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IntroductionAlthough cardiovascular surgery societies in Europe and the USA constantly strive for the exchange of knowledge and best practices in coronary artery bypass grafting (CABG), the available evidence on whether such efforts result in similar patient outcomes is limited. Therefore, in the present analysis, we sought to compare patient profiles and overall survival outcomes for up to 3 years between large European and US patient cohorts who underwent isolated CABG.MethodsPatients from the European DuraGraft Registry (n = 2,522) who underwent isolated CABG at 45 sites in eight different European countries between 2016 and 2019 were compared to randomly selected patients from the US STS database who were operated during the same period (n = 294,725). Free conduits (venous and arterial grafts) from the DuraGraft Registry patients were intraoperatively stored in DuraGraft, an endothelial damage inhibitor, before anastomosis, whereas grafts from the STS Registry patients in standard-of-care solutions (e.g., saline). Propensity score matching (PSM) models were used to account for differences in patient baseline and surgical characteristics, using a primary PSM with 35 variables (2,400 patients matched) and a secondary PSM with 25 variables (2,522 patients matched, sensitivity analysis). The overall survival for up to 3 years after CABG was assessed as the primary endpoint.ResultsThe comparison of patient profiles showed significant differences between the European and US cohorts. The European patients had more left main disease, underwent more off-pump CABG, and received more arterial grafts together with more complete arterial grafting procedures. In contrast, the US patients received more distal anastomoses with more saphenous vein grafts (SVGs) that were mainly harvested endoscopically. Such differences, however, were well balanced after PSM for the mortality comparison. Mortality comparison at 30 days, 12 months, and 24 months between the European and US patients was 2.38% vs. 1.96%, 4.32% vs. 4.79%, and 5.38% vs. 6.96%, respectively. At 36 months, the mortality was significantly lower in the European patients than that of their US counterparts (7.37% vs. 9.65%; p-value = 0.016). The estimated hazard ratio (HR) was 1.29 (95% CI 1.05–1.59).ConclusionThis large-scale transatlantic comparative analysis shows that there are some significant differences in patient profiles between large cohorts of European and US patients. These differences were adjusted by using PSM for the mortality analysis. No significant difference in mortality was detected between groups through 2 years, but survival was significantly better in the European DuraGraft Registry patients at 3 years post-CABG.

Esophagectomy remains being a surgical procedure with a high morbidity and mortality rate. Therefore, prehabilitation, defined as the group of interventions performed on the patient in the preoperative period to improve their functional capacity and clinical condition, becomes highly important to ensure that the patient faces the stress that surgery entails under the best possible clinical situation. Hereby, we describe our prehabilitation protocol that has been implementedsince 2017 and we present the clinical results achieved so far. Preoperative risk assessment and various modalities of prehabilitation protocols are discussed to enhance the patient´s preoperative physiological condition and to reduce the impact of the neuroendocrine and inflammatory response induced by an esophagectomy. Finally, we describe the protocol we intend to implement to improve our clinical practice and reduce complications.

Obesity and neurometabolic diseases have been linked to neurodegenerative diseases. Our hypothesis is that the endogenous estrogenic component of human astrocytes plays a critical role in cell response during lipotoxic damage, given that obesity can disrupt hormonal homeostasis and cause brain inflammation. Our findings showed that high concentrations of palmitic acid (PA) significantly reduced cell viability more in male astrocytes, indicating sex-specific vulnerabilities. PA induced a greater increase in cytosolic reactive oxygen species (ROS) production in males, while female astrocytes exhibited higher superoxide ion levels in mitochondria. In addition, female astrocytes treated with PA showed increased expression of antioxidant proteins, including catalase, Gpx-1 and Nrf2 suggesting a stronger cellular defence mechanism. Interestingly, there was a difference in the expression of estrogenic components, such as estrogen, androgens, and progesterone receptors, as well as aromatase and 5α-reductase enzymes, between males and females. PA induced their expression mainly in females, indicating a potential protective mechanism mediated by endogenous hormones. In summary, our findings highlight the impact of sex on the response of human astrocytes to lipotoxicity. Male astrocytes appear to be more susceptible to cellular damage when exposed to high concentrations of fatty acids.

Abstract A prominent feature of COVID-19, both in the short and long term, is the reduction in quality of life (QoL) due to low functionality scores and the presence of fatigue, which can hinder daily activities. The main objective of this study is to compare the functional status, level of physical activity, fatigue, and QoL of patients with Long COVID to other COVID-19 patients who did not develop persistent illness, and to determine whether there is a relationship between these variables and QoL. A cross-sectional study was conducted with 170 participants who had been infected with COVID-19 or had developed Long COVID. The main variables studied were functionality, physical activity, QoL and fatigue, measured using the PostCOVID-19 Functional Status Scale (PCFS), International Physical Activity Questionnaire (IPAQ), Short Form 12 (SF-12), and Fatigue Severity Scale (FSS). The main findings show a significant relationship (p

Melothria pendula L., a wild relative of cucurbit crops, is also used for food and as a medicinal plant in Mexico. The objective of this study was to ecogeographically characterize the known populations of M. pendula in Mexico, determining its adaptive range and possible sites for in situ and ex situ conservation. To achieve this goal, we compiled a dataset of 1270 occurrences of M. pendula from herbarium and botanical databases and individual observations. Adaptive scenarios were generated through the development of an ecogeographic land characterization (ELC) map, preceded by the identification of abiotic variables influencing the species’ distribution. Eleven bioclimatic, edaphic, and geophysical variables were found to be important for the species’ distribution. The ELC map obtained contained 21 ecogeographic categories, with 14 exhibiting the presence of M. pendula. By analyzing ecogeographic representativeness, 111 sites of high interest were selected for the efficient collection of M. pendula in Mexico. Eight high-priority hotspots for future in situ conservation of M. pendula were also identified based on their high ecogeographic diversity, with only three of these hotspots located within protected natural areas. In this study, ecogeographic approaches show their potential utility in conservation prioritization when genetic data are scarce, a very common condition in crop wild relatives.

Cyberbullying is a growing problem in the Italian educational sector, with a prevalence of 17%. This study analyzes its impact on the psychosocial well-being and academic performance of Italian adolescents. Method: A cross-sectional study was conducted with 502 students from six schools in different Italian regions, using the European Cyberbullying Intervention Project Questionnaire (ECIPQ) to assess cyberbullying, in addition to collecting data on satisfaction, friends, and academic performance. Chi-square and ANOVA analyses were conducted to identify significant associations between the variables. Results: The analyses showed significant associations between cyberbullying and gender and in psychosocial well-being, with significant differences in personal satisfaction and body satisfaction. On the other hand, there were no significant differences in academic performance or in the ability to make new friends, although victims showed a significantly lower ability to make new friends compared to those who were neither victims nor aggressors. Conclusions: Cyberbullying has a significant impact on students’ psychosocial well-being, especially on personal satisfaction and school happiness, making it essential to implement interventions that promote safe school environments to mitigate these negative effects.

