Search

Purpose: Ascending aorta (AAo) acute pathology still has an open-surgery indication with a high mortality rate associated to cardiopulmonary bypass and circulatory arrest. In these cases, the endovascular aortic approach could be an excellent option. The aim of the present study is to detail an optimized technique for the endovascular treatment of AAo diseases, based on thoracic endovascular aortic repair (TEVAR) and transcatheter aortic valve implantation (TAVI) procedures.Technique: The procedure implies the usual preparation for TEVAR and TAVI implants. A transient pacemaker lead is necessary to deliver the prosthesis under “rapid pacing.” As in the TAVI technique, a final high-support guidewire is placed at the left ventricle. The proximal landing zone is the sinotubular junction (zone 0B). Transesophageal echocardiography is essential to ensure aortic valve function and patency in coronary arteries during the delivery. To assess a potential occlusion of the brachiocephalic artery, a guidewire is positioned in the descending aorta from the axillary artery. Finally, a noncovered stent is implanted to stabilize the AAo prosthesis.Conclusion: The technique presented here can standardize a safe and reproducible procedure to endovascular repair of AAo diseases. However, new devices specifically designed for the AAo could facilitate the transcatheter approach.Clinical Impact Ascending aorta acute pathology still has an open-surgery indication with high mortality rate associated to cardiopulmonary bypass and circulatory arrest. Moreover, near 30% of patients are not considered suitable for surgery because of age, critical situation or the presence of severe comorbidities. The present study provides a detailed and optimized technique for the endovascular treatment of ascending aorta disease, based on TEVAR and TAVI procedures.

This article presents the results of a theoretical investigation that aimed to develop a comprehensive model regarding the phenomenon of imagination and private speech as liminal experiences of consciousness. A theoretical articulation between the phenomena was developed to explain how imagination and private speech allow to make sense in the liminal space between inner and outer worlds. It is concluded that the double role of iconic and verbal signs allows to configure future experiences and to construct meanings in the transitional space between oneself and others. The iconic and verbal signs used in imaginative and private speech processes, respectively, allow to experience situations ‘as if they were real’, and at the same time, to distance from them as a mental play separated from reality. This is all based on an affective matrix which determines the emergence of mental meanings and mental content. This article constitutes a contribution to the study of micro-genetic intrapsychic liminal processes.

Background: Retrospective studies and randomized controlled trials support the safety of laparoscopic complete mesocolic excision (CME) for the treatment of right-sided colon cancer (RSCC). Few studies, however, examine the learning curve of this operation and its impact on safety during an implementation period. We aim to evaluate the learning curve and safety of the implementation of laparoscopic CME with intracorporeal anastomosis for RSCC. Methods: Consecutive patients undergoing a laparoscopic right colectomy with intracorporeal anastomosis for RSCC between January 2016 and June 2023 were included. Clinical, perioperative, and histopathological variables were collected. Correlation and cumulative sum (CUSUM) analyses between the operating time and case number were performed. Breakpoints of the learning curve were estimated using the broken-line model. CME and conventional laparoscopic right colectomy outcomes were compared after propensity score matching (PSM). Results: Two hundred and ninety patients underwent laparoscopic right colectomy during study period. One hundred and eight met inclusion criteria. After PSM, 56 non-CME and 28 CME patients were compared. CME group had a non-statistically significant tendency to a longer operating time (201 versus 195 min; p= 0.657) and a shorter hospital stay (3 versus 4 days; p= 0.279). No significant differences were found in total complication rates or their profile. Correlation analysis identified a significant trend toward operating time reduction with increasing case numbers (Pearson correlation coefficient =  − 0.624; p= 0.001). According to the CUSUM analysis, an institutional learning curve was deemed completed after 13 cases and the broken-line model identified three phases: learning (1–6 cases), consolidation (7–13 cases), and mastery (after 13 cases). Conclusion: The learning curve of laparoscopic CME for RSCC can be achieved after 13 cases in centers with experience in advanced laparoscopic surgery and surgeons with familiarity with this technique. Its implementation within this setting seems to be as safe as performing a conventional right colectomy.

