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Neuroimaging research on functional connectivity can provide valuable information on the developmental differentiation of the infant cerebral cortex into its functional areas. We examined healthy neonates to comprehensively map brain functional connectivity using a combination of local measures that uniquely capture the rich spatial structure of cerebral cortex functional connections. Optimal functional MRI scans were obtained in 61 neonates. Local functional connectivity maps were based on Iso-Distance Average Correlation (IDAC) measures. Single distance maps and maps combining three distinct IDAC measures were used to assess different levels of cortical area functional differentiation. A set of brain areas showed higher connectivity than the rest of the brain parenchyma in each local distance map. These areas were consistent with those supporting basic aspects of the neonatal repertoire of adaptive behaviors and included the sensorimotor, auditory and visual cortices, the frontal operculum/anterior insula (relevant for sucking, swallowing and the sense of taste), paracentral lobule (processing anal and urethral sphincter activity), default mode network (relevant for self-awareness), and limbic-emotional structures such as the anterior cingulate cortex, amygdala and hippocampus. However, the results also indicate that brain areas presumed to be actively developing may not necessarily be mature. In fact, combined distance, second-level maps confirmed that the functional differentiation of the cerebral cortex into functional areas in neonates is far from complete. Our results provide a more comprehensive understanding of the developing brain systems, while also highlighting the substantial developmental journey that the neonatal brain must undergo to reach adulthood.

Amphibians and reptiles are important indicators of ecosystem health, yet their populations are declining worldwide due to habitat loss and climate change. Agroecosystems, such as coffee plantations, can provide important habitat for these species. We conducted field surveys in the Sumapaz region of Colombia to identify the habitat structural variables that influence the diversity and abundance of herpetofauna in coffee crops. The canonical correspondence analysis revealed that abundance of leaf litter, leaf litter moisture, shade percentage, plantation area, and plantation age category were the most important variables for determining herpetofauna diversity. Our findings suggest that shaded coffee plantations can sustain herpetofauna diversity, and maintaining a thick layer of leaf litter is critical for establishing complex and structured animal communities. This study proposes a set of sustainable agricultural management principles to promote the existence of amphibians and reptiles in coffee crops. By adopting these practices, it is possible to prevent the decline in the population of amphibians and reptiles due to the expansion of the agricultural frontier, as seen in other coffee-growing regions. The findings of this study contribute to a better understanding of how to balance agricultural production and biodiversity conservation in the context of agroecosystems.

During pregnancy, physiological changes in the immune response make pregnant women more susceptible to serious infection, increasing the risk for the mother as well as the foetus, newborn and infant. All women should be correctly and fully vaccinated as they enter their reproductive years, especially against diseases such as tetanus, hepatitis B, measles, rubella and varicella. In addition to the recommended vaccines, in risk situations, inactivated vaccines could be administered to women who were not correctly vaccinated before, while attenuated vaccines are contraindicated.Despite the fact that vaccination during pregnancy is a very important preventive measure and the existing recommendations from public health authorities, scientific societies and health professionals, the vaccination coverage could clearly be improved, especially against influenza and SARS-CoV-2, so any health professional involved in the care of pregnant women should proactively recommend these vaccines.The Spanish Association of Pediatrics (AEP), through its Advisory Committee on Vaccines, and the Spanish Society of Gynaecology and Obstetrics (SEGO) recommend vaccination against the following diseases during pregnancy: against influenza and COVID-19, in any trimester of pregnancy and during the postpartum period (up to 6 months post birth) in women not vaccinated during pregnancy; against pertussis, with the Tdap vaccine, between weeks 27 and 36 of gestation (in the CAV-AEP recommendations, preferably between weeks 27 and 28); and against RSV, with RSVPreF, between weeks 24 and 36 of gestation, preferably between weeks 32 and 36. Resumen: Durante el embarazo, los cambios fisiológicos en la respuesta inmunitaria favorecen que las gestantes sean más susceptibles a infecciones graves, tanto para ellas como para el feto, recién nacido y lactante. Todas las mujeres deberían entrar en el período reproductivo con su calendario vacunal correctamente cumplimentado, sobre todo en lo que respecta a enfermedades como tétanos, hepatitis B, sarampión, rubeola y varicela. Además de las vacunas recomendadas, en situaciones de riesgo las vacunas inactivadas podrían ser administradas en aquellas mujeres que no estuvieran correctamente inmunizadas con anterioridad, mientras que las atenuadas están contraindicadas.A pesar de que la vacunación durante el embarazo es una medida preventiva muy importante, y de las recomendaciones de autoridades sanitarias, sociedades científicas y profesionales sanitarios, las coberturas vacunales son claramente mejorables, especialmente en lo que respecta a gripe y COVID-19, por lo que todo profesional sanitario que atienda a la embarazada debe ser proactivo en aconsejarlas.La Asociación Española de Pediatría, a través de su Comité Asesor de Vacunas, y la Sociedad Española de Ginecología y Obstetricia recomiendan las siguientes vacunaciones durante la gestación: frente a gripe y COVID-19, en cualquier trimestre del embarazo, y durante el puerperio (hasta los 6 meses) en aquellas que no hubieran sido vacunadas durante la gestación; frente a tosferina con Tdpa, entre las 27 y 36 semanas de gestación (el CAV-AEP da preferencia entre las 27 y 28 semanas); y frente al VRS con RSVPreF, entre las 24 y 36 semanas de gestación, de preferencia entre las 32 y 36 semanas.

Background: There is little evidence regarding the characteristics of adults who self-reported not having had COVID-19 after two years of the pandemic. This study aimed to analyse the characteristics of no-COVID-19 respondents and the associated factors to better understand which may have conditioned not having had the disease as guidance to help in the design of better public health strategies. Methods: This cross-sectional, observational study was conducted in the Spanish general population in a representative sample of 1051 adults who completed an online survey in September 2022. Multivariable logistic regression was performed to assess which factors were related to reporting not having had COVID-19. Results: Almost half of the respondents (47.8%) reported not having ever had COVID-19. Significant differences were found between people who reported having had and not having had COVID-19 according to sex, age, education level, employment and living with children. No-COVID-19 respondents had greater concern and less fear of the disease and were more worried about the new variants. After the multivariable analysis, factors associated with no-COVID-19 respondents were male sex (OR)=1.40; 95% (CI=1.07–1.82), older age (OR=1.01; 95% CI=1.01–1.03), having a greater perception of disease severity if infected (OR=4.71; 95% CI=2.97–7.47), greater adherence to preventive measures (OR=1.02; 95% CI=1.01–1.03), and having received a complete vaccination schedule and booster dose (OR=1.56; 95% CI=1.03–2.36). Conclusions: Analysing the characteristics of people reporting not having had COVID-19 can support public health decision-makers in designing better interventions and facilitating the implementation of effective prevention and control measures to prepare for and respond to a possible future pandemic.

Summary: Background & Aims: Overweight and obesity in children are a public health problem worldwide. There are few studies about nutritional interventions with different diet macronutrient distribution and their potential application in regulating food consumption in this age group. This study aimed to assess the impact of a high protein diet over satiety, energy intake, and body composition in children diagnosed with overweight (Ov) or obesity (Ob). Methods: School-age children (6–10 years) diagnosed Ov or Ob were randomized to receive three different dietary interventions for two months: standard diet (SD), high protein (HP) diet, and HP diet with calcium caseinate (HPC); BMI (Z-score and percentiles), body composition, indirect calorimetry (REEIC), energy intake (24-h recall questionnaire) and satiety (visual analog scale) were evaluated before and two-months after intervention. Results: Sixty-four children diagnosed with overweight (12.5%) and obesity (87.5%) were evaluated. There were no changes in the perception of satiety between groups (p>0.05). There was a tendency for a reduction in waist circumference in the HPC group after treatment (p=0.05). There were no significant differences in body composition, and children's growth was homogeneous between groups. However, intragroup Z-score values for BMI were significantly reduced in all groups (p

Summary: Background: Neuroimaging-based brain-age delta has been shown to be a mediator linking cardiovascular risk factors to cognitive function. We aimed to assess the mediating role of brain-age delta in the association between modifiable risk factors of dementia and longitudinal cognitive decline in middle-aged and older individuals who are asymptomatic, stratified by Alzheimer's disease pathology. We also explored whether the mediation effect is specific to cognitive domain. Methods: In this cohort study, we included participants from the ALFA+ cohort aged between 45 years and 65 years who were cognitively unimpaired and who had available structural MRI, cerebrospinal fluid β-amyloid (Aβ)42 and Aβ40 measurements obtained within 1 year of each other, modifiable risk factors assessment, and cognitive evaluation over 3 years. Participants were recruited from the Barcelonaβeta Brain Research Center (Barcelona, Spain). Included individuals underwent a first assessment between Oct 25, 2016, and Jan 28, 2020, and a follow-up cognitive assessment 3·28 (SD 0·27) years later. We computed brain-age delta and composites of different cognitive function domains (preclinical Alzheimer's cognitive composite [PACC], attention, executive function, episodic memory, visual processing, and language). We used partial least squares path modelling to explore mediation effects in the associations between modifiable risk factors (including cardiovascular, mental health, mood, metabolic or endocrine history, and alcohol use) and changes in cognitive composites. To assess the role of Alzheimer's disease pathology, we computed separate models for Aβ-negative and Aβ-positive individuals. Findings: Of the 419 participants enrolled in ALFA+, 302 met our inclusion criteria, of which 108 participants were classified as Aβ-positive and 194 as Aβ-negative. In Aβ-positive individuals, brain-age delta partially mediated (percent mediation proportion 15·73% [95% CI 14·22–16·66]) the association between modifiable risk factors and decline in overall cognition (across cognitive domains). Brain-age delta fully mediated (mediation proportion 28·03% [26·25–29·21]) the effect of modifiable risk factors on the PACC, wherein increased values for risk factors correlated with an older brain-age delta, and, consequently, an older brain-age delta was linked to greater PACC decline. This effect appears to be primarily driven by memory decline. Mediation was not significant in Aβ-negative individuals (3·52% [0·072–4·17]) on PACC, although path coefficients were not significantly different from those in the Aβ-positive group. Interpretation: Our findings suggest that brain-age delta captures the association between modifiable risk factors and longitudinal cognitive decline in middle-aged and older people. In asymptomatic middle-aged and older individuals who are Aβ-positive, the pathology might be the strongest driver of cognitive decline, whereas the effect of risk factors is smaller. Our results highlight the potential of brain-age delta as an objective outcome measure for preventive lifestyle interventions targeting cognitive decline. Funding: La Caixa Foundation, the TriBEKa Imaging Platform, and the Universities and Research Secretariat of the Catalan Government. Translation: For the Spanish translation of the abstract see Supplementary Materials section.

