Reconstruction Using Perforator Propeller Flaps After Malignant Melanoma Resection of the Lower Extremity.

Introduction: Surgical excision with margin of 2 cm is the treatment of choice in malignant cutaneous melanoma when Breslow index is >1 mm. When located on the lower limb, these resections can lead to large defects that require complex reconstruction in order to salvage the limb. The use of propeller-perforator flaps has multiple advantages such as the preservation of adjacent muscles, decrease in morbidity in the donor site, and good aesthetic and functional results. Our objective is to expose our experience and results with the use of propeller-perforator flaps for coverage of this kind of defects. Materials and Methods: Patients with malignant cutaneous melanoma of the lower limb who required reconstruction with a propeller-perforator flap between the years 2015 and 2021 in our plastic surgery department were included in this retrospective research. Demographic, reconstructive, oncologic, and functional data were collected and analyzed. Results: The cohort of 22 patients showed 100% of successful reconstructive outcomes. Only 2 patients experienced distal necrosis of the flap that was resolved with local dressings. Fast recovery and early capacity to walk were achieved in the majority of the patients with an average of 10.1 days until weight-baring walking. The 2-year overall and progression-free survival rates were 86.37% and 81.82%, respectively. Conclusion: The use of propeller perforator flaps for oncological defects coverage in the lower limb location has to be considered as a reliable choice as it takes less surgical time and a faster recovery. It allows limb salvage with an adequate length and functionality, with minimal donor site morbidity and a lower index of complications, contributing to improve patient's quality of life and not delaying other oncological treatments.

Introduction: Une excision chirurgicale aux marges de 2 cm est le traitement de première intention des mélanomes cutanés malins lorsque l'indice de Breslow est supérieur à 1 mm. Situées sur un membre inférieur, ces résections peuvent provoquer de grosses anomalies qui exigent une reconstruction complète pour sauver le membre. Le recours aux lambeaux perforants en hélice comporte de multiples avantages, tels que la préservation des muscles adjacents, la diminution des problèmes médicaux au foyer du donneur ainsi que des résultats esthétiques et fonctionnels satisfaisants. Les auteurs visent à présenter leur expérience et leurs résultats lorsqu'ils recouvrent ce type d'anomalie à l'aide de lambeaux perforants en hélice. Matériel et méthodologie: Les patients atteints d'un mélanome cutané malin d'un membre inférieur qui nécessitaient une reconstruction à l'aide d'un lambeau perforant en hélice entre 2015 et 2021 au département de chirurgie plastique des auteurs ont été inclus dans la présente recherche rétrospective. Les auteurs ont recueilli et analysé les caractéristiques démographiques ainsi que les données reconstructives, oncologiques et fonctionnelles des patients. Résultats: Les résultats reconstructifs ont été satisfaisants dans toute la cohorte de 22 patients. Seuls deux d'entre eux ont vécu une nécrose distale du lambeau, qui a été corrigée par des pansements locaux. La majorité des patients se sont remis rapidement et ont pu recommencer à marcher tôt, soit en moyenne au bout de 10,1 jours avec mise en charge. Le taux de survie global et le taux d'absence de détérioration au bout de deux ans s'élevaient à 86,37 % et à 81,82 %, respectivement. Conclusion: Le recours à des lambeaux perforants en hélice pour couvrir des anomalies oncologiques du membre inférieur doit être considéré comme un choix fiable, car l'intervention chirurgicale et la convalescence sont plus courtes. Cette intervention permet de sauver le membre, dont la longueur et la fonction demeurent appropriées, elle est associée à des problèmes médicaux minimes au foyer du donneur et à un faible indice de complications, elle contribue à améliorer la qualité de vie du patient et elle ne retarde pas les autres traitements oncologiques.

Spatially offset optical coherence tomography: Leveraging multiple scattering for high-contrast imaging at depth in turbid media.

The penetration depth of optical coherence tomography (OCT) reaches well beyond conventional microscopy; however, signal reduction with depth leads to rapid degradation of the signal below the noise level. The pursuit of imaging at depth has been largely approached by extinguishing multiple scattering. However, in OCT, multiple scattering substantially contributes to image formation at depth. Here, we investigate the role of multiple scattering in OCT image contrast and postulate that, in OCT, multiple scattering can enhance image contrast at depth. We introduce an original geometry that completely decouples the incident and collection fields by introducing a spatial offset between them, leading to preferential collection of multiply scattered light. A wave optics-based theoretical framework supports our experimentally demonstrated improvement in contrast. The effective signal attenuation can be reduced by more than 24 decibels. Notably, a ninefold enhancement in image contrast at depth is observed in scattering biological samples. This geometry enables a powerful capacity to dynamically tune for contrast at depth.

