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BackgroundThe incidence of incisional hernia following laparotomy varies between 2% and 30%. It is well-established that the need to control several risk factors prior to surgery exists (weight loss before surgery, diabetes control). Postoperative abdominal binder (AB) is often recommended by surgeons, yet evidence on this topic is lacking. The aim of this review was to present current evidence on the use of abdominal binders after abdominal surgery.Material and MethodsA comprehensive literature review between January and May 2024 was conducted using a range of search engines, including PubMed, Science Direct, EMBASE, Google Scholar, and Google. The following keywords were used: “abdominal binder,” “abdominal support,” “hernia,” “girdle and hernia,” “compression belt and hernia,” and “abdominal support and hernia.”ResultsSixteen articles were selected for further analysis (7 RCTs, 6 non-RCTs and 3 meta-analyses). None of the studies reported a reduction in the incidence of abdominal dehiscence or incisional hernia. Postoperative use of the AB has been shown to reduce postoperative discomfort and pain for a limited period of up to 48–72 h. There was no discernible difference in the incidence of surgical site complications.ConclusionThe current evidence indicates that the use of AB following abdominal surgery is safe, although no benefit has been established (except 48 h after surgery). AB may enhance comfort in select patients; however, further studies are necessary to justify their routine use, with a particular focus on the medical and economic implications.

Objective:. To evaluate the diagnostic accuracy of drain fluid lipase as an early predictor of postoperative pancreatic fistula and establish the most appropriate day for their measure. Background:. Clinically relevant postoperative pancreatic fistula remains a potentially life-threatening complication after pancreatic surgery. Early detection strategies remain key to reduce both the incidence and the burden of pancreatic fistula. Methods:. The LIPAse DRAIN (LIPADRAIN) study is a multicenter, prospective diagnostic study conducted in 7 tertiary university hospitals. Drain fluid values to detect clinically relevant postoperative pancreatic fistula from postoperative day 1 to postoperative day 6 were evaluated using receiver operating characteristic curve analysis. A biomarker was considered to be relevant for clinical use if its area under the curve (AUC) was greater than 0.75. Results:. Of the 625 patients included in the analysis, clinically relevant postoperative pancreatic fistula occurred in 203 (32%) patients. On postoperative days 3 and 4, drain fluid lipase was a reliable biomarker to detect clinically relevant postoperative pancreatic fistula (AUC: 0.761; 95% confidence interval [CI]: 0.761–0.799 and AUC: 0.784; 95% CI: 0.743–0.821, respectively). On postoperative day 3, with a threshold of 299 units/L, drain fluid lipase yielded a negative predictive value of 51%, sensitivity of 78%, and specificity of 63% for the detection of clinically relevant postoperative pancreatic fistula. Conclusions:. In this multicenter prospective study, drain fluid lipase is a reliable biomarker at postoperative days 3 and 4 for the diagnosis of clinically relevant postoperative pancreatic fistula after pancreatic surgery and should be systematically measured on postoperative day 3.

Abstract In this paper, we employ a general relativistic formalism and develop new theoretical tools that allow us to analytically express the mass and electric charge of the Reissner–Nordström black hole as well as its distance to a distant observer in terms of few directly observable quantities, such as the total frequency shift, aperture angle of the telescope, and redshift rapidity. Our analytic and concise formulas are valid on the midline, and the redshift rapidity is a relativistic invariant observable that represents the evolution of the frequency shift with respect to the proper time in the Reissner–Nordström spacetime. This procedure is applicable for particles undergoing circular motion around a spherically symmetric and electrically charged black hole, which is the case for accretion disks orbiting supermassive black holes hosted at the core of active galactic nuclei. Although this type of black hole is expected to be electrically neutral, our results provide a novel method to measure the electric charge of the Reissner–Nordström black hole, hence can shed some light on this claim. Besides, these results allow us to measure the mass of the black hole and its distance from the Earth, and we can employ the general formulas in black hole parameter estimation studies.

This work highlights the impact of growth temperature on the electrical and optical properties of Al-doped ZnO (AZO) films deposited by the atomic layer deposition (ALD) technique. The ALD process and super-cycle sequence have been optimized, identifying their influence on film resistivity. By using this optimum ALD procedure, the optical and electrical properties of AZO films have been widely analyzed considering the deposition temperature. Results show promising values with film resistivity in the range of 1 mΩcm and average optical absorption below 2% for 50 nm thick AZO layers. Hall effect, X-ray diffraction and ellipsometry measurements point out that these excellent values are related to their high carrier concentration and mobility, crystalline phase and optical band gap, resulting in ALD AZO films with excellent properties to be applied in photovoltaic devices as transparent conductive oxide electrode.

Abstract Numerical Earth System Models (ESMs) are our best tool to predict the evolution of atmospheric CO2 concentration and its effect on Global temperature. However, large uncertainties exist among ESMs in the variance of the year-to-year changes of atmospheric CO2 concentration. This prevents us from precisely understanding its past evolution and from accurately estimating its future evolution. Here we analyze various ESMs simulations from the 6th Coupled Model Intercomparison Projects (CMIP6) to understand the origins of the inter-model uncertainty in the interannual variability of the atmospheric CO2 concentration. Considering the observed period 1986-2013, we show that most of this uncertainty is coming from the simulation of the land CO2 flux internal variability. Although models agree that those variations are driven by El Niño Southern Oscillation (ENSO), similar ENSO-related surface temperature and precipitation teleconnections across models drive different land CO2 fluxes, pointing to the land vegetation models as the dominant source of the inter-model uncertainty.

