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BACKGROUND: Low-level Laser Therapy (LLLT) has demonstrated its potential in promoting fiber matrix maturation, collagen synthesis, and fibroblast proliferation, contributing to tissue regeneration. Our study aimed to investigate the impact of LLLT on collagen type I synthesis, cell proliferation, and viability in human ligament fibroblasts derived from the Anterior Cruciate Ligament (ACL). METHODS: Tissue samples were obtained from individuals undergoing arthroscopic ACL reconstruction surgery. Primary human fibroblasts were isolated, and immunohistochemical assays confirmed their characteristics. LLLT at 850 nm was administered in three groups: Low dose (1.0 J/cm²), High dose (5.0 J/cm²), and Control (0.0 J/cm²). Cell viability was calculated using a membrane integrity assay, proliferation was determined by automated counting, and collagen type I concentration in cell culture was measured using an immunoassay. RESULTS: Fibroblasts showed decreased viability after low and high doses of LLLT, increased proliferation at the low dose, and increased collagen synthesis at the high dose on day 10 for both sexes after treatment. CONCLUSION: Our study demonstrated that LLLT may improve the early ligament healing process by increasing cell proliferation at the low dose and enhancing collagen type I synthesis at the high dose in human ligament fibroblasts.

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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.

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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.

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In Lesch-Nyhan disease (LND), deficiency of the purine salvage enzyme hypoxanthine guanine phosphoribosyl transferase (HGprt) leads to a characteristic neurobehavioral phenotype dominated by dystonia, cognitive deficits and incapacitating self-injurious behavior. It has been known for decades that LND is associated with dysfunction of midbrain dopamine neurons, without overt structural brain abnormalities. Emerging post mortem and in vitro evidence supports the hypothesis that the dopaminergic dysfunction in LND is of developmental origin, but specific pathogenic mechanisms have not been revealed. In the current study, HGprt deficiency causes specific neurodevelopmental abnormalities in mice during embryogenesis, particularly affecting proliferation and migration of developing midbrain dopamine (mDA) neurons. In mutant embryos at E14.5, proliferation was increased, accompanied by a decrease in cell cycle exit and the distribution and orientation of dividing cells suggested a premature deviation from their migratory route. An abnormally structured radial glia-like scaffold supporting this mDA neuronal migration might lie at the basis of these abnormalities. Consequently, these abnormalities were associated with an increase in area occupied by TH+ cells and an abnormal mDA subpopulation organization at E18.5. Finally, dopaminergic innervation was disorganized in prefrontal and decreased in HGprt deficient primary motor and somatosensory cortices. These data provide direct in vivo evidence for a neurodevelopmental nature of the brain disorder in LND. Future studies should not only focus the specific molecular mechanisms underlying the reported neurodevelopmental abnormalities, but also on optimal timing of therapeutic interventions to rescue the DA neuron defects, which may also be relevant for other neurodevelopmental disorders.

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The understanding of the tribological behavior of natural structures has been used as inspiration to design and optimize surfaces for diverse applications in engineering. In the present work, morphological, microstructural, mechanical and tribological characterization of the shed skin of two snake species, namely Boa Red Tail and Python Regius was carried out. Atomic Force Microscopy (AFM) and Scanning Electron Microscopy (SEM) analyses showed the existence of deterministic patterns, i.e., ordered arrays of geometrical features at the surface, while Transmission Electron Microscopy (TEM) allowed studying the internal structure and chemical composition of the skin sheds. Nanoindentation measurements showed significant variations in hardness and elastic modulus from the surface to the inner layers of the skin, and pin-on-disc tests revealed anisotropic behavior of the friction coefficient (COF) as a function of the sliding direction against balsa wood in dry conditions. Correlations between the friction data, nano-indentation mechanical properties and subsurface skin structure were established for both species taking into account the ways in which the skins' deterministic patterns influence the tribological performance.

