La importancia de la geriatría transversal en la cirugía abdominal oncológica / The importance of cross-speciality geriatrics in abdominal oncologic surgery

Introducción. El paciente de edad avanzada es el usuario más frecuente en los centros sanitarios. La Geriatría transversal comparteel proceso asistencial con el cirujano atendiendo la esfera cognitiva, funcional y social del paciente, con el objetivo de optimizar loscuidados (tales como mantenimiento de la independencia funcional, nutrición, detección del deterioro cognitivo…) ofreciendo unacobertura integral y reduciendo complicaciones, costes y estancia hospitalaria de manera sobreañadida. El objetivo del trabajo esdar visibilidad a la contribución que el geriatra puede llevar acabo en los servicios de Cirugía General. Material y métodos. Seriede casos mediante estudio descriptivo retrospectivo en el que se analizaron los pacientes mayores de 75 años intervenidos de cáncerde colón durante el año 2021 en el Hospital Central de la Cruz Roja mediante cirugía programada y su evolución clínica posteriora los 6 meses. Resultados: 10 pacientes (80% mujeres), edad media 76,4 años (±3,2), Escala Cruz Roja Funcional media de 1/5(±0,9), con índice de Barthel modificado 80/100 (±15,2), Escala Cruz Roja Mental de 0/5 (±0,6). Índice de Charlson medio de 4,3puntos (±2,2) con 60% enfermedades cardiovasculares, 20% insuficiencia renal crónica y 20% neumopatías. Destacó la elevadapolifarmacia (100%) y desnutrición (60%) previo a la cirugía. El 50% presentó delirium y el 40% padeció insuficiencia cardiacadescompensada. Conclusiones. La Geriatría transversal ayuda a detectar necesidades silentes y debe participar en la atenciónmulticomponente tanto previa a la cirugía (prehabilitación) como en la hospitalización y seguimiento posterior, colaborando con el cirujano en la atención al paciente crónico complejo geriátrico. (AU)

Introduction. The older patient is the most frequent user in healthcare centers. Cross-speciality geriatrics shares the care processwith the surgeon attending the cognitive, functional and social sphere of the patient, with the aim of optimizing care (such asmaintenance of functional independence, nutrition, detection of cognitive deterioration...) offering a comprehensive coverage andreducing complications, costs and hospital stay in a superadded way. The aim of this study is to give visibility to the contributionthat geriatricians can make in general surgery services. Material and methods. Case series by retrospective descriptive study inwhich patients over 75 years of age operated on for colon cancer during the year 2021 in the Central Hospital of the Red Cross byscheduled surgery and their clinical evolution after 6 months were analyzed. Results: 10 patients (80% women), mean age 76.4years (±3.2), mean Functional Red Cross Scale of 1/5 (±0.9), with modified Barthel index 80/100 (±15.2), Mental Red Cross Scaleof 0/5 (±0.6). Mean Charlson index of 4.3 points (±2.2) with 60% cardiovascular disease, 20% chronic renal failure and 20% pneumopathies. The high polypharmacy (100%) and malnutrition (60%) prior to surgery stood out. Fifty percent presented deliriumand 40% suffered from decompensated heart failure. Conclusions. Cross-speciality geriatrics helps to detect silent needs and shouldparticipate in multicomponent care both prior to surgery, during hospitalization and subsequent follow-up, collaborating with thesurgeon in the care of the geriatric complex chronic patient. (AU)

Divergent abiotic spectral pathways unravel pathogen stress signals across species.

Plant pathogens pose increasing threats to global food security, causing yield losses that exceed 30% in food-deficit regions. Xylella fastidiosa (Xf) represents the major transboundary plant pest and one of the world's most damaging pathogens in terms of socioeconomic impact. Spectral screening methods are critical to detect non-visual symptoms of early infection and prevent spread. However, the subtle pathogen-induced physiological alterations that are spectrally detectable are entangled with the dynamics of abiotic stresses. Here, using airborne spectroscopy and thermal scanning of areas covering more than one million trees of different species, infections and water stress levels, we reveal the existence of divergent pathogen- and host-specific spectral pathways that can disentangle biotic-induced symptoms. We demonstrate that uncoupling this biotic-abiotic spectral dynamics diminishes the uncertainty in the Xf detection to below 6% across different hosts. Assessing these deviating pathways against another harmful vascular pathogen that produces analogous symptoms, Verticillium dahliae, the divergent routes remained pathogen- and host-specific, revealing detection accuracies exceeding 92% across pathosystems. These urgently needed hyperspectral methods advance early detection of devastating pathogens to reduce the billions in crop losses worldwide.

Detection of Xylella fastidiosa in almond orchards by synergic use of an epidemic spread model and remotely sensed plant traits.

