Optimización del modelo de abordaje a pacientes con asma en Atención Primaria en un entorno COVID-19 / Optimisation of the approach model for asthma patients in Primary Care in a COVID-19 setting

JUSTIFICACIÓN: el asma genera importante morbimortalidad. Una estrategia dirigida a optimizar el modelo de abordaje a pacientes con asma en Atención Primaria en un entorno COVID-19 puede mejorar los resultados en salud.OBJETIVO: crear un marco de actuación de referencia para mejorar el abordaje y satisfacer las necesidades de los pacientes asmáticos en un entorno COVID-19 en Atención Primaria.MATERIAL Y MÉTODOS: se revisó y rediseñó el modelo actual de abordaje de los pacientes adultos con asma en Atención Primaria, desde una perspectiva multidisciplinar, incorporando el concepto Asthma Right Care (1) y el impacto COVID-19.Pensamos que funcionaría por ser un proyecto desarrollado bajo el liderazgo clínico con un enfoque multidisciplinar . Estrategia para el cambio: entre septiembre 2020 - diciembre 2021: Creación de un comité científico. Análisis de la situación actual en 17 centros de salud de Atención Primaria de 7 comunidades autónomas españolas: Personal Médico de Familia, Enfermería y administrativo de cada Centro de Salud con farmacéuticos caracterizaron su modelo de abordaje del paciente asmático e identificaron áreas de mejora, acompañadas de planes de acción. Sesión grupal on line. Informe de resultados para cada centro, con propuesta de indicadores de evaluación de resultado. Laboratorio Digital de Innovación Nacional on line.14-12-2021Usando Mentimeter, referentes de los Centros de Salud y comité científico priorizaron las áreas de mejora identificadas y desarrollaron planes de acción para las dos áreas de mejora más prioritarias. Presentación Informe final del Laboratorio Digital. Impactos esperados• Identificación de áreas de mejora en los itinerarios del paciente asmático en un entorno COVID-19•Diseño participativo de planes de acción seguros y eficientes• Difundir el movimiento Asthma Right Care (AU)

[Polylactic acid injections (Newfill) in the treatment of facial lipodystrophy in HIV-positive patients]. / Traitement par injections d'acide polylactique (Newfill) des lipoatrophies faciales chez les malades infectés par le VIH.

BACKGROUND: Lipodystrophy is a side-effect associated with treatment for human immunodeficiency virus (HIV) and is found chiefly on the face (disappearance of buccal fat pads) and is detrimental to self-esteem. PATIENTS AND METHODS: This was a retrospective study in HIV-positive patients with facial lipoatrophy treated between 1999 and 2004 by means of subcutaneous injections of polylactic acid (Newfill). We assessed the efficacy of treatment, the number of injections given, treatment methods and adverse effects. RESULTS: Eighty-three patients were treated between 1999 and 2004. Each patient received a mean of between 3 and 4 treatment sessions comprising subdermal injection of 1 ampoule of Newfill into each cheek. Ultrasound assessment of the dermis over the cheekbone was performed in 45 patients and showed an increase in dermal thickness of between 3 and 7 mm. Following injection, edema was observed in all cases and lasted between 1 and 2 days. Five patients presented bruising at the injection sites. Two patients presented asymmetry lasting 4 months and requiring correction. Four patients had non-inflammatory granulomas, which were not visible but were palpable in 2 cases; all nodules regressed after 4 months. DISCUSSION: Treatment of facial lipoatrophy in HIV patients by injection of polylactic acid (Newfill) was shown to be efficacious in the majority of subjects. Training in the administration of this treatment is needed to ensure optimal efficacy and safety. A number of technical difficulties led to changes in treatment methods, i.e. routine adoption of a mask and protective glasses and use of a Luer-lock syringe due to blockage of syringes in more than 20% of cases, with splashing; increase in dilution volume from 3 to 5 ml; use of a centrifuge to ensure greater homogeneity of the solution; use of lidocaine in place of water for injections in order to reduce pain for patients.

Development and applications of a DNA labeling method with magnetic nanoparticles to study the role of horizontal gene transfer events between bacteria in soil pollutant bioremediation processes.

