Exploring the muscle architecture effect on the mechanical behaviour of mouse rotator cuff muscles.

Incorporating detailed muscle architecture aspects into computational models can enable researchers to gain deeper insights into the complexity of muscle function, movement, and performance. In this study, we employed histological, multiphoton image processing, and finite element method techniques to characterise the mechanical dependency on the architectural behaviour of supraspinatus and infraspinatus mouse muscles. While mechanical tests revealed a stiffer passive behaviour in the supraspinatus muscle, the collagen content was found to be two times higher in the infraspinatus. This effect was unveiled by analysing the alignment of fibres during muscle stretch with the 3D models and the parameters obtained in the fitting. Therefore, a strong dependence of muscle behaviour, both active and passive, was found on fibre orientation rather than collagen content.

Treatment of calcific tendinopathy of the rotator cuff with ultrasound-guided puncture and aspiration.

OBJECTIVE: Calcific tendinopathy of the rotator cuff is a common condition caused by the deposition of calcium crystals in the tendons of the rotator cuff. This study aimed to analyze the effectiveness of ultrasound-guided puncture and aspiration in calcific tendinopathy of the should in 86 patients treated at our center and to determine the factors associated with poor prognosis after this treatment. MATERIAL AND METHODS: This retrospective descriptive study included 86 patients with calcific tendinopathy of the rotator cuff treated with ultrasound-guided puncture and aspiration between 2015 and 2019 for whom clinical and radiological variables were collected 1, 3, 6, and 12 months after the procedure. RESULTS: One year after treatment, 81.4% patients showed clinical improvement and 96.5% showed radiological improvement. Complications were observed in 34.9%; all complications were mild. CONCLUSIONS: Ultrasound-guided puncture and aspiration is an effective treatment for calcific tendinopathy of the shoulder, resulting in a high rate of clinical and radiological improvement and a low rate of minor complications. This technique has additional advantages, such as interaction with the patient and the lack of ionizing radiation.

Use of aequorin-based indicators for monitoring Ca2+ in acidic organelles.

Over the last years, there is accumulating evidence that acidic organelles can accumulate and release Ca2+ upon cell activation. Hence, reliable recording of Ca2+ dynamics in these compartments is essential for understanding the physiopathological aspects of acidic organelles. Genetically encoded Ca2+ indicators (GECIs) are valuable tools to monitor Ca2+ in specific locations, although their use in acidic compartments is challenging due to the pH sensitivity of most available fluorescent GECIs. By contrast, bioluminescent GECIs have a combination of features (marginal pH sensitivity, low background, no phototoxicity, no photobleaching, high dynamic range and tunable affinity) that render them advantageous to achieve an enhanced signal-to-noise ratio in acidic compartments. This article reviews the use of bioluminescent aequorin-based GECIs targeted to acidic compartments. A need for more measurements in highly acidic compartments is identified.

Sistema inteligente para la gestión de la demanda en atención primaria.

INTRODUCTION AND OBJECTIVES: The Galician Health Service designed a system to improve demand management in primary care known as "XIDE". In it, all professionals participate in an interdisciplinary manner and within their competence framework, to respond to a reason for consultation in a certain time and manner. This article evaluates the pilot phase of implementation of XIDE in primary care of the Galician Health Service. MATERIALS AND METHODS: Cross-sectional descriptive study carried out in 45 primary care centers selected opportunistically at the discretion of the management of the Galician Health Service. For each center, were included all on-demand appointments requested by the adult population in the administrative units in person or by telephone, between 11/2021-05/2022. The XIDE integrates an intelligent search engine that, through algorithms, guides the administrative staff to make an appointment on demand. It performed a descriptive analysis of all the variables, as well as a bivariate analysis with chi-square to identify the causes of the population's rejection of XIDE. RESULTS: The three most frequent reasons for consultation were: knowing the results of the analysis (11.2%), performing blood tests (11.2%) and prescriptions for drugs (10.9%). Family medicine and nursing professionals are the ones who received the most citations. 22.1% of the appointments required to be scheduled on the same day or immediately. The acceptance of the population to the XIDE system was 85.0%. The reason for consultation, response time, mode of care and the recipient professional had a significant influence (p<0.0001) on the rejection of the appointment. CONCLUSIONS: The XIDE adapts globally well to the appointment systems and the organization of primary care of the Galician Health Service, which could facilitate its extension to all health centers in Galicia. However, it is necessary to delve deeper into the causes of rejection in order to introduce improvements that guarantee its viability in the medium-long term.

