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Abstract Bridging therapy (BT) after leukapheresis is required in most relapsed/refractory (R/R) large B‐cell lymphoma (LBCL) patients receiving chimeric antigen receptor (CAR) T cells. Bendamustine‐containing regimens are a potential BT option. We aimed to assess if this agent had a negative impact on CAR‐T outcomes when it was administered as BT. We included R/R LBCL patients from six centers who received systemic BT after leukapheresis from February 2019 to September 2022; patients who only received steroids or had pre‐apheresis bendamustine exposure were excluded. Patients were divided into two BT groups, with and without bendamustine. Separate safety and efficacy analyses were carried out for axi‐cel and tisa‐cel. Of 243 patients who received BT, bendamustine (benda) was included in 62 (26%). There was a higher rate of BT progressors in the non‐benda group (62% vs. 45%, p = 0.02). Concerning CAR‐T efficacy, complete responses were comparable for benda versus non‐benda BT cohorts with axi‐cel (70% vs. 53%, p = 0.12) and tisa‐cel (44% vs. 36%, p = 0.70). Also, 12‐month progression‐free and overall survival were not significantly different between BT groups with axi‐cel (56% vs. 43% and 71% vs. 63%) and tisa‐cel (25% vs. 26% and 52% vs. 48%); there were no differences when BT response was considered. CAR T‐cell expansion for each construct was similar between BT groups. Regarding safety, CRS G ≥3 (6% vs. 6%, p = 0.79), ICANS G ≥3 (15% vs. 17%, p = 0.68), severe infections, and neutropenia post‐infusion were comparable among BT regimens. BT with bendamustine‐containing regimens is safe for patients requiring disease control during CAR T‐cell manufacturing.

Abstract Background Health education is one of the main items to enable health promotion to patients with fibromyalgia. The objective of the study “Amigos de Fibro (Fibro Friends)” is to evaluate the impact of an educational intervention associated with physical exercise based on the web in promoting health and quality of life of patients with fibromyalgia in Brazil. Methods A study with a randomized controlled trial approach will be carried out. The sample will consist of 24 participants, divided into two groups, with 12 individuals each. The experimental group will participate in meetings with lectures, debates, conversation rounds and exercises by a multidisciplinary team. Physical exercises will also be performed in an online environment. On the other hand, the control group will receive an e-book of education and self-care. Primary outcomes will be quality of life. The secondary outcomes will be sociodemographic and health profile, pain intensity, sleep quality, self-care agency, usage and costs of health and social care services, viability of the program and program participation. In addition, a qualitative evaluation process will be carried out with the participants. After the intervention, the data of both groups will be collected again, as well as after 3, 6, and 12 months to verify the effect and the maintenance of the intervention. Discussion The results will provide data for studies to consider the use of this tool in the future by professionals working in the field of rheumatology. Trial registration The protocol was registered in the Brazilian Registry of Clinical Trials RBR-3rh759 ( https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-3rh759 ). Date of registration: 07/02/2020].

The UTEC-UNED-TECSUP University Consortium took part in the eighth edition of the Support programme for the design and implementation of strategies for continuity of the Higher Education service in public universities of the Peruvian Ministry of Education (PMESUT), devised to promote the continuity of non-classroom-based educational service in public universities. This article presents the assessment carried out in four universities, with the aim of ensuring the ongoing digitization of education in the aftermath of the pandemic. Once the diagnosis had been made, the techno-pedagogical virtualization of 138 model courses was carried out in three phases: planning; curriculum design and teaching support; and implementation of the courses in the virtual classroom. Limitations were related to existing digital divides: time constraints, personal self-regulation and limited training in pedagogical and digital competences of teachers. Individualised support and tutoring measures were sought, increasing the number of synchronous sessions to facilitate assessment. The feedback focused on information, interaction and accountability on what has been done and the improvement of the didactic act in virtual mode. In conclusion, the complexity of the process was notable, as well as the high level of demand to achieve results which, although positive, encountered several obstacles arising from the different agents and elements involved.

IntroductionThe survival of patients with metastatic renal cell carcinoma (mRCC) has improved dramatically due to novel systemic treatments. However, mRCC mortality continues to rise in Latin America.MethodsA retrospective, multicenter study of patients diagnosed with mRCC between 2010-2018 in Mexico City was conducted. The aim of the study was to evaluate the impact of healthcare insurance on access to treatment and survival in patients with mRCC.ResultsAmong 924 patients, 55.4%, 42.6%, and 1.9% had no insurance (NI), social security, (SS) and private insurance (PI), respectively. De novo metastatic disease was more common in NI patients (70.9%) compared to SS (47.2%) and PI (55.6%) patients (p

Badgers (Meles meles) are a major tuberculosis (TB) reservoir in Europe, with the potential to transmit infection to cattle. Here we assessed whether a recently described oral tuberculosis vaccine based on heat-inactivated Mycobacterium bovis (HIMB), delivered as edible baits, can protect badgers from infection. Eight badgers were given individually five baits, each one consisting of a ball of peanut butter, natural peanut and oat flakes including a dose of the vaccine containing 5 × 107 colony-forming units. In parallel, a control group of seven badgers did not receive the vaccine. One month and a half later a second dose of the vaccine was offered to the vaccinated group. Ninety-four days after the second dose, all badgers were challenged with M. bovis (103 colony-forming units per animal) delivered endobronchially to the right middle lung lobe. Clinical, immunological, pathological and bacteriological variables were measured throughout the whole study to assess the efficacy of the vaccine. Two vaccinated animals showed high bacterial load of M. bovis and worsening of pathological lesions of TB. Conversely, the other six vaccinated animals showed slight improvement in bacterial load and pathology with respect to the control group. These results suggest that delivering the TB vaccine via food bait can partially protect wild badger populations, although vaccination can lead to either protection or tolerization, likely depending on the animal's immune status and general condition at the time of vaccination. Further optimization of the vaccination trial/strategy is needed to reduce the rate of tolerization, such as altering vaccine dose, number of doses, type of bait, use of adjuvants or route of administration.

