Energy Self-Sufficiency Urban Module (ESSUM): GIS-LCA-based multi-criteria methodology to analyze the urban potential of solar energy generation and its environmental implications.

The concentration of the population in cities has turned them into sources of environmental pollution, however, cities have a great potential for generating clean energy through renewable sources such as a responsible use of solar energy that reaches its rooftops. This work proposes a methodology to estimate the level of energy self-sufficiency in urban areas, particularly in a district of the city of Zaragoza (Spain). First, the Energy Self-Sufficiency Urban Module concept (ESSUM) is defined, then the self-sufficiency capacity of the city or district is determined using Geographical Information Systems (GIS), Light Detection and Ranging (LiDAR) point clouds and cadastral data. Secondly, the environmental implications of the implementation of these modules in the rooftops of the city using the LCA methodology are calculated. The results obtained show that total self-sufficiency of Domestic Hot Water (DHW) can be achieved using 21 % of available rooftop area, meanwhile the rest of rooftop area, dedicated to photovoltaic (PV), can reach 20 % of electricity self-sufficiency, supposing a final balance of a reduction in CO2 emissions of 12,695.4 t CO2eq/y and energy savings of 372,468.5 GJ/y. This corresponds to a scenario where full self-sufficiency of DHW was prioritized, with the remaining roof area dedicated to PV installation. In addition, other scenarios have been analyzed, such as the implementation of the energy systems separately.

GIS-based assessment for the potential of implementation of food-energy-water systems on building rooftops at the urban level.

This research develops a bottom-up procedure to assess the potential of food-energy-water (FEW) systems on the rooftops of buildings in an urban district in Spain considering the urban morphology of the built environment and obtains accurate assessments of production and developmental patterns. A multicriteria decision-making technique implemented in a geographical information system (GIS) environment was used to extract suitable rooftop areas. To implement this method, the slope (tilt), aspect (azimuth), shading, and solar radiation of the rooftops were calculated using LiDAR (Light Detection and Ranging) data and building footprints. The potential of FEW system implementation was analysed at the building and morphology levels. The results showed several differences between residential and non-residential urban morphologies. Industrial areas contained the highest productivity for FEW systems. The production was 2.51 kg of tomatoes/m2, 48 kWh of photovoltaic energy/m2, and 0.16 l of rainwater/m2. Regarding the residential urban morphologies, the more compact tents resulted in better performance. Among the FEW systems, although water could best benefit from the features of the entire roof surface, the best production results were achieved by energy. The food system is less efficient in the built environment since it requires flat roofs. The methodology presented can be applied in any city, and it is considered optimal in the European context for the development of self-production strategies for urban environments.

Implications of immunomodulatory interleukins for the hyperimmunoglobulinemia of Sjögren's syndrome.

A prospective study of 37 patients with pSS and 20 healthy controls was performed to analyze the differences in circulating levels of macrophage-derived and Th1/Th2 cytokines which could explain the hyperimmunoglobulinemia, characteristic of primary Sjögren's syndrome (pSS). Serum levels of interleukin (IL)-6, IL-10, IL-12, gamma-interferon (gamma-INF) and IL-4 were analyzed by a sandwich immunoassay-based protein array system. When compared with the control group, higher levels of IL-6, IL-12 and IL-10 and a lower Th1/Th2 ratio, as demonstrated by the gamma-INF/IL-4 ratio, were detected in patients. The levels of IL-4 were notably higher in pSS patients with monoclonal gammopathy. Serum IL-4 and IL-10 levels and immunoglobulin G concentrations were significantly correlated. In conclusion, patients with pSS show a state of macrophage and T-lymphocyte activation with increased concentrations of cytokines implicated in the differentiation of B cells and secretion of immunoglobulins.

Health-related quality of life in patients with primary Sjögren's syndrome: relationship with serum levels of proinflammatory cytokines.

OBJECTIVE: A cross-sectional study of 30 patients with primary Sjögren's syndrome (pSS) was performed to analyse the health-related quality of life and its relationship with serum levels of macrophage- and lymphocyte-derived cytokines. PATIENTS AND METHODS: Health-related quality of life was evaluated using the 36-item Short Form Health Survey (SF-36). Serum levels of interleukin (IL)-1beta, IL-6, IL-10, tumour necrosis factor (TNF)-alpha, and gamma-interferon (gamma-INF) were analysed by a sandwich immunoassay-based protein array system. RESULTS: Each of the eight scales of the SF-36 evaluating quality of life, as well as the physical composite score (PCS) and the mental composite score (MCS), showed a decrease in pSS patients. Similarly, patients with pSS showed significantly increased concentrations of each of the five cytokines analysed, when compared with the healthy control group (n = 20). In pSS patients, a significant negative correlation was detected between serum levels of IL-6 and the PCS of the SF-36. Those patients with concentrations of IL-6 higher than those of the healthy controls showed a significantly lower score in the dimensions of bodily pain and physical functioning, and in the PCS. CONCLUSIONS: Patients with pSS showed increased levels of several macrophage- and lymphocyte-derived cytokines, indicating the existence of an immune activation state. Serum levels of one of these cytokines, IL-6, were correlated with poor quality of life in these individuals.

