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OBJECTIVE: Renal graft dysfunction or worsened hypertension in renal transplanted patients may be a manifestation of graft hypoperfusion due to transplant renal artery stenosis (TRAS) or stenosis of iliac arteries proximal to renal transplant (pseudo-TRAS). Endovascular management of TRAS has been increasingly used to preserve renal graft function. With this study, we aim to evaluate the impact of endovascular treatment of TRAS on renal function in the short to medium term. MATERIAL AND METHODS: This is an observational, retrospective, single-center study that included all adult renal transplant patients who underwent endovascular intervention on TRAS between September 2017 and June 2020. Renal graft function was monitored by serum Creatinine (sCr) levels. RESULTS: Thirteen patients were included (53.8% female), with a median age of 57 (21-70) years. Eleven patients (84.6%) presented with graft dysfunction. Ten subjects (76.9%) underwent transluminal angioplasty and stenting of renal artery and three (23,1%) of donor iliac arteries. Most cases (69.2%) were interventioned in the first-year post-transplant. Overall technical success was 100%, with no periprocedural deaths. Overall 30-day morbidity was 15.4%. Median follow-up time was 20.2 (1,3 – 36,3) months. One patient died during follow up and other worsened graft dysfunction, requiring hemodi- alysis and nephrectomy. Reduction in sCr levels was statistically significant in the first postoperative month, compared to preoperative values, but sCR levels were still increased when compared to baseline levels (pre-TRAS diagnosis). CONCLUSIONS: The majority (12/13) of patients showed improvement or stabilization of renal graft function compared to the preoperative period, during the follow-up period, supporting the procedure’s safety. Despite this, most patients did not recover baseline sCr levels, reinforcing the importance of prompt graft revascularization. Delayed diagnosis of TRAS may compromise the benefit of revascularization and prevent full recovery of renal function.

Introdução: A presença de múltiplos vasos renais é frequente na população geral e, quando presente num dador, aumenta a complexidade da cirurgia de transplantação renal, aumentando o risco de complicações. Embora a transplantação de enxertos de dador cadáver com estas características seja aceite, o mesmo procedimento em dador vivo permanece controverso. O objetivo deste trabalho é apresentar o caso de uma cirurgia de transplantação de dador vivo com anatomia vascular complexa – duas artérias e duas veias renais. Caso Clínico: Mulher de 42 anos, com doença renal crónica terminal (DRCT) por nefropatia IgA, em programa regular de hemodiálise há 9 meses, avaliada em mais de um centro para transplantação renal de dador vivo e recusada pela complexidade da anatomia vascular do par dador - rim direito com duas artérias e duas veias renais curtas. No nosso centro, onde a cirurgia vascular integra a equipa multidisciplinar de transplantação renal, foi aceite o transplante considerando-se tecnicamente exequível a reconstrução vascular ex-vivo do enxerto (back table). Na reconstrução arterial foi realizada anastomose látero-lateral das duas artérias renais. A reconstrução venosa incluiu o alongamento das veias renais com veia safena interna (VSI) da recetora e a sua posterior anastomose em “cano de espingarda”. O rim foi implantado na fossa ilíaca direita da recetora. Verificou-se diurese imediata após desclampagem, com descida rápida dos valores de creatinina para o normal e com alta ao 16.º dia de pós-operatório. Conclusão: A escassez de órgãos é um importante fator limitante à transplantação renal. A inclusão de dadores com múltiplos vasos renais tem demonstrado bons resultados e pode aumentar a disponibilidade de órgãos. A integração de um cirurgião vascular experiente na equipa multidisciplinar de transplantação renal permite a realização de reconstruções arteriais e venosas complexas em enxertos com anatomia vascular menos favorável.

Abstract Introduction: Intra-atrial catheter (IAC) placement through an open surgical approach has emerged as a life-saving technique in hemodialysis (HD) patients with vascular access exhaustion. Objective: To assess the complications of IAC placement, as well as patient and vascular access survival after this procedure. Methods: The authors retrospectively analyzed all seven patients with vascular capital exhaustion, without immediate alternative renal replacement therapy (RRT), who underwent IAC placement between January 2004 and December 2015 at a single center. Results: Seven patients were submitted to twelve IAC placements. Bleeding (6/7) and infections (3/7) were the main complications in the early postoperative period. Two (2/7, 29%) patients died from early complications and 5/7 were discharged with a properly functioning IAC. The most frequent late complication was catheter accidental dislodgement in all remaining five patients, followed by catheter thrombosis and catheter-related infections in the same proportion (2/5). During follow-up, two of five patients died from vascular accesses complications. After IAC failure, one patient was transferred to peritoneal dialysis and a kidney transplant was performed in the other. Only one patient remains on HD after the third IAC, with a survival of 50 months. The mean patient survival after IAC placement was 19 ± 25 (0-60) months and the mean IAC patency was 8 ± 11 (0-34) months. Conclusion: Placing an IAC to perform HD is associated to significant risks and high mortality. However, when alternative RRT are exhausted, or as a bridge to others modalities, this option should be considered.

