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Abstract The characteristics of the host are crucial in the final outcome of COVID-19. Herein, the influence of genetic and clinical variants in COVID-19 severity was investigated in a total of 1350 patients. Twenty-one single nucleotide polymorphisms of genes involved in SARS-CoV-2 sensing as Toll-like-Receptor 7, antiviral immunity as the type I interferon signalling pathway (TYK2, STAT1, STAT4, OAS1, SOCS) and the vasoactive intestinal peptide and its receptors (VIP/VIPR1,2) were studied. To analyse the association between polymorphisms and severity, a model adjusted by age, sex and different comorbidities was generated by ordinal logistic regression. The genotypes rs8108236-AA (OR 0.12 [95% CI 0.02–0.53]; p = 0.007) and rs280519-AG (OR 0.74 [95% CI 0.56–0.99]; p = 0.03) in TYK2, and rs688136-CC (OR 0.7 [95% CI 0.5–0.99]; p = 0.046) in VIP, were associated with lower severity; in contrast, rs3853839-GG in TLR7 (OR 1.44 [95% CI 1.07–1.94]; p = 0.016), rs280500-AG (OR 1.33 [95% CI 0.97–1.82]; p = 0.078) in TYK2 and rs1131454-AA in OAS1 (OR 1.29 [95% CI 0.95–1.75]; p = 0.110) were associated with higher severity. Therefore, these variants could influence the risk of severe COVID-19.

Abstract Aims Compensatory mechanisms in heart failure (HF) are triggered to maintain adequate cardiac output. Among them, hyperactivation of the sympathetic nervous system (SNS) is one of the main ones and carries a worse prognosis. The pupillary reflex depends on the SNS, and we can evaluate it through pupillometry. The aim of the study was to compare the differences in pupillary reflex between patients with acute HF and controls and to analyse whether these differences in pupillary reflex may offer a new and easy prognostic factor in such patients. Methods and results We prospectively and consecutively included 107 patients admitted with decompensated HF. Quantitative pupillometry was performed with the NeuroOptics pupillometry during the first 24 h after admission and prior to discharge. The results were compared with those of a group of 100 healthy volunteers who also underwent pupillometry. The maximum baseline pupil size (MBPS) and the minimum pupil diameter (MPD) were measured. Patients with decompensated HF have a higher MBPS (3.64 ± 0.81) and higher MPD (2.60 ± 0.58) than HF patients at discharge and in the control group (P‐value = 0.01 and 0.01, respectively). Also, HF patients presented an improvement in pupillometric values at discharge [MBPS (3.47 ± 0.79) and MPD (2.51 ± 0.58)] and showed no differences compared with the control group [MBPS (3.34 ± 0.82) and MPD (2.40 ± 0.53)] (P‐value = 0.19 and 0.14, respectively). In addition, MBPS provides a good independent predictor of in‐hospital and 1 month mortality in patients admitted with HF. Six patients (5.61%) died during hospital admission, and 11 patients (10.2%) died in the first month after discharge. Also, four patients (3.74%) were readmitted within 1 month of discharge. The receiver operating characteristic (ROC) curve for predicting in‐hospital mortality through MBPS was 0.823. No patient with an MBPS

Spontaneous pregnancy loss is relatively common, although the exact prevalence of these losses is difficult to estimate. Women may also choose to abort. The current Spanish Organic Law 1/2023, of February 28, on sexual and reproductive health and voluntary pregnancy termination allows abortion by the woman’s free and voluntary decision up to the 14th week of gestation. Additionally, up to the 22nd week, termination can be performed for medical reasons, such as fetal malformation or danger to the mother’s life. Nowadays, pregnancies are intensely thought out and planned before they become a reality. Therefore, spontaneous pregnancy loss has significant meaning for the woman and her partner, who may feel vulnerable. For healthcare professionals, maintaining an appropriate psychological and moral environment to care for these women and their families is not always easy. Sometimes, professionals are not able to provide the necessary care for a variety of reasons, leading to cases of obstetric violence. If vulnerability is considered alongside other anthropological elements of medicine itself, such as co-responsibility or solidarity—thus understanding medicine beyond mere technique—we arrive at a bioethical approach where the ethics of care and responsibility become key to providing proper healthcare in these situations.

Esta propuesta de hermenéutica arquitectónica se formula por un grupo de investigadores de distintas áreas de conocimiento. Nuestro objetivo es enriquecer la investigación y la docencia de la Arquitectura, enfocándonos en la producción de los últimos 30 años en un contexto internacional. Se trata de un modo de trabajo colectivo y transversal que permite, profundizando en casos concretos, encontrar modos de hacer que permitan entender iterativamente sectores crecientes, de arquitectura reciente y de arquitectura precedente. Nuestro grupo evoluciona enfocándonos en objetivos a medio plazo que nos permitirán mejorar nuestra interacción docente e investigadora. Exponemos uno de los casos, una obra del estudio OMA, el BLOX (Copenhague, 2006-2018). En este ejemplo se pone de manifiesto la utilidad de la metodología escogida para desvelar aspectos del edificio que no aparecen en las reseñas bibliográficas disponibles hasta la fecha. Las fases propuestas en la interpretación —descripción, genealogía-teratología, y significado— se han visto enriquecidas por las aportaciones transversales de los componentes del grupo. Así se han identificado cuestiones subyacentes en la obra que articulan tanto el entretejido de funciones, como la descomposición volumétrica del edificio. Estas claves están también presentes en muchos edificios contemporáneos construidos con volúmenes complejos que desafían la estática tradicional de la Arquitectura. El estudio del BLOX nos facilita el conocimiento sobre cómo esta técnica tiene resultados formales muy diversos y abre la comprensión de la producción arquitectónica contemporánea, a medida que se complementa con el estudio sucesivo de más obras.

BackgroundsAlthough allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative therapy for hematological malignancies, it can be associated with relevant post-transplant complications. Several reports have shown that polymorphisms in immune system genes are correlated with the development of post-transplant complications. Within this context, this work focuses on identifying novel polymorphisms in cytokine genes and developing predictive models to anticipate the risk of developing graft-versus-host disease (GVHD), transplantation-related mortality (TRM), relapse and overall survival (OS).MethodsOur group developed a 132-cytokine gene panel which was tested in 90 patients who underwent an HLA-identical sibling-donor allo-HSCT. Bayesian logistic regression (BLR) models were used to select the most relevant variables. Based on the cut-off points selected for each model, patients were classified as being at high or low-risk for each of the post-transplant complications (aGVHD II-IV, aGVHD III-IV, cGVHD, mod-sev cGVHD, TRM, relapse and OS).ResultsA total of 737 polymorphisms were selected from the custom panel genes. Of these, 41 polymorphisms were included in the predictive models in 30 cytokine genes were selected (17 interleukins and 13 chemokines). Of these polymorphisms, 5 (12.2%) were located in coding regions, and 36 (87.8%) in non-coding regions. All models had a statistical significance of p

Abstract In the last decade, fatigue in clinical populations has been re-conceptualized, including dimensions such as perceived fatigue (trait and state fatigue) and fatigability. The aim of this study was to evaluate different expressions of fatigue in Spinal Cord Injury (SCI) and Multiple Sclerosis (MS) participants compared to able-bodied controls, during activities of daily living, especially during gait. A total of 67 participants were included in this study (23 with SCI, 23 with MS, and 21 able-bodied controls). All participants performed two functional tests (6-Minute Walk Test and 10-Meter Walk Test) and they completed the Fatigue Severity Scale (FSS). The rate of trait fatigue was different between groups, with MS participants showing the highest rate. Moreover, scores on functional tests and state fatigue were different between groups after the tests. Our results indicate that trait fatigue and state fatigue in individuals with SCI and MS are different with respect to able-bodied population. Both SCI and MS groups experienced more trait fatigue than control group in daily life. In addition, walking tasks produced similar levels of state fatigue between healthy people and patients with MS/SCI. However, these tests induced longer-lasting levels of state fatigue in the patients.

