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Key Clinical Message The coexistence of rheumatoid arthritis (RA) and PLA2R‐associated membranous nephropathy (MN) is uncommon. It is difficult to demonstrate whether the mechanisms of renal pathology are triggered by RA, but it has been observed that the pro‐inflammatory molecules present in RA increase the expression of PLA2R. Rituximab could be effective in both conditions. Abstract RA affects 0.5% of adults in our country. It is an inflammatory disease that predominantly affects the joints causing destruction of the articular cartilage. Approximately 50% of patients present extra‐articular manifestations. Renal involvement is relatively frequent and clinically significant because it worsens the course and mortality of the primary disease. The histological renal damage observed in these patients includes a wide variety of entities and histological patterns with both glomerular and tubulointerstitial involvement, with secondary MN being one of the most frequent. Coexistence with primary MN is rare. We present the case of a 46‐year‐old male recently diagnosed with RA who was referred to the nephrology department for renal function deterioration and subnephrotic proteinuria. The autoimmune study showed positive anti‐PLA2R. Due to the unusual association between both entities, it was decided to perform a renal biopsy which showed abundant spikes. The immunofluorescence study showed contiguous parietal IgG positivity (3+). Immunohistochemistry showed positive granular IgG4, confirming the diagnosis of PLA2R‐associated MN. MN is one of the most common causes of nephrotic syndrome in adults. The determination of anti‐PLA2R has been a great advance in the rapid differential diagnosis of MN. In recent years, new target antigens associated with certain underlying pathologies have been discovered. However, PLA2R is not associated with any disease or exposure and therefore remains the antigen responsible for 80% of primary NMs. Anti‐PLA2R antibodies can be produced by loss of central or peripheral tolerance. Whether these mechanisms are triggered by RA itself is difficult to prove. The cytokine TNF‐like weak inducer of apoptosis (TWEAK) has been associated with RA. This proinflammatory molecule increases the expression of PLA2R in podocytes, sensitizing them to the damaging action of anti‐PLA2Rs, which could justify a causal relationship between the two pathologies. The anti‐PLA2R positivity in a patient with membranous nephropathy should not be sufficient to refrain from searching for a secondary cause, as a kidney biopsy is mandatory when another underlying disease coexists. Treatment should be tailored to the individual risk profile for progression. Rituximab could be an optimal option for both entities.

Lockdowns, restrictions on people's movements and gatherings, and other COVID-19 containment measures have had economic, social, and environmental effects. The pandemic resulted in major disruption to food systems, highlighting serious weaknesses in the way such systems are currently configured. However, the pandemic also created important opportunities to develop transformative actions enabling the creation of more resilient and sustainable food systems. In this paper, we delve more deeply into the strategies developed by consumers, as key stakeholders in the food system, through an in-depth survey and statistical analysis of changes in consumers' habits during the pandemic lockdowns. We adopt a city-region food system (CRFS) approach to explore ways to enhance food system resilience to future crises.Data were collected through a telephone survey of a representative sample (600 consumers), conducted in the region of Madrid in May 2021. First, descriptive analyses allowed different consumer strategies to be identified. Differences in food preferences and behaviour changes between individuals in the sample were analysed by age, gender, income, and level of education using exponential family Principal Component Analysis (EPCA), logistic regression, and Multiple Correspondence Analysis (MCA). Lastly, Principal Component Analysis (PCA) was applied to classify the consumer strategies into four discrete profiles.The findings show significant differences in consumers' responses according to age, income, and level of education. Additionally, the results highlight increased consumption of local and organic products, and online shopping, as typical strategies employed by consumers to respond to the COVID-19 pandemic. In this context, alternative food networks were shown to play a key role in enhancing food security. Interestingly, no significant differences were found between urban and rural areas. Our discussion addresses this apparent homogeneity in consumers’ habits from a resilient CRFS approach.

Abstract Background Cardiac hemangiomas are very uncommon benign primary tumors. They are usually located preferentially in the right atrium and their location in the interatrial septum is extremely rare. Case presentation We report the case of a 41-year-old patient who was admitted due to a stroke. The transthoracic echocardiogram revealed a large mass in the right atrium adhered to the interatrial septum. Suspecting an atrial myxoma, surgical intervention was performed confirming that the mass extended within the thickness of the interatrial septum, protruding into the right atrial cavity. The histologic report confirmed a hemangioma. Conclusions Cardiac hemangiomas are rare primary tumors and are usually misdiagnosed as other cardiac tumors. Histopathological examination is essential for a definitive diagnosis.

