Resilience as Anticipation in Organizational Systems: An Agent-based Computational Approach.

The literature on organizational resilience explores various viewpoints, ranging from strategies to recover after disruptions to proactive anticipation of threats. Formal models primarily focus on the ability to recover from shocks, analyzing factors like deviation from performance targets, recovery time, and potential adaptation in function and structure. However, incorporating anticipation into such models remains scarce. Additionally, existing anticipatory systems models often neglect key aspects of organizational behavior. This work addresses these gaps by introducing an agent-based modeling approach that integrates anticipation into organizational decision-making. Our computational model features agents embedded in different organizational structures who make decisions based on projected market states (levels and trends). These decisions are subject to delays in perceiving market conditions and vary depending on the organization's adaptive capacity to update its offering. We analyze different organizational structures and market behaviors (trend direction and volatility). Our results indicate that full connectivity among agents can be detrimental to organizational resilience, as it may reduce the diversity of anticipation strategies for forecasting the market. Conversely, either sparse or highly clustered networks demonstrate a greater ability, on average, to keep up with changing market levels and trends.

Enhancing the Retention and Oxidative Stability of Volatile Flavors: A Novel Approach Utilizing O/W Pickering Emulsions Based on Agri-Food Byproducts and Spray-Drying.

Spray-drying is a commonly used method for producing powdered flavors, but the high temperatures involved often result in the loss of volatile molecules. To address this issue, our study focused on a novel approach: developing O/W Pickering emulsions with agri-food byproducts to encapsulate and protect D-limonene during spray-drying and storage. Emulsions formulated with lupin hull, lupin-byproduct (a water-insoluble protein-fiber byproduct derived from the production of lupin protein isolate), and camelina press-cake were subjected to spray-drying at 160 °C. The results revealed that these emulsions exhibited good stability against creaming. The characteristics of the dry emulsions (powders) were influenced by the concentration of byproducts. Quantitative analysis revealed that Pickering emulsions enhanced the retention of D-limonene during spray-drying, with the highest retention achieved using 3% lupin hull and 1% camelina press-cake. Notably, lupin-stabilized emulsions yielded powders with enhanced oxidative stability compared to those stabilized with camelina press-cake. Our findings highlight the potential of food-grade Pickering emulsions to improve the stability of volatile flavors during both processing and storage.

Evolution of interconsultal activity to endocrinology and nutrition in hospitalization floor in a third level hospital.

INTRODUCTION: Endocrinology and Nutrition (EyN) is an outpatient and hospital medical specialty. This study aims to understand the evolution of the activity of interdepartmental consultation (IC) carried out by EyN in hospitalization floor of a third level hospital, comparing its evolution with other medical specialties, and comparing endocrine IC with nutritional IC. MATERIAL AND METHODS: Longitudinal and retrospective study which analyzes IC notes of EyN and other medical specialties between 01-01-2013 and 31-12-2022. RESULTS: A total of 76093 IC notes (12623 patients) were performed by the EyN service (average age 65.4 years; 59% male) with an average of 4.8 notes per patient. Average annual growth was 7% in notes and 4% in patients (versus 6% and 3% of all other medical services, differences statistically significant). Of all patients hospitalized for 4 or more days, EyN went from attending 7.9% (2013) to 12.3% (2022). 66% of the IC performed by EyN was for nutritional cause and 34% for other pathologies. CONCLUSIONS: The EyN service is the one that most patients attend in hospital IC activity, with growth over the last few years greater than other medical specialties. Nutritional pathology is the main reason for IC.

IKZF1plus is a frequent biomarker of adverse prognosis in Mexican pediatric patients with B-acute lymphoblastic leukemia.

