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BackgroundTridimensional medical knowledge of human anatomy is a key step in the undergraduate and postgraduate medical education, especially in surgical fields. Training simulation before real surgical procedures is necessary to develop clinical competences and to minimize surgical complications.MethodsLatex injection of vascular system in brain and in head-neck segment is made after washing out of the vascular system and fixation of the specimen before and after latex injection.ResultsUsing this latex injection technique, the vascular system of 90% of brains and 80% of head-neck segments are well-perfused. Latex-injected vessels maintain real appearance compared to silicone, and more flexible vessels compared to resins. Besides, latex makes possible a better perfusion of small vessels.ConclusionsLatex vascular injection technique of the brain and head-neck segment is a simulation model for neurosurgical training based on real experiencing to improve surgical skills and surgical results.

Allergic rhinitis and asthma are two prevailing chronic airway diseases and serious public health concerns. Previous research has already described the role of the airway bacteriome in these two diseases, but almost no study so far has explored the mycobiome and its possible association to airway inflammation. Here we sequenced the internal transcribed spacers (ITS) 1 and 2 to characterize the oral mycobiome of 349 Portuguese children and young adults with allergic rhinitis alone (AR) or with asthma (ARAS), asthmatics (AS) and healthy controls (HC). Our genomic analyses showed that the two most abundant fungal phyla (Ascomycota and Basidiomycota) and 3–5 of the 14 most abundant fungal genera (Cladosporium, Aspergillus, Aleurina, Candida and Rhodotorula) in the mouth differed significantly (P ≤ 0.04) between both rhinitic groups and HC. However, none of the same taxa varied significantly between the three respiratory disease groups (AR, ARAS and AS). The oral mycobiomes of respiratory ill patients showed the highest intra-group diversity (microbial richness and evenness), while HC showed the lowest, with all alpha-diversity indices varying significantly (P ≤ 0.0424) between them. Similarly, all disease groups showed significant differences (P ≤ 0.0052) in microbial structure (i.e., beta-diversity indices) when compared to HC samples. Thirty metabolic pathways (PICRUSt2) were differentially abundant (Wald's test) between AR or ARAS and HC patients, but only one of them (D-galactose degradation I) was over abundant (log2 Fold Change >0.75) in the ARAS group. Spiec-Easi fungal networks varied greatly among groups, which suggests chronic respiratory allergic diseases may alter fungal connectivity in the mouth. This study increases our comprehension of the role of the oral mycobiome in allergy-related conditions. It shows for the first time that the oral mycobiota changes during health and allergic rhinitis (with and without asthma comorbidity) and highlights specific taxa, metabolic pathways and fungal interactions that may relate to chronic airway disease.

Resumen: Introducción y objetivos: La reparación valvular mitral es la técnica quirúrgica de elección en el tratamiento de la insuficiencia mitral degenerativa. El objetivo del presente estudio es evaluar los resultados a muy largo plazo de la reparación valvular mitral por prolapso de velo posterior en nuestro centro. Métodos: Estudio retrospectivo de todos los pacientes consecutivos con insuficiencia mitral severa degenerativa por prolapso de velo posterior operados en nuestro centro (2001-2021). Se recogieron las técnicas y los resultados quirúrgicos y el seguimiento clínico y ecocardiográfico. Resultados: Se intervinieron 260 pacientes (edad media 65,3 ± 12,4 años, hombres 67,7%). Se utilizaron exclusivamente técnicas resectivas en 185 pacientes (71,2%), neocuerdas en 53 (20,4%) y otras técnicas en 15 (5,8%). La tasa de reparabilidad fue del 97,3%. En 45 pacientes (17,3%) se realizó una anuloplastia tricuspídea. La mortalidad hospitalaria fue del 1,5%. El seguimiento medio fue de 6,6 ± 5 años (0-20). La tasa libre de mortalidad fue del 51,3% a los 20 años, con una edad media de los pacientes en el momento de la muerte de 82,1 ± 7,2 años. Las tasas libres de recidiva de insuficiencia mitral grado ≥ II y reintervención de la insuficiencia mitral fueron, respectivamente, del 59,2% y del 97,7% a los 20 años. Se observaron menores tasas libres de recidiva de insuficiencia mitral ≥ II y reintervención de la insuficiencia mitral en la reparación con neocuerdas respecto a las técnicas resectivas (p = 0,001 y p = 0,002, respectivamente). Conclusiones: Los resultados a largo plazo de la reparación mitral del prolapso de velo posterior en nuestro centro han sido excelentes. Las técnicas resectivas parecen relacionarse con una mayor durabilidad a largo plazo. Abstract: Introduction and objectives: Mitral valve repair is the gold standard treatment of degenerative mitral regurgitation. The objective of this study is to evaluate the very long-term results of mitral valve repair for posterior leaflet prolapse in our center. Methods: Retrospective study of all consecutive patients with severe degenerative mitral regurgitation due to posterior leaflet prolapse operated in our center (2001-2021). Surgical techniques and results, and clinical and echocardiographic follow-up were recorded. Results: A total of 260 patients were operated (mean age 65.3 ± 12.4 years, men 67.7%). Isolated resection techniques were used in 185 patients (71.2%), neochords in 53 (20.4%) and other techniques in 15 (5.8%). Successful repair rate was 97.3%. Tricuspid annuloplasty was performed in 45 patients (17.3%). Hospital mortality was 1.5%. The mean follow-up was 6.6 ± 5 years (0-20). Actuarial survival was 51.3% at 20 years, with a mean age of the patients at the time of death of 82.1 ± 7.2 years. The freedom of recurrent grade ≥ II mitral regurgitation and reoperation at 20 years were 59.2% and 97.7% respectively. Worse freedom of recurrent mitral regurgitation and reoperation were observed in the neochord repair compared to resection techniques (P = .001 and P = .002, respectively). Conclusions: Long-term results of mitral valve repair of posterior leaflet prolapse in our center have been excellent. Resective techniques seem to be related with greater long-term durability than neochord implantation.