Abstract The value of circulating tumor DNA (ctDNA) as a biomarker of disease activity in classic Hodgkin lymphoma (cHL) patients has not yet been well established. By profiling primary tumors and ctDNA, we identified common variants between primary tumors and longitudinal plasma samples in most of the cases, confirming high spatial and temporal heterogeneity. Although ctDNA analyses mirrored HRS cell genetics overall, the prevalence of variants shows that none of them can be used as a single biomarker. Conversely, the estimation of hGE/mL, based on measures of total ctDNA, reflects disease activity and is almost perfectly correlated with standard parameters such as PET/CT that are associated with refractoriness.

The Hodgkin and Reed – Sternberg (HRS) cells in classical Hodgkin Lymphoma (cHL) actively modify the immune tumor microenvironment (TME) attracting immunosuppressive cells and expressing inhibitory molecules. A high frequency of myeloid cells in the TME is correlated with an unfavorable prognosis, but more specific and rare cell populations lack precise markers. Myeloid-derived suppressor cells (MDSCs) have been identified in the peripheral blood of cHL patients, where they appear to be correlated with disease aggressiveness. TNFRSF9 (CD137) is a T cell co-stimulator expressed by monocytic and dendritic cells. Its expression has also been described in HRS cells, where it is thought to play a role in reducing antitumor responses. Here, we perform qualitative and quantitative analyses of lymphocytic and MDSC subtypes and determine the CD137 cell distribution in cHL primary tumors using multiplex immunofluorescence and automated multispectral imaging. The results were correlated with patients’ clinical features. Cells were stained with specific panels of immune checkpoint markers (PD-1, PD-L1, CD137), tumor-infiltrating T lymphocytes (CD3, PD-1), and monocytic cells/MDSCs (CD68, CD14, CD33, Arg-1, CD11b). This approach allowed us to identify distinct phenotypes and to analyze spatial interactions between immune subpopulations and tumor cells. The results confirm CD137 expression by T, monocytic and HRS cells. In addition, the expression of CD137, T exhausted cells, and monocytic MDSCs (m-MDSCs) in the vicinity of malignant HRS cells were associated with a worse prognosis. Our findings reveal new elements of the TME that mediate immune escape, and confirm CD137 as a candidate target for immunotherapy in cHL.

A través del presente artículo abordaremos de forma íntegra el estudio de la antigua Fábrica de Tabacos de San Sebastián y su reciente reconversión en Tabakalera, el Centro Internacional de Cultura Contemporánea (CICC). En primera instancia, nos volcaremos en el contexto histórico del edificio, para pasar, seguidamente, a la descripción e interpretación del mismo. A su vez, destacaremos el ámbito laboral que caracterizó a la fábrica, dada su impronta y relevancia en el camino hacia la igualdad de género. En segundo lugar, analizaremos la nueva Tabakalera, empezando por contextualizar la apuesta de rehabilitar el patrimonio industrial con fines culturales. A continuación, se facilitarán los detalles de la intervención, para concluir con la concreción de su actual función e impacto en el entorno social y urbano. Todo ello constituirá el sustrato para una valoración crítica de la actuación acometida en la fábrica donostiarra, atendiendo tanto al patrimonio material como inmaterial.

Grammatical redundancy is a widespread feature across languages. Although redundant cues can be seen to increase the complexity and processing burden of structures, it has been suggested that they can assist language acquisition. Here, we explored if this learning benefit can be observed from the very initial stages of second language (L2) acquisition and whether the effect of redundancy is modulated by the perceptual salience of the redundant linguistic cues. Across two experiments, three groups of adult native speakers of English were incidentally exposed to three different artificial languages; one that had a fixed word order, Verb-Object-Subject, and two in which thematic role assignment was additionally determined by a low-salient (Experiment 1) or a high-salient (Experiment 2) redundant case marker. While all groups managed to learn the novel language, our results pointed towards a hindering role of redundancy, with participants in the non-redundant condition achieving greater learning outcomes compared to those in both redundant conditions. Results also revealed that this impeding effect of redundancy on L2 learners can be attenuated by the salience of the redundant cue (Experiment 2). In conjunction with earlier findings, the present results suggest that the effect of redundancy on L2 acquisition can be differentially manifested depending on the stage of L2 development, learners’ first language biases and age.

Abstract Classic Hodgkin lymphoma (cHL) is characterized by a rich immune microenvironment as the main tumor component. It involves a broad range of cell populations, which are largely unexplored, even though they are known to be essential for growth and survival of Hodgkin and Reed–Sternberg cells. We profiled the gene expression of 25 FFPE cHL samples using NanoString technology and resolved their microenvironment compositions using cell-deconvolution tools, thereby generating patient-specific signatures. The results confirm individual immune fingerprints and recognize multiple clusters enriched in refractory patients, highlighting the relevance of: (1) the composition of immune cells and their functional status, including myeloid cell populations (M1-like, M2-like, plasmacytoid dendritic cells, myeloid-derived suppressor cells, etc.), CD4-positive T cells (exhausted, regulatory, Th17, etc.), cytotoxic CD8 T and natural killer cells; (2) the balance between inflammatory signatures (such as IL6, TNF, IFN-γ/TGF-β) and MHC-I/MHC-II molecules; and (3) several cells, pathways and genes related to the stroma and extracellular matrix remodeling. A validation model combining relevant immune and stromal signatures identifies patients with unfavorable outcomes, producing the same results in an independent cHL series. Our results reveal the heterogeneity of immune responses among patients, confirm previous findings, and identify new functional phenotypes of prognostic and predictive utility.

Abstract Acute inflammation can either resolve through immunosuppression or persist, leading to chronic inflammation. These transitions are driven by distinct molecular and metabolic reprogramming of immune cells. The anti-diabetic drug Metformin inhibits acute and chronic inflammation through mechanisms still not fully understood. Here, we report that the anti-inflammatory and reactive-oxygen-species-inhibiting effects of Metformin depend on the expression of the plasticity factor ZEB1 in macrophages. Using mice lacking Zeb1 in their myeloid cells and human patient samples, we show that ZEB1 plays a dual role, being essential in both initiating and resolving inflammation by inducing macrophages to transition into an immunosuppressed state. ZEB1 mediates these diverging effects in inflammation and immunosuppression by modulating mitochondrial content through activation of autophagy and inhibition of mitochondrial protein translation. During the transition from inflammation to immunosuppression, Metformin mimics the metabolic reprogramming of myeloid cells induced by ZEB1. Mechanistically, in immunosuppression, ZEB1 inhibits amino acid uptake, leading to downregulation of mTORC1 signalling and a decrease in mitochondrial translation in macrophages. These results identify ZEB1 as a driver of myeloid cell metabolic plasticity, suggesting that targeting its expression and function could serve as a strategy to modulate dysregulated inflammation and immunosuppression.

