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A central assumption of conversation and multimodal analysts is that the participants have sensorial access to the acoustic features, most notably talk, of the studied interactions, which are available thanks to the recordings. If speakers stand in close proximity, a microphone is placed between or on one of them, and the analyst considers that the resulting recording captures the sound that is relevant both for the participants and for research purposes. The study of mobile and spatially distributed interactions comes with a challenge: If speakers are not spatially close but apart from each other, what is the relevant sound for the researcher to collect and examine? In this article, we show that prosodic, compositional and sequential features of the same segment of talk sound differently depending on the exact location of the hearer, or recording device, which is relevant for the analyst as well as for the participants. Our study was based on a corpus of hospital staff corridor interactions captured with a set-up composed of four video-cameras and eight wireless microphones operating simultaneously.

Abstract Recommendations regarding the best time to start treatment in patients with relapsed/refractory multiple myeloma (RRMM) after biological relapse/progression (BR) are unclear. This observational, prospective, multicenter registry aimed to evaluate the impact on time to progression (TTP) of treatment initiation at BR versus at symptomatic clinical relapse (ClinR) based on the Spanish routine practice in adult patients with RRMM. Patients had two or less previous treatment lines and at least one previous partial response. Baseline characteristics and treatment outcomes were recorded, and survival was analyzed. Of 225 patients, 110 were treated at BR (TxBR group) and 115 at ClinR (TxClinR group) according to the investigators' criteria. The proportion of patients with higher ECOG, previous noncomplete remission (CR), and second relapse were significantly higher in the TxBR group compared to the TxClinR group. TheTxClinR group showed improved outcomes, including TTP, compared to the TxBR group. Progression‐free survival increased in the TxClinR group (56.2 months) compared to the TxBR group (32.5 months) (p = 0.0137), and median overall survival also increased (p = 0.0897). Median TTP was significantly longer in patients relapsing from a CR (50.4 months) and in their first relapse (38.7 months) compared to those relapsing from a non‐CR response (32.9 months) and in their second relapse (25.2 months). Physicians seemed to start treatment earlier in RRMM patients with poor prognosis features. Previous responses to anti‐MM treatment and the number of prior treatment lines were identified as prognosis factors, whereby relapse from CR and first relapse were associated with a longer time to progression.

Abstract Background About one in ten adults are living with diabetes worldwide. Intake of carbohydrates and carbohydrate-rich foods are often identified as modifiable risk factors for incident type 2 diabetes. However, strong correlation between food variables can make it difficult to identify true associations. The purpose of this study was to identify clusters of carbohydrate-rich foods and analyse their associations with type 2 diabetes incidence in the Malmö Diet and Cancer Study cohort in southern Sweden. Methods Dietary intake of 26 622 participants was assessed using a validated three-part diet history method: a 7-day food diary, a 168-item food frequency questionnaire, and a 60-minute interview. K-means clustering analysis identified five clusters from 21 food variables. The Cox proportional hazard regression model was applied to calculate hazard ratios (HR) and 95% confidence intervals (CI) of the association between clusters and incident type 2 diabetes. Results The cluster analysis resulted in five clusters; high vegetables/low added sugar, high sugar-sweetened beverages, high juice, high fruit, and high refined carbohydrates/low fruit & vegetables (reference). During mean follow-up of 18 years, 4046 type 2 diabetes cases were identified. After adjustment for potential confounding (including lifestyle, body mass index, and diet), a high fruit cluster (HR 0.86; 95% CI 0.78, 0.94) was inversely associated with type 2 diabetes compared to the reference cluster. No other significant associations were identified. Conclusions A dietary pattern defined by a high intake of fruits was associated with a lower incidence of type 2 diabetes. The findings provide additional evidence of a potential protective effect from fruit intake in reducing type 2 diabetes risk. Future studies are needed to explore this association further.

RESUMEN Introducción. La monitorización de la utilización del conocimiento y la evaluación de resultados permiten conocer la aplicación de la evidencia, cambios en los conocimientos y actitudes, el impacto en resultados de salud y la integración y el mantenimiento de las prácticas adoptadas. Existen debilidades relacionadas con la falta de sistematización, limitaciones de los registros y calidad del proceso. El objetivo de este artículo es describir la experiencia en la generación de estrategias de monitorización y evaluación de resultados de implantación de Guías de Buenas Prácticas en España. División de temas tratados. En primer lugar, se revisan los procesos de medición de resultados en la implantación de Guías, en el marco del Programa Best Practice Spotlight Organizations®, cuya herramienta para liderar el cambio incluye la monitorización y evaluación como una de las seis fases del ciclo de acción. En segundo lugar, se analizan las estrategias de monitorización y evaluación propuestas en la literatura, destacando la Asociación Profesional de Enfermeras de Ontario. Finalmente, se analizan las estrategias de monitorización y evaluación generadas por dos instituciones españolas participantes en el programa, centradas en adecuación de registros, explotación y análisis de indicadores, desarrollo de herramientas, procedimientos de evaluación y mecanismos de difusión y retroalimentación. Conclusiones. La definición de estrategias de monitorización y evaluación planificada de forma temprana contribuye a la viabilidad de la evaluación de la implantación y su sostenibilidad. Es necesario adaptarlas al contexto, con estrategias transversales que alcancen a toda la institución, facilitadas por la institución. Palabras clave: Ciencia de la Implementación; Práctica Clínica Basada en la Evidencia; Evaluación de Resultado en la Atención de Salud; Mecanismos de Evaluación de la Atención de Salud; Indicadores de Calidad de la Atención de Salud ABSTRACT Introduction. Monitoring the usage of knowledge and evaluating results permits one to know the application of the evidence, knowledge, and attitude changes, the impact on health results, integration, and maintenance of the adopted practices. There exist weaknesses related to lack of systematization, limitation of the records, and quality of the process. This article’s objective is to describe the experience generating monitoring strategies and evaluation of the results regarding the implementation of good practice guides in Spain. Topics for Reflection. In the first place, the measurement process of the results regarding the implementation of guides are reviewed, in the Best Practice Spotlight Organizations® program frame, whose tool to lead the change includes monitoring and evaluation as one of the sixth phases of the action cycle. In the second place, monitoring and evaluation strategies proposed in the literature are analyzed, highlighting the Professional Nurses Association of Ontario. Finally, the monitoring and evaluation strategies are analyzed by two Spanish institutions participating in the program, focused on the adequation of records, exploitation and indicator analysis, tools development, evaluation procedures, dissemination, and feedback mechanisms. Conclusions: The definition of monitoring and evaluation strategies planned in advance contributes to the viability of the evaluation regarding the implementation and its sustainability. Is necessary to adapt them to the context, with transversal strategies that reach the whole institution, facilitated by the institution. Keywords: Implementation Science; Evidence-Based Practice; Outcome Assessment, Health Care; Health Care Evaluation Mechanisms; Quality Indicators, Health Care RESUMO Introdução. Monitorizar a utilização do conhecimento e avaliar os resultados permite-nos conhecer a aplicação das evidências, as mudanças nos conhecimentos e atitudes, o impacto nos resultados de saúde e a integração e manutenção das práticas adotadas. Existem fragilidades relacionadas à falta de sistematização, limitações de registros e qualidade do processo. O objetivo deste artigo é descrever a experiência na geração de estratégias de monitoramento e avaliação dos resultados da implementação de Manuais de Boas Práticas na Espanha. Divisão dos temas abordados. Em primeiro lugar, são revistos os processos de medição de resultados na implementação dos Manuais, no âmbito do Programa Best Practice Spotlight Organizations®, cuja ferramenta para liderar a mudança inclui a monitorização e avaliação como uma das seis fases do ciclo de ação. Em segundo lugar, são analisadas as estratégias de monitoramento e avaliação propostas na literatura, com destaque para a Associação Profissional de Enfermeiros de Ontário. Por fim, são analisadas as estratégias de monitoramento e avaliação geradas por duas instituições espanholas participantes do programa, focadas na adaptação de registros, exploração e análise de indicadores, desenvolvimento de ferramentas, procedimentos de avaliação e mecanismos de divulgação e feedback. Conclusões. A definição de estratégias de monitoramento e avaliação planeadas antecipadamente contribui para a viabilidade da avaliação da implementação e para a sua sustentabilidade. É necessário adaptá-los ao contexto, com estratégias transversais que alcancem toda a instituição, facilitadas pela instituição. Palavras-chave: Ciência da Implementação; Prática Clínica Baseada em Evidências; Avaliação de Resultados em Cuidados de Saúde; Mecanismos de Avaliação da Assistência à Saúde; Indicadores de Qualidade em Assistência à Saúde

Problem and objectiveUniversity dropout is a major problem that affects more than 31,000 students each year in Andalusian universities, with serious personal and social consequences and an economic cost of more than 222 million euros for the region’s public administration. As concluded from the review of explanatory models we reviewed, dropout has a multicausal origin. The purpose of our work is to test the efficacy of the use of a screening for the early detection of the risk of academic dropout in Higher Education in Andalusian universities.ProcedureWe applied a screening instrument adapted for incoming students in public universities in Andalusia. The survey was applied at the beginning of the second semester. In this article we present data from a sample composed of 976 subjects from the universities of Granada UGR, Jaén UJA and Pablo de Olavide de Sevilla UPO.ResultsWith the data obtained we have established the dropout risk group, which includes those students who do not reach an average score of 3.00 in the total screening. There are 34 students representing 3.48% of the sample. Of these 34 students, 26 are women and 8 are men; 20 belong to the UGR, 8 to the UJA and 5 to the UPO. The detection of the risk group will allow the universities to apply preventive measures in a personalized and adjusted way to avoid possible dropout.