Background: Recurrent genetic alterations contributing to leukemogenesis have been identified in pediatric B-cell Acute Lymphoblastic Leukemia (B-ALL), and some are useful for refining classification, prognosis, and treatment selection. IKZF1plus is a complex biomarker associated with a poor prognosis. It is characterized by IKZF1 deletion coexisting with PAX5, CDKN2A/2B, or PAR1 region deletions. The mutational spectrum and clinical impact of these alterations have scarcely been explored in Mexican pediatric patients with B-ALL. Here, we report the frequency of the IKZF1plus profile and the mutational spectrum of IKZF1, PAX5, CDKN2A/2B, and ERG genes and evaluate their impact on overall survival (OS) in a group of patients with B-ALL. Methods: A total of 206 pediatric patients with de novo B-ALL were included. DNA was obtained from bone marrow samples at diagnosis before treatment initiation. A custom-designed next-generation sequencing panel was used for mutational analysis. Kaplan-Meier analysis was used for OS estimation. Results: We identified the IKZF1plus profile in 21.8% of patients, which was higher than that previously reported in other studies. A significantly older age (p=0.04), a trend toward high-risk stratification (p=0.06), and a decrease in 5-year Overall Survival (OS) (p=0.009) were observed, although heterogeneous treatment protocols in our cohort would have impacted OS. A mutation frequency higher than that reported was found for IKZF1 (35.9%) and CDKN2A/2B (35.9%) but lower for PAX5 (26.6%). IKZF1MUT group was older at diagnosis (p=0.0002), and most of them were classified as high-risk (73.8%, p=0.02), while patients with CDKN2A/2BMUT had a higher leukocyte count (p=0.01) and a tendency toward a higher percentage of blasts (98.6%, >50% blasts, p=0.05) than the non-mutated patients. A decrease in OS was found in IKZF1MUT and CDKN2A/2BMUT patients, but the significance was lost after IKZF1plus was removed. Discussion: Our findings demonstrated that Mexican patients with B-ALL have a higher prevalence of genetic markers associated with poor outcomes. Incorporating genomic methodologies into the diagnostic process, a significant unmet need in low- and mid-income countries, will allow a comprehensive identification of relevant alterations, improving disease classification, treatment selection, and the general outcome.

Changes in glucometric parameters in people living with diabetes users of the free-style libre 2 system before and after the update possibility to real-time glucose readings in real world practice.

In Spain, from October 10th, 2023, the FreeStyle Libre 2 system offers the possibility to automatically changed from isCGM to rtCGM with a system update. Our study aimed to evaluate the glucometric before and after that date. We didn't find significant changes in TIR, however time of use increased and TBR decreased.

Differences in the clinical and hormonal presentation of patients with familial and sporadic primary aldosteronism.

Purpose: To compare the clinical and hormonal characteristics of patients with familial hyperaldosteronism (FH) and sporadic primary aldosteronism (PA). Methods: A systematic review of the literature was performed for the identification of FH patients. The SPAIN-ALDO registry cohort of patients with no suspicion of FH was chosen as the comparator group (sporadic group). Results: A total of 360 FH (246 FH type I, 73 type II, 29 type III, and 12 type IV) cases and 830 sporadic PA patients were included. Patients with FH-I were younger than sporadic cases, and women were more commonly affected (P = 0.003). In addition, the plasma aldosterone concentration (PAC) was lower, plasma renin activity (PRA) higher, and hypokalemia (P < 0.001) less frequent than in sporadic cases. Except for a younger age (P < 0.001) and higher diastolic blood pressure (P = 0.006), the clinical and hormonal profiles of FH-II and sporadic cases were similar. FH-III had a distinct phenotype, with higher PAC and higher frequency of hypokalemia (P < 0.001), and presented 45 years before sporadic cases. Nevertheless, the clinical and hormonal phenotypes of FH-IV and sporadic cases were similar, with the former being younger and having lower serum potassium levels. Conclusion: In addition to being younger and having a family history of PA, FH-I and III share other typical characteristics. In this regard, FH-I is characterized by a low prevalence of hypokalemia and FH-III by a severe aldosterone excess causing hypokalemia in more than 85% of patients. The clinical and hormonal phenotype of type II and IV is similar to the sporadic cases.

Epidemiology of childhood acute leukemias in marginalized populations of the central-south region of Mexico: results from a population-based registry.

Introduction: Acute leukemias (AL) are the main types of cancer in children worldwide. In Mexico, they represent one of the main causes of death in children under 20 years of age. Most of the studies on the incidence of AL in Mexico have been developed in the urban context of Greater Mexico City and no previous studies have been conducted in the central-south of the country through a population-based study. The aim of the present work was to identify the general and specific incidence rates of pediatric AL in three states of the south-central region of Mexico considered as some of the marginalized populations of Mexico (Puebla, Tlaxcala, and Oaxaca). Methods: A population-based study was conducted. Children aged less than 20 years, resident in these states, and newly diagnosed with AL in public/private hospitals during the period 2021-2022 were identified. Crude incidence rates (cIR), standardized incidence rates (ASIRw), and incidence rates by state subregions (ASIRsr) were calculated. Rates were calculated using the direct and indirect method and reported per million children under 20 years of age. In addition, specific rates were calculated by age group, sex, leukemia subtype, and immunophenotype. Results: A total of 388 cases with AL were registered. In the three states, the ASIRw for AL was 51.5 cases per million (0-14 years); in Puebla, it was 53.2, Tlaxcala 54.7, and Oaxaca de 47.7. In the age group between 0-19 years, the ASIRw were 44.3, 46.4, 48.2, and 49.6, in Puebla, Tlaxcala, and Oaxaca, respectively. B-cell acute lymphoblastic leukemia was the most common subtype across the three states. Conclusion: The incidence of childhood AL in the central-south region of Mexico is within the range of rates reported in other populations of Latin American origin. Two incidence peaks were identified for lymphoblastic and myeloid leukemias. In addition, differences in the incidence of the disease were observed among state subregions which could be attributed to social factors linked to the ethnic origin of the inhabitants. Nonetheless, this hypothesis requires further investigation.