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OBJECTIVE: An adequate knowledge of the anterior inferior cerebellar artery (AICA) is oriented to the morphological sciences, clinical management and surgical planning of the posterior fossa. We aimed to determine the morphology of AICA in a sample from Colombian population. METHOD: We studied 92 AICA from fresh cadavers. For each specimen, the vertebral arteries were injected with 100 cc of semi-synthetic resin (a mixture of Palatal E210® BASF 80 cc and Styrene 20 cc) dyed with mineral red. The biometrics and morphological variables of AICA were registered. RESULTS: AICA originated at 9.9 ± 3.2 mm from the vertebrobasilar junction. In 12 samples (8.1%), we observed a common trunk between AICA and posterior inferior cerebellar artery, which presented a caliber of 1.56 ± 0.23 mm and a length of 11.3  ± 3. 53 mm. In 80 (51.3%) specimens, AICA was originated from the proximal segment of basilar artery, while in 76 (48.7%) of them emerged from the medium segment. The AICA bifurcation distance from its origin was less than 20 mm in 20.5% of cases; between 20 and 40 mm in 62.3%. In its trajectory, AICA passed ventral to the facial nerve in 85 samples (53.2%), dorsal to the facial nerve in 68 samples (43.6%) and between the roots in 5 samples (3.2%). CONCLUSIONS: The origin of the AICA from the proximal segment of the basilar artery is confirmed in this study, which disagrees with reports that point out its origin in the middle segment.

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In information security, one way to keep a secret content is through encryption. The objective is to alter the content so that it is not intelligible, and therefore only the intended user can reveal the secret content. With the aim to provide examples of encrypted audio data, we applied a novel method of encryption based on the Collatz conjecture in five hundred speech recordings (50 speakers, 10 different messages), and then five hundred encrypted audio files were obtained. The main characteristics of our encrypted recordings are as follows: the spectrogram is quasi-uniform, histograms have a repetitive pattern, average of samples is around -0.4, standard deviation is around 0.55; Shannon entropy is around 7.5 (for 8-bits per sample). The novelty of the results consists in obtaining a completely different behavior than natural speech recordings, i.e.: spectrogram with higher energy in low frequencies, histogram with Gaussian behavior, average of samples around 0, standard deviation around 0.11, entropy around 5.5. A more comprehensive analysis of our encrypted signals may be obtained from the article "High-uncertainty audio signal encryption based on the Collatz conjecture" in the Journal of Information Security and Applications.

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BACKGROUND: Despite the importance of the coronary system in the African sheep as a possible experimental model, there is little information about this particular vascular system. The objective of this investigation was to characterise morpho- logically the coronary arteries and their branches in African sheep. MATERIALS AND METHODS: This descriptive cross-sectional study evaluated the coronary arteries and their branches of 62 hearts of short hair sheep. The right and left coronary ostia were perfused with a semi-synthetic resin (Palatal GP40L 85%; styrene 15%) dyed with mineral red. The morphological characteristics were evaluated using a digital calibrator and the biometrics of the coronary arteries and their branches were registered. RESULTS: The right coronary artery had a proximal calibre of 2.11 ± 0.46 mm. The subsinusal interventricular branch ended at the middle third of the homonym sulcus in 19 (30.6%) specimens. The left coronary artery had a diameter of 5.38 ± ± 1.59 mm and a length of 4.67 ± 3.32 mm. This artery bifurcated itself in the paraconal interventricular branch and the left circumflex branch in 57 (91.9%) hearts and trifurcated with an additional left diagonal branch in 5 (8.1%) spec- imens. Left coronary artery dominance was observed in 51 (82.3%) specimens, whereas in 11 (17.7%) cases the coronary circulation dominance was balanced. CONCLUSIONS: Due to the similitude in the features of the coronary arteries between African sheep and humans, this animal model can be proposed for procedural and haemodynamic activities.

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BACKGROUND: The accessory head of the flexor pollicis longus (AHFPL) has an oblique trajectory from medial to lateral aspect of the forearm below the flexor digitorum superficialis muscle and then joins the flexor pollicis longus muscle. When the anterior interosseous nerve (AIN) courses underneath the muscle belly of the AHFPL an entrapment neuropathy may occur, known as anterior interosseous nerve syndrome (AINS). MATERIALS AND METHODS: This descriptive cross-sectional study evaluated 106 fresh upper extremities. When the AHFPL was present, its fascicle was traced up to evaluate the origin site. The morphometric variables were measured using a digital micrometre (Mitutoyo, Japan). The relationship between the AHFLP and the AIN was evaluated. RESULTS: The AHFPL was found in 34 (32.1%) of the 106 forearms. The AHFPL arose from the flexor digitorum superficialis muscle in 16 (47.1%) forearms, the medial epicondyle of the humerus in 10 (29.4%) forearms and the coronoid process of ulna in 8 (23.5%) forearms. The average total length of the AHFPL was 94.11 ± ± 10.33 mm. The AIN was located lateral to the AHFPL in 3 (8.8%) forearms, posterolateral in 7 (20.6%) forearms and posterior in 24 (70.6%) forearms. CONCLUSIONS: This study performed in a South American population sample revealed a prevalence of the AHFPL in a lower range compared to previous studies in North Americans and Asians. The AIN coursed more frequently underneath the muscle belly of AHFPL. This finding has clinical significance in the onset of the AINS and the subsequent surgical procedure for the AIN decompression.

