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Objetivo: El objetivo del presente estudio es de comparar la velocidad de marcha (VM), fuerza de tren superior (PM) y el Índice de Masa Corporal (IMC) en mujeres mayores que participan de forma regular en talleres de actividad física, según rango de edad, así como, verificar la asociación entre Edad, IMC y PM con VM en 10 metros. Metodología: Participaron voluntariamente 85 mujeres (70,1±6,9años) vinculadas al programa de talleres de adulto mayor del IND de la región de Ñuble. Las participantes fueron categorizadas según rango de edad (grupo total [GT], 60-64, 65-69, 70-74, 75-79 y 80-84 años). Se evaluó el peso corporal y la estatura para el cálculo de IMC, la fuerza de tren superior con la prueba de prensión manual (PM) en la mano dominante y la VM en 10 metros. Resultados: Los principales resultados apuntan que la VM fue significativamente inferior para el grupo de 80-84 años comparados a los grupos GT (p

Study objective: There is very limited information about the effect of continuous positive airway pressure (CPAP) in the very elderly. Here we aimed to analysed the effect of CPAP on a clinical cohort of patients with obstructive sleep apnea (OSA) >= 80 years old. Methods: Post-hoc pooled analysis of two open-label, multicenter clinical trials aimed to determine the effect of CPAP in a consecutive clinical cohort of elderly (>= 70 years old) with moderate-to-severe OSA (apnea-hipopnea index >= 15 events/hour) randomized to receive CPAP or no CPAP for three months. Those consecutive patients >= 80 years old were included in the study. The primary endpoint was the change in Epworth Sleepiness scale (ESS). Secondary outcomes included sleep-related symptoms, quality of life, neurocognitive and mood status as well as office blood pressure measurements. Results: From the initial 369 randomized individuals with >= 70 years, 97 (26.3%) with >= 80 years old were included (47 in the CPAP group and 50 in the no-CPAP group). The mean (SD) age was 81.5 (2.4) years. Average use of CPAP was 4.3 (2.6) hours/night (53% with good adherence) Patients in the CPAP group significantly improved snoring and witnessed apneas as well as AHI (from 41.9 to 4.9 events/hour). However no clinical improvements were seen in ESS (>= 1.2 points, 95%CI, 0.2 to >= 2.6), any domain of QSQ, any neurocognitive test, OSA-related symptoms, depression/anxiety or blood pressure levels. Conclusions: The present study does not support the use of CPAP in very elderly patients with moderateto-severe OSA. (C) 2021 Elsevier B.V. All rights reserved.

Obstructive sleep apnea (OSA) is associated with increased incidence of both cerebrovascular and coronary events and of overall cardiovascular risk. However, it seems that these relationships are less clear in the elderly population. On the other hand, continuous positive airway pressure (CPAP), the treatment of choice for severe and symptomatic OSA patients, seems to be more effective in preventing cerebrovascular than coronary events, also in the elderly. This review describes the existing literature in the field and exposes the different hypotheses that try to explain these phenomena. There is a growing body of evidence showing that low-grade intermittent hypoxia (a feature that characterized OSA) is associated with increased levels of hypoxia-inducible factor 1 (HIF-1) and vascular endothelial growth factor (VEGF) which in turn lead to neovascularization in the coronary tree (preconditioning hypoxia hypothesis). However, little is known about the effect of intermittent hypoxia in the formation of new vessels in the cerebral vasculature. Moreover, the effect of intermittent hypoxia in both coronary and cerebral vessels could change with age. On the other hand, recent randomized clinical trials have shown that CPAP may not be effective in preventing cardiovascular events in the context of secondary prevention. However, a more detailed analysis of the results and subsequent meta-analyses show that this treatment exerts a protective effect in cerebrovascular disease but not in cardiovascular diseases, especially in elderly patients. Although OSA is clearly related to an increased cardiovascular risk, this seems less obvious in the elderly and in the coronary vessels. As a consequence, the effect of CPAP in the elderly with coronary disease remains controversial.

Background In patients with pulmonary embolism (PE), there is a lack of comprehensive data on the prevalence and prognostic significance of pre-existing obstructive sleep apnea (OSA). Methods In this study of patients with PE from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry, we assessed the prevalence of OSA, and the association between pre-existing OSA and the outcomes of all-cause mortality, PE-related mortality, recurrences, and major bleeding over 30 days after initiation of PE treatment. Additionally, we also examined rates of outcomes within 90 days and 1 year following the diagnosis of PE. Results Of 4,153 patients diagnosed with PE, 241 (5.8%; 95% confidence interval [CI]: 5.1–6.6%) had pre-existing OSA. Overall, 166 (4.0%; 95% CI: 3.4–4.6%) died during the first 30 days of follow-up. In multivariable analysis, the OSA syndrome was not a significant predictor of death from any cause (odds ratio [OR]: 1.5; 95% CI: 0.8–2.9; p = 0.19). However, patients with pre-existing OSA had an increased PE-specific mortality (adjusted OR: 3.0; 95% CI: 1.3–6.8; p = 0.01) compared with those without OSA. OSA was not significantly associated with 30-day recurrent venous thromboembolism (adjusted OR: 0.6; 95% CI: 0.1–4.7; p = 0.65) or major bleeds (adjusted OR: 1.0; 95% CI: 0.4–2.2; p = 1.0). Findings were similar at 90-day and 1-year follow-ups. Conclusion In patients presenting with PE, pre-existing OSA is relatively infrequent. Patients with OSA were at increased risk of PE-related mortality when compared with those without OSA.

The knowledge on demyelinating and autoimmune optic neuropathies has experienced a revolution the last decade since the discovery of anti-aquaporin 4 antibody. Improvements in diagnostic techniques, and the finding of new targets, along with advances in neuro-immunology have led to the detection of antibodies related to demyelinating diseases. A review is presented on the classical and new concepts in optic neuritis. The debate on the classification of demyelinating and autoimmune optic neuritis is presented. Furthermore, the updated diagnostic criteria in multiple sclerosis and neuro-myelitis optics are described. Finally, the latest insights into Myelin Oligodendrocyte Glycoprotein (MOG) disorders and chronic-recurring optic neuropathies (CRION) are highlited.

Pneumosinus dilatans (PD) is a rare disorder of unknown etiology which consists of an abnormal dilatation of one or more paranasal air sinuses without radiological evidence of localized mucous membrane alterations, hyperostosis, or bony erosion. Sinus walls are therefore of normal thickness. The enlargement of the bone may be generalized or focal, and apart from the aesthetic problem it carries, it is important to bear in mind the possible functional consequences it may imply. Although PD is usually a benign asymptomatic condition, some patients may develop progressive neurological signs and symptoms caused by the expanded sinuses. We herein present the case of a 12-year-old boy who had been referred to the Ophthalmology Department, complaining of a progressive and painless exophthalmos of his left eye, developed during 1 year. The cause was unknown and there were no functional problems. Computed tomography and magnetic resonance showed a large pneumatized ethmoidal sinus and confirmed the resulting proptosis. We asked the Ear Nose and Throat (ENT) department for a further examination, and finally, the patient was taken to the operating room, where the left ethmoidal sinus was exposed to an endoscopic endonasal technique; in particular, a maxillary and frontal endoscopic antrostomy ethmoidectomy was performed. Excellent results were obtained and the patient had no complaints. Currently, he remains well after a 16-month postoperative period.

