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Background: Limited studies have evaluated the joint influence of redox-related metals and genetic variation on metabolic pathways. We analyzed the association of 11 metals with metabolic patterns, and the interacting role of candidate genetic variants, in 1145 participants from the Hortega Study, a population-based sample from Spain. Methods: Urine antimony (Sb), arsenic, barium (Ba), cadmium (Cd), chromium (Cr), cobalt (Co), molybdenum (Mo) and vanadium (V), and plasma copper (Cu), selenium (Se) and zinc (Zn) were measured by ICP-MS and AAS, respectively. We summarized 54 plasma metabolites, measured with targeted NMR, by estimating metabolic principal components (mPC). Redox-related SNPs (N = 291) were measured by oligo-ligation assay. Results: In our study, the association with metabolic principal component (mPC) 1 (reflecting non-essential and essential amino acids, including branched chain, and bacterial co-metabolism versus fatty acids and VLDL subclasses) was positive for Se and Zn, but inverse for Cu, arsenobetaine-corrected arsenic (As) and Sb. The association with mPC2 (reflecting essential amino acids, including aromatic, and bacterial co-metabolism) was inverse for Se, Zn and Cd. The association with mPC3 (reflecting LDL subclasses) was positive for Cu, Se and Zn, but inverse for Co. The association for mPC4 (reflecting HDL subclasses) was positive for Sb, but inverse for plasma Zn. These associations were mainly driven by Cu and Sb for mPC1; Se, Zn and Cd for mPC2; Co, Se and Zn for mPC3; and Zn for mPC4. The most SNP-metal interacting genes were NOX1, GSR, GCLC, AGT and REN. Co and Zn showed the highest number of interactions with genetic variants associated to enriched endocrine, cardiovascular and neurological pathways. Conclusions: Exposures to Co, Cu, Se, Zn, As, Cd and Sb were associated with several metabolic patterns involved in chronic disease. Carriers of redox-related variants may have differential susceptibility to metabolic alterations associated to excessive exposure to metals.

Background Platelet FcγRIIa amplifies platelet activation and, thus, increased expression identifies patients with increased platelet reactivity. Previous work has demonstrated that platelet FcγRIIa can identify patients at high and low risk of subsequent cardiovascular events after myocardial infarction (MI). This study was designed to compare platelet expression of FcγRIIa in patients with stroke and transient ischemic attack (TIA) with that in patients with a recent MI. Methods Patients were enrolled based on an admitting diagnosis of stroke/TIA, and the discharge diagnosis was used to categorize patients into stroke/TIA (n=99) and other causes of neurologic dysfunction (hemorrhagic, trauma, toxic, and seizure; n=14). Patients with stroke/TIA were divided into embolic (both cardioembolic and thromboembolic; n=32) and not embolic causes (n=67). Results were compared with platelet FcγRIIa expression in patients with recent MI from a previous study (n=197). Platelet expression of FcγRIIa (molecules of FcγRIIa/platelet) was quantified with the use of flow cytometry. Results are mean±SD. Results Platelet expression of FcγRIIa was similar in patients with ischemic (both embolic and nonembolic) stroke/TIA (11 332±4127), embolic (11 204±3889) and nonembolic (11 393±4263) causes, and MI (11 479±2405). Patients with other causes of neurologic dysfunction had modestly but not significantly lower platelet expression of FcγRIIa (9389±2883; P=0.13). Conclusions Platelet expression of FcγRIIa was similar in patients with stroke/TIA and recent MI. These results support future studies designed to determine whether platelet FcγRIIa expression can discriminate risk of subsequent stroke/TIA and its potential use as a precision tool capable of guiding individualized treatment decisions.

Summary:. Bilateral facial paralysis is a challenging situation requiring complex management. Surgical treatment can include nerve transfers, mainly masseter-to-facial, or muscle transfers, gracilis free flap, or temporalis transposition. Deciding on the surgical option depends on the duration of the paralysis and the feasibility of facial muscles. We present the case of a 10-year-old child with permanent bilateral facial paralysis after brainstem tumor surgery. The patient was treated with bilateral simultaneous hypoglossal-to-facial transfer followed by bilateral simultaneous masseter-to-facial 12 months later. After 23 months of follow-up and specific physical therapy, she has good and symmetric resting tone, complete eye closure, moderate bilateral smile excursion, mild lip pucker movement, and good oral competence. The combination of these two nerve transfers, when possible, gives the opportunity of restoring movement taking the best of each technique, with acceptable results and no significant clinical deficits in the donor sites.

