Enhancing Robotic Perception through Synchronized Simulation and Physical Common-Sense Reasoning.

We introduce both conceptual and empirical findings arising from the amalgamation of a robotics cognitive architecture with an embedded physics simulator, aligning with the principles outlined in the intuitive physics literature. The employed robotic cognitive architecture, named CORTEX, leverages a highly efficient distributed working memory known as deep state representation. This working memory inherently encompasses a fundamental ontology, state persistency, geometric and logical relationships among elements, and tools for reading, updating, and reasoning about its contents. Our primary objective is to investigate the hypothesis that the integration of a physics simulator into the architecture streamlines the implementation of various functionalities that would otherwise necessitate extensive coding and debugging efforts. Furthermore, we categorize these enhanced functionalities into broad types based on the nature of the problems they address. These include addressing challenges related to occlusion, model-based perception, self-calibration, scene structural stability, and human activity interpretation. To demonstrate the outcomes of our experiments, we employ CoppeliaSim as the embedded simulator and both a Kinova Gen3 robotic arm and the Open-Manipulator-P as the real-world scenarios. Synchronization is maintained between the simulator and the stream of real events. Depending on the ongoing task, numerous queries are computed, and the results are projected into the working memory. Participating agents can then leverage this information to enhance overall performance.

Improved lipid-lowering treatment and reduction in cardiovascular disease burden in homozygous familial hypercholesterolemia: The SAFEHEART follow-up study.

AIM: We aimed to describe clinical and genetic characteristics, lipid-lowering treatment and atherosclerotic cardiovascular disease (ASCVD) outcomes over a long-term follow-up in homozygous familial hypercholesterolemia (HoFH). METHODS: SAFEHEART (Spanish Familial Hypercholesterolaemia Cohort Study) is a long-term study in molecularly diagnosed FH. Data analyzed in HoFH were prospectively obtained from 2004 until 2022. ASCVD events, lipid profile and lipid-lowering treatment were determined. RESULTS: Thirty-nine HoFH patients were analyzed. The mean age was 42 ± 20 years and nineteen (49%) were women. Median follow-up was 11 years (IQR 6,18). Median age at genetic diagnosis was 24 years (IQR 8,42). At enrolment, 33% had ASCVD and 18% had aortic valve disease. Patients with new ASCVD events and aortic valve disease at follow-up were six (15%), and one (3%), respectively. Median untreated LDL-C levels were 555 mg/dL (IQ 413,800), and median LDL-C levels at last follow-up was 122 mg/dL (IQR 91,172). Most patients (92%) were on high intensity statins and ezetimibe, 28% with PCSK9i, 26% with lomitapide, and 23% with lipoprotein-apheresis. Fourteen patients (36%) attained an LDL-C level below 100 mg/dL, and 10% attained an LDL-C below 70 mg/dL in secondary prevention. Patients with null/null variants were youngers, had higher untreated LDL-C and had the first ASCVD event earlier. Free-event survival is longer in patients with defective variant compared with those patients with at least one null variant (p=0.02). CONCLUSIONS: HoFH is a severe life threating disease with a high genetic and phenotypic variability. The improvement in lipid-lowering treatment and LDL-C levels have contributed to reduce ASCVD events.

Concentration of low-density lipoproteins (LDL) is significantly reduced after nilotinib discontinuation.

Dyslipidemia is a frequent side effect associated with nilotinib treatment. Patients with chronic myeloid leukemia (CML) under treatment with nilotinib who develop dyslipidemia have been shown to have a higher risk of presenting atherosclerotic cardiovascular disease (ACVD). Therapeutic discontinuation in selected individuals could be a strategy in order to prevent the development of ACVD. Observational study of patients with CML under nilotinib treatment. The lipid values were gathered before starting with nilotinib and after 3 months. Such values were also measured before discontinuation in patients who suspended nilotinib treatment, as well as 3 and 12 months later. 32 patients were included, 19 of them treated in monotherapy with nilotinib. The concentrations of total cholesterol and low-density lipoproteins (LDL) increased significantly after 3 months of treatment (27.29 mg/dL ± 22.88, p < 0.01). Of the total number of patients treated, 12 discontinued the treatment. LDL concentration was significantly reduced after 3 months of the nilotinib discontinuation (- 27.58 mg/dL ± 38.30, p = 0.030), remaining substantially lower after 12 months, compared to the time previous to discontinuation (- 24.58 mg/dL ± 37.31, p = 0.043). Nilotinib suspension reduces significantly LDL concentrations. These data support the strategy of therapeutic discontinuation in order to prevent future cardiovascular complications, especially in patients with prior cardiovascular risk factors.

