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This study investigated the somatic growth and energy allocation strategy of two sympatric hake species (Merluccius polli and Merluccius senegalensis), coexisting under the strong influence of the Mauritanian upwelling. The results revealed that ontogeny, bathymetry, geography and reproduction shaped the differences found between the condition dynamics of the two species. Aside from species-specific differences, individuals were observed in better condition in the northernmost area (more influenced by the permanent upwelling) and in the deepest waters, probably the most favourable habitat for Merluccius spp. Both species also displayed contrasting trade-offs in energy allocation probably due to the dissimilarity of their habitats, which favours the existence of divergent adaptive strategies in response to different ontogenic requirements. It was hypothesized that M. polli invests in mass and energy reserves while sacrificing growth, as larger sizes may not provide an ecological advantage in a deeper and more stable environment. Moreover, M. senegalensis capitalizes on a steady growth without major disruptions, enabling earlier spawning at the expense of a lower somatic mass, which is fitting to a less stable shallower environment. This study sheds new light on differences in the biological traits and life strategies of Merluccius spp., which permit their overlap in a complex upwelling system and may contribute to the long-lasting scientific-based management of these species. 2

Resumen Objetivo: El objetivo de este estudio es presentar la actuación, tratamiento y resultados funcionales obtenidos en una Unidad de Prevención de Fracturas y Caídas. Material y métodos: Estudio prospectivo descriptivo de pacientes, con fractura osteoporótica previa, atendidos entre el 25 de abril de 2016 y el 20 de noviembre de 2017. Resultados: Se han analizado 43 pacientes con edad media 80,2 años (DS±5,19), mujeres 81,40% (n=35). Número de fracturas 61, 28% de cadera (n=17), 25% vertebrales (n=15) y 21% distales de radio (n=13). Al alta mejoran todas las escalas de valoración utilizadas, destacando los resultados del SPPB (39,80%), TUG (30,66%) y Tinetti (21,60%). Conclusiones: El paciente atendido corresponde a mujer de 80,2 años, con fractura de cadera, Tinetti 22:09, Daniels en Extremidades de 3,95, 4:05, 3,81, 3,91, SPPB de 6,63, TUG de 17,81 y FIM de 87,19 puntos. Se objetiva mejora en la puntuación de todas las escalas valoradas. Summary Objective: The aim of this study is to present the performance, treatment and functional results obtained in a Fracture and Fall Prevention Unit. Methods: Descriptive prospective study of patients with previous osteoporotic fracture, treated between April 25, 2016 and November 20, 2017. Results: We analyzed 43 patients with a mean age of 80.2 years (SD±5.19), 81.40% women (n=35). Number of fractures 61,28% hip (n=17), 25% vertebral (n=15) and 21% distal radius (n=13). At discharge, all the assessment scales used improved, highlighting the results of the SPPB (39.80%), TUG (30.66%) and Tinetti (21.60%). Conclusions: The profile patient treated corresponds to an 80.2-year-old woman, with a hip fracture, Tinetti 22:09, Daniels in extremities of 3.95, 4:05, 3.81, 3.91, SPPB of 6.63, TUG of 17.81 and FIM of 87.19 points. An improved score in all the assessed scales is reported.

The Canine Distemper is one of the main infectious diseases in domestic dogs. The introduction of live attenuated-viral vaccines has helped to maintain the disease under control. However, in the past few decades it has been observed worldwide a rising number of cases even in vaccinated animals. The canine distemper virus lineages circulating in the world have been described based on the hemagglutinin analyses, due to its high degree of genetic variability. Recently, new studies have reported greater variations in the amino acidic sequence of a region in the fusion protein. In order to determine the variability of the field strains in comparison with the vaccines and strains from other lines, in this dissertation the genomic variability of the Fsp region from the canine distemper virus fusion protein gene is analyzed. With this purpose, a chain-reaction of the polymerase with reverse transcription, capable of amplifying this variable region, was implemented and identified through its nucleotide sequence. These sequences were compared with vaccine strains and with field strains of known lineages. Additionally, a phylogenetic tree was built for this variable region. The results of the nucleotides comparison show that the field strains have more homology to the vaccine strain Onderstepoort and according to phylogeny, it would belong to the America 1 lineage.

As more ambitious protected area (PA) targets for the post-2020 global biodiversity framework are set beyond Aichi Target 11, renew thinking into spatial prioritisation is required to enable PA expansion that maximises environmental values. Our study focuses on the biodiverse and forest-rich Indonesian island of Sulawesi, which has a terrestrial PA network that covers 10% of the island. We used Marxan to investigate trade-offs in the design of an expanded PA network that prioritised different conservation features (biodiversity, forest cover, carbon stock, karst and valuable metal-rich areas) under varying island-wide coverage targets (17%, 30%, and 50%). Our first scenario, which required existing PAs to be selected, required larger areas to meet these coverage targets, in contrast to our second scenario, which allowed for any part of the island to be chosen, irrespective of PA status. The vast Mekongga and Bangkiriang Landscapes, and Gorontalo corridor were consistently identified as a high priority for protection under all scenarios. To meet our conservation targets through expanding current PAs, creating new PAs, and creating corridors that connect existing PAs, we used a spatially explicit three-phase approach. Our findings identified 26,508 km2 of priority areas to be included in the current PA network, potentially assisting Indonesia in meeting its post-2020 GBF target, if our approach is replicated across Indonesia as a national or sub-national analysis. We discuss various land management options through other effective area-based conservation measures (OECMs) and the costs to deliver this strategy.