Adequate coordination between healthcare levels has been proven to improve clinical indicators, care costs, and user satisfaction. This is more relevant to complex or vulnerable patients, who often require increased care. This study aims to evaluate the differences between hospital discharge follow-up indicators, including number of general practitioners’ (GPs) and community nurses’ (CNs) consultations, presentiality of consultations, type of first post-discharge consultation, and time between hospital discharge and first consultation. Vulnerable and non-vulnerable patients were compared. A longitudinal retrospective study was carried out in the north of Tenerife on the post-discharge care of patients discharged from the Canary Islands University Hospital (Spanish acronym HUC) between 1 January 2018 and 31 December 2022. The results obtained show deficiencies in the care provided to patients by primary care (PC) after being discharged from the hospital, including delayed first visits, low presentiality of those visits that were less frequent even with increased patient complexity, scarce first home visits to functionally impaired patients and delays in such visits, and a lack of priority visits to patients with increased follow-up needs. Addressing these deficiencies could help those most in need of care to receive PC, thus reducing inequalities and granting equal access to healthcare services in Spain.

The essay studies the different manifestations of the concept of antiquity in relation to the edition of Osservazioni di Ennio Quirino Visconti su due musaici, sponsored by the Spanish diplomat José Nicolás de Azara and produced at the Stamperia Reale run by the printer Giambattista Bodoni in Parma in 1788. The artistic and cultural context of the work and the agents involved in the material production process of the volume are examined, dwelling on the content and values conveyed. Starting from the interpretations of two ancient mosaics, the Osservazioni redefine the concept of antiquarian object, which is embodied in the volume itself as an object of bibliophilia, with its symbolic value (artistic, historical-antiquarian and identity) and its relation to contemporary and future consumers. The methodology adopted is critical-documentary, using the Azara-Bodoni correspondence as primary source, and theoretical-critical for the interpretive approach.

Abstract Intracellular bacterial pathogens gain entry to mammalian cells inside a vacuole derived from the host membrane. Some of them escape the bacteria-containing vacuole (BCV) and colonize the cytosol. Bacteria replicating within BCVs coopt the microtubule network to position it within infected cells, whereas the role of microtubules for cyto-invasive pathogens remains obscure. Here, we show that the microtubule motor cytoplasmic dynein-1 and specific activating adaptors are hijacked by the enterobacterium Shigella flexneri. These host proteins were found on infection-associated macropinosomes (IAMs) formed during Shigella internalization. We identified Rab8 and Rab13 as mediators of dynein recruitment and discovered that the Shigella effector protein IpaH7.8 promotes Rab13 retention on moving BCV membrane remnants, thereby facilitating membrane uncoating of the Shigella-containing vacuole. Moreover, the efficient unpeeling of BCV remnants contributes to a successful intercellular spread. Taken together, our work demonstrates how a bacterial pathogen subverts the intracellular transport machinery to secure a cytosolic niche.

Delayed discharge for non-clinical reasons is defined as a period of stay that continues after a patient has been deemed medically fit to leave the hospital but is unable to do so for non-medical reasons. This circumstance overburdens the healthcare system and constitutes a major problem for healthcare systems and the patients themselves in this situation. The aim of this study was to evaluate the delay in effective discharge for non-medical reasons for patients admitted to acute care hospitals in Spain. A scoping review followed the Joanna Briggs Institute methodology guidelines to search for and synthesize studies published between 2019 and 2022. To identify potentially relevant documents, the following bibliographic databases were searched: EMBASE, CINAHL and MEDLINE. For the search, we used free terms («delayed discharges», «discharge delays», «bed-blocking», «timely discharge», «unnecessary days» and «inappropriate stays»). Quantitative or qualitative studies published in scientific journals on delayed effective discharge for non-medical reasons for patients admitted to a hospital for any health issue of medical or surgical origin were selected. Information collection of the documents was performed using a structured datasheet specifically developed by the authors. The initial search strategy identified a total of 124 references, which were successively screened to a final selection of 13 studies. To conclude, delayed discharge from a hospital for non-clinical reasons is a multifactorial problem. This may be due to factors internal or external to the hospital, as well as personal factors. The main causes of the delay were similar among the studies found, as were the clinical characteristics of the patients, most of whom were elderly, frail and more dependent due to declining functional capacities. Further studies addressing the socio-familial characteristics of the patients and the perspective of the patient and families would be necessary.

Spermatozoon volume regulation is an essential determinant of male fertility competence in mammals and oviparous fishes. In mammals, aquaporin water channels (AQP3, -7 and -8) have been suggested to play a role in spermatozoon cell volume regulatory responses in the hypotonic female oviduct. In contrast, the ejaculated spermatozoa of marine teleosts, such as the gilthead seabream (Sparus aurata), experience a high hypertonic shock in seawater, initially resulting in an Aqp1aa-mediated water efflux, cell shrinkage and the activation of motility. Further regulatory recovery of cell volume in post-activated spermatozoa is mediated by Aqp4a in cooperation with the Trpv4 Ca2+ channel and other ion channels and transporters. Using a paralog-specific antibody, here, we show that seabream spermatozoa also express the aquaglyceroporin AQP3 ortholog Aqp3a, which is highly accumulated in the mid posterior region of the spermatozoon flagella, in a similar pattern to that described in mouse and human sperm. To investigate the role of Aqp3a in seabream sperm motility, we used a recently developed AQP3 antagonist (DFP00173), as well as the seabream Aqp3a-specific antibody (α-SaAqp3a), both of which specifically inhibit Aqp3a-mediated water conductance when the channel was heterologously expressed in Xenopus laevis oocytes. Inhibition with either DFP00173 or α-SaAqp3a did not affect sperm motility activation but did impair the spermatozoon motion kinetics at 30 s post activation in a dose-dependent manner. Interestingly, in close resemblance to the phenotypes of AQP3-deficient murine sperm, electron microscopy image analysis revealed that both Aqp3a inhibitors induce abnormal sperm tail morphologies, including swelling and angulation of the tail, with complete coiling of the flagella in some cases. These findings suggest a conserved role of Aqp3a as an osmosensor that regulates cell volume in fish spermatozoa under a high hypertonic stress, thereby controlling the efflux of water and/or solutes in the post-activated spermatozoon.