Currently, there is much controversy surrounding the therapeutic approach to pulmonary function abnormalities in patients with bronchiectasis and, consequently, whether and when to use bronchodilators in these patients. National and international guidelines on the treatment of bronchiectasis in adults do not recommend the routine use of bronchodilators because there is no evidence that a significant response to a bronchodilator or the presence or hyperresponsiveness of the airway are good predictors of future effective clinical response. However, some guidelines recommend them in the presence of airway obstruction and/or special conditions, which vary according to the guideline in question, although there are no recommendations on optimal dosing and bronchodilator treatment combined with or without inhaled corticosteroids. Nonetheless, in contrast with guideline recommendations, bronchodilators are overused in real-world patients with bronchiectasis even in the absence of airway obstruction, as demonstrated by analysis of national and international registries. This overuse can be explained by the awareness of the existence of a solid pharmacological rationale that supports the use of bronchodilators in the presence of chronic airway obstruction independent of its aetiology. We performed a systematic review of the literature and were able to verify that there are no randomised controlled trials (apart from a small study with methodological limitations and a very recent trial involving a not-very-large number of patients), or any long-term observational studies on the short- or long-term effect of bronchodilators in patients with bronchiectasis. Therefore, we believe that it is essential and even urgent to evaluate the effects of bronchodilators in these patients with appropriately designed studies.

Mini-EUSO is a telescope launched on board the International Space Station in 2019 and currently located in the Russian section of the station. Main scientific objectives of the mission are the search for nuclearites and Strange Quark Matter, the study of atmospheric phenomena such as Transient Luminous Events, meteors and meteoroids, the observation of sea bioluminescence and of artificial satellites and man-made space debris. It is also capable of observing Extensive Air Showers generated by Ultra-High Energy Cosmic Rays with an energy above 10$^{21}$ eV and detect artificial showers generated with lasers from the ground. Mini-EUSO can map the night-time Earth in the UV range (290 - 430 nm), with a spatial resolution of about 6.3 km and a temporal resolution of 2.5 μs, observing our planet through a nadir-facing UV-transparent window in the Russian Zvezda module. The instrument, launched on 2019/08/22 from the Baikonur cosmodrome is based on an optical system employing two Fresnel lenses and a focal surface composed of 36 Multi-Anode Photomultiplier tubes, 64 channels each, for a total of 2304 channels with single photon counting sensitivity and an overall field of view of 44°. Mini-EUSO also contains two ancillary cameras to complement measurements in the near infrared and visible ranges. In this paper we describe the detector and present the various phenomena observed in the first year of operation.

[Background] The length of hospital stay (LOS) for acute pulmonary embolism (PE) varies considerably. Whether the upfront use of a PE prognostic assessment and management pathway is effective in reducing the LOS remains unknown., [Methods] We conducted a randomised controlled trial of adults hospitalised for acute PE: patients were assigned either to a prognostic assessment and management pathway involving risk stratification followed by predefined criteria for mobilisation and discharge (intervention group) or to usual care (control group). The primary end-point was LOS. The secondary end-points were the cost of prognostic tests and of hospitalisation, and 30-day clinical outcomes., [Results] Of 500 patients who underwent randomisation, 498 were included in the modified intention-to-treat analysis. The median LOS was 4.0 days (interquartile range (IQR) 3.7–4.2 days) in the intervention group and 6.1 days (IQR 5.7–6.5 days) in the control group (p, [Conclusions] The use of a prognostic assessment and management pathway was effective in reducing the LOS for acute PE.

Background Sleep-disordered breathing (SDB) has been associated with a greater incidence and mortality of cancer, although such findings are inconsistent. However, no large studies are currently available to investigate this association in patients with a specific type of cancer. This study seeks to assess potential relationships between SDB severity and aggressiveness markers of cutaneous melanoma. Methods Four hundred and forty-three patients with a diagnosis of melanoma underwent a sleep study within 6 months of diagnosis. General demographics were collected, along with melanoma characteristics and polygraphic parameters consisting of the apnea-hypopnea index (AHI) and indices of both continuous and intermittent night-time oxyhemoglobin desaturation (DI4%). An exploration of independent relationships between SDB and various objective melanoma aggressiveness markers (Breslow index, presence of ulceration, presence of regression, mitotic index, stage of severity, damage to the sentinel lymph, and spreading of the melanoma) was performed. Results Patients in the upper tertiles of AHI or DI4% were 1.94 (95% CI, 1.14-3.32; P = .022) and 1.93 (95% CI, 1.14-3.26; P = .013) times more likely, respectively, to present with aggressive melanoma (Breslow index > 1 mm) than those in the lowest tertiles of these sleep attributes after adjustment for age, sex, tumor location, and BMI. This association was particularly prominent among patients 2 mm. The presence of the additional markers of aggressiveness was also associated with higher AHI and DI4% values. Conclusions The severity of SDB was independently associated with greater aggressiveness of cutaneous melanoma, particularly among younger patients.

Severe mental disorders have been reported to be associated with an increased cardiovascular risk. To measure the potential risk excess as compared, not with the baseline cardiovascular risk for the general population, but with the cardiovascular risk associated with drug iatrogenia. 197 reported cases of cardiovascular adverse reaction to antipsychotic drugs as compared to the reported cases of this type of adverse reactions to drugs other than antipsychotics entered in the Spanish Pharmacovigilance System database (FEDRA) (1995–2018) in an observational case/non-case study. Risk estimates of association were reporting odds ratio (ROR), and, chi-square test (χ2). Overall disproportionality for the whole drug class was found [ROR 2.3 (95% CI 2.0–2.7)], χ2 = 127.07]. When the two types of antipsychotics (typical and atypical) were analysed separately, we also found statistically significant disproportionality, and this disproportionality is similar between both groups, with disproportionality measures around 2.30, with the confidence intervals not including the 1. The disproportionality observed suggests a risk excess that might be greater than expected, which holds particularly true for torsade de pointes, sudden death and cardiac arrhythmias in patients treated with any of the two types of antipsychotics. There was no significant risk for ischaemic heart disease.

