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Resumen: Objetivos: Evaluar la prevalencia de inactividad física y el riesgo de sarcopenia en los pacientes de atención primaria y en sus acompañantes. Diseño: Estudio transversal. Se realizó una encuesta anónima a usuarios y acompañantes de atención primaria en consulta y en estand dentro de los centros de atención primaria (CAP) coincidiendo con una actividad de salud comunitaria para el día Mundial de la Actividad Física. Emplazamiento: Cinco CAP de la región sanitaria Metropolitana Sud: en Cornellà de Llobregat (CAP Jaume Soler), en l’Hospitalet de Llobregat (CAP Florida Nord, CAP Florida Sud y CAP Bellvitge) y en Viladecans (CAP Maria Bernades) entre el 27 de marzo y el 6 de abril de 2023. Participantes: La población de atención primaria formada por paciente y sus acompañantes mayores de 18 años. Intervenciones: Los sanitarios administraron cuestionarios a los usuarios y sus acompañantes. Mediciones principales: Se valoró la presencia de inactividad física con el cuestionario BPAAT y el riesgo de sarcopenia con el test SARC-F, además del sexo y el tramo de edad. Se realizó un análisis descriptivo univariante para la descripción de las prevalencias. Resultados: En 998 participantes observamos inactividad física en un 38,9% de los encuestados (33,8% hombres y 42,3% mujeres). Entre los mayores de 50 años (665 participantes), un 15,4% presentó riesgo de sarcopenia (9,58% varones y 19,2% mujeres). Conclusiones: La prevalencia de inactividad física y riesgo de sarcopenia (en mayores de 50 años) en la población estudiada es elevada. Las mujeres presentan mayor inactividad física y mayor riesgo de sarcopenia que los varones. Abstract: Objectives: Assess the prevalence of physical inactivity and risk of sarcopenia in primary care patients and their companions. Design: Cross-sectional study. We carried out an anonymous survey of primary care users (patients and companions) in primary care consultations and stands coinciding with a community health activity for World Physical Activity Day. Site: Five primary care centers (CAPs) of the South Metropolitan health region: in Cornellà de Llobregat (CAP Jaume Soler), in l’Hospitalet de Llobregat (CAP Florida Nord, CAP Florida Sud and CAP Bellvitge) and in Viladecans (CAP Maria Bernades) between 27 March to April 6, 2023 (coinciding with World Physical Activity Day). Participants: Primary care population consists of patients and their companions over 18 years of age. Interventions: The health workers administered questionnaires to users and companions. Main measurements: We evaluated physical inactivity with the BPAAT questionnaire, risk of sarcopenia with SARC-F screening test, sex and age range. We performed an univariate descriptive analysis to report prevalence. Results: Nine hundred ninety-eight participants were surveyed. Physical inactivity was present in 38.9% of the participants. Among those over 50 years (665 participants), 15.4% were at risk of sarcopenia (9.58% men, 19.2% women). Conclusions: The prevalence of physical inactivity and risk of sarcopenia (in individuals over 50 years old) in the studied population is high. Women have greater physical inactivity and a greater risk of sarcopenia than men.

Abstract Background The Paediatric Eosinophilic Oesophagitis Module (PedsQL-EoE) was developed in English as a valid and reliable questionnaire to assess health-related quality of life (HRQoL) in children with EoE. The aim of this study was to evaluate the validity and reliability of the PedsQL-EoE that was previously adapted to Spanish by our group. Methods This cross-sectional multicentre study was conducted in 36 paediatric gastroenterology units. Groups with and without dietary restrictions were studied separately. The PedsQL-EoE consists of 33 items divided into seven factors. Age-specific versions of the PedsQL-EoE were sent by e-mail to children and parents. Statistical analysis was used to study the questionnaire structure by means of exploratory factor analysis and interitem correlations. Confirmatory factor analysis (CFA) was applied to verify the proposed model as well as its psychometric properties through SMSR (standardized root mean square), outer loadings and R-square. To study construct validity and reliability, Cronbach´s alpha coefficient, convergent validity (AVE), discriminant validity (HTMT) and intraclass correlation coefficients (ICC) were used. Results A total of 341 children and 394 parents participated with 307 matched answers. The median age was 12 years, and 75% were male. The questionnaire structure explained 68% and 66% of the total variance for parents and children, respectively. Five items showed negative correlations and were removed from the questionnaire. CFA applied to the new model supported the following construct: SMRS was less than 0.08, outer loadings measured above 0.5, and R2 explained more than 89% of the total variance. Once the modifications were performed, good internal consistency was demonstrated, with Cronbach’s alpha values > 0.7, AVE values > 0.5 and HTMT

Schelling presents the existence of God’s internal duality between ground and existence as the only real starting point for the true explanation of the phenomena of evil and human freedom. We will explicate here the essential relation between the reality of evil and the constitution of a system of freedom. Since the metaphysical monism that Schelling attributes to Spinoza, and later also to Hegel, cannot explain the subsistence of evil, subsumed in a whole or reality equivalent to the good or perfection, neither can account for freedom considered as the capacity of individual human beings. The broad link connecting the duality of ground and existence, and human freedom, as well as the way in which this new duality negatively impacts the concept of rationality is finally elucidated.