Adult morbid obesity is defined as abnormal or excessive fat accumulation, mostly resulting from a long-term unhealthy lifestyle. Between 10% and 30% of people with obesity exhibit low cardiometabolic risk. The metabolic syndrome has been suggested as an indicator of obesity-related metabolic dysregulation. Although the prevalence of obesity does not seem to be sex-related and metabolic syndrome occurs at all ages, in the last few years, sex-specific differences in the pathophysiology, diagnosis, and treatment of metabolic syndrome have received attention. The aim of this study was to determine the prevalence of metabolic syndrome and its components in different sex and age groups in people with metabolic unhealthy obesity and to compare them with people with metabolic healthy obesity. We analyzed the metabolome in 1350 well-phenotyped morbidly obese individuals and showed that there is a strong sex-dependent association of metabolic syndrome with circulating metabolites. Importantly, we demonstrated that metabolic dysregulation in women and men with severe obesity and metabolic syndrome is age-dependent. The metabolic profiles from our study showed age-dependent sex differences in the impact of MetS which are consistent with the cardiometabolic characterization. Although there is common ground for MetS in the metabolome of severe obesity, men older than 54 are affected in a more extensive and intensive manner. These findings strongly argue for more studies aimed at unraveling the mechanisms that underlie this sex-specific metabolic dysregulation in severe obesity. Moreover, these findings suggest that women and men might benefit from differential sex and age specific interventions to prevent the adverse cardiometabolic effects of severe obesity.

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Abstract Background Falls are major adverse events in hospitals. The appropriateness of using risk assessment instruments for falls in hospitals has recently been questioned, although the research performed in this respect presents some methodological shortcomings. The purpose of the present study is to evaluate the accuracy of the Downton and STRATIFY instruments to determine the risk of falls and to predict their incidence in acute care hospitals in the public health system in Andalusia (Spain). Methods A longitudinal, multicentre prospective study was made of a cohort of patients recruited between May 2014 and March 2016. The risk of falls was assessed using each of the above instruments during the first 24 h after hospital admittance, with later re-evaluations every 72 h until discharge. Descriptive statistics were obtained, bivariate and multivariate analysis were performed. The diagnostic validity of the process was assessed by calculations of sensitivity, specificity, positive and negative predictive values and ratios of positive and negative likelihood. ROC curve analysis was performed for both instruments. Results For this study, 1247 patients were recruited, of whom 977 completed all the follow-up assessments. Twenty-three of these patients (2.35%) suffered 24 falls. ROC curve analysis showed that the optimal cut-off point for each assessment instrument was below that described by the authors: AUC STRATIFY = 0.69 (95% CI: 0.57–0.8); AUC Downton = 0.6 (95% CI: 0.48–0.72). With a cut-off point of 1, the sensitivity of STRATIFY was 47.6% and its specificity, 85%. With a cut-off point of 2, Downton presented a sensitivity of 66.7% and a specificity of 55.3%. Conclusions The Downton and STRATIFY falls risk assessment instruments presented little utility as means of detecting the risk of falls among a sample of adult patients admitted to acute care hospitals. Fall prevention in hospitals should be based on the study of individual risk factors.

BackgroundGraft thrombosis is a devastating complication after renal transplantation. We recently described the association of anti-beta-2-glycoprotein-I (IgA-ab2GP1) antibodies with early graft loss mainly caused by thrombosis in a monocenter study.MethodsMulticenter prospective observational cohort study.Setting and participantsSeven hundred forty patients from five hospitals of the Spanish Forum Renal Group transplanted from 2000 to 2002 were prospectively followed-up for 10 years.OutcomesEarly graft loss and graft loss by thrombosis.MeasurementsThe presence of IgA anti-B2GP1 antibodies in pretransplant serum was examined using the same methodology in all the patients.ResultsAt transplantation, 288 patients were positive for IgA-B2GP1 (39%, Group-1) and the remaining were negative (Group-2). Graft loss at 6 months was higher in Group-1 (12.5 vs. 4.2% p

IgA anti-beta-2-glycoprotein I (aB2GPI) antibodies have been related to vascular pathology in the general population and mainly in hemodialyzed patients (prevalence 33%) in whom an elevated incidence of thrombosis and mortality is found. In this paper we have studied the presence of IgA aB2GPI antibodies at pretransplant and their evolution after transplantation with a cross-sectional-based follow-up study of a cohort of 288 endstage renal disease (ESRD) patients treated with kidney transplantation. Pretransplant IgA aB2GPI levels were elevated 31.7±4.2 U/mL without differences in age or type of dialysis. Patients with different etiologies of ESRD showed higher levels of IgA aB2GPI than blood donors, except the groups of non-IgA glomerular disease and systemic erythematosus lupus, whose nonsignificant differences were observed. IgA aB2GPI antibodies dropped immediately after transplantation (10.7±1.0 U/mL, P

