miRNAs associated with endoplasmic reticulum stress and unfolded protein response during decidualization.

RESEARCH QUESTION: Do microRNAs (miRNAs) play a role in regulating endoplasmic reticulum stress (ERS) and unfolded protein response (UPR) in decidualized cells and endometrium associated with reproductive failures? DESIGN: Endometrial stromal cell line St-T1b was decidualized in vitro with 8-Br-cAMP over 5 days, or treated with the ERS inducer thapsigargin. Expression of ERS sensors, UPR markers and potential miRNA regulators was analysed by quantitative PCR. Endometrial biopsies from patients with recurrent pregnancy loss (RPL) and recurrent implantation failure (RIF) were investigated for the location of miRNA expression. RESULTS: Decidualization of St-T1b cells resulted in increased expression of ERS sensors including ATF6α, PERK and IRE1α, and the UPR marker, CHOP. TXNIP, which serves as a link between the ERS pathway and inflammation, as well as inflammasome NLRP3 and interleukin 1ß expression increased in decidualized cells. An in-silico analysis identified miR-17-5p, miR-21-5p and miR-193b-3p as miRNAs potentially involved in regulation of the ERS/UPR pathways and inflammation associated with embryo implantation. Their expression decreased significantly (P ≤ 0.0391) in non-decidualized cells in the presence of thapsigargin. Finally, expression of the selected miRNAs was localized by in-situ hybridization in stromal and glandular epithelial cells in endometrial samples from patients with RPL and RIF. Expression in stroma cells from patients with RPL was lower in comparison with stroma cells from patients with RIF. CONCLUSIONS: Decidualization in St-T1b cells is accompanied by ERS/UPR processes, associated with an inflammatory response that is potentially influenced by miR-17-5p, miR-21-5p and miR-193b-3p. These miRNAs are expressed differentially in stromal cells from patients with RPL and RIF, indicating an alteration in regulation of the ERS/UPR pathways.

Host-pathogen interactions mediated by extracellular vesicles in Toxoplasma gondii infection during pregnancy.

Molecular communication between a pathogen and its host is crucial for a successful interplay. Extracellular vesicles (EVs) act as mediators for the delivery of molecular signals among pathogens or between pathogens and the host. Toxoplasma gondii (T. gondii), an intracellular parasite with a worldwide presence, produces EVs itself, or induces the secretion of EVs from infected host cells potentially having capacities to modulate the host immune response. T. gondii infection is particularly important during pregnancy. Depending on the gestational age at the time of infection, the parasite can be transmitted through the placenta to the fetus, causing clinical complications such as jaundice, hepatosplenomegaly, chorioretinitis, cranioencephalic abnormalities, or even death. T. gondii infection is related to a pro-inflammatory immune response in both mother and fetus, which may enhance parasite transmission, but the implication of EV signaling in this process remains unclear. In this review, we summarize the current knowledge on EV release from T. gondii and its human host cells in regard to the immunological consequences and the passage through the placenta.

Teleconsultation for outpatient care of patients during the Covid-19 pandemic at a University Hospital in Colombia.

BACKGROUND: During the COVID 19 pandemic, direct-to-consumer telehealth (DTC) services allowed patients real-time virtual access to healthcare providers, especially those with an established relationship. In Colombia, this care modality was implemented between 2019 and 2020, under national considerations, it was implemented for outpatient care in a highly complex university hospital in Cali, Colombia. METHODS: A descriptive study with prospective information collection was used to describe the implementation of the outpatient teleconsultation care model for patients. We constructed the clinical and process indicators with which we evaluated the model. FINDINGS: A total of 56,560 patients from our institution were treated by virtual outpatient consultation during the first nine months of the health emergency declared by COVID 19 in Colombia. The strategy made it possible to achieve coverage more significant than 100% in Cali and the departments of Colombia. Attention by teleconsultation was 19% of the total ambulatory care. The effectiveness in carrying out scheduled teleconsultations had an overall result of 91.5%. The accessibility results demonstrated the need to strengthen connectivity and accessibility to payments and strengthen technology adoption in the institution, health personnel, and patients. INTERPRETATION: Implementing an outpatient teleconsultation model allowed the continuity of the management with comprehensive coverage nationwide from a highly complex hospital in southwestern Colombia. The indicators' analysis should help strengthen the policies of access to telemedicine, especially with the consequences of the pandemic in low- and middle-income countries. Latin American evidence is necessary to establish the safety profile of telemedicine and the costs associated with the provision.

