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Microsurgical anastomosis of the fallopian tubes after tubal ligation: a systematic review and meta-analysis
Get PDFObjective: Between 20% and 30% of women who have undergone tubal ligation regret their decision. The
alternative to regain fertility for these women is either in vitro fertilization or tubal re-anastomosis. This article
presents a systematic review with meta-analysis to assess the current evidence on the efficacy of tubal recanalization surgery in patients who have previously undergone tubal ligation.
Study design: The search was conducted in the World of Science (WOS) database, The Cochrane Library and
ClinicalTrials.gov record using the keywords “tubal reversal”, “tubal reanastomosis” and “tubal anastomosis”.
The review was carried out by two of the authors. Data from 22 studies were evaluated, comprising over 14,113
patients who underwent the studied surgery, following strict inclusion criteria: articles published between
January 2012 and June 2022, in English and with a sample size bigger than 10 patients were included. A
random-effects meta-analysis was performed.
Results: The overall pregnancy rate after anastomosis was found to be 65.3 % (95 % CI: 61.0–69.6). The percentage of women who had at least one live birth, known as the birth rate, was 42.6 % (95 % CI: 34.9–51.4).
Adverse outcomes after surgery were also examined: the observed abortion rate among women who underwent
surgery was 9.4 % (95 % CI: 7.0–11.7), and the overall ectopic pregnancy rate was 6.8 % (95 % CI: 4.6–9.0). No
differences were found between the outcomes when differentiating surgical approaches: laparotomy, laparoscopy, or robotic-assisted surgery. The patient’s age was identified as the most significant determining factor for
fertility restoration. Finally, when comparing the results of tubal reversal with in vitro fertilization, reversal
procedures appear more favorable for patients over 35 years old, while the results are similar for patients under
35 years old, but more data is needed to evaluate this finding.
Conclusion: Therefore, the available literature review demonstrates that surgical anastomosis following tubal
ligation is a reproducible technique with relevant success rates, performed by multiple expert groups worldwide
Ways of being bound: perspectives from post-Kantian philosophy and relational sociology
No full textThis book addresses the topic of 'being bound' from a philosophical and a sociological perspective. It examines several ways in which we are bound. We are bound to acknowledge the truth and to follow laws; we are bound to others and to the world. Who we are is partly defined by those bonds, regardless of whether we live up to them – or even of whether we acknowledge them. Puzzling questions arise from the fact that we are bound, such as: How are those bonds binding? Wherein lies their normative character? A venerable philosophical tradition, particularly since Kant, has provided an account of normativity that crucially appeals to such notions as “self-legislation.” But can our normative bonds be properly understood in these essentially first-personal terms? Many argue that our social condition resists any account of those bonds that fails to acknowledge the perspectives of the second and the third person.
The first part of the book explores these themes from a historical perspective in the tradition of transcendental philosophy (Kant, Fichte, Hegel, Husserl and Heidegger); it examines the phenomenon of “being bound”, i.e., why and how we are bound. The second part of the book offers a sociological analysis of social bonds that is both historical and systematic. Based on sociological approaches to “solidarity” and “reflexivity”, it explores the way in which the phenomenon of “being bound” manifests through the concept of a “social relation”
Overcoming the age barrier: Improving older adults' detection of political disinformation with media literacy
Get PDFThis experimental study analyzes the effect of media literacy on the ability of Spanish seniors over 50 years of age to identify
fake news. The experiment measures the improvement achieved by older adults in the detection of political disinformation
thanks to a digital competence course offered through WhatsApp. The study comprises a total sample of 1,029 individu‐
als, subdivided into a control group (n = 531) and an experimental group (n = 498), from which a qualified experimental
subsample (n = 87) was extracted. Results reveal that participants’ political beliefs, ranging from left to right positions,
influence their ability to detect misinformation. A progressive political position is associated with higher accuracy in iden‐
tifying right‐biased news headlines and lower accuracy for left‐biased headlines. A conservative position is associated with
higher accuracy when the news headline has a progressive bias, but lower accuracy when the headline is right‐wing. Users
