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Objective. To estimate the prevalence of unknown HIV infection in patients who consulted in hospital emergency services (ED) for conditions defined in the SEMES-GESIDA Consensus Document (DC), evaluate the efficiency of its im-plementation and investigate the efficiency of HIV serology determination in other conditions. Methods. Results were reviewed in 10 Catalan EDs for 12 months (July-21-June-22) after implementing CD recommendations: request HIV serology in case of suspected sexually transmitted infection, chemsex, post-exposure prophylaxis (PEP), mononucleosis syndrome, community pneumonia (18-65 y-o) or herpes zoster (18-65 y-o). Other reasons for request were included. Prevalence (%) of global seropositivity and for each circumstance was calculated, with a 95% confidence interval (95%CI). The efficient strategy was considered if the lower limit of the CI95%>0.1%. Results. A total of5,107 HIV serologies were performed: 2,847(56%) in situations specified in CD, and 2,266 (44%) in other 138 circumstances. Forty-eight unknown HIV infections were detected (prevalence=0.94%;95%CI=0.69-1.24). The prevalence was somewhat higher in DC requests (30 cas-es 1.12%) than the rest (18 cases 0.71%; p=0.16). The individualized prevalence of CD reasons ranged between 7.41% (95%CI=0.91-24.3) in chemsex and 0.42% 95%CI=0.14-0.98) in PPE, always efficient except herpes zoster (0.76%; CI95%=0.02-4.18). In other reasons, cases were detected in 12 circumstances, and in four the determination could be efficient: lymphopenia (10%;CI95%=0.25-44.5), fever with polyarthralgia-polyarthritis (7.41%;CI95% =0.91-24.3), behavioral alteration-confusion-encephalopathy (3.45%;95%CI=0.42-11.9) and fever of unknown origin (2.50%;95%CI=0.82-5.74). Conclusion. The determination of HIV serology in HES in the processes defined by DC SEMES-GESIDA is efficient. Some circumstances are identified that could be added to those previously contemplated to increase efficiency.

International audience; No abstract available

Background: Malfunctioning of the default mode network (DMN) has been consistently related to mild cognitive impairment (MCI) and Alzheimer’s disease (AD). However, evidence on differences in this network between MCI converters (MCI-c) and non-converters (MCI-nc), which could mark progression to AD, is still inconsistent. Objective: To multimodally investigate the DMN in the AD continuum. Methods: We measured gray matter (GM) volume, white matter (WM) integrity, and functional connectivity (FC) at rest in healthy elderly controls, MCI-c, MCI-nc, and AD patients, matched on sociodemographic variables. Results: Significant differences between AD patients and controls were found in the structure of most of the regions of the DMN. MCI-c only differed from MCI-nc in GM volume of the left parahippocampus and bilateral hippocampi and middle frontal gyri, as well as in WM integrity of the parahippocampal cingulum connecting the left hippocampus and precuneus. We found significant correlations between integrity in some of those regions and global neuropsychological status, as well as an excellent discrimination ability between converters and non-converters for the sum of GM volume of left parahippocampus, bilateral hippocampi, and middle frontal gyri, and WM integrity of left parahippocampal cingulum. However, we found no significant differences in FC. Conclusion: These results further support the relationship between abnormalities in the DMN and AD, and suggest that structural measures could be more accurate than resting-state estimates as markers of conversion from MCI to AD.

Background: This longitudinal study addressed whether mindfulness practice prevents psychological and behavioral symptoms, especially mood disorders, in Alzheimer’s disease (AD). Objective: To assess the incidence of depression in the course of AD and to determine which non-pharmacological treatment (NPT) is most effective in preventing psychopathological symptoms. Methods: We conducted a longitudinal, non-inferiority and equivalence randomized clinical trial, repeated-measures design, with a control group and three experimental treatments: mindfulness, cognitive stimulation, and relaxation. Each experimental group performed three weekly sessions for two years. The pharmacological treatment of all participants was donepezil (10 mg). Participants were patients with probable AD without diagnosed depression from the public neurology services of the Canary Health Service, Spain. Psychological evaluation was performed using the Geriatric Depression Scale (GDS), Hamilton Depression Rating Scale (HDRS), and Neuropsychiatric Inventory (NPI-Q). The statistical analysis included only patients who attended at least 75% of the sessions. A nonparametric, repeated-measures analysis was performed with Kruskal-Wallis H test and between-group differences with Mann-Whitney U test with Bonferroni correction (p 0.14) between mindfulness and the rest of the experimental groups as well as the control in the GDS, HDRS, and NPI-Q scales. Conclusion: Compared to the other experimental groups, only mindfulness prevented the onset of depression and other psychopathologies in early-stage AD. Based on its effectiveness in maintaining cognitive functions and preventing psychopathology, we recommend mindfulness as the first-choice NPT for mild to moderate AD.

The daily intake of table olives to spontaneously hypertensive rats induced changes in faecal microbiota associated with antihypertensive activity and promoted the growth of probiotic strains.

El artículo analiza, a partir de una perspectiva jurídico penal y criminológica, el rol del género en la concepción y aplicación del sistema de justicia penal, a lo largo de sus distintas etapas. En esa línea, parte de los cuestionamientos a la aparente neutralidad que ofrecen las categorías jurídico-penales, construidas e interpretadas desde un lente androcéntrico que excluye y desvalora las experiencias, intereses y valores femeninos. A través de una revisión crítica de la literatura que estudia la interacción del poder punitivo y el poder patriarcal, se expone y analizan los efectos empíricos, a nivel comparado de leyes penales, sustantivas y procesales, pensadas y aplicadas sin perspectiva de género.Se sostiene, así, la necesidad de operadores de la justicia de aplicar el derecho penal con perspectiva de género, mientras se idean fórmulas de justicia que descentralicen el paradigma punitivo tradicional.

