[Postoperative pain after cardiac surgery: neurobiological basis and treatment]. / Dolor en el postoperatorio de cirugía cardíaca: bases neurobiológicas y tratamiento.

INTRODUCTION: Despite the evolution of surgical techniques, pain continues to be one of the most frequent disorders in the postoperative period of cardiac surgery (CS), leading to the appearance of complications in the acute period and impairment of quality of life due to the appearance of chronic pain. In this narrative review, we aim to analyze the prognostic factors for the appearance of postoperative pain after CS, to locate and quantify the severity of neuropathic pain, and determine the most appropriate assessment methods in these patients. DEVELOPMENT: Postoperative pain in CS is a complex pain, which associates neuropathic, somatic and visceral components. Its origin is multifactorial; factors depending on the patient, the preoperative symptoms and the type of intervention, as well as sequelae derived from the surgery itself, determine the variability in its manifestation. Multiple studies have tried to identify the risk factors for its development, but the quantification of pain is limited by the subjective perception of the patients. CONCLUSIONS: Neurologists can play a relevant role in the differentiation of the different types of pain after CS, thanks to the understanding of its neurobiological bases, properly handling neuromodulators that control the neuropathic component of pain and collaborating in the indication of invasive techniques, necessary occasionally in the management of these patients.

TITLE: Dolor en el postoperatorio de cirugía cardíaca: bases neurobiológicas y tratamiento.Introducción. A pesar de la evolución de las técnicas quirúrgicas, el dolor sigue siendo uno de los trastornos más frecuentes en el postoperatorio de la cirugía cardíaca (CCA), lo que condiciona la aparición de complicaciones en la fase aguda y el deterioro de la calidad de vida por la aparición de dolor crónico. En esta revisión narrativa pretendemos analizar los factores pronósticos de la aparición de dolor postoperatorio tras CCA, localizar y cuantificar la gravedad del dolor neuropático y determinar cuáles son los métodos de evaluación más adecuados en estos pacientes. Desarrollo. El dolor postoperatorio en la CCA es un dolor complejo, que asocia componentes neuropáticos, somáticos y viscerales. Su origen es multifactorial; factores dependientes del paciente, de la clínica preoperatoria y el tipo de intervención, así como de secuelas derivadas de la propia cirugía, determinan la variabilidad en su manifestación. Múltiples estudios han intentado identificar los factores de riesgo de su desarrollo, pero la cuantificación del dolor se ve limitada por la percepción subjetiva del paciente. Conclusiones. Los neurólogos pueden tener un papel relevante en la diferenciación de los distintos tipos de dolor tras CCA, gracias a la comprensión de sus bases neurobiológicas, manejando adecuadamente neuromoduladores que controlen el componente neuropático del dolor y colaborando en la indicación de técnicas invasivas, necesarias ocasionalmente en el manejo de estos pacientes.

Modeling and Simulation of an Energy Integrated Distillation Column in a Bond Graph Approach.

The bond graph methodology for modelling an integrated energy distillation column is applied in this paper. The distillation column is built by five trays for a binary mixture. However, due to its modular construction in a bond graph, the number of trays can be increased. In order to link the analysis tools of systems modeled in the bond graph to the mathematical model given to a distillation column, a junction structure of the proposed bond graph is presented. Hence, this junction structure is a way to obtain the state space representation of the modeled column in bond graphs. Likewise, it is well known that distillation columns determine a class of nonlinear systems, so throughout this paper, these systems in a bond graph approach can be analyzed. In order to learn the behavior of the distillation column in the physical domain, simulation results using 20-Sim software are shown. In addition, with the simulation of two case studies consisting of two mixtures with different relative volatilities, the versatility of the column model in a bond graph is presented. In both cases, the increase in the feed flow, the mole fraction of the light component in the feed or the distillate reflux that enriches the concentration of light in the column determine an increase in the mole fraction of light in the distillate and in the bottom reflow. Further, the control design for a distillation column in the physical domain can be extended.

