[Effect on the time of admission to the Intensive Care Unit of the start-up of an Critical Care Outreach Team]. / Efecto sobre el momento del ingreso en la unidad de cuidados intensivos de la puesta en marcha de un servicio extendido de medicina intensiva.

INTRODUCTION: The implementation of the Critical Care Outreach Teams can influence the time of admission of patients to the Intensive Care Unit (ICU). MATERIAL AND METHODS: Retrospective, descriptive, quasi-experimental "before-after" cohort study. All patients admitted to the unit urgently from Monday to Friday for two periods (between February 1, 2022 and June 30 and between February 1, 2023 and June 30, 2023) are included. The patients were divided into regular shift admissions (08-15h) and on-call (15-08h). The secondary objective was to assess whether there were differences in mortality between the two periods. RESULTS: During the first period of the study, 239 patients were admitted. 29.29% entered the ordinary shift and 70.71% on duty shift. During the second period, 211 patients were included with 43.13% of admissions in the ordinary shift. The comparison between the two periods observed a significant increase in the percentage of admissions in the morning hours in the second period (P=.0031). Mortality in the first period was 13.80% and in the second period 9.95%. The comparison between the two periods did not reveal significant differences. CONCLUSIONS: The start-up of the Critical Care Outreach Teams is associated with an increase in the proportion of ICU admissions in the morning period without any observed changes in mortality.

Pan-Genomic Regulation of Gene Expression in Normal and Pathological Human Placentas.

In this study, we attempted to find genetic variants affecting gene expression (eQTL = expression Quantitative Trait Loci) in the human placenta in normal and pathological situations. The analysis of gene expression in placental diseases (Pre-eclampsia and Intra-Uterine Growth Restriction) is hindered by the fact that diseased placental tissue samples are generally taken at earlier gestations compared to control samples. The difference in gestational age is considered a major confounding factor in the transcriptome regulation of the placenta. To alleviate this significant problem, we propose here a novel approach to pinpoint disease-specific cis-eQTLs. By statistical correction for gestational age at sampling as well as other confounding/surrogate variables systematically searched and identified, we found 43 e-genes for which proximal SNPs influence expression level. Then, we performed the analysis again, removing the disease status from the covariates, and we identified 54 e-genes, 16 of which are identified de novo and, thus, possibly related to placental disease. We found a highly significant overlap with previous studies for the list of 43 e-genes, validating our methodology and findings. Among the 16 disease-specific e-genes, several are intrinsic to trophoblast biology and, therefore, constitute novel targets of interest to better characterize placental pathology and its varied clinical consequences. The approach that we used may also be applied to the study of other human diseases where confounding factors have hampered a better understanding of the pathology.

Computational Models on Pathological Redox Signalling Driven by Pregnancy: A Review.

Oxidative stress is associated with a myriad of diseases including pregnancy pathologies with long-term cardiovascular repercussions for both the mother and baby. Aberrant redox signalling coupled with deficient antioxidant defence leads to chronic molecular impairment. Abnormal placentation has been considered the primary source for reactive species; however, placental dysfunction has been deemed secondary to maternal cardiovascular maladaptation in pregnancy. While various therapeutic interventions, aimed at combating deregulated oxidative stress during pregnancy have shown promise in experimental models, they often result as inconclusive or detrimental in clinical trials, warranting the need for further research to identify candidates. The strengths and limitations of current experimental methods in redox research are discussed. Assessment of redox status and oxidative stress in experimental models and in clinical practice remains challenging; the state-of-the-art of computational models in this field is presented in this review, comparing static and dynamic models which provide functional information such as protein-protein interactions, as well as the impact of changes in molecular species on the redox-status of the system, respectively. Enhanced knowledge of redox biology in during pregnancy through computational modelling such as generation of Systems Biology Markup Language model which integrates existing models to a larger network in the context of placenta physiology.

Urothelial Cancer Associated 1 (UCA1) and miR-193 Are Two Non-coding RNAs Involved in Trophoblast Fusion and Placental Diseases.

