Oviductal extracellular vesicles miRNA cargo varies in response to embryos and their quality.

BACKGROUND: Increasing evidence points to an active role of oviductal extracellular vesicles (oEVs) in the early embryo-maternal dialogue. However, it remains unclear whether oEVs contribute to the recognition of the presence of embryos and their quality in the oviduct. Hence, we examined whether the molecular cargo of oEVs secreted by bovine oviduct epithelial cells (BOEC) differs depending on the presence of good (≥ 8 cells, G) or poor (< 8 cells, P) quality embryos. In addition, differences in RNA profiles between G and P embryos were analyzed in attempt to distinguish oEVs and embryonic EVs cargos. METHODS: For this purpose, primary BOEC were co-cultured with in vitro produced embryos (IVP) 53 h post fertilization as follows: BOEC with G embryos (BGE); BOEC with P embryos (BPE); G embryos alone (GE); P embryos alone (PE); BOEC alone (B) and medium control (M). After 24 h of co-culture, conditioned media were collected from all groups and EVs were isolated and characterized. MicroRNA profiling of EVs and embryos was performed by small RNA-sequencing. RESULTS: In EVs, 84 miRNAs were identified, with 8 differentially abundant (DA) miRNAs for BGE vs. B and 4 for BPE vs. B (P-value < 0.01). In embryos, 187 miRNAs were identified, with 12 DA miRNAs for BGE vs. BPE, 3 for G vs. P, 8 for BGE vs. GE, and 11 for BPE vs. PE (P-value < 0.01). CONCLUSIONS: These results indicated that oEVs are involved in the oviductal-embryo recognition and pointed to specific miRNAs with signaling and supporting roles during early embryo development.

Sperm exposure to accessory gland secretions alters the transcriptomic response of the endometrium in cattle.

In cattle, mating to intact, but not vasectomised, bulls has been shown to modify the endometrial transcriptome, suggesting an important role of sperm in the modulation of the uterine environment in this species. However, it is not clear whether these changes are driven by intrinsic sperm factors, or by factors of accessory gland (AG) origin that bind to sperm at ejaculation. Therefore, the aim of the present study was to determine whether ejaculated sperm, which are suspended in the secretions of the AGs, elicit a different endometrial transcriptomic response than epididymal sperm, which have never been exposed to AG factors. To this end, bovine endometrial explants collected from heifers in oestrus were (co-)incubated for 6 h alone (control), or with epididymal sperm or ejaculated sperm, following which transcriptomic changes in the endometrium were evaluated. Epididymal sperm elicited a more dramatic endometrial response than ejaculated sperm, in terms of the number of differentially expressed genes (DEGs). Indeed, RNA-sequencing data analysis revealed 1912 DEGs in endometrial explants exposed to epididymal sperm compared with control explants, whereas 115 DEGs were detected between endometrial explants exposed to ejaculated sperm in comparison to control explants. The top pathways associated with genes upregulated by epididymal sperm included T cell regulation and TNF, NF-KB and IL17 signalling. Interestingly, ejaculated sperm induced downregulation of genes associated with T cell immunity and Th17 differentiation, and upregulation of genes involved in NF-KB signalling, in comparison to epididymal sperm. These data indicate that factors of AG origin modulate the interaction between sperm and the endometrium in cattle.

A novel TAp73-inhibitory compound counteracts stemness features of glioblastoma stem cells.

Glioblastoma (GB) is the most common and fatal type of primary malignant brain tumor for which effective therapeutics are still lacking. GB stem cells, with tumor-initiating and self-renewal capacity, are mostly responsible for GB malignancy, representing a crucial target for therapies. The TP73 gene, which is highly expressed in GB, gives rise to the TAp73 isoform, a pleiotropic protein that regulates neural stem cell biology; however, its role in cancer has been highly controversial. We inactivated TP73 in human GB stem cells and revealed that TAp73 is required for their stemness potential, acting as a regulator of the transcriptional stemness signatures, highlighting TAp73 as a possible therapeutic target. As proof of concept, we identified a novel natural compound with TAp73-inhibitory capacity, which was highly effective against GB stem cells. The treatment reduced GB stem cell-invasion capacity and stem features, at least in part by TAp73 repression. Our data are consistent with a novel paradigm in which hijacking of p73-regulated neurodevelopmental programs, including neural stemness, might sustain tumor progression, pointing out TAp73 as a therapeutic strategy for GB.

Clinical Results of a Monofocal Aspheric Bitoric Intraocular Lens with Plate Haptics in Hyperopic Eyes.

