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–La carga asistencial de hospitalización a domicilio es un campo de gran relevancia.–No existe un consenso sobre los factores que afectan esta carga.–Se realiza un estudio Delphi para consensuar una lista de posibles factores.–Se trata del primer estudio de este tipo en el ámbito de interés.–Los factores indicados pueden mejorar la predicción de las cargas asistenciales.–Esta predicción ayudará a mejorar la calidad del servicio.

Analizar la importancia de los factores de riesgo vascular, los hallazgos ecográficos de los troncos supraaórticos, y la presencia de fibrilación auricular no valvular (FANV) anticoagulada en pacientes con obstrucción venosa retiniana (OVR) y en un grupo control.

To describe health‐related quality of life (HRQOL) and physical function in patients with early axial spondyloarthritis (SpA) and to assess their associations with disease activity and radiographic damage. This was a cross‐sectional study drawing upon baseline data of axial SpA patients (Assessment of SpondyloArthritis international Society criteria) from the ESPERANZA cohort. Linear regression analyses were used to evaluate the associations between disease activity and radiographic damage (spine and sacroiliac joints) with HRQOL, physical function, and spinal mobility. In total, 259 patients were included. The mean ± SD age was 32.2 ± 6.9 years, disease duration was 13.3 ± 6.8 months, Ankylosing Spondylitis Quality of Life score was 5.9 ± 4.8, Bath Ankylosing Spondylitis Functional Index score was 2.4 ± 2.3, Bath Ankylosing Spondylitis Metrology Index score was 1.4 ± 1.3, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score was 3.8 ± 2.3, C‐reactive protein (CRP) level was 9.7 ± 13.2 mg/liter, and Bath Ankylosing Spondylitis Radiology Index for the spine (BASRI‐s) score was 1.7 ± 1.6. HRQOL was mainly associated with disease activity on univariate analysis (β values for BASDAI 0.646, patient global visual analog scale [VAS] 0.641, night back pain VAS 0.598, physician VAS 0.560, and CRP level 0.275; P< 0.01 for all), whereas the association with radiographic damage was weaker (standardized β for BASRI‐s 0.142; P< 0.05). On multivariate models, HRQOL only remained significantly associated with disease activity (standardized β for BASDAI 0.330; P< 0.01, and physician VAS 0.205 and night back pain VAS 0.210; P= 0.01). Similarly, physical function was associated with disease activity and radiographic damage on univariate analysis, but only with disease activity (BASDAI β 0.466; P< 0.01) on multivariate analysis. However, spinal mobility was associated with radiographic damage in both univariate and multivariate analyses. Patients with axial SpA already have impaired quality of life and physical function, albeit mildly, at the beginning of their disease course. Both outcomes are mainly associated with disease activity in these patients.

Endothelial protein C receptor (EPCR) must be bound to a molecule of phosphatidylcholine (PC) to be fully functional, i.e. to interact with protein C/activated protein C (APC) properly. PC can be replaced with other lipids, such as lysophosphatidylcholine or platelet‐activating factor, by the action of group V secretory phospholipase A2 (sPLA2‐V), an enzyme that is upregulated in a variety of inflammatory conditions. Studies in purified systems have demonstrated that the substitution of PC notably impairs EPCR function in a process called EPCR encryption.

