Predictive factors of six-week mortality in critically ill patients with SARS-CoV-2: A multicenter prospective study.

OBJECTIVE: The objective of the study is to identify the risk factors associated with mortality at six weeks, especially by analyzing the role of antivirals and munomodulators. DESIGN: Prospective descriptive multicenter cohort study. SETTING: 26 Intensive care units (ICU) from Andalusian region in Spain. PATIENTS OR PARTICIPANTS: Consecutive critically ill patients with confirmed SARS-CoV-2 infection were included from March 8 to May 30. INTERVENTIONS: None. VARIABLES: Variables analyzed were demographic, severity scores and clinical condition. Support therapy, drug and mortality were analyzed. An univariate followed by multivariate Cox regression with propensity score analysis was applied. RESULTS: 495 patients were enrolled, but 73 of them were excluded for incomplete data. Thus, 422 patients were included in the final analysis. Median age was 63 years and 305 (72.3%) were men. ICU mortality: 144/422 34%; 14 days mortality: 81/422 (19.2%); 28 days mortality: 121/422 (28.7%); 6-week mortality 152/422 36.5%. By multivariable Cox proportional analysis, factors independently associated with 42-day mortality were age, APACHE II score, SOFA score at ICU admission >6, Lactate dehydrogenase at ICU admission >470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h post-ICU admission <6.5%, and thrombocytopenia whereas the use of lopinavir/ritonavir was a protective factor. CONCLUSION: Age, APACHE II, SOFA>value of 6 points, along with vasopressor requirements or renal replacement therapy have been identified as predictor factors of mortality at six weeks. Administration of corticosteroids showed no benefits in mortality, as did treatment with tocilizumab. Lopinavir/ritonavir administration is identified as a protective factor.

Análisis del impacto de la curva de aprendizaje de la cistectomía radical asistida por robot con derivación urinaria intracorpórea sobre los resultados perioperatorios / Evaluating the impact of the learning curve on the perioperative outcomes of robot-assisted radical cystectomy with intracorporeal urinary diversion

Introducción La cistectomía radical asistida por robot (CRAR) con derivación urinaria intracorpórea (DUIC) es un procedimiento técnicamente complejo. Nuestro objetivo fue analizar el impacto de la curva de aprendizaje (CA) de la CRAR con DUIC sobre los resultados perioperatorios y patológicos.Material y métodos Estudio retrospectivo de 62 pacientes consecutivos intervenidos mediante CRAR con DUIC por tumor vesical entre 2015 y 2020. Se compararon 3 grupos consecutivos de 20 (G1), 20 (G2) y 22 (G3) pacientes para analizar el impacto de la CA. Los casos de G1 fueron intervenidos por un cirujano sénior con experiencia en cirugía robótica y los de G2-G3 por 2cirujanos júnior sin experiencia, pero tutorizados por el sénior.Resultados Los 3grupos tenían características clínico-patológicas similares. A 15 pacientes (24%) se les realizó una neovejiga y a 47 (75%) un conducto ileal. El tiempo medio operatorio descendió 60 min entre G1 y G3 (p=0,001). Ningún paciente precisó conversión a cirugía abierta ni tuvo complicaciones intraoperatorias. No se objetivaron diferencias en la tasa de márgenes positivos (p=0,6) ni en el número de ganglios extraídos (p=0,061) entre los grupos. La tasa de complicaciones postoperatorias fue del 77% y no varió durante la CA (p=0,49). Se objetivó una tendencia en la reducción de tasa de estenosis ureteroileal del 25% en G1 al 9% en G3 (p=0,217).Conclusiones La incorporación de cirujanos júnior a un programa de CRAR con DUIC a partir de los 20 primeros casos no compromete los resultados perioperatorios ni patológicos. Durante la CA se podría reducir el tiempo operatorio y la tasa de estenosis ureteroileal (AU)

