Assessment of the Correlation and Diagnostic Accuracy between Cerebrospinal Fluid and Plasma Alzheimer's Disease Biomarkers: A Comparison of the Lumipulse and Simoa Platforms.

We compared the clinical and analytical performance of Alzheimer's disease (AD) plasma biomarkers measured using the single-molecule array (Simoa) and Lumipulse platforms. We quantified the plasma levels of amyloid beta 42 (Aß42), Aß40, phosphorylated tau (Ptau181), and total tau biomarkers in 81 patients with mild cognitive impairment (MCI), 30 with AD, and 16 with non-AD dementia. We found a strong correlation between the Simoa and Lumipulse methods. Concerning the clinical diagnosis, Simoa Ptau181/Aß42 (AUC 0.739, 95% CI 0.592-0.887) and Lumipulse Aß42 and Ptau181/Aß42 (AUC 0.735, 95% CI 0.589-0.882 and AUC 0.733, 95% CI 0.567-0.900) had the highest discriminating power. However, their power was significantly lower than that of CSF Aß42/Aß40, as measured by Lumipulse (AUC 0.879, 95% CI 0.766-0.992). Simoa Ptau181 and Lumipulse Ptau181/Aß42 were the markers most consistent with the CSF Aß42/Aß40 status (AUC 0.801, 95% CI 0.712-0.890 vs. AUC 0.870, 95% CI 0.806-0.934, respectively) at the ≥2.127 and ≥0.084 cut-offs, respectively. The performance of the Simoa and Lumipulse plasma AD assays is weaker than that of CSF AD biomarkers. At present, the analysed AD plasma biomarkers may be useful for screening to reduce the number of lumbar punctures in the clinical setting.

Silicon nitride TM-pass polarizer using inverse design.

Integrated silicon nitride polarizers play a critical role in the design of complex integrated devices such as filters, switches, and large Mach-Zehnder interferometer networks. These devices require precise control of both polarizations on a single circuit. In addition, polarizers are essential to accurately characterize these devices, primarily due to the low efficiency and polarization extinction ratio (PER) of the surface coupling gratings used in CMOS-compatible silicon nitride platforms for test-specific optical I/O. In this article, we present the design and experimental performance of six prototypes of TE-reflector/TM-pass polarizers specifically optimized for the C-band. These prototypes resemble subwavelength gratings with several additional intricate aspects. In particular, the longer prototypes feature two distinct regions, one representing non-intuitive tapers and the other showcasing a more distinct subwavelength grating. We achieve a high TM transmission efficiency of -0.28 dB along with a PER of 18.2 dB. These results are obtained with a device occupying an area as low as 11 µm × 2 µm, setting a new performance benchmark for compact polarizers compatible with standard silicon nitride platforms.

Efficient integrated tri-modal coupler for few-mode fibers.

This paper demonstrates a high-efficiency vertical grating coupler for the LP01x, LP11ax, and LP11bx modes of a graded-index few-mode fiber. The coupler is composed of a non-uniform straight bidirectional grating that was inverse-designed to address the desired fiber modes, combined with two mode-selective directional couplers and two tapers. The device was fabricated by e-beam lithography with a minimum feature size of 100 nm and presented coupling efficiencies of -3.0 dB, -3.6 dB, and -3.4 dB for the LP01x, LP11ax, and LP11bx modes, respectively. The high efficiency of the proposed CMOS-compatible coupler demonstrates its potential as a key device for high-capacity networks exploiting space division multiplexing on few-mode fibers.

Compact dual-polarization silicon integrated couplers for multicore fibers.

Compact fiber-to-chip couplers play an important role in optical interconnections, especially in data centers. However, the development of couplers has been mostly limited to standard single-mode fibers, with few devices compatible with multicore and multimode fibers. Through the use of state-of-the-art optimization algorithms, we designed a compact dual-polarization coupler to interface chips and dense multicore fibers, demonstrating, for the first time, coupling to both polarizations of all the cores, with measured coupling efficiency of -4.3dB and with a 3 dB bandwidth of 48 nm. The dual-polarization coupler has a footprint of 200µm2 per core, which makes it the smallest fiber-to-chip coupler experimentally demonstrated on a standard silicon-on-insulator platform.

Optimization of the electromagnetic scattering problem based on the topological derivative method.

