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Resumen Introduccion En Espana, al igual que en otros paises donde el sarampion endemico ha sido eliminado, es necesario utilizar de forma rutinaria las herramientas diagnosticas que confirmen los casos para su prevencion y control de la diseminacion. Se describen los diferentes ensayos microbiologicos utilizados para su diagnostico durante un brote de sarampion en 2019 en la provincia de Guadalajara (Espana). Metodos Las pruebas serologicas y moleculares se realizaron en el laboratorio de Microbiologia del Hospital Universitario de Guadalajara y en el Centro Nacional de Microbiologia del Instituto de Salud Carlos III (Majadahonda, Espana). Los datos de los pacientes se obtuvieron del sistema epidemiologico de vigilancia. Resultados Se diagnosticaron de sarampion un total de 43 pacientes por metodos microbiologicos: 29 casos por PCR (exudado faringeo u orina) junto con IgM especifica positiva, 11 pacientes solamente por PCR, y 3 pacientes exclusivamente por presencia de IgM. El genotipo D8 fue identificado en 35 pacientes y el genotipo A en 2 casos descartados como postvacunal. La PCR en suero fue positiva en 11 de 14 pacientes con ausencia de IgM en su primera muestra recogida de suero. Once casos confirmados habian recibido una o 2 dosis de la vacuna. Doce adultos fueron ingresados, todos diagnosticados de hepatitis. Conclusiones La combinacion de pruebas moleculares y la presencia de IgG e IgM especificas son necesarias para un diagnostico correcto y la clasificacion de los pacientes como fallo vacunal (primario o secundario). El genotipado es una herramienta fundamental para la correcta clasificacion de los pacientes en el contexto de un programa de eliminacion del sarampion.

Resumen Antecedentes y objetivo El objetivo de este estudio es presentar una nueva aplicacion de realidad virtual (RV) de bajo coste basada en el dispositivo Leap Motion Controller (LMC) desarrollada para la rehabilitacion motora de miembros superiores tras patologia neurologica y mostrar su viabilidad clinica realizando una experiencia piloto. Material y metodos El LMC permite la interaccion con las aplicaciones virtuales mediante la captacion de los movimientos de la mano. Se realizo una prueba piloto con cuatro pacientes con afectacion de miembros superiores con Upper Extremity Motor Score (UEMS) mayor de 10. Se les valoro con los test Box and Block (BBT) y tarea de escritura del Jebsen-Taylor Hand Function (JTHF) antes y despues de la intervencion. Resultados Los pacientes completaron el protocolo de nueve sesiones de 30 minutos de duracion dividido en tres sesiones por semana. En el BBT pasaron de 38 (DE 20) cubos antes de la intervencion a 44 (DE 21,72) cubos tras finalizarla. En el JTHF pasaron de 28,25 s (DE 8,61) a 26, 75 s (DE 21,72). No hubo diferencias estadisticamente significativas. La usabilidad del dispositivo se valoro con la escala Quebec User Evaluation of Satisfaction with assistive Technology, version 2.0 (QUEST) siendo la seguridad, efectividad y facilidad de uso los aspectos prioritarios. Conclusion Se presenta un nuevo desarrollo de RV basado en el dispositivo LMC y se ha comprobado su viabilidad clinica en pacientes neurologicos con afectacion de los miembros superiores. Es preciso realizar un estudio clinico con una muestra amplia para valorar su posible efectividad clinica como elemento de tratamiento.

To evaluate the visual and refractive outcomes of laser corneal enhancement after trifocal intraocular lens (IOL) implantation in eyes previously treated with myopic/hyperopic laser corneal refractive surgery (LCRS).Clinica Baviera-AIER-Eye Group, Spain.Retrospective comparative case series.Patients were divided by primary LCRS into myopic and hyperopic groups. The outcomes evaluated were uncorrected distance (UDVA), corrected distance (CDVA), uncorrected intermediate (UIVA), and uncorrected near visual acuity (UNVA), and predictability, safety, efficacy, and satisfaction after implantation of 2 trifocal IOL models (Physiol-FineVision and Zeiss-ATLisa 839) and subsequent laser enhancement.186 eyes (89 myopic and 97 hyperopic eyes) from 146 patients were assessed. At the last visit, refractive outcomes were better in myopic than those in hyperopic eyes, with statistically significant differences for sphere ( P.001), cylinder ( P.001), manifest refraction spherical equivalent (MRSE) ( P = .003), CDVA ( P = .005), UDVA ( P = .047), and UNVA ( P = .003) but not for UIVA ( P = .580), binocular UIVA ( P = .660), or binocular UNVA ( P = .836). Predictability differences were nonsignificant between groups for a final MRSE of ±0.5 diopters (D) and ±1.0 D (P = .167 and .502, respectively). Efficacy and safety were similar in both groups ( P = .235 and P = .080). A greater myopic MRSE was present after trifocal implantation in myopic than in hyperopic eyes (MRSE = -0.93 vs -0.69 D, P = .013), and the statistically significant differences were maintained after enhancement between both groups (MRSE -0.00 vs 0.00 D, P = .003). Overall satisfaction was similar in both groups ( P.05 all items).Corneal laser enhancement after implantation of a trifocal IOL in eyes previously treated for myopia or hyperopia with LCRS was safe, effective, predictable, and highly satisfactory.

Resumen Introduccion El diverticulo de Zenker (DZ) es una protrusion de la mucosa hipofaringea con una prevalencia de 2/100.000 habitantes. La clinica condiciona la necesidad del tratamiento, pudiendo ser quirurgico o endoscopico. Este ultimo, denominado septotomia o diverticulotomia endoscopica (DE), consiste en la diseccion del septo diverticular, pudiendo realizarse con distintos dispositivos disectores. Objetivo El objetivo del estudio es evaluar la eficacia y seguridad de la DE mediante el dispositivo Stag-Beetle Knife™, asi como realizar una revision de la literatura para valorar el posicionamiento de la tecnica en el panorama cientifico actual. Material y metodos Estudio retrospectivo descriptivo que incluye pacientes intervenidos mediante DE con SB-Knife™ entre junio de 2017 y febrero de 2020. Revision de la literatura de la evidencia disponible entre enero de 2013 y abril 2020 de la DE mediante la tecnica con SB-Knife™ y sus variantes. Resultados Se recopilaron 12 pacientes (66% varones) con una mediana de 70,5 anos. El tamano diverticular fue de 32,5 mm de mediana y la remision completa se objetivo en el 75% de los casos. Se realizaron 14 intervenciones con un exito tecnico del 92,8%. No se produjeron complicaciones graves. Se realizo una revision de la literatura encontrando 13 trabajos de los cuales se incluyeron finalmente 8 (6 estudios retrospectivos, una serie de casos y un caso clinico). Conclusiones En funcion de nuestra experiencia y a la bibliografia revisada, consideramos que la DE mediante SB-Knife™ es una tecnica segura, eficaz y reproducible, pudiendo ser una mejor alternativa a la cirugia en pacientes con DZ.

Temporomandibular joint dislocation is defined as the loss of joint congruency between the mandibular condyle and the glenoid fossa of the temporal bone. Multiple therapeutic options have been proposed for the treatment of recurrent TMJ dislocation. The aim of this paper is to present two recently treated cases with a modification of Wolford's technique, replacing the Mitek anchors with orthodontic screws. Case series: The first case concerns a 36 year-old women with recurrent temporomandibular dislocation, and the second one a 26 year-old patient with the same diagnosis. In both cases, one 8mm orthodontic screw was placed in the lateral pole of mandibular condyle, sutured with PremiCron® 2/0 to a hole made in the root of each zygomatic arch. At twelve-month follow-up (first patient) and at six-month follow-up (second patient), patients had not presented new episodes of mandibular dislocation and mouth opening range remained stable. This technique can be considered as an alternative to Wolford's technique in treating recurrent temporomandibular dislocation when conservative management fails.