Bioactive compounds extracted from plum seeds were identified and quantified, aiming to establish how the brandy manufacturing process affects the properties and possible cascade valorization of seed residues. Extraction with n-hexane using Soxhlet has provided oils rich in unsaturated fatty acids (92.24–92.51%), mainly oleic acid (72–75.56%), which is characterized by its heart-healthy properties. The fat extracts also contain tocopherols with antioxidant and anti-inflammatory properties. All the ethanol–water extracts of the defatted seeds contain neochlorogenic acid (90–368 µg·g−1), chlorogenic acid (36.1–117 µg·g−1), and protocatechuate (31.8–100 µg·g−1) that have an impact on bioactive properties such as antimicrobial and antioxidant. Anti-amyloidogenic activity (25 mg·mL−1) was observed in the after both fermentation and distillation extract, which may be related to high levels of caffeic acid (64 ± 10 µg·g−1). The principal component analysis showed that all plum seed oils could have potential applications in the food industry as edible oils or in the cosmetic industry as an active ingredient in anti-aging and anti-stain cosmetics, among others. Furthermore, defatted seeds, after both fermentation and distillation, showed the greatest applicability in the food and nutraceutical industry as a food supplement or as an additive in the design of active packaging.

In this study, a piezoelectric harvesting device was developed using polyvinylidene fluoride (PVDF) nanofibers reinforced with either BaTiO3 nanoparticles or graphene powder. BaTiO3 nanoparticles were synthesized through the sol-gel method with an average size of approximately 32 nm. The PVDF nanofibers, along with the nanoparticle composites in an acetone-N,N-dimethylformamide mixture, were produced using a centrifugal Forcespinning™ machine, resulting in a heterogeneous arrangement of fiber meshes, with an average diameter of 1.6 μm. Experimental tests revealed that the electrical performance of the fabricated harvester reached a maximum value of 35.8 Voc, demonstrating the potential of BaTiO3/ PVDF-based piezoelectric devices for designing wearable applications such as body-sensing and energy-harvesting devices.

Abstract Background The evaluation of the DNA damage generated in cumulus cells after mature cumulus-oocyte complexes vitrification can be considered as an indicator of oocyte quality since these cells play important roles in oocyte developmental competence. Therefore, the aim of this study was to determine if matured cumulus-oocyte complexes exposure to cryoprotectants (CPAs) or vitrification affects oocytes and cumulus cells viability, but also if DNA damage is generated in cumulus cells, affecting fertilization and embryo development. Results The DNA damage in cumulus cells was measured using the alkaline comet assay and expressed as Comet Tail Length (CTL) and Olive Tail Moment (OTM). Results demonstrate that oocyte exposure to CPAs or vitrification reduced oocyte (75.5 ± 3.69%, Toxicity; 66.7 ± 4.57%, Vitrification) and cumulus cells viability (32.7 ± 5.85%, Toxicity; 7.7 ± 2.21%, Vitrification) compared to control (95.5 ± 4.04%, oocytes; 89 ± 4.24%, cumulus cells). Also, significantly higher DNA damage expressed as OTM was generated in the cumulus cells after exposure to CPAs and vitrification (39 ± 17.41, 33.6 ± 16.69, respectively) compared to control (7.4 ± 4.22). In addition, fertilization and embryo development rates also decreased after exposure to CPAs (35.3 ± 16.65%, 22.6 ± 3.05%, respectively) and vitrification (32.3 ± 9.29%, 20 ± 1%, respectively). It was also found that fertilization and embryo development rates in granulose-intact oocytes were significantly higher compared to denuded oocytes in the control groups. However, a decline in embryo development to the blastocyst stage was observed after CPAs exposure (1.66 ± 0.57%) or vitrification (2 ± 1%) compared to control (22.3 ± 2.51%). This could be attributed to the reduction in both cell types viability, and the generation of DNA damage in the cumulus cells. Conclusion This study demonstrates that oocyte exposure to CPAs or vitrification reduced viability in oocytes and cumulus cells, and generated DNA damage in the cumulus cells, affecting fertilization and embryo development rates. These findings will allow to understand some of the mechanisms of oocyte damage after vitrification that compromise their developmental capacity, as well as the search for new vitrification strategies to increase fertilization and embryo development rates by preserving the integrity of the cumulus cells.

