Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 969
Filtrar
1.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32873477

RESUMO

In order to avoid radial tearing of the anterior capsule while performing continuous circular capsulorhexis (CCC) in a white intumescent cataract, called the "Argentinian flag sign" when CCC is associated with a previous capsular stain with trypan blue, an initial puncture of the anterior capsule is performed with a 30G needle as the first step of the surgical procedure, that means, prior to any previous aperture of the anterior chamber. This act seems to allow the pressure of the intracrystalline space and the pressure of the anterior chamber to be equalized, as the liquefied content of the intumescent white cataract is released into a presumably hermetic anterior chamber, avoiding the dreaded anterior capsular radial tear. This technique, called "white-puncture", has been used in 174 cases without any associated complications.

2.
Patient Educ Couns ; 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32782178

RESUMO

OBJECTIVE: The aim of this study is to explore barriers and opportunities in non-pharmacological treatment of depression in primary care (PC) from the perspective of family physicians (FPs). METHODS: Qualitative analysis was used to explore a sample of 36 FPs treating patients with depressive symptoms. Criteria to maximize variability were followed. Participants were identified by key informants. Six group interviews were developed following a semi-structured thematic script. All interviews were transcribed, analyzed and triangulated. Information was saturated. Principals of reflexivity and circularity were implemented. RESULTS: The results obtained followed 3 main theoretical axes: the FP, the patient, the healthcare system, and the interaction between them. Barriers included poor alignment with clinical practice guidelines, inadequate FP training, patients' preferences and structural challenges in PC. Among opportunities were good FP clinical interview skills, the beneficial bond of trust between patients and FPs and improved communication with mental healthcare services. CONCLUSION: Based on FPs' perceptions, non-pharmacological treatment of depression in PC is particularly limited by lack of structured training; patients' preferences and treatment expectations; structural challenges in PC; and insufficient support from specialized mental health professionals. PRACTICE IMPLICATIONS: Resources for education, structural support in PC and modified back up from mental healthcare services are needed.

3.
Eur J Clin Pharmacol ; 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32613537

RESUMO

BACKGROUND: Studies validating indirect methods to identify nonadherence in chronic patients who visit pharmacies are lacking. The aim of this study was to validate self-reported adherence and assess the variables associated with both overestimation and underestimation of good adherence when using this method. MATERIALS AND METHODS: An observational, cross-sectional study was undertaken to validate self-reported adherence in 132 community pharmacies throughout Spain in 6237 chronic patients. The Morisky-Green test was used as the validation method and through a 2 × 2 table, the validity indicators, predictive values, and likelihood ratios were calculated. To assess the variables associated with both overestimation and underestimation of good adherence, multivariate logistic regression analysis and calculation of the area under the ROC curve were used to evaluate discriminatory capacity. RESULTS: Sensitivity was 27.8% (95% CI: 26.2-29.4) and specificity was 93.9% (95% CI: 93.1-94.7). Discrepancy analysis obtained a significant overestimation of good adherence (p < 0.001). The factors associated with overestimating good adherence were performing a mnemonic trick (p < 0.001), not self-medicating (p < 0.001), a high level of physical activity (p < 0.001), and an older age (p = 0.014). Factors associated with underestimation were self-medication (p < 0.001), desiring more information (p < 0.001), smoking (p = 0.014), not engaging in physical activity in the low (p = 0.006) or high (p < 0.001) categories, having a younger mean age (p = 0.007), and taking two to three (p = 0.029) or four or more (p < 0.001) chronic treatments. CONCLUSION: Self-reported adherence has good specificity but poor sensitivity. The associated profiles of the discrepancies were obtained to identify both good and poor adherence.