Review of economic studies and budget impact analysis of ocriplasmin as a treatment of vitreomacular traction. / Revisión de estudios económicos y análisis de impacto presupuestario de la ocriplasmina como tratamiento de la tracción vitreomacular.

OBJECTIVE: To review the evidence on the cost-effectiveness of ocriplasmin as a treatment for vitreomacular traction (VMT), and to estimate the impact on the Spanish National Health System (NHS). MATERIAL AND METHODS: 1) Systematic review. The following databases were searched in January 2015: MEDLINE, PREMEDLINE, EMBASE, CRD, the Cochrane Library, and key websites. Selection criteria were: full economic evaluations that compared ocriplasmin with usual care ('watch and wait' and/or vitrectomy) in patients with VMT. The outcomes to extract were costs of the alternatives and the incremental cost-effectiveness ratio. Studies of budget impact analysis were also included. The methodological quality was assessed, and a narrative synthesis of the included studies was carried out. 2) Estimation of budget impact. The impact on the budget as a result of the introduction of ocriplasmin in the NHS was estimated, including data from different sources. RESULTS: Six studies were identified, none of them performed in Spain. The two best studies concluded that ocriplasmin is cost-effective in their respective countries (Canada and United Kingdom), but only in patients with certain conditions (without epiretinal membrane, for example). The results of the budget impact analysis are different between countries. The analysis for Spain showed that the introduction of ocriplasmin would mean a saving over 1 million Euros for the NHS in 5 years. CONCLUSIONS: The cost-effectiveness of ocriplasmin has not been demonstrated in Spain. However, good studies performed in other countries found that ocriplasmin is cost-effective in selected patients. Given the current prices in Spain, ocriplasmin could involve a saving for the Spanish NHS.

Comparison of aceclofenac with piroxicam in the treatment of osteoarthritis.

A multicentre, double-blind, randomised, parallel group study was undertaken to investigate the efficacy and safety of aceclofenac (123 patients, 100 mg twice daily) in comparison to piroxicam (117 patients, 20 mg once daily and placebo once daily) in patients with osteoarthritis of the knee. The treatment period of two months was preceded by a washout period of one week duration. On completion of the study, patients in both aceclofenac and piroxicam-treated groups exhibited significant improvement in pain intensity and functional capacity of the affected knee, as represented by the Osteoarthritis Severity Index (OSI) (p < 0.0001 and p < 0.001 respectively). This was further substantiated following the patient's assessment of pain intensity using the Visual Analogue Scale (VAS), in which significant improvements were demonstrated at all time points for each treatment group (p < 0.001). Although both treatment groups showed a significant improvement in all investigator's clinical assessments (functional exploration of the knee, knee flexion and extension (EXT)), there were no significant differences between the groups. There was, however, a more rapid improvement in knee flexion in the aceclofenac group after 15 days of treatment. Both aceclofenac and piroxicam were well tolerated by patients, the most commonly reported adverse events being gastrointestinal, although their incidence was low. Only 24 patients on aceclofenac, as opposed to 33 on piroxicam complained of dyspepsia, epigastralgia and pyrosis. While 7 patients in each group were withdrawn because of adverse events, only one patient with piroxicam was withdrawn because of severe upper gastrointestinal bleeding. Twice as many reports of fecal blood loss were made in the piroxicam group in comparison to the aceclofenac group. In summary, this study confirms the therapeutic efficacy of aceclofenac and suggests that it is a well-tolerated alternative NSAID to piroxicam in the treatment of osteoarthritis.

[Multicenter comparative study of synthetic salmon calcitonin administered nasally in the treatment of established postmenopausal osteoporosis]. / Estudio comparativo multicéntrico de la calcitonina sintética de salmón, administrada por vía nasal en el tratamiento de la osteoporosis postmenopáusica establecida.

We study the effectivity and tolerance of synthetic salmon calcitonin nasally administered (Miacalcic) in the treatment of established postmenopausic osteoporosis. During one year, two randomized groups of postmenopausic women diagnosed of osteoporosis were treated in an outpatient service either with 1 gr of calcium element per day during the whole study or with 100 daily I.U. of salmon synthetic calcitonin nasally administered in patterns of 14 days and the same period of rest, plus a supplement of 500 mgr of calcium element per day. Globally, 43 patients were assessed at the end of the study in the calcitonin plus calcium group and 45 in the group receiving only calcium. The main evaluation parameters were pain and presence of new fractures. At the beginning and at the end of the study, complementary tests of blood biochemistry were conducted, including alkalin phosphatase, calcium, phosphorus and uric acid, as well as calcium, hydroxiprolin and creatinini in the urine. The results showed a significant improvement of pain (p < 0.001) in the group treated with calcitonin, supported by a lower consumption of analgesics. The rate of vertebral fractures determined according to the Meunier's index, was also significantly lower (p < 0.001) in the group treated with calcitonin at the end of the study period. These results suggest that, compared to only calcium, nasally administered calcitonin precludes the formation of new vertebral fractures during one year of treatment and it is effective in terms of pain reduction.(ABSTRACT TRUNCATED AT 250 WORDS)

