[Characteristics and evolution of COVID-19 in an urban Health Center at the pandemic beginning']. / Características y evolución de los pacientes COVID-19 en un centro de salud urbano al inicio de la pandemia.

OBJETIVE: To evaluate SAR-COV-2 pacients' features. To analyse de diferences between those who required hospital care and those who didn't. DESIGN: Observational, descriptive and retrospective study. SETTING: Twomedical practices of an urban health center in Salamanca (Spain). PARTICIPANTS: ≥18 years diagnosed with SAR-CoV-2 between March 11th and April 20th. MAIN MEASUREMENTS: clinical-epidemiological chatacteristics, diagnosis, treatment and outcome at the end of study RESULTS: 122 patients (63.9% female), 19.7% social and health care workers y 4.9% from nursing homes. Predominant age group: 46-60 years. 67.2% without comorbility. Predomint symptoms: low-grade fever (73.5%), cough (65.2%) y fever (43%). Average age of the patients requiring hospital care was higher: 59.85 (DE16.22) versus 50.78 (DE17.88) P=.013. 63.6% of all the patients monitored by Primary Health Care and 14.1% of patients that required assistance did not present dyspnea P=.001. Only 2.5% of the hospital-assisted patients, compared to 61.5% of Primary Health Care, were not tested P=.0001. 26 patients were attendedn at an emergency room: 11(9%) stayed and 2 (1.6%) passed away. No antibiotic or inhaler treatment for 52.5% and 70.5% respectively. The most used antipyretic treatment was paracetamol (78.7%). CONCLUSIONS: Prevalence in females, comorbility-free patients and in age range: 46-60 years. Complementary and confirmatory test were performed mainly in hospital care. Predominance of mild symptoms and favourable evolution. Highliting the role played by Primary Health Care in detection, early intervention and monitoring of severe cases.

Characterization of the new AmpC ß-lactamase FOX-8 reveals a single mutation, Phe313Leu, located in the R2 loop that affects ceftazidime hydrolysis.

A novel class C ß-lactamase (FOX-8) was isolated from a clinical strain of Escherichia coli. The FOX-8 enzyme possessed a unique substitution (Phe313Leu) compared to FOX-3. Isogenic E. coli strains carrying FOX-8 showed an 8-fold reduction in resistance to ceftazidime relative to FOX-3. In a kinetic analysis, FOX-8 displayed a 33-fold reduction in kcat/Km for ceftazidime compared to FOX-3. In the FOX family of ß-lactamases, the Phe313 residue located in the R2 loop affects ceftazidime hydrolysis and alters the phenotype of E. coli strains carrying this variant.

Ultrafast 30-min infusion of a rituximab biosimilar (Truxima).

In this clinical trial, we demonstrate that ultrarapid fast infusion of rituximab (Truxima) in 30 min with oral premedication is feasible and secure for patients, and reduce the day-care hospital stays.

Design, synthesis and structure-activity-relationship of 1,5-tetrahydronaphthyridines as CETP inhibitors.

This Letter describes the discovery and SAR optimization of 1,5-tetrahydronaphthyridines, a new class of potent CETP inhibitors. The effort led to the identification of 21b and 21d with in vitro human plasma CETP inhibitory activity in the nanomolar range (IC(50)=23 and 22nM, respectively). Both 21b and 21d exhibited robust HDL-c increase in hCETP/hApoA1 dual heterozygous mice model.

The Medical versus Zoological Concept of Outflow Tract Valves of the Vertebrate Heart.

The anatomical elements that in humans prevent blood backflow from the aorta and pulmonary artery to the left and right ventriclesare the aortic and pulmonary valves, respectively. Each valve regularly consists of three leaflets (cusps), each supported by its valvular sinus. From the medical viewpoint, each set of three leaflets and sinuses is regarded as a morpho-functional unit. This notion also applies to birds and non-human mammals. However, the structures that prevent the return of blood to the heart in other vertebrates are notably different. This has led to discrepancies between physicians and zoologists in defining what a cardiac outflow tract valve is. The aim here is to compare the gross anatomy of the outflow tract valvular system among several groups of vertebrates in order to understand the conceptual and nomenclature controversies in the field.