Resumen: Introducción: La reparación de la insuficiencia mitral por prolapso del velo posterior ha evolucionado en los últimos 20 años desde las técnicas clásicas de Carpentier hacia procedimientos menos agresivos con el tejido valvular. Nuestro objetivo es describir la evolución del tratamiento de esta patología en nuestro centro. Métodos: Estudio retrospectivo de pacientes con prolapso de velo posterior operados en nuestro centro desde 2001 a 2021. Recogida de datos intraoperatorios y datos ecocardiográficos y de seguimiento durante 20 años. Resultados: Se incluyeron 260 pacientes operados en dos períodos: hasta 2010, 84 pacientes (grupo A) y desde 2011, 176 pacientes (grupo B). Las técnicas más utilizadas en el grupo A fueron la resección cuadrangular (51 pacientes, 60,7%), la triangular (20 pacientes, 23,8%) y la implantación de neocuerdas (8 pacientes, 9,5%) siendo la tasa de reparabilidad del 98,8%, y en el grupo B fueron la resección triangular (86 pacientes, 48,9%), la implantación de neocuerdas (45 pacientes, 25,6%) y la resección cuadrangular (28 pacientes, 15,9%) con una reparabilidad del 96,6%. La mortalidad hospitalaria fue del 3,6% (n = 3) en el grupo A y del 0,6% (n = 1) en el B. Supervivencia actuarial 50% a los 20 años (A) y 81% a los 10 años (B). Tasa libre de reintervención del 98% (A) y del 97,2% (B). Teniendo en cuenta las técnicas más frecuentemente utilizadas, la recidiva de insuficiencia mitral ≥ II fue mayor en los pacientes con neocuerdas (n = 14, 26,4%) que en los casos de resección cuadrangular (n = 10, 13,2%) o triangular (n = 13, 12,4%). Conclusiones: Nuestro centro ha evolucionado hacia técnicas con menor resección tisular y mayor utilización de neocuerdas, aunque ambas técnicas han mostrado excelentes resultados a largo plazo. Las técnicas resectivas son más reproducibles y duraderas que la implantación de neocuerdas. Abstract: Introduction: Repair of mitral regurgitation due to posterior leaflet prolapse has evolved in the last 20 years from the classic Carpentier techniques towards less aggressive procedures with the valve tissue. The objective of this study is to describe the evolution of our center in the treatment of this pathology. Methods: Retrospective study of 260 patients with posterior leaflet prolapse operated on our center since 2001, including them into two groups: A (until 2010) and B (since 2011). We collected intraoperative data and echocardiographic and follow-up data for 20 years. Results: 260 patients operated on in two periods were included: until 2010, 84 patients (group A) and since 2011, 176 patients (group B). The most commonly used techniques in group A were quadrangular resection (51 patients, 60.7%), triangular resection (20 patients, 23.8%), and neochordal implantation (8 patients, 9.5%), with a reparability rate of 98.8% and in group B, triangular resection (86 patients, 48.9%), neochordal implantation (45 patients, 25.6%) and quadrangular resection (28 patients, 15.9%) with a reparability rate of 96.6%. Hospital mortality was 3.6% (n = 3) in group A and 0.6% (n = 1) in group B. Actuarial survival was 50% at 20 years (A) and 81% at 10 years (B). Reoperation-free rate was 98% (A) and 97.2% (B). Taking into account the most frequently used techniques, the recurrence of mitral regurgitation ≥ II was greater in patients with neochordae (n = 14, 26.4%) than in cases with quadrangular (n = 10, 13.2%) or triangular resection (n = 13, 12.4%). Conclusions: Our center has evolved towards techniques with less tissue resection and greater use of neochordae although both techniques have showed excellent long-term results. Resective techniques are more reproducible and durable than neochordal implantation.

Background: The trunk of the basilar artery has not been included in microanatomy studies. Anatomical variants of the perforant branches of the vertebrobasilar trunk and their relationship with neural structures are very important in surgical approaches. Surgical dissection for the treatment of vascular lesions requires a perfect knowledge of the microsurgical anatomy. Methods: We conducted a descriptive analysis of 50 brains, which were fixed with formalin at 10% for 2 weeks, and the arterial system was injected with colored latex. After microsurgical dissection, it was divided into three segments: the lower portion went from the anterior spinal artery to the anteroinferior cerebellar artery, the middle segment was raised from the upper limit of the lower portion to the origin of the superior cerebellar artery, and the upper segment ranged from the previous portion until the origin of the posterior cerebral artery. Results: The basilar artery had an average length of 30 mm. The average diameter at its junction with the vertebral arteries was 4.05 mm. The average middle segment was 3.4 mm in diameter and 15.2 mm in length. The diameter of the upper segment was 4.2 mm, and its average length was 3.6 mm. The average number of bulbar arteries was three, and their average diameter was 0. 66 mm. The number of caudal perforator arteries were five on average, with a diameter of 0.32 mm. We found three rare cases of anatomical variants in the vertebra–basilar junction. Conclusions: The basilar artery emits penetrating branches in its lower, middle, and upper portions. The origin of penetrating branches was single or divided after forming a trunk. However, we observed long branches from perforant arteries.

Objetivo. Evaluar los cursos de Física General (teoría y laboratorio) de la carrera de Enseñanza de las Ciencias a través del personal docente universitario, en el periodo comprendido entre el 2014 al 2019, con el fin de identificar las fortalezas y debilidades en la metodología y replantear nuevas estrategias educativas. Metodología. La investigación mixta (cuantitativa y cualitativa) se realizó mediante una encuesta virtual con el programa LimeSurvey al profesorado que ha impartido los cursos de Física para la carrera de Enseñanza de las Ciencias en los últimos cinco años. Esta se aplicó a la población total de 20 docentes de la cual solo 12 participaron. El instrumento fue diseñado por el personal docente que trabaja en el proyecto de mejoramiento de las guías de laboratorio y su análisis se realizó con la ayuda de una hoja de cálculo de Excel, suministrada por el programa LimeSurvey. El instrumento se validó por personal del IDESPO de la Universidad Nacional en cuanto a la pertinencia del contenido de los enunciados, la claridad de las preguntas y la coherencia con el objetivo de este estudio. Resultados. La estructura y organización de los cursos de Física General tiene una valoración positiva por parte del profesorado, que también mostró una preferencia por la clase magistral; pero, aun así, mostró disposición a capacitarse y aprender nuevas estrategias didácticas. Conclusiones. Además, se determinó que el personal docente está anuente al cambio tecnológico y a trabajar en los retos que han propuesto las políticas del gobierno.

Antecedentes: Si bien el seno cavernoso (SC) ha sido estudiado desde 1695, su anatomía y nombre aún están bajo discusión. Métodos: Se estudiaron la anatomía y la histología de 40 SC de cadáveres humanos, incluyendo los dos de un recién nacido. Resultados: El SC está limitado por dos paredes, una inferomedial compuesta solo por la capa más externa de la duramadre y otra superolateral compuesta por ambas capas de la duramadre. Hay venas sinusoidales que atraviesan la pared lateral del SC formando una transición entre venas tributarias y el SC. Una capa endotelial recubre la superficie interna del SC y la superficie externa de la arteria carótida interna. El espacio dentro del SC presenta trabéculas, las cuales son escasas en el adulto en comparación con el recién nacido. La pérdida de trabéculas en el SC puede ser un proceso natural a lo largo de la vida. Conclusiones: En conclusión, el SC es un verdadero seno, por lo que el término «seno cavernoso» se aplica de forma correcta.

