Socio-Ecological Regionalization of the Urban Sub-Basins in Mexic

Mexico is a diverse country in terms of culture and natural environments. For this reason, the delimitation of homogeneous basins with similar environmental, social, and economic attributes is important in order to facilitate the elaboration of high-impact regional development strategies. However, this represents an ongoing challenge due to the complexity of the interactions that occur within socio-ecological systems at a regional scale. In the present study, the main objective was to identify the interrelationships among different aspects of the socio-ecological system located within basins, with the goal of utilizing this information to promote the region-specific sustainable development of an Integrated Water Resources Management (IWRM). Therefore, in this study, environmental, social, economic, and institutional variables, relevant to water management and with thecapacitytobeexpressedspatially,wereutilizedtoidentifyregionswithsimilarcharacteristicsand to regionalize the urban sub-basins of Mexico based on a principal component analysis (PCA) and the k-medoids clustering algorithm. The identification of the most adequate number of regions at the national level was determined by the silhouette method. As a result, five distinct regions for Mexico were generated, which forms the first step in the design of integrated water resources management strategies for these regions.Universidad Autónoma del Estado de MéxicoConsejo Nacional de Ciencia y Tecnología (CONACyT-México

Ultrasound Examination of the Ligament Complex Within the Medial Aspect of the Ankle and Foot

To properly diagnose and treat injuries to the ankle or foot, the physician must have good anatomical knowledge of the ligaments involved. The bundles can be distinguished and identified by ultrasound examination of the medial aspect, but this may be a challenging task. In the present illustrated study, we discuss how a detailed ultrasound examination can be made of the different ligaments within the medial aspect of the ankle and foot.Funding for open access charge is provided by Universidad de Malaga/CBU

Competitividad del comercio exterior de la porcicultura mexicana en el Tratado de Libre Comercio de América del Norte

El concepto de competitividad utilizado en este trabajo, se define desde el punto de vista del desempeño en el comercio internacional, y se expresa como la capacidad de un país, de una industria, de un segmento o de una cadena productiva para conquistar, mantener o incrementar su participación en los mercados nacionales e internacionales. La competitividad comercial porcícola de los países que conformaron el tlcan en el periodo 1990-2004, se midió con los indicadores siguientes: la participación en los mercados internacionales (pmi), el coeficiente de la ventaja comparativa revelada (vcr), tasa de penetración de las importaciones (tpi) y la exposición a la competencia internacional (eci). Para México, la pmi y la vcr crecieron de 0.02 a 0.8% y de 0.2 a 1.9%, debido al incremento de las exportaciones, lo que significó aumento de competitividad; en contraste los incrementos en la tpi y la eci al pasar de 5.8 a 42.6% y de 5.8 a 41.2%, reflejaron la alta dependencia de México a las importaciones porcícolas, principalmente de los Estados Unidos. Los indicadores para los Estados Unidos y Canadá mostraron un mejor desempeñoEl concepto de competitividad utilizado en este trabajo, se deÀne desde el punto de vista del desempeño en el comercio internacional, y se expresa como la capacidad de un país, de una industria, de un segmento o de una cadena productiva para conquistar, mantener o incrementar su participación en los mercados nacionales e internacionales. La competitividad comercial porcícola de los países que conformaron el tlcan en el periodo 1990-2004, se midió con los indicadores siguientes: la participación en los mercados internacionales (pmi), el coeÀciente de la ventaja comparativa revelada (vcr), tasa de penetración de las importaciones (tpi) y la exposición a la competencia internacional (eci). Para México, la pmi y la vcr crecieron de 0.02 a 0.8% y de 0.2 a 1.9%, debido al incremento de las exportaciones, lo que signiÀcó aumento de competitividad; en contraste los incrementos en la tpi y la eci al pasar de 5.8 a 42.6% y de 5.8 a 41.2%, reÁejaron la alta dependencia de México a las importaciones porcícolas, principalmente de los Estados Unidos. Los indicadores para los Estados Unidos y Canadá mostraron un mejor desempeño

From the North-Iberian Margin to the Alboran Basin: A lithosphere geo-transect across the Iberian Plate

