SINUSOIDAL OBSTRUCTION SYNDROME/VENO-OCCLUSIVE DISEASE AFTER UNMANIPULATED HAPLOIDENTICAL HSCT WITH POST-TRANSPLANT CYCLOPHOSPHAMIDE: A STUDY ON BEHALF OF THE SPANISH HEMATOPOIETIC STEM CELL TRANSPLANTATION AND CELLULAR THERAPY GROUP (GETH).

BACKGROUND: Sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) is a life threatening complication after both autologous and allogeneic hematopoietic stem cell transplantation (HSCT). However, its characterization after haploidentical HSCT (haplo-HSCT) with post-transplant cyclophosphamide (PT-Cy) is scarce. OBJECTIVES: To describe characteristics and outcomes of patients with SOS/VOD after haplo-HSCT with PT-Cy. STUDY DESIGN: We conducted a retrospective study of 797 patients undergoing a haplo-HSCT with PT-Cy between 2007 and 2019 in 9 centers in Spain. SOS/VOD was defined according to modified Seattle, Baltimore or revised EBMT criteria. Severity was retrospectively graded according to revised EBMT severity criteria into 4 categories: mild, moderate, severe and very severe. RESULTS: From 797 haplo-HSCT performed, 46 patients (5.77%) were diagnosed from SOS/VOD at a median of 19 days (range 4-84) after transplant. Based on revised EBMT severity criteria, there were 4 mild (8.7%), 10 moderate (21.7%), 12 severe (26.1%) and 20 very severe (43.5%) grade SOS/VOD cases. Overall, 30 patients (65%) achieved SOS/VOD complete response, 25 (83%) of whom were treated with defibrotide. Twenty patients (43%) died before day 100 after HSCT. Death was attributed to SOS/VOD in 11 patients, and 5 patients died of other causes without resolution of SOS/VOD. CONCLUSIONS: Incidence of SOS/VOD after haplo-HSCT with PT-Cy was comparable to those reported after HLA-identical HSCT series. Most of the patients developed very severe SOS/VOD according to revised EBMT severity criteria. In spite of a promising SOS/VOD CR rate (65%), 100-day mortality remained high (43%), indicating that further improvement in the management of this potentially fatal complication is needed.

Integrated photon pair source based on a silicon nitride micro-ring resonator for quantum memories.

We report the design of an integrated photon pair source based on spontaneous four-wave mixing (SFWM), implemented in an integrated micro-ring resonator in the silicon nitride platform (Si3N4). The signal photon is generated with emission at 606 nm and bandwidth of 3.98 MHz, matching the spectral properties of praseodymium ions (Pr), while the idler photon is generated at 1430.5 nm matching the wavelength of a CWDM channel in the E-band. This novel, to the best of our knowledge, device is designed to interact with a quantum memory based on a Y2SiO5 crystal doped with Pr3+ ions, in which we used cavity-enhanced SFWM along with dispersion engineering to reach the required wavelength and the few megahertz signal photon spectral bandwidth.

Guidelines for the management of coagulation disorders in patients with cirrhosis.

Coagulation management in the patient with cirrhosis has undergone a significant transformation since the beginning of this century, with the concept of a rebalancing between procoagulant and anticoagulant factors. The paradigm that patients with cirrhosis have a greater bleeding tendency has changed, as a result of this rebalancing. In addition, it has brought to light the presence of complications related to thrombotic events in this group of patients. These guidelines detail aspects related to pathophysiologic mechanisms that intervene in the maintenance of hemostasis in the patient with cirrhosis, the relevance of portal hypertension, mechanical factors for the development of bleeding, modifications in the hepatic synthesis of coagulation factors, and the changes in the reticuloendothelial system in acute hepatic decompensation and acute-on-chronic liver failure. They address new aspects related to the hemorrhagic complications in patients with cirrhosis, considering the risk for bleeding during diagnostic or therapeutic procedures, as well as the usefulness of different tools for diagnosing coagulation and recommendations on the pharmacologic treatment and blood-product transfusion in the context of hemorrhage. These guidelines also update the knowledge regarding hypercoagulability in the patient with cirrhosis, as well as the efficacy and safety of treatment with the different anticoagulation regimens. Lastly, they provide recommendations on coagulation management in the context of acute-on-chronic liver failure, acute liver decompensation, and specific aspects related to the patient undergoing liver transplantation.

Physico-Chemical Properties of CdTe/Glutathione Quantum Dots Obtained by Microwave Irradiation for Use in Monoclonal Antibody and Biomarker Testing.

