Validation of the synthetic model for the imaging heavy ion beam probe at the ASDEX Upgrade tokamak (invited).

Recent experiments at the ASDEX Upgrade tokamak have provided the first ever measurements from the imaging heavy-ion beam probe. In this work, we show that the developed simulation framework can reproduce qualitatively the measurement's observed shape and position. Quantitatively, we demonstrate that the model reproduces, within the experimental uncertainties, the observed signal levels. A detailed explanation of the synthetic model is presented, along with the calibration of the optical setup that reproduces the measurements.

Four-bar Geometry is Shared among Ecologically DivergentFish Species.

Understanding the factors that influence morphological evolution is a major goal in biology. One such factor is the ability to acquire and process prey. Prey hardness and evasiveness are important properties that can impact evolution of the jaws. Similar diets and biomechanical systems have repeatedly evolved among fish lineages, providing an opportunity to test for shared patterns of evolution across distantly related organisms. Four-bar linkages are structures often used by animals to transmit force and motion during feeding and that provide an excellent system to understand the impact of diet on morphological and biomechanical evolution. Here, we tested how diet influences the evolutionary dynamics of the oral four-bar linkage system in wrasses (Family: Labridae) and cichlids (Family: Cichlidae). We found that shifts in prey hardness/evasiveness are associated with limited modifications in four-bar geometry across these two distantly related fish lineages. Wrasse and cichlid four-bar systems largely exhibit many-to-one mapping in response to dietary shifts. Across two iconic adaptive radiations of fish, an optimal four-bar geometry has largely been co-opted for different dietary functions during their extensive ecological diversification. Given the exceptional jaw diversity of both lineages, many-to-one mapping of morphology to mechanical properties may be a core feature of fish adaptive radiation.

Entender los factores que influyen en la evolución morfológica es un objetivo principal en biología. Uno de esos factores es la capacidad para atrapar y procesar presas. La dureza y evasividad de las presas son propiedades importantes que pueden impactar la evolución de las mandíbulas. Dietas y sistemas biomecánicos similares han evolucionado repetidamente entre linajes de peces, proporcionando una oportunidad para evaluar patrones evolutivos compartidos entre organismos lejanamente emparentados. Los mecanismos de cuatro barras en animales, usados usualmente para transmitir fuerza y movilidad durante la alimentación, proveen un sistema excelente para entender el efecto de la dieta en la evolución morfológica y biomecánica. Aquí, evaluamos cómo la dieta influye en las dinámicas evolutivas del mecanismo oral de cuatro barras en lábridos (Familia: Labridae) y cíclidos (Familia: Cichlidae). Encontramos que los cambios en la dureza y evasividad de las presas están asociados con modificaciones limitadas de la geometría de las cuatro barras entre esos dos linajes de peces lejanamente emparentados. Los mecanismos de cuatro barras de los lábridos y cíclidos muestran en gran medida diferentes estructuras que conducen a un mismo resultado funcional en respuesta a cambios de dieta. A lo largo de dos radiaciones adaptativas icónicas de peces, una geometría óptima de cuatro barras ha sido en gran medida adaptada para diferentes funciones dietéticas durante una diversificación ecológica extensa. Dada la excepcional diversidad de mandíbulas en ambos linajes, estructuras que conducen a un mismo resultado en morfología y propiedades mecánicas podrían ser características esenciales durante la radiación adaptativa de peces.Translated by Saúl Dominguez-Guerrero, Postdoctoral Associate- Yale University.

Comprendre les facteurs qui influencent l'évolution morphologique est un objectif majeur en biologie. L'un de ces facteurs est la capacité d'acquérir et de traiter des proies. La dureté et le caractère évasif des proies sont des propriétés importantes qui peuvent avoir un impact sur l'évolution des mâchoires. Des régimes alimentaires et des systèmes biomécaniques similaires ont évolué à plusieurs reprises parmi les lignées de poissons, offrant ainsi l'occasion de tester des modèles d'évolution partagés entre des organismes éloignés. Les liaisons à quatre barres sont des structures souvent utilisées par les animaux pour transmettre la force et le mouvement pendant l'alimentation, et qui constituent un excellent système pour comprendre l'impact du régime alimentaire sur l'évolution morphologique et biomécanique. Ici, nous avons testé comment le régime alimentaire influence la dynamique évolutive du système de liaison orale à quatre barres chez les labres (famille : Labridae) et les cichlidés (famille : Cichlidae). Nous avons constaté que les changements dans la dureté/le caractère évasif des proies sont associés à des modifications limitées de la géométrie à quatre barres dans ces deux lignées de poissons éloignées. Les systèmes à quatre barres de labres et de cichlidés présentent en grande partie une cartographie plusieurs-à-un en réponse aux changementsde régime alimentaire. Pour deux radiations adaptatives emblématiques de poissons, une géométrie optimale à quatre barres a été largement adoptée pour différentes fonctions alimentaires au cours de leur vaste diversification écologique. Compte tenu de la diversité exceptionnelle des mâchoires des deux lignées, la cartographie plusieurs-à-un de la morphologie aux propriétés mécaniques peut être une caractéristique essentielle du rayonnement adaptatif des poissons.Translated by Pauline Raimondeau, Postdoctoral Associate, Yale University.

