Suicidal behavior in persons attended in out-of-hospital emergency services in Spain.

Background: The aims of this study were to describe the use of health services by patients attended for suicidal behavior by out-of-hospital emergency services and to identify the variables associated with the repetition of this behavior in Spain. Methods: An analytical, observational, retrospective study was carried out. A total of 554 patients attended by the mobile teams of the Primary Care Emergency (mt-PCES) of the Malaga Health District (Spain), after being coordinated by the 061 Emergency Coordination Center (ECC) were analyzed. Results: Of the total, 61.9% of the patients were women and the mean age was 43.5 years. Ninety-six percent (N = 532) of the patients attended by mt-PCES were transferred to hospital emergency services. Regarding clinical decision, of those transferred 436 persons (82%) were discharged home. Of the total sample 25.5% (N = 141) were referred to primary care, while 69% (N = 382) were referred to outpatient mental health care. Regarding follow up in the 6 months after being seen by emergency services, among those referred to a mental health facility, 64.4% (N = 246) attended the follow-up appointment while out of the total sample only 50.5% (N = 280) attended a follow-up appointment with an outpatient mental health service. Finally, it should be noted that 23.3% presented a relapse of suicidal behavior in the 6 months following index episode. The variables associated with repetition of suicidal behavior were older age, greater number of previous suicide attempts and having any contact with mental health services in the following 6 months. Conclusion: We believe that selective suicide prevention initiatives should be designed to target the population at risk of suicide, especially those receiving both out-of-hospital and in-hospital emergency services.

Technology for supporting emotion regulation of individuals with developmental disabilities: A scoping review.

BACKGROUND: Emotional competencies are skills necessary to adequately understand, express, and regulate emotional phenomena. Among the emotional competencies is emotion regulation. Not having adequate development of this emotional competence is related to psychological problems such as depression. One of the characteristics of individuals with developmental disabilities is the presence of difficulties with emotion regulation. These difficulties can affect an individual's autonomy, social competence, and the development of independent life. AIMS: This paper presents a scoping review to identify the technology designed and developed to support the emotion regulation of individuals with developmental disabilities. METHODS AND PROCEDURES: We combined the guidelines for a systematic literature review in computer science and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The process resulted in twelve stages through which we conducted this scoping review. First, a search query was defined and executed in computer science's five most representative search engines. We used different inclusion, exclusion, and quality criteria for selecting the works included in this review. OUTCOMES AND RESULTS: Thirty-nine papers aimed at supporting the emotional competencies of individuals with developmental disabilities were included, of which nine support emotion regulation. As a result, different areas of opportunity in developing technology to support the emotion regulation of individuals with developmental disabilities are discussed. CONCLUSIONS AND IMPLICATIONS: Technology supporting emotion regulation in individuals with developmental disabilities is a growing but little-explored field. For the literature supporting emotion regulation, we detected opportunities for study. Some of them aimed at investigating whether we could use technologies developed for other emotional competencies to support emotion regulation and how the characteristics of this technology can support individuals with developmental disabilities.

Bioaccumulation of CuO nanomaterials in rainbow trout: Influence of exposure route and particle shape.

The bioaccumulation potential of spherical and rod-shaped CuO nanomaterials (NMs) was assessed in rainbow trout (Oncorhynchus mykiss) exposed via water and diet following the OECD Test Guideline No. 305. Fish were exposed via diet to both NMs at concentrations of 70 and 500 mg Cu/kg for 15 days, followed by 44 days of depuration. For water-borne exposure, only the rod-shaped CuO NMs were tested at 0.08 and 0.8 mg Cu/L for 28 days, followed by 14 days of depuration. The concentration of Cu was determined in fish whole body to derive biomagnification and bioconcentration factors (BMF and BCF). Different tissues were sampled to investigate the total Cu biodistribution and target organs as well as the particle number-based bioaccumulation of CuO NMs. Estimated BMF and BCF values were below the thresholds of concern. However, shape and route influenced depuration. Following dietary exposure, there was a higher depuration of Cu from fish exposed to the rod-shaped compared to the spherical CuO NMs. A higher depuration was also observed for rod-shaped CuO NMs following the dietary exposure compared the aqueous one. Despite the much higher dietary exposure concentrations of rod-shape CuO NMs, similar Cu body burdens were reached via water. Cu was found in particulate form in different tissues. Although these NMs had a low bioaccumulation potential, differences in distribution and elimination patterns of Cu were observed depending on the exposure route and particle shape. Careful consideration of the most relevant exposure route is needed when designing a bioaccumulation experiment for testing NMs.

