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Juan Parra EN 1928, UN 6C 1500 SUPER SPORT PILOTADO por Giuseppe Campari y Giulio Ramponi dio a Alfa Romeo la primera victoria en la legendaria Mille Miglia. Aquella gesta, [...]

Juan Parra PARA BODEGAS IZADI EL ENOTURISMO REPRESENTA UN VALOR CLAVE en la construcción de su identidad. Con viñedos de más de 35 años en un enclave privilegiado de la [...]

TEXTO NICOLA D. BONETTTI / JUAN PARRA El empresario Jim Ratcliffe, sus hijos George y Samuel y varios amigos, preparados para atravesar el desierto de Gobi al volante de tres [...]

TEXTO JUAN PARRA NUEVO CUPRA FORMENTOR EN APENAS SEIS AÑOS DESDE SU NACIMIENTO, LA MARCA CUPRA ha alcanzado cifras de récord. En ello ha tenido mucho que ver el éxito [...]

TEXTO JUAN PARRA PUERTO PORTALS Un destino abierto PORTALS NOUS-CALVIÀ (MALLORCA) Situado estratégicamente en la bahía de Palma, este complejo náutico y de ocio se posiciona como un referente de [...]

TEXTO JUAN PARRA MÁS DE LA MITAD DE LOS VEHÍCULOS que se venden en España son SUV. Y, entre ellos, el SEAT Arona es el preferido: acaba 2023 como el [...]

TEXTO JUAN PARRA FOTOGRAFÍA BLAI CARDA En la página siguiente , Marta Vidal, CEO de Vallformosa, en la sede de la bodega, en el Penedès, donde elaboran el 100% del [...]

Juan Parra EN UNA INICIATIVA INÉDITA HASTA ENTONCES, MADAME LILLY BOLLINGER decidió lanzar una añada antigua recién degollada y dosificada como un extra brut para ofrecer así una experiencia única: [...]

Juan Parra ANTEQUERA, EN MÁLAGA, ES UNA DE ESAS LOCALIDADES que la cultura popular y la tradición han acabado asociando a un producto. En su caso, a los mantecados. La [...]

TEXTO JUAN PARRA FOTOGRAFÍA JACOBO MEDRANO ESE IMPRESCINDIBLE APOYO El Palacio de Linares-Casa de América acogió el pasado 25 de octubre la fiesta de celebración del 20 aniversario de la [...]

Juan Parra NACIDA EN 1936 EN ESTADOS UNIDOS, LA FIRMA BLAUER se convirtió pronto en el principal proveedor de prendas de material técnico para los cuerpos de policía, ejércitos, bomberos [...]

Juan Parra El CUPRA DarkRebel fue desvelado como concept car en la Volkswagen Group Night, durante el Salón IAA de Múnich. CREADO ÍNTEGRAMENTE EN EL ESPACIO VIRTUAL DE LA FIRMA, [...]

Post-traumatic stress disorder (PTSD) is a hypermnesic condition that develops in a subset of individuals following exposure to severe trauma. PTSD symptoms are debilitating, and include increased anxiety, abnormal threat generalization, and impaired extinction. In developing treatment strategies for PTSD, preclinical studies in rodents have largely focused on interventions that target post-encoding memory processes such as reconsolidation and extinction. Instead, here we focus on forgetting, another post-encoding process that regulates memory expression. Using a double trauma murine model for PTSD, we asked whether promoting neurogenesis-mediated forgetting can weaken trauma memories and associated PTSD-relevant behavioral phenotypes. In the double trauma paradigm, consecutive aversive experiences lead to a constellation of behavioral phenotypes associated with PTSD including increases in anxiety-like behavior, abnormal threat generalization, and deficient extinction. We found that post-training interventions that elevate hippocampal neurogenesis weakened the original trauma memory and decreased these PTSD-relevant phenotypes. These effects were observed using multiple methods to manipulate hippocampal neurogenesis, including interventions restricted to neural progenitor cells that selectively promoted integration of adult-generated granule cells into hippocampal circuits. The same interventions also weakened cocaine place preference memories, suggesting that promoting hippocampal neurogenesis may represent a broadly useful approach in hypermnesic conditions such as PTSD and substance abuse disorders.