Dolor en el postoperatorio de cirugía cardíaca: bases neurobiológicas y tratamiento / Postoperative pain after cardiac surgery: neurobiological basis and treatment

Introducción: A pesar de la evolución de las técnicas quirúrgicas, el dolor sigue siendo uno de los trastornos más frecuentes en el postoperatorio de la cirugía cardíaca (CCA), lo que condiciona la aparición de complicaciones en la fase aguda y el deterioro de la calidad de vida por la aparición de dolor crónico. En esta revisión narrativa pretendemos analizar los factores pronósticos de la aparición de dolor postoperatorio tras CCA, localizar y cuantificar la gravedad del dolor neuropático y determinar cuáles son los métodos de evaluación más adecuados en estos pacientes. Desarrollo: El dolor postoperatorio en la CCA es un dolor complejo, que asocia componentes neuropáticos, somáticos y viscerales. Su origen es multifactorial; factores dependientes del paciente, de la clínica preoperatoria y el tipo de intervención, así como de secuelas derivadas de la propia cirugía, determinan la variabilidad en su manifestación. Múltiples estudios han intentado identificar los factores de riesgo de su desarrollo, pero la cuantificación del dolor se ve limitada por la percepción subjetiva del paciente. Conclusiones: Los neurólogos pueden tener un papel relevante en la diferenciación de los distintos tipos de dolor tras CCA, gracias a la comprensión de sus bases neurobiológicas, manejando adecuadamente neuromoduladores que controlen el componente neuropático del dolor y colaborando en la indicación de técnicas invasivas, necesarias ocasionalmente en el manejo de estos pacientes.(AU)

INTRODUCTION: Despite the evolution of surgical techniques, pain continues to be one of the most frequent disorders in the postoperative period of cardiac surgery (CS), leading to the appearance of complications in the acute period and impairment of quality of life due to the appearance of chronic pain. In this narrative review, we aim to analyze the prognostic factors for the appearance of postoperative pain after CS, to locate and quantify the severity of neuropathic pain, and determine the most appropriate assessment methods in these patients. DEVELOPMENT: Postoperative pain in CS is a complex pain, which associates neuropathic, somatic and visceral components. Its origin is multifactorial; factors depending on the patient, the preoperative symptoms and the type of intervention, as well as sequelae derived from the surgery itself, determine the variability in its manifestation. Multiple studies have tried to identify the risk factors for its development, but the quantification of pain is limited by the subjective perception of the patients. CONCLUSIONS: Neurologists can play a relevant role in the differentiation of the different types of pain after CS, thanks to the understanding of its neurobiological bases, properly handling neuromodulators that control the neuropathic component of pain and collaborating in the indication of invasive techniques, necessary occasionally in the management of these patients.(AU)

Safety of Intranasal Insulin in Type 2 Diabetes on Systemic Insulin: A Double-Blinded Placebo-Controlled Sub-Study of Memaid Trial.

Aims: To determine safety of intranasal insulin (INI) in MemAID trial participants with diabetes treated with systemic insulins. Materials and Methods: This randomized, double-blinded trial consisted of 24-week INI or placebo treatment once daily and 24-week follow-up. Safety outcomes were: 1) Short-term effects on glycemic variability, hypoglycemic episodes on continuous glucose monitoring (CGM) at baseline and on-treatment. 2) Long-term effects on glucose metabolism and weight on INI/placebo treatment and post-treatment follow-up. Of 86 screened subjects, 14 were randomized, 9 (5 INI, 4 Placebo) completed CGM at baseline and on-treatment, and 5 (2 INI, 3 Placebo) completed treatment and follow-up. Results: INI was safe and was not associated with serious adverse events, hypoglycemic episodes or weight gain. INI administration did not acutely affect capillary glucose. Glycemic variability on CGM decreased with INI, compared to baseline. On INI treatment, there was a long-term trend toward lower HbA1c, plasma glucose and insulin. No interactions with subcutaneous insulins were observed. Conclusions: INI is safe in older people with diabetes treated with systemic insulins, and it is not associated with adverse events, hypoglycemia or weight gain. Future studies are needed to determine whether INI administration can reduce glycemic variability, improve insulin sensitivity and thus potentially lessen diabetes burden in this population.

Embolic stroke of undetermined source: beyond atrial fibrillation.

INTRODUCTION: Embolic stroke of undetermined source (ESUS) accounts for 25% of all cerebral infarcts; only 30% are associated with paroxysmal atrial fibrillation (AF). Various biochemical, electrocardiographic, and echocardiographic findings may suggest left atrial damage and increased risk of embolism in the absence of clinically documented AF or atrial flutter. In this review, we analyse the available evidence on atrial cardiopathy or atrial disease, its involvement in ESUS, and its identification through electrocardiographic, echocardiographic, and serum markers and its possible therapeutic implications. DEVELOPMENT: A systematic search was conducted on MEDLINE (PubMed) using the following MeSH terms: MeSH [ESUS]+[atrial cardiopathy]+[atrial fibrillation]+[interatrial block]+[treatment]. We selected what we considered to be the most useful original prospective or retrospective studies and systematic reviews. We then read the full texts of the articles and checked the references cited in each article. We analyse epidemiological and demographic variables of patients with ESUS, as well as recent evidence related to presentation and prognosis and factors associated with recurrence and mortality. We review the contribution of atrial cardiopathy diagnosis prior to the detection of AF and the clinical, electrocardiographic, and echocardiographic variables and the biochemical markers associated with its development and its potential contribution to cerebral embolism. CONCLUSIONS: The systematic search of biochemical and electrocardiographic, and echocardiographic alterations can be useful to identify ESUS patients at higher risk of recurrence.

