Overview of progress in European medium sized tokamaks towards an integrated plasma-edge/wall solution

Integrating the plasma core performance with an edge and scrape-off layer (SOL) that leads to tolerable heat and particle loads on the wall is a major challenge. The new European medium size tokamak task force (EU-MST) coordinates research on ASDEX Upgrade (AUG), MAST and TCV. This multi-machine approach within EU-MST, covering a wide parameter range, is instrumental to progress in the field, as ITER and DEMO core/pedestal and SOL parameters are not achievable simultaneously in present day devices. A two prong approach is adopted. On the one hand, scenarios with tolerable transient heat and particle loads, including active edge localised mode (ELM) control are developed. On the other hand, divertor solutions including advanced magnetic configurations are studied. Considerable progress has been made on both approaches, in particular in the fields of: ELM control with resonant magnetic perturbations (RMP), small ELM regimes, detachment onset and control, as well as filamentary scrape-off-layer transport. For example full ELM suppression has now been achieved on AUG at low collisionality with n = 2 RMP maintaining good confinement HH(98,y2) 0.95. Advances have been made with respect to detachment onset and control. Studies in advanced divertor configurations (Snowflake, Super-X and X-point target divertor) shed new light on SOL physics. Cross field filamentary transport has been characterised in a wide parameter regime on AUG, MAST and TCV progressing the theoretical and experimental understanding crucial for predicting first wall loads in ITER and DEMO. Conditions in the SOL also play a crucial role for ELM stability and access to small ELM regimes.European Commission (EUROfusion 633053

Trends in prevalence and the effects on hospital outcomes of dementia in patients hospitalized with acute COPD exacerbation

Aims: To assess changes in prevalence and the effects on hospital outcomes of dementia among patients hospitalized with an acute exacerbation of chronic obstructive pulmonary disease (AE-COPD); and to evaluate sexdifferences, as well as the impact of COVID-19 pandemic in this relationship. Methods: We used a nationwide discharge database to select patients admitted with AE-COPD in Spain from 2011 to 2020. We identified those with any type of dementia, vascular dementia (VaD) or Alzheimer’s disease (AD). Results: We identified 658,429 hospitalizations with AE-COPD (4.45% had any type of dementia, 0.79% VaD and 1.57% AD). The presence of any type of dementia remained stable from 2011 to 2015, and increased significantly between 2016 and 2020. For VaD, the time trend showed no change until 2020, when a significant increment was found. The probability of AD decreased significantly overtime. The in-hospital mortality (IHM) among patients with any type of dementia remained stable overtime until 2020, when it increased significantly. Older age, higher comorbidity, COVID-19, and use of mechanical ventilation were variables associated to IHM. Women had lower risk of dying in the hospital than men in all subgroups. Conclusions: After a previous period of stability, the prevalence of any type of dementia increased over the last 5 years of the study, although we identified different trends depending on the specific cause of dementia. The IHM remained stable overtime until 2020, when it increased, probably related to the COVID-19 pandemic. It is remarkable the protective effect of female sex for IHM.Depto. de Salud Pública y Materno - InfantilFac. de MedicinaTRUEResearch Aid 2022Sociedad Madrileña de Neumología y Cirugía de Tórax (NEUMOMADRID)Comunidad de MadridUniversidad Complutense de Madrid. Grupo de Investigación en Epidemiología de las Enfermedades Crónicas de Alta Prevalencia en EspañaSociedad Española de Neumología y Cirugía de Tórax (SEPAR)pu

Survival of patients receiving a liver transplant for hepatocellular carcinoma, and risk of tumor recurrence

Objective: the goal of this research has been to evaluate the survival, in long and short term, of the patient receiving liver transplant for hepatocellular carcinoma (HCC), the risk of posttransplant tumor relapse and factors related to this complication. Design: retrospective study of a consecutive series of patients having had liver transplant for HCC. Patients and methodology: transplant patients for HCC from 1989 to November 2003. Patients were selected due to general limitations of nodule size and quantity, which were subsequently published as Milan criteria. Also, criteria agreed in the Conference of Barcelona were followed in the pre-transplant diagnosis. Results: the survival of this 81 patients group was of the 80, 61 and 52% for 1, 5 and 10 years respectively. In the 32% of the cases the HCC was an incidental finding in the explant. In the 12.3%, the tumor relapse was verified. The multivariate research identified the size of the nodule (OR = 1,7944) (IC 95% = 1,1332-2,8413) and the vascular invasion (OR = 6,6346) (IC 95% = 1,4624-30,1003) as risk factors of relapse. Conclusions: the liver transplant in selected patients with HCC has good results in medium and long term. The risk of post-transplant tumor relapse becomes notably reduced and is associated with the size of the nodule and the microscopic vascular invasion

