A new strategy to design SIW-fed arrays

In this work, a new full-wave strategy, with very low iteration times, is proposed for the optimization and design of antenna arrays fed by substrate integrated waveguides. The device is decomposed into fixed and modifiable (to be optimized) sections, whose generalized scattering matrices are precomputed. The response of the array is calculated by considering firstly only the interactions between the fixed sections, which are then coupled to the modifiable ones in each iteration of an optimization process. To validate the proposed strategy, a transversal 16-slot antenna array, placed on the top plate of a substrate integrated waveguide, has been designed. A speed-up factor of over 2000 times, compared to general purpose commercial software, has been obtained in this optimization process. The final design presents a 1.05 GHz bandwidth under - 10 dB in terms of |S11|, a maximum realized gain of 17.5 dBi at 17 GHz, and a 99.95% maximum efficiency (without dielectric and conductor losses). Index Terms—Addition theorems, cylindrical modes, spherical modes, optimization process, antenna array, substrate integrated waveguide (SIW)

Testing for alpha-1 antitrypsin in COPD in outpatient respiratory clinics in Spain: A multilevel, cross-sectional analysis of the EPOCONSUL study

Background Alpha-1 antitrypsin deficiency (AATD) is the most common hereditary disorder in adults, but is under-recognized. In Spain, the number of patients diagnosed with AATD is much lower than expected according to epidemiologic studies. The objectives of this study were to assess the frequency and determinants of testing serum α1-antitrypsin (AAT) levels in COPD patients, and to describe factors associated with testing. Methods EPOCONSUL is a cross-sectional clinical audit, recruiting consecutive COPD cases over one year. The study evaluated serum AAT level determination in COPD patients and associations between individual, disease-related, and hospital characteristics. Results A total of 4,405 clinical records for COPD patients from 57 Spanish hospitals were evaluated. Only 995 (22.5%) patients had serum AAT tested on some occasion. A number of patient characteristics (being male [OR 0.5, p < 0.001], ≤55 years old [OR 2.38, p<0.001], BMI≤21 kg/m2 [OR 1.71, p<0.001], FEV1(%)<50% [OR 1.35, p<0.001], chronic bronchitis [OR 0.79, p < 0.001], Charlson index ≥ 3 [OR 0.66, p < 0.001], or history or symptoms of asthma [OR 1.32, p<0.001]), and management at a specialized COPD outpatient clinic [OR 2.73,p<0.001] were identified as factors independently associated with ever testing COPD patients for AATD. Overall, 114 COPD patients (11.5% of those tested) had AATD. Of them, 26 (22.8%) patients had severe deficiency. Patients with AATD were younger, with a low pack-year index, and were more likely to have emphysema (p<0.05). Conclusion Testing of AAT blood levels in COPD patients treated at outpatient respiratory clinics in Spain is infrequent. However, when tested, AATD (based on the serum AAT levels ≤100 mg/dL) is detected in one in five COPD patients. Efforts to optimize AATD case detection in COPD are needed.SEPA

