Perioperative intensive care medicine.

Surgery represents one of the main therapeutic references in the world, affording greater survival and life expectancy for many patients. In general, the estimated postoperative mortality is low (around 1–4%). Thirteen percent of the surgical procedures have a high risk of complications, accounting for 80% of all postoperative deaths. Recently, there have been significant advances related to organizational aspects, new anesthetic and surgical techniques, prognostic scales, perioperative management and greater participation and involvement of the patient. This new series of Medicina Intensiva will address fundamental aspects of how Departments of Intensive Care Medicine can add value to the surgical process, in a coordinated manner with other services. Institutional policies are required to ensure the detection of patients at risk in hospitalization wards, with early admission to the ICU of those patients in whom admission is indicated, adapting the treatment in the ICU and optimizing the criteria for discharge. The detection and prevention of post-ICU syndrome in patients and relatives, and the follow-up of ICU discharge and hospitalization in a multidisciplinary manner can reduce the sequelae among critical surgical patients, improving the outcomes and quality of life, and restoring the patient to society. In future publications of this series directed to the surgical patient, updates will be provided on the perioperative management of some of the most complex surgeries.post-print823 K

Robust mean absolute deviation problems on networks with linear vertex weights

This article deals with incorporating the mean absolute deviation objective function in several robust single facility location models on networks with dynamic evolution of node weights, which are modeled by means of linear functions of a parameter. Specifically, we have considered two robustness criteria applied to the mean absolute deviation problem: the MinMax criterion, and the MinMax regret criterion. For solving the corresponding optimization problems, exact algorithms have been proposed and their complexities have been also analyzed.Ministerio de Ciencia e Innovación MTM2007-67433-C02-(01,02)Ministerio de Ciencia e Innovación MTM2009-14243Ministerio de Ciencia e Innovación MTM2010-19576-C02-(01,02)Ministerio de Ciencia e Innovación DE2009-0057Junta de Andalucía P09-TEP-5022Junta de Andalucía FQM-584

Locating Two Transfer Points on a Network with a Trip Covering Criterion and Mixed Distances

In this paper we consider a set of origin-destination pairs in a mixed model in which a network embedded in the plane represents an alternative high-speed transportation system, and study a trip covering problem which consists on locating two points in the network which maximize the number of covered pairs, that is, the number of pairs which use the network by acceding and exiting through such points. To deal with the absence of convexity of this mixed distance function we propose a decomposition method based on formulating a collection of subproblems and solving each of them via discretization of the solution set.Ministerio de Educación, Ciencia e Innovación MTM2009-14243Ministerio de Economía y Competitividad MTM2012-37048Junta de Andalucía P09-TEP-5022Junta de Andalucía P10-FQM-584

A general approach for the location of transfer points on a network with a trip covering criterion and mixed distances

In this paper we consider a trip covering location model in a mixed planar-network space. An embed- ded network in the plane represents an alternative transportation system in which traveling is fasterthan traveling within the plane. We assume that the demand to be covered is given by a set of origin- destination pairs in the plane, with some traffic between them. An origin-destination pair is covered bytwo facility points on the network (or transfer points), if the travel time from the origin to destinationby using the network through such points is not higher than a given acceptance level related to the traveltime without using the network. The facility location problems studied in this work consist of locatingone or two transfer points on the network such that, under several objective functions, the traffic throughthe network is maximized. Due to the continuous nature of these problems, a general approach is pro- posed for discretizing them. Since the non-convexity of the distance function on cyclic networks alsoimplies the absence of convexity of the mixed distance function, such an approach is based on a decom- position process which leads to a collection of subproblems whose solution set can be found by adaptingthe general strategy to each problem considered.Ministerio de Economía y Competitividad MTM2012-37048Ministerio de Economía y Competitividad MTM2015-67706-PJunta de Andalucía P10-FQM-584

Major candidate variables to guide personalised treatment with steroids in critically ill patients with COVID-19: CIBERESUCICOVID study.