Simulation of a scintillator-based fast ion loss detector for steady-state operation in Wendelstein 7-X (invited).

A quantitative theoretical framework has been created to model neutral beam injection and fast ion losses in the Wendelstein 7-X (W7-X) stellarator, including a novel method to develop synthetic diagnostics for fast ion loss detectors (FILDs) of many types, such as scintillating and Faraday Cup FILDs. This is the first time that this has been done in stellarator geometry with this level of fidelity, providing a way for fast ion losses to be predicted more precisely in future stellarator experiments and in W7-X. Simulations of the signal seen by a Faraday Cup FILD have been completed for multiple W7-X plasmas and show close agreement with the measured signals. This method is now applied to an actively water-cooled, scintillator-based FILD, which is currently in development to measure the fast ion loss distribution in W7-X in greater detail. The design makes use of a double slit to measure energy-and-pitch-angle-resolved losses of both co-going and counter-going fast ions. The diagnostic, which can be inserted to different radial positions, has been designed to withstand steady-state heat fluxes of up to 120 kW/m2 along with additional transient heat loads of 100 kW/m2 lasting for up to 20 s at a time. Simulations of W7-X standard magnetic configuration show up to 8 × 1013 (s-1 cm-2) ion fluxes onto the sensor from each neutral beam source and no signal from the counter-going slit. These simulations will help inform experimental proposals for future W7-X campaigns after installation of this diagnostic.

[Translated article] Total hip arthroplasty with second generation dual mobility system as a treatment for primary coxarthrosis, medium-term results.

INTRODUCTION: Osteoarthritis is a disabling pathology characterised by joint pain and stiffness. A prevalence of coxarthrosis of 7.4% is reported in our country. Total hip joint replacement is indicated in advanced stages, a procedure that is not free of complications, the most frequent being prosthetic dislocation, which can be prevented with dual mobility systems. The following study aims to determine the rate of complications and clinical outcomes in dual mobility systems in primary coxarthrosis. MATERIALS AND METHODS: A retrospective study included 120 cases in 114 patients diagnosed with grade III coxarthrosis, mean age was 62.43 years, with a mean follow-up of 4.5 years. Joint replacement was performed by Hardinge approach. All cases were assessed clinically using the Harris Hip Score (HHS) and radiologically to demonstrate mid-term results. RESULTS: The preoperative value on the HHS scale had a mean of 56.45, postoperative at one month 74.23; 6 months 85.40; 1 year 94.01 and at 5 years 94.84 points, representing a functional improvement of 17.78 postoperative month; 28.95 at 6 months postoperative; 37.56 at one year postoperative and 38.39 points at 5 years postoperative. A complication rate of 3.44%; 0.86% of complications were associated with the prosthetic components. CONCLUSION: The dual mobility system should be considered as a therapeutic option in primary hip joint replacement due to excellent functional results and low complication rates. EVIDENCE LEVEL: IV. Retrospective observational case series study.

Design, characterization, and modeling of the Charge eXchange Recombination Spectroscopy (CXRS) suite at the SMall Aspect Ratio Tokamak (SMART).

Ion temperature, rotation, and density are key parameters to evaluate the performance of present and future fusion reactors. These parameters are critical for understanding ion heat, momentum, and particle transport, making it mandatory to properly diagnose them. A common technique to measure these properties is charge exchange recombination spectroscopy (CXRS). For characterizing positive and negative triangularity plasmas at the small aspect ratio tokamak, a poloidal array of gas puff based CXRS diagnostics will be measuring the ion properties in different poloidal positions. In this work, the modeling of the expected signal and spatial coverage using the FIDASIM code is presented. Furthermore, the design and characterization of the low field side midplane CXRS diagnostic are described. Each diagnostic is composed of a gas injection system, an optical system that collects the light emitted by the plasma, and a spectrometer. These systems will provide ion temperature, rotation, and density with a radial resolution of 3.75 mm and a temporal resolution of 2.2 ms.