El granate de hierro itrio, YIG (Y3Fe5O12), es un cerámico con propiedades magnéticas, dieléctricas y ópticas, las cuales se atribuyen a su estructura cristalina. El YIG contiene 160 iones que forman huecos tetraédricos, octaédricos y dodecaédricos; así como a la ubicación de los cationes, distorsión e interacciones atómicas. Su baja coercitividad y mínimas pérdidas por corriente inducida es útil en dispositivos que operan en microondas. Con la finalidad de ampliar el rango de aplicaciones se sustituyen iones de Y3+ (1.019Å y 0 µB) por Ce3+ (1.01Å y 1.0 µB), Nd3+ (1.109Å y 3.62 µB) y Bi3+ (1.17Å y 0 µB). Se evalúa el efecto del tipo y nivel de dopaje, sobre la estructura cristalina y propiedades magnéticas del YIG dopado, cuando se emplea molienda de alta energía asistida con tratamiento térmico como método de síntesis

The accuracy of contemporary risk scores in predicting perioperative mortality in infective endocarditis (IE) remains controversial. The aim is to evaluate the performance of existent mortality risk scores for cardiovascular surgery in IE and the impact on operability at high-risk thresholds. A single-center retrospective review of adult patients diagnosed with acute left-sided IE undergoing surgery from May 2014 to August 2019 (n = 142) was done. Individualized risk calculation was obtained according to the available mortality risk scores: EuroScore I and II, PALSUSE, Risk-E, Costa, De Feo-Cotrufo, AEPEI, STS-risk, STS-IE, APORTEI, and ICE-PCS scores. A cross-validation analysis was performed on the score with the best area under the curve (AUC). The 30-day survival was 96.5% (95%CI 91–98%). The score with worse area under the curve (AUC = 0.6) was the STS-IE score, while the higher was for the RISK-E score (AUC = 0.89). The AUC of the majority of risk scores suggested acceptable performance; however, statistically significant differences in expected versus observed mortalities were common. The cross-validation analysis showed that a large number of survivors (> 75%) would not have been operated if arbitrary high-risk threshold estimates had been used to deny surgery. The observed mortality in our cohort is significantly lower than is predicted by contemporary risk scores. Despite the reasonable numeric performance of the analyzed scores, their utility in judging the operability of a given patient remains questionable, as demonstrated in the cross-validation analysis. Future guidelines may advise that denial of surgery should only follow a highly experienced Endocarditis Team evaluation.

Las hexaferritas tipo y son materiales cerámicos magnéticos, los cuales poseen una estructura cristalina compleja con grupo espacial R-3m, lo que da origen a que se presenten distintas fases magnéticas en función de la composición química y la temperatura. El aspecto más interesante desde el punto de vista tecnológico es la ferroelectricidad producida mediante spin que poseen algunas de las fases magnéticas de las hexaferritas tipo y, lo cual les confiere propiedades multiferroicas magnetoeléctricas. Con la finalidad de entender el mecanismo que da origen a las fases magnéticas en el presente trabajo se estudia el efecto de la concentración de Sr2+ en el campo de transición magnética de hexaferritas tipo y con composición química Ba1-xSrxNi2Fe11AlO22 con x = 1.0, 1.1 y 1.3.

En este trabajo se presenta el efecto de la temperatura de tratamiento térmico en la estructura y las propiedades, magnéticas, ópticas y fotocatalíticas de ferrita de níquel (NiFe2O4) obtenida por molienda mecánica de alta energía. Mediante difracción de rayos X (DRX) y refinamiento Rietveld se confirmó la formación de NiFe2O4 y la presencia de Fe2O3 a temperaturas inferiores a 1273 K. Por medio de magnetometría de muestra vibrante (MMV) se observó un aumento en los valores de magnetización cuando se incrementa la temperatura de tratamiento, siendo atribuido a la distribución catiónica de los iones magnéticos de Fe3+ y Ni2+ en la celda unitaria. Por medio de reflectancia difusa se determinaron los valores de banda prohibida, los cuales confirmaron que absorbe luz en el espectro visible. Las muestras muestran una buena eficiencia de degradación, alcanzando valores superiores al 60 %, siendo una buena alternativa como fotocatalizadores empleando el rango de luz visible y recuperables magnéticamente.

Los elementos de tierras raras han sido considerados por diversos países como elementos críticos, debido a su importancia tecnológica que impulsa al mundo moderno, además, aunque las tierras raras pueden encontrarse en la mayor parte del mundo, en la actualidad existe un desabasto a nivel mundial, debido a la cada vez menor cantidad de yacimientos minerales que pueden ser económicamente rentables para su extracción y producción. En este sentido, poco más del 50% de la cantidad de tierras raras que se comercializan a nivel mundial, provienen de China, quien ha creado un monopolio en la producción y exportación de dichos elementos, de igual manera es importante mencionar que aunque ciertos elementos de tierras raras son indispensables para las nuevas tecnologías, sus procesos de extracción generan gases y efluentes peligrosos para el medio ambiente y el ser humano, razón por la cual diversos países han implementado políticas que encarecen el procedimiento de producción de tierras raras, encaminando a buscar alternativas que sean amigables con el ambiente y al mismo tiempo sean económicamente rentables.

