Usefulness of Lung Ultrasound as a Method for Early Diagnosis of Interstitial Lung Disease in Patients with Rheumatoid Arthritis.

Purpose: To determine the value of lung ultrasound (LUS) compared to high-resolution computed tomography (HRCT) in the early diagnosis of interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA). Patients and Methods: An observational prospective study was performed. Were included patients with respiratory symptoms or/and, patients with crackles in auscultation during medical consultation. All patients underwent to chest X-rays, LUS, HRCT,and respiratory function tests. Results: A total of 192 patients with RA were included. Mean disease duration was 16.8 ± 11.1 years. 72% were positive for rheumatoid factor or anti-citrullinated antibodies. Of the total number of subjects, 54.7% had respiratory symptoms. The other patients did not have respiratory symptoms, but they did have had crackles on pulmonary auscultation. B lines > 11.5 on the ROC curve predicted ILD (AUC 0.63; CI 95%: 0.55-0.71; p < 0.003). A DLCO value of <7.13 significantly predicted the presence of ILD (AUC 0.61; 95% CI: 0.52-0.70; p < 0.028). Conclusion: The findings of this study suggest that LUS is a valuable tool for the early diagnosis of ILD in patients with RA, and together with DLCO, can adequately predict the presence of ILD in this population. LUS also helps to determine which patients with respiratory symptoms and signs suggestive for ILD are undergo to HRCT.

Lesión ovárica compleja. Localización infrecuente de metástasis de cáncer medular de tiroides. Reporte de caso y revisión de la bibliografía / Complex ovarian lesion. Infrequent localization of metastasis of medullary thyroid cancer. Case report and review of the literature

Resumen ANTECEDENTES: El carcinoma medular de tiroides es un tumor maligno poco frecuente que se origina en las células parafoliculares tiroideas productoras de calcitonina. Si bien puede aparecer espontáneamente, la asociación familiar pocas veces es excepcional. Aunque la supervivencia en estadios iniciales es considerable, es frecuente la posibilidad de metástasis al momento del diagnóstico. CASO CLÍNICO: Paciente de 72 años, con un abultamiento en la región anterior del cuello y una adenopatía cervical izquierda de 15 días de evolución. La TAC, la ecografía y la biopsia reportaron: carcinoma bilateral de ovario poco diferenciado. Se procedió a la cirugía radical (histerectomía, doble anexectomía, linfadenectomía pélvica y para aórtica, omentectomía y apendicectomía) con la que se consiguió una citorreducción completa. En el estudio definitivo se encontraron metástasis de carcinoma medular de tiroides en ambos ovarios, miometrio y peritoneo. Enseguida se inició la quimioterapia con vandetanib. Después de 25 ciclos de tratamiento, la paciente continuó con el ácido zoledrónico y asintomática. Un mes después de finalizarlo comenzó con crisis comiciales que se trataron con quetiapina, con respuesta satisfactoria. Posteriormente, la paciente tuvo una celulitis facial que se trató con antibiótico y corticosteroide; tres semanas después falleció debido a insuficiencia multiorgánica. CONCLUSIONES: El carcinoma medular de tiroides es una rara localización de metástasis que aún requiere investigación que permita establecer protocolos de diagnóstico, tratamiento y estimación de la supervivencia.

Abstract BACKGROUND: Medullary thyroid carcinoma is a rare malignant tumor originating in the calcitonin-producing parafollicular thyroid cells. Although it can occur spontaneously, familial association is rarely exceptional. Although survival in early stages is considerable, the possibility of metastasis at the time of diagnosis is frequent. CLINICAL CASE: 72-year-old patient with a lump in the anterior neck region and left cervical adenopathy of 15 days of evolution. CT, ultrasound, and biopsy reported: bilateral poorly differentiated ovarian carcinoma. Radical surgery (hysterectomy, double adnexectomy, pelvic and para-aortic lymphadenectomy, omentectomy and appendectomy) was performed and complete cytoreduction was achieved. In the definitive study, metastases of medullary thyroid carcinoma were found in both ovaries, myometrium and peritoneum. Chemotherapy with vandetanib was then started. After 25 cycles of treatment, the patient continued with zoledronic acid and was asymptomatic. One month after the end of the treatment, she began to have comic crises that were treated with quetiapine, with satisfactory response. Subsequently, the patient had a facial cellulitis that was treated with antibiotics and corticosteroids; three weeks later she died due to multiorgan failure. CONCLUSIONS: Medullary thyroid carcinoma is a rare site of metastasis that still requires research to establish diagnostic and treatment protocols and to estimate survival.

