Minimally Invasive Endoscopic Sinus Surgery for Frontal Sinus Pathologies Using Interventional Flexible Bronchoscopy: Case Reports.

Background: Lateral pathologies of the frontal sinus are difficult to visualize and treat with classical endoscopic sinus surgery (ESS) using rigid endoscopes and instruments. Hence, they often require extended endoscopic or external approaches. Methods and Results: We describe the advantages of using interventional flexible bronchoscopy in frontal ESS without extended approaches in 2 illustrated cases: (1) A fungus ball in the frontal sinus with a frontoethmoidal cell. The flexible bronchoscope allowed treatment of all recesses of the frontal sinuses and the opening of a frontoethmoidal cell through a Draf IIa. (2) A revision surgery with a frontoethmoidal cell obstructing drainage pathway was successfully treated with this same technique. Patients did not experience complications or recurrent symptomatology after, respectively, 4 and 15 months of follow-up. Conclusion: Flexible bronchoscopy allows a good visualization and treatment of lateral frontal sinus pathologies through limited endoscopic approaches. Through-the-scope instruments permit the resection of frontoethmoidal cells

Predictive Maintenance of Floating Offshore Wind Turbine Mooring Lines using Deep Neural Networks

The recent massive deployment of onshore wind farms has caused controversy to arise mainly around the issues of land occupation, noise and visual pollution and impact on wildlife. Fixed offshore turbines, albeit beneficial in those aspects, become economically unfeasible when installed far away from coastlines. The possibility of installing floating offshore wind turbines is currently hindered by their excessive operation and maintenance costs. We have developed a comprehensive model to help companies plan their operations in advance by detecting failure in mooring lines in almost real time using supervised deep learning techniques. Given the lack of real data, we have coupled numerical methods and OpenFAST simulations to build a dataset containing the displacements and rotations of a turbine's floating platform across all directions. These time series and their corresponding frequency spectra are used to obtain a set of key statistical parameters, including means and standard deviations, peak frequencies, and several relevant momenta. We have designed and trained a Deep Neural Network to understand and distinguish amongst a series of common failure modes for mooring lines considering a range of metocean and structural conditions. We have obtained promising results when monitoring severe changes in the line's mass and damping using short time spans, achieving a 95.7% validation accuracy when detecting severe biofouling failure.N Gorostidi has received funding from the Spanish Ministry of Science and Innovation project DEEPINVERSE, with reference PID2019-108111RB-I00 (FEDER/AEI). V Nava has received funding from the project IA4TES - Inteligencia Artificial para la Transición Energética Sostenible funded by Ministry of Economic Affairs and Digital Transformation (MIA.2021.M04.0008); the “BCAM Severo Ochoa” accreditation of excellence (SEV-2017-0718); and the Basque Government through the BERC 2022-2025 program, the Elkartek project EXPERTIA (KK-2021/00048)

Utility of flexible interventional endoscopy in endoscopic sinus surgery: a case series.

During endoscopic sinus surgery (ESS), difficult-to-reach pathologies need an extended endoscopic approach or an external approach. We started to use a flexible interventional endoscope (FIE) to evaluate the necessity of those approaches. The study's objective is to describe our experience and define patients who could benefit from this technique. We reviewed every patient who benefited from FIE associated with ESS at our tertiary University Hospital between January 2021 and February 2022. During this period, we did 107 ESS, and 14 patients benefited from the FIE, representing 13% of our ESS. The median duration of the flexible endoscopy time was 14 min (4-38 min). We identified three groups of patients who can benefit from the FIE. The first one is for patients with a fungal infection, to control and to clean lateral recesses in a noninvasive manner. The second one is for patients with a pathology of the lateral frontal sinus, to remove the frontoethmoidal cells or mucocele with the biopsy forceps through the working channel. The third group is for patients with inverted papillomas, to precisely identify the insertion and to decide on the most appropriate surgical approach. In selected cases, using flexible endoscopy during ESS helps decide the optimal surgical approach and sometimes treat the pathology through a limited approach. Prospective studies for each group of patients are needed to confirm the benefit of this new combined procedure

SEOM Clinical Guidelines For Endometrial Cancer (2017)

