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2. Snowmass white paper: beyond the standard model effects on neutrino flavor

Author

C. A. Argüelles, G. Barenboim, M. Bustamante, P. Coloma, P. B. Denton, I. Esteban, Y. Farzan, E. Fernández Martínez, D. V. Forero, A. M. Gago, T. Katori, R. Lehnert, M. Ross-Lonergan, A. M. Suliga, Z. Tabrizi, L. Anchordoqui, K. Chakraborty, J. Conrad, A. Das, C. S. Fong, B. R. Littlejohn, M. Maltoni, D. Parno, J. Spitz, J. Tang, and S. Wissel

Subjects
Astrophysics, QB460-466, Nuclear and particle physics. Atomic energy. Radioactivity, QC770-798
Abstract

Abstract Neutrinos are one of the most promising messengers for signals of new physics Beyond the Standard Model (BSM). On the theoretical side, their elusive nature, combined with their unknown mass mechanism, seems to indicate that the neutrino sector is indeed opening a window to new physics. On the experimental side, several long-standing anomalies have been reported in the past decades, providing a strong motivation to thoroughly test the standard three-neutrino oscillation paradigm. In this Snowmass21 white paper, we explore the potential of current and future neutrino experiments to explore BSM effects on neutrino flavor during the next decade.

Published
2023
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5. Gastric bezoar in a patient hospitalized in an eating disorder unit. Case report

Author

J. Torres Cortés, I. Esteban Avendaño, J. B. González del Valle, R. González Lucas, J. J. Padín Calo, and J. P. Morillo González

Subjects
Psychiatry, RC435-571
Abstract

Introduction It is well known that eating disorders are related to comorbidity. At least, half of these patients have other mental disorders and, in addition to it, the presence of physical comorbidity (cardiovascular, kidney, nervous system, digestive tract, metabolic or endocrine disorders) comes with a decline in life expectancy. Objectives Description of a patient with a diagnosis of anorexia nervosa (AN) who developed a gastric bezoar during hospitalization. Methods Case treated in a specific Eating Disorder Unit in a Third-Level Hospital. Results 26 years old woman with a diagnosis of AN hospitalized in General Psychiatric Unit with BMI of 11,78 kg/m2. Nasogastric tube was necessary and, after 1 month with a progressive weight recovery (BMI 13,84 kg/m2), the patient was transferred to the Eating Disorder Unit in order to follow specific psychological therapy. No incidence related to physical exploration or clinical analyses happened during this month apart from pancytopenia due to malnutrition. However, 8 days after, patient developed nausea and had 3 vomit episodes, constant abdominal pain at hipogastrium (moderate intensity), dizziness, instability and constipation. The patient refused possibility of pregnancy. The physical exam showed bowel sounds augmented but no mass or peritoneal irritation appeared. Blood test results were normal. Abdominal X-Ray showed gastric dilatation with small bowel faeces sign, which suggested diagnosis of gastric bezoar. The treatment was the dissolution of the bezoar by Coca-Cola, solving the symptoms completely. The patient refused having eaten hair or any other kind of object or indigestible material but admitted to be following a strict vegan diet. Finally, after an endoscopy was done, the patient was diagnosed of phytobezoar. Conclusions Based on literature, bezoars are rare in AN, being phytobezoars the most common between the types of bezoars. Nevertheless, there are some risk factors, such as delayed gastric emptying, dehydration or, in the case of phytobezoar, ingestion of food containing high amount of cellulose, hemi-cellulose, lignin, and tannins (celery, pumpkin, grape skins, prunes, raisins and, in particular, persimmons). Some of the symptoms caused by phytobezoar can be similar to those of the AN (abdominal pain, intestinal obstruction, poor appetite, vomiting, malnutrition, weight loss). Therefore, gastric bezoar could be an underdiagnosed or even undiagnosed disease in this group of patients. Taking this into account could reduce time until diagnosis and treatment, decreasing the risks associated. Disclosure of Interest None Declared

Published
2023
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6. EARLY ONSET AGGRESSIVE BEHAVIOR INDUCED BY PERAMPANEL IN THE TREATMENT OF CHRONIC INSOMNIA: A CASE REPORT

Author

I. Esteban-Avendaño, J. Torres Cortés, and J. Padín Calo

Subjects
Psychiatry, RC435-571
Abstract

Introduction Chronic insomnia, resistant to different treatments (pharmacological, sleep hygiene and cognitive-behavioral therapy) remains one of the greatest challenges in our daily practice as psychiatrists. The pharmacological options include benzodiazepines and their analogues (zolpidem, zopiclone, etc.). However, when trying to treat chronic insomnia the use of off-label drugs, including antidepressants with sedative action (such as trazodone), antipsychotics or antiepiletic drugs, is not uncommon. Perampanel is a non-competitive AMPA receptor antagonist, marketed for the treatment of partial onset epilepsy and primary generalized tonic-clonic seizures. It has been used in the treatment of chronic insomnia with positive results and it has shown to improve the quality of sleep in a recent observational retrospective cohort study. The most frequent adverse effects of Perampanel include dizziness and drowsiness. Perampanel can also cause psychiatric and behavioral adverse effects, aggression and irritability in up to 10% of patients, as well as depression, and suicidal ideation, with higher rates in patients with psychiatric history. Objectives To draw attention to possible adverse effects of Perampanel and to add knowledge to improve the treatment for chronic insomnia. Methods Case report and non-systematic literature review of the current data. Results A 33 year old woman with Anorexia Nervosa was admitted to the psychiatric hospitalization unit due to suicidal ideation and a history of chronic insomnia. Perampanel was started at a dose of 2mg/day, progressively titrated to 6mg/day, following patient’s informed consent. A week after the initiation of treatment, her sleep pattern had improved but she became aggressive, showed low tolerability to minor frustrations and suffered from an intensification of suicidal ideation. She became extremely hostile to the personnel, had severe tantrums and deliberate self injurious behavior. Perampanel was discontinued and in less than a week her aggressive behavior succumbed. Although she was not re-exposed to Perampanel the symptoms she presented are considered a very likely adverse drug reaction. Levomepromazine 20mg/day and Lormetazepam 0.5mg/day were reinstated as a treatment for insomnia. Conclusions Psychiatric comorbidity is known to be a risk factor for behavioral adverse effects of Perampanel. Therefore Perampanel as a treatment for chronic insomnia needs a careful individual benefit-risk assessment and monitoring for adverse effects. Disclosure of Interest None Declared

Published
2023
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7. Evaluation of factors that may influence the development of chronic kidney disease in patients with bipolar disorder treated with lithium.

Author

N. Gutiérrez Mora, J. Torres Cortés, I. Esteban Avendaño, V. Burguera Vion, and J. M. Montes Rodríguez

Subjects
Psychiatry, RC435-571
Abstract

Introduction Bipolar disorder (BD) is a serious and chronic mental disease of mood. Lithium is used for treatment and studies have demonstrated that it is the most efficient drug, reducing suicide risk in a high percentage of patients. However, this drug has well known side effects, such as kidney damage. Lithium could cause chronic kidney disease, specially with the presence of other risk factors. Objectives Observational and retrospective study of creatinine levels and glomerular filtration rates observed in blood analysis (follow-up period of 11 years). Sample size of 263 patients diagnosed of BD I and BD II in treatment with lithium. We used socio-demographic (age, sex) and clinic variables (diabetes mellitus, hypertension, use of nonsteroidal anti-inflammatory drugs (NSAIDs) and/or diuretics) to generate bivariate and multivariate analysis. Methods Our main objective is to analyze the deterioration of kidney function and the development of chronic kidney disease that chronic treatment with lithium can induce in patients with BD. Our secondary objective is to determine variables which could promote the development of chronic kidney disease, and to assess if these variables could be considered as risk factors during the treatment with lithium. Results 11,3 % of patients in our study developed chronic kidney disease during monitoring. The deterioration of GFR in patients in treatment with lithium was significantly associated with female sex and NSAIDs consumption. A trend towards statistical significance was found regarding the use of diuretics (p=0,060). No statistical significance was found between diabetes mellitus, hypertension or type of BD and the deterioration of kidney function in our sample. An inverse association was found between the GFR decline and the age but no statistical significance was demonstrated. Conclusions We conclude that female sex and use of NSAIDs are predicting factors of GFR decline in patients with BD in chronic treatment with lithium. We must take into account these drugs or even avoid concomitant treatment (lithium and NSAIDs) in order to prevent chronic kidney disease. In addition to it, we should recommend careful use of diuretics during treatment with lithium because of risk of dehydration. Diabetes mellitus and hypertension have universally been associated to increase risk of development of chronic kidney disease. However, we have not found statistical significance in our study. Therefore, research should be done in order to determine specific risk factors in this group of patients and, consequently, optimize their treatment. Disclosure of InterestNone Declared

Published
2023
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8. Holistic approach of the care of the infant with hypoxic-ischaemic encephalopathy in Spain

Author

Juan Arnaez, Nuria Herranz-Rubia, Alfredo Garcia-Alix, J. Diez-Delgado, I. Benavente-Fernández, I. Tofé, A.E. Jerez, J.A. Hurtado, J.M. Ceballos, M.L. Millán, M.D. Esquivel, C. Ruiz, M. Baca, E. Tapia, M. Losada, E. Torres, A. Pavón, P.J. Jiménez, F. Jiménez, M.P. Ventura, S. Rite, T. González, R.P. Arias, P.R. Balliu, J.M. Lloreda-García, J.L. Alcaráz, C. Tapia, A. de la Morena, I. Centelles, I. Güemes, J. Estañ, A. Alberola, S. Aparici, R. López, J. Beceiro, B. García, L. Martínez, E. González, L. Arruza, M.D. Blanco, M.T. Moral, B. Arias, F. Mar, J. Jiménez, G. Romera, A. Cuñarro, C. Muñóz, F. Cabañas, E. Valverde, R. Montero, J.C. Tejedor, C. Santana, B. Reyes, S. Romero, A. Orizaola, M. Baquero, D. Hernández, A. Pantoja, C. Vega-del-Val, L. Castañón, E.P. Gutiérrez, M. Benito, S. Caserío, G. Arca, M.J. García, M.A. López-Vílchez, L. Castells, M. Domingo, W. Coroleu, H. Boix, R. Porta, A. García-Alix, S. Martínez-Nadal, E. Jiménez, E. Sole, M. Albújar, E.M. Fernández, A.R. Barrio, E. Piñán, A. Avila-Alvarez, M.E. Vázquez, N. Balado, P.A. Crespo, M.L. Couce, A. Concheiro-Guisán, I. Esteban, A. Lavilla, V. Alzina, A. Aguirre, B. Loureiro, I. Echániz, M.D. Elorza, and A. Euba

Subjects
Hipoxia-isquemia, Asfixia, Neonato, Hipotermia terapéutica, Biomarcadores, Pronóstico, Pediatrics, RJ1-570
Abstract

Introduction: There is not much information about the care of infants with hypoxic-ischaemic encephalopathy (HIE) treated with therapeutic hypothermia (TH) in Spain. This includes whether protocols are routinely used, the type of neuro-monitoring performed, and how information on the neurological prognosis is presented to families. The answers to these would allow to detect and implement areas of improvement. Method: A cross-sectional analysis was performed on the responses to structured questionnaires sent to all the Spanish neonatal units that were performing TH in June 2015. Questions were divided into 5 sections: (1) the availability of protocols and technological resources, (2) the use of neuro-monitoring tools, (3) the knowledge and training of the professionals; (4) the prognostic information given to the parents; and (5) the discharge report and the follow-up plan. Results: Most centres (95%) use servo controlled whole-body cooling methods and have specific management protocols. Sedation is used in 70% of centres, and in 68% of them the onset of enteral feeding is delayed until the end of the cooling period. Amplitude-integrated electroencephalography monitoring is used in more than 80% of the centres, although only in 50% are nurses able to interpret it. Cerebral oxygen saturation is not often monitored (16%). As regards diagnostic-prognostic studies, neuroimaging is universal, but brain damage biomarkers are hardly used (29%). Prognostic information is offered within the first 72 posnatal hours in 21% of the centres, and is given without the presence of the nurse in 70% of the centres. Follow-up is performed by a neuro-paediatrician (84%), with an uneven duration between centres. Conclusions: The care of infants with HIE treated with TH in Spain is generally adequate, although there are areas for improvement in neuromonitoring, sedation, prognostic information, teamwork, and duration of follow-up. Resumen: Introducción: Apenas conocemos cómo es la asistencia de los recién nacidos (RN) con encefalopatía hipóxico-isquémica (EHI) en hipotermia terapéutica (HT), especialmente si existen protocolos asistenciales, la neuromonitorización que se realiza o cómo es la aproximación al pronóstico neurológico. Este conocimiento permite detectar e implementar áreas de mejora asistencial. Método: Estudio transversal de los 57 hospitales españoles que realizaban HT en 2015, mediante cuestionario sobre: 1) la disponibilidad de protocolos y de recursos tecnológicos; 2) el uso de herramientas de neuromonitorización; 3) los conocimientos de los profesionales; 4) la información pronóstica que se da los padres, y 5) el informe al alta y del plan de seguimiento. Resultados: El 95% utiliza enfriamiento corporal-total servocontrolado y dispone de protocolos específicos de actuación. El 70% utiliza sedación y el 68% deja al paciente a dieta absoluta. La monitorización con electroencefalografía integrada por amplitud se utiliza en más del 80% de los centros, aunque solo en el 50% la enfermera es capaz de interpretarlo. La saturación de oxígeno cerebral es escasamente monitorizada (16%). Entre los estudios diagnóstico-pronósticos, la neuroimagen es universal, pero los neurobiomarcadores apenas se utilizan (29%). Solo el 21% ofrece información pronóstica antes de las 72 h de vida; sin presencia de la enfermera en el 70%. El seguimiento lo realiza el neuropediatra (84%), con una duración desigual entre centros. Conclusiones: La asistencia del RN con EHI en España es adecuada, con áreas de mejora en: neuromonitorización, sedación, marco temporal de la información pronóstica, trabajo en equipo y estandarización de la duración del seguimiento.