Immunoparesis (IP) in multiple myeloma (MM) patients can be measured by classic assessment of immunoglobulin (Ig) levels or by analysis of the uninvolved heavy/light chain pair of the same immunoglobulin (uHLC) by the Hevylite® assay. In this study we evaluate the prognostic value of recovery from IP measured by classic total Ig and uHLC assessment in newly diagnosed MM transplant-eligible (NDMM-TE) patients with intensive treatment and its association with minimal residual disease (MRD). Patients were enrolled and treated in the PETHEMA/GEM2012MENOS65 trial and continued in the PETHEMA /GEM2014MAIN trial. Total Ig (IgG, IgA and IgM) and uHLC were analyzed in a central laboratory at diagnosis, after consolidation treatment and after the first year of maintenance. MRD was analyzed by next-generation flow cytometry after consolidation (sensitivity level 2x10-6). We found no differences in progression-free survival (PFS) between patients who recovered and patients who didn’t recover from IP after consolidation when examining classic total Ig and uHLC. However, after the first year of maintenance, in contrast to patients with classic IP, patients with recovery from uHLC IP had longer PFS than patients without recovery, with hazard ratio of 0.42 (95% confidence interval [CI]: 0.21-0.81; P=0.008). Multivariate analysis with Cox proportional-hazards regression models confirmed recovery from uHLC IP after the first year of maintenance as an independent prognostic factor for PFS, with an increase in C-statistic of 0.05 (95% CI: -0.04 to 0.14; P

This Guide for Living Donor Kidney Transplantation (LDKT) has been prepared with the sponsorship of the Spanish Society of Nephrology (SEN), the Spanish Transplant Society (SET), and the Spanish National Transplant Organization (ONT). It updates evidence to offer the best chronic renal failure treatment when a potential living donor is available. The core aim of this Guide is to supply clinicians who evaluate living donors and transplant recipients with the best decision-making tools, to optimise their outcomes.Moreover, the role of living donors in the current KT context should recover the level of importance it had until recently. To this end the new forms of incompatible HLA and/or ABO donation, as well as the paired donation which is possible in several hospitals with experience in LDKT, offer additional ways to treat renal patients with an incompatible donor.Good results in terms of patient and graft survival have expanded the range of circumstances under which living renal donors are accepted. Older donors are now accepted, as are others with factors that affect the decision, such as a borderline clinical history or alterations, which when evaluated may lead to an additional number of transplantations.This Guide does not forget that LDKT may lead to risk for the donor. Pre-donation evaluation has to centre on the problems which may arise over the short or long-term, and these have to be described to the potential donor so that they are able take them into account. Experience over recent years has led to progress in risk analysis, to protect donors’ health. This aspect always has to be taken into account by LDKT programmes when evaluating potential donors.Finally, this Guide has been designed to aid decision-making, with recommendations and suggestions when uncertainties arise in pre-donation studies. Its overarching aim is to ensure that informed consent is based on high quality studies and information supplied to donors and recipients, offering the strongest possible guarantees. Resumen: Esta guía de recomendaciones para el TR de donante vivo (TRDV) es un documento elaborado con el patrocinio de la Sociedad Española de Nefrología, la Sociedad Española de Trasplantes y la Organización Nacional de Trasplantes que actualiza la calidad de la evidencia disponible para ofrecer el mejor tratamiento de la insuficiencia renal crónica cuando se disponga de un donante vivo potencial. El objetivo principal de esta guía es proporcionar a los profesionales con responsabilidad en los estudios previos del donante vivo y del receptor trasplantado, las mejores herramientas para tomar decisiones en beneficio del donante vivo y del receptor del trasplante.Además, en el contexto actual del TR, el donante vivo debe recuperar el protagonismo que alcanzó en un pasado reciente. Para ello, las nuevas modalidades de donación HLA y/o ABO incompatible, así como la donación cruzada disponibles en diversos centros con experiencia en TRDV, son oportunidades adicionales para el tratamiento de enfermos renales que tienen un donante incompatible.Los buenos resultados en supervivencia del paciente y del injerto están ampliando las circunstancias de aceptación de donantes vivos de riñón, incluyendo donantes de mayor edad y otros con algunos condicionantes que incluyen antecedentes o alteraciones límite que, cuando son evaluados con criterios objetivos, pueden aportar un numero adicional de trasplantes.No se ha obviado en esta guía que el TRDV puede representar algún riesgo para el que dona. Estos problemas que pueden aparecer a corto o largo plazo tienen que ser objeto principal de valoración previa a la donación y presentados al potencial donante para que en ejercicio de su autonomía los asuma o rechace. La experiencia acumulada en los últimos años ha permitido avanzar en el análisis de riesgos para preservar la salud de los donantes, aspecto que debe estar siempre presente en los responsables de programas de TRDV cuando se procede al estudio de idoneidad de un potencial donante.Finalmente, esta guía ha sido estructurada para facilitar la toma de decisiones con recomendaciones y sugerencias ante incertidumbres derivadas de los resultados en los exhaustivos estudios predonación. Y todo ello, con el objetivo de que el consentimiento informado que debe certificar la calidad de los estudios y la información proporcionada a donante y receptor, alcancen las mayores garantías posibles.

Sin resumen.

IntroductionElevated pulse pressure (ePP) is an independent marker of cardiovascular risk (CVR) in people older than 60, and a functional marker of subclinical target organ damage (sTOD) which can predict cardiovascular events in patients with hypertension (HTN), regardless of sTOD.ObjectiveTo evaluate the prevalence of ePP in adult population seen in primary care and its association with other vascular risk factors, sTOD and with cardiovascular disease (CVD).Materials and methodsObservational multicentre study conducted in Spain (8,066 patients, 54.5% women) from the prospective cohort study IBERICAN recruited in Primary Care. Pulse pressure (PP) was defined as the difference between the systolic blood pressure (SBP) and the diastolic blood pressure (DBP) ≥60 mmHg. Adjusted (for age and sex) ePP prevalence were determined. Bivariate and multivariate analyses of the possible variables associated with ePP were carried out.ResultsThe mean of PP was 52.35 mmHg, and was significantly higher (p

Abstract Genetic determinants of BK polyomavirus infection after kidney transplantation remain poorly investigated. We assessed the potential impact of 13 different single nucleotide polymorphisms within genes mainly involved in innate immune responses on the risk of BKPyV viremia in 204 KT recipients. After a median follow-up of 1121.5 days, the cumulative incidence of any-level BKPyV viremia was 24.5% (50/204). There was a significant association between the minor T allele of TLR3 (rs3775291) SNP and the development of BKPyV viremia (adjusted hazard ratio [aHR]: 2.16; 95% confidence interval [CI]: 1.08–4.30; P value = 0.029), whereas the minor G allele of CD209 (rs4804803) SNP exerted a protective role (aHR: 0.54; 95% CI: 0.29–1.00; P value = 0.050). A higher incidence of BKPyV viremia was also observed for the minor G allele of IL10 (rs1800872) SNP, although the absence of BKPyV events among homozygotes for the reference allele prevented multivariable analysis. The BKPyV viremia-free survival rate decreased with the increasing number of unfavorable genotypes (100% [no unfavorable genotypes], 85.4% [1 genotype], 70.9% [2 genotypes], 52.5% [3 genotypes]; P value = 0.008). In conclusion, SNPs in TLR3, CD209 and IL10 genes play a role in modulating the susceptibility to any-level BKPyV viremia among KT recipients.

Abstract Background Cordyceps militaris, a kind of edible and medicinal fungus widely accepted in East Asia, has attracted much attention as a potential cell factory for producing adenosine analogs. Despite the rapid development in gene editing techniques and genome modeling, the diversity of DNA elements in C. militaris was too short to achieve rational heterogeneous expression for metabolic engineering studies. Results In this study, PtrpC, a kind of promoter with a relatively appropriate expression level and small size, was selected as a monomer for promoter library construction. Through in vitro BioBricks assembly, 9 overlapping PtrpC promoters with different copy numbers as well as reporter gene gfp were connected and subsequently integrated into the genome of C. militaris. Both the mRNA transcription level and the expression level of gene gfp gradually increased along with the copy number of the overlapping promoter NPtrpC and peaked at 7. In the meantime, no significant difference was found in either the biomass or morphological characteristic of engineered and wild-type strains. Conclusions This study firstly expanded the overlapping promoter strategy used in model microorganism in C. militaris. It was a proof-of-concept in fungi synthetic biology and provide a general method to pushed the boundary of promoter engineering in edible mushroom.