Antiphospholipid syndrome is an autoimmune disorder characterized by vascular thromboses and pregnancy morbidity associated with antiphospholipid antibodies: lupus anticoagulant, IgG or IgM anticardiolipin or anti-beta 2-glycoprotein I. The kidney is one of the major target organs in antiphospholipid syndrome (APS). However, beyond the known involvement of the kidney in primary and associated APS, we may be observing a new form of APS within the context of renal failure. This review describes the classical kidney manifestations of APS and provides new considerations to be taken into account.

Analizando los sitios web de universidades de diferentes países es posible construir mapas que reflejen gráficamente las relaciones que se establecen entre ellas, utilizando para ello nuevas técnicas de representación de la información como el análisis de cocitación de sitios web (análisis de cositación) y el escalamiento multidimensional (MDS). Pretendemos demostrar que estas relaciones no son ajenas al mundo real, y que siguen un patrón político, en lugar de un patrón académico, permitiéndonos construir auténticos “mapas geopolíticos” de Internet. Proponemos utilizar este tipo de representaciones como una herramienta para el análisis sociopolítico de la realidad, ya que con estos mapas obtenemos una instantánea de una región geográfica y un momento determinados, de la que es posible extraer nueva y valiosa información. Palabras clave Sitios web de universidades; Técnicas de representación de la información; Webmetría; Escalamiento multidimensional; Análisis de cositación; Mapas del conocimiento. “Geopolitical” maps of the Internet: Aplication of new information representation methods Abstract Based on university websites analysis, from different countries, we can build maps that show visual relations among them. We use new information representation methods, such as web site cocitation (cositation analisys) and multidimensional scaling (MDS). We try to demonstrate that these relations are closely tied to the ones established in the real world, and that they suit a political pattern instead an academical one, allowing us to generate Internet “geopolitical” maps. Our proposal is to use these kind of representations as tools for the social-political analisys of the real world environment. We can get a snapshot of a particular geographical region in a specific time, from wich we can get new and valuable information. Keywords University web sites; Information representation methods; Webometrics; Multidimensional Scaling; Cositation analisys; Knowledge maps.

Abstract The performance of ultrasonic transducers is largely determined by the piezoelectric properties and geometries of their active elements. Due to the brittle nature of piezoceramics, existing processing tools for piezoelectric elements only achieve simple geometries, including flat disks, cylinders, cubes and rings. While advances in additive manufacturing give rise to free-form fabrication of piezoceramics, the resultant transducers suffer from high porosity, weak piezoelectric responses, and limited geometrical flexibility. We introduce optimized piezoceramic printing and processing strategies to produce highly responsive piezoelectric microtransducers that operate at ultrasonic frequencies. The 3D printed dense piezoelectric elements achieve high piezoelectric coefficients and complex architectures. The resulting piezoelectric charge constant, d 33 , and coupling factor, k t , of the 3D printed piezoceramic reach 583 pC/N and 0.57, approaching the properties of pristine ceramics. The integrated printing of transducer packaging materials and 3D printed piezoceramics with microarchitectures create opportunities for miniaturized piezoelectric ultrasound transducers capable of acoustic focusing and localized cavitation within millimeter-sized channels, leading to miniaturized ultrasonic devices that enable a wide range of biomedical applications.

Designing a new astronomical instrument typically challenges the available cameras on the market. In many cases, no camera can fulfill the requirements of the instrument in terms of photon budget, speed, and even interfaces with the rest of the instrument. In this situation, the only options are to either downgrade the performance of the instrument or design new cameras from scratch, provided it is possible to identify a compliant detector. The latter is the case of the SPGCams, the cameras developed to be used with the Tunable Magnetograph (TuMag) and the Sunrise Chromospheric Infrared spectroPolarimeter (SCIP) for the Sunrise iii mission. SPGCams have been designed, developed, and built entirely in-house by the Solar Physics Group (SPG) at the Instituto de Astrofísica de Andalucía (IAA-CSIC). We report here on the scientific rationale and system engineering requirements set by the two instruments that drove the development, as well as on the technical details and trade-offs used to fulfill the specifications. The cameras were fully verified before the flight, and results from the assembly and verification campaign are presented as well. SPGCams share the design, although some parametric features differentiate the visible cameras (for TuMag) and the IR ones (for SCIP). Even though they were specifically developed for the Sunrise iii mission, the robust and careful design makes them suitable for different applications in other astronomical instruments.

