Respuesta hepática durante la isquemia-reperfusión pulmonar modulada con precondicionamiento isquémico en un modelo experimental de autotrasplante pulmonar en cerdo

El daño por isquemia-reperfusión es reconocido como un serio problema que acompaña a diversos procedimientos médicos y quirúrgicos habituales tales como la terapia trombolítica, el trasplante de órganos, la angioplastia coronaria y el by-pass cardiopulmonar. La isquemia-reperfusión pulmonar induce una respuesta inflamatoria local en el propio parénquima pulmonar caracterizada por daño alveolar inespecífico, edema pulmonar e hipoxemia. La isquemia-reperfusión pulmonar también induce una respuesta inflamatoria sistémica con afectación de órganos remotos, la cual es incluso más dañina que sus efectos locales. Estudios previos han demostrado en modelos clínicos y experimentales que el hígado es particularmente sensible a la liberación de mediadores inflamatorios, hecho que ocurre tras la isquemia-reperfusión de órganos remotos tales como: riñón, intestino y músculo esquelético. Se ha comprobado que el precondicionamiento isquémico directo es capaz de proteger a diversos órganos frente al daño por isquemia-reperfusión. Nuestro grupo ha demostrado previamente en un modelo de autotrasplante pulmonar en cerdo, que el precondicionamiento isquémico atenúa el daño por isquemia-reperfusión pulmonar mediante la prevención del aumento de los metabolitos de peroxidación lipídica, la activación leucocitaria y las citoquinas proinflamatorias en el parénquima pulmonar..

Nuevas configuraciones de reactor para valorización energética conjunta de biogás e hidrógeno renovable

La investigación presentada en esta tesis doctoral se ubica en la iniciativa `Power to Gas¿ (PtG o P2G) y contribuye al `estudio de nuevas fuentes de energía asequibles, seguras, sostenibles y modernas¿ (Objetivo de Desarrollo Sostenible ODS nº 7). Pretende facilitar el almacenamiento indirecto de energía (p. ej. electricidad excedentaria), en forma de gas combustible de origen renovable y su distribución a través de la red gasista ya existente. Para ello, se ha analizado el desempeño del proceso para producir metano (principal constituyente del gas natural sintético, SNG) a partir de CO2, particularmente el contenido en un biogás desulfurado. La reacción llevada a cabo ha sido la reacción de metanación de CO2 o reacción de Sabatier, utilizando distintas configuraciones de reactores catalíticos.El procedimiento para ejecutar este análisis, ha consistido en el estudio en laboratorio de varias especies catalíticas activas en reacciones de hidrogenación (níquel, rutenio o mezclas níquel ¿ hierro), sobre soportes adecuados (alúmina). Los catalizadores se han preparado en laboratorio, mediante el método de impregnación a humedad incipiente. Las materias primas, ricas en dióxido de carbono (CO2) e hidrógeno (H2) renovable, se han simulado mediante mezclas sintéticas. Así, para cada sistema reaccionante, constituido por una alimentación (bien mezclas H2 + CO2 puras en distintas proporciones, o bien H2 + biogás sintético ¿en una proporción CH4:CO2= 7:3 v.- como fuente de CO2) y un reactor, se ha determinado el rendimiento en función de las condiciones de operación (temperatura, presión parcial, proporción de reactivos y tiempo de residencia).Las dos primeras configuraciones de reactor propuestas han sido las de lecho fijo (FBR) y lecho fluidizado (FLBR). Éstas, constituyen los dos tipos más habituales de reactor y mediante su operación se ha determinado el catalizador con mejores características (actividad catalítica, estabilidad ¿desactivación-, fluidodinámica y precio) para llevar a cabo la reacción. La configuración FBR ofrece los mayores rendimientos a CH4. De igual forma sucede con la formación de puntos calientes o `hot-spots¿. La operación en FLBR resulta viable, con una alta estabilidad de los sólidos (tanto mecánica, como catalítica) y tasas de producción de CH4 que se encuentran por debajo de las logradas en FBR (diferente modelo de contacto reactivo ¿ catalizador). Respecto a la comparativa de catalizadores, señalar que, en términos de actividad específica, el rutenio supera claramente al níquel. Por su parte, el catalizador níquel ¿ hierro llega a duplicar el rendimiento a CH4 en el rango de media ¿ baja temperatura (250 ¿ 350 ºC) con la configuración FLBR.Paralelamente, y para el catalizador de níquel, se ha estudiado el desempeño de una configuración de reactor más avanzada, como es la del reactor politrópico (3 alimentaciones laterales) (PTR). Su uso, resulta en una mejora notable de los perfiles de temperatura en el lecho (disminución de sobrecalentamiento de hasta 25 ºC con respecto a la operación análoga en FBR). Respecto a qué reactivo distribuir, se propone que sea aquel que queda en exceso con respecto a la relación estequiométrica de la reacción de Sabatier (H2:CO2= 4:1).A partir de los resultados experimentales obtenidos en FBR y con el catalizador en base Ni, se ha procedido a su modelado cinético. El modelo más ajustado muestra un mecanismo de reacción en serie, con el monóxido de carbono (CO) como producto intermedio en la formación final de CH4. Finalmente, se da paso a la simulación (Aspen HYSYS), y posterior análisis técnico y económico (CAPEX y OPEX), de una planta de demostración real para la producción de gas natural sintético (SNG) a partir del biogás proveniente del vertedero de RSU de un núcleo de población de 150.000 habitantes.<br /

