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Introduction: Chronic kidney disease (CKD) is associated with high cardiovascular disease (CVD) risk, and requires specific interventions to decreases CVD risk.The guidelines indicate that systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. The European Society Cardiology (ESC) guidelines, he European Renal Association (ERA) Council and the Spanish Society of Nephrology (S.E.N.) in collaboration with 15 Scientific Societies recommend assessing albuminuria in all these populations.We have evaluated current clinical practice regarding the assessment of CVD risk factors (blood pressure, albuminuria, serum cholesterol, glycemia and creatinine) in different adult health user populations, analyzing the results separately for men and women, given recent evidence on gender differences in the recognition, monitoring, and management of CKD. Methods: Observational, retrospective, non-interventional single center study performed in a hospital using Electronic Health Record (EHR) data. Results: Among 707,493 healthcare users, 612,619 were adults, and of these 332,943 (54.3%) females; 73,632 (12.0%) had DM and 121,445 (19.8%) hypertension. Mean (SD) age was 68.91 ± 21.4 years; 261,694 (36.9%) were older than 50 years.Only 8522 (1.39%) had undergone albuminuria testing as compared with 264,684 (43.21%) tested for serum creatinine, 140,492 (22.93%) for serum cholesterol, 263,381 (42.99%) for serum glucose, and 226,448 (36.96%) for blood pressure. Albuminuria was the only cardiovascular risk factor assessed more frequently in men than in women.Albuminuria, as other CVD risk factors, was more frequently assessed in patients with DM (6.71% of patients) or hypertension (4.81%), but albuminuria assessment remained suboptimal compared with 58–87% for other cardiovascular risk factors. For adults with diabetes or hypertension, albuminuria was assessed more frequently in men than in women.Albuminuria assessment in those older than 50 years was also suboptimal at 2.24%, as compared with 31–47% for other CVD risk factors.Albuminuria and EGFR are needed to screen for CKD, meaning that a urine test for albumin and creatinine and a serum test for creatinine are needed. To these, we may add assessment of blood pressure, serum cholesterol (for familial hypercholesterolemia) and serum glucose for Diabetes. Albuminuria was the only cardiovascular risk factor that was assessed more frequently in men (up to nearly 60% more frequently), indicating that screening for CKD and CVD risk in women is suboptimal. This result is surprisingly consistent across time and in all age groups. This is the first time that gender disparities in the assessment of albuminuria have been revealed. Conclusion: Albuminuria is assessed infrequently, even in patients with a high cardiovascular risk, especially in women. Resumen: Introducción: La enfermedad renal crónica (ERC) se asocia con un alto riesgo de enfermedad cardiovascular (ECV) y requiere intervenciones específicas para disminuir este riesgo.Las guías recomiendan una evaluación global sistemática del riesgo de ECV en personas con cualquier factor de riesgo vascular importante. Las guías de la Sociedad Europea de Cardiología (SEC), la Asociación Renal Europea (ERA) y la Sociedad Española de Nefrología (SEN), en colaboración con 15 sociedades científicas, recomiendan evaluar la albuminuria en todas estas poblaciones.Hemos evaluado la práctica clínica actual con respecto a la evaluación de los factores de riesgo de ECV (presión arterial, albuminuria, colesterol sérico, glucemia y creatinina) en diferentes poblaciones adultas de usuarios de salud, analizando los resultados por separado para los hombres y las mujeres, dada la evidencia reciente sobre las diferencias de género en el reconocimiento, el seguimiento y el tratamiento de la ERC. Métodos: Estudio observacional, retrospectivo, no intervencionista, unicéntrico, realizado en un hospital utilizando datos de la historia clínica electrónica. Resultados: De los 707.493 usuarios de atención sanitaria, 612.619 eran adultos. De ellos, 332.943 (54,3%) eran mujeres, 73.632 (12,0%) tenían DM y 121.445 (19,8%) tenían hipertensión. La edad media (DE) fue 68,91 ± 21,4 años; 261.694 (36,9%) eran mayores de 50 años.Solo 8.522 (1,39%) se habían sometido a pruebas de albuminuria en comparación con 264.684 (43,21%) de creatinina sérica, 140.492 (22,93%) de colesterol sérico, 263.381 (42,99%) de glucosa sérica y 226.448 (36,96%) de presión arterial. La albuminuria fue el único factor de riesgo cardiovascular evaluado con mayor frecuencia en hombres que en mujeres.La albuminuria, como otros factores de riesgo de ECV, se evaluó con mayor frecuencia en pacientes con DM (6,71% de los pacientes) o hipertensión (4,81%), pero la evaluación de la albuminuria siguió siendo subóptima en comparación con el 58% al 87% para otros factores de riesgo cardiovascular. Para los adultos con diabetes o hipertensión, la albuminuria se evaluó con mayor frecuencia en hombres que en mujeres.La evaluación de la albuminuria en los mayores de 50 años también fue subóptima, con un 2,24%, en comparación con un 31% a un 47% para otros factores de riesgo de ECV.La albuminuria y el FGe son necesarios para detectar ERC, lo que implica la determinación de albúmina y creatinina en orina y de creatinina en suero. A estos podemos agregar la evaluación de la presión arterial, el colesterol sérico (para la hipercolesterolemia familiar) y la glucosa sérica para la diabetes. La albuminuria fue el único factor de riesgo cardiovascular que se evaluó con mayor frecuencia en hombres (hasta casi un 60% más frecuentemente), lo que indica que la detección de ERC y riesgo de ECV en mujeres es subóptima. Este resultado es sorprendentemente consistente a lo largo del tiempo y en todos los grupos de edad. Esta es la primera vez que se revelan disparidades de género en la evaluación de la albuminuria. Conclusión: La albuminuria se evalúa con poca frecuencia, incluso en pacientes con alto riesgo cardiovascular, especialmente en mujeres.