Presentación de la sección monográfica

Gabriel Álvarez de Toledo escribió un romance elogiando una fábula alegórica de Prometeo del portugués Manuel de Sousa Moreira, conocida en España solo a partir del manuscrito anónimo Eccos de la musa transmontana. Prometeo, de la Biblioteca Nacional. En este trabajo se indaga en las trayectorias biográficas, redes sociales y obras de los autores para establecer las similitudes y vías de contacto que pudieron conducir a su diálogo poético. Al centrarnos en estos poetas diletantes, que se movieron en círculos letrados principales, participaron en tertulias y academias y establecieron relaciones clientelares con nobles de gran relevancia política y cultural —el marqués de Távora, el conde de Ericeira, el cardenal Luís de Sousa, el duque de Montellano…—, el estudio ahonda en sus perfiles al tiempo que desvela un amplio panorama de las relaciones hispano-portuguesas de las décadas finales del siglo XVII y primera mitad del XVIII.

Abstract Ergosterol is a specific sterol component of yeast and fungal membranes. Its biosynthesis is one of the most effective targets for antifungal treatments. However, the emergent resistance to multiple sterol‐based antifungal drugs emphasizes the need for new therapeutic approaches. The allylamine terbinafine, which selectively inhibits squalene epoxidase Erg1 within the ergosterol biosynthetic pathway, is mainly used to treat dermatomycoses, whereas its effectiveness in other fungal infections is limited. Given that ergosterol biosynthesis depends on iron as an essential cofactor, in this report, we used the yeast Saccharomyces cerevisiae to investigate how iron bioavailability influences Erg1 expression and terbinafine susceptibility. We observed that both chemical and genetic depletion of iron decrease ERG1 expression, leading to an increase in terbinafine susceptibility. Deletion of either ROX1 transcriptional repressor or CTH1 and CTH2 post‐transcriptional repressors of ERG1 expression led to an increase in Erg1 protein levels and terbinafine resistance. On the contrary, overexpression of CTH2 led to the opposite effect, lowering Erg1 levels and increasing terbinafine susceptibility. Although strain‐specific particularities exist, opportunistic pathogenic strains of S. cerevisiae displayed a response similar to the laboratory strain. These data indicate that iron bioavailability and particular regulatory factors could be used to modulate susceptibility to terbinafine.

Abstract Patients undergoing cardiac surgery represent a challenge in terms of pain management due to multiple factors relating to the patients and to the procedure itself. Our aim was to identify the influence of levels of preoperative anxiety on postoperative pain in patients undergoing cardiac surgery and explore associations between preoperative anxiety, postoperative pain, analgesic requirements, and sex. We present a prospective cohort study of 116 patients undergoing cardiac surgery between January and April 2020. Preoperative anxiety was evaluated using the State-Trait Anxiety Inventory and the amount of morphine needed to keep pain intensity below 4 on the verbal numerical rating scale was recorded for 48 h post-surgery. Given the extracorporeal circulation time, type of surgery and body surface, it was observed that every percentile increase in preoperative state anxiety led to an extra 0.068 mg of morphine being administered. For each extra year of age, the amount of morphine needed decreased by 0.26 mg, no difference was observed between men and women in terms of preoperative anxiety or postoperative analgesics requirements. It may be concluded that in cardiac surgery, postoperative analgesic requirements increased with higher levels of preoperative state anxiety and decreased for every extra year of age.

Summary: Background: Lack of specific definitions of clinical characteristics, disease severity, and risk and preventive factors of post-COVID-19 syndrome (PCS) severely impacts research and discovery of new preventive and therapeutics drugs. Methods: This prospective multicenter cohort study was conducted from February 2020 to June 2022 in 5 countries, enrolling SARS-CoV-2 out- and in-patients followed at 3-, 6-, and 12-month from diagnosis, with assessment of clinical and biochemical features, antibody (Ab) response, Variant of Concern (VoC), and physical and mental quality of life (QoL). Outcome of interest was identification of risk and protective factors of PCS by clinical phenotype, setting, severity of disease, treatment, and vaccination status. We used SF-36 questionnaire to assess evolution in QoL index during follow-up and unsupervised machine learning algorithms (principal component analysis, PCA) to explore symptom clusters. Severity of PCS was defined by clinical phenotype and QoL. We also used generalized linear models to analyse the impact of PCS on QoL and associated risk and preventive factors. CT registration number: NCT05097677. Findings: Among 1796 patients enrolled, 1030 (57%) suffered from at least one symptom at 12-month. PCA identified 4 clinical phenotypes: chronic fatigue-like syndrome (CFs: fatigue, headache and memory loss, 757 patients, 42%), respiratory syndrome (REs: cough and dyspnoea, 502, 23%); chronic pain syndrome (CPs: arthralgia and myalgia, 399, 22%); and neurosensorial syndrome (NSs: alteration in taste and smell, 197, 11%). Determinants of clinical phenotypes were different (all comparisons p

BackgroundTelematic assistance has become indispensable in recent years. The increased prevalence of Acquired brain injury and the sequels it causes, requires long–lasting multidisciplinary treatments. Validated tools to assess the evolution of the disabilities and limitations of this pathology are essential to individualize and prescribe adapted treatments. The aim has been to create the telematic version of the Fugl Meyer Assessment-Upper Extremity Motor Function (TFMA-UE) Spanish scale and its adaptation to the remote assessment of neurologic patients.MethodsAn adapted scale was designed based on the Fugl Meyer Assessment scale-telematic version (FMA-TV): TFMA-UE. This scale is composed by 21 items which evaluate the upper extremity motor function. Physiotherapists trained in this tool, evaluate the results obtained from applying the two versions (on-site and telematic) to compare the results.ResultsTFMA-UE was administered to 30 patients with acquired brain injury. It was applied on site and through the web platform selected by the patients in two different days. Patients completed all the scale in an easily way without help. The exploratory and confirmatory factor analysis confirmed a factorial structure with a factor (76.08% of the variance). The Cronbach’s internal consistency index obtained was 0.98 and the weight kappa index used to measure agreement between the two versions was 0.78 which represents substantial agreement.ConclusionThe Telematic Fugl Meyer Assessment-Upper Extremity Motor Function (TFMA-UE) scale is a viable, useful and easy to apply tool that allows the upper extremity motor function assessment of Acquired Brain Injury patients.

