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2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)

Abstract Background Natural killer (NK) cells are important anti-tumor cells of our innate immune system. Their anti-cancer activity is mediated through interaction of a wide array of activating and inhibitory receptors with their ligands on tumor cells. After activation, NK cells also secrete a variety of pro-inflammatory molecules that contribute to the final immune response by modulating other innate and adaptive immune cells. In this regard, external proteins from NK cell secretome and the mechanisms by which they mediate these responses are poorly defined. Methods TRANS-stable-isotope labeling of amino acids in cell culture (TRANS-SILAC) combined with proteomic was undertaken to identify early materials transferred between cord blood-derived NK cells (CB-NK) and multiple myeloma (MM) cells. Further in vitro and in vivo studies with knock-down of histones and CD138, overexpression of histones and addition of exogenous histones were undertaken to confirm TRANS-SILAC results and to determine functional roles of this material transferred. Results We describe a novel mechanism by which histones are actively released by NK cells early after contact with MM cells. We show that extracellular histones bind to the heparan sulfate proteoglycan CD138 on the surface of MM cells to promote the creation of immune-tumor cell clusters bringing immune and MM cells into close proximity, and thus facilitating not only NK but also T lymphocyte anti-MM activity. Conclusion This study demonstrates a novel immunoregulatory role of NK cells against MM cells mediated by histones, and an additional role of NK cells modulating T lymphocytes activity that will open up new avenues to design future immunotherapy clinical strategies.

Sub-daily meteorological observations are needed for input to and assessment of high-resolution reanalysis products to improve understanding of weather and climate variability. While there are millions of such weather observations that have been collected by various organisations, many are yet to be transcribed into a useable format.Under the auspices of the Uncertainties in Ensembles of Regional ReAnalyses (UERRA) project, we describe the compilation and development of a digital dataset of 8.8 million meteorological observations of essential climate variables (ECVs) rescued across the European and southern Mediterranean region. By presenting the entire chain of data preparation, from the identification of regions lacking in digitised sub-daily data and the location of original sources, through the digitisation of the observations to the quality control procedures applied, we provide a rescued dataset that is as traceable as possible for use by the research community.Data from 127 stations and of 15 climate variables in the northern African and European sectors have been prepared for the period 1877 to 2012. Quality control of the data using a two-step semi-automatic statistical approach identified 3.5 % of observations that required correction or removal, on par with previous data rescue efforts.In addition to providing a new sub-daily meteorological dataset for the research community, our experience in the development of this sub-daily dataset gives us an opportunity to share some suggestions for future data rescue projects.All versions of the dataset, from the raw digitised data to data that have been quality controlled and converted to standard units, are available on PANGAEA: https://doi.org/10.1594/PANGAEA.886511 (Ashcroft et al., 2018).

Resumen: Introducción: Se describen las características epidemiológicas y clínicas de los casos de síndrome de trombosis con trombocitopenia (STT) notificados en España. Métodos: Se incluyeron los casos de trombosis venosa o arterial con trombocitopenia tras recibir vacuna con vectores de adenovirus no replicantes frente a la COVID-19 (AstraZeneca y Janssen) del 1 de febrero al 26 de septiembre de 2021. Se describe la tasa de notificación (número de casos notificados/número de dosis administradas), y el análisis de casos observados vs. esperados (O/E). Se evaluaron los predictores de mortalidad. Resultados: Se notificaron 61 casos, cumpliendo 45 los criterios de elegibilidad, 82% mujeres. La tasa de notificación global fue 4/1.000.000 dosis y 14-15/1.000.000 dosis entre los 30-49 años. El número de casos de trombosis de senos cerebrales observados fue 6-18 veces superior al esperado en menores de 49 años. Los síntomas comenzaron 10 (rango intercuartílico: 7-14) días tras la vacunación. El 80% (intervalo de confianza [IC] al 95%: 65-90%) tenía trombocitopenia en el momento de su visita a urgencias y el 65% (IC 95%: 49-78%) elevación del dímero D (> 2.000 ng/mL). La trombosis fue de múltiples localizaciones en 36% y fatal en 24% de los pacientes. Un valor nadir de trombocitopenia < 50.000 /μL (odds ratio [OR]: 7,4; IC 95%: 1,2-47,5) y la presencia de hemorragia cerebral (OR: 7,9; IC 95%: 1,3-47,0) se asociaron a un desenlace fatal. Conclusiones: Debe sospecharse el STT en pacientes que presenten síntomas unos 10 días tras la vacunación y presenten trombocitopenia y/o elevación de dímero D. Abstract: Background: We describe the epidemiological and clinical characteristics of thrombosis with thrombocytopenia syndrome (TTS) cases reported in Spain. Methods: We included all venous or arterial thrombosis with thrombocytopenia following adenovirus vector-based vaccines (AstraZeneca or Janssen) to prevent COVID-19 disease between February 1st and September 26th, 2021. We describe the crude rate and the standardized morbidity ratio. We assessed the predictors of mortality. Results: Sixty-one cases were reported and 45 fulfilled eligibility criteria, 82% women. The crude TTS rate was 4/1,000,000 doses and 14-15/1,000,000 doses between 30-49 years. The number of observed cases of cerebral venous thrombosis was 6-18 higher than the expected in patients younger than 49 years. Symptoms started 10 (interquartile range [IQR]: 7-14) days after vaccination. Eighty percent (95% confidence interval [CI]: 65-90%) had thrombocytopenia at the time of the emergency department visit, and 65% (95% CI: 49-78%) had D-dimer >2,000 ng/mL. Patients had multiple location thrombosis in 36% and fatal outcome in 24% cases. A platelet nadir < 50,000/μL (odds ratio [OR]: 7.4; CI 95%: 1.2-47.5) and intracranial hemorrhage (OR: 7.9; IC 95%: 1.3-47.0) were associated with fatal outcome. Conclusion: TTS must be suspected in patients with symptoms 10 days after vaccination and thrombocytopenia and/or D-dimer increase.

