Search

Abstract Background The Gran Chaco ecoregion is a well-known hotspot of several neglected tropical diseases (NTDs) including Chagas disease, soil-transmitted helminthiasis and multiparasitic infections. Interspecific interactions between parasite species can modify host susceptibility, pathogenesis and transmissibility through immunomodulation. Our objective was to test the association between human co-infection with intestinal parasites and host parasitaemia, infectiousness to the vector and immunological profiles in Trypanosoma cruzi-seropositive individuals residing in an endemic region of the Argentine Chaco. Methods We conducted a cross-sectional serological survey for T. cruzi infection along with an intestinal parasite survey in two adjacent rural villages. Each participant was tested for T. cruzi and Strongyloides stercoralis infection by serodiagnosis, and by coprological tests for intestinal parasite detection. Trypanosoma cruzi bloodstream parasite load was determined by quantitative PCR (qPCR), host infectiousness by artificial xenodiagnosis and serum human cytokine levels by flow cytometry. Results The seroprevalence for T. cruzi was 16.1% and for S. stercoralis 11.5% (n = 87). We found 25.3% of patients with Enterobius vermicularis. The most frequent protozoan parasites were Blastocystis spp. (39.1%), Giardia lamblia (6.9%) and Cryptosporidium spp. (3.4%). Multiparasitism occurred in 36.8% of the examined patients. Co-infection ranged from 6.9% to 8.1% for T. cruzi-seropositive humans simultaneously infected with at least one protozoan or helminth species, respectively. The relative odds of being positive by qPCR or xenodiagnosis (i.e. infectious) of 28 T. cruzi-seropositive patients was eight times higher in people co-infected with at least one helminth species than in patients with no such co-infection. Trypanosoma cruzi parasite load and host infectiousness were positively associated with helminth co-infection in a multiple regression analysis. Interferon-gamma (IFN-γ) response, measured in relation to interleukin (IL)-4 among humans infected with T. cruzi only, was 1.5-fold higher than for T. cruzi-seropositive patients co-infected with helminths. The median concentration of IL-4 was significantly higher in T. cruzi-seropositive patients with a positive qPCR test than in qPCR-negative patients. Conclusions Our results show a high level of multiparasitism and suggest that co-infection with intestinal helminths increased T. cruzi parasitaemia and upregulated the Th2-type response in the study patients. Graphical Abstract

Resumen: La Sociedad Española de Cirugía Cardiovascular y Endovascular, conjuntamente con el registro general de actividad 2022, muestra sus datos de actividad en pacientes con cardiopatía congénita (CC) del período temporal 2012-2022, basado en un registro voluntario y anónimo de los centros participantes. En 2022 ha aumentado significativamente la actividad de cirugía de CC en España, alcanzando cifras similares a las del año 2019, pre-pandemia. Presentamos agrupados los datos de actividad de los últimos 11 años para reflejar mejor nuestros resultados con estas patologías relativamente infrecuentes. En este tiempo se realizaron 22.056 cirugías de CC, que suponen un 9,5% de la cirugía cardiovascular mayor de nuestro país durante ese tiempo. El 82% de las cirugías congénitas se hicieron con circulación extracorpórea y el 18% restante, sin ella. Destacamos las intervenciones neonatales y en adultos con CC que asocian elevada complejidad, y suponen respectivamente el 18% y el 22% de la actividad total. Las CC operadas más prevalentes continúan siendo los defectos septales en los casos que requieren circulación extracorpórea y los ductus en pacientes operados sin circulación extracorpórea. Los datos se presentan ajustados a la escala Aristóteles básico de riesgo quirúrgico preoperatorio. La mortalidad observada en cirugías con circulación extracorpórea fue del 3% (Aristóteles: 6,39), y en cirugías sin circulación extracorpórea, del 2,34% (Aristóteles: 4,89).Nuestro registro nacional de actividad quirúrgica en CC muestra buenos resultados, permite establecer comparaciones a nivel nacional e internacional, para diseñar estrategias de mejora, fijar objetivos y aumentar la calidad de nuestras actuaciones. Abstract: The Spanish Society of Cardiovascular & Endovascular Surgery presents the 2012-2022 report of the activity in congenital cardiovascular surgery, based on a voluntary and anonymous registration involving most of Spanish centres. This article is complementary to the 2022 cardiovascular surgery annual report, and they are published together. In 2022 we observe an increase in congenital cardiovascular surgery, reaching numbers similar to pre-pandemic activity in year 2019. We included data from the previous 11 years, in order to obtain real information related to our activity with these relatively scarce pathologies. From year 2012 to 2022, 22,056 congenital heart surgeries were performed, accounting for 9.5% of all major surgery (congenital + acquired) performed in Spain during that period. Of these surgeries, 82% of them required extracorporeal circulation and 18% not. We highlight the interventions in neonates and adult patients, which mean respectively 18% and 22% of our whole activity and are a real challenge. The most prevalent congenital heart pathologies operated on were: septal defects in cases requiring extracorporeal circulation, and ductus in patients without extracorporeal circulation. The presented data are adjusted to the basic Aristotle score of preoperative surgical risk. The observed mortality of surgeries with extracorporeal circulation was 3% (Aristotle-6.39), and without cardiopulmonary bypass 2.34% (Aristotle-4.89).Our national registry of surgical activity in congenital heart disease shows good results, allows us to compare ourselves within a national and international framework, design improvement strategies, set objectives and improve the quality of our actions.

Resumen: El presente artículo resume los datos correspondientes a la actividad de cirugía cardiovascular realizada en España en el año 2022. Se elabora a partir de un registro anónimo y voluntario de datos agregados de hospitales de todo el país, quienes transfieren sus datos a la Sociedad Española de Cirugía Cardiovascular y Endovascular. Este es el 34.° año consecutivo en el que se reportan los datos de la actividad nacional. El análisis de la información del año 2022 servirá para evaluar la actividad en España después del fin de la pandemia por COVID-19 y sus estragos en el Sistema Nacional de Salud.En el año 2022 comunicaron su actividad 58 centros. Se realizaron 28.998 intervenciones, con 20.127 procedimientos de cirugía cardiaca mayor. De estos, 17.923 procedimientos fueron realizados con circulación extracorpórea, 18.210 fueron de enfermedad adquirida y 1.917 de enfermedad congénita. Además, se registraron 2.828 intervenciones de cirugía vascular periférica. En cuanto a los diferentes tipos de cirugía cardiaca mayor se realizaron: 7.596 procedimientos de cirugía valvular aislada, 1.621 de cirugía valvular combinada, 4.701 procedimientos de revascularización, 2.432 de cirugía de aorta y 579 procedimientos de válvulas transcatéter.En comparación con el año 2021, observamos un aumento de la cirugía cardiaca mayor adquirida, pero sin llegar a recuperar el nivel de actividad previo a la pandemia. Así mismo, se observó una reducción significativa de la mortalidad con respecto del año 2021, con índices de mortalidad ajustada al riesgo por debajo de 1 en todos los tipos de intervenciones salvo en cirugía polivalvular, combinada valvular y coronaria y en las complicaciones mecánicas del infarto. Abstract: This manuscript summarizes the data corresponding to the cardiovascular surgery activity carried out in Spain in 2022. It has been written based on an anonymous and voluntary registry of aggregated data from hospitals throughout the country, who transfer their data to the Spanish Society of Cardiovascular and Endovascular Surgery. This is the 34th consecutive year in which national activity data has been reported. The analysis of the information collected in 2022 will serve to evaluate the activity in Spain after the end of the COVID-19 pandemic and its impact to the National Health System.In 2022, 58 centers reported their activity. 28,998 interventions were performed, with 20,127 major cardiac surgery procedures. Of these, 17,923 procedures were performed with cardiopulmonary bypass, 18,210 were for acquired disease and 1,917 were for congenital disease. In addition, 2,828 peripheral vascular surgery interventions were recorded. Regarding the different types of major cardiac surgery, the following were performed: 7,596 isolated valve surgery procedures, 1,621 combined valve surgery, 4,701 revascularization procedures, 2,432 aortic surgery, and 579 transcatheter valve procedures.Compared to 2021, we observed an increase in acquired major cardiac surgery, but without recovering the level of activity prior to the pandemic. Likewise, a significant reduction in mortality was observed compared to 2021, with risk-adjusted mortality rates below 1 in all types of interventions except for multiple valve, combined valve and coronary procedures, and repair of mechanical complications of infarction.