Purpose: To assess the refractive and visual outcomes of hyperopic and astigmatic eyes implanted with a monofocal, aspheric, bitoric intraocular lens (IOL) with plate haptics following cataract surgery. Methods: The study evaluated 51 eyes implanted with the AT TORBI 709M IOL (Carl Zeiss Meditec AG, Jena, Germany) during a follow-up of 12-months. Refractive error, rotational stability, monocular uncorrected distance visual acuity (UDVA), monocular corrected distance visual acuity (CDVA), and contrast sensitivity were analyzed at 1-, 6-, and 12-months post-surgery. Results: At 12 months, the cumulative CDVA was 20/25 in 94.12% of eyes and 20/32 or better in 98.04%. The UDVA was the same as, or better than, the CDVA in 88.24% of eyes. The mean logMAR UDVA and CDVA values were 0.06 ± 0.11 and 0.00 ± 0.08, respectively. In addition, 92.16% of eyes were within ±0.50 D and 98.04% were within ±1.00 D of a spherical equivalent, and 86.27% of eyes had refractive astigmatism ≤0.50D and 100% were ≤1.00D. The mean spherical equivalent was 0.21 ± 0.31D and the mean refractive cylinder 0.34 ± 0.27D. The IOL rotation was 1.18 ± 1.35 degrees and all eyes had a rotation ≤5 degrees. The log contrast sensitivity functions were good and similar for all spatial frequencies during follow-up. Conclusion: Our results demonstrate that implantation of the AT TORBI 709M IOL in hyperopic and astigmatic eyes is effective and safe. The visual and refractive outcomes were good, showing excellent rotational stability.

Gender, smoking, and tobacco cessation with pharmacological treatment in a cluster randomized clinical trial.

INTRODUCTION: Whether men find it easier to quit smoking than women is still controversial. Different studies have reported that the efficacy of pharmacological treatments could be different between men and women. This study conducted a secondary analysis of 'Subsidized pharmacological treatment for smoking cessation by the Spanish public health system' (FTFT-AP study) to evaluate the effectiveness of a drug-funded intervention for smoking cessation by gender. METHODS: A pragmatic randomized clinical trial by clusters was used. The population included smokers aged ≥18 years, smoking >10 cigarettes per day, randomly assigned to an intervention group receiving regular practice and financed pharmacological treatment, or to a control group receiving only regular practice. The main outcome was continued abstinence at 12 months, self-reported and validated with CO-oximetry. The percentage, with 95% confidence intervals, of continued abstinence was compared between both groups at 12 months post-intervention, by gender and the pharmacological treatment used. Multilevel logistic regression analysis was performed. RESULTS: A total of 1154 patients from 29 healthcare centers were included. The average age was 46 years (SD=11.78) and 51.7% were men. Overall, the self-reported abstinence at 12 months was 11.1% (62) in women and 15.7% (93) in men (AOR=1.4; 95% CI: 1.0-2.0), and abstinence validated by CO-oximetry was 4.6% (26) and 5.9% (35) in women and men, respectively (OR=1.3; 95% CI: 0.7-2.2). In the group of smokers receiving nicotine replacement treatment, self-reported abstinence was higher in men compared to women (29.5% vs 13.5%, OR=2.7; 95% CI: 1.3-5.8). CONCLUSIONS: The effectiveness of a drug-financed intervention for smoking cessation was greater in men, who also showed better results in self-reported abstinence with nicotine replacement treatment.

Treatment outcomes in patients with large B-cell lymphoma after progression to chimeric antigen receptor T-cell therapy.

Over 60% of relapsed/refractory (R/R) large B-cell lymphoma (LBCL) patients who receive chimeric antigen receptor (CAR) T cells will experience disease progression. There is no standard next line of therapy and information in this setting is scarce and heterogeneous. We analyzed 387 R/R LBCL patients who progressed after CAR T cells from July 2018 until March 2022 in Spain and the United Kingdom. Median overall survival (OS) was 5.3 months, with significant differences according to the interval between infusion and progression (<2 months [1.9 months], 2-6 months [5.2 months], and >6 months [not reached]). After progression, 237 (61%) patients received treatment. Focusing on the first subsequent therapy, overall (complete) response rates were 67% (38%) for polatuzumab-bendamustine-rituximab (POLA), 51% (36%) for bispecific antibodies (BsAb), 45% (35%) for radiotherapy (RT), 33% (26%) for immune checkpoint inhibitors (ICIs), 25% (0%) for lenalidomide (LENA), and 25% (14%) for chemotherapy (CT). In terms of survival, 12-month progression-free survival and OS was 36.2% and 51.0% for POLA, 32.0% and 50.1% for BsAb, 30.8% and 37.5% for RT, 29.9% and 27.8% for ICI, 7.3% and 20.8% for LENA, and 6.1% and 18.3% for CT. Thirty-two (14%) patients received an allogeneic hematopoietic cell transplant with median OS not reached after a median follow-up of 15.1 months. In conclusion, patients with R/R LBCL who progress within the first 2 months after CAR T-cell therapy have dismal outcomes. Novel targeted agents, such as polatuzumab and BsAbs, can achieve prolonged survival after CAR T-cell therapy failure.