En este artículo se ofrece la referencia de una serie de documentos inéditos sobre el interrogatorio a que fue sometido en 1584 un varón de nombre Ottaviano de Gante (o Urrea), que decía ser hijo de Carlos V. El interrogatorio y las cartas citadas se conservan en el Archivo General de Simancas. En las respuestas mencionó la decisiva participación en las peripecias de su vida del aragonés Juan de Verzosa, con datos que colman algunas lagunas de la vida del humanista, y de otros personajes notables como Francisco de Borja, Pedro Juan Núñez y los diplomáticos españoles en Roma y en Venecia.

Pedacio Dioscórides de Anazarba (siglo I) fue médico, botánico y cirujano militar del ejército en Roma durante el gobierno de Nerón. Escribió el De Materia Medica, popularmente conocido como el Dioscórides, una obra en cinco volúmenes que recoge la descripción de más de 600 plantas medicinales, así como varias decenas de sustancias minerales y animales, también con propiedades curativas. Esta obra, considerada la precursora de la farmacopea moderna, tuvo una gran difusión durante la Edad Media y el Renacimiento, en su griego original y en las traducciones que se hicieron primero al árabe y el latín y, posteriormente, a lenguas vernáculas. A mitad del siglo XVI empezó la vernacularización de esta obra a través de sus traducciones al italiano, primero de mano de Fausto da Longiano, luego de Andrea Mattioli, el autor que más contribuyó a la difusión de las ediciones impresas de esta obra en la Italia renacentista. El objetivo de este trabajo es conocer la importancia que llegó a tener esta obra en Italia a través del estudio de dedicatorias de sus múltiples ediciones italianas en el siglo XVI: a quién iban dirigidas estas dedicatorias y qué valor tenían para los dedicatarios.

Purpose: Systemic sclerosis (scleroderma) is a chronic autoimmune connective tissue disorder that can lead to notable pain and functional limitations of the digits. This study assessed complications and reoperations after interphalangeal (IP) joint arthrodesis in patients with scleroderma. Methods: A retrospective review was performed of all patients who underwent digital joint arthrodesis of the proximal IP (PIP), distal IP, or thumb IP joints between September 1, 2006, and December 31, 2019, at an integrated health system comprising two level-I trauma centers and two community teaching hospitals. Six patients who underwent arthrodesis of 13 IP joints were included in the study. Patient demographics, comorbidities, surgical information, and postoperative outcomes were collected from the medical record. Results: Thirteen digits in six patients were treated with digital joint arthrodesis. Three patients had diffuse scleroderma, and four patients were women. The majority of procedures were performed on the PIP joint with Kirshner wires (nine of 13). No patients experienced intraoperative complications. Three patients experienced postoperative complications including flexion deformity, discomfort, and cellulitis. In patients who had primary arthrodesis, two of nine joints went on to nonunion. One patient who underwent arthrodesis of four PIP joints for failed PIP arthroplasties went on to nonunion of all four digits. Of the patients with complications and nonunion, three required reoperation. Conclusions: Our study suggests that arthrodesis is an acceptable treatment option for patients with joint deformities secondary to scleroderma; however, surgeons and patients should be aware of higher rates of complications. Type of study/level of evidence: Therapeutic III.

