Integrated dilator-needle transseptal crossing device in atrial fibrillation cryoballoon ablation procedures.

INTRODUCTION: In cryoballoon ablation (CBA) procedures, transseptal access (TSA) is generally achieved using a standard sheath and needle system that is exchanged for the cryoballoon delivery sheath and dilator over a long wire. Sheath exchange has been related with air embolic events. Recently, an integrated dilator-needle system assembled to the cryoballoon sheath was introduced. We aimed to evaluate the efficacy and safety of an integrated TSA tool compared with the traditional approach in atrial fibrillation CBA procedures. METHODS: Patients scheduled for CBA procedures were randomized 1:1 to traditional TSA (t-TSA) or integrated TSA (i-TSA). TSA time was defined as time from superior vena cava to LA insertion of the cryoballoon delivery sheath, after sheath exchange (t-TSA) or directly (i-TSA). RESULTS: Ninety-seven patients (76 males, mean age 59 ± 10 years) were randomized, 48 patients underwent t-TSA, and 49 i-TSA. Mean TSA time was 5 min 59 s ± 5 min 36 s in the t-TSA group and 2 min 59 s ± 2 min 14 s in the i-TSA group (p < .001). Total fluoroscopy time, skin-to-skin procedure time, and LA dwell time were respectively 15 ± 6, 69 ± 16, and 44 ± 12 min in the t-TSA group and 13 ± 6, 65 ± 15, and 43 ± 11 min in the i-TSA group (p = ns). No clinically significant acute complications related to TSA were noted in both cohorts. CONCLUSION: This is the first randomized study comparing both TSA approaches. TSA in CBA procedures using this integrated tool enables a safe and efficient workflow, reducing TSA time and avoiding sheath exchange.

Solving difficulties in transseptal sheath crossing: The shoehorn technique.

The shoehorn technique is a simple and safe maneuver that can help to solve difficulties in challenging transseptal sheath crossing for atrial fibrillation cryoablation procedures.

Left bundle branch pacing in alternating bundle branch block.

We present a case of symptomatic intermittent AV block showing during monitorization alternating bundle branch block. Presuming a high need of pacing, conduction system pacing was considered a more physiological alternative in this patient. Left bundle branch pacing restored a stable atrioventricular synchrony with a paced QRS complex similar to the native one and might be a good alternative in these cases.

Deep Learning for chaos detection.

In this article, we study how a chaos detection problem can be solved using Deep Learning techniques. We consider two classical test examples: the Logistic map as a discrete dynamical system and the Lorenz system as a continuous dynamical system. We train three types of artificial neural networks (multi-layer perceptron, convolutional neural network, and long short-term memory cell) to classify time series from the mentioned systems into regular or chaotic. This approach allows us to study biparametric and triparametric regions in the Lorenz system due to their low computational cost compared to traditional techniques.

Epidemiology, Diagnosis and Management of Penile Cancer: Results from the Spanish National Registry of Penile Cancer.

INTRODUCTION: Penile cancer (PC) is a rare malignancy with an overall incidence in Europe of 1/100,000 males/year. In Europe, few studies report the epidemiology, risk factors, clinical presentation, and treatment of PC. The aim of this study is to present an updated outlook on the aforementioned factors of PC in Spain. MATERIALS AND METHODS: A multicentric, retrospective, observational epidemiological study was designed, and patients with a new diagnosis of PC in 2015 were included. Patients were anonymously identified from the Register of Specialized Care Activity of the Ministry of Health of Spain. All Spanish hospitals recruiting patients in 2015 were invited to participate in the present study. We have followed a descriptive narration of the observed data. Continuous and categorical data were reported by median (p25th-p75th range) and absolute and relative frequencies, respectively. The incidence map shows differences between Spanish regions. RESULTS: The incidence of PC in Spain in 2015 was 2.55/100,000 males per year. A total of 586 patients were identified, and 228 patients from 61 hospitals were included in the analysis. A total of 54/61 (88.5%) centers reported ≤ 5 new cases. The patients accessed the urologist for visually-assessed penile lesions (60.5%), mainly localized in the glans (63.6%). Local hygiene, smoking habits, sexual habits, HPV exposure, and history of penile lesions were reported in 48.2%, 59.6%, 25%, 13.2%, and 69.7%. HPV-positive lesions were 18.1% (28.6% HPV-16). The majority of PC was squamous carcinoma (95.2%). PC was ≥cT2 in 45.2% (103/228) cases. At final pathology, PC was ≥pT2 in 51% of patients and ≥pN1 in 17% of cases. The most common local treatment was partial penectomy (46.9% cases). A total of 47/55 (85.5%) inguinal lymphadenectomies were open. Patients with ≥pN1 disease were treated with chemotherapy in 12/39 (40.8%) of cases. CONCLUSIONS: PC incidence is relatively high in Spain compared to other European countries. The risk factors for PC are usually misreported. The diagnosis and management of PC are suboptimal, encouraging the identification of referral centers for PC management.