Summary: Escape from the bacterial-containing vacuole (BCV) is a key step of Shigella host cell invasion. Rab GTPases subverted to in situ-formed macropinosomes in the vicinity of the BCV have been shown to promote its rupture. The involvement of the BCV itself has remained unclear. We demonstrate that Rab35 is non-canonically entrapped at the BCV. Stimulated emission depletion imaging localizes Rab35 directly on the BCV membranes before vacuolar rupture. The bacterial effector IcsB, a lysine Nε-fatty acylase, is a key regulator of Rab35-BCV recruitment, and we show post-translational acylation of Rab35 by IcsB in its polybasic region. While Rab35 and IcsB are dispensable for the first step of BCV breakage, they are needed for the unwrapping of damaged BCV remnants from Shigella. This provides a framework for understanding Shigella invasion implicating re-localization of a Rab GTPase via its bacteria-dependent post-translational modification to support the mechanical unpeeling of the BCV.

Book review

Presentamos el estudio y edición de una epístola poética inédita dirigida por José Iglesias de la Casa a Juan Meléndez Valdés. Tras plantear una revisión del manuscrito y de la amistad entre estos dos pastores dentro del grupo poético salmantino, la epístola fechada en 1778 es encuadrada en la dinámica de ese grupo y en la tradición horaciana. Se analizan en ella, además, las referencias al mundo poético de su tiempo, el posicionamiento de Iglesias en ese escenario y en la polémica del Parnaso español, los tonos y construcción de la epístola, y el apremio a Batilo para que publique sus poesías.

Background: The object is to analyze the influence of the nocturnal period and lunar phases on the frequency of obstetrical events in pregnant women. Methods: This was a retrospective, transversal observational study of 1409 births in a hospital from northwest Spain (α = 0.05; precision = ±2.65%). A review of patients’ clinical records was performed recording the following data: labor onset type, date of last menstrual period, parity, gestational age, duration of pre-labor and labor, type of delivery, the hour, work shift, and lunar phase pattern of events. Statistical evaluation included descriptive and inferential analysis. Results: Labor was spontaneous in 58.3% of all cases; spontaneous deliveries accounted for 54.2% of the total and 19.2% were instrumental. In the cases of spontaneous labor onset, 48.5% began during the nocturnal period. The early labor phase was less than 6 hours in 62.7% of cases (44.8% during the full moon phase). During the nocturnal period, rupture of membranes and dilation periods of less than 3 hours were more common, with 32% of spontaneous membrane rupture occurring during a full moon. A significant dependence was observed between the labor type and nocturnal period, as 40.8% of all spontaneous births, 36.2% of instrumental births and 46.9% of emergency cesarean sections occurred during the night shift. Furthermore, 66.3% of precipitous deliveries (

Background: Attention to mothers during pregnancy, childbirth, and postpartum has focused on the physical aspects, overlooking mental health, which is critical to maternal well-being and childbirth. The aim of this study was to analyze the levels of anxiety experienced during labor and within the first 24 hours post-delivery, in order to identify the associated social and clinical factors associated with such anxiety. Methods: We performed a prospective observational follow-up study involving 448 women. Validated state and trait anxiety questionnaires, namely State-Trait Anxiety Inventory (STAI), which were employed in the study participants. All tests were performed with a bilateral approach. The p-values < 0.05 were considered significant. Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS, v.22.0, IBM Corp, Chicago, IL, USA). Results: State anxiety was more frequent among primiparous pregnant women, individuals who did not attend maternal education classes, and those with a history of prior abortion or cesarean section. Additionally, a significant association was observed with a history of mental disorder. Concerning Trait anxiety, significantly higher levels of anxiety were found in women with lower levels of education and in patients with a history of mental health issues. At 24 hours postpartum, elevated anxiety was more frequent in primiparous and significantly more frequent in patients with difficult deliveries, women whose infants were admitted to the Neonatal Intensive Care Unit (NICU), those lacking skin-to-skin contact, and those with previous mental health disorders. Conclusions: Insufficient maternal education, along with a complicated birthing process requiring infant hospitalization, both contribute to elevated levels of postpartum anxiety.

Este trabajo trata de explicar la relación de desencuentro mantenida entre el diplomático español José Nicolás de Azara y el historiador del arte Johann Joachim Winckelmann. Para ahondar en la falta de inclinación entre estos dos ilustres neoclásicos se parte, de un lado, de las actuaciones de Winckelmann en Italia y su amistad con el pintor Rafael Mengs; y de otro, la estrecha amistad entre Mengs y Azara. A partir de ese marco de encuentro, se analizan y documentan diversos casos donde el español prueba su desafecto hacia Winckelmann, cuya imagen ataca y procura degradar en favor de la del amigo Mengs.