Escala para la identificación del paciente pediátrico crónico complejo (Escala PedCom). Estudio piloto / A scale for the identification of the complex chronic pediatric patient (PedCom Scale): A pilot study

Introducción y objetivos: La condición crónica compleja (CCC) es una realidad cada vez más prevalente en pediatría. Sin embargo, padecer una CCC no supone necesariamente ser un paciente crónico complejo (PCC). Desde esta perspectiva, nos propusimos el desarrollo de un instrumento (Escala PedCom) que facilitase la identificación del PCC. Material y métodos: Inicialmente se definieron aspectos generales para la clasificación de un paciente como PCC. Posteriormente se desarrollaron los ítems de la escala puntuándolos de 0,5 a 4 puntos. Se realizó análisis factorial confirmatorio (AFC) y se estudió la consistencia interna mediante alfa de Cronbach. La concordancia se evaluó mediante estudio intra- e interobservador. El gold standard fue la clasificación realizada por 2 evaluadores tras valoración de la historia clínica del paciente. El punto de corte para considerar al paciente como PCC se estableció mediante curva ROC. Resultados: La versión inicial incluyó 43 ítems con índice de validez de contenido global (IVC) de 0,94. Para el estudio se incluyeron 180 pacientes. Tras el AFC se eliminó un ítem, por lo que la versión final consta de 42 ítems con IVC de 0,95. El valor alfa de Cronbach fue 0,723. El índice de correlación intraclase del análisis test-retest fue de 0,998 y 0,996 para el estudio interobservador. El punto de corte para considerar a un paciente como PCC se estableció en 6,5 puntos, con el que se obtuvo una sensibilidad del 98% y especificidad del 94%. Conclusiones: La Escala PedCom es una herramienta de fácil uso enfocada a la identificación del PCC. En nuestra muestra, presentó adecuada consistencia interna y niveles adecuados de concordancia intra- e interobservador; con buenos resultados de sensibilidad y especificidad para la identificación del PCC. (AU)

Introduction and objectives: The complex chronic condition (CCC) is an increasingly prevalent reality in pediatrics. However, having a CCC does not necessarily mean being a complex chronic patient (CCP). From this perspective, we developed an instrument (PedCom Scale) that would facilitate the identification of the PCC. Material and methods: Initially, general aspects for the classification of patients as CCP were defined. Subsequently, the items of the scale were developed, scoring them from 0.5 to 4 points. We performed a confirmatory factor analysis (CFA) and the internal consistency was studied using alpha-Cronbach. Concordance was evaluated by intra- and inter-observer study. The gold standard was the classification performed by two evaluators after assessing the patient's medical history. The cut-off point for considering the patient as a CCP was established using the ROC curve. Results: The initial version included 43 items with a global content validity index (CVI) of 0.94. A total of 180 patients were included. After the CFA, one item was eliminated, so the final version consists of 42 items with an CVI of 0.95. The alpha-Cronbach value was 0.723. The intraclass correlation coefficient of the test–retest analysis was 0.998 and 0.996 for the inter-observer study. The cut-off point for considering a patient as a CCP was established at 6.5 points, with these results we obtained a sensitivity of 98% and specificity of 94%. Conclusions: The PedCom Scale is an easy-to-use tool focused on the identification of the CCP. In our sample, it presented satisfactory levels of internal consistency and adequate levels of intra- and inter-observer agreement, with good sensitivity and specificity for the identification of the PCC. (AU)

Causal attributions in early childhood education: a new categorization system / Atribuciones causales en Educación Infantil: nuevo sistema de categorización

BACKGROUND: From Early Childhood Education onwards, causal attributions influence explanations of school performance. We performed a systematic review of the available knowledge (1970-2019) about Weiner's (1986) Attribution Theory of the Motivation of Achievement in order to examine studies related to the causal attributions of success and failure at school. We found numerous empirical studies related to Bernard Weiner's theory. However, little research exists about students in Early Childhood Education. Therefore, the aim of this study was to identify the causes to which children attribute their successes and failures during this educational period. METHOD: A sample of 200 students aged between 3 and 6 years old was selected. To collect the data, an individually implemented Piagetian clinical interview was used. RESULTS: A large volume of qualitative information was collected for classification which exceeded Weiner's traditional causal attributions. Creating a category to group all new attributions implied losing too much information under a non-specific label. CONCLUSION: A new categorization of the causal attributions was designed, made up of 10 categories -adapted to the 3-6 years age range- which revises and expanding on the categorization created by Weiner

