Macrophages direct cancer cells through a LOXL2-mediated metastatic cascade in pancreatic ductal adenocarcinoma.

OBJECTIVE: The lysyl oxidase-like protein 2 (LOXL2) contributes to tumour progression and metastasis in different tumour entities, but its role in pancreatic ductal adenocarcinoma (PDAC) has not been evaluated in immunocompetent in vivo PDAC models. DESIGN: Towards this end, we used PDAC patient data sets, patient-derived xenograft in vivo and in vitro models, and four conditional genetically-engineered mouse models (GEMMS) to dissect the role of LOXL2 in PDAC. For GEMM-based studies, K-Ras +/LSL-G12D;Trp53 LSL-R172H;Pdx1-Cre mice (KPC) and the K-Ras +/LSL-G12D;Pdx1-Cre mice (KC) were crossed with Loxl2 allele floxed mice (Loxl2Exon2 fl/fl) or conditional Loxl2 overexpressing mice (R26Loxl2 KI/KI) to generate KPCL2KO or KCL2KO and KPCL2KI or KCL2KI mice, which were used to study overall survival; tumour incidence, burden and differentiation; metastases; epithelial to mesenchymal transition (EMT); stemness and extracellular collagen matrix (ECM) organisation. RESULTS: Using these PDAC mouse models, we show that while Loxl2 ablation had little effect on primary tumour development and growth, its loss significantly decreased metastasis and increased overall survival. We attribute this effect to non-cell autonomous factors, primarily ECM remodelling. Loxl2 overexpression, on the other hand, promoted primary and metastatic tumour growth and decreased overall survival, which could be linked to increased EMT and stemness. We also identified tumour-associated macrophage-secreted oncostatin M (OSM) as an inducer of LOXL2 expression, and show that targeting macrophages in vivo affects Osm and Loxl2 expression and collagen fibre alignment. CONCLUSION: Taken together, our findings establish novel pathophysiological roles and functions for LOXL2 in PDAC, which could be potentially exploited to treat metastatic disease.

Pessary with perineal suture for treatment of pelvic organ prolapse: description and benefit of the technique.

INTRODUCTION AND HYPOTHESIS: Vaginal pessaries are used as a conservative treatment for POP in women who do not want or are not candidates for surgery, or as a preliminary step to surgery. Our goals are: evaluate the evolution of patients with advanced POP and repeated expulsion of the pessary, who underwent perineal suture to try to maintain the device. Describe the epidemiological characteristics of patients treated with pessaries in our environment, with or without perineal closure. METHODS: Observational, descriptive and prospective study (October 2016-March 2021) that includes 352 women with advanced-stage POP treated with a pessary, of which 55, after repeated expulsion of the pessary, were treated with a pessary and perineal suture. RESULTS: After pessary insertion associated with perineal closure, 26 patients (47.2%) expelled the pessary and underwent surgery, and 29 (52.8%) kept the device, avoiding surgery. Regarding the women who required perineal suture: The mean age was higher than in the group of patients who did not need this intervention (75.3 vs. 68.3 years), 94.5% had POP ≥ grade III and 100% had a perineal width > 2.5 cm. CONCLUSIONS: Treatment with pessary and perineal closure avoids surgery in women with advanced age and repeated expulsion. Although age should not be an independent factor that limits surgical treatment or the type of intervention, it would be useful to have scales to quantify the frailty of patients, being able to standardize perineal closure in elderly and/or frail women, and in those who do not want or have contraindications for surgery.

Initial management of hydatidiform mole

Introduction: Hydatidiform mole is a type of gestational trophoblastic disease that results from the abnormal fertilization of an oocyte and causes nonspecific symptoms such as amenorrhea, metrorrhagia, and enlarged uterus. Although rare, its most characteristic symptoms include hyperemesis, early-onset pre-eclampsia, anemia, and respiratory distress. Case presentation: A 47-year-old Moroccan woman consulted the emergency department of the Hospital Clínico Universitario in Valladolid (Spain) after a month of persistent coughing and emesis. The patient reported epigastralgia and amenorrhoea for two months, as well as scant vaginal bleeding two days prior to consultation. Taking into account that the patient tested positive for pregnancy, that a heterogeneous intrauterine mass measuring 124x120mm was observed on transvaginal ultrasound, that no abnormal findings were reported on Doppler ultrasound, and that her serum ßhCG levels reached a value of 772.110 mIU/mL, a diagnosis of hydatidiform mole was suspected. Once informed about the possible therapeutic options, the patient decided to undergo a total hysterectomy, as she stated that she had already fulfilled her desire to be a mother. After the procedure, the patient's clinical condition improved, and the pathology report of the mass confirmed the diagnosis of partial hydatidiform mole. Conclusion: Early diagnosis of hydatidiform mole is paramount in order to provide adequate treatment and improve the prognosis of these patients. Therefore, despite its low incidence and non-specific clinical manifestations, it should be considered as a differential diagnosis for first-trimester metrorrhagia.

