Assessment of the Molecular Responses of an Ancient Angiosperm against Atypical Insect Oviposition: The Case of Hass Avocados and the Tephritid Fly Anastrepha ludens.

Anastrepha spp. (Diptera: Tephritidae) infestations cause significant economic losses in commercial fruit production worldwide. However, some plants quickly counteract the insertion of eggs by females by generating neoplasia and hindering eclosion, as is the case for Persea americana Mill., cv. Hass (Hass avocados). We followed a combined transcriptomics/metabolomics approach to identify the molecular mechanisms triggered by Hass avocados to detect and react to the oviposition of the pestiferous Anastrepha ludens (Loew). We evaluated two conditions: fruit damaged using a sterile pin (pin) and fruit oviposited by A. ludens females (ovi). We evaluated both of the conditions in a time course experiment covering five sampling points: without treatment (day 0), 20 min after the treatment (day 1), and days 3, 6, and 9 after the treatment. We identified 288 differentially expressed genes related to the treatments. Oviposition (and possibly bacteria on the eggs' surface) induces a plant hypersensitive response (HR), triggering a chitin receptor, producing an oxidative burst, and synthesizing phytoalexins. We also observed a process of cell wall modification and polyphenols biosynthesis, which could lead to polymerization in the neoplastic tissue surrounding the eggs.

Efficacy, safety and cost-effectiveness of a web-based platform delivering the results of a biomarker-based predictive model of biotherapy response for rheumatoid arthritis patients: a protocol for a randomized multicenter single-blind active controlled clinical trial (PREDIRA).

BACKGROUND: Rheumatoid arthritis (RA) is one of the leading chronic inflammatory rheumatism. First-line therapy with synthetic disease-modifying antirheumatic drugs (sDMARD) is insufficiently effective in 40% of cases and these patients are treated with biotherapies. The increased use of these drugs each year is becoming a public health issue with considerable economic burden. This cost is 20 times higher than that of sDMARD. However, among patients treated with biotherapies, clinical practice shows that about one third will not respond to the selected drug. In nonresponse cases, practitioners currently have no choice but to perform an empirical switching between different treatments, because no tool capable of predicting the response or nonresponse to these molecules is currently available. METHODS: The study is a prospective, phase III, controlled, multicenter, and randomized, single-blind (patient) clinical trial, including RA patients with a previous failure to anti-TNF therapies. The main objective is the analysis of the clinical and pharmacoeconomic impact after 6 months of treatment. Intervention arm: prescription of biotherapy (rituximab, adalimumab, abatacept) using SinnoTest® software, a prediction software based on proteomic biomarkers. Control arm: prescription of biotherapy based on current practice, without the SinnoTest® software (any biotherapy). In addition, a substudy will be carried out within this trial to generate a biobank and further analyze the proteomic profile of the patients and their modification throughout the study. DISCUSSION: This clinical trial study will be the first validation study of a biotherapy response prediction software, bringing personalized medicine into the management of RA. We expect that the findings from this study will bring several benefits for the patient and the Health Care System. TRIAL REGISTRATION: ClincalTrials.gov NCT04147026 . Registered on 31 October, 2019.

Centro SOL Research Consultation Services: Improving Research with Limited English Proficiency Latinx Populations.

From 2014-2019, Centro SOL provided research consultation services to 77 investigators interested in including Latinx and limited English proficiency populations in their research. The most common requests were for study recruitment (the very most common) and for translation and materials review. Challenges to providing services included financial sustainability and variable institutional review board policies, among others.

Centro SOL: A Community-Academic Partnership to Care for Undocumented Immigrants in an Emerging Latino Area.

PROBLEM: From 2000 to 2014, the Latino population in Baltimore city, an emerging Latino settlement area, experienced rapid growth. Many of these individuals are undocumented and not eligible for coverage. Academic medical centers often lead the way in addressing the health needs of undocumented immigrants; however, examples from emerging immigrant areas are limited. APPROACH: In October 2013, Johns Hopkins Medicine clinicians established the Center for Salud/Health and Opportunities for Latinos (Centro SOL) to better address the health needs of Baltimore's growing Latino community. Centro SOL's mission focuses on four core activities: clinical services; advocacy and community engagement efforts; pipeline/education opportunities; and research consultations. Progress is measured through a scorecard reviewed annually by Centro SOL leadership. OUTCOMES: Centro SOL's program has expanded health care access for undocumented immigrants, patient safety and quality of service/care programs for patients with limited English proficiency, and pipeline opportunities for Latino youth. In 2017, 2,763 uninsured patients received primary or specialty care and 290 people received group therapy to address stress-related conditions. In addition, 49 Latino students (ranging from high school to postgraduate students) received mentorship at Centro SOL. NEXT STEPS: In the next five years, Centro SOL plans to expand the pipeline for Latinos interested in health professions fields and to further improve access to health services for Latino families through both advocacy efforts and enhanced clinical services.

Testimonios, A Mental Health Support Group for Latino Immigrants in an Emergent Latino Community.