This work aims to analyze if hospitalization in short-stay units (SSU) of patients diagnosed in the emergency department with acute heart failure (AHF) is effective in terms of the length of hospital stay and if it is associated with differences in short-term progress.Patients from the EAHFE registry diagnosed with AHF who were admitted to the SSU (SSU group) were included and compared to those hospitalized in other departments (non-SSU group) from all hospitals (comparison A) and, separately, those from hospitals with an SSU (comparison B) and without an SSU (comparison C). For each comparison, patients in the SSU/non-SSU groups were matched by propensity score. The length of hospital stay (efficacy), 30-day mortality, and post-discharge adverse events at 30 days (safety) were compared.A total of 2,003 SSU patients and 12,193 non-SSU patients were identified. Of them, 674 pairs of patients were matched for comparison A, 634 for comparison B, and 588 for comparison C. The hospital stay was significantly shorter in the SSU group in all comparisons (A: median 4 days (IQR = 2-5) versus 8 (5-12) days, p 0.001; B: 4 (2-5) versus 8 (5-12), p 0.001; C: 4 (2-5) versus 8 (6-12), p 0.001). Admission to the SSU was not associated with differences in mortality (A: HR = 1.027, 95%CI = 0.681-1.549; B: 0.976, 0.647-1.472; C: 0.818, 0.662-1.010) or post-discharge adverse events (A: HR = 1.002, 95%CI = 0.816-1.232; B: 0.983, 0.796-1.215; C: 1.135, 0.905-1.424).The hospitalization of patients with AHF in the SSU is associated with shorter hospital stays but there were no differences in short-term progress.

Introduction and objectives Composite endpoints are widely used but have several limitations. The Clinical Outcomes, HEalthcare REsource utilizatioN and relaTed costs (COHERENT) model is a new approach for visually displaying and comparing composite endpoints including all their components (incidence, timing, duration) and related costs. We aimed to assess the validity of the COHERENT model in a patient cohort. Methods A color graphic system displaying the percentage of patients in each clinical situation (vital status and location: at home, emergency department [ED] or hospital) and related costs at each time point during follow-up was created based on a list of mutually exclusive clinical situations coded in a hierarchical fashion. The system was tested in a cohort of 1126 patients with acute heart failure from 25 hospitals. The system calculated and displayed the time spent in each clinical situation and health care resource utilization-related costs over 30 days. Results The model illustrated the times spent over 30 days (2.12% in ED, 23.6% in index hospitalization, 2.7% in readmissions, 65.5% alive at home, and 6.02% dead), showing significant differences between patient groups, hospitals, and health care systems. The tool calculated and displayed the daily and cumulative health care-related costs over time (total, €4 895 070; mean, €144.91 per patient/d). Conclusions The COHERENT model is a new, easy-to-interpret, visual display of composite endpoints, enabling comparisons between patient groups and cohorts, including related costs. The model may constitute a useful new approach for clinical trials or observational studies, and a tool for benchmarking, and value-based health care implementation.

To evaluate the spectrum of glaucoma surgery undertaken among members of the Spanish Glaucoma Society (SEG).A 10 question web-based anonimous survey was mailed through the Annals of the Spanish Glaucoma Society to all its members on January, February and July 2019 to determine their preferred surgical approach.Age, type of Glaucoma, surgery undertaken, type of anti-scarring strategy and prothesis introduced for the last 10 surgeries since the survey was received. The surgeon experience was registered in years of practice.A total of 97 SEG members across the country answered the survey. Sixty-two (63.4%) responders had more than 10 years of experience. Primary open angle glaucoma was the most frequent type of glaucoma (60.6%). The most popular surgery was deep-sclerectomy (37.3%) followed by trabeculectomy (17,6%) and the collagen microshunt (XEN® Allergan Inc., Irvine, CA) (14.1%). Glaucoma drainage device (GDD) was used in 10.5% of the cases. Up to 21.7% of surgeries were reinterventions, where GDD was used in 27.3% and trabeculectomy in 20.3% of the cases. Glaucoma surgery was combined with phacoemulsification in 47.3% of the eyes. Mitomycin C (MMC) was used in 54,8% of the cases, collagen matrix (Ologen®, Aeon Astron Corporation, Taipei, Taiwan) was used alone in 8.2% of the cases and in 13,7% combined with MMC. MMC was used in a soaked sponge in 79% of cases (concentrations of 0.02% in 99% and 0.04% in 1%) and in 21% of cases MMC was injected subconjunctivally (concentrations of 0,01% in 81% and 0.02% in 19%).Although the glaucoma surgeon performs a wide range of surgical techniques, deep sclerectomy remains the most widely used surgical technique in Spain. Combined cataract and glaucoma surgery is performed almost in half of the patients and MMC is the most frequently selected antifibrotic agent, alone or combined with collagen matrix. The new minimal invasive surgical techniques represent the 20% of the total.

GRE@T-PIONEeR - GRaduate Education Alliance for Teaching the PhysIcs and safety Of NuclEar Reactors - is a project funded by the Euratom – Horizon 2020 Framework Programme which aims at developing and providing specialised and advanced courses in computational and experimental reactor physics at the graduate level (MSc and PhD levels) and post-graduate level, as well as the staff members working in the nuclear industry. One of the work packages of GRE@T-PIONEeR is devoted to developing a specific course on the nuclear data pipeline processes and to present the role of nuclear data to play in calculations of innovative reactor systems. This course covers all steps in the nuclear data life cycle, starting from the measurements to their validation and final use in nuclear reactor calculations. Beyond the technical contents of the courses being developed, the paper describes the use of innovative pedagogical methods and active learning techniques, such as flipped classes, aimed at promoting student learning.