Unraveling the clinicopathological and molecular changes induced by neoadjuvant chemotherapy and endocrine therapy in hormone receptor-positive/HER2-low and HER2-0 breast cancer.

BACKGROUND: The characterization and comparison of gene expression and intrinsic subtype (IS) changes induced by neoadjuvant chemotherapy (NACT) and endocrine therapy in hormone receptor-positive (HR+)/human epidermal growth factor receptor 2 (HER2)-low versus HR+/HER2-0 breast cancer (BC) has not been conducted so far. Most evidence on the association of HER2 status with pathologic responses and prognosis in HR+/HER2-negative BC is controversial and restricted to NACT-treated disease. Similarly, a temporal heterogeneity in HER2 status has been described only with NACT. METHODS: We retrospectively recruited a consecutive cohort of 186 patients with stage I-IIIB HR+/HER2-negative BC treated with neoadjuvant therapy (NAT). Available diagnostic biopsies and surgical samples were characterized for main pathological features, PAM50 IS and ROR-P score, and gene expression. Associations with pathologic complete response, residual cancer burden-0/I, event-free survival (EFS) and overall survival (OS) based on HER2 status were assessed. Pre/post pathologic/molecular changes were analyzed in matched samples. RESULTS: The HER2-low (62.9%) and HER2-0 (37.1%) cohorts did not differ significantly in main baseline features, treatments administered, breast-conserving surgery, pathologic complete response and residual cancer burden-0/I rates, EFS, and OS. NAT induced, regardless of HER2 status, a significant reduction of estrogen receptor/progesterone receptor and Ki67 levels, a down-regulation of PAM50 proliferation- and luminal-related genes/signatures, an up-regulation of selected immune genes, and a shift towards less aggressive IS and lower ROR-P. Moreover, 25% of HER2-0 changed to HER2-low and 34% HER2-low became HER2-0. HER2 shifts were significant after NACT (P < 0.001), not neoadjuvant endocrine therapy (P = 0.063), with consistent ERBB2 mRNA level dynamics. HER2 changes were not associated with EFS/OS. CONCLUSIONS: HER2-low and HER2-0 status change after NAT in ∼30% of cases, mostly after NACT. Targeted adjuvant strategies should be investigated accordingly. Molecular downstaging with current chemo/endocrine agents and immunotherapy should not rely on HER2 immunohistochemical levels in HR+/HER2-negative BC. Instead, HER2-low-targeted approaches should be explored to pursue more effective and/or less toxic dimensional downstaging.

Rotational order-disorder and spin crossover behaviour in a neutral iron(II) complex based on asymmetrically substituted large planar ionogenic ligand.

Octahedrally coordinated spin crossover (SCO) FeII complexes represent an important class of switchable molecular materials. This study presents the synthesis and characterisation of a novel complex, [FeII(ppt-2Fph)2]0·2MeOH, where ppt-2Fph is a new asymmetric ionogenic tridentate planar ligand 2-(5-(2-fluorophenyl)-4H-1,2,4-triazol-3-yl)-6-(1H-pyrazol-1-yl)pyridine. The complex exhibits a hysteretic thermally induced SCO transition at 285 K on cooling and at 293 K on heating, as well as light induced excited spin state trapping (LIESST) at lower temperatures with a relaxation T(LIESST) temperature of 73 K. Single crystal analysis in both spin states shows that the compound undergoes an unusual partial (25%) reversible order-disorder of the asymmetrically substituted phenyl group coupled to the thermal SCO. The highly cooperative SCO transition, analysed by structural energy framework analysis at the B3LYP/6-31G(d,p) theory level, revealed the co-existence of stabilising and destabilising energy variations in the lattice. The observed antagonism of intermolecular interactions and synchronous rotational disorder, which contributes to the overall entropy change, is suggested to be at the origin of the cooperative SCO transition.

Divergent Gut Microbiota: Archaeal and Bacterial Signatures Unveil Unique Patterns in Colombian Cyclists Compared to Weightlifters and Non-Athletes.

