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La pintura mural romana constituye un material de gran interés desde el punto de vista arqueológico por la gran cantidad de información que aporta al estudio del mundo romano, tanto desde un punto de vista cronológico como arquitectónico, funcional-espacial, económico, social o político. No obstante, dada la fragilidad del material empleado para su ejecución, así como su común hallazgo fragmentario, su estudio requiere de una importante formación más allá de su análisis técnico-descriptivo o compositivo, que incluye el propio proceso de extracción, almacenaje, análisis, conservación y restauración. En este sentido, las escuelas europeas, especialmente la italiana y la francesa, conscientes de estas necesidades, han desarrollado a lo largo de los años cursos de especialización, integrados dentro de centros de estudio creados ex profeso para este ámbito de la investigación, destinados a dotar de las herramientas y conocimientos necesarios a los nuevos investigadores. En España, a pesar de la existencia de algunas tentativas previas como la Escuela Taller de Restauración de Aragón, cuya actividad comenzó en 2004 y cesó en 2011, la falta de centros y cursos a este respecto limita las posibilidades de formación de nuevos especialistas para el estudio de pintura mural romana en España. Ante esta situación, este trabajo pretende sentar las bases para la creación de un taller de estas características que, partiendo de la base establecida por los investigadores franceses e italianos, permita preparar a los investigadores del futuro.

Aims: There are controversial data on the ability of the components of mineral metabolism (vitamin D, phosphate, parathormone [PTH], fibroblast growth factor-23 [FGF23], and klotho) to predict cardiovascular events. In addition, it is unknown whether they add any prognostic value to other well-known biomarkers. Methods and results: In 969 stable coronary patients, we determined plasma levels of all the aforementioned components of mineral metabolism with a complete set of clinical and biochemical variables, including N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin I (hs-TnI), and high-sensitivity C-reactive protein. Secondary outcomes were ischaemic events (any acute coronary syndrome, stroke, or transient ischaemic attack) and heart failure or death. The primary outcome was a composite of the secondary outcomes. Median follow-up was 5.39 years. Age was 60 (52–72) years. Median glomerular filtration rate was 80.4 (65.3–93.1) mL/min/1.73 m2. One-hundred and eighty-five patients developed the primary outcome. FGF23, PTH, hs-TnI, and NT-proBNP were directly related with the primary outcome on univariate Cox analysis, while Klotho and calcidiol were inversely related. On multivariate analysis, only PTH (HR 1.058 [CI 1.021–1.097]; P = 0.002) and NT-proBNP (HR 1.020 [CI 1.012–1.028]; P 85.5 RU/mL) (P, This work was supported by grants from Instituto de Salud Carlos III (ISCIII) and Fondos FEDER (Fondo Europeo de Desarrollo Regional) European Union (PI05/0451, PI14/1567, PI17/01615, and PI17/01495); Spanish Society of Cardiology; Spanish Society of Arteriosclerosis; RECAVA (Red Temática de Investigación Cooperativa en Enfermedades Cardiovasculares) (RD06/0014/0035); and Instituto de Salud Carlos III FEDER (FJD biobank: RD09/0076/00101). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Los residuos plasticos derivados de la industria del "packaging" representan actualmente un importante problema de caracter medioambiental. Por ello, es necesario que disenadores e ingenieros de producto tomen conciencia de este hecho y busquen la incorporacion del vector medioambiental a la hora de disenar, redisenar y desarrollar envases y embalajes para que sean mas sostenibles y eco-eficaces. Partiendo de esta premisa, en este trabajo se han planteado los siguientes objetivos: (1) estudio e identificacion de posibles estrategias de Ecodiseno aplicables a un envase agricola existente (modelo utilizado en la recoleccion y distribucion de productos hortofruticolas); (2) planteamiento de una propuesta de rediseno de dicho envase (caso de estudio), aplicando la informacion y conocimientos obtenidos previamente; (3) analisis comparativo entre el envase existente (comercial) y la propuesta de rediseno desarrollada. Para dar respuesta a este planteamiento se ha integrado en un mismo flujo de trabajo estrategias de Ecodiseno y herramientas CAD/CAE (SolidWorks 3D CADTM software). Los resultados obtenidos del caso de estudio desarrollado en este trabajo apuntan a que la aplicacion de herramientas CAD/CAE apoyadas en las estrategias de Ecodiseno propuestas pueden ser un instrumento muy util y efectivo en el diseno y desarrollo de este tipo de envases para su aplicacion practica en la industria agroalimentaria y del packaging, lo cual puede facilitar a corto-medio plazo la transicion hacia un modelo de economia circular, basado en el concepto “Cradle to Cradle”.

