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Although kidney transplantation from living donors (LD) offers better long-term results than from deceased donors (DD), elderly recipients are less likely to receive LD transplants than younger ones. We analyzed renal transplant outcomes from LD versus DD in elderly recipients with a propensity-matched score. This retrospective, observational study included the first single kidney transplants in recipients aged ≥65 years from two European registry cohorts (2013–2020, n = 4,257). Recipients of LD (n = 408), brain death donors (BDD, n = 3,072), and controlled cardiocirculatory death donors (cDCD, n = 777) were matched for donor and recipient age, sex, dialysis time and recipient diabetes. Major graft and patient outcomes were investigated. Unmatched analyses showed that LD recipients were more likely to be transplanted preemptively and had shorter dialysis times than any DD type. The propensity score matched Cox’s regression analysis between LD and BDD (387-pairs) and LD and cDCD (259-pairs) revealing a higher hazard ratio for graft failure with BDD (2.19 [95% CI: 1.16–4.15], p = 0.016) and cDCD (3.38 [95% CI: 1.79–6.39], p < 0.001). One-year eGFR was higher in LD transplants than in BDD and cDCD recipients. In elderly recipients, LD transplantation offers superior graft survival and renal function compared to BDD or cDCD. This strategy should be further promoted to improve transplant outcomes.

Este estudio, como parte de una investigación doctoral, contribuye a la profundización sobre la salud socioemocional de los educadores para el ejercicio docente. Para dicho fin, se realizó el análisis psicométrico de la prueba de Yoder (2014) quien caracteriza las competencias socioemocionales del Colaborative for Academic, Social and Emotional Learning para promover la reflexión pedagógica en base a las actuaciones del docente en el aula de clase. En total participaron 380 maestros pertenecientes a las siete Unidades de Gestión Educativa Local de Lima Metropolitana. Se determinó la validez y confiabilidad; así como los baremos de interpretación. Los resultados evidencian coeficientes estadísticamente significativos y la reorganización de los ítems respetando su contenido y las dimensiones originales del test. La conclusión más relevante es que este estudio aporta un instrumento de medida adaptado a la realidad sociocultural de los profesores peruanos. Además, permitirá realizar investigaciones en el campo de la emoción docente y diseñar programas de formación para maestros en servicio.

Antibody-mediated rejection is the leading cause of kidney graft dysfunction. The process of diagnosing it requires the performance of an invasive biopsy and subsequent histological examination. Early and sensitive biomarkers of graft damage and alloimmunity are needed to identify graft injury and eventually limit the need for a kidney biopsy. Moreover, other scenarios such as delayed graft function or interstitial fibrosis and tubular atrophy face the same problem. In recent years, interest has grown around extracellular vesicles, specifically exosomes actively secreted by immune cells, which are intercellular communicators and have shown biological significance. This review presents their potential as biomarkers in kidney transplantation and alloimmunity.

This Guide for Living Donor Kidney Transplantation (LDKT) has been prepared with the sponsorship of the Spanish Society of Nephrology (SEN), the Spanish Transplant Society (SET), and the Spanish National Transplant Organization (ONT). It updates evidence to offer the best chronic renal failure treatment when a potential living donor is available. The core aim of this Guide is to supply clinicians who evaluate living donors and transplant recipients with the best decision-making tools, to optimise their outcomes.Moreover, the role of living donors in the current KT context should recover the level of importance it had until recently. To this end the new forms of incompatible HLA and/or ABO donation, as well as the paired donation which is possible in several hospitals with experience in LDKT, offer additional ways to treat renal patients with an incompatible donor.Good results in terms of patient and graft survival have expanded the range of circumstances under which living renal donors are accepted. Older donors are now accepted, as are others with factors that affect the decision, such as a borderline clinical history or alterations, which when evaluated may lead to an additional number of transplantations.This Guide does not forget that LDKT may lead to risk for the donor. Pre-donation evaluation has to centre on the problems which may arise over the short or long-term, and these have to be described to the potential donor so that they are able take them into account. Experience over recent years has led to progress in risk analysis, to protect donors’ health. This aspect always has to be taken into account by LDKT programmes when evaluating potential donors.Finally, this Guide has been designed to aid decision-making, with recommendations and suggestions when uncertainties arise in pre-donation studies. Its overarching aim is to ensure that informed consent is based on high quality studies and information supplied to donors and recipients, offering the strongest possible guarantees. Resumen: Esta guía de recomendaciones para el TR de donante vivo (TRDV) es un documento elaborado con el patrocinio de la Sociedad Española de Nefrología, la Sociedad Española de Trasplantes y la Organización Nacional de Trasplantes que actualiza la calidad de la evidencia disponible para ofrecer el mejor tratamiento de la insuficiencia renal crónica cuando se disponga de un donante vivo potencial. El objetivo principal de esta guía es proporcionar a los profesionales con responsabilidad en los estudios previos del donante vivo y del receptor trasplantado, las mejores herramientas para tomar decisiones en beneficio del donante vivo y del receptor del trasplante.Además, en el contexto actual del TR, el donante vivo debe recuperar el protagonismo que alcanzó en un pasado reciente. Para ello, las nuevas modalidades de donación HLA y/o ABO incompatible, así como la donación cruzada disponibles en diversos centros con experiencia en TRDV, son oportunidades adicionales para el tratamiento de enfermos renales que tienen un donante incompatible.Los buenos resultados en supervivencia del paciente y del injerto están ampliando las circunstancias de aceptación de donantes vivos de riñón, incluyendo donantes de mayor edad y otros con algunos condicionantes que incluyen antecedentes o alteraciones límite que, cuando son evaluados con criterios objetivos, pueden aportar un numero adicional de trasplantes.No se ha obviado en esta guía que el TRDV puede representar algún riesgo para el que dona. Estos problemas que pueden aparecer a corto o largo plazo tienen que ser objeto principal de valoración previa a la donación y presentados al potencial donante para que en ejercicio de su autonomía los asuma o rechace. La experiencia acumulada en los últimos años ha permitido avanzar en el análisis de riesgos para preservar la salud de los donantes, aspecto que debe estar siempre presente en los responsables de programas de TRDV cuando se procede al estudio de idoneidad de un potencial donante.Finalmente, esta guía ha sido estructurada para facilitar la toma de decisiones con recomendaciones y sugerencias ante incertidumbres derivadas de los resultados en los exhaustivos estudios predonación. Y todo ello, con el objetivo de que el consentimiento informado que debe certificar la calidad de los estudios y la información proporcionada a donante y receptor, alcancen las mayores garantías posibles.

