Salt Tolerance of Sea Flax (Linum maritimum L.), a Rare Species with Conservation Interest in Eastern Spain.

Seldom found in saltmarshes, Linum maritimum is a halophyte of great conservation interest in the eastern Iberian Peninsula. Although the species has been reported in different plant communities, there is no information on its range of salinity tolerance or mechanisms of response to environmental stress factors. In this study, L. maritimum plants were subjected to increasing salt concentrations in controlled conditions in a greenhouse. After six months of watering with salt solutions, only plants from the control, 50 mM and 100 mM NaCl treatment groups survived, but seeds were produced only in the first two. Significant differences were found between the plants from the various treatment groups in terms of their growth parameters, such as plant height, fresh weight, and the quantity of flowers and fruits. The main mechanism of salt tolerance is probably related to the species' ability to activate K+ uptake and transport to shoots to partly counteract the accumulation of toxic Na+ ions. A biochemical analysis showed significant increases in glycine betaine, flavonoids and total phenolic compounds, highlighting the importance of osmotic regulation and antioxidant compounds in the salt tolerance of Linum maritimum. These findings have implications for the conservation of the species, especially under changing climatic conditions that may lead to increased soil salinity in its Mediterranean distribution area.

Postfire biodiversity database for eastern Iberia.

In the summer of 2012, two fires affected Mediterranean ecosystems in the eastern Iberian Peninsula. The size of these fires was at the extreme of the historical variability (megafires). Animals are traditionally assumed to recolonize from source populations outside of the burned area (exogenous regeneration) while plants recover from endogenous regeneration (resprouting and seeding). However, there is increasing evidence of in situ fire survival in animals. To evaluate the effect of large-scale fires on biodiversity and the mechanism of recovery, in 2013, we set up 12 plots per fire, covering burned vegetation at different distances from the fire perimeter and unburned vegetation. In each plot, we followed the postfire recovery of arthropods, reptiles (including some of their parasites), and plants for 2 to 5 years. Here we present the resulting database (POSTDIV) of taxon abundance. POSTDIV totals 19,906 records for 457 arthropod taxa (113,681 individuals), 12 reptile taxa (503 individuals), 4 reptile parasites (234 individuals), and 518 plant taxa (cover-abundance). We provide examples in the R language to query the database.

Constitutive and Adaptive Traits of Environmental Stress Tolerance in the Threatened Halophyte Limonium angustebracteatum Erben (Plumbaginaceae).

Limonium angustebracteatum is a halophyte endemic to the E and SE Iberian Peninsula with interest in conservation. Salt glands represent an important adaptive trait in recretohalophytes like this and other Limonium species, as they allow the excretion of excess salts, reducing the concentration of toxic ions in foliar tissues. This study included the analysis of the salt gland structure, composed of 12 cells, 4 secretory and 8 accessory. Several anatomical, physiological and biochemical responses to stress were also analysed in adult plants subjected to one month of water stress, complete lack of irrigation, and salt stress, by watering with aqueous solutions of 200, 400, 600 and 800 mM NaCl. Plant growth was inhibited by the severe water deficit and, to a lesser extent, by high NaCl concentrations. A variation in the anatomical structure of the leaves was detected under conditions of salt and water stress; plants from the salt stress treatment showed salt glands sunken between epidermal cells, bordered by very large epidermal cells, whereas in those from the water stress treatment, the epidermal cells were heterogeneous in shape and size. In both, the palisade structure of the leaves was altered. Salt excretion is usually accompanied by the accumulation of salts in the foliar tissue. This was also found in L. angustebracteatum, in which the concentration of all ions analysed was higher in the leaves than in the roots. The increase of K+ in the roots of plants subjected to water stress was also remarkable. The multivariate analysis indicated differences in water and salt stress responses, such as the accumulation of Na and Cl, or proline, but K+ homeostasis played a relevant role in the mechanism of tolerance to both stressful conditions.

Nivel de conocimiento de Sífilis en adolescentes de dos Instituciones Educativas del distrito de Buenaventura / Level of knowledge of Syphilis in adolescents of two Educational Institutions of the Buenaventura district

