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Temperature significantly impacts ectotherm physiology, with thermal tolerance and metabolic traits typically varying with latitude across species ranges. The drivers of this variation remain unclear, however, despite obvious consequences for population persistence and conservation in the face of ongoing global change. This study explored local adaptation and phenotypic plasticity of metabolic rates and thermal limits in the supratidal rockpool beetle Ochthebius lejolisii. Using populations from localities at different ends of the species range that experience contrasting thermal variability, we simultaneously tested two of the major paradigms of spatial physiological ecology: metabolic cold adaptation (MCA) and the climatic variability hypothesis (CVH). Reciprocal acclimation was conducted under spring temperature regimes of both localities, incorporating local diurnal variation. Metabolic rates were measured by closed respirometry, and thermal tolerance limits estimated through thermography. In line with MCA, the higher-latitude population (colder climate) showed higher metabolic rates and temperature coefficients (Q10s) at lower temperatures than the lower-latitude population. As predicted by the CVH, the lower-latitude population (more variable climate) showed higher upper thermal tolerance but only the higher-latitude population was able to acclimate upper thermal limits. This result suggests trade-offs between physiological thermal limits and thermal plasticity in this species. A limited acclimation capacity could make populations on Mediterranean coasts especially vulnerable in the face of projected increases in extreme temperatures under ongoing climate change.
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Frío , Escarabajos , Animales , Escarabajos/fisiología , Aclimatación , TermotoleranciaRESUMEN
This dataset provides a collection of Continuous Glucose Monitoring (CGM) data, insulin dose administration, meal ingestion counted in carbohydrate grams, steps, calories burned, heart rate, and sleep quality and quantity assessment ac- quired from 25 people with type 1 diabetes mellitus (T1DM). CGM data was acquired by FreeStyle Libre 2 CGMs, and Fitbit Ionic smartwatches were used to obtain steps, calories, heart rate, and sleep data for at least 14 days. This dataset could be utilized to obtain glucose prediction models, hypoglycemia and hyperglycemia prediction models, and research on the relationships among sleep, CGM values, and the rest of the mentioned variables. This dataset could be used directly from the preprocessed version or customized from raw data. The data set has been used previously with different machine learning algorithms to predict glucose values, hypo, and hyperglycemia and to analyze influences among the features and the quality and quantity of sleep in people with T1DM.
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INTRODUCTION: Management of the patient with cirrhosis of the liver that requires surgical treatment has been relatively unexplored. In Mexico, there is currently no formal stance or expert recommendations to guide clinical decision-making in this context. AIMS: The present position paper reviews the existing evidence on risks, prognoses, precautions, special care, and specific management or procedures for patients with cirrhosis that require surgical interventions or invasive procedures. Our aim is to provide recommendations by an expert panel, based on the best published evidence, and consequently ensure timely, quality, efficient, and low-risk care for this specific group of patients. RESULTS: Twenty-seven recommendations were developed that address preoperative considerations, intraoperative settings, and postoperative follow-up and care. CONCLUSIONS: The assessment and care of patients with cirrhosis that require major surgical or invasive procedures should be overseen by a multidisciplinary team that includes the anesthesiologist, hepatologist, gastroenterologist, and clinical nutritionist. With respect to decompensated patients, a nephrology specialist may be required, given that kidney function is also a parameter involved in the prognosis of these patients.
