Changes in glucometric parameters in people living with diabetes users of the free-style libre 2 system before and after the update possibility to real-time glucose readings in real world practice.

In Spain, from October 10th, 2023, the FreeStyle Libre 2 system offers the possibility to automatically changed from isCGM to rtCGM with a system update. Our study aimed to evaluate the glucometric before and after that date. We didn't find significant changes in TIR, however time of use increased and TBR decreased.

Temporal and spatial variability in population traits of an intertidal fucoid reveals local-scale climatic refugia.

Global change is imposing significant losses in the functional traits of marine organisms. Although areas of climatic refugia ameliorate local conditions and help them to persist, the extent to which mesoscale effects contribute for intraregional variability on population traits and conservation is uncertain. Here we assess patterns of conservation status of Fucus guiryi, the main intertidal habitat-forming seaweed in the Strait of Gibraltar (southern Spain and northern Morocco). We investigated the demography, reproductive phenology, and morphology at northern and southern side populations. Population traits were compared seasonally within populations from each side, and at spatial scale in early summer 2019. In the last decade three populations became extinct; two marginal populations had dispersed individuals with a narrower fertility season and miniaturized individuals below 3 cm; and five populations showed variable density and cover with more than 20% of reproductive individuals over the seasons. Highest density, cover, morphology, and reproductive potential was detected at one population from each side, suggesting local-scale climatic refugia in upwelling areas located inside marine protected areas. Southern recruits were more warm-tolerant but grew less at colder conditions than northern ones, revealing a mesoscale heterogeneity in thermal affinities. This study evidenced functional losses and distinct reproductive strategies experienced by F. guiryi at peripheral locations and urges to prioritize its conservation and restoration at contemporary climatic refugia.

Effect of the historic Spanish heatwave over glycemic control in adult patients with type 1 diabetes.

AIM: To evaluate the effect of the historic Spanish heatwave (9th-26th July 2022) over glycemic control in adults with type 1 diabetes (T1D). METHODS: Cross-sectional retrospective analysis of adult patients with T1D in Castilla-La Mancha (south-central Spanish region) using intermittently scanned continuous glucose monitoring (isCGM) during and after the heatwave. Primary outcome was change in time in range (TIR) 3.0-10 mmol/L (70-180 mg/dL) of interstitial glucose in the two weeks following the heatwave. RESULTS: A total of 2701 T1D patients were analyzed. We detected a TIR reduction of 4.0 % (95 % CI -3.4, -4.6; P < 0.001) in the two weeks following the heatwave. Patients in the highest daily scan frequency quartile (>13 scans/day) during the heatwave showed the greatest deterioration in TIR after it concluded (-5.4 % [95 % CI -6.5, -4.3; P < 0.001]). The percentage of patients meeting all the recommendations of the International Consensus of Time in Range was greater during the heatwave than after it ended (10.6 % vs. 8.4 %, P < 0.001). CONCLUSIONS: Adults with T1D had better glycemic control during the historic Spanish heatwave compared to the following period.

Identifying Characteristic Frequencies in the Electrochemical Impedance of Ion-Exchange Membrane Systems.

In this study, the characteristic frequencies of the electrochemical impedance of ion-exchange membrane systems constituted by the membrane and two diffusion boundary layers adjacent to the membrane were investigated. Approximations of the impedance of the Randles equivalent electric circuit in multiple frequency ranges were considered, and the characteristic frequencies of the zeros and poles of orders ½ and 1 were derived. The characteristic geometric frequencies, those associated with the interfacial charge transfer and the diffusive transport processes, as well as those associated with the transitions between processes, were identified by means of analytical expressions.

Perception of knowledge about Clinical Hospital Nutrition among resident doctors in a tertiary hospital.

