Assessing rheoencephalography dynamics through analysis of the interactions among brain and cardiac networks during general anesthesia

Cerebral blood flow (CBF) reflects the rate of delivery of arterial blood to the brain. Since no nutrients, oxygen or water can be stored in the cranial cavity due to space and pressure restrictions, a continuous perfusion of the brain is critical for survival. Anesthetic procedures are known to affect cerebral hemodynamics, but CBF is only monitored in critical patients due, among others, to the lack of a continuous and affordable bedside monitor for this purpose. A potential solution through bioelectrical impedance technology, also known as rheoencephalography (REG), is proposed, that could fill the existing gap for a low-cost and effective CBF monitoring tool. The underlying hypothesis is that REG signals carry information on CBF that might be recovered by means of the application of advanced signal processing techniques, allowing to track CBF alterations during anesthetic procedures. The analysis of REG signals was based on geometric features extracted from the time domain in the first place, since this is the standard processing strategy for this type of physiological data. Geometric features were tested to distinguish between different anesthetic depths, and they proved to be capable of tracking cerebral hemodynamic changes during anesthesia. Furthermore, an approach based on Poincaré plot features was proposed, where the reconstructed attractors form REG signals showed significant differences between different anesthetic states. This was a key finding, providing an alternative to standard processing of REG signals and supporting the hypothesis that REG signals do carry CBF information. Furthermore, the analysis of cerebral hemodynamics during anesthetic procedures was performed by means of studying causal relationships between global hemodynamics, cerebral hemodynamics and electroencephalogram (EEG) based-parameters. Interactions were detected during anesthetic drug infusion and patient positioning (Trendelenburg positioning and passive leg raise), providing evidence of the causal coupling between hemodynamics and brain activity. The provided alternative of REG signal processing confirmed the hypothesis that REG signals carry information on CBF. The simplicity of the technology, together with its low cost and easily interpretable outcomes, should provide a new opportunity for REG to reach standard clinical practice. Moreover, causal relationships among the hemodynamic physiological signals and brain activity were assessed, suggesting that the inclusion of REG information in depth of anesthesia monitors could be of valuable use to prevent unwanted CBF alterations during anesthetic procedures.Peer ReviewedPostprint (published version

A novel way to build expert systems with infinite-valued attributes

An expert system is a computer program that uses the knowledge of an expert to solve problems in a specific domain. Expert systems are used in a wide variety of fields, such as medicine, financial diagnosis and engineering. The attributes of an expert system are the characteristics of the problems that the system can solve. In traditional expert systems, attributes typically have a finite number of possible values. However, in scenarios where an attribute can assume a value from an infinite (or significantly large finite) set, the expert system cannot be represented using propositional logic. Until now, no method had been identified to implement such a system on a Computer Algebra System. Here, we break new ground by presenting a model that not only addresses this gap but also provides a fresh perspective on previous results. In fact, these prior results can be viewed as specific instances within the broader framework of our proposed solution. In this paper, we put forth an algebraic approach for the development of expert systems capable of handling attributes with infinite values, thereby expanding the problem-solving capacity of these systems

Dot Immunobinding Assay for the Rapid Serodetection of Scedosporium/Lomentospora in Cystic Fibrosis Patients