Introduction Unilateral spatial neglect (USN) is a stroke complication of stroke. Optokinetic stimulation (OKS) is one of the treatments, but its effects on motor symptoms, such as poverty or alterations in movements on the affected side, are not clear yet. The aim of this study will be to evaluate the OKS effects on the perceptual and postural complications of patients with USN.Methods and analysis Randomised double-blinded clinical trial, with an intervention group that will undergo OKS and a control placebo group. The research will take place at the Faculty of Nursing and Physiotherapy, University of Salamanca, 102 patients older than 18 years with diagnosed USN will participate. The intervention group will receive 2 weekly OKS session for 10 weeks. Virtual reality glasses will be used for the application of a video. The video will project OKS at a preset speed and will request the participant’s attention throughout the session. The control group will receive a placebo treatment, through a virtual reality video. The measurement variables will be posturography, Fluff test, line bisection, Fullerton Advance Balance Scale and Diller’s cancellation test.Ethics and dissemination This study has been approved by the Ethics Committee University of Salamanca on February 2020 (registration number: 584). All patients in the study will be informed about the objective of the study and will give their written informed consent to participate in the study. The anonymised database will be available from the publication of the results for 10 years in the repository of the University of Salamanca GREDOS (https://gredos.usal.es/). The trial results will be shared with the scientific community at international conferences and by publication in a peer-reviewed journal.Trial registration number NCT04663646.

Abstract Background Chronic graft versus host disease (cGVHD) simulating eosinophilic fasciitis (EF) is an underdiagnosed and challenging complication due to the lack of knowledge about its pathogenesis, refractoriness to traditional immunosuppressive agents and their negative impact on the physical function and quality of life. The aim of this study is to describe the clinical-biological characteristics and response to treatment of a case series and to provide a comprehensive literature review on cGVHD related EF involvement. Methods Prospective observational study to describe the clinical and diagnostic evaluation characteristics of patients with EF-like follow-up as part of our multidisciplinary cGVHD consultations. In addition, the literature on joint and/or fascial musculoskeletal manifestations due to cGVHD was comprehensively reviewed. Results 118 patients were evaluated in multidisciplinary cGVHD consultations, 39 of whom (33%) developed fasciitis. Notably, 11 patients had isolated joint contractures without sclerotic skin. After a median of three lines of treatment, the vast majority of patients achieved some degree of response. 94 potentially eligible articles were identified by the search strategy, with 17 of them, the majority isolated case reports, making the final selection. The validated staging scales used for the assessment were the Joint and Fascial Score and the Photographic Range of Motion. Conclusion Fascial/articular involvement needs to be recognized and evaluated early. To our knowledge, our cohort is the second largest series to have been reported. Literature addressing fascial/joints complications related to cGVHD is scarce. The search for new biomarkers, the use of advanced imaging techniques and multidisciplinary approach may help improve the prognosis of patients with cGVHD.

Objectives: This study contributes to the neuroscience of offending behavior by addressing two aims: a) to examine differences in the cortical features in a group of male serious juvenile offenders (21 OG), versus controls (28 CG), both ranging from 18 to 21 years old; and b) to determine to what extent the differential cortical features and the risk psychological profile discriminate between the two groups. Method: Besides cortical measures, demographics, executive functioning, childhood trauma, psychopathic traits, psychopathological symptoms, and antisocial and delinquent behavior were assessed. Results: Whole-brain analysis of the cortical mantle identified increased cortical thickness in the cluster comprising the right middle temporal gyrus and a smaller surface area in the lateral orbitofrontal cortex for the OG compared to the CG. The discriminant function correctly classified 100% of cases of the CG and 94.7% of the OG. Right temporal cluster, childhood trauma, callousness and symptoms of interpersonal sensitivity, psychoticism, depression, phobic anxiety, and obsessive-compulsive behavior contributed to the OG. In turn, the lateral orbitofrontal cluster, psychopathic traits of grandiosity, unemotionality, and thrill seeking, and working memory contributed to the CG. Conclusions: The increased right middle temporal gyrus of the OG could be indicative of impaired brain development in social cognition processes since it appeared in combination with the higher risk profile. The reduced orbitofrontal cortex could be indicative of immature brain development in emotional control processes since it appeared in combination with the normative psychological profile in adolescence. Based on these novel findings, areas of potential improvement for research and intervention are suggested.

Introducción: Actualmente la práctica investigativa constituye una característica en la Educación Superior, referida a la búsqueda, análisis y sistematización del conocimiento, así como a la apropiación de técnicas, métodos y protocolos propios de la actividad investigativa. Por ello, el objetivo, del presente texto es exponer actividades de aprendizaje que propician la formación investigativa desde la asignatura Información Científica en carreras Tecnológicas. Material y Métodos: La aplicación de métodos teóricos (analítico-sintético; inductivo-deductivo) y de nivel empírico como el análisis documental permitieron el diseño e implementación de actividades de aprendizaje para propiciar la formación investigativa desde el primer año de la carrera. Resultados y discusión: Las estrategias de enseñanza deben orientarse a privilegiar un procesamiento de la información que permanezca en el alumno como un conocimiento ligado a su vida considerando las necesidades de los alumnos, del profesor, de la comunidad y de la institución. Se asume al registro de experiencia en la actuación del estudiante en la pesquisa activa como información inicial en la formación investigativa. En la Educación Superior a raíz de la pandemia del COVID-19 el cambio de modalidad de estudio condujo a una nueva era del aprendizaje. En la modalidad Educación a Distancia (EaD), el trabajo independiente logra su objetividad cuando el alumno consigue relacionar correctamente el planteamiento de la tarea con los métodos a seguir para realizarla, puede aplicar sus conocimientos y capacidades para realizarla sin necesidad de que el maestro intervenga directamente para orientar cada detalle.