La satisfacción del paciente diabético en la consulta de atención primaria: una aproximación España vs. Europa / Diabetic patient satisfaction in primary care: A comparison of Spain vs. Europe

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Revisión de estudios económicos y análisis de impacto presupuestario de la ocriplasmina como tratamiento de la tracción vitreomacular / Review of economic studies and budget impact analysis of ocriplasmin as a treatment of vitreomacular traction

OBJETIVO: Revisar las pruebas sobre el coste-efectividad de la ocriplasmina para la tracción vitreomacular (TVM) y estimar el impacto presupuestario que supondría su uso en el Sistema Nacional de Salud (SNS). MATERIAL Y MÉTODOS: 1) Revisión sistemática. Se realizaron búsquedas en enero del 2015 en MEDLINE, PREMEDLINE, EMBASE, CRD y The Cochrane Library, y páginas web clave. Se incluyeron evaluaciones económicas completas que comparaban ocriplasmina con tratamiento habitual (espera vigilante y/o vitrectomía) en pacientes con TVM. Las medidas de resultado de interés fueron los costes de las alternativas y la ratio coste-efectividad incremental. También se incluyeron estudios de análisis de impacto presupuestario. Se valoró la calidad metodológica y se realizó una síntesis narrativa de los estudios incluidos. 2) Estimación del impacto presupuestario. Se estimó el impacto presupuestario que supondría incorporar ocriplasmina en el SNS tomando datos de varias fuentes. RESULTADOS: Se identificaron 6 estudios, ninguno realizado en España. Los 2 estudios de mejor calidad concluyen que ocriplasmina es coste-efectiva en sus respectivos ámbitos (Canadá y Reino Unido) pero solo en pacientes con determinadas condiciones (sin membrana epirretiniana, por ejemplo). Los resultados del análisis de impacto presupuestario son contradictorios entre países. El análisis para España encontró que la introducción de ocriplasmina supondría un ahorro para el SNS superior a un millón de euros en 5 años. CONCLUSIONES: El coste-efectividad de ocriplasmina no ha sido demostrado en España aunque buenos estudios realizados en otros países encontraron que ocriplasmina es coste-efectiva en pacientes seleccionados. Dados los precios vigentes en España, ocriplasmina podría suponer un ahorro para el SNS

OBJECTIVE: To review the evidence on the cost-effectiveness of ocriplasmin as a treatment for vitreomacular traction (VMT), and to estimate the impact on the Spanish National Health System (NHS). MATERIAL AND METHODS: 1) Systematic review. The following databases were searched in January 2015: MEDLINE, PREMEDLINE, EMBASE, CRD, the Cochrane Library, and key websites. Selection criteria were: full economic evaluations that compared ocriplasmin with usual care ('watch and wait' and/or vitrectomy) in patients with VMT. The outcomes to extract were costs of the alternatives and the incremental cost-effectiveness ratio. Studies of budget impact analysis were also included. The methodological quality was assessed, and a narrative synthesis of the included studies was carried out. 2) Estimation of budget impact. The impact on the budget as a result of the introduction of ocriplasmin in the NHS was estimated, including data from different sources. RESULTS: Six studies were identified, none of them performed in Spain. The two best studies concluded that ocriplasmin is cost-effective in their respective countries (Canada and United Kingdom), but only in patients with certain conditions (without epiretinal membrane, for example). The results of the budget impact analysis are different between countries. The analysis for Spain showed that the introduction of ocriplasmin would mean a saving over 1 million Euros for the NHS in 5 years. CONCLUSIONS: The cost-effectiveness of ocriplasmin has not been demonstrated in Spain. However, good studies performed in other countries found that ocriplasmin is cost-effective in selected patients. Given the current prices in Spain, ocriplasmin could involve a saving for the Spanish NHS

Association of HLA-DR5 with mucocutaneous lesions in patients with rheumatoid arthritis receiving gold sodium thiomalate.

OBJECTIVE: To investigate the possible association between HLA antigens and adverse reactions to gold sodium thiomalate therapy (GSTM). METHODS: Ninety consecutive patients with rheumatoid arthritis (RA) were studied for possible association between HLA antigens and adverse reactions to GSTM therapy. RESULTS: HLA-DR5 was significantly increased in patients who developed gold induced mucocutaneous lesions. On the other hand, patients with RA carrying B8 and DR3 antigens are of a high risk of developing proteinuria after gold therapy. A very interesting finding was the low incidence of DR7 antigen in patients who developed adverse reactions to GSTM. We also report the relationship between B27 antigen and chrysiasis due to gold therapy. CONCLUSION: Our results support suggestions that the DR7 antigen provides a protective effect against gold toxicity. We also found a strong association between DR5 and mucocutaneous lesions in patients with RA treated with GSTM.

Bacteriemia, espondilodiscitis y artritis por estreptococo del grupo G en un paciente sin inmunodeficiencia conocida / Bacteriemia, spondylodiscitis and group B streptococcus arthritis in an adult without known immunodeficiency

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