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The characteristics of students who begin a medical degree in Spain are determined by the results of the entrance tests (EBAU). In order to select a student profile more closely aligned with the skills that must be acquired in order to practice the profession, the medical schools of Catalonia, with the health and university departments of the Generalitat, carried out a pilot test, inspired by the selection processes that are carried out in other countries around us. Objective: To develop a test for the detection of non-technical skills in students who are admitted to the degree. Methodology: The test consisted of answering three types of tests, to measure communication and relationship with the professional environment (CREP), ethical judgment in specific situations (JUESC) and, finally, critical reasoning ability (CRAC). There was a total of 134 multiple-choice questions that had previously been validated by members of the dean's teams. 511 first-year students (49% of the total) answered the test in September 2022. Results: The means and standard deviations of the three tests were: CREP (7.18, 0.99), JUESC (4.68, 0.81), CRAC (5.43, 1.02), and the total of the test (5.67, 0.62). The reliability tests (Cronbach) were: CREP (0.56), JUESC (0.54), CRAC (0.49), total (0.65). Conclusion: A test that better selects medical students based on a profile more in line with humanistic values is perfectly feasible, although based on this experience, the instrument needs to be improved to make it more reliable. © 2024 The Authors

Supplementary Material of the article "Association of HCG20 and LINC00243 with schizophrenia and bipolar disorder through the regulation of DDR1 transcript expression in the adult brain dorsolateral prefrontal cortex". Article prepared to be submitted. It contains the results derived from the analyses performed to study whether the long non coding RNAs (lncRNAs) HCG20 and LINC00243 regulate DDR1 transcript expression in brain, particularly: Table S1. Expression levels of the HCG20, LINC02570, DDR1-DT and DDR1 transcripts included. Table S2. Blocks of linkage disequilibrium in the HCG20-DDR1 estimated by PLINK. Table S3. List of SNPs associated with schizophrenia or bipolar disorder in the latest genome-wide and candidate gene association analyses. Table S4. Complementarity hits between lncRNAs and DDR1. Table S5. Correlations between lncRNAs and DDR1 transcripts in healthy controls. Table S6. Mediation analyses between lncRNAs trnascripts, DDR1 transcripts and the diagnoses of schizophrenia and bipolar disorder. Table S7. Differential expression analyses of lncRNAs in schizophrenia and bipolar disorder. Table S8. List of eQTLs for lncRNAs and DDR1 transcripts in the HCG20-DDR1 locus. (2024-01-30)

Supplementary Material of the article: Processing speed mediates the relationship between DDR1 and psychosocial functioning in euthymic patients with bipolar disorder presenting psychotic symptoms, which is aimed to finding genetic variants associated to the diagnosis, neurocognitive performance, psychosocial functioning and white matter microstructure of patients with bipolar disorder. Particularly: Figre S1. Effect of rs1264323AA-rs2267641AC/CC on psychosocial functioning in patients with BD with psychotic symptoms. Table S1. SNP association tests in the whole patient sample and in the subsamples of bipolar disorder with and without psychotic symptoms. Table S2. SNP-SNP association tests in the whole patient sample and in the subsamples of bipolar disorder with and without psychotic symptoms. Table S3. Linear regression models of the neurocognition assessment in all participants. Table S4. Linear regression models of the neurocognition assessment healthy controls. Table S5. Linear regression models of the neurocognition assessment in patients with BD. Table S6. Linear regression models of the neurocognition assessment in patients with BD withpsychotic symptoms. (2024-01-30)

The characteristics of students who begin a medical degree in Spain are determined by the results of the entrance tests (EBAU). In order to select a student profile more closely aligned with the skills that must be acquired in order to practice the profession, the medical schools of Catalonia, with the health and university departments of the Generalitat, carried out a pilot test, inspired by the selection processes that are carried out in other countries around us. Objective: To develop a test for the detection of non-technical skills in students who are admitted to the degree. Methodology: The test consisted of answering three types of tests, to measure communication and relationship with the professional environment (CREP), ethical judgment in specific situations (JUESC) and, finally, critical reasoning ability (CRAC). There was a total of 134 multiple-choice questions that had previously been validated by members of the dean's teams. 511 first-year students (49% of the total) answered the test in September 2022. Results: The means and standard deviations of the three tests were: CREP (7.18, 0.99), JUESC (4.68, 0.81), CRAC (5.43, 1.02), and the total of the test (5.67, 0.62). The reliability tests (Cronbach) were: CREP (0.56), JUESC (0.54), CRAC (0.49), total (0.65). Conclusion: A test that better selects medical students based on a profile more in line with humanistic values is perfectly feasible, although based on this experience, the instrument needs to be improved to make it more reliable.

