Search

Open clusters are key coeval structures that help us understand star formation, stellar evolution and trace the physical properties of our Galaxy. In the past years, the isolation of open clusters from the field has been heavily alleviated by the access to accurate large-scale stellar parallaxes and proper motions along a determined line of sight. Still, there are limitations regarding their completeness since large-scale studies rely on optical wavelengths. Here we extend the open clusters sequences towards fainter magnitudes complementing the Gaia photometric and astrometric information with near-infrared data from the VVV survey. We performed a homogeneous analysis on 37 open clusters implementing two coarse-to-fine characterization methods: extreme deconvolution Gaussian mixture models coupled with an unsupervised machine learning method on 8-dimensional parameter space. The process allowed us to separate the clusters from the field at near-infrared wavelengths. We report an increase of $\sim$47\% new member candidates on average in our sample (considering only sources with high membership probability p$\geqq$0.9). This study is the second in a series intended to reveal open cluster near-infrared sequences homogeneously., 16 pages. 5 figures. MNRAS accepted. v2: language edits and references updated at the proof stage; arXiv admin note: text overlap with arXiv:2102.04303

Context. The young massive cluster Westerlund 1 offers the promise of a grand laboratory for the study of high-mass star evolution, but its basic parameters are still poorly known. Aims. In this paper, we aim at a better characterisation of the cluster by determining some basic kinematic properties and analysing the area surrounding the cluster and the population in its foreground. Methods. We have used Gaia early data release 3 (EDR3) data, together with spectra of a large sample of luminous stars in the field surrounding Westerlund 1, to explore the extent of the cluster. We carried out a non-parametric analysis of proper motions and membership determination. We investigated the reddening and proper motions of several dozen OB stars and red supergiants less than one degree away from Westerlund 1. Results. We identify a population of kinematic members of Westerlund 1 that largely includes the known spectroscopic members. From their EDR3 parallaxes, we derive a distance to the cluster of kpc. We analyse the extinction in this direction, finding that it increases by a large amount around 2.8 kpc, which in all likelihood is due to dark clouds associated with the Scutum-Crux arm. As a consequence, we hardly see any stars at distances comparable (or higher) than that of the cluster. The proper motions of Westerlund 1, however, are very similar to those of stars in the field surrounding it which are – almost without exception – less distant, but distinct. We find a second, astrometrically well-defined population in the foreground (d ≈ 2 kpc), centred ∼8′ away, which is likely connected to the possible open cluster BH 197. Westerlund 1 is very elongated, an effect that seems real and not driven by the very heavy extinction to the east and south. We find a low-density halo extending to distances up to 10′ from the cluster centre, mainly in the north-west quadrant. A few OB stars at larger distances from the cluster, most notably the luminous blue variable (LBV) MN48, share its proper motions, suggesting that Westerlund 1 has little or no peculiar motion with respect to the field population of the Norma arm. Despite this, we are unable to find any red supergiant that could belong to an extended population related to the cluster, although we observe several dozen such objects in the foreground, demonstrating the richness of the field population along this sightline. We find a substantial population of luminous OB members obscured by several more magnitudes of extinction than most known members. These objects, mostly located in the central region of the cluster, increase the population of OB supergiants by about 25%. © ESO 2022., This research is partially supported by the Spanish Government Ministerio de Ciencia, Innovación y Universidades under grants PGC2018-093 741-B-C21/C22 and PGC2018-095 049-B-C21/C22 (MICIU/AEI/FEDER, UE) and the Generalitat Valenciana under grant PROMETEO/2019/041. EJA acknowledges financial support from the State Agency for Research of the Spanish MCIU through the “Center of Excellence Severo Ochoa” award to the Instituto de Astrofísica de Andalucía (SEV-2017-0709)”. RD acknowledges further support from the Spanish Government Ministerio de Ciencia e Innovación through grant SEV 2015-0548, and from the Canarian Agency for Research, Innovation and Information Society (ACIISI), of the Canary Islands Government, and the European Regional Development Fund (ERDF), under grant with reference ProID2 017 010 115. The AAOmega observations have been supported by the OPTICON project (observing proposal 2011A/014), which was funded by the European Commission under the Seventh Framework Programme (FP7). This research has made use of the Simbad, Vizier and Aladin services developed at the Centre de Données Astronomiques de Strasbourg, France. This work has made use of data from the European Space Agency (ESA) mission Gaia (https://www.cosmos.esa.int/gaia), processed by the Gaia Data Processing and Analysis Consortium (DPAC, https://www.cosmos.esa.int/web/gaia/dpac/consortium). Funding for the DPAC has been provided by national institutions, in particular the institutions participating in the Gaia Multilateral Agreement. The Gaia data are processed with the computer resources at Mare Nostrum and the technical support provided by BSC-CNS. In this work, we have made extensive use of TOPCAT (Taylor et al. 2005). We thank its author, and subsequent contributors, for the creation and development of this tool.

Oysters are keystone species that use external fertilization as a sexual mode. The gametes are planktonic and face a wide range of stressors, including plastic litter. Nanoplastics are of increasing concern because their size allows pronounced interactions with biological membranes, making them a potential hazard to marine life. In the present study, oyster spermatozoa were exposed for 1

Three low-grade carbonaceous materials from biomass (Scenedesmus algae and wheat straw) and waste treatment (sewage sludge) have been selected as feedstock for solar-driven thermochemical processes. Solar-driven pyrolysis and gasification measurements were conducted directly irradiating the samples in a 7 kWe high flux solar simulator and the released gases H2, CO, CO2 and CH4 and the sample temperature were continuously monitored. Solar-driven experiments showed that H2 and CO evolved as important product gases demonstrating the high quality of syngas production for the three feedstocks. Straw is the more suitable feedstock for solar-driven processes due to the high gas production yields. Comparing the solar-driven experiments, gasification generates higher percentage of syngas (mix of CO and H2) respect to total gas produced (sum of H2, CO, CO2 and CH4) than pyrolysis. Thus, solar-driven gasification generates better quality of syngas production than pyrolysis.

