COLECISTECTOMÍA LAPAROSCÓPICA POR COLECISTITIS ALITIÁSICA EN PACIENTE CON SITUS INVERSUS TOTALIS

Introducción: La Incidencia de Situs Inversus Totalis (SIT) es de 1:400.000 nacidos vivos, caracterizada por error en la migración de órganos torácicos y abdominales durante el desarrollo embrionario, colocándose como una “imagen de espejo” con respecto al eje sagital de la posición anatómica normal, puede ser parte del síndrome de Kartagener, donde además existe infertilidad e infecciones respiratorias a repetición. La colecistitis o inflamación de la vesícula biliar, es una patología frecuente, que, asociado al SIT, presenta manifestaciones clínicas especiales por la ubicación del dolor en lado izquierdo del abdomen, lo que retrasa el diagnóstico y la resolución. Objetivo: Reportar un caso de Colecistitis alitiásica y Situs Inversus Totalis. Descripción del caso:  Paciente femenina de 72 años, que acudió a emergencias en varias ocasiones por dolor tipo cólico, en hipocondrio izquierdo, estudios como ecografía abdominal, ecocardiograma confirma la presencia de SIT y Colecistitis alitiásica. El laboratorio expresa leucocitosis. Se programa la Colecistectomía por vía laparoscópica, realizando el procedimiento quirúrgico con la distribución de los trócares en forma de espejo, mirando hacia el lado izquierdo del paciente. Evolución clínica: satisfactoria sin complicaciones. Se establece protocolo para descartar Síndrome de Kartagener, en vista de antecedentes respiratorios. Conclusiones: La colecistitis es una patología con una alta incidencia, pero en combinación con el SIT es poco frecuente. La mayoría de los pacientes con SIT, tienen una vida normal, su diagnóstico precoz orienta ante la presencia de patologías quirúrgicas agudas, con características clínicas especiales como la ubicación del dolor en el lado opuesto, retrasando el diagnóstico y la resolución quirúrgica con abordaje en modalidades especiales   Palabras clave: colecistitis alitiásica, colecistectomía, síndrome de Kartagener, situs inversus.   ABSTRACT Introduction: The incidence of Situs Inversus Totalis (SIT) is 1:400,000 live births, characterized by an error in the migration of thoracic and abdominal organs during embryonic development, positioning itself as a "mirror image" with respect to the sagittal axis of the normal anatomical position, it may be part of Kartagener's syndrome, where there is also infertility and recurrent respiratory infections. Cholecystitis or inflammation of the gallbladder is a frequent pathology, which, associated with SIT, presents special clinical manifestations due to the location of pain on the left side of the abdomen, which delays diagnosis and resolution. Objective: To report a case of acalculous cholecystitis and Situs Inversus Totalis. Description of the case: A 72-year-old female patient, who went to the emergency room on several occasions due to colicky pain in the left hypochondrium, studies such as abdominal ultrasound, echocardiogram confirmed the presence of SIT and acalculous cholecystitis. The laboratory expresses leukocytosis. Laparoscopic cholecystectomy is scheduled, performing the surgical procedure with the distribution of the trocars in the form of a mirror, looking towards the left side of the patient. Clinical evolution: satisfactory without complications. A protocol is established to rule out Kartagener's Syndrome, in view of a respiratory history. Conclusions: Cholecystitis is a pathology with a high incidence, but in combination with SIT it is rare. Most of the patients with SIT have a normal life, their early diagnosis guides the presence of acute surgical pathologies, with special clinical characteristics such as the location of the pain on the opposite side, delaying the diagnosis and surgical resolution with an approach in modalities specials   Keywords: acalculous cholecystitis, cholecystectomy, Kartagener syndrome, situs inversus

Modelo de Negocios Canvas y Calidad de Servicios en Clientes del Sector Hospedaje de la Región Junín

