Cierre percutáneo de orejuela izquierda tras hemorragia intracraneal: ¿cuándo realizarlo?

[ES] Introducción La anticoagulación oral es el tratamiento por excelencia para la prevención de eventos embólicos en pacientes con fibrilación auricular, arritmia cardiaca más prevalente en nuestro medio. Su uso conlleva un incremento del riesgo de sangrado, complicación especialmente grave cuando se trata de una hemorragia intracraneal. El cierre percutáneo de orejuela izquierda es una alternativa segura y eficaz a la anticoagulación oral, si bien, la evidencia en cuanto a su indicación en pacientes con sangrados intracraneales, y especialmente el momento más indicado para realizar el mismo, es aún controvertido. Objetivos Evaluar la eficacia y seguridad del cierre percutáneo de orejuela izquierda en pacientes con sangrado intracraneal y fibrilación auricular (CHA2DS2-VASC >1 punto) y el momento óptimo del mismo. Métodos Análisis ambispectivo de casos consecutivos de pacientes sometidos a cierre de orejuela entre los años 2009 y 2021 en el Hospital Universitario de Salamanca. Se incluyeron un total de 397 enfermos, de los que 115 habían presentado hemorragia intracraneal. De ellos, a 68 se realizó cierre de forma precoz y a 47 cierre tardío tras más de 90 días. Resultados Con un 97% de éxito en el procedimiento de cierre de forma global, la incidencia anual de eventos isquémicos se situó en tan solo el 0,6%, mostrando una reducción absoluta del riesgo del 5,9% y relativa del 90,3% respecto a los eventos estimados por la puntuación CHA2DS2-VASC del grupo de cierre. En relación a los sangrados la incidencia anual registrada fue del 4% con una disminución del riesgo absoluto del 3,4% y relativo del 45% frente a la estimación de la escala HASBLED. No se objetivaron diferencias significativas entre los procedimientos realizados en pacientes con antecedente de sangrado cerebral y los pacientes con otras indicaciones para el cierre. No hubo diferencias en términos de eficacia y seguridad entre el cierre precoz (antes de 90 días) y cierre tardío tras un episodio de hemorragia intracraneal. Además, en el seguimiento a largo plazo (mediana de 27 meses), el grupo de cierre precoz presentaba menor mortalidad (11,76% frente a 46,8%; HR 0,2, IC95% 0,07-0,55; p<0,001). Conclusiones El cierre percutáneo de orejuela izquierda es una técnica segura y eficaz a la hora de reducir el riesgo embólico en pacientes con fibrilación auricular y antecedente de hemorragia intracraneal. El cierre precoz, realizado en los primeros 90 días tras el sangrado, es al menos igual de seguro y eficaz que el tardío, pudiendo aportar potencialmente ventajas a la hora de minimizar riesgos y facilitar su realización, en pacientes seleccionados. [EN] Background Oral anticoagulation (OAC) use increases the risk of intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF). Left atrial appendage occlusion (LAAO) is an alternative to OAC, however data about its use in patients with prior ICH is scare and the timing of its performance is controversial. Furthermore, the long-term outcomes in this group of patients have not been described. Objective To evaluate the safety and efficacy of LAAO in patients with non-valvular AF and prior ICH (CHA2SVASc >2) and to determine adequate timing of its performance. Methods The sample was obtained from a cohort of 397 patients with AF in which LAAO was performed between 2009 and 2020. In 115 of these patients, the indication for this procedure was ICH (29.8 %). Patients were divided into two groups: early occlusion (n=68; 59%), in which the procedure was performed before 90 days had elapsed after the bleeding, and late occlusion (n=47; 41%), after 90 days. Results Procedure success was 97% globally. Annual incidence of ischemic events was of 0,6%, with an absolute risk reduction of 5,9% and relative risk reduction of 90,3% compared to the predicted risk by CHA2DS2-VASC score. Regarding major hemorrhagic events, annual incidence was of 4%, with an absolute risk reduction of 3,4% and relative risk reduction of 45% compared to the predicted risk by HASBLED score. There were no significant differences between the procedures performed in patients with history of intracranial bleeding and other indications for the procedure. Early closure (first 90 days after the intracranial hemorrhage) was as safe as late closure, without an increase in in-hospital bleedings or complications. Furthermore, long-term follow-up demonstrated a significant reduction in all-cause mortality (11.76% versus 46.8%; HR 0.2, IC95% 0.07-0.55; p<0.001). compared with late occlusion. Conclusions Left atrial appendage occlusion is an effective and safe treatment option to reduce the risk of ischemic stroke in selected patients with AF patients and history of ICH over mean follow-up of 3 years. Early occlusion seems to be at least as safe and effective as late occlusion and therefore could potentially reduce the rate of complications after ICH in selected patients