IntroductionChange in lifestyle and diets is a part of the bariatric surgery process. Preoperative weight loss is still considered obligatory in some programs, but its benefits remain controversial. This study aimed to evaluate the influence of the preoperative weight loss on the postoperative results, in terms of long-term weight loss and perioperative morbidity.Methods.A retrospective review from the prospective collected database was performed. Patients operated for Roux-n-Y Gastric bypass (RYGB) or Sleeve Gastrectomy (SG) as a primary procedure with at least 5 years of follow-up were analysed. Two group of patients were defined depending on if any preoperative weight loss was achieved or not. Patients with 5% or more weight loss were independently evaluated too. Weight loss up to 5 years, nadir weight loss and early postoperative morbidity were analysed.Results.419 Patients were included (225 RYGB and 194 SG), 324 (77.3%) were women, with a mean age of 45.85 years (ranging 15 to 69). 178 patients (42.5%) achieved any weight loss prior to surgery, and just 26 (13.4%) more than 5%. Preoperative weight loss did not correlate with less morbidity, leak o reoperation rate after SG. In the RYGB preoperative weight loss patients showed a trend to higher morbidity.In terms of weight loss, preoperative weight loss patients did not achieve better nadir BMI (27.99kg/m2 vs 28.55kg/m2, p=0.213) nor final BMI (31.56kg/m2 vs 32.04kg/m2, p=0.412). Those results were repeated when RYGB and SG patients were analysed independently. Univariate and multivariate analyses did not find that PWL had any relationship to nadir BMI, final BMI nor postoperative morbidity, leak or reoperation risk.Conclusions.Preoperative weight loss did not correlate to better postoperative results nor to better weight loss results in our series.

El objetivo principal del estudio esconocer los niveles de ansiedad cognitiva, autoconfi anza y ansiedad somática previa y posterior al partido y el impacto en el rendimiento deportivo (victoria-derrota) en ambos sexos. Participaron 95 futbolistas (26 mujeres y 69 varones) pertenecientes a las categorías cadete, juvenil y senior de clubes Vitoria Gasteiz. Se utilizó el Inventario de Ansiedad Competitiva en el Deporte (CSAI-2). (19), formado por 27 ítems, adaptado y validado al español. Los resultados refl ejan una mayor autoconfi anza por parte de los hombres en el momento previo a competir respecto a las mujeres, las cuales, muestran elevados valores de ansiedad somática. La lectura correcta de los estados de ansiedad de los deportistas puede ayudar a entrenadores y preparadores físicos a modular el tono y el contenido de las charlas motivacionales y las consignas técnico-tácticas de manera que exista un mayor aprovechamiento. The main objective of the study is to know the levels of cognitive anxiety, self-confi dence and somatic anxiety before and after the match and the impact on sports performance (victory-loss) in both sexes. 95 footballers participated (26 women and 69 men) belonging to the cadet, youth and senior categories of Vitoria Gasteiz clubs. The Sports Competitive Anxiety Inventory (CSAI-2) was used. (19), made up of 27 items, adapted and validated into Spanish. The results refl ect a greater self-confi dence on the part of men in the moment prior to competing compared to women, who show high values of somatic anxiety. The correct reading of athletes’ states of anxiety can help coaches and physical trainers to modulate the tone and content of motivational talks and technical-tactical instructions so that there is greater use.

Artículo incluído en la sección: Investigación en educación científica [Resumen] Este trabajo tiene como finalidad evaluar una propuesta de enseñanza sobre seres vivos destinada a contribuir al desarrollo de la competencia científica. Participaron 49 estudiantes de 4º de Primaria y como instrumento de recogida de datos se elaboró una propuesta que incluye diferentes actividades dirigidas al estudio de animales invertebrados (caracoles y lombrices) donde el alumnado debe realizar observaciones centradas en la morfología externa del animal y su movimiento, así como responder a cuestiones más abstractas relacionadas con la función de relación. Además, incluye cuestiones de reflexión sobre la propia actividad y la satisfacción que suponen esas tareas. La mayoría de los estudiantes mostraron habilidades para observar y describir las características de los animales, fueron capaces de identificar los elementos que intervienen en la función de relación y desarrollaron emociones positivas hacia los mismos (satisfacción, felicidad…), mientras que pocos mostraron miedo o asco. [Abstract] The aim of this article is to assess the results of a teaching proposal using live animals for the development of scientific competence among 4th-class primary school pupils. The sample for the study consisted of 49 pupils, and data were collected through a series of innovative learning activities about invertebrate animals (snails and earthworms), in which students were required to make observations about the external morphology of the animals and their movement, and answer more abstract questions related to relationship function. The pupils were also asked to reflect on the activity itself and their satisfaction with the tasks. The majority of pupils were found to possess the necessary skills to identify and describe the characteristics of the animals used in the classroom. Most also developed positive emotions towards the animals (satisfaction, happiness, etc.), while few showed negative emotions such as fear or disgust. Este trabajo fue financiado por el Proyecto de Investigación EDU2016-79563-R (FEDER/Ministerio de Economía Industria y Competitividad y AGI)