Sponges play a significant role in many marine environments. In tropical regions, the relationship between Porifera and spongivorous organisms, including fish, has been extensively studied. In the Mediterranean Sea, the dominant predators of sponges are sea stars, sea urchins and nudibranches, while knowledge of fish feeding on sponges is limited to sporadic events. This study aimed to investigate sponges as part of the diet of the white seabream Diplodus sargus. The results revealed that sponges were abundantly present in seabream stomachs, reaching up to 79.7% of the total biomass ingested by a single individual. Five different species were found in fish stomachs. The presence and organization of the spicular component seemed to affect the biting strategy of fish. Sponges with a prevalent organic component, such as Chondrosia reniformis Nardo, 1847, and Chondrilla nucula Schmidt, 1862, were ingested as fragments, while specimens of the Tethya citrina Sarà & Melone, 1965, characterized by a globular body, were engulfed entirely. Data from this study represent the first effort to investigate the trophic relationship between fish and Porifera in the Mediterranean Sea.

Introduction Discriminating between bipolar disorder (BD) and behavioral variant Frontotemporal Dementia (bvFTD) is a clinical challenge as it is still based on clinical judgement, which often leads to misdiagnosis. This challenge is particularly pronounced in cases involving the C9orf72 hexanucleotide expansion, a genetic factor responsible for a substantial portion of familial FTD cases, as in these patients the development of late psychoses is particularly frequent. Moreover, individuals with C9orf72 bvFTD are also characterized by behavioral changes that resemble those seen in late-life BD, especially during the early stages of the disease. This raises questions about whether the clinical similarities between BD and bvFTD are rooted in specific alterations within the brain networks involved in cognitive processing or in selective genetic and epigenetic mutations. In light of this, our recently published neuroimaging study has shed light on the presence of distinctive structural and metabolic characteristics in elderly individuals with BD and bvFTD. These findings offer valuable neurobiological insights that may lead to differentiate between bvFTD and elderly BD patients. Objectives Building on our previous research, this study further explores the existence of similar epigenetic expression patterns in plasma neural derived extra cellular vesicles (NDEs), such as miRNA and lncRNA, and seeks to correlate these epigenetic data with shared or distinct biological markers obtained through structural Magnetic Resonance Imaging and [18F]-fluorodeoxyglucose (FDG)-Positron Emission Tomography (PET). Methods We will plan to conduct statistical analyses on epigenetic and neuroimaging data on C9orf72 and sporadic bvFTD as well as on late-and early-onset BD patients and on healthy controls. Additionally, A PET study will be also performed on a subpopulation of these patients. Results Our hypothesis posits that selective epigenetic modifications may impact the brain’s structure and function, in a way that can change the glutamatergic neurotransmission in prefrontal regions, with subsequent indirect effects on subcortical areas. Conclusions Our findings will not only help identifying the specific biological signatures of BD and bvFTD, which might have important implications not only in prevention but also in differential diagnosis and treatment, but also offer insights into potential targets for slowing the onset and progression of the structural alterations characterizing these disorders. Disclosure of Interest None Declared

Introduction: The aim of this work is to describe the characteristics of stroke units and stroke teams in Spain. Methods: We performed a cross-sectional study based on an ad-hoc questionnaire designed by 5 experts and addressed to neurologists leading stroke units/teams that had been operational for ≥ 1 year. Results: The survey was completed by 43 stroke units (61% of units in Spain) and 14 stroke teams. A mean (standard deviation) of 4 (3) neurologists were assigned to each stroke unit/team; 98% of stroke units (and 38% of stroke teams) have an on-call neurologist available 24 hours a day, 98% of units (79% of stroke teams) included specialised nurses, 86% of units (71% of stroke teams) included a social worker, and 81% of units (71% of stroke teams) included a rehabilitation physician. Most stroke units (80%) had 4--6 beds with continuous non-invasive monitoring. The mean number of unmonitored beds was 14 (8) for stroke units and 12 (7) for stroke teams. The mean duration of non-invasive monitoring was 3 (1) days. All stroke units and 86% of stroke teams had intravenous thrombolysis available, and 81% of stroke units and 21% of stroke teams were able to perform mechanical thrombectomy, whereas the remaining centres had referral pathways in place. Telestroke systems were in place at 44% of stroke units, providing support to a mean of 4 (3) centres. Activity is recorded in clinical registries by 77% of stroke units and 50% of stroke teams, but less than 75% of data is completed in 25% of cases. Conclusions: Most stroke units/teams comply with the current recommendations. The systematic use of clinical registries should be improved to further improve patient care. Resumen: Introducción: El objetivo del trabajo es describir las características de las unidades (UI) y equipos (EI) de ictus en España. Método: Estudio transversal basado en un cuestionario ad-hoc, diseñado por 5 expertos y dirigido a los neurólogos responsables de las UI/EI con al menos un año de funcionamiento. Resultados: Participaron 43 UI (61% del total) y 14 EI. La media (±DE) de neurólogos adscritos a las UI/EI es de 4 ± 3. 98% de las UI frente a 38% de EI cuentan con neurólogo de guardia 24 h/7d. Disponen de enfermería especializada 98% de las UI frente a 79% de los EI, de médico rehabilitador 81% frente a 71% y de trabajador social 86% frente a 71%. La mayoría de UI (80%) tienen 4-6 camas con monitorización continua no invasiva. El número medio de camas no monitorizadas de las UI es de 14 ± 8 y de 12 ± 7 en los EI. La estancia media de los pacientes en las camas monitorizadas de las UI es de 3 ± 1 días. Todas las UI y el 86% de EI pueden realizar trombólisis intravenosa; el 81% de UI y 21% de EI trombectomía mecánica; el resto de los centros tiene posibilidad de derivación. El 44% de UI dispone del sistema teleictus, dando soporte a 4 ± 3 centros. La actividad se recoge sistemáticamente en el 77% de UI y 50% de EI, pero su cumplimentación es < 75% en un 25% de los casos. Conclusiones: La mayoría de las UI y de los EI cumple las recomendaciones actuales. Para seguir mejorando la atención del paciente, resulta necesario optimizar el registro sistemático de su actividad.