Abstract Background A child's socioeconomic environment can shape central aspects of their life, including vulnerability to mental disorders. Negative environmental influences in youth may interfere with the extensive and dynamic brain development occurring at this time. Indeed, there are numerous yet diverging reports of associations between parental socioeconomic status (SES) and child cortical brain morphometry. Most of these studies have used single metric‐ or unimodal analyses of standard cortical morphometry that downplay the probable scenario where numerous biological pathways in sum account for SES‐related cortical differences in youth. Methods To comprehensively capture such variability, using data from 9758 children aged 8.9–11.1 years from the ABCD Study®, we employed linked independent component analysis (LICA) and fused vertex‐wise cortical thickness, surface area, curvature and grey‐/white‐matter contrast (GWC). LICA revealed 70 uni‐ and multimodal components. We then assessed the linear relationships between parental education, parental income and each of the cortical components, controlling for age, sex, genetic ancestry, and family relatedness. We also assessed whether cortical structure moderated the negative relationships between parental SES and child general psychopathology. Results Parental education and income were both associated with larger surface area and higher GWC globally, in addition to local increases in surface area and to a lesser extent bidirectional GWC and cortical thickness patterns. The negative relation between parental income and child psychopathology were attenuated in children with a multimodal pattern of larger frontal‐ and smaller occipital surface area, and lower medial occipital thickness and GWC. Conclusion Structural brain MRI is sensitive to SES diversity in childhood, with GWC emerging as a particularly relevant marker together with surface area. In low‐income families, having a more developed cortex across MRI metrics, appears beneficial for mental health.

Introduction: Adjustment disorder (AjD) is a maladaptive response to one or more psychosocial stressors. In many cases, the symptomatology of this disorder disappears once the stressor or its consequences are no longer present. However, in some cases, if left untreated, the symptoms may worsen and develop into a more severe mental disorder. In this regard, different authors propose that a low-intensity intervention may be suitable for this disorder. Previous studies with other mental disorders and with patients with AjD found that blended interventions can be a viable and effective option. The aim of this study is to analyze the feasibility (the participants' expectations and preferences, the satisfaction and acceptance, the appropriateness of different methods of recruitment and data collection, and the reasons for dropping out) of a blended cognitive-behavioral intervention (CBT) for AjD that combines the use of a self-applied Internet-based program with videoconference sessions with a therapist. As a secondary objective, the potential efficacy of this intervention will be tested. Method and analysis: A feasibility trial with a single-group and open-trial design will be conducted. A total of 41 participants will be assigned to the single treatment group. All the participants will be assessed for eligibility and respond at four measurement points: pre-treatment, post-treatment, and 3- and 12-month follow-ups. The treatment combines the use of an Internet-based intervention through a web platform with videoconference sessions with a therapist every 10–12 days. The intervention contains seven modules and is based on CBT. The main outcome measures are related to the feasibility of the intervention (adherence, treatment satisfaction and expectations, participants' opinions, preferences, therapeutic alliance, and usability). Clinical measures will also be assessed. Discussion: To the best of our knowledge, this is the first study to test a blended intervention for AjD in the Spanish language. We expect this intervention to be feasible, and that a future Randomized Controlled Trial will be able to show its efficacy. Potential limitations include difficulties in recruiting the sample, failures in the computer systems, or a high dropout rate. Measures have been taken to try to reduce the impact of these limitations. This study received the approval of the Ethics committee of Universitat Jaume I in March 2022 (CD/42/2022). Trial registration: ClinicalTrials.gov Identifier: NCT05464121. Registered 19 July 2022, https://clinicaltrials.gov/ct2/show/NCT05464121.

Background and objectives: Variable diagnostic criteria and growth charts have been used for extrauterine growth restriction (EUGR). The objective was to assess the prevalence and concordance of EUGR in extremely-low-birthweight (ELBW) infants with the most frequent diagnostic criteria and growth charts. Materials and methods: An observational, retrospective and multicenter study was conducted from 2011 to 2020 including ELBW infants from the Spanish SEN1500 Network. EUGR prevalence was calculated at discharge using different definitions: cross-sectional (anthropometry less than the 10th centile), longitudinal (decrease of more than 1 SD from birth to discharge), “true” cross-sectional and “true” longitudinal (using the criteria previously described, excluding infants small for gestational age at birth). Concordance among Fenton, Olsen and INTERGROWTH-21st was assessed with Fleiss’ Kappa coefficient. Results: The prevalence of EUGR was variable with the different definitions and growth references studied in the 7914 ELBW infants included. Overall, it was higher with Fenton for all the EUGR criteria studied by weight and length. The agreement among growth charts was substantial (κ > 0.6) for all the definitions except for longitudinal EUGR by weight (moderate, κ = 0.578). Conclusions: The prevalence of EUGR was variable in our cohort with the different diagnostic criteria and growth charts. The agreement among charts was good for all the definitions of EUGR except longitudinal EUGR by weight.

Vascular calcification has a global health impact that is closely linked to bone loss. The Receptor Activator of Nuclear Factor Kappa B (RANK)/RANK ligand (RANKL)/osteoprotegerin (OPG) system, fundamental for bone metabolism, also plays an important role in vascular calcification. The Leucine-rich repeat-containing G-protein-coupled receptor 4 (LGR4), a novel receptor for RANKL, regulates bone remodeling, and it appears to be involved in vascular calcification. Besides RANKL, LGR4 interacts with R-spondins (RSPOs), which are known for their roles in bone but are less understood in vascular calcification. Studies were conducted in rats with chronic renal failure fed normal or high phosphorus diets for 18 weeks, with and without control of circulating parathormone (PTH) levels, resulting in different degrees of aortic calcification. Additionally, vascular smooth muscle cells (VSMCs) were cultured under non-calcifying (1 mM phosphate) and calcifying (3 mM phosphate) media with different concentrations of PTH. To explore the role of RANKL in VSMC calcification, increasing concentrations of soluble RANKL were added to non-calcifying and calcifying media. The effects mediated by RANKL binding to its receptor LGR4 were investigated by silencing the LGR4 receptor in VSMCs. Furthermore, the gene expression of the RANK/RANKL/OPG system and the ligands of LGR4 was assessed in human epigastric arteries obtained from kidney transplant recipients with calcification scores (Kauppila Index). Increased aortic calcium in rats coincided with elevated systolic blood pressure, upregulated Lgr4 and Rankl gene expression, downregulated Opg gene expression, and higher serum RANKL/OPG ratio without changes in Rspos gene expression. Elevated phosphate in vitro increased calcium content and expression of Rankl and Lgr4 while reducing Opg. Elevated PTH in the presence of high phosphate exacerbated the increase in calcium content. No changes in Rspos were observed under the conditions employed. The addition of soluble RANKL to VSMCs induced genotypic differentiation and calcification, partly prevented by LGR4 silencing. In the epigastric arteries of individuals presenting vascular calcification, the gene expression of RANKL was higher. While RSPOs show minimal impact on VSMC calcification, RANKL, interacting with LGR4, drives osteogenic differentiation in VSMCs, unveiling a novel mechanism beyond RANKL-RANK binding.