Horizontal gene transfers are critical mechanisms of bacterial evolution and adaptation that are involved to a significant level in the degradation of toxic molecules such as xenobiotic pesticides. However, understanding how these mechanisms are regulated in situ and how they could be used by man to increase the degradation potential of soil microbes is compromised by conceptual and technical limitations. This includes the physical and chemical complexity and heterogeneity in such environments leading to an extreme bacterial taxonomical diversity and a strong redundancy of genes and functions. In addition, more than 99 % of soil bacteria fail to develop colonies in vitro, and even new DNA-based investigation methods (metagenomics) are not specific and sensitive enough to consider lysis recalcitrant bacteria and those belonging to the rare biosphere. The objective of the ANR funded project "Emergent" was to develop a new culture independent approach to monitor gene transfer among soil bacteria by labeling plasmid DNA with magnetic nanoparticles in order to specifically capture and isolate recombinant cells using magnetic microfluidic devices. We showed the feasibility of the approach by using electrotransformation to transform a suspension of Escherichia coli cells with biotin-functionalized plasmid DNA molecules linked to streptavidin-coated superparamagnetic nanoparticles. Our results have demonstrated that magnetically labeled cells could be specifically retained on micromagnets integrated in a microfluidic channel and that an efficient selective separation can be achieved with the microfluidic device. Altogether, the project offers a promising alternative to traditional culture-based approaches for deciphering the extent of horizontal gene transfer events mediated by electro or natural genetic transformation mechanisms in complex environments such as soil.

Analysis of a ribosomal RNA operon in the actinomycete Frankia.

The organisation of ribosomal RNA-encoding (rrn) genes has been studied in Frankia sp. strain ORS020606. The two rrn clusters present in Frankia strain ORS020606 were isolated from genomic banks in phage lambda EMBL3 by hybridization with oligodeoxyribonucleotide probes. The 5'-3' gene order is the usual one for bacteria: 16S-23S-5S. The two clusters are not distinguishable by restriction enzyme mapping inside the coding section, but vary considerably outside it. Sequencing showed that the 16S-rRNA-encoding gene of ORS020606 is very closely related to that of another Alnus-infective Frankia strain (Ag45/Mut15) and highly homologous to corresponding genes of Streptomyces spp. Two possible promoter sequences were detected upstream from the 16S gene, while no tRNA-encoding gene was detected in the whole operon. Regions with a high proportion of divergence for the study of phylogenetic relationships within the genus were looked for and found in the first intergenic spacer, in the 23S and in the 16S gene.

Distribution of gymnostoma spp. microsymbiotic frankia strains in new caledonia is related to soil type and to host-plant species

The diversity of the Frankia strains that are naturally in symbiosis with plants belonging to the Gymnostoma genus in New Caledonia was investigated. A direct molecular characterization of DNA extracted from nodules was performed, followed by characterization by restriction fragment length polymorphism (RFLP) of the ribosomal rrs-rrl (16S-23S) intergenic spacer (IGS) polymerase chain reaction (PCR)-amplified region. Seventeen different patterns were identified among the 358 microsymbiotic strains studied in the eight species of host plant present in New Caledonia. This genotypical approach permitted us to show that a large diversity existed among the patterns and that these did not exhibit a strict specificity to any host-plant species comparable with that previously found in the Casuarina and Allocasuarina symbioses in Australia. Despite this lack of specificity, a correspondence analysis nevertheless showed that the distribution of these patterns was related to soil type and to host-plant species. Furthermore, several Frankia strains were exclusively associated with the ultramafic soils.

Horizontal gene transfers in the environment: natural transformation as a putative process for gene transfers between transgenic plants and microorganisms.

Horizontal gene transfers among bacteria, such as natural transformation or conjugation, may have played an important role in bacterial evolution. They are thought to have been involved in promoting genome plasticity which permitted bacteria to adapt very efficiently to any change in their environment and to colonize a wide range of ecosystems. Evidence that some genes were transferred from eukaryotes, and in particular, from plants to bacteria, was obtained from nucleotide and protein sequence analyses. However, numerous factors, including some which are endogenous to the bacterial cells, tend to limit the extent of transfer, particularly among phylogenetically distant organisms. The goal of this paper is to give an overview of the potentials and limits of natural interkingdom gene transfers, with particular focus on prokaryote-originating sequences which fit the nuclear genome of transgenic plants.

