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Objective To analyse cognitive status in relation to activities of daily living (ADL) dependency in stroke patients. Methods A cross-sectional study was carried out. The Mini Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA) and the Barthel index were used to assess cognitive status and ADL, respectively. A Pearson and Spearman correlation was used considering the normality of the data in cognitive status. Results 62 patients were evaluated. The most impaired domains were associated with writing and drawing in the MMSE (mean = 24.9 ± 4.1) and language, visuospatial/executive function, and memory in the MoCA (mean = 18.3 ± 5.6). The ADLs with most dependency on the Barthel index (mean = 78.1 ± 14.0) were eating, dressing/undressing, bathing, and going up and down stairs. On the other hand, the ADL dependency showed a correlation with the MMSE (Rho = 0.3) and the MoCA (r = 0.2). In addition, MMSE was correlated with activities including dressing/undressing (Rho = 0.3) and bathing (Rho = 0.3) and MoCA with transfer from chair to bed (r = 0.2). Conclusions The domains with the highest cognitive impairment were related to memory and visuospatial/executive function. The correlations reflect that stroke survivors with greater cognitive impairment show greater ADL dependency.

Objective To determine whether the burden of the family caregiver is related to cognitive status and dependence on the activities of daily living (ADL) of the stroke patient under their care. Methods A cross-sectional study was carried out. The Mini Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA) and the Barthel index were used to assess, respectively, the patient’s cognitive status and ADL. The Zarit scale was applied to assess the burden on caregivers. A Spearman correlation was used assuming data abnormality on the Zarit scale and considering a significance of P Results 28 patients and 28 caregivers were evaluated. The Zarit scale showed correlations with the MMSE (Rho = −.48) and MoCA (Rho = −.43), as well as in the cognitive domains associated with temporo-spatial orientation (Rho = −.45) and reading (Rho = −.45) of the MMSE and language (Rho = −.41), memory (Rho = −.40) and temporo-spatial orientation (Rho = −.46) of the MoCA. On the other hand, the Zarit scale was correlated with the Barthel index (Rho = −.56) and the ADLs relating to dressing and undressing (Rho = −.45), bathing (Rho = −.38) and transferring from the chair to the bed (Rho = −.41). Conclusions The caregiver burden was correlated with impaired cognitive status and dependence on ADL in stroke patients.

This document is an update to the clinical practice recommendations for the management of cardiovascular risk factors (CVRF) in diabetes mellitus. The consensus has been developed by a multidisciplinary team made up of members of the Cardiovascular Risk Group of the Spanish Diabetes Society (SED). The work is a necessary update as, since the last review three years ago, there have been many clinical trials that have studied the cardiovascular outcomes of numerous drugs in the diabetic population. We believe that this guideline update may be of interest to all clinicians treating patients with diabetes.

RESUMEN En las últimas décadas, numerosos puentes peatonales experimentaron vibraciones excesivas en la dirección lateral, casos como el Millenniun, Solferino y Toda entre los más conocidos, causando en los peatones dificultades para cruzarlos y muy frecuentemente requiriendo caras reparaciones. Esta investigación estudia el problema de las vibraciones laterales producidas por el cruce de peatones en puentes peatonales conocido como Fenómeno de excitación sincrónica lateral a través del análisis de vibración lateral de la pasarela adyacente al puente peatonal “Rayitos de Sol”, que cruza el rio Rímac, cerca al centro de Lima. Este puente en particular presentaba excesivas vibraciones laterales desde su construcción en 2006 hasta el momento que fue desarrollada este estudio en 2016. Esta situación particular constituyó un estado ideal para el desarrollo del trabajo experimental. Durante esta investigación fueron encontrados detalles particulares del fenómeno de excitación sincrónica lateral, el primero que la densidad peatonal es directamente proporcional a la probabilidad de ocurrencia del fenómeno, el segundo que el fenómeno es de naturaleza cíclica y la ocurrencia de una aceleración máxima a partir de la cual el peatón rompe su paso y el fenómeno decae. ABSTRACT In the last decades, numerous footbridges experienced excessive displacements in the lateral direction of passage, cases such as Millennium, Solferino and Toda among the most known, which caused that the pedestrian have difficulties in using these structures and often requiring expensive repairs. This research studies the problem of the lateral vibrations produced by the pedestrian crossing in footbridges known as the phenomenon of synchronous lateral excitation through the lateral vibration analysis of the walkway adjacent to the “Rayitos de Sol” footbridge, which crosses the Rímac river, near the center of Lima. This particular footbridge had presented excessive lateral vibrations from its construction in 2006, until 2016 when this research was developed. This particular situation constituted an ideal state for the development of experimental work. Particular details of the phenomenon of synchronous lateral excitation were found during this research. first, that the pedestrian density is directly proportional to the probability of occurrence of the phenomenon, second, that the phenomenon is cyclic in nature and the occurrence of a maximum acceleration from which the pedestrian breaks its path and the phenomenon decays.

Resumen Objetivos La tendencia actual en el tratamiento de la diverticulitis aguda no complicada es el manejo ambulatorio de los pacientes con pautas cortas de antibiotico o incluso con antiinflamatorios en casos seleccionados. Presentamos una comparativa de los resultados obtenidos en nuestro hospital con distintos protocolos aplicados en 2016 y 2017. Material y metodos Todos los pacientes seleccionados para este estudio fueron diagnosticados de diverticulitis grado Ia de la clasificacion de Hinchey, segun los hallazgos radiologicos en la TC abdominal. Hemos analizado dos cohortes retrospectivas: 100 pacientes tratados en 2016 segun protocolo antiguo y 104 pacientes tratados en 2017 con protocolo nuevo. En el ano 2016 los pacientes candidatos a tratamiento ambulatorio permanecieron en observacion durante 24 horas antes de ser dados de alta. El tratamiento consistio en 14 dias de ciprofloxacino y metronidazol. En 2017 solo se observaron durante 24 horas los pacientes con sintomatologia mas aguda y se prescribio amoxicilina-clavulanico durante solo cinco dias. Resultados La persistencia de la enfermedad en 2016 fue del 6% y en 2017 solo alcanzo el 5,77% (p = 0,944). La recidiva durante el primer ano fue del 13% en el primer grupo, mientras que en el segundo fue del 5,7%, aunque esta diferencia no fue estadisticamente significativa. Asimismo, se consiguio una significativa reduccion del coste sanitario. Conclusiones El tratamiento ambulatorio de la diverticulitis aguda no complicada con pauta corta de antibiotico oral parece ser una estrategia terapeutica segura y efectiva en pacientes seleccionados con escasa comorbilidad.