Introduction and Objectives:Massive hemorrhage (MH) is a growing pathology in military settings and increasingly in civilian settings; it is now considered a public health problem in the United States with large-scale programs. Tourniquets are the fastest and most effective intervention in MH if direct pressure is not effective.The Liaison Committee on Resuscitation (ILCOR) recognizes a knowledge gap in optimal education techniques for first aid providers. This review aims to describe training and evaluation methods for teaching tourniquet use to both health care and military professionals.Methods:The MEDLINE, CINAHL, WEB of Science, and Scopus databases were reviewed (from 2010 through April 2020). The quality of the selected studies was assessed using the Consolidated Standards of Reporting Trials (CONSORT) scale. Studies that met at least 65% of the included items were included. Data were extracted independently by two reviewers.Results:Ten of the 172 articles found were selected, of which three were randomized clinical trials. Heterogeneity was observed in the design of the studies and in the training and evaluative methods that limit the comparison between studies.Conclusions:The results suggest that the training strategies studied are effective in improving knowledge, attitudes, and practical skills. There is no universal method, learning is meaningful but research should be directed to find out which ones work best.

Syndrome of the trephined (SoT) is the neurological deterioration that occurs after the performance of decompressive craniectomy in which bone is not replaced. The incidence of SoT varies, but this entity seems to be underdiagnosed. It is characterized by symptom reversal after bone replacement, which is the only definitive treatment. We report the case of a patient assessed by the Rehabilitation Service in the Critical Care Unit after a stroke, who had altered level of consciousness and abrupt motor impairment. The patient was diagnosed with SoT. Rehabilitation, with early postural changes, helped to ameliorate the symptoms until the provision of definitive treatment.

We describe two fatal cases of COVID-19 in which Rhizopus microsporus and Lichtheimia corymbifera were cultured from endotracheal aspirate samples. Both patients had no underlying comorbidities other than obesity. Despite antifungal therapy, both cases developed septic shock and progressive refractory hypoxemia without evidence of other underlying infections. It is unclear whether isolation of these fungal organisms represents invasive disease or corresponds to an epiphenomenon of critical illness. Yet, patients suffering from COVID-19 may be at risk of superinfection from a broader range of fungal organisms than previously thought.

La salud sexual de las personas con discapacidad física (PDF) no sólo se ve influenciada por las limitaciones derivadas de la propia discapacidad sobre todo a la hora de iniciar contactos sino también, y sobre todo, por la estigmatización social. Creencias como que poseer un cuerpo con una funcionalidad no normativa puede interferir en la conducta sexual y en su función reproductiva son muestras de ello. Así mismo, se ha comprobado que la familia y los profesionales que se proporcionan apoyos a las PDF son el principal agente de formación, por lo que sus actitudes hacia la sexualidad de este colectivo van a condicionar su desarrollo sexual y la vivencia que hagan de la misma. Dada la importancia de estas actitudes y la escasez de instrumentos fiables dirigidos a evaluarlas, el objetivo de este trabajo ha sido construir y validar un instrumento de evaluación de las actitudes hacia la sexualidad de las personas con discapacidad física (ASEX-PDF). Para ello, se contó con 554 participantes (41.3% hombres y 58.7% mujeres) con edades comprendidas entre 20 y 92 años, de los cuales 100 eran profesionales que trabajan con este colectivo y 454 pertenecían a la población general. El Análisis Factorial Exploratorio extrajo una estructura unifactorial, que fue verificada y corregida a través del Análisis FactorialConfirmatorio, mostrando unos buenos índices de bondad de ajuste. La consistencia interna de la escala total fue de .79 ( de Cronbach) y de .89 ( ordinal). Así mismo, las correlaciones con una escala afín resultaron significativas y en la dirección esperada. En conclusión, la ASEX-PDF se presenta como un instrumento válido y fiable que puede resultar útil en la exploración de las actitudes hacia la sexualidad de las PDF.

Background and aim Most patients with Parkinson's disease (PD) develop speech disorders during the course of the disease. These disorders severely affect the speech intelligibility and vocal quality of these people. The aim of this paper is to characterize the voice and speech of subjects with PD through the automatic analysis of voice recordings. We also study whether there is a relationship between the acoustic parameters extracted from the recordings and the quality of the voice perceived by the subjects themselves. Materials and methods This is a descriptive correlational study in which 20 subjects with PD and 20 healthy controls were compared. The subjects with PD completed the VHI-30 instrument and performed sustained phonation of different vowels in Spanish. The stage of the disease was also evaluated using the Hoehn and Yahr scale. Results There are greater vocalic changes in subjects with PD than in healthy controls. In particular, significant differences were found for the vowel space area, intensity, F0, jitter and shimmer. No statistically significant associations were found between these acoustic parameters and the voice quality as perceived by the subjects with PD. Conclusions Acoustic analysis of voice and speech may be of great help in characterizing the state of hypokinetic dysarthria in PD patients. In addition, automatic tools of this type could be used in the future in a complementary manner to facilitate identifying treatment needs in PD patients.

We aimed to study the predictive factors for recovery of parathyroid function in hypoparathyroid patients after total thyroidectomy for thyroid cancer.We designed a retrospective, multicentre and nation-wide analysis of patients with total thyroidectomy who were seen in twenty endocrinology departments from January to March 2018. We selected patients with histologically proven thyroid cancer and retrieved information related to surgical procedure and thyroid cancer features. Survival analysis and Cox regression analysis were used to study the relationship between these variables and the recovery of parathyroid function.From 685 patients with hypoparathyroidism at discharge of surgery, 495 (72.3%) recovered parathyroid function over time. Kaplan-Meier analysis showed that this recovery was significantly related to the presence of specialized surgical team (P0.001), identification of parathyroid glands at surgery (P0.001), papillary histopathology (P=0.040), and higher levels of postoperative calcium (Ca) (P0.001) and parathyroid hormone (PTH) (P0.001). Subjects with gross extrathyroidal extension (P=0.040), lymph node metastases (P=0.004), and surgical re-intervention after initial surgery (P=0.024) exhibited a significant risk of persistence of hypoparathyroidism. Multivariate Cox regression analysis showed that the significant and independent factors for recovery of parathyroid function were postoperative concentrations of Ca (P=0.038) and PTH (P=0.049). The presence of lymph node metastases was a negative predictor of recuperation of parathyroid function (P=0.042) in this analysis.In patients with thyroid cancer, recovery of parathyroid function after total thyroidectomy was directly related to postoperative Ca and PTH concentrations, and inversely related to lymph node metastases.

Background Fondaparinux is thought to have the most favorable risk–benefit profile among all anticoagulants in non-ST-elevation acute coronary syndrome (NSTE-ACS). However, conflicting findings exist whether this holds true in current clinical practice. We aimed to assess the net clinical benefit of fondaparinux versus enoxaparin in the contemporary management of NSTE-ACS. Methods Analysis of prospective multicenter registry data of NSTE-ACS patients who received fondaparinux or enoxaparin from February 2015, through December 2017. Survival models within a competing risks framework including site-specific random effects, were used to assess the composite of clinically relevant bleedings and major adverse cardiovascular events at 30 days. Results Of 2094 patients, 1724 (82%) received enoxaparin and 370 (18%) fondaparinux. Both groups were comparable except for a lower prevalence of diabetes and renal impairment, and greater use of transradial approach in the fondaparinux group. Multivariate analysis revealed a net clinical benefit in favour of fondaparinux versus enoxaparin (Subhazard Ratio [SHR] 0.59; 95%CI 0.37–0.92), mainly driven by a reduction in bleeding (SHR 0.57; 95%CI 0.37–0.89). Exploratory analysis suggested greater reductions in bleeding with fondaparinux among patients undergoing transradial approach, revealing a significant interaction between treatment and vascular access on the multiplicative scale (Pinteraction = 0.0056), but not on an additive scale (P = 0.457). Propensity-score-matching analysis yielded similar results. Conclusions In contemporary management of NSTE-ACS, fondaparinux seems to provide a favorable net clinical benefit compared with enoxaparin, primarily driven by a bleeding reduction. Effect modification on the safety profile of fondaparinux by the vascular access approach warrants further investigation.

