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Producción Científica, Deep-learning algorithms have been proposed to analyze overnight airflow (AF) and oximetry (SpO2) signals to simplify the diagnosis of pediatric obstructive sleep apnea (OSA), but current algorithms are hardly interpretable. Explainable artificial intelligence (XAI) algorithms can clarify the models-derived predictions on these signals, enhancing their diagnostic trustworthiness. Here, we assess an explainable architecture that combines convolutional and recurrent neural networks (CNN + RNN) to detect pediatric OSA and its severity. AF and SpO2 were obtained from the Childhood Adenotonsillectomy Trial (CHAT) public database (n = 1,638) and a proprietary database (n = 974). These signals were arranged in 30-min segments and processed by the CNN + RNN architecture to derive the number of apneic events per segment. The apnea-hypopnea index (AHI) was computed from the CNN + RNN-derived estimates and grouped into four OSA severity levels. The Gradient-weighted Class Activation Mapping (Grad-CAM) XAI algorithm was used to identify and interpret novel OSA-related patterns of interest. The AHI regression reached very high agreement (intraclass correlation coefficient > 0.9), while OSA severity classification achieved 4-class accuracies 74.51% and 62.31%, and 4-class Cohen’s Kappa 0.6231 and 0.4495, in CHAT and the private datasets, respectively. All diagnostic accuracies on increasing AHI cutoffs (1, 5 and 10 events/h) surpassed 84%. The Grad-CAM heatmaps revealed that the model focuses on sudden AF cessations and SpO2 drops to detect apneas and hypopneas with desaturations, and often discards patterns of hypopneas linked to arousals. Therefore, an interpretable CNN + RNN model to analyze AF and SpO2 can be helpful as a diagnostic alternative in symptomatic children at risk of OSA., Ministerio de Ciencia e Innovación /AEI/10.13039/501100011033/ FEDER (grants PID2020-115468RB-I00 and PDC2021-120775-I00), CIBER -Consorcio Centro de Investigación Biomédica en Red- (CB19/01/00012), Instituto de Salud Carlos III, National Institutes of Health (HL083075, HL083129, UL1-RR-024134, UL1 RR024989), National Heart, Lung, and Blood Institute (R24 HL114473, 75N92019R002), Ministerio de Ciencia e Innovación - Agencia Estatal de Investigación- “Ramón y Cajal” grant (RYC2019-028566-I)

2023 Otros acuerdos transformativos UCM, Objective: To evaluate whether hydroxychloroquine (HCQ) or chloroquine (CQ) are effective for the treatment of oral lichen planus (OLP). Materials and methods: A literature search was conducted in four databases. Clinical studies investigating the effect of HCQ/CQ in patients with OLP were included. Results: Eleven studies were included. Four were RCTs and seven quasi-experimental studies. The studies included 390 patients diagnosed with OLP, of which 326 and 7 received HCQ and CQ, respectively. 46 patients received topical dexamethasone, 5 placebo and 6 griseofulvin as controls. Five studies assessed pain, and all of them obtained pain reduction with the use of HCQ. Six studies reported objective clinical improvement of OLP with the use of HCQ. Five studies that used a subjective scale obtained that 24%-100% of the patients achieved a complete/almost complete improvement of OLP lesions and its symptomatology. The most frequent side effects were vision problems, gastric discomfort, rash, nauseas, headaches, skin pigmentation, and elevated kidney function. 17 patients had to withdraw from the studies. Conclusions: Current evidence is scarce to confirm HCQ as a therapeutic option for OLP. More RCTs are needed to compare its efficacy with topical corticosteroids and to evaluate whether HCQ reduces relapses of OLP., Depto. de Especialidades Clínicas Odontológicas, Fac. de Odontología, TRUE, pub, APC financiada por la UCM

2023 Descuento MDPI, International adoption has declined in recent years, although the adoption of children with special needs has arisen. We aim to describe our experience in the international adoption of children with special needs and to analyze the concordance between the pathologies included in pre-adoption reports and the diagnosis made upon arrival. We conducted a retrospective descriptive study including internationally adopted children with special needs evaluated at a reference Spanish unit between 2016 and 2019. Epidemiological and clinical variables were collected from medical records, and pre-adoption reports were compared to established diagnoses following their evaluation and complementary tests. Fifty-seven children were included: 36.8% females, a median age of 27 months [IQR:17–39], mostly coming from China (63.2%) and Vietnam (31.6%). The main pathologies described in the pre-adoption reports were congenital surgical malformations (40.3%), hematological (22.6%), and neurological (24.6%). The initial diagnosis that motivated the international adoption via special needs was confirmed in 79% of the children. After evaluation, 14% were diagnosed with weight and growth delay, and 17.5% with microcephaly, not previously reported. Infectious diseases were also prevalent (29.8%). According to our series, the pre-adoption reports of children with special needs appear accurate, with a low rate of new diagnoses. Pre-existing conditions were confirmed in almost 80% of cases., Ministerio de Ciencia e Innovación (España), Instituto de Salud Carlos III, European Commission, Depto. de Medicina, Fac. de Medicina, TRUE, pub, Descuento UCM

La enfermedad de Huntington (EH) es una patología neurodegenerativa que afecta la función motora, cognitiva y psiquiátrica, con inicio entre la quinta y sexta década con una supervivencia media de 15-20 años. Actualmente no hay cura, y los tratamientos son sintomáticos, destacando la importancia de continuar participando en ocupaciones para lograr bienestar físico y emocional. Investigaciones sugieren que factores epigenéticos, como la actividad física y nutrición, pueden influir en la progresión de la enfermedad. Nuestro objetivo fue identificar dificultades en el desempeño ocupacional, y validar medidas específicas de evaluación en la EH. Se concluyó que presentan dificultades en el autocuidado; se han establecido unos puntos de corte para medir la actividad física pueden promover un estilo saludable; se ha determinado la precisión de dispositivos que miden el gasto energético y la composición corporal. La investigación proporciona información para desarrollar intervenciones no farmacológicas proporcionando una medicina de precisión y que mejore la calidad de vida de los pacientes y familiares., Huntington's Disease (HD) is an autosomal dominant neurodegenerative disease characterized by a triad of motor symptoms, cognitive impairment, and personality disorders. The onset age of the disease ranges from 35 to 50 years with a slow although relentless decline over 15 to 20 years, leading to a loss of autonomy and independence in Activities of Daily Living. Occupational therapists believe that engagement in occupation is crucial as they consider it essential for achieving physical, emotional, and social wellbeing of individuals. To assess occupational performance, a specific evaluation process must be undertaken using tools that enable the identification of day-to-day challenges and the impact that the illness has on their life. Up to the present moment, there is no cure for the disease, and pharmacological treatment adopts a symptomatic approach, not without various side effects. In recent decades, several studies have concluded that epigenetic factors such as physical activity and nutrition can produce changes in the clinical manifestations of genetic diseases, influencing the progression of the disease. In order to quantify these changes, the use of reliable and validated measures of assessment within the study population is essential. This thesis provides information about different aspects influencing HD progression. This might facilitate the development of patient-centred non-pharmacological interventions and treatments that delay the disease and help to improve the quality of life and well-being of HD patients and their families.

Depto. de Química en Ciencias Farmacéuticas, Fac. de Farmacia, pub

Depto. de Química en Ciencias Farmacéuticas, Fac. de Farmacia, pub

During routine dissection of a left upper limb of a 68-year-old male human cadaver, an unusual muscle was observed originating from the radius and flexor retinaculum, and continued in the hypothenar region with the muscle belly of the abductor digiti minimi. We checked that it was an accessory abductor digiti minimi (ADM). Its muscular belly was in close relation to the median and ulnar nerves. We review the literature regarding such muscle variations and discuss the potential for compression of the median and ulnar nerves. Although the accessory ADM is usually asymptomatic and only rarely results in nerve compression, it should be taken into account by surgeons when establishing a differential diagnosis in the compression neuropathies of the median and ulnar nerves. An ultrasound scanning can help establish the differential diagnosis., Universidad Complutense de Madrid, Depto. de Anatomía y Embriología, Fac. de Medicina, TRUE, pub

Simvastatin (SIM) is a potent lipid-lowering drug used to control hyper-cholesterolemia and prevent cardiovascular diseases. SIM presents low oral bioavailability (5%) because of its low aqueous solubility. In this work, polyelectrolyte complexes (PEC) are developed with different chitosan (CS) and carboxymethylcellulose (CMC) ratios that will allow for an increase in the SIM dissolution rate (2.54-fold) in simulated intestinal medium (pH 4.5). Scanning Electron Microscopy (SEM) images revealed highly porous structures. The changes between both complexes, PEC-SIM:CS:CMC (1:1:2) and (1:2:1), were related to the relaxation of the polymer chains upon absorption of the dissolution medium. Fourier-transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC) and powder X-ray diffraction (XRPD) studies were used to evaluate the polymer/polymer and drug/polymer interactions on the different PEC-SIM:CS:CMC ratios. In addition, the PEC-SIM:CS:CMC (1:2:1) complex exhibited a high ratio of protonated amino groups (NH3+) and an increase in intramolecular hydrogen bonds, which were correlated with a high expansion of the interpolymer chains and an increase in the SIM dissolution rate. Different kinetic models such as zero-order, first-order, Higuchi and Korsmeyer–Peppas were studied to evaluate the influence of CS/CMC ionic interactions on the ability to improve the release rate of poorly soluble drugs., Ministerio de Ciencia e Innovación, España., Universidad Complutense de Madrid, Depto. de Farmacia Galénica y Tecnología Alimentaria, Fac. de Farmacia, TRUE, pub