The impact of short-chain fatty acid-producing bacteria of the gut microbiota in hyperuricemia and gout diagnosis.

INTRODUCTION/OBJECTIVES: Persistent hyperuricemia is a key factor in gout; however, only 13.5% of hyperuricemic individuals manifest the disease. The gut microbiota could be one of the many factors underlying this phenomenon. We aimed to assess the difference in taxonomic and predicted functional profiles of the gut microbiota between asymptomatic hyperuricemia (AH) individuals and gout patients. METHODS: The V3-V4 region of the 16S rRNA gene of the gut microbiota of AH individuals, gout patients, and controls was sequenced. Bioinformatic analyses were carried out with QIIME2 and phyloseq to determine the difference in the relative abundance of bacterial genera among the study groups. Tax4fun2 was used to predict the functional profile of the gut microbiota. RESULTS: AH individuals presented a higher abundance of butyrate- and propionate-producing bacteria than gout patients; however, the latter had more bacteria capable of producing acetate. The abundance of Prevotella genus bacteria was not significantly different between the patients but was higher than that in controls. This result was corroborated by the functional profile, in which AH individuals had less pyruvate oxidase abundance than gout patients and less abundance of an enzyme that regulates glutamate synthetase activation than controls. CONCLUSION: We observed a distinctive taxonomic profile in AH individuals characterized by a higher abundance of short-chain fatty acid-producing bacteria in comparison to those observed in gout patients. Furthermore, we provide scientific evidence that indicates that the gut microbiota of AH individuals could provide anti-inflammatory mediators, which prevent the appearance of gout flares. Key Points • AH and gout patients both have a higher abundance of Prevotella genus bacteria than controls. • AH individuals' gut microbiota had more butyrate- and propionate-producing bacteria than gout patients. • The gut microbiome of AH individuals provides anti-inflammatory mediators that could prevent gout flares.

Fractionation of High-Value Compounds from Hops Using an Optimised Sequential Extraction Procedure.

This study describes the development and optimisation of a process for the extraction and fractionation of high-value compounds from hops. Firstly, the efficacy of ten organic solvents was compared for performing the initial solid-liquid extraction of compounds from hop pellets with subsequent fractionation steps. A methanol-dichloromethane mixture was selected and the extraction variables were optimised in order to maximise the recovery of valuable hop compounds separated into different streams (α- and ß-acids in soft resins, xanthohumol in hard resins, and phenolics in spent solids) after fractionation steps. The optimisation results showed that extraction of hop pellets performed at room temperature with 19.7% (v/v) methanol for 89 min yielded recoveries of 86.57% α-acids and 89.14% ß-acids in soft resins, 78.48% xanthohumol in hard resins and 67.10% phenolics in spent solids. These conditions were successfully validated using six hop varieties. Moreover, the antioxidant properties of all recovered fractions were compared and the soft resins showed the highest antioxidant activities, reaching values of 3.91 ± 0.10 g AAE/100 g for ferric reducing power (FRAP) and 0.10 ± 0.01 mg/mL for 50% of radical scavenging activity (EC50). The optimised sequential extraction could serve as a basis for larger scale-up for industrial production.

Cell Immobilization for Erythritol Production.

Nowadays, commercial erythritol synthesis is performed by free-cell fermentation with fungi in liquid media containing high concentrations of pure carbon sources. Alternative fermentation techniques, such as cell immobilization, could imply an economic and energetic improvement for erythritol-producing factories. The present work describes, for the first time, the feasibility of achieving cell immobilization during erythritol production. Cells of the fungus Moniliella pollinis were successfully immobilized on a cotton cloth which was placed inside a 2-L bioreactor, where they were fed with red grape must supplemented with yeast extract. They produced 47.03 ± 6.16 g/L erythritol in 96 h (yield 0.18 ± 0.04 g/g) over four consecutive fermentation batches. The immobilized cells remained stable and operative during a 456 h period. The erythritol concentration attained was similar (p > 0.05; Tukey HSD test) to the reference value obtained with the use of free cells (41.88 ± 5.18 g/L erythritol) under the same fermentation conditions. The comparable results observed for free and immobilized cells evidences the efficiency of the immobilization system. Therefore, the proposed method for erythritol bioproduction eliminates the need for the continuous preparation of fungal inocula before each fermentation batch, thus reducing the costs of the reagents and energy.