ObjectivesThe main objective of this study was to device-assess the levels of physical activity and sedentary behaviour patterns of older adults during the situation prior to COVID-19 pandemic, home-quarantine and the ending of isolation. We also aimed analysing the effectiveness of an unsupervised home-based exercise routine to counteract the potential increase in sedentary behaviour during the periods within the pandemic.Methods18 non-institutionalized elderly (78.4±6.0 y.), members of the Spanish cohort of EXERNET-Elder 3.0 project participated in the study. They were recommended to perform an exercise prescription based on resistance, balance and aerobic exercises during the pandemic. Wrist triaxial accelerometers (ActiGraph GT9X) were used to assess the percentage of sedentary time, physical activity and sedentary bouts and breaks of sedentary time. An ANOVA for repeated measures was performed to analyse the differences between the three different periods.ResultsDuring home-quarantine, older adults spent more time in sedentary behaviours (71.6±5.3%) in comparison with either the situation prior to the pandemic (65.5±6.7%) or the ending of isolation (67.7±7.1%) (all ppConclusionsAccording with our results, the home-quarantine could negatively affect health due to increased sedentary lifestyle and the reduction of physical activity. Therefore, our unsupervised exercise program does not seem to be a completely effective strategy at least in this period.What is already known on this topicAlthough the available information is scarce and includes subjective methodology (questionnaires), it seems that the COVID-19 pandemic has negatively affected physical activity patterns.It is known that physical activity interventions are effective in improving health and reducing sedentary lifestyle in older adults. Nevertheless, little is known about whether an unsupervised home-based exercise routine is an effective alternative to counteract the potential increase in sedentary behaviour in this specific population during the pandemic lockdown.What are the findings? / What this study addsDespite unsupervised training, during home-quarantine, older adults spent more sedentary time than in the situation prior to COVID-19 and the ending of isolation (phase 0).There were no differences in break of sedentary time patterns between the situation prior to COVID-19 and the periods within the pandemic.During home-quarantine older adults performed fewer and shorter physical activity bouts than in the situation prior to COVID-19 despite unsupervised training.Our unsupervised home-exercise routine was not a completely effective alternative to avoid the increase of sedentary behaviour during home-quarantine.How might it impact on clinical practice in the future?Our findings can be used as a starting point to manage isolation restrictions more effectively and to develop strategies to promote physical activity and reduce sedentary behaviour among older adults during situations of forced lockdowns, as in the present COVID-19 pandemic.

Introducción En este estudio se describe un brote de parotiditis que afectó a un grupo de jóvenes que compartieron un narguile para fumar. Métodos La notificación de un caso de parotiditis dio lugar a una investigación epidemiológica. Se recabó información de otras 6 personas sintomáticas que se habían reunido en una discoteca en la que habían fumado en un mismo narguile. Se obtuvieron muestras de saliva para RT-PCR y sangre para serología de parotiditis de otros 3 de estos casos. Las muestras RT-PCR positivas se genotipificaron por secuenciación. Resultados Los 7 pacientes residían en 3 municipios diferentes. Hacía más de un mes que no habían coincidido hasta que estuvieron en la discoteca. Cuatro casos se confirmaron por RT-PCR o IgM específica. La investigación genómica mostró secuencias idénticas. Conclusiones Este brote es consecuencia de un uso compartido de un narguile. Consideramos que se debería regular la utilización pública de estas pipas.

The main objectives of facial reanimation procedures include restoring facial symmetry at resting state and regaining facial mobility. Static procedures usually provide unsatisfactory results, especially in younger patients. For this reason, over the years, several different surgical alternatives based on autologous, locoregional, or muscle free flaps have been proposed. The gracilis muscle is the gold standard technique for dynamic reanimation of long-standing facial paralysis. The excessive muscle bulk and the differences regarding the type of predominant muscle fiber were compared with the zygomaticus major force reconstructive surgeons to search for alternatives to the gracilis as a potential free flap for reanimation. One of them is the sternohyoid muscle flap. We report a patient with long-standing facial paralysis who underwent a dynamic facial reanimation by using a sternohyoid muscle free flap, thus proposing the procedure as an alternative to the conventional gracilis muscle flap.

Purpose: To identify the association between single-nucleotide polymorphisms (SNPs) in CFH, ARMS2, HTRA1, CFB, C2, and C3 genes and exudative age-related macular degeneration (AMD) in a Spanish population. Methods: In 187 exudative AMD patients and 196 healthy controls (61% women, mean age 75 years), 12 SNPs as risk factors for AMD in CFH (rs1410996, rs1061170, r380390), ARMS2 (rs10490924, rs10490923), HTRA1 (rs11200638), CFB (rs641153), C2 (rs547154, rs9332739), and C3 (rs147859257, rs2230199, rs1047286) genes were analyzed. Results: The G allele was the most frequent in CFH gene (rs1410996) with a 7-fold increased risk of AMD (OR 7.69, 95% CI 3.17–18.69), whereas carriers of C allele in CFH (rs1061170) showed a 3-fold increased risk for AMD (OR 3.22, 95% CI 1.93–5.40). In CFH (rs380390), the presence of G allele increased the risk for AMD by 2-fold (OR 2.52, 95% CI 1.47–4.30). In ARMS2 (rs10490924), the T-allele was associated with an almost 5-fold increased risk (OR 5.49, 95% CI 3.23–9.31). The A allele in HTRA1 (rs11200638) was more prevalent in AMD versus controls (OR 6.44, 95% CI 3.62–11.47). In C2 gene (rs9332739) the presence of C increased risk for AMD by 3-fold (OR 3.10, 95% CI 1.06–9.06). Conclusion: SNPs in CFH, ARMS2, HTRA1, and C2 genes were associated in our study with an increased risk for exudative AMD in Spanish patients.

To compare visual outcomes and patient satisfaction between unilateral and bilateral trifocal diffractive intraocular lens (IOL) implantation in emmetropic patients with presbyopia.Retrospective observational case series.This is a multicenter, multisurgeon study of emmetropic presbyopes who underwent refractive lens exchange (RLE) followed by an implantation of FineVision IOL (PhysIOL). Inclusion criteria were emmetropic eyes, with a sphere between -0.25 and +0.50 diopters (D), cylinder of less than 0.75 D and spherical equivalent (SE) between -0.25 and +0.25 D. In addition, uncorrected distance visual acuity (UDVA) had to be Snellen0.9 in each eye. A total of 171 eyes of 122 patients were evaluated. This sample was divided into 2 groups depending on whether they have been operated monocularly or binocularly. Visual and refractive performance, patient satisfaction, and spectacle independence were evaluated.UDVA and corrected distance visual acuity (CDVA) remained almost unchanged after monocular and binocular surgery. Binocular uncorrected intermediate (UIVA) and near visual acuity (UNVA) were better in those operated binocularly (0.3±0.12 vs 0.22±0.06, P .063, and 0.09±0.08 vs 0.04±0.05, P.027, respectively). Predictability and efficacy were higher in the binocular group, whereas safety was better in the monocular group. Visual dysphotopsia was worse and spectacle independence for all distances was higher in binocular group.Our research shows that RLE with binocular implantation of a trifocal diffractive IOL in presbyopic emmetropic patients is more successful in UNVA than monocular implantation. However, no significant differences were observed in UDVA, UIVA, and patient satisfaction.