We aim to examine the incidences, clinical characteristics, and in-hospital outcomes of type 2 diabetes (T2DM) patients hospitalized with urinary tract infections (UTIs) in Spain and to identify the factors associated with in-hospital mortality (IHM). A retrospective observational study was carried out with a sample that included all adult patients who were hospitalized for UTIs between 2001 and 2018 and collected in the Spanish National Health System Hospital Discharge Database. We identified 850,276 patients with UTIs (25.49% with T2DM). The incidence of UTIs increased in patients with and without diabetes from 290.76 and 74.79 cases per 100,000 inhabitants in the period from year 2001 to year 2003 to 568.45 and 144.0 in the period from 2016 to 2018, respectively (p < 0.001). Adjusted incidence of UTIs was higher in T2DM patients (incidence rate ratio (IRR) 4.36; 95% CI 4.35-4.39). The multivariable analysis showed a significant reduction in the IHM over time for men and women with T2DM. In T2DM, patients' higher IHM was associated with older age, comorbidities, and Staphylococcus aureus isolation. Women with T2DM had a higher risk of dying than men. The risk of IHM with an episode of UTIs was independent of the presence of T2DM (odds ratio (OR) 0.97; 95% CI 0.91-1.01). We conclude that the incidence of UTIs was over four times higher in T2DM than nondiabetic patients and has increased over time., Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Background: Synchronization between the left ventricle and a left ventricular assist device (LVAD) may be important for ventricular unloading and coronary perfusion. We assessed the synchrony between cardiac and LVAD cycles by increasing delays in steps of 100 msec throughout the cycle, under conditions of total and partial left ventricular support. Methods: We studied 7 healthy minipigs weighing 30-40 kg. A 60-cc Berlin Heart Excor LVAD was implanted and connected to a BCM 1200 console, making it possible to synchronize the LVAD systole and the EKG signal with a prefixed delay. We recorded hemodynamic parameters (including aortic, pulmonary, and left ventricular pressure) and LVAD flow for each delay. Results: Intraventricular pressure during LVAD systole was minimized with delays of around 40-80% of one cycle. In addition, total flow was higher under these conditions. Conclusions: This study shows that the synchronous mode of LVAD operation is feasible. Moreover, a delay in device contraction until the second half of the cardiac cycle optimizes ventricular unloading and may eventually improve myocardial recovery, Depto. de Farmacología y Toxicología, Fac. de Medicina, TRUE, pub

Epitope tagging is widely used to fuse a known epitope to proteins for which no affinity receptor is available by using recombinant DNA technology. One example is FLAG epitope (DYKDDDDK), which provides better purity and recoveries than the favorite polyhistidine tag. However, purification requires using anti-FLAG antibody resins, the high cost and non-reusability of which restrict widespread use. One cost-effective solution is provided by the use of bioinspired anti-FLAG molecularly imprinted polymers (MIPs). This work describes the development of MIPs, based on the epitope approach, synthesized from the tetrapeptide DYKD as template that affords purification of FLAG-derived recombinant proteins. Polymer was optimized by using a combinatorial approach to select the functional monomer(s) and cross-linker(s), resulting in the best specific affinity toward FLAG and the peptide DYKD. The imprinted resin obtained was used to purify mCherry proteins tagged with either FLAG or DYKD epitopes from crude cell lysates. Both mCherry variants were highly efficiently purified (R ≥ 95%, RSD ≤ 15%, n = 3) and impurities were removed. Unlike existing antibody-based resins, the proposed tag-imprinting strategy provides a general method for meeting the growing demand for efficient, inexpensive, and versatile materials for tagged proteins purification., Spanish Ministry of Economy and Competitiveness, Depto. de Química Analítica, Fac. de Ciencias Químicas, FALSE, pub

Hybrid compounds containing structural fragments of the Rho kinase inhibitor fasudil and the NRF2 inducers caffeic and ferulic acids were designed with the aid of docking and molecular mechanics studies. Following the synthesis of the compounds using a peptide-coupling methodology, they were characterized for their ROCK2 inhibition, radical scavenging, effects on cell viability (MTT assay), and NRF2 induction (luciferase assay). One of the compounds (1d) was selected in view of its good multitarget profile and good tolerability. It was able to induce the NRF2 signature, promoting the expression of the antioxidant response enzymes HO-1 and NQO1, via a KEAP1-dependent mechanism. Analysis of mRNA and protein levels of the NRF2 pathway showed that 1d induced the NRF2 signature in control and SOD1-ALS lymphoblasts but not in sALS, where it was already increased in the basal state. These results show the therapeutic potential of this compound, especially for ALS patients with a SOD1 mutation., Comunidad de Madrid (grant B2017/BMD-3813), MINECO (grant RTI2018-097662-B-I00 to J.C.M. and PID2019-105600RB-I00 to A.M. and I.L.-B), ISCiii CIBERNED (CB18/05/00040 to A.M. and Á.M.-R. and CB06/05/0089 to I.L.-B.), Fundela (2019/00325/001) to I.L.-B, Depto. de Farmacología y Toxicología, Fac. de Veterinaria, TRUE, pub

Aim: To evaluate the efficacy of a 0.03% chlorhexidine and 0.05% cetylpyridinium chloride mouth rinse, as an adjunct to professionally and patient-administered mechanical plaque removal, in the treatment of peri-implant mucositis (PiM). Material and methods: Patients displaying PiM in, at least, one implant were included in this randomized, double-blinded, clinical trial. Subjects received professional prophylaxis (baseline and 6 months) and were instructed to regular oral hygiene practices and to rinse, twice daily, with the test or placebo mouth rinses, during one year. Clinical, radiographic and microbiological outcomes were evaluated at baseline, 6 and 12 months. Disease resolution was defined as absence of bleeding on probing (BOP). Data were analysed by repeated measures ANOVA, Student's t and chi-square tests. Results: Fifty-four patients were included and 46 attended the final visit (22 in control and 24 in test group). In the test group, there was a 24.49% greater reduction in BOP at the buccal sites (95% confidence interval [3.65-45.34%]; p = 0.002) than in controls. About 58.3% of test implants and 50% controls showed healthy peri-implant tissues at final visit (p > 0.05). Conclusions: The use of the test mouth rinse demonstrated some adjunctive benefits in the treatment of PiM. Complete disease resolution could not be achieved in every case. Trial registration: ClinicalTrials.gov NCT03533166. Keywords: chlorhexidine; dental implant; mouth rinse; peri-implant diseases; peri-implant mucositis., Depto. de Especialidades Clínicas Odontológicas, Fac. de Odontología, TRUE, pub

Background: Aging is not just a risk factor of stroke, but it has also been associated with poor recovery. It is known that stroke-induced neurogenesis is reduced but maintained in the aged brain. However, there is no consensus on how neurogenesis is affected after stroke in aged animals. Our objective is to determine the role of aging on the process of neurogenesis after stroke. Methods: We have studied neurogenesis by analyzing proliferation, migration, and formation of new neurons, as well as inflammatory parameters, in a model of cerebral ischemia induced by permanent occlusion of the middle cerebral artery in young- (2 to 3 months) and middle-aged mice (13 to 14 months). Results: Aging increased both microglial proliferation, as shown by a higher number of BrdU(+) cells and BrdU/Iba1(+) cells in the ischemic boundary and neutrophil infiltration. Interestingly, aging increased the number of M1 monocytes and N1 neutrophils, consistent with pro-inflammatory phenotypes when compared with the alternative M2 and N2 phenotypes. Aging also inhibited (subventricular zone) SVZ cell proliferation by decreasing both the number of astrocyte-like type-B (prominin-1(+)/epidermal growth factor receptor (EGFR)(+)/nestin(+)/glial fibrillary acidic protein (GFAP)(+) cells) and type-C cells (prominin-1(+)/EGFR(+)/nestin(-)/Mash1(+) cells), and not affecting apoptosis, 1 day after stroke. Aging also inhibited migration of neuroblasts (DCX(+) cells), as indicated by an accumulation of neuroblasts at migratory zones 14 days after injury; consistently, aged mice presented a smaller number of differentiated interneurons (NeuN(+)/BrdU(+) and GAD67(+) cells) in the peri-infarct cortical area 14 days after stroke. Conclusions: Our data confirm that stroke-induced neurogenesis is maintained but reduced in aged animals. Importantly, we now demonstrate that aging not only inhibits proliferation of specific SVZ cell subtypes but also blocks migration of neuroblasts to the damaged area and dec, Unión Europea, Ministerio de Ciencia e Innovación, Comunidad de Madrid, Depto. de Farmacología y Toxicología, Fac. de Medicina, TRUE, pub