Water resources play a vital role in sustaining ecosystems, human life, food security, and biodiversity. However, these resources currently face serious threats caused primarily by human activities. Because of that, European Union have mandated that all its member states monitor the ecological status of their water bodies. One of the most commonly used bioindicator groups for routine river biomonitoring is benthic macroinvertebrates, which rely mainly on morphological identification at the family level and the use of diverse indices to estimate the ecological status of the river ecosystem. The morphological approach has certain limitations, and metabarcoding is now considered an alternative technique for biodiversity studies and biomonitoring of surface waters. However, the efficacy of this approach depends on the comparison of sequencing data with genetic databases, which are often incomplete and geographically biased. In this study, we collected 92 macroinvertebrate samples from rivers in the northern Iberian Peninsula to identify all possible species and generate new DNA sequences for the COI-5P region. The objectives were to perform region-specific enrichment of reference databases for the geographical area of northern Spain and to assess the impact, before and after this strategy, on the taxonomic assignments used for ecological status inference in metabarcoding samples. The results showed that 21% of morphospecies lacked reference sequences in the BOLD or GenBank databases, indicating that a significant number of macroinvertebrate species in the northwestern Iberian Peninsula lack reference sequences in major genetic databases. Enriching the BOLD databases with new sequences led to the detection of an average of 17.25 more BINs (species-assimilable gene cluster) and 1.54 more IBMWP taxa (river ecological status indicator macroinvertebrate taxa) per sample, causing changes in the ecological status determination for 16% of the samples, which clearly shows that improving the databases with local species sequences could enhance the detection and identification of new IBMWP taxa, potentially impacting ecological status inference from molecular data. Additionally, a historical analysis of Iberian macroinvertebrate addition in the BOLD database using public BOLD records revealed an asymptotic trend that can be partially mitigated by region-specific enrichment. These results indicate that a local biota sequencing effort can considerably improve metabarcoding results rather than waiting for a gradual improvement of genetic databases. In conclusion, we advocate for a creation an Iberian freshwater macroinvertebrate checklist and then the initiation of a coordinated effort for sequencing any unsequenced species from the region.

Las Tecnologías de la Información y de la Comunicación (TIC) aplicadas a la docencia, permiten dinamizar las actividades docentes convencionales realizadas en el aula, y reforzar las clases tradicionales. Dentro de este marco, el podcast representa una herramienta con gran potencial para la innovación docente y, por ello, este trabajo se centra en analizar el uso del learning podcast en un trabajo grupal de la asignatura de Economía Española del grado en Administración y Dirección de Empresas, y del doble grado de esa misma titulación con Ingeniería Informática de la Universidad Complutense de Madrid. Su aplicación se ha realizado en dos grupos con características diferentes y se han obtenido resultados muy positivos. Estos resultados se demuestran analizando las calificaciones de la actividad obtenidas por los estudiantes, con un promedio de notable para ambos grupos, y por otra, evaluando la percepción del alumnado sobre la actividad, para lo que se han desarrollado dos cuestionarios: uno inicial -antes de realizar la actividad- y otro final -una vez terminada-.

In the aftermath of the 2007–08 financial crisis, the worsening financial conditions of households increased concerns about their financial vulnerability (FV). In this context, policymakers embraced the notion of financial knowledge to foster sound financial behaviors among individuals and households, aiming to mitigate the detrimental effects of FV on households’ financial wellbeing and the overall economy. However, the relationship between FV and financial literacy remains inconclusive. This lack of definitive findings may stem from limitations in measuring FV and narrow focus on specific dimensions of financial literacy. This paper analyzes the relationship between financial literacy and FV by creating a comprehensive measure of (the level of) FV and considering different dimensions of financial literacy. Using a sample of 8,554 individuals in Spain obtained from the 2016–17 Survey of Financial Competences, we construct a continuous measure of FV by using Nonlinear Principal Components Analysis (NLPCA). Then, we employ OLS and ordered probit regressions to examine the potential association between different dimensions of financial literacy and FV. The findings indicate that the level of FV is negatively related to self-perceived financial knowledge, while no statistically significant relationship is found regarding objective financial knowledge. Evidence also reveals that “highly financially included” individuals are more likely to exhibit financial resilience. These findings highlight the need for the development of financial education initiatives that are action-oriented.

Background Population distribution of reduced diffusing capacity of the lungs for carbon monoxide (DLCO) in smokers and main consequences are not properly recognised. The objectives of this study were to describe the prevalence of reduced DLCO in a population-based sample of current and former smoker subjects without airflow limitation and to describe its morphological, functional and clinical implications.Methods A sample of 405 subjects aged 40 years or older with postbronchodilator forced expiratory volume in 1 s/forced vital capacity (FVC) >0.70 was obtained from a random population-based sample of 9092 subjects evaluated in the EPISCAN II study. Baseline evaluation included clinical questionnaires, exhaled carbon monoxide (CO) measurement, spirometry, DLCO determination, 6 min walk test, routine blood analysis and low-dose CT scan with evaluation of lung density and airway wall thickness.Results In never, former and current smokers, prevalence of reduced DLCO was 6.7%, 14.4% and 26.7%, respectively. Current and former smokers with reduced DLCO without airflow limitation were younger than the subjects with normal DLCO, and they had greater levels of dyspnoea and exhaled CO, greater pulmonary artery diameter and lower spirometric parameters, 6 min walk distance, daily physical activity and plasma albumin levels (all p

Background: Despite the increasing number of ICU admissions among patients with solid tumours, there is a lack of tools with which to identify patients who may benefit from critical support. We aim to characterize the clinical profile and outcomes of patients with solid malignancies admitted to the ICU. Methods: Retrospective observational study of patients with cancer non-electively admitted to the ICU of the Hospital Clinic of Barcelona (Spain) between January 2019 and December 2019. Data regarding patient and neoplasm characteristics, ICU admission features and outcomes were collected from medical records. Results: 97 ICU admissions of 84 patients were analysed. Lung cancer (22.6%) was the most frequent neoplasm. Most of the patients had metastatic disease (79.5%) and were receiving oncological treatment (75%). The main reason for ICU admission was respiratory failure (38%). Intra-ICU and in-hospital mortality rates were 9.4% and 24%, respectively. Mortality rates at 1, 3 and 6 months were 19.6%, 36.1% and 53.6%. Liver metastasis, gastrointestinal cancer, hypoalbuminemia, elevated basal C-reactive protein, ECOG-PS greater than 2 at ICU admission, admission from ward and an APACHE II score over 14 were related to higher mortality. Functional status was severely affected at discharge, and oncological treatment was definitively discontinued in 40% of the patients. Conclusion: Medium-term mortality and functional deterioration of patients with solid cancers non-electively admitted to the ICU are high. Surrogate markers of cachexia, liver metastasis and poor ECOG-PS at ICU admission are risk factors for mortality.

Bone represents a metabolically active tissue subject to continuous remodeling orchestrated by the dynamic interplay between osteoblasts and osteoclasts. These cellular processes are modulated by a complex interplay of biochemical and mechanical factors, which are instrumental in assessing bone remodeling. This comprehensive evaluation aids in detecting disorders arising from imbalances between bone formation and reabsorption. Osteoporosis, characterized by a reduction in bone mass and strength leading to heightened bone fragility and susceptibility to fractures, is one of the more prevalent chronic diseases. Some epidemiological studies, especially in patients with chronic kidney disease (CKD), have identified an association between osteoporosis and vascular calcification. Notably, low bone mineral density has been linked to an increased incidence of aortic calcification, with shared molecules, mechanisms, and pathways between the two processes. Certain molecules emerging from these shared pathways can serve as biomarkers for bone and mineral metabolism. Detecting and evaluating these alterations early is crucial, requiring the identification of biomarkers that are reliable for early intervention. While traditional biomarkers for bone remodeling and vascular calcification exist, they suffer from limitations such as low specificity, low sensitivity, and conflicting results across studies. In response, efforts are underway to explore new, more specific biomarkers that can detect alterations at earlier stages. The aim of this review is to comprehensively examine some of the emerging biomarkers in mineral metabolism and their correlation with bone mineral density, fracture risk, and vascular calcification as well as their potential use in clinical practice.

