Electrical conductivity of warm dense silica from double-shock experiments.

Understanding materials behaviour under extreme thermodynamic conditions is fundamental in many branches of science, including High-Energy-Density physics, fusion research, material and planetary science. Silica (SiO2) is of primary importance as a key component of rocky planets' mantles. Dynamic compression is the most promising approach to explore molten silicates under extreme conditions. Although most experimental studies are restricted to the Hugoniot curve, a wider range of conditions must be reached to distill temperature and pressure effects. Here we present direct measurements of equation of state and two-colour reflectivity of double-shocked α-quartz on a large ensemble of thermodynamic conditions, which were until now unexplored. Combining experimental reflectivity data with numerical simulations we determine the electrical conductivity. The latter is almost constant with pressure while highly dependent on temperature, which is consistent with simulations results. Based on our findings, we conclude that dynamo processes are likely in Super-Earths' mantles.

X-ray powder diffraction in reflection geometry on multi-beam kJ-type laser facilities.

An ultrafast x-ray powder diffraction setup for laser-driven dynamic compression has been developed at the LULI2000 laser facility. X-ray diffraction is performed in reflection geometry from a quasi-monochromatic laser-generated plasma x-ray source. In comparison to a transmission geometry setup, this configuration allows us to probe only a small portion of the compressed sample, as well as to shield the detectors against the x-rays generated by the laser-plasma interaction on the front side of the target. Thus, this new platform facilitates probing of spatially and temporarily uniform thermodynamic conditions and enables us to study samples of a large range of atomic numbers, thicknesses, and compression dynamics. As a proof-of-concept, we report direct structural measurements of the bcc-hcp transition both in shock and ramp-compressed polycrystalline iron with diffraction signals recorded between 2θ ∼ 30° and ∼150°. In parallel, the pressure and temperature history of probed samples is measured by rear-side visible diagnostics (velocimetry and pyrometry).

Metallization of Shock-Compressed Liquid Ammonia.

Ammonia is predicted to be one of the major components in the depths of the ice giant planets Uranus and Neptune. Their dynamics, evolution, and interior structure are insufficiently understood and models rely imperatively on data for equation of state and transport properties. Despite its great significance, the experimentally accessed region of the ammonia phase diagram today is still very limited in pressure and temperature. Here we push the probed regime to unprecedented conditions, up to ∼350 GPa and ∼40 000 K. Along the Hugoniot, the temperature measured as a function of pressure shows a subtle change in slope at ∼7000 K and ∼90 GPa, in agreement with ab initio simulations we have performed. This feature coincides with the gradual transition from a molecular liquid to a plasma state. Additionally, we performed reflectivity measurements, providing the first experimental evidence of electronic conduction in high-pressure ammonia. Shock reflectance continuously rises with pressure above 50 GPa and reaches saturation values above 120 GPa. Corresponding electrical conductivity values are up to 1 order of magnitude higher than in water in the 100 GPa regime, with possible significant contributions of the predicted ammonia-rich layers to the generation of magnetic dynamos in ice giant interiors.

Melting Curve and Isostructural Solid Transition in Superionic Ice.

The phase diagram and melting curve of water ice is investigated up to 45 GPa and 1600 K by synchrotron x-ray diffraction in the resistively and laser heated diamond anvil cell. Our melting data evidence a triple point at 14.6 GPa, 850 K. The latter is shown to be related to a first-order solid transition from the dynamically disordered form of ice VII, denoted ice VII^{'}, toward a high-temperature phase with the same bcc oxygen lattice but larger volume and higher entropy. Our experiments are compared to ab initio molecular dynamics simulations, enabling us to identify the high-temperature bcc phase with the predicted superionic ice VII^{''} phase [J.-A. Hernandez and R. Caracas, Phys. Rev. Lett. 117, 135503 (2016).PRLTAO0031-900710.1103/PhysRevLett.117.135503].

Laser-driven shock compression of "synthetic planetary mixtures" of water, ethanol, and ammonia.