Background and importance Management of immunosuppression in recipients of solid organ transplantation (SOT) is challenging Drugs used in COVID-19 involve drug-drug interactions (DDIs) with immunosuppressants Aim and objectives To describe DDIs in hospitalised SOT recipients (SOTr) and to analyse DDI management and their clinical impact Material and methods A retrospective single centre study was conducted in SOTr with COVID-19 hospitalised from 11 March to 25 April Clinical data and pharmacotherapy were recorded from admission up to 28 days or discharge Lexicomp was used to detect and categorise DDIs according to: risk level (X: avoid combination;D: consider therapy modification;C: monitor therapy;B: no action needed), reliability rating and severity 46 patients were included: 33 (71 7%) men, aged 62 7 ±12 6 (mean±SD) years They had received kidney (30;56 2%), lung (13;28 3%) or liver (3;6 5%) transplants Results Immunosuppression at admission: tacrolimus (41;89 1%), mycophenolate mofetil/mycophenolate sodium (28;60 9%), prednisone (39;84 8%), everolimus (7;15 2%), sirolimus (7;15 2%) and cyclosporine (1;2 2%) 106 DDIs affecting 42 (91 3%) patients were detected (patients could have >1 DDI) DDIs were classified as confirmed (18;39 1%) or potential (33;71 7%) Immunosuppressants with DDIs: tacrolimus (65;61 3%), everolimus (12;11 3%), sirolimus (6;5 7%), methylprednisolone (12;11 3%), prednisone (10;9 4%) and mycophenolate (1;0 9%) Drugs for COVID-19 with DDIs: lopinavir/ritonavir (45;42 5%), azithromycin (32;30 2%), tocilizumab (15;14 2%), darunavir/cobicistat (10;9 4%), and hydroxychloroquine (4;3 8%) DDIs were risk X (6;5 6%), risk D (42;40 8%), risk C (57;53 7%) and risk B (1;0 9%) The reliability rate of DDIs was excellent (0 9%), good (52 8%) and fair (44 3%) Severity was low, moderate and major in 6 6%, 84 9% and 8 5% of cases, respectively Immunosuppression was withheld in 33 (71 7%) patients due to DDIs 36 (87 7%) of 41 patients receiving tacrolimus had 65 DDIs;tacrolimus was withdrawn in 22 (61 1%), reduced in 18 (50%) and increased in 4 (11 1%) cases Seven patients receiving everolimus had 12 DDIs and 4 patients with sirolimus had 6 DDIs;immunosuppressant was stopped in all cases Tacrolimus levels were supratherapeutic (>10 ng/mL) in 8 (25%) patients at admission, 13 (43 3%;n=30) at 48 hours, 10 (31 3%, n=32) at 7 days and 2 at 14 days (17 7%, n=28) No graft rejection was detected Mean creatinine serum concentration was 2 2 mg/dL at admission and 2 6 mg/ dL 7 days later Two cases of acute kidney failure were attributable to tacrolimus intoxication Conclusion and relevance DDIs were highly prevalent in hospitalised SOTr with COVID-19 Pharmaceutical care is critical to promptly detect and manage DDIs in SOTr

The accurate diagnosis of subcentimeter lesions is controversial, and therefore a standardized diagnosis algorithm is needed. The objective of the present work was to study the value of the elastography patterns obtained through the use of the shear wave elastography (SWE) technique with respect to histopathology for the evaluation of nodular breast lesions ≤1 cm. A retrospective study was conducted which included 65 sub-centimeter lesions from 57 patients with an average age of 45.6 ± 11.9. For all the cases, a B-mode ultrasound study, shear wave elastography, and a posterior anatomopathological study were conducted. The lesions had a diameter greater than 7.5 ± 1.7 mm (range: 4–9 mm). Through elastography, the distribution of the patterns was: cyst artifact (n = 13), pattern 1 (n = 4), pattern 2 (n = 31), pattern 3 (n = 13), and pattern 4 (n = 4). Of the 65 lesions, 15 were cysts, 46 were solid benign lesions, and 3 were malignant lesions. The sensitivity of the elastography was 75%, with a specificity of 98.46% and a correct diagnosis in 96.92% of the cases (n = 63). The results from this study show the usefulness of SWE for the evaluation of sub-centimeter breast lesions. In addition, this diagnostic strategy helps with the differential diagnosis between benign and malignant lesions and contributes to the early detection of malignant breast lesions.

The new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been an unprecedented global health problem, causing more than 20 million infections and more than 900,000 deaths (September 2020). The SARS-CoV-2 infection, known as COVID-19, has various clinical presentations, from asymptomatic or mild catarrhal processes to severe pneumonia that rapidly progresses to acute respiratory distress syndrome (ARDS) and multiple organ failure. In the last few months, much scientific literature has been devoted to descriptions of different aspects of the coagulation disorders and arterial and venous thrombotic complications associated with COVID-19, particularly venous thromboembolism (VTE). These studies have revealed that SARS-CoV-2 could lead to a prothrombotic state reflecting the high cumulative incidence of associated thrombotic events, particularly in patients admitted to intensive care units (ICUs). As regards the coagulopathy observed in association with SARS-CoV-2 infection, the mechanisms that activate coagulation have been hypothesized as being linked to immune responses, through the release of pro-inflammatory mediators that interact with platelets, stimulate the expression of tissue factor, induce an upregulation of plasminogen activator inhibitor-1, suppress the fibrinolytic system and lead to endothelial dysfunction, triggering thrombogenesis. D-dimer elevation has been recognized as a useful biomarker of poor prognosis, although the best cut-off point for predicting VTE in COVID-19 patients has still not been clarified. This review will try to update all the available scientific information on this important topic with enormous clinical and therapeutic implications.

Background Venous thromboembolism (VTE) represents a relevant cause of morbidity in patients with solid-organ transplant (SOT), but there are scarce data on the management and outcomes in these patients. Methods RIETE is a worldwide, ongoing observational registry of patients with objectively confirmed, acute VTE. We used the RIETE database to compare the clinical characteristics, treatment and outcomes in SOT recipients vs. non-recipients. Results From January 2001 to December 2019, 83,210 patients were enrolled in RIETE. Of these, 329 (0.4%) were SOT recipients: in the kidney 221, liver 41, lung 28 and heart 25. Median duration of anticoagulation was similar in SOT recipients and non-recipients (174 vs. 182 days). During anticoagulation, 1180 patients developed deep vein thrombosis (DVT) recurrences, 1028 pulmonary embolism (PE) recurrences, 2392 had major bleeding, 3119 non-major bleeding and 8157 died. SOT recipients had a higher rate of major bleeding (hazard ratio [HR]: 2.55; 95% CI: 1.62-3.84) and clinically relevant non-major bleeding (HR: 1.94; 95% CI: 1.23-2.93) than non-recipients, with no differences in the rates of DVT recurrences (HR: 0.96; 95% CI: 0.30-2.32), PE recurrences (HR: 1.11; 95% CI: 0.35-2.67) or death (HR: 0.98; 95% CI: 0.67-1.40). On multivariable analysis, only liver transplant recipients were at an increased risk for major bleeding compared to non-recipients (adjusted HR: 3.17; 95% CI: 1.02-9.87). Conclusions Treatment of VTE in SOT recipients is associated with an increased risk of bleeding compared to non-recipients. This is mainly due to the influence of liver transplant recipients. In non-liver SOT recipients, the risk for bleeding was similar to that in non-recipients.

Spanish Sleep Network., [Introduction] Short-term treatment with continuous positive airway pressure (CPAP) produces a clinically significant reduction in blood pressure (BP) in patients with obstructive sleep apnea (OSA) and resistant hypertension. However, it is unknown whether this effect continues over the long-term. Our objective was to assess the effect of long-term CPAP on BP in patients with OSA and resistant hypertension., [Methods] The study included 161 patients diagnosed with both OSA [apnea--hypopnea index (AHI) ≥15] and resistant hypertension diagnosed via 24-hour ambulatory BP measurement (24-h ABPM), in whom a second analysis via 24-h ABPM was performed at the end of the follow-up., [Results] Patients were followed up within 59 months [interquartile range (IQR): 44–70]. CPAP treatment was prescribed to 82% of the patients (70% with good adherence to CPAP defined as use of CPAP at least 4 h/night). A comparison between the adherent group and nonadherent group (including those with CPAP not prescribed) showed that CPAP adherents had a significant drop in the 24-h BP, both systolic [−3.9 mmHg; 95% confidence interval (CI): −8.1 to 0.3] and diastolic pressure (−3.5 mmHg [95% [CI]: −6.4–0.5]), with a higher magnitude during the night (−5.5 and −4.9 mmHg, respectively). The CPAP adherent group needed a mean of 1.1 less antihypertensive drugs (particularly spironolactone). Finally, there was a positive correlation between the drop in 24-h SBP and the hours of CPAP use (r = 0.24; P = 0.01)., [Conclusion] Good adherence to long-term CPAP treatment largely succeeded in significantly reducing BP in those patients with OSA and resistant hypertension, despite the use of a lower number of antihypertensive drugs.