Book review

Abstract Background Human papillomavirus (HPV) infection is recognized as one of the major causes of infection-related cancer worldwide. In Spain, the HPV vaccination program started in 2007 and until 2022, it targeted 12-year-old girls. Methods This was a cross-sectional, multicenter survey-based research carried out at 24 pediatric offices to describe HPV knowledge and vaccine acceptability in parents of children aged between 9 and 14 years-old in Spain. Parents were randomly selected from the medical records following specific quotas to ensure representativeness. The survey included five sections that aim to collect information about sociodemographic characteristics, knowledge of HPV, knowledge and acceptability of vaccines in general, HPV vaccination knowledge and HPV vaccine acceptability. Each section was constituted by a number of close questions with different answer options. Specific scores were assigned to each possible answer to these questions. Based on these scores, four composite variables were created to assess HPV knowledge, HPV vaccine knowledge, HPV vaccine acceptability and vaccines knowledge and acceptability in general. A latent class analysis was performed to identify different group of respondents according to their HPV vaccine acceptability. Results A total of 1405 valid surveys were included, with 86.19% of the respondents being mothers. The mean score of HPV knowledge was 28.92 out of 40 (maximum value) (95% CI 28.70–29.20) and the mean score of HPV vaccine acceptability was 3.37 out of 5 (maximum value). One third of parents still need more information to take a final decision about HPV vaccination in their children. Parents perceived that females were more likely to become infected than males and tended to associate HPV infection mainly with cervical cancer, showing a. a lack of information about other HPV-related diseases affecting males. Conclusions This study results highlight the need for future actions and educational initiatives to raise awareness of HPV consequences in both genders and to contribute to achieving the elimination of HPV-related diseases beyond cervical cancer.

El mero nombre del autor madrileño Juan Mayorga (figura sobresaliente de la dramaturgia contemporánea en español, y cuya profunda rigurosidad y densidad de motivos temáticos y constructivos singulariza y acredita su trabajo) ya debería poner siempre en guardia a sus lectoespectadores. No obstante, a finales de febrero de 2022 el autor sorprendió a sus seguidores con un texto complejo y profundamente filosófico: El Golem. Publicado por Ediciones La Uña Rota (2022), este libro era esperado porque Mayorga lo escribió durante la pandemia y, sobre todo, porque en él acoge un drama cuyo estreno, ligeramente anterior a la edición, creó la necesidad de ir o volver sobre su texto con el detenimiento que nos permite la página escrita; leer para descifrar una obra basada, precisamente, en el potencial de la palabra. Puesta en escena y libro de El Golem, por tanto, se miran y abrazan de manera muy estrecha. En esta reseña referiremos la recepción de ambas, pues su orden de llegada al público ha resultado significativo y complementario, si bien nuestro objeto de base, de partida y de vuelta a las palabras, siempre es el libro.

Este artículo propone una puesta en diálogo de dos sobresalientes nombres del teatro contemporáneo en español, poseedores ambos del Premio Nacional de Literatura dramática: el consagrado y reconocido dramaturgo Juan Mayorga y la voz no menos potente, aunque sí más joven, de Paco Bezerra. El primer objetivo es, mediante una presentación de sus trayectorias y su dramaturgia, evidenciar puntos en común entre ellos, y en segundo lugar centrar la atención en dos obras suyas, Hamelin y Grooming, para conocer sus respectivos tratamientos de una terrible lacra social como la pederastia o el ciberacoso a menores de edad.

Con la eliminación de la publicidad en TVE se consigue que los shares no determinen el modelo programático, y, por tanto, la dependencia implícita del anunciante como fuente de financiación de la compañía. En el trabajo se aborda la situación actual a través de un análisis de las audiencias. Además, mediante un trabajo de campo en el que se examina la programación de La 1, se analiza la cantidad de publicidad, el tipo de autopromociones y las cortinillas que las acompañan. También se comprueba la repetición de anuncios y el porcentaje de tiempo total que ocupan este tipo de emisiones.

La yema de huevo (YH) es un componente común de los diluyentes de semen por su eficacia para proteger la membrana de los espermatozoides del choque de frío durante la criopreservación y además de ser rica en proteínas, vitaminas, antioxidantes y fosfolípidos. No obstante, la YH es un componente no definido y al mismo tiempo peligroso por el riego de transmisión de agentes patógenos, por esta razón, es necesario evaluar el uso de otros componentes que disminuyan este problema; una alternativa poco estudiada es alcohol poli vinílico (APV). Por lo que en esta investigación se evaluó el efecto del APV y la YH suplementados al diluyente TCG (tris, ácido cítrico, glucosa) sobre la criosupervivencia de espermatozoides epididimarios (EE) de perro. Para ello, se recuperaron EE mediante la técnica de flujo retrógrado en 15 perros adultos orquiectomizados para conformar cinco agrupaciones (4-6 muestras epididimarias / agrupación). Cada muestra agrupada se dividió en dos alícuotas, que posteriormente fueron diluidas y congeladas usando dos aditivos suplementados al diluyente TCG: APV al 1 % (peso/volumen –p/v– [TCG–APV] y yema de huevo al 20 % (volumen/volumen –v/v– [TCG–YH]. Posterior a la descongelación, se analizaron las anormalidades morfológicas, la vitalidad (eosina / nigrosina), la integridad de membrana plasmática (ioduro de propido), y las variables cinemáticas (sistema CASA, SCA-2018®). Los resultados demostraron que la vitalidad e integridad de la membrana plasmática fueron superiores (P

