Sedación y analgesia puntual para procedimientos en el paciente crítico grave: revisión de la evidencia científica

El trabajo consistirá en una revisión bibliográfica de las últimas evidencias en farmacología en cuanto a medicación analgésica y sedante a utilizar en pacientes críticos para procedimientos como por ejemplo reducciones de fracturas, cardioversiones, endosocopias urgentes, etc, así como la monitorización requerida en las mismas al utilizar cada tipo de fármaco

Strategies to Personalize and to Depersonalize Donors in Parental Narratives of Children’s Genetic / Gestational Origins (Spain)

What strategies do parents who resort to ‘third-party’ reproduction use to deal with donors in the conversations they have with their children on the topic? Few studies deal with the images and representations that families build of donors and transmit to their children through stories about their origins, strategies that vary according to the family model and the type of donation. A qualitative investigation was carried out in Spain between 2013 and 2015 on the dissemination of their genetic or gestational origins to children conceived through assisted reproduction with donors. This article studies families in favor of disclosure who were contacted through associations, blogs, online forums, and the snowball method. The analysis has revealed strategies of depersonalization (concealing one of the donors, treating the donor as an object, pluralization, transformation into a magical and evanescent character, individualization) and personalization (the personalized construction, naming the donor and visualizing him or her, pluriparentality) that have the effect (and purpose) of de-kinning the children from the donors while kinning them with the social parents and their extended families. Thus, the strategies of de-kinning that we find in the stories about origins are the necessary preparatory step to kin the child to the non-genetic parent and to manage intervention by third parties in the production of children that challenges the exclusivity of the motherhood / paternity characteristic of our cultural kinship system. The dissociation between biogenetic, social and legal links as a result of the intervention of third parties opens the possibility of generating new parental connections that exceed the hegemonic model of biparentality

Eco-trench: a novel trench solution based on reusing excavated material and a finishing layer of expansive concrete

Installing utility pipelines generates a significant amount of trench arisings, which are usually transported to landfills instead of being reused as backfill material. This practice generates CO2 emissions and wastes raw materials. This paper presents a more sustainable solution, an eco-trench, which is based on re-using trench arisings as backfill and adding a top layer of expansive concrete to improve the eco-trench’s structural performance. The technical feasibility of the eco-trench was evaluated through a finite element model, which identified the degree of expansion in concrete required to avoid failure or subside the stresses caused by traffic. The potential expansion of concrete was measured under confined conditions in the laboratory by means of a novel test developed for this purpose. The results showed that adding calcium oxide generates the required internal stress. The results were then confirmed in a pilot experience.Peer ReviewedPostprint (published version

Nutrition and cellular senescence in obesity-related disorders

Julio Plaza-Diaz is part of the “UGR Plan Propio de Investigación 2016 and the “Excellence actions: Unit of Excellence on Exercise and Health (UCEES), University of Granada”. Julio Plaza-Diaz is sup- ported by a grant awarded to postdoctoral researchers at foreign universities and research centers from the “Fundación Ramón Are- ces”, Madrid, Spain. Funding for open access charge: Universidad de Granada / CBUA.Adequate nutrition is vital for immune homeostasis. However, the incidence of obesity is increasing worldwide due to the adoption of the Western diet and a sedentary lifestyle. Obesity is associated with chronic inflammation which alters the function of adipose tissue, liver, pancreas, and the nervous system. Inflammation is related to cellular senescence, distinguished by irreversible cell cycle arrest. Senescent cells secrete the senescence-associated secretory phenotype (SASP) which contains pro-inflammatory factors. Targeting processes in senescence might have a salutary approach to obesity. The present review highlights the impact of an unhealthy diet on tissues affected by obesity, and the mechanisms that promote the consequent inflammation and senescence.UGR Plan Propio de Investigación 2016Excellence actions: Unit of Excellence on Exercise and Health (UCEES), University of Granada“Fundación Ramón Are- ces”, Madrid, Spain.Universidad de Granada / CBU

Testing for Vitamin D in High-Risk COPD in Outpatient Clinics in Spain: A Cross-Sectional Analysis of the VITADEPOC Study