Influencia de la fuerza isométrica máxima sobre el tiempo en sprints de 20 metros

Introduction: The squat is an exercise that is widely used for the development of strength in sports. However, considering that not all sports gestures are vertical, it is important to investigate the effectiveness of propulsive force stimuli applied in different planes. Objective: The main purpose of this study was to determine the influence of maximum isometric force (MIF) exerted on starting blocks over performance in 5, 10 and 20-meter sprints. Methods: Seven high-level male sprinters (mean age ± SD = 28 ± 5.77 years) participated in this study. The variables were: a) MIF in squats and on starting blocks (measured using a functional electromechanical dynamometer [FEMD]), b) time in 5, 10 and 20-m sprints and c) jump height (measured by the squat jump test). For data analysis, a Pearson correlation was performed between the different variables. The criteria for interpreting the strength of the r coefficients were as follows: trivial (<0.1), small (0.1−0.3), moderate (0.3−0.5), high (0.5−0.7), very high (0.7−0.9), or practically perfect (>0.9). The level of significance was p < 0.05. Results: There was very high correlation between MIF exerted on starting blocks and performance in the first meters of the sprint (5-m: r = -0.84, p = 0.01). However, there was small correlation between MIF in squats and performance in the first meters of the sprint (5-m: r = -0.22, p < 0.62). Conclusion: The MIF applied on starting blocks correlates very high with time in the first meters of the sprint in high-level athletes. In addition, the use of the FEMD provides a wide range of possibilities for evaluation and development of strength with a controlled natural movement. Level of evidence IV; Prognostic Studies - Case series.Introdução: O agachamento é um exercício amplamente utilizado para o desenvolvimento de força nos esportes. No entanto, considerando que nem todos os gestos esportivos são verticais, é importante investigar a eficácia dos estímulos de força propulsiva em diferentes planos. Objetivo: O principal objetivo deste estudo foi determinar a influência da força isométrica máxima (FIM) exercida em os blocos de largada sobre o desempenho em sprints de 5, 10 e 20 metros. Métodos: Sete velocistas de alto nível do sexo masculino (média ± DP = 28,0 ± 5,77 anos) fizeram parte deste estudo. As variáveis foram: a) FIM no agachamento e nos blocos de largada (avaliados com um dinamômetro eletromecânico funcional (DEF)), b) tempo de sprints de 5, 10 e 20 metros e c) altura do salto (medida pelo teste de squat jump). Para análise dos dados, foi usada a correlação de Pearson entre as diferentes variáveis. Os critérios para interpretar o coeficiente r foi: nulo (< 0,1), pequeno (0,1 a 0,3), moderado (0,3 a 0,5), alto (0,5 a 0,7), muito alto (0,7 a 0,9) ou praticamente perfeito (> 0,9). O nível de significância foi p < 0,05. Resultados: Houve correlação muito alta entre a FIM exercida nos blocos de largada e o desempenho nos primeiros metros do sprint (5-m: r = -0,84, p = 0,01). No entanto, a correlação entre o agachamento da FIM e os primeiros metros de sprint foi pequena (5-m: r = -0,22, p < 0,62). Conclusão: A FIM aplicada aos blocos de largada teve uma correlação muito alto com o tempo nos primeiros metros de sprint em atletas de alto nível. Além disso, o uso de um DEF oferece uma ampla gama de possibilidades para avaliar e desenvolver força com um movimento natural controlado. Nível de evidência IV; Estudos Prognósticos – Série de casos.Introducción: La sentadilla es un ejercicio ampliamente usado para el desarrollo de fuerza en los deportes. Sin embargo, considerando que no todos los gestos deportivos son verticales, es importante investigar la eficacia de los estímulos de fuerza propulsiva en diferentes planos. Objetivo: El principal objetivo de este estudio fue determinar la influencia de la fuerza isométrica máxima (FIM) ejercida en los bloques de salida sobre el rendimiento en sprints de 5, 10 y 20 metros. Métodos: Siete velocistas de alto nivel del sexo masculino (promedio ± SD = 28,0 ± 5,7 años) formaron parte de este estudio. Las variables fueron: a) FIM en la sentadilla y en los bloques de salida (evaluados con un dinamómetro electromecánico funcional [DEF]) b) tiempo de sprints de 5, 10 y 20-metros y c) altura del salto (medida a través del test de squat jump). Para el análisis de los datos se usó la correlación de Pearson entre las diferentes variables. Los criterios para interpretar el coeficiente r fueron: nulo (<0,1), pequeño (0,1 a 0,3), moderado (0,3 a 0,5), alto (0,5 a 0,7), muy alto (0,7 a 0,9) o prácticamente perfecto (>0,9). El nivel de significancia fue p < 0,05. Resultados: Hubo correlación muy alta entre a FIM ejercida en los bloques de salida y el rendimiento en los primeros metros del sprint (5-m: r = -0,84, p = 0,01). Sin embargo, la correlación entre la FIM en sentadilla y los primeros metros de sprint fue pequeña (5-m: r = -0,22, p < 0,62). Conclusión: La FIM aplicada a los bloques de salida tuvo una correlación muy alta con el tiempo en los primeros metros de sprint en atletas de alto nivel. Además, el uso de un DEF ofrece una amplia gama de posibilidades para evaluar y desarrollar fuerza con un movimiento natural controlado. Nivel de evidencia IV; Estudios pronósticos: Serie de casos.Spanish Ministry of Economy and Competitiveness RTI2018-099723-B-I0