Infarto cerebral embólico de origen no determinado: más allá de la fibrilación auricular / Embolic stroke of undetermined source: Beyond atrial fibrillation

Introducción: El infarto cerebral embólico de origen no determinado (ESUS por sus siglas en inglés) representa el 25% de todos los infartos cerebrales y solo el 30% se asocia con fibrilación auricular (FA) paroxística. Existen diferentes hallazgos bioquímicos, electro y ecocardiográficos que sugieren daño auricular izquierdo y aumento del riesgo de embolismo en ausencia de FA o flutterauricular clínicamente documentados. En la presente revisión analizamos la evidencia disponible sobre cardiopatía atrial o enfermedad auricular, su implicación en el ESUS y su identificación mediante marcadores electrocardiográficos, ecocardiográficos y séricos y sus posibles implicaciones terapéuticas. Desarrollo: Se realizó una búsqueda sistematizada a través de la fuente de información MEDLINE (PubMed), utilizando una estrategia diseñada con términos MeSH [ESUS] + [atrial cardiopathy] + [atrial fibrillation] + [interatrial block] + [treatment]. Se seleccionaron las publicaciones originales de estudios prospectivos, retrospectivos y de revisión consideradas como las más útiles. Se procedió a la lectura del texto completo y la bibliografía aportada en cada artículo. Se incluyeron los factores epidemiológicos y demográficos de los pacientes ESUS, así como la evidencia reciente relacionada con su forma de presentación, pronóstico y factores asociados con recurrencia y mortalidad. Se revisó la contribución de la presencia de cardiopatía auricular previo a la documentación de FA y las variables clínicas, electro y ecocardiográficas, así como los marcadores bioquímicos asociados con su desarrollo y su contribución como fuente potencial de embolismo cerebral. Conclusiones: La búsqueda sistemática de alteraciones bioquímicas, electro y ecocardiográficas pueden ser de utilidad para identificar pacientes ESUS con mayor riesgo de recurrencia. (AU)

Introduction: Embolic stroke of undetermined source (ESUS) accounts for 25% of all cerebral infarcts; only 30% are associated with paroxysmal atrial fibrillation (AF). Various biochemical, electrocardiographic, and echocardiographic findings may suggest left atrial damage and increased risk of embolism in the absence of clinically documented AF or atrial flutter. In this review, we analyse the available evidence on atrial cardiopathy or atrial disease, its involvement in ESUS, and its identification through electrocardiographic, echocardiographic, and serum markers and its possible therapeutic implications. Development: A systematic search was conducted on MEDLINE (PubMed) using the following MeSH terms: MeSH [ESUS] + [atrial cardiopathy] + [atrial fibrillation] + [interatrial block] + [treatment]. We selected what we considered to be the most useful original prospective or retrospective studies and systematic reviews. We then read the full texts of the articles and checked the references cited in each article. We analyse epidemiological and demographic variables of patients with ESUS, as well as recent evidence related to presentation and prognosis and factors associated with recurrence and mortality. We review the contribution of atrial cardiopathy diagnosis prior to the detection of AF and the clinical, electrocardiographic, and echocardiographic variables and the biochemical markers associated with its development and its potential contribution to cerebral embolism. Conclusions: The systematic search of biochemical and electrocardiographic, and echocardiographic alterations can be useful to identify ESUS patients at higher risk of recurrence. (AU)

Effect of voltage and oxygen on inactivation of E. coli and S. typhi using pulsed dielectric barrier discharge.

This work presents the study of the voltage and oxygen effect on bacterial inactivation in water using a pulsed dielectric barrier discharge (DBD) under atmospheric pressure, where Escherichia coli (E. coli) and Salmonella typhi (S. typhi) bacteria were used as model microorganisms. A cylindrical DBD reactor was developed and tested in applications to assay the efficiency of bacterial inactivation in water on a volume of 500 mL flowing continuously throughout the system assisted with a peristaltic pump at 4.4 ± 0.1 mL/s. The efficiency of the treatment reached a 6-log10 reduction for both E. coli and S. typhi bacteria at 106 CFU/mL of concentration at the end of the first cycle of treatment at a minimum voltage of 12 kV with oxygen bubbling gas, concluding that there was a minimum voltage to produce inactivation of E. coli and S. typhi samples. Bacterial inactivation without the oxygen condition contrasted with the high rate of inactivation with oxygen at relatively low voltage discharges.

