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The increasing trend of child migration, whether forced or voluntary, poses a challenge to policies aimed at ensuring social cohesion and protecting children's rights. Inclusive educational environments play a crucial role in the integration of migrant and refugee children by promoting intercultural dialogue and participation. This study aims to explore the potential of a child-centred approach to the socio-educational inclusion of migrant and refugee children in Europe, proposing a framework of inclusive interculturalism to address the specific challenges these children face in educational settings. A narrative review was conducted, examining a wide range of peer-reviewed sources to synthesise current knowledge on child-centred education and its applicability to migrant and refugee children. The review identifies key challenges in adopting a child-centred approach, including socio-cultural, linguistic and psychological barriers that hinder migrant and refugee children's full participation in education. It highlights the importance of promoting agency, cultural competence and emotional well-being through inclusive and intercultural educational practices. Implementing a child-centred, inclusive intercultural approach can promote social cohesion and reduce inequalities by ensuring that all children, regardless of their background, have access to quality education and opportunities for personal development. However, more empirical research is needed to translate these theoretical frameworks into practical interventions.

La disponibilidad de órganos para donación pediátrica es limitada, este hecho provoca un gran desequilibrio entre oferta y demanda que obliga a los profesionales a considerar todas las opciones que puedan optimizarla. La donación en asistolia controlada pediátrica, además de integrarse en los cuidados al final de vida “centrados en la familia”, podría incrementar ampliamente el global de donación si se incluyen a niños asistidos en cuidados paliativos pediátricos, como son neonatos con graves malformaciones del tubo neural y pacientes en régimen de hospitalización domiciliaria. No obstante, las particulares situaciones clínicas y humanas de estos pacientes hacen necesario unas consideraciones éticas especiales.

Teacher training for high ability students represents a critical need that has been neglected. In this context, it is essential to implement programs that demystify high abilities and provide teachers with effective tools to inspire and challenge these students. The aim of this study was to evaluate the impact and satisfaction of a course-workshop offered to university professors for the educational attention of students with high abilities. For this purpose, a mixed methodology was used; in the quantitative part, two approaches were combined: a quasi-experimental design with a non-equivalent control group, and a pre-experimental design. In the qualitative part, the content of open-ended questions was analyzed. Quantitative results show significant differences in the interaction and timing of the intervention in the experimental group (p = 0.000). Likewise, a positive level of achievement and approval was observed in each of the subjects taught, obtaining an average of 41.12 out of 47 total points. In addition, a satisfactory evaluation of the course-workshop offered was reported, since 95.2% said that they agreed fairly or strongly agreed with the contents, 96.8% agreed fairly or strongly agreed with the didactic material, and 90.47% rated the performance of the instructors as excellent. The lexical analysis yielded three classes in relation to the most significant learning acquired during the course, while the comments and suggestions for improvement were grouped into four classes. The findings of this study highlight the importance of developing teacher training programs based on a clear understanding of high abilities and allow expanding knowledge in this field of study.

Background/Objectives: This study aimed to investigate the acute effects of a single session of a VR exergame (Beat Saber) and a VR nature video (Ireland 4K) on attentional performance, using the Flanker and Attentional Blink (AB) tasks. The objective was to assess whether these VR interventions could enhance attentional control, as measured by improvements in response times and accuracy. Methods: A total of 39 psychology students, aged 19–25, were randomly assigned to one of three groups: VR exergame, VR nature video, or control. Participants completed the Flanker and AB tasks before and after the intervention. A repeated measures design was employed to analyze changes in response times and accuracy across pre- and post-test sessions. Results: The study revealed significant improvements in response times and accuracy across all groups in the post-test measures, indicating a strong training effect. In the AB task, shorter stimulus onset asynchrony (SOA) led to decreased accuracy and slower response times, emphasizing the difficulty in processing closely spaced targets. The interaction between Type and Group in response times for target stimuli suggested that the intervention types differentially influenced processing speed in specific conditions. Conclusions: The findings suggest that while brief VR interventions did not produce significant differences between groups, the training effect observed highlights the influence of task-specific factors such as SOA and target presence. Further research is needed to explore whether longer or repeated VR sessions, as well as the optimization of task-specific parameters, might lead to more pronounced cognitive benefits.

BackgroundIntellectual disability (ID) affects approximately 1% of the worldwide population and individuals with ID have a higher comorbidity with mental illness, and specifically psychotic disorders. Unfortunately, among individuals with ID, limited research has been conducted since ID individuals are usually excluded from mental illness epidemiological studies and clinical trials. Here we perform a clinical trial to investigate the effectiveness of clozapine in the treatment of resistant psychosis in individuals with ID. The article highlights the complexity of diagnosing and treating psychopathological alterations associated with ID and advocates for more rigorous research in this field.MethodsA Phase IIB, open-label, randomized, multicenter clinical trial (NCT04529226) is currently ongoing to assess the efficacy of oral clozapine in individuals diagnosed with ID and suffering from treatment-resistant psychosis. We aim to recruit one-hundred and fourteen individuals (N=114) with ID and resistant psychosis, who will be randomized to TAU (treatment as usual) and treatment-with-clozapine conditions. As secondary outcomes, changes in other clinical scales (PANSS and SANS) and the improvement in functionality, assessed through changes in the Euro-QoL-5D-5L were assessed. The main outcome variables will be analyzed using generalized linear mixed models (GLMM), assessing the effects of status variable (TAU vs. Clozapine), time, and the interaction between them.DiscussionThe treatment of resistant psychosis among ID individuals must be directed by empirically supported research. CLOZAID clinical trial may provide relevant information about clinical guidelines to optimally treat adults with ID and treatment-resistant psychosis and the benefits and risks of an early use of clozapine in this underrepresented population in clinical trials.Trial registrationClinicaltrials.gov: NCT04529226. EudraCT: 2020-000091-37.

Abstract Schizophrenia may represent a trade-off in the evolution of human-specific ontogenetic mechanisms that guide neurodevelopment. Human Accelerated Regions (HARs) are evolutionary markers functioning as neurodevelopmental transcription enhancers that have been associated with brain configuration, neural information processing, and schizophrenia risk. Here, we have investigated the influence of HARs’ polygenic load on neuroanatomical measures through a case-control approach (128 patients with schizophrenia and 115 controls). To this end, we have calculated the global schizophrenia Polygenic Risk Score (Global PRSSZ) and that specific to HARs (HARs PRSSZ). We have also estimated the polygenic burden restricted to the HARs linked to transcriptional regulatory elements active in the foetal brain (FB-HARs PRSSZ) and the adult brain (AB-HARs PRSSZ). We have explored the main effects of the PRSs and the PRSs x diagnosis interactions on brain regional cortical thickness (CT) and surface area (SA). The results indicate that a higher FB-HARs PRSSZ is associated with patients’ lower SA in the lateral orbitofrontal cortex, the superior temporal cortex, the pars triangularis and the paracentral lobule. While noHARs-derived PRSs show an effect on the risk, our neuroanatomical findings suggest that the human-specific transcriptional regulation during the prenatal period underlies SA variability, highlighting the role of these evolutionary markers in the schizophrenia genomic architecture.

Abstract Background The SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) pandemic changed the distribution of healthcare resources, leading in many cases to the suspension of all non-essential treatments and procedures and representing a challenge for medical professionals. The objective of this study was to evaluate whether clinical protocols in gynecologic oncology care were modified as a result of the pandemic and to assess surgeons’ perceptions regarding the management of gynecologic cancers". Methods Data were collected through an anonymous and voluntary survey sent via email to healthcare professionals in the field of gynecologic oncology in Spain. Results A total of 75 gynecologic oncologists completed the online survey. Of these, 93.2% (69) reported working in public hospitals and 62.5% (45) in tertiary care hospitals. 97.3% (71) were affiliated with hospitals treating patients infected with SARS-CoV-2. 85.1% (63) of the respondents expressed concern about the SARS-CoV-2 pandemic and 52.1% (38) indicated that the pandemic impacted the diagnostic and therapeutic quality of care for oncology patients. SARS-CoV-2 nasopharyngeal swab PCR (Polymerase Chain Reaction) testing was always performed before surgical interventions by 97.3% (71), being considered a best practice in triage by 94.4% (68). 87.5% (63) reported no change in the type of surgical approach during the pandemic. 62.5% (45) experienced limitations in accessing special personal protective equipment for SARS-CoV-2. An impact on the follow-up of patients with gynecologic cancers due to the pandemic was reported by 70.4% (50). Conclusions Most of the Spanish gynecologic oncologists who responded to our survey reported that the SARS-CoV-2 pandemic had affected their clinical practice. The primary measures implemented were an increase in telemedicine, restricting outpatient visits to high-risk or symptomatic patients and the use of SARS-CoV-2 screening prior to surgery. No major changes in the surgical approach or management of the treatment of ovarian, endometrial or cervical cancer during the pandemic were reported.