Effects of the COVID-19 pandemic on gestational diabetes in Castilla-La Mancha (Spain).

SUBJECT-MATTER: To assess the effect of the 2019 coronavirus (COVID-19) pandemic on gestational diabetes (GDM). MATERIAL AND METHODS: In this retrospective, multicentre, non-interventional study carried out in Castilla-La Mancha, Spain, we compared 663 women with GDM exposed to the pandemic (pandemic group), with 622 women with GDM seen one year earlier (pre-pandemic group). The primary endpoint was a Large for Gestational Age (LGA) newborn as an indicator of poor GDM control. Secondary endpoints included obstetric and neonatal complications. RESULTS: During the pandemic, the gestational week at diagnosis (24.2 ±â€¯7.4 vs 22.9 ±â€¯7.7, p = 0.0016) and first visit to Endocrinology (26.6 ±â€¯7.2 vs 25.3 ±â€¯7.6, p = 0.0014) were earlier. Face-to-face consultations were maintained in most cases (80.3%). The new diagnostic criteria for GDM were used in only 3% of cases. However, in the pandemic group, the final HbA1c was higher (5.2 ±â€¯0.48 vs 5.29 ±â€¯0.44%, p = 0.047) and there were more LGA newborns (8.5% vs 12.8%, p = 0.015). There were no differences in perinatal complications. CONCLUSIONS: Care for GDM in our Public Health System did not significantly deteriorate during the COVID-19 pandemic. However, this did not prevent a higher number of LGA newborns.

Renin as a Biomarker to Guide Medical Treatment in Primary Aldosteronism Patients. Findings from the SPAIN-ALDO Registry.

INTRODUCTION: Primary aldosteronism (PA) is associated with several cardiometabolic comorbidities. Specific treatment by mineralocorticoid receptor antagonists (MRA) or adrenalectomy has been reported to reduce the cardiometabolic risk. However, the cardiovascular benefit could depend on plasma renin levels in patients on MRA. AIM: To compare the development of cardiovascular, renal and metabolic complications between medically treated patients with PA and those who underwent adrenalectomy, taking the renin status during MRA treatment into account. METHODS: A multicenter retrospective study (SPAIN-ALDO Register) of patients with PA treated at 35 Spanish tertiary hospitals. Patients on MRA were divided into two groups based on renin suppression (n = 90) or non-suppression (n = 70). Both groups were also compared to unilateral PA patients (n = 275) who achieved biochemical cure with adrenalectomy. RESULTS: Adrenalectomized patients were younger, had higher plasma aldosterone concentration, and lower potassium levels than MRA group. Patients on MRA had similar baseline characteristics when stratified into treatment groups with suppressed and unsuppressed renin. 97 (55.1%) of 176 patients without comorbidities at diagnosis, developed at least one comorbidity during follow-up (median 12 months vs. 12.5 months' follow-up after starting MRA and surgery, respectively). Surgery group had a lower risk of developing new cardiovascular events (HR 0.40 [95% CI 0.18-0.90]) than MRA group. Surgical treatment improved glycemic and blood pressure control, increased serum potassium levels, and required fewer antihypertensive drugs than medical treatment. However, there were no differences in the cardiometabolic profile or the incidence of new comorbidities between the groups with suppressed and unsuppressed renin levels (HR 0.95 [95% CI 0.52-1.73]). CONCLUSION: Cardiovascular, renal, and metabolic events were comparable in MRA patients with unsuppressed and suppressed renin. Effective surgical treatment of PA was associated with a decreased incidence of new cardiovascular events when compared to MRA therapy.

