Reconstruction and numerical modelling of the abdominal wall. Application to hernia surgery

Routine hernia repair surgery involves the implant of synthetic mesh. However, this proceduremay give rise to several problems causing considerable patient disability. With the aim ofimproving surgical procedures, the healthy and the herniated human abdomen are simulatedusing finite element (FE) simulations. For that purpose, a reconstruction of the physiologicalgeometry of a human abdomen was created using magnetic resonance images. Besides,following the anatomy of the abdomen, the different muscles and aponeurosis were defined.Furthermore, collagen fibres were included in each muscle layer and their passive anisotropicmechanical contribution was modelled within the framework of hyperelasticity. In the FEsimulation of the abdomen, the constraint imposed by the shoulder is applied and an internalpressure of 23 kPa was applied to the interior abdominal wall to reproduce the abdominal loadwhen standing jumping. After generating a hernia in the front of the abdomen, differentprostheses (Surgipro®, Optilene® and Infinit®), modelled using a membrane model, are placedin the defect to simulate the behaviour of the abdomen after the surgical procedure. In thehealthy abdomen, maximal principal stresses (MPS) and displacements (MD) appear in thefront of the belly. On the other hand, once the hernia is created and the mesh is placed, theMD and MPS are higher than those attained in the healthy abdomen. Thus, just after surgery,surgical repair procedure does not fully restore normal physiological conditions and the risk ofhernia recurrence by the suture is high due to the stress concentration

¿Cuál es la actitud de los médicos hacia el actual modelo de atención primaria?

ObjetivoDeterminar cómo es la actitud de los médicos hacia el actual modelo de atención primaria de salud y estimar su relación con variables de tipo sociodemográfico y/o laboral.DiseñoEstudio multicéntrico, transversal.EmplazamientoCentros de salud del Área II de la Región de Murcia.ParticipantesTotalidad de médicos generales, de familia y pediatras de los centros de salud mencionados (54 en total).Mediciones principalesComo instrumento de evaluación se utiliza la «Escala de actitudes hacia los contenidos de atención primaria de salud», de Ballesteros et al. Esta escala proporciona una puntuación total, así como una puntuación específica para cada una de las 7 dimensiones que la componen.ResultadosEn general, la actitud de los médicos es favorable (4,1 puntos de media sobre 5). En la dimensión «Inclusión de los profesionales del segundo nivel en atención primaria» es donde hemos encontrado una actitud menos favorable, siendo los médicos de familia los que se muestran más de acuerdo. En cuanto a las demás variables asociadas, los profesionales que trabajan en centros periféricos y en situación de interinidad muestran una actitud más positiva hacia el actual modelo.ConclusionesEl conocimiento de las actitudes de los profesionales, así como de las variables relacionadas, puede servir de base para diseñar posibles estrategias de intervención dirigidas a la mejora de la calidad asistencial en atención primaria y para una evolución positiva de los profesionales que prestan sus servicios.ObjectivesTo determine the attitude of doctors towards the current model of primary care and to calculate its relationship with social and demographic and/or work variables.DesignMulti-centre cross-sectional study.SettingHealth centres in Area II of the Murcia region.ParticipantsAll general practitioners, family doctors and paediatricians in the health centres mentioned (54 in all).Main measurementsThe «Scale of attitudes towards the contents of primary health care» by Ballesteros et al. was used as the tool of evaluation. This scale provides both a total score and a specific score for each of its 7 dimensions.ResultsIn general, doctors´ attitudes were favourable (4.1 points average out of 5). We found a less favourable attitude in the dimension «Inclusion of second-level professionals in primary care», with family doctors most in agreement. The professionals working in centres on the periphery and those without tenure had a more positive attitude towards the current model, for the remaining variables.ConclusionsUnderstanding professionals´ attitudes and the variables related to them may serve as a basis for designing intervention strategies aimed at improving the quality of primary care and for the positive evolution of professionals working in PC

