PCP and Septins govern the polarized organization of the actin cytoskeleton during convergent extension.

Convergent extension (CE) requires the coordinated action of the planar cell polarity (PCP) proteins1,2 and the actin cytoskeleton,3,4,5,6 but this relationship remains incompletely understood. For example, PCP signaling orients actomyosin contractions, yet actomyosin is also required for the polarized localization of PCP proteins.7,8 Moreover, the actin-regulating Septins play key roles in actin organization9 and are implicated in PCP and CE in frogs, mice, and fish5,6,10,11,12 but execute only a subset of PCP-dependent cell behaviors. Septin loss recapitulates the severe tissue-level CE defects seen after core PCP disruption yet leaves overt cell polarity intact.5 Together, these results highlight the general fact that cell movement requires coordinated action by distinct but integrated actin populations, such as lamella and lamellipodia in migrating cells13 or medial and junctional actin populations in cells engaged in apical constriction.14,15 In the context of Xenopus mesoderm CE, three such actin populations are important, a superficial meshwork known as the "node-and-cable" system,4,16,17,18 a contractile network at deep cell-cell junctions,6,19 and mediolaterally oriented actin-rich protrusions, which are present both superficially and deeply.4,19,20,21 Here, we exploited the amenability of the uniquely "two-dimensional" node and cable system to probe the relationship between PCP proteins, Septins, and the polarization of this actin network. We find that the PCP proteins Vangl2 and Prickle2 and Septins co-localize at nodes, and that the node and cable system displays a cryptic, PCP- and Septin-dependent anteroposterior (AP) polarity in its organization and dynamics.

Psoriasis Severity, Health-Related Quality of Life, Work Productivity, and Activity Impairments Among Patients With Moderate to Severe Psoriasis Receiving Systemic Treatment: Real-World Data From Clinical Practice in Spain / Gravedad de la psoriasis, calidad de vida relacionada con la salud, productividad laboral y deterioro de la actividad en pacientes con psoriasis moderada a grave que reciben tratamiento sistémico: datos de la vida real de la práctica clínica en España

Background and objective The treatment of psoriasis should not only focus on skin affectations but also weigh the parameters for health-related quality of life (HRQoL), thereby tackling the concept of cumulative life course impairment (CLCI) and treating the patient from a holistic perspective. The CRYSTAL study aimed to characterize psoriasis with real-word data from Spanish clinical practice in patients with moderate to severe disease who received continuous systemic treatment for at least 24 weeks by using the absolute Psoriasis Area and Severity Index (PASI) score and its correlation to HRQoL. Material and methods This was a non-interventional, cross-sectional study conducted in 30 centers in Spain, with 301 patients between the ages of 18 and 75 years. The study collected data regarding current treatment and absolute PASI and their relationship to HRQoL using the Dermatology Life Quality Index (DLQI), to activity impairment using the Work Productivity and Activity Impairment (WPAI) questionnaire, and to treatment satisfaction. Results The mean (SD) age was 50.5 (12.5) years, with a duration of disease of 14 (14.1) years. The mean (SD) absolute PASI reported was 2.3 (3.5), with 28.7% of patients presenting with PASI from >1 to ≤3 and 22.6% with PASI>3. Higher PASI scores were associated with higher DLQI (p<0.001) and WPAI scores and lower levels of treatment satisfaction (p<0.001). Conclusions These data indicate that achieving lower absolute PASI values may correlate not only with better HRQoL but also with better work productivity and treatment satisfaction (AU)

Antecedentes y objetivo El tratamiento de la psoriasis debe centrarse más allá de las afectaciones cutáneas, y valorar la calidad de vida relacionada con la salud (CVRS), abordando así el concepto de discapacidad acumulada en el transcurso vital y tratando al paciente desde una perspectiva holística. El estudio CRYSTAL tuvo como objetivo caracterizar la psoriasis con datos de la práctica clínica española en pacientes con enfermedad moderada a grave que recibieron tratamiento sistémico continuado durante al menos 24 semanas mediante la puntuación absoluta del Índice de la Severidad del área de Psoriasis (PASI) (medida del estado de la enfermedad en un momento dado y no por comparación con una puntuación basal) y su correlación con la CVRS. Material y métodos Se trata de un estudio no intervencionista, transversal, realizado en 30 centros de España, con 301 pacientes de edades comprendidas entre los 18 y los 75 años. Se recogieron datos relativos al tratamiento actual y al PASI absoluto y su relación con la CVRS mediante el Índice de Calidad de Vida en Dermatología (DLQI), con el deterioro de la actividad mediante el Cuestionario para el Deterioro de la Actividad y la Productividad Laboral (WPAI) y con la satisfacción con el tratamiento. Resultados La edad media (DE) fue de 50,5 (12,5) años, con una duración de la enfermedad de 14 (14,1) años. La media (DE) del PASI absoluto notificado fue de 2,3 (3,5), con 28,7% de pacientes que presentaban un PASI de > 1 a ≤ 3 y 22,6% con un PASI > 3. Las puntuaciones más altas del PASI se asociaron a puntuaciones más altas del DLQI (p < 0,001) y del WPAI y a niveles más bajos de satisfacción con el tratamiento (p < 0,001). Conclusiones Estos datos indican que alcanzar valores absolutos más bajos de PASI puede correlacionarse no solo con una mejor CVRS, sino también con una mejor productividad laboral y satisfacción con el tratamiento (AU)