The detection of Scedosporium/Lomentospora is still based on non-standardized low-sensitivity culture procedures. This fact is particularly worrying in patients with cystic fibrosis (CF), where these fungi are the second most common filamentous fungi isolated, because a poor and delayed diagnosis can worsen the prognosis of the disease. To contribute to the discovery of new diagnostic strategies, a rapid serological dot immunobinding assay (DIA) that allows the detection of serum IgG against Scedosporium/Lomentospora in less than 15 min was developed. A crude protein extract from the conidia and hyphae of Scedosporium boydii was employed as a fungal antigen. The DIA was evaluated using 303 CF serum samples (162 patients) grouped according to the detection of Scedosporium/Lomentospora in the respiratory sample by culture, obtaining a sensitivity and specificity of 90.48% and 79.30%, respectively; positive and negative predictive values of 54.81% and 96.77%, and an efficiency of 81.72%. The clinical factors associated with the results were also studied using a univariate and a multivariate analysis, which showed that Scedosporium/Lomentospora positive sputum, elevated anti-Aspergillus serum IgG and chronic Pseudomonas aeruginosa infection were significantly associated with a positive result in DIA, while Staphylococcus aureus positive sputum showed a negative association. In conclusion, the test developed can offer a complementary, rapid, simple and sensitive method to contribute to the diagnosis of Scedosporium/Lomentospora in patients with CF.This research was funded by the Basque Government, grant numbers IT1362-19 and IT1657-22. L.M-S and M.A have received a predoctoral grant from the Basque Government and L.A-F from the University of the Basque Country (UPV/EHU)

Filtros suavizadores en imágenes sintéticas de resonancia magnética cerebral: un estudio comparativo

This paper presents the evaluation of two computational techniques for smoothing noise that might be present in synthetic images or numerical phantoms of magnetic resonance (MRI). The images that will serve as the databases (DB) during the course of this evaluation are available freely on the Internet and are reported in specialized literature as synthetic images called BrainWeb. The images that belong to this DB were contaminated with Rician noise, this being the most frequent type of noise in real MRI images. Also, the techniques that are usually considered to minimize the impact of Rician noise on the quality of BrainWeb images are matched with the Gaussian filter (GF) and an anisotropic diffusion filter, based on the gradient of the image (GADF). Each of these filters has 2 parameters that control their operation and, therefore, undergo a rigorous tuning process to identify the optimal values that guarantee the best performance of both the GF and the GADF. The peak of the signal-to-noise ratio (PSNR) and the computation time are considered as key elements to analyze the behavior of each of the filtering techniques applied. The results indicate that: a) both filters generate PSNR values comparable to each other. b) The GF requires a significantly shorter computation time to soften the Rician noise present in the considered DB. Keywords: Synthetic Cerebral images, Magnetic resonance, Rician noise, Gaussian filter, Anisotropic diffusion filter, PSNR.Este artículo presenta la evaluación de dos técnicas computacionales para el suavizado de ruido, que puede estar presente en imágenes sintéticas o phantoms numéricos de resonancia magnética (MRI). Las imágenes que servirán como bases de datos (DB) para el desarrollo de la mencionada evaluación están disponibles, de manera libre, en la Internet y se reportan, en la literatura especializada, como imágenes sintéticas denominadas BrainWeb. Las imágenes pertenecientes a esta DB fueron contaminadas con ruido Riciano debido a que este es el tipo de ruido más frecuente en imágenes de MRI reales. Por otra parte, las técnicas consideradas para minimizar el impacto de este ruido, en la calidad de las imágenes de la BrainWeb, se hacen coincidir con el filtro Gausiano (GF) y un filtro de difusión anisotrópica, basado en el gradiente de la imagen (GADF). Cada uno de estos filtros posee 2 parámetros que controlan su funcionamiento y, por ende, deben someterse a un proceso de entonación riguroso para identificar los valores óptimos que garanticen el mejor desempeño tanto del GF como del GADF. El pico de la relación señal a ruido (PSNR) y el tiempo de cómputo son considerados como elementos clave para analizar el comportamiento de cada una de las técnicas de filtrado aplicadas. Los resultados indican que: a) Ambos filtros generan valores de PSNR comparables entre sí. b) El GF requiere de un tiempo de cómputo, significativamente, menor para suavizar el ruido Riciano presente en la DB considerada. Palabras clave: Imágenes sintéticas cerebrales, Resonancia magnética, Ruido Riciano, Filtro Gausiano, Filtro de difusión anisotrópica, PSNR

Memoria del Mapa Geológico de España, Escala 1:50.000, 2ª Serie, 1ª Edición, (MAGNA), Hoja Nº 512, Cifuentes

