The transmetalation step in Pd-catalyzed processes: understanding the role of the classical nucleophile, the ligands and the synthetic potential of a third metal

The transmetalation step of Pd-catalyzed reactions is studied in-depth in this Doctoral Thesis. New bimetallic systems based on the Au/Pd and the Cu/Pd couple have been developed in the context of the Stille reaction and the Hiyama reaction that are very efficient for the coupling of bulky groups. This type of couplings are very challenging with other methodologies and provide excellent results under a synthetic point of view with our bimetallic approach. The bimetallic systems have been examined under a mechanistic point of view. The role of the cocatalyst, the auxiliary ligands and the tin and silicon organometallics have been understood, providing relevant information for the improvement of these systems and the development of new others. The secondary transmetalations that lead to undesired byproducts in the Negishi reaction have been studied in detail by experimental and computational techniques. The information obtained in our study provides important information that will contribute to develop more efficient Negishi reactions. A ligand designed in our group to promote challenging reductive eliminations has been tested for the Pd-catalyzed fluorination and trifluoromethylation of aryl halides. The ligand is not effective for this reaction due to the existence of a migratory insertion process that prevents the desired reductive elimination. This process has been studied by DFT calculations. The mechanisms of the N-H activation of anilines by Ir(PCP) complexes has been carried out by experimental and computational techniques. The information obtained will be used to design more efficient reactions based on this activation.Departamento de Química Física y Química InorgánicaDoctorado en Química: Química de Síntesis, Catálisis y Materiales Avanzado

Comparison of seven prognostic tools to identify low-risk pulmonary embolism in patients aged <50 years

publishersversionPeer reviewe

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Rate and duration of hospitalisation for acute pulmonary embolism in the real-world clinical practice of different countries : Analysis from the RIETE registry

publishersversionPeer reviewe

Educafarma 10.0

Memoria ID-030. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2021-2022

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Un centro abierto al entorno

Un centro de Eduación Compensatoria y de Necesidades Educativas Especiales pretende convertir el entorno en fuente de aprendizaje real y directo con una extensión desde la localidad de Pozuelo de Alarcón a las nacionalidades del alumnado. Los objetivos son: fomentar las relaciones del colegio con otras instituciones locales y empresas que puedan favorecer la educación participativa, integrar las actividades extraescolares en la programación didáctica, elaborar fichas técnicas sobre los recursos de la zona, utilizar los talleres como metodología activa, participativa y creativa para el estudio del medio natural, cultural y social. Se elabora material fotográfico y vídeos de las jornadas (semana de la paz, carnaval, fiesta de los juegos cooperativos, semana del libro, etc.); material didáctico: fichas técnicas de organización y resumen de las visitas y cuadernillos de observación; materiales elaborados en los talleres; y reportajes y crónicas para su publicación en revistas técnicas. Se evalúa el grado de consecución de los objetivos a partir de escalas de obseración, actas de actividades y encuestas a alumnado y profesorado.Madrid (Comunidad Autónoma). Consejería de Educación y CulturaMadridMadrid (Comunidad Autónoma). Subdirección General de Formación del Profesorado. CRIF Las Acacias; General Ricardos 179 - 28025 Madrid; Tel. + 34915250893ES

Neurological comorbidity is a predictor of death in Covid-19 disease: A cohort study on 576 patients

[Introduction]: Prognosis of Coronavirus disease 2019 (Covid-19) patients with vascular risk factors, and certain comorbidities is worse. The impact of chronic neurological disorders (CND) on prognosis is unclear. We evaluated if the presence of CND in Covid-19 patients is a predictor of a higher in-hospital mortality. As secondary endpoints, we analyzed the association between CND, Covid-19 severity, and laboratory abnormalities during admission.[Methods]: Retrospective cohort study that included all the consecutive hospitalized patients with confirmed Covid-19 disease from March 8th to April 11th, 2020. The study setting was Hospital Clínico, tertiary academic hospital from Valladolid. CND was defined as those neurological conditions causing permanent disability. We assessed demography, clinical variables, Covid-19 severity, laboratory parameters and outcome. The primary endpoint was in-hospital all-cause mortality, evaluated by multivariate cox-regression log rank test. We analyzed the association between CND, covid-19 severity and laboratory abnormalities.[Results]: We included 576 patients, 43.3% female, aged 67.2 years in mean. CND were present in 105 (18.3%) patients. Patients with CND were older, more disabled, had more vascular risk factors and comorbidities and fewer clinical symptoms of Covid-19. They presented 1.43 days earlier to the emergency department. Need of ventilation support was similar. Presence of CND was an independent predictor of death (HR 2.129, 95% CI: 1.382–3.280) but not a severer Covid-19 disease (OR: 1.75, 95% CI: 0.970–3.158). Frequency of laboratory abnormalities was similar, except for procalcitonin and INR.[Conclusions]: The presence of CND is an independent predictor of mortality in hospitalized Covid-19 patients. That was not explained neither by a worse immune response to Covid-19 nor by differences in the level of care received by patients with CND.Peer reviewe

La pizarra digital : motor de renovación pedagógica

Se desarrolla un proyecto de innovación educativa que pretende impulsar la innovación pedagógica y la motivación en el aula mediante el uso adecuado de las Nuevas Tecnologías, lo que supone una renovación de la metodología docente y de los procesos de enseñanza y aprendizaje. Se trata de familiarizar al profesorado con el uso de la Nuevas Tecnologías y de Internet como herramientas educativas útiles en la atención a la diversidad en el alumnado. Se conocen e intercambian experiencias con otros centros y profesorado que utilicen las nuevas Tecnologías en la práctica docente. El proyecto consigue que el alumnado elabore materiales obtenidos de Internet o de otros medios, resuelvan problemas, y realicen la presentación de los mismos a sus compañeros. El proyecto se desarrolla en tres fases: la primera se centra en la formación inicial en la que se realiza una formación técnica del funcionamiento de los nuevos elementos de la pizarra digital y una formación didáctica para que el profesorado realice propuestas didácticas de su materia y se lleve a la práctica; en la segunda fase se desarrolla el proyecto en el aula con el alumnado, cada profesor o profesora realiza las actividades programadas utilizando la pizarra digital y se realiza una encuesta para valorar los resultados de dichas actividades; en la tercera etapa se realiza la recogida de materiales elaborados, se evalúan y se realiza una memoria final en la que se aportan los resultados obtenidos tras la aplicación del proyecto de innovación. La experiencia ha favorecido el aprendizaje del alumnado y ha potenciado el uso por parte de los docentes de metodologías innovadoras que favorezcan los procesos de enseñanza aprendizaje.Castilla y LeónConsejería de Educación. Dirección General de Universidades e Investigación; Monasterio de Nuestra Señora de Prado, Autovía Puente Colgante s. n.; 47071 Valladolid; +34983411881; +34983411939ES