En este artículo exploramos las circunstancias que rodearon el fallido estreno de la obra de teatro Camila O’Gorman de Heraclio Fajardo en 1856 en Buenos Aires y en 1857 en Montevideo. En el contexto político en el que Buenos Aires buscaba diferenciarse tanto de la tiranía de Juan Manuel de Rosas como del gobierno de la Confederación Argentina, su autor acusó a los herederos del rosismo como responsables de operar a favor de la censura. Sin embargo, un conjunto de intereses menos evidentes surge de un corpus que recoge las voces de una diversidad de actores involucrados en el debate sobre la obra, que deriva en el de las normas e instituciones que debían regular la actividad teatral: autoridades eclesiásticas y municipales, familiares, escritores y prensa. A través del análisis del acontecimiento, pretendemos reconstruir los contextos pertinentes e interactuantes de una particular trama compuesta de tensiones preexistentes: entre clericalismo y anticlericalismo, libertad y orden, gobierno e Iglesia, presente y pasado reciente, lo público y lo privado.

Resumen: Introducción-objetivos: Analizar los resultados clínicos y la supervivencia tras el implante de asistencia ventricular de larga duración en pacientes pediátricos en situación de insuficiencia cardiaca terminal. Métodos: Entre enero de 2006 y noviembre 2021 se implantaron 34 dispositivos Berlin Heart EXCOR® en pacientes pediátricos. Analizamos las características preoperatorias, las intraoperatorias y las complicaciones tras el implante, así como la evolución de los pacientes (trasplante o fallecimiento). Estudio estadístico con STATA IC 15. Resultados: Edad media 51 ± 53 meses (1-180), peso medio 17 ± 16 kg (2,2-65). La cardiopatía de base fue miocardiopatía en el 68% y cardiopatía congénita en el 32%. Inicialmente el Berlin Heart EXCOR® implantado fue univentricular en el 65% de los pacientes. La indicación de implante fue puente a trasplante en el 97%. Duración media de soporte 92 ± 105 días (1-511). Complicaciones frecuentes: 62% infecciosas, 44% neurológicas (29% isquémicas y 15% hemorrágicas). Mortalidad de ictus hemorrágicos 80% y de isquémicos 20%. A partir de 2019, cuando se sustituyó la heparina por bivalirudina, los eventos neurológicos disminuyeron y no ha habido muertes por causa neurológica. El 71% han sido trasplantados y el 29% han fallecido. Conclusiones: Ante el creciente número de pacientes pediátricos en situación de insuficiencia cardiaca terminal, ha aumentado el uso del dispositivo Berlin Heart EXCOR®, especialmente como puente a trasplante. Los eventos neurológicos, sobre todo hemorrágicos, son los más temidos por su alta mortalidad. Por eso, la terapia antitrombótica continúa siendo el principal reto. A pesar de ello, supone una alternativa esperanzadora como asistencia de larga duración en población pediátrica, y permite llegar al trasplantarse al 71% de ellos. Abstract: Background and aim: The aim is to analyse clinical and survival results after the implant of a long-term mechanical assist device in pediatric patients in the end stages of heart failure. Methods: Between January 2006 and November 2021 34 Berlin Heart EXCOR® devices were implanted in pediatric patients. We analysed preoperative and intraoperative characteristics, together with complications after implant. Outcomes were also evaluated (transplant vs. death). Statistical analysis with STATA IC 15. Results: The mean age was 51 ± 53 months (1-180), mean weight 17 ± 16 kg (2.2-65). Underlying heart disease was myocardiopathy in 68% and congenital heart disease in 32%. The Berlin Heart EXCOR® device was univentricular in 64% of the patients. Surgical indication was bridge to transplant in 97%. Mean duration of mechanical support was 92 ± 105 days (1-511). Postoperative complications were common: 62% infectious and 44% neurological (29% ischaemic and 15% haemorrhagic). Mortality of haemorrhagic strokes 80%, ischaemic 20%. Since 2019, when heparin was changed to bivalirudin, no mortal strokes were observed. 71% of the patients has been transplanted, 29% has died. Conclusions: As a response to the increasing number of paediatric patients in end stages of congestive heart failure, the use of the Berlin Heart EXCOR® device has spread, especially if the intention is to use it as bridge to transplant. Neurological events, mostly haemorrhagic, are the most feared because of high mortality. Nevertheless, it is an encouraging alternative as a long-term mechanical assist device in children, allowing them to reach the transplant in 71% of the cases.

Hypoplastic left heart syndrome (HLHS) continues to be a challenge in terms of morbimortality. Norwood-Sano surgery has been classically the correction of choice, the introduction of new techniques like biventricular repair, in favorable cases, and hybrid procedures as a step prior to cardiac transplantation have not improved the univentricular results. Technological advances and improvements in anticoagulation therapies have made possible to implant ventricular assist devices (VAD) during the neonatal period. This has motivated us to start a left VAD program in an animal model of HLHS. Our objective is to use long term VAD in a biventricular condition in patients with HLHS as a bridge to cardiac transplantation. Although the conditions have not been met to start a program for patients, the initial results show that the technique is feasible in pigs. We believe that this line of research is worth exploring as cardiac transplant in conditions of biventricular physiology could be less risky and offer better results than the classical univentricular path. Resumen: El síndrome del corazón izquierdo hipoplásico (SCIH) continúa siendo un reto en términos de morbimortalidad. La cirugía clásica de Norwood-Sano continúa siendo de elección y la introducción de nuevas técnicas como la reparación biventricular en los casos más favorables y los procedimientos híbridos para poder optar a un trasplante cardiaco posterior, no han conseguido una mejora en los resultados de la cirugía univentricular clásica. El avance de la tecnología y la terapia anticoagulante en los últimos años ha hecho realidad la asistencia ventricular mecánica (AVM) de larga duración en el periodo neonatal. Por estos motivos hemos iniciado un programa de implante de AVM izquierda en un modelo animal de hipoplasia de SCIH. Con el objetivo de que en un futuro la SCIH se pueda trasplantar en condiciones de biventricularidad, con el implante de una AVM izquierda de larga evolución. Los resultados iniciales muestran que técnicamente es posible en cerdos y, aunque actualmente no se dan las condiciones para iniciar un programa de este tipo en pacientes, pensamos que es una vía para seguir investigando, porque creemos que, el trasplante cardiaco en condiciones de biventricularidad, puede ser una opción con menos riesgos y mejores resultados que la vía univentricular.

In this work, AgNPs were synthesized using an anthocyanin extract from Peruvian purple potato INIA 328—Kulli papa. The anthocyanin extract was obtained through a conventional extraction with acidified ethanolic aqueous solvent. This extract acted as both a reducing and stabilizing agent for the reduction of silver ions. Optimization of synthesis parameters, including pH, reaction time, and silver nitrate (AgNO3) concentration, led to the optimal formation of AgNPs at pH 10, with a reaction time of 30 min and an AgNO3 concentration of 5 mM. Characterization techniques such as X-ray diffraction (XRD) and dynamic light scattering (DLS) revealed that the AgNPs had a crystallite size of 9.42 nm and a hydrodynamic diameter of 21.6 nm, with a zeta potential of −42.03 mV, indicating favorable colloidal stability. Fourier Transform Infrared (FTIR) analysis confirmed the presence of anthocyanin functional groups on the surface of the AgNPs, contributing to their stability. Furthermore, the bacterial activity of the AgNPs was evaluated by determining the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). For E. coli, the MIC was 0.5 mM (0.05 mg/mL) and the MBC was 4.5 mM (0.49 mg/mL). Similarly, for S. aureus, the MIC was 0.5 mM (0.05 mg/mL) and the MBC was 4.0 mM (0.43 mg/mL). These results highlight the potential benefits of AgNPs synthesized from Peruvian purple potato anthocyanin extract, both in biomedical and environmental contexts.

Objective When considering proposals to improve diets, it is important to understand how factors like price and income can affect saturated fat (SF) intake and demand. In this study, we examine and estimate the influence of price and income on intake across 160 countries, by age and sex, and derive sensitivity measures (price elasticities) that vary by age, sex and world region.Design We econometrically estimate intake responsiveness to income and prices across countries, accounting for differences by world region, age and sex. Intake data by age, sex and country were obtained from the 2018 Global Dietary Database. These data were then linked to global price data for select food groups from the World Bank International Comparison Programme and income data from the World Development Indicators Databank (World Bank).Results Intake differences due to price were highly significant, with a 1% increase in price associated with a lower SF intake (% energy/d) of about 4.3 percentage points. We also find significant differences across regions. In high-income countries, median (age 40) intake reductions were 1.4, 0.8 and 0.2 percentage points, given a 1% increase in the price of meat, dairy, and oils and fats, respectively. Price elasticities varied with age but not sex. Intake differences due to income were insignificant when regional binary variables were included in the analysis.Conclusion The results of this study show heterogeneous associations among prices and intake within and across countries. Policymakers should consider these heterogeneous effects as they address global nutrition and health challenges.

