Showing papers by "Hospital Universitario La Paz published in 2022"

Omicron and Thrombosis in Children: Cause for Concern?

Abstract: To the Editors: We have recently diagnosed 2 cases of cerebral venous sinus thrombosis in children with a positive severe acute respiratory syndrome (SARS)-CoV-2 reverse transcription polymerase chain reaction during the emergence of the Omicron variant in our country. Large studies have proven that coronavirus disease 2019 (COVID-19) can cause, in severe cases, thrombotic complications in adults.1 However, these hematologic disorders have been so far exceptional in children with the last predominant virus variants.2,3 Since the beginning of the pandemic, only 4 cases of venous thrombosis have been reported in Spain in children with SARS-CoV-2 infection.2 Two of these children associated several significant thrombotic risk factors, and the other 2 were female teenagers, one of whom had lupus anticoagulants. Nevertheless, since the emergence of the Omicron variant, 2 new cases of thrombosis, in a 7- and 11-year-old healthy boys were recorded in our country in December 2021. In these 2 new cases, severe cerebral venous sinus thrombosis occurred in relation with a concomitant complicated sinusitis, requiring both of them intensive care unit admission at diagnosis. In the case of the 7-year-old patient, cavernous sinus and both internal jugular veins were affected (Fig. 1). The oldest patient presented a superior sagittal sinus thrombosis (Fig. 2). Both patients had a close contact with a COVID-19 case and a positive SARS-CoV-2 reverse transcription polymerase chain reaction when the hematologic disorders were diagnosed. The Omicron variant was confirmed by genomic sequencing in the first case. In the other patient, the virus could not be sequenced but infection by the Omicron variant is highly likely, as this variant represented during the week (December 20–26) around the 80% of cases of COVID-19.4FIGURE 1.: Axial enhanced computed tomography (CT) show cavernous sinus and both internal jugular veins thrombosis. (A) Thrombosis of bilateral internal jugular veins evidenced by intraluminal nonocclusive filling defects and (B) filling defects in both cavernous sinuses and irregularity of the intracavernous internal carotid arteries (arrowheads).FIGURE 2.: Subacute thrombus of the superior sagittal sinus. A, Sagittal T1-weighted magnetic resonance (MR) image and multiplanar reconstructions (right), (B) coronal T2-weighted, and (C) axial fluid-attenuated inversion recovery MR images show an area of abnormal increased signal intensity in the anterior part of the superior sagittal sinus (arrows).Both cases were treated with endoscopic sinus surgery, intravenous broad-spectrum antibiotics, and anticoagulation therapy. The evolution was favorable, and they were discharged after 2 weeks of admission with oral antibiotics and anticoagulation treatment, which will be continued for at least three months. Thrombophilia workup was performed in both patients with normal results. These 2 new cases of thrombosis in such a short period of time coinciding with the emergence of the Omicron variant, make us wonder whether this is just a coincidence or whether this new variant is associated with an increased risk of thrombus formation. More studies are needed to analyze this possible association, but meanwhile pediatricians must be aware of similar cases in children with no comorbidities during the Omicron outbreak.

The current role of the virtual elements of artificial intelligence in total knee arthroplasty

Abstract: The current applications of the virtual elements of artificial intelligence (AI), machine learning (ML), and deep learning (DL) in total knee arthroplasty (TKA) are diverse. ML can predict the length of stay (LOS) and costs before primary TKA, the risk of transfusion after primary TKA, postoperative dissatisfaction after TKA, the size of TKA components, and poorest outcomes. The prediction of distinct results with ML models applying specific data is already possible; nevertheless, the prediction of more complex results is still imprecise. Remote patient monitoring systems offer the ability to more completely assess the individuals experiencing TKA in terms of mobility and rehabilitation compliance. DL can accurately identify the presence of TKA, distinguish between specific arthroplasty designs, and identify and classify knee osteoarthritis as accurately as an orthopedic surgeon. DL allows for the detection of prosthetic loosening from radiographs. Regarding the architectures associated with DL, artificial neural networks (ANNs) and convolutional neural networks (CNNs), ANNs can predict LOS, inpatient charges, and discharge disposition prior to primary TKA and CNNs allow for differentiation between different implant types with near-perfect accuracy.

Spanish National Registry of Paediatric Coeliac Disease: Changes in the Clinical Presentation in the 21st Century

Abstract: Objectives: Over the last several decades, there has been a tendency towards a predominance of less symptomatic forms of coeliac disease (CD) and an increase in the patient age at diagnosis. This study aimed to assess the clinical presentation and diagnostic process of paediatric CD in Spain. Methods: A nationwide prospective, observational, multicentre registry of new paediatric CD cases was conducted from January 2011 to June 2017. The data regarding demographic variables, type of birth, breast-feeding history, family history of CD, symptoms, height and weight, associated conditions, serological markers, human leukocyte antigen (HLA) phenotype, and histopathological findings were collected. Results: In total, 4838 cases (61% girls) from 73 centres were registered. The median age at diagnosis was 4 years. Gastrointestinal symptoms were detected in 71.4% of the patients, and diarrhoea was the most frequent symptom (45.9%). The most common clinical presentation was the classical form (65.1%) whereas 9.8% ofthe patients were asymptomatic. There was a trend towards an increase in the age at diagnosis, proportion of asymptomatic CD cases, and usage of anti-deamidated gliadin peptide antibodies and HLA typing for CD diagnosis. There was, however, a decreasing trend in the proportion of patients undergoing biopsies. Some of these significant trend changes may reflect the effects of the 2012 ESPGHAN diagnosis guidelines. Conclusions: Paediatric CD in Spain is evolving in the same direction as in the rest of Europe, although classical CD remains the most common presentation form, and the age at diagnosis remains relatively low.

Prognosis Stratification Tools in Early-Stage Endometrial Cancer: Could We Improve Their Accuracy?

