Formación universitaria en protección radiológica: nuestra experiencia en la Universidad de Málaga (España)

La Universidad de Málaga (UMA) desde 2011 tiene acreditada la formación en protección radiológica, con homologación del Consejo de Seguridad Nuclear (CSN). Desde este año, hasta nuestros días se han impartido un total de 31 cursos. La temática de los cursos impartidos han sido: director y operador de instalaciones de radiodiagnóstico médico; supervisor y operador de instalaciones radiactivas (radioterapia, medicina nuclear, laboratorio de fuentes no encapsuladas, control de procesos y técnicas analíticas), y de isótopos en el medio marino. Se han formado un total de 397 alumnos, con un 93 % de aprobados, profesionales de la enfermería, médicos, podólogos, veterinarios, odontólogos y auxiliares de higiene bucodental. Los cursos de formación constan de una parte teórica impartida por profesores del departamento de radiología y medicina física, del laboratorio de protección radiológica del CIMES y del servicio de instalación radiactiva; y de otra práctica, desarrollada en los laboratorios IRUMA de los Servicios Centrales de Investigación de la UMA, y en centros asistenciales de Radiología y Radioterapia del grupo VITHAS Salud. Todos estos cursos están integrados en titulaciones propias de la UMA, formando parte de su campus virtual (https://epropias.cv.uma.es/), basado en una plataforma Moodle. Esto supone un total de 159 créditos ECTS impartidos, en cursos de formación superior y de extensión universitaria. Por lo tanto, obtienen una doble titulación integrada

Estimación de niveles de referencia de dosis y contribución a la dosis poblacional de las TC en España

La Tomografía Computarizada (TC) es una de las pruebas de radiodiagnóstico que mayor dosis de radiación emite. En los últimos años ha aumentado mucho su uso en la práctica médica y, por ello, hemos querido estudiar en este trabajo la dosis de radiación procedente de los TC que recibe la población en España Tras analizar los datos recopilados de los centros hospitalarios de todas las Comunidades Autónomas Españolas y basándonos en los principales tipos de procedimiento de TC referenciados en el Report Radiation Protection nº154, hemos estimado los valores de referencia de dosis (DRLs) (3ºquartil) para los procedimientos que mayor contribución aportan a la dosis colectiva, por encima de 1000 hombre-Sv. Se ha tenido en cuenta la dosis por longitud (DLP). Los DRLs estimados han sido (mGy*cm) son TC cabeza 450, TC tórax 490, TC columna 690, TC abdomen 750, TC pelvis 780 y TC tronco 890. Los resultados obtenidos confirmaron que más de la mitad de la Dosis Efectiva Colectiva (dosis poblacional), el 66%, depende de las Tomografías Computarizadas, 645,23 mSv/1000 habitantes para un total global de todos los estudios con RX de 969,35 mSv/1000 habitantes. Por lo tanto, es importante intentar disminuir la exposición de la población a la radiación, haciendo un buen uso de las nuevas tecnologías e incluyendo la Protección Radiológica en la práctica médica

Sistema de registro de dosis radiológica a pacientes en la historia clínica digital.

Este trabajo fue premiado en el Congreso con el 3º mejor póster de más de 400 trabajos presentados.La importancia del registro de la dosis radiológica recibida por un paciente tras una exposición a una exploración de radiodiagnóstico en la historia clínica es uno de los procesos claves dentro de la seguridad del paciente, como pone de manifiesto la Directiva Europea 2013/59 EURATOM, que obliga a la adaptación de los sistemas de información hospitalaria para gestionar la medición y evaluación de las dosis así como la evaluación del riesgo asociado a las mismas. El objetivo de este trabajo es exponer los procesos a desarrollar para la inclusión de esta información en la historia médica electrónica. Para ello, se ha analizado la información de dosis de los sistemas radiológicos y su forma de registro, cálculo y extracción de 33 hospitales españoles participantes en el proyecto DOPOES I (Dosis a la población derivadas de exploraciones de radiodiagnóstico en España). Dicha base de datos recoge información de 9 millones de procedimientos radiológicos. Como resultado, se ha obtenido un sistema de codificación unificado (codRis_DOPOES v.19) para 500 procedimientos radiológicos, así como el establecimiento de las bases para el diseño e implementación de un sistema de registro de dosis hospitalario. De esta manera que se pueda integrar en el historial médico del paciente permitiendo conocer tanto las dosis recibidas en cada procedimiento, facilitando el trabajo de los profesionales sanitarios y valorando mejor el riesgo asociado al uso de las radiaciones ionizantes

