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Introduction: Breastfeeding appears to protect the onset of obesity in infants. The aim is to know whether breastfeeding duration is associated with the risk of obesity in infants and toddlers aged 12 and 24 months. Material and methods: Prospective longitudinal study in a cohort of children born in Spain between April 2017 and March 2018 (LAyDI study) in the paediatric primary care system conducted in the framework of the PAPenRed research network. Analysis of breastfeeding duration (group 1: fewer than 6 months; group: more than 6 months) and its association with anthropometric variables. Results: A total of 1495 patients attended the 12 months preventive child health visit and 1073 patients the 24 months visit. We found a statistically significant association between breastfeeding duration and weight-for-age, BMI-for-age and weight-for-length/height at 12 and 24 months; breastfeeding duration of less than 6 months was significantly associated with overweight and obesity (based on BMI-for-age and weight-for-length/height) at ages 12 and 24 months. Maternal pre-pregnancy BMI acted as a modifier on the association between breastfeeding duration and overweight and obesity (based on BMI-for-age). Conclusions: A breastfeeding duration of less than 6 months is associated with a higher percentage of overweight and obesity at ages 12 and 24 months, although maternal pre-pregnancy BMI modifies this relationship at 24 months. Resumen: Introducción: La lactancia materna parece proteger la aparición de la obesidad en los lactantes. El objetivo es conocer si la duración de la lactancia materna se relaciona con el riesgo de obesidad en lactantes de 12 y 24 meses de edad. Material y métodos: Estudio longitudinal prospectivo de una cohorte de nacidos en España entre abril de 2017 y marzo de 2018 (estudio LAyDI) en pediatría de atención primaria, dentro de la red de investigación PAPenRed. Análisis de duración de lactancia materna (Grupo 1: menos de 6 meses, Grupo: más de 6 meses) y su relación con parámetros somatométricos. Resultados: Acudieron a la visita de los 12 meses un total de 1495 pacientes, y a la de los 24 meses 1073 pacientes. Se observa una relación estadísticamente significativa entre la duración de la lactancia materna y el peso para la edad, el IMC para la edad y el peso para longitud/talla a los 12 y 24 meses, la duración de la lactancia materna menor de 6 meses se relaciona con el sobrepeso y obesidad (según los índices IMC para la edad y peso para la longitud/talla) de forma estadísticamente significativa a los 12 y 24 meses de edad. El IMC pregestacional materno es una variable modificadora de efecto sobre la relación entre la duración de la lactancia materna y el sobrepeso y obesidad (por IMC para la edad). Conclusiones: La duración menor de 6 meses de la lactancia materna se asocia a un mayor porcentaje de sobrepeso y obesidad a los 12 y 24 meses, aunque el IMC materno pregestacional modifica esta relación a los 24 meses.

Resumen: Objetivo: Conocer estadísticas reales sobre lactancia materna en España, así como factores socioculturales y perinatales que afectan a su inicio y mantenimiento. Diseño: Estudio prospectivo, multicéntrico, longitudinal, de ámbito nacional (estudio LAyDI). Sitio: Consulta de pediatras de atención primaria. Participantes: Cohorte de recién nacidos entre abril de 2017 y marzo de 2018 en España que se siguieron hasta los dos años en ocho visitas. Medidas principales: Se analizaron las tasas de los diferentes tipos de lactancia en cada visita y también se analizaron variables relacionadas con la gestación, el parto, el período neonatal, sociales, económicas y biológicas. Resultados: Muestra inicial de 1.946 (50,1% varones). El 90,7% decidieron iniciar lactancia materna al nacimiento. La cifra de lactancia materna exclusiva (LME) fue del 66,4% a los 15 días y del 35,2% a los 6 meses. Cualquier tipo de lactancia materna (lactancia materna total [LMT]) a los 6 meses fue del 61,7%. La supervivencia de LMT presentó una mediana de 6,0 meses (IC 95%: 6,0-6,1). Variables relacionadas con LME a los 15 días: hijos previos, nivel de educación de madre, ausencia de enfermedad durante el embarazo, no separación madre e hijo al nacer, no utilización de chupete, no existencia de problemas en pezones, y momento de decisión tipo lactancia. Variables relacionadas con mayor duración LMT son: la relación mayor de 5 años de los padres, no usar de chupete, colecho al mes de vida, decidir lactancia materna antes del embarazo, recibir información sobre lactancia durante el embarazo y utilizar apoyo de asociaciones. Conclusiones: El abandono temprano de la lactancia materna es un problema importante en las sociedades occidentales. Existen factores sobre los que se puede actuar para mejorar resultados. Abstract: Objective: To find out actual statistics on breastfeeding in Spain, as well as sociocultural and perinatal factors that affect its initiation and maintenance. Design: Prospective, multicentre, longitudinal, nationwide study (XXX study). Site: Primary care paediatricians’ office. Participants: Cohort of newborns born between April 2017 and March 2018 in Spain who were followed up to two years of age in 8 visits. Main measures: Rates of different types of breastfeeding were analysed at each visit and variables related to gestation, delivery, neonatal period, social, economic and biological variables were also analysed. Results: Initial sample of 1946 (50.1% male). 90.7% decided to initiate breastfeeding at birth. Exclusive breastfeeding (EBF) was 66.4% at 15 days and 35.2% at 6 months. Any type of breastfeeding (total breastfeeding [TBF]) at 6 months was 61.7%. Median survival from TBF was 6.0 months (95% CI: 6.0-6.1). Variables related to EBF at 15 days: previous children, mother's level of education, absence of illness during pregnancy, no separation of mother and child at birth, no dummy use, no nipple problems, and time of decision to breastfeed. Variables related to longer duration of TBF: relationship of parents older than 5 years, no dummy use, co-sleeping at one month of life, deciding to breastfeed before pregnancy, receiving information on breastfeeding during pregnancy and using support from associations. Conclusions: Early abandonment of breastfeeding is a major problem in Western societies. There are factors that can be worked on to improve outcomes.