In this randomized phase II study (GEM-KyCyDex, clinicaltrials gov. Identifier: NCT03336073), the combination of weekly carfilzomib 70 mg/m2, cyclophosphamide and dexamethasone (KCd) was compared to carfilzomib and dexamethasone (Kd) in relapsed/refractory multiple myeloma (RRMM) after 1-3 prior lines (PL). One hundred and ninety-seven patients were included and randomized 1:1 to receive KCd (97 patients) or Kd (100 patients) in 28-day cycles until progressive disease or unacceptable toxicity occurred. Patient median age was 70 years, and the median number of PL was one (range, 1-3). More than 90% of patients had previously been exposed to proteasome inhibitors, approximetely 70% to immunomodulators, and approximetely 50% were refractory to their last line (mainly lenalidomide) in both groups. After a median follow-up of 37 months, median progression-free survival (PFS) was 19.1 and 16.6 months in KCd and Kd, respectively (P=0.577). Of note, in the post hoc analysis of the lenalidomide-refractory population, the addition of cyclophosphamide to Kd resulted in a significant benefit in terms of PFS: 18.4 versus 11.3 months (hazard ratio =1.7, 95% confidence interval: 1.1-2.7; P=0.043). The overall response rate and the percentage of patients who achieved complete response was around 70% and 20% in both groups. The addition of cyclophosphamide to Kd did not result in any safety signal, except for severe infections (7% vs. 2%). In conclusion, the combination of cyclophosphamide with Kd 70 mg/m2 weekly does not improve outcomes as compared with Kd alone in RRMM after 1-3 PL, but a significant benefit in PFS was observed with the triplet combination in the lenalidomide-refractory population. The administration of weekly carfilzomib 70 mg/m2 was safe and convenient, and, overall, the toxicity was manageable in both arms.

El presente trabajo de investigación centra su atención en una cuestión novedosa que se ha introducido en la escena política en España a partir del año 2015, con la crisis del bipartidismo: la presencia de mujeres en los debates electorales televisados. Para ello, este artículo analiza cuáles han sido las etapas de construcción de la imagen política a través de los diferentes medios de difusión para después adentrarse en los debates televisados en España, haciendo una especial mención a los debates donde han aparecido mujeres. Es por esta razón que se habla expresamente de los debates autonómicos, por su alta presencia de mujeres. Finalmente, con toda esta información, las autoras reflexionan sobre los diferentes elementos que desde esta óptica afectan al Estado constitucional de Derecho, llegando a definir los nuevos parámetros interpretativos a aplicar en la materia tratada en estas páginas.

Resumen: Esta guía de recomendaciones para el TR de donante vivo (TRDV) es un documento elaborado con el patrocinio de la Sociedad Española de Nefrología, la Sociedad Española de Trasplantes y la Organización Nacional de Trasplantes que actualiza la calidad de la evidencia disponible para ofrecer el mejor tratamiento de la insuficiencia renal crónica cuando se disponga de un donante vivo potencial. El objetivo principal de esta guía es proporcionar a los profesionales con responsabilidad en los estudios previos del donante vivo y del receptor trasplantado, las mejores herramientas para tomar decisiones en beneficio del donante vivo y del receptor del trasplante.Además, en el contexto actual del TR, el donante vivo debe recuperar el protagonismo que alcanzó en un pasado reciente. Para ello, las nuevas modalidades de donación HLA y/o ABO incompatible, así como la donación cruzada disponibles en diversos centros con experiencia en TRDV, son oportunidades adicionales para el tratamiento de enfermos renales que tienen un donante incompatible.Los buenos resultados en supervivencia del paciente y del injerto están ampliando las circunstancias de aceptación de donantes vivos de riñón, incluyendo donantes de mayor edad y otros con algunos condicionantes que incluyen antecedentes o alteraciones límite que, cuando son evaluados con criterios objetivos, pueden aportar un numero adicional de trasplantes.No se ha obviado en esta guía que el TRDV puede representar algún riesgo para el que dona. Estos problemas que pueden aparecer a corto o largo plazo tienen que ser objeto principal de valoración previa a la donación y presentados al potencial donante para que en ejercicio de su autonomía los asuma o rechace. La experiencia acumulada en los últimos años ha permitido avanzar en el análisis de riesgos para preservar la salud de los donantes, aspecto que debe estar siempre presente en los responsables de programas de TRDV cuando se procede al estudio de idoneidad de un potencial donante.Finalmente, esta guía ha sido estructurada para facilitar la toma de decisiones con recomendaciones y sugerencias ante incertidumbres derivadas de los resultados en los exhaustivos estudios predonación. Y todo ello, con el objetivo de que el consentimiento informado que debe certificar la calidad de los estudios y la información proporcionada a donante y receptor, alcancen las mayores garantías posibles. Abstract: This guide for living donor renal transplantation (LDRT) has been prepared with the sponsorship of the Spanish Society of Nephrology (SEN), the Spanish Transplant Society (SET), and the Spanish National Transplant Organization (ONT). It updates evidence to offer the best chronic renal failure treatment when a potential living donor is available. The core aim of this guide is to supply clinicians who evaluate living donors and transplant recipients with the best decision-making tools, to optimise their outcomes.Moreover, the role of living donors in the current RT context should recover the level of importance it had until recently. To this end the new forms of incompatible HLA and/or ABO donation, as well as the paired donation which is possible in several hospitals with experience in LDRT, offer additional ways to treat renal patients with an incompatible donor.Good results in terms of patient and graft survival have expanded the range of circumstances under which living renal donors are accepted. Older donors are now accepted, as are others with factors that affect the decision, such as a borderline clinical history or alterations, which when evaluated may lead to an additional number of transplantations.This guide does not forget that LDRT may lead to risk for the donor. Pre-donation evaluation has to centre on the problems which may arise over the short or long-term, and these have to be described to the potential donor so that they are able to take them into account. Experience over recent years has led to progress in risk analysis, to protect donors’ health. This aspect always has to be taken into account by LDRT programmes when evaluating potential donors.Finally, this guide has been designed to aid decision-making, with recommendations and suggestions when uncertainties arise in pre-donation studies. Its overarching aim is to ensure that informed consent is based on high quality studies and information supplied to donors and recipients, offering the strongest possible guarantees.

Background and aims: Whether cytomegalovirus (CMV) infection increases the risk of cardiovascular complications after kidney transplantation (KT) through different indirect effects remains controversial. Methods: We analyzed the incidence of post-transplant atherosclerotic (PAEs) and thrombotic events (PTEs) in 465 KT recipients according to the previous exposure to any level or high-level (≥1,000 IU/mL) CMV viremia (either asymptomatic or clinical disease) by means of landmark analysis beyond days 30, 180 and 360 after transplantation. Proportional hazards models were constructed with death and graft loss as competing risks. Results: After a median of 722 days, the cumulative incidences of PAE and PTE were 6.0% each. Most PAEs (53.6%) occurred beyond post-transplant day 360, whereas most PTEs (60.7%) were diagnosed between days 30–180.The incidence of PAE beyond day 180 was higher among patients with previous CMV viremia compared to those without (two-year rates: 4.7% versus 0.4%; P-value = 0.035). This difference was more pronounced in recipients developing high-level viremia (6.3% versus 0.7%, respectively; P-value = 0.013). After multivariate adjustment for age, pre-transplant cardiovascular risk, antiplatelet and statin therapy and graft function, however, associations were not maintained either for any-level (hazard ratio [HR]: 1.84; 95% confidence interval [CI]: 0.48–7.05) or high-level CMV viremia (HR: 2.84; 95% CI: 0.78–10.36). No significant differences were found in the remaining landmark analyses (days 30 or 360) or for the outcome of PTE either. Conclusions: Our study does not support that CMV infection independently contributes to the risk of PAE or PTE after KT.

Background: Wild-type transthyretin amyloidosis is a systemic disease with predominantly cardiac symptoms. The aim of this study was to assess the short-term prognosis of these patients through contractile reserve measured by stress echocardiography, given the usefulness that this parameter has demonstrated in other populations. We considered major events as death from any cause and hospitalization for heart failure. Material and methods: We conducted a study with a 1-year follow-up in 11 patients who were proposed to undergo a stress echocardiogram, with the follow-up as usual according to their doctor. We excluded pacemaker wearers, patients with permanent atrial fibrillation, those incapable of exertion at low loads, and those with poor acoustic windows. Results: We found that contractile reserve estimated by right ventricular free wall longitudinal strain is correlated with a lower rate of death (all of them cardiovascular deaths) and hospitalizations for heart failure. Conclusions: Contractile reserve assessed by right ventricular free wall longitudinal strain is a predictor of major events in patients with wild-type transthyretin cardiac amyloidosis.

Carbohydrate quality might be more important than quantity to reduce type 2 diabetes (T2D) risk. Various metrics of carbohydrate quality exist; however, their associations with T2D have only been studied to a limited extent. Consequently, the aim was to investigate the association between four different pre-defined carbohydrate quality indices, with various amounts of fiber (≥1 g) and free sugar (

We aimed to analyse whether patients with ischaemic stroke (IS) occurring within eight days after the onset of COVID-19 (IS-COV) are associated with a specific aetiology of IS. We used SUPERGNOVA to identify genome regions that correlate between the IS-COV cohort (73 IS-COV cases vs. 701 population controls) and different aetiological subtypes. Polygenic risk scores (PRSs) for each subtype were generated and tested in the IS-COV cohort using PRSice-2 and PLINK to find genetic associations. Both analyses used the IS-COV cohort and GWAS from MEGASTROKE (67,162 stroke patients vs. 454,450 population controls), GIGASTROKE (110,182 vs. 1,503,898), and the NINDS Stroke Genetics Network (16,851 vs. 32,473). Three genomic regions were associated (p-value < 0.05) with large artery atherosclerosis (LAA) and cardioembolic stroke (CES). We found four loci targeting the genes PITX2 (rs10033464, IS-COV beta = 0.04, p-value = 2.3 × 10−2, se = 0.02), previously associated with CES, HS6ST1 (rs4662630, IS-COV beta = −0.04, p-value = 1.3 × 10−3, se = 0.01), TMEM132E (rs12941838 IS-COV beta = 0.05, p-value = 3.6 × 10−4, se = 0.01), and RFFL (rs797989 IS-COV beta = 0.03, p-value = 1.0 × 10−2, se = 0.01). A statistically significant PRS was observed for LAA. Our results suggest that IS-COV cases are genetically similar to LAA and CES subtypes. Larger cohorts are needed to assess if the genetic factors in IS-COV cases are shared with the general population or specific to viral infection.

