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The case is presented on a young Honduran female with no medical history of note, who presented with multiple areas of exudative retinal detachment (RD), and a best-corrected visual acuity of 1.3logMAR in both eyes. She was diagnosed with incomplete Vogt-Koyanagi-Harada syndrome, and treated early with a combination of intravenous therapy with 1g of prednisolone per day for 3 days, as recommended by published evidence, as well as mycophenolate mofetil (2g per day). During the corticosteroids tapering, there was a recurrence of exudative retinal detachments, and megadoses of 1g of intravenous corticosteroids per day were reintroduced for 6 days until the complete resolution of the fluid of the exudative RD, and cyclosporine (100mg per day), subtenon triamcinolone (40mg/mL), and intravitreal ranibizumab once a month in the both eyes were added to the treatment, with a great control of choroidal inflammation that resulted in the remission of symptoms and signs.

Resumen Presentamos el caso de una mujer hondurena de 27 anos sin antecedentes medicos de interes que presento multiples areas de desprendimientos de retina (DR) exudativos y una mejor agudeza visual corregida de 1,3 logMAR en ambos ojos. Fue diagnosticada de sindrome de Vogt-Koyanagi-Harada incompleto y tratada con prednisolona intravenosa (1 g/24 h) durante 3 dias, tal y como recomienda la evidencia publicada, junto con micofenolato de mofetilo (2 g/24 h). Durante el descenso paulatino de corticoesteroides, los DR recidivaron, por lo que se reintrodujeron las megadosis de 1 g/24 h de corticoesteroides intravenosos durante 6 dias hasta la resolucion completa de los DR y se anadieron ciclosporina (100 mg/24 h), triamcinolona subtenoniana (40 mg/mL) e inyecciones intravitreas mensuales de ranibizumab en ambos ojos, con un adecuado control de la inflamacion coroidea que se tradujo en la remision de los sintomas y signos.

6 p.-2 fig., Self-assembling protein filaments are at the heart of cell function. Among them, tubulin-like proteins are essential for cell division, DNA segregation and cytoskeletal functions across the domains of life. FtsZ and tubulin share their core structures, a characteristic nucleotide-binding pocket and similar protofilament architecture. GTP hydrolysis between consecutive subunits drives their assembly dynamics. Two recent studies provide previously missing, filament atomic structures of bacterial FtsZ and a recently discovered archaeal tubulin in their nucleotide triphosphate-bound states. Both filament structures reveal strikingly conserved interfacial GTPase active sites, with Mg2+ and K+ /Na+ cations and an NxDxxD/E triad of catalytic residues, probably inherited from the common ancestor of FtsZs and tubulins. Moreover, both proteins exhibit nucleotide-regulated subunit association mediated by interfacial water bridges, as well as polymerization-induced structural changes, likely enabling related dynamic assembly mechanisms., Work in our laboratories was supported by the Spanish Ministry of Science grants BFU2014-51823-R (to JMA), BFU2017-87397-P and PID20220-116722GB-I00 (to CF-T).

Introduction Continuity equation is the cornerstone of aortic valve area (AVA) calculation in patients with aortic stenosis (AS). In patients with irregular rhythms (IR) - especially atrial fibrillation (AF)-, values of velocity-time integral (VTI) at left ventricular outflow tract (LVOT) and aortic valve (AV) vary between heart beats. The usual recommendation is to average the measurements of 5 or 10 beats in both locations. However, original papers describing continuity equation, from which that recommendation arises (refs 1 & 2), only included 3 and 2 AF patients, respectively. To our knowledge, there are not clinical studies to support this procedure and its accuracy has not been established. In contrast, in a previous study our team had evaluated the accuracy of the double envelope technique to assess both LVOT and AV VTI in the same beat, with a 7.8% (CI 95%: 5.8–10.3) difference (error) in the estimation of AVA when compared to pulsed wave of LVOT in patients with stable sinus rhythm. Purpose To evaluate how dispersion in VTIs due to IR impacts on variability of AVA calculations. Methods For each patient, we recorded multiple measurements of VTI in both LVOT and AV (mean 36.8 beats, range 29–47) per patient and location). Reference AVA was estimated using the average of all these measurements. To estimate the accuracy of averaging 5 or 10 heart beats, we created a computer code which simulated the AVA calculation using random samples of these measurements, and calculated the difference between true AVA and that obtained in the simulation (expressed as percentage of the true value). The process was iterated 10,000 times to obtain the distribution of differences and to estimate its mean value. Data handling and graphic representation was performed with Python 3.9.6 and Pyodbc, Pandas, NumPy, Matplotlib and Seaborn libraries. Results We included data from 8 patients with AS and IR (Age: 71 to 89, mean 82.5 years; Aetiology: degenerative (100%); Sex: 3 males / 5 females; Rhythm: AF [7], atrial flutter [1]; Severity: severe [3], moderate [4], mild [1]). Mean difference in AVA calculations was 8.2% (range: 5.1–13.5%). With 10 beats, mean difference was 5.7% (range: 3.6–9.5%). Figute 1 shows violin plot with distribution in each patient of recorded VTIs at both AV (left) and LVOT (right). To ease visualization, data are expressed as percentage of mean values. Fig 2 shows how that variability results in inaccuracy of AVA calculations with 5 (left) or 10 beats (right). Note that in many cases, possible results are located on both sides of the severity threshold of 1 cm2 (red line). Conclusion AVA assessment using 5 beats average results in a mean difference (error) of 8.2%, which can be reduced to a mean of 5.7% using 10 beats. These differences are comparable with the previously observed with the double envelope technique (7.8%). Funding Acknowledgement Type of funding sources: None.

El objetivo de este artículo editorial es difundir los comentarios y reflexiones más destacadas del “Encuentro de socios de la Asociación de Científicos en Salud Mental del Niño y del Adolescente- Fundación Alicia Koplowitz del 2019” como opinión de expertos para invitar a reflexión de profesionales sobre los diagnósticos en salud mental infantil.