Resumen: La Sociedad Española de Cirugía Cardiovascular y Endovascular, de manera conjunta al registro general de actividad 2021, muestra sus datos de actividad en pacientes con cardiopatía congénita del período temporal 2012-2021, basado en un registro voluntario y anónimo de los centros participantes. En 2021, aún marcado por las secuelas de la pandemia COVID-19, persiste el descenso de actividad quirúrgica en cardiopatías congénitas (CC) del 2020 respecto a los años previos. Presentamos agrupados los datos de actividad de la última década, para reflejar mejor nuestros resultados con estas patologías relativamente infrecuentes. En este tiempo se realizaron en España 20.139 cirugías de CC, que suponen el 9,5% de la cirugía cardiovascular mayor realizada en nuestro país durante ese tiempo. El 81,5% de las cirugías congénitas se hicieron con circulación extracorpórea y el 18,5% restante sin ella. Destacamos las intervenciones neonatales y en adultos, que asocian elevada complejidad y suponen, respectivamente, el 18% y el 21% de la actividad total. Las CC operadas más prevalentes continúan siendo los defectos septales en los casos que requieren circulación extracorpórea y los ductus en pacientes operados sin circulación extracorpórea. Los datos se presentan ajustados a la escala Aristóteles básico de riesgo quirúrgico preoperatorio. La mortalidad observada en cirugías con circulación extracorpórea fue del 3,07% (Aristóteles: 6,29), y en cirugías sin circulación extracorpórea, del 2,25% (Aristóteles: 4,82).Nuestro registro nacional de actividad quirúrgica en CC muestra buenos resultados, permite establecer comparaciones a nivel nacional e internacional, para diseñar estrategias de mejora, fijar objetivos y aumentar la calidad de nuestras actuaciones. Abstract: The Spanish Society of Cardiovascular & Endovascular Surgery presents the 2012-2021 report of the activity in congenital cardiovascular surgery, based on a voluntary and anonymous registration involving most of Spanish centres. This article is complementary to the 2021 cardiovascular surgery annual report, and they are published together. In 2021, still marked by the aftermath of the COVID-19 pandemic, the decline in our 2020 congenital activity persists, compared with previous years. We included data from the previous 10 years, in order to obtain real information related to our activity with these relatively scarce pathologies. In the last decade, a total of 20,139 congenital heart surgeries were performed, accounting for 9.5% of all major surgery (congenital + acquired) performed in Spain during that period. Of these surgeries, 81.5% of them required extracorporeal circulation and 18.5% not. We highlight the interventions in neonates and adult patients, which mean respectively 18% and 21% of our whole activity and are a real challenge. The most prevalent congenital heart pathologies operated on were: septal defects in cases requiring extracorporeal circulation, and ductus in patients without extracorporeal circulation. The presented data are adjusted to the basic Aristotle score of preoperative surgical risk. The observed mortality of surgeries with extracorporeal circulation was 3.07% (Aristotle: 6.29), and without cardiopulmonary bypass 2.25% (Aristotle: 4.82).Our national registry of surgical activity in congenital heart disease shows good results, allows us to compare ourselves within a national and international framework, design improvement strategies, set objectives and improve the quality of our actions.

Resumen: El presente registro aporta los datos correspondientes a la actividad de cirugía cardiovascular realizada en España durante el año 2021. Se trata de un registro anónimo y voluntario de datos agregados en el que han participado hospitales del territorio nacional, transfiriendo sus datos a la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE). Se comunican, por trigésimo tercer año consecutivo, los datos de la actividad nacional. El registro de 2021 puede tener valor para analizar la posible recuperación de la actividad en cirugía cardiaca después de la pandemia de SARS-CoV-2 en nuestro país.En el año 2021 comunicaron su actividad 58 hospitales frente a los 60 que compartieron datos en 2020. En total, se realizaron 29.319 intervenciones, con 19.229 procedimientos de cirugía cardiaca mayor. De estos, 16.863 procedimientos fueron realizados con circulación extracorpórea, 17.616 fueron de enfermedad adquirida y 1.613 de enfermedad congénita. Además, se registraron 2.637 intervenciones de cirugía vascular periférica.Como en años previos, tanto la cirugía cardiaca congénita como el trasplante cardiaco disponen de su propio registro. Dentro de los diferentes apartados de cirugía cardiaca mayor se realizaron: 7.673 procedimientos de cirugía valvular aislada, 1.523 de cirugía valvular combinada, 4.287 procedimientos de revascularización, 2.159 de cirugía de aorta y 654 procedimientos de válvulas transcatéter. En comparación con 2020, observamos un aumento generalizado de la actividad, que fue del 7,9% con respecto de dicho año previo, pero con una reducción de más del 12% con respecto de la media de los 9 años anteriores (2012-2020). Abstract: This report provides the data corresponding to the cardiovascular surgery activity performed in Spain during 2021. The Spanish Registry is an anonymous and voluntary registry of aggregated data in which hospitals in the national territory have taken part, transferring their data to the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE). For the thirty-third consecutive year, the national activity data is reported. The 2021 registry may be of some value for analyzing the possible recovery of the cardiac surgery activity after the SARS-CoV-2 pandemic in our country.In 2021, 58 hospitals reported their activity compared to the 60 that shared their data in 2020. In total, 29,319 interventions were performed, with 19,229 major cardiac surgical procedures. Of these, 16,863 procedures were performed with cardiopulmonary bypass, 17,616 were indicated because of acquired disease and 1,613 for congenital disease. In addition, 2,637 peripheral vascular surgical interventions were registered.As in previous years, both congenital heart surgery and heart transplantation activity and outcomes will be reported in separate registries. Within the different types of major cardiac surgical procedures, the following were performed: 7,673 isolated valve procedures, 1,523 combined valve and coronary surgeries, 4,287 coronary revascularization procedures, 2,159 aortic surgeries, and 654 transcatheter valve implantations. Compared to 2020, we observed a general increase in activity, which was 7.9% compared to the previous year, but with a reduction of more than 12% compared to the mean of the previous 9 years (2012-2020).

The research and scientific production of Universidad de Ciencias Aplicadas y Ambientales U.D.C.A was analyzed based on the intellectual capital approach, global academic rankings, research, and scientific production in the last 40 years. The Scimago Graphica tool and the VOSviewer software were used for the bibliometric and content analysis of the scientific publications available in the Scopus database. The bibliometric analysis showed that there are 534 scientific documents in the Scopus database, with at least one author affiliated with U.D.C.A. Of these, 84 % can be found in SciELO and 56 % on Publindex. Most documents (70 %) are in English, and 27 % are in Spanish. The citations of 7 articles account for 64.4 % (37,147) of the total citations. Authors with affiliation U.D.C.A have collaborated with researchers from 72 countries. Based on intellectual capital and scientific production, U.D.C.A is currently in model 2.0 and is transitioning towards model 3.0, drawn by three areas: Medicine, Environmental Sciences, and Veterinary. These areas have focused on inter-institutional cooperation, internationalization, regionalization, and globalization. However, they must incorporate business development, digital technologies, virtual learning, knowledge capitalization, and entrepreneurship. The other areas of knowledge need to reconsider the type and scope of research they develop to be relevant to the academic community and society.

Summary: Patient-derived xenografts (PDX) remain valuable models for understanding the biology and for developing novel therapeutics. To expand current PDX models of childhood leukemia, we have developed new PDX models from Hispanic patients, a subgroup with a poorer overall outcome. Of 117 primary leukemia samples obtained, successful engraftment and serial passage in mice were achieved in 82 samples (70%). Hispanic patient samples engrafted at a rate (51/73, 70%) that was similar to non-Hispanic patient samples (31/45, 70%). With a new algorithm to remove mouse contamination in multi-omics datasets including methylation data, we found PDX models faithfully reflected somatic mutations, copy-number alterations, RNA expression, gene fusions, whole-genome methylation patterns, and immunophenotypes found in primary tumor (PT) samples in the first 50 reported here. This cohort of characterized PDX childhood leukemias represents a valuable resource in that germline DNA sequencing has allowed the unambiguous determination of somatic mutations in both PT and PDX.