Living donor kidney transplantation (LDKT) is the best treatment option for end stage renal disease in terms of both patient and graft survival. However, figures on LDKT in Spain that had been continuously growing from 2005 to 2014, have experienced a continuous decrease in the last five years.One possible explanation for this decrease is that the significant increase in the number of deceased donors in Spain during the last years, both brain death and controlled circulatory death donors, might have generated the false idea that we have coped with the transplant needs. Moreover, a greater number of deceased donor kidney transplants have caused a heavy workload for the transplant teams.Furthermore, the transplant teams could have moved on to a more conservative approach to the information and assessment of patients and families considering the potential long-term risks for donors in recent papers. However, there is a significant variability in the LDKT rate among transplant centers and regions in Spain independent of their deceased donor rates. This fact and the fact that LDKT is usually a preemptive option for patients with advanced chronic renal failure, as time on dialysis is a negative independent factor for transplant outcomes, lead us to conclude that the decrease in LDKT depends on other factors.Thus, in the kidney transplant annual meeting held at ONT site in 2018, a working group was created to identify other causes for the decrease of LDKT in Spain and its relationship with the different steps of the process. The group was formed by transplant teams, a representative of the transplant group of the Spanish Society of Nephrology (SENTRA), a representative of the Spanish Society of Transplants (SET) and representatives of the Spanish National Transplant Organization (ONT).A self-evaluation survey that contains requests about the phases of the LDKT processes (information, donor work out, informed consent, surgeries, follow-up and human resources) were developed and sent to 33 LDKT teams. All the centers answered the questionnaire. The analysis of the answers has resulted in the creation of a national analysis of strengths, weaknesses, opportunities, threats (SWOT) of the LDKT program in Spain and the development of recommendations targeted to improve every step of the donation process. The work performed, the conclusions and recommendations provided, have been reflected in the following report: Spanish living donor kidney transplant program assessment: recommendations for optimization. This document has also been reviewed by a panel of experts, representatives of the scientific societies (Spanish Society of Urology (AEU), Spanish Society of Nephrology Nursery (SEDEN), Spanish Society of Immunology (SEI/GETH)) and the patient association ALCER. Finally, the report has been submitted to public consultation, reaching ample consensus. In addition, the transplant competent authorities of the different regions in Spainhave adopted the report at institutional level.The work done and the recommendations to optimize LDKT are summarized in the present manuscript, organized by the different phases of the donation process. Resumen: El trasplante renal de donante vivo (TRDV) es la opción terapéutica con las mejores expectativas de supervivencia para el injerto y para el paciente con insuficiencia renal terminal; sin embargo, este tipo de trasplantes ha experimentado un descenso progresivo en los últimos años en España.Entre las posibles explicaciones del descenso de actividad se encuentra la coincidencia en el tiempo con un aumento en el número de donantes renales fallecidos, tanto por muerte encefálica como por asistolia controlada, que podría haber generado una falsa impresión de ausencia de necesidad del TRDV. Además, la disponibilidad de un mayor número de riñones para trasplante habría supuesto un incremento en la carga de trabajo de los profesionales que pudiera enlentecer los procesos de donación en vida. Otro posible argumento radica en un posible cambio de actitud hacia posturas más conservadoras a la hora de informar a pacientes y a familiares acerca de esta opción terapéutica, a raíz de los artículos publicados respecto al riesgo de la donación a largo plazo. Sin embargo, existe una importantísima variabilidad en la actividad entre centros y comunidades autónomas, no explicada por el volumen de trasplante procedente de otros tipos de donante. Este dato, unido a que la indicación de donación renal en vida se realiza de manera mayoritaria en situación de enfermedad renal crónica avanzada (ERCA) y que el tiempo en diálisis es un factor pronóstico negativo respecto a la supervivencia postrasplante, permite concluir que el descenso depende además de otros factores.Por este motivo, en la reunión anual de equipos de trasplante renal, celebrada en la sede de la Organización Nacional de Trasplantes (ONT) en 2018, se constituyó un grupo de trabajo formado por equipos de trasplante renal, el grupo de trasplantes de la Sociedad Española de Nefrología (SEN) (SENTRA), la Sociedad Española de Trasplantes (SET) y la ONT, con el objetivo de identificar otras causas que condicionaron el descenso de la actividad de este tipo de trasplantes en España y su posible relación con la gestión del proceso de donación de vivo.El grupo de trabajo diseñó un cuestionario de autoevaluación, que fue cumplimentado por las 33 unidades de trasplante renal de donante vivo activas en España. El cuestionario contiene preguntas sobre las diferentes fases del proceso de donación de vivo: información inicial, estudio del donante vivo e información de los riesgos, consentimiento, recursos humanos (RRHH), nefrectomía, trasplante y seguimiento posterior.El análisis de las respuestas ha dado como resultado la creación de un análisis de debilidades, amenazas, fortalezas y oportunidades (DAFO) del programa a nivel nacional y ha permitido elaborar recomendaciones específicas dirigidas a mejorar cada una de las fases del proceso de donación en vida. El documento, denominado Análisis de situación del trasplante renal de donante vivo y hoja de ruta ha sido también revisado por un panel de expertos en TRDV, representantes de varias sociedades científicas implicadas (Asociación Espa˜nola de Urología [AEU], Sociedad Espa˜nola de Enfermería Nefrológica [SEDEN], Sociedad Espa˜nola de Inmunología [SEI/GETH]), el Grupo de Trabajo Enfermedad Renal Crónica Avanzada (ACERCA), la Asociación de Pacientes para la Lucha Contra la Enfermedad Renal (ALCER) y sometido posteriormente a consulta pública. Tras incluir las mejoras sugeridas, el documento final ha sido adoptado institucionalmente en el Consejo Interterritorial de Trasplantes (CIT) del Sistema Nacional de Salud.El trabajo realizado y las recomendaciones para optimizar el TRVD se describen a lo largo del presente artículo, organizados por los diferentes apartados del proceso de donación.

Guaitacargols és un projecte adreçat a centres d’educació secundària que proposa fer un estudi de la biodiversitat de cargols terrestres en espais propers als centres. La iniciativa és impulsada pel Museu de Ciències Naturals de Barcelona (MCNB), afavoreix el treball en xarxa amb el personal docent participant i compta amb l’acompanyament expert de l’Associació Catalana de Malacologia (ACM). El projecte apropa l’alumnat a la metodologia científica a través d’un estudi de camp real i inclou la filosofia de la ciència ciutadana, tot posant en valor la participació democratitzada de la ciutadania en la construcció del coneixement científic. Arran de la formació i les eines aportades pel MCNB i l’ACM, els equips docents de l’Institut ca n’Oriac (Sabadell) i de I’Institut Moianès (Moià) han dissenyat seqüències educatives que desenvolupen competències i continguts científics a partir del context dels cargols terrestres. Les dades obtingudes amb el treball de camp i la seva posterior identificació han estat validades científicament.

Background: Torque teno virus (TTV) DNAemia has been proposed as a surrogate marker of immunosuppression after kidney transplantation (KT), under the assumption that the control of viral replication is mainly exerted by T-cell-mediated immunity. However, Tthe impact on post-transplant TTV kinetics of single genetic polymorphisms (SNPs) in genes orchestrating innate responses remains unknown. We aimed to characterize the potential association between 14 of these SNPs and TTV DNA levels in a single-center cohort of KT recipients.Methods: Plasma TTV DNAemia was quantified by real-time PCR in 221 KT recipients before transplantation (baseline) and regularly through the first 12 post-transplant months. We performed genotyping of the following SNPs: CTLA4 (rs5742909, rs231775), TLR3 (rs3775291), TLR9 (rs5743836, rs352139), CD209 (rs735240, rs4804803), IFNL3 (rs12979860, rs8099917), TNF (rs1800629), IL10 (rs1878672, rs1800872), IL12B (rs3212227) and IL17A (rs2275913).Results: The presence of the minor G allele of CD209 (rs4804803) in the homozygous state was associated with undetectable TTV DNAemia at the pre-transplant assessment (adjusted odds ratio: 36.96; 95% confidence interval: 4.72–289.67; p-value = 0.001). After applying correction for multiple comparisons, no significant differences across SNP genotypes were observed for any of the variables of post-transplant TTV DNAemia analyzed (mean and peak values, areas under the curve during discrete periods, or absolute increments from baseline to day 15 and months 1, 3, 6 and 12 after transplantation).Conclusion: The minor G allele of CD209 (rs4804803) seems to exert a recessive protective effect against TTV infection in non-immunocompromised patients. However, no associations were observed between the SNPs analyzed and post-transplant kinetics of TTV DNAemia. These negative results would suggest that post-transplant TTV replication is mainly influenced by immunosuppressive therapy rather than by underlying genetic predisposition, reinforcing its clinical application as a biomarker of adaptive immunity.