Peer reviewe

Human Immunodeficiency Virus/Hepatits C Virus Coinfection in Spain: Elimination Is Feasible, but the Burden of Residual Cirrhosis Will Be Significant

Background: We assessed the prevalence of antibodies against hepatitis C virus (HCV-Abs) and active HCV infection in patients infected with human immunodeficiency virus (HIV) in Spain in 2016 and compared the results with those of similar studies performed in 2002, 2009, and 2015. Methods: The study was performed in 43 centers during October-November 2016. The sample was estimated for an accuracy of 2% and selected by proportional allocation and simple random sampling. During 2016, criteria for therapy based on direct-acting antiviral agents (DAA) were at least significant liver fibrosis, severe extrahepatic manifestations of HCV, and high risk of HCV transmissibility. Results: The reference population and the sample size were 38904 and 1588 patients, respectively. The prevalence of HCV-Abs in 2002, 2009, 2015, and 2016 was 60.8%, 50.2%, 37.7%, and 34.6%, respectively (P trend <.001, from 2002 to 2015). The prevalence of active HCV in 2002, 2009, 2015, and 2016 was 54.0%, 34.0%, 22.1%, and 11.7%, respectively (P trend <.001). The anti-HCV treatment uptake in 2002, 2009, 2015, and 2016 was 23.0%, 48.0%, 59.3%, and 74.7%, respectively (P trend <.001). In 2016, HCV-related cirrhosis was present in 7.6% of all HIV-infected individuals, 15.0% of patients with active HCV, and 31.5% of patients who cleared HCV after anti-HCV therapy. Conclusions: Our findings suggest that with universal access to DAA-based therapy and continued efforts in prevention and screening, it will be possible to eliminate active HCV among HIV-infected individuals in Spain in the short term. However, the burden of HCV-related cirrhosis will continue to be significant among HIV-infected individuals.This work was funded by grant Ref. no. GLD14-00279 from the GILEAD Fellowship Programme (Spain) and by the Spanish AIDS Research Network (RD16/0025/0017, RD16/0025/0018) that is included in the Spanish I+D+I Plan and is co-financed by ISCIII-Subdirección General de Evaluacion and European Funding for Regional Development (FEDER).S

HTLV-1 infection in solid organ transplant donors and recipients in Spain

HTLV-1 infection is a neglected disease, despite infecting 10-15 million people worldwide and severe illnesses develop in 10% of carriers lifelong. Acknowledging a greater risk for developing HTLV-1 associated illnesses due to immunosuppression, screening is being widely considered in the transplantation setting. Herein, we report the experience with universal HTLV testing of donors and recipients of solid organ transplants in a survey conducted in Spain. All hospitals belonging to the Spanish HTLV network were invited to participate in the study. Briefly, HTLV antibody screening was performed retrospectively in all specimens collected from solid organ donors and recipients attended since the year 2008. A total of 5751 individuals were tested for HTLV antibodies at 8 sites. Donors represented 2312 (42.2%), of whom 17 (0.3%) were living kidney donors. The remaining 3439 (59.8%) were recipients. Spaniards represented nearly 80%. Overall, 9 individuals (0.16%) were initially reactive for HTLV antibodies. Six were donors and 3 were recipients. Using confirmatory tests, HTLV-1 could be confirmed in only two donors, one Spaniard and another from Colombia. Both kidneys of the Spaniard were inadvertently transplanted. Subacute myelopathy developed within 1 year in one recipient. The second recipient seroconverted for HTLV-1 but the kidney had to be removed soon due to rejection. Immunosuppression was stopped and 3 years later the patient remains in dialysis but otherwise asymptomatic. The rate of HTLV-1 is low but not negligible in donors/recipients of solid organ transplants in Spain. Universal HTLV screening should be recommended in all donor and recipients of solid organ transplantation in Spain. Evidence is overwhelming for very high virus transmission and increased risk along with the rapid development of subacute myelopathy

Gestión territorial de la salud: perspectivas, aprendizajes y aportes a la práctica.