Introduction: Studies updating the evidence in advanced maternal age as an independent factor of obstetric risk are needed. The aim of this study was to determine the prevalence of ≥ 35-years-old pregnant women who give birth in a Spanish hospital in Northwestern Spain, and to describe the incidence of maternal and perinatal morbidity and mortality. Material and Methods: Retrospective follow-up observational study including women ≥ 20 years-old who gave birth over one year (n = 1378). Data were collected from medical records, including socio-demographic characteristics, comorbidities, gestational conditions, variables related with the delivery and perinatal outcomes. Multivariable logistic regression analysis was performed to determine the association of advanced maternal age with obstetric and perinatal outcomes. Results: Forty-two percent of pregnant women were ≥ 35 years old. In the multivariable analysis, advanced maternal age was associated with the likelihood of gestational diabetes (OR = 1.84; 95% CI = 1.10 - 3.07), hypothyroidism (OR = 2.11; 95% CI = 1.17 - 3.80), lower probability of an eutocic delivery (OR = 0.74; 95% CI = 0.56 - 0.98), and a hospital admission > four days (OR = 2.91; 95% CI = 1.95 - 4.35). An association with the rate of C-sections was not found (OR = 1.24; 95% CI = 0.89 - 1.72). Conclusion: A high prevalence of pregnant women of advanced maternal age was confirmed. There was a higher rate of comorbidities and longer hospital admissions in older women but not a higher rate of higher C-sections and other complications.

This article addresses and documents the influence of the economic variable on the production of one of the most outstanding typographers in the history of the book, Giambattista Bodoni, who was famous for his books to the 18th century European bibliophile elite. Three main financing channels are distinguished in his catalog, resulting various types of editions, and this perspective of analysis shows the relevance of the Spanish patron José Nicolás de Azara in Bodoni’s work. But Azara did not only leave his mark on Bodoni’s catalog by promoting bibliographic projects; also by advising the typographer to achieve examples of the beautiful book, which should balance in his opinion its functionality with its aesthetic waste, that was always directly proportional to the economic cost. As a conclusion, the article confirms the prominence of patronage -especially Azara’s- even in Bodoni’s art of printing along the transition from the Eighteenth to the Nineteenth century.

Este artículo da a conocer una sucesión de episodios que documentan la atención e interés político-cultural de la Francia pre y posrevolucionaria hacia la oficina del tipógrafo Giambattista Bodoni, que representaba lo más granado de la imprenta italiana de finales del siglo XVIII. Esta breve panorámica muestra la preocupación del creciente poder francés por posicionarse a la cabeza de la tipografía europea, evidencia la competencia entre Francia e Italia (Didot-Bodoni) en este arte y aporta nuevos datos para el análisis de la compleja relación entre imprenta y poder, que fue clave en Occidente a finales de la Edad Moderna. La metodología adoptada se basa en el empleo de fuentes primarias, archivísticas y bibliográficas, a fin de armar una reflexión que constate la habilidad de Bodoni para mantenerse en el eje entre imprenta y poder, mediante el protagonismo de su arte tipográfica.

Book review

La etapa universitaria tiende a cambiar los patrones de conducta saludable, como la disminución de la actividad física. Diversas intervenciones han promovido la inclusión de jóvenes de escasos recursos al contexto universitario peruano. Por tanto, el objetivo de este estudio fue determinar la prevalencia de la actividad física saludable y los factores sociodemográficos asociados a la actividad física en estos estudiantes. Se realizó unainvestigación de tipo cuantitativa, descriptiva, prospectiva y transversal, con una muestra de 1.598 becarios, utilizando el Cuestionario Global de Actividad Física (GPAQ) y un cuestionario de recolección de datos sociodemográficos, que fueron administrados virtualmente. Se encontró una prevalencia de actividad física por debajo del nivel saludable del 18.3%. Los factores determinantes para ser activos físicamente fueron: sexo (p

An amendment to this paper has been published and can be accessed via the original article.

Abstract Background Since the introduction of HPV vaccines, several studies have been conducted in different countries to assess HPV knowledge and vaccine acceptance. The aim of this study was to perform a systematic literature review to summarize results and identify factors associated with HPV knowledge and vaccine acceptance in adolescents and their parents and to compile the measurement tools used in the published research studies performed in European countries where HPV is licensed. Methods A systematic literature review was conducted for studies published between January 1st 2006 and December 31st 2017. Results Seventy non-interventional studies performed in 16 European countries met the inclusion criteria. Thirty-eight of them reported data on HPV knowledge and 40 reported data on HPV vaccine acceptance. Further, 51.8% of adolescents (range 0% to 98.6%) and 64.4% of parents (range 1.7% to 99.3%) knew about HPV infection. Insufficient information and safety concerns were the main barriers to vaccination acceptance. Conclusion HPV knowledge and vaccine acceptance are still modest and vary widely between studies across EU countries. Coordinated efforts should be made to provide the relevant population with information for informed decision-making about HPV vaccination.

Human Papillomavirus (HPV) is one of the most common sexually transmitted infections associated with a wide range of diseases and cancers that may affect both genders. Since 2007, the Spanish National Immunization Program includes HPV vaccination, and currently it only targets 12-year-old girls. The objective of our study is to assess differences in the knowledge of HPV and HPV vaccine acceptability according to different factors, and to identify the role of different sources of information. A cross-sectional, multicenter survey research was carried out in twenty-four pediatric offices in Spain, and included parents of children aged 9 to 14 years old. 1,405 valid survey-responses were considered for the analysis. Parental awareness of HPV and HPV vaccine, as well as vaccine acceptability, are still strongly associated with child gender (girls) and age (12–14 years old). HPV knowledge and HPV vaccine acceptability are related to parental gender, HPV vaccination status and having at least one daughter. Parents who consulted a healthcare source to obtain further information about HPV had greater HPV and HPV vaccine knowledge and acceptability. HPV and HPV vaccine awareness and acceptability are strongly associated with child gender and age, which correlates with the current immunization program.

