MIS Transistor with Integrated Waveguide for Electrophotonics and the Effect of Channel Length in Light Detection

In this work, we study the optical response of MOS-like transistors with a Si3N4 integrated waveguide which serves also as the dielectric of the gate, and P-type substrate with 1´1012 cm-3 acceptor concentration and different channel length. Simulation results show the possibility to integrate this kind of MIS transistor as detectors in an electrophotonic circuit compatible with CMOS fabrication process and obtaining electrical gain for low power light signals (below 400 nW)

Docencia en cirugía general. Una propuesta para su perfeccionamiento Teaching in General Surgery: a proposal for its training

La metodología propia del diseño curricular para la formación de recursos humanos de la salud, se fundamenta en el enfoque histórico cultural y por tanto tiene en cuenta el aprendizaje basado en el desarrollo social de cada etapa histórico-social concreta. La Educación Superior en Cuba marcha acorde con el desarrollo de la ciencia contemporánea, esto hace que indiscutiblemente la entrada al tercer milenio tenga que estar encaminada a la formación de profesionales con una elevada calificación científico- técnica, lo cual implica que los curriculum tengan un alto nivel científico y respondan a los intereses de la sociedad. La metodología en sí misma, tiene en cuenta como punto de partida los problemas de salud y el modo de actuación profesional, este último como objetivo supremo. No obstante lo anterior, el hecho del desarrollo científico técnico acelerado en las ciencias, como es el caso de la Cirugía General, marca una nueva pauta ya que los objetivos supremos dejan de ser la esencialidad al ser superados por los contenidos, o lo que es lo mismo dejan de ser la categoría rectora obligando a nuevos diseños, como es el caso que nos ocupa. Palabras clave: DOCENTE MEDICO, CIRUGÍA, APRENDIZAJE, ESTUDIANTES DE MEDICINA ABSTRACT The typical methodology for the curricular design for the training of the health human resources is based on the historical-cultural approach, bearing in mind the learning based on the social development in every specific historical-social stage. In Cuba, Higher Education goes on according to the development of the contemporary science. This unquestionably causes the entering into the third millennium to be directed to a high scientific-technical qualification of the professionals, that means that the curricula have a high scientific level and respond to the needs of the society. The methodology itself deals with the health problems and the ways of professional performance, this being the supreme objective. In spite of the above mentioned, the fact of an accelerated scientific-technical development in sciences, and that is the case in General Surgery, makes us face the dilemma that the supreme objectives are not so essential, being overcome by the contents, that is to say, they are not the principal category which leads to new designs, this being the case we are discussing. Key words: FACULTY MEDICAL, SURGERY, LEARNING, MEDICAL STUDENTS

Enfermedad del hígado graso no alcohólico, asociación con la enfermedad cardiovascular y tratamiento (I). Enfermedad del hígado graso no alcohólico y su asociación con la enfermedad cardiovascular

La enfermedad del hígado graso no alcohólico (EHGNA) comprende una serie de lesiones hepáticas histológicamente similares a las inducidas por el alcohol, en personas con un consumo del mismo muy escaso o nulo. La importancia de la EHGNA radica en su alta prevalencia en el mundo occidental y, desde el punto de vista hepático, en su progresiva evolución desde esteatosis a esteatohepatitis, cirrosis y cáncer de hígado. Durante la última década se ha observado que la EHGNA da lugar a un incremento del riesgo cardiovascular con aceleración de la arteriosclerosis y de los eventos a ella vinculados, principal causa de su morbimortalidad. Esta revisión actualizada a enero de 2016 consta de dos partes, analizando en esta primera parte la asociación de la EHGNA con la enfermedad cardiovascular. Non-alcoholic fatty liver disease (NAFLD) comprises a series of histologically lesions similar to those induced by alcohol consumption in people with very little or no liver damage. The importance of NAFLD is its high prevalence in the Western world and, from the point of view of the liver, in its gradual progression from steatosis to steatohepatitis, cirrhosis, and liver cancer. During the last decade it has been observed that NAFLD leads to an increased cardiovascular risk with acceleration of arteriosclerosis and events related to it, being the main cause of its morbidity and mortality. This review, updated to January 2016, consists of two parts, with the first part analysing the association of NAFLD with cardiovascular disease