Juan Parra HACE MÁS DE UN SIGLO, CARLOS DE SALAMANCA Y HURTADO ZALDÍVAR, descendiente del Marqués de Salamanca que levantó el barrio más elegante y lujoso de Madrid, fundó en [...]

TEXTO JUAN PARRA Jorge Diez, director de Diseño de CUPRA, ante el nuevo Tavascan. TODO NUEVO MODELO COMIENZA CON UN EJERCICIO DE CREATIVIDAD por parte de los diseñadores. No hay [...]

Hummingbird feathers have some of the brightest and most iridescent colors in nature--light bounces off them like it does off a soap bubble, resulting in shimmering hues that shift as [...]

Background: Parkinson’s disease is now one of the fastest-growing neurodegenerative disorders in the developed world, with an increasing prevalence and associated socioeconomic costs. Progression of the disease leads to a gradual deterioration in patients’ quality of life, despite optimal treatment, and both medical and societal needs increase, often with the assistance of paid and/or unpaid caregivers. Objective: We aimed to quantify the incremental economic burden of Parkinson’s disease by disease severity in a real-world setting across differing geographic regions. Methods: Demographics, clinical characteristics, health status, patient quality of life, caregiver burden, and healthcare resource utilization data were drawn from the Adelphi Parkinson’s Disease Specific Program™, conducted in the USA, five European countries, and Japan. Results: A total of 563 neurologists provided data for 5299 individuals with Parkinson’s disease; 61% were male, with a mean age of 64 years. Approximately 15% of individuals were deemed to have advanced disease, with significantly more comorbidities, and a poorer quality of life, than those with non-advanced disease. Overall, the mean annual healthcare resource utilization increased significantly with advancing disease, and resulted in a three-fold difference in the USA and Europe. The main drivers behind the high economic burden included hospitalizations, prescription medications, and indirect costs. Conclusions: People with Parkinson’s disease, and their caregivers, incur a higher economic burden as their disease progresses. Future interventions that can control symptoms or slow disease progression could reduce the burden on people with Parkinson’s disease and their caregivers, whilst also substantially impacting societal costs.

Fast radio bursts (FRBs) are millisecond-duration flashes of radio waves that are visible at distances of billions of light years1. The nature of their progenitors and their emission mechanism remain open astrophysical questions2. Here we report the detection of the multicomponent FRB 20191221A and the identification of a periodic separation of 216.8(1) ms between its components, with a significance of 6.5σ. The long (roughly 3 s) duration and nine or more components forming the pulse profile make this source an outlier in the FRB population. Such short periodicity provides strong evidence for a neutron-star origin of the event. Moreover, our detection favours emission arising from the neutron-star magnetosphere3,4, as opposed to emission regions located further away from the star, as predicted by some models5.

Objective: To describe the role of local anaesthetic blocks as a potential cause of paracentral acute middle maculopathy (PAMM) after uneventful ocular surgery. Methods: Retrospective, observational, international, multicentre case series. Nine cases of PAMM with associated visual loss following uneventful ocular surgery with local anaesthetic blocks were observed in a 9-year period (2011–2020). Demographic, ocular and systemic data, anaesthetic data and surgical details were collected. Visual acuity (VA), fundus photography, fluorescein angiography, optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) images were reviewed. Results: All nine cases were associated with decreased VA at 24 h postoperative check (ranging from hand movement to 20/200). A hyperreflective band within the middle retinal layers was observed in the structural OCT in the acute phase, evolving to thinning and atrophy of the inner retinal layers in sequential follow-up scans performed. Fluorescein angiography showed delayed perfusion in early arterial phase with normal perfusion in late venous phases. OCTA showed decreased perfusion in the deep capillary plexus. Visual recovery was variable between cases during follow-up (ranging from count fingers to 20/20). Conclusions: A combination of a vasoconstrictive effect of the anaesthetic agent, an intraocular pressure spike and a mechanical effect of the volume of anaesthetic injected may result in decreased retinal artery perfusion and be evidenced as PAMM in OCT scans. PAMM may present as a potential complication of local anaesthetic blocks in cases of unexpected visual loss after uneventful ocular surgery.