Persistence and dropout are two sides of the same coin. Together with personal and social factors, associated with the quality of teaching provided by universities determine students' ability to persist in achieving their academic degree or, on the contrary, to drop out of university studies. Our working hypothesis is that the impact on improving the quality of teaching by considering neurodidactic factors, which are currently being researched and experimented with, can improve the overall persistence rate by reducing the dropout rate. In this preliminary study, we intend to make a first approach to the phenomenon of academic failure in Andalusian universities from the prediction and diagnosis of risk groups and the recommendation of preventive measures. Among the measures we proposed for prevention, highlighting those that have an impact on neurodidactic factors. Our work consisted of applying an instrument to diagnose the risk of dropping out of university studies to a sample of first-year university students in Andalusian universities. The instrument was applied at the beginning of the second semester. Of the 976 students surveyed, we have established a risk group of 34 students. We will propose measures oriented towards the neurodidactics factors that predict dropout and calling for the use of ICT in the implementation of preventive measures.

Abstract Although case-control analyses have suggested an additive value with the association of clarithromycin to continuous lenalidomide and dexamethasone (Rd), there are not phase III trials confirming these results. In this phase III trial, 286 patients with MM ineligible for ASCT received Rd with or without clarithromycin until disease progression or unacceptable toxicity. The primary endpoint was progression-free survival (PFS). With a median follow-up of 19 months (range, 0–54), no significant differences in the median PFS were observed between the two arms (C-Rd 23 months, Rd 29 months; HR 0.783, p = 0.14), despite a higher rate of complete response (CR) or better in the C-Rd group (22.6% vs 14.4%, p = 0.048). The most common G3–4 adverse events were neutropenia [12% vs 19%] and infections [30% vs 25%], similar between the two arms; however, the percentage of toxic deaths was higher in the C-Rd group (36/50 [72%] vs 22/40 [55%], p = 0.09). The addition of clarithromycin to Rd in untreated transplant ineligible MM patients does not improve PFS despite increasing the ≥CR rate due to the higher number of toxic deaths in the C-Rd arm. Side effects related to overexposure to steroids due to its delayed clearance induced by clarithromycin in this elderly population could explain these results. The trial was registered in clinicaltrials.gov with the name GEM-CLARIDEX: Ld vs BiRd and with the following identifier NCT02575144. The full trial protocol can be accessed from ClinicalTrials.gov. This study received financial support from BMS/Celgene.

El objetivo de este trabajo es describir las características del cambio paradigmático que se está produciendo en la Educación Superior y sus efectos para la profesionalización y la calidad docente. El estudio se basa en tres ámbitos de la acción política y en sus correspondientes fundamentos teóricos que están explicando parte de la transformación de las instituciones de Educación Superior y de la profesión académica y que, de manera integrada, constituyen un nuevo modelo o paradigma. Se trata de: (a) el efecto de las políticas de acreditación y evaluación basada en estándares; (b) la extensión del movimiento SoTL (Scholarship of Teaching and Learning); (c) la aparición de nuevos espacios regionales de integración de la Educación Superior que trasladan el foco de la transferibilidad desde los programas de enseñanza a los resultados de aprendizaje. El modelo de investigación adoptado es de naturaleza descriptiva, explicativa. La investigación se realiza en el marco de un proyecto de I+D+i del Programa Operativo FEDER, en el que participan 28 universidades (9 de Andalucía, 6 del resto de España y 13 de América Latina) y 21 equipos de investigación. En esta investigación se emplea para la recogida de información un cuestionario y una entrevista oral en profundidad. El cuestionario ya ha sido utilizado en estudios previos que nos sirven de antecedente. En esta comunicación se presentan los resultados previos más pertinentes para el proyecto.

Risk stratification for cytomegalovirus (CMV) infection after kidney transplantation (KT) remains to be determined. Since endosomal toll-like receptors (TLRs) are involved in viral sensing, we investigated the impact of common single-nucleotide polymorphisms (SNPs) located within TLR3 and TLR9 genes on the occurrence of overall and high-level (≥1,000 IU/ml) CMV infection in a cohort of 197 KT recipients. Homozygous carriers of the minor allele of TLR3 (rs3775291) had higher infection-free survival compared with reference allele carriers (60.0% for TT versus 42.3% for CC/CT genotypes; P-value = 0.050). Decreased infection-free survival was observed with the minor allele of TLR9 (rs352139) (38.2% for TC/CC versus 59.3% for TT genotypes; P-value = 0.004). After multivariable adjustment, the recessive protective effect of the TLR3 (rs3775291) TT genotype was confirmed (adjusted hazard ratio [aHR]: 0.327; 95% CI: 0.167–0.642; P-value = 0.001), as was the dominant risk-conferring effect of TLR9 (rs352139) TC/CC genotypes (aHR: 1.865; 95% CI: 1.170–2.972; P-value = 0.009). Carriers of the TLR9 (rs352139) TC/CC genotypes showed lower CMV-specific interferon-γ-producing CD4+ T-cell counts measured by intracellular cytokine staining compared with the TT genotype (median of 0.2 versus 0.7 cells/μl; P-value = 0.003). In conclusion, TLR3/TLR9 genotyping may inform CMV infection risk after KT.

Abstract The use of non‐pegylated liposomal doxorubicin (Myocet®) in diffuse large B‐cell lymphoma (DLBCL) has been investigated in retrospective and single‐arm prospective studies. This was a prospective phase 2 trial of DLBCL patients ≥60 years old with left ventricular ejection fraction (LVEF) ≥55% randomized to standard R‐CHOP or investigational R‐COMP (with Myocet® instead of conventional doxorubicin). The primary end point was to evaluate the differences in subclinical cardiotoxicity, defined as decrease in LVEF to

En este trabajo se presentan los hábitos de higiene y el conocimiento que tiene un conjunto de 69 alumnos de Educación Infantil (4-6 años) sobre microorganismos y se analiza la posible influencia sobre ellos de dos propuestas didácticas diferentes (tradicional –grupo control- y con indagación –grupo experimental-). La información se obtuvo en tres momentos diferentes -pre-intervención didáctica, post intervención y dos meses después-, mediante dibujos de los niños, un cuestionario aplicado oral e individualmente con preguntas cerradas y abiertas y un cuestionario dirigido a las familias. Se detectan indicios de que el alumnado reconoce a los microorganismos como seres vivos. Tras la intervención no se encuentran diferencias estadísticamente significativas entre el grupo experimental y el control. Dos meses después se observa una mejora en el grupo control respecto a algunos hábitos de higiene y en el grupo experimental se recuerda el proceso de indagación con placas de Petri. Estos resultados abren nuevos interrogantes.

El presente paper pretende contribuir a la explicación de los conceptos de derecho constitucional y constitucionalismo desde un análisis centrado en su interpretación histórica y de derecho comparado. Para ello se realiza un repaso sobre la “genealogía constitucional”, es decir, sobre las diferentes vías de influencia del sinfín de constituciones que se promulgaron en Europa desde 1791 a 1931 y que tomaron como punto de partida las revoluciones americana y francesa, pero también la inglesa aunque aquella se manifestase antes y de otro modo. Este análisis ofrece unas conclusiones que permitirán comenzar a construir la categoría científica de “Revolución constitucional” que va más allá de la mera sucesión de revueltas políticas o intentonas revolucionarias con sentido constitucional desconectadas entre sí. Bien al contrario, todo lo acaecido desde mediados del siglo XVIII permite hablar de un continuum en el devenir histórico, que alumbró un verdadero cambio político-constitucional, amén del social e institucional.

This is a study of Political Economy, Law & Economics, and Public Choice, applied to COVID-19 crisis management, and how the Spanish healthcare sector has operated under stressful conditions. Market and state failures are evaluated and some improvements are offered, according to the theories of Austrian Economics and New-Institutional Economics. At the macro level, the premise is the decentralization of the Spanish healthcare system a long time ago, to provide a better service to citizens, according to the idiosyncrasies of the Autonomous Communities (similar to federal states). The crisis has evidenced the failures of the Spanish system and its semi-federal model, without coordination to manage the trouble. Also, the General Government's recentralization attempt has failed too, proving Mises's theorem on the impossibility of economic calculation in intervened and coactive systems, with problems of shortages, lack of coordination, etc.; Buchanan-Tullock's theorem on the unfinished agenda of state interventionist and it suppression of private sector was also proven. At the micro level, health institutions (hospitals and health centers) have fallen into the paradox of media overexposure and the fake-news risk, because the more information they have tried to transmit, the more confusion they have caused, reducing the value of the supposed transparency and accountability, in addition to decreasing citizen wellbeing, giving way to a higher level of dissatisfaction and more risk of a syndemic. To perform the analysis of accountability and wellbeing perceived, this paper has used quantitative contrast techniques on secondary sources, such as the surveys of Centro de Investigaciones Sociológicas (part of the Public Sector) or Merco rankings (independent institution).