Triglicéridos, colesterol HDL y dislipidemia aterogénica en la guía europea para el control de las dislipidemias 2019

En general, las guías de práctica clínica tanto europeas con americanas han abordado el control de la dislipidemia aterogénica de forma poco convincente e incluso superficial, en gran medida por las limitaciones terapéuticas disponibles. En consecuencia, esta dislipidemia está infradiagnosticada, infratratada e infracontrolada. Dada la reciente aparición de la guía 2019 de la European Atherosclerosis Society y de la European Society of Cardiology sobre el control de las dislipidemias, parece oportuno examinar su posicionamiento con respecto a la dislipidemia aterogénica y/o sus principales componentes, el aumento en las lipoproteínas ricas en triglicéridos y la disminución del colesterol de las lipoproteínas de alta densidad In general, both European and American clinical guidelines have addressed the management of atherogenic dyslipidaemia in an unconvincing and even superficial way, largely because of the available therapeutic limitations. Consequently, this type of dyslipidaemia is underdiagnosed, under-treated, and under-controlled. Given the recent presentation of the 2019 guidelines of the European Atherosclerosis Society and the European Society of Cardiology on the management of dyslipidaemias, it seems appropriate to examine its position with respect to atherogenic dyslipidaemia and/or its main components, the increase in triglyceride-rich lipoproteins, and the decrease of high-density lipoprotein cholesterol

Riesgo cardiovascular residual de origen lipídico. Componentes y aspectos fisiopatológicos

Resumen Es indudable la relación del cLDL y el riesgo cardiovascular, así como de los beneficios del tratamiento con estatinas. Una vez conseguido el objetivo de cLDL, son notables las evidencias que demuestran la persistencia de un elevado riesgo cardiovascular, concepto denominado riesgo residual. El riesgo residual de origen lipídico se fundamenta en la dislipidemia aterogénica, caracterizada por un aumento de triglicéridos y de las lipoproteínas ricas en triglicéridos, un descenso del cHDL y alteraciones cualitativas de las partículas LDL. Las medidas más utilizadas para identificar esta dislipidemia se basan en la determinación de colesterol total, triglicéridos, HDL, colesterol no HDL y colesterol remanente, además de las apolipoproteínas B100 y la lipoproteína(a) en determinados casos. El tratamiento de la dislipidemia aterogénica se basa en la pérdida de peso y ejercicio físico. En cuanto al tratamiento farmacológico, no tenemos evidencia del beneficio cardiovascular con los fármacos dirigidos al descenso de triglicéridos y cHDL; el fenofibrato parece tener eficacia en situaciones de dislipidemia aterogénica. There is no doubt about the relationship between LDL-c and cardiovascular risk, as well as about the benefits of statin treatment. Once the objective of LDL-c has been achieved, the evidences that demonstrate the persistence of a high cardiovascular risk, a concept called residual risk, are notable. The residual risk of lipid origin is based on atherogenic dyslipidemia, characterized by an increase in triglycerides and triglyceride-rich lipoproteins, a decrease in HDL-c and qualitative alterations in LDL particles. The most commonly used measures to identify this dyslipidemia are based on the determination of total cholesterol, triglycerides, HDL, non-HDL cholesterol and remaining cholesterol, as well as apolipoprotein B100 and lipoprotein (a) in certain cases. The treatment of atherogenic dyslipidemia is based on weight loss and physical exercise. Regarding pharmacological treatment, we have no evidence of cardiovascular benefit with drugs aimed at lowering triglycerides and HDL-c, fenofibrate seems to be effective in situations of atherogenic dyslipidemia