In advanced Parkinson’s disease (PD), dyskinesias and non-motor symptoms such as sleep dysfunction can significantly impair quality of life, and high-quality management is an unmet need. To analyze changes in dyskinesia and non-motor symptoms (including sleep) among studies with levodopa-carbidopa intestinal gel (LCIG) in patients with advanced PD. A comprehensive literature review identified relevant studies examining LCIG efficacy. Outcomes of interest were dyskinesia (UDysRS, UPDRS IV item 32), overall non-motor symptoms (NMSS), mentation/behavior/mood (UPDRS I), and sleep/daytime sleepiness (PDSS-2, ESS). The pooled mean (95% confidence interval) change from baseline per outcome was estimated for each 3-month interval with sufficient data (i.e., reported by≥3 studies) up to 24 months using a random-effects model. Seventeen open-label studies evaluating 1,243 patients with advanced PD were included. All outcomes of interest with sufficient data for meta-analysis showed statistically significant improvement within 6 months of starting LCIG. There were statistically significant improvements in dyskinesia duration as measured by UPDRS IV item 32 at 6 months (–1.10 [–1.69, –0.51] h/day) and 12 months (–1.35 [–2.07, –0.62] h/day). There were statistically and clinically significant improvements in non-motor symptoms as measured by NMSS scores at 3 months (–28.71 [–40.26, –17.15] points). Significant reduction of NMSS burden was maintained through 24 months (–17.61 [–21.52, –13.70] points). UPDRS I scores significantly improved at 3 months (–0.39 [–0.55, –0.22] points). Clinically significant improvements in PDSS-2 and ESS scores were observed at 6 and 12 months in individual studies. Patients with advanced PD receiving LCIG showed significant sustained improvements in the burden of dyskinesia and non-motor symptoms up to 24 months after initiation.

Objective: To determine whether children referred to a sexual abuse clinic because of anogenital symptoms or signs have examination findings that are suggestive of or probable or definitive for sexual abuse. Design: Case series of 157 patients. Setting: Child and adolescent ambulatory care sexual abuse clinic. Results: A medical records review of 3660 cases was done; 157 cases were identified for study. Most (75%) referrals were from medical clinics. Of 184 complaints, the most common presenting symptom or sign was anogenital bleeding or bruising (29.3%), followed by irritation or redness (21.7%), abnormal anogenital anatomy (20.7%), vaginal discharge (18.4%), lesions (6.5%), and 'other' symptoms or signs (3.3%). We used a standardized classification system and determined that 25 patients (15%) had examination findings in the sexual abuse clinic that were suggestive of or probable or definitive for sexual abuse. Although 85 patients had examination findings that corroborated the presenting symptom(s), 70 had nonspecific examination findings or a diagnosis other than sexual abuse. Seventy-two patients had normal examination findings. Only patients with the presenting symptom of lesions had an increased likelihood of a sexual abuse diagnosis. Common examination findings included anogenital erythema, enhanced vascularity of the hymen or vestibule in prepubertal girls, labial adhesions, and culture-negative vaginitis. Conclusions: Few children are referred for sexual abuse evaluations based on physical signs or symptoms alone. Children with anogenital symptoms but without a disclosure or suspicion of sexual abuse are unlikely to have examination findings suggestive of abuse. The evaluation of children with anogenital symptoms and signs should include a consideration of alternative conditions and causes not directly related to sexual abuse. Arch Pediatr Adolesc Med. 1998;153:634-641, Children should not usually be referred for determination of sexual abuse based on physical genital symptoms alone, without additional evidence suggestive of a sexual predator, since most signs in that area are not sexually caused. Of 157 children examined at a sexual abuse clinic, the most common genital signs were anogenital bleeding or bruising, irritation or redness, abnormal anatomy, vaginal discharge, and lesions. Only the patients with lesions (6.5% of the total) had a higher than average likelihood of sexual abuse.

