Search

Gema Requena,1 Alexandrosz Czira,1 Victoria Banks,2 Robert Wood,2 Theo Tritton,2 Catherine Castillo,2 Jie Yeap,2 Rosie Wild,2 Chris Compton,1 Kieran J Rothnie,1 Felix JF Herth,3 Jennifer K Quint,4 Afisi S Ismaila5,6 1GSK, R&D Global Medical, Brentford, Middlesex, UK; 2Real-World Evidence, Adelphi Real World, Bollington, Cheshire, UK; 3Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg, Heidelberg, Germany; 4National Heart and Lung Institute, Imperial College London, London, UK; 5Value Evidence and Outcomes, GSK, Collegeville, PA, USA; 6Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, CanadaCorrespondence: Gema Requena, Epidemiology, Value Evidence and Outcomes, R&D Global Medical, GSK, Brentford, Middlesex, UK, Tel +44 20 80476893, Email gema.x.requena@gsk.comPurpose: Chronic obstructive pulmonary disease (COPD) exacerbations are associated with significant morbidity and mortality and increased economic healthcare burden for patients with COPD. Long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA) dual therapy is recommended for patients receiving mono-bronchodilator therapy who experience exacerbations or ongoing breathlessness. This study compared two single-inhaler LAMA/LABA dual therapies, umeclidinium/vilanterol (UMEC/VI) and indacaterol/glycopyrronium (IND/GLY), on moderate-to-severe exacerbation rates in patients with COPD in England.Patients and Methods: This retrospective cohort study used linked primary care electronic health record data (Clinical Practice Research Datalink-Aurum) and secondary care data (Hospital Episode Statistics) to assess outcomes for patients with COPD who had a first prescription for single-inhaler UMEC/VI or IND/GLY (index date) between 1 January 2015 and 30 September 2019 (indexing period). Analyses compared UMEC/VI and IND/GLY on moderate-to-severe, moderate, and severe exacerbations, healthcare resource utilization (HCRU), and direct costs at 6, 12, 18, and 24 months, and time-to-first on-treatment exacerbation up to 24 months post-index date. Following inverse probability of treatment weighting (IPTW), non-inferiority and superiority of UMEC/VI versus IND/GLY were assessed.Results: In total, 12,031 patients were included, of whom 8753 (72.8%) were prescribed UMEC/VI and 3278 (27.2%) IND/GLY. After IPTW, for moderate-to-severe exacerbations, weighted rate ratios were < 1 at 6, 12, and 18 months and equal to 1 at 24 months for UMEC/VI; around the null value for moderate exacerbations and < 1 at all timepoints for severe exacerbations. UMEC/VI showed lower HCRU incidence rates than IND/GLY for all-cause Accident and Emergency visits and COPD-related inpatient stays and associated all-cause costs at 6 months post-indexing. Time-to-triple therapy was similar for both treatments.Conclusion: UMEC/VI demonstrated non-inferiority to IND/GLY in moderate-to-severe exacerbation reduction at 6, 12 and 18 months. These results support previous findings demonstrating similarity between UMEC/VI and IND/GLY on reduction of moderate-to-severe exacerbations.Plain Language Summary: Sudden exacerbations, or flare-ups, of chronic obstructive pulmonary disease (COPD) are linked with worsening health and increased risk of death, as well as increased healthcare costs for people with COPD. Long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA) dual therapy is recommended for patients with COPD who take LAMA or LABA monotherapy but continue to experience flare-ups or ongoing breathlessness. This study compared two single-inhaler LAMA/LABA dual therapies, umeclidinium/vilanterol (UMEC/VI) and indacaterol/glycopyrronium (IND/GLY), in terms of flare-ups in patients with COPD in England.We used two linked databases of de-identified medical records from general practitioners and hospitals for patients with COPD who had a first prescription for UMEC/VI or IND/GLY between 1 January 2015 and 30 September 2019. We compared the two treatments on COPD flare-ups, healthcare resource utilization and related costs, and changes in medication over the 2 years following starting treatment.We found that the treatments were comparable for moderate-to-severe flare-ups. Patients taking UMEC/VI had less Accident and Emergency (A&E) visits in total and less inpatient stays related to their COPD, and had a lower overall cost of healthcare for A&E visits and inpatient stays than patients taking IND/GLY. Changes to treatment and time before their first flare-up were similar for all patients, regardless of their prescribed treatment.This study showed that UMEC/VI is as effective as IND/GLY at preventing moderate-to-severe flare-ups. These results support previous findings demonstrating similarity between UMEC/VI and IND/GLY in reducing the rate of moderate-to-severe exacerbations after starting treatment.Keywords: COPD dual therapy, LABA/LAMA new users, healthcare resource utilization, exacerbations, comparative effectiveness, single-inhaler dual therapy