BACKGROUND: Navigation guidance in cardiac interventions is provided by X-ray angiography. Cumulative radiation exposure is a serious concern for pediatric cardiac interventions. PURPOSE: A generative learning-based approach is proposed to predict X-ray angiography frames to reduce the radiation exposure for pediatric cardiac interventions while preserving the image quality. METHODS: Frame predictions are based on a model-free motion estimation approach using a long short-term memory architecture and a content predictor using a convolutional neural network structure. The presented model thus estimates contrast-enhanced vascular structures such as the coronary arteries and their motion in X-ray sequences in an end-to-end system. This work was validated with 56 simulated and 52 patients’ X-ray angiography sequences. RESULTS: Using the predicted images can reduce the number of pulses by up to three new frames without affecting the image quality. The average required acquisition can drop by 30% per second for a 15 fps acquisition. The average structural similarity index measurement was 97% for the simulated dataset and 82% for the patients’ dataset. CONCLUSIONS: Frame prediction using a learning-based method is promising for minimizing radiation dose exposure. The required pulse rate is reduced while preserving the frame rate and the image quality. With proper integration in X-ray angiography systems, this method can pave the way for improved dose management.

RESUMEN Objetivo Conocer el enfoque terapéutico que se realiza en los servicios de urgencias hospitalarios (SUH) españoles a los pacientes con sospecha de infección de transmisión sexual (ITS), analizándolo según tamaño del hospital, afluencia en urgencias y comunidad autónoma. Material y métodos Encuesta estructurada a los responsables de los 282 SUH públicos que atienden adultos 24 horas/día. Se preguntó sobre rutinas asistenciales en urgencias en la atención a pacientes con sospecha de ITS. Los resultados se comparan mediante odds ratio (OR) e intervalo confianza del 95% (IC95%) según tamaño del hospital (grande vs mediopequeño: ≥500 vs. 60% en Cataluña y País Vasco, más en hospitales grandes (OR=2,65, IC95%=1,46-4,82) y SUH con alta afluencia (OR=3,49, IC95%=2,03-5,98)]. El 70% de SUH frecuentemente o casi siempre realizan tomas de exudados (>80% en Cataluña, Madrid, Castilla-La Mancha, Aragón, Navarra y País Vasco), el 44% serologías de ITS (>60% en Madrid) y el 35% serología VIH [(>60% en Navarra y Baleares; más en hospitales grandes (OR=2,43, IC95%=1,34-4,42) y SUH con alta afluencia (OR=1,94, IC95%=1,15-3,29)]. Al alta, remiten al paciente para seguimiento a dispositivos hospitalarios el 53% de SUH [>60% en Cataluña, Comunidad Valenciana, Murcia, CastillaLa Mancha, País Vasco, Asturias; más en hospitales grandes (OR=2,45, IC95%=1,31-4,57) y SUH de alta afluencia (OR=2,25, IC95%=1,35-3,76)] y a atención primaria el 28% (>80% en Cantabria). En el 55% de SUH los pacientes frecuentemente o casi siempre son dados de alta con visita de seguimiento programada (>80% en Extremadura, La Rioja y Navarra) y en el 32% esta visita es el siguiente día hábil [>60% en País Vasco; más en hospitales grandes (OR=3,43, IC95%=1,87-6,30) y SUH de alta afluencia (OR=3,63, IC95%=2,08-6,37)]. Conclusión La atención al paciente con sospecha de ITS no es homogénea en los SUH españoles y se detectan áreas de mejora, especialmente en la necesidad de protocolos de diagnósticos y seguimientos específicos.

[Background] Infective endocarditis (IE) is a severe condition. Our aim was to describe the profile and prognosis of patients with multivalvular infective endocarditis (MIE) and compare them to single-valve IE (SIE). Methods. We used a retrospective analysis of the Spanish IE Registry (2008−2020)., [Results] From 4064 definite cases of valvular IE, 577 (14.2%) had MIE. In patients with MIE, the most common locations were mitral (552, 95.7%) and aortic (550, 95.3%), with mitral-aortic involvement present in 507 patients (87.9%). The most common etiologies were S. viridans (192, 33.3%) and S. aureus (113, 19.6%). MIE involved only native valves in 450 patients (78.0%). Compared with patients with SIE, patients with MIE had a similar age (69 vs. 67 years, respectively, p = 0.27) and similar baseline characteristics, but were more frequently men (67.1% vs. 72.9%, p = 0.005) and had a higher incidence of intracardiac complications (36.2% vs. 50.4%, p < 0.001), heart failure (42.7% vs. 52.9%, p < 0.001), surgical indication (67.7 vs. 85.1%, p < 0.001), surgery (46.3% vs. 56.3%), and in-hospital mortality (26.9% vs. 34.3%, p < 0.001). MIE was an independent predictor of in-hospital mortality (odds ratio (OR) 1.3, 95% confidence interval (CI) 1.1−1.7, p = 0.004) but did not have an independent association with 1-year mortality (OR 1.1, 95% CI 0.9−1.4, p = 0.43)., [Conclusions] About one-seventh of the valvular IE patients had MIE, mainly due to mitral-aortic involvement. MIE is associated with a poor in-hospital prognosis. An early diagnosis and treatment of IE might avoid its spread to a second valve.