Analytical sensitivity and specificity of a loop-mediated isothermal amplification (LAMP) kit prototype for detection of Trypanosoma cruzi DNA in human blood samples

This study aimed to assess analytical parameters of a prototype LAMP kit that was designed for detection of Trypanosoma cruzi DNA in human blood. The prototype is based on the amplification of the highly repetitive satellite sequence of T.cruzi in microtubes containing dried reagents on the inside of the caps. The reaction is carried out at 65°C during 40 minutes. Calcein allows direct detection of amplified products with the naked eye. Inclusivity and selectivity were tested in purified DNA from Trypanosoma cruzi stocks belonging to the six discrete typing units (DTUs), in DNA from other protozoan parasites and in human DNA. Analytical sensitivity was estimated in serial dilutions of DNA samples from Sylvio X10 (Tc I) and CL Brener (Tc VI) stocks, as well as from EDTA-treated or heparinized blood samples spiked with known amounts of cultured epimastigotes (CL Brener). LAMP sensitivity was compared after DNA extraction using commercial fiberglass columns or after ?Boil & Spin? rapid preparation. Moreover, the same DNA and EDTA-blood spiked samples were subjected to standardized qPCR based on the satellite DNA sequence for comparative purposes. A panel of peripheral blood specimens belonging to Chagas disease patients, including acute, congenital, chronic and reactivated cases (N = 23), and as well as seronegative controls (N = 10) were evaluated by LAMP in comparison to qPCR. LAMP was able to amplify DNAs from T. cruzi stocks representative of the six DTUs, whereas it did not amplify DNAs from Leishmania sp, T. brucei sp, T. rangeli KPN+ and KPN-, P. falciparum and non-infected human DNA. Analytical sensitivity was 1x10-2fg/μL of both CL Brener and Sylvio X10 DNAs, whereas qPCR detected up to 1x 10−1fg/μL of CL Brener DNA and 1 fg/μl of Sylvio X10 DNA. LAMP detected 1x10-2parasite equivalents/mL in spiked EDTA blood and 1x10-1par.eq/mL in spiked heparinized blood using fiberglass columns for DNA extraction, whereas qPCR detected 1x10-2par.eq./mL in EDTA blood. Boil & Spin extraction allowed detection of 1x10-2par.eq /mL in spiked EDTA blood and 1 par.eq/ml in heparinized blood. LAMP was able to detect T.cruzi infection in peripheral blood samples collected from well-characterised seropositive patients, including acute, congenital, chronic and reactivated Chagas disease. To our knowledge, this is the first report of a prototype LAMP kit with appropriate analytical sensitivity for diagnosis of Chagas disease patients, and potentially useful for monitoring treatment response.Fil: Besuschio, Susana Alicia. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; ArgentinaFil: Llano Murcia, Mónica. Pontificia Universidad Javeriana; ColombiaFil: Benatar, Alejandro Francisco. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; ArgentinaFil: Monnerat, Severine. Foundation for Innovative New Diagnostics; SuizaFil: Cruz, Israel. Foundation for Innovative New Diagnostics; SuizaFil: Picado, Albert. Foundation for Innovative New Diagnostics; SuizaFil: Curto, Maria de Los Angeles. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; ArgentinaFil: Kubota, Yutaka. Eiken Chemical Company; JapónFil: Wehrendt, Diana Patricia. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; ArgentinaFil: Pavia, Paula. Pontificia Universidad Javeriana; ColombiaFil: Mori, Yasuyoshi. Eiken Chemical Company; JapónFil: Puerta, Concepción. Pontificia Universidad Javeriana; ColombiaFil: Ndung'u, Joseph M.. Foundation for Innovative New Diagnostics; SuizaFil: Schijman, Alejandro Gabriel. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; Argentin

The parthenocarpic hydra mutant reveals a new function for a SPOROCYTELESS-like gene in the control of fruit set in tomato