Abstract Marine Ecosystem Models (MEMs) are increasingly driven by Earth System Models (ESMs) to better understand marine ecosystem dynamics, and to analyze the effects of alternative management efforts for marine ecosystems under potential scenarios of climate change. However, policy and commercial activities typically occur on seasonal‐to‐decadal time scales, a time span widely used in the global climate modeling community but where the skill level assessments of MEMs are in their infancy. This is mostly due to technical hurdles that prevent the global MEM community from performing large ensemble simulations with which to undergo systematic skill assessments. Here, we developed a novel distributed execution framework constructed of low‐tech and freely available technologies to enable the systematic execution and analysis of linked ESM/MEM prediction ensembles. We apply this framework on the seasonal‐to‐decadal time scale, and assess how retrospective forecast uncertainty in an ensemble of initialized decadal ESM predictions affects a mechanistic and spatiotemporal explicit global trophodynamic MEM. Our results indicate that ESM internal variability has a relatively low impact on the MEM variability in comparison to the broad assumptions related to reconstructed fisheries. We also observe that the results are also sensitive to the ESM specificities. Our case study warrants further systematic explorations to disentangle the impacts of climate change, fisheries scenarios, MEM internal ecological hypotheses, and ESM variability. Most importantly, our case study demonstrates that a simple and free distributed execution framework has the potential to empower any modeling group with the fundamental capabilities to operationalize marine ecosystem modeling.

Introduction: Children’s walking patterns evolve with age, exhibiting less repetitiveness at a young age and more variability than adults. Three-dimensional gait analysis (3DGA) is crucial for understanding and treating lower limb movement disorders in children, traditionally performed using Optical Motion Capture (OMC). Inertial Measurement Units (IMUs) offer a cost-effective alternative to OMC, although challenges like drift errors persist. Machine learning (ML) models can mitigate these issues in adults, prompting an investigation into their applicability to a heterogeneous pediatric population. This study aimed at 1) quantifying personalized and generalized ML models’ performance for predicting gait time series in typically developed (TD) children using IMUs data, 2) Comparing random forest (RF) and convolutional neural networks (CNN) models’ performance, 3) Finding the optimal number of IMUs required for accurate predictions.Methodology: Seventeen TD children, aged 6 to 15, participated in data collection involving OMC, force plates, and IMU sensors. Joint kinematics and kinetics (targets) were computed from OMC and force plates’ data using OpenSim. Tsfresh, a Python package, extracted features from raw IMU data. Each target’s ten most important features were input in the development of personalized and generalized RF and CNN models. This procedure was initially conducted with 7 IMUs placed on all lower limb segments and then performed using only two IMUs on the feet.Results: Findings suggested that the RF and CNN models demonstrated comparable performance. RF predicted joint kinematics with a 9.5% and 19.9% NRMSE for personalized and generalized models, respectively, and joint kinetics with an NRMSE of 10.7% for personalized and 15.2% for generalized models in TD children. Personalized models provided accurate estimations from IMU data in children, while generalized models lacked accuracy due to the limited dataset. Furthermore, reducing the number of IMUs from 7 to 2 did not affect the results, and the performance remained consistent.Discussion: This study proposed a promising personalized approach for gait time series prediction in children, involving an RF model and two IMUs on the feet.

Introduction

Due to large northward heat transport, the Atlantic meridional overturning circulation (AMOC) strongly affects the climate of various regions. Its internal variability has been shown to be predictable decades ahead within climate models, providing the hope that synchronizing ocean circulation with observations can improve decadal predictions, notably of the North Atlantic subpolar gyre (SPG). Climate predictions require a starting point which is a reconstruction of the past climate. This is usually performed with data assimilation methods that blend available observations and climate model states together. There is no unique method to derive the initial conditions. Moreover, this can be performed using full-field observations or their anomalies superimposed on the model's climatology to avoid strong drifts in predictions. How critical ocean circulation drifts are for prediction skill has not been assessed yet. We analyze this possible connection using the dataset of 12 decadal prediction systems from the World Meteorological Organization Lead Centre for Annual-to-Decadal Climate Prediction. We find a variety of initial AMOC errors within the predictions related to a dynamically imbalanced ocean states leading to strongly displaced or multiple maxima in the overturning structures. This likely results in a blend of what is known as model drift and initial shock. We identify that the AMOC initialization influences the quality of the SPG predictions. When predictions show a large initial error in their AMOC, they usually have low skill for predicting internal variability of the SPG for a time horizon of 6-10 years. Full-field initialized predictions with low AMOC drift show better SPG skill than those with a large AMOC drift. Nevertheless, while the anomaly-initialized predictions do not experience large drifts, they show low SPG skill when skill also present in historical runs is removed using a residual correlation metric. Thus, reducing initial shock and model biases for the ocean circulation in prediction systems might help to improve their prediction for the SPG beyond 5 years. Climate predictions could also benefit from quality-check procedure for assimilation/initialization because currently the research groups only reveal the problems in initialization once the set of predictions has been completed, which is an expensive effort.

Summary: Background: Acute appendicitis is the most common digestive disease requiring emergency surgery. Colorectal cancer is the third most common cancer in France. An increased risk of colorectal cancer after acute appendicitis has been suggested. We aimed to assess the frequency of hospitalization for colon cancer after appendicitis in a nationwide analysis. Methods: Using the French Hospital Discharge Database (PMSI), we included all patients aged 18–59 years presenting with acute appendicitis between 2010 and 2015. Univariate and multivariate analyses were performed to compare colon cancer occurrence in these patients vs a control-matched population with a hospital stay for trauma in the same period. Patients presenting strong risk factors for colorectal cancer were excluded. Findings: A total of 230,349 patients with acute appendicitis (exposed group) were included. We used a propensity score to match each exposed patient with two unexposed patients (controls) to ensure the comparability of the groups, resulting in a control group of 460,698 patients. Univariate analysis found significantly more colon cancer in the appendicitis group, especially during the first year after appendicitis (5 per 10,000 vs 1 per 10,000, p

Book review

This study presents a last millennium reconstruction of Atlantic Multidecadal Variability fluctuations. This sufficiently long and validated reconstruction suggests the potential approach of a tipping point in the North Atlantic current system.

