WM-SIMA: Herramienta de simulación para el enlace descendente LTE-Advanced

In this paper, we present a novel and efficient link level simulation framework for the donwlink (DL) of Long Term Evolution Advanced (LTE-A) cellular networks. The tool, called Wireless Mobile SIMulator Advanced (WM-SIMA), is available to be downloaded so that researchers can use it to evaluate the performance for different network configurations. In this work, the main characteristics of WM-SIMA are presented. As a case of use, the Average Spectral Efficiency (ASE) is obtained for the DL of a two-tier network, composed of Macro Access Points (MAPs) and Pico APs (PAPs). Simulation results confirms that there exist an optimal Cell Range Expansion (CRE) bias in the cell association that maximizes the ASE. Interestingly, it is confirmed that this optimal bias does not depend on the number of PAPs, while increasing the number of PAPs leads to a higher ASE for the same bias.Ministerio de Economía y Competitividad (TEC2013-44442-P). Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Geographical and temporal distribution of SARS-CoV-2 clades in the WHO European Region, January to June 2020

We show the distribution of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) genetic clades over time and between countries and outline potential genomic surveillance objectives. We applied three genomic nomenclature systems to all sequence data from the World Health Organization European Region available until 10 July 2020. We highlight the importance of real-time sequencing and data dissemination in a pandemic situation, compare the nomenclatures and lay a foundation for future European genomic surveillance of SARS-CoV-2

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Riesgo cardiovascular asociado al consumo de antiinflamatorios no esteroideos: estudio de cohortes retrospectivo en un área de salud, 2008-2012

Background: Since the clinical trial VIGOR, in which the use of rofecoxib was proved to be connected to a larger number of cardiovascular accidents, an increase of cardiovascular diseases connected to the use of non Steroidal Anti-Inflammatory Drugs has been observed. This study intends to evaluate cardiovascular impact related to the use of non steroidal anti-inflammatory drugs in a Health Care Area in Castilla La Mancha (Spain). Method: A retrospective observational study of clinical cohort during 5 years is done in which all patients older than 18 years (n = 116 686) was included. The statistical analysis was done estimating the incidence of acute coronary syndrome in relation to the exposure time. The risk associated with the consumption of non-steroidal anti-inflammatory drugs was made by Poisson regression adjusting by sex and age. Calculation of the Daily Inhabitants Doses by means of the Defined Daily Doses, through DIGITALIS program of pharmaceutical consumption. Results: The connection between acute coronary syndrome and the use of anti-inflammatory drugs was positive (RR 3,64; IC95% 2,94 a 4,52; p<0,001). The cardiovascular risk was higher en alkanones (RR 18; IC95% 2,53 a 127; p=0,004), followed by propionoicos as ibuprofen (RR 2,58; IC95% 2,16 a 3,69; p<0,001), it is also the only group that is time-dependent. Thirdly arylacetic (RR 1,88; IC95% 1,6 a 2,22; p<0,001) and finally the coxib (RR 1,55; IC95% 1,25 a 1,92; p<0,001), in others antiinflammatory no increased cardiovascular risk was observed. Conclusions: The use of non steroidal anti-inflammatory drugs has been connected to a higher risk of cardiovascular accidents, suggesting that not during prolonged or high-dose or should take.Fundamentos: Desde el ensayo clínico VIGOR cuyos resultados asociaron el uso del medicamento rofecoxib a la ocurrencia de eventos cardiovasculares se ha observado un aumento en patologías cardiovasculares asociadas al uso de antiinflamatorios no esteroideos. El objetivo de esta investigación fue evaluar el impacto cardiovascular asociado al consumo de antiinflamatorios en un Área de Salud de Castilla La-Mancha (España). Métodos: Estudio retrospectivo de cohortes de base poblacional en un área de salud del período 2008-2012. Se incluyó a todos los pacientes mayores de 18 años (116.686). El análisis estadístico se realizó estimando las incidencias de síndrome coronario agudo en relación al tiempo de exposición. Se calculó el riesgo relativo (RR) asociado al consumo de antiinflamatorios no esteroideos se modelizó mediante regresión de Poisson, ajustando por edad y sexo. También se calculó la Dosis Habitante Día (DHD) mediante la Dosis Diaria Definida. Resultados: La asociación entre el síndrome coronario agudo y el consumo de antiinflamatorios fue positiva (RR 3,64; IC95% 2,94-4,52; p<0,001). El riesgo cardiovascular fue mayor en las alcanonas (RR 18; IC95% 2,53-127; p=0,004), seguido de los propionoicos como el ibuprofeno (RR 2,58; IC95% 2,16-3,69; p<0,001), además es el único grupo que es tiempo-dependiente. En tercer lugar los arilacéticos (RR 1,88; IC95% 1,6-2,22; p<0,001) y por último los coxib (RR 1,55; IC95% 1,25-1,92; p<0,001). En los demás antiinflamatorios no se observó aumento de riesgo cardiovascular. Conclusiones: El consumo de antiinflamatorios se asocia a un mayor riesgo de sufrir un síndrome coronario agudo sobretodo en los considerados como tradicionales, lo que sugiere que no se deberían tomar ni durante tiempo prolongado ni a altas dosis

Association of visual and quantitative heterogeneity of 18F-FDG PET images with treatment response in locally advanced rectal cancer: A feasibility study.