Objective to determine the presence of marginal bacterial microfiltration in the IAI in different implant/abutment systems, in vitro. Material and methods Fifty‐six implants from seven different brand names, 4 with cone and 3 with straight connections were used, implant and abutment were connected using the Ncm tightening as indicated by each of the manufacturers and then were sealed. The samples were subjected occlusal load and thermal cycling, a first sample of each group was observed by micro CT and in a second sample (both samples randomly selected) length of connection was measured, while the rest of the samples were mounted on devices according to the bacterial microfiltration model with Porphyromonas gingivalis. Results Two of the conical connection system groups did not present bacterial microfiltration, one of the three straight connection groups only microfiltered in one sample, while the other two conical as well as the two straight connection samples showed different and important levels of bacterial microfiltration, all groups presented a direct relationship between the implant‐abutment adjustment determined by micro‐CT and bacterial microfiltration levels, not related to the connection length. Conclusion: Only two conical connection systems presented no bacterial microfiltration.

AIMS: The role of revascularization in chronic coronary syndrome (CCS) and the value of ischaemia vs. anatomy to guide decision-making are in constant debate. We explored the potential of a combined assessment of ischaemic burden by vasodilator stress cardiovascular magnetic resonance (CMR) and presence of multivessel disease by angiography to predict the effect of revascularization on all-cause mortality in CCS. METHODS AND RESULTS: The study group comprised 1066 CCS patients submitted to vasodilator stress CMR pre-cardiac catheterization (mean age 66 ± 11 years, 69% male). Stress CMR-derived ischaemic burden (extensive if >5 ischaemic segments) and presence of multivessel disease in angiography (two- or three-vessel or left main stem disease) were computed. The influence of revascularization on all-cause mortality was explored and adjusted hazard ratios (HRs) with the corresponding 95% confidence intervals were obtained. During a median 7.51-year follow-up, 557 (52%) CMR-related revascularizations and 308 (29%) deaths were documented. Revascularization exerted a neutral effect on all-cause mortality in the whole study group [HR 0.94 (0.74-1.19), P = 0.6], in patients without multivessel disease [n = 598, 56%, HR 1.12 (0.77-1.62), P = 0.6], and in those with multivessel disease without extensive ischaemic burden [n = 181, 17%, HR 1.66 (0.91-3.04), P = 0.1]. However, compared to non-revascularized patients, revascularization significantly reduced all-cause mortality in patients with simultaneous multivessel disease and extensive ischaemic burden (n = 287, 27%): 3.77 vs. 7.37 deaths per 100 person-years, HR 0.60 (0.40-0.90), P = 0.01. CONCLUSIONS: In patients with CCS submitted to catheterization, evidence of simultaneous extensive CMR-related ischaemic burden and multivessel disease identifies the subset in whom revascularization can reduce all-cause mortality.

BACKGROUND: Stress cardiac MRI permits comprehensive evaluation of patients with known or suspected chronic coronary syndromes (CCS). The impact of sex on the use of invasive cardiac angiography (ICA) after vasodilator stress cardiac MRI is unclear.; PURPOSE: To evaluate the impact of sex on ICA use after vasodilator stress cardiac MRI.; STUDY TYPE: Retrospective.; POPULATION: A total of 6229 consecutive patients (age [mean±standard deviation] 65.2±11.5years, 38.1% women).; FIELD STRENGTH/SEQUENCE: A 5-T; a steady-state free-precession cine sequence; stress first-pass perfusion imaging; late enhancement imaging.; ASSESSMENT: Patients underwent vasodilator stress cardiac MRI for known or suspected CCS. The ischemic burden (at stress first-pass perfusion imaging) was computed (17-segment model).; STATISTICAL TESTS: Multivariate logistic regression was used to evaluate the potential differential association between ischemic burden and use of cardiac MRI-related ICA across sex.; RESULTS: A total of 1109 (17.8%) patients were referred to ICA, among which there were significantly more men (762, 19.7%) than women (347, 14.6%). Overall, after multivariate adjustment, female sex was not associated with lower use of ICA (odds ratio [OR]=0.99; confidence interval [CI] 95%: 0.84-1.18, P=0.934). However, significant sex differences were detected across ischemic burden. Whereas women with nonischemic vasodilator stress cardiac MRI (0 ischemic segments) were less commonly submitted to ICA (OR=0.49; CI 95%: 0.35-0.69) in patients with ischemia (>1 ischemic segment), adjusted use of ICA was more frequent in women than men (OR=1.27; CI 95%: 1.1-1.5).; DATA CONCLUSIONS: In patients with known or suspected CCS submitted to undergo vasodilator stress cardiac MRI, cardiac MRI-related ICA may be overused in men without ischemia. Furthermore, ICA referral in patients with negative ischemia resulted in greater odds of revascularization in men.; EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 5. © 2022 International Society for Magnetic Resonance in Medicine.

Objectives: To evaluate the potential epidemiologic and economic impact of applying an HIV screening protocol in hospital emergency departments (ED) and compare it to current clinical practice in Spain. Material and methods: We estimated the cumulative incidence of human immunodeficiency virus (HIV) infections and associated costs in Spain for a 20-year time horizon based on a model comprised of various health states with different risks for HIV transmission. The impact of current clinical practices in Spain, in which there is no established protocol for HIV screening, was compared to the potential impact of applying a targeted screening protocol in persons who come to the ED with certain conditions suggestive of HIV infection (diagnosis of a sexually transmitted infection, mononucleosis, herpes zoster infection, community-acquired pneumonia; practice of chemsex, and need for postexposure prophylaxis). Results: Screening all persons with a condition suggestive of HIV infection in hospital EDs would require an investment of epsilon 20 million over 20 years, but it would prevent 13 615 new infections (reducing the incidence by 20.6%, down from 66 265 to 52 650 cases) in comparison with the current diagnostic approaches. Such a reduction in the incidence of HIV infection would potentially save epsilon 4411 million over 20 years, giving a return of epsilon 224 per euro invested. Conclusion: A protocol for targeted screening of persons in circumstances suggestive of risk for HIV infection in Spain would increase diagnoses, avert new infections, and generate savings in comparison with screening practices currently in effect.