Energy-socio-economic-environmental modelling for the EU energy and post-COVID-19 transitions.

Relevant energy questions have arisen because of the COVID-19 pandemic. The pandemic shock leads to emissions' reductions consistent with the rates of decrease required to achieve the Paris Agreement goals. Those unforeseen drastic reductions in emissions are temporary as long as they do not involve structural changes. However, the COVID-19 consequences and the subsequent policy response will affect the economy for decades. Focusing on the EU, this discussion article argues how recovery plans are an opportunity to deepen the way towards a low-carbon economy, improving at the same time employment, health, and equity and the role of modelling tools. Long-term alignment with the low-carbon path and the development of a resilient transition towards renewable sources should guide instruments and policies, conditioning aid to energy-intensive sectors such as transport, tourism, and the automotive industry. However, the potential dangers of short-termism and carbon leakage persist. The current energy-socio-economic-environmental modelling tools are precious to widen the scope and deal with these complex problems. The scientific community has to assess disparate, non-equilibrium, and non-ordinary scenarios, such as sectors and countries lockdowns, drastic changes in consumption patterns, significant investments in renewable energies, and disruptive technologies and incorporate uncertainty analysis. All these instruments will evaluate the cost-effectiveness of decarbonization options and potential consequences on employment, income distribution, and vulnerability.

Long-Term Effects of Bariatric Surgery on Gut Microbiota Composition and Faecal Metabolome Related to Obesity Remission.

Obesity is one of the main worldwide public health concerns whose clinical management demands new therapeutic approaches. Bariatric surgery is the most efficient treatment when other therapies have previously failed. Due to the role of gut microbiota in obesity development, the knowledge of the link between bariatric surgery and gut microbiota could elucidate new mechanistic approaches. This study aims to evaluate the long-term effects of bariatric surgery in the faecal metagenome and metabolome of patients with severe obesity. Faecal and blood samples were collected before and four years after the intervention from patients with severe obesity. Biochemical, metagenomic and metabolomic analyses were performed and faecal short-chain fatty acids were measured. Bariatric surgery improved the obesity-related status of patients and significantly reshaped gut microbiota composition. Moreover, this procedure was associated with a specific metabolome profile characterized by a reduction in energetic and amino acid metabolism. Acetate, butyrate and propionate showed a significant reduction with bariatric surgery. Finally, correlation analysis suggested the existence of a long-term compositional and functional gut microbiota profile associated with the intervention. In conclusion, bariatric surgery triggered long-lasting effects on gut microbiota composition and faecal metabolome that could be associated with the remission of obesity.

Factors affecting energy-efficiency investment in the hotel industry: survey results from Spain.

Increasing energy efficiency is a major way of saving energy and thus reducing energy expenses. However, adoption of energy efficiency is generally low, as demonstrated by the energy efficiency gap. To understand that gap, this paper analyses the factors that affect how the energy efficiency attribute is rated in investment in heating, ventilation and air conditioning (HVAC) systems in the hotel industry in Spain. A survey conducted on two hundred owners of hotels, hostels and holiday cottages (referred to jointly here for the sake of convenience as "the hotel industry") shows that the value placed on energy efficiency is influenced not just by climate conditions, environmental concern and type of hotel but also by other attributes of the HVAC system such as brand reliability, price and performance. The hotel industry may also be identifying EE as a proxy for quality rather than savings. Designing the right energy-efficiency policy entails accounting for potential responses by agents, and this analysis helps identify those drivers to which they may or may not respond.

An altered fecal microbiota profile in patients with non-alcoholic fatty liver disease (NAFLD) associated with obesity