Residents do not appear to adequately document the physical findings in childhood sexual abuse cases. These physical findings can be vital for future legal proceedings. The documentation in the medical records of 1,487 children 17 years of age and younger evaluated by residents for sexual abuse was compared with the corresponding physical findings. Residents either did not document any findings or indicated a vague conclusion in most of the medical records with physical evidence of penetration.

Supplemental Digital Content is Available in the Text.This national audit provides clinical outcomes and complication rates of retropupillary iris-claw intraocular lens implantation and pars plana vitrectomy in a large multicenter series of aphakic eyes. These data are relevant for patient counseling and preoperative discussions, especially in the context of previous surgical complications in a real-world scenario.

Libman-Sacks endocarditis (LSE) is a cardiac manifestation of systemic lupus erythematosus and antiphospholipid syndrome characterized by non-bacterial verrucous vegetations with thrombogenic potential, causing valvular disfunction in left heart predominantly, we present a case of Libman-Sacks endocarditis with aortic and tricuspid valve location, which is very rare.

Sexual assault can cause a rectovaginal fistula in a child. A rectovaginal fistula is an abnormal opening between the vagina and the rectum. A 4-year-old girl was seen at a sexual abuse clinic who was found to have a rectovaginal fistula. Both she and her mother reported a history of vaginal penile penetration by the father. Because the injury had occurred some weeks earlier and had healed poorly, she required a diverting colostomy and a vaginal flap was used to repair the defect. She will require further surgery.

Flexible ureterorenoscopy is increasingly used as a first-line treatment for patients with renal lithiasis and proximal ureteral calculi, with varying success rates among different groups of authors and with great heterogeneity in defining the minimum size to assess stone-free rate. The article presents a literature review on the state of the art in flexible ureterorenoscopy, as well as it clarifies different concepts, while offering tips and tricks that have been implemented in a reference center for the management of urolithiasis, aiming to reduce complications, while improving stone-free rate and the performance of the procedure for urologists.

La ureterorrenoscopia flexible es cada vez más utilizada como tratamiento de primera línea para pacientes con litiasis renal y del uréter proximal, con tasas de éxito variables entre los diferentes grupos de autores y con gran heterogeneidad a la hora de definir el tamaño mínimo para definir tasa libre de cálculo. Se presenta una revisión de la literatura sobre el estado del arte en ureterorrenoscopia flexible, se aclaran diferentes conceptos y se exponen consejos y trucos que se han implementado en un centro de referencia para el manejo de litiasis urinaria, con el objetivo de disminuir las complicaciones, mejorar la tasa libre de cálculos y mejorar el desempeño del procedimiento al urólogo.

Acute type A thoracic aortic dissection is a life-threatening condition that requires rapid diagnosis and prompt surgical intervention. Prior cardiac surgery is recognized as a predisposing risk factor. Here, we report a rare case and successful surgical repair of a late presenting acute type A thoracic aortic dissection four years after a three-vessel coronary artery bypass grafting. Resection of the aortic valve and aneurysmal tissue was required, reconstruction was done with a composite graft, and the native coronary ostia and aorto-saphenous buttons were preserved.

Supplemental Digital Content is available in the text.

