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Survival rates for many forms of thoracic malignancies have improved over the past few decades, however, many survivors are coping with the side effects of cancer treatment for longer. Physical activity (PA) has been proposed as a therapeutic strategy to combat the effects of treatment in cancer survivors and eHealth could be a good way to encourage patients to practice it.To explore the effects of eHealth in the promotion of PA among thoracic malignancies.Suitable articles were searched using PubMed, Web of Science and Scopus databases using a combination of medical subject headings.In total, 4781 articles were identified, of which ten met eligibility criteria. Different eHealth interventions were described in these studies: mobile application (app) (n = 3), website (n = 2), email (n = 2), web and mobile application (n = 1), telephone counseling (n = 1) and online sheet (n = 1). All studies reported improvements in PA, with 8/10 studies reporting statistically significant changes.Our results show that eHealth programs are useful to promote PA in malignancy thoracic survivors, compared to no intervention, conventional treatment or a dietary approach. Moreover, the meta-analysis also revealed eHealth is a good way to improve the level of PA in thoracic malignancies survivors.

Resumen El mesotelioma papilar bien diferenciado (MPBD) es una neoplasia muy infrecuente que afecta fundamentalmente a mujeres en edad reproductiva. La localizacion mas habitual es el peritoneo y se trata de un hallazgo incidental, con un pronostico generalmente favorable. Presentamos tres casos diagnosticados de manera incidental, en el trascurso de una intervencion quirurgica de causas diversas, que se presentaron como lesiones exofiticas peritoneales no detectadas en el estudio de imagen prequirurgico. Es importante tener presente esta entidad para diferenciarla de otras neoplasias de pronostico y evolucion desfavorable, como el mesotelioma maligno o carcinomas primarios y metastasicos. Estudios recientes le confieren al MPBD un perfil inmunohistoquimico y molecular especifico que permiten una mayor precision diagnostica de la entidad.

The impact of the COVID-19 pandemic influences of COPD patients. The worsening of their health status may contribute to a higher pain prevalence.The aim of this study was to analyze the pain-related variables before and during the COVID-19 pandemic in patients with chronic obstructive pulmonary disease.In this cross-sectional case-control study, stable patients with chronic obstructive pulmonary disease without a COVID-19 diagnosis were evaluated before and during the pandemic. The main outcomes were the pronociceptive pain profile (general pain sensitivity, pain intensity, pain interference, and pressure pain sensitivity) and the psychological vulnerability (perceived health status, anxiety, and depression).Our results showed that patients with chronic obstructive pulmonary disease during COVID-19 pandemic experienced higher general pain sensitivity and intensity with statistical differences in pain interference (p.001), being the overall perceived health status lower than before the pandemic (p.05).We concluded that patients with chronic obstructive pulmonary disease during the COVID-19 pandemic showed a rise the pronociceptive pain profile accompanied by increased psychological vulnerability.

Moisture is one of the most important factors causing building stone decay and rain penetration is one of the leading factors. Particularly, wind-driven rain spells, which are becoming increasingly common and seasonal as a result of climate change. Historic buildings' sometimes intricate design features can be a factor multiplying meteorological anisotropy, either shielding walls or increasing the surface that is affected by wind-driven rain spells. This paper aims to identify the effect of pilasters and tower buttresses on the wetting dynamics of a listed 9th Century historic building during a rain spell by means of electrical resistivity methods coupled with GIS mapping, paying special attention to how data representation and map algebra can improve the interpretation of several data sets of non-destructive testing. Results show how building features can modify deeply moisture dynamics and maximise local anisotropy. In the present case, a compound of an external tower buttress and an internal pilaster decreases moisture ingress through ground infiltration while increasing moisture retention into the wall due to its larger mass. This, in turn, multiplies the incidence of moisture-related processes inside the building. The presented data also highlight the usefulness of mapping over time (4D mapping) and of GIS to improve interpretations through map algebra, This research was supported by Top Heritage (P2018/NMT-4372) programme from the Regional Government of Madrid (Spain) and Grants “PIC2020–116896RB-C21”, “PIC2020–116896RB-C22” funded by MCIN/AEI/ 10.13039/501100011033

We evaluated the interlaboratory agreement, the essential agreement, and the categorical agreement between the Sensititre YeastOneTM panel and the reference methods M27 4th Edition of the Clinical and Laboratory Standards Institute (CLSI), and the EDef 7.3.1 of the European Committee on Antifungal Susceptibility Testing (EUCAST). We studied 67 Candida strains isolated from different clinical samples and 9 Candida strains with resistance to fluconazole and echinocandins. The highest percentage of interlaboratory agreement was observed with amphotericin B (96.8%), and the lowest percentage with voriconazole (77.2%). Caspofungin showed 5.8% of very major errors when compared with the CLSI reference method. For EUCAST, itraconazole, posaconazole, and anidulafungin showed high percentages of major errors: 17.6%, 18.1%, and 19.6%, respectively. Sensititre YeastOneTM is a reliable alternative, and easy to perform for detecting Candida species resistant to antifungal drugs, with some limitations for echinocandins. Results are comparable to those of the reference methods.