Engagement in physical activity, across various sports, promotes a diverse microbiota in active individuals. This study examines the gut microbiota of Colombian athletes, specifically weightlifters (n = 16) and road cyclists (n = 13), compared to non-athletes (n = 15). Using Kruskal-Wallis tests, the physical activity level of a group of non-athletic individuals and the sports experience of a group of professional athletes is analyzed. The median age of participants is 24 years, comprising 25 men and 19 women. The microbiota is collected using fecal samples. Participants provided these samples during their pre-competitive stage, specifically during the concentration phase occurring two weeks prior to national competitions. This timing is chosen to capture the microbial composition during a period of heightened physical preparation. Questionnaire responses and microbial composition assessments identify disparities among groups. Microbial composition analysis explores core microbiome, abundance, and taxonomy using Pavian, MicrobiomeAnalyst 2.0, and GraPhlAn. ANCOM-BC2 reveals differentially abundant species. Road cyclists exhibit decreased Bacteria and increased Archaea abundance. Phylum-level variations included Planctomycetes, Acidobacteria, and Proteobacteria, while Bacteroidetes prevailed. Key families influencing gut microbiota are Bacteroidaceae, Muribaculaceae, and Selenomonadaceae. Weightlifters exhibit unique viral and archaeal community connections, while cyclists showed specialized microbial interplay influenced by endurance exercise. Correlation network analysis emphasizes distinctive microbial interactions within athlete groups, shedding light on the impact of physical activities on gut microbiota and athlete health.

Transferrin Saturation, Serum Ferritin, and C-Reactive Protein vs. Serum Ferritin for an optimal Iron Deficiency Diagnosis in Candidates for Bariatric Surgery.

INTRODUCTION: Iron has different physiological processes and is regulated by hepcidin that is also an acute phase reactant, which increases with inflammation. Obesity produces a pro-inflammatory state, affecting directly the normal regulation of iron, causing ferritin (FER) deficiency. FER is used as the only indicator of the status of iron in patients with obesity, so the majority of them would be underdiagnosed, leading to a high prevalence of iron deficiency (ID) and anemia. The aim of this study is to evaluate the diagnostic tests: transferrin saturation (TS), FER, and C-reactive protein (CRP) vs. FER with the objective of analyzing the most accurate variable for the diagnosis of ID. MATERIALS AND METHODS: We present a cross-sectional, analytical, and retrospective study, evaluating the diagnostic tests in 96 patients, to whom two methods were applied for the diagnosis of ID: method 1 (FER < 30 ng/mL) and method 2 divided into 2A (FER < 30 ng/mL), 2B (FER 30-100 ng/mL + CRP ≥ 5 mg/L), 2C (FER 100-300 ng/mL + CRP ≥ 5 mg/L + TS < 20%), and 2D (TS < 20%). RESULTS: The prevalence of ID obtained using method 1 was 30.2% while 69.8% presented ID using total method 2, confirming an underdiagnosis of 39.6%. CONCLUSION: The inflammatory state in patients with obesity must be considered in the diagnosis of ID. The use of TS, FER, and CRP has greater validity than the use of serum FER for the diagnosis of ID in patients with obesity.

Executive summary of the consensus document on the management of perioperative anemia in Spain.

Perioperative anemia is an independent risk factor for postoperative morbidity and mortality. However, conceptual, logistical and administrative barriers persist that hinder the widespread implementation of protocols for their management. The project coordinator convened a multidisciplinary group of 8 experienced professionals to develop perioperative anemia management algorithms, based on a series of key points (KPs) related to its prevalence, consequences, diagnosis and treatment. These KPs were assessed using a 5-point Likert scale, from "strongly disagree [1]" to "strongly agree [5]". For each KP, consensus was reached when receiving a score of 4 or 5 from at least 7 participants (>75%). Based on the 36 KPs agreed upon, diagnostic-therapeutic algorithms were developed that we believe can facilitate the implementation of programs for early identification and adequate management of perioperative anemia, adapted to the characteristics of the different institutions in our country.

The stigma of intellectual disability in Spain: a nationally representative survey.