The Canadian Agility and Movement Skill Assessment (CAMSA) is a valid and reliable circuit-based test of motor competence which can be used to assess children's skills in a live or recorded performance and then coded. We aimed to analyze the intrarater reliability of the CAMSA scores (total, time, and skill score) and time measured, by comparing the live audio with the video assessment method. We also aimed to assess the interrater reliability using both audio- and video coding on a sample of 177 Spanish children. We found moderate-to-excellent inter- and intrarater video-audio intraclass correlation coefficients for the CAMSA score, time measured, time score, and skill score. Nonsignificant differences were found between video and audio recordings in the CAMSA score, time measured, and time score. Our findings support the rationale that different raters and scoring methods can accurately assess the participants' motor competence level using the CAMSA Spanish version.

Presentación del número monográfico sobre cifra y lenguajes cifrados.

El presente artículo aborda el estudio de los lenguajes cifrados que usó la gobernadora de los Países Bajos, Margarita de Parma, durante los años 1562-1567. Los cifrarios reconstruidos a partir de sus cartas cifradas a Felipe II y a embajadores de la Monarquía permiten conocer el sistema adoptado para garantizar el secreto de las comunicaciones en tiempos difíciles. Se trata de lenguajes artificiales con la intención de dificultar la comprensión de la comunicación en el caso de que las cartas fueran interceptadas. Los cifrarios usados son cuatro claves generales y dos particulares.

El objetivo principal del criptoanálisis es la decodificación de textos cifrados sin disponer de una clave. Durante el siglo XVI el uso de los textos cifrados era una herramienta de uso común para transmitir mensajes de información sensible, es decir, de índole diplomática o política. El proceso de cifrado y descifrado trascendió al plano popular y despertó el interés de teóricos e intelectuales, que escribieron tratados sobre el arte de la cifra y la “contracifra”. En este artículo estudiamos uno de estos tratados y ponemos a prueba las reglas que propone su autor para descifrar textos españoles de los que se desconoce la clave.

Introduction Reducing unplanned hospital admissions in chronic patients at risk is a key area for action due to the high healthcare and societal burden of the phenomenon. The inconclusive results of preventive strategies in patients with chronic obstructive respiratory disorders and comorbidities are explainable by multifactorial but actionable factors.The current protocol (January 2024–December 2025) relies on the hypothesis that intertwined actions in four dimensions: (1) management change, (2) personalisation of the interventions based on early detection/treatment of acute episodes and enhanced management of comorbidities, (3) mature digital support and (4) comprehensive assessment, can effectively overcome most of the limitations shown by previous preventive strategies. Accordingly, the main objective is to implement a novel integrated care preventive service for enhanced management of these patients, as well as to evaluate its potential for value generation.Methods and analysis At the end of 2024, the specifics of the novel service will be defined through the articulation of its four main components: (1) enhanced lung function testing through oscillometry, (2) continuous monitoring of indoor air quality as a potential triggering factor, (3) digital support with an adaptive case management (ACM) approach and (4) predictive modelling for early identification and management of exacerbations. During 2025, the novel service will be assessed using a Quintuple Aim approach. Moreover, the Consolidated Framework for Implementation Research will be applied to assess the implementation. The service components will be articulated through four sequential 6-month plan-do-study-act cycles. Each cycle involves a targeted cocreation process following a mixed-methods approach with the active participation of patients, health professionals, managers and digital experts.Ethics and dissemination The Ethics Committee for Human Research at Hospital Clinic de Barcelona approved the protocol on 29 June 2023 (HCB/2023/0126). Before any procedure, all patients in the study must sign an informed consent form.Trial registration number NCT06421402.

Artificial intelligence (AI) is transforming rheumatology research, with a myriad of studies aiming to improve diagnosis, prognosis and treatment prediction, while also showing potential capability to optimise the research workflow, improve drug discovery and clinical trials. Machine learning, a key element of discriminative AI, has demonstrated the ability of accurately classifying rheumatic diseases and predicting therapeutic outcomes by using diverse data types, including structured databases, imaging and text. In parallel, generative AI, driven by large language models, is becoming a powerful tool for optimising the research workflow by supporting with content generation, literature review automation and clinical decision support. This review explores the current applications and future potential of both discriminative and generative AI in rheumatology. It also highlights the challenges posed by these technologies, such as ethical concerns and the need for rigorous validation and regulatory oversight. The integration of AI in rheumatology promises substantial advancements but requires a balanced approach to optimise benefits and minimise potential possible downsides.