A ~ 1000-km-long lithospheric transect running from the North-Iberian Margin to the Alboran Basin (W-Mediterranean) is investigated. The main goal is to image the changes in the crustal and upper mantle structure occurring in: i) the North-Iberian margin, whose deformation in Alpine times gave rise to the uplift of the Cantabrian Mountains related to Iberia-Eurasia incipient subduction; ii) the Spanish Meseta, characterized by the presence of Cenozoic basins on top of a Variscan basement with weak Alpine deformation in the Central System, and localized Neogene-Quaternary deep volcanism; and iii) the Betic-Alboran system related to Africa-Iberia collision and the roll-back of the Ligurian-Tethyan domain. The modeling approach, combines potential fields, elevation, thermal, seismic, and petrological data under a self-consistent scheme. The crustal structure is mainly constrained by seismic data whereas the upper mantle is constrained by tomographic models. The results highlight the lateral variations in the topography of the lithosphere-asthenosphere boundary (LAB), suggesting a strong lithospheric mantle strain below the Cantabrian and Betic mountain belts. The LAB depth ranges from 180 km beneath the Cantabrian Mountains to 135-110. km beneath Iberia Meseta deepening again to values of 160. km beneath the Betic Cordillera. The Central System, with a mean elevation of 1300. m, has a negligible signature on the LAB depth. We have considered four lithospheric mantle compositions: a predominantly average Phanerozoic in the continental mainland, two more fertile compositions in the Alboran Sea and in the Calatrava Volcanic Province, and a hydrated uppermost mantle in the North-Iberian Margin. These compositional differences allowed us to reproduce the main trends of the geophysical observables as well as the inferred P- and S-wave seismic velocities from tomography models and seismic experiments available in the study transect. The high mean topography of Iberia can be partly consistent with a low-velocity/high-temperature/low-density layer in the sublithospheric mantle.The presented work has been supported by Topo-Iberia Consolider-IngenioCSD2006-0004, GASAM/TopoMed (CGL2008-03474-E/BTE/07-TOPO-EUROPE-FP-006), TECLA (CGL2011-26670) funded by the Spanish Government, and PYRTEC-IP2 (SV-PA-10-03, funded by the Government of Asturias/ESF TOPO-EUROPE Programme) projects. AC benefitted from a JAE-PreCP grant from CSIC. JCA acknowledges the support from ARC GrantDP120102372.Peer Reviewe

Microbiota diversity in nonalcoholic fatty liver disease and in drug-induced liver injury

The gut microbiota could play a significant role in the progression of nonalcoholic fatty liver disease (NAFLD); however, its relevance in drug-induced liver injury (DILI) remains unexplored. Since the two hepatic disorders may share damage pathways, we analysed the metagenomic profile of the gut microbiota in NAFLD, with or without significant liver fibrosis, and in DILI, and we identified the main associated bacterial metabolic pathways. In the NAFLD group, we found a decrease in Alistipes, Barnesiella, Eisenbergiella, Flavonifractor, Fusicatenibacter, Gemminger, Intestinimonas, Oscillibacter, Parasutterella, Saccharoferementans and Subdoligranulum abundances compared with those in both the DILI and control groups. Additionally, we detected an increase in Enterobacter, Klebsiella, Sarcina and Turicibacter abundances in NAFLD, with significant liver fibrosis, compared with those in NAFLD with no/mild liver fibrosis. The DILI group exhibited a lower microbial bacterial richness than the control group, and lower abundances of Acetobacteroides, Blautia, Caloramator, Coprococcus, Flavobacterium, Lachnospira, Natronincola, Oscillospira, Pseudobutyrivibrio, Shuttleworthia, Themicanus and Turicibacter compared with those in the NAFLD and control groups. We found seven bacterial metabolic pathways that were impaired only in DILI, most of which were associated with metabolic biosynthesis. In the NAFLD group, most of the differences in the bacterial metabolic pathways found in relation to those in the DILI and control groups were related to fatty acid and lipid biosynthesis. In conclusion, we identified a distinct bacterial profile with specific bacterial metabolic pathways for each type of liver disorder studied. These differences can provide further insight into the physiopathology and development of NAFLD and DILI.This work was supported in part by a grant from the Instituto de Salud Carlos III (Spain) (PI18/01804, PI19/00883, PI21/01248), from the Consejería de Economía, Conocimiento, Empresas y Universidad (Junta de Andalucía, Spain) (PI18–RT‐3364, UMA18-FEDERJA-194), and from the Consejería de Salud (Junta de Andalucía, Spain) (PI-0285–2016). This study has been co-funded by FEDER funds (“A way to make Europe”) (“Andalucía se mueve con Europa”). CRD is supported by a grant from the Consejería de Transformación Económica, Industria, Conocimiento y Universidades de Junta de Andalucía (Spain) (DOC_01610). FMR is supported by a grant from the ISCIII (Spain) (FI19/00189). AC is supported by a grant from the ISCIII (Spain) (IFI18/00047). EGF is supported by the Nicolas Monardes program from the Consejería de Salud de Andalucía (Spain) (C-0031–2016). Funding for open access charge: Universidad de Málaga / CBUA (Spain)

Metabolomics analysis of type 2 diabetes remission identifies 12 metabolites with predictive capacity: a CORDIOPREV clinical trial study.