are more critical when the headline has a bias against theirs, while they are more likely to believe news that confirms their
own beliefs. The study adds evidence on the relevance of cognitive biases in disinformation and supports the convenience
of designing specific media literacy actions aimed at older adults
Silane-modified hydroxyapatite nanoparticles incorporated into polydioxanone/poly(lactide-co-caprolactone) creates a novel toughened nanocomposite with improved material properties and in vivo inflammatory responses
No full textThe interface tissue between bone and soft tissues, such as tendon and ligament (TL), is highly prone to injury. Although different biomaterials have been developed for TL regeneration, few address the challenges of the TL bone interface. Here, we aim to develop novel hybrid nanocomposites based on poly(p-dioxanone) (PDO), poly (lactide-co-caprolactone) (LCL), and hydroxyapatite (HA) nanoparticles suitable for TL-bone interface repair. Nanocomposites, containing 3-10% of both unmodified and chemically modified hydroxyapatite (mHA) with a silane coupling agent. We then explored biocompatibility through in vitro and in vivo studies using a subcutaneous mouse model. Through different characterisation tests, we found that mHA increases tensile properties, creates rougher surfaces, and reduces crystallinity and hydrophilicity. Morphological observations indicate that mHA nanoparticles are attracted by PDO rather than LCL phase, resulting in a higher degradation rate for mHA group. We found that adding the 5% of nanoparticles gives a balance between the properties. In vitro experiments show that osteoblasts' activities are more affected by increasing the nanoparticle content compared with fibroblasts. Animal studies indicate that both HA and mHA nanoparticles (10%) can reduce the expression of pro inflammatory cytokines after six weeks of implantation. In summary, this work highlights the potential of PDO/ LCL/HA nanocomposites as an excellent biomaterial for TL-bone interface tissue engineering applications
El nuevo código de deontología (2022) y sus principios generales
No full textThe article describes and analyses the General Principles of the 2022 Code of Medical Ethics that are included in the articles 4 to 6 of the second chapter. The General Principles make it possible to understand and interpret the set of precepts and recommendations of the code, for which reason the study of this second chapter is of special relevance. In addition, I contextualize General Principles by relating them to other current international ethical-deontological documents. We will also review how they are extended in the broad articles of the new code. We will observe that there is a clear relationship between the General Principles of the new code with respect to previous Spanish Medical Codes, which is logical since they gather permanent values of Medical Ethics. In the General Principles is proposed that each doctor is at the service of the human being and of society and has as primary duties, respect for human life, dignity of each person, as well as the health care of the individual and the society (Article 4.1)
Impact of the COVID-19 pandemic on the diagnosis and treatment of onco-hematologic patients: a discussion paper
No full textWe do not know the precise figure for solid organ tumors diagnosed each year in Spain and it is therefore difficult to calculate whether there has been a decrease in cancer diagnoses as a consequence of the pandemic. Some indirect data suggest that the pandemic has worsened the stage at which some non-hematological neoplasms are diagnosed. Despite the lack of robust evidence, oncology patients seem more likely to have a poor outcome when they contract COVID-19. The antibody response to infection in cancer patients will be fundamentally conditioned by the type of neoplasia present, the treatment received and the time of its administration. In patients with hematological malignancies, the incidence of infection is probably similar or lower than in the general population, due to the better protective measures adopted by the patients and their environment. The severity and mortality of COVID-19 in patients with hematologic malignancies is clearly higher than the general population. Since the immune response to vaccination in hematologic patients is generally worse than in comparable populations, alternative methods of prevention must be established in these patients, as well as actions for earlier diagnosis and treatment. Campaigns for the early diagnosis of malignant neoplasms must be urgently resumed, post-COVID manifestations should be monitored, collaboration with patient associations is indisputable and it is urgent to draw the right conclusions to improve our preparedness to fight against possible future catastrophes