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OBJETIVOS: hasta el momento no existen trabajos de auditorías clínicas que evalúen la práctica clínica en la enfermedad pulmonar obstructiva crónica (EPOC) en el ámbito de consultas externas. El presente trabajo es un primer proyecto piloto que tiene por objetivo evaluar la variabilidad de la práctica clínica para la EPOC en este ámbito asistencial. MÉTODO: proyecto piloto de auditoría de historias clínicas llevada a cabo en consultas externas de Neumología en 9 hospitales públicos de Andalucía entre octubre 2013 y septiembre 2014. El objetivo era auditar 80 casos por centro, repartidos durante los 4 trimestres del año. La información se recogió mediante cuestionario estandarizado con 182 variables. Los datos se describen con medias y rangos interhospitalarios para evaluar la variabilidad. RESULTADOS: durante el año de estudio se analizaron 621 historias. Los pacientes eran mayoritariamente hombres, en la séptima década de la vida, con un porcentaje de fumadores activos del 26,2%, un considerable número de comorbilidades y mayoritariamente del ámbito urbano. Los datos indican que la atención sanitaria es en general correcta como promedio, pero indicando áreas de mejora en algunos puntos y una considerable variabilidad entre centros con diferencias significativas (p <0,001) para los cambios intercentro de la mayoría de las variables. CONCLUSIONES: la atención sanitaria al paciente con EPOC en consultas externas de Neumología en Andalucía muestra una considerable variabilidad que probablemente no pueda ser explicada sólo por la condición clínica del paciente. Estudios futuros deberán dilucidar qué factores inciden en esta variabilidad

OBJECTIVES: To date, there have been no clinical audits that evaluate clinical practice for chronic obstructive pulmonary disease (COPD) in outpatient clinics. This study is the first pilot project that aims to evaluate the variability in clinical practice for COPD in this healthcare setting. METHOD: A medical history audit pilot project carried out in outpatient pulmonology clinics in 9 public hospitals in Andalusia from October 2013 to September 2014. The objective was to audit 80 cases per center, distributed across the 4 quarters of the year. Information was collected using a standardized questionnaire with 182 variables. Data is described as averages and inter-hospital ranges to evaluate variability. RESULTS: 621 histories were analyzed during the year of the study. Patients were primarily male, in the seventh decade of life, 26.2% were active smokers, there were a considerable number of comorbidities and subjects lived in mainly urban areas. Data indicates that healthcare is generally appropriate on average, but there are areas of improvement in some points and there is a considerable variability between centers with significant differences (p <0.001) for inter-center changes for the majority of variables. CONCLUSIONS: Healthcare for patients with COPD in outpatient pulmonology clinics in Andalusia shows considerable variability that likely cannot be explained solely by the patient's clinical condition. Future studies must clarify what factors come into play in this variability

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Introducción. La historia clínica electrónica y los soportes informáticos en la consulta han modificado la relación médico-paciente. Este tipo de historia ofrece múltiples ventajas, aunque dudamos del protagonismo que ha adquirido el ordenador, que ha pasado de ser una herramienta de trabajo a ser el centro de nuestra atención durante la entrevista clínica, disminuyendo la interacción con el paciente. El objetivo del estudio fue estimar el tiempo empleado por el médico de familia en el manejo del soporte informático frente al dedicado a la comunicación interpersonal durante cada consulta y si se modifica en función de variables como la edad del médico o el motivo de consulta. Material y métodos. Realizamos un estudio observacional, descriptivo y transversal, donde participaron 2 centros de salud durante 10 semanas. El investigador asistió a todas las consultas, registrando la hora de entrada y salida del paciente de la consulta. Se cronometró cada vez que el médico fijaba su mirada en los soportes informáticos. Resultados. Se recogieron 436 consultas. Los médicos miraron los soportes informáticos una mediana del 38,33% de la duración total de una consulta. Los mayores de 45 años dedicaron más tiempo a fijar su vista en los soportes informáticos (p<0,05). Conclusión. Los médicos de familia utilizaron casi un 40% del tiempo de la consulta en mirar los soportes informáticos, variando según edad del médico, número de motivos de consulta y pacientes citados (AU)

