Shedding Light on the Origin of

Asymptotic giant branch stars are responsible for the production of most of the heavy isotopes beyond Sr observed in the solar system. Among them, isotopes shielded from the r-process contribution by their stable isobars are defined as s-only nuclei. For a long time the abundance of ^{204}Pb, the heaviest s-only isotope, has been a topic of debate because state-of-the-art stellar models appeared to systematically underestimate its solar abundance. Besides the impact of uncertainties from stellar models and galactic chemical evolution simulations, this discrepancy was further obscured by rather divergent theoretical estimates for the neutron capture cross section of its radioactive precursor in the neutron-capture flow, ^{204}Tl (t_{1/2}=3.78 yr), and by the lack of experimental data on this reaction. We present the first ever neutron capture measurement on ^{204}Tl, conducted at the CERN neutron time-of-flight facility n_TOF, employing a sample of only 9 mg of ^{204}Tl produced at the Institute Laue Langevin high flux reactor. By complementing our new results with semiempirical calculations we obtained, at the s-process temperatures of kT≈8 keV and kT≈30 keV, Maxwellian-averaged cross sections (MACS) of 580(168) mb and 260(90) mb, respectively. These figures are about 3% lower and 20% higher than the corresponding values widely used in astrophysical calculations, which were based only on theoretical calculations. By using the new ^{204}Tl MACS, the uncertainty arising from the ^{204}Tl(n,γ) cross section on the s-process abundance of ^{204}Pb has been reduced from ∼30% down to +8%/-6%, and the s-process calculations are in agreement with the latest solar system abundance of ^{204}Pb reported by K. Lodders in 2021.

Measurement of the

^{140}Ce(n,γ) is a key reaction for slow neutron-capture (s-process) nucleosynthesis due to being a bottleneck in the reaction flow. For this reason, it was measured with high accuracy (uncertainty ≈5%) at the n_TOF facility, with an unprecedented combination of a high purity sample and low neutron-sensitivity detectors. The measured Maxwellian averaged cross section is up to 40% higher than previously accepted values. Stellar model calculations indicate a reduction around 20% of the s-process contribution to the Galactic cerium abundance and smaller sizeable differences for most of the heavier elements. No variations are found in the nucleosynthesis from massive stars.

Management of peri-surgical anemia in elective surgery. Conclusions and recommendations according to Delphi-UCLA methodology.