Background: Palpation, a traditional haptic ability, is used daily by practitioners of all medical and surgical specialties to assess patients. In the current study, one of the authors, in a routine clinical setting, was able to deduce the dynamic features of the putative inferior belly of omohyoid. This led to a proof-of-concept study that yielded results consistent with the clinical findings. Methods: The first part of the study involved a survey of 300 rheumatic disease patients in whom the greater supraclavicular fossa was explored by palpation. While the patient kept the head straight, the clinician placed his middle three fingers 2.5-3 cm dorsal to the clavicle in the window between the sternocleidomastoid and trapezius clavicular insertions, explored the supraclavicular fossa, and palpated the paired contractile inferior belly of the assumed omohyoid during flexion in the three orthogonal planes. In the second part of the study, five normal subjects were examined in a similar manner by the same clinician and had independent ultrasonography performed on the dominant side. Descriptive statistics were used, and Yates' corrected chi-squared test was applied to certain nominal variables. Additionally, a comparative anterolateral bilateral neck dissection was performed in a cadaveric specimen. Results: Both studies showed that the contractile structure was the inferior belly of omohyoid and that its contraction occurred during anterior neck flexion and was opposite to the side of neck rotation, resembling the sternocleidomastoid. Conclusions: Palpation uncovered a previously unknown function of the inferior belly of omohyoid, suggesting that physical examination of the musculoskeletal system based on palpation may lead to hypotheses worthy of exploration., Instituto de Salud Carlos III, Research Committee of the American British Cowdray (ABC) Medical Center (Mexico City), Jiménez Díaz Foundation Ethics Committee, Depto. de Anatomía y Embriología, Fac. de Medicina, TRUE, pub

Pillar pain represents one of the most common complications of classic open carpal tunnel release (CTR). This complication causes a sense of discomfort worse than the compression syndrome itself. We, herein, introduce a new treatment method for CTR through a mini-incision, which allows subcutaneously cutting the transverse carpal ligament (TCL) and releasing the median nerve without neurovascular complications. This mini-incision approach can allow the direct visualization and preservation of the thenar motor branch in those rare cases where it has an aberrant origin. For the past 10 years, we have consecutively performed this technique in the surgical treatment of 318 patients with the diagnosis of primary CTS, without developing any neurovascular and tendon injuries as well as pillar pain., Universidad Complutense de Madrid, Depto. de Anatomía y Embriología, Fac. de Medicina, TRUE, pub

Se recomienda que los supervivientes en coma de una parada cardiaca extrahospitalaria se sometan a hipotermia terapéutica a una temperatura entre 32° y 34°C durante 12 a 24 horas. Sin embargo, se desconoce el nivel óptimo de enfriamiento. El objetivo de este estudio piloto era obtener datos iniciales sobre el efecto de distintos niveles de hipotermia. Nuestra hipótesis era que temperaturas más bajas se asociarían con mejor supervivencia y resultado neurológico. Métodos y resultados: los pacientes se incluían en el estudio si habían sufrido una parada cardiaca extrahospitalaria presenciada entre marzo de 2008 y agosto de 2011. La temperatura objetivo se asignó aleatoriamente a 32 °C o 34 °C. La estratificación se realizó en función del ritmo inicial como desfibrilable o asistolia. La temperatura objetivo se mantuvo durante 24 horas, seguidas de 12 a 24 horas de recalentamiento controlado. El objetivo primario fue la supervivencia libre de dependencia grave a los 6 meses. Se incluyeron 36 pacientes en el ensayo (26 con ritmo desfibrilable, 10 en asistolia), 18 de los cuales fueron asignados a 34 °C y 18 a 32 °C. Ocho de los 18 pacientes del grupo de 32 °C (44,4%) alcanzaron el objetivo primario, frente a con 2 de 18 en el grupo de 34 °C (11,1%) (log-rank P=0,12). Todos los pacientes cuyo ritmo inicial fue asistolia murieron antes de los 6 meses en ambos grupos. Ocho de 13 pacientes con ritmo inicial desfibrilable asignados a 32 °C (61,5%) estaban vivos sin dependencia grave a los 6 meses en comparación con 2 de 13 (15,4%) asignados a 34 °C (log rank P=0,029). La incidencia de complicaciones fue similar en ambos grupos, excepto la incidencia de convulsiones, que fue inferior (1 frente a 11; P=0,0002) en los pacientes asignados a 32°C en comparación con los asignados a 34°C. Por el contrario, hubo una tendencia hacia una mayor incidencia de bradicardia (7 frente a 2; P=0,054) en los pacientes asignados a 32°C ., Background: It is recommended that comatose survivors of out-of-hospital cardiac arrest should be cooled to 32° to 34°C for 12 to 24 hours. However, the optimal level of cooling is unknown. The aim of this pilot study was to obtain initial data on the effect of different levels of hypothermia. We hypothesized that deeper temperatures will be associated with better survival and neurological outcome. Methods and results: Patients were eligible if they had a witnessed out-of-hospital cardiac arrest from March 2008 to August 2011. Target temperature was randomly assigned to 32°C or 34°C. Enrollment was stratified on the basis of the initial rhythm as shockable or asystole. The target temperature was maintained during 24 hours followed by 12 to 24 hours of controlled rewarming. The primary outcome was survival free from severe dependence (Barthel Index score ≥60 points) at 6 months. Thirty-six patients were enrolled in the trial (26 shockable rhythm, 10 asystole), with 18 assigned to 34°C and 18 to 32°C. Eight of 18 patients in the 32°C group (44.4%) met the primary end point compared with 2 of 18 in the 34°C group (11.1%) (log-rank P=0.12). All patients whose initial rhythm was asystole died before 6 months in both groups. Eight of 13 patients with initial shockable rhythm assigned to 32°C (61.5%) were alive free from severe dependence at 6 months compared with 2 of 13 (15.4%) assigned to 34°C (log-rank P=0.029). The incidence of complications was similar in both groups except for the incidence of clinical seizures, which was lower (1 versus 11; P=0.0002) in patients assigned to 32°C compared with 34°C. On the contrary, there was a trend toward a higher incidence of bradycardia (7 versus 2; P=0.054) in patients assigned to 32°C. Although potassium levels decreased to a greater extent in patients assigned to 32°C, the incidence of hypokalemia was similar in both groups. Conclusions: The findings of this pilot trial suggest that a lower cooling level may be associated wit, Depto. de Medicina, Fac. de Medicina, TRUE, pub

The online version contains supplementary material available at https://doi.org/10.1007/s00431-023-04873-w, The purpose of this study is to describe and assess changes in incidence, clinical conditions, use of mechanical ventilation, length of hospital stay (LOHS), and in-hospital mortality (IHM) among children hospitalized with asthma in Spain from 2011 to 2020. We analyzed children aged 0 to 15 years hospitalized with an ICD code for asthma included in the Spanish National Hospital Discharge Database (SNHDD). The analysis was conducted for asthma as the primary diagnosis and with asthma in any diagnosis position. Joinpoint regression was used to assess time trends in incidence. We included a total of 85,664 children hospitalized with asthma; of these, 46,727 (54.55%) had asthma coded as the primary diagnosis. The number of boys was higher than the number of girls, irrespective of age group or diagnostic position. The frequency of asthma as primary diagnosis decreased from 55.7% in 2011 to 43.96% in 2020 (p < 0.001). The incidence of hospitalizations because of asthma decreased significantly from 2011 to 2020, with a faster decrease from 2018 onwards. Over time, the proportion of older children increased. In the year 2020, only 55 children had codes for asthma and COVID-19 in their discharge report, and this infection had no effect on hospitalizations this year. A significant increase in the use of non-invasive ventilation (NIV) was observed over time. Irrespective of the diagnostic position, LOHS and IHM remained stable over time, with the IHM under 0.1%. Conclusion: Our results show a decrease in the incidence of hospital admissions with asthma either as the primary diagnosis or in any position. The age of children hospitalized seems to be increasing as the use of NIV. Better management of the disease from primary care and the emergency department as is the use of NIV could explain the reduction in incidence. What is Known: • Asthma is the most common chronic respiratory in childhood in high income countries. • The incidence of hospital admissions with asthma and assoc, Comunidad Autónoma de Madrid, Universidad Complutense de Madrid, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Background The aim of this study was to assess the impact of ileostomy closure following preoperative physiological stimulation (PPS) on postoperative ileus (POI) in patients with loop ileostomy after low anterior resection for rectal cancer. Methods Patients who underwent ileostomy closure between January 2017 and February 2020 in two tertiary referral centers were prospectively included. PPS stimulation was compared to standard treatment. Stimulation was carried out daily during the 15 days prior to ileostomy closure by the patient's self-instillation of 200 ml of fecal contents from the ileostomy bag via the efferent loop, using a rectal catheter. Standard treatment (ST) consisted of observation. Outcomes measures were POI, morbidity, stimulation feasibility, and predictors to ileus. Results A total of 58 patients were included [42 males and 16 females, median age 67 (43–85) years]. PPS was used in 24 patients, who completed the entire stimulation process, and ST in 34 patients. No differences in preoperative factors were found between the two groups. POI was significantly lower in the PPS group (4.2%) vs the ST group (32.4%); p < 0.01, OR: 0.05 (CI 95% 0.01–0.65). The PPS group had a shorter time to restoration of bowel function (1 day vs 3 days) p = 0.02 and a shorter time to tolerance of liquids (1 day vs 2 days), p = 0.04. Age (p = 0.01), open approach at index surgery, p = 0.03, adjuvant capecitabine (p = 0.01). and previous abdominal surgeries (p = 0.02) were associated with POI in the multivariate analysis. C-reactive-protein values on the 3rd (p = 0.02) and 5th (p < 0.01) postoperative day were also associated with POI. Conclusions PPS for patients who underwent ileostomy closure after low anterior resection for rectal cancer is feasible and might reduce POI., Depto. de Cirugía, Fac. de Medicina, TRUE, pub