Background: In order to be used safely, accurately and reliably, measuring instruments in the health field must first be validated, for which the study of their psychometric properties is necessary. The Short Physical Performance Battery (SPPB) tool is a widely used clinical assessment test that has been approved for usage across several nations, languages and demographics. Finding SPPB’s psychometric properties for a sample of institutionalized older individuals is the aim of this research. Methods: This is a multicenter, retrospective and observational study of the psychometric properties of the Short Physical Performance Battery tool with a convenience sample of 194 institutionalized older adults. Reliability (internal consistency) and validity (construct validity and convergent validity) tests were performed. Results: The results show a very good internal consistency, construct validity and convergent validity. In addition, the factorial structure of the SPPB is provided, which reflects that it is a unidimensional scale. Conclusions: In conclusion, the Short Physical Performance Battery is a valid and reliable tool for use with institutionalized older adults. Its use is recommended as part of the Comprehensive Geriatric Assessment for the evaluation of the physical or functional sphere. This study was not registered.

This study evaluates teacher self-efficacy perceptions among students in the Master’s Degree in Secondary Education and Baccalaureate, Vocational Training, and Language Teaching (MDSE), as well as the variables influencing these perceptions and their connection to the program’s training. The research sheds light on how self-efficacy affects views on concerns, feelings, and attitudes towards diversity and inclusive education in the current educational landscape. Out of 205 female and 100 male MDSE students surveyed, who are either graduates or nearing completion, data were gathered using the “Teacher Education in Secondary Education: Key Elements for Teaching in an Inclusive School for All” (FORPES-IN) questionnaire distributed across Spanish universities. Three primary instruments from the questionnaire were utilized: the Teachers’ Self-Efficacy Short Form (TSES-SF), the Questionnaire for Future Secondary Education Teachers regarding Perceptions of Diversity, and the Revised Scale of Feelings, Attitudes, and Concerns about Inclusive Education (SACIE-R). Findings suggest that the majority of prospective teachers exhibit moderate-to-high levels of self-efficacy. Variables such as non-formal teaching experiences, the reason for joining the MDSE program, and regular interactions with vulnerable individuals, especially in Social and Health Science domains, moderately influence self-efficacy. This study reveals a strong link between the received training and the perceived level of self-efficacy. In particular, participants with higher self-efficacy feel better equipped to handle classroom diversity and rate the MDSE program positively. Areas for enhancement are identified, such as classroom management and diversified assessment strategies. Finally, a positive correlation is observed between high self-efficacy and positive attitudes toward disability, inclusive education principles, and reduced apprehensions about inclusive teaching.

Background: The COVID-19 pandemic generated uncertainty and disruption among the child and adolescent population. Multiple studies have documented a worsening of mental health following the pandemic. The main objective of this longitudinal study is to analyze the short-, medium-, and long-term evolution of the overall functioning of children and adolescents treated by a child and adolescent mental health team in the context of the COVID-19 pandemic. Methods: 420 patients aged 3 to 18 were assessed using the Global Assessment of Functioning (GAF) scale at three time points: during the lockdown, three months later, and three years later. Differences based on gender, diagnosis, and time were analyzed. Results: A significant improvement was observed in the short-term (three months) and long-term (three years) compared to the lockdown period. This improvement was maintained in all diagnostic subgroups except for mixed cases (severe mental pathology), which showed the least improvement. No significant differences were found between males and females. Conclusions: The child and adolescent population showed a greater capacity for adaptation to the lockdown than expected. Family support, decreased stress, and therapeutic intervention appear to have played an important role in improving mental health.

ABSTRACT2016 witnessed the birth of the first baby conceived using mitochondrial replacement technology (MRT), a procedure conducted by an international team in a Mexican clinic. The story soon made it to the international press, where authorship was assigned to the USA team and Mexico was described as lacking regulation, thus a suitable location. The Mexican media offered a different version. The baby was stamped as “made in Mexico” and the Mexican physician involved was described as a remarkable citizen and bold scientist. The story served as a counter-narrative to the one circulating in the press and academic circles. It dismantled the notion of Mexico as a country with “no rules” and instead offered a story of a country producing cutting-edge technology and of a government ready to back up scientific progress. In this paper, we analyze the performative acts that transformed this breakthrough into a national success and we ask about the role the Mexican team had in this accomplishment. This analysis contributes to the conversation held within the field of postcolonial science and technology studies, regarding knowledge production, authorship, and the role of science stories in the process of nation building.

3D printing is driving a shift in patient care away from a generalised model and towards personalised treatments. To complement fast-paced clinical environments, 3D printing technologies must provide sufficiently high throughputs for them to be feasibly implemented. Volumetric printing is an emerging 3D printing technology that affords such speeds, being capable of producing entire objects within seconds. In this study, for the first time, rotatory volumetric printing was used to simultaneously produce two torus- or cylinder-shaped paracetamol-loaded Printlets (3D printed tablets). Six resin formulations comprising paracetamol as the model drug, poly(ethylene glycol) diacrylate (PEGDA) 575 or 700 as photoreactive monomers, water and PEG 300 as non-reactive diluents, and lithium phenyl-2,4,6-trimethylbenzoylphosphinate (LAP) as the photoinitiator were investigated. Two printlets were successfully printed in 12 to 32 s and exhibited sustained drug release profiles. These results support the use of rotary volumetric printing for efficient and effective manufacturing of various personalised medicines at the same time. With the speed and precision it affords, rotatory volumetric printing has the potential to become one of the most promising alternative manufacturing technologies in the pharmaceutical industry.

Abstract Aims To assess the effect of a multicomponent intervention on reducing social isolation and loneliness and improving the quality of life in community‐dwelling older adults. Design A cluster‐randomized controlled clinical trial. Methods A total of 56 older adults participated in the control group and 63 older adults in the experimental group. The intervention consisted of 6 home‐based face‐to‐face sessions, intercalated with 5 telephone calls and was conducted by nursing students and volunteer staff with experience in the subject. The study was conducted between April 2018 and December 2019. In terms of statistical analysis, several procedures were carried out: a statistical analysis per protocol and intention to treat, considering isolation, loneliness and quality of life as endpoints; a comparison of paired means, to analyse the behaviour of the outcome variables at baseline and the end of the study; and finally, a binary logistic regression analysis, considering social support as a dependent variable. Results The study results do not show the effectiveness of the modified CARELINK programme, analysed as a whole, on the decrease in social isolation or loneliness or the improvement in HRQL. However, a detailed analysis of the behaviour of some of the variables during the study indicates some results that deserve to be commented on. Comparing the mean confidential support scores between the experimental and control group at the initial and final stages shows significant differences in the analysis by protocol, and close to statistical significance in the analysis by intention to treat. Comparing the paired means obtained in the experimental group, an improvement in emotional loneliness scores was found. Finally, the variables associated with the social support of the subjects at the end of the follow‐up period were as follows: having people who help them and mobility. Conclusion Although the results obtained do not allow us to affirm that the intervention programme is effective, these same results point to improved confidential support and emotional loneliness in older adults participating in the intervention. Having people to help them and a greater degree of mobility are factors favouring the decrease in social isolation. Impact This study suggested that modified CARELINK, a multicomponent intervention performed by trained volunteers, could improve confidential support in community‐dwelling older adults. It also reports the importance of considering the level of mobility and support networks as determinants of the improvement caused by the intervention.