In this report, we present the results on the physicochemical characterization of cadmium telluride quantum dots (QDs) stabilized with glutathione and prepared by optimizing the synthesis conditions. An excellent control of emissions and the composition of the nanocrystal surface for its potential application in monoclonal antibody and biomarker testing was achieved. Two samples (QDYellow, QDOrange, corresponding to their emission colors) were analyzed by dynamic light scattering (DLS), and their hydrodynamic sizes were 6.7 nm and 19.4 nm, respectively. Optical characterization by UV-vis absorbance spectroscopy showed excitonic peaks at 517 nm and 554 nm. Photoluminescence spectroscopy indicated that the samples have a maximum intensity emission at 570 and 606 nm, respectively, within the visible range from yellow to orange. Infrared spectroscopy showed vibrational modes corresponding to the functional groups OH-C-H, C-N, C=C, C-O, C-OH, and COOH, which allows for the formation of functionalized QDs for the manufacture of biomarkers. In addition, the hydrodynamic radius, zeta potential, and approximate molecular weight were determined by dynamic light scattering (DLS), electrophoretic light scattering (ELS), and static light scattering (SLS) techniques. Size dispersion and the structure of nanoparticles was obtained by Transmission Electron Microscopy (TEM) and by X-ray diffraction. In the same way, we calculated the concentration of Cd2+ ions expressed in mg/L by using the Inductively Coupled Plasma Atomic Emission Spectrometry (ICP-OES). In addition to the characterization of the nanoparticles, the labeling of murine myeloid cells was carried out with both samples of quantum dots, where it was demonstrated that quantum dots can diffuse into these cells and connect mostly with the cell nucleus.

Specific Multiomic Profiling in Aortic Stenosis in Bicuspid Aortic Valve Disease.

INTRODUCTION AND PURPOSE: Bicuspid aortic valve (BAV) disease is associated with faster aortic valve degeneration and a high incidence of aortic stenosis (AS). In this study, we aimed to identify differences in the pathophysiology of AS between BAV and tricuspid aortic valve (TAV) patients in a multiomics study integrating metabolomics and transcriptomics as well as clinical data. METHODS: Eighteen patients underwent aortic valve replacement due to severe aortic stenosis: 8 of them had a TAV, while 10 of them had a BAV. RNA sequencing (RNA-seq) and proton nuclear magnetic resonance spectroscopy (1H-NMR) were performed on these tissue samples to obtain the RNA profile and lipid and low-molecular-weight metabolites. These results combined with clinical data were posteriorly compared, and a multiomic profile specific to AS in BAV disease was obtained. RESULTS: H-NMR results showed that BAV patients with AS had different metabolic profiles than TAV patients. RNA-seq also showed differential RNA expression between the groups. Functional analysis helped connect this RNA pattern to mitochondrial dysfunction. Integration of RNA-seq, 1H-NMR and clinical data helped create a multiomic profile that suggested that mitochondrial dysfunction and oxidative stress are key players in the pathophysiology of AS in BAV disease. CONCLUSIONS: The pathophysiology of AS in BAV disease differs from patients with a TAV and has a specific RNA and metabolic profile. This profile was associated with mitochondrial dysfunction and increased oxidative stress.

Description of Acromoldavicus xerophilus n. sp. (Nematoda, Rhabditida, Elaphonematidae) from the southern Iberian Peninsula, including a key to species of the genus.

A new species of the genus Acromoldavicus is described from coastal sand dunes and sandy soil in the southeast of the Iberian Peninsula. Acromoldavicus xerophilus n. sp. is characterized by its 557-700 µm body length, cuticle tessellated, lip region with three pairs of expanded lips bearing a large labial expansion, primary axils bearing guard processes with two different morphology, secondary axils lacking guard processes, stoma short and tubular with prostegostom bearing prominent rhabdia directed towards the stoma lumen, female reproductive system monodelphic-prodelphic, post-vulval sac 0.6-0.9 times body diameter, rectum very large, female tail short with biacute terminus and males unknown. The description, light micrographs, scanning electron microscope images, illustrations, and molecular analyses are provided. Molecular analyses (based on 18S and 28S rDNA) revealed its relationship with some species of the genera Cephalobus (18S tree), Nothacrobeles, Paracrobeles, and Spinocephalus (28S tree). Keys to species identification of this genus are also included.