Resumen: Introducción y objetivos: La insuficiencia cardíaca congestiva aparece en cardiopatías congénitas (CC) tras agotar los tratamientos convencionales médico-quirúrgicos. En adecuados candidatos, el trasplante cardíaco mejora su calidad y cantidad de vida.Presentamos los resultados a corto-medio plazo de nuestros trasplantes cardíacos en CC durante los últimos 20 años, centrándonos en las modificaciones técnicas que requiere el trasplante. Material y métodos: Revisión retrospectiva de 44 pacientes con CC trasplantados durante 2001-2021 en nuestro centro especializado en CC. Estudio estadístico: SPSS-15.0. Resultados: Edad mediana, 17,5 años (RIC: 3,2-40,6); 22 niños y 22 adultos. Tienen cirugías previas el 93% y asistencia ventricular previa el 25%. Diagnósticos iniciales más frecuentes: ventrículo único (45%) y trasposición de grandes vasos (20%).Trasplante bicavo 43 (98%), biatrial 1 (2%). Técnicas quirúrgicas adicionales requeridas con más frecuencia: retirada de material protésico (marcapasos-desfibriladores-asistencia ventricular-stents) y reconstrucción de ramas pulmonares. Mediana de tiempos de circulación extracorpórea 208 min (RIC: 160-245), e isquemia del órgano 271 min (RIC: 220-302).Mortalidad hospitalaria, 9 (20%). Las cirugías previas (p = 0,01), el ECMO (p = 0,007) y hemofiltro por fallo renal postoperatorios (p = 0,003) asocian mayor mortalidad hospitalaria.Seguimiento mediano 21 meses (RIC: 9-72), 4 fallecimientos tardíos. La supervivencia tras el alta hospitalaria es del 93% al año, 87% a los 3 años y 80% a partir de los 5 años. Conclusiones: El trasplante de pacientes con CC en nuestro entorno especializado tiene buenos resultados. Frecuentemente son reintervenciones que prolongan los tiempos quirúrgicos y requieren modificaciones técnicas.Las cirugías previas y la necesidad de ECMO o hemofiltro en el postoperatorio inmediato asocian significativamente una mayor mortalidad al trasplante de CC. La supervivencia tras el alta hospitalaria es favorable. Abstract: Introduction and objectives: Congestive heart failure develops in congenital heart disease (CHD) after failure of conventional medical-surgical treatments. In suitable candidates, heart transplantation improves their quality and quantity of life.We present our heart transplants in CHD performed in the last 20 years, focusing on technical modifications required, and transplant short-medium-term results. Material and methods: Retrospective analysis of 44 patients with CHD transplanted during 2001-2021 in our specialized CHD hospital. Statistical study: SPSS-15.0. Results: Median age 17.5 years (IQR: 3.2-40.6), 22 children and 22 adults. Previous surgeries: 93% and mechanical circulatory support: 25%. Most frequent initial diagnoses: single ventricle-45%, and transposition of the great vessels-20%.Transplant was bicaval: 43 (98%), biatrial: 1 (2%). Additional surgical techniques needed more frequently: removal of prosthetic material (pacemakers-defibrillators-ventricular assist-stents) and reconstruction of pulmonary arteries. Median cardiopulmonary bypass time: 208 min (IQR: 160-245), and heart ischemia 271 min (IQR: 220-302).Inhospital mortality: 9 (20%). Previous surgeries (p = 0.01), postoperative ECMO (p = 0.007) and hemofiltration for acute renal failure (p = 0.003) are statistically associated with inhospital mortality.Median follow-up: 21 months (IQR: 9-72), 4 late deaths. Survival after hospital discharge is 93% at 1 year, 87% at 3 years, and 80% after 5 years. Conclusions: Transplantation of patients with CHD with our multidisciplinary approach in a specialized setting has good results. Reoperations that prolong surgical times and transplant with technical modifications are frequent.Previous surgeries, postoperative need of ECMO or hemofiltration are significantly associated with higher inhospital mortality in these patients. Survival after hospital discharge is favourable.

Resumen: La Sociedad Española de Cirugía Cardiovascular y Endovascular muestra sus datos de actividad en pacientes con cardiopatía congénita (CC) del período temporal 2012-2020, basado en un registro voluntario y anónimo de los centros participantes. Este manuscrito complementa al registro general de actividad 2020 y ambos se publican conjuntamente. En 2020, marcado por la pandemia COVID-19 en todos los ámbitos sanitarios, observamos un descenso de actividad quirúrgica en CC del 14% respecto al año previo. Agrupamos los datos de actividad de los últimos 9 años, porque reflejan mejor nuestros resultados con estas enfermedades relativamente infrecuentes. En este período se realizaron en España 18.526 cirugías de CC, que suponen un 9,6% de la cirugía mayor (congénita + adquirida) realizada en nuestro país durante ese tiempo. El 81% de las cirugías congénitas se hicieron con circulación extracorpórea y el 19% restante sin ella. Destacamos las intervenciones en neonatos y en adultos que asocian elevada complejidad, suponiendo respectivamente un 19 y 21% de la actividad total. Las CC operadas más prevalentes continúan siendo los defectos septales dentro de los casos que requieren circulación extracorpórea, y los ductus en pacientes operados sin circulación extracorpórea. Los datos se presentan ajustados a la escala Aristóteles básico de riesgo quirúrgico preoperatorio. La mortalidad observada en cirugías con circulación extracorpórea fue del 3,1% (Aristóteles-6,48), y en cirugías sin circulación extracorpórea del 2,41% (Aristóteles-4,81). Este registro muestra detalladamente nuestros datos de actividad quirúrgica en CC, y permite comparaciones tanto a nivel nacional como internacional, para establecer estrategias de mejora de nuestros resultados. Abstract: The Spanish Society of Cardiovascular & Endovascular Surgery presents the 2012-2020 report of the activity in congenital cardiovascular surgery, based on a voluntary and anonymous registration involving the most of Spanish centres. This article is complementary to the 2020 cardiovascular surgery annual report, and they are published together. In 2020, seriously damaged by the COVID-19 pandemic related to all sanitary fields, we observe a 14% drop in our congenital activity compared with 2019. Data from the previous 9 years are included, in order to obtain real information related to our activity in these relatively scarce pathologies. In the last nine years, a total of 18526 congenital heart surgeries were performed, accounting for 9.6% of major surgery (congenital + acquired) performed in Spain during that period. Of these surgeries, 81% of them required extracorporeal circulation and 19% not. We highlight the interventions in neonates and adult patients, which represent respectively 19% and 21% of the whole activity and are a real challenge. The most prevalent congenital heart pathologies operated on were septal defects in cases requiring extracorporeal circulation, and ductus in patients not requiring extracorporeal circulation. The presented data are adjusted to the basic Aristotle score of preoperative surgical risk. The observed mortality of surgeries with extracorporeal circulation was 3.1% (Aristotle-6.48), and without cardiopulmonary bypass 2.41% (Aristotle-4.81). This data analysis shows accurate and reliable information about our surgery for congenital heart disease and allow us to compare ourselves within an international framework, and to organize strategies directed to improve our results.

Resumen: El presente registro aporta los datos correspondientes a la actividad de cirugía cardiovascular realizada en España durante el año 2020. Se trata de un registro anónimo y voluntario de datos agregados en el que han participado 60 hospitales del territorio nacional, transfiriendo sus datos a la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE). Se comunican, por trigésimo segundo año consecutivo los datos de la actividad nacional.El de este año es, sin duda, un registro singular e importante para valorar el impacto que tuvo la pandemia de SARS-CoV-2 sobre la actividad en cirugía cardiaca en nuestro país, más allá de los datos que han sido ya comunicados en este sentido en diversos estudios comunicados por la SECCE.En el año 2020 comunicaron su actividad 60 hospitales frente a los 57 que compartieron datos en 2019. En total, se realizaron 27.017 intervenciones totales, con 17.880 procedimientos de cirugía cardiaca mayor. De estas, 15.534 procedimientos fueron realizados con circulación extracorpórea (CEC). Los 17.880 procedimientos de cirugía cardiaca mayor se pueden desglosar en 16.271 de enfermedad adquirida y 1.609 de enfermedad congénita. Además, se registraron 2.462 intervenciones de cirugía vascular periférica en los diferentes servicios de cirugía cardiovascular.Como en registros previos, tanto la cirugía cardiaca congénita como el trasplante cardiaco disponen de su propio registro. Dentro de los diferentes apartados de cirugía cardiaca mayor se realizaron: 6.766 procedimientos de cirugía univalvular aislada, 1.609 de cirugía valvular combinada, 4.219 procedimientos de revascularización, 1.912 de cirugía de aorta y 502 procedimientos de válvulas transcatéter (TAVI). En comparación con 2019, observamos un descenso generalizado de la actividad, siendo más marcado para la cirugía valvular (−21% para univalvular, −52% para TAVI transapical) y menos para cirugía coronaria (−11%). Además, informamos de diversos datos de distribución geográfica de la actividad quirúrgica a nivel nacional. Abstract: The Spanish Society of Cardiovascular and Endovascular Surgery (SECCE) reports the results of the 2020 registry of the surgical activity in our country. This year represents the 33rd consecutive year in which this report is published. The participation in this registry is anonymous and voluntary, and it is based on the analysis of the information gathered from 60 centers with activity in cardiovascular surgery in our country, and the confidentiality of the individual data of each center is warranted. It is certainly an important issue in which COVID-19 impact on cardiac surgical activity is analysed.The registry reports the global activity in our country, the observed mortality and the estimated mortality risk, stratified in different types of procedures.In 2020, 27.017 interventions were performed, with 17.880 of major heart surgery. Among these, 16.271 procedures were adult cardiac surgery and 1.609 of congenital heart surgery. Congenital heart surgery and cardiac transplant registries are specifically analysed in their corresponding reports.Among the 17.311 procedures of acquired major cardiac surgery, isolated valve surgery was predominant (6.766 procedures), followed by coronary by-pass surgery (4.239), aorta surgery (1.902). TAVI procedures were performed in 502 cases. Coronary surgery showed a 11% decrease in activity.The information derived from this national registry allows to know the state-of-the-art of the surgical specialty in our country, through the knowledge of the surgical activity, the risk profile and the observed results, which is a keystone for an adequate evaluation of the quality of the health care that we deliver to the patients affected with cardiovascular pathologies. Risk adjusted mortality seems adequately adjusted, though important local differences are observed.

