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Statement of problem. Polyetheretherketone (PEEK) has been advocated to replace metal components in dentistry. Although PEEK is a high-performance polymer with a white color, adequate biological response, and resistance to fracture, data to support PEEK as an alternative material for implant abutments are lacking. Purpose. The purpose of this in vitro study was to assess the mechanical and functional properties of PEEK implant abutments as a nonmetallic alternative to titanium abutments, which presents esthetic limitations and greater difficulty to customize clinically. Material and methods. Implant abutments manufactured by using PEEK (n=24) or titanium grade 5 (n=24) were attached to MIS Implants type M4 3.75×16 mm with an internal screw tightened to 25 Ncm. Screw loosening and microleakage was assessed by submersion in a 2% methylene blue solution for 48 hours at 37 C. Both groups were compared with and without applying dynamic loading; fatigue testing was performed following the International Organization for Standardization (ISO) 14801:2016 standard. All specimens were observed under a stereomicroscope at ×8 magnification. Statistically significant differences among the PEEK and titanium implant abutments were tested with 2-factor ANOVA and the chi-square analysis for nonpaired and paired data, respectively (a=.05). Results. The implant abutments made of titanium were better in all mechanical tests. The torque loss of titanium abutments was approximately 10%, while PEEK showed a significantly higher (P

The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) that causes coronavirus disease-2019 (COVID-19) has provoked a global pandemic, mainly affecting the respiratory tract; however, a percentage of infected individuals can develop gastrointestinal (GI) symptoms. Some studies describe the development of GI symptoms and how they affect the progression of COVID-19. In this review, we summarize the main mechanisms associated with gut damage during infection by SARS-CoV-2 as well as other organs such as the liver and pancreas. Not only are host factors associated with severe COVID-19 but intestinal microbiota dysbiosis is also observed in patients with severe disease.

Multi-branched molecules have recently demonstrated interesting behaviour as charge-transporting materials within the fields of perovskite solar cells (PSCs). For this reason, extended triarylamine dendrons have been grafted onto a pillar[5]arene core to generate dendrimer-like compounds, which have been used as hole-transporting materials (HTMs) for PSCs. The performances of the solar cells containing these novel compounds have been extensively investigated. Interestingly, a positive dendritic effect has been evidenced as the hole transporting properties are improved when going from the first to the second-generation compound. The stability of the devices based on the best performing pillar[5]arene material has been also evaluated in a high-throughput ageing setup for 500 h at high temperature. When compared to reference devices prepared from spiro-OMeTAD, the behaviour is similar. An analysis of the economic advantages arising from the use of the pillar[5]arene-based material revealed however that our pillar[5]arene-based material is cheaper than the reference.

Talent identification (TID) and development (TDE) are large fields in professional soccer and in science. However, TID and TDE processes in youth academies have not been assessed in detail. As such, our aim was to survey professional clubs from around the world about their youth academy TID and TDE processes, with 29 clubs responding to the survey. TID and TDE processes changed as a function of player age. TID processes involved finding the best players locally and regionally, but for older players the search widened to nationally and internationally for the needs of the first team. Clubs used a multidisciplinary approach to TID, but more so with older players. Median number of academy players was 80, 100, and 66 players at 8-11 years, 12-16 years, and 17-21 years, respectively. Annual player turnover in the most recent season (selections/de-selections) was 29% across all age groups, with competition from other clubs cited as a limitation to TID. TDE processes involved weekly matches and 3-5 training sessions per week led by experienced, well-qualified coaches, with most clubs providing players with academic education, residency and transportation services. Our findings extend previous research assessing professional soccer youth academy TID and TDE processes by quantifying worldwide practices.

Pancreatic cancer leads the most common lethal tumor in America. This lethality is related to limited treatment options. Conventional treatments involve a non-specific use of chemotherapeutical agents like 5-FU, capecitabine, gemcitabine, cisplatine, oxaliplatine, or irinotecan, that produce several side effects. This review we focus on the use of targeted nanoparticles as an alternative to the standard treatment for the pancreatic cancer. The principal objective of the use of nanoparticles is the reduction in side effects that conventional treatments produce, mostly because of their nonspecificity. Currently, several molecular markets of pancreatic cancer cells have been studied to target nanoparticles and improve the actual treatment. Therefore, properly functionalizated nanoparticles with specific aptamers or antibodies can be used to recognize pancreatic cancer cells and once cancer is recognized, these nanoparticles can attack the tumor by drug delivery, hyperthermia, or gene therapy.

The growing interest of consumers to find products with greater health benefits has led to multiple research works focused on product developments with antioxidant-rich foods by creating safe, acceptable, and high-value nutrition, even in those foods susceptible to deterioration, in order to replace synthetic preservatives with natural ones. Bee products are an alternative addition for food products (dairy and meat products, coating fruits, and alcoholic and non-alcoholic drinks), which can improve the final quality of the food for the benefit of the consumer. The aim of this review was to provide detailed information on the main findings of innovative food products based on the addition of bee products by highlighting their physicochemical and functional properties and their behavior throughout storage.

Resumen La incorporacion precoz del enfermo al que se ha realizado una angioplastia con stent a su vida habitual, por ausencia de impedimentos propios de la tecnica, ha permitido incluir mas pronto a estos pacientes en la fase II de la rehabilitacion cardiaca. Aunque la rehabilitacion del paciente coronario sigue para todos los pacientes unas pautas generales que pretenden abordar desde un punto de vista de prevencion secundaria la aterosclerosis coronaria, las circunstancias de cada enfermo, entre las que se incluye la tecnica con que ha sido revascularizado, determinan aspectos individuales de la rehabilitacion del enfermo con cardiopatia isquemica. El ejercicio fisico continuado (entrenamiento fisico) produce, por si mismo, grandes beneficios cardiovasculares para la prevencion cardiovascular primaria y secundaria. En pacientes con infarto disminuye la mortalidad y mejora la capacidad funcional, la funcion ventricular y el remodelado ventricular, y hay esperanzas de que pueda mejorar la circulacion colateral. Tambien mejora la funcion endotelial y estimula la circulacion de celulas madre. Se ha demostrado que el entrenamiento fisico tras revascularizacion percutanea disminuye el numero de eventos y que en pacientes con angina estable el entrenamiento fisico produce menos eventos que la revascularizacion percutanea.