In this work, silver nanoparticles (AgNPs) were synthesized from cashew nutshell liquid (CNSL) by varying the concentration of silver ions and the pH of the CNSL extract. The synthesized AgNPs were further characterized to study their surface, structural, and morphological properties and tested for the removal of methylene blue (MB) dye. The results of this study showed that depending on the conditions, particles of various sizes, ranging from 1 to 60 nm, and different degrees of stabilization and agglomeration were produced. The concentration of silver ions equal to 3 mM and the pH of the extract of ~4.5 (AgNP3) resulted in the most efficient synthesis, where particles appeared to be highly stabilized and homogeneously distributed on the surface, exhibiting a small average particle size and a narrow particle size distribution (6.7 ± 6.5 nm). Such particles further showed the highest percent removal of MB, where up to 80% removal was recorded within the first 20 min. Higher concentrations of silver ions and higher pH of the extract resulted in substantial particle agglomeration and particles being over-capped by the CNSL biomolecules, respectively, which further negatively affected the ability of particles to remove MB. Finally, the fact that visible light showed no significant effect on the removal of MB, with the average removal rates found to be about the same as in the dark, suggests the strong catalytic nature of AgNPs, which facilitates the electron transfer reactions leading to MB reduction.

The increasing trend of children's migration, whether forced or voluntary, presents a challenge to policies that aim to ensure social cohesion and protect children's rights. Therefore, adopting a child-centred approach to the socio-educational inclusion of migrant and refugee children can aid in the creation of cohesive and inclusive societies. Inclusive educational environments are collaborative settings that promote participation among children, educators, the community, and other local institutions. Educational communities can play a leading role in implementing public policies that promote social inclusion and intercultural dialogue. Schools play a crucial role in integrating migrant and refugee children. Child-centred practices can be implemented to promote intercultural and linguistic competences, capacity building, and children's agency. This can help to develop a sense of belonging and inclusion for all students. To unlock the potential of inclusive education, reduce inequalities, and achieve more equitable societies, it is essential to integrate a child-centred approach that promotes access to fundamental rights, participation, recognition of cultural diversity, and children's socio-emotional well-being. This review discusses the challenges of adopting a child-centred approach to education for migrant and refugee children. It proposes inclusive interculturalism as a child-centred approach to address the socio-educational deficits of these children in educational settings in Europe.

This paper presents the Delphi methodology employed to select a final dashboard of 30 indicators on the socio-educative inclusion of refugee and migrant children in Europe. Firstly, a procedure for identifying Key Performance Indicators (KPIs) was carried out, including a specialized scientific literature review, the mapping of previous indicators, and qualitative workshops with key stakeholders at micro, meso, and macro levels in six countries. Then, a Delphi design was implemented to assess, rate, and provide meaningful qualitative improvements to a pool of pre-selected indicators. The Delphi methodology involved a group of international experts on the matters of inclusive education or migration, researchers, NGOs, and public officers. As an alternative to traditional "benchmark-based" consensus, we introduced the use of a) the CARA model and b) an alternative multi-input and mixed-method consensus-building procedure. The results provided a significant contribution to qualitative methods on the one hand and to migration and integration literature on the other. The methodological innovations, the diversity of experts' perspectives involved in the process, and the structured nature of the method constituted significant advantages to improve the robustness of the Delphi methodology for selecting and validating indicators. Future research involving a Delphi methodology can benefit from applying the present procedure.

Abstract Successful vaccines rely on activating a functional humoral immune response through the generation of class-switched high affinity immunoglobulins (Igs). The germinal center (GC) reaction is crucial for this process, in which B cells are selected in their search for antigen and T cell help. A major hurdle to understand the mechanisms of B cell:T cell cooperation has been the lack of an antigen-specific in vitro GC system. Here we report the generation of antigen-specific, high-affinity, class-switched Igs in simple 2-cell type cultures of naive B and T cells. B cell antigen uptake by phagocytosis is key to generate these Igs. We have used the method to interrogate if T cells confer directional help to cognate B cells that present antigen and to bystander B cells. We find that bystander B cells do not generate class-switched antibodies due to a defective formation of T-B conjugates and an early conversion into memory B cells.

Los niños presentan mayor morbimortalidad que los adultos en lista de espera a trasplante de órganos, teniendo además una gran dificultad para la obtención de donantes. La donación en asistolia controlada pediátrica (DACp) podría mejorar las opciones de trasplante de muchos pacientes. No obstante, dado que precisa modificar algunos aspectos de la asistencia médica antes de la muerte del donante, expertos bioeticistas y profesionales sanitarios han expresado reservas y dudas deontológicas no suficientemente debatidas. Este trabajo expone las cuestiones bioéticas con mayor relevancia en la práctica clínica y que deberían ser consideradas a fin de respetar los principios éticos de la donación.

Hypertension mediated organ damage (HMOD) refers to structural or functional changes in arteries or target organs that can be present in long-standing hypertension, but it can be also found in naïve never treated patients. Traditionally, cardiovascular risk is stratified with charts or calculators that tend to underestimate the real cardiovascular risk. The diagnosis of HMOD automatically reclassifies patients to the highest level of cardiovascular risk. Subclinical HMOD can be present already at the diagnosis of hypertension and more than 25% of hypertensives are misclassified with the routine tests recommended by hypertension guidelines. Whether HMOD regression improves cardiovascular outcomes has never been investigated in randomized clinical trials and remains controversial. However, different drugs have been probed with promising results in high cardiovascular risk patients, such as the new antidiabetic or the novel non-steroid mineralocorticoid antagonists. Accordingly, trials have shown that lowering blood pressure reduces cardiovascular events. In this narrative review, we will discuss the role of HMOD in cardiovascular risk stratification, the different types of organ damage, and the evidence available to define whether HMOD can be used as a therapeutic target. Resumen: El daño orgánico mediado por hipertensión (HMOD) se refiere a cambios estructurales o funcionales de larga duración en las arterias u órganos diana de la hipertensión, pero también se puede encontrar en pacientes que nunca han recibido tratamiento antihipertensivo previo. Tradicionalmente, el riesgo cardiovascular se ha estratificado utilizando tablas, calculadoras o algoritmos que tienden a subestimar el riesgo cardiovascular real. El diagnóstico del HMOD reclasifica automáticamente a los pacientes al nivel más alto de riesgo cardiovascular. El HMOD subclínico ya puede estar presente en el momento del diagnóstico de hipertensión y más del 25% de los hipertensos están mal clasificados con las pruebas de rutina recomendadas por las guías de hipertensión. Sin embargo, si la regresión del HMOD mejora los resultados cardiovasculares no suele ser un objeto de investigación en ensayos clínicos aleatorizados y sigue siendo un aspecto controvertido. A pesar de ello, se han probado diferentes fármacos con resultados prometedores en pacientes de alto riesgo cardiovascular, como los nuevos antidiabéticos o los nuevos antagonistas de mineralocorticoides no esteroides. De hecho, diferentes estudios han demostrado que bajar la presión arterial reduce los eventos cardiovasculares. En esta revisión narrativa, se discutirá el papel del HMOD en la estratificación del riesgo cardiovascular, los diferentes tipos de daño orgánico y la evidencia disponible para definir si HMOD puede usarse como un objetivo terapéutico.

Mathematic proficiency has long been associated with the male gender and with high levels of intelligence. Similarly, STEM careers have been linked to the male gender, so both ideas are central to the present article. This study aims to observe differences in attitudes towards mathematic and STEM careers, considering, on the one hand, gender differences and, on the other hand, intelligence, separating the latter variable into a high-ability group and a normative intelligence group. A mixed methods approach was used for the analysis due to its methodological richness, using a reduced version of the Expectations and Values Questionnaire (EVQ) analysed using SPSS v. 25 and two open-ended questions analysed qualitatively using the ALCESTE software. v.1. The results show differences as a function of intelligence, but no gender differences were observed. It is concluded that the results challenge historical conceptions of attitudes towards mathematic and STEM careers.