Introduction Polycystic ovary syndrome (PCOS) is a complex metabolic disorder associated with ovulatory dysfunction, hyperandrogenism, obesity, and insulin resistance, that leads to subfertility. Sam68 is an RNA-binding protein with signaling functions that is ubiquitously expressed, including gonads. Sam68 is recruited to leptin signaling, mediating different leptin actions. Objective We aimed to investigate the role of Sam68 in leptin signaling, mediating the effect on aromatase expression in granulosa cells and the posible implication of Sam68 in the leptin resistance in PCOS. Materials and methods Granulosa cells were from healthy donors (n = 25) and women with PCOS (n = 25), within the age range of 20 to 40 years, from Valencian Infertility Institute (IVI), Seville, Spain. Sam68 expression was inhibited by siRNA method and overexpressed by expression vector. Expression level was analysed by qPCR and immunoblot. Statistical significance was assessed by ANOVA followed by different post-hoc tests. A P value of Results We have found that leptin stimulation increases phosphorylation and expression level of Sam68 and aromatase in granulosa cells from normal donors. Downregulation of Sam68 expression resulted in a lower activation of MAPK and PI3K pathways in response to leptin, whereas overexpression of Sam68 increased leptin stimulation of signaling, enhancing aromatase expression. Granulosa cells from women with PCOS presented lower expression of Sam68 and were resistant to the leptin effect on aromatase expression. Conclusions These results suggest the participation of Sam68 in leptin receptor signaling, mediating the leptin effect on aromatase expression in granulosa cells, and point to a new target in leptin resistance in PCOS.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may produce a systemic disease, the coronavirus disease-19 (COVID-19), with high morbidity and mortality. Even though we do not fully understand the interaction of innate and adaptive immunity in the control and complications of the viral infection, it is well recognized that SARS-CoV-2 induces an immunodepression that impairs the elimination of the virus and favors its rapid dissemination in the organism. Even less is known about the possible participation of inhibitory cells of the innate immune system, such as the myeloid-derived suppressor cells (MDSCs), or the adaptive immune system, such as the T regulatory cells (Tregs). That is why we aimed to study blood levels of MDSCs, as well as lymphocyte subpopulations, including Tregs, and activated (OX-40+) and inhibited (PD-1) T lymphocytes in patients with mild COVID-19 in comparison with data obtained from control donors. We have found that 20 hospitalized patients with COVID-19 and no health history of immunosuppression had a significant increase in the number of peripheral monocytic MDSCs (M-MDSC), but a decrease in Tregs, as well as an increase in the number of inhibited or exhausted T cells, whereas the number of activated T cells was significantly decreased compared with that from 20 healthy controls. Moreover, there was a significant negative correlation (r = 0.496) between the number of M-MDSC and the number of activated T cells. Therefore, M-MDSC rather than Tregs may contribute to the immunosuppression observed in patients with COVID-19., S.-M. received support from Junta de Andalucia and University of Seville (PAIDI CTS-151 group), A.P. and J.R.-B. receive support for research from Plan Nacional de I+D+i 2013–2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001), cofinanced by European Development Regional Fund “A way to achieve Europe,” Operative Program Intelligence Growth 2014–2020. LdC-M received support from the Asociación de Mujeres con Cáncer de Mama (AMAMA Sevilla), Fundación Sandra Ibarra, and Asociación de Cáncer de Mama de Brenes.

Atopic dermatitis (AD) is the most frequent chronic inflammatory skin disease, and its incidence has been rapidly increasing in developed countries in the last years. AD presents a high degree of heterogeneity due to biases and confounding factors such as age range, sex, or ethnicity. For those reasons, the search for new biomarkers is crucial. At the same time, obesity, which is a global health problem, has also increased over the years. It has been associated with many pathophysiological states, including skin diseases such as AD, mostly in childhood. Obesity promotes a low grade inflammation driven by many different cytokines and adipokines, including leptin, which has a key role in many other diseases due to its pleiotropic effects. Leptin also has a role in both skin and allergic diseases very related to AD. Thus, this adipokine could have an important role in the pathogenesis of AD, especially in its chronicity. Despite the limited literature available, there is some evidence that leads us to consider leptin as an important adipokine in this skin disease. For this reason, here we have reviewed the role of leptin in the pathophysiology of AD.

The PANGEA-Breast trial evaluated a new chemo-immunotherapeutic combination that would synergistically induce long-term clinical benefit in HER2-negative advanced breast cancer patients. Treatment consisted of 21-day cycles of 200 mg of pembrolizumab (day 1) plus gemcitabine (days 1 and 8). The primary objective was the objective response rate (ORR). The tumor infiltrating lymphocytes (TILs) density and PD-L1 expression in tumor, and the myeloid-derived suppressor cells (MDSCs) level in peripheral blood, were analyzed to explore associations with treatment efficacy. Considering a two-stage Simon’s design, the study recruitment was stopped after its first stage as statistical assumptions were not met. A subset of 21 triple-negative breast cancer (TNBC) patients was enrolled. Their median age was 49 years, 15 patients had visceral involvement, and 16 had ≤3 metastatic locations. Treatment discontinuation due to progressive disease (PD) was reported in 16 patients. ORR was 15% (95% CI 3.2–37.9). Four patients were on treatment &gt, 6 months before PD. Grade ≥3 treatment-related adverse events were observed in 8 patients, where neutropenia was the most common. No association was found between TILs density, PD-L1 expression or MDSCs levels and treatment efficacy. ORR in TNBC patients also did not meet the assumptions, but 20% were on treatment &gt, 6 months.

The search of prognostic factors is a priority in diffuse large B-cell lymphoma (DLBCL) due to its aggressiveness. We have recently found that the level of circulating MDSCs is a good marker of survival in a translational study based on a trial (EudraCT Number: 2014-001620-29), using lenalidomide combined with R-GDP (rituximab plus gemcitabine, cisplatin, and dexamethasone). Since Vitamin D is a known immunomodulator, we have studied blood levels of these cell populations comparing patients with deficit of vitamin D levels (&lt, 15 ng/mL with those with normal levels &gt, 15 ng/mL. Mann–Whitney U test was used to compare cells distributions between groups, Wilcoxon test to compare cells distribution at different times and Spearman test to measure the association between cell populations. Patients with vitamin D deficit maintained the increased level of immune suppressor cells, whereas we observed a depletion of all immune suppressor cells in patients with normal vitamin D levels. In conclusion, we have confirmed the importance of vitamin D in the response to treatment in R/R DLBCL, suggesting that vitamin D deficit may be involved in the immune deficit of these patients, and thus, vitamin D supplementation in these patients may help to obtain a better response, warranting further investigation.

Introduction: The access of surgeons to liver transplant teams in Spain is heterogeneous. This study aims to portray the current human resources of Spanish transplant teams, distribution of transplant duties among team members, how transplant team members acquire their skills, their leaders' view of their future, as well the motivations of Spanish General Surgery residents to choose transplantation as their future career choice. Methods: Two different surveys were created, one for head surgeons and one for residents, about the number of team members and their training, recruitment, organization of tasks and motivation to work in transplantation. The questionnaires were e-mailed to both the transplant program directors and the surgical residents. Results: There are on average 8 surgeons in each transplant unit. More than four surgeons perform the hepatectomy in 54.2% of the groups, while the graft implantation is performed by more than 4 surgeons at just 25% of the centers. Forty-two percent of the transplant chiefs advocated a fellowship training system, and 87.5% believe that generational turnover is guaranteed. Out of 525 residents, 101 responded. Regarding training, 12.8% had no interest in transplantation. Concerning their work preferences, 37.6% were not interested in transplantation because it is excessively demanding, and 52.5% would not like to be part of a liver transplant team in the future. Conclusions: The generational turnover seems to be guaranteed according to liver transplant program directors. The new generations of surgeons generally opt for other areas of surgery other than transplantation. Studies with a greater number of responses are necessary to validate these results (C) 2019 AEC. Published by Elsevier Espana, S.L.U. All rights reserved.

Resumen Introduccion El acceso de los cirujanos a los equipos de trasplante hepatico en Espana se realiza de manera heterogenea. El objetivo de este estudio ha sido cuantificar los recursos humanos de los equipos de trasplante espanoles, la distribucion de las diferentes tareas del trasplante entre los miembros del equipo, el mecanismo mediante el cual se adquieren las habilidades, la vision de sus lideres sobre su continuidad, asi como las motivaciones de los residentes de cirugia general espanoles para elegir el trasplante como su futura carrera profesional. Metodos Se elaboraron dos encuestas diferentes, para los jefes de equipo y para residentes, sobre numero de personas, capacitacion, reclutamiento, organizacion de tareas y motivacion para trabajar en trasplantes. Los cuestionarios se enviaron por correo electronico tanto a los directores de programa de trasplante como a los residentes de cirugia. Resultados Hay en promedio 8 cirujanos en cada unidad de trasplante. Mas de 4 cirujanos realizan la hepatectomia en el 54,2% de los grupos, mientras que el implante lo realiza mas de 4 cirujanos en solo el 25% de los centros. El 42% de los jefes de trasplante hepatico aboga por un sistema tipo fellowship y el 87,5% cree que el recambio generacional esta garantizado. De los 525 residentes, 101 respondieron. Respecto a la formacion, un 12,8% no tiene interes en el trasplante. En cuanto a sus preferencias laborales, el 37,6% no esta interesado en el trasplante por ser excesivamente exigente, y el 52,5% no desea ser parte de un equipo de trasplante de higado en el futuro. Conclusiones El recambio generacional parece estar garantizado segun los directores de programa de trasplante de higado. Las nuevas generaciones de cirujanos generalmente optan por otras areas de cirugia diferentes al trasplante. Son necesarios estudios con mayor numero de respuestas para validar estos resultados.

