Tratamientos paliativos del cáncer uterino en relación con la etiología del cáncer tesis del doctorado

El verso de las h. en blanco. Tesis de doctorado leída en la Universidad Central el 31 de enero de 1910.Universidad Central (Madrid)TRUEProQuestpu

Tafonomía y paleoecología del ecosistema acuático de Las Hoyas (Barremiense superior, Serranía de Cuenca).

The freshwater ecosystem of Las Hoyas contains one of the most significant records of aquatic organisms described from the Early Cretaceous worldwide. The benthos was formed by a diverse assemblage of animals such as aquatic insects, ostracods, cray-fishes, and juvenile and small adult fishes, which depended on the ground cover of charophytes and aquatic angiosperms for shelter and food. The nekton was mainly composed o f crustaceans and a large variety of fishes. Phytoplankton is represented by two chlorophytes and zooplankton is represented by planktonic pupae of dipterans. Cheirolepidiaceous conifers, matoniaceous tree-ferns and herbaceous schizaeacean ferns were growing in swamps. Among tetrapods with aquatic habitats modern amphibians and reptiles were found. In spite of the exceptional preservation, the fossil record of Las Hoyas includes sedimentological, taphonomic and palaeoecological biases. Form the palaeoecological point o f view, mass mortality levels contain thousands of individuals of crayfish associated with freshwater plant remains. These levels are attributed to eutrophication events of the otherwise oligotrophic lake. Other mass-mortality levels include hundreds of juvenile teleostean individuals associated with small shrimps. Changes in the water-table and related temperature changes, variation of acidity or input of toxic substances may account for this type of mass mortality

Spread of a SARS-CoV-2 variant through Europe in the summer of 2020.

Following its emergence in late 2019, the spread of SARS-CoV-21,2 has been tracked by phylogenetic analysis of viral genome sequences in unprecedented detail3–5. Although the virus spread globally in early 2020 before borders closed, intercontinental travel has since been greatly reduced. However, travel within Europe resumed in the summer of 2020. Here we report on a SARS-CoV-2 variant, 20E (EU1), that was identified in Spain in early summer 2020 and subsequently spread across Europe. We find no evidence that this variant has increased transmissibility, but instead demonstrate how rising incidence in Spain, resumption of travel, and lack of effective screening and containment may explain the variant’s success. Despite travel restrictions, we estimate that 20E (EU1) was introduced hundreds of times to European countries by summertime travellers, which is likely to have undermined local efforts to minimize infection with SARS-CoV-2. Our results illustrate how a variant can rapidly become dominant even in the absence of a substantial transmission advantage in favourable epidemiological settings. Genomic surveillance is critical for understanding how travel can affect transmission of SARS-CoV-2, and thus for informing future containment strategies as travel resumes. © 2021, The Author(s), under exclusive licence to Springer Nature Limited

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Potential influence of Bond events on mid-Holocene climate and vegetation in southern Pyrenees as assessed from Burg lake LOI and pollen records.

10 páginas.Superimposed on the long-term climate variability attributed to orbital forcing, there are other modes of variability covering timescales from interannual to millennial throughout the Holocene. Their signatures in climate proxy archives can differ substantially because of their lower magnitude and regional diversity. However, if identified they can yield better understanding of the physical mechanisms regionally linking causes and effects. Here we describe a high-resolution record of organic matter accumulation in the sediments of Burg lake (Pyrenees, NE Iberian Peninsula), as assessed using loss on ignition (LOI), and compare it with the ice rafted debris (IRD) indexes from the North Atlantic. The LOI record indicates two main phases in the water body, a lacustrine phase as a shallow lake and a palustrine phase as a fen. The latter covers the period 2600—7200 cal. yr BP and within it there is a high coherence between LOI and IRD, which indicates submillennial climate fluctuations in the Pyrenees that can be related to the North Atlantic influence. The Burg’s LOI record suggests wetter (and occasionally colder) situations in the Pyrenees during high IRD in the Atlantic (Bond oscillations). These fluctuations would likely affect the snow covered period in the mountains (winter and spring seasons) the most, the period in which Atlantic westerlies currently have higher influence on precipitation over the Pyrenees. These climatic oscillations could have favoured Abies penetration during the mid Holocene, as evidenced by increased pollen percentages of this taxon during low IRD values (drier conditions). The pollen record also suggests potential relationships between climate and human activity as early as at mid Holocene, as human-related cereals increase during all the low IRD periods. The human signature (charcoal, cereals) becomes particularly evident at around 2800 cal. yr BP; in this oscillation Pinus overtake Abies in the conifer response to low IRD.Peer reviewe

Difficulties Fulfilling Self-Care Needs Among Family Caregivers: An Observational Study

Importance: Assuming the care of a family member with a disability or chronic illness constitutes a health risk factor for caregivers, who frequently overlook their own self-care. Objective: To analyze the self-care activities (SCAs) among caregivers of a family member with a disability or chronic illness and assess the impact on their satisfaction and quality of life (QoL). Design: Descriptive, cross-sectional, analytic study. Setting: Community. Participants: Five hundred caregivers of family members with a disability or chronic illness in the city of Zaragoza, Spain. Outcomes and Measures: The family caregivers’ occupational performance and satisfaction were assessed with the Canadian Occupational Performance Measure, and their QoL was assessed with the World Health Organization—Quality of Life. Results: In total, 32.8% of family caregivers had difficulty in all activities related to self-care, 46.6% had difficulty sleeping and resting, 31.6% had difficulty receiving health-related treatments, and 31.2% had difficulty with physical exercise. Women and younger family caregivers showed greater impairment in self-care. Occupational performance, satisfaction, and QoL worsened as the number of affected activities increased. Conclusions and Relevance: Caring for a family member with a disability or chronic illness has a negative impact on the SCAs of caregivers, especially among female caregivers and those of younger age. Caregiving is also associated with lower occupational performance, satisfaction, and QoL. Plain-Language Summary: Caring for a family member with a disability or chronic illness can become a health risk for caregivers, who frequently ignore their own self-care. The study results found that women and younger family caregivers showed a greater decline in self-care. This study provides information to help occupational therapists to work with family caregivers to prevent a decline in their self-care and improve their quality of life

