Sedación en pruebas endoscópicas funcionales digestivas y respiratorias

Los procedimientos endoscópicos están suponiendo un gran avance en la medicina a nivel mundial. La satisfacción percibida por el paciente depende en gran medida de la sedo-analgesia empleada. Es por ello que la sedación ha adquirido un papel cada vez más relevante en esta área.La importancia de la sedación durante las pruebas diagnósticas es bien conocida. Sus objetivos son principalmente, mejorar la tolerancia y la calidad de la endoscopia, consiguiendo un adecuado nivel de sedación con el mínimo riesgo posible. Este riesgo depende del paciente, del tipo de exploración y de las dosis y de la forma de administración de los fármacos utilizados. Siendo otro objetivo, conseguir un grado de sedación que sea confortable para el paciente (cuando el paciente está sedado pero conserva los reflejos de la tos y el vómito).La sedación consciente se basa en el uso combinado de benzodiacepinas (siendo el Midazolam de elección) junto con un opioide (siendo el Fentanilo el más empleado). Considerando el propofol como el fármaco de elección en la sedación profunda. Cabe destacar la importancia de la realización de una correcta evaluación pre anestésica, así como una monitorización continua durante y después de la exploración. Todo ello con el objetivo de prevenir y/o disminuir las posibles complicaciones derivadas de la intervención y conseguir la máxima tolerancia por parte del paciente.<br /

Updated taxonomic descriptions, iconography, and habitat preferences of <em>Brachypodium distachyon, B. stacei</em>, and <em>B. hybridum</em> (Poaceae)

We present an updated morphological revision of the three annual species of the genus <em>Brachypodium</em> (Poaceae): <em>B. distachyon, B. tacei</em>, and <em>B. hybridum</em>, which were recently segregated as independent species from the single-species complex <em>B. distachyon</em> s.l. These three species have been proposed as a model system for grass polyploid speciation, and their genomes have been sequenced. However, despite the increasing number of genomic and population-genetic studies conducted for each of these species, no taxonomic updating has been done on them since their original descriptions. <em>B. stacei</em>, the rarest species of the complex, has a protologue based only on the study of specimens from its type locality in Torrent (Formentera, Spain). In this study we update the taxonomic descriptions of the three species using morphoanatomical data from specimens collected throughout their respective native circum-Mediterranean distributions as well as in other localities where they are non-autochthonous. We also provide icons for each species and information about their habitat preferences and geographic distributions.<br><br>Presentamos una revisión morfológica actualizada de las tres especies anuales del género <em>Brachypodium</em> (Poaceae), <em>B. distachyon, B. stacei</em> y <em>B. ybridum</em>. Estas dos últimas han sido recientemente segregadas como especies independientes dentro del complejo <em>B. distachyon</em> s.l. Las tres especies han sido propuestas como grupo modelo de especiación poliploide en gramíneas y sus genomas han sido secuenciados. Sin embargo, pese al incremento de estudios genómicos y genético-poblacionales desarrollados en poblaciones de estas especies, no se ha llevado a cabo todavía ninguna actualización taxonómica para las mismas desde que se describieron. El protólogo de <em>B. stacei</em>, la especie más rara del complejo, está basado únicamente en el estudio de especímenes de su localidad clásica en Torrent (Formentera, España). En este estudio actualizamos las descripciones taxonómicas de las tres especies, utilizando datos morfoanatómicos obtenidos de especímenes colectados a lo largo de sus respectivas áreas de distribución autóctona circunmediterráneas y en otras localidades donde no son autóctonas. Proporcionamos icones de cada una de las especies e información adicional sobre sus preferencias de hábitat y sus distribuciones geográficas conocidas

Actualización de las descripciones taxonómicas, iconografía y preferencias de hábitat de Brachypodium distachyon, B. stacei, y B. hybridum (Poaceae)