Aggressive Acute Marjolin's Ulcer Arising in a Burn Scar.

Marjolin's ulcer is one of the clinical variants of squamous-cell carcinoma. It is a highly aggressive disease that develops from chronic wounds. Almost 65% of these lesions have been diagnosed on underlying burn scars. Although the mean latency time between the primary lesion and the apparition of the ulcer is around 25 years, some cases with an early debut have been described. Squamous-cell carcinomas arising in chronic wounds are typically aggressive and are related with a poor prognosis due to their late diagnosis. Therefore, it is important to recognize symptoms that indicate malignant degeneration of chronic wounds, allowing the clinician to make an early diagnosis in order not to delay the surgical treatment that is required to improve the global survival of the patient. The time elapsed between our patient's burn and the appearance of Marjolin's ulcer was only 7 months, drawing attention to its fast and aggressive progression.

Liposomal formulations for treating lysosomal storage disorders.

Lysosomal storage disorders (LSD) are a group of rare life-threatening diseases caused by a lysosomal dysfunction, usually due to the lack of a single enzyme required for the metabolism of macromolecules, which leads to a lysosomal accumulation of specific substrates, resulting in severe disease manifestations and early death. There is currently no definitive cure for LSD, and despite the approval of certain therapies, their effectiveness is limited. Therefore, an appropriate nanocarrier could help improve the efficacy of some of these therapies. Liposomes show excellent properties as drug carriers, because they can entrap active therapeutic compounds offering protection, biocompatibility, and selectivity. Here, we discuss the potential of liposomes for LSD treatment and conduct a detailed analysis of promising liposomal formulations still in the preclinical development stage from various perspectives, including treatment strategy, manufacturing, characterization, and future directions for implementing liposomal formulations for LSD.

Engineering pH-Sensitive Stable Nanovesicles for Delivery of MicroRNA Therapeutics.

MicroRNAs (miRNAs) are small non-coding endogenous RNAs, which are attracting a growing interest as therapeutic molecules due to their central role in major diseases. However, the transformation of these biomolecules into drugs is limited due to their unstability in the bloodstream, caused by nucleases abundantly present in the blood, and poor capacity to enter cells. The conjugation of miRNAs to nanoparticles (NPs) could be an effective strategy for their clinical delivery. Herein, the engineering of non-liposomal lipid nanovesicles, named quatsomes (QS), for the delivery of miRNAs and other small RNAs into the cytosol of tumor cells, triggering a tumor-suppressive response is reported. The engineered pH-sensitive nanovesicles have controlled structure (unilamellar), size (<150 nm) and composition. These nanovesicles are colloidal stable (>24 weeks), and are prepared by a green, GMP compliant, and scalable one-step procedure, which are all unavoidable requirements for the arrival to the clinical practice of NP based miRNA therapeutics. Furthermore, QS protect miRNAs from RNAses and when injected intravenously, deliver them into liver, lung, and neuroblastoma xenografts tumors. These stable nanovesicles with tunable pH sensitiveness constitute an attractive platform for the efficient delivery of miRNAs and other small RNAs with therapeutic activity and their exploitation in the clinics.

Application of Quality by Design to the robust preparation of a liposomal GLA formulation by DELOS-susp method.

Fabry disease is a lysosomal storage disease arising from a deficiency of the enzyme α-galactosidase A (GLA). The enzyme deficiency results in an accumulation of glycolipids, which over time, leads to cardiovascular, cerebrovascular, and renal disease, ultimately leading to death in the fourth or fifth decade of life. Currently, lysosomal storage disorders are treated by enzyme replacement therapy (ERT) through the direct administration of the missing enzyme to the patients. In view of their advantages as drug delivery systems, liposomes are increasingly being researched and utilized in the pharmaceutical, food and cosmetic industries, but one of the main barriers to market is their scalability. Depressurization of an Expanded Liquid Organic Solution into aqueous solution (DELOS-susp) is a compressed fluid-based method that allows the reproducible and scalable production of nanovesicular systems with remarkable physicochemical characteristics, in terms of homogeneity, morphology, and particle size. The objective of this work was to optimize and reach a suitable formulation for in vivo preclinical studies by implementing a Quality by Design (QbD) approach, a methodology recommended by the FDA and the EMA to develop robust drug manufacturing and control methods, to the preparation of α-galactosidase-loaded nanoliposomes (nanoGLA) for the treatment of Fabry disease. Through a risk analysis and a Design of Experiments (DoE), we obtained the Design Space in which GLA concentration and lipid concentration were found as critical parameters for achieving a stable nanoformulation. This Design Space allowed the optimization of the process to produce a nanoformulation suitable for in vivo preclinical testing.