Estudio del concepto de milagro como vía de mediación en el diálogo entre ciencia y fe
Get PDFLa relación entre ciencia y fe ha sido objeto de debate y controversia a lo largo de la historia, y la palabra milagro es una fuente de incomodidad para algunos en este ámbito. Pero, ¿por qué? ¿Qué sucede cuando intentamos conceptualizar un evento milagroso y qué es un milagro en términos generales? Aunque estas preguntas plantean desafíos significativos, son abordables mediante un enfoque cuidadoso. El milagro es un concepto límite en la comprensión de la relación entre la ciencia y la fe, y su naturaleza fenoménica lo convierte en un mediador importante en este diálogo. Comprender la noción de milagro implica analizar sus diferentes formas y dimensiones, así como la influencia de la ciencia en su definición. A pesar de las dificultades que plantea, la noción de milagro puede ser una vía de mediación en el diálogo entre ciencia y fe. Al explorar cuidadosamente esta noción, podemos comprender su importancia y su papel en la relación entre ciencia y fe, lo que puede tener implicaciones significativas para nuestra comprensión del mundo que nos rodea.The relationship between science and faith has been a subject of debate and controversy throughout history, and the word «miracle» is a source of discomfort for some in this field. But why? What happens when we attempt to conceptualize a miraculous event, and what is a miracle in general terms? While these questions pose significant challenges, they are addressable through careful examination. The miracle is a boundary concept in understanding the relationship between science and faith, and its phenomenological nature makes it an important mediator in this dialogue. Understanding the notion of miracle involves analyzing its different forms and dimensions, as well as the influence of science in its definition. Despite the difficulties it poses, the notion of miracle can be a path of mediation in the dialogue between science and faith. By carefully exploring this notion, we can comprehend its significance and its role in the relationship between science and faith, which may have significant implications for our understanding of the world around us
Towards an adiposity-related disease framework for the diagnosis and management of obesities
No full textObesity is a complex disease that relapses frequently and associates with multiple complications that comprise a worldwide health priority because of its rising prevalence and association with numerous complications, including metabolic disorders, mechanic pathologies, and cancer, among others. Noteworthy, excess adiposity is accompanied by chronic inflammation, oxidative stress, insulin resistance, and subsequent organ dysfunction. This dysfunctional adipose tissue is initially stored in the visceral depot, overflowing subsequently to produce lipotoxicity in ectopic depots like liver, heart, muscle, and pancreas, among others. People living with obesity need a diagnostic approach that considers an exhaustive pathophysiology and complications assessment. Thus, it is essential to warrant a holistic diagnosis and management that guarantees an adequate health status, and quality of life. The present review summarizes the different complications associated with obesity, at the same time, we aim to fostering a novel framework that enhances a patient-centered approach to obesity management in the precision medicine era
From urban microclimate to indoor overheating: Analysis of residential typologies during typical climate series and extreme warm summer
No full textIndoor overheating is a current problem due to increasingly higher external temperatures and more frequent and extreme heatwaves which specially impact naturally ventilated dwellings. This paper presents a methodology at neighbourhood-scale to analyse indoor overheating hours (IOH) of residential typologies and to investigate building parameters that most influence IOH. This study is based on energy simulations for two climate scenarios: typical meteorological year and extreme warm summer with heatwaves (2022), and the effect of urban microclimate is considered by using the Urban Weather Generator tool. Results with the typical meteorological year show 0% IOH for all dwellings, while those derived from simulation with summer 2022 show a significant increase in IOH with values above 30% IOH in the most overheated ones. The effect of microclimate is especially relevant in the extreme warm summer and increases the IOH by 7,5% on average. Among the building parameters studied, the number of orientations (related to potential of natural ventilation), orientation and the floor level of the dwellings have the highest influence on IOH. These results could help policy-makers and technicians detect the risk of overheating in cities and buildings and prevent it by improving the adaptation of the residential stock to current warming