Efecto de la osteotomía medializante de calcáneo sobre tejidos blandos de soporte del arco plantar: un estudio computacional

Medializing calcaneal osteotomy forms part of the treatment options for adult acquired flat foot. The structural correction that is achieved is widely known. However, the effect of this procedure on the soft tissues that support the plantar arch has been little studied, since it is not possible to quantify experimentally the tension and deformation variations generated. Therefore, the objective of this study was to evaluate the effect of medializing calcaneal osteotomy on the soft tissue that supports the plantar arch, using a computational model of the human foot designed with a clinical approach. The proposed finite element model was reconstructed from computerized tomography images of a healthy patient. All the bones of the foot, the plantar fascia, cartilages, plantar ligaments and the calcaneus-navicular ligament were included, respecting their anatomical distribution and biomechanical properties. Simulations were performed emulating the monopodal support phase of the human walk of an adult. The effect on each tissue was evaluated according to clinical and biomechanical criteria. The results show that calcaneal osteotomy reduces the tension normally generated on the evaluated tissues, with the effect on the calcaneus-navicular ligament and the plantar fascia being the most notable. The deformation results obtained are consistent with experimental tests and clinical knowledge. The versatility of this model allows the objective assessment of different conditions and supports decision making for the treatment of adult acquired flat foot in middle and advanced stages

Adaptable Security in Wireless Sensor Networks by Using Reconfigurable ECC Hardware Coprocessors

Specific features of Wireless Sensor Networks (WSNs) like the open accessibility to nodes, or the easy observability of radio communications, lead to severe security challenges. The application of traditional security schemes on sensor nodes is limited due to the restricted computation capability, low-power availability, and the inherent low data rate. In order to avoid dependencies on a compromised level of security, a WSN node with a microcontroller and a Field Programmable Gate Array (FPGA) is used along this work to implement a state-of-the art solution based on ECC (Elliptic Curve Cryptography). In this paper it is described how the reconfiguration possibilities of the system can be used to adapt ECC parameters in order to increase or reduce the security level depending on the application scenario or the energy budget. Two setups have been created to compare the software- and hardware-supported approaches. According to the results, the FPGA-based ECC implementation requires three orders of magnitude less energy, compared with a low power microcontroller implementation, even considering the power consumption overhead introduced by the hardware reconfiguratio

Simple nonlinearity evaluation and modeling of low-noise amplifiers with application to radio astronomy receivers

This paper describes a comparative nonlinear analysis of low-noise amplifiers (LNAs) under different stimuli for use in astronomical applications. Wide-band Gaussian-noise input signals, together with the high values of gain required, make that figures of merit, such as the 1 dB compression (1 dBc) point of amplifiers, become crucial in the design process of radiometric receivers in order to guarantee the linearity in their nominal operation. The typical method to obtain the 1 dBc point is by using single-tone excitation signals to get the nonlinear amplitude to amplitude (AM-AM) characteristic but, as will be shown in the paper, in radiometers, the nature of the wide-band Gaussian-noise excitation signals makes the amplifiers present higher nonlinearity than when using single tone excitation signals. Therefore, in order to analyze the suitability of the LNA’s nominal operation, the 1 dBc point has to be obtained, but using realistic excitation signals. In this work, an analytical study of compression effects in amplifiers due to excitation signals composed of several tones is reported. Moreover, LNA nonlinear characteristics, as AM-AM, total distortion, and power to distortion ratio, have been obtained by simulation and measurement with wide-band Gaussian-noise excitation signals. This kind of signal can be considered as a limit case of a multitone signal, when the number of tones is very high. The work is illustrated by means of the extraction of realistic nonlinear characteristics, through simulation and measurement, of a 31 GHz back-end module LNA used in the radiometer of the QUIJOTE (Q U I JOint TEnerife) CMB experimen

Smoking cessation improves clinical outcome in severe mental disorders and is modulated by genetic variability at CHRNA5 gene

Smoking has been traditionally tolerated for patients with mental disorders due to its hypothesized self-medication function (Schroeder and Morris, 2010).[...

