AVIP Project (Prosthetic Virtual Friend): Study of clinical-functional outcomes and satisfaction with a mobile application in the perioperative management and follow-up of hip arthroplasty. / Proyecto AVIP (Amigo VIrtual Protésico): estudio de resultados clínico-funcionales y de satisfacción con una aplicación móvil en el manejo perioperatorio y seguimiento de implantes protésicos de cadera.

OBJECTIVE: To analyze the clinical, quality of life, and healthcare quality outcomes obtained in a series of patients undergoing total hip arthroplasty (THA), who were empowered and monitored using the AVIP application. These results will be compared with a control group followed through a standard protocol. MATERIAL AND METHOD: Randomized clinical trial with parallel groups involving patients with an indication for THA. Clinical variables were measured and compared using the WOMAC and mHHS, pain assessed by the VAS, quality of life with the SF-12 test. Walking capabilities were analyzed using the Functional Gait Assessment Scale, along with satisfaction levels assessed through the SUCE questionnaire, and perceived anxiety levels related to the process. RESULTS: A total of 68 patients were evaluated, with 31 patients in the AVIP group and 33 in the Control group completing the follow-up. Both groups demonstrated improvement in clinical outcomes based on the WOMAC and mHHS hip tests, a reduction in perceived pain, and an enhancement in quality of life according to the SF-12 test. Patients in the AVIP study group exhibited non-inferiority in clinical outcomes and satisfaction compared to the control group, as well as lower anxiety levels and improved walking capabilities after the first month of follow-up. Notably, 82.25% of the follow-up visits for this group were conducted remotely. CONCLUSION: The implementation of a mHealth application like AVIP can be safely offered to selected patients undergoing hip arthroplasty, enabling effective monitoring and providing continuous information and training.

Low levels of miR-143-3p are associated with severe chronic rhinosinusitis with nasal polyps.

microRNAs (miRNAs) are small, single-stranded, non-coding RNA molecules that regulate post-transcriptional gene expression. Accumulating evidence suggests their involvement in regulating various biological and pathological processes, including inflammation. Studies have revealed distinct expression patterns of miRNAs in Chronic Rhinosinusitis with (CRSwNP) and without (CRSsNP) nasal polyps (1). Specifically, miR-155 and miR-21 have been observed to be upregulated in CRSwNP, increasing and attenuating the expression of pro-inflammatory cytokines, respectively (2,3). Conversely, the downregulation of miR-34, miR-449, and members of the miR-200 family has been associated with impaired ciliogenesis and the regulation of epithelial-mesenchymal transition, respectively (4,5). Nonetheless, the direct role of miRNAs in CRSwNP is still being investigated.

Mast Cell Activation Profile and TFH13 Detection Discriminate Food Anaphylaxis Versus Sensitization.

BACKGROUND AND OBJECTIVE: The prevalence of food allergy (FA) has increased significantly, and the risk of developing anaphylaxis is unpredictable. Thus, discriminating between sensitized patients and those at risk of having a severe reaction is of utmost interest. To explore mast cell activation pattern and T follicular helper (TFH) 13 presence in sensitized and food anaphylaxis patients. METHODS: Patients sensitized to Lipid transfer protein (LTP) were classified as anaphylaxis or sensitized depending on the symptoms elicited by LTP-containing food. CD34+-derived MCs from patients and controls were obtained, sensitized with pooled sera, and challenged with Pru p 3 (peach LTP). Degranulation, PGD2, and cytokine/chemokine release were measured. The TFH13 population was examined by flow cytometry in the peripheral blood of all groups. In parallel, LAD2 cells were activated similarly to patients' MCs. RESULTS: A distinguishable pattern of mast cell activation was found in anaphylaxis compared to sensitized patients. Robust degranulation, PGD2, and IL-8 and GM-CSF secretion were higher in anaphylaxis, whereas TFG- and CCL2 secretion increased in sensitized patients. Concomitantly, anaphylaxis patients had a larger TFH13 population. MC activation profile was dependent on the sera rather than the MC source. In agreement with that, LAD2 cells reproduce the same pattern as MCs from anaphylactic and sensitized patients. CONCLUSION: The distinct profile of mast cell activation allows to discriminate between anaphylaxis and sensitized patients. Pooled sera may determine mast cell activation independently of mast cell origin. Besides, the presence of TFH13 cells in anaphylaxis patients points to an essential role of IgE affinity.