Abstract Future precipitation changes are typically estimated from climate model simulations, while the credibility of such projections needs to be assessed by their ability to capture observed precipitation changes. Here we evaluate how skillfully historical climate simulations contributing to the Coupled Model Intercomparison Project Phase 6 (CMIP6) capture observed changes in mean and extreme precipitation. We find that CMIP6 historical simulations skillfully represent observed precipitation changes over large parts of Europe, Asia, northeastern North America, parts of South America and western Australia, whereas a lack of skill is apparent in western North America and parts of Africa. In particular in regions with moderate skill the availability of very large ensembles can be beneficial to improve the simulation accuracy. CMIP6 simulations are regionally skillful where they capture observed (positive or negative) trends, whereas a lack of skill is found in regions characterized by negative observed precipitation trends where CMIP6 simulates increases.

Projections of near-term climate change in the next few decades are subject to substantial uncertainty from internal climate variability. Approaches to reduce this uncertainty by constraining the phasing of climate variability based on large ensembles of climate simulations have recently been developed. These approaches select those ensemble members that are in closer agreement with sea surface temperature patterns from either observations or initialized decadal predictions. Previous studies demonstrated the benefits of these constraints for projections up to 20 years into the future, but these studies applied the constraints to different ensembles of climate simulations, which prevents a consistent comparison of methods or identification of specific advantages of one method over another. Here we apply several methods to constrain internal variability phases, using either observations or decadal predictions as constraining reference, to an identical multi-model ensemble consisting of 311 simulations from 37 models from the Coupled Model Intercomparison Project phase 6 (CMIP6), and compare their forecast qualities. We show that constraining based on both observations and decadal predictions significantly enhances the skill of 10 and 20-year projections for near-surface temperatures in some regions, and that constraining based on decadal predictions leads to the largest added value in terms of probabilistic skill. We further explore the sensitivity to different implementations of the constraint that focus on the patterns of either internal variability alone or a combination of internal variability and long-term changes in response to forcing. Looking into the near-term future, all variations of the constraints suggest an accelerated warming of large parts of the Northern Hemisphere for the period 2020–2039, in comparison to the unconstrained CMIP6 ensemble.

Abstract Background The modulation of perioperative inflammation seems crucial to improve postoperative morbidity and cancer-related outcomes in patients undergoing oncological surgery. Data from the literature suggest that perioperative corticosteroids decrease inflammatory markers and might be associated with fewer complications in esophageal, liver, pancreatic and colorectal surgery. Their benefit on cancer-related outcomes has not been assessed. Methods The CORTIFRENCH trial is a phase III multicenter randomized double-blind placebo-controlled trial to assess the impact of a flash dose of preoperative corticosteroids versus placebo on postoperative morbidity and cancer-related outcomes after elective curative-intent surgery for digestive cancer. The primary endpoint is the frequency of patients with postoperative major complications occurring within 30 days after surgery (defined as all complications with Clavien-Dindo grade > 2). The secondary endpoints are the overall survival at 3 years, the disease-free survival at 3 years, the frequency of patients with intraabdominal infections and postoperative infections within 30 days after surgery and the hospital length of stay. We hypothesize a reduced risk of major complications and a better disease-survival at 3 years in the experimental group. Allowing for 5% of drop-out, 1 200 patients (600 per arm) should be included. Discussion This will be the first trial focusing on the impact of perioperative corticosteroids on cancer related outcomes. If significant, it might be a strong improvement on oncological outcomes for patients undergoing surgery for digestive cancers. Trial registration ClinicalTrials.gov, NCT03875690, Registered on March 15, 2019, URL: https://clinicaltrials.gov/ct2/show/NCT03875690 .

Strong evidence suggests that differences in the molecular composition of lipids in exosomes depend on the cell type and has an influence on cancer initiation and progression. Here, we analyzed by liquid chromatography–mass spectrometry (LC‐MS) the lipidomic signature of exosomes derived from the human cell lines normal colon mucosa (NCM460D), and colorectal cancer (CRC) nonmetastatic (HCT116) and metastatic (SW620), and exosomes isolated from the plasma of nonmetastatic and metastatic CRC patients and healthy donors. Analysis of this exhaustive lipid study highlighted changes in some molecular species that were found in the cell lines and confirmed in the patients. For example, exosomes from primary cancer patients and nonmetastatic cells compared with healthy donors and control cells displayed a common marked increase in phosphatidylcholine (PC) 34 : 1, phosphatidylethanolamine (PE) 36 : 2, sphingomyelin (SM) d18 : 1/16 : 0, hexosylceramide (HexCer) d18 : 1/24 : 0 and HexCer d18 : 1/24 : 1. Interestingly, these same lipids species were decreased in the metastatic cell line and patients. Further, levels of PE 34 : 2, PE 36 : 2, and phosphorylated PE p16 : 0/20 : 4 were also significantly decreased in metastatic conditions when compared to the nonmetastatic counterparts. The only molecule species found markedly increased in metastatic conditions (in both patients and cells) when compared to controls was ceramide (Cer) d18 : 1/24 : 1. These decreases in lipid species in the extracellular vesicles might reflect function‐associated changes in the metastatic cell membrane. Although these potential biomarkers need to be validated in a larger cohort, they provide new insight toward the use of clusters of lipid biomarkers rather than a single molecule for the diagnosis of different stages of CRC.