Shortly after the discovery of Klotho, interest grew in its potential role in chronic kidney disease (CKD). There are three isoforms of the Klotho protein: αKlotho, βKlotho and γKlotho. This review will focus on αKlotho due to its relevance as a biomarker in CKD. αKlotho is synthesized mainly in the kidneys, but it can be released into the bloodstream and urine as soluble Klotho (sKlotho), which undertakes systemic actions, independently or in combination with FGF23. It is usually accepted that sKlotho levels are reduced early in CKD and that lower levels of sKlotho might be associated with the main chronic kidney disease–mineral bone disorders (CKD-MBDs): cardiovascular and bone disease. However, as results are inconsistent, the applicability of sKlotho as a CKD-MBD biomarker is still a matter of controversy. Much of the inconsistency can be explained due to low sample numbers, the low quality of clinical studies, the lack of standardized assays to assess sKlotho and a lack of consensus on sample processing, especially in urine. In recent decades, because of our longer life expectancies, the prevalence of accelerated-ageing diseases, such as CKD, has increased. Exercise, social interaction and caloric restriction are considered key factors for healthy ageing. While exercise and social interaction seem to be related to higher serum sKlotho levels, it is not clear whether serum sKlotho might be influenced by caloric restriction. This review focuses on the possible role of sKlotho as a biomarker in CKD-MBD, highlighting the difference between solid knowledge and areas requiring further research, including the role of sKlotho in healthy ageing.

IntroductionSARS-CoV-2 viral load has been related to COVID-19 severity. The main aim of this study was to evaluate the relationship between SARS-CoV-2 viremia and SNPs in genes previously studied by our group as predictors of COVID-19 severity.Materials and methodsRetrospective observational study including 340 patients hospitalized for COVID-19 in the University Hospital La Princesa between March 2020 and December 2021, with at least one viremia determination. Positive viremia was considered when viral load was above the quantifiable threshold (20 copies/ml). A total of 38 SNPs were genotyped. To study their association with viremia a multivariate logistic regression was performed.ResultsThe mean age of the studied population was 64.5 years (SD 16.6), 60.9% patients were male and 79.4% white non-Hispanic. Only 126 patients (37.1%) had at least one positive viremia. After adjustment by confounders, the presence of the minor alleles of rs2071746 (HMOX1; T/T genotype OR 9.9 p

Abstract Background Phenotyping sputum-resident leukocytes and evaluating their functional status are essential analyses for exploring the cellular basis of pathological processes in the lungs, and flow cytometry is widely recognized as the gold-standard technique to address them. However, sputum-resident leukocytes are found in respiratory samples which need to be liquefied prior to cytometric analysis. Traditional liquefying procedures involve the use of a reducing agent such as dithiothreitol (DTT) in temperature-controlled conditions, which does not homogenize respiratory samples efficiently and impairs cell viability and functionality. Methods Here we propose an enzymatic method that rapidly liquefies samples by means of generating O2 bubbles with endogenous catalase. Sputum specimens from patients with suspected pulmonary infection were treated with DTT, the enzymatic method or PBS. We used turbidimetry to compare the liquefaction degree and cell counts were determined using a hemocytometer. Finally, we conducted a comparative flow cytometry study for evaluating frequencies of sputum-resident neutrophils, eosinophils and lymphocytes and their activation status after liquefaction. Results Enzymatically treated samples were better liquefied than those treated with DTT or PBS, which resulted in a more accurate cytometric analysis. Frequencies of all cell subsets analyzed within liquefied samples were comparable between liquefaction methods. However, the gentle cell handling rendered by the enzymatic method improves cell viability and retains in vivo functional characteristics of sputum-resident leukocytes (with regard to HLA-DR, CD63 and CD11b expression). Conclusion In conclusion, the proposed enzymatic liquefaction method improves the cytometric analysis of respiratory samples and leaves the cells widely untouched for properly addressing functional analysis of lung leukocytes.

The natural bridge over the Bitirí River, located in Holguín province, shows visible signs of weakining that put its stability at risk. The purpose of the study is to evaluate and proposing a set of strategic actions aimed at preserving this unique geological structure declared a natural monument. Based on field and cabinetwork, a comprehensive environmental analysis was carried out in three stages, which allowed diagnosing the degradation of the bridge, proposing an action plan and assessing the effectiveness of the actions in the long term. For this last purpose, the PROMETHEE software was applied to assess the applicability, efficiency and relevance of the 13 proposed actions. In this way, six optimal actions were differentiated, two with indirect incidence and five not relevant. It was also possible to establish that the environmental problems affecting bridge stability are mainly associated with natural erosion accentuated by the anthropic overexploitation of the place.

Cancer is one of the leading causes of death worldwide. Treatment outcome is largely dictated by the tumor type, disease stage, and treatment success rates, but also by the variation among patients in endogenous anti-tumor responses. Studies indicate that the presence of neutrophils in the tumor microenvironment is associated with a worse patient outcome due to their ability to suppress local anti-tumor T cell activity. Our previous studies investigated the mechanisms by which neutrophils suppress and damage T cells to become smaller in size (small T cells), debilitating their effector activities. Several studies indicate a role for tumor-associated macrophages in scavenging damaged or dead cells. We hypothesized that the observed lack of small T cells in the TME by confocal microscopy is due to immediate uptake by macrophages. In this study, we confirmed that indeed only the smaller, damaged T cells are taken up by macrophages, once serum-opsonized. Damaged T cells opsonized with complement factor C3 fragments were phagocytosed by macrophages, resulting in almost instantaneous and highly efficient uptake of these small T cells. Inhibition of the complement receptors CR1, CR3 and CR4 expressed by macrophages completely blocked phagocytosis. By contrast, actively proliferating T cells (large T cells) were neither impaired in neutrophil-MDSC activity nor opsonized for phagocytosis by macrophages. Rapid removal of damaged T cells suggests a role of complement and macrophages within the tumor microenvironment to clear suppressed T cells in cancer patients.

Video game trailers are very useful tools for attracting potential players. This research focuses on analyzing the emotions that arise while viewing video game trailers and the link between these emotions and storytelling and visual attention. The methodology consisted of a three-step task test with potential users: the first step was to identify the perception of indie games; the second step was to use the eyetracking device (gaze plot, heat map, and fixation points) and link them to fixation points (attention), viewing patterns, and non-visible areas; the third step was to interview users to understand impressions and questionnaires of emotions related to the trailer’s storytelling and expectations. The results show an effective assessment of visual attention together with visualization patterns, non-visible areas that may affect game expectations, fixation points linked to very specific emotions, and perceived narratives based on the gaze plot. The innovation in the mixed methodological approach has made it possible to obtain relevant data regarding the link between the emotions perceived by the user and the areas of attention collected with the device. The proposed methodology enables developers to understand the strengths and weaknesses of the information being conveyed so that they can tailor the trailer to the expectations of potential players.

