Editorial
Translational research in acute respiratory distress syndrome
Investigación traslacional sobre el síndrome de dificultad respiratoria aguda
P. Cardinal-Fernandez
Department of Emergency, Hospital Universitario HM Sanchinarro, Madrid, Spain
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EPLS, early protective lung strategy; EPHS, early protective hemodynamic strategy. <span class="elsevierStyleItalic">C</span><span class="elsevierStyleInf">dyn</span>, dynamic compliance of respiratory system; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleInf">awi</span>, inspiratory airway resistance; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleInf">awe</span>, expiratory airway resistance; WOB, total inspiratory work of breathing (*<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 compared to baseline by two-way analysis of variance for repeated measures; <span class="elsevierStyleSup">#</span><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 compared to one hour by two-way analysis of variance for repeated measures).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Gil Cano, M. Gracia Romero, M.I. Monge García, P. Guijo González, J. Ruiz Campos" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Gil Cano" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Gracia Romero" ] 2 => array:2 [ "nombre" => "M.I." "apellidos" => "Monge García" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Guijo González" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Ruiz Campos" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S217357271730053X" "doi" => "10.1016/j.medine.2016.08.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357271730053X?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021056911630184X?idApp=WMIE" "url" => "/02105691/0000004100000003/v1_201703290106/S021056911630184X/v1_201703290106/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Translational research in acute respiratory distress syndrome" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "133" "paginaFinal" => "134" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "P. Cardinal-Fernandez" "autores" => array:1 [ 0 => array:3 [ "nombre" => "P." "apellidos" => "Cardinal-Fernandez" "email" => array:1 [ 0 => "pablocardinal@hotmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Emergency, Hospital Universitario HM Sanchinarro, Madrid, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Investigación traslacional sobre el síndrome de dificultad respiratoria aguda" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Translational research (TR) or “bench to bedside research” is defined as the “process of transformation of knowledge through successive fields of research from a basic science discovery to public health impact”.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> TR should be considered a type of pragmatic and patient-centered research, whose main aim is to reduce the time lag between the problem identification and its solution.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In TR, the first step is to have a clear definition of the disease and the problem. Recently, the importance of linking clinical manifestations (syndrome) to pathological findings with the aim to define a specific disease has been highlighted.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">2,3</span></a> Identifying physiopathological mechanisms that link this relation (clinical–pathological) allows to understand the disease, identify subcategories and recognize therapeutic targets. In reference to the problem, it sometimes seems that identifying it is an easy or fast process, but nothing could be furthest from the truth. Selecting the problem implies the answer to the following questions: (a) Is it possible to address the problem with the intellectual, logistic and economic resources available for the researcher? (feasibility) and (b) which scientific, social and economic impact could the research have? (interest or relevance).</p><p id="par0015" class="elsevierStylePara elsevierViewall">The second step is to enunciate the hypothesis. In several cases, experiments in humans are not possible. However, animal models allow us to partially simulate certain human conditions. In other words, animal models are a simplification of the human reality that permits to focus the attention on a specific event (or a few events) and reduces the influence of confusion factors. How similar to the human disease the animal model should be mainly depends on which question researchers want to answer. In all experimental conditions, it is necessary to have a reference by which to assess the efficacy of an intervention. This reference, which is indeed more important than the intervention itself, derives from at least two groups: controls and sham. The former are animals that only differ from the experimental group in that they receive a placebo. All the animals are prepared similarly [e.g. anesthesiated, operated, etc.], but then the researcher randomizes each one to the intervention or placebo groups. The latter are animals on which investigators apply the same preparation than on the control group, but which do not receive any intervention nor placebo. On the one hand, the control group allows to know the specific effect of the intervention since both groups share the same confusion variables. On the other, the sham group ensures that the scientific data reflect the effect of the experiment itself, and this is not merely a consequence of the procedure. Finally, if preclinical studies are positive and there is enough evidence in favor of the new treatment (or solution for the problem), this should be evaluated at the bedside and, if effective, incorporated to the clinical practice.