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This study examined using peanut shells, rice husks, and cocoa husks as soil conditioners to boost yields in Allium cepa var. Alvara onions. Three types of biochar and four application rates (1%, 1.5%, 3%, and 5%) were compared to a control with no biochar. The biochars had different nutrient makeups, with cocoa husk biochar (CHB) containing the most essential elements. While overall plant growth (height, leaves, and roots) was not significantly affected (p > 0.05) by any biochar type compared to the control, some plant parts responded differently. CHB (5%) and peanut husk biochar (PHB) (1%) yielded the tallest onion plants (71 and 65 cm), while 1% rice and cocoa biochar resulted in the shortest (below 42 cm). PHB (3% and 5%) produced the longest roots (9 cm), while 1.5% rice husk biochar (RHB) had the shortest. Biochar application had no significant effect on leaf count. However, specific application rates of RHB and PHB increased the harvest index (HI), indicating more efficient yield allocation. HI values > 0.85 were obtained with specific biochar rates (e.g., 1.0–1.5% PHB, 1.5–5% RHB, or 5.0% CHB).

Background: Cytomegalovirus (CMV) infection is a common complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT) and in patients receiving novel hematological therapies. Its impact on morbidity and mortality necessitates effective management strategies. Despite recent advances in diagnostics and treatment, unresolved questions persist regarding monitoring and treatment, prompting the need for updated recommendations. Methods: A consensus was reached among a panel of experts selected for their expertise in CMV research and clinical practice. Key clinical areas and questions were identified based on previous surveys and literature reviews. Recommendations were formulated through consensus and graded using established guidelines. Results: Recommendations were provided for virological monitoring, including the timing and frequency of CMV DNAemia surveillance, especially during letermovir (LMV) prophylaxis. We evaluated the role of CMV DNA load quantification in diagnosing CMV disease, particularly pneumonia and gastrointestinal involvement, along with the utility of specific CMV immune monitoring in identifying at-risk patients. Strategies for tailoring LMV prophylaxis, managing breakthrough DNAemia, and implementing secondary prophylaxis in refractory cases were outlined. Additionally, criteria for initiating early antiviral treatment based on viral load dynamics were discussed. Conclusion: The consensus provides updated recommendations for managing CMV infection in hematological patients, focusing on unresolved issues in monitoring, prophylaxis, treatment, and resistance. These recommendations aim to guide clinical practice and improve outcomes in this high-risk population. Further research is warranted to validate these recommendations and address ongoing challenges in CMV management with emerging antiviral combinations, particularly in pediatric populations.

IntroductionUnderstanding intestinal permeability is paramount for elucidating gastrointestinal health and pathology. The size and nature of the molecule traversing the intestinal barrier offer crucial insights into various acute and chronic diseases, as well as the evolution of some conditions. This study aims to assess the urinary excretion kinetics of gluten immunogenic peptides (u-GIP), a unique class of dietary peptides detectable in urine, in volunteers under controlled dietary conditions. This evaluation should be compared to established probes like lactulose, a non-digestible disaccharide indicative of paracellular permeability, and mannitol, reflecting transcellular permeability.MethodsFifteen participants underwent simultaneous ingestion of standardized doses of gluten (10 g), lactulose (10 g), and mannitol (1 g) under fasting conditions for at least 8 hours pre-ingestion and during 6 hours post-ingestion period. Urine samples were collected over specified time intervals. Excretion patterns were analyzed, and correlations between the lactulose-to-mannitol ratio (LMR) and u-GIP parameters were assessed.ResultsThe majority of u-GIP were detected within the first 12 hours post-ingestion. Analysis of the variability in cumulative excretion across two sample collection ranges demonstrated that lactulose and u-GIP exhibited similar onset and excretion dynamics, although GIP reached its maximum peak earlier than either lactulose or mannitol. Additionally, a moderate correlation was observed between the LMR and u-GIP parameters within the longest urine collection interval, indicating potential shared characteristics among permeability pathways. These findings suggest that extending urine collection beyond 6 hours may enhance data reliability.DiscussionThis study sheds light on the temporal dynamics of u-GIP in comparison to lactulose and mannitol, established probes for assessing intestinal permeability. The resemblance between u-GIP and lactulose excretion patterns aligns with the anticipated paracellular permeability pathway. The capacity to detect antigenic food protein fragments in urine opens novel avenues for studying protein metabolism and monitoring pathologies related to the digestive and intestinal systems.

Biochar's impact on plant growth is complex, varying with type and application rate. This study explored how four biochars (rice husk, cocoa shell, peanut shell, carob) affect rice (Oryza sativa L) at five rates (0-5%). Biochar significantly enhanced rice growth, but the optimal type and rate varied. Total dry mass increased by an average of 20% in biochar-treated groups compared to controls, with rice husk and cocoa shell biochar at 5% application rate achieving the highest yields. The effects on plant components differed. While leaf mass fraction responded favorably to all biochar types, stem and root mass fractions remained largely unchanged. Additionally, root strength, as measured by root dry matter content, increased with all biochars, particularly rice husk biochar which boosted it by 8%. All biochar types also enhanced leaf mass per area, a key indicator of photosynthetic efficiency. These findings highlight the importance of tailoring biochar application strategies to specific crops and soil conditions. Optimizing biochar application based on its influence on root strength, leaf mass allocation, and growth across different crop species and soil conditions can unlock its full potential for sustainable development.

IntroductionScarce real-life data exists for COVID-19 management in hematologic disease (HD) patients in the Omicron era.PurposeTo assess the current clinical management and outcome of SARS-CoV-2 infection diagnosed, identify the risk factors for severe outcomes according to the HD characteristics and cell therapy procedures in a real-world setting.MethodsA retrospective observational registry led by the Spanish Transplant Group (GETH-TC) with 692 consecutive patients with HD from December 2021 to May 2023 was analyzed.ResultsNearly one-third of patients (31%) remained untreated and presented low COVID-19-related mortality (0.9%). Nirmatrelvir/ritonavir was used mainly in mild COVID-19 cases in the outpatient setting (32%) with a low mortality (1%), while treatment with remdesivir was preferentially administered in moderate-to-severe SARS-CoV-2 infection cases during hospitalization (35%) with a mortality rate of 8.6%. The hospital admission rate was 23%, while 18% developed pneumonia. COVID-19-related mortality in admitted patients was 14%. Older age, autologous hematopoietic stem cell transplantation (SCT), chimeric antigen receptor T-cell therapy, corticosteroids and incomplete vaccination were factors independently associated with COVID-19 severity and significantly related with higher rates of hospital admission and pneumonia. Incomplete vaccination status, treatment with prior anti-CD20 monoclonal antibodies, and comorbid cardiomyopathy were identified as independent risk factors for COVID-19 mortality.ConclusionsThe results support that, albeit to a lower extent, COVID-19 in the Omicron era remains a significant problem in HD patients. Complete vaccination (3 doses) should be prioritized in these immunocompromised patients. The identified risk factors may help to improve COVID-19 management to decrease the rate of severe disease, ICU admissions and mortality.

The objective of this work is to identify and visualize the intellectual structure of the Lean Manufacturing research field. To achieve this, a bibliometric analysis will be carried out that combines a performance and co-occurrence analysis, to identify and analyze the relationships between the topics that have had the greatest impact on the construction of the knowledge base of this discipline. To achieve this objective, a bibliometric analysis was carried out that began with a search on the Web of Science (WOS) platform with the Lean Manufacturing theme. From this database, the references were exported and subsequently processed using the Bibliometrix software, which allows for both an analysis of indexes and the number of articles, which showed us that it was not until 2012 that a progressive publication of works on the subject begins, of productivity by country, with the USA appearing as the country with the greatest number of publications and the greatest number of citations on the topic analyzed, and of authors and journals with the greatest publications, as well as a co-occurrence analysis, which shows us the keywords most used by the authors and the thematic areas where they are most published, the results of which yielded five clusters or groups of keywords led by the terms Lean Management, Lean, Industry 4.0, Value Stream Map and Six Sigma.

