Muscle damage, physiological changes and energy balance in ultra-endurance mountain event athletes

The biological response to ultra-endurance mountain race events is not yet well understood. The aim of this study was to determine the biochemical and physiological changes after performing an ultra-endurance mountain race in runners. We recruited 11 amateur runners (age: 29.7 ± 10.2 years; height: 179.7 ± 5.4 cm; body mass: 76.7 ± 10.3 kg). Muscle damage, lactate concentration, energy balance, rating of perceived exertion (RPE), heart rate (HR), heart rate variability (HRV), body composition changes, and jump performance were analyzed before, during (only lactate, HR, and HRV), and after the race. Athletes completed 54 km in 6 h, 44 min (±28 min). After the race, myoglobin and creatine kinase concentration increased from 14.9 ± 5.2 to 1419.9 ± 1292.1 μg/L and from 820.0 ± 2087.3 to 2421.1 ± 2336.2 UI/L, respectively (p < 0.01). In addition, lactate dehydrogenase and troponin I significantly increased after the race (p < 0.01). Leukocyte and platelet count increased by 180.6% ± 68.9% and 23.7% ± 11.2%, respectively (p < 0.001). Moreover, after the competition, athletes presented a 3704 kcal negative energy balance; a significant increase in RPE values; a decrease in countermovement and squat jump height; and a decrease in body mass and lower limb girths. During the event, lactate concentration did not change and subjects presented a mean HR of 158.8 ± 17.7 beats/min, a significant decrement in vagal modulation, and a significant increase in sympathetic modulation. Despite the relative “low” intensity achieved, ultra-endurance mountain race is a stressful stimulus that produces a high level of muscle damage in the athletes. These findings may help coaches to design specific training programs that may improve nutritional intake strategies and prevent muscle damage.Actividad Física y Deport

Long term biotransformation and toxicity of dimercaptosuccinic acid-coated magnetic nanoparticles support their use in biomedical applications

Although iron oxide magnetic nanoparticles (MNP) have been proposed for numerous biomedical applications, little is known about their biotransformation and long-term toxicity in the body. Dimercaptosuccinic acid (DMSA)-coated magnetic nanoparticles have been proven efficient for in vivo drug delivery, but these results must nonetheless be sustained by comprehensive studies of long-term distribution, degradation and toxicity. We studied DMSA-coated magnetic nanoparticle effects in vitro on NCTC 1469 non-parenchymal hepatocytes, and analyzed their biodistribution and biotransformation in vivo in C57BL/6 mice. Our results indicate that DMSA-coated magnetic nanoparticles have little effect on cell viability, oxidative stress, cell cycle or apoptosis on NCTC 1469 cells in vitro. In vivo distribution and transformation were studied by alternating current magnetic susceptibility measurements, a technique that permits distinction of MNP from other iron species. Our results show that DMSA-coated MNP accumulate in spleen, liver and lung tissues for extended periods of time, in which nanoparticles undergo a process of conversion from superparamagnetic iron oxide nanoparticles to other non-superparamagnetic iron forms, with no significant signs of toxicity. This work provides the first evidence of DMSA-coated magnetite nanoparticle biotransformation in vivo.RM holds a post-doctoral contract supported by EU-FP7 MULTIFUN project (no. 262943), LG holds a Sara Borrell post-doctoral contract (CD09/00030) from the Carlos III Health Institute, Spanish Ministry for Health, Social Services and Equality (MSSSI), and TMZ received a FPU pre-doctoral fellowship from the Spanish Ministry of Economy and Competitiveness (MINECO). This work was partially supported by grants from the MINECO (SAF-2011-23639 to DFB and MAT2011-23641 and CSD2007-00010 to MPM), the Research Network in Inflammation and Rheumatic Diseases (RIER) of the ISCIII-MSSSI Cooperative Research Thematic Network program (RD08/0075/0015 to DFB), the Madrid regional government (S009/MAT-1726 to MPM), and EU-FP7 MULTIFUN project (no. 262943 to DFB and MPM).S2009/MAT-1726/NanobiomagnetPeer Reviewe

Variability estimation in resistive switching devices, a numerical and kinetic Monte Carlo perspective