Potential dissemination of antibiotic resistance genes from transgenic plants to microorganisms.

Evidence that genes were transferred during evolution from plants to bacteria was obtained from nucleotide and protein sequence analyses. However, the extent of such transfers among phylogenetically distant organisms is limited by various factors, including those related to complexity of the environment and those endogenous to the bacteria, designed to prevent a drift of the genome integrity. The goal of this article is to give an overview of the potentials and limits of natural interkingdom gene transfers, with a particular focus on prokaryote originating sequences fitting the nuclear genome of transgenic plants.

Variable virological outcomes according to the center providing antiretroviral therapy within the PharmAdapt clinical trial.

PURPOSE: Differences in virological response between HIV-infected patients at different study centers were analyzed as a substudy of PharmAdapt, a multicenter prospective randomized study to evaluate the utility of therapeutic drug monitoring after a genotypic-based treatment adaptation. RESULTS: After 12 weeks, the percentage of patients participating in PharmAdapt with HIV RNA < 200 copies/mL ranged from 17% to 69% between centers providing antiretroviral care. In a multivariate analysis, independent factors predictive of viral load <200 HIV RNA copies/mL at Week 12 included: lower baseline viral load, lower nonnucleoside reverse transcriptase inhibitor resistance, lower protease inhibitor resistance, and the center providing antiretroviral therapy. To evaluate the final factor, study sites were divided into two groups based on Week 12 HIV RNA values above or below the median. CONCLUSION: Using this definition, observed differences between centers included the use of stavudine, abacavir-, and/or efavirenz-based regimens and use of online expert advice.

The optical transverse chromatic aberration on the fovea of the human eye.

The horizontal component of optical transverse chromatic aberration (TCA) at the fovea between 486 and 656 nm is measured in a sample of 8 eyes by two novel methods, both using vernier adjustment tasks with a retinal illumination of approx. 780 td and for a pupil size of approximately 5.5 mm dia. Initially, in an indirect method, TCA is derived along the line of sight from chromatic parallax. Secondly, TCA is measured directly using a semi-Maxwellian view and compensating for longitudinal chromatic aberration (LCA). Both techniques are unaffected by coma or by the Stiles-Crawford effects, thus optical TCA rather than the TCA perceived in normal view is measured. On average, optical TCA is in the same direction but less than previously predicted by eye models and predictions of the optical quality of the eye in white light are modified. Factors underlying the lower average value of optical TCA and variability among subjects, especially pupil centration and foveal position, are discussed. The relationship of optical TCA to TCA perceived in normal view and to chromostereopsis is analysed. The results suggest that the optical design of the human eye is optimized to reduce the wavelength dependent phase shift in the optical transfer function, which could be produced by optical TCA.

Psychophysical measurement of the blur on the retina due to optical aberrations of the eye.

The blur on the retina in the horizontal meridian due to monochromatic and chromatic aberrations has been measured using a novel psychophysical technique. Longitudinal chromatic aberration gives the dominant blur for pupil sizes of 4-5 mm, followed by monochromatic aberrations, and blur due to optical transverse chromatic aberration. In some eyes, coma was present as a result of a displacement of the axis of symmetry from the centre of the pupil, but in three eyes, coma was present without spherical aberration. The technique also allows a measurement of the effective pupil centre relative to the geometric centre and a partial analysis of the relative positions of the reference axes of the eye.

Comparison between electrochemical and optoelectrochemical impedance measurements for detection of DNA hybridization.

The principles of the electrochemical and optoelectrochemical impedance measurements on bare electrolyte/dielectric/semiconductor structures are described. The analysis of the experimental curves allows access to several indications concerning the electrical behavior of such structures. The application of these techniques to follow the electrical behavior of structures modified with two biological systems was investigated. The antibody/antigen recognition did not change the surface charge and, therefore, did not affect the impedance curves with respect to the applied potential. By contrast, the hybridization of two complementary DNA strands on the surface of the structure induced a variation of flat band potential of the semiconductor leading to a shift of impedance curves along the potential axis. This means that it is possible to detect directly the DNA hybridization without the use of labeled probes. The use of light allows the surface to be probed locally. In the future, the application of this technique for direct detection of hybridization on DNA chips should be possible.