Purpose Although there is evidence supporting the benefits of corticosteroids in patients affected with severe coronavirus disease 2019 (COVID-19), there is little information related to their potential benefits or harm in some subgroups of patients admitted to the intensive care unit (ICU) with COVID-19. We aim to investigate to find candidate variables to guide personalized treatment with steroids in critically ill patients with COVID-19. Methods Multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish ICUs. The primary outcome was 90-day mortality. Subsequent analyses in clinically relevant subgroups by age, ICU baseline illness severity, organ damage, laboratory findings and mechanical ventilation were performed. High doses of corticosteroids (≥ 12 mg/day equivalent dexamethasone dose), early administration of corticosteroid treatment (< 7 days since symptom onset) and long term of corticosteroids (≥ 10 days) were also investigated. Results Between February 2020 and October 2021, 4226 patients were included. Of these, 3592 (85%) patients had received systemic corticosteroids during hospitalisation. In the propensity-adjusted multivariable analysis, the use of corticosteroids was protective for 90-day mortality in the overall population (HR 0.77 [0.65–0.92], p = 0.003) and in-hospital mortality (SHR 0.70 [0.58–0.84], p < 0.001). Significant effect modification was found after adjustment for covariates using propensity score for age (p = 0.001 interaction term), Sequential Organ Failure Assessment (SOFA) score (p = 0.014 interaction term), and mechanical ventilation (p = 0.001 interaction term). We observed a beneficial effect of corticosteroids on 90-day mortality in various patient subgroups, including those patients aged ≥ 60 years; those with higher baseline severity; and those receiving invasive mechanical ventilation at ICU admission. Early administration was associated with a higher risk of 90-day mortality in the overall population (HR 1.32 [1.14–1.53], p < 0.001). Long-term use was associated with a lower risk of 90-day mortality in the overall population (HR 0.71 [0.61–0.82], p < 0.001). No effect was found regarding the dosage of corticosteroids. Moreover, the use of corticosteroids was associated with an increased risk of nosocomial bacterial pneumonia and hyperglycaemia. Conclusion Corticosteroid in ICU-admitted patients with COVID-19 may be administered based on age, severity, baseline inflammation, and invasive mechanical ventilation. Early administration since symptom onset may prove harmful.post-print910 K

Methodology of a Large Multicenter Observational Study of Patients with COVID-19 in Spanish Intensive Care Units.

Introduction The COVID-19 pandemic created tremendous challenges for health-care systems. Intensive care units (ICU) were hit with a large volume of patients requiring ICU admission, mechanical ventilation, and other organ support with very high mortality. The Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CIBERES), a network of Spanish researchers to investigate in respiratory disease, commissioned the current proposal in response to the Instituto de Salud Carlos III (ISCIII) call. Methods CIBERESUCICOVID is a multicenter, observational, prospective/retrospective cohort study of patients with COVID-19 admitted to Spanish ICUs. Several work packages were created, including study population and ICU data collection, follow-up, biomarkers and miRNAs, data management and quality. Results This study included 6102 consecutive patients admitted to 55 ICUs homogeneously distributed throughout Spain and the collection of blood samples from more than 1000 patients. We enrolled a large population of COVID-19 ICU-admitted patients including baseline characteristics, ICU and MV data, treatments complications, and outcomes. The in-hospital mortality was 31%, and 76% of patients required invasive mechanical ventilation. A 3-6 month and 1 year follow-up was performed. Few deaths after 1 year discharge were registered. Low anti-SARS-CoV-2 S antibody levels predict mortality in critical COVID-19. These antibodies contribute to prevent systemic dissemination of SARS-CoV-2. The severity of COVID-19 impacts the circulating miRNA profile. Plasma miRNA profiling emerges as a useful tool for risk-based patient stratification in critically ill COVID-19 patients. Conclusions We present the methodology used in a large multicenter study sponsored by ISCIII to determine the short- and long-term outcomes in patients with COVID-19 admitted to more than 50 Spanish ICUs.post-print1142 K

Wooden material culture and long-term historical processes in Heping Dao (Keelung, Taiwan)

