General and Substantive Accountability in Nursing Home Services: Assessing Messages from the Demand Side and the Supply Side.

This study examines the extent to which general and substantive accountability is integrated into the language used by key actors involved in nursing home services. Particularly, we investigate the messages used by the supply side, which includes public and private organizations involved in residential care for older adults, and the demand side, which comprises organizations representing service beneficiaries. Moreover, we explore the alignment between the messages used by both sides of the accountability relationship. In the context of Spanish nursing homes, we analyzed a corpus of tweets by organizations from both sides of the accountability relationship, from one year before the outbreak of COVID-19 restrictions to after their implementation. Using text analysis techniques, we found that messages related to general and substantive accountability had a low priority before and after the outbreak. Public organizations were slightly more likely to employ general accountability terms than private organizations. This is particularly in non-crisis situations, although less frequently than organizations representing beneficiaries. Our analysis demonstrates a lack of convergence between the messaging on the supply and demand sides, indicating a communication breakdown between the two sides in the accountability relationship.

Difficulties on the access to innovative targeted therapies for lung cancer in Spain.

PURPOSE: Spanish Lung Cancer Group (SLCG) conducted a review to analyze the barriers to access to innovative targeted therapies for non-small cell lung cancer (NSCLC) in clinical practice in Spain. METHODS: Review all relevant content published on websites of European Commission, European Medicines Agency, and Spanish Agency of Medicines and Medical Products regarding the authorization and access to oncology treatments. RESULTS: More than 20 targeted therapies are available to treat different molecular alterations in patients with NSCLC. European Commission has approved treatments for genomic alterations involving the following genes: ALK, RET, ROS1, EGFR, BRAF, NTRK, KRAS, MET. However, the availability of these therapies in Spain is not complete, as innovative treatments are not reimbursed or funded late, with only five of these alterations currently covered by National Health System. CONCLUSION: SLCG considers imperative to improve the access in Spain to innovative treatments for NSCLC to reduce inequity across European countries.

Rescate endoscópico de endoprótesis biliar plástica fistulizante / Endoscopic rescue of a fistulizing biliary plastic stent

55-year-old male with a history of cholecystectomy complicated by perforation of the common bile duct, contained with placement of a plastic biliary stent. He presented several subsequent episodes of recurrent cholangitis secondary to biliary lithiasis and residual benign stenosis of the common bile duct, resolved with the implantation of plastic biliary prostheses. Finally, given the recurrent episodes of cholangitis, it was agreed to perform a hepaticojejunostomy. During the operation, the last implanted stent was not detected, which was identified by CT scan of the abdomen, causing a fistulous tract between the duodenum and the ascending colon. The stent was removed endoscopically, without complications, and the fistulous tract was resolved.(AU)

A Retrospective Analysis of High Resolution Ultrasound Evaluation of the "Split Fat Sign" in Peripheral Nerve Sheath Tumors.

Peripheral nerve sheath tumors (PNST) comprise schwannomas and neurofibromas. The finding of increased adipose tissue around benign PNSTs has been described as the "split fat sign" on magnetic resonance imaging exams, which is suggestive of an intramuscular or intermuscular location of the tumor. However, few studies have described this sign as a salient ultrasound feature of PNSTs. The main purpose of this study was to retrospectively evaluate the presence of increased fatty tissue deposition around benign PNSTs diagnosed by high-resolution ultrasound. In addition, we aimed to corroborate the presence of vascularization around the affected area. A retrospective analysis of ten cases of PNSTs and two cases of post-traumatic neuromas diagnosed by high-resolution ultrasound was performed with a Logiq® P8 ultrasound with a 2-11 MHz multifrequency linear probe L3-12-D (central frequency: 10 MHz). Localized types of neurofibromas and schwannomas in any location were seen as predominantly hypoechoic tumors with an oval or fusiform shape. Exiting and entering nerves (tail sign) were observed in six cases, showing localized lesions both in intermuscular and subcutaneous locations. The presence of increased hyperechoic tissue (the split fat sign) was noted in cases of solitary intermuscular and intramuscular peripheral nerve sheath tumors, mainly the schwannomas. Though small tumors did not demonstrate the tail sign, the increase in adipose tissue and vascularity on US was well demonstrated. In conclusion, the nerve in continuity forms the basis of the ultrasonographic diagnosis of PNSTs. However, high-resolution US can convincingly demonstrate the increased presence of fat in the upper and lower poles as well as circumferentially in intermuscular or intramuscular benign PNSTs.