Solar Thermal Energy power plants operating with traditional steam Rankine cycles have a low thermal and exergy efficiency. An attractive pathway to increase the competitiveness of this technology is to investigate Closed Brayton cycles working with different fluids with desirable properties that show potential for improving their efficiency In this work a solar driven regenerative Brayton cycle is studied employing two different working fluids: Helium and supercritical CO2. The cycle efficiencies are determined for different turbine inlet temperatures and for the optimal compressor pressure ratios. Additionally, an exergy analysis breakdown of the different plant components is shown for each case, while the solar field sizes and working fluid flows are calculated for a fixed gas turbine output.

We present a photometric detection of the first brightness dips of the unique variable star KIC 8462852 since the end of the Kepler space mission in 2013 May. Our regular photometric surveillance started in October 2015, and a sequence of dipping began in 2017 May continuing on through the end of 2017, when the star was no longer visible from Earth. We distinguish four main 1-2.5% dips, named "Elsie," "Celeste," "Skara Brae," and "Angkor", which persist on timescales from several days to weeks. Our main results so far are: (i) there are no apparent changes of the stellar spectrum or polarization during the dips; (ii) the multiband photometry of the dips shows differential reddening favoring non-grey extinction. Therefore, our data are inconsistent with dip models that invoke optically thick material, but rather they are in-line with predictions for an occulter consisting primarily of ordinary dust, where much of the material must be optically thin with a size scale <, 19 pages, 8 figures, accepted for publication in ApJL

In this paper we describe the routine photometric calibration of data taken with the VIRCAM instrument on the ESO VISTA telescope. The broadband ZYJHKs data are directly calibrated from 2MASS point sources visible in every VISTA image. We present the empirical transformations between the 2MASS and VISTA, and WFCAM and VISTA, photometric systems for regions of low reddening. We investigate the long-term performance of VISTA+VIRCAM. An investigation of the dependence of the photometric calibration on interstellar reddening leads to these conclusions: (1) For all broadband filters, a linear colour-dependent correction compensates the gross effects of reddening where $E(B-V), 22 pages, 22 figures. Accepted for publication in MNRAS

Resumen Objetivo Evaluar durante un ano consecutivo la magnitud de la auto-extubacion (AE), buscando las variables no dependientes del enfermo relacionadas. Material y metodos Estudio prospectivo y observacional de casos y controles en una unidad de cuidados intensivos polivalente, dentro de un complejo hospitalario de tercer nivel. Fueron considerados casos enfermos con ventilacion mecanica superior a las 24 h que presentaban un episodio de AE. Se realizo recogida prospectiva de variables de casos. Como principales variables de interes se estudiaron momento de AE (recogida horaria), identificacion del box donde el enfermo se encontraba ingresado, presencia y tipo de contencion fisica, desarrollo de neumonia asociada a ventilacion mecanica (NAVM) y fallecimiento. Resultados Se produjeron 17 AE en 15 pacientes, 1,21 AE por cada 100 dias de VM. Las AE tuvieron una distribucion espacial (numero de box) no homogenea. La distribucion horaria de los casos, comparada con los controles, evidencio diferencias de distribucion horaria significativas (p = 0,02). El analisis comparativo entre los casos y los controles evidencio mayor mortalidad, mayor estancia en la UCI, mayor estancia hospitalaria y mayor riesgo de contraer una NAVM cuando los enfermos sufren un episodio de AE. Discusion La AE ocurre con mayor frecuencia en una franja horaria determinada del dia, pudiendo jugar un papel la situacion espacial del enfermo; ocurre con mayor frecuencia en enfermos que se encuentran en proceso de destete de la ventilacion mecanica, y desarrollan mayor NAVM.

International audience; Biogas production is one of the means to produce a biofuel from microalgae. Biomass consisting mainly of Scenedesmus sp. was thermally pretreated and optimum pretreatment length (1 h) and temperature (90 degrees C) was selected. Different chemical composition among batches stored at 4 C for different lengths of time resulted in organic matter hydrolysis percentages ranging from 3% to 7%. The lower percentages were attributed to cell wall thickening observed during storage for 45 days. The different hydrolysis percentages did not cause differences in anaerobic digestion. Pretreatment of Scenedesmus sp. at 90 degrees C for 1 h increased methane production 2.9 and 3.4-fold at organic loading rates (OLR) of 1 and 2.5 kg COD m(-3) day(-1), respectively. Regardless the OLR, inhibition caused by organic overloading or ammonia toxicity were not detected. Despite enhanced methane production, anaerobic biodegradability of this biomass remained low (32%). Therefore, this microalga is not a suitable feedstock for biogas production unless a more suitable pretreatment can be found. (C) 2012 Elsevier Ltd. All rights reserved.