BACKGROUND: Autoimmune thyroid diseases are the most common types of autoimmune diseases, but their physiopathology is still relatively unexplored. Genotype-tissue expression (GTEx) is a publicly available repository containing RNAseq data, including profiles from thyroid. Approximately 14.8% of these glands were affected by focal lymphocytic thyroiditis and 6.3% were annotated as Hashimoto. We interrogated these data to improve the characterization of infiltrating cells and to identify new molecular pathways active in autoimmune thyroiditis. MATERIALS AND METHODS: Histological GTEx images of 336 thyroid samples were classified into three categories, that is, non-infiltrated thyroid, small focal infiltrated thyroid, and extensive lymphoid infiltrated thyroid. Differentially expressed genes among these categories were identified and subjected to in silico pathway enrichment analysis accordingly. CIBERSORTx deconvolution was used to characterize infiltrating cells. RESULTS: As expected, most of the transcriptional changes were dependent on tissue infiltration. Upregulated genes in tissues include—in addition to lineage-specific B and T cell genes—a broad representation of inhibitory immune checkpoint receptors expressed by B and T lymphocytes. CIBERSORTx analysis identified 22 types of infiltrating cells showed that T cells predominate 3:1 over B cells in glands with small infiltrates, only by 1.7:1 in those with large infiltrates. Follicular helper and memory CD4 T cells were significantly more abundant in glands with large infiltrates (p

Background and importance Deep brain stimulation of the posteromedial hypothalamus (PMH DBS) appears to be an effective treatment for drug-resistant aggressiveness. Weaver syndrome (WS) is a rare genetic disorder in which patients develop some degree of intellectual disability and rarely severe behavioral alterations that may benefit from this procedure. Clinical presentation We present the case of a 26-yr-old man diagnosed with WS presenting with uncontrollable self and heteroaggressiveness and disruptive behavior refractory to pharmacological treatment and under severe physical and mechanical restraining measures. The patient was successfully treated with bilateral PMH DBS resulting in affective improvement, greater tolerance for signs of affection, regularization in his sleep pattern and appetite disturbances at 12-mo follow-up. A detailed description and video of the procedure are presented, and a review of the clinical characteristics of WS and the utility and benefits of PMH DBS for refractory aggressiveness are reviewed. Conclusion To our knowledge, this is the first case of refractory aggressiveness described in WS as well as the first patient with WS successfully treated with PMH DBS.

With national data from tourists who reside in Spain, this article researches antecedents of tourist autonomy in trip planning, including both tourists’ characteristics and details of their trips. The results indicate positive relationships of tourists’ educational background and their travel experience with autonomy but negative relationships of trip length with autonomy. These data from Spain also highlight the role of the last global economic crisis, revealing its moderating influence on the relationships among several of the antecedent factors and autonomy. These results in turn have relevant managerial implications for tourism operators.

Background Several studies suggest that statins, besides reducing cardiovascular disease, have anti-inflammatory properties which might provide a benefit in downregulating the immune response after a respiratory viral infection (RVI) and, hence, decreasing subsequent complications. We aim to analyse the effect of statins on mortality after RVI. Methods A single-centre, observational and retrospective study was carried out including all adult patients with a RVI confirmed by PCR tests from October 2, 2017 to May 20, 2018. Patients were divided between statin users and non-statin users and followed-up for 1 year, and all causes of death were recorded. In order to analyse the effect of statin treatment on mortality after RVI we planned two different approaches, a multivariate Cox regression model with the overall population and a univariate Cox model with a propensity-score matched population. Results We included 448 patients, 154 (34.4%) of whom were under statin treatment. Statin users had a worse clinical profile (older population with more comorbidities). During the 1-year follow-up, 67 patients died, 17 (11.0%) in the statin group and 50 (17.1%) in the non-statin group. Multivariate Cox analysis showed that statins were associated with mortality benefit (HR 0.47, 95% CI 0.26–0.83; p=0.01). In a matched population (101 statins users and 101 non-statins users) statins also remained associated with mortality benefit (HR 0.32, 95% CI 0.14–0.72; p=0.006). Differences were mainly driven by non-cardiovascular mortality (HR 0.31, 95% CI 0.13–0.73; p=0.004). Conclusions Chronic statin treatment was associated with reduced 1-year mortality in patients with laboratory-confirmed RVI. Further studies are needed to determine the exact role of statin therapy after RVI., Statin treatment is associated with reduced 1-year mortality after respiratory viral infections, despite the higher risk profile of patients on statins. Statins seem a good candidate to be tested during the current global pandemic. https://bit.ly/36t0tDh