Background: Vitamin D deficiency has been associated with an accelerated deterioration in lung function and increased exacerbations in chronic obstructive pulmonary disease (COPD). 25(OH) vitamin D levels have been indicated as a potentially useful marker for adverse results related to COPD. Methods: VITADEPOC is a cross-sectional clinical study recruiting consecutive patients with high-risk COPD. The objective of our study was to investigate vitamin D determination frequency in patients with high-risk COPD in clinical practice at outpatient clinics in Spain and to describe the factors associated with vitamin D testing. We also aimed to determine the frequency of vitamin D deficiency in these patients. Results: Only 51 (44%) patients underwent vitamin D determination and 33 (28.4%) had received vitamin D supplements in clinical practice. The patients who underwent testing for vitamin D in clinical practice were more often women (58.8% vs. 26.2%, p < 0.001) with comorbidities such as osteoporosis (19.6% vs. 6.2%, p < 0.001) or chronic renal failure (7.8% vs. 0%, p < 0.001) and with exacerbator phenotype (55% vs. 32.3%, p = 0.015). A total of 63 (54.3%) patients had serum vitamin D levels <20 ng/mL at the inclusion visit. Of these, 29 (46%) had serum vitamin D levels <12 ng/mL (severe deficiency). Having a history of inhaled corticosteroids (OR 3.210, p < 0.016), being treated with a cycle of systemic corticosteroids (OR 2.149, p < 0.002), and having a lower physical activity level (OR 3.840, p < 0.004) showed a statistically significant positive association with vitamin D deficiency. Conclusion: The testing of vitamin D levels in patients with high-risk COPD treated at outpatient respiratory clinics in Spain is infrequent. However, when tested, a severe deficiency is detected in one in four patients. Efforts to optimize case detection in COPD are needed.Depto. de MedicinaFac. de MedicinaTRUESociedad Madrileña de Neumología y Cirugía TorácicaResearch Pharma S.Lpu

Development of a screening test for cognitive impairment in alcoholic population: TEDCA.

ntroducción. Numerosos estudios han encontrado alteraciones cognitivas en pacientes con historia de trastorno por consumo de alcohol, afectando su funcionamiento psicosocial y consecución de objetivos terapéuticos. Para identificar estas afectaciones se han utilizado pruebas de cribado cognitivo a pesar de que no han sido diseñadas para esta población, aumentando el riesgo de error. Objetivo. Valorar los principales déficits cognitivos en pacientes con historia de trastorno por consumo de alcohol, para desarrollar una prueba de cribado de alteraciones cognitivas específica para estos pacientes. Metodología. El TEDCA (Test de detección de deterioro cognitivo en alcoholismo) se diseñó en base a tres dimensiones: Cognición Viso-espacial, Memoria/Aprendizaje y Función Ejecutiva. El estudio se dividió en dos fases: En la fase 1 se seleccionaron las pruebas con mayor capacidad de discriminación entre pacientes con diferentes niveles de afectación cognitiva, y en la fase 2 se realizaron los análisis de validez y fiabilidad. La muestra estuvo formada por 248 participantes, 88 controles (fase 2) y 160 pacientes (fase 1: n=70 y fase 2: n=90). Resultados. El TEDCA obtuvo una fiabilidad elevada (alfa de Cronbach 0.754), el análisis factorial confirmó la presencia de las 3 dimensiones definidas previamente, dis- criminó entre pacientes y controles, y presenta una buena validez diagnóstica de afectación cognitiva. Conclusiones. El TEDCA es una nueva prueba de cribado, que permite identificar la posible presencia de afectación cognitiva en pacientes con historia de trastorno por onsumo de alcohol, que puede ser utilizado en los ámbitos de psiquiatría, atención primaria e investigación.post-print146 K

Environmental and economic impacts of combining backfill materials for novel circular narrow trenches

