Deterioro cognitivo, cirugía cardíaca y circulación extracorpórea

El deterioro cognitivo postoperatorio junto con otras alteraciones neurológicas suponen unas de las complicaciones más frecuentes tras la cirugía cardíaca. Para evaluar los efectos cognitivos de esta cirugía, hemos realizado este estudio donde se evalúan diferentes dominios neurocognitivos mediante una batería de test incluyendo la evaluación preoperatoria y un seguimiento hasta un año posterior, convertiéndose en el primer estudio de estas características en población española

Deterioro cognitivo postquirúrgico en pacientes con enfermedad coronaria y/o valvulopatía aórtica

Se muestra la presencia de deterioro cognitivo postquirúrgico en pacientes con enfermedad coronaria y/o valvulopatía aórticaUniversidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Delay effects in the response of low-grade gliomas to radiotherapy: a mathematical model and its therapeutical implications

Low-grade gliomas (LGGs) are a group of primary brain tumours usually encountered in young patient populations. These tumours represent a difficult challenge because many patients survive a decade or more and may be at a higher risk for treatment-related complications. Specifically, radiation therapy is known to have a relevant effect on survival but in many cases it can be deferred to avoid side effects while maintaining its beneficial effect. However, a subset of LGGs manifests more aggressive clinical behaviour and requires earlier intervention. Moreover, the effectiveness of radiotherapy depends on the tumour characteristics. Recently Pallud et al. (2012. Neuro-Oncology, 14, 1-10) studied patients with LGGs treated with radiation therapy as a first-line therapy and obtained the counterintuitive result that tumours with a fast response to the therapy had a worse prognosis than those responding late. In this paper, we construct a mathematical model describing the basic facts of glioma progression and response to radiotherapy. The model provides also an explanation to the observations of Pallud et al. Using the model, we propose radiation fractionation schemes that might be therapeutically useful by helping to evaluate tumour malignancy while at the same time reducing the toxicity associated to the treatmen

Escoliosis congénitas causadas por hemivertebras

Presentamos un estudio retrospectivo de 26 pacientes diagnosticados de escoliosis congénitas causadas por hemivertebras, liemos analizado la evolución de las curvas según el tipo de hemivértebra, su localización y el tratamiento recibido. Se han obtenido los peores resultados en las niñas, cuando el diagnóstico se realizó después de los 10 años de edad, en las curvas localizadas en la región toracolumbar, en las hemivértebras múltiples y, dentro de ellas, en las unilaterales segmentadas no adyacentes y en los pacientes tratados ortopédicamente.A retrospective study of 26 patients with congenital scoliosis due to hemivertebra was conducted. Curve progression was analysed regarding the type of hemivertebra, its localization, and the applied treatment. The worst results were found in girls, in cases who were diagnosed with more than to years of age, in thoraco-lumbar curves, in multiple hemivertebra, especially in non-adjacent segmented unilateral hemivertebra and, finally, in patients treated with orthopaedic methods

Repair of complete bilateral cleft lip with severely protruding premaxilla performing a premaxillary setback and vomerine ostectomy in one stage surgery

Background: The authors present a technique for selected cases of CBCL. The primary repair of the CBCL with a severely protruding premaxilla in one stage surgery is very difficult, essentially because a good muscular apposition is difficult, forcing synchronously to do a premaxillary setback to facilitate subsequent bilateral lip repair and, thus, achieving satisfactory results. We achieve this by a reductive ostectomy on the vomero- premaxillary suture. Material and Methods: 4 patients with CBCL and severely protruding premaxilla underwent premaxillary setback by vomerine ostectomy at the same time of lip repair in the past 24 months. The extent of premaxillary setback varied between 9 and 16 mm. The required amount of bone was removed anterior to the vomero-premaxillary suture. The authors did an additional simultaneous gingivoperiosteoplasty in all patients, achieving an enough stability of the premaxilla in its new position, to be able to close the alveolar gap bilaterally. The authors have examined the position of premaxilla and dental arch between 6 and 24 months. We did not do the primary nose correction, because this increased the risk of impairment of the already compromised vascularity of the philtrum and premaxilla. Results : The follow-up period ranged between 6 and 24 months. None of the patients had any major complication. During follow-up, the premaxilla was minimally mobile. We achieved a good lip repair in all cases: adequate muscle repair, symmetry of the lip, prolabium and Cupid’s bow, as well as good scars. Conclusions : To our knowledge, there are few reports of one stage surgery with vomerine ostectomy to repair CBCL with severely protruding premaxilla. Doing this vomerine ostectomy, we don’t know how it will affect the subsequent growth of the premaxila and restrict the natural maxillary growth. Applying this alternative treatment for children with CBCL and protruded premaxilla without any preoperative orthopedic, we can successfully perform, in a single-stage surgery, a good primary lip repair at our center. Further confirmations of this surgery with follow up and anthropometric studies of these patients during childhood and adolescence are require

Relationship between quadriceps femoris echotexture biomarkers and muscle strength and physical function in older adults with heart failure with preserved ejection fraction

