CO33 188. Abordaje mínimamente invasivo frente a abordaje estándar en cirugía de recambio valvular aórtico

ObjetivoComparar resultados obtenidos en pacientes sometidos a recambio valvular aórtico aislado por abordaje mínimamente invasivo frente a esternotomía estándar.MétodosEntre enero de 2006 – diciembre de 2011, 524 pacientes fueron sometidos de forma programada a recambio valvular aórtico aislado, de los cuales 454 fueron realizados mediante abordaje estándar (grupo E) y 70 mediante miniesternotomía en «J» (grupo M). Consideradas variables preoperatorias, tiempos de circulación extracorpórea (CEC) y clampaje aórtico, resultados postoperatorios (morbimortalidad, estancias en unidad de cuidados intensivos [UCI] y postoperatoria total) y coste económico global (estancias en UCI, sala, intervención quirúrgica, consumo de fungible, implante y otros recursos).ResultadosLas características preoperatorias de la población fueron similares, sin diferencias significativas en cuanto a edad (68±9 vs 69±8 años) y EuroSCORE I aditivo (6,04±3,00 vs 5,38±2,23) entre grupo E y M, respectivamente. Sin embargo sí hubo diferencias significativas en cuanto a mortalidad (4,2 vs 0%; p < 0,005), tiempo de CEC (95±38 vs 84±21 min; p < 0,001), tiempo de clampaje aórtico (72±28 vs 65±15 min; p < 0,001), días de estancia en UCI (4,31±5,27 vs 3,14±1,2; p < 0,05) y días totales de estancia hospitalaria (9,68±7,6 vs 7,87±4,0; p < 0,05) entre grupo E y M, respectivamente. El grupo M presentó un consumo de 1.771,21 €/paciente inferior al grupo E.ConclusiónLa cirugía mínimamente invasiva para el recambio valvular aórtico puede ser beneficiosa tanto en términos de morbimortalidad como en términos económicos. Dado que el estudio presentado es retrospectivo, creemos que futuros análisis prospectivos aleatorizados serían convenientes para profundizar los hallazgos obtenidos

Factors Controlling Properties of Ca-Mg, Ca-Er, Ca-Nd, or Ca-Y-Modified Aluminosilicate Glasses Containing Nitrogen and Fluorine

Glasses with composition (in eq.%) (30 − x)Ca:xM:55Si:15Al:80O:15N:5F have been prepared with different levels of substitution of Ca2+ cations by Mg2+, Y3+, Er3+, or Nd3+. The properties of these glasses are examined in detail and changes observed in molar volume (MV), free volume, fractional glass compactness, Young's modulus, microhardness, glass transition temperature, and thermal expansion as a function of M content are presented. Using linear regression analysis, evidence is presented which clearly shows that these glass properties are either solely dependent on the effective cation field strength, if modifier cation valency is the same (e.g., Mg substitution for Ca), or dependent on the effective cation field strength and the number of (Si, Al) (O, N, F) tetrahedra associated with each modifier when Ca is replaced by the trivalent modifiers. Combining these correlations with those observed previously relating glass properties to N and F substitution for O, it becomes apparent that glass properties for Ca–M–Si–Al–O–N–F glasses can be described by correlations which involve independent, but additive contributions by N and F substitution levels, effective cation field strength, and the number of tetrahedra associated with each modifier ion

Properties of Ca–(Y)–Si–Al–O–N–F Glasses: Independent and Additive Effects of Fluorine and Nitrogen