Supplementary material of the Article "Coexpression of the discoidin domain receptor 1 gene with oligodendrocyte-related and schizophrenia risk genes in the developing and adult human brain". It contains the data derived form a stuy aimed at identifying the genes that coexpressed with DDR1 in different stages of brain development, particularly: Figure S1. Spatiotemporal expression levels of DDR1, collagen, oligodendrocyte and myelin genes in human brain. Figure S2. Module eigengenes (ME) correlations with sample characteristics at each period studied. Figure S3. Gene overlap between each module identified and the pre-defined cell type modules according to Miller and cols (2010) in each developmental period. Figure S4. Cell type expression of DDR1 in prenatal and adult human brain. Table S1: Sample description. Table S2: Module correspondence. Table S3: List of genes in each DDR1 module according to time interval. Table S4: Module localization of oligodendrocyte, myelin, astrocyte, microglia and collagen genes. Table S5: Gene overlap with premade gene-lists from Cahoy et al. in the DDR1-modules. Table S6: Pathway enrichment in the DDR1-module in I-1. Table S7: Pathway enrichment in the DDR1-module in I-2. Table S8: Pathway enrichment in the DDR1-module in I-3. Table S9: Pathway enrichment in the DDR1-module in I-4. Table S10: Overlapp of genes between DDR1-module and SCZ-susceptibility genes according to time interval. (2024-01-30)

It contains the Supplementary Material of the following article: Coexpression network analysis of the adult brain sheds light on the pathogenic mechanism of DDR1 in schizophrenia and bipolar disorder, which is aimed to know the biological function of DDR1 transcripts in adult brain dorsolateral prefrontal cortex. Particularly: Figure S1. Plot of principal components (PCs) of the whole sample matrices before (A) and after (B) adjusting for surrogate variables. Figure S2. (A) Variance explained by the identified surrogate variables (SVs). Figure S3. Analysis of the network topology under various soft-thresholding power values in the control (A) and whole-sample (B) networks. Figure S4. Quantification of DDR1 transcripts in healthy controls, patients with schizophrenia and patients with bipolar disorder. Figure S5. Correlations between the expression of DDR1 transcripts and cell type proportion estimates of astrocytes, OPCs, oligodendrocytes, neurons, microglia and endothelial cells. Table S1. List of the nominally associated p-values of the eQTL analysis. Table S2. ID and module of the genes in the control network. Table S3. Full list of the results of the cell type enrichment analyses in the control network. Table S4. Full list of the results of the GO enrichment analysis in the control network. Table S5. Correlation of the surrogate variables with the cell type proportion estimates. Table S6. Module distribution and transcript significance of DDR1 transcripts. (2024-01-30)

Background The study of thoracic injuries and biomechanics during CPR requires detailed studies that are very scarce. The role of the heart in CPR biomechanics has not been determined. This study aimed to determine the risk factors importance for serious ribcage damage due to CPR. Methods Data were collected from a prospective registry of out-of-hospital cardiac arrest between April 2014 and April 2017. This study included consecutive out-of-hospital CPR attempts undergoing an autopsy study focused on CPR injuries. Cardiac mass ratio was defined as the ratio of real to expected heart mass. Pearson’s correlation coefficient was used to select clinically relevant variables and subsequently classification tree models were built. The Gini index was used to determine the importance of the associated serious ribcage damage factors. The LUCAS® chest compressions device forces and the cardiac mass were analyzed by linear regression. Results Two hundred CPR attempts were included (133 manual CPR and 67 mechanical CPR). The mean age of the sample was 60.4 ± 13.5, and 56 (28%) were women. In all, 65.0% of the patients presented serious ribcage damage. From the classification tree build with the clinically relevant variables, age (0.44), cardiac mass ratio (0.26), CPR time (0.22), and mechanical CPR (0.07), in that order, were the most influential factors on serious ribcage damage. The chest compression forces were greater in subjects with higher cardiac mass. Conclusions The heart plays a key role in CPR biomechanics being cardiac mass ratio the second most important risk factor for CPR injuries.