The early detection of Xylella fastidiosa (Xf) infections is critical to the management of this dangerous plan pathogen across the world. Recent studies with remote sensing (RS) sensors at different scales have shown that Xf-infected olive trees have distinct spectral features in the visible and infrared regions (VNIR). However, further work is needed to integrate remote sensing in the management of plant disease epidemics. Here, we research how the spectral changes picked up by different sets of RS plant traits (i.e., pigments, structural or leaf protein content), can help capture the spatial dynamics of Xf spread. We coupled a spatial spread model with the probability of Xf-infection predicted by a RS-driven support vector machine (RS-SVM) model. Furthermore, we analyzed which RS plant traits contribute most to the output of the prediction models. For that, in almond orchards affected by Xf (n = 1426 trees), we conducted a field campaign simultaneously with an airborne campaign to collect high-resolution thermal images and hyperspectral images in the visible-near-infrared (VNIR, 400-850 nm) and short-wave infrared regions (SWIR, 950-1700 nm). The best performing RS-SVM model (OA = 75%; kappa = 0.50) included as predictors leaf protein content, nitrogen indices (NIs), fluorescence and a thermal indicator (Tc), alongside pigments and structural parameters. Leaf protein content together with NIs contributed 28% to the explanatory power of the model, followed by chlorophyll (22%), structural parameters (LAI and LIDFa), and chlorophyll indicators of photosynthetic efficiency. Coupling the RS model with an epidemic spread model increased the accuracy (OA = 80%; kappa = 0.48). In the almond trees where the presence of Xf was assayed by qPCR (n = 318 trees), the combined RS-spread model yielded an OA of 71% and kappa = 0.33, which is higher than the RS-only model and visual inspections (both OA = 64-65% and kappa = 0.26-31). Our work demonstrates how combining spatial epidemiological models and remote sensing can lead to highly accurate predictions of plant disease spatial distribution.

Chlorophyll content estimation in an open-canopy conifer forest with Sentinel-2A and hyperspectral imagery in the context of forest decline.

With the advent of Sentinel-2, it is now possible to generate large-scale chlorophyll content maps with unprecedented spatial and temporal resolution, suitable for monitoring ecological processes such as vegetative stress and/or decline. However methodological gaps exist for adapting this technology to heterogeneous natural vegetation and for transferring it among vegetation species or plan functional types. In this study, we investigated the use of Sentinel-2A imagery for estimating needle chlorophyll (Ca+b) in a sparse pine forest undergoing significant needle loss and tree mortality. Sentinel-2A scenes were acquired under two extreme viewing geometries (June vs. December 2016) coincident with the acquisition of high-spatial resolution hyperspectral imagery, and field measurements of needle chlorophyll content and crown leaf area index. Using the high-resolution hyperspectral scenes acquired over 61 validation sites we found the CI chlorophyll index R750/R710 and Macc index (which uses spectral bands centered at 680 nm, 710 nm and 780 nm) had the strongest relationship with needle chlorophyll content from individual tree crowns (r2 = 0.61 and r2 = 0.59, respectively; p < 0.001), while TCARI and TCARI/OSAVI, originally designed for uniform agricultural canopies, did not perform as well (r2 = 0.21 and r2 = 0.01, respectively). Using lower-resolution Sentinel-2A data validated against hyperspectral estimates and ground truth needle chlorophyll content, the red-edge index CI and the Sentinel-specific chlorophyll indices CI-Gitelson, NDRE1 and NDRE2 had the highest accuracy (with r2 values >0.7 for June and >0.4 for December; p < 0.001). The retrieval of needle chlorophyll content from the entire Sentinel-2A bandset using the radiative transfer model INFORM yielded r2 = 0.71 (RMSE = 8.1 µg/cm2) for June, r2 = 0.42 (RMSE = 12.2 µg/cm2) for December, and r2 = 0.6 (RMSE = 10.5 µg/cm2) as overall performance using the June and December datasets together. This study demonstrates the retrieval of leaf Ca+b with Sentinel-2A imagery by red-edge indices and by an inversion method based on a hybrid canopy reflectance model that accounts for tree density, background and shadow components common in sparse forest canopies.

Previsual symptoms of Xylella fastidiosa infection revealed in spectral plant-trait alterations.

Plant pathogens cause significant losses to agricultural yields and increasingly threaten food security1, ecosystem integrity and societies in general2-5. Xylella fastidiosa is one of the most dangerous plant bacteria worldwide, causing several diseases with profound impacts on agriculture and the environment6. Primarily occurring in the Americas, its recent discovery in Asia and Europe demonstrates that X. fastidiosa's geographic range has broadened considerably, positioning it as a reemerging global threat that has caused socioeconomic and cultural damage7,8. X. fastidiosa can infect more than 350 plant species worldwide9, and early detection is critical for its eradication8. In this article, we show that changes in plant functional traits retrieved from airborne imaging spectroscopy and thermography can reveal X. fastidiosa infection in olive trees before symptoms are visible. We obtained accuracies of disease detection, confirmed by quantitative polymerase chain reaction, exceeding 80% when high-resolution fluorescence quantified by three-dimensional simulations and thermal stress indicators were coupled with photosynthetic traits sensitive to rapid pigment dynamics and degradation. Moreover, we found that the visually asymptomatic trees originally scored as affected by spectral plant-trait alterations, developed X. fastidiosa symptoms at almost double the rate of the asymptomatic trees classified as not affected by remote sensing. We demonstrate that spectral plant-trait alterations caused by X. fastidiosa infection are detectable previsually at the landscape scale, a critical requirement to help eradicate some of the most devastating plant diseases worldwide.