Acknowledgments The authors thank the support of the Spanish Ministry of Science, Innovation and Universities and the FEDER program through projects TEC2017-84321-C4-1-R, TEC2017-84321-C4-3-R, and projects A.TIC.117.UGR18, IE2017-5414 and B.TIC.624.UGR20 funded by the Consejería de Conocimiento, Investigación y Universidad, Junta de Andalucía (Spain) and the FEDER program. Funding for open access charge: Universidad de Granada/CBUAWe have analyzed variability in resistive memories (Resistive Random Access Memories, RRAMs) making use of advanced numerical techniques to process experimental measurements and simulations based on the kinetic Monte Carlo technique. The devices employed in the study were fabricated using the TiN/Ti/HfO2/W stack. The switching parameters were obtained making use of new developed extraction methods. The appropriateness of the advanced parameter extraction methodologies has been checked by comparison to kinetic Monte Carlo simulations; in particular, the reset and set events have been studied and detected. The data obtained were employed to shed light on the resistive switching operation and the cycle-to-cycle variability. It has been shown that variability depends on the numerical technique employed to obtain the set and reset voltages, therefore, this issue must be taken into consideration in RS characterization and modeling studies. The proposed techniques are complementary and depending on the technology and the curves shape the features of a particular method could make it to be the most appropriate.Spanish Ministry of Science, Innovation and Universities and the FEDER program through projects TEC2017-84321-C4-1-R, TEC2017-84321-C4-3-RConsejería de Conocimiento, Investigación y Universidad, Junta de Andalucía (Spain) and the FEDER program, projects A.TIC.117.UGR18, IE2017-5414 and B.TIC.624.UGR20Funding for open access charge: Universidad de Granada/CBU

Virus Replication as a Phenotypic Version of Polynucleotide Evolution

In this paper we revisit and adapt to viral evolution an approach based on the theory of branching process advanced by Demetrius, Schuster and Sigmund ("Polynucleotide evolution and branching processes", Bull. Math. Biol. 46 (1985) 239-262), in their study of polynucleotide evolution. By taking into account beneficial effects we obtain a non-trivial multivariate generalization of their single-type branching process model. Perturbative techniques allows us to obtain analytical asymptotic expressions for the main global parameters of the model which lead to the following rigorous results: (i) a new criterion for "no sure extinction", (ii) a generalization and proof, for this particular class of models, of the lethal mutagenesis criterion proposed by Bull, Sanju\'an and Wilke ("Theory of lethal mutagenesis for viruses", J. Virology 18 (2007) 2930-2939), (iii) a new proposal for the notion of relaxation time with a quantitative prescription for its evaluation, (iv) the quantitative description of the evolution of the expected values in in four distinct "stages": extinction threshold, lethal mutagenesis, stationary "equilibrium" and transient. Finally, based on these quantitative results we are able to draw some qualitative conclusions.Comment: 23 pages, 1 figure, 2 tables. arXiv admin note: substantial text overlap with arXiv:1110.336

Prognostic value of discharge heart rate in acute heart failure patients: more relevant in atrial fibrillation?

[Abstract] Aims. The prognostic impact of heart rate (HR) in acute heart failure (AHF) patients is not well known especially in atrial fibrillation (AF) patients. The aim of the study was to evaluate the impact of admission HR, discharge HR, HR difference (admission-discharge) in AHF patients with sinus rhythm (SR) or AF on long- term outcomes. Methods. We included 1398 patients consecutively admitted with AHF between October 2013 and December 2014 from a national multicentre, prospective registry. Logistic regression models were used to estimate the association between admission HR, discharge HR and HR difference and one- year all-cause mortality and HF readmission. Results. The mean age of the study population was 72 ± 12 years. Of these, 594 (42.4%) were female, 655 (77.8%) were hypertensive and 655 (46.8%) had diabetes. Among all included patients, 745 (53.2%) had sinus rhythm and 653 (46.7%) had atrial fibrillation. Only discharge HR was associated with one year all-cause mortality (Relative risk (RR) = 1.182, confidence interval (CI) 95% 1.024–1.366, p = 0.022) in SR. In AF patients discharge HR was associated with one year all cause mortality (RR = 1.276, CI 95% 1.115–1.459, p ≤ 0.001). We did not observe a prognostic effect of admission HR or HRD on long-term outcomes in both groups. This relationship is not dependent on left ventricular ejection fraction. Conclusions. In AHF patients lower discharge HR, neither the admission nor the difference, is associated with better long-term outcomes especially in AF patients

Mortality and cardiovascular disease burden of uncontrolled diabetes in a registry-based cohort: the ESCARVAL-risk study