Abstract: There are three prognostic stratification tools used for endometrial cancer: ESMO-ESGO-ESTRO 2016, ProMisE, and ESGO-ESTRO-ESP 2020. However, these methods are not sufficiently accurate to address prognosis. The aim of this study was to investigate whether the integration of molecular classification and other biomarkers could be used to improve the prognosis stratification in early-stage endometrial cancer. Relapse-free and overall survival of each classifier were analyzed, and the c-index was employed to assess accuracy. Other biomarkers were explored to improve the precision of risk classifiers. We analyzed 293 patients. A comparison between the three classifiers showed an improved accuracy in ESGO-ESTRO-ESP 2020 when RFS was evaluated (c-index = 0.78), although we did not find broad differences between intermediate prognostic groups. Prognosis of these patients was better stratified with the incorporation of CTNNB1 status to the 2020 classifier (c-index 0.81), with statistically significant and clinically relevant differences in 5-year RFS: 93.9% for low risk, 79.1% for intermediate merged group/CTNNB1 wild type, and 42.7% for high risk (including patients with CTNNB1 mutation). The incorporation of molecular classification in risk stratification resulted in better discriminatory capability, which could be improved even further with the addition of CTNNB1 mutational evaluation.

Determinants of Disclosure, Adherence and Viral Suppression in Children and Adolescents Living With HIV in Ecuador

Abstract: Studies on HIV disclosure and adherence among children performed in Latin America are anecdotal. We aimed to assess the factors associated with HIV disclosure, adherence and viral suppression among Ecuadorian children and compare the psychologic consequences and the impact on adherence and viral suppression of early against late disclosure age.Cross-sectional study using a questionnaire and collected data on medical records of HIV-infected children between 6 and 21 years of age in Ecuador.In 250 children included, HIV diagnosis was revealed at a median age of 11 years (p25-p75 9-12). Children 12 years old or older (P < 0.0001), 10 or more years since HIV diagnosis (P = 0.001), antiretroviral initiation above 3 years of age (P = 0.018) and decease of the mother (P = 0.048) were significantly associated with total disclosure in multivariate analysis. Profound sadness or anxiety was significantly more common when diagnosis was disclosed after 12 years of age (28.4%) than before (15.4%, P = 0.047). According to the simplified medication adherence questionnaire, 194 children (78.2%) were adherent to antiretroviral therapy and HIV-RNA viral load was undetectable in 168 (67.7%). In multivariate analysis, variables associated with nonadherence were age ≥14 years (P < 0.001), taking ≥3 daily antiretroviral pills (P = 0.013) and the presence of adverse effects (P < 0.001), whereas nonadherence (P = 0.001) was the only variable significantly associated with an unsuppressed HIV-RNA viral load.Although we failed to show that an earlier disclosure age is followed by better adherence outcomes, psychological outcomes did seem to improve, supporting disclosure before 12 years of age.

Suicidal and accidental drug poisoning mortality among older adults and working-age individuals in Spain between 2000 and 2018

Abstract: Although medication poisoning in older adults is considered an increasingly important, but preventable cause of death, it has received relatively little attention. We explored recent trends and correlates of suicidal and accidental fatal drug poisonings among older and working-age individuals using nationwide data from Spain.We identified all 15,353 fatal drug poisonings involving decedents aged ≥15 years in Spain between 2000 and 2018 and divided them by age into older adults (≥65 years) and working-age (15-64 years) individuals. For each age group, we analyzed time trends in suicidal and accidental fatal drug poisoning rates (overall and by ICD-10 drug categories) using joinpoint regressions. To understand the specific drugs classified as "Non-psychotropic/non-specified", we used 2018 data including substance-specific ICD-10 supplementary codes. We explored relevant sociodemographic correlates of suicidal and accidental fatal poisoning rates using multivariable negative binomial regressions.Between 2000 and 2018, suicidal fatal poisonings increased faster among older (from 0.19 to 0.63 per 100,000 - average annual change: 7.7%) than working-age individuals (from 0.40 to 0.72 per 100,000 - average annual change: 3.8%). Accidental fatal poisonings increased among older adults (from 0.25 to 2.67 per 100,000 - average annual change: 16.2%) but decreased among working-age counterparts (from 2.38 to 1.42 per 100,000 - average annual change: - 1.9%). Anticoagulants and cardiac-stimulants glycosides accounted for 70% of the 223 accidental fatal poisonings due to non-psychotropic/non-specified drugs registered among older adults in 2018. Roles of gender and urban dwelling in suicidal and accidental poisonings were heterogeneous across age groups.Increases in suicidal drug poisonings were faster among older than working-age individuals. Accidental fatal poisonings increased only among older adults. Our findings that (i) sociodemographic correlates were heterogeneous across age groups and (ii) anticoagulant and cardiac-stimulant glycosides were particularly salient drivers of accidental poisonings among older adults have implications for prevention.

Randomized, Double-Blind, Placebo-Controlled Study to Assess the Effect of Two Probiotics on the Preterms’ Gut Microbiota

Abstract: To evaluate the effect of a new probiotic strain combination, Ligilactobacillus salivarius subsp infantis PS11603 and Bifidobacterium longum PS10402, on gut bacterial colonization of preterm infants.A randomized, double-blind, placebo-controlled study was conducted in preterm infants from 28 weeks + 0days to 30 weeks + 6days of gestation. Thirty preterm infants were randomly selected after birth to receive either probiotics or placebo. Stool samples were collected before product intake and then sequentially during the first weeks of their admission. Classical microbiological, metagenomics and multiplex immunological analyses were performed to assess the bacterial and immune profile of the samples.Twenty-seven infants completed the study (14 vs 13, probiotic and placebo groups). A higher number of participants were colonized by Lactobacilli in the probiotic group than in the placebo group (93% vs 46%; P = 0.013). Similar results were obtained when analysing bifidobacterial colonization (100% vs 69%; P = 0.041). Earlier colonization was observed in the probiotics group versus the placebo group, specifically 5 weeks for Lactobacillus and 1 week for Bifidobacterium. Although no effect was observed in the faecal immunological profile, a decreasing trend could be observed in Th17 response during the first week of probiotic treatment. None of the adverse events (AEs) registered were related to product intake.Probiotic supplementation with L salivarius PS11603 and B longum subsp. infantis PS10402 enhanced an earlier colonization of Lactobacillus and Bifidobacterium in preterm infants' guts in 5 and 1 week, respectively. A higher number of infants were colonized by Lactobacilli with the probiotics' intake at the end of the study.

