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Introduction: Chronic kidney disease (CKD) is associated with high cardiovascular disease (CVD) risk, and requires specific interventions to decreases CVD risk.The guidelines indicate that systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. The European Society Cardiology (ESC) guidelines, he European Renal Association (ERA) Council and the Spanish Society of Nephrology (S.E.N.) in collaboration with 15 Scientific Societies recommend assessing albuminuria in all these populations.We have evaluated current clinical practice regarding the assessment of CVD risk factors (blood pressure, albuminuria, serum cholesterol, glycemia and creatinine) in different adult health user populations, analyzing the results separately for men and women, given recent evidence on gender differences in the recognition, monitoring, and management of CKD. Methods: Observational, retrospective, non-interventional single center study performed in a hospital using Electronic Health Record (EHR) data. Results: Among 707,493 healthcare users, 612,619 were adults, and of these 332,943 (54.3%) females; 73,632 (12.0%) had DM and 121,445 (19.8%) hypertension. Mean (SD) age was 68.91 ± 21.4 years; 261,694 (36.9%) were older than 50 years.Only 8522 (1.39%) had undergone albuminuria testing as compared with 264,684 (43.21%) tested for serum creatinine, 140,492 (22.93%) for serum cholesterol, 263,381 (42.99%) for serum glucose, and 226,448 (36.96%) for blood pressure. Albuminuria was the only cardiovascular risk factor assessed more frequently in men than in women.Albuminuria, as other CVD risk factors, was more frequently assessed in patients with DM (6.71% of patients) or hypertension (4.81%), but albuminuria assessment remained suboptimal compared with 58–87% for other cardiovascular risk factors. For adults with diabetes or hypertension, albuminuria was assessed more frequently in men than in women.Albuminuria assessment in those older than 50 years was also suboptimal at 2.24%, as compared with 31–47% for other CVD risk factors.Albuminuria and EGFR are needed to screen for CKD, meaning that a urine test for albumin and creatinine and a serum test for creatinine are needed. To these, we may add assessment of blood pressure, serum cholesterol (for familial hypercholesterolemia) and serum glucose for Diabetes. Albuminuria was the only cardiovascular risk factor that was assessed more frequently in men (up to nearly 60% more frequently), indicating that screening for CKD and CVD risk in women is suboptimal. This result is surprisingly consistent across time and in all age groups. This is the first time that gender disparities in the assessment of albuminuria have been revealed. Conclusion: Albuminuria is assessed infrequently, even in patients with a high cardiovascular risk, especially in women. Resumen: Introducción: La enfermedad renal crónica (ERC) se asocia con un alto riesgo de enfermedad cardiovascular (ECV) y requiere intervenciones específicas para disminuir este riesgo.Las guías recomiendan una evaluación global sistemática del riesgo de ECV en personas con cualquier factor de riesgo vascular importante. Las guías de la Sociedad Europea de Cardiología (SEC), la Asociación Renal Europea (ERA) y la Sociedad Española de Nefrología (SEN), en colaboración con 15 sociedades científicas, recomiendan evaluar la albuminuria en todas estas poblaciones.Hemos evaluado la práctica clínica actual con respecto a la evaluación de los factores de riesgo de ECV (presión arterial, albuminuria, colesterol sérico, glucemia y creatinina) en diferentes poblaciones adultas de usuarios de salud, analizando los resultados por separado para los hombres y las mujeres, dada la evidencia reciente sobre las diferencias de género en el reconocimiento, el seguimiento y el tratamiento de la ERC. Métodos: Estudio observacional, retrospectivo, no intervencionista, unicéntrico, realizado en un hospital utilizando datos de la historia clínica electrónica. Resultados: De los 707.493 usuarios de atención sanitaria, 612.619 eran adultos. De ellos, 332.943 (54,3%) eran mujeres, 73.632 (12,0%) tenían DM y 121.445 (19,8%) tenían hipertensión. La edad media (DE) fue 68,91 ± 21,4 años; 261.694 (36,9%) eran mayores de 50 años.Solo 8.522 (1,39%) se habían sometido a pruebas de albuminuria en comparación con 264.684 (43,21%) de creatinina sérica, 140.492 (22,93%) de colesterol sérico, 263.381 (42,99%) de glucosa sérica y 226.448 (36,96%) de presión arterial. La albuminuria fue el único factor de riesgo cardiovascular evaluado con mayor frecuencia en hombres que en mujeres.La albuminuria, como otros factores de riesgo de ECV, se evaluó con mayor frecuencia en pacientes con DM (6,71% de los pacientes) o hipertensión (4,81%), pero la evaluación de la albuminuria siguió siendo subóptima en comparación con el 58% al 87% para otros factores de riesgo cardiovascular. Para los adultos con diabetes o hipertensión, la albuminuria se evaluó con mayor frecuencia en hombres que en mujeres.La evaluación de la albuminuria en los mayores de 50 años también fue subóptima, con un 2,24%, en comparación con un 31% a un 47% para otros factores de riesgo de ECV.La albuminuria y el FGe son necesarios para detectar ERC, lo que implica la determinación de albúmina y creatinina en orina y de creatinina en suero. A estos podemos agregar la evaluación de la presión arterial, el colesterol sérico (para la hipercolesterolemia familiar) y la glucosa sérica para la diabetes. La albuminuria fue el único factor de riesgo cardiovascular que se evaluó con mayor frecuencia en hombres (hasta casi un 60% más frecuentemente), lo que indica que la detección de ERC y riesgo de ECV en mujeres es subóptima. Este resultado es sorprendentemente consistente a lo largo del tiempo y en todos los grupos de edad. Esta es la primera vez que se revelan disparidades de género en la evaluación de la albuminuria. Conclusión: La albuminuria se evalúa con poca frecuencia, incluso en pacientes con alto riesgo cardiovascular, especialmente en mujeres.