The growing relevance of video games in the social landscape requires an in-depth evaluation of the bidirectional influences of these adjacent contexts, among which the educational and cultural contexts stand out. This permeability allows the study of the cultural aspects surrounding the production and use of video games as tools for cultural dissemination. Our research enunciates, recognises, analyses and evaluates the impact of these tools with the aim of being taken into consideration by the scientific community and the general population, who most frequently consume, use and socialise through video games around the world. Based on this, a systematic literature review (SLR) was carried out using the Prisma 2020 Protocol, using the WOS and SCOPUS databases as documentary sources, and the selection of research articles that explore the cultural aspects of video games according to pre-established criteria. The final sample (N = 45) was subjected to a study that posed 12 research questions around which this work is structured. As a result, it is evident that video games have a direct impact on the transmission of culture. Patterns and agents of cultural representation, transmission and communication were identified, allowing researchers to evaluate the impact of video games on culture and to approach this object of study from an academic perspective, helping to open up other lines of research related to the influence of video games on the assimilation of culture, the learning of relevant issues related to it or the transmission of specific cultural elements.

Resumen: Esta guía de recomendaciones para el TR de donante vivo (TRDV) es un documento elaborado con el patrocinio de la Sociedad Española de Nefrología, la Sociedad Española de Trasplantes y la Organización Nacional de Trasplantes que actualiza la calidad de la evidencia disponible para ofrecer el mejor tratamiento de la insuficiencia renal crónica cuando se disponga de un donante vivo potencial. El objetivo principal de esta guía es proporcionar a los profesionales con responsabilidad en los estudios previos del donante vivo y del receptor trasplantado, las mejores herramientas para tomar decisiones en beneficio del donante vivo y del receptor del trasplante.Además, en el contexto actual del TR, el donante vivo debe recuperar el protagonismo que alcanzó en un pasado reciente. Para ello, las nuevas modalidades de donación HLA y/o ABO incompatible, así como la donación cruzada disponibles en diversos centros con experiencia en TRDV, son oportunidades adicionales para el tratamiento de enfermos renales que tienen un donante incompatible.Los buenos resultados en supervivencia del paciente y del injerto están ampliando las circunstancias de aceptación de donantes vivos de riñón, incluyendo donantes de mayor edad y otros con algunos condicionantes que incluyen antecedentes o alteraciones límite que, cuando son evaluados con criterios objetivos, pueden aportar un numero adicional de trasplantes.No se ha obviado en esta guía que el TRDV puede representar algún riesgo para el que dona. Estos problemas que pueden aparecer a corto o largo plazo tienen que ser objeto principal de valoración previa a la donación y presentados al potencial donante para que en ejercicio de su autonomía los asuma o rechace. La experiencia acumulada en los últimos años ha permitido avanzar en el análisis de riesgos para preservar la salud de los donantes, aspecto que debe estar siempre presente en los responsables de programas de TRDV cuando se procede al estudio de idoneidad de un potencial donante.Finalmente, esta guía ha sido estructurada para facilitar la toma de decisiones con recomendaciones y sugerencias ante incertidumbres derivadas de los resultados en los exhaustivos estudios predonación. Y todo ello, con el objetivo de que el consentimiento informado que debe certificar la calidad de los estudios y la información proporcionada a donante y receptor, alcancen las mayores garantías posibles. Abstract: This guide for living donor renal transplantation (LDRT) has been prepared with the sponsorship of the Spanish Society of Nephrology (SEN), the Spanish Transplant Society (SET), and the Spanish National Transplant Organization (ONT). It updates evidence to offer the best chronic renal failure treatment when a potential living donor is available. The core aim of this guide is to supply clinicians who evaluate living donors and transplant recipients with the best decision-making tools, to optimise their outcomes.Moreover, the role of living donors in the current RT context should recover the level of importance it had until recently. To this end the new forms of incompatible HLA and/or ABO donation, as well as the paired donation which is possible in several hospitals with experience in LDRT, offer additional ways to treat renal patients with an incompatible donor.Good results in terms of patient and graft survival have expanded the range of circumstances under which living renal donors are accepted. Older donors are now accepted, as are others with factors that affect the decision, such as a borderline clinical history or alterations, which when evaluated may lead to an additional number of transplantations.This guide does not forget that LDRT may lead to risk for the donor. Pre-donation evaluation has to centre on the problems which may arise over the short or long-term, and these have to be described to the potential donor so that they are able to take them into account. Experience over recent years has led to progress in risk analysis, to protect donors’ health. This aspect always has to be taken into account by LDRT programmes when evaluating potential donors.Finally, this guide has been designed to aid decision-making, with recommendations and suggestions when uncertainties arise in pre-donation studies. Its overarching aim is to ensure that informed consent is based on high quality studies and information supplied to donors and recipients, offering the strongest possible guarantees.