Internet-based interdisciplinary therapeutic group (Grupo Interdisciplinar Online, GIO) for perinatal anxiety and depression-a randomized pilot study during COVID-19.

Early interventions may promote reductions in mothers' anxiety-depression (AD) symptoms and improvements in their offspring. This longitudinal randomized research was conducted to assess the effects of interdisciplinary online therapeutic groups (GIO) in at-risk mothers and babies during the COVID-19 pandemic in a disadvantaged neighborhood in Barcelona (Spain). A total of 135 babies were born from March 2020 to June 2021 in a primary healthcare center of Barcelona (Spain). Pregnant woman and new mothers were screened for AD symptomatology through EPDS and STAI questionnaires. Seventy-two of them met high-risk criteria for AD and were included in the study. They were randomly assigned into the two groups of the study: 40 participants were assigned to GIO, the therapeutic group (TG), while 32 of them were assigned to the control group (CG) and received treatment as usual. The course of the mothers' symptomatology was assessed, as well as the baby's development at 6 months old in a blind pediatric follow-up. No differences were found in AD between both groups before the intervention. However, we obtained a significant decrease in AD symptomatology (EPDS p < .001; STAI state p = .015 and STAI trait p < .001at 6 months of life) after the intervention in the TG compared to the CG. Pediatric follow-up at 6 months demonstrated significant differences between groups in babies' development assessment (manipulation p = .003; language p < .001; sociability p < .001). The GIO helped to ensure healthy development of the baby and reduction of the mothers' depressive-anxiety symptomatology.

Weight Loss and Vitamin D Improve Hyporesponsiveness to Corticosteroids in Obese Asthma.

BACKGROUND AND OBJECTIVES: Obesity negatively impacts on the response of asthma patients to inhaled corticosteroids. The mechanisms underlying this impact are unknown. Objective: To demonstrate that the poor response to inhaled corticosteroids in obese asthma patients is associated with impaired anti-inflammatory activity of corticosteroids and vitamin D deficiency, both of which are improved by weight loss. METHODS: The study population comprised 23 obese asthma patients (OA) (18 females; median (IQR) age 56 [51-59] years), 14 nonobese asthma patients (NOA) (11 females; 53 [43-60] years), 15 obese patients (OP) (13 females; 47 [45-60] years), and 19 healthy controls (HC) (14 females; 43 [34-56] years). Ten OA and 11 OP were evaluated at baseline (V1) and 6 months after bariatric surgery (V2). Corticosteroid response was measured using dexamethasone-induced inhibition of peripheral blood mononuclear cell (PBMC) proliferation. Lung function and serum levels of leptin, adiponectin, and vitamin D were measured at V1 and V2. RESULTS: We found a reduced response to dexamethasone in PBMCs of OP and OA with respect to NOA and HC; this inversely correlated with the adiponectin/leptin ratio and vitamin D levels. Bariatric surgery improved corticosteroid responses in OP and OA and normalized the adiponectin/leptin ratio and vitamin D levels. Exposure of PBMCs to vitamin D potentiated the antiproliferative effects of corticosteroids. Dexamethasone and vitamin D induced similar MKP1 expression in OP and OA. CONCLUSION: The efficacy of weight loss to improve symptoms and lung function in OA may be due, at least in part, to the recovered anti-inflammatory effects of corticosteroids. Vitamin D deficiency may contribute to corticosteroid hyporesponsiveness in OA.

