Estudio de los elementos implicados en el acoplamiento estímulo-secreción en la célula cromafín humana

Tesis doctoral inédita realizada en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Farmacología y Terapéutica. Fecha de lectura: 21 de Junio de 2010

Guía de manejo para pacientes con disrupción de la vía biliar posterior a colecistectomía laparoscópica.

Más del 80% de todas las complicaciones relativas a la disrupción de los conductos biliares ocurren durante la colecistectomía, y pueden ocurrir tanto en el abordaje abierto como por la vía laparoscópica. La inflamación vía biliar o vesícula propiamente, la anatomía biliar variable, la exposición inadecuada, los intentos agresivos de hemostasia y la inexperiencia del cirujano comúnmente se citan como factores de riesgo (Ruiz Gómez et al., 2010). Aunque los primeros informes sugieren que la inexperiencia quirúrgica (con menos de 20 colecistectomías laparoscópicas) estaba altamente correlacionada con la lesión del conducto biliar, la evidencia ha sugerido que la percepción errónea visual representa el 97% de las lesiones biliares iatrogénicas y la habilidad técnica o el conocimiento representa solo el 3% (Nuzzo, 2005). Esto hace imperativo tener un concepto muy claro sobre su presentación clínica, su diagnóstico, clasificación, complejidad y su tratamiento adecuado. La naturaleza multifactorial de la disrupción de vía biliar ha generado múltiples niveles de protección por parte del cirujano para evitar este tipo de complicaciones, entre las que se destacan: el conocimiento de la anatomía biliar y la anatomía aberrante, las garantías para obtener una visión laparoscopia adecuada, la tracción y la contracción apropiada y dirigida en el abordaje de la vesícula biliar, la sospecha suficiente de hallazgos y enfoque de riesgo y consigo un umbral bajo para la conversión a una operación abierta. Lamentablemente solo una tercera parte de las complicaciones relativas a la disrupción de la vía biliar son diagnosticadas en el trans-operatorio (Waage, 2006) y cuando ocurren, en la mayoría de los casos el cirujano actuante no está capacitado para repararlas. Las disrupciones que tienen lugar durante la cirugía laparoscópica suelen ser más devastadoras que aquellas que ocurren durante la cirugía abierta acompañándose en muchas ocasiones de lesiones vasculares añadidas que requieren re intervenciones complejas y que además deben ser realizadas por personal con experiencia en cirugía hepatobiliar (Waage, 2006), (Tantia et al., 2008).Teniendo en cuenta la gravedad del problema que entrañan las complicaciones relativas a la disrupción de la vía biliar, se propone la realización del presente trabajo con el fin de plantear el manejo más adecuado ante la presencia de una disrupción biliar tanto presenciadas en el transquirurgico como en el diagnóstico de las mismas en el post operatorio y su tratamiento idóneo

Terminal Au-N and Au-O Units in Organometallic Frames

Since gold is located well beyond the oxo wall, chemical species with terminal Au−N and Au−O units are extremely rare and limited to low coordination numbers. We report here that these unusual units can be trapped within a suitable organometallic frame. Thus, the terminal auronitrene and auroxyl derivatives [(CF3)3AuN]− and [(CF3)3AuO]− were identified as local minima by calculation. These open-shell, high-energy ions were experimentally detected by tandem mass spectrometry (MS2): They respectively arise by N2 or NO2 dissociation from the corresponding precursor species [(CF3)3Au(N3)]− and [(CF3)3Au(ONO2)]− in the gas phase. Together with the known fluoride derivative [(CF3)3AuF]−, they form an interesting series of isoleptic and alloelectronic complexes of the highly acidic organogold(iii) moiety (CF3)3Au with singly charged anions X− of the most electronegative elements (X=F, O, N). Ligand-field inversion in all these [(CF3)3AuX]− species results in the localization of unpaired electrons at the N and O atoms

Manejo de la bronquiolitis aguda en el servicio de neumología pediátrica de Pinar del Río

