunicaciones interauriculares. Dieciocho pacientes tenían cirugía cardíaca previa. El EuroSCORE I medio fue de 6,08. La mortalidad hospitalaria fue del 0,9% (un paciente). La reconversión a esternotomía se realizó en 6 pacientes. El tiempo medio de pinzamiento aórtico y circulación extracorpórea fue de 88 ± 27 y 137 ± 36 min, respectivamente. La estancia media hospitalaria fue de 5,8 ± 1,9 días. El 78% de los pacientes no recibió transfusión de hematíes. Cuando se compararon los resultados perioperatorios de los primeros 55 pacientes con el grupo de cirugía videoasistida (51 pacientes), la estancia hospitalaria y la transfusión de hematíes mejoró significativamente en el grupo videoasistido. Conclusiones: La minitoracotomía anterior derecha es una alternativa segura a la esternotomía, al menos con los mismos estándares de calidad y morbimortalidad postoperatoria. La introducción de una torre videotoracoscópica y la experiencia mejoraron los resultados iniciales. Abstract: Introduction: The right anterior mini-thoracotomy is an alternative approach to medial sternotomy to treat mitral pathology, tricuspid valve, and atrial septal defect. In addition to avoiding complications associated with sternotomy, this approach provides cosmetic advantages and early recovery. Methods: A retrospective observational study was performed on the entire series of 106 patients operated using a right anterior mini-thoracotomy between January 2013 and June 2019. In the first 55 cases the procedure was performed with direct vision, and from October 2017 the surgery was video-assisted. A comparison is made of the perioperative data of both groups. Results: The procedures performed were: 46 mitral repairs, 30 mitral replacements, 15 tricuspid replacements, and 15 atrial septal defect closures. Eighteen patients had previous cardiac surgery. The mean EuroSCORE I was 6.08. Hospital mortality was 0.9% (one patient). Conversion to sternotomy was performed in 6 patients. The mean aortic clamping time and bypass time was 88 ± 27 and 137 ± 36 minutes, respectively. The mean hospital stay was 5.8 ± 1.9 days. Only 22% of patients received a red blood cell transfusion. When the perioperative results of the first 55 patients were compared with the group in which video-assisted surgery was performed (51 patients), hospital stay and red blood cell transfusion improved significantly in the video-assisted group. Conclusions: The right anterior mini-thoracotomy is a safe alternative to sternotomy with at least the same standards of quality and postoperative morbidity and mortality. The introduction of a thoracoscopic camera and experience, improved the initial results. Palabras clave: Cirugía cardiaca, Minitoracotomía, Reparación mitral, Cirugía videoasistida, Visión directa, Keywords: Cardiac Surgery, Mini-thoracotomy, Mitral repair, Video-assisted surgery, Direct vision

Resumen Introduccion y objetivos Los resultados del estudio FREEDOM, fundamento de las guias de practica clinica, concluyen que la cirugia de revascularizacion coronaria es superior a la intervencion coronaria percutanea en pacientes diabeticos multivaso. El objetivo de este trabajo fue evaluar que porcentaje de pacientes de la vida real serian incluibles en dicho estudio y sus implicaciones pronosticas. Metodos Se siguio a 617 diabeticos multivaso, a los que se les habia realizado una coronariografia entre 2012 y 2014. Se clasificaron segun el cumplimiento de criterios para participar en dicho estudio y se analizo su impacto en la mortalidad y en los eventos cardiovasculares mayores. Resultados El 51,2% de los pacientes no cumplia los criterios de inclusion, tenian mas edad (69,3 frente a 66,1 anos; p Conclusiones Mas de la mitad de los diabeticos multivaso de la vida real no serian incluibles en un gran ensayo clinico, presentando 4 veces mas riesgo de muerte en el seguimiento.