Resumen: Introducción: El objetivo del trabajo es describir las características de las unidades y equipos de ictus en España. Método: Estudio transversal basado en un cuestionario ad hoc, diseñado por 5 expertos y dirigido a los neurólogos responsables de las unidades de ictus (UI) y los equipos de ictus (EI) con al menos un año de funcionamiento. Resultados: Participaron 43 UI (61% del total) y 14 EI. La media (±DE) de neurólogos adscritos a las UI/EI fue de 4 ± 3. El 98% de las UI frente al 38% de los EI cuentan con neurólogo de guardia 24 h los 365 días. Disponen de enfermería especializada un 98% de las UI frente al 79% de los EI, de médico rehabilitador un 81% frente al 71% y de trabajador social un 86% frente al 71%. La mayoría de las UI (80%) tienen 4-6 camas con monitorización continua no invasiva. El número medio de camas no monitorizadas de las UI es de 14 ± 8 y de 12 ± 7 en los EI. La estancia media de los pacientes en las camas monitorizadas de las UI es de 3 ± 1 días. Todas las UI y el 86% de los EI pueden realizar trombólisis intravenosa; el 81% de las UI y el 21% de los EI pueden realizar trombectomía mecánica y el resto de los centros tiene posibilidad de derivación. El 44% de las UI dispone de un sistema de teleictus, que da servicio a 4 ± 3 centros. La actividad se recoge sistemáticamente en el 77% de las UI y en el 50% de los EI, pero su cumplimentación es

The skeleton of most Porifera species consists of siliceous spicules that, after the sponge death, persist for a long time in the sediment. The reduced suspension occurring within the meadows of the seagrass Posidonia oceanica makes these habitats a stable deposit for sponge spicules. Spicules trapped into the network of rhizomes progressively buried, named “matte”, represent a sedimentary sequence interpretable on a temporal scale. By means of a vertical corer we collected samples of sediment at 0.5, 1, 1.5 and 2 m depth along the matte profile in order to quantify the amount of biogenic silica used to assess past dynamics of the sponge community in four P. oceanica meadows of the Ligurian sea. The content in biogenic silica was determined by spectrophotometric analysis of the sediments. While at Prelo Bay the values are constant in the core sample, a general decreasing trend with depth was observed in the meadows of Punta Pedale, while in the site of Punta Manara the major amount of silica was found deeper in the matte. The temporal variations of sponge abundance were probably due to historical anthropogenic factors. In the meadow of Bergeggi, BSi concentrations, significantly lower compared to all other sites, were likely caused from inputs from the close Savona harbor and strong bottom currents avoiding spicule deposition.

Recent observations by JWST yield a large abundance of luminous galaxies at z ≳ 10 compared to that expected in the ΛCDM scenario based on extrapolations of the star formation efficiency measured at lower redshifts. While several astrophysical processes can be responsible for such observations, here we explore to what extent such an effect can be rooted in the assumed dark energy (DE) sector of the current cosmological model. This is motivated by recent results from different cosmological probes combined with the last data release of the Dark Energy Spectroscopic Instrument, which indicate a tension in the DE sector of the concordance ΛCDM model. We have considered the effect of assuming a DE characterized by a negative Λ as the ground state of a quintessence field on the galaxy luminosity function at high redshifts. We find that such models naturally affect the galaxy UV luminosities in the redshift range 10 ≲ z ≲ 15 needed to match the JWST observations, and with the value of Ω _Λ = [−0.6, −0.3] remarkably consistent with that required by independent cosmological probes. A sharp prediction of such models is the steep decline of the abundance of bright galaxies in the redshift range 15 ≲ z ≲ 16.

