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We aim to examine the incidences, clinical characteristics, and in-hospital outcomes of type 2 diabetes (T2DM) patients hospitalized with urinary tract infections (UTIs) in Spain and to identify the factors associated with in-hospital mortality (IHM). A retrospective observational study was carried out with a sample that included all adult patients who were hospitalized for UTIs between 2001 and 2018 and collected in the Spanish National Health System Hospital Discharge Database. We identified 850,276 patients with UTIs (25.49% with T2DM). The incidence of UTIs increased in patients with and without diabetes from 290.76 and 74.79 cases per 100,000 inhabitants in the period from year 2001 to year 2003 to 568.45 and 144.0 in the period from 2016 to 2018, respectively (p < 0.001). Adjusted incidence of UTIs was higher in T2DM patients (incidence rate ratio (IRR) 4.36; 95% CI 4.35-4.39). The multivariable analysis showed a significant reduction in the IHM over time for men and women with T2DM. In T2DM, patients' higher IHM was associated with older age, comorbidities, and Staphylococcus aureus isolation. Women with T2DM had a higher risk of dying than men. The risk of IHM with an episode of UTIs was independent of the presence of T2DM (odds ratio (OR) 0.97; 95% CI 0.91-1.01). We conclude that the incidence of UTIs was over four times higher in T2DM than nondiabetic patients and has increased over time., Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Aims To evaluate if rivaroxaban, an oral factor Xa (FXa) inhibitor, could modify the expression in vitro of inflammatory and oxidative stress biomarkers in abdominal aortic aneurysmal (AAA) sites showing intraluminal thrombus. Methods AAA sites with intraluminal mural thrombus were obtained from six patients undergoing elective AAA repair. In addition, control abdominal aortic samples were obtained from six organ donors. AAA sites were incubated in the presence and absence of 50 nmol l–1 rivaroxaban. Results AAA sites showing thrombus demonstrated higher content of FXa than control. Interleukin-6 levels released from AAA [Control: median: 23.45 (interquartile range: 16.17–37.15) vs. AAA: median: 153.07 (interquartile range: 100.80–210.69) pg ml–1 mg tissue–1, P < 0.05] and the expression levels of nitric oxide synthase 2 were significantly higher in AAA than in control. The protein expression level of NADPH oxidase subunits gp67-and gp91-phox, but did not gp47-phox, were also significantly higher in the AAA sites than in control. Addition of rivaroxaban to AAA sites explants significantly reduced the release of interleukin-6 [median: 51.61 (interquartile range: 30.87–74.03) pg ml–1 mg tissue–1, P < 0.05 with respect to AAA alone] and the content of nitric oxide synthase 2, gp67 and gp91-phox NADPH subunits. The content of matrix metallopeptidase 9 was significantly higher in the AAA sites as compared to control. Rivaroxaban also reduced matrix metallopeptidase 9 content in AAA sites to similar levels to control. Conclusions FXa inhibition by rivaroxaban exerted anti-inflammatory and antioxidative stress properties in human AAA sites, suggesting a role of FXa in these mechanisms associated with the pathogenesis of AAA., Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Thromboembolic events are the second cause of death in cancer patients, although the mechanisms underlying this increased thromboembolic risk remain unclear. The aims of this study were to examine whether BRCA2 gene mutations may modify the circulating levels of thrombocoagulation biomarkers and whether breast cancer development may influence changes in such circulating biomarkers. The study was performed in 25 women with mutations in the BRCA2 gene (n=12 breast cancer, n=13 breast cancer-free) and in 13 BRCA2 non-mutant controls. Results revealed that plasma levels of fibrinogen gamma chain isotypes 2 and 3, haptoglobin isotypes 4 and 5, serotransferrin isotypes 3 and 4 and convertase C3/C5 isotypes 4 and 5 were significantly higher in BRCA2 mutation carriers compared to controls. However, plasma levels of vitamin D binding protein isotype 1 and alpha1-antitrypsin isotypes 2, 3 and 4 were significantly decreased in BRCA2 mutation carriers compared to controls. Plasma expression of PF4 and P-selectin was significantly higher in BRCA2 mutations carriers than in controls. BRCA2 truncated mutations conserving a binding region for RAD51 were associated with increased plasma levels of alpha1-antitrypsin isotypes 3 and 4 with respect to women showing BRCA2 mutations that loss the binding RD51 region to BRCA2. Only plasma levels of vitamin D binding protein isotypes 1 and 3 were significantly reduced and alpha 1-antitrypsin isotype 1 was increased in cancer-free BRCA2 mutation carriers compared to BRCA2 mutation carriers with breast cancer. The presence of BRCA2 mutations is associated with increased plasma levels of thrombo-coagulating-related proteins, which are independent to breast cancer development., Sociedad Española de Oncología, Fondo Europeo de Desarrollo Regional, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Background: We analyzed the association between atrial fibrillation or atrial flutter (AF) and in-hospital mortality (IHM) among patients who underwent solid organ transplants in Spain from 2004 to 2021. (2) Methods: We gathered information from all hospital admissions for lung, liver, kidney, and heart transplants. (3) Results: A total of 71,827 transplants were analyzed (4598 lung transplants; 18,127 liver transplants; 45,262 kidney transplants; and 4734 heart transplants). One third of these were for women. Overall, the prevalence of AF was 6.8% and increased from 5.3% in 2004-2009 to 8.6% in 2016-2021. The highest prevalence of AF was found for heart transplants (24.0%), followed by lung transplants (14.7%). The rates for kidney and liver transplants were 5.3% and 4.1%, respectively. The AF code increased over time for all of the transplants analyzed (p < 0.001). The patients' IHM decreased significantly from 2004-2009 to 2016-2021 for all types of transplants. AF was associated with a higher IHM for all of the types of transplants analyzed, except for heart transplants. (4) Conclusions: The prevalence of AF among patients admitted for solid organ transplants was highest for those who underwent heart transplants. The mortality rate during the patients' admission for lung, liver, kidney, or heart transplants decreased over time. AF was independently associated with a higher risk of dying in the hospital for those who underwent lung, liver, or kidney transplants., Comunidad Autónoma de Madrid, Universidad Complutense de Madrid, Depto. de Inmunología, Oftalmología y ORL, Fac. de Medicina, TRUE, pub