Persistence with long-term PCSK9 inhibitor treatment and its effectiveness in familial hypercholesterolaemia: data from the SAFEHEART study.

AIMS: Most heterozygous familial hypercholesterolaemia (FH) patients require intensive lipid-lowering therapy (LLT) including PCSK9 inhibitors (PCSK9is) to reach current low-density lipoprotein cholesterol (LDL-C) goals. Persistence with chronic treatment is important to reduce the burden of atherosclerotic cardiovascular disease. We analysed persistence, efficacy, and impact on quality of life (QoL) of PCSK9i in FH patients in clinical practice setting. METHODS AND RESULTS: Spanish Familial Hypercholesterolaemia Cohort Study (SAFEHEART) is an open, prospective study in genetically defined FH patients in Spain. Patients ≥18 years of age (n = 696, 46% females) on stable LLT treated with PCSK9i were analysed. Median LDL-C at starting PCSK9i was 145 mg/dL [interquartile range (IQR), 123-177], 3.8 mmol/L (IQR 3.2-4.6). After a median follow up of 3.7 years (IQR 2.3-4.8), 27 patients (4%) discontinued PCSK9i treatment: 5 temporarily (0.7%) and 22 permanently (3.2%). Persistence with PCSK9i was 96.1% in the whole period. Median LDL-C levels and % LDL-C reduction attained after 1 year of treatment and in the last follow-up visit were 63 mg/dL (IQR 43-88), 1.6 mmol/L (IQR 1.1-2.23); 61 mg/dL (IQR 44-82), 1.6 mmol/L (IQR 1.1-2.1); 57.6% (IQR 39.5-69); and 58% (IQR 44-68), respectively. 2016 and 2019 ESC/EAS LDL-C goals were attained by 77 and 48% of patients, respectively, at the last follow-up visit (P < 0.001). Mean QoL score increased slightly in the first year and remained stable. CONCLUSION: Long-term persistence with PCSK9i in FH patients is very high, with a good QoL. Effectiveness in LDL-C reduction and LDL-C goal achievement dramatically improved with PCSK9i in this high-risk population in clinical practice setting. TRIAL REGISTRATION: ClinicalTrials.gov number NCT02693548.

Clinical, psychological, social, and family characterization of suicidal behavior in Chilean adolescents: a multiple correspondence analysis. / Caracterización clínica, psicológica y sociofamiliar de la conducta suicida en adolescentes chilenos: análisis de correspondencias múltiples.

Introduction Suicide is the second leading cause of premature death in people between 15 and 29 years old and the third in young people between 15 and 19 years old. Adolescence is a critical period concerning mental health disorders since there is greater vulnerability to suicidal behaviors. The situation in Latin America is worrying, with Chile being one of the two countries where suicide rates of children and adolescents increase yearly. This study aims to analyze clinical, psychological, family, and social risk factors associated with suicidal behavior in a clinical sample of adolescents treated in the public health system of the Maule region. Methods The study design is cross- sectional. We used a sample of 388 adolescents between 10 and 21 years old admitted to the health system of the Maule Region. The participants were evaluated by applying five measuring instruments (The Barrat Impulsivity Scale, The Difficulties in Emotional Regulation Scale, The Depression, Anxiety and Stress Scale, The General Help-Seeking Questionnaire for mental health problems in adolescents, and The Columbia Suicide Severity Rating Scale) in addition to collecting social and family information and relevant clinical history from the medical records. Results The analysis allowed us to identify distinctive characteristics of adolescent suicidal behavior by describing clinical, psychological, and family social factors. Conclusions Adolescents with a history of suicide attempts are characterized by having suicidal ideation, anxious-depressive symptoms, stress, insomnia, and impulsiveness. Likewise, they report being non-religious, belonging to sexual minorities, and victims of sexual harassment and/or abuse.