Inequality in life expectancies across Europe and the US.

We use harmonized household panel data from Europe and the US and a three-state survival model to provide comparable measurements of education and gender inequalities in total, healthy, and unhealthy life expectancies at age 50. Common across countries, the education advantage in total life expectancy is larger for males but the education advantage in (fewer) unhealthy years is larger for females. Counterfactual decompositions show that these results arise because the education advantage in conditional survival rates is relatively more important for males, while the education advantage in better health transitions is relatively more important for females. Across countries, the US stands out with the largest education gradient in healthy life expectancy.

Impact of Chemical Composition on the Nanostructure and Biological Activity of α-Galactosidase-Loaded Nanovesicles for Fabry Disease Treatment.

Fabry disease is a rare lysosomal storage disorder characterized by a deficiency of α-galactosidase A (GLA), a lysosomal hydrolase. The enzyme replacement therapy administering naked GLA shows several drawbacks including poor biodistribution, limited efficacy, and relatively high immunogenicity in Fabry patients. An attractive strategy to overcome these problems is the use of nanocarriers for encapsulating the enzyme. Nanoliposomes functionalized with RGD peptide have already emerged as a good platform to protect and deliver GLA to endothelial cells. However, low colloidal stability and limited enzyme entrapment efficiency could hinder the further pharmaceutical development and the clinical translation of these nanoformulations. Herein, the incorporation of the cationic miristalkonium chloride (MKC) surfactant to RGD nanovesicles is explored, comparing two different nanosystems-quatsomes and hybrid liposomes. In both systems, the positive surface charge introduced by MKC promotes electrostatic interactions between the enzyme and the nanovesicles, improving the loading capacity and colloidal stability. The presence of high MKC content in quatsomes practically abolishes GLA enzymatic activity, while low concentrations of the surfactant in hybrid liposomes stabilize the enzyme without compromising its activity. Moreover, hybrid liposomes show improved efficacy in cell cultures and a good in vitro/in vivo safety profile, ensuring their future preclinical and clinical development.

Clinical validation of risk scoring systems to predict risk of delayed bleeding after EMR of large colorectal lesions.

BACKGROUND AND AIMS: The Endoscopic Resection Group of the Spanish Society of Endoscopy (GSEED-RE) model and the Australian Colonic Endoscopic Resection (ACER) model were proposed to predict delayed bleeding (DB) after EMR of large superficial colorectal lesions, but neither has been validated. We validated and updated these models. METHODS: A multicenter cohort study was performed in patients with nonpedunculated lesions ≥20 mm removed by EMR. We assessed the discrimination and calibration of the GSEED-RE and ACER models. Difficulty performing EMR was subjectively categorized as low, medium, or high. We created a new model, including factors associated with DB in 3 cohort studies. RESULTS: DB occurred in 45 of 1034 EMRs (4.5%); it was associated with proximal location (odds ratio [OR], 2.84; 95% confidence interval [CI], 1.31-6.16), antiplatelet agents (OR, 2.51; 95% CI, .99-6.34) or anticoagulants (OR, 4.54; 95% CI, 2.14-9.63), difficulty of EMR (OR, 3.23; 95% CI, 1.41-7.40), and comorbidity (OR, 2.11; 95% CI, .99-4.47). The GSEED-RE and ACER models did not accurately predict DB. Re-estimation and recalibration yielded acceptable results (GSEED-RE area under the curve [AUC], .64 [95% CI, .54-.74]; ACER AUC, .65 [95% CI, .57-.73]). We used lesion size, proximal location, comorbidity, and antiplatelet or anticoagulant therapy to generate a new model, the GSEED-RE2, which achieved higher AUC values (.69-.73; 95% CI, .59-.80) and exhibited lower susceptibility to changes among datasets. CONCLUSIONS: The updated GSEED-RE and ACER models achieved acceptable prediction levels of DB. The GSEED-RE2 model may achieve better prediction results and could be used to guide the management of patients after validation by other external groups. (Clinical trial registration number: NCT03050333.).

