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Patients with decompensated cirrhosis, particularly those with acute-on-chronic liver failure (ACLF), show profound alterations in plasma metabolomics. The aim of this study was to investigate the effect of treatment with simvastatin and rifaximin on plasma metabolites of patients with decompensated cirrhosis, specifically on compounds characteristic of the ACLF plasma metabolomic profile. Two cohorts of patients were investigated. The first was a descriptive cohort of patients with decompensated cirrhosis (n = 42), with and without ACLF. The second was an intervention cohort from the LIVERHOPE-SAFETY randomized, double-blind, placebo-controlled trial treated with simvastatin 20 mg/day plus rifaximin 1,200 mg/day (n = 12) or matching placebo (n = 13) for 3 months. Plasma samples were analyzed using ultrahigh performance liquid chromatography-tandem mass spectroscopy for plasma metabolomics characterization. ACLF was characterized by intense proteolysis and lipid alterations, specifically in pathways associated with inflammation and mitochondrial dysfunction, such as the tryptophan-kynurenine and carnitine beta-oxidation pathways. An ACLF-specific signature was identified. Treatment with simvastatin and rifaximin was associated with changes in 161 of 985 metabolites in comparison to treatment with placebo. A remarkable reduction in levels of metabolites from the tryptophan-kynurenine and carnitine pathways was found. Notably, 18 of the 32 metabolites of the ACLF signature were affected by the treatment. Conclusion: Treatment with simvastatin and rifaximin modulates some of the pathways that appear to be key in ACLF development. This study unveils some of the mechanisms involved in the effects of treatment with simvastatin and rifaximin in decompensated cirrhosis and sets the stage for the use of metabolomics to investigate new targeted therapies in cirrhosis to prevent ACLF development.

Aims Pelvic organ prolapse (POP) is a very prevalent condition with a great impact on women's quality of life. At present, there is great controversy regarding the use of mesh in POP surgery. To understand the current moment, it is advisable to make a brief summary of the historical evolution of mesh use for pelvic floor pathology. The aim of this paper is to establish the position of the Ibero-American Society of Neurourology and UroGynecology (SINUG for its acronym in Spanish) regarding vaginal mesh reconstructive surgery. Methods A working committee from the SINUG's scientific board performed a literature search about the use of vaginal meshes for pelvic organ prolapse reconstructive surgery and about the position of different societies. We analyzed the evolution into three periods: before the Food and Drug Administration (FDA) statement, FDA statement, and after the statement. SINUG drew up a position statement regarding vaginal mesh reconstructive surgery, based on the available scientific evidence and the evolution of its use in different contexts. Results Before mesh appearance in the 1990s, native tissue repair was the surgical treatment of choice for POP. Vaginal mesh reconstructive surgery has been frequently accompanied by procedure underestimation by inexperienced surgeons, besides inadequate diagnoses and indications. This situation led to the presentation of serious complications including mesh extrusion, exposure, and contraction. Conclusions Once reviewed the available evidence and the position of different societies, SINUG presents its vision in this communication, which is a summary of the document prepared by the society's scientific board.

The aim of this paper is to stablish de position of the Ibero-American Society of Neurourology and Urogynecology (SINUG) in relation to the use of suburethral meshes for the surgical treatment of female stress incontinence.

Aims The aim of this paper is to stablish de position of the Ibero-American Society of Neurourology and Urogynecology (SINUG) in relation to the use of suburethral meshes for the surgical treatment of female stress incontinence. Methods Tension-free mid-urethral slings (MUS) have become the most popular procedure for the treatment of stress urinary incontinence (SUI). In July 2018, the British government announced a pause in the use of meshes for both pelvic organ prolapse (POP) and urinary incontinence (UI) treatment without differentiating whether the meshes were used for treating UI or POP. The decision was taken to stop their use until the publication of the updated UI and POP guidelines of the British National Health Service, which is available from April 2019. SINUG has reviewed the evidence and official position of different societies in relation to the safety and efficacy of MUS in the surgical treatment of incontinence differentiating them from meshes used to repair POP. Results Data from synthetic mesh manufacturers indicate that in 2010, 300 000 women underwent surgical procedures to repair POP and approximately 260 000 were operated on for SUI. According to these estimates, approximately more than 80% of the surgical techniques for UI treatment were performed transvaginally with meshes. Conclusions Once reviewed evidence and position of different societies, the SINUG presents its vision in this communication, which is a summary of the document analysing the state of topic prepared by the society.