Analysis of individual performance indicators of football goalkeeper

One of the most widely used strategies for performance analysis in different sports is notational analysis through direct observation of technical-tactical actions, which allows to understand the main indicators of sporting performance of the players, both individually and collectively. Football goalkeepers (GKs) are involved in the game differently when compared to the rest of the players in the team and, therefore, they develop different high-level and high-intensity tactical-technical actions. Therefore, the present work aimed to analyse the different performance indicators of football GKs through a search in the following databases: Web of Science (WOS), Scopus (Elsevier), PubMed (NIH) and, SPORTDiscus (EBSCO), until February 2023. The following keywords were used: "Football" or "Soccer", "Goalkeeper" and "Performance analysis". The results show that the main performance indicators are the percentage of avoided goals, the distribution of the ball at the goal kick as well as the number of offensive and defensive actions. Therefore, training sessions should be planned and implemented aimming to improve these skills. (AU)

Una de las estrategias más utilizadas para analizar el rendimiento en diferentes modalidades deportivas, es el análisis notacional a través de la observación directa de las acciones técnico-tácticas, lo que permite conocer los principales indicadores de rendimiento deportivo de los jugadores, tanto individual como colectivamente. Los porteros de fútbol tienen una involucración en el juego diferente comparativamente al resto de los jugadores del equipo, y, por ende, desarrollan diferentes acciones táctico-técnicas de alto nivel y de alta intensidad. Por ello, el objetivo del presente trabajo fui a analizar los diferentes indicadores de rendimiento de los porteros de fútbol mediante una búsqueda en las bases de datos: Web of Science (WOS), Scopus (Elsevier), PubMed (NIH) y SPORTDiscus (EBSCO), hasta febrero del 2023. Para ello, se emplearon las siguientes palabras claves, “Football” o “Soccer”, “Goalkeeper” y “Performance analysis”. Los resultados muestran como los principales indicadores de rendimiento son el porcentaje de goles evitados, la distribución del balón en el saque de portería, así como el número de acciones ofensivas y defensivas. Por tanto, se deben planificar e implementar sesiones de entrenamiento para la mejora de dichas habilidades. (AU)

PD-1/PD-L1 Inhibitors as Monotherapy in the First-Line Treatment of Advanced Non-Small Cell Lung Cancer Patients with High PD-L1 Expression: An Expert Position Statement.

INTRODUCTION: There are currently three first-line immunotherapy options used as monotherapy in advanced non-small cell lung cancer (NSCLC) patients with high programmed death ligand 1 (PD-L1) expression (≥50%). This manuscript aims to evaluate the available data on atezolizumab (AT), cemiplimab (CEMI), and pembrolizumab (PEMBRO) and to study the results obtained during pivotal trials, especially regarding patient subgroups. METHODS: Nominal group and Delphi techniques were used. Eight Spanish experts in lung cancer (the scientific committee of the project) analyzed the use of immunotherapy monotherapy as first-line treatment in patients with NSCLC and high PD-L1 expression. The expert scientific committee formulated several statements based on a scientific review and their own clinical experience. Subsequently, 17 additional Spanish lung cancer experts were selected to appraise the committee's statements through two Delphi rounds. They completed a Delphi round via an online platform and voted according to a scale from 1 (strongly disagree) to 10 (strongly agree). The statements were approved if ≥70% of experts voted 7 or more. RESULTS: A total of 20 statements were proposed covering the following areas: (1) general characteristics of pivotal clinical trials; (2) overall main outcomes of pivotal clinical trials; and (3) subgroup analysis. All statements reached consensus in the first round. CONCLUSIONS: AT, CEMI, and PEMBRO as monotherapy can be considered the standard of care in patients with advanced NSCLC and high PD-L1 expression (≥50%). Moreover, some differences noted among the drugs analyzed in this document might facilitate treatment decision-making, especially in clinically relevant patient subgroups, when using PD-1/PD-L1 inhibitors. The high level of agreement reached among experts supports the proposed statements.

Semiempirical Two-Dimensional Model of the Bipolar Resistive Switching Process in Si-NCs/SiO2 Multilayers.