BackgroundFibrotic interstitial lung diseases (fILDs) are a heterogeneous group of lung diseases associated with significant morbidity and mortality. Despite a large increase in the number of clinical trials in the last 10 years, current regulatory-approved management approaches are limited to two therapies that prevent the progression of fibrosis. The drug development pipeline is long and there is an urgent need to accelerate this process. This manuscript introduces the concept and design of an innovative research approach to drug development in fILD: a global Randomised Embedded Multifactorial Adaptive Platform in fILD (REMAP-ILD).MethodsDescription of the REMAP-ILD concept and design: the specific terminology, design characteristics (multifactorial, adaptive features, statistical approach), target population, interventions, outcomes, mission and values, and organisational structure.ResultsThe target population will be adult patients with fILD, and the primary outcome will be a disease progression model incorporating forced vital capacity and mortality over 12 months. Responsive adaptive randomisation, prespecified thresholds for success and futility will be used to assess the effectiveness and safety of interventions. REMAP-ILD embraces the core values of diversity, equity, and inclusion for patients and researchers, and prioritises an open-science approach to data sharing and dissemination of results.ConclusionBy using an innovative and efficient adaptive multi-interventional trial platform design, we aim to accelerate and improve care for patients with fILD. Through worldwide collaboration, novel analytical methodology and pragmatic trial delivery, REMAP-ILD aims to overcome major limitations associated with conventional randomised controlled trial approaches to rapidly improve the care of people living with fILD.

La endocarditis infecciosa (EI) es una patología que conlleva una elevada morbimortalidad y representa un problema creciente de salud pública. El tratamiento quirúrgico es necesario en más de la mitad de los casos, y su principal finalidad es eliminar totalmente el tejido infectado y reconstruir la anatomía cardiaca normal, incluyendo la reparación o la sustitución de la/s válvula/s afectada/s.

SARS CoV2 infection has had a major impact on renal transplant patients with a high mortality in the first months of the pandemic. Intentional reduction of immunosuppressive therapy has been postulated as one of the cornerstone in the management of the infection in the absence of targeted antiviral treatment. This has been modified according to the patient`s clinical situation and its effect on renal function or anti-HLA antibodies in the medium term has not been evaluated.

La infección por SARS-CoV2 ha impactado de forma importante en los pacientes con trasplante renal causando una elevada mortalidad en los primeros meses de la pandemia. La reducción intencionada de la inmunosupresión se ha postulado como uno de los pilares en el manejo de la infección ante la falta de un tratamiento antiviral dirigido. Esta se ha modificado de acuerdo con la situación clínica de los pacientes, y su efecto sobre la función renal o los anticuerpos anti-HLA a medio plazo no ha sido evaluado.

Heterozygous germline mutations in PTEN gene predispose to hamartomas and tumors in different tissues, as well as to neurodevelopmental disorders, and define at genetic level the PTEN Hamartoma Tumor Syndrome (PHTS). The major physiologic role of PTEN protein is the dephosphorylation of phosphatidylinositol (3,4,5)-trisphosphate (PIP3), counteracting the pro-oncogenic function of phosphatidylinositol 3-kinase (PI3K), and PTEN mutations in PHTS patients frequently abrogate PTEN PIP3 catalytic activity. PTEN also displays non-canonical PIP3-independent functions, but their involvement in PHTS pathogeny is less understood. We have previously identified and described, at clinical and genetic level, novel PTEN variants of unknown functional significance in PHTS patients. Here, we have performed an extensive functional characterization of these PTEN variants (c.77 C > T, p.(Thr26Ile), T26I; c.284 C > G, p.(Pro95Arg), P95R; c.529 T > A, p.(Tyr177Asn), Y177N; c.781 C > G, p.(Gln261Glu), Q261E; c.829 A > G, p.(Thr277Ala), T277A; and c.929 A > G, p.(Asp310Gly), D310G), including cell expression levels and protein stability, PIP3-phosphatase activity, and subcellular localization. In addition, caspase-3 cleavage analysis in cells has been assessed using a C2-domain caspase-3 cleavage-specific anti-PTEN antibody. We have found complex patterns of functional activity on PTEN variants, ranging from loss of PIP3-phosphatase activity, diminished protein expression and stability, and altered nuclear/cytoplasmic localization, to intact functional properties, when compared with PTEN wild type. Furthermore, we have found that PTEN cleavage at the C2-domain by the pro-apoptotic protease caspase-3 is diminished in specific PTEN PHTS variants. Our findings illustrate the multifaceted molecular features of pathogenic PTEN protein variants, which could account for the complexity in the genotype/phenotype manifestations of PHTS patients.