Background and Aims:Physical activity (PA) and some dietary patterns like Mediterranean Diet (MeDiet) are associated with a decreased stroke risk but there are limited data on their association with stroke characteristics and prognosis. We aimed to study the association of pre-stroke PA and adherence to MeDiet with different outcome variables in patients with acute ischemic ischemic stroke (IS) treated with endovascular therapyMethods:We included consecutive patients with IS in 12 NORDICTUS (Stroke network of North Spain) hospitals. Inclusion criteria were: MCA and/or TICA occlusion and baseline mRS 0-1. Degree of PA prior to stroke was evaluated with Spanish Short Version of the Minnesota Leisure Time Physical Activity Questionnaire and adherence to the MeDiet with PREDIMED 14-points questionnaire. Clinical, radiological and prognostic variables were prospectively collected by blind investigators.Results:From 1/15/2018 to 10/30/2018, 239 patients were included (mean age 71 years,48% women, median NIHSS 16). Low adherence to MeDiet was associated with atherotrombotic etiology. Daily intake of red wine was associated with a higher probability of complete recanalization (p=0.048). In multivarable analysis, use of olive oil as the principal source of fat was independently associated with mRS u22642 at 3 months, OR 3.2 [1.2-8.7]. Patients with a lower activity level prior to stroke (sedentary) had more frequently cardioembolic stroke and a higher incidence of symptomatic intracranial hemorrhage. No associations were found between PA or MeDiet and collateral grade, final infarct volume or mortality.Conclusions:PA and some MeDiet patterns may act as preconditioning factors improving prognosis after stroke.

A pesar de que existen diferentes estudios en las Ciencias de la Actividad Física y del Deporte sobre autores humanistas, el objetivo del presente trabajo es poner en valor la obra de una de las figuras más importantes del humanismo español, Blas Álvarez de Miraval, insigne médico y teólogo, a través del análisis pormenorizado de su obra cumbre, titulada De la conservación de la salud del cuerpo y el alma, cuyos resultados arrojan una visión única y diferente de lo que ha de ser la conservación de la salud desde una perspectiva integral por parte del individuo, In spite of the fact that there are different studies in the Sciences of the Sport on humanist authors, the aim of the present work is to put of relevancy the work of one of the most important figures of the Spanish humanism, Blas Álvarez de Miraval, celebrated doctor and theologian, with regard to the Sciences of the Physical Activity and of the Sport by means of the study detailed of his greatest work, "Of the conservation of the health of the body and the soul", which results throw an only and different vision from what has to be the conservation of the health from the integral care of the individual

1992), con cerca de 3 100 especies. Berazaín et al. (2005), con un endemismo que sobrepasa el 50 %. Otro indicador de elevada biodiversidad se expresa en 30 tipos diferentes de vegetación (Capote & Berazaín, 1984; Vales & al., 1998), por lo cual se incluye en uno de los hotspot del planeta (Mittermeier & al., 1999), ocupando el lugar principal. El Estado cubano se esfuerzan por proteger los paisajes, ecosistemas y hábitats, a través del Sistema Nacional de Áreas Protegidas, que implementa las principales acciones para conservar la biodiversidad, donde identifica para 2015, integrar áreas protegidas más amplias, mediante la creación de corredores biológicos o restauración de ecosistemas degradados, que garanticen la continuidad ecológica, con la declaración de Reservas de Biosferas y Sitios Ramsar. Asimismo adopta medidas que permiten ampliar, las que se encuentran dentro de un área natural grande, íntegra o relativamente poco fragmentada o altamente irremplazable, bajo gran amenaza o que alberguen especies amenazadas (Plan de Acción Nacional 2006/2010 sobre Diversidad Biológica. República de Cuba). Pinar del Río cuenta con 3290 especies vegetales, con 890 endémicas, que representan el 27 % del total de su fitodiversidad. De ellas, más de 1800 habitan la Sierra de Los Órganos, con cerca del 24 % de endemismo (Urquiola et al. 2008). De estos 430 vegetales endémicos cubanos, 126 son occidentales, mientras que de este total 82 son exclusivos de la provincia. Si tomamos en consideración que en esta área sólo existe el Parque Nacional Viñales, donde habitan menos de la mitad en poblaciones circunscritas a escasas localidades, notaremos la necesidad de ampliar el área para que puedan ser protegidas el total de su riqueza y existan poblaciones suficientes para que ocurran intercambios genéticos.