Endometrial cancer (EC) is the most common gynecological cancer in developed countries. Most patients are diagnosed at an early stage with a low risk of relapse. However, there is a group of patients with a high risk of relapse and poor prognosis. Despite the recent publication of randomized trials, the adjuvant treatment of high-risk EC is still to be defined and there are many open questions about the best approach and the right timing. Unfortunately, the survival of metastatic or recurrent EC is short, due to the poor results of chemotherapy and the lack of a second line of treatment. Advances in the knowledge of the molecular abnormalities in EC have permitted the development of promising targeted therapies

Human papillomavirus (HPV) DNA in penile carcinomas in Argentina: Analysis of primary tumors and lymph nodes

Among sexually transmitted diseases, infection by human papillomavirus (HPV) has become one of the most important. On the other hand, though epidemiological data show that some HPV types are closely associated with cervical cancer, few reports have been found with reference to penile carcinoma because of its rare occurrence. The aim of this study was to investigate the relationship between HPV infection and penile cancer in Argentina. A retrospective study was carried out on 38 white men with penile squamous-cell carcinoma. Sixty-five archival fixed biopsies taken from 34 primary penile tumors, 25 nodal metastases, 1 skin “satellite” metastasis and 5 histologically normal lymph nodes were used as specimens. HPV detection and typing were carried out by the polymerase chain reaction (PCR) using generic primers, combined with single-stranded conformational polymorphism (SSCP) analysis. HPV DNA was found in 71% patients, corresponding 81% of them to “high risk” types, with predominance of HPV 18. Both primary tumors and metastases showed concordance of HPV occurrence and type in both lesions. In 3 patients, HPV 16 was detected not only in primary tumors and metastases, but also in histologically normal lymph nodes. Our data indicate that most penile carcinomas in Argentine patients are etiologically related to HPV, especially to “high risk” genital types. The agreement in HPV detection between primary tumors and metastases suggests a potential viral role in tumor progression. HPV detection in otherwise histologically normal lymph nodes might be useful as early marker of a metastatic process.Fil: Picconi, María A.. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud “Dr. C.G. Malbrán”; ArgentinaFil: Eijan, Ana Maria. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires; ArgentinaFil: Distéfano, Angélica L.. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud “Dr. C.G. Malbrán”; ArgentinaFil: Pueyo, Silvia. Provincia de Buenos Aires. Ministerio de Salud. Hospital Materno Infantil de San Isidro. Servicio de Dermatología; ArgentinaFil: Alonio, Lidia Virginia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud “Dr. C.G. Malbrán”; ArgentinaFil: Gorostidi, Susana. Universidad de Buenos Aires; ArgentinaFil: Teyssié, Angélica R.. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud “Dr. C.G. Malbrán”; ArgentinaFil: Casabone, Bernardo Adalberto. Universidad de Buenos Aires; Argentin

More, smaller bacteria in response to ocean's warming?

Heterotrophic bacteria play a major role in organic matter cycling in the ocean. Although the high abundances and relatively fast growth rates of coastal surface bacterioplankton make them suitable sentinels of global change, past analyses have largely overlooked this functional group. Here, time series analysis of a decade of monthly observations in temperate Atlantic coastal waters revealed strong seasonal patterns in the abundance, size and biomass of the ubiquitous flow-cytometric groups of low (LNA) and high nucleic acid (HNA) content bacteria. Over this relatively short period, we also found that bacterioplankton cells were significantly smaller, a trend that is consistent with the hypothesized temperature-driven decrease in body size. Although decadal cell shrinking was observed for both groups, it was only LNA cells that were strongly coherent, with ecological theories linking temperature, abundance and individual size on both the seasonal and interannual scale. We explain this finding because, relative to their HNA counterparts, marine LNA bacteria are less diverse, dominated by members of the SAR11 clade. Temperature manipulation experiments in 2012 confirmed a direct effect of warming on bacterial size. Concurrent with rising temperatures in spring, significant decadal trends of increasing standing stocks (3% per year) accompanied by decreasing mean cell size (-1% per year) suggest a major shift in community structure, with a larger contribution of LNA bacteria to total biomass. The increasing prevalence of these typically oligotrophic taxa may severely impact marine food webs and carbon fluxes by an overall decrease in the efficiency of the biological pump.Versión del editor5,064

Action guide for community pharmacist in patients with hypertension and cardiovascular risk. Consensus Document