Living donor kidney transplantation (LDKT) is the best treatment option for end stage renal disease in terms of both patient and graft survival. However, figures on LDKT in Spain that had been continuously growing from 2005 to 2014, have experienced a continuous decrease in the last five years.One possible explanation for this decrease is that the significant increase in the number of deceased donors in Spain during the last years, both brain death and controlled circulatory death donors, might have generated the false idea that we have coped with the transplant needs. Moreover, a greater number of deceased donor kidney transplants have caused a heavy workload for the transplant teams.Furthermore, the transplant teams could have moved on to a more conservative approach to the information and assessment of patients and families considering the potential long-term risks for donors in recent papers. However, there is a significant variability in the LDKT rate among transplant centers and regions in Spain independent of their deceased donor rates. This fact and the fact that LDKT is usually a preemptive option for patients with advanced chronic renal failure, as time on dialysis is a negative independent factor for transplant outcomes, lead us to conclude that the decrease in LDKT depends on other factors.Thus, in the kidney transplant annual meeting held at ONT site in 2018, a working group was created to identify other causes for the decrease of LDKT in Spain and its relationship with the different steps of the process. The group was formed by transplant teams, a representative of the transplant group of the Spanish Society of Nephrology (SENTRA), a representative of the Spanish Society of Transplants (SET) and representatives of the Spanish National Transplant Organization (ONT).A self-evaluation survey that contains requests about the phases of the LDKT processes (information, donor work out, informed consent, surgeries, follow-up and human resources) were developed and sent to 33 LDKT teams. All the centers answered the questionnaire. The analysis of the answers has resulted in the creation of a national analysis of strengths, weaknesses, opportunities, threats (SWOT) of the LDKT program in Spain and the development of recommendations targeted to improve every step of the donation process. The work performed, the conclusions and recommendations provided, have been reflected in the following report: Spanish living donor kidney transplant program assessment: recommendations for optimization. This document has also been reviewed by a panel of experts, representatives of the scientific societies (Spanish Society of Urology (AEU), Spanish Society of Nephrology Nursery (SEDEN), Spanish Society of Immunology (SEI/GETH)) and the patient association ALCER. Finally, the report has been submitted to public consultation, reaching ample consensus. In addition, the transplant competent authorities of the different regions in Spainhave adopted the report at institutional level.The work done and the recommendations to optimize LDKT are summarized in the present manuscript, organized by the different phases of the donation process. Resumen: El trasplante renal de donante vivo (TRDV) es la opción terapéutica con las mejores expectativas de supervivencia para el injerto y para el paciente con insuficiencia renal terminal; sin embargo, este tipo de trasplantes ha experimentado un descenso progresivo en los últimos años en España.Entre las posibles explicaciones del descenso de actividad se encuentra la coincidencia en el tiempo con un aumento en el número de donantes renales fallecidos, tanto por muerte encefálica como por asistolia controlada, que podría haber generado una falsa impresión de ausencia de necesidad del TRDV. Además, la disponibilidad de un mayor número de riñones para trasplante habría supuesto un incremento en la carga de trabajo de los profesionales que pudiera enlentecer los procesos de donación en vida. Otro posible argumento radica en un posible cambio de actitud hacia posturas más conservadoras a la hora de informar a pacientes y a familiares acerca de esta opción terapéutica, a raíz de los artículos publicados respecto al riesgo de la donación a largo plazo. Sin embargo, existe una importantísima variabilidad en la actividad entre centros y comunidades autónomas, no explicada por el volumen de trasplante procedente de otros tipos de donante. Este dato, unido a que la indicación de donación renal en vida se realiza de manera mayoritaria en situación de enfermedad renal crónica avanzada (ERCA) y que el tiempo en diálisis es un factor pronóstico negativo respecto a la supervivencia postrasplante, permite concluir que el descenso depende además de otros factores.Por este motivo, en la reunión anual de equipos de trasplante renal, celebrada en la sede de la Organización Nacional de Trasplantes (ONT) en 2018, se constituyó un grupo de trabajo formado por equipos de trasplante renal, el grupo de trasplantes de la Sociedad Española de Nefrología (SEN) (SENTRA), la Sociedad Española de Trasplantes (SET) y la ONT, con el objetivo de identificar otras causas que condicionaron el descenso de la actividad de este tipo de trasplantes en España y su posible relación con la gestión del proceso de donación de vivo.El grupo de trabajo diseñó un cuestionario de autoevaluación, que fue cumplimentado por las 33 unidades de trasplante renal de donante vivo activas en España. El cuestionario contiene preguntas sobre las diferentes fases del proceso de donación de vivo: información inicial, estudio del donante vivo e información de los riesgos, consentimiento, recursos humanos (RRHH), nefrectomía, trasplante y seguimiento posterior.El análisis de las respuestas ha dado como resultado la creación de un análisis de debilidades, amenazas, fortalezas y oportunidades (DAFO) del programa a nivel nacional y ha permitido elaborar recomendaciones específicas dirigidas a mejorar cada una de las fases del proceso de donación en vida. El documento, denominado Análisis de situación del trasplante renal de donante vivo y hoja de ruta ha sido también revisado por un panel de expertos en TRDV, representantes de varias sociedades científicas implicadas (Asociación Espa˜nola de Urología [AEU], Sociedad Espa˜nola de Enfermería Nefrológica [SEDEN], Sociedad Espa˜nola de Inmunología [SEI/GETH]), el Grupo de Trabajo Enfermedad Renal Crónica Avanzada (ACERCA), la Asociación de Pacientes para la Lucha Contra la Enfermedad Renal (ALCER) y sometido posteriormente a consulta pública. Tras incluir las mejoras sugeridas, el documento final ha sido adoptado institucionalmente en el Consejo Interterritorial de Trasplantes (CIT) del Sistema Nacional de Salud.El trabajo realizado y las recomendaciones para optimizar el TRVD se describen a lo largo del presente artículo, organizados por los diferentes apartados del proceso de donación.