Paleogeografía y Paleosismicidad: El caso de estudio Bajo Segura, SE España

Trabajo presentado en la XIV Reunión Nacional de Cuaternario, celebrada en Granada (España), del 30 de junio al 2 de julio de 2015El presente trabajo aborda el análisis paleogeográfico de la Depresión del Bajo Segura donde se ubicaba la antigua bahía Ibero-Romana del Sinus ilicitanus. Se confrontan datos de reconstrucciones paleogeográficas, documentos históricos con el análisis geomorfológico del sistema de acequias, azudes y canales de la zona y su desarrollo en diferentes periodos. Se concluye que durante la época musulmana la zona afectada por el terremoto en las inmediaciones de Orihuela era un sistema deltáico palmeado 1048 AD se relacionan con fracturación del terreno y procesos de licuefacción, así como un relevante cambio del curso del rí Segura y abandono del sistema deltaico.This work has been funded by the Spanish research projects CGL2012 (QTECTBETICA -USAL), CGL2012-33430 (CSIC) and CGL2013-42847-R (UNED) and W. G. QTECT-AEQUAPeer reviewe

Mortality and other adverse outcomes in patients with type 2 diabetes mellitus admitted for COVID-19 in association with glucose-lowering drugs: a nationwide cohort study

Background: Limited evidence exists on the role of glucose-lowering drugs in patients with COVID-19. Our main objective was to examine the association between in-hospital death and each routine at-home glucose-lowering drug both individually and in combination with metformin in patients with type 2 diabetes mellitus admitted for COVID-19. We also evaluated their association with the composite outcome of the need for ICU admission, invasive and non-invasive mechanical ventilation, or in-hospital death as well as on the development of in-hospital complications and a long-time hospital stay. Methods: We selected all patients with type 2 diabetes mellitus in the Spanish Society of Internal Medicine's registry of COVID-19 patients (SEMI-COVID-19 Registry). It is an ongoing, observational, multicenter, nationwide cohort of patients admitted for COVID-19 in Spain from March 1, 2020. Each glucose-lowering drug user was matched with a user of other glucose-lowering drugs in a 1:1 manner by propensity scores. In order to assess the adequacy of propensity score matching, we used the standardized mean difference found in patient characteristics after matching. There was considered to be a significant imbalance in the group if a standardized mean difference > 10% was found. To evaluate the association between treatment and study outcomes, both conditional logit and mixed effect logistic regressions were used when the sample size was ≥ 100. Results: A total of 2666 patients were found in the SEMI-COVID-19 Registry, 1297 on glucose-lowering drugs in monotherapy and 465 in combination with metformin. After propensity matching, 249 patients on metformin, 105 on dipeptidyl peptidase-4 inhibitors, 129 on insulin, 127 on metformin/dipeptidyl peptidase-4 inhibitors, 34 on metformin/sodium-glucose cotransporter 2 inhibitor, and 67 on metformin/insulin were selected. No at-home glucose-lowering drugs showed a significant association with in-hospital death; the composite outcome of the need of intensive care unit admission, mechanical ventilation, or in-hospital death; in-hospital complications; or long-time hospital stays. Conclusions: In patients with type 2 diabetes mellitus admitted for COVID-19, at-home glucose-lowering drugs showed no significant association with mortality and adverse outcomes. Given the close relationship between diabetes and COVID-19 and the limited evidence on the role of glucose-lowering drugs, prospective studies are needed

