TP30 210. Tratamiento de la fibrilación auricular mediante ablación con ultrasonidos concomitante a otra cirugía cardíaca. Resultados a largo plazo en nuestro centro

Introducción y objetivosActualmente la ablación quirúrgica de la fibrilación auricular (FA) es un procedimiento simple que puede realizarse en la mayoría de los pacientes durante la cirugía cardíaca. Presentamos nuestros resultados a largo plazo en ablación con ultrasonidos.Pacientes y métodosEn 23 pacientes con diferentes afecciones quirúrgicas cardíacas y FA (12 pacientes con FA permanente, 2 con FA persistente, 7 con FA paroxística, 1 paciente con fibrilo-flutter y un paciente con flutter auricular aislado), se asoció la ablación con ultrasonidos con el dispositivo UltraCinch™ Epicor, durante 2007–2008. El tamaño preoperatorio por ecocardiografía (ECO) de la aurícula izquierda (AI) fue de 45mm (rango 34–55). En un paciente no pudo realizarse por fallo de la consola.ResultadosNo hubo mortalidad intrahospitalaria. Un paciente precisó un marcapasos definitivo. Dos casos registrados de accidente cerebrovascular (ACV). Tras el procedimiento el 63,6% de los pacientes recuperó el ritmo sinusal, bajando al 54% de los pacientes en el momento del alta. A los 6 meses el 63% de los pacientes se encontraban en ritmo sinusal (RS) y a los 12 meses el 68%. Tras un seguimiento de 4 años obtenemos que sólo el 45% de los pacientes mantiene el RS, de los cuales el 20% tiene episodios de FA paroxística.ConclusiónLa ablación mediante ultrasonidos (US) de la FA es un procedimiento sencillo, reproducible y seguro, siendo su efectividad a corto y medio plazo similar a la de otros procedimientos de ablación. En nuestra corta serie, su eficacia a largo plazo disminuye significativamente

The new powder diffractometer D1B of the Institut Laue Langevin

D1B is a medium resolution high flux powder diffractometer located at the Institut Laue Langevin, ILL. D1B a suitable instrument for studying a large variety of polycrystalline materials. D1B runs since 1998 as a CRG (collaborating research group) instrument, being exploited by the CNRS (Centre National de la Recherche Scientifique, France) and CSIC (Consejo Superior de Investigaciones Cientificas, Spain). In 2008 the Spanish CRG started an updating program which included a new detector and a radial oscillating collimator (ROC). The detector, which has a sensitive height of 100mm, covers an angular range of 128°. Its 1280 gold wires provide a neutron detection point every 0.1°. The ROC is made of 198 gadolinium- based absorbing collimation blades, regular placed every 0.67°. Here the present characteristics of D1B are reviewed and the different experimental performances will be presented

Formación continuada en un equipo de atención primaria: análisis de las sesiones docentes 1996-1998

ObjetivoDescribir las sesiones docentes de un equipo de atención primaria en el trienio 1996-1998. Identificar los profesionales que las realizaron, así como estudiar las áreas del conocimiento abordadas.DiseñoEstudio descriptivo transversal, retrospectivo.EmplazamientoCentro de salud docente perteneciente a una zona de salud rural.ParticipantesTotal de sesiones docentes realizadas durante el trienio estudiado (n = 249).IntervencionesDe la hoja de registro mensual del programa de formación continuada de nuestra gerencia, se extrajeron las siguientes variables: fecha actividad, duración, número de asistentes, tipo de sesión, profesional docente y contenido de actividad (clasificada por patología según órganos y sistemas para sesión bibliográfica, clínica y con experto; cartera servicios de atención primaria-INSALUD 1996 para sesión sobre programa; informática).Mediciones y resultados principalesSesiones por mes: media 6,9 (DE, 4,8). Media asistentes: 9,3 (DE, 3,01). Duración media: 36,5 minutos (DE, 11,0). Tipo de sesión: bibliográfica, 65,2%; sobre programa, 18; sesión con experto, 7,2; informática, 5,6; clínica, 4. Responsables docentes: médico residente, 39,4%; médico de familia tutor, 34,9; médico de familia no tutor, 7,2; ATS, 6,4; médico hospitalario, 4; médico de familia sustituto, 3,6; farmacéutico, 2,8; pediatra, 1,2; fisioterapeuta, 0,4. Contenido actividades más frecuentes: patología general inespecífica, 16,1%; enfermedades de la piel, 8,8, y enfermedades del sistema endocrino, 7,6%.ConclusionesBaja frecuencia de sesiones clínicas. Los responsables docentes fueron mayoritariamente médicos de familia tutores y médicos residentes, siendo escasa la participación del resto de personal.ObjectivesTo describe the teaching sessions of a primary care team in the three-year period 1996-1998. To identify the professionals who ran them and study the areas of knowledge tackled. Design. A retrospective, cross-over, descriptive study.SettingTeaching health centre belonging to a rural health district.ParticipantsAll the teaching sessions that took place during the three-year period (n = 249). Interventions. The following variables were extracted from the monthly register sheet of the ongoing training programme of our management: date of activity, duration, number attending, type of session, teaching professional and contents of activity (classified by pathology according to organs and systems for bibliographic, clinical and expert sessions; portfolio of 1996 Primary Care- INSALUD services for session on programme; computer studies).Measurements and main resultsMean sessions per month: 6.9 (SD: 4.8). Mean attendance: 9.3 persons (SD: 3.01). Mean length: 36.5 minutes (SD: 11.0). Type of session: bibliographic 65.2%, on programme 18%, session with expert 7.2%, computer studies 5.6%, clinical 4%. Responsible for teaching: intern 39.4%; family doctor tutor 34.9%; family doctor not a tutor 7.2%; nurse 6.4%; hospital doctor 4%; locum family doctor 3.6%; pharmacist 2.8%; paediatrician 1.2%; physiotherapist 0.4%. Most common contents: non-specific general pathology (16.1%), skin diseases (8.8%), diseases of the endocrine system (7.6%).ConclusionsLow frequency of clinical sessions. The teachers in charge were mainly family doctor tutors and interns, with the rest of the staff participating little