Resumen: Introducción: El monitor NIPE (Newborn Infant Parasympathetic Evaluation) es una herramienta rápida, continua y objetiva de evaluación del disconfort neonatal. Los objetivos fueron describir los cambios del NIPE tras una extracción sanguínea y los factores implicados en su variación. Material y métodos: Estudio observacional analítico con recogida de datos prospectiva. Se incluyeron los recién nacidos ingresados en cuidados intensivos entre junio y diciembre de 2021 a quienes se les realizó extracción sanguínea. Se recogieron variables demográficas, las relacionadas con la realización del procedimiento, la puntuación NIPE, la frecuencia cardiaca previa y en los minutos 1, 2, 3, 4, 5, 10 y 15 posteriores. Resultados: Se incluyeron 86 registros de 49 pacientes. Durante los primeros cuatro minutos tras el procedimiento hubo un descenso significativo en la puntuación NIPE, siendo el descenso máximo de un 22,8% respecto al valor basal, produciéndose el nadir a los 2,79 minutos. El mayor descenso del NIPE ocurrió en pacientes prematuros, varones, con menor Apgar a los cinco minutos, en procedimientos ya realizados previamente, tras cesárea y en horario matutino. No hubo diferencias con la realización en canguro. La correlación entre NIPE y frecuencia cardíaca fue débil. Conclusiones: Tras un procedimiento doloroso, como una extracción sanguínea, el monitor NIPE mostró un descenso significativo los primeros cuatro minutos, agudizándose el descenso con la prematuridad, la reiteración de procedimientos o el nacimiento tras cesárea. El monitor NIPE puede ayudar a identificar eficazmente a aquellos neonatos que sufren dolor agudo tras un procedimiento, complementándose con las escalas de valoración clínica. Abstract: Introduction: The Newborn Infant Parasympathetic Evaluation (NIPE) index is an instrument that enables continuous, fast and objective assessment of neonatal discomfort. The aim of the study was to analyse changes in NIPE values after performance of blood draws and the factors involved in this variation. Material and methods: We conducted a prospective observational study. We included infants admitted to the neonatal intensive care unit between June and December 2021 who underwent blood draws. We recorded demographic data, aspects related to the procedure, the NIPE index and the heart rate at baseline and 1, 2, 3, 4, 5, 10 and 15 min after the procedure. Results: The study included 86 records for 49 patients. In the first 4 min after the procedure, there was a significant decrease in the NIPE index, with a maximum decrease of 22.8% relative to baseline and the nadir at 2.79 min. The decrease in NIPE values was greater in infants born preterm, male, with lower 5-min Apgar scores and following procedures that had been performed previously, after caesarean section or in the morning. There were no differences when the blood draw was obtained during kangaroo care. The correlation between the NIPE index and the heart rate was weak. Conclusions: After a painful procedure, such as a blood draw, the NIPE monitor showed a significant decrease in the first 4 min, which was more pronounced in preterm infants, in repeated procedures or after caesarean delivery. The NIPE index could help identify infants experiencing acute procedural pain, complementing clinical rating scales.

