Ayudando a la toma de decisiones en el diagnóstico, tratamiento y seguimiento de úlceras de etiología vascular mediante el empleo de una aplicación móvil / A mobile decision support system for diagnosis, treatment and follow-up of vascular ulcers

Introducción y objetivo: los sistemas de ayuda a la decisión médica (SADM) son sistemas computacionales que utilizan dispositivos inteligentes, lo que facilita el diagnóstico y el tratamiento de múltiples patologías, transformando la atención sanitaria en un sistema dinámico y de precisión. Las úlceras de etiología vascular representan un importante problema de salud que suponen un gran consumo de recursos. La transformación digital puede mejorarla calidad de los diagnósticos, de los tratamientos y de los seguimiento de los pacientes, mejorando la eficacia y la eficiencia de la asistencia sanitaria. El objetivo es desarrollar una aplicación móvil que facilite el diagnóstico y el tratamiento de úlceras de etiología vascular. Métodos: para desarrollar este SADM se elaboraron algoritmos para los diagnósticos y los tratamientos capaces de generar una respuesta correcta, guiando al usuario hacia un diagnóstico más probable o a la aplicación del tratamiento específico. En Android se empleó el entorno de programación Android Studio y el lenguaje de programación JAVA, y para el desarrollo en iOS se empleó XCode y el lenguaje de programación Swift. El diagnóstico de úlceras de etiología vascular incluye: úlcera neuropática, isquémica, neuroisquémica, venosa o flebostática, úlceramixta y úlcera hipertensiva o de Martorell. Resultados: UlcerAPP es visual e intuitiva. Orientará en el diagnóstico en respuesta a los algoritmos desarrollados. Además, podrá accederse al tratamiento específico de cada una de ellas. Incluirá recomendaciones de seguimiento y criterios de derivación. Conclusiones: UlcerAPP es un proyecto desarrollado para mejorar el manejo clínico de las úlceras en el entorno de la Atención Primaria y potenciar el conocimiento de la patología vascular y del tratamiento de las úlceras de dicha etiología. (AU)

Introduction and objective: decision support systems (DSS) are computer systems that use computer devicesor smartphones, facilitating the diagnosis and properly treatment of multiple pathologies, transforming healthcare into a dynamic, preventive and precision system. Vascular ulcers represent an important health problem, witha great consumption of resources. Digital transformation can improve the quality of diagnoses, treatments andpatient follow-up, and therefore improve the effectiveness and efficiency of healthcare. This paper aims to develop UlcerApp, a totally new mobile DSS for vascular ulcers management, which facilitates the diagnosis, treatment andmonitoring of ulcers of vascular etiology, in the primary health care. Methods: for achieving the main purpose of this research work, a decision algorithm will be developed and implemented by an Android (Android Studio- JAVA) and iOS (XCode- Switf ) mobile applications. Results: the App developed which implements the algorithms UlcerApp is capable of diagnose 6 kind of vascularulcers: neuropathic, ischemic, neuroischemic, venous ulcer, mixed ulcer and hypertensive or Martorell ulcer. UlcerAPP is a visual and intuitive application that will guide the user to correct diagnosis. After them, users will be able to access the specific treatment. It will include follow-up recommendations as well as referral criteria. Conclusions: UlcerAPP is a project developed to improve the clinical management of vascular ulcers in the primary health care, enhance knowledge of vascular pathology and treatment of ulcers of said etiology. (AU)

Comparative Analysis of Concurrent (CC), Mixed Flow (MX), and Combined Spray Drying Configurations on the Physicochemical Characteristics of Satsuma Mandarin (Citrus unshiu) Juice Powders.

Satsuma mandarins are good sources of vitamin C and can be used as raw materials to produce novel plant-based food ingredients including satsuma mandarin juice powders (SJP). Food powders produced via spray drying often show thermal degradation due to the drying conditions and high drying air temperatures. The aim of this study was to evaluate the effect of using different spray drying configurations, including concurrent (CC), mixed flow (MX), and combined (CC + MX), at two inlet air temperatures (160 and 180 °C) on the physicochemical properties of SJP. Remarkably, SJP produced using the CC spray drying configuration exhibited a higher vitamin C content (3.56-4.01 mg/g) and lower moisture levels (15.18-16.35 g/100 g) than powders produced via MX or CC + MX. The vitamin C content of MX and CC + MX powders ranged from 2.88 to 3.33 mg/g. Meanwhile, all SJP had water activity values below 0.19. Furthermore, MX powders displayed the largest mean particle sizes (D50) (8.69-8.83 µm), higher agglomeration, and a rapid dissolution. Despite these differences, all SJP variants exhibited consistent color, surface area, and pore volumes. Notably, powders dried at higher inlet air temperatures (180 °C) showed less vitamin C content and increased thermal damage when compared with powders dried at 160 °C inlet air temperature. This study demonstrated the feasibility of producing high-quality SJP with an extended shelf life. SJP can be used as a novel plant-based ingredient in different food applications.