In this study, hydrogen production by steam reforming was carried out in a tubular fixed-bed reactor. The influence of some operating variables such as temperature, flow rate of the feeding glycerol solution and space velocity on hydrogen production under a non-catalyzed reaction was analyzed. The results showed that the hydrogen yield increased with temperature and decreased with the space velocity. As the feedstock flow rate increased, the hydrogen yield decreased rapidly. Compared with a reference experiment without fixed-bed, the use of non-porous alumina fixed-bed showed better results. Under the best reaction conditions (900 °C and a feedstock flow rate of 0.85 g/min), 17 L/h of syngas were obtained, with a purity of about 55% of hydrogen and a production of 2.7 moles of hydrogen by mol of glycerol.

According to World Health Organization estimates, more than 1 million patients aged less than 15 years develop tuberculosis (TB) each year worldwide. In some regions, up to 25% of new TB cases are caused by drug-resistant strains. Although Spain is considered a low-incidence country, several hundred children and adolescents develop TB each year. The importance of paediatric TB has been minimized for years due to the lack of microbiological confirmation in many patients and because these patients are not usually contagious. Nevertheless, in the past 15 years there have been major improvements in the epidemiological reporting of TB in children and adolescents, new immunodiagnostic tests have been developed, molecular methods that allow rapid microbiological diagnosis and detection of variants associated with drug resistance have become available, novel second-line antituberculosis drugs have been discovered, including for paediatric use, and the results of clinical trials have validated shorter courses of treatment for some patients. This document, developed by a group of experts from the Sociedad Española de Infectología Pediátrica and the Sociedad Española de Neumología Pediátrica, updates and complements the previous guidelines for the diagnostic and therapeutic management of children with TB in Spain based on the newly available scientific evidence. Resumen: Más de un millón de pacientes menores de 15 años desarrollan tuberculosis (TB) anualmente en el Mundo, según estimaciones de la Organización Mundial de Salud. La TB por cepas resistentes a los fármacos de primera línea alcanza al 25% de los nuevos casos en algunas regiones. Aunque España es considerada un país de baja incidencia, varios centenares de niños y adolescentes enferman de TB cada año. La importancia de la TB pediátrica ha sido minimizada durante años por la dificultad en confirmar el diagnóstico microbiológico y la escasa contagiosidad que asocia. Sin embargo, en los últimos 15 años, se han reportado mejoras relevantes en los informes epidemiológicos de la TB en niños y adolescentes, han surgido nuevos tests inmunodiagnósticos, se dispone de estudios de biología molecular que permiten un diagnóstico microbiológico y una identificación de mutaciones asociadas a resistencia rápidos, han surgido nuevos fármacos antituberculosos de segunda línea, también en pediatría, y se han publicado ensayos clínicos que validan tratamientos acortados en algunos pacientes. Este documento, realizado por un grupo de expertos de la Sociedad Española de Infectología Pediátrica y la Sociedad Española de Neumología Pediátrica, actualiza y complementa las recomendaciones previas para el manejo diagnóstico y terapéutico del niño con TB en España, en base a las nuevas evidencias científicas disponibles.

The bagasse of Agave salmiana (maguey pulquero) is a residue generated during the exploitation of the plant to obtain pulque, inulin, honey, etc. Due to its chemical composition, it can be used for the cultivation of fungi of the Pleurotus genus and the subsequent use of the degraded material ''degraded substrate (DS)'' as a support for the germination of vegetables. The objective of the study was to characterize the bagasse of maguey pulquero biodegraded by Pleurotus djamor as a new perspective in its value chain, and subsequent use for the germination of Lycopersicon esculetum (tomato). The DS was recovered at 60 d from the P. djamor culture, characterized physicochemically and the conformation of the plant tissue was observed by scanning electron microscopy. The DS showed a decrease in protein (4.8–3.3 %) content and fibrous fraction (54–36 %), but dry matter digestibility increased from 47 to 71 %; in addition, changes in mineral composition were observed, mainly in calcium concentration (6 %). Due to its composition, it is possible to revalue DS in the germination of L. esculetum to reduce the use of peat moss (commercial peat). The results show that up to 25 % of maguey DS mixed with 75 % peat moss can be used (25:75), reaching a germination percentage of 85 % and increasing the seedling emergence speed index from 0.96 – 1.25. Concluding that it is possible to implement a circular strategy in which agave bagasse is used for mushroom cultivation and the subsequent recovery of the spent substrate for tomato germination.

Background: Giant cerebral aneurysms are rare lesions which are defined as aneurysms with a diameter greater than 2.5 cm. This group includes giant thrombosed cerebral aneurysms that can remain clinically asymptomatic for a long time or produce symptoms related to the mass effect on surrounding structures which simulates other pathologies, both clinically and radiologically. Thus, their diagnosis is a challenge. Methods: A retrospective review of the patients treated at the Neurosurgery Department in Centro Médico Nacional Siglo XXI from 2010 to 2023 was made. Only those with an initial misdiagnosis and a final diagnosis of giant thrombosed cerebral aneurysm were selected. Results: Eleven patients were included in this series, they all had an initial diagnosis of another pathology, mostly tumors, and a final diagnosis of cerebral aneurysm. Three patients were diagnosed transoperatively and eight patients were diagnosed preoperatively after additional imaging studies were made. Nine patients were treated with open surgery (eight clippings and one bypass), one patient had endovascular treatment and one patient was kept in observation. Four patients passed away, seven had a neurological improvement or remained with the same neurological status. Conclusions: Even with the advances in technology and imaging studies, diagnosis of these lesions is a challenge since they do not have distinct clinical and imaging characteristics. The diagnosis can be suspected in patients with an insidious presentation, slowly progressive symptoms, and neurologic deficit seemingly secondary to lesion mass effect that in MRI and/or CT have rounded, heterogeneous lesions with calcification towards the periphery, with flow voids (even if small), and heterogeneous reinforcement with contrast that seems to diminish towards the periphery. Cerebral angiography can sometimes offer valuable information about the aneurysmal neck and the parent vessel, but it gives little to no information about the dome due to the thrombosis, these lesions can even be invisible.

The study of diets in North American carnivores has been assessed from different methods, essentially analyzing the composition of their diet, and classifying the species based on the breadth of their trophic niche. Still, studies that explore aspects of their interactions are limited. This work studies the predator-prey relationship through an interaction network analysis approach, nesting, and the analysis of core vs peripheral individuals, for two sympatric species of the Mexican highlands, the bobcat (Lynx rufus) and the coyote (Canis latrans). In addition, the effect on the structure of the interaction networks under two conditions of environmental disturbance was evaluated. In environments with high disturbance: A network was obtained for 46 bobcats and 18 coyotes, identifying six bobcats and five core coyotes; and in environments with low disturbance, the network was obtained for 134 bobcats and 38 coyotes, identifying 30 bobcats and eight core coyotes. Three of the analyzed networks presented a nested pattern with the WNOFD metric (High disturbance: L. rufus: Nesting = 0.51, p

The purpose of this research is to assess the impact of Green Human Resource Management (GHRM) on the economic, social, and environmental performance of Spanish wineries. Additionally, age, size, and Protected Designation of Origin (PDO) membership are introduced as control variables in order to increase the accuracy of the cause-effect associations examined. To reach this objective, a conceptual model has been constructed and assessed through Structural Equation Modeling (PLS-SEM) using data gathered from a survey conducted between September 2022 and January 2023, involving 196 Spanish wineries. The results demonstrate the occurrence of a positive and meaningful relationship between GHRM activities and the three yield typologies assessed in the Spanish wine context. This study is novel in the academic literature on environmental and human resource management, since, to the best of our knowledge, no previous research has looked into the effect of GHRM on the sustainable performance of Spanish wineries. Thus, it is useful for both academics and wine industry professionals who are examining potential variables that can catalyze winery performance.

Complementary feeding (CF) is defined as the feeding of infants that complements breastfeeding, or alternatively, feeding with a breast milk substitute, and is a process that is more than simply a guide as to what and how to introduce foods. The information provided by healthcare professionals must be up-to-date and evidence-based. Most of the recommendations that appear in the different international guidelines and position papers are widely applicable, but some must be regionalized or adapted to fit the conditions and reality of each geographic zone. The Nutrition Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) summoned a group of experts from each of the society’s member countries, to develop a consensus on CF, incorporating, whenever possible, local information adapted to the reality of the region. The aim of the present document is to show the results of that endeavor. Utilizing the Delphi method, a total of 34 statements on relevant aspects of CF were evaluated, discussed, and voted upon. Resumen: La alimentación complementaria (AC) se define como la alimentación de los lactantes que complementa a la lactancia humana o en su defecto, a la lactancia con un sucedáneo de la leche humana, y es un proceso que va más allá de simplemente una guía sobre qué y cómo introducir los alimentos. La información brindada por parte de los profesionales de la salud debe ser actualizada y basada en evidencia. Existen diferentes guías o documentos de posición a nivel internacional, que, aunque la mayoría de las recomendaciones pueden ser aplicables, hay algunas otras que requieren una regionalización o adecuación a las condiciones y realidad de cada zona. El grupo de trabajo de Nutrición de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica convocó a un grupo de expertos, representantes de cada uno de los países que conforman la sociedad, con el objetivo de desarrollar un consenso sobre AC, que incorporó cuando así fue posible, información local que se adapte a la realidad de la región. El objetivo de este documento es mostrar los resultados de dicho trabajo. A través de metodología Delphi, se evaluaron, discutieron y votaron un total de 34 declaraciones o enunciados con respecto a aspectos relevantes de la AC.