A bioinformatics screen for non-coding genes was performed from microarrays analyzing on the one hand trophoblast fusion in the BeWo cell model, and on the other hand, placental diseases (preeclampsia and Intra-Uterine Growth Restriction). Intersecting the deregulated genes allowed to identify two miRNA (mir193b and miR365a) and one long non-coding RNA (UCA1) that are pivotal for trophoblast fusion, and deregulated in placental diseases. We show that miR-193b is a hub for the down-regulation of 135 cell targets mainly involved in cell cycle progression and energy usage/nutrient transport. UCA1 was explored by siRNA knock-down in the BeWo cell model. We show that its down-regulation is associated with the deregulation of important trophoblast physiology genes, involved in differentiation, proliferation, oxidative stress, vacuolization, membrane repair and endocrine production. Overall, UCA1 knockdown leads to an incomplete gene expression profile modification of trophoblast cells when they are induced to fuse into syncytiotrophoblast. Then we performed the same type of analysis in cells overexpressing one of the two major isoforms of the STOX1 transcription factor, STOX1A and STOX1B (associated previously to impaired trophoblast fusion). We could show that when STOX1B is abundant, the effects of UCA1 down-regulation on forskolin response are alleviated.

Alternative splicing in normal and pathological human placentas is correlated to genetic variants.

Two major obstetric diseases, preeclampsia (PE), a pregnancy-induced endothelial dysfunction leading to hypertension and proteinuria, and intra-uterine growth-restriction (IUGR), a failure of the fetus to acquire its normal growth, are generally triggered by placental dysfunction. Many studies have evaluated gene expression deregulations in these diseases, but none has tackled systematically the role of alternative splicing. In the present study, we show that alternative splicing is an essential feature of placental diseases, affecting 1060 and 1409 genes in PE vs controls and IUGR vs controls, respectively, many of those involved in placental function. While in IUGR placentas, alternative splicing affects genes specifically related to pregnancy, in preeclamptic placentas, it impacts a mix of genes related to pregnancy and brain diseases. Also, alternative splicing variations can be detected at the individual level as sharp splicing differences between different placentas. We correlate these variations with genetic variants to define splicing Quantitative Trait Loci (sQTL) in the subset of the 48 genes the most strongly alternatively spliced in placental diseases. We show that alternative splicing is at least partly piloted by genetic variants located either in cis (52 QTL identified) or in trans (52 QTL identified). In particular, we found four chromosomal regions that impact the splicing of genes in the placenta. The present work provides a new vision of placental gene expression regulation that warrants further studies.

Differential Response of Gestational Tissues to TLR3 Viral Priming Prior to Exposure to Bacterial TLR2 and TLR2/6 Agonists.

Background: Infection/inflammation is an important causal factor in spontaneous preterm birth (sPTB). Most mechanistic studies have concentrated on the role of bacteria, with limited focus on the role of viruses in sPTB. Murine studies support a potential multi-pathogen aetiology in which a double or sequential hit of both viral and bacterial pathogens leads to a higher risk preterm labour. This study aimed to determine the effect of viral priming on bacterial induced inflammation in human in vitro models of ascending and haematogenous infection. Methods: Vaginal epithelial cells, and primary amnion epithelial cells and myocytes were used to represent cell targets of ascending infection while interactions between peripheral blood mononuclear cells (PBMCs) and placental explants were used to model systemic infection. To model the effect of viral priming upon the subsequent response to bacterial stimuli, each cell type was stimulated first with a TLR3 viral agonist, and then with either a TLR2 or TLR2/6 agonist, and responses compared to those of each agonist alone. Immunoblotting was used to detect cellular NF-κB, AP-1, and IRF-3 activation. Cellular TLR3, TLR2, and TLR6 mRNA was quantified by RT-qPCR. Immunoassays were used to measure supernatant cytokine, chemokine and PGE2 concentrations. Results: TLR3 ("viral") priming prior to TLR2/6 agonist ("bacterial") exposure augmented the pro-inflammatory, pro-labour response in VECs, AECs, myocytes and PBMCs when compared to the effects of agonists alone. In contrast, enhanced anti-inflammatory cytokine production (IL-10) was observed in placental explants. Culturing placental explants in conditioned media derived from PBMCs primed with a TLR3 agonist enhanced TLR2/6 agonist stimulated production of IL-6 and IL-8, suggesting a differential response by the placenta to systemic inflammation compared to direct infection as a result of haematogenous spread. TLR3 agonism generally caused increased mRNA expression of TLR3 and TLR2 but not TLR6. Conclusion: This study provides human in vitro evidence that viral infection may increase the susceptibility of women to bacterial-induced sPTB. Improved understanding of interactions between viral and bacterial components of the maternal microbiome and host immune response may offer new therapeutic options, such as antivirals for the prevention of PTB.