Un aspecto relevante en la vinculación con la sociedad es obtener resultados pro-positivos a través de los procesos entre beneficiarios, estudiantes y docentes. Este estudio devela los conocimientos adquiridos por los participantes de un proyecto de vinculación en la carrera de Comunicación de la Universidad Estatal Península de Santa Elena. El objetivo fue analizar cómo los beneficiarios aprovecharon los conocimientos generando en conjunto con los estudiantes, insumos comunicacionales que coadyuvan a la potencialización del sector turístico. Se aplicó una metodología descriptiva de carácter cuali-cuantitativo, con la que se generaron grupos focales y encuestas a todos los colaboradores antes, durante y después del proceso. Este estudio demuestra desde el punto de vista de los beneficiarios, que no solo se necesita un capital económico para emprender un negocio sino conocimientos básicos en procesos comunicacionales; mientras que en el personal universitario se evidenció lo fundamental de integrar acciones para contribuir a las mejoras sociales.

Abstract Physical exercise is known to be beneficial for breast cancer survivors (BCS). However, avoiding nonfunctional overreaching is crucial in this population, as they are in physiological dysregulation. These factors could decrease their exercise capacity or facilitate nonfunctional overreaching, which can increase their risk of additional morbidities and even all-cause mortality. The focus of this study is to evaluate the reliability and validity of the ATOPE+ mHealth system to estimate autonomic balance and specific wellness parameters associated with BCS’ perceived load, thereby informing nonlinear prescriptions in individualized physical exercise programs for BCS.Twenty-two BCS were included in the reliability and validity analysis. Measures were taken for four days, including morning autonomic balance by heart rate variability, self-reported perception of recovery from exercise, sleep satisfaction, emotional distress and fatigue after exertion. Measures were taken utilizing the ATOPE+ mHealth system application. The results of these measures were compared with criterion instruments to assess validity.The reliability results indicated that the intraclass correlation coefficient (ICC) showed an excellent correlation for recovery (0.93; 95% CI 0.85–0.96) and distress (0.94, 95% CI 0.89–0.97) as well as good correlation for the natural logarithm of the mean square root differences of the standard deviation (LnRMSSD) (0.87; 95% CI 0.74–0.94). Sleep satisfaction also showed an excellent correlation with a weighted kappa of 0.83. The validity results showed no significant differences, except for fatigue. ATOPE+ is reliable and valid for remotely assessing autonomic balance, perception of recovery, sleep satisfaction and emotional distress in BCS; however, it is not for fatigue. This highlights that ATOPE+ could be an easy and efficient system used to assess readiness in BCS, and could help to improve their health by supporting the prescription of optimal and safe physical exercise. Trial registration NCT03787966 ClinicalTrials.gov, December 2019 [ATOPE project]. https://clinicaltrials.gov/ct2/show/NCT03787966 .

The clinical manifestation of median nerve entrapment at the carpal tunnel level is known as carpal tunnel syndrome (CTS). Electroneurography (ENG) is considered the gold standard in CTS evaluation. We conducted a retrospective study and analyzed some clinical and demographic variables, relating them to the degree of neuropathy using ENG, to better understand the role of ENG in this very common disease. We studied 816 patients referred to our service for neurographic evaluation. Their symptoms were classified as compatible with CTS (cCTS) (n = 646) and atypical for CTS (aCTS) (n = 170). A blind ENG was performed on 797 patients. Patient characteristics were coded as variables and analyzed to study whether they could predict neuropathy severity (sensory and motor involvement or grade ≥ 3 in our classification). We found a correlation between typical symptomatology, age over 50 years, male gender, positivity of Phalen’s maneuver and Tinel’s sign, and a neuropathy grade ≥ 3. We also found a correlation with CTS in the contralateral hand if the other hand showed neuropathy, despite the lack of symptoms in this hand. We propose a practical algorithm for ENG referral based on clinical symptoms, demographic factors, and neurophysiological variables.

Maize is part of the traditional diet of Mexico and other Latin American countries. The diverse varieties of maize produced by adaptation to different regions and climates are known as creole or native maize. The characteristics and nutritional contributions of each of these native maize are relatively diverse areas of study. This work specifically analyzes the nutritional aspects of creole maize grown in the Sierra Gorda in Querétaro. For this, a proximal chemical analysis was carried out, with a quantification of polyphenolic compounds and antioxidant capacities using the ABTS (2,20-azinobis (3-ethyl-benzothiazolin,6-sulfonic acid) and DPPH (2,2-difenil-1-picrilhidrazilo) methods to examine four landraces and one commercial hybrid control. The results indicate that, in general, the landraces present similar—and, in some cases, higher—nutritional indices than the commercial hybrid. With regard to polyphenolic compounds, the Elotes Occidentales and Tuxpeño varieties present greater amounts of total phenols and antiradical activity (ARA), as well as a higher concentration of flavonoids and percentage inhibition, respectively. Condensed tannins are identified both in the creole varieties and in the commercial hybrid. Creole maize presents important nutritional characteristics and can be a good source of antioxidant compounds, which can help the population as a source of food and in the prevention of chronic diseases.

En 2016 y después de más de cincuenta años de conflicto armado y de múltiples intentos por realizar la reforma rural integral (RRI), el Gobierno de Colombia y la guerrilla de las Fuerzas Armadas Revolucionarias de Colombia-Ejército del Pueblo (FARC-EP) llegaron al acuerdo final para la terminación del conflicto y la construcción de una paz estable y duradera, donde el primer punto, titulado “Hacia un nuevo campo colombiano: reforma rural integral”, se proyecta como una posibilidad para solucionar los problemas del sector rural. El objetivo de la presente investigación fue analizar la percepción que tienen los estudiantes de ingeniería agronómica de la Universidad Pedagógica y Tecnológica de Colombia (UPTC) respecto a la RRI. Para ello, se empleó el método científico de la medición con la escala de actitudes tipo Likert y el análisis factorial. Las conclusiones indican que los estudiantes de ingeniería agronómica de la UPTC conciben el reconocimiento del campesinado como un componente fundamental de la RRI, además de admitir que su intervención en el desarrollo rural va más allá de la transferencia de tecnología.

