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RESUMEN: El presente trabajo tiene por objetivo el estudio y contextualización de dos obras claves de la arquitectura gótica barcelonesa, como son la Catedral de la Santa Cruz y Santa Eulalia (1298-1420) y la Basílica de Santa María del Mar (1329-1383), localizadas en el corazón de la ciudad condal. Para ello, es necesario partir del análisis de las diferentes interpretaciones de la arquitectura gótica, comenzando en el siglo XIX, así como un repaso por las sucesivas innovaciones estructurales, técnicas y formales, que fueron aportando los edificios góticos franceses y castellanos, para así valorar en su contexto lo acontecido en Barcelona. ABSTRACT: The objective of this work is to study and contextualize two significant works of Barcelona's Gothic architecture, specifically the Cathedral of Santa Cruz and Santa Eulalia (1298-1420) and the Basilica of Santa María del Mar (1329-1383), located in the centre of the city of Barcelona. For this, it is necessary to start from the studies of the different interpretations of Gothic architecture, beginning in the 19th century, as well as a review of the successive structural, technical and formal innovations, which were contributed by the French and Castilian Gothic buildings, for be able to assess in its context what happened in Barcelona. Grado en Historia

BACKGROUND: Pregnant women with type 1 diabetes are a high-risk population who are recommended to strive for optimal glucose control, but neonatal outcomes attributed to maternal hyperglycaemia remain suboptimal. Our aim was to examine the effectiveness of continuous glucose monitoring (CGM) on maternal glucose control and obstetric and neonatal health outcomes. METHODS: In this multicentre, open-label, randomised controlled trial, we recruited women aged 18-40 years with type 1 diabetes for a minimum of 12 months who were receiving intensive insulin therapy. Participants were pregnant (≤13 weeks and 6 days' gestation) or planning pregnancy from 31 hospitals in Canada, England, Scotland, Spain, Italy, Ireland, and the USA. We ran two trials in parallel for pregnant participants and for participants planning pregnancy. In both trials, participants were randomly assigned to either CGM in addition to capillary glucose monitoring or capillary glucose monitoring alone. Randomisation was stratified by insulin delivery (pump or injections) and baseline glycated haemoglobin (HbA1c). The primary outcome was change in HbA1c from randomisation to 34 weeks' gestation in pregnant women and to 24 weeks or conception in women planning pregnancy, and was assessed in all randomised participants with baseline assessments. Secondary outcomes included obstetric and neonatal health outcomes, assessed with all available data without imputation. This trial is registered with ClinicalTrials.gov, number NCT01788527. FINDINGS: Between March 25, 2013, and March 22, 2016, we randomly assigned 325 women (215 pregnant, 110 planning pregnancy) to capillary glucose monitoring with CGM (108 pregnant and 53 planning pregnancy) or without (107 pregnant and 57 planning pregnancy). We found a small difference in HbA1c in pregnant women using CGM (mean difference -0·19%; 95% CI -0·34 to -0·03; p=0·0207). Pregnant CGM users spent more time in target (68% vs 61%; p=0·0034) and less time hyperglycaemic (27% vs 32%; p=0·0279) than did pregnant control participants, with comparable severe hypoglycaemia episodes (18 CGM and 21 control) and time spent hypoglycaemic (3% vs 4%; p=0·10). Neonatal health outcomes were significantly improved, with lower incidence of large for gestational age (odds ratio 0·51, 95% CI 0·28 to 0·90; p=0·0210), fewer neonatal intensive care admissions lasting more than 24 h (0·48; 0·26 to 0·86; p=0·0157), fewer incidences of neonatal hypoglycaemia (0·45; 0·22 to 0·89; p=0·0250), and 1-day shorter length of hospital stay (p=0·0091). We found no apparent benefit of CGM in women planning pregnancy. Adverse events occurred in 51 (48%) of CGM participants and 43 (40%) of control participants in the pregnancy trial, and in 12 (27%) of CGM participants and 21 (37%) of control participants in the planning pregnancy trial. Serious adverse events occurred in 13 (6%) participants in the pregnancy trial (eight [7%] CGM, five [5%] control) and in three (3%) participants in the planning pregnancy trial (two [4%] CGM and one [2%] control). The most common adverse events were skin reactions occurring in 49 (48%) of 103 CGM participants and eight (8%) of 104 control participants during pregnancy and in 23 (44%) of 52 CGM participants and five (9%) of 57 control participants in the planning pregnancy trial. The most common serious adverse events were gastrointestinal (nausea and vomiting in four participants during pregnancy and three participants planning pregnancy). INTERPRETATION: Use of CGM during pregnancy in patients with type 1 diabetes is associated with improved neonatal outcomes, which are likely to be attributed to reduced exposure to maternal hyperglycaemia. CGM should be offered to all pregnant women with type 1 diabetes using intensive insulin therapy. This study is the first to indicate potential for improvements in non-glycaemic health outcomes from CGM use. FUNDING: Juvenile Diabetes Research Foundation, Canadian Clinical Trials Network, and National Institute for Health Research.