Assessment of vine shoots and surplus grape must for succinic acid bioproduction.

Vine shoots and surplus grape must were assessed as feedstocks for succinic acid production with Actinobacillus succinogenes and Basfia succiniproducens. After acidic and enzymatic hydrolysis, vine shoots released 35-40 g/L total sugars. Both bacterial species produced 18-21 g/L succinic acid from this hydrolysate in 120 h. Regarding grape must fermentation, A. succinogenes clearly outperformed B. succiniproducens. Yeast extract (a source of organic nitrogen and vitamins) was the only additional nutrient needed by A. succinogenes to grow on grape must. Under mathematically optimized conditions (145.7 g/L initial sugars and 24.9 g/L yeast extract), A. succinogenes generated 88.9 ± 1.4 g/L succinic acid in 96 h, reaching a succinic acid yield of 0.66 ± 0.01 g/g and a sugar consumption of 96.64 ± 0.30%. Substrate inhibition was not observed in grape musts with 125-150 g/L initial sugars, provided that an adequate amount of yeast extract was available for bacteria. Alternative nitrogen sources to yeast extract (red wine lees, white wine lees, urea, NH4Cl, and choline chloride) were not suitable for A. succinogenes in grape must. KEY POINTS: • Vine shoots and surplus grape must were assessed for succinic acid bioproduction. • Succinic acid bioproduction was 21 g/L with vine shoots and 89 g/L with grape must. • Fermentation was efficient at high sugar loads if organic N supply was adequate.

Severe Quantitative Scale of Acanthosis Nigricans in Neck is Associated with Abdominal Obesity, HOMA-IR, and Hyperlipidemia in Obese Children from Mexico City: A Cross-Sectional Study.

Background: Acanthosis nigricans (AN) is a clinical sign that commonly occurs in obesity; however, its specificity and sensitivity have been controversial. It is unknown if AN severity degree can be a useful marker for cardiometabolic disorders screening. We suggest that the stratified analysis of AN severity degree in neck by Burke's scale could be a useful tool in the screening of cardiometabolic alterations in obese children. Objective: The aim of this study was the association of AN severity degree in neck by Burke's scale with anthropometric, biochemical, and inflammatory parameters in obese school-age children from Mexico City. Methods: A cross-sectional study was conducted, including 95 obese school-age children stratified by AN severity degree in neck by Burke's scale. Anthropometric and fasting biochemical measurements were determined. Variables were compared by x 2 test for frequencies and one-way ANOVA with Bonferroni posttest for continuous variables. Linear regression analysis adjusted by gender, BMI, and age was performed to evaluate the association between AN severity degree and cardiometabolic alterations. Statistical significance was set at p < 0.05. Results: As AN severity degree in neck by Burke's scale increased, diastolic blood pressure (p=0.001) and triglycerides (p=0.02) significantly increased and adiponectin significantly decreased (p=0.02). Positive associations between grade 3 AN and waist circumference, HOMA-IR, triglycerides, total cholesterol, and LDL cholesterol were observed. Conclusion: Our findings could be used to identify an easier clinical tool to prevent obesity progression and its complications in pediatrics. There are no similar studies.

