Context-Based e2e Autonomous Operation in B5G Networks.

The research and innovation related to fifth-generation (5G) networks that has been carried out in recent years has decided on the fundamentals of the smart slice in radio access networks (RANs), as well as the autonomous fixed network operation. One of the most challenging objectives of beyond 5G (B5G) and sixth-generation (6G) networks is the deployment of mechanisms that enable smart end-to-end (e2e) network operation, which is required for the achievement of the stringent service requirements of the envisioned use cases to be supported in the short term. Therefore, smart actions, such as dynamic capacity allocation, flexible functional split, and dynamic slice management need to be performed in tight coordination with the autonomous capacity management of the fixed transport network infrastructure. Otherwise, the benefits of smart slice operation (i.e., cost and energy savings while ensuring per-slice service requirements) might be cancelled due to uncoordinated autonomous fixed network operation. Notably, the transport network in charge of supporting slices from the user equipment (UE) to the core expands across access and metro fixed networks. The required coordination needs to be performed while keeping the privacy of the radio and fixed network domains, which is important in multi-tenant scenarios where both network segments are managed by different operators. In this paper, we propose a novel approach that explores the concept of context-aware network operation, where the slice control anticipates the aggregated and anonymized information of the expected slice operation that is sent to the fixed network orchestrator in an asynchronous way. The context is then used as the input for the artificial intelligence (AI)-based models used by the fixed network control for the predictive capacity management of optical connections in support of RAN slices. This context-aware network operation aims at enabling accurate and reliable autonomous fixed network operation under extremely dynamic traffic originated by smart RAN operation. The exhaustive numerical results show that slice context availability improves the benchmarking fixed network predictive methods (90% reduction in prediction maximum error) remarkably in the foreseen B5G scenarios, for both access and metro segments and in heterogeneous service demand scenarios. Moreover, context-aware network operation enables robust and efficient operation of optical networks in support of dense RAN cells (>32 base stations per cell), while the benchmarking methods fail to guarantee different operational objectives.

Electrochemical and Spectroscopic Studies Performed for Indomethacin and 1-Naphthol Incorporated in 1-Butyl-3-methyl-imidazolium Bis(2-ethylhexyl) Sulfosuccinate Vesicles to Investigate Them as a Potentially pH-Sensitive Nanocarrier.

Characterization studies of 1-butyl-3-methyl-imidazolium bis(2-ethylhexyl) sulfosuccinate vesicles at different pH values have been carried out by using liquid surface tension, transmission electron microscopy, and dynamic light scattering. The results show that there are no vesicle changes in its size and negative Z potential at pH 3, 6, and 10. Furthermore, indomethacin and 1-naphthol, both pH-dependent, electroactive, and fluorescence probes, were used to further characterize the bilayer employing electrochemical and emission techniques. The partition of indomethacin and 1-naphthol between the water and bilayer pseudophases only occurs for the neutral species and does not happen for the anionic species because the highly negative Z bilayer potential prevents incorporation due to negative repulsion. For the neutral species, the partition constant values were evaluated by square wave voltammetry and emission spectroscopy. Finally, for the indomethacin incorporated into the vesicle bilayer at pH 3, the release profile was monitored over time at pH 6. It was found that a change in the pH values causes the complete release of indomethacin after 25 min, which led us to think that the vesicles presented in this work can be used as a pH-sensitive nanocarrier for neutral pH-sensitive drugs.

Investigating Imperfect Cloning for Extending Quantum Communication Capabilities.

Quantum computing allows the implementation of powerful algorithms with enormous computing capabilities and promises a secure quantum Internet. Despite the advantages brought by quantum communication, certain communication paradigms are impossible or cannot be completely implemented due to the no-cloning theorem. Qubit retransmission for reliable communications and point-to-multipoint quantum communication (QP2MP) are among them. In this paper, we investigate whether a Universal Quantum Copying Machine (UQCM) generating imperfect copies of qubits can help. Specifically, we propose the Quantum Automatic Repeat Request (QARQ) protocol, which is based on its classical variant, as well as to perform QP2MP communication using imperfect clones. Note that the availability of these protocols might foster the development of new distributed quantum computing applications. As current quantum devices are noisy and they decohere qubits, we analyze these two protocols under the presence of various sources of noise. Three major quantum technologies are studied for these protocols: direct transmission (DT), teleportation (TP), and telecloning (TC). The Nitrogen-Vacancy (NV) center platform is used to create simulation models. Results show that TC outperforms TP and DT in terms of fidelity in both QARQ and QP2MP, although it is the most complex one in terms of quantum cost. A numerical study shows that the QARQ protocol significantly improves qubit recovery and that creating more clones does not always improve qubit recovery.