Mejora de las habilidades comunicativas y el pensamiento crítico en estudiantes de Ciencias de la Salud mediante la combinación de flipped classroom (clase invertida) y debate formal

Se propone la clase invertida (flipped classroom) y el debate formal como metodologías innovadoras para mejorar las habilidades comunicativas y el pensamiento crítico en respuesta a la demanda de tener futuros profesionales biomédicos mejor formados en estos ámbitos

Mortality and other adverse outcomes in patients with type 2 diabetes mellitus admitted for COVID-19 in association with glucose-lowering drugs: a nationwide cohort study

Background: Limited evidence exists on the role of glucose-lowering drugs in patients with COVID-19. Our main objective was to examine the association between in-hospital death and each routine at-home glucose-lowering drug both individually and in combination with metformin in patients with type 2 diabetes mellitus admitted for COVID-19. We also evaluated their association with the composite outcome of the need for ICU admission, invasive and non-invasive mechanical ventilation, or in-hospital death as well as on the development of in-hospital complications and a long-time hospital stay. Methods: We selected all patients with type 2 diabetes mellitus in the Spanish Society of Internal Medicine’s registry of COVID-19 patients (SEMI-COVID-19 Registry). It is an ongoing, observational, multicenter, nationwide cohort of patients admitted for COVID-19 in Spain from March 1, 2020. Each glucose-lowering drug user was matched with a user of other glucose-lowering drugs in a 1:1 manner by propensity scores. In order to assess the adequacy of propensity score matching, we used the standardized mean difference found in patient characteristics after matching. There was considered to be a significant imbalance in the group if a standardized mean difference > 10% was found. To evaluate the association between treatment and study outcomes, both conditional logit and mixed effect logistic regressions were used when the sample size was ≥ 100. Results: A total of 2666 patients were found in the SEMI-COVID-19 Registry, 1297 on glucose-lowering drugs in monotherapy and 465 in combination with metformin. After propensity matching, 249 patients on metformin, 105 on dipeptidyl peptidase-4 inhibitors, 129 on insulin, 127 on metformin/dipeptidyl peptidase-4 inhibitors, 34 on metformin/sodium-glucose cotransporter 2 inhibitor, and 67 on metformin/insulin were selected. No at-home glucose-lowering drugs showed a significant association with in-hospital death; the composite outcome of the need of intensive care unit admission, mechanical ventilation, or in-hospital death; in-hospital complications; or long-time hospital stays. Conclusions: In patients with type 2 diabetes mellitus admitted for COVID-19, at-home glucose-lowering drugs showed no significant association with mortality and adverse outcomes. Given the close relationship between diabetes and COVID-19 and the limited evidence on the role of glucose-lowering drugs, prospective studies are needed