Introduction and objectives: Nonagenarians are a fast-growing age group among cardiovascular patients, especially with aortic stenosis, but data about their prognosis after transcatheter aortic valve implantation (TAVI) is scarce. The objective of our study is to analyze the baseline characteristics of nonagenarians treated with TAVI and determine whether age ≥ 90 years is associated with a worse prognosis compared to non-nonagenarian patients. Methods: We included all patients ≥75 years enrolled in the multicenter prospective Spanish TAVI registry between 2009 and 2018. Patients < 75 years were excluded. Results: A total of 8073 elderly patients (≥ 75 years) from 46 Spanish centers were enrolled in the Spanish TAVI registry; 7686 were between ≥ 75 and < 90 years old (95.2%), and 387 were nonagenarian patients (4.79%). A gradual increase of nonagenarians was observed. The transfemoral access was used in 91.6% of the cases, predominantly among the nonagenarian patients (91.4% vs 95.1%, P = .01). Nonagenarians were more likely to die during their hospital stay (4.3% vs 7.0% among nonagenarians, P = .01). However, no difference was seen in the all-cause mortality rates reported at the 1-year follow-up (8.8% vs 11.3%, P =.07). In the multivariate analysis, age ≥ 90 years was not independently associated with a higher adjusted all-cause mortality rate (HR, 1.37, 95%CI, 0.91–1.97, P = .14). The baseline creatinine levels, and the in-hospital bleeding complications were all associated with a worse long-term prognosis in nonagenarians treated with TAVI. Conclusions: Nonagenarians are a very high-risk and growing population with severe AS in whom TAVI may be a safe and effective strategy. Careful patient selection by the TAVI heart team is mandatory to achieve maximum efficiency in this population where the baseline kidney function and bleeding complications may determine the long-term prognosis after TAVI.

Background Autonomic imbalance characterized by sympathetic predominance and decreased parasympathetic transmission is a classic feature of heart failure (HF) with reduced left ventricular ejection fraction, leading to disease progression, exercise intolerance, ventricular remodelling, arrhythmias, and premature death. The underlying mechanisms to these processes are not yet fully understood, but the current treatments influence this dysregulation, towards an inhibition of sympathetic hyperactivation. New therapies, such as the stimulation of carotid baroreceptors, enhance this inhibition to restore autonomic balance and to be able to cope with these mechanisms. Case summary We report the case of a 76-year-old male with advanced HF at an advanced stage, refractory to optimal treatment, and included in a programme of ambulatory infusions of Levosimendan as compassionate treatment. The patient presented with multiple episodes of decompensated HF secondary to ventricular arrhythmias. A multidisciplinary team decided to implant a baroreceptor stimulator device (Barostim Neo) in order to improve HF symptoms and quality of life, as well as trying to decrease the burden of arrhythmias. The procedure was performed with no complications and good therapeutic response, resulting in a significant reduction of arrhythmias. Discussion Treatment with a baroreceptor stimulating device is presented as a safe and effective option in our patients with advanced HF refractory to conventional treatment, to improve their quality of life and reduce symptoms; in addition to appearing as a promising option in those with arrhythmic events, which are difficult to control with usual treatments and procedures.

Resumen Objetivos Investigar la supervivencia y las complicaciones mayores cardiovasculares a 10 anos (muerte a 30 dias, accidente cerebrovascular, reoperacion protesica y sangrado mayor) en pacientes de 50 a 65 anos tras sustitucion valvular aortica aislada con protesis biologicas o mecanicas debido a estenosis aortica severa. Material y metodo Estudio analitico y retrospectivo de 721 pacientes procedentes de 5 centros con servicio de Cirugia Cardiovascular en Andalucia intervenidos entre los anos 2000 y 2015. Como criterios de exclusion se encuentran: la cirugia concomitante, las reintervenciones y la endocarditis. Se realiza posteriormente un pareado por puntuacion de propension 1:1 para obtener 2 grupos de 181 pacientes para su comparacion. Resultados El 26% recibio bioprotesis (n = 187), con un 35% de mujeres, y un Euroscore I medio de 2,5% para las protesis mecanicas versus un 2,9% para las biologicas (p = 0,05). La supervivencia a 10 anos fue del 70% para las biologicas versus el 78% para las mecanicas, con diferencias entre grupos (p = 0,02) a favor de las mecanicas, que desaparecen tras el pareado (2 grupos de 181 pacientes, log-rank p = 0,269). Las protesis mecanicas presentaron mas sangrado mayor (p = 0,01), con mayor reintervencion en las biologicas (p = 0,01). No hubo diferencias en accidente cerebrovascular (p = 0,660) ni en mortalidad a 30 dias (p = 0,08). El seguimiento medio fue de 6,7 ± 4,3 anos en el grupo mecanicas, y de 6,1 ± 3,1 anos en el grupo biologicas (p = 0,03). Conclusiones No existen diferencias en supervivencia a 10 anos. Las protesis mecanicas presentaron mayor sangrado mayor, y las bioprotesis mayor necesidad de reintervencion. Es preciso finalizar el estudio a 15 anos para confirmar estos datos.