Introduction. The introduction of electronic medical records and computer media in clinics, has influenced the physician-patient relationship. These modifications have many advantages, but there is concern that the computer has become too important, going from a working tool to the centre of our attention during the clinical interview, decreasing doctor interaction with the patient. The objective of the study was to estimate the percentage of time that family physicians spend on computer media compared to interpersonal communication with the patient, and whether this time is modified depending on different variables such as, doctor's age or reason for the consultation. Material and methods. An observational and descriptive study was conducted for 10 weeks, with 2 healthcare centres involved. The researchers attended all doctor- patient interviews, recording the patient time in and out of the consultation. Each time the doctor fixed his gaze on computer media the time was clocked. Results. A total of 436 consultations were collected. The doctors looked at the computer support a median 38.33% of the total duration of an interview. Doctors of 45 years and older spent more time fixing their eyes on computer media (P<.05). Conclusions. Family physicians used almost 40% of the consultation time looking at computer media, and depends on age of physician, number of queries, and number of medical appointments (AU)

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INTRODUCTION: The introduction of electronic medical records and computer media in clinics, has influenced the physician-patient relationship. These modifications have many advantages, but there is concern that the computer has become too important, going from a working tool to the centre of our attention during the clinical interview, decreasing doctor interaction with the patient. The objective of the study was to estimate the percentage of time that family physicians spend on computer media compared to interpersonal communication with the patient, and whether this time is modified depending on different variables such as, doctor's age or reason for the consultation. MATERIAL AND METHODS: An observational and descriptive study was conducted for 10 weeks, with 2 healthcare centres involved. The researchers attended all doctor- patient interviews, recording the patient time in and out of the consultation. Each time the doctor fixed his gaze on computer media the time was clocked. RESULTS: A total of 436 consultations were collected. The doctors looked at the computer support a median 38.33% of the total duration of an interview. Doctors of 45 years and older spent more time fixing their eyes on computer media (P<.05). CONCLUSIONS: Family physicians used almost 40% of the consultation time looking at computer media, and depends on age of physician, number of queries, and number of medical appointments.

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BACKGROUND: Despite the importance of the pyelocalyceal system in the pig as an experimental model, there is little information about this particular anatomical subject. We determined the morphological characteristics of the renal excretory system in pigs. MATERIALS AND METHODS: This descriptive cross-sectional study evaluated 130 pairs of kidneys of pigs destined to slaughter. The pyelocalyceal system was subjected to injection technique - corrosion by infusion of polyester resin (85% Palatal and 15% Styrene) and subsequent infusion in potassium hydroxide (KOH) for 10 days. The significance level used was p < 0.05. RESULTS: The renal excretory system is characterised by the presence of type A major cranial and caudal calyxes seen in 34.3% of the kidneys (type A1 in 30% and type A2 in 4.3%). type B calyxes, corresponding to minor calyxes draining directly into the renal pelvis, were present in 65.7% of the specimens (type B1 59.2%; type B2 6.5% of the cases). The number of minor calyxes in the collector system was 7.9 ± 2.27 with statistically significant differences in side (p = 0.0047). CONCLUSIONS: The morphometric characteristics of the kidneys in this study are slightly smaller than reported in humans. Similarly, the incidence of type A renal excretory system distribution is highest in humans and lowest in pigs. Due to its few morphological differences, the pig kidney is an excellent model for teaching- -learning processes, for research purposes, and for training of urologic applications.