Ensemble of diluted attractor networks with optimized topology for fingerprint retrieval

The present study analyzes the retrieval capacity of an Ensemble of diluted Attractor Neural Networks for real patterns (i.e., non-random ones), as it is the case of human fingerprints. We explore the optimal number of Attractor Neural Networks in the ensemble to achieve a maximum fingerprint storage capacity. The retrieval performance of the ensemble is measured in terms of the network connectivity structure, by comparing 1D ring to 2D cross grid topologies for the random shortcuts ratio. Given the nature of the network ensemble and the different characteristics of patterns, an optimization can be carried out considering how the pattern subsets are assigned to the ensemble modules. The ensemble specialization splitting into several modules of attractor networks is explored with respect to the activities of patterns and also in terms of correlations of the subsets of patterns assigned to each module in the ensemble network.This work was funded by and UDLA-SIS.MGR.20.01. This research was also funded by the Spanish Ministry of Science and Innovation/FEDER, under the \RETOS" Programme, with grant numbers: TIN2017-84452-R and RTI2018-098019-B-I00; and by the CYTED Network \Ibero-American Thematic Network on ICT Applications for Smart Cities", grant number: 518RT0559

A Tandem Drone-ground Vehicle for Accessing Isolated Locations for First Aid Emergency Response in Case of Disaster

The collapse of infrastructures is very often a complicating factor for the early emergency actuations after a disaster. A proper plan to better cover the needs of the affected people within the disaster area while maintaining life-saving relief operations is mandatory hence. In this paper, we use a drone for flying over a set of difficult-to-access locations for imaging issues to get information to build a risk assessment as the earliest stage of the emergency operations. While the drone provides the flexibility required to visit subsequently a sort of isolated locations, it needs a commando vehicle in ground for (i) monitoring the deployment of operations and (ii) being a recharging station where the drone gets fresh batteries. This work proposes a decision-making process to plan the mission, which is composed by the ground vehicle stopping points and the sequence of locations visited for each drone route. We propose a Genetic Algorithm (GA) which has proven to be helpful in finding good solutions in short computing times. We provide experimental analysis on the factors effecting the performance of the output solutions, around an illustrative test instance. Results show the applicability of these techniques for providing proper solutions to the studied problem

Ecocardiografía en el intervencionismo estructural. ¿Cómo, cuándo y por qué?

Percutaneous structural heart intervention procedures have experienced a huge expansion recently. Echocardiographic monitoring is crucial in these procedures. However, thanks to the technical improvements and the experience acquired, some procedures are beginning to be simplified reducing image monitoring. In the present review we analyze the role of echocardiography and its alternatives for some of the most common procedures in the field of structural heart interventions.Los procedimientos de intervencionismo estructural percutáneo han mostrado una gran expansión en los últimos años. La monitorización ecocardiográfica es una piedra angular en estos procedimientos. Sin embargo, recientemente y gracias a las mejoras técnicas y experiencia acumulada, en algunos procedimientos se comienza a simplificar o prescindir de la monitorización por imagen. En la presente revisión se analiza el papel de la ecografía en la actualidad y sus alternativas para algunos de los procedimientos más habituales en el campo del intervencionismo estructural

2D/3D Simulations of black-silicon interdigitated back-contacted c-si(n) solar cells