Abstract Background The use of remote consultation modalities has exponentially grown in the past few years, particularly since the onset of the COVID-19 pandemic. Although a huge body of the literature has described the use of phone (tele) and video consultations, very few of the studies correspond to randomized controlled trials, and none of them has assessed the safety of these consultation modalities as the primary objective. The primary objective of this trial was to assess the safety of remote consultations (both video and teleconsultation) in the follow-up of patients in the hospital setting. Methods Multicenter, randomized controlled trial being conducted in four centers of an administrative healthcare area in Catalonia (North-East Spain). Participants will be screened from all individuals, irrespective of age and sex, who require follow-up in outpatient consultations of any of the departments involved in the study. Eligibility criteria have been established based on the local guidelines for screening patients for remote consultation. Participants will be randomly allocated into one of the two study arms: conventional face-to-face consultation (control) and remote consultation, either teleconsultation or video consultation (intervention). Routine follow-up visits will be scheduled at a frequency determined by the physician based on the diagnostic and therapy of the baseline disease (the one triggering enrollment). The primary outcome will be the number of adverse reactions and complications related to the baseline disease. Secondary outcomes will include non-scheduled visits and hospitalizations, as well as usability features of remote consultations. All data will either be recorded in an electronic clinical report form or retrieved from local electronic health records. Based on the complications and adverse reaction rates reported in the literature, we established a target sample size of 1068 participants per arm. Recruitment started in May 2022 and is expected to end in May 2024. Discussion The scarcity of precedents on the assessment of remote consultation modalities using randomized controlled designs challenges making design decisions, including recruitment, selection criteria, and outcome definition, which are discussed in the manuscript. Trial registration NCT05094180. The items of the WHO checklist for trial registration are available in Additional file 1. Registered on 24 November 2021.

El tratamiento del infarto agudo de miocardio con elevación del segmento ST tiene barreras dependiendo de la región geográfica. La angioplastia coronaria primaria es el tratamiento de elección, siempre y cuando sea realizada dentro de tiempo y por operadores experimentados. Sin embargo, cuando no está disponible, la administración de fibrinólisis y el envío para angioplastia de rescate, en caso de reperfusión negativa, es la mejor estrategia. De la misma manera, la angioplastia coronaria, como parte de una estrategia farmacoinvasiva, es la mejor alternativa cuando hay reperfusión positiva. El desarrollo de redes de tratamiento del infarto aumenta el número de pacientes reperfundidos dentro de los tiempos recomendados y mejora los desenlaces. En América Latina, los programas nacionales para el tratamiento del infarto deben centrarse en mejorar los resultados y el éxito a largo plazo depende de trabajar hacia objetivos definidos y obtener métricas de rendimiento, por lo tanto, estos deben desarrollar métricas para cuantificar su desempeño. El siguiente documento discute todas estas alternativas y sugiere oportunidades de mejora.

Astrocytes represent the most abundant cell type in the brain, where they play critical roles in synaptic transmission, cognition, and behavior. Recent discoveries show astrocytes are involved in synaptic dysfunction during Alzheimer’s disease (AD). AD patients have imbalanced cholesterol metabolism, demonstrated by high levels of side-chain oxidized cholesterol known as 27-hydroxycholesterol (27-OH). Evidence from our laboratory has shown that elevated 27-OH can abolish synaptic connectivity during neuromaturation, but its effect on astrocyte function is currently unclear. Our results suggest that elevated 27-OH decreases the astrocyte function in vivo in Cyp27Tg, a mouse model of brain oxysterol imbalance. Here, we report a downregulation of glutamate transporters in the hippocampus of CYP27Tg mice together with increased GFAP. GLT-1 downregulation was also observed when WT mice were fed with high-cholesterol diets. To study the relationship between astrocytes and neurons, we have developed a 3D co-culture system that allows all the cell types from mice embryos to differentiate in vitro. We report that our 3D co-cultures reproduce the effects of 27-OH observed in 2D neurons and in vivo. Moreover, we found novel degenerative effects in astrocytes that do not appear in 2D cultures, together with the downregulation of glutamate transporters GLT-1 and GLAST. We propose that this transporter dysregulation leads to neuronal hyperexcitability and synaptic dysfunction based on the effects of 27-OH on astrocytes. Taken together, these results report a new mechanism linking oxysterol imbalance in the brain and synaptic dysfunction through effects on astrocyte function.

The blade of a hydraulic turbine is the critical element of the energy conversion process in a hydroelectric plant; therefore, numerous blade reconstruction techniques are based on stacking cross-sections along the flow streamlines generated inside the runner passage. The uneven distribution along the spanwise direction causes surfaces with a lower degree of uniformity and continuity, especially in highly twisted and re-flexed blades. To solve this problem, the researchers often stack many cross-sections, causing a proportional increase in the number of parameters and points that define each section, which is detrimental when performing hydrodynamic optimization or numerical machining of the runner. In consequence, in this paper, we created the Smoothed Numerical Blade (SNB), a blade that is computationally cheap and defined with the lowest number of well-defined cross-sections placed orthogonality on a grid instead of following the fluid trajectory. The quantitative and qualitative analysis developed in the model test of the Francis GAMM turbine shows that the runner created by SNB achieves a high degree of smoothness and continuity on the blade surfaces, thereby maintaining the GAMM turbine performance of the original parameters.

RESUMEN Introducción y objetivos: Las diferencias geográficas y organizativas entre distintas comunidades autónomas (CCAA) pueden generar diferencias en la atención al infarto agudo de miocardio con elevación del segmento ST (IAMCEST). Se han comparado 17 programas de Código Infarto en términos de incidencia, características clínicas, tratamiento de reperfusión, retraso hasta la reperfusión y mortalidad a 30 días. Métodos: Estudio observacional prospectivo nacional (83 centros en 17 redes de infarto). El periodo de selección fue de 3 meses (1 de abril a 30 de junio de 2019), con seguimiento clínico a 30 días. Resultados: Se incluyeron 4.366 pacientes con IAMCEST. La tasa de incidencia fue variable entre las CCAA (p < 0,0001), igual que el sexo (p = 0,003) y la prevalencia de factores de riesgo cardiovascular (p < 0,0001). El tratamiento de reperfusión fue angioplastia primaria (rango 77,5-97,8%), fibrinolisis (rango 0- 12,9%) o ninguno (rango 2,2-13,5%). El análisis del retraso hasta la reperfusión mostró diferencias significativas (p < 0,001) para todos los intervalos analizados. Hubo diferencias significativas en la mortalidad cruda a 30 días que desaparecieron tras ajustar por las características clínicas y dependientes de la red asistencial (primer contacto, tiempo hasta la reperfusión y abordaje de críticos). Conclusiones: Se han detectado diferencias en la atención al IAMCEST entre las distintas CCAA, en términos de incidencia, características clínicas, tratamiento de reperfusión, retraso hasta la reperfusión y mortalidad a 30 días. Las diferencias en mortalidad desaparecen tras ajustar por las características del paciente y de la red asistencial.

ABSTRACT Introduction and objectives: Geographical and organizational differences between different autonomous communities (AC) can generate differences in care for ST-segment elevation myocardial infarction (STEMI). A total of 17 heart attack code programs have been compared in terms of incidence rate, clinical characteristics, reperfusion therapy, delay to reperfusion, and 30-day mortality. Methods: National prospective observational study (83 centers included in 17 infarction networks). The recruitment period was 3 months (April 1 to June 30, 2019) with clinical follow-up at 30 days. Results: 4366 patients with STEMI were included. The incidence rate was variable between different AC (P < .0001), as was gender (P = .003) and the prevalence of cardiovascular risk factors (P < .0001). Reperfusion treatment was primary angioplasty (range 77.5%-97.8%), fibrinolysis (range 0%-12.9%) or no treatment (range 2.2%- 13.5%). The analysis of the delay to reperfusion showed significant differences (P < .001) for all the intervals analyzed. There were significant differences in 30-days mortality that disappeared after adjusting for clinical and healthcare network characteristics. Conclusions: Large differences in STEMI care have been detected between the different AC, in terms of incidence rate, clinical characteristics, reperfusion treatment, delay until reperfusion, and 30-day mortality. The differences in mortality disappeared after adjusting for the characteristics of the patient and the care network.

Objectives: Cardiovascular conditions like hypercholesterolemia and hypertension increase the risk for Alzheimer's Disease (AD). Thus, certain AD risk profiles may benefit from optimized multi- medication therapies including for example cholesterol-lowering and antihypertensive drugs. We previously showed that the drugs most frequently prescribed in older patients in Sweden are compounds from cardiovascular drug classes such as antithrombotic agents, lipid modifying agents, ACE inhibitors, selective calcium channel blockers and are used in combination. In this study we aim to investigate the effects of two multiple-drug regimens in the APPNL-G-F knock-in (APP KI) mouse model of AD and explore whether this could affect the disease progression at early stages. Methods: APP KI mice were fed for 2 months with a control or multi-medication diet (including anti- hypertensive, lipid lowering and psychotropic drugs, in two different combinations) based on the most used medications by older adults in Sweden. In addition to the multi-medication regimens, mice were also tested for specific monotherapies from the compounds used in combination. Animals were assessed for locomotion, cognition, and anxiety-like behavior. Brain tissues were collected for molecular biology experiments, while blood was analyzed by GC/LC-MS to measure serum metabolomics. Results: We found that multi-medication therapies in AD mice differentially affected essential functions such as locomotion, and distinct types of memory. APP KI male mice treated with combination#1 exhibited a rescue of cognitive deficits compared to controls, which we didn´t observe in females. These findings positively correlate with the significant reduction of cortical Aβ plaques observed in treated APP KI males. Conversely, combination#2 didn´t exert a positive effect on cognitive abilities. Monotherapy treatments induced different effects on functional and cognitive outcomes depending on sex, partially explaining the results observed in polypharmacy groups. Discussion: We show that multi-medication therapies comprising cardiovascular drugs like statins and β-blockers or ACE inhibitors may impact the progression of AD pathophysiology depending on sex and multiple-drug combination, suggesting some synergic effects deriving from the multi- medication rather than the administration of single compounds. The outcomes from this study can provide knowledge for designing more individualized therapies in aging and AD, taking sex and gender into special consideration.

