Milloria de l'aplicabilitat i la fiabilitat diagnòstica de l'elastografia per avaluar la rigidesa hepàtica en les malalties hepàtiques cròniques

L'elastografia de transició (ET) és un mètode no invasiu per avaluar la fibrosi hepàtica. El major problema és la baixa aplicabilitat (20% de resultats inadequats), relacionats amb obesitat del pacient i baixa experiència de l'explorador. En aquest estudi es planteja augmentar aplicabilitat i fiabilitat diagnòstica. L'estudi va incloure 868 registres. Amb una segona avaluació per personal experimentat i una tercera amb material específic es van obtenir registres adequats en la majoria dels prèviament inadequats. La fiabilitat diagnòstica va augmentar a la segona i tercera exploracions. Conclusió: La revaluació dels registres inadequats permet augmentar aplicabilitat i fiabilitat diagnòstica de la tècnica

Earliest evidence of pollution by heavy metals in archaeological sites

Homo species were exposed to a new biogeochemical environment when they began to occupy caves. Here we report the first evidence of palaeopollution through geochemical analyses of heavy metals in four renowned archaeological caves of the Iberian Peninsula spanning the last million years of human evolution. Heavy metal contents reached high values due to natural (guano deposition) and anthropogenic factors (e.g. combustion) in restricted cave environments. The earliest anthropogenic pollution evidence is related to Neanderthal hearths from Gorham's Cave (Gibraltar), being one of the first milestones in the so-called "Anthropocene". According to its heavy metal concentration, these sediments meet the present-day standards of "contaminated soil". Together with the former, the Gibraltar Vanguard Cave, shows Zn and Cu pollution ubiquitous across highly anthropic levels pointing to these elements as potential proxies for human activities. Pb concentrations in Magdalenian and Bronze age levels at El Pirulejo site can be similarly interpreted. Despite these high pollution levels, the contaminated soils might not have posed a major threat to Homo populations. Altogether, the data presented here indicate a long-term exposure of Homo to these elements, via fires, fumes and their ashes, which could have played certain role in environmental-pollution tolerance, a hitherto neglected influence.Francisco J. Jiménez Palacios and to the Analytical Chemistry Department (Sevilla University) are gratefully acknowledged for their help in the use of Carbolite electric oven. A.G.-A. was supported by a Marie Curie Intra-European Fellowship of the 7th Framework Programme for Research, Technological Development and Demonstration (European Commission). R.B. is a Beatriu de Pinós-A post-doctoral fellowship recipient (Generalitat de Catalunya and COFUND Marie Curie Actions, EU-FP7). This work also was partially financed by projects 19434/PI/14 Fundación Séneca, HARP2013-44269P, , CGL2012-38434-C03-03 and CGL2012-38358 Ministerio de Economía y Competitividad, 2014 SGR 900 and 2014/100573 Generalitat de Catalunya-AGAUR, RNM 432 Research Group 179 (Junta de Andalucia) and MEXT-Japan

A multi-proxy approach to the palaecological reconstruction of the Orce Basin Archaeological Zone (Granada, Spain)

Comunicación oral presentada en XXI INQUA Congress. July 14th – 20th 2023, Rome (Italy)The Orce Basin Archaeological Zone (OZAB, Granada, Spain) extends over a surface area of some > 8.5 km2 and constitutes one of the richest Pleistocene vertebrate fossil records in western Europe including one of the oldest hominin presence in this part of Eurasia. Exceptionally rich collections of stone tools have been excavated from both of the Orce Oldowan sites: Barranco León (BL) (1.4 Ma) and Fuente Nueva 3 (FN3) (1.2 Ma), while BL has yielded a hominin deciduous lower molar. We present a multi-proxy approach to determine the palaeoeocological context of these first hominin settlements in Western Europe. By combining results from macrovertebrates, microvertebrates, as well as from pollen and stable isotopes from macrovertebrate tooth enamel, we determine whether the palaeo landscapes were dominated by savanna or open woodland. The results reveal the regional specificities of the OAZB, and also allow us to infer local features within the Orce sites. Overall, our data reveal the dominance of a typically Mediterranean climate and landscape since 1.8 Ma ago. The climatic conditions were generally more humid than at present, with warmer temperatures during the coldest months, indicating a higher net primary productivity (NPP). We find that precipitation and NPP appear to have been limiting factors for hominin presence in the OAZB. Thus, at the older palaeontological site of Venta Micena (1.6 Ma), climatic conditions appear to have been less compatible with hominin presence than during the BL and FN3 sequences, when early hominins inhabiting the OAZB were able to cope with changing climatic and environmental settings. Lastly, the comparison of the isotopic results of the Orce sites with those of the contemporaneous Shungura Formation (Ethiopia) reveals that the habitat in the westernmost part of Eurasia was distinctly unlike a typical African savanna