Introducción. La mola hidatiforme es un tipo de enfermedad trofoblástica gestacional que se presenta como resultado de la fertilización anormal de un ovocito y que ocasiona síntomas inespecíficos como amenorrea, metrorragia y aumento del tamaño del útero. Aunque infrecuentes, sus síntomas más característicos incluyen hiperémesis, preeclampsia de inicio temprano, anemia y distrés respiratorio. Presentación del caso. Mujer marroquí de 47 años que consultó al servicio de urgencias del Hospital Clínico Universitario de Valladolid debido a que había presentado tos y vómitos por un mes. La paciente refirió haber sufrido epigastralgia y amenorrea por dos meses, así como escaso sangrado vaginal en los últimos dos días. Teniendo en cuenta que la paciente dio positivo en una prueba de embarazo, que en la ecografía transvaginal se observó una masa intrauterina heterogénea de 124x120mm, que no se reportaron hallazgos anormales en la ecografía Doppler y que sus niveles séricos de ßhCG alcanzaron un valor de 772.110 mUI/mL, se sospechó un diagnóstico de mola hidatiforme. Una vez informada sobre las posibles alternativas terapéuticas, la paciente decidió someterse a una histerectomía total, pues refirió que ya había cumplido su deseo de ser madre. Luego de realizar procedimiento, la condición clínica de la paciente mejoró; además, el informe de patología de la masa permitió confirmar el diagnóstico de mola hidatiforme parcial. Conclusiones. El diagnóstico temprano de la mola hidatiforme es de gran importancia para ofrecer un tratamiento adecuado y, de esta forma, mejorar el pronóstico de estas pacientes. Por tanto, a pesar de su baja incidencia y sus manifestaciones clínicas inespecíficas, se debe considerar como diagnóstico diferencial de las metrorragias del primer trimestre.

Platos olvidados o de consumo ocasional en la gastronomía española: Comunidad Valenciana / Forgotten dishes or occasional consumption in Spanish gastronomy: Valencian Community

La gastronomía de la Comunidad Valenciana está protagonizada por productos característicos de la Costa Mediterránea, productos del mar, de la huerta y de montaña. Existen importantes diferencias entre la cocina de las zonas costeras, donde los productos del mar y la verdura tienen mucho protagonismo, y la de interior, más rústica y con mayor importancia de los productos cárnicos. Sin embargo, ambas zonas tienen en común el empleo del arroz, cultivado desde la época musulmana en tierras valencianas. Es muy apreciado y usado en infinidad de platos, el más conocido a nivel internacional, la paella valenciana. Arroz de Valencia, alcachofa de Benicarló, el aceite de oliva valenciano, el níspero de Callosa, el turrón de Xixona o la xufa (entre otros), con la que se prepara la bebida más tradicional, la horchata de chufa son algunos productos característicos, sin olvidar los cítricos valencianos (limones, naranjas y mandarinas). (AU)

The products in the gastronomy of the Valencian Community are those products characteristic of the Mediterranean Coast, products from the sea, from theorchard and from the mountains. There are important differences between the cuisine of the coastal areas, where seafood and vegetables play a major role, and that of the interior, more rustic and with greater importance of meat products. However, both areas have in common the use of rice, cultivated since Muslim times in Valencian lands. It ishighly appreciated and used in countless dishes, the best known internationally, the Valencian paella. Rice from Valencia, artichoke from Benicarló, Valencian olive oil, loquat from Callosa, nougat from Xixona or xufa (among others), with which the most traditional drinkis prepared, tiger nut horchata, are some characteristic products, without forgetting the Valencian citrus fruits (lemons, oranges, and tangerines). (AU)

Substance Use and Addictive Behavior in Spanish Adolescents in Secondary School.