This study focuses on the issue of school bullying and explores the potential of video games as a tool to prevent and address this problem. To accomplish this, the video game Monité, specifically designed for the prevention of school bullying, was utilized, using the paradigm of digital game-based learning as an intervention methodology that emphasizes its educational and recreational potential. This study was conducted using a quasi-experimental approach, employing a pre-test and post-test design with a non-equivalent control group. The sample consisted of 92 boys and girls from fifth and sixth grade in primary education in the province of Cáceres, Spain. Data were collected through questionnaires from the System for the Evaluation of Children and Adolescents (SENA), which allowed for the gathering of information on peer problems, school problems and family issues. The results show that there are significant differences between the intervention group and the control group regarding problems external to individuals. In conclusion, this study investigates the use of the video game Monité as a tool to prevent school bullying and analyzes its impact on students’ perception of external agents such as family, peer group, and school. Our findings support its implementation in educational environments as an effective strategy.

Background. In kidney transplant recipients, there is discordance between the development of cellular and humoral response after vaccination against SARS-CoV-2. We sought to determine the interplay between the 2 arms of adaptive immunity in a 3-dose course of mRNA-1273 100 μg vaccine. Methods. Humoral (IgG/IgM) and cellular (N- and S-ELISpot) responses were studied in 117 kidney and 12 kidney-pancreas transplant recipients at the following time points: before the first dose, 14 d after the second dose‚ and before and after the third dose, with a median of 203 and 232 d after the start of the vaccination cycle, respectively. Results. After the second dose, 26.7% of naive cases experienced seroconversion. Before the third dose and in the absence of COVID-19, this percentage increased to 61.9%. After the third dose, seroconversion occurred in 80.0% of patients. Naive patients who had at any time point a detectable positivity for S-ELISpot were 75.2% of the population, whereas patients who maintained S-ELISpot positivity throughout the study were 34.3%. S-ELISpot positivity at 42 d was associated with final seroconversion (odds ratio‚ 3.14; 95% confidence interval‚ 1.10-8.96; P = 0.032). Final IgG titer was significantly higher in patients with constant S-ELISpot positivity (P

This paper aims to reflect on educational innovation from the point of view of its representation as an indispensable element within the pedagogical culture of educational centers. We present the current elements that constitute the definition of educational innovation, its dimensions, obstacles, and determining factors that will delimit the institutionalization of the innovation process in education. To achieve this aim, we applied the Delphi technique and formulated questions whose answers were agreed upon in several iterations by 20 experts. The results have been organized into four categories that provide the backbone features of the visions, paradigms, opinions, and relevant pedagogical reflections on the concept of innovation, on the organization and participants in the process of innovation, on the pressures and resistance encountered during the process, and on the promotion and trends of educational innovation. We conclude that the definition of educational innovation requires a reflective yet critical and transformative component and that there is a close relationship between innovation and leadership in educational centers. We highlight the lack of time and weak training as the main factors limiting the implementation of reflective and transformative educational innovation processes. Finally, we highlight that promoting an educational innovation culture should be based on flexible research and evaluation processes that enable decision-making and favor pedagogical beliefs for change, together with continuous collaborative support.

The aim objective of this study was to analyze the incorporation procedure for the Portal 2 video game in the subject Mathematical Knowledge in Early Childhood Education. Two specific objectives were proposed: (a) to consider whether the inclusion of a video game is a motivating educational resource, and (b) to determine the degree of knowledge related to visuospatial perception acquired through interaction with the video game.A total of 170 students from the Faculty of Education Sciences of the University of Cádiz participated in this study.Three variables were analyzed: the use of the video game as a resource, the degree of motivation towards mathematics-related learning, and the acquisition of visuospatial skills.The results show that the students affirmed the video game's suitability as a learning resource, although as a supplementary resource to the dynamics of the subject, highlighting the strong motivational factor and the set of knowledge acquired.

El uso de videojuegos en el aula es una tendencia educativa planteada, documentada e investigada desde hace décadas. Este artículo de investigación parte con la premisa de plasmar mediante, una revisión sistemática de literatura, el estado actual de los estudios con videojuegos en contextos educativos formales. Para ello, se realizó una búsqueda de documentos en la base de datos Scopus, obteniéndose una muestra de 7320 documentos, la cual, tras pasar por un proceso de screening, se obtuvieron 90 que cumplían con los criterios de inclusión planteados para esta revisión en el periodo de 2015 a 2020. Los datos hallados fueron sometidos a análisis estadístico, mediante la utilización de software de análisis estadístico spss. Las conclusiones que se extrajeron de los documentos analizados arrojan que en las investigaciones con videojuegos y educación la metodología cuantitativa es la más utilizada por la comunidad científica; también destacan los estudios con diseños descriptivos, los cuales sirven para obtener datos de un modo general sobre el funcionamiento de los videojuegos en el aula. Finalmente, se ha destacado a los videojuegos educativos como los más utilizados en los documentos analizados debido a sus connotaciones didácticas.

