San Antonio College

Introduction: This study aims to investigate the access to leadership development opportunities among European psychiatric trainees and early career psychiatrists (ECPs) and their perceptions and needs related to leadership skills training.

AntecedentesEl síndrome de bajo gasto cardíaco constituye una de las complicaciones mas importantes de la cirugía coronaria, por lo que el objetivo del presente trabajo fue determinar los antecedentes, la incidencia, la evolución intrahospitalaria y los predictores independientes de bajo gasto cardíaco posquirúrgico. Material y método Se incluyeron prospectivamente 1 .293 pacientes a quienes se les efectuó cirugía de revascularización miocárdica provenientes de 41 centros médicos de la Argentina . Se cuantificaron los predictores independientes de bajo gasto card´íaco mediante los odds ratios analizados con una ecuación de regresión logística. ResultadosLa incidencia de bajo gasto cardíaco fue de 17,1% y su mortalidad de 44,6%. Mediante análisis univariado se asociaron al bajo gasto cardiaco el sexo femenino, la edad avanzada (2:70 aflos), la angina inestable y una función ventricular con deterioro moderado o severo . Luego de realizar un ajuste multivariado se hallaron como predictores independientes de bajo gasto cardíaco en el posoperatorio las siguientes variables : sexo femenino (odds ratio = 1,61, intervalo de confianza del 95% = 1,10-2,34), edad >_ 70 años (odds ratio = 2, intervalo de confianza del 95% = 1,41-2,82) y deterioro severo de la función ventricular izquierda (odds ratio = 3,53, intervalo de confianza del 95% = 2,21-5,69) . ConclusionesEn los pacientes sometidos a cirugía de revascularización miocárdica el bajo gasto cardíaco en el posoperatorio presentó :1) una incidencia del 17,1%,2) una mortalidad del 44,6% y 3) sexo femenino, edad mayor de 70 años y deterioro severo de la función ventricular izquierda

Long COVID (LC) is a post-infectious condition affecting millions worldwide, characterized by persistent multisystem symptoms. Females are disproportionately affected, reporting higher symptom burden, particularly neurocognitive and neurosensory complaints. While short-term immunopathology has been described, the long-term clinical course, immune dysregulation, and sex-specific underpinnings remain poorly understood. We analyzed 34 participants experiencing persisting symptoms from 9months to 5years post-SARS-CoV-2 infection, alongside 26 SARS-CoV-2-infected controls without symptoms. Clinical assessments, symptom inventories, comorbidity analysis, and work capacity evaluation were performed. Immune profiling included flow cytometry of CD4⁺ and CD8⁺ T cells, NK cells, and B cells, as well as quantification of plasma cytokines, soluble factors, and cytotoxic molecules, analyzed in a sex-disaggregated manner. Females with LC exhibited higher symptom burden, particularly persistent fatigue, neurocognitive and neurosensory complaints, which increased with age and tended to increase with disease duration, whereas males showed no clear age- or duration-related patterns. Comorbidities, especially affecting endocrine, metabolic, and circulatory systems, were more frequent in females and aligned with symptom severity. Immune profiling revealed subtle but sex-specific differences: females had reduced CD8⁺ T cell cytotoxic profile, lower NKG2D and granzyme K expression, increased sCD40L and sFAS, and decreased perforin, whereas males displayed elevated TNF-α. NK cell function, B cells, and humoral immunity remained largely intact. Over half of participants reported functional impairments affecting work capacity. Even though our cohort is small it suggests that prolonged LC is characterized by sex-specific differences in symptom burden and immune profiles. Reduced cytotoxic CD8⁺ T cell profile in females may contribute to viral persistence and neurological symptoms, whereas elevated inflammatory markers in males suggest distinct immune pathways. These findings highlight the need for sex- and duration-specific management strategies, the identification of biomarkers, and the development of personalized therapies targeting specific LC endotypes.

To describe a CT-guided dual-fluorescent marking technique (methylene blue + indocyanine green stabilized in fibrin-thrombin matrix) for intraoperative localization of non-palpable pulmonary nodules during robotic-assisted thoracic surgery (RATS) and to report feasibility and key outcomes. Retrospective, single-center series of 84 consecutive patients with solid or subsolid nodules ≤ 2cm referred for RATS (Oct/2021-Oct/2024). Under general anesthesia, a 22-G Chiba needle was used for CT-guided percutaneous injection of a standardized solution (1mL 1% methylene blue + 1mL indocyanine green + 3mL fibrin-thrombin + 1mL iodinated contrast; typical injected volume 0.2-1.0mL). Resection proceeded using near-infraredFirefly®imaging. intraoperative identification, complete resection, margin status, timing, and complications. Prespecified subgroup analysis compared subsolid vs. solid lesions. All 84 nodules were localized intraoperatively and resected with negative margins; no conversion to open surgery occurred and no complications attributable to marking were recorded. Mean operative time was 163.7 ± 66.7min; mean interval between marking and surgery was 74.6 ± 20.6min. Patients with subsolid nodules were older (70.5 vs. 63.1years, p = 0.003) and had larger lesions (14.7 vs. 11.4mm, p = 0.010). During a mean clinical follow-up of 17.3months, no local recurrences were observed. CT-guided dual-fluorescent marking is a practical, fluoroscopy-free localization strategy that integrates smoothly with RATS workflows and enables reliable sublobar resections with negative margins in this series. The incremental contribution of methylene blue beyond ICG could not be isolated and warrants prospective evaluation. However, this study did not include a control group, such as conventional marking techniques, which should be considered when interpreting the results.

The private rural service road is a customary legal figure, mainly rooted in rural areas throughout the Spanish territory, which refers to a path that crosses privately owned land and is used by the owners of adjacent properties to access their properties or public roads. Unlike a right of way (servidumbre de paso), the serventía does not involve dominant and servient estates; instead, it establishes a common and shared use of the path among the neighboring owners who have ceded part of their land for its creation. Its origin is usually motivated by the topographical configuration of the land and small landholdings, seeking collaboration for the efficient use of the properties. Legally, it is constituted by the voluntary, tacit, or express agreement between the neighboring owners, with the execution of the path being the most significant evidence of said agreement. It is configured as a functional community of use with Germanic characteristics, where the participants have a collective right of use without the assignment of quotas. Its operating regime is based on good faith and the necessity of collective will for the administration and conservation of the path, generally requiring unanimity for its modification or termination. Although not mandatory, registration in the Property Registry grants greater legal certainty. The serventía has specific legal recognition in Galicia, and it is compiled as custom in Asturias, in addition to being recognized jurisprudentially in other autonomous communities such as Canarias, Andalucía, Castilla y León, and Navarra.