L’argomentazione delle decisioni della Cassazione: tra autorevolezza del precedente ed esigenze di semplificazione.

La relazione mira ad approfondire il ruolo dell'argomentazione nel ragionamento dei giudici della Corte di Cassazione italiana e processo decisionale, indicando la funzione del vincolo dello stare decisis (precedente) in un sistema di civil law, quale quello italiano, e tenendo conto del carico di ricorsi che ogni anno la Corte deve gestire

Finding Respondents from Minority Groups

The recruitment of respondents belonging to ethnic minorities poses important challenges in social and health research. This paper reflects on the enablers and barriers to recruitment that we encountered in our research work with persons belonging to ethnic minorities. Additionally, we applied the Matching Model of Recruitment, a theoretical framework concerning minority recruitment, to guide our reflection. We also explored its applicability as a research design tool. In assessing our research experience, we learned that minority recruitment in social and health research is influenced by the social context of all key players involved in the research. Also, there are enablers and barriers within that social context facilitating or delaying the recruitment process. The main enablers to recruit respondents belonging to ethnic minorities include working with community agencies and gatekeepers who share a common vision with researchers and the latter’s ability to gain the trust of potential respondents. The main barriers include demanding too much from these same community agencies and gatekeepers and ignoring factors that could delay the completion of the research. Although we found the Matching Model of Recruitment to be an effective tool in assessing the processes of recruiting respondents belonging to ethnic minorities, further empirical research is needed to explore its usefulness during the research planning phase

National survey of the rat hepatitis E virus in rodents in Spain, 2022 to 2023

BackgroundRat hepatitis E virus (ratHEV) is an emerging virus causing acute and chronic hepatitis in humans. Rats are the main natural reservoir of this pathogen. Large-scale studies assessing ratHEV circulation in rodents in Spain are lacking.AimWe aimed to determine the prevalence of ratHEV in rats in Spain and evaluate potential transmission risk to humans.MethodsWe designed a cross-sectional nationwide study where black (Rattus rattus) and Norway (R. norvegicus) rats were collected and analysed between 2022 and 2023 for ratHEV infection using real-time (RT)-qPCR testing of liver tissue. Sequencing and analysis of ratHEV shedding in faeces were carried out in positive animals.ResultsRatHEV was detected in 125 of the 481 rats analysed, supposing a prevalence of 26.0% (95 CI%: 22.3-30.1). Positive rats were found in urban (25.6%), and farm (29.8%) settings. Black rats (31.3%) had 1.5 times higher odds of being infected by the virus than Norway rats (22.5%) (p = 0.049). Significantly higher prevalence of ratHEV was detected in rodents sampled from southern (31.9%) than northern (17.8%) Spain (p = 0.003). Viral RNA was detected in faeces from 45.5% of infected rats. Phylogenetic analysis evidenced a wide genetic diversity of ratHEV sequences, some showing high homology with ratHEV strains found in patients from Spain.ConclusionsCirculation of ratHEV appears to be heterogeneous and the virus appears to be endemic among rat populations in Spain, highlighting the possible risk of zoonotic transmission of this emerging virus in this country.This work was supported by the Andalusian General Secretariat for Research, Development, and Innovation in Health (PI-0287-2019), the Spanish Ministry of Health (RD12/0017/0012), co-financed by European Regional Development Fund (ERDF), and the Carlos III Health Institute (Research Project grant numbers: PI21/00793 and PI22/01098). Projects “PI21/00793” and “PI22/01098” were funded by Carlos III Health Institute (ISCIII) and co-funded by the European Union. LRM is the recipient of a “INVESTIGO” research programme grant funded by the European Union NextGenerationEU Plan. MCJ is the recipient of a PFIS predoctoral grant (FI22/00180) from the Carlos III Health Institute and co-funded by the European Union. ARJ is supported by a contract from the Spanish Junta de Andalucía (Nicolas Monardes programme: C1-0001-2023). JCG is supported by the CIBERINFEC (CB21/13/00 083), Carlos III Health Institute, Spanish Ministry of Science, and NextGenerationEU. RM was supported by a postdoctoral contract (POSTDOC_21_00041) at the University of Córdoba (ROR code 05yc77b46) from the Consejería de Transformación Económica, Industria, Conocimiento y Universidades of the Junta de Andalucía (ROR code 01jem9c82) Regional Government (Andalucía, Spain). MG was supported by a postdoctoral contract Margarita Salas (University of Murcia) from the Programme of Requalification of the Spanish University System (Spanish Ministry of Universities) financed by the European Union-NextGenerationEU

Delineation of intracavitary electrograms for the automatic quantification of decrement-evoked potentials in the coronary sinus with deep-learning techniques

Cardiac arrhythmias cause depolarization waves to conduct unevenly on the myocardial surface, potentially delaying local components with respect to a previous beat when stimulated at faster frequencies. Despite the diagnostic value of localizing the distinct local electrocardiogram (EGM) components for identifying regions with decrement-evoked potentials (DEEPs), current software solutions do not perform automatic signal quantification. Electrophysiologists must manually measure distances on the EGM signals to assess the existence of DEEPs during pacing or extra-stimuli protocols. In this work, we present a deep learning (DL)-based algorithm to identify decrement in atrial components (measured in the coronary sinus) with respect to their ventricular counterparts from EGM signals, for disambiguating between accessory pathways (APs) and atrioventricular re-entrant tachycardias (AVRTs). Several U-Net and W-Net neural networks with different configurations were trained on a private dataset of signals from the coronary sinus (312 EGM recordings from 77 patients who underwent AP or AVRT ablation). A second, separate dataset was annotated for clinical validation, with clinical labels associated to EGM fragments in which decremental conduction was elucidated. To alleviate data scarcity, a synthetic data augmentation method was developed for generating EGM recordings. Moreover, two novel loss functions were developed to minimize false negatives and delineation errors. Finally, the addition of self-attention mechanisms and their effect on model performance was explored. The best performing model was a W-Net model with 6 levels, optimized solely with the Dice loss. The model obtained precisions of 91.28%, 77.78% and of 100.0%, and recalls of 94.86%, 95.25% and 100.0% for localizing local field, far field activations, and extra-stimuli, respectively. The clinical validation model demonstrated good overall agreement with respect to the evaluation of decremental properties. When compared to the criteria of electrophysiologists, the automatic exclusion step reached a sensitivity of 87.06% and a specificity of 97.03%. Out of the non-excluded signals, a sensitivity of 96.77% and a specificity of 95.24% was obtained for classifying them into decremental and non-decremental potentials. Current results show great promise while being, to the best of our knowledge, the first tool in the literature allowing the delineation of all local components present in an EGM recording. This is of capital importance at advancing processing for cardiac electrophysiological procedures and reducing intervention times, as many diagnosis procedures are performed by comparing segments or late potentials in subsequent cardiac cycles

Association of a serotonin transporter gene (SLC6A4) 5-HTTLPR polymorphism with body mass index categories but not type 2 diabetes mellitus in Mexicans

The serotonergic system has been hypothesized to contribute to the biological susceptibility to type 2 diabetes mellitus (T2DM) and body-mass index (BMI) categories. We investigate a possible association of 5-HTTLPR polymorphism (L and S alleles) in the promoter region of the serotonin transporter gene (SLC6A4) with the development of T2DM and/or higher BMI by analyzing a sample of 138 individuals diagnosed with T2DM and 172 unrelated controls from the Mexican general population. In the total sample genotypes were distributed according to Hardy-Weinberg equilibrium, and S allele frequency was 0.58. There was no statistical association between 5-HTTLPR polymorphism and the development of T2DM in this Mexican population sample (p = 0.12). Nevertheless, logistic regression analysis of the L allele and increased BMI disclosed an association, after adjusting for age, sex and T2DM (p = 0.02, OR 1.74, 95% CI: 1.079–2.808)

Ophthalmology

OBJECTIVE: In the current study we aimed to identify metabolites associated with age-related macular degeneration (AMD) by performing the largest metabolome association analysis in AMD to date. In addition, we aimed to determine the effect of AMD-associated genetic variants on metabolite levels, and aimed to investigate associations between the identified metabolites and activity of the complement system, one of the main AMD-associated disease pathways. DESIGN: Case-control assocation analysis of metabolomics data. SUBJECTS: 2,267 AMD cases and 4,266 controls from five European cohorts. METHODS: Metabolomics was performed using a high-throughput H-NMR metabolomics platform, which allows the quantification of 146 metabolite measurements and 79 derivative values. Metabolome-AMD associations were studied using univariate logistic regression analyses. The effect of 52 AMD-associated genetic variants on the identified metabolites was investigated using linear regression. In addition, associations between the identified metabolites and activity of the complement pathway (defined by the C3d/C3 ratio) were investigated using linear regression. MAIN OUTCOME MEASURES: Metabolites associated with AMD RESULTS: We identified 60 metabolites that were significantly associated with AMD, including increased levels of large and extra-large HDL subclasses and decreased levels of VLDL, amino acids and citrate. Out of 52 AMD-associated genetic variants, seven variants were significantly associated with 34 of the identified metabolites. The strongest associations were identified for genetic variants located in or near genes involved in lipid metabolism (ABCA1, CETP, APOE, LIPC) with metabolites belonging to the large and extra-large HDL subclasses. In addition, 57 out of 60 metabolites were significantly associated with complement activation levels, and these associations were independent of AMD status. Increased large and extra-large HDL levels and decreased VLDL and amino acid levels were associated with increased complement activation. CONCLUSIONS: Lipoprotein levels were associated with AMD-associated genetic variants, while decreased essential amino acids may point to nutritional deficiencies in AMD. We observed strong associations between the vast majority of the AMD-associated metabolites and systemic complement activation levels, independent of AMD status. This may indicate biological interactions between the main AMD disease pathways, and suggests that multiple pathways may need to be targeted simultaneously for successful treatment of AMD

Farmacovigilancia: ¿y si notificamos?

Introducción: Farmacovigilancia es la actividad de salud pública que tiene como objetivo la identificación, cuantificación, evaluación y prevención de los riesgos del uso de los medicamentos una vez comercializados, permitiendo así el seguimiento de los posibles efectos adversos. Según las últimas estadísticas del Centro Andaluz de Farmacovigilancia las notificaciones por farmacéuticos solo suponen el 9 % de las realizadas por los profesionales sanitarios. A la vista de estos datos se propuso un estudio para conocer los motivos de la falta de notificación y resolver los posibles problemas. Método: Se elaboró un cuestionario ad hoc, que se envió a todos los farmacéuticos de la provincia de Huelva. Resultados: Participaron 66 farmacéuticos. El 91 % conoce la tarjeta amarilla, dispone de ella el 45 %, conoce la vía web el 34 %, ha notificado alguna vez 34 % (7 % lo hace siempre que se encuentra una reacción adversa). El 60 % no ha notificado nunca y un 15 % piensa que no es obligatorio. Los motivos por los que no se notifica son falta de información 44 %, falta de formación 41 %, falta de tiempo 36 % y no disponer de tarjeta amarilla 29 %. Los titulares demandan una mayor información y formación. Los adjuntos ven la falta de tiempo como principal motivo de la no notificación. Discusión: Ante la poca notificación por los farmacéuticos y la importancia de este tema, se propone una campaña de concienciación entre los farmacéuticos de Huelva para mejorar estos resultados. Para ello se enviará a todos los colegiados un díptico formativo con la finalidad de resolver los principales inconvenientes de la notificación