Nanogram-scale boron isotope analysis through micro-distillation and Nu Plasma 3 MC-ICP-MS.

The determination of boron isotopes (δ11B) represents a powerful tool for a variety of applications such as the reconstruction of past ocean pH and atmospheric pCO2 from the analysis of marine biogenic carbonates. In recent years, MC-ICP-MS has gained popularity over other techniques thanks to its superior sample throughput and high ionization efficiency. This study evaluates, for the first time, the performance of the Nu Instruments Plasma 3 MC-ICP-MS for measuring δ11B using different sample introduction systems and detector configurations. The main goal is to provide a detailed methodology for nanogram-scale boron isotope analysis through a straightforward approach that can be easily adopted. Boron (B) purification from the carbonate matrix was performed through micro-distillation, using a temperature of 95 °C and a minimum heating duration of 15 h, allowing the full recovery of B from up to 3 mg of carbonate mass. We attained blank values (on average 14 ± 6 pg, 1 SD, n = 27) comparable to the lowest micro-distillation blanks reported in the literature. Three sample introduction systems were tested, and the 30 µL min-1 nebuliser system outperformed the 50 and 170 µL min-1 systems in terms of signal intensity per mass of B. Two detector configurations were used based on the total boron signal intensity achieved: (1) FC11/FC12, with two Faraday cups fitted to 1011 Ω and 1012 Ω amplifier resistors to detect 11B and 10B ion beams, respectively, and (2) FC12/IC, with which we investigated, for the first time, the feasibility of combining an ion counter for detecting 10B, and a Faraday cup fitted to a 1012 Ω amplifier for 11B. The FC12/IC configuration provided accurate results compared to the use of two Faraday cups for total boron signals lower than 0.35 V (∼12 ng of B in the analysed solution). The proposed analytical procedure was validated through the analysis of several reference materials with varying boron amounts, including clam JCt-1, coral JCp-1, NIST RM 8301 Foram and Coral solutions, and boric acid ERM-AE121. Furthermore, the long-term reproducibility was assessed with two in-house standards (coral CLD-1 and foraminifera GINF-1), providing values of 25.68 ± 0.23 ‰ (2SD, n = 53; with 14-36 ng of B) and 14.90 ± 0.16 ‰ (2SD, n = 12; with 11-16 ng of B), respectively.

Miedo a la muerte y a su proceso en personal de Pediatría durante la pandemia por COVID-19

Introducción: La evidencia obtenida en estudios previos señala que existe mayor ansiedad por el proceso de morir que, por la muerte misma, aunque falta mayor investigación. Objetivo: Analizar el miedo a la muerte y al proceso de morir propio y de otros en el servicio de Pediatría del Hospital Pablo Tobón Uribe. Metodología: Se realizó un estudio analítico transversal con la Escala de Miedo a la Muerte de Collett-Lester en 143 personas: 25,2 % pediatras generales y subespecialistas, 70,6 % profesionales de Enfermería y auxiliares, y 4,2 % terapeutas respiratorios. El análisis incluyó estadística descriptiva, pruebas de Chi2, U de Mann-Whitney, Fisher, T de Student, ANOVA y el Alfa de Cronbach. Resultados: los hallazgos del estudio sugieren que es menor el miedo a la propia muerte que el miedo a la muerte de otros, y no hay diferencia entre el miedo al proceso de morir propio y de otros. Es mayor el miedo a la muerte en enfermeras profesionales y menor en pediatras subespecialistas. Existe mayor miedo a la muerte en el servicio de UCI-UCE (media: 3,53 DS: 0,88) comparado con Urgencias (media: 2,66 DS: 0,59). Hay asociación entre el miedo a la muerte con: el sexo femenino (p = 0,000), tener una creencia religiosa (p = 0,048), y el cargo (p = 0,007). La escala tuvo muy alta fiabilidad (Alfa de Cronbach: 0,95). Discusión: es de aclarar que este estudio fue realizado durante el segundo año de la pandemia del COVID-19, cuando había menor temor, mayor conocimiento y vacunas, cuyos resultados se corresponden con otros estudios. Conclusión: en el presente estudio el mayor miedo a la muerte se asoció con ser mujer, tener creencia religiosa y laborar en UCI-UCE comparado con Urgencias.