We present an updated morphological revision of the three annual species of the genus Brachypodium (Poaceae): B. distachyon, B. tacei, and B. hybridum, which were recently segregated as independent species from the single-species complex B. distachyon s.l. These three species have been proposed as a model system for grass polyploid speciation, and their genomes have been sequenced. However, despite the increasing number of genomic and population-genetic studies conducted for each of these species, no taxonomic updating has been done on them since their original descriptions. B. stacei, the rarest species of the complex, has a protologue based only on the study of specimens from its type locality in Torrent (Formentera, Spain). In this study we update the taxonomic descriptions of the three species using morphoanatomical data from specimens collected throughout their respective native circum-Mediterranean distributions as well as in other localities where they are non-autochthonous. We also provide icons for each species and information about their habitat preferences and geographic distributions.Presentamos una revisión morfológica actualizada de las tres especies anuales del género Brachypodium (Poaceae), B. distachyon, B. stacei y B. ybridum. Estas dos últimas han sido recientemente segregadas como especies independientes dentro del complejo B. distachyon s.l. Las tres especies han sido propuestas como grupo modelo de especiación poliploide en gramíneas y sus genomas han sido secuenciados. Sin embargo, pese al incremento de estudios genómicos y genético-poblacionales desarrollados en poblaciones de estas especies, no se ha llevado a cabo todavía ninguna actualización taxonómica para las mismas desde que se describieron. El protólogo de B. stacei, la especie más rara del complejo, está basado únicamente en el estudio de especímenes de su localidad clásica en Torrent (Formentera, España). En este estudio actualizamos las descripciones taxonómicas de las tres especies, utilizando datos morfoanatómicos obtenidos de especímenes colectados a lo largo de sus respectivas áreas de distribución autóctona circunmediterráneas y en otras localidades donde no son autóctonas. Proporcionamos icones de cada una de las especies e información adicional sobre sus preferencias de hábitat y sus distribuciones geográficas conocidas

Delirium Postoperatorio tras Anestesia General

El Delirium Postoperatorio es una complicación frecuente y potencialmente grave en los pacientes añosos sometidos a intervenciones quirúrgicas bajo anestesia general. Su aparición se ha asociado con un peor pronóstico a corto y a largo plazo, aumento de reingresos, mayor mortalidad, peor calidad de vida al alta, mayor riesgo de depresión y ansiedad, aumento del riesgo de desarrollar deterioro cognitivo o demencia e incremento de los gastos sanitarios. Actualmente, las estrategias de prevención con un enfoque multimodal son el método más eficaz para disminuir la incidencia del Delirium Postoperatorio.Numerosos estudios observacionales y ensayos clínicos han analizado la relación entre los niveles de profundidad anestésica controlados con un monitor BIS y el desarrollo de Delirium Postoperatorio. Se ha planteado la hipótesis de que la administración de anestésicos controlada con un monitor BIS, manteniendo un nivel de hipnosis óptimo, puede disminuir el riesgo de desarrollar esta complicación. El objetivo principal de esta revisión es analizar la evidencia científica existente hasta la fecha acerca de la efectividad de la monitorización de la profundidad anestésica mediante el BIS en la reducción de la incidencia del Delirium Postoperatorio. Además, se realizará un metaanálisis de los ensayos clínicos publicados recientemente con el objetivo de obtener conclusiones firmesbasadas en la evidencia.<br /

Targeting γ-secretases protect against angiotensin II-induced cardiac hypertrophy

OBJECTIVE: The Notch pathway has been linked to pulmonary hypertension, but its role in systemic hypertension and, in particular in left ventricular hypertrophy (LVH), remains poorly understood. The main objective of this work was to analyse the effect of inhibiting the Notch pathway on the establishment and maintenance of angiotensin II (Ang-II)-induced arterial hypertension and LVH in adult mice with inducible genetic deletion of γ-secretase, and to test preclinically the therapeutic efficacy of γ-secretase inhibitors (GSIs). BASIC METHODS: We analysed Ang-II responses in primary cultures of vascular smooth muscle cells obtained from a novel mouse model with inducible genetic deletion of the γ-secretase complex, and the effects of GSI treatment on a mouse cardiac cell line. We also investigated Ang-II-induced hypertension and LVH in our novel mouse strain lacking the γ-secretase complex and in GSI-treated wild-type mice. Moreover, we analysed vascular tissue from hypertensive patients with and without LVH. MAIN RESULTS: Vascular smooth muscle cells activate the Notch pathway in response to Ang-II both 'in vitro' and 'in vivo'. Genetic deletion of γ-secretase in adult mice prevented Ang-II-induced hypertension and LVH without causing major adverse effects. Treatment with GSI reduced Ang-II-induced hypertrophy of a cardiac cell line 'in vitro' and LVH in wild-type mice challenged with Ang-II. We also report elevated expression of the Notch target HES5 in vascular tissue from hypertensive patients with LVH compared with those without LVH. CONCLUSION: The Notch pathway is activated in the vasculature of mice with hypertension and LVH, and its inhibition via inducible genetic γ-secretase deletion protects against both conditions. Preliminary observations in hypertensive patients with LVH support the translational potential of these findings. Moreover, GSI treatment protects wild-type mice from Ang-II-induced LVH without affecting blood pressure. Our results unveil the potential use of GSIs in the treatment of hypertensive patients with LVH.Juan de la Cierva postdoctoral contract from MINECO [JCI-2011-09663]; MINECO; ProCNIC Foundation; Spanish Ministry of Economy and Competitivity (MINECO) [SAF2013-46663-R]; Instituto de Salud Carlos III [RD12/0042/0028, RD12/0042/0009, MS-00151]; Inserm (jeune chercheur accueilli)S