Resumen La incorporacion precoz del enfermo al que se ha realizado una angioplastia con stent a su vida habitual, por ausencia de impedimentos propios de la tecnica, ha permitido incluir mas pronto a estos pacientes en la fase II de la rehabilitacion cardiaca. Aunque la rehabilitacion del paciente coronario sigue para todos los pacientes unas pautas generales que pretenden abordar desde un punto de vista de prevencion secundaria la aterosclerosis coronaria, las circunstancias de cada enfermo, entre las que se incluye la tecnica con que ha sido revascularizado, determinan aspectos individuales de la rehabilitacion del enfermo con cardiopatia isquemica. El ejercicio fisico continuado (entrenamiento fisico) produce, por si mismo, grandes beneficios cardiovasculares para la prevencion cardiovascular primaria y secundaria. En pacientes con infarto disminuye la mortalidad y mejora la capacidad funcional, la funcion ventricular y el remodelado ventricular, y hay esperanzas de que pueda mejorar la circulacion colateral. Tambien mejora la funcion endotelial y estimula la circulacion de celulas madre. Se ha demostrado que el entrenamiento fisico tras revascularizacion percutanea disminuye el numero de eventos y que en pacientes con angina estable el entrenamiento fisico produce menos eventos que la revascularizacion percutanea.

In this work, two novel polymeric semiconductors (D2 and D3), with perfluorinated side chains in their backbone, were developed. Moreover, a novel small molecule (D1), with a similar structure to polymers D2 and D3, was also designed for comparison purposes. Compounds D1–D3 were successfully synthesized, completely characterized and used as additives in perovskite solar cells (PSCs). The novel materials contain 26 fluorine atoms per unit, which is the largest amount of fluorine atoms reported for additives in PSCs. In this regard, D1–D3 were incorporated into the perovskite layer as additives and their effect on the film formation, stability and performance of PSCs was studied. As a result, D1–D3-based devices showed very good performances comparable to devices fabricated without additives and an increased stability. Thus, D1- and D2-fabricated devices retained 94 and 85% of their initial power, respectively, after 80 min under a bias, while the reference devices broke down completely. These results illustrate the extraordinary protective action of the perfluorinated polymers against humidity and oxygen, even at a low concentration of 2 mg ml−1 used in our experiments.

Background: Atrial Fibrillation (AF) is associated with an increased risk of stroke and systemic embolism. Several studies have suggested that female AF patients could have a greater risk for stroke. There is scarce information about clinical characteristics and use of antithrombotic therapies in Latin American patients with nonvalvular AF. Objective: To describe the gender differences in clinical characteristics, thromboembolic risk, and antithrombotic therapy of patients with nonvalvular AF recruited in Mexico, an upper middle-income country, into the prospective national CARMEN-AF Registry. Methods: A total of 1423 consecutive patients, with at least one thromboembolic risk factor were enrolled in CARMEN-AF Registry during a three-year period (2014–2017). They were categorized according to Gender. Results: Overall, 48.6% were women, mean age 70 ± 12 years. Diabetes, smoking, alcoholism, non-ischemic cardiomyopathy, coronary artery disease, and obstructive sleep apnea were higher in men. Most women were found with paroxysmal AF (40.6%), and most men with permanent AF (44.0%). No gender differences were found in the use of vitamin K antagonists (VKA) (30.5% in women vs. 28.0% in men). No gender differences were found in the use of direct oral anticoagulants (DOAC) (33.8% women vs 35.4% men). Conclusions: CARMEN-AF Registry demonstrates that in Mexico, regardless of gender, a large proportion of patients remain undertreated. No gender differences were found in the use of VKA or DOAC. Keywords: Atrial fibrillation, Gender, Thromboembolic risk, Antithrombotic therapy, Stroke, Mexico

Herein, we describe the synthesis of a hole transporting material based on a partially planarised quart-p-phenylene core incorporating tetraketal and diphenylamine substituents that show optimal energy levels and solubility for perovskite solar cell applications. The triple-cation perovskite devices incorporating such quart-p-phenylene derivatives show power-conversion efficiencies, short circuit currents, open circuit voltages, and fill factors that are comparable to those of spiro-OMeTAD.

Background: The Coronavirus disease 2019 (COVID-19) has had devastating effects all over the world. Particularly Mexico, continues being hit hard and has been identified as one of the highest countries with an infection to death rate in Latin-America. Technological advances have made it possible to develop novel vaccines in record time, leading to fear and misinformation around it. Methods: We did a cross-sectional study using a cohort of 1512 participants, using a COVID-19 vaccine questionnaire focusing on identifying key factors: fear of infection, xenophobia, vaccine adverse effects, vaccination hesitancy in children. We further related them to sociodemographic profile, general vaccination posture (interests in researching information, previous vaccination of influenza, etc.), and the economic perception it would have on the country. Findings: The general posture on vaccination correlates (p

The development of trajectory-based operations and the rolling network operations plan in European air traffic management network implies a move towards more collaborative, strategic flight planning. This opens up the possibility for inclusion of additional information in the collaborative decision-making process. With that in mind, we define the indicator for the economic risk of network elements (e.g., sectors or airports) as the expected costs that the elements impose on airspace users due to Air Traffic Flow Management (ATFM) regulations. The definition of the indicator is based on the analysis of historical ATFM regulations data, that provides an indication of the risk of accruing delay. This risk of delay is translated into a monetary risk for the airspace users, creating the new metric of the economic risk of a given airspace element. We then use some machine learning techniques to find the parameters leading to this economic risk. The metric is accompanied by an indication of the accuracy of the delay cost prediction model. Lastly, the economic risk is transformed into a qualitative economic severity classification. The economic risks and consequently economic severity can be estimated for different temporal horizons and time periods providing an indicator which can be used by Air Navigation Service Providers to identify areas which might need the implementation of strategic measures (e.g., resectorisation or capacity provision change), and by Airspace Users to consider operation of routes which use specific airspace regions., Comment: 19 pages, 14 figures

Stress and anxiety have shown to be indirect effects of the COVID-19 pandemic, therefore managing stress becomes essential. One of the most affected populations by the pandemic are healthcare professionals. Thus, it is paramount to understand and categorize their perceived levels of stress, as it can be a detonating factor leading to mental illness. In our study, we used a machine learning prediction model to help measure perceived stress; a C5.0 decision tree algorithm was used to analyze and classify datasets obtained from healthcare professionals of the northeast region of Mexico. Our analysis showed that 6 out of 102 instances were incorrectly classified. Missing two cases for mild, three for moderate and 1 for severe (accuracy of 94.1%), statistical correlation analysis was performed to ensure integrity of the method, in addition we concluded that severe stress cases can be related mostly to high levels of Xenophobia and Compulsive stress.