Introduction Robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) is a technically difficult procedure. Our aim was to evaluate the potential impact of the learning curve (LC) on perioperative and pathological outcomes of RARC with ICUD.Material and methods Retrospective study of 62 consecutive patients who underwent RARC with ICUD for bladder cancer between 2015-2020. We compared 3 consecutive groups of 20 (G1), 20 (G2), and 22 (G3) patients to analyze the impact of the LC. G1 cases were performed by a senior surgeon experienced in robotic surgery, while G2-G3 were performed by 2 junior surgeons without experience under the mentorship of the senior surgeon.Results The 3 groups had similar clinical and pathological characteristics. A total of 15 patients (24%) received a neobladder and 47 (75%) an ileal conduit. The mean operative time decreased 60minutes between G1-G3 (P=0.001). No conversions to open approach or intraoperative complications were reported. There were no differences between groups regarding positive margin rates (P=0.6) or the number of lymph nodes removed (P=0.061). The postoperative complication rate was 77% and did not change during the LC (P=0.49). Uretero-enteric stricture rate decreased from 25% in G1 to 9% in G3 (P=0.217).Conclusions The inclusion of júnior surgeons to a RARC with ICUD program after the initial 20 cases does not have an impact on the perioperative and pathological outcomes of the procedure. The operative time and the uretero-enteric stricture rate could be reduced during the LC (AU)

Evaluating the impact of the learning curve on the perioperative outcomes of robot-assisted radical cystectomy with intracorporeal urinary diversion.

INTRODUCTION: Robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) is a technically difficult procedure. Our aim was to evaluate the potential impact of the learning curve (LC) on perioperative and pathological outcomes of RARC with ICUD. MATERIAL AND METHODS: Retrospective study of 62 consecutive patients who underwent RARC with ICUD for bladder cancer between 2015-2020. We compared 3 consecutive groups of 20 (G1), 20 (G2), and 22 (G3) patients to analyze the impact of the LC. G1 cases were performed by a senior surgeon experienced in robotic surgery, while G2-G3 were performed by 2 junior surgeons without experience under the mentorship of the senior surgeon. RESULTS: The 3 groups had similar clinical and pathological characteristics. A total of 15 patients (24%) received a neobladder and 47 (75%) an ileal conduit. The mean operative time decreased 60 min between G1-G3 (p = 0.001). No conversions to open approach or intraoperative complications were reported. There were no differences between groups regarding positive margin rates (p = 0.6) or the number of lymph nodes removed (p = 0.061). The postoperative complication rate was 77% and did not change during the LC (p = 0.49). Uretero-enteric stricture rate decreased from 25% in G1 to 9% in G3 (p = 0.217). CONCLUSIONS: The inclusion of junior surgeons to a RARC with ICUD program after the initial 20 cases does not have an impact on the perioperative and pathological outcomes of the procedure. The operative time and the uretero-enteric stricture rate could be reduced during the LC.

Evaluating the impact of the learning curve on the perioperative outcomes of robot-assisted radical cystectomy with intracorporeal urinary diversion. / Análisis del impacto de la curva de aprendizaje de la cistectomía radical asistida por robot con derivación urinaria intracorpórea sobre los resultados perioperatorios.

INTRODUCTION: Robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) is a technically difficult procedure. Our aim was to evaluate the potential impact of the learning curve (LC) on perioperative and pathological outcomes of RARC with ICUD. MATERIAL AND METHODS: Retrospective study of 62 consecutive patients who underwent RARC with ICUD for bladder cancer between 2015-2020. We compared 3 consecutive groups of 20 (G1), 20 (G2), and 22 (G3) patients to analyze the impact of the LC. G1 cases were performed by a senior surgeon experienced in robotic surgery, while G2-G3 were performed by 2 junior surgeons without experience under the mentorship of the senior surgeon. RESULTS: The 3 groups had similar clinical and pathological characteristics. A total of 15 patients (24%) received a neobladder and 47 (75%) an ileal conduit. The mean operative time decreased 60minutes between G1-G3 (P=0.001). No conversions to open approach or intraoperative complications were reported. There were no differences between groups regarding positive margin rates (P=0.6) or the number of lymph nodes removed (P=0.061). The postoperative complication rate was 77% and did not change during the LC (P=0.49). Uretero-enteric stricture rate decreased from 25% in G1 to 9% in G3 (P=0.217). CONCLUSIONS: The inclusion of júnior surgeons to a RARC with ICUD program after the initial 20 cases does not have an impact on the perioperative and pathological outcomes of the procedure. The operative time and the uretero-enteric stricture rate could be reduced during the LC.

Predictive factors of six-week mortality in critically ill patients with SARS-CoV-2: A multicenter prospective study.