ObjectiveTo evaluate the evolution of telomere length from peripheral blood leukocytes (PBLs) in subjects from the Osteoarthritis Initiative (OAI) cohort in relation to the incidence of osteoarthritis (OA), and to explore its possible interactive influence with the mitochondrial DNA (mtDNA) haplogroup.MethodsDynamics of telomere sequence loss were quantified in PBLs from initially healthy individuals (without symptoms or radiological signs), 78 carrying the mtDNA cluster HV, and 47 with cluster JT, from the OAI, during a 72-month follow-up period. The incidence of knee OA during this period (n = 39) was radiographically established when Kellgren-Lawrence (KL) score increased from < 2 at recruitment, to ≥ 2 at the end of 72 months of follow-up. Multivariate analysis using binary logistic regression was performed to assess PBL telomere loss and mtDNA haplogroups as associated risk factors of incidence of knee OA.ResultsCarriers of cluster HV showed knee OA incidence twice that of the JT carriers (n = 30 vs 9). The rate of PBL telomere loss was higher in cluster HV carriers and in individuals with incident knee OA. Multivariate analysis showed that the dynamics of PBL telomere shortening can be a consistent risk marker of knee OA incidence. Subjects with nonincident knee OA showed a slower telomere loss than those with incident knee OA; the difference was more significant in carriers of cluster JT than in HV.ConclusionAn increased rate of telomere loss in PBLs may reflect a systemic accelerated senescence phenotype that could be potentiated by the mitochondrial function, increasing the susceptibility of developing knee OA.

The transient current technique (TCT) is widely used in the field of silicon particle detector development. So far, only laser wavelengths with a photon energy larger than or similar to the silicon bandgap (single photon absorption) were used. Recently, measurements using two-photon absorption (TPA) for silicon detector testing have been carried out for the first time. Excess carriers are only created at the focal point of the laser beam and thus resolution in all three spatial directions could be achieved. The resolution perpendicular to the incident laser beam could be increased roughly by a factor of 10. First measurements using this new method were performed at the Singular Laser Facility of Universidad del País Vasco (UPV)/Euskal Herriko Unibertzitatea (EHU). Following the initial success of the method, a compact TPA-TCT setup is under development. A first description of the setup and laser system is presented in this article., This work was supported in part by the Spanish Ministry of Economy and Competitiveness (MINECO) under Grant FPA2013-48387-C6-1-P and in part by the Wolfgang Gentner Programme of the German Federal Ministry of Education and Research under Grant 05E15CHA.

Resumen Esta investigación se ha llevado a cabo para conocer las diferencias en las variables temporales que conforman la competencia docente “Tiempo de compromiso motor” en la clase de Danza Clásica, bien acompañada de música grabada o por profesor pianista acompañante de danza. Se ha procedido al análisis de 50 grabaciones con ambos soportes musicales en un Conservatorio Superior de Danza de 89 alumnas que realizaban sus clases en un aula de ballet. Los resultados obtenidos destacan que según el soporte musical utilizado hay diferencias en las categorías de “Tiempo de Tarea” y “Tiempo de Organización”, mostrándose un mayor valor en el “Tiempo de Tarea” en las sesiones en las que se utilizó la música en vivo, así como un menor tiempo en la “Organización”, por lo que emplear la música en vivo podría proporcionar sesiones más productivas y con menor pérdida de tiempo. Resumo Esta pesquisa foi realizada com o objetivo de conhecer as diferenças nas variáveis temporais que compõem a competência docente, “Tempo de compromisso motor” nas aulas de Dança Clássica, seja acompanhado por música gravada ou por professor pianista acompanhando a dança. A análise de 50 gravações com ambos os suportes musicais foi realizada em um Conservatório Superior de Dança de 89 alunos que realizaram suas aulas em uma sala de ballet. Os resultados obtidos destacam que, de acordo com o suporte musical utilizado, existem diferenças nas categorias de “Tempo de Tarefa” e “Tempo de Organização”, mostrando um maior valor no “Tempo de Tarefa” nas sessões em que a música ao vivo foi utilizada, bem como um menor tempo na “Organização”, de modo que o uso de música ao vivo poderia proporcionar sessões mais produtivas com menor perda de tempo. Abstract This study looked into time variable differences in the teaching competence “Time of motor commitment” in Classical Dance lessons accompanied by either recorded music or a pianist teacher. Fifty recordings of 89 students of a Higher Education Dance Conservatory were analyzed in their ballet lessons with both musical supports. The results show differences in the categories of “Task Time” and “Organization Time” according to the musical support used, showing longer “Task Time” and shorter “Organization time” in lessons with live music. Therefore, live music could provide more productive lessons with less loss of time.

The use of 11C-acetate as a PET/CT tracer for atherosclerotic lesions preferentially labels anti-inflammatory/pro-resolution intra-plaque macrophages. An overview of the mechanisms involved in the selective uptake.

Yes

Tumor necrosis factor alpha antagonist drug therapy has been beneficial in the treatment of several diseases such as connective tissue and inflammatory bowel diseases, but it is not without risks. The main complications of these immunosuppressive drugs are infections, and pulmonary tuberculosis is one of the main conditions, which can be observed in patients with this type of treatment. A 31-year-old woman, treated at the Hermanos Ameijeiras Clinical Surgical Hospital, Havana, Cuba, with a history of ulcerative colitis, who has been receiving infliximab therapy for 3 months, presented. He went to the hospital for referring 4 days prior to admission, a fever of 390 C twice a day, accompanied by headache, loss of appetite and pain in the perineal region. A chest X-ray was performed, which described heterogeneous radiopacity that goes from the upper horn of the right hilum to axillary planes, in the chest axial tomography they report consolidation in the anterior segment of the right upper lobe with the presence of air bronchogram and in the bronchial lavage microbiological for acid-fast bacilli coding 8, positive for mycobacterium tuberculosis was reported. Accurate diagnosis of tuberculosis related to the use of tumor necrosis factor alpha antagonist drugs requires a high index of suspicion and detailed investigation. There is a high degree of diagnostic complexity, due to the existence of a wide clinical spectrum and the need to exclude other diseases.

This paper is based on a teacher effectiveness model with six teaching behaviour domains (safe learning climate, efficient classroom management, clarity of instruction, activating teaching, differentiation, and teaching–learning strategies). The main purpose was to examine university students’ perceptions of teaching effectiveness and its influence on students’ academic engagement. The sample comprised 782 students from 16 universities. Data was collected using a transversal design and the instruments My Teacher Questionnaire and the Academic Engagement Scale, both using Likert-type response formats and adapted to the study population. The findings suggest differences regarding teacher gender and type of course: students perceived their male teachers as better, and there were more positive perceptions of teachers in arts and humanities, social and legal sciences, and health sciences courses. With respect to student engagement, the results confirmed the predictive power of the effective classroom management, activating teaching and differentiation domains. The percentage of explained variance was greater for emotional engagement than for behavioural engagement. This kind of study gives us very interesting information which can help to identify the aspects of higher education that need to be reinforced and in contrast, those about which students already have positive perceptions.

Introduction: Although practicing physical activity according to recommendations has health benefits, many studies have reported that the level of participation is lower than recommended. Methods: In this behavioural epidemiological study, we used a correlational design to determine the contribution made by physical education (PE) classes to daily physical activity in a sample of 694 Spanish adolescents. Physical activity levels were determined using the Four by One-Day Physical Activity Questionnaire. Results: 65.1% of adolescents comply with the recommendations on PE school days, compared to 36.6% who do so on the days with no PE class. Moreover, on PE school days, they obtain significantly higher physical activity level scores compared to days with no PE class. Conclusion: The study, therefore, shows the fundamental role of PE in increasing daily physical activity levels. Proposals to improve physical activity levels in these adolescents should be put forward, with educational centres being one of the best settings to achieve this goal.