Water, methane, and ammonia are commonly considered to be the key components of the interiors of Uranus and Neptune. Modelling the planets' internal structure, evolution, and dynamo heavily relies on the properties of the complex mixtures with uncertain exact composition in their deep interiors. Therefore, characterising icy mixtures with varying composition at planetary conditions of several hundred gigapascal and a few thousand Kelvin is crucial to improve our understanding of the ice giants. In this work, pure water, a water-ethanol mixture, and a water-ethanol-ammonia "synthetic planetary mixture" (SPM) have been compressed through laser-driven decaying shocks along their principal Hugoniot curves up to 270, 280, and 260 GPa, respectively. Measured temperatures spanned from 4000 to 25000 K, just above the coldest predicted adiabatic Uranus and Neptune profiles (3000-4000 K) but more similar to those predicted by more recent models including a thermal boundary layer (7000-14000 K). The experiments were performed at the GEKKO XII and LULI2000 laser facilities using standard optical diagnostics (Doppler velocimetry and optical pyrometry) to measure the thermodynamic state and the shock-front reflectivity at two different wavelengths. The results show that water and the mixtures undergo a similar compression path under single shock loading in agreement with Density Functional Theory Molecular Dynamics (DFT-MD) calculations using the Linear Mixing Approximation (LMA). On the contrary, their shock-front reflectivities behave differently by what concerns both the onset pressures and the saturation values, with possible impact on planetary dynamos.

Proton dynamics and the phase diagram of dense water ice.

All the different phases of water ice between 2 GPa and several megabars are based on a single body-centered cubic sub-lattice of oxygen atoms. They differ only by the behavior of the hydrogen atoms. In this study, we investigate the dynamics of the H atoms at high pressures and temperatures in water ice from first-principles molecular dynamics simulations. We provide a detailed analysis of the O-H⋯O bonding dynamics over the entire stability domain of the body-centered cubic (bcc) water ices and compute transport properties and vibrational density-of-states. We report the first ab initio evidence for a plastic phase of water and we propose a coherent phase diagram for bcc water ices compatible with the two groups of melting curves and with the multiple anomalies reported in ice VII around 15 GPa.

Epónimos del síndrome Ehlers-Danlos y su variante tipo IV o Sack-Barabas / Eponyms of Ehlers-Danlos syndrome and its type IV variant or Sack-Barabas

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Diagnóstico ecográfico y manejo de la infección fetal por parvovirus B19 / Prenatal diagnosis and management of fetal parvovirus B19 infection

Introducción: El parvovirus humano B19 (B19V) es una de las principales causas de anemia fetal que puede ocasionar hidropesía fetal grave, siendo el responsable de un 18-27% de las hidropesías fetales no inmunitarias. La infección por el B19V presenta brotes epidémicos cada 4-6 años, ocasionando un mayor número de casos de anemia fetal en los que es necesario realizar tratamiento. Objetivo: Conocer los resultados de los fetos con infección por B19V, su evolución, manejo y resultados perinatales. Material y métodos: Estudio descriptivo retrospectivo de los casos de infección congénita por B19V, diagnosticados en un periodo de 5 años. Resultados: Se analizaron 14 fetos con infección y afectación por el B19V. Un 71,4% de los fetos tuvieron hidropesía fetal. El hallazgo ecográfico más frecuente fue la cardiomegalia (78,6%). Se realizó transfusión intrauterina a 7 fetos. Fallecieron un 40% de los fetos. De los fetos a los que se les realizó TIU, un 42,85% falleció tras el procedimiento, todos ellos presentaron una pancitopenia grave arregenerativa. Conclusiones: Aunque es una patología de buen pronóstico, los resultados dependen en gran medida del estado hemodinámico del feto, así como el grado de afectación hematológica y los riesgos de las técnicas invasivas. Existen parámetros de anemia fetal como es la presencia de regurgitación de la válvula tricúspide que ayudan a predecir un grado de afectación fetal y, por lo tanto, debería tenerse en cuenta para valorar la realización de técnicas invasivas para estimación directa del grado de anemia fetal

