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The design and implementation inconsistency of perioperative care programs limits their universalization, and it is where e-Health can standardize these processes. The objective of the study is to create a Smartphone App with a perioperative care program, implement it in a group of patients scheduled for a thoracic surgical procedure, and evaluates its use.A prospective and descriptive study. We created a Smartphone app (Fissios App) which contains 40 perioperative recommendations and 10 chest physical exercises. Patients were recommended to use it before and after surgery; to measure its use, we created and applied a questionnaire. A descriptive analysis of patient variables and questionnaire responses was performed and their association evaluated.One hundred four patients were included, 60.3% were men with a median age of 62 years (51-71), and 26.72% had completed high school. The 89.3% of patients highlighted the ease of downloading and setting up the app. More than 90% of patients positively assessed clarity in explaining chest physical exercises and perioperative recommendations. One hundred four (79.4%) patients highlighted the contribution of the use of the app during the preoperative period to face the postoperative period.We created a Smartphone app (Fissios App) with a perioperative care program and it was successfully implemented regardless of the age or educational level of patients. The tool clearly explains the information contained and the patients reported that its use before surgery helped them to face the postoperative period, with an appropriate level of physical demand and time of use.

The maximum expression of hemodynamic instability during liver transplant is the so-called postreperfusion syndrome (PRS) that increases both overall mortality and postoperative complications. It was first defined by Aggarwal et al in 1987, but the results are still conflicting when establishing the relationship between PRS and acute kidney failure (AKF). We conducted a retrospective observational study of transplant recipients with deceased-donor liver grafts between January 2002 and December 2018. We analyzed the incidence of PRS and its potential negative impact over kidney function. A total of 551 transplants were analyzed. PRS was recorded in 130 patients (23.6%). The incidence of AKF was 61.5%. A total of 111 patients required kidney replacement therapy (32.7%). Regarding the severity of AKF, 128 patients were classified as acute kidney injury (AKI) 1 (23.2%), 76 as AKI 2 (13.8%), and 135 as AKI 3 (24.5%). In the group with PRS, 75.4% (n = 98) developed AKF vs 57.2% (n = 241) in the group without PRS. In the multivariate analysis we found a relationship between PRS and AKF with an odds ratio of 2.18 (95% CI, 1.30-3.64; P = .003), once adjusted by the length of the anhepatic phase, donor age, Model for End-Stage Liver Disease score, history of ascites, and need for early surgical reintervention. The incidence of AKF decreased (44.5%) ever since the implementation of delayed calcineurin inhibitors therapy and piggyback surgical technique, but a clear influence of the occurrence of PRS on the development of AKF is still observed, with an OR of 3.78 (95% CI, 1.92-7.43; P.001), once adjusted by albumin and hemoglobin levels, Model for End-Stage Liver Disease score, and Child classification.

IgG4 related disease is a term used to describe a fibroinflammatory condition characterized by storiform fibrosis, inflammation with a dense lymphoplasmocytic infiltrate rich in plasma cells expressing IgG4, and often, if not always, raised serum levels of IgG4. We report a case of a patient with a past history of retroperitoneal fibrosis presenting with a swollen left testicle, who underwent an orchidectomy due to suspicion of malignancy. The surgical specimen revealed a paratesticular pseudotumor with histopathological and immunohistochemical characteristics of IgG4 related disease. To the best of our knowledge, just nine such cases have previously been reported, of which only three were manifestations of systemic disease, as in the present case. Whilst it is important to recognize the clinical and radiological features of this entity, histopathology is often essential in order to confirm the diagnosis.

To study the impact of neoadjuvant therapies on postoperative complications and mortality among non-small-cell lung cancer (NSCLC) patients subjected to anatomic lung resection and included in the Spanish cohort of the video-assisted thoracic surgery (GE-VATS) multicenter database.The study included a total of 3085 patients from 33 centers between December 2016 and March 2018. We performed a comparative analysis of the complications and mortality in patients who received neoadjuvant therapies (n = 263) versus those who did not (n = 2822). A propensity score-matched analysis was used to adjust for potential confounders. Association between exposure in two groups and outcomes were estimated by logistic regression weighted by inverse of probability of receiving the treatment that actually received.In the unadjusted analysis, the chemotherapy (CT) and chemoradiotherapy (CRT) group presented a higher frequency of ICU readmissions, reinterventions, empyema, cardiovascular complications, a greater frequency of atrial fibrillation, and an increased need for blood product transfusions. In the adjusted group, CT and CRT patients had a higher rate of cardiovascular complications (CT p = 0.002; OR 2.29; 95% CI 1.34-3.94 and CRT p = 0.001; OR 2.90; 95% CI 1.52-5-52), arrhythmias (CT p = 0.013; OR 2.23; 95% CI 1.18-4.20 and CRT p = 0.046; OR 2.22; 95% CI 1.01-4.90) and transfussions (CT p = 0.042; OR 2.95; 95% CI 1.04-8.35 and CRT p 0.001; OR 7.74; 95% CI 3.01-19-92).Based on our series, neoadjuvant CT and CRT were associated with a higher rate of cardiovascular complications, arrhythmias and transfussions in patients with NSCLC subjected to anatomic lung resection.

