Different Perspectives of Spanish Patients and Professionals on How a Dialysis Unit Should Be Designed.

Aim: The opinion of hemodialysis patients, professionals and family members is rarely considered in the design of a hemodialysis unit. Purpose: To know and compare the opinion and preferences of patients, family members and professionals regarding the design of a dialysis unit and the potential activities they believe should be carried out during the session in order to provide architects with real information for the construction of a dialysis center. Patients and Methods: Anonymous and voluntary survey in electronic format addressed to patients, relatives and professionals belonging to the 18 hemodialysis centers of the renal foundation and to ALCER and its different delegations, in relation to leisure activities to be carried out in the dialysis center and preferred design of the treatment room. The results obtained between the patient-family group and the professionals were compared. Results: We received 331 responses, of which 215 were from patients and family members (65%) and 116 (35%) from professionals. The most represented category among professionals was nursing (53%), followed by assistants (24%) and physicians (12.9%). A higher proportion of patients (66%) preferred rooms in groups of 10-12 patients as opposed to professionals who preferred open-plan rooms (p<0.001). The options that showed the most differences between patients and professionals were chatting with colleagues and intimacy (options most voted by patients/families), versus performing group activities and visibility (professionals). Conclusion: The professionals' view of patients' needs does not always coincide with the patients' perception. The inclusion of the perspective of people with kidney disease continues to be a pending issue in which we must improve both patient organizations and professionals, and the opinion of professionals and patients must be included in the design of a dialysis unit and the activities to be developed in it.

Chronic Kidney Disease-Associated Pruritus and Quality of Life: Learning from Our Patients.

Chronic kidney disease-associated pruritus is itching directly related to kidney disease that cannot be explained by any other condition. Despite technological advances in the different aspects of dialysis sessions and the best treatment for chronic kidney disease patients, it is still a common problem in our patients. The many complex physiological mechanisms involved, the different hypotheses made over the years on the aetiology of the condition, and the great clinical variability may partially explain the limited knowledge about this problem and the difficulties in treating it. The presence of all these factors leads to the persistence of unpleasant symptoms, which must affect the disease burden and quality of life of kidney patients. Through the presentation of an illustrative clinical case, the aim of this review article is to highlight the need for adequate diagnosis and an improved approach to all aspects of chronic kidney disease-associated pruritus, in view of the heavy burden of the disease and the huge impact on the patient's quality of life.

Perception of Spanish nephrologists on an old unsolved problem: Pruritus associated with chronic kidney disease (CKD-aP).

INTRODUCTION: Pruritus associated with chronic kidney disease is defined as the sensation of itching, in people with chronic kidney disease, in a one area or all over the body that causes the need to scratch, after having ruled out other dermatological or systemic causes. It is an old and known problem whose prevalence has been able to decrease with the improvement of dialytic techniques but which still persists and is underdiagnosed. OBJECTIVES: The objective of this study was to analyse the current perception of nephrologists about this problem that influences the quality of life of people with chronic kidney disease through a survey. RESULTS: 135 nephrologists, most of them engaged in haemodialysis, participated. 86% considered that pruritus associated with chronic kidney disease is still a problem today that affects the quality of life. Most nephrologists believe that the main pathophysiological cause is uremic toxins (60%) and only 16% believe that it is due to the dysregulation of the opioid system/endorphins-dynorphins. Only 16% comment that the prevalence of pruritus in their centre is greater than 20%. 40% believe that the diagnosis is made because it is manifested by the patient and only 27% because it is asked by the doctor. Moreover, it is not usual to use scales to measure it or the codification in the medical records. The main treatment used is antihistamines (96%), followed by moisturizers/anaesthetics (93%) and modification of the dialysis regimen (70%). CONCLUSIONS: Pruritus associated with chronic kidney disease is still a current problem, it is underdiagnosed, not codified and with a lack of indicated, effective and safe treatments. Nephrologists do not know its real prevalence and the different pathophysiological mechanisms involved in its development. Many therapeutic options are used with very variable results, ignoring their efficacy and applicability at the present time. The new emerging kappa-opioid-receptor agonist agents offer us an opportunity to reevaluate this age-old problem and improve the quality of life for our patients with chronic kidney disease.