En este reporte se muestran los resultados de una investigación etnomusicológica que tuvo lugar entre finales de 2020 y principios de 2021, que consistió en la comparación de dos estudios de caso referidos a dos exponentes de música okinawense en México: Nayuta Tsugaoka y Harumi Pérez Nakandakara. El objetivo general de la investigación fue contrastar la actividad artística de ambos intérpretes y determinar la influencia que tiene en esta el contexto particular de cada uno, así como visibilizar estas manifestaciones artísticas en México; ello mediante el análisis de entrevistas realizadas a través de plataformas digitales. Entre los hallazgos, se pudieron explorar sus trasfondos –Harumi como nikkei mexicana y Nayuta como reciente emigrante japonés–, cómo se interesaron y comenzaron a tocar dicha música, así como algunas características de los diferentes géneros que interpretan, que son música clásica y folklórica okinawense, respectivamente.

Abstract Background Acute adhesion-related small bowel obstruction (ASBO) is a common digestive emergency, accounting for 1 to 3% of all digestive emergencies. The efficacy of conservative management in this setting is a subject of debate, as it may delay the decision to perform surgery and increase the frequency of bowel resection (e.g., in the presence of bowel necrosis) or, in contrast, prompt an excessive number of unnecessary laparotomies. Thus, the decision to perform surgery is difficult. We propose that the introduction of the procalcitonin (PCT)-based algorithm improves the quality of the management of patients with ASBO by aiding the decision of whether or not to perform surgery. Methods This is a 1:1 cluster-randomized clinical trial (use of algorithm: no algorithm) using an independent computer to ensure that investigators cannot interfere with the randomization. Each cluster will correspond to one investigating center. All patients in a center will be managed in the same way. Before randomization, each principal investigator will provide a commitment to participate in the study to avoid the risk of “empty clusters”. The patients included will constitute two parallel arms (use of algorithm versus no algorithm), with no expected crossover between arms. The inclusion criteria are being an adult with uncomplicated acute ASBO (i.e., absence of fever, abdominal pain and distension, nausea and/or vomiting, and the absence of gas and/or stool, in conjunction with a contrast-enhanced CT scan, for patients with previous abdominal surgery) who is able to express consent with a signed written informed consent form. Patients with complicated acute ASBO (strangulation or peritonitis) will be excluded. Discussion There is an ongoing debate on the management of uncomplicated ASBO. The main points are to avoid a surgery if it is unnecessary and to avoid delayed surgery if it is necessary. Currently, there are no robust criteria to objectively determine the failure of non-surgical treatment or to establish the indications for surgery in acute ASBO. Our team proposes the use of procalcitonin (PCT) to help distinguish patients for whom conservative management is likely to be successful from those for whom surgical management is required. The results from a randomized control trial could help in the selection of patients through clear inclusion and exclusion criteria and simplify or clarify the management algorithm. In conclusion, PCT may be useful in evaluating the proper strategy for ASBO. Trial registration The trial is registered at clinical trials under the reference: NCT03905239

Background The incidence of high-output stoma (HOS) was reported to be approximately 3 to 16% in the literature, and HOS can cause dehydration. This complication is often severe enough to warrant hospital readmission and may result in renal failure. The aim of this study was to show a decrease of 50% in ileostomy output in the experimental arm using lanreotide treatment. Methods Patients with an ileostomy output ≥ 1.5 l/24 hours were included in this prospective, open, multicentre randomized trial. Patients were randomly allocated between treatment arms with either lanreotide (LAN) and antidiarrhoeal treatments (TAD) (LAN-TAD group) or antidiarrhoeal treatments only (TADS group). The primary outcome was ileostomy output after 72 days. The secondary endpoints were ileostomy output during the first 6 days, blood urea and creatinine values, hospital length of stay and serious adverse events. Results In the per-protocol analysis, there were nine patients in the control group (TADS) and six patients in the experimental group (TAD-LAN group). The stoma outputs at Day 3 (D3) in the experimental and control groups were 1,900 ± 855.7 mL and 1,728.6 ± 845.5 mL, respectively (p = 0.2). No differences were found concerning stoma output at D6, renal function, or hospital length of stay between the two groups. Conclusion The trial was prematurely stopped due to the low number of patients included. The question of the usefulness of somatostatin analogues in HOS persists, especially as the cost of this treatment is high, and there is a lack of evidence of its effectiveness.

En el presente trabajo se analiza la estrategia de la Real Armada en América durante la guerra anglo-española de 1796-1802. El propósito es comprender el despliegue y la verdadera operatividad de la Marina en el continente americano, yendo más allá de las visiones tradicionales que estudian este conflicto a partir de los combates y las grandes batallas. Como se podrá comprobar en el texto, además de la presión naval británica y la crisis económica y política de la Monarquía, la estrategia española estuvo marcada por la extensión geográfica del conflicto y el imposible despliegue simultáneo de las fuerzas navales en varios escenarios del imperio colonial.