4.
Comput Methods Programs Biomed ; 196: 105613, 2020 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-32593974

RESUMO

BACKGROUND AND OBJECTIVE: Health care costs represent a substantial an increasing percentage of global expenditures. One key component is treatment of respiratory diseases, which account for one in twelve deaths in Europe. Computational simulations of lung airflow have potential to provide considerable cost reduction and improved outcomes. Such simulations require accurate in silico modeling of the lung airway. The geometry of the lung is extremely complex and for this reason very simple morphologies have primarily been used to date. The objective of this work is to develop an effective methodology for the creation of hybrid pulmonary geometries combining patient-specific models obtained from CT images and idealized pulmonary models, for the purpose of carrying out experimental and numerical studies on aerosol/particle transport and deposition in inhaled drug delivery. METHODS: For the construction of the hybrid numerical model, lung images obtained from computed tomography were exported to the DICOM format to be treated with a commercial software to build the patient-specific part of the model. At the distal terminus of each airway of this portion of the model, an idealization of a single airway path is connected, extending to the sixteenth generation. Because these two parts have different endings, it is necessary to create an intermediate solid to link them together. Physically realistic treatment of truncated airway boundaries in the model was accomplished by mapping of the flow velocity distribution from corresponding conducting airway segments. RESULTS: The model was verified using two sets of simulations, steady inspiration/expiration and transient simulation of forced spirometry. The results showed that the hybrid model is capable of providing a realistic description of air flow dynamics in the lung while substantially reducing computational costs relative to models of the full airway tree. CONCLUSIONS: The model development outlined here represents an important step toward computational simulation of lung dynamics for patient-specific applications. Further research work may consist of investigating specific diseases, such as chronic bronchitis and pulmonary emphysema, as well as the study of the deposition of pollutants or drugs in the airways.

5.
Diabetes Metab Res Rev ; : e3320, 2020 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-32239693

RESUMO

BACKGROUND AND AIMS: Tools to detect type 1 diabetes (T1D) individuals at overt cardiovascular disease (CVD) risk are scarce. We aimed to assess the usefulness of the score 'Steno Type 1 Risk Engine' (Steno-Risk) to identify T1D patients with advanced carotid atherosclerosis. MATERIAL AND METHODS: T1D patients without CVD with at least one of the following were included: ≥40 years, diabetic nephropathy, or diabetes duration ≥10 years with ≥1 CVD risk factor. Intima-media thickness (IMT) and plaque presence (IMT ≥1.5 mm) were assessed by standardized B-mode ultrasonography. Steno-Risk was used to estimate 10-year risk (<10% low; 10%-20% moderate; ≥20% high risk). Associations between Steno-Risk and preclinical atherosclerosis were assessed after adjusting for other CVD risk factors. RESULTS: We evaluated 302 patients (55% men, age 47.8 ± 9.8 years, T1D duration 26.3 ± 9.3 years). The prevalence of carotid plaque and ≥2 plaques were 36.4% and 19.2%, respectively; without sex differences. Age (57.4 ± 7.4 vs 37.1 ± 6.2 years), T1D duration (31.3 ± 10.4 vs 21.5 ± 7.1 years), hypertension (52.3% vs 6.3%), nephropathy (25.6% vs 5.1%) and retinopathy (53.5% vs 32.9%) were higher in high-risk (n = 86) vs low-risk participants (n = 79; P < .001 for all). Preclinical atherosclerosis (IMT and plaque) increased in parallel with Steno-Risk (P < .001). In logistic regression analysis, both age ≥40 years and Steno-Risk ≥20% were associated with the presence of plaque (OR 4.22 [1.57-11.36] and 3.79 [1.61-6.80]; respectively), but only high Steno-Risk remained independently associated with ≥2 plaques (OR 3.31 [1.61-6.80]). CONCLUSION: Steno-Risk is independently associated with preclinical atherosclerosis. Further studies are needed to ascertain its usefulness in this high-risk population.

6.
Sci Rep ; 10(1): 1039, 2020 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-31974468

RESUMO

Extracellular vesicles (EVs) are nano-sized vesicles containing nucleic acid and protein cargo that are released from a multitude of cell types and have gained significant interest as potential diagnostic biomarkers. Human serum is a rich source of readily accessible EVs; however, the separation of EVs from serum proteins and non-EV lipid particles represents a considerable challenge. In this study, we compared the most commonly used isolation techniques, either alone or in combination, for the isolation of EVs from 200 µl of human serum and their separation from non-EV protein and lipid particles present in serum. The size and yield of particles isolated by each method was determined by nanoparticle tracking analysis, with the variation in particle size distribution being used to determine the relative impact of lipoproteins and protein aggregates on the isolated EV population. Purification of EVs from soluble protein was determined by calculating the ratio of EV particle count to protein concentration. Finally, lipoprotein particles co-isolated with EVs was determined by Western blot analysis of lipoprotein markers APOB and APOE. Overall, this study reveals that the choice of EV isolation procedure significantly impacts EV yield from human serum, together with the presence of lipoprotein and protein contaminants.