Thirty glasses of composition (in equivalent percent) 20-xCa:xY:50Si:30Al:(100-y-z)O:yN:zF, with x = 0, 10; y = 0, 10, 20, and z = 0, 1, 3, 5, 7 were prepared by melting and casting. All glasses were X-ray amorphous. Glass molar volumes (MV) decreased with nitrogen substitution for oxygen for all fluorine contents and, correspondingly, glass fractional compactness increased. Fluorine substitution of oxygen had virtually no effect on molar volume or fractional glass compactness for the three nitrogen contents tested. Young's modulus and microhardness were virtually unaffected by fluorine substitution for oxygen while nitrogen substitution for oxygen caused increases in these two properties. Glass-transition temperature and dilatometric-softening point values all decreased with increasing fluorine substitution levels, while increasing nitrogen substitution caused values for these thermal properties to increase. Correspondingly, the thermal expansion coefficient increased with fluorine and decreased with nitrogen substitution levels. Using property value differences between glasses containing fluorine and the corresponding glass containing 0 eq.% F enabled 24 data points to be used to determine the effect of fluorine on Tg,dil and TDS. The trends were linear with a gradient for both properties of the order of −22°C (eq.% F)−1. For the nitrogen effect, 20 data points were analyzed for trend effects. As expected from earlier work, all trends had good linearity. Gradients were for Tg,dil and TDS +2.5°C (eq.% N)−1, which are fairly similar to previous results in oxynitride systems. All of the data collected and its analysis clearly shows that the substitution effects of fluorine for oxygen and nitrogen for oxygen are independent and additive with the fluorine substitution. The property trends of the glasses are discussed in terms of their implications for glass structure.The authors wish to acknowledge Science Foundation Ireland and Valencian Small and Medium Enterprise Institute for financial support of this research and to thank colleagues in Materials Ireland and the Materials and Surface Science Institute for their help and advice

Evaluation of a program for updating recommendations about hand hygiene

Introducción. La higiene de manos (HM) es la medida más importante para prevenir las infecciones nosocomiales. El objetivo es evaluar el programa de actualización de las recomendaciones sobre HM implantado. Material y métodos. Intervenciones: marzo-octubre/2005 se realizaron sesiones de actualización sobre cuándo y cómo realizar la HM y mayo/2006 se repartió un tríptico explicativo a todos los trabajadores informando del grado de cumplimiento de las recomendaciones. Indicadores: nivel conocimientos (NC) medido con un cuestionario de cinco preguntas que se pasaba antes y después de las sesiones y se consideró respuesta inadecuada cuando se fallaban tres o más preguntas; el consumo soluciones alcohólicas (CSA) en ml/estancia agrupado en semestres desde 2004-2006; el grado cumplimiento de recomendaciones (GCR) sobre la HM medida por observación directa en dos momentos (diciembre/2005-febrero/2006 y octubre-noviembre/2006) y la prevalencia de infecciones nosocomiales (PI) y de pacientes con infección nosocomial (PPI) a partir estudios EPINE 2004-2005-2006. Resultados. La frecuencia de respuestas inadecuadas para evaluar NC pasó de un 57,5% antes a 18,9% después (p<0,001). El CSA para HM pasó de 3 ml/estancia en 2º semestre/2004 a 17 ml/estancia en 2º semestre/2006 (p<0,001). El GCR ha pasado del 31,0% al 55,6% (p<0,001). La PI y PPI han pasado del 11,4% y el 9,6% respectivamente en el 2004 al 9,4% y 8,9% en 2006 (N.S.). Conclusión. El programa está consiguiendo de manera progresiva sus objetivos ya que los tres indicadores de proceso (NC, CSA, GC) han mejorado de manera estadísticamente significativa, y los de resultado (PI y PPI) han mejorado aunque sin significación estadística.Background. Hand Hygiene (HH) is the most important measure in the prevention of nosocomial infections. The objective was to evaluate the program for updating recommendations on HH that had been introduced. Methods. Interventions: between March-October/2005 realisation of updating sessions about when and how to realize HH and May/2006 distribution of an explicative three-part document to all healthcare workers reporting on compliance with the recommendations. Indicators: level of knowledge (LK) measured with a questionnaire of five questions that was given to those attending before and after sessions, responses were considered inadequate when three or more questions were not answered; consumption of alcoholic solutions (CAS) on ml/stay grouped into semesters from 2004-2006; compliance (CO) with recommendations on HH was measured by direct observation at two times (December/2005-February/2006 and October-November/2006); and infections prevalence (IP) and patients with infection (IPP) for EPINE studies 2004-2005-2006. Results. The frequency of inadequate answers for evaluating LK has fallen from 57,5% before to 18,9% afterwards (p <0.001). The CAS for HH has passed from 3 ml/stay in 2nd semester/2004 to 17 ml/stay 2nd semester/2006 (p <0.001). The CO with HH has risen from 31,0% to 55,6% (p <0.001). The IP and IPP have risen respectively from 11,4% and 9,6% in 2004 to 9,4% and 8,9% in 2006 (N.S.). Conclusion. The program is progressively achieving its objectives as the three process indicators (LK, CAS, CO) have improved in a statistically significant way, and the indicators of results (IP and IPP) have improved but without achieving statistical significance.Proyecto de investigación financiado por el Fondo de Investigaciones Sanitarias del Ministerio de Sanidad, Nº Expte: PI0542075 y la Dirección General de Calidad de la Conselleria de Sanitat de la Generalitat Valenciana. Nº Expte: 12-2004