Resumen: La alimentación complementaria (AC) se define como la alimentación de los lactantes que complementa a la lactancia materna o en su defecto, a la lactancia con un sucedáneo de la leche materna, y es un proceso que va más allá de simplemente una guía sobre qué y cómo introducir los alimentos. La información brindada por parte de los profesionales de la salud debe ser actualizada y basada en evidencia. Existen diferentes guías o documentos de posición a nivel internacional, que, aunque la mayoría de las recomendaciones pueden ser aplicables, hay algunas otras que requieren una regionalización o adecuación a las condiciones y realidad de cada zona. El grupo de trabajo de Nutrición de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica convocó a un grupo de expertos, representantes de cada uno de los países que conforman la sociedad, con el objetivo de desarrollar un consenso sobre la AC, que incorporó cuando así fue posible, información local que se adapte a la realidad de la región. El objetivo de este documento es mostrar los resultados de dicho trabajo. A través de metodología Delphi, se evaluaron, discutieron y votaron un total de 34 declaraciones o enunciados con respecto a aspectos relevantes de la AC. Abstract: Complementary feeding (CF) is defined as the feeding of infants that complements breastfeeding, or alternatively, feeding with a breast milk substitute, and is a process that is more than simply a guide as to what and how to introduce foods. The information provided by healthcare professionals must be up-to-date and evidence-based. Most of the recommendations that appear in the different international guidelines and position papers are widely applicable, but some must be regionalized or adapted to fit the conditions and reality of each geographic zone. The Nutrition Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) summoned a group of experts from each of the society's member countries, to develop a consensus on CF, incorporating, whenever possible, local information adapted to the reality of the region. The aim of the present document is to show the results of that endeavor. Utilizing the Delphi method, a total of 34 statements on relevant aspects of CF were evaluated, discussed, and voted upon.

Resumen: Introducción y objetivos: El eccema de contacto es un motivo frecuente de consulta. El grado y la frecuencia de sensibilización a alérgenos varían dependiendo de la población de referencia atendida. Revisamos los resultados de sensibilización a alérgenos de la Batería Estándar Española en una población dedicada mayoritariamente al sector turístico (Islas Canarias). Material y métodos: Estudio descriptivo retrospectivo tomando la base de datos de la Unidad de Dermatitis de Contacto del Servicio de Dermatología del Complejo Hospitalario Universitario Insular de Las Palmas de Gran Canaria, incluyéndose pacientes parcheados con la Batería Estándar Española desde enero de 2005 hasta junio de 2018. Se recogieron edad, sexo, atopia, localización, positividades y relevancia. Resultados: Se estudiaron 1.568 pacientes. El 71,6% fueron mujeres, con una baja proporción de atopia (14,2%) y dermatitis ocupacional (15,8%). La mayoría fueron mayores de 40 años (65,2%). Los alérgenos positivos más frecuentes fueron níquel (36,5%), metilcloroisotiazolinona/metilisotiazolinona (11,9%), metilisotiazolinona (11,8%), parafenilendiamina (7,5%) y dicromato potásico (6,3%). Conclusiones: En la población estudiada se observa una mayor frecuencia de sensibilización respecto al resto de España para la mayoría de los alérgenos, siendo estas diferencias especialmente llamativas en el caso del níquel, de la metilcloroisotiazolinona/metilisotiazolinona y de la parafenilendiamina. Abstract: Background and objectives: Contact dermatitis is a common reason for consultation in dermatology. Sensitization levels and frequency, however, vary from one population to the next. The aim of this study was to review patch test results showing sensitization to allergens in the Spanish standard series in the Canary Islands, where a large proportion of the population works in tourism. Material and methods: Retrospective, descriptive study of data from the dermatology department's contact dermatitis unit at Complejo Hospitalario Universitario Insular in Las Palmas de Gran Canaria, Spain. We studied results recorded for patients patch tested with the Spanish standard series between January 2005 and June 2018. Results: Data for 1568 patients were studied; 71.6% were women, and overall rates of atopy (14.2%) and occupational dermatitis (15.8%) were low. Most patients with a positive test (65.2%) were older than 40 years. The main allergens eliciting positive reactions were nickel (36.5%), methylchloroisothiazolinone/methylisothiazolinone (11.9%), methylisothiazolinone (11.8%), paraphenylenediamine (7.5%), and potassium dichromate (6.3%). Conclusions: Contact sensitization rates were higher than those reported elsewhere in Spain for most of the allergens studied. The differences were particularly notable for nickel, methylchloroisothiazolinone/methylisothiazolinone, and paraphenylenediamine.

Resumen: El Servicio Canario de la Salud es consciente de los riesgos para la salud derivados del cambio climático y de que los sistemas de salud deben ser, con su acción, parte de la solución y no parte del problema. Actualmente, el 4,4% de las emisiones mundiales de dióxido de carbono provienen de actividades relacionadas con el ámbito sanitario. Para dar respuesta a esta situación, el Servicio Canario de la Salud ha puesto en marcha la estrategia «Salud Zer0 Emisiones Netas 2030», con la que se pretende alcanzar la neutralidad en emisiones netas de carbono en el año 2030 aplicando medidas tanto directas como indirectas, en especial sobre la cadena de suministro del sistema público de salud de Canarias. Este proyecto es pionero en España y está sujeto a revisión continua, sumándose nuevas acciones concretas a la estrategia conforme se vaya cuantificando la huella de carbono de los diferentes procedimientos implicados en la prestación de servicios sanitarios. Abstract: The Canary Islands Health Service is aware of the health risks arising from climate change. So health systems must be, with their action, part of the solution, not part of the problem. Currently, 4.4% of global carbon dioxide emissions come from activities related to the health field. To respond to this situation, the Canary Islands Health Service has launched the “Carbon Net Zer0 2030” strategy intending to achieve neutrality in net carbon emissions in the year 2030, applying measures direct and indirect, especially on the supply chain of the public health system. This is a ground-breaking project in Spain and is under continuous review, adding new specific actions to the strategy as the carbon footprint of the different procedures involved in the provision of health services is quantified.

Cells release membrane-delimited particles into the environment. These particles are called “extracellular vesicles” (EVs), and EVs are present in fluids contacting cells, including body fluids and conditioned culture media. Because EVs change and contribute to health and disease, EVs have become a hot topic. From the thousands of papers now published on EVs annually, one easily gets the impression that EVs provide biomarkers for all diseases, and that EVs are carriers of all relevant biomolecules and are omnipotent therapeutics. At the same time, EVs are heterogeneous, elusive and difficult to study due to their physical properties and the complex composition of their environment. This overview addresses the current challenges encountered when working with EVs, and how we envision that most of these challenges will be overcome in the near future. Right now, an infrastructure is being developed to improve the reproducibility of EV measurement results. This infrastructure comprises expert task forces of the International Society of Extracellular Vesicles (ISEV) developing guidelines and recommendations, instrument calibration, standardized and transparent reporting, and education. Altogether, these developments will support the credibility of EV research by introducing robust reproducibility, which is a prerequisite for understanding their biological significance and biomarker potential.

Background: Oxidative stress has a predominant role in the pathogenesis of neurodegenerative diseases and therefore the modulation of genes and the identification of biological pathways associated with antioxidant therapies, have an impact on its treatment. Objective: The objective of this study was the comparison of 2 methods for the analysis of real-time PCR (qPCR) data, through the use of the evaluation of genes that mediate the effect of Phycocyanobilin (PCB) and its validation in animal models. Methods: We evaluated the effect of PCB:” in vitro” on gene modulation through qPCR analyzed by parametric ANOVA and multivariate principal component analysis (PCA) in a model of glutamate-induced excitotoxicity in the SH-SY5Y cell line and” in vivo”; in animal models of multiple sclerosis (MS) and cerebral ischemia (CI). Results: The results showed that PCA is a robust and powerful method that allows the assessment of gene expression profiles. We detected the significant down-regulation of the CYBB (NOX2), and HMOX1 by the action of PCB in SH-5YSH cell line insulted with Glutamate. The decrease in pro-inflammatory cytokines and markers related to apoptosis and innate immune response, mediated the effect of PCB in the animal models of MS and CI, respectively. Conclusion: We concluded that the mechanisms by which PCB protected cells included the reduction of oxidative stress damage, which could contribute to its clinical efficacy for the treatment of neurodegenerative diseases.

Background and objectives: Contact dermatitis is a common reason for consultation in dermatology. Sensitization levels and frequency, however, vary from one population to the next. The aim of this study was to review patch test results showing sensitization to allergens in the Spanish standard series in the Canary Islands, where a large proportion of the population works in tourism. Material and methods: Retrospective, descriptive study of data from the dermatology department's contact dermatitis unit at Complejo Hospitalario Universitario Insular in Las Palmas de Gran Canaria, Spain. We studied results recorded for patients patch tested with the Spanish standard series between January 2005 and June 2018. Results: Data for 1568 patients were studied; 71.6% were women, and overall rates of atopy (14.2%) and occupational dermatitis (15.8%) were low. Most patients with a positive test (65.2%) were older than 40 years. The main allergens eliciting positive reactions were nickel (36.5%), methylchloroisothiazolinone/methylisothiazolinone (11.9%), methylisothiazolinone (11.8%), paraphenylenediamine (7.5%), and potassium dichromate (6.3%). Conclusions: Contact sensitization rates were higher than those reported elsewhere in Spain for most of the allergens studied. The differences were particularly notable for nickel, methylchloroisothiazolinone/methylisothiazolinone, and paraphenylenediamine. Resumen: Introducción y objetivos: El eccema de contacto es un motivo frecuente de consulta. El grado y la frecuencia de sensibilización a alérgenos varían dependiendo de la población de referencia atendida. Revisamos los resultados de sensibilización a alérgenos de la Batería Estándar Española en una población dedicada mayoritariamente al sector turístico (Islas Canarias). Material y métodos: Estudio descriptivo retrospectivo tomando la base de datos de la Unidad de Dermatitis de Contacto del Servicio de Dermatología del Complejo Hospitalario Universitario Insular de Las Palmas de Gran Canaria, incluyéndose pacientes parcheados con la Batería Estándar Española desde enero de 2005 hasta junio de 2018. Se recogieron edad, sexo, atopia, localización, positividades y relevancia. Resultados: Se estudiaron 1.568 pacientes; 71,6% fueron mujeres, con una baja proporción de atopia (14,2%) y dermatitis ocupacional (15,8%). La mayoría fueron mayores de 40 años (65,2%). Los alérgenos positivos más frecuentes fueron níquel (36,5%), metilcloroisotiazolinona/metilisotiazolinona (11,9%), metilisotiazolinona (11,8%), parafenilendiamina (7,5%) y dicromato potásico (6,3%). Conclusiones: En la población estudiada se observa una mayor frecuencia de sensibilización respecto al resto de España para la mayoría de los alérgenos, siendo estas diferencias especialmente llamativas en el caso del níquel, de la metilcloroisotiazolinona/metilisotiazolinona y de la parafenilendiamina.