Purpose: Systemic sclerosis (scleroderma) is a chronic autoimmune connective tissue disorder that can lead to notable pain and functional limitations of the digits. This study assessed complications and reoperations after interphalangeal (IP) joint arthrodesis in patients with scleroderma. Methods: A retrospective review was performed of all patients who underwent digital joint arthrodesis of the proximal IP (PIP), distal IP, or thumb IP joints between September 1, 2006, and December 31, 2019, at an integrated health system comprising two level-I trauma centers and two community teaching hospitals. Six patients who underwent arthrodesis of 13 IP joints were included in the study. Patient demographics, comorbidities, surgical information, and postoperative outcomes were collected from the medical record. Results: Thirteen digits in six patients were treated with digital joint arthrodesis. Three patients had diffuse scleroderma, and four patients were women. The majority of procedures were performed on the PIP joint with Kirshner wires (nine of 13). No patients experienced intraoperative complications. Three patients experienced postoperative complications including flexion deformity, discomfort, and cellulitis. In patients who had primary arthrodesis, two of nine joints went on to nonunion. One patient who underwent arthrodesis of four PIP joints for failed PIP arthroplasties went on to nonunion of all four digits. Of the patients with complications and nonunion, three required reoperation. Conclusions: Our study suggests that arthrodesis is an acceptable treatment option for patients with joint deformities secondary to scleroderma; however, surgeons and patients should be aware of higher rates of complications. Type of study/level of evidence: Therapeutic III.

Objectives: Adherence to healthy lifestyle recommendations has been reported to improve health-related quality of life (HRQL) in breast cancer (BC) patients, but the influence of long-term behavioral changes remains unknown. We evaluated the association between adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations and HRQL both, at BC diagnosis and the change 7−12 years later. Design: Prospective cohort study. Settings and participants: A total of 406 breast cancer survivors, from the EpiGEICAM study, were recruited in 16 Spanish hospitals. Measurements: Epidemiological, clinical, dietary, physical activity and HRQL information was collected both at recruitment and 7−12 years later. A 7-item score to measure compliance with recommendations was assessed according to the 2018 WCRF/AICR scoring criteria. HRQL was evaluated using SF-36 questionnaire. Linear mixed models for longitudinal data were used to assess the cross-sectional and longitudinal association between adherence score and the physical and mental component summary scores. Results: At diagnosis, for each unit increase in WCRF/AICR score adherence, the HRQL physical domain increased 0.78 points (95%CI: −0.04 to 1.60; P trend:0.06). The mean change in physical HRQL from diagnosis to follow-up per unit increase in within-subject adherence score was 0.73 points (95%CI: −0.18 to 1.65; P trend: 0.12). For the mental domain, no association was observed with compliance with the recommendations at diagnosis, nor with changes in adherence over time. Conclusions: Our results suggest that Increased adherence to WCRF/AICR cancer prevention recommendations over time could contribute to slightly improved long-term physical HRQoL in BC survivors.

Resumen: Introducción: los métodos analíticos que proporcionan los valores plasmáticos de las hormonas tiroideas son vulnerables a diferentes interferencias que alteran los resultados. Un ejemplo son los anticuerpos antihormona tiroidea (anti-HT), frecuentes en pacientes con hipotiroidismo autoinmunitario, que pueden alterar la señal del aparato y dar un falso valor elevado de hormona en la muestra. Se reporta solo el 50% de los casos de interferencias analíticas. Pueden conducir a diagnósticos erróneos y a un manejo terapéutico inapropiado que genera perjuicio para el paciente e incrementa el gasto sanitario. Caso: una mujer de 72 años con hipotiroidismo autoinmunitario en tratamiento sustitutivo, que en su analítica rutinaria se detecta una elevación de T4 con una TSH también por encima de rango, cuando lo esperable sería la inhibición de esta última. Se confirma este patrón 2 veces con el mismo analizador. Al estar la paciente asintomática, se sospecha una interferencia analítica. Con un protocolo establecido por el laboratorio de análisis clínico se descartan las principales interferencias conocidas hasta llegar a la detección de anti-HT como causante de un falso valor de T4. El manejo cambia, ahora se debe controlar la dosis de medicación vigilando únicamente el valor de TSH. Conclusiones: las interferencias provocan interpretaciones erróneas. En este caso, si se considerase una sobredosificación de tratamiento y se redujese la dosis de LT4, se provocaría sintomatología de hipotiroidismo. Si se considerase un hipertiroidismo de otra clase, se suspendiese el tratamiento o se iniciasen antitiroideos, se generaría el mismo daño. Al detectar la interferencia, se puede evitar la iatrogenia. Abstract: Introduction: Analytical methods providing plasma values of thyroid hormones are vulnerable to various interferences that alter the results. An example is the presence of anti-thyroid hormone antibodies (anti-HT), common in patients with autoimmune hypothyroidism, which can disrupt the instrument signal and yield a falsely elevated hormone value in the sample. Only 50% of cases of analytical interferences are reported. These interferences can lead to misdiagnoses and inappropriate therapeutic management, resulting in harm to the patient and increased healthcare expenditure. Case: A 72-year-old woman with autoimmune hypothyroidism on replacement therapy. Routine analysis reveals an elevation in T4 with TSH also above the reference range, when the expected outcome would be TSH suppression. This pattern is confirmed twice with the same analyzer. As the patient is asymptomatic, analytical interference is suspected. Following a protocol established by the Clinical Analysis laboratory, major known interferences are ruled out, leading to the detection of anti-HT as the cause of the false T4 value. Management changes, with medication dosage now monitored solely based on TSH levels. Conclusions: Interferences lead to erroneous interpretations. In this case, considering overdosing of treatment and reducing the LT4 dose would induce hypothyroidism symptoms. Assuming another form of hyperthyroidism, discontinuing treatment, or initiating anti-thyroid drugs would result in similar harm. By detecting the interference, unnecessary iatrogenesis is avoided.