OBJECTIVE: The objective of the study is to identify the risk factors associated with mortality at six weeks, especially by analyzing the role of antivirals and munomodulators. DESIGN: Prospective descriptive multicenter cohort study. SETTING: 26 Intensive care units (ICU) from Andalusian region in Spain. PATIENTS OR PARTICIPANTS: Consecutive critically ill patients with confirmed SARS-CoV-2 infection were included from March 8 to May 30. INTERVENTIONS: None. VARIABLES: Variables analyzed were demographic, severity scores and clinical condition. Support therapy, drug and mortality were analyzed. An univariate followed by multivariate Cox regression with propensity score analysis was applied. RESULTS: 495 patients were enrolled, but 73 of them were excluded for incomplete data. Thus, 422 patients were included in the final analysis. Median age was 63 years and 305 (72.3%) were men. ICU mortality: 144/422 34%; 14 days mortality: 81/422 (19.2%); 28 days mortality: 121/422 (28.7%); 6-week mortality 152/422 36.5%. By multivariable Cox proportional analysis, factors independently associated with 42-day mortality were age, APACHE II score, SOFA score at ICU admission >6, Lactate dehydrogenase at ICU admission >470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h post-ICU admission <6.5%, and thrombocytopenia whereas the use of lopinavir/ritonavir was a protective factor. CONCLUSION: Age, APACHE II, SOFA>value of 6 points, along with vasopressor requirements or renal replacement therapy have been identified as predictor factors of mortality at six weeks. Administration of corticosteroids showed no benefits in mortality, as did treatment with tocilizumab. Lopinavir/ritonavir administration is identified as a protective factor.

Evaluación de la cirugía de la catarata asistida con láser femtosegundo tras 10 años de aplicación clínica / Evaluation of femtosecond laser-assisted cataract surgery after 10 years of clinical application

INTRODUCCIÓN: La cirugía de la catarata asistida con el láser femtosegundo (FLACS) se ha considerado un avance tecnológico en la cirugía moderna de la catarata. Tras los años de experiencia, se ha observado que los resultados clínicos presentan más complicaciones de las esperadas al inicio. Con este estudio queremos comparar los beneficios e inconvenientes de la técnica FLACS con la cirugía de catarata convencional. MÉTODO: Utilizamos las plataformas PubMed y Web of Science para la búsqueda de la literatura científica. RESULTADOS: Actualmente, el FLACS ha mejorado la técnica quirúrgica en cuanto al menor tiempo de ultrasonidos empleado y a la menor pérdida de células endoteliales. Asimismo, el centrado de la capsulotomía y la corrección del astigmatismo con las incisiones arqueadas han mejorado. Como inconvenientes destacan el alto coste del láser, las complicaciones intraoperatorias sobre la cápsula, la inducción de miosis intraoperatoria y la curva de aprendizaje de la técnica. CONCLUSIONES: Consideramos la técnica FLACS beneficiosa para casos concretos como pacientes con cirugía premium programada o con bajo recuento de células endoteliales. No obstante, creemos que, dado el coste tecnológico, no es una técnica rentable para la mayoría de los casos de nuestra práctica clínica diaria, que son casos estándares

INTRODUCTION: Femtosecond laser-assisted cataract surgery (FLACS) has been considered a technological advance in modern cataract surgery. After years of experience, it has been observed that clinical outcomes had more complications than expected at the beginning. The aim of this study is to compare the benefits and disadvantages of the FLACS technique with conventional cataract surgery. METHOD: The PubMed and Web of Science platforms were used to search for scientific literature. RESULTS: The FLACS has currently improved the surgical technique in terms of the shorter ultrasound time used and the lower loss of endothelial cells. Likewise, the centration of capsulotomy and the correction of astigmatism with arcuate incisions have also been improved. As disadvantages, are the high cost of the laser, the intraoperative capsular complications, the induction of intraoperative myosis, and the learning curve of the technique. CONCLUSIONS: The FLACS technique is considered beneficial for specific cases, such as patients with scheduled premium surgery, or with low endothelial cell count. However, it is believed that given the technological cost it is not a cost effective technique for most standard cases in our daily clinical practice

Evaluation of femtosecond laser-assisted cataract surgery after 10 years of clinical application. / Evaluación de la cirugía de la catarata asistida con láser femtosegundo tras 10 años de aplicación clínica.