European climate polices acknowledge the role that energy communities can play in the energy transition. Self-consumption installations shared among those living in the same building are a good example of such energy communities. In this work, a regional analysis of optimal self-consumption installations under the new legal framework recently passed in Spain is performed. Results show that the optimal sizing of the installation leads to economic savings for self-consumers in all the territory, for both options with and without remuneration for energy surplus. A sensitivity analysis on technology costs revealed that batteries still require noticeably cost reductions to be cost-effective in a behind the meter self-consumption environment. In addition, solar compensation mechanisms make batteries less attractive in a scenario of low PV costs, since feeding PV surplus into the grid, yet less efficient, becomes more cost-effective. An improvement for the energy surplus remuneration policy in the context of the current legislation was proposed and analysed. It consists in the inclusion of the economic value of the avoided power losses in the remuneration.

La poesía prehispánica es la primera etapa evolutiva del género poético en Latinoamérica, por medio de sus discursos no solo podemos conocer las dimensiones conflictivas que se suscitaron durante el desencuentro entre la oralidad con la escritura, también se observa las cualidades discursivas preexistentes a la invasión española que forman parte tanto de la concepción literaria como de la visión del mundo que se desarrollaron en la civilización azteca e incaica. En tal sentido, el artículo tiene el objetivo de analizar una de estas características líricas, el huérfano, que desde la cultura quechua se le denomina wakcha, mientras que para la náhuatl, icnopilli; ambas comparten una similitud en su representación, pero cada una de ellas conlleva y corresponde a una racionalidad distinta, gracias a estas diferencias e interrelaciones se logra aprehender e interpretar la naturaleza conjuntiva y ramificadora del sistema poético prehispánico.

Cecilia Castillo,1 Natalia Camejo,1 Monika Rondan,1 Florencia Savio,1 Guadalupe Herrera,2 Gabriel Krygier,1 Lucia Delgado1 1Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay; 2Department of Quantitative Methods, School of Medicine, University of Uruguay, Montevideo, UruguayCorrespondence: Cecilia CastilloDepartment of Clinical Oncology, School of Medicine, University of Uruguay, Avenida Italia s/n, Montevideo, 11600, UruguayTel +59824872075Email cascecilia@gmail.comIntroduction: Increases in disease-free survival and overall survival (OS) with the use of adjuvant chemotherapy in early breast cancer (BC) are widely known; however, the optimal time to initiate treatment with adjuvant chemotherapy remains controversial.Objective: To evaluate the time elapsed between surgery and the initiation of adjuvant chemotherapy and its possible impact on OS in patients diagnosed with BC stages I–III.Materials and Methods: This retrospective study included 112 patients diagnosed with BC stages I–III who received adjuvant chemotherapy at the Mastology Unit of the Hospital de Clínicas in Uruguay from 2009 to 2019. OS was estimated using the Kaplan–Meier method, and a Cox proportional hazards model was used to estimate hazard ratios (HRs) and 95% confidence intervals.Results: No statistically significant association was found between the time from surgery to the initiation of chemotherapy and the described variables. OS was worse for patients initiating chemotherapy more than 90 days after breast surgery (n = 19) (HR 7.63; p = 0.004) and between 61 and 90 days after surgery (n = 46) (HR 4.58; p = 0.040) compared to those who started before 30 days (n = 23). Controlling by type of surgery and stage, the prognosis of patients who started chemotherapy between 61 and 90 days after surgery was similar to that of patients who underwent chemotherapy within the first 30 days, controlling for surgery (HR 4.10; p = 0.056) and controlling for stage (HR 3.76; p = 0.075). Prognosis was worse for patients with stage III disease (p = 0.022) who underwent a mastectomy and/or axillary lymph node dissection (p = 0.025).Conclusion: Patients who started chemotherapy more than 90 days following surgery and those with stage III disease or underwent mastectomy and/or axillary lymph node dissection who initiated it between 61 and 90 days had a worse OS. Multiple factors are involved in the time between surgery and the initiation of chemotherapy, and further studies are needed to evaluate which of these factors influence the delay of chemotherapy in order to design strategies to avoid such delays and their negative impact on survival.Keywords: time, adjuvant chemotherapy, breast cancer, survival