[Power in the periphery of several aspheric eyeglasses for aphakic patients]. / La puissance dans la périphérie de différents verres asphériques pour aphake.

A special device adapted to a Nikon projection vertexometer permits the power to be measured in the periphery of recent aspheric aphakic lenses. The peripheral power is measured with respect to the vertex sphere. A blended lenticular aspheric lens and three types of zonal aspheric full field lenses are studied, with various base curves on three samples. Four meridians of each lens are evaluated with ocular rotations varying by 5 degrees step up to 35 degrees at least. The results show a variable oblique astigmatism and a high under-correction of the mean oblique power for the Welsh 4 drop. The other zonal aspheric lenses give only a slight improvement of the peripheral powers compared with some conventional aspheric lenses. The Omega lens shows a reasonable correction of off-axis power errors up to 30 degrees. Beyond, the powers variation follows the general characteristics of blended lenticular aspheric lenses.

[Measuring the level of tonic accomodation as a function of wavelength]. / Mesure du niveau d'accommodation tonique en fonction de la longueur d'onde.

PURPOSE: Tonic accommodation contributes to the refractive state of the human eye in the absence of any visual stimulation. As the power of the eye, tonic accommodation level should be a function of wavelength and its variation should constitute a measure of longitudinal chromatic aberration of the eye. METHODS: The level of tonic accommodation was measured with a vernier optometer on a sample of 10 subjects (21-39 years). Five monochromatic filters of wavelengths 450, 486, 550, 600, 656 nm have been used. RESULTS: Results show a tonic accommodation variation with wavelength. The sample mean of longitudinal chromatic aberration (left eye) resulting from the variation of tonic accommodation as a function of wavelength is 1.42 +/- 0.08 D between 450 and 656 nm and 0.96 +/- 0.06 D between 486 and 656 nm. CONCLUSION: These results fit the predictions from theorical models and question previous results.

Guía española de la enfermedad pulmonar obstructiva crónica (GesEPOC) 2017: tratamiento farmacológico en fase estable / Spanish guidelines for management of chronic obstructive pulmonary disease (GesEPOC) 2017: pharmacological treatment of stable phase

La enfermedad pulmonar obstructiva crónica (EPOC) presenta una gran heterogeneidad clínica, por lo que su tratamiento se debe individualizar según el nivel de riesgo y el fenotipo. La Guía española de la EPOC (GesEPOC) estableció por primera vez en 2012 unas pautas de tratamiento farmacológico basadas en fenotipos clínicos. Estas pautas han sido adoptadas posteriormente por otras normativas nacionales, y han sido respaldadas por nuevas evidencias publicadas desde entonces. En esta actualización 2017 se ha sustituido la clasificación de gravedad inicial por una clasificación de riesgo mucho más sencilla (bajo o alto riesgo), basándose en la función pulmonar, el grado de disnea y la historia de agudizaciones, y se recomienda la determinación del fenotipo clínico únicamente en pacientes de alto riesgo. Se mantienen los mismos fenotipos clínicos: no agudizador, EPOC-asma (ACO), agudizador con enfisema y agudizador con bronquitis crónica. La base del tratamiento farmacológico de la EPOC es la broncodilatación, y también es el único tratamiento recomendado en pacientes de bajo riesgo. En los pacientes con alto riesgo se añadirán diversos fármacos a los broncodilatadores según el fenotipo clínico. GesEPOC supone una aproximación al tratamiento de la EPOC más individualizado según las características clínicas de los pacientes y su nivel de riesgo o de complejidad.(AU)

The clinical presentation of chronic obstructive pulmonary disease (COPD) varies widely, so treatment must be tailored according to the level of risk and phenotype. In 2012, the Spanish COPD Guidelines (GesEPOC) first established pharmacological treatment regimens based on clinical phenotypes. These regimens were subsequently adopted by other national guidelines, and since then, have been backed up by new evidence. In this 2017 update, the original severity classification has been replaced by a much simpler risk classification (low or high risk), on the basis of lung function, dyspnea grade, and history of exacerbations, while determination of clinical phenotype is recommended only in high-risk patients. The same clinical phenotypes have been maintained: non-exacerbator, asthma-COPD overlap (ACO), exacerbator with emphysema, and exacerbator with bronchitis. Pharmacological treatment of COPD is based on bronchodilators, the only treatment recommended in low-risk patients. High-risk patients will receive different drugs in addition to bronchodilators, depending on their clinical phenotype. GesEPOC reflects a more individualized approach to COPD treatment, according to patient clinical characteristics and level of risk or complexity.(AU)

Inter-laboratory evaluation of the ISO standard 11063 "Soil quality - Method to directly extract DNA from soil samples".