Rat hepatitis E virus (ratHEV; species Rocahepevirus ratti) is considered a newly emerging cause of acute hepatitis of zoonotic origin. ratHEV infection of people living with HIV (PLWH) might portend a worse, as with hepatitis E virus (HEV; species Paslahepevirus balayani), and consequently this group may constitute a high-risk population. We aimed to evaluate the prevalence of ratHEV by measuring viral RNA and specific IgG antibodies in a large Spanish cohort of PLWH. Multicentre study conducted in Spain evaluating PLWHIV included in the Spanish AIDS Research Network (CoRIS). Patients were evaluated for ratHEV infection using PCR at baseline and anti-ratHEV IgG by dot blot analysis to evaluate exposure to ratHEV strains. Patients with detectable ratHEV RNA were followed-up to evaluate persistence of viremia and IgG seroconversion. Eight-hundred and forty-two individuals were tested. A total of 9 individuals showed specific IgG antibodies against ratHEV, supposing a prevalence of 1.1 (95% CI; 0.5%−2.1%). Of these, only one was reactive to HEV IgG antibodies by ELISA. One sample was positive for ratHEV RNA (prevalence of infection: 0.1%; 95% CI: 0.08%−0.7%). The case was a man who had sex with men exhibiting a slightly increased alanine transaminase level (49 IU/L) as only biochemical alteration. In the follow-up, the patients showed undetectable ratHEV RNA and seroconversion to specific ratHEV IgG antibodies. Our study shows that ratHEV is geographical broadly distributed in Spain, representing a potential zoonotic threat.

Background. Coronavirus disease 2019 (COVID-19) disproportionately affects migrants and ethnic minorities, including those with human immunodeficiency virus (HIV). Comprehensive studies are needed to understand the impact and risk factors.Methods. Using data from the PISCIS cohort of people with HIV (PWH) in Catalonia, Spain, we investigated COVID-19 outcomes and vaccination coverage. Among 10 640 PWH we compared migrants and non-migrants assessing rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing, diagnosis, and associated clinical outcomes through propensity score matching and multivariable Cox regression.Results. The cohort (mean age, 43 years; 83.5% male) included 57.4% (3053) Latin American migrants. Migrants with HIV (MWH) had fewer SARS-CoV-2 tests (67.8% vs 72.1%, P < .0001) but similar COVID-19 diagnoses (29.2% vs 29.4%, P = .847) compared to Spanish natives. Migrants had lower complete vaccination (78.9% vs 85.1%, P < .0001) and booster doses (63.0% vs 65.5%, P = .027). COVID-19 hospitalizations (8.1% vs 5.1%, P < .0001) and intensive care unit (ICU) admissions (2.9% vs 1.2%, P < .0001) were higher among migrants, with similar hospitalization duration (5.5 vs 4.0 days, P = .098) and mortality (3 [0.2%] vs 6 [0.4%], P = .510). Age >= 40 years, CD4 counts <200 cells/mu L, >= 2 comorbidities, and incomplete/nonreception of the SARS-CoV-2 vaccine increased the risk of severe COVID-19 among migrants.Conclusions. MWH had lower rates of SARS-CoV-2 testing and vaccination coverage, although the rates of COVID-19 diagnosis were similar between migrants and non-migrants. Rates of COVID-19-associated hospitalizations and ICU admissions were higher among migrants in comparison with non-migrants, with similar hospitalization duration and mortali

Introduction: Engineered bone graft substitutes are a promising alternative and supplement to autologous bone grafts as treatments for bone healing impairment. Advances in human medicine extend an invitation to pursue these biomimetic strategies in animal patients, substantiated by the theory that specialized scaffolds, multipotent cells, and biological cues may be combined into a bioactive implant intended for the enhancement of tissue regeneration. Methods: This proof-of-concept study was designed to evaluate and validate the feasibility of beta-tricalcium phosphate foam scaffolds seeded with canine mesenchymal stem cells derived from adipose tissue. Cell-inoculated samples and sham controls were cultured statically for 72 hours in complete growth medium to evaluate seeding capacity, while a subset of loaded scaffolds was further induced with osteogenic culture medium for 21 days. Produced implants were characterized and validated with a combination of immunofluorescence and reflection confocal microscopy, scanning electron microscopy, and polymerase chain reaction to confirm osteogenic differentiation in tridimensional-induced samples. Results: After 72 hours of culture, all inoculated scaffolds presented widespread yet heterogeneous surface seeding, distinctively congregating stem cells around pore openings. Furthermore, at 21 days of osteogenic culture conditions, robust osteoblastic differentiation of the seeded cells was confirmed by the change of cell morphology and evident deposition of extra-cellular matrix, accompanied by mineralization and scaffold remodeling; furthermore, all induced cell-loaded implants lost specific stemness immunophenotype expression and simultaneously upregulated genomic expression of osteogenic genes Osterix and Ostecalcin. Conclusions: ß-TCP bio-ceramic foam scaffolds proved to be suitable carriers and hosts of canine adipose-derived MSCs, promoting not only surface attachment and proliferation, but also demonstrating strong in-vi, Peer Reviewed, Postprint (published version)