There is interest to analyse newer biomarkers to identify healthy individuals at risk to develop cardiovascular disease (CVD) incidents and death. To determine in healthy individuals new circulating protein biomarkers, whose systemic levels may be associated with the risk of future development of CVD incidents and death. The study was performed in 82 individuals from the Malm€o Diet and Cancer study cohort, free from CVD of whom 41 developed CVD and 41 did not. Plasma proteins related to inflammation and thrombo-coagulating processes were analysed. a1-antitrypsin isotype 3 plasma levels were significantly higher while apolipoprotein J plasma levels were lower in participants that developed CVD incidents than those that did not develop acute cardiovascular episode. Of 82 participants, 17 died by CVD causes. There were proteins whose expression in plasma was significantly higher in participants suffering CVD death as compared with those that did not die by CVD. These proteins included: fibrinogen b-chain isotypes 1 and 3, fibrinogen-c-chain isotype 2, vitamin D-binding protein isotypes 1, 2 and 3, a1-antitrypsin isotypes 3 and 6, haptoglobin isotypes 3,4,5 and 5, haemopexin isotypes 1 and 2, and Rho/Rac guanine nucleotide exchange factor 2. Moreover, apolipoprotein J plasma levels were found lower in participants that died by cardiovascular cause. Association between plasma levels of proteins and CVD death was independent of age, gender, conventional risk factors and plasma C-reactive protein levels. Several protein plasma levels and protein isotypes related to inflammation and thrombo-coagulating phenomena were independently associated with the risk of future CVD death., Fondo de Investigaciones de la Seguridad Social, Unión Europea, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Background: We examined trends in the incidence of ventilator support with noninvasive ventilation (NIV) or invasive mechanical ventilation (IMV) among patients hospitalized in Spain from 2001 to 2015. We also assessed in-hospital mortality (IHM) after receiving these types of ventilator support. Methods: This study was an observational retrospective epidemiological study. Our data source was the Spanish National Hospital Discharge Database. Results: In total, 1,031,497 patients received ventilator support in Spain over the study period. NIV use increased from 18.8 patients per 100.000 inhabitants in 2001 to 108.7 in 2015. IMV utilization increased significantly from 2001 to 2003 and then decreased from 2003 until 2015. Patients who required NIV had the highest mean Charlson Comorbidity Index (CCI) score. Patients who received IMV had the highest in-hospital mortality. Factors associated with an increased risk for IHM were sex, age, conditions included in the CCI (except for COPD and diabetes), haemodialysis, presence of a peripheral arterial catheter, presence of a central venous catheter, readmission and emergency room admission. Undergoing a surgical procedure was a risk factor only for IMV. IHM decreased significantly from 2001 to 2015 in patients who underwent NIV or IMV. Conclusions: We identified an increase in the utilization of NIV over time, whereas use of IMV decreased from 2003 until 2015 after an initial increase from 2001 to 2003. We also found a significant decrease in IHM over time., Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Aims: We aim to compare the incidence and in-hospital outcomes of communityacquired pneumonia (CAP), ventilator-associated pneumonia (VAP) and nonventilator hospital-acquired pneumonia (NV-HAP) according to gender. Methods: This was a retrospective observational epidemiological study using the Spanish National Hospital Discharge Database for the years 2016 and 2017. Results: Of 277 785 hospital admissions, CAP was identified in 257 455 (41.04% females), VAP was identified in 3261 (30.42% females) and NV-HAP was identified in 17 069 (36.58% females). The incidence of all types of pneumonia was higher amongst males (CAP: incidence rate ratio [IRR] 1.05, 95% CI 1.03-1.06; VAP: IRR 1.36, 95% CI 1.26-1.46; and NV-HAP: IRR 1.16, 95% CI 1.14-1.18). The crude in-hospital mortality (IHM) rate for CAP was 11.44% in females and 11.80% in males (P = .005); for VAP IHM, the rate was approximately 35% in patients of both genders and for NV-HAP IHM, the rate was 23.97% for females and 26.40% for males (P < .001). After multivariable adjustment, in patients of both genders, older age and comorbidities were factors associated with IHM in the three types of pneumonia analysed. Female gender was a risk factor for IHM after VAP (OR 1.24; 95% CI 1.06-1.44), and no gender differences were found for CAP or NV-HAP. Conclusions: Our findings show a difference between females and males, with females presenting a lower incidence of all types of pneumonia. However, female gender was a risk factor for IHM after VAP., Unión Europea, Instituto de Salud Carlos III, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Background: The aims of this study were to examine trends in the incidence, clinical characteristics, and in-hospital outcomes of patients hospitalized with pulmonary embolism in Spain and to identify factors associated with in-hospital mortality (IHM). (2) Methods: We included all patients who were hospitalized for pulmonary embolism between 2001 and 2018. Data were collected from the Spanish National Hospital Discharge Database. (3) Results: We identified 241,821 hospitalizations for pulmonary embolism during the study period. The incidence of pulmonary embolism increased from 20.49 cases per 100,000 inhabitants in the period 2001–2002 to 35.9 cases in the period 2017–2018 (p < 0.001). After controlling for possible confounders, there was a significant increase in the incidence over the study period (adjusted incidence rate ratio 1.53, 95% Confidence Interval I 1.51–1.56). The median length of hospital stay was 11 days in the period 2001–2002, decreasing to seven days in the period 2017–2018 (p < 0.001). For the total time period, the crude IHM rate was 9.51%. After multivariable adjustment, IHM decreased significantly over time. The IHMwas significantly higher in women, in patients suffering from more comorbidities, and in those with a massive pulmonary embolism. (4) Conclusions: Our results revealed an increase in the incidence of pulmonary embolism hospitalizations from 2001 to 2018 in Spain, with older patients being the most affected., Instituto de Salud Carlos III, Unión Europea, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Introduction and objectives: Tako-tsubo syndrome produces a variable degree of transient left ventricular dysfunction. Our objective was to determine the short- and long-term prognosis of this syndrome, the incidence of and risk factors for the development of heart failure, and the influence on heart failure on the long-term outcome in our patient population. Methods: We prospectively recorded the clinical features and events during the hospital stay and follow-up of 100 patients with tako-tsubo syndrome. The risk factors for heart failure during hospital stay, considered as Killip class≥II, were assessed. Results: Most of the patients were women (89%), with a mean age of 68 years. The distribution according to Killip class was: Killip I, 70 patients; Killip II, 15; Killip III, 5; and Killip IV, 10. Cardiovascular risk factors, including diabetes, were common in the overall group, but were more so in the heart failure cohort. The left ventricular ejection fraction was lower in the heart failure group (51% vs 42%; P<.01). There were no differences in preadmission medications or biomarkers of necrosis. Over a median follow-up of 1380 days, the incidence of events reported during the hospital stay and long-term follow-up, both for death and the combined endpoints, was higher in the heart failure cohort. Conclusions: Although the prognosis in tako-tsubo syndrome is usually good, heart failure occurs quite frequently, mainly in patients with a greater number of comorbidities and poorer previous functional class. Moreover, heart failure is associated with a higher number of early and late adverse events. The overall long-term prognosis is good., Fundación Mutua Madrileña, Depto. de Medicina, Fac. de Medicina, TRUE, pub

Background/aims Kidneys from uncontrolled non heart-beating donors achieve a good level of renal function after transplantation. However, a number of them will never function in the recipient. Our aim was to determine if serum biomarkers associated with platelet activity, inflammation and the nitric oxide system in uncontrolled non heart-beating donors may help to predict no renal function recovery after renal transplantation. Methods Serum levels of interleukin (IL)-6, IL-10, intercellular cell adhesion molecule-1 (ICAM-1), cyclic guanosine monophosphate (cGMP), nitrite + nitrate and platelet factor-4 (PF4) were measured using enzyme-linked immunosorbent assay (ELISA) kits in 88 uncontrolled non heart-beating donors divided according to the renal functionality achieved in the recipients into functional (n = 76) and non functional (n = 12). Results Kidneys from donors with higher IL-6 levels (>900 pg/ml) were functional after transplantation. Serum cGMP levels below 372.3 fmol/l were also associated with kidneys that recovered the renal function. However, serum levels of PF4 showed the best correlation with recovery of renal functional in the recipients since they were significantly lower in the donors whose kidneys functioned after transplantation. Conclusions Serum PF4 levels in uncontrolled non heart-beating donors may be a good predictor for kidneys that never will reach functional recovery. Some serum cGMP, IL-6 and IL-10 levels may simply help identify kidneys that will function after transplantation., Fondo de Investigaciones de la Seguridad Social, Fondo Europeo de Desarrollo Regional, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