The association of urine metals and metal mixtures with cardiovascular incidence in an adult population from Spain: the Hortega Follow-Up Study.

BACKGROUND: The association of low-level exposure to metals and metal mixtures with cardiovascular incidence in the general population has rarely been studied. We flexibly evaluated the association of urinary metals and metal mixtures concentrations with cardiovascular diseases in a representative sample of a general population from Spain. METHODS: Urine antimony (Sb), barium (Ba), cadmium (Cd), chromium (Cr), cobalt (Co), copper (Cu), molybdenum (Mo), vanadium (V) and zinc (Zn) were measured in 1171 adults without clinical cardiovascular diseases, who participated in the Hortega Study. Cox proportional hazard models were used for evaluating the association between single metals and cardiovascular incidence. We used a Probit extension of Bayesian Kernel Machine Regression (BKMR-P) to handle metal mixtures in a survival setting. RESULTS: In single-metal models, the hazard ratios [confidence intervals (CIs)] of cardiovascular incidence, comparing the 80th to the 20th percentiles of metal distributions, were 1.35 (1.06, 1.72) for Cu, 1.43 (1.07, 1.90) for Zn, 1.51 (1.13, 2.03) for Sb, 1.46 (1.13, 1.88) for Cd, 1.64 (1.05, 2.58) for Cr and 1.31 (1.01, 1.71) for V. BKMR-P analysis was confirmatory of these findings, supporting that Cu, Zn, Sb, Cd, Cr and V are related to cardiovascular incidence in the presence of the other metals. Cd and Sb showed the highest posterior inclusion probabilities. CONCLUSIONS: Urine Cu, Zn, Sb, Cd, Cr and V were independently associated with increased cardiovascular risk at levels relevant for the general population of Spain. Urine metals in the mixture were also jointly associated with cardiovascular incidence, with Cd and Sb being the most important components of the mixture.

Depth-resolved multimodal imaging: Wavelength modulated spatially offset Raman spectroscopy with optical coherence tomography.

A major challenge in biophotonics is multimodal imaging to obtain both morphological and molecular information at depth. We demonstrate a hybrid approach integrating optical coherence tomography (OCT) with wavelength modulated spatially offset Raman spectroscopy (WM-SORS). With depth colocalization obtained from the OCT, we can penetrate 1.2-mm deep into strong scattering media (lard) to acquire up to a 14-fold enhancement of a Raman signal from a hidden target (polystyrene) with a spatial offset. Our approach is capable of detecting both Raman and OCT signals for pharmaceutical particles embedded in turbid media and revealing the white matter at depth within a 0.6-mm thick brain tissue layer. This depth resolved label-free multimodal approach is a powerful route to analyze complex biomedical samples.

Quantifying Force and Viscoelasticity Inside Living Cells Using an Active-Passive Calibrated Optical Trap.

As described in the previous chapters, optical tweezers have become a tool of precision for in vitro single-molecule investigations, where the single molecule of interest most often is studied in purified form in an experimental assay with a well-controlled fluidic environment. A well-controlled fluidic environment implies that the physical properties of the liquid, most notably the viscosity, are known and the fluidic environment can, for calibrational purposes, be treated as a simple liquid.In vivo, however, optical tweezers have primarily been used as a tool of manipulation and not so often for precise quantitative force measurements, due to the unknown value of the spring constant of the optical trap formed within the cell's viscoelastic cytoplasm. Here, we describe a method for utilizing optical tweezers for quantitative in vivo force measurements. The experimental protocol and the protocol for data analysis rely on two types of experiments, passive observation of the thermal motion of a trapped object inside a living cell, followed by observations of the response of the trapped object when subject to controlled oscillations of the optical trap. One advantage of this calibration method is that the size and refractive properties of the trapped object and the viscoelastic properties of its environment need not be known. We explain the protocol and demonstrate its use with experiments of trapped granules inside live S. pombe cells.