INTRODUCTION: Femtosecond laser-assisted cataract surgery (FLACS) has been considered a technological advance in modern cataract surgery. After years of experience, it has been observed that clinical outcomes had more complications than expected at the beginning. The aim of this study is to compare the benefits and disadvantages of the FLACS technique with conventional cataract surgery. METHOD: The PubMed and Web of Science platforms were used to search for scientific literature. RESULTS: The FLACS has currently improved the surgical technique in terms of the shorter ultrasound time used and the lower loss of endothelial cells. Likewise, the centration of capsulotomy and the correction of astigmatism with arcuate incisions have also been improved. As disadvantages, are the high cost of the laser, the intraoperative capsular complications, the induction of intraoperative myosis, and the learning curve of the technique. CONCLUSIONS: The FLACS technique is considered beneficial for specific cases, such as patients with scheduled premium surgery, or with low endothelial cell count. However, it is believed that given the technological cost it is not a cost effective technique for most standard cases in our daily clinical practice.

Comparación de los resultados perioperatorios de la cistectomía radical asistida por robot con derivación urinaria extracorpórea vs. Intracorpórea / Comparison of perioperative outcomes and complications of robot assisted radical cystectomy with extracorporeal vs intracorporeal urinary diversion

Objetivos: Comparar los resultados perioperatorios y las complicaciones de la cistectomía radical asistida por robot (CRAR) con derivación urinaria extracorpórea (DUEC) vs. intracorpórea (DUIC). Material y métodos: Revisión retrospectiva de 43 pacientes sometidos a CRAR por tumor vesical entre 2015-2018 con seguimiento mínimo de 3 meses. Se analizó la serie inicial de CRAR realizada por un cirujano con amplia experiencia en cistectomía radical abierta. Resultados: Cuarenta y tres pacientes, 40 hombres (93%) y 3 mujeres (7%), con mediana de edad de 65 años (44-83) y seguimiento medio de 27,7 meses (± 20,1) fueron sometidos a CRAR. Se realizó DUEC en 22 casos (51%), 10 conductos ileales (45,5%) y 12 neovejigas (54,5%), y DUIC en 21 (49%), 14 conductos ileales (66,7%) y 7 neovejigas (33,3%). Las características clínicas y preoperatorias fueron comparables entre grupos. La mediana de tiempo operatorio fue 360minutos (240-540) y de estancia hospitalaria 12 días (7-73). Treinta y cinco pacientes (81%) presentaron complicaciones postoperatorias, de las cuales 10 (23%) fueron mayores. No se encontraron diferencias en tiempo operatorio, complicaciones perioperatorias, estadificación patológica, márgenes y número de ganglios extirpados entre DUEC y DUIC. Los pacientes sometidos a DUEC presentaron mayor tasa de estenosis uretero-ileal en comparación con la DUIC (45,5% vs. 14,3%, p = 0,026). En las neovejigas la DUEC presentó mayor tasa de estenosis uretroneovesical que la DUIC (33% vs. 0%, p = 0,044). Conclusiones: La CRAR con derivación urinaria intracorpórea ofrece resultados perioperatorios y complicaciones comparables a la extracorpórea. La derivación intracorpórea podría reducir el riesgo de desarrollar estenosis ureteroileal y uretroneovesical

Objectives: To compare perioperative outcomes and complications of robot assisted radical cystectomy (RARC) with extracorporeal (ECUD) vs. intracorporeal urinary diversion (ICUD) for bladder cancer. Material and methods: Retrospective revision of 43 patients who underwent RARC for bladder cancer between 2015 and 2018 with at least 3 months of follow-up. The analysis included the initial series of RARC performed by one surgeon with extensive experience in open radical cystectomy. Results: Forty-three patients, 40 men (93%) and 3 women (7%), with a median age of 65 years (44-83) and mean follow-up of 27.7 months (±20.1) underwent RARC. A ECUD was performed in 22 cases (51%), of whom 10 were ileal conduits (45.5%) and 12 neobladders (54.5), and ICUD in 21 cases (49%), of whom 14 were ileal conduits (66.7%) and 7 neobladders (33.3%). Clinical and preoperative characteristics were similar in both groups. The median operative time was 360 min (240-540) and length of hospital stay was 12 days (7-73). Thirty-five patients (81%) had postoperative complications, of whom 10 (23%) were major. Operative time, peroperative complications, pathological stage, positive margins, and number of lymph nodes removed did not significantly differ among groups. Patients who underwent ECUD had a higher rate of uretero-ileal strictures than those with ICUD (45.5% vs. 14.3%, p = 0.026). Among the neobladders, the ECUD developed a higher rate of urethro-neobladder stricture than the ICUD (33% vs. 0%, p = 0.044). Conclusions: RARC with ICUD achieved peroperative outcomes and complication rates comparable than those with ECUD. The ICUD could reduce the risk of developing uretero-ileal and urethro-neobladder strictures

Comparison of perioperative outcomes and complications of robot assisted radical cystectomy with extracorporeal vs intracorporeal urinary diversion. / Comparación de los resultados perioperatorios de la cistectomía radical asistida por robot con derivación urinaria extracorpórea vs. intracorpórea.