Abstract Background We previously reported that impaired type I IFN activity, due to inborn errors of TLR3- and TLR7-dependent type I interferon (IFN) immunity or to autoantibodies against type I IFN, account for 15–20% of cases of life-threatening COVID-19 in unvaccinated patients. Therefore, the determinants of life-threatening COVID-19 remain to be identified in?~?80% of cases. Methods We report here a genome-wide rare variant burden association analysis in 3269 unvaccinated patients with life-threatening COVID-19, and 1373 unvaccinated SARS-CoV-2-infected individuals without pneumonia. Among the 928 patients tested for autoantibodies against type I IFN, a quarter (234) were positive and were excluded. Results No gene reached genome-wide significance. Under a recessive model, the most significant gene with at-risk variants was TLR7, with an OR of 27.68 (95%CI 1.5–528.7, P?=?1.1?×?10?4) for biochemically loss-of-function (bLOF) variants. We replicated the enrichment in rare predicted LOF (pLOF) variants at 13 influenza susceptibility loci involved in TLR3-dependent type I IFN immunity (OR?=?3.70[95%CI 1.3–8.2], P?=?2.1?×?10?4). This enrichment was further strengthened by (1) adding the recently reported TYK2 and TLR7 COVID-19 loci, particularly under a recessive model (OR?

Despite being frequently observed in cancer cells, chromosomal instability (CIN) and its immediate consequence, aneuploidy, trigger adverse effects on cellular homeostasis that need to be overcome by anti-stress mechanisms. As such, these safeguard responses represent a tumor-specific Achilles heel, since CIN and aneuploidy are rarely observed in normal cells. Recent data have revealed that epitranscriptomic marks catalyzed by RNA-modifying enzymes change under various stress insults. However, whether aneuploidy is associated with such RNA modifying pathways remains to be determined. Through an in silico search for aneuploidy biomarkers in cancer cells, we found TRMT61B, a mitochondrial RNA methyltransferase enzyme, to be associated with high levels of aneuploidy. Accordingly, TRMT61B protein levels are increased in tumor cell lines with an imbalanced karyotype as well as in different tumor types when compared to control tissues. Interestingly, while TRMT61B depletion induces senescence in melanoma cell lines with low levels of aneuploidy, it leads to apoptosis in cells with high levels. The therapeutic potential of these results was further validated by targeting TRMT61B in transwell and xenografts assays. We show that TRM61B depletion reduces the expression of several mitochondrial encoded proteins and limits mitochondrial function. Taken together, these results identify a new biomarker of aneuploidy in cancer cells that could potentially be used to selectively target highly aneuploid tumors.

Background While a low CD4/CD8 ratio during HIV treatment correlates with immunosenescence, its value in identifying patients at an increased risk for clinical events remains unclear.Methods We analyzed data from the CoRIS cohort to determine whether CD4 count, CD8 count, and CD4/CD8 ratio at year two of antiretroviral therapy (ART) could predict the risk of serious non-AIDS events (SNAEs) during the next five years. These included major adverse cardiovascular events, non-AIDS-defining malignancies, and non-accidental deaths. We used pooled logistic regression with inverse probability weighting to estimate the survival curves and cumulative risk of clinical events.Findings The study included 4625 participants, 83% male, of whom 200 (4.3%) experienced an SNAE during the follow-up period. A CD4/CD8 ratio <0.3 predicted an increased risk of SNAEs during the next five years (OR 1.63, 95% CI 1.03-2.58). The effect was stronger at a CD4/CD8 ratio cut-off of <0.2 (OR 3.09, 95% CI 1.57-6.07). Additionally, low CD4 count at cut-offs of <500 cells/mu L predicted an increased risk of clinical events. Among participants with a CD4 count >500 cells/mu L, a CD8 count >1500 cells/mu L or a CD4/CD8 ratio <0.4 predicted increased SNAE risk.Interpretation Our results support the use of the CD4/CD8 ratio and CD8 count as predictors of clinical progression. Patients with CD4/CD8 ratio <0.3 or CD8 count >1500/mu L, regardless of their CD4 count, may benefit from closer monitoring and targeted preventive interventions.Copyright (c) 2023 The Author(s). Published by Elsevier B.V.

SLC30A9 encodes a ubiquitously zinc transporter (ZnT9) and has been consistently suggested as a candidate for positive selection in humans. However, no direct adaptive molecular phenotype has been demonstrated. Our results provide evidence for directional selection operating in two major complementary haplotypes in Africa and East Asia. These haplotypes are associated with differential gene expression but also differ in the Met50Val substitution (rs1047626) in ZnT9, which we show is found in homozygosis in the Denisovan genome and displays accompanying signatures suggestive of archaic introgression. Although we found no significant differences in systemic zinc content between individuals with different rs1047626 genotypes, we demonstrate that the expression of the derived isoform (ZnT9 50Val) in HEK293 cells shows a gain of function when compared with the ancestral (ZnT9 50Met) variant. Notably, the ZnT9 50Val variant was found associated with differences in zinc handling by the mitochondria and endoplasmic reticulum, with an impact on mitochondrial metabolism. Given the essential role of the mitochondria in skeletal muscle and since the derived allele at rs1047626 is known to be associated with greater susceptibility to several neuropsychiatric traits, we propose that adaptation to cold may have driven this selection event, while also impacting predisposition to neuropsychiatric disorders in modern humans.Copyright: © 2023 Roca-Umbert et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