Influence of MUC5B gene on antisynthetase syndrome

ABSTRACT: MUC5B rs35705950 (G/T) is strongly associated with idiopathic pulmonary fibrosis (IPF) and also contributes to the risk of interstitial lung disease (ILD) in rheumatoid arthritis (RA-ILD) and chronic hypersensitivity pneumonitis (CHP). Due to this, we evaluated the implication of MUC5B rs35705950 in antisynthetase syndrome (ASSD), a pathology characterised by a high ILD incidence. 160 patients with ASSD (142 with ILD associated with ASSD [ASSD-ILD+]), 232 with ILD unrelated to ASSD (comprising 161 IPF, 27 RA-ILD and 44 CHP) and 534 healthy controls were genotyped. MUC5B rs35705950 frequency did not significantly differ between ASSD-ILD+ patients and healthy controls nor when ASSD patients were stratified according to the presence/absence of anti Jo-1 antibodies or ILD. No significant differences in MUC5B rs35705950 were also observed in ASSD-ILD+ patients with a usual interstitial pneumonia (UIP) pattern when compared to those with a non-UIP pattern. However, a statistically significant decrease of MUC5B rs35705950 GT, TT and T frequencies in ASSD-ILD+ patients compared to patients with ILD unrelated to ASSD was observed. In summary, our study does not support a role of MUC5B rs35705950 in ASSD. It also indicates that there are genetic differences between ILD associated with and that unrelated to ASSD.We are indebted to the patients and healthy controls for their essential collaboration to this study. We also thank the National DNA Bank Repository (Salamanca) for supplying part of the control samples. This study was partially supported by grants from the Foundation for Research in Rheumatology (FOREUM). RL-M is a recipient of a Miguel Servet type I programme fellowship from the ‘Instituto de Salud Carlos III’ (ISCIII), co-funded by the European Social Fund (ESF, ‘Investing in your future’) (grant CP16/00033). SR-M is supported by funds of the RETICS Program (RD16/0012/0009), co-funded by the European Regional Development Fund (ERDF). VP-C is supported by a pre-doctoral grant from IDIVAL (PREVAL 18/01). VM is supported by funds of a Miguel Servet type I programme (grant CP16/00033) (ISCIII, co-funded by ESF). LL-G is supported by funds of PI18/00042 (ISCIII, co-funded by ERDF). OG is Staff Personnel of Xunta de Galicia (Servizo Galego de Saude, SERGAS) through a research-staff stabilization contract (ISCIII/SERGAS). OG,is member of RETICS Programme, RD16/0012/0014 (RIER: Red de Investigación en Inflamación y Enfermedades Reumáticas) via Instituto de Salud Carlos III (ISCIII) and FEDER. The work of OG (PI17/00409), was funded by Instituto de Salud Carlos III and FEDER. OG is a beneficiary of a project funded by Research Executive Agency of the European Union in the framework of MSCA-RISE Action of the H2020 Programme (Project number 734899). OG is beneficiary of a grant funded by Xunta de Galicia, Consellería de Educación, Universidade e Formación Profesional and Consellería de Economía, Emprego e Industria (GAIN), GPC IN607B2019/10

The impact of diabetes on the pathogenesis of sepsis

Diabetes is associated with an increased susceptibility to infection and sepsis. Conflicting data exist on whether the mortality of patients with sepsis is influenced by the presence of diabetes, fuelling the ongoing debate on the benefit of tight glucose regulation in patients with sepsis. The main reason for which diabetes predisposes to infection appears to be abnormalities of the host response, particularly in neutrophil chemotaxis, adhesion and intracellular killing, defects that have been attributed to the effect of hyperglycaemia. There is also evidence for defects in humoral immunity, and this may play a larger role than previously recognised. We review the literature on the immune response in diabetes and its potential contribution to the pathogenesis of sepsis. In addition, the effect of diabetes treatment on the immune response is discussed, with specific reference to insulin, metformin, sulphonylureas and thiazolidinediones

The management of acute venous thromboembolism in clinical practice. Results from the European PREFER in VTE Registry