OBJECTIVES: To compare perioperative outcomes and complications of robot assisted radical cystectomy (RARC) with extracorporeal (ECUD) vs. intracorporeal urinary diversion (ICUD) for bladder cancer. MATERIAL AND METHODS: Retrospective revision of 43 patients who underwent RARC for bladder cancer between 2015-2018 with at least 3 months of follow-up. The analysis included the initial series of RARC performed by one surgeon with extensive experience in open radical cystectomy. RESULTS: Forty-three patients, 40 men (93%) and 3 women (7%), with a median age of 65 years (44-83) and mean follow-up of 27.7 months (±20.1) underwent RARC. A ECUD was performed in 22 cases (51%), of whom 10 were ileal conduits (45.5%) and 12 neobladders (54.5), and ICUD in 21 cases (49%), of whom 14 were ileal conduits (66.7%) and 7 neobladders (33.3%). Clinical and preoperative characteristics were similar in both groups. The median operative time was 360 minutes (240-540) and length of hospital stay was 12 days (7-73). Thirty-five patients (81%) had postoperative complications, of whom 10 (23%) were major. Operative time, peroperative complications, pathological stage, positive margins, and number of lymph nodes removed did not significantly differ among groups. Patients who underwent ECUD had a higher rate of uretero-ileal strictures than those with ICUD (45.5% vs. 14.3%, P=.026). Among the neobladders, the ECUD developed a higher rate of urethro-neobladder stricture than the ICUD (33% vs. 0%, P=.044). CONCLUSIONS: RARC with ICUD achieved peroperative outcomes and complication rates comparable than those with ECUD. The ICUD could reduce the risk of developing uretero-ileal and urethro-neobladder strictures.

Vasculatura fetal persistente unilateral asociada a disgenesia del segmento anterior / Unilateral persistent fetal vasculature coexisting with anterior segment dysgenesia

CASO CLÍNICO: Presentamos un caso clínico de una neonata de 4 semanas con anomalía de Peters (PA, por sus siglas en inglés) y persistencia de vasculatura fetal unilateral (PFV, por sus siglas en inglés), remitida a nuestro servicio con el diagnóstico de esotropia. A las 12 semanas de vida se realizó una queratoplastia penetrante y vitrectomía, sin complicaciones relevantes en el postoperatorio inmediato. Actualmente la paciente se encuentra bajo tratamiento intensivo de ambliopía y glaucoma secundario. Discusión: El tratamiento quirúrgico de la PFV es controvertido, siendo la prevención de ambliopía, phthisis y glaucoma las principales razones que lo motivan. Los pacientes afectos de PFV unilateral y PA tipo II, podrían ser buenos candidatos para un procedimiento quirúrgico combinado como el descrito

CASE REPORT: A case is presented of a 4 week-old female neonate with Peters anomaly (PA) and unilateral persistent foetal vasculature (PFV) referred to our centre due to esotropia. At 12 weeks of age, a penetrating keratoplasty and vitrectomy were performed without major complications in the immediate post-operative period. The patient is currently under an intensive treatment for amblyopia and secondary glaucoma. Discussion: Surgical treatment of PFV is controversial, with prevention of amblyopia, phthisis, and glaucoma being the main reasons for it. Patients with unilateral PFV and type II PA could be good candidates for this combined surgical procedure

Unilateral persistent fetal vasculature coexisting with anterior segment dysgenesia. / Vasculatura fetal persistente unilateral asociada a disgenesia del segmento anterior.