There is a link between depression, cardiovascular events and inflammation. We have explored this connection through endothelial dysfunction, using in vivo and in vitro approaches. We evaluated circulating biomarkers of endothelial dysfunction in patients with major depression at their diagnosis (MD-0) and during antidepressant treatment with the selective serotonin reuptake inhibitor escitalopram, for 8 and 24 weeks (MD-8 and MD-24). Results were always compared with matched healthy controls (CON). We measured in vivo circulating endothelial cells (CECs) and endothelial progenitor cells (EPCs) in blood samples, and assessed plasma levels of soluble von Willebrand factor (VWF) and vascular cell adhesion molecule-1 (VCAM-1). CEC counts, soluble VWF and VCAM-1 were statistically elevated in MD-0 (P<0.01 versus CON) and gradually decreased during treatment. Conversely, EPC levels were lower in MD-0, tending to increase throughout treatment. In vitro studies were performed in human endothelial cells cultured in the presence of sera from each study group. Elevated expression of the inflammation marker intercellular adhesion molecule-1 and oxidative stress, with lower presence of endothelial nitric oxide synthase and higher reactive oxygen species production, were found in cells exposed to MD-0 sera (P<0.05 versus CON). These results were normalized in cells exposed to MD-24 sera. Thrombogenicity of extracellular matrices generated by these cells, measured as expression of VWF, tissue factor and platelet reactivity, showed non-significant differences. We provide a model of cultured endothelial cells reproducing endothelial dysfunction in naive patients with major depression, demonstrating endothelial damage and inflammation at diagnosis, and recovering with selective serotonin reuptake inhibitor treatment for 24 weeks., Instituto de Salud Carlos III, Cardiovascular Research Net, Health Institutes, Ministerio de Economía y Competitividad, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

(1) Background: The relationship between type 2 diabetes (T2DM) and pulmonary embolism (PE) has not been well stablished so far. We aim to analyze incidence, clinical conditions and in-hospital mortality (IHM) according to the presence of T2DM among patients hospitalized for suffering from PE. The factors associated with IHM were identified. (2) Methods: Patients aged ≥40 years hospitalized for PE from 2016 to 2018 included in the Spanish National Health System Hospital Discharge Database were analyzed. Dependent variables included incidence, IHM and length of hospital stay. Independent variables were age, sex, diagnosed comorbidities, thrombolytic therapy and inferior vena cava filter placement. Poisson and logistic regression models were constructed for multivariable analysis. (3) Results: Of the 47,190 hospitalizations for PE recorded, 16.52% had T2DM. Adjusted incidence of PE was higher among T2DM women (IRR 1.83; 95% CI: 1.58-1.96) and men (IRR 1.22; 95% CI: 1.18-1.27) than among non-diabetic subjects. Crude IHM in T2DM patients with PE was similar in both sexes but higher than in non-diabetic patients. Among T2DM patients with PE, risk factors for IHM included older age, comorbidity, atrial fibrillation and massive PE. Obesity was associated with lower IHM. Suffering T2DM was a risk of IHM (OR 1.15; 95% CI 1.05-1.26) after PE. (4) Conclusions: The incidence of PE is higher in T2DM men and women than in non-diabetic patients. T2DM was a risk factor for IHM after PE., Unión Europea, Instituto de Salud Carlos III, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Objective: To analyse if platelet responsiveness to aspirin (ASA) may be associated with a different ability of platelets to generate nitric oxide (NO). Patients/methods: Platelets were obtained from 50 patients with stable coronary ischemia and were divided into ASA-sensitive (n = 26) and ASA-resistant (n = 24) using a platelet functionality test (PFA-100). Results: ASA-sensitive platelets tended to release more NO (determined as nitrite + nitrate) than ASA-resistant platelets but it did not reach statistical significance. Protein expression of nitric oxide synthase 3 (NOS3) was higher in ASA-sensitive than in ASA-resistant platelets but there were no differences in the platelet expression of nitric oxide synthase 2 (NOS2) isoform. The highest NOS3 expression in ASA-sensitive platelets was independent of the presence of T-to-C mutation at nucleotide position -786 (T(-786) → C) in the NOS3-coding gene. However, platelet content of phosphorylated NOS3 at Serine (Ser)(1177), an active form of NOS3, was higher in ASA-sensitive than in ASA-resistant platelets. The level of platelet NOS3 Ser(1177) phosphorylation was positively associated with the closure time in the PFA-100 test. In vitro, collagen failed to stimulate the aggregation of ASA-sensitive platelets, determined by lumiaggregometry, and it was associated with a significant increase (p = 0.018) of NOS3 phosphorylation at Ser(1177). On the contrary, collagen stimulated the aggregation of ASA-resistant platelets but did not significantly modify the platelet content of phosphorylated NOS3 Ser(1177). During collagen stimulation the release of NO from ASA-sensitive platelets was significantly enhanced but it was not modified in ASA-resistant platelets. Conclusions: Functional platelet responsiveness to ASA was associated with the platelet content of phosphorylated NOS3 at Ser(1177)., Instituto de Salud Carlos III, Unión Europea, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Background Serotonin reuptake inhibitors (SSRIs) may impair platelet function. Thrombin is a strong platelet agonist causing irreversible aggregation, release of granules' contents, cytoskeletal rearrangement and activation of signalling pathways. We investigated the effects of the SSRI escitalopram (SCIT) on thrombin-induced platelet response. Methods Isolated platelets were exposed to SCIT and activated with thrombin. We evaluated (1) platelet response by aggregometry and flow cytometry; (2) modifications in cytoskeleton proteins and signalling pathways by electrophoresis and Western blot; and (3) ultrastructural changes in platelets by electron microscopy. Results SCIT inhibited platelet response to thrombin, measured as platelet aggregation and expression of activation markers CD62-P and CD63 from platelet granules. Platelet aggregation decreased in a dose-dependent manner, reaching statistical significance with SCIT ≥32 µg/mL (65.4 ± 6.8% vs. 77.7 ± 2.5% for controls; p < 0.05). Expression of activation markers was statistically reduced with SCIT ≥20 µg/mL (p < 0.05). SCIT impaired the polymerization of the actin cytoskeleton and association of contractile proteins during activation with thrombin (p < 0.05 with SCIT ≥50 µg/mL). Resting platelets incubated with SCIT became most spherical, with increased platelet roundness (p < 0.01, SCIT 50 µg/mL vs. control). SCIT interfered with signalling pathways modulated by thrombin (RhoA, PKC, Erk1/2 and PI3K/AKT). Conclusions Our data indicate that SCIT inhibits thrombin-induced platelet response and interferes with cytoskeletal assembly and related signalling pathways, thus resulting in compromised release of granules' contents, reduced platelet activation and aggregation. These mechanisms may explain the antithrombotic benefits observed in patients treated with this SSRI, and could become new therapeutic targets for future antithrombotic strategies., Instituto de Salud Carlos III, Red de Investigación Cardiovascular, European Regional Development Fund, Ministerio de Economía y Competitividad, Technology Development Projects in Health, CIBERSAM, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

The purpose of this study was to compare the effect of dual antiplatelet therapy [clopidogrel + aspirin (ASA)] with respect to ASA on the protein expression of platelets from controlled type-2 diabetic patients with stable coronary ischemia. Patients had been taking ASA (100 mg day) and they were randomized to receive (n = 29) or not (n = 28) 75 mg day clopidogrel for 12 ± 2 weeks in a blind form. Protein expression was analyzed by two-dimensional electrophoresis and mass spectrometry. The protein expression of a limited number of proteins such as actin-binding protein isotypes 2 and 5, lactate dehydrogenase, serotransferrin isotype 4, protein disulfide isomerase-A3 isotype 1, fibrinogen beta chain isotype 5, Ras-related protein Rab-7b isotypes 1 and 6, and immunoglobulin heavy chain was changed after dual antiplatelet therapy. Plasma level of platelet factor 4 (PF4), an in vivo marker of platelet activity, was not different between both groups. These changes suggest lower platelet reactivity after dual antiplatelet therapy in the studied patients. However, the variation in platelet proteome was lower than it would be initially expected, taking into account the apparent clinical beneficial effects of dual antiplatelet therapy. PF4 plasma level was not further decreased in the platelets treated for a longer time than 9-12 months with ASA + clopidogrel, as compared with ASA alone., Fondo de Investigacion de la Seguridad Social, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Background Several mechanisms have been proposed to explain why some platelets have a reduced response to aspirin (ASA). Among them, it was reported an increased circulating level of vitamin-D-binding protein (DBP). In addition, nitric oxide (NO) released from mononuclear cells was involved in the antiplatelet effects of ASA. The aim was to analyse the relationship between platelet response to ASA and both NO generation and vitamin-D-binding protein content in mononuclear cells. Materials and methods Mononuclear cells were obtained from patients with stable coronary artery disease that were divided by a platelet functionality test (PFA-100) as ASA-sensitive (n = 23) and ASA resistant (n = 27). Results Both the release of NO (determined by nitrite + nitrate concentration) and the expression of endothelial-type NO synthase (eNOS) were higher in mononuclear cells from ASA sensitive as compared with those from ASA-resistant patients. There was a positive correlation between either the release of NO and the expression of eNOS protein in mononuclear cells with the ability of ASA to inhibit platelet activity. DBP content in mononuclear cells was higher in ASA resistant than in ASA sensitive. The level of DBP content in mononuclear cells was negatively associated with the ability of ASA to inhibit platelets. However, in vitro experiments suggested that there was no association between DBP and NO production by mononuclear cells. Conclusions Mononuclear cells from patients with platelets with lower responsiveness to ASA showed a reduced ability to produce NO., Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, FALSE, pub