Supporting Heterogenous Traffic on Top of Point-to-Multipoint Light-Trees.

New 5 G and beyond services demand innovative solutions in optical transport to increase efficiency and flexibility and reduce capital (CAPEX) and operational (OPEX) expenditures to support heterogeneous and dynamic traffic. In this context, optical point-to-multipoint (P2MP) connectivity is seen as an alternative to provide connectivity to multiple sites from a single source, thus potentially both reducing CAPEX and OPEX. Digital subcarrier multiplexing (DSCM) has been shown as a feasible candidate for optical P2MP in view of its ability to generate multiple subcarriers (SC) in the frequency domain that can be used to serve several destinations. This paper proposes a different technology, named optical constellation slicing (OCS), that enables a source to communicate with multiple destinations by focusing on the time domain. OCS is described in detail and compared to DSCM by simulation, where the results show that both OCS and DSCM provide a good performance in terms of the bit error rate (BER) for access/metro applications. An exhaustive quantitative study is afterwards carried out to compare OCS and DSCM considering its support to dynamic packet layer P2P traffic only and mixed P2P and P2MP traffic; throughput, efficiency, and cost are used here as the metrics. As a baseline for comparison, the traditional optical P2P solution is also considered in this study. Numerical results show that OCS and DSCM provide a better efficiency and cost savings than traditional optical P2P connectivity. For P2P only traffic, OCS and DSCM are utmost 14.6% more efficient than the traditional lightpath solution, whereas for heterogeneous P2P + P2MP traffic, a 25% efficiency improvement is achieved, making OCS 12% more efficient than DSCM. Interestingly, the results show that for P2P only traffic, DSCM provides more savings of up to 12% than OCS, whereas for heterogeneous traffic, OCS can save up to 24.6% more than DSCM.

Ten-year prevalence of rhegmatogenous retinal detachment in myopic eyes after posterior chamber phakic implantable collamer lens.

PURPOSE: To determine and compare the prevalence of rhegmatogenous retinal detachment (RRD) in myopic eyes operated of posterior chamber phakic implantable collamer lens (ICL) with a control group of nonoperated myopic eyes over 10 years of follow-up. SETTING: Clinica Baviera, Madrid, Spain. DESIGN: Retrospective cohort study. METHODS: There were 2 study cohorts: one with patients operated with ICL and a control group of nonoperated patients. The primary outcome of RRD was measured retrospectively, first through chart review of ICL-operated patients with at least 10 years of follow-up, then secondarily through telephone questionnaires and specialist verification for those with incomplete follow-up. Prevalence and incidence were calculated and compared, as well as their possible association with other risk factors. RESULTS: 58 operated patients completed follow-up in our clinic. A survey of 3849 more patients was conducted for a total of 252 operated with a mean spherical equivalent (SEQ) of -12.6 diopters (D) and 221 nonoperated with a mean SEQ of -10.5 D. 7 eyes developed an RRD in the operated vs 5 eyes among the nonoperated (prevalence 1.71% vs 1.25%, respectively, P = .773). The equivalence tests, the two one-sided test and the null hypothesis test between groups, were within the 0.02 limits, confirming the null hypothesis, and compared survival curves did not show significant differences ( P = .59). CONCLUSIONS: ICL implantation surgery for high myopia did not affect the prevalence of RRD in operated eyes compared with similar nonoperated eyes, in this long-term study.

Deep Learning-Based Adaptive Compression and Anomaly Detection for Smart B5G Use Cases Operation.