Graphene Oxide: Key to Efficient Charge Extraction and Suppression of Polaronic Transport in Hybrids with Poly (3-hexylthiophene) Nanoparticles.

Nanoparticles (NPs) of conjugated polymers in intimate contact with sheets of graphene oxide (GO) constitute a promising class of water-dispersible nanohybrid materials of increased interest for the design of sustainable and improved optoelectronic thin-film devices, revealing properties exclusively pre-established upon their liquid-phase synthesis. In this context, we report for the first time the preparation of a P3HTNPs-GO nanohybrid employing a miniemulsion synthesis approach, whereby GO sheets dispersed in the aqueous phase serve as a surfactant. We show that this process uniquely favors a quinoid-like conformation of the P3HT chains of the resulting NPs well located onto individual GO sheets. The accompanied change in the electronic behavior of these P3HTNPs, consistently confirmed by the photoluminescence and Raman response of the hybrid in the liquid and solid states, respectively, as well as by the properties of the surface potential of isolated individual P3HTNPs-GO nano-objects, facilitates unprecedented charge transfer interactions between the two constituents. While the electrochemical performance of nanohybrid films is featured by fast charge transfer processes, compared to those taking place in pure P3HTNPs films, the loss of electrochromic effects in P3HTNPs-GO films additionally indicates the unusual suppression of polaronic charge transport processes typically encountered in P3HT. Thus, the established interface interactions in the P3HTNPs-GO hybrid enable a direct and highly efficient charge extraction channel via GO sheets. These findings are of relevance for the sustainable design of novel high-performance optoelectronic device structures based on water-dispersible conjugated polymer nanoparticles.

Patients with hepatocellular carcinoma that die during the first year of liver transplantation have high blood sFasL concentrations.

BACKGROUND: Fas ligand (FasL) is one ligand that activates extrinsic apoptosis pathway. High expression in lymphocytes of FasL have been found in patients with acute rejection of liver transplantation (LT). No high blood concentrations of soluble FasL (sFasL) have been found in patients with acute LT rejection; however, the samples size of those studies was small. AIM: To determine whether patients with hepatocellular carcinoma (HCC) that dead during the first year of LT have higher blood sFasL concentrations previously to LT that those who that remain alive in a study of higher sample size. METHODS: Patients underwent LT due to HCC were included in this retrospective study. Serum sFasL levels prior to LT were measured and one-year LT mortality was registered. RESULTS: Non-surviving patients (n = 14) showed higher serum sFasL levels [477 (269-496) vs 85 (44-382) pg/mL; P < 0.001] than surviving patients (n = 113). Serum sFasL levels (pg/mL) were associated with mortality (OR = 1.006; 95%CI = 1.003-1.010; P = 0.001) independently of age of LT donor in the logistic regression analysis. CONCLUSION: We report for the first time that HCC patients who die within the first year of HT have higher blood sFasL concentrations prior to HT than those who remain alive.

An Integrated Analysis of the Impact of Spanish Family Support Programmes with Informed Evidence / Un análisis integrado del impacto de los programas españoles de apoyo familiar basados en la evidencia

A description is made of the quality of Spanish family support programmes, based on their impact, dissemination, scaling up in communities, and sustainability; 57 implemented programmes with informed evidence were selected by EurofamNet. Most of the programmes were shown to make a positive impact, using quantitative methodologies, and they were manualized, while about half of them defined the core contents and included professional training. From a cluster analysis of programmes with scaling up, those with a high and moderate level of systematization were identified, based on the existence of defined core contents, implementation conditions, institutional support, professional training, and reports of findings. The highly systematized programmes were characterized by a greater use of mixed methodologies, their scientific dissemination through different means, and their inclusion in services. A programme quality analysis is proposed, taking an integrated approach that relates the programme’s impact with its design, implementation, and evaluation of sustainability.(AU)

