Assessment of fetal cardiac function in early fetal life: feasibility, reproducibility, and early fetal nomograms.

BACKGROUND: Fetal cardiology has shown a rapid development in the past decades. Fetal echocardiography is not only used for the detection of structural anomalies but also to assess fetal cardiac function. Assessment of the fetal cardiac function is performed mostly in the second and third trimesters. The study of fetal cardiac function at the end of first trimester has not been investigated properly, and there is a lack of reference values at early gestational weeks. OBJECTIVE: This study aimed to assess if the measurement of time-related parameters of cardiac function in the left ventricle of the fetal heart is feasible and reproducible at the end of the first trimester. If possible, we provide nomograms of these parameters from 11 to 13+6 gestational weeks. STUDY DESIGN: We conducted a prospective observational study from March to September 2022. The study was carried out in 2 hospitals (Hospital Universitari Dexeus, Barcelona, and Hospital VITAHS 9 Octubre, Valencia, Spain). The scans were performed by 3 specialists in fetal medicine. The exclusion criteria were fetal cardiac rhythm abnormalities, abnormal nuchal translucency, abnormal ductus venosus, fetal malformations, stillbirth, estimated fetal weight <10 percentile, diabetes, and gestational hypertensive disorders. The cardiac function parameters studied in the left ventricle were isovolumetric contraction time, isovolumetric relaxation time, ejection time, filling time, cycle time, myocardial performance index, ejection time fraction, and filling time fraction. We study the feasibility and intra- and interobserver reproducibility of these parameters using the interclass correlation coefficient. Nomograms were created and the percentiles of the values of the different parameters were calculated. RESULTS: A total of 409 cases were recruited but only 296 could be included in the statistical analysis once the exclusion criteria were applied. The intraobserver reproducibility study was excellent (interclass correlation coefficient >0.900), and the interobserver reproducibility study was good (interclass correlation coefficient >0.700). The data regression analysis showed that cycle time, filling time, isovolumetric contraction time, and filling time fraction increased with gestational age, whereas ejection time fraction decreased with gestational age and myocardial performance index (mean, 0.43±0.08), isovolumetric relaxation time (mean, 0.04±0.01), and ejection time (mean, 0.16±0.01) remained constant from 11 to 13 weeks. CONCLUSION: The study of fetal cardiac function is feasible and reproducible at 11 to 13+6 gestational weeks. Nomograms of the studied parameters are provided.

Unburnt carbon from coal fly ashes as a precursor of activated carbon for nitric oxide removal.

The aim of this work is to evaluate the characteristics of an activated carbon obtained from unburnt carbon in coal fly ashes to be used in the removal of NO. Carbon-rich fraction was obtained by mechanical sieving of fly ashes. The mineral matter was removed by conventional HCl and HF demineralization procedure. Activation was carried out with steam at 900 degrees C in order to develop porosity onto the sample. Characterization of samples was performed by several techniques with a main objective: to follow the mineral matter content, composition and distribution on the samples in order to better understand how to remove it from unburnt carbon in fly ashes. To study the use of this unburnt carbon as a precursor for the preparation of activated carbons for gas cleaning, the NO removal by ammonia using activated carbon as a catalyst at low temperature was performed. Results show a good performance of activated carbon in this reaction that is in relationship with BET surface area.

Tail-end Hg capture on Au/carbon-monolith regenerable sorbents.

In this work, a regenerable sorbent for Hg retention based on carbon supported Au nanoparticles has been developed and tested. Honeycomb structures were chosen in order to avoid pressure drop and particle entrainment in a fixed bed. Carbon-based supports were selected in order to easily modify the surface chemistry to favour the Au dispersion. Results of Hg retention and regeneration were obtained in a bench scale experimental installation working at high space velocities (for sorbent, 53,000 h(-1); for active phase, 2.6 × 10(8) h(-1)), 120 °C for retention temperature and Hg inlet concentration of 23 ppbv. Gold nanoparticles were shown to be the active phase for mercury capture through an amalgamating mechanism. The mercury captured by the spent sorbent can be easily released to be disposed or reused. Mercury evolution from spent sorbents was followed by TPD experiments showing that the sorbent can be regenerated at temperatures as low as 220 °C.

