Real Academia Española

The Supreme Court ruling of June 12, 2025, analyzes a case from the perspective of underparticipation and unilateral termination of the contract ad nutum.

Mesoaphyosemion izyarae sp. nov., is described from a small left-bank tributary of the Mitemele River in southern Equatorial Guinea. The new species is distinguished from all other described Mesoaphyosemion species by a unique combination of male colouration characters: dorsal fin yellow with red streaks between fin rays; anal and pelvic fins yellow with black or dark red margin, basally light blue, caudal fin in centre black with red streaks between fin rays, broad yellow area on dorsal and ventral margin, body metallic light blue with more or regular rows of red dots on side, posteriorly denser and forming a reticulated pattern. The species status is supported by mtDNA analyses, including nine of the eleven described valid Mesoaphyosemion species.

Abstract Understanding formation processes is crucial for interpreting sites with complex sedimentary histories and exceptional archaeological records, such as Level 3 of Des-Cubierta Cave. This Middle Paleolithic unit contains an assemblage of anthropically modified ungulate horned crania, Mousterian lithics, and evidence of fire use, all preserved in a clast-supported gravel deposit shaped by successive rockfalls. This study integrates geostatistical analyses with traditional spatial and taphonomic methods to examine the cone-shaped sedimentary structure that dominates the level and its influence on the spatial distribution and preservation of archaeological materials. The results reveal distinct spatial patterns for geological and archaeological materials, indicating separate formation dynamics. Size-based spatial analyses of boulders characterize the morphology of the conical structure, highlighting size sorting and intensity variations that may indicate sedimentary hiatuses. Bone refitting analysis suggests limited post-depositional movement, with material distribution shaped by the conical sedimentary structure and karst gallery morphology. Variability in crania preservation correlates with proximity to the cone’s apex and elevation, with better-preserved specimens in central areas and more fragmented remains in zones affected by erosive and edaphic processes. These findings underscore the value of integrating geostatistical and traditional archaeological approaches to advance interpretations of spatial and temporal patterns in karst environments and provide a methodological approach for examining sites with similar sedimentary histories. Moreover, the results support the interpretation of a recurrent, culturally motivated Neanderthal behaviour centred on the deliberate accumulation of large ungulate crania, pointing to a symbolic dimension in these practices.

This paper refers to common points relevant to both palliative medicine and geriatrics. We may find these relationships in parallel initial histories, doctrines, purposes, and working methodologies. Prioritizing quality of life over length of life has great relevance in both branches of Medicine. Common ground also appears in the interdisciplinary approach needed in both sciences, demanding a holistic clinical approach and a permanent fight against any form of ageism. The main focus is directed to elderly patients with advanced diseases, in the understanding that patient, family, and caregivers are an integral care unit. The paper stresses the need for advances in the development of both specialities in assistential, formative, and research fields.

Se analizan los primeros años de la revista Archivos Iberoamericanos de Historia de la Medicina. Se busca su origen, el proyecto y la realización de la revista. También sus secciones, principales colaboradores y temas estudiados. Con varios cambios en su nombre, es el origen de la actual revista Asclepio.

Obituario dedicado a Enrique Valdivieso González, Catedrático de la Universidad de Sevilla

Se realiza un recuerdo emotivo del Dr. Jesús Culebras Fernández.

The management of patients with acute paraesophageal hernia (APEH) remains to be standardized. This study evaluates the safety and outcomes of a novel staged approach for patients with APEH, which is based on gastric decompression followed by non-operative management and either emergency or semi-elective surgical treatment when deemed necessary. Observational study of a consecutive case series of APEH patients admitted to the hospital between 2007 and 2024, with a minimum follow-up of 3months. All patients were managed according to the staged approach. Clinical outcomes including postoperative complications, recurrence, and readmission rates were assessed. Fifty-eight patients (70.7% women) with a mean age of 81 ± 9.2years (20.7% of patients aged over 90years) and significant comorbidities were included. Early decompression via nasogastric tube and/or esophagogastroduodenoscopy relieved symptoms in 81% of cases, avoiding emergency surgery. Surgery was deemed unsuitable for 15 patients of whom 4 died due to acute complications, while 11 were successfully managed non-operatively. Surgical intervention was performed in 43 patients (74.1%) primarily through laparoscopic fundoplication, 10 of whom required urgent procedures. Compared to semi-elective repair, urgent surgery was associated with a higher rate of major postoperative complications (40% vs. 21.2%). Over a median follow-up of 27months, 5 patients (11.6%) required readmission within a 90-day period and 3 (7%) experienced hernia recurrence. None of the patients died. A staged approach for the management of APEH was feasible, with definitive repair achieved in 93% of surgical patients, via laparoscopy in 72% of cases, and without perioperative mortality.

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