En este trabajo se presenta una descripción de la calidad de los programas españoles de apoyo a las familias, basándose en su impacto, difusión, diseminación institucional y sostenibilidad. En el marco de EurofamNet se seleccionaron 57 programas implementados con evidencia fundamentada. La mayoría de los programas mostraron un impacto positivo utilizando metodologías cuantitativas y estaban manualizados, mientras que cerca de la mitad de ellos definían los contenidos clave e incluían la formación de los profesionales. A partir de un análisis de conglomerados se identificaron los que tenían un nivel de sistematización alto y moderado, definidos los contenidos clave y las condiciones de implementación, apoyo institucional, formación profesional e informes de resultados. Los programas con alto nivel de sistematización se caracterizaron por un mayor uso de metodologías mixtas, su difusión científica a través de diferentes medios y su inclusión en las instituciones. Se propone un análisis de la calidad de los programas, con un enfoque integrado que relacione el impacto del programa con su diseño, implementación y la evaluación de la sostenibilidad.(AU)

Actitudes de profesionales del ámbito de la intervención familiar hacia las prácticas basadas en la evidencia / Attitudes of family intervention professionals towards evidence-based practices

A la hora de poner en marcha procesos de innovación en los servicios de intervención familiar que supongan la incorporación de programas basadas en la evidencia (PBE), es fundamental considerar el papel que desempeñan los/as profesionales, ya que de ellos depende en gran parte la fidelidad y calidad de la implementación de los programas. Este estudio se centra en analizar las actitudes de profesionales hacia las prácticas basadas en la evidencia, así como su percepción y valoración del Programa de Intervención Familiar (PIF), desarrollado en el Ayuntamiento de Pamplona (España) dentro de la cartera de servicios de preservación familiar. Los participantes fueron los/as 27 profesionales que aplican el PIF, que cumplimentaron la escala Evidence-Based Practice Attitude Scale (EBPAS) y la de Expectativas y Valoración Inicial del PIF (EVI-PIF). Los resultados obtenidos mostraron la relación existente entre las actitudes hacia las prácticas basadas en la evidencia y algunas características de los/as profesionales. Asimismo, también se encontró relación significativa entre una alta valoración del PIF y unas actitudes positivas hacia los PBE. Estos resultados avalan la importancia de las actitudes profesionales como elementos que pueden facilitar o dificultar los procesos de innovación y mejora en los servicios de atención e intervención familiar (AU)

When implementing innovation processes in family intervention services that involve the incorporation of eviden-ce-based programmes (EBP), it is essential to take into consideration the role played by professionals, since the fidelity and quality of the implementation of the programmes largely depends on them. This study focuses on analysing the attitudes of professionals towards EBP, as well as their perception and assessment of the Family Intervention Programme (FIP), developed in the family prevention services of Pamplona City Council (Spain). The participants in the study were the 27 professionals who implement the FIP, who completed the Evidence-Based Practice Attitude Scale (EBPAS) and he Expectations and Initial Assessment of the FIP (EVI-FIP). The results obtained showed the relationship between attitudes towards evidence-based practice and some characteristics of the professionals. A significant relationship was also found between a high valuation of the FIP and positive attitudes towards EBP. These results support the importance of professional attitudes as elements that can facilitate or hinder innovation and improvement processes in family care and intervention services. (AU)

DNA and RNA oxidative damage in hepatocellular carcinoma patients and mortality during the first year of liver transplantation.

BACKGROUND: Oxidative damage of DNA and RNA has been associated with mortality of patients with different diseases. However, there is no published data on the potential use of DNA and RNA oxidative damage to predict the prognosis of patients with hepatocellular carcinoma (HCC) undergoing liver transplantation (LT). AIM: To determine whether patients with increased DNA and RNA oxidative damage prior to LT for HCC have a poor LT prognosis. METHODS: Patients with HCC who underwent LT were included in this observational and retrospective study. Serum levels of all three oxidized guanine species (OGS) were measured prior to LT since guanine is the nucleobase that forms DNA and RNA most prone to oxidation. LT mortality at 1 year was the end-point study. RESULTS: Surviving patients (n = 101) showed lower serum OGS levels (P = 0.01) and lower age of the liver donor (P = 0.03) than non-surviving patients (n = 13). An association between serum OGS levels prior to LT and 1-year LT (odds ratio = 2.079; 95% confidence interval = 1.356-3.189; P = 0.001) was found in the logistic regression analysis. CONCLUSION: The main new finding was that high serum OGS concentration prior to LT was associated with the mortality 1 year after LT in HCC patients.