Injectable decellularized nucleus pulposus tissue exhibits neuroinhibitory properties.

Background: Chronic low back pain (LBP) is a leading cause of disability, but treatments for LBP are limited. Degeneration of the intervertebral disc due to loss of neuroinhibitory sulfated glycosaminoglycans (sGAGs) allows nerves from dorsal root ganglia to grow into the core of the disc. Treatment with a decellularized tissue hydrogel that contains sGAGs may inhibit nerve growth and prevent disc-associated LBP. Methods: A protocol to decellularize porcine nucleus pulposus (NP) was adapted from previous methods. DNA, sGAG, α-gal antigen, and collagen content were analyzed before and after decellularization. The decellularized tissue was then enzymatically modified to be injectable and form a gel at 37°C. Following this, the mechanical properties, microstructure, cytotoxicity, and neuroinhibitory properties were analyzed. Results: The decellularization process removed 99% of DNA and maintained 74% of sGAGs and 154% of collagen compared to the controls NPs. Rheology demonstrated that regelled NP exhibited properties similar to but slightly lower than collagen-matched controls. Culture of NP cells in the regelled NP demonstrated an increase in metabolic activity and DNA content over 7 days. The collagen content of the regelled NP stayed relatively constant over 7 days. Analysis of the neuroinhibitory properties demonstrated regelled NP significantly inhibited neuronal growth compared to collagen controls. Conclusions: The decellularization process developed here for porcine NP tissue was able to remove the antigenic material while maintaining the sGAG and collagen. This decellularized tissue was then able to be modified into a thermally forming gel that maintained the viability of cells and demonstrated robust neuroinhibitory properties in vitro. This biomaterial holds promise as an NP supplement to prevent nerve growth into the native disc and NP in vivo.

Análisis de redes sociales: un estudio de caso en Educación Física / Social network analysis: a case study in Physical Education

Este estudio analiza de forma gráfica las redes sociales en una clase de educación física de un centro público de secundaria de Valencia durante la pandemia del COVID-19, a partir de las conexiones que se producen entre los alumnos. El objetivo es comprobar el estado social del aula e identificar situaciones potencialmente problemáticas en el aula, a partir del análisis de dimensiones como la interacción agradable, el apoyo emocional, el apoyo social y el coestudio. Se utilizó una metodología cuantitativa mediante un cuestionario donde los estudiantes debían responder en función de su percepción del resto de compañeros a partir de varios ítems correspondientes a dimensiones sociológicas. Se realizó un análisis de redes sociales (SNA) y se extrajeron valores numéricos y gráficos que exponían la situación social del alumnado. Se hallaron problemas de integración, derivadas de las grandes diferencias de centralidad entre los alumnos más aislados y la media de la clase, así como una gran cantidad de conexiones en la dimensión “interacción agradable” y pocas conexiones en “apoyo emocional”. Se hallaron también diferencias sustanciales de liderazgo dependiendo de la dimensión de forma que los alumnos líderes en unos ámbitos, en otros no lo eran. Por último, se encontraron diferencias entre las conexiones cara a cara y digitales, siendo mayores estas últimas. Este estudio anima a los docentes de educación física a utilizar en SNA para conocer de forma objetiva la situación social de la clase, teniendo en cuenta el gran componente social que envuelve a una sesión de esta asignatura. (AU)

This study analyzes social networks in a physical education class in a public high school in Valencia during the COVID-19 pandemic. The main objective of this paper is to check the social status of the classroom and identify potentially problematic situations in the classroom, based on the analysis of dimensions such as pleasant interaction, emotional support, social support and co-study. To do this, a quantitative methodology was used through a questionnaire where students had to respond based on their perception of the rest of their classmates from various items corresponding to sociological dimensions. From this point, a social network analysis (SNA) was carried out and numerical and graphic values were extracted that exposed the social situation of the students. Integration problems were found, derived from the great differences in centrality between the most isolated students and the average of the class, as well as a large number of connections in the dimension “pleasant interaction”, and few connections in “emotional support”. Substantial leadership differences were also found depending on the dimension, so that the student leaders in some areas were not leaders in others. Finally, differences were found between face-to-face and digital connections, the latter being greater. This study encourages physical education teachers to use SNA to objectively know the social situation of the class, taking into account the great social component that surrounds a session of this subject. (AU)

Effect of fatigue strength exercise on anterior thigh skin temperature rewarming after cold stress test.