Evaluación de la fuerza muscular en niños: una revisión de la literatura / Evaluation of muscle strength in children: a review of literature

Introducción: la fuerza muscular es un indicador importante de la función neuromuscular y un componente de la aptitud física esencial para el desempeño en actividades cotidianas. Su alteración puede causar deficiencias funcionales, afectar la independencia y los roles que desempeña una persona. Por esto, evaluar la fuerza muscular en niños es necesario para determinar el grado de rendimiento motor e identificar riesgos asociados al crecimiento y al desarrollo. Objetivo: describir el estado del arte relacionado con la utilización de escalas de valoración de la fuerza muscular en niños entre 3 y 8 años de edad. Materiales y Métodos: se realizó una revisión de la literatura empleando la estrategia PICO, con búsqueda bibliográfica en las bases de datos Ovid, Sage, Science Direct, Proquest y Clinical Key. Resultados: en la fase inicial del proceso de cribado se identificaron 69 registros elegibles por título y resumen, de los cuales se excluyeron 56 por no cumplir con los criterios de inclusión. Adicionalmente se identificaron 3 libros con información relevante, razón por la cual fueron tenidas en cuenta 16 referencias que hacen parte de la síntesis cualitativa del presente estudio. Conclusiones: estrategias y pruebas como la dinamometría, la Functional Strength Measurement, el Test de Competencias Motoras de Bruininks Oseretsky, el Fitness Testing Preschool Children y FUPRECOL son herramientas que permiten evaluar la fuerza muscular en la infancia, y aportan elementos importantes en la identificación temprana de factores de riesgo para la salud de la persona..Au

Introduction: muscle strength is an important indicator of neuromuscular function and a component of physical fitness essential for performance in different activities of daily life. Its alteration may cause functional limitations and affects the independence and the roles that a person develops. That is why the evaluation of muscle strength is necessary to determine the level of motor performance and identify risks associated with growth and development. Objective: to describe the state of art related to the use of muscle strength assessment scales in children between 3 and 8 years of age. Materials and Methods: a review of the literature was performed using the PICO strategy, with bibliographic search in the Ovid, Sage, Science Direct, Proquest and Clinical Key databases. Results: in the initial phase of the screening process, 69 eligible records were identified by title and abstract, of which 56 were excluded because they did not meet the inclusion criteria. Additionally, 3 books with relevant information were identified, which is why 16 references that are part of the qualitative synthesis of this study were taken into account. Conclusions: srategies and tests such as dynamometry, Functional Strength Measurement, Bruininks Oseretsky's Motor Skills Test, Fitness Testing Preschool Children and FUPRECOL are tools that allow evaluating muscle strength in childhood, and provide important elements in early identification of risk factors for the person's health..Au

Effect of Moderate- Versus High-Intensity Interval Exercise Training on Heart Rate Variability Parameters in Inactive Latin-American Adults: A Randomized Clinical Trial.

Ramírez-Vélez, R, Tordecilla-Sanders, A, Téllez-T, LA, Camelo-Prieto, D, Hernández-Quiñonez, PA, Correa-Bautista, JE, Garcia-Hermoso, A, Ramírez-Campillo, R, and Izquierdo, M. Effect of moderate- versus high-intensity interval exercise training on heart rate variability parameters in inactive Latin-American adults: a randomized clinical trial. J Strength Cond Res 34(12): 3403-3415, 2020-We investigated the effect of moderate versus high-intensity interval exercise training on the heart rate variability (HRV) indices in physically inactive adults. Twenty inactive adults were randomly allocated to receive either moderate-intensity training (MCT group) or high-intensity interval training (HIT group). The MCT group performed aerobic training at an intensity of 55-75%, which consisted of walking on a treadmill at 60-80% of the maximum heart rate (HRmax) until the expenditure of 300 kcal. The HIT group ran on a treadmill for 4 minutes at 85-95% peak HRmax and had a recovery of 4 minutes at 65% peak HRmax until the expenditure of 300 kcal. Supine resting HRV indices (time domain: SDNN = SD of normal-to-normal intervals; rMSSD = root mean square successive difference of R-R intervals and frequency domain: HFLn = high-frequency spectral power; LF = low-frequency spectral power and HF/LF ratio) were measured at baseline and 12 weeks thereafter. The SDNN changes were 3.4 (8.9) milliseconds in the MCT group and 29.1 (7.6) milliseconds in the HIT group {difference between groups 32.6 (95% confidence interval, 24.9 to 40.4 [p = 0.01])}. The LF/HFLn ratio changes were 0.19 (0.03) milliseconds in the MCT group and 0.13 (0.01) milliseconds in the HIT group (p between groups = 0.016). No significant group differences were observed for the rMSSD, HF, and LF parameters. In inactive adults, this study showed that a 12-week HIT training program could increase short-term HRV, mostly in vagally mediated indices such as SDNN and HF/LFLn ratio power. Trial registration. ClinicalTrials.gov NCT02738385 https://clinicaltrials.gov/ct2/show/NCT01796275, registered on March 23, 2016.