International audience; Ultrasound at 20 Hz was applied at different energy levels (Es) to treat Scenedesmus biomass, and organic matter solubilization, particle size distribution, cell disruption and biochemical methane potential were evaluated. An Es of 35.5 and 47.2 MJ/kg resulted in floc deagglomeration but no improvement in methane production compared to untreated biomass. At an Es of 128.9, cell wall disruption was observed together with a 3.1-fold organic matter solubilization and an approximately 2-fold methane production in comparison with untreated biomass. Thermal pretreatment at 80 degrees C caused cell wall disruption and improved anaerobic biodegradability 1.6-fold compared to untreated biomass. Since sonication caused a temperature increase in samples to as high as 85 degrees C, it is likely that thermal effects accounted for much of the observed changes in the biomass. Given that ultrasound treatment at the highest Es studied only increased methane production by 1.2-fold over thermal treatment at 80 degrees C, the higher energy requirement of sonication might not justify the use of this approach over thermal treatment.

Resumen Objetivo Comprobar que valor tiene la fraccion de espacio muerto (Vd/Vt) como predictor del fracaso en la extubacion de los enfermos que necesitaron ventilacion mecanica (VM) ingresados en las unidades de cuidados intensivos. Diseno Estudio de cohortes, prospectivo, observacional. Desde el 1 de septiembre de 2010 hasta 1 de marzo de 2011. Ambito Unidad de cuidados intensivos generales (UCIG), del complejo hospitalario de tercer nivel Hospital Universitario Marques de Valdecilla. Pacientes o participantes Se han incluido en el estudio aquellos enfermos que recibian VM por un espacio de tiempo superior a las 12 horas; y quienes en el proceso de destete seguian un protocolo de presion soporte de bajo nivel. Han sido criterios de exclusion la edad inferior a 18 anos, enfermos ventilados a traves de traqueotomia y enfermos considerados no colaboradores por diversas causas. Durante el periodo de estudio, ingresaron en UCIG 392 enfermos. De ellos 214 precisaron ventilacion mecanica. En 154 se inicio proceso de destete. Fueron excluidos del estudio 54 enfermos y no fueron extubados de VM 24. Finalmente 76 enfermos fueron extubados y analizados. Variables de interes principales Se calculo Vd/Vt como el cociente (PaCO2-Pє CO2)/PaCO2; con los parametros registrados. Resultados El analisis de regresion logistica mostro una asociacion significativa entre la variable Vd/Vt y el fracaso en la extubacion con una OR de 1,52 (IC 95%: 1,11-2,09; p = 0,008). El area bajo la curva ROC, con respecto a predecir el fracaso en la extubacion mediante el valor de Vd/Vt fue de 0,94 (IC 95%: 0,86-0,98; p Conclusiones Consideramos Vd/Vt un potente predictor del fracaso en la extubacion de la VM.

Objetivo: Analizar la supervivencia a corto (un mes), medio (un año) y largo plazo (cinco años) en todos los pacientes sometidos a un trasplante pulmonar (TP) cuyo donante tuviera al menos 55 años. Pacientes y métodos: Se incluyó a todos los pacientes sometidos a un TP cuyo donante tuviera 55 años o más. Se analizó la asociación de las diferentes variables estudiadas con la mortalidad precoz, anual y al quinto año. Se utilizó la regresión logística en el estudio de factores de riesgo para mortalidad precoz y se utilizó la regresión de riesgos proporcionales de Cox en el estudio de factores de riesgo para la mortalidad al año y al quinto año, introduciendo las variables con un valor de p < 0,2 en el análisis bivariante. Se efectuó un análisis de supervivencia mediante el método de Kaplan-Meier. Resultados: Se analizó un total de 33 pacientes sometidos a un TP con donantes de 55 años o más. La probabilidad de supervivencia fue del 90,9, el 78,5 y el 44,8% al mes, año y cinco años respectivamente. La edad elevada del receptor (p=0,16) y la realización de un trasplante unipulmonar (p=0,09) fueron las variables que se asociaron o mostraron tendencia a la asociación con la mortalidad. Conclusiones: La decisión final en la aceptación de un injerto pulmonar se debe basar en la evaluación individual de cada donante y receptor. Sin embargo, dada la escasez de injertos pulmonares, parece adecuado considerar de inicio para la donación pulmonar a los pacientes de 55 o más años.

Resumen La diseccion traumatica de la arteria carotida interna (DTACI) por traumatismo cerrado es una entidad rara e infradiagnosticada, y su incidencia es del 0,08–0,4% entre los pacientes que presentan lesiones traumaticas. El espectro de la lesion traumatica de la arteria carotida interna incluye desde lesiones menores, como el espasmo, lesiones intimales o contusiones hasta seudoaneurismas y oclusion completa. La presentacion clinica tardia es tipica, incluyendo cefalea, hemiparesia, sindrome de Horner y paralisis de nervios craneales. La embolizacion secundaria a la diseccion puede provocar ictus isquemico con resultados que pueden ser fatales. La DTACI secundaria al cinturon de seguridad es muy rara, debida habitualmente al trauma cervical directo en el lado de la fijacion al hombro con lesiones equimoticas externas tipicas en el trayecto del cinturon. Presentamos 2 casos de DTACI con infarto cerebral asociado debida al cinturon de seguridad, y se discuten los aspectos clinicos, diagnosticos y terapeuticos propios de la lesion.