Abstract Living kidney donors’ follow-up is usually focused on the assessment of the surgical and medical outcomes. Whilst the psychosocial follow-up is advocated in literature. It is still not entirely clear which exact psychosocial factors are related to a poor psychosocial outcome of donors. The aim of our study is to prospectively assess the donors’ psychosocial risks factors to impaired health-related quality of life at 1-year post-donation and link their psychosocial profile before donation with their respective outcomes. The influence of the recipient’s medical outcomes on their donor’s psychosocial outcome was also examined. Sixty donors completed a battery of standardized psychometric instruments (quality of life, mental health, coping strategies, personality, socio-economic status), and ad hoc items regarding the donation process (e.g., motivations for donation, decision-making, risk assessment, and donor-recipient relationship). Donors’ 1-year psychosocial follow-up was favorable and comparable with the general population. So far, cluster-analysis identified a subgroup of donors (28%) with a post-donation reduction of their health-related quality of life. This subgroup expressed comparatively to the rest, the need for more pre-donation information regarding surgery risks, and elevated fear of losing the recipient and commitment to stop their suffering.

En el contexto del Proyecto de Investigación «Ecologías de aprendizaje en contextos múltiples: análisis de proyectos de educación expandida y conformación de ciudadanía (EDU2014- 51961-P)» desde el Grupo de Investigación «Nodo Educativo» se presenta el estudio de caso que pretende destacar cuáles son las estrategias de aprendizaje de componente social en espacios de creación similares a la «cultura Maker« a partir del uso de videojuegos online. Para ello, se diseño un estudio cualitativo y se seleccionó el método de estudio de caso. Seleccionamos a 21 participantes del evento «Gumiparty». Se utilizó la entrevista oral como técnica de recogida de información. El análisis de los datos se realizó a través del método de comparación constante y para ello usamos el software NVivo versión 11. Se analizaron categorías relacionadas con las posibilidades de creación y transformación social propias del movimiento maker y aplicados a la comunidad de videojugadores del evento. Se observó cómo los videojugadores crean una comunidad dinámica que da soporte al aprendizaje individual de sus miembros y los convierte en prosumidores de contenidos relacionados con los videojuegos. Se concluye que la «cultura Maker» ofrece un modelo educativo con una serie de prácticas que puede llevarse al aula convencional para el desarrollo de aprendizajes conectados y profundos. /// In the context of the Research Project «Learning ecologies in multiple contexts: analysis of expanded education projects and conformation of citizenship (EDU2014- 51961-P)» from «Nodo Educativo» Research Group, a case study is presented which aims to highlight which are the learning strategies of social component in creation spaces similar to the maker culture from the use of online videogames. For this, a qualitative study was designed and the case study method was selected. We selected 21 participants of the Gumiparty event. The oral interview was used as a technique for collecting information. The analysis of the data was done through the constant comparison method and for this we used the software NVivo version 11. We analyzed categories related to the possibilities of creation and social transformation of the maker movement and applied to the community of gamers of the event. It was observed how the gamers create a dynamic community that supports the individual learning of its members and converts them into prosumers of content related to videogames. It is concluded that the maker culture offers an educational model with a series of practices that can be taken to the conventional classroom for the development of connected and deep learning.

Background: Living-donor kidney transplant (LDKT) recipients undergoing desensitization for Human Leukocyte Antigen (HLA)-incompatibility have a high risk of developing antibody-mediated rejection (ABMR). The purpose of the study is to evaluate if residual B cell activity after desensitization could be estimated by the presence of circulating B cell-derived extracellular vesicles (BEVs).Methods: BEVs were isolated by Sepharose-based size exclusion chromatography and defined as CD19+ and HLA-II+ extracellular vesicles. We analyzed stored serum samples from positive crossmatch LDKT recipients before and after desensitization at first post-transplant biopsy and at 12-month protocol biopsy (n = 11). Control groups were formed by hypersensitized patients who were not submitted to desensitization (n = 10) and by low-risk recipients (n = 9). A prospective validation cohort of 11 patients also included the analysis of B cells subpopulations in recipients' blood and lymph nodes recovered upon graft implantation, along with BEVs analysis before and after desensitization.Results: We found out that CD19+ and HLA-II+BEVs dropped significantly after desensitization and relapse in patients who later developed ABMR was evident. We validated these findings in a proof-of-concept prospective cohort of 6 patients who received the same desensitization protocol and also in a control group of 5 LDKT recipients. In these patients, B cell subpopulations were also studied in recipients' blood and lymph nodes that were recovered before the graft implantation. We confirmed the significant drop in BEVs after desensitization and that this paralleled the reduction in CD19+cells in lymph nodes, while in peripheral blood B cells, this change was almost undetectable.Conclusions: BEVs reflected B cell residual activity after desensitization and this could be a valid surrogate of humoral alloreactivity in this setting.