AIM: Asses training, perception of readiness and training needs in palliative care (PC) theoretical and practical of primary care nurses in Spain, through descriptive cross-sectional study. DESIGN: Descriptive cross-sectional study. SETTING: Primary care nurses in Spain with online access. PARTICIPANTS: Primary care nurses in Spain, January and February 2021. 344 responses, 339 met the inclusion criteria. MAIN NEASUREMENTS: Sociodemographic variables, PC training, training needs were analyzed. Through Google Forms online questionnaire and INCUE Instrument. Descriptive analyses were performed and the results were compared using the exact symmetry test and the Mann-Whitney test. RESULTS: 82,6% women, with an average age of 45.5years. 86.1% of the nurses had training in PC, been basic in the 45.4%. Only 40.5% feel quite or very prepared to take care for palliative patients. Nurses demanded more training in psycho-emotional and grief and coping with losses. 83.76% passed the theoretical block compared to 43.36% of the practical, detecting higher training needs in the last (P

Collagen bundle orientation (CBO) in myocardial infarct scars plays a major role in scar mechanics and complications after infarction. We aim to compare four histopathological methods for CBO measurement in myocardial scarring. Myocardial infarction was induced in 21 pigs by balloon coronary occlusion. Scar samples were obtained at 4 weeks, stained with Masson's trichrome, Picrosirius red, and Hematoxylin-Eosin (H&E), and photographed using light, polarized light microscopy, and confocal microscopy, respectively. Masson's trichrome images were also optimized to remove non-collagenous structures. Two observers measured CBO by means of a semi-automated, Fourier analysis protocol. Interrater reliability and comparability between techniques were studied by the intraclass correlation coefficient (ICC) and Bland-Altman (B&A) plots and limits of agreement. Fourier analysis showed an almost perfect interrater reliability for each technique (ICC >= 0.95, p < 0.001 in all cases). CBO showed more randomly oriented values in Masson's trichrome and worse comparability with other techniques (ICC vs. Picrosirius red: 0.79 [0.47-0.91], p = 0.001; vs. H&E-confocal: 0.70 [0.26-0.88], p = 0.005). However, optimized Masson's trichrome showed almost perfect agreement with Picrosirius red (ICC 0.84 [0.6-0.94], p < 0.001) and H&E-confocal (ICC 0.81 [0.54-0.92], p < 0.001), as well as these latter techniques between each other (ICC 0.84 [0.60-0.93], p < 0.001). In summary, a semi-automated, Fourier-based method can provide highly reproducible CBO measurements in four different histopathological techniques. Masson's trichrome tends to provide more randomly oriented CBO index values, probably due to non-specific visualization of non-collagenous structures. However, optimization of Masson's trichrome microphotographs to remove non-collagenous components provides an almost perfect comparability between this technique, Picrosirius red and H&E-confocal.

INTRODUCTION AND OBJECTIVES: The management of elderly patients with chronic coronary syndrome (CCS) is challenging. We explored the prognostic value and usefulness for decision-making of ischemic burden determined by vasodilator stress cardiac magnetic resonance (CMR) imaging in elderly patients with known or suspected CCS. METHODS: The study group comprised 2496 patients older than 70 years who underwent vasodilator stress CMR for known or suspected CCS. The ischemic burden (number of segments with stress-induced perfusion deficit) was calculated following the 17-segment model. Subsequently, we retrospectively analyzed its association with all-cause mortality and the effect of CMR-guided revascularization. RESULTS: During a median follow-up of 4.58 years, there were 430 deaths (17.2%). A higher ischemic burden was an independent predictor of mortality (HR, 1.04; 95%CI, 1.01-1.07 for each additional ischemic segment; P=.006). This association was also found in patients older than 80 years and in women (P

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INTRODUCTION AND OBJECTIVES: Microvascular obstruction (MVO) is negatively associated with cardiac structure and worse prognosis after ST-segment elevation myocardial infarction (STEMI). Epithelial cell adhesion molecule (EpCAM), involved in epithelium adhesion, is an understudied area in the MVO setting. We aimed to determine whether EpCAM is associated with the appearance of cardiac magnetic resonance (CMR)-derived MVO and long-term systolic function in reperfused STEMI. METHODS: We prospectively included 106 patients with a first STEMI treated with percutaneous coronary intervention, quantifying serum levels of EpCAM 24hours postreperfusion. All patients underwent CMR imaging 1 week and 6 months post-STEMI. The independent correlation of EpCAM with MVO, systolic volume indices, and left ventricular ejection fraction was evaluated. RESULTS: The mean age of the sample was 59±13 years and 76% were male. Patients were dichotomized according to median EpCAM (4.48 pg/mL). At 1-week CMR, lower EpCAM was related to extensive MVO (P=.021) and larger infarct size (P=.019). At presentation, EpCAM values were significantly associated with the presence of MVO in univariate (OR, 0.58; 95%CI, 0.38-0.88; P=.011) and multivariate logistic regression models (OR, 0.55; 95%CI, 0.35-0.87; P=.010). Although MVO tends to resolve at chronic phases, decreased EpCAM was associated with worse systolic function: reduced left ventricular ejection fraction (P=.009) and higher left ventricular end-systolic volume (P=.043). CONCLUSIONS: EpCAM is associated with the occurrence of CMR-derived MVO at acute phases and long-term adverse ventricular remodeling post-STEMI.

BACKGROUND: The growing number of patients on home mechanical ventilation has driven considerable progress in the performance and functionality of ventilators, with features comparable with those used in the ICU. However, a publication gap exists in the evaluation and comparison of their performance and each ventilator choice depends on machine characteristics defined by manufacturers. METHODS: We bench tested 8 home-care ventilators that are currently available: Monnal T50, EOVE EO-150, Puritan Bennet 560, Weinmann, PrismaVent 50, Trilogy Evo, Astral 150, and Vivo 60 by using an active lung model. These devices were tested under 18 experimental conditions that combined 3 variables: respiratory mechanics, ventilatory mode, and inspiratory muscle effort. The volume delivered, trigger response, pressurization capacity, and synchronization were analyzed. RESULTS: Significant differences were observed in the performance among the devices. Decreased inspiratory muscle effort caused changes in the delivered volume, which worsened the response-to-trigger time, pressurization capacity, and synchronization. Increased pressure support favored the development of asynchronies. All the ventilators developed asynchronies under at least 1 set of conditions, but the EOVE and Trilogy Evo ventilators showed the fewest asynchronies during the experimental conditions studied. CONCLUSIONS: Great variability in terms of technical performance was observed among the 8 home-care ventilators analyzed. Asynchronies became a major issue when home mechanical ventilation was used under higher pressure-support values and lower muscle efforts. Our results may prove to be useful in helping choose the best suited machine based on a patient's clinical therapy needs.