Background Chimeric antigen receptor (CAR)-T cell-based immunotherapy constitutes a revolutionary advance for treatment of relapsed/refractory hematological malignancies. Nevertheless, cytokine release and immune effector cell-associated neurotoxicity syndromes are life-threatening toxicities in which the endothelium could be a pathophysiological substrate. Furthermore, differential diagnosis from sepsis, highly incident in these patients, is challenging. Suitable laboratory tools could be determinant for their appropriate management.Methods Sixty-two patients treated with CAR-T cell immunotherapy for hematological malignancies (n=46 with CD19-positive diseases, n=16 with multiple myeloma) were included. Plasma samples were obtained: before CAR-T cell infusion (baseline); after 24–48 hours; at suspicion of any toxicity onset and 24–48 hours after immunomodulatory treatment. Biomarkers of endothelial dysfunction (soluble vascular cell adhesion molecule 1 (sVCAM-1), soluble TNF receptor 1 (sTNFRI), thrombomodulin (TM), soluble suppression of tumorigenesis-2 factor (ST2), angiopoietin-2 (Ang-2)), innate immunity activation (neutrophil extracellular traps (NETs), soluble C5b-9 (sC5b-9)) and hemostasis/fibrinolysis (von Willebrand Factor antigen (VWF:Ag), ADAMTS-13 (A13), α2-antiplasmin (α2-AP), plasminogen activator inhibitor-1 antigen (PAI-1 Ag)) were measured and compared with those in cohorts of patients with sepsis and healthy donors.Results Patients who developed CAR-T cell toxicities presented increased levels of sVCAM-1, sTNFRI and ST2 at the clinical onset versus postinfusion values. Twenty-four hours after infusion, ST2 levels were good predictors of any CAR-T cell toxicity, and combination of ST2, Ang-2 and NETs differentiated patients requiring intensive care unit admission from those with milder clinical presentations. Association of Ang-2, NETs, sC5b-9, VWF:Ag and PAI-1 Ag showed excellent discrimination between severe CAR-T cell toxicities and sepsis.Conclusions This study provides relevant contributions to the current knowledge of the CAR-T cell toxicities pathophysiology. Markers of endotheliopathy, innate immunity activation and hemostatic imbalance appear as potential laboratory tools for their prediction, severity and differential diagnosis.

Dante Alighieri's Divine Comedy has reached our days as one of the most important works of universal literature. The so-called Commedia opened the doors to the modernity of the city of Florence, whose importance lasted in time until today. In this sense, art has been a direct witness of how and why a 14th century work, such as that of the Florentine poet, has managed to survive with the same importance it originally had in the collective memory. From the first artistic representations in illuminated manuscripts, the moment in which the Dantesque imaginary as we know it was configured, to its echo in the new artistic media. Dante and his work are, even today, a cultural landmark fully established in our society.

El incremento de inversiones en las zonas costeras del norte oriental de Cuba demanda la evaluación de la aptitud de las formaciones rocosas para soportar las construcciones, con vistas al diseño de los cimientos y la ubicación de los objetos de obra. Este artículo expone la evaluación desde el punto de vista físico, mecánico y de calidad de las rocas de la formación Jaimanitas, al ser esta una formación geológica de amplia extensión en la zona y con gran desarrollo del carso. La investigación se sustentó en trabajos de gabinete y de campo incluyendo perforación y análisis de laboratorio. Como resultado se obtuvo, para la parcela 63 A del Hotel Baracutey en la península El Ramón de Antilla, la zonificación de la carsificación y el mapa de favorabilidad constructiva, el cual facilitó la elección de las alternativas más favorables en el proyecto ingenieril con menos costos constructivos y ambientales.

A family of acylhydrazones have been prepared and characterized with the aim of investigating their potential as information storage systems. Their well-established synthetic methodologies allowed for the preparation of seven chemically stable acylhydrazones in excellent yields that have been photophysically and photochemically characterized. In addition, DFT and TD-DFT calculations have been performed to gain more insights into the structural, energetic and photophysical properties of the E/Z isomers. Our results reveal that E/Z configurational isomerization upon irradiation is highly dependent on the stabilization of the E or Z isomers due to the formation of intramolecular H bonds and the electronic/steric effects intrinsically related to their structures. In addition, Raman spectroscopy is also used to confirm the molecular structural changes after the formation of hydrogen bonds in the isomers.

Vascular calcification (VC) is a common complication in patients with chronic kidney disease which increases their mortality. Although oxidative stress is involved in the onset and progression of this disorder, the specific role of some of the main redox regulators, such as catalase, the main scavenger of H2O2, remains unclear. In the present study, epigastric arteries of kidney transplant recipients, a rat model of VC, and an in vitro model of VC exhibiting catalase (Cts) overexpression were analysed. Pericalcified areas of human epigastric arteries had increased levels of catalase and cytoplasmic, rather than nuclear runt-related transcription factor 2 (RUNX2). In the rat model, advanced aortic VC concurred with lower levels of the H2O2-scavenger glutathione peroxidase 3 compared to controls. In an early model of calcification using vascular smooth muscle cells (VSMCs), Cts VSMCs showed the expected increase in total levels of RUNX2. However, Cts VMSCs also exhibited a lower percentage of the nucleus stained for RUNX2 in response to calcifying media. In this early model of VC, we did not observe a dysregulation of the mitochondrial redox state; instead, an increase in the general redox state was observed in the cytoplasm. These results highlight the complex role of antioxidant enzymes as catalase by regulation of RUNX2 subcellular location delaying the onset of VC.

IntroductionAlthough a reduction in admissions for pathologies other than SARS-CoV-2 has been reported during the pandemic, there are hardly any specific studies in relation to COPD. The objective of this study was to analyse differences in the profile of those admitted for AEPOC and their prognosis during this period.MethodsProspective study (SocioEPOC validation cohort) conducted in two hospitals. Demographic, clinical and social characteristics were compared among patients admitted for an AECOPD before and after the declaration of the COVID-19 healthcare emergency. Mortality and the need for hospital care in the following 3 months were analysed.Results340 patients (76.6% male, 72 years, FEV1 43.5%) were included, 174 in the post-pandemic phase. During pandemic, especially before population-level vaccination, admissions for AECOPD were in patients with more severe disease and with a higher level of eosinophils. No differences were found in social profile, except they had more informal caregivers. The mortality rate at 90 days was the same (9%), although those admitted during the pandemic came for more hospital visits in the following 3 months (53.8% vs. 42%; p = 0.003), with the pandemic phase being an independent predictor of this possibility (OR = 1.6.; 95% IC = 1.1-2.6).ConclusionsIn the first few months of the pandemic, the clinical profile of patients hospitalised for an AECOPD differed from that both prior to this period and during the latter months of the pandemic, with minimal changes at the social level. Although the mortality rate were similar, unscheduled hospital visits increased during the COVID-19 pandemic.

El objetivo de la investigación es determinar el nivel de fragilidad financiera de los hogares gallegos, así como analizar si sus características sociodemográficas, económicas y conductuales se asocian con esta problemática, desde una perspectiva comparada con respecto al resto de comunidades autónomas. Partiendo de los datos de la primera edición de la Encuesta de Competencias Financieras (ECF), se observa que, comparado con España, un menor porcentaje de la población gallega presenta situaciones de fragilidad financiera media o alta. Además, los ingresos del hogar y la capacitación financiera del individuo son factores amortiguadores de la fragilidad financiera (FF), tanto en Galicia como en el resto de España. También, un mayor nivel educativo reduce la probabilidad de experimentar un alto nivel de FF autopercibida individual, mientras que la relación contraria se experimenta cuando se habita en un hogar con menores a cargo. Estos resultados, similares en ambas submuestras, no ocultan diferencias destacables. En comparación con España, el impacto de la capacitación financiera resulta menos relevante en Galicia, mientras que la inclusión financiera se relaciona positivamente con la FF.