Background: There is currently intense debate as to whether pharmacogenetic algorithms for estimating the initial dose of coumarins provide a more accurate dose than the fixed-dose approach. Recently, it has been suggested that the greatest benefit of pharmacogenetic algorithms is observed in patients with extreme dose requirements. Objectives: To identify clinical and genetic factors that better characterize patients who need extreme acenocoumarol doses for steady anticoagulation state. Patients/methods: We reviewed 9538 patients with a steady acenocoumarol dose from three Spanish hospitals, selecting 83 who took ≤ 5.00 mg week−1(percentile 5, p5) and 203 taking ≥ 30.00 mg week−1(p95). We also selected patients matched by gender and age taking 13.50–14.00 mg week−1(p50). We genotyped VKORC1(rs9923231), CALU(rs1043550), GGCX(rs699664), CYP2C9(rs1799853; rs1057910), CYP4F2(rs2108622) and F7(rs5742910) single-nucleotide polymorphisms (SNPs). Results: Comparison between p5 and p95 revealed five parameters with significant differences: body surface area (BSA) (P = 0.006), age, VKORC1, CYP2C9and CYP4F2genotypes (all P < 0.001). First VKORC1, and second, CYP2C9SNPs played a strong effect by determining extreme doses, particularly in p95. Only one out of 203 p95 had the VKORC1A-1639A genotype, but this subject was CYP2C9*1/*1. In contrast, nine out of 83 p5 carried the VKORC1 G-1639G genotype, although six of them were CYP2C9*3 homozygotes and another two were heterozygotes. Surprisingly, CYP4F2V433M SNP displayed prevalences that suggest that its influence might only be evident when patients are treated with high doses. Conclusion: Two clinical data, age and BSA, and three SNPs in the VKORC1, CYP2C9and CYP4F2genes strongly predict outlier patients treated with acenocoumarol.

Recently, new maize hybrids have been introduced in northern Mexico to reduce importations of grain, which is mainly directed for the production of flour and animal feed. This represents a potential risk to both human and animal health because of the development of fungal pathogens under the local weather conditions; thus, the identification of tolerant hybrids has become a priority. In this way, the objective of this study was to observe the mycoflora development in maize. There were 12 yellow and 10 white seed maize hybrids randomly planted. At harvest time, a grain sample of each plot was collected, surface-sterilized, plated in culture media, and incubated. After 7 days, colonies were observed and analyzed. The major fungi encountered were Fusarium spp., Penicillium spp., and Aspergillus spp. When compared with the yellow hybrids, white hybrids had 34, 52 and 22% less infection by F. verticillioides, Aspergillus flavus, and Aspergillus niger, respectively, and almost the double infection with Penicillium spp. White hybrids presented 51% more healthy grains than the yellow hybrids.

Background: Endothelial cell protein C receptor (EPCR) binds protein C through its γ‐carboxyglutamic acid (Gla) domain and enhances its thrombin–thrombomodulin complex‐dependent activation. So far, only protein C/activated protein C has been shown to interact with EPCR. Factor VII (FVII), the coagulation trigger upon tissue factor (TF) interaction, is a serine protease whose Gla domain is highly homologous to the Gla domain of protein C. Objectives:  To characterize the binding of FVII/FVIIa to EPCR and its functional consequences. Methods and results:  We demonstrated by surface plasmon resonance (SPR) that FVII/FVIIa binds to EPCR through its Gla domain. At therapeutic concentrations, FVIIa reduced the activation of protein C by 40%. Soluble EPCR (sEPCR) was also able to prolong dose‐dependently the clotting time induced by the FVIIa–TF complex. SPR and amidolytic experiments showed that FVIIa is able to interact simultaneously with TF and EPCR, thus ruling out the possibility that the effect of EPCR on clotting time was due to the inhibition of the binding between FVIIa and TF. sEPCR inhibited dose‐dependently the activation of FX by the FVIIa–TF complex. Notably, blocking the binding site of EPCR on the endothelial surface increased the generation of FXa 2‐fold. Conclusions: EPCR binds to FVII/FVIIa and inhibits the procoagulant activity of the FVIIa–TF complex.