Resumen: Introducción: Los pacientes, tras un ictus o un ataque isquémico transitorio, presentan un riesgo muy elevado de sufrir nuevos episodios vasculares. La reducción del nivel de colesterol unido a lipoproteínas de baja densidad (cLDL) reduce la incidencia de nuevos episodios, si bien una proporción importante de pacientes no alcanza los objetivos terapéuticos recomendados con los tratamientos hipolipemiantes actuales. El objetivo de este documento de consenso es actualizar el papel de los inhibidores de la proproteína convertasa subtilisina/kexina tipo 9 (iPCSK9; alirocumab y evolocumab) en la prevención secundaria de episodios vasculares en pacientes con ictus isquémico previo. Métodos: Se realizó una revisión bibliográfica para identificar las principales evidencias sobre el uso de iPCSK9 en estos pacientes y los objetivos terapéuticos recomendados de cLDL. Los resultados se discutieron en 2 reuniones de consenso, que constituyeron la base para la elaboración del documento. Conclusiones: Los iPSCSK9 son eficaces en la reducción del riesgo vascular en prevención secundaria y, específicamente, evolocumab ha demostrado esta reducción en pacientes con ictus isquémico previo. Ambos fármacos han demostrado un buen perfil de seguridad, incluso en pacientes que alcanzaron un nivel de cLDL

Abstract Chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary arterial hypertension (PAH) are two forms of pulmonary hypertension (PH) characterized by obstructive vasculopathy. Endothelial dysfunction along with metabolic changes towards increased glycolysis are important in PAH pathophysiology. Less is known about such abnormalities in endothelial cells (ECs) from CTEPH patients. This study provides a systematic metabolic comparison of ECs derived from CTEPH and PAH patients. Metabolic gene expression was studied using qPCR in cultured CTEPH-EC and PAH-EC. Western blot analyses were done for HK2, LDHA, PDHA1, PDK and G6PD. Basal viability of CTEPH-EC and PAH-EC with the incubation with metabolic inhibitors was measured using colorimetric viability assays. Human pulmonary artery endothelial cells (HPAEC) were used as healthy controls. Whereas PAH-EC showed significant higher mRNA levels of GLUT1, HK2, LDHA, PDHA1 and GLUD1 metabolic enzymes compared to HPAEC, CTEPH-EC did not. Oxidative phosphorylation associated proteins had an increased expression in PAH-EC compared to CTEPH-EC and HPAEC. PAH-EC, CTEPH-EC and HPAEC presented similar HOXD macrovascular gene expression. Metabolic inhibitors showed a dose-dependent reduction in viability in all three groups, predominantly in PAH-EC. A different metabolic profile is present in CTEPH-EC compared to PAH-EC and suggests differences in molecular mechanisms important in the disease pathology and treatment.

Objective: We present an update of the Spanish Society of Neurology’s recommendations for prevention of both primary and secondary stroke in patients with dyslipidaemia. Development: We performed a systematic review to evaluate the main aspects of the management of dyslipidaemias in primary and secondary stroke prevention and establish a series of recommendations. Conclusions: In primary prevention, the patient’s vascular risk should be determined in order to define target values for low-density lipoprotein cholesterol. In secondary prevention after an atherothrombotic stroke, a target value

We present a rest-frame optical morphological analysis of galaxies observed with the NIRCam imager on the James Webb Space Telescope (JWST) as part of the GLASS-JWST Early Release Science program. We select 388 sources at redshifts 0.8 < z < 5.4 and use the seven 0.9–5 μ m NIRCam filters to generate rest-frame gri composite color images, and conduct visual morphological classification. Compared to Hubble Space Telescope (HST)–based work we find a higher incidence of disks and bulges than expected at z > 1.5, revealed by rest-frame optical imaging. We detect 123 clear disks (58 at z > 1.5) of which 76 have bulges. No evolution of bulge fraction with redshift is evident: 61% at z < 2 ( N = 110) versus 60% at z ≥ 2 ( N = 13). A stellar mass dependence is evident, with bulges visible in 80% of all disk galaxies with mass >10 ^9.5 M _⊙ ( N = 41) but only 52% at M < 10 ^9.5 M _⊙ ( N = 82). We supplement visual morphologies with nonparametric measurements of Gini and asymmetry coefficients in the rest-frame i band. Our sources are more asymmetric than local galaxies, with slightly higher Gini values. When compared to high- z rest-frame ultraviolet measurements with HST, JWST shows more regular morphological types such as disks, bulges, and spiral arms at z > 1.5, with smoother (i.e., lower Gini) and more symmetrical light distributions.

We present a first look at the reddest 2–5 μ m sources found in deep images from the GLASS Early Release Science program. We undertake a general search, i.e., not looking for any particular spectral signatures, for sources detected only in bands redder than is reachable with the Hubble Space Telescope, and which would likely not have been identified in pre-JWST surveys. We search for sources down to AB ∼27 (corresponding to >10 σ detection threshold) in any of the F200W to F444W filters, with a >1 magnitude excess relative to F090W to F150W bands. Fainter than F444W >25 we find 56 such sources of which 37 have reasonably constrained spectral energy distributions to which we can fit photometric redshifts. We find the majority of this population (∼65%) as 2 < z < 6 star-forming low-attenuation galaxies that are faint at rest-frame ultraviolet-optical wavelengths, have stellar masses 10 ^8.5 –10 ^9.5 M _⊙ , and have observed fluxes at >2 μ m boosted by a combination of the Balmer break and emission lines. The typical implied rest equivalent widths are ∼200 Å with some extreme objects up to ∼1000 Å. This is in contrast with brighter magnitudes where the red sources tend to be z < 3 quiescent galaxies and dusty star-forming objects. Our general selection criteria for red sources allow us to independently identify other phenomena as diverse as extremely low-mass (∼10 ^8 M _⊙ ) quiescent galaxies at z < 1, recovering recently identified z > 11 galaxies and a very cool brown dwarf.