BackgroundMotivational interviewing (MI) could be a method for minimizing alcohol-related harm. The study aims to assess the effectiveness of a brief intervention, based on a MI, in patients with risky alcohol use attended in Primary Care (PC).Materials and methodsA cluster-randomized, two-arm parallel, multicenter, open-label, controlled clinical trial. Fifty PC healthcare professionals from the province of Córdoba (Spain) will be randomized to one of the two study groups: (1) Experimental Group (EG): MI-based approach; (2) Control Group (CG): Usual care based on health advice. EG intervention: Professionals will receive a training program focused on MI, consisting of a training workshop and the use of pre- and post-workshop questionnaires to measure knowledge and skills acquired, as well as the degree of empathy, with a videotape of the health professionals with standardized patients, before and after the workshop, and subsequent training feedback. CG intervention: Workshop on the management of risky alcohol use based on health advice; participants will also complete the pre-and post-workshop questionnaires and be videotaped. Study population: Patients ≥ 14 years old with risky alcohol consumption (28 Standard Drink Units-SDU-/week in men and 17 SDU/week in women) or excessive alcohol use (≥ 6 SDU in men or ≥ 4 SDU in women, in less than 2 h). It would be necessary to include 110 subjects/group to find a difference of 20% between the percentage of patients in abstinence between EG (37%) and CG (20%), alpha error of 5%, and statistical power of 80%. Assuming a loss rate of 5% and the cluster design effect, the number of subjects to be recruited is estimated at 197/group. The follow-up period will be 12 months. The primary outcome variables will be the self-reported alcohol use level and the Alcohol Use Disorders Identification Test (AUDIT) questionnaire score.DiscussionThe study aims to demonstrate the effectiveness of the motivational approach in the comprehensive treatment of the patient with risky alcohol use, improving the empathy of the healthcare professionals and strengthening the healthcare professional-patient relationship to achieve the behavioral change of the patients with this problem in primary care consultations.Clinical trial registrationClinicalTrials.gov.

Resumen: Antecedentes y objetivo: Mantener niveles adecuados de fósforo sérico en el paciente con enfermedad renal crónica es fundamental para su correcto manejo clínico. Sin embargo resulta difícil su control de forma aislada porque normalmente se asocian con aumentos séricos de hormona paratiroidea (PTH). En el presente estudio se analizaron los efectos de la hiperfosfatemia aislada, en presencia de PTH elevada y normal, sobre la inflamación, hipertrofia y fibrosis cardíaca en un modelo de insuficiencia renal experimental. Materiales y métodos: Se formaron cuatro grupos de ratas. A dos grupos se les realizó paratiroidectomía total (PTx). A las ratas con Ca

In recent years, forest fires have experienced an increase in magnitude, frequency and socio-environmental damage globally. In Cuba, they are recognized as one of the main natural hazards affecting the country. In its management, fragmented and atomized management of resilience prevails due to the subdivision into typologies that limit the integration of various dimensions, processes and capacities in the local context. The objective of this study was to evaluate local resilience to forest fires in the Matamoros-Oscar Lucero area, in the municipality of Holguín. The characterization of the risk scenario was carried out, and based on the bibliographic review with the use of factorial and centrality analysis, the dimensions, variables and indicators that allow the assessment of robustness and specific resilience, as components of local resilience and implementation of a community management plan, were identified. A checklist was used to corroborate the increase in resilience in its sociocultural, environmental and governance dimensions, and to a lesser extent in its structural-technological and economic dimensions. From the integration of the results, it is concluded that the proposed indicators are useful and relevant for risk reduction in the face of this hazard.

Background and objective: Adequate serum phosphorus levels in patients with chronic kidney disease is essential for their clinical management. However, the control of hyperphosphatemia is difficult because is normally associated with increases in serum PTH. In the present study, the effects of hyperphosphatemia, in the presence of elevated and normal PTH, on cardiac inflammation, hypertrophy and fibrosis in an experimental renal failure model were analyzed. Materials and methods: 4 groups of rats were formed. Two groups underwent total parathyroidectomy (PTx). Rats with Ca

Background: Adjustment Disorder (AjD) is one of the most frequently diagnosed mental disorders worldwide. However, there is still no treatment of choice for this problem. One of the first treatment programs specifically designed for AjD is the one presented in this study, a CBT protocol that uses Virtual Reality (VR) to improve patients’ adherence. Another key aspect to improve treatment outcomes is the use of between-sessions homework. However, little is known about how to increase patient engagement with these tasks. The use of Information and Communication Technologies (ICTs) can help patients to see homework as less demanding and provides greater flexibility. A previous study tested the feasibility of TEO (Online Emotional Therapy), a program to implement online homework during treatment. The aim of this study is to present session-to-session efficacy data from the homework assignment component and the patients’ preferences and opinions about this component in both formats (Traditional vs. TEO).Methods: A two-arm pilot randomised clinical trial (RCT) was conducted with 57 patients with AjD. The two groups received the same CBT intervention with VR support, but one group completed homework in the traditional way and the other using TEO. Mood, self-efficacy and positive and negative emotions were measured to test the effect of the homework component in each treatment session. Preferences about the homework format were also assessed before and after treatment.Results: Both types of administration produced significant improvements in mood, self-efficacy and emotional variables after completion of the homework component and before and after each homework session. Effect sizes ranged from small to large, with no differences between groups. Regarding the acceptability of the program, most participants preferred the TEO condition both before starting the treatment and after completing the homework assignment. Overall, participants were satisfied with all homework sessions and found them useful. Again, no significant differences were found between groups.Conclusion: This is the first time that the effect of an online homework program during AjD treatment has been tested. It is proposed that this way of implementing homework could be as effective as the traditional format, but would be preferred by patients.Clinical Trial Registration:clinicaltrials.gov, identifier NCT02452411

This study presents two specimens of Chimaeriformes from Upper Jurassic strata of central Chile. The material was recovered from Tithonian levels of the Baños del Flaco Formation and includes two different individuals, one preserving two articulated mandibular plates, and the second, a fragment of an isolated palatine plate. Morphologic traits allow us to refer the material to Ischyodus townsendi and Ischyodus sp., respectively. These are the oldest Chimaeriformes known to date in the Southern Hemisphere and the first Late Jurassic record from Gondwana. The presence of I. townsendi in the Tithonian of central Chile evidences this taxon as part of the proposed faunal interchange between the northern Tethys and the southeastern Pacific during the Late Jurassic.