BACKGROUND: Despite the epidemiological evidence about the relationship between diabetes, mortality and cardiovascular disease, information about the population impact of uncontrolled diabetes is scarce. We aimed to estimate the attributable risk associated with HbA1c levels for all-cause mortality and cardiovascular hospitalization. METHODS: Prospective study of subjects with diabetes mellitus using electronic health records from the universal public health system in the Valencian Community, Spain 2008-2012. We included 19,140 men and women aged 30 years or older with diabetes who underwent routine health examinations in primary care. RESULTS: A total of 11,003 (57%) patients had uncontrolled diabetes defined as HbA1c ≥6.5%, and, among those, 5325 participants had HbA1c ≥7.5%. During an average follow-up time of 3.3 years, 499 deaths, 912 hospitalizations for coronary heart disease (CHD) and 786 hospitalizations for stroke were recorded. We observed a linear and increasingly positive dose-response of HbA1c levels and CHD hospitalization. The relative risk for all-cause mortality and CHD and stroke hospitalization comparing patients with and without uncontrolled diabetes was 1.29 (95 CI 1.08,1.55), 1.38 (95 CI 1.20,1.59) and 1.05 (95 CI 0.91, 1.21), respectively. The population attributable risk (PAR) associated with uncontrolled diabetes was 13.6% (95% CI; 4.0-23.9) for all-cause mortality, 17.9% (95% CI; 10.5-25.2) for CHD and 2.7% (95% CI; - 5.5-10.8) for stroke hospitalization. CONCLUSIONS: In a large general-practice cohort of patients with diabetes, uncontrolled glucose levels were associated with a substantial mortality and cardiovascular disease burden

Rationale and methods of the cardiometabolic valencian study (escarval-risk) for validation of risk scales in mediterranean patients with hypertension, diabetes or dyslipidemia

BackgroundThe Escarval-Risk study aims to validate cardiovascular risk scales in patients with hypertension, diabetes or dyslipidemia living in the Valencia Community, a European Mediterranean region, based on data from an electronic health recording system comparing predicted events with observed during 5 years follow-up study.Methods/DesignA cohort prospective 5 years follow-up study has been designed including 25000 patients with hypertension, diabetes and/or dyslipidemia attended in usual clinical practice. All information is registered in a unique electronic health recording system (ABUCASIS) that is the usual way to register clinical practice in the Valencian Health System (primary and secondary care). The system covers about 95% of population (near 5 million people). The system is linked with database of mortality register, hospital withdrawals, prescriptions and assurance databases in which each individual have a unique identification number. Diagnoses in clinical practice are always registered based on IDC-9. Occurrence of CV disease was the main outcomes of interest. Risk survival analysis methods will be applied to estimate the cumulative incidence of developing CV events over time.DiscussionThe Escarval-Risk study will provide information to validate different cardiovascular risk scales in patients with hypertension, diabetes or dyslipidemia from a low risk Mediterranean Region, the Valencia Community