A new optimization method based on the topological derivative concept is developed for the electromagnetic design problem. Essentially, the purpose of the topological derivative method is to measure the sensitivity of a given shape functional with respect to a singular domain perturbation, so that it has applications in many relevant fields such as shape and topology optimization for imaging processing, inverse problems, and design of metamaterials. The topological derivative is rigorously derived for the electromagnetic scattering problem and used as gradient descent direction to find local optima for the design of electromagnetic devices. We demonstrate that the resulting topology design algorithm is remarkably simple and efficient and naturally leads to binary designs, while depending only on the solution of the conventional finite element formulation for electrodynamics. Finally, several numerical experiments in two and three spatial dimensions are presented to illustrate the performance of the proposed formulation.

Lithium management of periodic mood fluctuations in behavioural frontotemporal dementia: a case report.

The behavioural variant of Frontotemporal Dementia (bvFTD) is a neurodegenerative condition characterized by behavioural and cognitive symptoms. Mood disturbances, including manic-like episodes, can occur in bvFTD, posing diagnostic and therapeutic challenges. This case report presents a 62-year-old male with bvFTD exhibiting weekly mood fluctuations alternating between manic and depressive-like states. While initial treatment with quetiapine and trazodone showed partial improvement, the periodicity of mood fluctuations persisted. Subsequently, lithium was introduced, resulting in a notable reduction in symptom severity for both manic and depressive episodes. This report highlights the potential use of lithium as a mood stabilizer in bvFTD patients with periodic mood fluctuations, refractory to standard treatments. Further research is needed to elucidate the mechanisms underlying lithium's efficacy in bvFTD and to establish treatment guidelines.

Failure to Identify Robust Latent Variables of Positive or Negative Valence Processing Across Units of Analysis.

BACKGROUND: The heterogeneous nature of mood and anxiety disorders highlights a need for dimensionally based descriptions of psychopathology that inform better classification and treatment approaches. Following the Research Domain Criteria approach, this investigation sought to derive constructs assessing positive and negative valence domains across multiple units of analysis. METHODS: Adults with clinically impairing mood and anxiety symptoms (N = 225) completed comprehensive assessments across several units of analysis. Self-report assessments included nine questionnaires that assess mood and anxiety symptoms and traits reflecting the negative and positive valence systems. Behavioral assessments included emotional reactivity and distress tolerance tasks, during which skin conductance and heart rate were measured. Neuroimaging assessments included fear conditioning and a reward processing task. The latent variable structure underlying these measures was explored using sparse Bayesian group factor analysis. RESULTS: Group factor analysis identified 11 latent variables explaining 31.2% of the variance across tasks, none of which loaded across units of analysis or tasks. Instead, variance was best explained by individual latent variables for each unit of analysis within each task. Post hoc analyses 1) showed associations with small effect sizes between latent variables that were derived separately from functional magnetic resonance imaging and self-report data and 2) showed that some latent variables are not directly related to individual valence system constructs. CONCLUSIONS: The lack of latent structure across units of analysis highlights challenges of the Research Domain Criteria approach and suggests that while dimensional analyses work well to reveal within-task features, more targeted approaches are needed to reveal latent cross-modal relationships that could illuminate psychopathology.

Assessment of the Concordance and Diagnostic Accuracy Between Elecsys and Lumipulse Fully Automated Platforms and Innotest.

Manual ELISA assays are the most commonly used methods for quantification of biomarkers; however, they often show inter- and intra-laboratory variability that limits their wide use. Here, we compared the Innotest ELISA method with two fully automated platforms (Lumipulse and Elecsys) to determine whether these new methods can provide effective substitutes for ELISA assays. We included 149 patients with AD (n = 34), MCI (n = 94) and non-AD dementias (n = 21). Aß42, T-tau, and P-tau were quantified using the ELISA method (Innotest, Fujirebio Europe), CLEIA method on a Lumipulse G600II (Fujirebio Diagnostics), and ECLIA method on a Cobas e 601 (Roche Diagnostics) instrument. We found a high correlation between the three methods, although there were systematic differences between biomarker values measured by each method. Both Lumipulse and Elecsys methods were highly concordant with clinical diagnoses, and the combination of Lumipulse Aß42 and P-tau had the highest discriminating power (AUC 0.915, 95% CI 0.822-1.000). We also assessed the agreement of AT(N) classification for each method with AD diagnosis. Although differences were not significant, the use of Aß42/Aß40 ratio instead of Aß42 alone in AT(N) classification enhanced the diagnostic accuracy (AUC 0.798, 95% CI 0.649-0.947 vs. AUC 0.778, 95% CI 0.617-0.939). We determined the cut-offs for the Lumipulse and Elecsys assays based on the Aß42/Aß40 ratio ± status as a marker of amyloid pathology, and these cut-offs were consistent with those recommended by manufacturers, which had been determined based on visual amyloid PET imaging or diagnostic accuracy. Finally, the biomarker ratios (P-tau/Aß42 and T-tau/Aß42) were more consistent with the Aß42/Aß40 ratio for both Lumipulse and Elecsys methods, and Elecsys P-tau/Aß42 had the highest consistency with amyloid pathology (AUC 0.994, 95% CI 0.986-1.000 and OPA 96.4%) at the ≥0.024 cut-off. The Lumipulse and Elecsys cerebrospinal fluid (CSF) AD assays showed high analytical and clinical performances. As both automated platforms were standardized for reference samples, their use is recommended for the measurement of CSF AD biomarkers compared with unstandardized manual methods, such as Innotest ELISA, that have demonstrated a high inter and intra-laboratory variability.