Cholesterol mediates its proliferative and metastatic effects via the metabolite 27-hydroxycholesterol (27-HC), at least in breast and endometrial cancer. We determined the serum lipoprotein profile, intratumoral cholesterol and 27-HC levels in a cohort of patients with well-differentiated papillary thyroid carcinoma (PTC; low/intermediate and high risk), advanced thyroid cancers (poorly differentiated, PDTC and anaplastic thyroid carcinoma, ATC) and benign thyroid tumors, as well as the expression of genes involved in cholesterol metabolism. We investigated the gene expression profile, cellular proliferation, and migration in Nthy-ori 3.1 and CAL-62 cell lines loaded with human low-density lipoprotein (LDL). Patients with more aggressive tumors (high-risk PTC and PDTC/ATC) showed a decrease in blood LDL cholesterol and apolipoprotein B. These changes were associated with an increase in the expression of the thyroid’s LDL receptor, whereas 3-hydroxy-3-methylglutaryl-CoA reductase and 25-hydroxycholesterol 7-alpha-hydroxylase were downregulated, with an intratumoral increase of the 27-HC metabolite. Furthermore, LDL promoted proliferation in both the Nthy-ori 3.1 and CAL-62 thyroid cellular models, but only in ATC cells was its cellular migration increased significantly. We conclude that cholesterol and intratumoral accumulation of 27-HC promote the aggressive behavior process of PTC. Targeting cholesterol metabolism could be a new therapeutic strategy in thyroid tumors with poor prognosis.