La hipertensión arterial (HTA) es un problema de salud estrechamente relacionado con un aumento del riesgo de padecer una enfermedad cardiovascular. Además, la HTA puede producir o empeorar la lesión de ciertos órganos diana, lo que también puede influir negativamente en el pronóstico cardiovascular del paciente. En España, la HTA es una condición muy frecuente, afectando a unos 10 millones de sujetos adultos.Por su accesibilidad y formación especializada en materia de medicamentos, el farmacéutico comunitario puede jugar un papel clave en la detección y seguimiento del paciente con HTA. Hasta la fecha, se han publicado numerosas guías clínicas sobre la atención a pacientes con HTA, dirigidas principalmente a médicos. Sin embargo, cada vez es más evidente la necesidad de que todos los profesionales de la salud participen en la atención integral a los pacientes con HTA y riesgo cardiovascular (RCV). La cooperación entre farmacéutico, médico, personal de enfermería y otros profesionales sanitarios es imprescindible para conseguir resultados que optimicen la prevención cardiovascular y mejoren la calidad de vida del paciente. Así, a fin de promover la gestión compartida de los pacientes con HTA y RCV se publica este documento, cuyo principal destinatario es el farmacéutico comunitario.El presente documento pretende ser una herramienta de referencia que dé soporte a los programas de Atención Farmacéutica al paciente con HTA y RCV que se están desarrollando actualmente en las oficinas de farmacia. El texto ha sido desarrollado de forma consensuada entre expertos de la Sociedad Española de Hipertensión- Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA), la Sociedad Española de Farmacia Comunitaria (SEFAC) y el Grupo de Investigación en Atención Farmacéutica de la Universidad de Granada (GIAF-UGR).Arterial hypertension (AH) is an important health-related problem, as responsible for an important part of cardiovascular disorders. Moreover, AH is related to the development and progression of organ damage, which has indeed a negative influence in the cardiovascular prognosis of the individual. In Spain, AH is a frequent condition, affecting about 10 millions of the adult population.Due to their accessibility and specific background on drug management, the community pharmacist could play a key role in the detection and follow-up of the hypertensive patient. To date, several guidelines on hypertension management have been released, although almost invariably have been addressed to the medical community. However, it has become more evident the need for a global management of hypertension and cardiovascular risk with the participation of several health-care providers, such as pharmacists and nurses, with the aim of improving cardiovascular prevention and the quality of life of subjects affected. The present document, particularly addressed to the community pharmacist, is intended to provide current knowledge with the aim of a better shared management of patients with hypertension and cardiovascular risk.The present document pretends to serve as a tool for currently developed programs supporting the involvement of the community pharmacy in the care of patients with hypertension and cardiovascular risk. The document has been developed after a consensus between members from the Spanish Society of Hypertension, the Spanish Society of Community Pharmacy and the Research Group on Pharmaceutical Care from the University of Granada

Estimación de la saturación arterial de oxígeno en función de la altitud

Fundamento y objetivosLa saturación arterial de oxígeno (SAO) es capaz de predecir el desarrollo de mal de altura. Objetivos: estimar los valores de SAO en función de la altitud y, adicionalmente, diseñar un gráfico para usar sobre el terreno que muestre la saturación esperada para cada altitud y sus límites de normalidad.Pacientes y métodoSe registraron valores de SAO a los participantes de 8 actividades de alta montaña en los Alpes, el Himalaya, el Cáucaso y los Andes. Participaron 53 montañeros; 17 de ellos repitieron en más de una actividad. Se registraron 761 mediciones de SAO.ResultadosSe diseñó un modelo de regresión lineal múltiple para estimar los valores de SAO en función de la altitud, ajustados por distintos posibles factores relacionados. Existe una fuerte relación lineal entre altitud y SAO (R2 = 0, 83, p < 0, 001), dando valores 0, 7 puntos mayores en mujeres. La SAO a una determinada altitud no se relaciona con la edad, el peso, la talla, el tabaquismo, la frecuencia cardíaca ni con la experiencia previa en montaña.El cálculo de la estimación de la SAO responde a la siguiente ecuación: SAO = 103, 3 – (altitud × 0, 0047) + (Z), siendo Z = 0, 7 en hombres y 1, 4 en mujeres.Se ha diseñado una gráfica de coordenadas que relaciona la altitud con los valores estimados de SAO con sus límites de normalidad: percentiles 2, 5 y 97, 5.ConclusionesLa sencillez en el cálculo de la SAO estimada para una determinada altitud mediante la gráfica propuesta ayudará en la toma de decisiones precoces sobre el terreno.Background and objectives Arterial Oxygen Saturation (AOS) predicts altitude sickness. Objectives: To estimate the AOS values with relation to altitude. Furthermore, make a graph to use during activity which assesses the AOS for each altitude and the normal range. Patients and method Values of AOS were assessed during eight high mountain activities in the Alps, Himalaya, Caucasus and Andes; 53 mountaineers participated, 17 of them in more than one activity; 761 measurements of AOS were registered. Results A Logistic Regression Model was made to estimate the AOS values dependent on altitude, adjusted to possible related factors. A strong lineal relationship exists between altitude and AOS (R2 = .83, P < .001);.7 points more in women. The AOS in a particular altitude is not related to age, weight, height, smoking, heart rate, or even with previous experiences in mountains. The calculation of the AOS responds to the follow equation: Blood Oxygen Saturation = 103.3 – (altitude ×.0047) + (Z), being Z = .7 in men and 1.4 in women. A scatter plot was made to relate the estimated altitude with the AOS, with their normal limits values: percentiles 2.5 and 97.5. Conclusions The simple calculation of the AOS estimated for a particular altitude with the proposed graphic can help in the early decision-making onsite