Mexico is a country with a vast and extraordinary cultural heritage, which is the result of a rich history of cultural exchange, syncretism and transculturation. This rich culture has been materialized through the consolidation of a long and prestigious museum tradition, which at the same time is sadly characterized by an endemic lack of technological resources rather than professional skills. As a result, we have found that Mexican museums produce very heterogeneous forms of documentation, which are often not even managed using information technologies. Furthermore, most museums deploy ad hoc solutions that directly limit the usefulness and value of the documentation process itself. In response, the recently founded Mexican Ministry of Culture is undertaking the development of the Mexican cultural heritage data model (Modelo de Datos México), which is aimed at contributing to the cultural heritage domain of our country through the correct characterization and documentation of its cultural objects. It is the first documented experience in Mexico of a large-scale data model inspired by CIDOC-CRM, which is complemented by a set of terminological tools that attempt to capture the singularities and idiosyncrasies of the Mexican cultural sector. In the present paper, we will describe the motivations and decisions made so far to optimize the data model to the Mexican reality and the development of the project that will define a set of local terminologies built on the expertise of linguists, information architects, developers and especially, museum professionals.

El proyecto web semántica se perfila cada vez más como una nueva alternativa que viene a resolver algunos de los problemas que presenta el actual modelo de Web. Este trabajo pretende, mediante el planteamiento de ejemplos sencillos y desde el punto de vista del "profesional de la información", hacer una aproximación a las tecnologías básicas que permiten definir una infraestructura semántica sobre la cual desarrollar los sistemas de información del futuro. Además, se analiza el impacto que puede suponer la implantación de estas tecnologías en las metodologías y técnicas de trabajo de una disciplina como la documentación. Por último se discute brevemente la viabilidad de este nuevo modelo.The Semantic Web is arising as a new alternative that could solve some of the problems of the actual Web model. By means of simple examples from an information professional perspective, this paper attempts to approach the basic technologies that will define the semantic infrastructure for developing the information systems of the future. Furthermore, the impact that the implementation of these technologies may have on work methodologies and techniques of a research area such as Information Science, is analyzed. Finally, the viability of this new model is briefly discussed.

En este trabajo hacemos uso de las nuevas técnicas de representación de la información, como el análisis de cocitación de sitios web (análisis de cositacion) y el escalamiento multidimensional (MDS), para analizar de forma gráfica las relaciones que establecen entre sí los sitios web de universidades de diferentes países. Pretendemos demostrar que estas relaciones siguen un patrón geopolítico en lugar de académico, y que, por lo tanto, pueden ser consideradas como auténticos mapas «geopolíticos» de Internet. Este tipo de representaciones nos permiten obtener una instantánea de una región geográfica y un momento en el tiempo determinados, por lo que podrían ser utilizadas como herramienta auxiliar para el análisis sociopolítico de la realidad.…

Seronegative antiphospholipid syndrome (SNAPS) is an autoimmune disease present in patients with clinical manifestations highly suggestive of Antiphospholipid Syndrome (APS) but with persistently negative consensus antiphospholipid antibodies (a-PL). IgA anti-β2 Glycoprotein I (aB2-GPI) antibodies are associated with APS. However, they are not currently considered to be laboratory criteria due to the heterogeneity of published works and the use of poor standardized diagnostic systems. We have aimed to assess aPL antibodies in a group of patients with clinical manifestations of APS (C-APS) to evaluate the importance of the presence of IgA aB2GPI antibodies in APS and its relation with other aPL antibodies. Only 14% of patients with C-APS were positive for any consensus antibody, whereas the presence of isolated IgA aB2GPI antibodies was found in 22% of C-APS patients. In patients with arterial thrombosis IgA aB2GPI, antibodies were the only aPL antibodies present. Serologic profile in primary APS (PAPS) is different from systemic autoimmune disorders associated APS (SAD-APS). IgA aB2GPI antibodies are more prevalent in PAPS and IgG aB2GPI antibodies are predominant in SAD-APS. The analysis of IgA aB2GPI antibodies in patients with clinical manifestations of PAPS might avoid underdiagnosed patients and provide a better diagnosis in patients with SAD-APS. Laboratory consensus criteria might consider including analysis of IgA aB2GPI for APS diagnosis.