Diabetes mellitus (DM) is considered one of the most massive epidemics of the twenty-first century due to its high mortality rates caused mainly due to its complications; therefore, the early identification of such complications becomes a race against time to establish a prompt diagnosis. The research of complications of DM over the years has allowed the development of numerous alternatives for diagnosis. Among these emerge the quantification of advanced glycation end products (AGEs) given their increased levels due to chronic hyperglycemia, while also being related to the induction of different stress-associated cellular responses and proinflammatory mechanisms involved in the progression of chronic complications of DM. Additionally, the investigation for more valuable and safe techniques has led to developing a newer, noninvasive, and effective tool, termed skin fluorescence (SAF). Hence, this study aimed to establish an update about the molecular mechanisms induced by AGEs during the evolution of chronic complications of DM and describe the newer measurement techniques available, highlighting SAF as a possible tool to measure the risk of developing DM chronic complications.

INTRODUCTION AND OBJECTIVES: Angiogenesis helps to reestablish microcirculation after myocardial infarction (MI). In this study, we aimed to further understand the role of the antiangiogenic isoform vascular endothelial growth factor (VEGF)-A165b after MI and to explore its potential as a coadjuvant therapy to coronary reperfusion.; METHODS: Two mice MI models were formed: a) permanent coronary ligation (nonreperfused MI); b) transient 45-minute coronary occlusion followed by reperfusion (reperfused MI); in both models, animals underwent echocardiography before euthanasia at day 21 after MI induction. We determined serum and myocardial VEGF-A165b levels. In both experimental MI models, we assessed the functional and structural role of VEGF-A165b blockade. In a cohort of 104 ST-segment elevation MI patients, circulating VEGF-A165b levels were correlated with cardiovascular magnetic resonance-derived left ventricular ejection fraction at 6 months and with the occurrence of adverse events (death, heart failure, and/or reinfarction).; RESULTS: In both models, circulating and myocardial VEGF-A165b levels were increased 21 days after MI induction. Serum VEGF-A165b levels inversely correlated with systolic function evaluated by echocardiography. VEGF-A165b blockade increased capillary density, reduced infarct size, and enhanced left ventricular function in reperfused, but not in nonreperfused, MI experiments. In patients, higher VEGF-A165b levels correlated with depressed ejection fraction and worse outcomes.; CONCLUSIONS: In experimental and clinical studies, higher serum VEGF-A165b levels are associated with worse systolic function. Their blockade enhances neoangiogenesis, reduces infarct size, and increases ejection fraction in reperfused, but not in nonreperfused, MI experiments. Therefore, VEGF-A165b neutralization represents a potential coadjuvant therapy to coronary reperfusion. Copyright © 2020 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.

BACKGROUND: Coronary arteries supply oxygen and nutrients to the heart. We evaluated the dynamics of microscopic damage throughout the ischemia-reperfusion process in the wall of coronary arteries following myocardial infarction (MI). METHODS: In a swine model of reperfused MI, animals were divided into one control and four MI groups: 90-minutes ischemia without reperfusion, or followed by one minute, one week or one month reperfusion. Left anterior descending (LAD; infarct-related artery) and control right coronary arteries (RCA) were isolated. Taking the balloon inflation region as a reference, we isolated the proximal and distal LAD areas, performing histological staining and immunohistochemistry. RESULTS: Although mild changes in tunica intima were observed during ischemia, an almost complete absence of endothelium, and abnormal breaks in the internal elastic layer were found post-revascularization. In tunica media, increased thickness was observed soon after reperfusion, whereas larger thickness, disorganized muscle cell distribution and edema were found one week after reperfusion. This damage was more pronounced in distal rather than proximal LAD, whereas no changes were detected in RCA. In the tunica adventitia, vasa vasorum density decayed during ischemia in both LAD regions, but was restored after one month. Leukocyte adhesion to the artery was observed post-revascularization, developing into a massive presence in the three layers one week post-reperfusion. CONCLUSIONS: Ischemia-reperfusion can itself induce damage in the wall of the epicardial coronary artery, becoming more pronounced in the region distal to balloon inflation. Exploring these abnormalities will provide insight into the pathophysiology of coronary circulation and MI.

Ischemic heart disease (IHD) persists as the leading cause of death in the Western world. In recent decades, great headway has been made in reducing mortality due to IHD, based around secondary prevention. The advent of coronary revascularization techniques, first coronary artery bypass grafting (CABG) surgery in the 1960s and then percutaneous coronary intervention (PCI) in the 1970s, has represented one of the major breakthroughs in medicine during the last century. The benefit provided by these techniques, especially PCI, has been crucial in lowering mortality rates in acute coronary syndrome (ACS). However, in the setting where IHD is most prevalent, namely chronic coronary syndrome (CCS), the increase in life expectancy provided by coronary revascularization is controversial. Over more than 40 years, several clinical trials have been carried out comparing optimal medical treatment (OMT) alone with a strategy of routine coronary revascularization on top of OMT. Beyond a certain degree of symptomatic improvement and lower incidence of minor events, routine invasive management has not demonstrated a convincing effect in terms of reducing mortality in CCS. Based on the accumulated evidence more than half a century after the first revascularization procedures were used, invasive management should be considered in those patients with uncontrolled symptoms despite OMT or high-risk features related to left ventricular function, coronary anatomy, or functional assessment, taking into account the patient expectations and preferences.