IntroductionPain is one of the most persistent symptoms after cancer treatment. The central nervous system can erroneously stay in its alarm phase, altering the pain experience of patients who have cancer. Pain neuroscience education (PNE) with multimodal approaches may benefit these patients.ObjectiveThis protocol aims to determine the effectiveness of a PNE tool on pain, physical function and quality of life, as a supplement to a multimodal rehabilitation (MR) program in patients who had breast cancer (BC).MethodsAn 8-week double-blinded randomized controlled trial will be conducted, including 72 participants who had BC and who have persistent pain, randomized into three groups: PNE program + MR program, traditional biomedical information + MR program and control group. The PNE program will include educational content that participants will learn through a mobile app and the MR program will include a concurrent exercise program and manual therapy. The primary outcome will be the perceived pain assessed using the Visual Analogue Scale and secondary outcomes are others related to pain, physical function and quality of life. All outcomes will be evaluated at baseline, at the end of the intervention and 6 months after the end of intervention.DiscussionThe proposed study may help BC patients with persistent pain improve their pain experience, quality of life and provide for more adaptive pain-coping strategies. This protocol could propose an action guide to implement different integral approaches for the treatment of sequelae. This treatment option could be offered to this patient profile and it could be easily implemented in the healthcare systems due to its low costs.Trial registrationClinicalTrials.gov, NCT04877860. (February18, 2022).

BackgroundSince the beginning of the COVID-19 pandemic, a great variability of symptoms that affect all organs and systems of the body has been identified in patients with SARS-CoV-2 infection; this symptomatology can sometimes persist over time, giving rise to the so-called long COVID or post-COVID. The aim of this study is to delve into the clinical characterization of these patients, as well as to take into account the influence of factors such as hospitalization, admission to ICU, history of pneumonia, or vaccination status on the persistence of symptoms.Material and methodsAn observational, descriptive, multicenter, and retrospective study was designed with a series of cases of people who presented long COVID, which includes univariate, bivariate, and multivariate analyses. Data were obtained from an online ad hoc questionnaire, and statistical analysis was performed using SPSS Software Version 25 (IBM-Inc., Chicago, IL, USA).ResultsHospitalization, ICU admission, history of pneumonia, and vaccination were predictive factors (positive or negative) for the following long-COVID symptoms: headache, menstrual disorders, joint pain, cough, chills, nasal congestion, back pain, abdominal pain, weight loss, eye discomfort, facial erythema, itching, tremors, dizziness, seizures, sleeping difficulty, dry eyes, palpitations, fatigue, paresthesia, dyspnea, aphonia, chest pain, high blood pressure, vomiting, memory loss, brain fog, hypothermia, low blood pressure, sputum or phlegm, lack of concentration, hair loss, and erectile dysfunction.ConclusionThis study provides evidence on the clinical characterization of patients suffering from long COVID in order to offer them the most appropriate treatments.

Resumen: Introducción y objetivos: La pandemia por COVID-19 causada por infección del virus SARS-CoV-2 ha saturado al sistema sanitario español, afectándose la atención de las enfermedades cardiovasculares. Queremos cuantificar el impacto de la pandemia en el número de las intervenciones quirúrgicas cardíacas analizando los grupos relacionados con el diagnóstico (GRD) más prevalentes de nuestra especialidad. Métodos: A instancias de la Sociedad Española de Cirugía Cardiovascular y Endovascular, se solicitó a todos los centros nacionales que quisieron participar, los datos de los códigos de GRD números 162 (cirugía sobre válvulas cardíacas con infarto o diagnóstico complejo), 163 (cirugía sobre válvulas cardíacas sin infarto o diagnóstico complejo), 165 (bypass coronario con infarto o diagnóstico complejo), 166 (bypass coronario sin infarto o diagnóstico complejo) y 167 (otros procedimientos cardiotorácicos o vasculares torácicos) entre el 1 de marzo de 2020 y el 30 de septiembre de 2020 (siete meses), y como período control las mismas fechas de 2019. Resultados: Se recibieron los datos de 24 hospitales, 22 públicos y dos privados. Existió un descenso global en el número de intervenciones del 30% (rango -19 a -42%, p < 0,001) de 4.648 en 2019 a 3.262 en 2020 (-1.386 de diferencia), siendo +7% para el GRD 162 (p = 0,500), -37% para el 163 (p = 0,001), -9% para el 165 (p = 0,304), -32% para el 166 (p = 0,001), y -16% para el 167 (p = 0,062). Conclusiones: Existió un descenso global de cirugías estadísticamente significativo en 2020 del 30% respecto del 2019 entre el 1 de marzo y el 30 de septiembre. Abstract: Introduction and objectives: The COVID-19 pandemic caused by the SARS-CoV-2 virus infection has saturated the Spanish health system, affecting the care of cardiovascular diseases. In this phase 2 of the SECCE-COVID-19 study we want to quantify the impact of the pandemic on the number of cardiac surgeries by analyzing the most prevalent diagnostic-related groups (DRGs) in our specialty. Methods: At the request of the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE), all the centers in the national territory that wanted to participate were asked for the data of the DRG codes number 162 (surgery on heart valves with infarction or complex diagnosis), 163 (surgery on heart valves without infarction or complex diagnosis), 165 (coronary bypass with infarction or complex diagnosis), 166 (coronary bypass without infarction or complex diagnosis) and 167 (other cardiothoracic or thoracic vascular procedures) between March 1, 2020 and September 30, 2020 (7 months), and as a control period the same dates of the year 2019. Results: Data were received from 24 Hospital Centers, 22 public and 2 private. There was a global decrease in the number of interventions of 30% (Range -19 a -42%, p < 0.001) from 4648 in 2019 to 3262 in 2020 (-1386 difference), being +7% for the GRD 162 (p = 0.500), -37% for 163 (p = 0.001), -9% for 165 (p = 0,304), -32% for 166 (p = 0.001) and -16% for 167(p = 0.062). Conclusions: There was a statistical significant global decrease in surgeries in 2020 of 30% compared to 2019 between March 1 and September 30.

The main objective of this work has focused on extending the existing literature on the analysis of total factor productivity of the Health Care Centers (HCC) of the Community of Madrid (Spain) in the period 2015-2017, with two important contributions; the application and comparison of the Malmquist indices with two robust methodologies such as the Hicks-Moorsteen and Färe Primont indices which, except for error, have not been previously used in this sector and the regional scope, which has been scarcely analyzed. The main results reveal decreases in HC productivity due to the three proposed methodologies. These decreases range between 4.90% and 0.25% for the Färe-Primont and Hicks-Moorsteen indices respectively between 2015/17 in average terms. Convergence analyses confirm that this takes place in the case of the Malmquist and Hicks-Moorsteen proposals. || El objetivo principal de este trabajo se ha enfocado en extender la literatura existente sobre el análisis de la productividad total de los factores, de los Centros Sanitarios de la Comunidad de Madrid en el periodo 2015-2017, con dos importantes contribuciones, la aplicación y comparación de los índices de Malmquist con dos metodologías robustas, los índices de Hicks-Moorsteen y Färe Primont que salvo error no han sido previamente utilizadas en este sector y el ámbito regional, que ha sido escasamente analizado. Los principales resultados revelan disminuciones de la productividad de los CS por las tres metodologías propuestas. Estas disminuciones oscilan entre 4.90% y 0.25% para los índices de Färe-Primont y de Hicks-Moorsteen respectivamente entre 2015/17 en términos medios. Los análisis de convergencia confirman que esta tiene lugar en el caso de las propuestas de Malmquist y Hicks-Moorsteen.