Large animal models of acute myocardial infarction (AMI) play a crucial role in translating novel therapeutic approaches to patients as denoted by their use in the right-before-human testing platform. At present, the porcine model of AMI is used most frequently as it mimics the human condition and its anatomopathological features accurately. We want to describe to, and share with, the translational research community our experience of how different anaesthetic protocols (sevoflurane, midazolam, ketamine+xylazine+midazolam, and propofol) and pig breeds [Large White and Landrace x Large White (LLW)] can dramatically modify the outcomes of a well-established porcine model of closed-chest AMI. Our group has extensive experience with the porcine model of reperfused AMI and, over time, we reduced the time of ischaemia used to induce the disease from 90 to 50 min to increase the salvageable myocardium for cardioprotection studies. For logistical reasons, we changed both the anaesthetic protocol and the pig breed used, but these resulted in a dramatic reduction in the size of the myocardial infarct, to almost zero in some cases (sevoflurane, 50-min ischaemia, LLW, 2.4 ± 3.9% infarct size), and the cardiac function was preserved. Therefore, we had to re-validate the model by returning to 90 min of ischaemia. Here, we report the differences in infarct size and cardiac function, measured by different modalities, for each combination of anaesthetic protocol and pig breed we have used. Furthermore, we discuss these combinations and the limited literature pertaining to how these two factors influence cardiac function and infarct size in the porcine model of AMI.

Abstract Background Clinically evident interstitial lung disease (ILD) affects between 10 and 42% of the patients with rheumatoid arthritis (RA). Airway involvement seems to be even more common. Most of the available evidence comes from studies performed in established RA patients. The aim of our study was to know the prevalence of non-diagnosed lung disease (airway and interstitial involvement) in patients with early RA and look for associated factors. Methods We designed an observational, multicenter, cross-sectional study, and included patients with RA of less than two years since diagnosis. We performed a structured questionnaire, HRCT and lung functional tests looking for lung disease, together with joint disease evaluation. We analyzed which variables were associated with the presence of lung disease on HRCT. Results We included 83 patients, 83% females. The median (IQR) of time since RA diagnosis was 3 (1–6) months. In the HRCT, 57 patients had airway compromisea (72%), and 6 had interstitial abnormalities (7.5%). The most common altertion found in lung functional tests was a reduced DLCO (14%). The presence of at least one abnormality in the physical exam was associated with lung involvement on HRCT [13 (21.6%) vs 0 (0%); p = 0.026]. Also, patients with lung involvement presented significantly lower values of FVC% and DLCO%, and higher values of RV/TLC. No variable related to joint involvement was found associated with alterations in HRCT. Conclusion Our study shows that a large proportion of early RA patients has abnormal findings in HRCT. Further studies are required to confirm these findings.

Abstract Venta Micena is an area containing several palaeontological sites marking the beginning of the Calabrian stage (Early Pleistocene). The richness of the fossil accumulation including species of Asian, African and European origin, makes Venta Micena a key site for the the palaeoecological and palaeoenvironmental study of southern Europe during the Early Pleistocene. Thus, research has been focused on Venta Micena 3, which was originally interpreted as a single palaeosurface associated with a marshy context, in which most of the fauna was accumulated by Pachycrocuta brevirostris. Recent excavations have unearthed a new site, Venta Micena 4, located in the same stratigraphic unit (Unit C) and in close proximity to Venta Micena 3. Here we show the first analyses regarding the taphonomic and spatial nature of this new site, defining two stratigraphic boundaries corresponding to two different depositional events. Furthermore, the taphonomic analyses of fossil remains seem to indicate a different accumulative agent than Pachycrocuta, thus adding more complexity to the palaeobiological interpretation of the Venta Micena area. These results contribute to the discussion of traditional interpretations made from Venta Micena 3.

In this work we analyse the anthropological consequences of the Schellinguian metaphysical and cosmological model of explanation that, from 1809 onwards, confers on the world and on man, under the categories of finitude, evil and human freedom, a new central role that is unmarked of his previous monistic and immanent thought (1801-1804). The hypothesis that we defend consists of affirming that the criticisms of the notions of immanence and identity based on the concepts of separation (Zertrennung, Scheidung) and ground (Grund) place man in a privileged role to continue in human history, the work of freedom, the process initiated by God with the creation of nature. However, this withdrawal of God with respect to the destiny of the world, which allows the human individual to take control of his destiny and to assume all his metaphysical and moral responsibility, places us in front of the problematic scenario of the loss of the universality and of atheism that link our author to contemporary philosophical traditions. This is the essential difference, then, between God and man, or as we shall see, between the God who is and the God who becomes.