Sorption behavior of the MgH2-Mg2FeH6 hydride storage system synthesized by mechanical milling followed by sintering

The hydrogen sorption behavior of the Mg2FeH6eMgH2hydride system is investigated via in-situ synchrotron and laboratory powder X-ray diffraction (SR-PXD), differential scanning calorimetry (DSC), scanning electron microscopy (SEM), particle size distribution (PSD) and volumetric techniques. The Mg2FeH6eMgH2 hydride system is obtained by mechanical milling in argon atmosphere followed by sintering at high temperature and hydrogen pressure. In-situ SR-PXD results show that upon hydriding MgH2 is a precursor for Mg2FeH6 formation and remained as hydrided phase in the obtained material. Diffusion constraints preclude the further formation of Mg2FeH6. Upon dehydriding, our results suggest that MgH2 and Mg2FeH6 decompose independently in a narrow temperature range between 275 and 300 C. Moreover, the decomposition behavior of both hydrides in the Mg2FeH6eMgH2 hydride mixture is influenced by each other via dual synergetic-destabilizing effects. The final hydriding/dehydriding products and therefore the kinetic behavior of the Mg2FeH6eMgH2 hydride system exhibits a strong dependence on the temperature and pressure conditions.Fil: Puszkiel, Julián Atilio. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Comisión Nacional de Energía Atómica; ArgentinaFil: Gennari, Fabiana Cristina. Comision Nacional de Energia Atomica. Gerencia de Area de Aplicaciones de la Tecnologia Nuclear. Gerencia de Investigacion Aplicada; . Universidad Nacional de Cuyo; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Arneodo Larochette, Pierre Paul. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Comision Nacional de Energia Atomica. Gerencia de Area de Aplicaciones de la Tecnologia Nuclear. Gerencia de Investigacion Aplicada; . Universidad Nacional de Cuyo; ArgentinaFil: Karimi, Fahim. Materials Technology. Institute of Materials Research; AlemaniaFil: Pistidda, Claudio. Materials Technology. Institute of Materials Research; AlemaniaFil: Gosalawit Utke, Rapee. Materials Technology. Institute of Materials Research; Alemania. Suranaree University of Technology. Institute of Science, School of Chemistry; TailandiaFil: Jepsen, Julian. Materials Technology. Institute of Materials Research; AlemaniaFil: Jensen, Torben R.. University of Aarhu. Center for Energy Materials, iNANO and Department of Chemistry; DinamarcaFil: Gundlach, Carsten. Lund University. MAX-lab; SuizaFil: Bellosta von Colbe, José. Materials Technology. Institute of Materials Research; AlemaniaFil: Klassen, Thomas. Materials Technology. Institute of Materials Research; AlemaniaFil: Dornheim, Martin. Materials Technology. Institute of Materials Research; Alemani

New Insight on the Hydrogen Absorption Evolution of the Mg-Fe-H System under Equilibrium Conditions