Background: Complete pathological response to neoadjuvant treatment (NAT) in breast cancer is associated with prolonged survival. Compared to other breast cancer immunophenotypes, luminal tumors are the least chemosensitive with low rates of pathological response within this molecular subtype. Thus, finding predictors of response in this subset remains challenging. The emerging concept of low human epidermal growth factor receptor 2 (HER2) expression has led to a repurpose of the current prognostic system. Little is known about its correlation with response to NAT. Objectives: This study aims to evaluate predictors of response in early-stage luminal breast cancer receiving neoadjuvant chemotherapy. Design: A total of 252 luminal patients who received NAT were retrospectively assessed in this cohort study. Methods: We analyzed the correlation of ki67 and HER2 low expression with the rate of pathologic response. Using ki67 as a continuous variable and applying the receiver operating characteristic curves method. Results: We identified that in patients with a ki67 expression level >37%, the probability of having a complete pathological response was 4.80 times higher (odds ratio = 4.80, 95% confidence interval: 1.92–12.04). In Her2-low breast cancer patients, Her2 expression did not correlate with a better response rate. Conclusion: In our study, a ki67 expression value greater than 37% constitutes a predictive biomarker of pathological complete response in the subgroup of patients with luminal B tumors and could be considered, therefore, an indicator for treatment decisions in this subgroup.

