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PURPOSE: It is unclear whether preoperative serum uric acid (SUA) elevation may play a role in the development of acute kidney injury (AKI) associated with cardiac surgery (CSA-AKI). We conducted a cohort study to evaluate the influence of preoperative hyperuricemia on AKI in patients at high risk for developing SC-AKI. DESIGN: Multicenter prospective international cohort study. SETTING: Fourteen university hospitals in Spain and the United Kingdom. PARTICIPANTS: We studied 261 consecutive patients at high risk of developing CSA-AKI, according to a Cleveland scoreâ¯≥â¯4 points, from July to December 2017. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: AKIN criteria were used for the definition of AKI. Multivariable logistic regression models and propensity score-matched pairwise analysis were used to determine the adjusted association between preoperative hyperuricemia (≥7â¯mg/dL) and AKI. Elevated preoperative AUS (≥7â¯mg/dL) was present in 190 patients (72.8%), whereas CSA-AKI occurred in 145 patients (55.5%). In multivariable logistic regression models, hyperuricemia was not associated with a significantly increased risk of AKI (adjusted Odds Ratio [OR]: 1.58; 95% confidence interval [CI]: 0.81-3; Pâ¯=â¯.17). In propensity score-matched analysis of 140 patients, the hyperuricemia group experienced similar adjusted odds of AKI (OR 1.05, 95%CI 0.93-1.19, Pâ¯=â¯.37). CONCLUSIONS: Hyperuricemia was not associated with an increased risk of AKI in this cohort of patients undergoing cardiac surgery at high risk of developing CSA-AKI.
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Lesión Renal Aguda , Procedimientos Quirúrgicos Cardíacos , Hiperuricemia , Complicaciones Posoperatorias , Ácido Úrico , Humanos , Lesión Renal Aguda/etiología , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/sangre , Estudios Prospectivos , Masculino , Femenino , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Ácido Úrico/sangre , Anciano , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/sangre , Persona de Mediana Edad , Hiperuricemia/epidemiología , Hiperuricemia/sangre , Factores de Riesgo , Puntaje de PropensiónRESUMEN
This work focuses on the development and analysis of a new multifunctional facade panel incorporating PCM in foam layers. The thermal performance was analysed recurring to a hotbox heat flux meter method to determine the thermal transmittance (U-value) and the main findings are presented. The experimental setup was based on the steady-state approach, using climatic chambers, assuring a stable thermal environment. Even small fractions of PCM achieved a small reduction in thermal amplitude. Numerical simulations using Ansys Fluent were developed to evaluate the performance of PCM use over a wide range of temperature boundary conditions and operating modes. These numerical models were calibrated and validated using the results of experimental tests, achieving a correlation factor of 0.9674, and, thus, accurately representing a real-world scenario. The decrement factor (f) was used to analyse the data. It was identified that the efficiency of the panel and size of the optimum region increased with the PCM fraction growth. The results showed the significant potential of the multi-layered panel, with the thermal regulator effect of the PCM incorporated, on indoor space temperature so as to reach good thermal comfort levels. The efficiency of the panel can be improved by nearly 50% depending on the input boundary conditions. The efficiency of the panel and the size of the optimum region increase with growth in the PCM fraction. The simulated behaviour was at an optimum when the input mean temperature was 20 °C for a room temperature of between 18-20 °C.
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Abstract Objective: To analyze the performance of the cystic fibrosis (CF) newborn screening (NBS) program over its first five years in a Brazilian northeastern state. Methods: A population-based study using a screening algorithm based on immunoreactive trypsinogen (IRT)/IRT. Data were retrieved from the state referral screening center registry. The program performance was evaluated using descriptive indicators such as the results of an active search, coverage, newborn's age at the time of blood sampling, the time between sample collection and its arrival at the laboratory, and the child's age at diagnosis of disease. Results: The public CF screening program covered 82.6% of the 1,017,576 births that occurred, with an accumulated five-year incidence of 1:20,767 live births. The median (25th-75th) age at diagnosis was 3.5 (2.3-7.3) months. The sampling before 7 days of life for the first IRT (IRT1) increased between 2013 and 2017 from 42.2 to 48.3%. Around 5% of IRT1 samples and 30% of the second samples were collected after 30 days of life. In the first and second stages of screening, 23.6% and 19.9% of the infants, respectively, were lost to follow-up. In both stages of screening, the samples were retained at the health units for a median (25th-75th) of 9.0 (7.0-13.0) days. Conclusions: The coverage by the CF-NBS program was satisfactory as compared to other Brazilian state rates and the percentage of IRT1 samples collected within the first week of life increased progressively. However, time of samples retention at the health units, inappropriate sampling, inherent methodological problems, and loss of follow-up need to improve.