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Cirrosis Hepática , Atención Perioperativa , Humanos , Cirrosis Hepática/complicaciones , Cirrosis Hepática/cirugía , Atención Perioperativa/métodos , Atención Perioperativa/normas , México , Complicaciones Posoperatorias/prevención & controlRESUMEN
Elevation gradients provide powerful study systems for examining the influence of environmental filters in shaping species assemblages. High-mountain habitats host specific high-elevation assemblages, often comprising specialist species adapted to endure pronounced abiotic stress, while such harsh conditions prevent lowland species from colonizing or establishing. While thermal tolerance may drive the altitudinal segregation of ectotherms, its role in structuring aquatic insect communities remains poorly explored. This study investigates the role of thermal physiology in shaping the current distribution of high-mountain diving beetles from the Sierra Nevada Iberian mountain range and closely related lowland species. Cold tolerance of five species from each altitudinal zone was measured estimating the supercooling point (SCP), lower lethal temperature (LLT) and tolerance to ice enclosure, while heat tolerance was assessed from the heat coma temperature (HCT). Alpine species exhibited wider fundamental thermal niches than lowland species, likely associated with the broader range of climatic conditions in high-mountain areas. Cold tolerance did not seem to prevent lowland species from colonizing higher elevations, as most studied species were moderately freeze-tolerant. Therefore, fundamental thermal niches seem not to fully explain species segregation along elevation gradients, suggesting that other thermal tolerance traits, environmental factors, and biotic interactions may also play important roles.
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Altitud , Termotolerancia , Animales , Escarabajos/fisiología , Ecosistema , Aclimatación , FríoRESUMEN
INTRODUCTION: In recent years, different urinary markers such as the Bladder Epicheck® have been developed in an attempt to reduce the number of cystoscopies in the follow-up of non-muscle invasive bladder cancer (NMIBC). AIM: To provide a systematic review of Bladder Epicheck® and its current clinical utility in the follow-up and detection of recurrence of NMIBC. MATERIAL AND METHODS: Systematic review based on a literature search of PubMed, Web of Science and Scopus databases until October 2023, according to PRISMA and Quadas-2 criteria. Sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of the marker were calculated. Diagnostic performance was evaluated by the area under the curve (AUC). RESULTS: Fifteen studies were analyzed (nâ¯=â¯3761) including 86.7% prospective studies. Of the patient series, 53.2% had received previous intravesical instillations. The mean Se of the biomarker in the detection of recurrence varied according to tumor grade (87.9%-high grade/HG vs. 44.9%-low grade/LG, respectively). Their weighted mean Se and Sp were 71.6% and 84.5%, respectively. The mean recurrence rate was 29.1%. The weighted mean PPV and NPV were 56.4% and 92.8% (97.7% non-LG), respectively. The mean AUC was 85.63%. CONCLUSION: Bladder Epicheck® is a useful urinary marker in the follow-up of NMIBC, with significantly high Se and NPV in the detection of recurrences, especially in cases of HG disease. Its use can reduce the number of cystoscopies required in the follow-up of NMIBC, improving the quality of life of patients and potentially increasing health economic savings.
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Immunotherapy with immune checkpoint inhibitors (ICIs) has revolutionized advanced cancer management. Nevertheless, the generalized use of these medications has led to an increase in the incidence of adverse immune-mediated events and the liver is one of the most frequently affected organs. Liver involvement associated with the administration of immunotherapy is known as immune-mediated hepatitis (IMH), whose incidence and clinical characteristics have been described by different authors. It often presents as mild elevations of amino transferase levels, seen in routine blood tests, that spontaneously return to normal, but it can also manifest as severe transaminitis, possibly leading to the permanent discontinuation of treatment. The aim of the following review was to describe the most up-to-date concepts regarding the epidemiology, diagnosis, risk factors, and progression of IMH, as well as its incidence in different types of common cancers, including hepatocellular carcinoma. Treatment recommendations according to the most current guidelines are also provided.