The advances in floating offshore wind energy are opening deep sea areas, like the coastal waters of Iberian Peninsula (IP), for the installation of wind farms. The integration of this new energy source in a semi-closed power system with an already high share of variable renewable energies would be facilitated if the potential contribution of offshore wind energy shows reduced variability and limited seasonal variations, as the power demand in IP shows two maxima in winter and summer. The aims of this study are the analysis of temporal variability and spatial complementarity of the potential installation sites, and the identification of an optimal combination of installation areas that minimizes the temporal variability of the aggregated offshore contribution. In order to better capture the marked mesoscale features of winds around the IP, wind data from a very high resolution reanalysis (COSMO-REA6) are used. The analysis considers allowed areas for installation, delimited by the maritime spatial planning. Northern coast areas are characterized by high capacity factors (CFs) and high seasonality, while the lower CFs at the western and southern coasts are compensated by a limited seasonality. Pairwise correlation between the potential areas shows outstanding results, with several negative correlation values within a synoptic scale region, in contrast to other mid-latitude regions like the North Sea or the Eastern USA coast. An optimal aggregation of areas includes at least one area at each of the four main Iberian coasts. A strong reduction of hourly variability is obtained through the resulting combinations, and the seasonality of the aggregated CF is clearly below the values for other offshore areas. Therefore, offshore wind energy can indeed offer an added value for the Iberian power system beyond the high resource amount, reducing the need for storage or backup plants.

This work raises a new approach to the mordant style of José Nicolás de Azara practiced in the private correspondence with his typographer friend Giambattista Bodoni, which is developed in an Italian sociocultural context. Despite the treatment of high themes of mutual professional interest and Azara’s polite expressive moderation in these missives, the mockery is shown in them as an intrinsic mechanism of his writing and it emerges to expose his critical vision towards the reality of that time. He observes some facts and characters with a distorting mirror in order to denounce their defects, which mostly refer to a lack of culture or a political-personal rivalry. Thus, these cases of mockery portray Azara as a demanding intellectual dedicated to diplomacy. They serve also to depict a living picture of the European society of the moment, irregular in its Lights.

La Teoría de la Mente (ToM) se define como la habilidad de atribuir estados mentales para así comprender y predecir la conducta de otros. Los estudios sobre ToM en adultos mayores muestran datos contradictorios (sobre si permanece estable, continúa evolucionando o experimenta un deterioro) debido a que las habilidades cognitivas subyacentes a los distintos componentes de ToM (ToM Implícita, ToM Explícita) evolucionan de forma diferente con la edad y con la experiencia. Este estudio pretende analizar el papel de la reserva cognitiva y la actividad actual, social y cognitiva, en los cambios en ToM implícita asociados a la edad. Se ha examinado una muestra de adultos mayores sanos (N= 157) de entre 58 y 87 años procedentes de la provincia de Málaga. Los instrumentos utilizados para la evaluación han sido el Test de Lectura de la Mente en los Ojos y un cuestionario de actividad social y cognitiva. Los resultados indican que la ToM implícita disminuye con la edad y que está directamente relacionada con la habilidad de ToM implícita, la experiencia de interacción social e intelectual a lo largo de la vida y la actividad sociocognitiva que los mayores mantienen en el presente. Estos resultados son de relevancia para el desarrollo de programas de intervención para la promoción de la cognición social en adultos mayores y la mejora del bienestar psicológico general.

E2F4 was initially described as a transcription factor with a key function in the regulation of cell quiescence. Nevertheless, a number of recent studies have established that E2F4 can also play a relevant role in cell and tissue homeostasis, as well as tissue regeneration. For these non-canonical functions, E2F4 can also act in the cytoplasm, where it is able to interact with many homeostatic and synaptic regulators. Since E2F4 is expressed in the nervous system, it may fulfill a crucial role in brain function and homeostasis, being a promising multifactorial target for neurodegenerative diseases and brain aging. The regulation of E2F4 is complex, as it can be chemically modified through acetylation, from which we present evidence in the brain, as well as methylation, and phosphorylation. The phosphorylation of E2F4 within a conserved threonine motif induces cell cycle re-entry in neurons, while a dominant negative form of E2F4 (E2F4DN), in which the conserved threonines have been substituted by alanines, has been shown to act as a multifactorial therapeutic agent for Alzheimer’s disease (AD). We generated transgenic mice neuronally expressing E2F4DN. We have recently shown using this mouse strain that expression of E2F4DN in 5xFAD mice, a known murine model of AD, improved cognitive function, reduced neuronal tetraploidization, and induced a transcriptional program consistent with modulation of amyloid-β (Aβ) peptide proteostasis and brain homeostasis recovery. 5xFAD/E2F4DN mice also showed reduced microgliosis and astrogliosis in both the cerebral cortex and hippocampus at 3-6 months of age. Here, we analyzed the immune response in 1 year-old 5xFAD/E2F4DN mice, concluding that reduced microgliosis and astrogliosis is maintained at this late stage. In addition, the expression of E2F4DN also reduced age-associated microgliosis in wild-type mice, thus stressing its role as a brain homeostatic agent. We conclude that E2F4DN transgenic mice represent a promising tool for the evaluation of E2F4 as a therapeutic target in neuropathology and brain aging.