The use of a “business model to provide quality services in lodging establishments is essential for the development of this sector; Little research currently deals with this topic. The main objective of the study was to determine the association of the canvas business model and the quality of services in clients of lodging companies in the Junín region, the research was of a basic type, relational level with a descriptive-correlational design; the sample was made up of clients of lodging service in the Junín region, the sample was made up of 80 clients, the sampling technique was non-probabilistic for convenience (Otzen & Manterola, 2017), the approach was quantitative, the type of research Due to its purpose, it was basic, the level was descriptive and the design was not experimental-transversal; the theoretical methods were inductive-deductive and the empirical method was observational; the statistical test used was Kendall's tau b association coefficient, the scales were ordinal, the instruments were questionnaires prepared according to the literature review based on Osterwalder and Pigneur (2011) and Matsumoto-Nishizawa, (2014); the statistical treatment was carried out in SPSS 25; the main result was that there is a significant association between the canvas business model and quality of services in clients of the lodging sector of the Junín region, since the p-value found was 0,634 and the Kendall tau b statistic was 0.001, reflecting a significant relationship.El empleo de un modelo de negocios para brindar servicios de calidad en establecimientos de hospedaje es esencial para el desarrollo de este sector; actualmente pocas investigaciones tratan este tema. El objetivo principal del estudio fue determinar la asociación del modelo de negocios canvas y la calidad de servicios en clientes de empresas de hospedaje de la región Junín, la investigación fue de tipo básica, nivel relacional con un diseño descriptivo-correlacional; la muestra estuvo conformada por los clientes de servicio de hospedaje de la región Junín, la muestra estuvo conformada por 80 clientes, la técnica de muestreo fue no probabilística por conveniencia (Otzen & Manterola, 2017), el enfoque cuantitativo, el tipo de investigación por su finalidad fue básico, el nivel fue descriptivo y el diseño no experimental-transversal; los métodos teóricos fueron inductivo-deductivo y el método empírico fue el observacional; la prueba estadística empleada fue el coeficiente de asociación tau b de Kendall, las escalas fueron ordinales, los instrumentos fueron cuestionarios elaborados de acuerdo a la revisión de la literatura basados en Osterwalder y Pigneur (2011) y Matsumoto-Nishizawa, (2014); el tratamiento estadístico se realizó en SPSS 25; el resultado principal fue que existe asociación significativa entre el modelo de negocios canvas y calidad de servicios en clientes del sector hospedaje de la región Junín, puesto que el p-valor hallado fue de 0,634 y el estadístico tau b de Kendall fue de 0,001 reflejando una relación significativa

Shape-resonant superconductivity in nanofilms: from weak to strong coupling

Ultrathin superconductors of different materials are becoming a powerful platform to find mechanisms for enhancement of superconductivity, exploiting shape resonances in different superconducting properties. Here we evaluate the superconducting gap and its spatial profile, the multiple gap components, and the chemical potential, of generic superconducting nanofilms, considering the pairing attraction and its energy scale as tunable parameters, from weak to strong coupling, at fixed electron density. Superconducting properties are evaluated at mean field level as a function of the thickness of the nanofilm, in order to characterize the shape resonances in the superconducting gap. We find that the most pronounced shape resonances are generated for weakly coupled superconductors, while approaching the strong coupling regime the shape resonances are rounded by a mixing of the subbands due to the large energy gaps extending over large energy scales. Finally, we find that the spatial profile, transverse to the nanofilm, of the superconducting gap acquires a flat behavior in the shape resonance region, indicating that a robust and uniform multigap superconducting state can arise at resonance.Comment: 7 pages, 4 figures. Submitted to the Proceedings of the Superstripes 2016 conferenc

Valorization of date palm (Phoenix dactylifera L.) pruning biomass by co-composting with urban and agri-food sludge

In the Mediterranean countries, there is an increasing production of date palm wastes (Phoenix dactylifera L.), not only due to the raising production of date palm fruits, but also derived from the maintenance of urban and peri-urban green areas, especially in those affected by red palm weevil (Rhynchophorus ferrugineus). The management of this increasing volume of green wastes usually concludes with a controlled disposal that implies an important loss of resources, in terms of organic matter, nutrients and energy. In addition, the rise of wastewater generation and the incentive of the wastewater treatment processes have derived in an increase of the amount of the sludge produced, which makes difficult its management. This work studies the feasibility of co-composting palm wastes with sludge from the urban and agri-food sectors as alternative treatment to manage these organic waste streams and to obtain added-value compost. For this, four mixtures (P1, P2, P3 and P4) were prepared using as main component palm leave waste (PL) mixed with different types of sludge. In the piles P1, P2 and P3, sewage sludge (SS) was used as co-composting agent, while agri-food sludge (AS) was used in P4. Throughout composting, the thermal profile of the composting piles was assessed, as were physical, chemical, physico-chemical and maturity parameters. In addition, the changes in water-soluble organic matter were assessed using chemical analytical methods and the excitation–emission matrix (EEM) fluorescence spectroscopy. The results obtained showed the viability of the co-composting process to obtain end-products with adequate maturity degree and physical characteristics for their potential use as substrates, except for the salt contents that can limit their use in some agricultural sectors.This work has been financed by the Spanish Ministry of Economy and Competitiveness and by European Regional Development Funds (ERDF, “Una manera de hacer Europa”), in the framework of the project “Development of new resources and bioproducts based on residues of palmaceous species oriented to carbon sequestration and mitigation strategies, Palmresource” (Project AGL2013-41612-R)

Metodología de diseño de LNA de banda ancha robustos frente a variaciones de proceso

Los amplificadores de bajo ruido requieren cumplir unas especificaciones de diseño muy estrictas. Esto hace delicado y tedioso su diseño, especialmente si se desea garantizar su robustez al sufrir las variaciones de proceso. Para solventarlo, este trabajo presenta una metodología de optimización

Metodología de diseño de LNA de banda ancha robustos frente a variaciones de proceso

