Nuevas técnicas en el abordaje endoscópico de la vía biliar en escenarios complejos

El acceso a la vía biliar y pancreática mediante endoscopia ha permitido el estudio y tratamiento de la patología bilio-pancreática de manera mínimamente invasiva. En los últimos años la colangiopancreatografía retrógrada endoscópica y la ecoendoscopia se emplean de manera combinada, permitiendo el abordaje anterógrado y retrógrado al mismo tiempo de la vía biliar. En la presente tesis evaluamos la tasa de éxito técnico y clínico de la colangiopancreatografía retrógrada endoscópica vía acceso transgástrico USE-guiado (CPRE-GATU) en pacientes con bypass gástrico en Y-de-Roux. A su vez, comparamos la seguridad y la eficacia de las PAL con las PMA en colédoco-duodenostomías USE-guiadas para drenaje biliar paliativo en obstrucciones biliares malignas (OBM) no susceptibles de colangiopancreatografía retrógrada endoscópica. Además, evaluamos la tasa de recanalizaciones y remodelaciones completas en pacientes con transección ductal completa post-colecistectomía empleando el abordaje puramente endoscópico mediante creación de ETU como puerta de acceso a la vía biliar para terapéutica.Departamento de Anatomía y RadiologíaDoctorado en Investigación en Ciencias de la Salu

Estudio de la Seguridad en Redes de Sensores Corporales aplicadas al Ámbito Sanitario

Nowadays, the technology has become necessary in daily aspects of everyday life, included healthcare and healthy lifestyle. Thus, in the last years has taken place an important development of Body Sensor Networks (BSN) to let a continuous monitoring. Security is becoming increasingly important in all areas related to Information Technology, and becomes even more important when patient’s health is involved. Confiability and privacy are necessary requirements for patients to feel secure with the sensors, but the reliability is necessary too, because if all measured data are lost or damage before reaching their destination, it cannot be made an adequate monitor or make the best diagnosis. The aim of this work is to provide a review of the security for BSN applied to the healthcare, in order to enable the development of applications to improve the patient's diagnosis and treatment with chronic diseases.Keywords: BSN, healthcare,confiability, reliability, chronic diseases

Participatory collective farming as a leverage point for fostering human-nature connectedness

Human-nature connectedness is key to foster environmental and socio-cultural sustainability in agricultural landscapes since it promotes the establishment of belonging, stewardship, and connections to nature. Cooperation, collective action, and the role of women at sustainable agroecological practices could be leverage points in which small interventions may hold great potential for system transformation. We analyse the different types of human-nature connectedness mediated by the Agrolab participatory collective farming initiative running in Madrid (Spain). Our results described and quantified a participatory collective farming initiative using the leverage point perspective, and identified factors explaining nature relatedness of participants (i.e. social importance of agricultural landscapes, linkages with farming activities, time spent outdoors, gender and a negative relationship with the rural residence). We found that women showed a stronger and broader worldview on the philosophical arguments about their connection with nature, while men identified themselves and nature through more cognitive responses. Our results give indication of participatory collecting farming as a leverage point to foster human-nature connectedness. Finally, we discussed how participatory collective farming activities are suitable for introducing nature into people’s daily lives and may help to identify pathways towards a stronger human-nature connectedness.This study received funding from: (1) Environmental and social services provided by agroecological farming systems (FP20-SERVIAGROECO), (2) from the European Union's Horizon 2020 research and innovation programme under grant agreement N◦ 81819, by the project entitled: Co-design of novel contract models for innovative agri-environmental-climate measures and for valorisation of environmental public goods, and from (3) the Madrid Government (Comunidad de Madrid-Spain) under the Multiannual Agreement with Universidad Autónoma de Madrid in the line of action encouraging youth research doctors, in the context of the V PRICIT (Regional Programme of Research and Technological Innovation) (SI1/PJI/2019-00444), through SAVIA-Sowing Alternatives for Agroecological Innovation project

Analysis of University STEM Students’ Mathematical, Linguistic, Rhetorical–Organizational Assignment Errors

Although Error Analysis (EA) has been broadly used in Foreign Language and Mother Tongue learning contexts, it has not been applied in the field of engineering and by STEM (Science, Technology, Engineering, and Mathematics) students in a systematic way. In this interdisciplinary pilot study, we applied the EA methodology to a wide corpus of exercises and essays written by third-year students of mechanical engineering, with the main purpose of achieving a precise diagnosis of the students’ strengths and weaknesses in writing skills. For the analysis to be as exhaustive as possible, the errors were typologized into three main categories (linguistic, mathematical, and rhetorical–organizational), each of which is, in turn, subdivided into 15 items. The results show that the predominant errors are rhetorical–organizational (39%) and linguistic (38%). The application of EA permits the precise identification of the areas of improvement and the subsequent implementation of an educational design that allows STEM students to improve their communicative strategies, especially those related to the writing skills and, more precisely, those having to do with the optimal use of syntax, punctuation, rhetorical structure of the text, and mathematical coherence

A Rubric to Assess and Improve Technical Writing in Undergraduate Engineering Courses