Validity of the classification of emergency service requests related to suicidal behavior / Validez de la clasificación de las demandas por conducta suicida a un servicio de emergencias

Abstract Introduction Suicide attempts are the most predictive risk factor for suicide deaths. Most people who attempt suicide receive care from out-of-hospital Emergency Services (OES), where these requests are managed and classified. Objective Validate the Emergency Coordination Center (ECC) classification for the detection of suicidal behavior requests. Method A descriptive, cross-sectional study of requests to the ECC of Málaga (Spain) during 2013 and 2014 was conducted. To classify the requests, the authors considered the ECC categorization when answering the call and the clinical assessment of the healthcare professional when attending the person who had made the call at the scene, which was considered the reference standard. To analyze the validity of the ECC classification system, sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated. Results The total number of requests for medical assistance analyzed was 112,599. The validity indicators of the classification system for suicidal behavior were sensitivity = 44.78%, specificity = 99.34%, PPV = 46.91% and NPV = 99.28%. Discussion and conclusion The ECC classification system has a lower capacity to detect the presence of suicidal behavior and a higher capacity to identify its absence in the requests received. OES provide key information on suicidal behavior requests as they can be one of the first places people with this problem go to. It would therefore be extremely useful to improve the classification systems for requests related to suicidal behavior.

Resumen Introducción Los intentos de suicidio constituyen el factor de riesgo más predictivo de todos los casos de suicidio consumado. La mayoría de las personas que intentan suicidarse reciben atención en los Servicios de Urgencias Extrahospitalarios (SUE) donde se gestionan y clasifican estas demandas. Objetivo Validar la clasificación del Centro Coordinador de Urgencias y Emergencias (CCUE) para detectar las demandas relacionadas con la conducta suicida. Método Se llevó a cabo un estudio descriptivo y transversal de las demandas al CCUE de Málaga (España) realizadas durante 2013 y 2014. Para su clasificación se tuvo en cuenta la categorización en el CCUE al responder la llamada y el juicio clínico del profesional sanitario cuando atiende al demandante in situ, considerando éste como patrón de referencia. Para evaluar la validez del sistema de clasificación se calcularon la sensibilidad, la especificidad y los valores predictivos positivo (VPP) y negativo (VPN). Resultados El total de demandas sanitarias analizadas fue de 112,599. Los indicadores de validez del sistema de clasificación para las demandas por conductas de suicidio fueron una sensibilidad = 44.78%, especificidad = 99.34%, VPP = 46.91% y VPN = 99.28%. Discusión y conclusión El sistema de clasificación del CCUE presenta una capacidad más baja para detectar presencia de conducta suicida comparada con una capacidad más alta para identificar su ausencia en las demandas recibidas. Los SUE aportan información relevante sobre las demandas por conducta suicida ya que pueden ser uno de los primeros lugares a los que acuden las personas con este problema. Por ello, sería de gran utilidad mejorar los sistemas de clasificación de las demandas por conducta suicida.

Seven-versus 14-day course of antibiotics for the treatment of bloodstream infections by Enterobacterales: a randomized, controlled trial.

OBJECTIVE: To prove that 7-day courses of antibiotics for bloodstream infections caused by members of the Enterobacterales (eBSIs) allow a reduction in patients' exposure to antibiotics while achieving clinical outcomes similar to those of 14-day schemes. METHODS: A randomized trial was performed. Adult patients developing eBSI with appropriate source control were assigned to 7 or 14 days of treatment, and followed 28 days after treatment cessation; treatments could be resumed whenever necessary. The primary endpoint was days of treatment at the end of follow-up. Clinical outcomes included clinical cure, relapse of eBSI and relapse of fever. A superiority margin of 3 days was set for the primary endpoint, and a non-inferiority margin of 10% was set for clinical outcomes. Efficacy and safety were assessed together with a DOOR/RADAR (desirability of outcome ranking and response adjusted for duration of antibiotic risk) analysis. RESULTS: 248 patients were assigned to 7 (n = 119) or 14 (n = 129) days of treatment. In the intention-to-treat analysis, median days of treatment at the end of follow-up were 7 and 14 days (difference 7, 95%CI 7-7). The non-inferiority margin was also met for clinical outcomes, except for relapse of fever (-0.2%, 95%CI -10.4 to 10.1). The DOOR/RADAR showed that 7-day schemes had a 77.7% probability of achieving better results than 14-day treatments. CONCLUSIONS: 7-day schemes allowed a reduction in antibiotic exposure of patients with eBSI while achieving outcomes similar to those of 14-day schemes. The possibility of relapsing fever in a limited number of patients, without relevance to final outcomes, may not be excluded, but was overcome by the benefits of shortening treatments.

Revisiting the production of L( +)-lactic acid from vine shoots: bioconversion improvements by employing thermotolerant bacteria.