Trabajadores pobres y pobreza en el trabajo: concepto y evolución de la pobreza en la oculación: el impacto de las últimas reformas legales

Secretaría de Estado de Investigación, Desarrollo e InnovaciónFondo Europeo de Desarrollo Regional (FEDER) de la Unión Europe

Trends in asthma hospitalizations among adults in Spain: Analysis of hospital discharge data from 2011 to 2020

Aims: To analyze trends in asthma hospitalizations in patients over 15 years of age in Spain. To identify possible changes in incidence, demographic characteristics, clinical conditions, and outcomes. Methods: We conducted an observational retrospective epidemiological study using the Spanish National Hospital Discharge Database and included all patients hospitalized with a diagnosis of asthma from 2011 to 2020. Results: A total of 1,102,923 patients were hospitalized with a code for asthma in any diagnostic position; of these, 153,749 (13.94%) had asthma coded as the primary diagnosis (asthma exacerbation). The number of patients with an asthma exacerbation decreased over time, from 15,356 in 2011 to 8804 in 2020. In-hospital mortality (IHM) remained low (around 1.5%) and stable in this subgroup of patients. When the diagnosis of asthma appeared in any diagnostic position, hospitalizations increased for all ages and sexes. In this case, a significant change was observed for IHM, which increased from 3.27% in 2011–12 to 4.36% in 2019–20 (p < 0.001). The main risk factors for IHM in both cases were age over 65 years, need for mechanical ventilation, and associated diagnoses of pneumonia, heart disease, or atrial fibrillation. In contrast, obesity was a predictor of lower mortality. Conclusion: Our results suggest a decline in the incidence of hospitalizations for asthma exacerbations from 2011 to 2020. In contrast, the number of patients with asthma in any diagnostic position increased progressively, as did mortality, probably owing to an increase in comorbidities in a gradually ageing population

Time Trends in Clinical Characteristics and Hospital Outcomes of Hospitalizations for Lung Transplantation in COPD Patients in Spain from 2016 to 2020—Impact of the COVID-19 Pandemic

This study is part of the research funded by: Sociedad Española de Neumología y Cirugía de Tórax (SEPAR), Research Aid 2022, Project number 1309; and Sociedad Madrileña de Neumología y Cirugía de Tórax (NEUMOMADRID), XXII Awards Edition, 2022, and by: Convenio V-PRICIT de la Comunidad de Madrid y la Universidad Complutense de Madrid (“Programa de Excelencia para el Profesorado Universitario” INV.AY.20.2021.1E126), and by: Universidad Complutense de Madrid. Grupo de Investigación en Epidemiología de las Enfermedades Crónicas de Alta Prevalencia en España (970970).(1) Background: To examine the clinical characteristics and hospital outcomes of hospitalization for lung transplantation in COPD patients in Spain from 2016 to 2020; and to assess if the COVID-19 pandemic has affected the number or the outcomes of lung transplantations in these patients. (2) Methods: We used the Spanish National Hospital Discharge Database to select subjects who had a code for COPD (ICD-10: J44) and had undergone a lung transplantation (ICD-10 codes OBYxxxx). (3) Results: During the study period, 704 lung transplants were performed among COPD patients (single 31.68%, bilateral 68.32%). The absolute number of transplants increased with raising rates of 8%, 14% and 19% annually from 2016 to 2019. However, a marked decrease of −18% was observed from 2019 to year 2020. Overall, 47.44% of the patients suffered at least one complication, being the most frequent lung transplant rejection (24.15%), followed by lung transplant infection (13.35%). The median length of hospital stay (LOHS) was 33 days and the in-hospital-mortality (IHM) was 9.94%. Variables associated with increased risk of mortality were a Comorbidity Charlson Index ≥ 1 (OR 1.82; 95%CI 1.08–3.05) and suffering any complication of the lung transplantation (OR 2.14; 95%CI 1.27–3.6). COPD patients in 2020 had a CCI ≥ 1 in a lower proportion than 2019 patients (29.37 vs. 38.51%; p = 0.015) and less frequently suffered any complications after the lung transplantation (41.26 vs. 54.6%; p = 0.013), no changes in the LOHS or the IHM were detected from 2019 to 2020. (4) Conclusions: Our study showed a constant increase in the number of lung transplantations from 2016 to 2019 in COPD patients, with a drop from 2019 to 2020, probably related to the COVID-19 pandemic. However, no changes in LOHS or IHM were detected over time.Depto. de Salud Pública y Materno - InfantilFac. de MedicinaTRUESociedad Española de Neumología y Cirugía de Tórax (SEPAR)Sociedad Madrileña de Neumología y Cirugía de Tórax (NEUMOMADRID)Convenio V-PRICITUniversidad Complutense de MadridUniversidad Complutense de Madrid. Grupo de Investigación en Epidemiología de las Enfermedades Crónicas de Alta Prevalencia en España (970970)pu