In this work, the SET and RESET processes of bipolar resistive switching memories with silicon nanocrystals (Si-NCs) embedded in an oxide matrix is simulated by a stochastic model. This model is based on the estimation of two-dimensional oxygen vacancy configurations and their relationship with the resistive state. The simulation data are compared with the experimental current-voltage data of Si-NCs/SiO2 multilayer-based memristor devices. Devices with 1 and 3 Si-NCs/SiO2 bilayers were analyzed. The Si-NCs are assumed as agglomerates of fixed oxygen vacancies, which promote the formation of conductive filaments (CFs) through the multilayer according to the simulations. In fact, an intermediate resistive state was observed in the forming process (experimental and simulated) of the 3-BL device, which is explained by the preferential generation of oxygen vacancies in the sites that form the complete CFs, through Si-NCs.

An intercommunicated nanosystem for dual delivery.

Here, we describe the design of a novel particle-to-particle intercommunicated nanosystem for dual delivery, triggered by physical and chemical inputs. The nanosystem was composed of an Au-mesoporous silica Janus nanoparticle loaded with paracetamol, mechanized with light-sensitive supramolecular gates at the mesoporous face and functionalized on the metal surface with the enzyme acetylcholinesterase. The second component was a mesoporous silica nanoparticle loaded with rhodamine B and gated with thiol-sensitive ensembles. Upon irradiation of this nanosystem with a near-UV light laser, an analgesic drug was released from the Janus nanomachine due to disassembling of the photosensitive gating mechanism. Further addition of N-acetylthiocholine leads to the enzymatic production of thiocholine at the Janus nanomachine, thus acting as a "chemical messenger" causing the disruption of the gating mechanism at the second mesoporous silica nanoparticle with the subsequent dye release.

Endoscopic rescue of a fistulizing biliary plastic stent.

55-year-old male with a history of cholecystectomy complicated by perforation of the common bile duct, contained with placement of a plastic biliary stent. He presented several subsequent episodes of recurrent cholangitis secondary to biliary lithiasis and residual benign stenosis of the common bile duct, resolved with the implantation of plastic biliary prostheses. Finally, given the recurrent episodes of cholangitis, it was agreed to perform a hepaticojejunostomy. During the operation, the last implanted stent was not detected, which was identified by CT scan of the abdomen, causing a fistulous tract between the duodenum and the ascending colon. The stent was removed endoscopically, without complications, and the fistulous tract was resolved.

Influencia del ciclo menstrual en el rendimiento físico y cognitivo en mujeres eumenorreicas / Influence of the menstrual cycle on physical and cognitive performance in eumenorrheic women

Introducción: Las hormonas sexuales femeninas propias del ciclo menstrual no solo tienen funciones reproductivas, tambiéninfluyen en otros sistemas fisiológicos pudiendo afectar al rendimiento deportivo y cognitivo. El propósito del presente estudioha sido evaluar distintos aspectos como la composición corporal, la resistencia, la fuerza muscular y algunas capacidadescognitivas en diferentes etapas del ciclo menstrual. Material y método: En el estudio participaron ocho mujeres jóvenes eumenorreicas (edad = 23,1 ± 4,4 años) con ciclosmenstruales regulares. Se realizó una prueba de densitometría y una bioimpedancia para estudiar la composición corporal, unaprueba de memoria visual a corto plazo y un test de tiempo de reacción para evaluar habilidades cognitivas y se analizaroncaracterísticas del músculo (grosor y rigidez del recto anterior y fuerza muscular) junto a una prueba de esfuerzo para evaluarel rendimiento durante las fases folicular media (FF) y lútea media (FL) del ciclo menstrual de las participantes. Resultados: Durante la fase folicular las participantes registraron un mayor tiempo total (FF = 488,5 ± 93,18 s vs. FL = 468,6± 81,29 s; p = 0,015) y una frecuencia cardiaca inicial menor (FF = 83,3 ± 10,23 PPM vs. FL = 92,9 ± 7,67 PPM; p = 0,034) en laprueba de esfuerzo. Además, Respecto a las habilidades cognitivas, en la fase folicular se obtuvieron mejores resultados enel tiempo de reacción tanto con la mano derecha (FF = 0,426 ± 0,082 s vs. FL = 0,453 ± 0,087 s; p = 0,036) como con la manoizquierda (FF = 0,435 ± 0,096 s vs. FL = 0,466 ± 0,077 s; p = 0,034). Por otro lado, se encontró un mayor porcentaje de grasa(FF = 27,3 ± 5,1% vs. FL = 27,9 ± 5,0%; p = 0,041) en la fase lútea. Conclusión: El rendimiento en resistencia y en aspectos cognitivos como es el tiempo de reacción fue mejor en la FaseFolicular mientras que se observó un mayor porcentaje de grasa en la Fase Lútea. Sin embargo, la memoria, la fuerza y lascaracterísticas...(AU)