INTRODUCTION: Resident physicians' proper use of nutritional support and knowledge about Clinical Nutrition is essential to ensuring that their patients receive suitable nutritional care. MATERIALS AND METHOD: An online survey was sent to resident physicians at our hospital in specialisations with hospital beds. The survey featured 20 multiple-choice questions scored from 1 to 10 (1 being "completely disagree" and 10 being "completely agree") across the following themes: nutritional assessment, diets, oral nutritional supplements, enteral nutrition and perception of the Nutrition Unit. RESULTS: The survey was completed by 69% of resident physicians in medical specialisations and 70% of those in surgical specialisations. Overall, the average survey score was 6.28, with higher scores among medical residents than surgical residents (6.86 versus 5.38; p < 0.001), especially in the sections on nutritional assessment, diets and oral nutritional supplements. The respondents had a positive perception of the Nutrition Unit (mean score 7.6). DISCUSSION: Residents in medical specialisations afford greater importance to their patients' nutrition than residents in surgical specialisations, although in both groups the average score was rather low. There is much room for improvement in the training in Clinical Nutrition of this group, and it is important to include topics in Clinical Nutrition in training programmes for all residents in hospital specialisations.

Economic analysis of an educational human security model in southwestern bateyes of the Dominican Republic / Análisis económico de un modelo educativo de seguridad humana en los bateyes del suroeste de la República Dominicana

Objetivos: realizar un análisis económico para evaluar los costos de una intervención educativa, utilizando los principios de un modelo de seguridad humana en Bateyes del suroeste de la República Dominicana. Métodos: se consideraron cuatro recursos de intervención, incluyendo la capacitación del personal, los incentivos mensuales, la supervisión de las actividades de campo y el costo total asociado al tratamiento anual de la diarrea aguda. El gasto se comparó entre el programa estándar de atención (Batey Control) y la intervención con el modelo de seguridad humana (Batey Caso). Resultados: el ahorro del costo total anual para el Ministerio de Salud de República Dominicana asociado con la reducción de la incidencia de episodios de diarrea aguda fue de US$252,399. Si se extrapolan a los 300 Bateyes de República Dominicana, se podría ahorrar aproximadamente US$75 millones en prevención de enfermedades infecciosas. Conclusiones: el modelo de seguridad humana luce ser un método eficaz para mejorar el conocimiento sobre la prevención de enfermedades y aumentar el empoderamiento de la comunidad para la movilización de recursos. Aplicada a otros entornos, la intervención podría tener una incidencia beneficiosa en las poblaciones de refugiados e indocumentados bajo el impacto de la violencia estructural.

Objectives: To conduct an economic analysis to evaluate the costs of an educational intervention, using the human security model, and potential sources of economic benefits, in Southwestern Bateyes in the Dominican Republic. Methods: Four intervention resources were considered, including staff training, monthly incentives, supervision of field activities, and total cost associated with annual treatment for acute diarrhea. The expenditure was compared between the standard program of care and the intervention using the human security model. Results: The total annual cost saving to the Dominican Republic Ministry of Health, associated with reducing the incidence of acute diarrhea episodes, was US$252,399. If this is extrapolated to the 300 Bateyes of the Dominican Republic, the Ministry of Health could save approximately US$75 million in infectious disease prevention by implementing this intervention model in these isolated rural communities. Conclusions: The educational intervention, which incorporated a human security approach, appeared to be an effective method to enhance knowledge about disease prevention and to increase empathy among community members for resource mobilization and local empowerment. Applied to other settings, the intervention could have a beneficial impact on refugee and undocumented populations under the

Analysis of the evolution of the publication of case reports in endocrinology journals.

INTRODUCTION: A case report is a scientific article describing one or more patients with unusual clinical presentations. In recent years, the number of case reports in publications has decreased. In this study, we analyze the publication of case reports in journals of Endocrinology during the years 2010, 2015 and 2019. MATERIALS AND METHODS: The Pubmed web was browsed for clinical journals of Endocrinology, those published in English and/or Spanish being selected, and the relevant variables analyzed. RESULTS: Of 84 analyzed journals, 51 accepted cases for publication, 29 did not, and 4 did so only in exceptional cases. In 2010, 11,754 articles were published, of which 709 were clinical cases (6.9% of the total); in 2015, a total of 14,594 articles of which 655 were clinical cases (5.8% of the total); and in 2019 a total of 14,110 articles, of which 472 were clinical cases (4.6% of the total). In journals demanding payment for the publishing of clinical cases, case reports represented 9% of all articles, and in free journals, 3% (P < 0.05). CONCLUSION: There has been a decline in publication of case reports in journals of Endocrinology in recent years, both in absolute and relative terms. Even though the cases described by these reports are, by definition, exceptional, the decline of their publication implies a significant loss of scientific information and clinical knowledge regarding certain pathologies.