Background: Despite recent advances in immunosuppression treatment, antibody-mediated rejection (ABMR) remains the leading cause of kidney graft loss. Information about prognostic markers and the efficacy of treatment is scarce.Methods: Retrospective study with kidney recipients diagnosed an active ABMR from January 1, 2004 to December 31, 2019 to explore the influence of persistent inflammation in follow-up biopsies on graft survival after ABMR treatment.Results: About 116 patients were included. Active ABMR were treated with a combination of plasma exchange (PE), intravenous immunoglobulin (IVIg), rituximab, and steroids. At 6 months of treatment, 63 (54.3%) patients presented a stabilization or improvement in kidney-graft function. The effectiveness varied depending on the timepoint of the presentation between transplantation and rejection, which is lower for those with late ABMR (63 vs. 21% for early vs. late ABMR, respectively). Ninety patients (77%) underwent a control biopsy after ABMR treatment, from which 46 (51%) responded to the treatment. Microvascular inflammation (MVI) persisted in 64 (71%) biopsies, whereas tubulitis persisted in 17 (19%) biopsies. Death-censored graft survival at 1 year was significantly lower in patients with persistent MVI (86% vs. 95% without persistent MVI, P = 0.002), or with persistent tubulitis (44% vs. 66% without tubulitis, P = 0.02). In the Cox Regression analysis, the persistence of MVI [hazard ratio (HR), 4.50 (95%CI, 1.35–14.96), P = 0.01] and tubulitis [HR 2.88 95%CI (1.24–6.69), P = 0.01) in follow-up biopsies significantly increased the risk of graft failure.Conclusion: Persistent inflammation in follow-up biopsies after ABMR treatment was associated with an increased risk of graft loss, even without meeting Banff rejection criteria.Study Registration: Agencia Española de Medicamentos y Productos Sanitarios (AEMPS): 14566/RG 24161. Study code: UTRINM-2017-01.

Abstract Background Chronic active antibody-mediated rejection (c-aABMR) is an important cause of allograft failure and graft loss in long-term kidney transplants. Methods To determine the efficacy and safety of combined therapy with rituximab, plasma exchange (PE) and intravenous immunoglobulins (IVIG), a cohort of patients with transplant glomerulopathy (TG) that met criteria of active cABMR, according to BANFF’17 classification, was identified. Results We identified 62 patients with active c-aABMR and TG (cg ≥ 1). Twenty-three patients were treated with the combination therapy and, 39 patients did not receive treatment and were considered the control group. There were no significant differences in the graft survival between the two groups. The number of graft losses at 12 and 24 months and the decline of eGFR were not different and independent of the treatment. A decrease of eGFR≥13 ml/min between 6 months before and c-aABMR diagnosis, was an independent risk factor for graft loss at 24 months (OR = 5; P = 0.01). Infections that required hospitalization during the first year after c-aABMR diagnosis were significantly more frequent in treated patients (OR = 4.22; P = 0.013), with a ratio infection/patient-year of 0.65 and 0.20 respectively. Conclusions Treatment with rituximab, PE, and IVIG in kidney transplants with c-aABMR did not improve graft survival and was associated with a significant increase in severe infectious complications. Trial registration Agencia Española de Medicametos y Productos Sanitarios (AEMPS): 14566/RG 24161. Study code: UTR-INM-2017-01.

The educational integration of Information and Communication Technologies (ICT) has been put to the test because of the need to implement «emergency remote education» as a result of COVID-19. Within this context of uncertainty («viral modernity»), flexible education is an option to promote a more just, equitable, accessible and creative educational system. In order to properly interpret the effects of this unique educational circumstance, it is essential to study the previous situation in terms of the use of digital technologies in teaching practices. The objective of the study is to describe the educational integration of ICT and the teacher education model to obtain evidence that contributes to understanding the phenomenon. To this end, a questionnaire consisting of two self-reporting tools and a scale on the description of teaching practice with ICT was applied. The sample is made up of teachers from public primary and secondary schools (N = 251). Data collection was carried out in the months prior to the closure of schools due to the Covid-19 pandemic. A univariate analysis of the variables and contrast tests of non-parametric hypotheses was carried out, along with calculation of the reliability and construction validity of the measuring instruments. The results reveal the most frequent types of teaching practice with ICT and the spaces where digital technologies are commonly used. Various weaknesses can be identified in digital competence among teachers, as well as in the initial/continuing training model, which contribute to the understanding of the difficulties encountered during "emergency remote education". Participation in ICT didactic innovation projects and the performance of ICT Coordination are associated with more experiential training. Flexible education requires a redefinition of the teacher training model that encourages learning anywhere, anytime.

Video game use is widespread among all age groups, from young children to older adults. The wide variety of video game genres, which are adapted to all tastes and needs, is one of the factors that makes them so attractive. In many cases, video games function as an outlet for stress associated with everyday life by providing an escape from reality. We took advantage of this recreational aspect of video games when investigating whether there are similarities between the procedures used to pass a video game level and those used to solve a mathematical problem. Moreover, we also questioned whether the use of video games can reduce the negative emotions generated by mathematical problems and logical–mathematical knowledge in general. To verify this, we used the Portal 2 video game as a research method or tool. This video game features concepts from the spatial–geometric field that the students must identify and relate in order to carry out the procedures required to solve challenges in each level. The procedures were recorded in a questionnaire that was separated into two blocks of content in order to compare them with the procedures used to solve mathematical problems. The first block pertains to the procedures employed and the second block to the emotions that the students experienced when playing the video game and when solving a mathematical problem. The results reveal that the recreational aspect of video games is more important than the educational aspect. However, the students were not aware of using the problem-solving procedures they learned at school to solve different challenges in the video games. Furthermore, overcoming video game challenges stimulates positive emotions as opposed to the negative emotions generated when solving mathematical problems.

Gamification allows for the implementation of experiences that simulate the design of (video) games, giving individuals the opportunity to be the protagonists in them. Its inclusion in the educational environment responds to the need to adapt teaching–learning processes to the characteristics of homo videoludens, placing value once again on the role of playful action in the personal development of individuals. The interest that has arisen in studying the implications of gamification processes in the different educational stages, in order to determine their impact and suitability, has led to an increase in scientific publications. With the intention of studying the presence and implications of gamification in teacher training as a methodological principle implemented in the teaching–learning process, both in its initial and permanent stages, this systematic review of the literature identifies those instructional design models applied in the field of gamification, as well as its educational significance. Thus, the need to introduce gamified practices in the field of teacher training is observed, providing an experiential learning that allows teachers to apply this methodology in a relevant way in their professional development, based on their own experience.