Objetivo: Establecer el nivel de conocimiento de sífilis en adolescentes de dos Instituciones Educativas del distrito de Buenaventura de grados: noveno, décimo y once. Material y métodos: Estudio descriptivo de corte transversal en jóvenes entre 12 y 18 años; muestra a conveniencia de 420 estudiantes. Se aplicó una encuesta anónima dividida en 5 secciones. Se determinaron características sociodemográficas, hábitos, vida sexual y conocimiento sobre ITS. Resultados: 91% manifestó conocer sobre las ITS; 22,4% expresó conocer los signos y síntomas. 3,1& presentó diagnóstico de ITS; no reportaron casos de sífilis; 51,9% manifestó conocer la sífilis; el 10% expresó conocer signos y síntomas. 16% manifestó conocer mecanismo de prevención. 4% de los estudiantes tiene un buen nivel de conocimiento sobre sífilis. Sobre actividad sexual, 58,7% había iniciado vida sexual, 28% tuvo su primer encuentro a los 11 años o menos, siendo mayormente de género masculino. 33,8% habían tenido 1 pareja sexual, seguido de 23,8% con 6 o más parejas sexuales. El análisis de conocimiento sobre sífilis según institución educativa evidenció que el 8,9% y el 3% de los estudiantes tenía un nivel bueno de conocimiento, en la institución rural y urbana respectivamente. Al evaluar el conocimiento sobre ETS, se encontró que el 85% y 96% de estudiantes en zona rural y urbana respectivamente afirman tener conocimiento; sobre la sintomatología, 21% y 23 % es conocedor de esta, en área rural y urbana respectivamente. Conclusiones: Un alto porcentaje de estudiantes encuestados tienen un bajo nivel de conocimiento sobre sífilis; las mayores falencias se presentan en manifestaciones clínicas, la prevención y la cura de dicha enfermedad; aunque los adolescentes tienen múltiples fuentes de conocimiento, dicha información es deficiente, especialmente la transmitida por los padres y la pareja.

Objective: To establish the level of knowledge about syphilis in adolescents of two Educational Institutions in the district of Buenaventura of the ninth, tenth and eleventh grades. Material and methods: Descriptive cross-sectional study in young people between 12 and 18 years; convenience sample of 420 students. An anonymous survey divided into five sections was applied. Sociodemographic characteristics, habits, sexual life, and knowledge about STIs were determined. Results: 91% said they know about STIs, and 22.4% said they knowing the signs and symptoms. STI diagnoses were presented in 3.1%; not report syphilis cases. 51.9% said that knew about syphilis, 10% said they know signs and symptoms. 16% said they knew about mechanism prevention. 4% of students have a good level of knowledge about syphilis. About sexual activity 58.7% had started sexual life, 28% had their first encounter at age 11 or less, they were principally male. 33.8% had one sexual partner, followed by 23.8% with six or more sexual partners. Institutional Analysis showed that 8.9% (rural) and 3% (urban) of the students, were at a good level of knowledge. When evaluating knowledge about STDs, it was found that 85% (urban) and 96% (rural) students say they know, however, when inquiring about the symptoms, in rural and urban areas, 21 % and 23% respectively are aware of it. Conclusions: The highest percentage of students surveyed has a bad level of knowledge about syphilis, where the highest % was in clinical manifestations, the prevention, and cure of said disease; although adolescents have multiple sources of knowledge, this information is deficient, especially that shared by the parents and the couple.

Responses to Increased Salinity and Severe Drought in the Eastern Iberian Endemic Species Thalictrum maritimum (Ranunculaceae), Threatened by Climate Change.

Thalictrum maritimum is an endangered, endemic species in East Spain, growing in areas of relatively low salinity in littoral salt marshes. A regression of its populations and the number of individuals has been registered in the last decade. This study aimed at establishing the causes of this reduction using a multidisciplinary approach, including climatic, ecological, physiological and biochemical analyses. The climatic data indicated that there was a direct negative correlation between increased drought, especially during autumn, and the number of individuals censused in the area of study. The susceptibility of this species to water deficit was confirmed by the analysis of growth parameters upon a water deficit treatment applied under controlled greenhouse conditions, with the plants withstanding only 23 days of complete absence of irrigation. On the other hand, increased salinity does not seem to be a risk factor for this species, which behaves as a halophyte, tolerating in controlled treatments salinities much higher than those registered in its natural habitat. The most relevant mechanisms of salt tolerance in T. maritimum appear to be based on the control of ion transport, by (i) the active transport of toxic ions to the aerial parts of the plants at high external salinity-where they are presumably stored in the leaf vacuoles to avoid their deleterious effects in the cytosol, (ii) the maintenance of K+ concentrations in belowground and aboveground organs, despite the increase of Na+ levels, and (iii) the salt-induced accumulation of Ca2+, particularly in stems and leaves. This study provides useful information for the management of the conservation plans of this rare and endangered species.

Intra- and Inter-Specific Crosses among Centaurea aspera L. (Asteraceae) Polyploid Relatives-Influences on Distribution and Polyploid Establishment.