Caracterización clínico-epidemiológica de las enterocolitis necrosantes neonatales de siete hospitales públicos

Resumen Introducción: Enterocolitis necrosante (ECN) representa una elevada mortalidad y morbilidad post-quirúrgica, gastrointestinal y del neuro-desarrollo. Existe limitada información en Chile. Objetivo: Describir el comportamiento clínico/epidemiológico de recién nacidos que cursaron con ECN. Pacientes y Métodos: Estudio multicéntrico descriptivo de pacientes con ECN de siete hospitales de Santiago, Chile, durante el 2016. Se realizó estadística descriptiva y análisis univariable/multivariable (software SPSS v22). Resultados: Se recolectaron 75 casos. Mediana de edad al diagnóstico fue 11 días, el promedio de edad gestacional 29 semanas y peso de nacimiento 1.285 g. La incidencia fue 2,6 por 1.000/recién nacidos vivos y letalidad de 18,6%, mayor en ≤ 750 g, ≤ 25 semanas y ECN quirúrgica. Hubo aislamiento microbiológico en 45,3% y se utilizaron 19 distintos esquemas antimicrobianos empíricos para el tratamiento de ECN. El análisis multivariable mostró tendencia a que la ECN fuese quirúrgica en usuarios de catéter umbilical arterial, PCR > 10 mg/L y aislamiento microbiológico, y hubo tendencia a fallecer en usuarios de catéter umbilical arterial. Discusión: Es el primer estudio multicéntrico que recopila información de datos locales. La incidencia fue similar a la descrita en la literatura médica, en cambio la letalidad fue algo menor. No existen consensos del tratamiento antimicrobiano a utilizar. Con estos resultados esperamos avanzar en mejorar el diagnóstico y unificar tratamientos antimicrobianos, para reducir cifras de morbimortalidad.

Abstract Background: Necrotizing enterocolitis (NEC) presents high mortality and postoperative, gastrointestinal and neurodevelopmental morbidity. There is limited information about NEC in Chile. Aim: To describe the clinical/epidemiological behavior of newborns who underwent NEC. Methods: Multicenter descriptive study of patients with NEC from seven hospitals of Santiago, Chile, during 2016. Descriptive statistics and univariate/multivariate analysis were performed (SPSS v22 software). Results: 75 cases were collected. Median days of life at diagnosis was 11, gestational age was 29 weeks, birth weight 1,114 g. The incidence was 2.6 per 1,000 live newborns and mortality was 18.6%, higher in ≤ 750 g, ≤ 25 weeks and surgical NEC. There was 45.3% microbiological isolation and 19 different empirical antibiotic schemes were used for the treatment of NEC. The multivariate analysis showed a higher risk of surgery in umbilical arterial catheter users, CRP > 10 mg/L and positive microbiological isolation. The highest risk of death was in umbilical arterial catheter users. Discussion: This ie the first multicenter study that collects local data information. The incidence was similar to that found in medical reports but with a lower mortality. There is no consensus of antibiotic treatment to use. With these results we hope to advance in improving the diagnosis and unify antimicrobial treatments, to reduce morbidity and mortality figures.

Alarm Fatigue in the Intensive Care Unit: Relevance and Response Time. / Fatiga de alarmas en Unidad de Cuidados Intensivos: relevancia y tiempo de respuesta.

OBJECTIVE: To establish the presence of alarm fatigue, the clinical relevance of alarms and the stimulus-response time of the health team in an Adult Intensive Care Unit. METHOD: Descriptive, quantitative, observational study, developed in the Multipurpose Adult Intensive Care Unit. Population made up of health personnel and the ICU teams. The method used was non-participant observation. Follow-up was carried out over 120 hours in three months. The variables studied were number of alarms activated, time elapsed between the alert sound of the blood pressure parameter, heart rate and oximetry and the response of the health personnel who attended the alarm. A descriptive statistical analysis was carried out. RESULTS: 5,147 alarms were detected, on average 43 alarms / hour, of these 52.8% corresponded to multiparameter monitors and the rest to other equipment. Of those generated by multiparameter monitors, 37.3% were blood pressure, 33.4% oximetry and 29.3% heart rate. The clinical relevance was low in 42.7%, medium in 49.8% and high in 7.5%. The stimulus response time was between 0 and 60 seconds for 37% of the alarms; however, 42.5% had no response, which is why they are considered fatigued. A statistically significant relationship was found between the response time and the clinical relevance of the alarms (p = .000). CONCLUSIONS: The presence of alarm fatigue was evident; with predominance of clinical relevance in the middle and low ranges. The health personnel responded within the time established for timely attention to the non-fatigued alarms.

