Valor diagnóstico y pronóstico de nuevos biomarcadores de infección en pacientes oncológicos con neutropenia febril postquimioterapia.

El cáncer sigue siendo la principal causa de muerte a escala mundial a pesar del desarrollo de la tecnología, que ha logrado un diagnóstico en estadíos cada vez más precoces de la enfermedad, y la aparición de tratamientos más eficaces, que han permitido que a pesar de su elevada mortalidad se haya alargado la supervivencia de estos pacientes en los últimos años. Fruto del aumento de la supervivencia, junto con la edad más avanzada de los pacientes que se pueden someter a tratamiento quimioterápico, y combinado con el efecto mielosupresor de los tratamientos citostáticos de nueva generación, han aparecido complicaciones asociadas al propio tratamiento de la enfermedad. La neutropenia febril (NF) es una de las principales complicaciones en estos pacientes tratados con quimioterapia (QT), ya que constituye un factor de alto riesgo para el desarrollo de complicaciones infecciosas, asociadas a una elevada morbimortalidad. Por ello, en este tipo de enfermos es esencial disponer de herramientas que contribuyan a un diagnóstico precoz de la infección y a seleccionar pacientes de bajo o alto riesgo y ayuden al clínico a la toma de decisiones, en cuanto al tratamiento, seguimiento o necesidad de hospitalización. Es en este punto, y en base a las últimas recomendaciones de la ASCO (American Society of Clinical Oncology), donde se recomienda el empleo de biomarcadores séricos para completar y mejorar a las actuales escalas clínicas, por lo que creemos de interés el estudio de diferentes biomarcadores. Dentro de los estos, la proteína C reactiva (PCR) y la procalcitonina (PCT) han sido de los más estudiados, incluso en poblaciones similares; sin embargo, no se trata de biomarcadores perfectos, por lo que es necesario ampliar el estudio a nuevas alternativas, como es el caso de los biomarcadores que se emplean en el estudio: Pancreatic Stone Protein (PSP) y el CD25 soluble (sCD25). MATERIAL Y MÉTODOS Se trata de un estudio unicéntrico, observacional y prospectivo, donde se incluyeron pacientes que ingresaron por el Servicio de Urgencias cumpliendo los criterios establecidos para el diagnóstico de neutropenia febril. Se realizó la determinación de los biomarcadores al ingreso y mediante la consulta de la historia clínica y en base a las pruebas microbiológicas se clasificó a los pacientes. Para evaluar el rendimiento de los biomarcadores, tanto para el diagnóstico de infección como para predecir complicaciones, empleamos la comparación de curvas ROC (Receiver Operating Characteristics). RESULTADOS Se recogieron para el estudio un total de 114 episodios de NF postQT de manera consecutiva, que se corresponden a 105 pacientes, con una mediana de edad de 63 años, donde hay predominio de las mujeres (61%). Con respecto a la localización del tumor, hay un predominio de los tumores sólidos (77,2%), frente a un total de 26 episodios de neoplasias hematológicas. La incidencia de complicaciones infecciosas en nuestra cohorte fue de 51,8%, con un predominio del foco urinario (32%) y respiratorio (27%). Todos los biomarcadores han mostrado utilidad para el diagnóstico de infección con diferencias estadísticamente significativas. Si nos remitimos al AUC ROC de cada uno de los biomarcadores para el diagnóstico de infección, PSP (0,750) y sCD25 (0,729) presentan un rendimiento similar a PCR (0,760), aunque inferior a PCT, que es el biomarcador que presenta mayor AUC ROC (0,901) para el diagnóstico de infección. Además, tras realizar el análisis multivariante de los datos, PCT se ha mostrado como el único predictor independiente para el diagnóstico de infección. Si valoramos la utilidad de los biomarcadores para la predicción de eventos adversos frente a la escala MASCC, encontramos que PSP está al nivel de la propia escala con un AUC ROC de 0,782, frente a 0,818 de la escala. Por su parte, PCT mejora al score MASSC con un AUC ROC de 0,861. Al realizar el análisis de regresión logística, tanto PCT como PSP, junto a la escala MASCC, aparecen como variables independientes en el análisis multivariante. Por último, se evaluó su utilidad para detectar complicaciones, tal como la bacteriemia, en este tipo de pacientes, mostrando todos los biomarcadores, así como la escala MASCC, diferencias significativas. A la hora de comparar el rendimiento y las características de los biomarcadores mediante la comparación de curvas ROC, PCT (0,850) es el biomarcador que presenta mejor rendimiento, seguido de PSP (0,752) y sCD25 (0,739). CONCLUSIONES El empleo de biomarcadores en pacientes oncológicos con neutropenia febril postQT ha mostrado ser una herramienta de utilidad, que puede ayudar a un diagnóstico precoz y fiable de los episodios infecciosos. PCT es el biomarcador que presenta mejor rendimiento, pero PSP y sCD25 han mostrado un rendimiento notable, por lo que podrían complementar a PCT para el manejo de estos pacientes. A su vez, PSP ha mostrado, junto a PCT, su utilidad para evaluar el pronóstico de estos pacientes, ayudando a la predicción de posibles complicaciones, con unas prestaciones que incluso mejoran a la de la propia escala MASCC.Medicin