Over the last few years, several policies and new technological solutions have targeted the construction sector with the aim of reducing the sector's impacts on the environment. Among the different technological advances proposed, the reuse of materials in construction has been reported as a promising solution for an increase in sustainability and circularity. In particular, a type of cities' undergrounds assets for which materials' reuse is being explored are trenches for protecting services (i.e., water and gas transport pipelines, and optic fibre and other telecommunications services). Nonetheless, the economic and environmental benefits and impact of this type of system is still insufficiently quantified. In this research study, the economic and environmental impacts of four scenarios of trenches were assessed by using Life Cycle Costing (LCC) and Life Cycle Assessment (LCA). The four alternatives analysed consisted of: (1) the classical solution; (2) the classical solution with the reuse of soil; (3) the control low-strength material, and (4) the eco-trench. The results allowed concluding that in the eco-trench system, for which all material is reused, the environmental and economic impacts could be reduced by more than 80% and 50%, respectively. A parametric study for which the dimensions of the trenches were varied, permitted to reinforce these results and to quantify the impact's change along with the width and depth of the trench. Overall, this study provides a comprehensive view of the high-impact potential of reusing material for the construction of trenches in cities. The outcomes allow also remarking that the eco-trench system could be an attractive and advantageous solution for urban infrastructure stakeholders, both from an economic and environmental perspective.Peer ReviewedObjectius de Desenvolupament Sostenible::11 - Ciutats i Comunitats SosteniblesObjectius de Desenvolupament Sostenible::11 - Ciutats i Comunitats Sostenibles::11.6 - Per a 2030, reduir l’impacte ambiental negatiu per capita de les ciutats, amb especial atenció a la qualitat de l’aire, així com a la gestió dels residus municipals i d’altre tipusPostprint (published version

Relationship between the Duration of the Second Stage of Labour and Neonatal Morbidity

(1) Background: To assess the relationship between the duration of the second stage of labour and the neonatal morbidity risk; (2) Methods: An observational, analytical, retrospective cohort study was performed at the “Mancha-Centro” Hospital (Spain) during the 2013–2016 period. Data were collected from 3863 women who gave a vaginal birth. The studied neonatal morbidity variables were umbilical cord arterial pH, 5-min Apgar score, need for advanced neonatal resuscitation, and a composite neonatal morbidity variable on which the multivariate analysis was done. A univariate analysis was used for the potential risk factors and a multivariate analysis with binary logistic regression to control for possible confounding factors; (3) Results: The univariate analysis showed a statistically significant relationship between the duration of the second stage of labour and a high risk of advanced neonatal resuscitation and composite neonatal morbidity in multiparous women. However, after performing the multivariate analysis for the variable “composite neonatal morbidity”, we observed no relationship with the duration of the second stage of labour in either nulliparous or multiparous women; (4) Conclusions: The duration of the second stage of labour was not related to an increased risk of neonatal morbidity in our study population

Polymer [Pd(CH2SO2C6H4Me)2]n, a precursor to remarkably stable Pd organometallics

Producción CientíficaA polymer [Pd(CH2SO2C6H4Me)2]n is obtained by thermolysis of cis-[Pd(CH2SO2C6H4Me)2(NCMe)2] to release the MeCN ligands. The corresponding coordination sites are then occupied by weak Pd–O bonds, easier to break than the previous Pd–N bonds. This allows us to produce from the polymer cis complexes containing ligands weaker than NCMe, such as acetone or water. The complexes cis-[Pd(CH2SO2C6H4Me)2{OC(CD3)2}2], cis-[Pd(CH2SO2C6H4Me)2(OH2)2], and cis-[Pd(CH2SO2C6H4Me)2(OH2){OC(CD3)2}], and cyclic dimers [Pd(CH2SO2C6H4Me)2(OH2)]2 with bridging methylsulphone groups are formed. The Pd : PPh3 : OH2 1 : 1 : 1 reaction of the polymer produces cis-[Pd(CH2SO2C6H4Me)2(OH2)(PPh3)], which isomerizes to trans-[Pd(CH2SO2C6H4Me)2(OH2)(PPh3)], with water O-coordinated to Pd and making hydrogen bonds to the two SO2 groups as seen in its X-ray structure. A similar role is played by RNH2 groups in the structures of trans-[Pd(CH2SO2C6H4Me)2(NH3)(PPh3)] and the dimer μ-(N2H4)(trans-[Pd(CH2SO2C6H4Me)2(PPh3)])2. In addition to these interesting intramolecular hydrogen bonding properties provided by the SO2 groups, the structural and 1H NMR data available suggest that the CH2SO2C6H4Me group is an interesting kind of strong alkyl σ donor, with high trans influence, and forms very stable Pd complexes extraordinarily resistant to reductive elimination and to hydrolysis by water at room temperature.2018-08-08Ministerio de Economía, Industria y Competitividad (Projects CTQ2014-52796-P and CTQ2016-80913-P)Junta de Castilla y León (programa de apoyo a proyectos de investigación – Ref. VA256U13; UIC 176