Understanding the temporal dimension of the red-edge spectral region for forest decline detection using high-resolution hyperspectral and Sentinel-2a imagery.

The operational monitoring of forest decline requires the development of remote sensing methods that are sensitive to the spatiotemporal variations of pigment degradation and canopy defoliation. In this context, the red-edge spectral region (RESR) was proposed in the past due to its combined sensitivity to chlorophyll content and leaf area variation. In this study, the temporal dimension of the RESR was evaluated as a function of forest decline using a radiative transfer method with the PROSPECT and 3D FLIGHT models. These models were used to generate synthetic pine stands simulating decline and recovery processes over time and explore the temporal rate of change of the red-edge chlorophyll index (CI) as compared to the trajectories obtained for the structure-related Normalized Difference Vegetation Index (NDVI). The temporal trend method proposed here consisted of using synthetic spectra to calculate the theoretical boundaries of the subspace for healthy and declining pine trees in the temporal domain, defined by CItime=n/CItime=n+1 vs. NDVItime=n/NDVItime=n+1. Within these boundaries, trees undergoing decline and recovery processes showed different trajectories through this subspace. The method was then validated using three high-resolution airborne hyperspectral images acquired at 40 cm resolution and 260 spectral bands of 6.5 nm full-width half-maximum (FWHM) over a forest with widespread tree decline, along with field-based monitoring of chlorosis and defoliation (i.e., 'decline' status) in 663 trees between the years 2015 and 2016. The temporal rate of change of chlorophyll vs. structural indices, based on reflectance spectra extracted from the hyperspectral images, was different for trees undergoing decline, and aligned towards the decline baseline established using the radiative transfer models. By contrast, healthy trees over time aligned towards the theoretically obtained healthy baseline. The applicability of this temporal trend method to the red-edge bands of the MultiSpectral Imager (MSI) instrument on board Sentinel-2a for operational forest status monitoring was also explored by comparing the temporal rate of change of the Sentinel-2-derived CI over areas with declining and healthy trees. Results demonstrated that the Sentinel-2a red-edge region was sensitive to the temporal dimension of forest condition, as the relationships obtained for pixels in healthy condition deviated from those of pixels undergoing decline.

Calidad de vida a los 6 meses tras un ictus / Quality of life 6 months after a stroke

Objetivo. Describir la calidad de vida (CV) de los pacientes a los 6 meses de evolución del ictus y su relación con variables sociodemográficas, clínicas y funcionales. Material y métodos. Estudio multicéntrico de cohortes longitudinal (n = 157). Los pacientes incluidos ingresaron en la fase subaguda tras un ictus en 2 Servicios de Rehabilitación. Se recogieron los siguientes datos a los 6 meses postictus: género, edad, riesgo social, comorbilidad, disfagia, afasia, estado cognitivo, depresión y grado de discapacidad evaluado mediante el índice de Barthel modificado. Se evaluó la influencia de estas variables en la CV, para lo que se empleó la escala específica de calidad de vida para el ictus ECVI-38. Resultados. La media de edad fue de 70,93 ± 11,85 años; fue significativamente superior en las mujeres. El paciente tipo presentó una elevada comorbilidad, un bajo riesgo social y dependencia moderada. La puntuación media total de la escala ECVI-38 fue de 35,30 ± 16,17 y los dominios más afectados los referentes a las actividades comunes y básicas de la vida diaria. Las variables que más se relacionan con la CV fueron el género, la afasia, la disfagia, la depresión, el déficit cognitivo y el estado funcional. El dolor de elevada intensidad estuvo presente en un 21% de los pacientes. Conclusión. Son muy diversas las variables que influyen en la CV del paciente con ictus que se deben considerar, para su potencial abordaje, en la planificación de las intervenciones rehabilitadoras (AU)

Objective. To describe quality of life (QoL) in patients at 6 months poststroke and its relationship with sociodemographic, clinical and functional characteristics. Material and method. This multicenter longitudinal cohort study (n = 157) included patients from 2 hospital rehabilitation services who were admitted for stroke in the subacute phase. The following data were gathered at 6 months poststroke: gender, age, social risk, comorbidity, dysphagia, aphasia, cognitive status, depression, and disability measured by the modified Barthel Index. The influence of these variables on QoL was evaluated using the stroke-specific quality of life scale, ECVI-38. Results. The mean age was 70.93 ± 11.85 years and was significantly higher in women. Most of the patients had high comorbidity, low social risk and moderate dependence. The mean total score on the ECVI-38 scale was 35.30 ± 16.17 and the most affected domains were those concerning common and basic activities of daily living. The variables associated with QoL were gender, aphasia, dysphagia, depression, cognitive impairment, and functional status. High-intensity pain was present in 21% of patients. Conclusion. Numerous variables influence QoL in patients with stroke and should be considered in the planning of rehabilitation interventions (AU)

Unmanned aerial platform-based multi-spectral imaging for field phenotyping of maize.