Black silicon (b-Si) reduces drastically light reflectance in the front side of c-Si solar cells to values near zero for the whole absorbed solar spectrum. In this work, we apply 2D and 3D simulations to explore the efficiency limits of interdigitated back-contacted c-Si(n) solar cells with line or point contacts respectively, using ALD Al2O3 passivated b-Si in the front surface. Realistic physical and technological parameters involved in a conventional oven-based fabrication process are considered in the simulations, especially those related to surface recombination on the b-Si as well as high doped p+/n+ strip regions. One important issue is the temporal stability of surface passivation on b-Si surfaces. In this work experimental long-term b-Si surface passivation data after two years and its impact on cell performance are studied. Simulations demonstrate initial and final photovoltaic efficiencies over 24.6% and 23.2% respectively for an emitter coverage of 80% independently of the cell contact strategy. A photocurrent loss about 1.3 mA/cm2 occurs when surface recombination velocity at the b-Si surfaces degrades from 6 cm/s to a final value of 28 cm/s.Postprint (author's final draft

Daytime and nighttime aerosol optical depth implementation in CÆLIS

The University of Valladolid (UVa, Spain) has managed a calibration center of the AErosol RObotic NETwork (AERONET) since 2006. The CÆLIS software tool, developed by UVa, was created to manage the data generated by AERONET photometers for calibration, quality control and data processing purposes. This paper exploits the potential of this tool in order to obtain products like the aerosol optical depth (AOD) and Ångström exponent (AE), which are of high interest for atmospheric and climate studies, as well as to enhance the quality control of the instruments and data managed by CÆLIS. The AOD and cloud screening algorithms implemented in CÆLIS, both based on AERONET version 3, are described in detail. The obtained products are compared with the AERONET database. In general, the differences in daytime AOD between CÆLIS and AERONET are far below the expected uncertainty of the instrument, ranging in mean differences between −1.3×10−4 at 870 nm and 6.2×10−4 at 380 nm. The standard deviations of the differences range from 2.8×10−4 at 675 nm to 8.1×10−4 at 340 nm. The AOD and AE at nighttime calculated by CÆLIS from Moon observations are also presented, showing good continuity between day and nighttime for different locations, aerosol loads and Moon phase angles. Regarding cloud screening, around 99.9 % of the observations classified as cloud-free by CÆLIS are also assumed cloud-free by AERONET; this percentage is similar for the cases considered cloud-contaminated by both databases. The obtained results point out the capability of CÆLIS as a processing system. The AOD algorithm provides the opportunity to use this tool with other instrument types and to retrieve other aerosol products in the future. This research has been supported by the Spanish Ministry of Science and Innovation (grant no. RTI2018-097864-B-I00) and the European Union's Horizon 2020 research and innovation program (grant no. 871115).The authors gratefully thank AERONET and PHOTONS teams for the collaboration and support. The authors thank the Spanish Ministry of Science, Innovation and Universities for the support through the ePOLAAR project (RTI2018-097864-B-I00). This research has been supported by the Spanish Ministry of Science and Innovation (grant no. RTI2018-097864-B-I00) and the European Union's Horizon 2020 research and innovation program (grant no. 871115)

Hemorragia espontánea de origen incierto

Acquired hemophilia A is a rare disease caused by autoantibodies targeting coagulation factor VIII. It should be suspected in case of spontaneous bleeding and extended aPTT. We present an 85-year-old male patient with retroperitoneal hematoma and prolonged aPTT. Factor VIII activity is determined, which is significantly reduced. The patient begins treatment, with excellent clinical response. This is an illustrativeexample of this unknown disease, which may provide its better understanding and management of these patients.La hemofilia A adquirida es un trastorno infrecuente de la coagulación debido a autoanticuerpos frente al factor VIII. Se debe sospechar en caso de sangrado espontáneo y prolongación del TTPA. Presentamos el caso de un varón de 85 años con hematoma retroperitoneal. En los análisis de laboratorio destacaba TTPA prolongado. Se determinó la actividad del factor VIII, que se encontraba significativamente disminuida. El paciente inició tratamiento, con excelente respuesta clínica. Este caso clínico es un ejemplo ilustrativo de esta enfermedad desconocida, que puede ayudar a su mejor comprensión y a un mejor manejo de estos pacientes

Columnar and surface aerosol load over the Iberian Peninsula establishing annual cycles, trends, and relationships in five geographical sectors