Vine shoots (Vitis vinifera L.) constitute an abundant lignocellulosic source which is frequently underutilised. Alkaline and acidic pretreatments (with and without washing steps) were compared and optimised to release fermentable sugars from vine shoots. An acidic pretreatment using 1.72% H2SO4 at 134 °C for 17 min (with 10% w/w solid biomass), followed by an enzymatic hydrolysis, offered the most cost-effective results, releasing 40.21 g/L sugars. Three thermotolerant strains, namely, Bacillus coagulans DSM 2314, Geobacillus stearothermophilus DSM 2313, and G. stearothermophilus DSM 494, were assessed to produce lactic acid from vine-shoot hydrolysates under aerobic and non-sterile conditions, without the need of detoxification steps. In addition, wine lees were satisfactorily employed as nitrogen sources for the fermentation, providing similar results to yeast extract and being the only nutrient added to vine-shoot hydrolysates. Under optimal conditions, B. coagulans DSM 2314 produced 29.21 ± 0.23 g/L lactic acid in 24 h, with a sugar consumption of 98.74 ± 0.07% and a yield of 96.38 ± 0.76%, when supplemented with red wine lees. The purity of the isomer L( +) reached 97.59 ± 1.35% of the total lactic acid produced. Although G. stearothermophilus was able to transform the hexoses from vine-shoot hydrolysates into lactic acid, it proved to be inefficient for metabolising pentoses, thus obtaining lower lactic acid values (16-18 g/L).

Erratum to: Founding mutations explains hotspots of polycystic kidney disease in Southern Spain.

[This corrects the article DOI: 10.1093/ckj/sfaa261.].

Infant feeding, appetite and satiety regulation, and adiposity during infancy: a study design and protocol of the 'MAS-Lactancia' birth cohort.

INTRODUCTION: The prevalence of childhood obesity has risen dramatically in recent years. A proportion of this burden has been attributed to factors that occur during the first 1000 days of life such as genetic predisposition, breast feeding and complementary feeding. Although the mechanisms by which these factors affect weight and adiposity are less well understood, appetite and satiety regulation may be a key to understanding them. This cohort study aims to investigate the role of appetite and satiety regulation as a mediator in the association between infant feeding practices and genetic polymorphisms with children's growth, adiposity and metabolic risk factors. METHODS AND ANALYSIS: 'MAS-Lactancia' (the first word means 'more' and is also an acronym in Spanish for 'Appetite and Satiety Mechanisms', the second word is 'breastfeeding') is an open, ongoing, prospective birth cohort that began the enrolment in 2016 of mother-child pairs affiliated to the Mexican Social Security Institute and that live in the city of Cuernavaca, Mexico. Pregnant women between 16-week and 22-week gestation are followed during the second half of their pregnancies, at birth and throughout their infant's first 48 months of life (at 1 month, 3 months, 6 months, 9 months, 12 months, 18 months, 24 months, 36 months and 48 months) at the clinic and at-home visits that include questionnaires, anthropometric measurements and biospecimen collection. The main exposure variables are infant feeding (breast feeding and complementary feeding) and genetic polymorphisms (fat mass and obesity-associated, leptin and adiponectin genes). Outcome variables include infant's growth, adiposity and metabolic risk factors. We will conduct longitudinal models and path analyses to identify the potential mediating role of satiety and appetite indicators (leptin, adiponectin, insulin concentrations, appetite and satiety perception). ETHICS AND DISSEMINATION: The study protocol, data collection instruments, consent forms and procedures were approved by the institutional review boards of the National Institute of Public Health and the Mexican Social Security Institute in Mexico. Findings will be disseminated through conferences, peer-reviewed publications and meetings with stakeholders.

Founding mutations explains hotspots of polycystic kidney disease in Southern Spain.

Our group identified two pathogenic variants on the PKD1 gene, c.10527_10528delGA and c.7292T>A, from unrelated families. They came from two small counties in Granada, with 61 and 26 autosomal dominant polycystic kidney disease (ADPKD) individuals affected. To determine a common ancestor, healthy and ADPKD individuals from these families were genotyped by analysing four microsatellites located on chromosome 16. Our study identified a common haplotype in all ADPKD individuals. These findings underpin our hypothesis of the founder effect and explain why there is a high frequency of ADPKD in small regions. Determining hotspots of ADPKD will help to better plan healthcare in the future.