Weight Loss and Vitamin D Improve Hyporesponsiveness to Corticosteroids in Obese Asthma

Background: Obesity negatively impacts on the response of asthma patients to inhaled corticosteroids. The mechanisms underlying this impact are unknown. Objective: To demonstrate that the poor response to inhaled corticosteroids in obese asthma patients is associated with impaired anti-inflammatory activity of corticosteroids and vitamin D deficiency, both of which are improved by weight loss. Methods: The study population comprised 23 obese asthma patients (OA) (18 females; median (IQR) age 56 [51-59] years), 14 nonobese asthma patients (NOA) (11 females; 53 [43-60] years), 15 obese patients (OP) (13 females; 47 [45-60] years), and 19 healthy controls (HC) (14 females; 43 [34-56] years). Ten OA and 11 OP were evaluated at baseline (V1) and 6 months after bariatric surgery (V2). Corticosteroid response was measured using dexamethasone-induced inhibition of peripheral blood mononuclear cell (PBMC) proliferation. Lung function and serum levels of leptin, adiponectin, and vitamin D were measured at V1 and V2. Results: We found a reduced response to dexamethasone in PBMCs of OP and OA with respect to NOA and HC; this inversely correlated with the adiponectin/leptin ratio and vitamin D levels. Bariatric surgery improved corticosteroid responses in OP and OA and normalized the adiponectin/leptin ratio and vitamin D levels. Exposure of PBMCs to vitamin D potentiated the antiproliferative effects of corticosteroids. Dexamethasone and vitamin D induced similar MKP1 expression in OP and OA. (AU)

Antecedentes: La obesidad tiene un impacto negativo en la respuesta del asma a los corticosteroides inhalados por mecanismos desconocidos. Objetivo: Demostrar que la mala respuesta a los corticosteroides inhalados en pacientes obesos asmáticos se asocia con una actividad antiinflamatoria alterada de los corticosteroides, así como también a la deficiencia de vitamina D, ambos mejorados por la pérdida de peso. Métodos: 23 obesos asmáticos (OA) (18 mujeres; mediana de edad [rango intercuartílico] 56 [51-59] años), 14 asmáticos no obesos (NOA) (11 mujeres; 53 [43-60] años), 15 obesos (O) (13 mujeres; 47 [45-60] años), y 19 controles sanos (HC) (14 mujeres; 43 [34-56] años) fueron incluidos. Se evaluaron 10 pacientes OA y 11 O al inicio (V1) y seis meses después (V2) de cirugía bariátrica. La respuesta a los corticosteroides se midió mediante la inhibición con dexametasona de la proliferación de células mononucleares de sangre periférica (PBMC). La función pulmonar, los niveles séricos de leptina, adiponectina y vitamina D se midieron en V1 y V2. Resultados: Encontramos una respuesta reducida a la dexametasona en PBMC de pacientes O y OA con respecto a los NOA y HC, que se correlacionó de forma inversamente proporcional con la relación adiponectina/leptina y los niveles de vitamina D. La cirugía bariátrica mejoró las respuestas de los corticosteroides en los grupos de pacientes O y OA, y normalizó la relación adiponectina/leptina y los niveles de vitamina D. La exposición de las PBMC a la vitamina D potenció los efectos antiproliferativos de los corticosteroides. La dexametasona y la vitamina D indujeron una expresión similar de MKP-1 en los pacientes O y OA. (AU)

The use of digital escape rooms in nursing education.

Negative attitudes and prejudices towards people with a mental disorder are common across cultures and societies. The stigma associated with mental illness leads to a lower quality of life, given the discrimination and social exclusion suffered by people with this type of disorder. In the field of health, research has shown that doctors and nurses also manifest these types of stigmatizing behaviors and attitudes. The present study aims to create and apply an educational escape room for the purpose of training nursing students in mental health, promoting positive attitudes towards people who have a mental disorder. To do so, a pre-post study was conducted with an experimental group and a control group to determine whether the escape room was effective for the modification of stigmatizing behaviors compared to transmissive lecture class, and a third measurement was made at 6 months only to the experimental group to evaluate whether the changes produced by the escape room were maintained in the long term. The results indicate that the students participating in the study obtained better scores in sensitization and these remain better over time. It is concluded that the escape room used is suitable for the training and sensitization of future nursing professionals in the field of mental health, facilitating the learning of knowledge and positive attitudes towards severe mental disorder.

Surface-Enriched Boron-Doped TiO2 Nanoparticles as Photocatalysts for Propene Oxidation.