ATLAS silicon module assembly and qualification tests at IFIC Valencia

ATLAS experiment, designed to probe the interactions of particles emerging out of proton proton collisions at energies of up to 14 TeV, will assume operation at the Large Hadron Collider (LHC) at CERN in 2007. This paper discusses the assembly and the quality control tests of forward detector modules for the ATLAS silicon microstrip detector assembled at the Instituto de Fisica Corpuscular (IFIC) in Valencia. The construction and testing procedures are outlined and the laboratory equipment is briefly described. Emphasis is given on the module quality achieved in terms of mechanical and electrical stability.Comment: 23 pages, 38 EPS figures, uses JINST LaTeX clas

Forward SCT Module Assembly and Quality Control at IFIC Valencia

This note discusses the assembly and the quality control tests of 282 forward detector modules for the ATLAS Semiconductor Tracker assembled at the Instituto de Fisica Corpuscular (IFIC) in Valencia. The construction and testing procedures are outlined and the laboratory equipment is briefly described. Emphasis is given on the module quality achieved in terms of mechanical and electrical stability

Análisis de la relevancia y factibilidad de indicadores de calidad en las unidades de nutrición

Introducción: La evaluación de la calidad en las actividades sanitarias exige la elección de unos indicadores acordes con los resultados que queremos medir. De todos los posibles, debemos priorizar aquellos que nos permitan obtener la información más relevante sin sobrecargar el trabajo habitual de nuestras Unidades. Objetivo: Conocer la opinión de los socios de SENPE respecto a la relevancia y la viabilidad del uso de una selección de indicadores de calidad para su aplicación en nutrición clínica. Métodos: Encuesta remitida mediante correo electrónico a los socios de SENPE solicitando a los mismos su opinión sobre 12 indicadores de calidad, valorándose cada uno en cuanto a su relevancia y factibilidad de la aplicación en su medio. Resultados: Contestaron 40 encuestados de 40 centros diferentes de 12 comunidades autónomas. En general, los indicadores fueron considerados más relevantes que factibles. Los indicadores mejor puntuados fueron: “identificación en las bolsas de nutrición artificial”, “posición semi-incorporada del paciente con nutrición enteral por sonda nasogástrica” y “protocolos clínicos básicos”. Considerando los indicadores por grupos (de estructura, proceso o resultado) los mejor valorados fueron: “identificación del paciente en las bolsas de nutrición artificial” (estructura), “posición semi-incorporada” y “protocolos clínicos básicos” (proceso), y “cumplimiento del objetivo calórico” (resultado). Conclusión: Los resultados de la encuesta permiten seleccionar indicadores prioritarios para su aplicación en las Unidades de NutriciónIntroduction: The quality assessment in health activities requires the choice of indicators in line with the results we want to measure. Of all possible, we should prioritize those that allow us to obtain the most relevant information without overloading the regular work of our units. Objective: To determine the opinion of the members of SENPE regarding the relevance and feasibility of using a selection of quality indicators designed for use in clinical nutrition. Methods: E-mail survey sent to members of SENPE asking them their views on 12 quality indicators, evaluating each in terms of their relevance and feasibility of implementation in their environment. Results: 40 respondents answered from 40 centers in 12 different regions. In general, the indicators were considered more relevant than feasible. The indicators best rated were: “identification in artificial nutrition bags, “semi-recumbent position in patient with nasogastric tube feeding” and “basic clinical protocols”. Considering the type of indicator: “patient identification in the bags of artificial nutrition (structure),” a semi-incorporated “and” basic clinical protocols (process), and “fulfillment of the caloric goal” (result). Conclusion: The results of the survey can make a selection of indicators that could be considered for first-line introduction in a Nutrition Uni