Published
2020
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9. Atención integral del neonato con encefalopatía hipóxico-isquémica en España

Author

Juan Arnaez, Nuria Herranz-Rubia, Alfredo Garcia-Alix, J. Diez-Delgado, I. Benavente-Fernández, I. Tofé, A.E. Jerez, J.A. Hurtado, J.M. Ceballos, M.L. Millán, M.D. Esquivel, C. Ruiz, M. Baca, E. Tapia, M. Losada, E. Torres, A. Pavón, P.J. Jiménez, F. Jiménez, M.P. Ventura, S. Rite, T. González, R.P. Arias, P.R. Balliu, J.M. Lloreda-García, J.L. Alcaráz, C. Tapia, A. de la Morena, I. Centelles, I. Güemes, J. Estañ, A. Alberola, S. Aparici, R. López, J. Beceiro, B. García, L. Martínez, E. González, L. Arruza, M.D. Blanco, M.T. Moral, B. Arias, F. Mar, J. Jiménez, G. Romera, A. Cuñarro, C. Muñóz, F. Cabañas, E. Valverde, R. Montero, J.C. Tejedor, C. Santana, B. Reyes, S. Romero, A. Orizaola, M. Baquero, D. Hernández, A. Pantoja, C. Vega-del-Val, L. Castañón, E.P. Gutiérrez, M. Benito, S. Caserío, G. Arca, M.J. García, M.A. López-Vílchez, L. Castells, M. Domingo, W. Coroleu, H. Boix, R. Porta, A. García-Alix, S. Martínez-Nadal, E. Jiménez, E. Sole, M. Albújar, E.M. Fernández, A.R. Barrio, E. Piñán, A. Avila-Alvarez, M.E. Vázquez, N. Balado, P.A. Crespo, M.L. Couce, A. Concheiro-Guisán, I. Esteban, A. Lavilla, V. Alzina, A. Aguirre, B. Loureiro, I. Echániz, M.D. Elorza, and A. Euba

Subjects
Hypoxia-ischaemia, Asphyxia, Newborn, Therapeutic hypothermia, Biomarkers, Prognosis, Pediatrics, RJ1-570
Abstract

Resumen: Introducción: Apenas conocemos cómo es la asistencia de los recién nacidos (RN) con encefalopatía hipóxico-isquémica (EHI) en hipotermia terapéutica (HT), especialmente si existen protocolos asistenciales, la neuromonitorización que se realiza o cómo es la aproximación al pronóstico neurológico. Este conocimiento permite detectar e implementar áreas de mejora asistencial. Método: Estudio transversal de los 57 hospitales españoles que realizaban HT en 2015, mediante cuestionario sobre: 1) la disponibilidad de protocolos y de recursos tecnológicos; 2) el uso de herramientas de neuromonitorización; 3) los conocimientos de los profesionales; 4) la información pronóstica que se da los padres, y 5) el informe al alta y del plan de seguimiento. Resultados: El 95% utiliza enfriamiento corporal-total servocontrolado y dispone de protocolos específicos de actuación. El 70% utiliza sedación y el 68% deja al paciente a dieta absoluta. La monitorización con electroencefalografía integrada por amplitud se utiliza en más del 80% de los centros, aunque solo en el 50% la enfermera es capaz de interpretarlo. La saturación de oxígeno cerebral es escasamente monitorizada (16%). Entre los estudios diagnóstico-pronósticos, la neuroimagen es universal, pero los neurobiomarcadores apenas se utilizan (29%). Solo el 21% ofrece información pronóstica antes de las 72 h de vida; sin presencia de la enfermera en el 70%. El seguimiento lo realiza el neuropediatra (84%), con una duración desigual entre centros. Conclusiones: La asistencia del RN con EHI en España es adecuada, con áreas de mejora en: neuromonitorización, sedación, marco temporal de la información pronóstica, trabajo en equipo y estandarización de la duración del seguimiento. Abstract: Introduction: There is not much information about the care of infants with hypoxic-ischaemic encephalopathy (HIE) treated with therapeutic hypothermia (TH) in Spain. This includes whether protocols are routinely used, the type of neuro-monitoring performed, and how information on the neurological prognosis is presented to families. The answers to these would allow to detect and implement areas of improvement. Method: A cross-sectional analysis was performed on the responses to structured questionnaires sent to all the Spanish neonatal units that were performing TH in June 2015. Questions were divided into 5 sections: 1) the availability of protocols and technological resources, 2) the use of neuro-monitoring tools, 3) the knowledge and training of the professionals; 4) the prognostic information given to the parents; and 5) the discharge report and the follow-up plan. Results: Most centres (95%) use servo controlled whole-body cooling methods and have specific management protocols. Sedation is used in 70% of centres, and in 68% of them the onset of enteral feeding is delayed until the end of the cooling period. Amplitude-integrated electroencephalography monitoring is used in more than 80% of the centres, although only in 50% are nurses able to interpret it. Cerebral oxygen saturation is not often monitored (16%). As regards diagnostic-prognostic studies, neuroimaging is universal, but brain damage biomarkers are hardly used (29%). Prognostic information is offered within the first 72 posnatal hours in 21% of the centres, and is given without the presence of the nurse in 70% of the centres. Follow-up is performed by a neuro-paediatrician (84%), with an uneven duration between centres. Conclusions: The care of infants with HIE treated with TH in Spain is generally adequate, although there are areas for improvement in neuromonitoring, sedation, prognostic information, teamwork, and duration of follow-up.

Published
2020
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10. Characteristics of hepatitis C virus resistance in an international cohort after a decade of direct-acting antivirals

Author

Anita Y.M. Howe, Chaturaka Rodrigo, Evan B. Cunningham, Mark W. Douglas, Julia Dietz, Jason Grebely, Stephanie Popping, Javier Alejandro Sfalcin, Milosz Parczewski, Christoph Sarrazin, Adolfo de Salazar, Ana Fuentes, Murat Sayan, Josep Quer, Midori Kjellin, Hege Kileng, Orna Mor, Johan Lennerstrand, Slim Fourati, Velia Chiara Di Maio, Vladimir Chulanov, Jean-Michel Pawlotsky, P. Richard Harrigan, Francesca Ceccherini-Silberstein, Federico Garcia, Marianne Martinello, Gail Matthews, Fay Fabián Fernando, Juan I. Esteban, Beat Müllhaupt, Julian Schulze zur Wiesch, Peter Buggisch, Christoph Neumann-Haefelin, Thomas Berg, Christoph P. Berg, Jörn M. Schattenberg, Christophe Moreno, Rudolf Stauber, Andrew Lloyd, Gregory Dore, Tanya Applegate, Juan Ignacio, Damir Garcia-Cehic, Josep Gregori, Francisco Rodriguez-Frias, Ariadna Rando, Yael Gozlan, Mario Angelico, Massimo Andreoni, Sergio Babudieri, Ada Bertoli, Valeria Cento, Nicola Coppola, Antonio Craxì, Stefania Paolucci, Giustino Parruti, Caterina Pasquazzi, Carlo Federico Perno, Elisabetta Teti, C. Vironet, Anders Lannergård, Ann-Sofi Duberg, Soo Aleman, Tore Gutteberg, Alexandre Soulier, Aurélie Gourgeon, Stephane Chevaliez, Stanislas Pol, Fabrice Carrat, Dominique Salmon, Rolf Kaiser, Elena Knopes, Perpetua Gomes, Rob de Kneght, Bart Rijnders, Mario Poljak, Maja Lunar, Rafael Usubillaga, Carole Seguin_Devaux, Enoch Tay, Caroline Wilson, Dao Sen Wang, Jacob George, Jen Kok, Ana Belén Pérez, Natalia Chueca, Miguel García-Deltoro, Ana María Martínez-Sapiña, María Magdalena Lara-Pérez, Silvia García-Bujalance, Teresa Aldámiz-Echevarría, Francisco Jesús Vera-Méndez, Juan Antonio Pineda, Marta Casado, Juan Manuel Pascasio, Javier Salmerón, Juan Carlos Alados-Arboledas, Antonio Poyato, Francisco Téllez, Antonio Rivero-Juárez, Dolores Merino, María Jesús Vivancos-Gallego, José Miguel Rosales-Zábal, María Dolores Ocete, Miguel Ángel Simón, Pilar Rincón, Sergi Reus, Alberto De la Iglesia, Isabel García-Arata, Miguel Jiménez, Fernando Jiménez, José Hernández-Quero, Carlos Galera, Mohamed Omar Balghata, Joaquín Primo, Mar Masiá, Nuria Espinosa, Marcial Delgado, Miguel Ángel von-Wichmann, Antonio Collado, Jesús Santos, Carlos Mínguez, Felícitas Díaz-Flores, Elisa Fernández, Enrique Bernal, José De Juan, José Joaquín Antón, Mónica Vélez, Antonio Aguilera, Daniel Navarro, Juan Ignacio Arenas, Clotilde Fernández, María Dolores Espinosa, María José Ríos, Roberto Alonso, Carmen Hidalgo, Rosario Hernández, María Jesús Téllez, Francisco Javier Rodríguez, Pedro Antequera, Cristina Delgado, Patricia Martín, Javier Crespo, Berta Becerril, Oscar Pérez, Antonio García-Herola, José Montero, Carolina Freyre, Concepción Grau, Joaquin Cabezas, Miguel Jimenez, Manuel Alberto Macias Rodriguez, Cristina Quilez, Maria Rodriguez Pardo, Leopoldo Muñoz-Medina, and Blanca Figueruela

Subjects
RAS, HCV, DAA, virologic failure, NS5A, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Background & Aims: Direct-acting antiviral (DAA) regimens provide a cure in >95% of patients with chronic HCV infection. However, in some patients in whom therapy fails, resistance-associated substitutions (RASs) can develop, limiting retreatment options and risking onward resistant virus transmission. In this study, we evaluated RAS prevalence and distribution, including novel NS5A RASs and clinical factors associated with RAS selection, among patients who experienced DAA treatment failure. Methods: SHARED is an international consortium of clinicians and scientists studying HCV drug resistance. HCV sequence linked metadata from 3,355 patients were collected from 22 countries. NS3, NS5A, and NS5B RASs in virologic failures, including novel NS5A substitutions, were examined. Associations of clinical and demographic characteristics with RAS selection were investigated. Results: The frequency of RASs increased from its natural prevalence following DAA exposure: 37% to 60% in NS3, 29% to 80% in NS5A, 15% to 22% in NS5B for sofosbuvir, and 24% to 37% in NS5B for dasabuvir. Among 730 virologic failures, most were treated with first-generation DAAs, 94% had drug resistance in ≥1 DAA class: 31% single-class resistance, 42% dual-class resistance (predominantly against protease and NS5A inhibitors), and 21% triple-class resistance. Distinct patterns containing ≥2 highly resistant RASs were common. New potential NS5A RASs and adaptive changes were identified in genotypes 1a, 3, and 4. Following DAA failure, RAS selection was more frequent in older people with cirrhosis and those infected with genotypes 1b and 4. Conclusions: Drug resistance in HCV is frequent after DAA treatment failure. Previously unrecognized substitutions continue to emerge and remain uncharacterized. Lay summary: Although direct-acting antiviral medications effectively cure hepatitis C in most patients, sometimes treatment selects for resistant viruses, causing antiviral drugs to be either ineffective or only partially effective. Multidrug resistance is common in patients for whom DAA treatment fails. Older patients and patients with advanced liver diseases are more likely to select drug-resistant viruses. Collective efforts from international communities and governments are needed to develop an optimal approach to managing drug resistance and preventing the transmission of resistant viruses.

Published
2022
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12. Looking at the axionic dark sector with ANITA

Author

I. Esteban, J. Lopez-Pavon, I. Martinez-Soler, and J. Salvado

Subjects
Astrophysics, QB460-466, Nuclear and particle physics. Atomic energy. Radioactivity, QC770-798
Abstract

Abstract The ANITA experiment has recently observed two anomalous events emerging from well below the horizon. Even though they are consistent with tau cascades, a high-energy Standard Model or Beyond the Standard Model explanation is challenging and in tension with other experiments. We study under which conditions the reflection of generic radio pulses can reproduce these signals. Furthermore, we propose that these pulses can be resonantly produced in the ionosphere via axion–photon conversion. This naturally explains the direction and polarization of the events and avoids other experimental bounds.

Published
2020
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13. Coherent elastic neutrino-nucleus scattering at the European Spallation Source

Author

D. Baxter, J. I. Collar, P. Coloma, C. E. Dahl, I. Esteban, P. Ferrario, J. J. Gomez-Cadenas, M.C. Gonzalez-Garcia, A. R. L. Kavner, C. M. Lewis, F. Monrabal, J. Munõz Vidal, P. Privitera, K. Ramanathan, and J. Renner

Subjects
Neutrino Detectors and Telescopes (experiments), Beyond Standard Model, Electroweak interaction, Nuclear and particle physics. Atomic energy. Radioactivity, QC770-798
Abstract

Abstract The European Spallation Source (ESS), presently well on its way to completion, will soon provide the most intense neutron beams for multi-disciplinary science. Fortuitously, it will also generate the largest pulsed neutrino flux suitable for the detection of Coherent Elastic Neutrino-Nucleus Scattering (CEνNS), a process recently measured for the first time at ORNL’s Spallation Neutron Source. We describe innovative detector technologies maximally able to profit from the order-of-magnitude increase in neutrino flux provided by the ESS, along with their sensitivity to a rich particle physics phenomenology accessible through high-statistics, precision CEνNS measurements.

