New alternatives to conventional Internal Medicine

El aumento de la prevalencia de las enfermedades crónicas asociado al envejecimiento de la población es uno de los desafíos más importantes a los que se enfrentan los sistemas de salud en el mundo. Se está produciendo un cambio en los motivos de ingresos hospitalarios, con un alto porcentaje de ellos por motivos diagnósticos mas que terapéuticos, en parte por la presión asistencial a la que se está sometiendo a los dispositivos asistenciales ambulatorios, con generación de importantes listas de espera para estudio

Boundaries of Siegel Disks: Numerical Studies of their Dynamics and Regularity

Siegel disks are domains around fixed points of holomorphic maps in which the maps are locally linearizable (i.e., become a rotation under an appropriate change of coordinates which is analytic in a neighborhood of the origin). The dynamical behavior of the iterates of the map on the boundary of the Siegel disk exhibits strong scaling properties which have been intensively studied in the physical and mathematical literature. In the cases we study, the boundary of the Siegel disk is a Jordan curve containing a critical point of the map (we consider critical maps of different orders), and there exists a natural parametrization which transforms the dynamics on the boundary into a rotation. We compute numerically this parameterization and use methods of harmonic analysis to compute the global Holder regularity of the parametrization for different maps and rotation numbers. We obtain that the regularity of the boundaries and the scaling exponents are universal numbers in the sense of renormalization theory (i.e., they do not depend on the map when the map ranges in an open set), and only depend on the order of the critical point of the map in the boundary of the Siegel disk and the tail of the continued function expansion of the rotation number. We also discuss some possible relations between the regularity of the parametrization of the boundaries and the corresponding scaling exponents. (C) 2008 American Institute of Physics.NSFMathematic

Phase behavior and oil recovery investigations using mixed and alkaline-enhanced surfactant systems

The results of an evaluation of different mixed surfactant and alkaline-enhanced surfactant systems for enhanced oil recovery are described. Several mixed surfactant systems have been studies to evaluate their oil recovery potential as well as improved adaptability to different ranges of salinity, divalent ion concentrations, and temperature. Several combinations of screening methods were used to help identify potential chemical formulations and determine conditions where particular chemical systems can be applied. The effects of different parameters on the behavior of the overall surfactant system were also studied. Several commercially available surfactants were tested as primary components in the mixtures used in the study. These surfactants were formulated with different secondary as well as tertiary components, including ethoxylated and non-ethoxylated sulfonates and sulfates. Improved salinity and hardness tolerance was achieved for some of these chemical systems. The salinity tolerance of these systems were found to be dependent on the molecular weight, surfactant type, and concentration of the surfactant components

Linearization of Cohomology-free Vector Fields

We study the cohomological equation for a smooth vector field on a compact manifold. We show that if the vector field is cohomology free, then it can be embedded continuously in a linear flow on an Abelian group

The Cadiz Contourite Channel: Sandy contourites, bedforms and dynamic current interaction

The Cadiz Contourite Channel is the largest and most prominent contourite channel in the middle slope of the Gulf of Cadiz, and is known to channelise the southern branch of the Lower Core of Mediterranean Outflow Water (MOW) as it flows westwards from the Gibraltar Gateway. The channel lies in water depth between 650 and 1500 m, is 150 km long, 2–12 km wide, up to 120 m deep, and broadly s-shaped in plan view. It has several associated subparallel marginal channels and shorter spillover channel segments. Its geometry is controlled by the interaction of a strong bottom current with the seafloor morphology, affected by neotectonic deformation and diapiric intrusion. Bottom photographs and dredge hauls reveal a channel floor shaped by high-energy flow, in places with bare rock, boulders and gravel, and elsewhere covered with sandy contourites. The rocky substrate and derived clasts are formed of authigenic iron-rich carbonates, testifying the high degree of fluid escape from adjacent diapiric ridges and mud volcanoes. The sandy substrate shows a wide range of current-induced bedforms including small, straight-crested ripples, large sinuous sand waves and dunes (wavelength 3.5–5 m, height 0.3–0.9 m), weak surface lineation on sands, and aligned gravel stringers and deep erosive scours around large boulders. Bedform orientation indicates flows directed to the south/south-west (main channel) and west (spillover channel), which can be related to MOW bottom currents, and current velocities that vary between about 0.2 and 0.8 m s− 1, even in the same channel location. However, current vane orientation was clearly responding, at least in part, to tidal effects and periodicity in the Gulf of Cadiz at the time the photographs were taken. Maximum current velocities are achieved by a combination of barotropic and internal tides (probably generated at the continental slope) that reinforce the normal MOW flow. In addition, meteorologically-induced internal waves with periods shorter than tidal ones may exert an even greater influence on current intensity, especially when they occur at times of sudden changes of meteorological forcing. This effect further influences MOW variability. In all cases, the funnelling effect of the Cadiz Channel amplifies tidal or meteorologically-induced bottom currents