Microrna-21 and colorectal cancer

Introducción. Los microRNAs son estructuras moleculares con actividad post-transcripcional que están implicados en la regulación de la expresión genética. Diversos estudios ponen de manifiesto la participación de los microRNAs con distintas funciones fisiológicas, así como con el proceso de la oncogénesis. La expresión de los microRNAs puede verse alterada en las neoplasias por su interacción bien con los genes supresores de tumores, bien con los oncogenes. Discusión. Llevamos a cabo una revisión de la literatura sobre el microRNA-21, poniendo de manifiesto la evidencia existente entre el microRNA-21 y la enfermedad neoplásica, de forma especial con el cáncer colorrectal. Conclusiones. El estado actual de los microRNAs hace necesario continuar con la investigación existente entre la etiopatogenia de las neoplasias y los microRNAs. El conocimiento de la verdadera implicación de los microRNAs en la fisiopatología de la enfermedad neoplásica, permitirá ampliar las supuestas aplicaciones clínicas del miR-21 no sólo a la determinación del pronóstico del cáncer colorrectal, sino también desde el punto de vista diagnóstico al poder diferenciar las lesiones de la mucosa colónicaIntroduction. MicroRNAs are molecular structures with post-transcriptional activity, involved in the gene expression regulation. Several studies have demonstrated the involvement of microRNAs in different physiological functions, as well as in the oncogenesis process. The expression of microRNAs may be altered in the tumors by either interaction with tumor suppressor genes or oncogenes. Discussion. A review of the medical literature on microRNA-21 has been conducted, showing the evidence between microRNA-21 and neoplastic disease, specially with colorectal cancer. Conclusion. The current status of microRNAs makes necessary to continue the investigation of the pathogenesis of cancer and microRNAs. The knowledge of the involvement of microRNAs in the pathophysiology of neoplastic disease, will allow to extend the supposed clinical applications of miR-21 not only to the determination of the prognosis of colorectal cancer, but also for the differential diagnosis of processes of colonic mucosa

¿Es mayor la mortalidad en los pacientes que han sufrido una fractura de cadera?

Introducción y objetivos El objetivo de este estudio es valorar si los pacientes que han sufrido una fractura de cadera tienen una mortalidad más alta de la esperada. Material y métodos Se realizó un estudio prospectivo, observacional donde se toma como muestra los pacientes con fractura de cadera a lo largo de un año, cuya cifra fue de 284 y el seguimiento mínimo fue de 2 años. La edad media de estos pacientes fue de 84, 26 años, siendo el 21, 48% (61/284) varones y el 78, 5% (223/284) mujeres. La supervivencia y las enfermedades previas que afectan a la mortalidad como factores de riesgo se recogieron y se analizaron mediante el método de Kaplan-Meier y mediante la regresión de Cox. Se comparó la mortalidad real con la esperada según el Índice de Comorbilidad de Charlson, ajustado por la edad. Resultados La patología previa fue el principal factor de mortalidad, siendo la cardiopatía la más significativa (HR: 1, 817; IC95%: 1, 048; 3, 149). La mortalidad real al año de la muestra fue del 22, 5%, mientras que la mortalidad anual estimada según el Índice de Comorbilidad de Charlson era de un 29, 68% (IC95%: 44, 36-15). Conclusiones La fractura de cadera no provoca un aumento de mortalidad según la estimación del Índice de Comorbilidad de Charlson. Background and objective The aim of this study is to value whether patients who have suffered a hip fracture have a higher mortality than expected. Material and methods A prospective, observational study was carried out where patients with hip fracture were collected as a sample over a year. The study included 284 patients and a minimum follow-up was 2 years. The mean age of these patients was 84.26 years, with 21.48% (61/284) males and 78.5% (223/284) females. Survival and previous diseases that affect mortality, as risk factors, were collected and analyzed using the Kaplan-Meier method and the Cox regression model. Actual mortality was compared with that expected according to the Charlson Comorbidity Index, adjusted for age. Results Previous pathology was the main mortality factor, with heart disease being the most significant (OR 1.817, CI95%: 1.048; 3.149). The real mortality at one year of the sample was 22.5%, while the estimated annual mortality according to the Charlson Comorbidity Index was 29.68% (CI95%:44, 36-15). Conclusions Hip fracture does not cause an increase in mortality according to the Charlson Comorbidity Index estimate

Protective role of mindfulness, self-compassion and psychological flexibility on the burnout subtypes among psychology and nursing undergraduate students