Published
2020
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14. Gastrointestinal symptoms and complications in patients hospitalized due to COVID-19, an international multicentre prospective cohort study (TIVURON project)

Author

Karina Cárdenas-Jaén, Sergio A. Sánchez-Luna, Alicia Vaillo-Rocamora, Micaela Riat Castro-Zocchi, Laura Guberna-Blanco, Daniel Useros-Brañas, José M. Remes-Troche, Antonio Ramos-De la Medina, Bryan A. Priego-Parra, José A. Velarde-Ruiz Velasco, Pedro Martínez-Ayala, Álvaro Urzúa, Dannette Guiñez-Francois, Katarzyna M. Pawlak, Katarzyna Kozłowska-Petriczko, Irati Gorroño-Zamalloa, Clara Urteaga-Casares, Inmaculada Ortiz-Polo, Adolfo del Val Antoñana, Edgard E. Lozada-Hernández, Enrique Obregón-Moreno, Guillermo García-Rayado, María José Domper-Arnal, Diego Casas-Deza, Elena I. Esteban-Cabello, Luis A. Díaz, Arnoldo Riquelme, Helena Martínez-Lozano, Francisco Navarro-Romero, Ignasi Olivas, Guillem Iborra-Muñoz, Alicia Calero-Amaro, Ibán Caravaca-García, Francisco J. Lacueva-Gómez, Rubén Pastor-Mateu, Berta Lapeña-Muñoz, Violeta Sastre-Lozano, Nazaret M. Pizarro-Vega, Luigi Melcarne, Marc Pedrosa-Aragón, José J. Mira, Aurora Mula MStat, Irene Carrillo, and Enrique de-Madaria

Subjects
Hepatology, gastrointestinal symptoms, complicaciones gastrointestinales, gastrointestinal complications, Gastroenterology, COVID-19, hospitalización, hepatitis, síntomas gastrointestinales, hospitalization
Abstract

Retrospective studies suggest that coronavirus disease (COVID-19) commonly involves gastrointestinal (GI) symptoms and complications. Our aim was to prospectively evaluate GI manifestations in patients hospitalized for COVID-19.This international multicentre prospective cohort study recruited COVID-19 patients hospitalized at 31 centres in Spain, Mexico, Chile, and Poland, between May and September 2020. Patients were followed-up until 15 days post-discharge and completed comprehensive questionnaires assessing GI symptoms and complications. A descriptive analysis as well as a bivariate and multivariate analysis were performer using binary logistic regression. p0.05 was considered significant.Eight hundred twenty-nine patients were enrolled; 129 (15.6%) had severe COVID-19, 113 (13.7%) required ICU admission, and 43 (5.2%) died. Upon admission, the most prevalent GI symptoms were anorexia (n=413; 49.8%), diarrhoea (n=327; 39.4%), nausea/vomiting (n=227; 27.4%), and abdominal pain (n=172; 20.7%), which were mild/moderate throughout the disease and resolved during follow-up. One-third of patients exhibited liver injury. Non-severe COVID-19 was associated with ≥2 GI symptoms upon admission (OR 0.679; 95% CI 0.464-0.995; p=0.046) or diarrhoea during hospitalization (OR 0.531; 95% CI 0.328-0.860; p=0.009). Multivariate analysis revealed that worse hospital outcomes were not independently associated with liver injury or GI symptoms.GI symptoms were more common than previously documented, and were mild, rapidly resolved, and not independently associated with COVID-19 severity. Liver injury was a frequent complication in hospitalized patients not independently associated with COVID-19 severity.

Published
2023
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15. Manejo clínico y terapéutico de un tumor fibroso pleural con translocación de ALK

Author

Patricia Cruz-Castellanos, Laura Gutiérrez-Sainz, Julia Villamayor, María I. Esteban, Alberto Peláez, and Francisco J. de Castro

Subjects
Tumor fibroso solitario pleural. Translocación ALK. Cáncer., Surgery, RD1-811
Abstract

Presentamos un caso clínico de un tumor fibroso solitario pleural (TFSP) de comportamiento anómalo por su alta agresividad y mal pronóstico a corto plazo, en el que se identificó una translocación de ALK. El TFSP es un tumor infrecuente, con una incidencia estimada en torno a 8 casos por 100,000 habitantes y con pocos reportes en la literatura. Lo más habitual es que se trate de una neoplasia de comportamiento benigno, con debut como una masa localizada y cuyo tratamiento de elección es la resección quirúrgica. Todos los datos de la literatura contrastan con nuestra experiencia, que presentamos a continuación.

Published
2021
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16. Care of the newborn with perinatal asphyxia candidate for therapeutic hypothermia during the first six hours of life in Spain

Author

Juan Arnaez, Alfredo Garcia-Alix, Sara Calvo, Simón Lubián-López, J. Diez-Delgado, I. Benavente, I. Tofé, A.E. Jerez, J.A. Hurtado, J.M. Ceballos, M.L. Millán, M.D. Esquivel, C. Ruiz, M. Baca, E. Tapia, M. Losada, E. Torres, A. Pavón, P.J. Jiménez, F. Jiménez, M.P. Ventura, S. Rite, T. González, R.P. Arias, P.R. Balliu, J.M. Lloreda-García, J.L. Alcaráz, C. Tapia, A. de la Morena, I. Centelles, I. Güemes, J. Estañ, A. Alberola, S. Aparici, R. López, J. Beceiro, B. García, L. Martínez, E. González, L. Arruza, M.D. Blanco, M.T. Moral, B. Arias, F. Mar, J. Jiménez, G. Romera, A. Cuñarro, C. Muñóz, F. Cabañas, E. Valverde, R. Montero, J.C. Tejedor, C. Santana, B. Reyes, S. Romero, A. Orizaola, M. Baquero, D. Hernández, A. Pantoja, C. Vega, L. Castañón, E.P. Gutiérrez, M. Benito, S. Caserío, G. Arca, M.J. García, M.A. López-Vílchez, L. Castells, M. Domingo, W. Coroleu, H. Boix, R. Porta, A. García-Alix, S. Martínez-Nadal, E. Jiménez, E. Sole, M. Albújar, E.M. Fernández, A.R. Barrio, E. Piñán, A. Avila-Alvarez, M.E. Vázquez, N. Balado, P.A. Crespo, M.L. Couce, A. Concheiro-Guisán, I. Esteban, A. Lavilla, V. Alzina, A. Aguirre, B. Loureiro, I. Echániz, and M.D. Elorza A. Euba

Subjects
Hipoxia-isquemia, Asfixia, Recién nacido, Hipotermia terapéutica, España, Horas de oro, Pediatrics, RJ1-570
Abstract

Introduction: The process of care and assistance from birth to the starting of therapeutic hypothermia (TH) is crucial in order to improve its effectiveness and prevent the worsening of hypoxic-ischaemic injury. Methods: A national cross-sectional study carried out in 2015 by use of a questionnaire sent to all level III units on the care of the newborn ≥ 35 weeks gestation within the first hours of life after a perinatal asphyxia event. According to clinical practice guidelines, the quality of care was compared between the hospitals that carried out or did not carry out TH, and according to the level of care. Results: A total of 89/90 hospitals participated, of which 57/90 performed TH. They all used resuscitation protocols and turned off the radiant warmer after stabilisation. All of them performed glucose and blood gas analysis, monitored the central temperature, put the newborn on a diet, and performed at least two examinations for the diagnosis of hypoxic-ischaemic encephalopathy. Greater than one-third (35%) of hospitals did not have amplitude-integrated electroencephalogram, and 6/57 were TH-hospitals. The quality of care among hospitals with and without TH was similar, childbirth being better in those that performed TH, and those with a higher level of care. Level IIIc hospitals had higher scores than the others. The TH-hospitals mentioned not always having neonatologists with experience in neurological assessment and interpretation of amplitude-integrated electroencephalogram (25%), or in brain ultrasound (62%). Conclusions: In response to the recommendations of the asphyxiated newborn, there is a proper national health care standard with differences according to the level of care and whether TH is offered. More amplitude-integrated electroencephalogram devices are necessary, as well as more neonatologists trained in the evaluations that will be required by the newborn with hypoxic-ischaemic encephalopathy. Resumen: Introducción: El proceso asistencial hasta el inicio de la hipotermia terapéutica (HT) es crucial para mejorar su efectividad y prevenir el agravamiento del daño hipóxico-isquémico. Método: Estudio transversal nacional realizado en 2015 mediante cuestionario a todas las unidades nivel iii sobre la asistencia al recién nacido (RN) con asfixia perinatal en las primeras horas de vida. Se comparó la calidad asistencial entre los hospitales que realizaban o no HT y según el nivel asistencial, de acuerdo a las guías de práctica clínica. Resultados: Participaron 89/90 hospitales, 57/90 realizaban HT. Todos utilizaban protocolos de reanimación y apagaban la cuna tras estabilización. Fue universal realizar medición de glucemia y gasometría, monitorizar la temperatura, dejar al RN a dieta y realizar al menos 2 exploraciones para el diagnóstico de encefalopatía hipóxico-isquémica. El 35% no disponía de electroencefalograma integrado por amplitud; 6/57 eran hospitales que realizaban HT. La calidad asistencial entre los hospitales con/sin HT fue similar, siendo mejor la del parto en los que hacían HT, y la de aquellos con mayor nivel asistencial. El 25% de aquellos que realizaban HT no tenían neonatólogos con experiencia en la exploración neurológica o en la interpretación del electroencefalograma integrado por amplitud; ni en la realización de ecografía cerebral en el 62%. Conclusiones: Atendiendo a las recomendaciones del RN asfíctico, existe un adecuado estándar asistencial nacional, con diferencias según el nivel asistencial y si realizan o no hipotermia. Son necesarios más equipos de electroencefalograma integrado por amplitud y formación de los neonatólogos en las evaluaciones que requerirá el RN con encefalopatía hipóxico-isquémica.

Published
2018
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17. [Translated article] Comparison of three different minimally invasive intramedullary screw for proximal phalanx fractures. A biomechanical study

Author

I. Gallardo-Calero, R. Sevil-Mayayo, A. Lluch-Bergada, N. Vidal-Tarrasón, A. Rodríguez-Baeza, and I. Esteban-Feliu

Subjects
Orthopedics and Sports Medicine, Surgery
Abstract

Phalangeal fractures are the most common hand fractures. In the last years, intramedullary compression screw (IMHCS) for instable transverse or short oblique proximal P1 fractures have been described. Although both anterograde (intraarticular or trans-articular) and retrograde IMHCS techniques have shown good results, no comparison between anterograde and retrograde screw in P1 fractures has been published. We sought to determine stability with retrograde IMHCS and anterograde IMHCS, both trans-articular and intra-articular technique, in a cadaveric transverse proximal P1 fracture model, at two different levels.We performed a biomechanical study in 30 fresh-frozen human cadaveric P1 fracture model. Fracture was performed at 9-mm from the metacarpo-phalangeal (MCP) joint in 15 specimens, whereas it was done at 15mm in the other 15. In turn, in each group, five fractures were stabilised with an anterograde intra-articular IMHCS, five with anterograde trans-articular IMHCS and other five with retrograde IMHCS.Anterograde IMHCS fixation in 9-mm P1 fractures (both trans- and intra-articular technique, 62.74N and 70.86N, respectively) was found to be more stable than retrograde IMHCS one (32.72N) (p=0.022). Otherwise, retrograde IMHCS fixation was found to be more stable in more distal P1 fractures (90.52N retrograde vs. 57.64N trans-articular vs. 42.92N intra-articular; p=0.20).Anterograde IMHCS fixation in proximal transverse P1 bone cut in a cadaveric model provides more stability than retrograde IMHCS, while retrograde screw provides more stability when the bone cut is located more distal.

Published
2023
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18. Comparación de tres técnicas de tornillo endomedular mínimamente invasivo para fracturas de falange proximal. Estudio biomecánico

Author

I. Gallardo-Calero, R. Sevil-Mayayo, A. Lluch-Bergada, N. Vidal-Tarrasón, A. Rodríguez-Baeza, I. Esteban-Feliu, Institut Català de la Salut, [Gallardo-Calero I, Sevil-Mayayo R, Vidal-Tarrasón N, Esteban-Feliu I] Unitat de Cirurgia de Canell i Mà, Servei de Cirurgia Ortopèdica i Traumatologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Lluch-Bergada A] Unitat de Cirurgia de Canell i Mà, Servei de Cirurgia Ortopèdica i Traumatologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Cirugía de Mano, Institut Kaplan, Barcelona, España. [Rodríguez-Baeza A] Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain, and Vall d'Hebron Barcelona Hospital Campus

Subjects
Ossos - Propietats mecàniques, Mans - Cirurgia, Osteosíntesi, Equipment and Supplies::Prostheses and Implants::Internal Fixators::Bone Screws [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], Wounds and Injuries::Hand Injuries [DISEASES], Ossos - Ferides i lesions, intervenciones quirúrgicas::procedimientos ortopédicos::fijación de fractura::fijación interna de fractura::fijación intramedular de fractura [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], fenómenos físicos::fenómenos biofísicos::fenómenos biomecánicos [FENÓMENOS Y PROCESOS], Orthopedics and Sports Medicine, Surgery, heridas y lesiones::traumatismos de la mano [ENFERMEDADES], Physical Phenomena::Biophysical Phenomena::Biomechanical Phenomena [PHENOMENA AND PROCESSES], equipos y suministros::prótesis e implantes::fijadores internos::tornillos óseos [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], Surgical Procedures, Operative::Orthopedic Procedures::Fracture Fixation::Fracture Fixation, Internal::Fracture Fixation, Intramedullary [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT]
Abstract

Falange proximal; Tornillo endomedular; Biomecánica Proximal phalanx; Intramedullary screw; Biomechanics Falange proximal; Cargol endomedular; Biomecànica Antecedentes y objetivo Las fracturas de falange proximal (FP) son las fracturas más frecuentes de la mano. En los últimos años, se ha descrito el uso de tornillos endomedulares sin cabeza (TESC) para las fracturas inestables transversas u oblicuas de la FP. A pesar de que tanto la técnica anterógrada como retrógrada con TESC han mostrado buenos resultados, no se ha publicado ningún estudio comparativo de su uso en fracturas de FP. Nuestro objetivo es determinar la estabilidad que se obtiene con el uso de TESC retrógrados y anterógrados en un modelo en cadáver de fractura transversa proximal de FP, a dos niveles diferentes. Material y métodos Realizamos un estudio biomecánico en 30 modelos de fractura de FP de cadáver fresco-congelado. La osteotomía se realizó a los 9 mm desde la articulación metacarpofalángica (MCF) en 15 especímenes, y a una distancia de 15 mm en los otros 15. A su vez, en cada grupo, cinco osteotomías se estabilizaron con un TESC anterógrado intraarticular, cinco mediante un TESC anterógrado transarticular y cinco con un TESC retrógrado. Resultados La fijación con TESC anterógrado en osteotomías realizadas a los 9 mm (tanto con la técnica transarticular como intraarticular, 62,74 N y 70,86 N, respectivamente) fue más estable que la fijación con TESC retrógrado (32,72 N) (p 0,022). Por otra parte, la fijación con TESC retrógrado fue más estable en el modelo de fractura más distal (90,52 N retrógrado vs. 57,64 N transarticular vs. 42,92 N intraarticular (p = 0,20). Conclusiones La fijación con TESC retrógrado ofrece más estabilidad en fracturas más distales, mientras que las técnicas anterógradas son más estables en fracturas proximales. Background and objective Phalangeal fractures are the most common hand fractures. In the last years, intramedullary compression screw (IMHCS) for instable transverse or short oblique proximal P1 fractures have been described. Although both anterograde (intraarticular or trans-articular) and retrograde IMHCS techniques have shown good results, no comparison between anterograde and retrograde screw in P1 fractures has been published. We sought to determine stability with retrograde IMHCS and anterograde IMHCS, both trans-articular and intra-articular technique, in a cadaveric transverse proximal P1 fracture model, at two different levels. Material and methods We performed a biomechanical study in 30 fresh-frozen human cadaveric P1 fracture model. Fracture was performed at 9-mm from the metacarpo-phalangeal (MCP) joint in 15 specimens, whereas it was done at 15 mm in the other 15. In turn, in each group, five fractures were stabilized with an anterograde intra-articular IMHCS, five with anterograde trans-articular IMHCS and other five with retrograde IMHCS. Results Anterograde IMHCS fixation in 9-mm P1 fractures (both trans- and intra-articular technique, 62.74 N and 70.86 N, respectively) was found to be more stable than retrograde IMHCS one (32.72 N) (p = 0.022). Otherwise, retrograde IMHCS fixation was found to be more stable in more distal P1 fractures (90.52 N retrograde vs. 57.64 N trans-articular vs. 42.92 N intra-articular; p = 0.20). Conclusions Anterograde IMHCS fixation in proximal transverse P1 bone cut in a cadaveric model provides more stability than retrograde IMHCS, while retrograde screw provides more stability when the bone cut is located more distal. El presente trabajo ha sido financiado por la Sociedad Española de Cirugía Ortopédica y Traumatología: Proyectos de Iniciación a la Investigación Fundación SECOT.