The aim of this article is to investigate how value co-creation in a B2B context influences relationship quality and economic satisfaction between tourism companies considering factors of trust, commitment, and social satisfaction as key antecedents to determining the quality of the relationship. This study was carried out with a sample of 268 hotels in Spain. The data were analysed via the partial least squares (PLS) regression technique, using the “SEMinR” and “matrixpls” packages with the R software. The results show that value co-creation in a B2B context is a differentiating, integrating, dynamic tool that is capable of improving relationship quality between partners in the hotel sector. In addition, it was confirmed that co-creation leads to economic satisfaction and improved results for all the agents involved in a commercial interaction. This work contributes conceptually and empirically to the relationship marketing literature by providing an innovative route to understand how B2B value co-creation networks are organised. Quantitative evidence is revealed about how co-creation can stimulate the positive evaluation of a company regarding the economic results or benefits obtained thanks to the quality of the relationship with its tourism supplier.

AbstractAs a consequence of advances in the digitisation process and increased consumer awareness of social, economic and environmental issues, more and more companies are embarking on innovative and sustainable initiatives in response to these new demands. However, given the nature and scope of these practices, research in this direction has not reported clarifying results to date, especially when pursuing a marketing approach to their analysis. Through this research, it is intended to test a model that makes it possible to analyse the effect of innovative and sustainable actions on retail and explain their contribution to customer satisfaction. To do this, this research is based on those studies stating that the progress in retailing is based on two main pillars: innovation and sustainability. From a sample of 510 customers across three retail business formats, empirical evidence has been obtained that both innovation and sustainability drive customer satisfaction, but in a different way according to gender, evidencing the moderating nature of this last variable when explaining satisfaction. In this way, the study highlights that the path to achieving satisfaction in retail trade requires the promotion of both innovative (product, marketing and relational innovation) and sustainable (environmental, social and economic) practices, especially in the case of women.

This article develops a theoretical model about the trajectories and transitions of thought from a perspective of semiotic cultural psychology. An integration between the inner speech theory, concept formation, and dialogical self theory was done to explore the particularity of thought transitions. It is concluded that the thought transits in a vertical and horizontal axis—from an irrevocable past to an uncertain future and from the lower levels of consciousness to the higher levels of thought—determined by the nature of inner speech—structural and semantic—the quality of concept formation process and the different dialogical relationships that occur between the I-positions of the self. It is proposed that it is these dynamics of thought that make it an idiosyncratic, historical, and genetic phenomenon, which makes empirical approaches difficult and influences theorizing about the thinking process.