[Awareness, Treatment and Control of Hypertension in Population Aged 16 to 90 Years Old in the Valencia Region, Spain, 2010]. / Conocimiento, tratamiento y control de la hipertensión arterial por las personas de 16 a 90 años de edad participantes en la Encuesta de Nutrición de la Comunitat Valenciana de 2010.

OBJECTIVE: Hypertension is an important risk factor in terms of mortality attributable and the main modifiable cardiovascular risk factor. The aim of the study is to estimate the degree of awareness, treatment and control of hypertension in population of Valencia Region and identify predictors that explain the lack of proper control. METHODS: Cross-sectional population-based study in 413 men and 415 women between 16 and 90 years participants in Nutrition Survey of Valencia held in 2010. Automatic sphygmomanometer was used for taking blood pressure. Hypertension was defined according to the criteria of 2007 European Society of Hypertension and the European Society of Cardiology. Data on knowledge and treatment were obtained by survey. Predictors for awareness, treatment and control of hypertension were estimated by logistic regression models. RESULTS: The prevalence of hypertension estimated for the study population was 38.2% (95% CI: 34.9%-41.5%). 51.4% (95% CI: 45.9%-57.0%) of the hypertensive population, knew his condition. 88.8% of them (95% CI: 83.9%-93.6%) were receiving drug therapy and of these, 45.1% (95% CI: 36.9%-53.3%) maintained blood pressure controlled. CONCLUSIONS: Since the last survey in Valencia Region, the degree of awareness of hypertension has not improved although an increase in those treated with antihypertensive drugs is observed.

Making sense of big data in health research: Towards an EU action plan.

Medicine and healthcare are undergoing profound changes. Whole-genome sequencing and high-resolution imaging technologies are key drivers of this rapid and crucial transformation. Technological innovation combined with automation and miniaturization has triggered an explosion in data production that will soon reach exabyte proportions. How are we going to deal with this exponential increase in data production? The potential of "big data" for improving health is enormous but, at the same time, we face a wide range of challenges to overcome urgently. Europe is very proud of its cultural diversity; however, exploitation of the data made available through advances in genomic medicine, imaging, and a wide range of mobile health applications or connected devices is hampered by numerous historical, technical, legal, and political barriers. European health systems and databases are diverse and fragmented. There is a lack of harmonization of data formats, processing, analysis, and data transfer, which leads to incompatibilities and lost opportunities. Legal frameworks for data sharing are evolving. Clinicians, researchers, and citizens need improved methods, tools, and training to generate, analyze, and query data effectively. Addressing these barriers will contribute to creating the European Single Market for health, which will improve health and healthcare for all Europeans.

[Prevalence of Hypertension and Associated Factors in Population Aged 16 to 90 Years Old in Valencia Region, Spain]. / Prevalencia de hipertensión arterial y factores asociados en población de 16 a 90 años de edad en la Comunidad Valenciana.

OBJECTIVE: Hypertension is one of the main risk factor in terms of attributable mortality and the most common modifiable cardiovascular risk factor. The aim of the study was to estimate the prevalence of hypertension in population more than fifteen years of Valencia region and describe the strength of association between specific factors and the presence of hypertension. METHODS: Cross-sectional population-based study in 413 men and 415 women between 16 and 90 years participants in Nutrition Survey of Valencia held in 2010. Data were collected through household survey and blood pressure was measured using an automated sphygmomanometer. Hypertension was defined according to criteria established in 2007 by the European Society of Hypertension and the European Society of Cardiology. Strength of association between hypertension and associated factors was measured by binary logistic regression for demographic explanatory variables, family history, lifestyle, anthropometric variables and others. RESULTS: The prevalence of hypertension estimated for Valencia region was 38,2% [95% CI 34,9 to 41,5]; 40,7% in men [95% CI 35,0 to 45,5] and 35,7% in women [95% CI 31,1 to 40,3]. Remained as associated variables with hypertension: age [45-64 years OR 4.3, IC 95% 2.1-8.8; 65 or more years, OR 15.5, IC 95% 7.2-33.2], body mass index [overweight OR 2.1 95% CI 1.3 to 3.2; obesity OR 5.3, 95% CI 3.3 to 8.5] and diabetes [OR 2.4, 95% CI 1.2-4.8]. CONCLUSIONS: More than a third of the study population suffers from hypertension. Its risk increases with age. Overweight and diabetes mellitus double the likelihood of developing hypertension.