This paper illustrates a methodology developed to analyze the influence of traffic conditions, i.e. volume and composition on accidents on different types of interurban roads in Spain, by applying negative binomial models. The annual average daily traffic was identified as the most important variable, followed by the percentage of heavy goods vehicles, and different covariate patterns were found for each road type. The analysis of hypothetical scenarios of the reduction of heavy goods vehicles in two of the most representative freight transportation corridors, combined with hypotheses of total daily traffic mean intensity variation, produced by the existence or absence of induced traffic gives rise to several scenarios. In all cases a reduction in the total number of accidents would occur as a result of the drop in the number of heavy goods transport vehicles, However the higher traffic intensity, resulting of the induction of other vehicular traffic, reduces the effects on the number of accidents on single carriageway road segments compared with high capacity roads, due to the increase in exposure. This type of analysis provides objective elements for evaluating policies that encourage modal shifts and road safety enhancements.

Objetivo Evaluar de manera independiente la capacidad al ejercicio como factor predictivo de supervivencia en el trasplante pulmonar. Diseno Estudio retrospectivo. Ambito Unidad de trasplante pulmonar de la Unidad de Cuidados Intensivos (UCI) de un hospital universitario. Pacientes Se realizaron y analizaron 132 trasplantes pulmonares, en un total de 130 enfermos. El seguimiento de cada caso se realizo hasta fecha de 18 de junio de 2005 o fallecimiento del paciente. Variables de interes Se valoro la capacidad preoperatoria al ejercicio mediante la prueba de marcha de los 6 minutos (PM6M). Tambien se valoro la supervivencia a largo plazo en relacion con el valor obtenido en la PM6M. Las curvas de supervivencia se estimaron por el metodo de Kaplan-Meier; la comparacion entre curvas se hizo por el metodo de Log-Rank y las hazard ratios se estimaron por regresion de Cox. Resultados El estudio de asociacion a mortalidad de la PM6M mostro un riesgo relativo de 0,99 (intervalo de confianza del 95%: 0,99-1,00) por cada unidad de medida metrica (metro) (p = 0,282). Se clasifico a los enfermos segun la distancia recorrida en 4 grupos: grupo I (distancia recorridamenor de 100 metros), grupo II (distancia recorrida entre 101-200 metros), grupo III (distancia recorrida entre 201 y 300 metros) y grupo 4 (distancia mayor de 301 metros). No se encontraron diferencias significativas al comparar las curvas de supervivencia entre los grupos (p = 0,709). El analisis multivariante tampoco aporto significacion estadistica. Conclusion La distancia recorrida en la PM6M realizada en el protocolo de estudio de candidatos a trasplante pulmonar no creemos que sea util como marcador de mortalidad a largo plazo en los enfermos sometidos a recambio pulmonar.

This book chapter deals with the production of biogas coupled with the use of waste effluents for microalgae biomass growth. Biogas production through anaerobic digestion of microalgae uses the whole organic content of microalgae to produce energy. Furthermore, biogas generation seems to be the least complex of the different energy conversion routes since anaerobic digestion avoids energy-intensive steps such as biomass drying and extraction. Biogas can be produced as the main product from microalgae (direct anaerobic digestion of the whole biomass) or can be a coproduct of an industry culturing microalgae for different purposes. The integration of different technologies in a biorefinery aims at maximizing benefits while reducing the environmental impact. The future of algae biorefineries would include the extraction of several components from microalgae. Waste biomass can be treated by anaerobic digestion, reducing the pollutant load while producing energy. Additionally, there is a synergy between anaerobic digestion and microalgae growth. Biogas contains a high percentage of CO2, and if it is combusted in CHP units, CH4 is converted to CO2. The digestate produced after anaerobic digestion is a liquid medium where most of the nutrients of the organic substrate are mineralized. Therefore, the two main products of anaerobic digestion could serve as sources of nutrients for microalgae growth. If the nutrient loop is closed, profitable processes can be achieved. Consequently, biofuels and high-value products would be obtained at the same time from microalgal biomass, reducing environmental impact and increasing profits.

To evaluate, for a consecutive year, the magnitude of unplanned extubation, looking for non-dependent patient variables.Prospective, observational study of cases and controls in a mixed intensive care unit within in a tertiary hospital. Patients were considered cases with more than 24 hours who had an episode of unplanned extubation. Prospective collection of variables case as time of unplanned extubation (collection time), identification of the box where the patient was admitted, presence and type of physical restraint, development of ventilator-associated pneumonia (VAP) and death.There were 17 unplanned extubation in 15 patients, 1.21 unplanned extubation per 100 days of MV. The unplanned extubation had an inhomogeneous spatial distribution (number of boxes). The time distribution of cases compared with controls showed significant differences in time distribution (P=.02). The comparative analysis between cases and controls, showed increased mortality, increased length of ICU stay, longer hospital stay and increased risk for VAP when patients suffer an episode of unplanned extubation.Unplanned extubation occurs most frequently in a given time slot of the day, may play a role in the spatial location of the patient; occurs most often in patients who are in the process of weaning from mechanical ventilation, and develop greater VAP.

Background: The mortality rate from bacteraemia is one of the highest among infections in hospitals, especially in the intensive care unit (ICU). Recently, an increase in nosocomial bacteraemia caused by gram-negative resistant pathogens has been observed. In this work we review the clinical and laboratory findings of adult patients with Acinetobacter bacteraemia in order to identify risk factors associated with mortality. Methods: A retrospective review of the medical records of patients with Acinetobacter bacteraemia identified by blood cultures from the Diagnostic Microbiology Laboratory was conducted between January 1989 and March 1998. Results: We identified 59 cases of Acinetobacter bacteraemia. Most of the infections (71%) were nosocomial; the majority occurred in the Department of Internal Medicine (28.8%), followed by Haematology (27%) and the ICU (23%). A. lwoffii was isolated in 52.5% of cases and A. baumannii in 47.5%. The related mortality was 17%. Staying in the ICU was associated with A. baumannii bacteraemia (P