Changes in the growth rate of Chlamydomonas reinhardtii under long-term selection by temperature and salinity: Acclimation vs. evolution.

We investigated the roles of acclimation and different components involved in evolution (adaptation, chance and history) on the changes in the growth rate of the model freshwater microalga Chlamydomonas reinhardtii P. A. Dang. exposed to selective temperature and salinity. Three C. reinhardtii strains previously grown during one year in freshwater medium and 20 °C were exposed to 5 °C temperature increase and a salinity of 5 g L-1 NaCl. Cultures under each selective scenario and in combination (increase of salinity and temperature), were propagated until growth rate achieved an invariant mean value for 6 months (100-350 generations, varying as a function of scenario and strain). The changes of the growth rate under increased temperature were due to both adaptation and acclimation, as well as history. However, acclimation was the only mechanism detected under salinity increase as well as in the selective scenario of both temperature and salinity, suggesting that genetic variability would not allow survival at salinity higher than that to which experimental populations were exposed. Therefore, it could be hypothesized that under a global change scenario an increase in salinity would be a greater challenge than warming for some freshwater phytoplankton.

Photosynthetic performance in cyanobacteria with increased sulphide tolerance: an analysis comparing wild-type and experimentally derived strains.

Sulphide is proposed to have influenced the evolution of primary stages of oxygenic photosynthesis in cyanobacteria. However, sulphide is toxic to most of the species of this phylum, except for some sulphide-tolerant species showing various sulphide-resistance mechanisms. In a previous study, we found that this tolerance can be induced by environmental sulphidic conditions, in which two experimentally derived strains with an enhanced tolerance to sulphide were obtained from Microcystis aeruginosa, a sensitive species, and Oscillatoria, a sulphide-tolerant genus. We have now analysed the photosynthetic performance of the wild-type and derived strains in the presence of sulphide to shed light on the characteristics underlying the increased tolerance. We checked whether the sulphide tolerance was a result of higher PSII sulphide resistance and/or the induction of sulphide-dependent anoxygenic photosynthesis. We observed that growth, maximum quantum yield, maximum electron transport rate and photosynthetic efficiency in the presence of sulphide were less affected in the derived strains compared to their wild-type counterparts. Nevertheless, in 14C photoincoporation assays, neither Oscillatoria nor M. aeruginosa exhibited anoxygenic photosynthesis using sulphide as an electron donor. On the other hand, the content of photosynthetic pigments in the derived strains was different to that observed in the wild-type strains. Thus, an enhanced PSII sulphide resistance appears to be behind the increased sulphide tolerance displayed by the experimentally derived strains, as observed in most natural sulphide-tolerant cyanobacterial strains. However, other changes in the photosynthetic machinery cannot be excluded.

Unexpected resilience in relict Abies pinsapo Boiss forests to dieback and mortality induced by climate change.

