Model d’atenció a l’endometriosi a Catalunya

Endometriosi; Planificació sanitària; Model d'atencióEndometriosis; Planificación sanitaria; Modelo de atenciónEndometriosis; Health planning; Attention modelEl Model d’atenció a l’endometriosi a Catalunya estableix les bases per a l’ordenació dels serveis assistencials que intervenen en el procés integral d’atenció a les dones afectades amb endometriosi, inclou aspectes clínics, aspectes assistencials i aspectes d’ordenació de circuits assistencials, que venen determinats per les actuacions necessàries per donar una atenció integral a les dones afectades

Protocol per a la vigilància i el control de les arbovirosis transmeses per mosquits a Catalunya

Arbovirus; Mosquits; Malalties víriquesArboviruses; Mosquitoes; Viral diseasesArbovirus; Mosquitos; Enfermedades víricasThis protocol aims to provide a guide for the surveillance of the most likely arbovirosis transmitted by mosquito vectors in Catalonia (West Nile virus, dengue and chikungunya), establishing a set of surveillance activities for these diseases and control of the vectors, depending on the risk level of arbovirosisEste protocolo tiene como objetivo ofrecer una guía para la vigilancia de las arbovirosi más probables transmitidas por vectores mosquitos en Cataluña (virus del Nilo Occidental, dengue y chikungunya), estableciendo un conjunto de actividades de vigilancia de estas enfermedades y de control los vectores, según el nivel de riesgo de arbovirosiAquest protocol té com a objectiu oferir una guia per a la vigilància de les arbovirosis més probables transmeses per vectors mosquits a Catalunya (virus del Nil Occidental, dengue i chikungunya), establint un conjunt d’activitats de vigilància d’aquestes malalties i de control dels vectors, segons el nivell de risc d’arbovirosi

Investigación de la osteopontina y la integrina αvβ3 como marcadores de receptividad endometrial para la implantación embrionaria