[Artículo traducido] Gravedad de la psoriasis, calidad de vida relacionada con la salud, productividad laboral y deterioro de la actividad en pacientes con psoriasis moderada a grave que reciben tratamiento sistémico: datos de la vida real de la práctica clínica en España / Psoriasis Severity, Health-Related Quality of Life, Work Productivity, and Activity Impairments Among Patients With Moderate to Severe Psoriasis Receiving Systemic Treatment: Real-World Data From Clinical Practice in Spain

Antecedentes y objetivo El tratamiento de la psoriasis debe centrarse más allá de las afectaciones cutáneas, y valorar la calidad de vida relacionada con la salud (CVRS), abordando así el concepto de discapacidad acumulada en el transcurso vital y tratando al paciente desde una perspectiva holística. El estudio CRYSTAL tuvo como objetivo caracterizar la psoriasis con datos de la práctica clínica española en pacientes con enfermedad moderada a grave que recibieron tratamiento sistémico continuado durante al menos 24 semanas mediante la puntuación absoluta del Índice de la Severidad del área de Psoriasis (PASI) (medida del estado de la enfermedad en un momento dado y no por comparación con una puntuación basal) y su correlación con la CVRS. Material y métodos Se trata de un estudio no intervencionista, transversal, realizado en 30 centros de España, con 301 pacientes de edades comprendidas entre los 18 y los 75 años. Se recogieron datos relativos al tratamiento actual y al PASI absoluto y su relación con la CVRS mediante el Índice de Calidad de Vida en Dermatología (DLQI), con el deterioro de la actividad mediante el Cuestionario para el Deterioro de la Actividad y la Productividad Laboral (WPAI) y con la satisfacción con el tratamiento. Resultados La edad media (DE) fue de 50,5 (12,5) años, con una duración de la enfermedad de 14 (14,1) años. La media (DE) del PASI absoluto notificado fue de 2,3 (3,5), con 28,7% de pacientes que presentaban un PASI de > 1 a ≤ 3 y 22,6% con un PASI > 3. Las puntuaciones más altas del PASI se asociaron a puntuaciones más altas del DLQI (p < 0,001) y del WPAI y a niveles más bajos de satisfacción con el tratamiento (p < 0,001). Conclusiones Estos datos indican que alcanzar valores absolutos más bajos de PASI puede correlacionarse no solo con una mejor CVRS, sino también con una mejor productividad laboral y satisfacción con el tratamiento (AU)

Background and objective The treatment of psoriasis should not only focus on skin affectations but also weigh the parameters for health-related quality of life (HRQoL), thereby tackling the concept of cumulative life course impairment (CLCI) and treating the patient from a holistic perspective. The CRYSTAL study aimed to characterize psoriasis with real-word data from Spanish clinical practice in patients with moderate to severe disease who received continuous systemic treatment for at least 24 weeks by using the absolute Psoriasis Area and Severity Index (PASI) score and its correlation to HRQoL. Material and methods This was a non-interventional, cross-sectional study conducted in 30 centers in Spain, with 301 patients between the ages of 18 and 75 years. The study collected data regarding current treatment and absolute PASI and their relationship to HRQoL using the Dermatology Life Quality Index (DLQI), to activity impairment using the Work Productivity and Activity Impairment (WPAI) questionnaire, and to treatment satisfaction. Results The mean (SD) age was 50.5 (12.5) years, with a duration of disease of 14 (14.1) years. The mean (SD) absolute PASI reported was 2.3 (3.5), with 28.7% of patients presenting with PASI from >1 to ≤3 and 22.6% with PASI>3. Higher PASI scores were associated with higher DLQI (p<0.001) and WPAI scores and lower levels of treatment satisfaction (p<0.001). Conclusions These data indicate that achieving lower absolute PASI values may correlate not only with better HRQoL but also with better work productivity and treatment satisfaction (AU)

Psoriasis Severity, Health-Related Quality of Life, Work Productivity, and Activity Impairments Among Patients With Moderate to Severe Psoriasis Receiving Systemic Treatment: Real-World Data From Clinical Practice in Spain.