Although there is consensus in the literature that writing skills are important in STEM (Science, Technology, Engineering, and Mathematics) studies, they are often neglected. However, some efforts have been made to correct this deficiency, one of them being the development of assessment rubrics. This study seeks to contribute to the discussion by presenting the results of the application of a rubric designed to assess the writing skills of a group of 3rd year engineering students. This rubric, which includes linguistic and rhetorical-organizational criteria alongside the mathematical and technical, was used to assess a number of written exercises and essays submitted by students in a 15-week course. The main interest of this study was to test the efficacy of the rubric as a diagnostic tool, conceived to detect the areas of improvement in the students’ written performance and, ultimately, to also help them to achieve higher levels of competence. This goal was achieved, as one of the main conclusions of the study is that, although students usually master the technical aspects of the course, they must improve the linguistic and rhetorical aspects of their written communication. It can likewise be said that all the participants involved in the study profited in one way or another from the application of the rubric and contributed to identifying the ways in which the rubric itself can be improved for future application

A Non-Targeted Capillary Electrophoresis-Mass Spectrometry Strategy to Study Metabolic Differences in an In Vitro Model of High-Glucose Induced Changes in Human Proximal Tubular HK-2 Cells

Diabetic nephropathy is characterized by the chronic loss of kidney function due to high glucose renal levels. HK-2 proximal tubular cells are good candidates to study this disease. The aim of this work was to study an in vitro model of high glucose-induced metabolic alterations in HK-2 cells to contribute to the pathogenesis of this diabetic complication. An untargeted metabolomics strategy based on CE-MS was developed to find metabolites affected under high glucose conditions. Intracellular and extracellular fluids from HK-2 cells treated with 25 mM glucose (high glucose group), with 5.5 mM glucose (normal glucose group), and with 5.5 mM glucose and 19.5 mM mannitol (osmotic control group) were analyzed. The main changes induced by high glucose were found in the extracellular medium where increased levels of four amino acids were detected. Three of them (alanine, proline, and glutamic acid) were exported from HK-2 cells to the extracellular medium. Other affected metabolites include Amadori products and cysteine, which are more likely cause and consequence, respectively, of the oxidative stress induced by high glucose in HK-2 cells. The developed CE-MS platform provides valuable insight into high glucose-induced metabolic alterations in proximal tubular cells and allows identifying discriminative molecules of diabetic nephropathy

Estudio relativo a los recursos de que la industria nacional dispone para las construcciones y armamentos navales

Holandes

Duration of Treatment for Pseudomonas aeruginosa Bacteremia: a Retrospective Study

Introduction: There is no consensus regarding optimal duration of antibiotic therapy for Pseudomonas aeruginosa bacteremia. We aimed to evaluate the impact of short antibiotic course. Methods: We present a retrospective multicen ter study including patients with P. aeruginosa bacteremia during 2009–2015. We evaluated outcomes of patients treated with short (6–- 10 days) versus long (11–15 days) antibiotic courses. The primary outcome was a composite of 30-day mortality or bacteremia recurrence and/or persistence. Univariate and inverse probability treatment-weighted (IPTW) adjusted multivariate analysis for the primary outcome was performed. To avoid immortal time bias, the landmark method was used. Results: We included 657 patients; 273 received a short antibiotic course and 384 a long course. There was no significant difference in baseline characteristics of patients. The com posite primary outcome occurred in 61/384 patients in the long-treatment group (16%) versus 32/273 in the short-treatment group (12%) (p = 0.131). Mortality accounted for 41/384 (11%) versus 25/273 (9%) of cases, respectively. Length of hospital stay was signif icantly shorter in the short group [median 13 days, interquartile range (IQR) 9–21 days, versus median 15 days, IQR 11–26 days, p = 0.002]. Ten patients in the long group dis continued antibiotic therapy owing to adverse events, compared with none in the short group. On univariate and multivariate analyses, dura tion of therapy was not associated with the primary outcome. Conclusions: In this retrospective study, 6–- 10 days of antibiotic course for P. aeruginosa bacteremia were as effective as longer courses in terms of survival and recurrence. Shorter ther apy was associated with reduced length of stay and less drug discontinuation

Exploratory Metabolomic Analysis Based on Reversed-Phase Liquid Chromatography-Mass Spectrometry to Study an In Vitro Model of Hypoxia-Induced Metabolic Alterations in HK-2 Cells

Oxygen deficiency in cells, tissues, and organs can not only prevent the proper development of biological functions but it can also lead to several diseases and disorders. In this sense, the kidney deserves special attention since hypoxia can be considered an important factor in the pathophysiology of both acute kidney injury and chronic kidney disease. To provide better knowledge to unveil the molecular mechanisms involved, new studies are necessary. In this sense, this work aims to study, for the first time, an in vitro model of hypoxia-induced metabolic alterations in human proximal tubular HK-2 cells because renal proximal tubules are particularly susceptible to hypoxia. Different groups of cells, cultivated under control and hypoxia conditions at 0.5, 5, 24, and 48 h, were investigated using untargeted metabolomic approaches based on reversed-phase liquid chromatography-mass spectrometry. Both intracellular and extracellular fluids were studied to obtain a large metabolite coverage. On the other hand, multivariate and univariate analyses were carried out to find the differences among the cell groups and to select the most relevant variables. The molecular features identified as affected metabolites were mainly amino acids and Amadori compounds. Insights about their biological relevance are also provided