Levodopa-carbidopa intestinal gel (LCIG) is effective in the treatment of advanced Parkinson’s disease (PD). However, the patients’ profile that might benefit from treatment with LCIG has not been characterized. This retrospective study explored the influence of disease duration (DD) on the effectiveness of LCIG and identified factors associated with treatment discontinuation in a cohort of advanced PD patients. Patients initiating LCIG therapy between Jan-2006 and Dec-2011 in 18 Spanish centers were included. Effectiveness in treating motor symptoms (MSs), non-motor symptoms (NMSs), and adverse events (AEs) occurrence was compared in DD≥10 or <10 years and LCIG continuation/discontinuation groups. Factors associated with LCIG discontinuation were evaluated using univariate and multivariate analyses. Overall, 177 PD patients were included (52.5% male; mean age 70.6±8.4 years; mean LCIG duration 35.6±18.6 months). Patients with DD≥10 years (n = 125) experienced less reduction in “off” time (–29%) than those with DD <10 years (–38%; n = 51; p = 0.021), and reported more severe AEs (32.8% vs. 17.6%; p = 0.043). DD did not significantly influence changes in NMSs or discontinuation rates. Fifty-four patients discontinued LCIG therapy, factors associated with discontinuation were higher percentages of waking day in the “off” state (OR, 1.028; 95% CI, 1.002–1.055; p = 0.0360) and in the “on” state with troublesome dyskinesia (OR, 1.032; 95% CI, 1.002–1.064; p = 0.0376) at baseline. Advanced PD patients with DD <10 years might benefit more from treatment with LCIG than patients with a longer DD. Although MSs severity at baseline was statistically associated with LCIG discontinuation, the probability was very low with little clinical significance.

Aim:To evaluate the effectiveness and safety of ertapenem in patients hospitalized at home. Patients & methods:Retrospective analysis of data from Spanish Outpatient Parenteral Antimicrobial Therapy (OPAT) registry. Results:Data from 1428 patients (median age 70 years; 5.4 institutionalized) and 1547 infectious processes (24 self-administration) were analyzed. Clinical cure or improvement was achieved in 93.8 of cases. Rate of related readmissions was 4.2, of clinically important complications -3.9, and of adverse drug reactions -3.2. High comorbidity burden, contagion in nursing home and certain types of infection were associated with worse prognosis. Self-administration was effective and safe, except in case of nursing home-acquired infections. Conclusion:Ertapenem OPAT was effective and safe. Caregivers in nursing homes should be better trained in OPAT-related procedures.

Las principales secuelas del trauma raquimedular (TRM) en la esfera sexual tienen que ver con disfunción eréctil y la ausencia de eyaculación. El promedio de edad del TRM en Colombia oscila alrededor de 35 años y el 76% de las personas afectadas son hombres y, de estos, el 80%, independientemente del nivel de la lesión, conservan su habilidad para tener una erección.

Supplemental Digital Content is available in the text.

Supplemental Digital Content is available in the text.

Supplemental Digital Content is available in the text.

PPARγ activation with RSG induces 5‐LO‐dependent CD36 expression in resident microglia that participates in resolution of inflammation by phagocytosis, in an experimental model of stroke. PPARγ‐achieved neuroprotection in experimental stroke has been explained by the inhibition of inflammatory genes, an action in which 5‐LO, Alox5, is involved. In addition, PPARγ is known to promote the expression of CD36, a scavenger receptor that binds lipoproteins and mediates bacterial recognition and also phagocytosis. As phagocytic clearance of neutrophils is a requisite for resolution of the inflammatory response, PPARγ‐induced CD36 expression might help to limit inflammatory tissue injury in stroke, an effect in which 5‐LO might also be involved. Homogenates, sections, and cellular suspensions were prepared from brains of WT and Alox5−/−mice exposed to distal pMCAO. BMMs were obtained from Lys‐M Cre+PPARγf/fand Lys‐M Cre−PPARγf/fmice. Stereological counting of double‐immunofluorescence‐labeled brain sections and FACS analysis of cell suspensions was performed. In vivo and in vitro phagocytosis of neutrophils by microglia/macrophages was analyzed. PPARγ activation with RSG induced CD36 expression in resident microglia. This process was mediated by the 5‐LO gene, which is induced in neurons by PPARγ activation and at least by one of its products—LXA4—which induced CD36 independently of PPARγ. Moreover, CD36 expression helped resolution of inflammation through phagocytosis, concomitantly to neuroprotection. Based on these findings, in addition to a direct modulation by PPARγ, we propose in brain a paracrine model by which products generated by neuronal 5‐LO, such as LXA4, increase the microglial expression of CD36 and promote tissue repair in pathologies with an inflammatory component, such as stroke.