We exploit James Webb Space Telescope (JWST) NIRCam observations from the GLASS-JWST-Early Release Science program to investigate galaxy stellar masses at z > 7. We first show that JWST observations reduce the uncertainties on the stellar mass by a factor of at least 5–10, when compared with the highest-quality data sets available to date. We then study the UV mass-to-light ratio, finding that galaxies exhibit a a two orders of magnitude range of M / L _UV values for a given luminosity, indicative of a broad variety of physical conditions and star formation histories. As a consequence, previous estimates of the cosmic stellar-mass density—based on an average correlation between UV luminosity and stellar mass—can be biased by as much as a factor of ∼6. Our first exploration demonstrates that JWST represents a new era in our understanding of stellar masses at z > 7 and, therefore, of the growth of galaxies prior to cosmic reionization.

We present the first James Webb Space Telescope/NIRCam-led determination of 7 < z < 9 galaxy properties based on broadband imaging from 0.8 to 5 μ m as part of the GLASS-JWST Early Release Science program. This is the deepest data set acquired at these wavelengths to date, with an angular resolution ≲0.″14. We robustly identify 13 galaxies with signal-to-noise ratio ≳ 8 in F444W from 8 arcmin ^2 of data at m _AB ≤ 28 from a combination of dropout and photometric redshift selection. From simulated data modeling, we estimate the dropout sample purity to be ≳90%. We find that the number density of these F444W-selected sources is broadly consistent with expectations from the UV luminosity function determined from Hubble Space Telescope data. We characterize galaxy physical properties using a Bayesian spectral energy distribution fitting method, finding a median stellar mass of 10 ^8.5 M _⊙ and age 140 Myr, indicating they started ionizing their surroundings at redshift z > 9.5. Their star formation main sequence is consistent with predictions from simulations. Lastly, we introduce an analytical framework to constrain main-sequence evolution at z > 7 based on galaxy ages and basic assumptions, through which we find results consistent with expectations from cosmological simulations. While this work only gives a glimpse of the properties of typical galaxies that are thought to drive the reionization of the universe, it clearly shows the potential of JWST to unveil unprecedented details of galaxy formation in the first billion years.

Star-forming galaxies can exhibit strong morphological differences between the rest-frame far-UV and optical, reflecting inhomogeneities in star formation and dust attenuation. We exploit deep, high-resolution, NIRCAM seven-band observations to take a first look at the morphology of galaxies in the epoch of reionization ( z > 7), and its variation in the rest-frame wavelength range between Ly α and 6000–4000 Å, at z = 7–12. We find no dramatic variations in morphology with wavelength—of the kind that would have overturned anything we have learned from the Hubble Space Telescope. No significant trends between morphology and wavelengths are detected using standard quantitative morphology statistics. We detect signatures of mergers/interactions in 4/19 galaxies. Our results are consistent with a scenario in which Lyman-break galaxies—observed when the universe is only 400–800 Myr old—are growing via a combination of rapid, galaxy-scale star formation supplemented by the accretion of star-forming clumps and interactions.

Objective: To update the recommendations of the Spanish Society of Neurology on primary and secondary stroke prevention in patients with arterial hypertension. Development: We proposed several questions to identify practical issues for the management of blood pressure (BP) in stroke prevention, analysing the objectives of blood pressure control, which drugs are most appropriate in primary prevention, when antihypertensive treatment should be started after a stroke, what levels we should aim to achieve, and which drugs are most appropriate in secondary stroke prevention. We conducted a systematic review of the PubMed database and analysed the main clinical trials to address these questions and establish a series of recommendations. Conclusions: In primary stroke prevention, antihypertensive treatment should be started in patients with BP levels > 140/90 mmHg, with a target BP of < 130/80 mmHg. In secondary stroke prevention, we recommend starting antihypertensive treatment after the acute phase (first 24 hours), with a target BP of < 130/80 mmHg. The use of angiotensin-II receptor antagonists or diuretics alone or in combination with angiotensin-converting enzyme inhibitors is preferable. Resumen: Objetivo: Actualizar las recomendaciones de la Sociedad Española de Neurología para la prevención de ictus, tanto primaria como secundaria, en pacientes con hipertensión arterial. Desarrollo: Se han planteado diferentes preguntas para identificar cuestiones prácticas para el manejo de la presión arterial (PA) en prevención de ictus, analizando cuál debe ser el objetivo de control de la presión arterial y cuáles son los fármacos más adecuados en prevención primaria, cuándo iniciar el tratamiento antihipertensivo después de un ictus, cuáles son las cifras que debemos alcanzar y qué fármacos son los más adecuados en prevención secundaria de ictus. Se ha realizado una revisión sistemática en Pubmed analizando los principales ensayos clínicos para dar respuesta a estas preguntas y se han elaborado unas recomendaciones. Conclusiones: En prevención primaria se recomienda iniciar tratamiento antihipertensivo con cifras de PA > 140/90 mmHg, con un objetivo de control de PA