Selenium pollution in water is a worldwide issue. Se(IV) and Se(VI) are mainly found in contaminated water due to their high solubility and mobility; their presence poses a serious risk as they can severely harm human health. Although iron oxide and hydroxide nanoparticles can be efficient candidates for the removal of selenium oxyanions due to their high adsorption capacity, the role of each iron species has not been fully elucidated. Furthermore, iron species are often found to be less effective for Se(VI) than Se(IV). The challenge and novelty of this study was to develop a carbon material impregnated with different iron phases, including oxides (magnetite/hematite) and hydroxides (goethite/lepidocrocite) capable of removing both Se(IV) and Se(VI). Since the phase and morphology of the iron nanoparticles play a significant role in Se adsorption, the study evaluated both characteristics by modifying the impregnation method, which is based on an oxidative hydrolysis with FeSO4 7H2O and CH3COONa, and the type of carbonaceous support (activated carbon or sucrose-based carbon foam). Impregnated activated carbons provide better removal efficiencies (70–80%) than carbon foams (

Hyaline cartilage’s inability to self-repair can lead to osteoarthritis and joint replacement. Various treatments, including cell therapy, have been developed for cartilage damage. Autologous chondrocyte implantation (ACI) is considered the best option for focal chondral lesions. In this article, we aimed to create a narrative review that highlights the evolution and enhancement of our chondrocyte implantation technique: High-Density-ACI (HD-ACI) Membrane-assisted Autologous Chondrocyte Implantation (MACI) improved ACI using a collagen membrane as a carrier. However, low cell density in MACI resulted in softer regenerated tissue. HD-ACI was developed to improve MACI, implanting 5 million chondrocytes per cm2, providing higher cell density. In animal models, HD-ACI formed hyaline-like cartilage, while other treatments led to fibrocartilage. HD-ACI was further evaluated in patients with knee or ankle defects and expanded to treat hip lesions and bilateral defects. HD-ACI offers a potential solution for cartilage defects, improving outcomes in regenerative medicine and cell therapy. HD-ACI, with its higher cell density, shows promise for treating chondral defects and advancing cartilage repair in regenerative medicine and cell therapy.

Abstract Background Chronic kidney disease (CKD) is associated with increased propensity for arrhythmias. In this context, ventricular repolarization alterations have been shown to predispose to fatal arrhythmias and sudden cardiac death. Between mineral bone disturbances in CKD patients, increased fibroblast growth factor (FGF) 23 and decreased Klotho are emerging as important effectors of cardiovascular disease. However, the relationship between imbalanced FGF23-Klotho axis and the development of cardiac arrhythmias in CKD remains unknown. Methods We carried out a translational approach to study the relationship between the FGF23–Klotho signaling axis and acquired long QT syndrome in CKD-associated uremia. FGF23 levels and cardiac repolarization dynamics were analyzed in patients with dialysis-dependent CKD and in uremic mouse models of 5/6 nephrectomy (Nfx) and Klotho deficiency (hypomorphism), which show very high systemic FGF23 levels. Results Patients in the top quartile of FGF23 levels had a higher occurrence of very long QT intervals (> 490 ms) than peers in the lowest quartile. Experimentally, FGF23 induced QT prolongation in healthy mice. Similarly, alterations in cardiac repolarization and QT prolongation were observed in Nfx mice and in Klotho hypomorphic mice. QT prolongation in Nfx mice was explained by a significant decrease in the fast transient outward potassium (K+) current (I tof ), caused by the downregulation of K+ channel 4.2 subunit (Kv4.2) expression. Kv4.2 expression was also significantly reduced in ventricular cardiomyocytes exposed to FGF23. Enhancing Klotho availability prevented both long QT prolongation and reduced I tof current. Likewise, administration of recombinant Klotho blocked the downregulation of Kv4.2 expression in Nfx mice and in FGF23-exposed cardiomyocytes. Conclusion The FGF23–Klotho axis emerges as a new therapeutic target to prevent acquired long QT syndrome in uremia by minimizing the predisposition to potentially fatal ventricular arrhythmias and sudden cardiac death in patients with CKD. Graphical abstract

This sequential mixed-methods study aims to: 1) assess spatial and temporal trends in cardiovascular risk factors by socioeconomic position from 2001 to 2020 in Spain; 2) explore public health professionals’ perspectives regarding interventions that might have impacted these inequities; and 3) analyze determinants on social inequities in cardiovascular risk factors. First, we will measure the change in absolute and relative social inequities in eight cardiovascular risk factors through time trend analysis using repeated cross-sectional data from both National and European Health Surveys for Spain from 2001 to 2020. Second, we will interview key informants —both at the regional and national level—, to contextualize data obtained in phase 1 and capture the content and variation of policies across regions. Third, we will use econometric methods to analyze how these identified interventions have impacted these social inequities within and across regions. Resumen: Este estudio tiene por objetivos: 1) evaluar las tendencias espacio-temporales de los factores de riesgo cardiovascular en España, por posición socioeconómica, entre 2001 y 2020; 2) explorar las perspectivas de profesionales salubristas con respecto a las intervenciones que pueden influir en estas inequidades; 3) analizar los determinantes de las inequidades sociales en los factores de riesgo cardiovascular. Primero se medirá el cambio en las desigualdades, en términos absolutos y relativos, según ocho factores de riesgo mediante un análisis de tendencias temporales y datos de las encuestas nacionales y europeas de salud para España entre 2001 y 2020. Después se entrevistará a informantes clave, en los ámbitos de comunidad autónoma y nacional, para contextualizar los datos obtenidos en la primera fase y explorar la variabilidad entre comunidades autónomas. Por último, se analizará mediante métodos econométricos cómo influyen dichas intervenciones en las desigualdades sociales entre comunidades autónomas.

Background: Several studies have evaluated whether depressed persons have older appearing brains than their nondepressed peers. However, the estimated neuroimaging-derived “brain age gap” has varied from study to study, likely driven by differences in training and testing sample (size), age range, and used modality/features. To validate our previously developed ENIGMA brain age model and the identified brain age gap, we aim to replicate the presence and effect size estimate previously found in the largest study in depression to date (N = 2126 controls & N = 2675 cases; +1.08 years [SE 0.22], Cohen's d = 0.14, 95% CI: 0.08–0.20), in independent cohorts that were not part of the original study. Methods: A previously trained brain age model (www.photon-ai.com/enigma_brainage) based on 77 FreeSurfer brain regions of interest was used to obtain unbiased brain age predictions in 751 controls and 766 persons with depression (18–75 years) from 13 new cohorts collected from 20 different scanners. Meta-regressions were used to examine potential moderating effects of basic cohort characteristics (e.g., clinical and scan technical) on the brain age gap. Results: Our ENIGMA MDD brain age model generalized reasonably well to controls from the new cohorts (predicted age vs. age: r = 0.73, R2 = 0.47, MAE = 7.50 years), although the performance varied from cohort to cohort. In these new cohorts, on average, depressed persons showed a significantly higher brain age gap of +1 year (SE 0.35) (Cohen's d = 0.15, 95% CI: 0.05–0.25) compared with controls, highly similar to our previous finding. Significant moderating effects of FreeSurfer version 6.0 (d = 0.41, p = 0.007) and Philips scanner vendor (d = 0.50, p 3400 patients and >2800 controls worldwide show reliable but subtle effects of brain aging in adult depression. Future studies are needed to identify factors that may further explain the brain age gap variance between cohorts.

Background: Renal ischemia and reperfusion injury (IRI) is the main cause of acute kidney injury (AKI). AKI induces the development of cardiac hypertrophy (CH) during cardiorenal syndrome (CRS), and cardiomyocyte calcium mishandling though systemic inflammation after 8 days of renal IRI. Klotho has recently been described as an anti-inflammatory component. Given this, Klotho treatment could prevent or attenuate the inflammation, thereby also preventing electrical cardiac outcomes incurred by CRS. The aim of this study was to investigate the therapeutic role of Klotho in CRS after unilateral renal IRI through its anti-inflammatory action. Methods: We examined renal tissue structure and function, intracellular Ca2+ dynamics in adult ventricular cardiomyocytes and serum cytokine levels from C57BL/6 mice that suffered unilateral renal IRI by occluding the left pedicle for 60 min and reperfusion for 8 days. The animals were treated with recombinant Klotho protein starting from the day of the surgery, then daily for 8 days. Results: After Klotho treatment for 8 days, the left renal tissue remained damaged, however the renal function was restored due to the right kidney tissue preservation. In parallel, Klotho also prevented an increase in serum interleukin (IL-) 6, IL-1β, and tumor necrosis factor alpha (TNF-α) levels. CH and low cell contraction were also prevented, as well as a decrease in systolic Ca2+ transients and sarco/endoplasmic reticulum Ca2+-ATPase (SERCA2a) activity measured as Ca2+ transient decay, an increase in spontaneous Ca2+ release and the incidence of pro-arrhythmic events. Conclusions: The Klotho treatment showed promise, playing an important role in the pathophysiology of CRS. We were unable to observe a total renoprotective role of the compound in the model; in turn, a cardioprotective role of Klotho was demonstrated through the prevention of hypertrophy and normalization of the Ca2+ cycle dysfunction of cardiomyocytes. We propose that Klotho acts in the cardiorenal syndrome by systematically preventing inflammation and increased FGF23, alleviating cardiac outcomes.