Introducción El suicidio es la segunda causa de muerte prematura en personas entre 15 y 29 años, y la tercera en jóvenes entre 15 y 19 años. La adolescencia es un periodo crítico, dado que existe mayor vulnerabilidad para conductas suicidas. La situación en América Latina es crítica, siendo Chile uno de los dos países donde las tasas de suicidio de niños y adolescentes aumentan año tras año. En este estudio se analizan factores de riesgo clínicos, psicológicos y sociofamiliares asociados con la conducta suicida, en una muestra clínica de adolescentes atendidos en el sistema de salud público de la región del Maule. Método El diseño del presente estudio es transversal. En él se utilizó una muestra de 388 adolescentes de 10 a 21 años ingresados al sistema de salud de la Región del Maule. Durante la recogida de información se aplicaron cinco instrumentos de medición (escalas de impulsividad de Barrat, de dificultades de regulación emocional, de depresión, ansiedad y estrés, cuestionario general de búsqueda de ayuda para problemas de salud mental en adolescentes y escala de clasificación de gravedad del suicidio de Columbia). Además se recabó información sociofamiliar y antecedentes relevantes desde las fichas clínicas. Resultados El análisis realizado permitió identificar características distintivas de la conducta suicida adolescente, mediante la descripción de factores clínicos, psicológicos y sociofamiliares evaluados. Conclusión Los adolescentes con historial de intentos de suicidio se caracterizan por presentar ideación suicida, sintomatología ansiosa- depresiva, estrés, insomnio e impulsividad. Asimismo, reportan no tener creencias religiosas, pertenecer a minorías sexuales y haber sido víctima de acoso y/o abuso sexual.

Financial Hardship, Hope, and Life Satisfaction Among Un/Underemployed Individuals With Psychiatric Diagnoses: A Mediation Analysis.

Background: Individuals with psychiatric diagnoses who are unemployed or underemployed are likely to disproportionately experience financial hardship and, in turn, lower life satisfaction (LS). Understanding the mechanisms though which financial hardship affects LS is essential to inform effective economic empowerment interventions for this population. Aim: To examine if subjective financial hardship (SFH) mediates the relationship between objective financial hardship (OFH) and LS, and whether hope, and its agency and pathways components, further mediate the effect of SFH on LS among individuals with psychiatric diagnoses seeking employment. Methods: We conducted structured interviews with participants (N = 215) of two peer-run employment programs using indicators of OFH and SFH and standardized scales for hope (overall hope, hope agency, and hope pathways) and LS. Three structural equation models were employed to test measurement models for OFH and SFH, and mediational relationships. Covariates included gender, age, psychiatric diagnosis, race/ethnicity, education, income, employment status, SSI/SSDI receipt, and site. Results: Confirmatory factor analysis (CFA) for items measuring OFH and SFH supported two separate hypothesized factors. OFH had a strong and significant total effect on SFH [standardized beta (B) = 0.68] and LS (B = 0.49), and a weak-to-moderate effect on hope (B = -0.31). SFH alone mediated up to 94% of the effect of OFH on LS (indirect effect B = -0.46, p < 0.01). The effect of SFH on LS through hope was small (indirect effect B = -0.09, p < 0.05), primarily through hope agency (indirect effect B = -0.13, p < 0.01) and not hope pathways. Black and Hispanic ethno-racial identification seemed to buffer the effect of financial hardship on hope and LS. Individuals identifying as Black reported significantly higher overall hope (B = 0.41-0.47) and higher LS (B = 0.29-0.46), net of the effect of OFH and SFH. Conclusion: SFH is a strong mediator of the relationship between OFH and LS in our study of unemployed and underemployed individuals with psychiatric diagnoses. Hope, and particularly its agency component, further mediate a modest but significant proportion of the association between SFH and LS. Economic empowerment interventions for this population should address objective and subjective financial stressors, foster a sense of agency, and consider the diverse effects of financial hardship across ethno-racial groups.

Is it necessary to perform cardiovascular screening in migrant patients? / ¿Es necesario realizar un screening cardiovascular en los pacientes migrantes?