The accelerated discard and mismanagement of human-made products are resulting in the continued input of litter into the oceans. Models and field observations show how floating litter can accumulate in remote areas throughout the global ocean, but far less is known about the non-floating litter fraction. Seagrass meadows play an important role in the sediment and natural-debris dynamics, and likely also in the storage and processing of non-floating litter. In this work, non-floating litter was studied across six Posidonia oceanica meadows. Litter accumulated mainly around the landside edge of the meadow. The outer margin of the edge predominantly trapped macro-litter, whilst microplastics accumulated mainly along the inner margin. On average, macro-litter concentrations increased 3-fold after heavy rainfall. Retention of non-floating litter by coastal meadows facilitates the recurrent landward-seaward conveyance of the easily-transportable litter (mainly plastic items) and its fragmentation before it is buried or transferred to deeper areas., This work was supported by Ministry of Economy and Competitiveness of the Government of Spain (‘MIDaS’ CTM2016-77106-R, 2016); University of Cadiz (FPUCA2018, Support for university professors training for doctoral students at the University of Cadiz); CEIMAR Foundation, C´adiz (Grant for international mobility of doctoral students for development of thesis in co-tutelage regime, 2019); ‘Diputaci´on de C´adiz’ and SEA-EU (Beca Talento, 2021).

The Mediterranean region is one of the most vulnerable regions to climate change. The majority of climate models forecast a rise in temperatures and less rainfall, which have been observed in recent decades. These changes will affect several vegetation properties, especially phenological dynamics and traits, by increasing drought intensity and recurrence. In this climate change context, the present study aims to assess the evolution of vegetation state and its relation with the climate dynamics in the Mediterranean forest region of northeast Tunisia using Land Surface Phenology (LSP) metrics and the vegetation index (NDVI) analysis from 2000 to 2017. To conduct this work, we used precipitation and temperature data from the two closest weather stations and 16-day NDVI composite images from the MODIS satellite source, with 250-m spatial resolution. Three phenological metrics— start of season (SOS), end of season (EOS), and length of season (LOS) — were obtained and compared for different vegetation types. The LSP variation in response to climatic metrics was also analyzed. The results showed that the LSP in our study area changed significantly during the 2000–2017 period, which includes an average 7.8 days delay in the SOS, an average advance in the EOS by 5 days, and LOS shortened by an average 12.8 days. Autumn (Pr_9) and spring (Pr_3 and P3_4) precipitations, as well as maximum temperature (Tx9+10), represent the best climate parameters to explain the changes in LSP. Both the NDVI and SPEI showed a significant high correlation (p < 0.001) on longer time scales. LSP and NDVI proved useful tools for monitoring the vegetation state according to climate for better planning territory purposes. This research was supported by the National Research Institute for Rural Engineering, Waters, and Forestry-INRGREF. Laboratory of Management and Valorization of Forest Resources, Tunisia. This research is part of the project: HYDROMED (PID-2019-111332RB-C21).

Resumen La enfermedad causada por SARS-CoV-2 (Covid-19) se ha convertido en una pandemia mundial y en consecuencia en un problema de salud publica. Se han descrito multiples complicaciones asociadas a la COVID-19, entre ellas alteraciones de la coagulacion. Si bien es conocido que la infeccion induce un estado protrombotico, tambien se han descrito complicaciones hemorragicas en estos pacientes, sobre todo en pacientes anticoagulados. Presentamos dos casos de hematoma pulmonar espontaneo en pacientes con neumonia COVID-19 y terapia anticoagulante. Nuestro objetivo es describir esta complicacion, que, aunque poco frecuente, conviene tener en cuenta en pacientes anticoagulados y con COVID-19 concomitante.

Resumen Objetivos La inmunoterapia es un nuevo tratamiento en estadios avanzados del cancer de pulmon de celula no pequena (CPCNP) que modula la respuesta inmunitaria frente a celulas malignas. Un reto para el radiologo es la valoracion del fenomeno de la pseudoprogresion, en la que se observa un aumento o aparicion de lesiones por infiltracion de celulas inflamatorias, con posterior disminucion o desaparicion de estas, hecho que traduce en realidad la respuesta al tratamiento. El objetivo fue determinar la frecuencia de pseudoprogresion en pacientes con CPCNP en estadios avanzados tratados con nivolumab. Pacientes y metodos Se incluyeron 56 pacientes con CPCNP en estado avanzado tratados con nivolumab en segunda linea o posterior. Se analizaron las tomografias computarizadas (TC) realizadas durante el periodo de tratamiento. Se considero pseudoprogresion tumoral al aumento o aparicion de lesiones con posterior disminucion o desaparicion en una TC de control realizada a las 4-8 semanas. Se realizo un analisis descriptivo. Resultados No se pudo valorar la existencia de pseudoprogresion en 15 pacientes porque no se disponia de al menos dos TC (por cambio de tratamiento o fallecimiento). Se observo pseudoprogresion tumoral en un 12,2% (5/41) de los pacientes, en la mayoria de los casos antes de las 12 semanas del inicio del tratamiento (en el 4.° ciclo). Un 40% (2/5) de los pacientes con pseudoprogresion presento un segundo episodio, que se produjo de forma tardia, a partir de las 12 semanas del inicio del tratamiento. Conclusion Se observo pseudoprogresion tumoral en un 12,2% de los pacientes con CPCNP tratados con nivolumab. El aumento o aparicion de lesiones debe valorarse evolutivamente para evitar diagnosticar erroneamente progresion de la enfermedad.