Systemic autoimmune diseases are characteristically associated with aberrant autoreactive innate and adaptive immune responses that lead to tissue damage and increased morbidity and mortality. Autoimmunity has been linked to alterations in the metabolic functions of immune cells (immunometabolism) and, more specifically, to mitochondrial dysfunction. Much has been written about immunometabolism in autoimmunity in general, so this Essay focuses on recent research into the role of mitochondrial dysfunction in the dysregulation of innate and adaptive immunity that is characteristic of systemic autoimmune diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Enhancing the understanding of mitochondrial dysregulation in autoimmunity will hopefully contribute to accelerating the development of immunomodulatory treatments for these challenging diseases.

Resumen: Introducción y objetivo: Las valvulopatías congénitas comprenden un espectro amplio y heterogéneo de anomalías valvulares con una incidencia baja. Analizamos los resultados y la evolución de las valvuloplastias quirúrgicas múltiples de 2 o más válvulas de nuestro centro en los últimos 15 años. Métodos: Análisis retrospectivo de todas las valvuloplastias combinadas desde enero de 2007 hasta junio de 2021 en un centro de referencia de tercer nivel. Resultados: Se operaron 25 pacientes con una mediana de edad de 4 años en global: 8 adultos con mediana de edad de 54 años y 17 niños con mediana de edad de 13,5 meses. Veintidós pacientes presentaron insuficiencia mitral, 8 insuficiencia aórtica, 2 estenosis mitral y uno estenosis aórtica severa. Dieciocho pacientes presentaron insuficiencia tricuspídea. Se realizaron 16 plastias mitrotricuspídeas, 7 mitroaórticas, una tricúspide-pulmonar y una triple plastia mitroaortotricuspídea. Tres fallos primarios de valvuloplastia requirieron reintervención, con un fallecimiento. Tres pacientes requirieron marcapasos definitivo en el postoperatorio inmediato y un paciente presentó infarto perioperatorio por estenosis de la coronaria derecha secundario a un punto del anillo tricúspide. La mediana del seguimiento fue de 45,3 meses. No hubo fallecimientos tardíos. Dos pacientes se reintervinieron en el seguimiento. En el último ecocardiograma de seguimiento 2 presentan insuficiencia mitral severa, uno una insuficiencia aórtica moderada y otro una insuficiencia tricuspídea severa, todas clínicamente bien toleradas. Conclusión: La cirugía reparadora valvular múltiple en pacientes con cardiopatías congénitas es factible y tiene buenos resultados a corto-medio plazo. Se puede emplear como tratamiento definitivo o como terapia paliativa a favor del crecimiento anular. Abstract: Introduction and objective: Congenital heart valve disease is a wide and heterogeneous spectrum of valvular anomalies with low incidence. We analysed the results and follow-up of all our patients with 2 or more surgical heart valve repairs over a period of 15 years. Methods: We retrospectively analysed all combined valve repairs performed from January 2007 to June 2021 in a tertiary referral hospital. Results: Twenty-five patients were operated with a median age of 4 years: 8 adults with a median age of 54 years, and 17 children with a median age of 13.5 months. Twenty-two patients presented mitral regurgitation, 8 aortic regurgitation, 2 mitral stenosis, and one severe aortic stenosis. Eighteen patients presented tricuspid regurgitation. Sixteen mitro-tricuspid, 7 mitro-aortic, one tricuspid-pulmonary, and one triple mitro-aortic-tricuspid combined heart valve plasties were performed. Three primary plasty failures required reintervention, and one resulted in death. Three patients required a permanent pacemaker in the immediate postoperative course, and one suffered from perioperative myocardial infarction due to right coronary artery kinking secondary to a tricuspid ring suture. Median follow-up was 45.3 months, without late deaths. Two patients were reoperated during follow-up. In the last follow-up echocardiogram, 2 patients had severe mitral regurgitation, one moderate aortic regurgitation, and one severe tricuspid regurgitation, all of them clinically well tolerated. Conclusion: Heart valve plasties of 2 or more valves in patients with congenital heart disease is viable with good short-midterm results. It could be performed as a definitive solution or as palliative treatment in favour of annular growth.

Resumen: La enfermedad valvular reumática continúa siendo la causa más frecuente de afección valvular en los países en desarrollo. A pesar de las dificultades técnicas en este tipo de enfermedad en niños, la reparación valvular presenta mejores resultados a medio y largo plazo frente a la sustitución valvular en niños y adultos jóvenes.Presentamos 2 casos clínicos que ilustran la discusión acerca de las diferentes técnicas utilizadas en la reparación valvular mitral en este grupo de edades. Abstract: Rheumatic valve disease remains the most common cause of valve disease in developing countries. Despite the technical difficulties in this pathology in children, valve repair has shown better medium and long-term outcomes than valve replacement in children and young adults.We present two clinical cases that illustrate the discussion of the different techniques used in mitral valve repair in this age group.

National and international tests have yielded low reading comprehension results for education in Panama, although there is limited information regarding literacy development and performance. There are wide gaps in social inequality, access to technology, and public versus private school achievement. Considering this, after a year off from regular face-to-face classes and a partial transition to online education due to the COVID-19 pandemic, the present study utilizes existing data to carry out a pre-post comparison of the reading performance of fourth (n = 167) and sixth (n = 164) grade students in the province of Panama employing a subsample stratified by educational system for comparability (Mann–Whitney U test, α = 0.05). The pre-post comparison was also carried out independently in both the public (n = 235) and private (n = 106) systems, as well as an additional comparison of the average weekly hours of online academic engagement in both systems during the pandemic in fourth (n = 117) and sixth grade (n = 109). The results support a significant decrease in reading performance. Based on the comparative analysis, findings indicate that public school students interacted online with their teachers significantly less than their private schools’ counterparts; and that, in the same sample, only the public-school students exhibited a significant decrease in reading speed by phonological and lexical route with a medium effect size compared to pre-pandemic standards, greater than those reported in other contexts. This highlights the need to develop effective strategies to narrow the existing educational gaps in the country, which seem to have widened due to the pandemic, with particular emphasis on reading performance in primary school.

Introducción: los niños con tetralogía de Fallot afrontan grandes desafíos durante su etapa posoperatoria, por lo cual es necesario que el personal de enfermería reconozca los mecanismos involucrados en este proceso con el fin de contribuir a que estos alcancen un nivel de adaptación fisiológico y psicosocial integrado. Objetivo: establecer las intervenciones de enfermería para niños en posoperatorio paliativo o correctivo de tetralogía de Fallot. Materiales y método: a través de la metodología propuesta por Fawcett et al. y el Instituto Joanna Briggs, se realizó una búsqueda en diez bases de datos y motores de búsqueda de artículos publicados del 2014 al 2019 utilizando dos fórmulas: Pediatric AND Tetralogy of Fallot AND Postoperative y Pediatric AND Tetralogy of Fallot AND Postoperative AND Psychosocial Adaptation. Resultados: se obtuvieron 1.901 estudios, de los cuales 56 cumplieron todos los criterios de elegibilidad. Los resultados se estructuraron según el plan de atención de enfermería y se enmarcaron en los modos de adaptación y necesidades del modelo de adaptación de Callista Roy. Con la información obtenida, se construyeron doce diagnósticos NANDA correspondientes al modo de adaptación fisiológico y once al modo psicosocial. Conclusión: existe información relevante que permite establecer las intervenciones de cuidado desde el campo de acción para enfermería en este contexto de unidad de cuidado intensivo pediátrico, ya que se obtuvieron intervenciones para abordar todas las necesidades que el modelo epistemológico plantea.