The detection and prevention of addictive behaviour at an early age is essential given the relationship between the age of the onset of consumption and the appearance of addiction disorders. The aim of this study was to describe the behavior related to substance use and addictive behaviors in adolescents at secondary school from 12 to 16 years of age. A cross-sectional descriptive study has been conducted. The prevalence of consumption of different addictive substances (alcohol, tobacco, cannabis, cocaine) and addictive behaviours (use of social networks and video games) were collated, and the influence of the surrounding social environment and risk perception were evaluated. The final sample was 1298 students. Alcohol, tobacco and cannabis use reflect the prevalence of last month's consumption: 14% (11.8-15.6), 15% (13.4-17.4) and 3% (1.9-2.7) respectively. 76% of the sample frequently use the Internet (5-7 days per week). There is a positive association between the frequency of use and use in the immediate environment. The relationships found show the need for educational and preventive intervention aimed at parents and students that will allow them to know and effectively deal with possible problems associated with the consumption of addictive substances.

Real-World Data and Machine Learning to Predict Cardiac Amyloidosis.

(1) Background: Cardiac amyloidosis or "stiff heart syndrome" is a rare condition that occurs when amyloid deposits occupy the heart muscle. Many patients suffer from it and fail to receive a timely diagnosis mainly because the disease is a rare form of restrictive cardiomyopathy that is difficult to diagnose, often associated with a poor prognosis. This research analyses the characteristics of this pathology and proposes a statistical learning algorithm that helps to detect the disease. (2) Methods: The hospitalization clinical (medical and nursing ones) records used for this study are the basis of the learning and training techniques of the algorithm. The approach consisted of using the information generated by the patients in each admission and discharge episode and treating it as data vectors to facilitate their aggregation. The large volume of clinical histories implied a high dimensionality of the data, and the lack of diagnosis led to a severe class imbalance caused by the low prevalence of the disease. (3) Results: Although there are few patients with amyloidosis in this study, the proposed approach demonstrates that it is possible to learn from clinical records despite the lack of data. In the validation phase, the algorithm first acted on data from the general study population. It then was applied to a sample of patients diagnosed with heart failure. The results revealed that the algorithm detects disease when data vectors profile each disease episode. (4) Conclusions: The prediction levels showed that this technique could be useful in screening processes on a specific population to detect the disease.

Optimization of roasting conditions in hydroSOStainable almonds using volatile and descriptive sensory profiles and consumer acceptance.

HydroSOStainable almonds are harvested from trees cultivated under controlled water stress by using a regulated deficit irrigation (RDI) strategy. The aim of this study was to investigate consumers' perception to select the best roasting temperature for the hydroSOStainable almonds and its correlation with volatile compounds, descriptive sensory attributes, instrumental color, and texture. Thirty-five volatile compounds were identified and the key compounds for the roasting process were 2,5-dimethylpyrazine, furfural, and trimethyl pyrazine. Pyrazines, furans and, in general, volatiles were higher in hydroSOStainable almonds than in control. Instrumental color and trained panel showed that almonds roasted at 190 °C presented intense color and burnt notes in both irrigation treatments, while almonds roasted at 150 °C were under-roasted. Principal component analysis (PCA) grouped together the samples of the same irrigation treatment, but separated samples roasted at different temperatures. Partial least square regression (PLS) results indicated that consumers overall liking was positively linked to specific volatiles (alkanes, alcohols, aldehydes, and furans) and sensory attributes (sweetness, roasted, almond ID, nutty, hardness, and crispiness), but, negatively correlated with pyrazines, bitterness, astringency, woody, and burnt flavor notes. Penalty analysis showed that almonds roasted at 150 and 190 °C were penalized due to low roasted aroma and soft almonds, and over-roasted samples with too intense color and burn notes, respectively. While no penalization being found for almonds roasted at 170 °C. Overall, roasting at 170 °C for 10 min in a convective oven were the optimum conditions for roasting Vairo almonds. PRACTICAL APPLICATION: This research describes the link between physicochemical and sensory analysis of roasted almonds giving evidence about possible sensory quality markers. Besides, it provides valuable information for the food industry to produce roasted almonds that meet consumer demands and for the agricultural sector by encouraging reduction of irrigation water consumption by almond trees.

How a Spanish Group of Millennial Generation Perceives the Commercial Novel Smoothies?

