University of Pamplona

Background Physical activity (PA) is known to protect against incident hypertension, but the preferred intensity of PA to prevent hypertension remains unknown. Energy expenditure (EE) in PA is generally considered the primary determinant of effect, whereas intensity is usually considered nondifferential provided it is moderate or above. However, intensity may produce its own distinct effect. Methods and Results We used data from the SUN ( Seguimiento Universidad de Navarra ) cohort—a large prospective longitudinal cohort in Spain—to investigate the relation between intensity of habitual PA and hypertension incidence. Average intensity of habitual PA was calculated including both leisure time PA and incidental PA (walking and stairclimbing). Hazard ratios (HRs) for incident hypertension and 95% CIs were estimated using Cox regression analyses adjusted for EE, body mass index, and other important covariables. Comparative models explored how duration of time in PA and EE in PA related to hypertension incidence. In the study,10 524 participants without prior diagnosis of hypertension (62.5% women, mean age 36.2 years, mean body mass index 23.3 kg/m ² ) were followed for 126 876 person‐years. A total of 1504 cases of incident hypertension emerged. After adjustment for EE and other covariables, increasing intensity of PA was monotonically associated with decreased risk for incident hypertension (adjusted HR for Q5 versus Q1, 0.77 [95% CI, 0.64–0.92]). In contrast, increasing time in PA did not appear to affect risk of incident hypertension following adjustment for EE (aHR for Q5 versus Q1, 0.94 [95% CI, 0.57–1.55]). Conclusions Intensity of habitual PA is independently and inversely associated with incidence of hypertension. Registration URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT02669602.

Purpose Radiofrequency works by applying continuous waveforms which ablate the surface of the cartilage. Despite its utility, the limits and possible risks of this technology have not been thoroughly investigated in the literature. This review aims to systematically summarise the most recent studies regarding the effects of the various radiofrequency on cartilage and compare the side effects they may bring. Methods A search following the PRISMA guidelines was conducted on scientific databases: Web of Science, Embase CINAHL, ProQuest and Medline from May 2021 to January 2025. The databases were searched from their inception to September 2023. Only articles in English were included. In vivo, ex vivo, cadaveric, and in vitro studies were all included. To assess the risk of bias, Rob2 and ROBINS‐I were used. Results Twenty‐eight studies were included in this systematic review. The level of evidence of the included studies ranged from level II to III. The most analysed specimen was human tissue, followed by swine, ovine, bovine, equine, canine and rabbit. Cartilage damage was reported in most of the articles. Monopolar radiofrequency was considered safer than bipolar radiofrequency. However, controversial results were found on the superiority of radiofrequency energy to mechanical debridement. Conclusion This review shows that there is not enough evidence to precisely identify the possible dangers or benefits that may come from the use of radiofrequency energy on cartilage. Therefore, the real risks of radiofrequency are not fully explored. Further research needs to include radiofrequency energy in the clinical and surgical environment. Level of Evidence Level II, evidence from one or more well designs randomised control trials (RCT).

The transesterification process for biodiesel production is constrained by high thermal input, prolonged residence time, and intensive mechanical agitation. This study investigates process intensification via hydrodynamic cavitation using a custom-built Shockwave Power Reactor (SPR), enabling continuous biodiesel synthesis from soybean and used cooking oils. A statistically designed experimental matrix was applied to evaluate the reactor’s transient–stable thermal regime and the influence of operational parameters: rotor speed (1700–3415 rpm), volumetric flow rate (60–105 mL/min), methanol-to-oil molar ratio (6:1 to 12:1), and alkali catalyst type (NaOH or KOH). For benchmarking, conventional alkaline transesterification was optimized. The FAME yields from the SPR system exceeded 96.5% and complied with EN14103 standards. Specific energy analysis showed that cavitation-enhanced transesterification reduced energy consumption and peak temperature compared to traditional methods. The SPR’s capacity to induce high shear and localized turbulence under controlled cavitation offers a promising pathway for low-energy, scalable biodiesel production.