SummarySince the inception of single-cell level measuring techniques, identification of distinct cell stages, phenotypes and populations has been a challenge. Cell clustering and dimensionality reduction methods are the most popular approaches to identify heterogeneity of single-cell data. But, as public repositories continue to grow in number, integrative analyses and merging of large pools of samples from different and heterogeneous datasets becomes a difficult challenge, which showcases the impossibility of scalability of some of the existing methods. Here we present ClusterFoldSimilarity, an R package that calculates a measure of similarity between clusters from different datasets/batches, without the need of correcting for batch effect or normalizing and merging the data, thus avoiding artifacts and the loss of information derived from these kinds of techniques. The similarity metric is based on the average vector module and sign of the product of logarithmic fold-changes. ClusterFoldSimilarity compares every single pair of clusters from any number of different samples/datasets, including different number of clusters for each sample. Additionally, the algorithm is able to select the top genes which contribute the most to the similarity of two specific clusters, serving also as a feature selection tool.Availability and implementationThe algorithm is freely available as an R package at: https://github.com/OscarGVelasco/ClusterFoldSimilarityContactoscargvelasco@gmail.com

Introduction There is scarce real-world experience regarding direct oral anticoagulants (DOACs) perioperative management. No study before has linked bridging therapy or DOAC-free time (pre-plus postoperative time without DOAC) with outcome. The aim of this study was to investigate real-world management and outcomes. Methods RA-ACOD is a prospective, observational, multicenter registry of adult patients on DOAC treatment requiring surgery. Primary outcomes were thrombotic and hemorrhagic complications. Follow-up was immediate postoperative (24–48 hours) and 30 days. Statistics were performed using a univariate and multivariate analysis. Data are presented as odds ratios (ORs [95% confidence interval]). Results From 26 Spanish hospitals, 901 patients were analyzed (53.5% major surgeries): 322 on apixaban, 304 on rivaroxaban, 267 on dabigatran, 8 on edoxaban. Fourteen (1.6%) patients suffered a thrombotic event, related to preoperative DOAC withdrawal (OR: 1.57 [1.03–2.4]) and DOAC-free time longer than 6 days (OR: 5.42 [1.18–26]). Minor bleeding events were described in 76 (8.4%) patients, with higher incidence for dabigatran (12.7%) versus other DOACs (6.6%). Major bleeding events occurred in 17 (1.9%) patients. Bridging therapy was used in 315 (35%) patients. It was associated with minor (OR: 2.57 [1.3–5.07]) and major (OR: 4.2 [1.4–12.3]) bleeding events, without decreasing thrombotic events. Conclusion This study offers real-world data on perioperative DOAC management and outcomes in a large prospective sample size to date with a high percentage of major surgery. Short-term preprocedural DOAC interruption depending on the drug, hemorrhagic risk, and renal function, without bridging therapy and a reduced DOAC-free time, seems the safest practice.

Introduction and objectives Information regarding long-term outcomes in patients surviving out-of-hospital cardiac arrest (OHCA) is scarce. Our aim was to study the long-term clinical outcomes of a large cohort of OHCA patients surviving until hospital discharge and to identify predictors of mortality and cardiovascular events. Methods Consecutive OHCA patients admitted in the Acute Cardiac Care Unit who survived at least until hospital discharge between 2007 and 2019 were included. All received therapeutic hypothermia according to the local protocol. Pre- and intra-hospital clinical and analytical variables were analyzed, as well as the clinically relevant events during follow-up. Results A total of 201 patients were included, with a mean age of 57.6 ± 14.2 years, 168 (83.6%) were male. Thirty-six (17.9%) died during a median follow-up of 40.3 months (18.9–69.1), the most frequent causes of death being cardiovascular and neurological, followed by cancer. We calculated a predictive model for mortality during follow-up using Cox regression that included the following variables: poor neurological outcome [HR 3.503 (1.578–7.777)], non-shockable rhythm [HR 2.926 (1.390–6.163)], time to onset of CPR [HR 1.063 (0.997–1.134)], older age [1.036 (1.008–1.064)) and worse ejection fraction at discharge [1.033 (1.009–1.058)]. Conclusions Even though few patients experience recurrent cardiac arrest events, survivors after OHCA face high morbidity and mortality during long-term follow-up. Therefore, they may benefit from multidisciplinary teams providing an integral management and ensuring continuity of care.

The purpose of the immune system is to protect the body from pathogenic microorganisms such as bacteria, viruses, fungi and even tumor cells, which could cause disease. When the encounter with pathogens occurs, defenses are produced immediately through the innate response, faster and more nonspecific, and through the adaptive response, more defined and personalized for each attacker. Both are triggered by the cells of the immune system being able to communicate with each other, once they have been activated. The innate immune system works in tune with the acquired immune system through the close intervention of the sex hormones, with specific strategies of estrogen and progesterone. Both have a proven anti-inflammatory and antioxidant action not only at the level of the wall of blood vessels, skin and mucous membranes, but also in the protection of the central nervous system against all toxic agents, such as viruses. Estrogens and progesterone play an essential role in the immune response and its evolution, and although they initially appear as antagonistic responses, they are not, despite the fact that estrogens increase and progesterone seems to suppress the immune response, depending on the immune target according to the case.

