Years of sunlight exposure and cataract: a case-control study in a Mediterranean population.

BACKGROUND: We aimed to investigate the relation between sunlight exposure and risk of cataract. METHODS: We carried out a frequency-matched case-control study of 343 cases and 334 controls attending an ophthalmology outpatient clinic at a primary health-care center in a small town near Valencia, Spain. All cases were diagnosed as having a cataract in at least one eye based on the Lens Opacification Classification system (LOCS II). Controls had no opacities in either eye. All cases and controls were interviewed for information on outdoor exposure, "usual" diet, history of severe episodes of diarrhea illness, life-style factors and medical and socio-demographic variables. Blood antioxidant vitamin levels were also analyzed. We used logistic regression models to estimate sex and age-adjusted odds ratios (ORs) by quintiles of years of occupational outdoor exposure, adjusting for potential confounders such as smoking, alcohol consumption, serum antioxidants and education. RESULTS: No association was found between years of outdoor exposure and risk of cataract. However, exploratory analyses suggested a positive association between years of outdoor exposure at younger ages and risk of nuclear cataract later in life. CONCLUSION: Our study does not support an association with cataract and sunlight exposure over adult life

Optimal Reconfiguration of a Limited Parallel Robot for Forward Singularities Avoidance

[EN] The positioning of the anchoring points of a Parallel Kinematic Manipulator has an important impact on its later performance. This paper presents an optimization problem to deal with the reconfiguration of a Parallel Kinematic manipulator with four degrees of freedom and the corresponding algorithms to address such problem, with the subsequent test on an actual robot. The cost function minimizes the forces applied by the actuators along the trajectory and considers singular positions and the feasibility of the active generalized coordinates. Results are compared among different algorithms, including evolutionary, heuristics, multi-strategy and gradient-based optimizers.This work was supported by the Spanish Ministry of Education, Culture and Sports through the Project for Research and Technological Development with Ref. DPI2017-84201-RLlopis-Albert, C.; Valero, F.; Mata, V.; Escarabajal, RJ.; Zamora-Ortiz, P.; Pulloquinga, JL. (2020). Optimal Reconfiguration of a Limited Parallel Robot for Forward Singularities Avoidance. Multidisciplinary Journal for Education, Social and Technological Sciences. 7(1):113-127. https://doi.org/10.4995/muse.2020.13352OJS11312771Arakelian, V., Briot, S., & Glazunov, V. (2008). Increase of singularity-free zones in the workspace of parallel manipulators using mechanisms of variable structure. Mechanism and Machine Theory, 43(9), 1129-1140. https://doi.org/10.1016/J.MECHMACHTHEORY.2007.09.005Araujo-Gómez, P., Díaz-Rodríguez, M., Mata, V., & González-Estrada, O. A. (2019). Kinematic analysis and dimensional optimization of a 2R2T parallel manipulator. Journal of the Brazilian Society of Mechanical Sciences and Engineering, 41(10), 425. https://doi.org/10.1007/s40430-019-1934-1Araujo-Gómez, P., Mata, V., Díaz-Rodríguez, M., Valera, A., & Page, A. (2017). Design and kinematic analysis of a novel 3UPS/RPU parallel kinematic mechanism with 2T2R motion for knee diagnosis and rehabilitation tasks. Journal of Mechanisms and Robotics, 9(6), 061004. https://doi.org/10.1115/1.4037800Beiranvand, V., Hare, W., & Lucet, Y. (2017). Best practices for comparing optimization algorithms. Optimization and Engineering, 18(4), 815-848. https://doi.org/10.1007/s11081-017-9366-1Dash, A. K., Chen, I. M., Yeo, S. H., & Yang, G. (2005). Workspace generation and planning singularity-free path for parallel manipulators. Mechanism and Machine Theory, 40(7), 776-805. https://doi.org/10.1016/j.mechmachtheory.2005.01.001Gosselin, C., & Angeles, J. (1990). Singularity Analysis of Closed-Loop Kinematic Chains. IEEE Transactions on Robotics and Automation, 6(3), 281-290. https://doi.org/10.1109/70.56660Llopis-Albert, C., Rubio, F., & Valero, F. (2018). Optimization approaches for robot trajectory planning. Multidisciplinary Journal for Education, Social and Technological Sciences, 5(1), 1. https://doi.org/10.4995/muse.2018.9867Patel, Y. D., & George, P. M. (2012). Parallel Manipulators Applications-A Survey. Modern Mechanical Engineering, 02(03), 57-64. https://doi.org/10.4236/mme.2012.23008Rubio, F., Llopis-Albert, C., Valero, F., & Suñer, J. L. (2016). Industrial robot efficient trajectory generation without collision through the evolution of the optimal trajectory. Robotics and Autonomous Systems, 86, 106-112. https://doi.org/10.1016/j.robot.2016.09.008Rubio, F., Valero, F., & Llopis-Albert, C. (2019). A review of mobile robots: Concepts, methods, theoretical framework, and applications. International Journal of Advanced Robotic Systems, 16(2), 172988141983959. https://doi.org/10.1177/1729881419839596Tsai, L.-W. (1999). Robot Analysis and Design. John Wiley & Sons, Inc. New York, NY, USA ©1999.Valero, F., Rubio, F., & Llopis-Albert, C. (2019). Assessment of the Effect of Energy Consumption on Trajectory Improvement for a Car-like Robot. Robotica, 37(11), 1998-2009. https://doi.org/10.1017/S0263574719000407Vallés, M., Araujo-Gómez, P., Mata, V., Valera, A., Díaz-Rodríguez, M., Page, Á., & Farhat, N. M. (2018). Mechatronic design, experimental setup, and control architecture design of a novel 4 DoF parallel manipulator. Mechanics Based Design of Structures and Machines, 46(4), 425-439. https://doi.org/10.1080/15397734.2017.1355249Wehage, K. T., Wehage, R. A., & Ravani, B. (2015). Generalized coordinate partitioning for complex mechanisms based on kinematic substructuring. Mechanism and Machine Theory, 92, 464-483. https://doi.org/10.1016/j.mechmachtheory.2015.06.006www.esteco.com. (n.d.). Retrieved June 10, 2019, from https://www.esteco.com/Xianwen Kong, B., & Gosselin, C. M. (2002). Kinematics and singularity analysis of a novel type of 3-CRR 3-DOF translational parallel manipulator. International Journal of Robotics Research, 21(9), 791-798. https://doi.org/10.1177/02783649020210090501Yang, X. (2017). Optimization Algorithms Optimization and Metaheuristic Algorithms in Engineering. (March). https://doi.org/10.1007/978-3-642-20859-