Pressure-induced amorphization of YVO4:Eu3+ nanoboxes

This is an author-created, un-copyedited version of an article published in Nanotechnology. IOP Publishing Ltd is not responsible for any errors or omissions in this version of the manuscript or any version derived from it. The Version of Record is available online at http://dx.doi.org/10.1088/0957-4484/27/2/025701A structural transformation from the zircon-type structure to an amorphous phase has been found in YVO4:Eu3+ nanoboxes at high pressures above 12.7 GPa by means of x-ray diffraction measurements. However, the pair distribution function of the high-pressure phase shows that the local structure of the amorphous phase is similar to the scheelite-type YVO4. These results are confirmed both by Raman spectroscopy and Eu3+ photoluminescence which detect the phase transition to a scheelite-type structure at 10.1 and 9.1 GPa, respectively. The irreversibility of the phase transition is observed with the three techniques after a maximum pressure in the upstroke of around 20 GPa. The existence of two D-5(0)-> F-7(0) photoluminescence peaks confirms the existence of two local environments for Eu3+, at least for the low-pressure phase. One environment is the expected for substituting Y3+ and the other is likely a disordered environment possibly found at the surface of the nanoboxes.This work has been performed under financial support from Spanish MINECO under the National Program of Materials (MAT2013-46649-C4-1/2/3/4-P) and the Consolider-Ingenio 2010 Program (MALTA CSD2007-00045). Funding by the Fundacion Caja Canarias (ENER-01) and the EU-FEDER funds is also acknowledged. JR-F thanks the Alexander von Humboldt Foundation for a postdoctoral fellowship and NS thanks the German Research Foundation (DFG) for financial support (Project RA2585/1-1). We acknowledge Diamond Light Source for time on beamline I15 under proposals EE3652 and EE6517. Parts of this research were carried out at the light source PETRA III at DESY (Hamburg), a member of the Helmholtz Association (HFG). We would like to thank H-P Liermann and W Morgenroth for assistance in using beamline P02.2.Ruiz Fuertes, J.; Gomis, O.; León Luis, SF.; Schrodt, N.; Manjón Herrera, FJ.; Ray, S.; Santamaría Pérez, D.... (2016). Pressure-induced amorphization of YVO4:Eu3+ nanoboxes. Nanotechnology. 27(2):025701-1-025701-8. https://doi.org/10.1088/0957-4484/27/2/025701S025701-1025701-8272Piot, L., Le Floch, S., Cornier, T., Daniele, S., & Machon, D. (2013). Amorphization in Nanoparticles. The Journal of Physical Chemistry C, 117(21), 11133-11140. doi:10.1021/jp401121cZhang, F. X., Wang, J. W., Lang, M., Zhang, J. M., Ewing, R. C., & Boatner, L. A. (2009). High-pressure phase transitions ofScPO4andYPO4. Physical Review B, 80(18). doi:10.1103/physrevb.80.184114Lacomba-Perales, R., Errandonea, D., Meng, Y., & Bettinelli, M. (2010). High-pressure stability and compressibility ofAPO4(A=La, Nd, Eu, Gd, Er, and Y) orthophosphates: An x-ray diffraction study using synchrotron radiation. Physical Review B, 81(6). doi:10.1103/physrevb.81.064113Yuan, H., Wang, K., Li, S., Tan, X., Li, Q., Yan, T., … Zou., B. (2012). Direct Zircon-to-Scheelite Structural Transformation in YPO4 and YPO4:Eu3+ Nanoparticles Under High Pressure. The Journal of Physical Chemistry C, 116(46), 24837-24844. doi:10.1021/jp3088995Mishra, A. K., Garg, N., Pandey, K. K., Shanavas, K. V., Tyagi, A. K., & Sharma, S. M. (2010). Zircon-monoclinic-scheelite transformation in nanocrystalline chromates. Physical Review B, 81(10). doi:10.1103/physrevb.81.104109Wang, L., Yang, W., Ding, Y., Ren, Y., Xiao, S., Liu, B., … Mao, H. (2010). Size-Dependent Amorphization of NanoscaleY2O3at High Pressure. Physical Review Letters, 105(9). doi:10.1103/physrevlett.105.095701Mukherjee, S., Kim, K., & Nair, S. (2007). Short, Highly Ordered, Single-Walled Mixed-Oxide Nanotubes Assemble from Amorphous Nanoparticles. Journal of the American Chemical Society, 129(21), 6820-6826. doi:10.1021/ja070124cŞopu, D., Albe, K., Ritter, Y., & Gleiter, H. (2009). From nanoglasses to bulk massive glasses. Applied Physics Letters, 94(19), 191911. doi:10.1063/1.3130209Ozawa, L., & Itoh, M. (2003). Cathode Ray Tube Phosphors. Chemical Reviews, 103(10), 3835-3856. doi:10.1021/cr0203490Zhu, Y., Xu, W., Zhang, H., Wang, W., Tong, L., Xu, S., … Song, H. (2012). Highly modified spontaneous emissions in YVO4:Eu3+ inverse opal and refractive index sensing application. Applied Physics Letters, 100(8), 081104. doi:10.1063/1.3688167Khan, A. F., Haranath, D., Yadav, R., Singh, S., Chawla, S., & Dutta, V. (2008). Controlled surface distribution and luminescence of YVO4:Eu3+ nanophosphor layers. Applied Physics Letters, 93(7), 073103. doi:10.1063/1.2973163Cho, Y.-S., & Huh, Y.