Photodynamic therapy (PDT) has developed as an efficient strategy for cancer treatment. PDT involves the production of reactive oxygen species (ROS) by light irradiation after activating a photosensitizer (PS) in the presence of O2. PS-coupled nanomaterials offer additional advantages, as they can merge the effects of PDT with conventional enabling-combined photo-chemotherapeutics effects. In this work, mesoporous titania nanorods were surface-immobilized with Chlorin e6 (Ce6) conjugated through 3-(aminopropyl)-trimethoxysilane as a coupling agent. The mesoporous nanorods act as nano vehicles for doxorubicin delivery, and the Ce6 provides a visible light-responsive production of ROS to induce PDT. The nanomaterials were characterized by XRD, DRS, FTIR, TGA, N2 adsorption–desorption isotherms at 77 K, and TEM. The obtained materials were tested for their singlet oxygen and hydroxyl radical generation capacity using fluorescence assays. In vitro cell viability experiments with HeLa cells showed that the prepared materials are not cytotoxic in the dark, and that they exhibit photodynamic activity when irradiated with LED light (150 W m−2). Drug-loading experiments with doxorubicin (DOX) as a model chemotherapeutic drug showed that the nanostructures efficiently encapsulated DOX. The DOX-nanomaterial formulations show chemo-cytotoxic effects on Hela cells. Combined photo-chemotoxicity experiments show enhanced effects on HeLa cell viability, indicating that the conjugated nanorods are promising for use in combined therapy driven by LED light irradiation.

Con la llegada del siglo XVIII, Francia y Rusia estrecharon sus lazos, las ideas de la Ilustración calaron profundamente entre la aristocracia rusa y aumentó significativamente el número de ciudadanos franceses que viajaban a Rusia. En el siglo XVIII, las mujeres comenzaron a luchar por sus derechos, y durante la centuria siguiente fueron conquistando espacios que habían sido tradicionalmente masculinos. El viaje fue uno de los ámbitos donde aumentó la presencia de las mujeres. Las viajeras francesas también visitaron el país de los zares, y muchas de ellas dejaron testimonios valiosos para conocer el pasado de esta nación. El objetivo de este artículo es analizar las percepciones que tuvieron las viajeras del arte y la cultura rusa. También tendremos presente el papel que jugaron estas mujeres en Rusia que, en muchos casos estuvo estrechamente ligado con los cambios políticos, sociales y culturales que estaban teniendo lugar en la época.

The agri-food system needs to transition into a more balanced system that takes into account economic, social, and environmental factors. Young people are a key demographic group to consider as they are open to new trends of consumption, including sustainable buying practices. Public universities can play a significant role in promoting sustainable and healthy eating habits among students. In this paper, we focus on the perceptions of young people regarding sustainable food in the Madrid Region. We conducted a survey using a questionnaire-based approach among 1940 students in 2022. The results highlight that young consumers are highly concerned about food sustainability. They perceive sustainability as local and non-processed foods. However, this perception varies among young consumers, and we identified five different consumer profiles. Principal component analysis and cluster analysis provide insights into potential actions that universities can take to promote sustainable and healthy eating habits among students.

En la actualidad la telerehabilitación ha tomado un gran auge debido a los acontecimientos de la COVID-19, éste trata de la aplicación de un programa bajo la supervisión remota, usando las tecnologías de información y comunicación, eliminando limitantes de las personas para su desplazamiento, minimizando riesgos y aportando mayor cumplimiento a los programas de rehabilitación y reacondicionamiento. El presente trabajo propone el desarrollo de una herramienta para el reconocimiento en tiempo real de ejercicios del método fisioterapéutico Klapp, basándonos en el concepto de telerehabilitación. El objetivo de este proyecto es dar apoyo a los fisioterapeutas para dar seguimiento al tratamiento de rehabilitación o reacondicionamiento. La herramienta permite evaluar la ejecución en tiempo real de cada uno de los ejercicios para informarle al paciente si lo realizó correctamente, y el fisioterapeuta podrá consultar dichos resultados. El desarrollo del proyecto fue gestionado bajo el modelo V como referencia para cada una de las actividades realizadas. La técnica utilizada para el reconocimiento son las redes neuronales recurrentes, pues su arquitectura permite modelar la siguiente predicción basándose en la información pasada y lograr modelar datos en secuencia como videos. Y para la implementación fueron empleadas las herramientas Keras, TensorFlow, Python, librerías de OpenCV y OpenPose, con el cual se obtuvieron los puntos de referencias de los ejercicios basándonos en los ángulos de Cobb. Los resultados obtenidos de reconocimiento de la red recurrente fueron medidos bajo la métrica de exactitud (Accuracy), logrando un 97% considerando 6 ejercicios, los cuales comprenden los ejercicios del método Klapp.