El nuevo coronavirus SARS-CoV-2 ha supuesto un problema sanitario mundial sin precedentes, y ha ocasionado más de 250.000 muertes confirmadas. La enfermedad producida por este virus, denominada COVID-19, cursa con presentaciones clínicas variables, desde cuadros paucisintomáticos y procesos catarrales hasta neumonías graves que evolucionan rápidamente a síndrome de distrés respiratorio agudo (SDRA) y fallo multiorgánico. En las últimas semanas se han publicado algunos trabajos que describen alteraciones de la coagulación y complicaciones trombóticas arteriales y venosas en estos pacientes, principalmente entre aquellos ingresados en unidades de cuidados intensivos. Las infecciones desencadenan una respuesta inmunitaria, que provoca la liberación de distintos mediadores inflamatorios a la sangre. Entre ellos se encuentran las citocinas, que interaccionan con las plaquetas y con distintas proteínas de la coagulación, y favorecen la trombogénesis. Uno de los marcadores de la coagulación más estudiados en la COVID-19 es el dímero D (DD), y su elevación tiene implicaciones pronósticas, aunque no se ha aclarado el mejor punto de corte para el diagnóstico de enfermedad tromboembólica venosa (ETEV) en esta población ni su utilidad para decidir la intensidad de la tromboprofilaxis para estos pacientes. Hasta disponer de información suficientemente robusta (preferentemente de ensayos clínicos bien diseñados), se deberían seguir las recomendaciones de las guías de práctica clínica para la profilaxis, diagnóstico y tratamiento de la ETEV en los pacientes COVID-19.

[Background]: Bronchiectasis (BE) impact the clinical course and prognosis of patients with chronic obstructive pulmonary disease (COPD). Yet, the temporal evolution of BE in these patients is unknown. This study seeks to assess the temporal evolution of BE in persons with COPD., [Methods]: 201 moderate-to-severe patients were recruited between 2004 and 2007 and followed up at least every 6 monts (median of 102 months). To investigate the temporal evolution of BE, in 2015 a second high-resolution computed tomography scan (HRCT) was obtained in survivors and compared with the one obtained at recruitment., [Results]: 99 (49.3%) died during follow-up. The second HRCT could be obtained in 77 patients and showed that (1) in 27.3% of patients BE never developed, in 36.4% they remained stable, in 16.9% they increased in size and/or extension, and in 19.5% new BE emerged; and that (2) the presence of chronic purulent sputum (hazard ratio [HR], 2.8 [95% confidence interval {CI}, 1.3–5.8]), number of hospitalizations due to exacerbatons (HR, 1.2 [95% CI, 1.1–1.5]), and number of pathogenic microorganism (PPM) isolations (HR, 1.1 [95% CI, 1.02–1.3]) were independent risk factors for the progression or development of BE., [Conclusions]: The presence of chronic purulent sputum production, number of PPMs isolated in sputum, and number of hospitalizations due to exacerbations of COPD are independent risk factors of BE progression in patients with COPD.

Background There are important advances in the management of bacterial infection in patients with cystic fibrosis (CF), but there are many gaps in the field of fungal infections. Aims The aim of this study was to analyse whether chronic respiratory filamentous fungal colonization had clinical impact and whether antifungal treatment can change the disease. Methods The prospective, bicentric and descriptive study was carried out within a 3-year follow-up period, with four-month periodicity medical controls. Adult patients from two CF units of tertiary hospitals were included. Clinical, microbiological, analytical and spirometric variables were collected. Quality of life was evaluated in a subgroup, using the Spanish version of the Revised Cystic Fibrosis Quality of Life Questionnaire (CFQ-R). To statistically analyze the evolution of forced expiratory along time (volume of air blown out in 1 second -FEV1-) and the forced vital capacity (FVC), mixed linear models were carried out. Results From the ninety-eight patients under study, 40 suffered chronic filamentous fungal colonization. The presence of filamentous fungi in airway was associated to an annual fall of FEV1 and FVC of 0.029 and 0.017 litres, respectively (p Conclusions Chronic filamentous fungal colonization in patients with CF is associated with a significant annual decline of lung function that persists over time. Chronic antifungal therapy slows down this progression, mainly in the patient with more advanced disease.

Malignant melanoma (MM) is the most aggressive and life-threatening form of skin cancer. It is characterized by an extraordinary metastasis capacity and chemotherapy resistance, mainly due to melanoma cancer stem cells (CSCs). To date, there are no suitable clinical diagnostic, prognostic or predictive biomarkers for this neoplasia. Therefore, there is an urgent need for new MM biomarkers that enable early diagnosis and effective disease monitoring. Exosomes represent a novel source of biomarkers since they can be easily isolated from different body fluids. In this work, a primary patient-derived MM cell line enriched in CSCs was characterized by assessing the expression of specific markers and their stem-like properties. Exosomes derived from CSCs and serums from patients with MM were characterized, and their metabolomic profile was analysed by highresolution mass spectrometry (HRMS) following an untargeted approach and applying univariate and multivariate statistical analyses. The aim of this study was to search potential biomarkers for the diagnosis of this disease. Our results showed significant metabolomic differences in exosomes derived from MM CSCs compared with those from differentiated tumour cells and also in serum-derived exosomes from patients with MM compared to those from healthy controls. Interestingly, we identified similarities between structural lipids differentially expressed in CSC-derived exosomes and those derived from patients with MM such as the glycerophosphocholine PC 16:0/0:0. To our knowledge, this is the first metabolomic-based study aimed at characterizing exosomes derived from melanoma CSCs and patients’ serum in order to identify potential biomarkers for MM diagnosis. We conclude that metabolomic characterization of CSC-derived exosomes sets an open door to the discovery of clinically useful biomarkers in this neoplasia., MICIU FPU15/03682 FPU15/02350, Ministerio de Ciencia, Innovación y Universidades (MICIU) MAT2015-62644.C2.2.R RTI2018-101309-BC2, Instituto de Salud Carlos III PIE16-00045, Junta de Andalucía SOMM17/6109/UGR (UCE-PP2017-3), European Union (EU) SOMM17/6109/UGR (UCE-PP2017-3), Chair 'Doctors Galera-Requena in cancer stem cell research' CMC-CTS963, Fundación MEDINA