BACKGROUND AND OBJECTIVE: The treatment of psoriasis should not only focus on skin affectations but also weigh the parameters for health-related quality of life (HRQoL), thereby tackling the concept of cumulative life course impairment (CLCI) and treating the patient from a holistic perspective. The CRYSTAL study aimed to characterize psoriasis with real-word data from Spanish clinical practice in patients with moderate to severe disease who received continuous systemic treatment for at least 24 weeks by using the absolute Psoriasis Area and Severity Index (PASI) score and its correlation to HRQoL. MATERIAL AND METHODS: This was a non-interventional, cross-sectional study conducted in 30 centers in Spain, with 301 patients between the ages of 18 and 75 years. The study collected data regarding current treatment and absolute PASI and their relationship to HRQoL using the Dermatology Life Quality Index (DLQI), to activity impairment using the Work Productivity and Activity Impairment (WPAI) questionnaire, and to treatment satisfaction. RESULTS: The mean (SD) age was 50.5 (12.5) years, with a duration of disease of 14 (14.1) years. The mean (SD) absolute PASI reported was 2.3 (3.5), with 28.7% of patients presenting with PASI from >1 to ≤3 and 22.6% with PASI>3. Higher PASI scores were associated with higher DLQI (p<0.001) and WPAI scores and lower levels of treatment satisfaction (p<0.001). CONCLUSIONS: These data indicate that achieving lower absolute PASI values may correlate not only with better HRQoL but also with better work productivity and treatment satisfaction.

Psoriasis Severity, Health-Related Quality of Life, Work Productivity, and Activity Impairments Among Patients With Moderate to Severe Psoriasis Receiving Systemic Treatment: Real-World Data From Clinical Practice in Spain. / [Artículo traducido] Gravedad de la psoriasis, calidad de vida relacionada con la salud, productividad laboral y deterioro de la actividad en pacientes con psoriasis moderada a grave que reciben tratamiento sistémico: datos de la vida real de la práctica clínica en España.

BACKGROUND AND OBJECTIVE: The treatment of psoriasis should not only focus on skin affectations but also weigh the parameters for health-related quality of life (HRQoL), thereby tackling the concept of cumulative life course impairment (CLCI) and treating the patient from a holistic perspective. The CRYSTAL study aimed to characterize psoriasis with real-word data from Spanish clinical practice in patients with moderate to severe disease who received continuous systemic treatment for at least 24 weeks by using the absolute Psoriasis Area and Severity Index (PASI) score and its correlation to HRQoL. MATERIAL AND METHODS: This was a non-interventional, cross-sectional study conducted in 30 centers in Spain, with 301 patients between the ages of 18 and 75 years. The study collected data regarding current treatment and absolute PASI and their relationship to HRQoL using the Dermatology Life Quality Index (DLQI), to activity impairment using the Work Productivity and Activity Impairment (WPAI) questionnaire, and to treatment satisfaction. RESULTS: The mean (SD) age was 50.5 (12.5) years, with a duration of disease of 14 (14.1) years. The mean (SD) absolute PASI reported was 2.3 (3.5), with 28.7% of patients presenting with PASI from >1 to ≤3 and 22.6% with PASI>3. Higher PASI scores were associated with higher DLQI (p<0.001) and WPAI scores and lower levels of treatment satisfaction (p<0.001). CONCLUSIONS: These data indicate that achieving lower absolute PASI values may correlate not only with better HRQoL but also with better work productivity and treatment satisfaction.

Pharmacogenetic biomarkers for secukinumab response in psoriasis patients in real-life clinical practice.