Las dislipidemias son un conjunto de enfermedades asintomáticas provocadas por concentraciones anormales de lipoproteínas en sangre, siendo importante el control general de lípidos para la prevención de enfermedades, principalmente cardiovascular, obesidad y la resistencia a la insulina, hipertensión. El objetivo del estudio fue caracterizar las dislipidemias en los pacientes adultos, para lo cual se realizó un estudio descriptivo, retrospectivo, observacional, a 229 adultos atendidos en el centro de Salud Portoviejo, Manabí, Ecuador, durante enero de 2017 a diciembre de 2018; se recopilaron datos demográficos, perfil lipídico, comorbilidades y el índice de masa corporal. De la muestra el 57.21% (n=131) correspondió al género femenino y el 42,79% (n=98) al masculino. La edad de mayor prevalencia recayó en los adultos mayores tardíos y los de la fase culminante de la edad adulta intermedia de 23,14% y 22,71%, respectivamente, la prevalencia global de dislipidemia mixta fue de 41%; seguida de hipertrigliceridemia con 31%; y por último de hipercolesterolemia 28%. En cuanto al índice de masa corporal, 31,34% de los pacientes estudiados presentaban obesidad, mientras que el sobrepeso 2 alcanzó 27,51%. En conclusión, este estudio identificó las características en pacientes con dislipidemia siendo más frecuente la forma mixta, en la edad de 55 a 59 años, de estado civil unión libre, procedentes del sector urbano, con instrucción secundaria. La dislipidemia se asocia a comorbilidades como diabetes tipo 2, hipertensión arterial, y de acuerdo al IMC, se presentó en pacientes con grado 1 y 2 de obesidad, al igual que en condiciones de sobrepeso. Dyslipidemias are a group of asymptomatic diseases caused by abnormal concentrations of lipoproteins in the blood, the general control of lipids being important for the prevention of diseases, mainly cardiovascular, obesity and insulin resistance, hypertension. The objective of the study was to characterize dyslipidemias in adult patients, for which a descriptive, retrospective, observational study was carried out on 229 adults treated at the Portoviejo Health Center, Manabí, Ecuador, during January 2017 to December 2018; they were collected demographic data, lipid profile, comorbidities and body mass index. Of the sample, 57.21% (n = 131) corresponded to the female gender and 42.79% (n = 98) to the male. The age with the highest prevalence was 23.14% and 22.71%, respectively, in late older adults and those in the culminating phase of middle adulthood; the overall prevalence of mixed dyslipidemia was 41%; followed by hypertriglyceridemia with 31%; and finally hypercholesterolemia 28%. Regarding the body mass index, 31.34% of the patients studied had obesity, while overweight 2 reached 27.51%. In conclusion, this study identified the characteristics in patients with dyslipidemia, the most frequent being the mixed form, between 55 and 59 years of age, with a free union marital status, from the urban sector, with secondary education. Dyslipidemia is associated with comorbidities such as type 2 diabetes, arterial hypertension, and according to BMI, they occurred in patients with grade 1 and 2 obesity as well as in overweight conditions.

Abstract Background New tetragonal zirconia polycrystal dental implants stabilized with yttria (Y-TZP) have appeared in the implantology market in the form of single piece or two-piece zircona implant system. These new type of implants improve the aesthetical properties compared to conventional commercially pure (c.p.) titanium used for implants, although the long term mechanical behavior of these new implants is not yet well known. In orthopaedics, the application of zirconia as femoral balls presented an important controversial use due to the premature fracture once implanted. Y-TZP dental implants can be affected by hydrothermal degradation and its behavior should be analysed to avoid a premature fracture. The scientific question behind the study is to analyse if the degradation mechanism observed in orthopaedics applications of Y-TZP is similar to that of Y-TZP for dental applications. Materials and methods For this purpose, 30 original Y-TZP dental implants and 42 Y-TZP femoral balls fractured in vivo have been studied. Dental implants were submitted to an accelerated hydrothermal degradation to compare with the femoral balls fractured in vivo. Phase transformation as well as the mechanical behaviour of the degraded samples was studied by X ray diffraction and nanoindentation tests, respectively. Results Results have shown that the fracture mechanism of dental implants does not resemble the mechanism observed in orthopaedic samples, presenting a good long-term behaviour. Conclusion The results ensure the good performance of zirconia dental implants, because the degradation of the ceramic is very limited and does not affect the mechanical properties.

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.

Conectamos investigación y práctica docente con el análisis del diseño de una secuencia que integra la contextualización, indagación, modelización y la evaluación de su efectividad desde las ideas del alumnado que moviliza. La metodología cualitativo-interpretativa utilizada permite analizar la práctica docente y los resultados muestran que la contextualización en un problema cercano (muerte de peces y algas en la playa) genera en los estudiantes diversidad de explicaciones sobre las posibles causas y coherencia en qué pruebas necesitarían para demostrarlas o refutarlas. La búsqueda de pruebas para detectar la auténtica causa de la muerte, en este caso por deshidratación, ofrece conocimiento descriptivo que condiciona sus explicaciones, necesarias para que el modelo de simulación diseñado de ósmosis tenga sentido para el alumnado y les sea de utilidad para transferir a otros contextos.

Amaranth has been of interest for its nutritional quality and its multiple benefits; however, there is little research on its toxicological effect. This work studied antinutritional compounds, the cytotoxic and genotoxic effect in the Amaranthus protein extract (PEAh). The content of lectins, tannins, saponins, and trypsin inhibitors was determined. Biological studies were conducted to determine toxicity in male CD-1 mice by intraperitoneal administration. The genotoxic potential was determined by the micronucleus test. The bone marrow cytotoxicity was determined by polychromatic erythrocyte (PE) rate and the cytotoxic effect was evaluated by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) test. Our results showed considerably high concentrations of lectins and trypsin inhibitors, lower concentrations of tannins and saponins in PEAh. The PEAh was toxic to mice, presenting genotoxic and cytotoxic damage to bone marrow and hepatocytes.

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.

Abstract 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.