Background: The endothelial protein C receptor (EPCR) binds protein C and enhances its activation. Anti‐EPCR autoantibodies are found in patients with antiphospholipid syndrome and may explain the increased risk of thrombosis in these patients. Anti‐EPCR autoantibodies have been associated with fetal death and myocardial infarction in young women. Objectives: To determine whether anti‐EPCR autoantibodies are associated with deep vein thrombosis (DVT). Patients/methods: We measured plasma anti‐EPCR autoantibody levels in the Leiden Thrombophilia Study (LETS), a population‐based case–control study consisting of 474 patients with a first DVT and 474 control subjects. Results: The estimated risk of DVT was increased approximately 2‐fold in the presence of elevated IgA, IgG or IgM anti‐EPCR autoantibodies (i.e. levels above the 90th percentile as measured in the control subjects). The risk conferred by anti‐EPCR increased in a dose‐dependent manner for IgA and IgG. When anti‐EPCR autoantibodies were considered in the co‐presence of lupus anticoagulant (LAC) the odds ratio (OR) was 6.1 [95% CI 1.3–27.9]. Anti‐EPCR without LAC remained associated with DVT (OR 1.6; 95% CI 1.2–2.1). Anti‐EPCR autoantibodies were associated with high levels of D‐dimer and soluble EPCR in controls, suggestive of a prothrombotic status induced by the autoantibodies. Conclusions: This study demonstrates that the presence of anti‐EPCR autoantibodies is a moderate risk factor for DVT in the general population.

Background: The endothelial cell protein C receptor (EPCR) presents protein C to the thrombin:thrombomodulin complex on the endothelium of large vessels, and enhances the generation of activated protein C (APC) and activation of protease‐activated receptor‐1. A previous report has demonstrated binding of soluble (s) EPCR to activated neutrophils via surface proteinase 3 (PR3). Methods: We now report further characterization of this interaction. Activated neutrophils and purified PR3 both decrease endothelial cell (EC) surface EPCR, suggestive of its proteolysis. Results: When added to purified recombinant sEPCR, PR3 produced multiple cleavages, with early products including 20 kDa N‐terminal and C‐terminal (after Lys176) fragments. The binding of active site blocked PR3 to sEPCR was studied by surface plasmon resonance. Estimates of the KDof 18.5–102 nmwere obtained with heterogeneous binding, suggestive of more than a single interaction site. Conclusions: This work demonstrates PR3 binding to and proteolysis of EPCR and suggests a mechanism by which anticoagulant and cell protective pathways can be down‐regulated during inflammation.

Abstract: Cell line cross-contamination is a phenomenon that arises as a result of the continuous cell line culture. It has been estimated that around 20% of the cell lines are misidentified, therefore it is necessary to carry out quality control tests for the detection of this issue. Since cell line cross-contamination discovery, different methods have been applied, such as isoenzyme analysis for inter-species cross-contamination; HLA typing, and DNA fingerprinting using short tandem repeat and a variable number of tandem repeat for intra-species cross-contamination. The cell banks in this sense represent the organizations responsible for guaranteeing the authenticity of cell lines for future research and clinical uses.

Abstract: Human embryonic stem cells (hESCs) have an unlimited capacity to proliferate by a self-renewal process and can be differentiated in the three germ layers, opening doors to new clinical therapies to replace missing or damaged cells. The number of research groups and projects using human stem cells has increased largely in the last 5 yr. The creation of stem cell banks is another important step to support the advance of research in this field. Banks must be operated within the strict regulatory famework of good manufacturing practices and good laboratory practices that assure the highest quality standards and must implement a quality system that complies with international quality systems standards. It may also be appropriate to aim at an accreditation in order to assure correct laboratory practices at all times. Stem cell banks should receive the lines previously derived by other groups and hESCs should be provided for groups that justify their use in a research project previously approved by an ethical committee. The assays generally accepted as typical of hESCs, together with the microbiological analysis should be performed in order to assure a consistent, reliable, and safe line for the researchers. In this article, the Andalusian Stem Cell Bank proposes a model of a stem cell banking process in order to create a flow diagram of hESC lines and, following the international initiatives instem cells research, to achieve the full characterization of cells and a standardization of protocols that would simplilify the hESCs culture.