Sustainability requires a combination of meaningful co-production of locally relevant solutions, synthesis of insights gained across regions, and increased cooperation between science, policy and practice. The Programme for Ecosystem Change and Society (PECS) has been coordinating Place-Based Social-Ecological Sustainability Research (PBSESR) across the globe and emphasizes the need for regional scientific nodes from diverse biocultural regions to inform sustainability science and action. In this paper, we assess the strengths of the PBSESR communities in Latin America and the Caribbean (LAC). We provide an overview of PBSESR literature associated with this region and highlight the achievements of two prominent regional networks: The Social-Ecological Systems and Sustainability Research Network from Mexico (SocioEcoS) and the South American Institute for Resilience and Sustainability Studies from Uruguay (SARAS Institute). Finally, we identify the potential in these nodes to constitute a regional PECS node in Latin America and discuss the capacity needed to ensure such function. The results of the literature review show that while still loosely interconnected across the region, networks play key roles in connecting otherwise cloistered teams and we illustrate how the SocioEcoS network (focusing on transdisciplinary co-production of knowledge towards sustainability) and the SARAS Institute (focusing on innovative approaches for looking at complex social-ecological problems, rooted in slow science and arts) operate as key connectors in the region. We conclude that these organizations combined can embody a Latin American node for PECS, and would thereby not only contribute to regional but also global capacities to advance the sustainability agenda.

The purpose of this study was to implement the Content and Language Integrated Learning (CLIL) approach employing online games for English as a Foreign Language (EFL) teaching and learning. The participants were 53 EFL Ecuadorian university students, 17 males and 36 females, who were enrolled in an English Major and a TEFL Master program. Their proficiency level corresponded to B2 according to the Common European Framework of Reference. The study followed a mixed-method approach, which involved the administration of a diagnostic survey, an online perceptions questionnaire, an interview, and an observation checklist. Games designed in Quizizz, Kahoot, Genially, and Socrative were implemented for 8 weeks so that the participants could access them to practice the content of each lesson. The findings revealed that the CLIL approach through games improves language learning and communication. Moreover, they foster students' confidence, knowledge retention, and comprehension of the subject matter, enhancing reasoning, problem-solving, critical thinking, and cultural awareness.

The adoption of learning analytics (LA) in higher education institutions (HEIs) in Mexico is still at an early stage despite increasing global interest and advances in the field. The use of educational data remains a challenging puzzle for many universities, which strive to provide students, teachers, and institutional administrators with information and insights to better understand their performance. The objective of this study was to identify the perspectives of teachers, students, and administrators about the use of educational data to explore opportunities for the adoption and integration of LA in three different Mexican universities. A qualitative approach was used, adopting instruments and guidelines previously developed in the framework of Learning Analytics for Latin America (LALA) project, adapting them to the Mexican context. Methods included (1) structured interviews with high-level institutional administrators and (2) focus groups with students, teachers, and other educational administrators. Results showed that perceptions are oriented toward improving school performance through data-based feedback, with ethical responsibility. Emergent categories were physical and mental health, development of healthy relationships and well-being, feedback style, and governance in a bureaucratic setting. The specific modern construct of LA still needs to be internalized and disseminated to Mexican universities' educational stakeholders to increase the likelihood of successful adoption.

Introduction : L’évaluation de l’état de santé effectuée par une infirmière joue un rôle clé dans le parcours de rétablissement d’une personne avec une problématique de santé mentale. Or, l’application d’une telle évaluation centrée sur les besoins d’une personne avec une problématique de santé mentale demeure un défi pour plusieurs infirmières exerçant dans un contexte de santé communautaire. Objectifs : Décrire le processus de développement d’un programme visant à 1) renforcer les capacités des infirmières en santé communautaire à appliquer les bonnes pratiques en matière d’évaluation infirmière auprès des personnes avec une problématique de santé mentale; et 2) renforcer les capacités des acteurs de soutien à accompagner les infirmières dans l’application des bonnes pratiques d’évaluation. Démarche et évaluation : Une recherche participative de type laboratoire vivant a été privilégiée pour développer le programme en partenariat avec des acteurs de soutien clinique d’un établissement de santé du Québec. Le programme est développé en trois phases : 1) La phase de conceptualisation a permis de faire émerger un premier modèle du programme impliquant les stratégies suivantes : auto-évaluation de sa pratique, formation didactique, réflexions de groupe et individuelles, discussion de cas clinique et rétroaction. 2) La phase de prototypage (automne 2022) sera effectuée avec environ 6 infirmières et 3 acteurs de soutien qui seront invités à discuter de la faisabilité et de l’acceptabilité des stratégies initiales. 3) Le développement final sera réalisé (hiver 2023) avec une trentaine d’infirmières et acteurs de soutien afin d’affiner les stratégies et activités de même que de documenter les effets perçus du programme. Retombées anticipées : Le projet permettra, entre autres, de former des leaders et champions en matière d’évaluation infirmière pour les personnes vivant avec des problématiques de santé mentale au sein des organisations, mais également de mieux comprendre l’impact des stratégies de soutien clinique sur la qualité des pratiques infirmières.

Background: The coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known. Objectives: This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia. Methods: The International Atomic Energy Agency conducted a worldwide survey to assess changes in cardiovascular procedure volume and safety practices caused by COVID-19. Testing volumes were reported for March 2020 and April 2020 and were compared to those from March 2019. Data from 180 centers across 33 Asian countries were grouped into 4 subregions for comparison. Results: Procedure volumes decreased by 47% from March 2019 to March 2020, showing recovery from March 2020 to April 2020 in Eastern Asia, particularly in China. The majority of centers cancelled outpatient activities and increased time per study. Practice changes included implementing physical distancing and restricting visitors. Although COVID testing was not commonly performed, it was conducted in one-third of facilities in Eastern Asia. The most severe reductions in procedure volumes were observed in lower-income countries, where volumes decreased 81% from March 2019 to April 2020. Conclusions: The COVID-19 pandemic in Asia caused significant reductions in cardiovascular diagnostic procedures, particularly in low-income countries. Further studies on effects of COVID-19 on cardiovascular outcomes and changes in care delivery are warranted.

Resumen: La Sociedad Española de Cirugía Cardiovascular y Endovascular muestra los datos de actividad en pacientes con cardiopatía congénita del período temporal 2012-2019 basándose en un registro voluntario y anónimo de los centros españoles. Este manuscrito es complementario al registro general del año 2019 y ambos son publicados de manera conjunta. Presentamos datos de los últimos 8 años que reflejan mejor nuestros resultados con estas patologías relativamente infrecuentes. En este período se realizaron 16.917 cirugías de cardiopatías congénitas, que supone el 9,7% de la cirugía mayor (congénita + adquirida) realizada en nuestro país durante ese tiempo. El 81% de las cirugías congénitas se hicieron con circulación extracorpórea y el 19% sin ella. Destacamos las intervenciones en neonatos y en adultos por su elevada complejidad, que supusieron respectivamente el 18 y el 21% de la actividad total. Las cardiopatías congénitas operadas más prevalentes continúan siendo los defectos septales en los casos que requieren circulación extracorpórea, y los ductus en pacientes operados sin circulación extracorpórea. Presentamos los datos ajustados a la escala Aristóteles básico de riesgo quirúrgico preoperatorio. La mortalidad observada en cirugías con circulación extracorpórea fue del 3,06% (Aristóteles: 6,72), y en cirugías sin circulación extracorpórea del 2,41% (Aristóteles: 4,79). Este registro muestra con precisión datos de nuestra actividad quirúrgica en cardiopatías congénitas y permite comparaciones, a nivel tanto nacional como internacional, para establecer estrategias de mejora de nuestros resultados. Abstract: The Spanish Society of Cardiovascular & Endovascular Surgery presents the 2012-2019 report of the activity in congenital cardiovascular surgery, based on a voluntary and anonymous registration involving the majority of Spanish centres. This article is complementary to the 2019 cardiovascular surgery annual report, and they are published together. Data from the previous 8 years are included, in order to obtain real information related to our activity in these relatively scarce pathologies. In the last eight years, a total of 16,917 congenital heart surgeries were performed, accounting for 9.7% of major surgery (congenital + acquired) performed in Spain during that period. Of these surgeries, 81% of them required extracorporeal circulation and 19% not. We highlight the interventions in neonates and adult patients, which represent respectively 18% and 21% of the whole activity, and are a real challenge. The most prevalent congenital heart pathologies operated on were septal defects in cases requiring extracorporeal circulation, and ductus in patients not requiring extracorporeal circulation. The presented data are adjusted to the basic Aristotle score of preoperative surgical risk. The observed mortality of surgeries with extracorporeal circulation was 3.06% (Aristotle: 6.72), and without cardiopulmonary bypass 2.41% (Aristotle: 4.79). This data analysis show accurate and reliable information about our surgery for congenital heart disease and allow us to compare ourselves within an international framework, and to organize strategies directed to improve our results.