Objectives Immunotherapy is a new treatment in advanced lung cancer that works by modulating the immune response against malignant cells. One aspect that is challenging for radiologists in the evaluation of the response to immunotherapy is the phenomenon of pseudoprogression, in which the infiltration of inflammatory cells causes lesions to increase in size or new lesions to appear and then decrease in size or disappear. Pseudoprogression actually represents a response to treatment. We aimed to determine the frequency of pseudoprogression in patients with advanced stages of lung cancer treated with nivolumab. Patients and methods We included 56 patients with advanced stages of lung cancer treated with nivolumab as a second-line or later treatment. We analyzed CT studies done while patients were undergoing nivolumab treatment. Tumor pseudoprogression was defined as an increase in the size of lesions or appearance of new lesions followed by a decrease in size or disappearance of these lesions on follow-up CT studies 4–8 weeks later. We did a descriptive analysis. Results In 15 patients, it was impossible to evaluate possible pseudoprogression because a second CT study was unavailable due to change of treatment or death. Tumor pseudoprogression was observed in 5 (12.2%) of the 41 patients, in most cases within 12 weeks of treatment initiation (in the fourth cycle). A second episode of pseudoprogression occurred in 2 (40%) of the 5 patients with an initial episode; the second episode occurred more than 12 weeks after treatment initiation. Conclusion Tumor pseudoprogression occurred in 12.2% of patients with advanced stage lung cancer treated with nivolumab. An increase in lesion size or the appearance of new lesions must be assessed over time to avoid mistaking pseudoprogression for true progression of disease.

Objective Compare 18F-FDG PET/CT and CTangio in the diagnosis of extracraneal large vessel involvement in patients with suspicion of large vessel vasculitis (LVV). Material and methods A retrospective database reviewed 59 patients with clinical suspicion of LVV undergoing 18F-FDG PET/CT and CTangio. In 55 patients PET/TC and CTangio were done simultaneously in the same machine and in 4 patients with a scan interval of Results 18F-FDG PET/CT and CTangio show high specificity (97.2%) for LVV diagnosis, with an excellent sensitivity for 18F-FDG PET/CT (95.6%) and lower for CTangio (60.9%), which leads to a high negative predictive value for 18F-FDG PET/CT (97.2%) and a high false negative rate for CTangio (39.1%). A 70% concordance between 18F-FDG PET/CT and CTangio was obtained (Kappa index 0.70 ± 0.095 (p Conclusion The results show the greater potential of 18F-FDG PET/CT for the detection and extension of LVV. Therefore, 18F-FDG PET/CT should be exploited to the maximum and consider as the first line imaging technique in the extracranial diagnosis of LVV and its possible association with polymyalgia rheumatica. The addition of CTangio could be more indicated in patients with Takayasu arteritis and in long-standing and/or severe vasculitis since it increases the accuracy in the detection of possible vascular complications.

We thank Pablo Lardelli Claret for his helpful advice in statistical methods. We also acknowledge the staff of Hospital Universitario Virgen de las Nieves who took (and are taking) care of the COVID-19 patients., Tocilizumab (TCZ) has been administered in SARS-CoV-2 pneumonia but the factors associated with mortality before and after treatment remain unclear. Cox regression models were used to estimate the predictors of time to death in a cohort of hospitalized patients with COVID-19 receiving TCZ. In addition, the mean differences between discharged and deceased patients in laboratory parameters measured before and 3, 6 and 9 days after TCZ administration were estimated with weighted generalized estimation equations. The variables associated with time to death were immunosuppression (Hazard Ratio-HR 3.15; 95% confidence interval-CI 1.17, 8.51), diabetes mellitus (HR 2.63; 95% CI 1.23–5.64), age (HR 1.05; 95% CI 1.02–1.09), days since diagnosis until TCZ administration (HR 1.05, 95% CI 1.00–1.09), and platelets (HR 0.27; 95% CI: 0.11, 0.69). In the post-TCZ analysis and compared to discharged patients, deceased patients had more lactate dehydrogenase (p 0.013), troponin I (p 0.013), C-reactive protein (p 0.013), neutrophils (p 0.024), and fewer platelets (p 0.013) and lymphocytes (p 0.013) as well as a lower average PaO2/FiO2 ratio. In conclusion, in COVID-19 diagnosed patients receiving TCZ, early treatment decreased the risk of death, while age, some comorbidities and baseline lower platelet counts increased that risk. After TCZ administration, lower platelet levels were again associated with mortality, together with other laboratory parameters.

For decades, the Province of Alicante, located in the Southeast of Spain, has experienced important economic development associated with groundwater exploitation. The scarcity of superficial resources and irregular distribution in the time and space of rainfall, typical of the Mediterranean environment, together with the extensive limestone outcrops, have made groundwater a key resource for the area. However, insufficient knowledge about aquifers, especially the lack of precise recharge estimates, hinders regional water management. This study establishes updated recharge estimates and water budgets for the 200 aquifers found in Alicante, using readily usable methodologies and available data. These are soil water budget models, groundwater flow models, water table fluctuation methods, and spring flow analyses. The results show low mean annual values of recharge from precipitation (69 mm/year and a coefficient of 12%) and two main differentiated domains. The first one, in the northeast of the province, under more humid climatic conditions with larger carbonate aquifer systems, has higher recharge coefficients, ranging from 14% to 24%, and greater resources. For the rest of the province, where aquifers are smaller and annual averages of rainfall range between 250 and 400 mm, average recharge rates are low (9–12%). This research was funded partially by the projects of the Spanish Ministry of Economy and Competitiveness (ALTERACLIM; CGL2015-69773-C2-1-P) and the Ministry of Science and Innovation (PID2019-111332RB-C21). In the same way, this work was partially funded by Cátedra del Agua (Water Chair) of the University of Alicante and Diputación de Alicante (https://catedradelaguaua.org/ accessed on 10 February 2021).

18 p.-7 fig., The global spread of bacterial antimicrobial resistance is associated to millions of deaths from bacterial infections per year, many of which were previously treatable. This, combined with slow antibiotic deployment, has created an urgent need for developing new antibiotics. A still clinically unexploited mode of action consists in suppressing bacterial cell division. FtsZ, an assembling GTPase, is the key protein organizing division in most bacteria and an attractive target for antibiotic discovery. Nevertheless, developing effective antibacterial inhibitors targeting FtsZ has proven challenging. Here we review our decade-long multidisciplinary research on small molecule inhibitors of bacterial division, in the context of global efforts to discover FtsZ-targeting antibiotics. We focus on methods to characterize synthetic inhibitors that either replace bound GTP from the FtsZ nucleotide binding pocket conserved across diverse bacteria or selectively bind into the allosteric site at the interdomain cleft of FtsZ from Bacillus subtilis and the pathogen Staphylococcus aureus. These approaches include phenotype screening combined with fluorescence polarization screens for ligands binding into each site, followed by detailed cytological profiling, and biochemical and structural studies. The results are analyzed to design an optimized workflow to identify effective FtsZ inhibitors, and new approaches for the discovery of FtsZ-targeting antibiotics are discussed., Research in our laboratories was funded in part by the Ministerio de Ciencia e Innovación, grants BFU 2014-51823-R (JMA, SH, LAB) and PID2019-106279RB-I00 (HVV, MMF).