Academic performance (AP) is a topic of particular interest in the academic context. Attributions for academic success (AAS) have been shown to have a significant impact on AP, and more specifically internal controllable attributions (ICA) are closely linked to academic success. Similarly, positive emotions (PE) have a significant influence on AP and may in turn be influenced by bullying. This study examines the connections between ICA of academic success and AP mediated through PE in late primary and early secondary school students and analyzes the relationships between PE and bullying categories. Students (N = 562, 49.46% female, Mage = 11.6 SD = 1.2) reported on their perceptions of ICA and PE in relation to exams and their relationship with bullying through validated questionnaires. The AP was obtained as the average mark of all subjects in the immediately preceding assessment. First, a multiple linear regression analysis considering ICA and PE as predictor variables was carried out, which showed a significantly positive link between ICA and PE, between ICA and AP, and between PE and AP. Subsequently, using the SPSS macro PROCESS, a simple mediation model was implemented to quantify the effect of ICA on AP through PE in exams, and finally an ANOVA between the categories of bullying and PE was performed. The results showed a significant indirect relationship with a positive predictive relationship for AP. The model shows that PE proves to be a significant mediator between ICA and AP, and it is shown that students disengaged from bullying score higher in PE.

Las genealogías contables, constituyen la estrategia más avanzada para alcanzar experticia al abordar los más disímiles constructos del saber. En ese sentido el producto derivado es contexceptual: situado y legitimado. Las autoridades producen las reglas, conceptos, métodos, incluso teorías. Dichos constructos pautan el comportamiento humano, por su influencia en todos y a la vez en cada orden determinado. La regulación contable es una materialización social que impacta la realidad y una forma de incidir que marca las actuaciones de sus profesionales, sean practicantes, docentes o académicos. Utilizando las genealogías como recurso de investigación histórica, este documento analiza, la verdad y validez que subyace a la depreciación, desde la perspectiva del regulador institucional. Se evidencia como tal organismo determina, la operacionalización de las reglas emitidas como política, sin que los conceptos, los métodos y las teorías aportados desde la academia, tengan la relevancia que ameritan. Desde esta perspectiva, estudiar cada trozo de verdad producido, reviste al constructo depreciación de un estado actual, cuya génesis-evolución es producto del metabolismo intelectual que nutre su discusión en el contexto organizacional. Y, aun así, el todo alcanzado, será a la vez más y menos que la suma de sus partes. Constituye estar un paso más cerca de la verdad, abriendo de nuevo oportunidad a la investigación histórica, en contraste a otro tipo de encerramientos que evidencian dar más validez a las oposiciones dicotómicas.

La arquitectura sustentable es un modo de concebir el diseño arquitectónico de manera sostenible y tiene como uno de sus principios la reducción del consumo de energía. El uso de la domótica es también fundamental para lograr este propósito de ahorro energético ofreciendo además confort a sus clientes. Este trabajo presentaun sistema de control de iluminación dependiente de la iluminación natural como una solución viable para una vivienda sustentable. La investigación teórico práctica fue realizada en dos etapas. Durante la primera etapa se realizó la simulación del sistema en el programa Simulink® de MATLAB® mostrando cómo se logra la iluminación deseada y el control de la iluminación total. En la segunda etapa se realizó la implementaciónpráctica del sistema a través de la plataforma Arduino®.Los resultadosalcanzados fueron validadosdesde el punto de vista energéticocon el uso práctico del sistema diseñado.

This paper shows the brain correlates of Cloninger’s personality model during the presentation of social scenarios under positive or negative valence situations. Social scenarios were constructed when participants played the Dictator game with two confederates that had two opposites roles as the cooperator (Coop) and non-cooperator (NoCoop). Later the same day during a fMRI scanning session, participants read negative (Neg) and positive (Pos) situations that happened to confederates in the past. Participants were asked to think “how do you think those people felt during that situation?” A dissimilarity matrix between stimuli were obtained from fMRI results. Results shown that Harm Avoidance trait people make use of right middle frontal gyrus and left superior frontal gyrus to discriminate between Coop and NoCoop. Cooperation as a trait makes use of the right superior temporal gyrus and the right precuneus to discriminate between Coop and NoCoop in positive social scenarios. Finally, Self-directedness trait people make use of the right inferior parietal lobe to discriminate between Coop and NoCoop in negative social scenarios and the right precuneus to discriminate between Coop and Strangers. An intuitive link between discrimination findings and behavioral patterns of those personality traits is proposed.

La localización de una reproducción fotográfica del diseño original del monumento de Semana Santa de la catedral de Oviedo (en paradero desconocido desde 1924) nos permite trazar la historia de este desaparecido altar de perspectiva y bastidores pintados. Concebido por el pintor madrileño Francisco Ortega Delgado en 1732 y consagrado en 1740, fue destruido en 1903. La investigación desvela otros datos desconocidos, como la participación del pintor madrileño Juan Delgado en 1731 y el diseño de un altar gótico en 1903 para reemplazarlo.

Objective: To analyze the influence of different risk factors on the age at which a stroke occurs. Method: An observational cross-sectional study was conducted including all patients admitted consecutively with ischemic stroke at the University Hospital of Burgos (Spain). Sociodemographic and clinical, parameters were collected, exploring possible association with patient’s age by univariate and multivariate analysis. Results: 436 patients were included, with a mean age of 75.39 years (SD ±12.674). The most frequent risk factors were high blood pressure and cardiovascular disease. In the case of having a personal history of arterial hypertension (Odds Ratio [OR] 2.49; 95% Confidence Interval [CI] 1.49-4.16), having a sedentary lifestyle (OR 3.24; 95%CI 1.97-5.31) was related with a greater probability that the patient is aged 75 years or older. However, being overweight/obese (OR 0.51; 95%CI 0.30-0.88), being an active smoker (OR 0.47; 95%CI 0.02-0.11) or alcohol consumption (OR 0.42; 95%CI 0.26-0.69) increased the probability of stroke occurrence before 75 years. Conclusion: The age of occurrence of a case is related to the occurrence of certain risk factors, which are determined in the planning of future education campaigns.