A series of nanostructured boron-TiO2 photocatalysts (B-X-TiO2-T) were prepared by sol-gel synthesis using titanium tetraisopropoxide and boric acid. The effects of the synthesis variables, boric acid amount (X) and crystallization temperature (T), on structural and electronic properties and on the photocatalytic performance for propene oxidation, are studied. This reaction accounts for the remediation of pollution caused by volatile organic compounds, and it is carried out at low concentrations, a case in which efficient removal techniques are difficult and costly to implement. The presence of boric acid during the TiO2 synthesis hinders the development of rutile without affecting the textural properties. X-ray photoelectron spectroscopy analysis reveals the interstitial incorporation of boron into the surface lattice of the TiO2 nanostructure, while segregation of B2O3 occurs in samples with high boron loading, also confirmed by X-ray diffraction. The best-performing photocatalysts are those with the lowest boron loading. Their high activity, outperforming the equivalent sample without boron, can be attributed to a high anatase and surface hydroxyl group content and efficient photo-charge separation (photoelectrochemical characterization, PEC), which can explain the suppression of visible photoluminescence (PL). Crystallization at 450 °C renders the most active sample, likely due to the development of a pure anatase structure with a large surface boron enrichment. A shift in the wavelength-dependent activity profile (PEC data) and the lowest electron-hole recombination rate (PL data) are also observed for this sample.

Modelling beef cows' individual response to short nutrient restriction in different lactation stages.

Short-term nutrient restrictions can occur naturally in extensive beef cattle production systems due to low feed quality or availability. The aims of the study were to (1) model the curves of milk yield, plasma non-esterified fatty acids (NEFAs) and ß-hydroxybutyrate (BHB) contents of beef cows in response to short nutritional challenges throughout lactation; (2) identify clusters of cows with different response profiles; (3) quantify differences in cows' response between the clusters and lactation stages. Data of BW, body condition score (BCS), milk yield, NEFA, and BHB plasma concentration from 31 adult beef cows (626 ± 48 kg at calving) were used to study the effect of 4-day feed restriction repeated over months 2, 3 and 4 of lactation. On each month, all cows received a single diet calculated to meet the requirements of the average cow: 100 % requirements for 4 days (d-4 to d-1, basal period), 55 % requirements on the next 4 days (d0 to d3, restriction period) and 100 % requirements for 4 days (d4 to d7, refeeding period). Natural cubic splines were used to model the response of milk yield, NEFA and BHB to restriction and refeeding in the 3 months. The new response variables [baseline value, peak value, days to peak and to regain baseline, and areas under the curve (AUC) during restriction and refeeding] were used to cluster cows according to their metabolic response (MR) into two groups: Low MR and High MR. The month of lactation affected all the traits, and basal values decreased as lactation advanced. Cows from both clusters had similar BW and BCS values, but those in the High MR cluster had higher basal milk yield, NEFA and BHB contents, and responded more intensely to restriction, with more marked peaks and AUCs. Reaction times were similar, and baseline values recovered during refeeding in both clusters. Our results suggest that the response was driven by cows' milk potential rather than size or body reserves, and despite high-responding cattle's higher milk yield, they were able to activate metabolic pathways to respond to and recover from the challenge.

Transforming a public university hospital and its area of influence into a comprehensive resource in response to the COVID-19 pandemic.

INTRODUCTION AND OBJECTIVES: The outbreak of COVID-19 has overwhelmed healthcare systems all over the world. The aim of this article is to describe the process of transforming the Vall d'Hebron University Hospital, the second largest hospital in Spain, into a COVID-19 centre coordinating response to the pandemic in its reference area. MATERIALS AND METHODS: The study draws on the experience of the authors in transforming the hospital into a comprehensive resource in response to the COVID-19 pandemic. The strategy is based on four central strategies: early planning, coordination of all healthcare agents in its reference area, definition of clear leadership roles, and the organisation of care based on multidisciplinary teams with minimal recruitment of new staff. RESULTS: The transformation strategy enabled the hospital to cope with the surge in patients without exceeding its capacity. During the response phases, which amounted to a period of 57 days, 3106 patients consulted the ER and 2054 were admitted, 346 of whom were treated at the ICU. To accommodate the number of adult COVID-19 patients, adult ICU availability was progressive increased by 371%, and ordinary beds increased by 240. A total of 671 staff members went on sick leave after testing positive for COVID-19. CONCLUSION: The transformation experience of the hospital provides insight into how effectively adapt the structures and functioning of large hospitals. The relevance of territorial coordination during the pandemic is stressed as an effective strategy that contributed coping the pandemic.