BACKGROUND: Stigma towards people with intellectual disability affects various aspects of their lives, including access to employment, housing, health and social care services. Furthermore, this stigma reduces their social opportunities and is even reflected in laws that diminish their autonomy. Due to the practical significance of this issue, the aim of this research is to explore for the first time the social stigma associated with intellectual disability in a representative sample of the Spanish population. METHOD: A cross-sectional quantitative descriptive study was conducted, involving a representative sample of the population (N = 2746). The study includes descriptive analyses and hierarchical regressions to examine various dimensions of stigma, such as attitudes, attributions, and intentions of social distance. RESULTS: Medium levels of stigma are found regarding attitudes and attributions towards people with intellectual disability, while levels are medium-low concerning the intention of social distance. The most reliable indicators of stigma across its various dimensions encompass attitudes, attributions, and the intention of social distance. Factors that contribute to lower stigma include knowing someone with an intellectual disability, being willing to discuss intellectual disability with an acquaintance who has it and having a progressive political ideology. People with intellectual disability show more negative attributions towards themselves. Living with a person with an intellectual disability is another predictor of more stigmatising attitudes, but less intention of social distance. Results are mixed regarding age, gender, and educational level. CONCLUSION: Combating the stigmatisation of people with intellectual disabilities must include comprehensive actions to address attitudes, attributions and behavioural intentions. Public policies, such as national campaigns and programmes, should include contact with and open conversations about intellectual disability, and sensitivity to sociodemographic variables.

Impact of malnutrition on the quality of life in older patients with advanced heart failure: a cohort study.

OBJECTIVES: The aim of this study was to assess the prevalence of malnutrition, the clinical characteristics associated with malnutrition and the impact of nutritional status on mortality, quality of life, self-care abilities, and activities of daily living in the older patients with advanced heart failure. METHODS: A prospective multicentre cohort study including 260 community-dwelling elderly patients with advanced HF was conducted between June 2017 and December 2019. The study was carried out in 22 primary healthcare centres, three university hospitals, one acute-care hospital, and one geriatric rehabilitation unit in the city of Barcelona (Spain). Nutritional status was assessed at baseline using the Mini Nutritional Assessment questionnaire. Patient-reported outcome measures included quality of life (EQ-5D-3L), self-care behaviour (European Heart Failure Self-care Behaviour Scale) and impact on activities of daily living (Barthel Index). RESULTS: Using the MNA-SF, 126 (48.5%) patients were identified as being at risk of malnutrition and 33 (12.7%) patients as having confirmed malnutrition. Compared to HF patients with normal nutritional status, patients with confirmed malnutrition were significantly older, with a lower BMI, and with reduced haemoglobin levels. During follow-up (median 14.9 months, Interquartile Range; 4.9-26.9), 133 (51.2%) of the included participants died, and mortality was significantly higher among patients identified as having malnutrition (p < 0.001). Better Barthel index and quality of life scores were inversely related to the risk of malnutrition, [Odds Ratio (OR) 0.97 (95% Confidence interval 0.96; 0.98) and OR 0.98 (95% Confidence interval, 0.96; 0.99)], respectively. Higher scores in the European Heart Failure Self-care Behaviour Scale, which implies worse self care, were related to higher malnutrition risk, OR 1.05 (95% Confidence interval, 1.02; 1.09. Adjusted multivariate logistic model found that malnutrition was significantly associated with poor quality of life, and adverse impacts on daily activities and self-care. CONCLUSIONS: In community-dwelling older patients with advanced HF, malnutrition was associated with worse patient reported outcome measures related to poor quality of life, and adverse impacts on self-care and daily activities. Nutritional status must be systematically addressed by primary care nurses and family doctors to improve survival rates in these patients. It would be helpful the incorporation of expert professionals in nutrition in the primary health care centres.

First measurements of an imaging heavy ion beam probe at the ASDEX Upgrade tokamak.

The imaging heavy ion beam probe (i-HIBP) diagnostic has been successfully commissioned at ASDEX Upgrade. The i-HIBP injects a primary neutral beam into the plasma, where it is ionized, leading to a fan of secondary (charged) beams. These are deflected by the magnetic field of the tokamak and collected by a scintillator detector, generating a strike-line light pattern that encodes information on the density, electrostatic potential, and magnetic field of the plasma edge. The first measurements have been made, demonstrating the proof-of-principle of this diagnostic technique. A primary beam of 85/87Rb has been used with energies ranging between 60 and 72 keV and extracted currents up to 1.5 mA. The first signals have been obtained in experiments covering a wide range of parameter spaces, with plasma currents (Ip) between 0.2 and 0.8 MA and on-axis toroidal magnetic field (Bt) between 1.9 and 2.7 T. Low densities appear to be critical for the performance of the diagnostic, as signals are typically observed only when the line integrated density is below 2.0-3.0 × 1019 m-2 in the central interferometer chord, depending on the plasma shape. The strike line moves as expected when Ip is ramped, indicating that current measurements are possible. Additionally, clear dynamics in the intensity of the strike line are often observed, which might be linked to changes in the edge profile structure. However, the signal-to-background ratio of the signals is hampered by stray light, and the image guide degradation is due to neutron irradiation. Finally, simulations have been carried out to investigate the sensitivity of the expected signals to plasma density and temperature. The results are in qualitative agreement with the experimental observations, suggesting that the diagnostic is almost insensitive to fluctuations in the temperature profile, while the signal level is highly determined by the density profile due to the beam attenuation.