Objective: To develop a protocol in thecare of patients with advanced dementiaand feed problems,according to thescientific evidence. Method: A systematic review was carried out, consulting CUIDEN, EMBASE, MEDLINE, SCIELO, HEALTH GUIDE and NHS databases as well as protocols of Scientific Societies and Health Centers. The DeCs and MeSH terms related to the objective of the study were used. Studies published in English or Spanish were selected, since 2000, which assessed dysphagia and eating disorders in the person with dementia, with at least the summary available. Results: Nine studies were selected, whose results allowed to develop an action protocol in patients with advanced dementia and feed problems. In the protocol obtained, any intervention in this type of patients should be based on the previous comprehensive geriatric and nutritional assessment. Conclusion: The implementation of the dysphagia and eating disorders protocol in patients with advanced dementia improves their clinical and nutritional status.

This descriptive transversal research studies the relationship between number of falls in the last month and fall risk on one side; and frailty situation in older adults on the other side; through a 194 old institutionalized people sample. Frailty is measured with the Short Physical Performance Battery; previous falls in the last month are measured with the number of events, and fall risk with Downton scale. The results do not show any significant differences in frailty groups related to the number of previous falls in the last month. However, significant differences do exist between frailty groups established in SPPB and fall risk; then, since descriptive results, they show how the arithmetical averages in fall risk increase as the continuum robust-prefrail-frail-dependent advances towards dependency. Concerning differences between groups, it is found that dependent group has got significant differences with all other (p=,001), there are significant differences also in frail-robust (p=,003). In opposition, the relation frail-prefrail and frail-robust do not show any significant differences Results allow the detection of high level fall risk population, which enables early intervention implementations aimed to falls prevention based on differences found between groups.

This descriptive transversal research studies frailty situation in older adults and basic and instrumental activities of daily living relationship through a 194 old institucionalized people sample. Frailty is measured with the Short Physical Performance Battery; basic activities of daily living with Barthel Index and instrumental activities of daily living with Lawton and Brody scale. Descriptive results show how the arithmetical averages in both activities of daily living decrease as the continuum robust-prefrail-frail-dependent advances towards dependency. There are significant differences in all subscales of Short Physical Performance Battery, as well as in Barthel and Lawton and Brody (p,001). Regarding to Barthel and SPPB groups, significant differences among all of them were found (,007p,001), except in the robust-prefrail relation, where differences are not meaningful. Concerning Lawton and Brody, differences are significant (,041p,001); except in fragil-prefrail relation. The differences found between groups allow an early diagnosis and interventions aimed to prevent or reverse the progress towards a dependency situation.

Resumen: Introducción y objetivos: El grupo de Trabajo en Reparación Valvular de la Sociedad Española de Cirugía Torácica y Cardiovascular presenta el registro anual de actividad en cirugía reparadora de la válvula mitral, aórtica y tricúspide realizada en España en los años 2016 y 2017. Métodos: La recogida de datos se realizó a través de un cuestionario online, de forma retrospectiva, voluntaria, anónima y no auditada. Se detallan parámetros en cuanto al tipo de cirugía, etiología, mortalidad y riesgo quirúrgico de cada una de las válvulas. Resultados: Se obtuvieron datos de 27 centros, con 6.751 y 7.634 intervenciones registradas en 2016 y 2017, respectivamente. La cirugía mitral reparadora supone el 35%, y 30% de las válvulas mitrales intervenidas. El porcentaje de cirugía reparadora aórtica (4,5%) se mantiene como en años anteriores. La cirugía valvular tricúspide aumenta un 26% en el 2017 respecto al año anterior, manteniendo una tasa de reparación estable del 88%, mayoritariamente con el uso de anillos protésicos. Respecto a la cirugía mitral miniinvasiva, se aprecia una disminución de los centros y del número de cirugías: de 14 centros con 109 cirugías en 2016 a 9 centros con 83 cirugías en 2017. La cirugía miniinvasiva aórtica se sitúa en un 15% en 2016 y un 13% en 2017. Conclusiones: Existe una disminución considerable de los centros participantes y consiguientemente del número de cirugías. La actividad reparadora mitral está establecida en la mayoría de los grupos, aunque con unas tasas de reparación bajas. Se observa una estabilización en la tasa de reparación valvular tricúspide. La cirugía miniinvasiva mitral disminuye mientras que la aórtica aumenta respecto a años anteriores. Abstract: Introduction and objectives: The Working Group on Valve Repair of the Spanish Society of Thoracic and Cardiovascular Surgery presents the annual report on reconstructive valve surgery of the mitral, aortic and tricuspid valves performed in Spain during 2016-2017. Methods: The data was gathered using an online form, in a retrospective, voluntary, anonymous and non-audited way. Different parameters regarding etiology, type of surgery, mortality and risk scores were collected. Results: Data was collected from 27 centers with 6.751 and 7.634 recorded interventions in 2017 and 2017, respectively. Mitral repair surgery accounts for 35% and 30% of all mitral valve operated. The percentage of aortic valve sparing interventions was 4,5%, similar to previous years. Tricuspid surgery has increased 26% in 2017 in relation to 2106, confirming a stable repair rate of 88%, mainly with a wide use of prosthetic rings. Regarding mini-invasive mitral surgery, a decrease in centers and number of surgeries is observed (14 centers reporting 109 surgeries in 2106 to 9 centers with 83 surgeries in 2017). Mini-invasive aortic surgery means a 15% in 2016 and 13% in 2017. Conclusions: It has been observed a decrease in the number of participating centers and therefore of the number of surgeries. Mitral valve repair is a established option in our country, although with very low repair rates. Tricuspid valve repair surgery has stabilized in the last years. Mini-invasive mitral surgery has decreased while aortic mini-invasive has increased. Palabras clave: Registro, Reparación valvular, Sustitución valvular, Válvula mitral, Válvula aórtica, Válvula tricúspide, Keywords: Registry, Valve repair, Valve replacement, Mitral valve, Aortic valve, Tricuspid valve

A patient with advanced rheumatic heart valve disease underwent aortic and mitral valve replacement with tricuspid ring annuloplasty. There was an anomalous left circumflex coronary artery (LCCA) arising from the right coronary artery (RCA) running along the anterior surface of an enlarged right ventricle (RV). During the immediate postoperative course, signs of inferior and lateral myocardial ischemia developed. An emergent coronary angiography revealed LCCA entrapment. An additional suture placed in the RV outflow tract used to optimize exposition of the aortic root during the aortotomy was determined to be the origin of the coronary entrapment. No similar case of LCCA occlusion has previously been reported. This is a description of successful management of this complication.

Proteus syndrome is an extremely rare disorder that manifests as an asymmetric, disproportionate overgrowth of any connective tissue, such as bone, fat or epidermal nevi, in a mosaic or patchy pattern. It has an estimated prevalence of less than 1/1,000,000 live births. The diagnosis can be difficult because the phenotypes of the patients are variable. Many individuals develop cutaneous capillary malformation and prominent varicosities (large and complex vascular malformations). Thus, Proteus syndrome patients are at risk of developing deep vein thrombosis and pulmonary embolism. The authors present the case of a patient with Proteus syndrome who was admitted because of pulmonary thromboembolism and presented hypertrophy of the left arm and left hemithorax.