AIMS: Lymphopenia after ST-segment elevation myocardial infarction (STEMI) correlates with deleterious cardiac consequences and worse prognosis. An in-depth examination of genes implicated in lymphocyte proliferation, activation and regulation and their association with short- and long-term cardiac structure and function is therefore of great interest. METHODS: Peripheral blood mononuclear cells were isolated from 10 control subjects and 64 patients with a first STEMI treated with primary percutaneous coronary intervention and submitted to cardiac magnetic resonance after 1week and 6months. mRNA expression of genes implicated in lymphocyte activation (CD25 and CD69) and regulation [programmed death (PD)-1 and cytotoxic T-lymphocyte antigen (CTLA)-4] were determined by qRT-PCR. RESULTS: In comparison to controls, STEMI patients showed heightened mRNA expression of CD25 and lower PD-1 and CTLA-4 96h after coronary reperfusion. Patients with extensive infarctions (>30% of left ventricular mass) at 1week displayed a notable reduction in CD25, CD69, PD-1, and CTLA-4 expression (p

The purpose of this research is to learn how engagement has been measured so far and what new techniques will be used to measure it in the future. To this end, firstly, there is a review of all the current research in engagement has been conducted, in addition to a review of the current traditional techniques used to measure it. Secondly, the concept of Artificial Intelligence has been analyzed and how one of its most common techniques (Natural Language Processing) is starting to be used as a new technique to measure engagement. Once the traditional and new techniques had been presented, a theoretical differentiation was made between them in order to test the benefits of the latter. The main conclusions were that Artificial Intelligence is increasing its fields of action, specifically in the psychology of organizations. In this field, the new techniques allow companies to save time in the administration and the conduction of surveys. Moreover, the data reported by AI is less biased than the one that comes from surveys, since the data is collected directly and these techniques do not bias the employee when answering the items. As a final conclusion, it is proposed that a study be carried out to compare the results of both techniques in real-life companies.

INTRODUCTION AND AIM: Perinatal transmission of human immunodeficiency virus (PHIV) is considered a chronic disease that has highlighted several cognitive deficits. From birth to early adulthood, cognition is known to play a fundamental role. However, although neurocognitive processes associated with PHIV have been extensively described by psychometric testing, data is scarce on neural activity from functional magnetic resonance imaging (fMRI) which provides in vivo physiological information. SUBJECTS AND METHODS: We studied described impaired cognitive processes using fMRI on a group of PHIV adolescents with good immunovirological indications and healthy matched controls. Psychological status and neurocognitive functions were also assessed. RESULTS: There were no significant differences between HIV+ and HIV- groups, either on neurocognitive testing nor in fMRI activity for phonological fluency tasks. Prolonged duration of cART was positively associated with greater brain activity in left inferior frontal gyrus (LIFG) which could indicate functional compensation. CONCLUSIONS: These results suggest that neural activity through fMRI in PHIV adolescents with good daily functioning and good immunovirological control may be similar to their peers.

Ischemic heart disease (IHD) persists as the leading cause of death in the Western world. In recent decades, great headway has been made in reducing mortality due to IHD, based around secondary prevention. The advent of coronary revascularization techniques, first coronary artery bypass grafting (CABG) surgery in the 1960s and then percutaneous coronary intervention (PCI) in the 1970s, has represented one of the major breakthroughs in medicine during the last century. The benefit provided by these techniques, especially PCI, has been crucial in lowering mortality rates in acute coronary syndrome (ACS). However, in the setting where IHD is most prevalent, namely chronic coronary syndrome (CCS), the increase in life expectancy provided by coronary revascularization is controversial. Over more than 40 years, several clinical trials have been carried out comparing optimal medical treatment (OMT) alone with a strategy of routine coronary revascularization on top of OMT. Beyond a certain degree of symptomatic improvement and lower incidence of minor events, routine invasive management has not demonstrated a convincing effect in terms of reducing mortality in CCS. Based on the accumulated evidence more than half a century after the first revascularization procedures were used, invasive management should be considered in those patients with uncontrolled symptoms despite OMT or high-risk features related to left ventricular function, coronary anatomy, or functional assessment, taking into account the patient expectations and preferences.

Objective To systematically review the literature on the use of the transcranial static magnetic stimulation (tSMS) technique in humans and animals, its effects on different areas of the central nervous system (CNS), its influence on neural excitability and on the subject's behavior, and its biological effects and future possibilities. All static magnetic field applications that can be considered to have a physiologically similar effect have been reviewed. Methods We searched studies using key terms in NCBI PubMed, Scopus, PEDro, SciELO, Cochrane, and links to publications (inception to September 2019). Three reviewers independently selected the studies, extracted data, and assessed the methodological quality of the studies using the recommendations described in the Cochrane Handbook for Systematic Reviews of Interventions, PRISMA guidelines. Results We analyzed 27 studies. The reviewed literature suggests that the use of these magnetic fields has an inhibitory effect on different areas of the CNS, such as motor, somatosensory, and visual cortex, cerebellum, and spinal cord. Regarding subject's behavior, the different effects of tSMS appear to be transient and dependent on the stimulated area, such as loss of visual discrimination or improvement of somatosensory perception. In addition, the technique has some therapeutic utility, specifically in pathologies with cortical hyperexcitability. Conclusions These results suggest that tSMS may be a promising tool to modulate cerebral excitability in a safe and non-invasive way. Further investigations could give a better explanation of its precise mechanisms of action and applications.

