Cut-offs and response criteria for the Hospital Universitario la Princesa Index (HUPI) and their comparison to widely-used indices of disease activity in rheumatoid arthritis

Objective To estimate cut-off points and to establish response criteria for the Hospital Universitario La Princesa Index (HUPI) in patients with chronic polyarthritis. Methods Two cohorts, one of early arthritis (Princesa Early Arthritis Register Longitudinal PEARL] study) and other of long-term rheumatoid arthritis (Estudio de la Morbilidad y Expresión Clínica de la Artritis Reumatoide EMECAR]) including altogether 1200 patients were used to determine cut-off values for remission, and for low, moderate and high activity through receiver operating curve (ROC) analysis. The areas under ROC (AUC) were compared to those of validated indexes (SDAI, CDAI, DAS28). ROC analysis was also applied to establish minimal and relevant clinical improvement for HUPI. Results The best cut-off points for HUPI are 2, 5 and 9, classifying RA activity as remission if =2, low disease activity if >2 and =5), moderate if >5 and <9 and high if =9. HUPI''s AUC to discriminate between low-moderate activity was 0.909 and between moderate-high activity 0.887. DAS28''s AUCs were 0.887 and 0.846, respectively; both indices had higher accuracy than SDAI (AUCs: 0.832 and 0.756) and CDAI (AUCs: 0.789 and 0.728). HUPI discriminates remission better than DAS28-ESR in early arthritis, but similarly to SDAI. The HUPI cut-off for minimal clinical improvement was established at 2 and for relevant clinical improvement at 4. Response criteria were established based on these cut-off values. Conclusions The cut-offs proposed for HUPI perform adequately in patients with either early or long term arthritis

Dietary α‐Linolenic Acid, Marine ω‐3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study

Background: Epidemiological evidence suggests a cardioprotective role of α‐linolenic acid (ALA), a plant‐derived ω‐3 fatty acid. It is unclear whether ALA is beneficial in a background of high marine ω‐3 fatty acids (long‐chain n‐3 polyunsaturated fatty acids) intake. In persons at high cardiovascular risk from Spain, a country in which fish consumption is customarily high, we investigated whether meeting the International Society for the Study of Fatty Acids and Lipids recommendation for dietary ALA (0.7% of total energy) at baseline was related to all‐cause and cardiovascular disease mortality. We also examined the effect of meeting the society's recommendation for long‐chain n‐3 polyunsaturated fatty acids (≥500 mg/day). Methods and Results: We longitudinally evaluated 7202 participants in the PREvención con DIeta MEDiterránea (PREDIMED) trial. Multivariable‐adjusted Cox regression models were fitted to estimate hazard ratios. ALA intake correlated to walnut consumption (r=0.94). During a 5.9‐y follow‐up, 431 deaths occurred (104 cardiovascular disease, 55 coronary heart disease, 32 sudden cardiac death, 25 stroke). The hazard ratios for meeting ALA recommendation (n=1615, 22.4%) were 0.72 (95% CI 0.56–0.92) for all‐cause mortality and 0.95 (95% CI 0.58–1.57) for fatal cardiovascular disease. The hazard ratios for meeting the recommendation for long‐chain n‐3 polyunsaturated fatty acids (n=5452, 75.7%) were 0.84 (95% CI 0.67–1.05) for all‐cause mortality, 0.61 (95% CI 0.39–0.96) for fatal cardiovascular disease, 0.54 (95% CI 0.29–0.99) for fatal coronary heart disease, and 0.49 (95% CI 0.22–1.01) for sudden cardiac death. The highest reduction in all‐cause mortality occurred in participants meeting both recommendations (hazard ratio 0.63 [95% CI 0.45–0.87]). Conclusions: In participants without prior cardiovascular disease and high fish consumption, dietary ALA, supplied mainly by walnuts and olive oil, relates inversely to all‐cause mortality, whereas protection from cardiac mortality is limited to fish‐derived long‐chain n‐3 polyunsaturated fatty acids. Clinical Trial Registration URL: http://www.Controlled-trials.com/. Unique identifier: ISRCTN35739639

Growth And The Growth Hormone-Insulin Like Growth Factor 1 Axis In Children With Chronic Inflammation:Current Evidence, Gaps In Knowledge And Future Directions