Background: A significant proportion of cases of cardiogenic shock (CS) are due aetiologies other than acute coronary syndromes (non ACS-CS). We assessed differences regarding clinical profile, management, and prognosis according to the cause of CS among nonselected patients with CS from a large nationwide database. Methods: We performed an observational study including patients admitted from the hospitals of the Spanish National Health System (SNHS) with a principal or secondary diagnosis code of CS (2016-2019). Data were obtained from the Minimum Basic Data Set (MBDS). Hospitals were classified according to the availability of cardiology related resources, as well as the availability of Intensive Cardiac Care Unit (ICCU). Results: A total of 10,826 episodes of CS were included, of whom 5,495 (50.8%) were non-ACS related. Non ACS-CS patients were younger (71.5 vs. 72.4 years) and had a lower burden of arteriosclerosis-related comorbidities. Non ACS-CS cases underwent less often invasive procedures and presented lower in-hospital mortality (57.1% vs. 61%,p

Abstract The long-term clinical efficacy of SARS-CoV-2 vaccines according to antibody response in immunosuppressed patients such as hematological patients has been little explored. A prospective multicenter registry-based cohort study conducted from December 2020 to July 2022 by the Spanish Transplant and Cell Therapy group, was used to analyze the relationship of antibody response over time after full vaccination (at 3–6 weeks, 3, 6 and 12 months) (2 doses) and of booster doses with breakthrough SARS-CoV-2 infection in 1551 patients with hematological disorders. At a median follow-up of 388 days after complete immunization, 266 out of 1551 (17%) developed breakthrough SARS-CoV-2 infection at median of 86 days (range 7–391) after full vaccination. The cumulative incidence was 18% [95% confidence interval (C.I.), 16–20%]. Multivariate analysis identified higher incidence in chronic lymphocytic leukemia patients (29%) and with the use of corticosteroids (24.5%), whereas female sex (15.5%) and more than 1 year after last therapy (14%) were associated with a lower incidence (p

Objectives To estimate the readiness of Spanish National Health Service (NHS) hospitals to provide chimeric antigen receptor T cell (CAR-T), and to identify and quantify the different resources needed to provide CAR-T considering three scenarios defined by 10, 25 and 50 patients per centre per year.Design Targeted literature review and quantitative study using a questionnaire and telephone interviews. An algorithm was created to determine hospitals’ readiness based on their capacity and capability. All the requirements for quantification were assessed and validated by the steering committee, formed by members of the Spanish Group of Haematopoietic Transplantation and Cell Therapy. A weighting system (from 0 to 1) was established for capability quantification. For resources quantification, a scoring system was established, with 0 points representing the minimum and 3 points the maximum of additional resources that a hospital indicated necessary.Setting 40 Spanish hospital centres that perform allogeneic haematopoietic stem cell transplantation were invited to complete the questionnaire for capacity quantification, 28 of which provided valid responses. Nine hospitals participated in the interviews for resource quantification, eight of which had previously been designated by the Ministry of Health (MoH) to provide CAR-T.Outcome measure Current capacity of NHS Spanish sites to administer CAR-T under different theoretical scenarios with varying numbers of procedures, and the potential healthcare resources that would be needed to realise the theoretical capacity requirements.Results Four hospitals were optimally ready, 17 were somewhat ready and 7 were not ready. The actual extrapolated capacity of the currently designated MoH CAR-T sites would allow treatment of approximately 250 patients per year. Regarding healthcare resource needs, the numbers of haematologists, nurses and beds were the most important limiting factors, and those requiring further growth as patient numbers increased.Conclusions Increasing the number of CAR-T-qualified centres and/or increasing resources in the current designated sites are two potential strategies that should be considered to treat CAR-T-eligible patients in Spain.

A large number of patients with celiac disease (CD) remain undiagnosed because they do not fulfill the criteria for entry into the conventional diagnostic workflow. This study evaluated the clinical utility of anti-tissue transglutaminase IgA antibody lateral flow immunoassays (anti-tTG-IgA LFIA) in the undiagnosed-CD-based pediatric population and the impact of a gluten-free diet (GFD) on screening-detected CD. A total of 576 volunteers were tested for anti-tTG-IgA. Gluten consumption habits, CD related symptoms, and risk factors for CD development were evaluated. Volunteers testing positive for anti-tTG-IgA were referred to the conventional CD diagnostic workflow, and the impact of the GFD on health-related quality of life (HR-QoL) was measured. Among them, 13 had a positive anti-tTG-IgA LFIA test result: 11 had confirmed CD (1.91%), one refused confirmatory tests, and another is undergoing diagnosis. Regarding the CD prevalence, no significant differences were observed among risk (1.89%) and symptomatic (2.65%) groups and the entire tested population (1.55%). Rapid anti-tTG-IgA LFIAs could be of clinical utility in primary care for the early identification of children with CD unidentified by the conventional diagnostic workflow. It could potentially reduce the costs of undiagnosed CD, avoiding unnecessary referrals to gastroenterologists, reducing diagnosis delays and long-term problems, and improving patients’ HR-QoL.

Abstract Background The clinical efficacy of SARS-CoV-2 vaccines according to antibody response in immunosuppressed patients such as hematological patients has not yet been established. Patients and methods A prospective multicenter registry-based cohort study conducted from December 2020 to December 2021 by the Spanish transplant and cell therapy group was used to analyze the relationship of antibody response at 3–6 weeks after full vaccination (2 doses) with breakthrough SARS-CoV-2 infection in 1394 patients with hematological disorders. Results At a median follow-up of 165 days after complete immunization, 37 out of 1394 (2.6%) developed breakthrough SARS-CoV-2 infection at median of 77 days (range 7–195) after full vaccination. The incidence rate was 6.39 per 100 persons-year. Most patients were asymptomatic (19/37, 51.4%), whereas only 19% developed pneumonia. The mortality rate was 8%. Lack of detectable antibodies at 3–6 weeks after full vaccination was the only variable associated with breakthrough infection in multivariate logistic regression analysis (Odds Ratio 2.35, 95% confidence interval 1.2–4.6, p = 0.012). Median antibody titers were lower in cases than in non-cases [1.83 binding antibody units (BAU)/mL (range 0–4854.93) vs 730.81 BAU/mL (range 0–56,800), respectively (p = 0.007)]. We identified 250 BAU/mL as a cutoff above which incidence and severity of the infection were significantly lower. Conclusions Our study highlights the benefit of developing an antibody response in these highly immunosuppressed patients. Level of antibody titers at 3 to 6 weeks after 2-dose vaccination links with protection against both breakthrough infection and severe disease for non-Omicron SARS-CoV-2 variants.

RESUMEN La hipertensión arterial es el factor de riesgo cardiovascular más prevalente. A pesar del tratamiento farmacológico, un alto porcentaje de pacientes no consiguen un adecuado control. La denervación renal es una intervención mínimamente invasiva para el tratamiento de la hipertensión que implica la interrupción de los nervios simpáticos renales mediante un abordaje con catéter. Los estudios iniciales mostraron resultados prometedores, pero los controvertidos resultados del ensayo SYMPLICITY HTN-3 llevaron al abandono de la técnica. En los últimos 3 años han aparecido los resultados de nuevos ensayos clínicos, con nuevos dispositivos y en diferentes poblaciones, que demuestran definitivamente la eficacia de la denervación renal. En este documento de posicionamiento conjunto de la Sociedad Española de Hipertensión-Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA) y la Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (ACI-SEC) se revisa la evidencia disponible sobre la eficacia y la seguridad de la denervación renal en el tratamiento de la hipertensión. A partir de los resultados de los ensayos clínicos, se generan recomendaciones sobre qué pacientes y en qué condiciones podrían ser candidatos a una denervación renal.

ABSTRACT Hypertension is the most prevalent cardiovascular risk factor. Despite pharmacological treatment, a high percentage of patients do not achieve an adequate blood pressure control. Renal sympathetic denervation is a minimally invasive intervention for the management of hypertension involving the interruption of the renal artery sympathetic nervous system using a catheter-based approach. The early studies showed promising results, but the controversial results coming from the SYMPLICITY HTN-3 trial sent this technique into oblivion. Over the last 3 years, new clinical trials have appeared including new devices used in different populations, which definitively proves the effectiveness of renal sympathetic denervation. This joint position statement from the Spanish Society of Hypertension-Spanish League for Combating High Blood Pressure (SEH-LELHA), and the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) reviews the evidence available on the efficacy and safety profile of renal sympathetic denervation for the management of hypertension. Based on the results of clinical trials, recommendations have been established on what patients may be eligible for renal sympathetic denervation and under what circumstances.