[Time series of non-work related sickness absence incidence by subgroups of duration (2009-2018)]. / Evolución temporal de la incidencia por incapacidad temporal de origen común según tramos de duración (2009-2018).

OBJECTIVE: We describe time trend incidence (2009-2018) of non-work related Sickness Absence(SA) segmented by duration of episodes in Spain. METHODS: We used SA cases from a health insurance company ("mutua") in Spain. Overall non-work related SA incidence and incidence by duration of episodes (1-3 days, 4-15 days, 16-30 days, 31-90 days and> 90 days) were obtained. A time series ecological study was carried out with an inflection point in 2013. The annual percentage of change and 95% confidence interval were obtained. The analyses were stratified by age and sex. RESULTS: Overall incidence went from 35.3 cases per 100 workers-years in 2009 to 25.2 in 2013. From 2014, there is a sustained rise in the incidence of ITCC, ending 2018 with 34.1 cases per 100 workers-years. The overall incidence is determined mainly by processes less than 16 days in young population. The decrease in 2009-2013 occurred in all the duration segments, especially in 4 to 15 (APC=-11,2; 95% CI=(-14,1 a -8,2)) and more than 90 days (APC =-9,4; 95% CI =(-15,5 a -2,8)), mainly in young people. The rise in 2013-2018 was observed in all the segments, with the largest significant increase in sections of 1-3 days(younger workers: APC =18,9; 95% CI =(14,8 a 23,2)) and in more than 90 days (mainly in older ones). Time trend of SA showed similar pattern in both sexes. CONCLUSIONS: Time trend analysis of SA incidence by duration segments offers a detailed information of SA. These results are useful for professionals in the prevention and management of SA.

OBJETIVO: Describir la evolución temporal (2009-2018) de la incidencia de la incapacidad temporal por contingencia común (ITCC) según tramos de duración en España. MÉTODOS: Se consideraron casos de ITCC de la población afiliada de una mutua laboral. Se obtuvo la incidencia global de la incapacidad temporal por ITCC y por tramos de duración (1-3 días, 4-15 días, 16-30 días, 31-90 días y >90 días). Se realizó un estudio ecológico de series temporales considerando un punto de inflexión en 2013. Se calculó el porcentaje de cambio anual e intervalo de confianza del 95%. Los análisis se estratificaron por edad y sexo. RESULTADOS: La incidencia global pasó de 35,3 casos por cada 100 trabajadores-año en 2009 a 25,2 en 2013. A partir del 2014 se observa un ascenso sostenido de la incidencia de ITCC, finalizando el 2018 con 34,1 casos por cada 100 trabajadores-año. La incidencia global está determinada fundamentalmente por procesos menores a 16 días en población joven. El descenso en 2009-2013 se produjo en todos los tramos de duración, en especial en 4 a 15 (PCA=-11,2; IC 95%=(-14,1 a -8,2)) y más de 90 días (PCA=-9,4; IC 95%=(-15,5 a -2,8)), principalmente en jóvenes. El ascenso en 2013-2018 se observó en todos los tramos, siendo el incremento más significativo en tramos de 1-3 días (trabajadores de menor edad: PCA=18,9; IC 95%=(14,8 a 23,2)) y en más de 90 días (principalmente en mayores). La evolución de la ITCC presentó un patrón similar en ambos sexos. CONCLUSIONES: La descripción temporal de la incidencia de ITCC por tramos de duración ofrece una información detallada de la incapacidad temporal. Estos resultados son útiles para profesionales de la prevención y gestión de la ITCC.

Giant aneurysmal bone cyst of the mandible with unusual presentation.