Aims To assess the impact of the declaration of the state of emergency due to the COVID-19 pandemic on the number of visits to a traumatology emergency department (ED), and on their severity. Methods Retrospective observational study. All visits to a traumatology ED were recorded, except for consultations for genitourinary, ocular and abdominal trauma and other ailments that did not have a musculoskeletal aetiology. Visit data were collected from March 14 to April 13 2020, and were subsequently compared with the visits recorded during the same periods in the previous two years. Results The number of visits dropped from a mean of 3,212 in 2018 to 2019 to 445 in 2020. Triage 1 to 3 level visits rose from 21.6% in 2018 to 2019% to 40.4% in 2020, meaning a reduction in minor injury visits and an increase in major ones. There was a relative reduction of 13.2% in femoral fractures in the elderly. The rate of justified visits rose from 22.3% to 48.1%. Conclusion A marked drop in the total number of visits to our traumatology ED was observed, as well as a relative increase in major injury visits and a relative fall in the minor ones. Cite this article: Bone Joint Open 2020;1-10:617–620.

Hemos leído en la revista el artículo de Chá M(1) referente a la Historia clínica electrónica: factores de resistencia para su uso por parte de los médicos, y consideramos que estamos transitando por un período donde se están optimizando los procedimientos en salud. La informática participa en procesos administrativos y ahora, en el ámbito clínico, con la tecnología de comunicación e información, y la historia clínica es un instrumento de información, pues es evidente que necesitamos una “alfabetización digital”(2).

This article presents a new, holistic model for the air traffic management system, built during the Vista project. The model is an agent-driven simulator, featuring various stakeholders such as the Network Manager and airlines. It is a microscopic model based on individual passenger itineraries in Europe during one day of operations. The article focuses on the technical description of the model, including data and calibration issues, and presents selected key results for 2035 and 2050. In particular, we show clear trends regarding emissions, delay reduction, uncertainty, and increasing airline schedule buffers.

Thermal switches have gained intense interest recently for enabling dynamic thermal management of electronic devices and batteries that need to function at dramatically varied ambient or operating conditions. However, current approaches have limitations such as the lack of continuous tunability, low switching ratio, low speed, and not being scalable. Here, a continuously tunable, wide-range, and fast thermal switching approach is proposed and demonstrated using compressible graphene composite foams. Large (~8x) continuous tuning of the thermal resistance is achieved from the uncompressed to the fully compressed state. Environmental chamber experiments show that our variable thermal resistor can precisely stabilize the operating temperature of a heat generating device while the ambient temperature varies continuously by ~10 °C or the heat generation rate varies by a factor of 2.7. This thermal device is promising for dynamic control of operating temperatures in battery thermal management, space conditioning, vehicle thermal comfort, and thermal energy storage., Current designs of thermal switches are limited by a lack of continuous tunability, low switching ratio, low speed, and not being scalable. Here the authors report a continuously tunable, wide-range, fast, and cost effective thermal switching approach that is demonstrated using compressible graphene composite foams.

Background Frailty is a geriatric syndrome that diminishes potential functional recovery after any surgical procedure. Preoperative surgical risk assessment is crucial to calibrate the risk and benefit of cardiac surgery. The aim of this study was to test usefulness of FRAIL Scale and other surgical-risk-scales and individual features of frailty in cardiac aortic valve surgery. Methods Prospective study. From May-2014 to February-2016, we collected 200 patients who underwent aortic valve replacement, either surgically or transcatheter. At 1-year follow-up, quality of life measurements were recorded using the EQ-5D (EuroQol). Univariate and multivariate analyses correlated preoperative condition, features of frailty and predicted risk scores with mortality, morbidity and quality of life at 1 year of follow-up. Results Mean age 78.2y, 56%male. Mean-preoperative-scores: FRAIL scale 1.5(SD 1.02), STS 2.9(SD 1.13), BI 93.8(SD 7.3), ESlog I 12.8(SD 8.5) and GS 7.3 s (SD 1.9). Morbidity at discharge, 6 m and 1 year was 51, 14 and 28%. Mortality 4%. Survival at 6 m/ 1-y was 97% / 88%. Complication-rate was higher in TAVI group due to-vascular complications. Renal dysfunction, anemia, social dependence and GS slower than 7 s were associated with morbidity. On multivariate analysis adjusted STS, BI and GS speed were statistically significant. Quality of life at 1-year follow-up adjusted for age and prosthesis type showed a significant association with STS and FRAIL scale scores. Conclusions Frailty increases surgical risk and is associated with higher morbidity. Preoperative GS slower 7 s, and STS and FRAIL scale scores seem to be reliable predictors of quality of life at 1-year follow-up.

Wallenberg syndrome, or lateral medullar syndrome, is the clinical presentation of the infarct in the territory of posterior inferior cerebellar artery. Its signs and symptoms include vertigo, nystagmus, diplopia, ipsilateral Horner syndrome, facial ruddiness and dry skin, dysphonia, dysphagia, dysarthria, ipsilateral loss of gag reflex, ipsilateral ataxia, ipsilateral impaired taste, ipsilateral facial pain and paresthesia, decreased ipsilateral blink reflex, contralateral hypoalgesia and thermoanaesthesia in the trunk and limbs; and ipsilateral facial hypoalgesia and thermoanaesthesia. Neuroanatomical knowledge is essential to its comprehension, study and diagnosis, because the classic neurological manifestations are easy to explain and understand if function and localization of affected anatomical structures are known as if the posterior cerebral circulation is.

Visual Abstract, Highlights • CpcPH is a relatively common complication of chronic HF, is associated with poor survival, and has no specific pharmacological treatment. • ß3AR stimulation has shown improvement in pulmonary hemodynamics and RV performance in a translational large animal model mimicking this condition. • The SPHERE-HF trial is a Phase II randomized, double-blind clinical trial designed to evaluate the efficacy and safety of mirabegron (oral β3 AR agonist) in patients with CpcPH secondary to HF. • The SPHERE-HF trial will include 80 patients treated with mirabegron or placebo for 16 weeks. • The main outcome is the change in PVR. Secondary outcomes include changes in RV performance, clinical status, NT-proBNP levels, and additional pulmonary hemodynamic parameters., Summary Combined pre-and post-capillary hypertension (CpcPH) is a relatively common complication of heart failure (HF) associated with a poor prognosis. Currently, there is no specific therapy approved for this entity. Recently, treatment with beta-3 adrenergic receptor (β3AR) agonists was able to improve pulmonary hemodynamics and right ventricular (RV) performance in a translational, large animal model of chronic PH. The authors present the design of a phase II randomized clinical trial that tests the benefits of mirabegron (a clinically available β3AR agonist) in patients with CpcPH due to HF. The effect of β3AR treatment will be evaluated on pulmonary hemodynamics, as well as clinical, biochemical, and advanced cardiac imaging parameters. (Beta3 Agonist Treatment in Chronic Pulmonary Hypertension Secondary to Heart Failure [SPHERE-HF]; NCT02775539)

