Características de la Hepatopatía Crónica tras la Cirugía de Fontan

La cirugía de Fontan constituye el procedimiento quirúrgico de elección para un gran número de pacientes con cardiopatías congénitas univentriculares. Su objetivo es derivar el retorno venoso directamente a las arterias pulmonares, sin pasar por el ventrículo derecho, lo que permite mantener la oxigenación sanguínea y prolongar la supervivencia. Sin embargo, la congestión venosa crónica produce un amplio abanico de alteraciones estructurales y funcionales en el hígado que se engloban dentro del término enfermedad hepática asociada a la cirugía de Fontan. La presente tesis se compone de tres publicaciones cuyo objetivo es evaluar esta entidad. El primer artículo es un estudio observacional, prospectivo y multicéntrico que pone de manifiesto que los nódulos hepáticos son frecuentes, especialmente cuando han trascurrido más de 10 años desde la cirugía de Fontan. Los resultados obtenidos sugieren que el diagnóstico de carcinoma hepatocelular requiere confirmación histológica, ya que los nódulos benignos pueden presentar una imagen radiológica similar. La segunda publicación es una revisión sistemática de la literatura del carcinoma hepatocelular, el cual constituye la principal causa de muerte hepática en esta población. Nuestra revisión indica que el carcinoma hepatocelular suele aparecer a partir de los 10 años de la cirugía y que suele diagnosticarse en estadios avanzados, lo que sugiere la necesidad de implementar programas de cribado. El tercer artículo es un estudio de casos y controles que encontró que la enteropatía pierde-proteínas se asocia con un mayor daño hepático y un estado proinflamatorio a nivel intestinal y sistémico. En conclusión, los pacientes con cirugía de Fontan presentan una prevalencia alta de nódulos hepáticos y un riesgo incrementado de carcinoma hepatocelular. La evaluación sistemática y el seguimiento de la enfermedad hepática es recomendable, siendo obligatorio en los pacientes con enteropatía pierde-proteínas y a partir de los 10 años de la cirugía

Los molinos de velas del campo de Cartagena: el paisaje del viento

La reflexión sobre los molinos de velas del Campo de Cartagena parte de una intención de aportar alternativas para su recuperación y puesta en valor. Se trata de, a partir de la nueva concepción del paisaje propuesta por el Convenio Europeo (Florencia 2000), analizar la situación actual de estos, más allá de su carácter funcional, a través del proceso histórico y social de percepción en cuanto a conformadores de paisaje, desde las primeras referencias de los viajeros extranjeros, hasta los pioneros impulsores de una protección que no se ha demostrado efectiva, tratando de organizar los valores que incidan en sus significados simbólicos, capaces de convertirlos en imagen representativa de la comarca

Towards a greener endoscopy: considerations on the strategies to improve sustainability

Climate crisis is dramatically changing life on earth. Environmental sustainability and waste management are rapidly gaining centrality in quality improvement strategies of healthcare, especially in procedure- dominant fields such as gastroenterology and digestive endoscopy. Therefore, healthcare interventions and endoscopic procedures must be evaluated through the ‘triple bottom line’ of financial, social, and environmental impact. The purpose of the paper is to provide information on the carbon footprint of gas- troenterology and digestive endoscopy and outline a set of measures that the sector can take to reduce the emission of greenhouse gases while improving patient outcomes. Scientific societies, hospital execu- tives, single endoscopic units can structure health policies and investment to build a “green endoscopy”. The AIGO study group reinforces the role of gastrointestinal endoscopy professionals as advocates of sus- tainability in digestive endoscopy. The “green endoscopy” can shape a more sustainable health service and lead to an equitable, climate-smart, and healthier future.info:eu-repo/semantics/publishedVersio

Spermatozoa recovery and post-thawing quality of brown bear ejaculates is affected for centrifugation regimes