Systematic approach to cyber resilience operationalization in SMEs

The constantly evolving cyber threat landscape is a latent problem for today’s companies. This is especially true for the Small and Medium-sized Enterprises (SMEs) because they have limited resources to face the threats but, as a group, represent an extensive payload for cybercriminals to exploit. Moreover, the traditional cybersecurity approach of protecting against known threats cannot withstand the rapidly evolving technologies and threats used by cybercriminals. This study claims that cyber resilience, a more holistic approach to cybersecurity, could help SMEs anticipate, detect, withstand, recover from and evolve after cyber incidents. However, to operationalize cyber resilience is not an easy task, and thus, the study presents a framework with a corresponding implementation order for SMEs that could help them implement cyber resilience practices. The framework is the result of using a variation of Design Science Research in which Grounded Theory was used to induce the most important actions required to implement cyber resilience and an iterative evaluation from experts to validate the actions and put them in a logical order. Therefore, this study proposes that the framework could benefit SME managers to understand cyber resilience, as well as help them start implementing it with concrete actions and an order dictated by the experience of experts. This could potentially ease cyber resilience implementation for SMEs by making them aware of what cyber resilience implies, which dimensions it includes and what actions can be implemented to increase their cyber resilience

Donor-derived Strongyloides stercoralis hyperinfection syndrome after simultaneous kidney/pancreas transplantation

Most cases of strongyloidiasis associated with solid organ transplantation have been due to the reactivation of a latent infection in the recipient as a result of the immunosuppressive therapy; however, donor-derived infections are becoming increasingly frequent. The case of a patient who nearly died of a Strongyloides stercoralis hyperinfection after receiving simultaneous kidney/pancreas transplants is described herein. No specific parasitological tests were performed pre-transplantation, despite the fact that both the recipient and the donor originated from endemic areas. Serological analysis of the donor's serum performed retrospectively revealed the origin of the infection, which if it had been done beforehand would have prevented the serious complications. Current practice guidelines need to be updated to incorporate immunological and molecular techniques for the rapid screening of Strongyloides prior to transplantation, and empirical treatment with ivermectin should be applied systematically when there is the slightest risk of infection in the donor or recipient

Counting BPS states on the Enriques Calabi-Yau

We study topological string amplitudes for the FHSV model using various techniques. This model has a type II realization involving a Calabi-Yau threefold with Enriques fibres, which we call the Enriques Calabi-Yau. By applying heterotic/type IIA duality, we compute the topological amplitudes in the fibre to all genera. It turns out that there are two different ways to do the computation that lead to topological couplings with different BPS content. One of them leads to the standard D0-D2 counting amplitudes, and from the other one we obtain information about bound states of D0-D4-D2 branes on the Enriques fibre. We also study the model using mirror symmetry and the holomorphic anomaly equations. We verify in this way the heterotic results for the D0-D2 generating functional for low genera and find closed expressions for the topological amplitudes on the total space in terms of modular forms, and up to genus four. This model turns out to be much simpler than the generic B-model and might be exactly solvable.Comment: 62 pages, v3: some results at genus 3 corrected, more typos correcte

The relationship of the atlantic diet with cardiovascular risk factors and markers of arterial stiffness in adults without cardiovascular disease