Automated method for the solid phase extraction of tetracyclines in wastewater followed by fluorimetric determination.

This work presents a multisyringe flow injection analysis (MSFIA) system for the automatic extraction and determination of tetracyclines in wastewater samples. The sample was adjusted with Na2EDTA buffer before solid-phase extraction with an Oasis HLB column used for the analyte preconcentration. The europium (Eu3+)-based and citrate-mediated method (using Tris-HCl buffer) was selected for the fluorimetric analysis (λexc/em = 400/612 nm). For fluorescence detection, a low-cost system consisting of an USB 2000 CCD detector and a 3D-printed support that holds a LED light source was used. Under optimized conditions, the proposed method provided low limits of detection (9.4 µg L-1) and quantification (31 µg L-1), and good values for intra-day (<4 %) and inter-day precisions (<6 %). Recoveries of spiked TCs in wastewater samples ranged from 87 to 106 %. The results of this work were in good agreement with the measurements obtained by liquid chromatography coupled to a fluorescence detector.

Relación de variables sociodemográficas con niveles de depresión, ansiedad y estrés en estudiantes universitarios / PRelation of socio-demographic variables with levels of depression, anxiety and stress in university students

RESUMEN: Introducción: La salud mental en universitarios es un tema que cada vez cobra más relevancia y la importancia que tiene identificar factores que afectan su aparición, así como también en qué medida influyen en el desempeño académico. Método: Se utilizó un diseño cuantitativo no experimental, descriptivo, correlacional y de corte transversal. Se aplicó Chi Cuadrado para evaluar asociación entre variables. La muestra fue no probabilística de 166 estudiantes de enfermería, nutrición y dietética, fonoaudiología y kinesiología. Se aplicó la versión chilena abreviada de las escalas de depresión, ansiedad y estrés DASS - 21, constituida por 21 ítems, con cuatro alternativas de respuesta en formato en escala Likert y un cuestionario sociodemográfico, éste instrumento consideró variables personales, etnia Mapuche y nivel de escolaridad de los padres. El protocolo de investigación realizado fue aprobado por el Comité Ético Científico del Servicio de Salud Del Reloncaví. Resultados: El 54, 82% de la muestra presenta algún nivel de alteración o riesgo de padecer ansiedad, un 47,59% de estrés y un 31,33% depresión. El 42,17% se identifica como perteneciente a la etnia mapuche, mientras que el 56,02% se identifica como no mapuche. En relación al nivel de escolaridad del padre y de la madre, el porcentaje más alto corresponde a la categoría de enseñanza media completa (padre 37,95% y madre 36,14%). Conclusiones: Existe una asociación entre sexo femenino y los niveles ansiedad, estrés y depresión. Además, una relación entre pertenecer al género femenino, cursar las carreras de Enfermería y nutrición y dietética con presentar algún nivel de ansiedad, destacándose una asociación entre ansiedad, depresión y estrés.

ABSTRACT Introduction: Mental health in university students is a topic that is becoming more and more relevant and the importance of identifying factors that affect its appearance, as well as to what extent they influence academic performance. Method: A non-experimental, descriptive, correlational and cross-sectional quantitative design was used. Chi Square was applied to evaluate the association between variables. The sample was non-probabilistic of 166 students from nursing, nutrition and dietetics, speech therapy, and kinesiology. The abbreviated Chilean version of the DASS-21 depression, anxiety and stress scales was applied, consisting of 21 items, with four response alternatives in Likert scale format and a sociodemographic questionnaire, this instrument considered personal variables, Mapuche ethnic group and level of parental education. The research protocol carried out was approved by the Scientific Ethics Committee of the Del Reloncaví Health Service. Results: 54.82% of the sample presented some level of alteration or risk of suffering from anxiety, 47.59% stress and 31.33% depression. 42.17% identify themselves as belonging to the Mapuche ethnic group, while 56.02% identify themselves as non-Mapuche. Regarding the level of education of the father and mother, the highest percentage corresponds to the category of complete secondary education (father 37.95% and mother 36.14%). Conclusions: There is an association between female sex and levels of anxiety, stress and depression. In addition, there is a relationship between belonging to the female gender, studying nursing, nutrition and dietetics careers with presenting some level of anxiety. An association between anxiety, depression and stress stands out.