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OBJECTIVE: To analyze the performance of the cystic fibrosis (CF) newborn screening (NBS) program over its first five years in a Brazilian northeastern state. METHOD: A population-based study using a screening algorithm based on immunoreactive trypsinogen (IRT)/IRT. Data were retrieved from the state referral screening center registry. The program performance was evaluated using descriptive indicators such as the results of an active search, coverage, newborn's age at the time of blood sampling, the time between sample collection and its arrival at the laboratory, and the child's age at diagnosis of disease. RESULTS: The public CF screening program covered 82.6% of the 1,017,576 births that occurred, with an accumulated five-year incidence of 1:20,767 live births. The median (25th-75th) age at diagnosis was 3.5 (2.3-7.3) months. The sampling before 7 days of life for the first IRT (IRT1) increased between 2013 and 2017 from 42.2 to 48.3%. Around 5% of IRT1 samples and 30% of the second samples were collected after 30 days of life. In the first and second stages of screening, 23.6% and 19.9% of the infants, respectively, were lost to follow-up. In both stages of screening, the samples were retained at the health units for a median (25th-75th) of 9.0 (7.0-13.0) days. CONCLUSIONS: The coverage by the CF-NBS program was satisfactory as compared to other Brazilian state rates and the percentage of IRT1 samples collected within the first week of life increased progressively. However, time of samples retention at the health units, inappropriate sampling, inherent methodological problems, and loss of follow-up need to improve.
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Fibrosis Quística , Pruebas Genéticas , Humanos , Lactante , Recién Nacido , Brasil/epidemiología , Fibrosis Quística/diagnóstico , Fibrosis Quística/genética , Regulador de Conductancia de Transmembrana de Fibrosis Quística/genética , Pruebas Genéticas/métodos , Tamizaje Neonatal/métodos , TripsinógenoRESUMEN
BACKGROUND: This international study aimed to characterise the impact of acute SARS-CoV-2 infection in people with cystic fibrosis and investigate factors associated with severe outcomes. Methods Data from 22 countries prior to 13th December 2020 and the introduction of vaccines were included. It was de-identified and included patient demographics, clinical characteristics, treatments, outcomes and sequalae following SARS-CoV-2 infection. Multivariable logistic regression was used to investigate factors associated with clinical progression to severe COVID-19, using the primary outcome of hospitalisation with supplemental oxygen. RESULTS: SARS-CoV-2 was reported in 1555 people with CF, 1452 were included in the analysis. One third were aged <18 years, and 9.4% were solid-organ transplant recipients. 74.5% were symptomatic and 22% were admitted to hospital. In the non-transplanted cohort, 39.5% of patients with ppFEV1<40% were hospitalised with oxygen verses 3.2% with ppFEV >70%: a 17-fold increase in odds. Worse outcomes were independently associated with older age, non-white race, underweight body mass index, and CF-related diabetes. Prescription of highly effective CFTR modulator therapies was associated with a significantly reduced odds of being hospitalised with oxygen (AOR 0.43 95%CI 0.31-0.60 p<0.001). Transplanted patients were hospitalised with supplemental oxygen therapy (21.9%) more often than non-transplanted (8.8%) and was independently associated with the primary outcome (Adjusted OR 2.45 95%CI 1.27-4.71 p=0.007). CONCLUSIONS: This is the first study to show that there is a protective effect from the use of CFTR modulator therapy and that people with CF from an ethnic minority are at more risk of severe infection with SARS-CoV-2.
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COVID-19 , Fibrosis Quística , COVID-19/epidemiología , COVID-19/terapia , Fibrosis Quística/complicaciones , Fibrosis Quística/epidemiología , Fibrosis Quística/terapia , Regulador de Conductancia de Transmembrana de Fibrosis Quística , Etnicidad , Humanos , Grupos Minoritarios , Oxígeno , SARS-CoV-2RESUMEN
Panoramic images are one of the most requested exams by dentists for allowing the visualization of the entire mouth. Interpreting X-ray images is a time-consuming task in which misdiagnoses can occur due to the inexperience or fatigue of professionals. In this work, we applied different image enhancement techniques as a pre-processing step to determine which image features correlate with improvements in teeth detection in panoramic images using deep learning architectures. We contrasted the performance of five object-detection architectures using 300 panoramic images of a public dataset. We evaluated the enhancement in the pre-processing step and the detection performance. Quality and detection metrics were considered, and the cross-correlation between them was computed for every object-detection method contemplated. We observe the dependence of the detection performance with some image enhancement techniques, especially those that introduce less noise and preserve the global contrast of the image.