Seminario de Economía Mexicana

Serie de ponencias referentes al Seminario de Economía Mexicana. Memorias del Seminario de Economía Mexicana de 199

What pulmonologists think about the asthma-COPD overlap syndrome

Some patients with COPD may share characteristics of asthma; this is the so-called asthma-COPD overlap syndrome (ACOS). There are no universally accepted criteria for ACOS, and most treatments for asthma and COPD have not been adequately tested in this population. We performed a survey among pulmonology specialists in asthma and COPD aimed at collecting their opinions about ACOS and their attitudes in regard to some case scenarios of ACOS patients. The participants answered a structured questionnaire and attended a face-to-face meeting with the Metaplan methodology to discuss different aspects of ACOS. A total of 26 pulmonologists with a mean age of 49.7 years participated in the survey (13 specialists in asthma and 13 in COPD). Among these, 84.6% recognized the existence of ACOS and stated that a mean of 12.6% of their patients might have this syndrome. In addition, 80.8% agreed that the diagnostic criteria for ACOS are not yet well defined. The most frequently mentioned characteristics of ACOS were a history of asthma (88.5%), significant smoking exposure (73.1%), and postbronchodilator forced expiratory volume in 1 second/forced vital capacity <0.7 (69.2%). The most accepted diagnostic criteria were eosinophilia in sputum (80.8%), a very positive bronchodilator test (69.2%), and a history of asthma before 40 years of age (65.4%). Up to 96.2% agreed that first-line treatment for ACOS was the combination of a long-acting β-agonist and inhaled steroid, with a long-acting antimuscarinic agent (triple therapy) for severe ACOS. Most Spanish specialists in asthma and COPD agree that ACOS exists, but the diagnostic criteria are not yet well defined. A previous history of asthma, smoking, and not fully reversible airflow limitation are considered the main characteristics of ACOS, with the most accepted first-line treatment being long-acting β-agonist/inhaled corticosteroids

Effectiveness and safety of anti-CGRP monoclonal antibodies in patients over 65 years: a real-life multicentre analysis of 162 patients

Background Anti-CGRP monoclonal antibodies have shown notable effectiveness and tolerability in migraine patients; however, data on their use in elderly patients is still lacking, as clinical trials have implicit age restrictions and real-world evidence is scarce. In this study, we aimed to describe the safety and effectiveness of erenumab, galcanezumab and fremanezumab in migraine patients over 65 years old in real-life. Methods In this observational real-life study, a retrospective analysis of prospectively collected data from 18 different headache units in Spain was performed. Migraine patients who started treatment with any anti-CGRP monoclonal antibody after the age of 65 years were included. Primary endpoints were reduction in monthly migraine days after 6 months of treatment and the presence of adverse effects. Secondary endpoints were reductions in headache and medication intake frequencies by months 3 and 6, response rates, changes in patient-reported outcomes and reasons for discontinuation. As a subanalysis, reduction in monthly migraine days and proportion of adverse effects were also compared among the three monoclonal antibodies. Results A total of 162 patients were included, median age 68 years (range 65-87), 74.1% women. 42% had dyslipidaemia, 40.3% hypertension, 8% diabetes, and 6.2% previous cardiovascular ischaemic disease. The reduction in monthly migraine days at month 6 was 10.17.3 days. A total of 25.3% of patients presented adverse effects, all of them mild, with only two cases of blood pressure increase. Headache and medication intake frequencies were significantly reduced, and patient-reported outcomes were improved. The proportions of responders were 68%, 57%, 33% and 9% for reductions in monthly migraine days >= 30%,>= 50%,>= 75% and 100%, respectively. A total of 72.8% of patients continued with the treatment after 6 months. The reduction in migraine days was similar for the different anti-CGRP treatments, but fewer adverse effects were detected with fremanezumab (7.7%). Conclusions Anti-CGRP mAbs are safe and effective treatments in migraine patients over 65 years old in real-life clinical practice