BACKGROUND: Prediction of the response to a biological treatment in psoriasis patients would allow efficient treatment allocation. OBJECTIVE: To identify polymorphisms associated with secukinumab response in psoriasis patients in a daily practice setting. METHODS: We studied 180 SNPs in patients with moderate-to-severe plaque psoriasis recruited from 15 Spanish hospitals. Treatment effectiveness was evaluated by absolute PASI ≤3 and ≤1 at 6 and 12 months. Individuals were genotyped using a custom Taqman array. Multiple logistic regression models were generated. Sensitivity, specificity and area under the curve (AUC) were analysed. RESULTS: A total of 173 patients were studied at 6 months, (67% achieved absolute PASI ≤ 3 and 65% PASI ≤ 1) and 162 at 12 months (75% achieved absolute PASI ≤ 3 and 64% PASI ≤ 1). Multivariable analysis showed the association of different sets of SNPs with the response to secukinumab. The model of absolute PASI≤3 at 6 months showed best values of sensitivity and specificity. Four SNPs were associated with the capability of achieving absolute PASI ≤ 3 at 6 months. rs1801274 (FCGR2A), rs2431697 (miR-146a) and rs10484554 (HLCw6) were identified as risk factors for failure to achieve absolute PASI≤3, while rs1051738 (PDE4A) was protective. AUC including these genotypes, weight of patients and history of biological therapy was 0.88 (95% CI 0.83-0.94), with a sensitivity of 48.6% and specificity of 95.7% to discriminate between both phenotypes. CONCLUSION: We have identified a series of polymorphisms associated with the response to secukinumab capable of predicting the potential response/non-response to this drug in patients with plaque psoriasis.

Association of bilateral oophorectomy and menopause hormone therapy with mild cognitive impairment: the REDLINC X study.

BACKGROUND: Dementia is a major public health problem. Estrogen is a regulator of the central nervous system and its deficit could be involved in cognitive decline in older women. OBJECTIVE: This study aimed to evaluate the association of bilateral oophorectomy, menopause hormone therapy (MHT) and other factors on mild cognitive impairment (MCI). METHOD: The case-control study included 941 otherwise healthy postmenopausal women aged 60 years and over from six Latin American countries. Personal and family data were recorded and MCI was assessed using the Montreal Cognitive Assessment test (MoCA). RESULTS: Average age, years of education and body mass index were 66.1 ± 5.8 years, 12.4 ± 5.0 years and 26.0 ± 4.3 kg/m2, respectively. A total of 30.2% had undergone bilateral oophorectomy and 40.3% had used MHT. A total of 232 women (24.7%) had MCI. The prevalence of MCI was higher in women with intact ovaries and non-MHT users as compared to MHT users (29.3% vs. 11.7% [odds ratio (OR) 0.32; 95% confidence interval (CI) 0.20-0.51]). Among oophorectomized women, MCI prevalence was higher among non-MHT users as compared to MHT users (45.2% vs. 12.8% [OR 0.18; 95% CI 0.10-0.32]). Logistic regression analysis determined that the variables associated with MCI were age >65 years (OR 1.69; 95% CI 1.20-2.38), parity (having >2 children; OR 1.69; 95% CI 1.21-2.37), bilateral oophorectomy (OR 1.56; 95% CI 1.09-2.24), hypertension (OR 1.41; 95% CI 1.01-1.96), being sexually active (OR 0.56; 95% CI 0.40-0.79), education >12 years (OR 0.46; 95% CI 0.32-0.65) and MHT use (OR 0.31; 95% CI 0.21-0.46). CONCLUSION: Age, parity, bilateral oophorectomy and hypertension are independent factors associated with MCI; contrary to this, higher educational level, maintaining sexual activity and using MHT are protective factors.

El papel del dermatólogo en el diagnóstico precoz de la artritis psoriásica: recomendaciones de un grupo de expertos / Dermatologists' Role in the Early Diagnosis of Psoriatic Arthritis: Expert Recommendations

La artritis psoriásica (APs) es una forma común de artritis inflamatoria que aparece hasta en el 40% de los pacientes con psoriasis. Dado que la afectación cutánea suele preceder a la afectación articular, los dermatólogos desempeñan un papel fundamental en la detección precoz de la APs. El diagnóstico precoz es importante para reducir el riesgo de daños estructurales irreversibles, limitar el deterioro de la función física y mejorar la calidad de vida de los pacientes. El presente documento ha sido elaborado por un grupo de especialistas (nueve dermatólogos y un reumatólogo) con el objetivo de proporcionar recomendaciones sencillas que ayuden a los dermatólogos en el cribado de la APs en pacientes con psoriasis. Los expertos elaboraron el presente documento ofreciendo unas recomendaciones consensuadas basadas en una revisión descriptiva de la evidencia científica disponible y en la experiencia adquirida en la práctica clínica diaria