Aims: To explore the relationship between mindfulness, self-compassion and psychological flexibility, and the burnout subtypes in university students of the Psychology and Nursing degrees, and to analyse possible risk factors for developing burnout among socio-demographic and studies-related characteristics. Design: Cross-sectional study conducted on a sample of 644 undergraduate students of Nursing and Psychology from two Spanish universities. Methods: The study was conducted between December 2015 and May 2016. Bivariate Pearson''s correlations were computed to analyse the association between mindfulness facets, self-compassion and psychological flexibility, and levels of burnout. Multivariate linear regression models and bivariate and multivariate binary logistic regressions were also computed. Results: The three subtypes of burnout presented significant correlations with psychological flexibility, self-compassion and some mindfulness facets. Psychological flexibility, self-compassion and the mindfulness facets of observing and acting with awareness were significantly associated to burnout. Among the risk factors, ‘year of study’ was the only variable to show significantly higher risk for every burnout subtype. Conclusion: The significant associations found between mindfulness, self-compassion, psychological flexibility and burnout levels underline the need of including these variables as therapeutic targets when addressing the burnout syndrome in university students. Impact. Undergraduate students, especially those of health sciences, often experience burnout. This study delves into the protective role of some psychological variables: mindfulness, self-compassion and psychological flexibility. These should be considered as potentially protective skills for developing burnout, and therefore, undergraduate students could be trained on these abilities to face their studies and their future profession to prevent experiencing burnout syndrome. © 2021 John Wiley & Sons Lt

Epidemiological cutoff values for fluconazole, itraconazole, posaconazole, and voriconazole for six Candida species as determined by the colorimetric Sensititre YeastOne method

In the absence of clinical breakpoints (CBP), epidemiological cutoff values (ECVs) are useful to separate wild-type (WT) isolates (without mechanisms of resistance) from non-WT isolates (those that can harbor some resistance mechanisms), which is the goal of susceptibility tests. Sensititre YeastOne (SYO) is a widely used method to determine susceptibility of Candida spp. to antifungal agents. The CLSI CBP have been established, but not for the SYO method. The ECVs for four azoles, obtained using MIC distributions determined by the SYO method, were calculated via five methods (three statistical methods and based on the MIC50 and modal MIC). Respectively, the median ECVs (in mg/liter) of the five methods for fluconazole, itraconazole, posaconazole, and voriconazole (in parentheses: the percentage of isolates inhibited by MICs equal to or less than the ECVs; the number of isolates tested) were as follows: 2 (94.4%; 944), 0.5 (96.7%; 942), 0.25 (97.6%; 673), and 0.06 (96.7%; 849) for Candida albicans; 4 (86.1%; 642), 0.5 (99.4%; 642), 0.12 (93.9%; 392), and 0.06 (86.9%; 559) for C. parapsilosis; 8 (94.9%; 175), 1 (93.7%; 175), 2 (93.6%; 125), and 0.25 (90.4%; 167) for C. tropicalis; 128 (98.6%; 212), 4 (95.8%; 212), 4 (96.0%; 173), and 2 (98.5; 205) for C. glabrata; 256 (100%; 53), 1 (98.1%; 53), 1 (100%; 33), and 1 (97.9%; 48) for C. krusei; 4 (89.2%; 93), 0.5 (100%; 93), 0.25 (100%; 33), and 0.06 (87.7%; 73) for C. orthopsilosis. All methods included =94% of isolates and yielded similar ECVs (within 1 dilution). These ECVs would be suitable for monitoring emergence of isolates with reduced susceptibility by using the SYO method

Factores de riesgo en fractura periprotésica femoral tras artroplastia sustitutiva primaria de rodilla