INTRODUCTION: Preoperative anemia affects approximately one third of surgical patients. It increases the risk of blood transfusion and influences short- and medium-term functional outcomes, increases comorbidities, complications and costs. The "Patient Blood Management" (PBM) programs, for integrated and multidisciplinary management of patients, are considered as paradigms of quality care and have as one of the fundamental objectives to correct perioperative anemia. PBM has been incorporated into the schemes for intensified recovery of surgical patients: the recent Enhanced Recovery After Surgery 2021 pathway (in Spanish RICA 2021) includes almost 30 indirect recommendations for PBM. OBJECTIVE: To make a consensus document with RAND/UCLA Delphi methodology to increase the penetration and priority of the RICA 2021 recommendations on PBM in daily clinical practice. MATERIAL AND METHODS: A coordinating group composed of 6 specialists from Hematology-Hemotherapy, Anesthesiology and Internal Medicine with expertise in anemia and PBM was formed. A survey was elaborated using Delphi RAND/UCLA methodology to reach a consensus on the key areas and priority professional actions to be developed at the present time to improve the management of perioperative anemia. The survey questions were extracted from the PBM recommendations contained in the RICA 2021 pathway. The development of the electronic survey (Google Platform) and the management of the responses was the responsibility of an expert in quality of care and clinical safety. Participants were selected by invitation from speakers at AWGE-GIEMSA scientific meetings and national representatives of PBM-related working groups (Seville Document, SEDAR HTF section and RICA 2021 pathway participants). In the first round of the survey, the anonymized online questionnaire had 28 questions: 20 of them were about PBM concepts included in ERAS guidelines (2 about general PBM organization, 10 on diagnosis and treatment of preoperative anemia, 3 on management of postoperative anemia, 5 on transfusion criteria) and 8 on pending aspects of research. Responses were organized according to a 10-point Likter scale (0: strongly disagree to 10: strongly agree). Any additional contributions that the participants considered appropriate were allowed. They were considered consensual because all the questions obtained an average score of more than 9 points, except one (question 14). The second round of the survey consisted of 37 questions, resulting from the reformulation of the questions of the first round and the incorporation of the participants' comments. It consisted of 2 questions about general organization of PBM programme, 15 questions on the diagnosis and treatment of preoperative anemia; 3 on the management of postoperative anemia, 6 on transfusional criteria and finally 11 questions on aspects pending od future investigations. Statistical treatment: tabulation of mean, median and interquartiles 25-75 of the value of each survey question (Tables 1, 2 and 3). RESULTS: Except for one, all the recommendations were accepted. Except for three, all above 8, and most with an average score of 9 or higher. They are grouped into: 1.- "It is important and necessary to detect and etiologically diagnose any preoperative anemia state in ALL patients who are candidates for surgical procedures with potential bleeding risk, including pregnant patients". 2.- "The preoperative treatment of anemia should be initiated sufficiently in advance and with all the necessary hematinic contributions to correct this condition". 3.- "There is NO justification for transfusing any unit of packed red blood cells preoperatively in stable patients with moderate anemia Hb 8-10g/dL who are candidates for potentially bleeding surgery that cannot be delayed." 4.- "It is recommended to universalize restrictive criteria for red blood cell transfusion in surgical and obstetric patients." 5.- "Postoperative anemia should be treated to improve postoperative results and accelerate postoperative recovery in the short and medium term". CONCLUSIONS: There was a large consensus, with maximum acceptance,strong level of evidence and high recommendation in most of the questions asked. Our work helps to identify initiatives and performances who can be suitables for the implementation of PBM programs at each hospital and for all patients.

Aporte de los inmigrantes a la tuberculosis en un Servicio de Salud de Chile / Contribution of immigrants to tuberculosis in a Health Service in Chile

La evaluación del Programa de Control de la Tuberculosis de Chile muestra un creciente aumento de casos de tuberculosis en pacientes extranjeros en las comunas de Santiago de mayor incidencia de esta enfermedad. Mediante la evaluación de los casos diagnosticados durante una década se comprobó un creciente aporte de casos de tuberculosis en el grupo de inmigrantes, desde cerca de 10% el año 2005 hasta cerca de 30% en 2014. La mayor proporción de casos de extranjeros ocurre en la comuna de mayor incidencia (Santiago), con cifras iniciales de 17% el año 2005, llegando a 29% en 2015. La eficacia del tratamiento en los inmigrantes (87,6%) está cerca de la meta nacional (90%) y es mejor que la de los chilenos (81,5%). Encontramos una proporción mayor de casos extranjeros que abandonan la terapia (11%) en relación a los chilenos (7,7%), pero la letalidad en extranjeros es menor (1,5%) que la de los chilenos (10,6%). Se deberán reforzar las estrategias de control de tuberculosis, focalizadas en la población extranjera.

The assessment of Chilean Tuberculosis Control Program shows a growing increase of tuberculosis cases in foreign patients in communes of the city of Santiago with higher incidence of this disease. Through the evaluation of the cases diagnosed in a decade we found an increasing contribution of foreigners, ranging from about 10% in 2005 to 30% in 2014. The greatest proportion of tuberculosis cases in foreigners was detected in Santiago, the commune with the highest incidence. In this area, tuberculosis incidence ranged from 17% in 2005, to 29% in 2015. Treatment efficiency in foreigners (87.6%) is close to our national goal (90%) and better than in Chilean patients (81.5%). We found a higher proportion of foreign cases defaulting therapy (11%) in relation to Chilean (7.7%), but the death rate in foreigners was less than in Chileans (1.5 versus 10.6%). We must strengthen tuberculosis control strategies focused on foreigner populations.