Background: Muscle wasting is pronounced in patients with heart failure with preserved ejection fraction (HFpEF). The quadriceps femoris echotexture biomarkers assessed by ultrasound (US) have not been studied in these patients. Objective: To describe echotexture biomarkers assessed by the US and to assess their relationship with sex, age, body mass index (BMI), self-reported outcomes, muscle strength and physical function in older adults with HFpEF. Methods: A cross-sectional study was conducted. Patients 70 years and older with HFpEF were included. The sex, age, BMI, and self-reported outcomes were collected. The US assessed muscle and subcutaneous fat tissue contrast, correlation, energy, homogeneity, and entropy at rest and maximal voluntary isometrical contraction (MVIC). The six-minute walk test (6MWT), the short physical performance battery (SPPB), the timed up and go test (TUG), the usual pace gait speed test (UGS), and the fast pace gait speed test (FGS) were used to assess physical function. The five-repetitions sit-to-stand test (5-STS) was performed to assess muscle strength. Bivariant Pearson correlations and subsequent multivariate linear regression analyses were conducted. Results: Seventy-two older adults with HFpEF [81.06 years, 29.13 BMI, and 55.60% females] were recruited. In women, relaxed and MVIC muscle energy and entropy explained 35.40% of the TUG variance; relaxed muscle entropy and MVIC muscle energy shared 24.00% of the UGS variance; relaxed and MVIC muscle entropy, MVIC muscle contrast and MVIC muscle energy explained 32.60% of the FGS variance, adjusted all the models by age and BMI.Funding for open access charge: Universidad de málaga /CBU

Vericiguat, nuevo pilar en el tratamiento de la insuficiencia cardiaca con fracción de eyección reducida

Heart failure with reduced ejection fraction (HFrEF) is associated with high morbidity and mortality, conditioned by multiple hospitalizations. Vericiguat has currently beenshown to be effective and safe in patients with a recent decompensation. We present a series of three cases using vericiguat in different clinical scenarios: an elderly patient with dilated cardiomyopathy of ischemic origin, a patient with alcoholic cardiomyopathy and polyvalvular heart disease, and a young patient with idiopathic cardiomyopathy. In the 3 cases vericiguat was effective and safe. This medication has been tested and monitored in other studies and we consider it plays an important role in the therapeutic armamentarium of this population, although it is necessary to accumulate more clinical experience.La insuficiencia cardiaca con fracción de eyección reducida (ICFEr) se asocia con una elevada morbimortalidad, condicionada por múltiples hospitalizaciones. Actualmente vericiguat ha mostrado ser eficaz y seguro en pacientes con una descompensación reciente. Presentamos una serie de tres casos clínicos usando vericiguat en diferentes perfiles clínicos: paciente de edad avanzada con miocardiopatía dilatada de origen isquémico, paciente con miocardiopatía de origen enólico y enfermedad polivalvular y paciente joven con miocardiopatía de origen idiopático. En los 3 casos el vericiguat mostró resultados eficaces y seguros. Este fármaco ha sido monitorizado en otros estudios y creemos que constituye un arma terapéutica importante para pacientes con ICFEr, aunque es necesario acumular mayor experiencia clínica

Primary Melanoma of the Small Intestine with a Metastatic Lymph Mass in the Inguinal Canal: A Case Report

Objectives: We report a case of primary melanoma of the small intestine. Primary intestinal melanoma (PIM) is an extremely rare neoplasm for which the cause is unknown. Materials and methods: A 67-year-old man was admitted to our department due to abdominal pain, constipation, a large, hard inguinal mass and severe anaemia. Results: After laboratory data, imaging techniques and histopathological examination, the diagnosis was confirmed. A surgical resection of the intestinal neoplasm, treatment with BRAF inhibitors and radiation therapy to the inguinal mass were performed. Conclusion: PIM is rare and it is usually difficult to establish its exact origin

BH-ShaDe: a software tool that assists architecture students in the ill-structured task of housing design

In this paper, we present BH-ShaDe, a new software tool to assist architecture students learning the ill-structured domain/task of housing design. The software tool provides students with automatic or interactively generated floor plan schemas for basic houses. The students can then use the generated schemas as initial seeds to develop complete residential projects. The main goal of our research was to obtain evidence about whether or not such schemas can be useful to architecture students. A first prototype of the tool was evaluated with 78 students, with positive results. However, the students seemed to demand increased user participation, so they could contribute to generating better quality starting points. A second prototype was therefore implemented, allowing a higher degree of interactivity. The second prototype was evaluated with a new group of 50 students. From the two evaluations performed, it can be concluded that both versions of the tool were able to generate useful starting points (either automatically or interactively) that expedited the design process. Additionally, in the second experiment, we found that neither the nature (automatic or interactive) nor the quality of the starting point seems to have any effect on the perceived quality of the final projects.This work has been partially supported by grant TIN2009-14179, Plan Nacional de I+D+i, Gobierno de España and by PIE 13-052, Universidad de Málaga. Manuela Ruiz-Montiel is funded by the Spanish Ministry of Education through the National F.P.U. Program

Randomness and control in design processes: an empirical study with architecture students.

The aim of this study is to explore designers' preferences between randomness and control in the generation of architectural forms. To this end, a generative computer tool was implemented that allows both random and controlled generation of elements. An assignment was given to fourth-year Architecture students which involved the designing of several megastructures using the tool. Results show that both randomness and control can have their own space and play a complementary role in design. Most students were willing to explore randomness and were able to exploit it to generate good designs. However, some of them have certain degree of preference for more controlled solutionshis work has been partially supported by grant TIN2009-14179, Plan Nacional de I+D+i, Gobierno de España. Manuela Ruiz-Montiel is funded by the Spanish Ministry of Education through the National F.P.U. Program