Background and purposeFew tools are available to predict tumor response to treatment. This retrospective study assesses visual and automatic heterogeneity from 18F-FDG PET images as predictors of response in locally advanced rectal cancer.MethodsThis study included 37 LARC patients who underwent an 18F-FDG PET before their neoadjuvant therapy. One expert segmented the tumor from the PET images. Blinded to the patient¿s outcome, two experts established by consensus a visual score for tumor heterogeneity. Metabolic and texture parameters were extracted from the tumor area. Multivariate binary logistic regression with cross-validation was used to estimate the clinical relevance of these features. Area under the ROC Curve (AUC) of each model was evaluated. Histopathological tumor regression grade was the ground-truth.ResultsStandard metabolic parameters could discriminate 50.1% of responders (AUC = 0.685). Visual heterogeneity classification showed correct assessment of the response in 75.4% of the sample (AUC = 0.759). Automatic quantitative evaluation of heterogeneity achieved a similar predictive capacity (73.1%, AUC = 0.815).ConclusionA response prediction model in LARC based on tumor heterogeneity (assessed either visually or with automatic texture measurement) shows that texture features may complement the information provided by the metabolic parameters and increase prediction accuracy.This work was partially supported by the Spanish Ministry of Economy and Competitiveness (TEC2016–78052-R, PID2019-109820RB-I00) (to AMB) and TEC2013-48251-C2 (to JP), Instituto de Salud Carlos III and European Regional Development Fund (FEDER) Funds from the European Commission, “A way of making Europe” (PI15/02121) and a Leonardo grant to Researchers and Cultural Creators 2017, BBVA Foundation (to AMB). PMG is supported by ‘Beca de Colaboración’ of the Spanish Ministry of Education, Culture and Sports. The CNIC is supported by the Ministry of Economy, Industry and Competitiveness (MEIC) and the Pro CNIC Foundation, and is a Severo Ochoa Center of Excellence (SEV-2015-0505)

Incidencia de la COVID-19 en pacientes en tratamiento crónico con hidroxicloroquina.

To analyze the incidence of Covid-19 in patients who are chronic users of hydroxychloroquine. Cross-sectional retrospective observational multicenter study in health areas and districts from Castilla La-Mancha and Andalucia. Of the 4451 participants included in the first recruitment, 3817 with valid data were selected. The main variable of the study is the presence or absence of Covid-19 infection by clinical, serological or polymerase chain reaction diagnosis. Sociodemographic and clinical variables and treatment and concomitant comorbidities were recorded. 169 (4,45%) patients had Covid-19 infection, of which 12 (7.1%) died and 32 (18.9%) required hospital admission. Previous respiratory pathology was related to Covid-19 infection (P There is no relationship between chronic use of hydroxychloroquine and the incidence of Covid-19

Pre-exposure prophylaxis with hydroxychloroquine for COVID-19: a double-blind, placebo-controlled randomized clinical trial.

Background: Pre-exposure prophylaxis (PrEP) is a promising strategy to break COVID-19 transmission. Although hydroxychloroquine was evaluated for treatment and post-exposure prophylaxis, it is not evaluated for COVID-19 PrEP yet. The aim of this study was to evaluate the efficacy and safety of PrEP with hydroxychloroquine against placebo in healthcare workers at high risk of SARS-CoV-2 infection during an epidemic period. Methods: We conducted a double-blind placebo-controlled randomized clinical trial in three hospitals in Barcelona, Spain. From 350 adult healthcare workers screened, we included 269 participants with no active or past SARS-CoV-2 infection (determined by a negative nasopharyngeal SARS-CoV-2 PCR and a negative serology against SARS-CoV-2). Participants allocated in the intervention arm (PrEP) received 400 mg of hydroxychloroquine daily for the first four consecutive days and subsequently, 400 mg weekly during the study period. Participants in the control group followed the same treatment schedule with placebo tablets. Results: 52.8% (142/269) of participants were in the hydroxychloroquine arm and 47.2% (127/269) in the placebo arm. Given the national epidemic incidence decay, only one participant in each group was diagnosed with COVID19. The trial was stopped due to futility and our study design was deemed underpowered to evaluate any benefit regarding PrEP efficacy. Both groups showed a similar proportion of participants experiencing at least one adverse event (AE) (p=0.548). No serious AEs were reported. Almost all AEs (96.4%, 106/110) were mild. Only mild gastrointestinal symptoms were significantly higher in the hydroxychloroquine arm compared to the placebo arm (27.4% (39/142) vs 15.7% (20/127), p=0.041)