Historia de la protección del patrimonio arquitectónico en España. 1933-1985

Abstract: El trabajo de investigación que presentamos tiene como principal objetivo, la recopilación, el registro, el análisis y la reflexión sobre una época, tan trascendental como poco estudiada desde el ámbito arquitectónico, como es el período comprendido entre las dos normas de mayor relevancia en relación a la protección del Patrimonio Histórico Español del último siglo. Nos referimos a la Ley sobre Defensa, Conservación y Acrecentamiento del Patrimonio Histórico Nacional de 13 de mayo de 1933 y la Ley 13/1985, de 25 de junio, del Patrimonio Histórico Español. A través de la investigación realizada, se pretende aportar una visión integral de esta etapa, desde el enfoque arquitectónico, fundamentando la misma en el desarrollo de pautas metodológicas, abordadas desde la recopilación exhaustiva del material bibliográfico y documental para su posterior análisis. A partir de esta fase inicial, se han identificado los nexos comunes entre los estudios existentes sobre el patrimonio monumental español previos a la Guerra Civil y las investigaciones dedicadas a la historia de las últimas décadas del siglo XX. De esta forma, se ha procurado trazar un “puente” documental, con el que trasponer virtualmente el vacío bibliográfico existente. Históricamente, la protección del patrimonio histórico edificado y urbano, ha preocupado y ocupado a multitud de profesionales que, desde disciplinas dispares, han emprendido la tarea ímproba de comprender y explicar cuáles han sido los avatares, históricos y legales, que han marcado su evolución. Tal preocupación ha generado una bibliografía ingente y diversa, desde la protección formal y precisa, sobre uno u otro material, pasando por el marco historiográfico de las tendencias conservacionistas y las teorías decimonónicas, las filigranas formadas por las cuantiosas normas promulgadas desde la Novísima Recopilación, hasta la incidencia del planeamiento urbano en la tutela del patrimonio, incluidas la trama de competencias y yuxtaposiciones administrativas. Documentos de toda índole y profundidad científica, que como mosaicos hispanomusulmanes, dibujan el panorama patrimonial en el que la criba de material resulta una tarea, en ocasiones, inextricable. El título de este documento, en sí mismo, circunscribe la materia que ha sido el objeto de análisis durante el proceso de investigación, el Patrimonio Arquitectónico Monumental. El eje o núcleo basal de estudio se sitúa en los bienes inmuebles, los edificados, que, a su vez, ostentan la declaración de Bien de Interés Cultural, y que, por ende, pertenecen al Patrimonio Histórico Español. La metodología de trabajo se ha desarrollado de forma concéntrica, desde aspectos generales de la protección del patrimonio monumental, como el marco legal que antecede a la promulgación de la Ley de 1933, y el estado previo de los bienes susceptibles de ser preservados. Reconocemos en el ámbito legislativo, el fundamento orgánico que regula y dirige la tutela del patrimonio histórico español y la acción conservadora, y que delimita el ámbito a partir del cual se condiciona el devenir de los bienes culturales. Del esquema de situación surgido del análisis previo, se han detectado los factores claves en la transición hacia la Ley de Patrimonio Histórico Español; la evolución conceptual del “Patrimonio”, como apreciación genérica, y el testimonio de este progreso a través de los valores históricos, artísticos y culturales. El presente documento de investigación, consta de una primera fase, correspondiente al Capítulo 1, que se ha desarrollado a partir, principalmente, de la ordenación jurídica que rige el Patrimonio Histórico Español, a través de leyes, decretos, órdenes y disposiciones anexas, complementado con el material bibliográfico dedicado a la revisión histórica del proceso legal de la protección del patrimonio histórico-artístico. Si bien no ha sido nuestro propósito realizar un estudio pormenorizado del volumen jurídico e histórico que precede a la Ley de 1933, y que da inicio al período de estudio de la presente investigación, sí lo ha sido centrarnos en la elaboración de un extracto de aquellos elementos de la doctrina de mayor relevancia y repercusión en la protección del patrimonio histórico-artístico y/o monumental español. A lo largo de este estudio hemos comprobado lo que algunos juristas ya habían planteado, acerca de la profunda dispersión, ramificación, y diversificación de esfuerzos, tanto en la legislación específica como en la urbanística. Esta disgregación se ha extendido al ámbito de las medidas de reconocimiento caracterizado por la elaboración de múltiples catálogos e inventarios, con desigual transcendencia, alcance y utilidad. El resultado ha sido una división de esfuerzos, desdibujando el objetivo y convirtiendo la acción del reconocimiento en múltiples empresas inconexas y de escasa trascendencia. Nuestra investigación avanza en el análisis de la protección del patrimonio, como concepto globalizador, con el desarrollo del Capítulo 2, en el que se incluye una serie de mecanismos directos e indirectos que, individualmente, suelen carecer de la fuerza efectiva que muchos de los monumentos o conjuntos monumentales requieren para sobrevivir al paso del tiempo y sus circunstancias. En primer lugar, en este segundo capítulo nos hemos centrado, específicamente, en el mecanismo regulado por la Ley del Patrimonio Histórico Español, y el régimen general de protección implementado a partir de su promulgación en 1985. En especial, consideraremos la declaración de Interés Cultural como grado máximo de protección y tutela de un bien, y su posterior inscripción en el Registro General correspondiente, dependiente del Ministerio de Educación, Cultura y Deporte. Este mecanismo representa el instrumento por antonomasia que condensa las facultades de tutela del Estado sobre un bien del que se considera poseedor y aglutinador de valores “culturales” —como cohesión de los valores históricos, artísticos, sociales, etc. — representativos de la idiosincrasia española, y sobre el cual no existen dudas sobre la necesidad de garantizar su permanencia a través de su conservación. En segunda instancia, hemos analizado el Planeamiento Urbanístico, como aglutinador de valores culturales contenidos en la ciudad y como contenedor de los efectos generados por el hombre a partir de su interacción con el medio en el que habita y se relaciona. En tercer término, hemos recopilado y estudiado la concepción de los catálogos, como noción genérica de protección. Desde hace siglos, este género ha estado definido como una herramienta capaz de intervenir en la protección del patrimonio histórico, aunque de una manera difícilmente cuantificable, mediante la identificación, enumeración y descripción de una tipología concreta de monumentos o grupos de ellos, contribuyendo al reconocimiento de los valores cualitativos contenidos en éstos. El tercer capítulo analiza el mecanismo directo de tutela que ejerce la Administración en el patrimonio monumental. La declaración de monumentalidad o de Bien de Interés Cultural y su inclusión en el Registro General de Protección. La protección teórica y la protección jurídica de un monumento, analizadas hasta el momento, resultan tan necesarias como pueriles si no van seguidas de su consumación. En el caso de este tipo de patrimonio monumental, toda acción que tenga como objeto resguardar los valores implícitos en un bien mueble o inmueble, y en su materia, implica el cumplimiento de la protección. Por último, el cuarto capítulo se convierte en el punto culminante, y por ende crucial, del proceso de protección del Patrimonio Cultural, el de la consumación de la intervención. La teoría, la crítica, la normativa y hasta las doctrinas más radicales en materia de protección del patrimonio cultural, carecen de sentido si no las suceden los hechos, la acción, en antítesis a la omisión o la desidia. De ello ha dado pruebas elocuentes la propia historia en multitud de ocasiones con la destrucción, por indolencia o desconocimiento, de importantes vestigios del patrimonio arquitectónico español. Por este motivo, y para ser consecuentes con nuestra tesis hemos recuperado, concentrado y analizado la documentación de obra de tres monumentos imprescindibles del patrimonio construido (la Catedral de Burgos, el Palacio-Castillo de la Aljafería en Zaragoza y la Muralla de Lugo). En ocasiones, al examinar retrospectivamente las intervenciones en monumentos de gran envergadura, física y cultural como catedrales o murallas, algunos investigadores han tenido la sospecha o prevención de que las actuaciones no han seguido un plan de actuación premeditado, sino que han sido el resultado de impulsos o arrebatos inconexos producto de la urgencia por remediar algún tipo de deterioro. En oposición a esto, y a través del estudio de las intervenciones llevadas a cabo en los tres monumentos mencionados, hemos podido corroborar que, a excepción de intervenciones de emergencia fruto de circunstancias puntuales, existe coherencia desde el proceso de análisis de situación de un bien a la designación de prioridades, que ha regido el proceso restaurador a lo largo de dos siglos. La evolución de las intervenciones realizadas en los monumentos analizados ha estado definida, además de por su complejidad, magnitud y singularidad constructiva, por el devenir de su estructura y su uso. En conclusión, la efectividad de la protección del patrimonio cultural español, radica en la concomitancia de múltiples aspectos, entre ellos: el cumplimiento acertado de las normas vigentes, específicas y accesorias; el conocimiento