Introduction: In this work we describe the use of high-density autologous chondrocyte implantation (HD-ACI) to treat 2 patients with chondral defects in the hip. Case Presentation: Two male, 35- and 37-year-old, with chondral lesions and femoroacetabular impingement (FAI) were included. Chondrocytes were isolated expanded in vitro and then implanted at a density of 5 million cells per cm2 onto a type I/III porcine collagen membrane. None of the patients had surgery-derived complications. Pain disappeared in both cases at 6 months after surgery and was maintained until follow-up end (36 months). International Hip Outcome Tool (iHOT) score increased at 6 and 12 months and then leveled off until month 36.Three-year arthro-MRI showed the cartilage defects had been filled with a material similar to the surrounding healthy cartilage. Conclusion: HD-ACI is a safe and effective technique for focal cartilage lesion treatment in patients affected by evolved FAI.

Abstract Background Although colorectal cancer (CRC) screening programs reduce CRC incidence and mortality, they are associated with risks in healthy subjects. However, the risk of overtreatment and overdiagnosis has not been determined yet. The aim of this study was to report the surgery rates in patients with nonmalignant lesions detected within the first round of a fecal immunochemical test (FIT) based CRC screening program and the factors associated with it. Methods We included in this analysis all patients with nonmalignant lesions detected between May 2013 and June 2019 in the Galician (Spain) CRC screening program. We calculated surgery rate according to demographic variables, the risk classification according to the colonoscopy findings (European guidelines for quality assurance), the endoscopist’s adenoma detection rate (ADR) classified into quartiles and the hospital’s complexity level. We determined which variables were independently associated with surgery rate and expressed the association as Odds Ratio and its 95% confidence interval (CI). Results We included 15,707 patients in the analysis with high (19.9%), intermediate (26.9%) low risk (23.3%) adenomas and normal colonoscopy (29.9%) detected in the analyzed period. Colorectal surgery was performed in 162 patients (1.03, 95% CI 0.87–1.19), due to colonoscopy complications (0.02, 95% CI 0.00–0.05) and resection of colorectal benign lesions (1.00, 95% CI 0.85–1.16). Median hospital stay was 6 days with 17.3% patients developing minor complications, 7.4% major complications and one death. After discharge, complications developed in 18.4% patients. In benign lesions, an endoscopic resection was performed in 25.4% and a residual premalignant lesion was detected in 89.9%. The variables independently associated with surgery in the multivariable analysis were age (≥60 years = 1.57, 95% CI 1.11–2.23), sex (female = 2.10, 95% CI 1.52–2.91), the European guidelines classification (high risk = 67.94, 95% CI 24.87–185.59; intermediate risk = 5.63, 95% CI 1.89–16.80; low risk = 1.43; 95% CI 0.36–5.75), the endoscopist’s ADR (Q4 = 0.44, 95% CI 0.28–0.68; Q3 = 0.44, 95% CI 0.27–0.71; Q2 = 0.71, 95% CI 0.44–1.14) and the hospital (tertiary = 0.54, 95% CI 0.38–0.79). Conclusions In a CRC screening program, the surgery rate and the associated complications in patients with nonmalignant lesions are low, and related to age, sex, endoscopic findings, endoscopist’s ADR and the hospital’s complexity.

Botanical collections are the basis for floristic and taxonomic work; every study requires the collection and herborization of specimens. This report presents the curatorship and recovery work of the carpo-spermoteca of the Villa Clara Botanical Garden herbarium, available to visitors and for academic and research purposes. The samples were identified and disinfected, followed by cleaning and packaging in glass jars. The collection comprises 307 species from 46 botanical families distributed in approximately 200 genera; dry preserved samples predominate.The Fabaceae and Poaceae families are the best represented by the number of species, 51 and 40 respectively.

Stress-activated p38 kinases control a plethora of functions, and their dysregulation has been linked to the development of steatosis, obesity, immune disorders, and cancer. Therefore, they have been identified as potential targets for novel therapeutic strategies. There are four p38 family members (p38α, p38β, p38γ, and p38δ) that are activated by MKK3 and MKK6. Here, we demonstrate that lack of MKK6 reduces the lifespan in mice. Longitudinal study of cardiac function in MKK6 KO mice showed that young mice develop cardiac hypertrophy which progresses to cardiac dilatation and fibrosis with age. Mechanistically, lack of MKK6 blunts p38α activation while causing MKK3-p38γ/δ hyperphosphorylation and increased mammalian target of rapamycin (mTOR) signaling, resulting in cardiac hypertrophy. Cardiac hypertrophy in MKK6 KO mice is reverted by knocking out either p38γ or p38δ or by inhibiting the mTOR pathway with rapamycin. In conclusion, we have identified a key role for the MKK3/6-p38γ/δ pathway in the development of cardiac hypertrophy, which has important implications for the clinical use of p38α inhibitors in the long-term treatment since they might result in cardiotoxicity.

Resumen: Introducción: La repercusión de la infección materna por SARS-CoV-2 y su riesgo de transmisión vertical es aún poco conocido. Las recomendaciones de las sociedades científicas buscan proporcionar seguridad para el recién nacido sin comprometer los beneficios del contacto precoz. El objetivo del estudio es describir las características y la evolución de recién nacidos de madres infectadas por SARS-CoV-2, así como las medidas implementadas siguiendo las recomendaciones de la Sociedad Española de Neonatología. Material y métodos: Estudio observacional, prospectivo y unicentro de cohortes. Se diseñó un circuito específico para madres con infección por SARS-CoV-2 y sus hijos. Se recogieron datos epidemiológicos y clínicos de las madres y sus recién nacidos. Se realizó PCR al nacer y a los 14 días. Resultados: Se incluyeron 73 madres y 75 neonatos. El 95,9% de infecciones maternas fueron diagnosticadas durante el tercer trimestre, el 43,8% fueron asintomáticas. La mediana de edad gestacional fue de 38 semanas (RIC: 37-40), el 25,9% de los neonatos requirió ingreso. En el 68% se realizó contacto piel con piel en paritorio y el 80% recibieron lactancia materna o donada exclusiva durante su estancia. No se objetivaron resultados positivos de PCR en la primera muestra obtenida nada más nacer, se objetivó un caso de PCR positiva en un neonato asintomático a los 14 días. Conclusiones: El riesgo de transmisión de la infección por SARS-CoV-2 es bajo cumpliendo los protocolos de la Sociedad Española de Neonatología, permitiendo el alojamiento conjunto de madre e hijo, el contacto precoz y el establecimiento eficaz de la lactancia materna. Abstract: Introduction: The impact of maternal SARS-CoV-2 infection and its risk of vertical transmission is still not well known. Recommendations from scientific societies seek to provide safety for newborns without compromising the benefits of early contact. The aim of the study is to describe characteristics and evolution of newborns born to mothers with SARS-CoV-2 infection, as well as the implemented measures following recommendations from the Sociedad Española de Neonatología. Methods: Observational, prospective and single-center cohort study. A specific circuit was designed for mothers with SARS-CoV-2 infection and their newborns. Epidemiological and clinical data were collected. PCR were performed in newborns at delivery and at 14 days of age. Results: 73 mothers and 75 newborns were included in the study. 95.9% of maternal infections were diagnosed during the third trimester of pregnancy, 43.8% were asymptomatic. Median gestational age was 38 weeks (IQR: 37-40), 25.9% of newborns required admission to Neonatology. Skin-to-skin mother care was performed in 68% of newborns, 80% received exclusive maternal or donated breast milk during hospital stay. No positive PCR results were observed in newborns at delivery, one case of positive PCR was observed in an asymptomatic neonate at 14 days of age. Conclusions: Risk of SARS-CoV-2 transmission is low when complying to the recommendations issued by Sociedad Española de Neonatología, allowing rooming-in and promoting breastfeeding.

