Marcadores biológicos tras la hemorragia intracerebral y su relación con la evolución clínico-radiológica

Consultable des del TDXTítol obtingut de la portada digitalitzadaLa hemorragia intracerebral (HIC) constituye un 15% de todos los ictus y está asociada a una elevada tasa de morbi-mortalidad. En muchos casos, en la evolución clínica, existe un crecimiento precoz de la HIC y/o la aparición de edema rodeando a la lesión que se pueden acompañar de deterioro neurológico. Aunque se desconoce en gran parte la fisiopatología subyacente a estos fenómenos, sabemos que tras el sangrado inicial, se desencadenan una serie de procesos que contribuyen al daño cerebral secundario producido por la HIC. En dichos procesos participan una serie de moléculas susceptibles de ser utilizadas como marcadores biológicos de la evolución clínica y radiológica de los pacientes que presentan una HIC. Los objetivos de esta tesis son: 1.- Revisar la literatura referente a dichos procesos. 2.- Determinar los niveles en plasma de diversos marcadores biológicos relacionados con sistemas de coagulación/fibrinólisis (D-dímero), con daño glial (proteína S100B), con sistemas proteolíticos (metaloproteasas de matriz MMP-2, MMP-3, MMP-9, y sus inhibidores tisulares TIMP-1 y TIMP-2) y con mecanismos de apoptosis (caspasa-3 y Fas soluble) en una amplia muestra de pacientes con HIC. 3.- Relacionar las determinaciones obtenidas con la evolución clínica y radiológica posterior. 4.- Determinar el papel del sistema Fas/Fas ligando en el tejido cerebral tras la HIC. Entre todos los procesos descritos toman un papel predominante, en fases iniciales, la coagulación de la sangre y los fenómenos de inflamación. En fases más tardías, el daño cerebral se agrava por la participación de enzimas proteolíticas y de sustancias derivadas de la lisis de los eritrocitos, entre otros. También se produce la muerte por necrosis y apoptosis de las células de la región que rodea a la hemorragia. En nuestros pacientes, todos los marcadores biológicos a estudio se encontraron de forma basal elevados en plasma (a excepción de Fas soluble, TIMP-2 y caspasa-3, que se encontraron por debajo o dentro del rango de normalidad) y presentaron un perfil temporal (24 horas, 48 horas, 7º día y tercer mes) característico para cada una de ellos. Los niveles basales de D-dímero> 1900 ng/mL fueron predictores independientes del deterioro neurológico precoz (OR 4.5, 95% IC 1.03 a 20.26; p=0.045) junto a la presión arterial sistólica>182 mmHg (OR 6.8, CI 1.25 a 36.9, p=0.026). Los niveles de D-dímero también se asociaron a la mortalidad durante la primera semana siendo predictores independientes de ésta, junto al volumen inicial de la HIC>30 mL. La proteína S100B se correlacionó directamente con el volumen inicial de la HIC (r=0.45, p2 al tercer mes). La MMP-9 y su inhibidor TIMP-1 se asociaron al edema perihematoma basal y la MMP-3 se asoció al volumen residual y a la mortalidad al tercer mes. Entre los marcadores de apoptosis, el Fas soluble sufrió un descenso inicial (1as 24 horas) significativo, y se asoció al crecimiento posterior del edema. Por último, la expresión del receptor de muerte celular Fas y de su ligando (FasL) se encontró aumentada en las áreas del tejido cerebral perihematoma con respecto a las áreas del hemisferio contralateral y a zonas sanas del hemisferio ipsilateral, sugiriendo un papel de este sistema en la muerte celular por apoptosis en la región del perihematoma.Intracerebral hemorrhage (ICH) accounts for 15% of all stroke and exposes patients to high rates of mortality and poor functional outcome. Early hematoma growth and perihematomal edema (PE) formation are considered determinants of early neurological worsening and poor outcome. After the initial bleeding, some molecular processes appear and contribute to the secondary brain damage. In this context, biological markers of these processes may add early prognostic information and be suitable targets for therapeutic research. The aims of the present thesis are: 1. To review the literature regarding the molecular processes involved in ICH. 2. To determine plasma level of biomarkers related to coagulation/fibrinolysis systems (such as D-dimer), of biomarkers related to glial damage (such as S100B), of biomarkers related to some proteolytic systems (such as metalloproteinases MMP-2, MMP-3 and MMP-9, and their tissular inhibitors TIMP-1 and TIMP-2) and of biomarkers involved in apoptosis (soluble Fas and caspase-3). 3. To study the relationship among these biomarkers and the clinical and radiological outcome in ICH patients. 4. To determine the role of Fas receptor/Fas ligand system in cerebral tissue after ICH. Coagulation and neuroinflammation has been reported as the main processes at the early stages and after them, clot lysis and some metalloproteinases may contribute to further brain damage. Cellular death in the tissue surrounding the hematoma has also been described to be present after ICH. In our patients, all biomarkers studied were increased at baseline (except for soluble Fas, TIMP-2 and caspase-3 which concentrations were below or within the normal range). Each one of them presented a characteristic temporal profile (24 hours, 48 hours, 7th day and third month determinations). Baseline D-dimer level>1900 ng/mL independently predicted neurological worsening (OR 4.5, 95% CI 1.03 to 20.26; p=0.045) besides systolic blood pressure>182 mmHg (OR 6.8, CI 1.25 to 36.9; p=0.026). Baseline D-dimer level was also associated with mortality within the first week. Moreover, ICH volume 1900 ng/mL (OR 8.75; 95% CI 1.41 to 54.16; p=0.020) emerged as independent predictors of mortality. S100B was closely correlated to baseline ICH volume (r=0.45, p<0.0001). Increased level of this protein was associated with a worse early and late clinical outcome. Among metalloproteinases and their tissular inhibitors, MMP-9 and TIMP-1 were associated with baseline perihematomal edema volume, whereas MMP-3 was related to the residual cavity volume and third month mortality. Regarding apoptosis, soluble Fas level showed an initial decrease and it was associated with further edema growing. Finally, the expression of Fas receptor and its ligand (Fas ligand) were found higher at perihematomal areas than in the areas from the contralateral hemisphere or from a healthy area in the ipsilateral hemisphere, suggesting a role for the activation of this system in apoptosis after ICH