West Nile virus (WNV) is a mosquito-borne flavivirus that can cause Central Nervous System infection in humans. Previous autochthonous cases of WNV encephalitis have been described in Spain, but none in Catalonia.We report on the first two autochthonous cases of encephalitis in humans caused by the West Nile virus (WNV) diagnosed in Catalonia (northeastern region of Spain).An old married couple presented with clinical and biological signs compatible with viral encephalitis. Acute and convalescent serum samples showed IgM and IgG positivity for WNV. In addition, IgM was also detected in cerebrospinal fluid in the male patient. The serological results were later confirmed by microneutralization assays.WNV infection must be considered in patients presenting with meningoencephalitis with viral CSF characteristics when common pathogens are excluded.

Metabolomics encounters challenges in cross-study comparisons due to diverse metabolite nomenclature and reporting practices. To bridge this gap, we introduce the Metabolites Merging Strategy (MMS), offering a systematic framework to harmonize multiple metabolite datasets for enhanced interstudy comparability. MMS has three steps. Step 1: Translation and merging of the different datasets by employing InChIKeys for data integration, encompassing the translation of metabolite names (if needed). Followed by Step 2: Attributes’ retrieval from the InChIkey, including descriptors of name (title name from PubChem and RefMet name from Metabolomics Workbench), and chemical properties (molecular weight and molecular formula), both systematic (InChI, InChIKey, SMILES) and non-systematic identifiers (PubChem, CheBI, HMDB, KEGG, LipidMaps, DrugBank, Bin ID and CAS number), and their ontology. Finally, a meticulous three-step curation process is used to rectify disparities for conjugated base/acid compounds (optional step), missing attributes, and synonym checking (duplicated information). The MMS procedure is exemplified through a case study of urinary asthma metabolites, where MMS facilitated the identification of significant pathways hidden when no dataset merging strategy was followed. This study highlights the need for standardized and unified metabolite datasets to enhance the reproducibility and comparability of metabolomics studies.

Background: Clinical outcomes of bicuspid aortic valve (BAV) patients with ascending aortic diameters ≥50 mm who are under surveillance are poorly defined. Objectives: The purpose of this study was to assess clinical outcomes in BAV patients with ascending aorta ≥50 mm. Methods: Multicenter retrospective cohort study of BAV adults with ascending aorta diameters ≥50 mm by transthoracic echocardiography (TTE). Patients were categorized into 50 to 54 mm and ≥55 mm groups. Clinical outcomes were aortic dissection (AoD), aorta surgery, surgical mortality, and all-cause death. Results: Of 875 consecutive BAV patients (age 60 ± 13 years, 86% men, aortic diameter 51 mm [interquartile range (IQR): 50-53 mm]), 328 (37%) underwent early surgery ≤3 months from index TTE. Of the remaining 547 patients under surveillance, 496 had diameters 50 to 54 mm and 51 had diameters ≥55 mm and were collectively followed for 7.51 (IQR: 3.98-12.20) years. Of 496 patients with diameters 50 to 54 mm under surveillance, 266 (54%) underwent surgery 2.0 (IQR: 0.77-4.16) years from index TTE. AoD occurred in 9/496 (1.8%) patients for an incidence of 0.4 cases per 100 person-years, surgical mortality was 5/266 (1.9%); and ≥moderate aortic stenosis (but not aorta size) was associated with all-cause death, hazard ratio: 2.05 (95% CI: 1.32-3.20), P = 0.001. Conversely, in 547 total patients under surveillance (including 50-54 mm and ≥55 mm), both aorta size and ≥moderate aortic stenosis were associated with all-cause death (both P ≤ 0.027). AoD rate in patients ≥55 mm under surveillance was 5.9%. Conclusions: In BAV patients with ascending aorta 50 to 54 mm under surveillance, AoD incidence is low and the overall rates of AoD and surgical mortality are similar, suggesting clinical equivalence between surgi