Acute and early symptoms of forest dieback linked to climate warming and drought episodes have been reported for relict Abies pinsapo Boiss. fir forests from Southern Spain, particularly at their lower ecotone. Satellite, orthoimages, and field data were used to assess forest decline, tree mortality, and gap formation and recolonization in the lower half of the altitudinal range of A. pinsapo forests (850-1550 m) for the last 36 years (1985-2020). Field surveys were carried out in 2003 and in 2020 to characterize changes in stand canopy structure and mortality rates across the altitudinal range. Time series of the Normalized Difference Vegetation Index (NDVI) at the end of the dry season (derived from Landsat 5 and 7 imagery) were used for a Dynamic Factor Analysis to detect common trends across altitudinal bands and topographic solar incidence gradients (SI). Historical canopy cover changes were analyzed through aerial orthoimages classification. Here we show that extensive decline and mortality contrast to the almost steady alive basal area for 17 years, as well as the rising photosynthetic activity derived from NDVI since the mid-2000s and an increase in the forest canopy cover in the late years at mid and high altitudes. We hypothesized that these results suggest an unexpected resilience in A. pinsapo forests to climate change-induced dieback, that might be promoted by compensation mechanisms such as (i) recruitment of new A. pinsapo individuals; (ii) facilitative effects on such recruitment mediated by revegetation with other species; and (iii) a 'release effect' in which surviving trees can thrive with fewer resource competition. Future research is needed to understand these compensation mechanisms and their scope in future climate change scenarios.

Detection of the maximum resistance to the herbicides diuron and glyphosate, and evaluation of its phenotypic cost, in freshwater phytoplankton.

One of the most important anthropogenic impacts on freshwater aquatic ecosystems close to intensive agriculture areas is the cumulative increase in herbicide concentrations. The threat is especially relevant for phytoplankton organisms because they have the same physiological targets as the plants for which herbicides have been designed. This led us to explore the evolutionary response of three phytoplanktonic species to increasing concentrations of two herbicides and its consequences in terms of growth and photosynthesis performance. Specifically, we used an experimental ratchet protocol to investigate the differential evolution and the limit of resistance of a cyanobacterium (Microcystis aeruginosa) and two chlorophyceans (Chlamydomonas reinhardtii and Dictyosphaerium chlorelloides) to two herbicides in worldwide use: glyphosate and diuron. Initially, the growth rate of M. aeruginosa and D. chlorelloides was completely inhibited when they were exposed to a dose of 0.23 ppm diuron or 40 ppm glyphosate, whereas a higher concentration of both herbicides (0.46 ppm diuron or 90 ppm glyphosate) was necessary to abolish C. reinhardtii growth. However, after running a ratchet protocol, the resistance of the three species to both herbicides increased by an adaptation process. M. aeruginosa and D. chlorelloides were able to grow at 1.84 ppm diuron and 80 ppm glyphosate and C. reinhardtii proliferated at twice these concentrations. Herbicide-resistant strains showed lower growth rates than their wild-type counterparts in the absence of herbicides, as well as changes on morphology and differences on photosynthetic pigment content. Besides, herbicide-resistant cells generally showed a lower photosynthetic performance than wild-type strains in the three species. These results indicate that the introduction of both herbicides in freshwater ecosystems could produce a diminution of primary production due to the selection of herbicide-resistant mutants, that would exhibit lower photosynthetic performance than wild-type populations.

Perception of knowledge about Clinical Hospital Nutrition among resident doctors in a tertiary hospital. / Percepción de conocimiento sobre Nutrición Clínica hospitalaria en los médicos residentes de un hospital terciario.

INTRODUCTION: Resident physicians' proper use of nutritional support and knowledge about Clinical Nutrition is essential to ensuring that their patients receive suitable nutritional care. MATERIALS AND METHOD: An online survey was sent to resident physicians at our hospital in specialisations with hospital beds. The survey featured 20 multiple-choice questions scored from 1 to 10 (1 being "completely disagree" and 10 being "completely agree") across the following themes: nutritional assessment, diets, oral nutritional supplements, enteral nutrition and perception of the Nutrition Unit. RESULTS: The survey was completed by 69% of resident physicians in medical specialisations and 70% of those in surgical specialisations. Overall, the average survey score was 6.28, with higher scores among medical residents than surgical residents (6.86 versus 5.38; p < 0.001), especially in the sections on nutritional assessment, diets and oral nutritional supplements. The respondents had a positive perception of the Nutrition Unit (mean score 7.6). DISCUSSION: Residents in medical specialisations afford greater importance to their patients' nutrition than residents in surgical specialisations, although in both groups the average score was rather low. There is much room for improvement in the training in Clinical Nutrition of this group, and it is important to include topics in Clinical Nutrition in training programmes for all residents in hospital specialisations.