Background Dysphagia and reflux are frequently experienced by individuals with hiatus hernia (HH), but the underlying mechanisms are not fully defined in radiological or manometric studies. This study explores the impact of HH on propulsive esophageal peristalsis and investigates the biomechanical underpinnings of HH‐concurrent–related dysphagia in affected individuals. Methods High‐resolution manometry with impedance (HRM‐I) studies compared the biomechanics of 195 gastroesophageal reflux disease (GERD) patients (excluding large HH and motility disorders) and 20 normal healthy volunteers. Assessments included dysphagia severity, esophageal pH monitoring, and HRM‐I with 5‐mL liquid and viscous swallows. Bolus distension pressures during bolus transport and esophageal emptying parameters were assessed in conjunction with standard pressure topography metrics. Data grouped by EGJ morphology type were analyzed by a mixed‐effects statistical model. Key Results Patients with unequivocal HH exhibited altered bolus transport through the mid‐distal esophageal body, indicated by increased intrabolus distension pressure during bolus transport (p < 0.01 for liquid and viscous swallows) and shorter bolus flow time through the EGJ (p ≤ 0.005 for liquid and viscous swallows). Increased HH size during swallows also correlated with increased intrabolus distension pressure (liquid r 0.243, p < 0.001) and shorter EGJ flow time (liquid r − 0.191, p < 0.005). Patients with confirmed GERD without HH showed a different pattern of altered bolus transport in the more proximal esophagus. Conclusion In the presence of a HH, esophageal biomechanics are altered, with elevated bolus distension pressure revealing resistance to bolus transport occurring in the mid‐lower esophageal body for liquid and viscous boluses, contributing to dysphagia symptoms.

The use of natural fibers in hydro turbine rotors promotes sustainability by offering biodegradable, renewable materials with a lower carbon footprint. This study compares the hydrodynamic performance of two rotors in a gravitational vortex turbine: Rotor 1, 3D-printed with polylactic acid (PLA), and Rotor 2, made from fique fiber and epoxy resin using manual molding. To compare the rotors, experimental tests were conducted on a laboratory-scale setup, where the behavior of both rotors was evaluated under different flow regimes. Rotor 1 achieved 61.01% efficiency at an angular velocity (ω) 160 RPM, while Rotor 2 reached only 19.03% at ω of 165 RPM. The lower performance of Rotor 2 was due to dynamic imbalances and mechanical vibrations, leading to energy losses. These challenges highlight the limitations of manual molding in achieving precise rotor geometry and balance. To improve natural fiber rotor viability, optimizing manufacturing techniques is crucial to enhance dynamic balance and minimize vibrations. Advancements in fabrication could bridge the performance gap between natural and synthetic materials, making bio-based rotors more competitive. This study emphasizes the potential of natural fibers in sustainable energy and the need to refine production methods to maximize efficiency and reliability. Addressing these challenges will help integrate eco-friendly rotors into hydro turbine technologies.

Background Type 2 diabetes (T2D) is a comorbidity commonly associated with obesity. Elevated concentrations of growth differentiation factor 15 (GDF15) and fibroblast growth factor 21 (FGF21) are associated with these conditions, making both cytokines interesting candidates to combat them. This study aimed to analyse the relationship between changes in plasma GDF15 and FGF21 levels and the resolution of T2D or obesity improvements after bariatric surgery. Methods Plasma samples from 104 patients (52 with obesity and normoglycemia and 52 with obesity and impaired glucose tolerance or T2D) were analysed before and after Roux‐en‐Y‐gastric bypass surgery. Results Plasma GDF15 levels increased significantly after bariatric surgery in patients with obesity and normoglycemia ( p < 0.01), as well as in those with obesity and impaired glucose tolerance or T2D ( p < 0.05). This increase was significant in patients analysed up to 8 months after surgery in both groups ( p < 0.01) but not in those analysed between 8 to 15 months after surgery, suggesting that GDF15 concentrations exhibit an early increase after surgery but may return to baseline levels over time. In contrast, plasma FGF21 levels after bariatric surgery decreased significantly in patients with impaired glucose tolerance or T2D ( p < 0.05). Pre‐surgery FGF21 concentrations were negatively correlated with the percentage of excess weight loss and the percentage of fat loss. Conclusions GDF15 and FGF21 exhibit a different behaviour after Roux‐en‐Y‐gastric bypass surgery, with FGF21 being more closely associated with glycemic status and weight loss. Elevated pre‐surgery FGF21 concentrations could predict a higher difficulty in losing the excess weight after surgery.