Introduction: Large randomized trials testing the effect of a multifactorial weight-loss lifestyle intervention including Mediterranean diet (MedDiet) on renal function are lacking. Here, we evaluated the 1-year efficacy of an intensive weight-loss intervention with an energy-reduced MedDiet (erMedDiet) plus increased physical activity (PA) on renal function. Methods: Randomized controlled "PREvención con DIeta MEDiterránea-Plus"(PREDIMED-Plus) trial is conducted in 23 Spanish centers comprising 208 primary care clinics. Overweight/obese (n = 6,719) adults aged 55-75 years with metabolic syndrome were randomly assigned (1:1) to an intensive weight-loss lifestyle intervention with an erMedDiet, PA promotion, and behavioral support (intervention) or usual-care advice to adhere to an energy-unrestricted MedDiet (control) between September 2013 and December 2016. The primary outcome was 1-year change in estimated glomerular filtration rate (EGFR). Secondary outcomes were changes in urine albumin-to-creatinine ratio (UACR), incidence of moderately/severely impaired EGFR (, This work was supported by the official Spanish Institutions for funding scientific biomedical research, CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN) and Instituto de Salud Carlos III (ISCIII), through the Fondo de Investigación para la Salud (FIS), which is cofunded by the European Regional Development Fund (5 coordinated FIS projects leaded by J.S.-S and J.V., including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI14/00972, PI14/00728, PI14/01471, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, PI17/00926; PI19/00957, PI19/00386, PI19/00309, PI19/01032, PI19/00576, PI19/00017, PI19/01226, PI19/00781, PI19/01560, and PI19/01332); the Especial Action Project entitled Implementación y evaluación de una intervención intensiva sobre la actividad física Cohorte PREDIMED-Plus grant to J.S.-S.; the European Research Council (Advanced Research Grant 2014–2019; agreement #340918) granted to M.Á.M.-G.; the Recercaixa (No. 2013ACUP00194) grant to J.S.-S.; grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013, PS0358/2016, and PI0137/2018); the PROMETEO/2017/017 grant from the Generalitat Valenciana; the SEMERGEN grant; funds from the European Regional Development Fund (CB06/03); International Nut & Dried Fruit Council – FESNAD (Long-term effects of an energyrestricted Mediterranean diet on mortality and cardiovascular disease 2014–2015, No. 201302) (PI: M.Á.M.-G.); the AstraZeneca Young Investigators Award in Category of Obesity and T2D 2017 (PI: D.R.); grant of support to research groups No. 35/2011 (Balearic Islands Gov.; FEDER funds) (J.A.T. and C.B.); the JR17/00022 (ISCIII) grant to O.C.; the Boosting young talent call grant program for the development of IISPV research projects 2019–2021 (Ref.: 2019/IISPV/03 grant to A.D.-L.); the Societat Catalana d’Endocrinologia i Nutrició (SCEN) Clinical-Research Grant 2019 (IPs: J.S.-S. and A.D.-L.). Collaborative Nutrition and/or Obesity Project for Young Researchers 2019 supported by CIBEROBN entitled Lifestyle Interventions and Chronic Kidney Disease: Inflammation, Oxidative Stress and Metabolomic Profile (LIKIDI study) grant to A.D.-L.

OBJECTIVE To explore the use of tobacco, alcohol, and illicit drugs and its associated factors among Chinese immigrants living in Spain. DESIGN AND MEASURES A mixed-method design, using surveys and semi-structured interviews. SAMPLE A total of 133 Chinese immigrants and stakeholders were assessed in the quantitative study and 7 stakeholders were interviewed in the qualitative study. RESULTS The use of tobacco and alcohol was higher than the use of illicit drugs in Chinese immigrants. The prevalence of daily smokers was greater in men than in women (37.3% vs. 2.5%, p

Introduction and objectives Metabolic syndrome (MetS) is a combination of various cardiovascular risk factors with a major impact on morbidity and premature mortality. However, the impact of MetS on self-reported health-related quality of life (HRQoL) is unknown. This study evaluated the HRQoL in a Spanish adult population aged 55 years and older with MetS. Method A cross-sectional analysis was performed with baseline data from the PREDIMED-Plus multicentre randomized trial. The participants were 6430 men and women aged 55–75 years with overweight/obesity (body mass index ≥27 and ≤40 kg/m2) and MetS. The SF-36 questionnaire was used as a tool to measure HRQoL. Scores were calculated on each scale of the SF-36 by gender and age. Results Participants showed higher scores in the social function (mean 85.9, 95% CI; 85.4–86.4) and emotional role scales (mean 86.8, 95% CI; 86.0–87.5). By contrast, the worst scores were obtained in the aggregated physical dimensions. In addition, men obtained higher scores than women on all scales. Among men, the worst score was obtained in general health (mean 65.6, 95% CI; 65.0–66.2), and among women, in body pain (mean 54.3, 95%CI; 53.4–55.2). A significant decrease was found in the aggregated physical dimensions score among participants 70–75 years old, but an increased one in the aggregated mental dimensions, compared to younger participants. Conclusions Our results reflect that the MetS may negatively affect HRQoL in the aggregated physical dimensions, body pain in women, and general health in men. However, this adverse association was absent for the psychological dimensions of HRQoL, which were less affected.

This work was supported by project grants of Gobierno de Espana (PSI2017-83893-R and PSI2017-90806-REDT) and Programa "Severo Ochoa" CONSEJERIA DE CULTURA Y DEPORTE del Principado de Asturias (PA-17-PF BP16090) to C. F-B. The authors thank "Asociacion Parkinson Asturias" and "Fundacion AINDACE" (Ayuda a la Investigacion del Dano y Enfermedades Cerebrales) for their collaboration. Also, they express their sincere thanks to all the therapists, patients, and their families for their cooperation.

People suffering from Huntington’s disease (HD) present cognitive deficits. Hippocampal dysfunction has been involved in the HD learning and memory impairment, but proteins leading this dysregulation are not fully characterized. Here, we studied the contribution of the family of transcription factors myocyte enhancer factor 2 (MEF2) to the HD cognitive deficits. To this aim, we first analyzed MEF2 protein levels and found that they are reduced in the hippocampus of exon-1 (R6/1) and full-length (HdhQ7/Q111) mutant huntingtin (mHTT) mice at the onset of cognitive dysfunction. By the analysis of MEF2 mRNA levels and mHTT-MEF2 interaction, we discarded that reduced MEF2 levels are due to changes in the transcription or sequestration in mHTT aggregates. Interestingly, we showed in R6/1 primary hippocampal cultures that reduction of MEF2 is strongly related to a basal and non-apoptotic caspase activity. To decipher the involvement of hippocampal decreased MEF2 in memory impairment, we used the BML-210 molecule that activates MEF2 transcriptional activity by the disruption MEF2–histone deacetylase class IIa interaction. BML-210 treatment increased the number and length of neurites in R6/1 primary hippocampal cultures. Importantly, this effect was prevented by transduction of lentiviral particles containing shRNA against MEF2. Then, we demonstrated that intraperitoneal administration of BML-210 (150 mg/Kg/day) for 4 days in R6/1 mice improved cognitive performance. Finally, we observed that BML-210 treatment also promoted the activation of MEF2-dependent memory-related genes and the increase of synaptic markers in the hippocampus of R6/1 mice. Our findings point out that reduced hippocampal MEF2 is an important mediator of cognitive dysfunction in HD and suggest that MEF2 slight basal activation could be a good therapeutic option.

Summary Background Spain is one of the European countries most affected by the COVID-19 pandemic. Serological surveys are a valuable tool to assess the extent of the epidemic, given the existence of asymptomatic cases and little access to diagnostic tests. This nationwide population-based study aims to estimate the seroprevalence of SARS-CoV-2 infection in Spain at national and regional level. Methods 35 883 households were selected from municipal rolls using two-stage random sampling stratified by province and municipality size, with all residents invited to participate. From April 27 to May 11, 2020, 61 075 participants (75·1% of all contacted individuals within selected households) answered a questionnaire on history of symptoms compatible with COVID-19 and risk factors, received a point-of-care antibody test, and, if agreed, donated a blood sample for additional testing with a chemiluminescent microparticle immunoassay. Prevalences of IgG antibodies were adjusted using sampling weights and post-stratification to allow for differences in non-response rates based on age group, sex, and census-tract income. Using results for both tests, we calculated a seroprevalence range maximising either specificity (positive for both tests) or sensitivity (positive for either test). Findings Seroprevalence was 5·0% (95% CI 4·7–5·4) by the point-of-care test and 4·6% (4·3–5·0) by immunoassay, with a specificity–sensitivity range of 3·7% (3·3–4·0; both tests positive) to 6·2% (5·8–6·6; either test positive), with no differences by sex and lower seroprevalence in children younger than 10 years (10%) and lower in coastal areas (

Spinal arachnoid cysts are rare entities, most of which have a congenital or spontaneous etiology. Secondary cases are infrequent and can constitute a cause of neurological deterioration several months or years after spinal trauma. We present the case of a male patient with traumatic spinal arachnoid cyst, together with a review of the cases published to date. Finally, we explain the different surgical options for this pathology relating them to the physiopathological theories that try to explain the origin of these lesions.