Introduction: The impact of maternal SARS-CoV-2 infection and its risk of vertical transmission is still not well known. Recommendations from scientific societies seek to provide safety for newborns without compromising the benefits of early contact. The aim of the study is to describe characteristics and evolution of newborns born to mothers with SARS-CoV-2 infection, as well as the implemented measures following recommendations from the Sociedad Española de Neonatología. Methods: Observational, prospective and single-center cohort study. A specific circuit was designed for mothers with SARS-CoV-2 infection and their newborns. Epidemiological and clinical data were collected. PCR were performed in newborns at delivery and at 14 days of age. Results: 73 mothers and 75 newborns were included in the study. 95.9% of maternal infections were diagnosed during the third trimester of pregnancy, 43.8% were asymptomatic. Median gestational age was 38 weeks (IQR: 37–40), 25.9% of newborns required admission to Neonatology. Skin-to-skin mother care was performed in 68% of newborns, 80% received exclusive maternal or donated breast milk during hospital stay. No positive PCR results were observed in newborns at delivery, one case of positive PCR was observed in an asymptomatic neonate at 14 days of age. Conclusions: Risk of SARS-CoV-2 transmission is low when complying to the recommendations issued by Sociedad Española de Neonatología, allowing rooming-in and promoting breastfeeding. Resumen: Introducción: La repercusión de la infección materna por SARS-Cov-2 y su riesgo de transmisión vertical es aún poco conocido. Las recomendaciones de las sociedades científicas buscan proporcionar seguridad para el recién nacido sin comprometer los beneficios del contacto precoz. El objetivo del estudio es describir las características y evolución de recién nacidos de madres infectadas por SARS-CoV2, así como las medidas implementadas siguiendo las recomendaciones de la Sociedad Española de Neonatología. Material y métodos: Estudio observacional, prospectivo y unicentro de cohortes. Se diseñó un circuito específico para madres con infección por SARS-CoV2 y sus hijos. Se recogieron datos epidemiológicos y clínicos de las madres y sus recién nacidos. Se realizó PCR al nacer y a los 14 días. Resultados: Se incluyeron 73 madres y 75 neonatos. El 95.9% de infecciones maternas fueron diagnosticadas durante el tercer trimestre, el 43.8% fueron asintomáticas. La mediana de edad gestacional fue 38 semanas (RIC:37–40), el 25.9% de los neonatos requirió ingreso. En el 68% se realizó contacto piel con piel en paritorio y el 80% recibieron lactancia materna o donada exclusiva durante su estancia. No se objetivaron resultados positivos de PCR en la primera muestra obtenida nada más nacer, se objetivó 1 caso de PCR positiva en un neonato asintomático a los 14 días. Conclusiones: El riesgo de transmisión de la infección por SARS-CoV2 es bajo cumpliendo los protocolos de la Sociedad Española de Neonatología, permitiendo el alojamiento conjunto de madre e hijo, el contacto precoz y el establecimiento eficaz de la lactancia materna.

Calcific aortic stenosis (CAS) and type 2 diabetes mellitus (T2DM) are related and often concomitant pathologies, accompanied by common comorbidities such as hypertension or dyslipidemia. Oxidative stress is one of the mechanisms that trigger CAS, and it can drive the vascular complications in T2DM. Metformin can inhibit oxidative stress, yet its effects have not been studied in the context of CAS. Here, we assessed the global oxidative status in plasma from patients with CAS, both alone and with T2DM (and under treatment with metformin), using multimarker scores of systemic oxidative damage (OxyScore) and antioxidant defense (AntioxyScore). The OxyScore was determined by measuring carbonyls, oxidized LDL (oxLDL), 8-hydroxy-20-deoxyguanosine (8-OHdG), and xanthine oxidase (XOD) activity. In contrast, the AntioxyScore was determined through the catalase (CAT) and superoxide dismutase (SOD) activity, as well as the total antioxidant capacity (TAC). Patients with CAS displayed enhanced oxidative stress compared to control subjects, probably exceeding their antioxidant capacity. Interestingly, patients with CAS and T2DM displayed less oxidative stress, possibly due to the benefits of their pharmacological therapy (metformin). Thus, reducing oxidative stress or enhancing antioxidant capacity through specific therapies could be a good strategy to manage CAS, focusing on personalized medicine.

Anti-Müllerian hormone (AMH) and antral follicular count (AFC) decrease in women with ovarian endometrioma (OMA) and in vitro fertilization (IVF). In addition, these parameters drop even further when women with OMA undergo surgery. In this study, the primary aim was to compare the reproductive variables in IVF-treated women with and without endometriosis. The secondary aim was to explore if the reproductive variables were modified by endometrioma surgery. In this retrospective study, 244 women undergoing IVF were enrolled at the Hospital Universitario La Paz (Madrid, Spain). Women were categorized as OMA not surgically treated (OMA; n = 124), OMA with surgery (OMA + S; n = 55), and women with infertility issues not related to OMA (control; n = 65). Demographic and clinical variables, including age, body mass index (BMI), and reproductive (AMH, AFC, number of extracted oocytes, and transferred embryos) and obstetrical data (biochemical pregnancy and fetal heart rate at 6 weeks) were collected. Adjusted logistic regression models were built to evaluate reproductive and pregnancy outcomes. The models showed that women with OMA (with and without surgery) had significantly decreased levels of AMH and AFC and numbers of cycles and C + D embryos. Women with OMA + S had similar rates of pregnancy to women in the control group. However, women with OMA had lower biochemical pregnancy than controls (aOR = 0.08 [0.01; 0.50]; p-value = 0.025). OMA surgery seems to improve pregnancy outcomes, at least until 6 weeks of gestation. However, it is important to counsel the patients about surgery expectations due to the fact that endometrioma itself reduces the quality of oocytes.

Background and AimsInflammation in overweight/obesity may condition the development of insulin resistance (IR). New markers of inflammation and systemic inflammation, such as leukocyte and platelet counts, the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), could be used as indicators of IR. The aim of the present study was to investigate the relationship between these markers and IR in overweight/obese children.Materials and MethodsA total of 1,035 schoolchildren were studied (398 overweight/obese). Anthropometric, hematological and biochemical measurements were collected. Inflammation was considered to be present when the values of leukocytes, platelets, NLR, PLR and MLR were ≥p75 for each sex. IR was defined as HOMA-IR >3.16.ResultsIn overweight/obese schoolchildren, leukocytes were higher in both boys and girls, and platelets and NLR were higher in boys with IR than in boys with insulin sensitivity. An association between leucocytes and NLR values (≥p75) and IR was found in the entire population [2.911 (1.328–6.381); p = 0.008 and 2.660 (1.185–5.968); p = 0.018, respectively] and in boys [9.255 (1.896–45.168); p = 0.006 and 6.996 (1.377–35.544); p = 0.019, respectively].ConclusionElevated white blood cell values and elevated NLR in overweight/obese children, and particularly in boys, could be indicators of the presence of IR in these subjects and should be considered when predicting possible complications, such as type II diabetes mellitus.

RESUMEN Objetivo: Describir la evolución de los ingresos hospitalarios, en plantas de hospitalización y Cuidados Intensivos, y la mortalidad en el hospital de un área afectada con tasas de incidencia medias por la pandemia COVID-19. Métodos: Estudio observacional de todos los ingresos, y fallecimientos, que se produjeron entre los días 1 de marzo y 30 de abril de los años 2017,2018,2019 y 2020 en un hospital general. Consideramos las 00.00 horas del día 14 de marzo como inicio del estado de alarma y separación entre dos periodos: pre-estado de alarma (1-13 de marzo) y estado de alarma (14 de marzo-30 de abril). Resultados: Comparando los meses de marzo-abril de los años 2017, 2018 y 2019 frente a 2020 se aprecia un descenso del número de ingresos: 23,33% (Área Médica), 33,46% (Área Quirúrgica) y 38,37% en cuidados intensivos ( p

Purpose: To study clinical outcome of patients with bilateral ankle chondral defects treated with High-Density Autologous Chondrocyte Implantation (HD-ACI) in the same surgical act. Cases presentation: Two men (27 and 48 years-old) with chondral defects in both ankles evidenced by MRI. Chondral lesions were treated with HD-ACI in the same surgical act and anesthesia, consecutively. Patients were evaluated 2, 6 and 12 months after surgery to check for treatment safety and efficacy. Pain, evaluated by the Visual Analogic Scale (VAS), decreased from very high values (8.5 – 9) to normal or almost normal scores one year after surgery (0 – 1). Ankle functionality measured by the American Orthopedic Foot & Ankle Society score (AOFAS) and quality of life evaluated by the EuroQol five-dimensional five-level questionnaire (EQ-5D-5L) behaved similarly to pain. Thus, both parameters increased and/or slightly decreased at 2 months (AOFAS score: 53 and 51; EQ-5D-5L score: 0.42 and 0.33) and reached their maximum value at 12 months (AOFAS score: 90 and 89; EQ-5D-5L score: 0.89 and 0.91). MRI from both ankles revealed that chondral defects were filled with a material of similar aspect to the surrounding cartilage. Conclusion: Treatment of both ankles with HD-ACI in the same surgical act in patients with bilateral chondral lesions is a safe procedure, providing positive results from the clinical and patients’ quality of life points of view.

This work focuses on carbon foams, whose peculiarity is a predominant open macroporous cellular network that can be provided with tailored texture and morphology by the modification of the preparation process. The goal was to obtain macroporous carbonaceous structures capable of being activated by following a simple thermo-foaming procedure using a few reagents. With this purpose in mind, carbon foams with different textural properties were synthesized from sucrose using two foaming processes: at atmospheric pressure and in a pressurized reactor. Iron and silver nitrates added to sucrose gave rise, after carbonization, to materials with iron oxides and elemental silver particles nano-dispersed in the carbon matrix and promoted microporosity in both cases and mesoporosity in the case of iron nitrate. Iron nitrate also catalyzes the graphitization of the carbon material during carbonization. All these findings show the potential of sucrose thermo-foaming process as a viable and sustainable path to produce versatile carbon materials, capable of being used in various applications.