Introducción y objetivos Las fracturas periprotésicas tras artroplastia primaria de rodilla cobran gran importancia en nuestro medio debido tanto al aumento de su incidencia, como al reto que suponen para el cirujano. Múltiples factores se han asociado a su producción. El objetivo del estudio fue identificar los factores de riesgo que podían influir en la aparición de estas fracturas, cuáles de todos ellos son modificables y generar un modelo de predicción de probabilidad de las mismas en función de dichos factores. Material y método Estudio analítico, observacional, retrospectivo, no pareado, de 38 casos de fracturas periprotésicas femorales de rodilla y 80 controles con prótesis de rodilla. En total, fueron incluidos en el estudio 118 pacientes, 83 mujeres y 35 hombres con una edad media de 72, 49 años. Se recogieron datos sociodemográficos, antecedentes médicos y consumo de fármacos, así como los relativos a la cirugía. Se realizó un análisis uni- y bivariante de los factores determinantes de fractura, usando un modelo de regresión logística para evitar el sesgo de confusión. Resultados De todos los factores estudiados según el modelo de regresión logística, se obtuvo que el sexo femenino (OR = 7, 6), la demencia (OR = 5), la alteración motora/párkinson (OR = 19, 3) y el sobrecorte femoral anterior (OR = 8, 6) eran factores asociados al incremento de riesgo de este tipo de fracturas. Conclusiones Este trabajo permite concluir que hay factores de riesgo, como son el sexo femenino, la demencia y el párkinson, que aumentan la probabilidad de fractura periprotésica, que son inherentes al paciente y no son modificables. Sin embargo, existe algún otro totalmente modificable que puede evitarse siendo exigente y exhaustivo en la técnica quirúrgica, como es el sobrecorte femoral anterior. Introduction and objectives: Periprosthetic fractures after primary knee arthroplasty has great importance in our environment due to the increase in their incidence and to the challenge they pose to the surgeon. Multiple factors have been associated with its production. The objective of the study was to identify the risk factors that could influence the appearance of these fractures, which of them are all modifiable and generate a probability prediction model based on these factors. Material and methods: Analytical, observational, retrospective, unpaired study of 38 cases of periprosthetic femoral knee fractures and 80 controls with knee prostheses. In total, 118 patients, 83 women and 35 men with a mean age of 72.49 years were included in the study. Sociodemographic data, medical history and drug consumption were collected, as well as those related to surgery. A univariate and bivariate analysis of the fracture determining factors was performed, using a logistic regression model to avoid confusion bias. Results: Of all the factors studied according to the logistic regression model, it was obtained that female sex (OR = 7.6), dementia (OR = 5), motor/parkinson''s alteration (OR = 19.3) and femoral overcut Previous (OR = 8.6) were factors associated with the increased risk of this type of fractures. Conclusions: This work allows us to conclude that there are risk factors such as female sex, dementia and parkinson''s that increase the probability of periprosthetic fracture that are inherent to the patient and are not modifiable. However, there is any other totally modifiable that can be avoided by being demanding and thorough in the surgical technique, such as the anterior femoral overcut

COPD Clinical Control: predictors and long-term follow-up of the CHAIN cohort

CHAIN Study Investigators.[Background] Control in COPD is a dynamic concept that can reflect changes in patients’ clinical status that may have prognostic implications, but there is no information about changes in control status and its long-term consequences.[Methods] We classified 798 patients with COPD from the CHAIN cohort as controlled/uncontrolled at baseline and over 5 years. We describe the changes in control status in patients over long-term follow-up and analyze the factors that were associated with longitudinal control patterns and related survival using the Cox hazard analysis.[Results] 134 patients (16.8%) were considered persistently controlled, 248 (31.1%) persistently uncontrolled and 416 (52.1%) changed control status during follow-up. The variables significantly associated with persistent control were not requiring triple therapy at baseline and having a better quality of life. Annual changes in outcomes (health status, psychological status, airflow limitation) did not differ in patients, regardless of clinical control status. All-cause mortality was lower in persistently controlled patients (5.5% versus 19.1%, p = 0.001). The hazard ratio for all-cause mortality was 2.274 (95% CI 1.394–3.708; p = 0.001). Regarding pharmacological treatment, triple inhaled therapy was the most common option in persistently uncontrolled patients (72.2%). Patients with persistent disease control more frequently used bronchodilators for monotherapy (53%) at recruitment, although by the end of the follow-up period, 20% had scaled up their treatment, with triple therapy being the most frequent therapeutic pattern.[Conclusions] The evaluation of COPD control status provides relevant prognostic information on survival. There is important variability in clinical control status and only a small proportion of the patients had persistently good control. Changes in the treatment pattern may be relevant in the longitudinal pattern of COPD clinical control. Further studies in other populations should validate our results.[Trial registration] Clinical Trials.gov: identifier NCT01122758.This study has been funded by AstraZeneca.Peer reviewe