[spa] El estudio del endometrio y de su estado de receptividad para la implantación embrionaria es crucial en la evaluación de la fertilidad de la mujer. No obstante, se ha demostrado que el estudio histológico clásico carece de utilidad clínica práctica para valorar la adecuada capacidad del endometrio para implantar embriones. Por tanto, la búsqueda de nuevos marcadores de receptividad endometrial constituye una línea de investigación de gran interés. Se ha descrito que tanto la integrina αvβ3 como la osteopontina presentan unos patrones de expresión temporales y espaciales específicos en los diferentes tipos celulares del endometrio, que definirían la fase de receptividad endometrial para la implantación embrionaria o "ventana de implantación". En base a lo anterior, nuestra hipótesis de trabajo es que la identificación y estudio de la osteopontina y la integrina αvβ3 como marcadores endometriales de implantación embrionaria en diferentes situaciones clínicas, debería permitir ir más allá de los simples criterios clásicos morfo-histológicos valorados por microscopia óptica y de esta forma poder definir de una manera más precisa y objetiva el grado de receptividad endometrial para la implantación embrionaria. Para ello, se han realizado 3 estudios, publicados en revistas del primer cuartil de la especialidad: I. “Osteopontin and αvβ3 integrin expression in the endometrium of infertile and fertile women” Casals G, Ordi J, Creus M, Fábregues F, Casamitjana R, Quinto L, Campo E, Balasch J. Reprod Biomed Online, 2008;16(6):808-816 II. “Osteopontin and αvβ3 integrin as markers of endometrial receptivity: the effect of different hormone therapies” Casals G, Ordi J, Creus M, Fábregues F, Carmona F, Casamitjana R, Balasch J. Reprod Biomed Online, 2010;21(3):349-359 III. “Expression pattern of osteopontin and αvβ3 integrin during the implantation window in infertile patients with early stages of endometriosis” Casals G, Ordi J, Creus M, Fábregues F, Carmona F, Casamitjana R, Balasch J. Hum Reprod, 2012;27(3):805-813 Según los datos obtenidos en estos estudios, podemos afirmar que no existe una relación causa-efecto entre la presencia o ausencia de estos dos marcadores endometriales (osteopontina e integrina αvβ3) durante la denominada "ventana de implantación" y la esterilidad de la mujer asociada o no a la presencia de endometriosis. Por otra parte, la administración de diferentes hormonas con efectos probados sobre el endometrio modifica la expresión de osteopontina e integrina αvβ3 sólo en tanto en cuanto son capaces de influir sobre el estado de maduración histológica de la mucosa endometrial. Por tanto, el interés de su uso rutinario en la valoración de la paciente estéril no puede confirmarse de acuerdo con los resultados de esta Tesis Doctoral.[eng] The study of the human endometrium as a fertility-determining factor and understanding the factors that contribute to a receptive endometrium are, at present, important areas of research. Investigation of endometrial function has traditionally been assessed by morphological criteria. However, the relationship between histological changes and endometrial receptivity has been seriously questioned in recent years and, consequently, a number of new biomarkers of endometrial receptivity have been described. The study of integrin αvβ3 and osteopontin (OPN) has been proposed as a means of distinguishing receptive from non-receptive endometrium in clinical practice and as a new method to investigate the impaired endometrial receptivity in certain groups of infertile patients. Both glycoproteins have been found to be coordinately expressed in the human endometrium across the menstrual cycle and maximally expressed at the time of the implantation window. According to these findings, we have developed and subsequently published the following studies: I. “Osteopontin and αvβ3 integrin expression in the endometrium of infertile and fertile women” Casals G, Ordi J, Creus M, Fábregues F, Casamitjana R, Quinto L, Campo E, Balasch J. Reprod Biomed Online, 2008;16(6):808-816 II. “Osteopontin and αvβ3 integrin as markers of endometrial receptivity: the effect of different hormone therapies” Casals G, Ordi J, Creus M, Fábregues F, Carmona F, Casamitjana R, Balasch J. Reprod Biomed Online, 2010;21(3):349-359 III. “Expression pattern of osteopontin and αvβ3 integrin during the implantation window in infertile patients with early stages of endometriosis” Casals G, Ordi J, Creus M, Fábregues F, Carmona F, Casamitjana R, Balasch J. Hum Reprod, 2012;27(3):805-813 The results of these studies indicate that although the expression of the OPN:αvβ3 integrin complex is closely correlated with histological maturation of endometrium evaluated by histological dating, neither OPN nor αvβ3 alone or in combination are useful markers of endometrial functional receptivity: there were no differences in expression or coexpression of these two markers between fertile controls and infertile patients. On the other hand, endometrial OPN and αvβ3 integrin expression or co-expression during the window of implantation are not impaired in patients with stage I–II endometriosis. Finally, OPN and alphavbeta3 integrin expression was closely related to endometrial maturation and this was irrespective of the hormonal treatment received. In conclusion, the results of our studies do not support the routine use of these markers in the clinical practice

Postnatal persistence of fetal cardiovascular remodelling associated with assisted reproductivetechnologies: a cohort study

OBJECTIVE: To assess the postnatal persistence of fetal cardiovascular remodelling associated with assisted reproductive technologies (ART) in children at 3 years of age. DESIGN: A cohort study of children conceived by ART. SETTING: Maternal-Fetal Medicine Unit, Hospital Clinic Barcelona, Spain. POPULATION SAMPLE: Eighty singleton pregnancies conceived by ART and 80 spontaneously conceived (controls) followed from fetal life up to childhood. METHODS: Cardiovascular evaluation was performed at 3 years of corrected age, including echocardiography, carotid intima-media (cIMT) by ultrasound, and blood pressure. MAIN OUTCOME MEASURES: Postnatal persistence of cardiovascular changes in children conceived by ART. RESULTS: Compared with controls, children conceived by ART showed larger atria (right atrial area: control 4.9 cm2 (0.9) versus ART 5.5 cm2 (0.9), P < 0.001), more globular ventricles (right ventricular sphericity index: control mean 1.8 (SD 0.5) versus ART 1.6 (0.2), P < 0.001), and signs of systolic (tricuspid annular plane systolic excursion: control 18 mm (2) versus ART 16 mm (3), P < 0.001) and diastolic dysfunction (isovolumic relaxation time: control 68 ms (12) versus ART 79 ms (12), P < 0.001). ART children also presented increased systolic blood pressure (control 90 mmHg (6) versus ART 94 mmHg (5), P < 0.003) and cIMT (control 0.52 μm (0.14) versus ART 0.60 μm (0.16), P < 0.001) as compared with those spontaneously conceived. CONCLUSIONS: Cardiovascular changes previously reported in ART fetuses persist postnatally at 3 years of age. These results underscore the importance of future studies for assessing the long-term cardiovascular health associated with ART. TWEETABLE ABSTRACT: Cardiovascular changes described in fetuses conceived by ART, persist in children at 3 years of age