Objectives To investigate long term survival (15 years) and major morbidity in patients aged 50–65 years undergoing primary isolated aortic valve replacement with bioprosthetic or mechanical valves. Methods A single center retrospective analytical study of all patients aged 50–65 years with severe aortic stenosis who underwent surgery between 2000 and 2015 was performed (n = 200). Two groups, mechanical (n = 117) and biological (n = 83) were obtained. Propensity score matching was performed for analysis. Primary outcome was survival, secondary outcome was major adverse cardiovascular complications (30-day mortality, stroke, any prosthesis-related reoperation and major bleeding). Results Mean age was 60 ± 4 years, 33% female, mean follow up was 8.2 ± 3 years (range 0–17 years). Matched overall survival was similar between groups, 65% at 15 years [Log Rank p = 0.71, hazard ratio 0.87 (95% CI, 0.41–1.82)]. After matching, mechanical prosthesis presented a trend toward of more major adverse cardiovascular complications (30% versus 15%, p = 0.07) with more major bleedings (15% versus 6.3%, p = 0.06), stroke 11% versus 7.6% (p = 0.44), and cardiac-related rehospitalization (33.7% versus 21.5%, p = 0.06). Reoperation was nonsignificant between groups (2.5% mechanical versus 6.3% bioprosthesis, with only 2 cases of structural valve degeneration). Follow up mean transprosthetic gradients were higher in the mechanical group (18 ± 6 versus 15 ± 7 mmHg, p = 0.01). Conclusions Among propensity matched patients there were no differences in survival between groups at 15 years. The mechanical prosthesis presented a trend toward twofold more major adverse cardiovascular complications specially due to major bleeding. Studies with larger sample sizes are needed to confirm these results.

Background During the last decade, the use of ministernotomy in cardiac surgery has increased. Quality of life and patient satisfaction after ministernotomy have never been compared to conventional full sternotomy in randomised trials. The aim of the study is to determine if this minimally invasive approach improves quality of life, satisfaction and clinical morbimortality outcomes. Methods/design The QUALITY-AVR trial is a single-blind, single-centre, independent, and pragmatic randomised clinical trial comparing ministernotomy (“J” shaped upper hemisternotomy toward right 4th intercostal space) to full sternotomy in patients with isolated severe aortic stenosis scheduled for elective aortic valve replacement. One hundred patients will be randomised in a 1:1 computational fashion. Sample size was determined for the primary end point with alpha error of 0.05 and with power of 90% in detecting differences between intervention groups of ≥ 0.10 points in change from baseline quality of life Questionnaire EuroQOL-index (EQ-5D-5 L®), measured at 1, 6 or 12 months. Secondary endpoints are: the differences in change from other baseline EQ-5D-5 L® utilities (visual analogue scale, Health Index and Severity Index), cardiac surgery specific satisfaction questionnaire (SATISCORE®), a combined safety endpoint of four major adverse complications at 1 month (all-cause mortality, acute myocardial infarction, neurologic events and acute renal failure), bleeding through drains within the first 24 h, intubation time, postoperative hospital and intensive care unit length of stay, transfusion needs during the first 72 h and 1-year survival rates. Clinical follow up is scheduled at baseline, 1, 6, and 12 months after randomization. All clinical outcomes are recorded following the Valve Academic Research Consortium 2 criteria. Discussion The QUALITY-AVR trial aims to test the hypothesis that ministernotomy improves quality of life, satisfaction and clinical outcomes in patients referred for isolated aortic valve replacement. Statistically significant differences favouring ministernotomy could modify the surgical “gold standard” for aortic stenosis surgery, and subsequently the need to change the control group in transcatheter aortic valve implantation trials. Recruitment started on 18 March 2016. In November 2017, 75 patients were enrolled. Trial registration ClinicalTrials.gov, NCT02726087. Registered on 13 March 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2486-x) contains supplementary material, which is available to authorized users.

