La ciencia y la dominación autoritaria del sujeto

La ciencia parece surgir como un amo incorpóreo en alianza con una política liberal y desde un discurso único que puede dominar al sujeto. Ese dominio se ejerce principalmente desde que se deifica a la ciencia como único relato sobre el mundo. Las consecuencias de ese cientificismo son múltiples y suponen una concepción del ser humano sostenida en metáforas mecanicistas.No se asume generalmente que la ciencia tiene límites intrínsecos y que su aproximación al mundo solo proporcionará en el mejor caso una realidad formal.Pero el límite fundamental a la ciencia cuando contempla lo humano deriva del choque de un método y teorías científicos esencialistas con lo singular existencial. Frente a un determinismo biológico cientificista, se defiende la libertad humana ensombrecida por un determinismo no biológico sino biográfico e inconsciente, mostrando así la vigencia del mandato délfico, no alcanzable por la ciencia.Ante la deshumanización cientificista es factible y necesaria una resistencia humanista, desde la reflexión filosófica y en la que la relación clínica debe jugar un papel relevante

Método de variación de masa para determinar propiedades modales

En la determinación de propiedades modales de las estructuras (frecuencias y modos de vibración) in˛uyen parámetros como su rigidez y masa que en prin-cipio se podrían calcular o estimar directamente en la etapa de proyecto. Sin embargo, una vez construida la estructura, se debe recurrir a métodos indirectos para su determinación. Uno de los más usados es el método de la variación de la masa. Consiste en añadir masas conocidas a la estructura y medir su respuesta libre ante determinadas excitaciones, con el ˝n de determinar (mediante post-procesado basado en FFT) sus frecuencias propias. Con un conjunto su˝ciente de experimentos de este tipo se puede construir un sistema de ecuaciones del que obtener las rigideces y masas buscadas.Departamento de Construcciones Arquitectónicas, Ingeniería del Terreno y Mecánica de los Medios Continuos y Teoría de EstructurasGrado en Ingeniería Mecánic

Célula robotizada de soldadura para componentes de vehículos

En la automatización de un puesto de soldadura para la industria de la automoción entran en juego muchos equipamientos e instalaciones. Se presentan en este trabajo aquellos más directamente relacionados con la propia tarea de soldadura, objeto de la célula.Departamento de Construcciones Arquitectónicas, Ingeniería del Terreno y Mecánica de los Medios Continuos y Teoría de EstructurasMáster en Ingeniería Industria

Serum levels of anti-alphaGalactosyl antibodies predict survival and peritoneal dialysis-related enteric peritonitis rates in patients undergoing renal replacement therapy

[Abstract] Background: Anti-Galα1-3Gal antibodies (anti-αGal) represent a significant fraction of natural antibodies and were implicated in several disease states, yet their origin and physiological significance remain largely undisclosed. Methods: Under a prospective observational design, we estimated anti-αGal immunoglobulin G (IgG)/IgM and antipig hemolytic antibody (APA) levels in 133 patients starting dialysis therapy and again after a 1-year follow-up. We used baseline data to show correlations with demographic, nutritional, inflammatory, and anemia markers and analyzed their correlation with outcomes by using univariate and multivariate strategies of survival analysis. Results: Serum anti-αGal and APA levels showed wide baseline variability, but remained relatively stable in time. Both were measurable in dialysate of peritoneal dialysis (PD) patients, showing close correlation to serum levels. We observed no association between levels of anti-αGal/APA and nutritional markers, but showed direct correlations of anti-αGal IgM (P = 0.005) and APA levels (P = 0.001) with tumor necrosis factor α (TNF-α) levels. High APA levels also were associated with severe anemia (P = 0.006). High baseline anti-αGal IgM (P = 0.03) and APA levels (P = 0.045) predicted later risk for enteric peritonitis in PD patients. Finally, univariate and multivariate analyses showed a consistent association between high baseline anti-αGal IgM (P = 0.014) and APA (P = 0.021) levels and global risk for mortality during follow-up. Conclusion: Anti-αGal IgM and APA levels at the start of dialysis therapy are significant predictors of later risk for mortality and, in PD patients, enteric peritonitis. Both correlate directly with TNF-α levels and, in the case of APA, severity of anemia in these patients