Resumen: Introducción y objetivo: El fibroxantoma atípico (FXA) y el sarcoma pleomórfico dérmico (SPD) son neoplasias de origen mesenquimal poco frecuentes. Debido a la baja incidencia del SPD y a una nomenclatura históricamente confusa existe poca información acerca de la verdadera agresividad de este tumor. Realizamos el presente estudio con el objetivo de identificar qué características clínicas y/o histológicas del SPD son predictoras de riesgo de recidiva. Material y método: Se diseñó un estudio bicéntrico observacional retrospectivo de 31 casos de SPD diagnosticados y tratados en el Hospital Clínico Universitario de Valencia y el Instituto Valenciano de Oncología, entre los años 2005 y 2020. Se realizó un análisis descriptivo de las características clínicas e histológicas, un análisis inferencial univariado y un análisis multivariado mediante la regresión de Cox. Resultados: En el análisis univariado, la recidiva tumoral (p

Background and objective: Atypical fibroxanthoma and pleomorphic dermal sarcoma (PDS) are rare mesenchymal tumors. Due to the low incidence of PDS and a historically confusing nomenclature, little is known about the true aggressiveness of this tumor. The aim of this study was to investigate clinical and histologic risk factors for recurrence in PDS. Material and methods: Retrospective, observational, bicentric study of 31 PDSs diagnosed and treated at Hospital Clínico Universitario de Valencia and Instituto Valenciano de Oncología in Valencia, Spain, between 2005 and 2020. We described the clinical and histologic features of these tumors and performed univariate analysis and multivariate Cox regression analysis. Results: In the univariate analysis, tumor recurrence (P

Resumen: Introducción: La parotiditis crónica recurrente juvenil es una enfermedad infrecuente de causa desconocida. Existe un creciente interés por su etiología autoinmune y su relación con disfunciones de la inmunidad celular y humoral aunque no existe un protocolo consensuado de investigaciones complementarias para su estudio. Se presenta una serie consecutiva de casos donde se investigan las alteraciones inmunes y trastornos autoinmunes asociados, proponiendo un algoritmo de estudio. Pacientes y métodos: Se realizó un estudio retrospectivo de pacientes que presentaron parotiditis crónica recurrente juvenil durante el periodo de 2013 a 2016 y seguimiento de al menos 2 años. Tras su diagnóstico clínico y ecográfico se realizaron de forma sistemática exámenes complementarios para investigación de patologías infecciosas, inmunes y autoinmunes asociadas. Resultados: De un total de 36 pacientes con criterios de inclusión, se encontraron 16 (44%) con alguna alteración analítica de carácter inmunológico inespecífico (ANA positivo, IgG elevada, factor 4 del complemento bajo) o asociada a un diagnóstico específico como ocurrió en 11 pacientes: déficit selectivo de IgA (2), síndrome de Sjögren asociado o no a lupus eritematoso sistémico (3), celiaquía asociada o no a diabetes mellitus (4), tiroiditis de Hashimoto (1) y síndrome de inmunodeficiencia adquirida (1). Conclusión: La parotiditis crónica recurrente juvenil puede considerarse un signo centinela de otras enfermedades de etiología inmunológica/autoinmune cuyo diagnóstico, seguimiento y tratamiento precoz puede mejorar su pronóstico. La etiología infecciosa vírica, exceptuando el VIH, no es prioritaria en el estudio de recurrencias. Abstract: Introduction: Juvenile recurrent chronic parotitis is a rare disease of unknown cause. There is a growing interest in its autoimmune aetiology and its relationship with dysfunctions of cellular and humoral immunity, although there is no agreed protocol for complementary investigations for its study. A consecutive series of cases is presented where the immune alterations and associated autoimmune disorders are investigated, proposing a study algorithm. Patients and methods: A retrospective study was carried out on patients who had juvenile recurrent chronic parotitis during the period from 2013 to 2016 and a follow-up of at least 2 years. After its clinical and ultrasound diagnosis, complementary examinations were systematically carried out to investigate infectious, immune, and autoimmune diseases. Results: Of a total of 36 patients with inclusion criteria, 16 (44%) were found with some analytical alteration of a non-specific immunological nature (positive ANA, high IgG, low complement factor 4), or associated with a specific diagnosis, as occurred in 11 patients: Selective IgA deficiency (2), Sjögren's syndrome associated or not with systemic lupus erythematosus (3), coeliac disease associated or not with diabetes mellitus (4), Hashimoto's thyroiditis (1), and acquired immunodeficiency syndrome (1). Conclusion: Juvenile recurrent chronic parotitis can be considered a sentinel sign of other diseases of immunological/autoimmune aetiology for which the diagnosis, monitoring and early treatment can improve its prognosis. Viral infectious aetiology, with the exception of HIV, is not a priority in the study of recurrences.