Objectives (a) to evaluate and compare the psychological treatment needs of patients with cancer and non-cancer, who are going to undergo scheduled thoracic surgery, and (b) evaluate and compare the diagnostic accuracy of the screening tests of psychological treatment needs for cancer and non-cancer patients. Method The need for psychological treatment was evaluated in a total of 169 patients prior to thoracic surgery, through a clinical interview. The screening tests used were: the physician's judgment (yes/no), the Hospital Anxiety and Depression Scale (HADS) and, the single-item interview to assess depression “Do you feel depressed?” (DEPQ). Results The number of patients who needed psychological treatment in the total sample was 47 (27.81%), in non-cancer-patients: 22 (30.99%) and in cancer patients: 25 (25.51%). The participants with treatment needs were more often young women with primary education levels, with more fears and concerns regarding their disease. With respect to the screening tests, the HADS-T (cut-off point ≥13) obtained a sensitivity (SE) of 0.75 and Specificity (SP) of 0.81 in the total sample. In patients with cancer, the HADS total score (cut-off point ≥10) obtained an SE = 0.84 and SP = 0.80, and, in non-cancer patients, the HADS total score (cut-off point ≥13) showed an SE = 0.59 and SP = 0.84. The DEPQ and the physician's judgment did not achieve adequate levels of precision. Conclusions A high percentage of patients have psychological treatment needs before performing thoracic surgery, which are similar for cancer and non-cancer patients. Preoperative detection of patients who need psychological intervention is feasible with a simple screening test: HADS, which achieves greater precision in cancer patients.

The aim of this study is to compare the postoperative complications, perioperative course, and survival among patients from the multicentric Spanish Video-assisted Thoracic Surgery Group database who received video-assisted thoracic surgery lobectomy or video-assisted thoracic surgery anatomic segmentectomy.From December 2016 to March 2018, a total of 2250 patients were collected from 33 centers. Overall analysis (video-assisted thoracic surgery lobectomy = 2070; video-assisted thoracic surgery anatomic segmentectomy = 180) and propensity score-matched adjusted analysis (video-assisted thoracic surgery lobectomy = 97; video-assisted thoracic surgery anatomic segmentectomy = 97) were performed to compare postoperative results. Kaplan-Meier and competing risks method were used to compare survival.In the overall analysis, video-assisted thoracic surgery anatomic segmentectomy showed a lower incidence of respiratory complications (relative risk, 0.56; confidence interval, 0.37-0.83;Video-assisted thoracic surgery segmentectomy showed results similar to lobectomy in terms of postoperative outcomes and midterm survival. In addition, a lower incidence of prolonged air leak was found in patients who underwent video-assisted thoracic surgery anatomic segmentectomy.

Objective To know the vascular age (VA) of a sample of general population included in the RICARTO study. Patients and method Epidemiological study of the general population aged ≥ 18 from the Health Area of Toledo, based on the health card database. VA was calculated from the absolute cardiovascular risk (CVR) estimated with the Framingham and SCORE equations (type 2 diabetes increased CVR in SCORE 2-fold in men and 4-fold in women). Patients with cardiovascular or renal disease were excluded. An ANCOVA analysis was conducted to adjust and compare the mean of VA by age and sex. Results 1,496 subjects (53.54% women) were analyzed. Mean (SD) age was 48.77 (14.89) years old and. Mean VA was 51.37 (19.13) with Framingham equation and 57.09 (17.63) years old with SCORE equation. VA was significantly higher in men, low education level, arterial hypertension, dyslipidemia, hypertriglyceridemia, diabetes mellitus, abdominal obesity, general obesity, smoking and in individuals with 5 CVR factors vs none (P 0.5) were found in non-diabetic vs diabetic people (1.58 Framingham; 2.44 SCORE), normotensive vs hypertensive subjects (1.64 Framingham; 1.19 SCORE), and non-dyslipidemia vs presence of dyslipidemia (0.95 Framingham; 0.66 SCORE). Conclusions VA of our sample is two and a half years older than chronological one with Framingham equation and more than eight years with SCORE equation. Control of CVR factors is the key to get a VA closer to real and to obtain a better cardiovascular health in the population.