Prognostic Value of Treadmill Exercise Echocardiography

[Abstract] Introduction and objectives. Exercise echocardiography (EE) is useful for diagnosing coronary disease, but little is known about its value for risk stratification. We aimed to determine: a) whether data from EE supplemented clinical data and data from exercise testing and resting echocardiography in predicting cardiac events; and b) whether the number and location of abnormal regions and their responses to exercise influenced risk stratification. Patients and method. The 2,436 patients referred for EE were followed up for 2.1 ±1.5 years. Some 120 serious cardiovascular events (i.e., non-fatal myocardial infarction or cardiovascular death) occurred before revascularization. Results. In 1203 patients (49%), EE gave abnormal results. There were 89 events in patients with an abnormal result (7.3%) and 31 in those with a normal result (2.5%; P <.0001). Multivariate analysis of clinical data, and data from exercise testing, resting echocardiography, and EE showed that male sex (RR=1.7; 95% CI, 1.1–2.8; P = .02), metabolic equivalents or METs (RR=0.9; 95% CI, 0.86–0.98; P=.01), peak heart rate × blood pressure (RR= 0.9; 95% CI, 0.9; P=.002), resting wall motion score index (RR=2.5; 95% CI, 1.5–4.1; P <.0001), and number of abnormal regions at peak exercise (RR=1.4; 95% CI, 1.2–1.7; P<.0001) were independently associated with the risk of a serious event (final model χ2, 170; incremental P <.0001). The same variables, excluding sex, were independently associated with cardiovascular death (final model χ2, 169; incremental P = .01). Conclusions. Exercise echocardiography supplements clinical data and data from exercise testing and resting echocardiography in patients with known or suspected coronary artery disease.[Resumen] Introducción y objetivos. Aunque la ecocardiografía de ejercicio es útil para el diagnóstico de la enfermedad coronaria, hay menos datos referentes a su valor pronós-tico. El objetivo de este estudio fue esclarecer: a) si hay un valor incremental de la ecocardiografía en el pico del ejercicio respecto a las variables clínicas, la prueba de esfuerzo y la ecocardiografía en reposo, y b) si el número y la localización de los territorios afectados, así como el tipo de respuesta al ejercicio, influyen en la estratificación. Pacientes y método. En 2.436 pacientes referidos para ecocardiografía de ejercicio se realizó un seguimien-to de 2,1 ± 1,5 años. Hubo 120 eventos (infarto no fatal o muerte cardiovascular) antes de la revascularización. Resultados. La ecocardiografía fue anormal en 1.203 pacientes (49%). Hubo 89 eventos en pacientes con resul-tado anormal (7,3%) frente a 31 con resultado normal (2,5%; p < 0,001). Mediante un análisis multivariable de variables clínicas, de la prueba de esfuerzo y de la ecocardiografía en reposo y ejercicio encontramos que las variables asociadas de manera independiente con el riesgo de eventos eran: ser varón (riesgo relativo [RR] = 1,7; interva-lo de confianza [IC] del 95%, 1,1–2,8; p = 0,02), los equiva-lentes metabólicos o MET (RR = 0,9; IC del 95%, 0,9–1,0; p = 0,01), el producto frecuencia cardíaca × presión arterial (RR = 0,9; IC del 95%, 0,9–1,0; p = 0,02), el índice de moti-lidad segmentaria basal (RR = 2,5; IC del 95%, 1,5–4,1; p < 0,0001) y el número de territorios afectados (RR = 1,4; IC del 95%, 1,2-1,7; p < 0,0001) (χ2 final = 170, valor incremental de la ecocardiografía en el máximo esfuerzo; p < 0,0001). Las mismas variables, excepto el sexo, estaban asociadas con la muerte (χ2 final = 169, valor incremental de la ecocardiografía de ejercicio; p = 0,01). Conclusiones. La ecocardiografía en el máximo ejercicio incrementa el valor pronóstico de las variables clínicas, la prueba de esfuerzo y la ecocardiografía de reposo