Psoriatic arthritis is a common type of inflammatory arthritis found in up to 40% of patients with psoriasis. Because skin involvement usually precedes joint involvement, dermatologists play a key role in early detection. Early diagnosis is important for reducing the risk of irreversible structural damage, attenuating the deterioration of physical function, and improving patients' quality of life. This consensus statement was drafted by a group of 9 dermatologists and 1 rheumatologist to provide simple recommendations to help dermatologists screen for psoriatic arthritis in patients with psoriasis. The experts offer consensus-based guidelines that draw on a review of available scientific evidence and on experience acquired in routine clinical practice

Adaptación lingüística y cultural al español del cuestionario Psoriatic arthritis UnclutteRed screening Evaluation (PURE-4) / Linguistic and Cultural Adaptation to Spanish of the Screening Tool Psoriatic Arthritis UnclutteRed Screening Evaluation (PURE4)

ANTECEDENTES Y OBJETIVO: El cuestionario 4-item Psoriatic arthritis UnclutteRed screening Evaluation (PURE-4) puede considerarse una herramienta útil para identificar pacientes con posible artritis psoriásica y derivarlos al servicio de reumatología para confirmar el diagnóstico. La versión original en inglés presenta alta validez discriminatoria (85,7% de sensibilidad, 83,6% de especificidad). El objetivo de este trabajo es adaptarlo para población española como paso previo a su validación. MATERIAL Y MÉTODO: Se aplicó la metodología recomendada por la International Society Pharmacoeconomic and Outcome Research (ISPOR) para adaptaciones culturales de medidas centradas en el paciente. Fases: preparación, traducción, reconciliación, retrotraducción/revisión, armonización, test de comprensión/revisión, corrección de pruebas. RESULTADOS: En la preparación se obtuvo el permiso del autor del cuestionario original. Dos traductores nativos realizaron la traducción del cuestionario original al español. En la reconciliación se realizaron pequeñas modificaciones, principalmente en el enunciado de los ítems. Se realizó retrotraducción al inglés, logrando una versión equivalente al cuestionario original. La versión española derivada se administró en el test de comprensión a 7 pacientes, obteniéndose la versión final en español. Durante las traducciones, el responsable del proyecto y un comité científico formado por un dermatólogo y un reumatólogo revisaron las diferentes versiones. Los intercambios de información entre el equipo durante todo el proceso integraron la fase de armonización, siendo un control de calidad continuo que garantizó la equivalencia conceptual de las traducciones. CONCLUSIONES: La adaptación del cuestionario PURE-4 para población española constituye la primera etapa para su uso en práctica clínica habitual. La metodología estandarizada garantiza la equivalencia entre la versión española y la original

BACKGROUND AND OBJECTIVE: The 4-item Psoriatic arthritis UnclutteRed screening Evaluation (PURE-4) questionnaire is a useful tool for identifying patients with suspected psoriatic arthritis before referring them to a rheumatology department for confirmation. The original English version has good discriminant validity (sensitivity, 85.7%; specificity, 83.6%). We aimed to produce an adapted Spanish version of the PURE-4 for validation and use in Spain. MATERIAL AND METHOD: We applied the method recommended by the International Society for Pharmacoeconomic and Outcome Research for the cultural adaptation of patient-centered measurement tools. The phases in the processes involved forward translation, reconciliation, back translation review, harmonization, cognitive debriefing and review, and proofreading. RESULTS: We obtained the permission of the author of the original questionnaire. Two native-speaking translators translated the questionnaire into Spanish. Small changes, mainly in the way the items were expressed, were then made in order to reconcile the 2 translations. The questionnaire was then back translated to English and revised to achieve a version equivalent to the original. A Spanish translation derived from the revision was tested for understandability in 7 patients, and the final Spanish version was then produced. During the translation phases, the project manager and a scientific committee made up of a dermatologist and a rheumatologist reviewed the different versions. Team members exchanged information throughout the process, providing for harmonization and the quality control that guaranteed conceptual equivalence. CONCLUSIONS: This adaptation of the PURE-4 questionnaire for use in Spain has been the first step toward using it in routine clinical practice. The standardized method we used ensures that the Spanish and the original versions are equivalent

Efectividad de certolizumab pegol en psoriasis en una cohorte de pacientes con artritis psoriásica / Effectiveness of Certolizumab Pegol in the Treatment of Psoriasis in a Cohort of Patients With Psoriatic Arthritis

No disponible

Dermatologists' Role in the Early Diagnosis of Psoriatic Arthritis: Expert Recommendations. / El papel del dermatólogo en el diagnóstico precoz de la artritis psoriásica: recomendaciones de un grupo de expertos.