Background: Corticosteroids have had a central role in the treatment of nephrotic syndrome. The management of these patients who become dependent to steroids is complex, involving different immunosuppressive drugs patterns. The monoclonal antibody anti CD20, Rituximab, is likely to have beneficial effects in cases of steroid-dependent nephrotic syndrome patients with no easy resolution, even when we cannot make a statement about the specific role in the impact. We bring our personal experience in pediatric patients treated with this medication during the last years, to provide a thorough overview and useful information about the role of Rituximab in this pathology. Methods: Retrospective study in patients with steroid-dependent idiopathic nephrotic syndrome controlled in the division of Pediatric Nephrology of a Spanish tertiary hospital in those patients who had received at least one treatment cycle of Rituximab, at any moment along the evolution of the disease. Results: The study involved 8 patients. All of them previously received immunosuppressive therapy. The Rituximab were administered as an intravenous infusion, in a dose of 375 mg/m2, and all doses were administered in a period during which the disease was in remission. The depletion of lymphocytes B (CD19, 0%) were confirmed after the first dose of Rituximab except for one, with a lymphocyte count of 1%. The period of depletion lasts 10,3 months (median; range 6,5–16 months), and only one of the patients registered a relapse of the disease in this period. A reduction of relapses suffered by patients has been shown after the treatment began (3,6 relapses/year in the previous year to the start of the treatment versus 0,1 relapses/year during the first year post-rituximab). The relapse-free survival in the first year reached 83,3% in patients who suffered more than one relapse (75% of patients), and without a relapse after the treatment began in 2 cases. One or more drugs could be removed in 87,5% of patients after the first cycle of rituximab. After the rituximab treatment, we reached a 96,5% decrease in the corticosteroids doses administered (28,5 mg/m2/day during the 3 months pre-treatment versus 1 mg/m2/day in the last 3 months of patient monitoring). Not a significant observed adverse effect attributed to the drug after the post-rituximab monitoring period (median 46,5 months, range 5–97 months). Conclusion: The favorable results reported after rituximab treatment in our patients seems to confirm the effectiveness of this drug in the steroid-dependent nephrotic syndrome, making that therapeutic option into consideration and legitimating the use of the drug in complex cases involving pediatric patients. Even so, it seems recommendable to design pertinent studies to clarify, among others, the optimum regimen of the treatment (dose, interval and cycles), clinical repercussion and potential adverse effects in long terms. Resumen: Introducción: La corticoterapia continúa siendo la piedra angular en el tratamiento del síndrome nefrótico. El manejo de los pacientes que desarrollan dependencia a esteroides es complejo, implicando distintas pautas de fármacos inmunosupresores. El rituximab, anticuerpo monoclonal anti-CD20, parece tener efectos beneficiosos en pacientes con síndrome nefrótico córtico-dependiente de difícil manejo clínico, si bien aún no está bien definido su papel en esta entidad. Con el fin de aportar información útil sobre el papel del rituximab en esta patología, presentamos nuestra experiencia personal en pacientes pediátricos tratados con este fármaco en los últimos años. Materiales y métodos: Estudio retrospectivo en pacientes con síndrome nefrótico idiopático cortico-dependiente controlados en la Sección de Nefrología Pediátrica de un hospital terciario español y que habían recibido, al menos, un ciclo de tratamiento con rituximab durante cualquier momento de la evolución de la enfermedad. Resultados: Se incluyeron en el estudio 8 pacientes. Todos habían recibido terapia inmunosupresora previamente. El rituximab se administró por vía intravenosa a una dosis de 375 mg/m2, y todas las dosis se administraron en situación de remisión de la enfermedad. Se confirmó la depleción completa de linfocitos B (CD19, 0%) tras la primera dosis de rituximab en todos excepto en uno, en el que el recuento fue del 1%. El período de depleción fue de 10,3 meses (mediana; rango 6,5–16 meses), y solamente en uno de los pacientes se registró una recaída de la enfermedad durante este período. Tras el inicio del tratamiento, se observó una reducción del número de recaídas (3,6 recaídas/año en el año previo al inicio del tratamiento versus 0,1 recaídas/año durante el primer año post-rituximab). La supervivencia libre de recaída en el primer año fue del 83,3% en los pacientes con más de una recaída (75% de los pacientes), sin existir recaídas tras el inicio del tratamiento en 2 pacientes. En un 87,5% de los pacientes se pudieron retirar uno o más fármacos tras el primer ciclo de rituximab. Tras el tratamiento con rituximab, se consiguió una reducción del 96,5% de las dosis de corticoides administrados (28,5 mg/m2/día en los 3 meses pre-tratamiento versus 1 mg/m2/día en los 3 últimos meses de seguimiento en los pacientes tratados). Tras el periodo de seguimiento post-rituximab (mediana 46,5 meses, rango 5–97 meses), no se observaron efectos adversos significativos atribuibles al fármaco. Conclusiones: Los resultados favorables reportados tras el tratamiento con rituximab en nuestros pacientes parecen confirmar la eficacia del fármaco en el síndrome nefrótico córtico-dependiente y lo hacen considerar como una opción terapéutica válida en casos de difícil manejo clínico en la edad pediátrica. Aun así, parece recomendable diseñar estudios apropiados que traten de aclarar, entre otros, el régimen óptimo de tratamiento (dosis, intervalo y número de ciclos), repercusión clínica y potenciales efectos adversos a largo plazo.