Stroke patients have a high risk of vascular recurrence. Biomarkers related to vascular recurrence, however, remain to be identified. The aim of the study was to identify, through proteomic analysis, plasma biomarkers associated with vascular recurrence within one year after the first ischemic stroke. This is a substudy (n = 134) of a large prospective multicenter study of post-stroke patients with an ischemic stroke. Plasma samples were obtained at inclusion. Among the identified proteins, only plasma levels of desmoplakin I were associated with protection against a new vascular event (Odds ratio: 0.64; 95% CI: 0.46-0.89; p = 0.009) after adjustment for hypercholesterolemia, statins and previous atherothrombotic stroke subtype. A greater number of patients without vascular recurrence had been treated with statins within three months of the recent ischemic stroke. Only patients who had been taking statins for 3 months after the ischemic stroke and did not suffer vascular recurrence over a follow-up year, have higher levels of desmoplakin I at the time of inclusion (Odds ratio 0.49; 95% CI: 0.28-0.86; p = 0.013). Increased desmoplakin I levels, determined within 1-3 months of the first ischemic stroke, could be a biomarker for statin responsiveness against a new vascular event in post-ischemic stroke patients taking statins early (1-3 months) after the ischemic stroke., Brystol-Myers Squibb, Fondo de Investigaciones de la Seguridad Social, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Background: Genioplasty as an isolated surgical technique is a highly demanded procedure in the maxillofacial surgery area. Advances in facial reconstructive surgery have been associated with less morbidity and more predictable results. In this paper, “conventional” genioplasty and genioplasty by means of virtual surgical planning (VSP), CAD-CAM cutting guides, and patient custom-made plates are compared. Methods: A descriptive observational study was designed and implemented, and 43 patients were treated, differentiating two groups according to the technique: 18 patients were treated by conventional surgery, and 25 patients were treated through virtual surgical planning (VSP), CAD-CAM cutting guides, STL models, and titanium patient-specific plates. Results: The operation time ranged from 35 to 107 min. The mean operative time in the conventional group was 60.06 + 3.74 min.; in the custom treatment group it was 42.24 + 1.29 min (p < 0.001). The difference between planned and obtained chin changes in cases of advancement or retrusion was not statistically significant (p = 0.125; p = 0.216). In cases of chin rotation due to asymmetry, guided and personalized surgery was superior to conventional surgery (p < 0.01). The mean hospital stay was equal in both groups. A decrease in surgical complications was observed in the group undergoing VSP and customized treatment. Conclusions: Multi-stage implementation of VSP with CAD-CAM cutting guides, STL models, and patient-specific plates increased the accuracy of the genioplasty surgery, particularly in cases of chin asymmetry, reducing operation time and potential complications., Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub, Descuento UCM

Background: The American Joint Committee on Cancer (AJCC), in its 8th edition, introduces modifications to the previous TNM classification, incorporating tumour depth of invasion (DOI). The aim of this research is to analyse the prognosis (in terms of disease-free survival and overall survival) of clinical early stage (I and II) squamous cell carcinomas of the oral tongue according to the DOI levels established by the AJCC in its latest TNM classification to assess changes to the T category and global staging system and to evaluate the association between DOI and other histological risk factors. Methods: A retrospective longitudinal observational study of a series of cases was designed. All patients were treated with upfront surgery at our institution between 2010 and 2019. The variables of interest were defined and classified into four groups: demographic, clinical, histological and evolutive control. Univariate and multivariate analyses were carried out and survival functions were calculated using the Kaplan–Meier method. Statistical significance was established for p values below 0.05. Results: Sixty-one patients were included. The average follow-up time was 47.42 months. Fifteen patients presented a loco-regional relapse (24.59%) and five developed distant disease (8.19%). Twelve patients died (19.67%). Statistically significant differences were observed, with respect to disease-free survival (p = 0.043), but not with respect to overall survival (p = 0.139). A total of 49.1% of the sample upstaged their T category and 29.5% underwent modifications of their global stage. The analysis of the relationship between DOI with other histological variables showed a significant association with the presence of pathological cervical nodes (p = 0.012), perineural invasion (p = 0.004) and tumour differentiation grade (p = 0.034). Multivariate analysis showed association between depth of invasion and perineural invasion. Conclusions: Depth of invasion is a histological risk f, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub, Descuento UCM

This study is part of the research funded by: Sociedad Española de Neumología y Cirugía de Tórax (SEPAR), Research Aid 2022, Project number 1309; and Sociedad Madrileña de Neumología y Cirugía de Tórax (NEUMOMADRID), XXII Awards Edition, 2022, and by: Convenio V-PRICIT de la Comunidad de Madrid y la Universidad Complutense de Madrid (“Programa de Excelencia para el Profesorado Universitario” INV.AY.20.2021.1E126), and by: Universidad Complutense de Madrid. Grupo de Investigación en Epidemiología de las Enfermedades Crónicas de Alta Prevalencia en España (970970)., (1) Background: To examine the clinical characteristics and hospital outcomes of hospitalization for lung transplantation in COPD patients in Spain from 2016 to 2020; and to assess if the COVID-19 pandemic has affected the number or the outcomes of lung transplantations in these patients. (2) Methods: We used the Spanish National Hospital Discharge Database to select subjects who had a code for COPD (ICD-10: J44) and had undergone a lung transplantation (ICD-10 codes OBYxxxx). (3) Results: During the study period, 704 lung transplants were performed among COPD patients (single 31.68%, bilateral 68.32%). The absolute number of transplants increased with raising rates of 8%, 14% and 19% annually from 2016 to 2019. However, a marked decrease of −18% was observed from 2019 to year 2020. Overall, 47.44% of the patients suffered at least one complication, being the most frequent lung transplant rejection (24.15%), followed by lung transplant infection (13.35%). The median length of hospital stay (LOHS) was 33 days and the in-hospital-mortality (IHM) was 9.94%. Variables associated with increased risk of mortality were a Comorbidity Charlson Index ≥ 1 (OR 1.82; 95%CI 1.08–3.05) and suffering any complication of the lung transplantation (OR 2.14; 95%CI 1.27–3.6). COPD patients in 2020 had a CCI ≥ 1 in a lower proportion than 2019 patients (29.37 vs. 38.51%; p = 0.015) and less frequently suffered any complications after the lung transplantation (41.26 vs. 54.6%; p = 0.013), no changes in the LOHS or the IHM were detected from 2019 to 2020. (4) Conclusions: Our study showed a constant increase in the number of lung transplantations from 2016 to 2019 in COPD patients, with a drop from 2019 to 2020, probably related to the COVID-19 pandemic. However, no changes in LOHS or IHM were detected over time., Sociedad Española de Neumología y Cirugía de Tórax (SEPAR), Sociedad Madrileña de Neumología y Cirugía de Tórax (NEUMOMADRID), Convenio V-PRICIT, Universidad Complutense de Madrid, Universidad Complutense de Madrid. Grupo de Investigación en Epidemiología de las Enfermedades Crónicas de Alta Prevalencia en España (970970), Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