In closed chest trauma, bronchial rupture is an unusual but potentially serious complication, with an associated mortality rate of 30%. Recent decades have seen an increase in incidence parallel to greater use of transport. Eighty percent of injuries are located 2.5 cm from the carina. Diagnosis is based on clinical signs, imaging and bronchoscopy. Subcutaneous emphysema and respiratory insufficiency are the most common findings. Images show the presence of pneumothorax, pneumomediastinum or both. Bronchoscopy is the diagnostic method of choice and must be performed early. Treatment consists of reestablishing anatomical continuity of the tracheobronchial tree by surgical repair if the lesion affects more than a third of the circumference and/or pneumothorax is not resolved after two chest drainages. This type of injury should be recognized and treated early, both to restore lung function and to prevent associated complications caused by delay. However, initial findings are seldom specific, requiring the physician to display a high degree of suspicion and explaining why diagnosis often comes late.

International audience; Research into the development of renewable and sustainable fuels has been a major concern during last decades. Microalgae, as a potential resource, have gained great attention for energy purposes. In this context, anaerobic digestion seems to be the most direct energy generation process. Nevertheless, the efficiency of this process is hampered due to the hard cell wall of some microalgae. In order to enhance its anaerobic biodegradability, the present research investigated the effect of thermal pretreatment at two temperatures (70 and 90 degrees C) applied to Scenedesmus biomass. No differences were detected in terms of organic matter or ammonium release upon the two tested temperatures. Nevertheless, a different fact was observed for their anaerobic biodegradability. While raw and pretreated at 70 degrees C microalgae attained 22-24% anaerobic biodegradability, microalgae pretreated at 90 degrees C achieved anaerobic biodegradability of 48%. Even though similar profiles were obtained for both temperatures along the pretreatment period, the damage caused in the cell wall at 90 degrees C seemed to be greater and rendered this substrate readily degradable for anaerobic digestion.

The protein family known as synucleins is composed of α-, β- and γ-synuclein. The most widely studied is the α-synuclein protein due to its participation in essential processes of the central nervous system. Neurotoxicity of this protein is related to the presence of multiplications (duplications and triplications) and point mutations in the gene sequence of the α-synuclein gene (SNCA), differential expression of its isoforms and variations in post-transductional modifications. Neurotoxicity is also related to cytoplasmic inclusions known as Lewy bodies (LBs) and Lewy neurites (LNs), which are also present in α-synucleinopathies. In general, the β-synuclein protein, codified by the SNCB gene, acts as a regulator of processes triggered by α-synuclein and its function is altered by variations in the gene sequence, while γ-synuclein, codified by the SNCG gene, seems to play a major role in certain tumoral processes.

Objetivo: Comprobar qué valor tiene la fracción de espacio muerto (Vd/Vt) como predictor del fracaso en la extubación de los enfermos que necesitaron ventilación mecánica (VM) ingresados en las unidades de cuidados intensivos. Diseño: Estudio de cohortes, prospectivo, observacional. Desde el 1 de septiembre de 2010 hasta 1 de marzo de 2011. Ámbito: Unidad de cuidados intensivos generales (UCIG), del complejo hospitalario de tercer nivel Hospital Universitario Marqués de Valdecilla. Pacientes o participantes: Se han incluido en el estudio aquellos enfermos que recibían VM por un espacio de tiempo superior a las 12 horas; y quienes en el proceso de destete seguían un protocolo de presión soporte de bajo nivel. Han sido criterios de exclusión la edad inferior a 18 años, enfermos ventilados a través de traqueotomía y enfermos considerados no colaboradores por diversas causas. Durante el periodo de estudio, ingresaron en UCIG 392 enfermos. De ellos 214 precisaron ventilación mecánica. En 154 se inició proceso de destete. Fueron excluidos del estudio 54 enfermos y no fueron extubados de VM 24. Finalmente 76 enfermos fueron extubados y analizados. Variables de interés principales: Se calculó Vd/Vt como el cociente (PaCO2-ε CO2)/PaCO2; con los parámetros registrados. Resultados: El análisis de regresión logística mostró una asociación significativa entre la variable Vd/Vt y el fracaso en la extubación con una OR de 1,52 (IC 95%: 1,11-2,09; p=0,008). El área bajo la curva ROC, con respecto a predecir el fracaso en la extubación mediante el valor de Vd/Vt fue de 0,94 (IC 95%: 0,86-0,98; p

Objetivo: Analizar la supervivencia a corto (un mes), medio (un año) y largo plazo (cinco años) en todos los pacientes sometidos a un trasplante pulmonar (TP) cuyo donante tuviera al menos 55 años. Pacientes y métodos: Se incluyó a todos los pacientes sometidos a un TP cuyo donante tuviera 55 años o más. Se analizó la asociación de las diferentes variables estudiadas con la mortalidad precoz, anual y al quinto año. Se utilizó la regresión logística en el estudio de factores de riesgo para mortalidad precoz y se utilizó la regresión de riesgos proporcionales de Cox en el estudio de factores de riesgo para la mortalidad al año y al quinto año, introduciendo las variables con un valor de p < 0,2 en el análisis bivariante. Se efectuó un análisis de supervivencia mediante el método de Kaplan-Meier. Resultados: Se analizó un total de 33 pacientes sometidos a un TP con donantes de 55 años o más. La probabilidad de supervivencia fue del 90,9, el 78,5 y el 44,8% al mes, año y cinco años respectivamente. La edad elevada del receptor (p=0,16) y la realización de un trasplante unipulmonar (p=0,09) fueron las variables que se asociaron o mostraron tendencia a la asociación con la mortalidad. Conclusiones: La decisión final en la aceptación de un injerto pulmonar se debe basar en la evaluación individual de cada donante y receptor. Sin embargo, dada la escasez de injertos pulmonares, parece adecuado considerar de inicio para la donación pulmonar a los pacientes de 55 o más años. Objective: We analyzed short, medium and long-term mortality in transplant recipients who received lungs from donors aged 55 years or more. Patients and methods: All patients who underwent lung transplantation from donors aged 55 years or more were included. The association between the different study variables and early death and death at 1 year and 5 years was studied. A logistic regression model was used to study the association between early death and variables with a trend towards significance (P