Published
2023
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19. Effects of physical exercise on health-related quality of life in coronary heart disease patients. a systematic review and meta-analysis

Author

A Toval, E A Bakker, J B Granada-Maia, S Nunez De Arenas-Arroyo, P Solis-Urra, P Molina-Garcia, T M H Eijsvogels, V Martinez-Vizcaino, I Esteban-Cornejo, and F B Ortega

Subjects
Epidemiology, Cardiology and Cardiovascular Medicine
Abstract

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): - HEARTY-BRAIN - Effects of Exercise on Brain in Patients with Coronary Heart Disease: The Heart-Brain Connection. Andalusian Plan for Research Development and Innovation (PAIDI). University of Granada. Funding: 116.000 €. PI: F. Ortega. 2021-2021. - VASCULACTIVE. Effects of exercise on brain vascularization in coronary heart disease patients. Spanish Ministry of Economy and Competitiveness (I+D+I RETOS). University of Granada. Funding: 121.000 €. PI: F. Ortega. 2021-2023. Background Coronary heart disease (CHD) is the most prevalent type of cardiovascular disease in the world, and a leading cause of mortality and morbidity. Previous research showed that patients with CHD have a decrease in health-related quality of life (HRQoL) during the course of the disease. Physical exercise may attenuate the decline in HRQoL observed in CHD patients. Purpose To determine the effect of exercise training interventions on HRQoL in CHD patients. Methods A systematic search of controlled trials (CTs) assessing the effects of exercise training on HRQoL in CHD patients was performed in Web of Science, PubMed, Scopus, EMBASE, Cochrane Register, SportDiscus, PsycINFO and Google Scholar from inception to 30 June 2022. A meta-analysis with fixed and random effects was performed on controlled trials (comparing at least one exercise group with one non-exercise group and including a global score of HRQoL assessments before and after the interventions. All statistical analyses were performed using R-Studio. Results A total of 26 CTs met all the eligibility criteria and were included in the review (25 randomized CTs and 1 non-randomized CTs). HRQoL was mostly assessed by the SF-36 instrument (11/26) and the MacNew Heart Disease Health-Related Quality of Life questionnaire (8/26). Six out of the 26 studies reported the total score of quality of life and were included in the meta-analysis, which resulted in 8 exercise interventions and 591 participants with a mean age of 61 years, and 33% was women. There was a small (effect size 0.20) borderline overall effect of exercise on HRQoL in CHD patients (95% confidence interval: fixed effect, 0.05–0.36; random effect, -0.06-0.46. The percentage of total variability attributed to between-study heterogeneity [I2] = 44%, P=0.09 (Figure 1). Conclusions Findings from this meta-analysis suggest that supervised exercise training may cause a modest improvement in HRQoL in CHD patients. Future studies should explore which type and loads of exercise lead to larger improvements.

Published
2023
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20. Pulmonary vein anatomy evaluated prior to atrial fibrillation ablation through multicentre electronic medical records: clinical decision support from a real-world multicentre observational study

Author

J Benezet Mazuecos, J Crosa, A Lozano, A Miracle, J Salas, M Cortes, J A Iglesias, I Narvaez, B Crespo, and I Esteban

Subjects
Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract

Funding Acknowledgements Type of funding sources: None. Background Pulmonary vein (PV) isolation is a cornerstone ablation strategy in the management of patients with atrial fibrillation (AF). PV frequently display anatomical variants, which may compromise the results of cryoballoon ablation (CBA). Purpose We aimed to determine PV variation patterns in real-world patients undergoing CBA for AF and their impact on procedural success using a multicentre electronic medical records (Casiopea) sharing cardiac computed tomography (CT) scan studies performed in the referring centres and evaluated prior to the procedure in the EP reference hospital. Methods We included consecutive patients with paroxysmal or persistent AF who referred for CBA to a EP reference hospital in Spain from 2017 to 2021. All patients underwent systematic standardized CBA. Prior to the procedure, PV variation and left atrium (LA) size were evaluated in all patients by CT- scan. Blinded data were analysed by a imaging Core Lab. PV and LA anatomy were evaluated in 3-dimensional reconstructions using EnSite NavX electroanatomic mapping system. Ablation procedure was performed using either 23 or 28 mm cryoballoon according to the operator's criteria and potential predictors for AF recurrence were recorded. Results 104 patients were included (mean age 58±8 year-old, 85% male). 76 patients (73%) had recurrent paroxysmal AF, failure of antiarrhythmic drugs was present in 96% and prior radiofrequency ablation in 4%. Conventional PV anatomy consisting in 4 veins was present in 83 patients (80%), left or right common vein in 13 (13%) and accessory veins in 8 (7%). Figure. 61 patients (59%) showed left atria enlargement (> 40 mm or area > 20 cm2). CBA was performed using a 28 mm cryoballoon in 98 patients (94%). Temperature achieved during ablation was below -40°C in all the veins in 80% of the procedures. Procedural-related complications occurred in 6 patients (5%), transient phrenic nerve palsy in 2 patients and vascular damage in 4. All patients were under antiarrhythmic drugs and continued for at least 6 months after the procedure. After 19±9 months of follow-up, freedom from AF recurrence after the blanking period was 73%. Univariate analyses identified the following baseline characteristics predicted AF recurrence: prior ablation (OR = 3.6 p=0.03; 95% CI 1.1-12.3), complete PV isolation with temperature below -40°C (OR = 0.16 p = 0.001; 95% CI 0.05-0.48) and AF recurrence during the blanking period (OR = 6.3, p Conclusion This evaluation of multicentre electronic medical records sharing CT scan studies prior CBA showed that the procedure was safe and effective with regard to the PV anatomy. The presence of anatomical variants of PV should not discourage about efficacy and it is not a limitation for CBA.

Published
2023
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21. The influence of BMI in asthma. Which traits are due to obesity and which to asthma and obesity phenotype?

Author

I, Esteban-Gorgojo, M P, Gorgojo, J, Sastre, F, García-Río, and S, Quirce

Subjects
Immunology, Immunology and Allergy
Abstract

Background: Characteristics of the asthma and obesity phenotype have been described by cluster studies, but they have not been subsequently confirmed. Specific characteristics of this phenotype have not been differentiated from those inherent to the patient’s body mass index (BMI). Objectives: This study aims to assess the effect of BMI on asthma. This will allow to identify which traits could define the asthma and obesity phenotype, and which are inherent to the patient's BMI. Methods: A real-life retrospective observational study was conducted with a 2,514 patients database. Data was collected on the first visit to the Allergy clinic of all patients who underwent a correct spirometry maneuver due to suspected asthma between November 2014 and November 2017. All BMI, sex and age groups were represented. Results: BMI influence over asthma differed in different age groups and genders. All spirometric results and FeNO were influenced by BMI. Concerning asthma characteristics only a later asthma onset with higher BMI values was observed. No other differences were found between different BMI groups. Conclusions: The effect of BMI on asthma is age dependent, so it should be corrected for age. The most important variations are on FeNO and spirometric results. The specific characteristics of the asthma and obesity phenotype are a greater perception of symptoms with fewer alterations in respiratory function tests and a lower prevalence of atopy, rhinitis and allergy, including allergic asthma. Other characteristics of this phenotype, such as a higher women prevalence or being late-onset or non-eosinophilic asthma, are non-specific for this phenotype.

Published
2022
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22. Protocolized nurse-guided intravenous conscious sedation for cryoballoon ablation of paroxysmal and persistent atrial fibrillation

Author

J A Iglesias, J Benezet Mazuecos, B Crespo, I Esteban, A Lozano, J Crosa, A Miracle, and M Jauregui

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background Nursing staff is playing an increasingly important role in arrhythmia units and it entails acquiring more specialized knowledge. Intravenous conscious sedation is being administered more frequently in a wide variety of cardiac procedures including cryoballoon ablation (CBA). Nurses and physicians have distinct yet collaborative roles in the management and care of the patient receiving conscious sedation. It is imperative that the nurse be aware of her/his role in caring for the patient before, during, and after the administration of intravenous conscious sedation. Purpose We aimed to evaluate the nurse's role, working in coordination with the medical staff, in intravenous conscious sedation for CBA following a standardized protocol ensuring proper handling and administration of the different drugs, monitorization of vital signs and management of drug infusion in order to avoid pain but also complications inherent to the procedure and sedation. Method We included consecutive patients with paroxysmal or persistent AF who underwent a CBA from 2017 to 2021. We evaluated a nurse-guided sedation, under medical surveillance, in CBA procedures using propofol. The dosage was based on the patient's weight, starting sedation with a bolus of 1 ml (1% solution) for every 20 kg of weight, and starting a perfusion at 10 ml/h (2% solution), monitoring constantly patient's vital signs, especially blood pressure and O2saturation. This infusion was adjusted according to the patient's response. During the procedure, on a stable hemodynamic situation, booster bolus of 1 ml (1% solution) could be administered approximately every 15 minutes when needed for sedation. When systolic blood pressure was under 100 mmHg, a solution of midazolam (1mg/ml) and fentanyl (0.05mg/ml) in a mixture of 1cc + 1cc was preferred as booster. Saline and colloid solutions andephedrine (30mg/ml) bolus could be used when severe hypotension to revert propofol's hypotensive effect. Systematic standardized CBA was performed and intraprocedural and periprocedural complications were recorded. Results 104 patients were included (mean age 58±8 year-old, 85% male). Of these patients, 76 (73%) had recurrent paroxysmal AF, failure of antiarrhythmic drugs was present in 96% and prior radiofrequency ablation in 4%, 61 (59%) showed left atria enlargement (>40 mm or area >20 cm2), and 11 (10%) had structural heart disease. Mean CHA2DS2VASc score was 1. Baseline characteristics in Table 1. Procedural-related complications occurred in 6 patients (5%), transient phrenic nerve palsy in 2 patients and vascular damage in 4. All sedations were performed without complications. Conclusions In our experience, protocolized nurse-guided intravenous conscious sedation under medical surveillance in CBA procedures is safe and really useful. It contributes to help medical operators to focus on the procedure sharing the patient's sedation management with trained nurses. Funding Acknowledgement Type of funding sources: None.

Published
2022
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24. Malignant pleural mesothelioma: clinical experience and prognostic value of derived neutrophil-to-lymphocyte ratio and PD-L1 expression

Author

F Arias-Lotto, Patricia Cruz, S Martinez-Recio, L Gutierrez-Sainz, M I Esteban-Rodriguez, R A Gonzalez, Oliver Higuera, and J De Castro-Carpeño

Subjects
0301 basic medicine, Oncology, Cancer Research, medicine.medical_specialty, business.industry, Pleural mesothelioma, Retrospective cohort study, General Medicine, Disease, University hospital, 03 medical and health sciences, 030104 developmental biology, 0302 clinical medicine, 030220 oncology & carcinogenesis, Internal medicine, medicine, Immunohistochemistry, Pd l1 expression, Neutrophil to lymphocyte ratio, Prospective cohort study, business
Abstract

Malignant pleural mesothelioma (MPM) is a rare and aggressive tumor, with a poor prognosis. MPM needs to find prognostic factors of survival. We provided the management of patients with MPM and sought to determine whether pre-treatment levels of derived neutrophil-to-lymphocyte ratio (dNLR) as well as PD-L1 expression were reliable prognostic factors of survival. We conducted a single-institution retrospective study, including all patients with MPM treated at La Paz University Hospital between December 2009 and March 2018. Baseline disease, demographics, clinical data, treatment characteristics and complete blood cell counts were collected. We examined dNLR at baseline and data for PD-L1 expression were analyzed in tumor cells by immunohistochemistry. We included 25 patients. The median overall survival (OS) was 15.7 months (95% CI 11.3–20.0). 5 patients had a dNLR greater than 3 (20%). Patients with a dNLR greater than 3 had shorter median OS (8.5 months), than patients with a dNLR less than 3 (17.0 months), with statistically significant differences (p = 0.038). Ten patients (40%) had positive PD-L1 expression (≥ 1%). Patients with positive PD-L1 expression had shorter median OS (8.5 months) than patients with negative PDL1 expression (15.7 months), but without statistically significant association (p = 0.319). The survival data obtained in our sample are consistent with those previously reported. Pretreatment levels of dNLR greater than 3 and positive PD-L1 expression could be significant prognostic factors for poor survival in patients with MPM. Further and prospective studies are needed to explore this relationship and to derive definitive conclusions.