Socioeconomic inequalities and their evolution in different historical contexts have been widely studied. However, some of their dimensions remain relatively unexplored, such as the role played by socioeconomic status in the trajectory of biological living standards, especially net nutritional status. The main objective of this article is to analyze whether the power of socioeconomic status (SES) to explain differences in the biological dimensions of human well-being (in this case, adult height, a reliable metric for health and nutritional status) has increased or diminished over time. Educational attainment and occupational category have been used as two different proxies for the SES of Spanish men and women born between 1940 and 1994, thus covering a historical period in Spain characterized by remarkable socioeconomic development and a marked increase in mean adult height. Our data is drawn from nine waves of the Spanish National Health Survey and the Spanish sample of two waves of the European Health Interview Survey (ENSE) for the period 1987 to 2017 (N = 73,699 citizens aged 23–47). A multivariate regression analysis has been conducted, showing that, as a whole, height differentials by educational attainment have diminished over time, whereas differences by occupational category of household heads have largely persisted. These results indicate the need for further qualification when describing the process of convergence in biological well-being indicators across social groups. For instance, the progressive enrollment of a greater proportion of the population into higher educational levels may lead us to underestimate the real differences between socioeconomic groups, while other proxies of SES still point to the persistence of such differences.

Extracellular vesicles (EVs) participate in cell-stroma crosstalk within the tumor microenvironment and fibroblasts (Fb) contribute to tumor promotion in thyroid cancer. However, the role of tumor-stroma derived EVs still needs to be deciphered. We hypothesized that the interaction of thyroid tumor cells with Fb would liberate EVs with a specific proteomic profile, which would have an impact on EV-functionality in thyroid tumor progression-related events. Tumor (TPC-1, 8505c) and non-tumor (NThyOri) thyroid cells were co-cultured with human Fb. EVs, obtained by ultracentrifugation of conditioned media, were characterized by nanoparticle tracking analysis and western blotting. EV-proteomic analysis was performed by mass-spectrometry, and metalloproteinases (MMPs) were studied by zymography. EV-exchange was evaluated using immunofluorescence, confocal microscopy and FACS. EVs expressed classical exosome markers, with EVs from thyroid tumor cell-Fb co-cultures showing a proteomic profile related to extracellular matrix (ECM) remodeling. Bidirectional crosstalk between Fb and TPC-1 cells produced significantly more EVs than their isolated cells, and potentiated EV-functionality. In line with this, Fb-TPC-1 derived EVs induced MMP2 activation in NThyOri supernatants, and MMP2 activity could be evidenced in Fb and TPC-1 contact-independent co-cultures. Besides, MMP2 interactors allowed us to discriminate between EVs from thyroid tumoral and non-tumoral milieus. Interestingly, Fb internalized more EVs from TPC-1 than from NThyOri producing cells. Fb and thyroid tumor cell crosstalk produces specialized EVs with an ECM remodeling proteomic profile, enabling activation of MMP2 and possibly facilitating ECM-degradation, which is potentially linked with thyroid tumor progression.

Background: PLA2G6-Associated Neurodegeneration (PLAN) is a rare neurodegenerative disease with autosomal recessive inheritance, which belongs to the NBIA (Neurodegeneration with Brain Iron Accumulation) group. Although the pathogenesis of the disease remains largely unclear, lipid peroxidation seems to play a central role in the pathogenesis. Currently, there is no cure for the disease. Objective: In this work, we examined the presence of lipid peroxidation, iron accumulation and mitochondrial dysfunction in two cellular models of PLAN, patients-derived fibroblasts and induced neurons, and assessed the effects of α-tocopherol (vitamin E) in correcting the pathophysiological alterations in PLAN cell cultures. Methods: Pathophysiological alterations were examined in fibroblasts and induced neurons generated by direct reprograming. Iron and lipofuscin accumulation were assessed using light and electron microscopy, as well as biochemical analysis techniques. Reactive Oxygen species production, lipid peroxidation and mitochondrial dysfunction were measured using specific fluorescent probes analysed by fluorescence microscopy and flow cytometry. Results: PLAN fibroblasts and induced neurons clearly showed increased lipid peroxidation, iron accumulation and altered mitochondrial membrane potential. All these pathological features were reverted with vitamin E treatment. Conclusions: PLAN fibroblasts and induced neurons reproduce the main pathological alterations of the disease and provide useful tools for disease modelling. The main pathological alterations were corrected by Vitamin E supplementation in both models, suggesting that blocking lipid peroxidation progression is a critical therapeutic target.

Resumen: Introducción: En 2014 se publicó el Documento de Consenso desarrollado por SEIP-SERPE-SEOP para el diagnóstico y el tratamiento de las infecciones osteoarticulares (IOA). En 2015 se constituyó RIOPed como red nacional multidisciplinar para la investigación en IOA. El objetivo del estudio ha sido valorar el grado de adecuación a las recomendaciones establecidas en el consenso durante un año de seguimiento. Material y métodos: Estudio prospectivo multicéntrico nacional realizado entre septiembre de 2015 y septiembre de 2016 en 37 hospitales con inclusión de pacientes menores de 16 años diagnosticados de IOA, confirmada mediante aislamiento microbiológico, o probable: artritis séptica (AS) con > 40.000 leucocitos en líquido sinovial u osteomielitis (OM)/osteoartritis (OA)/espondilodiscitis (ED) con prueba de imagen compatible. Los resultados se compararon con los obtenidos en el estudio retrospectivo realizado entre 2008 y 2012. Resultados: Se incluyeron 255 casos: 131 OM, 79 AS, 30 OA y 15 ED. Respecto a las pruebas complementarias que el consenso consideró de obligada realización, la radiografía se llevó a cabo en el 87,8% de los casos, el hemocultivo en el 91,6% y el cultivo de líquido sinovial en el 99% de AS. Se realizó RM en el 71% de las OM. La elección del tratamiento antibiótico intravenoso empírico se adecuó a las recomendaciones en el 65,1% de los casos, y en el 62,3% para el tratamiento oral. Se llevó a cabo cirugía en el 36,8% de las AS (85,7% artrotomía), con un descenso significativo respecto al estudio retrospectivo (p = 0,014). Solo el 58,5% de casos se ajustaron a las recomendaciones de duración del tratamiento; sin embargo, se comprobó una menor duración del tratamiento intravenoso. Conclusiones: En general, el grado de adecuación a las recomendaciones que marcaron el grupo de expertos es bueno para las pruebas complementarias y aceptable respecto a la elección del tratamiento antibiótico, aun detectándose casi un 40% de inadecuación. Se ha conseguido un descenso de la estancia hospitalaria. Abstract: Introduction: In 2014 the Consensus Document produced by the Spanish Paediatric Societies (SEIP-SERPE-SEOP) was published to help in the diagnosis and treatment of osteoarticular infections (OAI). In 2015 the RIOPed was considered as a multidisciplinary national network for the investigation into OAI. The aim of this study was to assess the level of adaption to the recommendations established in the Consensus during one year of follow-up. Material and methods: A prospective, national multicentre study was carried out in 37 hospitals between September 2015 and September 2016. The study included patients > 16 years-old with a diagnosis of OAI, confirmed by microbiological isolation, or probable: septic arthritis (SA) with > 40,000 white cells in synovial fluid, or osteomyelitis (OM)/spondylodiscitis (SD) with a compatible imaging test. The results were compared with those obtained in a retrospective study conducted between 2008 and 2012. Results: A total of 235 cases were included, of which 131 were OM, 79 SA, 30 OA, and 15 SD. As regards the complementary tests that the Consensus considered mandatory to perform, radiography was carried out on 87.8% of the cases, a blood culture on 91.6%, and culture of the synovial fluid in 99% of SA. A magnetic resonance (MR) was performed on 71% of the OM cases. The choice of intravenous empirical antibiotic treatment was adapted to the recommendations in 65.1% of cases, and in 62.3% for the oral treatment. Surgery was performed in 36.8% of SA cases (85.7% arthrotomy), with a significant decrease compared to the retrospective study (P = .014). Only 58.5% of cases followed the recommendations on the duration of the treatment; however, a lower duration of intravenous treatment was observed. Conclusions: In general, the level of adaptation to the recommendations that were set by the Expert Group, is good for the complementary tests, and acceptable as regards the choice of antibiotic treatment, although inadequate in almost 40% of cases. A decrease in hospital stay was achieved.

Introduction: In 2014 the Consensus Document produced by the Spanish Paediatric Societies (SEIP-SERPE-SEOP) was published to help in the diagnosis and treatment of osteoarticular infections (OAI). In 2015 the RIOPed was considered as a multidisciplinary national network for the investigation into OAI. The aim of this study was to assess the level of adaption to the recommendations established in the Consensus during one year of follow-up. Material and methods: A prospective, national multicentre study was carried out in 37 hospitals between September 2015 and September 2016. The study included patients >16 years-old with a diagnosis of OAI, confirmed by microbiological isolation, or probable: septic arthritis (SA) with >40,000 white cells in synovial fluid, or osteomyelitis (OM)/spondylodiscitis (SD) with a compatible imaging test. The results were compared with those obtained in a retrospective study conducted between 2008 and 2012. Results: A total of 235 cases were included, of which 131 were OM, 79 SA, 30 OA, and 15 SD. As regards the complementary tests that the Consensus considered mandatory to perform, radiography was carried out on 87.8% of the cases, a blood culture on 91.6%, and culture of the synovial fluid in 99% of SA. A magnetic resonance (MR) was performed on 71% of the OM cases. The choice of intravenous empirical antibiotic treatment was adapted to the recommendations in 65.1% of cases, and in 62.3% for the oral treatment. Surgery was performed in 36.8% of SA cases (85.7% arthrotomy), with a significant decrease compared to the retrospective study (P = .014). Only 58.5% of cases followed the recommendations on the duration of the treatment; however, a lower duration of intravenous treatment was observed. Conclusions: In general, the level of adaptation to the recommendations that were set by the Expert Group, is good for the complementary tests, and acceptable as regards the choice of antibiotic treatment, although inadequate in almost 40% of cases. A decrease in hospital stay was achieved. Resumen: Introducción: En 2014 se publicó el Documento de Consenso desarrollado por SEIP-SERPE-SEOP para el diagnóstico y el tratamiento de las infecciones osteoarticulares (IOA). En 2015 se constituyó RIOPed como red nacional multidisciplinar para la investigación en IOA. El objetivo del estudio ha sido valorar el grado de adecuación a las recomendaciones establecidas en el consenso durante un año de seguimiento. Material y métodos: Estudio prospectivo multicéntrico nacional realizado entre septiembre de 2015 y septiembre de 2016 en 37 hospitales con inclusión de pacientes menores de 16 años diagnosticados de IOA, confirmada mediante aislamiento microbiológico, o probable: artritis séptica (AS) con >40.000 leucocitos en líquido sinovial u osteomielitis (OM)/osteoartritis (OA)/espondilodiscitis (ED) con prueba de imagen compatible. Los resultados se compararon con los obtenidos en el estudio retrospectivo realizado entre 2008 y 2012. Resultados: Se incluyeron 255 casos: 131 OM, 79 AS, 30 OA y 15 ED. Respecto a las pruebas complementarias que el consenso consideró de obligada realización, la radiografía se llevó a cabo en el 87,8% de los casos, el hemocultivo en el 91,6% y el cultivo de líquido sinovial en el 99% de AS. Se realizó RM en el 71% de las OM. La elección del tratamiento antibiótico intravenoso empírico se adecuó a las recomendaciones en el 65,1% de los casos, y en el 62,3% para el tratamiento oral. Se llevó a cabo cirugía en el 36,8% de las AS (85,7% artrotomía), con un descenso significativo respecto al estudio retrospectivo (P = ,014). Solo el 58,5% de casos se ajustaron a las recomendaciones de duración del tratamiento; sin embargo, se comprobó una menor duración del tratamiento intravenoso. Conclusiones: En general, el grado de adecuación a las recomendaciones que marcaron el grupo de expertos es bueno para las pruebas complementarias y aceptable respecto a la elección del tratamiento antibiótico, aun detectándose casi un 40% de inadecuación. Se ha conseguido un descenso de la estancia hospitalaria.