Latino immigrants face many stressors before, during, and after migration to the U.S., but there are few mental health services available to help them cope with this transition. We established free group sessions moderated by bilingual therapists to address the unmet mental health needs of Latino immigrants.

Impact of the use of musculoskeletal ultrasound by rheumatologists in patients with shoulder and hand complaints compared with traditional clinical care.

OBJECTIVES: To compare the routine use of musculoskeletal ultrasonography (MSUS) with traditional clinical care in daily practice at shoulder and hand level. METHODS: An observational study was performed in four rheumatology departments. Within each department, 2 rheumatologists were selected; one rheumatologist used MSUS, and the other followed traditional rheumatology care. Consecutive patients with nontraumatic pain, hand numbness or disability, or pain and/or limitations in the shoulder were selected. We collected information regarding the clinical and MSUS diagnoses, changes in diagnosis and treatment following MSUS, local injections, the rheumatologist's satisfaction and the use of health care resources. A descriptive analysis was performed. RESULTS: A total of 168 patients were analysed, with 104 and 64 patients in the MSUS and traditional care groups, respectively. MSUS led to a diagnosis and therapeutic change in 53 (52%) and 55 patients (54%), respectively. The rate of local injection was 47% in the MSUS group (73% unexpected, 61% performed using US) compared with 21% in the traditional group (p=0.001). According to the rheumatologists, MSUS was useful in 72 cases (71%) and extremely useful in 20 cases (20%), and the rheumatologists reported a higher satisfaction with their patient evaluations (p<0.001). The MSUS group required fewer additional tests (38% vs. 81%, respectively, p<0.001), fewer medical visits (46% vs. 84%, p<0.001), and lower direct costs (11 vs. 30 euros, p<0.001) than the traditional care group. CONCLUSIONS: Compared with traditional care, the routine use of MSUS in rheumatology practice at hand and shoulder level can lead to important improvements in care, thereby reducing the number of additional tests and medical visits.

Pain assessment in turning procedures for patients with invasive mechanical ventilation.

BACKGROUND: The assessment of pain is particularly difficult in critical patients unable to self-report or with cognitive impairment. In such cases, the use of scales which evaluate pain through patient behaviour is important. AIMS: To compare the behavioural responses to pain, measured on the Critical-Care Pain Observation Tool (CPOT) scale, and the physiological responses prior to, during and after the positioning procedure in patients with invasive mechanical ventilation. We also sought to analyse whether there are differences in the CPOT scores between medical and surgical patients, and between conscious and unconscious patients. METHOD: Pain scores were evaluated in 96 patients. The data gathering was carried out 1 min before, during and 10 min after the turning by means of the CPOT scale which includes four behavioural indicators, each indicator scored from 0 to 2. Likewise, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR) and arterial oxygen saturation (SpO(2)) were recorded. RESULTS: The total mean score on the CPOT scale prior to the positioning procedure was 0·27; during turning it was 1·93 and 0·10 after the procedure (p < 0·05). Facial expression was the indicator that increased most with reference to the baseline situation, followed by body movements; compliance with the ventilator, and finally, muscle tension. There were also slight variations in these physiological variables during the turning procedure (p < 0·05). The total mean score on the CPOT scale during the turning of surgical patients was 2·02 and 1·80 for medical patients (p = 0·162). CONCLUSIONS: The observation of the patient's behaviour during the turning and the physiological changes produced allow professionals to objectify pain in critical patients with verbal communication difficulties. Moreover, our results also highlight the need to administer of additional analgesia before a painful procedure, particularly in post-surgical patients. RELEVANCE TO CLINICAL PRACTICE: The good measurement qualities of the CPOT scale obtained during a painful procedure recommend its use in intensive care units (ICUs) for adult patients with artificial ventilation.

El método de elementos finitos y su aplicación en la investigación odontológica / The finite elements method and its application to dental research

Hace aproximadamente dos siglos, basado en la teoría de la elasticidad y mediante la aplicación de diferentes ecuaciones, matemáticos franceses y alemanes propusieron un modelo teórico para predecir los esfuerzos a los que está sometido un cuerpo bajo carga. La solución de este problema fue muy compleja debido al escaso desarrollo tecnológico de la época. Sólo en 1956, Turner, Clough, Martin y Topp presentaron el Método Computarizado de Elementos Finitos (MEF), el cual resuelve con gran aproximación las múltiples ecuaciones utilizadas en esta predicción. El MEF es un procedimiento ejecutado en un computador, que tiene el potencial de simular un modelo matemático equivalente a un objeto real, compuesto por diferentes materiales y de forma complicada. Es un método numérico versátil, aplicable en todos los campos de las ciencias exactas, principalmente en las ingenierías, civil, mecánica, biomédica y nuclear, asimismo, en geomecánica, hidráulica, medicina y odontología. La literatura presenta varios estudios que demuestran su utilidad en la investigación odontológica. Este artículo pretende ilustrar su uso y aplicabilidad en implantología, ortodoncia, ortopedia maxilar, prostodoncia y cirugía maxilofacial