Biomechanical and morphological study of a new elastic mesh (Ciberlastic) to repair abdominal wall defects

The aim of this study was to conduct a preclinical evaluation of the behaviour of a new type of abdominal LW prosthesis (Ciberlastic), which was designed with a non-absorbable elastic polyurethane monofilament (Assuplus, Assut Europe, Italy) to allow greater adaptability to mechanical area requirements and higher bio-mimicking with the newly formed surrounding tissues. Our hypothesis was that an increase in the elasticity of the mesh filament could improve the benefits of LW prostheses. To verify our hypothesis, we compared the short- and long-term behaviour of Ciberlastic and Optilene® elastic commercial meshes by repairing the partially herniated abdomen in New Zealand White rabbits. The implanted meshes were mechanically and histologically assessed at 14 and 180 days post-implant. We mechanically characterized the partially herniated repaired muscle tissue and also determined mesh shrinkage at different post-implant times. This was followed by a histological study in which the tissue incorporation process was analysed over time. The new prosthesis designed by our group achieved good behaviour that was similar to that of Optilene®, one of the most popular LW prostheses on the market, with the added advantage of its elastic property. The mechanical properties are significantly lower than those of the polypropylene Optilene® mesh, and the new elastic mesh meets the basic mechanical requirements for positioning in the abdominal wall, which was also demonstrated by the absence of recurrences after implantation in the experimental model. We found that the growth of a connective tissue rich in collagen over the hernial defect and the proper deposit of the collagen fibres in the regenerated tissue substantially modified the original properties of the mesh, thereby increasing its biomechanical strength and making the whole tissue/mesh stiffer

Comparación entre las técnicas de cribado de patología cervical y las conizaciones de tres hospitales en españa

Objetivo: Analizar las características poblacionales y los métodos diagnósticos de patología cervical para la prevención del cáncer de cérvix de tres hospitales españoles para mejorar y unificar los programas de cribado y prevención. Material y métodos: Estudio retrospectivo de las características demográficas y clínicas de 408 mujeres con patología cervical uterina diagnosticadas en 3 hospitales españoles. Se comparan los factores de riesgo, el proceso diagnóstico y la indicación de tratamiento de dos grupos: las que requirieron conización cervical (n=222) y las que no precisaron tratamiento quirúrgico (n=186). También se analizan las recomendaciones vacunales y su grado de cumplimiento. Resultados: Las mujeres conizadas usaron más anticoncepción hormonal y tienen un mayor hábito tabáquico mientras que el número de compañeros sexuales es mayor en pacientes no conizadas. Más del 50% de pacientes con biopsia cervical positiva presentaron un resultado igual o más grave en la anatomía patológica de la pieza quirúrgica. Existen diferencias significativas en sensibilidad y valor predictivo positivo de la citología y de la determinación de HPV entre hospitales. La recomendación de vacunación en ambos grupos fue similar, el porcentaje de mujeres que no la cumplieron fue elevado y significativamente mayor entre pacientes conizadas. Conclusión: En nuestro medio las mujeres conizadas tienen características clínicas y epidemiológicas diferentes a las no conizadas, existen diferencias entre las técnicas diagnósticas de distintos hospitales y sin embargo la concordancia entre biopsia y resultado del cono es elevada. Sigue siendo necesaria una correcta educación sanitaria en relación con la vacunación en mujeres con patología cervical. Background: To analyse the characteristics of the population and diagnostic methods related to the cervical cancer prevention program in three different-level hospitals of a Spanish region in order to improve and unify the screening program. Methods: We retrospectively studied demographic and clinical characteristics of 408 women with cervical lesions diagnosed in three hospitals in Aragon (Spain). Correlation between risk factors, diagnosis process and conisation indication was analysed divided in two groups: conisation required (n=222) or non-conisation (n=186). We also assessed the number of vaccine recommendations made to the patients and the degree of compliance. Results: Conisaited women more frequently used a combined hormonal contraceptive method and are more smokers, while the sexual partners are more in women without conisation. More than 50% of women con positive biopsy was confirmed after surgical treatment. There are significant differences between sensibility and positive predictive value of pap-smear and HPV determination in different hospitals. The recombinant vaccine was recommended to both groups at a similar rate. The percentage of women who were recommended to receive the vaccine but chose not to do it, was high in both groups but significantly higher in the Conisation group. Conclusion: In our environment conisaited women have different clinical and epidemiological profiles, there are differences between diagnosis techniques in different hospitals, however, the concordance between biopsy and definitive result is high. A good sanitary education is necessary in relation with the vaccination of women with cervical pathology