Introduction Chronic kidney disease (CKD) is associated with an elevated thromboembolic and bleeding risk in atrial fibrillation (AF) patients, so the decision of antithrombotic therapy is a challenge. Purpose To analyze mortality, embolic and bleeding events in patients with advanced CKD and AF. Methods Multicentric retrospective registry on patients with AF and advanced CKD (CKD-EPI Results We analysed 405 patients with advanced CKD and newly diagnosed AF. 57 patients were not treated with antithrombotic therapy (14.1%), 80 only with antiplatelet/s (19.8%), 211 only with anticoagulation (52.1%), and 57 with anticoagulant plus antiplatelet/s (14.1%). During a follow-up of 4.6±2.5 years, 205 died (50.6%), 34 had embolic events (8.4%) and 85 had bleeding outcomes (21.0%). Bleeding event rate was significantly lower in patients without antithrombotic therapy (Figure). After multivariate analysis, anticoagulant treatment was associated with higher bleeding rates, without differences in mortality or embolic events (Table). Conclusion Anticoagulation therapy was associated with a significant increase in bleeding events in patients with advanced CKD and newly diagnosed AF. None of the antithrombotic therapy regimens resulted in lower embolic events rate neither benefit in mortality. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): This study was supported by an unconditional grant from BMS-Pfizer

Our hospital diagnosed the two first non‐imported COVID‐19 cases in Spain on 26th February. Up to date, a total of 1177 COVID‐19 patients have been hospitalized. Eight of them were referred for dermatological examination. Due to the overwhelming situation, the incidence of cutaneous manifestations in our hospitalized COVID‐19 patients is probably greater than this 0.7%1, 2.

The Betic Cordillera (S Spain), located in the convergent plate boundary between Eurasia and Nubia, is an area of moderate seismicity. These plates converge at a rate of approximately 4 to 6 mm/yr in the NW-SE direction (see review by Nocquet, 2012). Between 2.7 to 3.9 mm/yr of present-day plate convergence is accommodated in N Africa. Active shortening must occur at rates ranging from 1.6 to 2.7±0.6 mm/year across the Algero-Balearic Basin and the SE Iberian Peninsula (Serpelloni et al., 2007; Pérez-Peña et al., 2010; Echeverría et al., 2013). In the Betic Cordillera, most of the deformation is concentrated in the Betic Internal Zones, while the Betic External zones are considered as a slow-strain area.In SE of Spain onshore active deformation and seismicity are mainly located along the Eastern Betic Shear Zone (EBSZ), a major strike-slip tectonic corridor belonging to the Betic Internal Zones. Regional and local geodetic studies indicate that the EBSZ is absorbing between 0.2 and 1.3 mm/yr (Serpelloni et al., 2007; Pérez-Peña et al., 2010; Echeverría et al., 2013; Borque et al., 2019), i.e. only a portion of regional deformation. We postulate that part of this deformation not absorbed by the EBSZ is accommodated in the eastern Betic External Zones, located to the north of the EBSZ, where several major historical earthquakes occurred (e.g., the 1748 Estubeny, 1396 Tavernes, and 2017 Caudete earthquakes). These major events have been attributed to the Jumilla Fault, the only major active structure described in this area (Giner-Robles et al. 2014; García-Mayordomo, J. and Jiménez-Díaz, A., 2015).We present new CGPS data analysis that corroborate that the eastern Betic External Zones accommodate a significant part of the present convergence. Furthermore, our preliminary data quantify deformation in this area for the first time, as we obtain a shortening rate in the N-S direction of 1.43±0.06 mm/yr in the western sector of the Jumilla Fault (Murcia sector) and of 1.69±0.07 mm/yr in the eastern sector of the fault (Valencia sector). We propose that this deformation is likely related to the Jumilla Fault. Our study place constraints on the seismic potential of the highly populated eastern Betic External Zones, as the preliminary values that we obtained are significantly higher than those previously stated. Consequently, we propose that a re-assesment of seismic hazard is necessary for this highly populated region. Moreover, we also propose a regional geodynamic model that provide insights into mechanisms controlling earthquakes in the eastern Betic External Zones. ReferencesBorque et al. (2019). Tectonics, 38, 5, 1824-1839Echeverria et al. (2013). Tectonophysics, 608, 600-612.Giner-Robles et al. (2014). Resúmenes de la 2ª Reunión Ibérica sobre Fallas Activas y Paleosismología, Lorca, España, 155-158.García-Mayordomo, J. and Jiménez-Díaz, A. (2015). In: Quaternary Faults Database of Iberia v.3.0 - November 2015 (García-Mayordomo et al., eds.), IGME, Madrid.Nocquet, J.M. (2012). Tectonophysics, 579, 220-242.Pérez-Peña et al. (2010). Geomorphology, 119, 74-87Serpelloni et al. (2007). Geophysical Journal Internationl, 169(3), 1180-1200.

22 p.-6 fig., Treadmilling protein filaments perform essential cellular functions by growing from one end while shrinking from the other, driven by nucleotide hydrolysis. Bacterial cell division relies on the primitive tubulin homolog FtsZ, a target for antibiotic discovery that assembles into single treadmilling filaments that hydrolyse GTP at an active site formed upon subunit association. We determined high-resolution filament structures of FtsZ from the pathogen Staphylococcus aureus in complex with different nucleotide analogs and cations, including mimetics of the ground and transition states of catalysis. Together with mutational and biochemical analyses, our structures reveal interactions made by the GTP γ-phosphate and Mg2+ at the subunit interface, a K+ ion stabilizing loop T7 for co-catalysis, new roles of key residues at the active site and a nearby crosstalk area, and rearrangements of a dynamic water shell bridging adjacent subunits upon GTP hydrolysis. We propose a mechanistic model that integrates nucleotide hydrolysis signaling with assembly-associated conformational changes and filament treadmilling. Equivalent assembly mechanisms may apply to more complex tubulin and actin cytomotive filaments that share analogous features with FtsZ.