Mg2FeH6 is regarded as potential hydrogen and thermochemical storage mediumdue to its high volumetric hydrogen (150 kg/m3) and energy (0.49 kWh/L) densities. In this work, the mechanism of formation of Mg2FeH6 under equilibrium conditions is thoroughly investigated applying volumetric measurements, X-ray diffraction (XRD), X-ray absorption near edge structure (XANES), and the combination of scanning transmission electron microscopy (STEM) with energy-dispersive X-ray spectroscopy (EDS) and high-resolution transmission electron microscopy (HR-TEM). Starting from a 2Mg:Fe stoichiometric powder ratio, thorough characterizations of samples taken at different states upon hydrogenation under equilibrium conditions confirm that the formation mechanism of Mg2FeH6 occurs from elemental Mg and Fe by columnar nucleation of the complex hydride at boundaries of the Fe seeds. The formation of MgH2 is enhanced by the presence of Fe. However, MgH2 does not take part as intermediate for the formation of Mg2FeH6 and acts as solid-solid diffusion barrier which hinders the complete formation of Mg2FeH6. This work provides novel insight about the formation mechanism of Mg2FeH6.Fil: Puszkiel, Julián Atilio. Helmholtz–Zentrum Geesthacht; Alemania. Comisión Nacional de Energía Atómica. Centro Atómico Bariloche; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Castro Riglos, Maria Victoria. Comisión Nacional de Energía Atómica. Centro Atómico Bariloche; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Ramallo Lopez, Jose Martin. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas; ArgentinaFil: Mizrahi, Martin Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas; ArgentinaFil: Gemming, Thomas. IFW Dresden; AlemaniaFil: Pistidda, Claudio. Helmholtz–Zentrum Geesthacht; AlemaniaFil: Arneodo Larochette, Pierre Paul. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Comisión Nacional de Energía Atómica. Centro Atómico Bariloche; ArgentinaFil: Bellosta von Colbe, José. Helmholtz–Zentrum Geesthacht; AlemaniaFil: Klassen, Thomas. Helmut Schmidt University; Alemania. Helmholtz–Zentrum Geesthacht; AlemaniaFil: Dornheim, Martin. Helmholtz–Zentrum Geesthacht; AlemaniaFil: Gennari, Fabiana Cristina. Comisión Nacional de Energía Atómica. Centro Atómico Bariloche; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Effect of Fe additive on the hydrogenation-dehydrogenation properties of 2LiH + MgB2/2LiBH4 + MgH2 system

Lithium reactive hydride composite 2LiBH4 + MgH2 (Li-RHC) has been lately investigated owing to its potential as hydrogen storage medium for mobile applications. However, the main problem associated with this material is its sluggish kinetic behavior. Thus, aiming to improve the kinetic properties, in the present work the effect of the addition of Fe to Li-RHC is investigated. The addition of Fe lowers the starting decomposition temperature of Li-RHC about 30 °C and leads to a considerably faster isothermal dehydrogenation rate during the first hydrogen sorption cycle. Upon hydrogenation, MgH2 and LiBH4 are formed whereas Fe appears not to take part in any reaction. Upon the first dehydrogenation, the formation of nanocrystalline, well distributed FeB reduces the overall hydrogen storage capacity of the system. Throughout cycling, the agglomeration of FeB particles causes a kinetic deterioration. An analysis of the hydrogen kinetic mechanism during cycling shows that the hydrogenation and dehydrogenation behavior is influenced by the activity of FeB as heterogeneous nucleation center for MgB2 and its non-homogenous distribution in the Li-RHC matrix.Fil: Puszkiel, Julián Atilio. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Helmholtz-zentrum Geesthacht - Zentrum Für Material- Und Küstenforschung Gmbh;Fil: Gennari, Fabiana Cristina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Centro Atómico Bariloche; ArgentinaFil: Arneodo Larochette, Pierre Paul. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Centro Atómico Bariloche; ArgentinaFil: Ramallo Lopez, Jose Martin. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas; ArgentinaFil: Vainio, U.. Helmholtz-zentrum Geesthacht - Zentrum Für Material- Und Küstenforschung Gmbh; . Deutsches Elektronen-Synchrotron; AlemaniaFil: Karimi, F.. Helmholtz-zentrum Geesthacht - Zentrum Für Material- Und Küstenforschung Gmbh;Fil: Pranzas, P. K.. Helmholtz-zentrum Geesthacht - Zentrum Für Material- Und Küstenforschung Gmbh;Fil: Troiani, Horacio Esteban. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Centro Atómico Bariloche; ArgentinaFil: Pistidda, C.. Helmholtz-zentrum Geesthacht - Zentrum Für Material- Und Küstenforschung Gmbh;Fil: Jepsen, J.. Helmholtz-zentrum Geesthacht - Zentrum Für Material- Und Küstenforschung Gmbh;Fil: Tolkiehn, M.. Deutsches Elektronen-Synchrotron; AlemaniaFil: Welter, E.. Deutsches Elektronen-Synchrotron; AlemaniaFil: Klassen, T.. Helmholtz-zentrum Geesthacht - Zentrum Für Material- Und Küstenforschung Gmbh;Fil: Bellosta Von Colbe, J.. Helmholtz-zentrum Geesthacht - Zentrum Für Material- Und Küstenforschung Gmbh;Fil: Dornheim, M.. Helmholtz-zentrum Geesthacht - Zentrum Für Material- Und Küstenforschung Gmbh