Early diagnosis and patient stratification may improve sepsis outcome by a timely start of the proper specific treatment. We aimed to identify metabolomic biomarkers of sepsis in urine by (1)H-NMR spectroscopy to assess the severity and to predict outcomes. Urine samples were collected from 64 patients with severe sepsis or septic shock in the ICU for a (1)H NMR spectra acquisition. A supervised analysis was performed on the processed spectra, and a predictive model for prognosis (30-days mortality/survival) of sepsis was constructed using partial least-squares discriminant analysis (PLS-DA). In addition, we compared the prediction power of metabolomics data respect the Sequential Organ Failure Assessment (SOFA) score. Supervised multivariate analysis afforded a good predictive model to distinguish the patient groups and detect specific metabolic patterns. Negative prognosis patients presented higher values of ethanol, glucose and hippurate, and on the contrary, lower levels of methionine, glutamine, arginine and phenylalanine. These metabolites could be part of a composite biopattern of the human metabolic response to sepsis shock and its mortality in ICU patients. The internal cross-validation showed robustness of the metabolic predictive model obtained and a better predictive ability in comparison with SOFA values. Our results indicate that NMR metabolic profiling might be helpful for determining the metabolomic phenotype of worst-prognosis septic patients in an early stage. A predictive model for the evolution of septic patients using these metabolites was able to classify cases with more sensitivity and specificity than the well-established organ dysfunction score SOFA.

BACKGROUND: Metabolic Syndrome (MetS) is a complex disorder defined as a cluster of interconnected risk factors such as hypertension, dyslipidemia, obesity and high blood glucose levels. Premorbid metabolic syndrome (PMetS) is defined by excluding patients with previously diagnosed cardiovascular disease or diabetes mellitus from those suffering MetS. We aimed to determine the prevalence of PMetS in a working population, and to analyse the relationship between the diagnostic criteria of the International Diabetes Federation (IDF) and of the National Cholesterol Education Program Adult Treatment Panel III (ATPIII). The relationship between the presence of PMetS and cardiovascular risk factors was also analysed. RESEARCH METHODOLOGY/FINDINGS: A cross-sectional study was conducted in 24,529 male and 18,736 female Spanish (white western European) adult workers (20-65 years) randomly selected during their work health periodic examinations. Anthropometrics, blood pressure and serum parameters were measured. The presence of MetS and PMetS was ascertained using ATPIII and IDF criteria. Cardiovascular risk was determined using the Framingham-REGICOR equation. The results showed MetS had an adjusted global prevalence of 12.39% using ATPIII criteria and 16.46% using IDF criteria. The prevalence of PMetS was slightly lower (11.21% using ATPIII criteria and 14.72% using IDF criteria). Prevalence in males was always higher than in females. Participants with PMetS displayed higher values of BMI, waist circumference, blood pressure, glucose and triglycerides, and lower HDL-cholesterol levels. Logistic regression models reported lower PMetS risk for females, non-obese subjects, non-smokers and younger participants. Cardiovascular risk determined with Framingham-REGICOR was higher in participants with PMetS. CONCLUSIONS: PMetS could be a reliable tool for the early identification of apparently healthy individuals who have a significant risk for developing cardiovascular events and type 2 diabetes.

Background: The WHO recognises patient safety as a serious public health problem. The COVID-19 pandemic affected adult EDs (AEDs) and paediatric EDs (PEDs) differently. We compared the culture of safety in the adult AED and PED before and after the COVID-19 pandemic., Methods: A quasi-experimental study was performed. In 2019, we conducted a survey using the Spanish-adapted Hospital Survey on Patient Safety Culture open to all staff (doctors, nurses and paediatric residents) in AED and PED. This survey provides scores for 12 separate domains and a global assessment of safety (scale 0-10). The survey was repeated in 2021 after the first wave of the COVID-19 pandemic. After the second survey, the researchers constructed a Pareto Chart (based on the responses from the surveys), demonstrating the most important problems to develop improvement proposals., Results: The 2019 questionnaire was completed by 125 AED workers and 65 PED workers. The 2021 questionnaire was completed by 79 AED workers and 50 PED workers. The global assessment of safety in the AED was 6.13 points at baseline and increased to 7.58 points (p<0.001) after COVID-19. The global assessment for the PED was 6.8 points at baseline and increased to 7.62 points after COVID-19 (p<0.001). In both services, the dimension that was most favourably assessed was 'Teamwork in the Service' while 'Provision of Staff' was least favourably assessed. The Pareto charts showed four dimensions contributing more than 50% of negative responses: 'Provision of staff' and 'Hospital Management support for patient safety' coincided in both services., Conclusion: The baseline perception of the culture of safety was higher in the PED but improved in both services during the COVID-19 pandemic. Adverse situations can provide an opportunity to improve patient safety culture., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)