OBJETIVO: La hipertensión es un importante factor de riesgo en términos de mortalidad atribuible y como factor de riesgo cardiovascular modificable. El objetivo del estudio fue estimar la prevalencia de hipertensión arterial en población mayor de quince años de la Comunitat Valenciana y describir su asociación con determinados factores etiológicos. METODOS: Estudio transversal de base poblacional en 413 hombres y 415 mujeres de 16 a 90 años de edad participantes en la Encuesta de Nutrición de la Comunitat Valenciana realizada en 2010. La información se obtuvo mediante encuesta a domicilio y medida de la presión arterial utilizando esfigmomanómetro automático. Para la definición de hipertensión arterial se siguió el criterio establecido en 2007 por la Sociedad Europea de Hipertensión Arterial y la Sociedad Europea de Cardiología. La asociación entre factores asociados e hipertensión medida mediante regresión logística binaria para variables explicativas sociodemográficas, antecedentes, estilos de vida, variables antropométricas y otras. RESULTADOS: La prevalencia de hipertensión estimada para la Comunidad Valenciana fue de 38,2% [IC95% 34,9-41,5]; 40,7% en hombres [IC95%35,0-45,5] y 35,7% en mujeres [IC95% 31,1-40,3]. La edad [45-64 años OR: 4,3, IC 95% 2,1-8,8; 65 o más años, OR 15,5, IC 95% 7,2-33,2)], la categoría ponderal [sobrepeso OR 2,1 IC95% 1,3-3,2; obesidad OR 5,3, IC95% 3,3-8,5] y padecer diabetes [OR 2,4, IC95% 1,2-4,8] se constituyeron como variables asociadas con hipertensión. CONCLUSIONES: Más de un tercio de la población estudiada padece hipertensión. La probabilidad de presentarla aumenta con la edad. El sobrepeso así como la diabetes mellitus duplican la probabilidad de padecerla.

Prevalencia de hipertensión arterial y de sus factores asociados en población de 16 a 90 añor de edad en la Comunitat Valenciana / Prevalence of hypertension and associated factors in population aged 16 to 90 years old in Valencia Region, Spain

Fundamento: La hipertensión es un importante factor de riesgo en términos de mortalidad atribuible y como factor de riesgo cardiovascular modificable. El objetivo del estudio fue estimar la prevalencia de hipertensión arterial en población mayor de quince años de la Comunitat Valenciana y describir su asociación con determinados factores etiológicos. Métodos: Estudio transversal de base poblacional en 413 hombres y 415 mujeres de 16 a 90 años de edad participantes en la Encuesta de Nutrición de la Comunitat Valenciana realizada en 2010. La información se obtuvo mediante encuesta a domicilio y medida de la presión arterial utilizando esfigmomanómetro automático. Para la definición de hipertensión arterial se siguió el criterio establecido en 2007 por la Sociedad Europea de Hipertensión Arterial y la Sociedad Europea de Cardiología. La asociación entre factores asociados e hipertensión medida mediante regresión logística binaria para variables explicativas sociodemográficas, antecedentes, estilos de vida, variables antropométricas y otras. Resultados: La prevalencia de hipertensión estimada para la Comunidad Valenciana fue de 38,2% [IC95% 34,9-41,5]; 40,7% en hombres [IC95%35,0-45,5] y 35,7% en mujeres [IC95% 31,1-40,3]. La edad [45-64 años OR 4,3, IC 95% 2,1-8,8; ≥65 años, OR 15,5, IC 95% 7,2-33,2)], la categoría ponderal [sobrepeso OR 2,1 IC95% 1,3-3,2; obesidad OR 5,3, IC95% 3,3-8,5] y padecer diabetes mellitus [OR 2,4, IC95% 1,2-4,8] se constituyeron como variables asociadas con hipertensión. Conclusiones: Más de un tercio de la población estudiada padece hipertensión. La probabilidad de presentarla aumenta con la edad. El sobrepeso así como la diabetes mellitus duplican la probabilidad de padecerla (AU)