Introduction: Neonatal resuscitation demands equipment for respiratory support not always available in ruralareas. Innovative devices are required, and rapid prototyping allows to generate them using three-dimensional(3D) designs and printers. Objective: To evaluate the non-clinical performance and the acceptability byhealth personnel of a neonatal respiratory device produced by rapid prototyping. Methods: Observationalstudy, descriptive, of proof of concept developed in two steps. Step 1: Manufacture of the device with rapidprototyping in three-dimensional (3D) scanners and printers. Step 2: Demonstration of the invention duringtraining programs in neonatal resuscitation for health personnel in three regions of Peru (Tarapoto, Huánucoand Ayacucho). In both steps, we evaluated the performance of the device connected to a gas flow analyser.A survey was administered to the health workers of Tarapoto and Ayacucho to know their acceptability.Results: The developed prototype is T-shaped with two side bellows that, when pressed with one hand,project air through the centre towards a facial adapter. The use of the prototype in the laboratory generatedan average air flow of 4.8 Lt /min (SD ± 1.7) and an average pressure of 5.9 cmH2O (SD ± 1.4). This devicewas considered to be “very simple to use” in an acceptability survey involving 39 nurses and 11 doctors inremote areas of the capital of Peru. Conclusions: The evaluated prototype is acceptable by the staff and hasa performance capable of generating spontaneous breathing at birth., Introducción: La reanimación neonatal demanda dispositivos para apoyo respiratorio que no siemprese encuentran en áreas rurales. Se requieren dispositivos innovadores y el prototipado rápido permitegenerarlos usando diseños e impresoras tridimensionales (3D). Objetivo: Evaluar el desempeño no clínico y laaceptabilidad por el personal de salud de un dispositivo respiratorio neonatal producido mediante prototipadorápido. Métodos: Estudio observacional, descriptivo, de prueba de concepto desarrollado en dos etapas.Etapa 1: Fabricación del dispositivo con prototipado rápido en impresoras y escáneres tridimensionales (3D).Etapa 2: Demostración del dispositivo durante programas de capacitación en reanimación neonatal parapersonal de salud en tres regiones del Perú (Tarapoto, Huánuco y Ayacucho). En ambas etapas se evaluóel desempeño del dispositivo conectado a un analizador de flujo de gases. Se administró una encuesta alos trabajadores de salud de Tarapoto y Ayacucho para conocer su aceptabilidad. Resultados: El prototipodesarrollado tiene forma de T con dos fuelles laterales que al presionarse con una sola mano, proyectan airepor el centro hacia un adaptador facial. El uso del prototipo en laboratorio generó un flujo de aire promediode 4,8 Lt/min (DE ± 1,7) y una presión promedio de 5,9 cmH2O (DE ± 1,4). Este dispositivo fue consideradocomo “de uso muy simple” en una encuesta de aceptabilidad donde participaron 39 enfermeras y 11 médicosen zonas alejadas de la capital del Perú. Conclusiones: El prototipo evaluado fue aceptado por el personal ytuvo un desempeño capaz de generar un estímulo de la respiración espontánea al nacer.

Background Permanent hypoparathyroidism is the most common long-term complication after total thyroidectomy, causing significant morbidity and requiring long-term replacement therapy. Our study objective was to assess whether intact parathyroid hormone (iPTH) levels on the first day after total thyroidectomy are a good predictor of permanent hypoparathyroidism. Patients and methods A retrospective observational study of all patients undergoing total thyroidectomy between January 2009 and December 2014. iPTH and calcium levels were measured the first day after surgery. Patients were followed up for at least one year after surgery. Results The study group consisted of 481 patients with a mean age of 53 ± 14 years, 82% of them females. The most common reason for thyroidectomy was multinodular goiter (75%), followed by papillary thyroid cancer (15%). Transient hypocalcemia was the most common early complication after total thyroidectomy (49%), and permanent hypoparathyroidism was the most common long-term complication (6%). ROC curve analysis showed that iPTH level on the first postoperative day was a good predictor of permanent hypoparathyroidism (area under the curve 0.87; 95% CI: 0.84–0.91). Cut-off iPTH levels of 5 pg/mL had 95% sensitivity, 77% specificity, 21.6% positive predictive value, and 99.6% negative predictive value. Conclusions iPTH level on the first day after total thyroidectomy is a useful predictor of permanent hypoparathyroidism because of its high negative predictive value. Serum iPTH levels >5 pg/mL virtually exclude presence of permanent hypoparathyroidism.

Non-alcoholic fatty liver disease (NAFLD), which affects about a quarter of the global population, poses a substantial health and economic burden in all countries, yet there is no approved pharmacotherapy to treat this entity, nor well-established strategies for its diagnosis. Its prevalence has been rapidly driven by increased physical inactivity, in addition to excessive calorie intake compared to energy expenditure, affecting both adults and children. The increase in the number of cases, together with the higher morbimortality that this disease entails with respect to the general population, makes NAFLD a serious public health problem. Closely related to the development of this disease, there is a hormone derived from adipocytes, leptin, which is involved in energy homeostasis and lipid metabolism. Numerous studies have verified the relationship between persistent hyperleptinemia and the development of steatosis, fibrinogenesis and liver carcinogenesis. Therefore, further studies of the role of leptin in the NAFLD spectrum could represent an advance in the management of this set of diseases.

Leptin is an important regulator of basal metabolism and food intake, with a pivotal role in obesity. Leptin exerts many different actions on various tissues and systems, including cancer, and is considered as a linkage between metabolism and the immune system. During the last decades, obesity and leptin have been associated with the initiation, proliferation and progression of many types of cancer. Obesity is also linked with complications and mortality, irrespective of the therapy used, affecting clinical outcomes. However, some evidence has suggested its beneficial role, called the “obesity paradox”, and the possible antitumoral role of leptin. Recent data regarding the immunotherapy of cancer have revealed that overweight leads to a more effective response and leptin may probably be involved in this beneficial process. Since leptin is a positive modulator of both the innate and the adaptive immune system, it may contribute to the increased immune response stimulated by immunotherapy in cancer patients and may be proposed as a good actor in cancer. Our purpose is to review this dual role of leptin in cancer, as well as trying to clarify the future perspectives of this adipokine, which further highlights its importance as a cornerstone of the immunometabolism in oncology.