(1) Background: This paper aims to assess temporal trends (2016–2020) in incidence, patient’s characteristics, complications, length of hospital stay (LOHS) and in-hospital mortality (IHM) among patients with and without idiopathic pulmonary fibrosis (IPF) undergoing lung transplantation (LTx). We also analyse the effect of the COVID-19 pandemic on LTx in these populations. (2) Methods: A retrospective, population-based observational study was conducted using the Spanish National Hospital Discharge Database. Multivariable adjustment was conducted with logistic regression to analyse the IHM. (3) Results: We identified 1777 admissions for LTx during the study period, of which 573 (32.2%) were performed in patients with IPF. The number of hospital admissions for LTx rose from 2016 to 2020, both in patients with and without IPF, but a marked reduction was observed from year 2019 to year 2020. Over time, the proportion of single LTx decreased and bilateral LTx increased significantly in both groups. The incidence of LTx complications increased significantly over time along with the increase in the incidence of IPF. No significant differences in the incidence of complications or in the IHM between patients with and without IPF were found. Suffering any complication of the LTx and pulmonary hypertension were conditions positively associated with IHM in patients with and without IPF. The IHM remained stable from 2016 to 2020 in both study populations and was not affected by the COVID pandemic. (4) Conclusions: Patients with IPF account for almost a third of all lung transplants. The number of LTx increased over time in patients with and without IPF, but a marked reduction was observed from 2019 to 2020. Although the proportion of LTx complications increased significantly over time in both groups, the IHM did not change. IPF was not associated with increased complications or IHM after LTx., Comunidad de Madrid, Universidad Complutense de Madrid, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub, Descuento UCM

We aimed to assess the effect of the COVID-19 pandemic in Spain on people with diabetes undergoing cardiac procedures, such as coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), open surgical valve replacement (OSVR), and transcatheter valve implantation (TCVI). We compared the year 2019 with the year 2020. We conducted an observational study using data from the Spanish National Hospital Discharge Database from 1 January 2019 to 31 December 2020. In 2020, a total of 21,067 cardiac procedures were performed on people with diabetes compared with 24,675 in the previous year. The use of CABG, PCI, OSVR and TCVI decreased from 2019 to 2020 by 13.9%, 14.8%, 21.4% and 2.9%, respectively. In 2020, patients had a significantly higher mean Charlson Comorbidity Index than in 2019 for all the cardiac procedures analyzed. In-hospital mortality (IHM) was higher (p > 0.05) for all the procedures in the year 2020. Over the entire period, female sex was a significant risk factor for IHM among those who underwent CABG, PCI and OSVR (OR 1.94, 95%CI 1.41–2.66; OR 1.19, 95%CI 1.05–1.35; and OR 1.79, 95%CI 1.38–2.32, respectively). The sensitivity analysis including two more years, 2017 and 2018, confirmed that female patients and comorbidity were risk factors for IHM in patients with diabetes regardless of whether it was during the pandemic era or before. We conclude that the frequency of cardiac procedures among people with diabetes declined in 2020. IHM did not change significantly in the COVID-19 era., Unión Europea, Instituto de Salud Carlos III, Comunidad de Madrid, Universidad Complutense de Madrid, Universidad Complutense de Madrid. Grupo de Investigación en Epidemiología de las Enfermedades Crónicas de Alta Prevalencia en España (970970), Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Lymph node density (LND)—the proportion of positive nodes among the total number of resected nodes—has emerged as a reliable prognostic factor in solid tumors. This study aims to assess the importance of LND in lingual squamous cell carcinoma (LSCC) and its prognostic involvement. A retrospective longitudinal study with 62 patients was performed. All patients were diagnosed with LSCC and submitted for tumor resection and neck dissection. Patients were stratified into low (<0.04) and high risk (≥0.04) based on LND. We analyzed the impact of LND on overall survival (OS) and disease-free survival (DFS), as well as the relationship between LND and the pathological staging, the involvement of positive margins, depth of invasion (DOI) and perineural infiltration. This study provides a substantial relationship between lymph node density (LND), overall survival (OS) and disease-free survival (DFS) in lingual squamous cell carcinoma (LSCC). A statistically significant distribution was found between LND, perineural infiltration and pathological staging, whereas no association was found with the rest of the prognostic variables analyzed., Depto. de Cirugía, Fac. de Medicina, TRUE, pub, Descuento UCM

El aneurisma de aorta abdominal (AAA) es la decimoquinta causa de muerte en Occidente. Pese a ello, no existe en la actualidad ningún tratamiento médico eficaz capaz de evitar su aparición o frenar su crecimiento. Para el desarrollo de nuevas dianas terapéuticas se precisa de un conocimiento detallado de la patogenia de la enfermedad. En esta patogenia del AAA están implicados la degradación proteolítica de la matriz extracelular, la apoptosis de las células de músculo liso, la inflamación y el estrés oxidativo. No obstante, no se conocen aún los mecanismos celulares y moleculares específicos que están implicados en la formación, progresión y rotura del AAA. Las mitocondrias son organelas esenciales en el metabolismo energético celular y una importante fuente de estrés oxidativo. Estudios recientes han sugerido la implicación de la función mitocondrial en enfermedades cardiovasculares, incluyendo el AAA El factor X activado (FXa) presenta efectos pro-inflamatorios y proteolíticos en la pared vascular que son independientes de la activación de la protrombina. Además, el FXa es capaz de modificar la expresión de proteínas relacionadas con el estrés oxidativo y el metabolismo energético. Esta actividad podría estar mediada, al menos en parte, por alteraciones del metabolismo mitocondrial.., Abdominal aortic aneurysm (AAA) is a the fifteenth most common cause of death in western countries. However, no effective pharmacological treatment is currently available to prevent AAA development or progression. A deep understanding of the pathogenesis of the disease is needed in order to developnew therapeutic targets. This pathogenesis of the AAA involves proteolytic degradation of extracellular matrix, vascular smooth muscle cells apoptosis, infiltration of chronic inflammatory cells and oxidative stress. Nevertheless, the specific cellular and molecular mechanisms involved in the formation, progression, and rupture of AAA are not fully understood yet. Mitochondria have a critical role in cellular energy metabolism and they are an important source of oxidative stress. Mitochondrial function has recently been associated to cardiovascular disease, including AAA, in different studies. Factor Xa (FXa) has pro-inflammatory and proteolytic effects on the vascular wall which are independent from prothrombin activation. Moreover, FXa can modify the expression of proteins involved in oxidative stress and energy metabolism. This activity could be mediated, at least partially, by mitochondrial dysfunction...

