Gal3 Plays a Deleterious Role in a Mouse Model of Endotoxemia.

Lipopolysaccharide (LPS)-induced endotoxemia induces an acute systemic inflammatory response that mimics some important features of sepsis, the disease with the highest mortality rate worldwide. In this work, we have analyzed a murine model of endotoxemia based on a single intraperitoneal injection of 5 mg/kg of LPS. We took advantage of galectin-3 (Gal3) knockout mice and found that the absence of Gal3 decreased the mortality rate oflethal endotoxemia in the first 80 h after the administration of LPS, along with a reduction in the tissular damage in several organs measured by electron microscopy. Using flow cytometry, we demonstrated that, in control conditions, peripheral immune cells, especially monocytes, exhibited high levels of Gal3, which were early depleted in response to LPS injection, thus suggesting Gal3 release under endotoxemia conditions. However, serum levels of Gal3 early decreased in response to LPS challenge (1 h), an indication that Gal3 may be extravasated to peripheral organs. Indeed, analysis of Gal3 in peripheral organs revealed a robust up-regulation of Gal3 36 h after LPS injection. Taken together, these results demonstrate the important role that Gal3 could play in the development of systemic inflammation, a well-established feature of sepsis, thus opening new and promising therapeutic options for these harmful conditions.

Edad vascular de una muestra de población general del área sanitaria de Toledo (España). Estudio RICARTO / Vascular age in a sample of general population of the sanitary area of Toledo (Spain). RICARTO study

Objetivos: Conocer la edad vascular (EV) de una muestra de población general del área sanitaria de Toledo incluida en el estudio RICARTO.Pacientes y métodoEstudio epidemiológico transversal realizado en población general ≥18 años, aleatorizada según tarjeta sanitaria. La EV se calculó a partir del riesgo cardiovascular (RCV) absoluto estimado con las escalas de Framingham y SCORE (la presencia de diabetes mellitus duplicó el RCV obtenido en varones y lo cuadruplicó en mujeres). Se excluyeron los sujetos con patología cardiovascular o renal. Se realizó ANCOVA para ajustar y comparar las medias de EV por edad y sexo.ResultadosSe analizaron 1.496 individuos (53,54% mujeres), con una edad media (DE) de 48,77 (14,89) años. La EV media fue 51,37 (19,13) años con Framingham y 57,09 (17,63) años con SCORE, resultando significativamente mayor en varones, nivel de estudios bajo, hipertensión arterial, dislipidemia, hipertrigliceridemia, diabetes mellitus, obesidad abdominal, obesidad general, tabaquismo y en sujetos con 5 factores de RCV frente a ninguno (p<0,001 en todos). Las mayores diferencias (D de Cohen >0,5) se hallaron entre no diabéticos y diabéticos (1,58 Framingham; 2,44 SCORE), normotensos e hipertensos (1,64 Framingham; 1,19 SCORE) y no dislipidémicos y dislipidémicos (0,95 Framingham; 0,66 SCORE).ConclusionesEn nuestra muestra la EV es 2,5años superior a la cronológica con la ecuación de Framingham y más de 8años con la del SCORE. El control de los factores de RCV es clave para lograr una EV más próxima a la real y lograr una mejor salud cardiovascular de la población. (AU)

Objective: To know the vascular age (VA) of a sample of general population included in the RICARTO study.Patients and methodEpidemiological study of the general population aged ≥18 from the Health Area of Toledo, based on the health card database. VA was calculated from the absolute cardiovascular risk (CVR) estimated with the Framingham and SCORE equations (type2 diabetes increased CVR in SCORE 2-fold in men and 4-fold in women). Patients with cardiovascular or renal disease were excluded. An ANCOVA analysis was conducted to adjust and compare the mean of VA by age and sex.Results1,496 subjects (53.54% women) were analyzed. Mean (SD) age was 48.77 (14.89) years old and. Mean VA was 51.37 (19.13) with Framingham equation and 57.09 (17.63) years old with SCORE equation. VA was significantly higher in men, low education level, arterial hypertension, dyslipidemia, hypertriglyceridemia, diabetes mellitus, abdominal obesity, general obesity, smoking and in individuals with 5CVR factors vs none (P<.001 in all). Higher differences (Cohen's D >0.5) were found in non-diabetic vs diabetic people (1.58 Framingham; 2.44 SCORE), normotensive vs hypertensive subjects (1.64 Framingham; 1.19 SCORE), and non-dyslipidemia vs presence of dyslipidemia (0.95 Framingham; 0.66 SCORE).ConclusionsVA of our sample is two and a half years older than chronological one with Framingham equation and more than eight years with SCORE equation. Control of CVR factors is the key to get a VA closer to real and to obtain a better cardiovascular health in the population. (AU)