Introducción: El Síndrome de Burnout se caracteriza por despersonalización, agotamiento emocional y baja realización personal, tiene lugar en médicos que por su rol se ven expuesto a estrés crónico y la pandemia no ha sido la excepción, países como Rumania, México, Colombia entre otros, han reportado prevalencias altas del síndrome, en comparación al periodo anterior a la pandemia. El presente estudio tuvo como objetivo caracterizar a médicos residentes con Burnout durante la pandemia COVID-19. Métodos: Se realizó estudio descriptivo, observacional y transversal a 40 médicos residentes del Hospital Provincial de Portoviejo, Manabí, Ecuador. Aplicando el MBI-HSS con sus tres dimensiones despersonalización, agotamiento emocional y realización personal. Resultados: Del total de la población se obtuvieron 17 casos con alto agotamiento emocional (42.5%) y despersonalización 19 casos (47.5%): con realización personal baja 18 (45%). De estos, 15 (37.8%) profesionales cumplían los 3 criterios del burnout, en su mayoría mujeres (80%), edad promedio 30,75±2.30, casadas (60%), jornadas semanales ≤ 72 horas (75%), con hijos (91.67%), antigüedad laboral ≤ a 3 años (83.33%) que laboraban en emergencias (75%). Conclusión: Durante el periodo de estudio, se logró caracterizar a la población medica con burnout, en su mayoría mujeres, casadas, con más de un hijo, que laboran 3 días a la semana haciendo guardias en el servicio de emergencias, haciendo necesaria la identificación oportuna de estos casos para abordarlo efectiva e inmediata.

Allergic rhinitis and asthma are major public health concerns and economic burdens worldwide. However, little is known about nasal bacteriome dysbiosis during allergic rhinitis, alone or associated with asthma comorbidity. To address this knowledge gap we applied 16S rRNA high-throughput sequencing to 347 nasal samples from participants with asthma (AS = 12), allergic rhinitis (AR = 53), allergic rhinitis with asthma (ARAS = 183) and healthy controls (CT = 99). One to three of the most abundant phyla, and five to seven of the dominant genera differed significantly (p < 0.021) between AS, AR or ARAS and CT groups. All alpha-diversity indices of microbial richness and evenness changed significantly (p < 0.01) between AR or ARAS and CT, while all beta-diversity indices of microbial structure differed significantly (p < 0.011) between each of the respiratory disease groups and controls. Bacteriomes of rhinitic and healthy participants showed 72 differentially expressed (p < 0.05) metabolic pathways each related mainly to degradation and biosynthesis processes. A network analysis of the AR and ARAS bacteriomes depicted more complex webs of interactions among their members than among those of healthy controls. This study demonstrates that the nose harbors distinct bacteriotas during health and respiratory disease and identifies potential taxonomic and functional biomarkers for diagnostics and therapeutics in asthma and rhinitis.

Given the high prevalence of multiple-choice examinations with formula scoring in medical training, several studies have tried to identify other factors in addition to the degree of knowledge of students which influence their response patterns. This study aims to measure the effect of students' attitude towards risk and ambiguity on their number of correct, wrong, and blank answers. In October 2018, 233 3rd year medical students from the Faculty of Medicine of the University of Porto, in Porto, Portugal, completed a questionnaire which assessed the student's attitudes towards risk and ambiguity, and aversion to ambiguity in medicine. Simple and multiple regression models and the respective regression coefficients were used to measure the association between the students' attitudes, and their answers in two examinations that they had taken in June 2018. Having an intermediate level of ambiguity aversion in medicine (as opposed to a very high or low level) was associated with a significant increase in the number of correct answers and decrease in the number of blank answers in the first examination. In the second examination, high levels of ambiguity aversion in medicine were associated with a decrease in the number of wrong answers. Attitude towards risk, tolerance for ambiguity, and gender did not show significant association with the number of correct, wrong, and blank answers for either examination. Students' ambiguity aversion in medicine is correlated with their performance in multiple-choice examinations with negative marking. Therefore, it is suggested the planning and implementation of counselling sessions with medical students regarding the possible impact of ambiguity aversion on their performance in multiple-choice questions with negative marking.

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

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

Plants of the genus Opuntia spp are widely distributed in Africa, Asia, Australia and America. Specifically, Mexico has the largest number of wild species; mainly O. streptacantha, O. hyptiacantha, O. albicarpa, O. megacantha and O. ficus-indica. The latter being the most cultivated and domesticated species. Its main bioactive compounds include pigments (carotenoids, betalains and betacyanins), vitamins, flavonoids (isorhamnetin, kaempferol, quercetin) and phenolic compounds. Together, they favor the different plant parts and are considered phytochemically important and associated with control, progression and prevention of some chronic and infectious diseases. Part 1 collected information on its preventive actions against atherosclerotic cardiovascular diseases, diabetes and obesity, hepatoprotection, effects on human infertility and chemopreventive capacity. Now, this second review (Part 2), compiles the data from published research (in vitro, in vivo, and clinical studies) on its neuroprotective, anti-inflammatory, antiulcerative, antimicrobial, antiviral potential and in the treatment of skin wounds. The aim of both reviews is to provide scientific evidences of its beneficial properties and to encourage health professionals and researchers to expand studies on the pharmacological and therapeutic effects of Opuntia spp.

The mobility of the human body depends on, among other things, muscle health, which can be affected by several situations, such as aging, increased oxidative stress, malnutrition, cancer, and the lack or excess of physical exercise, among others. Genetic, metabolic, hormonal, and nutritional factors are intricately involved in maintaining the balance that allows proper muscle function and fiber recovery; therefore, the breakdown of the balance among these elements can trigger muscle atrophy. The study from the nutrigenomic perspective of nutritional factors has drawn wide attention recently; one of these is the use of certain compounds derived from foods and plants known as phytochemicals, to which various biological activities have been described and attributed in terms of benefiting health in many respects. This work addresses the effect that the phytochemicals curcumin from Curcuma longa Linn and sulforaphane from Brassicaceae species have shown to exert on muscle function, recovery, and the prevention of muscle atrophy, and describes the impact on muscle health in general. In the same manner, there are future perspectives in research on novel compounds as potential agents in the prevention or treatment of medical conditions that affect muscle health.

El síndrome de Wallenberg, o síndrome bulbar lateral, es la manifestación clínica del infarto en el territorio de irrigación de la arteria cerebelosa posteroinferior. Su presentación incluye vértigo, nistagmo, diplopía, síndrome de Horner, rubicundez y anhidrosis facial homolateral, disfonía, disfagia, disartria, pérdida homolateral del reflejo nauseoso, ataxia homolateral, disgeusia homolateral, dolor y parestesia faciales homolaterales, pérdida o disminución homolateral del reflejo corneal, hipoalgesia y termoanestesia de tronco y extremidades contralaterales, hipoalgesia y termoanestesia facial homolateral. El conocimiento neuroanatómico es imprescindible para su comprensión, estudio y diagnóstico, ya que sus manifestaciones neurológicas clásicas son fácilmente explicables y entendibles si se conocen la función y la localización de las estructuras anatómicas afectadas, así como la irrigación cerebral posterior.