Multiple myeloma (MM) arises following malignant proliferation of plasma cells in the bone marrow, that secrete high amounts of specific monoclonal immunoglobulins or light chains, resulting in the massive production of unfolded or misfolded proteins. Autophagy can have a dual role in tumorigenesis, by eliminating these abnormal proteins to avoid cancer development, but also ensuring MM cell survival and promoting resistance to treatments. To date no studies have determined the impact of genetic variation in autophagy-related genes on MM risk. We performed meta-analysis of germline genetic data on 234 autophagy-related genes from three independent study populations including 13,387 subjects of European ancestry (6863 MM patients and 6524 controls) and examined correlations of statistically significant single nucleotide polymorphisms (SNPs; p < 1 × 10−9) with immune responses in whole blood, peripheral blood mononuclear cells (PBMCs), and monocyte-derived macrophages (MDM) from a large population of healthy donors from the Human Functional Genomic Project (HFGP). We identified SNPs in six loci, CD46, IKBKE, PARK2, ULK4, ATG5, and CDKN2A associated with MM risk (p = 4.47 × 10−4−5.79 × 10−14). Mechanistically, we found that the ULK4rs6599175 SNP correlated with circulating concentrations of vitamin D3 (p = 4.0 × 10−4), whereas the IKBKErs17433804 SNP correlated with the number of transitional CD24+CD38+ B cells (p = 4.8 × 10−4) and circulating serum concentrations of Monocyte Chemoattractant Protein (MCP)-2 (p = 3.6 × 10−4). We also found that the CD46rs1142469 SNP correlated with numbers of CD19+ B cells, CD19+CD3− B cells, CD5+IgD− cells, IgM− cells, IgD−IgM− cells, and CD4−CD8− PBMCs (p = 4.9 × 10−4−8.6 × 10−4) and circulating concentrations of interleukin (IL)-20 (p = 0.00082). Finally, we observed that the CDKN2Ars2811710 SNP correlated with levels of CD4+EMCD45RO+CD27− cells (p = 9.3 × 10−4). These results suggest that genetic variants within these six loci influence MM risk through the modulation of specific subsets of immune cells, as well as vitamin D3−, MCP-2−, and IL20-dependent pathways.

Chronic lymphocytic leukemia (CLL) is the most common leukemia among adults worldwide. Although genome-wide association studies (GWAS) have uncovered the germline genetic component underlying CLL susceptibility, the potential use of GWAS-identified risk variants to predict disease progression and patient survival remains unexplored. Here, we evaluated whether 41 GWAS-identified risk variants for CLL could influence overall survival (OS) and disease progression, defined as time to first treatment (TTFT) in a cohort of 1039 CLL cases ascertained through the CRuCIAL consortium. Although this is the largest study assessing the effect of GWAS-identified susceptibility variants for CLL on OS, we only found a weak association of ten single nucleotide polymorphisms (SNPs) with OS (p < 0.05) that did not remain significant after correction for multiple testing. In line with these results, polygenic risk scores (PRSs) built with these SNPs in the CRuCIAL cohort showed a modest association with OS and a low capacity to predict patient survival, with an area under the receiver operating characteristic curve (AUROC) of 0.57. Similarly, seven SNPs were associated with TTFT (p < 0.05); however, these did not reach the multiple testing significance threshold, and the meta-analysis with previous published data did not confirm any of the associations. As expected, PRSs built with these SNPs showed reduced accuracy in prediction of disease progression (AUROC = 0.62). These results suggest that susceptibility variants for CLL do not impact overall survival and disease progression in CLL patients.

Listeria monocytogenes is considered a foodborne pathogen of serious concern capable of forming multispecies biofilms with other bacterial species, such as Pseudomonas spp., adhered onto stainless steel (SS) surfaces. In an attempt to link the biofilms’ morphology and resistance to biocides, dual-species biofilms of L. monocytogenes, in co-culture with either Pseudomonas aeruginosa, Pseudomonas fluorescens, or Pseudomonas putida, were assayed to ascertain their morphological characteristics and resistance toward benzalkonium chloride (BAC) and neutral electrolyzed water (NEW). Epifluorescence microscopy analysis revealed that each dual-species biofilm was distributed differently over the SS surface and that these differences were attributable to the presence of Pseudomonas spp. Confocal laser scanning microscopy (CLSM) assays demonstrated that despite these differences in distribution, all biofilms had similar maximum thicknesses. Along with this, colocalization analyses showed a strong trend of L. monocytogenes to share location within the biofilm with all Pseudomonas assayed whilst the latter distributed throughout the surface independently of the presence of L. monocytogenes, a fact that was especially evident in those biofilms in which cell clusters were present. Finally, a modified Gompertz equation was used to fit biofilms’ BAC and NEW dose-response data. Outcomes demonstrated that L. monocytogenes was less susceptible to BAC when co-cultured with P. aeruginosa or P. fluorescens, whereas susceptibility to NEW was reduced in all three dual-species biofilms, which can be attributable to both the mechanism of action of the biocide and the architectural features of each biofilm. Therefore, the results herein provided can be used to optimize already existing and develop novel target-specific sanitation treatments based on the mechanism of action of the biocide and the biofilms’ species composition and structure.