Introduction: acute bronchiolitis is the most frequent lower respiratory tract infection in children under one year of old and accounts for 18% of all pediatric hospitalizations.Objective: to characterize the management of acute bronchiolitis in patients admitted to the pulmonology service at Pepe Portilla Pediatric Teaching Hospital during 2019.Methods: an observational, descriptive and cross-sectional study was carried out. The target group comprised 612 patients diagnosed with bronchiolitis and the sample included 482 patients who met the inclusion criteria: moderate, mild cases with risk factors and clinical history with complete data. Descriptive statistical techniques were applied to process the information collected.Results: patients were admitted for mild bronchiolitis (75.9%), with an average stay of less than 5 days. Complete Blood Count (CBC), erythrocyte sedimentation and chest radiography was performed in 100% of patients, with low percentage of positivity. Prechordal ultrasound was reported in 15.6% by transitory auscultation of cardiac murmurs. Oxygen therapy was prescribed in 98.9% of cases, with no clinical evidence of hypoxemia.Conclusions: there was an excess in the indication of complementary examinations and medication prescription. There was found an irrational prescription of inhaled bronchodilators, systemic steroids and antihistamines. There is dependence on diagnostic means, which reflects the need for a better application of the clinical method.Introducción: la bronquiolitis aguda es la infección de vías respiratorias inferiores más frecuente en niños menores de un año, y supone el 18 % de todas las hospitalizaciones pediátricas.Objetivo: caracterizar el manejo de la bronquiolitis aguda en los pacientes ingresados en el servicio de neumología del Hospital Pediátrico Provincial Docente “Pepe Portilla” durante el año 2019.Métodos: se realizó un estudio observacional, descriptivo y de corte transversal. El universo estuvo constituido por los 612 pacientes con diagnóstico de bronquiolitis y la muestra fue de 482 pacientes.Resultados: predominaron los pacientes ingresados por cuadros ligeros de bronquiolitis (75,9 %), con estadía hospitalaria promedio menor de cinco días. Se realizaron hemograma, eritrosedimentación y radiografía de tórax en el 100 % de los pacientes, con bajo porcentaje de positividad. La ecografía de precordio se reportó en el 15,6 % por auscultación transitoria de soplos cardíacos. La oxigenoterapia fue prescrita en el 98,9 % de los casos, sin evidencia clínica de hipoxemia.Conclusiones: existió un exceso en la indicación de exámenes complementarios y prescripción de medicamentos. Se encontró prescripción irracional de broncodilatadores inhalados, esteroides sistémicos y antihistamínicos. Existe dependencia de los medios diagnósticos, lo cual refleja la necesidad de un mayor empleo del método clínico

Real-world analysis of main clinical outcomes in patients with polycythemia vera treated with ruxolitinib or best available therapy after developing resistance/intolerance to hydroxyurea

Hemorrhage; Polycythemia vera; RuxolitinibHemorràgia; Policitèmia vera; RuxolitinibHemorragia; Policitemia vera; RuxolitinibBackground Ruxolitinib is approved for patients with polycythemia vera (PV) who are resistant/intolerant to hydroxyurea, but its impact on preventing thrombosis or disease-progression is unknown. Methods A retrospective, real-world analysis was performed on the outcomes of 377 patients with resistance/intolerance to hydroxyurea from the Spanish Registry of Polycythemia Vera according to subsequent treatment with ruxolitinib (n = 105) or the best available therapy (BAT; n = 272). Survival probabilities and rates of thrombosis, hemorrhage, acute myeloid leukemia, myelofibrosis, and second primary cancers were calculated according to treatment. To minimize biases in treatment allocation, all results were adjusted by a propensity score for receiving ruxolitinib or BAT. Results Patients receiving ruxolitinib had a significantly lower rate of arterial thrombosis than those on BAT (0.4% vs 2.3% per year; P = .03), and this persisted as a trend after adjustment for the propensity to have received the drug (incidence rate ratio, 0.18; 95% confidence interval, 0.02-1.3; P = .09). There were no significant differences in the rates of venous thrombosis (0.8% and 1.1% for ruxolitinib and BAT, respectively; P = .7) and major bleeding (0.8% and 0.9%, respectively; P = .9). Ruxolitinib exposure was not associated with a higher rate of second primary cancers, including all types of neoplasia, noncutaneous cancers, and nonmelanoma skin cancers. After a median follow-up of 3.5 years, there were no differences in survival or progression to acute leukemia or myelofibrosis between the 2 groups. Conclusions The results suggest that ruxolitinib treatment for PV patients with resistance/intolerance to hydroxyurea may reduce the incidence of arterial thrombosis.This work was supported by the Instituto de Salud Carlos III through a National Plan for Scientific and Technical Research and Innovation Innovación (PI18/01472, PI18/00205, and PI21/00231). The Spanish Group of Myeloproliferative Neoplasms (GEMFIN) received a grant from Novartis for developing the Spanish Registry of Polycythemia Vera and for conducting the current project