Introducción: Para las instituciones de Educación Superior pertenecientes al sector de la salud, es una necesidad evaluar su desempeño ambiental e identificar avances y retrocesos en su relación con el medio ambiente. De ahí la importancia de contar con indicadores que faciliten la evaluación del desempeño ambiental en aras de lograr resultados positivos en la gestión ambiental de la institución. Objetivo: Definir indicadores para evaluar el desempeño ambiental en instituciones de Educación Superior de la Salud. Método: Se sustenta en una investigación estructurada en tres etapas: una exploratoria, otra confirmatoria y una última valorativa, conjugándose la metodología cualitativa y cuantitativa a través del empleo de métodos teóricos, empíricos y estadísticos, como son: la revisión bibliográfica, el criterio de especialistas, el análisis de clúster y el método de Proceso de Análisis jerárquico AHP. Resultados: Se obtuvieron 15 indicadores de evaluación de desempeño ambiental que están en correspondencia con los indicadores clasificados por la Norma ISO 14031. Estos fueron validados estadísticamente a través de un proceso de selección y análisis jerárquico. Conclusiones: Los indicadores seleccionados constituyen la garantía de contar con herramientas eficientes y apropiadas, con un reconocimiento mayoritario marcando las pautas para una buena evaluación del desempeño ambiental en la Facultad de Enfermería Arides Estevez Sánchez de Holguín. Palabras clave: Desempeño ambiental, indicadores, medio ambiente.

Phosphorus is a vital element for life found in most foods as a natural component, but it is also one of the most used preservatives added during food processing. High serum phosphorus contributes to develop vascular calcification in chronic kidney disease; however, it is not clear its effect in a population without kidney damage. The objective of this in vivo and in vitro study was to investigate the effect of high phosphorus exposure on the aortic and serum levels of miR-145 and its effect on vascular smooth muscle cell (VSMCs) changes towards less contractile phenotypes. The study was performed in aortas and serum from rats fed standard and high-phosphorus diets, and in VSMCs exposed to different concentrations of phosphorus. In addition, miR-145 silencing and overexpression experiments were carried out. In vivo results showed that in rats with normal renal function fed a high P diet, a significant increase in serum phosphorus was observed which was associated to a significant decrease in the aortic α-actin expression which paralleled the decrease in aortic and serum miR-145 levels, with no changes in the osteogenic markers. In vitro results using VSMCs corroborated the in vivo findings. High phosphorus first reduced miR-145, and afterwards α-actin expression. The miR-145 overexpression significantly increased α-actin expression and partially prevented the increase in calcium content. These results suggest that miR-145 could be an early biomarker of vascular calcification, which could give information about the initiation of the transdifferentiation process in VSMCs.

Preclinical biomedical models are a fundamental tool to improve the knowledge and management of diseases, particularly in diabetes mellitus (DM) since, currently, the pathophysiological and molecular mechanisms involved in its development are not fully clarified, and there is no treatment to cure DM. This review will focus on the features, advantages and limitations of some of the most used DM models in rats, such as the spontaneous models: Bio-Breeding Diabetes-Prone (BB-DP) and LEW.1AR1-iddm, as representative models of type 1 DM (DM-1); the Zucker diabetic fatty (ZDF) and Goto-kakizaki (GK) rats, as representative models of type 2 DM (DM-2); and other models induced by surgical, dietary and pharmacological—alloxan and streptozotocin—procedures. Given the variety of DM models in rats, as well as the non-uniformity in the protocols and the absence of all the manifestation of the long-term multifactorial complications of DM in humans, the researchers must choose the one that best suits the final objectives of the study. These circumstances, added to the fact that most of the experimental research in the literature is focused on the study of the early phase of DM, makes it necessary to develop long-term studies closer to DM in humans. In this review, a recently published rat DM model induced by streptozotocin injection with chronic exogenous administration of insulin to reduce hyperglycaemia has also been included in an attempt to mimic the chronic phase of DM in humans.

Resumen: Bartonella henselae es un bacilo intracelular facultativo que puede infectar al ser humano después de ser arañado o mordido por gatos portadores y es uno de los agentes causantes de endocarditis con hemocultivo negativo. Se presenta el caso de una paciente de 73 años portadora de una bioprótesis aórtica que un año después de la mordedura de su gato fue ingresada por cuadro sistémico de astenia, anorexia y fiebre ocasional de varios meses de evolución. Los hemocultivos resultaron negativos, pero las pruebas serológicas indicaron infección por B. henselae. La realización de una tomografía por emisión de positrones/tomografía computarizada demostró la afectación de la prótesis valvular. La paciente fue reintervenida y la evolución postoperatoria fue satisfactoria. El estudio de la prótesis infectada mediante técnicas moleculares permitió identificar B. henselae. Se discuten algunos aspectos relacionados con el diagnóstico y tratamiento de esta enfermedad. Abstract: Bartonella henselae is a facultative intracellular rod that can infect humans after being scratched or bitten by carrier cats. It is one of the causative agents of blood culture-negative endocarditis. We report the case of a 73-year-old patient with an aortic bioprosthesis. She had been bitten by her cat. One year later she was admitted for systemic symptoms of asthenia, anorexia and occasional fever of several months of evolution. Blood cultures were negative, but serological tests indicated infection with B. henselae. Positron emission tomography/computed tomography demonstrated prosthetic valve involvement. The patient underwent a redo procedure, and the postoperative evolution was satisfactory. The study of the infected prosthesis using molecular techniques allowed the identification of B. henselae. Some considerations regarding the diagnosis and management of this entity are discussed.

To this day, there are only a few studies that have used a controlled instructional intervention on specific linguistic structures to investigate if language instruction is beneficial for heritage learners (HLs), in the same way it is for second (L2) language learners, and more research in this area is rapidly needed (Bowles, 2018). The results from this small body of research suggest that explicit language instruction can be beneficial for HLs, but overall L2 learners still appear to benefit from language instruction more than their HLs counterparts (Potowski et al., 2009; Torres, 2018, inter alia). The present study seeks to contribute to this growing body of research and further examines if the type of task employed to measure learning gains plays a role in the uneven outcomes heritage and L2 learners evidence after receiving language instruction.

Introducción: La pérdida involuntaria del embarazo es un evento relativamente común, especialmente en la práctica clínica de matronas y enfermeras. El cuidado de los profesionales sanitarios, y en especial de enfermeras y matronas, es crucial para el bienestar a corto y largo plazo de los padres. Sin embargo, el personal sanitario informa lo poco preparado que se encuentra y lo estresante y exigente que resulta el cuidado de estas pérdidas. Para conocer las experiencias de enfermeras y matronas en el cuidado de las pérdidas involuntarias del embarazo, se desarrollaron dos estudios, uno con metodología meta-etnográfica (meta-síntesis cualitativa), y otro inspirado en el diseño hermenéutico fenomenológico (estudio empírico), lo que dio lugar a la triangulación metodológica de dicho objetivo. Objetivos: Este manuscrito pretende mostrar y reflexionar sobre el empleo de la triangulación metodológica, entre un estudio meta-etnográficos y uno empírico, para el estudio de las experiencias de cuidado en las pérdidas del embarazo. Métodos: El desarrollo de la meta-etnografía siguió las siete fases descritas por Noblit y Hare (1988), y el estudio hermenéutico fenomenológico se inspiró en el trabajo de Lindseth y Norberg (2004). Resultados: Las enfermeras y matronas que cuidaron de padres que habían sufrido una pérdida involuntaria del embarazo, lidiaron con dificultades que exigieron abandonar la zona de confort. Esto ocasionó que no se involucraran emocionalmente con ellos y que, si lo hacían, el cuidado se basase en su intuición. Conclusiones: La triangulación metodológica nos ha permitido tener una mayor confianza en la credibilidad de los hallazgos del estudio. Ambos estudios informaron al cuerpo de conocimiento en ciencias de enfermería y promueven un cambio en la práctica clínica, ya que los resultados muestran la complejidad de la experiencia del cuidado de enfermería y partería en pérdidas involuntarias de embarazo.