[Autism spectrum disorder: the impact of an online training strategy on the knowledge of the healthcare staff of a tertiary care hospital]. / Trastorno del espectro autista: impacto de una estrategia de formación en línea en los conocimientos del personal sanitario de un hospital de tercer nivel.

INTRODUCTION: Autism spectrum disorder (ASD) often presents related medical disorders that require specialised healthcare. Professionals in the health sector therefore face difficulties that require specific training in the healthcare needs of this population. AIM: The aim of this study is to quantify paediatric healthcare professionals' knowledge about ASD and to assess the impact of online training. SUBJECTS AND METHODS: It is a quasi-experimental, longitudinal, prospective before-and-after study; study subjects: health professionals; independent variable: online training in ASD; dependent variable: knowledge about ASD. An online training course was held for paediatric professionals to address the core characteristics of diagnosis, as well as the needs they present in the hospital context and the adaptations it is recommended that should be carried out. Fifty-eight healthcare professionals took part. RESULTS: An increase in knowledge about ASD was observed at the end of the intervention (from 73.9% to 85% according to the ASD background knowledge questionnaire), which showed that more than 90% of the participants had the highest level of knowledge about ASD. CONCLUSIONS: Online training courses are a useful and effective way to increase knowledge about ASD and the adaptations that are recommended in the hospital setting. More training in ASD should be made available in these settings.

TITLE: Trastorno del espectro autista: impacto de una estrategia de formación en línea en los conocimientos del personal sanitario de un hospital de tercer nivel.Introducción. El trastorno del espectro autista (TEA) frecuentemente presenta trastornos médicos relacionados que requieren una atención sanitaria especializada. En este sentido, los profesionales del ámbito sanitario se enfrentan a dificultades que precisan una formación específica en las necesidades sanitarias que presenta esta población. Objetivo. Cuantificar los conocimientos sobre el TEA de los profesionales sanitarios del área pediátrica y valorar el impacto de una formación en línea. Sujetos y métodos. Estudio cuasi experimental del antes y después, longitudinal y prospectivo; sujetos a estudio: profesionales sanitarios; variable independiente: formación en línea en TEA; variable dependiente: conocimiento sobre el TEA. Se llevó a cabo una formación en línea para profesionales del área de pediatría en la que se abordaron las características nucleares del diagnóstico, así como las necesidades que presentan en el contexto hospitalario y las adaptaciones que se recomiendan llevar a cabo. Participaron 58 profesionales sanitarios. Resultados. Se observó un aumento en el conocimiento sobre el TEA al finalizar la intervención (del 73,9 al 85% según el cuestionario de conocimientos previos del TEA), que mostró que más del 90% de los participantes tenía el grado máximo de conocimiento sobre el TEA. Conclusiones. Las formaciones en línea son un método para ampliar conocimiento útil y eficaz para aumentar el conocimiento sobre el TEA y las adaptaciones que se recomiendan en el ámbito hospitalario. Se recomienda aumentar la disponibilidad de formación sobre TEA en estos entornos.

Thermal evaluation of plant biomass from the phytostabilisation of soils contaminated by potentially toxic elements.

The combination of phytoremediation of soils contaminated by potentially toxic elements with energy production by combustion of the generated biomass can be a sustainable land management option, combining the production of renewable bioenergy with soil restoration while minimising energy consumption and CO2 emission. In this work, plant biomass from phytoremediation of soils contaminated by potentially toxic elements was studied as solid biofuel for combustion by thermal analysis and biomass composition. Six plant species were grown in two soils with differing degrees of contamination: Brassica juncea, Cynara cardunculus, Atriplex halimus, Nicotiana glauca, Dittrichia viscosa, Retama sphaerocarpa and Salvia rosmarinus. The composition of the plant biomass was characterised chemically and thermogravimetric analyses were performed for the mass loss (TG), derivative curves of mass loss (DTG) and temperature difference (DTA) signal. The cellulose concentration correlated with the parameters of the thermal analysis in the low temperature range (150-350 °C), while lignin correlated with the thermal parameters of the second peak in the high temperature range. Salvia rosmarinus and R. sphaerocarpa showed the best combustion characteristics according to the thermal profile and mineral residue results. The accumulation of potentially toxic elements in B. juncea grown in heavily contaminated soil led to a higher amount of residue at 750 °C, with a global activation energy lower than the one obtained when this species was grown in a soil with lower contamination. Therefore, the most beneficial combination of soil phytoremediation and energy production (combustion) that can be suggested would depend on the level of soil contamination: in heavily contaminated soil, phytostabilisation using R. sphaerocarpa and S. rosmarinus; in slightly contaminated soil, B. juncea due to its high energy of activation, although the concentrations of potentially toxic elements in the residue must be controlled, as well as possible particulate matter emissions during combustion.