Ciencia y tecnología (No. 8 jun 2011)

Publicación Bianual de la Dirección de Investigación Científica de la Universidad Nacional Autónoma de Honduras.Contenido: La innovación, el desarrollo y la propiedad intelectual en la universidad / Alberto Urbina 3. La propiedad Intelectual y su importancia en la Universidad / Rodulio Perdomo 15. Anormalidades electroencefalográficas en pacientes pediátricos hondureños con desnutrición proteico-energética: un estudio de casos y controles / Miguel Solano, Marco Tulio Medina, Rebeca Hernández, José Lara 21. Caracterización Molecular de Aislados Centroamericanos de Beauveria bassiana para el Control de la Broca del Café / Gustavo Fontecha, Rogelio Trabanino, Beatriz Pérez-Borrero, Pablo Catalán, Estela Aguilar, Francisco Javier Gallego, Ana Margarita Figueiras, César Benito 39. Efecto gradiente del calentamiento global / César Mauricio Urbizo Vivas 62. El tejido discursivo de una subjetividad. Notas sobre la identidad / Miguel Barahona 82. Neoliberalismo y conflictos socioambientales en Honduras: Cuatro casos de estudio: agua, bosque, explotación minera y agricultura / Luis Manuel Martínez 93. La habilidad pedagógica de planificar: Una necesidad de los maestros que imparten Educación Física. Raúl Orlando Figueroa Soriano 107

Safety and efficacy of intraperitoneal drain placement after emergency colorectal surgery. An international, prospective cohort study

Intraperitoneal drains are often placed during emergency colorectal surgery. However, there is a lack of evidence supporting their use. This study aimed to describe the efficacy and safety of intraperitoneal drain placement after emergency colorectal surgery. Method: COMPlicAted intra-abdominal collectionS after colorectal Surgery (COMPASS) is a prospective, international, cohort study into which consecutive adult patients undergoing emergency colorectal surgery were enrolled (from 3 February 2020 to 8 March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included rate and time-to-diagnosis of postoperative intraperitoneal collections, rate of surgical site infections (SSIs), time to discharge and 30-day major postoperative complications (Clavien-Dindo III-V). Multivariable logistic and Cox proportional hazards regressions were used to estimate the independent association of the outcomes with drain placement. Results: Some 725 patients (median age 68.0 years; 349 [48.1%] women) from 22 countries were included. The drain insertion rate was 53.7% (389 patients). Following multivariable adjustment, drains were not significantly associated with reduced rates (odds ratio [OR] = 1.56, 95% CI: 0.48-5.02, p = 0.457) or earlier detection (hazard ratio [HR] = 1.07, 95% CI: 0.61-1.90, p = 0.805) of collections. Drains were not significantly associated with worse major postoperative complications (OR = 1.26, 95% CI: 0.67-2.36, p = 0.478), delayed hospital discharge (HR = 1.11, 95% CI: 0.91-1.36, p = 0.303) or increased risk of SSIs (OR = 1.61, 95% CI: 0.87-2.99, p = 0.128). Conclusion: This is the first study investigating placement of intraperitoneal drains following emergency colorectal surgery. The safety and clinical benefit of drains remain uncertain. Equipoise exists for randomized trials to define the safety and efficacy of drains in emergency colorectal surgery

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function.Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system.Results: A total of 3288 patients were included in the analysis, of whom 301 (9.2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P < 0.001). There were no significant differences in rates of readmission between these groups (6.6 versus 8.0 per cent; P = 0.499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0.90, 95 per cent c.i. 0.55 to 1.46; P = 0.659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34.7 versus 39.5 per cent; major 3.3 versus 3.4 per cent; P = 0.110).Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients

Timing of nasogastric tube insertion and the risk of postoperative pneumonia: an international, prospective cohort study

Aim: Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastric tube (NGT) is often performed, but this can be distressing. The aim of this study was to determine whether the timing of NGT insertion after surgery (before versus after vomiting) was associated with reduced rates of pneumonia in patients undergoing elective colorectal surgery. Method: This was a preplanned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January 2018 and April 2018 were eligible. Those receiving a NGT were divided into three groups, based on the timing of the insertion: routine NGT (inserted at the time of surgery), prophylactic NGT (inserted after surgery but before vomiting) and reactive NGT (inserted after surgery and after vomiting). The primary outcome was the development of pneumonia within 30 days of surgery, which was compared between the prophylactic and reactive NGT groups using multivariable regression analysis. Results: A total of 4715 patients were included in the analysis and 1536 (32.6%) received a NGT. These were classified as routine in 926 (60.3%), reactive in 461 (30.0%) and prophylactic in 149 (9.7%). Two hundred patients (4.2%) developed pneumonia (no NGT 2.7%; routine NGT 5.2%; reactive NGT 10.6%; prophylactic NGT 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the prophylactic and reactive NGT groups (odds ratio 1.03, 95% CI 0.56–1.87, P = 0.932). Conclusion: In patients who required the insertion of a NGT after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery compared with reactive insertion