-D. (2011). Preparation of Transparent Red-Emitting YVO4:Eu Nanophosphor Suspensions. Bulletin of the Korean Chemical Society, 32(1), 335-337. doi:10.5012/bkcs.2011.32.1.335Jayaraman, A., Kourouklis, G. A., Espinosa, G. P., Cooper, A. S., & Van Uitert, L. G. (1987). A high-pressure Raman study of yttrium vanadate (YVO4) and the pressure-induced transition from the zircon-type to the scheelite-type structure. Journal of Physics and Chemistry of Solids, 48(8), 755-759. doi:10.1016/0022-3697(87)90072-2Wang, X., Loa, I., Syassen, K., Hanfland, M., & Ferrand, B. (2004). Structural properties of the zircon- and scheelite-type phases ofYVO4at high pressure. Physical Review B, 70(6). doi:10.1103/physrevb.70.064109Manjón, F. J., Rodríguez-Hernández, P., Muñoz, A., Romero, A. H., Errandonea, D., & Syassen, K. (2010). Lattice dynamics ofYVO4at high pressures. Physical Review B, 81(7). doi:10.1103/physrevb.81.075202Boehler, R. (2006). New diamond cell for single-crystal x-ray diffraction. Review of Scientific Instruments, 77(11), 115103. doi:10.1063/1.2372734Mao, H. K., Xu, J., & Bell, P. M. (1986). Calibration of the ruby pressure gauge to 800 kbar under quasi-hydrostatic conditions. Journal of Geophysical Research, 91(B5), 4673. doi:10.1029/jb091ib05p04673Hammersley, A. P., Svensson, S. O., Hanfland, M., Fitch, A. N., & Hausermann, D. (1996). Two-dimensional detector software: From real detector to idealised image or two-theta scan. High Pressure Research, 14(4-6), 235-248. doi:10.1080/08957959608201408Holland, T. J. B., & Redfern, S. A. T. (1997). Unit cell refinement from powder diffraction data: the use of regression diagnostics. Mineralogical Magazine, 61(404), 65-77. doi:10.1180/minmag.1997.061.404.07Kraus, W., & Nolze, G. (1996). POWDER CELL – a program for the representation and manipulation of crystal structures and calculation of the resulting X-ray powder patterns. Journal of Applied Crystallography, 29(3), 301-303. doi:10.1107/s0021889895014920Toby, B. H. (2001). EXPGUI, a graphical user interface forGSAS. Journal of Applied Crystallography, 34(2), 210-213. doi:10.1107/s0021889801002242Qiu, X., Thompson, J. W., & Billinge, S. J. L. (2004). PDFgetX2: a GUI-driven program to obtain the pair distribution function from X-ray powder diffraction data. Journal of Applied Crystallography, 37(4), 678-678. doi:10.1107/s0021889804011744Chupas, P. J., Qiu, X., Hanson, J. C., Lee, P. L., Grey, C. P., & Billinge, S. J. L. (2003). Rapid-acquisition pair distribution function (RA-PDF) analysis. Journal of Applied Crystallography, 36(6), 1342-1347. doi:10.1107/s0021889803017564Farrow, C. L., Juhas, P., Liu, J. W., Bryndin, D., Božin, E. S., Bloch, J., … Billinge, S. J. L. (2007). PDFfit2 and PDFgui: computer programs for studying nanostructure in crystals. Journal of Physics: Condensed Matter, 19(33), 335219. doi:10.1088/0953-8984/19/33/335219Trenque, I., Mornet, S., Duguet, E., & Gaudon, M. (2013). New Insights into Crystallite Size and Cell Parameters Correlation for ZnO Nanoparticles Obtained from Polyol-Mediated Synthesis. Inorganic Chemistry, 52(21), 12811-12817. doi:10.1021/ic402152fLangford, J. I., & Wilson, A. J. C. (1978). Scherrer after sixty years: A survey and some new results in the determination of crystallite size. Journal of Applied Crystallography, 11(2), 102-113. doi:10.1107/s0021889878012844Klotz, S., Chervin, J.-C., Munsch, P., & Le Marchand, G. (2009). Hydrostatic limits of 11 pressure transmitting media. Journal of Physics D: Applied Physics, 42(7), 075413. doi:10.1088/0022-3727/42/7/075413Jeong, I.-K., Proffen, T., Mohiuddin-Jacobs, F., & Billinge, S. J. L. (1999). Measuring Correlated Atomic Motion Using X-ray Diffraction. The Journal of Physical Chemistry A, 103(7), 921-924. doi:10.1021/jp9836978Frogley, M. D., Sly, J. L., & Dunstan, D. J. (1998). Pressure dependence of the direct band gap in tetrahedral semiconductors. Physical Review B, 58(19), 12579-12582. doi:10.1103/physrevb.58.12579Birch, F. (1978). Finite strain isotherm and velocities for single-crystal and polycrystalline NaCl at high pressures and 300°K. Journal of Geophysical Research, 83(B3), 1257. doi:10.1029/jb083ib03p01257Popescu, C., Sans, J. A., Errandonea, D., Segura, A., Villanueva, R., & Sapiña, F. (2014). Compressibility and Structural Stability of Nanocrystalline TiO2 Anatase Synthesized from Freeze-Dried Precursors. Inorganic Chemistry, 53(21), 11598-11603. doi:10.1021/ic501571uChen, G., Stump, N. A., Haire, R. G., Peterson, J. R., & Abraham, M. M. (1992). Pressure-induced phase transition in YVO4:Eu3+: A luminescence study at high pressure. Journal of Physics and Chemistry of Solids, 53(10), 1253-1257. doi:10.1016/0022-3697(92)90241-5Rivera-López, F., Martín, I. R., Da Silva, I., González-Silgo, C., Rodríguez-Mendoza, U. R., Lavín, V., … Fernández-Urban, J. (2006). Analysis of the Eu3+emission in a SrWO4laser matrix under pressure. High Pressure Research, 26(4), 355-359. doi:10.1080/08957950601105085Dieke, G. H., & Crosswhite, H. M. (1963). The Spectra of the Doubly and Triply Ionized Rare Earths. Applied Optics, 2(7), 675. doi:10.1364/ao.2.000675Lavı́n, V., Babu, P., Jayasankar, C. K., Martı́n, I. R., & Rodrı́guez, V. D. (2001). On the local structure of Eu3+ ions in oxyfluoride glasses. Comparison with fluoride and oxide glasses. The Journal of Chemical Physics, 115(23), 10935-10944. doi:10.1063/1.1420731Peacock, R. D. (s. f.). The intensities of lanthanide f ↔ f transitions. Rare Earths, 83-122. doi:10.1007/bfb0116556Oomen, E. W. J. L., & van Dongen, A. M. A. (1989). Europium (III) in oxide glasses. Journal of Non-Crystalline Solids, 111(2-3), 205-213. doi:10.1016/0022-3093(89)90282-2Song, H., Chen, B., Peng, H., & Zhang, J. (2002). Light-induced change of charge transfer band in nanocrystalline Y2O3:Eu3+. Applied Physics Letters, 81(10), 1776-1778. doi:10.1063/1.1501441Ray, S., León-Luis, S. F., Manjón, F. J., Mollar, M. A., Gomis, Ó., Rodríguez-Mendoza, U. R., … Lavín, V. (2014). Broadband, site selective and time resolved photoluminescence spectroscopic studies of finely size-modulated Y2O3:Eu3+ phosphors synthesized by a complex based precursor solution method. Current Applied Physics, 14(1), 72-81. doi:10.1016/j.cap.2013.07.02