[Vascular age in a sample of general population of the sanitary area of Toledo (Spain). RICARTO study]. / Edad vascular de una muestra de población general del área sanitaria de Toledo (España). Estudio RICARTO.

OBJECTIVE: To know the vascular age (VA) of a sample of general population included in the RICARTO study. PATIENTS AND METHOD: Epidemiological study of the general population aged ≥18 from the Health Area of Toledo, based on the health card database. VA was calculated from the absolute cardiovascular risk (CVR) estimated with the Framingham and SCORE equations (type2 diabetes increased CVR in SCORE 2-fold in men and 4-fold in women). Patients with cardiovascular or renal disease were excluded. An ANCOVA analysis was conducted to adjust and compare the mean of VA by age and sex. RESULTS: 1,496 subjects (53.54% women) were analyzed. Mean (SD) age was 48.77 (14.89) years old and. Mean VA was 51.37 (19.13) with Framingham equation and 57.09 (17.63) years old with SCORE equation. VA was significantly higher in men, low education level, arterial hypertension, dyslipidemia, hypertriglyceridemia, diabetes mellitus, abdominal obesity, general obesity, smoking and in individuals with 5CVR factors vs none (P<.001 in all). Higher differences (Cohen's D >0.5) were found in non-diabetic vs diabetic people (1.58 Framingham; 2.44 SCORE), normotensive vs hypertensive subjects (1.64 Framingham; 1.19 SCORE), and non-dyslipidemia vs presence of dyslipidemia (0.95 Framingham; 0.66 SCORE). CONCLUSIONS: VA of our sample is two and a half years older than chronological one with Framingham equation and more than eight years with SCORE equation. Control of CVR factors is the key to get a VA closer to real and to obtain a better cardiovascular health in the population.

TET2 Regulates the Neuroinflammatory Response in Microglia.

Epigenomic mechanisms regulate distinct aspects of the inflammatory response in immune cells. Despite the central role for microglia in neuroinflammation and neurodegeneration, little is known about their epigenomic regulation of the inflammatory response. Here, we show that Ten-eleven translocation 2 (TET2) methylcytosine dioxygenase expression is increased in microglia upon stimulation with various inflammogens through a NF-κB-dependent pathway. We found that TET2 regulates early gene transcriptional changes, leading to early metabolic alterations, as well as a later inflammatory response independently of its enzymatic activity. We further show that TET2 regulates the proinflammatory response in microglia of mice intraperitoneally injected with LPS. We observed that microglia associated with amyloid ß plaques expressed TET2 in brain tissue from individuals with Alzheimer's disease (AD) and in 5xFAD mice. Collectively, our findings show that TET2 plays an important role in the microglial inflammatory response and suggest TET2 as a potential target to combat neurodegenerative brain disorders.

La investigación en Atención Primaria de Salud / Research in Primary Healthcare

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Effects of repeated yearly exposure to exercise-training on blood pressure and metabolic syndrome evolution.