Introduction: increasing evidence suggests a role of intestinal dysbiosis in obesity and non-alcoholic fatty liver disease (NAFLD). The advances in recent years with regard to the role of the gut microbiota raise the potential utility of new therapeutic approaches based on the modification of the microbiome. Objective: the aim of this study was to compare the bacterial communities in obese patients with or without NAFLD to those of healthy controls. Patients and methods: the fecal microbiota composition of 20 healthy adults, 36 obese patients with NAFLD and 17 obese patients without NAFLD was determined by 16S ribosomal RNA sequencing using the Illumina MiSeq system. Results: the results highlighted significant differences in the phylum Firmicutes between patients with and without NAFLD, which was a determining factor of the disease and supported its possible role as a marker of NAFLD. At the genus level, the relative abundance of Blautia, Alkaliphilus, Flavobacterium and Akkermansia was reduced in obese patients, both with or without NAFLD, compared to healthy controls. Furthermore, the number of sequences from the genus Streptococcus was significantly higher in patients with NAFLD in comparison with individuals without the disease, constituting another possible marker. Comparison of bacterial communities at the genus level by a principal coordinate analysis indicated that the bacterial communities of patients with NAFLD were dispersed and did not form a group. Conclusion: in conclusion, these results indicate the role of intestinal dysbiosis in the development of NAFLD associated with obesity. There was a differential microbiota profile between obese patients, with and without NAFLD. Thus, supporting gut microbiota modulation as a therapeutic alternative for the prevention and treatment of NAFLD

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An altered fecal microbiota profile in patients with non-alcoholic fatty liver disease (NAFLD) associated with obesity.

INTRODUCTION: increasing evidence suggests a role of intestinal dysbiosis in obesity and non-alcoholic fatty liver disease (NAFLD). The advances in recent years with regard to the role of the gut microbiota raise the potential utility of new therapeutic approaches based on the modification of the microbiome. OBJECTIVE: the aim of this study was to compare the bacterial communities in obese patients with or without NAFLD to those of healthy controls. PATIENTS AND METHODS: the fecal microbiota composition of 20 healthy adults, 36 obese patients with NAFLD and 17 obese patients without NAFLD was determined by 16S ribosomal RNA sequencing using the Illumina MiSeq system. RESULTS: the results highlighted significant differences in the phylum Firmicutes between patients with and without NAFLD, which was a determining factor of the disease and supported its possible role as a marker of NAFLD. At the genus level, the relative abundance of Blautia, Alkaliphilus, Flavobacterium and Akkermansia was reduced in obese patients, both with or without NAFLD, compared to healthy controls. Furthermore, the number of sequences from the genus Streptococcus was significantly higher in patients with NAFLD in comparison with individuals without the disease, constituting another possible marker. Comparison of bacterial communities at the genus level by a principal coordinate analysis indicated that the bacterial communities of patients with NAFLD were dispersed and did not form a group. CONCLUSION: in conclusion, these results indicate the role of intestinal dysbiosis in the development of NAFLD associated with obesity. There was a differential microbiota profile between obese patients, with and without NAFLD. Thus, supporting gut microbiota modulation as a therapeutic alternative for the prevention and treatment of NAFLD.

Hepatitis aguda secundaria a megadosis de metilprednisolona intravenosa / Acute hepatitis secondary to high-dose intravenous methylprednisolone

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Performance assessment of dry electrodes for wearable long term cardiac rhythm monitoring: Skin-electrode impedance spectroscopy.

The use of wearable dry sensors for recording long term ECG signals is a requirement for certain studies of heart rhythm. Knowledge of the skin-electrode electrical performance of dry electrodes is necessary when seeking to improve various processing stages for signal quality enhancement. In this paper, methods for the assessment of dry skin-electrode impedance (ZSE) and its modelling are presented. Measurements were carried out on selected electrode materials such as silver, stainless steel, AgCl (dry) and polyurethane. These had ZSE values between 500 kΩ and 1 MΩ within the main ECG frequency range (1 Hz - 100 Hz); in contrast to plain iron material which had a significantly higher impedance. However, in spite of the high ZSE values, open bandwidth ECG traces were of acceptable quality and stability; with dry AgCl material offering the best ECG trace performance.

Helicobacter pylori Antibody Reactivities and Colorectal Cancer Risk in a Case-control Study in Spain.