Human respiratory syncytial virus (HRSV) is a ubiquitous ribonucleic acid (RNA) virus that represents the leading cause of acute lower respiratory infections (mainly bronchiolitis and pneumonia) in infants and young children worldwide. HRSV belongs to the Pneumovirinae subfamily within the Paramyxoviridae family of enveloped, negative-strand RNA viruses. Epithelial cells lining the nasal passages and respiratory tract are the primary target of HRSV infection, although alveolar macrophages and dendritic cells are also infected. Infected cells respond by producing a variety of cytokines, chemokines and interferons that are involved in the inflammatory response to HRSV. Although primary HRSV infection occurs at an early age, immunity is short-lived or incomplete and re-infections occur throughout life. Initial efforts to develop a vaccine based on formalin-inactivated HRSV resulted in vaccine-enhanced disease, and there is still no licensed prophylactic HRSV vaccine available. Key Concepts: Human respiratory syncytial virus (HRSV) is the leading cause of serious respiratory tract disease in children and infants worldwide. HRSV belongs to the Pneumovirinae subfamily within the Paramyxoviridae family of negative-strand RNA viruses. The HRSV genome comprises 10 genes that encode 11 viral proteins. HRSV derives its name from the formation of multinucleated, fused cells (syncytia), which are the hallmark of infection of cultured cells or lung tissue. Following attachment to the target cell, entry by HRSV is mediated by fusion of the viral envelope with the host cell plasma membrane at neutral pH. The entire replication cycle of HRSV takes place in the cytoplasm of the infected cell. Reverse genetics has permitted the recovery of infectious HRSV from complementary DNA. HRSV strains disseminate rapidly worldwide, accumulating mutations predominantly in the attachment protein, probably as a consequence of immune selection. Pathology associated with HRSV infections is not only the result of direct virus injury, but largely the consequence of an aberrant immune/inflammatory response. Palivizumab, a neutralising monoclonal antibody directed against HRSV fusion protein, is the only product available on the market for prophylactic treatment of children at high risk of severe infection. Keywords: negative-strand RNA viruses; subfamily Pneumovirinae; bronchiolitis; membrane fusion; pathogenesis; vaccines; antivirals

Resumen: Presentamos el caso de un varón de 51 años que es diagnosticado de enfermedad coronaria monovaso por una obstrucción total de la arteria descendente anterior prácticamente desde el ostium de la misma. Tras ser presentado en sesión clínica se opta por un abordaje quirúrgico mínimamente invasivo para la revascularización coronaria. Se realiza una disección endoscópica de la arteria mamaria y la anastomosis se efectúa a través de una minitoracotomía anterior izquierda de 5 cm. El paciente presenta un postoperatorio sin incidencias y es dado de alta al día 3.° de la cirugía. Abstract: We present a case of a male 51 years old who was diagnosed with a single vessel coronary disease by a totally obstruction of the left anterior descending artery from his ostium. We discuss the case in a clinical meeting and we chose a minimally invasive surgical approach for the coronary revascularization. We proceed to do an endoscopic harvesting of the mammary artery and the anastomosis is performed through a left anterior minithoracotomy of 5 cm. The patient had a successful postoperative recovery and was discharged in his 3rd postoperative day. Palabras clave: Disección endoscópica de la arteria mamaria, Cirugía mínimamente invasiva, Revascularización, Keywords: Endoscopic harvesting of the mammary artery, Minimally invasive coronary surgery, Revascularization

Background Oxidized low-density lipoproteins and scavenger receptors (SRs) play an important role in the formation and development of atherosclerotic plaques. However, little is known about their presence in epicardial adipose tissue (EAT). The objective of the study was to evaluate the mRNA expression of different SRs in EAT of patients with ischemic heart disease (IHD), stratifying by diabetes status and its association with clinical and biochemical variables. Methods We analyzed the mRNA expression of SRs (LOX-1, MSR1, CXCL16, CD36 and CL-P1) and macrophage markers (CD68, CD11c and CD206) in EAT from 45 patients with IHD (23 with type 2 diabetes mellitus (T2DM) and 22 without T2DM) and 23 controls without IHD or T2DM. Results LOX-1, CL-P1, CD68 and CD11c mRNA expression were significantly higher in diabetic patients with IHD when compared with those without T2DM and control patients. MSR1, CXCL16, CD36 and CD206 showed no significant differences. In IHD patients, LOX-1 (OR 2.9; 95% CI 1.6–6.7; P = 0.019) and CD68 mRNA expression (OR 1.7; 95% CI 0.98–4.5; P = 0.049) were identified as independent risk factors associated with T2DM. Glucose and glycated hemoglobin were also shown to be risk factors. Conclusions SRs mRNA expression is found in EAT. LOX-1 and CD68 and were higher in IHD patients with T2DM and were identified as a cardiovascular risk factor of T2DM. This study suggests the importance of EAT in coronary atherosclerosis among patients with T2DM.