El acceso a la justicia es una vía de garantía de este derecho humano a la ciudadanía mediante su administración. En el estado mexicano el artículo 17 Constitucional dispone de mecanismo heterocompositivo (juicio) y autocompositivo (negociación, mediación, conciliación, arbitraje) aplicables en diversas materias y conforme a su normativa. En ese sentido, es importante considerar la profesionalización de los facilitadores a cargo de llevar la gestión de conflictos de mecanismos que requiere considerar ser aplicados desde los principios de los mismos a partir de la justicia alternativa. Aunque hay un avance en la materia este documento expone la justicia alternativa a partir de los mecanismos alternativos en México.

Aesthetic and ecological qualities overlap and interrelate in people’s attitudes towards landscapes. Additionally, the way a landscape manager is perceived, as well as the way a landscape is managed, usually play a significant role in the interpretation of these dimensions and how they are evaluated. A qualitative study was conducted in a Mediterranean agroforestry landscape (Sierra Oeste, Madrid) to understand how different components of a landscape (ecology, aesthetics, and management) influence the way that itis understood and valued by local stakeholders. Based on the results of a series of semistructured interviews and focus groups, a detailed analysis of the participants’ discourse was conducted. A series of guidelines for land planning and management were derived to reinforce the social perceptions of the landscape and enhance its ecological and aesthetic conditions.

El concepto de polivictimización, entendido como la experimentación de múltiples tipos de victimización durante la infancia y la adolescencia, está ampliamente reconocido. El desarrollo del Cuestionario de Victimización Juvenil ha permitido un estudio comprehensivo de este fenómeno. No obstante, no hay acuerdo en la definición metodológica, existiendo múltiples elementos que inciden en la detección de polivíctimas. El objetivo es realizar una revisión del concepto de polivictimización desde una perspectiva metodológica. Se incluyen 30 artículos de los que se describe su método de análisis, el marco temporal analizado, el tipo de muestra y la versión del instrumento aplicada. Se discute cómo la variabilidad de criterios metodológicos construye una definición de polivíctimas diferente en cada investigación, afectando a los puntos de corte y a la detección de polivíctimas. Este trabajo ofrece orientación para comprender la prevalencia de la polivictimización, y puede servir como guía a nuevos investigadores de este campo de estudio.

La exposición a la violencia durante la infancia puede normalizar las percepciones de este tipo de conflictos. La intervención temprana es clave para evitar que esas actitudes se reproduzcan o padezcan en la juventud y adultez. El objetivo de esta investigación es analizar y comparar la percepción de violencia hacia la mujer en la relación de pareja y el sexismo de adolescentes acogidos en hogares tutelados con otros no institucionalizados. A una muestra de 112 adolescentes entre 11 y 18 años (30.4% varones y 60.6% mujeres), el 34.8% en acogimiento residencial y el 65.2% no institucionalizados, se les administró la escala de percepción de violencia psicológica en las relaciones de noviazgo juvenil heterosexual (VEC) y la escala de detección de conductas sexistas en la Adolescencia (DSA). Los resultados indicaron que la percepción de violencia correlaciona con el sexismo hostil, benevolente y total. Además, los adolescentes en acogimiento residencial obtuvieron puntuaciones inferiores en percepción general de violencia de género y sus dimensiones de amenazas, aislamiento, descalificaciones y presión sexual; y puntuaciones superiores en sexismo hostil, benevolente y total.

Abstract Brain preconditioning (PC) refers to a state of transient tolerance against a lethal insult that can be evoked by a prior mild event. It is thought that PC may induce different pathways responsible for neuroprotection, which may involve the attenuation of cell damage pathways, including the apoptotic cell death. In this context, p53 is a stress sensor that accumulates during brain ischemia leading to neuronal death. The murine double minute 2 gene (MDM2), a p53-specific E3 ubiquitin ligase, is the main cellular antagonist of p53, mediating its degradation by the proteasome. Here, we study the role of MDM2-p53 pathway on PC-induced neuroprotection both in cultured neurons (in vitro) and rat brain (in vivo). Our results show that PC increased neuronal MDM2 protein levels, which prevented ischemia-induced p53 stabilization and neuronal death. Indeed, PC attenuated ischemia-induced activation of the p53/PUMA/caspase-3 signaling pathway. Pharmacological inhibition of MDM2-p53 interaction in neurons abrogated PC-induced neuroprotection against ischemia. Finally, the relevance of the MDM2-p53 pathway was confirmed in rat brain using a PC model in vivo. These findings demonstrate the key role of the MDM2-p53 pathway in PC-induced neuroprotection against a subsequent ischemic insult and poses MDM2 as an essential target in ischemic tolerance.