Published
2021
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25. Clinical characteristics of heart failure patients with mid-range ejection fraction

Author

Anyuli Gracia Gutiérrez, Daniel Grados Saso, Elena I. Esteban Cabello, Eva M. Salas Trigo, Marta Sánchez Marteles, Vanesa Garcés Horna, Ignatios Ioakeim-Skoufa, Antonio Gimeno-Miguel, Alexandra Prados-Torres, and Fernando J. Ruiz Laiglesia

Subjects
General Medicine, Cardiology and Cardiovascular Medicine
Abstract

We aimed to characterise and compare the clinical profile of heart failure (HF) with mid-range (HFmrEF), reduced (HFrEF) and preserved (HFpEF) left-ventricular ejection fraction.We conducted a descriptive, observational study in 267 HF patients admitted to the Internal Medicine department of a tertiary hospital during 2010-2016. The study population was divided into three groups according to the ejection fraction rate: HFrEF (40%), HFmrEF (40-49%), and HFpEF (≥50%). We analysed and compared their demographic, clinical, and analytical characteristics.The mean age of the study population was 79.5 (standard deviation, 8.14) years; 56.6% were males. The most common phenotype was HFpEF (58.1%), followed by HFrEF (21.7%) and HFmrEF (20.2%). Ischaemic cardiopathy was the primary aetiology in the HFmrEF and HFrEF groups, and arterial hypertension in the HFpEF group. The most common comorbidities among HFmrEF patients were diabetes (43.4%), chronic obstructive pulmonary disease (35.8%), and anaemia (35.8%); 49.1% had impairment of segmental myocardial contractility, and 35.8% ventricular dilatation. No differences in HF outcomes were observed among the three phenotypes.HFmrEF shows characteristics similar to both HFpEF and HFrEF. Further large-scale studies with longer follow-up are needed to ascertain if it is worth distinguishing this phenotype in clinical practice in terms of management and prognosis.

Published
2022

26. EP16.02-014 A Comparative Analysis of Gene Alteration Detected With NGS in Tumor Tissue and Peripheral Blood in Lung Cancer

Author

Ozaez, I., primary, Hernández, I., additional, Cruz-Castellanos, P., additional, Gutiérrez-Sainz, L., additional, Rosas-Alonso, R., additional, Castillo, R., additional, Higuera, O., additional, Losantos, I., additional, Rodríguez-Antolín, C., additional, Ibanez de Caceres, I., additional, Rodríguez, I. Esteban, additional, and de Castro Carpeño, J., additional

Published
2022
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27. EP16.01-007 Molecular Characterization by Next-Generation Sequencing (NGS) of Patients with Non-Small Cell Lung Cancer (NSCLC) Treated with Immunotherapy

Author

Castellanos, P. Cruz, primary, Alonso, R. Rosas, additional, Ozaez, I., additional, Hernández, I., additional, Losantos, I., additional, Gutiérrez Sainz, L., additional, Gómez, O. Higuera, additional, Antolín, C. Rodríguez, additional, Rodríguez, I. Esteban, additional, Ibáñez de Cáceres, I., additional, and De Castro Carpeño, J., additional

Published
2022
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29. Comparison of three different minimally invasive intramedullary screw for proximal phalanx fractures. A biomechanical study

Author

I, Gallardo-Calero, R, Sevil-Mayayo, A, Lluch-Bergada, N, Vidal-Tarrasón, A, Rodríguez-Baeza, and I, Esteban-Feliu

Abstract

Phalangeal fractures are the most common hand fractures. In the last years, intramedullary compression screw (IMHCS) for instable transverse or short oblique proximal P1 fractures have been described. Although both anterograde (intraarticular or trans-articular) and retrograde IMHCS techniques have shown good results, no comparison between anterograde and retrograde screw in P1 fractures has been published. We sought to determine stability with retrograde IMHCS and anterograde IMHCS, both trans-articular and intra-articular technique, in a cadaveric transverse proximal P1 fracture model, at two different levels.We performed a biomechanical study in 30 fresh-frozen human cadaveric P1 fracture model. Fracture was performed at 9-mm from the metacarpo-phalangeal (MCP) joint in 15 specimens, whereas it was done at 15 mm in the other 15. In turn, in each group, five fractures were stabilized with an anterograde intra-articular IMHCS, five with anterograde trans-articular IMHCS and other five with retrograde IMHCS.Anterograde IMHCS fixation in 9-mm P1 fractures (both trans- and intra-articular technique, 62.74 N and 70.86 N, respectively) was found to be more stable than retrograde IMHCS one (32.72 N) (p = 0.022). Otherwise, retrograde IMHCS fixation was found to be more stable in more distal P1 fractures (90.52 N retrograde vs. 57.64 N trans-articular vs. 42.92 N intra-articular; p = 0.20).Anterograde IMHCS fixation in proximal transverse P1 bone cut in a cadaveric model provides more stability than retrograde IMHCS, while retrograde screw provides more stability when the bone cut is located more distal.

Published
2022

30. Physico-chemical characterization of EVOO adulterated with VOO deodorized in soft conditions

Author

T. Mehany, J.M. González-Sáiz, I. Esteban Díez, K. Tkachenko, and C. Pizarro

Subjects
Extra virgin olive oil, authentication, soft deodorization, optimization, physico- chemical characterization, sensory analysis
Abstract

The adulteration of extra virgin olive oils (EVOO) with virgin olive oils (VOO) previously subjected to a soft deodorization process (to eliminate organoleptic defects from these latter lower quality oils), in up to a 1:1 ratio, in order to be subsequently fraudulently distributed as genuine EVOO represent a serious problem of quality assurance for the olive sector still in force today [1]. The downward evolution of the comparative prices between VOO and EVOO, together with the difficulty of detecting the presence of deodorized oils in adulterated mixtures by means of the quality, purity and sensory analyses contemplated in the legislation, has awakened the ghost of this type of fraud among the main olive oil producing countries, with Spain at the head. To serve as a starting point for the development of a reliable methodology for the unequivocal detection of adulterations of EVOO with deodorized VOO, fraudulent mixtures are needed in order to characterize them in the search for differential quality markers. Likewise, generating fraudulent mixtures requires prior obtaining soft deodorized VOO to be used as adulterants. For obvious reasons, this type of oil is not directly available for purchase in the market so, in the present study, a lab-scale pilot plan was set up to carry out deodorization experiments. An experimental design methodology was used to optimize soft deodorization process conditions in the pilot plant throughout a two-stage procedure. In the first stage, optimization was tackled as a linear design problem considering temperature and deodorization time as the main process variables involved. The perceived intensities of the residual negative attributes that still retained the lampante olive oil used as raw material once deodorized under a certain set of operating conditions were evaluated by an expert sensory panel. A two-level full factorial design with two factors was selected for the analyzed sensory defects (vinegary, fusty/muddy sediment, metallic, mould/humidity and rancid). Design resolution provided a mathematical model that allowed to correlate the process variables with the response variable studied, i.e., to predicted the value of the response variable (degree of organoleptic defect removed) as a function of deodorization conditions. Then, in a second stage, the steepest ascent method was applied to establish optimal conditions for VOO deodorization processes. Optimal deodorization conditions were selected as those for which all undesirable organoleptic properties were entirely removed. For each experiment carried out during optimization, a double sensory evaluation was performed: the first one served to determine the percentage of defect removed immediately after deodorization was completed, and the second one to assess oil stability over time.The optimally deodorized lampante oil obtained was subsequently used to generate adulterated blends with both a recently harvested (fresh) EVOO (arbequina) and a two-year-old EVOO (oliberus) in the range 0-50%. All adulterated EVOO samples thus prepared were submitted to the regulatory analyses required: acidity, peroxide value, UV spectrophotometric measurements and organoleptic evaluation [2-3]. A detailed analysis of the values obtained for the various quality and purity parameters assessed in the set of EVOO adulterated with deodorized VOO allowed to verify that these fraudulent oils were able to evade their detection in all the adulteration range studied, although they were not able to preserve their stability over time. The results of this study confirmed the need for developing and validating new analytical methodologies capable of efficiently detecting and quantifying these adulterations in routine controls at any point of the complex food chain in order to avoid the sale and consumption of products of inferior quality to the one declared.

Published
2022

32. P2.07-02 RET Fusion Testing with FISH and Real-Time PCR: a Comparison with RNA-Based Next-Generation Sequencing in RET Positive NSCLC

Author

S. Hernandez, J.L. Rodriguez Carrillo, A. Caminoa, A. Benito, R. Martinez, M. Alonso, S. Clave, E. Arriola, I. Esteban-Rodriguez, J. De Castro, I. Sansano, E. Felip, I. Abdulkader, J. Garcia, F. Rojo, M. Domine, C. Teixido, N. Reguart, D. Compañ, A. Insa, N. Mancheño, S. Palanca, O. Juan, N. Baixeras, E. Nadal, M. Cebollero, A. Calles, P. Martin, C. Salas, M. Provencio, I. Aranda, B. Massuti, L. Lopez-Vilaro, M. Majem, P. Garrido, L. Paz-Ares, F. Lopez-Rios, and E. Conde

Subjects
Pulmonary and Respiratory Medicine, Oncology
Published
2022
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33. MicroBooNE and the ν_{e} Interpretation of the MiniBooNE Low-Energy Excess

Author

C A, Argüelles, I, Esteban, M, Hostert, K J, Kelly, J, Kopp, P A N, Machado, I, Martinez-Soler, and Y F, Perez-Gonzalez

Abstract

A new generation of neutrino experiments is testing the 4.7σ anomalous excess of electronlike events observed in MiniBooNE. This is of huge importance for particle physics, astrophysics, and cosmology, not only because of the potential discovery of physics beyond the standard model, but also because the lessons we will learn about neutrino-nucleus interactions will be crucial for the worldwide neutrino program. MicroBooNE has recently released results that appear to disfavor several explanations of the MiniBooNE anomaly. Here, we show quantitatively that MicroBooNE results, while a promising start, unquestionably do not probe the full parameter space of sterile neutrino models hinted at by MiniBooNE and other data, nor do they probe the ν_{e} interpretation of the MiniBooNE excess in a model-independent way.

Published
2021

34. Clinical and therapeutic management of a pleural fibrous tumor with ALK translocation

Author

Patricia, Cruz-Castellanos, Laura, Gutiérrez-Sainz, Julia, Villamayor, María I, Esteban, Alberto, Peláez, and Francisco J de, Castro

Subjects
Solitary Fibrous Tumor, Pleural, Pleural Neoplasms, Humans, Receptor Protein-Tyrosine Kinases, Syndrome
Abstract

We present a clinical case of a solitary fibrous pleural tumor (TFSP) with abnormal behavior due to its high aggressiveness and poor short-term prognosis, where an ALK translocation was identified. TFSP is an infrequent tumor, with an estimated incidence of around 8 per 100,000 inhabitants and with few cases reported in the literature. The most common is that it is a neoplasm of benign behavior, with debut as a localized mass and whose The treatment of choice is surgical resection. All the data in the literature contrast with our experience, which we report below.Presentamos un caso clínico de un tumor fibroso solitario pleural (TFSP) de comportamiento anómalo por su alta agresividad y mal pronóstico a corto plazo, en el que se identificó una translocación de ALK. El TFSP es un tumor infrecuente, con una incidencia estimada en torno a 8 casos por 100,000 habitantes y con pocos reportes en la literatura. Lo más habitual es que se trate de una neoplasia de comportamiento benigno, con debut como una masa localizada y cuyo tratamiento de elección es la resección quirúrgica. Todos los datos de la literatura contrastan con nuestra experiencia, que presentamos a continuación.

Published
2021

35. Pseudo-dynamic analysis of heart tube formation in the mouse reveals strong regional variability and early left-right asymmetry

Author

Miguel Torres, S. Temino, Leif Kobbelt, I. Esteban, and Patrick Schmidt

Subjects
Morphometric analysis, Heart development, Embryonic heart, Evolutionary biology, media_common.quotation_subject, Morphogenesis, Heart looping, Biology, Heart tube, Process (anatomy), Asymmetry, media_common
Abstract

Understanding organ morphogenesis requires a precise geometrical description of the tissues involved in the process. In highly regulative embryos, like those of mammals, morphological variability hinders the quantitative analysis of morphogenesis. In particular, the study of early heart development in mammals remains a challenging problem, due to imaging limitations and innate complexity. Around embryonic day 7.5 (E7.5), the cardiac crescent folds in an intricate and coordinated manner to produce a pumping linear heart tube at E8.25, followed by heart looping at E8.5. In this work we provide a complete morphological description of this process based on detailed imaging of a temporally dense collection of embryonic heart morphologies. We apply new approaches for morphometric staging and quantification of local morphological variations between specimens at the same stage. We identify hot spots of regionalized variability and identify left-right asymmetry in the inflow region starting at the late cardiac crescent stage, which represents the earliest signs of organ left-right asymmetry in the mammalian embryo. Finally, we generate a 3D+t digital model that provides a framework suitable for co-representation of data from different sources and for the computer modelling of the process.SUMMARY STATEMENTWe provide the first complete atlas for morphometric analysis and visualization of heart tube morphogenesis, reporting morphological variability and early emergence of left-right asymmetry patterns.

Published
2021
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36. Estreñimiento crónico debido a síndrome de Currarino

Author

María I. Esteban Rodríguez, Javier Manuel Saceda Gutiérrez, Manuel Parrón Pajares, and Nelson M. Buitrago Sánchez

Subjects
business.industry, Pediatrics, Perinatology and Child Health, Medicine, business, Pediatrics, RJ1-570
Published
2020

38. Malignant pleural mesothelioma: clinical experience and prognostic value of derived neutrophil-to-lymphocyte ratio and PD-L1 expression

Author

L, Gutierrez-Sainz, P, Cruz, S, Martinez-Recio, O, Higuera, M I, Esteban-Rodriguez, F, Arias-Lotto, R A, Gonzalez, and J, De Castro-Carpeño

Subjects
Aged, 80 and over, Male, Neutrophils, Pleural Neoplasms, Mesothelioma, Malignant, Antineoplastic Agents, Platinum Compounds, Pemetrexed, Middle Aged, Prognosis, Immunohistochemistry, Survival Analysis, B7-H1 Antigen, Blood Cell Count, Humans, Female, Lymphocytes, Aged, Retrospective Studies
Abstract

Malignant pleural mesothelioma (MPM) is a rare and aggressive tumor, with a poor prognosis. MPM needs to find prognostic factors of survival. We provided the management of patients with MPM and sought to determine whether pre-treatment levels of derived neutrophil-to-lymphocyte ratio (dNLR) as well as PD-L1 expression were reliable prognostic factors of survival.We conducted a single-institution retrospective study, including all patients with MPM treated at La Paz University Hospital between December 2009 and March 2018. Baseline disease, demographics, clinical data, treatment characteristics and complete blood cell counts were collected. We examined dNLR at baseline and data for PD-L1 expression were analyzed in tumor cells by immunohistochemistry.We included 25 patients. The median overall survival (OS) was 15.7 months (95% CI 11.3-20.0). 5 patients had a dNLR greater than 3 (20%). Patients with a dNLR greater than 3 had shorter median OS (8.5 months), than patients with a dNLR less than 3 (17.0 months), with statistically significant differences (p = 0.038). Ten patients (40%) had positive PD-L1 expression (≥ 1%). Patients with positive PD-L1 expression had shorter median OS (8.5 months) than patients with negative PDL1 expression (15.7 months), but without statistically significant association (p = 0.319).The survival data obtained in our sample are consistent with those previously reported. Pretreatment levels of dNLR greater than 3 and positive PD-L1 expression could be significant prognostic factors for poor survival in patients with MPM. Further and prospective studies are needed to explore this relationship and to derive definitive conclusions.