Objectives: To develop prognosis prediction models for COVID-19 patients attending an emergency department (ED) based on initial chest X-ray (CXR), demographics, clinical and laboratory parameters. Methods: All symptomatic confirmed COVID-19 patients admitted to our hospital ED between February 24th and April 24th 2020 were recruited. CXR features, clinical and laboratory variables and CXR abnormality indices extracted by a convolutional neural network (CNN) diagnostic tool were considered potential predictors on this first visit. The most serious individual outcome defined the three severity level: 0) home discharge or hospitalization ≤ 3 days, 1) hospital stay >3 days and 2) intensive care requirement or death. Severity and in-hospital mortality multivariable prediction models were developed and internally validated. The Youden index was used for model selection.Results: A total of 440 patients were enrolled (median 64 years; 55.9% male); 13.6% patients were discharged, 64% hospitalized, 6.6% required intensive care and 15.7% died. The severity prediction model included oxygen saturation/inspired oxygen fraction (SatO2/FiO2), age, C-reactive protein (CRP), lymphocyte count, extent score of lung involvement on CXR (ExtScoreCXR), lactate dehydrogenase (LDH), D-dimer level and platelets count, with AUC-ROC=0.94 and AUC-PRC=0.88. The mortality prediction model included age, SatO2/FiO2, CRP, LDH, CXR extent score, lymphocyte count and D-dimer level, with AUC-ROC=0.97 and AUC-PRC=0.78. The addition of CXR CNN-based indices slightly improved the predictive metrics for mortality (AUC-ROC=0.97 and AUC-PRC=0.83).Conclusion: The developed and internally validated severity and mortality prediction models could be useful as triage tools for COVID-19 patients and they should be further validated at different ED.

Background The epidemiological and clinical characteristics of solid organ transplant (SOT) patients during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic remains unclear. We conducted a matched retrospective cohort study to compare clinical outcomes among SOT recipients with the general population and to assess immunosuppression management. Methods Adult SOT recipients with laboratory PCR-confirmed SARS-CoV-2 infection admitted to a tertiary-care hospital in Barcelona, Spain, from March 11th to April 25th 2020, were matched to controls (1:4) on the basis of sex, age and age-adjusted Charlson's Index. Patients were followed for up to 28 days from admission or until censored. Primary endpoint was mortality at 28 days. Secondary endpoints included admission to the intensive care unit (ICU) and secondary complications. Drug-drug interactions (DDI) between immunosuppressants and COVID-19 management medication were collected. Results Forty-six transplant recipients and 166 control patients were included. Mean (SD) age of transplant recipients and controls was 62.7 (12.6) and 66.0 (12.7) years, 33 (71.7%) and 122 (73.5%) were male, and median (IQR) Charlson's Index was 5 (3-7) and 4 (2-7), respectively. Mortality was 37.0% in SOT recipients and 22.9% in controls (p=0.51).Thirty-three (71.7%) patients underwent transitory discontinuation of immunosuppressants due to potential or confirmed DDI. Conclusions In conclusion, hospitalized SOT recipients with COVID-19 had a trend toward higher mortality compared to controls, although it was not statistically significant, and a notable propensity for DDI.

The aim of this study was to investigate the usefulness of platelet-rich plasma (PRP) treatment for chronic wounds (CWs) of the breast. A prospective study was performed in 23 patients with CW of the breast who were treated with PRP. The procedure was repeated until the wound was closed completely. The study included patients with a history of breast cancer (n = 8) and patients without cancer (n = 15). The treatment with PRP was successful in all cases and observed in &le, 4 weeks in 82.6% (19/23) of patients. The patients without breast cancer showed significantly less time for wound closure than the patients with a history of breast cancer. Moreover, a greater number of PRP treatments were necessary to achieve wound closure in patients undergoing conservative breast treatment. No patients had complications associated with the application of PRP. Conclusions: To the best of our knowledge, this is the first study to reveal that PRP treatment for CWs of the breast is safe, simple, useful and well-tolerated by patients.

[EN] This paper studies the community involvement in decision-making on corporate social responsibility (CSR) investments of mining firms in Peru and its causal conditions through stakeholder's perceptions. To this end, community members, NGOs and consultants were interviewed. The focus was on various causal conditions in which stakeholders: a) explain the community needs, b) recognize the investments made by the companies, c) believe that mining benefits are not what they expected, d) declare the costs generated by these activities and e) point out that dialogue is the solution. Collected data were processed via a content analysis, followed by a Qualitative Comparative Analysis (QCA). The conditions which appeared in the QCA solutions were different depending on whether the community participated or not in decision-making, with the second situation prevailing. The results offer further understanding to all parties and may help companies to improve their performance., [ES] Este artículo estudia la participación de la comunidad en la toma de decisiones sobre las inversiones en responsabilidad social corporativa (RSE) de las empresas mineras en Perú y sus condiciones causales a través de las percepciones de los interesados. Con este fin, se entrevistó a miembros de la comunidad, ONGs y consultores. La atención se centró en varias condiciones causales en las que los interesados: a) explican las necesidades de la comunidad, b) reconocen las inversiones realizadas por las empresas, c) creen que los beneficios de la minería no son lo que esperaban, d) declaran los costos generados por estas actividades y e) señalan que el diálogo es la solución. Los datos recopilados se procesaron mediante un análisis de contenido, seguido de un Análisis Cualitativo Comparativo (QCA). Las condiciones que aparecieron en las soluciones del QCA fueron diferentes dependiendo de si la comunidad participaba o no en la toma de decisiones, prevaleciendo la segunda situación. Los resultados ofrecen una mayor comprensión a todas las partes y pueden ayudar a las empresas a mejorar su desempeño.

Icing occurs when an unheated solid structure is exposed to liquid cloud droplets at temperatures below the freezing point. Supercooled liquid water (SLW) in the atmosphere can persist in a physically metastable state until coming into contact with a solid object “In-cloud icing” occurs when super cooled liquid droplets (SLD) like clouds collide with a structure or object and freezes.Atmospheric icing prediction has gain attention in the last years. Despite the progress made in meteorology, both weather forecasting modelling and atmospheric observations through advanced experimental technologies, there are still limitations in the accurate forecast and detection of icing conditions. The GFA‐ULE group has carried out some NWPs. In a previous work, we investigated the capability of the Weather Research and Forecasting model to detect regions containing supercooled cloud drops, proposing a multiphysics ensemble approach. Four microphysics and two planetary boundary layer schemes were used. Morrison and Goddard parameterizations with the YSU scheme, yielded superior results in evaluating the presence of liquid water content.Concerning the remote detection of icing conditions, some European research centres (i.e. DLR, CIRA, ONERA, INCAS) as well as University of Leon (GFA-ULE) already have nowcasting or forecasting activities for detection of clouds and icing conditions. In this work a multichannel, microwave radiometer (MMWR) was used to detect the appearance of SLW. Consequently, we present both comparison between indirect detection of SLW and the output obtained by WRF with the two combination of parametrizations selected.In our work we have taken into account:The comparison has been made at different levels, from the ground up to 5000 meters high We have taken different thresholds of the SLW: 0.05, 0.1, 0.15, 0.20, 0.25 and 0.30 g m-3 because of the flight campaigns carried out previously, which revealed that the presence of low concentrations of SLW could lead to the appearance of aircraft icing. The results show a good concordance between the number of events found by the MMWR and the result of the two numerical modeling performed. Therefore, everything seems to indicate that indirect detection by MMWR can be an accurate technology to detect the appearance of SLW and that the models can be qualitatively validated.Acknowledgments: Data support came from the Atmospheric Physics Group, IMA, University of León, Spain, and the National Institute of Aerospace Technology (INTA). This research was carried out in the framework of the SAFEFLIGHT project, financed by MINECO (CGL2016‐78702) and LE240P18 project (Junta de Castilla y León). We also thank R. Weigand for computer support.