Measurement(s) Turn rate • Specific force • Magnetic field • Locations • Orientations Technology Type(s) Inertial measurement unit • Stereophotogrammetric system Factor Type(s) Time Sample Characteristic - Organism Humans

Social and academic interest in animal abuse has recently increased thanks to greater awareness of the importance of biodiversity in promoting sustainability. The redefinition of human-animal relationships, in the context of the fight against speciesism and the defense of veganism, has also contributed to this greater attention. Moreover, public awareness of animal rights has strengthened social reactions to violence against animals, though there are still some social sectors that are indifferent to these changes. Thus, better knowledge of the psychological mechanisms underlying reactions to animal abuse could contribute to better informal, social control of such abuse. The main aim of this study is to analyze the relationships between psychopathy, empathy with people, and empathy with nature arising from people’s reactions to protected and domestic animal abuse and illegal dumping. Also, as previous studies have shown differences between men and women, both in animal abuse and in personality traits, thus gender is taken into account when analyzing these relationships. A total of 409 people, resident in a highly environmentally protected territory, participated in this study. They were aged between 18 and 82 years old and 49.9% women. Participants were asked about assigned punishments, as well as the probability of intervening personally and/or calling the police, in relation to ten scenarios, based on press releases, describing one of three types of transgression of environmental laws: abuse of protected animals, abuse of domestic animals or illegal dumping. They also responded to Spanish adaptations of the Inventory of Callous Unemotional Traits, the Basic Empathy Scale, the Dispositional Empathy with Nature Scale, and the Social Desirability Scale. Each participant was randomly given ten scenarios corresponding to just one transgression type but all the personality scales. Results show that people’s reactions were greater for abuse of domestic than protected animals or for illegal dumping, irrespective of gender. Empathy with nature was related to the reaction against animal abuse more than empathy with people and psychopathy. Results are discussed highlighting the need for future research into similarities and differences between animal abuse and other types of environmental offences, which have many victims but no single being suffering.

Las mujeres kichwas realizan actividades productivas, reproductivas y de distribución en un modelo de organización patriarcal. En 2009 se modificó el reglamento del Pueblo Kichwa de Rukullakta (PKR) para facilitar la participación de la mujer en la gobernanza organizativa y productiva de la comunidad. Las mujeres han impulsado asociaciones y actividades con las que han mejorado las oportunidades de desarrollo sostenible (DS) de sus comunidades. Se presenta una breve referencia del enfoque de género en América Latina. Se utiliza metodología cualitativa (observación participante, grupos focales y entrevistas en profundidad) y cuantitativa (censo de la Fundación TNC). Se realiza un análisis de la participación de la mujer en las actividades de los cuatro modelos de comercialización del PKR. Cuando las mujeres participan en las asociaciones de organización productiva y de distribución, hay mejores resultados en el DS del territorio. Aunque hay un avance gradual de la participación de la mujer en todas las actividades, aún se mantiene una cierta distribución de tareas de acuerdo con las costumbres del pueblo kichwa.

During development microglia colonize the central nervous system (CNS) and play an important role in programmed cell death, not only because of their ability to remove dead cells by phagocytosis, but also because they can promote the death of neuronal and glial cells. To study this process, we used as experimental systems the developing in situ quail embryo retina and organotypic cultures of quail embryo retina explants (QEREs). In both systems, immature microglia show an upregulation of certain inflammatory markers, e.g., inducible NO synthase (iNOS), and nitric oxide (NO) under basal conditions, which can be further enhanced with LPS-treatment. Hence, we investigated in the present study the role of microglia in promoting ganglion cell death during retinal development in QEREs. Results showed that LPS-stimulation of microglia in QEREs increases (i) the percentage of retinal cells with externalized phosphatidylserine, (ii) the frequency of phagocytic contacts between microglial and caspase-3-positive ganglion cells, (iii) cell death in the ganglion cell layer, and (iv) microglial production of reactive oxygen/nitrogen species, such as NO. Furthermore, iNOS inhibition by L-NMMA decreases cell death of ganglion cells and increases the number of ganglion cells in LPS-treated QEREs. These data demonstrate that LPS-stimulated microglia induce ganglion cell death in cultured QEREs by a NO-dependent mechanism. The fact that phagocytic contacts between microglial and caspase-3-positive ganglion cells increase suggests that this cell death might be mediated by microglial engulfment, although a phagocytosis-independent mechanism cannot be excluded.

Introduction Sleep problems are a growing public health concern being related, among others, to an increased risk of cardiovascular diseases or worse cognitive functioning. In addition, they can affect aspects related to personal motivation and quality of life. However, very few studies have analysed the possible determinants of sleep quality in the adult population as a whole, establishing patterns based on these determinants.The objectives are to evaluate the determinants of sleep quality in a representative sample of the general adult population between 25 and 65 years old, and to establish patterns of sleep quality based on lifestyles, psychological factors, morbidities, sociodemographic variables, biological markers and other possible determinants.Methods and analysis Descriptive observational cross-sectional study. The study population will include a representative sample of 500 people between 25 and 65 years old from the cities of Salamanca and Ávila (Spain) selected by random sampling stratified by age groups and sex. A 90-minute visit will be performed, during which sleep quality will be assessed. The variables collected will be: morbidity, lifestyles (physical activity, diet, toxic habits), psychological factors (depression, stress, occupational stress and anxiety), socioeconomic and work-related variables, habitability conditions of the habitual residence and rest area, screen time, relaxation techniques and melatonin as a biological marker related to sleep quality.Discussion With the results of this work, improved interventions for behaviour modification could be designed, as well as intervention and education programmes or other research aimed at improving sleep quality.Ethics and dissemination This study has a favourable opinion from the Ethics Committee for Drug Research of the Health Areas of Salamanca and Ávila (CEim Code: PI 2021 07 815). The results of this study will be published in international impact journals of different specialties.Trial registration number NCT05324267.

