Evalución de la extensión ganglionar mediastínica en el cáncer de pulmón

En este trabajo, realizado sobre una muestra de 400 pacientes afectos de cáncer de pulmón y tratados quirúrgicamente en el Servicio de Cirugía Torácica del HCUV en el periodo 2012-2015, se ha elaborado un estudio de 17 pacientes diagnosticados inicialmente de cáncer de pulmón de células no pequeñas en estadio IIIA, en los que tras tratamiento con quimioterapia de inducción o neoadyuvancia fue realizada una evaluación del grado de regresión tumoral a fin de determinar su consecución y la posibilidad de rescate para tratamiento quirúrgico. Previo a la exposición del trabajo, se da respuesta a distintas cuestiones básicas acerca del cáncer de pulmón. Se expone de forma breve y a modo de introducción, el diagnóstico y las técnicas de estadificación del cáncer del pulmón con un algoritmo resumen, los distintos estadios y la indicación terapéutica de acuerdo con los mismos. Se analizan los criterios de resecabilidad y operabilidad y finalmente se valoran los resultados del estudio realizado en el servicio de Cirugía Torácica del HCUV.OtroGrado en Medicin

Calidad de vida entre pacientes con diálisis peritoneal y hemodiálisis

La Enfermedad renal crónica es una patología de prevalencia creciente en la sociedad actual. Cuando se constata el estadio V o fallo renal se hace necesario el tratamiento renal sustitutivo. Mientras el paciente se encuentra a la espera de un trasplante renal compatible, en el caso de que lo solicite, el tratamiento mediante peritoneal es considerado el más apropiado, aunque también encontramos la opción de hemodiálisis. Para ello se precisa de un acceso vascular, y en este caso, la fístula arteriovenosa radiocefálica latero-terminal distal cumple con los requisitos necesarios para ser indicada como el acceso vascular de primera elección. Este estudio aporta información potencialmente útil para mejorar el conocimiento de los tipos de diálisis y la calidad de vida de cada uno, así como para la información obtenida de enfermeros que trabajan en el Hospital General de La Palma. El objetivo de este proyecto de investigación consiste en el estudio de los dos tipos de diálisis (hemodiálisis y diálisis peritoneal), para obtener un resultado sobre cuál aporta mayor calidad de vida al paciente.Chronic Kidney Disease is an increasingly prevalent pathology in today's society. When the stage V or renal failure is observed, replacement therapy is required. While the patient is waiting for compatible kidney transplantation, if he want it, peritoneal dialysis treatment is considered the most appropriate, though also we find the option to realize the hemodialysis. This procedure requires a vascular access and distal latero-terminal radiocephalic arteriovenous fistula fulfil all requirements to be considered the best vascular access and the one of first choice. This study provides useful information to improve both the knowledge of types of dialysis ane the quality of life of each one by Nursing. Also we obtained of nurses who work in The Hospital General de La Palma. The objective is to study both types of dialysis (hemodialysis and peritoneal dialysis), to obtain a result on which it contributes major quality of life to the patient

La Convención Mundial sobre los Derechos de las Personas con Discapacidad: reflexiones en torno a la Educación Inclusiva en tiempos de crisis

La Convención sobre los Derechos de las Personas con Discapacidad (2006,, entró en vigor el 3 de mayo del 2008), en su artículo 24, configura el derecho a la educación desde la perspectiva de derechos humanos, sobre la base de la igualdad de oportunidades y la no discriminación y de acuerdo con el modelo social de la discapacidad presente en toda la Convención. Este artículo obliga a los Estados a garantizar un sistema educativo inclusivo. La actual crisis económica hace que nos planteamos, unas reflexiones que favorezcan la inclusión educativa y que no siempre tienen que suponer ampliación de la dotación económica, sino optimizar ideas fuerzas y recursos. Presentamos algunas ideas fuerzas y dentro de ellas indicadores para su desarrollo, entre los que destacamos: Saber de dónde venimos y hacia dónde vamos. Mejorar el sistema educativo en general; Defender modelos de inclusión educativa acordes con la convención en un sistema educativo más eficiente, sin renunciar a la equidad. Asumir responsabilidades y participación. Compromiso con una formación – capacitación de calidad. Nuevas tecnologías con accesibilidad universal y diseño para todos. Control y seguimiento; instaurando la cultura del seguimiento continuo, y evaluación de la gestión pública participativa y participada.The Convention on the Rights of Persons with Disabilities (2006...took effect on May 3, 2008), in Article 24, frames the right to education from the point of view of human rights, equal opportunities and no discrimination, according to the social model of disability present throughout the Convention. The Inclusive Education System is required by law and the States must assure this. The current economic crisis force us to think some thoughts to help inclusive education that does not necessarily increase the financial support but the optimization of ideas, forces and resources. We propose some ideas and within them some indicators to develop among which we highlight the following: to know where we come from and where we are going ; to improve the overall education system; to defend inclusion models according to the Convention in the context of a more efficient educational system but without sacrificing the equality; to assume responsibilities and participation; commitment to quality training; universal access to new technologies; control and monitoring, establish the culture of continuous monitoring and participatory evaluation of public management