Migrant patients arriving in Spain often come from countries where there is no universal access to healthcare. Although the prevalence of arterial hypertension (HTN) is lower in West Africa than in Spain, there is a higher prevalence of masked HT due to the absence of health screening. Furthermore, patients with secondary hypertension may not be diagnosed. We present the case of a 36-year-old Senegalese man, with no known pathological history, resident for a year in Spain, who debuted with a hypertensive emergency. At the time of diagnosis, the patient had severe end-organ damage (hypertensive heart disease, hypertensive retinopathy). After the study, he was diagnosed with arterial hypertension secondary to malformation of the renal artery. After performing angioplasty, blood pressure normalized and, at 18 months, target organ damage had reduced. Migrants who arrive in our country must be incorporated into health screening systems to diagnose and treat possible unknown pathologies. In our case, the clue to secondary hypertension was the development of resistant hypertension with target organ damage in a young subject.

Caracterización clínica, psicológica y sociofamiliar de la conducta suicida en adolescentes chilenos: análisis de correspondencias múltiples / Clinical, psychological, social, and family characterization of suicidal behavior in Chilean adolescents: a multiple correspondence analysis

Introducción El suicidio es la segunda causa de muerte prematura en personas entre 15 y 29 años, y la tercera en jóvenes entre 15 y 19 años. La adolescencia es un periodo crítico, dado que existe mayor vulnerabilidad para conductas suicidas. La situación en América Latina es crítica, siendo Chile uno de los dos países donde las tasas de suicidio de niños y adolescentes aumentan año tras año. En este estudio se analizan factores de riesgo clínicos, psicológicos y sociofamiliares asociados con la conducta suicida, en una muestra clínica de adolescentes atendidos en el sistema de salud público de la región del Maule. Método El diseño del presente estudio es transversal. En él se utilizó una muestra de 388 adolescentes de 10 a 21 años ingresados al sistema de salud de la Región del Maule. Durante la recogida de información se aplicaron cinco instrumentos de medición (escalas de impulsividad de Barrat, de dificultades de regulación emocional, de depresión, ansiedad y estrés, cuestionario general de búsqueda de ayuda para problemas de salud mental en adolescentes y escala de clasificación de gravedad del suicidio de Columbia). Además se recabó información sociofamiliar y antecedentes relevantes desde las fichas clínicas. Resultados El análisis realizado permitió identificar características distintivas de la conducta suicida adolescente, mediante la descripción de factores clínicos, psicológicos y sociofamiliares evaluados. Conclusión Los adolescentes con historial de intentos de suicidio se caracterizan por presentar ideación suicida, sintomatología ansiosa- depresiva, estrés, insomnio e impulsividad. Asimismo, reportan no tener creencias religiosas, pertenecer a minorías sexuales y haber sido víctima de acoso y/o abuso sexual.

Introduction Suicide is the second leading cause of premature death in people between 15 and 29 years old and the third in young people between 15 and 19 years old. Adolescence is a critical period concerning mental health disorders since there is greater vulnerability to suicidal behaviors. The situation in Latin America is worrying, with Chile being one of the two countries where suicide rates of children and adolescents increase yearly. This study aims to analyze clinical, psychological, family, and social risk factors associated with suicidal behavior in a clinical sample of adolescents treated in the public health system of the Maule region. Methods The study design is cross- sectional. We used a sample of 388 adolescents between 10 and 21 years old admitted to the health system of the Maule Region. The participants were evaluated by applying five measuring instruments (The Barrat Impulsivity Scale, The Difficulties in Emotional Regulation Scale, The Depression, Anxiety and Stress Scale, The General Help-Seeking Questionnaire for mental health problems in adolescents, and The Columbia Suicide Severity Rating Scale) in addition to collecting social and family information and relevant clinical history from the medical records. Results The analysis allowed us to identify distinctive characteristics of adolescent suicidal behavior by describing clinical, psychological, and family social factors. Conclusions Adolescents with a history of suicide attempts are characterized by having suicidal ideation, anxious-depressive symptoms, stress, insomnia, and impulsiveness. Likewise, they report being non-religious, belonging to sexual minorities, and victims of sexual harassment and/or abuse.