Resumen: El presente registro aporta los datos correspondientes a la actividad de cirugía cardiovascular realizada en España durante el año 2019. Se trata del trigésimo primer año en el que, desde la recién renombrada Sociedad Española de Cirugía Cardiovascular y Endovascular, se procede a la comunicación de los datos de la actividad en el territorio nacional. Por primera vez en los últimos 15 años, se rompe una tendencia creciente de participación de centros y baja el número de participantes. Se trata de un registro anónimo y voluntario de datos agregados en el que han colaborado 57 hospitales, transfiriendo sus datos al registro nacional, por los 62 centros que comunicaron su actividad durante el año 2018.El presente registro recoge un total de 33.660 cirugías. Se realizaron 21.525 procedimientos de cirugía cardiaca mayor (19.657 de cirugía cardiaca adquirida y 1.868 de cirugía cardiaca mayor congénita). De estos procedimientos, 19.221 se efectuaron con circulación extracorpórea (CEC).Como en registros previos, tanto la cirugía cardiaca congénita como el trasplante cardiaco disponen de su propio registro.La cirugía cardiaca mayor de patología adquirida se reparte de la siguiente manera: la cirugía univalvular aislada fue la más frecuente, una vez más, con 8.607 casos, seguida de la cirugía coronaria con 4.734 casos (3.415 con CEC y 1.443 sin CEC). Se registraron 2.315 procedimientos sobre la aorta y 1.983 casos de cirugía combinada. También se reflejan, en el presente informe, datos de implante de prótesis transcatéter, cirugía vascular periférica e implante de dispositivos de electroestimulación.Por primera vez en la serie histórica del registro, el número de implantes valvulares aórticos aislados es inferior al documentado en el registro cardiológico, pudiendo así afirmar que se implantan más prótesis transcatéter que «puramente» quirúrgicas, según los datos disponibles en 2019.Por último, se informa de diversos datos de distribución geográfica de la actividad quirúrgica a nivel nacional. Abstract: The Spanish Society of Cardiovascular and Endovascular Surgery (SECCE) reports the results of the 2019 registry of the surgical activity in our country. This year represents the 31th consecutive year in which this report is published. The participation in this registry is anonymous and voluntary, and it is based on the analysis of the information gathered from 57 centers with activity in cardiovascular surgery in our country, and the confidentiality of the individual data of each center is warranted. For the first time, in the last 15 years, a tendency is broken and fewer hospitals have communicated their activity. In certain cases, estimations have to be calculated in order to make comparisons possible. The registry reports the global activity in our country, the observed mortality and the estimated mortality risk, stratified in different types of procedures.The global cardiac surgical activity in our country remains stable, with an observed mortality that is adequately adjusted to the estimated surgical risk.During 2019, a total of 33,660 procedures of cardiovascular surgery were performed. Major heart surgery was performed in 21,525 cases, among which 19,657 procedures of adult cardiac surgery and 1,868 procedures of congenital cardiac surgery. Out of those, 19,221 procedures were performed under extracorporeal circulation (CEC). Congenital and transplant registries are specifically analysed in their corresponding reports.Among the 19,720 procedures of acquired major cardiac surgery, isolated valve surgery was predominant (8,607 procedures), followed by coronary by-pass surgery (4,734), aorta surgery (2,315) and combined coronary-valvular surgery (1,983). Vascular surgery and transcatheter activity are also reported.The information derived from this national registry allows to know the state-of-the-art of the surgical specialty in our country, through the knowledge of the surgical activity, the risk profile and the observed results, which is a keystone for an adequate evaluation of the quality of the health care that we deliver to the patients affected with cardiovascular pathologies. Risk adjusted mortality seems adequately adjusted, though important local differences are observed.

Las actividades académicas, como los congresos, son muy importantes para la investigación y el desarrollo; sin embargo, las emisiones de carbono derivadas de la realización de eventos presenciales han mostrado estar muy por encima de las que producen eventos en línea. El objetivo de este trabajo fue estimar las emisiones generadas por el 5º Congreso Nacional y 1º Internacional de Ciencias Ambientales “Las Ciencias Ambientales en el Antropoceno”, celebrado virtualmente, en su mayor parte. Se estimaron las emisiones del uso directo de computadores y de software (emisiones de los computadores, emisiones de la transferencia de los datos) y las emisiones de otras fuentes (reuniones de los organizadores, búsquedas y visitas a la página Web, uso de monitores externos y lámparas), así como las emisiones evitadas por transporte aéreo y terrestre. El congreso emitió 4,8 tCO2eq y evitó 33 tCO2eq. El desarrollo de eventos online o híbridos es más sostenible ambientalmente y podría ser más accesibles, a un mayor número de personas

Despite rising participation rates in Portugal, a gap persists between general and vocational upper secondary students' transition to higher education (HE). This study employs a qualitative methodology, specifically through content analysis of focus group discussions, to explore the factors influencing vocational students' reluctance towards higher education, amidst specific policies designed to aid their transition. Empirical findings suggest that vocational students may exhibit reservations stemming from self-perceived academic deficiencies, impacting their self-confidence in continuing their education at a HE level. Nevertheless, confidence in market-valued practical skills might motivate HE consideration within a vocational domain. Their practical focus also makes HE seem less immediately applicable in the labour market. Many prioritise integration into the workforce for short-run objectives, seeking breaks, experience and financial earnings. Aiming for earning and practicality, many lean towards the labour market over HE, even considering emigrating to achieve financial stability. The study emphasises the need for Portuguese educational policies to align vocational training with HE, supporting diverse student ambitions and holistic career paths.

As increasing numbers of Black immigrant students attend schools in Chile, we examine classroom practices to consider the limits of the mathematics education equity promise for this student population. We focus on the practices of a third-grade teacher who participated in professional development for enhancing reform-based mathematics teaching in a racially diverse classroom. Drawing on Stuart Hall's approach to race, our analysis shows how two technologies of race-power fabricate the Black immigrant child as an uneducable and impossible mathematics learner. We contend that rather than enhancing the inclusion of Black immigrant students, reform-based mathematics teaching might maintain and reinforce racial hierarchies of mathematics ability.

Resumen: Implantar asistencias ventriculares (AV) en situaciones anatómicas no convencionales asociadas a cardiopatía congénita puede constituir un problema para obtener un funcionamiento óptimo de la AV. Reparar la cardiopatía al mismo tiempo puede solventar estos inconvenientes.Describimos un caso de un niño de 3 años afecto de insuficiencia cardiaca terminal, secundaria a miocardiopatía restrictiva, y de drenaje venoso pulmonar anómalo parcial (DVPAP) derecho donde se realizó una intervención conjunta para la resolución del DVPAP y la colocación de una AV izquierda como puente a trasplante, ya que, el implante de una AV aislada habría dejado sin reparar un cortocircuito importante izquierda-derecha, que alteraría el funcionamiento de la AV.El empleo de AV en pacientes con insuficiencia cardiaca terminal y cardiopatía congénita, como puente al trasplante, es una alternativa terapéutica que en ciertas ocasiones precisa la reparación de las anomalías congénitas para lograr un funcionamiento óptimo de la asistencia. Abstract: Implantation of heart ventricular assists device (VAD) in unconventional anatomical situations associated with congenital heart disease may be a problem to obtain optimal functioning of the VAD. Repairing heart disease at the same time can solve these problems.We describe the case of a 3-year-old boy with end-stage heart failure, secondary to restrictive cardiomyopathy, and partial right-sided abnormal pulmonary venous connection (PAPVC), where a joint intervention was performed to resolve PAPVC and the placement of a left VAD as bridge to transplant, since the implantation of an isolated VAD would have left without repair a major left-right shunt, which would alter the functioning of the VAD.The use of VAD in patients with end-stage heart failure and congenital heart disease, as a bridge to transplantation, is a therapeutic alternative that sometimes requires the repair of congenital anomalies to achieve optimal performance.