Resumen: Introducción: Los grupos de morbilidad ajustados (GMA) y los clinical risk groups (CRG) son herramientas de estratificación poblacional basada en la morbilidad que permiten clasificar a los pacientes en categorías mutuamente excluyentes. Objetivo: Comparar la estratificación, según niveles de complejidad, proporcionada por los GMA con la de los CRG y con la realizada ad-hoc por los evaluadores. Diseño: Muestra aleatoria por estratos de riesgo de morbilidad. Emplazamiento: Cataluña. Participantes: Cuarenta médicos de atención primaria emparejados 2 a 2. Intervenciones: Cada pareja de evaluadores tuvo que validar 25 historias. Mediciones principales: Se evaluó la concordancia entre evaluadores, y entre los evaluadores y los resultados obtenidos por los 2 agrupadores de morbilidad con el índice kappa, la sensibilidad, la especificidad, el valor predictivo positivo y el negativo. Resultados: La concordancia entre evaluadores se situó alrededor del valor kappa 0,75 (valor medio = 0,67), entre los GMA y los evaluadores fue similar (valor medio = 0,63), y más elevada que para los CRG (valor medio = 0,35). Los profesionales otorgaron una puntuación de 7,5 a la bondad de ambos agrupadores, aunque para los estratos de mayor complejidad, según asignación de los profesionales, los GMA obtuvieron mejores puntuaciones que los CRG. Los profesionales prefirieron mayoritariamente los GMA frente a los CRG. Estas diferencias se incrementaron con el aumento de la complejidad de los pacientes según el criterio clínico.Globalmente, se encontró menos de un 2% de errores graves de clasificación proporcionada por ambos agrupadores. Conclusión: Los profesionales consideraron que ambos agrupadores clasificaban adecuadamente a la población, aunque los GMA tienen un mejor comportamiento en los estratos que los profesionales identifican como de mayor complejidad. Además, en la mayoría de los casos, los evaluadores clínicos prefirieron los GMA. Abstract: Introduction: Adjusted Morbidity Groups (GMAs) and the Clinical Risk Groups (CRGs) are population morbidity based stratification tools which classify patients into mutually exclusive categories. Objetive: To compare the stratification provided by the GMAs, CRGs and that carried out by the evaluators according to the levels of complexity. Design: Random sample stratified by morbidity risk. Location: Catalonia. Participants: Forty paired general practitioners in the primary care, matched pairs. Interventions: Each pair of evaluators had to review 25 clinical records. Main outputs: The concordance by evaluators, and between the evaluators and the results obtained by the 2 morbidity tools were evaluated according to the kappa index, sensitivity, specificity, and positive and negative predicted values. Results: The concordance between general practitioners pairs was around the kappa value 0.75 (mean value = 0.67), between the GMA and the evaluators was similar (mean value = 0.63), and higher than for the CRG (mean value = 0.35). The general practitioners gave a score of 7.5 over 10 to both tools, although for the most complex strata, according to the professionals’ assignment, the GMA obtained better scores than the CRGs. The professionals preferred the GMAs over the CRGs. These differences increased with the complexity level of the patients according to clinical criteria.Overall, less than 2% of serious classification errors were found by both groupers. Conclusion: The evaluators considered that both grouping systems classified the studied population satisfactorily, although the GMAs showed a better performance for more complex strata. In addition, the clinical raters preferred the GMAs in most cases. Palabras clave: Agrupador de morbilidad, Multimorbilidad, Validación clínica, Keywords: Morbidity grouper, Multimorbidity, Clinical Validation

Introduction and Objectives: Cystic Fibrosis (CF) is a genetic disease characterized by dysfunction of the exocrine glands. Hepatic involvement is the leading non-pulmonary cause of death in CF patients. This paper aims to present the case of a schoolchild with hepatic alterations as the initial clinical manifestation of CF. Results: 10-year-old male with a history of sibling death due to liver failure at three years of age, multiple respiratory symptoms in the first two years of life and hospitalization at 3 years of age due to bronchitis. The condition began one year before the assessment with growth arrest and in the last six months with two diarrheal episodes without mucus or blood. On physical examination, weight and height below p5 for age, icteric color, without hepatosplenomegaly, limbs with acropaquia (Image 1). Average bone age of 5-6 years, paraclinical tests with hypertransaminasemia, hypetriglyceridemia and decreased HDL (table 1), normal blood biometry, liver elastography with ARFI 2.1 m/s and liver biopsy with macro and microvesicular steatosis with moderate portoportal fibrosis (image 1-2). Negative approach for infectious hepatitis, Wilson´s disease. 1 alpha-antitrypsin deficiency and lysosomal acid lipase deficiency. Diagnosis of CF with sweat electrolytes of 105 mmol/L was made. Currently under follow-up by gastroenterology and pediatric pulmonology. Discussion: CF is the most common autosomal recessive disease in the Caucasian population, with multi-organ involvement. Liver disease has a high incidence in the first 10 years of life with 2.5/100 patient-years. However, no CFTR gene mutation has been directly associated with the presence or severity of the liver disease. Clinical presentation varies from mild asymptomatic form to cirrhosis with the need for liver transplantation in these patients. The most common initial suspicion is hepatomegaly and transaminases alteration and laboratory studies and histology alteration. Hepatic fibroelastography represents an emerging method of study for diagnosis, as it represents one of the forms of confirmation of the criteria for liver disease associated with cystic fibrosis. Liver biopsy provides information on the predominant type of lesion (steatosis or focal cirrhosis) and the extent of portal fibrosis. However, it should be taken with caution because of the risk of underestimating the severity of the lesions. Conclusions: Although the liver disease in cystic fibrosis does not represent the initial manifestation, the evaluation and monitoring in these patients are important for prognosis and survival since it can progress to cirrhosis and liver failure.The authors declare that there is no conflict of interest.

Introduction and Objectives: There are infectious diseases that produce alterations in liver function tests and histology, through the activation, by endotoxins and other agents of the innate immunity pathway. This work aims to review the hepatic manifestations of diseases such as dengue and brucellosis in the pediatric age by means of clinical cases. Results: Case 1: 17-year-old male with a history of travel to an endemic area and family members positive for dengue. Fever, myalgias, arthralgias, arthralgias and headache. On admission with leukocytes 6.93 thousand, platelets 189 thousand and positive IgG and IgM antibodies for dengue fever. Physical examination with hepatodynia and petechiae in the pelvic limbs. In control biochemistry with leukopenia and moderate thrombocytopenia, as well as alterations in liver function (Table 1). Ultrasound of the liver with data of acute inflammatory process. Seven days after admission, with clinical and biochemical improvement, it was decided the discharge of the patient. Caso 2: male, four years nine months old, with symptoms of 1 month of evolution characterized by fever, hyporexia and general malaise. Physical examination with icteric-pale color, hepatomegaly of 3 × 5 × 7 cm and splenomegaly of 4 cm. Paraclinical tests showed anemia, leukopenia and mild-moderate thrombocytopenia, hypertransaminasemia, cholestasis and TTP prolongation (Table 2) with positive rose bengal, hepatic USG with hepatomegaly and echogenicity changes, for which he was sent to the third level of care. Discussion: The mechanisms of liver injury can be divided into four pathways: vascular, toxic, immune and hormonal. In infections, the immune pathway is the cause of liver damage, being activated by endotoxins, leading to inflammatory infiltration, the release of cytokines, reactive oxygen species and necrosis. In dengue infection, liver injury manifests with hypertransaminasemia, with a peak between the seventh and ninth day, progressive decrease and normalization between 2 to 8 weeks. Hepatic involvement in brucellosis can occur in the acute or chronic phase of the disease. In the acute phase, establishing a non-specific granulomatous hepatitis, increasing in 63% of the cases the liver function tests. Conclusions: The functions of the liver and the relationships it establishes with other organs may favor its injury during some infectious pathologies, being at this level one of the first manifestations in the context of an infectious disease, ruling out, in both cases, liver pathology by hepatotropic virus, metabolic, autoimmune and anatomical cause.The authors declare that there is no conflict of interest.

Mechanical instabilities are emerging as novel actuation mechanisms for the design of biomimetic soft robots and smart structures. The present study shows that by coupling buckling-driven elastomeric auxetic modules actuated by a negative air-pressure, a novel metamaterial-based caterpillar can be designed—the Metarpillar. Following a detailed analysis of the caterpillar’s locomotion, we were able to mimic both its crawling movement and locomotion by using the unique isometric compression of the modules and properly programing the anterograde modular peristaltic contractions. The bioinspired locomotion of the Metarpillar uses the bending triggered by the buckling-driven module contraction to control the friction through a dynamic anchoring between the soft robot and the surface, which is the main mechanism for locomotion in caterpillars and other crawling organisms. Thus, the Metarpillar not only mimics the locomotion of the caterpillar but also displays dynamic similarity and equivalent, or even faster, speeds. Our approach based on metamaterial buckling actuator units opens up a novel strategy for biomimetic soft robotic locomotion that can be extended beyond caterpillars.