Background: Several studies have suggested that Helicobacter pylori (H. pylori) infection is a risk factor for colorectal cancer (CRC), while others have not confirmed this hypothesis. This work aimed to assess the relation of CRC with H. pylori seropositivity and with seropositivity to 16 H. pylori proteins, in the MultiCase-Control study, MCC-Spain. Methods: MCC-Spain is a multicase-control study carried out in Spain from 2008 to 2013. In total, 2,140 histologically-confirmed incident CRC cases and 4,098 population-based controls were recruited. Controls were frequency-matched by sex, age, and province. Epidemiological data were collected through a questionnaire fulfilled by face-to-face interviews and a self-administered food-frequency questionnaire. Seroreactivities against 16 H. pylori proteins were determined in 1,488 cases and 2,495 controls using H. pylori multiplex serology. H. pylori seropositivity was defined as positivity to ≥4 proteins. Multivariable logistic regression mixed models were used to estimate odds ratios (OR) and 95% confidence intervals (CI). Results:H. pylori seropositivity was not associated with increased CRC risk (OR = 0.91; 95% CI: 0.71-1.16). Among H. pylori seropositive subjects, seropositivity to Cagδ showed a lower CRC risk, and risk decreased with increasing number of proteins seropositive. Seropositivity to the most recognized virulence factors, CagA and VacA, was not associated with a higher CRC risk. No statistically significant heterogeneity was identified among tumor sites, although inverse relations were stronger for left colon cancer. An interaction with age and sex was found: H. pylori seropositivity was associated with a lower CRC risk in men younger than 65 and with a higher risk in older women. Conclusions: Our results suggest that neither H. pylori seropositivity, nor seropositivity to the virulence factor CagA are associated with a higher CRC risk. A possible effect modification by age and sex was identified.

Interferon-free treatments in patients with hepatitis C genotype 1-4 infections in a real-world setting.

AIM: To investigated the real-world effectiveness and safety of various regimens of interferon-free treatments in patients infected with hepatitis C virus (HCV). METHODS: We performed an observational study to analyze different antiviral treatments administered to 462 HCV-infected patients, of which 56.7% had liver cirrhosis. HCV RNA after 4 wk of treatment and at 12 wk after treatment sustained virologic response (SVR) as well as serious adverse events (SAEs) was analyzed first for the whole cohort and then separately in patients who met or did not meet the inclusion criteria of a clinical trial (CT-met and CT-unmet, respectively). RESULTS: The most frequently prescribed treatment was simeprevir/sofosbuvir (36.4%), followed by sofosbuvir/ledipasvir (24.9%) and ombitasvir/paritaprevir/ritonavir (r)/dasabuvir (19.9%). Ribavirin (RBV) was administered in 198 patients (42.9%). SVRs occurred in 437/462 patients (94.6%). The SVRs ranged between 93.3% and 100% for genotypes 1-4. SVRs were achieved in 96.2% patients in the CT-met group vs 91.9% patients in the CT-unmet group (P = 0.049). Undetectable HCV RNA at week 4 occurred in 72.9% of the patients. In the univariate analysis, the factors associated with SVRs were lower liver stiffness, absence of cirrhosis, higher platelet count, higher albumin levels, no RBV dose reduction, undetectable HCV RNA at week 4 and CT-met group. In the multivariate analysis, only albumin was an independent predictor of treatment failure (P = 0.04). Eleven patients (2.4%) developed SAEs; 5.2% and 0.7% of the patients in the CT-unmet and CT-met groups, respectively (P = 0.003). CONCLUSION: A high proportion of patients with HCV infection achieved SVRs. For patients who did not meet the CT criteria, treatment regimens must be optimized.

Evaluation of advanced fibrosis measured by transient elastography after hepatitis C virus protease inhibitor-based triple therapy.

AIM: Few studies have investigated the course of liver stiffness after treatment with protease inhibitors. We evaluated the impact of this therapy on liver fibrosis measured by transient elastography. METHODS: This multicenter observational, cohort, prospective study included 90 patients with hepatitis C genotype 1 treated with telaprevir or boceprevir who had advanced fibrosis evidenced by liver stiffness (≥9.5 kPa). Liver stiffness was measured at baseline and 24 weeks after treatment ended, and was compared with virological responses at week 12. RESULTS: Liver stiffness decreased in 89% of patients who achieved sustained virological response. The median intrapatient liver stiffness value at the end of follow-up decreased by 5.1 kPa (35%) from baseline compared with 0.1 kPa (0.5%) in those who did not achieve a sustained virological response (P<0.001). The liver stiffness level fell below 9.5 kPa in 58% of patients with sustained virological response, and 71% of those with sustained virological response and cirrhosis evidenced by liver stiffness at baseline achieved regression below 12.5 kPa by the end of follow-up. Sustained virological response was the only variable associated with improved liver stiffness in multivariate analysis (odds ratio: 17.3; 95% confidence interval: 4.4-67.6; P<0.001). CONCLUSION: In patients with advanced fibrosis measured by transient elastography at the beginning of protease inhibitor-based therapy with sustained virological response, liver stiffness was significantly reduced 24 weeks after treatment. This suggests the possibility of liver cirrhosis evidenced by liver stiffness regression after sustained virological response in a significant proportion of patients.