Introduction: The female sexual hormones typical of the menstrual cycle not only have reproductive functions, they alsoinfluence other physiological systems and can affect sports and cognitive performance. The purpose of this study has beento evaluate different aspects such as body composition, endurance, muscle strength and some cognitive abilities at differentstages of the menstrual cycle. Material and method: Eight young eumenorrheic women (age = 23.1 ± 4.4 years) with regular menstrual cycles participatedin the study. A densitometry and bioimpedance test were performed to study body composition, a short-term visual memorytest and a reaction time test to assess cognitive abilities, and muscle characteristics (thickness and stiffness of the anteriorrectus and muscle strength) along with a progressive test to exhaustion were analyzed to assess performance during themid-follicular (FF) and mid-luteal (FL) phases of the participants’ menstrual cycle. Results: During the follicular phase, the participants registered a greater total time (FF = 488.5 ± 93.18 s vs. FL = 468.6 ± 81.29 s;P = 0.015) and a lower initial heart rate (FF = 83.3 ± 10.23 PPM vs. FL = 92.9 ± 7.67 PPM; P = 0.034) in the progressive test toexhaustion. Regarding cognitive abilities, in the follicular phase, better results were obtained in reaction time both with theright hand (FF = 0.426 ± 0.082 s vs. FL = 0.453 ± 0.087 s; P = 0.036) and with the left hand (FF = 0.435 ± 0.096 s vs. FL = 0.466 ±0.077 s; P = 0.034). On the other hand, a higher percentage of fat (FF = 27.3 ± 5.1% vs. FL = 27.9 ± 5.0%; P = 0.041) was foundin the luteal phase. Conclusion: Performance in endurance and in cognitive test, such as reaction time was better in the Follicular Phase, whilea higher percentage of fat was observed in the Luteal Phase. However, memory, strength and muscular characteristics werenot affected by the hormonal fluctuations of the menstrual cycle.(AU)

Lysophosphatidylinositol Promotes Chemotaxis and Cytokine Synthesis in Mast Cells with Differential Participation of GPR55 and CB2 Receptors.

Mast cells (MCs) are the main participants in the control of immune reactions associated with inflammation, allergies, defense against pathogens, and tumor growth. Bioactive lipids are lipophilic compounds able to modulate MC activation. Here, we explored some of the effects of the bioactive lipid lysophosphatidylinositol (LPI) on MCs. Utilizing murine bone marrow-derived mast cells (BMMCs), we found that LPI did not cause degranulation, but slightly increased FcεRI-dependent ß-hexosaminidase release. However, LPI induced strong chemotaxis together with changes in LIM kinase (LIMK) and cofilin phosphorylation. LPI also promoted modifications to actin cytoskeleton dynamics that were detected by an increase in cell size and interruptions in the continuity of the cortical actin ring. The chemotaxis and cortical actin ring changes were dependent on GPR55 receptor activation, since the specific agonist O1602 mimicked the effects of LPI and the selective antagonist ML193 prevented them. The LPI and O1602-dependent stimulation of BMMC also led to VEGF, TNF, IL-1α, and IL-1ß mRNA accumulation, but, in contrast with chemotaxis-related processes, the effects on cytokine transcription were dependent on GPR55 and cannabinoid (CB) 2 receptors, since they were sensitive to ML193 and to the specific CB2 receptor antagonist AM630. Remarkably, GPR55-dependent BMMC chemotaxis was observed towards conditioned media from distinct mouse and human cancer cells. Our data suggest that LPI induces the chemotaxis of MCs and leads to cytokine production in MC in vitro with the differential participation of GPR55 and CB2 receptors. These effects could play a significant role in the recruitment of MCs to tumors and the production of MC-derived pro-angiogenic factors in the tumor microenvironment.