Assessment regarding the impact of Energy Performance Certificates (EPC) on the residential market is largely inconclusive, while the majority of hedonic analyses have found EPC ratings to be correlated with prices, opinion-based research has found a negligible impact on prices and other marketing variables. Using the opinion of qualified real estate agents, this paper explores whether, in Spain, EPC labels play any role in housing marketing, as well as the policy changes required to foster efficient dwellings. The results reveal a large misunderstanding of the EPC labels, since they are seen as a global home-quality indicator, while their impact on residential marketing is quite poor. Apparently, both supply and demand place a small interest in energy performance, although it is slightly larger for sellers/buyers in relation to lenders/tenants. In any case, EPC labels are far from blurring the energy information asymmetry, since most of the buyers/tenants are informed of the EPC rating after having selected their home. Overall, the EPC scheme has a poor reputation exacerbated by inaccuracies, unintelligible units to express the financial and environmental implications of energy efficiency, and an apparent weak supervision. These findings stress the need to improve the scheme, in doing so, realtors suggest the need for some companion policies.

Introduction and objectives: To describe the prevalence, clinical profile, and prognostic significance of interatrial block (IAB) in heart failure (HF) inpatients. Methods We included prospectively 557 hospitalized HF patients with sinus rhythm from nationwide registry. Partial IAB was defined as a P wave duration ≥120 ms, and advanced IAB as a P wave duration ≥120 ms with biphasic morphology in inferior electrocardiogram (ECG) leads. Clinical, blood test, and echocardiographic data were analyzed in a Cox regression to determine the impact of IAB at discharge on prognosis. The primary outcome was a composite of mortality or readmission for HF at 1-, 6-, and 12-month. Results Normal P wave, partial, and advanced IAB were identified in the discharge ECG in 336 (60.3%), 118 (21.1%), and 103 (18.5%) patients, respectively. The independent factors related to IAB at discharge were previous history of HF (OR, 1.78; 95%CI, 1.23–2.57), valvular HF etiology (OR, 1.88; 95%CI, 1.18–3.00), heart rate at admission (OR, 1.10 per 10 beats; 95%CI, 1.03–1.17) and left atrial diameter (OR, 1.24 per 5 mm; 95%CI, 1.11–1.38). The incidence of 1-, 6-, and 12-month mortality/readmission for HF was 4.8%, 7.7%, and 33.0% in normal P wave, 1.7%, 7.6%, and 33.2% in partial IAB, and 3.9%, 9.7%, and 36.9% in advanced IAB. Multivariable analysis showed no significant effect of IAB in major acute cardiovascular events. Conclusions IAB is found in 40% of patients in sinus rhythm discharged after a HF hospitalization. This ECG pattern at discharge does not imply a greater risk of readmission or death during the first year. Introducción y objetivos: Describir la prevalencia, el perfil clínico y el significado pronóstico del bloqueo interauricular (BIA) en pacientes hospitalizados por insuficiencia cardiaca (IC). Métodos Estudio de cohortes que incluye a 557 pacientes hospitalizados por IC de un registro nacional. El BIA parcial se definió como una onda p ≥ 120 ms, y BIA avanzado si, además presentaba una morfología bifásica en las derivaciones inferiores del electrocardiograma. Se analizaron variables ecocardiográficas, analíticas y clínicas para determinar el impacto pronóstico del BIA al alta en un modelo de Cox. El evento principal fue un combinado de muerte o reingreso por IC a 1, 6 y 12 meses. Resultados Al alta, la presencia de una onda P normal, BIA parcial y avanzado se detectó en 336 (60,3%), 118 (21,1%) y 103 (18,5%) pacientes, respectivamente. Los factores independientes de la presencia de BIA fueron IC previa (OR: 1,78; IC95%: 1,23-2,57), etiología valvular (OR: 1,88; IC95%: 1,18-3,00), frecuencia cardiaca al ingreso (OR: 1,10 por 10 latidos; IC95%: 1,03-1,17) y el diámetro auricular izquierdo (OR: 1,24 por 5 mm; IC95%: 1,11-1,38). La incidencia del evento combinado a 1, 6 y 12 meses fue del 4,8, 7,7 y 33,0% para los sujetos con P normal; 1,7, 7,6, y 33,2% en BIA parcial, y 3,9, 9,7, y 36,9% en aquellos con BIA avanzado. La presencia del BIA al alta no se identificó como predictor para el evento principal. Conclusiones Hasta el 40% de los pacientes en ritmo sinusal presentan algún grado de BIA al alta de un episodio de IC. Este patrón no supuso un mayor riesgo de reingreso por IC o muerte durante el primer año de seguimiento. Sin financiación No data JCR 2020 0.114 SJR (2020) Q4, 316/349 Cardiology and Cardiovascular Medicine No data IDR 2020 UEM

The economic impact of each new residential development on the public budget can be very different than expected when, due to the real estate speculation, a poor demand forecast or to unexpected reasons, the dwellings are not built and occupied by their final users within the planned term. To quantify to what extent public costs and revenues are affected in unfinished developments, the economic balance of the public services operation when vacant lots, empty dwellings and dwellings with temporary occupancy are persistent in the long term has been simulated in three theoretical developments under the tax burden and operating cost of a sample of Spanish municipalities. Regardless of the local particularities, the results obtained show a clear stress to public finances when dwellings are not built, and less robust statistical results when said dwellings are built but remain empty or are occupied only temporarily. This leads to a reflection on whether the current tax system, based more on the amount of real estate properties than on their effective use, is the most appropriate for the promotion of sustainable urban patterns.