Confidencialidad y conducta de búsqueda de ayuda para problemas de salud mental en adolescentes / Confidentiality and help-seeking behavior for adolescent mental health problems / Confidencialidade e conduta de busca de ajuda para problemas de saúde mental em adolescentes

Resumen: Prevenir y detectar tempranamente los problemas de salud mental en población adolescente es fundamental para disminuir la posibilidad de desarrollar trastornos más graves. Asimismo, buscar ayuda para estos problemas y acceder de manera oportuna a la atención en salud mental en este grupo es necesario. No obstante, se ha constatado que los adolescentes tienden a no buscar ayuda profesional cuando presentan sintomatología de trastornos emocionales y, cuando la buscan, más bien lo hacen en fuentes informales. Diversas barreras, a nivel individual, estructural, social, y de la relación profesional salud-paciente, pueden obstaculizar la conducta de búsqueda de ayuda en los adolescentes. Entre estas se encuentra la preocupación de los jóvenes por la confidencialidad. En el presente artículo se expone y analiza evidencia sobre el rol de la confidencialidad en la conducta de búsqueda de ayuda para problemas de salud mental en adolescentes, planteando en su análisis una mirada desde la bioética y señalando algunas de sus implicancias en el abordaje de las prestaciones de salud mental juvenil.

Abstract: Prevention and early detection of mental health problems in the adolescent population is essential to reduce the possibility of developing more serious disorders. Likewise, seeking help for these problems and timely access to mental health care in this group is necessary. However, it has been found that adolescents tend not to seek professional help when they present symptoms of emotional disorders and, when they do seek help, they do so from informal sources. Various barriers, at the individual, structural, social, and health professional-patient relationship levels, can hinder help-seeking behavior in adolescents. Among these is young people's concern about confidentiality. This article presents and analyzes evidence on the role of confidentiality in help-seeking behavior for mental health problems in adolescents, presenting an analysis from a bioethical perspective and pointing out some of its implications in the approach to youth mental health services.

Resumo: Prevenir e detectar precocemente os problemas de saúde mental em população adolescente é fundamental para diminuir a possibilidade de desenvolver transtornos mais graves. Assim mesmo, para esse grupo é necessário buscar ajuda para esses problemas e acessar oportunamente atenção em saúde mental. Não obstante, constatou-se que os adolescentes tendem a não buscar ajuda profissional quando apresentam sintomatologia de transtornos emocionais e, quando buscam, o fazem em fontes informais. Diversas barreiras, em nível individual, estrutural, social e da relação profissional da saúde-paciente, podem obstaculizar a conduta de busca de ajuda pelos adolescentes. Entre estas se encontra a preocupação dos jovens com a confidencialidade. No presente artigo se expõe e analisa-se evidencias sobre o papel da confidencialidade na conduta de busca de ajuda para problemas de saúde mental em adolescentes, propondo-se um olhar a partir da bioética e ressaltando algumas de suas implicações na abordagem da saúde mental juvenil.

Combining familial hypercholesterolemia and statin genetic studies as a strategy for the implementation of pharmacogenomics. A multidisciplinary approach.

The diagnostic process of familial hypercholesterolemia frequently involves the use of genetic studies. Patients are treated with lipid-lowering drugs, frequently statins. Although pharmacogenomic clinical practice guidelines focusing on genotype-based statin prescription have been published, their use in routine clinical practice remains very modest.We have implemented a new NGS strategy that combines a panel of genes related to familial hypercholesterolemia with genomic regions related to the pharmacogenomics of lipid-lowering drugs described in clinical practice guidelines and in EMA and FDA drug labels. A multidisciplinary team of doctors, biologists, and pharmacists creates a clinical report that provides diagnostic and therapeutic findings using a knowledge management and clinical decision support system, as well as an algorithm for treatment selection.For 12 months, a total of 483 genetic diagnostic studies for familial hypercholesterolemia were carried out, of which 221 (45.8%) requested a complementary pharmacogenomic test. Of these 221 patients, 66.5% were carriers of actionable variants in any of the studied pharmacogenomic pathways: 46.6% of patients in one pathway, 19.0% in two pathways, and 0.9% in three pathways. 45.7% of patients could have a response to atorvastatin different from that of the reference population, 45.7% for simvastatin and lovastatin, 29.0% for fluvastatin, and 6.7% patients for pitavastatin.This implementation approach facilitates the incorporation of pharmacogenomic studies in clinical care practice, it does not add complexity nor additional steps to laboratory processes, and improves the pharmacotherapeutic process of patients.