Type 2 diabetes mellitus (T2DM) is one of the most widely spread diseases, affecting around 90% of the patients with diabetes. Metabolomics has proven useful in diabetes research discovering new biomarkers to assist in therapeutical studies and elucidating pathways of interest. However, this technique has not yet been applied to a cohort of patients that have remitted from T2DM. All patients with a newly diagnosed T2DM at baseline (n = 190) were included. An untargeted metabolomics approach was employed to identify metabolic differences between individuals who remitted (RE), and those who did not (non-RE) from T2DM, during a 5-year study of dietary intervention. The biostatistical pipeline consisted of an orthogonal projection on the latent structure discriminant analysis (O-PLS DA), a generalized linear model (GLM), a receiver operating characteristic (ROC), a DeLong test, a Cox regression, and pathway analyses. The model identified a significant increase in 12 metabolites in the non-RE group compared to the RE group. Cox proportional hazard models, calculated using these 12 metabolites, showed that patients in the high-score tercile had significantly (p-value < 0.001) higher remission probabilities (Hazard Ratio, HR, high versus low = 2.70) than those in the lowest tercile. The predictive power of these metabolites was further studied using GLMs and ROCs. The area under the curve (AUC) of the clinical variables alone is 0.61, but this increases up to 0.72 if the 12 metabolites are considered. A DeLong test shows that this difference is statistically significant (p-value = 0.01). Our study identified 12 endogenous metabolites with the potential to predict T2DM remission following a dietary intervention. These metabolites, combined with clinical variables, can be used to provide, in clinical practice, a more precise therapy. ClinicalTrials.gov, NCT00924937.The CORDIOPREV study is supported by the Ministerio de Economia y Competitividad, Spain, under the grants AGL2012/39615, PIE14/00005, and PIE14/00031 associated to J.L.-M.; AGL2015-67896-P to J.L.-M. and A.C.; CP14/00114 to A.C.; PI19/00299 to A.C.; DTS19/00007 to A.C.; FIS PI13/00023 to J.D.-L., PI16/01777 to F.P.-J. and P.P.-M.; Antonio Camargo is supported by an ISCIII research contract (Programa Miguel-Servet CPII19/00007); Marina Mora-Ortiz has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 847468; ‘Fundacion Patrimonio Comunal Olivarero’, Junta de Andalucía (Consejería de Salud, Consejeria de Agricultura y Pesca, Consejería de Innovacion, Ciencia y Empresa), ‘Diputaciones de Jaen y Cordoba’, ‘Centro de Excelencia en Investigación sobre Aceite de Oliva y Salud’ and ‘Ministerio de Medio Ambiente, Medio Rural y Marino’, Gobierno de España; ‘Consejeria de Innovación, Ciencia y Empresa, Proyectos de Investigación de Excelencia’, Junta de Andalucía under the grant CVI-7450 obtaiend by J.L.-M.; and we would also like to thank the ‘Fondo Europeo de Desarrollo Regional (FEDER)’.S

Direct-acting Antivirals for the Treatment of Kidney Transplant Patients With Chronic Hepatitis C Virus Infection in Spain: A Long-term Prospective Observational Study

Background: Direct-acting antivirals (DAA) allow effective and safe eradication of hepatitis C virus (HCV) in most patients. There are limited data on the long-term effects of all-oral, interferon-free DAA combination therapies in kidney transplant (KT) patients infected with HCV. Here we evaluated the long-term tolerability, efficacy, and safety of DAA combination therapies in KT patients with chronic HCV infection. Methods: Clinical data from KT patients treated with DAA were collected before, during, and after the treatment, including viral response, immunosuppression regimens, and kidney and liver function. Results: Patients (N = 226) were mostly male (65.9%) aged 56.1 +/- 10.9 years, with a median time from KT to initiation of DAA therapy of 12.7 years and HCV genotype 1b (64.6%). Most patients were treated with sofosbuvir-based therapies. Rapid virological response at 1 month was achieved by 89.4% of the patients and sustained virological response by week 12 by 98.1%. Liver function improved significantly after DAA treatment. Tacrolimus dosage increased 37% from the beginning of treatment (2.5 +/- 1.7 mg/d) to 1 year after the start of DAA treatment (3.4 +/- 1.9 mg/d, P < 0.001). Median follow-up was 37.0 months (interquartile range, 28.4-41.9) and death-censored graft survival was 91.1%. Adverse events resulting from DAA treatment, especially anemia, were reported for 31.0% of the patients. Conclusions: Chronic HCV infection can be treated efficiently and safely with DAA therapy in KT patients. Most patients retained stable kidney function and improved liver function. Tacrolimus dose had to be increased in most patients, potentially as a result of better liver function