To assess the effectiveness and tolerability of dolutegravir (DTG)/lamivudine (3TC) among treatment-naive and virologically suppressed treatment-experienced individuals in the multicentre cohort of the Spanish HIV/AIDS Research Network (CoRIS) during the years 2018-2021.We used multivariable regression models to compare viral suppression (VS) [HIV RNA viral load (VL) <50 copies/mL] and the change in CD4 cell counts at 24 and 48 (±12) weeks after initiation with dolutegravir/lamivudine or other first-line ART regimens.We included 2160 treatment-naive subjects, among whom 401 (18.6%) started with dolutegravir/lamivudine. The remaining subjects started bictegravir (BIC)/emtricitabine (FTC)/tenofovir alafenamide (TAF) (n = 949, 43.9%), DTG + FTC/tenofovir disoproxil fumarate (TDF) (n = 282, 13.1%), DTG/3TC/abacavir (ABC) (n = 255, 11.8%), darunavir (DRV)/cobicistat(COBI)/FTC/TAF (n = 147, 6.8%) and elvitegravir (EVG)/COBI/FTC/TAF (n = 126, 5.8%). At 24 and 48 weeks after starting dolutegravir/lamivudine, 91.4% and 93.8% of the subjects, respectively, achieved VS. The probability of achieving VS with dolutegravir/lamivudine was not significantly different compared with any other regimen at 24 or 48 weeks, with the exception of a lower chance of achieving VS at 24 weeks for DRV/COBI/FTC/TAF (adjusted OR: 0.47; 95% CI: 0.30-0.74) compared with dolutegravir/lamivudine.For the analysis of treatment-experienced virally suppressed subjects we included 1456 individuals who switched to dolutegravir/lamivudine, among whom 97.4% and 95.5% maintained VS at 24 and 48 weeks, respectively. During the first 48 weeks after dolutegravir/lamivudine initiation, 1.0% of treatment-naive and 1.5% of treatment-experienced subjects discontinued dolutegravir/lamivudine due to an adverse event.In thi

People living with HIV (PLWH) face structural and psychosocial factors that affect health-related quality of life (HRQoL). We aimed to evaluate how syndemic conditions affected HRQoL in PLWH.A cross-sectional survey was conducted among 861 PLWH, to determine whether syndemic conditions (monthly income; sexual satisfaction; depressive symptoms; social role satisfaction; social isolation; cognitive function; nicotine dependence; perception of stigma) have an effect on HRQoL. A linear regression model and measures of Additive Interaction (AI) were used to determine the effects of syndemic conditions on HRQoL, controlling for other risk factors.Overall, the most frequently observed were stigma perception (56.9%), poor cognitive function (50.6%) and the perception of social isolation (51.6%). The presence of depressive symptoms was the risk factor most associated with worse Physical Health (PH) (B 3.93, 2.71-5.15) and Mental Health (MH) (B 5.08, 3.81-6.34) in linear regression model. Specifically, an interaction was observed between poor cognitive function and poor satisfaction with social role on worse PH and MH (AI 2.08, 0.14-4.02; AI 2.69, 0.15-5.22, respectively); and low income and perception of stigma (AI 2.98, 0.26-5.71), low income and perception of social isolation (AI 2.79, 0.27-5.32), and low income and poor satisfaction with social role (AI 3.45, 0.99-5.91) on MH.These findings provide evidence that syndemic factors impact HRQoL. HIV prevention programs should screen and address co-occurring health problems to improve patient-centered health care and outcomes.© 2023. The Author(s).

Central nervous system (CNS) neoplasms are highly frequent solid tumours in children and adolescents. While some studies have shown a rise in their incidence in Europe, others have not. Survival remains limited. We addressed two questions about these tumours in Spain: (1) Is incidence increasing? and (2) Has survival improved?This population-based study included 1635 children and 328 adolescents from 11 population-based cancer registries with International Classification of Childhood Cancer Group III tumours, incident in 1983-2007. Age-specific and age-standardised (world population) incidence rates (ASRws) were calculated. Incidence time trends were characterised using annual percent change (APC) obtained with Joinpoint. Cases from 1991 to 2005 (1171) were included in Kaplan-Meier survival analyses, and the results were evaluated with log-rank and log-rank for trend tests. Children's survival was age-standardised using: (1) the age distribution of cases and the corresponding trends assessed with Joinpoint; and (2) European weights for comparison with Europe.ASRw 1983-2007: children: 32.7 cases/106; adolescents: 23.5 cases/106. The overall incidence of all tumours increased across 1983-2007 in children and adolescents. Considering change points, the APCs were: (1) children: 1983-1993, 4.3%^ (1.1; 7.7); 1993-2007, -0.2% (-1.9; 1.6); (2) adolescents: 1983-2004: 2.9%^ (0.9; 4.9); 2004-2007: -7.7% (-40; 41.9). For malignant tumours, the trends were not significant. 5-year survival was 65% (1991-2005), with no significant trends (except for non-malignant tumours).CNS tumour incidence in Spain was found to be similar to that in Europe. Rises in incidence may be mostly attributable to changes in the registration of non-malignant tumours. The overall malignant CNS tumour trend