Background: Culture-based methods (culture broth bottles or lysis methods) have been the standard for detecting bacteremia. More recently, quantitative polymerase chain reaction (qPCR) was proposed as a more sensitive and specific test although none of them has been validated for the identification of periodontal pathogens (fastidious growing bacteria) in blood samples. Objective: To compare the ability to detect and quantify Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Streptococcus oralis (alone or in combination) in blood samples with three culture techniques [direct anaerobic culturing (DAC), haemo-culture (BACTEC), and lysis-centrifugation (LC)] and a non-culture dependent approach (qPCR) in an in vitro study. Material and methods: Blood samples from 12 periodontally healthy volunteers were contaminated with three concentrations [104,102 and 101 colony forming units (CFU)/mL] of A. actinomycetemcomitans, P. gingivalis and S. oralis, alone or in combination. Samples were analysed by DAC, BACTEC, LC and qPCR. Sensitivity, specificity, predictive values, kappa index and Lińs correlation coefficients were calculated. Results: DAC, LC and qPCR were able to detect the three target species at all concentrations. An excellent concordance (correlation coefficient r: 0.92-1) was observed between DAC and the reference standard (sensitivity raging 93.33-100% and specificity 88.89-100%) values. BACTEC was not able to identify P. gingivalis in any of the performed experiments. qPCR provided false negative results for S.oralis. Conclusions: DAC showed the best results for the proper identification and quantification of A. actinomycetemcomitans, P. gingivalis and S. oralis, alone or in combination, in blood samples., Depto. de Especialidades Clínicas Odontológicas, Fac. de Odontología, TRUE, pub

Objetivos: Durante el confinamiento por la COVID-19, algunas personas se involucraron en comportamientos que generaron una Mayor sensación de positividad y control. El objetivo del presente estudio fue identificar relaciones entre el afecto, las estrategias. de afrontamiento y la resiliencia con la gestión de tareas, la angustia causada por el encierro y la dificultad para observar las restricciones de salud pública. Métodos: Se realizó un estudio observacional transversal (mayo de 2020) en la Universidad Complutense de Madrid. La muestra estuvo conformada por 50 estudiantes de primer año de Ciencias de la Salud, los cuales fueron evaluados durante el confinamiento por la COVID19. Se utilizaron las siguientes escalas: Programa de Afectos Positivos y Negativos (PANAS), Afrontamiento Inventario de Orientación a Problemas Experimentados, Escala de Resiliencia Connor-Davidson y Escala de Gestión de Actividades en Situación Escala de Confinamiento. Resultados: 35 estudiantes (70%) presentaron una puntuación mayor de 6 en la escala que mide el malestar causado por las restricciones de salud pública. Las asociaciones con valores de r ≥0,5 fueron: angustia por la pandemia y afecto positivo (r=0,512); búsqueda de nuevos pasatiempos y búsqueda de apoyo social (r=0,567); búsqueda de nuevos pasatiempos y humor (r=0,56); lectura y afrontamiento activo centrado en el problema (r=0,5). Conclusiones: El afecto positivo está influenciado por conductas vinculadas a la ayuda al prójimo. Las estrategias que permitieron a los sujetos ocupar su tiempo de manera más constructiva fueron: afrontamiento activo centrado en el problema, búsqueda de apoyo psicosocial y aceptación y crecimiento personal. Los factores relacionados con el afecto negativo fueron el consumo de alcohol y/o drogas, el humor., Objetivos: Durante el confinamiento por la COVID-19, algunas personas se involucraron en comportamientos que generaron una mayor sensación de positividad y control. El objetivo del presente estudio fue identificar relaciones entre el afecto, las estrategias de afrontamiento y la resiliencia con la gestión de tareas, la angustia causada por el encierro y la dificultad para observar las restricciones de salud pública. Métodos: Se realizó un estudio observacional transversal (mayo de 2020) en la Universidad Complutense de Madrid. La muestra estuvo conformada por 50 estudiantes de primer año de Ciencias de la Salud, los cuales fueron evaluados durante el confinamiento por la COVID19. Se utilizaron las siguientes escalas: Positive and Negative Affect Schedule (PANAS), Coping Orientation to Problems Experienced Inventory, Connor-Davidson Resilience Scale y Escala de Gestión de Actividades en Situación de Confinamiento (Activity Management during Lockdown Scale). Resultados: 35 estudiantes (70%) presentaron una puntuación mayor de 6 en la escala que mide el malestar causado por las restricciones de salud pública. Las asociaciones con valores de r ≥0,5 fueron: angustia por la pandemia y afecto positivo (r=0,512); búsqueda de nuevos pasatiempos y búsqueda de apoyo social (r=0,567); búsqueda de nuevos pasatiempos y humor (r=0,56); lectura y afrontamiento activo centrado en el problema (r=0,5). Conclusiones: El afecto positivo está influido por conductas vinculadas a la ayuda al prójimo. Las estrategias que permitieron a los sujetos ocupar su tiempo de manera más constructiva fueron: afrontamiento activo centrado en el problema, búsqueda de apoyo psicosocial y aceptación y crecimiento personal. Los factores relacionados con el afecto negativo fueron el consumo de alcohol y/o drogas, el humor., Ninguna, Depto. de Enfermería, Fac. de Enfermería, Fisioterapia y Podología, TRUE, pub

This article presents two cases of anastomosis of hypoglossal nerves in the suprahyoid region in human embryos of CR length 10.75 and 17.5 mm. This variation was studied in two human specimens at this stage of development and compared with the normal arrangement of the hypoglossal nerves in embryos at the same stage. The anastomotic branches were of similar caliber to the main trunks. In both cases the anastomosis was located dorsal to the origin of the geniohyoid muscles and caudal to the genioglossus muscles, lying transversally over the cranial face of the body of the hyoid bone anlage. The anastomosis formed a suprahyoid nerve chiasm on the midline in the embryo of 10.75 mm CR length., Depto. de Anatomía y Embriología, Fac. de Medicina, TRUE, pub

Background and purpose: Hemorrhagic transformation is the main complication of revascularization therapies after stroke. Toll-like receptor 4 (TLR4) is implicated in cerebral damage and inflammation in stroke. This study was designed to determine the role of TLR4 in hemorrhagic transformation development after tissue plasminogen activator (tPA) administration. Methods: Mice expressing (TLR4+/+) or lacking functional TLR4 (TLR4-/-) were subjected to middle cerebral artery occlusion using an in situ thromboembolic model by thrombin injection into the middle cerebral artery, and tPA (10 mg/kg) was administered 20 minutes or 3 hours after ischemia. Infarct size, hemorrhages, IgG extravasation, matrix metalloproteinase 9 expression, and neutrophil infiltration were assessed 24 hours after ischemia. Results: In TLR4+/+, early reperfusion (tPA at 20 minutes) resulted infarct volume, whereas late recanalization (tPA at 3 hours) did not modify lesion size and increased the rate of the most severe hemorrhages. In TLR4-/- mice, both early and late reperfusion did not modify lesion size. Importantly, late tPA administration did not result in worse hemorrhages and in an increased bleeding area as occurred in TLR4+/+ group. In TLR4-/- animals, late reperfusion produced a lesser increase in matrix metalloproteinase 9 expression when compared with TLR4+/+ animals. Conclusions: Our results demonstrate TLR4 involvement in hemorrhagic transformation induced by delayed tPA administration, very likely by increasing matrix metalloproteinase 9 expression., Unión Europea, Ministerio de Economía y Competitividad, Instituto de Salud Carlos III, Depto. de Farmacología y Toxicología, Fac. de Medicina, TRUE, pub

Aims: Radiofrequency ablation (RFA) of septal accessory pathways (APs) is associated with a significant rate of first procedure failures and complications. Cryoablation is an alternative energy source but there are no studies comparing both ablation techniques. We aimed to systematically review the literature and compare the efficacy and safety of cryoablation vs. RFA of septal APs. Methods and results: We conducted two separate meta-analysis of cryoablation and RFA of septal APs and calculated the global estimates of the efficacy and safety. Sixty-four articles were included: 38 articles reporting RFA and 27 articles reporting cryoablation procedures. Additionally, we included the previously non-published cryoablation registry of septal APs performed at our institution. Overall, 4244 septal APs constitute our study population, 3495 in the RFA cohort and 749 in the cryoablation cohort. Acute procedural success rate of cryoablation was 86.0% (95% CI 81.6-89.4%) and RFA 89.0% (95% CI 86.8-91.0%). Recurrence rate of cryoablation was 18.1% (95% CI 14.8-21.8%) and RFA 9.9% (95% CI 8.2-12.0%). Long-term success rate after multiple ablation procedures of cryoablation was 75.9% (95% CI 68.2-82.3%) and RFA 88.4% (95% CI 84.7-91.3%). There were no reported cases of persistent atrioventricular block (AVB) with cryoablation and 2.7% (95% CI 2.2-3.4%) with RFA. Conclusion: Studies of RFA for treatment of septal APs report higher efficacy rates than do studies using cryoablation, but a significantly higher rate of AVB., Ministerio de Economía y Competitividad, Instituto Carlos III, CIBER Cardiovascular, Depto. de Medicina, Fac. de Medicina, TRUE, pub

The influence of toll-like receptor 4 on neurogenesis and inflammation has been scarcely explored so far by using neuroimaging techniques. For this purpose, we performed magnetic resonance imaging and positron emission tomography with 3'-deoxy-3'-[(18)F]fluorothymidine and [(11)C]PK11195 at 2, 7, and 14 days following cerebral ischemia in TLR4(+/+)and TLR4(-/-)mice. MRI showed similar infarction volumes in both groups. Despite this, positron emission tomography with 3'-deoxy-3'-[(18)F]fluorothymidine and [(11)C]PK11195 evidenced an increase of neurogenesis and a decrease of inflammation in TLR4(-/-)mice after ischemia. These results evidence the versatility of neuroimaging techniques to monitor the role of toll-like receptor 4 after cerebral ischemia., Depto. de Farmacología y Toxicología, Fac. de Medicina, TRUE, pub