How polyploids become established is a long-debated question, especially for autopolyploids that seem to have no evolutionary advantage over their progenitors. The Centaurea aspera polyploid complex includes diploid C. aspera and two related tetraploids C. seridis and C. gentilii. Our purpose was to study the mating system among these three taxa and to analyze its influence on polyploid establishment. The distribution and ploidy level of the Moroccan populations, and forced intra- and inter-specific crosses were assessed. Allotetraploid C. seridis produced more cypselae per capitulum in the intra-specific crosses. It is a bigger plant and autogamous, and previous studies indicated that selfing forces the asymmetric formation of sterile hybrids. All these characteristics help C. seridis to avoid the minority-cytotype-exclusion effect and become established. Inter-specific hybridization was possible between C. aspera and C. gentilii, and with the symmetric formation of hybrids. However, 49% of the hybrid cypselae were empty, which probably reveals postzygotic barriers. Autotetraploid C. gentilii produced the same number of cypselae per capitulum as those of the diploid parental, has an indistinguishable field phenotype, is allogamous, and symmetrically produces hybrids. Therefore, C. gentilii does not seem to have the same competitive advantages as those of C. seridis.

Insights on Salt Tolerance of Two Endemic Limonium Species from Spain.

We have analysed the salt tolerance of two endemic halophytes of the genus Limonium, with high conservation value. In the present study, seed germination and growth parameters as well as different biomarkers-photosynthetic pigments, mono and divalent ion contents-associated to salt stress were evaluated in response to high levels of NaCl. The study was completed with an untargeted metabolomics analysis of the primary compounds including carbohydrates, phosphoric and organic acids, and amino acids, identified by using a gas chromatography and mass spectrometry platform. Limonium albuferae proved to be more salt-tolerant than L. doufourii, both at the germination stage and during vegetative growth. The degradation of photosynthetic pigments and the increase of Na+/K+ ratio under salt stress were more accentuated in the less tolerant second species. The metabolomics analysis unravelled several differences between the two species. The higher salt tolerance of L. albuferae may rely on its specific accumulation of fructose and glucose under high salinity conditions, the first considered as a major osmolyte in this genus. In addition, L. albuferae showed steady levels of citric and malic acids, whereas the glutamate family pathway was strongly activated under stress in both species, leading to the accumulation of proline (Pro) and γ-aminobutyric acid (GABA).

Myotonometry as a measure to detect myofascial trigger points: an inter-rater reliability study.

OBJECTIVE: Several diagnostic methods have been used in the identification of mechanical properties of skeletal muscle, including myofascial trigger points (MTrPs), however, they are not suitable for daily clinical use. Myotonometry offers an easy noninvasive alternative to assess these muscle properties. Nevertheless, previous research has not yet studied the mechanical properties of MTrPs by myotonometry. The purposes of this study were (1) to analyze the differences in the mechanical properties between latent MTrPs and their taut bands by myotonometry, (2) to investigate the inter-rater reproducibility of myotonometric measurements, and (3) to examine the association between myotonometry and passive isokinetic dynamometry. APPROACH: Fifty individuals (58% male; age 24.6 ± 7.9 years) with a latent medial MTrP of the right soleus muscle participated. The mechanical properties of this MTrP area of soleus muscle and its taut band area were measured using a myotonometer (MyotonPRO). Additionally, passive resistive torque and extensibility of triceps surae muscle were assessed using a Kin-Com dynamometer. MAIN RESULTS: Statistical analysis indicated higher values for the stiffness parameter in the taut band with respect to the MTrP (P < 0.05). The inter-rater reliability of the myotonometric measurements was good for all variables (ICC3,1 > 0.75). The standard error of measurement (SEM) and minimal detectable difference (MDD) indicated a small measurement error for frequency and stiffness variables (SEM% < 10%; MDD95% < 20%). Significant fair correlations between myotonometric parameters and passive isokinetic parameters ranged from -0.29 to 0.48 (P < 0.05). SIGNIFICANCE: The myotonometer was demonstrated to be a reliable tool and was able to quantify differences in the mechanical properties of myofascial tissues. The potential of this method for the assessment of myofascial pain syndromes requires further investigation.

Hepatitis C hospitalizations in Spain, 2004-2013: a retrospective epidemiological study.

BACKGROUND: Hepatitis C is an important public health problem about which there is currently scarce epidemiological information. The objective of this study is to describe and analyse the demographic and epidemiological characteristics of hospitalized cases of hepatitis C in the Spanish population between 2004 and 2013. METHODS: The study uses the Hospital Discharge Records Database of the Spanish National Health System. It is a retrospective descriptive epidemiological study. The variables analysed were year of infection, age, sex, diagnostic category, days admitted and co-morbidity. RESULTS: There have been a total of 351,996 hospitalizations; 225,138 men (64%) and 126,858 women (36%). They are divided between acute hepatitis 8161 (2.3%); chronic hepatitis 325,185 (92.4%) and unspecified hepatitis 18,650 (5.3%). The mean age for men is 53.7 (+/-15.2) and for women 62.3 (+/-17.3). 22.8% also present with an Human immunodeficiency virus (HIV) disease coinfection, and 14.7% with opioid dependencies. The trend is for a gradual increase in cases without statistical significance. CONCLUSIONS: The Hepatitis C cases hospitalized had high levels of chronicity, which entails two distinct patterns of illness in men and women - who are affected in different age ranges.