In this study, sugarcane molasses (SCM) was pre-treated in a low-cost fermentation medium to produce probiotic biomass of Lactobacillus paracasei ssp. paracasei F19 (LPPF19) with the combination of dilution, centrifugation, and acid hydrolysis (5 molar sulfuric acid, 60 °C/2 h). Microtox analysis, inductively coupled mass spectrometry (ICP-MS), and high-performance liquid chromatography (HPLC) were used to measure the effects of SCM pretreatment on the fermentation process. The results showed that the hydrolysis of sucrose into glucose and fructose was 98%, which represented an increase of 44.4% in the initial glucose content (fermentation-limiting sugar), and harmful heavy metals, such as arsenic, cadmium, and lead, were reduced by 50.3, 60.0, and 64.3%, respectively. After pretreatment, with the supplementation of only yeast extract and salts (Na, K, Mg, and Mn), a biomass of 9.58 log CFU/mL was achieved, approximately ten times higher than that for the control medium used (MRS/DeMan, Rogosa, and Sharpe). The cost reduction achieved compared to this commercial medium was 68.7% in the laboratory and 78.9% on an industrial scale. This work demonstrated that SCM could be used in a cheaper and more effective alternative fermentation to produce LPPF19.

Hybrid multi-material joints of titanium alloy (Ti6Al4V) bonded to carbon fibre reinforced polymer (CFRP) are really interesting for lightweight high-performance structures, i.e., aeronautical and marine applications. Co-bonding technique, in which the joining takes place at the same time as the manufacturing of the CFRP, could be a great solution for easy manufacturing fibre metal laminate (FML) and complex structures, or a time saving process. One of the biggest challenges in this type of multi-material structures is to be able to confirm the structural health in service. The present work deals with the use, as matrix, of an epoxy resin reinforced with multiwalled carbon nanotubes (MWCNT) for manufacturing of Ti-CFRP joints by co-bonding. The aim is the structural health monitoring (SHM) of these hybrid structures, enhancing their mechanical properties.The obtained results show an improvement of more than 140% in fracture resistance of the multi-material joints with optimal surface preparation, by incorporating CNT. Furthermore, electrical monitoring makes it possible to discern the quality of the manufactured joints, increasing their reliability and performance. Besides, the ability to localize crack propagation and stresses prior to joint failure has been confirmed, so CNT addition results in a powerful tool for SHM multi-material joints.

During the first weeks of postnatal heart development, cardiomyocytes undergo a major adaptive metabolic shift from glycolytic energy production to fatty acid oxidation. This metabolic change is contemporaneous to the up-regulation and activation of the p38γ and p38δ stress-activated protein kinases in the heart. We demonstrate that p38γ/δ contribute to the early postnatal cardiac metabolic switch through inhibitory phosphorylation of glycogen synthase 1 (GYS1) and glycogen metabolism inactivation. Premature induction of p38γ/δ activation in cardiomyocytes of newborn mice results in an early GYS1 phosphorylation and inhibition of cardiac glycogen production, triggering an early metabolic shift that induces a deficit in cardiomyocyte fuel supply, leading to whole-body metabolic deregulation and maladaptive cardiac pathogenesis. Notably, the adverse effects of forced premature cardiac p38γ/δ activation in neonate mice are prevented by maternal diet supplementation of fatty acids during pregnancy and lactation. These results suggest that diet interventions have a potential for treating human cardiac genetic diseases that affect heart metabolism.

ABSTRACT: Introduction: Bilateral knee chondral defects can be treated in one or two surgical acts. Objectives: To study clinical outcome of patients with bilateral knee chondral defects treated with High-Density Autologous Chondrocyte Implantation (HD-ACI) during the same surgery. Methods: Study on eight patients (4 women and 4 men) with chondral defects in both knees treated with HD-ACI during the same surgical act. Patients were evaluated 2, 6, 12 and 24 months post-op for treatment safety and efficacy: visual analogic scale (VAS) for pain, International Knee Documentation Committee (IKDC) for subjective patient's perception of both knees and EuroQol five-dimensional five-level questionnaire (EQ-5D-5 L) for quality of life. Integrity of neoformed tissue at 12 and 24-month follow-up was assessed by the magnetic resonance observation of cartilage repair tissue (MOCART) score. Results: VAS decreased from baseline to 24 months from a median of 8 (6 – 9) to a median of 0 (0 – 5) (P < .001). IKDC increased from a median value of 39.0 (17.2 – 48.3) in the basal visit to a median of 83.7 (24.0 – 98.0) in the 24-month visit (P < .001). EQ-5D-5 L decreased at 2 months post-op and increased throughout the follow-up visits thereafter, needing 24 months after surgery to reach a value higher than the basal one. Median MOCART at 12 months was 80.3 (58.0 – 89.7) and 81.3 (54.0 – 89.9) at 24 months. Conclusions: Treatment of both knees with HD-ACI during the same surgical act in patients with bilateral chondral lesions is a safe procedure, providing good clinical results.

Introduction: The pectoralis major flap is a reconstructive option to consider in the treatment of pharyngocutaneous fistula after a total laryngectomy. There are not large studies assessing variables related to pharyngocutaneous fistula recurrence after removal of the larynx. Our objectives were to review the results obtained with this type of treatment when pharyngocutaneous fistula appears in laryngectomized patients, and to evaluate variables related to the results. Methods: We retrospectively reviewed our results using either a myocutaneous or fasciomuscular pectoralis major flap to repair pharyngocutaneous fistula in 50 patients. Results: There were no cases of flap necrosis. Oral intake after fistula repair with a pectoralis major flap was restored in 94% of cases. Fistula recurrence occurred in 22 cases (44%), and it was associated with a lengthening of the hospital stay. Performing the flap as an emergency procedure was associated with a significantly higher risk of fistula recurrence. Hospital stay was significantly shorter when a salivary tube was placed. Conclusions: The pectoralis major flap is a useful approach to repair pharyngocutaneous fistula. Placing salivary tubes during fistula repair significantly reduces hospital stay and complication severity in case of pharyngocutaneous fistula recurrence. Resumo: Introdução: O retalho do músculo peitoral maior é uma opção a ser considerada no fechamento de fístula faringocutânea pós-laringectomia total. Não há grandes estudos que avaliem as variáveis relacionadas à recorrência da fístula faringocutânea após esse procedimento. Nossos objetivos foram avaliar os resultados obtidos com esse tipo de tratamento em pacientes laringectomizados com fístula faringocutânea e as variáveis relacionadas aos resultados. Método: Revisamos retrospectivamente os nossos resultados em 50 pacientes nos quais um retalho miocutâneo ou fasciomuscular do músculo peitoral maior foram utilizados para reparar a fístula faringocutânea. Resultados: Não houve casos de necrose de retalho. Após o reparo da fístula com um retalho do músculo peitoral maior, a ingestão oral foi restaurada em 94% dos casos. Houve recorrência da fístula em 22 casos (44%), a qual foi associada à duração da hospitalização. O uso do retalho como procedimento de emergência foi associado a um risco significativamente maior de recorrência da fístula. A permanência hospitalar foi significativamente menor quando utilizado um tubo de derivação salivar. Conclusões: O uso do retalho do músculo peitoral maior é uma abordagem útil para reparar a fístula faringocutânea. A colocação de tubos de derivação salivar durante o reparo da fístula reduz significativamente o tempo de hospitalização e a gravidade das complicações em caso de recorrência da fístula faringocutânea. Keywords: Total laryngectomy, Pharyngocutaneous fistula, Pectoralis major flap, Bypass salivary tube, Pharynx closure, Palavras-chave: Laringectomia total, Fístula faringocutânea, Retalho do músculo peitoral maior, Tubo de derivação salivar, Fechamento da faringe