La Ley reguladora de la jurisdicción social (LRJS) unificó en el orden jurisdiccional social toda la materia relacionada con la prevención de riesgos laborales, ampliando su ámbito de aplicación subjetiva al comprender no solo al trabajador por cuenta ajena y al tertium genus autónomo económicamente dependiente, sino al empleado público en toda su amplitud, laboral, estatutario o funcionario. Unificación que se ha extendido al control jurisdiccional de los actos administrativos singulares o plurales dictados por la Administración pública en el ejercicio de sus potestades y funciones sobre materias típicamente laborales (laboral, sindical y seguridad social en sentido amplio) atribuidas tradicionalmente al orden contencioso-administrativo, incluidos los actos administrativos que exteriorizan el ejercicio de la potestad sancionadora de las distintas Administraciones públicas.

En este trabajo se presenta una nueva propuesta docente para las clases de dibujo técnico (expresión gráfica), en la que se incorpora el “Proceso de Diseño” al aula. Se ha trabajado la metodología de forma experimental, a través de un seminario-taller con un grupo de estudiantes del Máster en Profesorado de Educación Secundaria (especialidad en “Dibujo, Imagen y Artes Plásticas”) de la Universidad de Almería (España). El objetivo es brindar al futuro profesorado perspectivas y herramientas alternativas que proyecten un mayor dinamismo a la enseñanza-aprendizaje de la materia. El seminario se desarrolló siguiendo un planteamiento de co-participación (docente-alumnado). Además, inicialmente se reflexionó sobre el concepto de diseño y sus dificultades para abordar su definición. Con respecto al análisis de la experiencia, se han relacionado diferentes procedimientos metodológicos: índice NPS (Net Promoter Score), escala Likert de 0-10 puntos y estadísticos descriptivos. Los hallazgos obtenidos apuntan a que el enfoque metodológico propuesto es útil para el futuro profesorado de la asignatura de dibujo técnico, y favorece el desarrollo de la creatividad entre el alumnado. Esta propuesta podría inscribirse dentro de la incipiente filosofía educativa “STEAM”, interrelacionando diferentes disciplinas profesionales, como por ejemplo la ingeniería, el arte y el diseño.

Colección: Contextos Universitarios Transformadores (CUT). Número 7 [Resumen] En este trabajo, que forma parte de la tesis doctoral del primer autor, se muestra el diseño de una actividad académicamente dirigida sobre la materia, orientada a la formación de maestros en el Grado en Educación Primaria. La actividad se implementó con 132 futuros maestros del Grado en Educación Primaria después de haber realizado el estudio científico-didáctico del tema de la materia. Después de implementarse la actividad, a los participantes se les pidió que valorasen mediante una escala Likert las emociones que les generó esa implementación de la coevaluación en esa actividad. Los resultados muestran que con la realización de la coevaluación se obtuvo un alto grado de satisfacción de la valoración por parte de los participantes, generando en ellos muchas más emociones positivas que negativas. Estos datos ratifican que la aplicación de la coevaluación forma parte fundamental del proceso de evaluación auténtica, al mejorar la calidad educativa del estudiante. [Abstract] In this work, which is part of the doctoral thesis of the first author, the design of an academically directed activity on the subject is shown, oriented to the training of teachers in the Degree in Primary Education. The activity was implemented with 132 future teachers of the Degree in Primary Education after having carried out the scientific-didactic study of the subject matter. After the activity was implemented, the participants were asked to rate, using a Likert scale, the emotions that would follow that implementation of the co-evaluation in that activity. The results show that with the completion of the co-evaluation, a high degree of satisfaction was obtained from the evaluation by the participants, showing in them many more positive emotions than negative ones. These data confirm that the application of co-assessment is a fundamental part of the authentic assessment process, by improving the educational quality of the student. http://hdl.handle.net/2183/32493

This report presents the clinical characteristics, outcomes and complications of all consecutive patients implanted with a long-term mechanical circulatory support device in Spain between 2007 and 2020.Analysis of the Spanish Registry of durable ventricular assist devices (REGALAD) including data form Spanish centers with a mechanical circulatory support program.During the study period, 263 ventricular assist devices were implanted in 22 hospitals. The implanted device was an isolated continuous-flow left ventricular assist device in 182 patients (69%), a pulsatile-flow device (58 isolated left ventricular and 21 biventricular) in 79 (30%), and a total artificial heart in 2 patients (1%). The strategy of the implant was as bridge to heart transplant in 78 patients (30%), bridge to candidacy in 110 (42%), bridge to recovery in 3 (1%) and destination therapy in 72 patients (27%). Overall survival at 6, 12 and 24 months was 79%, 74% and 69%, respectively, and was better in continuous-flow left ventricular assist devices (84%, 80%, and 75%). The main adverse events related to this therapy were infections (37% of patients), bleeding (35%), neurological (29%), and device malfunction (17%).Durable ventricular assist devices have emerged in Spain in the last few years as a useful therapy for patients with advanced heart failure. As in other international registries, the current trend is to use continuous-flow intracorporeal left ventricular devices, which are associated with better results. Adverse events continue to be frequent and severe.