Memory advancement by intranasal insulin in type 2 diabetes (MemAID) randomized controlled clinical trial: Design, methods and rationale.

BACKGROUND: Type 2 diabetes mellitus (T2DM) accelerates brain aging and increases the risk for dementia. Insulin is a key neurotrophic factor in the brain, where it modulates energy metabolism, neurovascular coupling, and regeneration. Impaired insulin-mediated brain signaling and central insulin resistance may contribute to cognitive and functional decline in T2DM. Intranasal insulin (INI) has emerged as a potential therapy for treating T2DM-related cognitive impairment. METHODS/DESIGN: Ongoing from 2015, a prospective, two-center, randomized, double-blind, placebo-controlled trial of 210 subjects (120 T2DM and 90 non-diabetic older adults) randomized into four treatment arms (60 T2DM-INI, 60 T2DM-Placebo, 45 Control-INI, and 45 Control-Placebo) evaluating the long-term effects of daily intranasal administration of 40 International Units (IU) of human insulin, as compared to placebo (sterile saline) over 24 weeks and 24 weeks of post-treatment follow-up. Study outcomes are: 1) long-term INI effects on cognition, daily functionality, and gait speed; 2) identifying a clinically relevant phenotype that predicts response to INI therapy; 3) long-term safety. CONCLUSION: This study addresses an important knowledge gap about the long-term effects of intranasal insulin on memory and cognition in older people with T2DM and non-diabetic controls, and may provide a novel therapeutic target for prevention and treatment of cognitive and functional decline and dementia. Trial Registration NCT02415556.

Influence of an external electric field on the rapid synthesis of MoO3 micro- and nanostructures by Joule heating of Mo wires.

The growth mechanism of layered α-MoO3 nano- and microplates on the surface of Mo wires during Joule heating has been investigated by application of an external electric field to the current carrying wire. The observed rapid growth of the structures, involving enhanced diffusion processes associated to the intense electric current, is further enhanced by the external field leading to a near instantaneous formation of MoO3 plates. Thermally assisted electromigration in the Mo wire with the additional effect of the electric field appears as a very time effective method to grow MoO3 layered low dimensional structures. Other molybdenum oxide nanostructures, such as nanospheres and nanocrystallites with different shapes, have been found to grow by deposition from the Mo wire on the electrodes used to apply the external electric field. The growth on the electrodes takes place by a thermally assisted electric-field-driven process.

[Clinical-epidemiological characterization of neonatal necrotizing enterocolitis of seven public hospitals]. / Caracterización clínico-epidemiológica de las enterocolitis necrosantes neonatales de siete hospitales públicos.

BACKGROUND: Necrotizing enterocolitis (NEC) presents high mortality and postoperative, gastrointestinal and neurodevelopmental morbidity. There is limited information about NEC in Chile. AIM: To describe the clinical/epidemiological behavior of newborns who underwent NEC. METHODS: Multicenter descriptive study of patients with NEC from seven hospitals of Santiago, Chile, during 2016. Descriptive statistics and univariate/multivariate analysis were performed (SPSS v22 software). RESULTS: 75 cases were collected. Median days of life at diagnosis was 11, gestational age was 29 weeks, birth weight 1,114 g. The incidence was 2.6 per 1,000 live newborns and mortality was 18.6%, higher in ≤ 750 g, ≤ 25 weeks and surgical NEC. There was 45.3% microbiological isolation and 19 different empirical antibiotic schemes were used for the treatment of NEC. The multivariate analysis showed a higher risk of surgery in umbilical arterial catheter users, CRP > 10 mg/L and positive microbiological isolation. The highest risk of death was in umbilical arterial catheter users. DISCUSSION: This ie the first multicenter study that collects local data information. The incidence was similar to that found in medical reports but with a lower mortality. There is no consensus of antibiotic treatment to use. With these results we hope to advance in improving the diagnosis and unify antimicrobial treatments, to reduce morbidity and mortality figures.

Quantum nanoconstrictions fabricated by cryo-etching in encapsulated graphene.