ANTECEDENTES: las atribuciones causales de la motivación influyen desde Educación Infantil en la explicación del rendimiento escolar. Se realizó una revisión sistemática de los conocimientos disponibles (1970-2019) de la Teoría Atribucional de la Motivación de Logro de Weiner (1986) para conocer los trabajos relacionados con las atribuciones causales del éxito y fracaso escolar. Se hallaron numerosos estudios empíricos relacionados con la teoría de Bernard Weiner. Sin embargo, son escasas las investigaciones con estudiantes de Educación Infantil. Por ello, el objetivo de este estudio fue identificar las causas a las que atribuyen sus éxitos y fracasos escolares en Educación Infantil. MÉTODO: se seleccionó una muestra de 200 estudiantes con edades comprendidas entre los 3 y 6 años. Para recopilar los datos se utilizó una entrevista clínica piagetiana implementada individualmente. RESULTADOS: se recopiló un gran volumen de información cualitativa para clasificar que desbordaba las atribuciones causales tradicionales de Weiner. Crear una categoría para agrupar todas las nuevas atribuciones implicaba perder demasiada información bajo una etiqueta inespecífica. CONCLUSIÓN: se diseñó una nueva categorización de las atribuciones causales formada por 10 categorías -adaptada al rango de edad 3-6 años- que revisa y amplía la creada por Weiner

Científicos e intelectuales, una nueva cultura política: José Cuatrecasas y las colecciones de flora tropical / Scientists and intellectuals, a new political culture: José Cuatrecasas and the collections of tropical flora

Este trabajo quiere mostrar una faceta del papel desempeñado por el coleccionismo y las colecciones científicas en la formación de los naturalistas durante la Edad de Plata de la ciencia española. El objetivo es evidenciar que la Junta para Ampliación de Estudios, principal institución que impulsó ese proyecto, aspiraba a crear intelectuales con capacidad de participar en la gobernanza del país (una nueva cultura política). La JAE encarnó un proyecto científico racionalista que se oponía a las visiones más conservadoras, defensoras de una ciencia católica, en una lucha que no se restringía a la ciencia, sino que alcanzaba lo social, lo político y lo cultural. Para ello recurrimos a la biografía del botánico José Cuatrecasas partiendo del enfoque de una historia sociocultural de la ciencia y una historia de las ideas

This work aims to show a piece of the important role that collecting and scientific collections played in the training to become naturalist during the Silver Age of Spanish science (1900-1936). It attempts to show that the Junta para Ampliación de Estudios (JAE), the main institution that promoted such a modern scientific project, aspired to create an intellectual elite with the capacity to participate in the governance of the State (a new political culture). The JAE incarnated a rationalist scientific model that opposed the ultraconservative positions, which were defenders of a Catholic science. Both of them were involved in a struggle that was not only restricted to science, but it reached all social, political and cultural aspects of national living. This article takes the biography of the botanic José Cuatrecasas as starting point and its analysis will be processed from the sociocultural History of Science and the History of Ideas

Bronquiolitis obliterante en paciente con poliquistosis hepatorrenal en lista para trasplante / Bronchiolitis obliterans in a transplant-waitlisted patient with hepatorenal polycystic disease

No disponible

Malformación arteriovenosa de la vena de Galeno. Serie de casos / Vein of Galen aneurysmal malformation. A case series

No disponible

Plataformas digitales y empleo: necesidad de monitorización y vigilancia de salud pública / No disponible

No disponible

Aplicando la evidencia científica: protocolo ERAS (Fast-track) en la cistectomía radical / No disponible

No disponible

Análisis del uso ambulatorio de antibióticos en los hospitales generales de Asturias entre 2006 y 2015 / Analysis on the ambulatory usage of antibiotics at general hospitals in Asturias (2006-2015)