La fibrosis pulmonar idiopática se define como una neumonía intersticial fibrosante crónica progresiva de etiología desconocida. Existen factores de riesgo, tanto intrínsecos como extrínsecos, que pueden fomentar el desarrollo de la enfermedad en individuos con predisposición genética. El diagnóstico se realiza mediante hallazgos radiológicos y/o histológicos característicos en la tomografía axial computarizada de alta resolución y la biopsia pulmonar, respectivamente, en ausencia de causa específica identificable. La supervivencia media de la enfermedad sin tratamiento es de 3-5años desde el inicio de los síntomas, aunque su historia natural es variable e impredecible. Actualmente existen dos fármacos antifibróticos que enlentecen la progresión de la enfermedad. El abordaje multidisciplinar considerará el estado nutricional, el estado emocional, el acondicionamiento físico y el tratamiento de comorbilidades, así como el trasplante pulmonar y los cuidados paliativos en fases avanzadas. En este artículo se revisan los aspectos fundamentales para el diagnóstico y el tratamiento de la fibrosis pulmonar idiopática.

El remdesivir es el único tratamiento antiviral que ha demostrado ser útil frente al SARS-CoV-2 acortando el tiempo de hospitalización frente a placebo. Su efecto en pacientes trasplantados renales (TR) se limita a algunos casos publicados.

Remdesivir is the only antiviral treatment that has been shown to be useful against SARS-CoV-2 infection. It shorts hospitalization time compared to placebo. Its effects in Kidney transplant (KT) patients are limited to some published cases.

Objective: To assess the real-world, long-term effectiveness of rituximab (RTX) as a rescue therapy in patients with antisynthetase syndrome and progressive interstitial lung disease (ASS-ILD). Methods: Multicentre observational retrospective longitudinal study of a cohort of patients with ASS-ILD that started treatment with RTX due to recurrent or ongoing progressive ILD despite therapy with glucocorticoids and immunosuppressants. Results: Twenty-eight patients were analyzed. Examining the entire study population, before treatment with RTX the mean decline in %pFVC and %pDLCO from the ASS-ILD diagnosis to the initiation of RTX treatment (T0) was -6.44% and -14.85%, respectively. After six months of treatment, RTX reversed the decline in pulmonary function test (PFT) parameters: ∆%pFVC +6.29% (95% CI: -10.07 to 2.51; p=0.002 compared to T0) and ∆%pDLCO +6.15% (95% CI: -10.86 to -1.43; p=0.013). Conclusion: Based on our results, RTX appears to be effective as rescue therapy in most patients with recurrent or progressive ASS-ILD unresponsive to conventional treatment. The use of RTX was well tolerated in the majority of patients.

Comparar, entre 2regímenes de sedoanalgesia, el tiempo trascurrido desde la retirada de la medicación hasta el despertar y hasta la extubación del paciente.

Technology and information and communication technology (ICT) have been gaining importance in tourism and hospitality with a booming research interest during the last years and specifically recently due to the disruptions of the COVID-19 crisis. Hence it is useful to structure the existing knowledge in this field to better guide directions for future research. To that end, this study synthesizes the academic literature about ‘technology and ICT’ in tourism and hospitality by carrying out a bibliometric analysis. The study identified 2424 documents, including the words ‘technolog*’ and/or ‘ICT’ combined with ‘touris*’, ‘hospitality’, ‘hotel’, and/or ‘travel’ that were published in the period 1988–2021 and collected from tourism and hospitality journals indexed in the Web of Science (WOS) and SCOPUS databases. The analysis was carried out by using SciMAT software, which offers different bibliometric tools and methods in order to achieve consistent results through a keyword co-occurrence analysis and an evolution map. The findings revealed the major research themes, including technology acceptance model, electronic word-of-mouth, user-generated content, self-services technologies, robotics, smart tourism, virtual reality, and trust in technology. The study concludes by identifying and discussing a future research agenda.

Supplemental Digital Content is available in the text.