The common bean (Phaseolus vulgaris L.) is the most important grain legume in the human diet, mainly in Africa and Latin America. Argentina is one of the five major producers of the common bean in the world, and the main cultivation areas are concentrated in the northwestern provinces of this country. Crop production of the common bean is often affected by biotic factors like some endemic fungal diseases, which exert a major economic impact on the region. The most important fungal diseases affecting the common bean in Argentina are white mold caused by Sclerotinia sclerotiorum, angular leaf spot caused by Pseudocercospora griseola, web blight and root rot caused by Rhizoctonia solani, which can cause production losses of up to 100% in the region. At the present, the most effective strategy for controlling these diseases is the use of genetic resistance. In this sense, population study and characterization of fungal pathogens are essential for developing cultivars with durable resistance. In this review we report diversity studies carried out on these three fungal pathogens affecting the common bean in northwestern Argentina, analyzing more than 200 isolates by means of molecular, morphological and pathogenic approaches. Also, the screening of physiological resistance in several common bean commercial lines and wild native germplasm is reviewed. This review contributes to the development of sustainable management strategies and cultural practices in bean production aimed to minimize yield losses due to fungal diseases in the common bean.

Introduction Incisional hernia (IH) is the most frequent mid-term and long-term complication after midline laparotomy. The current standard treatment includes repair using a mesh. In a contaminated field, the use of a non-absorbable mesh increases the risk of surgical site infection and the costs. Slowly absorbable meshes are safe in contaminated fields, but no data have been reported regarding their long-term recurrence rate. COMpACT-BIO is a multicentre prospective randomised controlled phase III trial designed to compare the 3-year recurrence rate in patients undergoing contaminated IH repair with either a slowly absorbable mesh or standard care.Methods In patients undergoing midline IH repair in a contaminated surgical field (grade III of the modified Ventral Hernia Working Group classification), the COMpACT-BIO study compares the use of a slowly absorbable mesh with that of conventional care according to standardised surgical procedures (primary closure, non-absorbable synthetic mesh or biologic mesh, at the discretion of the surgeon). Randomisation is done during surgery before closure the fascia with an allocation ratio of 1:1. The choice of the slowly absorbable mesh is left to the criteria of each centre. The primary endpoint is the proportion of patients with scan-confirmed IH recurrence within 3 years after repair.Ethics/dissemination This trial is conducted in compliance with international standards for research practice and reporting. Written informed consent will be obtained from patients prior to inclusion. All data were identified and anonymised prior to analysis. The protocol has been approved by an Institutional Review Board (2020-A0823-36/SI:20.07.03.66831), and will be conducted in compliance with the CONSORT (Consolidated Standards of Reporting Trials) statement. Results will be submitted for publication in peer-reviewed medical journals and presented to patients and healthcare professionals.Protocol version Version 2—13 October 2020.Trial registration number NCT04597840.

Abstract Arctic sea-ice loss is a consequence of anthropogenic global warming and can itself be a driver of climate change in the Arctic and at lower latitudes, with sea-ice minima likely favoring extreme events over Europe and North America. Yet the role that the sea-ice plays in ongoing climate change remains uncertain, partly due to a limited understanding of whether and how the exact geographical distribution of sea-ice loss impacts climate. Here we demonstrate that the climate response to sea-ice loss can vary widely depending on the pattern of sea-ice change, and show that this is due to the presence of an atmospheric feedback mechanism that amplifies the local and remote signals when broader scale sea-ice loss occurs. Our study thus highlights the need to better constrain the spatial pattern of future sea-ice when assessing its impacts on the climate in the Arctic and beyond.

El Niño-Southern Oscillation (ENSO) is a key mode of climate variability with worldwide climate impacts. Here, the authors show that improved representation of summer equatorial Atlantic variability and its lagged teleconnection mechanism with the Pacific, relates to enhanced predictive capacity of autumn/winter ENSO.

This article seeks to study how the officers of the navy of the eighteenth and nineteenth centuries were imagined and represented by the 1870s as naval heroes. Therefore, it will be analysed how the individuals who formed naval officer corps from 1700 to 1870 were imagined as bearers of the dominant social and cultural values. The material examined for this purpose is based on the three hundred biographies that formed the work Galería biográfica de los generales de marina, jefes y personajes notables que figuraron en la misma corporación, written by Francisco de Paula Pavia ‒ highlighted general of the navy and Minister for the Navy twice during the Spanish Restoration‒ and published in 1873. They not only provided information on the life and career of these officers, but they also intended to create a general portrait of the body and a presentation before the public opinion as heroes. The main conclusion drawn is that this naval hero was not based on military virtues, but on social principles such as honesty, decorum, probity, decency or respectability.

Book review

Durante la segunda mitad del siglo XVIII, Asia se consolidó como un escenario clave de la interdependencia global. Ante esta realidad, la monarquía española no descuidó sus intereses en esta región y desplegó una serie de medidas de amplio calado. Más allá de las reformas promovidas en las islas Filipinas, las relaciones entre España y Asia se transformaron cuantitativa y cualitativamente. En este marco, la Real Armada adquirió un papel de enorme importancia que trascendió su rol militar, pues se convirtió en un agente de información clave para estas nuevas relaciones hispano-asiáticas. El objetivo de este trabajo es analizar cómo la institución naval recogió, creó y trasmitió multitud de datos de diversa naturaleza que fueron esenciales para la efectiva inserción de la monarquía española en los circuitos globales asiáticos.