The pathophysiological mechanisms underlying Myocardial Infarction with Non-Obstructive Coronary Artery Disease (MINOCA) are still under debate. Lipoprotein (a) [Lp(a)] has proinflammatory and prothrombotic actions and has been involved in the pathogenesis of atherosclerosis. However, no previous studies have linked Lp(a) levels with the probability of developing MINOCA. Moreover, the relationship between MINOCA and the plasma levels of other proatherogenic and proinflammatory molecules such as Interleukin-18 (IL18) and proprotein convertase subtilisin/kexin type 9 (PCSK9) has not been studied. We conducted a prospective, multicenter study involving 1042 patients with acute myocardial infarction (AMI). Seventy-six patients had no significant coronary lesions. All patients underwent plasma analysis on admission. MINOCA patients were younger (57 (47–68) vs. 61 (52–72) years; p = 0.010), more frequently female (44.7% vs. 21.0%; p < 0.001), and had lower rates of diabetes and of Lp(a) > 60 mg/dL (9.2% vs. 19.8%; p = 0.037) than those with coronary lesions; moreover, High Density Lipoprotein cholesterol (HDL-c) levels were higher in MINOCA patients. The absence of Lp(a) > 60 mg/dL and of diabetes were independent predictors of MINOCA, as well as female sex, high HDL-c levels, and younger age. IL-18 and PCSK9 levels were not predictors of MINOCA. During a follow-up of 5.23 (2.89, 7.37) years, the independent predictors of the primary outcome (acute ischemic events or death) in the whole sample were Lp(a) > 60 mg/dL, older age, low estimated Glomerular Filtration rate (eGFR), hypertension, previous heart failure (HF), coronary artery bypass graft, use of insulin, and no therapy with acetylsalicylic acid. In conclusion, in AMI patients, the absence of high Lp(a) levels, as well high HDL-c levels, were independent predictors of the inexistence of coronary artery disease. High Lp (a) levels were also an independent predictor of ischemic events or death.

Value co-creation with customers has emerged as a relevant topic at both academic and managerial level. Considering the positive outcomes derived from value co-creation, firms should learn how to properly manage this process which requires active customer involvement and this paper demonstrates that the level of customer participation (CP) depends to a large extent on their perception of how the hotel favours the process of value co-creation (CcV). Our model also proves the customer perception of the hotel's process of value co-creation has a positive impact on the hotel's brand equity (BE) whereas customer participation positively affects the customer's perceived value (PV). Additionally, both brand equity and perceived value are positively linked with customer satisfaction (CS). The findings indicate the moderating effect of customers' prior experience with the hotel chain in reference to some of the relationships considered (CcV→BE→CS and PV→CS).

ESC heart failure 8(6), 5542-5550 (2021). doi:10.1002/ehf2.13574, Published by Wiley, Chichester

Cholelithiasis is an issue in bariatric surgery patients. The incidence of cholelithiasis is increased in morbidly obese patients. After bariatric surgery, the management maybe sometimes challenging. There is no consensus about how to deal with cholelithiasis prior to bariatric surgery.A retrospective review from our prospectively collected bariatric surgery database. Primary bariatric procedures from 2009 to 2020 were included. Prevalence of cholelithiasis and its management prior to bariatric surgery and the incidence and management of postoperative biliary events were analyzed.Over 1445 patients analyzed, preoperatively cholelithiasis was found in 153 (10.58%), and 68 out of them (44.44%) were symptomatic. Seventy-six patients had a concomitant cholecystectomy. In those cases, the bariatric procedure did not show increased operative time, length of stay, morbidity, or mortality compared to the rest of primary bariatric procedures. Twelve patients (15.58%) with previous cholelithiasis and no concomitant cholecystectomy presented any kind of biliary event and required cholecystectomy. De novo cholelithiasis rate requiring cholecystectomy was 3.86%. Postoperative biliary events both in de novo and persistent cholelithiasis population did not show any difference between the type of surgery, weight loss, and other characteristics.Cholelithiasis was present in 10.58% of our primary bariatric surgery population. Concomitant cholecystectomy was safe in our series. Non-surgical management of asymptomatic cholelithiasis did not lead to a higher risk of postoperative biliary events. The global postoperative cholecystectomy rate was equivalent to the general population.