Efectividad de una intervención para mejorar la cultura de seguridad. ¿Menos es más? / Effectiveness of an intervention to improve safety culture. Less is more?

Objetivo. Evaluar el impacto de una iniciativa a largo plazo para contribuir a la mejora en cultura de seguridad entre profesionales de un área de salud, y conocer su utilidad percibida. Material y métodos. Estudio de intervención no controlado en una organización de la red pública asistencial incluyendo hospital de tercer nivel y 5.000 profesionales. Para medir impacto se realizó la encuesta de la Agency for Healthcare Research and Quality (AHRQ) por vía telefónica. Se midieron 7 dimensiones de cultura antes del proyecto (2012, n=100) y a los 3 años (2015, n=207). Se compararon variaciones entre 2012 y los conocedores del proyecto en 2015, y entre estos y no conocedores. Se valoró la utilidad (escala Likert de 5 ítems, alta utilidad medianas de 4 o superior). Resultados. Tasas de respuesta homogéneas superiores al 80%. El 41,5% conocían el proyecto (IC95%: 34,8-48,3), percibido de alta utilidad. En ambas comparaciones, variación negativa en «percepción de seguridad» (−9,9%, p<0,01, frente a 2012 y −4,2% entre grupos 2015) y «retroalimentación y comunicación sobre errores» (−10,0% frente a 2012 y −8,9% entre grupos 2015, p<0,05); y positiva no significativa en «franqueza en comunicación» (1,3% frente a 2012 y 6,9% entre grupos 2015). El «apoyo de gerencia» mejora no significativamente en 2015 (37,0%, IC95%: 30,9-43,1 en conocedores, y 38,3%, IC95%: 33,1-43,4 en no conocedores) frente a 2012 (31,4%, IC95%: 28,4-39,7. Conclusiones. Se detecta empeoramiento paradójico en varias dimensiones, probablemente por inmadurez de la organización y el instrumento utilizado. Herramientas que contemplen el grado de madurez pudieran ser más adecuadas en medición de cambios culturales, siendo necesarios más estudios (AU)

Objective. To assess the impact of a long-term initiative to improve safety culture among professionals working in a Health Area, and to know their perceived usefulness. Material and methods. An uncontrolled intervention study was designed in a public health care organization including a 3rd level hospital and 5,000 professionals. To measure the impact, the AHRQ Survey was conducted by telephone. A total of 7 dimensions of culture were measured, before starting the project (2012, n=100) and 3 years later (2015, n=207). Variations between 2012 and the respondents aware of the project in 2015 (RAP) were compared, as also between this last group and the rest of respondents (RNAP). The utility was assessed using a 5-item Likert scale, defining higher utility by medians 4 or higher. Results. The response rates were above 80%. In 2015, the 41.5% of respondents were RAP (95%CI: 34.8-48.3), which was perceived as of high utility. Negative variations were detected in "sense of security" (−9.9%, P<.01, vs. 2012, and −4.2% between 2015 groups) and "feedback and communication errors" (−10.0% vs. 2012, and −8.9% between 2015 groups, P<.05). There was a not-significant positive variation in "openness in communication" (1.3% vs. 2012, and 6.9% between 2015 groups). The "management support" showed a not-significant improve in 2015 (37.0%, 95%CI: 30.9-43.1, in RAP; and 38.3%, 95%CI: 33.1-43.4, in RANP) in comparison to 2012 (31.4%, 95%CI: 28.4-39.7). Conclusions. A paradoxical worsening is detected in several dimensions, this probably due to immaturity of the organization and the instrument used. Thus, tools explicitly considering the degree of maturity may be more appropriate to measure cultural changes, although more studies are needed (AU)

[Effectiveness of an intervention to improve safety culture. Less is more?] / Efectividad de una intervención para mejorar la cultura de seguridad. ¿Menos es más?