ABSTRACT Objective: To determine the level of satisfaction with childbirth and the postpartum period. Method: This is a longitudinal, observational study. Clinical variables of the patients and delivery were collected, and a descriptive and inferential analysis was performed. The validated state-trait anxiety inventory (STAI) and the satisfaction survey Care in Obstetrics Measure For Testing Satisfaction Scale (COMFORTS) in Spanish were used. Results: A total of 381 women was included in the study and grouped into satisfied vs. dissatisfied (94.54% vs. 5.46%). Women having given birth by eutocic delivery (p = 0.005), as well as those who had skin-to-skin time with their newborn (p = 0.012) after delivery, report more satisfaction. Mothers who were separated from their babies reported being less satisfied (p = 0.004), as did those who did not meet the expectations raised in the birth plan (p = 0.013). All the women with minimal anxiety are satisfied (p = 0.004), the same happening for those showing postpartum anxiety (p

Human papillomavirus (HPV) is one of the main causes of infection-related cancer. The bivalent vaccine (2vHPV) (16/18) and quadrivalent (6/11/16/18) HPV vaccine (4vHPV) have been included in the Spanish vaccination calendar since 2007. The new nonavalent HPV vaccine (9vHPV), approved in Europe in 2015, includes nine HPV types 6/11/16/18/31/33/45/52/58 and has been available in Spain since May 2017. Our study aims to estimate the epidemiological impact and the cost-effectiveness of a girls-only and a gender-neutral vaccination program with 9vHPV compared to the current vaccination program in Spain. A dynamic transmission model simulating the natural history of HPV infections was calibrated to the Spanish setting and applied to estimate costs and quality-adjusted life years (QALYs) associated with vaccination strategies using a payer perspective and a 100-year time horizon. A girls-only vaccination strategy at age 12 years with 9vHPV was found to be a cost-effective strategy compared with 4vHPV (incremental cost-effectiveness ratio (ICER) of €7,718 per QALY). Compared with girls-only vaccination with 4vHPV, gender-neutral vaccination with 9vHPV was associated with further reductions of up to 28.5% in the incidence of cervical intraepithelial neoplasia (CIN) 2/3 and 17.1% in the incidence of cervical cancer, as well as with a 14.0% reduction in cervical cancer mortality. Furthermore, a gender-neutral vaccination program with 9vHPV could potentially be cost-effective considering some parameters as head and neck protection or discount rates, leading to a reduction in the burden of HPV-related diseases in both sexes in the Spanish population.

Background: Vulvar and vaginal cancers are considered rare cancers in women. Human Papillomavirus is responsible for 30–76% of them. The aim of this study was to describe the burden of hospital admissions by malignant neoplasia (MN) and in situ carcinoma (ISC) of vulva and vagina from 2009 to 2013, in Spain Methods: This observational, descriptive study used discharge information obtained from the national surveillance system for hospital data, Conjunto Mínimo Básico de Datos, CMBD, provided by the Ministry of Health. Results: From 2009–2013, we found 9,896 hospitalizations coded as MN or ISC of vulva and vagina. Mean age of hospitalization was 69.94 ± 15.16 years; average length of hospital stay (ALOS) was 10.02 ± 12.40 days, and mean hospitalization costs were 5,140.31 ± 3,220.61 euros. Mean hospitalization rate was 9.874 per 100,000 women aged >14 years old (95% CI: 9.689–10.058); mean mortality rate was 0.932 per 100,000 women aged >14 years old (95% CI: 0.872–0.991) and mean case fatality rate was 9.438% (95% CI: 8.862–10.014). Conclusion: MN and ISC of vulva and vagina are responsible for a considerable hospitalization burden. Information about these hospitalizations could be useful for cost effectiveness analysis and monitoring of HPV vaccination effectiveness. Keywords: HPV, Vulva, Vagina, Malignant neoplasia, Hospitalizations, Carcinoma

Abstract Background A new nonavalent human papillomavirus (HPV) vaccine that includes genotypes 6/11/16/18/31/33/45/52/58 has been recently approved in Spain. A previous study has shown that attributable fraction of HPV related diseases in Spain is consistent with that reported in European and global studies. The aim of the present study was to estimate the annual direct costs associated to the following HPV-related diseases: genital warts, high grade precancerous lesions and cancer of cervix, vulva, vagina, anus and penis and head and neck cancer, caused by genotypes included in the nonavalent (9vHPV) and quadrivalent vaccines (4vHPV), in Spanish men and women. Methods Cancer registries and epidemiological studies were used to estimate the number of new annual cases of genital warts, anogenital precancerous lesions and cancer of cervix, vulva, vagina, anus, penis and head and neck, as well as the fraction attributable to HPV infection and to genotypes targeted by both vaccines in Spain. Costs per patient for each disease were obtained from the literature. In addition, 142 specialists were surveyed to estimate cost per patient of vulvar, vaginal, anal and penile precancerous lesions. The annual burden of diseases attributable to types targeted by both vaccines was estimated and compared. All results were validated by a panel of experts. Results In 2016, new genital warts, precancerous lesions and cancers attributable to types targeted by the 9vHPV were estimated at 49,251, 29,405 and 3381, respectively. Among them, 12,597 new precancerous lesions and 530 new cancers were related to the 5 additional types covered by the 9vHPV. Annual cost of new cases of these diseases associated to types targeted by the 4vHPV and 9vHPV were estimated at 116.7 and 150.9 million € for the Spanish National Health Service (NHS), respectively (2017 €). Conclusions HPV-related diseases represent a major burden for the Spanish NHS. Annual new cases and costs related to the 5 additional types from the 9vHPV represent a significant burden compared with that associated to types included in the 4vHPV.