We report on a novel implementation of the cryo-etching method, which enabled us to fabricate low-roughness hBN-encapsulated graphene nanoconstrictions with unprecedented control of the structure edges; the typical edge roughness is on the order of a few nanometers. We characterized the system by atomic force microscopy and used the measured parameters of the edge geometry in numerical simulations of the system conductance, which agree quantitatively with our low temperature transport measurements. The quality of our devices is confirmed by the observation of well defined quantized 2e2/h conductance steps at zero magnetic field. To the best of our knowledge, such an observation reports the clearest conductance quantization in physically etched graphene nanoconstrictions. The fabrication of such high quality systems and the scalability of the cryo-etching method opens a novel promising possibility of producing more complex truly-ballistic devices based on graphene.

Embolic stroke of undetermined source: Beyond atrial fibrillation. / Infarto cerebral embólico de origen no determinado: más allá de la fibrilación auricular.

INTRODUCTION: Embolic stroke of undetermined source (ESUS) accounts for 25% of all cerebral infarcts; only 30% are associated with paroxysmal atrial fibrillation (AF). Various biochemical, electrocardiographic, and echocardiographic findings may suggest left atrial damage and increased risk of embolism in the absence of clinically documented AF or atrial flutter. In this review, we analyse the available evidence on atrial cardiopathy or atrial disease, its involvement in ESUS, and its identification through electrocardiographic, echocardiographic, and serum markers and its possible therapeutic implications. DEVELOPMENT: A systematic search was conducted on MEDLINE (PubMed) using the following MeSH terms: MeSH [ESUS]+[atrial cardiopathy]+[atrial fibrillation]+[interatrial block]+[treatment]. We selected what we considered to be the most useful original prospective or retrospective studies and systematic reviews. We then read the full texts of the articles and checked the references cited in each article. We analyse epidemiological and demographic variables of patients with ESUS, as well as recent evidence related to presentation and prognosis and factors associated with recurrence and mortality. We review the contribution of atrial cardiopathy diagnosis prior to the detection of AF and the clinical, electrocardiographic, and echocardiographic variables and the biochemical markers associated with its development and its potential contribution to cerebral embolism. CONCLUSIONS: The systematic search of biochemical and electrocardiographic, and echocardiographic alterations can be useful to identify ESUS patients at higher risk of recurrence.

Reparación endovascular del aneurisma de aorta abdominal. Papel del deterioro postoperatorio de la función renal en la supervivencia / Endovascular aortic repair of abdominal aortic aneurysm: Role of post-surgical renal function decline in survival

Introducción: La reparación endovascular del aneurisma de aorta abdominal (EVAR) ha supuesto desde su llegada y desarrollo una disminución en la mortalidad precoz con respecto a la cirugía convencional. Como factores predictivos de mortalidad se han identificado el deterioro de función renal preoperatorio, la enfermedad pulmonar obstructiva crónica y la cardiopatía isquémica. Objetivo: Evaluar la influencia en la supervivencia a largo plazo de los factores de riesgo preoperatorios y del deterioro de función renal perioperatorio en los pacientes sometidos a EVAR en nuestro centro. Material y métodos: Se realizó un estudio observacional retrospectivo en pacientes sometidos a EVAR en nuestro centro entre los años 2008 y 2012. Se hizo un análisis de la supervivencia a medio y largo plazo, llevado a cabo mediante curvas de Kaplan-Meier. Se estudió la influencia de los factores de riesgo preoperatorios y del deterioro de función renal perioperatorio sobre la supervivencia empleando el modelo de regresión de Cox. Resultados: Se incluyeron 79 pacientes con una edad media de 75,2 años (57,6-85,9). La mediana del tiempo de seguimiento fue de 38 meses (0,4-83,4). Durante este periodo de tiempo se registraron 26 muertes (32,9%). La probabilidad de supervivencia al cabo de un año fue del 93,7%; a los 2 años del 82,3%; a los 4 años del 68,9%; y a los 6 años del 56,5%. Una mayor tasa de supervivencia se asoció con cifras analíticas de creatinina menores de 1,2 mg/dl a las 24 h y a los 7 días, y filtrado glomerular mayor de 60 ml/min a las 24 h y a los 7 días. El análisis multivariante evidenció una probabilidad de muerte 2,39 veces mayor en los pacientes que presentaron un valor analítico de creatinina a las 24 h mayor de 1,2 mg/dl con respecto a los que mostraron una cifra menor de 1,2 mg/dl (HR: 2,39; IC95%: 1,06-5,42); p = 0,037). Conclusión: El deterioro de función renal tras la EVAR es un factor independiente de mal pronóstico a largo plazo. Tanto en la preparación preoperatoria como durante el postoperatorio deben ponerse los medios necesarios encaminados a corregir las circunstancias que provoquen un deterioro de la función renal