The development of digital competence is a critical and unpostponable challenge for actual society and an emerging area of educational research. In order to give empirical support to the design of educational policies, this work to know what are the expectations of a group of higher education students with high performance and limited economic conditions, the scholarship program "Beca 18" of the Peruvian government, on the different factors that characterize digital competence, as well as knowing the socio-educational differences associated with this perception. For this purpose, the Digital Competencies in Higher Education Questionnaire (CDES) was used to a highly representative sample at the national level, 9,469 students. Among the main results we can highlight that there are significant differences on the appraisement of digital competence according to gender, place of origin and type of study institution. These variables are especially sensitive in public debate, promotion and research on digital competence as the educational component in the basic and professional training of citizens in the technologically mediated society. In conclusion, this high performance group has a vision of digital competence that is not limited to technical aspects, but is clearly associated with factors such as creativity and innovation.

La consideración del juego como herramienta educativa es una constante en la cultura humana. Actualmente, la esencia del juego es la misma, pero han cambiado los formatos para llevarlo a cabo. En éste marco nacen los videojuegos, los cuáles han tenido una vertiginosa evolución considerándose en los últimos años como elementos educativos mediante el Digital Game Based Learning. También se han tenido en cuenta las emociones como elementos propios de los procesos de aprendizaje vinculados con una serie de atributos y habilidades identificados con la docencia. La investigación realizada versa sobre la identificación de aprendizajes de atributos y habilidades docentes y el tratamiento de las emociones a través del análisis de videojuegos con temáticas sociales como son This War of Mine, Papers, please! y Unmanned. Las técnicas de acopio de información han sido la observación y la entrevista. Mediante éstas técnicas los videojugadores deben identificar qué emociones, atributos y habilidades son capaces de experimentar y/o desarrollar mientras están jugando. A modo de conclusión, se puede señalar que el análisis de los videojuegos fue efectivo y se hallaron respuestas emocionales ante acciones desarrolladas en el juego, así como aprendizajes destacados para el docente del siglo XXI presentes en los tres videojuegos.

Introduction: Despite the different assays available for immune-risk stratification before living-donor kidney transplantation (LDKT), the precise type and number of tests to perform remain uncertain. Methods: In a cohort of 330 consecutive LDKT patients, all of which were complement-dependent cytotoxicity (CDC)−crossmatch negative, we retrospectively analyzed the impact on main clinical outcomes of most sensitive immunoassays (complement-dependent cytotoxicity−panel-reactive antibody [CDC-PRA], flow cytometry crossmatch [FC-XM], donor-specific antibodies [DSAs], and their complement-binding capacity DSA-C3d]), together with donor/recipient HLA eplet matching. Mean follow-up was 67 months (range 24−190 months). Results: Of 330 patients, 35 (11%) showed a CDC-PRA >20%; 17 (5%) FC-XM+; 30 (9%) DSA+, 18(5%) DSA-C3d+, with low overlapping results (10 patients positive in all donor-specific tests). Unlike HLA allele compatibility, the mean number of HLA class II eplet mismatches was higher in LDKT patients with positive baseline test results. DSA-C3d+ showed higher mean fluorescence intensity (MFI) DSA, with a cut-off MFI of 6192 accurately predicting complement fixation (area under the curve = 0.85, P = 0.008). Although all assays were associated with acute rejection (AR), only DSA-C3d+ (odds ratio [OR] = 6.64, P = 0.038) or high MFI-DSA (OR = 7.54, P = 0.038) independently predicted AR. Likewise, poorly HLA class II eplet−matched patients were at higher risk for AR, particularly patients with negative baseline test results (OR = 1.14, P = 0.019). Finally, previous AR and FC-XM+/DSA+, regardless of C3d positivity, independently predicted graft loss. Conclusion: Combining FC-XM and solid-phase assays with the evaluation of donor/recipient HLA eplet mismatches, are most accurate tools for immune-risk stratification prior LDKT. Keywords: acute rejection, crossmatch immunoassays, donor-specific antibodies, HLA matchmaker, immune risk stratification, living donor kidney transplantation

Esta investigación se centra en el desarrollo de un modelo de integración de competencias digitales del docente universitario para su desarrollo profesional en la enseñanza de la matemática, como escenario para el crecimiento y fortalecimiento del ejercicio profesional docente. Metodológicamente se analizaron los aspectos más relevantes de las diferentes normas y modelos propuestos por varios ministerios de educación, entre ellos Australia, Bélgica, Canadá, Chile, España, Estados Unidos, Francia, Noruega y otros, así como organizaciones como la UNESCO O ISTE, y las investigaciones de prestigiosas universidades (Pozos Pérez, 2009; Carrera y Coiduras, 2012; Prendes y Gutiérrez, 2013). Este estudio determina un perfil preliminar del profesorado del área de matemáticas, en el que se describen las dimensiones, competencias e indicadores que desarrolla el profesorado de una universidad de Ecuador y que fue validado por un grupo de expertos internacionales en competencias digitales. Los resultados muestran que el perfil está compuesto por 44 indicadores que corresponden a 21 habilidades digitales que responden a los niveles: básico, intermedio y avanzado de las cuestiones de dominio, uso e innovación en cinco áreas: información y alfabetización, comunicación y colaboración, creación de contenidos digitales, seguridad y resolución de problemas.