Luminescent Thermochromism of 2D Coordination Polymers Based on Copper(I) Halides with 4-Hydroxythiophenol

This is the peer-reviewed version of the following article: Troyano, J., Perles, J., Amo‐Ochoa, P., Martínez, J. I., Concepción Gimeno, M., Fernández‐Moreira, V., ... & Delgado, S. (2016). Luminescent Thermochromism of 2D Coordination Polymers Based on Copper (I) Halides with 4‐Hydroxythiophenol. Chemistry–A European Journal, 22(50), 18027-18035., which has been published in final form at https://doi.org/10.1002/chem.201603675. This article may be used for non-commercial purposes in accordance with Wiley-VCH Terms and Conditions for Self-ArchivingSolvothermal reactions between copper(I) halides and 4-mercaptophenol give rise to the formation of three coordination polymers with general formula [Cu3X(HT)2]n(X=Cl, 1; Br, 2; and I, 3). The structures of these coordination polymers have been determined by X-ray diffraction at both room- and low temperature (110 K), showing a general shortening in Cu−S, Cu−X and Cu−Cu bond lengths at low temperatures. 1 and 2 are isostructural, consisting of layers in which the halogen ligands act as μ3-bridges joining two Cu1 and one Cu2 atoms whereas in 3 the iodine ligands is as μ4-mode but the layers are quasi-isostructural with 1 or 2. These compounds show a reversible thermochromic luminescence, with strong orange emission for 1 and 2, but weaker for 3 at room temperature, whereas upon cooling at 77 K 1 and 2 show stronger yellow emission, and 3 displays stronger green emission. DFT calculations have been used to rationalize these observations. These results suggest a high potential for this novel and promising stimuli-responsive materialsThis work was supported by MICINN (MAT2013-46753-C2-1-P). JIM acknowledges funding from the ERC-Synergy Program (Grant ERC-2013-SYG-610256 NANOCOSMOS) and computing resources from CTI-CSIC

Acquisition activity: do firm age and family control matter?