"Artículo escrito por un elevado número de autores, solo se referencian el que aparece en primer lugar, el nombre del grupo de colaboración, si le hubiere, y los autores pertenecientes a la UAM", Background: There is some controversy about the effect of continuous positive airway pressure (CPAP) on the incidence of cardiovascular events (CVE). However, the incidence of CVE among patients with both obstructive sleep apnea (OSA) ans resistant hypertension (HR) has not been evaluated. Our objective was to analyze the long-term effect of CPAP treatment in patients with RH and OSA on the incidence of CVE. Methods: Multi-center, observational and prospective study of patients with moderate-severe OSA and RH. All the patients were followed up every 3–6 months and the CVE incidence was measured. Patients adherent to CPAP (at least 4 h/day) were compared with those with not adherent or those who had not been prescribed CPAP. Results: Valid data were obtained from 163 patients with 64 CVE incidents. Treatment with CPAP was offered to 82%. After 58 months of follow-up, 58.3% of patients were adherent to CPAP. Patients not adherent to CPAP presented a non-significant increase in the total CVE incidence (HR:1.6; 95%CI: 0.96–2.7; p = 0.07). A sensitivity analysis showed that patients not adherent to CPAP had a significant increase in the incidence of cerebrovascular events (HR: 3.1; CI95%: 1.07–15.1; p = 0.041) and hypertensive crises (HR: 5.1; CI95%: 2.2–11.6; p = 0.006), but the trend went in the opposite direction with respect to coronary events (HR: 0.22; CI95%: 0.05–1.02; p = 0.053). Conclusions: In patients with RH and moderate-severe OSA, an uneffective treatment with CPAP showed a trend toward an increase in the incidence of CVE (particularly neurovascular events and hypertensive crises) without any changes with respect to coronary events., Antecedentes: Existe cierta controversia sobre el efecto de la presión positiva continua en las vías respiratorias (CPAP) sobre la incidencia de eventos cardiovasculares (ECV). Sin embargo, no se ha evaluado la incidencia de ECV en los pacientes con apnea obstructiva del sueño (AOS) e hipertensión resistente (HR).Nuestro objetivo fue analizar el efecto a largo plazo del tratamiento con CPAP en pacientes con HR y AOS en la incidencia de ECV. Métodos: Estudio multicéntrico, observacional y prospectivo de pacientes con AOS y HR. Cada paciente acudió a revisión cada 3-6 meses y se midió la incidencia de ECV. Se compararon los pacientes con buena adherencia a la CPAP (al menos 4 h/día) con aquellos con mala adherencia o aquellos a quienes no se les había indicado la CPAP. Resultados: Se obtuvieron datos válidos de 163 pacientes con 64 eventos de ECV. Se ofreció tratamiento con CPAP al 82%. Después de 58 meses de seguimiento, el 58,3% de los pacientes presentaron buena adherencia a la CPAP. Los pacientes con mala adherencia o sin prescripción de CPAP presentaron un aumento no significativo en la incidencia total de ECV (HR: 1,6; IC 95%: 0,96-2,7; p = 0,07). Un análisis desensibilidad mostró que los pacientes con mala adherencia a la CPAP tuvieron un aumento significativo en la incidencia de eventos cerebrovasculares (HR: 3,1; IC 95%: 1,07-15,1; p = 0,041) y crisis hipertensivas(HR: 5,1; IC 95%: 2,2-11,6; p = 0,006), pero la tendencia fue en la dirección opuesta con respecto a los eventos coronarios (HR: 0,22; IC 95%: 0,05-1,02; p = 0,053).Conclusiones: En pacientes con HR y AOS moderada o grave, un tratamiento ineficaz con CPAP mostró una tendencia hacia un aumento en la incidencia de ECV (particularmente eventos neurovasculares y crisis hipertensivas), sin ningún cambio con respecto a los eventos coronarios.

This paper presents the development of an embedded system prototype that performs the home security monitoring, through image processing and classification algorithms to detect human form. If human presence is detected, the system will send an alert message to the user. The embedded system is implemented on a Raspberry Pi 3 B, supported by a Pyroelectric Infrared Radial (PIR) motion sensor and a Raspberry Pi Camera V2. The algorithms are implemented in C language and were designed to take advantage of the hardware resources of the platform, through High Performance Computing (HPC) techniques. The selected classifier is a multilayer perceptron. This classifier obtained an accuracy of 96%, approximately.

Sciaenops ocellatus has a long history in aquaculture and many difficulties associated with its commercial culture have been addressed and successfully resolved; nevertheless, further research in lipid nutrition could address more comprehensive questions on the way these nutrients are utilized. The purpose of this study was to evaluate S. ocellatus growth and lipase gene expression in response to increasing dietary lipid supplementation. Four experimental diets were formulated to provide 3, 10, 16, or 23% lipid using menhaden fish oil. Twenty juveniles (mean initial weight 2.3 ± 0.1 g) were stocked per aquaria in a recirculating system; each diet was assigned to three aquaria and fed to fish for 6 weeks. At the end of the study, fish fed 3% of dietary lipid were significantly (P

El tratamiento con estatinas puede inducir toxicidad muscular con relativa frecuencia. Con una menor incidencia, también puede provocar una miopatía necrotizante autoinmune o una dermatomiositis, miopatías potencialmente graves con una presentación clínica, analítica e histológica características. El diagnóstico diferencial entre ambas patologías no siembre es fácil. Se expone el caso de una mujer de edad media que, tras iniciar tratamiento con atorvastatina, presenta un cuadro inequívoco de miopatía inflamatoria, pero difícil de encuadrar en un subtipo, con lesiones cutáneas a favor de dermatomiositis, sin embargo, histológicamente compatible con una miopatía necrotizante por estatinas.

EUSO-Balloon is a pathfinder mission for the Extreme Universe Space Observatory onboard the Japanese Experiment Module (JEM-EUSO). It was launched on the moonless night of the 25th of August 2014 from Timmins, Canada. The flight ended successfully after maintaining the target altitude of 38 km for five hours. One part of the mission was a 2.5 hour underflight using a helicopter equipped with three UV light sources (LED, xenon flasher and laser) to perform an inflight calibration and examine the detectors capability to measure tracks moving at the speed of light. We describe the helicopter laser system and details of the underflight as well as how the laser tracks were recorded and found in the data. These are the first recorded laser tracks measured from a fluorescence detector looking down on the atmosphere. Finally, we present a first reconstruction of the direction of the laser tracks relative to the detector., 0, SCOPUS: ar.j, info:eu-repo/semantics/published

The advent of global precipitation data sets with increasing temporal span has made it possible to use them for validating climate models. In order to fulfill the requirement of global coverage, existing products integrate satellite-derived retrievals from many sensors with direct ground observations (gauges, disdrometers, radars), which are used as reference for the satellites. While the resulting product can be deemed as the best-available source of quality validation data, awareness of the limitations of such data sets is important to avoid extracting wrong or unsubstantiated conclusions when assessing climate model abilities. This paper provides guidance on the use of precipitation data sets for climate research, including model validation and verification for improving physical parameterizations. The strengths and limitations of the data sets for climate modeling applications are presented, and a protocol for quality assurance of both observational databases and models is discussed. The paper helps elaborating the recent IPCC AR5 acknowledgment of large observational uncertainties in precipitation observations for climate model validation.