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Acute respiratory distress syndrome (ARDS) is a cataclysmic syndrome. Diffuse alveolar damage (DAD), the histological hallmark for the acute phase,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> is present in only 48% of ARDS patients.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> Furthermore, it has been recently demonstrated that patients with ARDS and DAD present a different outcome from patients with ARDS but without DAD.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">5,6</span></a> One of the most important problems in relation to ARDS is the lack of effective pharmacological treatments, despite positive results in preclinical studies. This dissonance may be due to the fact that animal models do not represent ARDS or that the population on which the treatment is tried out is incorrect.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> For example, clinical trials are not designed to demonstrate the effectiveness of a treatment in a random sample of the general population because the effect of an intervention is over targets (e.g. molecules, pathophysiologic pathways or anatomical structures) which should be present in the sample in which the intervention is evaluated. For that reason, it is only possible to lump patients who share the same. However, when the target is present only in a subset of patients, the population has to be splinted and the intervention must be tried out only on the subgroup which presents the target. Enrichment is the word used to describe the procedure of selecting subgroups of patients in which detection of an intervention effect is more likely than it would be in an unselected population.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> Biomarkers are currently the most useful way to enrich a specific population.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In this issue of <span class="elsevierStyleItalic">Medicina Intensiva</span>, Cano et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> use an elegant translational experiment to address the effect of a restrictive versus a liberal strategy of fluid management in a two-hit rabbit model of lung injury. Despite both strategies influence the outcome (wet and dry lung weight ratio [WW/DW]) several differences are evident. The liberal arm is associated to a decrease in the dynamic compliance and a bigger increase in WW/DW, as well as in the corrected aortic flow time than the restrictive strategy. Likewise, a trend to increase the total inspiratory work of breath, expiratory airway resistance and histology lung injury is reported in association to the liberal arm. On the contrary, the cardiac index is significantly reduced only in the restrictive arm. As a conclusion, Cano et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> mentioned that preemptive hemodynamic intervention by restricting the administration of fluids significantly slowed the progression of pulmonary edema and the decrease in pulmonary compliance. These interesting results provide a physiopathological explanation for the finding of the clinical study <span class="elsevierStyleItalic">Fluid and Catheter Treatment Trial (FACTT)</span>,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> which included 1001 ALI/ARDS patients. The FACTT study found that the conservative fluid protocol improves several secondary end-points but not the primary end-point (60 days mortality).<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> As it was mentioned earlier on,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> less than a half of FACTT participants could have been expected to present the ARDS histological hallmark (DAD) and the rest, a group of heterogeneous entities such as pulmonary embolism, fibrosis or atelectasis.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> For this reason, based on the results of Cano et al.,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> an intriguing question is what would have happened if the FACTT cohort had been enriched in DAD? In other words, was the effect of restrictive fluid in the FACTT study diluted by the lack of enrichment in DAD? One of the targets for restrictive fluid protocol may be the disrupted alveolar capillary barrier function.