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Non-heart-beating donors (NHBD) are an increasing source of organs for kidney transplantation (KT) compared with donation after brain death (DBD), but the results in each regional transplantation program require local analysis. We compared 164 KT from NHBD (83 Maastrich type II A-B [T2] and 81 type III [T3]) with 328 DBD controls. NHBD kidneys were implanted with less cold ischemia, mean time on renal replacement therapy for NHBD recipients before transplantation was less too, and a higher proportion of thymoglobulin was also used. Besides NHBD-T2 more frequently showing the A group and patients being younger (48.9 ± 11 vs DBD 55.2 ± 15 years old; P < .001), there was a lower proportion of retransplant recipients and HLA sensitization; HLA-DR compatibility was slightly worse. Proportion of nonfunctioning allograft and necessity of dialysis after transplantation for NHBD were 4.9 and 68.3% versus DBD 4.3 and 26.9% (P < .001); renal function after a year was significantly less in NHBD (serum creatinine 1.79 ± 0.9 mg/dL vs 1.46 ± 0.5 in DBD; P < .001). NHBD recipient survival rates were 96% and 96% for the 1st and 3rd years, respectively, versus 96% and 94% for DBD, respectively (not significant [NS]). Graft survival rates censored by death were 91% and 89% (1st and 3rd years, respectively) versus 95% and 94% for DBD, respectively (NS). We did not find significant differences about survival between NHBD-T2 and T3. In the multivariable survival study (Cox, covariables with statistical significance demonstrated previously in our region), NHBD is not a prognosis factor for recipient or graft survival. Regarding current criteria for choosing donors and the graft allocation applied in Andalusia, short-term survival for NHBD transplantation is similar to DBD. Renal function in the short term is slightly worse, which is why it is important to monitor results over a long term, especially those from NHBD-T2.

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The effect of different oxidation processes at mild conditions including the coupled-Fenton (sono-Fenton, photo-Fenton, and sono-photo-Fenton) and their blank systems (ultrasound, ultraviolet, zero valent iron, and Fenton) on anaerobic digestion of the sludge for biogas production was investigated. Ultrasounds led to the highest organic matter solubilization (3.8 up to 5.2 g chemical oxygen demand (COD)/L, for the raw and treated sludge, respectively), while for the rest, organic matter transformation was observed resulting in an almost soluble COD net balance. Results indicated that for the most oxidative processes, the released organic matter was probably mineralized by the hydroxyl radicals produced during the treatments. It is interesting to remark that even if the biochemical methane potential was barely enhanced by the different methods applied, all the methods demonstrated to enhance the overall kinetics of the biomethanation processes, increasing the rapidly biodegradable fraction of the sludge.

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INTRODUCCIÓN: Conocer el alcance socieoeconómico de la enfermedad de Parkinson es esencial para la planificación de recursos y concienciación social. Desarrollo: Se ha realizado una revisión de los datos publicados hasta el momento sobre epidemiología, morbimortalidad, dependencia e impacto económico de la enfermedad de Parkinson en España. Además se ha llevado a cabo un estudio cuyo objetivo principal ha sido definir los recursos asistenciales públicos y privados que tienen los afectados por la enfermedad de Parkinson en nuestro país mediante una encuesta por mail a todos los neurólogos con dedicación especial a esta enfermedad, pertenecientes al grupo de Trastornos del Movimiento de la Sociedad Española de Neurología. CONCLUSIONES: La enfermedad de Parkinson en España tiene una incidencia y prevalencia similar al resto de Europa. Con la estimación de población actual se obtiene que debe haber en España al menos 300.000 pacientes con enfermedad de Parkinson y a al menos un nuevo caso por 10.000 habitantes año. Esta produce gran impacto en la calidad de vida del paciente y aumenta a casi el doble la mortalidad de los pacientes. Además supone un coste económico muy importante para el país, que puede llegar hasta más de 17.000 € anuales por paciente y que con el envejecimiento de la población y las nuevas terapias va a ir incrementándose. Los profesionales y administraciones realizan un gran esfuerzo para proporcionar una asistencia de calidad a los pacientes. A pesar de ello es mucho el camino que nos queda por recorrer para que una asistencia de calidad, eficaz y multidisciplinar sea universal para todos los pacientes con esta enfermedad

INTRODUCTION: Understanding the social and economic impact of Parkinson's disease is essential for resource planning and raising social awareness. Development: Researchers reviewed the data published to date on epidemiology, morbidity and mortality, dependency, and economic impact of Parkinson's disease in Spain. In addition, a study has been carried out in order to define the public and private health care resources of Spanish patients affected by Parkinson's disease by means of an e-mail survey of all neurologists specialising in this disease and belonging to the Spanish Society of Neurology's study group for movement disorders. CONCLUSIONS: The incidence and prevalence rates of Parkinson's disease in Spain are similar to those in the rest of Europe. According to current population estimates, there are at least 300.000 patients with Parkinson's disease and one new case per 10.000 habitants per year in Spain. This has a major impact on the patient's quality of life and nearly doubles patient mortality. In addition, the disease generates sizeable costs for the country that may exceed 17.000 € per year per patient; costs will rise due to the ageing of the population and the new therapies employed. Healthcare professionals and administrators dedicate their efforts to providing quality care to patients. Despite the above, we still have a long way to go in order to provide quality, efficient, multidisciplinary, and universal healthcare