Background High incidence of cardiovascular events has been described among patients with COVID-19 and since the beginning of the pandemic concerns have been expressed with medical treatments for cardiovascular disease, as they could contribute to the severity of illness in patients with COVID-19. We aim to analyze the effect of chronic treatment with calcium channel blockers and beta-blockers on COVID 19 severity in a Spanish cohort during the 2020 pandemic. Methods Observational study including all consecutive patients (≥40 years old) diagnosed with SARS-CoV-2 through PCR in the microbiology laboratory of our hospital, from March 2nd to 20th 2020. Clinical characteristics and drugs were recorded. The Primary end-point (PE) was all-cause death and the secondary end-point (SE) was the combined of death or the need for orotracheal intubation until 30 days of infection symptoms onset. Results We included 704 patients in our study. Baseline characteristics of the overall cohort can be seen in the table. Median age was 61 years old (IQR 52.9–72.9); 52.7% were female. 34.7% and 12.6% had hypertension and diabetes respectively. After a median follow-up of 111.5 days, 58 patients (8.2%) needed orotracheal intubation and 133 patients (18.9%) died. Secondary endpoint (all-cause death or need for orotracheal intubation) was reached by 164 patients (23.3%). The table described clinical differences between survivors and deceased patients. After multivariate Cox modeling, age, male gender, diabetes, previous lung disease, BMI and the chronic intake of calcium channel blockers (HR 1.74, 95% CI (1.11–2.75), p=0.016) and beta-blockers (HR 1.71, 95% CI (1.07–2.76), p=0.026) were independently related with mortality. Other cardiovascular drugs (Antiplatelets, anticoagulants, diuretics, mineralcorticoid-receptor antagonists, angiotensin-receptor blockers, angiotensin-converting enzyme inhibitors and statins) did not influence survival after SARS-CoV 2 infection (Figure). The secondary outcome was reached by 164 patients (23.3%) and chronic treatment with calcium channel blockers remains as an independent predictor of mortality (HR 1.55, 95% CI (1.01–2.37), p=0.044). Conclusions Chronic treatment with calcium channel blockers and beta-blockers are independent predictors of mortality after SARS-CoV-2 infection. Further studies are needed to confirm these results. Funding Acknowledgement Type of funding sources: None. Description of studied populationOdds-ratio and CI for all-cause death

Background On January 2020, the first patient with coronavirus 2 (SARS-CoV-2) was detected in Spain. Since then, 3 280 000 cases have been confirmed and 75.305 people have died. We aimed to clarify the epidemiological and clinical characteristics related with poor short-term prognosis in patients diagnosed with SARS-CoV-2. Methods Observational, retrospective single-center study including consecutive patients (≥40yo) diagnosed with SARS-CoV-2 through PCR, since March 2nd to 20th 2020 in our center in Spain. The primary endpoint (PE) was the combined of all-cause death or need for orotracheal intubation within the first 30 days of infection symptoms. Results 704 patients were included (table). A follow-up period of thirty-days was fully completed in 692 of 704 patients (98.3%). At the end of this period, 148 patients (21.4%) met the PE; they were older, more frequently male, obese and smokers. Patients who met the PE had a higher prevalence of hypertension, diabetes, dyslipidemia, ischemic heart disease, heart failure, peripheral and cerebrovascular disease, cancer and lung pathologies. They received more frequently therapies with renin-angiotensin system inhibitors, betablockers, calcium channel blockers and statins, as well as antiplatelet and anticoagulant therapies Multivariate analysis showed that age (OR 1.99 for every 10 years, 95% CI [1.637–2.4], p Conclusion In our group of patients with SARS-CoV-2, age, male sex, diabetes, lung disease and obesity were found to be independent predictors of the combined of all case death or need for orotracheal intubation within the first 30 days of infection symptoms. Larger studies are needed to confirm these results. Funding Acknowledgement Type of funding sources: None. Description of studied populationOdds-ratio and CI for the combined PE