Resumen Objetivo Analizar la incidencia y los resultados visuales de cada uno de los subtipos de lesion neovascular en pacientes con degeneracion macular asociada la edad (DMAE). Material y metodos Revision retrospectiva de pacientes con DMAE neovascular tratados en el Hospital Universitario y Politecnico la Fe de Valencia por un mismo retinologo (RGP) desde diciembre de 2012 hasta julio del 2015. Se registraron las formas anatomicas del complejo neovascular, asi como el numero de tratamientos intravitreos administrados y el cambio de vision obtenido con este. Resultados Fueron incluidos 174 ojos de 156 pacientes con una edad media de 79,9 anos y un seguimiento de al menos 4 meses. El 40,8% presentaban neovascularizacion coroidea (NVC) tipo 1; el 12%, tipo 2; el 31%, tipo 3; el 14,4% presentaban formas mixtas y el 1,7%, vasculopatia polipoidea. La agudeza visual inicial media era de 0,32 y de 0,38 a los 24 meses, habiendo recibido una media de 9,3 inyecciones. Las formas neovasculares tipo 2, 3 y mixtas mostraron un resultado visual significativamente inferior a las tipo 1, no existiendo significacion estadistica en la vasculopatia polipoidea. Conclusiones La NVC tipo 1 fue la mas observada, y ademas se relaciono con un mejor pronostico visual, en comparacion con el resto de lesiones neovasculares, en pacientes tratados con ranibizumab.

The complete larval development of Pinnaxodes chilensis (including four zoeal stages and a megalopa stage) is described and illustrated in detail for the first time. The descriptions are based on laboratory-reared larvae obtained from ovigerous females found inside specimens of the sea urchin Loxechinus albus collected in the coast of Valparaiso, Chile. In order to allow the correct differentiation of specimens from plankton samples, the larval stages of P. chilensis are compared with those from other Pinnotheridae species, whose larval development is known for the Chilean continental waters (Calyptraeotheres politus). The morphological characters described for P. chilensis larvae, as well as the comparison with the remaining larval development descriptions available for the genus Pinnaxodes, are used to discuss the heterogeneity within this genus.

Groundwater is the major water source in arid and semi-arid regions and its availability under future climatic scenarios is uncertain. In this context, the knowledge of the likely changes in aquifer recharge is very important for sustainable management of groundwater resources in these environments. This work assesses the effect of future potential changes in the climate variables on aquifer recharge in a Mediterranean semi-arid aquifer (Sierra de Las Aguilas (SAG), SE Spain). We used monthly piezometric data to validate the aquifer recharge simulated by HYDROBAL ecohydrological model over the period 2001–2016. This model was then used to simulate the aquifer recharge over the historical period 1971–2000 and over two projected periods (2039–2068 and 2069–2098) using 18 downscaled climate projections. The results show that the percentage of aquifer recharge to precipitation (PAR) decreased significantly over the historical period (− 0.3% year−1, p

los efectos de biocontrol de Trichoderma viride (Ts-III-85) y Gliocladium Virens (Gv-02) sobre Fusarium moniliforme (Fm-01) y Thielaviopsis paradoxa (Tp-02) y el comportamiento varietal antes estos hongos patógenos se estudiaron en variedades comerciales de caña de azúcar. Para ello se efectuaron varios ensayos de laboratorio con distintos métodos de tratamiento a las estacas e inoculaciones artificiales de hongos patógenos. Los resultados mostraron el efecto de biocontrol de los hongos antagonistas sobre los hongos fitopatógenos, los síntomas fueron menores con tratamientos de T. viride y G. virens en las variedades Jaronú 60/5; Jaronú 64/19 y Cuba 1051/73. La variedad Jaronú 60/5 fue más atacada por F. moniliforme y la Cuba 1051/73 por T. paradoxa. Palabras Clave: Caña de azúcar, control biológico, Trichoderma, Gliocladium, Ustilago.

El presente trabajo se llevó efecto en el laboratorio de Fitopatología pertenecientes al centro de investigaciones de la universidad central de las Villas en el periodo comprendido de noviembre de 1993 a mayo de 1994. en el mismo se estudió el posible biocontrol de Trichoderma spp y gliocladium spp sobre ele carbón de caña de azúcar (Ustilago scitaminea) en condiciones de laboratorio y se obtuvo que ambos hongos ejercen biocontrol sobre el fitopatógeno Abstract : The present work was made in the laboratory of phytopathology of Agricultura reserch center (ARC) of central university of las villas in the period november 1993 to may 1994. the possible biocontrol of Trichoderma spp and Gliocladium above Ustilago scitaminea was studied in laboraory conditions. It was demostrated that U. scitaminea was controled by Trichoerma spp and Gliocladium spp.

Renal impairment and fluctuations in renal function are common in patients recently hospitalized for acute heart failure and in those with atrial fibrillation. The aim of the present study was to evaluate the hypothetical need for dosage adjustment (based on fluctuations in kidney function) of dabigatran, rivaroxaban and apixaban during the first 6 months after hospital discharge in patients with concomitant atrial fibrillation and heart failure.An observational study was conducted in 162 patients with nonvalvular atrial fibrillation after hospitalization for acute decompensated heart failure who underwent creatinine determinations during follow-up. The hypothetical recommended dosage of dabigatran, rivaroxaban and apixaban according to renal function was determined at discharge. Variations in serum creatinine and creatinine clearance and consequent changes in the recommended dosage of these drugs were identified during 6 months of follow-up.Among the overall study population, 44% of patients would have needed dabigatran dosage adjustment during follow-up, 35% would have needed rivaroxaban adjustment, and 29% would have needed apixaban dosage adjustment. A higher proportion of patients with creatinine clearance60 mL/min or with advanced age (≥ 75 years) would have needed dosage adjustment during follow-up.The need for dosage adjustment of nonvitamin K oral anticoagulants during follow-up is frequent in patients with atrial fibrillation after acute decompensated heart failure, especially among older patients and those with renal impairment. Further studies are needed to clarify the clinical importance of these needs for drug dosing adjustment and the ideal renal function monitoring regime in heart failure and other subgroups of patients with atrial fibrillation.