The evolution towards next-generation Beyond 5G (B5G) networks will require not only innovation in transport technologies but also the adoption of smarter, more efficient operations of the use cases that are foreseen to be the high consumers of network resources in the next decades. Among different B5G use cases, the Digital Twin (DT) has been identified as a key high bandwidth-demanding use case. The creation and operation of a DT require the continuous collection of an enormous and widely distributed amount of sensor telemetry data which can overwhelm the transport layer. Therefore, the reduction in such transported telemetry data is an essential objective of smart use case operation. Moreover, deep telemetry data analysis, i.e., anomaly detection, can be executed in a hierarchical way to reduce the processing needed to perform such analysis in a centralized way. In this paper, we propose a smart management system consisting of a hierarchical architecture for telemetry sensor data analysis using deep autoencoders (AEs). The system contains AE-based methods for the adaptive compression of telemetry time series data using pools of AEs (called AAC), as well as for anomaly detection in single (called SS-AD) and multiple (called MS-AGD) sensor streams. Numerical results using experimental telemetry data show compression ratios of up to 64% with reconstruction errors of less than 1%, clearly improving upon the benchmark state-of-the-art methods. In addition, fast and accurate anomaly detection is demonstrated for both single and multiple-sensor scenarios. Finally, a great reduction in transport network capacity resources of 50% and more is obtained by smart use case operation for distributed DT scenarios.

Accurate Low Complex Modulation Format and Symbol Rate Identification for Autonomous Lightpath Operation.

Network automation promises to reduce costs while guaranteeing the required performance; this is paramount when dealing with the forecasted highly dynamic traffic that will be generated by new 5G/6G applications. In optical networks, autonomous lightpath operation entails that the optical receiver can identify the configuration of a received optical signal without necessarily being configured from the network controller. This provides relief for the network controller from real-time operation, and it can simplify the operation in multi-domain scenarios, where an optical connection spans across more than one domain. Consequently, in this work, we propose a blind and low complex modulation format (MF) and symbol rate (SR) identification algorithm. The algorithm is based on studying the effects of decoding an optical signal with different MFs and SRs. Extensive MATLAB-based simulations have been carried out which consider a coherent wavelength division multiplexed system based on 32 and 64 quadrature amplitude modulated signals at up to 96 GBd, thus enabling bit rates of up to 800 Gb/s/channel. The results show remarkable identification accuracy in the presence of linear and nonlinear noise for a wide range of feasible configurations.

HRpI System Based on Wavenet Controller with Human Cooperative-in-the-Loop for Neurorehabilitation Purposes.

There exist several methods aimed at human-robot physical interaction (HRpI) to provide physical therapy in patients. The use of haptics has become an option to display forces along a given path so as to it guides the physiotherapist protocol. Critical in this regard is the motion control for haptic guidance to convey the specifications of the clinical protocol. Given the inherent patient variability, a conclusive demand of these HRpI methods is the need to modify online its response with neither rejecting nor neglecting interaction forces but to process them as patient interaction. In this paper, considering the nonlinear dynamics of the robot interacting bilaterally with a patient, we propose a novel adaptive control to guarantee stable haptic guidance by processing the causality of patient interaction forces, despite unknown robot dynamics and uncertainties. The controller implements radial basis neural network with daughter RASP1 wavelets activation function to identify the coupled interaction dynamics. For an efficient online implementation, an output infinite impulse response filter prunes negligible signals and nodes to deal with overparametrization. This contributes to adapt online the feedback gains of a globally stable discrete PID regulator to yield stiffness control, so the user is guided within a perceptual force field. Effectiveness of the proposed method is verified in real-time bimanual human-in-the-loop experiments.

Expert Panel Consensus for Addressing Anti-VEGF Treatment Challenges of Diabetic Macular Edema in Spain.

Purpose: The treatment of diabetic macular edema (DME) has evolved rapidly in the past decade, highlighting the need to address the challenges of routine clinical practice decision-making through expert consensus agreements. Methods: After a literature review and discussion of real-world experience on DME management, a group of ten retina specialists agreed on a consensus of recommendations for the most appropriate management of DME patients using vascular endothelial growth factor inhibitors (anti-VEGF) in Spain. Results: The panel recommended early treatment initiation in DME patients with worse baseline visual acuity (VA) to maintain or improve outcome. For patients with good VA, an observation strategy was recommended, considering the presence of diabetic retinopathy, optical coherence tomography biomarkers, and impact on patient's quality of life. Based on the available evidence and clinical experience, the panel recommended the use of anti-VEGF intensive loading doses with the objective of achieving anatomic and visual responses as soon as possible, followed by a Treat & Extend (T&E) strategy to maintain VA improvement. Aflibercept was recommended for patients with a baseline decimal VA <0.5, followed by a T&E strategy, including the possibility to extend frequency of injections up to 16 weeks. Conclusion: An expert panel proposes a consensus for the management of DME in Spain. Early treatment initiation with anti-VEGF in DME patients is recommended to maintain or improve VA; aflibercept is recommended for patients with a poor baseline VA.