Morphological and molecular characterization of Trichuris muris (Nematoda: Trichuridae): studies from two commensal rodent species.

In this paper we re-describe Trichuris muris based on morphological data following isolation from two commensal rodent species, Mus musculus from Mexico and Rattus rattus from Argentina. Furthermore, we provide a molecular characterization based on mitochondrial (cytochrome c oxidase subunit 1 mitochondrial gene) and nuclear (internal transcribed spacer 2 region) markers in order to support the taxonomic identification of the studied specimens of T. muris from M. musculus. We distinguished T. muris from 29 species of Trichuris found in American rodents based on morphological and biometrical features, such as the presence of a spicular tube, length of spicule, size of proximal and distal cloacal tube and non-protrusive vulva. We suggest that spicular tube patterns can be used to classify Trichuris species in three groups. Considering that the diagnosis among the species of this genus is mainly based on morphometry, this proposal represents a relevant contribution. We provide molecular studies on two markers, making this the first contribution for T. muris in the Americas. This study makes an important contribution to the integrative taxonomy of cosmopolitan nematode species, and its correct determination from the parasitological study of commensal rodents.

Increased body fat, physical inactivity, and hypertension are associated with poor quality of life in patients with type 2 diabetes.

BACKGROUND: Diabetes is a significant health problem that affects quality of life in the medium and long term. OBJECTIVE: To identify the association between quality of life with comorbidity, metabolic control, and lifestyle in patients with type 2 diabetes. METHOD: A cross-sectional study was performed in 392 patients. Glycosylated hemoglobin, fasting glucose, lipid profile, blood pressure, weight, waist circumference and body composition were measured. Diabetic neuropathy, renal disease, visual health, diet and physical exercise were measured. Health-related quality of life (HRQoL) was measured with the 36-item Short Form survey (SF-36). RESULTS: The mean age was 54.6 years, 68 % were women, median years of diabetes diagnosis was 7 years. Eighty percent had a good HRQoL (SF-36 ≥ 50). The dimension with the highest score was physical function (81.0), and vitality the lowest (46.5). Body fat was associated with more impairments in the SF-36 dimensions (p < 0.05). Factors associated with worse HRQOL are physical inactivity (odds ratio [OR]: 2.7; 95% confidence interval [95%CI]: 1.10-6.62; p = 0.009), arterial hypertension (OR: 1.78; 95% CI: 1.05-3.02; p = 0.032) and being female (OR: 2.7; 95% CI: 1.45-5.27; p = 0.002). CONCLUSIONS: Poor quality of life is associated with higher fat percentage, physical inactivity and hypertension in patients with type 2 diabetes.

ANTECEDENTES: La diabetes es un importante problema de salud que afecta la calidad de vida a mediano y largo plazo. OBJETIVO: Identificar la asociación entre la calidad de vida y la comorbilidad, el control metabólico y el estilo de vida de pacientes con diabetes tipo 2. MÉTODO: Se realizó un estudio transversal en 392 pacientes. Se midieron la hemoglobina glucosilada, la glucosa de ayuno, el perfil de lípidos, la presión arterial, el peso, la circunferencia de la cintura y la composición corporal. Se evaluaron la neuropatía diabética, la enfermedad renal, la salud visual, la dieta y el ejercicio físico. La calidad de vida relacionada con la salud (CVRS) se midió con la encuesta en su versión corta de 36 ítems (SF-36). RESULTADOS: La edad promedio fue de 54.6 años, el 68% fueron mujeres y la mediana de años de diagnóstico de diabetes fue de 7 años. Un 80% tienen una buena CVRS (SF-36 ≥ 50). La dimensión con mayor puntaje fue función física (81.0), y la más baja fue vitalidad (46.5). La grasa corporal se asoció a más afectaciones en las dimensiones del SF-36 (p < 0.05). Los factores asociados a una peor CVRS son la inactividad física (odds ratio [OR]: 2.7; intervalo de confianza del 95% [IC95%]: 1.10-6.62; p = 0.009), la hipertensión arterial (OR: 1.78; IC95%: 1.05-3.02; p = 0.032) y ser mujer (OR: 2.7; IC95%: 1.45-5.27; p = 0.002). CONCLUSIONES: Una pobre calidad de vida se asocia con mayor porcentaje de grasa, inactividad física e hipertensión en pacientes con diabetes tipo 2.