CompareA retrospective database reviewed 59 patients with clinical suspicion of LVV undergoingThe results show the greater potential of

Immunotherapy is a new treatment in advanced lung cancer that works by modulating the immune response against malignant cells. One aspect that is challenging for radiologists in the evaluation of the response to immunotherapy is the phenomenon of pseudoprogression, in which the infiltration of inflammatory cells causes lesions to increase in size or new lesions to appear and then decrease in size or disappear. Pseudoprogression actually represents a response to treatment. We aimed to determine the frequency of pseudoprogression in patients with advanced stages of lung cancer treated with nivolumab.We included 56 patients with advanced stages of lung cancer treated with nivolumab as a second-line or later treatment. We analyzed CT studies done while patients were undergoing nivolumab treatment. Tumor pseudoprogression was defined as an increase in the size of lesions or appearance of new lesions followed by a decrease in size or disappearance of these lesions on follow-up CT studies 4 to 8 weeks later. We did a descriptive analysis.In 15 patients, it was impossible to evaluate possible pseudoprogression because a second CT study was unavailable due to change of treatment or death. Tumor pseudoprogression was observed in 5 (12.2%) of the 41 patients, in most cases within 12 weeks of treatment initiation (in the fourth cycle). A second episode of pseudoprogression occurred in 2 (40%) of the 5 patients with an initial episode; the second episode occurred more than 12 weeks after treatment initiation.Tumor pseudoprogression occurred in 12.2% of patients with advanced stage lung cancer treated with nivolumab. An increase in lesion size or the appearance of new lesions must be assessed over time to avoid mistaking pseudoprogression for true progression of disease.

Background We are in a context where patients should become the centre of the healthcare system and where information is increasingly diverse and easily accessible. Adapting the information to the patients’ characteristics and to their point of view is essential for their empowerment. However, there is a significant variability between diseases in the research and elaboration of validated methods to evaluate, quantify and compare information needs. Purpose The aim of this study was to carry out a pilot test to validate a questionnaire that analyses the information needed by patients who visited the Outpatient Pharmaceutical Care Unit (OPCU) of a hospital. Second, to obtain a tool that indicates which information they want to receive and what they do not, and from which sources of information. Material and methods The internationally validated EORTC QLQ-INFO25 questionnaire for oncology patients was used. In order to be used in different pathologies, changes according to validity, viability and reliability criteria were made. Results To assess validity, an expert committee suggested appropriate changes to ensure that items were representative of the new target population. As a result, the modified EORTC QLQ-INFO25 was produced, being suitable for piloting (n=30). Viability was assessed by conducting the questionnaire. It was considered a necessary simplification, by eliminating items and modifying statements. Many patients raised doubts that had not been raised previously and were solved. Furthermore, Cronbach’s alpha statistical analysis indicated that reliability was high, as well as the items that could be eliminated if needed. Conclusion The definitive validation study questionnaire (n=200) was therefore obtained through relevant modifications based on observational criteria (viability) and statistics (reliability). It consists of 1–15 common items and 16–17 specific for neurology or rheumatology. Two sections were added: ‘Variables of interest’ and ‘Preferred sources of information’. According to the answers, patients prefer to be informed by specialists, followed by the rest of health professionals. They are satisfied with the quantity, quality and usefulness of the information received. However, they would like to receive more information about treatment and improvement in their quality of life. References and/or Acknowledgements Thanks to the whole hospital team for their willingness and especially to the patients for their collaboration No conflict of interest

Climate change forecasts in a semiarid region are of much interest to academics, managers and governments. A significant decrease in annual precipitation and an increase in mean annual air temperature are expected; consequently, changes in the soil water balance and groundwater recharge to aquifers are expected as a response to climate change forecasts. In this context, our study aimed to assess the impact of climate changes on the soil water balance and natural groundwater recharge in a semiarid area (Ventós-Castellar aquifer, SE, Spain). To this end, we selected Global Climate Model HadCM3 after comparing it with two other models (ECHAM4 and CGCM2). The HadCM3 model climate data (air temperature and precipitation in two emission scenarios: A2-high and B2-low; 2011–2099) were coupled to a HYDROBAL hydrological model to determine the soil water balance. The HYDROBAL model results showed that climate change will have a significant impact on the soil water balance in the study area, especially on groundwater recharge during the latter period. In both the A2-high and B2-low scenarios, the selected years to run the HYDROBAL model showed a decrease in water balance components (precipitation, actual evapotranspiration, aquifer recharge and runoff) in relation to the baseline period (1961–1990). Over the projected period (2011–2099), we expect fewer rainfall events (>15 mm), which promote aquifer recharge, longer dry summer seasons and, consequently, reduced average annual recharge that ranged from 3% to 17%; 10–49 mm, if compared to the baseline period. The methodology developed in the present study can be beneficial for assessing the impact of predicted climate change on groundwater recharge, and can help managers and planners to devise strategies for the efficient use and conservation of freshwater resources. This research has been supported by the United Nations Educational, Scientific and Cultural Organization – France (IGCP-513), the European Commission – Belgium (PRACTICE project), the Spanish Government through the Ministry of Economy and Competitiveness – Spain (ECOBAL Project, CGL2011-30531-C03-01 and SURVIVE project, CGL 2011-30531-C02-02), the Consolider programme INGENIO 2010 (GRACCIE Project, CSD2007-00067), and the Generalitat Valenciana – Spain (FEEDBACKS-PROMETEO; ACOMP/2010/272 and GV07/143).