Background Questions emerged about safety renin-angiotensin system (RAS) inhibitors (angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs)) in patients diagnosed with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Our objective was to evaluate the safety of this treatment in a Spanish cohort during 2020 pandemic. Methods Observational study including all consecutive patients (≥40 years old) diagnosed with SARS-CoV-2 through PCR in the microbiology laboratory of our hospital, since March 2nd to 20th 2020. Clinical characteristics and drugs were recorded. Primary end-point (PE) was the combined of all-cause death or need for orotracheal intubation until 30 days of infection symptoms onset. To assess the effect of RAS inhibitors, we performed a double statistical approach, with multivariate logistic regression and propensity-score matching. Results We included 704 patients (table). Median age was 61 years old (IQR 52.9–72.9); 52.7% were female. 34.7% and 12.6% had hypertension (HTA) and diabetes (DM) respectively. 92 patients (13.1%) and 87 patients (12.4%) were taking ACEI and ARB respectively. Baseline characteristics of both subgroups are shown in the table. Patients on RAS inhibitors treatment had a worse clinical profile: were older, more males and with higher prevalence of HTA, DM, dyslipemia, ischemic heart disease and heart failure. There were no differences in terms of respiratory nor neoplasic disease. After 30 days, 112 patients (15.9%) had died, 148 (21.4%) had died or had required invasive mechanical ventilation (PE); 390 patients (55.4%) had needed hospital admission. PE was reached in 33.3% patients under ACEI treatment (vs. 19.6% in control group, p=0.005) and in 41.9% patients under ARB treatment (vs. 18.5% in control group, p Using a propensity-score approach 79 patients under ACEI treatment and 72 patients under ARB treatment were matched 1:1 with control patients (characteristics of matched population are described in the table) Logistic binary regression showed no significant differences on incidence of the PE in patients under ACEI treatment (OR 0.84, 95% CI [0.43–1.63], p=0.613) nor ARB treatment (OR 1.82, 95% CI [0.92–3.60], p=0.085). Nevertheless, there was a trend towards worse prognosis in ARB patients. Kaplan-Meier curves of survival free of death or need for mechanical ventilation in matched population (ACEI and ARB treatment) are shown in the figure. Conclusions We have not found any correlation between the severity of the disease and the treatment with ACEI nor ARB. We do not recommend the withdrawal of these drugs during the current epidemic situation. Further studies are needed to assess this finding. Funding Acknowledgement Type of funding sources: None. Description of studied populationKaplan-Meier curve in matched population

Sugammadex is a cyclodextrin that reverses neuromuscular blockade, especially of rocuronium. The occurrence of anaphylaxis produced by its use is of 1:1000 and 1:20000; it is observed mainly in subjects of Asian origin.A 9-year-old boy of Asian origin who, after the administration of sugammadex, immediately manifested an episode of anaphylaxis, which was reverted by using adrenaline and antihistamines. The serum tryptase at two hours was 27.7 μg/L; at 6 weeks, it was 3 μ/L. The sugammadex 100 mg/mL skin test was positive. The basophil activation test was positive with sugammadex 20 mg/mL.The temporal relationship between the administration of the drug, the clinical manifestations, the elevation of tryptase, and the diagnostic tests performed, disclosed the episode of anaphylaxis associated with hypersensitivity to sugammadex.Introducción: Sugammadex es una ciclodextrina que revierte el bloqueo neuromuscular, especialmente de rocuronio. La incidencia de anafilaxia producida por su uso es de 1:1.000 y 1:20.000, se observa principalmente en sujetos de origen asiático. Reporte de caso: Niño de 9 años, de raza asiática que tras la administración de sugammadex, inmediatamente manifestó un episodio de anafilaxia, la cual revirtió con el uso de adrenalina y antihistamínicos. La triptasa sérica a las 2 h fue de 27.7 μg/L; a las 6 semanas fue 3 μg/L. La prueba cutánea a sugammadex 100 mg/mL fue positiva. La prueba de activación de basófilos fue positiva con 20 mg/mL sugammadex. Conclusión: La relación temporal de la administración del medicamento, las manifestaciones clínicas, la elevación de la triptasa y las pruebas diagnósticas realizadas, identificaron el episodio de anafilaxia asociado con hipersensibilidad por sugammadex.

N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma levels are increased in patients with cancer. In this paper, we test whether NT-proBNP may identify patients who are going to receive a future cancer diagnosis (CD) in the intermediate-term follow-up. We studied 962 patients with stable coronary artery disease and free of cancer and heart failure at baseline. This sample represents a re-analysis of a previous work expanding the sample size and the follow-up. NT-proBNP, galectin-3, monocyte chemoattractant protein-1, high-sensitivity C-reactive protein, high-sensitivity cardiac troponin I (hsTnI), and calcidiol (vitamin D) plasma levels were assessed. The primary outcome was new CD. After 5.40 (2.81–6.94) years of follow-up, 59 patients received a CD. NT-proBNP [HR 1.036 CI (1.015–1.056) per increase in 100 pg/mL, p = 0.001], previous atrial fibrillation (HR 3.140 CI (1.196–8.243), p = 0.020), and absence of previous heart failure (HR 0.067 CI (0.006–0.802), p = 0.033) were independent predictors of receiving a CD in the first three years of follow-up. None of the variables analyzed predicted a CD beyond this time. The number of patients developing heart failure during follow-up was 0 (0.0%) in patients receiving CD in the first three years of follow-up, 2 (6.9%) in those receiving a CD diagnosis beyond this time, and 40 (4.4%) in patients not developing cancer (p = 0.216). These numbers suggest that future heart failure was not a confounding factor. In patients with coronary artery disease, NT-proBNP was an independent predictor of CD in the first three years of follow-up but not later, suggesting that it could be detecting subclinical undiagnosed cancers.