Actividades deportivas con soporte musical: ¿una nueva forma de aprender reanimación cardiopulmonar? / Sports Activities with Musical Support: A New Way to Learn Cardiopulmonary Resuscitation?

El objetivo del estudio fue analizar la viabilidad de enseñar RCP en actividades deportivas con apoyo musical y evaluar si este nuevo enfoque iguala los resultados de un curso tradicional de reanimación cardiopulmonar (RCP). Participaron 84 estudiantes universitarias sin conocimientos de RCP distribuidas en dos grupos de forma aleatoria. El primero recibió formación de RCP sólo manos integradas en una clase de aeróbic y el otro recibió un curso de RCP de manera convencional. Los resultados en la clase coreografiada comparados con el curso tradicional fueron: Profundidad media de compresiones (41,64 vs 42,92; p = 0,446), re-expansión correcta (65,47% vs 72,47%; p = 0,423), frecuencia de compresiones en un minuto (102,50 vs 138,53; p < 0,001), compresiones totales (202,50 vs 277,95; p < 0,001). Los dos métodos formativos alcanzaron resultados similares por lo que la introducción de la enseñanza de RCP en actividades deportivas puede ser un nuevo método formativo

The aim of the study was to analyse the feasibility of teaching CPR in sports activities with musical support in order to assess if this new methodology of CPR training is as effective as a traditional CPR course. 84 university students with no knowledge of CPR participated. They were distributed in two groups randomly. The first one received an experimental fitness dance class CPR course and the other was given a traditional training CPR course. The following parameters were obtained: fitness dance class group vs traditional CPR course: Average compression depth (41,64 vs 42,92; p = 0,446), Chest Recoil (65,47% vs 72,47%; p = 0,423), average compression rate (102.50 vs 138.53; p<0.001), total number of compressions (202.50 vs 277.95; p< 0.001). The two training methods achieved similar results, so CPR teaching in sports activities with musical support can be a new training method

Subjective response to antipsychotics in bipolar disorders: A review of a neglected area.

BACKGROUND: The term "subjective response to antipsychotic" (SRA) refers to changes in the subjective state experienced due to antipsychotic (AP) exposition that is independent of the therapeutic or physical side effects of these drugs. This dimension of analysis has been extensively explored in schizophrenic disorders, finding that negative SRA is an early and independent predictor of compliance as well as a successful pathway to construct current theoretical frameworks of these disorders. There is an increasing use of AP in bipolar disorders' treatment (BD) but no reviews on the topic have been published to date in this population. The aim of this work is to review published data of SRA in BD patients and to discuss their clinical and theoretical implications. METHODS: An extensive search in online databases was performed. Reports were reviewed and included if they described SRA in BD or included instruments aimed to assess it. Reports of cognitive, sexual, motor autonomic side effects were excluded. Findings were summarized in a narrative fashion. RESULTS: Nine reports fulfilled the inclusion criteria and were included in the revision, reporting data from 1282 BD patients. Among these, three were prospective studies and three explored relations between SRA and treatment compliance. CONCLUSIONS: There is an asymmetry between the increase in the use of antipsychotics in BD and the lack of data regarding the SRA. Phenomenologically, SRA in BD is similar to that found in schizophrenic subjects. Some of these symptoms may be misdiagnosed as depressive symptoms. The existing data show that SRA has a strong correlation with treatment compliance as well as a promising way to develop theoretical paradigms for these disorders.