The World Health Organization (WHO) and the Food and Agriculture Organization of the United Nations (FAO) constantly emphasize the importance of increasing fruit and vegetable consumption; these natural products help in the prevention of major diseases. Smoothies are a simple and convenient way of doing so; thus, their demand is constantly growing and their market is becoming important for the food industry. Therefore, the objective of this research was to determine Millennial consumer opinion towards novel fruit- and vegetable-smoothies available on the retail market. Napping®, descriptive sensory analysis, and consumer studies were conducted. Napping® results group samples into four clusters of smoothies; the main grouping factor was the type of fruit and the percentage of vegetables. Penalty analysis showed that smoothies need improvement mainly dealing with sweetness, bitterness, and vegetable flavors. Millennial consumers formed a homogeneous sensory group in which the overall liking was negatively correlated with the level of sweetness, and earthy, carrot, beetroot, and pear flavors. The key liking drivers were sourness and notes of mango, banana, and peach flavors. This research is a new insight into the perception of smoothies, provides comprehensive knowledge for the food industry, and can guide the design of new healthy smoothies.

Applying Lean in Process Innovation in Healthcare: The Case of Hip Fracture.

Academic literature and practitioners acknowledge that there is a need to improve efficiency and service quality in the healthcare industry. In Spain, osteoporotic fractures represent a great cost in socio-economic and morbi-mortality terms, hip fracture being the surgical pathology with the second highest consumption of resources. The research questions that govern this study concern the use of Lean principles to identify waste, and an evaluation of the application of an innovative approach in the hip fracture surgery process. A research design based on a case study and action research was developed. Findings relate to (i) the identification of the main types of waste or muda (being the most frequent delay, transportation, over-processing and defects); (ii) the analysis of existing processes based on a Lean approach (identifying opportunities for improvement as a reduction of the number of steps and participants, improving communication, automation, standardization, etc.); and (iii) the application of an innovative process based on the Lean approach and action research in the healthcare industry. This research provides insights for academia, practitioners, management, and society: waste identification and process redesign helps to continue the improvement of operations, increase efficiency, reduce costs, and enhance services, providing benefits to patients, families, hospital employees, and the healthcare system.

Indomethacin for intracranial hypertension secondary to severe traumatic brain injury in adults.

BACKGROUND: Among people who have suffered a traumatic brain injury, increased intracranial pressure continues to be a major cause of early death; it is estimated that about 11 people per 100 with traumatic brain injury die. Indomethacin (also known as indometacin) is a powerful cerebral vasoconstrictor that can reduce intracranial pressure and, ultimately, restore cerebral perfusion and oxygenation. Thus, indomethacin may improve the recovery of a person with traumatic brain injury. OBJECTIVES: To assess the effects of indomethacin for adults with severe traumatic brain injury. SEARCH METHODS: We ran the searches from inception to 23 August 2019. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 8) in the Cochrane Library, Ovid MEDLINE, Ovid Embase, CINAHL Plus (EBSCO), four other databases, and clinical trials registries. We also screened reference lists and conference abstracts, and contacted experts in the field. SELECTION CRITERIA: Our search criteria included randomised controlled trials (RCTs) that compared indomethacin with any control in adults presenting with severe traumatic brain injury associated with elevated intracranial pressure, with no previous decompressive surgery. DATA COLLECTION AND ANALYSIS: Two review authors independently decided on the selection of the studies. We followed standard Cochrane methods. MAIN RESULTS: We identified no eligible studies for this review, either completed or ongoing. AUTHORS' CONCLUSIONS: We found no studies, either completed or ongoing, that assessed the effects of indomethacin in controlling intracranial hypertension secondary to severe traumatic brain injury. Thus, we cannot draw any conclusions about the effects of indomethacin on intracranial pressure, mortality rates, quality of life, disability or adverse effects. This absence of evidence should not be interpreted as evidence of no effect for indomethacin in controlling intracranial hypertension secondary to severe traumatic brain injury. It means that we have not identified eligible research for this review.