Introduction: The evidence obtained from previous research suggests that there is more anxiety related to dying compared with death. Nevertheless, more research is needed. Objective: To analyze the fear of death and dying, oneself and others, in the pediatric service personnel at Pablo Tobón Uribe Hospital in Medellín. Methodology: This was a transversal analytic study to apply the Collett-Lester Fear of Death Scale on 143 people: 25,2 % were general pediatricians and subspecialists, 70,6 % were professional nurses and medical assistants, and 4,2 % were respiratory therapists. The analysis included descriptive statistics, Chi2 test, Mann-Whitney U test, Fisher, StudentsT, ANOVA and Cronbach's Alpha. Results: Here we report the mean of one's fear of death is lower than the fear of others' death. There is no difference when comparing the fear of one's process of dying mean, rather than when it's others. Fear of death is higher in professional nurses and lower in pediatric subspecialists. The study shows higher fear of death in the ICU-IMC services (mean: 3,53 SD: 0,88) compared with the emergency room (mean:2,66 SD: 0,59). There is a statistical association between fear of death and being a woman (p=0,000), having a religious belief (p=0,048) and job position (p=0,007). The scale has a high internal consistency (Cronbach's Alpha: 0,95). Discussion: It is important to mention that this research was conducted during the second year of the COVID-19 pandemic, when the fear had decreased, and with more knowledge and the vaccines were ready, the results are coherent with other papers. Conclusion: In this study the higher fear of death was associated with being a woman, having a religious belief and working in ICU-IMC compared to the emergency room.

Apnea or cyanosis as COVID-19 initial presentation in newborns.

INTRODUCTION: The clinical manifestation of coronavirus disease 2019 (COVID-19) infection in newborns varies from asymptomatic infection to severe illness. Apnea or cyanosis as the earliest symptoms is rarely mentioned. The aim of this study is to describe the characteristics of newborns with COVID-19 infection admitted to the neonatal intensive care unit considering cyanosis or apnea as a form of presentation. METHODOLOGY: This is a descriptive observational study with retrospectively collected data. All neonates under 30 days old and preterm infants with corrected gestational age of 44 weeks who had confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with a positive antigen or reverse transcriptase polymerase chain reaction (RT-PCR) test and who were attended to between March 2020 and March 2022 were included. RESULTS: During the two years of the study, 410 patients were admitted to the neonatal unit. Twenty-six patients (6.3%) presented with confirmed SARS-CoV-2 infection. The main clinical characteristic at admission was apnea in 55% and cyanosis in 45%. Of the 11 patients admitted with this presentation, eight were diagnosed with COVID-19 acute upper respiratory disease, and three met the definition of COVID-19 bronchiolitis. A large proportion of the patients had a mild infection (65%, n = 17), 31% (n = 8) had a severe infection and only one patient had a critical infection, accounting for 4%. CONCLUSIONS: Apnea and cyanosis can be a manifestation of SARS-CoV-2 infection in newborns, which suggests the need to include it in the diagnostic workup as other viral respiratory infections.

Is adrenal venous sampling always necessary to differentiate between unilateral and bilateral primary aldosteronism? Lesson from the SPAIN-ALDO register.

PURPOSE: To evaluate whether the clinical, biochemical and radiological features of patients with primary aldosteronism (PA) can predict both main subtypes of PA. METHODS: A retrospective multicenter study of PA patients followed in 27 Spanish tertiary hospitals (SPAIN-ALDO Register). Only patients with confirmed unilateral or bilateral PA based on adrenal venous sampling (AVS) and/or postsurgical biochemical cure after adrenalectomy were included. Supervised regression techniques were used for model development. RESULTS: 328 patients [270 unilateral PA (UPA), 58 bilateral PA (BPA)] were included. The area under the curve (AUC) for aldosterone/potassium ratio and aldosterone responses following saline infusion test were 0.602 [95%CI 0.520 to 0.684] and 0.574 [95% CI 0.446-0.701], respectively, to differentiate UPA from BPA. The AUC was 0.825 [95% 0.764-0.886] when the prediction model with seven parameters - comorbidities (dyslipidemia, cerebrovascular disease, sleep apnea syndrome [SAS]), systolic blood pressure (SBP), plasma aldosterone levels (PAC), hypokalemia and unilateral adrenal nodule >1 cm and normal contralateral adrenal gland on CT/MRI - was used. In patients without comorbidities, hypokalemia, SBP > 160 mmHg, PAC > 40 ng/dL, and unilateral adrenal lesions were associated with a likelihood of having a UPA of 98.5%. The chance of BPA was higher in individuals with comorbidities, SBP < 140 mmHg, normokalemia, low PAC levels, and no adrenal tumors on the CT/MRI (91.5%). CONCLUSION: A combination of high PAC, SBP > 160 mmHg, low serum potassium, a unilateral adrenal nodule>1 cm and no comorbidities could predict a UPA with a 98.5% accuracy.