Background: Overhydration (OH) complicates frequently the clinical course of Peritoneal Dialysis (PD) patients, and keeps a controversial association with the risk of peritoneal infection. The main objective of this study was to disclose an association between persistent OH and the risk of enteric peritonitis in a relatively large sample of patients undergoing PD. Method: Following a prospective design, we monitorized systematically body composition of patients treated with PD in our unit (2011–2016), searching for a correlation with the ensuing risk of peritonitis, with an emphasis on the association between persistent OH (main study variable) and the risk of infection by enteric pathogens (main outcome). Essential demographic, clinical and laboratory variables with a potential influence on the risk of peritonitis were recorded. We used multivariate survival analysis to clarify the specific effect of different body composition parameters on the main outcome. Main results: We included 139 patients for analysis (mean follow-up 24 months). Sixty-three patients suffered at least one peritonitis, and 17 had at least one diagnosis of enteric peritonitis. Univariate analysis disclosed a general trend to an increased risk of enteric peritonitis in overhydrated patients, as evidenced by associations of this outcome with mean extracellular water/intracellular water (ECW/ICW)(p = 0007), OH/ECW (p = 0033) and ECW/total body water (ECW/TBW)(p = 0004) ratios, but not with absolute OH values. Multivariate analysis confirmed similar associations or trends (RR 3,48, 95 % CI 1,03–14,59, p = 0,046, highest versus lowest tertile of ECW/ICW, RR 2,31, 95 % CI 0,98-6,56, p = 0,061, highest versus lowest tertile of OH/ECW, and RR 6,33, 95 % CI 1,37-19,37, p = 0,011, highest versus lowest tertile of ECW/TBW). On the contrary, no apparent association was detected between OH and the overall risk of peritoneal infection. Conclusion: Persistent overhydration portends a significant risk of peritoneal infection by enteric pathogens, among patients undergoing chronic PD. Resumen: Antecedentes y Objetivos: La sobrehidratación (SH) es frecuente, y a menudo persistente, en pacientes tratados con Diálisis Peritoneal (DP), y mantiene una asociación controvertida con el riesgo de infección peritoneal. El objetivo principal de este estudio fue develar una posible asociación entre la presencia de SH y el riesgo subsiguiente de infección peritoneal por gérmenes entéricos, en una población relativamente amplia de pacientes tratados con DP. Método: Según diseño prospectivo, monitorizamos de manera sistemática la composición corporal de pacientes tratados con DP en nuestra Unidad (2011–2016), buscando una posible correlación con el riesgo de peritonitis durante el seguimiento, con un interés particular en la asociación entre SH persistente (variable de estudio principal) y el riesgo de infección peritoneal por patógenos entéricos (variable resultado principal). Para el análisis tuvimos en cuenta variables demográficas, clínicas y de laboratorio con influencia potencial en el riesgo de infección peritoneal. Utilizamos técnicas de análisis multivariante para clarificar el efecto específico de diferentes parámetros de composición corporal sobre la variable resultado principal. Resultados principales: Incluímos 139 pacientes, con seguimiento medio de 24 meses. Sesenta y tres pacientes sufrieron al menos una peritonitis, y 17 al menos una infección por gérmenes entéricos. El análisis univariante mostró una tendencia general a mayor riesgo de infección peritoneal entérica en pacientes sobrehidratados, que se hacía evidente cuando se usaba el cociente agua extracelular/agua intracelular (AEC/AIC)(p = 0,007), el cociente SH/AEC (SH/AEG)(p = 0,033), o el cociente AEC/agua corporal total (AEC/ACT)(p = 0,004), pero no cuando se usaba la sobrehidratación absoluta, como variable de estudio. El análisis multivariante confirmó estas asociaciones o tendencias (RR 3,48, IC 95% 1,03-14,59, p = 0,046, tercil mayor versus menor para AEC/AIC, RR 2,31, IC 95% 0,98-6,56, p = 0,061, tercil mayor versus menor para SH/AEC, y RR 6,33, IC 95% 1,37-19,37, p = 0,011, tercil mayor versus menor para AEC/ACT). Por el contrario, no observamos asociación consistente entre SH y riesgo general de infección peritoneal. Conclusión: La sobrehidratación persistente asocia un riesgo significativo de infección peritoneal por patógenos entéricos, en pacientes tratados con DP. Keywords: Overhydration, Peritonitis, Peritoneal infection, Enteric, Peritoneal dialysis, Body composition, Bioimpedance, Palabras clave: Sobrehidratación, Peritonitis, Infección peritoneal, Entérico, Diálisis peritoneal, Composición corporal, Bioimpedancia

Resumen: Antecedentes y objetivos: La sobrehidratación (SH) es frecuente, y a menudo persistente, en pacientes tratados con diálisis peritoneal (DP), y mantiene una asociación controvertida con el riesgo de infección peritoneal. El objetivo principal de este estudio fue desvelar una posible asociación entre la presencia de SH y el riesgo subsiguiente de infección peritoneal por gérmenes entéricos, en una población relativamente amplia de pacientes tratados con DP. Método: Según diseño prospectivo, monitorizamos de manera sistemática la composición corporal de pacientes tratados con DP en nuestra unidad (2011-2016), buscando una posible correlación con el riesgo de peritonitis durante el seguimiento, con un interés particular en la asociación entre SH persistente (variable de estudio principal) y el riesgo de infección peritoneal por patógenos entéricos (variable resultado principal). Para el análisis tuvimos en cuenta variables demográficas, clínicas y de laboratorio con influencia potencial en el riesgo de infección peritoneal. Utilizamos técnicas de análisis multivariante para clarificar el efecto específico de diferentes parámetros de composición corporal sobre la variable resultado principal. Resultados principales: Incluimos 139 pacientes, con seguimiento medio de 24 meses. Sesenta y tres pacientes sufrieron al menos una peritonitis, y 17 al menos una infección por gérmenes entéricos. El análisis univariante mostró una tendencia general a mayor riesgo de infección peritoneal entérica en pacientes sobrehidratados, que se hacía evidente cuando se usaba el cociente agua extracelular/agua intracelular (AEC/AIC) (p = 0,007), el cociente SH/AEC (SH/AEG) (p = 0,033), o el cociente AEC/agua corporal total (AEC/ACT) (p = 0,004), pero no cuando se usaba la SH absoluta, como variable de estudio. El análisis multivariante confirmó estas asociaciones o tendencias (RR: 3,48; IC 95%: 1,03-14,59; p = 0,046, tercil mayor versus menor para AEC/AIC, RR: 2,31; IC 95%: 0,98-6,56; p = 0,061, tercil mayor versus menor para SH/AEC, y RR: 6,33; IC 95%: 1,37-19,37; p = 0,011, tercil mayor versus menor para AEC/ACT). Por el contrario, no observamos asociación consistente entre SH y riesgo general de infección peritoneal. Conclusión: La SH persistente asocia un riesgo significativo de infección peritoneal por patógenos entéricos, en pacientes tratados con DP. Abstract: Background: Overhydration (OH) complicates frequently the clinical course of Peritoneal Dialysis (PD) patients, and keeps a controversial association with the risk of peritoneal infection. The main objective of this study was to disclose an association between persistent OH and the risk of enteric peritonitis in a relatively large sample of patients undergoing PD. Method: Following a prospective design, we monitorized systematically body composition of patients treated with PD in our unit (2011-2016), searching for a correlation with the ensuing risk of peritonitis, with an emphasis on the association between persistent OH (main study variable) and the risk of infection by enteric pathogens (main outcome). Essential demographic, clinical and laboratory variables with a potential influence on the risk of peritonitis were recorded. We used multivariate survival analysis to clarify the specific effect of different body composition parameters on the main outcome. Main results: We included 139 patients for analysis (mean follow-up 24 months). Sixty-three patients suffered at least one peritonitis, and 17 had at least one diagnosis of enteric peritonitis. Univariate analysis disclosed a general trend to an increased risk of enteric peritonitis in overhydrated patients, as evidenced by associations of this outcome with mean extracellular water/intracellular water (ECW/ICW) (p=.007), OH/ECW (p=.033) and ECW/total body water (ECW/TBW) (p=.004) ratios, but not with absolute OH values. Multivariate analysis confirmed similar associations or trends (RR: 3.48, 95% CI: 1.03-14.59; p=.046, highest versus lowest tertile of ECW/ICW, RR: 2.31, 95% CI: 0.98-6.56; p=.061, highest versus lowest tertile of OH/ECW, and RR: 6.33, 95% CI: 1.37-19.37; p=.011, highest versus lowest tertile of ECW/TBW). On the contrary, no apparent association was detected between OH and the overall risk of peritoneal infection. Conclusion: Persistent overhydration portends a significant risk of peritoneal infection by enteric pathogens, among patients undergoing chronic PD. Palabras clave: Sobrehidratación, Peritonitis, Infección peritoneal, Entérico, Diálisis peritoneal, Composición corporal, Bioimpedancia, Keywords: Overhydration, Peritonitis, Peritoneal infection, Enteric, Peritoneal dialysis, Body composition, Bioimpedance

Background: Fibromyalgia is a complex, relatively unknown disease characterised by chronic, widespread musculoskeletal pain. The gut-brain axis connects the gut microbiome with the brain through the enteric nervous system (ENS); its disruption has been associated with psychiatric and gastrointestinal disorders. To gain an insight into the pathogenesis of fibromyalgia and identify diagnostic biomarkers, we combined different omics techniques to analyse microbiome and serum composition. Methods: We collected faeces and blood samples to study the microbiome, the serum metabolome and circulating cytokines and miRNAs from a cohort of 105 fibromyalgia patients and 54 age- and environment-matched healthy individuals. We sequenced the V3 and V4 regions of the 16S rDNA gene from faeces samples. UPLC-MS metabolomics and custom multiplex cytokine and miRNA analysis (FirePlex™ technology) were used to examine sera samples. Finally, we combined the different data types to search for potential biomarkers. Results: We found that the diversity of bacteria is reduced in fibromyalgia patients. The abundance of the Bifidobacterium and Eubacterium genera (bacteria participating in the metabolism of neurotransmitters in the host) in these patients was significantly reduced. The serum metabolome analysis revealed altered levels of glutamate and serine, suggesting changes in neurotransmitter metabolism. The combined serum metabolomics and gut microbiome datasets showed a certain degree of correlation, reflecting the effect of the microbiome on metabolic activity. We also examined the microbiome and serum metabolites, cytokines and miRNAs as potential sources of molecular biomarkers of fibromyalgia. Conclusions: Our results show that the microbiome analysis provides more significant biomarkers than the other techniques employed in the work. Gut microbiome analysis combined with serum metabolomics can shed new light onto the pathogenesis of fibromyalgia. We provide a list of bacteria whose abundance changes in this disease and propose several molecules as potential biomarkers that can be used to evaluate the current diagnostic criteria. Keywords: Fibromyalgia, Gut microbiota, Pain, Metabolomics, Cytokines, miRNAs, Omics integration

Intellectual disability is the most limiting hallmark of Down syndrome, for which there is no gold-standard clinical treatment yet. The endocannabinoid system is a widespread neuromodulatory system involved in multiple functions including learning and memory processes. Alterations of this system contribute to the pathogenesis of several neurological and neurodevelopmental disorders. However, the involvement of the endocannabinoid system in the pathogenesis of Down syndrome has not been explored before. We used the best-characterized preclinical model of Down syndrome, the segmentally trisomic Ts65Dn model. In male Ts65Dn mice, cannabinoid type-1 receptor (CB1R) expression was enhanced and its function increased in hippocampal excitatory terminals. Knockdown of CB1R in the hippocampus of male Ts65Dn mice restored hippocampal-dependent memory. Concomitant with this result, pharmacological inhibition of CB1R restored memory deficits, hippocampal synaptic plasticity and adult neurogenesis in the subgranular zone of the dentate gyrus. Notably, the blockade of CB1R also normalized hippocampal-dependent memory in female Ts65Dn mice. To further investigate the mechanisms involved, we used a second transgenic mouse model overexpressing a single gene candidate for Down syndrome cognitive phenotypes, the dual specificity tyrosine-phosphorylation-regulated kinase 1A (DYRK1A). CB1R pharmacological blockade similarly improved cognitive performance, synaptic plasticity and neurogenesis in transgenic male Dyrk1A mice. Our results identify CB1R as a novel druggable target potentially relevant for the improvement of cognitive deficits associated with Down syndrome.