OBJECTIVE: To assess the impact of a long-term initiative to improve safety culture among professionals working in a Health Area, and to know their perceived usefulness. MATERIAL AND METHODS: An uncontrolled intervention study was designed in a public health care organization including a 3rd level hospital and 5,000 professionals. To measure the impact, the AHRQ Survey was conducted by telephone. A total of 7 dimensions of culture were measured, before starting the project (2012, n=100) and 3 years later (2015, n=207). Variations between 2012 and the respondents aware of the project in 2015 (RAP) were compared, as also between this last group and the rest of respondents (RNAP). The utility was assessed using a 5-item Likert scale, defining higher utility by medians 4 or higher. RESULTS: The response rates were above 80%. In 2015, the 41.5% of respondents were RAP (95%CI: 34.8-48.3), which was perceived as of high utility. Negative variations were detected in "sense of security" (-9.9%, P<.01, vs. 2012, and -4.2% between 2015 groups) and "feedback and communication errors" (-10.0% vs. 2012, and -8.9% between 2015 groups, P<.05). There was a not-significant positive variation in "openness in communication" (1.3% vs. 2012, and 6.9% between 2015 groups). The "management support" showed a not-significant improve in 2015 (37.0%, 95%CI: 30.9-43.1, in RAP; and 38.3%, 95%CI: 33.1-43.4, in RANP) in comparison to 2012 (31.4%, 95%CI: 28.4-39.7). CONCLUSIONS: A paradoxical worsening is detected in several dimensions, this probably due to immaturity of the organization and the instrument used. Thus, tools explicitly considering the degree of maturity may be more appropriate to measure cultural changes, although more studies are needed.

Validation of the International Metastatic Renal-Cell Carcinoma Database Consortium (IMDC) prognostic model for first-line pazopanib in metastatic renal carcinoma: the Spanish Oncologic Genitourinary Group (SOGUG) SPAZO study.

BACKGROUND: Patients with metastatic renal carcinoma (mRCC) treated with first-line pazopanib were not included in the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) prognostic model. SPAZO (NCT02282579) was a nation-wide retrospective observational study designed to assess the effectiveness and validate the IMDC prognostic model in patients treated with first-line pazopanib in clinical practice. PATIENTS AND METHODS: Data of 278 patients, treated with first-line pazopanib for mRCC in 34 centres in Spain, were locally recorded and externally validated. Mean age was 66 years, there were 68.3% male, 93.5% clear-cell type, 74.8% nephrectomized, and 81.3% had ECOG 0-1. Metastatic sites were: lung 70.9%, lymph node 43.9%, bone 26.3%, soft tissue/skin 20.1%, liver 15.1%, CNS 7.2%, adrenal gland 6.5%, pleura/peritoneum 5.8%, pancreas 5%, and kidney 2.2%. After median follow-up of 23 months, 76.4% had discontinued pazopanib (57.2% due to progression), 47.9% had received second-line targeted therapy, and 48.9% had died. RESULTS: According to IMDC prognostic model, 19.4% had favourable risk (FR), 57.2% intermediate risk (IR), and 23.4% poor risk (PR). No unexpected toxicities were recorded. Response rate was 30.3% (FR: 44%, IR: 30% PR: 17.3%). Median progression-free survival (whole population) was 11 months (32 in FR, 11 in IR, 4 in PR). Median and 2-year overall survival (whole population) were 22 months and 48.1%, respectively (FR: not reached and 81.6%, IR: 22 and 48.7%, PR: 7 and 18.8%). These estimations and their 95% confidence intervals are fully consistent with the outcomes predicted by the IMDC prognostic model. CONCLUSION: Our results validate the IMDC model for first-line pazopanib in mRCC and confirm the effectiveness and safety of this treatment.

Kaposi's sarcoma-associated herpesvirus lana2 protein interacts with the pocket proteins and inhibits their sumoylation.

The pocket proteins retinoblastoma protein (pRb), p107 and p130 are the key targets of oncoproteins expressed by DNA tumor viruses. Some of these viral proteins contain an LXCXE motif that mediates the interaction with the three pocket proteins and the inhibition of the pRb SUMOylation. Kaposi's sarcoma herpesvirus (KSHV) contains at least two proteins that can regulate pRb function but, so far, a KSHV-encoded protein targeting p107 and p130 has not been identified. Here, we show that the KSHV latent protein LANA2 binds to pRb, p107 and p130. LANA2 contains an LXCXE motif that is required for bypassing pRb-mediated cell-cycle arrest and for inhibiting pRb SUMOylation. Finally, we demonstrate that, in addition to pRb, both p107 and p130 can be SUMOylated, and this modification is also inhibited by LANA2 in an LXCXE-dependent manner. These results demonstrate, for the first time, the SUMOylation of p107 or p130 and, so far, they represent the first example of a KSHV protein able to interact with the three pocket proteins and to inhibit their conjugation to SUMO.