En el Centro Experimental Palmira del Instituto Colombiano Agropecuario ICA (Valle del Cauca), se realizó un ensayo con tomate "Chonto" en el que se compararon 2 sistemas de siembra: surco doble y surco sencillo y 4 sistemas de poda: poda a dos y 6 ramas, despunte a los 110 días luego del trasplante y libre crecimiento. En todos ellos se eliminaron los brotes nacidos bajo el primer racimo floral, excepto el inmediatamente debajo. Para ambos sistemas de siembra se utilizó la misma densidad de plantas: 26.666 plantas/Ha. Se cosechó dos veces por semana clasificando los frutos por tamaño y calidad. De los resultados obtenidos se desprende que para las densidades utilizadas, el sistema de poda más recomendable fue el despunte, por cuanto se indujo en general mayor rendimiento, mayor número de frutos grandes y menor número de frutos rajados. Los tratamientos, libre crecimiento y poda a 6 ramas, presentaron buenas producciones pero debido al excesivo crecimiento para el primero de ellos y la mayor mano de obra con el segundo deben tomarse como alternativas en condiciones especiales. El tratamiento con poda a dos ramas fue el que menores producciones indujo, lo mismo que el mayor porcentaje de frutos rajados, en comparación con los demás. No se observaron diferencias de producción entre siembra en surco sencillo y siembra en surco doble. No se observó interacción entre los sistemas de siembra y de poda, aunque el despunte fue el mejor tratamiento cuando se sembró en surco sencillo y el libre crecimiento lo fue en surco doble. At the National Experiment Center of ICA in Palmira an experiment was conducted with "Chonto" tomato in wich two planting system and four prunning systems were compared. They were: double row and single row planting with four methods of plant prunning, prunning at two branches, prunning at six branches, pinching of terminal shoots at 110 days after transplanting and free growth in all plants, Buds below the first floral inflorescence were removed with the exception of the closed bud of it. Tomatoes were harvested twice a week approximately and classified according to size and quality. It was found that for the density used, the most advisable prunning method was that of prunning at 110 days this method induced in general the greatest yield, the largest number of large fruits and the fewest cracked fruits. The systems of free growth and of prunning at 6 branches produced good results but because the management of the 1 st and the extra labor required for the 2nd, they must be considered as alternatives for use under special conditions. Prunning at two branches, induced the least production along with the most cracked fruit. There were no differences observed between double and single row planting. No relation was observed between the planting systems and the prunning systems but pinching at 110 days was the most productive at the single row and free growth at single row. Tomate-Solanum lycopersicum

Cirrhosis is a complex disease that is associated with disturbances in different organs besides the liver, including kidneys, heart, arterial circulation, lungs, gut, and brain. As a consequence, patients develop a number of complications that result in frequent hospital admissions and high morbidity and mortality. Patients with cirrhosis require constant and rigorous monitoring both in and outside the hospital. In this context, the role of nurses in the care of patients with cirrhosis has not been sufficiently emphasized and there is very limited information about nursing care of patients with cirrhosis compared with other chronic diseases. The current article provides a review of nursing care for the different complications of patients with cirrhosis. Nurses with specific knowledge on liver diseases should be incorporated into multidisciplinary teams managing patients with cirrhosis, both inpatient and outpatient. Conclusion: Nurses play an important role in the management and prevention of complications of the disease and improvement in patients' quality of life and bridge the gap between clinicians and families, between primary care and hospital care, and provide medical education to patients and caregivers.