Despite being a perishable material, wood can nonetheless show in its full complexity the materiality of daily life activities, identity construction, economic exploitation, and adaptation in colonial processes. The study of two sets of wood samples in well-defined archaeological colonial contexts from the site of Heping Dao, on the northern coast of Taiwan, has unveiled otherwise unknown aspects of native exchange, adoption of indigenous practices, and differences and similarities between early European colonialism and Japanese imperialism in Asia- Pacific. Despite the constraints of taxonomic identification in subtropical (and tropical) areas, the use of different coniferous wood types has been recorded: Cupressaceae, cf. Chamaecyparis spp., cf. Cryptomeria japonica and cf. Cunninghamia spp. The paper highlights the close relationship between wooden objects and diachronic historical processes and stresses the complexity of their study in colonial contexts, with implications toward the prehistoric period.Initial funding for this research under direction of MCB and ChT came from the Formosa Program 2010 between the National Science Council of Taiwan and the Spanish National Research Council (CSIC). MCB obtained further funding from the Spanish Ministry of Culture in its program Excavaciones Arqueol´ogicas en el Exterior in 2011, 2012, 2019; the Spanish Ministry of Economy and Competitiveness Acciones Complementarias program (HAR2011-16017-E); ; the University of Konstanz through its Anschubsfinanzierung-EU call, and the EU FP7 Marie Curie Zukunftskolleg Incoming Fellowship Programme, University of Konstanz (grant no. 291784); the Fundaci´on Palarq 2019; the Chiang Ching Kuo Foundation 2013–2016. She is currently funded by the program STAR2-Santander Universidades and Ministry of Education, Culture and Sports, in the frame of the Program Campus de Excelencia Internacional, call CEI 2015 of the project Cantabria Campus Internacional. ChT was funded by the Institute of History and Philology of the Academia Sinica. MMS was funded by a Post-Doc Grant Plan I2C mod. B with the project “MATERIAL-Materiality and Material Culture: Wood and Other Plant-based Materials in Archaeological Contexts” (2017–2019) and by the JIN project “Born to be wild. Crafting wild plants resources during Iron Age in the North of Iberia (B-WILD)” (PID2019-105302RJ-I00). She is currently funded by a Beatriz Galindo program as Junior Distinguished Researcher (BG20/00076) leading the project “WILD-Crafting wild plants resources during Bronze and Iron Age in the North of Iberia”. We thank Prof. Dr Chen Huei Fen (National Taiwan Ocean University, Keelung, Taiwan) for her support in the dating of sample LAB-002. Dr Hung Kuang-chi (NTU, Taipei) provided his research on Japanese wood exploitation and references on cypress. Dr Fang Chenchen provided further information and analysis on xiaolang and Yu Yonghe. The authors are grateful to Clíodhna Ní Lion´ain for reviewing the English version of the text and to C´eline Kerfant for providing information about plant uses in Taiwan

Seguridad del Paciente en Medicina Intensiva. Aspectos bioéticos

La Seguridad del Paciente se ha convertido en un reto y en una prioridad de todos los sistemas sanitarios. Se ha implantado políticas internacionales con el objetivo de reducir el número de incidentes relacionados con Seguridad del Paciente. Todavía son muchos los pacientes que sufren daños derivados de la atención sanitaria. Además, su impacto se extiende no solo a los familiares y allegados, sino también a los propios profesionales, a las instituciones sanitarias y todo ello con un coste económico y emocional con importantes consecuencias para todos los implicados. La mayoría de estudios realizados han ido dirigidos a conocer la epidemiología de los eventos adversos, a conocer sus causas y sus consecuencias. Se han promovido numerosas prácticas seguras con el objetivo de reducir los riesgos relacionados con la atención sanitaria. Recientemente han cobrado mayor relevancia aspectos relacionados con la actuación posterior a un evento adverso (EA). La gestión del riesgo implica entre otras acciones, la identificación, notificación y el análisis de los EA que señalen los fallos latentes en el sistema y la causa raíz con el objetivo último de establecer acciones de mejora y evitar su recurrencia. De forma paulatina estas estrategias se han ido incorporando en las políticas institucionales y mejorando con ello la cultura de seguridad. Pero todavía existen partes del proceso, que en nuestro ámbito se encuentran en su etapa más inicial, tales como el proceso de información sobre los EA a los pacientes y sus familiares y el soporte a los profesionales tras verse implicados en un EA. Todo ello debe construirse en un marco de confianza y credibilidad

Imaging Cognitive Impairment and Impulse Control Disorders in Parkinson's Disease

Dementia and mild forms of cognitive impairment as well as neuropsychiatric symptoms (i. e., impulse control disorders) are frequent and disabling non-motor symptoms of Parkinson's disease (PD). The identification of changes in neuroimaging studies for the early diagnosis and monitoring of the cognitive and neuropsychiatric symptoms associated with Parkinson's disease, as well as their pathophysiological understanding, are critical for the development of an optimal therapeutic approach. In the current literature review, we present an update on the latest structural and functional neuroimaging findings, including high magnetic field resonance and radionuclide imaging, assessing cognitive dysfunction and impulse control disorders in PD