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Aprendizaje Profundo , Diente , Benchmarking , Radiografía Panorámica , Rayos XRESUMEN
In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyzes, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.
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Anestesia , Cirugía Torácica , Humanos , Pulmón , Dolor , Estudios Retrospectivos , Procedimientos Quirúrgicos VascularesRESUMEN
The introduction of video-assisted thoracoscopic (VATS) techniques has led to a new approach in thoracic surgery. VATS is performed by inserting a thoracoscope through a small incisions in the chest wall, thus maximizing the preservation of muscle and tissue. Because of its low rate of morbidity and mortality, VATS is currently the technique of choice in most thoracic procedures. Lung resection by VATS reduces prolonged air leaks, arrhythmia, pneumonia, postoperative pain and inflammatory markers. This reduction in postoperative complications shortens hospital length of stay, and is particularly beneficial in high-risk patients with low tolerance to thoracotomy. Compared with conventional thoracotomy, the oncological results of VATS surgery are similar or even superior to those of open surgery. This aim of this multidisciplinary position statement produced by the thoracic surgery working group of the Spanish Society of Anesthesiology and Reanimation (SEDAR), the Spanish Society of Thoracic Surgery (SECT), and the Spanish Association of Physiotherapy (AEF) is to standardize and disseminate a series of perioperative anaesthesia management guidelines for patients undergoing VATS lung resection surgery. Each recommendation is based on an in-depth review of the available literature by the authors. In this document, the care of patients undergoing VATS surgery is organized in sections, starting with the surgical approach, and followed by the three pillars of anaesthesia management: preoperative, intraoperative, and postoperative anaesthesia.
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Anestesia , Anestesiología , Cirugía Torácica , Humanos , Pulmón , Modalidades de Fisioterapia , Neumonectomía/efectos adversos , Cirugía Torácica Asistida por Video/efectos adversos , Cirugía Torácica Asistida por Video/métodosAsunto(s)
Hemofilia A , Factor VIII , Hemofilia A/diagnóstico , Hemofilia A/terapia , Hemostasis , HumanosRESUMEN
There are limited published data in the bovine species on blood biological variables in response to intense work or after significant physical exertion. Lidia cattle, in addition to their exercise components, have some behavioral agonistic features that make them more susceptible to stress. The bullfight involves stress and exercise so intense that it causes significant changes in some metabolic variables. The study objective was to evaluate changes in blood biological variables in response to intense exercise and stress. After the fight in the arena, and once the bulls were dead (n = 438), blood samples were taken, and some biochemical and hormonal variables were determined in venous blood. A descriptive analysis was performed using the Statistica 8.0. computer program. The mean (±s.d.) results obtained were: total protein (85.8 ± 10.8 g/dL), albumin (3.74 ± 4.3 g/dL), triglycerides (39.65 ± 0.16 mg/dL), cholesterol (2.44 ± 0.03 mmol/L), glucose (22.2 ± 9.6 mmol/L), uric acid (340 ± 80 µmol/L), creatinine (236.9 ± 0.4 µmol/L), urea (5.93 ± 1.27 mmol/L), LDH (2828 ± 1975 IU/L), CK (6729 ± 10,931 IU/L), AST (495 ± 462 IU/L), ALP (90 ± 33 IU/L), GGT (50 ± 34 IU/L), ALT (59 ± 35 IU/L), cortisol (117.5 ± 46.6 nmol/L), and testosterone (20.2 ± 23.8 nmol/L). Most of the measured variables clearly increased; thus, we found severe hyperglycemia and increases in LDH, AST, GGT, and ALT enzymes, particularly in CK. The increases in all these variables are justified by the mobilization of energy sources, tissue/muscle damage, and dehydration due to continued stress and intense exercise.