Validez diagnóstica de cinco escalas de predicción clínica para la trombosis venosa profunda (TVP)

Introducción: la trombosis venosa profunda (TVP) es una entidad común que afecta principalmente el sistema venoso profundo de los miembros inferiores, para el cual se han desarrollado múltiples escalas de predicción clínica, las cuales han sido construidas y validadas en pacientes ambulatorios y hospitalizados. Objetivos: validar cinco escalas de predicción clínica para TVP en pacientes atendidos en un centro de tercer nivel en la sabana de Bogotá, Colombia. Métodos: se llevó a cabo un estudio de corte transversal con análisis de prueba diagnóstica en sujetos con sospecha de TVP, incluyendo aquellos que contaran con la realización de ecografía Doppler venosa de miembros inferiores. Se calculó el rendimiento de cinco escalas de predicción clínica para TVP (Wells clásico y modificado, Oudega, CEBI y Constans) para pacientes ambulatorios u hospitalizados, individualizando la población en la que fueron validadas. Resultados: ingresaron al análisis 974 pacientes, de estos 485 (49,7 %) presentaron TVP. La escala de Constans tuvo un mejor rendimiento diagnóstico entre los pacientes hospitalizados y ambulatorios, con un área bajo la curva ROC de 0,73 (95 % 0,70-0,78) al compararla con Wells clásico, Wells modificado, Oudega y CEBI. Al comparar el rendimiento de Constans en ambos grupos de pacientes por separado, también se observó un mejor rendimiento con respecto a las demás escalas. Conclusión: la escala de Constans presenta un mejor rendimiento diagnóstico comparado con las demás escalas al ser aplicada en paciente hospitalizados y ambulatorios.

Summary Introduction: The deep vein thrombosis (DVT) is a common entity that mainly affects the deep venous system of the lower limbs, for which multiple clinical prediction scales have been developed, which have been constructed and validated in outpatients and inpatients. Objetives: We aimed to validated five clinical prediction scores for the diagnosis of lower limb DVT in patients from La Sabana de Bogota, Colombia. Methods: A cross-sectional study with analysis of a diagnostic test was carried out in patiens with suspected deep vein thrombosis, including those who had venous Doppler ultrasound of the lower limbs for suspected DVT. The performance of five clinical prediction scales for DVT (classic and modified Wells, Oudega, CEBI and Constans) for outpatients and inpatients was calculated in those scores who are validated in both populations and only in ambulatory or hospitalized patients for those that are specific scores. Results: Nine hundred seventy-four patients were entered into the analysis, of which 485 (49.7%) presented DVT. The Constans scale had a better diagnostic performance among inpatients and outpatients with an area under the ROC curve of 0.73 (95% 0.70-0.78) when compared with classic Wells, modified Wells, Oudega and CEBI. When we compared Constans performance in both groups of patients separately, we observed better performance with respect to the other scores. Conclusion: The Constans scale presents a better diagnostic performance compared to the other scales when applied to inpatients and outpatients.

Characteristics, as a shield against ionizing photons, of concrete blocks used in the construction industry.

INEGI reports that 81% of new constructions are built with durable materials, such as concrete blocks, including rooms where ionizing radiation is used, such as clinics and hospitals. The volume ratios used in the manufacture of concrete blocks have a 1: 5: 2 ratio of: portland cement, sand and crushed gravel. The percentage mass content of each atom in the sample is obtained with the energy-dispersed X-ray fluorescence, these results are used to calculate the characteristics such as shielding of the concrete blocks, which have been partially reported, in this work several characteristics are presented for photons from 1 keV to 100 GeV, such as linear attenuation coefficients, the hemireductive layer, the effective, atomic and electronic sections, the effective atomic number (Zef). The exposure of accumulation and energy absorption factors (EBF, EABF) of 0.5-40 mfp are reported, using the Photon Shielding and Dosimetry (PSD) software. These characteristics are compared to those of NBS concrete. The concrete blocks have an attenuation capacity for energies used in radiological equipment such as mammography, 20-35 keV; dental, 50-90 keV and for conventional radiography equipment, 70-150 keV, so the block and lightened concrete block must be considered in the calculations of primary and secondary shielding walls.