Consensus statement on the diagnosis, management, and treatment of angioedema mediated by Bradykinin. Part. II: treatment, follow-up, and special situations

Background: There are no previous Spanish guidelines or consensus statements on bradykinin-induced angioedema. Aim: To draft a consensus statement on the management and treatment of angioedema mediated by bradykinin in light of currently available scientifi c evidence and the experience of experts. This statement will serve as a guideline to health professionals. Methods: The consensus was led by the Spanish Study Group on Bradykinin-Induced Angioedema, a working group of the Spanish Society of Allergology and Clinical Immunology. A review was conducted of scientifi c papers on different types of bradykinin-induced angioedema (hereditary and acquired angioedema due to C1 inhibitor defi ciency, hereditary angioedema related to estrogens, angioedema induced by angiotensin-converting enzyme inhibitors). Several discussion meetings were held to reach the consensus. Results: Treatment approaches are discussed, and the consensus reached is described. Specifi c situations are addressed, namely, pregnancy, contraception, travelling, blood donation, and organ transplantation. Conclusions: A review of and consensus on treatment of bradykinin-induced angioedema is presentedIntroducción: No existen guías previas españolas sobre el manejo del angioedema mediado por bradicinina. Objetivos: Alcanzar un consenso sobre el manejo y tratamiento del angioedema mediado por bradicinina a la luz de la evidencia científi ca disponible y la experiencia de los expertos, que sirva como guía para los profesionales de la salud. Métodos: SGBA/GEAB, un grupo de trabajo de la SEAIC dirigió el consenso. Se realizó una revisión de los documentos científi cos publicados sobre los diferentes tipos de angioedema mediado por bradicinina [angioedema hereditario o adquirido por defi ciencia de inhibidor de la C1 esterasa, angioedema hereditario relacionado con estrógenos (AEH tipo III, AEH-FXII), angioedema inducido por IECA (inhibidores del enzima convertidor de angiotensina]. Hubo varias reuniones del SGBA/GEAB para alcanzar el consenso. Resultados: Se revisan y discuten los diferentes tratamientos disponibles y se describe el consenso alcanzado. Se abordan situaciones específi cas (embarazo, anticoncepción, viajes, hemodonación, trasplante de órganos). Conclusiones: Se presenta una revisión del tratamiento del angioedema mediado por bradicinina y un consenso sobre su tratamiento en EspañaDr. Teresa Caballero is a researcher with the Hospital La Paz Health Research Institute (IdiPaz) program for promoting research activities (2009

Behavior of granite-epoxy composite beams subjected to mechanical vibrations

The capacity to damp mechanical vibrations is one of the most important properties of granite-epoxy composites, even superior to the cast iron one. For this reason, these materials have been adopted for manufacturing of tool machine foundations and precision instruments. This work presents a study concerning the behavior of particulate composite beams, based on granite powder and epoxy, subjected to mechanical vibrations. Composite samples were prepared with different combinations of processing variables, like the weight fraction of epoxy in the mixture and size distributions of granite particles. The damping behavior of the material was investigated adopting the logarithmic decrement method. Samples, in the form of prismatic beams, were excited in the middle point and the output signal was measured in a point located at the extremity. The obtained results showed that composite samples, with weight fractions of about 80% of granite and 20% of epoxy, presented damping properties approximately three times greater than gray cast iron