This article examines the relationship between firm age and acquisition activity and how family and non-family firms differ in the number of acquisitions they undertake. Inspired by previous research requiring firm age as a focal aspect and literature studying the antecedents of acquisitions, we draw on the SEW perspective to test our hypotheses based on the analysis of the acquisition activity of Asia-Pacific public firms. Our empirical findings support a U-shaped relationship between firm age and acquisition activity. Moreover, the findings reveal that family firms engage in fewer acquisitions than non-family firms irrespective of the age of the firm.Funding for open Access charge: Universidad de Málaga / CBU

Youtube’s growth in use among children 0–5 during covid19: the occidental european case

YouTube has become an educational and entertainment tool among Western European families, particularly during the COVID-19 pandemic. This study monitored the main channels for children aged 0–5 years by using the social media analysis (SNA) methodology from March 24, 2020 to August 24, 2020. The software used has been FanpageKarma, which allows the collection and interpretation of data. The results indicate not only a growth in the use of such channels during confinement, but also how their expansion is related to the evolution of the COVID-19, reflecting, in turn, the consequences of the government policies adopted. Social distancing generated a greater consumption of recreational content, but not a greater growth in educational content regardless of the country or culture

Patients' experience while transitioning from the intensive care unit to a ward

Background: Intensive care unit (ICU) patients can experience emotional distress and post-traumatic stress disorder when they leave the ICU, also referred to as post-intensive care syndrome. A deeper understanding of what patients go through and what they need while they are transitioning from the ICU to the general ward may provide input on how to strengthen patient-centred care and, ultimately, contribute to a positive experience. Aim: To describe the patients' experience while transitioning from the ICU to a general ward. Design: A descriptive qualitative study. Method: Data were gathered through in-depth interviews and analysed using a qualitative content analysis. The qualitative study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines. Findings: Forty-eight interviews were conducted. Impact on emotional well-being emerged as a main theme, comprising four categories with six subcategories. Conclusion: Transition from the ICU can be a shock for the patient, leading to the emergence of a need for information, and an impact on emotional well-being that has to be planned for carefully and addressed prior to, during, and following transition from the ICU to the general ward. Relevance to clinical practice: It is essential that nurses understand patients' experiences during transfer, identifying needs and concerns to be able to develop and implement new practices such as ICU Liaison Nurse or Nurse Outreach for the follow-up of these patients, the inclusion of a consultant mental health nurse, and the application of patient empowerment during ICU discharge

Estrategias de control de riesgos laborales a los que están expuestos los trabajadores de la finca el pino

Esta investigación permitió establecer las estrategias de control de riesgos laborales a los que están expuestos los trabajadores de la finca el pino. La finca el pino es una finca familiar ubicada en el municipio de Herrán, Norte de Santander, dedicada a actividades agropecuarias dentro de las que se destacan: ganadería, agricultura y apicultura. Inicialmente se aplicó un estudio sociodemográfico a los 6 trabajadores de la finca, basados en la ficha datos generales sugerida por el Fondo de Riesgos Laborales. El estudio sociodemográfico reveló que nos encontramos frente a una población que en su mayoría cuenta con bajo nivel de escolaridad, tienen a su cargo por lo menos dos personas y toda la vida han laborado en el campo de manera informal. Para la identificación, evaluación y valoración de riesgos se utilizó la herramienta proporcionada por la guía técnica colombiana gtc 45 versión 2012, determinando la existencia de alrededor de 80 peligros asociados a las tareas y procesos propios de la finca. Así mismo, se establecieron maneras de controlar o mitigar los riesgos que podrían generar dichos peligros, entre ellas podemos destacar: adecuación de terrenos y superficies, uso de ayudas mecánicas para levantamiento de cargas, sensibilizaciones, jornadas de aseo y uso de elementos de protección personal.This investigation allowed to establish the strategies of control of occupational hazards to which the workers of finca el pino are exposed. Finca el pino is a family farm located in the municipality of Herrán, Norte de Santander, dedicated to agricultural activities within which stand out: livestock, agriculture and beekeeping. Initially, a sociodemographic study was applied to the 6 workers of the farm, based on the general data sheet suggested by the fondo de riesgos laborales. The sociodemographic study revealed that we are facing a population that mostly has a low level of education, they are in charge of at least two people and they have worked informally in the field all their lives. For the identification, evaluation and evaluation of risks, the tool provided by the guía técnica colombiana gtc 45, version 2012 was used, determining the existence of around 80 risks associated with the tasks and processes of the farm. Likewise, ways were established to control or mitigate the risks that such hazards could generate, among which we can highlight: adequacy of land and surfaces, use of mechanical aids for lifting loads, sensitization, cleaning days and use of personal protection elements