Radiation shielding and dosimetric parameters of mexican artisanal bricks.

In this work, were determined some radiation shielding and dosimetric parameters of three types of bricks for photons energy from 1 keV to 100 GeV photons using the Phy-X/PSD software, and for comparison also has been calculated the same parameters for NBS concrete. The parameters calculated are the linear attenuation coefficients (LAC), effective atomic numbers (Zeff), half value layers (HVL), the energy absorption buildup factors (EABF) and the exposure buildup factors (EBF), as well as the coefficients to use the geometric progression (G-P) fitting method. Obtained results show that the three types of bricks can be used safely for the design of medical facilities housing mammography units (less than 30 keV).

First-in-human experience of preload regulation with percutaneous transluminal caval flow regulation in heart failure with reduced ejection fraction patients.

AIMS: This study aims to investigate the acute haemodynamic effects of percutaneous transluminal flow regulation (PTCR®) with an inferior vena cava regulator balloon in heart failure patients. Preload reduction in heart failure has been achieved with high potency diuretics. However, no study has been conducted in humans to assess the effect of inferior vena cava intermittent occlusion for preload reduction. METHODS AND RESULTS: Six patients were included in the study: four men (55 ± 6 years old) and two women (63 ± 4 years old). Baseline evaluations included Doppler echocardiogram, coronary angiogram, and right heart catheterization. Caval balloon was kept inflated for 30 min, and right catheterization and control echocardiogram were performed while the balloon was still inflated. The balloon was then deflated and removed. Right haemodynamic variables were evaluated before balloon insertion and with the inflated balloon. The mean right atrial pressure decreased by 42.59% (P = 0.005); systolic right ventricular pressure decreased by 30.19% (P < 0.003); mean pulmonary arterial pressure decreased by 25.33% (P < 0.043); mean pulmonary capillary wedge pressure decreased by 31.37% (P > 0.016); and cardiac output increased by 9.92% (P < 0.175). CONCLUSIONS: The haemodynamic and echocardiographic changes obtained in our study using PTCR® suggest that this innovative approach can play a beneficial role in the heart failure treatment.

Visual outcomes after vitrectomy for epiretinal membrane in pseudophakic eyes with a diffractive trifocal intraocular lens: a retrospective cohort study.

BACKGROUND: Diffractive intraocular lenses (IOLs) could affect visual acuity in patients with macular pathologies such as epiretinal membrane (ERM) and could influence the results of pars plana vitrectomy (PPV) for ERM removal in pseudophakic eyes with these IOLs. The aim of this study is to evaluate the effect on visual outcomes of a diffractive trifocal IOL in PPV for ERM peeling. METHODS: This is a retrospective cohort study on 20 eyes with a single model of trifocal IOL that underwent PPV for removal of ERM between January 2015 and September 2018 in our clinics. Follow up was at least 1 year. Primary outcome measure was mean change in visual acuity. Secondary outcome measures were mean change in central macular thickness (CMT), recovery of the external retinal layers, and change in spherical equivalent (SE). RESULTS: Mean corrected distance visual acuity (CDVA) was 0.03 ± 0.03 logMAR after phacoemulsification; this worsened to 0.23 ± 0.10 logMAR with ERM, improving to 0.10 ± 0.04 log MAR 12 months after PPV (p = 0.001). Mean uncorrected near visual acuity (UNVA) was Jaeger 2.62 ± 0.51 after lensectomy. This worsened to Jaeger 5.46 ± 1.67 with ERM and improved to the initial Jaeger 2.69 ± 0.84 after PPV (p = 0.005). CMT decreased significantly, from 380.15 ± 60.50 µm with the ERM to 313.70 ± 36.98 µm after PPV. Mean SE after lensectomy was - 0.18 ± 0.38 D, which minimally changed to - 0.18 ± 0.47 D after PPV (p = 0.99). The only complication recorded after PPV was a case of cystoid macular edema. No difficulties in visualization due to IOL design were reported during PPV. CONCLUSION: PPV for ERM in eyes with this trifocal IOL seems to be safe and effective, and allows recovery of the loss of UNVA.

Packet Flow Capacity Autonomous Operation Based on Reinforcement Learning.