The damage caused by chronic alcohol consumption is frequently reported, but the effects caused by weekend recreational consumption, which is much more frequent than even daily consumption, have not, to our knowledge, been reported. The metabolism of ethanol, once consumed, starts from the mouth, and the biotransformation process follows different routes. In this study, the effect of weekend alcohol consumption on the oral cavity was observed. Methods: Thirty male and female rats were divided into six groups (n = 5), with control groups (male/female) and groups administered with 5% and 40% ethanol solution ad libitum consumption 2 days a week for 3 months. After treatment, the animals were sacrificed, an incisional slice of the cheek and back of the tongue was obtained, and the tissues were processed according to the histological technique and routine staining (hematoxylin-eosin, H&E). Samples were observed using light microscopy. Results: Histological changes were observed in samples of tongue and cheek mucosa including different levels of keratinization of the surface layer. Epithelial dysplasia, acanthosis, and chronic inflammation were also observed. The vascularization level also increased because of the ethanol-induced damage. The results were very similar between female and male groups. Conclusion: Weekend alcohol consumption for a period of 3 months causes oral-cavity tissue alterations that could contribute to tumor growth and the development of cancer in the oral cavity.

Opuntia spp. is a diverse and widely distributed genus in Africa, Asia, Australia, and America. Mexico has the largest number of wild species; mainly O. streptacantha, O. hyptiacantha, O. albicarpa, O. megacantha and O. ficus-indica. The latter being the most cultivated and domesticated species. Throughout history, plants and their phytochemicals have played an important role in health care and Opuntia spp. has shown a high nutritional, medicinal, pharmaceutical, and economic impacts. Its main bioactive compounds include pigments (carotenoids, betalains and betacyanins), vitamins, flavonoids (isorhamnetin, kaempferol, quercetin) and phenolic compounds. Together, they favor the different plant parts and are considered phytochemically important and associated with control, progression and prevention of some chronic and infectious diseases. This first review (Part 1), compiles information from published research (in vitro, in vivo, and clinical studies) on its preventive effects against atherosclerotic cardiovascular diseases, diabetes and obesity, hepatoprotection, effects on human infertility and chemopreventive and/or antigenotoxic capacity. The aim is to provide scientific evidences of its beneficial properties and to encourage health professionals and researchers to expand studies on the pharmacological and therapeutic effects of Opuntia spp.

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.

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.

Introducción y objetivos: El grupo de Trabajo de en Reparación Valvular de la Sociedad Española de Cirugía Torácica y Cardiovascular presenta el quinto registro anual de actividad en cirugía reparadora de la válvulas mitral, aórtica y tricúspide realizada en España en el año 2015. Material y métodos: La recogida de datos se realizó a través de cuestionario on-line, de forma retrospectiva, voluntaria, anónima y no auditada. Se detallan parámetros en cuanto al tipo de cirugía, etiología, mortalidad y riesgo quirúrgico, tanto en el grupo global con en pacientes electivos. Resultados: Se obtuvieron datos de 31 centros, con 9.112 intervenciones reportadas. La cirugía mitral reparadora supone el 29,6% de las válvulas mitrales intervenidas, con una amplia diferencia relativa a la etiología del proceso, así como muy diferente perfil de riesgo. La tasa de cirugía reparadora aórtica continua en ascenso respecto a la sustitución valvular, aunque con gran variación intergrupos. La cirugía valvular tricúspide es mayoritariamente reparadora con uso de anillos con un número estable en el tiempo de reemplazos valvulares. Conclusiones: La actividad reparadora mitral está establecida en la mayoría de los grupos, siendo muy dependiente de etiología. Se observa un incremento en la tasa de reparación valvular aórtica y permanece estabilizada la actividad sobre la válvula tricúspide.

Objetivo: La introducción de las nuevas prótesis aórticas sin sutura ha supuesto una alternativa para el tratamiento quirúrgico de la estenosis aórtica severa. Presentamos la experiencia de nuestro grupo tras el inicio de un programa con prótesis Perceval S (Livanova, Saluggia, Italia). Pacientes y métodos: Entre marzo de 2012 y octubre de 2016 se implantó la prótesis Perceval S en 262 pacientes (edad media: 77,97 ± 6,12 años; 56,49% de mujeres). En 176 casos (67,18%) se realizó sustitución valvular aórtica aislada, con miniesternotomía en un 36,9%. El seguimiento clínico y ecocardiográfico se realizó 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 neurológicas en 2 pacientes (0,94%), y fuga periprotésica 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 prótesis sin sutura Perceval S ha permitido intervenir a pacientes de alto riesgo con buenos resultados y baja morbilidad. La prótesis ha demostrado ser muy versátil, tener un excelente comportamiento hemodinámico y favorecer la cirugía de mínimo acceso.

Introducción y objetivos: El empleo de doble mamaria se ha asociado con un aumento de complicaciones esternales, especialmente en pacientes diabéticos y obesos. El objetivo de este trabajo es revisar los factores de riesgo de aquellos pacientes en los que se ha usado doble mamaria y la tasa de complicación esternal en este grupo. Métodos: De nuestra base de datos se ha seleccionado a 526 pacientes revascularizados quirúrgicamente con uso de doble arteria mamaria. La edad media de los pacientes fue de 59 años, con un EuroScore logístico-1 medio de 2,7%. Resultados: Presentaron dehiscencia esternal 3 pacientes (0,57%), no se correlacionó con ningún factor de riesgo. Problemas de herida tanto superficial como profunda 31 pacientes (5.9%), (2 mediastinitis-0.38%). Con respecto a los pacientes que presentaron infección superficial de la herida quirúrgica (29 pacientes, 5,513%), se obtuvo mayor incidencia en mujeres, pacientes con insuficiencia renal y aquellos a los que se les realizó transfusión de concentrado de hematíes en quirófano, Siendo estas diferencias estadísticamente significativas (p

Legislative initiatives regarding universal accessibility promote the elimination of architectural barriers. This is a positive measure as it aims to ensure equal rights and opportunities for disabled people, in accordance with the Convention on the Rights of Persons with Disabilities (United Nations, 2006). One of the challenges facing society today is the determination of reasonable accommodation, a concept that encompasses those necessary modifications and adjustments which do not impose a disproportionate burden. For this purpose, technical, economic and social aspects shall be taken into consideration, as required by legislation. This paper proposes reasonable accommodation in residential buildings, taking into account the different options for its attainment, by applying a multi-criteria analysis based on a wide range of objective indicators of three types: technical, social and economic. This proposal was one of the objectives of the R + D + i Project called “VIVable-From accessible housing to sustainable housing: The essence of reasonable accommodation”. From VIVable, the fuzzy multi-criteria assessment method for determining reasonable accommodation may be totally extrapolated to other uses. At the same time, the proposed method may also be extrapolated to other countries where basic requirements for universal accessibility in buildings and equal rights of persons with disabilities are standardized. First published online 20 March 2019

Resumen La atribución de una potestad sancionadora eficaz es una de las características que han de poseer los órganos que ejercen una función de control económico-financiero de los partidos políticos. El Tribunal de Cuentas español posee esta potestad, aunque ha de reforzarse todavía más. En el trabajo se examina el régimen jurídico sancionador en el ámbito de la financiación ordinaria de los partidos políticos y de la financiación electoral, tras las reformas de la Ley de Financiación de los Partidos Políticos y de la Ley Electoral en 2012 y 2015. Abstract The attribution of an effective disciplinary powers is one of the characteristics to possess the bodies exercising a function of economic and financial control of political parties. The Spanish Court of Auditors has this power, but must be further strengthened. At work the disciplinary legal regime in the field of regular funding of political parties and electoral funding, after the reforms of the Law on Financing of Political Parties and the Electoral Law in 2012 and 2015 is examined.