A cost-effectiveness analysis of the introduction of a specialised consultation with duplex ultrasound assessment prior to vascular access surgery for haemodialysis.

INTRODUCTION: Duplex ultrasound (DUS) is increasingly used before vascular access (VA) surgery for haemodialysis. However, the cost-effectiveness of this approach is unknown. Our objective was to assess whether the introduction of a specialised consultation with DUS assessment modifies the cost and the time delay to achieve a first VA valid for haemodialysis. PATIENTS AND METHODS: Prospective cohort of patients undergoing a first VA (June 2014-July 2017) after a specialised consultation with DUS (ECO group). They were compared with a historical cohort (January 2012-May 2014) where VA was indicated exclusively by clinical evaluation (CLN group). We analysed the cost related to visits, DUS assessments, interventions, hospital admissions and graft materials to achieve a first VA valid for haemodialysis at least during 1 month. RESULTS: 86 patients in the CLN group were compared with 92 in the ECO group. Patients in the ECO group were younger (68.4 vs. 64.0 years; P=.038) but no other differences were seen among groups. The average cost to achieve a first AV valid for haemodialysis was significantly lower in the ECO group (2707 vs. 3347€; P=.024). There was a higher cost associated with DUS assessments in the ECO group yet the CLN group had a higher cost related to follow-up visits, successive surgical interventions, prosthetic material, days of hospital admission and catheters. The mean time needed to achieve a first AV valid for haemodialysis was also shorter in the ECO group (49.9 vs. 82.9 days, P=.002). CONCLUSION: The introduction of a specialised vascular access consultation with DUS prior to VA surgery has reduced the cost necessary to achieve a first VA valid for haemodialysis. From the patient's point of view this has meant less interventions and hospital admissions and a shortening of the time delay.

Assessment of the Volatile Profiles and Identification of Differentiating Aromas of Wild Undervalued Plants.

Wild edible plants have played an important role in traditional diets, including the Mediterranean diet. Many of these plants have acquired an undervalued status, since they are under-appreciated in terms of their nutritional, organoleptic qualities, or their seasonality. However, some of these species are still used in local gastronomy for their aromatic and taste characteristics. This study has investigated the quantitative and qualitative aromatic characteristics of seven undervalued wild plants that determine their organoleptic characteristics. Volatiles of the fresh leaves of each species have been determined by head-space solid-phase microextraction, a sensitive and solvent-free technique, coupled with gas chromatography and mass spectrometry. A total of 37 compounds with remarkable quantitative and qualitative differences were identified. In general, benzenoids and monoterpenoids were the most abundant groups, while branched unsaturated hydrocarbons, fatty alcohols, and sesquiterpenoids were the minor groups. Benzyl nitrile, benzyl isothiocyanate, p-cymene, and 2-hexenal were the main individual volatiles, while benzyl alcohol, eugenol, and α-copaene were the differentiating aromas. The results display that the undervalued species studied could be a suitable choice to include as new environmentally friendly crops, providing a double benefit to producers, because they are a possible way to achieve sustainable production systems, and they are an alternative for consumers, because these plants provide flavors that have high organoleptic qualities.

Impact of the COVID pandemic on vascular access creation for haemodialysis in 16 Spanish haemodialysis centres.