Summary: The rapid transit from hypoxia to normoxia in the lung that follows the first breath in newborn mice coincides with alveolar macrophage (AM) differentiation. However, whether sensing of oxygen affects AM maturation and function has not been previously explored. We have generated mice whose AMs show a deficient ability to sense oxygen after birth by deleting Vhl, a negative regulator of HIF transcription factors, in the CD11c compartment (CD11cΔVhl mice). VHL-deficient AMs show an immature-like phenotype and an impaired self-renewal capacity in vivo that persists upon culture ex vivo. VHL-deficient phenotype is intrinsic in AMs derived from monocyte precursors in mixed bone marrow chimeras. Moreover, unlike control Vhlfl/fl, AMs from CD11cΔVhl mice do not reverse pulmonary alveolar proteinosis when transplanted into Csf2rb−/− mice, demonstrating that VHL contributes to AM-mediated surfactant clearance. Thus, our results suggest that optimal AM terminal differentiation, self-renewal, and homeostatic function requires their intact oxygen-sensing capacity. : Izquierdo et al. show that the absence of VHL in lung alveolar macrophages prevents their terminal maturation. VHL-deficient alveolar macrophages induce HIF-target gene expression and are partially desensitized to oxygen. Moreover, they have a decreased self-renewal and surfactant clearance capacity, suggesting that oxygen sensing contributes to alveolar macrophage functional maturation. Keywords: alveolar macrophage, oxygen, VHL, HIF, self-renewal, differentiation, surfactant, lung, glycolysis, lipid metabolism

Objetivo: Conocer las explicaciones sobre prácticas sexuales de riesgo, la percepción del virus de la inmunodeficiencia humana (VIH) y propuestas de intervención para prevenir infecciones por VIH en un grupo de hombres que tienen sexo con hombres. Métodos: Estudio cualitativo con una muestra de 13 hombres que tenían sexo con hombres, participantes de una cohorte de VIH seronegativos contactados en saunas gay de Barcelona. Se realizaron entrevistas en profundidad semiestructuradas y un posterior análisis de contenido temático. Resultados: Las prácticas sexuales de riesgo se atribuyeron a una masculinidad asociada a una alta necesidad sexual, a determinados lugares de intercambio sexual (como saunas, fiestas privadas y clubs), al consumo de drogas y al deseo de experimentar con el riesgo y la propia sexualidad. La infección por VIH se percibía como una enfermedad normalizada, aunque contraerla se asociaba a vergüenza y culpa. Entre las propuestas de intervención se encontraban: concienciar sobre lo que significa vivir con el VIH, generar más alarma social, incorporar las nuevas tecnologías en la prevención y aumentar las acciones en lugares de encuentro gay. Conclusiones: El concepto de la masculinidad desempeña un papel fundamental en las prácticas sexuales entre los hombres que tienen sexo con hombres. Se sugiere innovar en los programas preventivos e incorporar la percepción de riesgo y la infección por el VIH desde una perspectiva de género.

Sustainable water management should consider climate change effects to ensure its future availability. Hydrological modeling is a supportive tool for this analysis, which has been used in this work to assess the climate change impacts on the water resources of three basins under Mediterranean climate (Ompólveda and Salado River basins, in Spain, and Guadalupe River basin, in Mexico).The outcomes of previous climate change scenarios simulation addressed with the Soil and Water Assessment Tool (SWAT) have been compiled, evaluating the impacts on the water balance, and focusing on the streamflow components. The potential implications of these effects on energy production have been discussed.The results point to a streamflow reduction by the end of the century around 50%–60% in the worst scenarios, with varying effects for each of the streamflow components. In the Spanish catchments, where groundwater contribution dominates in baseline conditions, a noticeable decrease of this component is expected (up to -74%), becoming lateral flow the main streamflow component. In the Mexican basin, lateral flow, which is already predominant (69%), will experience the largest absolute decrease, but the highest relative decrease might be experienced by groundwater flow, up to -92%. Absolute variations in the surface component are small and the different ways to simulate the climate change scenarios might hinder their interpretation.This work shows that water resources will be even more scarce in these regions, being especially worrying the groundwater component reduction, which currently maintains the streamflow during dry periods. This situation would limit energy production both from sources that directly use water, such as hydropower, and others that require water for cooling. Higher atmospheric and water temperatures will increase demands for irrigation and for cooling systems. Therefore, competition for water will rise among key sectors, and an accurate planning considering these factors must be a priority.