Periodontitis is associated with higher subclinical atherosclerosis in patients with systemic lupus erythematosus.

AIM: To determine periodontitis prevalence in patients with systemic lupus erythematosus (SLE) and to assess whether periodontitis in SLE patients is associated with a greater subclinical atherosclerosis. METHODS: An observational case-control study was conducted in SLE (cases) and patients without any rheumatic diseases (controls), matched for sex. Sociodemographic and cardiometabolic variables were gathered, and SLE activity was assessed through several indexes. Periodontal examination registered probing pocket depth, clinical attachment level, bleeding on probing, plaque index, and tooth loss. Subclinical atherosclerosis was assessed by measuring the carotid-femoral pulse wave velocity (PWV) by Doppler velocimetry, homocysteine levels, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Bivariate analyses and logistic regression were used to assess the association of any of the studied variables with SLE. RESULTS: Seventy-one cases and 72 controls were included in the study. Thirty-nine SLE patients (54.9%) were diagnosed with periodontitis, compared with 16 controls (22.2%). High levels of PWV (≥7.7 m/s, 75th percentile) were shown by 44.3% of the cases vs. 22.4% of the controls (p = .011). Among SLE patients, those with periodontitis showed higher PWV values (8.1 ± 1.52 vs. 7.16 ± 1.11 m/s, p = .006) and higher homeostasis model assessment index (indicative of insulin resistance) (1.7 ± 0.73 vs. 2.92 ± 3.05, p = .028) compared to those with periodontal health. Logistic regression showed that waist circumference (OR 1.06, 95% CI 1.01-1.12, p = .015); ESR (OR 1.09, 95% CI 1.03-1.16, p = .003); and bleeding on probing (OR 1.1, 95% CI 1.01-1.19, p = .018) were associated with the risk of SLE. CONCLUSION: Systemic lupus erythematosus patients showed a higher periodontitis percentage than controls. Higher PWV values were found in SLE patients with periodontitis, indicating a higher prevalence of subclinical atherosclerosis. Patients with higher gingival bleeding showed a higher risk of SLE.

Longitudinal trajectories of suicidal ideation and attempts in adolescents with psychiatric disorders in Chile: study protocol.

INTRODUCTION: Adolescent suicide is a worldwide public health problem, being the second and the third leading cause of death in the 15-29 and the 15-19 age groups, respectively. Among adolescents, it is estimated that for every suicide, there are 100-200 suicide attempts. Although 79% of suicides in the world occur in low/middle-income countries, most of scientific evidence comes from high-income and low-risk countries. In recent years, adolescent suicide rates have steadily increased in Chile. Deaths caused by self-harm increased by 220% in the population aged 10-19 years between 2000 and 2015. The Maule Region is one of the regions of Chile with the highest levels of suicide among those aged 15 and 19 years old. The objective of this study is to evaluate the trajectories of ideation and suicidal attempts in adolescents with psychiatric disorders treated within the public health system of the Maule Region, Chile, based on different clinical, psychological and neuropsychological factors. METHOD: A prospective naturalistic study of a clinical sample of adolescents under psychiatric treatment in the Maule Region, Chile. Adolescents will be evaluated using a thorough protocol that includes suicide-related clinical variables. The study seeks to establish patterns of change in the trajectories of ideation and suicide attempts among adolescents. ETHICS AND DISSEMINATION: Ethical approval was granted by the Scientific Ethics Committee of the Universidad Católica del Maule in Chile. This protocol was registered in ClinicalTrials.gov. The results of this study will be disseminated to health centres through executive reports and feedback sessions. In addition, the most relevant findings will be presented in scientific articles, conferences and seminars open to the community. TRIAL REGISTRATION NUMBER: NCT04635163.

Arterial hypertension assessment in a population with chronic myeloid leukemia.