Extracting DNA directly from micro-organisms living in soil is a crucial step for the molecular analysis of soil microbial communities. However, the use of a plethora of different soil DNA extraction protocols, each with its own bias, makes accurate data comparison difficult. To overcome this problem, a method for soil DNA extraction was proposed to the International Organization for Standardization (ISO) in 2006. This method was evaluated by 13 independent European laboratories actively participating in national and international ring tests. The reproducibility of the standardized method for molecular analyses was evaluated by comparing the amount of DNA extracted, as well as the abundance and genetic structure of the total bacterial community in the DNA extracted from 12 different soils by the 13 laboratories. High quality DNA was successfully extracted from all 12 soils, despite different physical and chemical characteristics and a range of origins from arable soils, through forests to industrial sites. Quantification of the 16S rRNA gene abundances by real time PCR and analysis of the total bacterial community structure by automated ribosomal intergenic spacer analysis (A-RISA) showed acceptable to good levels of reproducibility. Based on the results of both ring-tests, the method was unanimously approved by the ISO as an international standard method and the normative protocol will now be disseminated within the scientific community. Standardization of a soil DNA extraction method will improve data comparison, facilitating our understanding of soil microbial diversity and soil quality monitoring.

Theoretical computation of the refractive index in an ophthalmic lens.

In this technical note, the theoretical value of the refractive index of an ophthalmic lens is derived from central thickness and from power as measured with a focimeter and a lens gauge.

Influence of TMJ dysfunction on Bennett movement as recorded by a modified pantograph. Part I: Literature review.

This review has pointed out the difficulties in studying the lateral side shift of the mandible (Bennett movement) as well as the many contradictory results that have evolved from investigations. Based on the studies reported, it seems reasonable to conclude that Bennett movement accompanies most subject's lateral jaw movements, but its amount and "timing" varies between individuals and may be influenced by muscle incoordination and TMJ dysfunction. Furthermore, the axis around which all lateral movements occur may be oblique rather than vertical and perpendicular to the subject's hinge axis. The importance of Bennett movement has often been emphasized. Disagreement and controversy still exist regarding (1) the immutability of its magnitude throughout the occlusal therapy and (2) the possible relationship between TMJ dysfunction and Bennett movement. A clinical study has been completed and will be reported in subsequent articles to give insight into the possible influence of the neuromusculature on the lateral side shift of the mandible.

A review of available systems to investigate transfer of DNA to indigenous soil bacteria.

The deliberate or accidental release of genetically engineered microorganisms (GEMs) in the environment has led to some questions concerning microbial survival, transfer of DNA to the indigenous microflora and environmental consequences. Amongst horizontal gene transfer mechanisms, conjugation is probably the most frequent in the environment. With the aim of evaluating risks associated with environmental release of GEMs and their engineered DNA, studies of conjugative gene transfer between a donor strain and indigenous microflora have been conducted. Such studies required the development of a donor counterselection system to prevent growth of donor cells on transconjugant selective plates. This review summarizes the known and potential donor counterselection systems.

Transverse chromatic aberration and colour-defined motion.

A number of recent studies have explored the role of the chromatic system in motion processes using the isoluminance paradigm. A major concern when using such methodological procedures is potential artefacts produced by chromatic aberrations. In the present study we address the problem of optically induced luminance artefacts produced by transverse chromatic aberrations (TCA), which may contaminate the results obtained in chromatic motion-nulling experiments. Results show that different TCA levels artificially increase chromatic motion sensitivity values to varying degrees above 0.5 cpd for red/green gratings. The data also suggest the notion that naturally occurring TCA can decrease motion-nulling thresholds for chromatic gratings at high spatial frequencies. Furthermore, our data show that the motion-nulling paradigm for chromatic gratings may in fact be an efficient functional method for assessing the amount of TCA produced by optical factors.