Introduction: Juvenile recurrent chronic parotitis (JRCP) is a rare disease of unknown cause. There is a growing interest in its autoimmune aetiology and its relationship with dysfunctions of cellular and humoral immunity, although there is no agreed protocol for complementary investigations for its study. A consecutive series of cases is presented where the immune alterations and associated autoimmune disorders are investigated, proposing a study algorithm. Patients and methods: A retrospective study was carried out on patients who had JRCP during the period from 2013 to 2016 and a follow-up of at least 2 years. After its clinical and ultrasound diagnosis, complementary examinations were systematically carried out to investigate infectious, immune, and autoimmune diseases. Results: Of a total of 36 patients with inclusion criteria, 16 (44%) were found with some analytical alteration of a non-specific immunological nature (positive ANA, high IgG, low complement factor 4), or associated with a specific diagnosis, as occurred in 11 patients: Selective IgA deficiency (2), Sjögren’s syndrome associated or not with systemic lupus erythematosus (3), coeliac disease associated or not with diabetes mellitus (4), Hashimoto’s thyroiditis (1), and acquired immunodeficiency syndrome (1). Conclusion: Juvenile recurrent chronic parotitis can be considered a sentinel sign of other diseases of immunological/autoimmune aetiology for which the diagnosis, monitoring and early treatment can improve its prognosis. Viral infectious aetiology, with the exception of HIV, is not a priority in the study of recurrences. Resumen: Introducción: La parotiditis crónica recurrente juvenil (PCRJ) es una enfermedad infrecuente de causa desconocida. Existe un creciente interés por su etiología autoinmune y su relación con disfunciones de la inmunidad celular y humoral aunque no existe un protocolo consensuado de investigaciones complementarias para su estudio. Se presenta una serie consecutiva de casos donde se investigan las alteraciones inmunes y trastornos autoinmunes asociados, proponiendo un algoritmo de estudio. Pacientes y métodos: Se realizó un estudio retrospectivo de pacientes que presentaron PCRJ durante el periodo de 2013 a 2016 y seguimiento de al menos 2 años. Tras su diagnóstico clínico y ecográfico se realizaron de forma sistemática exámenes complementarios para investigación de patologías infecciosas, inmunes y autoinmunes asociadas. Resultados: De un total de 36 pacientes con criterios de inclusión, se encontraron 16 (44%) con alguna alteración analítica de carácter inmunológico inespecífico (ANA positivo, IgG elevada, factor 4 del complemento bajo) o asociada a un diagnóstico específico como ocurrió en 11 pacientes: déficit selectivo de IgA (2), síndrome de Sjögren asociado o no a lupus eritematoso sistémico (3), celiaquía asociada o no a Diabetes mellitus (4), tiroiditis de Hashimoto (1) y síndrome de inmunodeficiencia adquirida (1). Conclusión: La parotiditis crónica recurrente juvenile puede considerarse un signo centinela de otras enfermedades de etiología inmunológica/autoinmune cuyo diagnóstico, seguimiento y tratamiento precoz puede mejorar su pronóstico. La etiología infecciosa vírica, exceptuando el VIH, no es prioritaria en el estudio de recurrencias.

Resumen: Los datos abiertos (open data) son datos que pueden ser utilizados, reutilizados y redistribuidos libremente por cualquier persona, y que se encuentran sujetos, cuando más, al requerimiento de atribución y de compartirse de la misma manera en que aparecen. En este trabajo se describe el concepto de datos abiertos y de datos de investigación y por qué es necesario compartirlos. Se exponen las ventajas e inconvenientes de compartir datos y el procedimiento para llevar a cabo esta práctica. Se especifican los elementos que deben constituir el plan de gestión de los datos o documento que describe el tratamiento que van a recibir los datos de investigación recopilados o generados en el curso de un estudio o proyecto. Por último, se exponen las vías verde y dorada para la publicación de los datos y la necesidad de poner al servicio de los investigadores el asesoramiento técnico y las infraestructuras necesarias para que puedan llevar a cabo estas prácticas. Abstract: Open data are data that can be freely used, reused and redistributed by any person, and that are, at most, subject to the attribution requirement and shared in the same way in which they appear. This paper describes the concept of open data and research data and why it is important to share them. The advantages and disadvantages of data sharing and the procedure for carrying out this practice are discussed. We specifies the elements that should constitute the data management plan or document that describes the treatment that will receive the research data collected or generated in the course of a study or project. Finally, the green and gold routes for the publication of the data and the need to put at the service of the researchers the technical advice and the infrastructures necessary to carry out these practices are presented.