Introducción. La Organización para la Cooperación y el Desarrollo Económicos (OCDE) señala, en su informe sobre políticas de salud de 2017 que, España es uno de los países con mayor consumo en antibióticos, 21,6 DHD (dosis diaria definida por 1000 habitantes y día) en 2014 superior a los 20,5 DHD de media en sus países, situándose según el European Centre for Disease Prevention and Control (ECDC) en el puesto 11 de 30 países europeos en 2016. La prescripción ambulatoria de atención especializada se analiza con menor frecuencia, debido a la mayor contribución en consumo y gasto de la atención primaria. Material y métodos. Estudio descriptivo, observacional, y retrospectivo del consumo y gasto del grupo J01 derivado de la prescripción ambulatoria (consulta externa y urgencias) de los hospitales públicos generales de Asturias, en una década (2006- 2015). Se estudió el consumo a través de la base de datos de facturación de receta del Servicio de Salud del Principado de Asturias, los datos demográficos se obtuvieron del Instituto Nacional de Estadística. El consumo se expresó en DHD y el gasto: en gasto por habitante e importe por dosis diaria definida. Resultados. El consumo medio ambulatorio global del periodo fue de 23,4 DHD, correspondiendo el 11,5% (2,7 DHD) a la receta ambulatoria de atención especializada. En términos de gasto, supuso el 13,6% del gasto global ambulatorio en antibióticos. Conclusiones. Gasto y consumo tuvieron tendencias opuestas, las medidas de control del gasto no tuvieron, o tuvieron poco impacto en consumo, por tanto, se precisan en este ámbito medidas de racionalización independientes y específicas (AU)

Introduction. The Organization for Economic Co-operation and Development (OECD) emphasize, in its report on health policies from 2017 that, Spain is one of the countries with largest consumption of antibiotics, 21.6 DHD (defined daily dose per 1000 inhibitants per day) in 2014 greater than the average 20.5 DHD in their countries, ranking according to the European Center for Disease Prevention and Control (ECDC) in the 11th place out of 30 European countries in 2016. The outpatient prescription of specialized care is analyzed less frequently, due to the greater contribution in consumption and expenditure of primary care. Material and methods. A descriptive, observational, and retrospective study of the consumption and expenditure of the J01 group derived from outpatient prescription (outpatient and urgent care) of public hospitals in Asturias, in a period of ten years (2006-2015). Consumption data were obtained using the database of prescription billing of the Health Service of the Principality of Asturias, demographic data were provided by the National Institute of Statistics. Consumption was expressed in DHD and antibiotics expenditure in: expenditure per capita and expenditure in euros per defined daily dose. Results. The average global ambulatory consumption for the period was 23.4 DHD, corresponding 11.5% (2.7 DHD) to the ambulatory specialty care prescription. In terms of expenditure, it accounted for 13.6% of overall outpatient spending on antibiotics. Conclusions. Outlay and consumption had opposite tendencies, the expenditure control measures did not have or had little impact on consumption, therefore, independent and specific rationalization measures are required in this area (AU)

Reconstrucción escrotal: cobertura mediante colgajo muscular de gracilis pediculado frente a injerto de piel parcial / Scrotal reconstruction with pedicled gracilis muscle flap versus split thickness skin graft

Introducción y Objetivo: La región escrotal presenta unas características especiales que otorgan una adecuada protección y termorregulación testicular. La etiología de su defecto puede ser múltiple, siendo la causa más frecuente la gangrena de Fournier. Hasta el momento actual se han descrito múltiples opciones reconstructivas, no obstante no se ha llegado a encontrar un método ideal. El objetivo de este estudio es evaluar los efectos de la reconstrucción escrotal mediante colgajo de músculo gracilis o injerto de piel parcial sobre la función hormonal testicular y la satisfacción del paciente. Material y Método: Desde enero de 2006 hasta marzo de 2016, 19 pacientes fueron sometidos a reconstrucción de defecto escrotal en nuestra unidad mediante cobertura con injerto de piel parcial o colgajo de gracilis pediculado. En todos los casos el defecto fue secundario a gangrena de Fournier. Estudiamos las características de los pacientes y medimos su función hormonal testicular, así como su satisfacción tras la reconstrucción al cabo de 5 ±3.6 años de postoperatorio. Resultados: De los 19 pacientes intervenidos, incluimos 11 en el estudio: 5 con reconstrucción mediante colgajo muscular de gracilis pediculado con injerto de piel parcial y 6 mediante injerto de piel parcial. No apreciamos diferencias entre los grupos respecto a los valores de función hormonal testicular. No obstante, observamos diferencias a favor de la reconstrucción mediante colgajo de gracilis pediculado respecto a satisfacción (93 frente a 60 puntos), sensación de protección (98 frente a 68 puntos), influencia en la actividad sexual (20% frente a 80%) y sensibilidad táctil grosera del área reconstruida (80% frente a 0%). Conclusiones: La reconstrucción de defecto escrotal mediante colgajo de gracilis. en nuestra muestra, ofreció un mejor resultado estético y una mayor satisfacción del paciente que la reconstrucción mediante injertos de piel parcial. Además, no observamos diferencias notables entre las dos técnicas reconstructivas respecto a la función hormonal testicular de los pacientes