Background: The coronavirus disease (COVID) pandemic has resulted in a major disruption in healthcare that has affected several medical and surgical specialties. European and American Vascular Societies have proposed deferring the creation of an elective vascular access (VA) [autologous or prosthetic arteriovenous fistula (AVF) or arteriovenous graft (AVG)] in incident patients on haemodialysis (HD) in the era of the COVID pandemic. The aim of this study is to examine the impact of the COVID pandemic on VA creation and the central venous catheter (CVC)-related hospitalizations and complications in HD patients dialyzed in 16 Spanish HD units of three different regions. Methods: We compared retrospectively two periods of time: the pre-COVID (1 January 2019-11 March 2020) and the COVID era (12 March 2020-30 June 2021) in all HD patients (prevalent and incident) dialyzed in our 16 HD centres. The variables analysed were type of VA (CVC, AVF and AVG) created, percentage of CVC in incident and prevalent HD patients, CVC-related hospitalizations and complications (infection, extrusion, disfunction, catheter removal) and percentage of CVC HD sessions that did not reach the goal of Kt (>45) as a marker of HD adequacy. Results: A total of 1791 VAs for HD were created and 905 patients started HD during the study period. Patients who underwent vascular access surgery during the COVID period compared with pre-COVID period were significantly younger, with a significant decrease in surgical activity to create AVFs and AVGs in older HD patients (>75 and >85 years of age). There was a significant increase in CVC placement (from 59.7% to 69.5%; P < 0.001) from the pre-COVID to the COVID period. During the COVID pandemic, a significantly higher number of patients started HD through a CVC (80.3% versus 69.1%; P < 0.001). The percentage of CVC in prevalent HD patients has not decreased in the 19 months since the start of the pandemic [414 CVC/1058 prevalent patients (39.4%)]. No significant changes were detected in CVC-related hospitalizations between the pre-COVID and COVID periods. In the COVID period, a significant increase in catheter replacement and the percentage of HD session that did not reach the HD dose objective (Kt > 45) was observed. Conclusions: COVID has presented a public health system crisis that has influenced VA for HD, with an increase in CVCs relative to AVFs. A decrease in HD sessions that did not reach the HD dose objective was observed in the COVID period compared with a pre-COVID period.

Surgical Risk Following Anatomic Lung Resection in Thoracic Surgery: A Prediction Model Derived from a Spanish Multicenter Database. / Riesgo quirúrgico tras resección pulmonar anatómica en cirugía torácica. Modelo predictivo a partir de una base de datos nacional multicéntrica.

INTRODUCTION: The aim of this study was to develop a surgical risk prediction model in patients undergoing anatomic lung resections from the registry of the Spanish Video-Assisted Thoracic Surgery Group (GEVATS). METHODS: Data were collected from 3,533 patients undergoing anatomic lung resection for any diagnosis between December 20, 2016 and March 20, 2018. We defined a combined outcome variable: death or Clavien Dindo grade IV complication at 90 days after surgery. Univariate and multivariate analyses were performed by logistic regression. Internal validation of the model was performed using resampling techniques. RESULTS: The incidence of the outcome variable was 4.29% (95% CI 3.6-4.9). The variables remaining in the final logistic model were: age, sex, previous lung cancer resection, dyspnea (mMRC), right pneumonectomy, and ppo DLCO. The performance parameters of the model adjusted by resampling were: C-statistic 0.712 (95% CI 0.648-0.750), Brier score 0.042 and bootstrap shrinkage 0.854. CONCLUSIONS: The risk prediction model obtained from the GEVATS database is a simple, valid, and reliable model that is a useful tool for establishing the risk of a patient undergoing anatomic lung resection.

Mortality in Hemodialysis Patients with COVID-19, the Effect of Paricalcitol or Calcimimetics.