Resumen: Introducción: La nefritis focal bacteriana aguda es una infección intersticial bacteriana, localizada en el parénquima renal, que entraña mayor gravedad que la pielonefritis aguda. El objetivo del estudio es el análisis de factores predictivos que permitan su diagnóstico precoz, fundamental para un adecuado abordaje terapéutico. Pacientes y métodos: Estudio multicéntrico de casos y control retrospectivo. Centros participantes: hospitales de Castellón y Valencia. Periodo de estudio: 2010-2018. Casos: nefritis focal bacteriana. Controles: pielonefritis aguda. Resultados: Se incluyó a un total de 158 pacientes (1:1). La mediana de edad de los casos fue 2 años. El 75% de sexo femenino. No existieron diferencias en la presentación clínica. En el análisis univariante la nefritis focal se relacionó con malformaciones del tracto urinario, bacteriemia, recuento de neutrófilos y la procalcitonina, así como las convulsiones febriles en el límite de la significación. Valores de procalcitonina ≥ 2 ng/ml tiene una OR de 4,9 (IC del 95: 1,77-13,85) de presentar nefritis focal. En el análisis multivariante las malformaciones urológicas mantuvieron la significación estadística y la procalcitonina en el límite de la significación. Conclusiones: Las malformaciones del tracto urinario predisponen al desarrollo de nefritis focal bacteriana. Ante pacientes con infección del tracto urinario y factores predictivos de nefritis focal bacteriana aguda, sería recomendable la realización de una ecografía Doppler renal en fase aguda para un diagnóstico y un tratamiento adecuado. Abstract: Introduction: Acute focal bacterial nephritis is an interstitial bacterial infection, localised in the renal parenchyma, which can be more serious than acute pyelonephritis. The aim of this study is the analysis of predictive factors that may lead to its early diagnosis, which is essential for an adequate therapeutic approach. Patients and methods: A retrospective, multicentre case and control study. The participant centres were hospitals in Castellon and Valencia. The study period was 2010-2018, with the cases being patients with focal bacterial nephritis and the patients with pyelonephritis as controls. Results: A total of 158 (1:1) patients were included. The median age of the cases was 2 years and there were 75% females. There were no differences in the clinical presentation. In the univariate analysis, focal nephritis was associated with malformations of the urinary tract, bacteraemia, the neutrophil count, and procalcitonin, as well as febrile convulsions of borderline significance. Procalcitonin values ≥2 ng/ml had an OR of 4.9 (95%CI; 1.77-13.85) of presenting with focal nephritis. In the multivariate analysis, the urological malformations still maintained statistical significance and borderline significance for procalcitonin. Conclusions: The urinary tract malformations predispose the development of focal bacterial nephritis. In patients with a urinary tract infection and predictive factors of acute focal bacterial nephritis it would be worthwhile performing a renal Doppler ultrasound in the acute phase for its appropriate diagnosis and treatment.

Introduction: Acute focal bacterial nephritis is an interstitial bacterial infection, localised in the renal parenchyma, which can be more serious than acute pyelonephritis. The aim of this study is the analysis of predictive factors that may lead to its early diagnosis, which is essential for an adequate therapeutic approach. Patients and methods: A retrospective, multicentre case and control study. The participant centres were hospitals in Castellon and Valencia. The study period was 2010–2018, with the cases being patients with focal bacterial nephritis and the patients with pyelonephritis as controls. Results: A total of 158 (1:1) patients were included. The median age of the cases was 2 years and there were 75% females. There were no differences in the clinical presentation. In the univariate analysis, focal nephritis was associated with malformations of the urinary tract, bacteraemia, the neutrophil count, and procalcitonin, as well as febrile convulsions of borderline significance. Procalcitonin values ≥2 ng/mL had an OR of 4.9 (95% CI; 1.77–13.85) of presenting with focal nephritis. In the multivariate analysis, the urological malformations still maintained statistical significance and borderline significance for procalcitonin. Conclusions: The urinary tract malformations predispose the development of focal bacterial nephritis. In patients with a urinary tract infection and predictive factors of acute focal bacterial nephritis it would be worthwhile performing a renal Doppler ultrasound in the acute phase for its appropriate diagnosis and treatment. Resumen: Introducción: La nefritis focal bacteriana aguda es una infección intersticial bacteriana, localizada en el parénquima renal, que entraña mayor gravedad que la pielonefritis aguda. El objetivo del estudio es el análisis de factores predictivos que permitan su diagnóstico precoz, fundamental para un adecuado abordaje terapéutico. Pacientes y métodos: Estudio multicéntrico de casos y control retrospectivo. Centros participantes: hospitales de Castellón y Valencia. Periodo de estudio: 2010-2018. Casos: nefritis focal bacteriana. Controles: pielonefritis aguda. Resultados: Se incluyó a un total de 158 pacientes (1:1). La mediana de edad de los casos fue 2 años. El 75% de sexo femenino. No existieron diferencias en la presentación clínica. En el análisis univariante la nefritis focal se relacionó con malformaciones del tracto urinario, bacteriemia, recuento de neutrófilos y la procalcitonina, así como las convulsiones febriles en el límite de la significación. Valores de procalcitonina ≥ 2 ng/mL tiene una OR de 4,9 (IC del 95: 1,77-13,85) de presentar nefritis focal. En el análisis multivariante las malformaciones urológicas mantuvieron la significación estadística y la procalcitonina en el límite de la significación. Conclusiones: Las malformaciones del tracto urinario predisponen al desarrollo de nefritis focal bacteriana. Ante pacientes con infección del tracto urinario y factores predictivos de nefritis focal bacteriana aguda, sería recomendable la realización de una ecografía Doppler renal en fase aguda para un diagnóstico y un tratamiento adecuado.