Severe mental disorders are associated with an increased mortality risk and the use of antipsychotic drugs may be one of the causes. In this study, we addressed the potential association of the reported mortality among patients on antipsychotics compared to other drugs from a pharmacovigilance database with the aim of evaluating the drug-induced mortality risk. A database containing 189 441 entries of suspected adverse reactions reported from 1 January 1995 to 31 December 2012 was explored for fatal outcomes. Potential disproportionality was estimated using the reporting odds ratio, proportional reporting ratio, and the χ-test. Two-hundred fatal outcomes were reported in patients on antipsychotics, which indicated the occurrence of disproportionality for this pharmacological class compared with any other drugs. When data were analysed by antipsychotic subclass, disproportionality was found only for atypical but not for typical antipsychotics. When individually analysed by active substances and routes, only a few substances were found to show disproportionality. The disproportionality encountered in this study compared with the mortality associated with other drugs suggests that the active substances under study may be associated with a mortality risk higher than what is assumed currently. Also, it suggests that atypical antipsychotics are likely to have a mortality risk higher than the risk of typical antipsychotics. The disproportionality found for zuclopentixol, in both oral and depot formulations, can be considered to be a drug surveillance signal.

Objectives Antipsychotics are currently used to treat different diseases; even some off-labelled conditions are treated with this medication. Consumption and cost of antipsychotic drugs sharply increased in Spain after second-generation drugs were marketed; several regulatory measures were adopted to curb this trend. The aim of this study was to examine the impact of these measures upon the use and cost of antipsychotics. Study design Study of drug use (SDU) from 1995 to 2012. Consumption and cost data were obtained from the CONCYLIA database; this database contains the retail community pharmacies sales of medicinal products reimbursed by the National Health System in Castilla y Leon (Spain). Methods Data are presented as defined daily doses per 1000 inhabitants per day (DID) and day treatment cost (DTC). Results First-generation antipsychotics prescriptions gradually decreased from 3.0 to 1.8 DID; meanwhile, prescriptions for second-generation antipsychotics considerably increased from 0.3 to 9.9 DID. The use of risperidone dropped after the marketing of its structural derivative paliperidone with a similar efficacy but with a substantially higher cost per day. In 2011 and thereafter, patients in Spain began to pay a part of the medications cost, but this did not decrease antipsychotics consumption. Global cost of antipsychotics only began to fall after measures were adopted to lower the price of medicines because of the economic collapse in Spain after May 2010. Conclusion Several health policy measures have tried to reduce antipsychotics consumption in Spain, special ways of dispensing, marketing of generic drugs and special economic measures for patients. These measures eventually failed to avoid the increase in antipsychotics use. The cost only dropped when lowering prescription drug prices took place.

Several graph databases provide support to analyze a large amount of highly connected data, and it is not trivial for a company to choose the right one. We propose a new process that allows analysts to select the database that suits best to the business requirements. The proposed selection process makes possible to benchmark several graph databases according to the user needs by considering metrics such as querying capabilities, built-in functions, performance analysis, and user experience. We have selected some of the most popular native graph database engines to test our approach to solve a given problem. Our proposed selection process has been useful to design benchmarks and provides valuable information to decide which graph database to choose. The presented approach can be easily applied to a wide number of applications such as social network, market basket analysis, fraud detection, and others.

Obstructive sleep apnoea (OSA) is an important public health problem with an estimated prevalence of 5–15% in the general population. This increases with age, peaking at 20–25% in individuals aged >65 years. This high prevalence of OSA in the elderly will presumably continue to grow as a consequence of the increasing longevity of the general population [1]. It is therefore not surprising that there is a steady increase in the percentage of patients >65 years of age referred to sleep units for suspicion of OSA and subsequently receiving continuous positive airway pressure (CPAP) therapy. One Spanish study that analysed 51 000 sleep studies from 16 sleep units revealed that one in four of these studies was performed in individuals aged ≥65 years, and that 69% of these were eventually treated with CPAP [2]. Despite this high prevalence, there is little information about long-term CPAP adherence in this population, especially in the very elderly (aged >80 years). We thus aimed to analyse the relationship between age at diagnosis and long-term CPAP adherence, in a large cohort of OSA patients aged ≥65 years who had been prescribed CPAP treatment., In the very elderly, the indication and prescription of continuous positive airway pressure should be individualised http://ow.ly/NHfN30nC6VK

Spanish Sleep Network., [Rationale] Continuous positive airway pressure (CPAP) can significantly reduce blood pressure (BP) levels in patients with resistant hypertension and sleep apnea (OSA); however, the effect on patients with refractory hypertension (RfH) is not known. This study seeks to evaluate the effect of CPAP treatment on BP levels in patients with OSA and RfH, compared with those with OSA and resistant hypertension., [Methods] Post-hoc analysis of the HIPARCO randomized clinical trial on the effect of CPAP treatment on BP levels in patients with resistant hypertension. Those patients with uncontrolled 24-h ambulatory BP monitoring readings (>130 and/or >80 mmHg) in SBP or DBP were considered to have resistant hypertension (if they were taking three or four antihypertensive drugs) or RfH (if they were taking at least five drugs). OSA patients were randomized to receive CPAP or usual care for 3 months. They underwent a second 24-h ambulatory BP monitoring study to establish the effect of CPAP treatment on BP levels in both groups., [Results] A total of 98 patients were randomized to CPAP (19 RfH/79 resistant hypertension) and 96 to usual care (21 RfH/75 resistant hypertension). BP readings dropped more marked in patients with RfH than resistant hypertension, in both 24-h SBP (−9 vs. −1.6 mmHg, P = 0.021) and 24-h DBP (−7.3 vs. −2.3 mmHg, P = 0.074), especially at night (−11.3 vs. −3.8, P = 0.121 and −8.8 vs. −2.2, P = 0.054) respectively. Adjusted difference between groups was statistically significant in 24-h SBP levels (−7.4 mmHg, P = 0.021)., [Conclusion] CPAP lowers BP levels in both resistant hypertension and RfH patients although the degree of this reduction is higher in those with RfH especially during the night.