Background: Low levels of activated protein C (APC) are a risk factor for venous thrombosis. The mechanisms leading to interindividual differences in APC are not totally elucidated. Protein C is activated by the thrombin–thrombomodulin complex. As thrombin binds to fibrinogen and thrombomodulin through a common region, it is conceivable that fibrinogen influences the activation of protein C. This would help to explain the association between high levels of fibrinogen and an increased thrombotic risk. Methods: We analyzed the association between circulating APC levels and fibrinogen concentration in 382 healthy subjects. Subsequently, we studied the effect of increasing fibrinogen concentrations on the APC generation on cultured endothelial cells. Results: An independent inverse association between circulating APC levels and fibrinogen was found [βcoefficient, −0.16; 95% confidence interval (95% CI) −0.26, −0.06; P = 0.001]. For each 100 mg dL−1increase in fibrinogen, the independent risk of having low APC levels (<0.7 ng mL−1) was almost three times higher (OR 2.8; 95% CI 1.1, 7.2; P = 0.04). Accordingly, a notable association between increasing fibrinogen concentrations and the reduction in the thrombin–thrombomodulin dependent activation of protein C on endothelial cells was found (r = −0.57; P = 0.002). Conclusions: We present evidence of an inverse association between circulating APC and fibrinogen levels. According to this finding together with the results of our in vitroexperiments, we propose that the impairment in the generation of APC on endothelial cells constitutes a new prothrombotic mechanism of fibrinogen.

Background: Acute myocardial infarction (AMI) is rare among young women. The search for unknown risk factors is warranted. Endothelial protein C receptor (EPCR) is largely present at the endothelial surface of large arteries. No studies about association of anti‐EPCR autoantibodies (anti‐EPCR) with AMI are available. Methods: Plasma IgA, IgM and IgG anti‐EPCR levels were measured by enzyme‐linked immunosorbent assay in 165 women younger than 45 years who survived a first AMI and 165 healthy women, matched by age and geographical origin. Results: Using the 90th percentile of IgA anti‐EPCR in the control group, IgA anti‐EPCR were independently associated with AMI after adjustment for cardiovascular risk factors (OR 5.1; 95% CI 1.7–15.6; P = 0.004). The risk apparently conferred by IgA anti‐EPCR increased dose‐dependently (Pfor trend =0.0002). IgM anti‐EPCR were less consistently associated with AMI: a significant increase in the risk was found when women above the 90th percentile were compared with those in the lowest quartile (OR 3.6; 95% CI 1.2–11.5; P = 0.03). IgG anti‐EPCR were similar in patients and controls. A total of 145 patients underwent coronary arteriography. IgA or IgM anti‐EPCR were not different among patients with different degrees of atherosclerotic lesion (anova, P = 0.77 and 0.24, respectively). Conclusions: High levels of IgA and, to a lesser extent, IgM anti‐EPCR, are associated with AMI in young women.

Detrended Canonical Correspondence Analysis (DCCA) was used to describe the relationship between savanna environments and vegetation community composition in the Orinoco Basin. TWINSPAN derived three major types of savanna vegetation, each with its own floristic and physiognomic features. The first group reflected a plant association with species of Trachypogonoccurring in moderately infertile soils with low water availability and high bulk density. This group is distributed mostly on hilltops and dissected plains of the northern Orinoco savannas. The second group has the highest species diversity in habitats occurring in the northern Orinoco with extremely infertile soils. The third group, on the other hand, has a considerable number of species belonging to the Leguminosae and Cyperaceae families and linked to the habitats of the eastern Colombian savannas with the highest soil water availability, a shorter dry season and higher precipitation. The regional analysis of the Orinoco savannas suggests edaphic controls to be important. Changes in the underlying geology have affected topography and soil formation, which results in variation in water and nutrient status. The moisture regime and hydrological features are acting as the major regional determinants, while nutrient levels and distinctive surface soil properties provide the subregional determinants. The local boundary, at any given site, is strongly determined by nutrient shortage and acidity. Also, biogeographic and floristic considerations were taken into account to explain differences in species composition.

To compare clinical characteristics and risk factors of suppurative postsurgical mediastinitis according to its etiology.