El papel de las especies emblemáticas en la protección de los rasgos etnográficos. Caso del garbancillo de Tallante en el Campo de Cartagena

El Garbancillo de Tallante es una planta endémica que vive exclusivamente en la zona Oeste de Cartagena. En el año 2012 comenzó el proyecto LIFE+ ‘Conservación de Astragalus nitidiflorus en su hábitat potencial en la Región de Murcia’, cuyo objetivo se centra en la recuperación y conservación del Garbancillo de Tallante en la Región de Murcia para garantizar así la supervivencia a largo plazo de esta especie. Esta especie está localizada próxima a Tallante y los Puertos de Santa Bárbara, en el entorno rural y agrícola del Campo de Cartagena. Su hábitat está estrechamente ligado a los enclaves volcánicos del entorno, con edades geológicas de entre los 2,8-2,6 millones de años. En las cercanías de las poblaciones de Garbancillo encontramos importantes elementos de patrimonio cultural e histórico, como es el caso de las ermitas, los “molinos harineros”, o “norias de sangre”. Aprovechando el interés mediático de esta especie se están dando a conocer de forma significativa los elementos etnográficos claves del territorio. Así, se considera que la conservación de una especie endémica, como Astragalus nitidiflorus, puede tener efectos sinérgicos de estim, los recursos culturales o el mantenimiento de las actividades tradicionales del lugar

Rapid Breast Cancer Disease Progression Following Cyclin Dependent Kinase 4 and 6 Inhibitor Discontinuation.