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Heart disease is a major cause of death worldwide. Chronic Chagas cardiomyopathy (CCC) caused by infection with Trypanosoma cruzi leading to high mortality in adults, and rheumatic heart disease (RHD), resulting from infection by Streptococcus pyogenes affecting mainly children and young adults, are amongst the deadliest heart diseases in low-middle income countries. Despite distinct etiology, the pathology associated with both diseases is a consequence of inflammation. Here we compare systemic immune profile in patients with these cardiopathies, to identify particular and common characteristics in these infectious heart diseases. We evaluated the expression of 27 soluble factors, employing single and multivariate analysis combined with machine-learning approaches. We observed that, while RHD and CCC display higher levels of circulating mediators than healthy individuals, CCC is associated with stronger immune activation as compared to RHD. Despite distinct etiologies, univariate analysis showed that expression of TNF, IL-17, IFN-gamma, IL-4, CCL4, CCL3, CXCL8, CCL11, CCL2, PDGF-BB were similar between CCC and RHD, consistent with their inflammatory nature. Network analysis revealed common inflammatory pathways between CCC and RHD, while highlighting the broader reach of the inflammatory response in CCC. The final multivariate model showed a 100% discrimination power for the combination of the cytokines IL-12p70, IL-1Ra, IL-4, and IL-7 between CCC and RHD groups. Thus, while clear immunological distinctions were identified between CCC and RHD, similarities indicate shared inflammatory pathways in these infectious heart diseases. These results contribute to understanding the pathogenesis of CCC and RHD and may impact the design of immune-based therapies for these and other inflammatory cardiopathies that may also share immunological characteristics.
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Cardiomiopatía Chagásica/sangre , Cardiomiopatía Chagásica/inmunología , Quimiocinas/sangre , Citocinas/sangre , Péptidos y Proteínas de Señalización Intercelular/sangre , Adulto , Anciano , Análisis por Conglomerados , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mapas de Interacción de Proteínas , Cardiopatía Reumática/sangre , Cardiopatía Reumática/inmunología , SolubilidadRESUMEN
RESUMEN: El objetivo de este estudio fue comparar la estructura dentaria removida utilizando dos técnicas de acceso endodóntico diferentes en incisivos mandibulares. Treinta y cinco incisivos mandibulares extraídos fueron pesados individualmente con una balanza de precisión. Después de las radiografías iniciales tomadas por vestibular y proximal, los dientes fueron codificados y asignados aleatoriamente a dos grupos: acceso convencional (n = 17) o acceso incisal (n = 18). Luego se volvieron a pesar los dientes y se repitieron las radiografías. Las radiografías digitales se cargaron a un editor de imágenes (Adobe Photoshop) para la sustracción digital de las imágenes por las incidencias VP y MD. Dos observadores independientes y calibrados realizaron las mediciones de las áreas sustraídas. La concordancia inter-observador fue casi perfecta; coeficiente de correlación intraclase igual a 0,94 y 0,98 para las incidencias MD y VP, respectivamente. La prueba de Mann-Whitney encontró diferencias estadísticamente significativas entre los tipos de acc esos en cuanto a la diferencia mediana de los pesos (p = 0,0073) y el área VL (p = 0.0023). También encontró una diferencia estadísticamente significativa entre los tipos de acceso en cuanto al área MD (Prueba t de Welch, p < 0,001). La diferencia de peso fue menor para el acceso incisal que para el acceso convencional. El acceso incisal removió menos tejido dentario que el acceso convencional.
ABSTRACT: The aim of this study was to compare the area of tooth structure removed during two different endodontic access techniques in lower incisors. Thirty-two extracted lower incisors were weighed individually on a precision scale. After initial digital radiographs were taken from buccal and proximal, the teeth were coded and randomly assigned to two different groups: conventional access and incisal access. Once this stage was completed, each tooth was weighed again and 2 postoperative radiographs was taken again, buccal and proximal. Using an image processing software and digital subtraction technique, 2 independent and calibrated evaluators measured difference in tooth structure after access procedures. Interobserver agreement was almost perfect: intraclass correlation coefficient equal to 0,94 and 0,98 for proximal and buccal incidences, respectively. The Mann-Whitney test found statistically significant differences between the types of accesses in terms of weight difference (p = 0.0073) and area VL (p = 0.0023). Additionally, a statistically significant difference between the types of access in the MD area (Welch's t test, p <0.005) was observed. The difference in weight was less for incisal access than for conventional access with a statistically significant difference, in terms of MD and VL area, incisal access and areas of smaller size than conventional access.
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In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyses, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.