BACKGROUND: Recent developments in unmanned aerial platforms (UAP) have provided research opportunities in assessing land allocation and crop physiological traits, including response to abiotic and biotic stresses. UAP-based remote sensing can be used to rapidly and cost-effectively phenotype large numbers of plots and field trials in a dynamic way using time series. This is anticipated to have tremendous implications for progress in crop genetic improvement. RESULTS: We present the use of a UAP equipped with sensors for multispectral imaging in spatial field variability assessment and phenotyping for low-nitrogen (low-N) stress tolerance in maize. Multispectral aerial images were used to (1) characterize experimental fields for spatial soil-nitrogen variability and (2) derive indices for crop performance under low-N stress. Overall, results showed that the aerial platform enables to effectively characterize spatial field variation and assess crop performance under low-N stress. The Normalized Difference Vegetation Index (NDVI) data derived from spectral imaging presented a strong correlation with ground-measured NDVI, crop senescence index and grain yield. CONCLUSION: This work suggests that the aerial sensing platform designed for phenotyping studies has the potential to effectively assist in crop genetic improvement against abiotic stresses like low-N provided that sensors have enough resolution for plot level data collection. Limitations and future potential uses are also discussed.

[Best practices for the safe use of parenteral nutrition multi-chamber bags. Spanish Society of Hospital Pharmacist's Clinical Nutrition Group]. / Buenas prácticas para el uso seguro de las bolsas tricamerales de nutrición parenteral.

Patient security is one of the key aspects of the Health-System. Parenteral Nutrition is included in the ISMP's list of high-alert medication, being its appropiate use an essential element in maximizing effectiviness while minimizing the potential risk of errors associated with its use. Multi-chamber bags offer several advantages versus pharmacy bespoke bags. However, their apparent simplicity may induce to misuse, asuming their use requires limited consideration, thus increasing the risk of potential errors. For this reason, the Spanish Society of Hospital Pharmacist's Clinical Nutrition Group considered it essential to develop a list of safety practices regarding the use of parenteral nutrition multi-chamber bags. These recommendations are based on practices globally accepted to diminish errors in PN therapy.

La seguridad del paciente es un aspecto clave de la asistencia sanitaria. La Nutrición Parenteral está incluida en la lista de medicamentos de alto riesgo del ISMP, siendo su uso apropiado un elemento esencial para maximizar su efectividad y minimizar el riesgo potencial de errores asociados con su empleo. Las bolsas tricamerales presentan numerosas ventajas frente a las elaboradas en los Servicios de Farmacia. Sin embargo, su aparente simplicidad puede inducir a un uso inadecuado de las mismas, al asumir que su utilización requiere considerar menos aspectos, incrementando con ello el riesgo potencial de errores. Por este motivo, el Grupo de Nutrición Clínica de la SEFH consideró necesario elaborar una relación de buenas prácticas para el uso seguro de las bolsas tricamerales de NP. Estas recomendaciones están basadas en prácticas globalmente aceptadas para disminuir los errores con el empleo de NP.

Atención subaguda al paciente con ictus. Satisfacción y resultados / Subacute care of stroke-affected patients. Satisfaction and results

Objetivo: Conocer la satisfacción de los pacientes con ictus y sus cuidadores durante su hospitalización en rehabilitación y analizar la efectividad del tratamiento, el riesgo social y el destino del paciente al alta. Material y método: Estudio multicéntrico de cohorte longitudinal prospectivo. Se valoró el riesgo social (escala Gijón), la comorbilidad (índice de Charlson), la discapacidad (índice de Barthel), la efectividad del tratamiento rehabilitador, la satisfacción con la atención (cuestionario de Pound) y el destino al alta en 241 pacientes. De 119 cuidadores evaluados a los 6 meses postictus se recogieron la edad, el parentesco, las horas diarias dedicadas al cuidado y la satisfacción con la información/formación y con la accesibilidad del equipo rehabilitador. Resultados: El perfil del paciente era el de un varón de 71 años, con riesgo social bajo/intermedio, comorbilidad alta y dependencia total/severa. Un 27,1% vivían solos. El 96,6% referían estar satisfechos/muy satisfechos con el tratamiento, siendo menor la satisfación con la recuperación (80,3%). La efectividad fue de 32,5 ± 20,4. El 81,7% de los pacientes regresaron a su domicilio. La media de edad de los cuidadores fue de 58,8 ± 12,3 años y el 73,9% eran mujeres. La dedicación a los cuidados era superior a 6 h diarias en el 62%. El 89,9% de los cuidadores estaban satisfechos/muy satisfechos con la información recibida. Conclusiones: Los pacientes ingresados para tratamiento rehabilitador tras un ictus obtienen una ganancia funcional significativa durante su hospitalización y regresan a su domicilio en la mayoría de los casos. La satisfacción con el tratamiento rehabilitador y la información es elevada. Un campo especialmente mejorable es la formación del cuidador (AU)