Background: CDK 4 and 6 inhibitors (CDK4/6i), which arrest unregulated cancer cell proliferation, show clinical efficacy in breast cancer. Unexpectedly, a patient treated on a CDK4/6i-based trial, as first-line therapy in metastatic breast cancer, developed rapid disease progression following discontinuation of study drug while receiving standard second-line therapy off trial. We thus sought to expand this observation within a population of patients treated similarly at The University of Texas MD Anderson Cancer Center. Methods: Using an IRB-approved protocol, 4 patients previously enrolled on CDK4/6i trials were analyzed for outcomes after discontinuing study drug. These patients were treated on a randomized trial of first-line endocrine therapy +/- a CDK4/6i. Rapid disease progression was defined as progression occurring within 4 months of CDK4/6i discontinuation. Results: In total, 4 patients developed rapid disease progression and died; 2 of whom died within 6 months of CDK4/6i discontinuation. Conclusion: This case series suggests a potential for rapid disease progression following CDK4/6i discontinuation. However, the clinical course following progression must be validated in large CDK4/6i clinical trials and standard-of-care cohorts. If confirmed, such observations may alter the algorithm for subsequent therapy in patients with disease progression on CDK4/6i. Nevertheless, the need remains to define a mechanistic basis for this rapid progression and formulate alternative therapeutic strategies

Estrategias de ahorro de sangre en Artroplastia Total de Rodilla Primaria aplicadas en nuestra Comunidad

Antecedentes. El objetivo del presente estudio fue realizar una actualización sobre las diferentes estrategias en el ahorro de sangre en cirugía protésica de rodilla pri-maria, a través de una revisión bibliográfica; así como, conocer qué estrategias se siguen en diferentes centros hospitalarios de nuestro ámbito, mediante un estudio multicéntrico. Métodos. Se realizó un estudio observacional transversal descriptivo basado en una encuesta realizada a 64 cirujanos y una búsqueda bibliográfica sobre los distintos aspectos incluidos en la encuesta. Resultados. Los cirujanos refieren que cuentan con protocolos de ahorro sanguíneo prequirúrgicos implantados en su Hospital en un 48,4% (31/64). La utilización del ácido tranexámico es bastante generalizada 71,9% de los encuestados (46/64). Este se administra vía endovenosa previa a la cirugía en un 26,6% (17/64) de los casos, de manera intraarticular en un 21,9% (14/64) y en una combinación de ambas en un 23,4% (15/64). El momento preferido para la colocación de la isquemia por los cirujanos es en un 57,8% (37/64) previo a pintar el campo, mientras que un 39,1% (25/64) prefiere colocarla en estéril. Un 3,1% (2/64) de cirujanos afirma implantar las prótesis sin utilizar isquemia en la cirugía. Conclusiones. En los últimos años se está imponiendo la utilización de ATX como principal estrategia de ahorro de sangre en ATR, aunque no existe consenso en cuanto a la dosis óptima ni a su vía de administración. La eficacia del ATX está influyendo en la eliminación de los drenajes postquirúrgicos y en la implementación de programas de rehabilitación preco

Medidas de Tromboprofilaxis en Artroplastia Total de Rodilla. Práctica habitual en la Comunidad Valenciana y revisión bibliográfica.

Antecedentes: El tromboembolismo es una complicación de la cirugía de artroplastia total de rodilla. Para su prevención disponemos de múltiples medidas físicas y farmacológicas.Objetivo:Conocer quémedidas de prevención tromboembólica son las empleadas por los cirujanos ortopédicos en cirugía protésica de rodilla primaria en diferentes centros hospitalarios de nuestra región.Método: Estudio transversal descriptivo observacional basado en encuesta dirigida a especialistas COT de 9 hospitales públicos de la Comunidad Valenciana y búsqueda bibliográfica.Resultados: Se obtuvieron 64 encuestas. Todos los cirujanos eligen HBPM durante un mes como medida de tromboprofilaxis, descartando anticoagulantes orales o aspirina. El 29% también emplea dispositivos de movilización pasiva. Conclusiones: Los cirujanos ortopédicos de la comunidad valenciana optan por HBPM conforme a las mejores evidencias. Se estima, que la incidencia de eventos tromboembólicos sintomáticos desciende del 4,3 % al 1,8% con el uso de HBPM. El empleo de dispositivos de movilización pasiva y medias de compresión no están avaladas por las evidencias. La estratificación preoperatoria del riesgo de tromboembolismo, para emplear ácido acetil salicílico asociado a bombas de presión intermitente en caso de no existir alto riesgo es una tendencia cada vez más aceptada internacionalmente

Medidas para la prevención de la infección en la artroplastia de rodilla : prácticas habituales y evidencias