Mastoiditis enmascarada: Reporte de caso en un hospital pediátrico de alta complejidad / Masked mastoiditis: case report in a high-complexity pediatric hospital

La mastoiditis enmascarada es una forma poco frecuente dentro de las complicaciones de las otitis medias, ya sean aguda o crónicas. Su principal característica es presentar poca o mínima sintomatología ótica y tener un curso larvado en el tiempo. Este diagnóstico debe ser correctamente sospechado, ya que eventualmente puede generar consecuencias otológicas graves y presentar complicaciones mayores a nivel intra o extratemporal. En este trabajo se presenta el caso clínico de una paciente pediátrica sana, a la cual se diagnostica mastoiditis enmascarada de tres meses de evolución complicada con absceso de Bezold. Se inicia desde el ingreso hospitalario esquema antibiótico bi-asociado y se realiza mastoidectomía simple, evolucionando de forma satisfactoria.

Masked mastoiditis is a rare complication of acute or chronic otitis media. Its main characteristic is to present little or minimal otic symptoms and has a slowly progressive course over time. This diagnosis must be suspected correctly because it can eventually generate serious otological consequences and present major complications at intra or extratemporal levels. We report the clinical case of a healthy pediatric patient, who was diagnosed with masked mastoiditis complicated with a Bezold's abscess. A bi-associated antibiotic scheme was started from admission and a timpanomastoidectomy was performed, with a satisfactory outcome.

Effects of ascorbic acid addition on the oxidative stress response of Oryza sativa L. plants to As(V) exposure.

Accumulation of noxious elements in the edible part of crops and its impact on food safety is of increasing concern. Rice is one of the major staple food crops worldwide, including arsenic (As)-polluted areas, in which dietary As exposure is becoming a widespread health threat. Plant chemical priming has been shown to be an effective strategy to enhance tolerance to environmental stresses, including metal(loid) exposure. The priming effect of ascorbic acid (AsA) was assessed in rice seedlings exposed to As(V) in a hydroponics experiment. AsA treatment (co-addition to the growing media concomitantly (t0) or 24 h in advance (t24)) prevented an excessive accumulation of As in the roots (that decreased âˆ¼ 60%) and stimulated the activities of photosynthetic and antioxidant attributes (∼1.2-fold) in the aerial part of the plants. The increase in proline levels in both shoots (∼2.1-fold) and roots (∼2.4-fold) was found to be the most sensitive stress parameter, and was able to reflect the AsA-induced reduction of As toxic effects (concentrations back to Control levels, both simultaneously added or added as a pretreatment) in the aerial part of the plants. However, the phytotoxic effects related to As exposure were not fully prevented by priming with AsA, and further research is needed to find alternative priming approaches.

Response of Phragmites australis to increasing As(V) concentrations: Accumulation and speciation of As, and plant oxidative stress.

The use of macrophytes has been proposed recently as a suitable option for the phytostabilization or rhizofiltration of soils or waters contaminated by trace elements. As one of the most representative species of this type of plant, common reed (Phragmites australis (Cav.) Trin. ex Steud.) has shown tolerance to high concentrations of potentially hazardous elements, as is the case of arsenic. However, a deeper knowledge of how these plants deal with this toxicity, including their oxidative response, is needed for the optimum utilization of this species in phytoremediation procedures. In fact, little is known about how common reed plants react to As toxicity or the tolerance limits and accumulation potential of this species. In this work, common reed plants were exposed to a range of As(V) mass concentrations (0.5-10 mg L-1) in a hydroponic experiment, and the performance of the plants (growth, photosynthetic pigments, and oxidative stress related parameters) was evaluated and related to the major As species present in the different parts of the plants. The plants did not show any apparent symptom of toxicity and no significant effects were found for any of the different plant parameters analyzed. Arsenic was mostly accumulated as As(III) in the roots of the plants, and almost no translocation to the aerial part of the plants was observed for any of the As species analyzed. Common reed has shown a high capacity for As accumulation in its roots with no signs of toxicity, despite small nutrient imbalances. Thus, it can be considered to be a good candidate for use in the rhizofiltration and phytostabilization of As contaminated waters and soils, respectively.

Clinical utility of comprehensive circulating tumor DNA genotyping compared with standard of care tissue testing in patients with newly diagnosed metastatic colorectal cancer.