BACKGROUND: In COVID-19 patients, low serum vitamin D (VD) levels have been associated with severe acute respiratory failure and poor prognosis. In regular hemodialysis (HD) patients, there is VD deficiency and markedly reduced calcitriol levels, which may predispose them to worse outcomes of COVID-19 infection. Some hemodialysis patients receive treatment with drugs for secondary hyperparathyroidism, which have well known pleiotropic effects beyond mineral metabolism. The aim of this study was to evaluate the impact of VD status and the administration of active vitamin D medications, used to treat secondary hyperparathyroidism, on survival in a cohort of COVID-19 positive HD patients. METHODS: A cross-sectional retrospective observational study was conducted from 12 March to 21 May 2020 in 288 HD patients with positive PCR for SARS-CoV2. Patients were from 52 different centers in Spain. RESULTS: The percent of HD patients with COVID-19 was 6.1% (288 out of 4743). Mortality rate was 28.4% (81/285). Three patients were lost to follow-up. Serum 25(OH)D (calcidiol) level was 17.1 [10.6-27.5] ng/mL and was not significantly associated to mortality (OR 0.99 (0.97-1.01), p = 0.4). Patients receiving active vitamin D medications (16/94 (17%) vs. 65/191(34%), p = 0.003), including calcimimetics (4/49 (8.2%) vs. 77/236 (32.6%), p = 0.001), paricalcitol or calcimimetics (19/117 (16.2%) vs. 62/168 (36.9%); p < 0.001), and also those on both paricalcitol and calcimimetics, to treat secondary hyperparathyroidism (SHPTH) (1/26 (3.8%) vs. 80/259 (30.9%), p < 0.001) showed a lower mortality rate than patients receiving no treatment with either drug. Multivariate Cox regression analysis confirmed this increased survival. CONCLUSIONS: Our findings suggest that the use of paricalcitol, calcimimetics or the combination of both, seem to be associated with the improvement of survival in HD patients with COVID-19. No correlation was found between serum VD levels and prognosis or outcomes in HD patients with COVID-19. Prospective studies and clinical trials are needed to support these findings.

Impact of a Nosocomial COVID-19 Outbreak on a Non-COVID-19 Nephrology Ward during the First Wave of the Pandemic in Spain.

INTRODUCTION: The aim of this study was to analyze a nosocomial coronavirus disease 2019 (COVID-19) outbreak that occurred on a polyvalent non-COVID-19 ward at a tertiary care university hospital in Spain during the first wave of the pandemic and to describe the containment measures taken. The outbreak affected healthcare workers (HCWs) and kidney disease patients including transplant patients and those requiring maintenance hemodialysis. METHODS: The outbreak investigation and report were conducted in accordance with the Orion statement guidelines. RESULTS: In this study, 15 cases of COVID-19 affecting 10 patients and 5 HCWs were identified on a ward with 31 beds and 43 HCWs. The patients had tested negative for severe acute respiratory syndrome coronavirus 2 infection on admission. One of the HCWs was identified as the probable index case. Five patients died (mortality rate, 50%). They were all elderly and had significant comorbidities. The infection control measures taken included the transfer of infected patients to COVID-19 isolation wards, implementation of universal preventive measures, weekly PCR testing of patients and HCWs linked to the ward, training of HCWs on infection control and prevention measures, and enhancement of cleaning and disinfection. The outbreak was contained in 2 weeks, and no new cases occurred. CONCLUSION: Nosocomial COVID-19 outbreaks can have high attack rates involving both patients and HCWs and carry a high risk of patient mortality. Hospitals need to implement effective infection prevention and control strategies to prevent nosocomial COVID-19 spread.

A cost-effectiveness analysis of the introduction of a specialised consultation with duplex ultrasound assessment prior to vascular access surgery for haemodialysis. / Impacto de la introducción de una consulta específica con valoración eco-doppler en el costo asociado a la obtención de un primer acceso vascular para hemodiálisis.

INTRODUCTION: Duplex ultrasound (DUS) is increasingly used before vascular access (VA) surgery for haemodialysis. However, the cost-effectiveness of this approach is unknown. Our objective was to assess whether the introduction of a specialised consultation with DUS assessment modifies the cost and the time delay to achieve a first VA valid for haemodialysis. PATIENTS AND METHODS: Prospective cohort of patients undergoing a first VA (June 2014-July 2017) after a specialised consultation with DUS (ECO group). They were compared with a historical cohort (January 2012-May 2014) where VA was indicated exclusively by clinical evaluation (CLN group). We analysed the cost related to visits, DUS assessments, interventions, hospital admissions and graft materials to achieve a first VA valid for haemodialysis at least during 1 month. RESULTS: Eighty-six patients in the CLN group were compared with 92 in the ECO group. Patients in the ECO group were younger (68.4 vs. 64.0 years; P=.038) but no other differences were seen among groups. The average cost to achieve a first AV valid for haemodialysis was significantly lower in the ECO group (2707 vs. 3347€; P=.024). There was a higher cost associated with DUS assessments in the ECO group yet the CLN group had a higher cost related to follow-up visits, successive surgical interventions, prosthetic material, days of hospital admission and catheters. The mean time needed to achieve a first AV valid for haemodialysis was also shorter in the ECO group (49.9 vs. 82.9 days, P=.002). CONCLUSION: The introduction of a specialised vascular access consultation with DUS prior to VA surgery has reduced the cost necessary to achieve a first VA valid for haemodialysis. From the patient's point of view this has meant less interventions and hospital admissions and a shortening of the time delay.

