Herramienta Autor para la Gestión de Tests Informatizados dentro del Sistema AHA!

En este artículo presentamos Test Editor, una herramienta autor para la construcción de test informatizados, tanto clásicos como adaptativos, a través del Web. Esta herramienta facilita el desarrollo y mantenimiento de diferentes tipos de test de tipo multi-opción o multi-respuesta, con el objetivo de poder utilizarlos dentro de sistemas educativos basados en web. Test editor es una herramienta modular que permite configurar varios parámetros sobre las preguntas o ítems y los tests. También proporciona información estadística sobre la utilización de los tests, que puede ser utilizada para el mantenimiento de los tests. Esta herramienta se ha integrado dentro del sistema AHA!, pero se puede utilizar también dentro de otros sistemas basados en web. Para probar el funcionamiento de la herramienta se ha utilizado en la creación de un test adaptativo para evaluar a dos grupos de alumnos de un mismo curso de extensión universitaria sobre programación en el lenguaje Java.In this paper we describe Test Editor, an authoring tool for building adaptive and classic webbased tests. This tool facilitates the development and maintenance of different types of multiple-choice tests for use in web-based education systems. Test Editor is a modular tool, which lets you configure several parameters about questions or items and tests. It also provides statistical information about tests usage that can be used in tests maintenance. We have integrated the Test Editor with the AHA! system, but it can be used in other web-based systems as well. In order to test the performance of the tool, we have used it to create an adaptive test to evaluate two groups of students of the same university extension course about Java language

Bone marrow lesions and magnetic resonanceImaging–detected structural abnormalities in patients with midfoot pain and osteoarthritis: A cross-sectional study

To compare magnetic resonance imaging (MRI)–detected structural abnormalities in patients withsymptomatic midfoot osteoarthritis (OA), patients with persistent midfoot pain, and asymptomatic controls, and toexplore the association between MRI features, pain, and foot-related disability. One hundred seven adults consisting of 50 patients with symptomatic and radiographically confirmedmidfoot OA, 22 adults with persistent midfoot pain but absence of radiographic OA, and 35 asymptomatic adultsunderwent 3T MRI of the midfoot and clinical assessment. MRIs were read for the presence and severity of abnormal-ities (bone marrow lesions [BMLs], subchondral cysts, osteophytes, joint space narrowing [JSN], effusion-synovitis,tenosynovitis, and enthesopathy) using the Foot Osteoarthritis MRI Score. Pain and foot-related disability wereassessed with the Manchester Foot Pain and Disability Index. The severity sum score of BMLs in the midfoot was greater in patients with midfoot pain and no signs ofOA on radiography compared to controls (P= 0.007), with a pattern of involvement in the cuneiform–metatarsal jointssimilar to that in patients with midfoot OA. In univariable models, BMLs (ρ= 0.307), JSN (ρ= 0.423), and subchondralcysts (ρ= 0.302) were positively associated with pain (P< 0.01). In multivariable models, MRI abnormalities were notassociated with pain and disability when adjusted for covariates. In individuals with persistent midfoot pain but no signs of OA on radiography, MRIfindings suggestedan underrecognized prevalence of OA, particularly in the second and third cuneiform–metatarsal joints, where BMLpatterns were consistent with previously recognized sites of elevated mechanical loading. Joint abnormalities werenot strongly associated with pain or foot-related disability

Detection of partial-thickness supraspinatus tendon tears: is a single direct MR arthrography series in ABER position as accurate as conventional MR arthrography?

The purpose of this study was to retrospectively evaluate sensitivity and specificity of a single magnetic resonance (MR) arthrography series in abduction external rotation (ABER) position compared with conventional MR arthrography for detection of supraspinatus tendon tears, with arthroscopy as gold standard, and to assess interobserver variability. Institutional review board approval was obtained; informed consent was waived. MR arthrograms of 250 patients (170 men and 80 women; mean age, 36 years) were retrospectively and independently evaluated by three observers. Oblique coronal T1-weighted fat-suppressed images, proton density, and T2-weighted images and axial T1-weighted images and oblique sagittal T1-weighted fat-suppressed images were analyzed to detect supraspinatus tendon tears. Separately, a single T1-weighted fat-suppressed oblique axial series in ABER position was evaluated. Both protocols were scored randomly without knowledge of patients' clinical history and arthroscopy results. Tears were subclassified, based on articular surface integrity and extension (Lee classification). Interobserver agreement was assessed by kappa statistics for all patients. Ninety-two of 250 patients underwent arthroscopy; sensitivity and specificity of ABER and conventional MR arthrography were calculated and compared using paired McNemar test. Weighted kappa values of ABER and conventional MR arthrography were 0.48-0.65 and 0.60-0.67, respectively. According to arthroscopy, 69 of 92 patients had an intact cuff, and 23 patients had a cuff tear (16 partial thickness and seven full thickness). There were no statistically significant differences between ABER and conventional MR arthrography regarding sensitivity (48-61% and 52-70%, respectively) and specificity (80-94% and 91-95%). Sensitivity and specificity of a single T1-weighted series in ABER position and conventional MR arthrography are comparable for assessment of rotator cuff tear