Demographic changes and an ageing population require more effective methods to confront the increased prevalence of chronic diseases which generate dependence in older adults as well as an important rise in social expenditure. The challenge is not only to increase life expectancy, but also to ensure that the older adults can fully enjoy that moment in their lives, living where they wish to (private home, nursing home, …). Physical activity (PA) is a representative parameter of a person’s state of health, especially when we are getting older, because it plays an important role in the prevention of diseases, and that is the reason why it is promoted in older adults. One of the goals of this work is to assess the feasibility of objectively measuring the PA levels of older adults wherever they live. In addition, this work proposes long-term monitoring that helps to gather daily activity patterns. We fuse inertial measurements with other technologies (WiFi- and ultrasonic-based location) in order to provide not only PA, but also information about the place where the activities are carried out, including both room-level location and precise positioning (depending on the technology used). With this information, we would be able to generate information about the person’s daily routines which can be very useful for the early detection of physical or cognitive impairment.

Ascertaining the true prevalence of adolescent-to-parent violence (APV) is challenging because the measurement of APV in research is complex. There is no consensus on which behaviors constitute APV or how frequently they need to occur to be considered abusive. This study aimed to explore the normative beliefs about APV related to the perpetrator’s gender in a sample of Spanish parents, by developing Spanish adaptations of the BACPAQ and the ABC-I. The participants were 329 Spanish parents aged 19 to 81, and 77% were mothers. They answered the Spanish adaptation of the BACPAQ online after being contacted by university students using the snowball sampling technique. Results show that sons were judged more harshly than daughters; although, differences were statistically significant only for a few psychologically abusive behaviors. There was agreement with the original study on the abusive nature of most behaviors, especially regarding physical violence. Cultural differences were reflected in verbal, psychological, and economic violence, and Spanish parents used more stringent thresholds than Australians. Future research should tackle the difficulty of carrying out studies on APV using a single tool able to reflect normative beliefs about this type of domestic violence in different cultures.

No gingival shade guide exists that can be used as a ‘gold standard’ in gingival shade selection. This research, therefore, aimed to determine whether comparable results in subjective gingival shade selection can be achieved using basic gingival colours produced by distinct manufacturers. It also aimed to explore how coverage of the colour space is affected by mixing these basic colours to create additional shades. To achieve these objectives, the basic gingival colours of three ceramic systems (Heraceram, Kulzer, Madrid, Spain; Vita VM9, Vita Zahnfabrik, Bad Säckingen, Germany; IPS Style, Ivoclar, Schaan, Liechtenstein) were analysed. The colour systems were expanded by creating porcelain gingival samples, whose colours were obtained by mixing the basic colours, altering each mixture by increments of 10%, and respecting the numerical order used by manufacturers to identify the colours. The colour coordinates of the basic and additional colours were recorded using spectrophotometry, and the intra- and inter-system colour differences were calculated using the Euclidean (ΔEab) and CIEDE2000 (ΔE00) formulae. None of the basic colours in the three systems, despite their similar nomenclature, were found to be interchangeable (the colour differences exceeded the gingival acceptability threshold: ΔE00 2.9 units). The expanded gingival colour systems, with mixtures altered by 10% increments, notably increased the gingival colour space covered by the original systems. The authors concluded that there are clear differences between the basic gingival colours produced by distinct manufacturers using the same nomenclature. Ceramic samples produced by mixing basic gingival colours are a resource with the potential to improve subjective gingival shade matching.

Lipases have valuable potential for industrial use, particularly those mostly active against water-insoluble substrates, such as triglycerides composed of long-carbon chain fatty acids. However, in most cases, engineered variants often need to be constructed to achieve optimal performance for such substrates. Protein engineering techniques have been reported as strategies for improving lipase characteristics by introducing specific mutations in the cap domain of esterases or in the lid domain of lipases or through lid domain swapping. Here, we improved the lipase activity of a lipase (WP_075743487.1, or LipMRD) retrieved from the Marine Metagenomics MarRef Database and assigned to the Actinoalloteichus genus. The improvement was achieved through site-directed mutagenesis and by substituting its lid domain (FRGTEITQIKDWLTDA) with that of Rhizopus delemar lipase (previously R. oryzae; UniProt accession number, I1BGQ3) (FRGTNSFRSAITDIVF). The results demonstrated that the redesigned mutants gain activity against bulkier triglycerides, such as glyceryl tridecanoate and tridodecanoate, olive oil, coconut oil, and palm oil. Residue W89 (LipMRD numbering) appears to be key to the increase in lipase activity, an increase that was also achieved with lid swapping. This study reinforces the importance of the lid domains and their amino acid compositions in determining the substrate specificity of lipases, but the generalization of the lid domain swapping between lipases or the introduction of specific mutations in the lid domain to improve lipase activity may require further investigation.

Denervation-induced muscle atrophy is a frequent cause of skeletal muscle diseases. However, the role of the most important muscle growth factor, insulin-like growth factor (IGF-1), in this process is poorly understood. IGF-1 activity is controlled by six IGF-1 binding proteins (IGFBPs). In skeletal muscle, IGFBP-5 seems to have an important role in atrophic processes. Furthermore, pappalysins (PAPP-A) modulate muscle growth by increasing IGF-1 bioavailability through IGFBP cleavage. We aimed to study the time-dependent changes in the IGF1-IGFBP5-PAPP system and its regulators in gastrocnemius muscle after sciatic denervation. Gastrocnemius atrophy and overexpression of IGF-1 was observed from day 3 post-denervation. The proteolytic factors measured were elevated from day 1 post-denervation onwards. Expression of both IGFBP-5 and pappalysins were increased on days 1 and 3. Subsequently, on days 7 to 14 pappalysins returned to control levels while IGFBP-5 remained elevated. The ratio IGFBP-5/PAPP-A was correlated with the main proteolytic markers. All data suggest that the initial increase of pappalysins could facilitate the IGF-1 action on muscle growth, whereas their subsequent decrease could lead to further muscle wasting.