Laser metal deposition (LMD) and laser cladding (LC) could be innovative methods to the current thermal spray techniques for obtaining dense and high-quality bond coats with nickel and cobalt based superalloys in thermal barrier coatings (TBCs) systems. The microstructural evolution of the coatings when is subjected to high temperatures allows us to evaluate their oxidation behavior and integrity in the time, and is especially important in the development of bond coats for new TBCs systems. In this work, the microstructural evolution of a dense NiCoCrAlY overlay coating obtained by coaxial laser cladding and subjected to isothermal oxidation tests at 1100 °C up to 200 h was evaluated. The initial coating microstructure is composed of a β-NiAl phase within the γ-Ni matrix phase, and some Y inclusions, confirmed by X-ray diffraction (XRD) and Transmission Electron Microscopy (TEM). At high temperature, the thermally-grown oxides (TGO) protect the underlying coating and substrate from oxidation, modifying the initial microstructure of the coating. The formation, morphology and evolution of oxides α-Al2O3, Y2O3, YAlO3 and (Ni,Co)(AlCr2)2O4-type spinel oxides on the cross section of the oxidized coating on different oxidation stages were evaluated using focused ion beam (FIB) and field emission scanning electron microscopy (FESEM), and indexed by XRD and TEM. After oxidation tests, no cracks or spallation on oxidized sample for NiCoCrAlY coating were observed, and the formation of Y-Al oxides in TGO scale are strongly dependent on the initial Y distribution of as-built condition in the coating. Keywords: NiCoCrAlY, Laser cladding, Laser metal deposition, Bond coat, Microstructure, Oxidation

While it is recognized that acculturation influences adiposity risk, the direction and magnitude of this relationship remain unclear. Previous studies' use of proxy acculturation measures and exclusively cross-sectional study designs have limited understanding of this research question. The aim of this study was to examine associations between acculturation and adiposity among Puerto Ricans (45–75 years) living on the mainland United States. We analyzed data from the longitudinal (baseline, 2-year, 5-year) Boston Puerto Rican Health Study (n = 1114). Language-based and psychological-based acculturations were assessed at baseline using questionnaires. Acculturation scores were divided into tertile categories; higher tertiles indicate greater English- and U.S.-based acculturation. Adiposity was assessed using BMI and waist circumference at baseline and each follow-up. Linear mixed effects regression models were fit with baseline acculturation tertile as the predictor and baseline or change in adiposity as the outcome. When examining baseline associations with language acculturation tertiles, participants in the middle acculturation tertile (bilingual) had 2.48 cm (95%CI: −4.64, −0.31) lower waist circumference compared to the more Spanish-based acculturation tertile. When examining the associations between baseline language acculturation tertiles and change in adiposity, those in the more English-based acculturation tertile had higher annual gains in BMI (0.13 kg/m2 (95%CI: 0.01, 0.25)) and waist circumference (0.44 cm (95%CI: 0.01, 0.88)) over 5-years compared to those in the more Spanish-based acculturation tertile. No significant differences in adiposity were found across psychological-based acculturation tertiles. In conclusion, English language-based acculturation at baseline influences long-term adiposity. Psychological-based acculturation may capture distinct acculturation processes from the language-based construct. Keywords: Acculturation, Obesity, Minority health, Puerto Ricans, Hispanics/Latinos

Background: Worldwide, Peru has one of the highest infection fatality rates of COVID-19, and its capital city, Lima, accumulates roughly 50% of diagnosed cases. Despite surveillance efforts to assess the extent of the pandemic, reported cases and deaths only capture a fraction of its impact due to COVID-19′s broad clinical spectrum. This study aimed to estimate the seroprevalence of SARS-CoV-2 in Lima, stratified by age, sex, region, socioeconomic status (SES), overcrowding, and symptoms. Methods: We conducted a multi-stage, population-based serosurvey in Lima, between June 28th and July 9th, 2020, after 115 days of the index case and after the first peak cases. We collected whole blood samples by finger-prick and applied a structured questionnaire. A point-of-care rapid serological test assessed IgM and IgG antibodies against SARS-CoV-2. Seroprevalence estimates were adjusted by sampling weights and test performance. Additionally, we performed RT-PCR molecular assays to seronegatives and estimated the infection prevalence. Findings: We enrolled 3212 participants from 797 households and 241 sample clusters from Lima in the analysis. The SARS-CoV-2 seroprevalence was 20·8% (95%CI 17·2–23·5), and the prevalence was 25·2% (95%CI 22·5–28·2). Seroprevalence was equally distributed by sex (aPR=0·96 [95%CI 0·85–1·09, p = 0·547]) and across all age groups, including ≥60 versus ≤11 years old (aPR=0·96 [95%CI 0·73–1·27, p = 0·783]). A gradual decrease in SES was associated with higher seroprevalence (aPR=3·41 [95%CI 1·90–6·12, p

HER2-positive metastatic breast cancer is an aggressive disease with a limited number of treatment options. In the last 15 years, new drugs such as trastuzumab, pertuzumab, lapatinib or trastuzumab emtansine (TDM-1) have sprouted for these patients. There is a huge lack of evidence on the use of some of these drugs in patients with chronic renal failure, who need hemodialysis. We have reviewed the use of TDM-1 in these type of patients in the literature with unsuccessful results.In this article we want to present a case report to illustrate the safety and efficacy of TDM-1 in a patient on hemodialysis.

Purpose: To describe ocular findings in a patient with Type VI Ehlers-Danlos syndrome (EDS) and make ophthalmologists aware of the potential ophthalmic complications of this particular type of EDS. To briefly report the surgical technique utilized for the repair of spontaneous scleral rupture that may be associated with Type VI Ehlers-Danlos syndrome. Observations: A 36-year-old female visited the Emergency Room due to sudden vision loss, edema, and redness of the right eye consistent with spontaneous scleral rupture secondary to scleral thinning due to Type VI EDS. Repair with scleral patch graft resulted in improvement in visual acuity, a decrease in hyphema, and discomfort resolution. Conclusions and Importance: Spontaneous scleral perforation may occur in patients with Type VI EDS. A scleral patch graft may serve as a viable surgical repair alternative for such patients.

Delayed neurodevelopment is a common outcome in perinatally HIV-infected children. Our aim was to assess the intellectual profile of our cohort, considering both the infection and socio-environmental related variables. A cross-sectional cohort study was undertaken at seven major hospitals in Spain belonging to the CoRISpeS cohort (n = 97). Patients were followed up according to a standard protocol. Intellectual measures, psychosocial profile and HIV infection-related data have been analysed. The average patient age was 15 years. The median CD4 cell percentage was 35% (1,59). Viral load was undetectable in 80% of the patients and 27% were on AIDS category; 38% of whom had encephalopathy. The average composite score of both crystallized intelligence (CI) and intelligence quotient (IQ) for the cohort was lower than that of the general population (p < 0.001). Results revealed a significant difference of 38% between crystallized and fluid intelligence. There was a clear association between IQ and age of diagnosis (p = 0.022); CI and CDC classification (p = 0.035), CD4 count (p = 0.011) and CD4 nadir (p = 0.001). Higher parental education was associated with better performance across all intelligence scales (p < 0.002). A regression model showed that CI was influenced by the academic level of caregivers (p = 0.002), age at start of cART (p = 0.050) and primary language (p = 0.058). Findings revealed significant differences in verbal and non-verbal intellectual scales resulting in a misleading IQ Composite score. Crystallized intelligence demonstrated the highest level of impairment despite adequate treatment and good immunovirological status, while fluid intelligence results were average. Caregiver level of education was the strongest factor across all intelligence measures.

There is substantial evidence linking particulate matter air pollution with cardiovascular morbidity and mortality. However, health disparities between populations may exist due to imprecisely defined non-innate susceptibility factors. Psychosocial stressors are associated with cardiovascular disease and may increase non-innate susceptibility to air-pollution. We investigated whether the association between short-term changes in ambient particulate matter and cardiovascular health risk differed by psychosocial stressors in a Puerto Rican cohort, comparing women and men. We used data from the Boston Puerto Rican Health Study (BPRHS), a longitudinal study of cardiovascular health among adults, collected between 2004 and 2013. We used mixed effect models to estimate the association of current-day ambient particle number concentration (PNC) on C-reactive protein (CRP), a marker of systemic inflammation, and effect modification by psychosocial stressors (depression, acculturation, perceived stress, discrimination, negative life events and a composite score). Point estimates of percent difference in CRP per interquartile range change in PNC varied among women with contrasting levels of stressors: negative life events (15.7% high vs. 6.5% low), depression score (10.6% high vs. 4.6% low) and composite stress score (16.2% high vs. 7.0% low). There were minimal differences among men. For Puerto Rican adults, cardiovascular non-innate susceptibility to adverse effects of ambient particles may be greater for women under high stress. This work contributes to understanding health disparities among minority ethnic populations.

Summary: Background: Human papillomavirus (HPV) testing for cervical cancer prevention was introduced in Argentina through the Jujuy Demonstration Project (2011–14). The programme tested women aged 30 years and older attending the public health system with clinician-collected HPV tests. HPV self-collection was introduced as a programmatic strategy in 2014. We aimed to evaluate the effectiveness of programmatic HPV testing to detect cervical intraepithelial neoplasia (CIN) of grade 2 or worse (CIN2+) in comparison with cytology-based screening. Methods: We did a population-based, before-and-after retrospective cohort study using data from the National Cervical Cancer Prevention Program for the Jujuy province in northwest Argentina. We obtained data for the cytology-based screening period from Jan 1, 2010, until Dec 31, 2011, and for the HPV-based screening period from Jan 1, 2012, until Dec 31, 2014. The primary outcome was detection of histologically diagnosed CIN2+ among women aged 30 years and older. To assess the outcomes in all individuals included in the study, we used multivariable logistic regression and propensity score matching. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was used for the before-and-after analysis of programmatic dimensions. Findings: Of the 29 631 women who underwent cytology-based screening in 2010–11, CIN2+ was detected in 236 (0·8%) individuals. Of the 49 565 women HPV tested in 2012–14 (clinician-collected tests, n=44 700; self-collection tests, n=4865), 693 (1·4%; 658 clinician-collected tests; 35 self-collection tests) were found to have CIN2+ after the first round of screening. Compared with cytology-based screening, the odds ratio of being diagnosed with a CIN2+ lesion was 2·34 (95% CI 2·01–2·73; p

The APOE-ε4 genotype is the highest genetic risk factor for Alzheimer's disease (AD). In cognitively unimpaired individuals, it has been related to altered brain morphology, function and earlier amyloid beta accumulation. However, its impact on cognitive performance is less evident. Here, we examine the impact of APOE-ε4 allele load in modulating the association between cognitive functioning and brain morphology in middle-aged healthy individuals. A high-resolution structural MRI scan was acquired and episodic memory (EM) as well as executive functions (EFs) were assessed in a sample of 527 middle-aged unimpaired individuals hosting a substantial representation of ε4-homozygous (N = 64). We adopted a voxel-wise unbiased method to assess whether the number of APOE-ε4 alleles significantly modified the associations between gray matter volumes (GMv) and performance in both cognitive domains.Even though the APOE-ε4 allele load did not exert a direct impact on any cognitive measures, it reversed the relationships between GMv and cognitive performance in a highly symmetrical topological pattern. For EM, interactions mapped onto the inferior temporal gyrus and the dorsal anterior cingulate cortex. Regarding EFs, significant interactions were observed for processing speed, working memory, and visuospatial attention in distinct brain regions. These results suggest that APOE-ε4 carriers display a structure-function association corresponding to an older age than their chronological one. Our findings additionally indicate that APOE-ε4 carriers may rely on the integrity of multiple compensatory brain systems in order to preserve their cognitive abilities, possibly due to an incipient neurodegeneration. Overall this study provides novel insights on the mechanisms through which APOE-ε4 posits an increased AD risk. Keywords: Alzheimer's disease, APOE-ε4, Healthy participants, Voxel-based morphometry, Cognitive performance

La hipoacusia representa un importante problema de salud. La dificultad para oír y comunicarse es frustrante para la persona, provocando aislamiento social y baja autoestima, asociándose frecuentemente con depresión y con demencia en la senectud. Hay muy pocas tecnologías en el área sanitaria que se hayan desarrollado tan rápidamente como el Implante Coclear. En éste artículo nos centraremos en los aspectos más importantes, como la innovación tecnológica, la innovación en las indicaciones y en la técnica quirúrgica, y como no, en la innovación en el aspecto educativo y el impacto social. Probablemente queden aspectos por ver, pero en este apartado podremos recoger los aspectos más importantes de la técnica que ha revolucionado no solo la otorrinolaringología como especialidad, sino la forma de abordar un problema médico, social y comunicativo del ser humano.

Background: Irisin is an adipomyokine with claimed anti-obesity and anti-diabetic effects. This hormone has been insufficiently studied in patients with advanced chronic kidney disease (CKD). Objective: To perform an exploratory analysis of serum irisin levels in patients undergoing different CKD treatments. Method: Following a cross-sectional design, we estimated serum levels of irisin in 95 patients with CKD managed conservatively (advanced CKD), with peritoneal dialysis (PD) or with haemodialysis, and compared our findings with a control group of 40 healthy individuals. We investigated the correlations between serum irisin and demographic, clinical, body composition and metabolic variables. Results: Irisin levels were lower in all the CKD groups than in the control group. The univariate analysis revealed limited correlations between irisin, on the one hand, and fat (but not lean) mass, glomerular filtration rate (GFR) and plasma albumin and bicarbonate, on the other. The multivariate analysis confirmed that advanced CKD patients managed conservatively (difference 111.1 ng/mL), with PD (25.9 ng/mL) or haemodialysis (61.4 ng/mL) (all p

Antecedentes: La irisina es una adipomioquina con posibles efectos antiobesidad y antidiabéticos. Esta hormona ha sido insuficientemente estudiada en pacientes con enfermedad renal crónica (ERC) avanzada. Objetivo: Realizar un análisis exploratorio de los niveles séricos de irisina en pacientes con diferentes modalidades de tratamiento de la ERC. Método: Según diseño transversal, estimamos niveles de irisina en 95 pacientes con ERC manejados conservadoramente (ERCA), con diálisis peritoneal (DP) o con hemodiálisis, comparándolos con un grupo control de 40 individuos sanos. También investigamos las correlaciones entre irisina sérica y variables demográficas, clínicas, metabólicas y de composición corporal. Resultados: Los niveles de irisina fueron más bajos en cualquier grupo de pacientes que en los controles. El análisis univariante desveló correlaciones moderadas entre irisina, por un lado, y masa grasa (pero no magra), filtrado glomerular (GFR) y albúmina y bicarbonato plasmático, por otro. El análisis multivariante confirmó que los pacientes con ERCA (diferencia 111,1 ng/mL), en DP (25,9 ng/mL) o hemodiálisis (61,4 ng/mL) (todos p

Objectives: Several studies using 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) or diffusion tensor imaging (DTI) have found both temporal and extratemporal abnormalities in patients with mesial temporal lobe epilepsy with ipsilateral hippocampal sclerosis (MTLE-HS), but data are lacking about the findings of both techniques in the same patients. We aimed to determine whether the extent of 18F-FDG-PET hypometabolism is related to DTI abnormalities. Methods: Twenty-one patients with MTLE-HS underwent comprehensive preoperative evaluation; 18 (86%) of these underwent epilepsy surgery. We analyzed and compared the pattern of white matter (WM) alterations on DTI and cortical hypometabolism on 18F-FDG-PET. Results: We found widespread temporal and extratemporal 18F-FDG-PET and DTI abnormalities. Patterns of WM abnormalities and cortical glucose hypometabolism involved similar brain regions, being more extensive in the left than the right MTLE-HS. We classified patients into three groups according to temporal 18F-FDG-PET patterns: hypometabolism restricted to the anterior third (n = 7), hypometabolism extending to the middle third (n = 7), and hypometabolism extending to the posterior third (n = 7). Patients with anterior temporal hypometabolism showed DTI abnormalities in anterior association and commissural tracts while patients with posterior hypometabolism showed WM alterations in anterior and posterior tracts. Conclusions: Patients with MTLE-HS have widespread metabolic and microstructural abnormalities that involve similar regions. The distribution patterns of these gray and white matter abnormalities differ between patients with left or right MTLE, but also with the extent of the 18F-FDG-PET hypometabolism along the epileptogenic temporal lobe. These findings suggest a variable network involvement among patients with MTLE-HS.

Objetivo: El consumo de sustancias psicoactivas entre población penitenciaria es un importante problema de salud pública por su magnitud y consecuencias. El objetivo ha sido estimar su prevalencia en prisión y analizar su asociación con factores sociodemográficos y penitenciarios, destacando el mayor tamaño de la prisión. Métodos: Encuesta autoadministrada en 2484 internos varones de ocho centros penitenciarios de diferentes tamaños en España durante el año 2014. Se calculó la prevalencia de consumo de sustancias psicoactivas durante los últimos 6 meses en prisión con sus intervalos de confianza del 95% (IC95%). La asociación entre el consumo de sustancias y las variables sociodemográficas y penitenciarias se analizó con razones de prevalencia ajustadas para el total de las variables analizadas. Resultados: La prevalencia de consumo de sustancias psicoactivas durante los últimos 6 meses en prisión fue del 59,9% (IC95%: 57,9-62,0). Entre las variables sociodemográficas asociadas a un mayor consumo destacó el consumo de sustancias previo al ingreso en prisión (6,90; IC95%: 5,51-8,65) y ser reincidente en prisión (2,41; IC95%: 2,04-2,85). En las prisiones con mayor tamaño se hallaron mayores frecuencias de consumo. Conclusiones: Se encontró una alta prevalencia de consumo de sustancias psicoactivas en prisión, con diferencias significativas según el perfil de delincuente y el tamaño de la prisión.

Patients on renal replacement therapy (RRT) infected with the human immunodeficiency virus (HIV) are a special group with growing interest. In order to study the epidemiological data of HIV+ patients on RRT in Spain, we collected individual information from 2004 to 2011 (period of use of highly active antiretroviral therapy [HAART]) in the Autonomous Communities of Andalusia, Aragon, Asturias, Catalonia, Valencia, Castilla la Mancha, Castilla León, Galicia, Madrid, La Rioja and the Basque Country, comprising 85% of the Spanish population. A total of 271 incident and 209 prevalent patients were analysed. They were compared with the remaining patients on RRT during the same period. The annual incidence was 0.8 patients per one million inhabitants, with a significant increase during the follow-up period. The proportion of prevalent HIV+ patients was 5.1 per 1000 patients on RRT (95% confidence interval [CI] 4.4–5.8). Although glomerular diseases constituted the majority of cases (42%), diabetic nephropathy was the cause in 14% of patients. The nation-wide totals for these percentages were 13 and 25%, respectively. Compared to the total of patients in treatment, the risk of death was significantly higher in the HIV+ group: hazard ratio (HR) adjusted for age, sex and diabetes was 2.26 (95%CI 1.74–2.91). Hepatitis C coinfection increased the risk of death in the HIV+ group (HR 1.77; 95%CI 1.10–2.85). The probability of kidney transplantation in HIV+ was only 17% after 7 years, comparing with total RTT patients (HR 0.15; 95%CI: 0.10–0.24). Despite the use of HAART, the incidence of HIV+ patients on dialysis has increased; their mortality still exceeds non-HIV patients, and they have a very low rate of transplantation. It is necessary to further our knowledge of this disease in order to improve results.