Distant and new mutations in CTX-M-1 beta-lactamase affect cefotaxime hydrolysis.

The CTX-M ß-lactamases are an increasingly prevalent group of extended-spectrum ß-lactamases (ESBL). Point mutations in CTX-M ß-lactamases are considered critical for enhanced hydrolysis of cefotaxime. In order to clarify the structural determinants of the activity against cefotaxime in CTX-M ß-lactamases, screening for random mutations was carried out to search for decreased activity against cefotaxime, with the CTX-M-1 gene as a model. Thirteen single mutants with a considerable reduction in cefotaxime MICs were selected for biochemical and stability studies. The 13 mutated genes of the CTX-M-1 ß-lactamase were expressed, and the proteins were purified for kinetic studies against cephalothin and cefotaxime (as the main antibiotics). Some of the positions, such as Val103Asp, Asn104Asp, Asn106Lys, and Pro107Ser, are located in the (103)VNYN(106) loop, which had been described as important in cefotaxime hydrolysis, although this has not been experimentally confirmed. There are four mutations located close to catalytic residues-Thr71Ile, Met135Ile, Arg164His, and Asn244Asp-that may affect the positioning of these residues. We show here that some distant mutations, such as Ala219Val, are critical for cefotaxime hydrolysis and highlight the role of this loop at the top of the active site. Other distant substitutions, such as Val80Ala, Arg191, Ala247Ser, and Val260Leu, are in hydrophobic cores and may affect the dynamics and flexibility of the enzyme. We describe here, in conclusion, new residues involved in cefotaxime hydrolysis in CTX-M ß-lactamases, five of which are in positions distant from the catalytic center.

Vitamin D Receptor Polymorphisms and Non-Melanoma Skin Cancer Risk: A Case-Control Study.

Exposure to sunlight is the major source of vitamin D and the main environmental cause of non-melanocytic skin cancers. Vitamin D, partly mediated through the vitamin D receptor (VDR), has potential therapeutic applications in skin cancer. The aim of this study was to investigate the association of BsmI and ApaI VDR polymorphisms among patients with non-melanoma cancers and controls. An observational case-control study was conducted in a sample of 154 subjects. We observed no significant effects between these polymorphisms and skin cancer risk. When stratified for gender, GG and AG BsmI polymorphisms significantly increased the risk of basal cell carcinomas in males. In relation to ApaI, all three polymorphisms significantly increased the risk of basal cell carcinoma in males. When stratified for age, we found that being 70 years of age or younger was a protective factor against both skin cancers. Being a female and 70 years old or younger was a protective factor for basal cell carcinoma. A comparison of the frequencies of the VDR genotypes in patients older than 70 years vs. 70 years or younger also revealed age-dependent variations in patients with non-melanoma skin cancer. Our study suggests a role for VDR polymorphisms in non-melanoma skin cancer development.

The COMT Val158 Met polymorphism as an associated risk factor for Alzheimer disease and mild cognitive impairment in APOE 4 carriers.