Consenso chileno para el diagnóstico y tratamiento de gliomas del adulto / Diagnosis and treatment of glioma in adult: Chilean consensus

Resumen Los tumores cerebrales se caracterizan por su gran morbilidad y mortalidad. La gran mayoría corresponde a tumores secundarios (metástasis). Dentro de los tumores primarios del sistema nervioso central, los gliomas corresponden al 30% de éstos. En EEUU, entre el 2007-2011, se estima una incidencia aproximada de 21,4 casos por 100.000 habitantes. Los recientes avances en la comprensión molecular de la biología de estos tumores han permitido mejorar sustancialmente su clasificación, posibilitando realizar un mejor correlato con los desenlaces clínicos y el pronóstico. En esta línea, hoy en día es posible estratificar a los pacientes por riesgo y entregar tratamientos capaces de prolongar la sobrevida global entre 5-7 años, para los gliomas grado II y III. El presente consenso, elaborado por un panel multidisciplinario de expertos de diversas sociedades científicas chilenas y, por tanto, de todas las especialidades involucradas en el manejo médico-quirúrgico de las personas portadoras de gliomas cerebrales. A la luz de este nuevo conocimiento desarrollado al alero de la oncología molecular, esta propuesta ofrece un insumo de utilidad clínica real, que, articulado a una revisión actualizada en relación con el tratamiento y seguimiento de estos pacientes, permite entender la relevancia de estos biomarcadores en el manejo de precisión de la enfermedad. Cabe señalar que, este manuscrito emerge de la misma fuerza de trabajo, que elaboró el Protocolo Clínico de Gliomas del Adulto 2019, publicado por el Ministerio de Salud, y que ha diferencia de esta, que ofrece los detalles clínicos-operativos, como flujogramas y dosis, nuestra revisión intenta relevar los avances imagenológicos y moleculares y como estos impactan en el manejo actual de la enfermedad.

Brain tumors are characterized by high morbidity and mortality. The vast majority correspond to secondary tumors (metastasis). On the other hand, within the primary tumors of the central nervous system, gliomas correspond to 30% of these. In the US, between 2007-2011, an approximate incidence of 21.4 cases per 100,000 inhabitants was estimated. Recent advances in the molecular understanding of the biology of these tumors have made it possible to substantially improve their classification, allowing a better correlation with clinical outcomes and prognosis. Along these lines, today, it is possible to stratify patients by risk and deliver treatments capable of prolonging global survival between 5-7 years, for grade II and III gliomas. The present consensus, prepared by a multidisciplinary panel of experts from various Chilean scientific societies and, therefore, from all the specialties involved in the medical and surgical therapy. Enlightened from the molecular oncology, this proposal offers an input of clinical utility, which, together with an updated review in relation to the treatment and follow-up of these patients, allows us to understand the relevance of these biomarkers in precision disease management. It should be noted that this manuscript emerges from the same work force, which prepared the Clinical Protocol for Adult Gliomas 2019, published by the Ministry of Health, and that differs from it, which offers clinical-operative details, such as flowcharts and dose, our review attempts to reveal imaging and molecular advances and how they impact the current management of the disease.

Enfoque del tromboembolismo pulmonar agudo desde el momento inicial en el servicio de urgencias / Initial Approach to Acute Pulmonary Embolism since the Initial Moment in the Emergency Department / Abordagem para tromboembolismo pulmonar agudo desde o momento inicial no departamento de emergência

El tromboembolismo pulmonar es la manifestación más grave de la enfermedad tromboembólica venosa y la tercera causa de mortalidad cardiovascular. Su sintomatología puede ir desde un cuadro asintomático o con síntomas leves, hasta el paro cardiaco. Dentro del enfoque de esta patología es importante tener en cuenta escalas que permiten estimar la probabilidad de que determinado paciente con ciertos signos, síntomas y factores de riesgo presente un tromboembolismo pulmonar, así como escalas diseñadas para valorar el riesgo de morir, en pacientes en los que ya se estableció este diagnóstico. Los pilares del tratamiento son la anticoagulación y la trombólisis, sin embargo, esta última está indicada únicamente en algunos casos. La presente revisión tiene como objetivo presentar una actualización de la evidencia sobre el enfoque diagnóstico y terapéutico del tromboembolismo pulmonar agudo, desde el ingreso del paciente al servicio de urgencias.