The association between neurodegenerative diseases (NDs) and obesity has been well studied in recent years. Obesity is a syndrome of multifactorial etiology characterized by an excessive accumulation and release of fatty acids (FA) in adipose and non-adipose tissue. An excess of FA generates a metabolic condition known as lipotoxicity, which triggers pathological cellular and molecular responses, causing dysregulation of homeostasis and a decrease in cell viability. This condition is a hallmark of NDs, and astrocytes are particularly sensitive to it, given their crucial role in energy production and oxidative stress management in the brain. However, analyzing cellular mechanisms associated with these conditions represents a challenge. In this regard, metabolomics is an approach that allows biochemical analysis from the comprehensive perspective of cell physiology. This technique allows cellular metabolic profiles to be determined in different biological contexts, such as those of NDs and specific metabolic insults, including lipotoxicity. Since data provided by metabolomics can be complex and difficult to interpret, alternative data analysis techniques such as machine learning (ML) have grown exponentially in areas related to omics data. Here, we developed an ML model yielding a 93% area under the receiving operating characteristic (ROC) curve, with sensibility and specificity values of 80% and 93%, respectively. This study aimed to analyze the metabolomic profiles of human astrocytes under lipotoxic conditions to provide powerful insights, such as potential biomarkers for scenarios of lipotoxicity induced by palmitic acid (PA). In this work, we propose that dysregulation in seleno-amino acid metabolism, urea cycle, and glutamate metabolism pathways are major triggers in astrocyte lipotoxic scenarios, while increased metabolites such as alanine, adenosine, and glutamate are suggested as potential biomarkers, which, to our knowledge, have not been identified in human astrocytes and are proposed as candidates for further research and validation.

In this paper, we study some properties of the solutions of a stochastic Lotka–Volterra predator-prey model, namely, the boundedness in the mean of numerical solutions, the strong convergence for this kind of solutions, and the turnpike property of solutions of an optimal control problem in a population modelled by a Lotka–Volterra system with stochastic environmental fluctuations. Even though there are numerous results in the deterministic case, there are few results for the behavior of numerical solutions in a population dynamic with random fluctuations. First, we show, using the Euler–Maruyama scheme, that the boundedness of numerical solutions and the convergence of the scheme are preserved in the stochastic case. Second, we analyze a property of the long-term behavior of a Lotka–Volterra system with stochastic environmental fluctuations known as turnpike property. In optimal control theory, the optimal solutions dwell mostly in the neighborhood of a balanced equilibrium path, corresponding to the optimal steady-state solution. Our study shows, by means of the Stochastic Maximum Principle, that this turnpike property is preserved, when the noise in the system is small. Numerical simulations are implemented to support our results.

Background The determinants and consequences of pulmonary hypertension after successfully corrected valvular heart disease remain poorly understood. We aim to clarify the hemodynamic bases and risk factors for mortality in patients with this condition. Methods and Results We analyzed long‐term follow‐up data of 222 patients with pulmonary hypertension and valvular heart disease successfully corrected at least 1 year before enrollment who had undergone comprehensive hemodynamic and imaging characterization as per the SIOVAC (Sildenafil for Improving Outcomes After Valvular Correction) clinical trial. Median (interquartile range) mean pulmonary pressure was 37 mm Hg (32–44 mm Hg) and pulmonary artery wedge pressure was 23 mm Hg (18–26 mm Hg). Most patients were classified either as having combined precapillary and postcapillary or isolated postcapillary pulmonary hypertension. After a median follow‐up of 4.5 years, 91 deaths accounted for 4.21 higher‐than‐expected mortality in the age‐matched population. Risk factors for mortality were male sex, older age, diabetes mellitus, World Health Organization functional class III and higher pulmonary vascular resistance—either measured by catheterization or approximated from ultrasound data. Higher pulmonary vascular resistance was related to diabetes mellitus and smaller residual aortic and mitral valve areas. In turn, the latter correlated with prosthetic nominal size. Six‐month changes in the composite clinical score and in the 6‐minute walk test distance were related to survival. Conclusions Persistent valvular heart disease–pulmonary hypertension is an ominous disease that is almost universally associated with elevated pulmonary artery wedge pressure. Pulmonary vascular resistance is a major determinant of mortality in this condition and is related to diabetes mellitus and the residual effective area of the corrected valve. These findings have important implications for individualizing valve correction procedures. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00862043.

Estudio descriptivo y transversal que pretende estableces la relación de la situación de fragilidad en adultos mayores institucionalizados y la calidad de vida de los mismos en una muestra compuesta por 194 participantes. La fragilidad se mide con la herramienta Short Physical Performance Battery y la calidad de vida con la escala GENCAT; ambas con buenas propiedades psicométricas. Los resultados muestran que existen diferencias significativas entre los grupos de fragilidad en relación a la calidad de vida, tanto en su puntuación total como en cada una de sus subescalas. Además, tomando el valor numérico total de la escala SPPB, aparece una correlación estadísticamente significativa con la puntuación total en calidad de vida y con todas sus subescalas; de forma que, a medida que el estado de fragilidad avanza hacia la dependencia, la calidad de vida disminuye. Los resultados sugieren que, el síndrome de fragilidad, además de tratamientos encaminados a paliar el deterioro físico y funcional de las personas mayores, debería ser abordado igualmente desde las esferas social y emocional.

Investigación transversal y de tipo descriptivo para estudiar la relación entre la situación de fragilidad de las personas mayores institucionalizadasyla presencia de úlceras por presión yel riesgo desufrirlas;en una muestra de 194 participantes. La presencia de úlceras por presión se recoge a través de un registro ad hoc, el riesgo de padecer úlceras por presión se mide con la escala de Norton y la fragilidad se con la herramienta Short Physical Performance Battery; ambos instrumentos con buenas propiedades psicométricas. Los resultados no muestran relación significativa entre los grupos de fragilidad y la presencia de UPP, aunque resulta destacable la no existencia de ninguna persona con úlceras por presión en los grupos de personas robustas y prefrágiles; así, todas las personas que presentan úlceras por presión se catalogan como frágiles (21,4%) o dependientes (78,6%). Sin embargo, sí que existen diferencias significativas entre los grupos de fragilidad que establece el Short Physical Performance Battery y el riesgo de úlceras por presión entre todos los grupos de fragilidad (,060 mayor que p mayor que ,001) excepto en la relación prefrágil-robusto. Además, aparece una correlación positiva entre el riesgo de úlceras por presión y la situación de fragilidad, de forma que a mayor riesgo de UPP, existe mayor situación de fragilidad y/o dependencia. Los resultados obtenidos permiten la detección de la población con mayor riesgo de úlceras por presión, lo que posibilitaría implementar intervenciones precoces encaminadas a la prevención de las mismas en base a las diferencias encontradas entre los grupos.