7.
Clin Transl Oncol ; 22(4): 555-562, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31256362

RESUMO

PURPOSE: There is limited evidence on the efficacy and safety of anti-programmed cell death protein 1 (PD-1)-/anti-programmed death-ligand 1 (PD-L1)-based immunotherapy in the elderly, particularly those aged over 75 years. METHODS/PATIENTS: The clinical response and toxicity profile of anti-PD-1-/anti-PD-L1-based immunotherapy in patients aged over 75 years were assessed in this retrospective observational study conducted in the Medical Oncology Service of a tertiary level hospital. The associations among clinical responses, adverse events, and geriatric syndromes were evaluated. RESULTS: In total, 20 patients aged between 75 and 94 years were evaluated. Pembrolizumab and nivolumab were the most commonly used drugs. A clinical benefit (stable disease, partial response or complete response) was documented in 13 patients (65%). This proportion was 80% in patients aged between 75 and 79 years, and 50% in those aged over 79 years (p = 0.236). The adverse events were similar to those reported in younger patients. At least one clinical adverse event (cAE) and one laboratory adverse event (lAE) was reported in 75% and 55% of patients, respectively. Polypharmacy was observed for all patients and multi-morbidity in 95%. Patients without gait disorders showed more responses to immunotherapy. The number of lAEs was significantly associated with the number of commonly prescribed drugs (slope = 0.218, p = 0.010), the Eastern Cooperative Oncology Group score, and the number of cAEs. CONCLUSIONS: The elderly can obtain benefits from anti-PD-1-/anti-PD-L1-based immunotherapy. The toxicity profile was similar to that reported in younger counterparts.

8.
Med Intensiva ; 2019 Nov 15.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31740045

RESUMO

Intensive care to facilitate organ donation (ICOD) is defined as the initiation or continuation of life-sustaining measures, such as mechanical ventilation, in patients with a devastating brain injury with high probability of evolving to brain death and in whom curative treatment has been completely dismissed and considered futile. ICOD incorporates the option to organ donation allowing a holistic approach to end-of-life care, consistent with the patients wills and values. Should the patient not evolve to brain death, life-supportive treatment must be withdrawal and controlled asystolia donation could be evaluated. ICOD is a legitimate practice, within the ethical and legal regulations that contributes increasing the accessibility of patients to transplantation, promoting health by increasing deceased donation by 24%, and with a mean of 2.3 organs transplanted per donor, and collaborating with the sustainability of health-care system. This ONT-SEMICYUC recommendations provide a guide to facilitate an ICOD harmonized practice in spanish ICUs.

9.
Prog. obstet. ginecol. (Ed. impr.) ; 62(5): 464-471, sept.-oct. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-192129

RESUMO

De forma tradicional e histórica, las recomendaciones referidas al ejercicio físico durante el embarazo han estado basadas en cuestiones culturales y sociales, más que en evidencias científicas. De tal forma, la información científica disponible a través de guías de actuación profesional ha sido escasa o prácticamente inexistente. Ante esta situación, y con el ejercicio físico insertado en nuestra sociedad como un elemento básico de promoción de la salud, se hace importante disponer de unas guías prácticas que permitan a los profesionales, especialmente los sanitarios, disponer de recomendaciones para el ejercicio físico durante el embarazo basadas en sólidas evidencias científicas. El objetivo del presente estudio ha sido la elaboración de las primeras guías españolas de práctica clínica para el ejercicio físico durante el embarazo. El equipo de trabajo se formó producto de la solicitud de la Sociedad Española de Ginecología y Obstetricia (SEGO) al grupo de investigación Actividad Físico-deportiva en Poblaciones Específicas (AFIPE), de la Universidad Politécnica de Madrid; para la elaboración de las presentes guías estuvo formado por profesionales sanitarios, de las ciencias de la actividad física y del deporte y de la biblioteconomía y la documentación. El proceso metodológico desarrollado estuvo basado en el utilizado en las guías canadienses para la actividad física durante el embarazo, recientemente publicadas. Los resultados obtenidos permitieron elaborar unas recomendaciones básicas para el ejercicio físico durante la gestación, así como factores y situaciones que se deben tener en cuenta durante la práctica física en mujeres gestantes