Microbiomes are defined as complex microbial communities, which are mainly composed of bacteria, fungi, and viruses residing in diverse regions of the human body. The human stomach consists of a unique and heterogeneous habitat of microbial communities owing to its anatomical and functional characteristics, that allow the optimal growth of characteristic bacteria in this environment. Gastric dysbiosis, which is defined as compositional and functional alterations of the gastric microbiota, can be induced by multiple environmental factors, such as age, diet, multiple antibiotic therapies, proton pump inhibitor abuse, H. pylori status, among others. Although H. pylori colonization has been reported across the world, chronic H. pylori infection may lead to serious consequences; therefore, the infection must be treated. Multiple antibiotic therapy improvements are not always successful because of the lack of adherence to the prescribed antibiotic treatment. However, the abuse of eradication treatments can generate gastric dysbiotic states. Dysbiosis of the gastric microenvironment induces microbial resilience, due to the loss of relevant commensal bacteria and simultaneous colonization by other pathobiont bacteria, which can generate metabolic and physiological changes or even initiate and develop other gastric disorders by non-H. pylori bacteria. This systematic review opens a discussion on the effects of multiple environmental factors on gastric microbial communities.

Candida species cause an opportunistic yeast infection called Candidiasis, which is responsible for more than 50,000 deaths every year around the world. Effective treatments against candidiasis caused by non-albicans Candida species such as C. glabrata, C. parapsilosis, C. aureus, and C. krusei are limited due to severe resistance to conventional antifungal drugs. Natural drimane sesquiterpenoids have shown promising antifungal properties against Candida yeast and have emerged as valuable candidates for developing new candidiasis therapies. In this work, we isolated isodrimeninol (C1) from barks of Drimys winteri and used it as starting material for the hemi-synthesis of four sesquiterpenoids by oxidation with pyridinium chlorochromate (PCC). The structure of the products (C2, C3, C4, and C5) was elucidated by 1D and 2D NMR spectroscopy resulting in C4 being a novel compound. Antifungal activity assays against C. albicans, C. glabrata, and C. krusei revealed that C4 exhibited an increased activity (IC50 of 75 μg/mL) compared to C1 (IC50 of 125 μg/mL) in all yeast strains. The antifungal activity of C1 and C4 was rationalized in terms of their capability to inhibit lanosterol 14-alpha demethylase using molecular docking, molecular dynamics simulations, and MM/GBSA binding free energy calculations. In silico analysis revealed that C1 and C4 bind to the outermost region of the catalytic site of 14-alpha demethylase and block the entrance of lanosterol (LAN) to the catalytic pocket. Binding free energy estimates suggested that C4 forms a more stable complex with the enzyme than C1, in agreement with the experimental evidence. Based on this new approach it is possible to design new drimane-type sesquiterpenoids for the control of Candida species as inhibitors of 14-alpha demethylase.

Introducción: El hiperparatiroidismo secundario es muy prevalente en pacientes trasplantados renales. Cursa con frecuencia con hipercalcemia y se ha asociado al desarrollo de osteopenia y fracturas óseas. El paricalcitol ha mostrado su eficacia en el control del hiperparatiroidismo secundario en la enfermedad renal crónica con y sin diálisis, con una baja incidencia de hipercalcemia. La experiencia con paricalcitol en trasplantados renales es muy escasa. El objetivo de este trabajo fue mostrar el efecto sobre el metabolismo mineralóseo del paricalcitol en trasplantados renales con hiperparatiroidismo secundario. Material y métodos: Estudio retrospectivo multicéntrico con trasplantados renales de más de 18 años de edad y más de 12 meses de evolución postrasplante, con función renal estable, que hayan sido tratados con paricalcitol durante más de 12 meses, con seguimiento clínico hasta los 24 meses de tratamiento. Resultados: Se incluyó a 69 pacientes, con 120 ± 92 meses postrasplante, con creatinina inicial de 2,2 ± 0,9 mg/dl y FG-MDRD 36 ± 20 ml/min/1,73 m2. La dosis de paricalcitol se incrementó progresivamente durante el estudio: basal 3,8 ± 1,9 μg/semana, 12 meses 5,2 ± 2,4 μg/semana; 24 meses 6,0 ± 2,9 μg/semana (p 10 mg/dl mostraron una reducción progresiva de sus cifras. Quince (21,7%) pacientes seguían tratamiento previo con calcitriol y al cambiarlos a paricalcitol precisaron dosis significativamente mayores que los pacientes que no habían recibido calcitriol. El paricalcitol fue asociado a cinacalcet en 11 pacientes, con reducciones significativas de PTH, con evolución similar al resto de la población y con dosis de paricalcitol también similares. Conclusiones: Paricalcitol es eficaz en el tratamiento del hiperparatiroidismo secundario de trasplantados renales. Globalmente no observamos modificaciones significativas de los niveles de calcio ni de fósforo, ni en su excreción urinaria. Los pacientes en tratamiento previo con calcitriol precisaron dosis mayores de paricalcitol. Cuando el paricalcitol se administra a pacientes tratados con cinacalcet, se observa un descenso significativo de la PTH con dosis de paricalcitol similar a pacientes sin cinacalcet.