Complexity Analysis of the Default Mode Network Using Resting-State fMRI in Down Syndrome: Relationships Highlighted by a Neuropsychological Assessment.

BACKGROUND: Studies on complexity indicators in the field of functional connectivity derived from resting-state fMRI (rs-fMRI) in Down syndrome (DS) samples and their possible relationship with cognitive functioning variables are rare. We analyze how some complexity indicators estimated in the subareas that constitute the default mode network (DMN) might be predictors of the neuropsychological outcomes evaluating Intelligence Quotient (IQ) and cognitive performance in persons with DS. METHODS: Twenty-two DS people were assessed with the Kaufman Brief Test of Intelligence (KBIT) and Frontal Assessment Battery (FAB) tests, and fMRI signals were recorded in a resting state over a six-minute period. In addition, 22 controls, matched by age and sex, were evaluated with the same rs-fMRI procedure. RESULTS: There was a significant difference in complexity indicators between groups: the control group showed less complexity than the DS group. Moreover, the DS group showed more variance in the complexity indicator distributions than the control group. In the DS group, significant and negative relationships were found between some of the complexity indicators in some of the DMN networks and the cognitive performance scores. CONCLUSIONS: The DS group is characterized by more complex DMN networks and exhibits an inverse relationship between complexity and cognitive performance based on the negative parameter estimates.

Local adaptation optimizes photoprotection strategies in a Neotropical legume tree under drought stress.

Photoprotection is a plant functional mechanism to prevent photooxidative damage by excess light. This is most important when carbon assimilation is limited by drought, and as such, it entails a trade-off between carbon assimilation vs stress avoidance. The ecological adaptation of plants to local water availability can lead to different photoprotective strategies. To test this, we used different provenances of Caesalpinia spinosa (Mol.) Kuntze (commonly known as 'tara') along a precipitation gradient. Tara is a Neotropical legume tree with high ecological and commercial value, found in dry tropical forests, which are increasingly threatened by climate change. Morphological and physiological responses of tara provenances were analysed under three different treatments of drought and leaflet immobilization, i.e., light stress, in a common garden greenhouse experiment. Tara quickly responded to drought by reducing stomatal conductance, evapotranspiration, photochemical efficiency, carbon assimilation and growth, while increasing structural and chemical photoprotection (leaflet angle and pigments for thermal dissipation). Leaflet closure was an efficient photoprotection strategy with overall physiological benefits for seedlings as it diminished the evaporative demand and avoided photodamage, but also entailed costs by reducing net carbon assimilation opportunities. These responses depended on seed origin, with seedlings from the most xeric locations showing the highest dehydration tolerance, suggesting local adaptation and highlighting the value of different strategies under distinct environments. This plasticity in its response to environmental stress allows tara to thrive in locations with contrasting water availability. Our findings increase the understanding of the factors controlling the functional ecology of tara in response to drought, which can be leveraged to improve forecasts of changes in its distribution range, and for planning restoration projects with this keystone tree species.

Structural equation models to estimate dynamic effective connectivity networks in resting fMRI. A comparison between individuals with Down syndrome and controls.