Objective: To update the recommendations of the Spanish Society of Neurology regarding lifestyle interventions for stroke prevention. Development: We reviewed the most recent studies related to lifestyle and stroke risk, including randomised clinical trials, population studies, and meta-analyses. The risk of stroke associated with such lifestyle habits as smoking, alcohol consumption, stress, diet, obesity, and sedentary lifestyles was analysed, and the potential benefits for stroke prevention of modifying these habits were reviewed. We also reviewed stroke risk associated with exposure to air pollution. Based on the results obtained, we drafted recommendations addressing each of the lifestyle habits analysed. Conclusions: Lifestyle modification constitutes a cornerstone in the primary and secondary prevention of stroke. Abstinence or cessation of smoking, cessation of excessive alcohol consumption, avoidance of exposure to chronic stress, avoidance of overweight or obesity, a Mediterranean diet supplemented with olive oil and nuts, and regular exercise are essential measures in reducing the risk of stroke. We also recommend implementing policies to reduce air pollution. Resumen: Objetivo: Actualizar las recomendaciones de la Sociedad Española de Neurología relativas a la actuación sobre los hábitos de vida para la prevención del ictus. Desarrollo: Se ha realizado una revisión de los estudios más recientes relacionados con los hábitos de vida y el riesgo de ictus, incluyendo ensayos clínicos aleatorizados, estudios poblacionales y meta-análisis. Se ha analizado el riesgo de ictus asociado con determinados hábitos de vida como el tabaquismo, el consumo de alcohol, el estrés, la dieta, la obesidad y el sedentarismo, y se ha revisado el potencial beneficio que la modificación de esos hábitos de vida puede aportar en la prevención del ictus. Asimismo, se ha revisado el riesgo de ictus asociado a la exposición a la contaminación atmosférica. A partir de los resultados obtenidos se han redactado unas recomendaciones sobre cada uno de los hábitos de vida analizados. Conclusiones: La actuación sobre los hábitos de vida constituye una piedra angular en la prevención primaria y secundaria del ictus. La abstinencia o cese del hábito tabáquico, el cese del consumo excesivo de alcohol, evitar la exposición a estrés crónico, evitar el sobrepeso o la obesidad, seguir una dieta mediterránea suplementada con aceite de oliva y frutos secos, y la práctica regular de actividad física son medidas fundamentales para reducir el riesgo de sufrir un ictus. Además, se aconseja desarrollar políticas encaminadas a disminuir la contaminación atmosférica.

Resumen: Objetivo: Actualizar las recomendaciones de la Sociedad Española de Neurología para la prevención del ictus en pacientes con DM-2 o prediabetes, analizando las evidencias disponibles sobre el efecto del control metabólico y el posible beneficio de los antidiabéticos con beneficio vascular añadidos al tratamiento antidiabético estándar en la prevención de ictus. Desarrollo: Se han elaborado preguntas tipo PICO (Patient, Intervention, Comparison, Outcome) para identificar cuestiones prácticas para el manejo de pacientes con ictus y poder realizar recomendaciones específicas en cada una de ellas. Posteriormente se han realizado revisiones sistemáticas en Pubmed y se han seleccionado los ensayos clínicos aleatorizados que han evaluado ictus como variable independiente (principal o secundaria). Finalmente se ha elaborado metaanálisis para cada una de las preguntas PICO y se han redactado unas recomendaciones en respuesta a cada una de ellas. Conclusiones: Aunque no hay evidencia de que un mejor control metabólico reduzca el riesgo de ictus, algunas familias de antidiabéticos con beneficio vascular han mostrado reducción en el riesgo de ictus cuando se añaden al tratamiento convencional, tanto en el ámbito de prevención primaria en pacientes con DM-2 de alto riesgo vascular o con enfermedad vascular aterosclerosa establecida (agonistas GLP-1) como en prevención secundaria de ictus en pacientes con DM-2 y prediabetes (pioglitazona). Abstract: Objective: To update the Spanish Society of Neurology's guidelines for stroke prevention in patients with type 2 diabetes or prediabetes, analysing the available evidence on the effect of metabolic control and the potential benefit of antidiabetic drugs with known vascular benefits in addition to conventional antidiabetic treatments in stroke prevention. Development: PICO-type questions (Patient, Intervention, Comparison, Outcome) were developed to identify practical issues in the management of stroke patients and to establish specific recommendations for each of them. Subsequently, we conducted systematic reviews of the PubMed database and selected those randomised clinical trials evaluating stroke as an independent variable (primary or secondary). Finally, for each of the PICO questions we developed a meta-analysis to support the final recommendations. Conclusions: While there is no evidence that metabolic control reduces the risk of stroke, some families of antidiabetic drugs with vascular benefits have been shown to reduce these effects when added to conventional treatments, both in the field of primary prevention in patients presenting type 2 diabetes and high vascular risk or established atherosclerosis (GLP-1 agonists) and in secondary stroke prevention in patients with type 2 diabetes or prediabetes (pioglitazone).