Three virulent populations (CU194, SE193, and SE194) of the parasitic plant Orobanche cu-mana were inoculated onto four lines (KA-41, J-8281, HA-89, and RHA-273) of sunflower (Helianthus annuus L.). Pots were transferred to growth chambers set at 15, 19, 23, and 27°C. Emergence of broomrape plants and infection incidence were determinants of disease reaction. All broomrape populations were pathogenic to the sunflower lines KA-41, HA-89, and RHA-273, although differences in virulence were found. At 15 to 23°C, the populations of broomrape infected these three sunflower lines, but a delay in emergence of broomrape was found at 15°C; whereas, at 27°C, the level of infection was restricted. Only population CU194 infected the resistant line J-8281, with infection occurring mainly at 23 and 27°C, but few broomrape plants emerged. Our results suggest that the effect of temperature on the host-parasite relationship is complex.

Fifty-two isolates of Plasmopara halstedii Farl. Berl. & de Toni (causal agent of sunflower downy mildew) collected from sunflower (Helianthus annuus L.) in Spain from 1994 to 2000 were evaluated for metalaxyl resistance. The pathogen was identified on the basis of the morphology of the sporangiophores and zoosporangia recovered on the underside of the leaves (2). Metalaxyl (Apron 20% LS) at 2.0 g a.i./kg of seed (labeled European rate) was applied as seed dressing to the susceptible sunflower ‘Peredovik’. There were two replications of 40 plants, and the test was repeated three times. Inoculum (sporangia bearing zoospores) was produced on artificially inoculated plants. Seed were germinated in a humidity chamber at 28°C for 24 to 48 h. When the radicle was 0.5 to 1.0 cm long, untreated and treated seedlings were inoculated by dipping the entire plant in an aqueous suspension of 6.0 × 104 sporangia per ml for 4 h, planted in a sand/perlite mixture (2:3 vol/vol), and grown at 16 to 21°C with a 12-h photoperiod. Plants were incubated for 24 to 48 h at 100% relative humidity and 15°C in the dark to enhance sporulation. After 12 days, disease incidence (DI) of inoculated plants was determined as a percentage of plants displaying sporulation of the fungus on the cotyledons and/or true leaves (3). DI was 95 to 100% for the untreated seedlings, but mildew did not develop on seedlings treated with metalaxyl for 51 of the isolates. The remaining isolate caused symptoms on 67% of the treated plants. This isolate was tested in another experiment in which ‘Peredovik’ seed was treated with metalaxyl at 0, 0.5, 2.0, 3.5, and 5 g a.i./kg of seed. There were four replications of 12 seedlings per treatment, and seedlings were inoculated as described previously. DI in the untreated control was 77%, which was not significantly different from the DI for seed treated with metalaxyl at 0.5, 2.0, and 3.5 g a.i./kg of seed (97, 73, and 96%, respectively). DI for seed treated with metalaxyl at 5.0 g a.i./kg of seed was 37%, which was significantly lower than the other treatments. Although resistance of P. halstedii to metalaxyl has been reported in France (1), to our knowledge, this is the first report of resistance of sunflower downy mildew to metalaxyl in Spain. References: (1) J. M. Albourie et al. Eur. J. Plant Pathol. 104:235, 1998. (2) G. Hall, Mycopathologia 106:205, 1989. (3) M.L. Molinero-Ruiz et al. Plant Disease 86:736, 2002.