As the dynamicity of the traffic increases, the need for self-network operation becomes more evident. One of the solutions that might bring cost savings to network operators is the dynamic capacity management of large packet flows, especially in the context of packet over optical networks. Machine Learning, particularly Reinforcement Learning, seems to be an enabler for autonomicity as a result of its inherent capacity to learn from experience. However, precisely because of that, RL methods might not be able to provide the required performance (e.g., delay, packet loss, and capacity overprovisioning) when managing the capacity of packet flows, until they learn the optimal policy. In view of that, we propose a management lifecycle with three phases: (i) a self-tuned threshold-based approach operating just after the packet flow is set up and until enough data on the traffic characteristics are available; (ii) an RL operation based on models pre-trained with a generic traffic profile; and (iii) an RL operation with models trained for real traffic. Exhaustive simulation results confirm the poor performance of RL algorithms until the optimal policy is learnt and when traffic characteristics change over time, which prevents deploying such methods in operators' networks. In contrast, the proposed lifecycle outperforms benchmarking approaches, achieving noticeable performance from the beginning of operation while showing robustness against traffic changes.

Validity of the Pulmonary Embolism Rule-Out Criteria (PERC) for ruling out pulmonary embolism in low-risk patients at high altitudes

Abstract Objectives: to validate the diagnostic yield of the PERC score for ruling out pulmonary embolism in low-risk patients at high altitudes (>2500 meters above sea level [ASL]). Methods: a cross-sectional study with diagnostic test analysis in patients over the age of 18 with suspected pulmonary embolism on admission or during hospitalization, who underwent chest computed tomography angiography between August 2009 and January 2020 in a tertiary care hospital located on the Bogotá savannah. The yield of the PERC score was assessed, calculated with an SaO2<95% and an SaO2<90% in patients with different risk levels according to the Wells, Geneva and Pisa scores for pulmonary embolism. Results: one thousand eighty-seven were included in the final analysis, 42% with PE. Patients classified as low-risk using the Wells score had a PERC ACOR calculated with SaO2<95% of 0.56 (95%CI:0.50-0.62) (p=0.049), and calculated with SaO2<90% of 0.60 (95%CI:0.54-0.66) (p=0.002). The ACOR for subjects classified as low-risk using the Geneva score, with a PERC calculated with SaO2<95%, was: 0.53 (95%CI:0.45-0.60) (p=0.459) and for a PERC calculated with SaO2<90% it was: 0.55 (95%CI:0.47-0.62) (P=0.218). The ACOR for subjects with a less than 10% probability of PE according to the Pisa score classification, with a PERC calculated with SaO2<95%, was: 0.54 (95%CI:0.44-0.64)(p=0.422), and for a PERC calculated with SaO2<90% it was: 0.56 (95%CI:0.46-0.66)(p=0.236). Conclusions: the PERC score calculated with an oxygen saturation <90% has a similar diagnostic yield to the PERC score calculated with an oxygen saturation <95% for ruling out PE in patients classified as low-risk by the Wells score at high altitudes (>2,500 meters ASL). (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.2010).

Genome Sequences of Bacteriophages ClearAsMud and Kauala, Isolated from Microbacterium foliorum.

Cluster EC ClearAsMud and cluster EA4 Kauala are lytic Siphoviridae bacteriophages that were isolated from soil in southern California using Microbacterium foliorum NRRL B-24224 as the host. The ClearAsMud and Kauala genomes are 52,987 bp and 39,378 bp, respectively, and contain 92 and 56 predicted protein-coding genes, respectively.

Decision-making and therapeutic options in intact splenic artery aneurysms: single-center experience and literature review.

BACKGROUND: Splenic artery aneurysms are rare, potentially serious, and usually asymptomatic. Several methods are currently available to treat them, each with their own advantages and drawbacks. Therefore, its therapeutic paradigm has changed. METHODS: We review our database of splenic aneurysms (2009-2019) and undertake an exhaustive literature review. Demographic, clinical, diagnostic, therapeutic, early and follow-up outcome data were examined. Our experience comprised: 15 patients with 19 splenic aneurysms. 11 women (average age, 59.4 years) and 4 men (average age, 61.7 years). All asymptomatic. RESULTS: At diagnosis, aneurysms had a mean cross-sectional diameter of 3.4 cm (3.2 and 3.9 for women and men, respectively), the largest measuring 8.5 cm. Two independent aneurysms were detected in four patients. Diagnoses were always incidental to a CT scan. Treatments consisted of open surgery (2 patients), endovascular surgery (10 patients: 7 embolizations, 3 covered stent) and observation/follow-up (3 patients). The cases of open surgery (with splenectomy) were carried out without postoperative morbidity. One embolization failed (requiring subsequent open surgery) and two suffered localized splenic infarction, but without further complications. In patients treated with a covered stent, the aneurysm was always excluded, without complications. There was no 30-day or follow-up (average 26.2 months) mortality. Splenic aneurysms are diagnosed more frequently and earlier (in the asymptomatic phase), albeit incidentally, than in the past. CONCLUSIONS: The correct indication (identifying patients at risk) and individualization of treatment, in which endovascular techniques are the first-line option, have significantly improved morbidity and mortality outcomes in our hospital.