Abstract Background Postoperative upper gastrointestinal fistula (PUGIF) is a devastating complication, leading to high mortality (reaching up to 80%), increased length of hospital stay, reduced health-related quality of life and increased health costs. Nutritional support is a key component of therapy in such cases, which is related to the high prevalence of malnutrition. In the prophylactic setting, enteral nutrition (EN) is associated with a shorter hospital stay, a lower incidence of severe infectious complications, lower severity of complications and decreased cost compared to total parenteral nutrition (TPN) following major upper gastrointestinal (GI) surgery. There is little evidence available for the curative setting after fistula occurrence. We hypothesize that EN increases the 30-day fistula closure rate in PUGIF, allowing better health-related quality of life without increasing the morbidity or mortality. Methods/design The NUTRILEAK trial is a multicenter, randomized, parallel-group, open-label phase III trial to assess the efficacy of EN (the experimental group) compared with TPN (the control group) in patients with PUGIF. The primary objective of the study is to compare EN versus TPN in the treatment of PUGIF (after esophagogastric resection including bariatric surgery, duodenojejunal resection or pancreatic resection with digestive tract violation) in terms of the 30-day fistula closure rate. Secondary objectives are to evaluate the 6-month postrandomization fistula closure rate, time of first fistula closure (in days), the medical- and surgical treatment-related complication rate at 6 months after randomization, the fistula-related complication rate at 6 months after randomization, the type and severity of early (30 days after randomization) and late fistula-related complications (over 30 days after randomization), 30-day and 6-month postrandomization mortality rate, nutritional status at day 30, day 60, day 90 and day 180 postrandomization, the mean length of hospital stay, the patient’s health-related quality of life (by self-assessment questionnaire), oral feeding time and direct costs of treatment. A total of 321 patients will be enrolled. Discussion The two nutritional supports are already used in daily practice, but most surgeons are reluctant to use the enteral route in case of PUGIF. This study will be the first randomized trial testing the role of EN versus TPN in PUGIF. Trial registration ClinicalTrials.gov: NCT03742752 . Registered on 14 November 2018.

In this work, we have fabricated and studied p-type picene thin-film transistors. Although the devices exhibited good electrical performance with high field-effect mobility (up to 1.3 cm2/V·s) and on/off ratios above 105, the output electric characteristics of the devices exhibited a Negative Differential Resistance for higher drain-source voltage. Finally, a possible explanation for this phenomenon is developed.

Este trabajo tiene por objeto analizar las relaciones sociales de los oficiales de la Armada que vivieron en Ferrol entre 1740 y 1870. Se pretende estudiar cuáles eran los principales los vínculos sociales y las dependencias de estos individuos en la mencionada ciudad gallega, la cual fue fuertemente revitalizada a partir de la primera mitad del siglo XVIII como sede de uno de los Departamentos Marítimos de la Armada –junto a Cádiz y Cartagena? y por la construcción de un arsenal militar y un astillero. El interés del trabajo reside en que la oficialidad naval fue uno de los grupos más relevantes y destacados de la sociedad ferrolana durante décadas debido, en gran medida, a la importancia que la institución naval mantuvo en la urbe. Las fuentes consultadas se conforman por una amplia muestra de documentación notarial del Archivo Naval de Ferrol y el Archivo del Colegio de Notarios de Galicia. [gl] Este traballo ten por obxecto analizar as relacións sociais dos oficiais da Armada que viviron en Ferrol entre 1740 e 1870. Preténdese estudar cales eran os principais vínculos e as dependencias destes individuos na mencionada cidade galega, a cal foi fortemente revitalizada a partir da primeira metade do século XVIII como sede dun dos Departamentos Marítimos da Armada –xunto a Cádiz e Cartaxena? e pola construción dun arsenal militar e un estaleiro. O interese do traballo reside en que a oficialidade naval foi un dos grupos máis relevantes e destacados da sociedade ferrolá durante décadas debido, en gran medida, á importancia que a institución naval mantivo na urbe. As fontes consultadas confórmanse por unha ampla mostra de documentación notarial do Arquivo Naval de Ferrol e o Arquivo do Colexio de Notarios de Galicia.

La lepra es una enfermedad infecciosa que afecta a la piel, mucosas del tracto respiratorio superior, ojos y nervios periféricos, los microorganismos responsables son Mycobacterium leprae y Mycobacterium lepromatosis. Presentamos el caso clínico de un paciente masculino de 59 años quien acude por presentar lesiones serpentiginosas elevadas en tórax anterior y posterior, así como en piernas, desde hace aproximadamente 20 años atrás, asociadas con prurito y eritema en respuesta a la sudoración junto con áreas de anestesia e hipoestesia. Los hallazgos histológicos fueron consistentes con lepra lepromatosa (histioide), por lo que el paciente fue derivado al Ministerio de Salud Pública de Guayas-Ecuador, sitio de su residencia, para iniciar tratamiento con triple esquema, control y seguimiento. Palabras clave: infección, Mycobacterium Leprae, lesiones cutáneas eritematosas crónicas, anestesia, hipoestesia, lepra lepromatosa.

Abstract Floral nectaries are essential for plant reproduction but little is known about the relationship between these secretory structures and pollination system in cacti. To test phenotypic patterns in nectaries associated with pollination syndromes and/or with its pollinators, we selected from evolutionarily related genera Cleistocactus, Denmoza, and Echinopsis, a set of species with bird-pollinated flowers and floral traits that may fit with ornithophily or with sphingophily, and other set of sphingophilous species with moths as effective pollinator. Observations were made under light microscope and scanning and transmission electron microscopes. Nectaries are located at the base of the filaments welded to the tube, forming a chamber. The nectary consists of the epidermis with distinctive features in each genus, a secretory parenchyma which may be vascularized and a non-secretory vascularized parenchyma. Anatomical variants observed in nectaries of different species are not consistent with the floral pollination syndromes neither with groups of pollinators. The basic structure of the nectar chamber is relatively conserved, a fact that may be explained by phylogenetic conservatism among the genera investigated. Our results revalue the role of anatomical traits for the systematics of Cactaceae.