[Stability, function, alignment and associated injuries after surgical intervention and rehabilitation of tibial plate fracture]. / Estabilidad, función, alineación y lesiones asociadas después de una intervención quirúrgica y rehabilitación de fractura de platillos tibiales.

INTRODUCTION: tibial plateau fractures affect functionality of a large load bearing joint such as the knee, due to its multiple compromises, not only articular but also the ones including soft tissues. This study aims to evaluate the stability, function, alignment, associated injuries and complications of the knee after surgery and tibial plateau fractures rehabilitation. MATERIAL AND METHODS: a descriptive prospective observational study was carried out where patients with a tibial plateau fracture who had undergone surgery, that accomplish the inclusion criteria were included, in the period from April 2018 to June 2019. Analysis of variables was performed with t tests for independent samples. RESULTS: from a total of 92 patients with tibial plateau fracture, 66 (71%) were able to achieve the minimum six months follow-up. The most common fracture according to Schatzker classification was type II with 33.3%, and the most common according to Luo classification was the medial, lateral and posterior three column with 39.4%. More than 70% of patients who underwent surgery due to tibial plateau fractures developed soft tissue injury, therefore knee instability, specially with a higher rate of anterior cruciate ligament injuries or anterior instability. CONCLUSION: an important proportion of patients who underwent surgery for tibial plateau fractures have knee ligament injuries.

INTRODUCCIÓN: las fracturas de los platillos tibiales afectan la funcionalidad de una gran articulación de carga como la rodilla debido a sus múltiples compromisos no sólo articulares, sino también de tejidos blandos. Este estudio tiene como objetivo evaluar la estabilidad, función, alineación, lesiones asociadas y complicaciones de la rodilla después de intervención quirúrgica y rehabilitación de fractura de platillos tibiales. MATERIAL Y MÉTODOS: se realizó estudio observacional prospectivo descriptivo, donde se incluyeron los pacientes con fractura de platillos tibiales intervenidos quirúrgicamente que cumplieran los criterios de inclusión en el período comprendido entre Abril de 2018 y Junio de 2019. Se hizo análisis de variables con pruebas t para muestras independientes. RESULTADOS: de un total de 92 pacientes con fractura de platillos tibiales, 66 (71%) lograron completar los seis meses mínimos de seguimiento. La fractura más común según la clasificación de Schatzker fue tipo II con 33.3% y la más común según la clasificación de Luo fue la de tres columnas medial, lateral y posterior con 39.4%. Más de 70% de los pacientes intervenidos por fracturas de platillos tibiales presentaron lesión de tejidos blandos, por ende, una inestabilidad de rodilla, especialmente con mayor índice de lesiones del ligamento cruzado anterior e inestabilidad anterior. CONCLUSIÓN: una proporción importante de los pacientes intervenidos por fractura de platillos tibiales tienen lesión ligamentaria de rodilla.

[No infected union of subtrochanteric fracture of femur, treated with autograft and plate]. / No unión infectada de fractura subtrocantérica de fémur, tratada con autoinjerto y placa.

Hip fractures are considered a public health problem in the world. Among hip fractures we find subtrochanteric fractures that are defined as proximal femur fractures located in the trochanteric region within 5 cm below the lesser trochanter; and they have an approximate incidence of 15 to 20 per 100,000 people. The objective of this case is to report the success of the reconstruction of an infected subtrochanteric fracture, with a non-vascularized fibular segment and a distal femur condylar support plate. Clinical case: 41-year-old male patient suffering from a right subtrochanteric fracture as a result of a traffic accident that required the use of osteosynthesis material. With subsequent rupture of the cephalomedullary nail in its proximal third, non-union of the fracture and infections at the fracture site. He was treated with multiple surgical lavages, antibiotic therapy, and an unconventional orthopedic and surgical procedure, such as the use of a distal femur condylar support plate and an endomedullary bone graft with a 10-cm segment of non-vascularized fibula. Patient with satisfactory and favorable evolution.