Emerging evidence suggests that an effective or functional connectivity network does not use a static process over time but incorporates dynamic connectivity that shows changes in neuronal activity patterns. Using structural equation models (SEMs), we estimated a dynamic component of the effective network through the effects (recursive and nonrecursive) between regions of interest (ROIs), taking into account the lag 1 effect. The aim of the paper was to find the best structural equation model (SEM) to represent dynamic effective connectivity in people with Down syndrome (DS) in comparison with healthy controls. Twenty-two people with DS were registered in a functional magnetic resonance imaging (fMRI) resting-state paradigm for a period of six minutes. In addition, 22 controls, matched by age and sex, were analyzed with the same statistical approach. In both groups, we found the best global model, which included 6 ROIs within the default mode network (DMN). Connectivity patterns appeared to be different in both groups, and networks in people with DS showed more complexity and had more significant effects than networks in control participants. However, both groups had synchronous and dynamic effects associated with ROIs 3 and 4 related to the upper parietal areas in both brain hemispheres as axes of association and functional integration. It is evident that the correct classification of these groups, especially in cognitive competence, is a good initial step to propose a biomarker in network complexity studies.

Analysis of solitary pulmonary nodule after surgical resection in patients with 18F-FDG positron emission tomography integrated computed tomography in the preoperative work-up. / Análisis del nódulo pulmonar solitario tras su resección quirúrgica en pacientes con 18F-FDG PET-TC integrado en el estudio preoperatorio.

INTRODUCTION: To analyse clinicopathological characteristics of patients operated for pulmonary solitary nodule (PSN) and 18F-FDG integrated PET-CT scan after surgical resection. METHODOLOGY: Retrospective study on a prospective database of patients operated from January 2007 to October 2017 for PSN without preoperative diagnosis. Dependent variable was anatomopathological result (benign vs malignant) of PSN. Variables of the study were: age, sex, PET-CT uptake, SUVmax, smoking history, COPD, previous history of malignant disease, tumoral location, and tumour size on CT-scan. RESULTS: A total of 305 patients were included in this study, 225 (73.8%) men, 80 (26.2%) women, mean age = 63.9 (range 29-86 years), mean size PSN = 1.68 (s.d. .65 cm), benign = 46 (15.1%), malignant = 258 (84.6%), type of resection: pulmonary wedge = 151 (49.5%), lobectomy = 141 (46.2%), segmentectomy = 12 (3.9%), exploratory intervention = 1 (0.3%). Postoperative mortality was 1.9%. COPD = 50.8% cases, previous cancer disease = 172 cases (56.4%), smoking history = 250 cases (82.0%), positive PET = 280 cases (91.8%), PSN in upper pulmonary fields = 204 cases (66.9%), median SUVmax = 3.4 (range 0-20.7). Backward stepwise binary logistic regression model showed that age, SUVmax, previous malignant disease and female sex were independent risk factors with statistical significance (p < .05). Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 94.6%, 23.4%, 87.1%, 44.0%, and 83.6% respectively. There were 14 false negative cases (4.6%) and 36 false positive cases (11.8%). CONCLUSIONS: Age, SUVmax, previous malignant disease, and female sex were independent risk factors in our study. Each case should be individually evaluated in a multidisciplinary committee, and the patient's preferences or concerns should be kept in mind in decision-making. Surgical resection of PSN is not exempt from morbidity and mortality, even in sublobar or pulmonary wedge resection.

Minimally invasive technique for stage III adult-acquired flatfoot deformity: a mid- to long-term retrospective study.