Aporte de los inmigrantes a la tuberculosis en un Servicio de Salud de Chile / Contribution of immigrants to tuberculosis in a Health Service in Chile

The assessment of Chilean Tuberculosis Control Program shows a growing increase of tuberculosis cases in foreign patients in communes of the city of Santiago with higher incidence of this disease. Through the evaluation of the cases diagnosed in a decade we found an increasing contribution of foreigners, ranging from about 10% in 2005 to 30% in 2014. The greatest proportion of tuberculosis cases in foreigners was detected in Santiago, the commune with the highest incidence. In this area, tuberculosis incidence ranged from 17% in 2005, to 29% in 2015. Treatment efficiency in foreigners (87.6%) is close to our national goal (90%) and better than in Chilean patients (81.5%). We found a higher proportion of foreign cases defaulting therapy (11%) in relation to Chilean (7.7%), but the death rate in foreigners was less than in Chileans (1.5 versus 10.6%). We must strengthen tuberculosis control strategies focused on foreigner populations.

La evaluación del Programa de Control de la Tuberculosis de Chile muestra un creciente aumento de casos de tuberculosis en pacientes extranjeros en las comunas de Santiago de mayor incidencia de esta enfermedad. Mediante la evaluación de los casos diagnosticados durante una década se comprobó un creciente aporte de casos de tuberculosis en el grupo de inmigrantes, desde cerca de 10% el año 2005 hasta cerca de 30% en 2014. La mayor proporción de casos de extranjeros ocurre en la comuna de mayor incidencia (Santiago), con cifras iniciales de 17% el año 2005, llegando a 29% en 2015. La eficacia del tratamiento en los inmigrantes (87,6%) está cerca de la meta nacional (90%) y es mejor que la de los chilenos (81,5%). Encontramos una proporción mayor de casos extranjeros que abandonan la terapia (11%) en relación a los chilenos (7,7%), pero la letalidad en extranjeros es menor (1,5%) que la de los chilenos (10,6%). Se deberán reforzar las estrategias de control de tuberculosis, focalizadas en la población extranjera.

Atresia esofágica, análisis y seguimiento / Esophageal atresia: analysis and follow-up

Se presenta la evolución y seguimiento de 54 niños con atresia esofágica tratados en la Unidad de Recién Nacidos Patológicos del Hospital Luis Calvo Mackenna, analizando la muestra según la presencia (grupo A) o ausencia (grupo B) de fístula traqueoesofágica. Los niños con atresia esofágica y fístula traqueoesofágica (grupo A) se subdividen en: grupo A1, peso de nacimiento mayor a 1.500 g y sin malformaciones asociadas; grupo B, recién nacidos con atresia esofágica y sin fístula traqueoesofágica. El grupo A1 está formado por 28 recién nacidos con 100 por ciento de sobrevida. El promedio de hospitalización fue 20,7 días cuando la corrección quirúrgica se efectuó en un tiempo. En el seguimiento, los problemas más frecuentes fueron reflujo gastroesofágico (62,5 por ciento), estenosis esofágica (30,4 por ciento), incoordinación en la deglución (26 por ciento). El 36,3 por ciento está sano. El grupo A2 está formado por 21 recién nacidos con una mortalidad en el período neonatal de 33,3 por ciento y durante el primer año de vida de 57,1 por ciento. Las malformaciones asociadas más frecuentes fueron cardiológicas, anorrectal y urológicas. Siete niños están en seguimiento, tres sin patología. El grupo B está formado por cinco niños, dos con trisomía 21, uno con hidrocefalia y dos sin malformaciones asociadas. La solución de la atresia esofágica es larga y difícil. Se concluye que la mortalidad está dada por las malformaciones asociadas y la evolución posterior no está exenta de problemas