Not seen before. Unveiling depositional context and Mammuthus meridionalis exploitation at Fuente Nueva 3 (Orce, southern Iberia) through taphonomy and microstratigraphy

Meat consumption by early hominins is a hotly debated issue. A key question concerns their access to large mammal carcasses, including megafauna. Currently, the evidence of anthropic cut marks on proboscidean bones older than -or close to- 1.0 Ma are restricted to the archaeological sites of Dmanisi (Georgia), Olduvai (Tanzania), Gona (Ethiopia), Olorgesailie (Kenya) and La Boella (Spain). During an inspection of the almost complete carcass of Mammuthus meridionalis (FN3-5-MPS) from the Oldowan site of Fuente Nueva 3 (Orce, Spain, c. 1.2 Ma), a few traces compatible with human-made cut marks and carnivore tooth marks were found. From this finding and previous interpretations the following questions arise: When and under what conditions was FN3-5-MPS deposited? What is the nature of the marks found on the surface of the bones of this mammoth? To answer, we have conducted a high-resolution analysis of these remains, combining both taphonomic and microstratigraphic data. Our results, using microstratigraphic and micromorphological analyses of sediments based on thin-sections, show that this individual was deposited in a marshy environment. Subsequently, the carcass was exploited by hominins and large felids that left their marks on the surface of some of its bones. For this purpose, the identification and characterisation of both cut marks and tooth marks were performed using high-resolution 3D modelling, geometric morphometrics, and artificially intelligent algorithms. Based on the anatomical position of both the cut and tooth marks, we propose that both the hominins and the saber-toothed cats had early access to the animal. Finally, this paper shows how an interdisciplinary approach can shed detailed light on the particular story regarding the death and processing of the carcass of a female mammoth, deposited at Fuente Nueva 3.This research has been carried out thanks to projects PID 2021.125098NB.I00 funding by MCIN/AEI/10.13039/501100011033/FEDER Una manera de hacer Europa and ProyExcel_00274 funding by Dirección General de Planificación de la Investigación (Consejería de Universidad, Investigación e Innovación, Junta de Andalucía). In addition, this research has been supported by the following projects of the Spanish government: PID2021-122533NB-I00, PID2021-123092NB-C21, PID2022-136832NB-I00. We also acknowledge the support provided by the PALARQ Foundation through the project Ref: PR2004_19/01

Dietary diversity and nutritional adequacy among an older Spanish population with metabolic syndrome in the PREDIMED-Plus study: a cross-sectional analysis