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Carcinoma Hepatocelular , Hepatitis A , Hepatitis , Neoplasias Hepáticas , Humanos , Hepatitis/epidemiología , Hepatitis/etiología , Hepatitis/terapia , Carcinoma Hepatocelular/etiología , Inmunoterapia/efectos adversos , Neoplasias Hepáticas/complicacionesRESUMEN
INTRODUCTION: Stress urinary incontinence (SUI) is frequently associated with pelvic organ prolapse (POP) and may occur after its surgical treatment. AIM: To determine the incidence, risk factors and management of SUI during and after POP surgery through a review of the available literature. MATERIALS AND METHOD: Narrative literature review on the incidence and management of SUI after POP surgery after search of relevant manuscripts indexed in PubMed, EMBASE and Scielo published in Spanish and English between 2013 and 2023. RESULTS: Occult SUI is defined as visible urine leakage when prolapse is reduced in patients without SUI symptoms. De novo SUI develops after prolapse surgery without having previously existed. In continent patients, the number needed to treat (NNT) to prevent one case of de novo SUI is estimated to be 9 patients and about 17 to avoid repeat incontinence surgery. In patients with occult UI, the NNT to avoid repeat incontinence surgery is around 7. Patients with POP and concomitant SUI are the group most likely to benefit from combined surgery with a more favorable NNT (NNT 2). CONCLUSION: Quality studies on combined surgery for treatment SUI and POP repair are lacking. Continent patients with prolapse should be warned of the risk of de novo SUI, although concomitant incontinence treatment is not currently recommended. Incontinence surgery should be considered on an individual basis in patients with prolapse and SUI.
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People with diabetes must carefully monitor their blood glucose levels, especially after eating. Blood glucose management requires a proper combination of food intake and insulin boluses. Glucose prediction is vital to avoid dangerous post-meal complications in treating individuals with diabetes. Although traditional methods, and also artificial neural networks, have shown high accuracy rates, sometimes they are not suitable for developing personalised treatments by physicians due to their lack of interpretability. This study proposes a novel glucose prediction method emphasising interpretability: Interpretable Sparse Identification by Grammatical Evolution. Combined with a previous clustering stage, our approach provides finite difference equations to predict postprandial glucose levels up to two hours after meals. We divide the dataset into four-hour segments and perform clustering based on blood glucose values for the two-hour window before the meal. Prediction models are trained for each cluster for the two-hour windows after meals, allowing predictions in 15-minute steps, yielding up to eight predictions at different time horizons. Prediction safety was evaluated based on Parkes Error Grid regions. Our technique produces safe predictions through explainable expressions, avoiding zones D (0.2% average) and E (0%) and reducing predictions on zone C (6.2%). In addition, our proposal has slightly better accuracy than other techniques, including sparse identification of non-linear dynamics and artificial neural networks. The results demonstrate that our proposal provides interpretable solutions without sacrificing prediction accuracy, offering a promising approach to glucose prediction in diabetes management that balances accuracy, interpretability, and computational efficiency.
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Glucemia , Periodo Posprandial , Humanos , Periodo Posprandial/fisiología , Glucemia/análisis , Aprendizaje Automático , Algoritmos , Masculino , Diabetes Mellitus/sangre , Femenino , Redes Neurales de la ComputaciónRESUMEN
PURPOSE OF REVIEW: The purpose of this review is to update the information about the different types of reconstruction after partial nephrectomy, with special emphasis on the new methods of suture-free hemostasis currently available. RECENT FINDINGS: The aim of renal reconstruction is to avoid bleeding and leakage of the collecting system, but now the renorrhaphy technique used is considered one of the modifiable determinants of renal function after surgery. In an attempt to avoid the loss of renal function implicit in classic reconstruction, new techniques have been described to control hemostasis and urinary leakage, which employ fewer suture layers, different suture materials and designs, and a wide range of commercially available hemostatic materials. Multiple suture characteristics have been studied as a potential factor influencing the renal function observed after partial nephrectomy. Single-plane suture techniques, the use of bearded sutures, and running sutures seem to be associated with less deterioration in postoperative renal function, and deep medullary sutures should be avoided to avoid affecting the arcuate arteries. Sutureless hemostasis systems could prevent the deterioration of renal function and complications derived from suturing, also reducing ischemia time and surgical time without increasing the risk of complications.