[EN] Cervical cancer is the fourth most common malignancy in women worldwide, although it is preventable with prophylactic HPV vaccination. HPV transmission-dynamic models can predict the potential for the global elimination of cervical cancer. The random network model is a new approach that allows individuals to be followed, and to implement a given vaccination policy according to their clinical records. We developed an HPV transmission-dynamic model on a lifetime sexual partners network based on individual contacts, also accounting for the sexual behavior of men who have sex with men (MSM). We analyzed the decline in the prevalence of HPV infection in a scenario of 75% and 90% coverage for both sexes. An important herd immunity effect for men and women was observed in the heterosexual network, even with 75% coverage. However, HPV infections are persistent in the MSM population, with sustained circulation of the virus among unvaccinated individuals. Coverage around 75% of both sexes would be necessary to eliminate HPV-related conditions in women within five decades. Nevertheless, the variation in the decline in infection in the long term between a vaccination coverage of 75% and 90% is relatively small, suggesting that reaching coverage of around 70-75% in the heterosexual network may be enough to confer high protection. Nevertheless, HPV elimination may be achieved if men's coverage is strictly controlled. This accurate representation of HPV transmission demonstrates the need to maintain high HPV vaccination coverage, especially in men, for whom the cost-effectiveness of vaccination is questioned., This work has been supported by the Spanish Ministerio de Economia, Industria y Competitividad (MINECO), the Agencia Estatal de Investigacion (AEI) and Fondo Europeo de Desarrollo Regional (FEDER UE), grant MTM2017-89664-P. Authors also wish to acknowledge Maria Giovanna Ferrario, Victor Latorre, and the Medical Statistics Consulting team (Valencia, Spain) for their collaboration in writing this manuscript.

Early identification of patients with COVID-19 who may develop critical illness is of great importance.In this study a retrospective cohort of 264 COVID-19 cases admitted at Macarena University was used for development and internal validation of a risk score to predict the occurrence of critical illness in hospitalized patients with COVID-19. Backward stepwise logistic regression was used to derive the model, including clinical and laboratory variables predictive of critical illness. Internal validation of the final model used bootstrapped samples and the model scoring derived from the coefficients. External validation was performed in a cohort of 154 cases admitted at Valme and Virgen del Rocio University Hospital.A total of 62 (23.5%) patients developed a critical illness during their hospitalization stay, 21 (8.0%) patients needed invasive ventilation, 34 (12.9%) were admitted at the ICU and the overall mortality was of 14.8% (39 cases). 5 variables were included in the final model: age59.5 years (OR: 3.11;95%CI 1.39-6.97), abnormal CRP results (OR: 5.76;95%CI 2.32-14.30), abnormal lymphocytes count (OR: 3.252;95%CI 1.56-6.77), abnormal CK results (OR: 3.38;95%CI 1.59-7.20) and abnormal creatinine (OR: 3.30;95%CI 1.42-7.68). The AUC of this model was 0.850 with sensitivity of 65% and specificity of 87% and the IDI and NRI were 0.1744 and 0.2785, respectively. The validation indicated a good discrimination for the external population.Biomarkers add prognostic information in COVID-19 patients. Our risk-score provides an easy to use tool to identify patients who are likely to develop critical illness during their hospital stay.

Identification of the different elements intervening at the immunoedition process, in each body compartment, seems key to explain clinical evolution in several tumor types. In this study, a set of immune biomarkers (myeloid derived suppressor cells, regulatory T cells, and OX40+ and PD-1+ T lymphocytes counts) in peripheral blood of patients diagnosed with advanced breast cancer, were analyzed prior to and along the implementation of first line antineoplastic therapy. Subsequently, a formal comparison between groups with clinical benefit versus progression of disease and with a healthy women cohort was executed. Results reflected that patients basally showed higher levels of myeloid derived suppressor cells (35.43, IR=180.73 vs 17.53, IR=16.96 cells/μl; p=0.001) and regulatory T cells (32.05, IR=29.84 vs 22.61, IR=13.57 cells/μl; p=0.001) in comparison with healthy women. Furthermore, after therapy, an increase in the number of activated T lymphocytes (expressing OX40), and a decrease of immune inhibitory cells (MDSCs, and Tregs), and the number of inhibited (or exhausted) T lymphocytes (expressing PD-1), could be ascertained in patients with clinical benefit (p≤0.001). The opposite trend was observed in the case of disease progression. These findings suggest that some critical immune elements can be easily detected and measured in peripheral blood, which open a new opportunity for translational research, as they seem to be clearly correlated with clinical evolution, at least in ABC.

[EN] A major challenge in human papillomavirus (HPV) vaccine programs is the universal gender-neutral recommendation, as well as estimation of its long-term effect. The objective of this study is to predict the added benefit of male vaccination, especially in men who have sex with men (MSM), and to analyze the impact of the program on society. We propose a mathematical model of the HPV infection based on a network paradigm. Data from Spain allowed constructing the sexual network. HPV force of infection was taken from literature. Different scenarios using variable vaccine coverage in both males and females were studied. Strong herd immunity is shown in the heterosexual population, with an important decrease of HPV 6/11 infections both in men and in unvaccinated women with an only-women vaccination at 14 years of age. No impact of this program occurred in the infection incidence in MSM. This group would only benefit from a vaccination program that includes males. However, the impact at short term would be lower than in heterosexual men. The protection of MSM can only be achieved by direct vaccination of males. This may have important consequences for public health., This paper has been supported by the Spanish Ministerio de Economía, Industria y Competitividad (MINECO), the Agencia Estatal de Investigación (AEI) and Fondo Europeo de Desarrollo Regional (FEDER UE) grant MTM2017-89664-P. This paper has been supported by the European Union through the Operational Program of the [European Regional Development Fund (ERDF)/European Social Fund (ESF)] of the Valencian Community 2014¿2020. Files: GJIDI/2018/A/010 and GJIDI/2018/A/009

[EN] The application of project-based learning (PBL) in a course of statistics in the BSc. Degree in Aerospace Engineering at the Higher Technical School of Design Engineering at Universitat Politècnica de València has led to a significant and positive change in students¿ attitude towards learning and acquisition of statistical concepts. More specifically, PBL has provided the opportunity for students to overcome the limitations and preconceived barriers of classic learning methodologies and lectures, by applying statistical tools to improve the design of a cardboard glider. The PBL strategy is implemented by means of a long-term project that is carried out in teams ranging from three to four students. The project is closely supervised by the laboratory lecturers, who act as mentors to the students throughout the whole term. At the initial stage, all the teams are given the same initial design of a cardboard glider, and students apply descriptive statistics to characterize and describe the flight of the original design. Then, students are given a flight benchmark that they should improve with their final designs. By applying inference, regression, and design of experiment tools, students modify the original design to beat the benchmark. The results of a survey that has been conducted suggest that, through this methodology, students not only apply and experiment with the concepts that they learn, but their motivation, engagement, and interest in statistics is also increased., The authors would like to thank the UPV and their support by funding this article with Education Improvement and Innovation Project (PIME-185).

Background Preventing infantile anaemia and ensuring optimal growth and development during early childhood, particularly in resource-constrained settings, represent an ongoing public health challenge. Current responses are aligned to treatment-based solutions, instead of determining the roles of its inter-related causes. This project aims to assess and understand the complex interplay of eco-bio-social-political factors that determine infantile anaemia to inform policy, research design and prevention practices. Methods This is a longitudinal birth cohort study including four components: (1) biological, will assess known blood markers of iron homeostasis and anaemia and stool microbiota to identify and genetically analyse the participants' flora; (2) ecological, will assess and map pollutants in air, water and soil and evaluate features of nutrition and perceived food security; (3) social, which will use different qualitative research methodologies to explore key stakeholders and informants' perceptions related to nutritional, environmental and anaemia topics, participant observations and a participatory approach and (4) a political analysis, to identify and assess the impact of policies, guidelines and programmes at all levels for infantile anaemia in the three regions. Finally, we will also explore the role of social determinants and demographic variables longitudinally for all study participants. This project aims to contribute to the evidence of the inter-related causal factors of infantile anaemia, addressing the complexity of influencing factors from diverse methodological angles. We will assess infantile anaemia in three regions of Peru, including newborns and their mothers as participants, from childbirth until their first year of age. Ethics and dissemination Ethical approval was obtained from the Institutional Research Ethics Committee of the Instituto Nacional de Salud del Niño (Lima, Peru), CIEI-043-2019. An additional opinion has been granted by the Ethical Committee of Queen Mary University of London (London, UK). Dissemination across stakeholders is taking part as a continues part of the research process. © Funding This project is supported by the Medical Research Council—MRC grant number MR/S024654/1 and by the Fondo Nacional de Desarrollo Científico, Tecnológico y de Innovación Tecnológica—FONDECYT, grant number 033-2019. AJP is funded by the Wellcome Trust (108065/Z/15/Z).