Peritoneal total protein transport assessed from peritoneal equilibration tests using different dialysate glucose concentrations

Randomized controlled trial[Abstract] Background: The peritoneal equilibration test (PET) permits assessment of peritoneal protein transport, but this potential marker of outcome in peritoneal dialysis (PD) patients lacks adequate standardization. ♢ Objectives: To assess various approaches for estimation of peritoneal protein transport in PD patients during 2.27% and 3.86% glucose-based PETs, and to uncover the demographic, clinical, and biochemical correlates of this phenomenon. ♢ Patients and methods: We studied 90 PD patients who underwent 2.27% and 3.86% PETs in random order, and we used multivariate analysis to compare assessments of peritoneal protein transport in both tests, searching for correlations between D₂₄₀' - D₀' protein concentration (PETΔPConc), total peritoneal protein excretion (PET-PPE), or total protein clearance (PET-PC) on the one hand (the main study variables), and PET-derived markers of peritoneal function and selected demographic, clinical, and biochemical variables on the other. ♢ Results: The PETΔPConc was higher during the 2.27% PET (mean: 45.2 mg/dL vs 37.0 mg/dL for the 3.86% test; p = 0.003); the PET-PPE and PET-PC were comparable (1121.8 mg vs 1168.9 mg, p = 0.52, and 17.1 mL vs 17.8 mL, p = 0.66, respectively). All three variables sustained a significant, yet moderate correlation (all r² values < 0.30) with the 24-hour PPE rate. Multivariate analysis identified dialysate-to-plasma ratio (D/P₂₄₀') of creatinine, end-to-initial dialysate ratio (D₂₄₀'/D₀') of glucose, current daily peritoneal glucose load, ultrafiltration during PET, systolic blood pressure, and previous cardiovascular events (3.86% test only) as independent predictors of protein transport during PET. ♢ Conclusions: Either PET-PPE or PET-PC seems preferable to PETΔPConc for characterization of peritoneal protein transport. Small-solute transport characteristics, ultrafiltration, and current peritoneal glucose load sustain independent correlations with peritoneal protein transport. The latter variable shows also a moderate association with markers of cardiovascular disease in PD patients

Effect of low-GDP bicarbonate–lactate-buffered peritoneal dialysis solutions on plasma levels of adipokines and gut appetite-regulatory peptides: a randomized crossover study

This is a pre-cpyedited, author-produced version of an article accepted for publication in "Nephrology Dialysis Transplantation" following peer review. The version of record is avaliable online at Oxford Academic web page.Instituto de Salud Carlos III; PI051024Instituto de Salud Carlos III; PI070413Red de Grupos RGTO; G03/028Red de Grupos RGTO; PI050983Xunta de Galicia; PS07/12Xunta de Galicia; PGIDT05PXIC91605PNXunta de Galicia; INCITE08ENA916110E

Familial Dilated Cardiomyopathy and Isolated Left Ventricular Noncompaction Associated With Lamin A/C Gene Mutations