Fusarium wilt is a disease that restricts carnation (Dianthus caryophyllus L.) yield worldwide. Efficacies in reducing the Fusarium wilt of carnation (FWC), of various types of organic amendments (fresh or pelletized poultry manure, pelletized Brassica carinata and olive residue compost) combined with soil solarization, were compared in two biennial field trials conducted in a greenhouse with a history of carnation monoculture over 8 years. Soil treatments combining organic amendments and soil solarization significantly reduced disease incidence (86–99%) and increased the number of commercial carnation stems by 5–9 times compared to non-treated plots. Twenty-one Fusarium spp. isolates, with different colony morphologies were recovered from soil samples taken in the greenhouse, before the application of treatments in June 2013. Nineteen of them were morphological and molecularly characterized. Additionally, two pathogenicity tests with 17 isolates recovered from greenhouse soils and two isolates recovered from organic amendments were performed. Fusarium species associated with carnation cultivation were identified as Fusarium oxysporum (43%), Fusarium proliferatum (24%), and Fusarium solani (33%). The phylogenetic analysis of the translation elongation factor 1 alpha (EF-1α) region distinguished highly aggressive isolates of F. oxysporum f. sp. dianthi, from low aggressive isolates. The pathogenicity tests showed that FWC has a complex etiology, with several Fusarium spp. identified as causal agents. F. proliferatum and F. solani are associated with carnation wilt for the first time in Spain., Research supported by INIA projects RTA 2006-00011 and CC09-074 and EU FEDER founds.

ResumenEl envejecimiento de la población ha aumentado el número de cirugías sobre la válvula aórtica. Durante los últimos 20años la técnica quirúrgica ha evolucionado hacia una menor agresión corporal, apareciendo nuevos tipos de cirugía aórtica mínimamente invasiva (CMIAo). De todas estas técnicas, la hemiesternotomía superior (HES), o miniesternotomía, se ha convertido en la más utilizada, seguida por la minitoracotomía anterior derecha (MTA). Ambas, comparadas con la cirugía convencional, han demostrado una recuperación más rápida, mejor resultado cosmético, menor estancia hospitalaria y en UCI, mejor función respiratoria, menor pérdida de sangre y transfusiones, e incluso menor mortalidad precoz y tardía. A pesar de estos avances, su uso no se ha extendido definitivamente debido a un incremento en los tiempos de isquemia y de circulación extracorpórea (CEC) necesarios en estos procedimientos más complejos. La aparición de las prótesis sin sutura «Sutureless» de nueva generación puede solventar este contratiempo al reducir hasta en un 43% los tiempos de isquemia y CEC, y permitir que la CMIAo se expanda y sea una alternativa real a las válvulas transcatéter (TAVI) en los pacientes de alto riesgo operables. A pesar de que son recomendables ensayos clínicos prospectivos aleatorizados para confirmar estos datos, existe suficiente evidencia disponible como para considerar la CMIAo (sobre todo la HES) como el gold standard actual para la sustitución valvular aórtica aislada.AbstractThe aging of the population has led to an increase in the number of surgeries on the aortic valve. During the past 20years the surgical technique has progressed to less aggressive techniques, with new types of minimally invasive aortic valve surgery (MIAVR) emerging. Of these techniques, the upper hemi-sternotomy (UHS) or mini-sternotomy has become the most commonly used, followed by the right anterior thoracotomy (RAT). Compared with conventional surgery, both have shown a faster recovery, better cosmetic results, shorter hospital and ICU stay, better respiratory function, reduced blood loss and transfusions, as well as lower early and late mortality. Despite these advances, their use has not been definitively extended, due to an increase in the ischaemia and cardiopulmonary bypass (CPB) times needed in these more complex procedures. The emergence of new generation sutureless prosthesis can overcome this setback by reducing the ischemic and CPB by up to 43%, and allows MIAVR to expand and become a real alternative to the transcatheter valves (TAVI) in high risk operable patients. Although prospective randomised controlled trials are required to confirm these data, there is sufficient available evidence to consider MIAVR (especially UHS) as the current reference method for isolated aortic valve replacement.