OBJECTIVE To examine the performance of screening for early, preterm and term pre-eclampsia (PE) at 11-13 weeks' gestation by maternal factors and combinations of mean arterial pressure (MAP), uterine artery (UtA) pulsatility index (PI), serum placental growth factor (PlGF) and serum pregnancy-associated plasma protein-A (PAPP-A). METHODS The data for this study were derived from three previously reported prospective non-intervention screening studies at 11 + 0 to 13 + 6 weeks' gestation in a combined total of 61 174 singleton pregnancies, including 1770 (2.9%) that developed PE. Bayes' theorem was used to combine the prior distribution of gestational age at delivery with PE, obtained from maternal characteristics, with various combinations of biomarker multiples of the median (MoM) values to derive patient-specific risks of delivery with PE at

Objective To report the incidence of preterm pre-eclampsia (PE) in women who are screen positive according to the criteria of the National Institute for Health and Care Excellence (NICE) and the American College of Obstetricians and Gynecologists (ACOG), and compare the incidence with that in those who are screen positive or screen negative by The Fetal Medicine Foundation (FMF) algorithm. Methods This was a secondary analysis of data from the ASPRE study. The study population consisted of women with singleton pregnancy who underwent prospective screening for preterm PE by means of the FMF algorithm, which combines maternal factors and biomarkers at 11-13 weeks' gestation. The incidence of preterm PE in women fulfilling the NICE and ACOG criteria was estimated; in these patients the incidence of preterm PE was then calculated in those who were screen negative relative to those who were screen positive by the FMF algorithm. Results A total of 34 573 women with singleton pregnancy delivering at ≥ 24 weeks' gestation underwent prospective screening for preterm PE, of which 239 (0.7%) cases developed preterm PE. At least one of the ACOG criteria was fulfilled in 22 287 (64.5%) pregnancies and the incidence of preterm PE was 0.97% (95% CI, 0.85-1.11%); in the subgroup that was screen positive by the FMF algorithm the incidence of preterm PE was 4.80% (95% CI, 4.14-5.55%), and in those that were screen negative it was 0.25% (95% CI, 0.18-0.33%), with a relative incidence in FMF screen negative to FMF screen positive of 0.051 (95% CI, 0.037-0.071). In 1392 (4.0%) pregnancies, at least one of the NICE high-risk criteria was fulfilled, and in this group the incidence of preterm PE was 5.17% (95% CI, 4.13-6.46%); in the subgroups of screen positive and screen negative by the FMF algorithm, the incidence of preterm PE was 8.71% (95% CI, 6.93-10.89%) and 0.65% (95% CI, 0.25-1.67%), respectively, and the relative incidence was 0.075 (95% CI, 0.028-0.205). In 2360 (6.8%) pregnancies fulfilling at least two of the NICE moderate-risk criteria, the incidence of preterm PE was 1.74% (95% CI, 1.28-2.35%); in the subgroups of screen positive and screen negative by the FMF algorithm the incidence was 4.91% (95% CI, 3.54-6.79%) and 0.42% (95% CI, 0.20-0.86%), respectively, and the relative incidence was 0.085 (95% CI, 0.038-0.192). Conclusion In women who are screen positive for preterm PE by the ACOG or NICE criteria but screen negative by the FMF algorithm, the risk of preterm PE is reduced to within or below background levels. The results provide further evidence to support the personalized risk-based screening method that combines maternal factors and biomarkers. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

“The molecule, buckminsterfullerene, is beautiful physically and intellectually. Its qualities, and even some of its properties, can be appreciated instantly and intuitively by nonscientists. Its uniqueness is bound to lead to novel applications – superconductivity is the leading contender at the moment”. So the journalist Hugh Aldersey-Williams presented in his book about C60 fullerene, “The Most Beautiful Molecule”, first published in 1995. Despite being quite old, this sentence is still strongly valid. In fact, since their discovery in 1985, fullerenes have raised huge interest among the scientific community, and they still preserve and increase it. This resulted in an impressive amount of research dealing with the molecule and its derivatives, and most of these studies have been collected in numerous reviews concerning fullerene's various properties and applications. Precisely due to the existence of these uncountable reviews, the present paper will take a slightly different path by describing important facts about fullerenes in the field of photovoltaics.

This article presents some of the results on the implementation of a decentralised delay management process that we call 4D trajectory adjustments (4DTA) obtained with Mercury, a stochastic agent-based model. The model operates within a strong agent paradigm at the level of individual flights and passengers. It includes a realistic cost model for the airlines, allowing us to have a good tactical choice model and excellent estimation of airspace user costs. Due to the inclusion of different stakeholders, including passengers, and various processes – like aircraft turnaround or passenger reaccommodation – it is able to catch European-wide network effects that are inaccessible to other models. It was used to study the 4DTA process, a blend of ‘wait for passengers and tactical speed adjustments’, which is shown to have a significant impact on the system. Thanks to the detailed output of the model, we are able to breakdown the effect for different classes of flights and passengers, and show that important trade-offs exist in terms of delays and costs. In particular, the introduction of such mechanism could be detrimental to non-connecting passengers, especially at secondary airports.

Pancreatic cancer is the most common lethal tumor in America. This lethality is related to limited treatment options. Conventional treatments involve the non-specific use of chemotherapeutical agents such as 5-FU, capecitabine, gemcitabine, paclitaxel, cisplatin, oxaliplatin, or irinotecan, which produce several side effects. This review focuses on the use of targeted nanoparticles, such as metallic nanoparticles, polymeric nanoparticles, liposomes, micelles, and carbon nanotubes as an alternative to standard treatment for pancreatic cancer. The principal objective of nanoparticles is reduction of the side effects that conventional treatments produce, mostly because of their non-specificity. Several molecular markers of pancreatic cancer cells have been studied to target nanoparticles and improve current treatment. Therefore, properly functionalized nanoparticles with specific aptamers or antibodies can be used to recognize pancreatic cancer cells. Once cancer is recognized, these nanoparticles can attack the tumor by drug delivery, gene therapy, or hyperthermia.

Background: Exercise training induces adaptive physiological and morphological modifications in the entire organism, however, excessive loads of training may increase damage in tissues. The purpose of this study was to evaluate the effect of silymarin in lung and liver histological changes in rats subjected to exercise training (ET). Methods: Male Wistar rats were subjected to an 8-week ET treadmill program 5 days per week, 60 min/session, and were previously administered 100 mg ascorbic acid or 100 mg of silymarin. Results: Silymarin increased alveolar and bronchial muscle size, improve vascularization, and reduced tissue inflammation. In liver, silymarin promoted the reduction of lipid content. Conclusion: Silymarin supplementation may improve inflammation in pulmonary tissue after 8 weeks of the ET treadmill program, improve cell recovery, and reduce intrahepatic lipid content.