Prolonged wait time is associated with increased mortality for Chilean waiting list patients with non-prioritized conditions.

BACKGROUND: Most data on mortality and prognostic factors of universal healthcare waiting lists come from North America, Australasia, and Europe, with little information from South America. We aimed to determine the relationship between medical center-specific waiting time and waiting list mortality in Chile. METHOD: Using data from all new patients listed in medical specialist waitlists for non-prioritized health problems from 2008 to 2015 in three geographically distant regions of Chile, we constructed hierarchical multivariate survival models to predict mortality risk at two years after registration for each medical center. Kendall rank correlation analysis was used to measure the association between medical center-specific mortality hazard ratio and waiting times. RESULT: There were 987,497 patients waiting for care at 77 medical centers, including 33,546 (3.40%) who died within two years after registration. Male gender (hazard ratio [HR] = 1.17, 95% confidence interval [CI] 1.1-1.24), older age (HR = 2.88, 95% CI 2.72-3.05), urban residence (HR = 1.19, 95% CI 1.09-1.31), tertiary care (HR = 2.2, 95% CI 2.14-2.26), oncology (HR = 3.57, 95% CI 3.4-3.76), and hematology (HR = 1.6, 95% CI 1.49-1.73) were associated with higher risk of mortality at each medical center with large region-to-region variations. There was a statistically significant association between waiting time variability and death (Z = 2.16, P = 0.0308). CONCLUSION: Patient wait time for non-prioritized health conditions was associated with increased mortality in Chilean hospitals.

Función endotelial y lipemia postprandial en adultos con presencia de criterios asociados a síndrome metabólico: efecto del estado nutricional / Endothelial function and postprandial lipemia in adults presenting criteria associated to metabolic syndrome: effect of nutritional state

Resumen Introducción : La lipemia postprandial se caracteriza por un aumento de las lipoproteínas ricas en triglicéridos y varios trabajos lo describen como un factor que determina la salud metabólica de un individuo. El objetivo del estudio fue cuantificar la contribución del sobrepeso en la magnitud de la lipemia postprandial en 33 sujetos con criterios asociados al síndrome metabólico (n = 20, sobrepeso y n = 13 eutróficos, 66% hombres, edad media 31,2 ± 7,6 años). Métodos: Estudio descriptivo y transversal. Se midió la vasodilatación mediada por el flujo, la velocidad de onda del pulso, el perfil lipídico, el cociente Log triglicéridos/lipoproteínas de alta densidad, la glucosa y la presión arterial tras una ingesta estándar alta en lípidos (79% Kcal/grasa). Se calculó el Z-score de riesgo cardiovascular a partir de la suma de los residuos tipificados (Z) de las variables bioquímicas. El estado de lipemia se midió en ayuno (0 min.) y a los (60, 120, 180, y 240 minutos) postprandiales. Resultados: El valor basal de la vasodilatación mediada por el flujo y la velocidad de onda del pulso fue de 6,9 ± 5,9% y 7,0 ± 0,8 m/s, respectivamente. Se identificó que la lipemia postprandial reducía la vasodilatación mediada por el flujo en 19,2% a los 60 minutos (5,9 ± 1,5%) y a los 240 minutos (3,7 ± 1,2%) (p = 0,04), respectivamente. Este hallazgo se acompañó con un aumento en la velocidad de onda del pulso (p < 0,05). Al dividir los sujetos en dos grupos según el índice de masa corporal, los participantes en sobrepeso muestran cifras más elevadas en el Zscore de riesgo cardiovascular, la velocidad de onda del pulso, el Log triglicéridos/lipoproteínas de alta densidad y el Δ-velocidad de onda del pulso, (p < 0,001). Conclusión: Este estudio demuestra que los sujetos clasificados en sobrepeso y que presentan criterios asociados al síndrome metabólico, muestran un perfil cardiometabólico asociado con un mayor riesgo cardiovascular, tras una ingesta alta en grasas.