Digital and Analog Resistive Switching Behavior in Si-NCs Embedded in a Si/SiO2 Multilayer Structure for Neuromorphic Systems.

In this work, we report the digital and analog resistive-switching (RS) characteristics in a memristor based on silicon nanocrystals (Si-NCs) integrated into a complementary metal-oxide-semiconductor (MOS) structure. Si-NCs with a diameter of 5.48 ± 1.24 nm embedded in a SiO2/Si-NCs/SiO2 multilayer structure acts as an RS layer. These devices exhibit bipolar RS with an intermediate resistance step during SET and RESET processes, which is believed to lie in the Si-NCs layer acting as charge-trapping nodes. The endurance studies of about 70 DC cycles indicate an ON/OFF ratio of ~106 and a retention time larger than 104 s. Long-term potentiation (LTP, -2 V) and long-term depression (LTD, +4 V) are obtained by applying consecutive identical pulse voltages of 150 ms duration. The current value gradually increases/decreases (LTP/LTD) as the pulse number increases. Three consecutive identical pulses of -2 V/150 ms (LTP) separated by 5 and 15 min show that the last current value obtained at the end of each pulse train is kept, confirming an analog RS behavior. These characteristics provide a possible way to mimic biological synapse functions for applications in neuromorphic computing in Si-NCs-based CMOS structures.

Synthesis of (µ2,η3-allyl-η5-oxapentadienyl)diiron pentacarbonyl complexes, an unusual reaction product from η4-(vinylketene)Fe(CO)3 complexes: structure and electron density distribution analysis.

The synthesis of a series of ferrocenylvinylketenes as stable η4-[Fe(CO)3] complexes (3a-f) was successfully accomplished through the reaction of η2-[Fe(CO)4] complexes under mild carbonylation conditions. The reactivity of 3a-f under thermal conditions afforded the unexpected formation of a novel family of (µ2,η3-allyl-η5-oxapentadienyl)diiron pentacarbonyl complexes 5a-f proposed to be formed by a sequence metathesis-haptotropic rearrangement between the starting η4-vinylketene iron(0) complex 3 and a η4-vinylcarbene iron(0) complex trapped in situ after a reversible carbonylation process favored by the thermal conditions. An electron density distribution analysis (EDD) of 5e using high-resolution X-ray diffraction data in combination with the DFT framework was performed to understand the electronic communication between the two iron fragments.

Eagle's syndrome as a cause of oropharyngeal dysphagia.

Eagle's syndrome is a little known entity defined as the elongation of the stylohyoid process and/or calcification of the stylohyoid ligament. It is a rare pathology that due to its presentation and possible complications should be taken into consideration in the differential diagnosis of oropharyngeal dysphagia. We present the case of a patient with Eagle's syndrome as well as essential aspects in the diagnosis and treatment of this entity.

Síndrome del conducto pancreático desconectado. Abordaje endoscópico. / Disconnected pancreatic duct syndrome. Endoscopic approach

El síndrome del conducto pancreático desconectado (SCPD) es debido a la interrupción del conducto pancreático (CP) principal o sus ramas secundarias, complicación presente entre un 30-80% de las pancreatitis agudas necrotizantes. La secreción de enzimas pancreáticas por el tejido pancreático aislado funcionante puede facilitar la recurrencia de colecciones necróticas encapsuladas, por lo que su manejo endoscópico sigue siendo un tema controvertido en la práctica diaria. Exponemos un caso de síndrome de ducto pancreático desconectado resuelto tras colocación de prótesis pancreática. (AU)

Five-Compressions Protocol as a Valid Myotonometric Method to Assess the Stiffness of the Lower Limbs: A Brief Report.