Selection among microgametophytes usually exploits variation in pollen grain germination. Studies of variation in pollen grain size in common bean (Phaseolus vulgaris L.) suggested that selection for size might lead to changes in sporophytic traits. To determine whether microgametophytic selection based on size would affect pollen grain size in subsequent generations or sporophytic traits that were correlated with pollen grain size, pollen grains from three crosses were separated into two size categories by sieving and then used to pollinate cv. Diacol Calima. Selection resulted in changes in pollen grain diameter for pollen from F1, F2 and F3 plants for all crosses. In vitro germination indicated no differences between vigor of large and small grains, but extraction and sieving reduced germinability. F1 seed from two of the crosses with size-selected pollen varied in weight according to pollen grain size, but in subsequent generations, the effect disappeared. Both size categories of selected pollen resulted in F2 progeny with reduced numbers of seeds per pod as compared to controls, suggesting that the size selection process may have resulted in indirect selection for traits reducing seed set. The overall results suggested that genes determining pollen grain size in bean have little or no effect on sporophytic traits such as seed size and seed yield.

A method for the kinetic determination of nanogram amounts of nitrite based on its acceleration of the rate of bromination of pyridine-2-aldehyde 2-pyridylhydrazone in acidic medium has been developed. The reaction is followed by fluorometry while monitoring the formation of a fluorescent product using an excitation wavelength of 291 nm and an emission wavelength of 432 nm. The kinetic methods of the initial rate and induction period have been assessed regarding their analytical performance, the latter showing improved capabilities. This method has been applied to drinking water analysis, with a detection limit of 4.6 ng/ml and recoveries of 92-105%. The relative standard deviation of the method is 2.4%. The major advantages of this method are simplicity, absence of a reagent blank, selectivity and sensitivity.

Summary Kinetic Determination of Cobalt by Complexation with Pyridine-2-Aldehyde 2-Pyridylhydrazone and Ligand Oxidation with Bromate

Objective: To compare clinical characteristics and risk factors of suppurative postsurgical mediastinitis according to its etiology.

Multivariate structural data describing Trachypogon savanna relationships were used to characterize the sources of variation among savannas as a function of the environmental characteristics of the Orinoco Llanos. Twenty-six savannas including major physiognomic types of the Orinoco Llanos ranging from herbaceous to bush island savannas were ordinated on a regional scale. Results of Detrented Canonical Correspondence Analysis (DCCA) using floristics variables indicated that savannas were ordinated along two complex gradients. A soil physical and chemical gradient as expressed by changes in bulk density and magnesium concentration were evident after the analysis of the first DCCA axis. The second axis was a climatic gradient of decreasing annual precipitation and incresing monthly precipitation during the dry season. The impact of human disturbance on the savanna composition was also an explanatory variable of the second DCCA axis. Savanna sites overlapped considerably in composition and most species were widely distributed, with aboveground phytomass abundance depending upon the site.

Breath hydrogen testing (BHT) is a simple and reliable method for identifying impaired carbohydrate absorption. We describe a laboratory exercise in physiology for medical students using BHT as the teaching tool. The students collect fasting samples of expired air from each other using a simple nasal prong technique. They then drink one of several different aqueous carbohydrate solutions. Additional samples of expired air are collected by the students at 90 and 120 min after substrate ingestion and are analyzed by gas chromatography. Between sampling periods, discussions of digestive physiology are provided by the faculty. Students tabulate their BHT results as well as recording any symptoms using a standard scoring system. A total of 460 students have participated. We found that the percentage of students who malabsorbed a given substrate was similar each year. The results obtained in these student exercises closely parallel those reported in the literature. We conclude that BHT is an excellent teaching tool for illustrating carbohydrate digestion and absorption, even when performed by minimally trained subjects.

Common bean (Phaseolus vulgaris L.) is grown over a wide range of environments, including sites with low or high soil temperatures at sowing time. To describe the temperature responseof seed germination, 20 bean genotypes were evaluated using a rolled paper towel system with 11 constant temperatures ranging from 12 to 34 °C. Germination response was characterized by fitting cumulative counts using a maximum-likelihood analysis. Rate of germination increased from abase temperature (Tb) typically near 8 °C to an optimal development temperature (To) of 29 to 34 °C. Tb did not differ among common bean genotypes. Mesoamerican germplasm showed slightlyhigher To than Andean germplasm, but there was large variation in To within each of the two gene pools. The single accession of tepary bean (P. acutifolius) evaluated appeared to be the mosttolerant to high germination temperatures.