Efectividad de la realidad virtual en la rehabilitación del miembro superior en la lesión de la médula espinal. Revisión sistemática / Effectiveness of the virtual reality in the rehabilitation of the upper limb in the spinal cord injury. A systematic review

Introducción. La lesión de la médula espinal es un estado funcional complejo que limita gravemente la vida de la persona. Por ello, la recuperación de la funcionalidad del miembro superior en la tetraplejía se considera un objetivo primordial, ya que mejora significativamente la calidad de vida de estas personas. Además de las terapias convencionales, la realidad virtual supone un nuevo enfoque terapéutico en la rehabilitación del lesionado medular. Objetivo. Realizar una revisión sistemática sobre la efectividad de la rehabilitación del miembro superior en pacientes con lesión medular a través de la realidad virtual. Pacientes y métodos. Se recopilaron datos de ensayos clínicos hasta abril de 2018 que investigaran la rehabilitación con sistemas de realidad virtual en los miembros superiores de pacientes con lesión medular completa e incompleta. Las bases de datos consultadas en esta revisión incluyeron: Scopus, Web of Science, PubMed, Medline Complete, Science Direct, CINHAL y Brain. Resultados. Se analizaron cinco artículos, los cuales incluyeron ensayos controlados aleatorizados y ensayos clínicos. Los principales resultados de los estudios muestran buena tendencia de la rehabilitación a través de la realidad virtual en combinación con terapia convencional. Conclusiones. Las limitaciones encontradas en los estudios, así como su baja calidad metodológica, suponen la necesidad de mayores investigaciones acerca de la efectividad de esta nueva herramienta. Aun así, la buena tendencia de los estudios se considera de interés para futuras investigaciones

Introduction. Spinal cord injury is a complex and life-disrupting condition. The functional recovery of the upper limb has been considered as an important objective in tetraplegia because it improves significantly the quality of living in these patients. Virtual reality is a new emerging tool of rehabilitation in spinal cord injured patients. Aim. To carry out a systematic review about the information about the application of these systems in spinal cord injury in the rehabilitation of the upper limb. Patients and methods. This review includes clinical trials dated until April 2018, which investigate the functional recovery of the upper limb through virtual reality systems in patients with complete or incomplete tetraplegia. The following databases were used to search for those clinical trials: Scopus, Web of Science, PubMed, Medline Complete, Science Direct, CINHAL and Brain. Results. Five articles were selected for this review, including randomized clinical trials and clinical trials. The main results show a good tendency on the functional recovery with the combination of virtual reality systems and conventional therapy. Conclusions. The main limitations and the low quality of the studies show the necessity of further investigations with this new tool of rehabilitation. However, the incorporation of virtual reality systems as a rehabilitation supplement might be a beneficial tool on the functional recovery in spinal cord injury

El dolor de cóccix en la mujer tras el parto / Coccyx pain in women after childbirth

El cóccix es un hueso con morfología y movilidad propia y puede presentar dolor por causas traumáticas como el parto dificultoso o con terminación instrumental. Sufrir coccidinia puede imposibilitar la realización de las actividades de la vida diaria y afectar desde la esfera física hasta el área psicosocial, dando gran morbilidad a la puérpera. El presente artículo resalta los factores que predisponen a la puérpera a sufrir coccigodinia y qué acciones realizar para su alivio y mejora. La coccidinia posparto es el dolor que aparece tan pronto se adopta posición sentada tras el parto. Son factores de riesgo la morfología del cóccix, el índice de masa corporal, el parto vaginal, el parto instrumental, multiparidad, sexo femenino, edad madura y con periné corto en mujer con parto difícil. Entre las actividades para mejorar el dolor se encuentran los analgésicos y coadyuvantes, la rehabilitación y el masaje del suelo pélvico, las infiltraciones, la psicoterapia y, por último, la cirugía

The coccyx is a bone with its own morphology and mobility and pain can occur due to trauma such as a difficult or instrumental delivery. Coccydynia can make it impossible to carry out the activities of daily life, its affects can be both physical and psychosocial, and causes great maternal morbidity. This article highlights the factors that predispose women to coccydynia and actions to relieve and improve it. Postpartum coccydynia is pain that appears as soon as a sitting position is adopted after delivery. Coccyx morphology, body mass index, vaginal delivery, instrumental delivery, multiparity, female sex, mature age and short perineum in women with difficult delivery are risk factors. The activities to improve pain begin with analgesia and coadjuvants, rehabilitation and pelvic floor massage, infiltrations, psychotherapy or, finally, surgery

Successful management of anemia with sirolimus in blue rubber bleb nevus syndrome: update

Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder with characteristic skin hemangiomas and vascular malformations, mostly in the gastrointestinal (GI) tract. The GI lesions are mainly located in the stomach and small intestine, usually more than a hundred, leading to gastrointestinal bleeding and severe chronic anemia. Parenteral iron infusions and scheduled transfusions are frequently necessary. We describe the case of a 21-year-old male with anemia secondary to BRBNS, who becomes unresponsive to octreotide and shows an excellent response to sirolimus (SRL), dismissing the intravenous iron supplementations and being free of transfusions. During the treatment, the patient presents avascular hip necrosis, which is adequately treated with an injection of stem cells with complete recovery, and without the suspension of SRL. Two years later, adequate response persists with no other relevant side effects

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Successful management of anemia with sirolimus in blue rubber bleb nevus syndrome: case report and update.

Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder with characteristic skin hemangiomas and vascular malformations, mostly in the gastrointestinal (GI) tract. The GI lesions are mainly located in the stomach and small intestine, usually more than a hundred, leading to gastrointestinal bleeding and severe chronic anemia. Parenteral iron infusions and scheduled transfusions are frequently necessary. We describe the case of a 21-year-old male with anemia secondary to BRBNS, who becomes unresponsive to octreotide and shows an excellent response to sirolimus (SRL), dismissing the intravenous iron supplementations and being free of transfusions. During the treatment, the patient presents avascular hip necrosis, which is adequately treated with an injection of stem cells with complete recovery, and without the suspension of SRL. Two years later, adequate response persists with no other relevant side effects.

Coccyx pain in women after childbirth. / El dolor de cóccix en la mujer tras el parto.

The coccyx is a bone with its own morphology and mobility and pain can occur due to trauma such as a difficult or instrumental delivery. Coccydynia can make it impossible to carry out the activities of daily life, its affects can be both physical and psychosocial, and causes great maternal morbidity. This article highlights the factors that predispose women to coccydynia and actions to relieve and improve it. Postpartum coccydynia is pain that appears as soon as a sitting position is adopted after delivery. Coccyx morphology, body mass index, vaginal delivery, instrumental delivery, multiparity, female sex, mature age and short perineum in women with difficult delivery are risk factors. The activities to improve pain begin with analgesia and coadjuvants, rehabilitation and pelvic floor massage, infiltrations, psychotherapy or, finally, surgery.

Cannabinoid CB2 receptors in the mouse brain: relevance for Alzheimer's disease.

BACKGROUND: Because of their low levels of expression and the inadequacy of current research tools, CB2 cannabinoid receptors (CB2R) have been difficult to study, particularly in the brain. This receptor is especially relevant in the context of neuroinflammation, so novel tools are needed to unveil its pathophysiological role(s). METHODS: We have generated a transgenic mouse model in which the expression of enhanced green fluorescent protein (EGFP) is under the control of the cnr2 gene promoter through the insertion of an Internal Ribosomal Entry Site followed by the EGFP coding region immediately 3' of the cnr2 gene and crossed these mice with mice expressing five familial Alzheimer's disease (AD) mutations (5xFAD). RESULTS: Expression of EGFP in control mice was below the level of detection in all regions of the central nervous system (CNS) that we examined. CB2R-dependent-EGFP expression was detected in the CNS of 3-month-old AD mice in areas of intense inflammation and amyloid deposition; expression was coincident with the appearance of plaques in the cortex, hippocampus, brain stem, and thalamus. The expression of EGFP increased as a function of plaque formation and subsequent microgliosis and was restricted to microglial cells located in close proximity to neuritic plaques. AD mice with CB2R deletion exhibited decreased neuritic plaques with no changes in IL1ß expression. CONCLUSIONS: Using a novel reporter mouse line, we found no evidence for CB2R expression in the healthy CNS but clear up-regulation in the context of amyloid-triggered neuroinflammation. Data from CB2R null mice indicate that they play a complex role in the response to plaque formation.

The impact of a short-term cohousing initiative among schizophrenia patients, high school students, and their social context: A qualitative case study.