Background: Hypertension is the main risk factor in terms of attributable mortality and the most common modifiable cardiovascular risk factor. The aim of the study was to estimate the prevalence of hypertension in population more than fifteen years of Valencia region and describe the strength of association between specific factors and the presence of hypertension. Methods: Cross-sectional population-based study in 413 men and 415 women between 16 and 90 years participants in Nutrition Survey of Valencia held in 2010. Data were collected through household survey and blood pressure was measured using an automated sphygmomanometer. Hypertension was defined according to criteria established in 2007 by the European Society of Hypertension and the European Society of Cardiology. Strength of association between hypertension and associated factors was measured by binary logistic regression for demographic explanatory variables, family history, lifestyle, anthropometric variables and others. Results: The prevalence of hypertension estimated for Valencia region was 38,2% [95% CI 34,9 to 41,5]; 40,7% in men [95% CI 35,0 to 45,5] and 35,7% in women [95% CI 31,1 to 40,3]. Remained as associated variables with hypertension: age [45-64 years OR 4,3, IC 95% 2,1-8,8; ≥65 years, OR 15,5, IC 95% 7,2-33,2], body mass index [overweight OR 2,1 95% CI 1,3 to 3,2; obesity OR 5,3, 95% CI 3,3 to 8,5] and diabetes [OR 2,4, 95% CI 1,2-4,8]. Conclusions: More than a third of the study population suffers from hypertension. Its risk increases with age. Overweight and diabetes mellitus double the likelihood of developing hypertension (AU)

Conocimiento, tratamiento y control de la hipertensión arterial en la población de 16 a 90 años en la Comunitat Valenciana, 2010 / Awareness, treatment and control of hypertension in population aged 16 to 90 years old in the Valencia Region, Spain, 2010

Fundamento: La hipertensión arterial es un importante factor de riesgo en términos de mortalidad atribuible y el principal factor de riesgo cardiovascular modificable. El objetivo del estudio fue estimar el grado de conocimiento y control de la hipertensión e identificar los factores que influyen en la falta de control adecuado. Métodos: Estudio transversal de base poblacional en 413 hombres y 415 mujeres entre 16 y 90 años participantes en la Encuesta de Nutrición de la Comunitat Valenciana realizada en 2010. Para la toma de la presión arterial se utilizó esfigmomanómetro automático. La hipertensión fue definida según el criterio de 2007 de la Sociedad Europea de Hipertensión Arterial y la Sociedad Europea de Cardiología. Los datos sobre conocimiento y tratamiento fueron obtenidos de la encuesta. Los factores predictores del conocimiento, tratamiento y control de hipertensión se estimaron mediante modelos de regresión logística. Resultados: La prevalencia de hipertensión estimada para la población estudiada fue del 38,2% (IC 95% 34,9%-41,5%). El 51,4% (IC 95% 45,9%-57,0%) de la población hipertensa conocía su condición. De estos el 88,8% (IC 95% 83,9%-93,6%) recibía tratamiento farmacológico y de ellos el 45,1% (IC95% 36,9%-53,3%) mantenía la presión arterial controlada. Conclusiones: Desde la última encuesta realizada en la Comunitat Valenciana, el grado de conocimiento del hipertenso no es mejor si bien se observa un incremento de las personas tratadas (AU)

Background: Hypertension is an important risk factor in terms of mortality attributable and the main modifiable cardiovascular risk factor. The aim of the study is to estimate degree of awareness, treatment and control of hypertension in population of Valencia Region and identify predictors that explain the lack of proper control. Methods: Cross-sectional population-based study in 413 men and 415 women between 16 and 90 years participants in Nutrition Survey of Valencia held in 2010. Automatic sphygmomanometer was used for taking blood pressure. Hypertension was defined according to the criteria of 2007 European Society of Hypertension and the European Society of Cardiology. Data on knowledge and treatment were obtained by survey. Predictors for awareness, treatment and control of hypertension were estimated by logistic regression models. Results: The prevalence of hypertension estimated for the study population was 38.2% (95% CI 34.9%-41.5%). 51.4% (95% CI 45.9%-57.0%) of the hypertensive population, knew his condition. 88.8% of them (95% CI 83.9%-93.6%) were receiving drug therapy and of these, 45.1% (95% CI 36.9%-53.3%) maintained blood pressure controlled. Conclusions: Since the last survey in Valencia Region, the degree of awareness of hypertension has not improved although an increase in those treated with antihypertensive drugs is observed (AU)

[Care for patients with altered states of consciousness in a hospital for chronic and long-stay patients]. / Atencion a pacientes con estados alterados de conciencia en un hospital de pacientes cronicos y larga estancia.