Psoriatic arthritis is a common type of inflammatory arthritis found in up to 40% of patients with psoriasis. Because skin involvement usually precedes joint involvement, dermatologists play a key role in early detection. Early diagnosis is important for reducing the risk of irreversible structural damage, attenuating the deterioration of physical function, and improving patients' quality of life. This consensus statement was drafted by a group of 9 dermatologists and 1 rheumatologist to provide simple recommendations to help dermatologists screen for psoriatic arthritis in patients with psoriasis. The experts offer consensus-based guidelines that draw on a review of available scientific evidence and on experience acquired in routine clinical practice.

Linguistic and Cultural Adaptation to Spanish of the Screening Tool Psoriatic Arthritis UnclutteRed Screening Evaluation (PURE4). / Adaptación lingüística y cultural al español del cuestionario Psoriatic arthritis UnclutteRed screening Evaluation (PURE-4).

BACKGROUND AND OBJECTIVE: The 4-item Psoriatic arthritis UnclutteRed screening Evaluation (PURE-4) questionnaire is a useful tool for identifying patients with suspected psoriatic arthritis before referring them to a rheumatology department for confirmation. The original English version has good discriminant validity (sensitivity, 85.7%; specificity, 83.6%). We aimed to produce an adapted Spanish version of the PURE-4 for validation and use in Spain. MATERIAL AND METHOD: We applied the method recommended by the International Society for Pharmacoeconomic and Outcome Research for the cultural adaptation of patient-centered measurement tools. The phases in the processes involved forward translation, reconciliation, back translation review, harmonization, cognitive debriefing and review, and proofreading. RESULTS: We obtained the permission of the author of the original questionnaire. Two native-speaking translators translated the questionnaire into Spanish. Small changes, mainly in the way the items were expressed, were then made in order to reconcile the 2 translations. The questionnaire was then back translated to English and revised to achieve a version equivalent to the original. A Spanish translation derived from the revision was tested for understandability in 7 patients, and the final Spanish version was then produced. During the translation phases, the project manager and a scientific committee made up of a dermatologist and a rheumatologist reviewed the different versions. Team members exchanged information throughout the process, providing for harmonization and the quality control that guaranteed conceptual equivalence. CONCLUSIONS: This adaptation of the PURE-4 questionnaire for use in Spain has been the first step toward using it in routine clinical practice. The standardized method we used ensures that the Spanish and the original versions are equivalent.

PAAF y BAG ecoguiadas en metástasis ganglionar y subcutánea de adenocarcinoma de pulmón / Ultrasound-Guided Fine-Needle Aspiration Biopsy and Core Needle Biopsy of Lymph Node and Subcutaneous Metastases From Lung Adenocarcinoma

No disponible

High browsing skeletal adaptations in Spinophorosaurus reveal an evolutionary innovation in sauropod dinosaurs.

Sauropods were among the most diverse lineages of dinosaurs, with an ample geographic distribution throughout the Mesozoic. This evolutionary success is largely attributed to neck elongation and its impact on feeding efficiency. However, how neck elongation influenced exactly on feeding strategies is subject of debate. The process of mounting a nearly complete virtual skeleton of Spinophorosaurus nigerensis, from the Middle (?) Jurassic of Niger, has revealed several previously unknown osteological adaptations in this taxon. Wedged sacral and posterior dorsal vertebrae cause the presacral column to deflect antero-dorsally. This, together with elongated scapulae and humeri make the anterior region of the skeleton vertically lengthened. Also, elongated prezygapophyseal facets on the cervical vertebrae and a specialized first dorsal vertebra greatly increase the vertical range of motion of the neck. These characters support this early eusauropod as a more capable high browser than more basally branching sauropods. While limb proportions and zygapophyseal facets vary among Eusauropoda, the sacrum retained more than 10° of wedging in all Eusauropoda. This implied a functional constraint for sauropod species which evolved lower browsing feeding strategies: the antero-dorsal sloping caused by the sacrum had to be counteracted with further skeletal modifications, e.g. a ventrally curved mid to anterior presacral spine to hinder the dorsal slope of the whole presacral series caused by the wedged sacrum. This suggests that at least the last common ancestor of Eusauropoda developed high browsing capabilities, partially due to the modified wedged sacrum, likely a potential synapomorphy of the clade and key in the evolutionary history of the group.