Durante tres cursos, enmarcado en Proyectos de investigación, innovación y materiales de la Consejería de Educación de la Junta de Andalucía, se desarrolla un proyecto de acompañamiento y mentoría para profesorado novel en centros educativos de difícil desempeño del Polígono Sur (Sevilla); una de las zonas más pobres del país. Contempla dos figuras fundamentales: mentores y mentorizados. Este trabajo plantea definir variables socioeducativas representativas del mentor, perfil competencial deseable y aspectos positivos del programa. El tamaño de muestra es de 57 mentores en 6 centros de infantil, primaria y secundaria. Para la recogida de información se utilizan 2 formularios, con ítems de corte cualitativo y cuantitativo. Los resultados señalan como características claves del mentor en estos contextos: experiencia docente, conocimientos del centro y entorno, capacidad de mostrar empatía/asertividad y resolución de problemas e inmediata toma de decisiones. La conclusión principal es encontrar el perfil deseable del mentor para cada centro y etapa.

Aim: We examined the effects of space, climate, phylogeny and species traits on module composition in a cross-biomes plant–hummingbird network. Location: Brazil, except Amazonian region. Methods: We compiled 31 local binary plant–hummingbird networks, combining them into one cross-biomes metanetwork. We conducted a modularity analysis and tested the relationship between species’ module membership with traits, geographical location, climatic conditions and range sizes, employing random forest models. We fitted reduced models containing groups of related variables (climatic, spatial, phylogenetic, traits) and combinations of groups to partition the variance explained by these sets into unique and shared components. Results: The Brazilian cross-biomes network was composed of 479 plant and 42 hummingbird species, and showed significant modularity. The resulting six modules conformed well to vegetation domains. Only plant traits, not hummingbird traits, differed between modules, notably plants’ growth form, corolla length, flower shape and colour. Some modules included plant species with very restricted distributions, whereas others encompassed more widespread ones. Widespread hummingbirds were the most connected, both within and between modules, whereas widespread plants were the most connected between modules. Among traits, only nectar concentration had a weak effect on among-module connectivity. Main conclusions: Climate and spatial filters were the main determinants of module composition for hummingbirds and plants, potentially related to resource seasonality, especially for hummingbirds. Historical dispersal-linked contingency, or environmental variations not accounted for by the explanatory factors here evaluated, could also contribute to the spatial component. Phylogeny and morphological traits had no unique effects on the assignment of species to modules. Widespread species showed higher within- and/or among-module connectivity, indicating their key role connecting biomes, and, in the case of hummingbirds, communities within biomes. Our results indicate that biogeography and climate not only determine the variation of modularity in local plant–animal networks, as previously shown, but also affect the cross-biomes network structure.

Species traits are thought to predict feeding specialization and the vulnerability of a species to extinctions of interaction partners, but the context in which a species evolved and currently inhabits may also matter. Notably, the predictive power of traits may require that traits evolved to fit interaction partners. Furthermore, local abiotic and biotic conditions may be important. On islands, for instance, specialized and vulnerable species are predicted to be found mainly in mountains, whereas species in lowlands should be generalized and less vulnerable. We evaluated these predictions for hummingbirds and their nectar-food plants on Antillean islands. Our results suggest that the rates of hummingbird trait divergence were higher among ancestral mainland forms before the colonization of the Antilles. In correspondence with the limited trait evolution that occurred within the Antilles, local abiotic and biotic conditions-not species traits-correlate with hummingbird resource specialization and the vulnerability of hummingbirds to extinctions of their floral resources. Specifically, hummingbirds were more specialized and vulnerable in conditions with high topographical complexity, high rainfall, low temperatures and high floral resource richness, which characterize the Antillean Mountains. These findings show that resource specialization and species vulnerability to extinctions of interaction partners are highly context-dependent.