Resumen Introduccion y objetivos Se presentan las caracteristicas clinicas y los resultados de los trasplantes cardiacos realizados en Espana con la actualizacion correspondiente a 2019. Metodos Se describen las caracteristicas clinicas y los resultados de los trasplantes cardiacos realizados en 2019, asi como las tendencias de estos en el periodo 2010-2018. Resultados En 2019 se realizaron 300 trasplantes (8.794 desde 1984; 2.745 entre 2010 y 2019). Respecto a anos previos, los cambios mas llamativos son el descenso hasta el 38% de los trasplantes realizados en codigo urgente, y la consolidacion en el cambio de asistencia circulatoria pretrasplante, con la practica desaparicion del balon de contrapulsacion (0,7%), la estabilizacion del uso del oxigenador extracorporeo de membrana (9,6%) y el aumento de los dispositivos de asistencia ventricular (29%). La supervivencia en el trienio 2016-2018 es similar a la del trienio 2013-2015 (p = 0,34), y ambas mejores que la del trienio 2010-2012 (p = 0,002 y p = 0,01 respectivamente). Conclusiones Se mantienen estables tanto la actividad del trasplante cardiaco en Espana como los resultados en supervivencia en los ultimos 2 trienios. Hay una tendencia a realizar menos trasplantes urgentes, la mayoria con dispositivos de asistencia ventricular.

The study was conducted to explore the degree to which caregiver burden is associated with sleep quality in parents of children with autism spectrum disorder, and to determine a statistically valid cutoff score for the Caregiver Burden Inventory (CBI) in order to identify parents of risk of poor sleep quality.We conducted a cross-sectional analysis. We assessed caregiver burden with the CBI, sleep quality with the Pittsburgh Sleep Quality Index, emotional status with the Hospital Anxiety and Depression Scale, and impact on family with the Impact on Family Scale. Caregiver burden was evaluated with a logistic regression analysis. The best fit model was used in a receiver operating characteristic analysis. Likelihood ratios and post-test probabilities were calculated.A total of 116 parents were included in this study. Higher caregiver burden was associated with a reduction in sleep quality in the logistic regression analysis (p0.001). The area under the curve for the univariate burden test model (best fit) was 76.70 (p0.001). The cutoff score for poor sleep quality was caregiver burden ≥26.50. The post-test probability of poor sleep quality increased to 82.02% from a pre-test probability of 76.72%.Our findings suggest that caregiver burden is associated with sleep quality among parents of children with autism spectrum disorder. The findings suggest that a CBI cutoff score of 26.50 may help to detect risk of poor sleep quality in parents of children with autism spectrum disorder.

Background Gaucher disease (GD) is the most prevalent lysosomal storage disorder, affecting all ethnic groups, although its prevalence is higher in Ashkenazi Jewish populations. Three clinical forms of GD have been described: Type 1 non-neuronopathic, type 2 acute neuronopathic, and type 3 subacute neuronopathic. An autosomal recessive disorder is caused by variants in the human glucocerebrosidase gene (GBA; MIM*606463) located on chromosome 1q21, resulting from deficit or lack of activity of the β-glucocerebrosidase enzyme, leading to the accumulation of glucocerebroside substrate in the cells of the macrophage-monocyte system. The aim was to determine variants in Mexican and Spanish populations with GD. Methods We report the molecular analysis by a direct automatic method sequenced of both chains of the GBA gene, in 69 Mexican and 369 Spanish patients with GD. Results We detected 75 variants with pathogenic or likely pathogenic effect and, identified 3 new variants c.408_412del/p.Asn136Lysfs*15; c.820G>A/p.Glu274Lys and c.1058T>G/p*. The most frequent variants were c.1448T>C/p.Leu483Pro/L444P and c.1226A>G/p.Asn409Ser/N370S. The detected genotypes were compared with data from both GD registries to define similarities and differences in both populations. Conclusions We defined the variant profile in patients with GD in a Mexican and a Spanish population and compared them. The screening permitted the detection of common variants and the report of three new variants, in addition to a variant associated with Parkinson disease but not with GD. Since molecular diagnosis has considerable predictive value in GD, it is important to study the genotype-phenotype correlations, establishing the severity of the variant.