ResumenFundamentoLa cirugía valvular aórtica aislada mínimamente invasiva mediante miniesternotomía superior se está generalizando debido a ventajas respecto a la cirugía convencional. Analizamos los resultados a 2 años en nuestro centro tras la implementación de la técnica en noviembre del 2013.MétodosEstudio observacional analítico retrospectivo de 92 pacientes consecutivos intervenidos de sustitución valvular aórtica aislada por estenosis aórtica severa, desde noviembre del 2013. Se obtuvieron 2 grupos (grupo miniesternotomía y grupo convencional) de 40 pacientes mediante puntuación de propensión para su comparación (objetivo primario compuesto de 6 complicaciones cardíacas y cerebrovasculares mayores, y secundarios como tiempos de circulación extracorpórea e isquemia, tiempo intubación, sangrado en 24h, transfusiones y supervivencia).ResultadosLa mediana de los tiempos de circulación extracorpórea e isquemia fueron 15 y 10 min más largos en el grupo miniesternotomía (89 [75-110] y 74 [64-90] vs. convencional 65 [55-73] y 55 [47-63] min, respectivamente, p

ResumenLa enfermedad degenerativa de la válvula aórtica es cada vez más frecuente en nuestro medio. El tratamiento quirúrgico clásico consiste en la sustitución de la válvula por algún tipo de injerto mecánico o biológico. La reparación valvular, aunque no sea una opción posible en todos los pacientes, ofrece ventajas en cuanto a morbimortalidad, ofreciendo resultados duraderos a medio y largo plazo.En el presente artículo intentaremos establecer una guía de ayuda para decidir si la válvula –y el paciente– a los que nos enfrentamos pueden y deben repararse o no.AbstractAortic valve degnerative disease is increasingly prevalent in our environment. The stablished surgical treatment for this disease is valve replacement with a biological or mechanical substitute. Valve repair, although not always feasible, is superior to replacement in terms of morbidity and mortality with good medium and long term durabilities.This paper pretends to be an aid guide for those starting with aortic valve repair, to help them evaluate both the valve and the patient in order to decide what to do: repair or to replace.

Human respiratory syncytial virus (hRSV) remains one of the most prevalent human pathogens for which a vaccine is still missing. After several decades of hesitant efforts, particularly after the harmful effects of a formalin-inactivated hRSV vaccine trial in the 1960s, hRSV vaccine development has received new impetus from structure-based studies of its main protective antigen: the fusion (F) glycoprotein. This article reviews studies done with hRSV F, either in pieces (e.g. epitopes) or as soluble or membrane-anchored molecules folded in different conformations or presented under different forms. Knowledge gained from these studies has provided the basis for novel vaccines that are now in different phases of development and has generated tools and reagents for developing other control measures such as prophylactic or therapeutic antibodies against this virus, which remains the most important cause of hospitalization in infants and one of the leading global causes of infant mortality.

Resumen Presentamos el caso de una paciente de 44 anos, con insuficiencia mitral severa por prolapso de P2. Realizamos una reparacion mitral mediante reseccion cuadrangular y anuloplastia con anillo, a traves de auriculotomia izquierda en surco. La paciente se extuba a las 6 h, presentando buena hemodinamica sin aminas. Se realiza ecocardiograma a las 24 h confirmando el buen resultado de la cirugia. Se intenta retirar el cateter de Swan-Ganz sin exito, por lo que se decide reintervencion. En el quirofano se intenta retirar el cateter de manera directa comprobandose que se encuentra firmemente fijado. Se decide entrar en bypass y sin isquemia se realiza una auriculotomia derecha comprobando que se encuentra incluido en la sutura de cierre de la auriculotomia izquierda. Cortamos el cateter a nivel de la sutura y, con la ayuda de un gancho de nervio, se consigue movilizar y retirar el mismo. No fue necesario rehacer la sutura de la auriculotomia, por lo que se consiguio evitar el pinzamiento aortico. La paciente se volvio a extubar a las 4 h, siguiendo un curso postoperatorio satisfactorio y siendo dada de alta a los 5 dias.