Concordancia interobservador en la detección de bocio por palpación en población escolar / Interobserver agreement in detecting goitre by palpation in a school population

Objetivo: Estimar la concordancia interobservador en la detección de bocio por exploración física en población escolar. Metodología: Se realizó un estudio transversal para la detección de bocio en una muestra representativa de 1.134 escolares de 6 a 12 años de 20 colegios del área de salud de La Mancha Centro. La exploración fue realizada de forma enmascarada por 2 únicos observadores. Se establecieron 5 grados de tamaño tiroideo (0, I a, I b, II y III ). Se consideró bocio a partir del grado i a. La concordancia se valoró en relación con variables como edad, sexo, índice de masa corporal, talla y día de exploración. Se utilizó el índice kappa como medida de concordancia. Resultados: En los 1.097 escolares con doble exploración, en 96 (8,8%) se detectó bocio por el observador 1 y en 102 (9,3%) por el 2 (p = 0,58). El grado de acuerdo interobservador en la identificación y en la graduación del bocio fue moderado (kappa 0,55; IC del 95%, 0,46-0,64) para la primera y sustancial (kappa ponderado 0,61; IC del 95%, 0,51-0,71) para la segunda. Fue algo mayor en las niñas y en los escolares de mayor edad, peso, talla e índice de masa corporal. La concordancia entre observadores fue relativamente estable a lo largo de la realización del estudio. Conclusiones: La concordancia interobservador en la detección de bocio por palpación en nuestro estudio es moderada, aunque más baja en los niños más pequeños e invariable durante todo el periodo en el que se realizó (AU)

Objective: To estimate the agreement between observers on the detection of goitre by physical exploration in a school population. Methodology: We performed a cross-sectional study to detect goitre in a representative sample of 1134 schoolchildren aged 6 to 12 years from 20 schools in the health area of La Mancha Centro. The examination was performed blinded by two observers. Five grades in thyroid size were established (0, Ia, Ib, II and III ). Above grade Ia was considered as goitre. The agreement was assessed in relation to variables such as age, sex, body mass index, height, and day of examination. The weighted kappa was used to measure the agreement. Results: In the 1097 schoolchildren with a dual examination, 96 (8.8%) cases of goitre were detected by observer 1, and 102 (9.3%) cases by observer 2, (P=0.58). The degree of interobserver agreement in the identification and grading of goitre was moderate (kappa 0,55, 95%CI: 0,46 to 0,64) for the first, and substantial (weighted kappa 0,61; 95% CI: 0,51 to 0,71) for the second. The degree of agreement was somewhat higher in girls, older schoolchildren, increased weight, height, and body mass index. The interobserver agreement was relatively stable throughout the study. Conclusions: The interobserver agreement in detecting goitre by palpation in our study is moderate, but is lower in younger children and stable for the duration of study (AU)

Función visual sin corrección óptica tras cirugía de cataratas / Uncorrected visual function after cataract surgery

Objetivo: Estudiar la relación entre la refracción tras cirugía de cataratas y el uso de corrección óptica en pacientes mayores de 65 años. Métodos: Estudio retrospectivo tipo casos y controles. Se reclutaron 40 sujetos jubilados mayores de 65 años que cumplieron los criterios de inclusión. Se recogió información clínica y se pidió a los pacientes que completaran un cuestionario validado de función visual (VF14) y otro de independencia de lentes. Se estudió la diferencia entre VF14 con y sin gafas (difVF14). Resultados: La muestra incluye 16 hombres y 24 mujeres, con una edad media de 74 años. Hubo una correlación significativa entre difVF14 y refracción postoperatoria, con menores valores de difVF14 asociados con la refracción posquirúrgica en el rango de −0,50 a −1,00 dioptrías (D) (DE 0,479 [IC95%; 0,286-0,804]). El cuestionario de la independencia de lentes no mostró una correlación significativa con la refracción postoperatoria. Conclusiones: Los pacientes con la refracción posquirúrgica entre −0,50 y −1,00 D mostraron una mejor función visual sin corrección óptica que aquellos con refracción fuera de ese rango. La emetropía a distancia y las lentes positivas para visión cercana pueden no ser el objetivo ideal para todos los pacientes. La refracción posquirúrgica debe ser individualizada para cada paciente de acuerdo a sus preferencias personales con el fin de lograr la mejor función visual y la mejor calidad de vida relacionada con la visión (AU)