Growth failure is frequently encountered in children with chronic inflammatory conditions like juvenile idiopathic arthritis, inflammatory bowel disease and cystic fibrosis. Delayed puberty and attenuated pubertal growth spurt is often seen during adolescence. The underlying inflammatory state mediated by pro-inflammatory cytokines, prolonged use of glucocorticoid and suboptimal nutrition contribute to growth failure and pubertal abnormalities. These factors can impair growth by their effects on the growth hormone-insulin like growth factor axis and also directly at the level of the growth plate via alterations in chondrogenesis and local growth factor signaling. Recent studies on the impact of cytokines and glucocorticoid on the growth plate studies further advanced our understanding of growth failure in chronic disease and provided a biological rationale of growth promotion. Targeting cytokines using biologic therapy may lead to improvement of growth in some of these children but approximately one third continue to grow slowly. There is increasing evidence that the use of relatively high dose recombinant human growth hormone may lead to partial catch up growth in chronic inflammatory conditions, although long term follow-up data is currently limited. In this review, we comprehensively review the growth abnormalities in children with juvenile idiopathic arthritis, inflammatory bowel disease and cystic fibrosis, systemic abnormalities of the growth hormone-insulin like growth factor axis and growth plate perturbations. We also systematically reviewed all the current published studies of recombinant human growth hormone in these conditions and discuss the role of recombinant human insulin like growth factor-1

Diffusible signals, not autonomous mechanisms, determine the main proximodistal limb subdivision

ReportVertebrate limbs develop three main proximodistal (PD) segments (upper arm, forearm, and hand) in a proximal-to-distal sequence. Despite extensive research into limb development, whether PD specification occurs through nonautonomous or autonomous mechanisms is not resolved. Heterotopic transplantation of intact and recombinant chicken limb buds identifies signals in the embryo trunk that proximalize distal limb cells to generate a complete PD axis. In these transplants, retinoic acid induces proximalization, which is counteracted by fibroblast growth factors from the distal limb bud; these related actions suggest that the first limb-bud PD regionalization results from the balance between proximal and distal signals. The plasticity of limb progenitor cell identity in response to diffusible signals provides a unifying view of PD patterning during vertebrate limb development and regeneration.Supported by grants RD06/0010/0008, BFU2009-08331/BMC (M.T.) and BFU2008-00397 (M.A.R.), from the Spanish Ministry of Science and Innovation (MICINN) and fellowship CPI/0051/2007 (A. R.-D.) from Madrid’s Regional Government (CAM). The CNIC is supported by the MICINN and the Pro-CNIC Foundation.Peer reviewe

Evaluación cartográfica de la vulnerabilidad social ante inundaciones a escala intra­‐municipal: aplicación al municipio de Navaluenga (Ávila)

Reunión Nacional de Geomorfología (15ª. 2018. Palma de Mallorca). - Texto en español con resumen en inglés y palabras claves en inglés y españolVulnerability to floods has been an item with a careless appearance, versus dangerousness, in the risk management processes. These studies have traditionally focused on the economic loss potential estimation as equivalent to vulnerability, and/or on socio‐economic indicators of the inequity of the society addressed at a regional or global scale. In this statement, results of vulnerability to flood at intra-municipal scale Navaluenga Urban centre, Ávila) are provided, obtained from a methodology designed not only for the description of the vulnerability, but also for the resolution of specific vulnerability problems identified in previous flood events. The addressed problems refer to vulnerability versus danger or threat during the flood crisis. After this, the statement reflects on the performances that a cartography of vulnerability against floods aimed at risk management at local level should provide, and the difficulties, constraints and possibilities of the data sources for mapping social vulnerability versus flood.Departamento de Geografía, Universidad de Málaga, EspañaÁrea de Riesgos Geológicos, Instituto Geológico y Minero de España, Españ

Evaluación de caracteres agronómicos y de calidad industrial en líneas de tomate de industria resistentes al virus de las manchas bronceadas del tomate

Nowadays, Tomato spotted wilt virus (TSWV) is one of the most limiting factors for tomato culture in Spain. Some breeding programs have been recently developed to obtain cultivars with resistance to TSWV. The evaluation of six lines of processing tomato obtained from one of these breeding programs and carrying the Sw-5 gene that confers resistance to TSWV, has shown that all these lines have both agronomic (yield, vigor, etc.) and quality characters better or similar to those of control cultivars. The lines tested here could be very useful in regions where TSWV is an endemic disease and to get hybrids that would express heterosis and more stability in different environmental conditions.El virus de las manchas bronceadas del tomate (TSWV) constituye en la actualidad uno de los factores limitantes más importantes del cultivo del tomate en nuestro país. En los últimos años se han desarrollado programas de mejora para obtener variedades comerciales de tomate resistentes a esta virosis. La evaluación de seis líneas de tomate de industria que incorporan el gen Sw-5 de resistencia al TSWV, obtenidas mediante uno de estos programas, puso de manifiesto que estas líneas presentan vigor adecuado, buena cobertura foliar de los frutos, producción comercial elevada, agrupación óptima de la maduración y características de calidad externa e interna adecuadas para el procesado industrial. Estas líneas podrán utilizarse directamente en áreas con una elevada incidencia de la enfermedad causada por el TSWV, y para construir híbridos que expresen heterosis y tengan mayor estabilidad frente a variadas condiciones ambientales