Introduction: The human parvovirus B19 virus (B19V) is one of the most common infectious causes of foetal anaemia, which can lead to severe foetal hydrops. This infection causes 17-27% of non-immune foetal hydrops. Epidemic outbreaks of B19V infection occur at intervals of 4-6 years, increasing the number of cases of foetal anaemia requiring treatment. Objective: To determine the findings in foetuses with B19V infection, the clinical course of these pregnancies, their management and perinatal outcomes. Material and methods: A retrospective study of cases of congenital B19V infection diagnosed over a 5-year period. Results: We found 14 foetuses with B19V infection. Hydrops was present in 71.4% of the cases. The most frequent ultrasound finding was cardiomegaly (78.6%). Exchange transfusion was carried out in 7 foetuses. Overall mortality was 40%. Of the 7 treated foetuses, 42.85% died after the procedure. All of them had severe aregenerative pancytopenia. Conclusion: The results of B19V infections largely depend on the degree of the anaemia, the haemodynamic status of the foetus, and the risk of invasive procedures. Some parameters, such as the presence of tricuspid regurgitation, can be used to diagnose foetal anaemia and could therefore be useful as a tool to evaluate the use of invasive procedures to directly estimate the degree of foetal anaemiA

Onabotulinumtoxin A en la incontinencia urinaria: estudio prospectivo de serie de casos / Onabotulinumtoxin A in urinary incontinence: Prospective Study of a Case Series

Objetivo: Evaluar la eficacia y seguridad de una inyección intravesical única de Onabotulinumtoxin A (OnaBTA) en el tratamiento de la incontinencia urinaria de urgencia en mujeres. Método: Se realizó un estudio prospectivo de serie de casos en pacientes consecutivas con incontinencia urinaria de esfuerzo refractaria tratadas con una inyección intravesical de OnaBTA. Las pacientes recibieron 100 unidades de OnaBTA inyectada en la pared vesical después de 4 semanas de lavado de anticolinérgicos o agonistas beta 3. Las variables urodinámicas y clínicas fueron evaluadas antes y 6 meses después de la inyección de OnaBTA. La variable principal del estudio fue el número de episodios de escapes urinarios. Resultados: Un total de 204 de las 210 pacientes seleccionadas realizaron una visita válida al sexto mes de la aplicación terapéutica. A los 6 meses del tratamiento con OnaBTA 110 (53,9%) pacientes permanecieron continentes y fueron consideradas como éxito. Por otro lado, 57 (27,9%) presentaron un episodio de escape urinario por día y 37 (18,2%) tuvieron 2 o más. En relación con los parámetros urodinámicos se observaron los siguientes cambios: aumento de la capacidad vesical máxima (p<0,0001) y disminución de la presión del detrusor máxima (p<0,0001). En cuanto al perfil de seguridad, 8 (3,9%) pacientes tuvieron hematuria autolimitada durante el procedimiento, que se resolvió espontáneamente; 9 (4,4%) pacientes tuvieron una retención urinaria aguda que precisó cateterización intermitente. Conclusiones: Este estudio apoya el uso de onabotulinumtoxin A en pacientes con incontinencia urinaria de urgencia que no responden al tratamiento médico

Objective: To assess the safety and efficacy of a single intravesical injection of onabotulinumtoxinA (OnaBTA) for treating urge urinary incontinence (UUI) in women. Method: We performed a prospective case-series study of consecutive patients with refractory UUI treated with an intravesical injection of OnaBTA. The patients were administered 100 units of OnaBTA injected into the bladder wall following 4 weeks of flushing with anticholinergic agents or beta 3 agonists. The urodynamic and clinical endpoints were evaluated before and 6 months after the injection of OnaBTA. The primary study endpoint was the number of episodes of urinary leakage. Results: A total of 204 of the 210 selected patients conducted a valid visit 6 months after the therapeutic application. At 6 months of treatment with OnaBTA, 110 (53.9%) patients remained continent and were considered a success. However, 57 (27.9%) patients experienced one episode of urinary leakage per day, and 37 (18.2%) had 2 or more. In terms of the urodynamic parameters, we observed the following changes: increase in maximum bladder capacity (P<.0001) and reduced maximum pressure of the detrusor (P<.0001). In terms of the safety profile, 8 (3.9%) patients had self-limiting haematuria during the procedure, which resolved spontaneously, and 9 (4.4%) patients had acute urinary retention that required intermittent catheterisation. Conclusions: This study supports the use of OnabotulinumtoxinA in patients with urge urinary incontinence that does not respond to medical treatment

Síndrome de Ehlers-Danlos de tipo IV: a propósito de un caso / Ehlers-Danlos syndrome type IV: Presentation of a case