del bien y de sus valores históricos, artísticos, y culturales; su catalogación o inclusión en los inventarios correspondientes; el compromiso de los agentes e instituciones de los cuales depende; la planificación de las tareas necesarias que garanticen tanto la salvaguarda estructural como la conservación de sus valores; y la incorporación de un plan de seguimiento que permita detectar eventuales peligros que atenten contra su conservación. Pero, la situación óptima estaría dada por un sistema en el que estos mecanismos —regulaciones específicas y urbanísticas, Declaraciones de Bien de Interés Cultural, Catálogos e Inventarios, etc. — funcionaran, de forma parcial o total, como una maquinaria, donde cada pieza operara con independencia relativa, pero en sintonía con los demás engranajes. Hasta el momento, la realidad dista mucho de esta situación, convirtiendo esta convivencia en una utopía. Tanto los legisladores, como las autoridades y los técnicos involucrados, deben tener presente que, de ellos, de los parámetros asignados por la legislación, de la implementación de los instrumentos estipulados por ésta y de las decisiones tomadas por cada uno de los poderes directivos de los órganos competentes, dependerá el alcance y efectividad de la protección, ya que en cada vertiente existe, en mayor o menor medida, un porcentaje de interpretación y subjetividad. ABSTRACT The research that we present has as the main objective to collect, record, analyzed and reflection on a time, that was little studied from the architectural field. It is the period between the two laws of most relevance to the protection of Spanish Historical Heritage of the last century. We refer to the Law on the Protection and Conservation of National Heritage of 1933 and Law 16/1985 of Spanish Historical Heritage. Through this research, it aims to provide a comprehensive view of the stage from the architectural approach, basing it on the development of methodological guidelines. The investigation was initiated by the bibliography and documentary for further analysis. After this initial phase, we have identified the common links between existing studies on the Spanish architectural heritage prior to the Civil War and dedicated research into the history of the late twentieth century. Thus, we have tried to draw a documental bridge, with which virtually transpose the gap that has existed. Historically, professionals from diverse disciplines have been worried and busy of the protection of the built and urban heritage. They have undertaken the daunting task of understanding and explaining the historical and legal difficulties, which have marked its evolution. This concern has generated an enormous and diverse literature, from formal and precise protection, in the framework of conservation historiographical trends and nineteenth-century theories. Also, they have studied the impact of urban planning in the protection of heritage, including the competences and administrative juxtapositions. They have generated a lot of documents of all kinds and scientific depth. The title of this document, in itself, circumscribes the matter that has been analyzed during this research process, the Monumental Architectural Heritage. The basal studio is located in the historical buildings, which, in turn, hold the declaration of cultural interest, and thus belong to the Spanish Historical Heritage. The work methodology was developed concentrically from general aspects of the protection of monuments, such as the legal framework that predates the enactment of the 1933 Act, and the previous state of the monuments that should be preserved. We recognize in the legislative sphere, the organic base that regulates and directs the tutelage of Spanish heritage and conservative action. The situation scheme emerged from the previous analysis, and we detected the key factors in the transition to the Spanish Historical Heritage Act; the conceptual evolution of the Heritage as a generic assessment, and witness this progress through historical, artistic and cultural values. This research paper consists of a first phase, corresponding to Chapter 1, which has developed from the legal regulation governing the Spanish Historical Heritage, through laws, decrees, orders and related provisions, supplemented the bibliography dedicated to the historical review of the legal process of protecting historical and artistic heritage. While it was not our intention to conduct a detailed study of the legal and historical volume preceding the 1933 Act, and that started the study period of this investigation, yes he has been focusing on the production of an extract from those elements of the doctrine with greater relevance and impact on the protection of Spanish art-historical and / or architectural heritage. Throughout our study we have seen what some jurists had already raised, about the scattering, branching and diversification of efforts, both in specific law and in urban law. This disaggregation has been extended to the field of recognition measures characterized by the development of multiple catalogs and inventories, with varying significance, scope and usefulness. The result has been a division of efforts, blurring the objective and turning the action of the recognition in multiple attempts little consequence. Our research advances in the analysis of heritage protection, as globalization concept in the Chapter 2, which includes a number of direct and indirect mechanisms that individually, often lack the effective force that many of monuments have required to survive the test of time and circumstances. First, in this second chapter we focused specifically on the mechanism regulated by the Spanish Historical Heritage Act, and the general protection regime implemented since its enactment in 1985 . In particular, we consider the declaration of cultural interest as maximum protection and protection of cultural assets, and their subsequent entry in the relevant General Register under the Ministry of Education, Culture and Sports . This mechanism is the instrument par excellence that condenses the powers of state care about a cultural asset, and which represents the cohesion of the historical, artistic, social values , etc. Secondly, we analyzed the Urban Planning, as a unifying cultural value in the city and as a container for the effects caused by man from its interaction with the environment in which he lives and relates. Thirdly, we have collected and studied the origin of catalogs, as generic notion of protection. For centuries, this genre has been defined as a tool to intervene in the protection of historical heritage, although difficult to quantify, through the identification, enumeration and description of a particular typology of monuments, and that contributing to the recognition of qualitative values contained therein. The third chapter analyzes the direct mechanism of protection performed by the Administration in the monuments with the statement of Cultural asset and inclusion in the General Protection Register. The theoretical and legal protection of a monument is as necessary as puerile if they are not followed by intervention. For this type of architectural heritage, any action which has the aim to safeguard the values implicit in the cultural asset involves protection compliance. Finally, the fourth chapter becomes the highlight, because it treated of the end process of the cultural heritage protection, the consummation of the intervention. The theory, the criticism, the rules and even the radical doctrines on the protection of cultural heritage, are meaningless if they do not take place the facts, the action, in antithesis to the omission. The history of the architectural heritage has given eloquent proof by itself. A lot of vestiges have been lost, in many times, for the destruction, through indolence or unknowledge. For this reason, and to be consistent with our thesis, we have collected and analyzed the projects documentation of three monuments (the Burgos Cathedral, the Aljafería Palace-Castle in Zaragoza and the Wall of Lugo). Sometimes, some researchers have suspected that there had not been planning. They suspect that the projects have been the result of different emergency situations. In opposition of this, we confirm that, except for emergency interventions result of specific circumstances, there have been a process of analysis to conclude in the priorities designation, which has guided the restoration process over two centuries. The complexity, magnitude and constructive uniqueness have defined the evolution of intervention. In conclusion, the effectiveness of the protection of Spanish cultural heritage lies in the conjunction of many aspects, including: the successful implementation of existing, specific and ancillary standards; the knowledge of good and its historical, artistic and cultural values; the cataloging and inclusion in the relevant inventories; and the commitment of the actors and institutions on which it depends. These planning tasks are necessary to ensure both structural safeguards as conservation values; and the introduction of a monitoring plan to detect possible dangers that threaten its conservation. But, the optimal situation would be given by a system in which these urban-regulations and specific mechanisms, would work together like a machine, where each piece operated with relative independence, but in tune with the other gears. So far, the reality is far from this situation, turning this coexistence in a utopia. Both legislators and officials and technicians involved must be aware that the effectiveness and scope of protection depends on your insight and commitment.