Treatment of chronic myeloid leukaemia (CML) is based on tyrosine kinase inhibitors (TKI), whose introduction in 2001 improved the survival rate after 5 years from 40 to 90%. The longevity increase has been accompanied by a higher incidence of cardiovascular events (CVE) that can be explained due to the sum of cardiovascular risk factors (CVRF) together with the secondary effects of the TKI. The effect of the TKI over the blood pressure control is still unknown. An observational cross-sectional study of patients with CML under treatment with TKI (imatinib, dasatinib and nilotinib) was conducted. Blood pressure was analyzed through sphygmomanometer and 24-h ambulatory blood pressure monitoring (ABPM). A total of 73 patients were included, 57 treated with a single line of treatment. 32.9% of the total of individuals under this study showed uncontrolled blood pressure according to the ABPM. The factors related to uncontrolled BP were overweight, dyslipidemia, alcohol use, pulse wave velocity a high/very high cardiovascular risk. The subjects who received treatment with nilotinib did present worse control of their blood pressure in ABPM than those treated with imatinib and dasatinib (p = 0.041). This finding could indicate that an uncontrolled blood pressure is implied in the pro-inflammatory and pro-atherogenic mechanism underlying the development of the cardiovascular disease in those patients under treatment with nilotinib. The ABPM is a useful tool in the diagnosis and treatment of HT, being the reason why it should be included in the assessment of patients with CML whose HT diagnosis proves uncertain.

Who shot first? Three possible causes of a kidney infarction. / ¿Quién disparó primero? Infarto renal de tres posibles causas.

Renal infarction is a rare disease whose incidence is less than 1%. The symptoms can be abdominal or flank pain, nausea, vomiting, fever or hypertension. The diagnosis is complex, and it is based on symptoms, blood analysis with an elevated level of lactate dehydrogenase and computed tomography angiography. The two major causes of renal infarction are thromboembolism and in situ thrombosis. The treatment depends on an adequate etiological diagnosis.

Efficacy of PCSK9 inhibitors in the treatment of heterozygous familial hypercholesterolemia: A clinical practice experience.

BACKGROUND: PCSK9 inhibitors are a treatment option for patients with familial hypercholesterolemia not on low-density lipoprotein cholesterol goals despite the use of maximally tolerated high intensity-statins dose. OBJECTIVE: To evaluate the efficacy of alirocumab and evolocumab in LDL-C reduction and targets attainment in patients with heterozygous familial hypercholesterolemia in clinical practice setting. METHODS: SAFEHEART is an open, long-term prospective study of a cohort of subjects with molecular diagnosis of familial hypercholesterolemia. This study analyze subjects ≥ 20 years of age on stable lipid-lowering therapy, who received PCSK9 inhibitors during the period 2016 to January 2020. RESULTS: 433 patients (mean age 55 years, 53% male, 39% with cardiovascular disease) were included and followed-up for a median of 2.5 years (IQR 1.6-3.0). Median LDL-C level prior to PCSK9 inhibitors was 145 mg/dL (IQR 125-173). The addition of PCSK9 inhibitors (211 alirocumab, 222 evolocumab) reduced LDL-C by 58% (IQR 41-70) p<0.001, in men and women, achieving a median LDL-C level of 62 mg/dL (IQR 44-87) without differences between both PCSK9 inhibitors. Out of them 67% with and 80% without cardiovascular disease reached 2016 ESC/EAS LDL-C targets, and 46% very high risk and 50% high risk patients achieved 2019 ESC/EAS LDL-C goals. Independent predictor factors for attainment of 2019 ESC/EAS LDL-C goals were to be male, smoking and the use of statins with ezetimibe. Both inhibitors were well tolerated. CONCLUSIONS: PCSK9 inhibitors on top of maximum lipid-lowering treatment significantly reduced LDL-C levels in patients with familial hypercholesterolemia and improved the achievement of LDL-C targets.

Effectiveness and safety of PCSK9 inhibitors in real-world clinical practice. An observational multicentre study. The IRIS-PCSK9I study.