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Caso 17. Aneurisma bilateral de vena yugular externa y trombosis bilateral secuencial / Case 17. Bilateral aneurysm of external jugular vein and sequential bilateral thrombosis

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Solución del caso 17. Aneurisma bilateral de vena yugular externa y trombosis bilateral secuencial / Solution to case 17. Bilateral aneurysm of external jugular vein and sequential bilateral thrombosis

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Diagnóstico ecográfico de 2 casos de displasias esqueléticas con alteración en la mineralización. Papel de la ecografía 3D / Role of 3D ultrasound in the diagnosis of skeletal dysplasias with hypomineralisation. Report of two cases

Las displasias esqueléticas que cursan con alteraciones en la mineralización son difíciles de diferenciar desde el punto de vista ecográfico, debido a que comparten características comunes unas con otras. Es importante conocer el diagnóstico exacto de estas entidades para realizar un asesoramiento adecuado. El uso de la ecografía tridimensional (3D), la navegación multiplanar y las reconstrucciones nos permite visualizar mejor ciertas características ecográficas de este tipo de alteraciones, que nos puede ayudar en el diagnóstico diferencial. Se presentan 2 casos de fetos afectos de displasias esqueléticas letales con alteración en la mineralización ósea diagnosticados prenatalmente y su dificultad en el diagnóstico

Skeletal dysplasias with hypomineralisation are difficult to distinguish by ultrasound because they share common features. It is very important to determine the exact diagnosis and provide appropriate counselling to parents for future pregnancies. The use of 3D ultrasound, multiplanar navigation and reconstructions allows better visualization of certain ultrasonographic features of these types of alteration, which can help to establish the differential diagnosis. We report the cases of two foetuses with skeletal dysplasias and hypomineralisation and the difficulties of the differential diagnosis

Morbimortalidad en recién nacidos con una edad gestacional igual o inferior a 26 semanas: estudio de los límites de viabilidad en nuestro medio / Morbidity and mortality in newborns with gestational age of 26 or less: study of the limits of viability in our setting

Introducción: La toma de decisiones acerca de los cuidados perinatales en fetos y recién nacidos (RN) al límite de la viabilidad continúa siendo un problema clínico y ético de la máxima envergadura para obstetras y neonatólogos. La inclusión de los padres en el proceso de toma de decisiones exige que la información proporcionada esté basada en los mejores datos disponibles. El objetivo de nuestro estudio fue conocer las tasas específicas de supervivencia al alta y de supervivencia sin morbilidad mayor, por edad gestacional (EG), en RN ≤26 semanas. Pacientes y métodos: Durante el periodo 2004-2010 se recogieron datos de todos los RN vivos (RNV) intramuros, de ≤26 semanas de EG. Se estudiaron los datos demográficos, de intervenciones y los resultados en morbimortalidad específica por EG. Resultados: Se incluyeron 137 RNV con una EG ≤26 semanas, de los que 8 fallecieron en la sala de partos. Entre los 129 ingresados en la unidad de cuidados intensivos neonatales, la supervivencia se incrementó progresivamente en función de la EG desde el 30,4% a las 24 semanas hasta el 64,7% a las 26 semanas. Asimismo, la supervivencia sin morbilidad mayor se incrementó desde el 4,3 al 25,9% en dichas EG. La mediana (rango intercuartílico) de la estancia hospitalaria en los supervivientes fue de 90 (76,5-113) días, y en los que fallecieron de 8 (3-21,5) días. Conclusiones: La supervivencia y la supervivencia sin morbilidad mayor aumentan significativamente con la EG en RN al límite de la viabilidad. Estos resultados, específicos por EG, aportan una información relevante para la toma de decisiones asistenciales e indican el potencial impacto en la gestión de recursos sanitarios (AU)