Implantación del listado de verificación de seguridad quirúrgica en un hospital comarcal / Implementation of the surgical safety checklist in a regional hospital

OBJETIVO: describir el grado de cumplimentación del listado de verific ción de seguridad quirúrgica (LVSQ) en el servicio de quirófano de un hospital comarcal. MÉTODO: estudio descriptivo transversal llevado a cabo en el Hospital Santos Reyes de Aranda de Duero (Burgos) entre mayo de 2015 y mayo de 2016. Se realizó un muestreo aleatorio simple de 750 individuos sometidos a cirugía programada para la revisión de los LVSQ contenidos en sus historias clínicas. Se efectuó un análisis descriptivo con frecuencias absolutas y porcentajes de los ítems del listado categorizados por el momento del procedimiento quirúrgico (antes de la inducción anestésica, antes de la incisión cutánea y antes de la salida de quirófano) y por el profesional responsable de su cumplimentación (enfermera, anestesista y cirujano). RESULTADOS: se estudiaron un total de 604 listados de verificaciónde seguridad quirúrgica. Se observó una mayor cumplimentación del LVSQ en los momentos anteriores a la inducción anestésica y a la incisión cutánea que antes de la salida de quirófano y siempre en aquellos ítems cumplimentados por enfermeras. La cumplimentación de las cuestiones propias de las enfermeras rondó el 88%, fue del 49% en el caso de los ítems propios de los anestesistas y del 46,9% en los asignados a cirujanos. Fue necesario corregir el consentimiento informado en el 4,3% de las intervenciones. CONCLUSIONES: hay diferencias en la cumplimentación del LVSQ en función del momento quirúrgico y del profesional responsable. La formación del personal implicado, así como la implicación de los líderes institucionales, podría jugar un papel para conseguir una mayor adherencia en la cumplimentación

OBJECTIVE: to describe the level of compliance with the Surgical Safety Checklist (SSCL) at the Operating Room in a regional hospital. METHOD: a descriptive cross-sectional study conducted at the Hospital Santos Reyes of Aranda de Duero (Burgos) between May, 2015 and May, 2016. Simple random sampling was conducted on 750 individuals undergoing scheduled surgery, in order to review the SSCLs included in their clinical records. Descriptive analysis was conducted with absolute frequencies and percentages of the list items, classified by time point during the surgical procedure (before anesthetic induction, before skin incision, and before leaving the operating room), and by professional responsible for completion (nurse, anesthetist and surgeon). RESULTS: in total, 604 Surgical Safety Checklists were studied. Higher SSCL compliance was observed a the time point before anesthetic induction and skin incision, than before leaving the operating room, and always in those items completed by nurses. Completion of items by nurses reached about 88%; in the case of anesthetists, it was 49%, and 46.9% in those items assigned to surgeons. It was necessary to correct Informed Consents in 4.3% of interventions. CONCLUSIONS: there are differences in SSCL compliance according to the surgical time and the professional in charge. Training for the staff involved, as well as involvement by institution leaders, could play a role in order to achieve a higher adherence in terms of compliance

Aterosclerosis subclínica de la arteria carótida en pacientes con enfermedad coronaria / Silent carotid atherosclerosis in patients with coronary disease

FUNDAMENTO: La ecografía bidimensional es un modo sencillo y válido para evaluar la aterosclerosis subclínica de las grandes arterias superficiales. El objetivo de este estudio ha sido conocer mediante este método la prevalencia de aterosclerosis carotídea en los pacientes con enfermedad coronaria y sus factores asociados. PACIENTES Y MÉTODO: En 232 pacientes (205 varones y 27 mujeres; edad: media [desviación estándar] 59 [8] años) con enfermedad coronaria se evaluaron en las arterias carotídas, mediante una ecografía bidimensional, el grosor íntima-media (GIM), la presencia y número de placas de ateroma. Los controles fueron 50 sujetos voluntarios sanos cuya edad no difería de la de los pacientes. Se consideró aterosclerosis carotídea cuando el GIM era superior a la media más dos desviaciones estándar de los valores hallados en los controles, y/o existían placas de ateroma. RESULTADOS: El GIM carotídeo estaba aumentado en los pacientes en comparación con los controles (0,82 [0,22] frente a 0,62 [0,12] mm; p < 0,001) y había más pacientes que presentaban placas (el 67 frente al 20 por ciento; p < 0,001). En 170 pacientes y en 11 controles se objetivó aterosclerosis carotídea (el 73 frente al 22 por ciento; p < 0,001). En el análisis multivariante la aterosclerosis carotídea estaba asociada a la edad (odds ratio, 1,05; intervalo de confianza [IC] del 95 por ciento, 1,01-1,09) y al hábito tabáquico (odds ratio, 2,11; IC del 95 por ciento, 1,04-4,26). La existencia de más de una placa se asoció a los valores de colesterol unido a las lipoproteínas de baja-densidad (cLDL) (odds ratio, 1,01; IC del 95 por ciento, 1,00-1,02).CONCLUSIONES: En los pacientes con enfermedad coronaria la prevalencia de aterosclerosis carotídea subclínica es muy elevada (73 por ciento), y está asociada con la edad y el tabaquismo. El estado más avanzado de arteriosclerosis, evaluado por la existencia de más de una placa de ateroma, se correlaciona con las concentraciones de cLDL (AU)