AIMS: In this study, we evaluated the association between symptoms-guided revascularization occurred within three months following a negative vasodilator stress cardiovascular magnetic resonance (negative stress-CMR) and long-term adverse events in patients with known or suspected chronic coronary syndrome (CCS). METHODS: We retrospectively evaluated 3517 patients in which the stress first-pass perfusion imaging revealed no ischemia. The primary endpoint was the composite of death, spontaneous myocardial infarction, heart failure (HF), or stroke. The association between symptoms-guided revascularization after a negative stress-CMR and the endpoint was assessed using the multivariable Cox proportional hazard regression model. RESULTS: The mean age was 64.7 ± 11.9 years and 45.4% were females. Coronary angiography and revascularization following a negative stress-CMR were performed in 176 (5%) and 59 (1.7%) patients. At a median follow-up of 4.8 years (2.0-8.2), 529 (15%) patients experienced the primary endpoint (2.0 per 100 person-years). Revascularization following a negative CMR was associated with a higher incidence of the composite (4.85 vs. 1.96 per 100 person-years, p < 0.001) and each of the isolated components of the endpoint, except for the HF endpoint, in which differences were borderline significant. After multivariate adjustment, revascularization remained associated with an excess of risk (HR = 2.01, 95% CI:1.21-3.30; p = 0.007). CONCLUSIONS: In CCS patients with persistent symptoms but without evidence of ischemia in vasodilator stress CMR, revascularization was associated with a higher risk of adverse clinical events.

In acute ST-segment elevation myocardial infarction (STEMI) late gadolinium enhancement (LGE) may underestimate segmental functional recovery. We evaluated the predictive value of cardiac magnetic resonance (CMR) feature-tracking (FT) for functional recovery and whether it incremented the value of LGE compared to low-dose dobutamine stress echocardiography (LDDSE) and speckle-tracking echocardiography (STE). Eighty patients underwent LDDSE and CMR within 5-7 days after STEMI and segmental functional recovery was defined as improvement in wall-motion at 6-months CMR. Optimal conventional and FT parameters were analyzed and then also applied to an external validation cohort of 222 STEMI patients. Circumferential strain (CS) was the strongest CMR-FT predictor and addition to LGE increased the overall accuracy to 74% and was especially relevant in segments with 50-74% LGE (AUC 0.60 vs. 0.75, p = 0.001). LDDSE increased the overall accuracy to 71%, and in the 50-74% LGE subgroup improved the AUC from 0.60 to 0.69 (p = 0.039). LGE + CS showed similar value as LGE + LDDSE. In the validation cohort, CS was also the strongest CMR-FT predictor of recovery and addition of CS to LGE improved overall accuracy to 73% although this difference was not significant (AUC 0.69, p = 0.44). Conclusion: CS is the strongest CMR-FT predictor of segmental functional recovery after STEMI. Its incremental value to LGE is comparable to that of LDDSE whilst avoiding an inotropic stress agent. CS is especially relevant in segments with 50-74% LGE where accuracy is lower and further testing is frequently required to clarify the potential for recovery.

Immune response stimulation may be an adjuvant to antimicrobial treatment. Here, we evaluated the impact of immune response modification by lysophosphatidylcholine (LPC) combined with imipenem or ceftazidime in murine models of peritoneal sepsis (PS) and pneumonia by Pseudomonas aeruginosa. Imipenem and ceftazidime-susceptible strain (Pa39), and imipenem and ceftazidime-resistant strain (Pa238) were used. Ceftazidime pharmacokinetic and pharmacodynamic parameters were determined. Therapeutic efficacy, and TNF-α and IL-10 levels were determined in murine models of PS and pneumonia by Pa39 and Pa238 treated with LPC, imipenem or ceftazidime, alone or in combination. In PS model, LPC+ceftazidime reduced spleen and lungs Pa238 concentrations (-3.45 and -3.56 log10 CFU/g; P0.05). In pneumonia model, LPC+ceftazidime or LPC+imipenem reduced lungs Pa238 concentrations (-2.37 log10 CFU/g, P=0.1, or -1.35 log10 CFU/g, P=0.75). For Pa39 no statistically significant difference has been observed in PS and pneumonia models between combined therapy and monotherapy. Moreover, LPC+imipenem and LPC+ceftazidime decreased and increased significantly TNF-α and IL-10 levels, respectively, in comparison with untreated controls and monotherapies. These results demonstrate the impact of immune response modification by LPC plus antibiotics on the prognosis of infections by ceftazidime-resistant P. aeruginosa.

OBJECTIVES: This study explored the association of ischemic burden, as measured by vasodilator stress cardiovascular magnetic resonance (CMR), with all-cause mortality and the effect of revascularization on all-cause mortality in patients with stable ischemic heart disease (SIHD). Background: In patients with SIHD, the association of ischemic burden, derived from vasodilator stress CMR, with all-cause mortality and its role for decision-making is unclear. METHODS: The registry consisted of 6,389 consecutive patients (mean age: 65 +/- 12 years; 38% women) who underwent vasodilator stress CMR for known or suspected SIHD. The ischemic burden (at stress first-pass perfusion imaging) was computed (17-segment model). The effect of CMR-related revascularization (within the following 3 months) on all-cause mortality was retrospectively explored using the electronic regional health system registry. RESULTS: During a 5.75-year median follow-up, 717 (11%) deaths were documented. In multivariable analyses, more extensive ischemic burden (per 1-segment increase) was independently related to all-cause mortality (hazard ratio: 1.04; 95% confidence interval: 1.02 to 1.07; p < 0.001). In 1,032 1:1 matched patients using a limited number of variables (516 revascularized, 516 non-revascularized), revascularization within the following 3 months was associated with less all-cause mortality only in patients with extensive CMR-related ischemia (>5 segments, n = 432; 10% vs. 24%; p = 0.01). CONCLUSIONS: In a large retrospective registry of unselected patients with known or suspected SIHD who underwent vasodilator stress CMR, extensive ischemic burden was related to a higher risk of long-term, all-cause mortality. Revascularization was associated with a protective effect only in the restricted subset of patients with extensive CMR-related ischemia. Further research will be needed to confirm this hypothesis-generating finding. (C) 2020 by the American College of Cardiology Foundation.