Un aspecto esencial para garantizar la calidad de vida en las personas con Discapacidad Intelectual (PDI) es la salud sexual. Pese a que en los últimos años se ha aumentado la atención en esta cuestión, es determinante conocer si existen prejuicios que pueden afectar al desarrollo saludable. El objetivo de este estudio ha sido comparar las actitudes hacia la sexualidad de las PDI que tienen ellas mismas con las que tiene la población general (PPG). Para ello un total de 100 PDI (50% hombres y 50% mujeres), de 19 a 55 años completaron la Escala de Percepción Sexual, y 454 PPG (39.4% hombres y 60.6% mujeres), de entre 20-82 años completaron la Escala de Actitudes para la Sexualidad en Personas con Discapacidad Intelectual (ASEXDI). El 71.1% de las PPG presenta unas actitudes moderadas hacia la sexualidad de las PDI, el 18.7%, actitudes liberales y 10.1% conservadoras. Ambos grupos difieren en la tolerancia a las caricias siendo superior en el grupo de PPG (68.28% lo considera muy aceptable, frente al 22.78% de las PDI). Por el contrario, las relaciones sexuales con penetración entre PDI están ligeramente mejor valoradas por las PDI que entre la PG, aunque en ambos casos son actitudes conservadoras (el 15% de las PDI lo considera nada aceptable en absoluto, frente al 37.89% de la PG). Sin embargo, la PG tiendeaconsiderar deforma más positivalascompetencias delas PDI parael uso correcto del preservativo. Los resultados permiten concluir que la PG muestra una tolerancia moderada hacia la expresión de la sexualidad de este colectivo, con la excepción de la práctica de penetración hacia la que muestran cierta prevención. La actitud positiva de los PDI hacia esta práctica unida a su baja percepción de competencia en el uso del preservativo justifica la necesidad de programas de educación afectivo-sexual adaptados.

In this work, an embroidered textile moisture sensor is proposed and characterized with three different fabric substrates. The sensors are based on a capacitive interdigitated structure embroidered on a textile substrate with a conductive yarn. The performance of three different type of substrates has been addressed. In order to evaluate the sensor behavior, the impedance of the sensor has been measured by means of an LCR meter from 20 Hz to 200 kHz on a climatic chamber with a sweep of the relative humidity from 30% to 80% at 20ºC. The results show that the fabric substrate defines the electrical properties of the sensor due to both, the substrate permittivity and size yarn thickness increase. This sensor dependence determines the optimum substrate to be used to develop wearable applications for moisture measurement.

Introduction Scant evidence is available on whether dependency for basic (BADL) or instrumental (IADL) activities of daily living can be predictors of mortality after severe COPD exacerbation (COPDE). In addition, it is as yet unclear whether the inclusion of this parameter in a multidimensional score can improve the prediction of mortality. Methodology Prospective cohort study, with follow-up of patients discharged after COPDE and multivariate analysis of clinical-demographic and dependency variables (Barthel and Lawton and Brody indices) as predictors of mortality. Three scores were generated (including or not including dependency for BADL and IADL) that were compared with each other and with other commonly used multidimensional indices (BODEx, ADO, DOSE, CODEx). Results In total, 247 patients were included, 112 (45%, 3); and 195 (72.4%) had some dependency for BADL and IADL. Survival was 631.7 (258.8) days, 95% confidence interval (95% CI), 60–912 days. Fifty-four (21.9%, 95% CI 17–27) patients died. Age > 60 years, FEV1 Conclusions Dependence for activities of daily living, especially the most elementary ones, is an independent predictor of mortality after a severe COPDE that is comparable to clinical variables. Its inclusion in multidimensional scores clearly improves predictive capacity.

Resumen Introduccion Apenas existe evidencia si la dependencia para las actividades basicas de la vida diaria (ABVD) o instrumentales (AIVD) son predictores de mortalidad tras una agudizacion grave de EPOC (AEPOC). Ademas, no se ha evaluado si su inclusion en un score multidimensional puede mejorar esta prediccion. Metodologia Estudio prospectivo de cohortes, con seguimiento de pacientes tras un alta por AEPOC y analisis multivariante de variables clinico-demograficas y de dependencia (indices de Barthel y de Lawton y Brody) predictoras de mortalidad. Se generaron 3 scores (con/sin dependencia para ABVD y AIVD) que se compararon entre ellos y con otros indices multidimensionales habituales (BODEx, ADO, DOSE, CODEx). Resultados Se incluyo a 247 pacientes, 112 (45%,3) presentaron alguna dependencia para ABVD y 195% (72,4%) para AIVD. Supervivencia 631,7 (258,8) dias, intervalo de confianza del 95% (IC del 95%), 60-912. Fallecieron 54 (21,9%, IC del 95%, 17-27) pacientes. La edad > 60 anos, el FEV1 Conclusiones La dependencia para las actividades de la vida diaria, especialmente las mas elementales, es un predictor independiente de mortalidad tras una AEPOC grave, comparable con variables clinicas. Su inclusion en scores multidimensionales mejora de forma clara su capacidad predictiva.

Aim To describe the progress of implementing the “Preventing falls” Guideline of the Best Practice Spotlight Organization (BPSO®) Programme and fall outcomes in Centres Committed to Excellence in Care (CCEC®). Method A Quasi-experimental study pre-post test from a multicentric approach carried out between 2012 and 2018. The study is focused on patients aged 65 or older, discharged from guideline implementation units, analysing sociodemographic variables (sex, age, hospitalisation days; fall risk assessment on admission and patient in risk; fall prevention plan; incidence of falls. Data was compared from CCEC® programme indicators measured over the periods: baseline (T1), candidate during the first three years (T2), and sustainability (T3). Descriptive and inferential analysis was performed. Results 31,486 patients were evaluated in 7 centres (T1 = 465; T2 = 14,255; T3 = 16,766). Of the patients, 51.87% were men and average age was 79.06 years. Hospitalisation was 8.15 days. Fall risk assessment on admission was performed in 81.96% of patients (T1 = 44.30%, T2 = 81.11%, T3 = 83.73%) and 52.31% patients had high risk. A prevention falls plan was registered in 47.75% of patients (T1 = 24.73%, T2 = 42.43%, T3 = 52.90%). Four hundred and twenty-three falls were recorded, 62.17% without injuries. Conclusions Despite the differences between hospitals, such as structural characteristics, strategies, assessment tools and data progression pace; adherence to recommendations is proving successful, improving widely. Guideline implementation has allowed fall problems to be addressed, producing positive changes in the process and encouraging the implementation and sustainability of evidence-based nursing practice.

Many food items included in the Mediterranean diet (MedDiet) are rich in polyamines, small aliphatic amines with potential cardioprotective effects. The consumption of a MedDiet could increase polyamine concentrations. Based on experimental models, polyamine concentrations may be also influenced by physical activity (PA).We aimed to evaluate whether an intervention based on an energy-restricted MedDiet (er-MedDiet) and PA promotion, in comparison with an energy-unrestricted MedDiet and traditional health care, influences the serum pattern of polyamines and related metabolites in subjects at high risk of cardiovascular disease (CVD).This was a substudy from the PREDIMED-Plus trial, an ongoing randomized clinical trial including 6874 participants allocated either to an intensive weight-loss lifestyle intervention based on er-MedDiet, PA promotion, and behavioral support (er-MedDiet + PA group), or to an energy-unrestricted MedDiet and traditional health care group (MedDiet group). A total of 75 patients (n = 38, er-MedDiet + PA group; n = 37, MedDiet group) were included in this study. Serum concentrations of arginine, ornithine, polyamines, and acetyl polyamines at baseline and 26 wk of intervention were measured by an ultra-high-performance LC-tandem MS platform.At week 26, study groups had similar adherence to the MedDiet but patients randomly assigned to the er-MedDiet + PA group showed significantly lower mean energy intake (-340.3 kcal/d; 95% CI: -567.3, -113.4 kcal/d; P = 0.004), higher mean PA (1290.6; 95% CI: 39.9, 2541.3 metabolic equivalent tasks · min/d; P = 0.043), and higher mean decrease in BMI (in kg/m2) (-1.3; 95% CI: -1.8, -0.6; P 0.001) than the MedDiet group. However, no significant differences in serum polyamines or related metabolites were found between study groups after 26 wk of intervention and no significant between-group differences were found in glycated hemoglobin, HDL-cholesterol, or triglyceride concentrations.In individuals at high CVD risk, an er-MedDiet with increased PA did not result in significant changes of serum concentrations of polyamines or related metabolites in comparison with an energy-unrestricted MedDiet and no increase in PA. This trial was registered at isrctn.com as ISRCTN89898870.