Marine-derived proteins, such as blue whiting-derived protein hydrolysates (BWPH), represent high-quality sources of dietary protein, but their ability to support postexercise anabolism is not established. The impact of BWPH on whole-body anabolism was compared with an isonitrogenous whey protein isolate (WPI) and nonessential amino acid (NEAA) control in 10 trained young males (31 ± 4 years) who, on three separate visits, performed a session of whole-body resistance exercise and then consumed, in randomized crossover fashion, BWPH, WPI, or NEAA (0.33 g/kg; 19, 33, and 0 mg/kg leucine, respectively) with L-[1-13C]leucine. Breath, blood, and urine samples were collected for 6-hr postprandial to assess dietary leucine oxidation, amino acid (AA) concentrations, and 3-methylhistidine: creatinine ratio. Peak and area under the curve concentrations for leucine, branched-chain amino acids, and essential amino acids were greater in WPI compared with BWPH (all p <.05) but with no differences in time to peak concentration. Total oxidation reflected leucine intake (WPI > BWPH > NEAA; p <.01), whereas relative oxidation was greater (p <.01) in WPI (28.6 ± 3.6%) compared with NEAA (21.3 ± 4.2%), but not BWPH (28.6 ± 8.8%). Leucine retention, a proxy for whole-body protein synthesis, was greater in WPI (185.6 ± 9.5 μmol/kg) compared with BWPH (109.3 ± 14.1 μmol/kg) and NEAA (5.74 ± 0.30 μmol/kg; both p <.01), with BWPH being greater than NEAA (p <.01). Urinary 3-methylhistidine: creatinine ratio did not differ between conditions. Both WPI and BWPH produced essential aminoacidemia and supported whole-body anabolism after resistance exercise, but a higher intake of BWPH to better approximate the leucine and EAA content of WPI may be needed to produce an equivalent anabolic response. Consuming protein after exercise is generally considered to be important for recovery from a single session of exercise, and over time can support muscle growth in response to long-term strength training. This study aimed to understand how different types of protein might affect these so-called "anabolic" processes by studying a marker of the body's ability to recovery and grow muscle after exercise. Specifically, this study compared how well three different protein sources—a dairy-based protein in the form of whey protein isolate, a novel fish protein powder derived from blue whiting, and a blend of what are known as nonessential amino acids—help the body retain another amino acid named leucine, which is a key indicator of muscle-building potential, during the 6 hr of recovery after exercise. There are 20 amino acids that are used in the body, some come from our food and some can be made in the body, but regardless of source, these amino acids serve as building blocks for all of the proteins in the body. Ten healthy young men who had been regularly doing strength training participated in the study. On three different occasions, each participant completed a full-body workout and then drank one of the three protein drinks. The amount of protein they consumed was based on their body weight. The drink provided 20–30 g of protein depending, on body size. After each workout, how much leucine the body retained over a 6-hr period was assessed by collecting samples of blood, breath, and urine which effectively measures how well the proteins were absorbed and used by the body for processes supporting muscle recovery, repair, and growth. One of the key questions was whether this fish-derived protein could be a good alternative to whey protein for supporting muscle recovery after exercise. Whey protein is well-known for its ability to support these processes and help build muscle, but there is much interest in whether other protein sources, particularly those from fish, could offer similar benefits. Fish proteins may also have the added advantage of being more sustainable, which is increasingly important in today's world. The nonessential amino acid blend served as a control, as it was not expected to contribute to processes that support muscle recovery and growth due to its lack of essential amino acids. The results showed that whey protein was the most effective by leading to the highest concentrations of essential amino acids in the blood, and the greatest amount of leucine retained in the body, meaning that the body was potentially able to use more of it for muscle recovery and growth. The fish protein performed better than the nonessential amino acids, supporting the idea that it could help with muscle recovery, but it was not as effective as whey protein. This finding is likely because the fish protein contained less essential amino acids, which are critical for muscle recovery and growth processes. Consuming a larger amount of the fish protein could potentially provide benefits similar to whey protein, but more studies would be needed to confirm this. The nonessential amino acid blend was the least effective, as expected, because it lacked the necessary components to stimulate these anabolic processes in muscle. The interpretation of these results is that while whey protein would be the most effective of the three protein sources for promoting muscle recovery after exercise, fish-derived proteins, like the one tested in this study, could be a good alternative, especially for those who are looking for nondairy sources of protein. While the fish protein didn't perform as well as whey protein in this study, it did still support muscle recovery, suggesting it could be a viable option to match the effects of whey if provided at the right dosage. Overall, this research adds to our understanding of how different protein sources can help the body recover after exercise, and suggests that future research could focus on how adjusting the amount of fish protein consumed could improve its potential to support recovery and growth in response to exercise. Consuming protein after exercise is generally considered to be important for recovery from a single session of exercise, and over time can support muscle growth in response to long term strength training. This study aimed to understand how different types of protein might affect these so-called "anabolic" processes by studying a marker of the body's ability to recovery and grow muscle after exercise. Specifically, this study compared how well three different protein sources—a dairy-based protein in the form of whey protein isolate, a novel fish protein powder derived from blue whiting, and a blend of what are known as nonessential amino acids—help the body retain another amino acid named leucine, which is a key indicator of muscle-building potential, during the 6 hr of recovery after exercise. There are 20 amino acids that are used in the body, some come from our food and some can be made in the body, but regardless of source, these amino acids serve as building blocks for all of the proteins in the body. Ten healthy young men who had been regularly doing strength training participated in the study. On three different occasions, each participant completed a full-body workout and then drank one of the three protein drinks. The amount of protein they consumed was based on their body weight, and so the drink provided 20–30 g of protein depending on body size. After each workout, how much leucine the body retained over a 6-hr period was assessed by collecting samples of blood, breath, and urine, and this is effectively a measure of how well the proteins were absorbed and used by the body for processes supporting muscle recovery, repair, and growth. One of the key research questions was whether this fish-derived protein could be a good alternative to whey protein for supporting muscle recovery after exercise. Whey protein is well-known for its ability to support these processes and help build muscle, but there is much interest in whether other protein sources, particularly those from fish, could offer similar benefits. Fish proteins may also have the added advantage of being more sustainable, which is increasingly important in today's world. The nonessential amino acid blend served as a control, as it was not expected to contribute to processes that support muscle recovery and growth due to its lack of essential amino acids. The results showed that whey protein was the most effective by leading to the highest concentrations of essential amino acids in the blood, and the greatest amount of leucine retained in the body, meaning that the body was potentially able to use more of it for muscle recovery and growth. The fish protein performed better than the nonessential amino acids, supporting the idea that it could help with muscle recovery, but it was not as effective as whey protein. This finding is likely because the fish protein contained less essential amino acids, which are critical for muscle recovery and growth processes. Consuming a larger amount of the fish protein could potentially provide similar benefits to whey protein, but more studies would be needed to confirm this. The nonessential amino acid blend was the least effective, as expected, because it lacked the necessary components to stimulate these anabolic processes in muscle. The interpretation of these results is that while whey protein would be the most effective of the three protein sources for promoting muscle recovery after exercise, fish-derived proteins like the one tested in this study could still be a good alternative, especially for those who are looking for nondairy sources of protein. While the fish protein didn't perform as well as whey protein in this study, it did still support muscle recovery, suggesting it could be a viable option to match the effects of whey if provided at the right dosage. Overall, this research adds to our understanding of how different protein sources can help the body recover after exercise, and suggests that future research could focus on how adjusting the amount of fish protein consumed could improve its potential to support recovery and growth in response to exercise. [ABSTRACT FROM AUTHOR]