María Luna-Luna,1 Sergio Criales-Vera,2 Diana Medina-Leyte,1 Mariana Díaz-Zamudio,2 Adriana Flores-Zapata,1 David Cruz-Robles,1 Mauricio López-Meneses,3 Sergio Olvera-Cruz,3 Samuel Ramírez-Marroquín,4 Cristóbal Flores-Castillo,1 José Manuel Fragoso,1 Elizabeth Carreón-Torres,1 Jesús Vargas-Barrón,5 Gilberto Vargas-Alarcón,1 Óscar Pérez-Méndez1,6 1Molecular Biology, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico; 2Radiology, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico; 3Adult Cardiology, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico; 4Cardiothoracic Surgery, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico; 5Research Direction, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico; 6School of Engineering and Sciences, Tecnológico de Monterrey, Campus Monterrey, Mexico City, MexicoCorrespondence: Óscar Pérez-MéndezMolecular Biology Department, National Institute of Cardiology “Ignacio Chávez”, Mexico City, MexicoTel +52 55 55732911 ext 26300Email opmendez@yahoo.comPurpose: It has been proposed that the cardiovascular effects of obesity are related to epicardial adipose tissue (EAT), which seems to play an active role on the development and calcification of atherosclerotic plaques, but the mechanisms are still unknown. Therefore, the aim of this study was to determine whether the EAT expresses the genes of calcifying factors and whether such expression is associated with the body mass index (BMI) and with the presence of coronary artery calcium (CAC) in patients with coronary artery disease (CAD).Patients and Methods: Forty-three patients with CAD were enrolled specifically for this study, and their CAC score and EAT volume were determined by computed tomography. As the group of comparison, 41 patients with aortic valve stenosis and CAC = 0 were included (control group). A representative subgroup of 16 CAD patients and 23 controls were selected to obtain EAT biopsies during the chirurgical procedure from the atrio-interventricular groove. The mRNA expression of bone morphogenetic protein-2 and -4 (BMP-2, BMP-4), osteopontin (OPN), osteonectin (ON), and osteoprotegerin (OPG) in EAT was determined by qPCR.Results: The gene expression of OPN and BMP-2 was 70% and 52% higher in the EAT from CAD patients than that in controls, respectively, whereas the expression of OPG, ON, and BMP-4 was similar in both groups. The EAT volume positively correlated with OPG and with the BMI, suggesting a relationship of obesity with local higher expression of calcifying genes in the coronary territory. The logistic regression analysis showed that high levels of both OPN and BMP-2 increased about 6 and 8 times the odds of coronary calcification (CAC score > 0), respectively.Conclusion: EAT correlated with BMI and expressed the mRNA of calcifying genes but only OPN and BMP-2 expression was higher in CAD patients. Higher levels of both OPN and BMP-2 statistically determined the presence of calcium in coronary arteries of CAD patients.Keywords: obesity, adipocyte, calcifying proteins, coronary artery disease, atherosclerosis