Introduccion y objetivos Los nuevos anticoagulantes orales requieren ajuste de la posologia segun la funcion renal. El objetivo de este estudio es determinar la discrepancia existente entre la hipotetica posologia recomendada de estos farmacos empleando diferentes ecuaciones de filtrado glomerular estimado en pacientes con fibrilacion auricular. Metodos Analisis transversal de 910 pacientes con fibrilacion auricular e indicacion de anticoagulacion oral. Se estimo el filtrado glomerular con las ecuaciones de Cockcroft-Gault, Modification of Diet in Renal Disease y Chronic Kidney Disease Epidemiology Collaboration. Para dabigatran, rivaroxaban y apixaban, se identificaron discrepancias de la dosis cuando no coincidian con las dosis recomendadas segun se usara una u otra ecuacion. Resultados En el conjunto de la poblacion, respecto a la ecuacion de Cockcroft-Gault, la discrepancia de la posologia de dabigatran fue del 11,4% con la ecuacion Modification of Diet in Renal Disease y del 10 con la Chronic Kidney Disease Epidemiology Collaboration; las discrepancias de la posologia de rivaroxaban fueron del 10% y el 8,5% respectivamente. La menor discrepancia se observo con apixaban: el 1,4% con la primera y el 1,5% con la segunda. En los pacientes con un valor segun la ecuacion de Cockcroft-Gault < 60 ml/min o en los pacientes ancianos, las discrepancias en las posologias de dabigatran y rivaroxaban fueron superiores, entre el 13,2 y el 30,4%. La discrepancia en cuanto a la posologia de apixaban se mantuvo en un valor < 5% en estos pacientes. Conclusiones La discrepancia en las posologias de los nuevos anticoagulantes orales empleando ecuaciones distintas es frecuente, sobre todo en los pacientes ancianos con deterioro de la funcion renal. Esta discrepancia fue mayor para las posologias de dabigatran y rivaroxaban que para la de apixaban. Se necesitan nuevos estudios para esclarecer la importancia clinica de estas discrepancias y determinar la posologia optima de los anticoagulantes segun la ecuacion que se use para estimar la funcion renal.

Karst Aquifer GIS‐based model (KAGIS model) is developed and applied to Mela aquifer, a small karst aquifer located in a Mediterranean region (SE Spain). This model considers different variables, such as precipitation, land use, surface slope and lithology, and their geographical heterogeneity to calculate both, the run‐off coefficients and the fraction of precipitation which contributes to fill the soil water reservoir existing above the aquifer. Evapotranspiration uptakes deplete water, exclusively, from this soil water reservoir and aquifer recharge occurs when water in the soil reservoir exceeds the soil field capacity. The proposed model also obtains variations of the effective porosity in a vertical profile, an intrinsic consequence of the karstification processes. A new proposal from the Nash–Sutcliffe efficiency index, adapted to arid environments, is presented and employed to evaluate the model's ability to predict the water table oscillations. The uncertainty in the model parameters is determined by the Generalized Likelihood Uncertainty Estimation method. Afterwards, when KAGIS is calibrated, wavelet analysis is applied to the resulting data in order to evaluate the variability in the aquifer behaviour. Wavelet analysis reveals that the rapid hydrogeological response, typical of a wide variety of karst systems, is the prevailing feature of Mela aquifer. This study proves that KAGIS is a useful tool to quantify recharge and discharge rates of karst aquifers and can be effectively applied to develop a proper management of water resources in Mediterranean areas. This research was funded by the Spanish Ministry of Science and Innovation, Projects CGL2013‐48802‐C3‐3‐R and CGL2015‐69773‐C2‐1‐P; and by the University of Alicante, Projects GRE15‐19 and GRE17‐12.

Background Hypertrophic cardiomyopathy (HCM) is characterized by inappropriate hypertrophy, myocyte disarray and increased interstitial fibrosis. The tumour necrosis factor-like weak inducer of apoptosis (TWEAK) is a cell surface cytokine with biological activities including stimulation of cell growth, induction of inflammatory cytokines and stimulation of apoptosis. There are controversial data about the potential role of TWEAK in different cardiovascular pathologies. NT-proBNP is an established biomarker of myocardial wall stress, associated with poor functional class in HCM. We hypothesized that effort capacity in patients with HCM could be related to serum levels of these biomarkers. Materials and methods We included 40 haemodynamic stable HCM patients and 53 healthy controls with similar sex and age. We studied exercise capacity by maximal oxygen consumption in a limited treadmill exercise test. TWEAK and NT-proBNP were assayed by ELISA method and automated Elecsys® platform, respectively. We obtained 46 samples of myocardial tissues by septal myectomy in patients with HCM and evaluated myocardial fibrosis, immunoreaction with TWEAK antibody and apoptosis with TUNEL assay. Results We found raised TWEAK and NT-proBNP serum levels in patients when compared with control levels (both P

The Aggression Questionnaire (Bussamp; Perry, 1992) is one of the most widely used validated self-report measures to assess aggression. This study analyzes the factorial structure, internal consistency, and convergent validity of the AQ in a Spanish sample with high levels of violence.The questionnaire was administered to 767 partner-assaultive men undergoing psychological treatment.The results of the confirmatory factor analysis supported the four-factor structure. Also, positive correlations between the AQ and other instruments measuring aggression were found, finding that aggression and anger decrease with age in this sample.The results obtained showed that the AQ is a suitable instrument to assess aggression, anger, and hostility in partner-assaultive men.

Resumen Aortitis es un termino patologico que designa la inflamacion de la pared aortica, independientemente de su causa. Su presentacion clinica es inespecifica y variable, con sintomas como dolor abdominal, fiebre y perdida de peso. Tambien pueden estar elevados los reactantes de fase aguda. Un amplio espectro de entidades puede ocasionar aortitis, desde procesos infecciosos hasta enfermedades autoinmunes (de las que las mas frecuentes son la arteritis de Takayasu y la arteritis de celulas gigantes), cuyo pronostico y tratamiento son muy variables. Son varias las tecnicas de imagen que permiten evaluar tanto la luz como la pared vascular (como la tomografia computarizada multidetector, la resonancia magnetica, la angiografia o la PET-TC). Esta revision se centra en las enfermedades mas frecuentes que provocan aortitis y en los hallazgos clinicos y radiologicos mas relevantes que ayudan a diagnosticar y tratar adecuadamente esta entidad.