Infection after knee arthroplasty is one of the most feared complications and routine measures are applied to prevent it. The objective of this study is to identify which are the measures applied by the surgeons of the Valencian Community (CV) and know if the scientific evidence supports them or not. Methods. A descriptive cross-sectional observational study based on a survey of 64 surgeons and bibliographic searches on the aspects included in the survey were conducted. Results. 18.8% of the surgeons perform screening for SARM carriers and decolonization. 98.4% use cefazoline and 1.6% cefuroxime as antibiotic prophylaxis. With respect to the duration of antibiotic prophylaxis, 51% of surgeons administer three doses (24 hours prophylaxis), 23.4% use 2 doses and 17.2% of them use only one dose. 67.2% use 2% alcoholic chlorhexidine gluconate solution for surgical site preparation and 71.9% use adhesive incision drapes. Routine cement with antibiotics is used by 65.6% of respondents. The current scientific evidence supports antibiotic prophylaxis as performed by 100% of respondents; however there is no evidence for the superiority of the preparation of the skin with alcoholic chlorhexidine versus other antiseptics. There is also no evidence to support the use of adhesive incision drapes or the use of cement with antibiotics in a routine manner. Conclusions. It would be advisable for the CV surgeons to avoid the use of incision adhesive drapes and the application of cement with antibiotics in all cases. The preparation of the skin with alcoholic chlorhexidine does not seem to be more effective than other antiseptics in orthopaedic surgery. The screening of SAMR carriers and their decolonization seems to reduce the infection rate; its use can be recommended today, but studies with the largest number of patients that confirm their benefit are needed

Los efectos geoecológicos del cambio global en el Pirineo Central español: una revisión a distintas escalas espaciales y temporales

We review the effects of climate variability and land use / land cover changes in the Central Spanish Pyrenees at different spatial and temporal scales. Paleoclimatic studies based upon multi-proxy analyses of lacustrine, glacial and speleothematic deposits, among others, have demonstrated the occurrence of intense climatic fluctuations not only during the Late Upper Pleistocene associated to deglaciation, but also during the Holocene, affecting plant cover distribution, runoff generation, flood frequency, and the spatial organization of human activities, particularly during the 8.2 event, the Bronze Age, the Medieval Climatic Anomaly and the Little Ice Age. The study of the impact of human activity on landscape dynamics during the last 150 years has revealed dramatic changes in plant cover structure and distribution, in both the montane and the sub-alpine belts and, consequently, changes in runoff generation, soil erosion intensity, and sediment sources, whatever the spatial scale used. In general, the maximum human pressure on the territory was reached during the middle of the 19th century, with the cultivation of most of the south-facing slopes up to approximately 1650 m a.s.l., and the frequent use of fire to control shrub colonization, resulting in intense soil erosion and degradation processes, as well as the development of braided rivers with a high torrentiality. Farmland abandonment since the beginning of the 20th century (and, particularly, since the 1960s) and the declining livestock pressure have favoured plant recolonization, with the expansion of shrubs and forests in the old cultivated and grazing areas, the human-induced reforestation of large hillslopes, and the treeline upward in the subalpine belt, in this latter case with the contribution of climate warming. The most outstanding consequences of such an evolution have been: (i) the sustained decline of discharge in the Pyrenean rivers since the 1970s because of increasing actual evapotranspiration; (ii) the spatial shrinkage of sediment source areas; (iii) the increasing uncoupled geomorphic dynamics between hillslopes and channels; (iv) the decreasing importance of snow accumulation and snowmelt processes in the fluvial regime of the Pyrenean rivers, with earlier onset of the high spring discharges; (v) the changes in reservoir hydrological dynamics and the need for new management policies; and (vi) the increasing scouring processes that affect most of the Pyrenean rivers. The studies carried out on Global Change and its consequences in the Central Pyrenees confirm the extreme complexity of interactions occurring in the natural systems, and the quick response of plant cover, runoff generation and soil erosion as a consequence of climatic and land use changes.Se revisan los efectos de la evolución del clima y los cambios de uso del suelo / cubierta vegetal en el Pirineo Central español a diferentes escalas espaciales y temporales. Los estudios paleoclimáticos, basados en análisis multiproxy de sedimentos lacustres, glaciares, espeleotémicos y registros dendrológicos, entre otros, han demostrado la ocurrencia de importantes fluctuaciones climáticas durante la deglaciación de finales del Pleistoceno Superior y durante el Holoceno, afectando a la distribución de la vegetación, la generación de escorrentía, la frecuencia de avenidas y las formas de organización del espacio por parte de las sociedades humanas, en particular durante el evento 8.2, la Edad del Bronce, la Anomalía Climática Medieval y la Pequeña Edad del Hielo. El estudio del impacto de las actividades humanas sobre la dinámica del paisaje en el último siglo y medio ha revelado cambios espectaculares en la estructura y distribución de la vegetación, tanto en el piso montano como en el subalpino y, consecuentemente, cambios en la generación de escorrentía, la intensidad de la erosión del suelo y las fuentes de sedimento, cualquiera que sea la escala espacial a la que se contempla el problema. De forma general puede afirmarse que a mediados del siglo XIX se alcanza la máxima presión sobre el territorio, cultivándose todas las laderas posibles hasta una altitud aproximada de 1650 m s.n.m. y empleando frecuentemente el fuego para limitar la expansión de matorrales en zonas de pastos, lo que dio lugar a intensos procesos de erosión y degradación del suelo, y al desarrollo de ríos trenzados con una elevada torrencialidad. Posteriormente, el abandono de tierras de cultivo desde comienzos del siglo XX (y, en especial, desde la década de 1960) y el descenso de la presión ganadera han favorecido la revegetación de las antiguas áreas de cultivo y pastos bien por avance de formaciones naturales de matorral y bosque, bien por la reforestación artificial de extensas laderas, ascendiendo el treeline en el piso subalpino, en este último caso ayudado además por el incremento de la temperatura. Las consecuencias más destacadas de esta evolución han sido: (i) el descenso sostenido del caudal de los ríos pirenaicos desde la década de 1970 debido al aumento de la evapotranspiración; (ii) la contracción espacial de las áreas fuente de sedimento; (iii) la creciente desconexión entre laderas y cauces; (iv) el peso decreciente de la nieve en el régimen de los ríos pirenaicos, con un adelanto en la ocurrencia del momento de aguas altas primaverales; (v) los cambios en la dinámica de llenado de los embalses que han obligado a introducir nuevos patrones de gestión de los embalses; y (vi) la incisión de los cauces fluviales en su propia llanura aluvial. Los estudios llevados a cabo en el Pirineo Central durante las tres últimas décadas sobre el Cambio Global y sus consecuencias confirman la complejidad de las interacciones que se producen en los sistemas naturales y la rápida respuesta de la vegetación, la generación de escorrentía y la erosión frente a variaciones del clima y las actividades humanas