Exonic variants of the P2RX7 gene in familial multiple sclerosis.

INTRODUCTION: Several studies have analysed the presence of P2RX7 variants in patients with MS, reporting diverging results. METHODS: Our study analyses P2RX7 variants detected through whole-exome sequencing (WES). RESULTS: We analysed P2RX7, P2RX4, and CAMKK2 gene variants detected by whole-exome sequencing in all living members (n = 127) of 21 families including at least 2 individuals with multiple sclerosis. P2RX7 gene polymorphisms previously associated with autoimmune disease. Although no differences were observed between individuals with and without multiple sclerosis, we found greater polymorphism of gain-of-function variants of P2RX7 in families with individuals with multiple sclerosis than in the general population. Copresence of gain-of-function and loss-of-function variants was not observed to reduce the risk of presenting the disease. Three families displayed heterozygous gain-of-function SNPs in patients with multiple sclerosis but not in healthy individuals. We were unable to determine the impact of copresence of P2RX4 and CAMKK2 variants with P2RX7 variants, or the potential effect of the different haplotypes described in the gene. No clinical correlations with other autoimmune diseases were observed in our cohort. CONCLUSIONS: Our results support the hypothesis that the disease is polygenic and point to a previously unknown mechanism of genetic predisposition to familial forms of multiple sclerosis. P2RX7 gene activity can be modified, which suggests the possibility of preventive pharmacological treatments for families including patients with familial multiple sclerosis.

Variant rs4149584 (R92Q) of the TNFRSF1A gene in patients with familial multiple sclerosis.

INTRODUCTION: Genomic studies have identified numerous genetic variants associated with susceptibility to multiple sclerosis (MS); however, each one explains only a small percentage of the risk of developing the disease. These variants are located in genes involved in specific pathways, which supports the hypothesis that the risk of developing MS may be linked to alterations in these pathways, rather than in specific genes. We analyzed the role of the TNFRSF1A gene, which encodes one of the TNF-α receptors involved in a signaling pathway previously linked to autoimmune disease. METHODS: We included 138 individuals from 23 families including at least 2 members with MS, and analyzed the presence of exonic variants of TNFRSF1A through whole-exome sequencing. We also conducted a functional study to analyze the pathogenic mechanism of variant rs4149584 (-g.6442643C > G, NM_001065.4:c.362 G > A, R92Q) by plasmid transfection into human oligodendroglioma (HOG) cells, which behave like oligodendrocyte lineage cells; protein labeling was used to locate the protein within cells. We also analyzed the ability of transfected HOG cells to proliferate and differentiate into oligodendrocytes. RESULTS: Variant rs4149584 was found in 2 patients with MS (3.85%), one patient with another autoimmune disease (7.6%), and in 5 unaffected individuals (7.46%). The 2 patients with MS and variant rs4149584 were homozygous carriers and belonged to the same family, whereas the remaining individuals presented the variant in heterozygosis. The study of HOG cells transfected with the mutation showed that the protein does not reach the cell membrane, but rather accumulates in the cytoplasm, particularly in the endoplasmic reticulum and near the nucleus; this suggests that, in the cells presenting the mutation, TNFRSF1 does not act as a transmembrane protein, which may alter its signaling pathway. The study of cell proliferation and differentiation found that transfected cells continue to be able to differentiate into oligodendrocytes and are probably still capable of producing myelin, although they present a lower rate of proliferation than wild-type cells. CONCLUSIONS: Variant rs4149584 is associated with risk of developing MS. We analyzed its functional role in oligodendrocyte lineage cells and found an association with MS in homozygous carriers. However, the associated molecular alterations do not influence the differentiation into oligodendrocytes; we were therefore unable to confirm whether this variant alone is pathogenic in MS, at least in heterozygosis.