Green Strategies of Powdery Mildew Control in Hop: From Organic Products to Nanoscale Carriers.

Humulus lupulus L. is a long-lived, perennial, herbaceous, and dioecious climbing plant. The foremost producers in the European Union are Germany, the Czech Republic, Poland, Slovenia, and Spain. The Spanish cultivated area is concentrated in the province of León. Powdery mildew, caused by Podosphaera macularis, menaces hop production and quality in all hop growing regions located in the Northern hemisphere, colonizing leaves, petioles, inflorescences, and finally cones. In this work, powdery mildew control was monitored, comparing nine fungicide strategies: five organics, two integrated disease management (IDM)-based, with and without Nutragreen® nanoscale carrier, and two conventional treatments (CON) with and without Nutragreen® nanoscale carrier. The organic treatments were able to diminish P. macularis on leaves, but no effect was observed in cones. CON treatments reduced the infection on leaves and cones and increased the cone quantity and quality. Likewise, IDM-based treatments provided satisfactory results as they diminished powdery mildew on leaves and cones. Finally, dose reduction using a Nutragreen® nanoscale carrier showed beneficial effects in the control of powdery mildew compared to the commercial dose. Hence, the use of nanoscale carries permits a 30% reduction in pesticide dose, which optimizes yield and hop quality, reduces risks linked to pesticides, and aids in compliance with public and international policy demands.

Taxonomic variations in the gut microbiome of gout patients with and without tophi might have a functional impact on urate metabolism.

OBJECTIVE: To evaluate the taxonomic composition of the gut microbiome in gout patients with and without tophi formation, and predict bacterial functions that might have an impact on urate metabolism. METHODS: Hypervariable V3-V4 regions of the bacterial 16S rRNA gene from fecal samples of gout patients with and without tophi (n = 33 and n = 25, respectively) were sequenced and compared to fecal samples from 53 healthy controls. We explored predictive functional profiles using bioinformatics in order to identify differences in taxonomy and metabolic pathways. RESULTS: We identified a microbiome characterized by the lowest richness and a higher abundance of Phascolarctobacterium, Bacteroides, Akkermansia, and Ruminococcus_gnavus_group genera in patients with gout without tophi when compared to controls. The Proteobacteria phylum and the Escherichia-Shigella genus were more abundant in patients with tophaceous gout than in controls. Fold change analysis detected nine genera enriched in healthy controls compared to gout groups (Bifidobacterium, Butyricicoccus, Oscillobacter, Ruminococcaceae_UCG_010, Lachnospiraceae_ND2007_group, Haemophilus, Ruminococcus_1, Clostridium_sensu_stricto_1, and Ruminococcaceae_UGC_013). We found that the core microbiota of both gout groups shared Bacteroides caccae, Bacteroides stercoris ATCC 43183, and Bacteroides coprocola DSM 17136. These bacteria might perform functions linked to one-carbon metabolism, nucleotide binding, amino acid biosynthesis, and purine biosynthesis. Finally, we observed differences in key bacterial enzymes involved in urate synthesis, degradation, and elimination. CONCLUSION: Our findings revealed that taxonomic variations in the gut microbiome of gout patients with and without tophi might have a functional impact on urate metabolism.

Nueva mutación asociada a poliquistosis renal autosómica dominante con efecto fundador localizada en la Alpujarra de Granada / New mutation associated with autosomal dominant polycystic kidney disease with founder effect located in the alpujarra region of granada