The Role of Epigenetics in Placental Development and the Etiology of Preeclampsia.

In this review, we comprehensively present the function of epigenetic regulations in normal placental development as well as in a prominent disease of placental origin, preeclampsia (PE). We describe current progress concerning the impact of DNA methylation, non-coding RNA (with a special emphasis on long non-coding RNA (lncRNA) and microRNA (miRNA)) and more marginally histone post-translational modifications, in the processes leading to normal and abnormal placental function. We also explore the potential use of epigenetic marks circulating in the maternal blood flow as putative biomarkers able to prognosticate the onset of PE, as well as classifying it according to its severity. The correlation between epigenetic marks and impacts on gene expression is systematically evaluated for the different epigenetic marks analyzed.

Efecto de 3 métodos de enseñanza en soporte vital básico en futuros maestros de Educación Primaria. Un diseño cuasiexperimental / Effect of 3 basic life support training programs in future primary school teachers. A quasi-experimental design

OBJETIVO: Evaluar el aprendizaje en soporte vital básico (SVB) en personal lego tras 3 experiencias formativas diferentes. Dise˜no: Se trata de un estudio cuasi experimental antes-después de muestreo no probabilístico, sin grupo control. Ámbito: Estudiantes de formación de profesorado de educación primaria de la Universidad de Santiago de Compostela. PARTICIPANTES: Un total de 124 estudiantes (68,8% mujeres y 31,2% hombres) de entre 20 y 39 años (M = 22,23; DE = 3,79), cuyo criterio de inclusión fue el no tener conocimientos previos sobre SVB. INTERVENCIONES: Se aplicaron 3 programas formativos sobre SVB a estudiantes universitarios: curso tradicional, métodos audiovisuales y dispositivos de retroalimentación. Variables de interés principales: En masaje continuo: profundidad media de la compresión, porcentaje de reexpansión correcta, ratio de compresiones por minuto, porcentaje de compresiones correctas. Con el desfibrilador externo semiautomático: tiempo empleado en aplicar una descarga antes y después de la formación. RESULTADOS: Existen diferencias significativas en los resultados obtenidos tras 2 min de masaje continuo en función de los programas formativos recibidos, favorables al método de retroalimentación: ratio de compresiones por minuto (p < 0,001), profundidad media de la compresión (p < 0,001), porcentaje de compresiones correctas (p < 0,001) y porcentaje de reexpansión correcta (p < 0,001). En cuanto al desfibrilador externo semiautomático, se encontraron diferencias estadísticamente significativas en el T después (p = 0,025). CONCLUSIONES: El programa de formación con dispositivos de retroalimentación obtuvo los mejores resultados de calidad de compresiones cardíacas, seguido del curso tradicional y del método audiovisual. Sus superiores resultados se manifestaron tanto en hombres como en mujeres. Los 3 métodos formativos lograron el objetivo de reducir los tiempos de desfibrilación

AIM: To evaluate the learning of basic life support (BLS) measures on the part of laypersons after 3 different teaching programs. DESIGN: A quasi-experimental before-after study involving a non-probabilistic sample without a control group was carried out. Scope: Primary school teacher students from the University of Santiago (Spain). PARTICIPANTS: A total of 124 students (68.8% women and 31.2% men) aged 20-39 years (M = 22.23; SD = 3.79), with no previous knowledge of BLS, were studied. INTERVENTIONS: Three teaching programs were used: a traditional course, an audio-visual approach and feedback devices. Main variables of interest: Chest compressions as sole cardiopulmonary resuscitation skill evaluation: average compression depth, compression rate, chest recoil percentage and percentage of correct compressions. Automated external defibrillator: time needed to apply a shock before and after the course. RESULTS: There were significant differences in the results obtained after 2 minutes of chest compressions, depending on the training program received, with feedback devices having a clear advantage referred to average compression depth (p < 0.001), compression rate (p < 0.001), chest recoil percentage (p < 0.001) and percentage of correct compressions (p < 0.001). Regarding automated external defibrillator, statistically significant differences were found in Tafter (p = 0.025). CONCLUSIONS: The teaching course using feedback devices obtained the best results in terms of the quality of chest compressions, followed by the traditional course and audio-visual approach. These favorable results were present in both men and women. All 3 teaching methods reached the goal of reducing defibrillation time

Effect of 3basic life support training programs in future primary school teachers. A quasi-experimental design. / Efecto de 3métodos de enseñanza en soporte vital básico en futuros maestros de Educación Primaria. Un diseño cuasiexperimental.