Efecto de la erradicación del VHC sobre la frecuencia crítica de parpadeo en pacientes coinfectados por VIH/VHC con cirrosis avanzada

Abstract: La frecuencia crítica de parpadeo (FCP), definida como la frecuencia a la que un sujeto percibe una luz parpadeante como continua, se asocia directamente con el nivel de alerta del sistema nervioso central. Mediante el HEPAtonorm®-Analyzer (Medi-Business Freiburg GmGH, Alemania) hemos estudiado la FCP en el momento basal y tras la erradicación del virus de la hepatitis C (VHC) en 47 pacientes coinfectados por virus de la inmunodeficiencia humana (VIH)/VHC y cirrosis. Los pacientes tenían una edad media de 52 años; el 81% eran varones y el 80% tenía antecedentes de consumo de drogas. Observamos un incremento en la FCP al final del tratamiento del VHC comparado con el momento basal (42,3 ± 8,5 Hz vs. 45,9 ± 7,8 Hz; p = 0,001), y una reducción en la proporción de pacientes con encefalopatía hepática subclínica (definida como una FCP < 39 Hz) desde 15 (32%) de los 47 pacientes al inicio a 7 (17%) de los 41 pacientes tras el tratamiento del VHC (p = 0,180). La erradicación del VHC en pacientes coinfectados por VIH/VHC aumenta la FCP indicando una mejoría de la función hepática. Critical flicker frequency (CFF), defined as the frequency at which a subject perceives a flickering light as continuous, is directly associated with central nervous system alertness. We studied CFF using the HEPAtonorm™-Analyzer (Medi-Business Freiburg GmGH, Germany) at baseline and after hepatitis C virus (HCV) eradication in 47 patients with human immunodeficiency virus (HIV)/HCV coinfection and cirrhosis. Patients had a mean age of 52 years, 81% were male, and 80% had a history of drug use. We observed an increase in the CFF at the end of HCV therapy compared to baseline (42.3 ± 8.5 Hz vs. 45.9 ± 7.8 Hz; p = 0.001), and a reduction in the proportion of patients with subclinical hepatic encephalopathy (defined as a CFF < 39 Hz) from 15 (32%) of 47 patients at baseline to 7 (17%) of 41 patients after HCV therapy (p = 0.180). HCV eradication in HIV/HCV coinfected patients increases CFF, indicating improved liver function.