A new coronavirus respiratory disease (COVID-19) caused by the SARS-CoV-2 virus, surprised the entire world, producing social, economic, and health problems. The COVID-19 triggers a lung infection with a multiple proinflammatory cytokine storm in severe patients. Without effective and safe treatments, COVID-19 has killed thousands of people, becoming a pandemic. Stem cells has been suggested as a therapy for lung related diseases. In particular, mesenchymal stem cells (MSCs) have been successfully tested in some clinical trials in patients with COVID-19. The encouraging results positioned MSCs as a possible cell therapy for COVID-19. The amniotic membrane from human placenta at term is a valuable stem cell source, including human amniotic epithelial cells (hAECs) and human mesenchymal stromal cells (hAMSCs). Interestingly, amnion cells have immunoregulatory, regenerative, and anti-inflammatory properties. Moreover, hAECs and hAMSCs have been used both in preclinical studies and in clinical trials against respiratory diseases. They have reduced the inflammatory response and restored the pulmonary tissue architecture in lung-injury in vivo models. Here, we review the existing data about the stem cells use for COVID-19 treatment, including the ongoing clinical trials. We also consider the non-cellular therapies that are being applied. Finally, we discuss the human amniotic membrane cells use in patients who suffer from immune/inflammatory lung diseases and hypothesize their possible use as a successful treatment against COVID-19. Fil: Riedel, Rodrigo Nicolas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; Argentina Fil: Pérez Pérez, Antonio. Universidad de Sevilla; España Fil: Sánchez Margalet, Victor S. Universidad de Sevilla; España Fil: Varone, Cecilia Laura. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; Argentina Fil: Maymo, Julieta Lorena. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; Argentina

Cloud Computing is one of the most disruptive technologies of this century. This technology has been widely adopted in many areas of the society. In the field of manufacturing industry, it can be used to provide advantages in the execution of the complex geometric computation algorithms involved on CAD/CAM processes. The idea proposed in this research consists in outsourcing part of the load to be computed in the client machines to the cloud through the Mobile Cloud Computing paradigm. This practice gives substantial benefits to both the clients and the software-provider in terms of costs, flexibility, ubiquity and performance. In this document, an outsourcing architecture is proposed based on this paradigm. Extensive experiments have been done using highly parallelizable computational geometry operations to show the strengths and weaknesses of the proposal in combination of specialized computing platforms in the cloud. The results suggest that there are some issues that affect the overall performance and the stability of the QoS: the network communication delay, and the number of simultaneous clients and multiple requests. Some solutions have been proposed to face these challenges. This work was supported by the Spanish Research Agency (AEI) and the European Regional Development Fund (ERDF) under project CloudDriver4Industry TIN2017-89266-R, and by the Conselleria of Innovation, Universities, Science and Digital Society of the Community of Valencia, Spain, within the program of support for research under project AICO/2020/206.

Immunology and immunotherapy of cancer is an expanding field in oncology, with recent great achievements obtained through the new successful approaches implemented to circumvent immune evasion, which is undoubtedly considered a novel hallmark of cancer. Translational research in this topic has revealed targets that can be modulated in the clinical setting with new compounds and strategies. Like most of the tumors, breast cancer is considered a complex and heterogeneous disease in which host immune responses have been also recently demonstrated of critical relevance. T infiltrating lymphocyte measurement is suggested as a powerful new tool necessary to predict early breast cancer evolution, especially for the her2-positive and triple-negative subtypes. Other biomarkers in tissue and peripheral blood are under intense scrutiny to ascertain their eventual role as prognostic and/or predictive factors. This background has fueled the interest in developing clinical research strategies to test activity of modern immunotherapy in breast cancer, which constitutes the main focus of this review.

This document is an update to the clinical practice recommendations for the management of cardiovascular risk factors in diabetes mellitus. The consensus is made by members of the Cardiovascular Risk Group of the Spanish Diabetes Society. We have proposed and updated interventions on lifestyle, pharmacological treatment indicated to achieve therapeutic objectives according to the levels of HbA1c, degree of obesity, hypertension, hyperlipidemia, heart failure, platelet antiagregation, renal insufficiency, and diabetes in the elderly, as well as new biomarkers of interest in the evaluation of cardiovascular risk in individuals with diabetes mellitus. The work is an update of the interventions and therapeutic objectives in addition, it is noted the need for the inclusion of specialists in Endocrinology, Metabolism and Nutrition in Cardiac Rehabilitation Units for the control and monitoring of this population.

Endemic insular species are particularly vulnerable to anthropogenic threats. The fish-eating batMyotis vivesiis restricted mainly to the islands of the Gulf of California in Mexico and although several aspects of its biology have been studied there are no recent accounts of its current distribution. We conducted several expeditions during 2001–2016 to verify the current geographical distribution of this bat, and to record the presence of introduced predators. We identified the localities in which maternity colonies occur, estimated the size of the bat population on Partida Norte Island in 2003, and monitored bat presence on this island during 2004–2016. We found fish-eating bats on 36 islands and maternity colonies on 19 islands. Introduced ratsRattus rattusor catsFelis catuswere captured on seven islands where the bats were present, and on five islands where they were absent. We estimated a population of c. 30,000 fish-eating bats in May 2003 and we confirmed the species’ presence on Partida Norte Island during 2004–2016. Based on the information compiled from our surveys and previous studies, we discuss the adequacy of the species’ current categorization as Vulnerable on the IUCN Red List, and its conservation status conferred by Mexican conservation authorities.

Mujer de 74 años que presenta melenas, anemia y elevación de GGT. Se realiza endoscopia alta objetivando una lesión polipoidea que condiciona invaginación gástrica en el duodeno, no reductible. La TC de abdomen aprecia invaginación gastroduodenal con dilatación de la vía intra y extrahepática. Se decide cirugía, realizando una gastrotomía laparoscópica en la cara anterior del antro, sin conseguir reducirlo tras tracción del pedículo. Se reconvierte, se amplía la gastrotomía, se reduce la lesión y se realiza una resección en cuña. La Anatomía Patológica reveló un tumor estromal gastrointestinal (GIST) de bajo grado de 3x3 cm.

Leptin is highly expressed in the placenta, mainly by trophoblastic cells, where it has an important autocrine trophic effect. Moreover, increased leptin levels are found in the most frequent pathology of pregnancy: gestational diabetes, where leptin may mediate the increased size of the placenta and the fetus, which becomes macrosomic. In fact, leptin mediates the increased protein synthesis, as observed in trophoblasts from gestational diabetic subjects. In addition, leptin seems to facilitate nutrients transport to the fetus in gestational diabetes by increasing the expression of the glycerol transporter aquaporin-9. The high plasma leptin levels found in gestational diabetes may be potentiated by leptin resistance at a central level, and obesity-associated inflammation plays a role in this leptin resistance. Therefore, the importance of anti-inflammatory nutrients to modify the pathology of pregnancy is clear. In fact, nutritional intervention is the first-line approach for the treatment of gestational diabetes mellitus. However, more nutritional intervention studies with nutraceuticals, such as polyphenols or polyunsaturated fatty acids, or nutritional supplementation with micronutrients or probiotics in pregnant women, are needed in order to achieve a high level of evidence. In this context, the Mediterranean diet has been recently found to reduce the risk of gestational diabetes in a multicenter randomized trial. This review will focus on the impact of maternal obesity on placental inflammation and nutrients transport, considering the mechanisms by which leptin may influence maternal and fetal health in this setting, as well as its role in pregnancy pathologies.