Fetal neurosonography and infant neurobehavior in assisted reproductive technologies following fresh and frozen embryo transfer

Objective: We aimed to explore fetal cortical brain development by neurosonography in fetuses conceived by assisted reproductive technology (ART), including frozen and fresh embryo transfer (ET), compared with those conceived spontaneously (SC), and to investigate its association with infant neurobehavior at 12 months of age. Methods: This was a prospective cohort study of 210 singleton pregnancies, including 70 SC pregnancies, 70 conceived by in-vitro fertilization (IVF) following frozen ET and 70 conceived by IVF after fresh ET. Fetal neurosonography was performed at 32 ± 2 gestational weeks to assess cortical development. Sulci depths were measured offline and normalized by biparietal diameter (BPD). Ages and Stages Questionnaires (ASQ) were completed postnatally, at 12 ± 1 months of corrected age. Neurosonographic findings were adjusted by regression analysis for maternal age, ethnicity, parity, fetal sex and fetal-weight centile and gestational age at scan, and ASQ scores were adjusted for maternal age, ethnicity, parity, educational level and employment status, gestational age at birth, breastfeeding, infant sex and infant age at the ASQ evaluation. Results: Overall, in comparison to the SC fetuses, fetuses conceived by ART showed statistically significant differences in cortical development, with reduced parieto-occipital sulci depth adjusted for BPD (mean ± SD: fresh ET, 12.5 ± 2.5 vs frozen ET, 13.4 ± 2.6 vs SC, 13.4 ± 2.6, P < 0.001), cingulate sulci depth adjusted for BPD (median (interquartile range (IQR)): fresh ET, 5.8 (4.2-7.4) vs frozen ET, 5.8 (4.1-7.5) vs SC, 6.5 (4.8-7.8), P = 0.001) and calcarine sulci depth adjusted for BPD (median (IQR): fresh ET, 13.5 (10.1-16.1) vs frozen ET, 14.5 (12.1-15.8) vs SC, 16.4 (14.3-17.9), P < 0.001), together with lower Sylvian fissure grading score. Changes in cortical development were more pronounced in the fresh ET than in the frozen ET group. ART infants showed lower ASQ scores as compared to SC infants, particularly in the fresh ET group (mean ± SD global ASQ Z-score: fresh ET, -0.3 ± 0.4 vs frozen ET, -0.2 ± 0.4 vs SC, 0 ± 0.4, P < 0.001). Conclusions: Fetuses conceived by ART show a distinctive pattern of cortical development and suboptimal infant neurodevelopment, with more pronounced changes in those conceived following fresh ET. These findings support the existence of in-utero brain reorganization associated with ART and warrant follow-up studies to assess its long-term persistence. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology

Postnatal persistence of fetal cardiovascular remodelling associated with assisted reproductivetechnologies: a cohort study