Remote Training of Neurointerventions by Audiovisual Streaming

Telemedicine; Neuroendovascular training; StrokeTelemedicina; Formación neuroendovascular; IctusTelemedicina; Formació neuroendovascular; IctusBackground Remote access of trainees to training centers via video streaming (tele-observership, e‑fellowship) emerges as an alternative to acquire knowledge in endovascular interventions. Situational awareness is a summary term that is also used in surgical procedures for perceiving and understanding the situation and projecting what will happen next. A high situational awareness would serve as prerequisite for meaningful learning success during tele-observerships. We hypothesized that live perception of the angiographical procedures using streaming technology is feasible and sufficient to gain useful situational awareness of the procedure. Methods During a European tele-observership organized by the European Society of Minimally Invasive Neurological Therapy (ESMINT) and its trainee association (EYMINT), a total of six neurointerventional fellows in five countries observed live cases performed by experienced neurointerventionalists (mentors) in six different high-volume neurovascular centers across Europe equipped with live-streaming technology (Tegus Medical, Hamburg, Germany). Cases were prospectively evaluated during a 12-month period, followed by a final questionnaire after completion of the course. Results A total of 102/161 (63%) cases with a 1:1 allocation of fellow and mentor were evaluated during a 12-month period. Most frequent conditions were ischemic stroke (27.5%), followed by embolization of unruptured aneurysms (25.5%) and arteriovenous malformations (AVMs) (15.7%). A high level of situational awareness was reported by fellows in 75.5% of all cases. After finishing the program, the general improvement of neurointerventional knowledge was evaluated to be extensive (1/6 fellows), substantial (3/6), and moderate (2/6). The specific fields of improvement were procedural knowledge (6/6 fellows), technical knowledge (3/6) and complication management (2/6). Conclusion Online streaming technology facilitates location-independent training of complex neurointerventional procedures through high levels of situational awareness and can therefore supplement live hands-on-training. In addition, it leads to a training effect for fellows with a perceived improvement of their neurointerventional knowledge.Open Access funding enabled and organized by Projekt DEAL

Radial Access for Neurointerventions

Transradial access (TRA) has become the standard approach for cardiac intervention, with a large body of evidence demonstrating a lower incidence of vascular complications, better patient experience and cost reduction. There has been increasing interest in using TRA both for diagnostic neuroangiography and for interventional neurovascular procedures. This aim of this article is to discuss the advantages and limitations of TRA for neurointerventions. General technical details, such as pre-procedure recommendations, prevention of spasm and occlusion, haemostasis protocols and distal TRA puncture, are also described, along with the specific technical details of TRA for aneurysm embolisation, stroke thrombectomy and other neurovascular interventions. TRA provides additional tools to the neurointerventionist and – with appropriate training – the whole spectrum of intervention procedures can be achieved using this approach

Evaluación de Competencias Transversales en Universitarios. Propiedades Psicométricas Iniciales del Cuestionario de Competencias Transversales.

En este trabajo se presenta el desarrollo del Cuestionario de Competencias Transversales para estudiantes Universitarios, así como sus propiedades métricas iniciales. El cuestionario se basa en las competencias identificadas por el proyecto Tuning dentro del marco del Espacio Europeo de Educación Superior. Para su desarrollo se utilizan Escalas de Observación de Conducta. En un primer estudio (N=741) se pone a prueba la fiabilidad de las medidas, su validez de contenido y estructura dimensional. Los resultados muestran que las escalas que componen el cuestionario tienen una fiabilidad adecuada y unos altos índices de congruencia. La estructura dimensional parece reproducir el modelo sustantivo de partida. En un segundo estudio (N=46) se explora la validez criterio del cuestionario frente a los resultados académicos. Los resultados muestran que diferentes competencias apreciadas por el cuestionario correlacionan significativamente con los resultados obtenidos por los alumnos en una prueba objetiva de conocimientos y los indicadores de evaluación continua. Estas competencias incrementan significativamente la varianza explicada en las calificaciones académicas por la personalidad y la inteligencia. Tomados en conjunto los datos permiten avalar la fiabilidad y validez de las medidas obtenidas con el cuestionario.post-print728 K

Catheter tip distensibility substantially influences the aspiration force of thrombectomy devices