Background and objective: Matrix metalloproteinases (MMPs) are involved in deleterious tissue remodelling associated with target organ damage in renal disease. The aim of this study was to study the association between renal dysfunction and activity of the inflammatory metalloproteinase MMP-9 in hypertensive patients with mild-moderate chronic kidney disease (CKD). Material and methods: Plasmatic active MMP-9, total MMP-9, tissue inhibitor of MMP-9 (TIMP-1), MMP-9/TIMP-1 ratio and MMP-9-TIMP-1 interaction were analysed in 37 hypertensive patients distributed by estimated glomerular filtration rate (eGFR) in 3 groups: >90, 90–60 and 60–30 mL/min/1.73 m2. Results: Total MMP-9 was not different as eGFR declines. TIMP-1 was significantly increased in hypertensive patients with eGFR 60–30 mL/min/1.73 m2 (p 90 mL/min/1.73 m2). This relates to the significant decrease in the interaction between MMP-9-TIMP-1 observed in patients with eGFR 60–30 mL/min/1.73 m2 (p 90 mL/min/1.73 m2). Despite the systemic elevation of TIMP-1, active MMP-9 was significantly increased in hypertensive patients with eGFR 60–30 mL/min/1.73 m2 (p 90 and 90–60 mL/min/1.73 m2, respectively). TIMP-1, active MMP-9 and MMP-9-TIMP-1 interaction significantly correlate with the decline in renal function, which was not observed with total MMP-9. Conclusions: The progression of CKD, even in stages where the decline of renal function is still moderate, is associated with an increase in MMP-9 activity, which could be considered as a potential therapeutic target. Resumen: Antecedentes y objetivo: Las enzimas metaloproteinasas de matriz (MMP) están involucradas en el remodelado tisular deletéreo asociado al daño de órganos diana de la enfermedad renal. El objetivo de este estudio fue explorar la asociación entre la caída de la función renal y la actividad sistémica de la metaloproteinasa inflamatoria MMP-9 en el paciente hipertenso con enfermedad renal crónica (ERC) leve-moderada. Material y métodos: Se analizaron los niveles plasmáticos de MMP-9 activa, MMP-9 total, su inhibidor tisular (TIMP-1), el cociente MMP-9/TIMP-1 y la interacción entre MMP-9 y TIMP-1 en 37 pacientes hipertensos distribuidos según su tasa de filtración glomerular estimada (TFGe) en 3 grupos: > 90, 90–60 y 60–30 mL/min/1,73 m2. Resultados: La MMP-9 total no fue diferente con respecto a la disminución en la TFGe. TIMP-1 estaba significativamente incrementado en los pacientes hipertensos con TFGe entre 60–30 mL/min/1,73 m2 (p 90 mL/min/1,73 m2). Estos resultados fueron apoyados por la disminución significativa de la interacción MMP-9-TIMP-1 observada en los pacientes con TFGe entre 60–30 mL/min/1,73 m2 (p 90 mL/min/1,73 m2). A pesar de la elevación sistémica de TIMP-1 encontramos un incremento significativo de MMP-9 activa en los pacientes hipertensos con TFGe entre 60–30 mL/min/1,73 m2 (p 90 y 90–60 mL/min/1,73 m2, respectivamente). Los niveles de TIMP-1, MMP-9 activa e interacción proteica MMP-9-TIMP-1 correlacionaron significativamente con el deterioro de la función renal, lo cual no se observó para la MMP-9 total. Conclusiones: La progresión de la ERC, incluso en estadios donde la caída de la función renal es aún moderada, se asocia con un aumento específico de la actividad MMP-9, lo cual podría considerarse como una potencial diana terapéutica. Keywords: Chronic kidney disease, Metalloproteinases, Matrix metalloproteinase-9, Tissue inhibitor of metalloproteinase-1, Hypertension, Palabras clave: Enfermedad renal crónica, Metaloproteinasas, Metaloproteinasa de matriz-9, Inhibidor tisular de metaloproteinasas de matriz-1, Hipertensión

Resumen: Antecedentes y objetivo: Las enzimas metaloproteinasas de matriz (MMP) están involucradas en el remodelado tisular deletéreo asociado al daño de órganos diana de la enfermedad renal. El objetivo de este estudio fue explorar la asociación entre la caída de la función renal y la actividad sistémica de la metaloproteinasa inflamatoria MMP-9 en el paciente hipertenso con enfermedad renal crónica (ERC) leve-moderada. Material y métodos: Se analizaron los niveles plasmáticos de MMP-9 activa, MMP-9 total, su inhibidor tisular (TIMP-1), el cociente MMP-9/TIMP-1 y la interacción entre MMP-9 y TIMP-1 en 37 pacientes hipertensos distribuidos según su tasa de filtración glomerular estimada (TFGe) en 3 grupos: > 90, 90-60 y 60-30 mL/min/1,73 m2. Resultados: La MMP-9 total no fue diferente con respecto a la disminución en la TFGe. TIMP-1 estaba significativamente incrementado en los pacientes hipertensos con TFGe entre 60-30 mL/min/1,73 m2 (p 90 mL/min/1,73 m2). Estos resultados fueron apoyados por la disminución significativa de la interacción MMP-9-TIMP-1 observada en los pacientes con TFGe entre 60-30 mL/min/1,73 m2 (p 90 mL/min/1,73 m2). A pesar de la elevación sistémica de TIMP-1 encontramos un incremento significativo de MMP-9 activa en los pacientes hipertensos con TFGe entre 60-30 mL/min/1,73 m2 (p 90 y 90-60 mL/min/1,73 m2, respectivamente). Los niveles de TIMP-1, MMP-9 activa e interacción proteica MMP-9-TIMP-1 correlacionaron significativamente con el deterioro de la función renal, lo cual no se observó para la MMP-9 total. Conclusiones: La progresión de la ERC, incluso en estadios donde la caída de la función renal es aún moderada, se asocia con un aumento específico de la actividad MMP-9, lo cual podría considerarse como una potencial diana terapéutica. Abstract: Background and objective: Matrix metalloproteinases (MMPs) are involved in deleterious tissue remodeling associated with target organ damage in renal disease. The aim of this study was to study the association between renal dysfunction and activity of the inflammatory metalloproteinase MMP-9 in hypertensive patients with mild-moderate chronic kidney disease (CKD). Material and methods: Plasmatic active MMP-9, total MMP-9, tissue inhibitor of MMP-9 (TIMP-1), MMP-9/TIMP-1 ratio and MMP-9-TIMP-1 interaction were analyzed in 37 hypertensive patients distributed by estimated glomerular filtration rate (eGFR) in 3 groups: > 90, 90-60 y 60-30 mL/min/1.73 m2. Results: Total MMP-9 was not different as eGFR declines. TIMP-1 was significantly increased in hypertensive patients with eGFR 60-30 mL/min/1.73 m2 (P 90 mL/min/1.73 m2). This relates to the significant decrease in the interaction between MMP-9-TIMP-1 observed in patients with eGFR 60-30 mL/min/1.73 m2 (P 90 mL/min/1.73 m2). Despite the systemic elevation of TIMP-1, active MMP-9 was significantly increased in hypertensive patients with eGFR 60-30 mL/min/1.73 m2 (P 90 and 90-60 mL/min/1.73 m2, respectively). TIMP-1, active MMP-9 and MMP-9-TIMP-1 interaction significantly correlate with the decline in renal function, which was not observed with total MMP-9. Conclusions: The progression of CKD, even in stages where the decline of renal function is still moderate, is associated with an increase in MMP-9 activity, which could be considered as a potential therapeutic target. Palabras clave: Enfermedad renal crónica, Metaloproteinasas, Metaloproteinasa de matriz-9, Inhibidor tisular de metaloproteinasas de matriz-1, Hipertensión, Keywords: Chronic kidney disease, Metalloproteinases, Matrix metalloproteinase-9, Tissue inhibitor of metalloproteinase-1, Hypertension

Background: Creativity is one of the most relevant aspects in students’ training. One of the purposes of the present work is to show the lack of differences between boys and girls in creativity; the other is the possibility of improving creativity among high-ability students who received specific training as part of their intra-curricular content in a total grouping program for gifted students. Method: The sample consisted of 42 students from first to third grade (13 females and 29 males) and 58 students from fourth to sixth grade (21 females and 37 males). Creativity was measured with the CREA test for younger students and with the PIC-N for older students. Training was carried out through an Integral Innovation and Creativity Program (PIIC). Results: The results showed no differences between genders, except in one of the graphic creativity scales (Details). There were improvements due to the training in all measures of narrative creativity and in the scale of elaboration of graphic creativity. Conclusions: The main conclusions are the importance of increasing creativity with specific programs and the need to improve interventions in graphic creativity.

Fibroblast growth factor-23 (FGF)-23 is a phosphaturic hormone involved in mineral bone metabolism that helps control phosphate homeostasis and reduces 1,25-dihydroxyvitamin D synthesis. Recent data have highlighted the relevant direct FGF-23 effects on the myocardium, and high plasma levels of FGF-23 have been associated with adverse cardiovascular outcomes in humans, such as heart failure and arrhythmias. Therefore, FGF-23 has emerged as a novel biomarker of cardiovascular risk in the last decade. Indeed, experimental data suggest FGF-23 as a direct mediator of cardiac hypertrophy development, cardiac fibrosis and cardiac dysfunction via specific myocardial FGF receptor (FGFR) activation. Therefore, the FGF-23/FGFR pathway might be a suitable therapeutic target for reducing the deleterious effects of FGF-23 on the cardiovascular system. More research is needed to fully understand the intracellular FGF-23-dependent mechanisms, clarify the downstream pathways and identify which could be the most appropriate targets for better therapeutic intervention. This review updates the current knowledge on both clinical and experimental studies and highlights the evidence linking FGF-23 to cardiovascular events. The aim of this review is to establish the specific role of FGF-23 in the heart, its detrimental effects on cardiac tissue and the possible new therapeutic opportunities to block these effects.