Manejo reproductivo de la oveja Rasa Aragonesa: preparación de las ovejas destinadas a la inseminación artificial

raza Rasa aragonesaPublishe

Methodological barriers to studying the association between the economic crisis and suicide in Spain

BACKGROUND: The hypothetical relationship between economic recession and the increase in suicides in Spain is subject to various arguments. In addition to the inherent complexity of capturing and explaining the underlining mechanisms that could describe this causal link, different points of contention have been be identified. The period of this association and its possible starting points, the socioeconomic determinants that may explain the variation in suicide rate, and the data sources available are the main focus of controversy. The present study aims to identify the phases of association between different periods of economic recession and suicide rates, and compare the effect of different social determinants of health that have been mentioned in previous studies. METHODS: We have used interrupted time series analyses to assess the impact of economic recession on national rates of suicide mortality provided by the Spanish Statistical Office (1980-2014). In an attempt to consider the factors that have affected the study of suicide in Spain, different data sources/periods, predictors, and regions in Spain were analysed. RESULTS: The analysis revealed a positive and significant relationship between the Great Recession and suicide rates during the second period of economic recession (2011-2014), while appeared to decrease during the first recession period. However, the first decreasing trend was not statistically significant in the global analysis of the evolution of monthly suicide rates for the entire country. Both unemployment and per capita GDP were positively related to suicide trends. Finally, the regional analysis demonstrates a similar pattern in different Spanish areas. CONCLUSION: Although previous studies have mentioned the double-dip in the suicide rate associated with the corresponding period of double recession, our study only identify a positive relationship during the second recession period. ThThis study is subsidised by the Carlos III Health Institute (Ministry of Health of Spain) [project PI15/01986] and co-funded by FEDER funds and the Andalusian Studies Centre [PRY120/14]

Estimating Stand and Fire-Related Surface and Canopy Fuel Variables in Pine Stands Using Low-Density Airborne and Single-Scan Terrestrial Laser Scanning Data

In this study, we used data from a thinning trial conducted on 34 different sites and 102 sample plots established in pure and even-aged Pinus radiata and Pinus pinaster stands, to test the potential use of low-density airborne laser scanning (ALS) metrics and terrestrial laser scanning (TLS) metrics to provide accurate estimates of variables related to surface and canopy fires. An exhaustive field inventory was carried out in each plot to estimate the main stand variables and the main variables related to fire hazard: surface fuel loads by layers, fuel strata gap, surface fuel height, stand mean height, canopy base height, canopy fuel load and canopy bulk density. In addition, the point clouds from low-density ALS and single-scan TLS of each sample plot were used to calculate metrics related to the vertical and horizontal distribution of forest fuels. The comparative performance of the following three non-parametric machine learning techniques used to estimate the main stand- and fire-related variables from those metrics was evaluated: (i) multivariate adaptive regression splines (MARS), (ii) support vector machine (SVM), and (iii) random forest (RF). The selection of the best modeling approach was based on a comparison of the root mean square error (RMSE), obtained by optimizing the parameters of each technique and performing cross-validation. Overall, the best results were obtained with the MARS techniques for data from both sensors. The TLS data provided the best results for variables associated with the internal characteristics of canopy structure and understory fuel but were less reliable for estimating variables associated with the upper canopy, due to occlusion by mid-canopy foliage. The combination of ALS and TLS metrics improved the accuracy of estimates for all variables analyzed, except the height and the biomass of the understory shrubs. The variability demonstrated by the combined use of both types of metrics ranged from 43.11% for the biomass of duff litter layers to 94.25% for dominant height. The results suggest that the combination of machine learning techniques and metrics derived from low-density ALS data, drawn from a single-scan TLS or a combination of both metrics, may represent a promising alternative to traditional field inventories for obtaining valuable information about surface and canopy fuel variables at large scalesinfo:eu-repo/semantics/publishedVersio