Ninguno, Background: The MPOWER strategy encourages suitable monitoring of the tobacco epidemic among health professionals in all countries. Objective: To analyse the prevalence of and attitudes towards tobacco use among Spanish health professionals. Methods: A study was conducted based on an online survey. The study population consisted of health professionals (primary care physicians, specialist physicians and nurses). The questionnaire used included questions about tobacco consumption, knowledge of and attitudes towards smoking. The sample size was calculated according to a database with 9,500 e-mail addresses and listings of health centres and hospitals all over Spain. Statistical analysis was done using the SPSS software programme. Results: The study group comprised a total of 612 health professionals: 322 were women (52.6%), 196 were nurses and 416 were physicians. 11.7% of health professionals were smokers (9.6% regular smokers and 2.1% occasional smokers) and 41.3% were ex-smokers. Within the group of daily smokers, differences were observed between the nurses and the physicians: 11.2 versus 8.9% (p = 0.009). Smoking was recognized as a chronic disorder by 58.2% of health professionals, and 54.6% knew that the most effective intervention to help quit is a combination of psychological and pharmacological treatment. 56% of health professionals always asked their patients about their tobacco consumption. Conclusions: 11.7% of Spanish health professionals are smokers. We found that they have low knowledge about strategies to quit smoking and that there is a low level of therapeutic intervention on smokers., Depto. de Medicina, Fac. de Medicina, TRUE, pub

Eukaryotic initiation factor (eIF) 4E-binding protein 1 (4E-BP1) is a translational repressor that is characterized by its capacity to bind specifically to eIF4E and inhibit its interaction with eIF4G. Phosphorylation of 4E-BP1 regulates eIF4E availability, and therefore, cap-dependent translation, in cell stress. This study reports a physiological study of 4E-BP1 regulation by phosphorylation using control conditions and a stress-induced translational repression condition, ischemia-reperfusion (IR) stress, in brain tissue. In control conditions, 4E-BP1 was found in four phosphorylation states that were detected by two-dimensional gel electrophoresis and Western blotting, which corresponded to Thr(69)-phosphorylated alone, Thr(69)- and Thr(36)/Thr(45)-phosphorylated, all these plus Ser(64) phosphorylation, and dephosphorylation of the sites analyzed. In control or IR conditions, no Thr(36)/Thr(45) phosphorylation alone was detected without Thr(69) phosphorylation, and neither was Ser(64) phosphorylation without Thr(36)/Thr(45)/Thr(69) phosphorylation detected. Ischemic stress induced 4E-BP1 dephosphorylation at Thr(69), Thr(36)/Thr(45), and Ser(64) residues, with 4E-BP1 remaining phosphorylated at Thr(69) alone or dephosphorylated. In the subsequent reperfusion, 4E-BP1 phosphorylation was induced at Thr(36)/Thr(45) and Ser(64), in addition to Thr(69). Changes in 4E-BP1 phosphorylation after IR were according to those found for Akt and mammalian target of rapamycin (mTOR) kinases. These results demonstrate a new hierarchical phosphorylation for 4E-BP1 regulation in which Thr(69) is phosphorylated first followed by Thr(36)/Thr(45) phosphorylation, and Ser(64) is phosphorylated last. Thr(69) phosphorylation alone allows binding to eIF4E, and subsequent Thr(36)/Thr(45) phosphorylation was sufficient to dissociate 4E-BP1 from eIF4E, which led to eIF4E-4G interaction. These data help to elucidate the physiological role of 4E-BP1 phosphorylation in controlling protein synt, Depto. de Farmacología y Toxicología, Fac. de Medicina, TRUE, pub

Depto. de Farmacología y Toxicología, Fac. de Medicina, FALSE, pub

Background The authors aimed to compare the survival and complication rates of zirconia-ceramic (ZC) versus metal-ceramic (MC) restorative material in multiunit tooth-supported posterior fixed dental prostheses (FDP). Types of Studies Reviewed The authors conducted a systematic search of randomized controlled trials (RCTs), with no time or language restrictions, up to May 2019 using the MEDLINE (PubMed), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases, followed by a manual search. Results The authors included 7 RCTs in the review and 5 RCTs in the meta-analysis. All studies had a low risk of bias. The authors included 330 participants (177 ZC and 173 MC tooth-supported FDP) in the meta-analysis, which revealed a medium-term survival rate of 95.4% (95% confidence interval [CI], 90.5% to 99.1%) for ZC FDP compared with 96.9% (95% CI, 94.3% to 99.4%) for MC FDP, with no significant differences (P = .364). The biological or technical complications did not show statistically significant differences, except in the global ceramic veneering chipping analysis (P = .023; risk difference [RD], 22.3%; 95% CI, 3.0% to 41.6%) and their subanalysis: minor chipping or chipping that can be solved with polishing (P = .044; RD, 19.5%; 95% CI, 0.5% to 38.4%), and major chipping or chipping that needs repair in the laboratory (P = .023; RD, 6.0%; 95% CI, 0.8% to 11.3%). Conclusions and Practical Implications Posterior multiunit ZC restorations are considered a predictable treatment in the medium term, although they are slightly more susceptible to chipping of the veneering ceramic than MC restorations., Depto. de Odontología Conservadora y Prótesis, Fac. de Odontología, TRUE, pub

El delirium es un trastorno cognitivo que se produce con frecuencia durante la hospitalización en unidades de cuidados agudos cardiológicos (UCAC), pero su efecto tras la sustitución percutánea de la válvula aórtica (TAVI) no ha sido bien evaluado. El objetivo de este estudio es determinar la incidencia, los factores predictivos y el impacto pronóstico del delirium tras el implante de una TAVI. Métodos: Se incluyeron 501 pacientes consecutivos ingresados en una UCAC tras el implante de TAVI. Se utilizó el método de evaluación de la confusión para evaluar el delirium durante la estancia en la UCAC. Se evaluaron los factores de riesgo, el tratamiento farmacológico preventivo, las características periprocedimiento y las complicaciones. Se registraron los acontecimientos clínicos con una mediana de seguimiento de 24 meses. Resultados: La incidencia de delirium tras TAVI fue del 22,0% (n = 110). El deterioro cognitivo previo (OR 4,17; IC 95%: 1,11-15,71; p = 0,035), la enfermedad arterial periférica (OR 4,54; IC 95%: 1,79-11,54; p = 0,001), el uso de anestesia general (OR 2,55; IC 95%: 1,32-4,90; p = 0,005) y la ventilación mecánica prolongada (OR 18,86; IC 95%: 1,85-192,58; p = 0,013) se asociaron significativamente con el desarrollo de delirium. Los pacientes con delirium tuvieron una mayor estancia hospitalaria (7,5 [5,5-13,5] frente a 5,6 [4,6-8,2] días, y mayor mortalidad intrahospitalaria (OR 2,68; IC 95% 1,02-6,99; p = 0,045), a 1 año (HR 2,09; IC 95% 1,13-3,87; p = 0,018) y a 2 años (HR 1,94; IC 95% 1,12-3,34; p = 0,017). Conclusiones: El delirium es una complicación frecuente en los pacientes ingresados en la UCAC tras el implante de una TAVI, y se asocia con una estancia hospitalaria prolongada y una mayor mortalidad intrahospitalaria y a medio plazo., Depto. de Medicina, Fac. de Medicina, TRUE, pub

The case presented includes a left temporal bone from an individual exhumed from the Hispano-Mudejar necropolis in Uceda (Guadalajara, Spain) dated between the 13th and 14th centuries bc. External examination and computed tomography images show lesions in the external acoustic canal, in the form of diffuse widening, suggestive of a cholesteatoma originating in this canal, with invasion of the middle ear through the tympanic membrane. The difficulties with examining the internal elements of the ear are discussed, which causes the underestimation of these diseases in paleopathology studies., Banco de Santander, Universidad Complutense de Madrid, Depto. de Anatomía y Embriología, Fac. de Medicina, TRUE, pub

Background:Neuropsychologicalassessmentis considereda valid tool in the diag-nosisof neurodegenerativedisorders.However,thereis an importantoverlapincognitiveprofilesbetweenAlzheimer'sdisease(AD) and behaviouralvariantfronto-temporaldementia(bvFTD),andthe usefulnessin diagnosisis uncertain.Weaimedtodevelopmachinelearning‐basedmodelsfor the diagnosisusingcognitivetests. Methods:Threehundredand twenty‐nineparticipants(170AD, 72 bvFTD,87healthycontrol[HC])wereenrolled.Evolutionaryalgorithms,inspiredby the pro-cess of naturalselection,wereappliedfor both mono‐objectiveand multi‐objectiveclassificationand featureselection.Classicalalgorithms(NativeBayes,SupportVectorMachines,amongothers)werealso used,and a meta‐modelstrategy. Results:Accuraciesfor the diagnosisof AD, bvFTDand the differentialdiagnosisbetweenthemwerehigherthan 84%.Algorithmswereable to significantlyreducethe numberof testsand scoresneeded.Free and CuedSelectiveRemindingTest,verbalfluencyand Addenbrooke'sCognitiveExaminationwereamongstthe mostmeaningfultests. Conclusions:Our studyfoundhigh levelsof accuracyfor diagnosisusingexclusivelyneuropsychologicaltests,whichsupportsthe usefulnessof cognitiveassessmentindiagnosis.Machinelearningmay have a role in improvingthe interpretationand testselection., Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Fac. de Psicología, TRUE, pub