We analyzed short, medium and long-term mortality in transplant recipients who received lungs from donors aged 55 years or more.All patients who underwent lung transplantation from donors aged 55 years or more were included. The association between the different study variables and early death and death at 1 year and 5 years was studied. A logistic regression model was used to study the association between early death and variables with a trend towards significance (P.2) in the bivariate analysis. The risk factors for mortality at 1 year and 5 years were analyzed with a Cox regression model. The Kaplan-Meier method was used to analyze survival.A total of 33 patients were included. The probability of survival was 90.9%, 78.5% and 44.8% at 1 month, 1 year, and 5 years after lung transplantation, respectively. The elevated age of the recipient (P=.16) and single-lung transplantation (P=.09) were the variables associated to or with a trend towards significant associations with mortality.The final decision to accept a lung graft should be based on individual evaluation of each donor and recipient. However, given the lack of lung donors, donors aged 55 years or more should be considered for lung transplantation.

Journal Article; Research Support, Non-U.S. Gov't; "Comment in: What do we know about iodine supplementation in pregnancy? [J Clin Endocrinol Metab. 2009]" (Nota tomada de PubMed). CONTEXT The association between thyroid function during pregnancy and the later mental and psychomotor development of the child is supported by numerous experimental, clinical, and epidemiological studies. OBJECTIVE The aim of the study was to evaluate the psychological development of infants aged 3 to 18 months whose mothers had received 300 microg of potassium iodide during the first trimester of their pregnancy and compare with infants whose mothers had received no iodine supplements. DESIGN AND STUDY SUBJECTS: The study included 133 women who had received 300 microg of potassium iodine and 61 women who had received no iodine supplements. MAIN OUTCOME MEASURES The neuropsychological status of the children was evaluated with the Bayley Scales of Infant Development, and measurements were made of TSH, free T(3), free T(4), and urinary iodine. RESULTS Those children whose mothers had received an iodine supplement of 300 microg had a more favorable psychometric assessment than those of the other group of mothers. They had higher scores on the Psychomotor Development Index (P = 0.02) and the Behavior Rating Scale. CONCLUSIONS Dietary iodine supplements not only have no harmful effect on the neurodevelopment of the children, they may even be beneficial. Given the possible presence of confounding variables not controlled for in this study, these findings should be considered as preliminary. Yes 2010-09

Traumatic internal carotid artery dissection secondary to blunt trauma is a rare event accounting for 0.08 to 0.4% of all traumatic lesions. The spectrum of traumatic lesions that can affect the internal carotid artery includes minor lesions like spasm, intimal tears, or mural contusions and serious lesions like pseudoaneurysms and complete occlusion. Delayed clinical presentation is typical and can include headache, hemiparesis, partial Horner's syndrome, and cranial nerve palsy. Embolization secondary to the dissection can have devastating effects because it may cause ischemic stroke. Traumatic internal carotid artery dissection after safety belt trauma is very rare; it is usually due to direct cervical trauma on the side of the shoulder fixation point, which causes external bruising along the pathway of the safety belt. We present two cases of traumatic internal carotid artery dissection with concomitant cerebral infarcts caused by safety belts; we discuss the clinical, diagnostic, and therapeutic aspects of this lesion.

Intracranial subdural empyema (ISE) is an infrequent infectious disorder of diverse etiology and difficult to diagnose because of its non-specific clinical features.Retrospective study of patients diagnosed of ISE in a third-level university hospital in a 15-year period.Five men were included (mean age: 39.3 years). The most frequent primary source of infection was otic and sinusal (60%). The initial clinical manifestations were fever, headache, alteration of consciousness, and neurological focal symptoms. The mean time elapsed between onset of symptoms and diagnosis was 3.6 days. Diagnosis was performed by computed tomography in all patients. ISE was localized in the left hemisphere in 60% of cases mainly affecting the parietal lobe (80%). Anaerobic and streptococci germs were the most frequently isolated microorganisms. Therapy was based on antibiotics and surgical drainage in 100% of the cases. The surgical procedure used in the evacuation of empyema was craniotomy in all the patients. The mean time elapsed between diagnosis and surgery was 8.4 days. The mean Intensive Care Unit stay was 12.8 days, whereas the overall mean in-hospital stay was 45.2 days. Mortality was 40%.ISE, although infrequent, displays a high morbimortality that can be reduced with an early therapeutic approach which may include the surgical evacuation in all the cases.