IMPORTANCE:. Throughout the COVID-19 pandemic, thousands of temporary ICUs have been established worldwide. The outcomes and management of mechanically ventilated patients in these areas remain unknown. OBJECTIVES:. To investigate mortality and management of mechanically ventilated patients in temporary ICUs. DESIGN, SETTING, AND PARTICIPANTS:. Observational cohort study in a single-institution academic center. We included all adult patients with severe COVID-19 hospitalized in temporary and conventional ICUs for invasive mechanical ventilation due to acute respiratory distress syndrome from March 23, 2020, to April 5, 2021. MAIN OUTCOMES AND MEASURES:. To determine if management in temporary ICUs increased 30-day in-hospital mortality compared with conventional ICUs. Ventilator-free days, ICU-free days (both at 28 d), hospital length of stay, and ICU readmission were also assessed. RESULTS:. We included 776 patients (326 conventional and 450 temporary ICUs). Thirty-day in-hospital unadjusted mortality (28.8% conventional vs 36.0% temporary, log-rank test p = 0.023) was higher in temporary ICUs. After controlling for potential confounders, hospitalization in temporary ICUs was an independent risk factor associated with mortality (hazard ratio, 1.4; CI, 1.06–1.83; p = 0.016).There were no differences in ICU-free days at 28 days (6; IQR, 0–16 vs 2; IQR, 0–15; p = 0.5) or ventilator-free days at 28 days (8; IQR, 0–16 vs 5; IQR, 0–15; p = 0.6). We observed higher reintubation (18% vs 12%; p = 0.029) and readmission (5% vs 1.6%; p = 0.004) rates in conventional ICUs despite higher use of postextubation noninvasive mechanical ventilation (13% vs 8%; p = 0.025). Use of lung-protective ventilation (87% vs 85%; p = 0.5), prone positioning (76% vs 79%; p = 0.4), neuromuscular blockade (96% vs 98%; p = 0.4), and COVID-19 pharmacologic treatment was similar. CONCLUSIONS AND RELEVANCE:. We observed a higher 30-day in-hospital mortality in temporary ICUs. Although both areas had high adherence to evidence-based management, hospitalization in temporary ICUs was an independent risk factor associated with mortality.

Autophagy is a highly conserved metabolic pathway via which unwanted intracellular materials, such as unfolded proteins or damaged organelles, are digested. It is activated in response to conditions of oxidative stress or starvation, and is essential for the maintenance of cellular homeostasis and other vital functions, such as differentiation, cell death, and the cell cycle. Therefore, autophagy plays an important role in the initiation and progression of tumors, including hematological malignancies, where damaged autophagy during hematopoiesis can cause malignant transformation and increase cell proliferation. Over the last decade, the importance of autophagy in response to standard pharmacological treatment of hematological tumors has been observed, revealing completely opposite roles depending on the tumor type and stage. Thus, autophagy can promote tumor survival by attenuating the cellular damage caused by drugs and/or stabilizing oncogenic proteins, but can also have an antitumoral effect due to autophagic cell death. Therefore, autophagy-based strategies must depend on the context to create specific and safe combination therapies that could contribute to improved clinical outcomes. In this review, we describe the process of autophagy and its role on hematopoiesis, and we highlight recent research investigating its role as a potential therapeutic target in hematological malignancies. The findings suggest that genetic variants within autophagy-related genes modulate the risk of developing hemopathies, as well as patient survival.

Thallium (Tl) is a heavy and toxic metal and a byproduct of several human activities, such as cement production, mining, and coal combustion. Thallium is found in fruits, vegetables, and animal fodder with high Tl contamination; therefore, it is an environmental pollution issue and a toxicological contamination problem for human beings and other organisms when exposed to it. The mutagenic potential of Tl and its compounds is controversial, and there are few in vivo studies on its effects. We conducted the animal bioassay Drosophila wing somatic mutation and recombination test (SMART) to test for genotoxicity and assessed the genotoxic effects of Tl acetate (TlCH3COO) and Tl sulfate (Tl2SO4) on Drosophila melanogaster. Third instar larvae from the SMART standard cross (ST) were fed Tl acetate [0.2, 2, 20, 200, 600 and 1200 μM] and Tl sulfate [0.2, 2, 20, 200, and 600 μM]. Hexavalent chromium [CrO3, 500 μM] served as the positive control, and Milli-Q water served as the negative control. Only the high Tl2SO4 [600 μM] concentration resulted in genotoxicity with 87.6% somatic recombination, and both salts disrupted cell division of wing imaginal disc cells, showing the expected cytotoxic effects. Genotoxic risks due to high metal levels by bioaccumulation of Tl+1 or its compounds require further evaluation with other in vivo and in vitro assays.

Pompe disease (PD) is a rare disorder caused by mutations in the acid alpha-glucosidase (GAA) gene. Most gene therapies (GT) partially rely on the cross-correction of unmodified cells through the uptake of the GAA enzyme secreted by corrected cells. In the present study, we generated isogenic murine GAA-KO cell lines resembling severe mutations from Pompe patients. All of the generated GAA-KO cells lacked GAA activity and presented an increased autophagy and increased glycogen content by means of myotube differentiation as well as the downregulation of mannose 6-phosphate receptors (CI-MPRs), validating them as models for PD. Additionally, different chimeric murine GAA proteins (IFG, IFLG and 2G) were designed with the aim to improve their therapeutic activity. Phenotypic rescue analyses using lentiviral vectors point to IFG chimera as the best candidate in restoring GAA activity, normalising the autophagic marker p62 and surface levels of CI-MPRs. Interestingly, in vivo administration of liver-directed AAVs expressing the chimeras further confirmed the good behaviour of IFG, achieving cross-correction in heart tissue. In summary, we generated different isogenic murine muscle cell lines mimicking the severe PD phenotype, as well as validating their applicability as preclinical models in order to reduce animal experimentation.