OBJECTIVE: The aim of this study was to evaluate the survival benefit of sirolimus in patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC) (exploratory analysis of the SiLVER-trial). SUMMARY AND BACKGROUND DATA: Patients receiving LT) for HCC are at a high risk for tumor recurrence. Calcineurin inhibitors have shown evidence to promote cancer growth, whereas mammalian target of rapamycin (mTOR) inhibitors like sirolimus have anticancer effects. In the SiLVER-trial (Clinicaltrials.gov: NCT00355862), the effect of sirolimus on the recurrence of HCC after LT was investigated in a prospective randomized trial. Although the primary endpoint of improved disease-free survival (DFS) with sirolimus was not met, outcomes were improved for patients in the sirolimus-treatment arm in the first 3 to 5 years. To learn more about the key variables, a multivariate analysis was performed on the SiLVER-trial data. PATIENTS AND METHODS: Data from 508 patients of the intention-to-treat analysis were included in exploratory univariate and multivariate models for overall survival (OS), DFS and a competing risk analysis for HCC recurrence. RESULTS: Sirolimus use for ≥3 months after LT for HCC independently reduced the hazard for death in the multivariate analysis [hazard ratio (HR): 0.7 (95% confidence interval, CI: 0.52-0.96, P = 0.02). Most strikingly, patients with an alpha-fetoprotein (AFP) ≥10 ng/mL and having used sirolimus for ≥3 months, benefited most with regard to OS, DFS, and HCC-recurrence (HR: 0.49-0.59, P = 0.0079-0.0245). CONCLUSIONS: mTOR-inhibitor treatment with sirolimus for ≥3 months improves outcomes in LT for HCC, especially in patients with AFP-evidence of higher tumor activity, advocating particularly for mTOR inhibitor use in this subgroup of patients. CLINICAL TRIAL REGISTRATION: EudraCT: 2005-005362-36 CLINICALTRIALS.GOV:: NCT00355862. ispartof: ANNALS OF SURGERY vol:272 issue:5 pages:855-862 ispartof: location:United States status: published

Aim: to determine if dynamic balance is related to activities of daily living (ADL) dependence in stroke patients. Methods: a cross-sectional study was carried out. The Barthel index (BI) was used to assess ADL dependence. The Timed Up and Go Test (TUG) and the Four Square Step Test (FSST) were used to evaluate dynamic balance. A Spearman correlation was used assuming a data abnormality in the performance of TUG and FSST and considering a significance of p

espanolIntroduccion: la diverticulitis aguda es una enfermedad con una gran prevalencia y la necesidad de un manejo mas agresivo en pacientes inmunodeprimidos no ha quedado claramente consensuada. Objetivos: valorar la posibilidad de que el manejo conservador en este grupo sea tan valido como en la poblacion inmunocompetente. Metodos: presentamos un estudio analitico retrospectivo llevado a cabo en nuestro hospital. Se analizaron 40 pacientes inmunodeprimidos (trasplantados, tratamiento corticoideo, tratamiento renal sustitutivo, oncologicos, VIH positivos en situacion de inmunodepresion) diagnosticados de diverticulitis aguda. Los pacientes siguieron manejo no quirurgico o tratamiento quirurgico urgente segun su situacion clinica al ingreso. Las principales medidas estudiadas han sido la gravedad del cuadro agudo y la necesidad de tratamiento quirurgico segun la causa de inmunodepresion. Resultados: de 40 pacientes estudiados, 32 fueron manejados de forma conservadora en el momento agudo, con necesidad de intervencion quirurgica urgente en ocho casos (siete intervenciones de Hartmann y una reseccion con anastomosis), siendo el grupo de los trasplantados y los pertenecientes al rango de edad 40-50 anos los de mayor riesgo. Tres pacientes requirieron intervencion de forma programada por complicaciones posteriores. Veinticuatro pacientes evolucionaron sin complicaciones. Conclusiones: la proporcion de diverticulitis aguda complicada es superior que en la poblacion general. El tratamiento no quirurgico parece tan seguro como en la poblacion inmunocompetente. Los pacientes mas jovenes y los trasplantados constituyen los principales grupos de riesgo para sufrir un cuadro grave que precise un manejo mas agresivo de manera inicial. EnglishIntroduction: acute diverticulitis is a very prevalent disease. The need for a more aggressive management in immunodeficient patients has not been established. We present the results of our unit with immunodeficient patients diagnosed with acute diverticulitis and their follow-up. Objectives: to assess the possibility that a conservative management in this group is as valid as in the immunocompetent population. Methods: a retrospective analysis study was performed in our hospital. Forty immunodeficient patients (transplant, corticoid treatment, dialysis, oncologic, HIV patients) diagnosed with acute diverticulitis were analyzed. The patients were managed with a surgical or non-surgical treatment according to their status on admission. The main analyzed items were the severity of the acute episode and the need for surgical treatment compared to the cause of immunodeficiency. Other studied variables included follow-up results and recurrences. Results: thirty-two of the 40 patients studied received a non-surgical treatment during the acute episode, eight required emergency surgery (seven had a Hartmann procedure and one underwent a colon resection and anastomosis). Transplant patients and those between 40 and 50 years old proved to be higher risk groups. Three patients subsequently required elective surgery due to complications. Twenty-four patients had uneventful recoveries. Conclusions: the frequency of complicated acute diverticulitis is higher in immunodeficient patients than that of the general population. Non-surgical treatment seems to be as safe as in immunocompetent patients. Younger and transplanted patients were higher risk groups for severe acute diverticulitis that required a more aggressive management initially.

1 Tabla.-- 1 Figura, In obesity, an elevated accumulation and dysregulation of adipose tissue, due to an imbalance between energy intake and energy expenditure, usually coexists with the loss of responsiveness to leptin in central nervous system, and subsequently with hyperleptinemia. Leptin, a peptide hormone mainly produced by white adipose tissue, regulates energy homeostasis by stimulating energy expenditure and inhibiting food intake. Human obesity is characterized by increased plasma leptin levels, which have been related with different obesity-associated complications, such as chronic inflammatory state (risk factor for diabetes, cardiovascular and autoimmune diseases), as well as infertility and different types of cancer. Besides, leptin is also produced by placenta, and high leptin levels during pregnancy may be related with some pathological conditions such as gestational diabetes. This review focuses on the current insights and emerging concepts on potentially valuable nutrients and food components that may modulate leptin metabolism. Notably, several dietary food components, such as phenols, peptides, and vitamins, are able to decrease inflammation and improve leptin sensitivity by up- or down-regulation of leptin signaling molecules. On the other hand, some food components, such as saturated fatty acids may worsen chronic inflammation increasing the risk for pathological complications. Future research into nutritional mechanisms that restore leptin metabolism and signals of energy homeostasis may inspire new treatment options for obesity-related disorders., The present work was funded by grants from the Instituto de Salud Carlos III (ISCIII), PS12/00117, and PI15/01535, PI19/01741 funded in part by FEDER Funds, to Víctor Sánchez-Margalet.

Mexico holds an exceptional diversity and endemicity of amphibian and reptile species, but several factors pose a threat to their conservation. Here, we produced ecological niche models for 179 Mexican endemic amphibian and reptile species and examined the impact of habitat loss and mining activities on their projected potential distributions, resulting in their extant distributions. We compared extant species distributions to the area required to conserve a minimum proportion of the species distribution. The combined impact of habitat loss and mining on extant species distribution was significantly higher than the impact of habitat loss alone. Only 40 species lost &lt, 30% of their distribution, while 83 species lost between 30&ndash, 50%, 54 species lost between 50&ndash, 80%, and 2 species lost more than 80% of their distribution. Furthermore, the size and configuration of the area required to conserve 20% of the extant species distributions changed considerably by increasing the number of fragments, with a potential increase in local population extirpations. Our study is the first to address the combined impact of habitat loss and mining on a highly vulnerable rich endemic species group, leading to a decrease in their potential distribution and a potential increase in the extinction risk of species.