INTRODUCTION: Between 30% and 40% of patients with brain damage present alterations in their level of consciousness and, in some cases, altered states of consciousness: unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS). Recovery varies and survival is threatened by a number of complications. AIMS: The purpose of this study is to present the working methodology used at the Hospital La Pedrera (HLP) for patients in UWS or MCS and to analyse the clinical characteristics of the patients attended to, their progress, and the functional and cognitive situation at the time of their discharge from hospital. PATIENTS AND METHODS: The work consisted in a prospective descriptive study of patients seen at the HLP over the period 2009-2013, who had been diagnosed with UWS or MCS. RESULTS: The HLP uses the case management method, offering integrated care dispensed by a multidisciplinary team. Patients are classified according to healthcare goals. Patients with UWS or MCS are included in the integrated care and adaptation programme. A total of 23 patients (86.9% males) were attended to, the mean age being 54.9 years. Aetiology: brain haemorrhage, 30.4%; anoxic encephalopathy, 26.6%; metabolic encephalopathy, 17.3%; and other causes, 17.3%. Altogether 73.9% were admitted in UWS and the rest in MCS. COURSE: 43.4% improved their initial cognitive situation and 88.8% presented a situation of total dependence at the time of discharge. The most frequent complications were respiratory and urinary infections (53.6%). Death occurred in 65.2% of cases. CONCLUSIONS: Medical attention in UWS or MCS is complex and requires multidisciplinary care. Almost half of the patients improved their cognitive situation, which justifies a proactive attitude that attempts to improve the quality of life of both patients and their families.

TITLE: Atencion a pacientes con estados alterados de conciencia en un hospital de pacientes cronicos y larga estancia.Introduccion. Un 30-40% de los pacientes con daño cerebral presenta alteraciones del nivel de conciencia, y algunos casos, estados alterados de conciencia: sindrome de vigilia sin respuesta (SVSR) o estado de minima conciencia (EMC). La recuperacion es variable y la supervivencia esta amenazada por multiples complicaciones. Objetivos. Presentar la metodologia de trabajo del Hospital La Pedrera (HLP) para pacientes en SVSR o EMC y analizar las caracteristicas clinicas de los pacientes atendidos, la evolucion, y la situacion funcional y cognitiva en el momento del alta. Pacientes y metodos. Estudio descriptivo prospectivo de pacientes atendidos en el HLP durante el periodo 2009-2013, con diagnostico de SVSR o EMC. Resultados. El HLP trabaja mediante el metodo gestion de caso, ofreciendo una atencion integral por un equipo multidisciplinar. Los pacientes se clasifican segun objetivos asistenciales. Los pacientes con SVSR o EMC se incluyen en el programa de cuidados integrales y adaptacion. Se atendio a 23 pacientes (86,9% varones), con una edad media de 54,9 años. Etiologia: hemorragia cerebral, 30,4%; encefalopatia anoxica, 26,6%; encefalopatia metabolica, 17,3%; y otras causas, 17,3%. El 73,9% ingreso en SVSR y el resto en EMC. Evolucion: el 43,4% mejoro su situacion cognitiva inicial y el 88,8% presentaba una situacion de dependencia total en el momento del alta. Las complicaciones mas frecuentes fueron infecciones respiratorias y urinarias (53,6%). El 65,2% de los casos fueron exitus. Conclusiones. La asistencia en SVSR o EMC es compleja y precisa cuidados multidisciplinares. Casi la mitad de los pacientes mejoro su situacion cognitiva, lo que justifica una actitud proactiva que intente mejorar la calidad de vida de los pacientes y sus familias.

Heterogeneity in expected longevities.

We develop a new methodology to compute differences in the expected longevity of individuals of a given cohort who are in different socioeconomic groups at a certain age. We address the two main problems associated with the standard use of life expectancy: (1) that people's socioeconomic characteristics change, and (2) that mortality has decreased over time. Our methodology uncovers substantial heterogeneity in expected longevities, yet much less heterogeneity than what arises from the naive application of life expectancy formulae. We decompose the longevity differences into differences in health at age 50, differences in the evolution of health with age, and differences in mortality conditional on health. Remarkably, education, wealth, and income are health-protecting but have very little impact on two-year mortality rates conditional on health. Married people and nonsmokers, however, benefit directly in their immediate mortality. Finally, we document an increasing time trend of the socioeconomic gradient of longevity in the period 1992-2008, and we predict an increase in the socioeconomic gradient of mortality rates for the coming years.