Abstract Background Thioredoxin-80 (Trx80) is a cleavage product from the redox-active protein Thioredoxin-1 and has been previously described as a pro-inflammatory cytokine secreted by immune cells. Previous studies in our group reported that Trx80 levels are depleted in Alzheimer’s disease (AD) brains. However, no studies so far have investigated peripheral Trx80 levels in the context of AD pathology and whether could be associated with the main known AD risk factors and biomarkers. Methods Trx80 was measured in serum samples from participants from two different cohorts: the observational memory clinic biobank (GEDOC) (N = 99) with AD CSF biomarker data was available and the population-based lifestyle multidomain intervention trial Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) (N = 47), with neuroimaging data and blood markers of inflammation available. The GEDOC cohort consists of participants diagnosed with subjective cognitive impairment (SCI), mild cognitive impairment (MCI), and AD, whereas the FINGER participants are older adults at-risk of dementia, but without substantial cognitive impairment. One-way ANOVA and multiple comparison tests were used to assess the levels of Trx80 between groups. Linear regression models were used to explore associations of Trx80 with cognition, AD CSF biomarkers (Aβ42, t-tau, p-tau and p-tau/t-tau ratio), inflammatory cytokines, and neuroimaging markers. Results In the GEDOC cohort, Trx80 was associated to p-tau/t-tau ratio in the MCI group. In the FINGER cohort, serum Trx80 levels correlated with lower hippocampal volume and higher pro-inflammatory cytokine levels. In both GEDOC and FINGER cohorts, ApoE4 carriers had significantly higher serum Trx80 levels compared to non-ApoE4 carriers. However, Trx80 levels in the brain were further decreased in AD patients with ApoE4 genotype. Conclusion We report that serum Trx80 levels are associated to AD disease stage as well as to several risk factors for AD such as age and ApoE4 genotype, which suggests that Trx80 could have potential as serum AD biomarker. Increased serum Trx80 and decreased brain Trx80 levels was particularly seen in ApoE4 carriers. Whether this could contribute to the mechanism by which ApoE4 show increased vulnerability to develop AD would need to be further investigated. Trial registration ClinicalTrials.gov NCT01041989 . Registered on 4 January 2010—retrospectively registered

Background: Scarce data exist that analyze the outcomes of hematological patients with SARS-CoV-2 infection during the Omicron variant period who received treatment with remdesivir or nirmatrelvir/ritonavir. Methods: This study aims to address this issue by using a retrospective observational registry, created by the Spanish Hematopoietic Stem Cell Transplantation and Cell Therapy Group, spanning from 27 December 2021 to 30 April 2023. Results: This study included 466 patients, 243 (52%) who were treated with remdesivir and 223 (48%) with nirmatrelvir/ritonavir. Nirmatrelvir/ritonavir was primarily used for mild cases, resulting in a lower COVID-19-related mortality rate (1.3%), while remdesivir was preferred for moderate to severe cases (40%), exhibiting a higher mortality rate (9%). A multivariate analysis in the remdesivir cohort showed that male gender (odds ratio (OR) 0.35, p = 0.042) correlated with a lower mortality risk, while corticosteroid use (OR 9.4, p < 0.001) and co-infection (OR 2.8, p = 0.047) were linked to a higher mortality risk. Prolonged virus shedding was common, with 52% of patients shedding the virus for more than 25 days. In patients treated with remdesivir, factors associated with prolonged shedding included B-cell malignancy as well as underlying disease, severe disease, a later onset of and shorter duration of remdesivir treatment and a higher baseline viral load. Nirmatrelvir/ritonavir demonstrated a comparable safety profile to remdesivir, despite a higher risk of drug interactions. Conclusions: Nirmatrelvir/ritonavir proved to be a safe and effective option for treating mild cases in the outpatient setting, while remdesivir was preferred for severe cases, where corticosteroids and co-infection significantly predicted worse outcomes. Despite antiviral therapy, prolonged shedding remains a matter of concern.

Background: Glycation products have been linked to decreased bone mineral density (BMD) in a number of clinical settings. This study examined the correlation between early glycation products (HbA1c and glycated albumin (ALB-g)) and advanced glycation end products (pentosidine (PTD)) with BMD in two groups of participants: those with type 2 diabetes mellitus (DM2) and those without diabetes or any other comorbidities (noDM). All of the participants had resided in southeastern Mexico for a minimum of 10 years. Material and Methods: This study included 204 participants: 112 (55%) with DM2 and 92 (45%) healthy subjects. We utilized dual X-ray absorptiometry (DXA) to measure both the total and segment-specific BMD and adipose mass. In addition, the fasting blood glucose, HbA1c, PTD, and ALB-g parameters were measured. Correlation and logistic regression analyses were conducted. Results: There was an inverse correlation between PTD and BMD in all anatomical regions among postmenopausal women (PMW) in the DM2 group, whereas in non-PMW, only the waist-to-height ratio was statistically significant. A negative correlation was observed between HbA1c levels and BMD in the arms and legs of DM2 individuals. However, in the noDM group, a negative correlation was found between HbA1c levels and BMD in the pelvis, while a positive association was observed between HbA1c and indicators of adipose tissue. ALB-g, demonstrated a negative correlation with fat mass. After performing binary logistic regressions, the following odds ratios (OR) for osteopenia/osteoporosis risk were determined: PTD OR 1.1 (p = 0.047) for DM2 PMW, HbA1c OR 1.4 (p = 0.048), and fat mass content OR 1.011 (p = 0.023) for the entire sample. Conclusions: Glycation products are associated with BMD differentially depending on the analyzed anatomical segment, but PTD, HbA1c, and fat mass are significant predictors of low bone mass. In prospective studies, this association could be determined using other techniques involving three-dimensional analysis of bone architecture to evaluate bone architecture.

Listeria monocytogenes is a foodborne pathogen that causes listeriosis and can be a problem in areas where meat products are sold at unregulated storage temperatures. In this work, the prevalence of L. monocytogenes was determined in the five most widely traded meat products in the province of Quevedo (Ecuador): bacon, “chorizo paisa”, grilled hamburger meat, mortadella, and salami. A total of 1000 samples of these products were analyzed in two seasons of the year (dry season/rainy season). All L. monocytogenes isolates were confirmed by PCR with primers designed for the iap gene. Furthermore, the positive samples were quantified for L. monocytogenes. Of the 1000 meat products analyzed, 163 were positive for L. monocytogenes (16.3%). The prevalence of L. monocytogenes in the two seasons in different meat products was as follows: 22.5% in mortadella, 19% in hamburger meat, 15% in bacon, 14.5% in chorizo paisa and 10.5% in salami. In addition, the concentration of L. monocytogenes in most of the positive samples was in the range of 4–6 log CFU/g or even higher. The results show the need for improvements in the hygienic measures and meat storage temperatures in Quevedo (Ecuador) to avoid risks of foodborne listeriosis.

ObjectiveTo assess the clinical outcome (death and/or Intensive Care Unit (ICU) admission) based on the time from hospital admission to the administration of anakinra and the possible usefulness of a "simplified" SCOPE score to stratify the risk of worse prognosis in our cohort of patients with moderate/severe SARS-CoV-2 pneumonia, both vaccinated and unvaccinated, that received anakinra and corticosteroids. In addition, the clinical, analytical, and imaging characteristics of patients at admission are described.MethodsRetrospective cohort study of 312 patients admitted to Hospital Clínico San Cecilio in Granada for moderate/severe pneumonia caused by SARS-CoV-2 that received anakinra and corticosteroids between March 2020 and January 2022. Clinical and analytical data were collected as well as the patient outcome at 30 and 60 days after admission. Three treatment groups were established according to the time from hospital admission to administration of anakinra: early (1st-2nd day), intermediate (3rd-5th day), and late (after the 5th day).ResultsThe median age was 67.4 years (IQR 22-97 years) and 204 (65.4%) were male. The most common comorbidity was hypertension (58%). The median time from the start of symptoms to anakinra administration was 6 days (IQR 5-10) and the SaFi (SaO2/FiO2) was 228 (IQR 71-471). The cure rate was higher in the early-onset anakinra group versus the late-onset group (73% vs 56.6%). The latter had a higher percentage of deaths (27.4%) and a greater number of patients remained hospitalized for a month (16%). On admission, the patients had elevated C-reactive protein (CRP), ferritin, and D-dimer values and decreased total lymphocytes. Analytical improvement was observed at both 72 hours and one month after treatment. 42 (13.5%) required ICU admission, and 23 (7.3%) orotracheal intubation. At 60 days, 221 (70.8%) were discharged, 87 (27.8%) had died and 4 (1.4%) remained hospitalized. The mean dose of anakinra was 1000 mg (100-2600 mg) with differences found between the dose administered and the clinical outcome. There were no differences in the primary outcome based on vaccination. A simplified SCOPE score at the start of anakinra administration was lower in patients with better clinical evolution.ConclusionsEarly treatment with anakinra and corticosteroids was associated with a better outcome regardless of vaccination status. A simplified SCOPE was found to be a good prognostic tool.