Analysis of the evolution of the publication of case reports in endocrinology journals. / Análisis de la evolución en la publicación de casos clínicos en revistas de endocrinología.

INTRODUCTION: A case report is a scientific article describing one or more patients with unusual clinical presentations. In recent years, the number of case reports in publications has decreased. In this study, we analyze the publication of case reports in journals of Endocrinology during the years 2010, 2015 and 2019. MATERIALS AND METHODS: The Pubmed web was browsed for clinical journals of Endocrinology, those published in English and/or Spanish being selected, and the relevant variables analyzed. RESULTS: Of 84 analyzed journals, 51 accepted cases for publication, 29 did not, and 4 did so only in exceptional cases. In 2010, 11,754 articles were published, of which 709 were clinical cases (6.9% of the total); in 2015, a total of 14,594 articles of which 655 were clinical cases (5.8% of the total); and in 2019 a total of 14,110 articles, of which 472 were clinical cases (4.6% of the total). In journals demanding payment for the publishing of clinical cases, case reports represented 9% of all articles, and in free journals, 3% (P<.05). CONCLUSION: There has been a decline in publication of case reports in journals of Endocrinology in recent years, both in absolute and relative terms. Even though the cases described by these reports are, by definition, exceptional, the decline of their publication implies a significant loss of scientific information and clinical knowledge regarding certain pathologies.

The role of changes in environmental quality in multitrait plastic responses to environmental and social change in the model microalga Chlamydomonas reinhardtii.

Intraspecific variation plays a key role in species' responses to environmental change; however, little is known about the role of changes in environmental quality (the population growth rate an environment supports) on intraspecific trait variation. Here, we hypothesize that intraspecific trait variation will be higher in ameliorated environments than in degraded ones. We first measure the range of multitrait phenotypes over a range of environmental qualities for three strains and two evolutionary histories of Chlamydomonas reinhardtii in laboratory conditions. We then explore how environmental quality and trait variation affect the predictability of lineage frequencies when lineage pairs are grown in indirect co-culture. Our results show that environmental quality has the potential to affect intraspecific variability both in terms of the variation in expressed trait values, and in terms of the genotype composition of rapidly growing populations. We found low phenotypic variability in degraded or same-quality environments and high phenotypic variability in ameliorated conditions. This variation can affect population composition, as monoculture growth rate is a less reliable predictor of lineage frequencies in ameliorated environments. Our study highlights that understanding whether populations experience environmental change as an increase or a decrease in quality relative to their recent history affects the changes in trait variation during plastic responses, including growth responses to the presence of conspecifics. This points toward a fundamental role for changes in overall environmental quality in driving phenotypic variation within closely related populations, with implications for microevolution.

Lipoma arborescente bilateral de hombro: manejo de un caso en consulta de rehabilitación y revisión de la literatura / Bilateral lipoma arborescens of the shoulder: rehabilitation management inoutpatient clinic and literature review

La lipomatosis arborescente, también conocida como 'proliferación de vellosidades de la membrana sinovial', es una entidad que se caracteriza por la proliferación difusa de vellosidades con reemplazo del tejido sinovial por adipocitos maduros. La presentación típica es una enfermedad monoarticular que afecta a la rodilla, con predilección por la bolsa suprapatelar, aunque también se describe afectación mono o biarticular de articulaciones grandes como las caderas, los tobillos, los codos y los hombros. La resonancia magnética nuclear (RMN) es el método de imagen de elección para hacer el diagnóstico. El tratamiento consiste en practicar sinovectomía, ya sea abierta o artroscópica. En este estudio se presenta un caso de lipoma arborescente con afectación simultánea de la bursa subacromial-subdeltoidea, vaina del tendón de la porción larga del bíceps y articulación glenohumeral, que se asoció a lesión del manguito de los rotadores valorado en la Unidad de Alta Resolución de Hombro de nuestro servicio de rehabilitación