Plio‐Pleistocene Ocean Circulation Changes in the Gulf of Alaska and Its Impacts on the Carbon and Nitrogen Cycles and the Cordilleran Ice Sheet Development

Abstract: The modern Gulf of Alaska (GOA) is a Cordilleran Ice Sheet (CIS) region, estimated to be important for nutrient cycling and CO2 exchange. Little is known of the GOA evolution over the Pliocene and Pleistocene as well as its impact on the CIS development, when other evidence for changing North Pacific circulation has emerged. We analyzed Integrated Ocean Drilling Program Expedition 341 Site U1417 sediments, which extend through the Plio-Pleistocene transition (4–1.7 Ma), focusing on productivity-related biomarkers (alkenones, brassicasterol), siliceous microfossils and bulk carbon and nitrogen stable isotopes. Our results show two dominant water column regimes: one characterized by high silica and low organic matter (OM) preservation, containing microorganism remains from a mix of habitats (4–3.7 Ma) and a second characterized by low biogenic silica and increased OM preservation of microorganisms from dominantly open ocean habitats (3.33–3.32 Ma and 2.8–1.66 Ma). An increase of phytoplankton diversity (3.7–3.35 Ma, 3.19–2.82 Ma) characterizes the two transitions of water column conditions, from oxygenated to reductive, that we attribute to a change from ocean mixing to strong stratified conditions with some occasional mixing. The biogeochemical changes in the GOA follow 400 and 100 kyr eccentricity cycles which are also reflected in changes in the CIS. We conclude that the CIS expansion created high nutrient low chlorophyll conditions in the GOA during the Mid Piacenzian Warm Period and the early Pleistocene. In turn, positive feedbacks increased marine productivity export, atmospheric CO2 drawdown and further CIS expansion.

Postoperative analgesia after spine surgery: towards a multimodal approach including regional anaesthesia for an enhanced recovery

Abstract: article: Postoperative analgesia after spine surgery: towards a multimodal approach including regional anesthesia for an enhanced recovery - Minerva Anestesiologica 2022 June;88(6):428-30 - Minerva Medica - Journals

In Situ Normothermic Regional Perfusion in Controlled Donation After Circulatory Determination Death: Organ Utilization, Outcomes, and Elusiveness of a Randomized Clinical Trial

Abstract: At present, preservation in solid organ transplant is undergoing a paradigm shift away from continuous static hypothermia toward greater application of dynamic machine perfusion (MP) preservation modalities. A PubMed search of MP and transplantation reveals a sharp increase in publications in the past 15 y: there were <20 MP studies published in 2006; in 2021, there were nearly 300. Randomized clinical trials (RCTs) have been published demonstrating both improved early function and survival among transplanted kidneys and reduced transaminases and complications among recipients of livers undergoing ex situ MP.1-3 Use of in situ normothermic regional perfusion (NRP) in controlled donation after circulatory determination of death (cDCD) is another important part of this transformation. Although promising clinical results have been reported for recipients of cDCD kidneys and livers recovered with NRP,4 RCTs on NRP are still lacking. In this issue of Transplantation, UK authors analyze cDCD organ offers and actual transplants recorded in their national transplant registry between 2011 and 2019.5 They evaluate organ utilization rates with in situ NRP versus the alternative—immediate in situ cold preservation (ISP) and recovery. The authors claim use of NRP significantly increased transplantation of cDCD grafts from 2.6 organs/donor with ISP to 3.3 organs/donor with NRP. Furthermore, in line with previous observational studies published from other settings,6,7 posttransplant kidney and liver outcomes appeared improved with NRP. Study results are impressive, and the authors should be congratulated. At the same time, they highlight once again important issues related to the subjectivity of organ acceptance and discard and the consequent complexity of designing and executing RCTs on NRP. In the context of cDCD, in situ NRP restores flow of oxygenated blood to the abdomen (abdominal NRP) or chest and abdomen (thoracoabdominal NRP) following a period of progressive hypoperfusion and cardiac arrest in the donor. Although ISP is performed quickly and does not offer any feedback to the donor surgeon beyond limited gross findings, NRP eliminates the rush to remove organs, largely restores their normal macroscopic aspect and semi-physiological conditions, and even offers some concrete data related to their functionality. This combination of perceived benefits offered by NRP undoubtedly impacts organ acceptance and ultimate transplantation, regardless of any improvements NRP may produce in actual organ quality. In the UK study, the liver was the organ in which recovery technique had the greatest impact on utilization. Interestingly, a major difference in liver utilization rates in the UK study arose as early as the point of acceptance of the liver offer. For cDCD livers offered with NRP, 91% of those offers were accepted to be evaluated in situ versus only 61% among cDCD livers offered with ISP.5 A liver (or any organ, for that matter) will never be transplanted if it is never evaluated in situ. These results indicate that an important benefit of NRP might be added confidence in initially accepting cDCD offers, likely based on knowledge that viability of seemingly marginal grafts can be further assessed by measuring different parameters during NRP in a manner that is simply not possible with ISP. For cDCD donor offers included in the UK analysis, donor age and body mass index were both lower when NRP was the recovery method. In contrast, donor warm ischemia times were slightly but statistically longer in relation to additional time needed to establish the NRP circuit. Although the authors performed multivariate regression analyses attempting to adjust for these covariates, lack of randomization of donors between the 2 recovery methods and ongoing influence of other relevant confounders—both known and unknown—represent potential sources of bias when estimating the true impact of NRP on posttransplant outcomes. Unlike ex situ MP, which is capable of treating an organ individually, any effects of in situ NRP unavoidably extend to all organs in the region of perfusion (abdominal NRP: kidneys, liver, pancreas, and intestines; thoracoabdominal NRP: all the aforementioned organs plus the heart and lungs). NRP has yet to be evaluated in the context of an RCT based on the complexity of identifying an appropriate study endpoint for a preservation and recovery method that affects multiple organs and has to be applied before any of these organs have actually been accepted for transplantation. Even if cDCD donors are randomized at the point of their acceptance for in situ evaluation, it remains wholly impossible to blind donor surgeons to the method that has been assigned. As in the UK study, disparate numbers of organs would likely be accepted for transplantation and donor profiles among the transplanted organs vary significantly according to the recovery method used. Furthermore, any posttransplant endpoint that might be assessed (graft or recipient complications, survival, etc) would be conditioned by these confounding variables. The alternate option of comparing in situ NRP with ex situ MP in the liver or kidneys still does not ensure the absence of selection bias; does not adequately address risk to and collateral effects on “bystander” organs (pancreas ± intestines, heart, and lungs); and is somewhat nonsensical, given that in situ NRP and ex situ MP are not competitive preservation strategies and can and have been successfully applied sequentially in the same transplant grafts.8,9 Pursuit of an RCT on NRP in cDCD should not be abandoned, but the issues outlined above need to be adequately addressed before performing a complex study of limited clinical utility. In the meantime, this and other observational studies as well as anyone who has used NRP personally can speak to the tangible improvements it offers in cDCD organ quality. Moreover, its relatively low cost10 and the intangible benefit of the confidence it provides serve as indicators that application of NRP in cDCD will continue to spread, even without existence of a level 1 study in its support.