Published
2021

39. Extinction of hepatitis C virus by ribavirin in hepatoma cells involves lethal mutagenesis.

Author

Ana M Ortega-Prieto, Julie Sheldon, Ana Grande-Pérez, Héctor Tejero, Josep Gregori, Josep Quer, Juan I Esteban, Esteban Domingo, and Celia Perales

Subjects
Medicine, Science
Abstract

Lethal mutagenesis, or virus extinction produced by enhanced mutation rates, is under investigation as an antiviral strategy that aims at counteracting the adaptive capacity of viral quasispecies, and avoiding selection of antiviral-escape mutants. To explore lethal mutagenesis of hepatitis C virus (HCV), it is important to establish whether ribavirin, the purine nucleoside analogue used in anti-HCV therapy, acts as a mutagenic agent during virus replication in cell culture. Here we report the effect of ribavirin during serial passages of HCV in human hepatoma Huh-7.5 cells, regarding viral progeny production and complexity of mutant spectra. Ribavirin produced an increase of mutant spectrum complexity and of the transition types associated with ribavirin mutagenesis, resulting in HCV extinction. Ribavirin-mediated depletion of intracellular GTP was not the major contributory factor to mutagenesis since mycophenolic acid evoked a similar decrease in GTP without an increase in mutant spectrum complexity. The intracellular concentration of the other nucleoside-triphosphates was elevated as a result of ribavirin treatment. Mycophenolic acid extinguished HCV without an intervening mutagenic activity. Ribavirin-mediated, but not mycophenolic acid-mediated, extinction of HCV occurred via a decrease of specific infectivity, a feature typical of lethal mutagenesis. We discuss some possibilities to explain disparate results on ribavirin mutagenesis of HCV.

Published
2013
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40. Ultra-deep pyrosequencing (UDPS) data treatment to study amplicon HCV minor variants.

Author

Josep Gregori, Juan I Esteban, María Cubero, Damir Garcia-Cehic, Celia Perales, Rosario Casillas, Miguel Alvarez-Tejado, Francisco Rodríguez-Frías, Jaume Guardia, Esteban Domingo, and Josep Quer

Subjects
Medicine, Science
Abstract

We have investigated the reliability and reproducibility of HCV viral quasispecies quantification by ultra-deep pyrosequencing (UDPS) methods. Our study has been divided in two parts. First of all, by UDPS sequencing of clone mixes samples we have established the global noise level of UDPS and fine tuned a data treatment workflow previously optimized for HBV sequence analysis. Secondly, we have studied the reproducibility of the methodology by comparing 5 amplicons from two patient samples on three massive sequencing platforms (FLX+, FLX and Junior) after applying the error filters developed from the clonal/control study. After noise filtering the UDPS results, the three replicates showed the same 12 polymorphic sites above 0.7%, with a mean CV of 4.86%. Two polymorphic sites below 0.6% were identified by two replicates and one replicate respectively. A total of 25, 23 and 26 haplotypes were detected by GS-Junior, GS-FLX and GS-FLX+. The observed CVs for the normalized Shannon entropy (Sn), the mutation frequency (Mf), and the nucleotidic diversity (Pi) were 1.46%, 3.96% and 3.78%. The mean absolute difference in the two patients (5 amplicons each), in the GS-FLX and GS-FLX+, were 1.46%, 3.96% and 3.78% for Sn, Mf and Pi. No false polymorphic site was observed above 0.5%. Our results indicate that UDPS is an optimal alternative to molecular cloning for quantitative study of HCV viral quasispecies populations, both in complexity and composition. We propose an UDPS data treatment workflow for amplicons from the RNA viral quasispecies which, at a sequencing depth of at least 10,000 reads per strand, enables to obtain sequences and frequencies of consensus haplotypes above 0.5% abundance with no erroneous mutations, with high confidence, resistant mutants as minor variants at the level of 1%, with high confidence that variants are not missed, and highly confident measures of quasispecies complexity.

Published
2013
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41. Attitudes towards risk-reducing early salpingectomy with delayed oophorectomy for ovarian cancer prevention: a cohort study

Author

Ranjit Manchanda, Louise Izatt, Usha Menon, K Ragupathy, Sanjeev Goyal, Rosa Legood, Oleg Blyuss, V Tripathi, Magda Osman, I Esteban, D. G. R. Evans, D Chandrasekaran, Faiza Gaba, C Gan, L McNicol, and Robin Crawford

Subjects
Adult, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Ovariectomy, Population, 03 medical and health sciences, Salpingectomy, Young Adult, 0302 clinical medicine, Breast cancer, medicine, Humans, Genetic Predisposition to Disease, education, Aged, Aged, 80 and over, Ovarian Neoplasms, education.field_of_study, 030219 obstetrics & reproductive medicine, Obstetrics, business.industry, Obstetrics and Gynecology, Oophorectomy, Odds ratio, Middle Aged, medicine.disease, United Kingdom, Sexual dysfunction, Health Care Surveys, Cohort, Linear Models, Female, medicine.symptom, business, Attitude to Health, Cohort study
Abstract

OBJECTIVE To determine risk-reducing early salpingectomy and delayed oophorectomy (RRESDO) acceptability and effect of surgical prevention on menopausal sequelae/satisfaction/regret in women at increased ovarian cancer (OC) risk. DESIGN Multicentre, cohort, questionnaire study (IRSCTN:12310993). SETTING United Kingdom (UK). POPULATION UK women without OC ≥18 years, at increased OC risk, with/without previous RRSO, ascertained through specialist familial cancer/genetic clinics and BRCA support groups. METHODS Participants completed a 39-item questionnaire. Baseline characteristics were described using descriptive statistics. Logistic/linear regression models analysed the impact of variables on RRESDO acceptability and health outcomes. MAIN OUTCOMES RRESDO acceptability, menopausal sequelae, satisfaction/regret. RESULTS In all, 346 of 683 participants underwent risk-reducing salpingo-oophorectomy (RRSO). Of premenopausal women who had not undergone RRSO, 69.1% (181/262) found it acceptable to participate in a research study offering RRESDO. Premenopausal women concerned about sexual dysfunction were more likely to find RRESDO acceptable (odds ratio [OR] = 2.9, 95% CI 1.2-7.7, P = 0.025). Women experiencing sexual dysfunction after premenopausal RRSO were more likely to find RRESDO acceptable in retrospect (OR = 5.3, 95% CI 1.2-27.5, P

Published
2020

44. Ultra-deep pyrosequencing detects conserved genomic sites and quantifies linkage of drug-resistant amino acid changes in the hepatitis B virus genome.

Author

Francisco Rodriguez-Frías, David Tabernero, Josep Quer, Juan I Esteban, Israel Ortega, Esteban Domingo, Maria Cubero, Sílvia Camós, Carles Ferrer-Costa, Alex Sánchez, Rosendo Jardí, Melanie Schaper, Maria Homs, Damir Garcia-Cehic, Jaume Guardia, Rafael Esteban, and Maria Buti

Subjects
Medicine, Science
Abstract

BACKGROUND: Selection of amino acid substitutions associated with resistance to nucleos(t)ide-analog (NA) therapy in the hepatitis B virus (HBV) reverse transcriptase (RT) and their combination in a single viral genome complicates treatment of chronic HBV infection and may affect the overlapping surface coding region. In this study, the variability of an overlapping polymerase-surface region, critical for NA resistance, is investigated before treatment and under antiviral therapy, with assessment of NA-resistant amino acid changes simultaneously occurring in the same genome (linkage analysis) and their influence on the surface coding region. METHODOLOGY/PRINCIPAL FINDINGS: Serum samples obtained from chronic HBV-infected patients at pre-treatment and during sequential NA treatment with lamivudine, adefovir, and entecavir were analyzed by ultra-deep pyrosequencing (UDPS) using the GS-FLX platform (454 Life Sciences-Roche). The pre-treatment HBV quasispecies was not enriched with NA-resistant substitutions. The frequencies of this type of substitutions at pre-treatment did not predict the frequencies observed during lamivudine treatment. On linkage analysis of the RT region studied, NA-resistant HBV variants (except for rtA181T) were present in combinations of amino acid substitutions that increased in complexity after viral breakthrough to entecavir, at which time the combined variant rtL180M-S202G-M204V-V207I predominated. In the overlapping surface region, NA-resistant substitutions caused selection of stop codons in a significant percentage of sequences both at pre-treatment and during sequential treatment; the rtA181T substitution, related to sW172stop, predominated during treatment with lamivudine and adefovir. A highly conserved RT residue (rtL155), even more conserved than the essential residues in the RT catalytic motif YMDD, was identified in all samples. CONCLUSIONS: UDPS methodology enabled quantification of HBV quasispecies variants, even those harboring complex combinations of amino acid changes. The high percentage of potentially defective genomes, especially in the surface region, suggests effective trans-complementation of these variants.

Published
2012
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46. Infrequent Treatments for Occupational Asthma: Immunotherapy and Biological Therapy

Author

I Esteban-Gorgojo, Joaquín Sastre, and Manuel J Rial

Subjects
medicine.medical_specialty, Allergy, business.industry, medicine.medical_treatment, Medicine (miscellaneous), Omalizumab, Immunotherapy, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, medicine, Physical therapy, Immunology and Allergy, Refractory asthma, 030212 general & internal medicine, Intensive care medicine, business, Mepolizumab, Occupational asthma, Disadvantage, medicine.drug, Asthma
Abstract

Occupational asthma is an important social, health, and economic burden in our society, but its treatment options have not been yet sufficiently explored. Drug therapies do not differ much from ordinary asthma treatments, and avoidance is the main managing option for this condition. However, other therapeutic options like immunotherapy and biological therapies have not been used as in other asthma and rhinitis etiologies. Occupational asthma has different pathomechanisms depending of its triggers, but in immunological IgE-dependent asthma, these therapies can be fairly efficient. Not many immunotherapy studies have been carried out lately on this topic, and its reproducibility might be its biggest disadvantage. Maybe the main existing limitation is the lack of standardized extracts in order to perform this treatment. With no proper extracts, this treatment cannot be implemented, and its tolerance is going to differ depending on the extract used in each specific case. On the other hand, biological treatments are a promising option in the management of severe occupational asthma. Not many studies have been conducted so far in occupational allergy. Nevertheless, these biological treatments are upcoming and evolving therapies, so we expect further studies in a close future, including recently approved therapeutic options such as mepolizumab in eosinophilic refractory asthma. These new treatment possibilities should enhance their use and empower them also in the occupational field.

Published
2017
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47. S70. PROFILES OF SOCIAL COGNITION AND METACOGNITION IN FIRST-EPISODE PSYCHOSIS: A LATENT PROFILE ANALYSIS

Author

Eva Grasa, Apraiz A de, P Cortes, Fermín González-Higueras, C Franco, M Renovell, M Montes, L L Lalucat, H Sió, P Torres, M Teixidó, I Birulés, P Huertas, R Rubio, Emeterio M San, K Planell, E González, P Pleguezuelo-Garrote, C García, J Cid, A Luengo, Jordi Cid, N Mantecón, E Sánchez, M A Argany, A Jiménez-Díaz, V Gil, A Barajas, R Gonzalez-Casares, L Domínguez, Daniel Fernández, M Beltrán, E Paniego, N Camprubí, I Ruiz-Delgado, M Carbonero, A Escudero, Mª E Huerta-Ramos, Ana Barajas, L Schilling, E Pousa, Pinos I Esteban, R Vila-Badia, Marta Ferrer-Quintero, M L Barrigón, Steffen Moritz, Isabel Ruiz-Delgado, I Corripio, E Palomer, Ochoa Susana, LLacer B, J M Crosas, MªL González-Montoro, V Pérez, A Acevedo, M A Vila, R Villellas, M J Escartí, A Guasp, E Grasa, Esther Pousa, Higueras F González, María Luisa Barrigón, M Nuñez, E Murgui, E Conesa, F Villegas, S Ochoa, J Anglès, R López-Carrilero, J Sanjuán, M Delgado, E Lorente, Esther Lorente-Rovira, E Carrasco, B Sans, L Mas-Expósito, S Moritz, Raquel López-Carrilero, R Casañas, C Planellas, J L Bogas, M Rabella, and T Peláez

Subjects
Psychiatry and Mental health, Poster Session I, Social cognition, AcademicSubjects/MED00810, First episode psychosis, Metacognition, Psychology, Developmental psychology
Abstract

Background Social cognition and metacognition have emerged as cornerstones of research and treatment of schizophrenia. Both constructs are known to influence the onset of psychosis, to predict functional outcome and to be associated with symptoms. However, whether the deficits in first-episode psychosis are homogeneous or group in patterns remains to be studied. This study aimed to analyze patterns of social cognitive and metacognitive variables in a sample of subjects with first-episode psychosis. Methods We recruited 192 subjects with first-episode psychosis from ten public mental-health services in Spain. We collected: demographic information, measures of functioning, performance in social cognition (the Faces Test, IPSAQ and the Hinting Task), a battery of metacognitive tasks (BCIS, and the Beads Task) and a neuropsychological assessment. We performed a Latent Profile Analysis (LPA) with the metacognitive and social-cognitive variables. The variable importance was assessed via a classification tree (CART) and the mean differences among the resulting groups for clinical, neuropsychological and functioning variables were calculated with ANOVA and Kruskal-Wallis tests. Results Our sample was comprised of 192 (62 women) with first-episode psychosis. The mean age of the sample was 27.93(1.39). The mean PANSS total score of the sample was 58.48 (17.79). The average GAF score was 58.93 (12.25). We included 174 cases with complete social-cognitive and metacognitive data in the cluster analysis. We identified three type-VEE clusters (i.e. ellipsoidal clusters with equal shape and orientation) according to BIC (BIC=-3600.651). The 85-15 condition of the Beads Task and the Hinting Task emerged as the most important variables in determining the clustering structure. The first cluster (60.9%) was characterized by average scores in most of the metacognitive and social cognitive variables, but the presence of the jumping to conclusions bias. The second cluster (5.7%) was characterized by low self-reflectiveness, presence of personalizing bias and an excessive number of trials in the beads task. The third cluster (33.5%) was characterized by average scores in all metacognitive tasks but low scores in the social cognitive tasks. Discussion We found three clusters in a large sample of subjects with first-episode psychosis. Our results indicate that the three groups differ in the proneness to present deficits in specific domains. Furthermore, in our sample, patients may not exhibit a homogeneous deficit in all social-cognitive and metacognitive variables. Instead, the impairment may be particularly prominent in either social-cognitive or metacognitive variables. Subjects in different clusters may present differences in their clinical characteristics, what could be relevant in the treatment. Therefore, with further research, a thorough assessment of social cognition and metacognition may help personalize the treatment according to the person’s subtype of the deficit.