Adipokines and Inflammatory Markers in Acute Myocardial Infarction Patients with and without Obstructive Sleep Apnea: A Comparative Analysis.

An association has been suggested between acute myocardial infarction (AMI) and obstructive sleep apnea (OSA). Considering the role of adipose-tissue-derived inflammatory mediators (adipokines) and the shared risk factor of obesity in OSA and AMI, this study aimed to investigate the involvement of adipokines in AMI patients with and without OSA. Serum levels of adipokines and inflammatory mediators were quantified, and home respiratory polygraphy was conducted. A total of 30 AMI patients and 25 controls were included. Patients with AMI exhibited elevated levels of resistin (7.4 vs. 3.7 ng/mL), interleukin-6 (8.8 vs. 1.3 pg/mL), and endothelin-1 (3.31 vs. 1.8 pg/mL). Remarkably, AMI patients with concomitant OSA exhibited higher levels of resistin (7.1 vs. 3.7 ng/mL), interleukin-6 (8.9 vs. 1.3 pg/mL), endothelin-1 (3.2 vs. 1.8 pg/mL), creatin kinase (1430 vs. 377 U/L), creatine kinase-MB (64.6 vs. 9.7 ng/mL), and troponin T (2298 vs. 356 pg/mL) than their non-OSA counterparts. Leptin showed a correlation with OSA severity markers. OSA was associated with greater cardiac damage in AMI patients. Our findings underscore that adipokines alone are not sufficient to discriminate the risk of AMI in the presence of OSA. Further research is necessary to determine the potential mechanisms contributing to exacerbated cardiac damage in patients with both conditions.

El cuidado de enfermería: ¿Se puede aprender? / Nursing care: Can it be learned?

Transformar la educación de enfermería con una visión intercultural en donde el centro para el cuidado sean las personas, las familias y las comunidades, mediante la cual se logren los propósitos de proveer cuidados eficaces, eficientes y efectivos acordes a sus propias necesidades. Es así como se entiende que el cuidado se puede aprender, mediante un proceso de enseñanza-aprendizaje en el que haya una continuidad entre la teoría y la práctica, entre lo que se enseña, se aprende y se práctica en escenarios muy próximos a la realidad, con la utilización de lecturas, escritos, reflexiones, vivencias, diálogos de saberes, experiencias de otros, historias de vida y narrativas.

Transform nursing education with an intercultural vision where the center of care is people, families and communities, through which the purposes of providing effective, efficient and effective care are achieved according to their own needs. This is how it is understood that care can be learned, through a teaching-learning process in which there is continuity between theory and practice, between what is taught, learned and practiced in scenarios very close to reality, with the use of readings, writings, reflections, experiences, dialogues of knowledge, experiences of others, life stories and narratives.

Autonomous cortisol secretion in patients with primary aldosteronism: prevalence and implications on cardiometabolic profile and on surgical outcomes.

Purpose: The aim of this study was to evaluate the prevalence of autonomous cortisol secretion (ACS) in patients with primary aldosteronism (PA) and its implications on cardiometabolic and surgical outcomes. Methods: This is a retrospective multicenter study of PA patients who underwent 1 mg dexamethasone-suppression test (DST) during diagnostic workup in 21 Spanish tertiary hospitals. ACS was defined as a cortisol post-DST >1.8 µg/dL (confirmed ACS if >5 µg/dL and possible ACS if 1.8-5 µg/dL) in the absence of specific clinical features of hypercortisolism. The cardiometabolic profile was compared with a control group with ACS without PA (ACS group) matched for age and DST levels. Results: The prevalence of ACS in the global cohort of patients with PA (n = 176) was 29% (ACS-PA; n = 51). Ten patients had confirmed ACS and 41 possible ACS. The cardiometabolic profile of ACS-PA and PA-only patients was similar, except for older age and larger tumor size of the adrenal lesion in the ACS-PA group. When comparing the ACS-PA group (n = 51) and the ACS group (n = 78), the prevalence of hypertension (OR 7.7 (2.64-22.32)) and cardiovascular events (OR 5.0 (2.29-11.07)) was higher in ACS-PA patients than in ACS patients. The coexistence of ACS in patients with PA did not affect the surgical outcomes, the proportion of biochemical cure and clinical cure being similar between ACS-PA and PA-only groups. Conclusion: Co-secretion of cortisol and aldosterone affects almost one-third of patients with PA. Its occurrence is more frequent in patients with larger tumors and advanced age. However, the cardiometabolic and surgical outcomes of patients with ACS-PA and PA-only are similar.