Impact of previous tobacco use with or without cannabis on first psychotic experiences in patients with first-episode psychosis

Objective: There is high prevalence of cigarette smoking in individuals with first-episode psychosis (FEP) prior to psychosis onset. The purpose of the study was to determine the impact of previous tobacco use with or without cannabis on first psychotic experiences in FEP and the impact of this use on age of onset of symptoms, including prodromes. Methods: Retrospective analyses from the naturalistic, longitudinal, multicentre, “Phenotype-Genotype and Environmental Interaction. Application of a Predictive Model in First Psychotic Episodes (PEPs)” Study. The authors analysed sociodemographic/clinical data of 284 FEP patients and 231 matched healthy controls, and evaluated first psychotic experiences of patients using the Symptom Onset in Schizophrenia Inventory. Results: FEP patients had significantly higher prevalence of tobacco, cannabis, and cocaine use than controls. The FEP group with tobacco use only prior to onset (N = 56) had more sleep disturbances (42.9% vs 18.8%, P = 0.003) and lower prevalence of negative symptoms, specifically social withdrawal (33.9% vs 58%, P = 0.007) than FEP with no substance use (N = 70), as well as lower prevalence of ideas of reference (80.4% vs 92.4%, P = 0.015), perceptual abnormalities (46.4% vs 67.4%, P = 0.006), hallucinations (55.4% vs 71.5%, P = 0.029), and disorganised thinking (41.1% vs 61.1%, P = 0.010) than FEP group with previous tobacco and cannabis use (N = 144). FEP patients with cannabis and tobacco use had lower age at first prodromal or psychotic symptom (mean = 23.73 years [SD = 5.09]) versus those with tobacco use only (mean = 26.21 [SD = 4.80]) (P = 0.011). Conclusions: The use of tobacco alone was not related to earlier age of onset of a first psychotic experience, but the clinical profile of FEP patients is different depending on previous tobacco use with or without cannabis. © 2021 The Author

Oral Anticoagulation and Risk of Symptomatic Hemorrhagic Transformation in Stroke Patients Treated With Mechanical Thrombectomy: Data From the Nordictus Registry

Introduction: We aimed to evaluate if prior oral anticoagulation (OAC) and its type determines a greater risk of symptomatic hemorrhagic transformation in patients with acute ischemic stroke (AIS) subjected to mechanical thrombectomy. Materials and Methods: Consecutive patients with AIS included in the prospective reperfusion registry NORDICTUS, a network of tertiary stroke centers in Northern Spain, from January 2017 to December 2019 were included. Prior use of oral anticoagulants, baseline variables, and international normalized ratio (INR) on admission were recorded. Symptomatic intracranial hemorrhage (sICH) was the primary outcome measure. Secondary outcome was the relation between INR and sICH, and we evaluated mortality and functional outcome at 3 months by modified Rankin scale. We compared patients with and without previous OAC and also considered the type of oral anticoagulants. Results: About 1.455 AIS patients were included, of whom 274 (19%) were on OAC, 193 (70%) on vitamin K antagonists (VKA), and 81 (30%) on direct oral anticoagulants (DOACs). Anticoagulated patients were older and had more comorbidities. Eighty-one (5.6%) developed sICH, which was more frequent in the VKA group, but not in DOAC group. OAC with VKA emerged as a predictor of sICH in a multivariate regression model (OR, 1.89 [95% CI, 1.01–3.51], p = 0.04) and was not related to INR level on admission. Prior VKA use was not associated with worse outcome in the multivariate regression model nor with mortality at 3 months. Conclusions: OAC with VKA, but not with DOACs, was an independent predictor of sICH after mechanical thrombectomy. This excess risk was associated neither with INR value by the time thrombectomy was performed, nor with a worse functional outcome or mortality at 3 months

The continuity of effect of schizophrenia polygenic risk score and patterns of cannabis use on transdiagnostic symptom dimensions at first-episode psychosis: findings from the EU-GEI study

Diagnostic categories do not completely reflect the heterogeneous expression of psychosis. Using data from the EU-GEI study, we evaluated the impact of schizophrenia polygenic risk score (SZ-PRS) and patterns of cannabis use on the transdiagnostic expression of psychosis. We analysed first-episode psychosis patients (FEP) and controls, generating transdiagnostic dimensions of psychotic symptoms and experiences using item response bi-factor modelling. Linear regression was used to test the associations between these dimensions and SZ-PRS, as well as the combined effect of SZ-PRS and cannabis use on the dimensions of positive psychotic symptoms and experiences. We found associations between SZ-PRS and (1) both negative (B = 0.18; 95%CI 0.03–0.33) and positive (B = 0.19; 95%CI 0.03–0.35) symptom dimensions in 617 FEP patients, regardless of their categorical diagnosis; and (2) all the psychotic experience dimensions in 979 controls. We did not observe associations between SZ-PRS and the general and affective dimensions in FEP. Daily and current cannabis use were associated with the positive dimensions in FEP (B = 0.31; 95%CI 0.11–0.52) and in controls (B = 0.26; 95%CI 0.06–0.46), over and above SZ-PRS. We provide evidence that genetic liability to schizophrenia and cannabis use map onto transdiagnostic symptom dimensions, supporting the validity and utility of the dimensional representation of psychosis. In our sample, genetic liability to schizophrenia correlated with more severe psychosis presentation, and cannabis use conferred risk to positive symptomatology beyond the genetic risk. Our findings support the hypothesis that psychotic experiences in the general population have similar genetic substrates as clinical disorders