Application Of Pelvic Floor Ultrasound During Pregnancy To Detect Patients At Risk Of Cesarean Section Due To Failure Of Labor Progression IN A SPANISH Population

Abstract: Our study is aimed at evaluating the characteristics of the pelvic floor, assessed through transperineal ultrasound, since it may influence or increase the possibility of having a cesarean delivery, with the objective of acting on those variables that can be modified during pregnancy.Transperineal ultrasound was performed on 109 primiparous pregnant women in their first trimester of pregnancy, recruited between May 2018 and February 2019, with the purpose of studying the hiatus area at rest, retention and Valsalva. We have reassessed them at the end of pregnancy and delivery data were recorded. We selected 8 patients as case-study, who had cesarean section delivery due to failure of labor progression. We selected 4 control-cases for each, reaching the total of 32 controls, with similar age and body mass index, to avoid obtaining a biased result from these data.In the study of hiatal areas, patients who delivered by cesarean section had a smaller hiatal area at rest, during levator ani muscle contraction and during Valsalva maneuver, at all visits. In early pregnancy, the range of the resting hiatal area was 13.8 ± 2.0 cm2 for cesarean sections, compared to 16.2 ± 2.7 cm2 for vaginal deliveries with an OR of 0.57 (0.34-0.95, 95% CI). For hiatal area on Valsalva, the OR was 0.55 (0.35-0.88, 95% CI). Therefore, the smaller the hiatal area, the greater the possibility of cesarean section. At the end of pregnancy, between 34 and 36 weeks of gestation, the OR of hiatal area on Valsalva was 0.78 (0.60-1.00, 95% CI).The hiatus area measured by transperineal ultrasonography at the beginning and at the end of the pregnancy may be useful to identify the patients who are at a higher risk of cesarean delivery due to failure of labor progression.

New polyethylenes in total hip arthroplasty

Abstract: A significant reduction in wear at five and ten years was previously reported when comparing Durasul highly cross-linked polyethylene with nitrogen-sterilized Sulene polyethylene in total hip arthroplasty (THA). We investigated whether the improvement observed at the earlier follow-up continued, resulting in decreased osteolysis and revision surgery rates over the second decade.Between January 1999 and December 2001, 90 patients underwent surgery using the same acetabular and femoral components with a 28 mm metallic femoral head and either a Durasul or Sulene liner. A total of 66 hips of this prospective randomized study were available for a minimum follow-up of 20 years. The linear femoral head penetration rate was measured at six weeks, one year, and annually thereafter, using the Dorr method on digitized radiographs with a software package.In the Durasul group, no patients underwent revision due to loosening or showed radiological evidence of osteolysis. In the Sulene group, four patients (four hips) were revised due to femoral component loosening. The 20-year cumulative failure incidence in the presence of the competing event of death for revision surgery was 4.5% (95% confidence interval (CI) 0.8 to 13.6) in the Durasul group, and 8.9% (95% CI 2.8 to 19.5) in the Sulene group. The mean wear one year after surgery was 0.09 mm (SD 0.007) in the Durasul group and 0.24 (SD 0.015) in the Sulene group (p < 0.001). From one to 20 years after surgery, the mean total penetration was 0.32 mm (SD 0.045) in the Durasul group and 1.07 mm (SD 0.13) in the Sulene group (p < 0.001). Mean femoral head penetration at 20 years was approximately 70.0% less in the Durasul group than the Sulene group.The significant reduction in femoral head penetration obtained with the Durasul compared with Sulene in uncemented THA resulted in lower osteolysis and revision rates after 20 years.Cite this article: Bone Joint J 2022;104-B(9):1032-1038.

Análisis de la pobreza en México mediante el enfoque de redes complejas y optimización

Abstract: Para llevar a cabo la medición de la pobreza multidimensional en México, se hace uso de la metodología a propuesta por CONEVAL, el insumo que se utiliza para realizar esta medición es proporcionada por los datos generados en los diversos levantamientos que el INEGI capta en sus encuestas, por ejemplo, la Encuesta Nacional de Ingresos y Gastos en los Hogares. Lo que se propone en este trabajo, es adaptar el Problema de Máximo clique sobre un conjunto de variables que de acuerdo con CONEVAL miden el problema de pobreza multidimensional, con el objetivo de detectar comunidades que compartan atributos similares y relaciones entre las dimensiones de pobreza multidimensional entre los Estados de la República Mexicana. El desarrollo del presente trabajo consiste en lo siguiente: en el capítulo 2 se presentan las definiciones básicas sobre grafo, máximo clique, redes complejas, detección de comunidades, algoritmo genético y pobreza multidimensional. en el capítulo 3 se muestra una revisión al estado del arte tomando como base trabajos reportados en la literatura para el caso de Latinoamérica, México, así como a un conjunto de trabajos donde se han llevado a cabo detección de comunidades. En el capítulo 4 se presenta el planteamiento del problema, los objetivos generales y particulares, así mismo, se delimita el alcance de este trabajo. En el capítulo 5 se desarrolla la metodología propuesta, entre otros, se describen las configuraciones necesarias para el tratamiento de los datos y las configuraciones necesarias para el algoritmo genético propuesto. En el capítulo 6 se presentan los modelos gráficos obtenidos por los análisis, los resultados se describen en dos subapartados, en el primero se presentan los resultados obtenidos al analizar un subgrafo (clique) para una comunidad y en el segundo subapartado los resultados describen al subgrafo obtenidos para un clique con dos comunidades. En el capítulo 7, se presentan las conclusiones que se infieren luego de haber analizado los resultados antes mostrados.