Although dynamic thermography skin temperature assessment has been used in medical field, scientific evidence in sports is scarce. The aim of the study was to assess changes in anterior thigh skin temperature in response to a cold stress test after a strength exercise fatiguing protocol. Ten physically active adults performed a familiarization session and two strength exercise sessions, one with dominant and the other with non-dominant lower limb. Participants performed bouts of 10 concentric and eccentric contractions of leg extensions in an isokinetic device until reaching around 30% of force loss. Infrared thermographic images were taken at baseline conditions and after the fatigue level from both thighs after being cooled using a cryotherapy system. ROIs included vastus medialis, rectus femoris, adductor and vastus lateralis. Skin temperature rewarming was assessed during 180s after the cooling process obtaining the coefficients of the following equation: ΔSkin temperature = ß0 + ß1 * ln(T), being ß0 and ß1 the constant and slope coefficients, respectively, T the time elapsed following the cold stress in seconds, and ΔSkin temperature the difference between the skin temperature at T respect and the pre-cooling moment. Lower ß0 and higher ß1 were found for vastus lateralis and rectus femoris in the intervention lower limb compared with baseline conditions (p < 0.05 and ES > 0.6). Adductor only showed differences in ß0 (p = 0.01 and ES = 0.92). The regressions models obtained showed that ß0 and ß1 had a direct relationship with age and muscle mass, but an inverse relationship with the number of series performed until 30% of fatigue (R2 = 0.8). In conclusion, fatigue strength exercise results in a lower skin temperature and a faster thermal increase after a cold stress test.

Rebiopsy rate after transperineal or transrectal prostate biopsy.

BACKGROUND: In recent years, transperineal biopsies gained popularity for prostate cancer diagnosis; lower infective complications and improved sampling of the prostate are the main advantages of this technique. One question that remains unclear is whether an initial transperineal biopsy confers a lower risk for rebiopsy compared with the transrectal approach. METHODS: Six hundred seventy-one men were prospectively followed after an initial negative prostate biopsy for a median period of 49.50 (IQR: 37.62-61.17) months. Rebiopsy rate was analyzed attending to first biopsy approach (transrectal versus transperineal systematic) and clinical variables. RESULTS: Diagnostic rate was similar for transrectal and transperineal systematic biopsies. Targeted biopsies outperformed any systematic approach, and transperineal targeted in particular was superior to transrectal targeted. Rebiopsy rates were 15.4% and 5.26% for the transrectal and transperineal systematic groups, respectively. Prostate-specific antigen density and type of first biopsy were identified as rebiopsy predictors. CONCLUSION: Men undergoing transperineal systematic biopsies had a three times lower rate of rebiopsy over the study period compared with the traditional transrectal approach. This advantage could be added to the already described potential benefits of transperineal biopsies. Targeted biopsies had lower rebiopsy rate over the study period. Further innovations that decreased the cost of transperineal biopsies could favor this approach in the future.

[Diagnosis and treatment of complications related with lymph-node dissection surgery: Lymphorrea, lymphocele and lymphedema.] / Diagnóstico y tratamiento de las complicaciones y secuelas relacionadas con la linfadenectomía: linforrea, linfocele y linfedema.

OBJECTIVES: To describe the available techniques to prevent and treat complications related with surgery involving lymphatic nodes and drainage: lymphorrea, lymphocele and lymphedema. METHODS: Bibliographic review and personal experience communication of different image-assisted techniques in the prevention and management of lymphatic related complications. RESULTS: We describe the conventional lymphography with ethiodized oil contrast (lipiodol) by lymphatic catheterization and intranodal percutaneous puncture used in diagnostics and interventional radiology; the gammagraphic lymphography with radioactive isotopes for diagnostic use; and the utilization of colorants/dyes (patent blue, V-blue, methylene blue, indocyanine green) for diagnostic and therapeutic procedures. CONCLUSIONS: Lipiodol lymphography offers well-defined radiologic images and it is useful in interventional radiology procedures. It has the inconvenience of lymphatics catheterization and is not available for surgical dynamic identification of lymphatics. Isotopic techniques are used for diagnostics and sentinel-node procedures. Colorants and dyes have several advantages: no need for catheterization, not expensive technology, price, availability, easy management. It allows the dynamic identification of lymphatics for surgical resolution of lymph-related complications.