Traditionally and historically, recommendations regarding physical exercise during pregnancy have been based on cultural and social issues, rather than on scientific evidence. Thus, the scientific information available through professional guidelines has been scarce or virtually non-existent. In this situation, with the physical exercise inserted in our society as a basic element of health promotion, it is important to have practical guidelines for professionals, especially health practitioners, with recommendations for physical exercise during pregnancy based in solid scientific evidence. The objective of this study has been the elaboration of the first Spanish clinical practice guidelines for physical exercise during pregnancy. The work team was formed based on the request of the Spanish Society of Gynecology and Obstetrics (SEGO) to the research group "Physical-sport activity in specific populations" (AFIPE), of the Universidad Politécnica de Madrid for the elaboration of the present guidelines, the work team was composed by health professionals, the physical activity and sports sciences professionals and one professional from the library and documentation science. The methodological process developed was based on the Canadian guidelines for physical activity during pregnancy, recently published. The obtained results allowed to establish basic recommendations for physical exercise during pregnancy, as well as factors and situations that should be considered during exercise in pregnant women


Assuntos
Humanos , Feminino , Gravidez , Prática Clínica Baseada em Evidências , Exercício Físico/fisiologia , Gravidez/fisiologia
10.
Phys Rev Lett ; 123(2): 022002, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31386541

RESUMO

We present the first observation of K^{-} and ϕ absorption within nuclear matter by means of π^{-}-induced reactions on C and W targets at an incident beam momentum of 1.7 GeV/c studied with HADES at SIS18/GSI. The double ratio (K^{-}/K^{+})_{W}/(K^{-}/K^{+})_{C} is found to be 0.319±0.009(stat)_{-0.012}^{+0.014}(syst) indicating a larger absorption of K^{-} in heavier targets as compared to lighter ones. The measured ϕ/K^{-} ratios in π^{-}+C and π^{-}+W reactions within the HADES acceptance are found to be equal to 0.55±0.04(stat)_{-0.07}^{+0.06}(syst) and to 0.63±0.06(stat)_{-0.11}^{+0.11}(syst), respectively. The similar ratios measured in the two different reactions demonstrate for the first time experimentally that the dynamics of the ϕ meson in nuclear medium is strongly coupled to the K^{-} dynamics. The large difference in the ϕ production off C and W nuclei is discussed in terms of a strong ϕN in-medium coupling. These results are relevant for the description of heavy-ion collisions and the structure of neutron stars.

11.
Mar Pollut Bull ; 142: 206-215, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31232296

RESUMO

Sampling, cost-effective analysis, diagnosis of sources of pollution and assessment of potential toxicological effects were included in the case study. Marine sediments collected from 24 points along the eastern Mediterranean coast of Spain (Comunitat Valenciana region) in 2010, 2011, 2012 and 2015 have been analysed for polycyclic aromatic hydrocarbons. Fluoranthene, pyrene, chrysene, benzo[b]fluoranthene and benzo[a]pyrene were the most found. An analysis of the relative abundance of selected PAHs revealed that petrogenic and mixed petrogenic/pyrogenic sources are predominant in the area. The total concentrations of the target compounds ranged from 14.7 to 615.3 ng/g dry weight. The effects range-low (ERL) guideline values were used to assess potential toxicological effects. Rarely adverse biological effects can be expected in the tested area. The level of pollution by PAHs in the area can be considered low, although occasionally high values can be found, particularly in areas with high population or ship traffic.


Assuntos
Sedimentos Geológicos/análise , Hidrocarbonetos Policíclicos Aromáticos/análise , Poluentes Químicos da Água/análise , Monitoramento Ambiental , Espanha
12.
Biomech Model Mechanobiol ; 18(6): 1759-1771, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31154547

RESUMO

CFD modeling research about the lung airflow with a complete resolution and an adequate accuracy at all scales requires a great amount of computational resources due to the vast number of necessary grid elements. As a result, a common practice is to conduct simplifications that allows to manage it with ordinary computational power. In this study, the implementation of a special boundary condition in order to develop a simplified single conductive lung airway model, which exactly represents the effect of the removed airways, is presented. The boundary condition is programmed in the open-source software OpenFOAM®, and the developed source code is presented in the proper syntax. After this description, modeling accuracy is evaluated under different flow rate conditions typical of human breathing processes, including both inspiration and expiration movements. Afterward, a validation process is conducted using results of a Weibel's model (0-4 generations) simulation for a medium flow rate of 50 L/min. Finally, a comparison against the proposed boundary condition implemented in the commercial code ANSYS Fluent is made, which highlights the benefits of using the free code toolbox. The specific contribution of this paper will be to show that OpenFOAM® developed model can perform even better than other commercial codes due to a precise implementation and coupling of the default solver with the in-house functions by virtue of the open-source nature of the code.