El artículo ha recibido 2548 visualizaciones con 3 citaciones., Hypertriglyceridemia is a metabolic complication associated with parenteral nutrition (PN). It is unknown if patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19 are more at risk. Our aim was to describe the incidence, risk factors and clinical impact of hypertriglyceridemia in critically ill patients with ARDS-COVID-19 receiving PN. We designed a cohort study of patients with ARDS-COVID-19 infection that required admission to critical care units and nutritional support with PN. Individual PN prescriptions for macronutrients and insulin were provided. Lipid emulsion contained fish oil (SMOFlipid® or Lipoplus®). Hypertriglyceridemia was defined as plasma levels above 400 mg/dL. Eighty-seven patients, 66.6% men, 60.1 ± 10.8 years old, BMI 29.1 ± 5.6 kg/m2, 71% of whom received lopinavir/ritonavir, 56% received Propofol and 55% received Tocilizumab were included. The incidence of hypertriglyceridemia was 37 × 100 patientdays with PN. This complication was more frequent in obese patients (OR 3.34; 95% CI, 2.35–4.33) and in those treated with lopinavir/ritonavir (OR 4.98; 95% CI, 3.60–6.29) or Propofol (OR 2.45; 95% CI, 1.55–3.35). Total mortality was 33.3%, similar between the type of lipid emulsion (p = 0.478). On average, patients with hypertriglyceridemia had a longer requirement of PN compared to the group without elevated triglycerides (TG), probably because of their longer survival (p = 0.001). TG higher than 400 mg/dL was not a protective factor for mortality (OR 0.31; 95% CI, 0.01–1.30). In conclusion, the incidence of hypertriglyceridemia was 37 × 100 patient-days with PN. The risk of this complication is associated with obesity and the use of lopinavir/ritonavir or Propofol., Depto. de Medicina, Fac. de Medicina, TRUE, pub

Estudio retrospectivo unicéntrico que evaluó a 811 pacientes con un infarto agudo de miocardio. El estudio comparó el momento en el que presentaron el evento con el tamaño del infarto. Se pudo comprobar que los infartos fueron mas grandes en pacientes que lo padecieron durante la transición noche-día (entre las 6.00 y 12.00 am), resultados que ayudaron a interpretar el efecto cardioprotector de otras estrategias terapéuticas en pacientes con infarto de miocardio en ensayos clínicos posteriores., Background: The circadian clock influences a number of cardiovascular (patho)physiological processes including the incidence of acute myocardial infarction. A circadian variation in infarct size has recently been shown in rodents, but there is no clinical evidence of this finding. Objective: To determine the impact of time-of-day onset of ST segment elevation myocardial infarction (STEMI) on infarct size. Methods: A retrospective single-centre analysis of 811 patients with STEMI admitted between 2003 and 2009 was performed. Infarct size was estimated by peak enzyme release. The relationship between peak enzyme concentrations and time-of-day were characterised using multivariate regression splines. Time of STEMI onset was divided into four 6-hour periods in phase with circadian rhythms. Results: Model comparisons based on likelihood ratio tests showed a circadian variation in infarct size across time-of-day as evaluated by peak creatine kinase (CK) and troponin-I (TnI) concentrations (p=0.015 and p=0.012, respectively). CK and TnI curves described similar patterns across time, with a global maximum in the 6:00-noon period and a local minimum in the noon-18:00 period. Infarct size was largest in patients with STEMI onset in the dark-to-light transition period (6:00-noon), with an increase in peak CK and TnI concentrations of 18.3% (p=0.031) and 24.6% (p=0.033), respectively, compared with onset of STEMI in the 18:00-midnight period. Patients with anterior wall STEMI also had significantly larger infarcts than those with STEMI in other locations. Conclusions: Significant circadian oscillations in infarct size were found in patients according to time-of-day of STEMI onset. The infarct size was found to be significantly larger with STEMI onset in the dark-to-light transition period (6:00-noon). If confirmed, these results may have a significant impact on the interpretation of clinical trials of cardioprotective strategies in STEMI, Depto. de Medicina, Fac. de Medicina, TRUE, pub

Health Track; validation; blood pressure; heart rate; International Protocol, Background: Hypertension is a global public health issue and is closely related to chronic kidney disorder (CKD). In people with CKD, strict monitoring of blood pressure is an important part of therapy. Objective: The aim of this research was to validate the iHealth Track blood pressure monitoring device for patients with CKD according to the European Society of Hypertension International Protocol 2010 (ESH-IP2). Methods: In total, 33 patients who received hemodialysis in Plasencia participated in the study. There were 9 successive measurements made, which conformed to the ESH-IP2. We calculated the differences between the standard reference device (Omron M3 Intellisense) and the test device (iHealth Track) for blood pressure and heart rate values. For 99 total comparisons of paired measurements, we classified differences into various categories (≤5 mmHg, ≤10 mmHg, and ≤15 mmHg for blood pressure; ≤3, ≤5, and ≤8 beats per minute for heart rate). Results: In 90 of 99 systolic blood pressure and 89 of 99 diastolic blood pressure comparisons between the devices, measurement differences were within 5 mmHg. In 81 of 99 heart rate comparisons between the devices, measurement differences were within 3 beats per minute. The mean differences between the test and reference standard measurements were 3.27 (SD 2.99) mmHg for systolic blood pressure, 3.59 (SD 4.55) mmHg for diastolic blood pressure, and 2.18 (SD 2.75) beats per minute for heart rate. We also observed that for both systolic and diastolic blood pressure, 31 of 33 participants had at least two of three comparisons between the devices with measurement differences less than 5 mmHg. For heart rate, 28 of 33 patients had at least two of three comparisons between the devices with measurement differences less than 3 beats per minute. Conclusions: To our knowledge, this is the first study to show that iHealth Track meets the requirements of the ESH-IP2 in patients with CKD. Therefore, the iHealth Track is suitable for use, Depto. de Enfermería, Fac. de Enfermería, Fisioterapia y Podología, TRUE, pub

Este estudio, en el cual el solicitante es autor senior (útimo autor), estuvo encaminado a determinar si un protocolo de evaluación de enfermedad coronaria adaptado al riesgo basal en pacientes receptores de trasplante hepático, era capaz de atenuar el riesgo de enfermedad coronaria y en la supervivencia de pacientes trasplantados. El resultado fundamental de este estudio prospectivo fue que este protocolo (que comprende una evaluacion escalonada de la anatomía coronaria con intervenciones terapéuticas adaptadas) iguala la probabilidad de eventos cardiovasculares postrasplante con respecto a los pacientes de bajo riesgo. La aplicabilidad de este estudio es grande puesto que permite de forma protocolizada y adaptada a cada paciente la valoracion precisa del riesgo coronario, evitando exploraciones agresivas., The prevalence and management of coronary artery disease (CAD) in liver transplantation (LT) candidates are not well characterized. The aims of this study were to evaluate the impact on clinical outcomes of a specifically designed protocol for the management of asymptomatic CAD in LT candidates and to investigate noninvasive risk profiles for obstructive and nonobstructive CAD for 202 LT candidates. Those with high baseline cardiovascular risk (CVR; defined by the presence of classic CVR factors and/or decreased ejection fraction) received coronary angiography and significant arterial stenosis and were treated with percutaneous stents. Patients were followed up after LT until death or coronary event (CE). There were 78 patients who received coronary evaluation (62 direct angiography, 14 computed tomography coronary angiography, and 2 both). Of them, 39 (50%) patients had CAD of any severity, and 6 (7.7%) had significant lesions (5 were amenable to be treated with stents, whereas 1 patient had diffuse lesions which contraindicated the LT). Insulin-dependent diabetes was the only factor related to CAD of any severity (odds ratio, 3.44; 95% confidence interval [CI], 1.00-11.97). A total of 69 patients (46 with coronary evaluation) received LT. The incidence of CEs and overall survival after LT were similar between patients with and without coronary evaluation. Furthermore, no differences occurred between these groups in a multivariate competing risk model (subhazard ratio, 0.84; 95% CI, 0.27-2.61; P = 0.76). In conclusion, the application of an angiographic screening protocol of CAD in a selected high-risk Mediterranean population is safe and effective. The short- and medium-term incidence rates of CEs and death after LT in this population are similar to that observed in low-risk patients., Depto. de Medicina, Fac. de Medicina, TRUE, pub

ackground: Allergy to kiwi fruit is being increasingly reported, but it has never been evaluated by means of a double-blind, placebo-controlled food challenge (DBPCFC) study. Objective: We sought to assess kiwi allergy on the basis of a DBPCFC and identify the patterns of allergen recognition in sensitized patients from a birch-free area. Methods: Forty-three patients with allergy symptoms who were sensitized to kiwi were evaluated by means of clinical history, skin tests, IgE determinations, and DBPCFCs. The pattern of allergen recognition was assessed by means of IgE immunoblotting. Sequence analysis of IgE-binding bands was performed by using Edman degradation. Results: DBPCFCs were performed in 33 patients; 4 patients had experienced severe anaphylaxis, and 6 patients declined informed consent. DBPCFC results were positive in 23 patients and negative in 10 patients. The most frequent clinical manifestation was oral allergy syndrome. Twenty-one percent of the patients were not allergic to pollen. Forty-six percent of patients experienced systemic symptoms, and this happened with higher frequency in patients not allergic to pollen (100%). Twenty-eight percent of the patients were sensitized to latex. The IgE-binding bands in kiwi extract more frequently recognized by patient sera were those of 30, 24, 66, and 12 kd, and they could not be associated with any pattern of kiwi-induced allergic reactions. Conclusion: The results provide evidence that kiwi allergy is not a homogeneous disorder because several clinical subgroups can be established. No definite allergen-recognition pattern was associated with the type of allergic reactions to kiwi. One of 5 patients with kiwi allergy was not allergic to pollen, and these patients had the highest risk of systemic reactions to kiwi., Depto. de Bioquímica y Biología Molecular, Fac. de Ciencias Químicas, TRUE, pub

