Edema de reexpansión pulmonar “REPE” intraoperatorio tras toracoscopia mediante ventilación unipulmonar

The sudden pulmonar expansion which has remained collapsed among different hours or days, likewise the fast pneumothorax or pleural effusion drainage, can cause a flash or acute edema on the affected lung. It is believed that the rexpansive pulmonary syndrome (REPE), is caused due to an increment in the capillary permeability after being exposed the affected lung to high negative intra-pleural pressure. The ocurrence of REPE is a rare event with most cohort studies reporting an incidence of between 0%- 1%. It may extend with hypoxaemia, hypotension and even cardiac arrest. The treatment of these patients include mechanical ventilation with optimal PEEP levels, the use of vasopressors and an intesive electrolyte resuscitation. We expose the case of a 16 year old patient with mediastinal mass diagnosis and massive left-pleural effusion, where after a thorascocopy for biopsy and pleuritic drainage, it is observed a reexpansion pulmonary edema with respiratory repercussion, haemodynamics and the requirement of endotracheal reintubation.El “REPE” (Re-expansion Pulmonary Edema) es una complicación poco común que puede ocurrir después del drenaje rápido de un neumotórax o de abundante líquido pleural (1,2). La incidencia en adultos es del el 0-1%. Su mortalidad puede alcanzar  el 20% (1,3). Las hipótesis propuestas para el desarrollo de dicha entidad incluyen, el aumento de la permeabilidad de la microvasculatura pulmonar, cambios en el flujo linfático, disminución de la producción de surfactante y aumento de la presión hidrostática del flujo vascular del pulmón reexpandido (4). Se caracteriza por el desarrollo agudo de hipoxemia refractaria al oxígeno y la aparición de infiltrados alveolares intersticiales en un plazo de 24 horas tras el drenaje (5). Son factores de riesgo de REPE: la edad comprendida entre los 20 y 40 años, la duración del colapso pulmonar mayor de 72 horas, la aplicación de altas presiones negativas durante la toracocentesis (20 cm H2O), una rápida reexpansión tras drenajes de altos volúmenes de líquido pleural (> 1.5 L) o la existencia de factores predisponentes para el edema pulmonar (hipoalbuminemia, estasis en la circulación pulmonar)

Nuevos datos sobre la distribución, morfología y habitat de Brachythecium mildeanum (Schimp.) Schimp. (Brachytheciaceae, Bryophyta) en la Península Ibérica

New data of morphology, habitat and distribution, based on samples reviewed, are provided for Brachythecium mildeanum (Schimp.) Schimp. In the Iberian Peninsula this species has usually been confused with Brachythecium rutabulum (Hedw.) Schimp. and B. rivulare Schimp.En base a la revisión de numerosos ejemplares, se aportan nuevos datos sobre morfología, hábitat y distribución de Brachythe­cium mildeanum (Schimp.) Schimp., especie que ha sido usual- mente confundida en la Península Ibérica con Brachythecium rutabulum (Hedw.) Schimp. y B. rivulare Schimp

Adult Attachment, Conflict Resolution Style and Relationship Quality among Spanish Young-adult Couples

The evidence of the interrelationships between adult attachment, conflict resolution style and relationship quality in couple relationships shows some inconsistencies and it is mostly based on English-speaking adult samples, as well as on individuals’ rather than on both couple members’ reports. Therefore, the aim was to examine the associations between adult attachment, conflict resolution style and relationship quality from a dyadic approach. A sample of 405 heterosexual young couples completed online the brief version of the Experiences in Close Relationships-Revised Questionnaire, the respondent version of the Conflict Resolution Styles Inventory, and a 4-item measure of relationship quality. Avoidance attachment showed a stronger negative correlation than anxiety with relationship quality. Withdrawal and conflict engagement styles were more highly correlated with avoidance and anxiety, respectively. At a dyadic level, relationship quality was negatively predicted by actor avoidance attachment and positively predicted by partner relationship quality. No actor or partner effects of conflict resolution style on relationship quality were observed. Overall, partners with higher attachment anxiety and avoidance reported more dysfunctional conflict resolution styles and less satisfaction with the relationship