Assuntos
Hidrodinâmica , Pulmão/fisiologia , Modelos Biológicos , Software , Pulmão/diagnóstico por imagem , Pressão , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X
13.
Rev. osteoporos. metab. miner. (Internet) ; 11(2): 46-54, abr.-jun. 2019. graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-188336

RESUMO

Introducción: La artrosis (OA) es una enfermedad musculo esquelética degenerativa que afecta aproximadamente al13% de la población occidental. A día de hoy no existe un tratamiento eficaz que evite el progreso de la misma o facilite la regeneración del cartílago articular. La conexina43 (Cx43) es una proteína transmembrana que se encuentra en niveles elevados en el cartílago y en la membrana sinovial de pacientes con OA. Esta proteína forma canales que permiten el intercambio de moléculas e iones entre dos células en contacto o entre la célula y su entorno, denominados uniones co‐municantes (UCs) y hemicanales, respectivamente. En este estudio se investigó la función de la Cx43 y de las UCs en la degradación del cartílago articular de pacientes con OA. Material y métodos: Se han aislado condrocitos primarios del cartílago de donantes OA y sanos. Se evaluaron los niveles proteicos mediante Western blot, inmunofluorescencia y citometría de flujo. La expresión génica se ha evaluado mediante RT‐qPCR, mientras que la comunicación celular se estudió mediante el ensayo scrape loading/dye transfer. La senescencia celular se evaluó midiendo la actividad de la β‐galactosidasa mediante citometría celular o microscopía. Resultados: Los resultados obtenidos indican que la sobre actividad de la Cx43 y de la comunicación intercelular a través de UCs detectadas en OA están implicadas con el progreso de la enfermedad al activar procesos de desdiferenciación celular hacia un estado inmaduro y senescencia celular. Utilizando condrocitos en cultivo aislados del cartílago de donantes con OA hemos demostrado que el incremento de la Cx43 activa factores implicados en la transición epitelio‐me sénquima (TEM), como el factor de transcripción Twist‐1. El incremento en el número de células desdiferenciadas y con altos índices de proliferación celular desencadena en senescencia celular vía p53/p16INK4a, activando el fenotipo secretor asociado a senescencia (SASP, del inglés Senescence-Associated Secretory Phenotype) que incluye la síntesis y liberación de factores inflamatorios como la interleuquina 6 (IL‐6). La disminución de los niveles de la Cx43 utilizando pequeñas moléculas como la oleuropeína o técnicas de edición genética como CRISPR/Cas9 revirtió el proceso dando lugar a re‐diferenciación celular, mejorando el fenotipo celular con incremento en proteínas implicadas en formación del tejido y diminuyendo la síntesis de MMPs y del componente inflamatorio y senescencia. Conclusiones: La disminución de la Cx43 en condrocitos artrósicos restaura regeneración tisular, por activación de re‐diferenciación celular y disminución de senescencia. Estos resultados corroboran el uso de la Cx43 como una diana terapéutica eficaz para restaurar regeneración del cartílago en pacientes con OA y evitar la progresión de la enfermedad


Introduction: Osteoarthritis (OA) is a degenerative musculoskeletal disease, which affects approximately the 13% of western population. Nowadays, there is no effective treatment for OA to avoid disease progression or to promote cartilage regeneration. Connexin43 (Cx43) is a transmembrane protein increased in cartilage and synovium from OA patients.Cx43 forms membrane channels that allow the exchange of molecules and ions between two adjacent cells through gapjunctions (GJs), or between a cell and its environment through hemichannels. In this study we investigated the involvement of Cx43 and GJ intercellular communication in the degradation of articular cartilage in chondrocytes from patientswith OA. Material and methods:Primary chondrocytes were obtained from cartilage from OA and healthy donors. Protein levelswere evaluated by western‐blot, immunofluorescence and flow cytometry. RNA expression was evaluated by RT‐qPCR.A scrape loading/dye transfer assay was used to evaluate cell communication. Cell senescence was analysed by flowcytometry or by light microscopy using β‐galactosidase assay.Results:Cx43 and GJs overactivities were correlated with the progression of OA, by promoting chronic cell dedifferen‐tiation and senescence in vitroassays. We found that Cx43 over expression activates factors involved in epithelial‐to‐me‐senchymal transition, such as Twist‐1. Increased levels of dedifferentiated cells, with high rates of cell proliferation, led to cell senescence via p53/p16INK4a, activating the senescence‐associated secretory phenotype (SASP) and promoting the synthesis and liberation of inflammatory factors, including the interleukin‐6 (IL‐6). Cx43 down regulation by using small molecules, such as oleuropein, or by genetic edition with CRISPR technology, led to the chondrocyte redifferentiation and an improved phenotype, with increased synthesis of extracellular matrix proteins such as Col2A1 and down‐regulating the synthesis of MMPs, inflammation and senescence. Conclusions: Down regulation of Cx43 in OA chondrocytes restores regeneration by activating chondrocyte re‐differentiation and decreasing cellular senescence. These results corroborate the use of Cx43 as an effective therapeutic target in order to restore cartilage regeneration and avoid OA progression