ntroducción: El Cáncer Colorrectal (CCR) es la segunda causa más común de cáncer en los Estados Unidos y es el segundo tumor digestivo más frecuente en Ecuador. La sobrevida de estos pacientes aumenta con el tratamiento adecuado, el cual debe establecerse en función del estadiaje y la localización. El objetivo del presente estudio es describir nuestra experiencia en el tratamiento de los pacientes con cáncer de recto que acudieron al Instituto, en el período 1998-2007. Material y Métodos: El universo comprendió 49 pacientes con cáncer de recto (CR) tratados con fines curativos. Las variables estudiadas fueron edad, sexo, manifestaciones clínicas, etapa clínica y patológica, determinación de antígeno carcinoembrionario (CEA), tipos de tratamiento, metástasis postratamiento, supervivencia y estado actual. Los datos fueron elaborados, tabulados y resumidos mediante tablas y gráficos en el software SPSS v. 15. Para la determinación de supervivencia se utilizó Kaplan Meier. Resultados: El promedio de edad fue 60 años. La frecuencia fue mayor en mujeres. El síntoma más frecuente fue rectorragia (73.5%); el 81.6% no recibió transfusiones sanguíneas; el CEA se mantuvo dentro de los valores de normalidad. La localización tumoral más frecuente fue tercio inferior 53.1%; el 44.9 % perteneció estadío II, 30.6% a III. El grado de diferenciación más frecuente fue el moderado. La supervivencia media global fue de 30.55 meses (72.3 para hombres y 58.8 para mujeres). El promedio de supervivencia libre de enfermedad fue mayor en el sexo masculino, en los que no recibieron transfusiones y en estadío patológico 0 (Tis). Tanto la supervivencia global como libre de enfermedad fue menor en pacientes sometidos a resección anterior baja con margen inferior menor a 2cm. Conclusión: La etapa patológica y los márgenes quirúrgicos amplios (mayores a 2cm) en resecciones anteriores bajas son los principales factores que influyeron en la supervivencia de los pacientes estudiados.

Introducción: El carcinoma ductal infiltrante, sin patrón específico, representa el tipo histológico más frecuente de los tumores malignos mamarios y presenta un comportamiento biológico diverso. La variable evolución de la enfermedad ha estimulado a los investigadores a definir los parámetros que permitan delimitar subgrupos de pacientes con el objetivo de optimizar la terapéutica. Los factores pronósticos de primera generación han logrado tener resultados satisfactorios. Las técnicas inmunohistoquímicas han permitido señalizar nuevas rutas terapéuticas con resultados poco contrastados. La valoración comparativa de ambos parámetros está escasamente reflejada en la literatura. Material y métodos: Se han determinado en 107 pacientes con carcinoma ductal infiltrante (NOS) el tamaño tumoral, grado histológico combinado, estatus ganglionar axilar y la expresión de receptores estrogénicos, p53, MIB-1 y HER2/neu, correlacionándose entre sí los parámetros morfológicos e inmunohistoquímicos. Resultados: Hemos obtenido correlación estadísticamente significativa entre la expresión positiva de receptores estrogénicos con el grado nuclear, índice mitótico, formación de túbulos y grado histológico, estado ganglionar axilar y número de ganglios afectados cuando es superior a 4, pero no con el tamaño tumoral. La diferente expresión de p53 no muestra variaciones significativas cuando se relaciona con los diferentes parámetros morfológicos, solamente con la formación de túbulos. El MIB-1 se correlaciona solamente con el índice mitótico. La expresión de HER2/neu se correlaciona significativamente con grado nuclear, índice mitótico y grado histológico, estado ganglionar axilar y número de ganglios afectados cuando es superior a 4, pero no con el tamaño tumoral ni con la formación tubular. Conclusión: Los tumores que muestran positividad para receptores estrogénicos se asocian con tumores de grado histológico alto y con estado ganglionar positivo. Los tumores con expresión de HER2/neu se correlacionan con grado histológico alto y con estado ganglionar positivo, principalmente con el grupo de más de 4 ganglios axilares afectados.

White adipose tissue (WAT) possesses the endocannabinoid system (ECS) machinery and produces the two major endocannabinoids (ECs), arachidonoylethanolamide (AEA) and 2-arachidonoylglycerol (2-AG). Accumulating evidence indicates that WAT cannabinoid 1 receptors (CB1R) are involved in the regulation of fat storage, tissue remodeling and secretory functions but their role in controlling lipid mobilization is unclear. In the present study, we used different strategies to acutely increase ECS activity in WAT and tested the consequences on glycerol production as a marker of lipolysis. Treating lean mice or rat WAT explants with JLZ195, which inhibits ECs degrading enzymes, induced an increase in 2-AG tissue contents that was associated with a CB1R-dependent decrease in lipolysis. Direct treatment of rat WAT explants with AEA also inhibited glycerol production while mechanistic studies revealed it could result from the stimulation of Akt-signaling pathway. Interestingly, AEA treatment decreased lipolysis both in visceral and subcutaneous WAT collected on lean subjects suggesting that ECS also reduces fat store mobilization in Human. In obese mice, WAT content and secretion rate of ECs were higher than in control while glycerol production was reduced suggesting that over-produced ECs may inhibit lipolysis activating local CB1R. Strikingly, our data also reveal that acute CB1R blockade with Rimonabant did not modify lipolysis in vitro in obese mice and human explants nor in vivo in obese mice. Taken together, these data provide physiological evidence that activation of ECS in WAT, by limiting fat mobilization, may participate in the progressive tissue remodeling that could finally lead to organ dysfunction. The present findings also indicate that acute CB1R blockade is inefficient in regulating lipolysis in obese WAT and raise the possibility of an alteration of CB1R signaling in conditions of obesity.