Resumen: Objetivo: Identificar, en la literatura científica internacional, los obstáculos y factores potencialmente favorecedores para el avance durante su carrera profesional de las mujeres académicas e investigadoras en ciencias biomédicas. Método: Se realizó una búsqueda sistemática en PubMed, Scopus, CinahlPlus, Cochrane Database of Systematic Reviews, PsycInfo y Sociological Abstracts de artículos publicados en inglés y español entre enero de 2006 y diciembre de 2016 sobre el fenómeno del techo de cristal en mujeres académicas e investigadoras en ciencias biomédicas. El cribado se llevó a cabo por revisoras independientes. Resultados: Se encontraron 2254 estudios, de los cuales se incluyeron 23 en la revisión. Los obstáculos identificados para la promoción de las mujeres académicas o investigadoras en ciencias biomédicas son los sesgos de género en la evaluación de la investigación, el individualismo y la falta de colaboración, la falta de influencia de las mujeres, las desigualdades de género en la contratación y la promoción, la percepción de sexismo y discriminación en el clima laboral, y las dificultades de conciliación. Los elementos que favorecen son los ejemplos de mujeres en puestos de liderazgo, la mentorización, facilitar la conciliación, la transparencia en la contratación, la participación en la toma de decisiones, realizar auditorías de género en la evaluación de la investigación, la conciencia de las desigualdades de género, promover la colaboración y la equidad salarial. Conclusiones: Potenciar los elementos que favorecen la promoción de las mujeres académicas en ciencias biomédicas contribuiría a reducir el fenómeno del techo de cristal en esta área, al aumentar su participación, representación y liderazgo. Se requiere un cambio de valores organizacional e institucional. Abstract: Objective: To identify in the international scientific literature the obstacles and potential promoters for the advancement of women academics and researchers in biomedical sciences during their professional careers. Method: PubMed, Scopus, CinahlPlus, Cochrane Database of Systematic Reviews, PsycInfo and Sociological Abstracts were systematically searched for articles published in English and Spanish between January 2006 and December 2016 on the phenomenon of the glass ceiling in women academics and researchers in biomedical sciences. The screening was carried out by independent reviewers. Results: A total of 2254 studies were found, of which 23 were included in the review. The obstacles identified for the promotion of women academics and/or researchers in biomedical sciences are: gender bias in the evaluation of research results, individualism and lack of collaboration, women's lack of influence, the existence of gender inequalities in access to employment. The perception of sexism and discrimination in the work environment, and the difficulties in reconciling work and family life. The promoting elements are: examples of women in leadership positions, mentoring, facilitating conciliation, transparency in recruitment, participation in decision-making, gender assessment of research, awareness of gender inequalities in institutions, promoting collaboration, and pay equity. Conclusions: By enhancing the elements favouring the promotion of academic women in biomedical sciences would help to reduce the glass ceiling in the career paths of women academics and health science researchers by increasing their participation, leadership and representation. A change of organizational and institutional values is required to achieve this.

Introduction: Diabetic nephropathy (DN) is one of the most frequent complications in patients with diabetes mellitus (DM) and its diagnosis is usually established on clinical grounds. However, kidney involvement in some diabetic patients can be due to other causes, and renal biopsy might be needed to exclude them. The aim of our study was to establish the clinical and analytical data that predict DN and no-diabetic renal disease (NDRD), and to develop a predictive model (score) to confirm or dismiss DN. Material and methods: We conducted a transversal, observational and retrospective study, including renal biopsies performed in type 2 DM patients, between 2000 and 2018. Results: Two hundred seven DM patients were included in our study. The mean age was 64.5 ± 10.6 years and 74% were male. DN was found in 126 (61%) of the biopsies and NDRD in 81 (39%). Diabetic retinopathy was presented in 58% of DN patients, but only in 6% of NDRD patients (p 3 had DN and 94% of cases with a score ≤1 had NDRD (score ranked from −6 to 8 points). Conclusions: NDRD is common in DM patients (39%), being primary glomerulonephritis the most frequent ethology. The absence of retinopathy and the presence of microhematuria are highly suggestive of NDRD. The use of our predictive model could facilitate the indication of performing a renal biopsy in DM patients. Resumen: Introducción: La nefropatía diabética (ND) es una complicación frecuente de la diabetes mellitus (DM), y su diagnóstico suele ser clínico. Sin embargo, en numerosas ocasiones la enfermedad renal que presentan los pacientes diabéticos es debida a otras causas cuyo diagnóstico es histológico. El objetivo del estudio fue determinar los datos clínicos y analíticos predictores de ND y enfermedad renal no diabética (ERND), y elaborar un modelo predictivo (score) para confirmar o descartar ND. Material y métodos: Estudio observacional, transversal y retrospectivo de biopsias renales realizadas en pacientes diabéticos tipo 2 entre 2000 y 2018. Resultados: Se incluyeron 207 pacientes diabéticos con una edad media de 64.5 ± 10,6 años; el 74% eran varones. La biopsia mostró ND en 126 (61%) y en 81 ERND (39%). La retinopatía diabética estaba presente en el 58% de los pacientes con ND y en el 6% del grupo con ERND (p 3 era tenían ND, y el 94% de los casos con score ≤ 1 punto fueron ERND. Conclusiones: La ERND es frecuente en pacientes con DM (39%). La etiología más frecuente son las glomerulonefritis primarias. La ausencia de retinopatía y la presencia de microhematuria son altamente sugestivas de ERND. La utilización de un sistema de puntuación facilita la indicación de biopsia renal en pacientes diabéticos.

Abstract Background The evidence on the impact of high sugar consumption on micronutrient dilution does not yet allow for the establishment of clear thresholds of consumption. To establish upper and lower limit intake thresholds for added sugar, more studies from different countries and multiple populations are needed. The aim of this study was to examine the association between the intakes of added sugar and various micronutrients among the adult Swedish population across almost two decades. Methods The data were obtained from the samples from two populations: 1) Riksmaten Adults, a national dietary survey (n = 1797, 44% male, aged 18–80 years, data collection from 2010 to 11) that assessed dietary intake using a 4-day web-based food diary; and 2) the Malmö Diet and Cancer Study, a population-based cohort study (n = 12,238, 45% male, aged 45–68 years, data collection from 1991 to 1994) that assessed dietary intake via a combination of a 7-day food diary, a food frequency questionnaire and an interview. The mean daily intake of nine micronutrients (calcium, folate, iron, magnesium, potassium, selenium, vitamin C, vitamin D, and zinc), adjusted for age, sex, BMI and energy intake, were examined across six added-sugar-intake groups ( 20%E). Results We observed significant inverse associations between the intake of added sugar and the intake of all micronutrients in both populations. The associations were linear; however, we could not determine the threshold of added sugar intake beyond which the micronutrient intake was clearly compromised. Conclusions These findings suggest that in two Swedish populations the higher the intake of added sugar in the diet, the more likely it is that the intake of micronutrients will be compromised, in two Swedish populations. However, although the trends are significant and consistent with those obtained in other studies on the subject, future studies are needed in order to build the necessary scientific knowledge to establish a threshold of added sugar intake based on micronutrient dilution.

Resumen: Introducción: La nefropatía diabética (ND) es una complicación frecuente de la diabetes mellitus (DM), y su diagnóstico suele ser clínico. Sin embargo, en numerosas ocasiones la enfermedad renal que presentan los pacientes diabéticos es debida a otras causas cuyo diagnóstico es histológico. El objetivo del estudio fue determinar los datos clínicos y analíticos predictores de ND y enfermedad renal no diabética (ERND), y elaborar un modelo predictivo (score) para confirmar o descartar ND. Material y métodos: Estudio observacional, transversal y retrospectivo de biopsias renales realizadas en pacientes diabéticos tipo 2 entre 2000 y 2018. Resultados: Se incluyeron 207 pacientes diabéticos con una edad media de 64,5 ± 10,6 años; el 74% eran varones. La biopsia mostró ND en 126 (61%) y en 81 ERND (39%). La retinopatía diabética estaba presente en el 58% de los pacientes con ND y en el 6% del grupo con ERND (p 3 era tenían ND, y el 94% de los casos con score ≤ 1 punto fueron ERND. Conclusiones: La ERND es frecuente en pacientes con DM (39%). La etiología más frecuente son las glomerulonefritis primarias. La ausencia de retinopatía y la presencia de microhematuria son altamente sugestivas de ERND. La utilización de un sistema de puntuación facilita la indicación de biopsia renal en pacientes diabéticos. Abstract: Introduction: Diabetic nephropathy (DN) is one of the most frequent complications in patients with diabetes mellitus (DM) and its diagnosis is usually established on clinical grounds. However, kidney involvement in some diabetic patients can be due to other causes, and renal biopsy might be needed to exclude them. The aim of our study was to establish the clinical and analytical data that predict DN and no-diabetic renal disease (NDRD), and to develop a predictive model (score) to confirm or dismiss DN. Material and methods: We conducted a transversal, observational and retrospective study, including renal biopsies performed in type 2 DM patients, between 2000 and 2018. Results: Two hundred seven DM patients were included in our study. The mean age was 64.5 ± 10.6 years and 74% were male. DN was found in 126 (61%) of the biopsies and NDRD in 81 (39%). Diabetic retinopathy was presented in 58% of DN patients, but only in 6% of NDRD patients (P 3 had DN and 94% of cases with a score ≤ 1 had NDRD (score ranked from −6 to 8 points). Conclusions: NDRD is common in DM patients (39%), being primary glomerulonephritis the most frequent ethology. The absence of retinopathy and the presence of microhematuria are highly suggestive of NDRD. The use of our predictive model could facilitate the indication of performing a renal biopsy in DM patients. Palabras clave: Diabetes mellitus, Biopsia renal, Nefropatía diabética, Enfermedad renal no diabética, Modelo predictivo, Keywords: Diabetes mellitus, Renal biopsy, Diabetic nephropathy, Non-diabetic renal disease, Predictive model

Objectives. The aim of this study was to compare the creatinine equations with cystatin C (CysC) equations to define renal impairment (RI) in newly diagnosed multiple myeloma (MM) patients and to analyse the equation that allows for identifying patients with more and worse prognostic factors. Methods. Renal function was evaluated prospectively in 61 patients with newly diagnosed untreated MM employing CKD-EPI and CAPA equations. The comparison was conducted using Bland–Altman graphics and Cohen’s Kappa statistic. Mann–Whitney T and Chi-square tests were used, and univariate and multivariate analyses were carried out. Results. According to the IMWG criteria, 26% of patients showed RI (3 women/13 men) whilst the use of CysC equations allowed us to identify up to 39% of patients (7 women/17 men). The CAPA equation was less biased and dispersed and more sensitive than CKD-EPI-creatinine. Furthermore, univariate analysis unveiled an association between decreased CKD-EPI-CysC and poor prognosis based on R-ISS-3. Conclusions. The IMWG criteria may underestimate kidney disease, mostly in women, which could affect the dose received as well as its toxicity. Altogether, our data suggest that equations that include CysC are more accurate to detect hidden kidney disease, as well as patients with more and worse prognostic factors, in newly diagnosed MM.