Rosellinia necatrix Prill. is the causal soil-borne agent of avocado white root rot disease. This work proposes a new method of treatment with fungicide to combat this disease, aimed to obtain a quantitative assessment of the evolution of fungal inoculum in soil samples. A total of 39 avocado trees were selected from five commercial orchards affected by R. necatrix. Root samples were collected to recover R. necatrix isolates. The fluazinam treatments were applied around each tree by soil injection, and soil samples were collected before and after each fungicide application to analyze the evolution of the fungus by qPCR. In addition, two samplings of avocado fruits during two harvesting seasons were performed to measure the chemical residues. All 24 R. necatrix isolates taken from avocado roots were pathogenic. The qPCR quantification results showed that the percentage of fungal inoculum in the soil was significantly lower after the first fluazinam treatment compared to that before any fungicide had been applied. Furthermore, soil from non-treated avocado trees did not show any significant differences in the concentration of fungal inoculum. The chemical analysis of the fruits did not show residues. These results provide growers with a new method to control this soil-borne pathogen in crops., This study was partly supported by the Spanish Plan Nacional I+D+I Ministerio de Economía y Competitividad (AGL 2014-52518-C2-2-R). The research was also co-financed by FEDER funds (EU). The authors would like to thank Dr. Fernando Lafont Déniz for his technical assistance on fungicide residual detection, TROPS and PROJOCASA S.A. for their technical support, especially in the location of the orchards, and ISK Biosciences Europe S.A. for providing the fungicide fluazinam needed to carry out this work.

[Objectives]: The decision about whether to use a biological or a mechanical prosthesis for aortic valve replacement remains controversial in patients between 50 and 65 years of age and has yet to be addressed in a Mediterranean population. This research aimed to analyse long-term survival and major morbidity rates (30-day mortality, stroke, any prosthetic reoperation and major bleeding) within this population. [Methods]: Our multicentre observational retrospective study included all subjects aged 50–65 years who had a primary isolated aortic valve replacement due to severe aortic stenosis at 7 public hospitals from Andalusia (Spain) between 2000 and 2015. Concomitant surgery, reoperations and endocarditis were the exclusion criteria. A total of 1443 patients were enrolled in the study (272 with biological and 1171 with mechanical valves). Multivariate analyses including a 2:1 propensity score matching (506 mechanical and 257 biological prostheses) were conducted. [Results]: Bioprostheses were implanted in 18.8% (n = 272): 35% were women; the mean EuroSCORE-I was 3%. The mean follow-up was 8.1 ± 4.9 years in a matched sample: 8.8 ± 4.9 years in those receiving a mechanical vs 7.1 ± 4.5 years in those receiving a biological prosthesis (P = 0.001). In the paired sample, the 15-year survival rate was 73% in those who had a biological vs 76% in those who had a mechanical valve [hazard ratio (HR) 0.80, 95% confidence interval (CI) 0.54–1.20; P = 0.159]. No significant differences were observed in patients ≥55 years old (74% of 15-year survival in both groups: HR 0.88, 95% CI 0.56–1.34; P = 0.527). A higher rate of major bleeding was found in patients with a mechanical prosthesis (P = 0.004), whereas reoperation was more frequent among those with a biological prosthesis (P = 0.01). [Conclusions]: Long-term survival was comparable in patients above 55 years of age. Mechanical prostheses were associated with more major bleeding and bioprostheses, with more reoperations. A bioprosthesis in patients above 55 years old is a reasonable choice., This work was supported by Edwards Lifesciences, which provided funds for an independent statistical analysis.

The aim of our study was to assess the outcomes of surgical treatment for severe tricuspid regurgitation according to whether cardiac surgery had been performed before the tricuspid valve intervention. Between 1996 and 2013, 201 consecutive patients with severe tricuspid regurgitation underwent tricuspid surgery at our center. Patients were classified according to whether or not they had undergone previous cardiac surgery, which 33% of the sample had. Perioperative as well as long-term morbidity and mortality were analyzed. Mean patient age was 62.3 years. 32.8% underwent suture annuloplasty, 41.3% underwent ring annuloplasty, 15.4% received a bioprosthesis, and 10.4% received a mechanical prosthesis. There were no significant differences in perioperative mortality between the group that had not undergone previous cardiac surgery and the group that had (12.7% vs. 17.9%, respectively; p = 0.32). The long-term mortality rate (median follow-up time: 53 months) was 43.3%. Long-term survival curves showed no significant differences between the two groups (p = 0.884), and previous cardiac surgery was not a predictive factor for long-term mortality (hazard ratio = 1.211; p = 0.521). In a series of patients who underwent tricuspid valve surgery, no significant differences were observed in perioperative mortality or in long-term survival according to whether or not subjects had undergone previous cardiac surgery.