To make an independent evaluation of the capacity for exercise as a predictive factor in lung transplant recipients.Retrospective study.Lung transplant unit of the Intensive Care Unit (ICU) of a university hospital.We analyzed 132 lung transplants in a total of 130 patients. The patients were monitorized up to June 18, 2005 or their death.An evaluation was made of their pre-operative exercise capacity with the 6-minute walking test (6MWT). Long-term survival in relationship with the walking test value was also assessed. The survival curves were estimated using the Kaplan-Meier method. Comparison between curves was made with the Log-Rank methods and the hazard ratios were estimated by Cox regression.The association between mortality and the walking test value showed a hazard ratio of 0.99 (95% CI: 0.99-1.00) per metric unit (meter), (p = 0.282). The patients were classified according to the distance covered in the 4 groups: group 1 (distance covered less than 100 meters), group II (distance covered between 101-200 meters), group III (distance covered between 201 and 300 meters) and group IV (distance greater than 301 meters). No significant differences were found when comparing the survival curves of the four groups (p = 0.709). The multivariant analysis also did not show any statistical significance.We do not believe that the distance covered in the 6MWT conducted in the study protocol in the lung transplant candidates is useful as a marker to predict long-term mortality in patients undergoing lung transplant.

Clinical simulation is suggested as a new educational instrument to learn and train in different medical skills. It is conceived as a new method that integrates scientific knowledge and human factors. Experience with these systems has been limited up to now, but it is now being widely accepted since it seems to accelerate acquisition of skills and knowledge in a safe setting, that is, without risk for the patient. However, its effect on clinical performance has not been validated yet. They are two types of simulators for intensive cares: screen based and human patient simulator (HPS). These systems make it possible to simulate different situations that require the application of action protocols or the management of new drugs in the clinical practice, promoting the rational use of resources in urgent care of the critical and multiple-injured patients. The limiting factors that prevent the expansion of the simulation for clinical training are its high cost, human resources needed, and the difficulties to assess the effectiveness of the training in real situations.

La simulación clínica está surgiendo como un nuevo instrumento educativo para aprender y entrenar diferentes habilidades médicas. Está concebida como un novedoso método que integra conocimiento científico y factores humanos. La experiencia con estos sistemas es hasta ahora limitada, pero está siendo ampliamente aceptada, ya que parece acelerar la adquisición de habilidades y conocimientos en un ambiente seguro, es decir, sin riesgo para el paciente; si bien su efecto en el rendimiento clínico aún no ha sido validado. Hay dos tipos de simuladores para cuidados intensivos: de pantalla y simuladores de paciente a escala real (SER). Estos sistemas permiten simular distintas situaciones que requieren la aplicación de protocolos de actuación o el manejo de nuevos fármacos en la práctica clínica, fomentando el uso racional de recursos en la asistencia urgente del paciente crítico y politraumatizado. Los factores limitantes que impiden la expansión de la simulación para el entrenamiento clínico son su alto coste, los recursos humanos necesarios y las dificultades para valorar la efectividad del entrenamiento en situaciones reales. Clinical simulation is suggested as a new educational instrument to learn and train in different medical skills. It is conceived as a new method that integrates scientific knowledge and human factors. Experience with these systems has been limited up to now, but it is now being widely accepted since it seems to accelerate acquisition of skills and knowledge in a safe setting, that is, without risk for the patient. However, its effect on clinical performance has not been validated yet. They are two types of simulators for intensive cares: screen based and human patient simulator (HPS). These systems make it possible to simulate different situations that require the application of action protocols or the management of new drugs in the clinical practice, promoting the rational use of resources in urgent care of the critical and multiple-injured patients. The limiting factors that prevent the expansion of the simulation for clinical training are its high cost, human resources needed, and the difficulties to assess the effectiveness of the training in real situations.

Background The use of dexmedetomidine (dex) in Spanish intensive care units (ICU) patients is still unusual. Purpose To describe the use of dex as a sedative agent and asses the adherence to the 2013-SEMICYUC guideline recommendations, in a 20-bed Spanish ICU. Material and methods Retrospective six-month study (10/13–03/14) of patients treated with dex for sedation. The variables analysed were: indication for and duration of dex use, starting-maximum-maintenance doses, time to reach maintenance dose, co-administration of other sedatives, proportion of time in target sedation range (defined as a RASS score between −3 and 0) before and after dex initiation, duration of mechanical ventilation, % of patients with adverse events (AE) and causes of dex discontinuation. Results 14 patients were included. Dex indications were: to facilitate weaning (8; 57%), patient-ventilator synchrony (5; 36%), or to reduce other sedatives (1; 7%). The mean length of the treatment was 4.1 days (0.2–14.5). The mean starting/maximum/maintenance doses were 0.36 ± 0.15/0.91 ± 0.34/0.87 ± 0.33 µg/kg/h. The starting dose was 51% lower than the recommended (0.7 µg/kg/h) and it took over 53 h (3–192) to reach the maintenance dose. All patients received other sedatives prior to dex, and in 6 (43%) those sedatives could be discontinued. No patients were in the target sedation range >50% of the time prior to dex, 8 (57%) reached this status after dex. The mean duration of mechanical ventilation was 17.1 ± 13 days. All patients suffered several AE (28 AE recorded). Hypotension (8; 57%) and bradycardia (6; 43%) were the most common. The causes of dex discontinuation were extubation (8; 57%), death (2; 14%), lack of efficacy (2; 14%) and AE (2; 14%, extreme bradycardia). Conclusion All the dex indications met the SEMICYUC guidelines. It seems to be useful to reach the sedation range and facilitate successful weaning. The high rate of predictable AE and the need for dosage optimisation make dex a target drug for pharmaceutical monitoring. References and/or Acknowledgements No conflict of interest.