Introducción: La comunidad universitaria de la Universidad Complutense de Madrid (UCM) es diversa, existiendo una gran variedad de formas de alimentarse influenciadas por distintos contextos (culturales, religiosos, sanitarios, etc.), dando lugar en algunas ocasiones, a la aparición de restricciones alimentarias por estos motivos (de origen religioso, ético/moral, por salud…). Estas restricciones pueden afectar al bienestar emocional, la salud o incluso derivar en situaciones de discriminación para las personas que las siguen, sobre todo en lugares en los que no existan recursos suficientes para llevarlas a cabo o donde estas sean menos conocidas. El objetivo principal del proyecto fue estudiar la diversidad cultural existente dentro de la UCM, identificar las principales restricciones alimentarias que existen entre los integrantes de la comunidad universitaria (estudiantes y personal docente e investigador) así como divulgar y concienciar sobre esta materia. Metodología: Se diseñó una encuesta con 44 preguntas dirigida a la comunidad universitaria con el objetivo de realizar un estudio observacional transversal. Se creó una escala tipo Likert para medir la discriminación autopercibida en relación con las restricciones alimentarias, utilizando el análisis factorial de componentes principales y la prueba de la alfa de Cronbach con el programa estadístico SPSS v22.0 para medir la validez y fiabilidad de la escala diseñada en una muestra de participantes inicial (n = 324). Más tarde, con la muestra final del proyecto (n = 1691) se analizaron las preguntas de la encuesta con los programas JASP v0.18.1 y SPSS v22.0, obteniendo las prevalencias de las restricciones alimentarias acompañadas de los intervalos de confianza al 95%. Se calcularon las medias ± desviación estándar y las medianas junto los rangos intercuartílicos de las variables cuantitativas. Se compararon las puntuaciones de la escala de discriminación autopercibida entre las diferentes restricciones alimentar

The aim of this study is to evaluate the functional outcomes and quality of life (QoL) in oncologic patients with intraoral defects reconstructed with the buccinator myomucosal flap. A retrospective study was performed involving 39 patients with intraoral soft-tissue defects, reconstructed with a buccinator myomucosal flap during a six-year period. Patients completed the European Organization for Research and Treatment of Cancer questionnaires, the standard questionnaire (QLQ-C30) and the head-and-neck specific module (QLQ-H&N35). Thirty-nine patients with a mean age of 61.23 ± 15.80 years were included in the study. Thirty-three patients were diagnosed with an oncological condition (84.61%). Six patients (15.38%) developed orosinusal communication and underwent extensive debridement. The median global-health-status score was 79.27 and emotional performance was the lowest scoring, with a mean score of 76.93. As for the symptom items, the most outstanding were dental problems (33.33), oral opening (31.62) and dry mouth (37.61), followed by sticky saliva (24.79), problems with social eating (21.15) and pain (19.87). The most significant symptoms were radiotherapy-related adverse effects such as pain, fatigue, dental problems and dry mouth. Patients reconstructed with the buccinator myomucosal flap develop a good quality of life for all types of activities, and a correct function and aesthetics. Postoperative radiotherapy is associated with a poorer quality of life, and can lead to impairment of several symptoms such as swallowing, oral opening and dry mouth., Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

(1) Background: We aimed to analyze temporal trends in hospitalization and in-hospital mortality (IHM) in patients with sarcoidosis in Spain from 2001–2020. (2) Methods: Using the Spanish National Hospital Discharge Database, we included patients (aged ≥ 20 years) hospitalized with a sarcoidosis code in any diagnostic field. (3) Results: We included 44,195 hospitalizations with sarcoidosis (56.34% women). The proportion of women decreased over time, from 58.76% in 2001 and 2002 to 52.85% in 2019 and 2020 (p < 0.001). The crude rates per 100,000 inhabitants increased by 4.02% per year among women and 5.88% among men. These increments were confirmed using Poisson regression analysis, which yielded an IRR of 1.03; 95% CI 1.01–1.04 for women and 1.04; 95% CI 1.02–1.06 for men. During the study period, no significant sex differences in IHM were recorded. Older age, COVID-19, respiratory failure, and the need for mechanical ventilation were independent predictors of IHM in men and women hospitalized with sarcoidosis, with IHM remaining stable over time. (4) Conclusions: The number of hospital admissions among patients with sarcoidosis in Spain increased threefold from 2001 to 2020. Although the incidence rates were higher in women, the trend followed that the incidence rates between sexes became closer. IHM was similar among men and women, with no significant change over time in either sex after multivariable analysis., Comunidad de Madrid, Universidad Complutense de Madrid, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

(1) Background: Recent reports suggest a decrease in the prevalence of depression among people with diabetes and important sex-differences in the association between these conditions, however data from Spain is sparse. We aim to assess trends in the prevalence of depression and in-hospital outcomes among patients with type 2 diabetes (T2DM) hospitalized (2011–2020) identifying sex-differences. (2) Methods: Using the Spanish national hospital discharge database we analysed the prevalence of depression globally, by sex, and according to the conditions included in the Charlson comorbidity index (CCI). We tested factors associated with the presence of depression and with in-hospital mortality (IHM). Time trends in the prevalence of depression and variables independently associated with IHM were analyzed using multivariable logistic regression. (3) Results: From 2011 to 2020, we identified 5,971,917 hospitalizations of patients with T2DM (5.7% involved depression). The prevalence of depression decreased significantly between 2011 and 2020. The adjusted prevalence of depression was 3.32-fold higher in women than in men (OR 3.32; 95%CI 3.3–3.35). The highest prevalence of depression among men and women with T2DM was found among those who also had a diagnosis of obesity, liver disease, and COPD. Older age, higher CCI, pneumonia, and having been hospitalized in 2020 increased the risk of IHM in patients with T2DM and depression. Obesity was a protective factor for IHM in both sexes, with no differences detected for IHM between men and women. Among patients hospitalized with T2DM, concomitant depression was associated with lower IHM than among patients without depression (depression paradox). (4) Conclusions: The prevalence of depression decreased over time in both sexes. The prevalence of depression was over three-fold higher in women. Female sex and depression were not associated with higher IHM. Based on our results we recommend that clinicians screen regularly for depress, Unión Europea, Comunidad de Madrid, Instituto de Salud Carlos III, Universidad Complutense de Madrid, Universidad Complutense de Madrid. Grupo de Investigación en Epidemiología de las Enfermedades Crónicas de Alta Prevalencia en España (970970), Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

El aneurisma de aorta abdominal (AAA) es la decimoquinta causa de muerte en Occidente. Pese a ello, no existe en la actualidad ningún tratamiento médico eficaz capaz de evitar su aparición o frenar su crecimiento. Para el desarrollo de nuevas dianas terapéuticas se precisa de un conocimiento detallado de la patogenia de la enfermedad. En esta patogenia del AAA están implicados la degradación proteolítica de la matriz extracelular, la apoptosis de las células de músculo liso, la inflamación y el estrés oxidativo. No obstante, no se conocen aún los mecanismos celulares y moleculares específicos que están implicados en la formación, progresión y rotura del AAA. Las mitocondrias son organelas esenciales en el metabolismo energético celular y una importante fuente de estrés oxidativo. Estudios recientes han sugerido la implicación de la función mitocondrial en enfermedades cardiovasculares, incluyendo el AAA El factor X activado (FXa) presenta efectos pro-inflamatorios y proteolíticos en la pared vascular que son independientes de la activación de la protrombina. Además, el FXa es capaz de modificar la expresión de proteínas relacionadas con el estrés oxidativo y el metabolismo energético. Esta actividad podría estar mediada, al menos en parte, por alteraciones del metabolismo mitocondrial..