Life-threatening hemoptysis is a severe condition that requires rapid diagnosis and treatment. One of the treatments of choice is embolization. The initial assessment aims to locate the origin and cause of bleeding. The technological advance of the development of multidetector computed tomography (MDCT) has changed the management of patients with life-threatening hemoptysis. MDCT angiography makes it possible to evaluate the cause of bleeding and locate the vessels involved both rapidly and noninvasively; it is particularly useful for detecting ectopic bronchial arteries, nonbronchial systemic arteries, and pulmonary pseudoaneurysms. Performing MDCT angiography systematically before embolization enables better treatment planning. In this article, we review the pathophysiology and causes of life-threatening hemoptysis (including cryptogenic hemoptysis) and the MDCT angiography technique, and we review how to systematically evaluate the images (lung parenchyma, airways, and vascular structures).

Aortitis is a pathological term designating inflammation of the aortic wall, regardless of its cause. The clinical presentation of aortitis is nonspecific and variable. Symptoms include abdominal pain, fever, and weight loss; acute phase reactants may also be elevated. Aortitis can be caused by a wide spectrum of entities, including from infectious processes to autoimmune diseases (Takayasu arteritis and giant cell arteritis are among the most common of these causing aortitis), and the prognosis and treatment of these entities vary widely. Various imaging techniques can be used to evaluate the lumen and wall of the aorta (such as multidetector computed tomography, magnetic resonance imaging, angiography, or PET-CT). This review focuses on the most common diseases that cause aortitis and on the clinical and radiological findings that are most useful for diagnosing and treating this condition appropriately.

Life-threatening hemoptysis is a severe condition that requires rapid diagnosis and treatment. One of the treatments of choice is embolization. The initial assessment aims to locate the origin and cause of bleeding. The technological advance of the development of multidetector computed tomography (MDCT) has changed the management of patients with life-threatening hemoptysis. MDCT angiography makes it possible to evaluate the cause of bleeding and locate the vessels involved both rapidly and noninvasively; it is particularly useful for detecting ectopic bronchial arteries, nonbronchial systemic arteries, and pulmonary pseudoaneurysms. Performing MDCT angiography systematically before embolization enables better treatment planning. In this article, we review the pathophysiology and causes of life-threatening hemoptysis (including cryptogenic hemoptysis) and the MDCT angiography technique, and we review how to systematically evaluate the images (lung parenchyma, airways, and vascular structures).

Predictions of climate change have a high interest in semiarid regions like the province of Alicante (SE Spain). It is expected that the decrease of precipitation and the increase of air temperature according to climate change forecasts, could impact on the recharge to aquifers. In this context, the aim of this study was explore the possible impact of climate changes forecasts on recharge in a small aquifer southeastern Spain. Air temperature and precipitation data in two climate change scenarios, B2-low and A2-high have been coupled to HYDROBAL model. The HYDROBAL software is a useful eco-hydrological model with daily resolution for assessing water balances in different vegetation types in a semiarid region of southeastern Spain. Based on two models, HYDROBAL and DISRUM, water balance was calculated on two scales (vegetation plots and watershed). Over the latter period (2071-2099), we expect reduced average annual groundwater recharge, of up to 17% (49 mm), if compared to the baseline period (1961-1990). The European Commission (PRACTICE project), the Spanish Government through the Ministry of Economy and Competitiveness (ECOBAL project, CGL2011-30531-C02-01 and SURVIVE project, CGL 2011-30531-C02-02), the Consolider program INGENIO 2010 (GRACCIE project, CSD2007-00067), and the Generalitat Valenciana (FEEDBACKS-PROMETEO; ACOMP/2010/272 and GV07/143).

Mediterranean aquifers are frequently subject to the joint effect of intensive exploitation and low recharge values. Besides, groundwater is the only available water resource in many Mediterranean regions. Groundwater recharge studies are therefore necessary to underpin water management practices. This manuscript presents a methodology to estimate groundwater recharge in a small limestone aquifer of southeastern Spain. The HYDROBAL model is used to calculate daily soil water balances on the basis of hydrological and soil data as well as on vegetation cover. Deep drainage model outputs are converted into water table variations using a lumped model add-on. The adjustment between observed and calculated water table levels is in the order of r2 = 0.87. This correlation coefficient suggests that HYDROBAL is a useful tool to estimate groundwater recharge in the region. In addition, differences in groundwater recharge rates are observed for dry, average and wet years. Estimated recharge rates range between 0% and 18% of the mean annual rainfall, which corresponds to a net recharge of 0 to 59 mm year−1. Recharge rates increase proportionally with precipitation (r2 = 0.90). Copyright © 2012 John Wiley & Sons, Ltd.

Objectives: To determine whether serial measures of the interleukin receptor family member soluble ST2 (sST2) provide additional prognostic information to baseline measures for long-term risk stratification of acutely decompensated heart failure (ADHF) patients. Methods: We prospectively enrolled 72 ADHF patients. Blood samples were collected to measure sST2 concentrations at presentation and on day 4 of hospitalization. All patients were clinically followed, and vital status was registered. Results: Between presentation and day 4, sST2 concentrations decreased from 62 ng/ml (interquartile range 38–105) to 44 ng/ml (interquartile range 26–72; p < 0.001). Both sST2 concentrations at presentation [hazard ratio (HR) 1.011, 95% confidence interval (CI) 1.005–1.016; p < 0.001] and on day 4 (HR 1.015, 95% CI 1.005–1.024; p = 0.003) were independent predictors of mortality. Patients with sST2 ≤76 ng/ml at presentation and ≤46 ng/ml on day 4 had the lowest mortality rates (3%), whereas those with both sST2 values above these cutoff points had the highest mortality (50%). C index and reclassification analyses demonstrated that the use of serial sST2 measures resulted in an improvement in the accuracy of mortality prediction. Conclusions: Among ADHF patients, sST2 concentrations tend to decrease following initiation of treatment and are prognostic both at presentation and during hospitalization. Serial sampling of sST2 adds prognostic information and may provide a basis for enhanced clinical decision making.