BACKGROUND: Comprehensive biomarker testing is essential in selecting optimal treatment for patients with metastatic colorectal cancer (mCRC); however, incomplete genotyping is widespread, with most patients not receiving testing for all guideline-recommended biomarkers, in part due to reliance on burdensome sequential tissue-based single-biomarker tests with long waiting times or availability of only archival tissue samples. We aimed to demonstrate that liquid biopsy, associated with rapid turnaround time (TAT) and lower patient burden, effectively identifies guideline-recommended biomarkers in mCRC relative to standard of care (SOC) tissue testing. PATIENTS AND METHODS: Prospectively enrolled patients with previously untreated mCRC undergoing physician discretion SOC tissue genotyping submitted pretreatment blood samples for comprehensive circulating tumor DNA (ctDNA) analysis with Guardant360 and targeted RAS and BRAF analysis with OncoBEAM. RESULTS: Among 155 patients, physician discretion SOC tissue genotyping identified a guideline-recommended biomarker in 82 patients, versus 88 identified with comprehensive ctDNA (52.9% versus 56.8%, noninferiority demonstrated down to α = 0.005) and 69 identified with targeted PCR ctDNA analysis (52.9% versus 44.5%, noninferiority rejected at α = 0.05). Utilizing ctDNA in addition to tissue increased patient identification for a guideline-recommended biomarker by 19.5% by rescuing those without tissue results either due to tissue insufficiency, test failure, or false negatives. ctDNA median TAT was significantly faster than tissue testing when the complete process from sample acquisition to results was considered (median 10 versus 27 days, P < 0.0001), resulting in accelerated biomarker discovery, with 52.0% biomarker-positive patients identified by ctDNA versus 10.2% by SOC tissue 10 days after sample collection (P < 0.0001). CONCLUSIONS: Comprehensive ctDNA genotyping accurately identifies guideline-recommended biomarkers in patients with mCRC at a rate at least as high as SOC tissue genotyping, in a much shorter time. Based on these findings, the addition of ctDNA genotyping to clinical practice has significant potential to improve the care of patients with mCRC.

Análisis coste-efectividad del implante percutáneo de válvula aórtica SAPIEN 3 en pacientes con estenosis aórtica grave sintomática / Cost-effectiveness analysis of the SAPIEN 3 transcatheter aortic valve implant in patients with symptomatic severe aortic stenosis

Introducción y objetivos: El implante percutáneo de la válvula aórtica se ha consolidado como tratamiento de la estenosis aórtica grave inoperable o de alto riesgo quirúrgico. Recientemente las indicaciones se han ampliado a riesgo intermedio y bajo. Nuestro objetivo es evaluar la eficiencia de SAPIEN 3 frente al tratamiento médico conservador (TMC) o el reemplazo quirúrgico de válvula aórtica (RVA) en pacientes sintomáticos inoperables con riesgo alto e intermedio.´Métodos: Análisis de coste-efectividad de SAPIEN 3 frente a RVA/TMC mediante un modelo de Markov (ciclos mensuales) adaptado con 8 estados definidos por la New York Hearth Association y resultados a 15 años, incluidos las complicaciones mayores y el tratamiento tras el alta hospitalaria, desde la perspectiva del Sistema Nacional de Salud. Los parámetros de efectividad se basan en los estudios PARTNER. Se incluyeron costes sanitarios (en euros de 2019) derivados del procedimiento, hospitalización, complicaciones clínicas y seguimiento. Se aplicó una tasa de descuento anual del 3% en costes y beneficios. El análisis de sensibilidad fue determinístico y probabilístico (Monte Carlo). Resultados: En comparación con el RVA (riesgo alto e intermedio) y el TMC (inoperables), el SAPIEN 3 implicó mejores resultados en las 3 poblaciones y menor estancia. Las tasas de coste-utilidad incremental fueron 5.471 (riesgo alto), 8.119 (riesgo intermedio) y 9.948 (inoperables) euros/años de vida ajustados por calidad ganados. En el análisis probabilístico, el SAPIEN 3 resultó coste-efectivo por encima del 75% de las simulaciones en los 3 perfiles. Conclusiones: En nuestro medio, el SAPIEN 3 permite un tratamiento eficiente de la estenosis aórtica grave tanto en pacientes inoperables como en riesgo alto e intermedio (AU)