Phenological Study of 53 Spanish Minority Grape Varieties to Search for Adaptation of Vitiviniculture to Climate Change Conditions

The main phenological stages (budburst, flowering, veraison, and ripeness) of 53 Spanish minority varieties were studied to determine their potential to help winegrowers adapt to climate change conditions. In total, 43 varieties were studied in the same location in Spain (Alcalá de Henares, in the Madrid region) and 10 varieties in 5 other regions (Galicia, Navarre, Catalonia, Extremadura, and Andalusia). Other traits of agronomic and oenological interest, such as yield and acidity, were also monitored. The results allow for the grouping of the varieties into several clusters according to the time of ripeness (very early—only for red varieties—and early, intermediate, and late, for both red and white varieties) and yield (high, medium, and low). The total acidity in the grape juice ranged from 3 to 11 g of tartaric acid/L. The average temperatures were higher (up to 3–4 °C during summer) compared to historical averages during the 1957–2021 time period. Advanced phenology phases and reduced acidity are regarded as negative effects of climate change for winegrowing practices. Since some minority varieties showed late or intermediate ripening, high acidity, and high (1 Kg/shoot) or medium (0.5 Kg/shoot) yield, our findings suggest that they may be cultivated in the coming years by winegrowers as an approach to mitigate climate change effects.info:eu-repo/semantics/publishedVersio