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Neoplasias Renales , Laparoscopía , Humanos , Nefrectomía/métodos , Riñón/cirugía , Neoplasias Renales/cirugía , Pérdida de Sangre Quirúrgica/prevención & control , Técnicas de SuturaRESUMEN
Point-of-care ultrasound (POCUS) refers to the use of ultrasound imaging through pocket-sized sonographic devices at the patient's bedside, to make a diagnosis or direct a procedure and immediately answer a clinical question. Its goal is to broaden the physical examination, not to replace conventional ultrasound studies. POCUS has evolved as a complement to physical examination and has been adopted by different medical specialties, including hepatology. A narrative synthesis of the evidence on the applications of POCUS in hepatology was carried out, describing its usefulness in the diagnosis of cirrhosis of the liver, metabolic dysfunction-associated steatotic liver disease (MASLD), decompensated cirrhosis, and portal hypertension. The review also encompasses more recent applications in the hemodynamic evaluation of the critically ill patient with cirrhosis of the liver, patients with other liver diseases, as well as in the ultrasound guidance of procedures. POCUS could make up part of the daily clinical practice of gastroenterologists and hepatologists, simplifying the initial evaluation of patients and optimizing clinical management. Its accessibility, ease of use, and low adverse event profile make POCUS a useful tool for the properly trained physician in the adequate clinical setting. The aim of this review was to describe the available evidence on the usefulness of POCUS in the daily clinical practice of gastroenterologists and hepatologists.
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Gastroenterología , Sistemas de Atención de Punto , Humanos , Ultrasonografía/métodos , Cirrosis Hepática , Examen FísicoRESUMEN
PURPOSE: To provide agreed-upon guidelines on the management of a hyper-responsive patient undergoing ovarian stimulation (OS) METHODS: A literature search was performed regarding the management of hyper-response to OS for assisted reproductive technology. A scientific committee consisting of 4 experts discussed, amended, and selected the final statements. A priori, it was decided that consensus would be reached when ≥66% of the participants agreed, and ≤3 rounds would be used to obtain this consensus. A total of 28/31 experts responded (selected for global coverage), anonymous to each other. RESULTS: A total of 26/28 statements reached consensus. The most relevant are summarized here. The target number of oocytes to be collected in a stimulation cycle for IVF in an anticipated hyper-responder is 15-19 (89.3% consensus). For a potential hyper-responder, it is preferable to achieve a hyper-response and freeze all than aim for a fresh transfer (71.4% consensus). GnRH agonists should be avoided for pituitary suppression in anticipated hyper-responders performing IVF (96.4% consensus). The preferred starting dose in the first IVF stimulation cycle of an anticipated hyper-responder of average weight is 150 IU/day (82.1% consensus). ICoasting in order to decrease the risk of OHSS should not be used (89.7% consensus). Metformin should be added before/during ovarian stimulation to anticipated hyper-responders only if the patient has PCOS and is insulin resistant (82.1% consensus). In the case of a hyper-response, a dopaminergic agent should be used only if hCG will be used as a trigger (including dual/double trigger) with or without a fresh transfer (67.9% consensus). After using a GnRH agonist trigger due to a perceived risk of OHSS, luteal phase rescue with hCG and an attempt of a fresh transfer is discouraged regardless of the number of oocytes collected (72.4% consensus). The choice of the FET protocol is not influenced by the fact that the patient is a hyper-responder (82.8% consensus). In the cases of freeze all due to OHSS risk, a FET cycle can be performed in the immediate first menstrual cycle (92.9% consensus). CONCLUSION: These guidelines for the management of hyper-response can be useful for tailoring patient care and for harmonizing future research.