Modelos de integración: la farmacia comunitaria y atención primaria / Models of integration: community pharmacy and primary care

JUSTIFICACIÓN: en estos últimos años se ha puesto de manifiesto la necesidad de integración entre la farmacia comunitaria (FC) y atención primaria (AP). El envejecimiento de la población o el manejo de pacientes polimedicados, la pandemia y la eficiencia de AP, son desafíos a los que el colectivo sanitario ha de enfrentarse integrado. La comunicación, la confianza, el consenso de objetivos y la conectividad han sido identificados como elementos clave. Sin embargo, no existe un modelo específico a FC para guiar este proceso.OBJETIVOS: identificar un modelo para la integración de la FC en el sistema sanitario, particularmente en AP.MÉTODO: se realizó una revisión narrativa de la literatura en PubMed que incluyó los términos “integrated/organized delivery system, health care/services/systems integration, and integrated health care/services/system/ delivery”, desde 2013 hasta 2022.RESULTADOS/DISCUSIÓN: de los 1605 artículos identificados, 27 cumplían los criterios de inclusión, identificándose 18 modelos o teorías. Se encontraron distintos modelos de integración de sistemas, definiendo “sistema” como un conjunto de sectores, organizaciones y profesionales que participan en la prestación de servicios sanitarios. Es primordial definir el objetivo de la integración y su nivel de enfoque (macro, meso, micro o en combinación).Dos ejemplos importantes son: Complex Adaptive System theory (CAS) y Landscape of physician-system integration (LOPSI). CAS se ocupa de explicar la complejidad a nivel de sistema (macro) dando importancia al comportamiento de las organizaciones o los colectivos como unidades básicas de análisis. La competencia necesaria para llevar a cabo una tarea, no pertenece a una parte, sino que es el resultado de una cooperación dentro del sistema. Aunque los objetivos resultantes al aplicar esta teoría son amplios presenta limitaciones en su aplicación a nivel micro para resolver problemas individuales. (AU)

¿Qué es la integración de la farmacia comunitaria en el Sistema de Salud? / What is the integration of community pharmacy into the Health System?

JUSTIFICACIÓN: uno de los retos que debe abordar la farmacia comunitaria (FC) es conseguir su integración en el sistema de salud. Sin embargo, el término integración se utiliza indistintamente con términos como ‘comunicación’, ‘colaboración’, ‘coordinación’, ‘cooperación’, ‘confianza’, ‘práctica colaborativa’, o ‘atención integrada’ (Integrated care), entre otros.OBJETIVOS: describir el concepto de integración con el fin de trabajar en una integración entre la FC y la Atención Primaria (AP).MATERIAL Y MÉTODOS: revisión narrativa. Se realizó una búsqueda bibliográfica de las definiciones y tipos de integración existentes en el área de la salud tanto en la revista International Journal of Integrated Care desde su inicio en el año 2000 hasta enero del 2022 como en Google utilizando el query: integration health types OR processes OR dimensions filetype:pdf.RESULTADOS/ DISCUSIÓN: el concepto de integración es un término amplio al que se le han dado múltiples definiciones. Además, existen varios tipos de integración (clínica, de servicios, organizacional, profesional y de sistema) que se comprende que se pueden dar a diferente amplitud (horizontal, vertical) y con diferente intensidad (es decir, no siempre contiene todos los elementos que definen la integración).Algunos autores indican que la integración requiere de un proceso de distintas etapas, que incluyen: (0) Aislamiento, (1) Comunicación, (2) Colaboración entre profesionales, (3) Colaboración entre organizaciones (Coordinación), (4) Integración. La Integración de la FC depende en gran medida del contexto, por lo que hay que tener en cuenta si se aborda desde una perspectiva “micro” (a nivel del FC y centros de salud), “meso” (a nivel provincial o comunidad autónoma) o “macro” (a nivel estatal), conscientes además de que hay acciones /decisiones que están interrelacionadas y son interdependientes a distintos niveles. (AU)

Predicting the biomechanical stability of IOLs inside the postcataract capsular bag with a finite element model.