Grupo español de cirugía torácica asistida por videoimagen: método, auditoría y resultados iniciales de una cohorte nacional prospectiva de pacientes tratados con resecciones anatómicas del pulmón

Introduction: our study sought to know the current implementation of video-assisted thoracoscopic surgery (VATS) for anatomical lung resections in Spain. We present our initial results and describe the auditing systems developed by the Spanish VATS Group (GEVATS). Methods: we conducted a prospective multicentre cohort study that included patients receiving anatomical lung resections between 12/20/2016 and 03/20/2018. The main quality controls consisted of determining the recruitment rate of each centre and the accuracy of the perioperative data collected based on six key variables. The implications of a low recruitment rate were analysed for '90-day mortality' and 'Grade IIIb-V complications'. Results: the series was composed of 3533 cases (1917 VATS; 54.3%) across 33 departments. The centres' median recruitment rate was 99% (25-75th:76-100%), with an overall recruitment rate of 83% and a data accuracy of 98%. We were unable to demonstrate a significant association between the recruitment rate and the risk of morbidity/mortality, but a trend was found in the unadjusted analysis for those centres with recruitment rates lower than 80% (centres with 95-100% rates as reference): grade IIIb-V OR=0.61 (p=0.081), 90-day mortality OR=0.46 (p=0.051). Conclusions: more than half of the anatomical lung resections in Spain are performed via VATS. According to our results, the centre's recruitment rate and its potential implications due to selection bias, should deserve further attention by the main voluntary multicentre studies of our speciality. The high representativeness as well as the reliability of the GEVATS data constitute a fundamental point of departure for this nationwide cohort

Assessment of platelet REACtivity after transcatheter aortic valve replacement

OBJECTIVES: The REAC-TAVI (Assessment of platelet REACtivity after Transcatheter Aortic Valve Implantation) trial enrolled patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) pre-treated with aspirin + clopidogrel, aimed to compare the efficacy of clopidogrel and ticagrelor in suppressing high platelet reactivity (HPR) after TAVI. BACKGROUND: Current recommendations support short-term use of aspirin + clopidogrel for patients with severe AS undergoing TAVR despite the lack of compelling evidence. METHODS: This was a prospective, randomized, multicenter investigation. Platelet reactivity was measured at 6 different time points with the VerifyNow assay (Accriva Diagnostics, San Diego, California). HPR was defined as (P2Y12 reaction units (PRU) ≥208. Patients with HPR before TAVR were randomized to either aspirin + ticagrelor or aspirin + clopidogrel for 3 months. Patients without HPR continued with aspirin + clopidogrel (registry cohort). The primary endpoint was non-HPR status (PRU <208) in ≥70% of patients treated with ticagrelor at 90 days post-TAVR. RESULTS: A total of 68 patients were included. Of these, 48 (71%) had HPR (PRU 273 ± 09) and were randomized to aspirin + ticagrelor (n = 24, PRU 277 ± 08) or continued with aspirin + clopidogrel (n = 24, PRU 269 ± 49). The remaining 20 patients (29%) without HPR (PRU 133 ± 12) were included in the registry. Overall, platelet reactivity across all the study time points after TAVR was lower in patients randomized to ticagrelor compared with those treated with clopidogrel, including those enrolled in the registry (p < 0.001). The primary endpoint was achieved in 100% of patients with ticagrelor compared with 21% with clopidogrel (p < 0.001). Interestingly, 33% of clopidogrel responder patients at baseline developed HPR status during the first month after TAVR. CONCLUSIONS: HPR to clopidogrel is present in a considerable number of patients with AS undergoing TAVR. Ticagrelor achieves a better and faster effect, providing sustained suppression of HPR to these patients. (Platelet Reactivity After TAVI: A Multicenter Pilot Study [REAC-TAVI]; NCT02224066)

COMPUTACION APLICADA

GUIA DIDACTICA / PLANEACION DIDACTICA (NMS