Guía de actuación para el farmacéutico comunitario en pacientes con hipertensión arterial y riesgo cardiovascular. Documento de Consenso (versión extendida)

La hipertensión arterial (HTA) es un problema de salud estrechamente relacionado con un aumento del riesgo de padecer una enfermedad cardiovascular. Además, la HTA puede producir o empeorar la lesión de ciertos órganos diana, lo que también puede influir negativamente en el pronóstico cardiovascular del paciente. En España, la HTA es una condición muy frecuente, afectando a unos 10 millones de sujetos adultos. Por su accesibilidad y formación especializada en materia de medicamentos, el farmacéutico comunitario puede jugar un papel clave en la detección y seguimiento del paciente con HTA. Hasta la fecha, se han publicado numerosas guías clínicas sobre la atención a pacientes con HTA, dirigidas principalmente a médicos. Sin embargo, cada vez es más evidente la necesidad de que todos los profesionales de la salud participen en la atención integral a los pacientes con HTA y riesgo cardiovascular (RCV). La cooperación entre farmacéutico, médico, personal de enfermería y otros profesionales sanitarios es imprescindible para conseguir resultados que optimicen la prevención cardiovascular y mejoren la calidad de vida del paciente. Así, a fin de promover la gestión compartida de los pacientes con HTA y RCV se publica este documento, cuyo principal destinatario es el farmacéutico comunitario. El presente documento pretende ser una herramienta de referencia que dé soporte a los programas de Atención Farmacéutica al paciente con HTA y RCV que se están desarrollando actualmente en las oficinas de farmacia. El texto ha sido desarrollado de forma consensuada entre expertos de la Sociedad Española de Hipertensión- Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA), la Sociedad Española de Farmacia Comunitaria (SEFAC) y el Grupo de Investigación en Atención Farmacéutica de la Universidad de Granada (GIAF-UGR).Arterial hypertension (AH) is an important health-related problem, as responsible for an important part of cardiovascular disorders. Moreover, AH is related to the development and progression of organ damage, which has indeed a negative influence in the cardiovascular prognosis of the individual. In Spain, AH is a frequent condition, affecting about 10 millions of the adult population. Due to their accessibility and specific background on drug management, the community pharmacist could play a key role in the detection and follow-up of the hypertensive patient. To date, several guidelines on hypertension management have been released, although almost invariably have been addressed to the medical community. However, it has become more evident the need for a global management of hypertension and cardiovascular risk with the participation of several health-care providers, such as pharmacists and nurses, with the aim of improving cardiovascular prevention and the quality of life of subjects affected. The present document, particularly addressed to the community pharmacist, is intended to provide current knowledge with the aim of a better shared management of patients with hypertension and cardiovascular risk. The present document pretends to serve as a tool for currently developed programs supporting the involvement of the community pharmacy in the care of patients with hypertension and cardiovascular risk. The document has been developed after a consensus between members from the Spanish Society of Hypertension, the Spanish Society of Community Pharmacy and the Research Group on Pharmaceutical Care from the University of Granada