P. 77–84Sperm cryopreservation protocols for brown bear (Ursus arctos) require the centrifugation of semen samples to increase sperm concentration and to clean urine in contaminated samples. We evaluated the effect of centrifugation regimes (time and relative centrifugal force—RCF) on the quantity of sperm recovered and the quality of post-thawed sperm. Thirteen brown bears were electroejaculated. The ejaculates were diluted 1:1 in Tris–citric acid–glucose (TCG) extender and centrifuged with different RCF/time combinations: 600×g, 1,200×g and 2,400×g, for 3, 6 or 12 min. After centrifugation, spermatozoa were diluted in TES–Tris–fructose extender with egg yolk and glycerol (final glycerol concentration of 8%) and frozen in 0.25-mL straws. In the post-thawed semen, motility was assessed by CASA, and acrosomal status (PNA-FITC), viability (SYBR-14 with propidium iodide) and chromatin status (SCSA) were determined by flow cytometry. The longest centrifugation time (12 min) significantly decreased some motility parameters. Sperm recovery significantly decreased in brown bear at 600×g. Our results suggest that brown bear spermatozoa are more sensitive to long centrifugation times than to high RCF. Centrifugation regimes showed no effects on the post-thawing chromatin status. We recommend preparing the brown bear semen for freezing by centrifugation 1,200×g or 2,400×g for 6 min, after electroejaculation and dilution 1:1 in TCG extender, since these procedures increase the spermatozoa recovery without harmful effects on the post-thawed quality of brown bear spermatozoa.S

Effect of basic factors of extender composition on post-thawing quality of brown bear electroejaculated spermatozoa

P. 643-651The improvement of freezing extenders is critical when defining sperm cryopreservation protocols for wild species, in order to create germplasm banks. The aim of this study was to evaluate the effect of additives (Equex Paste and EDTA) supplementation, egg-yolk (10 and 20%) and glycerol (4 and 8%) concentrations and extender osmolality (300 and 320 mOsm/kg) on the post-thawing quality of brown bear semen. Semen was obtained from 20 adult males by electroejaculation, and centrifugated individually (600 × g for 6 min). The pellets were diluted 1:1 in the corresponding extender TTF (TES-Tris-Fructose with the aforementioned variants) and cooled to 5 °C. Then, it was diluted down to 100 × 106 spz/mL, loaded in 0.25 mL straws and frozen at −20°C/min. After thawing (in water at 65 °C for 6s), the semen samples were assessed for motility (CASA), viability (SYBR-14 with propidium iodide), acrosomal status (PNA-FITC with propidium iodide) and mitochondrial activity (JC-1). Extender supplementation with additives rendered significantly higher results for these sperm parameters. Comparing the two percentages of egg yolk, 20% egg yolk showed the highest motility results, percentages of viable spermatozoa and viable spermatozoa with intact acrosome. No differences were detected among samples frozen using 4 or 8% glycerol. For extender osmolality, 300 mOsm/kg showed higher values of VAP, VCL, VSL, and ALH than 320 mOsm/kg. Based on the best performance of sperm motility, viability and acrosome status, we conclude that the most suitable extender to cryopreserve brown bear spermatozoa was TTF adjusted to 300 mOsm/kg, supplemented with 20% egg yolk, 4–8% glycerol, and the additives 1% Equex paste and 2% EDTA.S

Early predictors of corticosteroid response in acute severe autoimmune hepatitis: a nationwide multicenter study