The Taylor expansion of the exponential map and geometric applications

The final publication is available at Springer via http://dx.doi.org/10.1007/s13398-013-0149-zIn this work we consider the Taylor expansion of the exponential map of a submanifold immersed in Rn up to order three, in order to introduce the concepts of lateral and frontal deviation. We compute the directions of extreme lateral and frontal deviation for surfaces in R3. Also we compute, by using the Taylor expansion, the directions of high contact with hyperspheres of a surface immersed in R4 and the asymptotic directions of a surface immersed in RnThis work was partially supported by DGCYT grant no. MTM2009-08933.Monera, M.; Montesinos Amilibia, Á.; Sanabria Codesal, E. (2014). The Taylor expansion of the exponential map and geometric applications. Revista de la Real Academia de Ciencias Exactas, Físicas y Naturales. Serie A: Matemáticas (RACSAM). 108(2):881-906. https://doi.org/10.1007/s13398-013-0149-zS8819061082Arnol’d, V.I., Gusein-zade, V.I., Varchenko, A.N.: Singularities of Differentiable Maps. Monographs in Mathematics, vol. 82. Birkhäuser, Boston (1985)Chen, B.-Y., Li, S.-J.: The contact number of a Euclidean submanifold. Proc. Edinburgh Math. Soc. 47, 69–100 (2004)Fessler, W.: $$\ddot{U}$$ U ¨ ber die normaltorsion von Fl $$\ddot{a}$$ a ¨ chen im vierdimensionalen euklidischen. Raum. Comm. Math. Helv. 33(2), 89–108 (1959)García, R., Sotomayor, J.: Geometric mean curvature lines on surfaces immersed in $$\mathbb{R}^3$$ R 3 . Annales de la faculté des sciences de Toulouse, $$6^e$$ 6 e ser, vol. 11, No. 3, pp. 377–401 (2002)García, R., Sotomayor, J.: Lines of axial curvature on surfaces immersed in $$R^4$$ R 4 . Differ. Geom. Appl. 12, 253–269 (2000)Golubitsky, M., Gillemin, V.: Stable Mappings and their Singularities. Springer, Berlin (1973)Hartmann, F., Hanzen, R.: Apollonius’s Ellipse and Evolute Revisited–The Discriminant of the Related Quartic. http://www3.villanova.edu/maple/misc/ellipse/Apollonius2004.pdfLlibre, J., Yanquian, Y.: On the dynamics of surface vector fields and homeomofphisms (preprint)Looijenga, E.J.N.: Structural stability of smooth families of $$C^{\infty }$$ C ∞ -functions. University of Amsterdam, Doctoral Thesis (1974)Mochida, D.K.H., Romero-Fuster, M.C., Ruas, M.A.S.: Inflection points and nonsingular embeddings of surfaces in $$\mathbb{R}^5$$ R 5 . Rocky Mt. J. Math. 33, 3 (2003)Mochida, D.K.H., Romero-Fuster, M.C., Ruas, M.A.S.: Osculating hyperplanes and asymptotic directions of codimension two submanifolds of Euclidean spaces. Geom. Dedicata 77(3), 305–315 (1999)Mochida, D.K.H., Romero Fuster, M.C., Ruas, M.A.S.: The geometry of surfaces in 4-space from a contact viewpoint. Geom. Dedicata 54, 323–332 (1995)Monera, G.M., Montesinos-Amilibia, A., Moraes, S.M., Sanabria-Codesal, E.: Critical points of higher order for the normal map of immersions in $$\mathbb{R}^d$$ R d . Topol. Appl. 159, 537–544 (2012)Montaldi, J.A.: Contact with application to submanifolds, PhD Thesis, University of Liverpool (1983)Montaldi, J.A.: On contact between submanifolds. Michigan Math. J. 33, 195–199 (1986)Montesinos-Amilibia, A.: Parametricas4, computer program freely available from http://www.uv.es/montesinMontesinos-Amilibia, A.: Parametricas5, computer program freely available from http://www.uv.es/montesinMoraes, S., Romero-Fuster, M.C., Sánchez-Bringas, F.: Principal configurations and umbilicity of submanifolds in $$I\!\! R^n$$ I R n . Bull. Bel. Math. Soc. 10, 227–245 (2003)Porteous, I.R.: The normal singularities of a submanifold. J. Differ. Geom. 5, 543–564 (1971)Romero-Fuster, M.C., Ruas, M.A.S., Tari, F.: Asymptotic curves on surfaces in $$R^5$$ R 5 . Commun. Contemp. Math. 10, 309–335 (2008)Romero-Fuster, M.C., Sánchez-Bringas, F.: Umbilicity of surfaces with orthogonal asymptotiv lines in $$R^4$$ R 4 . Differ. Geom. Appl. 16, 213–224 (2002)Tari, F.: On pairs of geometric foliations on a cross-cap. Tohoku Math. J. 59(2), 233–258 (2007