RESUMEN: Presentación. -- Lo clásico de los modelos de salud y de la atención primaria (APS): bases conceptuales previas a la investigación y a la renovación. -- Desigualdades territoriales en la salud de la población de la cuenca del río San Juan del suroeste antioqueño, caracterizadas por la estrategia de APS durante el periodo 2014-2015. -- Salud en los territorios (Escenas de una película colombiana). -- La relación universidad y municipios: visiones, acciones y decisiones para el desarrollo local. -- La acción intersectorial por la salud: una vía para la incidencia en los procesos sociales determinantes de la salud. -- La comunicación en la APS: una experiencia más allá de los medios. -- "Uno solo no es capaz". Desafíos de la gestión territorial de la salud en el ámbito municipal. -- El cuidado y la atención primaria en salud como simbiosis en un campo de acción de la enfermería: retos para una práctica interdisciplinaria basada en la atención primaria en salud. -- Influencia de los actores del sistema de salud en la reorientación de los servicios de salud en los municipios de la cuenca del río San Juan del suroeste antioqueño. -- Oportunidades y retos de la telesalud para la gestión integral de la atención primaria en salud. -- Construcción de una micro red integrada de servicios de salud. Diagnóstico inicial, conceptos básicos y criterios para su conformación. --- Sala situacional de salud. Una metodología para la toma de decisiones en salud, municipio de Ciudad Bolívar, Antioquia, 2016. RESUMEN : Gestión territorial de la salud: perspectivas, aprendizajes y aportes a la práctica es una compilación de análisis y reflexiones derivadas de la implementación del proyecto “Fortalecimiento de capacidades locales para la implementación de la estrategia de APS en los municipios de la cuenca del río San Juan de la región del Suroeste de Antioquia 2015-2016” cofinanciado por la Vicerrectoría de Extensión de la Universidad de Antioquia. El proyecto representó la posibilidad de resignificar la manera de entender los desafíos de la gestión territorial de la salud en un contexto de profundas contradicciones producto de la orientación mercantil del sistema de salud, entendiendo que mientras la política nacional permanezca dominada por los intereses de la competencia y el afán de lucro que promueve el mercado, es necesario intentar la construcción de fuerzas antagónicas en los actores locales, quienes pueden reivindicar la solidaridad, la participación y la cooperación como los criterios esenciales para gestionar la salud en el territorio y la reorganización de los servicios de salud. Los textos pretenden ser insumo para el diálogo y la discusión de los equipos locales de salud, los líderes comunitarios, los tomadores de decisiones en los territorios, para estudiantes, docentes e investigadores interesados en comprender el complejo escenario de la gestión local de la salud en el país

Lo glocal y el turismo. Nuevos paradigmas de interpretación.

El estudio del turismo se realiza desde múltiples escalas y enfoques, este libro aborda muchos temas que es necesario discutir desde diversas perspectivas; es el caso de la reflexión sobre la propia disciplina y sus conceptos, así como los asuntos específicos referidos al impacto territorial, los tipos de turismo, las cuestiones ambientales, el tema de la pobreza, la competitividad, las políticas públicas, el papel de las universidades, las áreas naturales protegidas, la sustentabilidad, la cultura, el desarrollo, la seguridad, todos temas centrales documentados y expuestos con originalidad y dominio del asunto. Lo multiescalar es básico para la comprensión del sistema turístico, sistema formado de procesos globales, regionales y locales. El eje de discusión del libro es lo glocal, esa interacción entre lo nacional y local con lo global

R.H. Moreno-Durán: fantasía y verdad. Valoración múltiple

Pocos escritores colombianos han explorado diversos géneros literarios con resultados satisfactorios; Moreno-Durán destaca en el panorama artístico de Colombia al cosechar logros en una amplia producción creativa que incluye novelas, cuentos, ensayos y en los últimos tiempos el teatro. / Contenido. Preliminares; Capítulo 1 - R.H. Moreno-Durán: a fondo; Capítulo 2 - R.H. Moreno-Durán: en breve; Anexos