Las fracturas de cadera se consideran un problema de salud pública en el mundo, entre las fracturas de cadera encontramos las subtrocantéricas, que se definen como fracturas proximales de fémur situadas en la región trocantérea dentro de los 5 cm debajo del trocánter menor; tienen una incidencia aproximada de 15 a 20 por cada 100,000 personas. El objetivo de este de caso es reportar el éxito de la reconstrucción de una fractura subtrocantérica infectada, con un segmento del peroné no vascularizado y una placa de soporte condíleo de fémur distal. Caso clínico: masculino de 41 años de edad que sufre fractura subtrocantérica derecha producto de un accidente de tránsito que requirió manejo de osteosíntesis. Con posterior ruptura del clavo cefalomedular en su tercio proximal, no unión de la fractura e infecciones en sitio de la fractura. Fue tratado con múltiples lavados quirúrgicos, antibioticoterapia y un procedimiento ortopédico y quirúrgico poco convencional como el uso de una placa de soporte condíleo de fémur distal y un injerto óseo endomedular con un segmento de 10 cm de peroné no vascularizado. Paciente con evolución satisfactoria y favorable.

[Influence of the covid-19 pandemic period of alert on perceived quality of hospital emergencies]. / Influencia del periodo de alarma por la pandemia covid-19 en la calidad percibida de la atención en urgencias hospitalarias.

OBJECTIVE: To assess changes in perceived quality in patients who required A&E hospital care before and during the COVID-19 period of alert. METHODS: Retrospective descriptive observational study using the «Net Promoter Score¼ (NPS), which classifies patients as promoters or detractors. Three perceived quality dimensions (accessibility, professionals, and information) were measured in 160 patients discharged home before alert, and in a further 160 in the first 2 months during alert. A standard of ≥90% promoters and ≤10% detractors was verified by lot acceptance (LQAS) in different access routes and times. Factors related to the probability that a patient was a promoter, or a detractor were analysed using logistic regression. RESULTS: The mean score was lower in accessibility than in the other dimensions (8.6 vs. 9.1 and 9.0, P<.0001). During alert, accessibility obtained better results (NPS 70 vs. 32, P<.001). Per access route, Paediatrics and Ophthalmology improved and Maternity did not experience changes. LQAS showed more lots accepted during alert (85 vs. 72%). The likelihood for a patient to be a promoter was higher during alert (OR 1.85, P<.0001), especially in accessibility (OR 3.08, P<0.0001). The likelihood to be a detractor was reduced (OR .54, P<.05), and also greater in accessibility (OR .39, P<.05). CONCLUSIONS: Perceived quality improved during the period of alert, its declaration being the most influential factor. This improvement is evident in paediatric and ophthalmological patients, but imperceptible in Maternity or Traumatology, perhaps because the pandemic acted as an adequacy corrector.

On-line monitoring of photosynthetic activity based on pH data to assess microalgae cultivation.

Microalgae performance of outdoor cultivation systems is influenced by environmental and operating dynamics. Monitoring and control systems are needed to maximise biomass productivity and nutrient recovery. The goal of this work was to corroborate that pH data could be used to monitor microalgae performance by means of data from an outdoor membrane photobioreactor (MPBR) plant. In this system, microalgae photosynthetic activity was favoured over other physical and biological processes, so that the pH data dynamics was theoretically related to the microalgae carbon uptake rate (CUR). Short- and long-term continuous operations were tested to corroborate the relationship between the first derivate of pH data dynamics (pH') and microalgae photosynthetic activity. Short-term operations showed a good correlation between gross pH' values and MPBR performance. An indicator of the maximum daily average microalgae activity was assessed by a combination of on-line pH' measurements obtained in the long-term and a microalgae growth kinetic model. Both indicators contributed to the development of advanced real-time monitoring and control systems to optimise microalgae cultivation technology.