BACKGROUND: Following myocardial infarction (MI), we aimed to characterize morphometric and genetic changes in extracellular matrix (ECM) components from ischemia onset until late phases after coronary reperfusion in necrotic and salvaged myocardium.; RESULTS: Swine were divided into one control (n=5) and three MI groups: 90-min of ischemia without reperfusion, or followed by 1-week or 1-month reperfusion (n=5 per group). In samples from the necrotic and salvaged areas, ECM components were morphometrically quantified and mRNA levels of factors involved in ECM remodeling were evaluated. After 90-min of ischemia, fibronectin, laminin, and elastic fibers content as well as upregulated mRNA expression of tissue inhibitors of metalloproteinases (TIMP)1, TIMP2, TIMP3 and connective tissue growth factor increased in the necrotic and salvaged myocardium. In both reperfused MI groups, collagen-I, collagen-III, elastic fibers, glycosaminoglycans, laminin, and fibronectin levels heightened in the necrotic but not the salvaged myocardium. Moreover, mRNA expression of TIMP1, TIMP2 and TIMP3, as well as metalloproteinase-2 and metalloproteinase-9 heightened in the necrotic but not in the salvaged myocardium.; CONCLUSIONS: Matrix remodeling starts after ischemia onset in both necrotic and salvaged myocardium. Even if ECM composition from the salvaged myocardium was altered after severe ischemia, ECM makes a full recovery to normal composition after reperfusion. Therefore, rapid coronary reperfusion is essential not only to save cardiomyocytes but also to preserve matrix, thus avoiding impaired left ventricular remodeling.

Background Cardiac magnetic resonance (CMR) permits robust risk stratification of discharged ST-segment-elevation myocardial infarction patients, but its indiscriminate use in all cases is not feasible. We evaluated the utility of left ventricular ejection fraction (LVEF) by echocardiography for a selective use of CMR after ST-segment-elevation myocardial infarction. Methods Echocardiography and CMR were performed in 1119 patients discharged for ST-segment-elevation myocardial infarction included in a multicenter registry. The prognostic power of CMR beyond echocardiography-LVEF was assessed using adjusted C statistic, net reclassification improvement index, and integrated discrimination improvement index. Results During a 4.8-year median follow-up, 136 (12%) first major adverse cardiac events (MACE) occurred (47 cardiovascular deaths and 89 readmissions for acute heart failure). In the entire group, CMR-LVEF (but not echocardiography-LVEF) independently predicted MACE occurrence. The MACE rate significantly increased only in patients with CMR-LVEF

This study aimed to assess the time course of circulating neutrophil and lymphocyte counts and their ratio (NLR) in ST-segment elevation myocardial infarction (STEMI) and coronavirus disease (COVID)-19 and explore their associations with clinical events and structural damage. Circulating neutrophil, lymphocyte and NLR were sequentially measured in 659 patients admitted for STEMI and in 103 COVID-19 patients. The dynamics detected in STEMI (within a few hours) were replicated in COVID-19 (within a few days). In both entities patients with events and with severe structural damage displayed higher neutrophil and lower lymphocyte counts. In both scenarios, higher maximum neutrophil and lower minimum lymphocyte counts were associated with more events and more severe organ damage. NLR was higher in STEMI and COVID-19 patients with the worst clinical and structural outcomes. A canonical deregulation of the immune response occurs in STEMI and COVID-19 patients. Boosted circulating innate (neutrophilia) and depressed circulating adaptive immunity (lymphopenia) is associated with more events and severe organ damage. A greater understanding of these critical illnesses is pivotal to explore novel alternative therapies.

Vasodilator stress cardiac magnetic resonance (stressCMR) has shown robust diagnostic and prognostic value in patients with known or suspected chronic coronary syndrome (CCS). However, it is unknown whether integration of stressCMR with clinical variables in a simple clinical-imaging score can straightforwardly predict all-cause mortality in this population. We included 6187 patients in a large registry that underwent stressCMR for known or suspected CCS. Several clinical and stressCMR variables were collected, such as left ventricular ejection fraction (LVEF) and ischemic burden (number of segments with stress-induced perfusion defects (PD)). During a median follow-up of 5.56 years, we registered 682 (11%) all-cause deaths. The only independent predictors of all-cause mortality in multivariable analysis were age, male sex, diabetes mellitus (DM), LVEF and ischemic burden. Based on the weight of the chi-square increase at each step of the multivariable analysis, we created a simple clinical-stressCMR (C-CMR-10) score that included these variables (age = 65 years = 3 points, LVEF = 50% = 3 points, DM = 2 points, male sex = 1 point, and ischemic burden > 5 segments = 1 point). This 0 to 10 points C-CMR-10 score showed good performance to predict all-cause annualized mortality rate ranging from 0.29%/year (score = 0) to >4.6%/year (score = 7). The goodness of the model and of the C-CMR-10 score was separately confirmed in 2 internal cohorts (n > 3000 each). We conclude that a novel and simple clinical-stressCMR score, which includes clinical and stressCMR variables, can provide robust prediction of the risk of long-term all-cause mortality in a population of patients with known or suspected CCS.

Objective. Ovarian cancers comprise several histologically distinct tumour groups with widely different prognosis. We aimed to describe the worldwide distribution of ovarian cancer histology and to understand what role this may play in international variation in survival. Methods. The CONCORD programme is the largest population-based study of global trends in cancer survival. Data on 681,759 women diagnosed during 1995–2009 with cancer of the ovary, fallopian tube, peritoneum and retroperitonum in 51 countries were included.We categorised ovarian tumours into six histological groups, and explored the worldwide distribution of histology. Results. During 2005–2009, type II epithelial tumours were the most common. The proportion was much higher in Oceania (73.1%), North America (73.0%) and Europe (72.6%) than in Central and South America (65.7%) and Asia (56.1%). By contrast, type I epithelial tumours were more common in Asia (32.5%), compared with only 19.4% in North America. From 1995 to 2009, the proportion of type II epithelial tumours increased from 68.6% to 71.1%, while the proportion of type I epithelial tumours fell from 23.8% to 21.2%. The proportions of germ cell tumours, sex cord-stromal tumours, other specific non-epithelial tumours and tumours of non-specific morphology all remained stable over time. Conclusions. The distribution of ovarian cancer histology varieswidely worldwide. Type I epithelial, germcell and sex cord-stromal tumours are generally associated with higher survival than type II tumours, so the proportion of these tumours may influence survival estimates for all ovarian cancers combined. The distribution of histological groups should be considered when comparing survival between countries and regions.