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INTRODUCCIÓN: la EPOC es una enfermedad con una elevada prevalencia, alta mortalidad intrahospitalaria y reingresos frecuentes. Una adecuada atención clínica podría influir en estos resultados. OBJETIVOS: conocer los resultados en calidad asistencial de la hospitalización de las exacerbaciones graves de la EPOC en un hospital de tercer nivel y en dos hospitales comarcales de dos regiones distintas, comparando indicadores de resultado en cada uno de los tres ámbitos. MATERIAL Y MÉTODOS: estudio multicéntrico, observacional y transversal que incluyó una cohorte consecutiva de ingresos hospitalarios por descompensación de EPOC entre el 1 de enero de 2013 y el 31 de diciembre de 2013. Se seleccionó a los pacientes mediante el cribado de las bases de datos proporcionadas por el servicio de documentación clínica de cada hospital. RESULTADOS: se incluyeron un total de 503 ingresos: Hospital Universitario Reina Sofía (HURS) (n=166; 33%), Hospital Infanta Margarita, de Cabra (HIM) (n=209; 41,6%) y Hospital San Agustín, de Linares (HSA) (n=128; 25,4%). En el HURS, los pacientes fueron significativamente más jóvenes (66,3 ± 8,2 años), (p< 0,001). El tiempo medio de estancia hospitalaria fue de 9,38 ± 7,3 días y la tasa global de mortalidad hospitalaria fue de 6% (n=30). CONCLUSIONES: la calidad asistencial de la hospitalización de la agudización de la EPOC, medida en términos de indicadores de resultados, no difiere de la publicada en la literatura, encontrando incluso una mejor calidad asistencial si tenemos en cuenta la menor mortalidad registrada en el hospital de tercer nivel analizado

INTRODUCTION: COPD is a highly prevalent disease with elevated intra-hospital mortality and frequent re-admittance to hospital. Appropriate clinical care could influence these results. OBJECTIVES: know the results regarding the quality of hospital care due to serious exacerbations of COPD at third level (reference) hospitals and at two different regional hospitals, comparing the resulting indicators for each. MATERIAL AND METHODS: multi-center, observational and cross-sectional study that included a consecutive cohort of hospital admissions due to COPD decompensation, between January 1, 2013 and December 31, 2013. Patients were selected using a database screening provided by the clinical documentation service at each hospital. RESULTS: a total of 503 admissions were included: Hospital Universitario Reina Sofía (HURS) (n=166; 33%), Hospital Infanta Margarita, in the town of Cabra (HIM) (n=209; 41.6%) and Hospital San Agustín, in the town of Linares (HSA) (n=128; 25.4%). At HURS, the patients were significantly younger (66.3 ± 8.2 years), (p< 0,001). The average hospital stay was 9.38 ± 7.3 days and the overall hospital mortality rate was 6% (n=30). CONCLUSIONS: the quality of hospital care due to exacerbated COPD, measured in terms of result indicators, does not differ from what has been published in the literature. Even better quality hospital care was found when considering the lesser mortality rate seen in the third level hospital analyzed

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Se presenta un raro caso de múltiples variaciones en la cavidad abdominal de un espécimen cadavérico de 50 años de género masculino, del laboratorio de anatomía de la Universidad Industrial de Santander (Bucaramanga-Colombia). Se observó variaciones arteriales (arteria renal adicional derecha y origen de la rama hepática derecha desde la arteria mesentérica superior), venosa (vena renal derecha adicional) y de vía urinaria (doble uréter en el lado derecho). Estas diversas variantes anatómicas además de suscitar interés académico, deben ser consideradas y descritas correctamente por los clínicos durante la realización de procedimientos quirúrgicos, radiológicos y de imágenes diagnósticas en la cavidad abdominal.

Here we present a rare case of multiple abdominal cavity variations in a 50-year-old male cadaveric specimen of the anatomy laboratory of the Universidad Industrial de Santander (Bucaramanga, Colombia). The anatomical dissection revealed arterial variations (right additional renal artery and origin of the right hepatic branch from the superior mesenteric artery), venous (right additional renal vein) and urinary tract (duplicated ureter on the right side). These multiple anatomic variations in addition to raising academic interest, should be considered and described correctly by clinicians while performing surgical, radiological and imaging procedures in the abdominal cavity.

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