Introducción y objetivos: El Grupo de Trabajo en Reparación Valvular de la Sociedad Española de Cirugía Torácica y Cardiovascular presenta el cuarto Registro anual de actividad en cirugía reparadora de las válvulas mitral, aórtica y tricúspide realizada en España durante el año 2014. Material y métodos: La recogida de datos se realizó mediante cuestionario on-line, de forma retrospectiva, voluntaria, anónima y no auditada. Se detalla la actividad reparadora y de recambio valvular por grupos. En el grupo mitral se clasificaron las intervenciones de acuerdo con su etiología y se recogieron como variables mortalidad y riesgo quirúrgico, tanto en el grupo total como en pacientes electivos. Resultados: Veintisiete centros participaron en la elaboración de registro. El 70% aportó datos sobre mortalidad. El número de procedimientos de reparación global fue del 22% (36,6% mitrales, 3,5% aórticas y 92,5% tricúspides). La cirugía mitral reparadora fue posible en el 60% de las valvulopatías degenerativas, isquémicas y funcionales, y solo en el 2,8% de las reumáticas. La mortalidad global fue del 1,95%. El porcentaje de reparaciones aórticas oscila por grupos entre el 0 y el 48%. La cirugía reparadora tricúspide se mantiene en cifras similares a años previos. Las técnicas miniinvasivas fueron empleadas en el 3,4% de las cirugías mitrales y el 11,8% de las aórticas. Conclusiones: La actividad reparadora valvular mitral está actualmente consolidada en España, siendo especialmente infrecuente cuando la etiología de la valvulopatía es reumática. La cirugía reparadora aórtica difiere mucho entre grupos y parece encontrarse estabilizada.

Silymarin (SM) is a mixture of flavolignans extracted from the seeds of species derived from Silybum marianum, commonly known as milk thistle or St. Mary’sthistle. These species have been widely used in the treatment of liver disorders in traditional medicine since ancient times. Several properties had been attributed to the major SM flavolignans components, identified as silybin, isosilybin, silychristin, isosilychristin, and silydianin. Previous research reported antioxidant and protective activities, which are probably related to the activation of the nuclear factor erythroid 2 (NFE2)-related factor 2 (Nrf2), known as a master regulator of the cytoprotector response. Nrf2 is a redox-sensitive nuclear transcription factor able to induce the downstream-associated genes. The disruption of Nrf2 signaling has been associated with different pathological conditions. Some identified phytochemicals from SM had shown to participate in the Nrf2 signaling pathway; in particular, they have been suggested as activators that disrupt interactions in the Keap1-Nrf2 system, but also as antioxidants or with additional actions regarding Nrf2 regulation. Thus, the study of these molecules makes them appear attractive as novel targets for the treatment or prevention of several diseases.

Recently, industry has been focusing on the development of new products made from food by-products in order to reduce and take advantage of food wastes. The objective of this study was to evaluate tablet formulations developed by mixing two commercial excipients, microcrystalline cellulose (M) and α-lactose-monohydrate (L), added with powder from residues (mesocarp and pericarp) of green and red (G and R) cactus pear fruit (Opuntia ficus-indica L. Mill), having the following formulations: green with microcrystalline cellulose (GM), green with lactose (GL), red with microcrystalline cellulose (RM), and red with lactose (RL). The results showed lower disintegration times for the tablets with microcrystalline cellulose. The fiber functional properties presented good values for lipid and water holding capacity. There was a higher total phenolic content (TPC) in formulations with green cactus pear residue powder with microcrystalline cellulose and lactose (GM and GL, respectively), but the DPPH and ferric reducing/antioxidant power (FRAP) values were higher in the formulations with red cactus pear residues (RM and RL), while ABTS values were similar among all formulations. In conclusion, tablets made from Opuntia residues are proposed as a product of interest for the food supplement industry because of the good quality parameters and the functional and antioxidant properties that they provide.

Roselle (Hibiscus sabdariffa L.), also known as jamaica in Spanish, is a perennial plant that grows in tropical and subtropical regions, including China, Egypt, Indonesia, Mexico, Nigeria, Thailand, and Saudi Arabia. It has a long history of uses, mainly focused on culinary, botanical, floral, cosmetic, and medicinal uses. The latter being of great impact due to the diuretic, choleretic, analgesic, antitussive, antihypertensive, antimicrobial, immunomodulatory, hepatoprotective, antioxidant, and anti-cancer effects. These therapeutic properties have been attributed to the bioactive compounds of the plant, mainly phenolic acids, flavonoids, anthocyanins, and organic acids (citric, hydroxycitric, hibiscus, tartaric, malic, and ascorbic). Most literature reviews and meta-analyses on the therapeutic potential of Hibiscus sabdariffa L. (Hs) compounds have not adequately addressed the contributions of its organic acids present in the Hs extracts. This review compiles information from published research (in vitro, in vivo, and clinical studies) on demonstrated pharmacological properties of organic acids found in Hs. The intent is to encourage and aid researchers to expand their studies on the pharmacologic and therapeutic effects of Hs to include assessments of the organic acid components.

Introducción y objetivos: El 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. Métodos: Los 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. Resultados: Se 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). Conclusiones: El porcentaje de pacientes que se benefician de las técnicas de reparación valvular sigue aumentando, con unos resultados satisfactorios en términos de mortalidad.