Epidemiological trends of HIV/HCV coinfection in Spain, 2015-2019

Altres ajuts: Spanish AIDS Research Network; European Funding for Regional Development (FEDER).Objectives: We assessed the prevalence of anti-hepatitis C virus (HCV) antibodies and active HCV infection (HCV-RNA-positive) in people living with HIV (PLWH) in Spain in 2019 and compared the results with those of four similar studies performed during 2015-2018. Methods: The study was performed in 41 centres. Sample size was estimated for an accuracy of 1%. Patients were selected by random sampling with proportional allocation. Results: The reference population comprised 41 973 PLWH, and the sample size was 1325. HCV serostatus was known in 1316 PLWH (99.3%), of whom 376 (28.6%) were HCV antibody (Ab)-positive (78.7% were prior injection drug users); 29 were HCV-RNA-positive (2.2%). Of the 29 HCV-RNA-positive PLWH, infection was chronic in 24, it was acute/recent in one, and it was of unknown duration in four. Cirrhosis was present in 71 (5.4%) PLWH overall, three (10.3%) HCV-RNA-positive patients and 68 (23.4%) of those who cleared HCV after anti-HCV therapy (p = 0.04). The prevalence of anti-HCV antibodies decreased steadily from 37.7% in 2015 to 28.6% in 2019 (p < 0.001); the prevalence of active HCV infection decreased from 22.1% in 2015 to 2.2% in 2019 (p < 0.001). Uptake of anti-HCV treatment increased from 53.9% in 2015 to 95.0% in 2019 (p < 0.001). Conclusions: In Spain, the prevalence of active HCV infection among PLWH at the end of 2019 was 2.2%, i.e. 90.0% lower than in 2015. Increased exposure to DAAs was probably the main reason for this sharp reduction. Despite the high coverage of treatment with direct-acting antiviral agents, HCV-related cirrhosis remains significant in this population

Choice of the initial antiretroviral treatment for HIV-positive individuals in the era of integrase inhibitors

BACKGROUND: We aimed to describe the most frequently prescribed initial antiretroviral therapy (ART) regimens in recent years in HIV-positive persons in the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) and to investigate factors associated with the choice of each regimen. METHODS: We analyzed initial ART regimens prescribed in adults participating in CoRIS from 2014 to 2017. Only regimens prescribed in >5% of patients were considered. We used multivariable multinomial regression to estimate Relative Risk Ratios (RRRs) for the association between sociodemographic and clinical characteristics and the choice of the initial regimen. RESULTS: Among 2874 participants, abacavir(ABC)/lamivudine(3TC)/dolutegavir(DTG) was the most frequently prescribed regimen (32.1%), followed by tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC)/elvitegravir(EVG)/cobicistat(COBI) (14.9%), TDF/FTC/rilpivirine (RPV) (14.0%), tenofovir alafenamide (TAF)/FTC/EVG/COBI (13.7%), TDF/FTC+DTG (10.0%), TDF/FTC+darunavir/ritonavir or darunavir/cobicistat (bDRV) (9.8%) and TDF/FTC+raltegravir (RAL) (5.6%). Compared with ABC/3TC/DTG, starting TDF/FTC/RPV was less likely in patients with CD4100.000 copies/mL. TDF/FTC+DTG was more frequent in those with CD4100.000 copies/mL. TDF/FTC+RAL and TDF/FTC+bDRV were also more frequent among patients with CD4<200 cells//muL and with transmission categories other than men who have sex with men. Compared with ABC/3TC/DTG, the prescription of other initial ART regimens decreased from 2014-2015 to 2016-2017 with the exception of TDF/FTC+DTG. Differences in the choice of the initial ART regimen were observed by hospitals' location. CONCLUSIONS: The choice of initial ART regimens is consistent with Spanish guidelines' recommendations, but is also clearly influenced by physician's perception based on patient's clinical and sociodemographic variables and by the prescribing hospital location