Aperiodic two-layer energy management system for community microgrids based on blockchain strategy

Regulatory changes in different countries regarding self-consumption and growing public concern about the environment are encouraging the establishment of community microgrids. These community microgrids integrate a large number of small-scale distributed energy resources and offers a solution to enhance power system reliability and resilience. This work proposes a geographically-based split of the community microgrids into clusters of members that tend to have similar consumption and generation profiles, mimicking the most typical layout of cities. Assuming a community microgrid divided into clusters, a two-layer architecture is developed to facilitate the greater penetration of distributed energy resources in an efficient way. The first layer, referred as the market layer, is responsible for creating local energy markets with the aim of maximising the economic benefits for community microgrid members. The second layer is responsible for the network reconfiguration, which is based on the energy balance within each cluster. This layer complies with the IEC 61850 communication standard, in order to control commercial sectionalizing and tie switches. This allows the community microgrid network to be reconfigured to minimise energy exchanges with the main grid, without requiring interaction with the distributed system operator. To implement this two-layer energy management strategy, an aperiodic market approach based on Blockchain technology, and the additional functionality offered by Smart Contracts is adopted. This embraces the concept of energy communities since it decentralizes the control and eliminates intermediaries. The use of aperiodic control techniques helps to overcome the challenges of using Blockchain technology in terms of storage, computational requirements and member privacy. The scalability and modularity of the Smart Contract-based system allow each cluster of members to be designed by tailoring the system to their specific needs. The implementation of this strategy is based on low-cost off-the-shelf devices, such as Raspberry Pi 4 Model B boards, which operate as Blockchain nodes of community microgrid members. Finally, the strategy has been validated by emulating two use cases based on the IEEE 123-node system network model highlighting the benefits of the proposal.Comunidad de Madri

Automated Classification of Severity in Cardiac Dyssynchrony Merging Clinical Data and Mechanical Descriptors

Cardiac resynchronization therapy (CRT) improves functional classification among patients with left ventricle malfunction and ventricular electric conduction disorders. However, a high percentage of subjects under CRT (20%-30%) do not show any improvement. Nonetheless the presence of mechanical contraction dyssynchrony in ventricles has been proposed as an indicator of CRT response. This work proposes an automated classification model of severity in ventricular contraction dyssynchrony. The model includes clinical data such as left ventricular ejection fraction (LVEF), QRS and P-R intervals, and the 3 most significant factors extracted from the factor analysis of dynamic structures applied to a set of equilibrium radionuclide angiography images representing the mechanical behavior of cardiac contraction. A control group of 33 normal volunteers (28 ± 5 years, LVEF of 59.7% ± 5.8%) and a HF group of 42 subjects (53.12 ± 15.05 years, LVEF < 35%) were studied. The proposed classifiers had hit rates of 90%, 50%, and 80% to distinguish between absent, mild, and moderate-severe interventricular dyssynchrony, respectively. For intraventricular dyssynchrony, hit rates of 100%, 50%, and 90% were observed distinguishing between absent, mild, and moderatesevere, respectively. These results seem promising in using this automated method for clinical follow-up of patients undergoing CRT