Purpose: Given the state of the opioid crisis and national pressure to minimize prescriptions, pain management after common hand procedures can pose a challenge for patients and providers. Despite the volume of recent literature on prescribing protocols and over-the-counter (OTC) medications, patient satisfaction has not been adequately assessed. The purposes of this study were (1) to investigate patient satisfaction with pain management using an opioid prescribing protocol after common hand procedures, and (2) to evaluate medication use in the postoperative period using this opioid prescribing protocol. Methods: A prospective survey was administered to 100 consecutive patients undergoing common soft tissue hand procedures at a Level I academic institution over a 5-month period. The medical record was reviewed for demographics and the number or dosage of opioid pills prescribed. The survey was conducted at 2 time points within 2 weeks after the procedure and assessed the number of opioid pills taken, use of OTC medications, visual analog scale (VAS) pain score, and satisfaction with pain management and surgery. Results: Mean number of opioid pills consumed at 2 weeks after the procedure was 1.5; 19 patients consumed all of their prescribed opioid pills. Acetaminophen was the most commonly used OTC medication and 84 patients reported using OTC medication in the postoperative period. The average VAS score at the end of the study period was 1.7. Nearly all patients were satisfied with the pain management and surgery; no patients received a second opioid prescription. Conclusions: We found that patients consumed far fewer opioid pills than were prescribed to them. We also found that patients who took more opioid pills had higher VAS pain scores, with lower satisfaction in both categories. The cohort demonstrated effective control of pain with high satisfaction, indicating that an opioid protocol is a successful and patient-accepted tool for managing postoperative pain. Type of study/level of evidence: Therapeutic IV.

Silkworm (Bombyx mori) pupae is a by-product from the silk industry which is rich in protein. Hydrolysates from silkworm pupae generated using Alcalase®, Prolyve®, Flavourzyme® and Brewers Clarex® proteolytic preparations were characterised. The antioxidant activity of the hydrolysates was investigated using in vitro antioxidant assays and an in situ assay for reactive oxygen species (ROS) reduction using hepatic HepG2. Overall, Alcalase and Prolyve hydrolysates had highest scavenging activities, however, Flavourzyme and Brewers Clarex hydrolysates had enhanced ferric reducing antioxidant power (FRAP) activity compared to the other samples. Furthermore, the Flavourzyme hydrolysate significantly reduced ROS by 40% compared to untreated control HepG2 cells. Peptides identified by LC-MS/MS were synthetised and then tested for their in vitro and in situ antioxidant activity. Peptides SWFVTPF and NDVLFF showed highest antioxidant activity (ROS reduction, superoxide dismutase (SOD) expression and glutathione (GSH) production activity) in HepG2 cells, and therefore may have potential as natural antioxidants.

Aims: The increase in scientific interest in so-called behavioral addictions has been growing in recent years. For this reason, the aim of our study is to use bibliometric techniques to identify where and with what intensity these behaviors are being studied. Methods: In October 2020, we conducted a search in the Web of Science Core Collection using a search equation designed to retrieve the articles that combine the general keywords of addiction with specific terms of the 7 groups of behavioral addictions analyzed (gambling; gaming; information and communication related disorders; and the so-called somatic addictions related to sex, shopping, food and sports). Articles published from 1995 to 2019 were included. Results: We found 9199 distinct articles. Gambling was the most studied addiction, but Information and Technology Communication-related disorders (ITC) had the highest growth rate over the span of five five-year periods, followed by gaming and food addiction. In general, there was a growth rate of 130.46% in the research on behavioral addiction issues. By geographical region, the United States was the most productive country regarding all addictions, but Oceania had the highest proportion of publications per million population. There was a clear interest among Asian countries in studying problems related to ITC and gaming problems. Conclusions: The importance of the seven behavioral addictions analyzed according to their growth rate in scientific research fields over the last 25 years was confirmed in our study. In addition, the differences in interest by geographical region show us that it is important to delve deeper into cultural particularities to better understand this phenomenon.

Independent of glucose, ingestion of protein evokes an insulinotropic response due to enterogastric incretin hormones and hyperaminoacidemia. The aim of this study was to characterise insulin and incretin secretion in healthy young women (age 22.0 ± 1.2 y, n = 8) following acute ingestion of a milk based protein matrix (MPM) containing casein, whey protein and whey protein hydrolysates with in vitro dipeptidyl peptidase IV (DPP-IV) inhibitory activity. Following ingestion of 0.33 g protein/kg body mass, plasma insulin, glucose, glucagon, total glucose-dependent insulinotropic polypeptide (GIP), active glucagon-like peptide-1 (GLP-1), DPP-IV activity and amino acids were measured over a 3 h period. These biomarkers were also determined following ingestion of an isocaloric maltodextrin drink (MALT) in order to estimate the equivalent glucose-dependent response. Ingestion of MPM evoked ~50% of the insulin response obtained with MALT without hyperglycaemia. Time-dependent changes in plasma GIP, GLP-1 and amino acid levels indicated these factors were probably regulators of insulin secretion on MPM ingestion.