Introduction: Decision-making about perinatal care in fetuses and newborns at the limit of viability remains an important clinical and ethical problem for obstetricians and neonatologists. The inclusion of parents in the decision-making process requires that the information provided be based on the best available data. The aim of our study was to determine the specific rates, by GA, of survival and survival without major morbidity at hospital discharge in infants of ≤26 weeks of gestational age (GA). Patients and methods: During the period 2004-2010, data were collected from all live inborn infants ≤26 weeks GA, who did not die in the delivery room, and that were admitted for intensive care. We studied demographics data, interventions and morbidity and mortality by GA. Results: We included 137 live born infants ≤26 weeks GA, of which 8 died in delivery room. Among the 129 admitted to NICU, survival increased progressively as a function of the GA, from 30.4% at 24 weeks to 64.7% at 26 weeks. Likewise, survival without major morbidity increased from 4.3 to 25.9% in these GA. The average length of stay at discharge in survivors decreased significantly with increasing GA, with a median (IQR) of 90 (76.5-113) days. In non-survivors, the median (IQR) at death was 8 (3-21.5) days. Conclusions: Survival and survival without major morbidity increase significantly with increasing GA in infants at the limit of viability. These results, specific by GA, provide relevant information for health care decision-making, and highlight the potential impact on the management of health resources (AU)

99mTc-BrIDA cholescintigraphy in a spontaneous biliary perforation of an infant / Colecistogammagrafía con 99mTc-BrIDA en una rotura espontánea biliar en un niño

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Evaluación de la respuesta sistémica en el postoperatorio de las cardiopatías congénitas / Evaluation of the postoperative systemic response in congenital heart defects

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Repercusión del cebado con coloides y la ultrafiltración sobre el sangrado posoperatorio y la transfusión sanguínea en cirugía cardiaca. Ensayo clínico aleatorizado / Effect of priming solution and ultrafiltration on post-operative bleeding and blood transfusion in cardiac surgery. Randomized controlled trial

Objetivo. Valorar la eficacia del cebado del sistema de circulación extracorpórea con albúmina-manitol asociado a ultrafiltración para reducir el sangrado posoperatorio y las necesidades transfusionales en cirugía cardiaca, así como su repercusión sobre los balances hídricos, los parámetros de coagulación y hematimetría, la reintervención por sangrado y la estancia en UCI y hospitalaria. Material y métodos. Ciento treinta y cuatro pacientes programados en cirugía cardiaca fueron aleatorizados para recibir en el cebado Ringer lactato 1.500 mL (grupo C), o 250 mL de manitol 20%, 150 mL de albúmina 20% y 1.100 mL de Ringer lactato asociado a ultrafiltración (grupo T). Se determinaron el volumen de sangrado, las transfusiones, los balances hídricos, los parámetros de coagulación y la hematimetría hasta las 48 h del posoperatorio. Resultados. Encontramos una reducción en el grupo T del sangrado posoperatorio, 1.165 ± 789 mL frente a 992 ± 662 mL (p = 0,17), y de la transfusión de hematíes, 694 ± 843 mL frente a 413 ± 605 mL (p = 0,03). El balance hídrico intraoperatorio y posoperatorio fue significativamente menos positivo en el grupo T, con un balance global de 2.292 ± 2.152 mL frente a 5.388 ± 2.834 mL (p < 0,001). Hubo valores superiores de hemoglobina y hematocrito intraoperatorio (p < 0,001), al ingreso en UCI (p = 0,001) y a las 6 h (p = 0,05) en el grupo T, e inferiores de INR a las 6 h (p = 0,01) y 24 h (p = 0,02). Las tasas de reintervención y estancia en UCI fueron superiores en el grupo C, pero no significativas. Conclusiones. El cebado del sistema de circulación extracorpórea con manitol, albúmina y Ringer lactato, asociado a ultrafiltración, mejora significativamente los balances hídricos intraoperatorio y posoperatorio y reduce el volumen de transfusión de sangre, con una repercusión no significativa sobre el sangrado posoperatorio, reintervenciones por sangrado y estancia en UCI (AU)