Antecedentes: La diabetes gestacional se produce cuando la función pancreática de la embarazada no es suficiente para superar la resistencia a la insulina producida por los cambios en las hormonas diabetógenas de la placenta. Es un importante factor de riesgo de complicaciones materno fetales y del neonato, y aumenta el riesgo de diabetes tipo 2 en la mujer y su descendencia, por lo que la gestante requiere de un control glucémico estricto. La nutrición es la primera línea de tratamiento. Las pacientes se enfrentan a una pendiente de aprendizaje muy empinada, ya que desde el diagnóstico (semana 24 a 28) hasta la finalización del embarazo (semana 40) tienen que aprender lo relativo a la autogestión de su enfermedad. Desde los años 1980 se están llevando a cabo iniciativas de telemedicina en diabetes, pero aún hay pocos estudios en diabetes gestacional. Revisiones sistemáticas y meta-análisis recientes concluyen que existen limitaciones en término de número, tamaño y alcance de los estudios, pero que no comprometen la calidad de la atención. Objetivo general: Evaluar si el uso de una app de educación diabetológica y monitorización de variables que complemente el tratamiento convencional, en mujeres con diabetes gestacional, produce mejores resultados de control metabólico y bienestar materno-fetal y promueve la adquisición de hábitos saludables en comparación con las pacientes seguidas por el protocolo estándar. Metodología: Ensayo clínico controlado aleatorizado, abierto, con dos grupos paralelos, que se llevará a cabo en un hospital de tercer nivel. En ambos grupos se compararán las variables antropométricas, clínicas y analíticas que conforman el bienestar materno-fetal, desde el momento del diagnóstico hasta tres mes postparto. La app pondrá énfasis en el tratamiento dietético, la educación nutricional, el fomento del ejercicio físico y de otros hábitos de vida saludables, la educación acerca de la diabetes gestacional y la monitorización de variables clínicas. Background: Gestational diabetes occurs when the pancreatic function of the pregnant woman is not sufficient to overcome the insulin resistance produced by changes in the diabetogenic hormones of the placenta. It is an important risk factor for maternal and fetal complications, and it increases the risk of type 2 diabetes in women and their offspring; therefore, the pregnant woman requires a strict glycemic control. Nutrition is the first line of treatment. Patients face a very steep learning slope, since from the diagnosis (week 24 to 28) until the end of pregnancy (week 40) they have to learn everything about self-management of their disease. Since the 1980s, telemedicine initiatives in diabetes have been carried out, but there are still few studies on gestational diabetes. Systematic reviews and recent metaanalysis conclude that there are limitations in terms of number, size and scope of studies, but that they do not compromise the quality of care. Aim: To evaluate if the use of a an app with education content and monitoring of clinical variables that complements conventional treatment in women with gestational diabetes, produces better results of metabolic control and maternal-fetal wellbeing and promotes the acquisition of healthy habits, compared to patients followed by the standard protocol. Methods: Open randomized controlled clinical trial with two parallel groups, to be carried out in a tertiary hospital. In both groups, anthropometric, clinical and analytical variables regarding maternal-fetal wellbeing will be compared, from the moment of diagnosis to three months postpartum. The app will emphasize dietary treatment, nutritional education, the promotion of physical exercise and other healthy lifestyles, education about gestational diabetes and monitoring of clinical variables.

To assess the association between maternal diabetes characteristics and sex ratio at birth (SRB) in women with type 1 diabetes mellitus. We performed a case–control study. The study subjects were infants born alive to women with type 1 diabetes and singleton pregnancies. Cases and controls were defined as male and female newborns, respectively. SRB was analysed according to diabetes-related characteristics adjusting in a logistic regression analysis for maternal characteristics known to affect SRB in the general population. The observed SRB (238 males/468 live births = 0.509) did not differ from the expected. In the logistic regression analysis, SRB was significantly associated with three diabetes characteristics: (1) diabetes duration, with odds ratios (ORs) for a live male newborn = 1.22 (95 % confidence interval (CI), 0.66–2.24 for ≤5 years, OR 2.79 (95 % CI 1.36–5.74) for >20 years; (2) mean first-trimester glycated haemoglobin, with OR 1.98 (95 % CI 1.09–3.62) for ≤6.7 % (50 mmol/mol) and OR 2.61 (95 % CI 1.16–5.85) for >8.2 % (66 mmol/mol) and (3) mean first-trimester insulin dose, with OR 0.70 (95 % CI 0.36–1.38) for ≤0.5 IU/kg/day and OR 0.18 (95 % CI 0.05–0.59) for >1.0 IU/kg/day. We conclude that SRB in this cohort is independently associated with three diabetes characteristics. These associations are to be confirmed.

Food composition tables and databases (FCTs or FCDBs) provide the necessary information to estimate intake of nutrients and other food components. In Spain, the lack of a reference database has resulted in use of different FCTs/FCDBs in nutritional surveys and research studies, as well as for development of dietetic for diet analysis. As a result, biased, non-comparable results are obtained, and healthcare professionals are rarely aware of these limitations. AECOSAN and the BEDCA association developed a FCDB following European standards, the Spanish Food Composition Database Network (RedBEDCA).The current database has a limited number of foods and food components and barely contains processed foods, which limits its use in epidemiological studies and in the daily practice of healthcare professionals.