Household confinement due to the rapid spread of the pandemic caused by COVID-19 has brought very significant changes, such as the forced stay-at-home of children due to the closure of schools. This has meant drastic changes in the organization of daily life and restrictions on their activities, including exercise, which could affect the quality of life of the children due to its importance. In order to study the relationship between physical activity and psychological well-being of minors, a study has been carried out with Mixed Methods Research, combining survey methodology with transversal design with qualitative methodology using discourse analysis. A total of 234 parents of minors in Spain and several Spanish-speaking countries in America participated. The instrument was a questionnaire in Google Forms, which included the Kidscreen-27 quality of life scale. The results show significant differences in both the type of physical activity and its frequency due to age, and differences in parents’ perception of whether their children’s physical activity levels were sufficient or not, both on the health, mood and school subscales, and in the categorization of open responses referring to concerns due to the pandemic, analyzed with the ALCESTE technique. The relationship between physical activity of children and adolescents and quality of life is clearly concluded.

IntroductionThe dietary carotenoids lutein (L) and zeaxanthin (Z) are transported in the bloodstream by lipoproteins, sequestered by adipose tissue, and eventually captured in the retina where they constitute macular pigment. There are no L&Z dietary intake recommendations nor desired blood/tissue concentrations for the Spanish general population. Our aim was to assess the correlation of L&Z habitual dietary intake (excluding food supplements), resulting serum concentrations and lipid profile with macular pigment optical density (MPOD) as well as the contrast sensitivity (CT), as visual outcome in normolipemic subjects (n = 101) aged 45-65.MethodsMPOD was measured by heterochromatic flicker photometry, serum L&Z by HPLC, the dietary intake by a 3-day food records and CT using the CGT-1000-Contrast-Glaretester at six stimulus sizes, with and without glare.ResultsLutein and zeaxanthin concentrations (median) in serum: 0.361 and 0.078 μmol/L, in dietary intake: 1.1 mg L+Z/day. MPOD: 0.34du. L+Z intake correlates with their serum concentrations (rho = 0.333, p = 0.001), which in turn correlates with MPOD (rho = 0.229, p = 0.000) and with fruit and vegetable consumption (rho = 0.202, p = 0.001), but not with lutein+zeaxanthin dietary intake. MPOD correlated with CT, with and without glare (rho ranges: -0.135, 0.160 and -0.121, -0.205, respectively). MPOD predictors: serum L+Z, L+Z/HDL-cholesterol (β-coeficient: -0.91±0.2, 95%CI: -1.3,-0.5) and HDL-cholesterol (R2 = 15.9%). CT predictors: MPOD, mainly at medium and smaller visual angles (corresponding to spatial frequencies for which sensitivity declines with age) and gender (β-coefficients ranges: -0.95,-0.39 and -0.13,-0.39, respectively).ConclusionA higher MPOD is associated with a lower ratio of L+Z/HDL-cholesterol and with a lower CT (higher contrast sensitivity). The HDL-cholesterol would also act indirectly on the CT improving the visual function.

The health alert caused by the COVID-19 pandemic and the lockdown have caused significant changes in people’s lives. Therefore, it has been essential to study the quality of life, especially in vulnerable populations, including children and adolescents. In this work, the psychological well-being, distribution of tasks and routines, as well as the physical activity done by children and adolescents from two samples: community and high abilities, have been analyzed. The methodology used was Mixed Method Research, through a survey conducted online through social networks. The informants were the parents of the children and adolescents, 209 in the community sample and 116 in the high ability sample. The instrument used was a questionnaire implemented through Google Forms, with open and closed questions, including the Kidscreen-27 scale to measure well-being. The assessment of the adequacy of the physical activity levels was analyzed through ALCESTE. The results showed the absence of differences between students from community samples and those with high capacities in well-being and physical activity. Parents residing in Spain observed less play time in the high ability sample, and more time spent on homework, whether or not they have a diagnosis of high ability. It is concluded that these results question the misconceptions held about high ability students in terms of poorer personal adjustment and better interest in physical activities.

Liver metabolism follows diurnal fluctuations through the modulation of molecular clock genes. Disruption of this molecular clock can result in metabolic disease but its potential regulation by immune cells remains unexplored. Here, we demonstrated that in steady state, neutrophils infiltrated the mouse liver following a circadian pattern and regulated hepatocyte clock-genes by neutrophil elastase (NE) secretion. NE signals through c-Jun NH2-terminal kinase (JNK) inhibiting fibroblast growth factor 21 (FGF21) and activating Bmal1 expression in the hepatocyte. Interestingly, mice with neutropenia, defective neutrophil infiltration or lacking elastase were protected against steatosis correlating with lower JNK activation, reduced Bmal1 and increased FGF21 expression, together with decreased lipogenesis in the liver. Lastly, using a cohort of human samples we found a direct correlation between JNK activation, NE levels and Bmal1 expression in the liver. This study demonstrates that neutrophils contribute to the maintenance of daily hepatic homeostasis through the regulation of the NE/JNK/Bmal1 axis.

In this work, Ni-doped ordered nanoporous carbon was prepared by a simple and green one-pot solvent evaporation induced self-assembly process, where chestnut wood tannins were used as a precursor, Pluronic® F-127 as a soft template, and Ni2+ as a crosslinking agent and catalytic component. The prepared carbon exhibited a 2D hexagonally ordered nanorod array mesoporous structure with an average pore diameter of ~5 nm. Nickel was found to be present on the surface of nanoporous carbon in the form of nickel oxide, nickel hydroxide, and metallic nickel. Nickel nanoparticles, with an average size of 13.1 nm, were well dispersed on the carbon surface. The synthesized carbon was then tested for the removal of methylene blue under different conditions. It was found that the amount of methylene blue removed increased with increasing pH and concentration of carbon but decreased with increasing concentration of methylene blue. Furthermore, photocatalytic tests carried out under visible light illumination showed that purple light had the greatest effect on the methylene blue adsorption/degradation, with the maximum percent degradation achieved at ~4 h illumination time, and that the percent degradation at lower concentrations of methylene blue was much higher than that at higher concentrations. The adsorption/degradation process exhibited pseudo second-order kinetics and strong initial adsorption, and the prepared carbon showed high magnetic properties and good recyclability.

Red peppers (Capsicum annuum) are rich in carotenoids and are widely grown and consumed all over the world. Today’s consumption patterns are characterized by periodical purchases of food and longer food storage periods, including raw fruits and vegetables, which could have a negative effect on healthy components. This study aims to investigate the individual carotenoid content in Lamuyo-variety red peppers in cool storage (7 °C) for three weeks. Carotenoid concentrations expressed in µg/100g of the edible portion were; lutein (1203), zeaxanthin (853), α-carotene (272), β-carotene (2167), β-cryptoxanthin (525), violaxanthin (770), capsanthin (9667), phytoene (348) and phytofluene (143). Carotenoid concentrations did not significantly vary after 21 days under household refrigeration conditions and thus the nutritional supply of provitamin A carotenoids and of carotenoids with eye health benefits such as lutein and zeaxanthin, as well as others with potential health benefits in humans such as capsanthin, violaxathin, phytoene and phytofluene.

Non-Hispanic blacks have higher mortality rates than non-Hispanic whites whereas Hispanics have similar or lower mortality rates than non-Hispanic blacks and whites despite Hispanics' lower education and access to health insurance coverage. This study examines whether allostatic load, a proxy for cumulative biological risk, is associated with all-cause and cardiovascular (CVD)-specific mortality risks in US adults; and whether these associations vary with race/ethnicity and further with age, sex and education across racial/ethnic groups. Data from the third National Health and Nutritional Examination Survey (NHANES III, 1988-1994) and the 2015 Linked Mortality File were used for adults 25 years or older (n = 13,673 with 6,026 deaths). Cox proportional hazards regression was used to estimate the associations of allostatic load scores (2 and ≥3 relative to ≤1) with a) all-cause and b) CVD-specific mortality risk among NHANES III participants before and after controlling for selected characteristics. Allostatic load scores are associated with higher all-cause and CVD-specific mortality rates among U.S. adults aged 25 years or older, with stronger rates observed for CVD-specific mortality. All-cause mortality rates for each racial/ethnic group differed with age and education whereas for CVD-specific mortality rates, this difference was observed for sex. Our findings of high allostatic load scores associated with all-cause and CVD-specific mortality among US adults call attention to monitor conditions associated with the allostatic load's biomarkers to identify high-risk groups to help monitor social inequities in mortality risk, especially premature mortality.

In the original publication, there was a mistake in Figure 1 as published [...]