Goals Current trend in the treatment of non-complicated diverticulitis is the outpatient management with antibiotic or even anti-inflammatory regimens in selected cases. We present a comparison of the results in our hospital with different protocols applied in 2016 and 2017. Material and methods All patients selected for this study were diagnosed with diverticulitis grade Ia of Hinchey's classification according to radiological findings on abdominal CT. We have analyzed two retrospective cohorts: 100 patients treated in 2016 according to the old protocol and 104 patients treated in 2017 with a new protocol. In 2016, the candidates for ambulatory treatment remained under observation for 24 h before being discharged. The treatment consisted of 14 days of ciprofloxacin and metronidazole. In 2017, only patients with more acute symptoms were observed 24 h and amoxicillin-clavulanic acid was prescribed for only 5 days. Results The persistence of the disease in 2016 was 6% and in 2017 was only 5.77% (P = .944). Recurrence during the first year was 13% in the first group, while in the second it was 5.7%, although this difference was not statistically significant. Likewise, a significant reduction in health costs was achieved. Conclusions Outpatient treatment of acute uncomplicated diverticulitis with oral treatment seems to be a safe and effective therapeutic strategy in selected patients with low comorbidity.

Copyright © 2019 Sánchez-Jiménez, Pérez-Pérez, de la Cruz-Merino and SánchezMargalet., Obesity-related breast cancer is an important threat that affects especially post-menopausal women. The link between obesity and breast cancer seems to be relying on the microenvironment generated at adipose tissue level, which includes inflammatory cytokines. In addition, its association with systemic endocrine changes, including hyperinsulinemia, increased estrogens levels, and hyperleptinemia may be key factors for tumor development. These factors may promote tumor initiation, tumor primary growth, tissue invasion, and metastatic progression. Although the relationship between obesity and breast cancer is already established, the different pathophysiological mechanisms involved are not clear. Obesity-related insulin resistance is a well-known risk factor for breast cancer development in post-menopausal women. However, the role of inflammation and other adipokines, especially leptin, is less studied. Leptin, like insulin, appears to be a growth factor for breast cancer cells. There exists a link between leptin and metabolism of estrogens and between leptin and other factors in a more complex network. As a result, obesity-associated hyperleptinemia has been suggested as an important mediator in the pathophysiology of breast cancer. On the other hand, recent data on the paradoxical effect of obesity on cancer immunotherapy efficacy has brought some controversy, since the proinflammatory effect of leptin may help the effect of immune checkpoint inhibitors. Therefore, a better knowledge of the molecular mechanisms that mediate leptin action may be helpful to understand the underlying processes which link obesity to breast cancer in post-menopausal women, as well as the possible role of leptin in the response to immunotherapy in obese patients., The present work was funded by grants from the Instituto de Salud Carlos III (ISCIII), PS12/00117, and PI15/01535, funded in part by FEDER Funds, to VS-M.

Jejunal diverticular disease is a very uncommon pathology often asymptomatic. Associated complications appear in less than 30% of patients and they can present as diverticulitis, refractary inflammation, obstruction, hemorrhage, perforation or intraabdominal abscess formation. Clinical manifestations are usually unspecific and high suspicion index is required to reach the diagnosis. Treatment of complications includes volume replacement, transfusions, antibiotic therapy, percutaneous drainage or surgical intervention. We present a retrospective observational study of the cases treated in our hospital between 2007 and 2016.

District Heating (DH) are a very efficient system for heating in urban areas and they are considered as key elements for the de-carbonization of the European Cities. High performance levels and low operational energy costs are part of the identity of these heating networks. The reduction of supply-line temperatures allows the possibility to introduce new low-grade and renewable source energy production, reducing dependence on fossil fuel-based energy plants. Moreover, heat-losses in distribution pipelines are also reduced, since the gradient temperature between supply line and ambient temperature is reduced. Operation of decentralized & Ultra Low Temperature (ULT) systems may adapt for the introduction of weather-dependent, distributed heat sources such as solar systems. Furthermore, although very dependent on local availability, waste heat streams from commercial and industrial installations are also considered because of the stability of heat supply all year round, resulting in minimally carbon intensive processes. Regarding building features, the reduced heat load derived from the transition from current buildings to Nearly Zero Energy Buildings (NZEB), RELaTED allows for the novel concept called prosumer, where buildings can deliver energy to the grid from decentralized energy sources installed in the building. In RELaTED, different subsystems are being developed by different industrial partners, to prove their efficiency in 4 real demonstration sites: Tartu (Estonia), Belgrade (Serbia), Vinge (Denmark) and Iurreta (Spain). A 3-FS (3-Function Scheme) DH substation that permits buildings to become prosumers. Two types of solar collectors, one is an all polymeric glazed collector and the second one is an unglazed collector, both as components of Building Integrated Large Solar Thermal Systems (BILSTS) solar loop. Finally, a reversible and high efficiency heat pump for domestic hot water is being developed. In this paper, an approach to ULT concept is studied, including transitory phases of the conversion. Research output presented in this paper has performed under project RELaTED (RELaTED, 2017). RELaTED project partners are: TECNALIA, Danish Technical Institute, Fortum Tartu, Beogradske Elektrane, Basque Government, Metro Therm, Nibe, Aventa, Industrias IMAR, Basque Energy Agency, Mazovia Energy Agency, Institute of Baltic Studies, FEDARENE, El Taller De Comunicación y CIA. This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 768567

Emerging research has highlighted the importance of leptin in fetal growth anddevelopment, independent of its essential role in the regulation of feeding andenergy metabolism. Leptin is now considered an important signaling molecule ofthe reproductive system, since it regulates the production of gonadotropins, theblastocyst formation and implantation, the normal placentation, as well as the feto-placental communication. Placental leptin is an important cytokine which regulatesplacental functions in an autocrine or paracrine manner. Leptin seems to play acrucial role during the first stages of pregnancy as it modulates critical processes likeproliferation, protein synthesis, invasion, and apoptosis in placental cells. Further-more, deregulation of leptin levels has been correlated with the pathogenesis ofvarious disorders associated with reproduction and gestation, including gestationaldiabetes mellitus (GDM). Due to the relevant incidence of the GDM and theimportance of leptin, we decided to review the latest information available aboutleptin action in normal and GDM pregnancies to support the idea of leptin as animportant factor and/or predictor of diverse disorders associated with reproductionand pregnancy. Fil: Guádix, Pilar. No especifíca; Fil: Pérez Pérez, Antonio. No especifíca; Fil: Vilariño, Teresa. No especifíca; Fil: Dueñas, Jose L.. No especifíca; Fil: Maymo, Julieta Lorena. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; Argentina Fil: Varone, Cecilia Laura. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; Argentina Fil: Sánchez Margalet, Victor. No especifíca

[Background & Aims] Although there is increasing interest in its use, definitive evidence demonstrating a benefit for postmortem normothermic regional perfusion (NRP) in controlled donation after circulatory death (cDCD) liver transplantation is lacking. The aim of this study was to compare results of cDCD liver transplants performed with postmortem NRP vs. super-rapid recovery (SRR), the current standard for cDCD., [Methods] This was an observational cohort study including all cDCD liver transplants performed in Spain between June 2012 and December 2016, with follow-up ending in December 2017. Each donor hospital determined whether organ recovery was performed using NRP or SRR. The propensity scores technique based on the inverse probability of treatment weighting (IPTW) was used to balance covariates across study groups; logistic and Cox regression models were used for binary and time-to-event outcomes., [Results] During the study period, there were 95 cDCD liver transplants performed with postmortem NRP and 117 with SRR. The median donor age was 56 years (interquartile range 45–65 years). After IPTW analysis, baseline covariates were balanced, with all absolute standardised differences, [Conclusions] The use of postmortem NRP in cDCD liver transplantation appears to reduce postoperative biliary complications, ischaemic type biliary lesions and graft loss, and allows for the transplantation of livers even from cDCD donors of advanced age., [Lay summary] This is a propensity-matched nationwide observational cohort study performed using livers recovered from donors undergoing cardiac arrest provoked by the intentional withdrawal of life support (controlled donation after circulatory death, cDCD). Approximately half of the livers were recovered after a period of postmortem in situ normothermic regional perfusion, which restored warm oxygenated blood to the abdominal organs, whereas the remainder were recovered after rapid preservation with a cold solution. The study results suggest that the use of postmortem normothermic regional perfusion helps reduce rates of post-transplant biliary complications and graft loss and allows for the successful transplantation of livers from older cDCD donors.