An ongoing clinical trial is testing the efficacy of web telematic support in a structured program for obesity treatment and diabetes prevention. Participants were recruited from two tertiary-care hospitals and randomized to receive either a telematic intervention (TI) supported by PREDIRCAM2 web platform or a non-telematic intervention (NTI). All receive 1-year follow-up. Both interventions consist of tailored dietary and exercise prescriptions, based on a Mediterranean dietary pattern and general WHO exercise recommendations for adults. At 6 months, both groups have received 7 contacts, 3 exclusively telematic for the TI group. This is a preliminary result intention-to-treat analysis. One hundred eighty-three participants were recruited, with a mean body mass index of 34.75 +/- 2.75kg/m(2). General dropout rate at 6 months was 26.8%. Weight changes were statistically significant at months 3 and 6 compared to baseline, -2.915 +/- 0.24kg, -3.29 +/- 0.36kg, respectively (P

Metabolic syndrome and hypovitaminosis D are 2 diseases with high prevalence that share several risk factors, while epidemiological evidence shows they are associated. Although the mechanisms involved in this association are not well established, hypovitaminosis D is associated with insulin resistance, decreased insulin secretion and activation of the renin-angiotensin system, mechanisms involved in the pathophysiology of metabolic syndrome. However, the apparent ineffectiveness of vitamin D supplementation on metabolic syndrome components, as well as the limited information about the effect of improving metabolic syndrome components on vitamin D concentrations, does not clarify the direction and the mechanisms involved in the causal relationship between these 2 pathologies. Overall, because of the high prevalence and the epidemiological association between both diseases, hypovitaminosis D could be considered a component of the metabolic syndrome.

463 Race and eugenics in inter-war Romania Social Darwinism is a term introduced for various late-nineteenth century ideologies which exploited ideas of “survival of the fi ttest”. It is also associated with ideas of struggle between national or racial groups. The theory was chiefl y exploited by Herbert Spencer who adapted Darwinian ideas to his own ethical theories. He argued that it was natural, normal and proper, for the strong to thrive at the expense of the weak. The fi rst use of Social Darwinism was in Joseph Fisher’s 1877 article on “The history of landholding in Ireland”, published in the Transactions of the Royal Historical Society. Some extreme Social Darwinists claim that it is morally incorrect to assist those weaker than one self, since that would be promoting the survival and possible reproduction of someone who is fundamentally unfi t. Many negative reactions to Darwinism come from the confusion of Darwinism as a scientifi c theory, describing a range of concepts of evolutionism or development, with Social Darwinism as an ethical theory. In reality, the two have very little in common. Main notable fi gures of Social Darwinism, in addition to Spencer, have been Thomas Malthus and Francis Galton, the founder of eugenics. The word eugenics was coined in 1883 by the English scientist Francis Galton, a cousin of Charles Darwin, to promote the ideal of perfecting the human race by encouraging the procreation of the social Darwinian fi t and discouraging that of the unfi t. In Galton’s own words, “perfecting the human race by getting rid of its ‘undesirables’ while multiplying its ‘desirables’”. As a social movement, eugenics was widely popular in the early decades of the 20 century. By the end of World War II, eugenics had been largely abandoned. Eugenics was practiced around the world and promoted by governments, infl uential institutions and individuals. Eugenics was supported by Alexander Graham Bell, Margaret Sanger, H.G. Wells, Woodrow Wilson, Theodore Roosevelt, Emile Zola, George Bernard Shaw, Winston Churchill, John Maynard Keynes, John Harvey Kellogg, and Linus Pauling, among many others. Eugenics became an academic discipline at universities. Three International Eugenics Conferences were held in 1912 (London), 1921 and 1932 (New York). G.K. Chesterton was an early critic of eugenics in his book “Eugenics and Other Evils”. The scientifi c reputation of eugenics declined in the 1930s when Ernst Historical Perspective