Las guías de práctica clínica actuales recomiendan centralizar la atención de los pacientes con shock cardiogénico en centros de alto volumen. El objetivo de este estudio era evaluar la asociación entre las características hospitalarias, incluida la disponibilidad de una unidad de cuidados intensivos cardiológicos y los resultados en los pacientes con shock cardiogénico relacionado con infarto de miocardio con elevación del segmento ST (IAMCEST). Métodos: Los episodios de alta con diagnóstico de SC relacionado con IAMCEST entre 2003 y 2015 fueron seleccionados del Conjunto Mínimo de Datos del Sistema Nacional de Salud español. Los centros se clasificaron en función de la disponibilidad de servicio de cardiología, laboratorio de hemodinámica, servicio de cirugía cardiaca y unidad de cuidados intensivos cardiológicos. El resultado principal medido fue la mortalidad intrahospitalaria. Resultados: Se identificaron un total de 19.963 episodios. La edad media era de 73,4 años. La proporción de pacientes con SC tratados en hospitales con laboratorio de hemodinámica y servicio de cirugía cardíaca aumentó del 38,4% en 2005 al 52,9% en 2015 (p < 0,005). Las tasas de mortalidad bruta y ajustada por riesgo disminuyeron con el tiempo, del 82% al 67,1%, y del 82,7% al 66,8%, respectivamente (ambas P < 0,001). La revascularización coronaria, ya fuera percutánea o mediante bypass coronario, se asoció de forma independiente a un menor riesgo de mortalidad (OR 0,29 y 0,25; ambas p < 0,001, respectivamente). La disponibilidad de cuidados intensivos cardiológicos se asoció a tasas de mortalidad ajustadas más bajas (65,3% frente a 72%; P < 0.001). Conclusiones: La proporción de pacientes con SC relacionada con IAMCEST tratados en centros altamente especializados aumentó mientras que la mortalidad disminuyó durante el período de estudio. Los mejores resultados se asociaron a la mayor realización de procedimientos de revascularización y al acceso a unidades de cuidados intensivos cardioló, Introduction and objectives: Current guidelines recommend centralizing the care of patients with cardiogenic shock in high-volume centers. The aim of this study was to assess the association between hospital characteristics, including the availability of an intensive cardiac care unit, and outcomes in patients with ST-segment elevation myocardial infarction (STEMI)-related cardiogenic shock (CS). Methods: Discharge episodes with a diagnosis of STEMI-related CS between 2003 and 2015 were selected from the Minimum Data Set of the Spanish National Health System. Centers were classified according to the availability of a cardiology department, catheterization laboratory, cardiac surgery department, and intensive cardiac care unit. The main outcome measured was in-hospital mortality. Results: A total of 19 963 episodes were identified. The mean age was 73.4±11.8 years. The proportion of patients with CS treated at hospitals with a catheterization laboratory and cardiac surgery department increased from 38.4% in 2005 to 52.9% in 2015 (P <.005). Crude- and risk-adjusted mortality rates decreased over time, from 82% to 67.1%, and from 82.7% to 66.8%, respectively (both P <.001). Coronary revascularization, either percutaneous or coronary artery bypass grafting, was independently associated with a lower mortality risk (OR, 0.29 and 0.25; both P <.001, respectively). Intensive cardiac care unit availability was associated with lower adjusted mortality rates (65.3%±7.9 vs 72±11.7; P <.001). Conclusions: The proportion of patients with STEMI-related CS treated at highly specialized centers increased while mortality decreased during the study period. Better outcomes were associated with the increased performance of revascularization procedures and access to intensive cardiac care units over time., Depto. de Medicina, Fac. de Medicina, TRUE, pub

Background/aims: A previous study has demonstrated that endogenous male sex hormones do not alter neuronal nitric oxide (NO) release in rat mesenteric artery. However, the regulatory role of endogenous male sex hormones on noradrenaline (NA) release in rat mesenteric artery is not known. The present study was designed to analyze whether endogenous male sex hormones influence the NA release induced by electrical field stimulation (EFS), as well as the possible modification in NA and neuronal NO release by presynaptic beta-adrenoceptor activation. Methods: For this purpose, mesenteric arteries from control and orchidectomized male Sprague-Dawley rats were used. Basal and EFS-induced neuronal NO and NA release, as well as the contractile effect induced by EFS, was measured. Results: Basal and EFS-induced neuronal NO and NA release were similar in arteries from control and orchidectomized rats. The beta-adrenoceptor agonist clenbuterol did not modify EFS-induced neuronal NO and NA release in arteries from control rats. In contrast, in arteries from orchidectomized animals, clenbuterol increased both neuronal NO and NA release; this increase was prevented by incubation with the beta-adrenoceptor antagonist propranolol. However, the contractile response elicited by EFS was not modified by clenbuterol in either group of rats. Conclusions: These results show that orchidectomy does not alter the EFS-induced NA release. What is more, activation of presynaptic beta-adrenoceptors does not modify EFS-induced NA and neuronal NO release in arteries from control rats although it increases the release of both neurotransmitters in arteries from orchidectomized rats. Despite these modifications, the EFS-induced contractile response is preserved in arteries from orchidectomized rats., Depto. de Biología Celular, Fac. de Odontología, TRUE, pub

This work was supported by grants from the Spanish Ministry of Economy and Competitiveness (SAF2015-65722-R to Dr. Lara-Pezzi and SAF2014-59594-R to Dr. Serratosa), Autonomous Community of Madrid (2010-BMD2321, FIBROTEAM Consortium), European Union's FP7 (CardioNeT-ITN-289600, CardioNext-ITN-608027), the Spanish Carlos III Institute of Health (CPII14/00027 to Dr. Lara-Pezzi, PI13/00865 to Dr. Sanchez and RD12/0042/066 to Drs. Garcia-Pavia and Lara-Pezzi), and the National Institute of Neurological Disorders And Stroke of the National Institutes of Health (P01NS097197 to Dr. Sanchez). This work was also supported by the Plan Estatal de I+D+I 2013-2016-European Regional Development Fund (FEDER) "A way of making Europe," Spain. The Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC) is supported by the Spanish Ministry of Economy and Competitiveness (MINECO) and the Pro-CNIC Foundation, and is a Severo Ochoa Center of Excellence (MINECO award SEV-2015-0505)., Ministerio de Economía y Competitividad (España), Comunidad de Madrid (España), Unión Europea. Comisión Europea, Instituto de Salud Carlos III, National Institutes of Health (Estados Unidos), Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF), Fundación ProCNIC, Depto. de Medicina y Cirugía Animal, Fac. de Veterinaria, TRUE, pub

Objectives: To describe neonatal and maternal characteristics of the largest prospective cohort of newborns from mothers with coronavirus disease 2019 (COVID-19), the data of which were prospectively collected from the nationwide registry of the Spanish Society of Neonatology. Methods: Between March 8, 2020, and May 26, 2020, the data of 503 neonates born to 497 mothers diagnosed with COVID-19 during pregnancy or at the time of delivery were collected by 79 hospitals throughout Spain. Results: Maternal symptoms were similar to that of the general population, with 5% of severe forms. In 45.8% of asymptomatic women at the time of delivery, severe acute respiratory syndrome coronavirus 2 infection was detected because of recommendations established in Spain to perform COVID-19 screening in all women admitted to the hospital for labor. The rate of preterm deliveries was 15.7% and of cesarean deliveries, 33%. The most common diagnostic test was detection of viral RNA by polymerase chain reaction of nasopharyngeal swabs at a median age of 3 hours after delivery (1-12 hours). Almost one-half of neonates were left skin-to-skin after delivery, and delayed clamping of umbilical cords was performed in 43% of neonates. Also, 62.3% of asymptomatic neonates were managed with rooming-in. Maternal milk was received by 76.5% of neonates, 204 of them as exclusive breastfeeding. Conclusions: The current study indicates that there is no need for separation of mothers from neonates, allowing delayed cord clamping and skin-to-skin contact along with maintenance of breastfeeding in a high percentage of newborns from mothers with COVID-19., Sociedad Española de Neonatología, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Zoonotic leishmaniases are a worldwide public health problem for which the development of effective vaccines remains a challenge. A vaccine against leishmaniases must be safe and affordable and should induce cross-protection against the different disease-causing species. In this context, the DNA vaccine pHisAK70 has been demonstrated to induce, in a murine model, a resistant phenotype against L. major, L. infantum, and L. amazonensis. Moreover, a chimeric multiepitope peptide, HisDTC, has been obtained by in silico analysis from the histone proteins encoded in the DNA vaccine and has showed its ability to activate a potent CD4+ and CD8+ T-cell protective immune response in mice against L. infantum infection. In the present study, we evaluated the plasmid DNA vaccine pHisAK70 in comparison with the peptide HisDTC (with and without saponin) against L. major and L. infantum infection. Our preliminary results showed that both formulations were able to induce a potent cellular response leading to a decrease in parasite load against L. infantum. In addition, the DNA candidate was able to induce better lesion control in mice against L. major. These preliminary results indicate that both strategies are potentially effective candidates for leishmaniases control. Furthermore, it is important to carry out such comparative studies to elucidate which vaccine candidates are the most appropriate for further development., COMUNIDAD DE MADRID, Depto. de Sanidad Animal, Fac. de Veterinaria, TRUE, pub