Enantiopure 4‐oxazolin‐2‐ones and 4‐methylene‐2‐oxazolidinones as chiral building blocks in a divergent asymmetric synthesis of heterocycles

En este trabajo se describe la reactividad de las oxazolidin-2-onas en un ambiente quiral obteniéndose resultados novedosos, los cuales se describen extensamente.Enantiopure 3‐((R)‐ and 3‐((S)‐1‐phenylethyl)‐4‐oxazoline‐2‐ones were evaluated as chiral building blocks for the divergent construction of heterocycles with stereogenic quaternary centers. The N‐(R)‐ or N‐(S)‐1‐phenylethyl group of these compounds proved to be an efficient chiral auxiliary for the asymmetric induction of the 4‐ and 5‐positions of the 4‐oxazolin‐2‐one ring through thermal and MW‐promoted nucleophilic conjugated addition to Michael acceptors and alkyl halides. The resulting adducts were transformed via a cascade process into fused six‐membered carbo‐ and heterocycles. The structure of the reaction products depended on the electrophiles and reaction conditions used. Alternative isomeric 4‐methylene‐2‐oxazolidinones served as chiral precursors for a versatile and divergent approach to highly substituted cyclic carbamates. DFT quantum calculations showed that the formation of bicyclic pyranyl compounds was generated by a diastereoselective concerted hetero‐Diels‐Alder cycloaddition.Instituto Politécnico Nacional, Secretaria de Investigación y Estudios Avanzados de la Universidad Autónoma del Estado de México, Universidad de Guanajuato y CONACYT

EMIR, the GTC NIR multi-object imager-spectrograph

EMIR, currently entering into its fabrication and AIV phase, will be one of the first common user instruments for the GTC, the 10 meter telescope under construction by GRANTECAN at the Roque de los Muchachos Observatory (Canary Islands, Spain). EMIR is being built by a Consortium of Spanish and French institutes led by the Instituto de Astrofísica de Canarias (IAC). EMIR is designed to realize one of the central goals of 10m class telescopes, allowing observers to obtain spectra for large numbers of faint sources in a time-efficient manner. EMIR is primarily designed to be operated as a MOS in the K band, but others a wide range of observing modes, including imaging and spectroscopy, both long slit and multi-object, in the wavelength range 0.9 to 2.5 um. It is equipped with two innovative subsystems: a robotic reconfigurable multi-slit mask and dispersive elements formed by the combination of high quality distraction grating and conventional prisms, both at the heart of the instrument. The present status of development, expected performances, schedule and plans for scientific exploitation are described and discussed. The development and fabrication of EMIR is funded by GRANTECAN and the Plan Nacional de Astronomía y Astrofísica (National Plan for Astronomy and Astrophysics, Spain).Peer ReviewedPostprint (published version

Management of a ruptured epidural catheter, an anesthesiologist's dilemma: a case report

Epidural anesthesia is a widely used anesthetic technique in lower extremity surgeries although it is a relatively safe procedure, it can have complications, such as rupture of the epidural catheter. This is a 69-year-old male patient with a diagnosis of Wagner IV diabetic foot is presented, which was scheduled for left supracondylar amputation in which after epidural block, retention of the catheter tip in the epidural space at level L2-L3 was seen, so hemi laminectomy was performed in a second surgical stage in L2 and removal of the epidural catheter. Ideally a broken needle should be removed as soon as possible