Assuntos
Humanos , Conexina 43/uso terapêutico , Artropatias/tratamento farmacológico , Artropatias/fisiopatologia , Plasticidade Celular/fisiologia , Senescência Celular/fisiologia , Condrócitos/fisiologia , Western Blotting , Imunofluorescência , Citometria de Fluxo , Progressão da Doença , Imuno-Histoquímica
14.
Exp Gerontol ; 123: 10-16, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31117002

RESUMO

Cortisol dysregulation is proposed as a factor in the development of Alzheimer's disease (AD). AD patients can show high cortisol levels in prodromal phases of AD, early enough that neuropsychological alterations exist but activities of daily living remain unimpaired. Nevertheless, it is unknown if biofluid cortisol levels can have some AD predictive power together with neuropsychological assessment in prodromal stages in comparison with other cognitive disorders. In this work, an analytical method based on ultra-performance liquid chromatography coupled to tandem mass spectrometry (UPLC-MS/MS) was applied to determine the cortisol levels in different biofluids (urine, plasma, saliva, cerebrospinal fluid). Early AD patients and non-AD patients recruited at out-patient neurological unit were classified from the standard cerebrospinal fluid biomarkers levels (ß-amyloid, tau, phosphorylated tau), and studied with an extensive neuropsychological assessment including global, neuropsychological, functional and affective scales. We used a logistic regression model to discriminate between the AD and non-AD groups. Higher plasma cortisol levels were found in the AD group than in the non-AD group (p < 0.001). Regarding neuropsychological evaluation, delayed memory was used as representative of the neuropsychological status, and lower scores were obtained in the AD group (p < 0.001). The prediction model, including plasma cortisol levels and delayed memory scores, achieved an AUC of 0.93, as well as a sensitivity of 97% and a specificity of 69.4%. In conclusion, plasma cortisol levels and delayed memory scores were specifically impaired in early AD, allowing the development of a new diagnostic model which could be employed as a very satisfactory screening system.

15.
Semin Fetal Neonatal Med ; 24(4): 101002, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30981693

RESUMO

The neonatal period is a highly sensitive time span during which stressful experiences may have an influence on later health outcomes. Medical procedures applied to newborn babies during hospitalization are stressors that trigger a physiological and psychological stress response. Stress response has been traditionally evaluated using scores based on behavioural signs such as facial expressions, limb movements, crying, etc., which are subjectively interpreted. Only few studies have employed measurable physiological signs to objectively evaluate the stress response to specific interventions. The aim of this review is to inform of recently developed biochemical methods that allow clinicians to evaluate the stress response to medical procedures performed in the neonatal period in biological samples non-invasively obtained. Stress biomarkers are based on the physiological stress response mediated by the hypophysis-pituitary-adrenal axis and the sympathetic-adreno-medullary systems. Cortisol is at present the most widely employed laboratory determination to measure stress levels. In recent years, sequentially determined salivary cortisol levels have allowed non-invasive monitoring of newborn infants under stressful conditions in the NICU.