The possible future introduction of Autonomous Vehicles (AVs) and Shared Autonomous Vehicles (SAVs) raises questions about how they might affect the demand for transport and especially modal choice. In this research, a stated preference (SP) survey and a modelling process using Mixed Logit are proposed to simulate the future market share of AVs/SAVs and how their introduction into the system could change the modal choice, especially in relation to active and public transport modes. An efficient SP survey design has been developed based on the state-of-the-art information and carried out in 2020 among citizens of two medium-sized Southern European cities within a car-intensive region. The design considered different trip purposes (compulsory, leisure), different trip distances, and attributes not taken into account before, such as comfort and the physical characteristics of the terrain for the active modes. The model results suggest that AVs and SAVs were the preferred transport modes for most respondents, accounting for more than 58% of the market share in the scenarios presented. Also, we detected some socioeconomic differences in the propensity to use this mode of transport showing that men living in high-income households and car users were more prone to use autonomous alternatives. The models allowed us to simulate different scenarios, such as experiencing higher costs for using the AV alternative. Policies imposing a higher cost for the AV alternative but lower costs and waiting times for the SAV and public transport alternatives could decrease the AV’s market share favouring more sustainable modes. The above scenario showed that achieving a more sustainable future mobility system considering AVs requires an in-depth transport demand knowledge and adequate transport policies.

The static magnetic fields (SMFs) impact on biological systems, induce a variety of biological responses, and have been applied to the clinical treatment of diseases. However, the underlying mechanisms remain largely unclear. In this report, by using human mesenchymal stem cells (MSCs) as a model, we investigated the biological effect of SMFs at a molecular and cellular level. We showed that SMF exposure promotes MSC proliferation and activates the expression of transcriptional factors such as FOS (Fos Proto-Oncogene, AP-1 Transcription Factor Subunit) and EGR1 (Early Growth Response 1). In addition, the expression of signal-transduction proteins p-ERK1/2 and p-JNK oscillate periodically with SMF exposure time. Furthermore, we found that the inhibition of the T-type calcium ion channels negates the biological effects of SMFs on MSCs. Together, we revealed that the SMFs regulate T-type calcium ion channels and mediate MSC proliferation via the MAPK signaling pathways.

Abstract Background The importance of submicroscopic malaria infections in high-transmission areas could contribute to maintain the parasite cycle. Regarding non-endemic areas, its importance remains barely understood because parasitaemia in these afebrile patients is usually below the detection limits for microscopy, hence molecular techniques are often needed for its diagnosis. In addition to this, the lack of standardized protocols for the screening of submicroscopic malaria in immigrants from endemic areas may underestimate the infection with Plasmodium spp. The aim of this study was to assess the prevalence of submicroscopic malaria in afebrile immigrants living in a non-endemic area. Methods A prospective, observational, multicentre study was conducted. Afebrile immigrants were included, microscopic observation of Giemsa-stained thin and thick blood smears, and two different molecular techniques detecting Plasmodium spp. were performed. Patients with submicroscopic malaria were defined as patients with negative blood smears and detection of DNA of Plasmodium spp. with one or both molecular techniques. Demographic, clinical, analytical and microbiological features were recorded and univariate analysis by subgroups was carried out with STATA v15. Results A total of 244 afebrile immigrants were included in the study. Of them, 14 had a submicroscopic malaria infection, yielding a prevalence of 5.7% (95% confidence interval 3.45–9.40). In 71.4% of the positive PCR/negative microscopy cases, Plasmodium falciparum alone was the main detected species (10 out of the 14 patients) and in 4 cases (28.6%) Plasmodium vivax or Plasmodium ovale were detected. One patient had a mixed infection including three different species. Conclusions The prevalence of submicroscopic malaria in afebrile immigrants was similar to that previously described in Spain. Plasmodium vivax and P. ovale were detected in almost a third of the submicroscopic infections. Screening protocols for afebrile immigrants with molecular techniques could be useful for a proper management of these patients.

The present text analyses a number of images of artists cre-ated after their deaths. Like any other individual, their ephemeral bodies are destined to rot, while their public figures provide another body to be honored, setting them apart from others. In this way, their memories are kept alive. Firstly, the paper reviews the precedents of post-mortem imagery, and it then explores some photographs of deceased artists from the 19th and 20th centuries, with a focus on issues emerging from the national context of each and from and the double-layered meaning of these artefacts, which serve both as memorial objects and as signs of propaganda, the two dimensions coexisting in this type of document. Finally, the paper examines the burial of Vicente Blasco Ibáñez, his post-mortem images and the issues they raise.

En la historia del arte y de la cultura visual aparecen cuerpos muertos femeninos, habitualmente remarcando su belleza y juventud, sobre los que se ejerce una serie de consideraciones bien distintas a las que merecen los muertos masculinos. Entre ellas la curiosidad científica, el erotismo o la atracción convergen para justificar la exhibición y contemplación de las muertas femeninas. Paralelamente, el imaginario literario ha alimentado mitos sobre el poder que procesaban dichos cuerpos fenecidos en los varones, recalando con el tiempo en los medios de comunicación de masas, especialmente en el cine. Otra vertiente que considerar ha sido la proliferación de fotografías post mortem en donde las mujeres aparecían con los atributos históricamente asociados a la feminidad: como dulces seres inmaculados o bien como dignas beatas. En suma, el cuerpo muerto de la mujer ha sido profanado simbólicamente hasta llegar a nuestros días.

Aims: Although diet is one of the main modifiable risk factors of cardiovascular disease, few studies have investigated the association between added sugar intake and cardiovascular disease risk. This study aims to investigate the associations between intake of total added sugar, different sugar-sweetened foods and beverages, and the risks of stroke, coronary events, atrial fibrillation and aortic stenosis.Methods: The study population consists of 25,877 individuals from the Malmö Diet and Cancer Study, a Swedish population-based prospective cohort. Dietary data were collected using a modified diet history method. National registers were used for outcome ascertainment.Results: During the mean follow-up of 19.5 years, there were 2,580 stroke cases, 2,840 coronary events, 4,241 atrial fibrillation cases, and 669 aortic stenosis cases. Added sugar intakes above 20 energy percentage were associated with increased risk of coronary events compared to the lowest intake category (HR: 1.39; 95% CI: 1.09–1.78), and increased stroke risk compared to intakes between 7.5 and 10 energy percentage (HR: 1.31; 95% CI: 1.03 and 1.66). Subjects in the lowest intake group for added sugar had the highest risk of atrial fibrillation and aortic stenosis. More than 8 servings/week of sugar-sweetened beverages were associated with increased stroke risk, while ≤2 servings/week of treats were associated with the highest risks of stroke, coronary events and atrial fibrillation.Conclusion: The results indicate that the associations between different added sugar sources and cardiovascular diseases vary. These findings emphasize the complexity of the studied associations and the importance of considering different added sugar sources when investigating health outcomes.

Dietary factors associated with stroke risk are still rather unknown. The aim was to examine the association between adherence to healthy dietary patterns and incidence of stroke among 25,840 individuals from the Swedish Malmö Diet and Cancer Study cohort. Dietary data were obtained using a combination of a 7-day food record, diet questionnaire, and interview. A Swedish Dietary Guidelines Score (SDGS), including five dietary components based on the current Swedish dietary guidelines, and a modified Mediterranean diet score (mMDS), composed of ten dietary components, were constructed. Over a mean follow-up period of 19.5 years, 2579 stroke cases, of which 80% were ischaemic, were identified through national registers. Weak, non-significant associations were found between the dietary indices and the risk of stroke. However, after excluding potential misreporters and individuals with unstable food habits (35% of the population), we observed significant inverse association (p-trend < 0.05) between SDGS and mMDS and total and ischaemic stroke (HR per point for total stroke: 0.96; 95% CI: 0.92–1.00 for SDGS and 0.95; 95% CI: 0.91–0.99 for mMDS). In conclusion, high quality diet in line with the current Swedish dietary recommendations or Mediterranean diet may reduce the risk of total and ischaemic stroke.