[EN] Fruit set is an essential process to ensure successful sexual plant reproduction. The development of the flower into a fruit is actively repressed in the absence of pollination. However, some cultivars from a few species are able to develop seedless fruits overcoming the standard restriction of unpollinated ovaries to growth. We report here the identification of the tomato hydra mutant that produces seedless (parthenocarpic) fruits. Seedless fruit production in hydra plants is linked to the absence of both male and female sporocyte development. The HYDRA gene is therefore essential for the initiation of sporogenesis in tomato. Using positional cloning, virus-induced gene silencing and expression analysis experiments, we identified the HYDRA gene and demonstrated that it encodes the tomato orthologue of SPOROCYTELESS/NOZZLE (SPL/NZZ) of Arabidopsis. We found that the precocious growth of the ovary is associated with changes in the expression of genes involved in gibberellin (GA) metabolism. Our results support the conservation of the function of SPL-like genes in the control of sporogenesis in plants. Moreover, this study uncovers a new function for the tomato SlSPL/HYDRA gene in the control of fruit initiation.This work was supported by grants from the Spanish Ministerio de Ciencia e Innovaci on (MICINN; AGL2009-07617 to C.G-M.; AGL2015-64991-C3-3-R to V.M.; and AGL2015-64991-C3-1-R to R.L.) and the Ram on y Cajal Program (RYC-2007-00627). We thank Rafael Martinez and Primitivo Murias for expert plant care; Marisol Gasc on for technical assistance with the microscope; and Dr Cristina Ferrandiz for critical reading of the manuscript. The authors declare no conflicts of interest.This work was supported by grants from the Spanish Ministerio de Ciencia e Innovaci on (MICINN; AGL2009-07617 to C.G-M.; AGL2015-64991-C3-3-R to V.M.; and AGL2015-64991-C3-1-R to R.L.) and the Ram on y Cajal Program (RYC-2007-00627). We thank Rafael Martinez and Primitivo Murias for expert plant care; Marisol Gasc on for technical assistance with the microscope; and Dr Cristina Ferrandiz for critical reading of the manuscript. The authors declare no conflicts of interest.Rojas-Gracia, P.; Roque Mesa, EM.; Medina Herranz, M.; Rochina Peñalver, MC.; Hamza, R.; Angarita-Diaz, MP.; Moreno Ferrero, V.... (2017). The parthenocarpic hydra mutant reveals a new function for a SPOROCYTELESS-like gene in the control of fruit set in tomato. New Phytologist. 214(3):1198-1212. https://doi.org/10.1111/nph.14433S11981212214

SF3B1, RUNX1 and TP53 Mutations Significantly Impact the Outcome of Patients With Lower-Risk Myelodysplastic Syndrome

[Introduction] Prognosis of patients with myelodysplastic syndrome (MDS), particularly the group with lower-risk disease (LR-MDS) is very heterogeneous. Several studies have described the prognostic value of recurrent somatic mutations in MDS including all risk categories. Recently, the incorporation of genomic data to clinical parameters defined the new Molecular International Prognostic Scoring System (IPSS-M).[Materials and Methods] In this study, we evaluated the impact of molecular profile in a series of 181 patients with LR-MDS and non-proliferative chronic myelomonocytic leukemia.[Results] Epigenetic regulators (TET2, ASXL1) and splicing (SF3B1) were the most recurrent mutated pathways. In univariate analysis, RUNX1 or TP53 mutations correlated with lower median overall survival (OS). In contrast, SF3B1 mutation was associated with prolonged median OS [95 months (95% IC, 32-157) vs. 33 months (95% CI, 19-46) in unmutated patients (P < 0.01)]. In a multivariate Cox regression model, RUNX1 mutations independently associated with shorter OS, while SF3B1 mutation retained its favorable impact on outcome (HR: 0.24, 95% CI, 0.1-0.5; P = 0.001). In addition, TP53 or RUNX1 mutations were identified as predictive covariates for the probability of leukemic progression (P < 0.001).[Conclusion] Incorporation of molecular testing in LR-MDS identified a subset of patients with expected poorer outcome, either due to lower survival or probability of leukemic progression.Peer reviewe

Role of vitamin D supplementation in the management of musculoskeletal diseases: update from an European Society of Clinical and Economical Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) working group.

Vitamin D is a key component for optimal growth and for calcium-phosphate homeostasis. Skin photosynthesis is the main source of vitamin D. Limited sun exposure and insufficient dietary vitamin D supply justify vitamin D supplementation in certain age groups. In older adults, recommended doses for vitamin D supplementation vary between 200 and 2000 IU/day, to achieve a goal of circulating 25-hydroxyvitamin D (calcifediol) of at least 50 nmol/L. The target level depends on the population being supplemented, the assessed system, and the outcome. Several recent large randomized trials with oral vitamin D regimens varying between 2000 and 100,000 IU/month and mostly conducted in vitamin D-replete and healthy individuals have failed to detect any efficacy of these approaches for the prevention of fracture and falls. Considering the well-recognized major musculoskeletal disorders associated with severe vitamin D deficiency and taking into account a possible biphasic effects of vitamin D on fracture and fall risks, an European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) working group convened, carefully reviewed, and analyzed the meta-analyses of randomized controlled trials on the effects of vitamin D on fracture risk, falls or osteoarthritis, and came to the conclusion that 1000 IU daily should be recommended in patients at increased risk of vitamin D deficiency. The group also addressed the identification of patients possibly benefitting from a vitamin D loading dose to achieve early 25-hydroxyvitamin D therapeutic level or from calcifediol administration