Objective: To determine the satisfaction of the stroke inpatients and their caregivers in Rehabilitation Service and to analyze the effectiveness, social risk, and discharge destination. Material and method: Prospective longitudinal cohort multicenter study. An analysis was made of the social risk (Gijón Scale), co-morbidity (Charlson Index), disability (Barthel Index), effectiveness of the rehabilitation treatment, satisfaction (Pound Questionnaire) and discharge destination of 241 patients. An evaluation was also made on 119 caregivers 6 months post-stroke, recording age, family relationship, time care-giving, satisfaction with the information/training, and accessibility to the rehabilitation team. Results: The patient profile is a 71 year-old male, with low/intermediate social risk, high comorbidity and total/severe dependence, with 27.1% living alone. Almost all (96.6%) of the patients claimed to be satisfied/very satisfied with the treatment, with satisfaction with the recovery being lower (80.3%). The effectiveness was 32.5 ± 20.4. Home was the discharge destination of 81.7% of the patients.The average age of the caregivers was 58.8 ± 12.3 years, and 73.9% were women. The time dedicated to care-giving was over 6 hours per day in the 62% of the cases. Being satisfied/very satisfied with the received information was recorded by 89.9% of the caregivers. Conclusions: Los pacientes ingresados para tratamiento rehabilitador tras un ictus obtienen una ganancia funcional significativa durante su hospitalización y regresan a su domicilio en la mayoría de casos. Patients admitted for stroke rehabilitation achieve significant functional gain during hospitalization and return to their homes in most cases. The satisfaction with the rehabilitation treatment and received information is high. The training of the caregiver is an aspect that needs improving

[Subacute care of stroke-affected patients. Satisfaction and results]. / Atención subaguda al paciente con ictus. Satisfacción y resultados.

OBJECTIVE: To determine the satisfaction of the stroke inpatients and their caregivers in Rehabilitation Service and to analyze the effectiveness, social risk, and discharge destination. MATERIAL AND METHOD: Prospective longitudinal cohort multicenter study. An analysis was made of the social risk (Gijón Scale), co-morbidity (Charlson Index), disability (Barthel Index), effectiveness of the rehabilitation treatment, satisfaction (Pound Questionnaire) and discharge destination of 241 patients. An evaluation was also made on 119 caregivers 6 months post-stroke, recording age, family relationship, time care-giving, satisfaction with the information/training, and accessibility to the rehabilitation team. RESULTS: The patient profile is a 71 year-old male, with low/intermediate social risk, high co-morbidity and total/severe dependence, with 27.1% living alone. Almost all (96.6%) of the patients claimed to be satisfied/very satisfied with the treatment, with satisfaction with the recovery being lower (80.3%). The effectiveness was 32.5 ± 20.4. Home was the discharge destination of 81.7% of the patients.The average age of the caregivers was 58.8 ± 12.3 years, and 73.9% were women. The time dedicated to care-giving was over 6 hours per day in the 62% of the cases. Being satisfied/very satisfied with the received information was recorded by 89.9% of the caregivers. CONCLUSIONS: Patients admitted for stroke rehabilitation achieve significant functional gain during hospitalization and return to their homes in most cases. The satisfaction with the rehabilitation treatment and received information is high. The training of the caregiver is an aspect that needs improving.

Rehabilitation efficiency and destination on discharge after stroke.

BACKGROUND: Predicting functional recovery of patients is key for setting the objectives of the rehabilitation programme and making decisions on their destination on discharge. Many variables have an impact on disability and quality of life after stroke, including patient age, comorbidity, severity of neurological deficit, state of mind and social risk. Accordingly, it is also essential from a care perspective to optimise the functional recovery and efficiency of rehabilitation programmes, exploring their relationship with these variables. AIM: To analyze the efficiency of post-stroke rehabilitation, identifying factors that most strongly influence functional recovery and destination on discharge. DESIGN: Multicentre prospective cohort study SETTING/POPULATION: All patients admitted to the Rehabilitation Units of the two hospitals after stroke over eight months METHODS: Collected data on sociodemographic characteristics, social risk (Gijón Scale), comorbidity (Charlson Index), neurological severity (National Institute of Health Stroke Scale), daily living functioning scale (Barthel Index), length of hospital stay and destination on discharge. RESULTS: We included 241 patients, with a mean stay of 35±22 days, 81.5% returning home on discharge. On admission 45.2% were totally dependent, and this figure fell to 12.8% on discharge, the mean Barthel Index score increasing by 32.5 points. Neurological severity, hemiparetic severity, impairment of deep sensation and trunk control on admission were the mayor variables influence on rehabilitation efficiency (P<0.001). Destination on discharge was most closely associated with civil status, social risk and Barthel Index score (P<0.001). The likelihood of transferring to residential care is 3- and 2.71-fold higher among patients with total dependence and high comorbidity scores, respectively. CONCLUSION: Many variables influence on outcomes of stroke inpatient rehabilitation. CLINICAL REHABILITATION IMPACT: Comprehensive assessments are required to predict patient recovery, efficiency and plan for discharge.

Automatic identification of agricultural terraces through object-oriented analysis of very high resolution DSMs and multispectral imagery obtained from an unmanned aerial vehicle.