Bipolar II disorder (BD‐II) is currently identified by both the DSM‐5 and ICD‐11 as a distinct subtype of bipolar disorder, defined by at least one depressive episode and at least one hypomanic episode, with no history of mania. Despite its prevalence and impact, the literature on BD‐II remains relatively sparse. This paper provides a comprehensive overview of the available research and current debate on the disorder, including its diagnostic criteria, clinical presentations, comorbidities, epidemiology, risk factors, and treatment strategies. Patients with BD‐II often present with recurrent depressive episodes, which outnumber hypomanic episodes by a ratio of 39:1. The condition is therefore often misdiagnosed as major depressive disorder and treated with antidepressant monotherapy, which may worsen its prognosis. The recognition of BD‐II is further complicated by the overlap of its symptoms with other disorders, in particular borderline personality disorder. Although BD‐II is often perceived as a less severe form of bipolar disorder, evidence suggests significant functional and cognitive impairment, accompanied by an elevated risk of suicidal behavior, including a rate of completed suicide at least equivalent to that observed in bipolar I disorder (BD‐I). Psychiatric comorbidities, in particular anxiety and substance use disorders, are common. The disorder is associated with a high prevalence of numerous physical comorbidities, with a particularly high risk of comorbid cardiovascular diseases. Various genetic and environmental risk factors have been identified. Inflammation, circadian rhythm dysregulation and mitochondrial dysfunction are being studied as potential pathophysiological mechanisms. Current treatment guidelines, often extrapolated from BD‐I and depression research, may not fully address the unique aspects of BD‐II. Nevertheless, substantial evidence supports the value of some pharmacological treatments – primarily mood stabilizers and atypical antipsychotics – augmented by psychoeducation, cognitive behavioral or interpersonal and social rhythm therapy, and lifestyle interventions. Further research on BD‐II should be a priority, in order to refine diagnostic criteria, identify potentially modifiable risk factors, and develop targeted interventions.

Knowledge on the distribution of species provides baseline information towards their conservation and the management of human activities affecting them. For endangered species, such as the Risso's dolphin ( Grampus griseus ) in the Mediterranean Sea, highlighting the areas within their distribution range to which individuals regularly return can reveal patterns of site fidelity. For Risso's dolphin, this information is scarce in the Mediterranean Sea. Here, photo identification was used to assess Risso's dolphin site fidelity patterns in the Garraf submarine canyon system (NW Mediterranean Sea). Data collected along 237 boat surveys between 2017 and 2023 resulted in 56 sightings and 364 unique individuals. Eight Site Fidelity Indices (SFIs) were calculated for each individual based on three indicators: Occurrence, Permanence and Periodicity. A divisive hierarchical clustering analysis based on the eight SFIs was used to detect different degrees of residency. Individuals seen in more than 2 months were divided into three clusters and defined as seasonal residents, regular and occasional visitors, whereas individuals seen only in 1 month were considered to be transient. Results show the importance of the Garraf submarine canyon system for Risso's dolphin and highlight the need to expand the photo identification studies to further regions to better understand the distribution and movements of the species in a wider context in the western Mediterranean Sea.

Having validated instruments for the evaluation of lifestyles becomes a necessity for professional practice in terms of promoting the adoption of health-promoting behaviors in various aspects of daily life, such as social interactions, nutrition, physical activity, oral health, environmental health, mobility, and psychoactive substance use. Objective To evaluate the construct validity and reliability of the ‘Lifestyle Questionnaire in the Colombian Population” over 18 years of age from the northeastern of Colombia. Methodology A psychometric study was conducted with the participation of 551 adults using the instrument proposed by the Pan American Health Organization (PAHO). A confirmatory analysis using the structural equation modeling (SEM) technique was carried out, in addition to an internal consistency analysis. Results The confirmatory factor analysis reports the same structure, with adequate goodness-of-fit indicators (X ² /df = 2.10, CFI = .88, TLI = .87, RSMEA = .05, SRMR = .04). The reliability estimation of the test and its dimensions, with internal consistency coefficients Cronbach’s α and McDonald’s ω, reported optimal levels in the total test (ω = .93). Conclusions The instrument developed by PAHO showed adequate construct validity and reliability indicators for evaluating lifestyles in northeastern Colombian people over 18 years old.

