Accompaniment of minors during health care procedures.

In clinical practice, it is not rare to encounter situations in which parents and families are asked to leave the child alone with the health care team in rooms full of devices throughout the performance of procedures, which at times may give rise not only to conflicts but, more importantly, emotional sequelae in children or adolescents. We conducted a narrative review of the literature by searching the digital library of the public health care system of Andalusia for articles concerning the experiences of health care professionals and families with the accompaniment of paediatric patients during health care procedures. We restricted the search to studies published in Spanish or English and conducted in humans. The review evinced the need to humanise care in order to improve care quality. The need to accompany minors is supported by the evidence from works that have analysed the factors involved in the persistence of these behaviours and attitudes in both professionals and parents. We consider it necessary to develop institutional policies and appoint mediators to compile the statements of different national and international societies, taking into account legal aspects but, above all, the pertinent values from a health care ethics perspective, and in pursuit of the best interests of the child.

Acompañamiento a los menores durante los procedimientos asistenciales / Accompaniment of minors during health care procedures

En la práctica clínica no es infrecuente observar situaciones en las cuales se invita a los progenitores y la familia a dejar a los menores en soledad junto al equipo asistencial en estancias repletas de tecnología durante la realización de procedimientos, dando lugar en ocasiones a conflictos, pero sobre todo con consecuencias emocionales en los niños o adolescentes.Se ha realizado una revisión narrativa de la literatura mediante búsqueda bibliográfica en la biblioteca virtual del sistema sanitario público de Andalucía, siendo los criterios de inclusión utilizados, estudios que conciernen a las experiencias de profesionales sanitarios y familiares sobre el acompañamiento de la población pediátrica en los procedimientos asistenciales. El resultado de la búsqueda se limitó a trabajos en humanos en español e inglés.Esta revisión pone de manifiesto la necesidad de humanizar la asistencia sanitaria para mejorar la calidad de la atención. Se justifica la necesidad de acompañamiento de los menores, a través de trabajos que han analizado los factores que intervienen en la permanencia de estas conductas y actitudes tanto por profesionales como padres. Se recomienda la necesidad de políticas institucionales y figuras mediadoras que recojan las declaraciones de algunas sociedades nacionales e internacionales teniendo en cuenta aspectos legales, pero sobre todo los valores en juego desde una ética del cuidado y búsqueda del interés superior del menor.(AU)

In clinical practice, it is not rare to encounter situations in which parents and families are asked to leave the child alone with the health care team in rooms full of devices throughout the performance of procedures, which at times may give rise not only to conflicts but, more importantly, emotional sequelae in children or adolescents.We conducted a narrative review of the literature by searching the digital library of the public health care system of Andalusia for articles concerning the experiences of health care professionals and families with the accompaniment of paediatric patients during health care procedures. We restricted the search to studies published in Spanish or English and conducted in humans.The review evinced the need to humanise care in order to improve care quality. The need to accompany minors is supported by the evidence from works that have analysed the factors involved in the persistence of these behaviours and attitudes in both professionals and parents. We consider it necessary to develop institutional policies and appoint mediators to compile the statements of different national and international societies, taking into account legal aspects but, above all, the pertinent values from a health care ethics perspective, and in pursuit of the best interests of the child.(AU)

Motor-Imagery-Based Brain-Computer Interface Using Signal Derivation and Aggregation Functions.