(1) Background: Atrial cardiomyopathy constitutes an intrinsically prothrombotic atrial substrate that may promote atrial fibrillation and thromboembolic events, especially stroke, independently of the arrhythmia. Atrial reservoir strain is the echocardiography marker with the most robust evidence supporting its prognostic utility. The main aim of this study is to identify atrial cardiomyopathy by investigating the association between left atrial dysfunction in echocardiography and P-wave abnormalities in the surface electrocardiogram. (2) Methods: This is a community-based, multicenter, prospective cohort study. A randomized sample of 100 patients at a high risk of developing atrial fibrillation were evaluated using diverse echocardiography imaging techniques, and a standard electrocardiogram. (3) Results: Significant left atrial dysfunction, expressed by a left atrial reservoir strain < 26%, showed a relationship with the dilation of the left atrium (p < 0.001), the left atrial ejection fraction < 50% (p < 0.001), the presence of advanced interatrial block (p = 0.032), P-wave voltage in lead I < 0.1 mV (p = 0.008), and MVP ECG score (p = 0.036). (4) Conclusions: A significant relationship was observed between left atrial dysfunction and the presence of left atrial enlargement and other electrocardiography markers; all of them are non-invasive biomarkers of atrial cardiomyopathy.

Bundled interventions usually reduce surgical site infection (SSI) when implemented at single hospitals, but the feasibility of their implementation at nationwide level and their clinical results are not well established.Pragmatic interventional study to analyse the implementation and outcomes of a colorectal surgery care bundle within a nationwide quality improvement program. The bundle consisted of: antibiotic prophylaxis, oral antibiotic prophylaxis (OAP), mechanical bowel preparation (MBP), laparoscopy, normothermia, and a wound retractor. Control (CG) and Intervention (IG) groups were compared. Overall SSI, superficial (S-SSI), deep (D-SSI) and organ/space (O/S-SSI) rates were analysed. Secondary endpoints included microbiology, 30-day mortality and hospital stay (LOS).A total of 37,849 procedures were included, 19,655 in the CG and 18,194 in the IG. In all, 5,462 SSIs (14.43%) were detected: 1,767 S-SSI (4.67%), 847 D-SSI (2.24%) and 2,838 O/S-SSI (7.5%). Overall SSI fell from 18.38% (CG) to 10.17% (IG), OR 0.503, [0.473-0.524]. O/S-SSI rates were 9.15% (CG) and 5.72% (IG), OR 0.602, [0.556-0.652]. The overall SSI rate was 16.71% when no measure was applied and 6.23% when all six were used. Bundle implementation reduced the probability of overall SSI (OR 0.331; CI95 0.242, 0.453), and also O/S-SSI rate (OR 0.643; CI95 0.416, 0.919). In the univariate analysis, all measures except normothermia were associated with a reduction in overall SSI, while only laparoscopy, OAP, and MBP were related with a decrease in O/S-SSI. Laparoscopy, wound retractor and OAP decreased overall SSI and O/S-SSI in the multivariate analysis.In this cohort study, the application of a specific care bundle within a nationwide nosocomial infection surveillance system proved feasible, and resul

Diffuse large B-cell lymphoma is the most frequent histological subtype of NHL and the paradigm for the management of aggressive lymphoma. An excisional or incisional lymph node biopsy evaluated by an experienced hemopathologist is recommended to establish the diagnosis. Twenty years following its introduction, R-CHOP remains the standard first-line treatment. No modification of this scheme (increased chemotherapy dose intensity, new monoclonal antibodies, or the addition of immunomodulators or anti-target agents) has significatively improved the clinical outcomes, whereas therapy for recurrence or progression is evolving rapidly. The irruption of CART cells, polatuzumab vedotin, tafasitamab, and CD20/CD3 bispecific antibodies are changing the natural history of relapsed patients and will challenge R-CHOP as the benchmark for newly diagnosed patients.© 2023. The Author(s).

Super-refractory status epilepticus (SRSE) is a neurological condition with an important morbidity and mortality rate, for which few therapeutic options are available. Inhalation sedation with isoflurane is currently a compassionate-use treatment in Spanish intensive care units. Little has been written about its usefulness in the treatment of refractory and super-refractory status epilepticus, but it appears to be a useful and safe therapeutic alternative for this condition.This article reviews three cases of SRSE treated with isoflurane. The capacity of isoflurane to control seizures was assessed by electroencephalographic monitoring. Other variables assessed were time to seizure control, survival, functional outcome and occurrence of complications secondary to isoflurane. In the three cases reviewed, isoflurane proved to be effective for seizure control in patients affected by SRSE. Seizure control was accomplished quickly and the minimum dose required to obtain a burst-suppression pattern was titrated easily and rapidly. Despite controlling epilepsy, high mortality was observed (66.66%). This is explained by both the mortality of SRSE and the underlying pathologies of the patients who died. The use of isoflurane did not give rise to any complications.With the results obtained, it is feasible to think that the use of isoflurane is not related to lesions in the central nervous system reported in other articles, and this treatment can be considered effective and safe for the control of SRSE.