Epidemiological trends of HIV/HCV coinfection in Spain, 2015-2019

Altres ajuts: Spanish AIDS Research Network; European Funding for Regional Development (FEDER).Objectives: We assessed the prevalence of anti-hepatitis C virus (HCV) antibodies and active HCV infection (HCV-RNA-positive) in people living with HIV (PLWH) in Spain in 2019 and compared the results with those of four similar studies performed during 2015-2018. Methods: The study was performed in 41 centres. Sample size was estimated for an accuracy of 1%. Patients were selected by random sampling with proportional allocation. Results: The reference population comprised 41 973 PLWH, and the sample size was 1325. HCV serostatus was known in 1316 PLWH (99.3%), of whom 376 (28.6%) were HCV antibody (Ab)-positive (78.7% were prior injection drug users); 29 were HCV-RNA-positive (2.2%). Of the 29 HCV-RNA-positive PLWH, infection was chronic in 24, it was acute/recent in one, and it was of unknown duration in four. Cirrhosis was present in 71 (5.4%) PLWH overall, three (10.3%) HCV-RNA-positive patients and 68 (23.4%) of those who cleared HCV after anti-HCV therapy (p = 0.04). The prevalence of anti-HCV antibodies decreased steadily from 37.7% in 2015 to 28.6% in 2019 (p < 0.001); the prevalence of active HCV infection decreased from 22.1% in 2015 to 2.2% in 2019 (p < 0.001). Uptake of anti-HCV treatment increased from 53.9% in 2015 to 95.0% in 2019 (p < 0.001). Conclusions: In Spain, the prevalence of active HCV infection among PLWH at the end of 2019 was 2.2%, i.e. 90.0% lower than in 2015. Increased exposure to DAAs was probably the main reason for this sharp reduction. Despite the high coverage of treatment with direct-acting antiviral agents, HCV-related cirrhosis remains significant in this population

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1.

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Angiotomografía computerizada, colgajos de perforante, cirujano y OsiriX Computed tomography angiography, perforator flaps, surgeon and OsiriX

Desde la introducción de la transferencia cutánea basada en perforantes, la angiotomografía computerizada ha emergido como una técnica de gran valor en la planificación preoperatoria de los colgajos de perforante. Sin embargo, parece probable que el aprovechamiento de la técnica sea menor del deseable. Evaluamos, a través de la experiencia en 144 pacientes, la utilidad del visor gratuito de imágenes DICOM OsiriX para Mac en la planificación preoperatoria de los colgajos de perforante con tres objetivos: 1) ampliar los conocimientos actuales relacionados con la aplicación de la angiotomografía computerizada en la planificación preoperatoria de los colgajos de perforante, 2) evaluar la aplicación OsiriX en el post-procesamiento de imágenes en la planificación preoperatoria de colgajos de perforante y 3) evaluar el rendimiento obtenible de la angiotomografía considerando que el postprocesamiento es realizado por un cirujano (no especialista en Radiodiagnóstico). La experiencia permite afirmar que el postprocesamiento de las imágenes DICOM por el cirujano con la aplicación Osirix permite habitualmente evaluar de manera adecuada diversas estructuras y parámetros de gran interés en la cirugía de colgajos de perforante: 1) arteria principal, origen de la perforante, 2) diámetro de arteria y vena/s en el hipotético sitio de anastomosis microquirúrgica, 3) recorrido y patrón de ramificación del pedículo del colgajo, 4) disposición de la perforante en la grasa subcutánea (teórico eje de diseño del colgajo), 5) medición del grosor cutáneo en el punto de perforación de la fascia profunda por la rama perforante (teórico grosor de colgajo), 6) medición de la distancia entre el punto de perforación de la fascia profunda por la rama perforante y el origen de la arteria principal (teórica longitud máxima posible de pedículo) y 7) medición del diámetro, en el punto de perforación de la fascia profunda, de la perforante. En consecuencia, parece aconsejable que el cirujano plástico relacionado con los colgajos de perforante se involucre decididamente en el postprocesamiento de las imágenes de angiotomografía computerizada. El visor de imágenes DICOM gratuito OsiriX es una alternativa eficiente, comparable a aplicaciones más profesionales sólo disponibles en servicios de Radiología.<br>With the advent of perforator-based skin transfer, computed tomography angiography has emerged as an invaluable tool in the preoperative planning of perforator flaps. But most likely, the exploitation of the technique is less than desirable. Through our experience with 144 patients, we evaluate the use of the free DICOM viewer OsiriX for Mac in the preoperative planning of perforator flaps with three objectives: 1) increase the present knowledge related with the preoperative planning of perforator flaps with computed tomography angiography, 2) evaluate the OsiriX application in the image post-processing of perforator flaps and 3) evaluate the performance of the procedure when performed by a surgeon (not specialized in Radiology). The experience has shown that the image post-processing performed by the surgeon with the OsiriX application usually allows an adequate evaluation of different structures and parameters of great preoperative interest in perforator flap surgery: 1) source artery, 2) diameter of artery and vein/s at the hypothetical site of microsurgical anastomoses, 3) course and branching pattern of the flap pedicle, 4) perforator course in the subcutaneous fat (theoretical flap axis), 5) measurement of the skin and fat where the perforator pierces the deep fascia (theoretical flap thickness ), 6) measurement of the distance between the point of entrance of the perforator in the subcutaneous fat to the source artery (theoretical maximal pedicle length) and 7) measurement of the perforator diameter where it pierces the deep fascia. Ultimately, in the authors' opinion, those plastic surgeons involved in perforator flap surgery would largely benefit from incorporating the image post-processing into their routine practice. The free DICOM viewer OsiriX is an efficient alternative, comparable to the more professional software only available in Radiology services