La comunicación de malas noticias, si bien supone un momento de importante vulnerabilidad para el paciente y sus allegados, es un acto necesario para una atención de calidad. Se trata de una habilidad transversal que, sin embargo, suele carecer de una formación específica en las facultades de Medicina. Existen numerosos protocolos que establecen las bases de una comunicación eficiente. No obstante, lo que marca la diferencia en términos de humanidad es el toque personal que cada médico ofrece. En este artículo ofrecemos una reflexión sobre la visión predominante en el Servicio de Oncología Médica de Fuenlabrada del proceso de comunicación de malas noticias. Exponemos conceptos metafísicos, psicológicos y sociales sobre los cuales impera la necesidad reflexionar para, desde una compresión profunda de la dificultad que la comunicación de malas noticias entraña, ser capaces de mejorar. Así mismo, sugerimos elementos fácilmente incorporables a la práctica clínica diaria. Recibido: Septiembre 7, 2022 Aceptado: Noviembre 2, 2022 Publicado: Diciembre 2, 2022 Editor: Dra. Evelyn Valencia Espinoza Introducción La comunicación de malas noticias es una herramienta fundamental en la práctica clínica, sin embargo, suele constituir una habilidad frecuentemente olvidada por los sistemas formativos en el ámbito de la sanidad. Se trata de una destreza difícil de perfeccionar y no existe una fórmula que garantice una comunicación eficiente y humana. No obstante, existen una serie de directrices que ayudan a sentar las bases del proceso comunicativo y una serie de matices que se pueden potenciar para cuidar el componente humano. El concepto de morir Oncólogos y paliativistas se enfrentan con frecuencia a la comunicación de malas noticias de gran magnitud, que suelen abordar el concepto de morir. La muerte es una noción cada vez más enmascarada en las sociedades occidentales. Paralelamente al desarrollo de la sociedad del bienestar, la muerte ha dejado de ser un recambio generacional natural para convertirse en algo evitable. Esto se encuentra en relación con la amplia aceptación de creencias como la fe en la ciencia y sus avances o la infalibilidad del sistema sanitario y sus profesionales. También se relaciona con la búsqueda continua de la inmediatez, que en el ámbito de la sanidad se traduce como la aspiración a la curación instantánea [1]. En nuestra sociedad, la muerte se siente como un hecho lejano e improbable. En algunas especialidades médicas, como la oncología, el médico es la persona que rompe por primera vez dicha ilusión de inmortalidad tan socialmente extendida. El choque entre la realidad y las expectativas La comunicación de malas noticias comienza siempre con un choque entre la realidad clínica y las expectativas de los pacientes, que engloban tanto las propias expectativas del médico basadas en el proceso terapéutico llevado a cabo, así como las expectativas que el paciente y sus familiares depositan en el personal sanitario y también las expectativas que el propio paciente puede tener sobre su existencia y su porvenir [2]. Quebrantar estas expectativas es doloroso y el médico se convierte en portador momentáneo de la más absoluta desolación. Esta desolación la trasladará al paciente y a sus familiares, entrando en juego emociones que harán que el impacto sea mucho mayor. La comunicación de malas noticias como una oportunidad para cuidar La buena comunicación de malas noticias es un paso necesario para una atención de calidad. Esto se debe a que centrar la situación clínica en la realidad del ahora, aunque inicialmente sea un duro golpe emocional, va a permitir adaptar la atención sanitaria posterior a las necesidades reales del paciente [2]. Además, aunque se trate uno de los momentos de mayor vulnerabilidad de todo el proceso clínico, también es una de las circunstancias donde más se puede poner en práctica el “arte” de cuidar [3]. La adquisición de competencias en este aspecto, más humano y menos técnico de la medicina, debe ser un objetivo fundamental en el desarrollo de cualquier profesional sanitario. Discusión La oncología es una especialidad con una dimensión humana fascinante y se presta a potenciar la capacidad de “cuidar” en aquellos que la ejercen. Desde la experiencia, la acción de “cuidar” muchas veces es algo tan sencillo y a la vez tan complicado como “saber estar”. Si entendemos la comunicación de malas noticias como una “ocasión de cuidar”, deduciremos fácilmente que no es suficiente el mero hecho de transmitir una información (“comunicar”), sino que debemos ser capaces de “estar” (“acompañar”) y recoger las emociones que este proceso genera: los miedos, las frustraciones, las ansiedades, las preguntas, la negación, la culpa, la ira y la tristeza Además, es importante aprender a “regresar”[3], a acompañar insistente y prolongadamente en el tiempo a nuestros pacientes para dar respuesta, si se puede, a la esfera psicológica y metafísica que surge en torno al final de la vida y que es tan importante como la esfera orgánica [4]. En muchas ocasiones, cuando no tenemos respuestas, la simple escucha activa y el hecho de demostrar que nos seguimos preocupando, resultan de gran ayuda tanto para el paciente como para sus familiares. Acompañar en momentos tan delicados, no es solo un deber, es un privilegio. Para aprender a comunicar malas noticias, existen una serie de directrices básicas sistematizadas, entre otros, en el protocolo SPIKES (acrónimo traducido al castellano como EPICEE) que se encuentran ampliamente aceptadas en las práctica clínica [5]. El protocolo EPICEE establece seis pasos fundamentales para una comunicación eficiente de malas noticias. “E”: Entorno, “P”: Percepción, “I”: Invitación, “C”: Conocimiento, “E”: Empatía y emociones “E”: Estrategia [5]. Sin embargo, son los matices que cada médico otorga a este protocolo los que marcan la diferencia en el proceso de comunicación. Por ello, presentamos a continuación, aquellas puntualizaciones que, desde la experiencia clínica, consideramos que pueden resultar de utilidad. Respecto a la “C” de “Conocimiento” Cuando el médico comunica una mala noticia, y más si hay que comunicarla en términos de posibilidades, existe una difícil encrucijada entre la esperanza y que quien nos escucha se sepa con la posibilidad de estar próximo al final de su vida y lograr que se encuentre en paz con ello. No debemos caer ni en el falso optimismo ni en el catastrofismo. Hay que buscar el término medio: medir las palabras, dosificarlas, dar respuestas, respetar los tiempos de cada persona. En este punto del protocolo, es muy importante adecuar el lenguaje y huir de los tecnicismos. Además, se debe dosificar la información y mandar mensajes concisos y claros. Puede parecer que el empleo de circunloquios ayuda a suavizar la mala noticia, pero no sólo no lo hace, sino que además aumenta el riesgo de malentendidos y puede traducirse en una elevación de la ansiedad del paciente si éste siente que se está perdiendo información relevante. Respecto a la “E” de “Empatía y emociones”: Durante la comunicación de malas noticias, se debe promover un ambiente de confianza que favorezca la expresión de emociones. Nos debemos entrenar en el reconocimiento de las mismas, tanto cuando el paciente las expresa directamente como cuando se pueden intuir a través de su lenguaje corporal. Es fundamental empatizar con las emociones y legitimarlas. No está de más tener unas nociones básicas de psicología que ayuden a comprender la emoción y a reconducirla en caso de ser preciso, aunque muchas veces basta con empatizar y dejar la conversación fluir. Entre las principales emociones se encuentran la ansiedad, la tristeza, la culpa y la ira. La ansiedad responde a una valoración de amenaza y pone en marcha mecanismos de anticipación. Se reconduce centrando a la persona en el ahora [6]. La tristeza responde a una valoración de pérdida donde se pone sistemáticamente el foco en lo negativo. Se reconduce ampliando la visión a otras áreas y rompiendo el mecanismo de atención selectiva hacia lo perjudicial [6]. La culpa responde a una valoración de responsabilidad y desencadena mecanismos de rumiación. Frenar la culpa pasa por hacer un análisis de error y responsabilidad, reparar lo modificable y tener un plan de acción alternativo en caso de volverse a dar una situación similar a la que nos ha hecho sentir culpables. Si a pesar de lo previo regresa el sentimiento, hay que evitar entrar nuevamente en el círculo de rumiación [7]. La ira es la emoción más compleja de todas y la que provoca el fenómeno de transferencia más negativo [8]. Traduce una valoración de daño, de la que se hace responsable a otro. Cuando surge la ira, se pone el foco en la intencionalidad del daño recibido y esto desencadena conductas agresivas. Se reconduce redefiniendo los objetivos. Se debe hacer entender que el agravio sufrido no se puede cambiar y, por tanto, el objetivo debe ser “estar bien”, en vez de hacer “justicia” (que es lo que se persigue con la conducta agresiva) [8]. Respecto a la “E” de “Estrategia”: En todas las situaciones clínicas, pero especialmente en las que perdemos la opción de la estrategia terapéutica orientada a la curación o a la cronificación y el objetivo pasa a ser el control de síntomas, se debe tener presente el concepto de “aliviar”. Si bien es cierto que manejar las emociones de manera empática y fijar unos objetivos terapéuticos ya supone alivio para muchos pacientes, se puede ir un paso más allá dando una respuesta humana y cercana a las necesidades metafísicas que indudablemente van a surgir [4]. Es importante entender el final de la vida como algo natural en la historia de todo ser humano, aceptar nuestras limitaciones y nuestra falta de control sobre cuándo llega y a quién le llega, abrir un tiempo de introspección y agradecimiento por lo ya vivido, entender que cada persona deja una huella única y maravillosa en el mundo, contribuir a que los últimos días supongan un tiempo de fortalecimiento de las relaciones humanas con los seres queridos, una oportunidad para cerrar asuntos pendientes, ayudar a encontrar paz. No es un terreno fácil y no es un terreno que todos los pacientes nos vayan a permitir o deseen abordar. Pero con aquellos que nos abran la puerta, si encontramos las palabras adecuadas, estaremos perfeccionando el “arte” de cuidar y nos convertiremos, sin duda, en portadores de alivio. Conclusión Siendo sinceros, los médicos nunca se acostumbra a la comunicación de malas noticias o al sufrimiento que existe en torno a la muerte. Esta falta de acontumbramiento es natural, y así debe ser. El error es evitar que surja la tristeza o el duelo, porque son reacciones intrínsecas al proceso de ruptura de expectativas. Tampoco se debe entender la comunicación de malas noticias como un proceso pasivo en el que se deja fluir la información y las emociones rebotan sin control y nos dañan a todos. El gran acierto es la formación para perfeccionar este proceso buscando no sólo transmitir información sino “cuidar” a través del mismo, siendo capaces de empatizar y, desde ahí, acompañar y aliviar. Estos valores son parte de nuestro compromiso para preservar la dignidad de nuestros pacientes en el proceso de enfermar y también en el proceso de morir, siendo buenos médicos, tan buenos como podamos, pero, ante todo, siendo buenos seres humanos. Abreviaturas EPICEE: “E”: Entorno, “P”: Percepción, “I”: Invitación, “C”: Conocimiento, “E”: Empatía y emociones “E”: Estrategia. Información administrativa Archivos Adicionales Ninguno declarado por los autores. Agradecimientos No declarada. Contribuciones de los autores Irene Solana López: conceptualización, validación, visualización, metodología, administración de proyecto, escritura: revisión y edición. Ignacio Juez Martel: conceptualización, curación de datos, análisis formal, adquisición de fondos, investigación, recursos, software. Elia Martínez Moreno, conceptualización, curación de datos, análisis formal, adquisición de fondos, investigación, recursos, software. Juan Antonio Guerra Martínez, conceptualización, curación de datos, análisis formal, adquisición de fondos, investigación, recursos, software. Todos los autores leyeron y aprobaron la versión final del manuscrito. Fondos Los autores no recibieron ningún tipo de reconocimiento económico por este trabajo de investigación. Disponibilidad de datos y materiales Existe la disponibilidad de datos bajo solicitud al autor de correspondencia. No se reportan otros materiales. Declaraciones Aprobación del comité de ética No aplica a estudios observacionales con revisión de bases de datos o historias clínicas. Consentimiento para publicación No aplica para estudios que no publican imágenes explícitas como tomografías, resonancias, imágenes de exámenes físicos. Conflictos de interés Los autores declaran que ellos no tienen ningún conflicto de competencia o interés. Nota del Editor La Revista Oncología Ecu permanece neutral con respecto a los reclamos jurisdiccionales en mapas publicados y afiliaciones institucionales. Referencias • Caycedo Bustos, Martha Ligia. "La muerte en la cultura occidental: antropología de la muerte." Revista Colombiana de psiquiatría 36.2 (2007): 332-339. • VandeKieft, Gregg. "Breaking bad news." American family physician 64.12 (2001): 1975. • Blackall GF. Stand and wait. J Clin Oncol. 2010 Dec 1;28(34):5124-5. doi: 1200/JCO.2010.32.5324. Epub 2010 Oct 4. PMid:20921470. • Puchalski CM, Sbrana A, Ferrell B, Jafari N, King S, Balboni T, Miccinesi G, Vandenhoeck A, Silbermann M, Balducci L, Yong J, Antonuzzo A, Falcone A, Ripamonti CI. Interprofessional spiritual care in oncology: a literature review. ESMO Open. 2019 Feb 16;4(1):e000465. DOI: 1136/esmoopen-2018-000465.PMid:30962955. PMCid:PMC6435249. • Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5(4):302-11. doi: 1634/theoncologist.5-4-302.PMid:10964998 • Dekker J, Karchoud J, Braamse AMJ, Buiting H, Konings IRHM, van Linde ME, Schuurhuizen CSEW, Sprangers MAG, Beekman ATF, Verheul HMW. Clinical management of emotions in patients with cancer: introducing the approach "emotional support and case finding". Transl Behav Med. 2020 Dec 31;10(6):1399-1405. DOI: 1093/tbm/ibaa115. PMid:33200793 PMCid:PMC7796719 • Harpham WS. View from the Other Side of the Stethoscope: Patient Handout-If Patients Feel Guilty…. Oncology Times, 2014;36(3):35. 1097/01.COT.0000444048.63798.a4 • Howells K, Day A. Readiness for anger management: clinical and theoretical issues. Clin Psychol Rev. 2003 Mar;23(2):319-37. DOI: 1016/s0272-7358(02)00228-3. PMid:12573674.