Los amplificadores de bajo ruido requieren cumplir unas especificaciones de diseño muy estrictas. Esto hace delicado y tedioso su diseño, especialmente si se desea garantizar su robustez al sufrir las variaciones de proceso. Para solventarlo, este trabajo presenta una metodología de optimización

A deep look at the nuclear region of UGC 5101 through high angular resolution mid-IR data with GTC/CanariCam

et al.We present an analysis of the nuclear infrared (IR, 1.6-18 μm) emission of the ultraluminous IR galaxy UGC5101 to derive the properties of its active galactic nucleus (AGN) and its obscuring material. We use new mid-IR high angular resolution (0.3-0.5 arcsec) imaging using the Si-2 filter (λ = 8.7 μm) and 7.5-13 μm spectroscopy taken with CanariCam (CC) on the 10.4 m Gran Telescopio CANARIAS. We also use archival Hubble Space Telescope/NICMOS and Subaru/COMICS imaging and Spitzer/IRS spectroscopy. We estimate the near- and mid-IR unresolved nuclear emission by modelling the imaging data with GALFIT. We decompose the Spitzer/IRS and CC spectra using a power-law component, which represents the emission due to dust heated by the AGN, and a starburst component, both affected by foreground extinction. We model the resulting unresolved near- and mid-IR, and the starburst subtracted CC spectrum with the CLUMPY torus models of Nenkova et al. The derived geometrical properties of the torus, including the large covering factor and the high foreground extinction needed to reproduce the deep 9.7 μm silicate feature, are consistent with the lack of strong AGN signatures in the optical.We derive an AGN bolometric luminosity L ~ 1.9 × 10 erg s that is in good agreement with other estimates in the literature.This work has been partly supported by Mexican CONACyT under research grant CB-2011-01-167291. MMP acknowledges support by the CONACyT PhD fellowship programme. AA-H and AH-C acknowledge financial support from the Spanish Plan Nacional de Astronomía y Astrofísica under grant AYA2012-31447, which is partly funded by the FEDER programme, and the Universidad de Cantabria through the Augusto G. Linares programme. CRA is supported by a Marie Curie Intra European Fellowship within the 7th European Community Framework Programme (PIEF-GA-2012-327934). IG-B ackowledges financial support from the Instituto de Astrofísica de Canarias through Fundacion La Caixa and from the Spanish Ministry of Science and Innovation (MICINN) through project PN AYA2013-47742-c4-2-P (Estallidos).Peer Reviewe

Marketing digital y fidelización de clientes en el desarrollo de la sostenibilidad comercial de la región Junín

Objective. To determine the relationship between digital marketing and customer loyalty in the development of commercial sustainability in the province of Tarma, Junín region (Peru). Methods. The research had a quantitative approach and was of basic type, correlational level and non-experimental-cross-sectional design; two instruments were used: the digital marketing questionnaire and the customer loyalty questionnaire. The first questionnaire consisted of 12 items referring to the dimensions of digital marketing and the second consisted of 15 items referring to the dimensions of customer loyalty. The sample consisted of 120 customers of commercial establishments in the province of Tarma. Results. 47.5 % of respondents considered that the implementation of digital marketing in commercial establishments is regular, 36.7 % considered that there is a low implementation and only 15.8 % considered that there is a high implementation of digital marketing. Referring to the customer loyalty questionnaire, 63.3 % considered that customer loyalty in commercial establishments occurs regularly, 21.7 % considered that customer loyalty is high and 15 % considered that customer loyalty is low. Conclusion. There is a direct and statistically significant relationship between digital marketing and customer loyalty in the development of sustainability in the province of Tarma, Junín region.Objetivo. Determinar la relación entre marketing digital y fidelización de clientes en el desarrollo de la sostenibilidad comercial de la provincia de Tarma, región Junín (Perú). Métodos. La investigación tuvo un enfoque cuantitativo y fue de tipo básico, nivel correlacional y diseño no experimental-transversal; se emplearon dos instrumentos: el cuestionario de marketing digital y el cuestionario de fidelización de clientes. El primer cuestionario constó de 12 ítems referidos a las dimensiones de marketing digital y el segundo constó de 15 ítems referidos a las dimensiones de la fidelización de clientes. La muestra estuvo conformada por 120 clientes de establecimientos comerciales de la provincia de Tarma. Resultados. El 47,5 % de encuestados consideró que la implementación del marketing digital en los establecimientos comerciales se da de forma regular, el 36,7% consideró que hay una baja implantación y solo el 15,8 % consideró que hay una alta implantación del marketing digital. Referente al cuestionario de fidelización de clientes, el 63,3 % consideró que la fidelización de clientes en los establecimientos comerciales se da de forma regular, el 21,7 % consideró que la fidelización de clientes es alta y el 15% considera que la fidelización de clientes es baja. Conclusión. Existe relación directa y estadísticamente significativa entre marketing digital y fidelización de clientes en el desarrollo de la sostenibilidad de la provincia de Tarma, región Junín