Assuntos
Biomarcadores/metabolismo , Estresse Fisiológico , Estresse Psicológico/diagnóstico , 17-alfa-Hidroxiprogesterona/metabolismo , Catecolaminas/metabolismo , Citocinas/metabolismo , Glicopeptídeos/metabolismo , Cabelo/metabolismo , Humanos , Hidrocortisona/metabolismo , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Peróxidos Lipídicos/metabolismo , Norepinefrina/metabolismo , Ocitocina/metabolismo , Saliva/metabolismo , alfa-Amilases/metabolismo
16.
Leuk Res ; 79: 69-74, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30773246

RESUMO

BACKGROUND: Flow cytometry (FC) is a valuable tool for the diagnosis of myelodysplastic syndromes (MDS). We present results of a survey carried out to evaluate FC current practice for MDS diagnosis in Latin America (LA), focusing on markers used and characteristics of the clinical diagnostic report. Compliance to IMDSflow recommendations was also evaluated. These practices were then compared with those used in other countries. METHODS: An online survey was sent through the Grupo Latino-Americano de Mielodisplasia to LA cytometrists and other international scientific societies. RESULTS: 91 responses from 15 LA countries were received. The median of the number of markers used was 20 ± 4.5, but only 8.1% of participants adopted the complete panel proposed by the International/European LeukemiaNet Working Group (IMDSflow). We received 140 eligible answers from regions other than LA (66 Europe, 59 USA-Canada, 8 Oceania, 6 Asia and 1 Africa). LA utilized more markers for MDS diagnosis than USA/Canada (p = 0.006), but similar to Europe. The use of MDS scoring systems differed among regions: 10.3% in LA, 0% USA/Canada and 25.7% Europe reported the "Ogata score". Finally, 52.0% of all participants included a general interpretation statement in the final report about the consistency of the FC results with MDS diagnosis, with no statistical differences between regions. CONCLUSIONS: This survey shows a low compliance with the IMDSflow recommendations and a scarce use of the scoring systems proposed in the literature. However, the number of surface markers used is high. We will work to develop a FC consensus for MDS diagnosis adapted to the clinical practice requirements in LA.


Assuntos
Citometria de Fluxo , Síndromes Mielodisplásicas/diagnóstico , Padrões de Prática Médica/estatística & dados numéricos , África/epidemiologia , Ásia/epidemiologia , Biomarcadores/análise , Biomarcadores/sangue , Canadá/epidemiologia , Europa (Continente)/epidemiologia , Geografia , Humanos , Imunofenotipagem/métodos , América Latina/epidemiologia , Síndromes Mielodisplásicas/sangue , Síndromes Mielodisplásicas/epidemiologia , Oceania/epidemiologia , Inquéritos e Questionários , Estados Unidos/epidemiologia
17.
Sci Total Environ ; 665: 314-328, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-30772561

RESUMO

Hydraulic heritage is a legacy that has generally been forgotten in territorial management and protective actions. This heritage expresses the way in which inhabitants have used their water resources and related structures for centuries. For proper management, it is necessary to draw up an inventory. Using Geographical Information System (GIS) tools, we have created a spatial and thematic inventory of the hydraulic heritage located in the Community of Madrid. This inventory shows the good conditions, both in abundance (more than 5800 point type entities) and diversity (28 categories in the point entities type layer), of historical hydraulic elements in the region. All the information in this work has been extracted from old maps (1870-1960). A database was designed to provide spatial, thematic and temporal information on this heritage. Element distribution was concentrated mainly in the river plains and the metropolitan areas of the region, and it has been proven how hydraulic elements are endangered due to increasing urban pressure. This phenomenon and agricultural modernisation are the main factors influencing the survival of this type of assets. Thanks to this methodology, it should be possible to analyse the status of the heritage ensemble included in the inventory.

18.
Planta ; 249(4): 1157-1175, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30603787

RESUMO

MAIN CONCLUSION: Stable QTL for grain protein content co-migrating with nitrogen-related genes have been identified by the candidate genes and genome-wide association mapping approaches useful for marker-assisted selection. Grain protein content (GPC) is one of the most important quality traits in wheat, defining the nutritional and end-use properties and rheological characteristics. Over the years, a number of breeding programs have been developed aimed to improving GPC, most of them having been prevented by the negative correlation with grain yield. To overcome this issue, a collection of durum wheat germplasm was evaluated for both GPC and grain protein deviation (GPD) in seven field trials. Fourteen candidate genes involved in several processes related to nitrogen metabolism were precisely located on two high-density consensus maps of common and durum wheat, and six of them were found to be highly associated with both traits. The wheat collection was genotyped using the 90 K iSelect array, and 11 stable quantitative trait loci (QTL) for GPC were detected in at least three environments and the mean across environments by the genome-wide association mapping. Interestingly, seven QTL were co-migrating with N-related candidate genes. Four QTL were found to be significantly associated to increases of GPD, indicating that selecting for GPC could not affect final grain yield per spike. The combined approaches of candidate genes and genome-wide association mapping led to a better understanding of the genetic relationships between grain storage proteins and grain yield per spike, and provided useful information for marker-assisted selection programs.