La lucha de los movimientos antirracistas brasileños registra un punto de inflexión durante las últimas décadas del siglo XX, cuando subvirtiendo la racialización históricamente usada para perjudicarlos, promueven la cuestión racial con el objetivo de reivindicar la transformación de la sociedad brasileña y, de forma más concreta, el establecimiento de políticas públicas orientadas a corregir los efectos de la discriminación racial. En este devenir, se torna cada vez más relevante la participación de los movimientos antirracistas estableciendo alianzas junto a sectores en el ejercicio do poder estatal. Diversos autores e líderes de los movimientos negros reconocen en algunas acciones de gobierno del expresidente Fernando Henrique Cardoso los primeros gestos que o poder político manifestó en este sentido, sobre todo en término de políticas de reconocimiento de valor identitario. Sin embargo, será a partir del gobierno del PT y del expresidente Luiz Inácio Lula da Silva cuando surgirán políticas públicas de reconocimiento con carácter redistributivo, en áreas como la Educación, en respuesta a las demandas do movimiento negro brasileño. En este trabajo, abordamos a Universidade da Integração Internacional da Lusofonia Afro-brasileira, creada por Lula en 2010, a través del análisis de diversos discursos que la tematizan como el objetivo de identificar cuáles son las bases axiomáticas que subyacen a tales discursos. Es que según la denominada Crítica do Discurso Social, Marc Angenot (2010, 2012), referencia teórico-metodológica adoptada en este trabajo, a través del estudio de los discursos sociales es posible des-cubrir las invariantes axiomáticas que, sujetas a un sistema regulador global que determina o decible, instituyen la realidad en una coyuntura histórica particular.Palabras clave: Movimiento negro - UNILAB – Crítica del discurso social. UMA UNIVERSIDADE DO BRASIL PARA A ÁFRICA: BASES AXIOMÁTICAS NO DISCURSO OFICIAL SOBRE A UNILABResumoA luta dos movimentos antirracistas brasileiros registra um ponto de inflexão durante as últimas décadas do século XX, quando subvertendo a racialização historicamente usada para prejudicá-los, promovem a questão racial com o objetivo de reivindicar a transformação da sociedade brasileira e, de forma mais concreta, o estabelecimento de políticas públicas orientadas a corrigir os efeitos da discriminação racial. Nesse devir, torna-se cada vez mais relevante a participação dos movimentos antirracistas estabelecendo alianças no exercício do poder estatal. Diversos autores e lideranças dos movimentos negros reconhecem em algumas ações de governo do ex-presidente Fernando Henrique Cardoso os primeiros gestos que o poder político manifestou neste sentido, sobre tudo em termos de reconhecimento identitário. No entanto, é a partir do governo do PT e do ex-presidente Luiz Inácio Lula da Silva quando surgem propostas de políticas públicas de reconhecimento com intuito redistributivo, em áreas como a Educação, em resposta às demandas do movimento negro brasileiro. Neste trabalho, abordamos a Universidade da Integração Internacional da Lusofonia Afro-brasileira, criada por Lula em 2010, através da análise de diversos discursos que a tematizam como o objetivo de identificar quais as bases axiomáticas que subjazem a tais discursos. Acontece que, segundo a denominada crítica do discurso social, Marc Angenot (2010, 2012), referencial teórico-metodológico adotado neste trabalho, através do estudo dos discursos sociais é possível des-cobrir as invariantes axiomáticas que, sujeitas a um sistema regulador global que determina o dizível, instituem a realidade numa conjuntura histórica particular.Palavras chave: Movimento negro - UNILAB – Crítica do discurso social -

Resumen: Objetivos: Evaluar si persiste el beneficio sobre los factores de riesgo cardiovascular (FRCV) a los 5 años de una intervención intensiva en estilos de vida (EV) que duró 2 años, en pacientes con hiperfibrinogenemia y riesgo cardiovascular moderado o alto. Diseño: Estudio observacional prospectivo multicéntrico. Emplazamiento: Trece Centros de Atención Primaria de Barcelona y Baix Llobregat. Participantes: Un total de 300 pacientes que finalizaron el estudio EFAP (146 del grupo intervención y 154 del control). Intervenciones: El estudio EFAP, realizado con pacientes con cifras de colesterol normal y fibrinógeno elevado, mostró que las intervenciones sobre el estilo de vida son eficaces en la reducción de FRCV. Finalizado el estudio EFAP, los 2 grupos siguieron los controles habituales. Pasados 5 años evaluamos los 2 grupos. Mediciones principales: Edad, sexo, FRCV (diabetes, dislipidemia, hipertensión arterial, obesidad), analítica (fibrinógeno, glucosa, hemograma, colesterol, triglicéridos), presión arterial, peso, talla, índice de masa corporal (IMC), hábitos tóxicos (tabaco y alcohol), REGICOR. Resultados: A los 5 años, el grupo intervención presentó respecto al control menor perímetro abdominal (98 y 101 cm, respectivamente; p = 0,043), menor peso (76,30 y 75,04 kg, respectivamente; p