INTRODUCCIÓN: El uso de selladores en la obturación endodóntica es fundamental para lograr un sellado tridimensional del conducto radicular. Según su composición, se presentan selladores a base de resina epóxica, como el AH Plus y de biocerámico, como Bio-C Sealer y BioRoot RCS, siendo considerados los últimos como materialesbioactivos, por su capacidad de promover una reacción biológica específica sobre el tejido receptor, por la liberación de calcio y pH alcalino OBJETIVO: Evaluar, in vitro la capacidad de diferentes selladores endodónticos para modificar el pH de la solución en la cual son inmersos, en distintos períodos de tiempo. MATERIALES Y METODOS: Se prepararon 15 probetas de sellador en un molde de plástico. Se dejaron fraguar 24 hs en estufa a 37° C y posteriormente, cada una fue inmersa en un frasco consolución fisiológica. La muestra se dividió en tres grupos (n=5) según el sellador: 1) BioRoot RCS, 2) Bio-C Sealer y 3) AHPlus. Se determinó el pH de la solución de cada grupo en diferentes períodos de tiempo: inmediato, 40 min, 24 y 48 hs, 7, 14, 21 y 30 días. Los resultados fueron analizados estadísticamente mediante Análisis de Varianza con Medidas Repetidas (ANOVA). RESULTADOS: El sellador AH Plus mantuvo constante el pH del medio durante toda la experiencia. Ambos selladores biocerámicos elevaron el pH del medio hasta llegar a ser alcalino (11,2 y 11,5) a las 24 hs, el cual se mantuvo para el grupo BioRoot RCS hasta los 30 días, con un pH promedio de 11.5. Mientras que, a partir de los 7 días, en el grupoBio-C Sealer comenzó a descender el pH del medio. La evolución del pH a lo largo del tiempo arrojó diferencias significativas entre los distintos selladores evaluados (p

Guojun Chen,1,* Longyuan Jiang,1,* Liwen Wang,1 Wei Zhang,2 Carlos Castillo,3,4 Xiangshao Fang1 1Department of Emergency Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; 2Department of Respiratory Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; 3Zhang Neuroscience Research Laboratories, School of Medicine, Loma Linda University, Loma Linda, CA, USA; 4Bioengineering Department, Gordon and Jill Bourns College of Engineering, California Baptist University, Riverside, CA, USA *These authors contributed equally to this work Background and aim: It is desirable to facilitate the use of an affordable, reliable, and portable spirometer, for earlier diagnosis of COPD in China, particularly in rural areas. The aim of this study was to assess the agreement of a handheld “disposable pneumotachograph” (D-PNEU) spirometer with the gold standard spirometer and to evaluate its diagnostic accuracy of spirometric classification of airflow obstruction. Subjects and methods: A total of 241 adult Chinese subjects ranging from healthy to those with mixed levels of pulmonary disease performed spirometry in a conventional body plethysmograph, and using a D-PNEU device in randomized order. The three best spirometric tests were recorded for comparative analysis. A Bland–Altman graph was created to assess the agreement between devices. Using FEV1/FVC

The studies on the pathogenic role of the Schistosoma mansoni focus on the hepatic damage and the immune response of the final host, in constrast to the limited information regarding intestinal lesion. This work evaluates. Intestinal granulomatous inflammation was measured in histological sections the effect of praziquantel in the angiogenic receptors (FLK1 and FLT1), inflammation and inflammatory cytokines on the murine intestinal schistosomiasis stained with H&E; the detection of TNF-α, IL-10, TGF-β, VEGF and its receptors was carried out by immunohistochemistry and ELISA, in serum and intestine sections of BALB/c mice infected with S. mansoni at 8 (RI8S) and 20 (RI20S) weeks post-infection, and mice infected for 8 weeks and evaluated 15 days post-treatment with praziquantel 40 μg/(RPT). In RI8S small granulomas (11.304 μm2 average), without sharp or marked edges within the granuloma; and large granulomas (70.650 μm2) with defined borders without defined zones within the granuloma, In both groups of mice macrophages predominated and plasma cells were present. In RI20S, granulomas have an inner zone composed by abundant macrophages and few plasma cells, and external zone constituted only by macrophages (11.985 μm2). In RPT, granulomas were not observed, only a few inflammatory foci nearby the muscularis mucosae and the Lieberkuhn glands. Localization of immune molecules in the intestine was only positive in RPT for VEGF, its receptors, TGF-β and IL-10; the results show a discrete response over the granuloma size, cellularity and cytokine expression at intestinal level.