Introduction Depressive, anxiety and adjustment disorders are highly prevalent among mental health outpatients. The lack of funding for mental health problems produces inefficient results and a high burden of disease. New cost-effective group interventions aimed at treating these symptoms might be an appropriate solution to reduce the healthcare burden in mental health units. Mindfulness-based interventions (MBIs) have shown significant reductions in anxious, depressive and adjustment symptomatology. Recent research highlights the influence of compassion as a key mechanism of change. However, MBIs only address compassion implicitly, whereas compassion-based protocols consider it a core aspect of psychotherapy. In this randomised controlled trial, we hypothesise that the provision of attachment-based compassion therapy (ABCT), which is a compassion-based protocol, will be more effective than mindfulness-based stress reduction (MBSR), which is a conventional MBI programme, for the treatment of depressive, anxious and adaptive symptoms in patients in mental health settings. Methods and analysis Approximately 90 patients suffering from depressive, anxious or adjustment disorders recruited from Spanish mental health settings will be randomised to receive 8 weekly 2 hours group sessions of ABCT, 8 weekly 2.5 hours group sessions of adapted MBSR (with no full-day silent retreat) or treatment as usual (TAU), with a 1:1:1 allocation rate. Patients in the ABCT and adapted MBSR groups will also receive TAU. The main outcome will be general affective distress measured by means of the 'Depression Anxiety Stress Scales-21' at post-test as primary endpoint. Other outcomes will be quality of life, mindfulness, self-compassion and the use of healthcare services. There will be a 6-month follow-up assessment. Intention-to-treat analysis will be conducted using linear mixed models. Per-protocol and secondary outcome analyses will be performed. A data monitoring committee comprising the trial manager, the ABCT and MBSR teachers and an independent clinical psychologist will monitor for possible negative side effects. Ethics and dissemination Approval was obtained from the Ethics Committee of the General University Hospital of Castellon, Spain. The results will be submitted to peer-reviewed specialised journals, and brief reports will be sent to participants on request.

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is considered a major cause of healthcare-associated (HA) and community-acquired (CA) infections. Considering non-ß-lactam susceptibility as a potential marker for mecC-MRSA and CA-MRSA, the aim of this study was to determine the frequency and the associated genetic lineages of non-beta-lactam-antibiotic susceptible MRSA (NBLS-MRSA) strains in a multicenter study in Spain. Methods: A collection of 45 NBLS-MRSA strains recovered in the period from January to June 2016 from 12 Spanish hospitals was analyzed. Molecular typing through spa-type characterization, agr group and multi-locus-sequence typing was performed. Methicillin-resistant genes (mecA and mecC) as well as immune evasion cluster (scn-chp-sak-sea-sep, considering scn gene as the marker of IEC system) and Panton-Valentine leukocidin (PVL) genes were determined with PCR/sequencing. Results: The NBLS-MRSA phenotype was uncommon in the 12 hospitals analyzed (NBLS-MRSA/MRSA frequency: 0.3%-7.7%). All strains contained the mecA gene (and none contained mecC). Twenty-two different spa-types were detected among NBLS-MRSA strains, with spa-t008/agr-I the most prevalent (27%). The main clonal complexes were (CC/%): CC8/42.2%, CC5/33.3% and CC30/4.4%, with ST8 and ST5 as the main sequence types. The PVL toxin was present in 38% of strains (with spa-types t008, t024, t019, t044, t068, t318 and t3060). The IEC genes were detected in 78% of strains: IEC type-B (n = 17), type-F (n = 16), type-A (n = 1) and type-E (n = 1); 10 MRSA isolates were scn-negative. Conclusion: The NBLS-MRSA phenotype is uncommon in the analyzed hospitals; although no mecC-positive strains were detected, it could be a good marker for MRSA PVL-positive isolates (38%), frequently associated with CA-MRSA infections.

Tagoro, the youngest submarine volcano of the Canary Islands, erupted in 2011 South of El Hierro Island. Pre-existing sea floor and inhabiting biological communities were buried by the newly erupted material, promoting the appearance of new habitats. The present study pursues to describe the first metazoans colonizing different new habitats formed during the eruption and to create precedent on this field. Through dredge and remote operated vehicle samplings, five main habitat types have been detected based on the substrate type and burial status after the eruption. Inside the Tagoro volcanic complex (TVC), two new habitats are located in and around the summit and main craters—hydrothermal vents with bacterial mats and sulfurous-like fields mainly colonized by small hydrozoan colonies. Two other habitats are located downslope the TVC; new hard substrate and new mixed substrate, holding the highest biodiversity of the TVC, especially at the mixed bottoms with annelids (Chloeia cf. venusta), arthropods (Monodaeus couchii and Alpheus sp.), cnidarians (Sertularella cf. tenella), and molluscs (Neopycnodonte cochlear) as the first colonizers. An impact evaluation was done comparing the communities of those habitats with the complex and well-established community described at the stable hard substrate outside the TVC, which is constituted of highly abundant hydrozoans (Aglaophenia sp.), antipatharians (Stichopates setacea and Antipathes furcata), and colonizing epibionts (e.g., Neopycnodonte cochlear). Three years after the eruption, species numbers at Tagoro were still low compared to those occurring at similar depths outside the TVC. The first dominant species at the TVC included a large proportion of common suspension feeders of the circalittoral and bathyal hard bottoms of the area, which could have exploited the uncolonized hard bottoms and the post eruptive fertilization of water masses.