Resumen: La supervisión de los médicos en formación exige la realización de entrevistas tutor-residente; sin embargo, ni los tutores ni los docentes clínicos sienten que hayan recibido apenas formación para poder llevarlas a cabo eficazmente. En esta segunda parte describimos cómo realizar una sesión de tutorización proporcionando feedback constructivo y satisfactorio tanto para el aprendiz como para el docente (feedback formal). Proponemos estructurar la entrevista tutor-residente en 10 pasos sencillos que permitan completarla con resultados positivos e ilustramos el proceso mediante un relato. Finalmente, invitamos a los tutores y docentes clínicos a dedicar tiempo y esfuerzo al entrenamiento y práctica del feedback. Abstract: Supervision of the training of physicians requires conducting tutor-resident interviews; nevertheless, neither the tutors nor the clinical teachers feel that they have received hardly any training to be able to carry them out effectively. In this second part we describe how to conduct a tutorial session providing constructive and satisfactory feedback for both the learner and the teacher (formal feedback). We propose to structure the tutor-resident interview in 10 simple steps that allow to complete it with positive results and we illustrate the process through a story. Finally, we invite the tutors and clinical teachers to dedicate time and effort to the training and practice of feedback. Palabras clave: Formación de tutores, Educación médica, Feedback, Residencia y rotaciones médicas, Keywords: Preceptor development, Medical education, Feedback, Internship and residency

Resumen: Las 2 preocupaciones más importantes de los tutores y los docentes clínicos son cómo hacer que los residentes y los alumnos se motiven, y cómo ofrecerles feedback de manera constructiva. Además, los docentes clínicos sienten que no tienen conocimientos ni entrenamiento suficiente sobre cómo dar feedback. En este artículo describimos cómo utilizar el feedback de forma que la supervisión resulte una experiencia productiva y estimulante tanto para el aprendiz como para el docente. Revisamos las características básicas que debe poseer un feedback a la vez constructivo y centrado tanto en el que aprende, como en su programa docente; proponemos una sistemática para dar feedback informal en 4 pasos y ofrecemos unos ejemplos para su puesta en escena. Abstract: The 2 most important concerns of tutors and clinical teachers are how to get residents and students motivated and how to offer feedback constructively. In addition, clinical teachers feel that they do not have enough knowledge or training on how to give feedback. In this article, we describe how to use feedback so that supervision is a productive and stimulating experience for both the learner and the teacher. We review the basic characteristics that a feedback should have to be constructive and focused on the learner and their teaching program at the same time. We propose a systematic structure for giving informal feedback in 4 steps and we offer some examples for its staging. Palabras clave: Formación de tutores, Educación médica, Feedback, Residencia y rotaciones médicas, Keywords: Preceptor development, Medical education, Feedback, Internship and residency

The concurrent management of type 2 diabetes mellitus and heart failure presents several challenges and unmet clinical needs. The sodium-glucose cotransporter 2 inhibitors (SGLT2i) are new generation of oral hypoglycemic agents, they inhibit renal glucose reabsorption and increase renal glucose excretion, thus lowering plasma glucose levels and contributing to a modest reduction in HbA1C. In two pivotal randomized clinical trial, SGLT2i have showed a clinically important reduction in cardiovascular mortality and hospitalization due to heart failure. However, also important adverse effects such as increased risk of bone fractures and lower limb amputations were found. Currently, physiological mechanisms leading to cardiovascular benefits with SGLT2i are not completely understood, but it seems accepted that some of these benefits are related to non-glycemic effects. In this review, we analyze the available clinical evidence focusing in cardiovascular outcomes and heart failure, physiological mechanism of action, and comment on future directions of research.

Mucosa-associated lymphoid tissue (MALT) lymphomas are a diverse group of lymphoid neoplasms with B-cell origin, occurring in adult patients and usually having an indolent clinical behavior. These lymphomas may arise in different anatomic locations, sharing many clinicopathological characteristics, but also having substantial variances in the aetiology and genetic alterations. Chromosomal translocations are recurrent in MALT lymphomas with different prevalence among different sites, being the 4 most common: t(11;18)(q21;q21), t(1;14)(p22;q32), t(14;18)(q32;q21), and t(3;14)(p14.1;q32). Several chromosomal numerical abnormalities have also been described, but probably represent secondary genetic events. The mutational landscape of MALT lymphomas is wide, and the most frequent mutations are: TNFAIP3, CREBBP, KMT2C, TET2, SPEN, KMT2D, LRP1B, PRDM1, EP300, TNFRSF14, NOTCH1/NOTCH2, and B2M, but many other genes may be involved. Similar to chromosomal translocations, certain mutations are enriched in specific lymphoma types. In the same line, variation in immunoglobulin gene usage is recognized among MALT lymphoma of different anatomic locations. In the last decade, several studies have analyzed the role of microRNA, transcriptomics and epigenetic alterations, further improving our knowledge about the pathogenic mechanisms in MALT lymphoma development. All these advances open the possibility of targeted directed treatment and push forward the concept of precision medicine in MALT lymphomas.