BACKGROUND: The aim of this study is to examine the influence of the catechol-O-methyltranferase (COMT) gene (polymorphism Val158 Met) as a risk factor for Alzheimer's disease (AD) and mild cognitive impairment of amnesic type (MCI), and its synergistic effect with the apolipoprotein E gene (APOE).A total of 223 MCI patients, 345 AD and 253 healthy controls were analyzed. Clinical criteria and neuropsychological tests were used to establish diagnostic groups.The DNA Bank of the University of the Basque Country (UPV-EHU) (Spain) determined COMT Val158 Met and APOE genotypes using real time polymerase chain reaction (rtPCR) and polymerase chain reaction (PCR), and restriction fragment length polymorphism (RFLPs), respectively. Multinomial logistic regression models were used to determine the risk of AD and MCI. RESULTS: Neither COMT alleles nor genotypes were independent risk factors for AD or MCI. The high activity genotypes (GG and AG) showed a synergistic effect with APOE epsilon4 allele, increasing the risk of AD (OR = 5.96, 95%CI 2.74-12.94, p < 0.001 and OR = 6.71, 95%CI 3.36-13.41, p < 0.001 respectively). In AD patients this effect was greater in women.In MCI patients such as synergistic effect was only found between AG and APOE epsilon4 allele (OR = 3.21 95%CI 1.56-6.63, p = 0.02) and was greater in men (OR = 5.88 95%CI 1.69-20.42, p < 0.01). CONCLUSION: COMT (Val158 Met) polymorphism is not an independent risk factor for AD or MCI, but shows a synergistic effect with APOE epsilon4 allele that proves greater in women with AD.

[Acute pancreatitis and obstructive jaundice secondary to metastases from lung cancer]. / Pancreatitis aguda e ictericia obstructiva secundaria a metástasis de cáncer de pulmón.

Lung cancer is one of the most frequent neoplasms. The symptoms are due to the cancer itself, its extension, and associated paraneoplastic syndromes. Although biliopancreatic metastases are common, biliopancreatic involvement as the initial symptom of lung cancer--whether as pancreatitis or obstructive jaundice--is rare. We describe our clinical experience, reporting two patients with acute pancreatitis and one patient with obstructive jaundice as the clinical presentation of advanced lung cancer. We also provide a brief review that highlights the absence of guidelines in this situation.

Pigmentation of the aortic and pulmonary valves in C57BL/6J x Balb/cByJ hybrid mice of different coat colours.

Neural crest-derived melanocytes have been recorded in several parts of the mammalian heart but not in the pulmonary valve. We report here the presence of melanin-containing cells in the leaflets (cusps) of both the aortic and pulmonary valves. A total of 158 C57BL/6J x Balb/cByJ hybrid mice exhibiting four coat colours, namely black, white, agouti and non-agouti brown, were examined. We sought for any relationship between the presence of melanocytes in the valves and the coat colour of the animals. The pigmentation levels of the leaflets were accomplished using a scale of five pigment intensities. White mice lacked pigment in the heart. In 10.5% of the remaining animals, there were melanocytes in the pulmonary valve leaflets. Thus, this is the first study to report the presence of such cells in the pulmonary valve of mammals. Melanocytes occurred in the leaflets of the aortic valves of 87.2% of mice. The incidence of melanocytes and the pigmentation level of the leaflets did not statistically differ according to the coat colours of the animals. This disagrees with previous observations, indicating that the amount of melanocytes in the heart reflects that of the skin. The incidence and distribution of melanocytes in aortic and pulmonary valves are consistent with the notion that the formation of the arterial valves is mediated by specific subpopulations of neural crest cells. We hypothesize that melanocytes, even not producing melanin, may be more frequent in the heart than previously thought, exerting presumably an immunological function.

The effect of startle reflex habituation on cardiac defense: interference between two protective reflexes.

The present study investigated the relationship between blink startle and cardiac defense, two protective reflexes that are said to be elicited by the transient and the sustained components, respectively, of high intensity stimuli. Three groups of participants were presented with three intense long lasting noise stimuli (500ms) after habituation training with 12 brief (50ms) high intensity noise bursts (High group), low intensity noise bursts (Low group) or high intensity visual stimuli (Light group). The transition from habituation to defense stimuli resulted in increased blink startles in groups Low and Light, but not in group High. A cardiac defense reflex, characterised by a short and long delayed increase in heart rate, was observed in group Light, but not in groups Low and High. This pattern of results indicates that habituation to startle eliciting stimuli will impair defense reflexes elicited on subsequent test trials and suggests some interrelation between the two reflex systems.

MAP17 (PDZK1IP1) and pH2AX are potential predictive biomarkers for rectal cancer treatment efficacy.