PURPOSE: The purpose of this study was to present the functional, radiological, and quality of life outcomes of a series of stage III adult-acquired flatfoot deformity corrections using an original operative approach based on minimal incision surgery (MIS). METHODS: Sixty-two patients (67 feet) with a symptomatic stage III flatfoot deformity were treated using a modified double arthrodesis by MIS. The mean age was 63 years (range, 50 to 81) and the mean follow-up was 6.6 years (range, 3.2 to 11.5). Clinical, radiological, American Orthopaedic Foot and Ankle Society Hindfoot score (AOFAS score), quality of life (SF-36), and satisfaction scores were collected retrospectively. RESULTS: The mean AOFAS score improved by 54.27 (95% [CI], 57.27-51.3; P < 0.0001), and the SF-36 improved by a mean of 17.5 points (95% CI, 1.4-20.9) in the physical component summary (PCS). Deformity correction was confirmed by a significant improvement in the x-ray measurements (six angles). Bony union was observed in 89.5% of cases (60/67). In all, nine patients (13.4%) needed a secondary surgery: three for talonavicular nonunion, four for progression of the flatfoot deformity, and two for screw protrusion. No cases of superficial infection, wound dehiscence, or avascular necrosis of the talus were observed. CONCLUSION: The present series represents the largest study of stage III flatfoot correction using MIS with a mid- to long-term follow-up. Because the data showed clinical and functional improvement after surgery with fewer complications, this technique may be ideal for patients at risk of complications. Graphical abstract.

Resting-state default mode network connectivity in young individuals with Down syndrome.

BACKGROUND: Down syndrome (DS) is a chromosomal disorder that causes intellectual disability. Few studies have been conducted on functional connectivity using resting-state fMRI (functional magnetic resonance imaging) signals or more specifically, on the relevant structure and density of the default mode network (DMN). Although data on this issue have been reported in adult DS individuals (age: >45 years), the DMN properties in young DS individuals have not been studied. The aim of this study was to describe the density and structure of the DMN network from fMRI signals in young DS (age: <36 years). METHOD: A sample of 22 young people with DS between the ages of 16 and 35 (M = 25.5 and SD = 5.1) was recruited in various centers for people with intellectual disability (ID). In addition to sociodemographic data, a six-minute fMRI session was recorded with a 3. T Philips Ingenia scanner. A control group of 22 young people, matched by age and gender, was obtained from the Human Connectome Project (to compare the networks properties between groups). RESULTS: The values of the 48 ROIs that configured the DMN were obtained, and the connectivity graphs for each subject, the average connectivity graph for each group, the clustering and degree values for each ROI, and the average functional connectivity network were estimated. CONCLUSIONS: A higher density of overactivation was identified in DS group in the ventral, sensorimotor, and visual DMN networks, although within a framework of a wide variability of connectivity patterns in comparison with the control group network. These results extend our understanding of the functional connectivity networks pattern and intrasubject variability in DS.

Spanish Video-Assisted Thoracic Surgery Group: Method, Auditing, and Initial Results From a National Prospective Cohort of Patients Receiving Anatomical Lung Resections.

INTRODUCTION: Our study sought to know the current implementation of video-assisted thoracoscopic surgery (VATS) for anatomical lung resections in Spain. We present our initial results and describe the auditing systems developed by the Spanish VATS Group (GEVATS). METHODS: We conducted a prospective multicentre cohort study that included patients receiving anatomical lung resections between 12/20/2016 and 03/20/2018. The main quality controls consisted of determining the recruitment rate of each centre and the accuracy of the perioperative data collected based on six key variables. The implications of a low recruitment rate were analysed for "90-day mortality" and "Grade IIIb-V complications". RESULTS: The series was composed of 3533 cases (1917 VATS; 54.3%) across 33 departments. The centres' median recruitment rate was 99% (25-75th:76-100%), with an overall recruitment rate of 83% and a data accuracy of 98%. We were unable to demonstrate a significant association between the recruitment rate and the risk of morbidity/mortality, but a trend was found in the unadjusted analysis for those centres with recruitment rates lower than 80% (centres with 95-100% rates as reference): grade IIIb-V OR=0.61 (p=0.081), 90-day mortality OR=0.46 (p=0.051). CONCLUSIONS: More than half of the anatomical lung resections in Spain are performed via VATS. According to our results, the centre's recruitment rate and its potential implications due to selection bias, should deserve further attention by the main voluntary multicentre studies of our speciality. The high representativeness as well as the reliability of the GEVATS data constitute a fundamental point of departure for this nationwide cohort.