Objetivo: Estudiar la presentación clínica, diagnóstico, tratamiento y pronóstico de la encefalitis herpética en nuestro medio. Material y método: Estudio retrospectivo de los pacientes mayores de 15 años que ingresaron en nuestro hospital por encefalitis herpética en los últimos 12 años. Resultados: Se incluyeron 23 pacientes, 14 varones y 9 mujeres. La edad media era de 52,30 ± 18,64 años (rango 18-84). La estancia media en el hospital fue de 26,74 ± 15,41 días (rango 5-64). Ingresaron en UCI 11 pacientes, requiriendo 9 ventilación mecánica. Los hallazgos clínicos más habituales fueron la alteración del nivel de conciencia y la fiebre. La pleocitosis linfocitaria fue el hallazgo más frecuente en el líquido cefalorraquídeo. Se encontraron lesiones temporales por tomografía en 14 enfermos (61%). Fallecieron 4 pacientes, quedando asintomáticos o con mínimas secuelas 7 y 12 desarrollaron secuelas incapacitantes. Conclusiones: La encefalitis herpética es una enfermedad poco frecuente. El tratamiento de elección es el aciclovir endovenoso y el uso de corticoides es controvertido. El retraso en el inicio del tratamiento empeora el pronóstico. Menos de un tercio de los pacientes consiguen la independencia funcional al alta.

Some patients (20–30%) with spondyloarthropathies (SpA) have a persistent and disabling disease,1 for which a limited number of alternative therapeutic approaches exist.2 The successful results from randomised, double blind, placebo controlled trials in ankylosing spondylitis (AS) and SpA which have been published 3–5 suggest that treatment with infliximab is highly effective. However, in most of these studies, criteria for the selection of patients are based on active disease, but not on refractory disease (failure of response to previous drugs, including non-steroidal anti-inflammatory drugs (NSAIDs) and disease modifying antirheumatic drugs). Therefore, we aimed at assessing the effectiveness and safety of infliximab in patients with active and refractory SpA. The study was an open label, multicentre, 38 week prospective study in 40 patients with active and refractory SpA: 34 patients had AS, 3 had arthritis with related inflammatory bowel disease, and 3 undifferentiated SpA. Infliximab (5 mg/kg) was given at weeks 0, …

Catheterization of central veins is a routine process, especially in severely-ill patients. It is a technique associated with multiple potential complications, fortunately infrequent, depending on the skill with which it is performed. Cardiac blockade is one of these infrequent complications with a high mortality. We describe a case in which suspicion, early diagnosis, and immediate manipulative treatment allowed a successful recovery of the patient. In addition, the literature is reviewed and possible mechanisms involved in these episodes are discussed.

Objectives: During the past 10 years, 30 adults (age > 15 years) were treated for varicella pneumonia in our centre. Methods: There were 16 males and 14 females. Ages ranged from 15 to 58 years (mean, 32.73±7.67 years). Twenty-seven patients (90%) were nonpregnant adult smokers and three patients (10%) were pregnant women. The hospital stay ranged from 4 to 57 days (mean, 14.96±12.02 days). Results: Seven patients (23.3%) were managed in the intensive care unit and two patients (6,6%) required mechanical ventilation. The most common radiographic findings were interstitial infiltrates in twenty-one patients (70%) and interstitial-alveolar infiltrates in seven patients (23.3%). Physical examination of the chest did not reveal abnormalities in twenty patients (66,6%). Fifteen patients (50%) were severely hipoxic with pO2/FiO2 ratio less than 300. Twelve patients (40%) presented thrombocytopenia and fifteen (50%) presented hyponatremia. The most frequent clinical features included: fever (100%), dry cough (86.6%), dysnea (66.6%) and chest pain (50%). One patient (3.3%) died. Three patients (10%) developed asthma and one other patient developed pulmonary fibrosis. Conclusions: Smoking is associated with an increase incidence of varicella pneumonia in adults. A chest x-ray should be practised in all cases of varicella in adults and they all should also be admitted to hospital. Intravenous aciclovir is recommended for treatment of varicella pneumonia in adults and in seriously ill patients the association of corticosteroids should be considered.

In closed chest trauma, bronchial rupture is an unusual but potentially serious complication, with an associated mortality rate of 30%. Recent decades have seen an increase in incidence parallel to greater use of transport. Eighty percent of injuries are located 2.5 cm from the carina. Diagnosis is based on clinical signs, imaging and bronchoscopy. Subcutaneous emphysema and respiratory insufficiency are the most common findings. Images show the presence of pneumothorax, pneumomediastinum or both. Bronchoscopy is the diagnostic method of choice and must be performed early. Treatment consists of reestablishing anatomical continuity of the tracheobronchial tree by surgical repair if the lesion affects more than a third of the circumference and/or pneumothorax is not resolved after two chest drainages. This type of injury should be recognized and treated early, both to restore lung function and to prevent associated complications caused by delay. However, initial findings are seldom specific, requiring the physician to display a high degree of suspicion and explaining why diagnosis often comes late.

Diagnostic techniques for stellar magnetic fields based upon spectropolarimetry. We propose and explore a new technique based upon the linear polarization emitted in Hanle-sensitive lines in disk-integrated stars where a dipolar magnetic field breaks the rotational symmetry of the resonance scattering polarization. A star with a simple dipolar field and a 1-0 spectral line are used to compute polarization amplitudes and angles.Predicted amplitudes are low but within reach of present instruments. A new application of the Hanle effect is proposed and analyzed, a tool that allows measuring of some of the weakest stellar magnetic fields., Comment: 6 pages, 3 figures. Accepted for publication in A&A