Abstract: The studies on the pathogenic role of the Schistosoma mansoni focus on the hepatic damage and the immune response of the final host, in constrast to the limited information regarding intestinal lesion. This work evaluates. Intestinal granulomatous inflammation was measured in histological sections the effect of praziquantel in the angiogenic receptors (FLK1 and FLT1), inflammation and inflammatory cytokines on the murine intestinal schistosomiasis stained with H&E; the detection of TNF-α, IL-10, TGF-β, VEGF and its receptors was carried out by immunohistochemistry and ELISA, in serum and intestine sections of BALB/c mice infected with S. mansoni at 8 (RI8S) and 20 (RI20S) weeks post-infection, and mice infected for 8 weeks and evaluated 15 days post-treatment with praziquantel 40 µg/(RPT). In RI8S small granulomas (11.304 µm2 average), without sharp or marked edges within the granuloma; and large granulomas (70.650 µm2) with defined borders without defined zones within the granuloma, In both groups of mice macrophages predominated and plasma cells were present. In RI20S, granulomas have an inner zone composed by abundant macrophages and few plasma cells, and external zone constituted only by macrophages (11.985 µm2). In RPT, granulomas were not observed, only a few inflammatory foci nearby the muscularis mucosae and the Lieberkuhn glands. Localization of immune molecules in the intestine was only positive in RPT for VEGF, its receptors, TGF-β and IL-10; the results show a discrete response over the granuloma size, cellularity and cytokine expression at intestinal level. Resumen: Los estudios en torno al papel patogénico del Schistosoma mansoni se enfocan en el daño hepático y la respuesta inmune en el hospedador definitivo, en contraste a la escasa información en relación a la patología intestinal. A tal fin, se evaluó el efecto del praziquantel en los receptores angiogenicos, citocinas inflamatorias y anti-inflamatorias en la esquitosomiasis intestinal murina. La respuesta inflamatoria granulomatosa intestinal se midió en secciones histológicas teñidas con H&E; la detección de TNF-α, IL-10, TGF-β, el VEGF y sus receptores (FLK1 y FLT1) mediante inmunohistoquímica y ELISA, en suero e intestino de ratones BALB/c infectados con S. mansoni a las 8 (RI8S) y 20 semanas (RI20S), y ratones con 8 semanas de infección a los quince días de post-tratamiento, con praziquantel 40 µgr/gr (RPT). En RI8S se observaron granulomas pequeños (11304 µm2 en promedio), sin bordes definidos ni zonas marcadas dentro del granuloma, y granulomas de gran tamaño con bordes definidos (70650 µm2) sin zonas definidas dentro del granuloma, ambos con predominio de macrófagos y presencia de plasmocitos. En RI20S, los granulomas presentan una zona interna constituida por abundantes macrófagos y escasos plasmocitos, y una externa constituida solo por macrófagos (11985 µm2). En RPT no se apreciaron granulomas, solo algunos focos inflamatorios cercanos a la muscularis mucosae y las glándulas de Lieberkuhn. La Inmunolocalización en el intestino solo fue positiva en RPT para VEGF y sus receptores, TGP-β e IL-10; Los resultados muestran una discreta respuesta en cuanto a tamaño del granuloma, celularidad y la expresión de citocinas a nivel intestinal.

Copyright of Panorama Económico is the property of Universidad de Cartagena and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This research is based in human rights perspectives with gender approach. The purpose was to evaluate the impact of an occupational therapy intervention regarding relationship between mother and child inside the Penitentiary Precinct of Punta Arenas. In order to accomplish the goal qualitative methods were used and the design was a case study. Data collection included active-participant observation and interviews with mothers. Data analysis was developed under the guidance of grounded theory. Results show positive changes in affection, attachment, motivation and empathy. There is a positive impact in attachment, development of the link mother-daughter, conscience of the affiliated relation and positive changes in the perception of the mother’s role. It is urgent to continue advancing in Chile about the recognition and boarding on needs of women who reside in the penitentiary system: in strategies that allow them to accede to significant occupations in this context, and therefore to respect their fundamental human rights.