Families of Canonical Transformations by Hamilton-Jacobi-Poincar\'e equation. Application to Rotational and Orbital Motion

The Hamilton-Jacobi equation in the sense of Poincar\'e, i.e. formulated in the extended phase space and including regularization, is revisited building canonical transformations with the purpose of Hamiltonian reduction. We illustrate our approach dealing with orbital and attitude dynamics. Based on the use of Whittaker and Andoyer symplectic charts, for which all but one coordinates are cyclic in the Hamilton-Jacobi equation, we provide whole families of canonical transformations, among which one recognizes the familiar ones used in orbital and attitude dynamics. In addition, new canonical transformations are demonstrated.Comment: 21 page

Prognostic Factors for Postoperative Chronic Pain after Knee or Hip Replacement in Patients with Knee or Hip Osteoarthritis: An Umbrella Review

Knee and hip osteoarthritis are highly prevalent in the older population. Management of osteoarthritis-related pain includes conservative or surgical treatment. Although knee or hip joint replacement is associated with positive outcomes, up to 30% of patients report postoperative pain in the first two years. This study aimed to synthesize current evidence on prognostic factors for predicting postoperative pain after knee or hip replacement. An umbrella review of systematic reviews was conducted to summarize the magnitude and quality of the evidence for prognostic preoperative factors predictive of postoperative chronic pain (&gt;6 months after surgery) in patients who had received knee or hip replacement. Searches were conducted in MEDLINE, CINAHL, PubMed, PEDro, SCOPUS, Cochrane Library, and Web of Science databases from inception up to 5 August 2022 for reviews published in the English language. A narrative synthesis, a risk of bias assessment, and an evaluation of the evidence confidence were performed. Eighteen reviews (nine on knee surgery, four on hip replacement, and seven on both hip/knee replacement) were included. From 44 potential preoperative prognostic factors, just 20 were judged as having high or moderate confidence for robust findings. Race, opioid use, preoperative function, neuropathic pain symptoms, pain catastrophizing, anxiety, other pain sites, fear of movement, social support, preoperative pain, mental health, coping strategies, central sensitization-associated symptoms, and depression had high/moderate confidence for an association with postoperative chronic pain. Some comorbidities such as heart disease, stroke, lung disease, nervous system disorders, and poor circulation had high/moderate confidence for no association with postoperative chronic pain. This review has identified multiple preoperative factors (i.e., sociodemographic, clinical, psychological, cognitive) associated with postoperative chronic pain after knee or hip replacement. These factors may be used for identifying individuals at a risk of developing postoperative chronic pain. Further research can investigate the impact of using such prognostic data on treatment decisions and patient outcomes.</p

Interplay of tectonics and magmatism during post-rift inversion on the central West Iberian Margin (Estremadura Spur)