BACKGROUND: A number of programs have been developed to promote the contact between adolescents and mentally-ill patients, in order to break the stigma, improve understanding, promote mental health and prevent substance abuse. The aim of this study was to describe the experience of patients with schizophrenia, high school students, and their social context, participating in a short-term cohousing initiative. METHODS: A qualitative case-study approach was implemented. Patients with schizophrenia from the San Juan de Dios Psychiatric Hospital, female students from Almen High School, and participants from their social context (parents, hospital staff, and teachers) were included, using purposeful sampling. Data were collected from 51 participants (15 patients, nine students, 11 hospital staff, six teachers, 10 parents) via non-participant observation, focus groups, informal interviews, researchers' field notes and patients' personal diaries and letters. A thematic analysis was performed. RESULTS: The themes identified included a) learning to live together: students and patients participate and learn together; b) the perception of the illness and the mentally-ill: the barrier between health and disease is very slim, and society tends to avoid contact with those who are ill; c) change: a transformation takes place in students, in their self-perception, based on the real and intense nature of the experience; d) a trial and an opportunity: patients test their ability to live outside the hospital; e) discharge and readmission: discharge is experienced as both a liberation and a difficulty, whereas relapse and readmission are experienced as failures. CONCLUSIONS: Our findings can help us to better understand schizophrenia and encourage a more positive approach towards both the illness and those who suffer from it. These results may be used for the development of cohousing programs in controlled environments.

Rotura del ligamento cruzado anterior en la mujer deportista: factores de riesgo y programas de prevención / Anterior cruciate ligament injury in the female athlete: risk and prevention

Objetivo: La lesión del ligamento cruzado anterior de la rodilla (LCA) es la segunda lesión deportiva más frecuente tras el esguince de tobillo. Provoca inestabilidad de la rodilla y afecta al rendimiento deportivo, por lo que es importante saber qué lo favorece y cómo lo podemos evitar. En este trabajo se expone la epidemiología de la lesión del LCA haciendo referencia a los factores de riesgo predisponentes y a los programas preventivos de la misma. El objetivo de este trabajo ha sido mostrar los factores de riesgo que predisponen a una mayor incidencia de lesión del ligamento cruzado anterior, así como presentar la efectividad de los programas de prevención de la misma. Método: Se ha realizado una revisión de la literatura a través de PubMEd, Cochrane y UpToDate incluyendo los metanálisis o ensayos clínicos publicados en los últimos 10 años. Resultados: La incidencia de lesión es mayor en la mujer que en el hombre con una relación 3:1, y sobre todo se produce en deportes como el fútbol y el baloncesto, donde se realizan ejercicios como pivotar, cambio brusco de dirección en la carrera o frenar de forma brusca. Los factores de riesgo son multifactoriales, entre ellos los únicos modificables son los factores de riesgo biomecánicos y es en ellos donde se centran los programas de prevención. Conclusiones: Las mujeres tienen una mayor incidencia de lesión de LCA. Los programas de prevención se centran en factores de riesgo modificable, principalmente en el entrenamiento neuromuscular y disminuyen de forma estadísticamente significativa tanto en el fútbol como en el balonmano, pero no en el baloncesto. Estos programas se centran en ejercicios de fortalecimiento, control proximal y ejercicios pliométricos

Background: The anterior cruciate ligament (ACL) injury of the knee is the second most common sports injury after the ankle sprain. It causes knee instability and impacts sport performance. Knowing what predisposes this injury is important to prevent it, specially in women, where the rate is higher. This paper presents the ACL injury epidemiology, making reference to the underlying risk factors and its preventive programmes. The aim of this study was to show the risk factors that predispose to a higher incidence of anterior cruciate ligament injury, as well as to present the effectiveness of the prevention programs. Methods: A literature review through PubMEd, Cochrane and UpToDate has been performed including the meta-analysis or clinical trials published over the past 10 years. Results: The injury incidence rate is three times higher in women than in men. It specially develops in sports like football and basketball, i.e., sports where pivoting, sharp running direction changes or abruptly stopping exercises are more common. The risk factors are multifactorial; and the only adjustable ones are the biomechanical risk factors. Prevention programmes are focused in these factors, trying to enhance strength and biomechanical propioception. Conclusions: After the review we can conclude that ACL injuries are more frequent in women. Prevention programmes focus on neuromuscular training (strengthening exercises, proximal control and plyometric exercises) and they reduces significantly the injury for football and handball players, but not for basketball ones. The programmes focus on strengthening exercises, proximal control and plyometric exercise

Anisakis y pólipo en colon, una asociación infrecuente / Anisakis and colonic polyp, a rare association

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