SARS-CoV-2 viral load in nasopharyngeal swabs is not an independent predictor of unfavorable outcome

The aim was to assess the ability of nasopharyngeal SARS-CoV-2 viral load at first patient’s hospital evaluation to predict unfavorable outcomes. We conducted a prospective cohort study including 321 adult patients with confirmed COVID-19 through RT-PCR in nasopharyngeal swabs. Quantitative Synthetic SARS-CoV-2 RNA cycle threshold values were used to calculate the viral load in log10 copies/mL. Disease severity at the end of follow up was categorized into mild, moderate, and severe. Primary endpoint was a composite of intensive care unit (ICU) admission and/or death (n = 85, 26.4%). Univariable and multivariable logistic regression analyses were performed. Nasopharyngeal SARS-CoV-2 viral load over the second quartile (≥ 7.35 log10 copies/mL, p = 0.003) and second tertile (≥ 8.27 log10 copies/mL, p = 0.01) were associated to unfavorable outcome in the unadjusted logistic regression analysis. However, in the final multivariable analysis, viral load was not independently associated with an unfavorable outcome. Five predictors were independently associated with increased odds of ICU admission and/or death: age ≥ 70 years, SpO2, neutrophils > 7.5 × 103/µL, lactate dehydrogenase ≥ 300 U/L, and C-reactive protein ≥ 100 mg/L. In summary, nasopharyngeal SARS-CoV-2 viral load on admission is generally high in patients with COVID-19, regardless of illness severity, but it cannot be used as an independent predictor of unfavorable clinical outcome

Dendritic cell deficiencies persist seven months after SARS-CoV-2 infection

Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)-2 infection induces an exacerbated inflammation driven by innate immunity components. Dendritic cells (DCs) play a key role in the defense against viral infections, for instance plasmacytoid DCs (pDCs), have the capacity to produce vast amounts of interferon-alpha (IFN-α). In COVID-19 there is a deficit in DC numbers and IFN-α production, which has been associated with disease severity. In this work, we described that in addition to the DC deficiency, several DC activation and homing markers were altered in acute COVID-19 patients, which were associated with multiple inflammatory markers. Remarkably, previously hospitalized and nonhospitalized patients remained with decreased numbers of CD1c+ myeloid DCs and pDCs seven months after SARS-CoV-2 infection. Moreover, the expression of DC markers such as CD86 and CD4 were only restored in previously nonhospitalized patients, while no restoration of integrin β7 and indoleamine 2,3-dyoxigenase (IDO) levels were observed. These findings contribute to a better understanding of the immunological sequelae of COVID-19

EUSO-SPB1 mission and science

The Extreme Universe Space Observatory on a Super Pressure Balloon 1 (EUSO-SPB1) was launched in 2017 April from Wanaka, New Zealand. The plan of this mission of opportunity on a NASA super pressure balloon test flight was to circle the southern hemisphere. The primary scientific goal was to make the first observations of ultra-high-energy cosmic-ray extensive air showers (EASs) by looking down on the atmosphere with an ultraviolet (UV) fluorescence telescope from suborbital altitude (33 km). After 12 days and 4 h aloft, the flight was terminated prematurely in the Pacific Ocean. Before the flight, the instrument was tested extensively in the West Desert of Utah, USA, with UV point sources and lasers. The test results indicated that the instrument had sensitivity to EASs of ⪆ 3 EeV. Simulations of the telescope system, telescope on time, and realized flight trajectory predicted an observation of about 1 event assuming clear sky conditions. The effects of high clouds were estimated to reduce this value by approximately a factor of 2. A manual search and a machine-learning-based search did not find any EAS signals in these data. Here we review the EUSO-SPB1 instrument and flight and the EAS search