Background: Current innovation in needle arthroscopy is improving the safety of anterior portals around the elbow. This study evaluated the proximity to the radial nerve, median nerve, and brachial artery on cadaveric specimens of an anterior portal used for elbow arthroscopy. Methods: Ten fresh-frozen adult cadaveric extremities were used. After marking the cutaneous references, the NanoScope cannula was introduced just lateral to the biceps tendon, through the brachialis muscle and the anterior capsule. Elbow arthroscopy was performed. Dissection was then carefully performed on all specimens with the NanoScope cannula in place. The shortest distance from the cannula to the median nerve, radial nerve, and brachial artery was measured with a handheld sliding digital caliper. Results: The cannula was an average of 12.92 mm away from the radial nerve, 22.27 mm from the median nerve, and 16.8 mm from the brachial artery. Needle arthroscopy performed through this portal allows complete visualization of the anterior compartment of the elbow, as well as direct visualization of the posterolateral compartment. Conclusion: Needle arthroscopy of the elbow through an anterior transbrachialis portal is safe for the main neurovascular structures. In addition, this technique allows complete visualization of the anterior and posterolateral compartments of the elbow through the humerus-radius-ulna space.

Introduction: The impact of COVID-19 pandemic represents a serious challenge for ‘frail’ patients' populations with inflammatory autoimmune systemic diseases such as systemic sclerosis (SSc). We investigated the prevalence and severity of COVID-19, as well the effects of COVID-19 vaccination campaign in a large series of SSc patients followed for the entire period (first 38 months) of pandemic. Patients and method: This prospective survey study included 1755 unselected SSc patients (186 M, 1,569F; mean age 58.7 ± 13.4SD years, mean disease duration 8.8 ± 7.3SD years) recruited in part by telephone survey at 37 referral centers from February 2020 to April 2023. The following parameters were carefully evaluated: i. demographic, clinical, serological, and therapeutical features; ii. prevalence and severity of COVID-19; and iii. safety, immunogenicity, and efficacy of COVID-19 vaccines. Results: The prevalence of COVID-19 recorded during the whole pandemic was significantly higher compared to Italian general population (47.3 % vs 43.3 %, p

Introduction: Hepatitis D Virus (HDV) infection is vanishing in Italy. It is therefore believed that hepatitis D is no longer a medical problem in the domestic population of the country but remains of concern only in migrants from HDV-endemic areas. Objectives: To report the clinical features and the medical impact of the residual domestic HDV infections in Italy. Methods: From 2010 to 2019, one hundred ninety-three first-time patients with chronic HDV liver disease attended gastroenterology units in Torino and San Giovanni Rotondo (Apulia); 121 were native Italians and 72 were immigrants born abroad. For this study, we considered the 121 native Italians in order to determine their clinical features and the impact of HDV disease in liver transplant programs. Results: At the last observation the median age of the 121 native Italians was 58 years. At the end of the follow-up, the median liver stiffness was 12.0 kPa (95% CI 11.2–17.4), 86 patients (71.1%) had a diagnosis of cirrhosis; 80 patients (66.1%) remained HDV viremic. The ratio of HDV to total HBsAg transplants varied from 38.5% (139/361) in 2000–2009 to 50.2% (130/259) in 2010–2019, indicating a disproportionate role of hepatitis D in liver transplants compared to the minor prevalence of HDV infections in the current scenario of HBsAg-positive liver disorders in Italy. Conclusion: Though HDV is vanishing in Italy, a legacy of ageing native-Italian patients with advanced HDV liver disease still represents an important medical issue and maintains an impact on liver transplantation.