AIM: To evaluate the learning of basic life support (BLS) measures on the part of laypersons after 3different teaching programs. DESIGN: A quasi-experimental before-after study involving a non-probabilistic sample without a control group was carried out. SCOPE: Primary school teacher students from the University of Santiago (Spain). PARTICIPANTS: A total of 124 students (68.8% women and 31.2% men) aged 20-39 years (M=22.23; SD=3.79), with no previous knowledge of BLS, were studied. INTERVENTIONS: Three teaching programs were used: a traditional course, an audio-visual approach and feedback devices. MAIN VARIABLES OF INTEREST: Chest compressions as sole cardiopulmonary resuscitation skill evaluation: average compression depth, compression rate, chest recoil percentage and percentage of correct compressions. Automated external defibrillator: time needed to apply a shock before and after the course. RESULTS: There were significant differences in the results obtained after 2minutes of chest compressions, depending on the training program received, with feedback devices having a clear advantage referred to average compression depth (p<0.001), compression rate (p<0.001), chest recoil percentage (p<0.001) and percentage of correct compressions (p<0.001). Regarding automated external defibrillator, statistically significant differences were found in Tafter (p=0.025). CONCLUSIONS: The teaching course using feedback devices obtained the best results in terms of the quality of chest compressions, followed by the traditional course and audio-visual approach. These favorable results were present in both men and women. All 3teaching methods reached the goal of reducing defibrillation time.

Evaluación del conocimiento y de las habilidades para el uso de un Desfibrilador Externo Automatizado (DEA) por estudiantes universitarios. Un diseño cuasiexperimental / Assessment of knowledge and skills in using an Automated External Defibrillator (AED) by university students. A quasi-experimental study

Objetivo: Evaluar la capacidad del personal lego (estudiantes universitarios) para usar un desfibrilador externo automatizado (DEA). Diseño: Estudio cuasiexperimental de medidas repetidas de muestreo no probabilístico con grupo control. Ámbito: Estudiantes de formación de profesorado de la Universidad de Santiago de Compostela. Participantes: La muestra estuvo compuesta por 129 sujetos, 69% mujeres y 31% hombres, de entre 19 y 47 años (media 23,2 ± 4,7), cuyo criterio de inclusión fue el no tener conocimientos previos sobre DEA. Intervenciones: Se tomaron los tiempos empleados en aplicar una descarga sobre un maniquí con DEA sin formación (T0); tras una explicación teórico-práctica inferior a 1 minuto (T1) y tras 6 meses del proceso formativo (T2). Variables de interés principales: La variable de resultado principal fue el tiempo empleado en aplicar una descarga. Se definió la variable «efecto de mejora» mediante la diferencia absoluta de tiempo entre T1 y T0, y la variable «efecto de grado de olvido» como la diferencia absoluta entre T1 y T2. Resultados: Las medias de tiempos fueron: T0 = 67,7 s; T1 = 44,2 s; T2 = 45,9 s. Se redujo el tiempo para realizar una descarga tras la explicación formativa (T1 < T0) (−23,4 s; p < 0,001). El T2 es inferior a T0 (−21,8 s; p < 0,001), pero mayor que T1 (1,6 s; p = 0,002). El efecto de mejora fue significativo (p < 0,001), al igual que el grado de olvido (p = 0,002). Conclusiones: Se demostró el fácil manejo del DEA, ya que personas sin formación fueron capaces de aplicar una descarga. El tiempo de administración de descarga se redujo tras una pequeña formación. Este tiempo apenas aumentó pasados 6 meses (AU)