Purpose: To study the relationship between refraction after cataract surgery and the use of spectacles in patients older than 65 years. Methods: Retrospective case control study. The study included 40 retired subjects older than 65 years-old who fulfilled our inclusion criteria. Clinical ophthalmic and optical information was collected, and patients were requested to complete a validated questionnaire of visual function (VF14) and a test of independence of spectacles. The difference between VF14 test results with and without glasses (difVF14) was calculated. Results: The study included 16 men and 24 women, with a mean age of 74 years. There was a significant correlation between difVF14 and postoperative refraction, with lower difVF14 values associated with postsurgical refraction in the range −0.50 to −1.00 D (OD 0.479 [95% CI; 0.286-0.804]). The questionnaire of independency of lenses did not show significant correlation with postoperative refraction. Conclusions: Patients with postsurgical refraction between −0.50 and −1.00 diopters displayed better visual function without glasses than those with refraction out of that range. Neutral distant refraction and positive lenses for near vision might not be the ideal solution for every patient. Postsurgical refraction should be individualized for each patient according to their personal preferences, in order to achieve the best visual function and the best vision-related quality of life (AU)

[Uncorrected visual function after cataract surgery]. / Función visual sin corrección óptica tras cirugía de cataratas.

PURPOSE: To study the relationship between refraction after cataract surgery and the use of spectacles in patients older than 65 years. METHODS: Retrospective case control study. The study included 40 retired subjects older than 65 years-old who fulfilled our inclusion criteria. Clinical ophthalmic and optical information was collected, and patients were requested to complete a validated questionnaire of visual function (VF14) and a test of independence of spectacles. The difference between VF14 test results with and without glasses (difVF14) was calculated. RESULTS: The study included 16 men and 24 women, with a mean age of 74 years. There was a significant correlation between difVF14 and postoperative refraction, with lower difVF14 values associated with postsurgical refraction in the range -0.50 to -1.00 D (OD 0.479 [95% CI; 0.286-0.804]). The questionnaire of independency of lenses did not show significant correlation with postoperative refraction. CONCLUSIONS: Patients with postsurgical refraction between -0.50 and -1.00 diopters displayed better visual function without glasses than those with refraction out of that range. Neutral distant refraction and positive lenses for near vision might not be the ideal solution for every patient. Postsurgical refraction should be individualized for each patient according to their personal preferences, in order to achieve the best visual function and the best vision-related quality of life.

Does chronic kidney disease improve the predictive value of the CHADS2 and CHA2DS2-VASc stroke stratification risk scores for atrial fibrillation?

Chronic Kidney Disease (CKD) constitutes an adverse risk factor in chronic anticoagulated atrial fibrillation (AF) patients, being related to adverse cardiovascular events, mortality and major bleeds. It is unclear if CKD adds independent prognostic information to stroke risk stratification schemes, as the risk factor components of the CHADS2 and CHA2DS2-VASc scores are themselves related to renal dysfunction. The aim of our study was to determine if CKD independently improves the predictive value of the CHADS2 and CHA2DS2-VASc stroke stratification scores in AF. We recruited consecutive patients (n=978) patients (49% male; median age 76) with permanent or paroxysmal AF on oral anticoagulants with acenocoumarol, from our out-patient anticoagulation clinic. After a median follow-up of 875 (IQR 706-1059) days, we recorded stroke/transient ischaemic attack (TIA), peripheral embolism, vascular events (acute coronary syndrome, acute heart failure and cardiac death) and all-cause mortality. During follow-up, 113 patients (4.82%/year) experienced an adverse cardiovascular event, of which 39 (1.66%/year) were strokes, 43 (1.83%/year) had an acute coronary syndrome and 32 (1.37%/year) had acute heart failure. Also, 102 patients (4.35%/year) died during the following up, 31 of them (1.32%/year) as a result of a thrombotic event. Based on c-statistics and the integrated discrimination improvement (IDI), CKD did not improve the prediction for stroke/systemic embolism, thrombotic events and all-cause mortality using the CHADS2 and CHA2DS2-VASc scores. In conclusion, evaluating renal function in AF patients is important as CKD would confer a poor overall prognosis in terms of thromboembolic events and all-cause mortality. Adding CKD to the CHADS2 and CHA2DS2-VASc stroke risk scores did not independently add predictive information.

[Interobserver agreement in detecting goitre by palpation in a school population]. / Concordancia interobservador en la detección de bocio por palpación en población escolar.

OBJECTIVE: To estimate the agreement between observers on the detection of goitre by physical exploration in a school population. METHODOLOGY: We performed a cross-sectional study to detect goitre in a representative sample of 1134 schoolchildren aged 6 to 12 years from 20 schools in the health area of La Mancha Centro. The examination was performed blinded by two observers. Five grades in thyroid size were established (0, Ia, Ib, II and III). Above grade Ia was considered as goitre. The agreement was assessed in relation to variables such as age, sex, body mass index, height, and day of examination. The weighted kappa was used to measure the agreement. RESULTS: In the 1097 schoolchildren with a dual examination, 96 (8.8%) cases of goitre were detected by observer 1, and 102 (9.3%) cases by observer 2, (P=.58). The degree of interobserver agreement in the identification and grading of goitre was moderate (kappa 0,55, 95%CI: 0,46 to 0,64) for the first, and substantial (weighted kappa 0,61; 95%CI: 0,51 to 0,71) for the second. The degree of agreement was somewhat higher in girls, older schoolchildren, increased weight, height, and body mass index. The interobserver agreement was relatively stable throughout the study. CONCLUSIONS: The interobserver agreement in detecting goitre by palpation in our study is moderate, but is lower in younger children and stable for the duration of study.