OBJECTIVE: To study if repeated yearly training programs consolidate the transient blood pressure (BP) improvements of one exercise program into durable adaptations. METHODS: Obese middle-age individuals with metabolic syndrome (MetS) underwent high-intensity aerobic interval training during 16 weeks (November to mid-March) in 3 consecutive years [training group (TRAIN); N = 23]. Evolution of MetS components was compared with a matched-group that remained sedentary [control group (CONT); N = 26]. RESULTS: At the end of the first training program (0-4 months), TRAIN lowered systolic arterial pressure, blood glucose, waist circumference and MetS Z-score below CONT (-8.5 ±â€Š2.5 mmHg; -19.9 ±â€Š2.6 mg/dl; -3.8 ±â€Š0.1 cm and -0.3 ±â€Š0.1, respectively, all P < 0.05). With detraining (month 4-12) TRAIN adaptations relapsed to the levels of baseline (month 0) except for BP. A second exercise program (month 12-16) lowered blood glucose and waist circumference below CONT (-19.0 ±â€Š2.0 mg/dl; -4.1 ±â€Š0.1 cm). After detraining (month 16-24) BP, blood glucose and Z-score started below CONT values (-6.8 ±â€Š0.9 mmHg; -24.6 ±â€Š2.5 mg/dl and -0.4 ±â€Š0.05, respectively, all P < 0.05) and those differences enlarged with the last training program (month 24-28). Ten-year atherosclerotic cardiovascular disease risk estimation increased only in CONT (8.6 ±â€Š1.1-10.1 ±â€Š1.3%; year 2-3; P < 0.05). CONCLUSION: At least two consecutive years of 4-month aerobic interval training are required to chronically improve MetS (Z-score). The chronic effect is mediated by BP that does not fully return to pretraining values allowing a cumulative improvement. On the other hand, sedentarism in MetS patients during 3 years increases their predicted atherosclerotic diseases risk. CLINICALTRIALS. GOV IDENTIFIER: NCT03019796.

[Breakfasting with experts: quality and innovation]. / Desayuno con expertos: calidad e innovación.

The 26th Congress of the Spanish Society for Healthcare Quality was held in the city of Saragossa, Spain, in October 2008. The Scientific Committee introduced a new session format, called "breakfasting with experts". The aim was to create a relaxed atmosphere, in which participants and experts could debate several matters. In this case, population involvement in Health care services planning and innovation, were examined. Firstly the Puertollano Health District (Ciudad Real) talked about their very interesting and practical experience with patient involvement. Then the Primary Health Care District of Ekialde (Gipuzkoa) discussed the effort of continuous improvement in achieving innovative changes. Both experts, and some other input from the participants, led to the discussion of interesting ideas and assured the success of this session. These experiences can lead to substantial improvement in health care services.

Desayuno con expertos: calidad e innovación / Talking with experts: quality and innovation

Durante el 26.o Congreso de la Sociedad Española de Calidad Asistencial, celebrado en Zaragoza en octubre de 2008, tuvimos la oportunidad de asistir a la presentación de un nuevo formato de ponencia denominado "Desayuno con expertos". Esta innovación, propuesta por el Comité Científico y conducida por dos profesionales innovadores con amplia experiencia, trataba de crear un ambiente distendido, en un grupo pequeño de asistentes, para reflexionar sobre temas de actualidad en gestión sanitaria. Este trabajo intenta recoger las reflexiones de los expertos y participantes en aquella experiencia. Es evidente que si una de las maneras de enriquecer el camino de la mejora continua es aprender de los avances más innovadores, en este desayuno tuvimos ocasión de comprobarlo al conocer de cerca dos experiencias en esta línea. En la primera de ellas, (Gerencia del área de Puertollano), se utilizan modelos conocidos de gestión de calidad y sostenibilidad (EFQM, GRI) y se apuesta por la participación ciudadana en gestión como herramienta de cambio; en la segunda, en la Comarca Ekial de de Atención Primaria de Osakidetza, se viene trabajando en la aplicación del modelo de gestión de calidad europeo con el objetivo de consolidar la mejora alcanzada y, sobre esta base, introducir cambios innovadores en la organización. En definitiva, en estos momentos en los que la mejora de la calidad necesita de cambios importantes e innovadores, estas y otras experiencias demuestran que metodologías como el modelo EFQM, la asunción de la sostenibilidad o la participación ciudadana, son válidas para lograr mejoras determinantes en nuestros servicios sanitarios (AU)