Resumen: Introducción: El objetivo de este trabajo es doble. Por una parte, identificar y caracterizar los indicadores de producción, citación, impacto y colaboración del área Pediatrics del Journal Citation Reports, y por otra, estudiar a la revista Anales de Pediatría en el contexto de las revistas españolas de otras 20 áreas y especialidades médicas. Material y método: Las fuentes de información utilizadas para la obtención de los indicadores fueron Science Citation Index-Expanded, Journal Citation Reports y Scimago Journal & Country Rank. Se realizó un análisis de regresión para comprobar la correlación entre la citación y otras variables. Resultados: Pediatrics ocupó el 8.o lugar en producción científica durante la década 2009-2018. En citas por revista se sitúa en el puesto 17.o y la media de citas por artículo se acerca a las 27, ocupando en este caso el puesto 18.o. Por debajo de Pediatrics se sitúan Emergency Medicine, Rehabilitation y Primary Health Care. El 12,47% de los artículos no fueron citados. El factor de impacto medio la sitúa en el puesto 18.o y su índice h fue 197, alcanzando la posición 14.a y situándose por encima de otras 7 áreas. El porcentaje de trabajos realizados en colaboración internacional fue del 17,71%, por encima de Primary Health Care (12,88%), Oncology (16,37%) y Emergency Medicine (17,03%). Entre las revistas españolas, Anales de Pediatría fue la cuarta revista más productiva y en número de citas ocupó una posición intermedia. Conclusiones: Los indicadores de citación e impacto del área Pediatrics suelen situarse por encima de áreas como Emergency Medicine, Primary Health Care, Dentistry, Oral Surgery & Medicine y Rehabilitation. El ejercicio profesional fuera de los grandes centros hospitalarios, unido a la deficiente financiación y al escaso número de ensayos clínicos debido a las exigencias éticas impuestas a los estudios con población infantil, pueden ser las causas que provocan unos indicadores de citación e impacto moderados. Abstract: Introduction: The purpose of this paper is twofold. On the one hand, to identify and characterise the production, citation, impact and collaboration indicators of the Pediatrics area of the Journal Citation Reports, and on the other hand, to place the journal Anales de Pediatría in the context of the Spanish journals of another twenty areas and medical specialties. Material and method: The sources of information used to obtain the indicators were Science Citation Index-Expanded, Journal Citation Reports, and Scimago Journal & Country Rank. A regression analysis was performed to determine the correlation between the citation and other variables. Results: Pediatrics ranked 8th in scientific production during the period 2009-2018. In citations per journal it ranks 17th, and the average citations per article approaches 27, occupying, in this case, the 18th position. Below Pediatrics are Emergency Medicine, Rehabilitation, and Primary Health Care. There are no citations for 12.47% of the articles. The average impact factor places the area in 18th place and its h index was 197, reaching 14th position, and standing above seven other areas. The percentage of works carried out with international collaboration was 17.71%, above Primary Health Care (12.88%), Oncology (16.37%), and Emergency Medicine (17.03%). Among the Spanish journals, Anales de Pediatría was the fourth most productive journal, and occupied an intermediate position in terms of the number of citations. Conclusions: The indicators of citation and impact of the Pediatrics area tend to be above areas such as Emergency Medicine, Primary Health Care, Dentistry, Oral Surgery & Medicine, and Rehabilitation. Professional practice outside large hospitals, together with poor funding, as well as the low number of clinical trials due to the ethical requirements imposed on studies with children, may be the causes that result in moderate citation and impact indicators.