Yeast biodiversity in fermented doughs and raw cereal matrices and the study of technological traits of selected strains isolated in spain

43 páginas, 12 tablas, 8 figurasBakers use pure microorganisms and/or traditional sourdoughs as the leavening agent for making bread. The performance of each starter and the substances produced by the microorganisms greatly affect the dough rheology and features of breads. Modern sourdoughs inoculated with selected lactic acid bacteria and yeasts are microbiologically stable, safer than traditional sourdoughs, and easy to use. However, the commercial repertoire of baker’s yeasts is still limited. Therefore, there is a demand for new strains of yeast species, capable of conferring distinctive traits to breads made from a variety of agri-food matrices, in the design of innovative starters. In this context, we report the first comprehensive study on yeasts isolated from a wide range of fermented doughs, cereal flours, and grains of Spain. Nine yeast species were identified from 433 isolates, which were distributed among separate clades. Moreover, phenotypic traits of potential technological relevance were identified in selected yeast strains. Mother doughs (MDs) showed the greatest yeast biodiversity, whereas commercial Saccharomyces starters or related and wild strains often dominated the bakery doughs. A metataxonomic analysis of wheat and tritordeum MDs revealed a greater richness of yeast species and percentage variations related to the consistency, flour type, and fermentation time of MDs.This work was supported by Projects PROPAN (IPT-2012-1321-06000) and InnoStarPan (RTC-2015-4391), funded by the Spanish Ministry of Science and Innovation (MICINN) and FEDERPeer reviewe

Effect of different media additives on capacitation of frozen-thawed ram spermatozoa as a potential replacement for estrous sheep serum

Capacitation is a key process through which spermatozoa acquire their fertilizing ability. This event is required for the successful application of assisted reproductive technologies such as IVF. The aim of the present study was to investigate the effect of using a synthetic oviductal fluid medium supplemented with either heparin–hypotaurine alone, in combination with progesterone (P4), 17β-estradiol (E2), or BSA, or just β-cyclodextrin, in replacement for estrous sheep serum (ESS) for ram sperm capacitation. After incubation in the corresponding media for 15 (time 0) or 60 minutes, sperm function was evaluated by computerized sperm motility analysis and flow cytometry (plasma membrane status and fluidity). Treatments rendering the best results in regards to sperm function parameters related to capacitation were used for an IVF test. Herein, neither heparin–hypotaurine (alone), or in combination with P4, or E2, nor β-cyclodextrin induced capacitation-related changes in frozen–thawed ram spermatozoa. Only the medium supplemented with heparin–hypotaurine–BSA was able to induce changes compatible with in vitro capacitation relating to sperm motility pattern and plasma membrane fluidity, comparable to those in ESS-containing medium. Both media yielded sperm parameter values that differed (P < 0.05) from those obtained in the rest of the media tested. However, after the IVF trial, BSA was unable to support cleavage rates (21.80%) comparable to those obtained with ESS (52.60%; P < 0.05). We conclude that heparin–hypotaurine, P4, E2, β-cyclodextrin, or BSA is not suitable for replacing ESS in capacitation and fertilization media for ram spermatozoa.M. Ramón was supported by the Research Recruitment Program from the National Institute for Agricultural and Food Research program.Peer Reviewe

IAA : Información y actualidad astronómica (31)

Sumario : Relámpagos en las alturas.-- El misterio de Di Herculis.-- Jets en galaxias activas.-- HISTORIAS DE ASTRONOMÍA. Los All-Star de la física.-- DECONSTRUCCIÓN Y otros ENSAYOS. Cómo “encender” un cuásar .-- EL “MOBY DICK” DE... María Rosa Zapatero Osorio (CAB, CSIC-INTA).-- ACTUALIDAD.-- ENTRE BASTIDORES.-- CIENCIA: PILARES E INCERTIDUMBRES : El Sistema Solar: ¿conocemos de verdad nuestro vecindario?.-- ACTIVIDADES IAA, AGENDA Y RECOMENDADOS.N

La imagen y la narrativa como como herramientas para el abordaje psicosocial en escenarios de violencia. Departamentos del Atlántico y Magdalena