La obesidad es una de las enfermedades más prevalentes en países industrialmente desarrollados, considerándose una de las cuatro pandemias del tercer milenio. El sobrepeso/obesidad es causa y consecuencia de otras patologías derivadas como las enfermedades cardiovasculares y metabólicas, diabetes, cáncer, etc. Por ello, la prevención y la predicción de la obesidad se ha convertido en uno de los principales objetivos de la comunidad médico‐científica en las últimas décadas. En la actualidad se conoce el papel crucial que juega el aspecto genético en la obesidad. Sin embargo, el control genético de las formas comunes de obesidad en el humano no se comprende bien. La genética, y en concreto la nutrigenética, nos permite valorar el efecto de diferentes variantes genéticas sobre aspectos íntimamente ligados con el riesgo de obesidad como el control del ciclo saciedad‐hambre, metabolización de hidratos de carbono, grasas, etc. y, por tanto, establecer estrategias para prevenir y disminuir el exceso de peso corporal. El imparable desarrollo de las nuevas tecnologías de análisis de datos por inteligencia artificial, como los árboles de decisión basados en el aprendizaje automático, aportan nuevas herramientas para la predicción de enfermedades. En este sentido, los árboles de decisión, a través del análisis de forma conjunta de las variables no modificables como edad, género y variantes genéticos, podrían estratificar y predecir el riesgo de sobrepeso/obesidad, con el objetivo de diseñar recomendaciones para la prevención de sobrepeso y obesidad..., Obesity is one of the most prevalent diseases in developed countries, being considered one of the four main pandemics of the third millennium. Overweight/obesity is both cause and consequence of other subsequent conditions such as cardiovascular and metabolic diseases, diabetes, cancer amongst others. Therefore, predicting and preventing obesity is one of the main goals for the scientific community in recent decades. Nowadays the crucial role that genetics play in obesity is well known. However, how genetics control and influence common obesity is not fully understood. Genetics, and more specific nutrigenetics, enables us to assess the effect of different genetic variants on aspects that are directly linked with obesity such as satiety‐hunger cycle control, fat, metabolism of carbohydrates, etc. And therefore, set different strategies to prevent and reduce excess body weight. The unstoppable development of new technologies for data analysis by artificial intelligence, such as decision trees based on automatic learning, provide new tools for the prediction of diseases. In this sense, decision trees, through joint analysis of non‐modifiable variables such as age, gender and genetic variants, could stratify and predict the risk of overweight/obesity, with the aim of designing recommendations for the prevention of overweight and obesity...

(1) Background: To analyze incidence, clinical characteristics, procedures, and in-hospital outcomes among patients hospitalized with community-acquired pneumonia (CAP) according to the presence of T2DM in Spain (2016–2019) and to assess the role of gender among those with T2DM. (2) Methods: Using the Spanish National Hospital Discharge Database, we estimated hospitalized CAP incidence. Propensity score matching was used to compare population subgroups. (3) Results: CAP was coded in 520,723 patients, of whom 140,410 (26.96%) had T2DM. The hospitalized CAP incidence was higher in patients with T2DM (both sexes) (IRR 4.25; 95% CI 4.23–4.28). The hospitalized CAP incidence was higher in men with T2DM than in women with T2DM (IRR 1.46; 95% CI 1.45–1.47). The hospitalized CAP incidence among T2DM patients increased over time; however, the in-hospital mortality (IHM) decreased between 2016 and 2019. IHM was higher among non-T2DM men and women than matched T2DM men and women (14.23% and 14.22% vs. 12.13% and 12.91%; all p < 0.001, respectively), After adjusting for confounders, men with T2DM had a 6% higher mortality risk than women (OR 1.06; 95% CI 1.02–1.1). (4) Conclusions: T2DM is associated with a higher hospitalized CAP incidence and is increasing overtime. Patients hospitalized with CAP and T2DM have lower IHM. Male sex is a significant risk factor for mortality after CAP among T2DM patients., Instituto de Salud Carlos III (ISCIII) / FEDER, Depto. de Enfermería, Depto. de Medicina, Depto. de Salud Pública y Materno - Infantil, Fac. de Enfermería, Fisioterapia y Podología, Fac. de Medicina, TRUE, pub

Microsurgical scalp reconstruction is indicated in patients with large scalp defects. The aim of this study was to compare the outcomes of scalp reconstruction in oncologic patients reconstructed with latissimus dorsi (LD), anterolateral thigh (ALT), and omental (OM) free flaps. Thirty oncologic patients underwent scalp reconstruction with LD (10), ALT (11), and OM (9) flaps. The length of the vascular pedicle, the operation time, the possibility of a two-team approach, the length of hospital stays, the complications, and the aesthetic results were evaluated. The OM flap was the flap with the shortest vascular pedicle length with a mean of 6.26 ± 0.16 cm, compared to the LD flap, which was 12.34 ± 0.55 cm and the ALT flap with 13.20 ± 0.26 cm (p < 0.05). The average time of surgery was 6.6 ± 0.14 h in patients reconstructed with OM, compared to the LD flap, which was 8.91 ± 0.32 h and the ALT flap with 7.53 ± 0.22 h (p < 0.05). A two-team approach was performed in all patients for OM flaps and ALT flaps, but only in two patients reconstructed with the LD flap (p < 0.001). In patients reconstructed with the OM flap, a very satisfactory or satisfactory result was reported in seven patients (77.8%). Eight patients reported a very unsatisfactory or unsatisfactory result with LD flap (80%) and 10 patients with ALT flap (90.9%) (p = 0.002). The mean hospital stay after surgery was not statistically significant (p > 0.05). As for complications, two patients reconstructed with OM flap, five LT flaps, and two ALT flaps developed complications, not statistically significant (p = 0.235). Omental flap, latissimus dorsi flap, and anterolateral thigh flap fulfill most of the characteristics for complex scalp reconstruction. The decision on which flap to use should be based on clinical aspects of the patients taking into account that the three flaps show similar rates of complications and length of hospital stay. Regarding the aesthetic outcome, OM flap or LD flap should be consid, Depto. de Medicina, Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

Medication-related osteonecrosis of the jaw (MRONJ) has been associated with the use of different drugs administered in the treatment of malignant neoplasms or metastases and in antiresorptive therapies. Since 2010, denosumab, a monoclonal antibody whose mechanism of action is to prevent the activation of the RANK receptor on the surface of osteoclasts, has been associated with osteonecrosis of the jaw. Primary intraosseous squamous cell carcinoma (PIOSCC) is a rare neoplasm characterised by the presence of squamous cells within the maxillary or mandibular bone without an initial clinical association with the oral mucosa. We present a case of a PIOSCC in an osteonecrosis of the jaw related to a patient who received antiresorptive treatment with denosumab outlining the clinical and histopathological features of MRONJ and PIOSCC., Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

La obesidad es una de las enfermedades más prevalentes en países industrialmente desarrollados, considerándose una de las cuatro pandemias del tercer milenio. El sobrepeso/obesidad es causa y consecuencia de otras patologías derivadas como las enfermedades cardiovasculares y metabólicas, diabetes, cáncer, etc. Por ello, la prevención y la predicción de la obesidad se ha convertido en uno de los principales objetivos de la comunidad médico‐científica en las últimas décadas. En la actualidad se conoce el papel crucial que juega el aspecto genético en la obesidad. Sin embargo, el control genético de las formas comunes de obesidad en el humano no se comprende bien. La genética, y en concreto la nutrigenética, nos permite valorar el efecto de diferentes variantes genéticas sobre aspectos íntimamente ligados con el riesgo de obesidad como el control del ciclo saciedad‐hambre, metabolización de hidratos de carbono, grasas, etc. y, por tanto, establecer estrategias para prevenir y disminuir el exceso de peso corporal. El imparable desarrollo de las nuevas tecnologías de análisis de datos por inteligencia artificial, como los árboles de decisión basados en el aprendizaje automático, aportan nuevas herramientas para la predicción de enfermedades. En este sentido, los árboles de decisión, a través del análisis de forma conjunta de las variables no modificables como edad, género y variantes genéticos, podrían estratificar y predecir el riesgo de sobrepeso/obesidad, con el objetivo de diseñar recomendaciones para la prevención de sobrepeso y obesidad...