[New therapeutic advances in patients with lung cancer immunosuppressed with chronic lung diseases in the period 2014-2022 from the review of the literature.] / Nuevos avances terapéuticos en pacientes con cáncer de pulmón inmunosuprimidos con enfermedades crónicas pulmonares en el periodo 2014-2022 a partir de la revisión de la literatura.

Lung cancer is a malignant neoplasm with a high prevalence and mortality, more so in patients with respiratory comorbidities, whose cells have a massive proliferation capacity in the lung tissue, managing to invade other organs, which deteriorates the patient's physical and emotional state, decreasing their quality of life and defense system; therefore, treatment today is not sufficient for patient survival and there has been evidence of a certain evolution in the treatment of the disease or early detection to prevent it. This article aimed to analyze the new therapeutic advances in patients with lung cancer associated with chronic lung diseases in the period 2014-2022 based on a review of the literature. Several parameters were used to limit the search, extrapolating the articles of interest, validating fifty three articles, six doctoral theses and two books, which were in Spanish and English.The various search strategies used were keywords, subject and author follow-up. The sections developed in this review are the concept of Lung Cancer (LC), clinical manifestations, risk factors, relationship between LC and chronic lung diseases, diagnosis, treatment, prevention and new therapeutic advances. All the filtered information of the selected articles shows us the importance that the use of various biomarkers is taking for its early detection; however, the transfer of antitumor T cells in patients with underlying lung disease had an efficiency of 48.

El cáncer de pulmón es una neoplasia maligna de gran prevalencia y mortalidad, más en pacientes con comorbilidades respiratorias, cuyas células tienen una capacidad de proliferación masiva en el tejido pulmonar logrando invadir otros órganos, deteriorando el estado físico y emocional del paciente, su calidad de vida y sistema de defensa. Además, el tratamiento no es suficiente hoy en día para la supervivencia del paciente y se ha evidenciado cierta evolución en la terapéutica de la enfermedad o su detección precoz. El objetivo fue analizar los nuevos avances terapéuticos en pacientes con Cáncer de Pulmón asociado a enfermedades crónicas pulmonares en el periodo 2014-2022 a partir de la revisión de la literatura. Se aplicaron diversos parámetros para la limitación de búsqueda, extrapolando los artículos de interés, siendo validados cincuenta y tres artículos, seis tesis doctorales y dos libros, los cuales eran de idioma español e inglés. Las diversas estrategias de búsquedas usadas fueron las palabras claves, tema y seguimiento de autor. Los apartados desarrollados en la presente revisión fueron el concepto de cáncer de pulmón (CP), las manifestaciones clínicas, los factores de riesgo, la relación entre CP y enfermedades crónicas pulmonares, el diagnóstico, el tratamiento, la prevención y los nuevos avances terapéuticos. Toda la información filtrada de los artículos seleccionados nos pone de manifiesto la importancia que está tomando el uso de diversos biomarcadores para su detección precoz; sin embargo, la transferencia de células T antitumorales en pacientes con una enfermedad pulmonar de base presentó una eficiencia del 48%.

Nuevos avances terapéuticos en pacientes con cáncer de pulmón inmunosuprimidos con enfermedades crónicas pulmonares en el periodo 2014-2022 a partir de la revisión de la literatura / New therapeutic advances in patients with lung cancer immunosuppressed with chronic lung diseases in the period 2014-2022 from the review of the literature

El cáncer de pulmón es una neoplasia maligna de gran prevalencia y mortalidad, más en pacientes con comorbilidades respiratorias,cuyas células tienen una capacidad de proliferación masiva en el tejido pulmonar logrando invadir otros órganos, deteriorando elestado físico y emocional del paciente, su calidad de vida y sistema de defensa. Además, el tratamiento no es suficiente hoy en díapara la supervivencia del paciente y se ha evidenciado cierta evolución en la terapéutica de la enfermedad o su detección precoz.El objetivo fue analizar los nuevos avances terapéuticos en pacientes con Cáncer de Pulmón asociado a enfermedades crónicaspulmonares en el periodo 2014-2022 a partir de la revisión de la literatura. Se aplicaron diversos parámetros para la limitación de bús-queda, extrapolando los artículos de interés, siendo validados cincuenta y tres artículos, seis tesis doctorales y dos libros, los cualeseran de idioma español e inglés. Las diversas estrategias de búsquedas usadas fueron las palabras claves, tema y seguimiento deautor. Los apartados desarrollados en la presente revisión fueron el concepto de cáncer de pulmón (CP), las manifestaciones clínicas,los factores de riesgo, la relación entre CP y enfermedades crónicas pulmonares, el diagnóstico, el tratamiento, la prevención y losnuevos avances terapéuticos. Toda la información filtrada de los artículos seleccionados nos pone de manifiesto la importancia queestá tomando el uso de diversos biomarcadores para su detección precoz; sin embargo, la transferencia de células T antitumoralesen pacientes con una enfermedad pulmonar de base presentó una eficiencia del 48%.(AU)