BACKGROUND AND OBJECTIVES: Although cataract surgery is a safe operation in developed countries, there is still room for improvement in terms of patient satisfaction. One of the key issues is assessing the biomechanical stability of the IOL within the capsular bag to avoid refractive errors that lead to a second surgery. For that purpose, a numerical model was developed to predict IOL position inside the capsular bag in the short- and long-term. METHODS: A finite element model containing the implanted IOL, the postcataract capsular bag, the zonules, and a portion of the ciliary body was designed. The C-loop hydrophobic LUCIA IOL was used to validate the numerical model and two more worldwide IOL designs were tested: the double C-loop hydrophobic POD FT IOL and the plate hydrophilic AT LISA IOL. To analyze the biomechanical stability in the long-term, the effect of the fusion footprint, which occurs days following cataract surgery, was simulated. Moreover, several scenarios were analyzed: the size and location of the capsulorexhis, the capsular bag diameter, the initial geometry of the capsular bag, and the material properties of the bag. RESULTS: The biomechanical stability of the LUCIA IOL was simulated and successfully compared with the in vitro results. The plate AT LISA design deformed the capsular bag diameter up to 11.0 mm against 10.5 mm for the other designs. This design presented higher axial displacement and lower rotation, 0.19 mm and 0.2∘, than the C-loop design, 0.09 mm and 0.9∘. CONCLUSIONS: All optomechanical biomarkers were optimal, assuring good optical performance of the three IOLs under investigation. Our findings showed that the capsulorexhis size influences the stiffness of the capsular bag; however, the shape in the anterior and posterior curvature surfaces of the bag barely affect. The results also suggested that the IOL is prone to mechanical perturbations with the fusion footprint, but they were not high enough to produce a significant refractive error. The proposed model could be a breakthrough in the selection of haptic design according to patient criteria.

Mechanical characterisation of hydrophobic and hydrophilic acrylates used in intraocular lenses through depth sensing indentation.

In this work, the mechanical behaviour of hydrophilic and hydrophobic acrylates has been characterised by depth sensing indentation. Time-dependent behaviour has been studied using load-relaxation tests. Experiments have been simulated with a finite element software using a visco-hyperelastic material model. The parameters of this model have been determined using deep learning techniques. The developed material models have been used to mechanically simulate a standard compression test of a prototype intraocular lens.

Experimental evaluation of the injection force exerted in intraocular lens delivery with syringe-type injectors.

The process of intraocular lens (IOL) delivery within the capsular bag during cataract surgery is crucial, as the integrity of the IOL, the injector and the ocular structures should be preserved at all times. This study aims to obtain the main parameters that affect the injection force exerted in the ejection of an intraocular lens (IOL) through syringe-type injectors. For that purpose, ejection tests were carried out in vitro, measuring the resistance force throughout the entire delivery process. The effect of IOL material, haptic design, IOL thickest area and ophthalmic viscosurgical device (OVD) was studied by ejecting seven IOLs with four syringe-type injectors of different sizes, 3.0, 2.2 and 1.8 mm. In all injectors, plate hydrophilic IOLs present the lowest resistance forces; hydrated C-loop hydrophobic IOLs present higher forces and the C-loop hydrophobic IOL in dry conditions presents the highest resistance forces. All IOLs could be properly delivered with an injector size of 2.2 mm, making injector sizes of 3.0 mm outdated. The injector size of 1.8 mm damaged several IOLs. IOL material and cartridge nozzle size were the most influential parameters in IOL delivery. IOL thickest area was also relevant but in a lesser extent whereas IOL haptic design was not as relevant.

Treatment of calcific tendinopathy of the rotator cuff with ultrasound-guided puncture and aspiration. / Tratamiento de la tendinopatía calcificante del manguito de los rotadores mediante punción-aspiración ecoguiada.