Rectal cancer represents approximately 10% of cancers worldwide. Preoperative chemoradiotherapy increases complete pathologic response and local control, although it offers a poor advantage in survivorship and sphincter saving compared with that of radiotherapy alone. After preoperative chemoradiotherapy, approximately 20% of patients with rectal cancer achieve a pathologic complete response to the removed surgical specimen; this response may be related to a better prognosis and an improvement in disease-free survival. However, better biomarkers to predict response and new targets are needed to stratify patients and obtain better response rates. MAP17 (PDZK1IP1) is a small, 17 kDa non-glycosylated membrane protein located in the plasma membrane and Golgi apparatus and is overexpressed in a wide variety of human carcinomas. MAP17 has been proposed as a predictive biomarker for reactive oxygen species, ROS, inducing treatments in cervical tumors or laryngeal carcinoma. Due to the increase in ROS, MAP17 is also associated with the marker of DNA damage, phosphoH2AX (pH2AX). In the present manuscript, we examined the values of MAP17 and pH2AX as surrogate biomarkers of the response in rectal tumors. MAP17 expression after preoperative chemoradiotherapy is able to predict the response to chemoradiotherapy, similar to the increase in pH2AX. Furthermore, we explored whether we can identify molecular targeted therapies that could help improve the response of these tumors to radiotherapy. In this sense, we found that the inhibition of DNA damage with olaparib increased the response to radio- and chemotherapy, specifically in tumors with high levels of pH2AX and MAP17.

[Psychophysiological mechanisms involved in the affective regulation and food restriction of women at risk of suffering from bulimia nervosa]. / Mecanismos psicofisiológicos implicados en la regulación afectiva y la restricción alimentaria de mujeres con riesgo de padecer bulimia nerviosa.

The aim of the study was to explore the effect of visualizing food images under different mood states and food restriction conditions on the emotional modulation of two defense reflexes (startle reflex and cardiac defense). 72 women at risk of suffering from bulimia nervosa were assigned to two groups: 1) a group under induced positive, neutral, or negative mood state and, 2) a 6-hour-food-deprived group or a non-deprived group. Second-by-second heart rate and electromyogram activity from the orbiculari oculi region were recorded after the auditory stimulus. The results showed that, while viewing food images, non-deprived women under negative mood state potentiated the cardiac defense response and the startle motor reflex. Results are discussed in the context of emotional eating theories and Peter Lang's motivational priming model.

Cardiac, mandibular and thymic phenotypical association indicates that cranial neural crest underlies bicuspid aortic valve formation in hamsters.

Bicuspid aortic valve (BAV) is the most prevalent human congenital cardiac malformation. It may appear isolated, associated with other cardiovascular malformations, or forming part of syndromes. Cranial neural crest (NC) defects are supposed to be the cause of the spectrum of disorders associated with syndromic BAV. Experimental studies with an inbred hamster model of isolated BAV showed that alterations in the migration or differentiation of the cardiac NC cells in the embryonic cardiac outflow tract are most probably responsible for the development of this congenital valvular defect. We hypothesize that isolated BAV is not the result of local, but of early alterations in the behavior of the NC cells, thus also affecting other cranial NC-derived structures. Therefore, we tested whether morphological variation of the aortic valve is linked to phenotypic variation of the mandible and the thymus in the hamster model of isolated BAV, compared to a control strain. Our results show significant differences in the size and shape of the mandible as well as in the cellular composition of the thymus between the two strains, and in mandible shape regarding the morphology of the aortic valve. Given that both the mandible and the thymus are cranial NC derivatives, and that the cardiac NC belongs to the cephalic domain, we propose that the causal defect leading to isolated BAV during embryonic development is not restricted to local alterations of the cardiac NC cells in the cardiac outflow tract, but it is of pleiotropic or polytopic nature. Our results suggest that isolated BAV may be the forme fruste of a polytopic syndrome involving the cranial NC in the hamster model and in a proportion of affected patients.