CASE REPORT: A case is presented of a 4 week-old female neonate with Peters anomaly (PA) and unilateral persistent foetal vasculature (PFV) referred to our centre due to esotropia. At 12 weeks of age, a penetrating keratoplasty and vitrectomy were performed without major complications in the immediate post-operative period. The patient is currently under an intensive treatment for amblyopia and secondary glaucoma. DISCUSSION: Surgical treatment of PFV is controversial, with prevention of amblyopia, phthisis, and glaucoma being the main reasons for it. Patients with unilateral PFV and type II PA could be good candidates for this combined surgical procedure.

Speed-up hyperspheres homotopic path tracking algorithm for PWL circuits simulations.

In the present work, we introduce an improved version of the hyperspheres path tracking method adapted for piecewise linear (PWL) circuits. This enhanced version takes advantage of the PWL characteristics from the homotopic curve, achieving faster path tracking and improving the performance of the homotopy continuation method (HCM). Faster computing time allows the study of complex circuits with higher complexity; the proposed method also decrease, significantly, the probability of having a diverging problem when using the Newton-Raphson method because it is applied just twice per linear region on the homotopic path. Equilibrium equations of the studied circuits are obtained applying the modified nodal analysis; this method allows to propose an algorithm for nonlinear circuit analysis. Besides, a starting point criteria is proposed to obtain better performance of the HCM and a technique for avoiding the reversion phenomenon is also proposed. To prove the efficiency of the path tracking method, several cases study with bipolar (BJT) and CMOS transistors are provided. Simulation results show that the proposed approach can be up to twelve times faster than the original path tracking method and also helps to avoid several reversion cases that appears when original hyperspheres path tracking scheme was employed.

The use of the acute Pd/Pa drop after intracoronary nitroglycerin infusion to rule out significant FFR: CANICA (Can intracoronary nitroglycerin predict fractional flow reserve without adenosine?) multicenter study.

OBJECTIVE: Functional assessment of coronary artery stenosis is performed by measuring the fractional flow reserve (FFR) under hyperemic conditions (Adenosine). However, the use of adenosine portends limitations. OBJECTIVE: We sought to investigate the relationship and correlation between FFR and the Pd/Pa value obtained just after the intracoronary infusion (acute drop) of nitroglycerin (Pd/Pa-NTG) and if this parameter enhances diagnostic accuracy for FFR prediction compared to the resting baseline Pd/Pa. METHODS: We conducted a multicenter study including prospectively patients presenting intermediate coronary artery stenosis (30-70%) evaluated with pressure wire. Resting baseline Pd/Pa, Pd/Pa-NTG and FFR were measured. RESULTS: 283 patients (335 lesions) were included. Resting baseline Pd/Pa value was 0.72 to 1.0 (0.93 ± 0.04), Pd/Pa-NTG was 0.60 to 1.0 (0.87 ± 0.07) and FFR 0.55 to 1.0 (0.83 ± 0.08). The ROC curves for resting baseline Pd/Pa and for Pd/Pa-NTG, using a FFR ≤ 0.80 showed an AUC of 0.88 (95% CI: 0.84-0.92, P < 0.001) and 0.94 (95% CI: 0.92-0.96, P < 0.001) respectively. The optimal cutoff values of resting baseline Pd/Pa and Pd/Pa-NTG for an FFR > 0.80, were >0.96 and >0.88, respectively. These values were present in a 29.8% (n = 100) and a 47.1% (n = 158), of the total lesions. Scatter plots showed a better correlation and agreement points with Pd/Pa-NTG than resting baseline Pd/Pa. The cutoff value of Pd/Pa-NTG > 0.88 showed an excellent NPV (96.2% for FFR > 0.8 and 100% for FFR > 0.75) and sensitivity (95% for FFR > 0.8 and 100% for FFR > 0.75) which were consistently high across all the subgroups analysis. CONCLUSION: The cutoff value of acute Pd/Pa-NTG > 0.88 has a high NPV meaning adenosine-FFR can be avoided in almost half of lesions.

Atrofia macular en el síndrome de Terson / Macular atrophy in Terson‘s syndrome

CASO CLÍNICO: Se presenta el caso clínico de un varón de 63 años con una atrofia macular en el curso de un síndrome de Terson. El paciente mostraba una disminución de la agudeza visual con adelgazamiento macular observado en la tomografía óptica de coherencia. DISCUSIÓN: El paciente presentó una atrofia macular probablemente secundaria a una hemorragia en polo posterior, tras síndrome de Terson causado por la rotura de un aneurisma cerebral

CASE REPORT: The case is presented on a 63-year-old patient with Terson's syndrome who complained of loss of visual acuity. The optical coherence tomography showed macular atrophy. DISCUSSION: The patient developed macular atrophy probably secondary to macular hemorrhage caused by the rupture of a cerebral aneurysm

[Macular atrophy in Terson's syndrome]. / Atrofia macular en el síndrome de Terson.