ABSTRACT: The combined effects of post-rift magma emplacement and tectonic inversion on the hyper-extended West Iberian Margin are unravelled in detail using multichan nel 2D/3D seismic data. The Estremadura Spur, acting as an uplifted crustal block bounded by two first-order transfer zones, shows evidence of four post-rift tectonic events each with a distinctive seismic-stratigraphic response that can be used to dem onstrate the tectono-magmatic interplay, namely: (a) the Campanian onset of mag matism (including the Fontanelas Volcano, the widespread evidence of multiple sill complexes and the detailed description of a >20 km long laccolith, the Estremadura Spur Intrusion; (b) the Campanian-Maastrichtian NE-SW event pervasively affecting the area, resulting in regional uplift, reverse faulting and folding; (c) the Paleocene mid Eocene inversion that resulted in widespread erosion and; (d) the Oligocene-mid Miocene evidence of rejuvenated NW-SE inversion marked by crestal faulting and forced-fault folding establishing the final geometry of the area. The distinct deforma tion styles within each tectonic phase document a case of decoupled deformation be tween Late Cretaceous and Tertiary units, in response to the predominant stress field evolution, revealing that the magnitude of Late Cretaceous inversion is far more sig nificant than the one affecting the latter units. A detailed analysis of the laccolith and its overburden demonstrate the distinct deformation patterns associated both with magma ascent (including extensional faulting, forced-folding and concentric reverse faulting) and its interference as a rigid intrusive body during subsequent transpres sive inversion. This reinforces the role that the combined tectono-magmatic events played on the margin. Also analysed is the wider impact of post-rift magmatism and the associate emplacement of sub-lithospheric magma on the rheology of a thinned continental crust. This takes into account the simultaneous tectonic inversion of the margin, the implied alternative views on characteristic heat flow, and on how these can be incorporated in source rock organic maturity modelling.info:eu-repo/semantics/publishedVersio

Toll-like receptor signaling adapter proteins govern spread of neuropathic pain and recovery following nerve injury in male mice.

BackgroundSpinal Toll-like receptors (TLRs) and signaling intermediaries have been implicated in persistent pain states. We examined the roles of two major TLR signaling pathways and selected TLRs in a mononeuropathic allodynia.MethodsL5 spinal nerve ligation (SNL) was performed in wild type (WT, C57BL/6) male and female mice and in male Tlr2-/-Tlr3-/-, Tlr4-/-, Tlr5-/-, Myd88-/-, Triflps2, Myd88/Triflps2, Tnf-/-, and Ifnar1-/- mice. We also examined L5 ligation in Tlr4-/- female mice. We examined tactile allodynia using von Frey hairs. Iba-1 (microglia) and GFAP (astrocytes) were assessed in spinal cords by immunostaining. Tactile thresholds were analyzed by 1- and 2-way ANOVA and the Bonferroni post hoc test was used.ResultsIn WT male and female mice, SNL lesions resulted in a persistent and robust ipsilateral, tactile allodynia. In males with TLR2, 3, 4, or 5 deficiencies, tactile allodynia was significantly, but incompletely, reversed (approximately 50%) as compared to WT. This effect was not seen in female Tlr4-/- mice. Increases in ipsilateral lumbar Iba-1 and GFAP were seen in mutant and WT mice. Mice deficient in MyD88, or MyD88 and TRIF, showed an approximately 50% reduction in withdrawal thresholds and reduced ipsilateral Iba-1. In contrast, TRIF and interferon receptor null mice developed a profound ipsilateral and contralateral tactile allodynia. In lumbar sections of the spinal cords, we observed a greater increase in Iba-1 immunoreactivity in the TRIF-signaling deficient mice as compared to WT, but no significant increase in GFAP. Removing MyD88 abrogated the contralateral allodynia in the TRIF signaling-deficient mice. Conversely, IFNβ, released downstream to TRIF signaling, administered intrathecally, temporarily reversed the tactile allodynia.ConclusionsThese observations suggest a critical role for the MyD88 pathway in initiating neuropathic pain, but a distinct role for the TRIF pathway and interferon in regulating neuropathic pain phenotypes in male mice