RESUMEN Introducción: la colangiopancreatografía retrógrada endoscópica (CPRE) sigue siendo la prueba de elección para el diagnóstico y el tratamiento de la patología biliar y pancreática, pero cuenta con una tasa de morbimortalidad no desdeñable, por lo que se proponen algoritmos para el manejo y tratamiento de sus complicaciones. Objetivo: revisar las perforaciones post-CPRE tratadas en el Servicio de Cirugía General del Hospital Puerta de Hierro de 1999 a 2014, evaluando los resultados en función del tipo de perforación y el tratamiento. Métodos y resultados: se ha realizado un estudio descriptivo y observacional de todas las perforaciones post-CPRE comunicadas y tratadas por el Servicio de Cirugía General del Hospital Puerta de Hierro de 1999 a 2014, en relación a la indicación de la prueba y hallazgos, el tipo de perforación (clasificación de Stapfer), el tiempo hasta el diagnóstico y el método de diagnóstico, el tiempo hasta la intervención y la técnica empleada, las complicaciones posteriores, así como la evolución y el tiempo de ingreso. Los resultados se han evaluado en función del tipo de perforación (Stapfer) y del tipo de tratamiento realizado. Se comunicaron 36 perforaciones (21 de tipo I, ocho de tipo II, dos de tipo III y cinco de tipo IV), lo que supone una incidencia menor del 1%. El diagnóstico fue inmediato (en las primeras 24 horas) en el 67% de los casos, siendo las de tipo I las más frecuentes. Se intervino a 28 de los 36 pacientes (77,7%), realizándose en la mayoría una colecistectomía seguida, siempre que fue posible, de sutura, colangiografía intraoperatoria y exploración de la vía biliar y drenaje. Fallecieron cuatro pacientes (dos intervenidos y dos manejados de manera conservadora), todos con perforaciones de tipo I. La complicación más frecuente fue la colección/fístula, que apareció en el 21,42% de los pacientes intervenidos. Conclusiones: el tratamiento de las perforaciones periduodenales secundarias a CPRE debe orientarse en función de los hallazgos clínicos y radiológicos. Según nuestra experiencia, las perforaciones de tipo I requieren una intervención quirúrgica inmediata, mientras que las perforaciones tipo II y III permiten, en algunos casos, un manejo conservador, siempre ante la ausencia de complicaciones como colecciones abdominales asociadas y/o signos de sepsis o de irritación peritoneal. Las perforaciones tipo IV responden bien al manejo conservador ABSTRACT Introduction: endoscopic retrograde cholangiopancreatography (ERCP) remains the gold standard in biliary and pancreatic pathology. Although the procedure has a significant morbidity and mortality rate. Algorithms are needed for the management and treatment of the associated complications. Objective: to review the post-ERCP perforations treated in the Department of General Surgery of the Hospital Puerta de Hierro from 1999 to 2014. The results were evaluated according to the types of perforation and treatment. Methods and results: this is a descriptive and observational study of all post-ERCP perforations reported and treated by the Department of General Surgery of the Hospital Puerta de Hierro from 1999 to 2014. The following data were collected: indication for the test and findings, type of perforation, time and method of diagnosis, time to surgery and the technique used; the subsequent complications as well as the evolution and time of admission were registered. Results were evaluated according to the type of perforation (Stapfer classification) and the treatment performed. Thirty-six perforations were reported (21 type I, eight type II, two type III and five type IV), with an associated incidence of less than 1%. The diagnosis was immediate (in the first 24 hours) in 67% of cases; type I was the most frequent: 28 of 36 patients (77.7%) required surgery. The majority underwent a cholecystectomy followed by suture, intraoperative cholangiography, bile duct exploration and drainage whenever possible. Four patients died with type I perforations; two were intervened and two were managed conservatively. The most frequent complication was a collection/fistula which occurred in 21.42% of patients who underwent surgery. Conclusions: periduodenal perforations secondary to ERCP treatment should be oriented according to the clinical and radiological findings. In our experience, type I perforations require immediate surgical intervention, whereas type II and III perforations can be managed conservatively in some cases when there are no complications such as associated abdominal collections, peritoneal irritation and/or sepsis. Type IV perforations respond to conservative management.

Electronic systems are interesting for beekeeping update.Bee colonies monitoring is essential to understand the response of bees against threats such as diseases or climate change.The records inside bee hives are important to design conservation strategies.Bees are able to thermoregulate inside the hive in very different conditions.Screening bottom boards are useful for Varroa control and they do not provoke problems of thermoregulation. Electronic systems are not widely used for measuring biological variables in beehives despite the importance that honeybees have for both the environment and humans. A better understanding of bee colonies is needed in order to prevent certain dangers that threaten the bee population. In this study, we have developed an electronic system based on the Arduino Open Hardware platform, to which we have added temperature and humidity sensors to adapt the system to the particular conditions of beehive management. The system has been used to record changes in temperature and humidity inside hives and assess bees' thermoregulation adaptability within colonies in hives with opened-screened bottom boards; an interesting management tool for controlling the harmful Varroa destructor mite as compared to beehives with conventional closed bottom boards. The results revealed that bee colonies were able to thermoregulate in hives with open anti-Varroa bottom boards to the same degree as those in conventional bottom board hives even under winter conditions in a mediterranean climate, thus indicating that there are no additional risks associated with the use of open-screened bottom board models.

Leptin is now considered an important signalling molecule of the reproductive system, as it regulates the production of gonadotrophins, the blastocyst formation and implantation, the normal placentation, as well as the foeto-placental communication. Leptin is a peptide hormone secreted mainly by adipose tissue, and the placenta is the second leptin-producing tissue in humans. Placental leptin is an important cytokine which regulates placental functions in an autocrine or paracrine manner. Leptin seems to play a crucial role during the first stages of pregnancy as it modulates critical processes such as proliferation, protein synthesis, invasion and apoptosis in placental cells. Furthermore, deregulation of leptin levels has been correlated with the pathogenesis of various disorders associated with reproduction and gestation, including polycystic ovary syndrome, recurrent miscarriage, gestational diabetes mellitus, pre-eclampsia and intrauterine growth restriction. Due to the relevant incidence of the mentioned diseases and the importance of leptin, we decided to review the latest information available about leptin action in normal and pathological pregnancies to support the idea of leptin as an important factor and/or predictor of diverse disorders associated with reproduction and pregnancy. Fil: Pérez Pérez, Antonio. Universidad de Sevilla; España Fil: Toro, Ayelen Rayen. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; Argentina Fil: Vilariño García, Teresa. Universidad de Sevilla; España Fil: Maymo, Julieta Lorena. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; Argentina Fil: Guadix, Pilar. Universidad de Sevilla; España Fil: Dueñas, José L.. Universidad de Sevilla; España Fil: Fernández Sánchez, Manuel. Instituto Valenciano de Infertilidad; España Fil: Varone, Cecilia Laura. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; Argentina Fil: Sánchez Margalet, Víctor. Universidad de Sevilla; España