OBJETIVO: Demostrar que la variante no descrita en el gen PKD1 c.7292T>A, identificada en cuatro familias de la comarca de la Alpujarra de Granada, es la causante de la poliquistosis renal autosómica dominante (PQRAD). Esta variante consiste en una sustitución transversión de timina (T) por adenina (A) que a nivel de la proteína policistina 1 produce un cambio de leucina (Leu/L) por glutamina (Gln/Q) en la posición 2431 (p.Leu2431Gln). MÉTODO: Registramos variables sociodemográficas y clínicas a través de la realización de historias clínicas, árboles genealógicos, ecografías y estudios genéticos a individuos afectos y sanos pertenecientes a estas familias en el contexto del estudio de segregación. RESULTADOS: Todos los individuos afectados portaban en heterocigosis la variante c.7292T>A, mientras que los individuos sanos no la portaron. En las familias estudiadas, el 62,9% eran mujeres. El diagnóstico de PQRAD se realizó a los 29,3 ± 15,82 años de edad, después de haber tenido el primer hijo en el 64,8%. Los motivos principales de diagnóstico de la enfermedad fueron antecedentes familiares y episodios de hematuria. El inicio de tratamiento renal sustitutivo (TRS) se produjo a la edad de 55,8 ± 7,62 años (rango 44-67), y el éxitus a los 63 ± 92,2 años (rango 48-76), siendo la causa desconocida, cardiovascular e insuficiencia renal las más frecuentes; la mediana de supervivencia renal se estableció a los 58,5 ± 0,77 años y la mediana de supervivencia del paciente a los 67 ± 3,54 años. No observamos diferencias en la supervivencia del riñón y del paciente según el sexo. De los pacientes fallecidos, el 52,2% necesitaron TRS y el 94,4% tenían algún grado de insuficiencia renal (IR). CONCLUSIONES: La variante c.7292T>A en el gen PKD1 es responsable de la enfermedad y su distribución en la comarca de la Alpujarra de Granada sugiere un efecto fundador. En la PQRAD es necesario realizar estudios de segregación que ayuden a reclasificar variantes genéticas, en este caso de indeterminada a patogénica

OBJECTIVE: To demonstrate that the variant not described in PKD1 gene c.7292T> A, identified in four families from the Alpujarra in Granada, is the cause of autosomal dominant polycystic kidney disease (ADPKD). This variant consists of a transversion of thymine (T) by adenine (A) that at the level of the Polycystin 1 protein produces a change of leucine (Leu / L) by Glutamine (Gln / Q) in position 2431 (p.Leu2431Gln). METHOD: Sociodemographic and clinical variables were registered using clinical histories, genealogical trees, ultrasounds and genetic analysis to ADPKD and healthy individuals belonging to these families in the context of segregation study. RESULTS: All PKD individuals carried the c.7292T>A variant in heterozygosis, whereas healthy ones did not. Among all ADPKD patients, 62.9% were women. ADPKD diagnosis was made at 29.3 ± 15.82 years, after having the first child in 64.8%. The main reasons for diagnosis were family history and hematuria episodes. The onset of renal replacement therapy (RRT) occurred at 55.8 ± 7.62 years (range 44-67), and death at 63 ± 92.2 years (range 48-76), being the cause unknown, cardiovascular and insufficiency kidney the most frequent; the median of renal survival was established at 58.5 ± 0.77 years and the median survival of patients at 67.2 ± 3.54 years. No differences in kidney and patient survivals were observed according to sex. Among deceased patients, 52.2% required RRT and 94.4% suffered from renal failure. CONCLUSIONS: The variant c.7292T>A in PKD1 gene is responsible for the disease, and its distribution in the Alpujarra region of Granada suggests a founder effect. In ADPKD it is necessary to perform segregation studies that help us to reclassify genetic variants, in this case from indeterminate to pathogenic

Práctica avanzada de la enfermera en urgencias extrahospitalarias y comparación con la casuística atendida por equipos con médicos / Advanced practice of the nurse in out-of-hospital emergencies and comparison with the casuistry attended by teams with doctors

OBJETIVO: Explorar la práctica enfermera en urgencias extrahospitalarias y comparar su casuística con la de equipos con médico presencial. METODOLOGÍA: Estudio transversal, con pacientes del Distrito Málaga atendidos por una enfermera (2012-2016) y por 6 equipos con médico presencial (2012). VARIABLES: prioridad, motivo de asistencia, diag-nósticos enfermeros, medicamentos y derivación. Estadística descriptiva e inferencial multivariante. RESULTADOS: La enfermera atendió 2253 pacientes. Los equipos con méicos atendieron 21226, presentando patologías similares el 34,8%. Motivos de asistencia: cérvico-dorso-lumbo-ciatalgia (12,6%), mareos/vértigo (9.6%), sin patología urgente (9,2%), etc. El 63,9% de pacientes precisó medicación: diazepam (19,3%), metoclopramida (13,6%), metamizol (12,5%), etc. El manejo del tratamiento y de dispositivos sanitarios, junto al afrontamiento de problemas se asociaron a los motivos de asistencia. El 92% de avisos fueron resueltos in situ. CONCLUSIÓN: La enfermera es una opción muy eficiente para la atención compartida de la demanda, aún con la legalización de la prescripción de medicamentos pendiente