Discovery of a Highly Selective NAMPT Inhibitor That Demonstrates Robust Efficacy and Improved Retinal Toxicity with Nicotinic Acid Coadministration.

NAMPT, an enzyme essential for NAD+ biosynthesis, has been extensively studied as an anticancer target for developing potential novel therapeutics. Several NAMPT inhibitors have been discovered, some of which have been subjected to clinical investigations. Yet, the on-target hematological and retinal toxicities have hampered their clinical development. In this study, we report the discovery of a unique NAMPT inhibitor, LSN3154567. This molecule is highly selective and has a potent and broad spectrum of anticancer activity. Its inhibitory activity can be rescued with nicotinic acid (NA) against the cell lines proficient, but not those deficient in NAPRT1, essential for converting NA to NAD+ LSN3154567 also exhibits robust efficacy in multiple tumor models deficient in NAPRT1. Importantly, this molecule when coadministered with NA does not cause observable retinal and hematological toxicities in the rodents, yet still retains robust efficacy. Thus, LSN3154567 has the potential to be further developed clinically into a novel cancer therapeutic. Mol Cancer Ther; 16(12); 2677-88. ©2017 AACR.

Características y evolución de los pacientes COVID-19 en un centro de salud urbano al inicio de la pandemia / Characteristics and evolution of COVID-19 in an urban Health Center at the pandemic beginning

OBJETIVO: Evaluar las características de los pacientes con SARS-CoV-2 y analizar diferencias entre los que requirieron asistencia hospitalaria y los seguidos ambulatoriamente. DISEÑO: Estudio observacional, descriptivo, retrospectivo. EMPLAZAMIENTO: 2 unidades básicas asistenciales de un centro de salud urbano en Salamanca (España). PARTICIPANTES: Pacientes ≥ 18 años diagnosticados de SARS-CoV-2 entre el 11 de marzo y el 20 de abril. MEDICIONES PRINCIPALES: Características clínico-epidemiológicas, diagnóstico, tratamiento y desenlace a fecha fin de estudio. RESULTADOS: Ciento veintidós pacientes (63,9% mujeres), 19,7% trabajadores sociosanitarios y 4,9% institucionalizados. Franja etaria predominante: 46-60 años, edad media: 52,1(DE 17,85). El 67,2% sin comorbilidad. Síntomas más prevalentes: febrícula (73,5%), tos (65,2%) y fiebre (43%). La edad media de los que requieren atención hospitalaria es mayor a los seguidos ambulatoriamente: 59,85 años (DE 16,22) vs. 50,78 (DE 17,88); p = 0,013. El 63,6% del total seguidos por Atención Primaria no presentó disnea, frente a 17 (14,1%) de los que acudieron a Urgencias; p = 0,001. No se realizaron pruebas confirmatorias al 2,5% de los que visitaron el hospital, frente al 61,5% de los seguidos ambulatoriamente; p = 0,0001; 26 acuden a Urgencias: 11 (9%) ingresaron y 2 (1,6%) fallecieron. El 52,5% no necesitó antibioterapia y el 70.5% no requirió inhaladores. El antipirético más empleado fue paracetamol (78.7%). CONCLUSIONES: Prevalencia en mujeres, personas sin comorbilidad y en la franja de edad de 46-60 años. Las pruebas complementarias y confirmatorias se realizaron mayoritariamente en asistencia hospitalaria. Predominancia de sintomatología leve y evolución favorable. Destacamos el papel de Atención Primaria en la detección, la intervención temprana y el seguimiento en casos graves