Abstract Introduction: Postprandial lipemia is characterised by an increase in triglyceride-rich lipoproteins and several studies describe it as a factor that determines metabolic health of an individual. The motivation of the study was to quantify the contribution to overweight in the magnitude of the postprandial lipemia in 33 persons with criteria associated to metabolic syndrome (n = 20 being overweight and n = 13 eutrophic, 66% male, average age 31.2 ± 7.6 years). Methods: Cross-sectional descriptive study. Flow-mediated vasodilation, pulse wave velocity, lipid profile, log of the triglyceride/protein ratio, glucose and blood pressure were measured after high standard intake of lipids (79% Kcal/fat). Z-score for cardiovascular risk was calculated using the sum of typified residues (Z) of biochemical variables. Lipemia state was measured at fasting (0 min) and after 60, 120, 180 and 240 postprandial minutes. Results: Baseline flow-mediated vasodilation and pulse wave velocity values were 6.9 ± 5.9% and 7.0 ± 0.8 m/s, respectively. It was identified that postprandial lipemia reduced flowmediated vasodilation by 19.2% after 60 minutes (5.9 ± 1.5%) and after 240 minutes (3.7 ± 1.2%) (p = 0.04), respectively. This finding was paired with an increase in pulse wave velocity (p < 0.05). When dividing subjects into two groups according to their body mass index, overweight participants show higher Z-score cardiovascular risk values, pulse wave velocity, log of the triglyceride/protein ratio and the Δ pulse wave velocity (p > 0.001). Conclusion: This study reveals that overweight individuals showing criteria associated to metabolic syndrome have a cardiometabolic profile linked to a higher cardiovascular risk, after high intake of lipids.

Similar cardiometabolic effects of high- and moderate-intensity training among apparently healthy inactive adults: a randomized clinical trial.

BACKGROUND: Metabolic syndrome (MetS) increases the risk of morbidity and mortality from cardiovascular disease, and exercise training is an important factor in the treatment and prevention of the clinical components of MetS. OBJECTIVE: The aim was to compare the effects of high-intensity interval training and steady-state moderate-intensity training on clinical components of MetS in healthy physically inactive adults. METHODS: Twenty adults were randomly allocated to receive either moderate-intensity continuous training [MCT group; 60-80% heart rate reserve (HRR)] or high-intensity interval training (HIT group; 4 × 4 min at 85-95% peak HRR interspersed with 4 min of active rest at 65% peak HRR). We used the revised International Diabetes Federation criteria for MetS. A MetS Z-score was calculated for each individual and each component of the MetS. RESULTS: In intent-to-treat analyses, the changes in MetS Z-score were 1.546 (1.575) in the MCT group and -1.249 (1.629) in the HIT group (between-groups difference, P =  0.001). The average number of cardiometabolic risk factors changed in the MCT group (-0.133, P = 0.040) but not in the HIT group (0.018, P = 0.294), with no difference between groups (P = 0.277). CONCLUSION: Among apparently healthy physically inactive adults, HIT and MCT offer similar cardiometabolic protection against single MetS risk factors but differ in their effect on average risk factors per subject. Trial registration ClinicalTrials.gov NCT02738385 registered on March 23, 2016.

Involvement of STAT1 in proliferation and invasiveness of trophoblastic cells.