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in Europe. Data from real-world registries are necessary, as clinical trials do not represent the full spectrum of VTE patients seen in clinical practice. We aimed to document the epidemiology, management and outcomes of VTE using data from a large, observational database. PREFER in VTE was an international, non-interventional disease registry conducted between January 2013 and July 2015 in primary and secondary care across seven European countries. Consecutive patients with acute VTE were documented and followed up over 12 months. PREFER in VTE included 3,455 patients with a mean age of 60.8 ± 17.0 years. Overall, 53.0 % were male. The majority of patients were assessed in the hospital setting as inpatients or outpatients (78.5 %). The diagnosis was deep-vein thrombosis (DVT) in 59.5 % and pulmonary embolism (PE) in 40.5 %. The most common comorbidities were the various types of cardiovascular disease (excluding hypertension; 45.5 %), hypertension (42.3 %) and dyslipidaemia (21.1 %). Following the index VTE, a large proportion of patients received initial therapy with heparin (73.2 %), almost half received a vitamin K antagonist (48.7 %) and nearly a quarter received a DOAC (24.5 %). Almost a quarter of all presentations were for recurrent VTE, with >80 % of previous episodes having occurred more than 12 months prior to baseline. In conclusion, PREFER in VTE has provided contemporary insights into VTE patients and their real-world management, including their baseline characteristics, risk factors, disease history, symptoms and signs, initial therapy and outcomes

Estandarización de la circunferencia de cintura (WC), para cada rango de índice de masa corporal (BMI) en pacientes adultos atendidos en un servicio de endocrinología y nutrición

By this study we seek the expectable range of waist circumference (WC) for every degree of body mass index (BMI), which will serve to studies targeting ascertaining the health risk. We studied 2,932 patients (39.6% men and 60.4% women, between 18 and 96 years ) of the same ethnic group who consecutively attended outpatient departments of our clinics between 2000 and 2004. BMI correlated linearly with the WC (cc: 0.85; p or = 102 cm and women > or = 88 cm) in 94.3% of the obese, in 32.3% of overweight patients, in 3.8% of patients with BMI < 25, in 84.3% of diabetics, and in 72.6% of patients without diabetes. We made graphic standardisation of WC with regard to BMI, and we calculated the percentiles 10, 25, 50, 75 and 90, grouping in ranges of 2 kg/m(2) of BMI. The diabetic patients are grouped in ranges of 4 kg/m(2). As conclusion we present a standardisation of the WC measurement of patients attended to in our Endocrinology and Nutrition practices distributed in percentiles as a clinically usable tool to define the ranges of WC for every BMI value.YesEn este estudio hemos buscado el rango de circunferencia de cintura (WC) para cada grado de índice de masa corporal (BMI), que sirva para estudios que determinen riesgos de salud. Estudiamos 2.932 pacientes (39,6% varones y 60,4% mujeres, entre 18 y 96 años) del mismo grupo étnico que consecutivamente asistieron a consultas externas de nuestras clínicas entre 2000 and 2004. El BMI correlacionó linealmente con la WC (cc:0,85; p < 0,001). Eran mayores los varones, los obesos y los diabéticos. El BMI era mayor en mujeres y la WC en varones. Las mujeres tenían mayor WC si eran diabéticas (p = 102 cm y mujeres > = 88 cm) la presentaban el 94,3% de los obesos, el 32,3% de los pacientes con sobrepeso y el 3,8% de pacientes con BMI <25, el 84,3% de diabéticos y el 72,6% de pacientes sin diabetes. Elaboramos una estandarización gráfica de WC en relación con BMI y calculamos los precentiles 10, 25, 50, 75 y 90, agrupados en rangos de 2 kg/m2 de BMI. Como el número de diabeticos es menor, los agrupamos en rangos de 4 kg/m2. En conclusión presentamos una estandarización de la WC de pacientes atendidos en nuestra consulta de endocrinología y nutrición distribuidos en percentiles como herramienta utilizable clínicamente para definir rangos de WC para cada valor de BMI