Resumen Objetivo La introduccion de las nuevas protesis aorticas sin sutura ha supuesto una alternativa para el tratamiento quirurgico de la estenosis aortica severa. Presentamos la experiencia de nuestro grupo tras el inicio de un programa con protesis Perceval S (Livanova, Saluggia, Italia). Pacientes y metodos Entre marzo de 2012 y octubre de 2016 se implanto la protesis Perceval S en 262 pacientes (edad media: 77,97 ± 6,12 anos; 56,49% de mujeres). En 176 casos (67,18%) se realizo sustitucion valvular aortica aislada, con miniesternotomia en un 36,9%. El seguimiento clinico y ecocardiografico se realizo al alta, a los 6 meses y anualmente. Resultados La mortalidad esperada fue del 14,19 ± 1,31% (Euroscore log I ) y del 7,47 ± 1,11% (Euroscore log II ). La mortalidad observada fue del 4,23%. Hubo complicaciones neurologicas en 2 pacientes (0,94%), y fuga periprotesica moderada al alta en 2 pacientes. El seguimiento medio fue de 26 ± 6,2 meses. La mortalidad en el seguimiento fue del 1,9% (4 pacientes); estabilidad de las fugas grado II en el seguimiento; gradiente medio de 10,2 mmHg. El 95% de los pacientes se encontraban en grado funcional I - II . Conclusiones El inicio de un programa de implante de protesis sin sutura Perceval S ha permitido intervenir a pacientes de alto riesgo con buenos resultados y baja morbilidad. La protesis ha demostrado ser muy versatil, tener un excelente comportamiento hemodinamico y favorecer la cirugia de minimo acceso.

Resumen Introduccion y objetivos El grupo de Trabajo de en Reparacion Valvular de la Sociedad Espanola de Cirugia Toracica y Cardiovascular presenta el quinto registro anual de actividad en cirugia reparadora de la valvulas mitral, aortica y tricuspide realizada en Espana en el ano 2015. Material y metodos La recogida de datos se realizo a traves de cuestionario on-line, de forma retrospectiva, voluntaria, anonima y no auditada. Se detallan parametros en cuanto al tipo de cirugia, etiologia, mortalidad y riesgo quirurgico, tanto en el grupo global con en pacientes electivos. Resultados Se obtuvieron datos de 31 centros, con 9.112 intervenciones reportadas. La cirugia mitral reparadora supone el 29,6% de las valvulas mitrales intervenidas, con una amplia diferencia relativa a la etiologia del proceso, asi como muy diferente perfil de riesgo. La tasa de cirugia reparadora aortica continua en ascenso respecto a la sustitucion valvular, aunque con gran variacion intergrupos. La cirugia valvular tricuspide es mayoritariamente reparadora con uso de anillos con un numero estable en el tiempo de reemplazos valvulares. Conclusiones La actividad reparadora mitral esta establecida en la mayoria de los grupos, siendo muy dependiente de etiologia. Se observa un incremento en la tasa de reparacion valvular aortica y permanece estabilizada la actividad sobre la valvula tricuspide.

A variety of novel chemically modified fullerenes, showing different electron-accepting capabilities, has been synthesized and used to prepare electron transport layer (ETL)-free solar cells based on perovskite/fullerene blends. In particular, isoxazolino[60] fullerenes are proven to be a good candidate for processing blend films with CH3 NH3 PbI3 and obtaining enhanced power conversion efficiency (PCE) ETL-free perovskite solar cells (PSCs), improving the state-of-the-art PCE (i.e., 14.3 %) for this simplified device architecture. A beneficial effect for pyrazolino and methano[60]fullerene derivatives versus pristine [60]/fullerene is also shown. Furthermore, a clear correlation between the LUMO energy level of the fullerene component and the open circuit voltage of the solar cells is found. Apart from the new knowledge on innovative fullerene derivatives for PSCs, the universality and versatility of perovskite/fullerene blend films to obtain efficient ETL-free PSCs is demonstrated.

In the last decades organic solar cells (OSCs) have been considered as a promising photovoltaic technology with the potential to provide reasonable power conversion efficiencies combined with low cost and easy processability. Unexpectedly, Perovskite Solar Cells (PSCs) have experienced unprecedented rise in Power Conversion Efficiency (PCE) thus emerging as a highly efficient photovoltaic technology. OSCs and PSCs are two different kind of devices with distinct charge generation mechanism, which however share some similarities in the materials processing, thus standard strategies developed for OSCs are currently being employed in PSCs. In this article, we recapitulate the main processes in these two types of photovoltaic technologies with an emphasis on interfacial processes and interfacial modification, spotlighting the materials and newest approaches in the interfacial engineering. We discuss on the relevance of well-known materials coming from the OSCs field, which are now being tested in the PSCs field, while maintaining a focus on the importance of the material design for highly efficient, stable and accessible solar cells.

Nowadays, regulations in Europe are applied at traffic volume (TV) level consisting in a reference location, i.e. a sector or an airport, and in some traffic flows, which act as directional traffic filters. This paper presents an enhanced demand and capacity balance (EDCB) formulation based on constrained capacities at traffic volume level. In addition, this approach considers alternative trajectories in order to capture the user driven preferences under the trajectory based operations scope. In fact, these alternative trajectories are assumed to be generated by the airspace users for those flights that cross regulated traffic volumes, where the demand is above the capacity. For every regulated trajectory the network manager requests two additional alternative trajectories to the airspace users, one for avoiding the regulated traffic volumes laterally and another for avoiding it vertically. This paper considers that the network manager allows more flexibility for the new alternative trajectories by removing restrictions in the Route Availability Document (RAD). All the regulated trajectories (and their alternatives) are considered together by the EDCB model in order to perform a centralised optimisation minimising the the cost deviation with respect to the initial traffic situation, considering fuel consumption, route charges and cost of delay. The EDCB model, based on Mixed-Integer Linear Programming (MILP), manages to balance the network applying ground delay, using alternative trajectories or both. A full day scenario over the ECAC area is simulated. The regulated traffic volumes are identified using historical data (based on 28th July of 2016) and the results show that the EDCB could reduce the minutes of delay by 70%. The cost of the regulations is reduced by 11.7%, due to the reduction of the delay, but also because of the savings in terms of fuel and route charges derived from alternative trajectories.