The incidence of catheter-related bloodstream infections (CRBSI) has fallen over the last decade, especially in intensive care units (ICUs).To assess the existence of concomitant trends in outcomes and to analyse the current risk factors for mortality.A multicentre retrospective cohort study was conducted at 24 Catalan hospitals participating in the Surveillance of healthcare associated infections in Catalonia (VINCat). All hospital-acquired CRBSI episodes diagnosed from January 2010 to December 2019 were included. A common protocol including epidemiological, clinical and microbiological data was prospectively completed. Mortality at 30 days after bacteraemia onset was analysed using the Cox regression model.Over the study period, 4,795 episodes of CRBSI were diagnosed. Among them, 75% were acquired in conventional wards and central venous catheters were the most frequently involved (61%). The 30-day mortality rate was 13.8%, presenting a significant downward trend over the study period: from 17.9% in 2010 to 10.6% in 2019 (HR 0.95 [0.92-0.98]). The multivariate analysis identified age (HR 1.03 [1.02-1.04]), femoral catheter (HR 1.78 [1.33-2.38]), medical ward acquisition (HR 2.07 [1.62-2.65] and ICU acquisition (HR 3.45 [2.7-4.41]), S. aureus (HR 1.59 [1.27-1.99]) and Candida sp. (HR 2.19 [1.64-2.94]) as risk factors for mortality while the mortality rate associated with episodes originating in peripheral catheters was significantly lower (HR 0.69 [0.54-0.88]).Mortality associated with CRBSI has fallen in recent years but remains high. Intervention programs should focus especially on ICUs and medical wards, where incidence and mortality rates are highest.Copyright © 2022 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Clinical and DNA methylation data of Gestational diabetes (2022)

Due to the differences in the definition, criteria of inclusion and coding of urothelial tumours (UTs), data of different cancer registries (CRs) are not comparable. The aim of this work is to study current practices of registration of UT in the European CR of the GRELL countries in order to propose new registration rules to correctly describe incidence and survival of progressive tumours like UT. A questionnaire was sent to 91 CRs to assess whether non-invasive (NI)UT, multiple UTs, UTs occurring outside or before the operating period and time between UTs are currently considered in tumour recording and reporting. All participating CRs (n = 42) record a NI bladder UT in sole occurrence. In case of progressive bladder UT, 98% of the CRs record at least one NIUT but 19% don’t record the invasive progression. 17% of the CRs don’t record an invasive pelvic tumour that occurs after a NI bladder UT. 19% of the CRs don’t record an invasive bladder UT that followed a NI tumour occurring outside the zone or period of time. The recording of two synchronous UTs is carried out with a grouping topography for 36% of the CRs. The same analysis conducted on the reporting of the incidence of UT also shows heterogeneity. We conclude that there is an urgent need to define clear rules for the registration of UT.

Background and purpose Oxaliplatin-induced neuropathy (OIN) implies axonal damage of both small and large sensory nerve fibers. We aimed at comparing the neurophysiological changes occurred after treatment and the capability to recovery based on histological marker of re-innervation GAP-43. Methods 48 patients with cancer were assessed before and after chemotherapy (at 3 months and 12 months if available). We recorded ulnar and sural sensory nerve action potentials (SNAP), determined quantitative sensory thresholds for warm and cold (WDT, CDT), pain thresholds and collected a distal biopsy of skin to assess the intra-epidermal nerve fiber density (IENFD) with PGP9.5 and GAP-43 markers (in a subgroup of 19 patients). Results Increased WDT and CDT as well as diminished IENFD at distal leg were already found in 30% of oncologic patients before treatment. After oxaliplatin, there was a significant increase in thermal thresholds in 52% of patients, and a decrease of SNAP amplitude in the sural nerve in 67% patients. IENFD was reduced in 47% and remained unchanged in 37% after oxiplatin. The density of GAP-43 + fibers and GAP-43/PGP 9.5 ratio was similar before and after treatment showing that cutaneous re-innervation is preserved despite no clinical recovery was observed after one year. Conclusion Non-selective axonal loss affects sensory fibers in OIN. However, the presence of intra-epidermal regenerative sprouts detected by GAP-43 may reduce the impact of neurotoxicity in the small fibers with long-term sequelae mostly on myelinated nerve endings. Pre-oxaliplatin GAP-43 failed to identify patients with higher risk of damage or worse recovery after treatment.