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Minerals are inorganic substances present in all body tissues and fluids that directly or indirectly influence the maintenance of multiple metabolic processes and, therefore, are essential for the development of various biological functions. The Lidia bull breed may be considered an athlete, as during a bull fight it displays considerable physical effort of great intensity and short duration in a highly stressful situation. The objective of this study was to assess plasma minerals concentration (macro- and microminerals) in Lidia bulls after intense physical exercise during a bull fight. Plasma Ca, Mg, P, K, Na, Fe, Cr, Co, Ni, Cu, Zn, Se and Mo concentrations were measured in 438 male Lidia bulls. Ca, P and Mg were measured using a Cobas Integra autoanalyzer, while Na and K were determined by ICP-AES, and Fe, Cr, Co, Ni, Cu, Zn, Se and Mo were measured by ICP-MS. All macrominerals, (Ca: 2.96 ± 0.31, Mg: 1.27 ± 0.17, P: 3.78 ± 0.65, K: 7.50 ± 1.58, Na: 150.15 ± 19.59 in mmol/L), and Cr (1.24 ± 0.58), Ni (0.249 ± 1.07), Cu (22.63 ± 4.84) and Zn (24.14 ± 5.59, in µmol/L) showed greater mean values than the reported reference values in the published literature, while Co (0.041 ± 0.07), Se (0.886 ± 0.21) and Mo (0.111 ± 0.08, in µmol/L) values were lower than those reported for other bovine breeds. These increased concentrations could be justified mainly by muscle cell metabolism, hepatic need to provide energy, and intense dehydration and hemoconcentration by losses through sweat glands or urination.
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The introduction of video-assisted thoracoscopic (VATS) techniques has led to a new approach in thoracic surgery. VATS is performed by inserting a thoracoscope through a small incisions in the chest wall, thus maximizing the preservation of muscle and tissue. Because of its low rate of morbidity and mortality, VATS is currently the technique of choice in most thoracic procedures. Lung resection by VATS reduces prolonged air leaks, arrhythmia, pneumonia, postoperative pain and inflammatory markers. This reduction in postoperative complications shortens hospital length of stay, and is particularly beneficial in high-risk patients with low tolerance to thoracotomy. Compared with conventional thoracotomy, the oncological results of VATS surgery are similar or even superior to those of open surgery. This aim of this multidisciplinary position statement produced by the thoracic surgery working group of the Spanish Society of Anesthesiology and Reanimation (SEDAR), the Spanish Society of Thoracic Surgery (SECT), and the Spanish Association of Physiotherapy (AEF) is to standardize and disseminate a series of perioperative anaesthesia management guidelines for patients undergoing VATS lung resection surgery. Each recommendation is based on an in-depth review of the available literature by the authors. In this document, the care of patients undergoing VATS surgery is organized in sections, starting with the surgical approach, and followed by the three pillars of anaesthesia management: preoperative, intraoperative, and postoperative anaesthesia.
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OBJECTIVE: Cross-sectional descriptive observational study of incidence and association, to determine whether the higher incidence of prostate cancer in Castilla y León (with respect to the national rate) could be due to modifiable factors. LOCATION: University Hospital Río Hortega. PARTICIPANTS: New prostate cancer diagnoses. MAIN MEASUREMENTS: Incidence rate (IR). Age, family history, symptoms, comorbidity, rectal examination, ultrasound volume (cc), PSA (ng/mL), cylinders, volume cylinder ratio, Gleason, TNM and D'Amico groups. RESULTS: Castilla y León showed the highest prostate cancer IR in Spain (141.1 per 100,000 inhabitants per year), with a peak of early incidence (65-74 years) and significant differences inâ¯<â¯64 and 65-74 years. Age at diagnosis was the lowest (Castilla y León, 66.9⯱7.1 vs. Spain, 69.1⯱â¯8.2 years; Pâ¯<â¯.001). No differences: family history, symptoms, comorbidity and PSA. The number of cylinders was 10.7⯱â¯1.8. In multivariate analysis (AUCâ¯=â¯0.801; Pâ¯<â¯.001), they were more frequent in Castilla y León: grade i rectal examination, non-palpable rectal examination, Gleasonâ¯<â¯6, stage T2c and the volume cylinder ratioâ¯<â¯6 (only inâ¯<â¯64 years: OR 5.2; 95% CI 1.2-22-22.3; Pâ¯=â¯.027). In Spanish regions, volume cylinder ratio showed inverse correlation with IR inâ¯<â¯74 years, while age showed positive correlation in all age groups. CONCLUSIONS: The higher prostate cancer IR in Castilla y León in 2010 was not associated to an older population. However, the biopsy technique influenced IR, as more cylinders were obtained in younger subjects, without conditioning overdiagnosis.