Joint transnational programs and qualifications are an essential element both for the internationalisation of universities and for the development of the European Higher Education Area (EHEA), by facilitating the mobility of students and teachers and the international cooperation of the participating institutions. However, its development and practical implementation are hampered by the different national regulations on the quality assurance of the programs and recognition of the granted degrees. Joint programs constitute a paradox of the Bologna process, since transnational programs and qualifications are developed, ensure quality and are recognised in a different national context. This paper discusses and analyzes the background and current situation of the projects and activities and the ministerial recommendations on joint programs in the EHEA, such as the Erasmus Mundus projects and the European Approach to Quality Assurance of Joint Programs, approved by the Ministerial Conference of 2015 of the EHEA with the recommendation of an unique accreditation of the programs and multiple recognition of the degrees. As a result, some suggestions are proposed on practical aspects of the joint programs and degrees that can help to facilitate their development at the level of practical implementation, evaluation process, recognition of evaluation decisions, recognition of degrees awarded and terminology. Los programas y titulaciones transnacionales conjuntos son un elemento esencial tanto para la internacionalización de las universidades como para el desarrollo del Espacio Europeo de Educación Superior (EEES), al facilitar la movilidad de estudiantes y profesores y la cooperación internacional de las instituciones participantes. Sin embargo, su desarrollo e implantación práctica se ve dificultada por las distintas regulaciones nacionales sobre el aseguramiento de la calidad de los programas y reconocimiento de las titulaciones otorgadas. De hecho, los programas conjuntos constituyen una paradoja del proceso de Bolonia al ser programas y cualificaciones transnacionales que se desarrollan, aseguran la calidad y son reconocidas en diferentes contextos nacionales. En este trabajo se discuten y analizan los antecedentes y situación actual de los proyectos y actividades y las recomendaciones ministeriales sobre los programas conjuntos en el EEES, tales como los proyectos Erasmus Mundus y el Enfoque Europeo sobre el Aseguramiento de la Calidad de los Programas Conjuntos aprobado por la Conferencia Ministerial de 2015 del EEES con la recomendación de acreditación única de los programas y reconocimiento múltiple de las titulaciones. Como resultado se proponen unas recomendaciones sobre aspectos prácticos de los programas y titulaciones conjuntos que permitan facilitar su desarrollo a nivel de implantación práctica, proceso de evaluación, reconocimiento de las decisiones de evaluación, reconocimiento de las titulaciones otorgadas y terminología.

espanolObjetivos: la preeclampsia es causa importante de morbilidad y mortalidad materna y perinatal. La identificacion de gestantes con riesgo de preeclampsia, el correcto diagnostico y la adecuada evaluacion del pronostico son fundamentales para la eleccion de la actitud clinica mas adecuada en cada caso y lograr evitar asi las complicaciones asociadas y la mortalidad por preeclampsia. En este sentido, en los ultimos anos se han desarrollado y estudiado numerosos biomarcadores que, bien por si mismos o en combinacion con otros parametros, muestran resultados prometedores en la prediccion y diagnostico de preeclampsia, y cuya incorporacion a la practica clinica habitual supondra un avance en el manejo clinico de las gestantes con preeclampsia. Material y metodos: desde la Sociedad Espanola de Ginecologia y Obstetricia se envio via internet una encuesta con 25 preguntas (3 de ellas casos clinicos) a 2.699 miembros de la secciones de Medicina Perinatal y Ecografia con el objetivo de revisar el estado actual de la prediccion, diagnostico y manejo clinico de la preeclampsia en nuestro pais. Resultados: a la encuesta respondieron 476 profesionales (17,63%) y de sus respuestas se concluye que la practica clinica entre los profesionales de los hospitales espanoles se ajusta en la mayoria de los aspectos evaluados a las recomendaciones actuales y al estado del conocimiento. Cabe destacar la baja utilizacion de biomarcadores en el primer trimestre para identificar gestantes con riesgo de preeclampsia e indicar profilaxis asi como en el segundo y tercer trimestre para establecer el pronostico y optimizar la actitud terapeutica. EnglishObjectives: Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality. The correct diagnosis, prognosis, and identification of patients at high risk of pre-eclampsia are crucial for the optimal treatment and prevention of pre-eclampsia-associated complications and mortality. A large variety of prognostic and diagnostic biomarkers have been studied in the recent years either alone or in combination with other parameters, with promising results. The routine use of these biomarkers in clinical practice would help optimize the clinical approach to pre-eclampsia. Material and methods: The Spanish Society of Gynecology and Obstetrics forwarded an online 25-item questionnaire (of which 3 were clinical cases) to 2.699 members of the departments of perinatal medicine and ultrasound with the aim of revising how pre-eclampsia is predicted, diagnosed, and treated in Spain. Results: A total of 476 questionnaires (17.63%) were returned. The conclusion was that most aspects addressed in the questionnaire were approached in hospitals in Spain in accordance with official guidelines and the current state of knowledge. Of note is the rare use of biomarkers either during the first trimester of gestation in patients at risk of pre-eclampsia for the indication of prophylaxis, or during the second and third trimester for the prognosis and selection of the best therapeutic option.

All authors are part of the research team and have contributed in the design, dissemination of the survey, data gathering, analysis and writing of this piece. The authors do express their gratitude to Carlos Pérez, Rolando Biere and Joyce de Botton for the support received. Also, to the Spanish International Realty Alliance (SIRA) for helping to disseminate the survey among its associates., In order to foster informed transactions, the Energy Performance of Buildings Directive has made it mandatory to get an Energy Performance Certificate in the marketing of the Communitarian Real Estate. Due to energy savings and environmental preservation, it is expected that efficient buildings do receive an increased willingness to pay. The evidence coming from a number of statistical studies has confirmed the existence of such premium. Nevertheless, such finding is contradictory in relation to the conclusions of opinion-based studies. This paper seeks to study whether energy efficiency drives market price and the marketing of homes in Spain. In doing so, a survey applied to realtors across the country has been implemented. The results are in line with other opinion-based studies pointing out that energy performance has a negligible impact on the marketing of homes. Furthermore, real estate agents suggest that companion policies in the sphere of subsidies and fiscal exceptions are needed in order to bring energy efficiency to the first line of elicitation attributes in the residential market., EnerValor project grant (MINECO/FEDER) BIA 2015-63606-R

IntroductionAutism spectrum disorder (ASD) is a neurodevelopmental disorder with a biological basis overlapped with obsessive compulsive disorders and body dysmorphic disorder (BDD). The combination of pharmacological treatment and psychological interventions have been considered the gold-standardObjectivesOur main objective was to present the case of a patient with ASD and comorbid BDD. As a second objective, we reviewed recent works on the common neurobiological substrate and therapeutic options for both conditions.Methods(1)Clinical case: Patient with ASD and BDD, treated with fluoxetine 60 mg/day and aripiprazole 30 mg/day. (2)Non-systematic narrative review focused on neurobiological substrate and treatment of ASD and BDD. The electronic search was performed by the PubMed database (1990-2020) using the following key terms: “autism spectrum disorder”, “body dysmorphic disorder”, “dysmorphophobia”, “neurobiology”, “pharmacological treatment”, “psychological treatment” and “treatment”.ResultsOur patient is a 31-year-old single male fulfilling DSM-5 criteria for ASD, diagnosed in childhood, and BDD. He received pharmacological treatment and CBT. He also verbalized having been concerned with his lips and mouth for the last 10 years. This discomfort leads to passive ideas of death. Review: All articles (n=4) supported the use of selective serotonin reuptake inhibitors (SSRIs) and CBT in this comorbidity. None of them reported the use of antipsychotics. Oone article described the use of Repetitive transcranial magnetic stimulation (rTMS) and oxytocin.ConclusionsASD and BDD share the basis of corticostriatal circuits. ISRS and CBT may be effective in treatment. Other options (oxytocin or rTMS) should be further investigated. Examining this comorbidity could be useful for discovering possible endophenotypes.