Brain-computer interface (BCI) technologies are popular methods of communication between the human brain and external devices. One of the most popular approaches to BCI is motor imagery (MI). In BCI applications, the electroencephalography (EEG) is a very popular measurement for brain dynamics because of its noninvasive nature. Although there is a high interest in the BCI topic, the performance of existing systems is still far from ideal, due to the difficulty of performing pattern recognition tasks in EEG signals. This difficulty lies in the selection of the correct EEG channels, the signal-to-noise ratio of these signals, and how to discern the redundant information among them. BCI systems are composed of a wide range of components that perform signal preprocessing, feature extraction, and decision making. In this article, we define a new BCI framework, called enhanced fusion framework, where we propose three different ideas to improve the existing MI-based BCI frameworks. First, we include an additional preprocessing step of the signal: a differentiation of the EEG signal that makes it time invariant. Second, we add an additional frequency band as a feature for the system: the sensorimotor rhythm band, and we show its effect on the performance of the system. Finally, we make a profound study of how to make the final decision in the system. We propose the usage of both up to six types of different classifiers and a wide range of aggregation functions (including classical aggregations, Choquet and Sugeno integrals, and their extensions and overlap functions) to fuse the information given by the considered classifiers. We have tested this new system on a dataset of 20 volunteers performing MI-based brain-computer interface experiments. On this dataset, the new system achieved 88.80% accuracy. We also propose an optimized version of our system that is able to obtain up to 90.76%. Furthermore, we find that the pair Choquet/Sugeno integrals and overlap functions are the ones providing the best results.

Off-Label Use of a Flared Endograft Limb for Treatment of a Complicated Anastomotic Abdominal Aortic Pseudoaneurysm: Reverse Deployment Throught Axillary Artery.

A case of complicated abdominal aortic pseudoaneurysm not suitable for open repair is described. It was treated by means of endovascular methods with a flared endograft limb. The uniqueness of this case is the absence of a suitable femoral access, requiring the deployment of the graft in a reversed configuration through axillary artery. The technique is described and the need of imaginative off label use of endovascular devices in such emergent cases is discussed.

Facial hemihypertrophy in a girl with sturge-weber syndrome: Treatment with oral sirolimus.

In the last few years, the use of oral sirolimus has shown promising results in the treatment of some complex vascular anomalies, and recently, it has been used in patients with Sturge-Weber syndrome (SWS). We present the case of an 11-year-old girl with the diagnosis of SWS and hemifacial overgrowth treated with oral sirolimus. Throughout the eight months of follow-up, improvement of the port-wine birthmark, intraocular pressure, and neurocognitive development was noted. The mTOR inhibitors may be useful in the treatment of some patients with SWS.

Exserohilum rostratum, a rare cause of opportunistic skin infection in children: Case report and review of the literature.

Exserohilum species are environmental molds that may rarely cause skin and nasal infections, especially in immunocompromised children. We present a 3-year-old girl with acute leukemia who presented with a skin infection caused by Exserohilum rostratum. Previously published cases of skin infections by Exserohilum spp. in children are reviewed.

Cyclotriphosphazenes as Scaffolds for the Synthesis of Metallomesogens.

(Amino)cyclotriphosphazenes have been used as new scaffolds for the synthesis of silver(I) metallomesogens. Two cyclotriphosphazenes, [N3P3(NHCy)6] (phos-1) and nongem-trans-[N3P3(NHCy)3(NMe2)3] (phos-2), were reacted with the silver complex having a pro-mesogenic ligand, [Ag(OTf)L] (L = CNC6H4{OC(O)C6H2(3,4,5-(OC10H21)3)}-4; OTf = OSO2CF3), in different molar ratios, 1:1, 1:2, or 1:3, to give two series of cationic metallophosphazenes, [N3P3(NHCy)6{AgL}n](TfO)n (phos-1.n) and nongem-trans-[N3P3(NHCy)3(NMe2)3{AgL}n](TfO)n (phos-2.n) with n = 1, 2, or 3. The chemical structure of these compounds, deduced from spectroscopic techniques, was in accordance with coordination of the silver fragments "AgL" to nitrogen atoms of the phosphazene ring, whereby their number n depends on the molar ratio used. Despite the presence of the bulky substituents on the core N atoms, cyclotriphosphazenes coordinated to three "AgL" units exhibited mesomorphism at room temperature. The mesophase was characterized as columnar hexagonal according to the optical microscopy and X-ray diffraction studies. A model based on an intermolecular association in pairs of the metallocyclotriphosphazenes having three AgL units has been proposed in order to explain the mesomorphic columnar arrangement in these materials. Starting silver complex, [Ag(OTf)L], also exhibited a columnar hexagonal mesophase at room temperature.