The objective of this study was to evaluate the validity of a short assessment MyotonPRO protocol to measure the stiffness of the superficial muscles and tendons of the lower limbs. The stiffness of the dominant lower limb vastus lateralis (VL), rectus femoris (RF) and patellar tendon (PT) was evaluated in 52 healthy participants (26.9 ± 3.4 years) with two MyotonPRO protocols: the standard protocol (10 mechanical taps) and the short protocol (five mechanical taps). The myotonometry was performed at the midpoint of the length from the upper pole of the patella to the greater trochanter for the VL, and to the anterior superior iliac spine for the RF. The PT was evaluated 1 cm caudal from the inferior pole of the patella. Pearson's correlation coefficients were calculated to determine the relationships between protocols. The validity of the short protocol was evaluated with Student's t-test. High positive correlations were observed between the short and standard protocols in the stiffness of the VL (r = 0.959; p < 0.001), the RF (r = 0.967; p < 0.001) and the PT (r = 0.953; p < 0.001) and no differences were found between both protocols in the stiffness assessment of the VL, RF and PT (p > 0.05). Therefore, the five-compressions protocol is a valid protocol for the assessment of lower limb mechanical properties.

Development of Heterojunction c-Si/a-Si1-xCx:H PIN Light-Emitting Diodes.

In this work, we explored the feasibility of the fabrication of PIN light-emitting diodes (LEDs) consisting of heterojunctions of amorphous silicon-carbide (a-Si1-xCx:H) thin films and crystalline silicon wafers (c-Si). The objective is the future development of electro-photonic systems in the same c-Si wafer, containing transistors, sensors, LEDs and waveguides. Two different heterojunction LEDs were fabricated consisting of PIN and PIN+N structures, where a-Si1-xCx:H thin films were used as P-type and I-type layers, while an N-type c-Si substrate was used as an active part of the device. The amorphous layers were deposited by the plasma-enhanced chemical vapor deposition (PECVD) technique at a substrate temperature of 200 °C. The PIN device presented electroluminescence (EL) only in the forward bias, while the PIN+N device presented in both the forward and reverse biases. The EL in reverse bias was possible due to the addition of an N+-type a-Si:H layer between the c-Si substrate and the I-type a-Si1-xCx:H active layer. Likewise, the EL intensity of the PIN+N structure was higher than that of the PIN device in forward bias, indicating that the addition of the N-type a-Si:H layer makes electrons flow more efficiently to the I layer. In addition, both devices presented red EL in the full area, which is observed with the naked eye.

The Applicability of Shear Wave Elastography to Assess Myotendinous Stiffness of Lower Limbs during an Incremental Isometric Strength Test.

The aim of the study was to describe the applicability of shear wave elastography to assess muscular and tendinous stiffness of the lower limbs during an incremental isometric strength test and to differentiate the stiffness evolution between superficial and deep muscle regions. Dominant rectus femoris and patellar tendons of 30 physically active people (28.3 ± 9.2 years, 173.2 ± 7.7 cm, 76.2 ± 12.6 kg) were measured in different isometric strength conditions (relaxed muscle, and at 10%, 20%, 30%, 40%, 50% and 60% of maximal voluntary contraction (MVC)). The percentage of success was >85% at all muscle contraction intensities for rectus femoris muscles but only in a relaxed condition for patellar tendons. Rectus femoris stiffness significantly increased compared to the relaxed condition from 30% to 60% MVC (p ≤ 0.011) in superficial muscle regions, and from 10% to 60% MVC (p ≤ 0.002) in deep muscle regions. Deep muscle regions showed higher stiffness values than superficial muscle regions at 30% MVC (51.46 ± 38.17 vs. 31.83 ± 17.05 kPa; p = 0.019), 40% MVC (75.21 ± 42.27 vs. 51.25 ± 28.90 kPa; p = 0.018), 50% MCV (85.34 ± 45.05 vs. 61.16 ± 37.03 kPa; p = 0.034) and 60% MVC (109.29 ± 40.04 vs. 76.67 ± 36.07 kPa; p = 0.002). Rectus femoris stiffness increased during the incremental isometric contraction test, and inter-region differences were found at 30% MVC.

Disconnected pancreatic duct syndrome. Endoscopic approach.

Disconnected pancreatic duct syndrome (DPCS) is due to disruption of the main pancreatic duct (PC) or its secondary branches, a complication present in 30-80% of acute necrotizing pancreatitis. The secretion of pancreatic enzymes by isolated functioning pancreatic tissue can facilitate the recurrence of encapsulated necrotic collections, so its endoscopic management remains a controversial issue in daily practice. We present a case of disconnected pancreatic duct syndrome resolved after placement of a pancreatic stent.