La importancia cada vez mayor de las inversiones extranjeras en el comercio internacional ha generado el desarrollo de una serie de mecanismos para atender las controversias que pueden surgir en el transcurso de la relación comercial. Los autores desarrollan no solo los métodos de resolución de conflictos, sino también los derechos que cuentan los actores participantes en la relación comercial, y las fuentes de donde aquellos derechos nacen. Los autores resaltan la importancia de contar con un marco normativo sólido y coherente antes de realizar cualquier inversión en un país extranjero, para lo que los Tratados de Inversión constituyen una estructura importante para asegurar a los inversionistas que su capital estará protegido ante cualquier circunstancia.

Fever is the most common symptom in childhood. Despite its prevalence and decades of education and research, the treatment of fever and febrile illnesses continues to cause concern and anxiety in parents. The objective of this systematic review with meta-synthesis is to analyse parents' perceptions, knowledge and attitudes towards the febrile child and how they influence the construction of the concept of fever. The PRISMA international standards and PRISMA checklist, as well as the Cochrane recommendations, were followed. Articles with qualitative methodology have been selected that analyse what fever means to parents, what their concerns about this sign are, where they get their information and what their expectations are of healthcare professionals during treating their feverish child. Finally, 17 articles that met the inclusion criteria were added in the qualitative meta-synthesis. The concept of fever has been represented as a non-harmful sign in and of itself, an aspect that emerges in fathers and mothers' discourse. Meanwhile, the perceived need to lower the temperature still appears to be the main aim of their approach, with attitudes implying an emergency to reach normothermia, focusing on temperature as the primary indicator of severity.

The current European Society of Cardiology (ESC) Heart Failure Guidelines are the most comprehensive ESC document covering heart failure to date; however, the section focused on acute heart failure remains relatively too concise. Although several topics are more extensively covered than in previous versions, including some specific therapies, monitoring and disposition in the hospital, and the management of cardiogenic shock, the lack of high-quality evidence in acute, emergency, and critical care scenarios, poses a challenge for providing evidence-based recommendations, in particular when by comparison the data for chronic heart failure is so extensive. The paucity of evidence and specific recommendations for the general approach and management of acute heart failure in the emergency department is particularly relevant, because this is the setting where most acute heart failure patients are initially diagnosed and stabilized. The clinical phenotypes proposed are comprehensive, clinically relevant and with minimal overlap, whilst providing additional opportunity for discussion around respiratory failure and hypoperfusion. F.P. has received research grants from Abbott, Becton Dickenson, Brainbox, Calcimedica, CSL Behring, Cue, Ortho Clinical Diagnostics, Relypsa, Roche, Salix, Siemens. Consultant: Abbott, Astra-Zeneca, Beckman, Bosch, Fast Biomedical, Forrest Devices, Ischemia Care, Dx, Instrument Labs, Janssen, Nabriva, Ortho Clinical Diagnostics, Osler, Relypsa, Roche, Quidel, Salix, Siemens, Upstream and has stock/ownership interests in AseptiScope Inc, Brainbox Inc, Braincheck Inc, Coagulo Inc, Comprehensive Research Associates LLC, Comprehensive Research Management Inc, Emergencies in Medicine LLC, Fast Inc, Forrest Devices, Ischemia DX LLC, Lucia Inc, Prevencio Inc, ScPharma, Trivirum Inc, Upstream Inc. E.P.’ employer has received support from Novartis for consulting work and she has consulted for scPharmaceuticals outside of the submitted work. She has received research support from the NIH (R01HL148439). Sí

Introducción: Para determinar la malignidad del cáncer de próstata, es necesario un proceso de catalogación de imágenes histológicas de tejido prostático con el que se obtiene el grado de Gleason. Este proceso es llevado a cabo manualmente por patólogos expertos, lo que supone una gran carga de trabajo y un elevado nivel de subjetividad. A raíz de ello surge la necesidad de desarrollar un sistema de clasificación automático. Metodología: Se utilizó una arquitectura de red neuronal convolucional VGG16 para desarrollar un modelo que permitiera realizar la clasificación de las imágenes. En primer lugar, se utilizaron únicamente las imágenes anotadas por el experto, y posteriormente se añadió la anotación no experta al modelo, combinando la información experta y no experta con el fin de obtener una clasificación más precisa de las imágenes. Resultados: Ambos modelos se evaluaron utilizando el estadístico de kappa de Cohen. Se obtuvo como resultados un valor de 0,571 para el modelo que utilizaba entradas anotadas por el experto, y un valor de 0,685 al combinar estas entradas con las anotadas por el no experto mediante el modelo híbrido. Superando los valores de kappa de Cohen más elevados presentes en la literatura: 0,58. Conclusión: Tras analizar los resultados, se comprueba que la combinación de ambas anotaciones ayuda a mejorar la precisión del método considerablemente. Por ello, se plantea la aplicación de un modelo híbrido como una posible solución para ayudar a reducir la carga de trabajo de patólogos sin que la precisión del sistema se vea excesivamente afectada. Introduction: To determine the malignancy of prostate cancer, a process of cataloging histological samples of prostate tissue is necessary to obtain the Gleason grade. This process is carried out manually by expert pathologists, which involves a heavy workload and a high level of subjectivity. As a result, the need arose to develop an automatic grading system. Methodology: A VGG16 convolutional neural network architecture was used to develop a model for sample classification. First, only the images annotated by the expert were used, and then the non-expert annotation was added to the model, combining the expert and non-expert information in order to obtain a more accurate classification of the samples. Results: Both models were evaluated using Cohen’s kappa statistic. A value of 0.571 was obtained for the model using inputs annotated by the expert, and a value of 0.685 when combining these inputs with those annotated by the non-expert using the hybrid model. Exceeding the highest Cohen’s kappa values present in the literature: 0.58. Conclusion: After analyzing the results, it is found that the combination of both annotations helps to improve the accuracy of the method considerably. Therefore, the application of a hybrid model is proposed as a possible solution to help reduce the workload of pathologists without excessively affecting the accuracy of the system.