CASE REPORT: The case is presented on a 63-year-old patient with Terson's syndrome who complained of loss of visual acuity. The optical coherence tomography showed macular atrophy. DISCUSSION: The patient developed macular atrophy probably secondary to macular hemorrhage caused by the rupture of a cerebral aneurysm.

[Physical activity programmes to reduce overweight and obesity in children and adolescents; a systematic review]. / Programas de actividad física para reducir sobrepeso y obesidad en niños y adolescentes; revisión sistemática.

INTRODUCTION: Obesity treatment has been the subject of much controversy; various authors have recommended the application of a comprehensive treatment programme, and in the light of this previous research, we consider the question of what is the most effective programme of physical activity to reduce overweight and obesity in children and adolescents. AIMS: To analyse major studies on the effectiveness of physical activity in reducing overweight and obesity in children and adolescents. METHOD: Systematic review of the results of physical activity programmes, published in scientific articles, to reduce overweight and obesity. Using an automated database search in PubMed and Google Scholar, conducted from October 2013 to March 2014, we identified 85 valid items. In selecting the items, the criteria applied included the usefulness and relevance of the subject matter and the credibility or experience of the research study authors. The internal and external validity of each of the articles reviewed was taken into account. CONCLUSIONS: This review confirmed the effectiveness of physical activity in reducing overweight and obesity in children and adolescents. The most effective programmes were those combining aerobic and anaerobic exercises. It is generally accepted that at least 180 minutes per week should be dedicated to exercise, in the form of three 60-minute sessions of moderate intensity. Such programmes could be sufficient for persons with overweight or obesity. Researchers in this field agree that when a diet based on an appropriate distribution of meals is combined with regular physical activity, they reinforce each other, and thus optimum results are obtained. Weight reduction programmes that take account of family involvement are more effective than nutrition education itself or other routine interventions that fail to consider family involvement. The role of pa rents and of the persons around the child or adolescent is essential to reinforce positive behaviour toward lifestyle change.

Introducción: El tratamiento contra la obesidad ha sido muy discutido y varios autores abogan por un tratamiento integral de la obesidad. Todos los referentes conducen a plantear ¿cuál es el programa de actividad física más efectivo para reducir el sobrepeso y la obesidad de niños y adolescentes? Objetivo: Analizar los principales estudios sobre la eficacia de la actividad física para reducir el sobrepeso y la obesidad de niños y adolescentes. Método: Revisión sistemática de los resultados de programas de actividad física para reducir el sobrepeso y la obesidad publicados en artículos científicos. Se identificaron 85 artículos a través de la búsqueda automatizada en las bases de datos PUBMED y Google Scholar; se llevó a cabo entre los meses de octubre de 2013 y marzo de 2014. Para seleccionar los artículos fue preciso considerar la utilidad y la relevancia del tema estudiado y la credibilidad o experiencia de los autores en la temática. Se tuvo en cuenta la validez interna y externa de cada uno de los artículos revisados. Conclusiones: Se identificó la efectividad de la actividad física para reducir el sobrepeso y la obesidad de niños y adolescentes. El programa de actividad física más efectivo es el que combina ejercicios aeróbicos y anaeróbicos. Existe consenso en acumular más de 180 minutos a la semana dedicados a estos fines, con 3 sesiones de 60 minutos cada una de ejercicio físico a la semana. De una intensidad moderada, podrían ser suficientes para ejecutar un programa de ejercicio físico para esas personas con sobrepeso y obesidad. Coinciden los autores en que, cuando se combina una dieta controlada por una adecuada distribución de las comidas y con la práctica de actividad física, se potencian mutuamente, con lo que se obtie nen los mejores resultados. Los programas de reducción de peso que tengan en cuenta la participación familiar son más eficaces que la propia educación alimentaria y otras intervenciones de rutina que no consideren esa participación familiar. El rol de los padres y de las personas que rodean al niño y al adolescente es fundamental para reforzar las conductas positivas hacia el cambio de estilo de vida.