Acoustic modelling of large aftertreatment devices with multimodal incident sound fields

[EN] The influence of multimodal incident sound fields on the acoustic behaviour of large aftertreatment devices (ATD) is analysed in detail. The mode matching method is applied to the compatibility conditions of the three-dimensional (3D) acoustic fields at the device geometric discontinuities, leading to the computation of the complex wave amplitudes in all the subdomains involved and the corresponding transmission loss (TL). To have a realistic model, 3D propagation must be considered in the inlet/outlet ducts and chambers, while 1D wave propagation has to be assumed along the small capillaries of the catalytic converter/particulate filter monoliths of the ATD; therefore, these monoliths can be replaced by plane wave four pole transfer matrices from an acoustical point of view [1]. On the other hand, for large ATD inlet ducts such as those found in heavy-duty and off-road engines, the usual models with plane incident wave excitation are not accurate since the onset of higher order incident modes in the inlet duct is expected for the frequency range of interest. Therefore, a TL variation is likely to occur depending on these modes, similar to the results found in large dissipative silencers [2]. Results are presented for three different multimodal incident sound field hypotheses [3]: equal modal amplitude (EMA), equal modal power (EMP) and equal modal energy density (EMED). A relevant influence on the sound attenuation is found for the test problems considered in the current investigation. References [1] Denia, F. D., Martínez-Casas, J., Carballeira, J., Nadal, E., Fuenmayor, F. J., Computational performance of analytical methods for the acoustic modelling of automotive exhaust devices incorporating monoliths. Journal of Computational and Applied Mathematics, 330: 995--1006, 2018. [2] Kirby, R., Lawrie, J. B., A point collocation approach to modelling large dissipative silencers. Journal of Sound and Vibration, 286: 313--339, 2005. [3] Mechel, F. P., Formulas of Acoustics. Berlin, Springer, 2008.The authors gratefully acknowledge Grants PID2020-112886RA-I00 and PID2020-118013RB-C21 funded by MCIN/AEI/10.13039/501100011033 and Project PROMETEO/2021/046 from Generalitat Valenciana.Denia, FD.; Sánchez-Orgaz, EM.; Martínez Casas, J.; Carballeira, J.; Baeza González, LM. (2021). Acoustic modelling of large aftertreatment devices with multimodal incident sound fields. Universitat Politècnica de València. 208-215. http://hdl.handle.net/10251/19055620821

Novedades corológicas para la flora briofítica ibérica. V

A partir del estudio de muestras recolectadas y revisadas en el marco del Proyecto Flora Briofítica Ibérica (FBI), se aportan un total de 15 novedades corológicas provinciales para España y 1 para Portugal. A destacar la segunda localidad conocida en el con- tinente europeo de Tetrastichium fontanum (Mitt.) Cardot

Caracterización Proteómica del trombo coronario en pacientes con infarto agudo de miocardio con elevación del segmento ST

Comunicaciones a congreso

Characterization of individualized proteomic profiles in ST-segment elevation and no ST-segment elevation acute coronary syndrome

Comunicaciones a congreso

Modelado numérico eficiente del comportamiento acústico de silenciadores de escape con material absorbente granular