Resumen Objetivos Conocer la edad vascular (EV) de una muestra de poblacion general del area sanitaria de Toledo incluida en el estudio RICARTO. Pacientes y metodo Estudio epidemiologico transversal realizado en poblacion general ≥ 18 anos, aleatorizada segun tarjeta sanitaria. La EV se calculo a partir del riesgo cardiovascular (RCV) absoluto estimado con las escalas de Framingham y SCORE (la presencia de diabetes mellitus duplico el RCV obtenido en varones y lo cuadruplico en mujeres). Se excluyeron los sujetos con patologia cardiovascular o renal. Se realizo ANCOVA para ajustar y comparar las medias de EV por edad y sexo. Resultados Se analizaron 1.496 individuos (53,54% mujeres), con una edad media (DE) de 48,77 (14,89) anos. La EV media fue 51,37 (19,13) anos con Framingham y 57,09 (17,63) anos con SCORE, resultando significativamente mayor en varones, nivel de estudios bajo, hipertension arterial, dislipidemia, hipertrigliceridemia, diabetes mellitus, obesidad abdominal, obesidad general, tabaquismo y en sujetos con 5 factores de RCV frente a ninguno (p 0,5) se hallaron entre no diabeticos y diabeticos (1,58 Framingham; 2,44 SCORE), normotensos e hipertensos (1,64 Framingham; 1,19 SCORE) y no dislipidemicos y dislipidemicos (0,95 Framingham; 0,66 SCORE). Conclusiones En nuestra muestra la EV es 2,5 anos superior a la cronologica con la ecuacion de Framingham y mas de 8 anos con la del SCORE. El control de los factores de RCV es clave para lograr una EV mas proxima a la real y lograr una mejor salud cardiovascular de la poblacion.

Bentonites are used in deep geological disposal facilities as an engineered barrier to isolate high level radioactive waste, contained in metallic canisters. The present study, performed at laboratory scale, evaluated the behaviour of MX-80 (Na-bentonite) and FEBEX (Ca-Mg-Na-bentonite) in contact with carbon steel, subjected to a hydrothermal gradient. A dominant Na-Cl-SO4 saline solution was injected towards the compacted bentonite from the top, while a heater, located at the bottom in contact with the steel disc, maintained a constant temperature of 100 °C. The cells were studied after one and six months of interaction. Changes in the physical (water content and specific surface area) and chemical (cation exchange capacity and element distribution) properties of the bentonite were observed, as well as the formation of a corrosion layer on the steel, at the interface with bentonite, mainly composed of magnetite, maghemite and hematite. The bentonites were mainly altered at the mm scale, being enriched in iron content, and changing their ion distribution to Ca-dominant smectite (in MX-80 bentonite), This project has received funding from the European Union’s Horizon 2020 research and innovation programme 2014-2018 under grant agreement N◦847593