El estudio PROPRESE: resultados de un nuevo modelo organizativo en atención primaria para pacientes con cardiopatía isquémica crónica basado en una intervención multifactorial

ResumenObjetivoComparando los resultados obtenidos en los estudios EUROASPIRE I y EUROASPIRE III en pacientes con cardiopatía isquémica se muestra que el grado de control de los factores de riesgo mayores es mejorable. El objetivo de este estudio es evaluar la eficacia de una intervención multifactorial orientada a la mejora del grado de control en estos pacientes en el ámbito de la atención primaria.MétodosEn este estudio de intervención aleatorizado, con 1 año de seguimiento, se reclutó a pacientes con diagnóstico de cardiopatía isquémica (145 en el grupo de intervención y 1.461 en el grupo control). Se aplicó una intervención organizativa mixta basada en la mejora de la relación profesional sanitario-paciente (de acuerdo a los modelos del Chronic Care, el Stanford Expert Patient Programme y el Kaiser Permanente) y en la formación profesional continuada. Los principales resultados fueron el efecto sobre el tabaquismo, el colesterol unido a lipoproteínas de baja densidad (cLDL), la presión arterial sistólica (PAS) y la presión arterial diastólica (PAD) a través de un análisis multivariable.ResultadosLas características de los pacientes fueron: edad (68,4±11,8 años), varones (71,6%), diabetes mellitus (51,3%), dislipemia (68,5%), hipertensión arterial (76,7%), no fumadores (76,1%); cLDL < 100mg/dl (46,9%); PAS < 140mmHg (64,5%); PAD < 90 (91,2%). El análisis multivariable mostró que el riesgo para el buen control en el grupo de intervención fue tabaquismo, riesgo relativo ajustado (RRa): 15,7 (intervalo de confianza del 95% [IC95%], 4,2–58,7); p < 0,001; cLDL, RRa: 2,98 (IC95%, 1,48–6,02); p < 0,002; PAS, RRa: 1.97 (IC95%, 1,21–3,23); p < 0,007, y PAD; RRa: 1,51 (IC95%, 0,65–3,50); p < 0,342.ConclusionesUna intervención multifactorial basada en el modelo de paciente crónico centrada en atención primaria y que facilite la toma de decisiones compartidas con los pacientes y la formación de los profesionales mejora el grado de control de los factores de riesgo cardiovascular (tabaquismo, cLDL y PAS). Las estrategias de mejora en la atención de la cronicidad pueden ser una herramienta eficaz para conseguir mejores resultados.AbstractObjectiveComparison of the results from the EUROASPIRE I to the EUROASPIRE III, in patients with coronary heart disease, shows that the prevalence of uncontrolled risk factors remains high. The aim of the study was to evaluate the effectiveness of a new multifactorial intervention in order to improve health care for chronic coronary heart disease patients in primary care.MethodsIn this randomized clinical trial with a 1-year follow-up period, we recruited patients with a diagnosis of coronary heart disease (145 for the intervention group and 1461 for the control group). An organizational intervention on the patient-professional relationship (centered on the Chronic Care Model, the Stanford Expert Patient Programme and the Kaiser Permanente model) and formative strategy for professionals were carried out. The main outcomes were smoking control, low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP) and diastolic blood pressure (DBP). A multivariate analysis was performed.ResultsThe characteristics of patients were: age (68.4±11.8 years), male (71.6%), having diabetes mellitus (51.3%), dyslipidemia (68.5%), arterial hypertension (76.7%), non-smokers (76.1%); LDL-C < 100mg/dL (46.9%); SBP < 140mmHg (64.5%); DBP < 90 (91.2%). The multivariable analysis showed the risk of good control for intervention group to be: smoking, adjusted relative risk (aRR): 15.70 (95% confidence interval [95%CI], 4.2–58.7); P < .001; LDL-C, aRR: 2.98 (95%CI, 1.48–6.02); P < .002; SPB, aRR: 1.97 (95%CI, 1.21–3.23); P < .007, and DBP: aRR: 1.51 (95%CI, 0.65–3.50); P < .342.ConclusionsAn intervention based on models for chronic patients focused in primary care and involving patients in medical decision making improves cardiovascular risk factors control (smoking, LDL-C and SBP). Chronic care strategies may be an efficacy tool to help clinicians to involve the patients with a diagnosis of CHD to reach better outcomes