Trophoblast proliferation and invasion are controlled by cytokines and growth factors present at the implantation site. Members of the Interleukin-6 (IL-6) family of cytokines trigger their effects through activation of intracellular cascades including the Janus Kinase/Signal Transducer and Activator of Transcription (JAK-STAT) pathway. Functions of several STAT molecules in trophoblast cells have been described, but the role of STAT1 remained unclear. Here, potential functions of STAT1 and its activation by Oncostatin M (OSM) have been investigated in an in vitro model. STAT1 expression and phosphorylation were analyzed in human term placenta tissue by immunohistochemistry. HTR-8/SVneo cells (immortalized human extravillous trophoblast cells) were stimulated with OSM, IL-6, IL-11, Leukemia Inhibitory Factor (LIF) and Granulocyte Macrophage Colony-Stimulating Factor. Expression and phosphorylation of STAT1 were analyzed by Western blotting and immunocytochemistry. Fludarabine and STAT1 siRNA were employed for STAT1 depletion. STAT1 transcriptional activity was evaluated by DNA-binding capacity assay. Cell viability and invasion were assessed by MTS and Matrigel assays, respectively. STAT1 was expressed in villous and extravillous trophoblast cells. Low phosphorylation was detectable exclusively in extravillous trophoblast cells. Only OSM and LIF induced phosphorylation of STAT1 in the in vitro model. Challenge with OSM increased cell invasion but not proliferation. Inhibition of STAT1 by fludarabine treatment or STAT1 siRNA transfection reduced cell viability and invasiveness in presence and absence of OSM. These results indicate the potential involvement of STAT1 in the regulation of trophoblast behavior. Furthermore, STAT 1 functions are more efficiently inhibited by blocking its expression than its phosphorylation.

Clinical and economic benefits of integrated pump/CGM technology therapy in patients with type 1 diabetes in Colombia. / Beneficios clínicos y económicos de la terapia con bomba de insulina integrada a sistema de monitoreo continuo de glucosa en los pacientes diabéticos tipo 1 en Colombia.

OBJECTIVE: To assess the long-term clinical and economic impact of integrated pump/CGM technology therapy as compared to multiple daily injections (MDI), for the treatment of type 1 diabetes (T1D) in Colombia. METHODS: The CORE Diabetes Model was used to simulate a hypothetical cohort of patients with T1D. Mean baseline characteristics were taken from a clinical study conducted in Colombia and a healthcare payer perspective was adopted, with a 5% annual discount rate applied to both costs and outcomes. RESULTS: The integrated pump/CGM improved mean life expectancy by 3.51 years compared with MDI. A similar increase occurred in mean quality-adjusted life expectancy with an additional 3.81 quality-adjusted life years (QALYs). Onset of diabetes-related complications was also delayed as compared to MDI, and mean survival time free of complication increased by 1.74 years with integrated pump/CGM. Although this increased treatment costs of diabetes as compared to MDI, savings were achieved thanks to reduced expenditure on diabetes-related complications. The estimated incremental cost-effectiveness ratio (ICER) for SAP was Colombian Pesos (COP) 44,893,950 (approximately USD$23,200) per QALY gained. CONCLUSIONS: Improved blood glucose control associated to integrated pump/CGM results in a decreased incidence of diabetes-related complications and improves life expectancy as compared to MDI. Using recommended thresholds from the World Health Organization and previous coverage decisions about health technologies in Colombia, it is a cost-effective alternative to MDI for the treatment of type 1 diabetes in Colombia.

Tratamiento del dolor lumbar desde la medicina tradicional china con acupuntura y auriculoterapia: revisión narrativa / Treatment of low back pain from traditional Chinese medicine with acupuncture and auriculotherapy: narrative review

Este trabajo tiene por objetivo determinar el papel de la acupuntura en el tratamiento del dolor lumbar inespecífico, identificando la mejor evidencia disponible que realice comparaciones con otro tipo de intervenciones, para establecer de manera objetiva su aplicabilidad clínica. Se realizó una revisión sistemática no estructurada como parte de la metodología con el fin de contestar las preguntas propuestas. Se identificaron en la búsqueda inicial 1155 referencias de las cuales finalmente cumplieron los criterios de inclusión 98, de estas referencias, fueron incluidas 19 revisiones sistemáticas y una vez realizado el análisis metodológico se encontraron 12 de alta calidad metodológica. Fueron adicionalmente incluidos cuatro artículos referentes a la acupuntura auricular. La adición de la acupuntura al tratamiento convencional es más efectiva en el manejo del dolor lumbar inespecífico tanto a corto como a largo plazo que la acupuntura o el tratamiento convencional como monoterapia, la electroacupuntura asociada con el tratamiento convencional es más efectiva para mejorar la función de la columna, alterada como consecuencia del dolor lumbar inespecífico y La auriculoterpia asociada con otras terapias es efectiva para el manejo del dolor lumbar inespecífico logrando un control adecuado del dolor.