Resumen: Objetivo: Revisar la mejor evidencia científica disponible sobre el uso de las nuevas tecnologías para evaluar actividad física y su relación con la salud. Diseño: Revisión sistemática de 39 artículos. Fuentes de datos: Artículos publicados en PubMed, Web of Science, Medline y Science Direct, durante los últimos 10 años. Selección de estudios: Se seleccionaron artículos relacionados con ensayos clínicos publicados en inglés/español en base a los siguientes términos: «aging», «physical activity assessment», «wearable technology», «telemedicine», «new technologies» y «disease». Extracción de datos: Mediante método PRISMA. Resultados: La actividad física (AF) diurna y nocturna se registra con dispositivos electrónicos inteligentes (DEI). Estos acoplan sensores de movimiento que permiten una monitorización activa y pasiva. Este sistema de registro está dentro del grupo de biomarcadores digitales. La gran ventaja que proporcionan los DEI es la posibilidad de estudiar evaluación remota y longitudinalmente la AF. Pero existen importantes limitaciones también, como son la falta de patrones de AF establecidos como gold standard, que caractericen a la población con base en los grupos de edad, sexo y enfermedad de base. Conclusiones: El uso de los DEI representa un nuevo sistema de monitorización de AF, dentro del grupo de biomarcadores digitales. No obstante, faltan estudios que permitan establecer su asociación con el estado de salud dentro de los diferentes grupos de población. Abstract: Objective: Review the best scientific evidence available on the use of new technologies to assess physical activity and its relationship with health. Design: Systematic review of 39 articles. Data sources: Articles published in PubMed, Web of Science, Medline and Science Direct, during the last 10 years. Selection of studies: Articles related to clinical trials published in English/Spanish were selected based on the following terms: «aging», «physical activity assessment», «wearable technology», «telemedicine», «new technologies» y «disease». Data extraction: Using the PRISMA method. Results: Day and night physical activity (PA) is recorded with intelligent electronic devices (DEI). These couple motion sensors that allow active and passive monitoring. This registration system is within the group of digital biomarkers. The great advantege provided by intelligent electronic devices is the possibility of stuyding reomte and longitudinal evaluation of PA. But there are important limitations as well, such as the lack of established PA standards such as gold-standard, that characterize the population based on age groups, sex and underlying disease. Conclusions: The use of DEI represents a new AF monitoring system, within the group of digital biomarkers. However, studies are lacking to establish its association with the health status within the different population groups.

El objetivo del trabajo fue analizar la sustentabilidad de las unidades productivas cafeteras de la provincia de Guanentá, Santander. Se utilizó la metodología del marco para la evaluación de sistema de manejo de recursos naturales mediante indicadores de sustentabilidad (Mesmis) en donde se evaluó –además de los tres elementos convencionalmente aceptados para la sustentabilidad: social, económico, ambiental– el componente institucional, en concordancia con las nuevas tendencias del desarrollo rural. Los resultados indican que el disímil comportamiento de la sustentabilidad en las seis unidades productivas de los tres municipios evaluados trasciende la dimensión ambiental para concentrarse en indicadores sociales, económicos e institucionales, los cuales, con una mayor variabilidad dada por una mayor desviación típica, explican la diferencia entre las fincas cafeteras. Basado en los resultados se concluye que las unidades poseen un alto desempeño en la dimensión ambiental relacionado con la cultura cafetera de la certificación de cafés especiales en contraposición a una alta variabilidad en los indicadores sociales. Al respecto, la dimensión social posee la menor sustentabilidad y mayor variabilidad con respecto a las otras dimensiones de la sustentabilidad. El análisis multidimensional de la sustentabilidad permite conocer las brechas de las unidades productivas cafeteras para transitar hacia la sustentabilidad y omite la fragmentación contenida en el estudio de una dimensión en particular.

Background and Objetives: Currently, total knee arthroplasty is one of the most common surgeries, increasing with the increase in life expectancy. Whether or not to replace the patella has been a subject of debate over the years, remaining in controversy and without reaching a consensus. Over the years, different meta-analyses have been carried out in order to provide evidence on the subject, although, in recent times, there have not been many new studies in this regard. Therefore, it is considered necessary that the latest works form part of a new meta-analysis. Materials and Method: We searched the literature using PUBMED, SCOPUS, the Cochrane database and VHL from 2010 to 2020. The search terms used were “patellar” AND “resurfacing” OR “Replacement” and “no resurfacing” OR “no replacement”. A meta-analysis was performed with Stata software (Stata version 15.1). Forest plots were generated to illustrate the overall effect of knee arthroplasty interventions. Results: As a result, it was obtained that there is a significantly higher risk of suffering AKP in the non-resurfacing group, in addition to a significant increase in the risk of undergoing a reoperation in the non-resurfacing group. On the other hand, significant differences were obtained in favor of the resurfacing group in both the clinical and Feller KSS, with functional KSS being inconclusive. After analyzing different variables throughout the literature, it does seem clear that the non-resurfacing group may present a higher risk of reoperation than the resurfacing group. Conclusions: For all these reasons, we think that, although it does seem that not replacing the patella can precipitate a reoperation, it is not clear whether this reoperation is a direct consequence of not having replaced the patella. Therefore, in our opinion, the treatment must be individualized for each patient.

Introducción: los trastornos temporomandibulares constituyen un problema de salud importante que afecta a más del 50% de la población mundial en algún momento de su vida. Objetivo: evaluar la efectividad de la ozonoterapia para disminuir el dolor en los pacientes con trastornos temporomandibulares. Método: se realizó un estudio cuasi-experimental prospectivo en enfermos con trastornos temporomandibulares pertenecientes a la Clínica Estomatológica “Mártires de Sagua” atendidos en la Sala de Rehabilitación del Policlínico Docente “Idalberto Revuelta” en 2016. La muestra estuvo constituida por 30 pacientes, la selección se realizó a través de un muestreo no probabilístico por criterios y quedó conformada por un grupo experimental de 10 enfermos en los que se añadió la ozonoterapia al tratamiento convencional y un grupo control de 20 pacientes con solo tratamiento convencional. En ambos grupos se solicitó el consentimiento informado para participar en la investigación según el tratamiento asignado y brindar datos acerca de su evolución. Resultados: predominaron las edades entre 50 y 59 años y el sexo femenino; antes del tratamiento predominó la intensidad del dolor moderada y los indicadores empleados para valorar la evolución clínica mostraron resultados porcentualmente superiores en el grupo experimental. Conclusiones: la modalidad de tratamiento que combina la terapia convencional con el ozono es más efectiva que la aplicación de la terapia convencional sola en los pacientes con trastornos temporomandibulares.