Introduction: The purpose of this paper is twofold. On the one hand, to identify and characterise the indicators of production, citation, impact and collaboration of the Pediatrics area of the Journal Citation Reports, and on the other, to place the journal Anales de Pediatría in the context of the Spanish journals of another twenty areas and medical specialties. Material and Method: The sources of information used to obtain the indicators were Science Citation Index- Expanded, Journal Citation Reports and Scimago Journal & Country Rank. A regression analysis was performed to check the correlation between the citation and other variables. Results: Pediatrics ranked 8th in scientific production during the period 2009–2018. In citations per journal it ranks 17th and in the average citations per article it approaches 27, occupying in this case the 18th position. Below Pediatrics are Emergency Medicine, Rehabilitation and Primary Health Care. 12.47% of the articles were not cited. The average impact factor places the area in 18th place and its h index were 197, reaching 14th position and standing above seven other areas. The percentage of works carried out in international collaboration was 17.71%, above Primary Health Care (12.88%), Oncology (16.37%) and Emergency Medicine (17.03%). Among the Spanish journals, Anales de Pediatría was the fourth most productive journal and occupied an intermediate position in terms of the number of citations. Conclusions: The indicators of citation and impact of the Pediatrics area tend to be above areas such as Emergency Medicine, Primary Health Care, Dentistry, Oral Surgery & Medicine and Rehabilitation. Professional practice outside large hospitals, together with poor funding and the low number of clinical trials due to the ethical requirements imposed on studies with children, may be the causes that result in moderate citation and impact indicators. Resumen: Introducción: El objetivo de este trabajo es doble. Por una parte, identificar y caracterizar los indicadores de producción, citación, impacto y colaboración del área Pediatrics del Journal Citation Reports, y por otra, estudiar a la revista Anales de Pediatría en el contexto de las revistas españolas de otras 20 áreas y especialidades médicas. Material y método: Las fuentes de información utilizadas para la obtención de los indicadores fueron Science Citation Index-Expanded, Journal Citation Reports y Scimago Journal & Country Rank. Se realizó un análisis de regresión para comprobar la correlación entre la citación y otras variables. Resultados: Pediatrics ocupó el 8.° lugar en producción científica durante la década 2009–2018. En citas por revista se sitúa en el puesto 17.° y la media de citas por artículo se acerca a las 27, ocupando en este caso el puesto 18.°. Por debajo de Pediatrics se sitúan Emergency Medicine, Rehabilitation y Primary Health Care. El 12,47% de los artículos no fueron citados. El factor de impacto medio la sitúa en el puesto 18.o y su índice h fue 197, alcanzando la posición 14.a y situándose por encima de otras 7 áreas. El porcentaje de trabajos realizados en colaboración internacional fue del 17,71%, por encima de Primary Health Care (12,88%), Oncology (16,37%) y Emergency Medicine (17,03%). Entre las revistas españolas, Anales de Pediatría fue la cuarta revista más productiva y en número de citas ocupó una posición intermedia. Conclusiones: Los indicadores de citación e impacto del área Pediatrics suelen situarse por encima de áreas como Emergency Medicine, Primary Health Care, Dentistry, Oral Surgery & Medicine y Rehabilitation. El ejercicio profesional fuera de los grandes centros hospitalarios, unido a la deficiente financiación y al escaso número de ensayos clínicos debido a las exigencies éticas impuestas a los estudios con población infantil, pueden ser las causas que provocan unos indicadores de citación e impacto moderados.

Purpose: There is limited literature characterizing intermediate-term surgical and clinical outcomes of basal thumb arthritis after trapeziectomy and modified abductor pollicis longus suspension arthroplasty (APLSA). We hypothesized that patients who underwent APLSA would have favorable intermediate-term outcomes. Methods: Patients were contacted after APLSA at a median follow-up of 4.8 years (interquartile range, 3.0–6.0 years). Follow-up clinical evaluation included grip, key pinch, and tip pinch strength. We obtained patient-reported outcomes surveys: visual analog pain score and Disabilities of the Arm, Shoulder, and Hand score. Information on demographics, surgical information, and complications was obtained from the electronic medical record and patient interviews. Results: This study evaluated 66 hands in 60 patients (51 women and 9 men, average age 60.4 years at surgery). At the time of index surgery, 8% of hands had prior ipsilateral surgery (not involving the carpometacarpal joint), 56% had concurrent ipsilateral surgery (35% carpal tunnel release, 32% hemitrapezoid resection, 22% other soft tissue procedures (mucous cyst excision, ganglion cyst excision, or trigger finger release), 5% metacarpal capsulodesis, and 5% metacarpal arthrodesis. Median time between operation and most recent evaluation was 4.8 years (interquartile range, 3.0–6.0 years). Operative hand grip (18.7 ± 11.1 kg), key pinch (4.7 ± 2.1 kg), and tip pinch (3.2 ± 1.7 kg) strength was 94%, 84%, and 86%, respectively, of nonsurgical grip, key pinch, and tip pinch strength. Median (interquartile range) outcomes were a visual analog pain score of 0.0 (0.0–2.0) and Disabilities of the Arm, Shoulder, and Hand score of 9.1 (2.3–26.1). Conclusions: Results at 4.8 years for APLSA demonstrated 84% to 94% grip, key pinch, and tip pinch compared with the contralateral side. Patients experienced little to no pain in the operated joint and minimal disability of the upper extremity at intermediate-term follow-up. Abductor pollicis longus suspension arthroplasty is a favorable procedure for achieving pain relief and functional use associated with basal thumb arthritis. Type of study/level of evidence: Prognostic IV. Key words: abductor pollicis longus, basal joint arthritis, carpometacarpal arthritis, suspensionplasty, trapeziectomy

Milk protein derived peptides have numerous well-documented bioactive properties. The conventional approach for the generation, identification and validation of bioactive peptides (BAPs) has involved (i) protein hydrolysis, (ii) bioactivity screening and (iii) validation in vivo. The low potency (in comparison to conventional drugs), susceptibility to breakdown during gastrointestinal transit and low intestinal permeability are key challenges in the development of highly bioactive food protein hydrolysates/peptides. However, the generation of potent and effective health enhancing hydrolysates/peptides can benefit from a range of in silico techniques including the application of structure bioactivity relationship modelling (e.g., quantitative structure activity relationship (QSAR) modelling), molecular docking and design of experiments (DOE) approaches to optimise BAP production and identification. Some examples of how these approaches have been employed in BAP discovery and generation will be outlined.