Sustainability makes it possible to understand that the human being is facing a world with exhaustible resources and limited needs, with a population in constant growth and with economic progress based on obsolete technologies that generate a huge energy consumption, apart from billions of tons of wastes added to the ecosystem. These factors unleash catastrophic climatic consequences that have put the “world” on alert when is understood that there is a limit of planetary support capacity and that we are approaching the collapse of the ecosystem and endangering future generations, in addition to undermining the quality of life of all living beings because they exceed the capacity for natural balance of the ecosystems that support it. The increase in poverty, the overproduction of waste, the enormous North-South differences, the desertification and climate change are some of the main factors that human beings must face with great urgency. Regarding this last factor, it should be noted that today it has become a problem of multidimensional proportions that involves governments, organizations and entire societies with the aim of reducing its catastrophic global consequences and has been categorized as one of the greatest challenges of the world in the 21st century. Damage to the environment is becoming an issue that has received greater interest and attention over the years. Therefore, it is necessary a construct that includes ecological and development perspectives, that is, Sustainable Development. Under this context, this article aims to analyse in detail this concept, its origins and evolution, as well as its dimensions, to also establish its link with climate change, both inseparable factors.

Background People living with HIV (PLWH) face structural and psychosocial factors that affect health-related quality of life (HRQoL). We aimed to evaluate how syndemic conditions affected HRQoL in PLWH. Methods A cross-sectional survey was conducted among 861 PLWH, to determine whether syndemic conditions (monthly income; sexual satisfaction; depressive symptoms; social role satisfaction; social isolation; cognitive function; nicotine dependence; perception of stigma) have an effect on HRQoL. A linear regression model and measures of Additive Interaction (AI) were used to determine the effects of syndemic conditions on HRQoL, controlling for other risk factors. Results Overall, the most frequently observed were stigma perception (56.9%), poor cognitive function (50.6%) and the perception of social isolation (51.6%). The presence of depressive symptoms was the risk factor most associated with worse Physical Health (PH) (B 3.93, 2.71–5.15) and Mental Health (MH) (B 5.08, 3.81–6.34) in linear regression model. Specifically, an interaction was observed between poor cognitive function and poor satisfaction with social role on worse PH and MH (AI 2.08, 0.14–4.02; AI 2.69, 0.15–5.22, respectively); and low income and perception of stigma (AI 2.98, 0.26–5.71), low income and perception of social isolation (AI 2.79, 0.27–5.32), and low income and poor satisfaction with social role (AI 3.45, 0.99–5.91) on MH. Conclusion These findings provide evidence that syndemic factors impact HRQoL. HIV prevention programs should screen and address co-occurring health problems to improve patient-centered health care and outcomes.

El presente artículo se centra en la trayectoria y actividad de algunos miembros de la familia Torres, de Málaga, que fueron prestigiosos hombres de la Iglesia y de la diplomacia. Desarrollaron sus trabajos y fundaciones en Italia, ya que fueron arzobispos de Salerno, de Monreale, así como cardenales con el título de san Pancrazio; templo romano que les fue asignado tras su nominación. Pero nunca se desvincularon de su ciudad de procedencia, comunicando sus éxitos a los cabildos religioso y civil de Málaga. Su emblema familiar, una torre que también se representa repetida hasta cinco, se mantiene en las obras que promovieron en Roma y otras ciudades, especialmente de Sicilia, aunque en este artículo se recogen únicamente las referentes a Málaga y Roma.

Introduction Mood disorders are frequent in Parkinson’s disease (PD) and a favorable effect of safinamide on mood has been observed. We aimed to analyze the effectiveness of safinamide on mood as a secondary objective from the SAFINONMOTOR (an open-label study of the effectiveness of SAFInamide on NON-MOTOR symptoms in patients with Parkinson’s disease) study. Methods SAFINONMOTOR is a prospective open-label single-arm study conducted in five centers from Spain. Patients with PD were required to have at baseline a Non-Motor Symptoms Scale (NMSS) total score of at least 40. In this analysis, the changes from V1 (baseline) to V4 (6 months ± 1 month) in the BDI-II (Beck Depression Inventory-II), NMSS mood/apathy domain, and PDQ-39 (Parkinson’s Disease Questionnaire-39) emotional well‐being domain were analyzed. Depression was identified and classified (DSM-IV and Judd criteria) at baseline and at the end of follow-up as major depression (MD), minor depression (mD), subthreshold depression (subD), and non-depression (nonD). Results Fifty patients with PD were included (age 68.5 ± 9.12 years; 58% women; 6.4 ± 5.1 years from diagnosis) and 44 patients (88%) completed the follow-up at 6 months. The BDI-II total score was reduced by 35.9% (from 15.88 ± 10.46 at V1 to 10.18 ± 6.76 at V4; p