Agricultural terraces are features that provide a number of ecosystem services. As a result, their maintenance is supported by measures established by the European Common Agricultural Policy (CAP). In the framework of CAP implementation and monitoring, there is a current and future need for the development of robust, repeatable and cost-effective methodologies for the automatic identification and monitoring of these features at farm scale. This is a complex task, particularly when terraces are associated to complex vegetation cover patterns, as happens with permanent crops (e.g. olive trees). In this study we present a novel methodology for automatic and cost-efficient identification of terraces using only imagery from commercial off-the-shelf (COTS) cameras on board unmanned aerial vehicles (UAVs). Using state-of-the-art computer vision techniques, we generated orthoimagery and digital surface models (DSMs) at 11 cm spatial resolution with low user intervention. In a second stage, these data were used to identify terraces using a multi-scale object-oriented classification method. Results show the potential of this method even in highly complex agricultural areas, both regarding DSM reconstruction and image classification. The UAV-derived DSM had a root mean square error (RMSE) lower than 0.5 m when the height of the terraces was assessed against field GPS data. The subsequent automated terrace classification yielded an overall accuracy of 90% based exclusively on spectral and elevation data derived from the UAV imagery.

Mamoplastia de reducción con cicatrices pequeñas para grandes hipertrofias mamariaso gigantomastias / Reduction mammoplasty with short scars in big mammary hypertrophy or gigantomasty

En la última década, algunos cirujanos plásticos hemos procurado crear técnicas de mamoplastia de reducción con cicatrices menores tratando de no alterar la morfología y la fisiología de la mama. Algunas de ellas dejan resultados poco agradables y ptosis inmediatas en pacientes con grandes hipertrofias mamarias o gigantomastias que necesitan de cicatriz en T invertida para eliminar el exceso de tejido presente en estos casos, con una cicatriz en surco inframamario que muchas veces sobrepasa lateralmente la línea axilar anterior y llega, medialmente, hasta la región esternal. Con el objetivo de obtener cicatrices en el surco inframamario que no sean mayores de 10 cm. de longitud, presentamos una nueva técnica de mamoplastia de reducción realizada en 52 pacientes, con edades comprendidas entre los 16 y los 70 años, que presentaban grandes hipertrofias mamarias o gigantomastias. Esta técnica, con la cual hemos logrado extirpar hasta 1.500 gr. de tejido mamario, tiene una marcación que permite desde el inicio resecar el exceso de tejido del polo inferior de la mama con una cicatriz no mayor de 10 cm. de longitud en el surco inframamario, debido a que las prolongaciones medial y lateral de la mama se tratan con liposucción superficial. Un colgajo glándulo adiposo de pedículo superior ayuda a elevar la mama, a llenar el polo superior de la misma y a aumentar su proyección (AU)

In the last decade, Plastic Surgery has created reduction mammoplasty techniques with less scarring trying not to modify the normal morphology and physiology ofthe breast. Some of them leave unpleasant results and immediateptosis in patients with great hypertrophy or gigantomasty; great need of inverted T scar for removal of excess tissue present in these cases produce a scar in the inframammary crease that often exceeds the antherioraxillary line side and reach the medial sternal region. In order to have minor scars in the inframammary crease, not greater than 10 cm. length, we present a new technique of reduction mammoplasty which has been performed in 52 patients whose ages ranged from 16 to70 years old and had large mammary hypertrophy or gigantomaty. This technique, managed to withdraw up to1.500 gr. of breast tissue, has a dial that allows from the start resects excess tissue of the lower pole of the breast, resulting in a scar no more than 10 cm length in the inframammarycrease, because the medial and lateral extensions have been treated with superficial liposuction. A pedicle adipose-gland flap will help to raise the breast, filling the upper pole and increasing its projection (AU)

[Hereditary glaucoma associated with oculodentodigital dysplasia]. / Glaucoma hereditario asociado a displasia oculodentodigital.

CASE REPORT: A newborn evaluated at 20 days old due to occasional nystagmus. Her mother had presented with oculodentodigital dysplasia (ODDD) and glaucoma. The physical examination revealed opaque micro-corneas, and horizontal nystagmus. The tonometry showed 35 mm Hg in OD and 40 mm Hg in OS and the fundus examination was normal. She had a narrow nasal bridge with narrow nostrils, and fourth and fifth finger syndactylyl in both hands. A bilateral trabeculectomy was performed with a good response. DISCUSSION: ODDD is a rare autosomal dominant disease with heterogeneous phenotype manifestations. The most frequent cause of loss of visual acuity is the glaucoma, requiring long-term follow up with periodical control of the intraocular pressure (IOP).