Pulmonary embolism is the most severe manifestation of venous thromboembolic disease and the third cause of cardiovascular mortality. Its symptoms can range from asymp-tomatic or mild symptoms to cardiac arrest. The approach to patients with suspected pulmonary embolism includes scores that allow estimating the clinical probability that a certain patient with certain signs, symptoms and risk factors will present a pulmonary thromboembolism, as well as scores that classify patients by severity and risk of hemody-namic decompensation. Treatment is based on anticoagulation and thrombolysis, which is used only in certain patients. The goal of this review is to present updated evidence regarding diagnosis and treatment of acute pulmonary embolism from the moment the patient arrives at the emergency room.

A embolia pulmonar é a manifestação mais grave da doença tromboembólica venosa e a terceira principal causa de mortalidade cardiovascular. Seus sintomas podem variar de sintomas assintomáticos ou leves a parada cardíaca. No enfoque desta patologia, é importante levar em consideração escalas que permitem estimar a probabilidade de um determinado paciente com determinados sinais, sintomas e fatores de risco apresentar tromboembolismo pulmonar, bem como escalas destinadas a avaliar o risco de morrer, em pacientes nos quais esse diagnóstico já foi estabelecido. Os pilares do tratamento são a anticoagulação e a trombólise, porém, esta última está indicada apenas em alguns casos. A presente revisão tem como objetivo apresentar uma atualização das evidências sobre a abordagem diagnóstica e terapêutica do tromboembolismo pulmonar agudo, desde a admissão do paciente no pronto-socorro.

Hemangioma lobular capilar lingual. Reporte de un caso / Lingual lobular capillary hemangioma. A case report

El hemangioma lobular capilar es una hiperplasia inflamatoria en respuesta a una irritación crónica, la cual da lugar a una lesión exofítica eritematosa debido a la proliferación de tejido fibrovascular. En la boca puede verse en cualquier ubicación, pero es más frecuente en la zona gingival. Se reporta el caso clínico de una paciente embarazada de 38 años que consultó al equipo de Cirugía Maxilofacial del Hospital San José al presentar una lesión tumoral compatible con hemangioma lobular capilar en cara lingual lateral derecha, diagnóstico confirmado con histopatología. El objetivo de este reporte es especificar características y tratamiento de dicha lesión con localización infrecuente.

Lobular capillary hemangioma is an inflammatory hyperplasia in response to chronic irritation, resulting in an exophytic erythematous lesion due to proliferation of fibrovascular tissue. Intraorally, it can appear in any location, but it is more frequent in the gingival region. This article describes a case of a 38-year-old pregnant woman who at- tended the Maxillofacial Surgery Unit at San José Hospital, presenting a tumoral lesion on the right lateral area of the tongue compatible with a lobular capillary hemangioma. The diagnosis was confirmed with histopathology. The aim of this report is to specify the characteristics and treatment of a lesion with infrequent location.

Tratamientos de primera línea para pacientes estadio IV con adenocarcinoma pulmonar de mutación EGFR / First-line treatments for stage IV patients with EGFR-mutated lung adenocarcinoma

Lung cancer is one of the leading causes of death in the world. Current treatments act directly on the signal transduction pathways in cancer cells, mainly. One of the main pathways is associated with the Epidermal Growth Factor (EGFR), whose mutations leads to uncontrolled cell proliferation and a higher rate of cell invasion. Activating mutations in the EGFR gene, which includes deletions in exon 19 and the L858R mutation in exon 21, were detected in most patients with non-small cell lung cancer (NSCLC). Studies of EGFR tyrosine kinase inhibitors (EGFR-TKIs) such as Gefitinib, Erlotinib and Afatinib, compared with platinum-based treatments, showed that EGFR-TKIs produce increased disease-free survival, although only in patients whose cancers harbor activating mutations in the EGFR gene. Clinical trials also demonstrated that EGFR-TKIs are effective as first-line therapies in stage IV pulmonary adenocarcinoma. Here, the main aspects of the activation of the EGFR pathway in NSCLC will be reviewed, highlighting the importance for health professionals of correctly identifying activating mutations in the EGFR gene and acting quickly at the molecular level based on aforementioned treatments. (AU)