Lung cancer is a malignant neoplasm with a high prevalence and mortality, more so in patients with respiratory comorbidities, whosecells have a massive proliferation capacity in the lung tissue, managing to invade other organs, which deteriorates the patient’s phy-sical and emotional state, decreasing their quality of life and defense system; therefore, treatment today is not sufficient for patientsurvival and there has been evidence of a certain evolution in the treatment of the disease or early detection to prevent it. This articleaimed to analyze the new therapeutic advances in patients with lung cancer associated with chronic lung diseases in the period2014-2022 based on a review of the literature. Several parameters were used to limit the search, extrapolating the articles of interest,validating fifty three articles, six doctoral theses and two books, which were in Spanish and English.The various search strategiesused were keywords, subject and author follow-up. The sections developed in this review are the concept of Lung Cancer (LC), clinicalmanifestations, risk factors, relationship between LC and chronic lung diseases, diagnosis, treatment, prevention and new therapeuticadvances. All the filtered information of the selected articles shows us the importance that the use of various biomarkers is takingfor its early detection; however, the transfer of antitumor T cells in patients with underlying lung disease had an efficiency of 48%.(AU)

Visual Parking Occupancy Detection Using Extended Contextual Image Information via a Multi-Branch Output ConvNeXt Network.

Along with society's development, transportation has become a key factor in human daily life, increasing the number of vehicles on the streets. Consequently, the task of finding free parking slots in metropolitan areas can be dramatically challenging, increasing the chance of getting involved in an accident and the carbon footprint, and negatively affecting the driver's health. Therefore, technological resources to deal with parking management and real-time monitoring have become key players in this scenario to speed up the parking process in urban areas. This work proposes a new computer-vision-based system that detects vacant parking spaces in challenging situations using color imagery processed by a novel deep-learning algorithm. This is based on a multi-branch output neural network that maximizes the contextual image information to infer the occupancy of every parking space. Every output infers the occupancy of a specific parking slot using all the input image information, unlike existing approaches, which only use a neighborhood around every slot. This allows it to be very robust to changing illumination conditions, different camera perspectives, and mutual occlusions between parked cars. An extensive evaluation has been performed using several public datasets, proving that the proposed system outperforms existing approaches.

Study protocol for a multisite randomized controlled trial of a peer navigator intervention for emergency department patients with nonfatal opioid overdose.

BACKGROUND: Patients presenting to emergency departments (EDs) after a nonfatal opioid-involved overdose are at high risk for future overdose and death. Responding to this risk, the New York City (NYC) Department of Health and Mental Hygiene operates the Relay initiative, which dispatches trained peer "Wellness Advocates" to meet patients in the ED after a suspected opioid-involved overdose and follow them for up to 90 days to provide support, education, referrals to treatment, and other resources using a harm reduction framework. METHODS: In this article, we describe the protocol for a multisite randomized controlled trial of Relay. Study participants are recruited from four NYC EDs and are randomized to receive the Relay intervention or site-directed care (the control arm). Outcomes are assessed through survey questionnaires conducted at 1-, 3-, and 6-months after the baseline visit, as well as through administrative health data. The primary outcome is the number of opioid-related adverse events, including any opioid-involved overdose or any other substance use-related ED visit, in the 12 months post-baseline. Secondary and exploratory outcomes will also be analyzed, as well as hypothesized mediators and moderators of Relay program effectiveness. CONCLUSION: We present the protocol for a multisite randomized controlled trial of a peer-delivered OD prevention intervention in EDs. We describe how the study was designed to minimize disruption to routine ED operations, and how the study was implemented and adapted during the COVID-19 pandemic. This trial is registered with ClinicalTrials.gov [NCT04317053].