Leiomiosarcoma intraluminal de vena femoral común / Intraluminal leiomyosarcoma of the common femoral vein

No disponible

Aneurysmal degeneration of brachial artery in kidney transplant receptors after arteriovenous fistula ligation.

OBJECTIVES: True brachial artery aneurysms are. Recent case reports have suggested aneurysmal degeneration of brachial artery in kidney transplant receptors after arteriovenous fistula (AVF) ligation. We present a study on the evolution of the brachial artery in this context in our center. MATERIAL AND METHODS: This is a descriptive study in kidney transplant receptors in whom AVF was ligated between 2008 and 2015. Patients with AVF in both upper limbs were excluded. Diameters of axillary artery, brachial artery in middle portion and its bifurcation, as well as brachial artery flow were measured using Dupplex ultrasound in AVF and contralateral limb. Both groups were compared using the Student t-test for paired samples. RESULTS: 20 patients were included in the study and had a mean age of 59.35 ± 2.49 years. The median time of use of AVF for hemodialysis was 729 days (range 120-6117) and the median time in which AVF was patent was 2261 days (range 791-7091). Mean diameters (in mm) of axillary artery, brachial in middle portion and bifurcation were respectively 9.33 ± 1.07, 7.5 ± 0.61 and 5.81 ± 0.43 in AVF arm and 5.6 ± 2.8, 4.4 ± 0.1, 4.9 ± 0.15 in control limb, finding statistically significant differences (p <0.01) in brachial and axillary arteries. 5 patients (25%) developed aneurysm, 2 of which (10%) underwent surgery and 3 are on follow up. CONCLUSION: True incidence of brachial artery aneurysm in kidney receptors following AVF ligation is high. Careful follow up with physical examination and dupplex scanning are needed to find this complication.

Major trauma registry of Navarre (Spain): the accuracy of different survival prediction models.

OBJECTIVE: To determine which factors predict death among trauma patients who are alive on arrival at hospital. METHODS: Design prospective cohort study method. Data were collected on 378 trauma patients who were initially delivered by the emergency medical services of Navarre (Spain) with multiple injuries with a new injury severity score of 15 or more in 2011-2012. These data related to age, gender, presence of premorbid conditions, abbreviated injury score, injury severity score, new injury severity score (NISS), revised trauma score (RTS), and prehospital and hospital response times. Bivariate analysis was used to show the association between each variable and time until death. Mortality prediction was modeled using logistic regression analysis. RESULTS: The variables related to the end result were the age of the patient, associated comorbidity, NISS, and hospital RTS. Two models were formulated: in one, the variables used were quantitative, while in the other model these variables were converted into dichotomous qualitative variables. The predictive capability of the two models was compared with the trauma and injury severity score using the area under the curve. The predictive capacities of the three models had areas under the curve of 0.93, 0.88, and 0.87. The response times of the Navarre emergency services system, measured as the sum of the time taken to reach the hospital (median time of 65 min), formulate computed tomography (46 min), and perform crucial surgery (115 min), when required, were not taken into account. CONCLUSION: Age, premorbid conditions, hospital RTS, and NISS are significant predictors of death after trauma. The time intervals between the accident and arrival at the hospital, arrival at the hospital and the first computed tomography scan or the first crucial emergency intervention, do not appear to affect the risk of death.

New liquid crystalline materials based on two generations of dendronised cyclophosphazenes.