The education system has become even more complex following the global pandemic, which saw face-to-face teaching transition to virtual teaching. To cope with this abrupt transition, it is essential that teachers have a sufficient level of digital teaching competence. This article aims to increase awareness of teachers’ self-perception of their digital teaching competences in the educational field. Specifically, this study explores Spanish secondary school teachers’ knowledge and use of different ICT tools by evaluating their competence based on different areas proposed by The National Institute of Technology and Professional Development (Instituto Nacional de Tecnologías Educativas y de Formación del Profesorado, INTEF), Madrid, Spain. From the results of the questionnaires, we have determined that teachers consider themselves to have an upper intermediate level of digital teaching competence, although there are still shortcomings that need to be addressed in order to improve this level of competence, and its true integration in the teaching–learning process.

En este estudio realizado en una institución argentina de educación superior se comparan tres estrategias pedagógicas: la tradicional (basada en resolver problemas), el desarrollo de juegos serios y el uso de estos. Se utilizó una metodología mixta con ejecución secuencial explicativa. Los datos cuantitativos se recogieron usando pruebas objetivas y el TEIQue (Trait Emotional Intelligence Questionnaire). Por conveniencia se realizó un muestreo incidental no probabilístico (tradicional: n=27; desarrollo de juegos: n=25; uso de juegos: n=25). Después se recabaron datos cualitativos mediante 16 entrevistas. Los resultados del análisis indican que existen diferencias significativas a favor de las estrategias lúdicas.

Despite the high incidence of posttransplant infections, postinfectious acute glomerulonephritis (PIAGN) in renal allograft is a rare entity, without effective treatment and a bad prognosis. We describe two cases of PIAGN: the first one was developed 2 years after kidney transplantation, secondary to Staphylococcus aureus bacteremia with presence of extracapillary proliferation in biopsy. The patient was treated with methylprednisolone and plasma exchanges without response, remaining dialysis dependent. The second case was reported 5 years after kidney transplantation, secondary to influenza A infection. Kidney biopsy showed an IgA-dominant PIAGN and methylprednisolone boluses were initiated without clinical response, suffering a progressive worsening and loss of kidney graft. Due to the aggressive clinical course of this entity, PIAGN should be considered in the differential diagnosis of acute kidney graft failure in the context of an infection. Elderly patients have a higher risk of more severe acute renal dysfunction, requiring dialysis in a great proportion of cases.

El desconocimiento del código PEGI por parte de padres, madres y docentes es un problema para el consumo responsable de videojuegos. La ignorancia de los símbolos y la falta de formación para interpretarlos hace que a pesar de estar ubicado desde hace años en las portadas y contraportadas de los videojuegos sea un desconocido por los consumidores y lo obvien a la hora de consultar la idoneidad del producto. Se realizó una investigación para conocer qué vinculaba al código PEGI con el contexto educativo haciendo que el alumnado de Grado de Infantil utilizasen este código para clasificar videojuegos y decidir sobre si son o no adecuados para la inclusión en la práctica educativa. Es de interés que los docentes conozcan este sistema pues son productos culturales relevantes que están presentes en el ocio de los discentes y cada vez en mayor medida en las aulas de todos los niveles educativos.

Somos conscientes de la dimensión temporal que existe desde el inicio de los estudios de los videojuegos desde diferentes prismas hasta el momento actual. Si nos detenemos en el punto de vista de la inclusión del videojuego en los procesos de enseñanza y aprendizaje, hemos podido comprobar a lo largo de estas décadas que se ha evolucionado desde el uso de videojuegos como recursos para cambiar patrones (desde el más puro estilo conductista) hasta la situación actual que transita por 3 líneas claramente diferenciadas: (a) el uso de videojuegos comerciales como recurso para afianzar un determinado contenido educativo, (b) el uso de los denominados «juegos serios» cuyo modelo integra el desarrollo de contenidos educativos que requieren ser utilizados en el juego como si de una simulación se tratase, esto conlleva la adquisición de nuevos aprendizajes y afianzar otros aprendizajes que adquiridos de otras formas, y; (c) los desarrollos y aplicaciones de la «deconstrucción» del juego que se denomina «gamificación», y que trata de «edulcorar» situaciones de aprendizaje a través del análisis del juego en su contexto general.

Standard immunosuppression is used in about 60% of patients receiving kidney grafts from their monozygotic twins living donor although an alloimmune response can not take place. The aim of the study was to asses the clinical response in patients receiving renal grafts from a monozygotic twin living donor when no immunosuppressive therapy is used. Methods: This is a retrospective observational study of patients receiving kidney grafts from their monozygotic twins from 1969 to 2013. The following data were recorded: age, renal graft recipient's primary disease, renal function, renal survival and overall survival. Immunosuppressive therapy included a single intraoperative dose of methylprednisolone 500 mg and no maintenance immunosuppression. Results: Five patients with kidney grafts from their monozygotic twins were dentified in our centre. Mean age at transplantation was 33 years (27–39). One-year overall survival and graft survival were 100%. Mean creatinine level was 0.96 ± 0.2 one year after transplanta tion, and 1.2 ± 0.37 mg/dl at most recent follow-up. Two patients died with a functional graft more than 15 years after kidney transplantation (causes were melanoma and cardiovascu lar event respectively). Follow-up was lost in a patient one year after transplantation. Two patients are alive with a functioning graft at 18 months and 42.5 years after transplantation respectively. Conclusion: Kidney transplantation from a monozygotic twin living donor is associated with excellent clinical outcomes. Immunosuppressive therapy to suppress alloimmune response is probably unnecessary if zygosity has been confirmed.