Objective: To update the Spanish Society of Neurology’s guidelines for stroke prevention in patients with type 2 diabetes or prediabetes, analysing the available evidence on the effect of metabolic control and the potential benefit of antidiabetic drugs with known vascular benefits in addition to conventional antidiabetic treatments in stroke prevention. Methods: PICO-type questions (Patient, Intervention, Comparison, Outcome) were developed to identify practical issues in the management of stroke patients and to establish specific recommendations for each of them. Subsequently, we conducted systematic reviews of the PubMed database and selected those randomised clinical trials evaluating stroke as an independent variable (primary or secondary). Finally, for each of the PICO questions we developed a meta-analysis to support the final recommendations. Conclusions: While there is no evidence that metabolic control reduces the risk of stroke, some families of antidiabetic drugs with vascular benefits have been shown to reduce these effects when added to conventional treatments, both in the field of primary prevention in patients presenting type 2 diabetes and high vascular risk or established atherosclerosis (GLP-1 agonists) and in secondary stroke prevention in patients with type 2 diabetes or prediabetes (pioglitazone). Resumen: Objetivo: Actualizar las recomendaciones de la Sociedad Española de Neurología para la prevención del ictus en pacientes con DM-2 o prediabetes, analizando las evidencias disponibles sobre el efecto del control metabólico y posible beneficio de los antidiabéticos con beneficio vascular añadidos al tratamiento antidiabético estándar en la prevención de ictus. Desarrollo: Se han elaborado preguntas tipo PICO (Patient, Intervention, Comparison, Outcome) para identificar cuestiones prácticas para el manejo de pacientes con ictus y poder realizar recomendaciones específicas en cada una de ellas. Posteriormente se han realizado revisiones sistemáticas en Pubmed y se han seleccionado los ensayos clínicos aleatorizados que han evaluado ictus como variable independiente (principal o secundaria). Finalmente se ha elaborado metaanálisis para cada una de las preguntas PICO y se han redactado unas recomendaciones en respuesta a cada una de ellas. Conclusiones: Aunque no hay evidencia de que un mejor control metabólico reduzca el riesgo de ictus, algunas familias de antidiabéticos con beneficio vascular han mostrado reducción en el riesgo de ictus cuando se añaden al tratamiento convencional, tanto en el ámbito de prevención primaria en pacientes con DM-2 de alto riesgo vascular o con enfermedad vascular aterosclerosa establecida (agonistas GLP-1) como en prevención secundaria de ictus en pacientes con DM-2 y prediabetes (pioglitazona).

Campi Flegrei caldera (Southern Italy) is one of the most hazardous volcanic complexes in the world since it is located inside the densely inhabited urban district of Naples-Pozzuoli. In the past, the caldera has produced devastating to moderate eruptions and periodically undergoes from strong to minor uplift episodes, named “bradyseism”, almost always accompanied by seismic swarms. Starting from 2005 Campi Flegrei has undergone an unrest crisis, characterized by ground uplift, localized gas emissions and seismicity, often occurring in seismic swarms. As a consequence, the monitoring activities have been progressively increasing, producing a huge amount of data, difficult to manage and match. GIS (Geographical Information System) represents a potent tool to manage great quantity of data, coming from different disciplines. In this study, we show two GIS technology applications to the seismic catalogue of Campi Flegrei. In the first one, a high-quality dataset is extracted from the GeoDatabase addressed to seismological studies that require high precision earthquake locations. In the second application, GIS are used to extract, visualize and analyse the typical seismic swarms of Campi Flegrei. Moreover, density and seismic moment distribution maps were generated for these swarms. In the last application, the GIS allow to highlight a clear variation in the temporal trend of the seismic swarms at Campi Flegrei.

Resumen: Introducción: El control de los factores de riesgo cardiovascular (CV) en la prevención secundaria tras un ictus isquémico es bajo, en parte debido a la falta de adherencia terapéutica. La polipíldora CV puede contribuir a la buena cumplimentación del adecuado tratamiento para la prevención cerebrovascular. El objetivo fue establecer cómo y en qué casos se debería administrar. Métodos: Un grupo de 8 neurólogos redactaron recomendaciones consensuadas mediante una técnica de brainstorming estructurado, basándose en su experiencia y en una revisión bibliográfica. Resultados: Los resultados atienden a la opinión de los expertos. El uso de la polipíldora CV tiene ventajas para pacientes, profesionales sanitarios y para el sistema de salud. Las situaciones clínicas más adecuadas para su uso son el ictus aterotrombótico, el lacunar, el asociado a deterioro cognitivo, el criptogénico con factores de riesgo CV y la enfermedad cerebrovascular silente. Su uso preferente incluye la sospecha de mal cumplimiento, a los pacientes polimedicados, ancianos, polivasculares o con alta carga aterotrombótica, jóvenes activos laboralmente y pacientes con preferencias por la polipíldora CV. Las opciones de administración incluyen el paso de fármacos individuales a la polipíldora CV, el inicio directo desde la fase aguda en casos particulares, a los pacientes con otra estatina o con un antagonista del receptor de la angiotensina ii, o de novo si hubiera sospecha de mala adherencia. No obstante, su uso implica realizar seguimiento del cumplimiento de los objetivos terapéuticos para ajustar la dosis. Conclusiones: Este documento es el primero en establecer recomendaciones de uso de la polipíldora CV en enfermedad cerebrovascular, aparte de sus ventajas sobre la adherencia. Abstract: Introduction: There is little control of cardiovascular (CV) risk factors in secondary prevention after an ischaemic stroke, in part due to a lack of adherence to treatment. The CV polypill may contribute to proper treatment adherence, which is necessary for CV disease prevention. This study aimed to establish how and in what cases the CV polypill should be administered. Methods: A group of 8 neurologists drafted consensus recommendations using structured brainstorming and based on their experience and a literature review. Results: These recommendations are based on the opinion of the participating experts. The use of the CV polypill is beneficial for patients, healthcare professionals, and the health system. Its use is most appropriate for atherothrombotic stroke, lacunar stroke, stroke associated with cognitive impairment, cryptogenic stroke with CV risk factors, and silent cerebrovascular disease. It is the preferred treatment in cases of suspected poor adherence, polymedicated patients, elderly people, patients with polyvascular disease or severe atherothrombosis, young patients in active work, and patients who express a preference for the CV polypill. Administration options include switching from individual drugs to the CV polypill, starting treatment with the CV polypill in the acute phase in particular cases, use in patients receiving another statin or an angiotensin ii receptor antagonist, or de novo use if there is suspicion of poor adherence. Nevertheless, use of the CV polypill requires follow-up on the achievement of the therapeutic objectives to make dose adjustments. Conclusions: This document is the first to establish recommendations for the use of the CV polypill in cerebrovascular disease, beyond its advantages in terms of treatment adherence.