Introduction and objectives: Transcatheter aortic valve implant has become a widely accepted treatment for inoperable patients with aortic stenosis and patients at high surgical risk. Its indications have recently been expanded to include patients at intermediate and low surgical risk. Our aim was to evaluate the efficiency of SAPIEN 3 vs conservative medical treatment (CMT) or surgical aortic valve replacement (SAVR) in symptomatic inoperable patients at high or intermediate risk. Methods: We conducted a cost-effectiveness analysis of SAPIEN 3 vs SAVR/CMT, using a Markov model (monthly cycles) with 8 states defined by the New York Heart Association and a time horizon of 15 years, including major complications and management after hospital discharge, from the perspective of the National Health System. Effectiveness parameters were based on the PARTNER trials. Costs related to the procedure, hospitalization, complications, and follow-up were included (euros in 2019). An annual discount rate of 3% was applied to both costs and benefits. Deterministic and probabilistic sensitivity analyses (Monte Carlo) were performed. Results: Compared with SAVR (high and intermediate risk) and CMT (inoperable), SAPIEN 3 showed better clinical results in the 3 populations and lower hospital stay. Incremental cost-utility ratios (€/quality-adjusted life years gained) were 5471 (high risk), 8119 (intermediate risk) and 9948 (inoperable), respectively. In the probabilistic analysis, SAPIEN 3 was cost-effective in more than 75% of the simulations in the 3 profiles. Conclusions: In our health system, SAPIEN 3 facilitates efficient management of severe aortic stenosis in inoperable and high- and intermediate-risk patients (AU)

Radiological Structured Report Integrated with Quantitative Imaging Biomarkers and Qualitative Scoring Systems.

The benefits of structured reporting (SR) in radiology are well-known and have been widely described. However, there are limitations that must be overcome. Radiologists may be reluctant to change the conventional way of reporting. Error rates could potentially increase if SR is used improperly. Interruption of the visual search pattern by keeping the eyes focused on the report rather than the images may increase reporting time. Templates that include unnecessary or irrelevant information may undermine the consistency of the report. Last, the lack of support for multiple languages may hamper the adaptation of the report to the target audience. This work aims to mitigate these limitations with a web-based structured reporting system based on templates. By including field validators and logical rules, the system avoids reporting mistakes and allows to automatically calculate values and radiological qualitative scores. The system can manage quantitative information from imaging biomarkers, combining this with qualitative radiological information usually present in the structured report. It manages SR templates as plugins (IHE MRRT compliant and compatible with RSNA's Radreport templates), ensures a seamless integration with PACS/RIS systems, and adapts the report to the target audience by means of natural language extracts generated in multiple languages. We describe a use case of SR template for prostate cancer including PI-RADS 2.1 scoring system and imaging biomarkers. For the time being, the system comprises 24 SR templates and provides service in 37 hospitals and healthcare institutions, endorsing the success of this contribution to mitigate some of the limitations of the SR.

Propiedades psicométricas de la escala de calidad percibida y satisfacción del deporte municipal / Propriedades psicométricas da escala de satisfação e qualidade percebida do esporte municipal / Psychometric properties of the perceived quality and satisfaction scale of municipal sport

El objetivo de este estudio fue determinar la validez y fiabilidad del instrumento de calidad percibida y satisfacción del servicio deportivo (EPOD2) en el contexto mexicano, así como invarianza de medición en función del sexo y de institutos del deporte. Participaron 1510 usuarios de servicios deportivos (Medad = 20.40, DT = 7.47). El valor de la medida de adecuación muestral del Análisis Factorial Exploratorio (AFE) fue óptimo, la prueba de Bartlett resultó estadísticamente significativa, por lo que el AFE es pertinente. El Análisis Factorial Confirmatorio (AFC) corroboró la estructura factorial de las escalas, el ajuste de los índices fue adecuado. La invarianza factorial indicó que la estructura es estable tanto para sexo como por instituto del deporte. Se concluye que el instrumento EPOD2 es válido y fiable para el estudio de la calidad percibida y satisfacción de servicios deportivos en población mexicana, además de ser un instrumento de fácil aplicación e interpretación. (AU)

The aim of this study was to determine the validity and reliability of the perceived quality and satisfaction of sports service instrument (EPOD2) in the Mexican context, as well as the measurement invariance regarding sex and sports institutes. Participants 1510 users of sports services (Mage = 20.40, SD = 7.47). The value of the measure for sample adequacy of the Exploratory Factor Analysis (EFA) was optimal, the Bartlett test result was statistically significant, which means the EFA is pertinent. The Confirmatory Factor Analysis (CFA) corroborated the scale's factorial structure, the adjustment of the indexes was adequate. The factorial invariance indicated that the structure is stable for sex as for sports institute. It is concluded that the EPOD2 instrument is valid and reliable for the study of the perceived quality and satisfaction of sports services within the Mexican population, besides being an instrument easy to interpret and to apply. (AU)