The Brief COPE: Measurement Invariance and Psychometric Properties among Community and At-Risk Portuguese Parents.

Parenting generally brings about high internal and external demands, which can be perceived as stressful when they exceed families' resources. When faced with such stressors, parents need to deploy several adaptive strategies to successfully overcome these challenges. One of such strategies is coping, an important cognitive and behavioural skill. In this study, we intended to examine the psychometric properties of Carver's (1997) Brief COPE (Coping Orientation to Problems Experienced), extending its cross-cultural validity among a Portuguese sample of community and at-risk parents. The sample comprised community (n = 153) and at-risk (n = 116) parents who completed the brief COPE, the Family Adaptability and Cohesion Scales and the Parenting Stress Index-Short Form. Confirmatory factor analysis, internal consistency, cross sample invariance, convergent and discriminant validity were analysed. Data from the confirmatory factor analysis revealed that the 14-factor model obtained the best fit. The results provided evidence that the Brief COPE is a psychometrically sound instrument that shows measurement invariance across samples and good reliability. Our findings demonstrated that the Portuguese version of brief COPE is a useful, time-efficient tool for both practitioners and researchers who need to assess coping strategies, a relevant construct in family context.

Lesión pancreática aislada tras traumatismo abdominal cerrado: a propósito de un caso / Isolated pancreatic injury after blunt abdominal trauma: a case report

Introducción. La incidencia de lesiones traumáticas del páncreas es baja debido a su localización retroperitoneal, y las lesiones aisladas son excepcionales debido a la proximidad del páncreas a otros órganos y estructuras vasculares. Caso clínico. Presentamos el caso de un varón de 21 años con lesión aislada del páncreas tras traumatismo abdominal cerrado, que precisó manejo quirúrgico. Discusión. Las lesiones pancreáticas aisladas secundarias a traumatismo son raras, pero debemos tenerlas en cuenta en un paciente politraumatizado. Su diagnóstico precoz y manejo adecuado son cruciales para evitar el desarrollo de complicaciones

Introduction. The incidence of traumatic injuries to the pancreas is low due to its retroperitoneal location, and isolated injuries are rare due to the proximity of the pancreas to other vascular organs and structures. Clinical case. We present the case of a 21-year-old man with an isolated lesion of the pancreas after blunt abdominal trauma, which required surgical management.Discussion. Isolated pancreatic injuries secondary to trauma are rare but must be taken into account in a multiple trauma patient. Its early diagnosis and proper management are crucial to avoid the development of complications

Locus coeruleus anchors a trisynaptic circuit controlling fear-induced suppression of feeding.

The circuit mechanisms underlying fear-induced suppression of feeding are poorly understood. To help fill this gap, mice were fear conditioned, and the resulting changes in synaptic connectivity among the locus coeruleus (LC), the parabrachial nucleus (PBN), and the central nucleus of amygdala (CeA)-all of which are implicated in fear and feeding-were studied. LC neurons co-released noradrenaline and glutamate to excite PBN neurons and suppress feeding. LC neurons also suppressed inhibitory input to PBN neurons by inducing heterosynaptic, endocannabinoid-dependent, long-term depression of CeA synapses. Blocking or knocking down endocannabinoid receptors in CeA neurons prevented fear-induced depression of CeA synaptic transmission and fear-induced suppression of feeding. Altogether, these studies demonstrate that LC neurons play a pivotal role in modulating the circuitry that underlies fear-induced suppression of feeding, pointing to new ways of alleviating stress-induced eating disorders.