MGMT methylation may benefit overall survival in patients with moderately vascularized glioblastomas

[EN] Objectives To assess the combined role of tumor vascularity, estimated from perfusion MRI, andMGMTmethylation status on overall survival (OS) in patients with glioblastoma. Methods A multicentric international dataset including 96 patients from NCT03439332 clinical study were used to study the prognostic relationships betweenMGMTand perfusion markers. Relative cerebral blood volume (rCBV) in the most vascularized tumor regions was automatically obtained from preoperative MRIs using ONCOhabitats online analysis service. Cox survival regression models and stratification strategies were conducted to define a subpopulation that is particularly favored byMGMTmethylation in terms of OS. Results rCBV distributions did not differ significantly (p > 0.05) in the methylated and the non-methylated subpopulations. In patients with moderately vascularized tumors (rCBV 10.73), however, there was no significant effect ofMGMTmethylation (HR = 1.72,p = 0.10, AUC = 0.56). Conclusions Our results indicate the existence of complementary prognostic information provided byMGMTmethylation and rCBV. Perfusion markers could identify a subpopulation of patients who will benefit the most fromMGMTmethylation. Not considering this information may lead to bias in the interpretation of clinical studies.Open Access funding provided by University of Oslo (incl Oslo University Hospital). This study has received funding from MTS4up project (National Plan for Scientific and Technical Research and Innovation 2013-2016, No. DPI2016-80054-R) (JMGG); H2020-SC12016-CNECT Project (No. 727560) (JMGG), H2020-SC1-BHC-20182020 (No. 825750) (JMGG), the European Research Council (ERC) under the European Union's Horizon 2020 (Grant Agreement No. 758657), the South-Eastern Norway Regional Health Authority Grants 2017073 and 2013069, the Research Council of Norway Grants 261984 (KEE). M.A.T was supported by Programa Estatal de Promocion del Talento y su Empleabilidad en I+D+i (DPI2016-80054-R). E.F.G was supported by the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement (No. 844646).Fuster García, E.; Lorente Estellés, D.; Álvarez-Torres, MDM.; Juan-Albarracín, J.; Chelebian-Kocharyan, EA.; Rovira, A.; Auger Acosta, C.... (2021). MGMT methylation may benefit overall survival in patients with moderately vascularized glioblastomas. European Radiology. 31(3):1738-1747. https://doi.org/10.1007/s00330-020-07297-41738174731