[ES] En este trabajo se presenta una técnica numérica precisa y de bajo coste computacional para el análisis del comportamiento acústico de silenciadores de escape con sección transversal arbitraria y material absorbente granular en su interior. Se plantea la utilización de dicho material como una posible alternativa a las tradicionales fibras utilizadas en silenciadores de tipo disipativo. Entre las ventajas de los materiales granulares en la aplicación concreta planteada aquí, cabe destacar la ausencia de su emisión al medio ambiente como consecuencia del arrastre provocado por los gases de escape y la posibilidad de conseguir configuraciones geométricas adaptables a la fuente de ruido mediante un proceso de llenado/vaciado in situ relativamente sencillo. La caracterización acústica del material granular se lleva a cabo mediante la utilización de propiedades como su impedancia y número de onda [1], a partir de las cuales pueden obtenerse la densidad y velocidad del sonido equivalentes, complejas y dependientes de la frecuencia. Con el objetivo de reducir el coste computacional de una formulación completa 3D de EF, se presenta una técnica computacionalmente eficiente basada en un problema de autovalores 2D y el método de ajuste modal, en su versión numérica para contemplar la posibilidad de secciones transversales de geometría arbitraria y propiedades no homogéneas [2, 3]. Para ello, en primer lugar, se resuelve el problema de autovalores y autovectores de la sección transversal mediante un planteamiento 2D de EF. Posteriormente, se acoplan los campos de presión y velocidad acústica en las discontinuidades geométricas mediante ajuste modal. Hallada la solución completa de la ecuación de ondas en el interior del silenciador, se cuantifican sus prestaciones acústicas con distintos niveles de llenado de material absorbente granular. REFERENCIAS [1] P. Cobo and F. Simón, A comparison of impedance models for the inverse estimation of the non-acoustical parameters of granular absorbers , Applied Acoustics, 104, 119-126 (2016). [2] R. Kirby, A comparison between analytic and numerical methods for modelling automotive and dissipative silencers with mean flow , Journal of Sound and Vibration, 325, 565-582 (2009). [3] F. D. Denia, E. M. Sánchez-Orgaz, L. Baeza and R. Kirby, Point collocation scheme in silencers with temperature gradient and mean flow , Journal of Computational and Applied Mathematics, 291, 127-141 (2016).Proyecto realizado con la Ayuda Fundación BBVA a Investigadores y Creadores Culturales 2016. La Fundación BBVA no se responsabiliza de las opiniones, comentarios y contenidos incluidos en el proyecto y/o los resultados derivados del mismo, los cuales son total y absoluta responsabilidad de los autoresSánchez Orgaz, EM.; Denia, FD.; Martínez Casas, J.; Baeza González, LM. (2017). Modelado numérico eficiente del comportamiento acústico de silenciadores de escape con material absorbente granular. International Center for Numerical Methods in Engineering (CIMNE). 12-22. http://hdl.handle.net/10251/179954S122

El blog como metodología activa de enseñanza-aprendizaje y herramienta de adquisición de competencias en la asignatura psicología del desarrollo en edad infantil (0-6 años)

Memoria ID-328. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2013-2014

Identification of factors associated with diagnostic error in primary care

Background Missed, delayed or incorrect diagnoses are considered to be diagnostic errors. The aim of this paper is to describe the methodology of a study to analyse cognitive aspects of the process by which primary care (PC) physicians diagnose dyspnoea. It examines the possible links between the use of heuristics, suboptimal cognitive acts and diagnostic errors, using Reason’s taxonomy of human error (slips, lapses, mistakes and violations). The influence of situational factors (professional experience, perceived overwork and fatigue) is also analysed.Methods Cohort study of new episodes of dyspnoea in patients receiving care from family physicians and residents at PC centres in Granada (Spain). With an initial expected diagnostic error rate of 20%, and a sampling error of 3%, 384 episodes of dyspnoea are calculated to be required. In addition to filling out the electronic medical record of the patients attended, each physician fills out 2 specially designed questionnaires about the diagnostic process performed in each case of dyspnoea. The first questionnaire includes questions on the physician’s initial diagnostic impression, the 3 most likely diagnoses (in order of likelihood), and the diagnosis reached after the initial medical history and physical examination. It also includes items on the physicians’ perceived overwork and fatigue during patient care. The second questionnaire records the confirmed diagnosis once it is reached. The complete diagnostic process is peer-reviewed to identify and classify the diagnostic errors. The possible use of heuristics of representativeness, availability, and anchoring and adjustment in each diagnostic process is also analysed. Each audit is reviewed with the physician responsible for the diagnostic process. Finally, logistic regression models are used to determine if there are differences in the diagnostic error variables based on the heuristics identified.Discussion This work sets out a new approach to studying the diagnostic decision-making process in PC, taking advantage of new technologies which allow immediate recording of the decision-making process.The authors gratefully acknowledge funding of this research from the Spanish Research Agency. Ministry of Health (Fondo de Investigaciones Sanitarias) FIS PI10/01468 and the European Regional Development Fund (ERDF)