CA125-Guided Diuretic Treatment Versus Usual Care in Patients With Acute Heart Failure and Renal Dysfunction

Background: The optimal diuretic treatment strategy for patients with acute heart failure and renal dysfunction remains unclear. Plasma carbohydrate antigen 125 (CA125) is a surrogate of fluid overload and a potentially valuable tool for guiding decongestion therapy. The aim of this study was to determine if a CA125-guided diuretic strategy is superior to usual care in terms of short-term renal function in patients with acute heart failure and renal dysfunction at presentation. Methods: This multicenter, open-label study randomized 160 patients with acute heart failure and renal dysfunction into 2 groups (1:1). Loop diuretics doses were established according to CA125 levels in the CA125-guided group (n = 79) and in clinical evaluation in the usual-care group (n = 81). Changes in estimated glomerular filtration rate (eGFR) at 72 and 24 hours were the co-primary endpoints, respectively. Results: The mean age was 78 ± 8 years, the median amino-terminal pro-brain natriuretic peptide was 7765 pg/mL, and the mean eGFR was 33.7 ± 11.3 mL/min/1.73m2. Over 72 hours, the CA125-guided group received higher furosemide equivalent dose compared to usual care (P = 0.011), which translated into higher urine volume (P = 0.042). Moreover, patients in the active arm with CA125 >35 U/mL received the highest furosemide equivalent dose (P <0.001) and had higher diuresis (P = 0.013). At 72 hours, eGFR (mL/min/1.73m2) significantly improved in the CA125-guided group (37.5 vs 34.8, P = 0.036), with no significant changes at 24 hours (35.8 vs 39.5, P = 0.391). Conclusion: A CA125-guided diuretic strategy significantly improved eGFR and other renal function parameters at 72 hours in patients with acute heart failure and renal dysfunction