Background A direct aspiration first pass thrombectomy (ADAPT) is a fast-growing technique for which a broad catalog of catheters that provide a wide range of aspiration forces can be used. We aimed to characterize different catheters' aspiration performance on stiff clots in an in vitro vascular model. We hypothesized that labeled catheter inner diameter (labeled-ID) is not the only parameter that affects the aspiration force (asp-F) and that thrombus–catheter tip interaction and distensibility also play a major role. Methods We designed an experimental setup consisting of a 3D-printed carotid artery immersed in a water deposit. We measured asp-F and distensibility of catheter tips when performing ADAPT on a stiff clot analog larger than catheter labeled-ID. Correlations between asp-F, catheter ID, and tip distensibility were statistically assessed. Results Experimental asp-F and catheter labeled-ID were correlated (r=0.9601; P<0.01). The relative difference between experimental and theoretical asp-F (obtained by the product of the tip’s section area by the vacuum pressure) correlated with tip’s distensibility (r=0.9050; P<0.01), evidencing that ADAPT performance is highly influenced by catheter tip shape-adaptability to the clot and that the effective ID (eff-ID) may differ from the labeled-ID specified by manufacturers. Eff-ID showed the highest correlation with experimental asp-F (r=0.9944; P<0.01), confirming that eff-ID rather than labeled-ID should be considered to better estimate the device efficiency. Conclusions Catheter tip distensibility can induce a significant impact on ADAPT performance when retrieving a stiff clot larger than the device ID. Our findings might contribute to optimizing thrombectomy strategies and the design of novel aspiration catheters.Peer ReviewedPostprint (published version

Coordinated Computation of Multi-layer Paths via Inter-layer PCE Communication: Standards, Interoperability and Deployment

The Path Computation Element (PCE) is positioned nowadays as one of the solutions that almost every carrier will eventually deploy. The PCE architecture as well as a number of components, including the PCE Communication Protocol (PCEP), have been standardized by the IETF. However, a number of challenges remain to be solved on its way from standards to deployment. In particular, the existing proposals for multilayer path computation within the PCE framework need to be further developed and tested, before considering their possible integration into operational networks. This is especially true for the interoperability of the various PCE implementations and the extensions such as the Virtual Network Topology Manager (VNTM) which cannot be taken for granted. This paper presents a functional implementation of coordinated computation of multilayer paths supported through inter-layer PCE communication, where one PCE is developed by industry and the other as an open-source effort. To this end, we consider an IP/MPLS network deployed over a Wavelength Switched Optical Network (WSON), each of which deploying its own PCE, in an attempt to create an inter-operable multilayer solution. We discuss the key challenges that the research community will face in this area, which in turn will drive a considerable part of the upcoming efforts in terms of standardizationPostprint (published version

Application of Electro-Fenton Technology to Remediation of Polluted Effluents by Self-Sustaining Process

The applicability of electro-Fenton technology to remediation of wastewater contaminated by several organic pollutants such as dyes and polycyclic aromatic hydrocarbons has been evaluated using iron-enriched zeolite as heterogeneous catalyst. The electro-Fenton technology is an advanced oxidation process that is efficient for the degradation of organic pollutants, but it suffers from the high operating costs due to the need for power investment. For this reason, in this study microbial fuel cells (MFCs) were designed in order to supply electricity to electro-Fenton processes and to achieve high treatment efficiency at low cost. Initially, the effect of key parameters on the MFC power generation was evaluated. Afterwards, the degradation of Reactive Black 5 dye and phenanthrene was evaluated in an electro-Fenton reactor, containing iron-enriched zeolite as catalyst, using the electricity supplied by the MFC. Near complete dye decolourization and 78% of phenanthrene degradation were reached after 90 min and 30 h, respectively. Furthermore, preliminary reusability tests of the developed catalyst showed high degradation levels for successive cycles. The results permit concluding that the integrated system is adequate to achieve high treatment efficiency with low electrical consumption

Intrasaccular Flow Disruptor-Assisted Coiling of Intracranial Aneurysms Using the Novel Contour Neurovascular Systems and NEQSTENT: A Single-Center Safety and Feasibility Study

Brain aneurysms; Endovascular treatment; Intrasaccular devicesAneurismas cerebrales; Tratamiento endovascular; Dispositivos intrasacularesAneurismes cerebrals; Tractament endovascular; Dispositius intrasacularsBackground: Intrasaccular flow disruptors (IFD) have been introduced in the treatment of intracranial aneurysms (IAs) to overcome the low aneurysm occlusion rate and the high recanalization rate of the coiling technique. Among them, the Contour Neurovascular System (CNS) and the Neqstent (NQS) were designed to reconstruct the aneurysmal neck and both can be used as assisting coiling devices. We aimed to report our preliminary experience with the flow disruptor-assisted coiling (IFD-AC) technique. Methods: We performed a retrospective analysis of prospectively collected data of all patients with IAs treated with the IFD-AC. Results: Between February 2021 and April 2022, we treated 15 IAs with the IFD-AC: 10 ruptured and 5 unruptured. The IFD-AC was successfully performed in 13 cases, with a post-operative RROC 1 in 12 cases (92.3%) and RROC 2 in 1 case (7.7%). There was one ischemic event (6.7%) and no hemorrhagic complications. Twelve patients underwent a mid-term radiologic follow-up: Ten IAs (83.4%) presented an adequate occlusion, while 2 (16.7%) had a recurrence. Conclusions: The IFD-AC, both with the CNS and the NQS, seems a safe technique with promising efficacy profile. The IFD-AC has proved to be safe without antiplatelet therapy in ruptured cases. Further studies are needed to confirm our preliminary results