Background and Aims Mesenchymal stem cells [MSCs] are used in preclinical and clinical studies for treatment of immune-mediated disorders, thanks to their immunomodulatory properties. Cell therapy with MSCs induces multiple effects in the immune system which ultimately lead to increase in the number of immune cells with regulatory phenotype. In this study, we investigated whether the beneficial effects of MSC therapy are maintained in the long term in a clinically relevant mouse model of colitis. Methods A single dose of adipose-derived MSCs [aMSCs] was infused into dextran sulphate sodium [DSS]-induced colitic mice during the induction phase of the disease. Following a latency period of 12 weeks, mice were re-challenged with a second 7-day cycle of DSS. Results DSS-induced colitic mice treated with aMSCs showed significant reduction in their colitic disease activity index during the second DSS challenge when compared with non-aMSC treated DSS-induced colitic mice. Strikingly, the long-term protection induced by aMSC therapy was also observed in Rag-1-/- mice where no adaptive immune memory cell responses take place. Increased percentages of Ly6G+CD11b+ myeloid cells were observed 12 weeks after the first inflammatory challenge in the peritoneal cavity, spleen, and bone marrow of DSS-induced colitic mice that were infused with aMSCs. Interestingly, upon re-challenge with DSS, these animals showed a concomitant increase in the regulatory/inflammatory macrophage ratio in the colon lamina propria. Conclusions Our findings demonstrate for the first time that MSC therapy can imprint an innate immune memory-like response in mice which confers sustained protection against acute inflammation in the long term.

Resumen Introduccion Aunque las guias de practica clinica recomiendan un ajuste continuado del tratamiento del asma, reduciendo la medicacion de mantenimiento cuando se alcanza el control (step-down), existen pocos estudios de practica clinica habitual orientados a recabar informacion de los factores que condicionan su fracaso. Objetivo Determinar los factores que condicionan en la practica clinica habitual el fracaso del step-down en los pacientes asmaticos moderados-graves controlados con una combinacion de glucocorticoides inhalados/agonistas beta-2 adrenergicos de accion larga. Metodo Estudio multicentrico retrospectivo sobre 374 pacientes con asma moderada-grave controlada con glucocorticoides inhalados/agonistas beta-2 adrenergicos de accion larga en quienes el facultativo indico en 2016 un step-down. Resultados El step-down fracaso en el 41,7%. Los factores relacionados con el fracaso fueron: la mayor edad del paciente (p = 0,006), la presencia de 2 o mas comorbilidades (p = 0,016), el mayor nivel de gravedad (persistente grave vs. persistente moderada) (p 40 anos) (p = 0,045), cuanto mas alto es el escalon terapeutico previo (p = 0,003) y posterior al cambio (p Conclusion En condiciones de practica clinica habitual el step-down fracasa en un porcentaje alto de pacientes y se recomienda indicarlo cuando el paciente lleve mas de 6 meses controlado.

Although the clinical practice guidelines recommend continuous adjustment of asthma treatment and reducing the maintenance drugs when achieving control (step-down), there are few studies of standard clinical practice aimed at collecting information on the factors that determine step-down failure.To determine the factors that determine step-down failure in standard clinical practice of patients with moderate-severe asthma controlled by a combination of inhaled glucocorticoids and long-acting beta agonists.A multicentre retrospective study included 374 patients with moderate-severe asthma controlled with inhaled glucocorticoids and long-acting beta agonists for whom the physician indicated a step-down in 2016.The step-down failed in 41.7% of the patients. The following factors were related to failure: greater patient age (P=.006), presence of at least 2 comorbidities (P=.016), greater severity level (severe persistent vs. moderate persistent) (P.001), greater age at diagnosis (40 years) (P=.045), the higher the therapeutic step before (P=.003) and after the change (P.001), the shorter the time of improvement/control prior to the change (P=.019), lower FEVIn standard clinical practice conditions, step-down fails in a high percentage of patients, and the suggestion is to indicate step-down when the patient has had more than 6 months of disease control.

Objective To determine whether there are social factors that affect the prolonged hospital stay (PHS) of patients with severe chronic obstructive pulmonary disease exacerbation (COPDE), as well as clinical-demographic factors. Methodology We conducted a prospective cohort study that consecutively included patients who were admitted to a Pneumology department for COPDE. We recorded demographic, clinical (tobacco use, exacerbations and infections, dyspnoea, impact according to CAT questionnaire, pulmonary function, comorbidities, oxygen therapy and noninvasive ventilation) and social (financial status, caregiver availability and overload, dependence for basic and instrumental activities, social risk and use of social services) variables, employing questionnaires and indices such as Barthel, Lawton-Brody, Zarit, Barber and Gijon. We performed a univariate and multivariate analysis using a logistic regression model. Results The study included 253 patients, with a mean age of 68.9 ± 9.8 years; 77.1% of whom were men. The logistic regression model included active tobacco use, FEV1 value, CAT score > 10, dyspnoea 3-4 on the MMRC, the presence of bacteria in sputum cultures, cardiovascular comorbidity, anaemia, home oxygen therapy, living alone, rural residence, caregiver overload and detecting social-family risks/problems. The variables independently associated with the possibility of PHS were a CAT score > 10 (OR, 8.9; P = .04) and detecting a social-family risk/problem (OR, 2.6; P = .04). Active smoking was a predictor of shorter stays (OR, 0.15; P = .002). Conclusions Variables related to the social sphere play a relevant role in hospital stays, as do the impact of the disease and the persistent use of tobacco by patients with severe COPD exacerbation.

Resumen Objetivo Describir y comparar desde una perspectiva de genero el perfil social de los pacientes ingresados por agudizaciones de EPOC (AEPOC) en un servicio de neumologia. Metodologia Estudio transversal en pacientes con AEPOC graves donde se recogieron variables demograficas, clinicas y de la esfera social (situacion economica, cuidados, dependencia en las actividades basicas e instrumentales, riesgo social, sobrecarga de cuidador, uso de servicios sociales) utilizando cuestionarios e indices como Barthel, Lawton-Brody, Zarit, Barber y Gijon. Se realiza un analisis descriptivo de la situacion sociosanitaria que se compara en funcion del genero. Resultados Se incluyeron 253 pacientes, edad de 68,9 ± 9,8 anos, 58 (23%) mujeres, FEV1 42,1 ± 14,2% e indice de Charlson 1,8 ± 0,9, 37,9% fumadores activos. El 55,2% cobran menos de 800 €/mes, el 46,2% tienen alguna dependencia para actividades basicas y el 89,3% para actividades instrumentales, el 89% presentan fragilidad social y el 64% estan en situacion de problema/riesgo social. Disponen de cuidador el 49%: el 83% no formales y el 90,9% mujeres, con alguna sobrecarga en el 69,2%. El 21,4% viven solos. El 22,9% han contactado con los servicios sociales. Las mujeres con AEPOC son mas jovenes, fuman mas activamente y tienen menos comorbilidades. Disponen de menos recursos economicos y ayuda y peor situacion sociofamiliar, pero son menos dependientes para algunas actividades. Conclusiones El perfil social de los pacientes con AEPOC graves que ingresan en neumologia es muy desfavorable, especialmente en las mujeres. Estas desigualdades parecen ir mas alla de las diferencias de la expresion de la EPOC en funcion del genero.