OBJECTIVE: Calcific tendinopathy of the rotator cuff is a common condition caused by the deposition of calcium crystals in the tendons of the rotator cuff. This study aimed to analyze the effectiveness of ultrasound-guided puncture and aspiration in calcific tendinopathy of the should in 86 patients treated at our center and to determine the factors associated with poor prognosis after this treatment. MATERIAL AND METHODS: This retrospective descriptive study included 86 patients with calcific tendinopathy of the rotator cuff treated with ultrasound-guided puncture and aspiration between 2015 and 2019 for whom clinical and radiological variables were collected 1, 3, 6, and 12 months after the procedure. RESULTS: One year after treatment, 81.4% patients showed clinical improvement and 96.5% showed radiological improvement. Complications were observed in 34.9%; all complications were mild. CONCLUSIONS: Ultrasound-guided puncture and aspiration is an effective treatment for calcific tendinopathy of the shoulder, resulting in a high rate of clinical and radiological improvement and a low rate of minor complications. This technique has additional advantages, such as interaction with the patient and the lack of ionizing radiation.

A numerical investigation of changes in lens shape during accommodation.

The purpose of this study was to investigate how the mechanical properties and geometry of the lens influence the changes in lens shape during accommodation. To do so, ex vivo stretching tests of the isolated lens were simulated via finite element analysis. In these tests, the lens is stretched from the accommodated state to the non-accommodated state. Several key characteristics of the lens were studied: the stiffness gradient of the lens material, the distribution of the capsule thickness, the mechanical properties of the capsule and the material comprising the lens, nucleus and cortex, and the influence of two different age-related lens geometries (17 and 29 y/o subjects). To determine the effects on the changes in lens shape during accommodation, changes in the anterior and posterior radius, the lens and nucleus thicknesses and the equatorial lens diameter were analysed. The results suggest that multiple factors exert statistically significant influences on how the lens changes its shape, but two factors predominate over the rest: the stiffness ratio between the nucleus and cortex and the stiffness of the capsule, specifically the posterior surface.

Effect of haptic geometry in C-loop intraocular lenses on optical quality.

The biomechanical stability of intraocular lenses (IOLs) must achieve high-quality optical performance and clinical outcomes after cataract surgery. For this reason, the quality and performance features of the IOLs should be previously analysed following the Standard ISO 11979-2 and ISO 11979-3. The ISO 11979-3 tries to reproduce the behaviour of the IOL in the capsular bag by compressing the lens between two clamps. With this test, it has been demonstrated that the haptic design is a crucial factor to obtain biomechanical stability. Hence, the main goal of this study was to design an aberration-free aspheric IOL and to study the influence of haptic geometry on the optical quality. For that purpose, 5 hydrophobic IOLs with different haptic design were manufactured and their biomechanical stability was compared experimentally and numerically. The IOLs were classified as stiff and flexible designs depending on their haptic geometry. The biomechanical response was measured by means of the compression force, the axial displacement, the angle of contact or contact area, the decentration, the tilt and the strain energy. The results suggest that in vitro and in silico compression tests present similar responses for the IOLs analysed. Furthermore, the flexible IOL designs presented better biomechanical stability than stiff designs. These results were correlated with the optical performance, where the optical quality decreases with worst biomechanical stability. This numerical methodology provides an indisputable advance regarding IOL designs, leading to reduce costs by exploring a feasible space of solutions during the product design process and prior to manufacturing.

Customised Selection of the Haptic Design in C-Loop Intraocular Lenses Based on Deep Learning.

In order to increase the probability of having a successful cataract post-surgery, the customisation of the haptic design of the intraocular lens (IOL) according to the characteristics of the patient is recommended. In this study, we present two prediction models based on deep neural networks (DNNs). One is capable of predicting the biomechanical stability of any C-loop IOL, whereas the other can predict the haptic design that fits a desired biomechanical response, enabling the selection of the optimal IOL as a function of the IOL diameter compression. The data used to feed the networks has been obtained from a validated finite element model in which multitude of geometries are tested according to the ISO 11979-3 compression test, a standard for the mechanical properties of the IOLs. The biomechanical response model provides a very high accurate response (Pearson's r = 0.995), whilst the IOL haptic design model shows that several IOL designs can provide the same biomechanical response (Pearson's r = 0.992). This study might help manufacturers and ophthalmologists both analyse any IOL design and select the best IOL for each patient. In order to facilitate its application, a graphical user interface (GUI) was created to show the potential of deep learning methods in cataract surgery.