Background and Objective: The scrotal area presents special characteristics that allow the protection and thermal regulation of testicles. The etiology of scrotum defect can be multiple, being the most frequent cause Fournier's gangrene. Multiple reconstructive options have been described, nevertheless it has not yet been reached an ideal method. This study was designed to evaluate the effects of scrotal reconstruction, using gracilis muscle flap or skin graft, on testicular hormonal function and patient satisfaction. Methods: From January 2006 to March 2016, 19 patients underwent a reconstruction of scrotum defect in our unit through covering by skin graft or pedicled gracilis flap. In all cases the defect was due to Fournier's gangrene. The characteristics of the patients were studied and testicle hormonal function as well as satisfaction after the reconstruction were assessed, with a mean follow-up of 5 ± 3.6 years. Results: From 19 operated patients, 11 were included in the survey: 5 patients were reconstructed through pedicled gracilis muscle flap with skin graft and 6 by means of split thickness skin graft. There were no differences between the groups with regard to the values of testicular hormonal function. Nevertheless, differences were observed in favor of the reconstruction by pedicled gracilis flap regarding to satisfaction (93 versus 60 points), feelings of protection (98 versus 68 points), effects on sexual activity (20% versus 80%) and tactile rude sensibility of the area reconstructed (80% versus 0%). Conclusions: Reconstruction of scrotum defect through pedicled gracilis flap turned out to be in our sample a better aesthetic result and a higher satisfaction of the patient that the reconstruction by means of skin grafts. However, no differences were found regarding testicular hormonal function

Attitudes of students of a health sciences university towards the extension of smoke-free policies at the university campuses of Barcelona (Spain) / Actitudes de los estudiantes de una universidad de ciencias de la salud sobre la extensión de las políticas de espacios sin humo en los campus universitarios de Barcelona (España)

Objective: To assess attitudes towards the extension of outdoor smoke-free areas on university campuses. Methods: Cross-sectional study (n=384) conducted using a questionnaire administered to medical and nursing students in Barcelona in 2014. Information was obtained pertaining to support for indoor and outdoor smoking bans on university campuses, and the importance of acting as role models. Logistic regression analyses were performed to examine agreement. Results: Most of the students agreed on the importance of health professionals and students as role models (74.9% and 64.1%, respectively) although there were statistically significant differences by smoking status and age. 90% of students reported exposure to smoke on campus. Students expressed strong support for indoor smoke-free policies (97.9%). However, only 39.3% of participants supported regulation of outdoor smoking for university campuses. Non-smokers (OR=12.315; 95% CI: 5.377-28.204) and students ≥22 years old (OR=3.001; 95% CI: 1.439-6.257) were the strongest supporters. Conclusions: The students supported indoor smoke-free policies for universities. However, support for extending smoke-free regulations to outdoor areas of university campuses was limited. It is necessary to educate students about tobacco control and emphasise their importance as role models before extending outdoor smoke-free legislation at university campuses (AU)

Objetivo: Evaluar las actitudes hacia la extensión de las políticas de campus exteriores sin humo. Métodos: Estudio transversal (n=384) mediante cuestionario administrado a estudiantes de enfermería y medicina de Barcelona en 2014. Se obtuvo información sobre el apoyo a los recintos universitarios sin tabaco (interior y exterior) y el acuerdo con el rol ejemplar. Se realizaron análisis de regresión logística para examinar el acuerdo. Resultados: La mayoría de los estudiantes están de acuerdo en la importancia del rol ejemplar de los profesionales y de los estudiantes sanitarios (74,9% y 64,1%, respectivamente), aunque hay diferencias estadísticamente significativas por edad y consumo de tabaco. El 90% afirman estar expuestos al tabaco en el campus. Existe un gran apoyo a los espacios interiores libres de humo (97,9%), pero solo el 39,3% apoya la regulación de los espacios exteriores en el campus; los no fumadores (odds ratio [OR]=12,315; intervalo de confianza del 95% [IC95%]: 5,377-28,204) y el grupo de ≥22 años de edad (OR=3,001, IC95%: 1,439- 6,257) expresaron el mayor apoyo. Conclusiones: Los estudiantes apoyan las prohibiciones de consumo de tabaco en los espacios interiores de las universidades. Existe un apoyo limitado para extender la regulación de espacios sin humo a los exteriores de los campus universitarios. Es necesario sensibilizar a los estudiantes sobre el control del tabaco y fomentar su rol ejemplar antes de extender la legislación de espacios exteriores (AU)

Síndrome GAPO, a propósito de un caso / GAPO syndrome: case report

El síndrome GAPO es una rara enfermedad autosómica recesiva caracterizada por retraso en el crecimiento, alopecia, pseudoanodoncia y atrofia óptica. Se han descrito mutaciones en el gen ANTXR1 como origen etiológico. Presenta afectación de múltiples aparatos, por lo que requiere un manejo multidisciplinar para lograr su adecuado tratamiento.