Introduction: Secondary hyperparathyroidism is highly prevalent in kidney transplant recipients, and commonly results in hypercalcaemia; an association to osteopenia and bone fractures has also been observed. Paricalcitol has proved effective to control secondary hyperparathyroidism in chronic kidney disease in both dialysed and non-dialysed patients, with a low hypercalcaemia incidence. Currently available experience on paricalcitol use in kidney transplant recipients is scarce. Our main aim was to show the effect of paricalcitol on mineral bone metabolism in kidney transplant recipients with secondary hyperparathyroidism. Material and methods: A retrospective multicentre study in kidney transplant recipients aged >18 years with a 12-month or longer post-transplantation course, stable renal function, having received paricalcitol for more than 12 months, with available clinical follow-up for a 24-month period. Results: A total of 69 patients with a 120 ± 92-month post-transplantation course were included. Baseline creatinine was 2.2 ± 0.9 mg/dL and GFR-MDRD was 36 ± 20 mL/min/1.73 m2. Paricalcitol doses were gradually increased during the study: baseline 3.8 ± 1.9 μg/week, 12 months 5.2 ± 2.4 μg/week; 24 months 6.0 ± 2.9 μg/week (P 10 mg/dL showed gradually decreasing levels. Fifteen (21.7%) patients had received prior calcitriol therapy. When shifted to paricalcitol, such patients required paricalcitol doses significantly larger than those not having received calcitriol. Paricalcitol was used concomitantly to cinacalcet in 11 patients with significant PTH reductions being achieved; clinical course was similar to other patients and paricalcitol doses were also similar. Conclusions: Paricalcitol is an effective therapy for secondary hyperparathyroidism in kidney transplant recipients. Overall, no significant changes were observed in calcium and phosphorus levels or urinary excretion. Patients having previously received calcitriol required higher paricalcitol doses. When used in patients receiving cinacalcet, paricalcitol results in a significant PTH fall, with paricalcitol doses being similar to those used in patients not receiving cinacalcet.

Travel literature is an important source for the study of artistic heritage as travelers used to describe the cities and their buildings. The travelers’ tales provide us with unknown information about some works of art and describe monuments that do not survive. The travelers’ tales help us to know how buildings were appreciated in the past. I have analyzed sixty-two authors’ tales to determine their contribution to Castilla-La Mancha’s Art History.

This report describes a simple, inexpensive and highly effective instructional model based on the use of a tablet device to enable the real-time projection of the instructor's digitally handwritten annotations to teach chemistry in undergraduate courses. The projection of digital handwriting allows the instructor to build, present and adapt the class contents in a dynamic fashion and to save anything that is annotated or displayed on the screen for subsequent sharing with students after each session. This method avoids the loss of continuity and information that often occurs when instructors switch between electronic slides and white/chalk board during lessons. Students acknowledged that this methodology allows them to follow the instructor's cognitive process and the progressive development of contents during lectures as the most valuable aspect of the implemented instructional model.

El infarto agudo de miocardio de origen embólico es poco frecuente y suele ocurrir en pacientes con la fibrilación auricular o las valvulopatías. Suele afectar a la arteria descendente anterior. La presentación simultánea de un embolismo pulmonar y un infarto agudo de miocardio también es rara y difícil de diagnosticar porque ambas entidades producen síntomas parecidos y alteraciones electrocardiográficas a veces superponibles. Se presenta el caso de un paciente con embolia pulmonar y un infarto agudo de miocardio simultáneos, en probable relación con una embolia paradójica.