Arborescent lipomatosis, also known as 'synovial membrane villous proliferation', is an entity characterized by diffuse proliferation of villi with replacement of synovial tissue by mature adipocytes. The typical presentation is a monoarticular disease affecting the knee, with a predilection for the suprapatellar bursa, although mono- or biarticular involvement of large joints such as the hips, ankles, elbows and shoulders is also described. Magnetic resonance imaging (MRI) is the imaging method of choice for diagnosis. Treatment consists of synovectomy, either open or arthroscopic. This study presents a case of arborescent lipoma with simultaneous involvement of the subacromial-subdeltoid bursa, tendon sheath of the long portion of the biceps and glenohumeral joint, which was associated with rotator cuff lesion assessed in the High Resolution Shoulder Unit of our rehabilitation service.

Using ForeStereo and LIDAR data to assess fire and canopy structure-related risks in relict Abies pinsapo Boiss. forests.

In this study we combine information from aerial LIDAR and hemispherical images taken in the field with ForeStereo-a forest inventory device-to assess the vulnerability and to design conservation strategies for endangered Mediterranean fir forests based on the mapping of fire risk and canopy structure spatial variability. We focused on the largest continuous remnant population of the endangered tree species Abies pinsapo Boiss. spanning 252 ha in Sierra de las Nieves National Park (South Andalusia, Spain). We established 49 sampling plots over the study area. Stand structure variables were derived from ForeStereo device, a proximal sensing technology for tree diameter, height and crown dimensions and stand crown cover and basal area retrieval from stereoscopic hemispherical images photogrammetry. With this information, we developed regression models with airborne LIDAR data (spatial resolution of 0.5 points∙m-2). Thereafter, six fuel models were fitted to the plots according to the UCO40 classification criteria, and then the entire area was classified using the Nearest Neighbor algorithm on Sentinel imagery (overall accuracy of 0.56 and a KIA-Kappa Coefficient of 0.46). FlamMap software was used for fire simulation scenarios based on fuel models, stand structure, and terrain data. Besides the fire simulation, we analyzed canopy structure to assess the status and vulnerability of this fir population. The assessment shows a secondary growth forest that has an increasing presence of fuel models with the potential for high fire spread rate fire and burn probability. Our methodological approach has the potential to be integrated as a support tool for the adaptive management and conservation of A. pinsapo across its whole distribution area (<4,000 ha), as well as for other endangered circum-Mediterranean fir forests, as A. numidica de Lannoy and A. pinsapo marocana Trab. in North Africa.

The limit of resistance to salinity in the freshwater cyanobacterium Microcystis aeruginosa is modulated by the rate of salinity increase.

The overall mean levels of different environmental variables are changing rapidly in the present Anthropocene, in some cases creating lethal conditions for organisms. Under this new scenario, it is crucial to know whether the adaptive potential of organisms allows their survival under different rates of environmental change. Here, we used an eco-evolutionary approach, based on a ratchet protocol, to investigate the effect of environmental change rate on the limit of resistance to salinity of three strains of the toxic cyanobacterium Microcystis aeruginosa. Specifically, we performed two ratchet experiments in order to simulate two scenarios of environmental change. In the first scenario, the salinity increase rate was slow (1.5-fold increase), while in the second scenario, the rate was faster (threefold increase). Salinity concentrations ranging 7-10 gL-1 NaCl (depending on the strain) inhibited growth completely. However, when performing the ratchet experiment, an increase in salinity resistance (9.1-13.6 gL-1 NaCl) was observed in certain populations. The results showed that the limit of resistance to salinity that M. aeruginosa strains were able to reach depended on the strain and on the rate of environmental change. In particular, a higher number of populations were able to grow under their initial lethal salinity levels when the rate of salinity increment was slow. In future scenarios of increased salinity in natural freshwater bodies, this could have toxicological implications due to the production of microcystin by this species.