COVID-19 has shown significant morbidity with the involvement of multiple systems, including the cardiovascular system. Cardiovascular manifestations in the acute phase can include myocardial injury itself, myocardial infarction, venous thromboembolic events, myocarditis, Takotsubo syndrome, and different arrhythmic events. Myocardial injury defined by the rise of cardiac biomarkers in blood has been found in multiple studies with a prevalence of about 20%. Its presence is related to worse clinical outcomes and in-hospital mortality. The mechanisms of myocardial injury have been the subject of intense research but still need to be clarified. The characterization of the cardiac affectation with echocardiography and cardiac magnetic resonance has found mixed results in different studies, with a striking incidence of imaging criteria for myocarditis. Regarding post-acute and chronic follow-up results, the persistence of symptoms and imaging changes in recovered COVID-19 patients has raised concerns about the duration and the possible significance of these findings. Even though the knowledge about this disease has increased incredibly in the last year, many aspects are still unclear and warrant further research.

The exact mechanisms leading to myocardial injury in the coronavirus disease 2019 (COVID-19) are still unknown. In this retrospective observational study, we include all consecutive COVID-19 patients admitted to our center. They were divided into two groups according to the presence of myocardial injury. Clinical variables, Charlson Comorbidity Index (CCI), C-reactive protein (CRP), CAC (COVID-19-associated coagulopathy), defined according to the ISTH score, treatment and in-hospital events were collected. Between March and April 2020, 331 COVID-19 patients were enrolled, 72 of them (21.8%) with myocardial injury. Patients with myocardial injury showed a higher CCI score (median (interquartile range), 5 (4–7) vs. 2 (1–4), p = 0.001), higher CRP values (18.3 (9.6–25.9) mg/dL vs. 12.0 (5.4–19.4) mg/dL, p ˂ 0.001) and CAC score (1 (0–2) vs. 0 (0–1), p = 0.001), and had lower use of any anticoagulant (57 patients (82.6%) vs. 229 patients (90.9%), p = 0.078), than those without. In the adjusted logistic regression, CRP, myocardial injury, CCI and CAC score were positive independent predictors of mortality, whereas anticoagulants resulted as a protective factor. Myocardial injury in COVID-19 patients is associated with inflammation and coagulopathy, resulting in a worse in-hospital prognosis. Treatment with anticoagulant agents may help to improve in-hospital outcomes.

Hypertrophic cardiomyopathy (HCM) can cause symptoms due to the obstruction of the left ventricle outflow tract (LVOT). Although pharmacological therapy is the first step for treating this condition, many patients do not fully respond to the treatment, and an invasive approach is required to manage symptoms. Septal reduction therapies include septal myectomy (SM) and alcohol septal ablation (ASA). ASA consists of a selective infusion of high-grade alcohol into a septal branch supplying the basal interventricular septum to create an iatrogenic infarction with the aim of reducing LVOT obstruction. Currently, SM and ASA have the same level of indication; however, ASA is normally reserved for patients of advanced age, with comorbidities or when the surgical approach is not feasible. Recent data suggests that there are no differences in short- and long-term all-cause mortality, cardiovascular mortality and sudden cardiac death between ASA and SM. Despite the greater experience and refinement of the technique gained in recent years, the most common complication continues to be complete atrio-ventricular block, requiring a permanent pacemaker. Septal reduction therapies should be performed in experienced centres with comprehensive programs.

In this study, we used a module for monitoring and detecting students at risk of dropping out. We worked with a sample of 49 third-year students in a Health Science degree during a lockdown caused by COVID-19. Three follow-ups were carried out over a semester: an initial one, an intermediate one and a final one with the UBUMonitor tool. This tool is a desktop application executed on the client, implemented with Java, and with a graphic interface developed in JavaFX. The application connects to the selected Moodle server, through the web services and the REST API provided by the server. UBUMonitor includes, among others, modules for log visualisation, risk of dropping out, and clustering. The visualisation techniques of boxplots and heat maps and the cluster analysis module (k-means ++, fuzzy k-means and Density-based spatial clustering of applications with noise (DBSCAN) were used to monitor the students. A teaching methodology based on project-based learning (PBL), self-regulated learning (SRL) and continuous assessment was also used. The results indicate that the use of this methodology together with early detection and personalised intervention in the initial follow-up of students achieved a drop-out rate of less than 7% and an overall level of student satisfaction with the teaching and learning process of 4.56 out of 5.