Background and objective Some studies observed a benefit of PD patients after treatment with safinamide in some non-motor symptoms. Our aim was to analyze the effectiveness of safinamide on sleep and daytime sleepiness in Parkinson’s disease (PD) patients. Material and methods SAFINONMOTOR is a prospective open-label single-arm study conducted in 5 centers from Spain. In this analysis, a secondary objective of the study, the score in the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) at V1 (baseline) and V4 (6 months ± 1 month) were compared. Results Fifty patients were included between May/2019 and February/2020 (age 68.5 ± 9.12 years; 58% women; 6.4 ± 5.1 years from diagnosis). At 6 months, 44 patients completed the follow-up (88%). The PSQI total score was reduced by 19.8% (from 10.43 ± 4.02 at V1 to 8.36 ± 4.41 at V4; p = 0.001). By domains, improvement was observed in subjective sleep quality (PSQI-C1; − 23.9%; p = 0.009), sleep latency (PSQI-C2; − 25%; p = 0.025), sleep duration (PSQI-C3; − 40%; p = 0.001), and habitual sleep efficiency (PSQI-C4; − 25.9%; p = 0.023). A significant reduction (− 24.7%) in the ESS total score from V1 to V4 was observed as well (from 9.20 ± 5.64 to 6.93 ± 5.11; p = 0.012). Specifically, the improvement in daytime sleepiness was observed in sitting and reading (p = 0.024) and sitting inactive in a public space (p = 0.027). A total of 21 adverse events in 11 patients (22%) were reported, 5 of which were severe (not related to safinamide). Conclusion Safinamide was well-tolerated and improved sleep and daytime sleepiness in PD patients at 6 months. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-021-05607-2.

Resumen Los sindromes pluriglandulares autoinmunes (SPA) afectan a multiples glandulas endocrinas y asocian otras enfermedades autoinmunes. El SPA tipo 1 se presenta con hipoparatiroidismo, candidiasis mucocutanea y enfermedad de Addison, se debe a una mutacion en el gen AutoImmune Regulator (AIRE). El diagnostico es clinico ademas de la secuenciacion del gen AIRE. El SPA tipo 2 se presenta con enfermedad de Addison, diabetes mellitus tipo1 o enfermedad tiroidea autoinmune, se han implicado multiples genes, entre ellos los del complejo mayor de histocompatibilidad tipo 2. El SPA tipo 3 se caracteriza por la presencia de enfermedad tiroidea autoinmune y otra enfermedad autoinmune, excluyendo la enfermedad de Addison y el hipoparatiroidismo, se han implicado cuatro genes que pueden conferir susceptibilidad. El diagnostico del SPA tipo 2 y tipo 3 es clinico, aunque la determinacion de autoanticuerpos puede ser util para la evaluacion del riesgo de presentar la enfermedad y para confirmar la enfermedad autoinmune en algunos casos.

The aim of this study was to conduct a meta-analysis of prospective studies assessing the relationship between bundle branch block (BBB) or wide QRS and risk of all-cause mortality in patients with acute heart failure (AHF).We searched the PubMed, Scopus and Web of Science database from inception to February 2022 to identify single centre or multicentre studies including a minimum of 400 patients and assessing the association between BBB or wide QRS and mortality in patients with AHF. Study-specific hazard ratio (HR) estimates were combined using a random-effects meta-analysis. Two meta-analyses were performed: (1) grouping by conduction disturbance and follow-up length and, (2) using the results from the longest follow-up for each study and grouping by the type of BBB. The meta-analysis included 21 publications with a total of 116,928 patients. Wide QRS (considering right (RBBB) and left (LBBB) altogether) was associated with a significant increment in the risk of all-cause mortality (pooled adjusted HR 1.112, 95% CI 1.065-1.160). The increased risk of death was also present when LBBB (HR 1.121, 95% CI 1.042-1.207) and RBBB (HR 1.187, 95% CI 1.045-1.348) were considered individually. There was no difference in risk between LBBB and RBBB (P for interaction = 0.533). Other outcomes including sudden death, rehospitalization and a combination of cardiovascular death or rehospitalization were also increased in patients with BBB or wide QRS.This meta-analysis suggests a modest increase in the risk of all-cause mortality among patients with AHF and BBB or wide QRS, irrespective of the type of BBB.

espanolFundamento. Describir el numero de consultas, total y por COVID-19, atendidas en servicios de urgencias hospitalarios (SUH) espanoles durante marzo y abril de 2020, compararlo con el mismo periodo del ano anterior, cuantificar el cambio de actividad asistencial e investigar la posible influencia del tamano del hospital y de la seroprevalencia provincial de COVID-19. Metodos. Estudio transversal. Se envio una encuesta a todos los responsables de SUH espanoles del sistema publico de salud sobre el numero de consultas atendidas durante marzo y abril de 2019 y de 2020. Se calculo el cambio de actividad asistencial por comunidad autonoma, y se comparo en funcion del tamano del hospital y del impacto provincial de la pandemia. Resultados. Participaron el 66 % de los 283 SUH. Se observo un descenso del 49,2 % de las consultas totales (solo los SUH de Castilla-La Mancha mostraron un descenso inferior al 30 %) y del 60 % de las consultas no-COVID-19 (solo los SUH de Asturias y Extremadura mostraron un descenso inferior al 50 %). el cambio de actividad asistencial no difirio en funcion del tamano del hospital, pero si en relacion al impacto provincial de la pandemia, con una correlacion directa respecto al descenso de actividad no-COVID-19 (a mayor impacto, mayor descenso; R2 = 0,05; p = 0,002) e inversa en relacion a la actividad global (a mayor impacto, menor descenso; R2 = 0,05; p = 0,002). Conclusiones. Durante la primera ola pandemica descendio el numero de consultas en los SUH, si bien dicho descenso no se explica unicamente por la incidencia local de la pandemia. EnglishBackground. To describe the number of visits (total and per COVID-19) attended by the Spanish hospital emergency departments (EDs) during March and April 2020 compared to the same period in 2019, and to calculate the quantitative changes in healthcare activity and investigate the possible influence of hospital size and regional COVID-19 seroprevalence. Method. Cross-sectional study that analyzes the number of visits to Spanish public EDs, reported through a survey of ED chiefs during the study periods. Changes in healthcare activity were described in each autonomous community and compared according to hospital size and the regional impact of the pandemic. Results. The 66% of the 283 Spanish EDs participated in the study. The total number of patients attended decreased to 49.2 % ( Conclusion. There was a very significant decrease in the number of ED visits during the first pandemic wave, although this decrease cannot be explained solely by the local incidence of the pandemic.