Early Tracheostomy for Managing ICU Capacity During the COVID-19 Outbreak: A Propensity-Matched Cohort Study

10 p.Background: During the first wave of the COVID-19 pandemic, shortages of ventilators and ICU beds overwhelmed health care systems. Whether early tracheostomy reduces the duration of mechanical ventilation and ICU stay is controversial. Research question: Can failure-free day outcomes focused on ICU resources help to decide the optimal timing of tracheostomy in overburdened health care systems during viral epidemics? Study design and methods: This retrospective cohort study included consecutive patients with COVID-19 pneumonia who had undergone tracheostomy in 15 Spanish ICUs during the surge, when ICU occupancy modified clinician criteria to perform tracheostomy in Patients with COVID-19. We compared ventilator-free days at 28 and 60 days and ICU- and hospital bed-free days at 28 and 60 days in propensity score-matched cohorts who underwent tracheostomy at different timings (≤ 7 days, 8-10 days, and 11-14 days after intubation). Results: Of 1,939 patients admitted with COVID-19 pneumonia, 682 (35.2%) underwent tracheostomy, 382 (56%) within 14 days. Earlier tracheostomy was associated with more ventilator-free days at 28 days (≤ 7 days vs > 7 days [116 patients included in the analysis]: median, 9 days [interquartile range (IQR), 0-15 days] vs 3 days [IQR, 0-7 days]; difference between groups, 4.5 days; 95% CI, 2.3-6.7 days; 8-10 days vs > 10 days [222 patients analyzed]: 6 days [IQR, 0-10 days] vs 0 days [IQR, 0-6 days]; difference, 3.1 days; 95% CI, 1.7-4.5 days; 11-14 days vs > 14 days [318 patients analyzed]: 4 days [IQR, 0-9 days] vs 0 days [IQR, 0-2 days]; difference, 3 days; 95% CI, 2.1-3.9 days). Except hospital bed-free days at 28 days, all other end points were better with early tracheostomy. Interpretation: Optimal timing of tracheostomy may improve patient outcomes and may alleviate ICU capacity strain during the COVID-19 pandemic without increasing mortality. Tracheostomy within the first work on a ventilator in particular may improve ICU availability

Beta-alanine (Carnosyn™) supplementation in elderly subjects (60–80 years): effects on muscle carnosine content and physical capacity

The aim of this study was to investigate the effects of beta-alanine supplementation on exercise capacity and the muscle carnosine content in elderly subjects. Eighteen healthy elderly subjects (60–80 years, 10 female and 4 male) were randomly assigned to receive either beta-alanine (BA, n = 12) or placebo (PL, n = 6) for 12 weeks. The BA group received 3.2 g of beta-alanine per day (2 × 800 mg sustained-release Carnosyn™ tablets, given 2 times per day). The PL group received 2 × (2 × 800 mg) of a matched placebo. At baseline (PRE) and after 12 weeks (POST-12) of supplementation, assessments were made of the muscle carnosine content, anaerobic exercise capacity, muscle function, quality of life, physical activity and food intake. A significant increase in the muscle carnosine content of the gastrocnemius muscle was shown in the BA group (+85.4%) when compared with the PL group (+7.2%) (p = 0.004; ES: 1.21). The time-to-exhaustion in the constant-load submaximal test (i.e., TLIM) was significantly improved (p = 0.05; ES: 1.71) in the BA group (+36.5%) versus the PL group (+8.6%). Similarly, time-to-exhaustion in the incremental test was also significantly increased (p = 0.04; ES 1.03) following beta-alanine supplementation (+12.2%) when compared with placebo (+0.1%). Significant positive correlations were also shown between the relative change in the muscle carnosine content and the relative change in the time-to-exhaustion in the TLIM test (r = 0.62; p = 0.01) and in the incremental test (r = 0.48; p = 0.02). In summary, the current data indicate for the first time, that beta-alanine supplementation is effective in increasing the muscle carnosine content in healthy elderly subjects, with subsequent improvement in their exercise capacity