[Abstract] LMNA mutations have been associated with familial or sporadic dilated cardiomyopathy (DC), with or without conduction system disease. We studied the LMNA gene in 67 consecutive patients with DC (18 had familial DC, 17 had possible familial DC, and 32 sporadic DC). From genomic DNA, coding regions of the LMNA gene were amplified by polymerase chain reaction, studied by single-strand conformation polymorphism, and cycle sequenced. Mutations were confirmed by restriction fragment length polymorphism. Two disease-causing mutations were found in families A and B. In family A, a novel R349L mutation was present in the mother and her identical twin daughters. They required cardiac transplantation at 36, 18, and 20 years of age. In family B, the R190W mutation was present in 2 cousins with DC and without conduction system disease (1 had cardiac transplantation at 45 years of age and 1 died suddenly at 46 years of age) and in 2 of their sons. The mothers of the 2 affected patients died due to cardiac causes in their 40s (1 died suddenly). One of the carriers fulfilled diagnostic criteria for isolated left ventricular noncompaction. Our data associated the R349L and R190W mutations in LMNA with severe forms of familial DC. LMNA mutations should be considered in the genetic screening of patients with familial DC without conduction system disease. Isolated left ventricular noncompaction may be part of the phenotypic spectrum of the laminopathies.Xunta de Galicia; PGIDT00PXI13401P

Economic evaluation of complete revascularization versus stress echocardiography-guided revascularization in the STEACS with multivessel disease

[Resumen] Introducción y objetivos. Los estudios económicos pueden ayudar a tomar decisiones en el tratamiento de la enfermedad multivaso en el infarto. Se planteó realizar una evaluación económica del ensayo clínico CROSS-AMI (Complete Revascularization or Stress Echocardiography in Patients With Multivessel Disease and ST-Segment Elevation Acute Myocardial Infarction). Métodos. Se realizó un análisis de comparación de costes económicos de las estrategias (revascularización angiográfica completa [RCom] y revascularización selectiva guiada por isquemia en ecocardiograma de estrés [RSel]) comparadas en el ensayo clínico CROSS-AMI (N = 306), derivados de la hospitalización inicial y del primer año de seguimiento, según las tarifas oficiales vigentes en nuestro sistema de salud. Resultados. El coste de la hospitalización inicial resultó superior en el grupo de RCom que en la rama de RSel (19.657,9 ± 6.236,8 frente a 14.038,7 ± 4.958,5 euros; p < 0,001). No hubo diferencias entre ambos grupos en el coste del primer año de seguimiento (RCom, 2.423,5 ± 4.568,0 euros; Rsel, 2.653,9 ± 5.709,1 euros; p = 0,697). El coste total fue 22.081,3 ± 7.505,6 euros en la rama de RCom y 16.692,6 ± 7.669,9 euros en la rama de RSel (p < 0,001). Conclusiones. En el ensayo clínico CROSS-AMI, el sobrecoste inicial de la RCom frente a la RSel no se vio compensado por un ahorro significativo en el seguimiento. La RSel parece ser una estrategia más eficiente que la RCom para los pacientes con síndrome coronario agudo con elevación del segmento ST y enfermedad multivaso tratados mediante angioplastia emergente.[Abstract] Introduction and objectives. Economic studies may help decision making in the management of multivessel disease in the setting of myocardial infarction. We sought to perform an economic evaluation of CROSS-AMI (Complete Revascularization or Stress Echocardiography in Patients With Multivessel Disease and ST-Segment Elevation Acute Myocardial Infarction) randomized clinical trial. Methods. We performed a cost minimization analysis for the strategies (complete angiographic revascularization [ComR] and selective stress echocardiography–guided revascularization [SelR]) compared in the CROSS-AMI clinical trial (N = 306), attributable the initial hospitalization and readmissions during the first year of follow-up, using current rates for health services provided by our health system. Results. The index hospitalization costs were higher in the ComR group than in SelR arm (19 657.9 ± 6236.8 € vs 14 038.7 ± 4958.5 €; P < .001). There were no differences in the costs of the first year of follow-up rehospitalizations between both groups for (ComR 2423.5 ± 4568.0 vs SelR 2653.9 ± 5709.1; P = .697). Total cost was 22 081.3 ± 7505.6 for the ComR arm and 16 692.6 ± 7669.9 for the SelR group (P < .001). Conclusions. In the CROSS-AMI trial, the initial extra economic costs of the ComR versus SelR were not offset by significant savings during follow-up. SelR seems to be more efficient than ComR in patients with ST-segment elevation acute coronary syndrome and multivessel disease treated by emergent angioplasty