Objectives: To evaluate four sample treatments in a safe and straightforward procedure to detect SARS-CoV-2 in saliva. Methods: Four sample treatments were evaluated in a 3-step procedure to detect SARS-CoV-2 in saliva: 1) heating at 95 °C for 5 min for sample inactivation; 2) sample treatment; 3) analysis by reverse-transcription loop-mediated isothermal amplification (LAMP). Saliva samples used were from infected individuals or were spiked with known quantities of viral particles. Results: Three treatments had a limit of detection (LOD) of 500.000 viral particles per ml of saliva and could be used to detect individuals with potential to transmit the disease. The treatment of phosphate buffer, dithiothreitol, ethylenediaminetetraacetic acid and proteinase K, with an additional 95 °C heating step, yielded a lower LOD of 95; its sensitivity ranged from 100% in patients with nasopharyngeal swab reverse-transcriptase polymerase chain reaction cycle threshold values 30. Conclusions: This report highlights the importance of an adequate sample treatment for saliva to detect SARS-CoV-2 and describes a flexible procedure that can be adapted to point-of-care. Although its sensitivity when LAMP is used is lower than reverse-transcriptase polymerase chain reaction, this procedure can contribute to COVID-19 control by detecting individuals able to transmit the disease.

Resumen: Objetivo: Evaluar si el vendaje de 2 capas es más efectivo que el vendaje de crepé en la cicatrización de úlceras venosas tras 12 semanas de seguimiento. Diseño: Ensayo clínico aleatorizado multicéntrico. Emplazamiento: 22 Centros de Salud de Madrid. Participantes: Mayores de 18 años, con diagnóstico de úlceras venosas. Se aleatorizaron 93 pacientes, 56 en el grupo de doble capa y 37 en crepé. Retiradas: 16 en el grupo de doble capa y 7 en el de crepé. Intervenciones: Grupo control: práctica clínica habitual: tratamiento de la herida y vendaje con crepé. Grupo experimental: misma práctica habitual para tratamiento de la herida y vendaje con doble capa. Mediciones principales: Variable respuesta principal: cicatrización completa a las 12 semanas. Variables secundarias: severidad de las lesiones, calidad de vida, reacciones adversas. Evaluación ciega de la variable respuesta. Resultados: Cicatrización completa: 25 (67%) en el grupo crepé (IC al 95% 50,2-81,9) y 32 (57,1%) en doble capa (IC al 95% 43,2-70,3). Sin diferencias en ambos grupos, RR = 1,10 (IC al 95% 0,864-1,424).La severidad de las úlceras basales se asocia al tiempo de cicatrización, HR = 0,86 (IC al 95% 0,78-0,94).Se objetiva mejora significativa en la calidad de vida total y en las dimensiones cosmesis y estado emocional. No se encuentran diferencias según el vendaje utilizado.Sin reacciones adversas graves en ninguno de los grupos. Conclusiones: No encontramos diferencias significativas en la cicatrización entre los 2 tipos de vendaje. Ambos son apropiados para la cicatrización de las úlceras y para mejorar la calidad de vida. Abstract: Objective: To evaluate if the two-layer bandage is more effective than the crepe bandage in the healing of venous ulcers after 12 weeks of follow-up. Design: Randomized multicentre controlled clinical trial. Location: 22 Primary Health Centers of Madrid. Participants: Over 18 years old, with diagnosis of venous ulcers. 93 patients were randomized, 56 in the double layer group and 37 in the crepe group. Withdrawals: 16 in double layer group, 7 in crepe group. Interventions: Control group: usual clinical practice: treatment of the wound and bandage with crepe. Experimental group: same usual clinical practice for wound treatment and bandage with double layer. Main measurements: Primary outcome: complete healing at 12 weeks. Secondary outcomes: severity of ulceration, health-related quality of life, adverse events. Blind evaluation of the response variable. Results: Complete healing: in crepe group, 25, 67.5% (95% CI 50.2-81.9) and in double layer group, 32, 57.1% (95% CI 43.2-70.3). No evidence of a difference in both groups, RR = 1.10 (95% CI 0.864-1.424).The basal severity of the ulcers is associated with the healing time. HR = 0.86 (95% CI 0.78-0.94).Our data showed a significant improvement in health-related quality of life, total and in the of cosmesis and emotional dimensions. No evidence of a difference in both groups.We didn’t find serious adverse events in any of the groups. Conclusions: We didn’t find significant differences in the healing between the two bandages evaluated. Both are appropriate for ulcer healing and to improve the health-related quality of life.

Summary: Cardiac function and morphology by mouse fetal echocardiography can be assessed by scanning the uterus extracted from the abdominal cavity (trans-uterine ultrasound) or the womb (trans-abdominal ultrasound). Advantages of trans-abdominal ultrasound include (1) non-invasive longitudinal analysis at different stages, reducing animal use; and (2) maintenance of natural environment, diminishing perturbations on functional parameters, which are more frequent in trans-uterine conditions. Here we describe both approaches, explaining how to identify congenital cardiac defects and defining the correlation between echocardiography findings and histological analysis.For complete details on the use and execution of this protocol, please refer to (Menendez-Montes et al., 2016) and (Menendez-Montes et al., 2021).