Aneurysmal bone cysts are rare benign lesions of bone tissue, infrequent in craneofacial skeleton with regard to other structures like long bones or the spine. They are composed of sinusoidal and vascular spaces blood-filled and surrounded by fibrous tissue septa. We present a case of a 29-year-old Caucasian male with a big swelling in the left mandible associated to pain and rapid growth. He referred previous extraction of the left inferior third molar. On the X-ray study, an expansive multilocular and high vascularized bony lesion within the mandibular angle was observed. It produced expansion and destruction of lingual and buccal cortex. An incisional biopsy was performed showing a fibrous tissue with blood-filled spaces lesion suggestive of an aneurysmal bone cyst. After selective embolization of the tumour, surgical resection was done with curettage and immediate reconstruction of the defect with an anterior iliac crest graft. Aneurysmal bone cysts are non-neoplastic but locally aggressive tumours with occasional rapid growth that may be differentiated from other multilocular process like ameloblastoma, ossifying fibroma, epithelial cyst, giant cell granuloma and sarcomas. Treatment of choice consists on conservative surgical excision of the mass with curettage or enucleation. When resection creates a big defect, primary surgical reconstruction is recommended.

Complete Resolution of Symptoms of Primary Orthostatic Tremor with Perampanel.

Background: Primary orthostatic tremor (POT) is an infrequent disorder whose physiopathology is unknown. Current medication is largely ineffective or only offers mild benefits. Case Report: A 75-year-old female with refractory POT treated with 4 mg/day of perampanel achieved complete symptom resolution. Owing to adverse effects, the patient reduced intake to 2 mg/day, but even at this lower dose the benefit was maintained. Discussion: We report the complete resolution of POT symptoms using low doses of perampanel, an antiepileptic drug that blocks glutamate-mediated post-synaptic excitation. Further controlled studies are necessary to confirm this finding.

[The analysis of sickness absence incidence by subgroups of duration]. / Segmentación de la incidencia de la incapacidad temporal según su duración como estrategia de análisis.

BACKGROUND: We describe the usefulness of performing an analysis of sickness absence (SA) incidence, segmented by the duration of episodes, in comparison with the more common analysis that considers the overall incidence of SA without segmentation. METHODS: We used data from a health insurance company ("mutua") in Spain during 2011 (230,332 episodes, 752,906 workers) and non-work related SA as a case study. We compared the overall incidence of SA and incidence segmented by duration of episodes: short (≤ 15 days), medium (16-30 and 31-90 days) and long (> 90 days). The analyses were also performed by age, as an example of one of the multiple variables that affect SA incidence. RESULTS: The overall incidence of SA was 30.6%, and declined steadily with increasing age. When SA incidence was analyzed by duration, we observed that: 1) the incidence of the episodes of short duration is the highest; 2) the overall excess observed in younger workers (<25 years) is driven mainly by short duration and 3) the pattern for long-term SA incidence was reversed, being more frequent among those ≥55 years of age relative to the youngest. CONCLUSIONS: Examining SA incidence by duration is more informative than relying on overall incidence of SA.

INTRODUCCIÓN: Se describe la utilidad de realizar un análisis de la incidencia de incapacidad temporal (IT) segmentado según la duración de los episodios, en comparación con el análisis que considera la incidencia global de la IT. MÉTODOS: Se considera un ejemplo utilizando datos de una mutua en España durante 2011 (230.332 episodios, 752.906 trabajadores) y la incapacidad temporal por contingencia común (ITcc). Comparamos la incidencia de ITcc global y la segmentada por la duración de los episodios: corta (≤ 15 días), media (16-30 y 31-90) y larga (> 90 días). Los análisis se realizaron también según edad, como ejemplo de una de las múltiples variables que afectan a la incidencia de la IT. RESULTADOS: La incidencia global de ITcc fue del 30,6%, mostrando una disminución con la edad (36,4% en <25 años frente a 29,3% en ≥55 años (RR = 1,24, IC del 95% = 1,22 - 1,27)). El análisis de la incidencia de ITcc segmentado por la duración de los episodios, permite obtener resultados más específicos: 1) la incidencia de corta duración es la más alta respecto al resto de segmentos (20,1% en la corta frente a 2,8% en larga duración (RR = 7,29, IC 95% = 7,19 ­ 7,40); 2) el exceso global observado en jóvenes se produce mayoritariamente por los episodios cortos (RR = 1,98, IC del 95% = 1,93-2,03, en <25 años frente a ≥55 años), y 3) la incidencia de larga duración cambia este patrón, siendo más frecuente en ≥55 años (5,2%) en relación a jóvenes (1,6%)(RR = 0,31, IC 95% = 0,29-0,34). CONCLUSIONES: El análisis de la incidencia de IT segmentada por duración ofrece una aproximación más precisa que la obtenida del análisis global.

[The relationship between unemployment rates and lost work time due to sickness absence in an economic recession]. / Relación entre las tasas de desempleo y los indicadores de absentismo por incapacidad temporal durante periodos de crisis económica.