Comparison of mortality rate in older adults with and without functional awareness: the Neurological Disorders in Central Spain (NEDICES) population-based study.

OBJECTIVES: The main aim of the study was to compare the rates of mortality in older adults with and without functional unawareness (FU). We also tested a possible interaction effect between levels of awareness and education, as a single cognitive reserve proxy, on mortality. STUDY DESIGN: The study design is a longitudinal population-based cohort study. METHODS: The Neurological Disorders in Central Spain is epidemiological study to detect main age-associated conditions in people aged 65 years and older. Participants were collected from updated population-based registers of residents in three areas of central Spain. Awareness of functional limitations was established in accordance with the discrepancy between two sources of information on functional impairments: reliable informants versus the participants themselves. Three mutually exclusive groups were formed, namely, Functional Limitation Complaints (FCs), FU, and Functional Awareness (FA). Cox's regression models, adjusted by different covariates, were used to calculate the risk of mortality for each group at 5-year follow-up (vs. reference group without limitations). RESULTS: Of 1818 selected individuals, 229 (12.5%) showed FA, 254 (13.9%) showed FC, and 96 (5%) were classified as FU. All these groups showed an increased risk of mortality at 5-year follow-up [adjusted hazard ratio (HR) for FC < FU < FA]. However, the association of FU with mortality remained significant only for highly educated individuals. CONCLUSIONS: Functional impairment was associated with increased mortality rates, regardless of the presence of unawareness. This study extends the role of education in modulating the symptoms and prognosis of individuals at very mild or preclinical dementia stages.

Long term comparative evaluation of two types of absorbable meshes in partial abdominal wall defects: an experimental study in rabbits.

PURPOSE: Synthetic prosthetic materials that are fully absorbable seek to reduce the host foreign body reaction and promote host tissue regeneration. This preclinical trial was designed to analyse, in the long term, the behaviour of two prosthetic meshes, one synthetic and one composed of porcine collagen, in abdominal wall reconstruction. METHODS: Partial defects were created in the abdominal walls of New Zealand rabbits and repaired using a synthetic absorbable mesh (Phasix™) or a non-crosslinked collagen bioprosthesis (Protexa™). After 3, 6, 12 and 18 months, specimens were recovered for light microscopy and collagen expression analysis to examine new host tissue incorporation, macrophage response and biomechanical strength. RESULTS: Both materials showed good host tissue incorporation in line with their spatial structure. At 18 months postimplant, Protexa™ was highly reabsorbed while the biodegradation of Phasix™ was still incomplete. Collagenization of both materials was good. Macrophage counts steadily decreased over time in response to Phasix™, yet persisted in the collagen meshes. At 18 months, zones of loose tissue were observed at the implant site in the absence of herniation in both implant types. The stress-stretch behaviour of Phasix™ implants decreased over time, being more pronounced during the period of 12-18 months. Nevertheless, the abdominal wall repaired with Protexa™ became stiffer over time. CONCLUSION: Eighteen months after the implant both materials showed good compatibility but the biodegradation of Phasix™ and Protexa™ was incomplete. No signs of hernia were observed at 18 months with the stress-stretch relations being similar for both implants, regardless of the more compliant abdominal wall repaired with Protexa™ at short term.

Metabolic effects and outcomes of sleeve gastrectomy and gastric bypass: a cohort study.