Refractory hypertension (RfH) is defined as a lack of blood pressure control despite the administration of at least 5 anti-hypertensive drugs. The factors associated with its natural history are unknown. This study aimed to evaluate both the incidence of RfH in an cohort of patients with resistant hypertension (RH) and the factors involved in that progression. This was an observational prospective multicenter study (24 centers) with 172 patients with confirmed RH (24-h ABPM) who underwent a further 24 h ABPM study at the end of the follow-up. Prospective information was obtained from all patients in their corresponding Hypertension Units via a standard clinical protocol, and they all underwent a sleep study. Thirty patients were diagnosed with RfH (17.4%) after a mean follow-up of 57 months, despite the prescription of a greater number of long-acting thiazide-like diuretics and mineralocorticoid receptor antagonists. The factors associated with progression to RfH were: a longer period since the diagnosis of RH (OR: 1.06, 95% CI: 1.01–1.1, p = 0.007); the HbA1c concentration (OR: 1.42, 95% CI: 1.42–1.8; p = 0.005); the initial heart rate (OR: 1.05, 95% CI: 1.01–1.09, p = 0.004); and poor adherence to continuous positive airway pressure (CPAP) in cases of obstructive sleep apnea (OR: 3.36, 95% CI: 1.47–7.7, p = 0.004). In conclusion, a considerable percentage of patients evolved from the RH to the RfH phenotype despite changes in their treatment. Some easily measurable variables, such as heart rate, the time since the diagnosis, the HbA1c level, and the presence of untreated obstructive sleep apnea (or poor adherence to CPAP) have been demonstrated to be prognostic factors in the progression to RfH.

Wire harnesses are used in several industrial sectors such as automotive, white goods, toys, or electrical and mechanical engineering. One of the key tasks of the process is to assemble and secure harnesses with a taping pistol in several spots to group single wires and make the final harness with all the required ramifications. The proposed method tries to advance the state of the art and enhance the current process, which is being performed manually, by adding robotic arms in a custom cell that collaborates with the human worker. The robotic solution of the proposal will perform all the spot tapings of the process, while the worker performs only the positioning of the cable. It reduces the processing time of the task and allows workers to work on two harnesses at the same time. The results of the present proposal will have a positive impact on companies dedicated to the production of wiring and the sectors to which they supply their products. The solution will also impact on the ergonomic conditions of workers through an innovative work environment that removes the most tedious and repetitive tasks of the operator. This work was supported by ESMERA Programme – European SMEs Robotic Applications started in January 2018 and coordinated by the Laboratory for Manufacturing Systems and Automation at the University of Patras. This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 780265.

Antecedentes: Existe incremento de reacciones adversas a medicamentos y pocos estudios para el diagnóstico.Objetivo: Determinar la utilidad de pruebas modificadas de degranulación de basófilos (DB) y del factor inhibidor de la migración de leucocitos (LIF, leukocyte migration inhibition factor) para comprobar la hipersensibilidad a medicamentos.Métodos: Se estudiaron 177 pacientes, de uno y otro sexo, con diagnóstico de hipersensibilidad a medicamentos, en quienes se determinó pruebas modificadas de DB, LIF, o ambas entre 2009 y 2014. Se parearon con controles positivos, negativos y población no alérgica. Las solicitudes se emitieron de acuerdo con el tipo de hipersensibilidad, considerando tipo I a DB y tipo IV a LIFResultados: 170 pacientes (96.04%) fueron positivos al menos a un medicamento (RR, 4.71). Se realizaron 561 pruebas modificadas de DB (73.62%) y 201 de LIF (26.37%). El sexo femenino fue más frecuente (64.41%); la edad promedio fue de 38.5 años. La prueba modificada de DB resultó positiva en 70.23% y la de LIF en 67.16%. La sensibilidad de las pruebas se incrementó en forma complementaria y a dos diluciones. La correlación de las pruebas fue altamente significativa.Conclusiones: Las mujeres presentan más reacciones a fármacos. La prueba modificada de DB es útil en cualquier edad. Como los medicamentos pueden activar uno u otro mecanismo de hipersensibilidad es importante solicitar las pruebas simultáneamente.

Introduction and objectives The use of ultrasound in peripheral thoracic lesions offers advantages over other radiological guiding methods. This diagnostic procedure has been applied in most studies published by radiologists. Our aim was to determine the diagnostic efficacy of percutaneous ultrasound-guided punctures and biopsies of peripheral thoracic lesions performed by pulmonologists. Methodology A retrospective analysis of 58 patients who underwent real-time ultrasound-guided transthoracic punctures and biopsy of peripheral thoracic lesions between March 2011 and September 2014 in the pulmonology department of our hospital, was carried out. Cases were classified into the following diagnostic categories: malignant, benign and non-diagnostic (non-specific benign without evidence of malignancy and insufficient specimen). Results A conclusive diagnosis was obtained in 47 procedures (81%), of which 13 (22.4%) were specific benign lesions and 34 (58.6%) cancers. In the remaining 11 (19%) patients, a non-diagnostic result was obtained [non-specific benign in 5 cases (8.6%) and insufficient specimen in 6 (10.3%)]. Sensitivity was 75.6%, negative predictive value was 54.2%, specificity and positive predictive value were 100%, and diagnostic accuracy was 81%. Excluding procedures with insufficient specimens, the results were 87.2%, 72.3%, 100%, 100% and 90.4% respectively. There were no serious complications. Conclusions Percutaneous ultrasound-guided puncture and biopsy in the diagnosis of peripheral thoracic lesions performed by pulmonologists is a safe procedure with high diagnostic accuracy. We achieved similar results to those previously obtained by radiologists.

Resumen Introduccion y objetivos La ecografia como guia en la puncion percutanea de lesiones toracicas perifericas (LTP) ofrece ventajas frente a otras tecnicas de imagen. La mayoria de los estudios con esta tecnica han sido comunicados por radiologos intervencionistas. El objetivo de este estudio ha sido analizar la rentabilidad diagnostica de la puncion percutanea guiada por ecografia en una unidad de tecnicas de neumologia. Metodologia Estudio retrospectivo de 58 pacientes con LTP puncionadas con visualizacion ecografica en tiempo real, entre el 1 de marzo de 2011 y el 1 de septiembre de 2014. Los resultados fueron divididos en 3 categorias diagnosticas: maligna, benigna y no diagnostica (ND); esta ultima incluye los resultados de benignidad no especifica (SD) y los de muestra insuficiente para diagnostico (MID). Resultados Se obtuvo: resultado maligno en 34 (58,6%) de los procedimientos, resultado benigno en 13 (22,4%) y ND en 11 (19%) (SD en 5 [8,6%] y MID en 6 [10,3%]). En 5 de los casos ND el resultado final fue de malignidad y en 4 de ellos se tratada de una MID. La sensibilidad diagnostica obtenida fue del 75,6%, el valor predictivo negativo del 54,2%, y la especificidad y el valor predictivo positivo del 100%, con una rentabilidad diagnostica del 81%. Cuando se excluyeron los casos con MID los valores fueron del 87,2%, 72,3%, 100% y 100%, respectivamente, con una rentabilidad diagnostica del 90,4%. No hubo complicaciones graves con la tecnica. Conclusiones La puncion percutanea bajo guia ecografica en LTP realizada por neumologos intervencionistas es una tecnica segura y con una alta rentabilidad diagnostica.

In this work, we describe the synthesis of meso-(9-ethyl-9H-carbazol-3-yl)-4,4-difluoro-4-bora-3a,4a-diaza-s-indacene and its incorporation as thin film by vapor deposition on indium tin oxide. The morphology of the film was analyzed by scanning electron microscopy and atomic force microscopy showing a granular and homogeneous structure, contact angle measurements revealed that this film exhibits a hydrophobic surface. Packing of the compound was simulated through molecular dynamics and Monte Carlo sampling, and the electronic features of aggregates were modeled with plane-wave DFT. A semiconductor behavior for the featured compound in aggregated state, which compares well with systems applied on electronic devices, is predicted for the featured F-BODIPY.