Introduction: There is little control of cardiovascular (CV) risk factors in secondary prevention after an ischaemic stroke, in part due to a lack of adherence to treatment. The CV polypill may contribute to proper treatment adherence, which is necessary for CV disease prevention. This study aimed to establish how and in what cases the CV polypill should be administered. Methods: A group of 8 neurologists drafted consensus recommendations using structured brainstorming and based on their experience and a literature review. Results: These recommendations are based on the opinion of the participating experts. The use of the CV polypill is beneficial for patients, healthcare professionals, and the health system. Its use is most appropriate for atherothrombotic stroke, lacunar stroke, stroke associated with cognitive impairment, cryptogenic stroke with CV risk factors, and silent cerebrovascular disease. It is the preferred treatment in cases of suspected poor adherence, polymedicated patients, elderly people, patients with polyvascular disease or severe atherothrombosis, young patients in active work, and patients who express a preference for the CV polypill. Administration options include switching from individual drugs to the CV polypill, starting treatment with the CV polypill in the acute phase in particular cases, use in patients receiving another statin or an angiotensin ii receptor antagonist, or de novo use if there is suspicion of poor adherence. Nevertheless, use of the CV polypill requires follow-up on the achievement of the therapeutic objectives to make dose adjustments. Conclusions: This document is the first to establish recommendations for the use of the CV polypill in cerebrovascular disease, beyond its advantages in terms of treatment adherence. Resumen: Introducción: El control de los factores de riesgo cardiovascular (CV) en la prevención secundaria tras un ictus isquémico es bajo, en parte debido a la falta de adherencia terapéutica. La polipíldora CV puede contribuir a la buena cumplimentación del adecuado tratamiento para la prevención cerebrovascular. El objetivo fue establecer cómo y en qué casos se debería administrar. Métodos: Un grupo de 8 neurólogos redactaron recomendaciones consensuadas mediante una técnica de brainstorming estructurado, basándose en su experiencia y en una revisión bibliográfica. Resultados: Los resultados atienden a la opinión de los expertos. El uso de la polipíldora CV tiene ventajas para pacientes, profesionales sanitarios y para el sistema de salud. Las situaciones clínicas más adecuadas para su uso son el ictus aterotrombótico, el lacunar, el asociado a deterioro cognitivo, el criptogénico con factores de riesgo CV y la enfermedad cerebrovascular silente. Su uso preferente incluye la sospecha de mal cumplimiento, a los pacientes polimedicados, ancianos, polivasculares o con alta carga aterotrombótica, jóvenes activos laboralmente y pacientes con preferencias por la polipíldora CV. Las opciones de administración incluyen el paso de fármacos individuales a la polipíldora CV, el inicio directo desde la fase aguda en casos particulares, a los pacientes con otra estatina o con un antagonista del receptor de la angiotensina ii, o de novo si hubiera sospecha de mala adherencia. No obstante, su uso implica realizar seguimiento del cumplimiento de los objetivos terapéuticos para ajustar la dosis. Conclusiones: Este documento es el primero en establecer recomendaciones de uso de la polipíldora CV en enfermedad cerebrovascular, aparte de sus ventajas sobre la adherencia.

Two Pinna nobilis populations thriving inside the borders of the Portofino Marine Protected Area (MPA) (Ligurian Sea, western Mediterranean Sea) were monitored before (2012) and after (September 2018) a dire mass mortality event that, since September 2016, spread through the whole Mediterranean Sea. In Portofino MPA, recorded mortality rates reached values of 91.29% and 43.94% in the two populations. The presence of a Haplosporidium protozoan parasite, considered to be the main cause of the mortality episodes, was confirmed from histological evidence: sporocysts and plasmodia were observed in all the tubules of the digestive glands of the collected specimens. Moreover, a catastrophic storm hit the Ligurian coasts at the end of October 2018, causing considerable damages both below and above the surface; a new survey conducted in November 2018 showed the complete annihilation of the two studied populations, as a probable combination of the continued parasite infections and the mechanical impacts caused by the storm. Finally, in June 2020 the sites were monitored again looking for traces of recovery, but no new specimens were recorded, indicating that P. nobilis became virtually absent from the MPA.