INTRODUCTION: Different countries have shown an inverse relationship between unemployment rates (UR) and indicators of sickness absence during periods of economic recession. OBJECTIVE: To evaluate the relationship between indicators of sickness absence and unemployment in Spain during 2009-2015. METHODS: We obtained incidence and absenteeism rates of non-work related sickness absence (NWSA) from Social Security data, and UR from the National Institute of Statistics. The relationship between indicators of NWSA and UR in the period 2009 to 2015 was graphically described using time trend plots. Scatter plots of NWSA indicators were also made against UR. Finally, we fitted linear regression models. RESULTS: Incidence (IR) and absenteeism rates (AR) of NWSA showed downward trends in 2009-2013 (IR 2009=28.07%, IR 2013=20.41%; AR 2009=2.53% and AR 2013=1.86%), changing to an upward trend up to 2015 (IR 2015=22.52%, AR 2015=2.12%). Unemployment rates trended upward in 2009-2013 (UR 2009=17.86%, UR 2013=26.10%), and then changed to a downward trend through 2015 (UR 2015=22.06%). There was an inverse relationship between UR and NWSA indicators. CONCLUSIONS: As in previous international studies, we found an inverse relationship between unemployment rates and indicators of sickness absence in Spain. More detailed studies are needed to evaluate explanatory hypotheses, such as those associated with the effects of discipline, selection and/or changes in the workforce.

INTRODUCCIÓN: Estudios realizados en varios países presentan una relación inversa entre las tasas de desempleo (TD) y los indicadores de absentismo por incapacidad temporal (IT) durante periodos de crisis económica. OBJETIVO: Evaluar la relación entre indicadores de absentismo y el desempleo en España (2009-2015). MÉTODOS: Se obtuvieron tasas de incidencia (TI) y absentismo (TA) por IT de origen común (ITcc) a partir de datos de la Seguridad Social, así como las TD según datos del Instituto Nacional de Estadística. Se describió gráficamente la evolución temporal de los indicadores de ITcc y el desempleo en el periodo 2009-2015. Para explorar dicha relación también se realizaron gráficos de dispersión de los indicadores frente a las TD. Posteriormente, se ajustaron modelos de regresión lineal simple. RESULTADOS: Las TI y TA descienden en 2009-2013 (TI 2009=28,07%, TI 2013=20,41%, TA 2009=2,53%, TA 2013=1,86%) momento en que cambia su tendencia, iniciando una fase ascendente hasta 2015 (TI 2015=22,52%, TA 2015=2,12%). La TD asciende en 2009-2013 (TD 2009=17,86%, TD 2013=26,10%), pasando a descender hasta 2015 (TD 2015=22,06%). Las TD y los indicadores de absentismo presentan una relación lineal inversa. CONCLUSIONES: Se observó una relación inversa entre el desempleo y los indicadores de absentismo en España. Son necesarios estudios específicos para poder evaluar hipótesis explicativas como las asociadas a los efectos de disciplina, selección y/o cambios en la fuerza de trabajo.

Altitudinal distribution of the functional feeding groups of aquatic macroinvertebrates using an ecological network in Andean streams / Distribución altitudinal de los grupos funcionales de alimentación de macroinvertebrados acuáticos utilizando una red ecológica en arroyos andinos

Abstract Introduction: Analysis of functional feeding groups (FFG) in aquatic macroinvertebrates is important in understanding the structure, function, and dynamics of ecological processes in ecosystems. Modularity refers to the degree of compartmentalization of food webs and varies between -1 and 1. A network with a modularity value close to 1 is resilient to disturbances and can be interpreted as an indicating factor for the stability of communities. Objective: In this study, we analyzed the trophic structure of benthic macroinvertebrates in La Nitrera stream, the San Juan River, and the Cauca River in the Colombian Andes. Methods: The study was supported by ecological networking techniques using Gephi software. We studied nine sites in dry, rainy, and transition seasons in 2017 and 2018, monitoring changes in the altitude gradient. At each of the sites, the organisms were captured and determined, and physicochemical and hydraulic information was obtained. Results: The variance component analysis allowed to explain the variability of the data by relating the following environmental variables: FFG, diversity, richness, modularity, season, and time. Simple multifactorial ANOVA indicated that significant changes in FFG were associated with altitude, and modularity to time. The allocation of the FFG was done by stomach analysis and secondary information. Conclusion: The transition season had the highest modularity, possibly due to the recolonization of some biotopes caused by the decrease in the velocity of water currents. La Nitrera and San Juan presented higher values than the Cauca, which may indicate that the altitudinal change and velocity of water currents affects the compartmentalization of the network.