Seed oils from two Mexican varieties of cactus pear (green: Opuntia albicarpa and red: Opuntia ficus indica) were extracted with different solvents (hexane, ethanol, and ethyl acetate) to evaluate their antioxidant activity. The seed oil with higher antioxidant activity was selected to evaluate antimicrobial activity. The fatty acid profile was analyzed by gas chromatography-mass spectrometry (GC-MS). Oil from green cactus pear seeds obtained with ethanol and ethyl acetate exhibited higher antioxidant activity (p

The purpose of the present study was to determine the optimal ultrasound conditions (amplitude level and time) for the extraction of cactus pear seed oil with the highest antioxidant activity using a closed system. Seed oil was analyzed for yield, antioxidant activity by ABTS and DPPH, and antimicrobial activity. Conventional extraction methods were assessed for comparison. Amplitude level significantly affected antioxidant activity in linear terms (p < 0.0001 DPPH and p < 0.001 ABTS, resp.) so, at lower amplitudes, the higher antioxidant activity was achieved. The optimum ultrasound extraction conditions were of 78% amplitude for 10 min and yielded antioxidant activity values of 66.25 mg AAE/100 g and 289 µmol TE/100 g for ABTS and DPPH, respectively. Compared with conventional extraction methods, ultrasound exhibited lower oil yield and antioxidant activity but had the potential to achieve comparable results if multiple ultrasound extractions are performed in the time needed by conventional methods. Seed oils showed similar antimicrobial activity despite the extraction method and were more effective against Escherichia coli. The results demonstrated that ultrasound can be an alternative extraction method of seed oils from fruits such as cactus pear.

Introducción y objetivos: El Grupo de Trabajo en Reparación Valvular de la Sociedad Española de Cirugía Torácica y Cardiovascular presenta el segundo Registro anual de actividad en cirugía reparadora de las válvulas mitral, aórtica y tricúspide realizadas en España en el año 2012. Este año adicionalmente se valora la mortalidad de los pacientes con válvulas mitrales reparadas. Métodos: Los datos se obtuvieron mediante encuesta por vía web. La participación fue voluntaria. Se contabilizan el número de intervenciones valvulares (reparaciones y recambios). Se detallan las reparaciones valvulares mitrales por etiologías y se analiza su relación con el volumen quirúrgico de cada centro. Se reporta la mortalidad. Se realiza una comparación de resultados de la cirugía valvular con años anteriores. Resultados: Se ofrecen datos de 34 centros que representan cerca del 80% de la actividad quirúrgica del país. El número de reparaciones valvulares ha aumentado en un 5% a pesar de observarse una ligera disminución en las intervenciones valvulares con respecto al 2011. Igualmente, se ha observado un aumento discreto en los cocientes de reparación/recambio valvular aórtico y mitral. El 58% de las válvulas mitrales reparadas fueron de etiología degenerativa, seguidas por las funcionales isquémicas (21%) y las funcionales no isquémicas (11%). No se ha encontrado una correlación entre el volumen quirúrgico y la tasa de reparación mitral. Las mortalidades observadas en la reparación mitral fueron del 1,1, el 3,3 y el 4,7% en las patologías degenerativa, reumática e isquémica, respectivamente. Conclusiones: El porcentaje de pacientes que se benefician de las técnicas de reparación valvular sigue aumentando. La mortalidad observada en la reparación valvular mitral es excelente.

For many years, several studies have been employing lectin from vegetables in order to prove its toxic effect on various cell lines. In this work, we analyzed the cytotoxic, antiproliferative, and post-incubatory effect of pure tepary bean lectins on four lines of malignant cells: C33-A; MCF-7; SKNSH, and SW480. The tests were carried out employing MTT and 3[H]-thymidine assays. The results showed that after 24 h of lectin exposure, the cells lines showed a dose-dependent cytotoxic effect, the effect being higher on MCF-7, while C33-A showed the highest resistance. Cell proliferation studies showed that the toxic effect induced by lectins is higher even when lectins are removed, and in fact, the inhibition of proliferation continues after 48 h. Due to the use of two techniques to analyze the cytotoxic and antiproliferative effect, differences were observed in the results, which can be explained by the fact that one technique is based on metabolic reactions, while the other is based on the 3[H]-thymidine incorporated in DNA by cells under division. These results allow concluding that lectins exert a cytotoxic effect after 24 h of exposure, exhibiting a dose-dependent effect. In some cases, the cytotoxic effect is higher even when the lectins are eliminated, however, in other cases, the cells showed a proliferative effect.

Introducción y objetivos: La reparación mitral es adecuada cuando en el control ecocardiográfico poscirculación extracorpórea no hay insuficiencia mitral residual o es ligera. Poco se conoce de la evolución clínica y ecocardiográfica de esta insuficiencia mitral ligera residual. El objetivo del estudio era valorar la evolución clínica y ecocardiográfica de los enfermos según la presencia o no de insuficiencia mitral residual ligera poscirugía. Métodos: Estudio prospectivo de pacientes con reparación mitral por regurgitación mitral severa degenerativa operados durante el período comprendido entre 2002–2010. Resultados: Fueron intervenidos 105 pacientes con afectación de 1 o 2 segmentos según la clasificación de Carpentier (edad media 67 ± 12 años, hombres 61%). En 102 casos (97,1%), la reparación mitral fue adecuada, y en 3 (2,9%) no, sustituyéndose la válvula. La mortalidad hospitalaria fue del 2,9% (EuroSCORE logístico 5 ± 5,5%). En el ecocardiograma transesofágico en quirófano, de los 102 pacientes reparados satisfactoriamente, 69 no presentaban insuficiencia mitral residual (grupo A) y 33 presentaban una regurgitación leve (grupo B). Durante el seguimiento [mediana 37 meses (1–105)], la evolución clínica fue correcta, aunque los pacientes del grupo B evolucionaron peor desde el punto de vista ecocardiográfico por recidiva más precoz de la insuficiencia mitral. Conclusiones: La reparación valvular mitral se ha mostrado como una técnica segura y eficaz. La ausencia de insuficiencia mitral al final de la reparación determina una mejor evolución con mínima recidiva durante un seguimiento a medio plazo.

The requirements demanded for pedestrian crossings, as the meeting point of pedestrian and vehicle traffic, are becoming more and more numerous and to guarantee that they are understandable, employable and feasible for all people in safe and convenient conditions, and in the most natural and autonomous manner(LEY 51, 2003). Natural stone is a highly demanded material used for covering and surface finishing of public external spaces. However, complying with the increasingly demanding requirements for pedestrian crossings, makes using natural stone much more difficult due to the inherent limitations that this material presents: from the labour-intensive mechanical procedures required to modify its shape, (as it cannot be moulded), to the inability to change its properties by chemical addition. This situation has been the premise of this investigation, with the objective of establishing a verification model of the functionalities of the pedestrian crossing, in general, and in particular, a verification model which can be used for a pedestrian crossing built with natural stone. The result is a model that can be used for the verification of the functionalities of a pedestrian crossing. In the process of building this model, the functionalities had to be classified in order to systematize the own verification method by which this classification can be considered as a secondary result of the investigation, even though it was not the main object. After realizing this investigation it can be confirmed that the functionality of a pedestrian crossing depends on almost a hundred parameters which must be checked or measured, in turn proving that this design and construction process is indeed complex.