Dietary guidelines emphasize the importance of a varied diet to provide an adequate nutrient intake. However, an older age is often associated with consumption of monotonous diets that can be nutritionally inadequate, increasing the risk for the development or progression of diet-related chronic diseases, such as metabolic syndrome (MetS). To assess the association between dietary diversity (DD) and nutrient intake adequacy and to identify demographic variables associated with DD, we cross-sectionally analyzed baseline data from the PREDIMED-Plus trial: 6587 Spanish adults aged 55-75 years, with overweight/obesity who also had MetS. An energy-adjusted dietary diversity score (DDS) was calculated using a 143-item validated semi-quantitative food frequency questionnaire (FFQ). Nutrient inadequacy was defined as an intake below 2/3 of the dietary reference intake (DRI) forat least four of 17 nutrients proposed by the Institute of Medicine (IOM). Logistic regression models were used to evaluate the association between DDS and the risk of nutritionally inadequate intakes. In the higher DDS quartile there were more women and less current smokers. Compared with subjects in the highest DDS quartile, those in the lowest DDS quartile had a higher risk of inadequate nutrient intake: odds ratio (OR) = 28.56 (95% confidence interval (CI) 20.80-39.21). When we estimated food varietyfor each of the food groups, participants in the lowest quartile had a higher risk of inadequate nutrient intake for the groups of vegetables, OR = 14.03 (95% CI 10.55-18.65), fruits OR = 11.62 (95% CI 6.81-19.81), dairy products OR = 6.54 (95% CI 4.64-9.22) and protein foods OR = 6.60 (95% CI 1.96-22.24). As DDS decreased, the risk of inadequate nutrients intake rose. Given the impact of nutrient intake adequacy on the prevention of non-communicable diseases, health policies should focus on the promotion of a healthy varied diet, specifically promoting the intake of vegetables and fruit among population groups with lower DDS such as men, smokers or widow(er)s

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

Manual de simulación clínica en especialidades médicas

Manual sobre técnicas y modos de simulación clínica en diversas especialidades médicas.La enseñanza y formación en medicina necesita el uso de la simulación. Existen evidencias de su uso desde hace cientos de años, pero, en los últimos años se ha incrementado y diseminado. La simulación clínica está validada científicamente en múltiples contextos médicos y de otras áreas profesionales de la salud. Y es considerada de gran importancia como proceso de entrenamiento y de mejora de las competencias y adquisición de habilidades médicas en campos que incluye desde la historia clínica, comunicación con el paciente, exploración, diagnóstico terapéutica médica-farmacológica y quirúrgica y seguridad al tratar al paciente. Hoy en día, para muchas técnicas y situaciones clínicas es inaceptable llegar junto a los pacientes sin un dominio adquirido en simulación. La simulación puede ocurrir sin el uso de recursos adicionales, solo las personas, o utilizando pocos o muchos recursos de baja hasta alta tecnología y se puede adaptar a los recursos disponibles, abarcando todas las áreas de conocimiento, y dentro de ellas competencias técnicas o actitudes, solas o en conjunto. El uso racional y basado en evidencia de la simulación es de la mayor importancia por la necesidad de una mayor efectividad y eficiencia en la transformación de los profesionales de la salud para que puedan mejorar su capacidad de atender a los pacientes. La simulación es también una buena herramienta de evaluación de competencias y habilidades en Medicina y otras disciplinas de las Ciencias de la Salud Este manual incluye técnicas y modos de simulación clínica en diversas especialidades médicas, útiles, para quien busque un manual práctico y actualizado.Cátedra de Mecenazgo de la Universidad de Málaga. Cátedra de Terapias Avanzadas en Patología Cardiovascular Cátedra de Mecenazgo de la Universidad de Málaga. Cátedra de Investigación Biomédica Quirón Salu

Multiancestry analysis of the HLA locus in Alzheimer’s and Parkinson’s diseases uncovers a shared adaptive immune response mediated by HLA-DRB1*04 subtypes

Across multiancestry groups, we analyzed Human Leukocyte Antigen (HLA) associations in over 176,000 individuals with Parkinson’s disease (PD) and Alzheimer’s disease (AD) versus controls. We demonstrate that the two diseases share the same protective association at the HLA locus. HLA-specific fine-mapping showed that hierarchical protective effects of HLA-DRB1*04 subtypes best accounted for the association, strongest with HLA-DRB1*04:04 and HLA-DRB1*04:07, and intermediary with HLA-DRB1*04:01 and HLA-DRB1*04:03. The same signal was associated with decreased neurofibrillary tangles in postmortem brains and was associated with reduced tau levels in cerebrospinal fluid and to a lower extent with increased Aβ42. Protective HLA-DRB1*04 subtypes strongly bound the aggregation-prone tau PHF6 sequence, however only when acetylated at a lysine (K311), a common posttranslational modification central to tau aggregation. An HLA-DRB1*04-mediated adaptive immune response decreases PD and AD risks, potentially by acting against tau, offering the possibility of therapeutic avenues