Resumen Introducción: El análisis de grupos funcionales de alimentación (GFA) en macroinvertebrados acuáticos es importante para comprender la estructura, función y dinámica de los ecosistemas de procesos ecológicos. La modularidad se refiere al grado de compartimentación de las redes alimentarias y varía entre -1 y 1. Una red con un valor de modularidad cercano a 1 es resistente a las alteraciones y puede interpretarse como un factor indicativo para la estabilidad de las comunidades. Objetivo: En este estudio se analizó la estructura trófica de los macroinvertebrados bentónicos, un elemento importante en la calidad ambiental, en el arroyo La Nitrera, el río San Juan y el río Cauca. Métodos: El estudio contó con el apoyo de técnicas de redes ecológicas utilizando el software Gephi. En 2017 y 2018, estudiamos nueve sitios en estaciones secas, lluviosas y de transición, monitoreando cambios en el gradiente de altitud. En cada uno de los sitios se capturaron y determinaron los organismos y se recogió información fisicoquímica e hidráulica. Resultados: El análisis de componentes de varianza permitió explicar la variabilidad de los datos relacionando las siguientes variables ambientales: GFA, diversidad, riqueza, modularidad, estación y tiempo. La ANOVA simple multifactorial indicó que existen cambios significativos en los GFA en relación con la altitud, y la modularidad con el tiempo. La asignación de los GFA se realizó mediante análisis estomacal e información secundaria. Conclusión: La temporada de transición tuvo la mayor modularidad, posiblemente debido a la recolonización de algunos biotopos provocada por la disminución de la velocidad del cauce. La Nitrera y San Juan presentaron valores superiores a los del Cauca, lo que puede indicar que el cambio altitudinal y la velocidad de las corrientes de agua influyen en la compartimentación de la red.

Causes of Death in Anticoagulated Patients With Atrial Fibrillation.

BACKGROUND: Oral anticoagulation reduces the risk of mortality in atrial fibrillation (AF), but examination of the causes of death is essential to design new strategies to further reduce the high mortality rates observed in this population. OBJECTIVES: The authors sought to analyze and compare causes of death in patients receiving direct oral anticoagulants (DOAC) or warfarin for prevention of stroke and systemic embolism (SE) in AF. METHODS: The authors systematically searched for randomized trials of DOAC versus warfarin for prevention of stroke/SE in AF. The main outcome was mortality and independently adjudicated specific causes of death. The authors used the random effects model of meta-analysis to combine the studies. RESULTS: 71,683 patients from 4 trials were included (134,046 patient-years of follow-up). A total of 6,206 patients (9%) died during follow-up. Adjusted mortality rate was 4.72%/year (95% confidence interval [CI]: 4.19 to 5.28). Cardiac deaths accounted for 46% of all deaths, whereas nonhemorrhagic stroke/SE and hemorrhage-related deaths represented 5.7% and 5.6% of the total mortality, respectively. Compared with patients who were alive, those who died had more frequent history of heart failure (odds ratio [OR]: 1.75; 95% CI: 1.25 to 2.44), permanent/persistent AF (OR: 1.38; 95% CI: 1.25 to 1.52) and diabetes (OR: 1.37; 95% CI: 1.11 to 1.68); were more frequently male (OR: 1.24; 95% CI: 1.13 to 1.37) and older (mean difference 3.2 years; 95% CI: 1.6 to 4.8); and had a lower creatinine clearance (-9.9 ml/min; 95% CI: -11.3 to -8.4). There was a small, but significant, reduction in all-cause mortality with the DOAC versus warfarin (difference -0.42%/year; 95% CI: -0.66 to -0.18), mainly driven by a reduction in fatal bleedings. CONCLUSIONS: In contemporary AF trials, most deaths were cardiac-related, whereas stroke and bleeding represented only a small subset of deaths. Interventions beyond anticoagulation are needed to further reduce mortality in AF.

Evolución temporal de la incidencia por incapacidad temporal de origen común según tramos de duración (2009-2018) / Time series of non-work related sickness absence incidence by subgroups of duration (2009-2018)