Resumen: Objetivos: Valorar si el peso ≤ 2,5 kg supone un incremento en la morbimortalidad de la cirugía cardiaca neonatal bajo circulación extracorpórea (CEC) y caracterizar este grupo de pacientes. Métodos: Estudio retrospectivo de todos los neonatos sometidos a una primera cirugía cardiaca con CEC entre 2007 y 2019, analizando los factores independientes de morbimortalidad. Resultados: Cuarenta y nueve pacientes ≤ 2,5 kg vs. 246 > 2,5 kg, sin diferencias significativas con relación a la edad en el momento de la reparación, aunque sí en la prematuridad y el sexo femenino, mayores en ≤ 2,5 kg. Los diagnósticos más frecuentes fueron hipoplasia del arco y truncus en ≤ 2,5 kg, y transposición de grandes arterias e hipoplasia de arco en > 2,5 kg. El tiempo de CEC y el uso de parada circulatoria fueron significativamente mayores en ≤ 2,5 kg. A pesar de que el grupo ≤ 2,5 kg tuvo una mortalidad mayor (22,4 vs. 8,1%; p 2,5 kg. El análisis de la prematuridad no mostró incremento significativo de morbimortalidad. Conclusiones: A pesar de los avances en el manejo peri-extracorpórea en ≤ 2,5 kg, disminuyendo la mortalidad en algunas enfermedades, el bajo peso sigue asociándose a aumento de mortalidad. El momento de cuándo intervenir deberá individualizarse por paciente, diagnóstico y resultados del propio centro. Abstract: Objectives: Evaluate whether a weight ≤2.5 kg carries an increase in morbi-mortality in neonatal cardiac surgery under cardiopulmonary bypass (CPB) and stablish the profile of these patients. Methods: Retrospective study of the neonates who underwent the first cardiac surgery under CPB between 2007-2019, analyzing independent risk factors for morbi-mortality. Results: Group of patients ≤2.5 kg: n = 49. Group of patients >2.5 kg: n = 246. No statistical differences found in age, although there were in prematurity and female sex, which were more frequent in ≤2.5 kg. Most frequent diagnosis in ≤2.5 kg was arch hypoplasia and truncus versus transposition of the great arteries (TGA) and arch hypoplasia in >2.5 kg. Cardiopulmonary bypass time and the use of circulatory arrest were significantly higher in ≤2.5 kg. Although ≤2.5 kg group presented a greater mortality (22.4 vs 8.1% p

Resumen: Introducción: Los objetivos son analizar las alteraciones neuropsicológicas a medio plazo de los niños intervenidos del arco aórtico mediante perfusión cerebral selectiva (PCS) y detectar posibles factores modificables en la técnica quirúrgica que pueden ayudar a minimizar la afectación neurológica posterior. Material y métodos: Se establecieron como criterios de inclusión: patología del arco aórtico intervenida mediante PCS durante el primer año de vida, entre el 10 de agosto del 2004 y el 24 de mayo del 2016, fisiología biventricular y edad gestacional mayor de 31 semanas. En ausencia de cromosomopatía, se clasificaron desde el punto de vista neurológico siguiendo el modified Rankin score. En mayores de 4 años se realizaron estudios de inteligencia, nivel de atención, maduración y aptitudes psicolingüísticas. Resultados: Se incluyeron ochenta y dos pacientes, cuya edad media en el momento de la cirugía fue de 1,8 meses. El flujo medio en PCS fue de 32 ml/kg/min. El tiempo medio de PCS fue de 31 min. La mortalidad global de la serie fue del 14,8%. Con disfunción neurológica se observaron un 35,9% y se detectaron como factores de riesgo: cirugía en menores de 10 días de edad, duración de PCS mayor de 40 min y la duración del enfriamiento o calentamiento. Un 35,2% de los pacientes mayor de 5 años fueron diagnosticados de déficit de atención. Conclusiones: Los pacientes intervenidos en el primer año de vida con PCS precisan un seguimiento neuropsicológico y hay factores modificables quirúrgicos que pueden influir en el desarrollo neurológico. Abstract: Introduction: The aims of this article are to analyse the neuropsychological changes in the medium–term in children subjected to aortic arch surgery using selective cerebral perfusion (SCP), as well as to detect any modifiable factors in the surgical technique that may contribute to minimising the subsequent neurological involvement. Material and methods: Inclusion criteria were established as: aortic arch disease operated on using SCP during the first year of life, between 10 August 2004 and 24 May 2016, biventricular physiology, and gestational age greater than 31 weeks.In the absence of a chromosomal disease, they were classified, from a neurological point of view, using the Rankin score. Children over 4-years of age were subjected to intelligence studies, including attention level, development, and psycho-lingual skills. Results: The study included a total of 82 patients with a mean age of 1.8 months. The mean SCP flow was 32 ml/kg/min. The mean time of SCP was 31 minutes. The overall mortality of the series was 14.8%. Neurological dysfunction was observed in 35.9% of patients, and the following were detected as risk factors: surgery in patients less than 10-days-old, duration of SCP greater than 40 minutes, and the time required for the cooling down and/or warming-up. Attention deficit was diagnosed in 35.2% of patients greater than 5-years-old. Conclusions: Patients operated on using SCP in in the first year of life required a neuropsychological follow-up, and there are modifiable surgical factors that may have an influence on neurological development.

Introduction: The aims of this article are to analyse the neuropsychological changes in the medium–term in children subjected to aortic arch surgery using selective cerebral perfusion (SCP), as well as to detect any modifiable factors in the surgical technique that may contribute to minimising the subsequent neurological involvement. Material and methods: Inclusion criteria were established as: aortic arch disease operated on using SCP during the first year of life, between 10 August 2004 and 24 May 2016, biventricular physiology, and gestational age greater than 31 weeks. In the absence of a chromosomal disease, they were classified, from a neurological point of view, using the Rankin score. Children over 4-years of age were subjected to intelligence studies, including attention level, development, and psycho-lingual skills. Results: The study included a total of 82 patients with a mean age of 1.8 months. The mean SCP flow was 32 ml/kg/min. The mean time of SCP was 31 min. The overall mortality of the series was 14.8%. Neurological dysfunction was observed in 35.9% of patients, and the following were detected as risk factors: surgery in patients less than 10-days-old, duration of SCP greater than 40 min, and the time required for the cooling down and/or warming-up. Attention deficit was diagnosed in 35.2% of patients greater than 5-years-old. Conclusions: Patients operated on using SCP in in the first year of life required a neuropsychological follow-up, and there are modifiable surgical factors that may have an influence on neurological development. Resumen: Introducción: Los objetivos son analizar las alteraciones neuropsicológicas a medio plazo de los niños intervenidos del arco aórtico mediante perfusión cerebral selectiva (PCS) y detectar posibles factores modificables en la técnica quirúrgica que pueden ayudar a minimizar la afectación neurológica posterior. Material y métodos: Se establecieron como criterios de inclusión: patología del arco aórtico intervenida mediante PCS durante el primer año de vida, entre el 10 de Agosto de 2004 y el 24 de Mayo de 2016, fisiología biventricular y edad gestacional mayor de 31 semanas. En ausencia de cromosomopatía se clasificaron desde el punto de vista neurológico siguiendo el modified Rankin score. En mayores de 4 años se realizaron estudios de inteligencia, nivel de atención, maduración y aptitudes piscolingüisticas. Resultados: 82 pacientes se incluyeron, cuya edad media en el momento de la cirugía fue de 1,8 meses. El Flujo medio en PCS fue de 32 ml/kg/min. El tiempo medio de PCS fue de 31 minutos. La mortalidad global de la serie fue de 14,8 %. Con disfunción neurológica se observaron un 35,9 % y se detectaron como factores de riesgo: cirugía en menores de 10 días de edad, duración de PCS mayor de 40 minutos y la duración del enfriamiento y/o calentamiento. Un 35,2 % de los pacientes mayor de 5 años fueron diagnosticados de déficit de atención. Conclusiones: Los pacientes intervenidos en el primer año de vida con PCS precisan un seguimiento neuropsicológico y hay factores modificables quirúrgicos que pueden influir en el desarrollo neurológico.

BACKGROUND Fasting and NAD+-boosting compounds, including NAD+ precursor nicotinamide riboside (NR), confer antiinflammatory effects. However, the underlying mechanisms and therapeutic potential are incompletely defined.METHODS We explored the underlying biology in myeloid cells from healthy volunteers following in vivo placebo or NR administration and subsequently tested the findings in vitro in monocytes extracted from patients with systemic lupus erythematosus (SLE).RESULTS RNA-Seq of unstimulated and LPS-activated monocytes implicated NR in the regulation of autophagy and type I IFN signaling. In primary monocytes, NR blunted LPS-induced IFN-β production, and genetic or pharmacological disruption of autophagy phenocopied this effect. Given that NAD+ is a coenzyme in oxidoreductive reactions, metabolomics was performed and identified that NR increased the inosine level. Inosine supplementation similarly blunted autophagy and IFN-β release. Finally, because SLE exhibits type I IFN dysregulation, we assessed the NR effect on monocytes from patients with SLE and found that NR reduced autophagy and IFN-β release.CONCLUSION We conclude that NR, in an NAD+-dependent manner and in part via inosine signaling, mediated suppression of autophagy and attenuated type I IFN in myeloid cells, and we identified NR as a potential adjunct for SLE management.TRIAL REGISTRATION ClinicalTrials.gov registration numbers NCT02812238, NCT00001846, and NCT00001372.FUNDING This work was supported by the NHLBI and NIAMS Intramural Research divisions.