OBJETIVOS: Describir los diferentes métodos de prevención y resolución de complicaciones y secuelas derivadas de actos quirúrgicos relacionados con el drenaje linfático ­ linforrea, linfocele y linfedema.MÉTODOS: Revisión de la literatura y comunicación de la experiencia personal de alternativas diagnósticas y terapéuticas con asistencia guiada de imagen. RESULTADOS: Describimos la linfografía mediante cateterización linfática e intranodal con aceite etiodizado (lipiodol) con fines diagnósticos y terapéuticos; la linfografía gammagráfica mediante el uso de isótopos radioactivos con fines diagnósticos; y el uso de colorantes -azul de isosulfan, azul patente, azul de metileno y verde de indocianina- con finalidad diagnóstica y terapeútica. CONCLUSIONES: La linfografía con lipiodol ofrece imágenes bien definidas y es útil en maniobras de radiología intervencionista. Presenta el inconveniente de precisar cateterismo linfático y la imposibilidad de su uso dinámico intraoperatorio. Las técnicas isotópicas son utilizadas con finalidad diagnóstica y en técnicas de biopsia de ganglio centinela. El uso de colorantes ofrece la ventaja de no precisar cateterismo linfático ni de tecnología compleja, precio, disponibilidad, facilidad de uso y de tratarse de una técnica dinámica que permite la identificación intraoperatoria para la resolución de las complicaciones mencionadas.

Diagnóstico y tratamiento de las complicaciones y secuelas relacionadas con la linfadenectomía: linforrea, linfocele y linfedema / Diagnosis and treatment of complications related with lymph-node dissection surgery: Lymphorrea, lymphocele and lymphedema

Objetivos: Describir los diferentes métodos de prevención y resolución de complicaciones y secuelas derivadas de actos quirúrgicos relacionados con el drenaje linfático - linforrea, linfocele y linfedema. Métodos: Revisión de la literatura y comunicación de la experiencia personal de alternativas diagnósticas y terapéuticas con asistencia guiada de imagen. Resultados: Describimos la linfografía mediante cateterización linfática e intranodal con aceite etiodizado (lipiodol) con fines diagnósticos y terapéuticos; la linfografía gammagráfica mediante el uso de isótopos radioactivos con fines diagnósticos; y el uso de colorantes -azul de isosulfan, azul patente, azul de metileno y verde de indocianina- con finalidad diagnóstica y terapeútica. Conclusiones: La linfografía con lipiodol ofrece imágenes bien definidas y es útil en maniobras de radiología intervencionista. Presenta el inconveniente de precisar cateterismo linfático y la imposibilidad de su uso dinámico intraoperatorio. Las técnicas isotópicas son utilizadas con finalidad diagnóstica y en técnicas de biopsia de ganglio centinela. El uso de colorantes ofrece la ventaja de no precisar cateterismo linfático ni de tecnología compleja, precio, disponibilidad, facilidad de uso y de tratarse de una técnica dinámica que permite la identificación intraoperatoria para la resolución de las complicaciones mencionadas

Objectives: To describe the available techniques to prevent and treat complications related with surgery involving lymphatic nodes and drainage:lymphorrea, lymphocele and lymphedema. Methods: Bibliographic review and personal experience communication of different image-assisted techniques in the prevention and management of lymphatic related complications. Results: We describe the conventional lymphography with ethiodized oil contrast (lipiodol) by lymphatic catheterization and intranodal percutaneous puncture used in diagnostics and interventional radiology; the gammagraphic lymphography with radioactive isotopes for diagnostic use; and the utilization of colorants/dyes (patent blue, V-blue, methylene blue, indocyanine green) for diagnostic and therapeutic procedures. Conclusions: Lipiodol lymphography offers well-defined radiologic images and it is useful in interventional radiology procedures. It has the inconvenience of lymphatics catheterization and is not available for surgical dynamic identification of lymphatics. Isotopic techniques are used for diagnostics and sentinel-node procedures.Colorants and dyes have several advantages: no need for catheterization, not expensive technology, price,availability, easy management. It allows the dynamic identification of lymphatics for surgical resolution of lymph-related complications

Smart Waste Collection System with Low Consumption LoRaWAN Nodes and Route Optimization.