Regulation of the tumor suppressor PTEN by SUMO.

The crucial function of the PTEN tumor suppressor in multiple cellular processes suggests that its activity must be tightly controlled. Both, membrane association and a variety of post-translational modifications, such as acetylation, phosphorylation, and mono- and polyubiquitination, have been reported to regulate PTEN activity. Here, we demonstrated that PTEN is also post-translationally modified by the small ubiquitin-like proteins, small ubiquitin-related modifier 1 (SUMO1) and SUMO2. We identified lysine residue 266 and the major monoubiquitination site 289, both located within the C2 domain required for PTEN membrane association, as SUMO acceptors in PTEN. We demonstrated the existence of a crosstalk between PTEN SUMOylation and ubiquitination, with PTEN-SUMO1 showing a reduced capacity to form covalent interactions with monoubiquitin and accumulation of PTEN-SUMO2 conjugates after inhibition of the proteasome. Moreover, we found that virus infection induces PTEN SUMOylation and favors PTEN localization at the cell membrane. Finally, we demonstrated that SUMOylation contributes to the control of virus infection by PTEN.

Efectos terapéuticos de la hipoterapia en la parálisis cerebral: una revisión sistemática / Therapeutic effects of hippotherapy in cerebral palsy: a systematic review

Objetivo: Revisar la evidencia científica existente respecto al tratamiento de hipoterapia en niños con parálisis cerebral en función de diferentes variables. Métodos Se ha realizado una búsqueda bibliográfica en las bases de datos Pubmed/Medline, Web of Knowledge, Cochrane, PEDro, Enfispo, y en los metabuscadores Trip Data Base y Excelencia clínica. Los términos utilizados en la búsqueda fueron: equine-assisted therapy, cerebral palsy, hippotherapy y horseback riding, combinados generalmente con el operador boleano AND. Resultados Después de eliminar artículos duplicados de las diferentes bases de datos se obtuvieron 25 artículos. Siete de ellos eran revisiones sistemáticas o metaanálisis, 7 eran ensayos clínicos y 11 estudios eran series clínicas no controladas o estudios descriptivos. La calidad de la evidencia científica proporcionada por los estudios utilizados en esta revisión sistemática fue de nivel I para 7 de ellos, de nivel III (evidencia científica proporcionada buena a regular) para otros 7 artículos, y de nivel VIII (evidencia científica proporcionada pobre) para los restantes 11 artículos. Discusión Las principales limitaciones encontradas en los estudios revisados han sido el tamaño muestral reducido, el uso de herramientas de valoración no estandarizadas y/o la heterogeneidad de los protocolos de tratamiento utilizados. Conclusión Resulta difícil encontrar evidencia científica del tratamiento de hipoterapia en niños con parálisis cerebral como consecuencia de diferentes factores, como son los reducidos tamaños muestrales utilizados por los estudios, la diversidad de escalas de valoración y de protocolos de tratamiento utilizados (AU)

Objective: To review the current scientific evidence regarding hippotherapy treatment in children with cerebral palsy through the analysis of different study variables.Methods: A bibliographic research of Pubmed/Medline, Web of Knowledge, Cochrane, PEDro,Enfispo databases and Trip Data Base and Excelencia clínica metasearchers was carried out. The terms used in the search were: Equine-Assisted Therapy, Cerebral Palsy, Hippotherapy and Horseback riding, usually combined with the Boolean operator AND. Results: After eliminating duplicated articles in the different databases, 25 articles were found. Seven of them were systematic reviews or meta-analysis, 7 articles were clinical trials and11 studies were uncontrolled clinical series or descriptive studies. The quality of scientific evidence provided by the studies used in this systematic review was level I for seven of them, level III for seven articles (scientific evidence provided good to regular) and level VIII (scientificevidence provided poor) for the remaining eleven articles. Discussion: The main limitations found in the studies reviewed have been small sample sizes, use of non-standardized assessment tools and/or heterogeneity of the treatment protocolsused. Conclusion: It is difficult to find scientific evidence regarding hippotherapy treatment in children with cerebral palsy due to different factors such as the small sample sizes used in the studies, the diversity of assessment scales and treatment protocols used (AU)