We report a case of complications following pars plana vitrectomy (PPV) for optic disc pit (ODP) and the role of plasma rich in growth factor membranes (PRGFm) as an adjunctive treatment. A 14-year-old girl presented with failed PPV for serous macular detachment in the right eye (OD) secondary to ODP, exhibiting poor visual acuity, an extrafoveal hole, and persistent retinal detachment. Detailed fundoscopic examinations and swept-source optical coherence tomography (SS-OCT) were used to assess the anatomical and functional status of the retina. A second PPV was performed with the addition of PRGFm, resulting in substantial improvement in both the macular structure and visual outcome. Our findings suggest that PRGFm is an effective adjunct in promoting recovery by sealing extrafoveal holes and ODP, offering a promising approach for improving the anatomical and functional prognosis in complex ODP cases.

Background: The aim of our study was to validate the classification proposed by the PANOMEN-3 group for the prediction of tumor recurrence/progression in pituitary tumors (PTs). Methods: Multicenter national case-control study of patients with PTs followed for at least 5 years. Kaplan-Meier curves were used to assess the time to tumor recurrence/progression. Uni- and multivariate Cox regression analyses were used to estimate the hazard ratio [HR] and prognostic capacity of the classification proposed by the PANOMEN-3 group. Findings: A total of 1143 patients were included. Pituitary surgery was performed in 814 patients and the remaining 329 patients were followed with active-surveillance or medical treatment. After a median follow-up of 8.8 years (5-29.8), 253 patients experienced tumor recurrence or biochemical/radiological progression and were classified as cases. The other 890 patients were classified as controls. The mean follow-up from PT diagnosis to recurrence was 7.2±5.4 years. The diagnostic accuracy of the PANOMEN-3 model to predict recurrence/progression was 75.6% (95% CI 0.716-0.796). Residual tumor (HR 2.20, p<0.001), hereditary syndrome (HR 5.15, p=0.026) and active secretory status (HR 1.80, p=0.021) were the most important variables in this model. Recurrence/progression rate increased with increasing PANOMEN-3 grade (2.5% in grade 0; 10.3% in grade 1, 33.7% in grade 2 and 33.3% in grade 3; p<0.001). Interpretation: The predictive model proposed by the PANOMEN-3 group may be useful to guide the prognosis and therapy of PTs in the Spanish population since it offers a good accuracy to predict tumoral/biochemical recurrence and/or progression in operated and non-operated patients.

Additive metal manufacturing (AM), particularly Wire Arc Additive Manufacturing (WAAM), offers a compelling alternative to traditional machining methods. While AM presents advantages such as reduced material waste and lower production costs, challenges remain in effectively controlling the process to prevent defects and optimise material deposition. This article proposes a multivariable control system for WAAM utilising Quantitative Feedback Theory (QFT) to maintain the shape of the heat‐affected zone (HAZ) during transitions in direction flips during layer deposition. By modelling these direction flips as predictable disturbances, the full potential of QFT to integrate feedback and feedforward actions is exploited. The resulting multivariable control laws seek to minimise temperature variation in two critical points around the welding pool by adequately manipulating the power and speed of the heat source. A benchmark system is established to evaluate the effectiveness of the proposed control system. The results demonstrate significant improvement in temperature control, leading to enhanced layer construction quality and reduced need for height corrections or cooling pauses.