Protocolo del estudio: Demanda y práctica farmacéutica en afección bucofaríngea en España. Estudio ACTUA

Introducción y justificación: La afección bucofaríngea, y más concretamente el dolor de garganta, por su prevalencia y relación con el uso inadecuado de medicamentos tiene una alta importancia en salud, el farmacéutico contribuye a que el usuario alcance una automedicación adecuada a través de los servicios de atención farmacéutica. Sin embargo, se conoce poco en el ámbito de la farmacia comunitaria sobre los usuarios que demandan esta atención, así como las consultas e intervenciones de los farmacéuticos.Aplicabilidad de los resultados: Conocer las características de la demanda y la práctica farmacéutica en afección bucofaríngea permitirá establecer estrategias sanitarias destinadas a optimizar la asistencia sanitaria.Objetivos: Caracterizar la práctica farmacéutica en afección bucofaríngea realizada en farmacias comunitarias españolas.Material y métodos: Estudio observacional descriptivo transversal. En farmacias comunitarias voluntarias del territorio español. La población de estudio serán los usuarios que acudan a las farmacias por una afección bucofaríngea. La duración del trabajo de campo será de tres meses. Las variables contempladas en el estudio serán aquellas que caracterizan al usuario, a la consulta realizada, y a la intervención del farmacéutico. Se realizará un análisis estadístico descriptivo de los datos (univariante y multivariante por la técnica de correspondencias múltiples). Se garantizará la confidencialidad y el consentimiento informado de los participantes

PRINCIPALES REFERENTES LEGALES Y EDUCATIVOS PARA EL DESARROLLO Y DE LA COEDUCACIÓN

This paper describes a work of synthesis and reflection based on a compilation of the main legal aspects (laws, regulations, etc.), historie aspects like the different movements to raise people 's awareness of the rights of women (Intemational Conferences) and educational aspects (first plans of equal opportunities and education) for being possible a complex, but necessary, social change (by reorganizing the roles between men and women, by sharing housework, and also by breaking up with the traditional gender stereotypes and so on). In all of this transformational process, coeducation -as an equality education- is being already developed at the school inside a seriously and consciously specific work according to a curricular planning ("Education for citizenship").En este artículo se realiza un trabajo de síntesis y reflexión basado en la compilación de los principales referentes legales (Constitución, normativa, etc.), históricos, como los diferentes movimientos de concienciación y sensibilización en pro de los derechos de la mujer (Conferencias Internacionales) y educativos (primeros planes de igualdad de oportunidades y de educación) a través de los cuales está siendo posible la viabilidad de un complejo pero necesario cambio social (reestructuración de roles entre hombres y mujeres; reparto de las tareas domésticas; ruptura de los estereotipos de género tradicionales, etc.). En todo este proceso transformacional el desarrollo de la coeducación, entendida como una educación igualitaria, comienza ya a implementarse en la escuela a través de un trabajo serio, consciente, explícito y acorde con una planificación curricular ("Educación para la Ciudadanía")