O objetivo deste studo foi determinar a validade e a confiabilidade do instrumento para percepção da qualidade e satisfação do serviço esportivo (EPOD2) no contexto mexicano, bem como a invariância de medição com base em institutos de sexo e esportes. Participaram 1.510 usuários de serviços esportivos (Medad = 20.40, DT = 7.47). O valor da medida de adequação da amostra da Análise Fatorial Exploratória (AFE) foi ótimo, o teste de Bartlett foi estatisticamente significativo, portanto, a AFE é relevante. A Análise Fatorial Confirmatória (AFC) corroborou a estrutura fatorial das escalas, o ajuste dos índices foi adequado. A invariância fatorial indicou que a estrutura é estável tanto para sexo quanto para institutos esportivos. Conclui-se que o instrumento EPOD2 é válido e confiável para o estudo da qualidade percebida e satisfação dos serviços esportivos na população mexicana, além de ser um instrumento de fácil aplicação e interpretação. (AU)

Approach to the patient with cholestasis and jaundice syndrome. Joint AMH, AMG, and AMEG scientific position statement.

The term cholestasis refers to bile acid retention, whether within the hepatocyte or in the bile ducts of any caliber. Biochemically, it is defined by a level of alkaline phosphatase that is 1.67-times higher than the upper limit of normal. Cholestatic diseases can be associated with an inflammatory process of the liver that destroys hepatocytes (hepatitis), withjaundice (yellowing of the skin and mucus membranes, associated with elevated serum bilirubin levels), or with both, albeit the three concepts should not be considered synonymous. Cholestatic diseases can be classified as intrahepatic or extrahepatic, depending on their etiology. Knowing the cause of the condition is important for choosing the adequate diagnostic studies and appropriate treatment in each case. A complete medical history, together with a thorough physical examination and basic initial studies, such as liver ultrasound and liver function tests, aid the clinician in deciding which path to follow, when managing the patient with cholestasis. In a joint effort, the Asociación Mexicana de Hepatología (AMH), the Asociación Mexicana de Gastroenterología (AMG) and the Asociación Mexicana de Endoscopia Gastrointestinal (AMEG) developed the first Mexican scientific position statement on said theme.

Differential response of Oryza sativa L. and Phragmites australis L. plants in trace elements contaminated soils under flooded and unflooded conditions.

Drastic changes in the water regime of trace elements (TEs) contaminated soils under semiarid conditions, from completely dry to flooding situations, may alter the solubility of the contaminants and, therefore, their potential mobility and availability to plants. Certain macrophyte species have shown a promising suitability for their use in the phytoremediation of TEs contaminated soils under fluctuating flooded-unflooded conditions, as a consequence of their high resistance and tolerance to contamination. Similarly, different water conditions occur during rice (Oryza sativa) cultivation, a species often used as a model plant for TEs toxicity studies. The aim of this work was to study the tolerance and oxidative response to TEs of common reed (Phragmites australis) and rice grown in contaminated mining soils, when exposed to different water saturation conditions. Both species (common reed and rice) were cultivated in three different contaminated soils from the Sierra Minera of La Unión-Cartagena (SE-Spain) under contrasting water saturation conditions (flooded and unflooded) in a pot experiment. Soil EC and elevated metal (mainly Cd and Zn) soluble concentrations conditioned the survival of the plants. Whereas, As accumulation in the aerial part of both species influenced the most oxidative stress homeostasis. Common reed showed to be a good candidate for its use in the phytostabilization of TEs contaminated soils under both flooded and unflooded conditions.

Pregnancy and placental development in horses: an update.

Horses have been domesticated by man and historical information mostly associates horses with men. Nowadays, however, horse riding is essentially by women. Women are also very much involved in equine sciences, with a large contribution to the understanding of fetoplacental development. While highlighting the work of female scientists, this review describes the recent advances in equine fetoplacental studies, focusing on data obtained by new generation sequencing and progress on the understanding of the role of placental progesterone metabolites throughout gestation. A second emphasis is made on fetal programming, a currently very active field, where the importance of maternal nutrition, mare management or the use of embryo technologies has been shown to induce long term effects in the offspring that might affect progeny's performance. Finally, new perspectives for the study of equine pregnancy are drawn, that will rely on new methodologies applied to molecular explorations and imaging.