How life arose on the primitive Earth is one of the biggest questions in science. Biomolecular emergence scenarios have proliferated in the literature but accounting for the ubiquity of oxidized (+ 5) phosphate (PO43−) in extant biochemistries has been challenging due to the dearth of phosphate and molecular oxygen on the primordial Earth. A compelling body of work suggests that exogenous schreibersite ((Fe,Ni)3P) was delivered to Earth via meteorite impacts during the Heavy Bombardment (ca. 4.1–3.8 Gya) and there converted to reduced P oxyanions (e.g., phosphite (HPO32−) and hypophosphite (H2PO2−)) and phosphonates. Inspired by this idea, we review the relevant literature to deduce a plausible reduced phospholipid analog of modern phosphatidylcholines that could have emerged in a primordial hydrothermal setting. A shallow alkaline lacustrine basin underlain by active hydrothermal fissures and meteoritic schreibersite-, clay-, and metal-enriched sediments is envisioned. The water column is laden with known and putative primordial hydrothermal reagents. Small system dimensions and thermal- and UV-driven evaporation further concentrate chemical precursors. We hypothesize that a reduced phospholipid arises from Fischer–Tropsch-type (FTT) production of a C8 alkanoic acid, which condenses with an organophosphinate (derived from schreibersite corrosion to hypophosphite with subsequent methylation/oxidation), to yield a reduced protophospholipid. This then condenses with an α-amino nitrile (derived from Strecker-type reactions) to form the polar head. Preliminary modeling results indicate that reduced phospholipids do not aggregate rapidly; however, single layer micelles are stable up to aggregates with approximately 100 molecules.

Aims To directly compare the diagnostic accuracy of high-sensitivity cardiac troponin (hs-cTn) T vs. hs-cTnI in the early non-invasive differentiation of Type 1 myocardial infarction (T1MI) due to plaque rupture and atherothrombosis from Type 2 myocardial infarction (T2MI) due to supply–demand mismatch. Methods and results In a prospective multicentre diagnostic study, two independent cardiologists centrally adjudicated the final diagnosis of T1MI vs. T2MI according to the fourth universal definition of myocardial infarction (MI), using all available clinical information including cardiac imaging in patients presenting with acute chest pain. Diagnostic accuracy was quantified by the area under the receiver operating characteristics curve (AUC). The most extensively validated hs-cTnT-Elecsys and hs-cTnI-Architect assays were measured at presentation, 1 h, and 2 h. Among 5887 patients, 1106 (19%) had a final diagnosis of MI, including 860 (78%) T1MI and 246 (22%) T2MI. The AUC of hs-cTnT-Elecsys to differentiate T1MI from T2MI was moderate and comparable to that provided by hs-cTnI-Architect: hs-cTnT-Elecsys AUC-presentation 0.67 [95% confidence interval (CI) 0.64–0.71], AUC-1 h 0.70 (95% CI 0.66–0.74), and AUC-2 h 0.71 (95% CI 0.66–0.75) vs. hs-cTnI-Architect AUC-presentation 0.71 (95% CI 0.67–0.74), AUC-1 h 0.72 (95% CI 0.68–0.76), and AUC-2 h 0.74 (95% CI 0.69–0.78), all P = not significant (NS). Similarly, the AUC of absolute changes was moderate and comparable for hs-cTnT-Elecsys and hs-cTnI-Architect (all P = NS). Cut-off concentrations achieving at least 90% specificity for the differentiation of T1MI vs. T2MI were >114 ng/L for hs-cTnT-Elecsys [odds ratio (OR) 4.2, 95% CI 2.7–6.6] and >371 ng/L for hs-cTnI-Architect (OR 4.0, 95% CI 2.6–6.2). Conclusion hs-cTnT-Elecsys and hs-cTnI-Architect provided comparable, albeit only moderate, diagnostic accuracy for the early differentiation of T1MI vs. T2MI. Clinical trial registration ClinicalTrials.gov number, NCT00470587, https://clinicaltrials.gov/ct2/show/NCT00470587.

In several mammalian species, acute endometritis driven by the recruitment of polymorphonuclear cells (PMN) occurs in response to semen. These PMNs release DNA to form neutrophil extracellular traps (NETs) in cattle, horse and human, leading to sperm entrapment. While there is no evidence of this phenomenon occurring in donkeys, artificial insemination (AI) with frozen-thawed semen, which results in very poor pregnancy rates, leads to a large PMN recruitment to the uterus.