Published
2020

48. Occupational Asthma and Rhinitis due to Yellow and Red Henna in a Hairdresser

Author

Joaquín Sastre, Carlos Pastor-Vargas, I Esteban, Manuel J Rial, Victor M. Villalobos, and J Cuesta

Subjects
Adult, Inhalation Exposure, medicine.medical_specialty, business.industry, Immunology, Cassia, Hair Dyes, Immunoglobulin E, medicine.disease, Dermatology, Lawsonia Plant, Occupational Exposure, medicine, Humans, Immunology and Allergy, Female, Asthma, Occupational, business, Occupational asthma, Naphthoquinones, Rhinitis, Asthma
Published
2020
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49. Safety of hospital discharge before return of bowel function after elective colorectal surgery

Author

J Chapman, S, Blanco-Colino, R, Pérez-Ajates, S, O Anabitarte Bautista, Hodson, J, C Glasbey, J, Pata, F, Pellino, G, Sgrò, A, Soares, A, T van Elst, S Van Straten, Nepogodiev, D, Borakati, A, F Bath, M, H Yasin, I, Mclean, K, Arthur, T, Kovacevic, M, Delibegovic, S, Karamanliev, M, Swamad, M, Žebrák, R, Paramasivam, R, Martensen, A, M Larsen, H, Rädeker, L, E Frey, P, Kechagias, A, Venara, A, Duchalais, E, Ioannidis, A, Pasquali, S, Simioni, A, Farina, V, Podda, M, Lorenzon, L, Schaeff, V, Otto, A, Jakubauskas, M, R van Elst, T, Chu, M, Pvb, Fagan, I Wells, C, A Alagoa João, Juloski, J, Y El Kasmy El Kasmi, Espin-Basany, E, Clerc, D, Ciubotaru, C, Popescu, S, Yanishev, A, Lee, S, B Ozkan, B, A Yagız Sen, K Aktas, M, E Baki, B, Yüksek, B, Kamarajah, S, A Khaw, R, Mills, E, Goodson, R, Thakral, N, D Ablett, A, Adra, M, Kwek, I, M Khan, S, Quinn, P, R Manley, L, Badran, A, Ramjeeawon, A, Campbell, A, L Tan, H, S Rye, D, Rajaraman, N, G Norman, J, Vutipongsatorn, K, Solomou, G, Akhbari, M, Ali, A, Murray, V, M Baker, D, D Brandao, B, Stainer, B, Thavayogan, R, Jones, D, O Onafowokan, O, Gharooni, A, Dabab, N, Carlton-Carew, S, Kungwengwe, G, Gabriel, M, Sewart, E, C Shortland, T, Lawday, S, Pockney, P, Dawson, A, D Brumfitt, C, Stewart, P, B, Ng, K Luong, J, Ivanov, V, Borisova, A, Neykov, V, Kunčarová, K, Kološová, B, Antonova, T, Farkašová, M, L Harbjerg, J, Brandsborg, S, Brinck, S, D Kjaer, M, Mark-Christensen, A, P Unbehaun, K, Dalsgaard, P, D Lycke, K, Lenaoures, P, Brigand, C, Dumange, E, Gout, M, Moehwald, C, Prem, M, Alhalabi, O, Sliwinski, S, Krupp, J, Gablenz, E, Schmitzer, L, Kopp, A, Steinle, J, Gsenger, J, J Pohl, L, Riccardi, M, M Christodoulou, I, Konstantinidis, M, Machairas, N, Zoikas, A, Balalis, D, K Manatakis, D, L Aguilera, M, Marano, L, Fleres, F, Lovisetto, F, Sasia, D, Segalini, E, Pata, G, Lucchi, A, Sagnotta, A, Campagnaro, T, Petrelli, F, Gallo, G, Papandrea, M, Testa, V, Sinibaldi, G, F Di Candido, Colombo, F, Perrone, G, Aresu, S, Biancafarina, A, Canonico, G, Pagnanelli, M, Curletti, G, Bini, R, A de Manzoni Garberini, Impellizzeri, H, Cillara, N, Tutino, R, Picciariello, A, Coletta, D, Savino, G, Ferrara, F, Tamini, N, Talamo, G, Parini, D, Giamundo, P, A Lo Conte, Pagano, G, Ripetti, V, Pesce, A, Menduni, N, Giudicissi, R, Goldin, E, Rega, D, Belli, A, Andriola, V, Gordini, L, Foppa, C, Piccolo, G, Birindelli, A, Ferrari, C, Ballarini, Z, Tirelli, F, Milone, M, M De Rosa, S Pipitone Federico, N, Molteni, B, L Tilocca, P, Sancini, G, N Piozzi, G, Lauretta, A, Poillucci, G, Mulas, S, Simcikas, D, Portelli, L, Jwm van Wijnbergen, L Dinger, T, Sfh Ten Doesschate, Ashm van Dalen, D van den Bos, D, Hansmann, M, J Medina Feliz, Z Kuiper, S, Abdulrahman, Z, R Pruijssers, S, Farik, S, M Elliott, B, P Geneta, V, Wilton, S, Kandelaki, H, L Peng, S, Campbell, S, K Lim, Y, S Yassaie, S, Murray, M, Haran, C, Tan, J, Castro, J, Laranjeira, A, Catarino, S, Neves-Marques, C, G Correia, J, N Vieira, B, C Quintela, A, L Serra, M, Maciel, J, Cunha, M, J Aparício, D, Neves, J, Azevedo, J, Romano, M, Eiró, F, Romano, J, Monteiro, C, Claro, M, R Almeida, M, Peyroteo, M, D Machado, N, Capote, H, Ferreira, M, Sousa, X, Devesa, H, Cavadas, D, Guerreiro, I, Costa, M, Rosete, M, Salman, M, English, C, Mohammed, N, Litvin, A, V Ćuk, V, Mészárosová, K, Jaich, R, H De Lima, Brooks, S, Marx, M, M Nshalati Salvation, J García Cardo, Mora-Guzmán, I, J Sancho Muriel, U de Andres Olabarria, Muriel, P, C Jimenez Viñas, Alconchel, F, O Esteban Sinovas, C Fairén Oro, M López Otero, S Figueroa Jiménez, O Claramonte Bellmunt, J Martínez Caballero, Rubio-Pérez, I, M Aguilar-Martínez, M, J Segura-Sampedro, J, C Olmedo Moreno, D Negre Parra, M Estévez Diz, A, Martín-Balbuena, R, C Bustamante Recuenco, E Licardie Bolaños, R, Fernández, P, A Díaz Padillo, Forero-Torres, A, I Alberdi San Román, H Salvador Rosés, M Merayo Álvarez, P Villarejo Campos, C Lopes Moreira, C, P Uriol Peralta, M Serrano Navidad, Ripollés-Melchor, J, Garcea, A, H Gómez Facundo, P Troncoso Pereira, V Pérez Guarinos, C, Blaser, B, Piazza, G, Gagliardi, B, Serin, H, S Yurdaor, S, Arslan, E, Kopac, O, Uyanik, A, B Ozmen, B, Tiftik, E, Aksoy, B, Yalcinkaya, A, Ozoglu, F, D Kocer, M, Bilicen, G, N Cinar, E, Uslu, Ö, Kaya, Y, Demirci, K, Wong, J, Mmh, Farhan-Alanie, Suresh, G, Asif, A, J Finch, B, Bhahirathan, Y, Herron, J, Z Yi Tew, Obukofe, R, Russell, C, Suchett-Kay, I, Netke, T, Williams, L, Kisiel, A, Y Liu, F, Claireaux, H, James, P, Mondal, A, Kalderon, R, H Nadama, H, Al-Saraff, Z, Jph, Tam, Powell-Chandler, A, Wood, F, Rebecca, Gorgievska, Ragavoodoo, A, Thakrar, C, Rojoa, D, Palmer, C, Davidson, K, Giacci, L, Hale, J, W Gan, F, Makin-Taylor, R, Y Hey, C, Toh, C, M Findlay, J, Griffiths, N, Ganesananthan, S, Jasionowska, S, Poustie, M, Wong, C, Turner, T, Pyc, W, Sloper, W, Warner, C, Coey, J, Mason, D, Sait, S, Kowal, M, Owen, M, Saiyed, A, Ashworth, I, Akbari, K, Curran, M, Martin, P, Parker, D, Kwok, K, Lye, C, Ghaly, M, Sammour, T, Lewis, D, Mundasad, R, Wilkes, A, Ctercteko, G, Maslyankov, S, Dimov, R, Iliev, S, Dimitrov, D, Marek, F, Örhalmi, J, Skalický, P, Skalický, T, Chrz, K, Christensen, P, Worsøe, J, S Kristensen, E, J Emmertsen, K, S Loeve, U, L Mihaljevic, A, Herrle, F, M Konstantinidis, K, Korkolis, D, Karanikas, I, Vincenti, L, Anania, G, Borghi, F, Agresta, F, Maretto, I, Parisi, A, Bucci, L, G De Palma, Guglielmi, A, Cucinotta, E, F La Torre, Cianchi, F, Guerrieri, M, Trompetto, M, Persiani, R, Micheletto, G, Delrio, P, Cantafio, S, Ronconi, M, Pag, Bisagni, M De Prizio, Franceschi, A, Galleano, R, Cavallini, M, Brescia, A, D'Ambra, L, Benevento, A, Niolu, P, Calgaro, M, Colangelo, E, Grottola, T, F Altomare, D, Puleo, S, Salamone, G, Pietrabissa, A, Poggioli, G, Erdas, E, Ottonello, R, Tonini, V, Selvaggi, F, Sammarco, G, Ceccarelli, G, C De Nisco, Surgo, D, Taglietti, L, Ozolins, A, Sivinš, A, Poskus, T, Psaila, J, A Bemelman, W, J Graat, L, Langenhoff, B, Bpl, Wijnhoven, Ahw van de Ven, Poelman, M, Lps, Stassen, Slooter, G, Yiz, Acherman, Hoff, C, F Gerhards, M, Mwj, Stommel, J Hazebroek, E, Aaw van Geloven, A Schasfoort, R, L van Leeuwen, B, B Tuynman, J, Mwa van Tilburg, G Boerma, E, Sharma, P, Jenkins, B, P Bissett, I, Herd, A, Gordon, A, Vernon, D, Omundsen, M, J, Ly, Reddy, A, Bonnet, G, Harmston, C, Morales, M, Francisco, V, Costa, S, Manso, A, Amorim, E, Pereira, J, Cardoso, J, Ourô, S, Caratão, M, Nascimento, C, B Ribeiro da Silva, Taranu, V, Dias, R, Mendes, J, Allen, M, Silva, A, Carlos, S, Barbosa, E, Carneiro, C, Ramos, L, Lencastre, L, Martins, R, Silva-Vaz, P, F Ridgway, P, A McNamara, D, Cahill, R, Hogan, A, Larkin, J, R O'Connell, P, Negoi, I, Abelevich, A, M Ćuk, V, Vician, M, Ede, C, Sardiwalla, I, Mulira, S, Montwedi, D, Oyomno, M, Sabia, D, V Portugal Porras, Vigorita, V, G Sanz Ortega, García, J, A Espí Macías, F Blanco Antona, A Luján Mompeán, J, S Salvans Ruiz, Villarejo-Campos, P, M Romero Simó, Sánchez-Guillén, L, M Jiménez-Gómez, L, A Sánchez López, Golda, T, D Julià Bergkvist, Nevado, C, F Noguera Aguilar, J, B Ricardo Felipe, Septiem, J, A Rodríguez Sánchez, Cañete-Gómez, J, I Ruiz Montesinos, Millán-Scheiding, M, Prieto-Nieto, I, Frasson, M, D García Olmo, Hübner, M, Petermann, D, O Sauvain, M, Ozben, V, E Geçim, I, Disçi, E, Rencuzogullari, A, Kurt, A, Bisgin, T, Pehlivan, M, Isik, A, Onur, E, Leventoglu, S, C Haksal, M, S Erturk, M, Keskin, M, Guner, A, S Tutcu Sahin, S Ozbalci, G, Pergel, A, Albayrak, D, Bruce, D, Fearnhead, N, Arthur, J, Harron, M, Beattie, G, Titu, L, Saunders, M, Phillips, J, Dindyal, S, Cresswell, B, Gercek, Y, Lee, J, Linn, T, Faulkner, G, Lockwood, S, Rees, J, Charalabopoulos, A, Campbell, B, Kontovounisios, C, Amarnath, T, Johnson, M, Epanomeritakis, E, Vigs, S, Nastro, P, Gilliam, A, Smolarek, S, Wilson, T, Orbell, J, Mcintyre, R, Agarwal, T, Hainsworth, P, Patel, P, Vijay, J, Liu, B, P Dhruva Rao, Roxburgh, C, Vipond, M, Youssef, H, Thorn, C, Schizas, A, Denley, S, Bowley, D, Das, K, Cuming, T, 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Kenny R., Kan P., Lee D.E., Khosla S., Samake M., Shaban F., Aftab R., Gough M., Woodburn B., Vayalapra S., McMurrugh K., Jimulia D., Deol S., Pike S., Embury-Young Y., Patel M., Kilgallon E., Keating R., Walsh A., Khan H., Logue G., Orekoya M., Alasmar M., Charalambides M., Llavall A.C., Williamson E., Bharwada Y., Zearmal S., Evans H., Panikkar M., de la Cruz G., Caplan J., Ruparelia A., Tanvir T., Soare C., Pang Y.L., Trotter J., Zaidi A., Thakrar V., Pulickal P., Ahmed H., Parnell J., Lennock S., Ford V., Brignall R., O'Neill D., Hanna R., Kane R., Nicola M., Rajput K., Xiao Y., Michael S., Wright E., Juniper S., Thompson E., Hoskyns L., Kanitkar A., Ross C., Unsworth A., Rshaidat H., Demarre K., Chiang A., Bareh A., van Dellen J., Faqihinejad C., Gadhvi A., Grant R., Lewsey J., Morris A., Martin H., McClarty C., Sanyal S., Alsaif A., Palkhi A., Bhopal S., Burford C., Huq T., Irwin E., Matthews L., Ngu W.S., Hosfield T., Muneeb F., Page O., Zeb E., Al-Azzawi A., McIntosh J., Vucicevic A., Hughes M., Brooks L., Fanibi B., Dixon M., Njoku P., Morris D., Jobson J., Chowdhury H., Joseph N., Zulkefley N., Hunt G., Christodoulou T., Wright O., Soman S., Jamal M., Beqiri S., Borgas P., Christie S., Pereira F., Browne S., Yiu J., Dworkin A., Brayley J., Palmer A., Charalambos M., Jones C.S., Toner S., Cowden R., Lee L., Nicol P., Holman O., Imtiaz M., Albert V., Leung S.P., Erotocritou M., Stroud R., Wilkin R., Thomson W., Mackee L., Kler A., Reynolds L., Mohamed S.H., Majeed Y., Fakim B., Jones A., Liversedge G., Carrington Z., Windebank J., Izzarina A., Akbani U., Craven J., Aldarragi A., Harding S., Millward A., Bedford M., Gopalan V., Midgen A., Khadka P., Cheng O., Taneja S., Manobharath N., Kok J.Y., Lim D.W.E., Buick T., Boland M., Piya S., Devlin R., Fairfield C.J., George R.J., Rahi M., Zaman S., Hajiev S., Ross T., Crisp E., Thompson C., Charalambous A., Hollywood J.L., Hammond R.F.L., Matthews J., Mendonca V., Spinty J., Khan K., Cheng J., Glynn N., 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M., Frade S., Senhorinho R., Peixoto R., Alves-Vale C., Lamas M., O'Connor D.B., Hoo M., Gopaul A., Scanlon K., O'Dwyer N., Jovanovic M., Panyko A., Van Vuuren S., Centeno A., Bernado I.R., Senorans M.P.G., Amor L.G., Ramirez A.C., Abrisqueta J., Gomez M.E., Arroyo A., Cerdan C., Romeu N.G., Enriquez-Navascues J.M., Collado-Roura F., Curchod P., Gaspar S., Imadalou L., Mutlu D., Akyol C., Uygur F.A., Eray I.C., Biyiklioglu O., Cetin M.F., Isik A.E., Karip B., Dogan H., Sarigul L., Tunc E., Aydin T., Bodur S., Karabulut K., Francis A.A., Al-hadithi A., Lau I.S.F., Smith E., Mahapatra S., McAuliffe O., Imam L., Akram B., Hossaini S., Davies R., Ko M., Collins J., Pandya A., Reilly S., Archer J., Livie J., Chaudhry F.A., Ntakomyti E., Diallo R., Bylinski T., Wright J., Masiha E., Tung J., Shirazi B., Neilson A., Epton S., Patel N., Trussell S., Couldrey A., Donnelly C., Eftychiou S., Salman M., Skejo, Licari L., Men, Chapman, S. 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Z., Abdulrahman, Z., Pruijssers, S. R., Geneta, V. P., Chu, M., Wilton, S., Kandelaki, H., Peng, S. L., Campbell, S., Lim, Y. K., Yassaie, S. S., Murray, M., Haran, C., Tan, J., Castro, J., Laranjeira, A., Catarino, S., Neves-Marques, C., Correia, J. G., Vieira, B. N., Quintela, A. C., Serra, M. L., Maciel, J., Cunha, M., Aparicio, D. J., Neves, J., Azevedo, J., Romano, M., Eiro, F., Romano, J., Monteiro, C., Claro, M., Capote, H., Ferreira, M., Sousa, X., Peyroteo, M., Machado, N. D., Guerreiro, I., Costa, M., Rosete, M., Salman, M., English, C., Mohammed, N., Litvin, A., Cuk, V. V., Meszarosova, K., Jaich, R., De Lima, H., Brooks, S., Marx, M., Salvation, M. N., Cardo, J. G., Mora-Guzman, I., Muriel, J. S., de Andres Olabarria, U., Muriel, P., Vinas, C. J., Alconchel, F., Sinovas, O. E., Oro, C. F., Otero, M. L., Jimenez, S. F., Bellmunt, O. C., Caballero, J. M., Rubio-Perez, I., Aguilar-Martinez, M. M., Segura-Sampedro, J. J., Moreno, C. O., Parra, D. N., Diz, A. M. 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M., Griffiths, N., Ganesananthan, S., Jasionowska, S., Poustie, M., Wong, C., Turner, T., Pyc, W., Sloper, W., Warner, C., Coey, J., Mason, D., Sait, S., Kowal, M., Owen, M., Saiyed, A., Ashworth, I., Akbari, K., Curran, M., Martin, P., Parker, D., Kwok, K., Lye, C., Ghaly, M., Sammour, T., Lewis, D., Mundasad, R., Wilkes, A., Ctercteko, G., Maslyankov, S., Dimov, R., Iliev, S., Dimitrov, D., Marek, F., Orhalmi, J., Skalicky, P., Skalicky, T., Chrz, K., Christensen, P., Worsoe, J., Kristensen, E. S., Emmertsen, K. J., Loeve, U. S., Mihaljevic, A. L., Herrle, F., Konstantinidis, K. M., Korkolis, D., Karanikas, I., Vincenti, L., Anania, G., Borghi, F., Agresta, F., Maretto, I., Parisi, A., Bucci, L., De Palma, G., Guglielmi, A., Cucinotta, E., La Torre, F., Cianchi, F., Guerrieri, M., Trompetto, M., Persiani, R., Micheletto, G., Delrio, P., Cantafio, S., Ronconi, M., Bisagni, P. A. 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G., Hubner, M., Petermann, D., Sauvain, M. O., Ozben, V., Gecim, I. E., Disci, E., Rencuzogullari, A., Kurt, A., Bisgin, T., Pehlivan, M., Isik, A., Onur, E., Leventoglu, S., Keskin, M., Guner, A., Sahin, S. T., Ozbalci, G. S., Pergel, A., Albayrak, D., Bruce, D., Fearnhead, N., Arthur, J., Harron, M., Beattie, G., Titu, L., Saunders, M., Phillips, J., Dindyal, S., Cresswell, B., Gercek, Y., Lee, J., Linn, T., Faulkner, G., Lockwood, S., Rees, J., Charalabopoulos, A., Campbell, B., Kontovounisios, C., Amarnath, T., Johnson, M., Epanomeritakis, E., Vigs, S., Nastro, P., Gilliam, A., Smolarek, S., Wilson, T., Orbell, J., Mcintyre, R., Agarwal, T., Hainsworth, P., Patel, P., Vijay, J., Liu, B., Rao, P. D., Roxburgh, C., Vipond, M., Youssef, H., Thorn, C., Schizas, A., Denley, S., Bowley, D., Das, K., Cuming, T., Saha, A., Chung, L., Pitt, J., Davis, P., Jones, O., Taylor, M., Bhargava, A., Haji, A., Watson, N., Bloom, I., Singh, B., Norwood, M., Gurjar, S., Stylianides, N., Mirza, S., Evans, M., Williams, G., Patil, P., Hernon, J., Finch, G., Green, S., Chapple, K., Fafemi, O., Warusavitarne, J., Samee, A., Carden, C., Ong, L., Verma, K., Joseph, A., Rawat, N., Pinkney, T., Oke, O., Glen, P., Maxwell-Armstrong, C., Oliphant, R., Garner, J., Moug, S. J., Middleton, S., Lund, J. N., Smart, N. J., Osborn, G., Moore, T., Raymond, T., Knowles, C. H., Hany, T. S., Clarke, R., Khera, G., Brady, R., Sellahewa, C., Mason, C., Torrance, A., Lasithiotakis, K., Knight, J., Pullybank, A., Ainsworth, P., Reid, F., Ramwell, A., Maslekar, S., George, R., Skull, A., Holtham, S., Muhammad, K., Lal, R., Varcada, M., Smith, F. M., Howlader, M., Defriend, D., Kirk, S., Richards, T., Evans, C., Borg, C. 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W., Gabbas, G., Marziali, I., Mazzocato, S., Vergari, R., Piazzai, F., Kubolli, I., Aggiusti, A., Paolucci, A., Ortenzi, M., Olivieri, M., Belluco, C., Antona, A. D., Basso, S., Morino, M., Mistrangelo, M., Clerico, G., De Santi, G., Bitonti, M. F., Frattalone, M., Fico, V., Santullo, F., Belia, F., Spinelli, A., Marco, M., Bevilacqua, M., Tringali, D., Bevilacqua, E., Panizzo, V., La Manna, V., Migliore, G., Aversano, A., Bucci, A. F., Marino, F., Carbone, F., Incollingo, P., Romano, F. M., Zalla, T., Baraghini, M., Romoli, L., Calussi, M., Vellei, S., Genzano, C., Feroci, F., Vita, M., Barberis, A., Serra, D., Grassia, M., Romelli, M., Ruggiero, S., Percassi, A., Piccinini, A. 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Subjects
operative, Male, postoperative discharge, Postoperative Complications, 0302 clinical medicine, Colostomy, CRITERIA, Prospective Studies, Bowel function, Colectomy, IMAGINE, stoma, intestines, Proctectomy, Ileostomy, digestive, oral, and skin physiology, patient discharge, colorectal surgery, hospital discharge, bowel function, RECOVERY, Middle Aged, adult, colostomy, elective surgical procedures, female, follow-up studies, humans, ileostomy, ileus, male, middle aged, multivariate analysis, patient readmission, patient safety, postoperative complications, prospective studies, recovery of function, colectomy, proctectomy, Patient Discharge, Colorectal surgery, ileus - - discharge - bowel function - elective - colorectal surgery, Elective Surgical Procedures, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Patient Safety, Cohort study, safety, Adult, medicine.medical_specialty, Ileus, Patient Readmission, defecation, 03 medical and health sciences, medicine, Hospital discharge, Humans, colorectal surgery, colorectal resection, Colorectal resection, defecation, postoperative complications, colorectal surgery, intestines, patient discharge, patient readmission, safety, surgical procedures, operative, colorectal resection, ileus, business.industry, Recovery of Function, Odds ratio, medicine.disease, digestive system diseases, surgical procedures, Surgery, Multivariate Analysis, Defecation, business, Follow-Up Studies
Abstract

Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function.A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system.A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110).Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients.El íleo es frecuente tras la cirugía colorrectal y se asocia con un aumento del riesgo de las complicaciones postoperatorias. Identificar las características de una recuperación normal del tránsito y la idoneidad para el alta hospitalaria es una tarea difícil. Este estudio examinó la seguridad del alta hospitalaria antes del restablecimiento de la función intestinal. MÉTODOS: Se llevó a cabo un estudio de cohortes prospectivo y multicéntrico a través de una red de colaboración internacional. Se incluyeron pacientes adultos sometidos a resección electiva colorrectal entre enero y abril 2018. El objetivo principal fue el reingreso hospitalario durante los 30 primeros días tras la intervención. Se utilizó un análisis de regresión multivariable para evaluar el impacto del momento del alta en función del restablecimiento de la función intestinal. El objetivo secundario fue las complicaciones postoperatorias en los primeros 30 días después de la cirugía, valoradas mediante el sistema de clasificación de Clavien-Dindo.Se incluyeron en el análisis 3.288 pacientes, de los cuales 301 (9,2%) fueron dados de alta antes del restablecimiento de la función intestinal. La mediana de la estancia hospitalaria de los pacientes dados de alta antes y después del restablecimiento de la función intestinal fue 5 (rango intercuartílico: 4-7) y 7 (6-8) días, respectivamente (P 0,001). No hubo diferencias significativas en las tasas de reingreso entre estos grupos (6,6% versus 8,0%; P = 0,499), y este resultado se mantuvo en el análisis multivariable tras el ajuste por diferencias basales (razón de opotunidades, odds ratio, OR 0,90; i.c. del 95% 0,55-1,46, P = 0,659). Las tasas de complicaciones postoperarorias fueron similares en aquellos dados de alta antes o después del restablecimiento de la función intestinal (complicaciones menores: 34,7% versus 39,5%; complicaciones mayores 3,3% versus 3,4%; P = 0,110). CONCLUSIÓN: Dar de alta antes del restablecimiento de la función intestinal tras cirugía colorrectal electiva parece ser seguro en pacientes debidamente seleccionados.

Published
2020
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50. Potential and limitations of co-fermentation: A review

Author

Pérez i Esteban, Noemí, Astals Garcia, Sergi, and Dosta Parras, Joan

Subjects
Master's theses, Circular economy, Economia circular, Fermentation, Environmental engineering, Volatile fatty acids, Enginyeria ambiental, Fermentació, Master's thesis, Àcids grassos volàtils, Treballs de fi de màster
Abstract

Màster d'Enginyeria Ambiental, Facultat de Química, Universitat de Barcelona, Curs: 2019-2020, Tutors: Sergi Astals García, Joan Dosta Parras, Fermentation is a biotechnological process to generate value from organic waste. During this process, volatile fatty acids (VFA) are obtained as a product, which can be directly used to support other biotechnologies and contribute to the circular economy. However, some substrates present a series of characteristics that are not totally optimal. Co-fermentation is a way to alleviate these drawbacks, which consists on fermenting two or more substrates simultaneously. Co-fermentation is a relatively new approach to the fermentation process as the articles ranging from 2013-2020 account for 77%. A wide range of substrates and combinations have been studied. The more utilised main substrate is waste activated sludge (WAS) followed by primary sludge (PS). Most publications have focused on studying the combination of WAS and food waste (FW) and WAS and agro-industrial (e.g. corn stalk and mushrooms). Most researchers emphasize pH control using chemicals and balancing C/N ratio. Besides, the substrate has been shown to influence the VFA profile as well as the pH. The addition of agro-industrial residue can delay the co-fermentation process due to its high content in lignocellulosic compounds. Overall, other parameters and mixtures should be studied, and more continuous experiments are needed to finish studying co-fermentation

Published
2020

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