The discovery, distribution and diversity of DNA viruses associated with Drosophila melanogaster in Europe

International audienceDrosophila melanogaster is an important model for antiviral immunity in arthropods, but very few DNA viruses have been described from the family Drosophilidae. This deficiency limits our opportunity to use natural host-pathogen combinations in experimental studies, and may bias our understanding of the Drosophila virome. Here we report fourteen DNA viruses detected in a metagenomic analysis of approximately 6500 pool-sequenced Drosophila, sampled from 47 European locations between 2014 and 2016. These include three new nudiviruses, a new and divergent entomopoxvirus, a virus related to Leptopilina boulardi filamentous virus, and a virus related to Musca domestica salivary gland hypertrophy virus. We also find an endogenous genomic copy of galbut virus, a dsRNA partitivirus, segregating at very low frequency. Remarkably, we find that Drosophila Vesanto virus, a small DNA virus previously described as a bidnavirus, may be composed of up to 12 segments and thus represent a new lineage of segmented DNA viruses. Two of the DNA viruses, Drosophila Kallithea nudivirus and Drosophila Vesanto virus are relatively common, found in 2% or more of wild flies. The others are rare, with many likely to be represented by a single infected fly. We find that virus prevalence in Europe reflects the prevalence seen in publicly-available datasets, with Drosophila Kallithea nudivirus and Drosophila Vesanto virus the only ones commonly detectable in public data from wild-caught flies and large population cages, and the other viruses being rare or absent. These analyses suggest that DNA viruses are at lower prevalence than RNA viruses in D. melanogaster, and may be less likely to persist in laboratory cultures. Our findings go some way to redressing an earlier bias toward RNA virus studies in Drosophila, and lay the foundation needed to harness the power of Drosophila as a model system for the study of DNA viruses

Surgical treatment for colorectal cancer: Analysis of the influence of an enhanced recovery programme on long-term oncological outcomes-a study protocol for a prospective, multicentre, observational cohort study

Introduction The evidence currently available from enhanced recovery after surgery (ERAS) programmes concerns their benefits in the immediate postoperative period, but there is still very little evidence as to whether their correct implementation benefits patients in the long term. The working hypothesis here is that, due to the lower response to surgical aggression and lower rates of postoperative complications, ERAS protocols can reduce colorectal cancer-related mortality. The main objective of this study is to analyse the impact of an ERAS programme for colorectal cancer on 5-year survival. As secondary objectives, we propose to analyse the weight of each of the predefined items in the oncological results as well as the quality of life. Methods and analysis A multicentre prospective cohort study was conducted in patients older than 18 years of age who are scheduled to undergo surgery for colorectal cancer. The study involved 12 hospitals with an implemented enhanced recovery protocol according to the guidelines published by the Spanish National Health Service. The intervention group includes patients with a minimum implementation level of 70%, and the control group includes those who fail to reach this level. Compliance will be studied using 18 key performance indicators, and the results will be analysed using cancer survival indicators, including overall survival, cancer-specific survival and relapse-free survival. The time to recurrence, perioperative morbidity and mortality, hospital stay and quality of life will also be studied, the latter using the validated EuroQol Five questionnaire. The propensity index method will be used to create comparable treatment and control groups, and a multivariate regression will be used to study each variable. The Kaplan-Meier estimator will be used to estimate survival and the log-rank test to make comparisons. A p value of less than 0.05 (two-tailed) will be considered to be significant. Ethics and dissemination Ethical approval for this study was obtained from the Aragon Ethical Committee (C.P.-C.I. PI20/086) on 4 March 2020. The findings of this study will be submitted to peer-reviewed journals (BMJ Open, JAMA Surgery, Annals of Surgery, British Journal of Surgery). Abstracts will be submitted to relevant national and international meetings.The present research study was awarded a Ministerio de Ciencia e Innovación health research project grant (PI19/00291) from the Carlos III Institute of the Spanish National Health Service as part of the 2019 call for Strategic Action in Health