The 26th Congress of the Spanish Society for Healthcare Quality was held in the city of Saragossa, Spain, in October 2008. The Scientific Committee introduced a new session format, called "breakfasting with experts". The aim was to create a relaxed atmosphere, in which participants and experts could debate several matters. In this case, population involvement in Health care services planning and innovation, were examined. Firstly the Puertollano Health District (Ciudad Real) talked about their very interesting and practical experience with patient involvement. Then the Primary Health Care District of Ekialde (Gipuzkoa) discussed the effort of continuous improvement in achieving innovative changes. Both experts, and some other input from the participants, led to the discussion of interesting ideas and assured the success of this session. These experiences can lead to substantial improvement in health care services (AU)

Calidad asistencial en atención primaria / Quality control in primary health care

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Propuesta de una nueva adaptación del acrónimo RADAR / Proposal for a new adaptation of the acronym RADAR

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Mejora en la calidad asistencial en el Servicio de Salud de Castilla-La Mancha (SESCAM) / Improvement of healthcare quality in the Health Care Service of Castilla-La Mancha (SESCAM)

La actual tendencia en la gestión de la calidad aconseja adoptar un Modelo de Gestión de la Calidad Total, de forma que todas las actividades de la organización estén orientadas a obtener mejores resultados y a alcanzar un nivel de excelencia en la prestación de los servicios. El nuevo Plan de Calidad en el Servicio de Salud de Castilla-La Mancha (SESCAM) comienza el ajuste hacia el modelo EFQM, y contribuye al desarrollo de los objetivos fijados por el Plan de Salud de Castilla-La Mancha 2001-2010.Además del Plan de Calidad, el SESCAM ha desarrollado distintas iniciativas que inciden claramente en la mejora continua de la calidad. De ellas, hay que destacar: la aprobación e implantación de la Ley de Garantías en Atención Sanitaria Especializada; el Plan de Inspección; el Plan de los Pequeños Detalles, y por último, el desarrollo de las tecnologías de la información. Transcurridos algo más de 2 años desde que el SESCAM asumió la responsabilidad de gestionar los servicios sanitarios públicos, los resultados alcanzados y la opinión mayoritariamente expresada entre los ciudadanos y los propios profesionales han venido a demostrar la capacidad técnica y humana de la organización. En el futuro inmediato, sólo desde una práctica profesional eficiente, orientada a la excelencia y centrada en las necesidades de los pacientes será posible prestar una atención sanitaria que garantice la equidad y dé respuesta a las diferentes demandas que se plantean en una sociedad abierta, plural y en cambio constante (AU)

[Quality control program in a group of Spanish public hospitals (1993-2001)]. / Plan de calidad en una red de hospitales públicos en España (1993-2001).

INTRODUCTION: The INSALUD (National Healthcare Institute) is a public institution that manages the provision of health services for 15 million Spanish people. INSALUD developed a quality control program for specialist care, which involved its 80 hospitals. OBJECTIVES OF THE PROGRAM: To promote leadership among the managers of quality assurance programs, to involve in the improvement of quality all the employees of the organization and to set out the Institution's following strategic outlines: to direct the services towards the needs of the population, to improve the quality and effectiveness of the care procedures, to minimize risks and to improve the information system. EQUIPMENT AND TECHNIQUES: The Management Contract, i.e. the main tool of specialist care management, included a Quality Control Program common to all the hospitals involved. The Program was divided in the following three parts: common improvement goals, monitoring of indicators and guidelines of the organization. OUTCOME AND FINDINGS: All the hospitals involved introduced their own quality assurance program which incorporated the Institution's Quality Control Program. The majority of the objectives assessed showed a continuous improvement of the outcome. The experience of the 1993-2001 INSALUD Quality program can prove to be very useful for the new Healthcare Services of the Autonomous Communities resulting from the decentralization of the healthcare provision of services in Spain.

Encuesta sobre las medidas de prevención antitabáquica en la red de hospitales del Insalud / A survey about the measures of smoking control in the network of Insalud hospitals

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