Model initialization is a matter of transferring the observed information available at the start of a forecast to the model. An optimal initialization is generally recognized to be able to improve climate predictions up to a few years ahead. However, systematic errors in models make the initialization process challenging. When the observed information is transferred to the model at the initialization time, the discrepancy between the observed and model mean climate causes the drift of the prediction toward the model-biased attractor. Although such drifts can be generally accounted for with a posteriori bias correction techniques, the bias evolving along the prediction might affect the variability that we aim at predicting, and disentangling the small magnitude of the climate signal from the initial drift to be removed represents a challenge. In this study, we present an innovative initialization technique that aims at reducing the initial drift by performing a quantile matching between the observed state at the initialization time and the model state distribution. The adjusted initial state belongs to the model attractor and the observed variability amplitude is scaled toward the model one. Multi-annual climate predictions integrated for 5 years and run with the EC-Earth3 Global Coupled Model have been initialized with this novel methodology, and their prediction skill has been compared with the non-initialized historical simulations from CMIP6 and with the same decadal prediction system but based on full-field initialization. We perform a skill assessment of the surface temperature, the heat content in the ocean upper layers, the sea level pressure, and the barotropic ocean circulation. The added value of the quantile matching initialization is shown in the North Atlantic subpolar region and over the North Pacific surface temperature as well as for the ocean heat content up to 5 years. Improvements are also found in the predictive skill of the Atlantic Meridional Overturning Circulation and the barotropic stream function in the Labrador Sea throughout the 5 forecast years when compared to the full field method.

Reseña de: Marchena Fernández, Juan y Cuño Bonito, Justo (eds.), Vientos de guerra. Apogeo y crisis de la Real Armada, 1750-1823, Madrid, Doce Calles, 3 vols, 2.148 pp., ISBN: 978-84-9744-180-3.

CONTEXT: Peritoneal closure with a barbed suture during laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is a controversial subject due to the risk of postoperative intestinal adhesions and occlusions formed by this type of suture. This risk, however, was only reported in several case reports. The purpose of this study is to determine the incidence of postoperative intestinal obstructions related to the use of barbed suture materials in laparoscopic hernia repair (TAPP). PATIENTS AND METHODS: We included all patients that underwent laparoscopic TAPP inguinal hernia repair between October 2012 and October 2017. All peritoneal closures were accomplished using absorbable barbed sutures. Operative data were collected in a dedicated database and analyzed retrospectively. RESULTS: Only 3 out of the 320 patients included (0.9%) presented with an early postoperative intestinal obstruction and required further surgery. Two of the three patients (0.6%) were found to have intestinal incarceration in the peritoneal defects initially created during the hernia repair. However, the last patient had an intestinal volvulus due to adhesions formed with the barbed suture. None of the patient characteristics collected were significant risk factors for developing postoperative intestinal obstructions. CONCLUSION: In this study, peritoneal closure using barbed suture material did not increase the risk of early postoperative intestinal obstruction, in comparison to other suture materials reported in the literature. The use of barbed absorbable sutures for peritoneal closure during laparoscopic TAPP seems to be safe when sutures are cut short and covered by the peritoneum.

The aim of this paper is to analyze the concepts of honor and honorability in Spain during the 18th and 19th centuries in order to offer an approximation of the changes in social values that took place in this period. Specifically, it is studied the development of these concepts, the transformations in their meanings and the reciprocal relations of these mu-tations. However, what is here so-called as from honor to honorability should not be in-terpreted as a finalist trajectory or a process of an evolutionary nature, but a complex de-velopment, composed of several variables and multiple directions. The work is organized in four sections that seek to show the complexity of these transformations. A first exami-nation was made through the national and international bibliography that focus on it and a second part is an analysis by means of primary sources of different nature —literature, presses, philosophical treatises, moralistic writings. One of the main conclusions that emerges is that the transformations of the concepts honor and honesty are closely linked with a deep variation of the sense of virtue, which gradually abandoned its traditional meaning —synonym of social inheritance— and acquiring a more personal matrix.

Abstract A multimodel, multiresolution ensemble using Coupled Model Intercomparison Project Phase 6 (CMIP6) High Resolution Model Intercomparison Project (HighResMIP) coupled experiments is used to assess the performance of key aspects of the North Atlantic circulation. The Atlantic Meridional Overturning Circulation (AMOC), and related heat transport, tends to become stronger as ocean model resolution is enhanced, better agreeing with observations at 26.5°N. However, for most models the circulation remains too shallow compared to observations and has a smaller temperature contrast between the northward and southward limbs of the AMOC. These biases cause the northward heat transport to be systematically too low for a given overturning strength. The higher‐resolution models also tend to have too much deep mixing in the subpolar gyre. In the period 2015–2050 the overturning circulation tends to decline more rapidly in the higher‐resolution models, which is related to both the mean state and to the subpolar gyre contribution to deep water formation. The main part of the decline comes from the Florida Current component of the circulation. Such large declines in AMOC are not seen in the models with resolutions more typically used for climate studies, suggesting an enhanced risk for Northern Hemisphere climate change. However, only a small number of different ocean models are included in the study.

The present work tries to offer an approach to Spanish naval officers’ social insertion through the study of the social relations with other social and professional groups; i.e., the article seeks to place the naval officers in the Spanish social structure of the eighteenth and nineteenth centuries by means of the most immediate circles of sociability that these individuals had. The Cádiz area ―the cities of Cadiz and Isla de León / San Fernando essentially― have been chosen because it was the place where the Spanish Navy had its main base and, therefore, where there was a greater concentration of naval officers. By using the network analysis, it was analyzed an extensive amount of notarial documentation of the Provincial Historical Archive of Cádiz that allowed to deal with the process of social transformation of this group, which emerged in the 18th century as part of the new Bourbon elites and eventually became an outstanding stratum of the middle classes of the 19th century.