# Introduction Evidence informed management of individuals presenting with subacromial impingement syndrome (SAIS) includes strengthening exercises directed at the shoulder musculature. Patients with subacromial impingement syndrome (SAIS) can present with pain during and after completion of heavy resistance training limiting the applicability of this recommended treatment approach. Blood flow restriction (BFR) training is indicated for patients who have pain while completing heavy resistance training and may represent an important treatment modification for patients with SAIS unable to fully participate in a strengthening exercise program. The purpose of this case series is to describe the inclusion of BFR in the treatment of two patients with SAIS. # Case descriptions Two middle aged, non-operative patients with signs and symptoms consistent with SAIS and high levels of irritability were included. Treatment over one month consisted of three commonly used exercises in the treatment of SAIS in conjunction with a standard BFR protocol: 75 reps broken up into sets of 30,15,15,15 with the BFR cuff placed over proximal humerus. # Outcomes Immediate within session improvements beyond measurement error were observed in resting pain and pain pressure thresholds at three sites. At the end of the course of treatment, clinically meaningful improvements were observed in patient reported outcomes including the PENN Score, ASES score, and the patient-specific functional scale. Clinically meaningful improvements and change beyond measurement error were also observed in range of motion and strength which (assessed via a handheld dynamometer). # Discussion The incorporation of low load resistance training with BFR may be a useful adjunct for treating patients with SAIS to promote exercise-induced hypoalgesia, decrease pain, and increase function in the upper extremity. # Level of Evidence 5

Several methodologies have successfully described the runner blade shape as a set of discrete sections joining the hub and shroud, defined by 3D geometrical forms of considerable complexity. This task requires an appropriate parametric approach for its accurate reconstruction. Among them, piecewise Bernstein polynomials have been used to create parametrizations of twisted runner blades by extracting some cross-sectional hydrofoil profiles from reference CAD data to be approximated by such polynomials. Using the interpolating polynomial coefficients as parameters, more profiles are generated by Lagrangian techniques. The generated profiles are then stacked along the spanwise direction of the blade via transfinite interpolation to obtain a smooth and continuous representation of the reference blade. This versatile approach makes the description of a range of different blade shapes possible within the required accuracy and, furthermore, the design of new blade shapes. However, even though it is possible to redefine new blade shapes using the aforementioned parametrization, a remaining question is whether the parametrized blades are suitable as a replacement for the currently used ones. In order to assess the mechanical feasibility of the new shapes, several stages of analysis are required. In this paper, bearing in mind the standard hydraulic test conditions of the hydrofoil test case of the Norwegian Hydropower Center, we present a structural stress–strain analysis of the reparametrization of a Francis blade, thus showing its adequate computational performance in two model tests.

Resumen: Antecedentes y objetivo: El objetivo del estudio fue caracterizar el perfil clínico y terapéutico de los pacientes con cardiopatía isquémica en España en los pacientes (grupo 1) al alta tras un síndrome coronario agudo, (grupo 2) en primera visita post-alta y (grupo 3) entre uno o 2 años tras el síndrome coronario agudo. Materiales y métodos: Estudio observacional, multicéntrico, transversal, de ámbito nacional, realizado en condiciones de práctica clínica habitual. Resultados: Se incluyeron 1.018 pacientes: 354 (34,8%) del grupo 1, 326 (32,0%) del 2 y 338 (33,2%) del 3. En comparación con el grupo 3, en el grupo 1 había un porcentaje significativamente mayor de pacientes fumadores (32,2 contra 10,9%), que consumían alcohol (28,2 contra 19,5%), que no realizaba ejercicio físico (61,0 contra 38,2%) o que no seguían una dieta (57,1 contra 32,5%). El 65,4% de los pacientes del grupo 1 no fue derivado a un programa de rehabilitación cardiaca (PRC). Del grupo 2, el 53,1% no tenía cita prevista para comenzar un PRC. Respecto al grupo 3, al 58,3% no se le recomendó nunca hacer rehabilitación cardiaca. Las variables asociadas al control de los factores de riesgo cardiovascular fueron la ausencia de obesidad y la asistencia a un PRC. Conclusiones: En el momento actual, menos de la mitad de los pacientes con cardiopatía isquémica en España son remitidos a un PRC, aunque estos programas se asocian a un mejor control de los factores de riesgo cardiovascular. Abstract: Introduction and objectives: The objective of the study was to characterize the clinical and therapeutic profile of patients with ischemic cardiopathy (IC) in Spain in patients (group 1) at the time of hospital discharge after an acute coronary syndrome (ACS), (group 2) at the first post-discharge follow-up visit, and (group 3) after one year of the ACS. Patients and methods: Observational, multicenter, cross-sectional, nationwide, performed in conditions of routine clinical practice. Results: A total of 1018 patients were included: 354 (34.8%) in the group 1, 326 (32.0%) in the 2, and 338 (33.2%) in the 3. Compared with group 3, a higher percentage of patients from group 1 were smokers (32.2% versus 10.9%), consumed alcohol (28.2% versus 19.5%), did not do any physical exercise (61.0% versus 38.2%) or followed a diet (57.1% versus 32.5%). Of patients in group 1, 65.4% were referred to a cardiac rehabilitation program (CRP). Of those in group 2, 53.1% had not a scheduled appointment to initiate a CRP. Regarding group 3, 58.3% did not receive the recommendation of doing a CRP. Absence of obesity and attendance to a CRP were variables associated with the control of cardiovascular risk factors. Conclusions: Currently, less than 50% of patients with IC in Spain are remitted to a CRP despite being associated with an improved control of cardiovascular risk factors.

BackgroundAn integrated and holistic approach is increasingly advocated in patients with atrial fibrillation (AF), based on the “Atrial fibrillation Better Care (ABC) pathway: A, Avoid stroke with anticoagulation; B, better symptom management; C, cardiovascular and comorbidity risk management.” The aim of this study was to examine the prevalence of adherence to each component of the ABC pathway and to analyze its impact on long-term prognosis in the “real-world” cohort of AF patients from the FANTASIIA registry.MethodsThis prospective study included consecutive AF outpatients anticoagulated with direct oral anticoagulants (DOAC) or vitamin K antagonists (VKA) from June 2013 to October 2014. From the ABC pathway, adherence to the “A criterion” was defined by a time in the therapeutic range (TTR) ≥ 70% or correct dose with DOAC; “B criterion” adherence was defined by a European Heart Rhythm Association (EHRA) Symptom Scale I-II; and “C criterion” adherence was defined as optimized risk factors and comorbidity management. Baseline features and embolic events, severe bleeding, and all-cause and cardiovascular mortality rates up to 3 years of follow-up were analyzed, and a Cox multivariate analysis was performed to investigate the role of each component of the ABC pathway in predicting major events.ResultsA total of 1,955 AF patients (age: 74.4 ± 9.4 years; 43.2% female patients) were included in this study: adherence to A criterion was observed in 920 (47.1%) patients; adherence to B criterion was observed in 1,791 (91.6%) patients; and adherence to C criterion was observed in 682 (34.8%) patients. Only 394 (20.2%) of the whole population had good control of AF according to the ABC pathway. After a median follow-up of 1,078 days (IQR: 766–1,113), adherence to A criterion was independently associated with reduced cardiovascular mortality [HR: 0.67, 95%CI (0.45–0.99); p = 0.048] compared with non-adherence. Adherence to the B criterion was independently associated with reduced stroke [HR: 0.28, 95%CI (0.14–0.59); p < 0.001], all-cause mortality [HR: 0.49, 95%CI (0.35–0.69); p < 0.001], cardiovascular mortality [HR: 0.39, 95%CI (0.25–0.62); p < 0.001], and major adverse cardiovascular events (MACE) [HR: 0.41, 95%CI (0.28–0.62); p < 0.001] compared with non-adherence. AF patients with C criterion adherence had a significantly lower risk of myocardial infarction [HR: 0.31, 95%CI (0.15–0.66); p < 0.001]. Fully adherent ABC patients had a significant reduction in MACE [HR: 0.64, 95%CI (0.42–0.99); p = 0.042].ConclusionIn real-world anticoagulated AF patients from FANTASIIA registry, we observed a lack of adherence to integrated care management of AF following the ABC pathway. AF managed according to the ABC pathway was associated with a significant reduction in adverse outcomes during long follow-up, suggesting the benefit of a holistic and integrated approach to AF management.