Assuntos
Grão Comestível/química , Genes de Plantas/genética , Proteínas de Plantas/análise , Triticum/genética , DNA de Plantas/genética , DNA de Plantas/isolamento & purificação , Genes de Plantas/fisiologia , Estudo de Associação Genômica Ampla , Técnicas de Genotipagem , Polimorfismo de Nucleotídeo Único/genética , Locos de Características Quantitativas/genética , Triticum/química , Triticum/metabolismo
19.
Cerebellum ; 18(3): 654-658, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30617627

RESUMO

SCA 17 is a rare, autosomal dominant disorder caused by TBP gene CAG/CAA repeat expansion. Ataxia and dementia are common. The presence of frontal dysfunction at outset of the disease may mimic frontotemporal dementia (FTD). Parkinsonism, chorea, dystonia, and pyramidal signs may occur. We report an Irish family with autosomal dominant partially penetrant frontal dementia with cerebellar atrophy due to SCA17 and present detailed neuropsychological assessment for the first time. A 44-year-old doctor presented with 18-month history of behavioral problems. She slowed down, became apathetic, and unable to multitask. She became more irritable and short tempered, and her work performance deteriorated. Brain MRI showed cerebellar atrophy and cerebellar hypometabolism was noted on FDG-PET. A sister developed personality changes at age 45 with apathy, and had problems with memory and social skills; another sister at age 39 became dysarthric and unsteady. A brother at age 52 demonstrated emotional lability, and became dysarthric, unsteady, and slowed down. Their mother aged 73 had an abnormal antalgic gait due to arthritis; their father was jocular and disinhibited. MAPT testing detected an exon 9 c.726C>T variant in the proband. Subsequent testing in nine siblings and both parents failed to show co-segregation with disease. SCA17 testing revealed a TBP gene 43 repeat expansion that co-segregated in all affected siblings and in the mother whose gait problems were initially attributed to arthritis. In over 80% of cases of FTD with clear autosomal dominant inheritance, causative gene defects involve MAPT, GRN, or C9orf72 mutations. A minority involves VCP, FUS, and CHMP2B. As evident from our case, SCA17 testing should also be considered, especially if cerebellar atrophy if found on imaging. Segregation analysis is crucial. MAPT variant (c.726C>T exon 9) detected in the family was deemed a polymorphism.


Assuntos
Ataxias Espinocerebelares/genética , Proteína de Ligação a TATA-Box/genética , Adulto , Feminino , Demência Frontotemporal/genética , Genes Dominantes , Humanos , Masculino , Linhagem
20.
Clin Microbiol Infect ; 25(4): 469-473, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29964233

RESUMO

OBJECTIVES: The question of whether to obtain two or three sets of blood cultures to assess the aetiology of bloodstream infections (BSIs) remains open to debate. Few studies have assessed the proportion of BSIs missed without the third blood culture set (BCS). The aim of our study was to determine the proportion of BSIs that would be missed without the third BCS in a hospital where obtaining three BCSs is the standard of care. METHODS: We performed a descriptive retrospective study in Hospital Gregorio Marañón (Madrid) from 2010 to 2013. We included all episodes of BSI in which three BCSs were systematically obtained. RESULTS: We included 4000 episodes of BSI between 2010 and 2013. Without the third BCS, we would have missed 298 (7.5%) episodes of BSI: 141 (47.3%) by gram-positive microorganisms, 147 (49.3%) by gram-negative microorganisms, and 10 (3.4%) by yeasts. In 132/298 (44.3%) of the episodes another clinical sample was obtained within a week of the BCS extraction; in 101/298 (33.9%), the same microorganism was present in a significant clinical sample other than blood. CONCLUSIONS: Our data suggest that performing a third BCS is useful, as not doing this could result in an unacceptable number of BSIs going undetected.


Assuntos
Bacteriemia/diagnóstico , Hemocultura/métodos , Erros de Diagnóstico/estatística & dados numéricos , Fungemia/diagnóstico , Bacteriemia/microbiologia , Feminino , Fungemia/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha , Centros de Atenção Terciária/estatística & dados numéricos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA