A longitudinal retrospective study on intracranial arterial pulsatility index: its evolution in ten years' time and how it relates to the occurrence of cerebral and systemic ischemic disease

BACKGROUND AND AIMS: Intracranial arterial pulsatility index (PI) has been related to old age, hypertension, diabetes and small vessel disease. However, the cross- sectional design of most studies prevents a proper assessment of causality and evolution. We sought to explore how this index changes through time, which conditions affect this evolution and whether or not it can predict the occurrence of future ischemic events. METHODS: Between the years 2001-2006, 1288 patients underwent a transcranial Doppler evaluation in the Department of Neurology of the Hospital Universitario Central de Asturias. PI values for the middle cerebral and basilar arteries were systematically annotated. After exclusion of deceased patients and significant large artery stenoses, 89 patients were recruited for a re-evaluation in 2012. Afterwards, the sample was expanded up to 150 patients, with 61 randomly selected patients –either alive or deceased- who did not undergo a second exploration. Both groups had their clinical files reviewed, with special attention to vascular risk factors and brain or coronary ischemic events. RESULTS AND DISCUSSION: Our results pointed to the following conclusions: • Intracranial arterial PI works as a dynamic measure of both cerebral and systemic vascular disease. • Age is the main factor influencing PI value and variation, but, within a certain age group, PI is able to point subjects at higher long-term risk of future ischemic events. • Basilar artery PI seems to be a better predictor of future cerebral and coronary ischemic disease than middle cerebral artery PI

Viral Loads and Disease Severity in Children with Rhinovirus-Associated Illnesses

The role of rhinoviruses (RVs) in children with clinical syndromes not classically associated with RV infections is not well understood. We analyzed a cohort of children <= 21 years old who were PCR+ for RV at a large Pediatric Hospital from 2011 to 2013. Using univariate and multivariable logistic regression, we analyzed the associations between demographic, clinical characteristics, microbiology data, and clinical outcomes in children with compatible symptoms and incidental RV detection. Of the 2473 children (inpatients and outpatients) with an RV+ PCR, 2382 (96%) had compatible symptoms, and 91 (4%) did not. The overall median age was 14 months and 78% had underlying comorbidities. No differences in RV viral loads were found according to the presence of compatible symptoms, while in children with classic RV symptoms, RV viral loads were higher in single RV infections versus RV viral co-infections. Bacterial co-infections were more common in RV incidental detection (7.6%) than in children with compatible symptoms (1.9%, p < 0.001). The presence of compatible symptoms independently increased the odds ratio (OR, 95% CI) of hospitalization 4.8 (3.1-7.4), prolonged hospital stays 1.9 (1.1-3.1), need for oxygen 12 (5.8-25.0) and pediatric intensive care unit (PICU) admission 4.13 (2.0-8.2). Thus, despite comparable RV loads, disease severity was significantly worse in children with compatible symptoms

Climate change facilitated the early colonization of the Azores Archipelago during medieval times

Humans have made such dramatic and permanent changes to Earth's landscapes that much of it is now substantially and irreversibly altered from its preanthropogenic state. Remote islands, until recently isolated from humans, offer insights into how these landscapes evolved in response to human-induced perturbations. However, little is known about when and how remote systems were colonized because archaeological data and historical records are scarce and incomplete. Here, we use a multiproxy approach to reconstruct the initial colonization and subsequent environmental impacts on the Azores Archipelago. Our reconstructions provide unambiguous evidence for widespread human disturbance of this archipelago starting between 700 -60/+50 and 850 -60/+60 Common Era (CE), ca. 700 y earlier than historical records suggest the onset of Portuguese settlement of the islands. Settlement proceeded in three phases, during which human pressure on the terrestrial and aquatic ecosystems grew steadily (i.e., through livestock introductions, logging, and fire), resulting in irreversible changes. Our climate models suggest that the initial colonization at the end of the early Middle Ages (500 to 900 CE) occurred in conjunction with anomalous northeasterly winds and warmer Northern Hemisphere temperatures. These climate conditions likelyinhibited exploration from southern Europe and facilitated human settlers from the northeast Atlantic. These results are consistent with recent archaeological and genetic data suggesting that the Norse were most likely the earliest settlers on the islands

Isotemporal substitution of inactive time with physical activity and time in bed: Cross-sectional associations with cardiometabolic health in the PREDIMED-Plus study

© 2019 The Author(s). Background: This study explored the association between inactive time and measures of adiposity, clinical parameters, obesity, type 2 diabetes and metabolic syndrome components. It further examined the impact of reallocating inactive time to time in bed, light physical activity (LPA) or moderate-To-vigorous physical activity (MVPA) on cardio-metabolic risk factors, including measures of adiposity and body composition, biochemical parameters and blood pressure in older adults. Methods: This is a cross-sectional analysis of baseline data from 2189 Caucasian men and women (age 55-75 years, BMI 27-40 Kg/m2) from the PREDIMED-Plus study (http://www.predimedplus.com/). All participants had ≥3 components of the metabolic syndrome. Inactive time, physical activity and time in bed were objectively determined using triaxial accelerometers GENEActiv during 7 days (ActivInsights Ltd., Kimbolton, United Kingdom). Multiple adjusted linear and logistic regression models were used. Isotemporal substitution regression modelling was performed to assess the relationship of replacing the amount of time spent in one activity for another, on each outcome, including measures of adiposity and body composition, biochemical parameters and blood pressure in older adults. Results: Inactive time was associated with indicators of obesity and the metabolic syndrome. Reallocating 30 min per day of inactive time to 30 min per day of time in bed was associated with lower BMI, waist circumference and glycated hemoglobin (HbA1c) (all p-values < 0.05). Reallocating 30 min per day of inactive time with 30 min per day of LPA or MVPA was associated with lower BMI, waist circumference, total fat, visceral adipose tissue, HbA1c, glucose, triglycerides, and higher body muscle mass and HDL cholesterol (all p-values < 0.05). Conclusions: Inactive time was associated with a poor cardio-metabolic profile. Isotemporal substitution of inactive time with MVPA and LPA or time in bed could have beneficial impact on cardio-metabolic health. Trial registration: The trial was registered at the International Standard Randomized Controlled Trial (ISRCTN: http://www.isrctn.com/ISRCTN89898870) with number 89898870 and registration date of 24 July 2014, retrospectively registered

Challenges of adapting English médium instruction into the Spanish university curricula and some novel solutions

The integration of the Spanish university system in the European Higher Education Area (EHEA) demands a series of concrete proposals. As we advance in the implementation of the process of Bologna, it is necessary to contemplate a new paradigm of teaching/learning. Central to this new paradigm is the adaptation of the curricula into the English language medium (EMI). Among many strategies for internationalization of the Universidad Politécnica de Madrid (UPM) under adoption, this university has funded a project TechEnglish intends to facilitate the conversion of subjects and eventually degree programs into the delivery in the English Language. This paper details a work in progress and describes the collaboration between content teachers and applied linguistics. The three collaborative actions are currently underway: observation of classes by applied linguists, seminar delivery on topics requested by the content teachers, and materials development with the help of teaching assistants. We are convinced that this collaboration is the necessary ingredient to promote teaching and learning through English at our university

Stroke genetics informs drug discovery and risk prediction across ancestries

Previous genome-wide association studies (GWASs) of stroke - the second leading cause of death worldwide - were conducted predominantly in populations of European ancestry(1,2). Here, in cross-ancestry GWAS meta-analyses of 110,182 patients who have had a stroke (five ancestries, 33% non-European) and 1,503,898 control individuals, we identify association signals for stroke and its subtypes at 89 (61 new) independent loci: 60 in primary inverse-variance-weighted analyses and 29 in secondary meta-regression and multitrait analyses. On the basis of internal cross-ancestry validation and an independent follow-up in 89,084 additional cases of stroke (30% non-European) and 1,013,843 control individuals, 87% of the primary stroke risk loci and 60% of the secondary stroke risk loci were replicated (P < 0.05). Effect sizes were highly correlated across ancestries. Cross-ancestry fine-mapping, in silico mutagenesis analysis(3), and transcriptome-wide and proteome-wide association analyses revealed putative causal genes (such as SH3PXD2A and FURIN) and variants (such as at GRK5 and NOS3). Using a three-pronged approach(4), we provide genetic evidence for putative drug effects, highlighting F11, KLKB1, PROC, GP1BA, LAMC2 and VCAM1 as possible targets, with drugs already under investigation for stroke for F11 and PROC. A polygenic score integrating cross-ancestry and ancestry-specific stroke GWASs with vascular-risk factor GWASs (integrative polygenic scores) strongly predicted ischaemic stroke in populations of European, East Asian and African ancestry(5). Stroke genetic risk scores were predictive of ischaemic stroke independent of clinical risk factors in 52,600 clinical-trial participants with cardiometabolic disease. Our results provide insights to inform biology, reveal potential drug targets and derive genetic risk prediction tools across ancestries.</p

Stroke genetics informs drug discovery and risk prediction across ancestries

Previous genome-wide association studies (GWASs) of stroke — the second leading cause of death worldwide — were conducted predominantly in populations of European ancestry1,2. Here, in cross-ancestry GWAS meta-analyses of 110,182 patients who have had a stroke (five ancestries, 33% non-European) and 1,503,898 control individuals, we identify association signals for stroke and its subtypes at 89 (61 new) independent loci: 60 in primary inverse-variance-weighted analyses and 29 in secondary meta-regression and multitrait analyses. On the basis of internal cross-ancestry validation and an independent follow-up in 89,084 additional cases of stroke (30% non-European) and 1,013,843 control individuals, 87% of the primary stroke risk loci and 60% of the secondary stroke risk loci were replicated (P < 0.05). Effect sizes were highly correlated across ancestries. Cross-ancestry fine-mapping, in silico mutagenesis analysis3, and transcriptome-wide and proteome-wide association analyses revealed putative causal genes (such as SH3PXD2A and FURIN) and variants (such as at GRK5 and NOS3). Using a three-pronged approach4, we provide genetic evidence for putative drug effects, highlighting F11, KLKB1, PROC, GP1BA, LAMC2 and VCAM1 as possible targets, with drugs already under investigation for stroke for F11 and PROC. A polygenic score integrating cross-ancestry and ancestry-specific stroke GWASs with vascular-risk factor GWASs (integrative polygenic scores) strongly predicted ischaemic stroke in populations of European, East Asian and African ancestry5. Stroke genetic risk scores were predictive of ischaemic stroke independent of clinical risk factors in 52,600 clinical-trial participants with cardiometabolic disease. Our results provide insights to inform biology, reveal potential drug targets and derive genetic risk prediction tools across ancestries

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Estudio integral del estado de conservación de la cueva de Altamira y su arte paleolítico (2007 - 2009). Perspectivas futuras de conservación

397 Páginas.-- Museo Nacional y Centro de Investigación de AltamiraEl planteamiento del presente estudio partió de las conclusiones obtenidas en el anteriorproyecto de investigación (2003-2005). En él se determinó que los problemas para la con-servación de la cueva y su arte estaban directamente relacionados con la perturbaciónmicroambiental provocada por las actividades antrópicas en su interior y su exterior inme-diato. Dichas perturbaciones se debían, en gran medida, al intercambio directo de materiay energía con la atmósfera externa por la puerta de acceso y se traducían en un grave pro-blema para la conservación: el desarrollo y proliferación de colonias de microorganismoshacia el interior de la cavidad.Tras ese estudio se realizaron una serie de recomendaciones enfocadas, por una parte, adisminuir esos procesos de intercambio, mediante la modificación de los cierres de la cavi-dad y, por otra, a la disminución de la llegada de elementos nutrientes a la cueva desde elexterior.Las investigaciones desarrolladas entre 2007 y 2009 se han centrado en evaluar la eficaciade las medidas correctoras propuestas y analizar los cambios microambientales que conlle-van los nuevos cierres de la cueva, así como el mantenimiento de la cobertera vegetal exter-na propuesto en su momento. El objetivo era determinar como influyen esos cambios micro-ambientales en la colonización microbiológica de las paredes y techos de la cueva. Para ello ha sido necesario llevar a cabo una caracterización del ecosistema-cavidad bajo susactuales condiciones físicoquímicas (microcilima e hidroquímica) con un análisis de detallede la diversidad y la actividad microbiana existente. El objetivo científico concreto ha sidodeterminar las condiciones ambientales que favorecen o dificultan la presencia y prolifera-ción microbiana y el origen y el tipo de nutrientes necesarios y/o útiles para los microorga-nismos presentes en la cueva. Los trabajos de investigación necesarios para lograr esos resultados se planearon con ante-rioridad estructurándose el estudio en cuatro aspectos fundamentales:•Cobertera edáfica exterior, geología y geomorfología.•Hidrogeoquímica •Microclima •Estudio y control microbiológico. A continuación se muestra un resumen de los principales resultados obtenidos en cada casoy de las implicaciones que dichos resultados pueden tener en la conservación del medio sub-terráneo y del patrimonio que alberga.Convenio específico de colaboración entre la Dirección General de Bellas Artes y Bienes Culturales (Ministerio de Educación, Cultura y Deporte) y el Consejo Superior de Investigaciones Científicas (Ministerio de Ciencia e Innovación).Peer reviewe

Impact of PLA/Mg films degradation on surface physical properties and biofilm survival

New biocompatible and bioabsorbable materials are currently being developed for bone regeneration. These serve as scaffolding for controlled drug release and prevent bacterial infections. Films of polylactic acid (PLA) polymers that are Mg-reinforced have demonstrated they have suitable properties and bioactive behavior for promoting the osseointegration process. However little attention has been paid to studying whether the degradation process can alter the adhesive physical properties of the biodegradable film and whether this can modify the biofilm formation capacity of pathogens. Moreover, considering that the concentration of Mg and other corrosion products may not be constant during the degradation process, the question that arises is whether these changes can have negative consequences in terms of the bacterial colonization of surfaces. Bacteria are able to react differently to the same compound, depending on its concentration in the medium and can even become stronger when threatened. In this context, physical surface parameters such as hydrophobicity, surface tension and zeta potential of PLA films reinforced with 10% Mg have been determined before and after degradation, as well as the biofilm formation capacity of Staphylococcus epidermidis. The addition of Mg to the films makes them less hydrophobic and the degradation also reduces the hydrophobicity and increases the negative charge of the surface, especially over long periods of time. Early biofilm formation at 8 h is consistent with the physical properties of the films, where we can observe a reduction in the bacterial biofilm formation. However, after 24 h of incubation, the biofilm formation increases significantly on the PLA/Mg films with respect to PLA control. The explosive release of Mg ions and other corrosion products within the first hours were not enough to prevent a greater biofilm formation after this initial time. Consequently, the Mg addition to the polymer matrix had a bacteriostatic effect but not a bactericidal one. Future works should aim to optimize the design and biofunctionality of these promising bioabsorbable composites for a degradation period suitable for the intended application.The authors gratefully acknowledge financial support from “Ministerio de Economía y Competitividad” (PCIN-2016-146, MAT2015-63974-C4-3-R, MAT2015-63974-C4-4-R, MAT2016-79869-C2-1-P, RTI2018-096862-B-I00 (AEI/FEDER;UE)) and “Junta de Extremadura-FEDER: European Regional Development Fund” (IB16117, IB16154, GR15089, GR15025, GR18153 and GR18096). Dr. María Carbajo Sánchez is also thanked for providing valuable technical assistance with SEM in the “Servicio de análisis y caracterización de sólidos y superficies (SACSS)” within the University of Extremadura