Abstract Background 27-Hydroxycholesterol (27-OH), the main circulating oxysterol in humans and the potential missing link between peripheral hypercholesterolemia and Alzheimer’s disease (AD), has not been investigated previously in relation to cognition and neuroimaging markers in the context of preventive interventions. Methods The 2-year Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) included older individuals (60–77 years) at increased risk for dementia but without dementia or substantial cognitive impairment from the general population. Participants were randomized to a multidomain intervention (diet, exercise, cognitive training, and vascular risk management) or control group (general health advice) in a 1:1 ratio. Outcome assessors were masked to group allocation. This FINGER exploratory sub-study included 47 participants with measures of 27-OH, cognition, brain MRI, brain FDG-PET, and PiB-PET. Linear regression models were used to assess the cross-sectional and longitudinal associations between 27-OH, cognition, and neuroimaging markers, considering several potential confounders/intervention effect modifiers. Results 27-OH reduction during the intervention was associated with improvement in cognition (especially memory). This was not observed in the control group. The intervention reduced 27-OH particularly in individuals with the highest 27-OH levels and younger age. No associations were found between changes in 27-OH levels and neuroimaging markers. However, at baseline, a higher 27-OH was associated with lower total gray matter and hippocampal volume, and lower cognitive scores. These associations were unaffected by total cholesterol levels. While sex seemed to influence associations at baseline, it did not affect longitudinal associations. Conclusion 27-OH appears to be a marker not only for dementia/AD risk, but also for monitoring the effects of preventive interventions on cholesterol metabolism. Trial registration ClinicalTrials.gov , NCT01041989 . Registered on 4 January 2010

ABSTRACT Over the last two decades, several key advances have been made in the field of interventional cardiology including new techniques and treatments, organizational changes such as the management of acute myocardial infarction, and the arrival of satellite catheterization laboratories. All these advances require the updating of the requirements and equipment that are needed in an interventional cardiology unit. This consensus document by the Interventional Cardiology Association of the Spanish Society of Cardiology, the Ischemic Heart Disease and Acute Cardiac Care Association of the Spanish Society of Cardiology and the Spanish Association of Nursing in Cardiology which describes the recommendations that should be followed by percutaneous coronary intervention capable hospitals or centers intend to build interventional cardiology units. It also describes the requirements for provision, qualification of professionals, technological and material resource allocation, and aspects related to supervised catheterization laboratories and structural heart disease programs.

RESUMEN En las últimas dos décadas han tenido lugar grandes avances en el campo de la cardiología intervencionista. Estos incluyen no solo nuevas técnicas y tratamientos, sino también cambios en la organización, como la atención continuada al infarto agudo de miocardio y la aparición de salas tuteladas. Todos estos avances hacen necesaria una actualización de los requisitos y del equipamiento necesarios en una unidad de hemodinámica y cardiología intervencionista. En este documento de consenso de la Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología, la Asociación de Cardiopatía Isquémica y Cuidados Agudos Cardiovasculares de la Sociedad Española de Cardiología, y la Asociación Española de Enfermería en Cardiología, se establecen las recomendaciones que deberían cumplir los centros hospitalarios donde esté instalada o se pretenda instalar una unidad de hemodinámica y cardiología intervencionista, los requisitos de dotación y cualificación de profesionales, las dotaciones tecnológicas y los materiales necesarios, y aspectos relacionados con las salas tuteladas y los programas de tratamiento de la cardiopatía estructural.

Abstract Alterations in brain cholesterol homeostasis in midlife are correlated with a higher risk of developing Alzheimer’s disease (AD). However, global cholesterol-lowering therapies have yielded mixed results when it comes to slowing down or preventing cognitive decline in AD. We used the transgenic mouse model Cyp27Tg, with systemically high levels of 27-hydroxycholesterol (27-OH) to examine long-term potentiation (LTP) in the hippocampal CA1 region, combined with dendritic spine reconstruction of CA1 pyramidal neurons to detect morphological and functional synaptic alterations induced by 27-OH high levels. Our results show that elevated 27-OH levels lead to enhanced LTP in the Schaffer collateral-CA1 synapses. This increase is correlated with abnormally large dendritic spines in the stratum radiatum. Using immunohistochemistry for synaptopodin (actin-binding protein involved in the recruitment of the spine apparatus), we found a significantly higher density of synaptopodin-positive puncta in CA1 in Cyp27Tg mice. We hypothesize that high 27-OH levels alter synaptic potentiation and could lead to dysfunction of fine-tuned processing of information in hippocampal circuits resulting in cognitive impairment. We suggest that these alterations could be detrimental for synaptic function and cognition later in life, representing a potential mechanism by which hypercholesterolemia could lead to alterations in memory function in neurodegenerative diseases.

Introduction and aim: Usually, adherence to the gluten-free diet (GFD) in celiac patients is indirectly assessed through serological analysis, questionnaires, or invasive methods such as intestinal biopsy. The detection of gluten immunogenic peptides in urine (urinary gluten immunogenic peptides—uGIP) is a novel technique that directly evaluates the ingestion of gluten. The aim of this study was to evaluate the clinical efficacy of uGIP in the follow-up of celiac disease (CD). Methods: From April 2019 to February 2020, CD patients reporting complete adherence to the GFD were prospectively enrolled but were unaware of the reason for the tests. Urinary GIP, the celiac dietary adherence test (CDAT), symptomatic visual analog scales (VAS), and tissue transglutaminase antibodies (tTGA) titres were evaluated. Duodenal histology and capsule endoscopy (CE) were performed when indicated. Results: A total of 280 patients were enrolled. Thirty-two (11.4%) had a positive uGIP test (uGIP+). uGIP+ patients did not show significant differences in demographic parameters, CDAT, or VAS scores. The tTGA+ titre was not related to the positivity of uGIP (14.4% vs. 10.9% in patients with tTGA+ and tTGA−). Regarding histology, 66.7% of the GIP+ patients had atrophy compared to 32.7% of the GIP patients (p-value 0.01). However, the presence of atrophy did not correlate with tTGA. Mucosal atrophy was detected in 29 (47.5%) out of 61 patients by CE. With this method, no noticeable dependence on uGIP results (24 GIP− vs. 5 GIP+) was observed. Conclusions: The single uGIP test was positive in 11% of CD cases referring a correct GFD adherence. Furthermore, uGIP results significantly correlated with the duodenal biopsy, formerly considered the gold standard for assessing CD activity.

Background: Patients with diabetes mellitus (DM) have worse outcomes following percutaneous coronary intervention than nondiabetic patients. The novel Supreme DES is a biodegradable polymer sirolimus-eluting stent designed to synchronize early drug delivery, limiting the potential for long-term inflammatory response. The purpose of this study was to evaluate the safety and efficacy of the Supreme DES in patients with DM. Methods: This is a prespecified analysis of the diabetic subgroup from the PIONEER III randomized (2:1), controlled trial, comparing the Supreme DES with a durable polymer everolimus-eluting stent (DP-EES). The primary safety and efficacy composite endpoint was target lesion failure at 1 year, a composite of cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization. Results: The PIONEER III trial randomized 1629 patients, of which 494 (30.3%) had DM with 331 (398 lesions) randomly assigned to Supreme DES and 163 (208 lesions) to DP-EES. Among patients with DM, target lesion failure at 1 year was 6.1% (20/331) with Supreme DES vs 3.7% (6/163) with DP-EES (hazard ratio = 1.65; 95% confidence interval = 0.66-4.10, P = .28). The composite of cardiac death or target vessel myocardial infarction was 3.3% (11/331) with Supreme DES and 3.7% (6/163) with DP-EES (hazard ratio = 0.90; 95% confidence interval = 0.33-2.44, P = .83). There were no significant differences in other secondary endpoints. Conclusions: This prespecified substudy of the PIONEER III trial demonstrated the relative safety and efficacy of the novel Supreme DES when compared with commercially available DP-EES in diabetics at 1 year. Longer term follow-up will be required to ensure continued safety and efficacy of the Supreme DES.