Isquemia crítica de miembros inferiores en paciente joven: presentación atípica del síndrome de atrapamiento poplíteo / Critical lower extremity ischemia in a young patient: atypical presentation of the popliteal artery entrapment syndrome

Introducción. El síndrome de atrapamiento poplíteo es una entidad infrecuente, cuya incidencia oscila entre 0,17 y 3,5 %, representando una de las principales causas de isquemia en miembros inferiores en adultos jóvenes. Suele manifestarse con claudicación intermitente (69 %) o isquemia aguda (26 %), siendo muy rara su presentación con isquemia crítica de miembros inferiores. Caso clínico. Paciente de 30 años quien presentó úlcera subungueal en primer dedo de pie derecho con dolor intenso. En la exploración física no se palpaban pulsos distales y se observó palidez cutánea intensa y frialdad. Se realizó arteriografía donde se observó defecto de repleción de bordes regulares y desplazamiento medial de la arteria poplítea. La resonancia magnética mostró una inserción anómala del gastrocnemio medial, con lo que se hizo diagnóstico de síndrome de atrapamiento poplíteo tipo I. Mediante abordaje posterior se realizó reconstrucción vascular con injerto venoso y sección tendinosa del gastrocnemio medial. En el postoperatorio inmediato el paciente recupera pulso pedio y en el seguimiento a un año el paciente no presenta clínica de isquemia de miembros inferiores, encontrándose el baipás permeable. Discusión. A pesar de su baja incidencia, es importante incluir el síndrome de atrapamiento poplíteo en el diagnóstico diferencial de isquemia en miembros inferiores en adultos jóvenes. Su presentación con isquemia crítica es excepcional, encontrando muy pocos casos publicados en la literatura. La reconstrucción arterial precoz mediante injerto o plastia con material autólogo constituye el tratamiento de elección

Introduction. The popliteal entrapment syndrome is an infrequent entity, whose incidence ranges between 0.17 and 3.5%, representing one of the main causes of lower limb ischemia in young adults. It usually manifests with intermittent claudication (69%) or acute ischemia (26%), being very rare its presentation with critical ischemia of the lower limbs.Clinical case. A 30-year-old patient with a history of smoking, with no other risk factors, who presented with a subungual ulcer on the first right toe. On physical examination, distal pulses are not palpated, intense skin paleness and coldness are observed. Magnetic resonance imaging showed an anomalous insertion of the medial gastrocnemius with extrinsic compression of the popliteal artery, confirming a diagnosis of popliteal entrapment syndrome type I. Vascular reconstruction with venous graft and tendon section of the medial gastrocnemius was performed through a posterior approach. In the immediate postoperative period, the patient recovers a pediatric pulse and in the one-year follow-up the patient does not present symptoms of lower limb ischemia, finding the bypass patent. Discussion. Despite its low incidence, it is important to include popliteal impingement syndrome in the differential diagnosis of lower limb ischemia in young adults. Its presentation with critical ischemia is exceptional, finding very few cases published in the literature. Early arterial reconstruction by graft or plasty with autologous material is the treatment of choice

EDAS-18: validación de la versión corta de la escala de dependencia y adicción al smartphone / EDAS-18: validation of the dependency and addiction to smartphone scale short-form

Resumen: La Escala de Dependencia y Adicción al Smartphone-EDAS, publicada en 2017, es uno de los instrumentos más recientes validados en población adulta para el estudio de las conductas adictivas derivadas del uso del smartphone. El objetivo del estudio fue la validación de la versión corta del instrumento, implicando la revisión de las propiedades psicométricas de los ítems y su dimensionalidad. Se contó con una muestra de 606 participantes jóvenes y adultos (de 18 a 48 años). Tras el ajuste psicométrico de los ítems y el análisis factorial exploratorio y confirmatorio, los 40 reactivos iniciales se redujeron a 18, quedando agrupados en un solo factor. El instrumento fue renombrado como EDAS-18, alcanzando una consistencia interna de α = .88 y diversas evidencias de validez. Los resultados replican los hallazgos previos sobre las diferencias en el uso del smartphone en función del sexo y la edad.

Abstract: The Dependency and addiction to Smartphone Scale ("Escala de Dependencia y Adicción al Smartphone"-EDAS), published in 2017, is one of the most recent instruments validated in adult population. It allows to study addictive behaviors derived from the use of the Smartphone. The purpose of this study was to develop and validate a shorter version of the EDAS, involving the review of the psychometric properties of the items and their dimensionality. A total of 606 young and adult people participated (18 to 48 years old). After the psychometric adjustment of the items and the exploratory and confirmatory factor analysis, the initial 40 items were reduced to 18, being grouped into a single factor. The instrument was renamed EDAS-18, reaching an internal consistency of α = .88 and various evidences of validity. The results replicate the previous research findings on the sex and age differences in the Smartphone use.