Background: Studying the adherence of the population to the Atlantic Diet (AD) could be simplified by an easy and quickly applied dietary index. The aim of this study is to analyse the relationship of an index measuring compliance with recommendations regarding the Atlantic diet and physical activity with cardiovascular disease risk factors, cardiovascular risk factors, obesity indexes and arterial stiffness markers. Methods: We included 791 individuals from the EVIDENT study (lifestyles and arterial ageing), (52.3 ± 12 years, 61.7% women) without cardiovascular disease. Compliance with recommendations on AD was collected through the responses to a food frequency questionnaire, while physical activity was measured by accelerometer. The number of recommendations being met was estimated using a global scale between 0 and 14 points (a higher score representing greater adherence). Blood pressure, plasma lipid and glucose values and obesity rates were measured. Cardiovascular risk was estimated with the Framingham equation. Results: In the overall sample, 184 individuals (23.3%) scored between 0–3 on the 14-point index we created, 308 (38.9%) between 4 and 5 points, and 299 (37.8%) 6 or more points. The results of multivariate analysis yield a common tendency in which the group with an adherence score of at least 6 points shows lower figures for total cholesterol (p = 0.007) and triglycerides (p = 0.002). Similarly, overall cardiovascular risk in this group is the lowest (p < 0.001), as is pulse wave velocity (p = 0.050) and the mean values of the obesity indexes studied (p < 0.05 in all cases). Conclusion: The rate of compliance with the Atlantic diet and physical activity shows that greater adherence to these recommendations is linked to lower cardiovascular risk, lower total cholesterol and triglycerides, lower rates of obesity and lower pulse wave velocity values

Strontium hexaferrite platelets: a comprehensive soft X-ray absorption and Mössbauer spectroscopy study

IBERMÖSS-2019, Bilbao, 30-31 may 2019. --https://www.ehu.eus/es/web/ibermossmeetingStrontium ferrite (SFO, SrFe12O19) is a ferrite employed for permanent magnets due to its high magnetocrystalline anisotropy. Since its discovery in the mid-20th century, this hexagonal ferrite has become an increasingly important material both commercially and technologically, finding a variety of uses and applications. Its structure can be considered a sequence of alternating spinel (S) and rocksalt (R) blocks. All the iron cations are in the Fe3+ oxidation state and it has a ferrimagnetic configuration with five different cationic environments for the iron (three octahedral sites, a tetraedrical site and a bipiramidal site)[1,2]. We have studied the properties of SrFe 12O19 in the shape of platelets, up to several micrometers in width, and tens of nanometers thick, synthesized by a hydrothermal method. We have characterized the structural and magnetic properties of these platelets by Mössbauer spectroscopy, x-ray transmission microscopy (TMX), transmission electron microscopy (TEM), x-ray diffraction (XRD), vibrating-sample magnetometry (VSM), x-ray absorption spectroscopy (XAS), x-ray circular magnetic dichroism (XMCD) and photoemission electron microscopy (PEEM). To the best of our knowledge this is the first time that the x-ray absorption spectra at the Fe L 2,3 edges of this material in its pure form have been reported. The Mössbauer results recorded from these platelets both in the electron detection and transmission modes have helped to understand the iron magnetic moments determined by XMCD (Fig.1). The experimental results have been complemented with multiplet calculations aimed at reproducing the observed XAS and XMCD spectra at the Fe L 2,3 absorption edge, and by density functional theory (DFT) calculations to reproduce the oxygen K- absorption edge. Finally the domain pattern measured in remanence is in good agreement with micromagnetic simulations [3]

Documento de consenso sobre el tratamiento antimicrobiano de las infecciones bacterianas odontogénicas

Las infecciones de la cavidad bucal son un problema de salud pública frecuente y motivo constante de prescripción antibiótica; el 10% de los antibióticos se emplean para tratar este problema. Sin embargo, hasta la fecha son pocos los estudios realizados para determinar su incidencia. Asímismo, su relación con ciertas enfermedades sistémicas (cardiacas, endocrinas, etc...) confiere a estas patologías una importancia vital. A pesar de la reconocida frecuencia e importancia de las infecciones odontogénicas, llama la atención la actual dispersión de criterio en varios aspectos referentes a su clasificación, terminología y recomendaciones terapéuticas. El objetivo principal de este documento, realizado con el consenso de especialistas en microbiología y odontología, es establecer unas recomendaciones útiles para todos los profesionales implicados en el manejo clínico de estas patologías. Recibe especial atención el aumento de la prevalencia de resistencias bacterianas observado durante los últimos años y, en concreto, la proliferación de cepas productoras de betalactamasas. Otro factor causal importante de la aparición de resistencias es la falta de cumplimiento terapéutico, en especial en lo que respecta a la dosis y a la duración del tratamiento. Así pues, estas patologías constituyen un problema complejo cuyo abordaje requiere la instauración de antimicrobianos de amplio espectro, con adecuados parámetros farmacocinéticos, con buena tolerancia y una posología cómoda que permita que el paciente reciba la dosis adecuada durante el tiempo necesario. Amoxicilina/ácido clavulánico a dosis altas (2000mg/ 125mg) ha demostrado buenos resultados y capacidad para superar resistencias. Otros agentes como metronidazol y clindamicina, seguidos de claritromicina y azitromicina han demostrado también ser activos frente a la mayoría de los microorganismos responsables de las infecciones odontogé[email protected]