A divergent approach was used for the synthesis of dendritic structures based on a cyclotriphosphazene core with 12 or 24 hydroxyl groups, by starting from [N(3)P(3)(OC(6)H(4)OH-4)(6)] and using an acetal-protected 2,2-di(hydroxymethyl)propionic anhydride as the acylating agent. Hydroxyl groups in these first- and second-generation dendrimers, G1-(OH)(12) or G2-(OH)(24), were then condensed in turn with mono- or polycatenar pro-mesogenic acids to study their ability to promote self-assembly into liquid crystalline structures. Reactions were monitored by using (31)P{(1)H} and (1)H NMR spectroscopy and the chemical structure of the resulting materials was confirmed by using different spectroscopic techniques and mass spectrometry (MALDI-TOF MS). The results were in accordance with monodisperse, fully functionalised cyclotriphosphazene dendrimers. Thermal and liquid crystalline properties were studied by using optical microscopy, differential scanning calorimetry and X-ray diffraction. The dendrimer with 12 4-pentylbiphenyl mesogenic units gives rise to columnar rectangular organisation, whereas the one with 24 pentylbiphenyl units does not exhibit mesomorphic behaviour. In the case of materials that contain polycatenar pro-mesogenic units with two aromatic rings (A4 vs. A5), the incorporation of a short flexible spacer connected to the periphery of the dendron (acid A5) was needed to achieve mesomorphic organisation. In this case, both dendrimer generations G1 A5 and G2 A5 exhibit a hexagonal columnar mesophase.

[Ecodoppler evaluation on the progress of atherosclerotic disease in patients undergoing contralateral carotid endarterectomy]. / Avaliação por ecodoppler da progressão da doença aterosclerótica em pacientes com endarterectomia carotídea contralateral.

PURPOSE: The clinical utility of monitoring by Doppler ultrasound patients undergoing carotid endarterectomy is not clearly established. Our goal is to evaluate by echo-Doppler the progress of contralateral stenosis in a real environment, in order to assess its usefulness. MATERIAL AND METHODS: Retrospective study with Doppler ultrasound monitoring in patients undergoing carotid endarterectomy for a period of 3 years. We included cases with Doppler echography before and at least one post-surgery. We excluded patients with contralateral thrombosis, contralateral stenosis, established surgical indication or prior carotid surgery. Analysis was performed using Kaplan-Meier curves to estimate the rate of patients free of progression and / or surgery, as well as an analysis of risk factors for progression of contralateral stenosis. RESULTS: We included 119 patients (41.2% symptomatic) age 68.3 +/- 8.41 years. The follow-up was 40.5 +/- 23.2 months, with a mean of 2.64 +/- 1.58 scans per patient. The likelihood of progression of contralateral carotid stenosis was estimated at 91, 86, 81 and 79% at one, two, three and four years respectively. The only significant risk factor for progression was the presence of moderate or greater contralateral stenosis (30% or more) at the time of surgery. CONCLUSIONS: The evolution of the contralateral carotid atherosclerosis is relatively common. The degree of stenosis correlates with early progression, the study by echo-Doppler plays an important role in monitoring these patients.

Mortality in patients undergoing open aortoiliac surgery: prognostic value of troponin T in the immediate postoperative period.

BACKGROUND: Patients undergoing open aortoiliac surgery constitute a high-risk subgroup. The aim of this study was to evaluate the relationship between postoperative troponin T (TnT) elevation with the associated postoperative mortality, and mean hospital stay. METHODS: This was a prospective observational study of consecutive patients who underwent open aortoiliac surgery during 2006. TnT levels in the first 72 hours after the operation, immediate mortality, postoperative care unit stay, and total postoperative hospital stay were recorded. Statistical analyses were performed with the program SPSS 14.0; the chi-square test (or the Fisher's exact test) was used for qualitative variables and the Mann-Whitney test for quantitative variables. RESULTS: Of the 65 patients included in the study, postoperative TnT was elevated in 14 (21.5%) patients. No significant differences were found in age, sex, hypertension, dyslipidemia, smoking, diabetes mellitus, ischemic heart disease, heart failure, bronchopathy, or renal failure between groups. Mortality in patients with elevated TnT levels was significantly higher (42% compared with 3.92%; relative risk 10.93 +/- 0.76; p = 0.001). Likewise, their mean postoperative intensive care unit stay was significantly greater (23.21 +/- 6.96 days compared to 2.86 +/- 1.96; p < 0.001). This finding resulted in a significantly longer postoperative hospital stay (32.57 +/- 25.38 days compared with 12.47 +/- 2.21). CONCLUSION: TnT level in the immediate postoperative period is a highly relevant indicator of prognosis in patients undergoing major vascular surgery.