El tratamiento crónico con dosis bajas de ácido acetilsalicílico (se utilizará en todo el texto indistintamente el término Aspirina o su abreviación ASA), entre 100-300 mg/día, es primera elección en la prevención de eventos vasculares trombóticos agudos. Sin embargo en, un número importante de pacientes tratados diariamente con ASA, sus plaquetas no son completamente inhibidas. Este efecto se conoce como síndrome de resistencia plaquetaria a la ASA. El síndrome plaquetario de resistencia a la ASA se calcula que ocurre en el 20% de la población general tratada con ASA y hasta en un 40% de población de pacientes diabéticos. Se ha especulado diferentes mecanismos implicados en el síndrome de resistencia plaquetaria a ASA entre los que se incluye la no adherencia al tratamiento, la administración previa de AINES, la existencia de una isoforma diferente de ciclooxigenasa, la ciclooxigenasa-2, en las plaquetas, la falta de capacidad de las plaquetas resistentes a ASA y/o de los leucocitos de los pacientes con plaquetas resistentes a ASA de generar óxido nítrico etc...

La obesidad es una de las enfermedades más prevalentes en la sociedad considerada incluso como una de las cuatro pandemias del tercer milenio, por lo que el abordaje de ésta, su predicción y tratamiento son objeto de intenso estudio en estos últimos años. El sobrepeso/obesidad, además, es causa y consecuencia de otras patologías derivadas como las enfermedades cardiovasculares, las enfermedades respiratorias, la diabetes, el cáncer, el síndrome metabólico, las enfermedades neurodegenerativas o las enfermedades músculo-esqueléticas, etc...

Breve descripción La adaptación de los planes de estudio a la normativa y a los criterios propuestos por el Espacio Europeo de Educación Superior (EEES) ha conllevado un importante reto de innovación pedagógica, y cambios significativos en el proceso enseñanza-aprendizaje. El sistema universitario español acumula ya una trayectoria y un bagaje importante de experiencias, buenas prácticas e innovaciones que se han ido encaminando hacia la continua mejora de la calidad de la formación ofertada. El proceso de cambio en el que está inmersa hoy en día la Educación Superior demanda nuevos sistemas y procedimientos de enseñanza y evaluación. Dos de los cambios derivados de la implantación del EEES son la elaboración de los plantes de estudio por competencias generales, transversales y específicas, y el diseño de herramientas e iniciativas de mejora de la calidad de los programas formativos, entre otros aspectos. En el contexto anterior, en el presente proyecto se han aplicado una serie de herramientas tecnológicas con el objetivo de mejorar la actividad docente que pretenden implantarse de forma transversal entre asignaturas del grado de Nutrición y Dietética Humana de la Facultad de Medicina de la Universidad Complutense. Además, esta novedosa iniciativa podría utilizarse en cualquier asignatura de cualquier grado de cualquier Facultad de la Universidad Complutense o incluso de otras Universidades. En concreto, el proyecto identifica al comienzo del curso académico a aquellos/as alumnos/as que tendrán dificultades para superar diferentes asignaturas del grado de Nutrición y Dietética Humana, para que el profesorado tome diferentes medidas docentes preventivas desde el mismo comienzo del curso académico. La identificación de estos alumnos al comienzo del curso académico se realizó mediante técnicas de inteligencia artificial para generar un algoritmo de predicción autoalimentado, considerando fundamentalmente una serie de parámetros académicos de los alumnos/as. El proyect

La obesidad es una de las enfermedades más prevalentes en la sociedad considerada incluso como una de las cuatro pandemias del tercer milenio, por lo que el abordaje de ésta, su predicción y tratamiento son objeto de intenso estudio en estos últimos años. El sobrepeso/obesidad, además, es causa y consecuencia de otras patologías derivadas como las enfermedades cardiovasculares, las enfermedades respiratorias, la diabetes, el cáncer, el síndrome metabólico, las enfermedades neurodegenerativas o las enfermedades músculo-esqueléticas, etc..., Obesity is one of the most prevalent diseases in society, even considered one of the four pandemics of the third millennium, so its approach, its prediction and treatment have been the subject of intense study in recent years. Overweight / obesity is also the cause and consequence of other derived pathologies such as cardiovascular diseases, respiratory diseases, diabetes, cancer, metabolic syndrome, neurodegenerative diseases or musculoskeletal diseases, etc...

El tratamiento crónico con dosis bajas de ácido acetilsalicílico (se utilizará en todo el texto indistintamente el término Aspirina o su abreviación ASA), entre 100-300 mg/día, es primera elección en la prevención de eventos vasculares trombóticos agudos. Sin embargo en, un número importante de pacientes tratados diariamente con ASA, sus plaquetas no son completamente inhibidas. Este efecto se conoce como síndrome de resistencia plaquetaria a la ASA. El síndrome plaquetario de resistencia a la ASA se calcula que ocurre en el 20% de la población general tratada con ASA y hasta en un 40% de población de pacientes diabéticos. Se ha especulado diferentes mecanismos implicados en el síndrome de resistencia plaquetaria a ASA entre los que se incluye la no adherencia al tratamiento, la administración previa de AINES, la existencia de una isoforma diferente de ciclooxigenasa, la ciclooxigenasa-2, en las plaquetas, la falta de capacidad de las plaquetas resistentes a ASA y/o de los leucocitos de los pacientes con plaquetas resistentes a ASA de generar óxido nítrico etc..., Chronic treatment with low doses of acetylsalicylic acid (the term Aspirin or its abbreviation ASA will be used interchangeably throughout the text). Between 100-300 mg/day ASA doses, is used in the prevention of acute thrombotic vascular events. However, in a significant number of patients treated daily with ASA, their platelets are not completely inhibited. This effect is known as platelet resistance syndrome to ASA. Platelet ASA resistance syndrome is estimated to occur in 20% of the general population treated with ASA and up to 40% of the diabetic patient population. Different mechanisms involved in platelet resistance syndrome to ASA have been speculated, including non-adherence to treatment, prior administration of NSAIDs, the existence of a different isoform of cyclooxygenase, cyclooxygenase-2, in platelets, lack of ability of ASA-resistant platelets and / or leukocytes of patients with ASA-resistant platelets to generate nitric oxide etc...

El ácido acetilsalicílico (AAS) ha demostrado ser eficaz en la prevención de efectostrombóticos cardiovasculares. A pesar del conocimiento de la reducción de riesgo de trombosis en prevención secundaria en pacientes sometidos a tratamiento con AAS, algunos pacientes no obtienen todos los beneficios de sus efectos antiagregantes. Este concepto se conoce como resistencia a la aspirina. Su mecanismo continúa siendo desconocido y probablemente sea multifactorial. Material y métodos Se analizó si la presencia de AAS en los megacariocitos puede, en las plaquetas formadas de novo, afectar a su capacidad para producir óxido nítrico (ON) y tromboxano A2 (TXA2),al sistema de generación del anión superóxido (SO) y/o al nivel de expresión de proteínas proapoptóticas. Las células Meg-01, pertenecientes a una línea celular megacarioblástica humana, fueron estimuladas para formar plaquetas (partículas platelet-like (PPL)) con 10nmol/l de forbol 12-miristato-13-acetato en presencia y en ausencia de AAS (0,33 mmol/l)..., Acetylsalicylic acid (ASA) has shown benefits on prevention of cardiovascular thrombotic events. In spite of the knowledge of the reduction of thrombotic risk in secondary prevention in patients undergoing ASA treatment, some patients may not obtain the full benefits of its antiplatelet effects. This concept is known as aspirin resistance. Its mechanism remains uncertain and is also probably multifactorial. Material and methodsIt was analyzed if the presence of ASA in megakaryocytes may in the newly formed platelets affect their ability to produce nitric oxide (NO) and thromboxane A2 (TXA2), the superoxide anion (SO) generation system and/or the expression level of proapoptotic-related proteins. Meg-01 cells, a human megakaryoblastic cell line, were stimulated to form platelets (platelet-like particles (PLPs)) with 10 nmol/l of phorbol 12-myristate-13-acetate in the presence and in the absence of ASA (0,33 mmol/l)...