Background: The crista terminalis (CT) has been identified as the posterior boundary of typical atrial flutter (AFL) in the lateral wall (LW) of the right atrium (RA). To study conduction properties across the CT, rapid pacing was performed at both sides of the CT after bidirectional conduction block was achieved in the cavotricuspid isthmus by radiofrequency catheter ablation. Methods and results: In 22 patients (aged 61+/-7 years) with AFL (cycle length, 234+/-23 ms), CT was identified during AFL by double electrograms recorded between the LW and posterior wall (PW). After the ablation procedure, decremental pacing trains were delivered from 600 ms to 2-to-1 local capture at the LW and PW or coronary sinus ostium (CSO). At least 5 bipolar electrograms were recorded along the CT from the high to the low atrium next to the inferior vena cava. No double electrograms were recorded during sinus rhythm in that area. Complete transversal conduction block all along the CT (detected by the appearance of double electrograms at all recording sites and craniocaudal activation sequence on the side opposite to the pacing site) was observed in all patients during pacing from the PW or CSO (cycle length, 334+/-136 ms), but it was fixed in only 4 patients. During pacing from the LW, complete block appeared at a shorter pacing cycle length (281+/-125 ms; P<0.01) and was fixed in 2 patients. In 3 patients, complete block was not achieved. Conclusions: These data suggest the presence of rate-dependent transversal conduction block at the crista terminalis in patients with typical AFL. Block is usually observed at longer pacing cycle lengths with PW pacing than with LW pacing. This difference may be a critical determinant of the counterclockwise rotation of typical AFL, Depto. de Medicina, Fac. de Medicina, TRUE, pub

Objective: to explore attitudes towards patients' self-reported data about foot health-related beliefs from a behavioural and attitudinal perspective. Methods: a sample of 282 participants of a mean age of 39.46 ± 16.026 came to a health centre where self-reported demographic, clinical characteristics and beliefs relating to foot health data were registered, informants' completed all the stages of the research process. Results: the results of the analysis revealed an 8-factor factorial structure based on (1) podiatric behaviours, (2) the intention to carry out protective behaviour, (3) attitudinal beliefs, (4) normative beliefs, (5) needs, (6) apathy, (7) self-care, and (8) the general perception of foot health. They all explained 62.78% of the variance, and were considered as independent variables in a regression analysis to determine which provided the best explanations for the importance attributed to foot health. Conclusions: the participants in the study revealed a positive attitude in relation to foot health care and responsible behaviour., Depto. de Enfermería, Fac. de Enfermería, Fisioterapia y Podología, TRUE, pub

Background: The FIRE AND ICE trial assessed efficacy and safety of pulmonary vein (PV) isolation using cryoballoon versus radiofrequency current (RFC) ablation in patients with drug refractory, symptomatic, paroxysmal atrial fibrillation (AF). The purpose of the current study was to assess index lesion durability as well as reablation strategy and outcomes in trial patients undergoing a reablation procedure. Methods: Patients with reablation procedures during FIRE AND ICEwere retrospectively consented and enrolled at 13 trial centers. The first reablation for each patient was included in the analysis. Documented arrhythmias before reablation, number and location of reconnected PVs, lesions created during reablations, procedural characteristics, and acute as well as long-term outcomes were assessed. Results: Eighty-nine (36 cryoballoon and 53 RFC) patients were included in this study. Paroxysmal atrial fibrillation was the predominant recurrent arrhythmia (69%) before reablation. Reablations occurred at a median of 173 and 182 days (P=0.54) in the cryoballoon and RFC cohorts, respectively. The number of reconnected PVs was significantly higher in the RFC than the cryoballoon group (2.1±1.4 versus 1.4±1.1; P=0.010), which was driven by significantly more reconnected left superior PVs and markedly more reconnected right superior PVs. The number of (predominantly RFC) lesions applied during reablation was significantly greater in patients originally treated with RFC (3.3±1.3 versus 2.5±1.5; P=0.015) with no difference in overall acute success (P=0.70). After reablation, no differences in procedure-related rehospitalization or antiarrhythmic drug utilization were observed between cohorts. Conclusions: At reablation, patients originally treated with the cryoballoon had significantly fewer reconnected PVs, which may reflect RFC catheter instability in certain left atrial regions, and thus required fewer lesions for reablation success. Repeat ablations were predominantly pe, Depto. de Medicina, Fac. de Medicina, TRUE, pub

Delayed gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) imaging requires novel and time-efficient approaches to characterize the myocardial substrate associated with ventricular arrhythmia in patients with ischemic cardiomyopathy. Using a translational approach in pigs and patients with established myocardial infarction, we tested and validated a novel 3D methodology to assess ventricular scar using custom transmural criteria and a semiautomatic approach to obtain transmural scar maps in ventricular models reconstructed from both 3D-acquired and 3D-upsampled-2D-acquired LGE-CMR images. The results showed that 3D-upsampled models from 2D LGE-CMR images provided a time-efficient alternative to 3D-acquired sequences to assess the myocardial substrate associated with ischemic cardiomyopathy. Scar assessment from 2D-LGE-CMR sequences using 3D-upsampled models was superior to conventional 2D assessment to identify scar sizes associated with the cycle length of spontaneous ventricular tachycardia episodes and long-term ventricular tachycardia recurrences after catheter ablation. This novel methodology may represent an efficient approach in clinical practice after manual or automatic segmentation of myocardial borders in a small number of conventional 2D LGE-CMR slices and automatic scar detection., Depto. de Medicina, Fac. de Medicina, TRUE, pub

A rare case in the remains of a full-term fetus was recovered from the archaeological site 'Arriaca-Zaide' (Guadalajara, Spain) that dates to the century V-VII BC. The right humerus presents an osseous tubercle, fractured at its end that extends obliquely forward and medially, from the anteromedial aspect of the lower third of the humerus. It is a supracondylar process, a rare osseous anatomic variation. The presence of the supracondylar process in the fetal period allowed us to propose its congenital nature. Furthermore, its disposition and state of ossification allowed us to suggest that it was formed from the ossification center of the humeral diaphysis and not from a secondary ossification center. This case represents the first time that the supracondylar process during the fetal period has been described in the anthropological physical literature., Banco de Santander/Universidad Complutense de Madrid, Depto. de Anatomía y Embriología, Fac. de Medicina, TRUE, pub

Objective: To prepare and characterize the physicochemical and pharmacokinetic properties of clarithromycin laurate (CLM-L), a fatty acid salt of clarithromycin (CLM). Methods: CLM-L was prepared by a simple co-melting process. The formation of CLM-L was confirmed using FTIR, 1H NMR, and 13C NMR. Solubility, intrinsic dissolution rate (IDR), and partitioning properties of CLM-L were determined and compared to those of CLM. Bioavailability of CLM from CLM-L tablets was evaluated in healthy volunteers and compared to immediate release CLM tablets. Results: CLM-L showed lower aqueous solubility, higher partitioning coefficient, and slower dissolution rate. Tablets of CLM-L also showed a significantly slower in vitro release in comparison to CLM tablets. Cmax, Tmax and AUC of CLM-L tablets and immediate release CLM tablets did not show a significant difference. However, the AUC0!1 for the CLM-L tablets tended to be higher than that of CLM tablets at all-time points. Conclusion: CLM-L was successfully prepared and its formation was confirmed. CLM-L was more hydrophobic than CLM. It exhibited a slight in vivo absorption enhancement in comparison to CLM. However, its pharmacokinetic behavior was comparable to that of CLM., Depto. de Farmacia Galénica y Tecnología Alimentaria, Fac. de Farmacia, Instituto Universitario de Farmacia Industrial, TRUE, pub

A double-bundle anterior cruciate ligament (ACL) reconstruction associated with an anterolateral ligament (ALL) reconstructions is performed. The semitendinosus and gracilis are harvested. At knee maximum flexion, the anteromedial (AM) femoral tunnel is performed in the AM footprint area. Through the anterolateral portal, the tip of the outside-in femoral guide is placed in the posterolateral footprint area. The guide sleeve is pushed onto the lateral femoral cortex at the ALL attachment. At 110° knee flexion, the posterolateral-ALL tunnel is performed. The tibial ACL tunnel is performed as usual. The tibial guide is placed between the ALL tibial attachment and the tibial ACL tunnel entrance to perform the ALL tibial tunnel. The gracilis graft is introduced from caudal to cranial, achieving fixation with a 6-mm diameter screw (outside-in). The AM femoral fixation is achieved with a suspension device. ACL tibial graft fixation is achieved with a screw. Afterward, the gracilis is passed under the fascia lata to the tibial entry point. A 6-mm diameter screw is placed from the external cortex into the tibial ALL tunnel. The biomechanical advantage of the double-bundle ACL reconstruction with the biomechanical advantage of the ALL anatomic reconstruction is achieved., Depto. de Anatomía y Embriología, Fac. de Medicina, TRUE, pub

Consejería de Educación, Juventud y Deporte of Comunidad de Madrid, Unión Europea, Depto. de Medicina y Cirugía Animal, Fac. de Veterinaria, TRUE, pub