The relationship between psychotic symptoms and global measures of functioning has been widely studied. No previous study has assessed so far the interplay between specific clinical symptoms and particular areas of functioning in first-episode psychosis (FEP) using network analysis methods. A total of 191 patients with FEP (age 24.45 ± 6.28 years, 64.9% male) participating in an observational and longitudinal study (AGES-CM) comprised the study sample. Functioning problems were assessed with the WHO Disability Assessment Schedule (WHODAS), whereas the Positive and Negative Syndrome Scale (PANSS) was used to assess symptom severity. Network analysis were conducted with the aim of analysing the patterns of relationships between the different dimensions of functioning and PANSS symptoms and factors at baseline. According to our results, the most important nodes were “conceptual disorganization”, “emotional withdrawal”, “lack of spontaneity and flow of conversation”, “delusions”, “unusual thought content”, “dealing with strangers” and “poor rapport”. Our findings suggest that these symptoms and functioning dimensions should be prioritized in the clinical assessment and management of patients with FEP. These areas may also become targets of future early intervention strategies, so as to improve quality of life in this population, This work was supported by the Madrid Regional Government (R&D activities in Biomedicine (grant number S2017/BMD-3740 - AGES-CM 2-CM)) and Structural Funds of the European Union. Ana Izquierdo’s work is supported by the PFIS predoctoral program (FI17/00138) from the Instituto de Salud Carlos III (Spain) and co-funded by the European Union (ERDF/ESF, "A way to make Europe”/ “Investing in your future”) and The Biomedical Research Foundation of La Princesa University Hospital. Angela Ib´a˜nez thanks the support of CIBERSAM and of the Spanish Ministry of Science, Innovation and Universities. Instituto de Salud Carlos III (PI16/00834 and PI19/01295) co-financed by ERDF Funds from the European Commission. Covadonga M. Díaz-Caneja holds a Juan Rod´es Grant from Instituto de Salud Carlos III (JR19/00024). Celso Arango was supported by the Spanish Ministry of Science and Innovation. Instituto de Salud Carlos III (SAM16PE07CP1, PI16/02012, PI19/ 024), co-financed by ERDF Funds from the European Commission, “A way of making Europe”, CIBERSAM. Madrid Regional Government (B2017/BMD-3740 AGES-CM-2), European Union Structural Funds. European Union Seventh Framework Program under grant agreements FP7-4-HEALTH-2009-2.2.1-2-241909 (Project EU-GEI), FP7- HEALTH- 2013-2.2.1-2-603196 (Project PSYSCAN) and FP7- HEALTH-2013- 2.2.1-2-602478 (Project METSY); and European Union H2020 Program under the Innovative Medicines Initiative 2 Joint Undertaking (grant agreement No 115916, Project PRISM, and grant agreement No 777394, Project AIMS-2-TRIALS), Fundaci´on Familia Alonso, Fundaci´on Alicia Koplowitz and Fundaci´on Mutua Madrile˜na

The historical anthropogenic impact on sediments from the Basque Mud Patch (southern Bay of Biscay) is explored using a multidisciplinary approach including the analysis of natural (210Pb) and artificial (137Cs, 239/240Pu) radiotracers, major elements (Al, Mn), metals (Zn, Pb, Cu, Cr), Pb isotopic ratios, and foraminiferal and pollen contents. The study of three short cores (19?46 cm), despite being hindered by the effects of biomixing, allow the calculation of a sedimentation rate of 1 ± 0.1 mm yr?1. Distribution with depth of Al-normalised concentrations of metals reflects an increasing trend since 1880 CE, related to the industrialization of the Basque coastal area. According to the Sediment Quality Guidelines applied, contents of Zn and Pb appear as a potential cause of concern, given that they exceed the values from which adverse biological effects can be occasionally expected. However, foraminiferal assemblages do not show recognizable changes along the cores following increasing trace metal concentrations. Finally, pollen results reveal an increasing trend of coniferous taxa and a parallel reduction of authochthonous Deciduous Quercus, probably as a consequence of reforestation works. Data obtained confirm that effects of coastal anthropogenic activities extend to the adjacent shelf, where muddy deposits are likely to act as a trap for contaminants. All samples were kindly provided by Dr Ana Pascual (UPV/EHU).Aintzane Goffard (UPV/EHU) prepared samples and produced for-aminiferal results from core KI-06. This research was funded by SpanishMINECO (CGL2013-41083-P and RTI2018-095678-B-C21, MCIU/AEI/FEDER, UE), UPV/EHU (UFI11/09) and EJ/GV (IT976-16) projects.Aitor Fernández Martín-Consuegra was supported by a predoctoralgrant from the Basque Government (PRE_2017_1_0173). The authorsthank technical and human support provided by SGIker ( UPV/EHU/ERDT, EU). Two anonymous reviewers improved the original manu-script with their comments and constructive suggestions. This is con-tribution 53 of the Geo-Q Zentroa Research Unit (Joaquín Gómez deLlarena Laboratory).

Hip arthrosis is a frequent and difficult to manage disease. The generated pain supposes a great impact in the quality life of the patient. The goal of the treatment should be to reduce pain and to improve function. Based on the complex innervation of the hip, the minimally invasive thecniques have been increasing. In this context, we present the results obtained in four patients with a hip chronic pain due to arthrosis, to whom we performed a quadratus lumborum block type 2 (QL2) with levobupivacaine plus dexametasone as therapeutic option. The results have shown a significant decrease of the intensity of pain (NRS) for more than 6 months.