Early predictors; Corticosteroid; Autoimmune hepatitisPredictors primerencs; Corticosteroides; Hepatitis autoimmunePredictores tempranos; Corticosteroide; Hepatitis autoinmuneBackground and Aims To assess whether corticosteroids improve prognosis in patients with AS-AIH, and to identify factors at therapy initiation and during therapy predictive of the response to corticosteroids. Methods This was a retrospective cohort study including all patients with AS-AIH admitted to 13 tertiary centres from January 2002 to January 2019. The composite primary outcome was death or liver transplantation within 90 days of admission. Kaplan–Meier and Cox regression methods were used for data analysis. Results Of 242 consecutive patients enrolled (mean age [SD] 49.7 [16.8] years), 203 received corticosteroids. Overall 90-day transplant-free survival was 61.6% (95% confidence interval [CI] 55.4–67.7). Corticosteroids reduced the risk of a poor outcome (adjusted hazard ratio [HR] 0.25; 95% CI 0.2–0.4), but this treatment failed in 30.5%. An internally validated nomogram composed of older age, MELD, encephalopathy and ascites at the initiation of corticosteroids accurately predicted the response (C-index 0.82; [95% CI 0.8–0.9]). In responders, MELD significantly improved from days 3 to 14 but remained unchanged in non-responders. MELD on day 7 with a cut-off of 25 (sensitivity 62.5%[95% CI: 47.0–75.8]; specificity 95.2% [95% CI: 89.9–97.8]) was the best univariate predictor of the response. Prolonging corticosteroids did not increase the overall infection risk (adjusted HR 0.75; 95% CI 0.3–2.1). Conclusion Older patients with high MELD, encephalopathy or ascites at steroid therapy initiation and during treatment are unlikely to show a favourable response and so prolonged therapy in these patients, especially if they are transplantation candidates, should be avoided.This study was supported in part by grants from the Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III, number PI20/01302, awarded to Agustín Albillos and number PI 21/01310, awarded to Luis Téllez. CIBEREHD is funded by the Instituto de Salud Carlos III using grants cofinanced by the European Development Regional Fund “A way to achieve Europe” (EDRF). María Carlota Londoño received support from the Plan Nacional de I+D+I co-funded by ISCIII-Subdirección General de Evaluación and Fondo Europeo de Desarrollo Regional (FEDER-"Una manera de Hacer Europa") (PI17/00955). Laura Patricia Llovet received the Resident Award “Clínic-La Pedrera” granted by the Hospital Clínic de Barcelona, Research, Innovation and Education Department

Human adipose tissue–derived mesenchymal stromal cells and their phagocytic capacity

This study was supported by Research Group BIO277 (Junta de Andalucia), the Department of Nursing of the University of Granada and The Cell Production Unit of the Virgen de las Nieves Hospital of Granada (Servicio Andaluz de Salud).Mesenchymal stromal cells (MSCs) have evidenced considerable therapeutic potential in numerous clinical fields, especially in tissue regeneration. The immunological characteristics of this cell population include the expression of Toll-like receptors and mannose receptors, among others. The study objective was to determine whether MSCs have phagocytic capacity against different target particles. We isolated and characterized three human adipose tissue MSC (HAT-MSC) lines from three patients and analysed their phagocytic capacity by flow cytometry, using fluorescent latex beads, and by transmission electron microscopy, using Escherichia coli, Staphylococcus aureus and Candida albicans as biological materials and latex beads as non-biological material. The results demonstrate that HAT-MSCs can phagocyte particles of different nature and size. The percentage of phagocytic cells ranged between 33.8% and 56.2% (mean of 44.37% +/- 11.253) according to the cell line, and a high phagocytic index was observed. The high phagocytic capacity observed in MSCs, which have known regenerative potential, may offer an advance in the approach to certain local and systemic infections.Junta de Andalucia BIO277Department of Nursing of the University of GranadaCell Production Unit of the Virgen de las Nieves Hospital of Granada (Servicio Andaluz de Salud

Sensitivity Evaluation Method for Aerospace Digital Systems with Collaborative Hardening

Complexity of current digital systems and circuits involves new challenges in the field of hardening and measuring circuits sensitivity under SEEs. In this work, a new solution for evaluating the SEU sensitivity of space systems based on using programmable logic devices is proposed. This solution is able to perform a deep analysis of fault effects in systems with hardware functionality distribution, taking into account the high complexity of the hardware nodes (complex programmable logic devices) and their collaborative hardening properties

Técnicas de programación neurolingüística ante la crisis Covid-19 una aproximación para el desarrollo de las habilidades productivas en la enseñanza del idioma Inglés en Ecuador