Background: Since its introduction and development, endovascular aortic repair (EVAR) has shown an improvement in short-term mortality compared to conventional surgery. Pre-operative renal function impairment, chronic obstructive pulmonary disease, and ischaemic heart disease, have been identified as mortality predictors. Objective:To assess the influence on long-term survival of pre-operative risk factors and peri-operative renal function impairment in patients that underwent EVAR in our centre. Material and methods: A retrospective observational study was conducted on patients subjected to EVAR in our centre between the years 2008 and 2012. The Kaplan-Meier curve was used to analyse the long and medium-term survival. The influence of pre-operative risk factors and perioperative renal impairment on survival was analysed using the Cox regression model. Results: A total of 79 patients were finally included in the study. The mean age was 75.2 years (57.6-85.9). The mean follow-up period was 38 months (0.4-83.4). During this period 26 (32.9%) deaths were registered. Survival probabilities during the first, second, fourth, and sixth years were 93.7%, 82.3%, 68.9%, and 56.5%, respectively. A greater survival rate was associated with creatinine levels lower than 1.2mg/dL at 24hours and at 7 days, and a glomerular filtration rate higher than 60mL/min at 24hours and at 7 days. Multivariate analysis showed a HR 2.39 higher in patients with a creatinine level higher than 1.2mg/dL at 24hours compared to patients with a creatinine level lower than 1.2mg/dL (HR: 2.39, 95% CI: 1.06-5.42; P=.037). Conclusion: Renal function impairment after endovascular aortic repair of abdominal aortic aneurysm represents an independent long-term poor prognosis factor. During pre-operative preparation and post-operative care necessary steps should be taken aimed at correcting the circumstances that cause renal function impairment

Size-selective breaking of the core-shell structure of gallium nanoparticles.

Core-shell gallium nanoparticles (Ga NPs) have recently been proposed as an ultraviolet plasmonic material for different applications but only at room temperature. Here, the thermal stability as a function of the size of the NPs is reported over a wide range of temperatures. We analyze the chemical and structural properties of the oxide shell by x-ray photoelectron spectroscopy and atomic force microscopy. We demonstrate the inverse dependence of the shell breaking temperature with the size of the NPs. Spectroscopic ellipsometry is used for tracking the rupture and its mechanism is systematically investigated by scanning electron microscopy, grazing incidence x-ray diffraction and cathodoluminescence. Taking advantage of the thermal stability of the NPs, we perform complete oxidations that lead to homogenous gallium oxide NPs. Thus, this study set the physical limits of Ga NPs to last at high temperatures, and opens up the possibility to achieve totally oxidized NPs while keeping their sphericity.

Adherencia al tratamiento en enfermedad cardiovascular: rediseño y validación de un instrumento / Adherence to treatment in cardiovascular disease: Re-design and validation of an instrument / Aderência ao tratamento em doença cardiovascular: Redesenho e validação de um instrumento

Objetivo: Determinar la validez de constructo y confiabilidad del «Cuestionario para medir la adherencia al tratamiento de los pacientes con enfermedad cardiovascular¼. Métodos: Estudio de tipo psicométrico. La muestra seleccionada fue de 250 pacientes con diagnóstico de enfermedad cardiovascular asistentes a una institución hospitalaria de tercer nivel de atención en la ciudad de Neiva (Colombia) en el primer semestre de 2016. Se desarrollaron cronológicamente diferentes fases investigativas: análisis del concepto, exploración y confirmación del constructo. Resultados: A través del análisis del concepto se estableció como teoría de soporte la «autoeficacia¼ con sus tres componentes teóricos, seis dimensiones temáticas transversales y los atributos esenciales de la adherencia al tratamiento, los cuales se evidenciaron en la reformulación de los 38 ítems de la versión final del instrumento. La muestra en su mayoría estuvo conformada por personas mayores de 60 años, factor de riesgo predominante de hipertensión arterial y diagnóstico médico más frecuente de enfermedad coronaria. El análisis factorial exploratorio reportó seis factores con una varianza total explicada de 61.83%. La matriz multirasgo-multimétodo demostró altas correlaciones intradimensión, lo cual evidenció la validez convergente del instrumento. El alfa de Cronbach obtenido fue de 0.92 para la escala total y dimensional por encima de 0.80. Conclusiones: La versión actual del instrumento es válida y homogénea para la medición de la adherencia al tratamiento de los pacientes con enfermedad cardiovascular; útil para la investigación y la práctica clínica.