Objective To describe and compare from a gender perspective the social profile of patients admitted to a respiratory unit for COPD exacerbations (COPDE). Methodology A cross-sectional study in patients with serious COPDE in which demographic, clinical, and social data (economic situation, care, dependency for basic and instrumental activities, social risk, caregiver overload, use of social services) were collected using questionnaires and indices such as Barthel, Lawton-Brody, Zarit, Barber, and Gijon. A descriptive analysis was made of patients’ social and healthcare situation, compared on the basis of gender. Results We included 253 patients, aged 68.9±9.8 years, 58 (23%) women, FEV1 42.1±14.2%, and Charlson index 1.8±0.9; 37.9% were active smokers. In total, 55.2% had an income of less than €800/month, 46.2% had some dependency for basic activities, and 89.3% for instrumental activities, 89% presented social fragility, while 64% were in a situation of social problem/risk; 49% had a caregiver, 83% in a non-formal arrangement, 90.9% of whom were women, with some overload reported by 69.2%. A total of 21.4% lived alone, and 22.9% had contacted social services. Women with COPDE are younger, smoke more actively, and have fewer comorbidities. They have more scant economic resources and assistance and are in a poorer socio-familiar situation, but they are less dependent for some activities. Conclusions The social profile of patients with serious COPDE admitted to respiratory units is very unfavorable, especially among women. These inequalities appear to go beyond differences in the expression of COPD, and are associated with gender.

Sara Fernández-García,1 Cristina Represas-Represas,1 Alberto Ruano-Raviña,2– 4 Alberto Fernández-García,1 Almudena González-Montaos,1 Ana Priegue-Carrera,1 Mónica Pérez-Ríos,2,3 Alberto Fernández-Villar1 1Pneumology Department, Alvaro Cunqueiro University Hospital, NeumoVigo I+i Research Group, Institute of Health Research Galicia Sur (IISGS), Vigo, Spain; 2Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago, Spain; 3Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; 4Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, SpainCorrespondence: Cristina Represas-RepresasPneumology Department, Alvaro Cunqueiro University Hospital, NeumoVigo I+i Research Group, Institute of Health Research Galicia Sur (IISGS), Estrada Clara Campoamor, Nº 341, Beade, Vigo, CP 36312, SpainEmail cristina.represas.represas@sergas.esObjective: To increase our knowledge of the patient variables related to the overburden of the caregivers of patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPDs).Methodology: This was a cross-sectional study of patients with severe COPD who have informal caregivers. We performed a multivariate analysis of sociodemographic (economic situation, care, dependence, social risk, and use of social services) and clinical (degree of dyspnea, previous hospitalizations, disease impact, pulmonary function, and comorbidity) factors and related these to the burden of informal caregivers, as evaluated using the Zarit scale.Results: The study included 91 patients, age 72.6± 8.7 years and 80 were male (89.7%); the mean modified Medical Research Council dyspnea scale (mMRC) score was 2.5± 0.8; mean FEV1 was 39.5 ± 13.2%; and 70 patients (76.9%) were dependent for basic activities. Of the informal caregivers, 90 (90.9%) were women, 49 (49.4%) were partners or spouses, and 29 (29.6%) were daughters. The mean Zarit questionnaire score was 51.4± 14.2, with 63 of carers (69.2%) perceiving some overburden, and 34 (37.4%) describing the overburden as mild–moderate. The variables related to informal caregiver overburden in the multivariate study were the previous use of social resources [OR = 8.1 (95% CI = 1.03– 69.9); p = 0.04], degree of mMRC dyspnea 3– 4 [OR =4.7 (95% CI = 1.7– 13.2); p = 0.003], and two or more admissions for AEPOC in the previous year [OR = 4.5 (95% CI = 1.7– 13.2); p = 0.003]. Of the informal caregivers of patients who had presented two or more of these variables, 92.3% perceived an overburden.Conclusion: The variables associated with overburden are easily accessible in patient medical records, or can be obtained by interviewing patients or their relatives. This information would allow to detect and assess the overburden of informal caregivers to provide an early warning of this problem.Keywords: COPD, hospitalizations, caregiver overburden, predictors

Little is known about the influence of gastric microbiota on host metabolism, even though the stomach plays an important role in the production of hormones involved in body weight regulation and glucose homeostasis. Proton pump inhibitors (PPIs) and Helicobacter pylori alter gut microbiota, but their impact on gastric microbiota in patients with obesity and the influence of these factors on the metabolic response to bariatric surgery is not fully understood. Forty-one subjects with morbid obesity who underwent sleeve gastrectomy were included in this study. The H. pylori group was established by the detection of H. pylori using a sequencing-based method (n = 16). Individuals in whom H. pylori was not detected were classified according to PPI treatment. Gastric biopsy specimens were obtained during surgery and were analyzed by a high-throughput-sequencing method. Patients were evaluated at baseline and 3, 6, and 12 months after surgery. β-Diversity measures were able to cluster patients according to their gastric mucosa-associated microbiota composition. H. pylori and PPI treatment are presented as two important factors for gastric mucosa-associated microbiota. H. pylori reduced diversity, while PPIs altered β-diversity. Both factors induced changes in the gastric mucosa-associated microbiota composition and its predicted functions. PPI users showed lower percentages of change in the body mass index (BMI) in the short term after surgery, while the H. pylori group showed higher glucose levels and lower percentages of reduction in body weight/BMI 1 year after surgery. PPIs and H. pylori colonization could modify the gastric mucosa-associated microbiota, altering its diversity, composition, and predicted functionality. These factors may have a role in the metabolic evolution of patients undergoing bariatric surgery. IMPORTANCE The gut microbiota has been shown to have an impact on host metabolism. In the stomach, factors like proton pump inhibitor treatment and Helicobacter pylori haven been suggested to alter gut microbiota; however, the influence of these factors on the metabolic response to bariatric surgery has not been fully studied. In this study, we highlight the impact of these factors on the gastric microbiota composition. Moreover, proton pump inhibitor treatment and the presence of Helicobacter pylori could have an influence on bariatric surgery outcomes, mainly on body weight loss and glucose homeostasis. Deciphering the relationship between gastric hormones and gastric microbiota and their contributions to bariatric surgery outcomes paves the way to develop gut manipulation strategies to improve the metabolic success of bariatric surgery.

Objective It has been proposed that a mild form of acquired resistance to thyroid hormone may occur in the general population. Its clinical significance remains largely unknown. The objective of the study was to explore whether a newly described thyroid hormone resistance index is associated with the risk of mortality in a sample of community-dwelling euthyroid subjects representative of the adult population of Spain. Design Longitudinal observational study including 3750 individuals, free of thyroid disease, TPO antibodies-negative ( Methods We used the Thyroid Feedback Quantile-based Index (TFQI) as a marker of resistance to thyroid hormone. The study population was grouped into categories according to their TFQI values at baseline. Fatal events were ascertained from the national death registry (end of follow-up December 2016). Results A total of 231 deaths were recorded during an average follow-up of 7.3 years. Compared with the category with the highest sensitivity to free thyroxine (TFQI ≤ p5) (reference), the relative risk of mortality in the categories with TFQI > p5 and ≤p25; >p25 and ≤p50; >p50 and ≤p75; >p75 and ≤p95 and >p95 were 1.01, (0.47–2.19), 1.42 (0.68–2.97), 1.54 (0.74–3.22), 1.47 (0.70–3.11) and 2.61 (1.16–5.89), respectively (P for trend 0.003). The association remained significant after multivariate adjustment of the data (P for trend 0.017). Conclusions A thyroid hormone resistance index focused on deviations of the average pituitary response to thyroid hormones may be associated with all-cause mortality independently of other conventional risk factors and comorbidities.