Education has undergone important changes, even more since the end of 2019 when a global pandemic begins that undoubtedly affects the teaching and learning of the English language in Ecuador, the primary objective of this research was to determine the influence of neurolinguistics programming on development of Productive skills in times of pandemic, given that students cannot express themselves correctly orally and in writing in their usual virtual classes today, using incorrect phrases with little use of vocabulary and without understanding, which shows low self-esteem and interest in learning English. Shame and fear of making a mistake without understanding on the part of the teacher and classmates are other important aspects when making a comment or starting a dialogue. In this context, it was proposed to carry out the present experimentation with 30 students. For this study, a single group design was adopted before and after the test using a quantitative methodology carried out in the era of the pandemic. The problems of the students in the development of productive skills were evaluated using the SPSS statistical program, applying the Student's T or Statistical related tests. Based on the results of the pre-test, neurolinguistic strategies (anchoring, creating a relationship, mirroring, maintaining flow) were applied for 4 weeks in face-to-face and virtual English classes due to the covid 19 pandemic. At the end of the experimentation , a post-test, and the results of the study revealed that the students, through neurolinguistic programming, presented significant improvements in the productive skills of the English language, highlighting that the use of the aforementioned strategies positively helps the Acquisition of a second language, especially in the way they express themselves in English, giving them greater freedom and confidence when issuing an oral and written comment in a second languageLa educación ha sufrido cambios importantes, a un más desde finales del año 2019 donde inicia una pandemia mundial que sin duda afecta la enseñanza y el aprendizaje en el idioma inglés en el Ecuador, el objetivo primordial de esta investigación fue determinar la influencia de las técnicas de  programación neurolingüística en el desarrollo de las habilidades productivas en tiempos de pandemia, dado que los estudiantes no pueden expresarse correctamente de forma oral y escrita en sus clases virtuales, utilizando frases incorrectas, con poco uso de vocabulario y sin comprensión, lo que muestra baja autoestima e interés al expresarse en idioma inglés. La vergüenza y el miedo de cometer errores sin tener un entendimiento por parte del profesor y los compañeros de clase son otros aspectos importantes al momento de emitir un comentario o entablar un diálogo. En este contexto, se propuso realizar la presente experimentación con 30 estudiantes. Para este estudio se adoptó un diseño de grupo único pre y post-prueba utilizando una metodología de carácter cuantitativo realizado durante la pandemia. Los problemas de los estudiantes en el desarrollo de habilidades productivas fueron evaluados mediante el programa estadístico SPSS, aplicando el test estadístico T Student de pruebas relacionadas. Con base en los resultados de la preprueba, se aplicaron técnicas neurolingüísticas (Anclaje, Crear relación, Espejo, Mantener el flujo) durante 4 semanas en las clases presenciales y virtuales de inglés por la pandemia Covid-19. Al final de la experimentación, se realizó una post prueba, y el resultado del estudio reveló que los estudiantes a través de la programación neurolingüística, presentaron mejoras significativas en las habilidades productivas del idioma inglés, destacando que el uso de las estrategias mencionadas ayuda positivamente a la adquisición de un segundo idioma, especialmente en la forma de expresarse en inglés, dándoles mayor libertad y confianza a la hora de emitir un comentario oral y escrito en un segundo idioma

Learning and training techniques in fuzzy control for energy efficiency in buildings

A novel procedure for learning Fuzzy Controllers (FC) is proposed that concerns with energy efficiency issues in distributing electrical energy to heaters in an electrical energy heating system. Energy rationalization together with temperature control can significantly improve energy efficiency, by efficiently controlling electrical heating systems and electrical energy consumption. The novel procedure, which improves the training process, is designed to train the FC, as well as to run the control algorithm and to carry out energy distribution. Firstly, the dynamic thermal performance of different variables is mathematically modelled for each specific building type and climate zone. Secondly, an exploratory projection pursuit method is used to extract the relevant features. Finally, a supervised dynamic neural network model and identification techniques are applied to FC learning and training. The FC rule-set and parameter-set learning process is a multi-objective problem that minimizes both the indoor temperature error and the energy deficit in the house. The reliability of the proposed procedure is validated for a city in a winter zone in Spain