To evaluate the effect of stocking density on pre-fattening growth and survival, Manila clam seeds from three different batches (B1, B2, and B3) were farmed in plastic net lanterns at two sites (western and northern) in Sacca degli Scardovari (Italy). Different stocking densities were compared, i.e. EXTRA (50,000 clams m−2), HIGH (30,000), and MEDIUM (20,000) for B1 and B2 clams; HIGH, MEDIUM, and LOW (10,000 clams m−2) for B3 clams. At the end of pre-fattening at the western site, the shell length decreased with increasing stocking density of both B1 (14.2 mm vs. 13.6 mm vs. 12.9 mm at HIGH vs. MEDIUM vs. EXTRA density; P < 0.001) and B2 (14.9 mm vs. 13.6 mm vs. 12.5 mm at MEDIUM vs. HIGH vs. EXTRA density; P < 0.001) clams. At the northern site, the shell length decreased in the following manner: MEDIUM to HIGH to EXTRA density for B1 clams (P < 0.001) and MEDIUM to EXTRA to HIGH density for B2 clams (P < 0.001). The same trend was recorded for B3 clams at both western (16.1 mm vs. 14.3 mm vs. 12.7 mm at LOW vs. MEDIUM vs. HIGH density; P < 0.001) and northern (15.6 mm vs. 13.9 mm vs. 13.2 mm; P < 0.001) sites. The stocking density did not affect the survival rate at the northern site and of the B3 clams, whereas the survival rate significantly decreased from MEDIUM and HIGH to EXTRA density for B1 (84.8 % and 85.4 % vs. 52.8 %; P < 0.05) and B2 (92.5 % and 87.6 % vs. 67.0 %; P < 0.01) clams at the western site where pre-fattening ended one week later than at the northern site. In the present conditions, clams in suspended lanterns reached the minimum sowing size (shell length 11 mm, weight 0.3 g) in 10 weeks. However, an increase in stocking density decreased clam growth and drastically increased mortality when water conditions became less favourable.

Summary: HIF1-alpha expression defines metabolic compartments in the developing heart, promoting glycolytic program in the compact myocardium and mitochondrial enrichment in the trabeculae. Nonetheless, its role in cardiogenesis is debated. To assess the importance of HIF1-alpha during heart development and the influence of glycolysis in ventricular chamber formation, herein we generated conditional knockout models of Hif1a in Nkx2.5 cardiac progenitors and cardiomyocytes. Deletion of Hif1a impairs embryonic glycolysis without influencing cardiomyocyte proliferation and results in increased mitochondrial number and transient activation of amino acid catabolism together with HIF2α and ATF4 upregulation by E12.5. Hif1a mutants display normal fatty acid oxidation program and do not show cardiac dysfunction in the adulthood. Our results demonstrate that cardiac HIF1 signaling and glycolysis are dispensable for mouse heart development and reveal the metabolic flexibility of the embryonic myocardium to consume amino acids, raising the potential use of alternative metabolic substrates as therapeutic interventions during ischemic events.

Resumen: La Ciudad de las Niñas y los Niños es un proyecto internacional que pretende fomentar la autonomía y la participación infantil plena en la construcción de la ciudad. Tras aprobarse en 2011 en el pleno del Ayuntamiento de Huesca, se crearon el Consejo de las Niñas y los Niños y el Laboratorio de la Ciudad, órganos en los que hay representación de todos los colegios de Huesca. Para hacer explícito el trabajo sobre la salud se han incorporado actividades como «Caminos saludables», en la que se utiliza la técnica del mapeo de activos. Además del trabajo interdisciplinario entre distintas áreas del ayuntamiento, profesionales de los sectores educativo (colegios y universidad), sanitario y social, se observan impactos en el entorno físico urbano, con la remodelación de un parque, una calle y una plaza; y en los estilos de vida de los escolares, al aumentar el número de aquellos que van andando solos al colegio. Abstract: The City of Girls and Boys of Huesca (Spain) is an international project that seeks to foster children's autonomy and full participation in the construction of the city. Following its formal approval at the City Council of Huesca, the Girls and Boys Board and the City Laboratory were created, both of which include children from all the schools of Huesca. To highlightthe work on health, activities such as “Healthy School Paths”, in which the asset mapping technique is used, were incorporated. Besides the interdisciplinary work among different areas of the city council, professionals from education (schools and university), health and social services, effects on the urban physical environment, with one street, park and square remodelled; and on the children's lifestyles, with more children walking to school alone, have been observed. Palabras clave: Participación comunitaria, Políticas públicas, Diseño del entorno, Keywords: Community participation, Public policy, Environment design