Mundo vegetal y enfermedad renal crónica: ¿riesgo o beneficio?

Abstract: La alimentación a lo largo de la enfermedad renal se encuentra unida a un gran número de restricciones. Actualmente las recomendaciones nutricionales en los pacientes con enfermedad renal están cambiando, presentando elementos comunes con la población general. Se recomienda disminuir el consumo de alimentos ultraprocesados, al considerarse fuente de sal, grasas y aditivos, de los que muchos de ellos son aditivos fosfóricos y potásicos; estos aditivos presentan una biodisponiblidad del 100%, en comparación con el fósforo y el potasio dietético que se encuentra en los alimentos de origen natural, y cuya absorción se encuentra entre el 50-80%, dependiendo del tipo de alimento.El manejo del potasio dietético es uno de los grandes problemas en la población renal. En la actualidad, se está demostrando que el aumento de sus niveles en sangre, presenta más agentes causales y no sólo la ingesta dietética de potasio, como: la presencia de ayunos prolongados, estreñimiento, mal control metabólico de la glucosa y el consumo de ciertos fármacos, entre otros factores.Estos datos ponen de manifiesto que antes de recurrir a la restricción alimentaria de fuentes de potasio dietético es conveniente considerar nuevos métodos de actuación.

Arthroscopic Approaches to Radial Head Fracture Fixation

Abstract: Arthroscopic fixation of radial head fractures is a valid alternative to the classic open reduction and internal fixation; the technique provides encouraging results and shows progressively evolving indications. The whole radial head circumference can be adequately addressed with appropriate use of anterolateral, anteromedial, and midlateral portals. This chapter describes the advantages and disadvantages of each portal and provides practical advice to improve visualization to guarantee the safety of the procedure.

Pb2083: study conduct and patient safety during the covid-19 pandemic: observations in patients with previously untreated follicular lymphoma from the gazelle trial of obinutuzumab short duration infusion

Abstract: Background: Obinutuzumab is routinely administered as a 3–4-hour infusion in patients (pts) with follicular lymphoma (FL). A 90-minute short duration infusion (SDI) of obinutuzumab is being evaluated in GAZELLE (NCT03817853), a Phase IV study in pts with previously untreated FL. Earlier analyses showed that response rates with obinutuzumab SDI were in line with previous studies of obinutuzumab administered at the standard rate and no new safety signals were reported (Canales, et al. 2021). In addition, >95% of healthcare providers preferred obinutuzumab SDI to the standard infusion, mainly due to clinic and pt time savings (Trask, et al. 2021). The time savings associated with obinutuzumab SDI could be particularly beneficial during the coronavirus disease 2019 (COVID-19) pandemic. Aims: To investigate the effect of the COVID-19 pandemic on the GAZELLE study conduct and to describe safety in vaccinated and unvaccinated pts in an exploratory analysis. Methods: Pts with previously untreated FL received obinutuzumab (1000mg) intravenously on Days (D) 1, 8 and 15 of Cycle (C) 1, and on D1 thereafter, plus chemotherapy (bendamustine; cyclophosphamide, doxorubicin, vincristine and prednisone [CHOP]; or cyclophosphamide, vincristine and prednisone [CVP]) for 6–8 cycles (induction phase). Pts received a standard infusion (3–4 hours) of obinutuzumab in C1. Pts without a Grade ≥3 infusion-related reaction during C1 received obinutuzumab SDI (90-minute infusion) from C2 onwards. Pts with a complete or partial response received maintenance with obinutuzumab SDI for 2 years or until disease progression (maintenance phase). All pts provided informed consent prior to study entry. Results: At the clinical cut-off date of January 18, 2022, 35/113 (31.0%) pts in the overall population had received a COVID-19 vaccine. Demographic and baseline characteristics were generally similar in the vaccinated and non-vaccinated groups; however, the vaccinated group had a greater proportion of pts who were aged ≥65 years (n=17/35, 48.6% vs n=27/78, 34.6%, respectively). The most common vaccine received was Pfizer BioNTech (n=22/35, 62.9%), and most pts received 2 vaccine doses (n=25/35, 71.4%). Fewer study discontinuations were reported in the vaccinated versus the non-vaccinated group (n=1 vs n=21, Figure). Five pts in the vaccinated group had adverse events (AEs) ≤7 days after vaccination (no serious AEs reported). None of these AEs were considered study drug related and all resolved without changes to study treatment. COVID-19 infection was reported in 5 pts (induction phase, n=1; maintenance phase, n=4). Of these, 1 pt had been vaccinated (Moderna, 2 doses; >6 months prior to infection) and 3 pts received concomitant medication to treat COVID-19 infection. Three of the 5 pts recovered, and 2 pts (both unvaccinated) died due to respiratory complications following COVID-19 infection. Low total leukocyte count (an indicator of COVID-19 disease severity) was observed in 4 pts with a COVID-19 infection (7 episodes of Grade 1/2; 3 episodes of Grade 3). Overall, 19/113 (16.8%) pts had ≥1 major protocol deviation related to the COVID-19 pandemic, the most common being delayed (n=8) or missed (n=7) study drug infusion. Image:Summary/Conclusion: The conduct of the GAZELLE study was not substantially impacted by the COVID-19 pandemic. Documented COVID-19 infections occurred in 5 pts and fatal outcomes were reported in 2 of these pts (both unvaccinated). Up to 7 days after COVID-19 vaccination, no AEs considered related to obinutuzumab or other study treatments were observed.