Reseña.

Background: Cervix uteri cancer is the 4th most common cancer among women worldwide and the second most frequent cancer in women under 45 years old in Spain. We aimed to describe the burden of hospital admissions by malignant neoplasia (MN) and in situ carcinoma (ISC) of the cervix in Spain from 2003 to 2014, a 12-year period that included the first years after introduction of an HPV vaccination program. Methods: This epidemiological study reviewed data from the Ministry of Health National Surveillance System, which includes more than 98% of Spanish hospitals. Hospitalization rate, mortality rate, and case fatality rates were calculated per year and age group. Results: We found 74,933 hospitalizations due to MN and ISC of the cervix. The average age at hospitalization increased significantly during the study period. The average length of hospital stay decreased significantly (p

Background Approximately 40,000 new cases of anal cancer and 26,000 new cases of penile cancer occurred in 2012 worldwide. Human Papillomavirus (HPV) infection is responsible for 88.3% and 33.0% of these cancers, respectively. The aim of this study was to describe the hospital burden associated with malignant neoplasm (MN) and in situ carcinoma (ISC) in the anus and penis in Spain from 2009 to 2013. Methods This observational, retrospective study used discharge information obtained from the national surveillance system for hospital data, Conjunto Mínimo Básico de Datos, provided by the Ministry of Health. Results We found 3,668 hospitalizations due to MN and ISC in the anus for both genders, and more than 55% of these hospitalizations occurred in men and were associated with a lower median age of hospitalization (p < 0.001), higher average length of hospital stay (ALOS) (p = 0.0032), higher hospitalization costs (p < 0.001) and higher hospitalization rate (2.141 per 100,000 males aged > 14 y old and 1.604 per 100,000 women aged > 14 y old, p < 0.001) than in women. During the same period, 4,156 hospitalizations due to MN and ISC of the penis were registered. The hospitalization rate was 4.320 per 100,000 males aged > 14 y old. The hospitalization rate due to MN and ISC in the anus in males increased significantly during this period (p = 0.048). Conclusion Our study provides relevant information about the hospital burden of anal and penile MN and ISC in Spain. This information could be useful for cost effectiveness analysis of universal HPV vaccination and for future HPV vaccination impact monitoring in Spain, and for other countries of similar socioeconomic status.

Reseña del libro Si fuese posible montar en una bruja. Seguido de Auto de Fe de Logroño, Leandro Fernández de Moratín (2016), de Alberto Santamaría.

Intracellular pathogens include all viruses, many bacteria and parasites capable of invading and surviving within host cells. Key to survival is the subversion of host cell pathways by the pathogen for the purpose of propagation and evading the immune system. The intracellular bacterium Shigella flexneri, the causative agent of bacillary dysentery, invades host cells in a vacuole that is subsequently ruptured to allow growth of the pathogen within the host cytoplasm. S. flexneri invasion has been classically described as a macropinocytosis-like process, however the underlying details and the role of macropinosomes in the intracellular bacterial lifestyle have remained elusive. We applied dynamic imaging and advanced large volume correlative light electron microscopy (CLEM) to study the highly transient events of S. flexneri's early invasion into host epithelial cells and elucidate some of its fundamental features. First, we demonstrate a clear distinction between two compartments formed during the first step of invasion: the bacterial containing vacuole and surrounding macropinosomes, often considered identical. Next, we report a functional link between macropinosomes and the process of vacuolar rupture, demonstrating that rupture timing is dependent on the availability of macropinosomes as well as the activity of the small GTPase Rab11 recruited directly to macropinosomes. We go on to reveal that the bacterial containing vacuole and macropinosomes come into direct contact at the onset of vacuolar rupture. Finally, we demonstrate that S. flexneri does not subvert pre-existing host endocytic vesicles during the invasion steps leading to vacuolar rupture, and propose that macropinosomes are the major compartment involved in these events. These results provide the basis for a new model of the early steps of S. flexneri epithelial cell invasion, establishing a different view of the enigmatic process of cytoplasmic access by invasive bacterial pathogens.

BACKGROUND:Whole rye (WR) consumption seems to be associated with beneficial health effects. Although rye fiber and polyphenols are thought to be bioactive, the mechanisms behind the health effects of WR have yet to be fully identified. This study in rats was designed to investigate whether WR can influence the metabolism of n-3 and n-6 long-chain fatty acids (LCFA) and gut microbiota composition. METHODS:For 12 weeks, rats were fed a diet containing either 50% WR or 50% refined rye (RR). The WR diet provided more fiber (+21%) and polyphenols (+29%) than the RR diet. Fat intake was the same in both diets and particularly involved similar amounts of essential (18-carbon) n-3 and n-6 LCFAs. RESULTS:The WR diet significantly increased the 24-hour urinary excretion of polyphenol metabolites-including enterolactone-compared with the RR diet. The WR rats had significantly more n-3 LCFA-in particular, eicosapentanoic (EPA) and docosahexanoic (DHA) acids-in their plasma and liver. Compared with the RR diet, the WR diet brought significant changes in gut microbiota composition, with increased diversity in the feces (Shannon and Simpson indices), decreased Firmicutes/Bacteroidetes ratio and decreased proportions of uncultured Clostridiales cluster IA and Clostridium cluster IV in the feces. In contrast, no difference was found between groups with regards to cecum microbiota. The WR rats had lower concentrations of total short-chain fatty acids (SCFA) in cecum and feces (p