OBJECTIVE: To explore prehospital emergency nursing and to compare the case-mix attended with prehospital medical teams. METHODS: Cross-sectional study, including patients from Málaga District attended by a prehospital nurse (2012 - 2016), and by prehospital medical teams (2012). MAIN VARIABLES: priority, cause of the demand, nursing diagnosis, medication and referral. Descriptive and multiple inferencial analyses. RESULTS: The nurse attended 2253 patients. Medical teams attended 21226 patients, and 34.8% presented similar pathologies. Case-mix: Cervical-back-sciatica pain (12.6%), dizziness/vertigo (9.6%), no urgent pathology (9.2%), etc. 63.9% of patients needed medication: Diazepam (19.3%), metoclopramida (13.6%), metamizol (12.5%), etc. Management of medication or healthcare devices, and problem coping were usually associated to assistance demands. 92% of demands were resolved in situ. CONCLUSIONS: The emergency nurse turns out to be an efficient choice for sharing prehospital demands, even with nursing prescription not yet legalized

Bovine Interferon-Tau Activates Type I interferon-Associated Janus-signal Transducer in HPV16-positive Tumor Cell.

The mechanisms of signal transduction by interferon-tau (IFN-τ) are widely known during the gestation of ruminants. In trophoblast cells, IFN-τ involves the activation of the JAK-STAT pathway, and it can have effects on other cell types, such as tumor cells. Here we report that the HPV16-positive BMK-16/myc cell treated with ovine IFN-τ, results in the activation of the canonical JAK-STAT and non-canonical JAK-STAT pathway. The MAPK signaling pathway was activated, we detected the proteins MEK1, MEK2, Raf1, STAT3, STA4, STAT5 and STAT6. Moreover, IFN-τ induced the expression of MHC Class I, MX and IP10 in the tumor cells and this response may be associated with the viral replication and with the anti-proliferative and the immunoregulatory effects of IFN-τ.

New mutation associated with autosomal dominant polycystic kidney disease with founder effect located in the alpujarra region of granada. / Nueva mutación asociada a poliquistosis renal autosómica dominante con efecto fundador localizada en la Alpujarra de Granada.

OBJECTIVE: To demonstrate that the variant not described in PKD1 gene c.7292T> A, identified in four families from the Alpujarra in Granada, is the cause of autosomal dominant polycystic kidney disease (ADPKD). This variant consists of a transversion of thymine (T) by adenine (A) that at the level of the Polycystin 1 protein produces a change of leucine (Leu / L) by Glutamine (Gln / Q) in position 2431 (p.Leu2431Gln). METHOD: Sociodemographic and clinical variables were registered using clinical histories, genealogical trees, ultrasounds and genetic analysis to ADPKD and healthy individuals belonging to these families in the context of segregation study. RESULTS: All PKD individuals carried the c.7292T>A variant in heterozygosis, whereas healthy ones did not. Among all ADPKD patients, 62.9% were women. ADPKD diagnosis was made at 29.3 ± 15.82 years, after having the first child in 64.8%. The main reasons for diagnosis were family history and hematuria episodes. The onset of renal replacement therapy (RRT) occurred at 55.8 ± 7.62 years (range 44-67), and death at 63 ± 92.2 years (range 48-76), being the cause unknown, cardiovascular and insufficiency kidney the most frequent; the median of renal survival was established at 58.5 ± 0.77 years and the median survival of patients at 67.2 ± 3.54 years. No differences in kidney and patient survivals were observed according to sex. Among deceased patients, 52.2% required RRT and 94.4% suffered from renal failure. CONCLUSIONS: The variant c.7292T>A in PKD1 gene is responsible for the disease, and its distribution in the Alpujarra region of Granada suggests a founder effect. In ADPKD it is necessary to perform segregation studies that help us to reclassify genetic variants, in this case from indeterminate to pathogenic.