Abstract Objective: To determine the construct validity and reliability of the ''Questionnaire to assess the adherence to treatment in patients with cardiovascular disease''. Methods: This is a psychometric study. The selected sample included 250 patients diagnosed with cardiovascular disease and treated in a third-level-attention hospital institution in Neiva, Colombia during the firrst semester of 2016. The diverse research stages were chronologically developed as concept analysis, exploration, and construct confirmation. Results: Through the concept analysis process, ''self-efficacy'' was established as a supporting theory with three theoretical components, six transversal thematic dimensions, and the essential attributes to the adherence to treatment, which were evidenced in the reformulation of the 38 ítems of the final version of the instrument. The sample was mainly constituted by persons older than 60 of age, which is a risk factor for hypertension and coronary problems. The exploratory factor analysis yielded 6 factors explaining 61.83% of the total variance. The multi-method and multi-treatment matrix demonstrated high intra-dimension correlations, and thus, the convergent validity of the instrument was evidenced. Cronbach alpha was 0.92 for the total scale, and 0.80 for the scale dimensions. Conclusions: The present version of the instrument is valid and homogenous for the assessment of adherence to treatment in patients suffering from cardiovascular disease, and it is useful for the clinical practice and research.

Objetivo: Determinar a validação de constructo e confiabilidade do «Questionário para medir a aderência ao tratamento dos pacientes com doença cardiovascular¼. Métodos: Estudo de tipo psicométrico. A amostra selecionada foi de 250 pacientes com diagnóstico de doença cardiovascular, pacientes de uma instituição hospitalar de terceiro nível de atenção na cidade de Neiva (Colômbia) no primeiro semestre de 2016. Desenvolveram-se cronologicamente diferentes fases pesquisadoras: análise do conceito, exploração e confirmação do constructo. Resultados: Através da análise do conceito estabeleceu-se como teoria de suporte a «autoeficácia¼ com seus três componentes teóricos, seis dimensões temáticas transversais e os atributos essenciais da aderência ao tratamento, os quais se evidenciaram na reformulação dos 38 itens da versão final do instrumento. A amostra em sua maioria esteve conformada por pessoas idosas de 60 anos, fator de risco predominante de hipertensão arterial e diagnóstico médico más frequente de doença coronária. A análise fatorial exploratória registou seis fatores com uma variância total explicada de 61.83%. A matriz multirasgo-multimétodo demonstrou altas correlações intradimensão, o qual evidenciou a validação convergente do instrumento. A alfa de Cronbach obtida foi de 0.92 para a escala total e dimensional por cima de 0.80. Conclusões: A versão atual do instrumento é válida e homogénea para a medição da aderência ao tratamento dos pacientes com doença cardiovascular; útil para a pesquisa e a prática clínica.

Improving risk assessment for post-surgical low cardiac output syndrome in patients without severely reduced ejection fraction undergoing open aortic valve replacement. The role of global longitudinal strain and right ventricular free wall strain.

Low cardiac output syndrome (LCOS) after surgical aortic valve replacement (SAVR) is related to increased mortality and treatment related costs. We aimed to evaluate whether echocardiography-derived left ventricular global longitudinal strain (LV-GLS) relates to the occurrence of postoperative LCOS in patients undergoing SAVR. We prospectively enrolled 75 patients with symptomatic severe aortic stenosis, left ventricular ejection fraction (LVEF) >40%, NYHA Class

Personalized medicine in severe influenza.

Existing therapies against infectious diseases may only be effective in limited subpopulations during specific phases of diseases, incorporating theranostics, and there is a clear need to individualize different therapeutic approaches depending on the host. Influenza A virus infection evolves into a severe respiratory failure in some young adult patients, related to an exaggerated inflammatory response. Mortality rates remain high despite antiviral treatment and aggressive respiratory support. The influenza A virus (IAV) infection will induce a proinflammatory innate immune response through recognition of viral RNA by Toll-like receptor (TLR) 7 and retinoic acid-inducible gene 1 (RIG-I) molecules by nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB route). Anti-inflammatory therapies focused on modulating this inflammatory response to "all patients" have not been satisfactory. Steroids should be avoided because they do not improve survival and promote superinfections. Since clinical judgment has often been proven inadequate, interest in the use of biomarkers to monitor host response and to assess severity and complications is growing. It is well known that, if used appropriately, these can be helpful tools to predict not only severity but also mortality. We need more biomarkers that predict host response: it is time to change lactate measurement to proteomics and transcriptomics. Theranostics describes an approach covering both diagnosis and coupled therapy. Death is usually a fatal complication of a dysregulated immune response more than the acute virulence of the infectious agent. Future research demonstrating the usefulness of adjunctive therapy in a subset of critically ill patients with IAV pneumonia is an unmet clinical need.