Real-world effectiveness and safety of apremilast in psoriasis at 52 weeks: a retrospective, observational, multicentre study by the Spanish Psoriasis Group.

BACKGROUND: Little has been published on the real-world effectiveness and safety of apremilast in psoriasis. OBJECTIVES: To evaluate the effectiveness, safety and drug survival of apremilast at 52 weeks in patients with moderate to severe plaque psoriasis or palmoplantar psoriasis in routine clinical practice. METHODS: Retrospective, multicentre study of adult patients with moderate to severe plaque psoriasis or palmoplantar psoriasis treated with apremilast from March 2016 to March 2018. RESULTS: We studied 292 patients with plaque psoriasis and 85 patients with palmoplantar psoriasis. The mean (SD) Psoriasis Area and Severity Index (PASI) score was 10.7 (7.0) at baseline and 3.0 (4.2) at 52 weeks. After 12 months of treatment, 73.6% of patients had a PASI score of 3 or less. In terms of relative improvement by week 52, 49.7% of patients achieved PASI-75 (≥75% reduction in PASI score) and 26.5% achieved PASI-90. The mean physician global assessment score for palmoplantar psoriasis fell from 4.2 (5.2) at baseline to 1.3 (1.3) at week 52. Overall drug survival after 1 year of treatment with apremilast was 54.9 %. The main reasons for treatment discontinuation were loss of efficacy (23.9%) and adverse events (15.9%). Almost half of the patients in our series (47%) experienced at least one adverse event. The most common events were gastrointestinal problems. CONCLUSIONS: Apremilast may be a suitable alternative for the treatment of moderate to severe psoriasis and palmoplantar psoriasis. Although the drug has a good safety profile, adverse gastrointestinal effects are common.

Low dose intrathecal morphine for hip arthroplasty / Dosis baja de morfina intratecal para artroplastía cadera

OBJECTIVES: 100 mcg intrathecal morphine (ITM) for hip arthroplasty provides adequate functional recovery and reduces associated complications but is not exempt from opioid-related adverse effects. We evaluate efficacy of a reduced dose of ITM (80 mcg) in terms of anesthetic quality, postoperative analgesia, complication rates and early recovery. METHODS: Case control study. Patients under hip arthroplasty were treated on a specific protocol, using neuraxial anesthesia with hyperbaric bupivacaine 10.5-13.5 mg plus 80 mcg ITM versus controls with 100 mcg ITM. Demographic variables, intra and perioperative course were extracted from medical records. Pain severity and morphine associated complications were blindly assessed at regular intervals postoperatively. p < 0.01 were considered significant. RESULTS: 82 patients were analyzed. Mean age was 64.21 years, 62.20% women and 70.73% ASA-2. Main endoprosthesis indication was arthrosis (58.53%). No statistically significant differences in demographic and operative data were found between groups, including surgical time, ambulation time, length of stay, and patient satisfaction for pain management. Mean VAS for pain during first 24 hours was 0.24 for the low ITM group and 0.22 for control. Rescue intravenous morphine was the same between groups. Compared to 80 mcg ITM, 100 mcg showed trends for higher complication rates for respiratory depression (OR 2.58, CI 95% 0.4514.54, p = 0.28), nausea without vomiting (OR 1.82, CI 95% 0.82-4.01, p = 0.13), urinary retention (OR 2.02, CI95% 0.88-4.61, p = 0.09) and significantly higher rates of pruritus (OR 3.55, CI 95% 1.61-7.82, p < 0.01). CONCLUSIONS: 80 mcg ITM during spinal anesthesia for hip arthroplasty provided comparable postoperative analgesia and lower incidence of opioid-related adverse effects.