New solutions for managing waste have emerged due to the rise of Smart Cities and the Internet of Things. These solutions can also be applied in rural environments, but they require the deployment of a low cost and low consumption sensor network which can be used by different applications. Wireless technologies such as LoRa and low consumption microcontrollers, such as the SAM L21 family make the implementation and deployment of this kind of sensor network possible. This paper introduces a waste monitoring and management platform used in rural environments. A prototype of a low consumption wireless node is developed to obtain measurements of the weight, filling volume and temperature of a waste container. This monitoring allows the progressive filling data of every town container to be gathered and analysed as well as creating alerts in case of incidence. The platform features a module for optimising waste collection routes. This module dynamically generates routes from data obtained through the deployed nodes to save energy, time and consequently, costs. It also features a mobile application for the collection fleet which guides every driver through the best route—previously calculated for each journey. This paper presents a case study performed in the region of Salamanca to evaluate the efficiency and the viability of the system’s implementation. Data used for this case study come from open data sources, the report of the Castilla y León waste management plan and data from public tender procedures in the region of Salamanca. The results of the case study show a developed node with a great lifetime of operation, a large coverage with small deployment of antennas in the region, and a route optimization system which uses weight and volume measured by the node, and provides savings in cost, time and workforce compared to a static collection route approach.

Etiología y frecuencia de factores de riesgo de sepsis tardía en una unidad de cuidados intensivos neonatales de nivel IIIb / Aetiology and frequency of risk factors for late onset neonatal sepsis in a level IIIBb NICU

No disponible

Combination of Multi-Agent Systems and Wireless Sensor Networks for the Monitoring of Cattle.

Precision breeding techniques have been widely used to optimize expenses and increase livestock yields. Notwithstanding, the joint use of heterogeneous sensors and artificial intelligence techniques for the simultaneous analysis or detection of different problems that cattle may present has not been addressed. This study arises from the necessity to obtain a technological tool that faces this state of the art limitation. As novelty, this work presents a multi-agent architecture based on virtual organizations which allows to deploy a new embedded agent model in computationally limited autonomous sensors, making use of the Platform for Automatic coNstruction of orGanizations of intElligent Agents (PANGEA). To validate the proposed platform, different studies have been performed, where parameters specific to each animal are studied, such as physical activity, temperature, estrus cycle state and the moment in which the animal goes into labor. In addition, a set of applications that allow farmers to remotely monitor the livestock have been developed.

Super-response to cardiac resynchronization therapy may predict late phrenic nerve stimulation.

Aims: Changes in the anatomical relationship between left phrenic nerve and coronary veins may occur due to the reverse remodelling observed in super-responders to cardiac resynchronization therapy (CRT) and might be the underlying mechanism in patients developing late-onset phrenic nerve stimulation (PNS) without evidence of lead dislodgement (LD). In this study, we sought to evaluate the role of super-response (SR) to CRT as a potential predictor of late-onset PNS. Methods and results: Consecutive patients implanted with a left ventricular (LV) lead in a single centre were retrospectively analysed. Phrenic nerve stimulation was classified as 'early' when it occurred within 3 months of implantation and 'late' for occurrences thereafter. 'Late' PNS was considered related to LD (LD-PNS) when LV threshold differed by > 1 V or impedance >250 Ω from baseline values or in case of radiological displacement. Cases not meeting the former criteria were classified as 'non-LD-PNS'. Super-response was defined as a decrease ≥30% of the left ventricluar end-systolic volume at 1-year echocardiography. At 32 ± 7 months follow-up, PNS occurred in 20 of 139 patients. Late non-LD-PNS incidence was significantly higher in the SR group (8/61; 13.1%) when compared with the non-SR (1/78; 1.3%) (P = 0.010). Super-response remained the only predictor of non-LD-PNS at multivariate analysis (odds ratio: 11.62, 95% confidence interval 1.41-95.68, P = 0.023). Conclusion: Incidence of late non-LD-PNS is higher among SR to CRT, suggesting a potential role of the changes in the anatomical relationship between left phrenic nerve and coronary veins.

Ivabradina como alternativa a la ablación del nódulo AV para un paciente con fibrilación auricular permanente / Ivabradine as an alternative to AV node ablation in a patient with permanent atrial fibrillation

No disponible