GAPO syndrome is a rare autosomal recessive disease characterized by growth retardation, alopecia, pseudoanodontia and optic atrophy. Gene alterations in the ANTXR1 gene have been reported to be causative of this disorder. Abnormalities of diverse organs and systems have been described. A multidisciplinary management to achieve an adequate treatment is required.

Tratamiento quirúrgico del paciente gran quemado: casuística de siete años en el Hospital Universitario y Politécnico la Fe de Valencia, España / Tratamento cirúrgico do paciente grande queimado: casuística de sete anos do Hospital Universitario y Politécnico la Fe de Valência, Espanha / Surgical treatment of the major burn: seven years experience in the University and Polytechnic La Fe Hospital of Valencia, Spain

Objetivo: Caracterizar los casos atendidos en el Hospital Universitario y Politécnico la Fe de Valencia, España, en el transcurso de 7 años de uso de un protocolo quirúrgico para pacientes con quemaduras de más del 50% de superfície corporal quemada (SCQ). Métodos: Se ha realizado un análisis descriptivo de los pacientes con quemaduras mayores al 50% de SCQ, tratados entre enero de 2011 y enero de 2017, en la Unidad de Quemados del Hospital La Fe (Valencia, España). Todos los pacientes fueron tratados de acuerdo al protocolo quirúrgico establecido en nuestra unidad para el paciente gran quemado. Resultados: Se trataron 35 pacientes, 25 varones y 10 mujeres, con edad media de 51,3±16,2 años. La llama fue el agente lesional más frecuente. La SC media afecta por quemadura fue 66,9±13,5%. La tasa de mortalidad (TM) neta fue del 55%, siendo el shock por quemadura la causa de muerte predominante en las primeras 48h y la sepsis tras las 48h. Conclusiones: El paciente gran quemado supone un reto terapéutico donde un enfoque multidisciplinar es determinante para su adecuada evolución. En nuestra serie, la estandarización del tratamiento quirúrgico mediante un protocolo ha permitido un adecuado manejo de los pacientes con una TM inferior a la estimada y comparable a la informada en la literatura.

Objetivo: Caracterizar os casos atendidos no Hospital Universitário y Politécnico la Fe de Valencia, Espanha, no transcurso de sete anos de uso de um protocolo cirúrgico para pacientes com queimaduras de superfície corporal queimada (SCQ) superior a 50%. Método: foi realizada análises descritiva dos casos de pacientes com SCQ superior a 50%, tratados entre janeiro de e janeiro de 2017, na Unidade de Queimados do Hospital La Fe (Valência, Espanha). Todos os pacientes foram tratados de acordo com o protocolo cirúrgico estabelecido na unidade para o paciente grande queimado. Resultados: Foram tratados 35 pacientes, 25 homens e 10 mulheres, com idade média de 51,3±16,2 anos. A chama foi o agente causador mais frequente. A SCQ media foi de 66,9±13,5%. A taxa de mortalidade (TM) foi de 55%, sendo o choque por queimadura a causa de morte predominante nas primeiras 48h e a sepses após 48h. Conclusões: O paciente grande queimado representa um desafio terapêutico no qual o foco multidisciplinar é determinante para sua adequada evolução. Nos casos estudados, a padronização do tratamento cirúrgico por meio de um protocolo permitiu um adequado manejo dos pacientes com una TM inferior à estimada e comparável à informada na literatura.

Objective: To characterize the cases treated at the University and Polytechnic la Fe Hospital in Valencia, Spain, over the course of 7 years with the use of a surgical protocol for patients with burns greater than 50% of total body surface area (TBSA). Methods: From January 2011 to January 2017, 35 patients with burns greater than 50% TBSA were treated in our Burn Unit. All patients were treated according to our major burn surgical protocol. Results: A total of 35 patients were treated, 25 men and 10 women, with a mean age of 51.3±16.2 years. Flame burn was the most common etiology. The mean TBSA affected was 66.9±13.5%. The mortality rate was 55%, with burn shock being the main cause of death in the first 48 hours. Conclusion: Patients with burns greater than 50% TBSA suppose a therapeutic challenge where a multidisciplinary approach is essential for its adequate evolution. In our series, the treatment standardization with a protocol has allowed an adequate management of the patients with a mortality rate similar to the literature report and lower than our estimated rate.