Weather events have a significant impact on airport performance and cause delayed operations if the airport capacity is constrained. We provide quantification of the individual airport performance with regards to an aggregated weather-performance metric. Specific weather phenomena are categorized by the air traffic management airport performance weather algorithm, which aims to quantify weather conditions at airports based on aviation routine meteorological reports. Our results are computed from a data set of 20.5 million European flights of 2013 and local weather data. A methodology is presented to evaluate the impact of weather events on the airport performance and to select the appropriate threshold for significant weather conditions. To provide an efficient method to capture the impact of weather, we modelled departing and arrival delays with probability distributions, which depend on airport size and meteorological impacts. These derived airport performance scores could be used in comprehensive air traffic network simulations to evaluate the network impact caused by weather induced local performance deterioration.

La reparación mitral es el tratamiento de elección de la insuficiencia mitral grave degenerativa por prolapso. El objetivo del estudio es analizar los resultados a medio plazo de la cirugía reparadora mitral. Métodos: Estudio prospectivo de pacientes con insuficiencia mitral grave degenerativa, por prolapso de uno o dos segmentos valvulares en los que se realizó cirugía reparadora mitral en nuestro centro (2002–2008). Se practicó valoración clínica y ecocardiográfica precirugía, en la intervención y en el seguimiento. Resultados: Se intervinieron 100 pacientes (edad media 65 ± 12 años, hombres 66%). El estudio ecocardiográfico prequirúrgico nos permitió una correcta identificación de los segmentos valvulares afectos en el 96,3% de los casos. La mortalidad quirúrgica fue del 0% y la postoperatoria del 4%. Durante el seguimiento (mediana 31 meses [1–93) hubo una tasa de pacientes libres de reintervención del 98% al año y del 96% a los 5 años. La supervivencia actuarial fue del 94% al año y del 92% a los 5 años. Ningún paciente operado en CF I-II requirió reintervención, siendo la mortalidad hospitalaria y durante el seguimiento de cero. Conclusiones: La reparación valvular mitral se ha mostrado como una técnica segura y eficaz. Un equipo multidisciplinario permite la correcta identificación de pacientes candidatos y la aplicación de las técnicas quirúrgicas adecuadas. A la espera de un mayor seguimiento, los resultados son satisfactorios.

Presentamos dos pacientes que sufrieron un accidente de tráfico con resultado de traumatismo de la válvula mitral. En el primer caso, al cuarto día del accidente, se diagnosticó insuficiencia mitral masiva por ruptura de la cabeza del músculo papilar anterolateral, con versión completa de los segmentos A1 y P1, procediéndose a reparación quirúrgica al mes del accidente, siendo la válvula mitral estructuralmente normal. En el segundo caso, el diagnóstico se hizo a los 10 días del accidente. Se trataba de una insuficiencia mitral grave por ruptura de cuerdas del velo posterior. La reparación quirúrgica se llevó a cabo a los 2 meses y medio del accidente. En este caso la válvula mitral era, además, degenerativa. En ambos casos la cirugía consistió en reparación valvular mitral. Se revisa la ruptura traumática de la válvula mitral.

Atopic dermatitis (AD) patients may benefit from using textiles coated with skin microbiome-modulating compounds. Chitosan, a natural biopolymer with immunomodulatory and antimicrobial properties, has been considered potentially useful.This randomized controlled trial assessed the clinical utility of chitosan-coated garment use in AD.Of the 102 patients screened, 78 adult and adolescents were randomly allocated to overnight use of chitosan-coated or uncoated cotton long-sleeved pyjama tops and pants for 8 weeks. The primary outcome was change in disease severity assessed by Scoring Atopic dermatitis index (SCORAD). Other outcomes were changes in quality of life, pruritus and sleep loss, days with need for rescue medication, number of flares and controlled weeks, and adverse events. Changes in total staphylococci and Staphylococcus aureus skin counts were also assessed. Comparisons were made using analysis of variance supplemented by repeated measures analysis for the primary outcome. Interaction term between time and intervention was used to compare time trends between groups.Chitosan group improved SCORAD from baseline in 43.8%, (95%CI: 30.9 to 55.9), P = 0.01, placebo group in 16.5% (-21.6 to 54.6); P = 0.02 with no significant differences between groups; Dermatology Quality of life Index Score significantly improved in chitosan group (P = 0.02) and a significant increase of skin Coagulase negative Staphylococci (P = 0.02) was seen.Chitosan coated textiles may impact on disease severity by modulating skin staphylococcal profile. Moreover, a potential effect in quality of life may be considered.ClinicalTrials.gov NCT01597817.

The aim of this study was to evaluate the stability of color, betaxanthin, and betacyanin pigments in the presence of Cu(II)-dependent hydroxyl radicals (HO•) from ultrasonicated purple cactus pear juice at amplitudes of 40%, 60%, and 80%, in comparison to untreated sample. L* parameter of juice treated at 40% and 80% amplitude for 25 and 15 min, respectively (11.3 and 9.3, respectively), were significantly higher compared to the control; b* and hue parameters of juice treated at 80%, 25 min showed values of 1.7 and 0.1, respectively. Color differences (ΔE) were lower (

Background: Barbed suture technology has shown promise in flexor tendon repairs, as there is an even distribution of load and the need for a knot is eliminated. We propose that a quick and simple, novel, barbed technique without any exposed barbs on the tendon surface has comparable strength and a smaller cross-sectional area at the repair site than traditional methods of repair. Methods: Forty porcine flexor tendons were randomized to polybutester 4-strand barbed repair or to 4-strand Adelaide monofilament repair. The cross-sectional area was measured before and after repair. Biomechanical testing was carried out and 2-mm gap formation force, ultimate strength of repair, and method of failure were recorded. Results: The mean ultimate strength of the barbed repairs was 54.51 ± 17.9 while that of the Adelaide repairs was 53.17 ± 16.35. The mean 2-mm gap formation force for the barbed group was 44.71 ± 17.86 whereas that of the Adelaide group was 20.25 ± 4.99. The postrepair percentage change in cross-sectional area at the repair site for the Adelaide group and barbed group was 12.0 ± 2.3 and 4.6 ± 2.8, respectively. Conclusions: We demonstrated that a 4-strand knotless, barbed method attained comparable strength to that of the traditional Adelaide repair technique. The barbed method had a significantly reduced cross-sectional area at the repair site compared with the Adelaide group. The 2-mm gap formation force was less in the barbed group than the Adelaide group. Barbed repairs show promise for tendon repairs; this simple method warrants further study in an animal model.