OBJETIVO: Describir la evolución temporal (2009-2018) de la incidencia de la incapacidad temporal por contingencia común (ITCC) según tramos de duración en España. MÉTODOS: Se consideraron casos de ITCC de la población afiliada de una mutua laboral. Se obtuvo la incidencia global de la incapacidad temporal por ITCC y por tramos de duración. Se realizó un estudio ecológico de series temporales considerando un punto de inflexión en 2013. Se calculó el porcentaje de cambio anual e intervalo de confianza del 95%. Los análisis se estratificaron por edad y sexo. RESULTADOS: La incidencia global pasó de 35,3 casos por cada 100 trabajadores-año en 2009 a 25,2 en 2013. A partir del 2014 se observa un ascenso sostenido de la incidencia de ITCC, finalizando el 2018 con 34,1 casos por cada 100 trabajadores-año. La incidencia global está determinada fundamentalmente por procesos menores a 16 días en población joven. El descenso en 2009-2013 se produjo en todos los tramos de duración, en especial en 4 a 15 (PCA = -11,2; IC 95% = (-14,1 a -8,2)) y más de 90 días (PCA = -9,4; IC 95% = (-15,5 a -2,8)), principalmente en jóvenes. El ascenso en 2013-2018 se observó en todos los tramos, siendo el incremento más significativo en tramos de 1-3 días (trabajadores de menor edad: PCA = 18,9; IC 95% = (14,8 a 23,2)) y en más de 90 días (principalmente en mayores). CONCLUSIONES: La descripción temporal de la incidencia de ITCC por tramos de duración ofrece una información detallada de la incapacidad temporal

OBJECTIVE: We describe time trend incidence (2009-2018) of non-work related Sickness Absence (SA) segmented by duration of episodes in Spain. METHODS: We used SA cases from a health insurance company ("mutua") in Spain. Overall non-work related SA incidence and incidence by duration of episodes (1-3 days, 4-15 days, 16-30 days, 31-90 days and> 90 days) were obtained. A time series ecological study was carried out with an inflection point in 2013. The annual percentage of change and 95% confidence interval were obtained. The analyses were stratified by age and sex. RESULTS: Overall incidence went from 35.3 cases per 100 workers-years in 2009 to 25.2 in 2013. From 2014, there is a sustained rise in the incidence of ITCC, ending 2018 with 34.1 cases per 100 workers-years. The overall incidence is determined mainly by processes less than 16 days in young population. The decrease in 2009-2013 occurred in all the duration segments, especially in 4 to 15 (APC = -11,2; 95% CI = (-14,1 a -8,2)) and more than 90 days (APC = -9,4; 95% CI = (-15,5 a -2,8)), mainly in young people. The rise in 2013-2018 was observed in all the segments, with the largest significant increase in sections of 1-3 days (younger workers: APC = 18,9; 95% CI = (14,8 a 23,2)) and in more than 90 days (mainly in older ones). Time trend of SA showed similar pattern in both sexes. CONCLUSIONS:Time trend analysis of SA incidence by duration segments offers a detailed information of SA. These results are useful for professionals in the prevention and management of SA

[ENDOSCOPIC TREATMENT OF UPPER GASTROINTESTINAL BLEEDINGCAUSED BY PEPTIC ULCER] / Tratamiento endoscópico del sangramientodigestivo alto (S.D.A) por úlcera péptica.

Upper digestive bleeding (UDB) owing to peptic ulcer, 52 Forrest I and 116 Forrest II, was studied prospectively in 168 patients. Therapeutic endoscopy was performed to those patients at the Endoscopic Surgery Center of the "General Calixto Garcia" Hospital during a period of 13 months, beginning on December, 1995. Different hemostatic methods, chosen at random, were used for determining their efficacy in bleeding control and therefore, reducing lethality, mortality, hospitalization time and others. Chi-square and f-Fischer tests were applied through the STATGRAPHICS 4,0 package for statistical analysis. Immediate hemostatic efficacy was obtained in 97,8%, not existing significant statistical differences between the methods used for bleeding control. Recurrent hemorrhage ocurred in 13,1%. Mean hospitalization time was 7,19 days and the most frequent hospitalization time (mode) was just 3 days. The average amount of blood units transfused was 2,87. Surgery was required by 9,5% of patients and just 2,9% were urgent cases due to hemorrhage. Lethality owing to bleeding was 1,8%, and mortality was 0,23%. This experimental group was compared with a historic control group composed of 404 patients who received conventional treatment for UDB owing to peptic ulcer from 1991 to 1993 in Militar Hospital "Carlos J. Finlay". Mean hospitalización time blood units transfused was 5,9 (according to the medical information available for this kind of treatment). Surgery was required by 27,2% of patients. Lethality was 9,9% and mortality was 1.5%. Comparing results obtained in both groups through statistial methods, the abatement of mortality, lethality, mean hospitalization time, transfused blood consumption, and emergency surgeries due to hemorrhage is highly significant.

[INTRAGASTRIC MIGRATION OF CLIPS. A NEW COMPLICATIONOF LAPAROSCOPIC VAGOTOMY] / Migración Intragástrica declips.Una nueva complicación de la Vagotomía Laparoscópica.