Aim: To evaluate layperson (university student) ability to use an automated external defibrillator (AED). Design: A repeated measures quasi-experimental study with non-probabilistic sampling and a control group was carried out. Scope: Teacher training degree students at the University of Santiago de Compostela (Spain). Participants: The sample consisted of 129 subjects (69% women and 31% men), between 19-47 years of age (mean 23.2 ± 4.7 years). As inclusion criterion, the subjects were required to have no previous knowledge of AED. Interventions: Times to apply defibrillation with an AED to a mannequin were recorded untrained (T0), after a theoretical and practice explanation lasting less than one minute (T1), and 6 months after the training process (T2). Main variables of interest: The primary endpoint was the time taken to deliver a defibrillation discharge. The «improvement effect» variable was defined by the absolute time difference between T1 and T0, while the «degree of forgetfulness effect» variable was defined as the absolute difference between T1 and T2. Results: The mean times were T0 = 67.7 s; T1 = 44.2 s; T2 = 45.9 s. The time to apply defibrillation was reduced after explanation training (T1 < T0) (−23.4 s; P < .001). T2 proved shorter than T0 (−21.8 s; P < .001) but longer than T1 (1.6 s; P = .002). The improvement effect was significant (P < .001), in the same way as the degree of forgetfulness (P = .002). Conclusions: Easy handling of AED was demonstrated, since untrained people were able to deliver a discharge. Defibrillation time was reduced after brief training. This time barely increased after 6 months (AU)

Assessment of knowledge and skills in using an Automated External Defibrillator (AED) by university students. A quasi-experimental study. / Evaluación del conocimiento y de las habilidades para el uso de un Desfibrilador Externo Automatizado (DEA) por estudiantes universitarios. Un diseño cuasiexperimental.

AIM: To evaluate layperson (university student) ability to use an automated external defibrillator (AED). DESIGN: A repeated measures quasi-experimental study with non-probabilistic sampling and a control group was carried out. SCOPE: Teacher training degree students at the University of Santiago de Compostela (Spain). PARTICIPANTS: The sample consisted of 129 subjects (69% women and 31% men), between 19-47 years of age (mean 23.2±4.7 years). As inclusion criterion, the subjects were required to have no previous knowledge of AED. INTERVENTIONS: Times to apply defibrillation with an AED to a mannequin were recorded untrained (T0), after a theoretical and practice explanation lasting less than one minute (T1), and 6 months after the training process (T2). MAIN VARIABLES OF INTEREST: The primary endpoint was the time taken to deliver a defibrillation discharge. The "improvement effect" variable was defined by the absolute time difference between T1 and T0, while the "degree of forgetfulness effect" variable was defined as the absolute difference between T1 and T2. RESULTS: The mean times were T0=67.7s; T1=44.2s; T2=45.9s. The time to apply defibrillation was reduced after explanation training (T1

[Standardization of the data reported in nasopharyngeal and fluoroscopy study of the velopharyngeal sphincter]. / Estandarización de los datos reportados en estudios de nasofaringoscopía y fluoroscopía del esfínter velofaríngeo.

There is a certain global awareness to unify the reports of the findings with the Fiber Optic Endoscopy and The Fluoroscopy in the Velopharyngeal Sphincter. The evaluation must be made by specialists. Nasopharyngoscopy: The required equipment is the nasopharyngoscope with a source of light. A videotape is desirable although not necessary. The report must be descriptive and should arrive at precise conclusions. The following are described: 1) nasal phosae, 2) meatus, 3) the exit orifice of the Eustachian Tube, 4) oropharyx, 5) velopharyngeal sphincter (posterior and lateral pharyngeal walls, and the palatal velum), 6) the closing pattern (form, separate structure, at rest, and in phonation), and 7) larynx. Fluoroscopy: It is useful to evaluate the lateral pharyngeal walls as well as the level at which the velopharyngela sphincter closes. The fluoroscopy is not required in every combination instance. Nevertheless, when it is used, it must be in complement with the nasopharyngoscopy. The videotape is not indispensable. Frontal, lateral, and basal incidences must always be performed.