OBJETIVOS: 100 mcg morfina intratecal (ITM), en artroplastía de cadera, proporciona una recuperación funcional adecuada y reduce complicaciones asociadas, pero no está exento de efectos adversos conocidos asociados a opioides. Evaluamos eficacia de reducir dosis (80 mcg ITM) en términos de calidad anestésica, analgesia, complicaciones y recuperación postoperatoria. MÉTODOS: Estudio de casos y controles. Pacientes sometidos a artroplastía de cadera fueron tratados con anestesia espinal con bupivacaína hiperbárica 10,5-13,5 mg más 80 mcg ITM y controles de manera similar, pero con 100 mcg ITM. Variables demográficas, así como intra y perioperatorio, se extrajeron de registros médicos. Severidad del dolor, y complicaciones asociadas a ITM, se evaluaron a ciegas según protocolo. p < 0,01 fue considerado significativo. RESULTADOS: 82 pacientes analizados. Edad promedio fue 64,21 años, 62,20% fueron mujeres y 70,73% ASA-2. Principal indicación de prótesis fue artrosis (58,53%). No se encontraron diferencias estadísticas entre variables demográficas, tiempo quirúrgico, tiempo deambulación, duración hospitalización y satisfacción paciente. EVA promedio dolor, primeras 24 horas, fue 0,24 para grupo 80 mcg ITM y 0,22 para control (100 mcg ITM). Morfina intravenosa de rescate fue similar entre grupos. En comparación con 80 mcg, 100 mcg presentó mayores tasas de complicaciones para depresión respiratoria (OR 2,58, IC 95% 0,45-14,54, p = 0,28), náuseas y vómitos (OR 1,82, CI 95% 0,82-4,01, p = 0,13), retención urinaria (OR 2,02, CI 95% 0,88-4,61, p = 0,09) y prurito (OR 3,55, CI 95% 1,61-7.82, p < 0,01). CONCLUSIONES: 80 mcg ITM, en anestesia espinal para artroplastía cadera, proporciona analgesia postoperatoria comparable a 100 mcg, pero con menor incidencia de efectos adversos relacionados a opioides.

Punción aspiración con aguja fina y biopsia con aguja gruesa ecoguiada en dermatología: un paso adelante / Ultrasound-Guided Fine-Needle Aspiration Cytology and Core-Needle Biopsy in Dermatology: A Step Forward

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Herramienta para mejorar la eficiencia en el manejo clínico de pacientes hipertensos / Tools to improve efficiency in the clinical management of hypertensive patients

Objetivo: Crear una herramienta que permita evaluar la eficiencia de la gestión clínica de los pacientes hipertensos en atención primaria. Material y métodos: Se creó un cuestionario dirigido a los centros de atención primaria, con acceso vía Web, para la autoevaluación del manejo de la hipertensión, respecto a 5 áreas de gestión: sistemas de información; pruebas diagnósticas y analíticas; aspectos organizativos; demanda asistencial y consumo de recursos; y programas de atención continuada para profesionales y para pacientes. Previamente, un comité de expertos definió estas preguntas, así como su respuesta ideal o «control», basándose en la literatura científica o, en caso de no haber referencias publicadas, de manera consensuada por dicho comité. Se realizó un análisis descriptivo de los datos y se creó un índice de adherencia de sus resultados con respecto al «control», que oscila entre 0 (ninguna adherencia) y 1 (total adherencia). Resultados: Un total de 35 centros de salud introdujeron sus datos de gestión de pacientes hipertensos en la Web de gestión clínica. Se observó la mayor adherencia en el área «Pruebas diagnósticas y analíticas» (0,69±0,10) y la menor en el área «Programas de formación continuada para pacientes y profesionales» (0,42±0,21). Conclusiones: La eficiencia de la gestión clínica en pacientes hipertensos puede analizarse mediante la herramienta web creada para este fin. Su uso permite realizar una auditoría interna para detectar las áreas que necesitan mejoras y también sirve para hacer evaluaciones comparativas en las distintas áreas de gestión a lo largo del tiempo

Objective: To create a tool to evaluate the efficiency of the clinical management of hypertensive patients in Primary Care. Material and methods: A web-based questionnaire was designed for Primary Care centres to self-evaluate the management of hypertension in five specific areas: information systems, diagnostic and analytical tests, organisational aspects, use of resources, and continuous training programmes for patients and healthcare professionals. A committee of experts previously defined these questions and their ideal responses or "control", based on the scientific literature or, if there were no published references, by consensus of the committee. A descriptive analysis was performed on the data, and an adherence score was created that ranged from 0 (no adherence) to 1 (total adherence). Results: A total of 35 Primary Care centres entered their data into the website for the clinical management of hypertensive patients. The highest adherence to the ideal algorithm was observed in the area "Diagnostic and analytical tests" (0.69±0.10), and the lowest in "Continuous training programmes for patients and professionals" (0.42±0.21). Conclusions: The efficiency of clinical management in hypertensive patients can be analysed using the website tool created for this purpose. Its use allows an internal audit to detect the areas that need improvement, and also serves to make comparative evaluations in the different areas of management over time