Since 1989, when Kathdouda, M. D. and Mouiel, M. D. performed a laparoscopic vagotomy following the Taylor technique, there have been several reports of duodenal peptic ulcer laparoscopic treatment through different methods of vagotomy, from the trouncular to the supraselective or any of their varieties, as Taylor and Hill-Baker procedures. With the appearance of this new form of surgery, new complications are expected. This study reports the intragastrical migration of clips as a complication not yet reported. The possible etiopathogenic factors that could have influenced the appearance of such complication, are here discussed.

Subclavicular pectoralis major myocutaneous flap for optimal reconstruction of large orbitozygomatic defects: a case report.

Since the introduction of microvascular free flaps, the pectoralis major myocutaneous flap (PMMF) has been relegated to background for most reconstructive surgeons. The objective of this article is to show the advantages of cervicofacial defects reconstruction with PMMF using the subclavicular plane route in a challenging clinical case. An 83-year-old man presented with cutaneous temporomalar lesion with orbital spread. Tumor resection was performed, including 12 × 11 cm skin and subcutaneous tissue, overlying zygomatic and malar bone, and orbital exenteration. Radical parotidectomy and functional neck dissection were performed. PMMF was chosen as reconstructive option routing the pedicle to the subclavicular plane. The length of the pedicle was 31 cm. The subclavicular route for PMMF increases the flap's length and arc of rotation compared with the conventional supraclavicular one. This procedure decreases the bulk of the PMMF pedicle which makes it functionally and cosmetically favorable. By using this modification, we may widen the "safe" reconstructive possibilities.

Relación entre las tasas de desempleo y los indicadores de absentismo por incapacidad temporal durante periodos de crisis económica / The relationship between unemployement rates adn lost work tiem due to sickness absence in an economic recession

Introducción: Estudios realizados en varios países presentan una relación inversa entre las tasas de desempleo (TD) y los indicadores de absentismo por incapacidad temporal (IT) durante periodos de crisis económica. Objetivo: Evaluar la relación entre indicadores de absentismo y el desempleo en España (2009-2015). Métodos: Se obtuvieron tasas de incidencia (TI) y absentismo (TA) por IT de origen común (ITcc) a partir de datos de la Seguridad Social, así como las TD según datos del Instituto Nacional de Estadística. Se describió gráficamente la evolución temporal de los indicadores de ITcc y el desempleo en el periodo 2009-2015. Para explorar dicha relación también se realizaron gráficos de dispersión de los indicadores frente a las TD. Posteriormente, se ajustaron modelos de regresión lineal simple. Resultados: Las TI y TA descienden en 2009-2013 (TI 2009=28,07%, TI 2013=20,41%, TA 2009=2,53%, TA 2013=1,86%) momento en que cambia su tendencia, iniciando una fase ascendente hasta 2015 (TI 2015=22,52%, TA 2015=2,12%). La TD asciende en 2009-2013 (TD 2009=17,86%, TD 2013=26,10%), pasando a descender hasta 2015 (TD 2015=22,06%). Las TD y los indicadores de absentismo presentan una relación lineal inversa. Conclusiones: Se observó una relación inversa entre el desempleo y los indicadores de absentismo en España. Son necesarios estudios específicos para poder evaluar hipótesis explicativas como las asociadas a los efectos de disciplina, selección y/o cambios en la fuerza de trabajo

Introduction: Different countries have shown an inverse relationship between unemployment rates (UR) and indicators of sickness absence during periods of economic recession. Objective: To evaluate the relationship between indicators of sickness absence and unemployment in Spain during 2009-2015. Methods: We obtained incidence and absenteeism rates of non-work related sickness absence (NWSA) from Social Security data, and UR from the National Institute of Statistics. The relationship between indicators of NWSA and UR in the period 2009 to 2015 was graphically described using time trend plots. Scatter plots of NWSA indicators were also made against UR. Finally, we fitted linear regression models. Results: Incidence (IR) and absenteeism rates (AR) of NWSA showed downward trends in 2009-2013 (IR 2009=28.07%, IR 2013=20.41%; AR 2009=2.53% and AR 2013=1.86%), changing to an upward trend up to 2015 (IR 2015=22.52%, AR 2015=2.12%). Unemployment rates trended upward in 2009-2013 (UR 2009=17.86%, UR 2013=26.10%), and then changed to a downward trend through 2015 (UR 2015=22.06%). There was an inverse relationship between UR and NWSA indicators. Conclusions: As in previous international studies, we found an inverse relationship between unemployment rates and indicators of sickness absence in Spain. More detailed studies are needed to evaluate explanatory hypotheses, such as those associated with the effects of discipline, selection and/or changes in the workforce