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> But, is this target shared by ARDS patients with and without DAD? This question should have a direct impact on the design of future ARDS studies since it could determine which patients could be lumped and which patients should be splinted.</p><p id="par0030" class="elsevierStylePara elsevierViewall">As a conclusion, Cano et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> use a refined animal model to explain what had been observed at the bedside with ARDS patients. This can be regarded as a clear example of TR, which could be considered one of the most powerful strategies to accelerate the long and winding process from “bench to beside”.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The author express that don’t have conflict of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Translational research: understanding the continuum from bench to bedside" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.C. Drolet" 1 => "N.M. Lorenzi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Transl Res J Lab Clin Med" "fecha" => "2011" "volumen" => "157" "paginaInicial" => "1" "paginaFinal" => "5" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0065" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute Respiratory Distress: from syndrome to disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Cardinal-Fernandez" 1 => "E. Correger" 2 => "J. Villanueva" 3 => "F. Rios" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Int/Soc Esp Med Int Unidades Coronarias" "fecha" => "2016" "volumen" => "40" "paginaInicial" => "169" "paginaFinal" => "175" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0070" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The ten diseases that are not true diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.O. Depuydt" 1 => "J.P. Kress" 2 => "J.I. Salluh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-015-3945-4" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2016" "volumen" => "42" "paginaInicial" => "411" "paginaFinal" => "414" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26130322" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0075" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute respiratory distress syndrome: the Berlin Definition" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.D.T. Force" 1 => "V.M. Ranieri" 2 => "G.D. Rubenfeld" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2012.5669" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2012" "volumen" => "307" "paginaInicial" => "2526" "paginaFinal" => "2533" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22797452" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0080" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The presence of diffuse alveolar damage on open lung biopsy is associated with mortality in patients with acute respiratory distress syndrome: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P. Cardinal-Fernandez" 1 => "E.K. Bajwa" 2 => "A. Dominguez-Calvo" 3 => "J.M. Menendez" 4 => "L. Papazian" 5 => "B.T. Thompson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.chest.2016.02.635" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2016" "volumen" => "149" "paginaInicial" => "1155" "paginaFinal" => "1164" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26896701" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0085" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute respiratory distress syndrome in patients with and without diffuse alveolar damage: an autopsy study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.A. Lorente" 1 => "P. Cardinal-Fernandez" 2 => "D. Munoz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-015-4046-0" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2015" "volumen" => "41" "paginaInicial" => "1921" "paginaFinal" => "1930" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26385863" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0090" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Toward smarter lumping and smarter splitting: rethinking strategies for sepsis and acute respiratory distress syndrome clinical trial design" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H.C. Prescott" 1 => "C.S. Calfee" 2 => "B.T. Thompson" 3 => "D.C. Angus" 4 => "V.X. Liu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.201512-2544CP" "Revista" => array:6 [ "tituloSerie" => "Am J Resp Crit Care Med" "fecha" => "2016" "volumen" => "194" "paginaInicial" => "147" "paginaFinal" => "155" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27244481" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0095" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ARDS. Time to separate the wheat from the chaff" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Cardinal-Fernandez" 1 => "C. Pey" 2 => "K.C. Kao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcrc.2016.03.015" "Revista" => array:7 [ "tituloSerie" => "J Crit Care" "fecha" => "2016" "volumen" => "34" "paginaInicial" => "31" "paginaFinal" => "32" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27288606" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0301211514000293" "estado" => "S300" "issn" => "03012115" ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0100" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Cano A, Romero M, Monge García M, Guijo González P, Ruiz Campos J. A preemptive hemodynamic intervention by restricting the administration of fluids attenuates pulmonary edema progression in oleic-induced lung injury. <span class="elsevierStyleItalic">Med Int/Soc Esp Med Intensiva Unidades Coronarias</span> 2016." ] ] ] 9 => array:3 [ "identificador" => "bib0105" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of two fluid-management strategies in acute lung injury" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L. National Heart" 1 => "N. Blood Institute Acute Respiratory Distress Syndrome Clinical Trials" 2 => "H.P. Wiedemann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa062200" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2006" "volumen" => "354" "paginaInicial" => "2564" "paginaFinal" => "2575" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16714767" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0110" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The acute respiratory distress syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.A. Matthay" 1 => "L.B. Ware" 2 => "G.A. Zimmerman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1172/JCI60331" "Revista" => array:6 [ "tituloSerie" => "J Clin Invest" "fecha" => "2012" "volumen" => "122" "paginaInicial" => "2731" "paginaFinal" => "2740" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22850883" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/02105691/0000004100000003/v1_201703290106/S0210569116301838/v1_201703290106/en/main.assets" "Apartado" => array:4 [ "identificador" => "18742" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/02105691/0000004100000003/v1_201703290106/S0210569116301838/v1_201703290106/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569116301838?idApp=WMIE" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 5 | 4 | 9 |
| 2024 Octubre | 43 | 52 | 95 |
| 2024 Septiembre | 44 | 28 | 72 |
| 2024 Agosto | 51 | 45 | 96 |
| 2024 Julio | 46 | 24 | 70 |
| 2024 Junio | 61 | 55 | 116 |
| 2024 Mayo | 48 | 43 | 91 |
| 2024 Abril | 68 | 50 | 118 |
| 2024 Marzo | 58 | 31 | 89 |
| 2024 Febrero | 71 | 39 | 110 |
| 2024 Enero | 51 | 38 | 89 |
| 2023 Diciembre | 50 | 37 | 87 |
| 2023 Noviembre | 38 | 35 | 73 |
| 2023 Octubre | 50 | 33 | 83 |
| 2023 Septiembre | 39 | 39 | 78 |
| 2023 Agosto | 22 | 27 | 49 |
| 2023 Julio | 36 | 38 | 74 |
| 2023 Junio | 22 | 18 | 40 |
| 2023 Mayo | 29 | 40 | 69 |
| 2023 Abril | 35 | 24 | 59 |
| 2023 Marzo | 35 | 34 | 69 |
| 2023 Febrero | 51 | 33 | 84 |
| 2023 Enero | 44 | 29 | 73 |
| 2022 Diciembre | 32 | 41 | 73 |
| 2022 Noviembre | 49 | 37 | 86 |
| 2022 Octubre | 46 | 41 | 87 |
| 2022 Septiembre | 32 | 49 | 81 |
| 2022 Agosto | 46 | 60 | 106 |
| 2022 Julio | 46 | 39 | 85 |
| 2022 Junio | 42 | 33 | 75 |
| 2022 Mayo | 50 | 50 | 100 |
| 2022 Abril | 25 | 43 | 68 |
| 2022 Marzo | 53 | 64 | 117 |
| 2022 Febrero | 44 | 22 | 66 |
| 2022 Enero | 34 | 41 | 75 |
| 2021 Diciembre | 51 | 50 | 101 |
| 2021 Noviembre | 51 | 53 | 104 |
| 2021 Octubre | 46 | 74 | 120 |
| 2021 Septiembre | 45 | 40 | 85 |
| 2021 Agosto | 44 | 56 | 100 |
| 2021 Julio | 30 | 34 | 64 |
| 2021 Junio | 48 | 28 | 76 |
| 2021 Mayo | 57 | 56 | 113 |
| 2021 Abril | 95 | 68 | 163 |
| 2021 Marzo | 85 | 46 | 131 |
| 2021 Febrero | 48 | 29 | 77 |
| 2021 Enero | 38 | 27 | 65 |
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| 2020 Noviembre | 25 | 19 | 44 |
| 2020 Octubre | 39 | 35 | 74 |
| 2020 Septiembre | 39 | 27 | 66 |
| 2020 Agosto | 33 | 27 | 60 |
| 2020 Julio | 35 | 28 | 63 |
| 2020 Junio | 26 | 38 | 64 |
| 2020 Mayo | 29 | 21 | 50 |
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| 2020 Marzo | 32 | 24 | 56 |
| 2020 Febrero | 83 | 66 | 149 |
| 2020 Enero | 26 | 39 | 65 |
| 2019 Diciembre | 27 | 29 | 56 |
| 2019 Noviembre | 30 | 24 | 54 |
| 2019 Octubre | 24 | 24 | 48 |
| 2019 Septiembre | 31 | 19 | 50 |
| 2019 Agosto | 45 | 33 | 78 |
| 2019 Julio | 26 | 24 | 50 |
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| 2019 Mayo | 50 | 91 | 141 |
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| 2019 Marzo | 24 | 39 | 63 |
| 2019 Febrero | 18 | 37 | 55 |
| 2019 Enero | 29 | 44 | 73 |
| 2018 Diciembre | 35 | 97 | 132 |
| 2018 Noviembre | 49 | 71 | 120 |
| 2018 Octubre | 42 | 18 | 60 |
| 2018 Septiembre | 27 | 13 | 40 |
| 2018 Agosto | 22 | 18 | 40 |
| 2018 Julio | 31 | 12 | 43 |
| 2018 Junio | 41 | 15 | 56 |
| 2018 Mayo | 34 | 9 | 43 |
| 2018 Abril | 37 | 9 | 46 |
| 2018 Marzo | 66 | 19 | 85 |
| 2018 Febrero | 25 | 12 | 37 |
| 2018 Enero | 62 | 30 | 92 |
| 2017 Diciembre | 29 | 20 | 49 |
| 2017 Noviembre | 40 | 21 | 61 |
| 2017 Octubre | 25 | 14 | 39 |
| 2017 Septiembre | 36 | 21 | 57 |
| 2017 Agosto | 37 | 19 | 56 |
| 2017 Julio | 34 | 20 | 54 |
| 2017 Junio | 22 | 14 | 36 |
| 2017 Mayo | 4 | 1 | 5 |
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| 2017 Marzo | 6 | 1 | 7 |
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