The term “hyperthyroidism” indicates a condition due to an exaggerate production of thyroid hormone; the most frequent cause is Graves’ disease (GD).We review cytokines and chemokines in hyperthyroidism, with a special focus in GD.In GD, recruited Th1 lymphocytes are responsible for enhanced IFN-γ and TNF-α production, which in turn stimulates Th1 chemokines release from thyrocytes, initiating and perpetuating the autoimmune process.Circulating levels of these chemokines are associated with the active phase of GD.Additional studies are necessary to investigate whether Th1 chemokines could be a novel therapeutic target in this disease. Keywords: Chemokines, Cytokines, Hyperthyroidism, Graves’ disease, CXCL10, CXCL9

The effect of different weekly feeding frequencies on Nile tilapia fingerlings of 2.02 g, was determined during 12 weeks. This was done by feeding the fish 7 days/week, 6 days/week or 5 days/week. After this restriction feeding period, all fish were fed as the control group (7 days/week) during 26 days to study the capability of the fish to compensate the growth during this re-feeding period. At the end of the feeding restriction period, there were significant differences in weights among the different treatments, although the significance was detected only at 7 days/week level, which presented the highest final body weight compared with the other 2 treatments. The daily feed intake and the feed conversion and protein efficiency ratios did not present significant differences. Crude protein efficiency (CPE) and gross energy efficiency (GEE) were affected by the feeding frequency, presenting high values in fish fed 7 days/week. Growth results obtained during this re-feeding period indicate that weight gain (WG) and specific growth rate (SGR) presented a linear increase from 7 to 5 days/week, i.e. with increasing feed deprivation period the fish could compensate the growth effectively, trying to reach to the weight as those of the control group.

Objetivo: Evaluar la efectividad de una intervención de consejo contraceptivo en adolescentes según sexo y origen. Métodos: Diseño pre-post con entrevista a los 3 meses. Participaron adolescentes de tres barrios desfavorecidos de Barcelona que recibieron una intervención de consejo contraceptivo. Se compararon el uso de contracepción en la última relación sexual, y diversos conocimientos, creencias y autoeficacias, estratificando por sexo y origen (autóctono o inmigrante), con pruebas de McNemar y χ2. Resultados: 138 adolescentes completaron el seguimiento (76%). El 55% eran chicas, el 85% tenían 16-19 años y el 71% eran inmigrantes. Tras la intervención mejoraron los conocimientos y diversas autoeficacias. El uso de contracepción efectiva aumentó en todos los grupos. En la muestra total, el uso de preservativo aumentó un 5,4% y la ausencia de método se redujo un 7,7%. Conclusiones: Tras la intervención mejoró el uso de contracepción y sus determinantes en los adolescentes, particularmente en los inmigrantes.

Resumo: A síndrome do QT longo congénito (SQTLC) é uma doença hereditária rara, com uma incidência de uma em cada 2000 pessoas, caracterizada por uma repolarização ventricular prolongada e por taquiarritmias ventriculares malignas.Reportamos o caso de uma doente de 30 anos, com diagnóstico prévio de síncope neurocardiogénica, em que identificamos a SQTLC. A doente implantou cardioversor‐desfibrilhador implantável por taquicardia ventricular polimórfica apesar da terapêutica com bloqueador beta.Foram identificadas nesta doente três mutações em heterozigotia nos genes KCNH2, KCNQ1 e SCN5A, achado raro que lhe confere um pior prognóstico. Abstract: Congenital long QT syndrome (LQTS) is a rare hereditary disease, with an incidence of 1 in 2000, characterized by prolonged ventricular repolarization and malignant ventricular tachyarrhythmias. We report the case of a 30‐year‐old woman, previously diagnosed with neurocardiogenic syncope, in whom LQTS was identified. The patient received an implantable cardioverter‐defibrillator due to polymorphic ventricular tachycardia under beta‐blocker therapy. Molecular genetic testing identified three mutations in heterozygosity in the KCNH2, KCNQ1 and SCN5A genes, which is a rare finding and is associated with worse prognosis. Palavras‐chave: Síndrome QT longo, Mutação trigénica, Gene KCNH2, Gene KCNQ1, Gene SCN5A, Taquicardia ventricular polimórfica, Keywords: Long QT syndrome, Triple mutation, KCNH2 gene, KCNQ1 gene, SCN5A gene, Polymorphic ventricular tachycardia