Resumen Objetivo Evaluar el efecto del «Programa de Capacitacion en Cuidados Integrales para la Prevencion Secundaria Cardiovascular en Enfermeria de Atencion Primaria» sobre el nivel de conocimientos, el grado de aplicacion de los cuidados cardiovasculares integrales y sobre la continuidad asistencial y de cuidados entre las unidades de rehabilitacion cardiaca y atencion primaria, con relacion a los pacientes postinfartados. Metodos Estudio cuasiexperimental antes-despues no comparativo. Comprendia una encuesta ad-hoc previa a una formacion via Internet y una encuesta posterior a la formacion; tanto la encuesta previa como la posterior al curso eran anonimas. El programa consistia en formacion en prevencion secundaria cardiovascular, cronicidad en el paciente cardiovascular y adherencia al plan terapeutico, y protocolizacion del seguimiento. Resultados Mas de una tercera parte no conocia los objetivos de control de los distintos factores de riesgo cardiovascular, de forma mas marcada para el control lipidico. El programa mejoro de forma significativa el conocimiento de los objetivos de presion arterial, colesterol total y colesterol LDL, y la autopercepcion de un mejor seguimiento de los parametros lipidicos y el perimetro abdominal. En los casos que contaban con una unidad de rehabilitacion cardiaca, antes del curso un 73% de los encuestados indicaron que no habia «ninguna» comunicacion con ella, reduciendose al 55% en la encuesta posterior al curso. Conclusion Existen claras necesidades de formacion de las enfermeras para su implicacion en estos programas de prevencion secundaria. Una formacion continua especifica en prevencion secundaria cardiovascular para enfermeras del ambito de la atencion primaria podria mejorar la adquisicion de conocimientos a este nivel asi como el abordaje de los pacientes con evento cardiovascular durante los primeros meses de dicho evento y la comunicacion con las unidades de rehabilitacion cardiaca de referencia.

Objective to assess the effect of the “Program of Training in Integral Care for Secondary Cardiovascular Prevention in Primary Care Nursing” on the level of knowledge, the degree of application of comprehensive cardiovascular care, and on the continuity of care between the cardiac rehabilitation and primary care units, in relation to post-infarction patients. Methods Quasi-experimental before-after study without control group. Comprised an ad-hoc survey prior to training via the Internet and a post-training survey; both the pre- and post-course surveys were anonymous. The program consisted of secondary cardiovascular prevention training, chronicity in the cardiovascular patient and adherence to the therapeutic plan, and follow-up protocol. Results Over one third of the respondents did not know the control objectives of the different cardiovascular risk factors, more marked regarding lipid control. The program significantly improved the knowledge of the objectives of blood pressure, total cholesterol and LDL cholesterol, and the self-perception of better monitoring of lipid parameters and waist circumference. In centers with a cardiac rehabilitation unit, 73% of respondents indicated that there was "no" communication with the unit before the course, reducing to 55% in the post-course survey. Conclusion There are clear training needs of nurses for their involvement in these secondary prevention programs. A specific continuous training in secondary cardiovascular prevention for nurses in the field of primary care, improves and facilitates the acquisition of knowledge at this level, can improve the approach of patients with cardiovascular events during the first months of said event and communication with the reference cardiac rehabilitation units.

Little is known about the usefulness of heart rate (HR) response to exercise for risk stratification in heart failure with preserved ejection fraction (HFpEF). Therefore, this study aimed to assess the association between HR response to exercise and the risk of total episodes of worsening heart failure (WHF) in symptomatic stable patients with HFpEF.This single-center study included 133 patients with HFpEF (NYHA II-III) who performed maximal cardiopulmonary exercise testing. HR response to exercise was evaluated using the chronotropic index (CIThe mean age of the sample was 73.2± 10.5 years; 56.4% were female, and 51.1% were in atrial fibrillation. The median for CIIn patients with HFpEF, CI

To estimate the incidence of clinical fragility fractures in postmenopausal women with rheumatoid arthritis (RA) and analyze risk factors for fracture.Incidence of clinical fragility fractures in 330 postmenopausal women with RA was compared to that of a control population of 660 age-matched postmenopausal Spanish women. Clinical fractures during the previous five years were recorded. We analyzed associations with risk factors for fracture in both populations and with disease-related variables in RA patients.Median age of RA patients was 64 years; median RA duration was eight years. Sixty-nine percent were in remission or on low activity. Eighty-five percent had received glucocorticoids (GCs); 85 %, methotrexate; and 40 %, ≥1 biologic DMARD. Fifty-four patients and 47 controls had ≥1 major osteoporotic fracture (MOF). Incidence of MOFs was 3.55 per 100 patient-year in patients and 0.72 in controls (HR: 2.6). Risk factors for MOFs in RA patients were age, previous fracture, parental hip fracture, years since menopause, BMD, erosions, disease activity and disability, and cumulative dose of GCs. Previous fracture in RA patients was a strong risk for MOFs (HR: 10.37).Of every 100 postmenopausal Spanish women with RA, 3-4 have a MOF per year. This is more than double that of the general population. A previous fracture poses a high risk for a new fracture. Other classic risk factors for fracture, RA disease activity and disability, and the cumulative dose of GCs are associated with fracture development.

Puberty is a transitional period from juvenile stage to adulthood, followed by the functional maturation of gonads and reproductive organs. This period is sensitive to environmental pollutants like cadmium (Cd), a heavy metal that represents a serious health risk. Cd is an endocrine disruptor that interferes with reproduction by causing oxidative stress in the reproductive organs, affecting the sexual function and decreasing testosterone (T) levels. However, little research has been done on the effects of Cd on puberty markers and antioxidant systems. In this study, we evaluated the effects of Cd on puberty markers: preputial separation, testes descent and T levels, and the antioxidant activity (SOD, CAT, GSH/GSSG and TAC) in the seminal vesicles, testis and epididymis. Male Wistar pups were treated with 1 mg/kg Cd or saline solution by i.p. injection from day 1 to 35; the other treatment was administrated for 49 days. At the end of treatment, the animals were sacrificed, and the tissues of interest dissected, weighed and prepared for the respective assays. Cd treated rats from birth to puberty showed a delay onset in the puberty markers and a low weight in reproductive organs. Also, Cd induced differential effects on the redox system in reproductive organs and decreased T levels, these effects played a pivotal role in the delay of puberty markers onset (testes descent and preputial separation), affecting the development and sexual maturity of the male rats.

Introduction Serum protein electrophoresis (SPE) is a well-established technique to identify alterations in plasma protein profiles, caused by diseases as multiple myeloma (MM). In addition, it could be a cost-effective technique to discover new plasma biomarkers. Relation between MM and lysosomal storage diseases (LSDs) as Gaucher disease has been set out but, it has not been evaluated on other LSDs nor the utility of the SPE as first step on LSDs biomarkers discovery projects. Materials and methods Stored plasma samples at diagnosis from several LSDs patients underwent analysis. Quality control was checked prior to the SPE was analyzed by capillary electrophoresis. The analysis for monoclonal spikes and the differences between each fraction on patients’ samples vs the control data previously published, were evaluated. Furthermore, immunoprotein quantification and free light chains ratio were done by nephelometry and turbidimetry. Results Seventy-five samples of LSD patients at diagnosis, were assessed. The frequency of the MGUS on LSDs patients was not higher than in general population whereas one lysosomal acid lipase deficiency infant showed increased IgA and kappa deviation. Regarding to the usefulness of SPE in biomarkers discovery, statistically significant differences were observed on SPE fractions between LSDs and healthy population. Discussion The evaluation of SPE fractions can be a useful tool to understand pathophysiologic aspects in LDSs and, to simplify new marker discovery projects. In some of them, the MGUS appearance is a risk factor for the MM development despite its frequency is not increased on the studied LSDs at diagnosis.