Glaucoma hereditario asociado a displasia oculodentodigital / Hereditary glaucoma associated with oculodentodigital dysplasia

Caso clínico: Recién nacida de 20 días de vida con nistagmo ocasional, de madre con displasia oculodentodigital. En el examen físico se hallaban microcórneas veladas, nistagmo horizontal, tonometría de 35 en ojo derecho y 40mm Hg en el izquierdo, fondo de ojo normal; pirámide nasal y narinas estrechas y sindactilia de los dedos cuarto y quinto de ambas manos. Buena respuesta a trabeculectomía bilateral.DiscusiónLa displasia oculodentodigital es una enfermedad hereditaria con marcada heterogeneidad fenotípica. La causa más frecuente de pérdida de visión es el glaucoma, siendo necesario su diagnóstico temprano con un seguimiento continuo y controles periódicos de la presión intraocular(AU)

Case report: A newborn evaluated at 20 days old due to occasional nystagmus. Her mother had presented with oculodentodigital dysplasia (ODDD) and glaucoma. The physical examination revealed opaque micro-corneas, and horizontal nystagmus. The tonometry showed 35mm Hg in OD and 40mm Hg in OS and the fundus examination was normal. She had a narrow nasal bridge with narrow nostrils, and fourth and fifth finger syndactylyl in both hands. A bilateral trabeculectomy was performed with a good response.DiscussionODDD is a rare autosomal dominant disease with heterogeneous phenotype manifestations. The most frequent cause of loss of visual acuity is the glaucoma, requiring long-term follow up with periodical control of the intraocular pressure (IOP)(AU)

Estudio clínico y cinético del tratamiento intraarticular de la gonartrosis con ácido hialurónico / Clinical and kinetics study of the intra-articular hyaluronic acid. Treatment of gonarthrosis

Introducción. En personas con gonartrosis la concentración de ácido hialurónico (AH) se ve reducida pudiendo provocar alteraciones en la marcha. El objetivo del presente artículo es realizar un análisis cinético, clínico y funcional de la evolución de la marcha de los pacientes con gonartrosis tras la administración intraarticular de AH. Material y métodos. La muestra estaba compuesta por 11 pacientes. Se realizó un análisis radiológico, una valoración del dolor y de la capacidad funcional y un análisis de los parámetros espacio-temporales y de la fuerza de reacción del suelo (FRS) en tres momentos diferentes: previamente a la administración de AH (estadio I), después de una semana de tratamiento (estadio II), y transcurridos los 6 meses (estadio III). Resultados. Los resultados muestran en el estadio II una reducción significativa del dolor, una mejora de la capacidad funcional y un aumento de la velocidad respecto al estadio I. La fuerza en el apoyo del talón, en el valle y en el despegue no muestra diferencias significativas entre estadios. La fuerza de frenado aumenta en el estadio II respecto al estadio I. Conclusiones. El tratamiento de la gonartrosis con AH ha mostrado ser eficaz en la disminución del dolor, en la mejora de la capacidad funcional, en el aumento de la velocidad espontánea de la marcha y en el aumento de la fuerza de frenado de los pacientes (AU)

Introduction. The walking pattern may be altered in people suffering from gonarthrosis due to the decrease in hyaluronic acid concentration. This study has aimed to conduct a kinetics, clinical and functional analysis of the evolution of gait in subjects suffering from gonarthrosis after intra-articular administration of hyaluronic acid. Material and methods. Eleven subjects participated in the study. An X-ray study, as well as pain and functional evaluation of the patients were performed. Spatio-temporal parameters and the ground reaction force were also measured. All these parameters were recorded prior to the injection of the hyaluronic acid treatment (stage I), at one week (stage II) and at 6 months of it (stage III). Results. The results obtained in the stage II showed a significant reduction in pain, an improvement in the functional capability, and an increase in velocity compared to the stage I. No significant differences among the stages were found for heel, valley and take off forces. The braking force manifested an increase in the stage II with respect to the stage I. Conclusions. The treatment of the gonarthrosis with the hyaluronic acid reduced pain, improved functional capability, and increased spontaneous walking velocity and breaking force of the patients (AU)

[Body weight profile in acute mesenteric ischemia. Experimental study in New-Zealand rabbits]. / Perfil del peso corporal en la isquemia mesenterica aguda. Estudio experimental en conejos Nueva Zelanda.

INTRODUCTION AND OBJECTIVES: There are few investigation studies that relate acute mesenteric ischemia and body weight in animal experimentation. The aim is to studying whether initial weight loss is related to the magnitude of the aggression induced by clamps of the superior mesenteric artery for 30 and 60 minutes, and whether reperfusion ischemia may hinder weight recovery in surviving animals at the end of 11 weeks of experimental work with New Zealand rabbits through a valid experimental model. MATERIALS AND METHOD: 80 animals (rabbits) were distributed in four series of 20 each one: series I (control), animals were weighed for 11 weeks; series II (simulated surgery); series III (mesenteric ischemia for 30 minutes); series IV (mesenteric ischemia for 60 minutes). We induced ischemia by clamping the superior mesenteric artery. Animals from series II, III, and IV were weighed 24 hours before the surgical procedure and weekly after surgery along their survival, until completing 11 weeks. For weight analysis, an ANOVA test was used by confronting the percentage weight variation according to the series. All animals were necropsied to know the cause of death and histological lesions of the intestinal mucosa. RESULTS: Series I had a linear weight increase until the end of the observation period. Series II, III and IV had a significant initial decrease of the percentage weight during the first post-surgical week, with a recovery towards the end of the study, but significantly lower as compared to the control series. Significant differences have also been found in weight recovery at 11 weeks between series II and series III and IV, and between ischemic series. CONCLUSIONS: Animals in series II, III, and IV reached at the end of the study a percentage weight significantly lower to that obtained by series I. In the experimental animal mesenteric ischemia-reperfusion processes, the initial percentage weight loss in the postsurgical period is influenced not only by ischemia time but also by pre-and postsurgical manipulations; by contrast, the longer ischemia time is, the greater weight loss at the end of the study will be.