Patients with newly‐diagnosed multiple myeloma (MM) who experience early relapse (ER) have dismal overall survival (OS). Their prospective identification, either before or soon after treatment initiation, is paramount to use alternative approaches and prevent ER. In this study, we investigated the frequency and disease characteristics of ER during the first 18 months after treatment initiation (ER18), in a series of 1215 newly‐diagnosed MM patients enrolled in four PETHEMA/GEM clinical trials for the transplant‐eligible and transplant‐ineligible populations. ER18 was observed in 266 of the 1215 patients (22%) and resulted in a median OS of 19 versus 114 months in cases without ER18. When compared to the ISS and the presence of ≥2 high‐risk cytogenetic abnormalities, a modified version of the new high‐risk definition from the International Myeloma Society (mHR‐IMS) showed the most balanced negative and positive predictive values of ER18 (83.5% and 40%, respectively). In addition to the mHR‐IMS, an ECOG = 2, ISS 3, and calcium levels ≥ 11 mg/dL were independently associated with ER18. These variables were modeled into a predictive score in which the rates of ER18 were 2%, 24.5%, and 59% in patients with low‐, intermediate‐, and high‐risk score. The risk of ER18 and OS were modulated by the VGPR status at 6–9 months after treatment initiation. In conclusion, we present a risk model that predicts ER18 and can be readily applied in clinical trials and routine practice to identify treatment strategies empowered to prevent ER18 and improve survival outcomes of newly‐diagnosed patients with functional high‐risk MM.

Background Overweight and obesity in children are rising globally, and the Mediterranean diet may help reduce obesity and related diseases. Objective To assess the association between adherence to the Mediterranean diet and body composition in Spanish preschool children. Methods This study included 1218 children aged 3–6 years from the CORALS cohort. Mediterranean diet adherence was evaluated using the validated MED4CHILD and COME‐Kids F&B‐FQ questionnaires. Body composition measurements included weight, height, waist circumference, BMI, Fat Mass (FM), Fat‐Free Mass Index (FFMI), and Waist‐to‐Height ratio (WtHR). Multivariate regression and ANCOVA were used to examine associations, adjusting for factors like age, physical activity, and energy intake. We also performed a Cohen's d analysis to assess effect size. Results Adherence to the Mediterranean diet was associated with more favourable body composition in children. Specifically, both the MED4CHILD score and the COME‐Kids‐derived score showed significant associations with BMI, FFMI, and Waist‐to‐Height ratio, showing differences by sex. Children who adhered to the Mediterranean diet exhibited lower BMI and higher fat‐free mass, and a more favourable waist‐to‐height ratio. Additionally, although some measures showed weaker associations, all analyses highlighted a trend towards improved body composition with higher adherence. Cohen's d analysis showed small to moderate effect sizes. Conclusion Adherence to the Mediterranean diet was significantly linked to favorable body composition indices in Spanish children, highlighting the importance of promoting healthy dietary patterns to prevent overweight and obesity.

Purpose In this experimental study, the Minimally Invasive Configuration (MIC), the Bunnell, Kessler and modified Bunnell–Kessler techniques for tendon rupture repair were compared in terms of the following biomechanical parameters: maximum load, mode of failure, failure elongation, tension/construct elongation and stiffness (Young's modulus). The scope of comparison involves understanding the properties of each suture technique in hopes of eventually contributing to surgical decision‐making. Methods Thirty‐two frozen ovine specimens were obtained, and transverse tenotomy was performed on each. Eight tendons were randomly allocated to each technique. Specimens were tested performing a unidirectional tensile load to failure using a servo‐hydraulic testing device. The tendons were also loaded to failure at a rate of 10 mm/s. The total length of the construct was defined as the distance from the two clamps. Stiffness was calculated by determining the slope of the force–displacement curve in the linear region. Total failure was defined as a drop of measured force or rupture of the tendon–suture complex. Results In the mode of failure, Tukey's post hoc test showed a statistically significant difference between the Bunnell group and the other three groups (p < 0.05). For Tension/construct elongation at 5 and 10 mm, Tukey's post hoc test showed a statistically significant difference between the MIC group and the other three groups (p < 0.05). At 15 mm Tukey's post hoc test showed a statistically significant difference between the MIC group and the Kessler group (p < 0.05). Conclusion The Bunnell suture performed best in terms of mode of failure, while the MIC suture technique outperformed the rest in terms of tension/construct elongation. Findings show sufficient biomechanical evidence to support the ongoing clinical application of all techniques. Level of Evidence Level V.