Disability in instrumental activities of daily living in hemodialysis patients: Influence on quality of life related to health. / Dependencia para las actividades instrumentales de la vida diaria en pacientes en hemodiálisis: influencia sobre la calidad de vida relacionada con la salud.

INTRODUCTION: Instrumental Activities of Daily Life (IADL) requires a higher level of personal autonomy and interaction with the environment than the basic activities of daily life (BADL). Few studies analyze the deficit on IADL. Early detection is important because an early action can delay the evolution of the dependency process. AIM: to know the prevalence of functional deficit in IADL of hemodialysis patients, its relationship with the functional deficit in the BADL and its influence on the health related quality of life (HRQoL). METHODS: Cross-sectional study in 66 patients on HD. Different scales were used: Lawton and Brody (AIVD dependency), Delta (BADL dependency), and COOP-WONCA (HRQOL). Clinical data were collected (age, sex, CKD etiology, months in HD, marital status, employment situation). RESULTS: 80.3% of the patients had some degree of dependence for the IADL (57.5% in moderate/severe degree) and 40.8% for the BADL (9% in moderate/severe degree). There was a correlation between dependence to the BADL and AIVD. Age and employment status influence the dependence on IADL and BADL. Patients with greater dependence on IADL had worse HRQoL (P<.000). The dimensions in which they showed greater differences were "Daily activities", "Social activities" and "Social support". CONCLUSIONS: HD patients are more dependent on IADL than on ADL and with a higher degree of severity and the level of dependence in both types of activities has important influence on HRQoL. Early detection of the occurrence of disability in the realization of IADL can be used to initiate intervention programs that help to prevent, reverse or delay the progression.

Consumer acceptability of a sweet bread nutritionally enriched through linear programming with broad bean, chia and amaranth flours / Aceptabilidad de un pan dulce enriquecido nutricionalmente mediante programación lineal con harinas de habas, chía y amaranto

ABSTRACT The aim of this work was to improve sweet bread (R1) nutritionally by partially replacing the wheat flour with other non-traditional flours through linear programming. Chemical Score, lipid profile, microbiological quality and acceptability were determined. Both recipes, R2 and R3, were formulated according to the Dietary Guidelines for Americans; and R3 according to the maximum amounts of flours that impart negative sensory attributes, as well. The resulting proportions were: wheat/broad bean/chia/ amaranth flours 64/22/13/0 (R2) and 83/2/4/11 (R3). The obtained products presented adequate contributions of proteins and lipids, while fiber increased significantly. The Chemical Score increased from 46% (R1) to 95% (R2) and to 91% (R3) respectively, and the fatty acids ratio ω3: ω6 improved. R2 was not sensorially accepted while R3 presented high acceptability in adults and school-aged children. Recipe R3 could be included in school menus to improve children's nutritional status.

RESUMEN El objetivo de este trabajo fue mejorar nutricionalmente un pan dulce (R1), reemplazando parcialmente la harina de trigo con otras harinas no tradicionales a través de la programación lineal. Se determinó la puntuación química, el perfil lipídico, la calidad microbiológica y la aceptabilidad. Ambas recetas enriquecidas nutricionalmente, R2 y R3, se formularon de acuerdo a pautas dietéticas estadounidenses; y para R3, además, se tuvieron en cuenta las cantidades máximas de harinas que imparten atributos sensoriales negativos. Las proporciones resultantes fueron harina de trigo/haba/chía/amaranto 64/22/13/0 (R2) y 83/2/4/11 (R3). Los productos obtenidos presentaron contenidos adecuados de proteínas y lípidos, mientras que la fibra aumentó significativamente. La puntuación química aumentó de 46% (R1) a 95% (R2) y a 91% (R3) respectivamente, y la relación de ácidos grasos ω3: ω6 mejoró. R2 no fue aceptado sensorialmente, mientras que R3 presentó alta aceptabilidad en adultos y niños en edad escolar. La receta R3 podría incluirse en los menús escolares para mejorar el estado nutricional de los niños.