Tratamiento antiangiogénico del cáncer / Anatiangiogenic treatment of cancer

El proceso de formación de nuevos vasos a partir de los capilares preexistentes es lo que se denomina angiogénesis. La angiogénesis es un proceso complejo que involucra a distintas células, componentes solubles y factores de la matriz extracelular y tiene gran importancia en una gran variedad de procesos fisiológicos y patológicos del organismo. La regulación de la angiogénesis se lleva a cabo mediante un perfecto equilibrio entre la producción y la liberación de diversos factores estimulantes e inhibidores, que varían en función de las necesidades y el tipo de tejido. Un número elevado de enfermedades se caracteriza por alteraciones del proceso angiogénico, tanto por insuficiencia como por exceso de angiogénesis. Hace ya más de un siglo que se observó que la proliferación de los vasos sanguíneos era necesaria para el crecimiento tumoral. El tratamiento antiangiogénico realizaría una acción antitumoral de forma indirecta mediante la inhibición de la vascularización del tumor e impidiendo que se le aporten los nutrientes necesarios para su crecimiento y desarrollo (AU)

The process of formation of new vessels from pre-existing capillaries is called angiogenesis. Angiogenesis is a complex process which involves distinct cells, soluble components and factors related to the extra-cellular matrix and which is highly important in a large variety of physiological and pathological processes in the body. Angiogenesis regulation takes place through a perfect equilibrium between the production and release of different stimulatory and inhibitory factors which vary in relation to needs and tissue types. A large number of diseases are characterized by alterations in the angiogenic process, either by an insufficiency or by excessive angiogenesis. The requirement of blood vessel proliferation for tumor growth was observed more than a century ago. Angiogenic treatment would have an indirect antitumoral action, inhibiting tumor vascularization and impairing the supply of essential nutrients for tumoral growth and development (AU)

[Antiangiogenic treatment of cancer]. / Tratamiento antiangiogénico del cáncer.

The process of formation of new vessels from pre-existing capillaries is called angiogenesis. Angiogenesis is a complex process which involves distinct cells, soluble components and factors related to the extra-cellular matrix and which is highly important in a large variety of physiological and pathological processes in the body. Angiogenesis regulation takes place through a perfect equilibrium between the production and release of different stimulatory and inhibitory factors which vary in relation to needs and tissue types. A large number of diseases are characterized by alterations in the angiogenic process, either by an insufficiency or by excessive angiogenesis. The requirement of blood vessel proliferation for tumor growth was observed more than a century ago. Angiogenic treatment would have an indirect antitumoral action, inhibiting tumor vascularization and impairing the supply of essential nutrients for tumoral growth and development.

TNP-470 inhibits oxidative stress, nitric oxide production and nuclear factor kappa B activation in a rat model of hepatocellular carcinoma.

The objective of this study is to determine if treatment with the angiogenesis inhibitor TNP-470 results in impairment of oxidative stress, inhibition of nuclear factor kappa B (NF-kappaB) activation and decrease of nitric oxide production in an experimental model of rat hepatocarcinogenesis. Tumour was induced by diethylnitrosamine and promoted by two-thirds hepatectomy plus acetaminofluorene administration. Experiments were carried out at 28 weeks after initiating the treatment. TNP-470 was administered at 30mg/kg, three times per week from 20 to 28 weeks. Carcinomatous tissue growing outside dysplastic nodules and a marked expression of placental glutathione S-transferase were detected in rats with induced carcinogenesis. Liver concentrations of thiobarbituric acid reactive substances, reduced glutathione (GSH) and glutathione disulfide (GSSG) were significantly higher than those of controls and there was a significant increase in the GSSG/GSH ratio. Tumour growth was accompanied by augmented expression of inducible nitric oxide synthase, activation of (NF-kappaB) and proteolysis of IkappaB. All these effects were absent in animals receiving TNP-470. Our results indicate that TNP-470 inhibits oxidative stress, nitric oxide production and NF-kappaB activation induced by experimental hepatocarcinogenesis. These changes would contribute to the beneficial effects of TNP-470 in cancer treatment.