BackgroundIn a situation of compulsory home isolation enacted by governments at the spreading of the Covid-19 pandemic, the emotional health and well-being of students became a key factor in the successful implementation of distance teaching methodologies in face-to-face education universities. Psychological well-being, an essential factor in preventing academic failure, has been threatened in this serious situation of unprecedented and stressful isolation. The aim of this study is to analyze the students’ cognitive-emotional regulation as well as their beliefs and perceptions about the pandemic and this lockdown situation. With this extensive study we are carrying out, want to describe the extent to which the lockdown situation is a risk factor, and, in the future, make proposals for preventive and palliative actions, if necessary, to minimize this potential risk.MethodWe applied the CERQ Cognitive Emotion Regulation Questionnaire by means of an online application together with a questionnaire, CC/covid-19, of objective description and subjective perception of the lockdown situation of the students, their conditions to study, general opinions about the pandemic and specific opinions about the real possibilities of implementing online education in the middle of the academic year at the university. 1910 valid responses from more than 80 universities in 13 different Spanish-speaking countries were obtained and submitted to descriptive analysis and modeling using structural equations.ResultsMost of them consider that the lockdown decision is correct, that health systems are not prepared to deal with the pandemic, and that although the universities have adequate means, the teaching staff is not competent to implement online teaching methodologies. They have a good perception of the conditions of isolation, however, the time devoted to studying has not increased. One of the results of our study is the students’ self-evaluation about their digital competence and their capacity to perform in online interactive communication. This is key to rejecting a feeling of loneliness or social isolation, even if there is momentary physical separation with friends and classmates which is consistent with the results of emotional well-being the surveyed students present. The cognitive strategies used by the students surveyed have allowed them coping with events arising from the pandemic, mandatory isolation and university closure, certainly adaptive and functional, while maintaining a positive perception of their new living and learning situation.

Resumen: El presente paper, analiza el régimen de responsabilidad del Gobierno contenido en la Constitución española de 29 de diciembre de 1978 desde una doble vertiente. Por un lado, explica las normas constitucionales que regulan el régimen de responsabilidad gubernamental tanto jurídica como política. Por otro, centra su atención en el desarrollo de las previsiones constitucionales en los cuarenta años de vigencia de nuestra Carta Magna, comentando los supuestos más sobresalientes de juicios penales en los que se ha visto inmersos ex-miembros del Consejo de Ministros y como las «cuestiones de confianza» o «mociones de censura» que han tenido lugar en sede parlamentaria. Por último, analiza, desde un punto de vista crítico, las insuficiencias del sistema y añade propuestas de futuro. Abstract: This paper analyzes the regime of government responsibility/responsiveness in the 1978 Spanish Constitution from a dual perspective. On one hand, it explains the constitutional rules that govern the regime of governmental responsibility/responsiveness, both legal and political. On the other hand, it focuses on the development of the constitutional provisions in the 40 years of our Constitution, commenting on the most outstanding cases of criminal trials in which former members of the Council of Ministers have been involved, such as «votes of confidence» or «motions of censorship» that have taken place in parliamentary seat. Finally, it analyzes, from a critical perspective, the inadequacies of the system and adding proposals for the future. Summary I. 1978: A Constitution, without doubt, meritorious, II. From criminal responsibility to political responsibility. III. The Government’s responsibility in the 1978s Spanish Constitution: A. Art. 102 and criminal responsibility, B. Political responsibility through censure: a. A forgotten «vote of confidence», b. The «motion of censure»: three times and no resignation, IV. The future is coming. Bibliography.

Hereditary mechanisms are partially responsible for individual differences in sensitivity to and the preference for sweet taste. The primary aim of this study was to examine the associations between 10 genetic variants and the intake of total sugar, added sugar, and sugars with sweet taste (i.e., monosaccharides and sucrose) in a middle-aged Swedish population. Two single nucleotide polymorphisms (SNPs) within the Fibroblast grow factor 21 (FGF21) gene, seven top hits from a genome-wide association study (GWAS) on total sugar intake, and one SNP within the fat mass and obesity associated (FTO) gene (the only SNP reaching GWAS significance in a previous study), were explored in relation to various forms of sugar intake in 22,794 individuals from the Malmö Diet and Cancer Study, a population-based cohort for which data were collected between 1991–1996. Significant associations (p = 6.82 × 10−7 − 1.53 × 10−3) were observed between three SNPs (rs838145, rs838133, and rs8103840) in close relation to the FGF21 gene with high Linkage Disequilibrium, and all the studied sugar intakes. For the rs11642841 within the FTO gene, associations were found exclusively among participants with a body mass index ≥ 25 (p < 5 × 10−3). None of the remaining SNPs studied were associated with sugar intake in our cohort. A further GWAS should be conducted to identify novel genetic variants associated with the intake of sugar.

It has been suggested that sugar intake may play a role in the development of atherosclerosis. However, studies on this matter are lacking. Intima media thickness (IMT) is a well-established measurement of subclinical atherosclerosis. This study aimed to investigate the cross-sectional association between sugar intake (i.e., added, free and total sugar and sugar-rich foods and beverages) and IMT. Our study comprised 5269 individuals (45–73 years, 40% men) of the Malmö Diet and Cancer Study, a population-based cohort conducted in Sweden with data collected from 1991 to 1994. Measurements of IMT were performed with B-mode ultrasound at the right common carotid artery (IMTcca) and the bifurcation of the carotids (IMTbif). Dietary intake was estimated using a combination of a 7-day food record, diet questionnaire and interview. After adjusting for methodological, lifestyle and dietary confounders, no statistically significant associations were observed for any of the sugar intake variables and IMT. For example, added sugar intake presented no significant linear association with IMTcca or IMTbif (Ptrends: IMTcca 0.81 for men and 0.98 for women and IMTbif 0.20 for men and 0.40 for women). In conclusion, we found no clear association between sugar intake and IMT measurements in this study.

Resumen: Nuestro propósito con este trabajo es dar a conocer la obra del autor irlandés George Moore. Hablaremos de la influencia que tuvo Francia, los pintores impresionistas y escritores franceses de finales del siglo XIX y principios del XX en su carrera de escritor. Tomaremos como análisis de estudio su libro de memorias Confessions d´un jeune anglais (1986) ya que dicha autobiografía es un el retrato del espectáculo que se vivía en París durante aquellos años. Sigamos a ese joven por las calles de Montmartre, véamoslo discutir de pintura con Manet y Renoir, oigámosle compartir ideas con Zola y Verlaine… Palabras clave: Francia, pasión, Montmartre, pintura, literatura. Title in English: George Moore: The French Passion. Abstract: Our aim with this piece is to introduce the work of the Irish author George Moore. We will speak of the influence which France, the impressionist painters, and the French writers from the end of the 19th century and the beginning of the 20th century, all had on his career as a writer. For research purposes we have chosen his memoirs Confessions d´un jeune anglais (1986) as this autobiography is a true portrayal of the artistic life which was experienced in Paris in those years. We follow this young man through the streets of Montmartre, we see him discuss painting with Manet and Renoir, we hear him share ideas with Zola and Verlaine…. Keywords: France, passion, Montmartre, painting, literature.

B-cell receptor (BCR)-dependent signaling is central for leukemia B-cell homeostasis, as underscored by the promising clinical results obtained in patients with chronic lymphocytic leukemia (CLL) treated with novel agents targeting components of this pathway. Herein, we demonstrate that the mithralog EC-7072 displays high ex vivo cytotoxic activity against leukemia cells from CLL patients independently from high-risk prognostic markers and IGHV mutational status. EC-7072 was significantly less toxic against T cells and NK cells and did not alter the production of the immune effector molecules IFN-γ and perforin. EC-7072 directly triggered caspase-3-dependent CLL cell apoptosis, which was not abrogated by microenvironment-derived factors that sustain leukemia cell survival. RNA-sequencing analyses revealed a dramatic EC-7072-driven reprograming of the transcriptome of CLL cells, including a wide downregulation of multiple components and targets of the BCR signaling pathway. Accordingly, we found decreased levels of phosphorylated signaling nodes downstream of the BCR. Crosslinking-mediated BCR activation antagonized CLL cell death triggered by EC-7072, increased the phosphorylation levels of the abovementioned signaling nodes and upregulated BCL2 expression, suggesting that the mithralog disrupts CLL cell viability by targeting the BCR signaling axis at multiple levels. EC-7072 exerted similar or higher antileukemic activity than that of several available CLL therapies and displayed additive or synergistic interaction with these drugs in killing CLL cells. Overall, our findings provide rationale for future investigation to test whether EC-7072 may be a potential therapeutic option for patients with CLL and other B-cell malignancies.

El progresivo proceso de europeización de la planificación territorial ha promovido la aparición de nuevos objetivos y mecanismos de control de los planes de ordenación, como son el desarrollo sostenible y los sistemas de evaluación y seguimiento. Sin embargo, en España, a diferencia de otros países que cuentan con directrices o guías nacionales, esta inclusión no se ha realizado de manera sistemática. Este artículo tiene como objetivo comprobar hasta qué punto y cómo se está integrando la evaluación y seguimiento de los planes territoriales españoles prestando especial atención al uso de sistemas de indicadores. La revisión de los planes actuales permite afirmar que España está todavía dando sus primeros pasos, dado que, de las 17 comunidades autónomas, diez contemplan sistemas de evaluación y seguimiento específicos, mediante la elaboración de planes o informes, y solo cinco los han desarrollado e implementado incluyendo el uso de sistemas de indicadores. Además, las metodologías empleadas difieren significativamente en cuanto a qué debe medirse, es decir, en cómo se conceptualiza la sostenibilidad, y al número y tipo de indicadores seleccionados. De cara al futuro se recomienda tender a una mayor convergencia en la definición de las metodologías de evaluación y seguimiento que contemplen el uso de indicadores e índices sintéticos, con el fin de facilitar su comparación entre distintos ámbitos territoriales, potenciar sinergias y optimizar el uso de recursos.