Background and aims: The benefits of the PCSK9 inhibitors, alirocumab and evolocumab, in lowering LDL-cholesterol and preventing major adverse cardiac events (MACE) have been demonstrated in pivotal clinical trials. However, few studies of routine clinical practice have been conducted to analyse and compare the efficacy and safety of the two drugs. Methods: Retrospective observational study of patients treated with a PCSK9 inhibitor in five hospitals in Andalusia (southern Spain). Baseline demographic and clinical data, LDL-cholesterol levels and the occurrence of MACEs during the follow-up period were recorded. Results: A total of 141 patients were included in the study: 90 were treated with alirocumab and 51 with evolocumab. The patients' mean age (IQR) was 58 (11) years and 58 (41%) were women. The most frequent concomitant medications were statins, 94 (66.7%), followed by antiplatelet therapy (66%) and ezetimibe (65.2%). The median (IQR) follow-up period was 18 (18) months, with 18 (24) for alirocumab and 11 (18) for evolocumab. At the six-month follow-up visit, LDL-cholesterol values had decreased to pre-treatment levels and remained significantly decreased (p < 0.05) over time, for both drugs, and a greater reduction was achieved in patients with established cardiovascular disease and concomitant treatment with statins. With respect to adverse effects, there were nine MACEs (6.4%), of which seven were with alirocumab (7.8%) and two with evolocumab (3.9%) (p NS). Other adverse effects (9.2%) included local erythema (3.5%), muscle cramps (2.1%), respiratory symptoms (2.1%) and asthaenia (1.4%). Conclusions: The efficacy and safety of alirocumab and evolocumab in routine clinical practice are consistent with the findings of the pivotal clinical trials.

Toward a Biosignature of Suicide Reattempt.

Suicidal behaviour (SB) is a major public health issue, which encompasses both suicide attempts and suicide completions. Suicide tragically accounts for up to almost one million deaths across the world every year. So far, suicide prediction models have focused on the so-called classic risk factors (male gender, depression, alcohol-related problems, and so on). However, suicide is, thankfully, a very rare outcome. As a result, these suicide predictive models have performed very poorly due to the high number of false positives to pick up suicides.However, a history previous suicide attempts has been consistently reported to be the strongest predictor of a future SB. Hence, suicide prevention strategies may prioritise high-risk groups such as those who reattempt/repeat suicide. More specifically, an alternative to the classic 'clinical' risk assessment approach, which is based on rating 'clinical' risk factors, may be to identify biomarkers, which may increase the specificity and sensitivity of the aforementioned suicide prediction models, thus helping clinicians to predict future SB.Within this context, this chapter provides an up-to-date literature review literature on biomarkers of repeated SB. Three main conclusions can be drawn from our review. First, there is a paucity of studies on the role of biomarkers in repeated suicide attempts to date. Second, the vast majority of these studies focused on two biomarkers, which have been also more comprehensively researched in SB, namely, the serotonin system abnormalities and the HPA axis dysfunction. Finally, 'it seems to be unlikely that there is a single biomarker of (repeated) SB'. Rather, future research should look at the complex dynamic interaction of a wide range of biological, clinical and neuropsychological contributing risk factors leading up to SB.

Designing a Cyber-Physical System for Ambient Assisted Living: A Use-Case Analysis for Social Robot Navigation in Caregiving Centers.

The advances of the Internet of Things, robotics, and Artificial Intelligence, to give just a few examples, allow us to imagine promising results in the development of smart buildings in the near future. In the particular case of elderly care, there are new solutions that integrate systems that monitor variables associated with the health of each user or systems that facilitate physical or cognitive rehabilitation. In all these solutions, it is clear that these new environments, usually called Ambient Assisted Living (AAL), configure a Cyber-Physical System (CPS) that connects information from the physical world to the cyber-world with the primary objective of adding more intelligence to these environments. This article presents a CPS-AAL for caregiving centers, with the main novelty that includes a Socially Assistive Robot (SAR). The CPS-AAL presented in this work uses a digital twin world with the information acquired by all devices. The basis of this digital twin world is the CORTEX cognitive architecture, a set of software agents interacting through a Deep State Representation (DSR) that stored the shared information between them. The proposal is evaluated in a simulated environment with two use cases requiring interaction between the sensors and the SAR in a simulated caregiving center.