OBJETIVE: To evaluate SAR-COV-2 pacients' features. To analyse de diferences between those who required hospital care and those who didn't. DESIGN: Observational, descriptive and retrospective study. SETTING: Two medical practices of an urban health center in Salamanca (Spain). PARTICIPANTS: ≥ 18 years diagnosed with SAR-CoV-2 between March 11 th and April 20 th. MAIN MEASUREMENTS: clinical-epidemiological chatacteristics, diagnosis, treatment and outcome at the end of study RESULTS: 122 patients (63.9% female), 19.7% social and health care workers y 4.9% from nursing homes. Predominant age group: 46-60 years. 67.2% without comorbility. Predomint symptoms: low-grade fever (73.5%), cough (65.2%) y fever (43%). Average age of the patients requiring hospital care was higher: 59.85 (DE16.22) versus 50.78 (DE17.88) P = .013. 63.6% of all the patients monitored by Primary Health Care and 14.1% of patients that required assistance did not present dyspnea P = .001. Only 2.5% of the hospital-assisted patients, compared to 61.5% of Primary Health Care, were not tested P = .0001. 26 patients were attendedn at an emergency room: 11(9%) stayed and 2 (1.6%) passed away. No antibiotic or inhaler treatment for 52.5% and 70.5% respectively. The most used antipyretic treatment was paracetamol (78.7%). CONCLUSIONS: Prevalence in females, comorbility-free patients and in age range: 46-60 years. Complementary and confirmatory test were performed mainly in hospital care. Predominance of mild symptoms and favourable evolution. Highliting the role played by Primary Health Care in detection, early intervention and monitoring of severe cases

Subjective and physiological reactivity to chocolate images in high and low chocolate cravers.

Cue-reactivity to chocolate images was assessed using self-report and physiological measures. From a pre-screening sample of 454, young women were selected and assigned to high and low chocolate craving groups (N = 36/group). The experimental procedure consisted in the elicitation and measurement of the cardiac defense and startle reflexes while viewing chocolate and standard affective images selected from the International Affective Picture System. In response to chocolate images, high cravers reported more pleasure and arousal but less control than low cravers. In high cravers, viewing chocolate images inhibited the cardiac defense but potentiated the startle reflex, as compared to low cravers. The results confirmed at the physiological level that the motivational state that underlies the experience of chocolate craving include both appetitive (inhibition of the defense reflex) and aversive (potentiation of the startle response) components. The findings supported a motivational conflict theory of chocolate craving.

Non-conscious modulation of cardiac defense by masked phobic pictures.

The present study investigated the modulation of cardiac defense by presenting emotional pictures under both effective and non-effective masking procedures. The aim was to test Ohman's model of pre-attentive processing of fear. Participants were 48 women volunteers with intense fear of spiders. The stimulus to elicit cardiac defense was a white noise of 105 dB, 500 ms duration and instantaneous risetime. Subjects had two trials of picture-noise presentation-one with a picture of a spider and one with a picture of a flower-, either under an effective masking procedure (30 ms duration) or a non-effective masking procedure (500 ms duration). Order of presentation was counterbalanced. Dependent variables were heart rate and subjective assessment of the noise. Results showed an increased cardiac response in the first trial and a less reduced cardiac response in the second trial when the noise was preceded by the phobic picture under both masking procedures. The response was accompanied by an increase in the subjective unpleasantness of the noise. These results provide support to Ohman's theoretical model.

A new look at cardiac defense: attention or emotion?

The study of cardiac defense has a long tradition in psychological research both within the cognitive approach--linked to Pavlov, Sokolov, and Graham's work on sensory reflexes--and within the motivational one--linked to the work of Cannon and subsequent researchers on the concepts of activation and stress. These two approaches have been difficult to reconcile in the past. We summarize a series of studies on cardiac defense from a different perspective, which allows integration of the traditional approaches. This new perspective emphasizes a sequential process interpretation of the cardiac defense response. Results of descriptive and parametric studies, as well as those of studies examining the physiological and psychological mechanisms underlying the response, show a complex response pattern with both accelerative and decelerative components, with both sympathetic and parasympathetic influences, and with both attentional and emotional significance. The implications of this new look at cardiac defense are discussed in relation to defensive reactions in natural settings, the brain mechanisms controlling such reactions, and their effects on health and illness.