Perfil del peso corporal en la isquemia mesentérica aguda. Estudio experimental en conejos Nueva Zelanda / Body weight profile in acute mesenteric ischemia. Experimental study in New-Zealand rabbits

Introducción y objetivos:  Hay pocos trabajos de investigación que relacionen la isquemia mesentérica aguda y el peso corporal en la experimentación animal. Se pretende estudiar, si la pérdida de peso inicial, está relacionada con la magnitud de la agresión provocada por los clampajes de la arteria mesentérica superior durante 30 y 60 minutos, y si la isquemia reperfusión puede dificultar la recuperación ponderal del peso en los animales supervivientes, al final de las 11 semanas del trabajo experimental con conejos Nueva Zelanda, mediante un modelo experimental válido. Material y método: Se distribuyeron 80 animales (conejos) en cuatro series de 20: serie I (control), los animales fueron pesados durante 11 semanas; serie II (operación simulada), serie III (isquemia mesentérica 30 minutos) y serie IV (isquemia mesentérica 60 minutos). Provocamos la isquemia por pinzamiento de la arteria mesentérica superior. Los animales de las series II, III y IV fueron pesados 24 horas antes del procedimiento quirúrgico y semanalmente en el postoperatorio durante su supervivencia hasta completar 11 semanas. Para el análisis de los pesos, se aplicó un ANOVA enfrentando la variación del peso porcentual en función de la serie. Todos los animales fueron necropsiados para conocer la causa del fallecimiento y las lesiones histológicas de la mucosa intestinal Resultados: La serie control tuvo un incremento lineal del peso hasta el final del período de observación. Las series II, III y IV sufrieron un descenso proceinicial significativo del peso porcentual en la primera semana del postoperatorio, con una recuperación al final del estudio, pero significativamente menor con respecto a la serie control. También se han encontrado diferencias significativas en la recuperación del peso a las 11 semanas entre la serie II y las series III y IV, y entre las series isquémicas entre sí. Conclusiones: Los animales de las series II, III, y IV alcanzaron al final del estudio un peso porcentual significativamente inferior que el alcanzado por la serie I. En los procesos de isquemia reperfusión mesentérica experimental animal, la pérdida de peso porcentual inicial en el postoperatorio, está influenciada no sólo por el tiempo de isquemia, sino por las manipulaciones pre y postoperatorias; en cambio, la pérdida de peso al final del estudio es más acentuada, cuanto mayor es el tiempo de isquemia (AU)

Introduction and objectives: There are few investigation studies that relate acute mesenteric ischemia and body weight in animal experimentation. The aim is to studying whether initial weight loss is related to the magnitude of the aggression induced by clamps of the superior mesenteric artery for 30 and 60 minutes, and whether reperfusion ischemia may hinder weight recovery in surviving animals at the end of 11 weeks of experimental work with New Zealand rabbits through a valid experimental model. Materials and method: 80 animals (rabbits) were distributed in four series of 20 each one: series I (control), animals were weighed for 11 weeks; series II (simulated surgery); series III (mesenteric ischemia for 30 minutes); series IV (mesenteric ischemia for 60 minutes). We induced ischemia by clamping the superior mesenteric artery. Animals from series II, III, and IV were weighed 24 hours before the surgical procedure and weekly after surgery along their survival, until completing 11 weeks. For weight analysis, an ANOVA test was used by confronting the percentage weight variation according to the series. All animals were necropsied to know the cause of death and histological lesions of the intestinal mucosa. Results: Series I had a linear weight increase until the end of the observation period. Series II, III and IV had a significant initial decrease of the percentage weight during the first post-surgical week, with a recovery towards the end of the study, but significantly lower as compared to the control series. Significant differences have also been found in weight recovery at 11 weeks between series II and series III and IV, and between ischemic series. Conclusions: Animals in series II, III, and IV reached at the end of the study a percentage weight significantly lower to that obtained by series I. In the experimental animal mesenteric ischemia-reperfusion processes, the initial percentage weight loss in the postsurgical period is influenced not only by ischemia time but also by pre-and postsurgical manipulations; by contrast, the longer ischemia time is, the greater weight loss at the end of the study will be (AU)

Umbilical cord transection in twin-reverse arterial perfusion syndrome with the use of a coaxial bipolar electrode (Versapoint).

Umbilical-cord occlusion has been proposed for the treatment of twin-reverse arterial perfusion syndrome (TRAP). Transection of the umbilical cord is necessary in patients with monoamniotic or 'pseudomonoamniotic' TRAP to avoid subsequent cord entanglement and demise of the pump twin. We present a case of TRAP in which the umbilical cord was successfully ligated with suture and transected with the Versapoint electrode.