BACKGROUND: The outcomes of bariatric surgery should not be evaluated only for weight loss purposes but from a wider point of view that is closer to the reality of morbidly obese patients. The study of the influence of bariatric surgery over obesity-related diseases in bariatric patients is worthwhile. METHODS: We present a cohort study of 329 patients who underwent either laparoscopic sleeve gastrectomy (LSG: 165 patients) or laparoscopic gastric bypass (LRYGBP: 164). We analyzed complication rate, comorbidities and weight loss evolution. RESULTS: Both groups were comparable in demographic characteristics at baseline. Significant statistical differences were found in length of hospital stay and operative time (both were lower in the LSG group). Bleeding and wound infection were higher in the LRYGBP group, as it happened with intestinal occlusion as a late complication (p < 0.05). After a 5-year follow-up, the percentage of excess weight loss (%EWL) was higher in gastric bypass than sleeve gastrectomy (p = 0.01) but there was no statistical difference in percentage of total weight loss (%TWL) (p = 0.2). The resolution of comorbidities was similar in both groups except for dyslipidemia, which resolution was significantly higher in the gastric bypass group (p = 0.005). Metabolic syndrome (MeTS) resolution was similar in both groups. CONCLUSIONS: Sleeve gastrectomy and gastric bypass achieve similar outcomes in hypertension, type 2 diabetes, obstructive sleep apnea and MeTS resolution even when there is weight regain. Although gastric bypass achieves higher weight loss in morbid obese patients, complication rates are also higher compared to those of sleeve gastrectomy. Thus, the appropriate procedure should be tailored based on patient factors and comorbidities, but also on surgeon comfort level and experience.

Systematic Study on the Biomechanical Stability of C-Loop Intraocular Lenses: Approach to an Optimal Design of the Haptics.

To study the main design parameters that affect the mechanical stability of C-loop intraocular lenses, leading to an optimal design that minimizes the axial displacement, tilt and rotation. A total of 144 geometrical variations were studied on a 1-piece, non-angulated, C-loop hydrophobic acrylate intraocular lens. The study was performed in a finite element modeling simulation. The suitable set of variations was determined using a mixed-factorial analysis, allowing to analyse the impact of the different designs on the mechanical stability of the lens (compression force, axial displacement, tilt and rotation). The design parameters under study were: the length, width, thickness and opening angle of the haptic, the haptic-optic junction and the start of the haptic curvature. The compression (or reaction) force is affected by the haptic width, the haptic-optic junction, and the interaction between both. The axial displacement is mainly affected by the width and thickness of the haptic, and the size of the haptic-optic junction as well. The tilt is affected by the haptic thickness and the interaction between the haptic curvature and the haptic-optic junction. The rotation is affected by the start of the haptic curvature, the haptic-optic junction and the haptic width. The haptic-optic juntion is one of the most influential parameters affecting the four responses studied of the C-Loop IOL. The smaller the haptic-optic juntion, the better biomechanical stability.

Oxigenación unilobar con fibroscopio durante cirugía de resección pulmonar / Single-lung ventilation with bronchofibroscopy during lung resection surgery

El aislamiento pulmonar mediante ventilación unipulmonar es frecuente en procedimientos de cirugía torácica, ya que permite una mejor visualización y manipulación del pulmón a intervenir. El bloqueo lobar selectivo está descrito en pacientes que no toleran la ventilación unipulmonar y se suele realizar por medio del bloqueador bronquial. Sin embargo, su realización está condicionada por la necesidad de disponer de dicho bloqueador, por la complejidad para su correcta colocación y la necesidad de vigilancia intensiva para asegurar la adecuada colocación del sellado bronquial. En el caso que presentamos hemos aplicado una técnica novedosa para aumentar la superficie de intercambio de oxígeno. Se ha logrado mediante la administración directa de este por el canal del fibrobroncoscopio a uno de los lóbulos no ventilados no objeto de la cirugía. Mediante esta técnica, el cirujano se benefició de un campo quirúrgico óptimo, se mejoró la hipoxemia de la ventilación unipulmonar y no se observó ninguna complicación perioperatoria

Lung isolation using one-lung ventilation is common during thoracic surgery procedures, as it allows proper visualisation and manipulation of the lung to be operated on. Selective lobar blockade has been described in patients that do not tolerate one-lung ventilation, and is usually achieved using endobronchial blockers. However, it depends on endobronchial blocker availability, its complexity regarding proper positioning, and the need for constant monitoring to ensure the correct placement of the bronchial seal. In the clinical case to be described, a new method was used to increase the available surface for oxygen exchange. This was accomplished by means of direct supply of oxygen through the bronchoscope's working channel to one of the not-to-be operated-on, non-ventilated lung lobes. With this technique, the surgeon had an optimal operating field, oxygenation from one-lung ventilation improved and no perioperative complications were found