Alternative mass spectrometry techniques for the validation of the fragmentation pattern of capsaicin and dihydrocapsaicin.

RATIONALE: Capsaicinoids are prevalent secondary metabolites in many natural and synthetic pharmacological compounds. To date, several soft ionization studies related to capsaicinoids have been reported; they all proposed a common fragmentation pattern based on a rearrangement of the aromatic double bonds and the fragmentation of the various positional acyl chains. However, the mechanism has never been validated by high-resolution analyses. Consequently, in this work, a validated fragmentation mechanism of the main capsaicinoids, capsaicin (1) and dihydrocapsaicin (2), is offered. METHODS: In order to propose and validate a common electron ionization (EI) fragmentation mechanism for the target analytes, the following mass spectrometric methods were employed: collision-induced dissociation (CID) by means of linked scans (LS), reinforcing the methodology by high-resolution mass spectrometry (HRMS), in addition to appropriate deuterium-labeled experiments performed using gas chromatography/mass spectrometry (GC/MS) and direct analysis in real time (DART). RESULTS: In a first stage, a common EI fragmentation pattern comprising two pathways was proposed for compounds 1 and 2; then, the suggested mechanism was validated by CID-LS together with HRMS complemented by DART-deuterium-labeling studies. The obtained results are indicative that the corresponding molecular ions were conveniently observed, m/z 305 and m/z 307; it is worth noting that the common base peak is in correspondence with a tropylium ion derivative (m/z 137), as a consequence of a McLafferty rearrangement. In addition to these highlighted fragments, other common ions, m/z 122 and m/z 94, and their corresponding trajectory, were confirmed using the same approach. Finally, the proposed mechanism was complementarily validated by deuterium-labeling studies, taking into account the two exchangeable hydrogens present in the phenolic and the amidic moieties. CONCLUSIONS: A common validated EI fragmentation pattern for both capsaicin and dihydrocapsaicin was established using appropriated mass spectrometric methods together with convenient hydrogen/deuterium labeling. This study provides a new alternative to validate mechanisms of fragmentation of important natural products.

[Children's medically complex diseases unit. A model required in all our hospitals]. / Unidad de niños con patología crónica compleja. Un modelo necesario en nuestros hospitales.

INTRODUCTION: The increase in survival of children with severe diseases has led to the rise of children with chronic diseases, sometimes with lifelong disabilities. In 2008, a unit for the specific care of medically complex children (MCC) was created in Hospital La Paz. OBJECTIVES: To describe the work and care activities of this Unit. Patients and methods An analysis was performed on all discharge reports of the Unit between January 2014 and July 2016. RESULTS: The MCC Unit has 6 beds and daily outpatient clinic. A total of 1,027 patients have been treated since the creation of the unit, with 243 from 2014. The median age was 24.2 months (IQ: 10.21-84.25). The large majority (92.59%) have multiple diseases, the most frequent chronic conditions observed were neurological (76.95%), gastrointestinal (63.78%), and respiratory diseases (61.72%). More than two-thirds (69.54%) of MCC are dependent on technology, 53.49% on respiratory support, and 35.80% on nutritional support. Hospital admission rates have increased annually. There have been 403 admissions since 2014, of which 8.93% were re-admissions within 30 days of hospital discharge. The median stay during 2014-2016 was 6 days (IQ: 3-14). The occupancy rate has been above 100% for this period. Currently, 210 patients remain on follow-up (86.42%), and 11 children (4.53%) were discharged to their referral hospitals. The mortality rate is 9.05% (22 deaths). The main condition of these 22 patients was neurological (9 patients). Infectious diseases were the leading cause of death. CONCLUSION: MCC should be treated in specialized units in tertiary or high-level hospitals.