SARS‐CoV‐2 infection has produced high mortality in kidney transplant (KT) recipients, especially in the elderly. Until December 2020, 1011 KT with COVID‐19 have been prospectively included in the Spanish Registry and followed until recovery or death. In multivariable analysis, age, pneumonia, and KT performed ≤6 months before COVID‐19 were predictors of death, whereas gastrointestinal symptoms were protective. Survival analysis showed significant increasing mortality risk in four subgroups according to recipient age and time after KT (age <65 years and posttransplant time >6 months, age <65 and time ≤6, age ≥65 and time >6 and age ≥65 and time ≤6): mortality rates were, respectively, 11.3%, 24.5%, 35.4%, and 54.5% (p< .001). Patients were significantly younger, presented less pneumonia, and received less frequently specific anti‐COVID‐19 treatment in the second wave (July–December) than in the first one (March–June). Overall mortality was lower in the second wave (15.1 vs. 27.4%, p< .001) but similar in critical patients (66.7% vs. 58.1%, p= .29). The interaction between age and time post‐KT should be considered when selecting recipients for transplantation in the COVID‐19 pandemic. Advanced age and a recent KT should foster strict protective measures, including vaccination. Older recipients diagnosed with COVID‐19 in the first 6 months after transplantation present the highest risk for a fatal outcome during the second wave of the COVID‐19 pandemic.

SARS-CoV-2 infection has produced high mortality in kidney transplant (KT) recipients, especially in the elderly. Until December 2020, 1011 KT with COVID-19 have been prospectively included in the Spanish Registry and followed until recovery or death. In multivariable analysis, age, pneumonia, and KT performed ≤6 months before COVID-19 were predictors of death, whereas gastrointestinal symptoms were protective. Survival analysis showed significant increasing mortality risk in four subgroups according to recipient age and time after KT (age <65 years and posttransplant time >6 months, age <65 and time ≤6, age ≥65 and time >6 and age ≥65 and time ≤6): mortality rates were, respectively, 11.3%, 24.5%, 35.4%, and 54.5% (p< .001). Patients were significantly younger, presented less pneumonia, and received less frequently specific anti-COVID-19 treatment in the second wave (July–December) than in the first one (March–June). Overall mortality was lower in the second wave (15.1 vs. 27.4%, p< .001) but similar in critical patients (66.7% vs. 58.1%, p= .29). The interaction between age and time post-KT should be considered when selecting recipients for transplantation in the COVID-19 pandemic. Advanced age and a recent KT should foster strict protective measures, including vaccination.

La enfermedad por coronavirus de 2019 (COVID-19) está causada por el segundo coronavirus del síndrome respiratorio agudo y grave. La fibrilación auricular (FA) es común en situaciones agudas, en las que conlleva más complicaciones y mortalidad.

La residencia es un modelo de formación profesional basado en la práctica supervisada. El Mini Clinical Evaluation Exercise(Mini-CEX) es una herramienta de evaluación mediante la observación directa. Permite diseñar estrategias para mejorar el desempeño profesional.

El estudio de las cardiopatías familiares implica realizar pruebas diagnósticas, a veces molestas, a familiares asintomáticos. El objetivo de este proyecto es cuantificar el rechazo a dichas pruebas y recomendaciones terapéuticas.

Specific identification of oestrid larvae is usually problematic not only when using morphobiometric features, but also when applying molecular criteria, since very few molecular markers have been described for this group of flies. New molecular markers for oestrid are needed for more reliable species identification, diagnostic purposes, and epidemiological surveys; moreover, they can help in phylogenetic reconstruction. Here, we report the characterization of COI, 28S rDNA, ITS1, and ITS2 in Cephenemyia stimulatorfrom roe deer and in Cephenemyia auribarbisand Pharyngomyia pictafrom red deer. The COI and 28S rDNA are very uniform in length, while the ITSs sequences are highly variable at both intraspecific and interspecific levels. The described ITSs sequences were longer than those described for other dipteran species by the presence of simple repeats and tandem repeat sequences. In C. auribarbisboth ITS1 and ITS2 appeared as two variants, one short and the other long. In general, the analyzed markers present low intraspecific genetic variation and high interspecific variation. ITSs showed the greatest amount of intraspecific and interspecific variation. Phylogenetic analysis demonstrated that the characterized sequences differentiate the species and genera of Oestridae.