Abstract Background Patients with cancer have been shown to have a higher risk of clinical severity and mortality compared to non-cancer patients with COVID-19. Patients with hematologic malignancies typically are known to have higher levels of immunosuppression and may develop more severe respiratory viral infections than patients with solid tumors. Data on COVID-19 in patients with hematologic malignancies are limited. Here we characterize disease severity and mortality and evaluate potential prognostic factors for mortality. Methods In this population-based registry study, we collected de-identified data on clinical characteristics, treatment and outcomes in adult patients with hematologic malignancies and confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection within the Madrid region of Spain. Our case series included all patients admitted to 22 regional health service hospitals and 5 private healthcare centers between February 28 and May 25, 2020. The primary study outcome was all-cause mortality. We assessed the association between mortality and potential prognostic factors using Cox regression analyses adjusted for age, sex, comorbidities, hematologic malignancy and recent active cancer therapy. Results Of 833 patients reported, 697 were included in the analyses. Median age was 72 years (IQR 60–79), 413 (60%) patients were male and 479 (69%) and 218 (31%) had lymphoid and myeloid malignancies, respectively. Clinical severity of COVID-19 was severe/critical in 429 (62%) patients. At data cutoff, 230 (33%) patients had died. Age ≥ 60 years (hazard ratios 3.17–10.1 vs 2 comorbidities (1.41 vs ≤ 2), acute myeloid leukemia (2.22 vs non-Hodgkin lymphoma) and active antineoplastic treatment with monoclonal antibodies (2·02) were associated with increased mortality; conventional chemotherapy showed borderline significance (1.50 vs no active therapy). Conversely, Ph-negative myeloproliferative neoplasms (0.33) and active treatment with hypomethylating agents (0.47) were associated with lower mortality. Overall, 574 (82%) patients received antiviral therapy. Mortality with severe/critical COVID-19 was higher with no therapy vs any antiviral combination therapy (2.20). Conclusions In this series of patients with hematologic malignancies and COVID-19, mortality was associated with higher age, more comorbidities, type of hematological malignancy and type of antineoplastic therapy. Further studies and long-term follow-up are required to validate these criteria for risk stratification.

Abstract Background Balance control deteriorates with age and nearly 30% of the elderly population in the United States reports stability problems. Postural stability is an integral task to daily living reliant upon the control of the ankle and hip. To this end, the estimation of joint parameters can be a useful tool when analyzing compensatory actions aimed at maintaining postural stability. Methods Using an analytical approach, this study expands on previous work and analyzes a two degrees of freedom human model. The first two modes of vibration of the system are represented by the neuro-mechanical parameters of a second-order, time-varying Kelvin–Voigt model actuated at the ankle and hip. The model is tested using a custom double inverted pendulum and healthy volunteers who were subjected to a positional step-like perturbation during quiet standing. An in silico sensitivity analysis of the influence of inertial parameters was also performed. Results The proposed method is able to correctly identify the time-varying visco-elastic parameters of of a double inverted pendulum. We show that that the parameter estimation method can be applied to standing humans. These results appear to identify a subject-independent strategy to control quiet standing that combines both the modulation of stiffness, and the use of an intermittent control. Conclusions This paper presents the analysis of the non-linear system of differential equations representing the control of lumped muscle–tendon units. It utilizes motion capture measurements to obtain the estimates of the system’s control parameters by constructing a simple time-dependent regressor for estimating the time-varying parameters of the control with a single perturbation. This work is a step forward into the understanding of the neuro-mechanical control parameters of human recovering from a fall. In previous literature, the analysis is either restricted to the first vibrational mode of an inverted-pendulum model or assumed to be time-invariant. The proposed method allows for the analysis of hip related movement for stability control and highlights the importance of core training.

Abstract Background Prognostic factors of poor outcome in patients with hematological malignancies and COVID-19 are poorly defined. Patients and methods This was a Spanish transplant group and cell therapy (GETH) multicenter retrospective observational study, which included a large cohort of blood cancer patients with laboratory-confirmed SARS-CoV-2 infection through PCR assays from March 1st 2020 to May 15th 2020. Results We included 367 pediatric and adult patients with hematological malignancies, including recipients of autologous (ASCT) (n = 58) or allogeneic stem cell transplantation (allo-SCT) (n = 65) from 41 hospitals in Spain. Median age of patients was 64 years (range 1–93.8). Recipients of ASCT and allo-SCT showed lower mortality rates (17% and 18%, respectively) compared to non-SCT patients (31%) (p = 0.02). Prognostic factors identified for day 45 overall mortality (OM) by logistic regression multivariate analysis included age > 70 years [odds ratio (OR) 2.1, 95% confidence interval (CI) 1.2–3.8, p = 0.011]; uncontrolled hematological malignancy (OR 2.9, 95% CI 1.6–5.2, p 20 mg/dL (OR 3.3, 95% CI 1.7–6.4, p

RESUMEN Introducción y objetivos: La epidemia de COVID-19 y la declaración del estado de alarma han propiciado una disminución en la actividad en la cardiología intervencionista. El objetivo de este estudio es cuantificar esta disminución, con especial interés en el funcionamiento del código infarto. Métodos: Se realizó una encuesta telemática a 81 centros de las 17 comunidades autónomas españolas con procedimientos de código infarto. Se recogió información sobre la actividad diagnóstica, el intervencionismo coronario, el intervencionismo estructural y el intervencionismo en el seno del infarto agudo de miocardio con elevación del segmento ST (IAMCEST) sobre cambios en la organización de las redes del infarto y sobre la afección por COVID-19 de las plantillas de cardiología intervencionista. Se compararon 2 periodos: uno entre el 24 de febrero y el 1 de marzo (antes del inicio de la pandemia en España) y el otro entre el 16 y el 22 de marzo (durante la pandemia). Resultados: Se obtuvo respuesta de 73 centros (90%) que evidenció una disminución significativa en el número de procedimientos diagnósticos (─56%), terapéuticos coronarios (─48%), terapéuticos estructurales (─81%) y en el seno del IAMCEST (─40%). Se indicó un leve incremento en el uso de trombolisis. Se diagnosticó infección por COVID-19 en 17 cardiólogos intervencionistas (5%). Conclusiones: Se observó una reducción importante de la actividad asistencial durante la epidemia de COVID-19 y una gran disminución en el número de pacientes tratados con IAMCEST, con el riesgo de incremento de morbimortalidad que esto supone. Las sociedades científicas y autoridades sanitarias deberían promover que los pacientes con síntomas compatibles con IAMCEST demanden asistencia al sistema sanitario para poder recibir el tratamiento de reperfusión de forma adecuada.

ABSTRACT Introduction and objectives: The COVID-19 epidemic and the declaration of the state of alarm have led to a decrease in healthcare activity in interventional cardiology units. The objective of this study is to quantify these changes in activity, with special interest in the treatment of patients with ST-segment elevation myocardial infarction (STEMI). Methods: A telematic survey of 81 centers involved in STEMI networks in the 17 autonomous communities of Spain. Information was collected on diagnostic activity, percutaneous coronary intervention (PCI), structural interventions, and PCI in STEMI on changes in the organization of STEMI networks, and on the prevalence of COVID-19 among interventional cardiologists. Data was compared for the week of February 24 through March 1 (before the outbreak) and for the week of March 16 through March 22 (during the outbreak). Results: Response has been obtained from 73 centers (90%). A very significant decrease in the number of diagnostic procedures (─56%), PCI (─48%), structural interventions (─81%) and PCI in STEMI (─40%) has been observed. A slight increase in the use of pharmacological thrombolysis has been reported, although primary angioplasty remains the leading reperfusion strategy. Up to 5% of interventional cardiologists (17) had COVID-19. Conclusions: An important reduction in the activity in interventional cardiology has been observed during the COVID-19 epidemic. Likewise, a great decrease has been detected in the number of patients treated in the STEMI networks, with the risk of increased morbidity and mortality that this represents. Scientific societies and health authorities have to promote that patients presenting STEMI compatible symptoms proceed with no delay to access the health system to receive reperfusion treatment in an appropriate way.

RESUMEN Introducción y objetivos: Las redes regionales de atención al infarto agudo de miocardio con elevación del segmento ST presentan grandes diferencias en términos de organización que puede llegar a comprometer sus resultados. La Sección de Hemodinámica y Cardiología Intervencionista ha realizado una encuesta entre sus miembros sobre el grado de satisfacción y la situación de los programas de angioplastia primaria en España. Métodos: Se realizó una encuesta online, abierta y anónima, entre los miembros de la Sección de Hemodinámica y Cardiología Intervencionista entre los días 22 de mayo y 5 de junio de 2018, sobre las necesidades de los programas y el grado de satisfacción de los profesionales. Resultados: Se obtuvieron 172 respuestas de profesionales, con representación de 75 centros y 17 comunidades autónomas. El número de angioplastias en el infarto agudo de miocardio con elevación del segmento ST por año y por centro fue de 259 ± 110. El grado de satisfacción de los profesionales con la aplicación del Código Infarto, así como el grado de satisfacción personal, obtuvieron una puntuación de 7,2 ± 2,2 y 7,2 ± 2,4 puntos sobre 10, respectivamente, aunque con diferencias regionales significativas. Las principales áreas de preocupación detectadas fueron las limitaciones logísticas, la retribución insuficiente y la falta de descanso. Si fuera posible, un 55% estaría dispuesto a dejar las guardias. Conclusiones: La encuesta ha puesto de manifiesto un alto grado de valoración del sistema por parte de los profesionales, aunque con diferencias notables entre las comunidades autónomas, y ha permitido detectar disfunciones logísticas, estructurales y retributivas que pueden poner a los programas de angioplastia primaria en situación de vulnerabilidad.