Objective. Assess the effectiveness of priming the extracorporeal circulation system with albumin-mannitol combined with ultrafiltration during extracorporeal circulation to reduce post-operative bleeding and transfusion requirements in heart surgery, as well as its impact on the fluid balance, coagulation and hematocrit parameters, re-operation for bleeding, ICU, and hospital length of stay. Material and methods. A total of 134 patients scheduled for heart surgery were randomized to receive Ringer's lactate 1,500 mL in the priming reservoir (group C), or mannitol 20% 250 mL, albumin 20% 150 mL and Ringer's lactate 1,100 mL combined with ultrafiltration (group T). Bleeding volume, transfusions, fluid balance, coagulation, and hematology parameters were determined until 48 h in the post-operative period. Results. There was a reduction of postoperative bleeding in group T, 1,165 ± 789 mL vs 992 ± 662 mL (P = .17), and red blood cell concentrate transfusions, 694 ± 843 mL vs 413 ± 605 mL (P = .03). Intra-operative and post-operative fluid balance was significantly less positive in group T, with an overall balance of 2,292 ± 2,152 mL vs 5,388 ± 2,834 mL (P < .001). There were higher values of hemoglobin and hematocrit, intraoperative (P < .001), on admission to ICU (P = .001), and at 6 h (P = .05) in group T, and lower INR at 6 h (P = .01) and 24 h (P = .02). Re-operation rate and length of stay in ICU were higher in group C, but not statiscally significant. Conclusions. The priming of extracorporeal reservoir with mannitol, albumin, and Ringer's lactate, combined with ultrafiltration, significantly improves intra- and post-operative fluid balance, resulting in a reduction in blood transfusions, with no significant decrease in post-operative bleeding, re-operation bleeding rate, and length of stay in the ICU (AU)

Fe de errores de "Morbimortalidad en recién nacidos al límite de la viabilidad en España: estudio de base poblacional" / Erratum of "Morbidity and mortality in newborns at the limit of viability in Spain: A population-based study"

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Violencia de los usuarios hacia el personal de enfermería en los servicios de urgencias hospitalarios. Factores de riesgo y consecuencias / Violence against nursing staff in hospital emergency services: risk factors and consequences

Objetivos: Estudiar las manifestaciones hostiles de usuarios hacia los profesionales de enfermería de los servicios de urgencia de los hospitales (SUH) públicos del Servicio Murciano de Salud (SMS) y determinar la frecuencia de exposición a diversas conductas violentas de los usuarios, así como las características sociodemográficas y laborales del trabajador asociadas a una mayor exposición. Analizar la relación de la exposición a conductas hostiles con la presencia de posibles consecuencias psicológicas sobre el trabajador, como variaciones en la satisfacción laboral, el burnout y el bienestar psicológico. Método: Se trata de un estudio descriptivo transversal llevado a cabo en el personal de enfermería de los SUH del SMS en el año 2010. Se entregó un cuestionario autoaplicado y anónimo al 30% de estos profesionales de urgencias, y estratificada por hospitales. Resultados: La manifestación de violencia más frecuente a la que están expuestos estos enfermeros son los enfados por la demora de asistencia o por la falta de información. Hemos encontrado diferencias significativas de puntuación en la escala de violencia no física según las variables tamaño del hospital, profesión y realización de otra actividad, y de violencia física según la antigüedad en el puesto. En estos profesionales, la violencia no física se correlaciona con el grado de burnout, la satisfacción laboral y el bienestar psicológico. Conclusión: Existe un número elevado de agresiones al personal de enfermería en los SUH, que en algunos aspectos es mayor respecto a otros servicios de enfermería hospitalarios. Reducir la frecuencia de las agresiones podría mejorar la salud psicológica delos trabajadores (AU)

Objective: To study hostility directed against nurses and auxiliary nurses by users of hospital emergency departments in the public health system of Murcia, Spain; to determine the frequency of the nursing staff's exposure to various types of user aggression; and to explore the sociodemographic characteristics and position (nurse or auxiliary nurse) of staff exposed to a higher rate of aggression. To analyze the relationship between exposure to hostile behaviors and potential psychological impact, such as changes in a nurse's job satisfaction, burnout, or psychological well-being. Methods: Descriptive cross-sectional survey of public health system hospital emergency department nursing staff in Murcia in 2010. The sample was stratified by hospital and corresponded to 30% of the emergency department nursing staff in the region. Participants responded to an anonymous self-administered questionnaire. Results: The hostile behavior the nurses were exposed to most often was the expression of anger at delayed care or lack of information. The scores for exposure to nonphysical aggression were significantly related to hospital size, staff position, and moonlighting practices; scores for exposure to physical violence were significantly related to staff seniority (years working). Non physical violence was correlated with degree of burnout, job satisfaction, and psychological wellbeing. Conclusions: Expressions of user hostility toward nursing staff are more common in emergency departments than inother hospital areas. Reducing the frequency of hostile encounters would help improve the psychological well-being of these staff members (AU)