Objectives To validate clinical scores [Testicular Workup for Ischemia and Suspected Torsion (TWIST), testicular torsion (TT) score, Artificial Intelligence–based Score (AIS), Boettcher Alert Score (BALS)] when evaluating children under 18 with non-traumatic testicular pain in the emergency department. Our secondary objective was to create and compare a new TT score [Testicular Emergency Score for Torsion (TEST) score]. Methods This was a multicenter prospective study in 21 Spanish pediatric emergency departments between 2020 and 2022, including 903 children 3 months to 18 years old with non-traumatic unilateral testicular pain, of them 93 TT (10.3%). To create a new score, the sample was randomly divided into derivation and validation set. Results The performance of the TWIST, TT score, AIS, and BALS was good, and the proportion of patients correctly classified as low risk was 37.9%, 52.7%, 30.3%, and 28%, respectively. The TEST score included the following predictors of TT identified by multivariable logistic regression analysis: age, duration of pain, nausea/vomiting, testicular volume increase, testicular elevation, induration, and absence of cremasteric reflex. TEST score had a higher area under the receiver operating curve (area under the curve) and correctly classified in the low-risk group of 63.6% of the patients. Conclusions Although TWIST, TT score, BALS, and AIS scores showed a good performance, the TEST score identifies a larger group of low-risk patients suitable for safe management without Doppler ultrasound.

Eucalyptus tereticornis extract is a promising drug for the treatment of type 2 diabetes mellitus and obesity, showing in vitro effects, such as increased glucose uptake and reduced lipid storage. However, its in vivo efficacy has been demonstrated only when administered intraperitoneally. Thus, this study focused on standardisation and optimisation of the preparation of polylactic-co-glycolic acid 50:50 nanoparticles (NPs). The size distribution of the NPs, polydispersity index, and zeta potential were evaluated to identify the NPs with the best encapsulation efficiency and loading capacity based on a first-order design using the response surface methodology. To evaluate cell viability of the NPs, in vitro viability assessments were performed using C2C12, 3T3-L1, HepG2, and J774A.1 cell lines and the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. The highest encapsulation efficiency and load capacity were 81.569 ± 1.798% and 1.885 ± 0.042%, respectively. These results confirmed the effective encapsulation of Eucalyptus tereticornis extract and the interactions between the components of the system. Finally, none of the evaluated concentrations negatively affected the cell line viability, confirming the reproducibility of the method with great pharmacological potential. In addition, this model can be used to develop nanoformulations that efficiently improve response.

In modern manufacturing, Digital Thread and Digital Twin technologies integrate and orchestrate data throughout the production lifecycle. To fully realize their potential, it is crucial to address challenges in data integration, management, and interoperability while enhancing system intelligence and contextual awareness. STEP-NC (STandard for the Exchange of Product model data - Numerical Control) emerges as a potential solution, enriching these digital systems with contextual information about products, processes, and machines. While STEP-NC has been extensively studied in machining, its application in Additive Manufacturing (AM) is still emerging. The current reliance on legacy formats like STL and G-code fails to meet the industry’s advancing needs. This work offers a comprehensive review of the current state of STEP-NC development for AM, highlighting a growing interest in its application, despite limited publications and advancements. To bridge these gaps, we propose STEP-NC entity definitions for managing data related to process parameters and operations in Fused Deposition Modeling (FDM) and Laser Metal Deposition (LMD) technologies. STEP-NC facilitates refined data management at the individual layer level, encompassing geometry, process parameters, material properties, and other key aspects. Additionally, we introduce a cyber-physical architecture for STEP-NC in manufacturing, aligned with the ISO 23247 framework. This architecture envisions a robust digital ecosystem driven by standards-based Digital Thread and Digital Twin technologies, with STEP and STEP-NC at its core, supported by essential open standards such as QIF, MTConnect, OPC-UA, and MQTT. By integrating contextual information, it enhances Digital Twin development for virtual monitoring, optimization, knowledge generation, and informed decision-making in manufacturing environments.