Introducción y objetivos Se presentan las características clínicas y los resultados de los trasplantes cardiacos realizados en España con la actualización correspondiente a 2019. Métodos Se describen las características clínicas y los resultados de los trasplantes cardiacos realizados en 2019, así como las tendencias de estos en el periodo 2010-2018. Resultados En 2019 se realizaron 300 trasplantes (8.794 desde 1984; 2.745 entre 2010 y 2019). Respecto a años previos, los cambios más llamativos son el descenso hasta el 38% de los trasplantes realizados en código urgente, y la consolidación en el cambio de asistencia circulatoria pretrasplante, con la práctica desaparición del balón de contrapulsación (0, 7%), la estabilización del uso del oxigenador extracorpóreo de membrana (9, 6%) y el aumento de los dispositivos de asistencia ventricular (29%). La supervivencia en el trienio 2016-2018 es similar a la del trienio 2013-2015 (p = 0, 34), y ambas mejores que la del trienio 2010-2012 (p = 0, 002 y p = 0, 01 respectivamente). Conclusiones Se mantienen estables tanto la actividad del trasplante cardiaco en España como los resultados en supervivencia en los últimos 2 trienios. Hay una tendencia a realizar menos trasplantes urgentes, la mayoría con dispositivos de asistencia ventricular. Introduction and objectives: The present report describes the clinical characteristics and outcomes of heart transplants in Spain and updates the data to 2019. Methods: We describe the clinical characteristics and outcomes of heart transplants performed in Spain in 2019, as well as trends in this procedure from 2010 to 2018. Results: In 2019, 300 transplants were performed (8794 since 1984; 2745 between 2010 and 2019). Compared with previous years, the most notable findings were the decreasing rate of urgent transplants (38%), and the consolidation of the type of circulatory support prior to transplant, with an almost complete disappearance of counterpulsation balloon (0.7%), stabilization in the use of extracorporeal membrane oxygenation (9.6%), and an increase in the use of ventricular assist devices (29.0%). Survival from 2016 to 2018 was similar to that from 2013 to 2015 (P = .34). Survival in both these periods was better than that from 2010 to 2012 (P = .002 and P = .01, respectively). Conclusions: Heart transplant activity has remained stable during the last few years, as have outcomes (in terms of survival). There has been a trend to a lower rate of urgent transplants and to a higher use of ventricular assist devices prior to transplant.

To assess the effectiveness of an individualized comprehensive rehabilitation program (ICPR) on impaired postural control, pain, self-perceived health status, and functionality in women with chronic pelvic pain.Randomized controlled trial.Women with chronic pelvic pain were recruited from the Gynecology Department of the University Hospital San Cecilio in Granada, Spain.Participants (N=38) who were randomly divided into 2 groups.The intervention group received an 8-week ICRP, and the control group received a leaflet with ergonomic information.The main outcomes included were postural control (Mini Balance Evaluation Systems [Mini BESTest] and timed Up and Go [TUG]), pain (Brief Pain Inventory), self-perceived health status (EuroQol 5 dimensions [EQ-5D]), and functionality (Oswestry Disability Index [ODI]).Significant differences were found between groups in the Mini BESTest and TUG scores with large effect sizes. The Brief Pain Inventory, EQ-5D, and ODI also presented significant differences in the between-groups analysis, with better scores in the intervention group after treatment. In the follow-up analysis, significant differences were found between groups in the Mini BESTest (P.001), the cognitive TUG subscale (P=.032), interference of pain (P.001), anxiety and depression (P=.001), and visual analog scale EQ-5D (P=.026) subscales, as well as the ODI (P.001).Our results show significant improvements on postural control, pain, self-perceived health status, and functionality in women with chronic pelvic pain who received an 8-week ICRP.

Targeted axillary dissection, which combines sentinel lymph node biopsy with removal of the proven involved node noted during the staging process, has been shown to improve axillary staging and decrease false negative rates after neoadjuvant chemotherapy in patients with breast cancer.The main goal of this study was to assess the ability to identify and remove the clipped node and the false negative rate of targeted axillary dissection.We performed a prospective study among patients with biopsy-confirmed nodal metastases who received neoadjuvant chemotherapy. A clip was placed on the sample node prior systemic therapy. After neoadjuvant chemotherapy, all patients underwent sentinel lymph node biopsy (dual tracer), localization and excision of the clipped node and axillary lymph node dissection. The clipped node was preoperatively localized in all cases placing an iodine-125 seed guided by ultrasound. The pathology of the sentinel nodes and clipped node was compared with other nodes.A total of 455 patients with invasive breast cancer were studied. Of the 148 patients with NAC, 32 met the eligibility criteria and were enrolled in the study. Mean age at diagnosis was 52.3 years. Systematic lymphadenectomy was performed in all patients, with an average of 14.3 lymph nodes removed. Detection rate of the clipped node alone was 96.9%, and 100% for targeted axillary dissection. Ability of clipped node alone to predict nodal status showed a FNR of 10,5% while SLNB alone performed by dual tracer and targeted axillary dissection, showed FNRs of 5.3% and 5.0%, respectively. Sentinel lymph nodes matched clipped node in 23 patients (74.2%).In node positive breast cancer patients, targeted axillary dissection is a reliably approach for axillary staging after neoadjuvant chemotherapy. The preoperative location of the clipped node is mandatory to increase the detection rate and optimize the results of the technique.