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Síndrome de Hiperestimulación Ovárica , Femenino , Humanos , Embarazo , Consenso , Técnica Delphi , Hormona Liberadora de Gonadotropina , Gonadotropina Coriónica , Fertilización In Vitro/métodos , Inducción de la Ovulación/métodos , Medición de Riesgo , Índice de EmbarazoRESUMEN
Las restricciones por la pandemia del COVID-19 supusieron la transición abrupta a una enseñanza online tanto del contenido teórico como práctico y de la evaluación final de las asignaturas que imparte el departamento en varias titulaciones. En previsión de que el siguiente curso académico 2020-21 se vería totalmente afectado, se desarrollaron una serie de materiales didácticos propios, como la elaboración de guiones de teoría y práctica que incorporaron imágenes de modelos anatómicos, prosecciones, anatomía radiológica y anatomía ecográfica. La percepción de esta innovación fue evaluada por los estudiantes a través de una encuesta en línea y sus respuestas mediante una escala tipo Likert. Participaron 346 estudiantes de las titulaciones de Fisioterapia (n= 66), Medicina (n= 169), Podología (n= 44) y Terapia Ocupacional (n= 67). Las puntuaciones medias más altas correspondieron a los estudiantes de Podología y Terapia Ocupacional, ambas presentaron diferencias significativas con los otros tres subgrupos de alumnos (p<.0001). El puntaje promedio más bajo correspondió a los estudiantes de Medicina de segundo año académico que presentó significancia con los otros cuatro subgrupos de estudiantes (p<.0001). Se analizaron las carencias del sistema educativo en la Universidad Complutense de Madrid reveladas por la pandemia del Covid19. Esta crisis ha puesto de manifiesto la necesidad de que los educadores médicos en general y los anatomistas en particular estén capacitados en el uso de la tecnología disponible y en la creación de sus propios materiales didácticos multimedia.
SUMMARY: Restrictions due to COVID-19 pandemic meant an abrupt transition to online teaching. This change affected teaching, practical sessions and assessments of the subjects taught by the department in various degrees. In anticipation that the following academic year 2020-21 would be totally affected, a series of didactic materials were therefor developed. These materials included the preparation of theory and practice scripts that incorporated images of anatomical models, pro-sections, radiological anatomy, and ultrasound anatomy. Perceptions by the students of these innovations were recorded through an online survey and their responses evaluated through a Likert-type scale. 346 students from Physiotherapy (n= 66), Medicine (n= 169), Podiatry (n= 44) and Occupational Therapy (n= 67) degrees participated. The highest average scores corresponded to the students of Podiatry and Occupational Therapy, both presented significant differences with the other three subgroups of students (p<.0001). The lowest average score corresponded to medical students in their second academic year, which presented significance with the other four subgroups of students (p<.0001). The shortcomings of the educational system of the Complutense University of Madrid that were highlighted by the COVID-19 pandemic were analyzed. This crisis underscored the need for medical educators in general, and anatomists in particular, to be trained in the use of available technology and to produce their own multimedia teaching materials.
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Humanos , Estudiantes/psicología , Educación a Distancia/métodos , COVID-19 , Anatomía/educación , Percepción , España , Estudios Transversales , Encuestas y Cuestionarios , Evaluación EducacionalRESUMEN
The first clinical guidelines on hepatic encephalopathy were published in 2009. Almost 14 years since that first publication, numerous advances in the field of diagnosis, treatment, and special condition care have been made. Therefore, as an initiative of the Asociación Mexicana de Gastroenterología A.C., we present a current view of those aspects. The manuscript described herein was formulated by 24 experts that participated in six working groups, analyzing, discussing, and summarizing the following topics: Definition of hepatic encephalopathy; recommended classifications; epidemiologic panorama, worldwide and in Mexico; diagnostic tools; conditions that merit a differential diagnosis; treatment; and primary and secondary prophylaxis. Likewise, these guidelines emphasize the management of certain special conditions, such as hepatic encephalopathy in acute liver failure and acute-on-chronic liver failure, as well as specific care in patients with hepatic encephalopathy, such as the use of medications and types of sedation, describing those that are permitted or recommended, and those that are not.