ABSTRACT Introduction and objectives: ST-segment elevation myocardial infarction (STEMI) regional networks pose great organizational differences that may compromise their results. The Working Group on Hemodynamics and Interventional Cardiology has carried out a survey among its members on the level of satisfaction and the state of primary angioplasty programs in Spain. Methods: On-line, open and anonymous survey, among the Hemodynamics and Interventional Cardiology Working Group members conducted between May 22 and June 5, 2018 on the necessities of the aforementioned programs and the degree of satisfaction of the professionals involved. Results: Answers were obtained from 172 professionals with representation from 75 centers and 17 autonomous communities. The number of angioplasties performed in the STEMI setting per year and per center was 259 ± 110. The degree of satisfaction of the professionals with the application of the Infarction Code and the degree of personal satisfaction scored 7.2 ± 2.2 and 7.2 ± 2.4 points out of 10, respectively, although with significant regional differences. The main areas of concern detected were logistics issues, insufficient paycheck compensations and lack of rest. The 55% were inclined to leave their on-call duties when possible. Conclusions: The survey has revealed a high degree of satisfaction by the professionals involved in STEMI treatment, although with notable differences among different autonomous communities and has allowed detecting logistical, structural and paycheck disturbances that can put primary angioplasty programs in situations of vulnerability.

The current researech deals daily mobility in urban low-density welfare society areas in order to identify pioneers in modal shift. Qualitative methodology was used; semi-structured interviews were conducted in a sample of residents in the municipality of Matadepera (Barcelona Region). The results show the prominence of the car in the daily life and the low permeability of the new mobility practices (active and shared) that similar social groups begin to practice in dense urban areas. The urban morphology and the design of a public space biased for the use of the private vehicle make difficult the modal change. Public policies are needed to make it possible to create proximity and redesign the public space to generate the conditions for modal change.

Introduction and objectivesPatients with type 2 diabetes (T2D) and stable coronary artery disease (CAD) previously revascularized with percutaneous coronary intervention (PCI) are at high risk of recurrent ischemic events. We aimed to provide real-world insights into the clinical characteristics and management of this clinical population, excluding patients with a history of myocardial infarction (MI) or stroke, using Natural Language Processing (NLP) technology.MethodsThis is a multicenter, retrospective study based on the secondary use of 2014-2018 real-world data captured in the Electronic Health Records (EHRs) of 1,579 patients (0.72% of the T2D population analyzed; n = 217,632 patients) from 12 representative hospitals in Spain. To access the unstructured clinical information in EHRs, we used the EHRead® technology, based on NLP and machine learning. Major adverse cardiovascular events (MACE) were considered: MI, ischemic stroke, urgent coronary revascularization, and hospitalization due to unstable angina. The association between MACE rates and the variables included in this study was evaluated following univariate and multivariate approaches.ResultsMost patients were male (72.13%), with a mean age of 70.5±10 years. Regarding T2D, most patients were non-insulin-dependent T2D (61.75%) with high prevalence of comorbidities. The median (Q1-Q3) duration of follow-up was 1.2 (0.3-4.5) years. Overall, 35.66% of patients suffered from at least one MACE during follow up. Using a Cox Proportional Hazards regression model analysis, several independent factors were associated with MACE during follow up: CAD duration (p < 0.001), COPD/Asthma (p = 0.021), heart valve disease (p = 0.031), multivessel disease (p = 0.005), insulin treatment (p < 0.001), statins treatment (p < 0.001), and clopidogrel treatment (p = 0.039).ConclusionsOur results showed high rates of MACE in a large real-world series of PCI-revascularized patients with T2D and CAD with no history of MI or stroke. These data represent a potential opportunity to improve the clinical management of these patients.

La relación entre espacio público y actividad comercial es constitutiva en los centros urbanos. De este modo, los establecimientos se concentran en espacios urbanos de mayor atracción (calles comerciales, centros comerciales y mercados) y también forman parte de los procesos socioespaciales de dichos entornos. El objetivo de este artículo es analizar el papel de la actividad comercial en el uso del espacio público basándonos en la dimensión humana del urbanista Jan Gehl (2010). Para ello se utilizan las variables del censo de la actividad comercial, flujos de peatones y la caracterización física de las calles de los siete centros urbanos trabajados. De esta manera, se obtendrán resultados del análisis clúster que evidencian las múltiples relaciones entre los distintos usos comerciales, los rasgos de las calles y su espacio público y el paso diario de peatones, así como la naturaleza independiente y explicativa que ha mostrado esta última variable en el análisis.

To estimate the repeatability values of productive and reproductive traits, 257 observations were made to 34 river buffalo cows on a dairy buffalo (Bubalus bubalis) farm, at Ruta Invasora Cattle Company, in Ciego de Ávila, Cuba. The buffalo herds were naturally bred, and were manually milked between 4:00 and 6:00 am; the animals grazed on native and introduced grass all the year. One stud was used per of 30-40 cows. The reproduction data were collected from individual control charts, which included the calving number, weight at weaning (WW), weight at breeding start (WBS), calving-calving interval (CCI), and milk production (MP). SPSS, version 23, for Windows was used to estimate the repeatability of the variables studied (weight at weaning, weight at breeding start, calving interval, and milk production), according to the variance components by the general linear model for inter and intra cow variance components. The repeatability values achieved were 0.41 ± 0.03 for WW; 0.50 ± 0.04 for IWM; 0.01 ± 0.03 for CCI; and 0.65 ± 0.06 for MP. High repeatability values for milk production occurred thanks to the absence of previous genetic selection.

ABSTRACT Primary percutaneous coronary intervention (pPCI) is the best modality of reperfusion in ST segment elevation in acute myocardial infarction (STEMI). Its application requires networked assistance systems whose implementation requires significant organizational and logistical changes. In comparison with other scenarios of urgent action, a series of aspects are specific to the pPCI programs. They require immediate, clearly pre-established strategies, carried out by highly skilled professionals who attend to a high volume of highly complex patients. The lack of homogeneity in the creation and development of reperfusion programs in Spain has led to great differences in their implementation. If the pPCI programs are not carried out under adequate conditions, their sustainability can be complex. The present document, agreed between different scientific societies, aims to analyze the current situation in Spain of the network care programs for STEMI, identify their limitations and deficiencies, assess their vulnerability and establish a series of recommendations to ensure their sustainability.

RESUMEN El intervencionismo coronario percutáneo primario (ICPp) es la mejor forma de reperfusión en el infarto agudo de miocardio con elevación del segmento ST (IAMCEST). Su aplicación requiere sistemas asistenciales en red cuya implementación exige cambios organizativos y logísticos importantes. En comparación con otros escenarios de actuación urgente, una serie de aspectos son específicos de los programas de ICPp. Requieren de estrategias inmediatas claramente preestablecidas, realizadas por profesionales muy expertos y que atienden a un elevado volumen de pacientes de alta complejidad. La falta de homogeneidad en la creación y desarrollo de los programas de reperfusión en España ha llevado a grandes diferencias en su implantación. Si los programas de ICPp no se efectúan en condiciones adecuadas su sostenibilidad puede ser compleja. El presente documento, consensuado entre diferentes sociedades científicas, tiene por objetivos analizar la situación actual en España de los programas de atención en red al IAMCEST, identificar sus limitaciones y deficiencias, evaluar su vulnerabilidad y establecer una serie de recomendaciones para asegurar su sostenibilidad.

Objetivo: Estimar los valores de la repetibilidad en rasgos productivos y reproductivo en una lechería de búfalas (Bubalus bubalis). Métodos: Se tomaron 257 observaciones correspondientes a 34 búfalas de río de la Empresa Pecuaria Ruta Invasora de la provincia de Ciego de Ávila, Cuba. El rebaño se explota bajo sistema de crianza natural con un ordeño manual diariamente en el horario de 4,00 a 6,00 am y pastorean todo el año sobre la base de pastos naturales y artificiales. La organización reproductiva de un semental por cada 30 a 40 hembras. Los datos fueron tomados a partir de las tarjetas de control individual de la reproducción, tomándose el número de partos de cada búfala, peso al destete (PD), peso incorporación (PI), intervalo parto-parto (IPP), y producción de leche (PL). Para la estimación de las repetibilidades de las variables estudiadas (peso al destete, peso a incorporación, intervalo entre partos y producción de leche) se utilizó el paquete estadístico SPSS, versión 23 para Windows, según la técnica de Componentes de Varianza por el Modelo Lineal General, obteniéndose los componentes de varianza entre y dentro de vaca. Resultados: Los valores de repetibilidad obtenidos fueron 0,41 ± 0,03 en PD, 0,50 ± 0,04 en PI, 0,01 ± 0,03 en IPP y 0,65 ± 0,06 en PL. Conclusiones: El valor alto de la repetibilidad para la producción de leche se debe a no haber existido selección genética anteriormente.