Air traffic management research lacks a framework for modelling the cost of resilience during disturbance. There is no universally accepted metric for cost resilience. The design of such a framework is presented and the modelling to date is reported. The framework allows performance assessment as a function of differential stakeholder uptake of strategic mechanisms designed to mitigate disturbance. Advanced metrics, cost- and non-cost-based, disaggregated by stakeholder sub-types, are described. A new cost resilience metric is proposed and exemplified with early test data.

In this article, a reduced folded dipole is designed by employing a short-circuited stub load, decreasing 42 % the length compared to a conventional antenna. The radiator presents low characteristic impedance (close to 50 ź), without using any matching network, taking into account that a conventional ź/2 folded dipole presents an impedance close to 300 ź. As well as the conventional radiator, the reduced folded dipole shows an omnidirectional radiation pattern. This antenna can also be employed as a driver for an array including a reflector-type antenna. In this work, a reduced 90° corner reflector is used and reduced, since it is function of the driver length, as a result a directive radiation pattern with a front to back lobe relationship close to 9 dB is achieved.

The aim of this study was to investigate the effectiveness of ultrasound as a conservation method for the inactivation of Escherichia coli inoculated into cactus pear juices (green and purple). Total soluble solids, pH, titratable acidity, and the kinetics of E. coli in cactus pear juices treated by ultrasound (60%, 70%, 80% and 90% amplitude levels for 1, 3 and 5 min) were evaluated over 5 days. Total inactivation was observed in both fruit juices after 5 min of ultrasound treatment at most amplitude levels (with the exception of 60% and 80%). After one and two days of storage, the recovery of bacteria counts was observed in all cactus pear juices. Ultrasound treatment at 90% amplitude for 5 min resulted in non-detectable levels of E. coli in cactus pear juice for 2 days. The parameters of pH, titratable acidity and soluble solids were unaffected.

Global health and medical practice seek to merge alternative medicine with evidence-based medicine for a better understanding of the metabolic process and its effects in the human body. An example is the use of complementary medicine like phytotherapy. Azadirachta indica (Neem), a tree originally from India and Myanmar, called by many “The village pharmacy” or “Divine tree” because of its many health properties. In recent times, Neem-derived extracts have been shown to work from anywhere from insect repellent, to supplements to lower inflammation, diabetic control, and even to combat cancer. Herein, we state the health benefits found in diverse compounds and extracts derived from Neem, highlighting the mechanisms and pathways in which Neem compounds produce their effects, while warning that the improper and unstandardized conditions to produce extracts can lead to health issues, particularly certain compounds might have damaging effects on the liver and kidneys.

ResumenIntroducción y objetivosLos órganos cardíacos deben ser priorizados hacia pacientes en los que se vaya a obtener máxima supervivencia con menor morbilidad. El objetivo del estudio fue analizar la influencia del receptor, el donante y e tiempo de isquemia del órgano en la mortalidad.MétodosSe consideraron todos los trasplantes cardíacos realizados en España hasta diciembre del 2011 (6.528 TC). Se excluyeron: 1) trasplantes previos al año 2000; 2) edad < 16 años; 3) combinados con otros órganos, y 4) retrasplantes. Los pacientes analizados fueron 3.006. Se definieron las categorías de óptimo/subóptimo para las variables del receptor, donante y tiempo de isquemia. Se compararon y se realizaron curvas de supervivencia para donante, receptor, tiempo de isquemia y combinaciones.ResultadosSe comparó el porcentaje de pacientes fallecidos. Las diferencias (p

ResumenIntroducción y objetivosEl Grupo de Trabajo en Reparación Valvular de la Sociedad Española de Cirugía Torácica y Cardiovascular presenta el tercer Registro anual de actividad en cirugía reparadora de las válvulas mitral, aórtica y tricúspide realizadas en España en el año 2013.MétodosLos datos se obtuvieron mediante encuesta por vía web. La participación fue voluntaria. Se contabiliza el número de intervenciones valvulares (reparaciones y recambios). Se detallan las reparaciones valvulares mitrales por etiologías. Se reporta la mortalidad. Se realiza una comparación de resultados de la cirugía valvular con años anteriores.ResultadosSe ofrecen datos de 25 centros (48% de la actividad quirúrgica del país). El volumen de reparación valvular global sigue incrementándose. La actuación sobre la válvula mitral degenerativa es mayoritariamente reparadora (61,7%). El 46% de todas las válvulas mitrales fueron reparadas. En la válvula aórtica esta técnica es todavía incipiente (2,7%). La etiología degenerativa sigue siendo la más habitual en caso de reparación valvular mitral; no obstante, en nuestro país la etiología reumática no acaba de desaparecer, siendo causa de gran cantidad de implantes protésicos. La mortalidad en la reparación fue del 1,5%±1,9, frente al 5,3%±3,5 en caso del recambio, aunque la comorbilidad asociada a los grupos fue también claramente diferente (Euroscore de 6,0±3,0 frente a 8,9±2,4).ConclusionesEl porcentaje de pacientes que se benefician de las técnicas de reparación valvular sigue aumentando, con unos resultados satisfactorios en términos de mortalidad.AbstractIntroduction and objectivesThe Spanish Society of Thoracic and Cardiovascular Surgery Valve Repair Working Group presents the third annual activity report in reconstructive surgery of the mitral, aortic and tricuspid valves performed in Spain in 2013.MethodsData were obtained using a web-based survey for which participation was voluntary. The number of valvular interventions (repairs and replacements) were recorded. Mitral valve repair surgery was reported by aetiology. Mortality was also reported. A comparison was made with the results of valve surgery performed in previous years.ResultsThe data from 25 centres (48% of the surgical activity in the country) are shown. The overall volume of valve repair continues to increase. Almost half (46%) of all mitral valves were repaired. Repair was most common (61.7%) intervention on degenerative mitral valves. Aortic valve repair technique is still developing (2.7% of overall valve surgery). Degenerative aetiology remains the most common in the case of mitral valve repair, however in Spain, rheumatic aetiology has still not disappeared, being the cause of many prosthetic implants. Overall repair mortality was 1.5%±1.9 versus 3.5±5.3% in the case of replacement. Nevertheless, the comorbidity associated with the two groups was also clearly different (EuroSCORE repair 6.0±3.0 vs. replacement 8.9±/2.4).ConclusionsThe percentage of patients who benefit from valve repair techniques continues to rise, with satisfactory results in terms of mortality.