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Encefalopatía Hepática , Lactulosa , Rifaximina , Encefalopatía Hepática/diagnóstico , Encefalopatía Hepática/tratamiento farmacológico , Rifaximina/uso terapéutico , Lactulosa/uso terapéuticoRESUMEN
OBJECTIVE: To determine the incidence and severity of ovarian hyperstimulation syndrome (OHSS) in high responders (25-35 follicles with a diameter of ≥12 mm on day of triggering) who received a gonadotropin-releasing hormone (GnRH) agonist to trigger final follicular maturation. METHODS: We used individual data from women who participated in four different clinical trials and were high responders to ovarian stimulation in a GnRH antagonist protocol in this retrospective combined analysis. All women were evaluated for signs and symptoms of OHSS using identical criteria based on Golan's system (1989). RESULTS: High responders (n = 77) were of different ethnicities. There were no differences in baseline characteristics between women with or without signs and symptoms of OHSS. Mean ± standard deviation baseline data were: age, 32.3 ± 3.5 years; anti-Müllerian hormone, 42.4 ± 20.7 pmol/L; antral follicle count, 21.5 ± 9.2. Before triggering, duration of stimulation was 9.5 ± 1.6 days and the mean number of follicles with a diameter of ≥12 mm and ≥17 mm was 26.5 ± 4.4 and 8.8 ± 4.7, respectively. Mean serum estradiol (17,159 pmol/l) and progesterone (5.1 nmol/l) levels were high at 36 h after triggering. Overall, 17/77 high responders (22%) developed signs and symptoms of mild OHSS which lasted 6-21 days. The most frequently prescribed medication was cabergoline to prevent worsening of OHSS. No severe OHSS occurred and no OHSS cases were reported as serious adverse events. CONCLUSIONS: High responders receiving GnRH agonist for triggering should be informed that they may experience signs and symptoms of mild OHSS.
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Síndrome de Hiperestimulación Ovárica , Femenino , Humanos , Adulto , Embarazo , Síndrome de Hiperestimulación Ovárica/epidemiología , Síndrome de Hiperestimulación Ovárica/prevención & control , Síndrome de Hiperestimulación Ovárica/etiología , Incidencia , Estudios Retrospectivos , Gonadotropina Coriónica/uso terapéutico , Inducción de la Ovulación/efectos adversos , Inducción de la Ovulación/métodos , Hormona Liberadora de Gonadotropina , Fertilización In Vitro/métodos , Índice de EmbarazoRESUMEN
Introducción El proceso de extracción renal debe ser una técnica estandarizada con el fin de optimizar las unidades renales para su posterior implante. Objetivos Revisión de la literatura disponible sobre el proceso de extracción renal. Material y métodos Revisión narrativa de la evidencia disponible sobre la técnica de extracción renal en paciente cadáver tras una búsqueda de los manuscritos relevantes indexados en PubMed, EMBASE y SciELO escritos en español e inglés. Resultados La extracción renal en paciente cadáver se divide en dos grupos, tras muerte encefálica (donation after brain death [DBD]) y tras muerte cardiaca (donation after circulatory death [DCD]). La extracción renal en DBD suele acompañarse de la extracción de otros órganos abdominales y/o torácicos, lo que requiere coordinación quirúrgica multidisciplinar. Durante el proceso de extracción debe asegurarse que los pedículos vasculares renales se mantienen íntegros para su posterior implante y disminuir el tiempo de isquemia. Conclusiones La ejecución adecuada y el perfecto conocimiento de la técnica quirúrgica de extracción y de la anatomía, permite disminuir el índice de pérdidas de injertos relacionados con una incorrecta extracción (AU)
Introduction Kidney procurement procedure must be carried out following a standardized technique in order to optimize kidney grafts for their subsequent implantation. Objectives Review of the available literatura on kidney procurement procedure. Material and methods Narrative review of the available evidence on deceased donor kidney procurement technique after a search of relevant manuscripts indexed in PubMed, EMBASE and Scielo written in English and Spanish. Result Deceased donor kidney procurement can be divided into two groups, donation after brain death (DBD) and donation after circulatory death (DCD). Kidney procurement in DBD frequently includes other chest and/or abdominal organs, requiring multidisciplinary surgical coordination. During the harvesting procedure, the renal vascular pedicle must remain intact for subsequent implantation and reduced ischemia time. Conclusions Adequate execution and perfect knowledge of the technique for surgical removal and anatomy reduces the rate of graft losses associated to inadequate harvesting techniques (AU)