Simulation studies for the Mini-EUSO detector

Mini-EUSO is a mission of the JEM-EUSO program flying onboard the International Space Station since August 2019. Since the first data acquisition in October 2019, more than 35 sessions have been performed for a total of 52 hours of observations. The detector has been observing Earth at night-time in the UV range and detected a wide variety of transient sources all of which have been modeled through Monte Carlo simulations. Mini-EUSO is also capable of detecting meteors and potentially space debris and we performed simulations for such events to estimate their impact on future missions for cosmic ray science from space. We show here examples of the simulation work done in this framework to analyze the Mini-EUSO data. The expected response of Mini-EUSO with respect to ultra high energy cosmic ray showers has been studied. The efficiency curve of Mini-EUSO as a function of primary energy has been estimated and the energy threshold for Cosmic Rays has been placed to be above 10$^{21}$ eV. We compared the morphology of several transient events detected during the mission with cosmic ray simulations and excluded that they can be due to cosmic ray showers. To validate the energy threshold of the detector, a system of ground based flashers is being used for end-to-end calibration purposes. We therefore implemented a parameterization of such flashers into the JEM-EUSO simulation framework and studied the response of the detector with respect to such sources

Neutrino Target-of-Opportunity Observations with Space-based and Suborbital Optical Cherenkov Detectors

Cosmic-ray accelerators capable of reaching ultra-high energies are expected to also produce very-high energy neutrinos via hadronic interactions within the source or its surrounding environment. Many of the candidate astrophysical source classes are either transient in nature or exhibit flaring activity. Using the Earth as a neutrino converter, suborbital and space-based optical Cherenkov detectors, such as EUSO-SPB2 and POEMMA, will be able to detect upward-moving extensive air showers induced by decay tau-leptons generated from cosmic tau neutrinos with energies ∼10 PeV and above. Both EUSO-SPB2 and POEMMA will be able to quickly repoint, enabling rapid response to astrophysical transient events. we calculate the transient sensitivity and sky coverage for both EUSO-SPB2 and POEMMA, accounting for constraints imposed by the Sun and the Moon on the observation time. We also calculate both detectors\u27 neutrino horizons for a variety of modeled astrophysical neutrino fluences. We find that both EUSO-SPB2 and POEMMA will achieve transient sensitivities at the level of modeled neutrino fluences for nearby sources. We conclude with a discussion of the prospects of each mission detecting at least one transient event for various modeled astrophysical neutrino sources

Measurement of UV light emission of the nighttime Earth by Mini-EUSO for space-based UHECR observations

The JEM-EUSO (Joint Experiment Missions for Extreme Universe Space Observatory) program aims at the realization of the ultra-high energy cosmic ray (UHECR) observation using wide field of view fluorescence detectors in orbit. Ultra-violet (UV) light emission from the atmosphere such as airglow and anthropogenic light on the Earth\u27s surface are the main background for the space-based UHECR observations. The Mini-EUSO mission has been operated on the International Space Station (ISS) since 2019 which is the first space-based experiment for the program. The Mini-EUSO instrument consists of a 25 cm refractive optics and the photo-detector module with the 2304-pixel array of the multi-anode photomultiplier tubes. On the nadir-looking window of the ISS, the instrument is capable of continuously monitoring a ~300 km x 300 km area. In the present work, we report the preliminary result of the measurement of the UV light in the nighttime Earth using the Mini-EUSO data downlinked to the ground. We mapped UV light distribution both locally and globally below the ISS obit. Simulations were also made to characterize the instrument response to diffuse background light. We discuss the impact of such light on space-based UHECR observations and the Mini-EUSO science objectives