Producción CientíficaThe study of atmospheric aerosol load over the Iberian Peninsula (IP) under a climatological perspective is accomplished by means of PM10 and AOD440nm measurements from EMEP and AERONET networks, respectively, in the period 2000-2013. The PM10 annual cycles in five Iberian sectors show a main maximum in summer and a secondary in spring, which is only observed in the southern area for the AOD climatology. The characteristics of PM10-AOD annual cycles of each geographical sector are explained by the different climatology of the air mass origins and their apportioning. The two magnitudes are correlated with a factor ranging between 20 and 90 depending on the sector. The temporal evolution of the aerosol load has shown a notable decrease in the IP since the 1980s. Statistically significant trends are obtained in the Northeastern sector with a reduction of 26% (period 1985-2000) for the total suspended particles, which continues for the PM10 data with a value of 35% per decade (2001-2013), and also in the whole column, 61% per decade in the AOD440nm (2004-2013).Financial supports from the Spanish MINECO (projects of ref. CGL2011-23413, CGL2012-33576) are also gratefully acknowledged

Dispositivos de asistencia circulatoria e infecciones asociadas: nuevas terapias, nuevas complicaciones

The use of left ventricular assist devices (LVAD) has significantly increased in the past few years. As a result, new complications, such as infections, have emerged. We present the case of the oldest LVAD carrier in our environment. Her cardiovascular disease has significantly improved, although at the cost of recurrent driveline infections and admissions to hospital. Complications associated with the implant of LVAD, such as infections, is a growing and challenging field. An outpatient and multidisciplinary approach might be the key to improve outcomes.El empleo de los dispositivos de asistencia ventricular ha aumentado exponencialmente. Esto se ha acompañado de la aparición de complicaciones, entre las que destacan las infecciones. Presentamos el caso de la portadora más longeva de uno de estos dispositivos en nuestro medio. Excelente evolución respecto a su patología cardiovascular, aunque con recurrentes infecciones del cable del dispositivo y reingresos que limitaban su calidad de vida. Las complicaciones asociadas al empleo de los dispositivos de asistencia ventricular, como las infecciones, supone un creciente y desafiante campo en el que trabajar. Un abordaje ambulatorio y multidisciplinar puede ser la base para obtener grandes resultados.  

AMP-activated kinase in human spermatozoa: Identification, intracellular localization, and key function in the regulation of sperm motility

AMP‑activated kinase (AMPK), a protein that regulates energy balance and metabolism, has recently been identified in boar spermatozoa where regulates key functional sperm processes essential for fertilization. This work’s aims are AMPK identification, intracellular localization, and their role in human spermatozoa function. Semen was obtained from healthy human donors. Sperm AMPK and phospho‑Thr172‑AMPK were analyzed by Western blotting and indirect immunofluorescence. High‑ and low‑quality sperm populations were separated by a 40%–80% density gradient. Human spermatozoa motility was evaluated by an Integrated Semen Analysis System (ISAS) in the presence or absence of the AMPK inhibitor compound C (CC). AMPK is localized along the human spermatozoa, at the entire acrosome, midpiece and tail with variable intensity, whereas its active form, phospho‑Thr172‑AMPK, shows a prominent staining at the acrosome and sperm tail with a weaker staining in the midpiece and the postacrosomal region. Interestingly, spermatozoa bearing an excess residual cytoplasm show strong AMPK staining in this subcellular compartment. Both AMPK and phospho‑Thr172‑AMPK human spermatozoa contents exhibit important individual variations. Moreover, active AMPK is predominant in the high motility sperm population, where shows a stronger intensity compared with the low motility sperm population. Inhibition of AMPK activity in human spermatozoa by CC treatment leads to a significant reduction in any sperm motility parameter analyzed: percent of motile sperm, sperm velocities, progressivity, and other motility coefficients. This work identifies and points out AMPK as a new molecular mechanism involved in human spermatozoa motility. Further AMPK implications in the clinical efficiency of assisted reproduction and in other reproductive areas need to be studied.Trabajo patrocinado por: Mutua Madrileña. Beca Junta de Extremadura y Fondos FEDER. Ayudas JUEX‑IBI13121, PCJ1008, GR10125, y GR10156 Fundación Tatiana Pérez Guzmán el Bueno. Beca para Violeta Calle Guisado Ministerio de Educación y Ciencia. Beca Predoctoral FPU para Violeta Calle GuisadopeerReviewe