Recomendaciones de rehabilitación en el paciente quemado: revisión de literatura / Recomendações de reabilitação para paciente queimado: revisão da literatura / Rehabilitation recommendations in the burn patient: literature review

OBJETIVO: Realizar una revisión bibliográfica acerca de la rehabilitación en el paciente quemado, sintetizando las recomendaciones expuestas por los documentos de consenso internacionales y la bibliografía reciente. Además, exponemos la manera en que estas recomendaciones se han aplicado en la Unidad de Grandes Quemados del Hospital La Fe, en forma de un protocolo multidisciplinar de rehabilitación intensiva. MÉTODO: Se realizó una búsqueda bibliográfica de la literatura existente y los consensos internacionales centrados en el ámbito de la rehabilitación en el paciente quemado. Seguidamente, se relata la forma en que estas recomendaciones fueron implementadas en la Unidad de Grandes Quemados del Hospital La Fe de Valencia; en forma de un protocolo de rehabilitación intensivo y multidisciplinar. RESULTADOS: La bibliografía revisada refuerza los argumentos en favor del desarrollo y aplicación de protocolos de rehabilitación intensiva en las unidades de quemados para la mejora de los resultados funcionales de los pacientes. La experiencia en nuestra unidad en la cual se aplica un protocolo de este tipo coincide con los buenos resultados reportados. CONCLUSIONES: La aplicación precoz de una terapia rehabilitadora intensiva resulta clave a la hora de prevenir y tratar las posibles complicaciones funcionales y secuelas producidas por las quemaduras. Este tratamiento rehabilitador interdisciplinar se ha de centrar en la prevención de problemas a largo plazo, como las contracturas, la cicatrización anómala, deformidades, atrofia muscular, limitación de movilidad y otros problemas que merman la función física. Su utilización en cualquier unidad de quemados, permitirá optimizar los resultados funcionales de nuestros pacientes.(AU)

Objetivo: Realizar uma revisão da literatura científica sobre a reabilitação do paciente queimado, resumindo as recomendações estabelecidas por documentos de consenso internacional e na literatura recente. Além disso, apresentamos como essas recomendações foram implementadas na Unidade de Grandes Queimados do Hospital La Fe, na forma de um protocolo de reabilitação intensivo multidisciplinar. Método: Pesquisa bibliográfica da literatura e do consenso internacional existente centrado no campo da reabilitação no paciente queimado. Foi relatado como as recomendações internacionais foram implementadas para a prática dentro da unidade para atendimento ao grande queimado, no Hospital La Fe, no formato de um protocolo de reabilitação intensivo multidisciplinar. Resultados: A literatura existente reforça o desenvolvimento e implementação de protocolos de reabilitação intensiva em unidades de queimados para melhorar os resultados funcionais dos pacientes. A experiência em nossa unidade, em que esse tipo de protocolo é aplicado, corresponde aos bons resultados descritos na literatura. Conclusões: A aplicação antecipada de terapia de reabilitação intensiva é fundamental para a prevenção e tratamento de complicações e possíveis consequências funcionais causadas por queimaduras. Este tratamento interdisciplinar de reabilitação tem de se concentrar na prevenção de problemas de longo prazo, tais como contraturas, cicatrizes anormais, deformidades, atrofia muscular, dificuldade de locomoção e outros problemas que prejudicam a função física. Seu uso em qualquer unidade de queimados irá otimizar os resultados funcionais dos nossos pacientes.(AU)

ABSTRACT: OBJECTIVE: To perform a bibliographic review about rehabilitation of the burn patient, summarizing recommendations provided by international consensus documents and the most recent evidence. Moreover, we present the method in which this recommendations have been applied to the Great Burns Unit of the Hospital La Fe, in the format of a interdisciplinary intensive rehabilitation protocol. METHOD: A bibliographic search was performed among existent literature and international consensus documents focused on the field of burn patient rehabilitation. Following, the way in which this recommendations were applied at the Great Burns Unit of the Hospital La Fe of Valencia are presented in the shape of an intensive and multidisciplinar rehabilitation protocol. RESULTS: Reviewed bibliography supports the development and application of intensive rehabilitation protocols in burn units for the improvement of the functional results of their patients. The experience in our unit in which this sort of protocol is applied, matches the good results described in literature. CONCLUSIONS: Early intensive rehabilitation therapy is a key stone when it comes to prevention and treatment of functional complications. This interdisciplinary approach must focus in prevention of long term complications, such as contractures, abnormal scarring, deformities, muscular atrophy, mobility limitations and other issues which can decrease physical function. Its utilization in a Burn Unit, will help optimize functional results of their patients.(AU)

Traumatismo renal grado v en paciente con estenosis de la unión pieloureteral no conocida / V grade renal trauma in patient with union pyeloureteral stenosis not known

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