OBJECTIVE: To assess the postnatal persistence of fetal cardiovascular remodelling associated with assisted reproductive technologies (ART) in children at 3 years of age. DESIGN: A cohort study of children conceived by ART. SETTING: Maternal-Fetal Medicine Unit, Hospital Clinic Barcelona, Spain. POPULATION SAMPLE: Eighty singleton pregnancies conceived by ART and 80 spontaneously conceived (controls) followed from fetal life up to childhood. METHODS: Cardiovascular evaluation was performed at 3 years of corrected age, including echocardiography, carotid intima-media (cIMT) by ultrasound, and blood pressure. MAIN OUTCOME MEASURES: Postnatal persistence of cardiovascular changes in children conceived by ART. RESULTS: Compared with controls, children conceived by ART showed larger atria (right atrial area: control 4.9 cm2 (0.9) versus ART 5.5 cm2 (0.9), P < 0.001), more globular ventricles (right ventricular sphericity index: control mean 1.8 (SD 0.5) versus ART 1.6 (0.2), P < 0.001), and signs of systolic (tricuspid annular plane systolic excursion: control 18 mm (2) versus ART 16 mm (3), P < 0.001) and diastolic dysfunction (isovolumic relaxation time: control 68 ms (12) versus ART 79 ms (12), P < 0.001). ART children also presented increased systolic blood pressure (control 90 mmHg (6) versus ART 94 mmHg (5), P < 0.003) and cIMT (control 0.52 μm (0.14) versus ART 0.60 μm (0.16), P < 0.001) as compared with those spontaneously conceived. CONCLUSIONS: Cardiovascular changes previously reported in ART fetuses persist postnatally at 3 years of age. These results underscore the importance of future studies for assessing the long-term cardiovascular health associated with ART. TWEETABLE ABSTRACT: Cardiovascular changes described in fetuses conceived by ART, persist in children at 3 years of age

Obesity-induced hepatic steatosis in mice is reverted by AAV9-mediated enhanced fatty-acid oxidation

Trabajo presentado en la 52nd Annual Scientifi Meeting of the European Society for Clinical Investigation (ESCI), celebrada en Barcelona, del miércoles, 30 de mayo de 2018 hasta el viernes, 1 de junio de 2018[Background] Obesity‐induced insulin resistance is associated, among others, with both ectopic lipid deposition and chronic, low‐grade adipose tissue inflammation. Despite the excess of fat, obese individuals show lower fatty‐acid oxidation rates. Thus, burning off the excess of fat could improve the obese metabolic phenotype. The aim of the present study was to evaluate the therapeutic potential of adenoassociated viruses (AAV) 9‐mediated liver expression of a human malonyl‐CoA‐insensitive carnitine palmitoyltransferase 1A (hCPT1AM), the key enzyme in fatty‐acid β‐oxidation (FAO), in a diet‐induced obese mouse model.[Materials and methods] We analyzed the metabolic and physiological effects of the long‐term liver hCPT1AM expression and the enhanced FAO on the diet‐induced obese mice.[Results] The enhanced hepatic FAO resulted in the reversion of the obese phenotype reducing body weight, hyperglycemia, hyperinsulinemia and hepatic steatosis. The mechanism involved are the hepatic activation of autophagy, lipolysis, cholesterol mobilization and energy dissipation by increasing liver temperature and the production of CO2, ATP and ketone bodies. Notably, the increase in hepatic FAO produced deep changes in the hepatic and serum lipidomic profile pointing out some ceramide and phosphatidylcholine species as potential markers for obesity reversion and hepatic steatosis improvement.[Conclusion] An increase in liver FAO improves the obese metabolic phenotype, which indicates that AAV9‐mediated hCPT1AM expression could be a potential molecular therapy for obesity and diabetes.Peer reviewe

Model d’atenció a l’endometriosi a Catalunya

Endometriosi; Planificació sanitària; Model d'atencióEndometriosis; Planificación sanitaria; Modelo de atenciónEndometriosis; Health planning; Attention modelEl Model d’atenció a l’endometriosi a Catalunya estableix les bases per a l’ordenació dels serveis assistencials que intervenen en el procés integral d’atenció a les dones afectades amb endometriosi, inclou aspectes clínics, aspectes assistencials i aspectes d’ordenació de circuits assistencials, que venen determinats per les actuacions necessàries per donar una atenció integral a les dones afectades