Programas de actividad física para reducir sobrepeso y obesidad en niños y adolescentes; revisión sistemática / Physical activity programmes to reduce overweight and obesity in children and adolescents; a systematic review

Introducción: El tratamiento contra la obesidad ha sido muy discutido y varios autores abogan por un tratamiento integral de la obesidad. Todos los referentes conducen a plantear ¿cuál es el programa de actividad física más efectivo para reducir el sobrepeso y la obesidad de niños y adolescentes? Objetivo: Analizar los principales estudios sobre la eficacia de la actividad física para reducir el sobrepeso y la obesidad de niños y adolescentes. Método: Revisión sistemática de los resultados de programas de actividad física para reducir el sobrepeso y la obesidad publicados en artículos científicos. Se identificaron 85 artículos a través de la búsqueda automatizada en las bases de datos PUBMED y Google Scholar; se llevó a cabo entre los meses de octubre de 2013 y marzo de 2014. Para seleccionar los artículos fue preciso considerar la utilidad y la relevancia del tema estudiado y la credibilidad o experiencia de los autores en la temática. Se tuvo en cuenta la validez interna y externa de cada uno de los artículos revisados. Conclusiones: Se identificó la efectividad de la actividad física para reducir el sobrepeso y la obesidad de niños y adolescentes. El programa de actividad física más efectivo es el que combina ejercicios aeróbicos y anaeróbicos. Existe consenso en acumular más de 180 minutos a la semana dedicados a estos fines, con 3 sesiones de 60 minutos cada una de ejercicio físico a la semana. De una intensidad moderada, podrían ser suficientes para ejecutar un programa de ejercicio físico para esas personas con sobrepeso y obesidad. Coinciden los autores en que, cuando se combina una dieta controlada por una adecuada distribución de las comidas y con la práctica de actividad física, se potencian mutuamente, con lo que se obtienen los mejores resultados. Los programas de reducción de peso que tengan en cuenta la participación familiar son más eficaces que la propia educación alimentaria y otras intervenciones de rutina que no consideren esa participación familiar. El rol de los padres y de las personas que rodean al niño y al adolescente es fundamental para reforzar las conductas positivas hacia el cambio de estilo de vida (AU)

Introduction: Obesity treatment has been the subject of much controversy; various authors have recommended the application of a comprehensive treatment programme, and in the light of this previous research, we consider the question of what is the most effective programme of physical activity to reduce overweight and obesity in children and adolescents. Aims: To analyse major studies on the effectiveness of physical activity in reducing overweight and obesity in children and adolescents. Method: Systematic review of the results of physical activity programmes, published in scientific articles, to reduce overweight and obesity. Using an automated database search in PubMed and Google Scholar, conducted from October 2013 to March 2014, we identified 85 valid items. In selecting the items, the criteria applied included the usefulness and relevance of the subject matter and the credibility or experience of the research study authors. The internal and external validity of each of the articles reviewed was taken into account. Conclusions: This review confirmed the effectiveness of physical activity in reducing overweight and obesity in children and adolescents. The most effective programmes were those combining aerobic and anaerobic exercises. It is generally accepted that at least 180 minutes per week should be dedicated to exercise, in the form of three 60-minute sessions of moderate intensity. Such programmes could be sufficient for persons with overweight or obesity. Researchers in this field agree that when a diet based on an appropriate distribution of meals is combined with regular physical activity, they reinforce each other, and thus optimum results are obtained. Weight reduction programmes that take account of family involvement are more effective than nutrition education itself or other routine interventions that fail to consider family involvement. The role of parents and of the persons around the child or adolescent is essential to reinforce positive behaviour toward lifestyle change (AU)

Modified hyperspheres algorithm to trace homotopy curves of nonlinear circuits composed by piecewise linear modelled devices.

We present a homotopy continuation method (HCM) for finding multiple operating points of nonlinear circuits composed of devices modelled by using piecewise linear (PWL) representations. We propose an adaptation of the modified spheres path tracking algorithm to trace the homotopy trajectories of PWL circuits. In order to assess the benefits of this proposal, four nonlinear circuits composed of piecewise linear modelled devices are analysed to determine their multiple operating points. The results show that HCM can find multiple solutions within a single homotopy trajectory. Furthermore, we take advantage of the fact that homotopy trajectories are PWL curves meant to replace the multidimensional interpolation and fine tuning stages of the path tracking algorithm with a simple and highly accurate procedure based on the parametric straight line equation.