En esta fase 4 del Diplomado de profundización del acompañamiento psicosocial en escenarios de Violencia se abordaron diferentes contextos de casos reales desde el enfoque narrativo y su respectivo análisis. Cada uno de los integrantes del grupo analizó una de las historias de vida tomadas del libro Voces: historias de violencia y esperanza en Colombia. Posteriormente, se eligió una de estas historias, el caso de Carlos Arturo, y se analizó en grupo, en el que se identificaron los impactos psicosociales positivos y negativos que se dan en el caso de Carlos Arturo, el protagonista de la historia, un niño campesino de 14 años de edad, nacido en Nariño, quien en su relato revela aspectos importantes que permitieron identificar las imágenes dominantes de violencia y sus significados subjetivos, y cómo estas imágenes se repiten y naturalizan en el tiempo, también destaca la voz del protagonista como sobreviviente, sobre una narrativa llena de episodios de violencia como víctima. Además es importante resaltar su capacidad de resiliencia y cómo usar los recursos de afrontamiento para superar imágenes y escenas de horror presenciadas como resultado de la violencia del conflicto armado. Adicionalmente, analizamos desde el enfoque narrativo el caso de Peñas Coloradas, que impacta desde el relato de la población, víctima del hostigamiento y persecución militar, con emergentes psicosociales latentes, quienes hacen uso de sus recursos de afrontamiento movilizándolos hacia una perspectiva positiva para superar eventos traumáticos de violencia y tratar de reconstruirse socialmente con una capacidad de resiliencia natural pero desarrollada. En ese análisis, el grupo propone acciones de apoyo a la crisis de los pobladores y estrategias encaminadas a fortalecer los recursos de afrontamiento de la población.In this phase 4 of the Diploma of deepening of the psychosocial accompaniment in scenes of Violence, different contexts of real cases were approached from the narrative approach and their respective analysis. Each of the members of the group analyzed one of the Life Stories taken from the book Voices: stories of violence and hope in Colombia. Subsequently, one of these stories, the case of Carlos Arturo, was chosen and analyzed in a group, in which the positive and negative psychosocial impacts that occur in the case of Carlos Arturo, the protagonist of the story, were identified, a 14-year-old peasant born in Nariño, who in his story reveals important aspects that allowed identifying the dominant images of violence and their subjective meanings, and how these images are repeated and naturalized over time, also highlights the voice of the protagonist as a survivor, about a narrative full of episodes of violence as a victim. It is also important to highlight their resilience capacity and how to use coping resources to overcome images and scenes of horror witnessed as a result of the violence of the armed conflict. Additionally, we analyze from the narrative approach the case of Peñas Coloradas, which impacts from the story of the population, victim of military harassment and persecution, with latent psychosocial emergents, who make use of their coping resources mobilizing them towards a positive perspective to overcome traumatic events of violence and try to rebuild themselves socially with a natural but developed capacity for resilience. In this analysis, the group proposes actions to support the crisis of the inhabitants and strategies aimed at strengthening the coping resources of the population

Pubertal stage, body mass index, and cardiometabolic risk in children and adolescents in Bogotá, Colombia: The cross-sectional fuprecol study

This study explored the association between pubertal stage and anthropometric and cardiometabolic risk factors in youth. A cross-sectional study was conducted in 2877 Colombian children and adolescents (9–17.9 years of age). Weight, height, and waist circumference were measured and body mass index (BMI) was calculated. A biochemical study was performed to determine the cardiometabolic risk index (CMRI). Blood pressure was evaluated and pubertal stage was assessed with the Tanner criteria. Hierarchical multiple regression analyses were performed. The most significant variable (p less than 0.05) in the prognosis of cardiometabolic risk was found to be the BMI in both boys and girls. In the case of girls, the pubertal stage was also a CMRI predictive factor. In conclusion, BMI was an important indicator of cardiovascular risk in both sexes. Pubertal stage was associated with cardiovascular risk only in the girls. © 2017 by the authors. Licensee MDPI, Basel, Switzerland

Anatomical Variants of Anterior Cerebral Arterial Circle: A Study by Multidetector Computerized 3D Tomographic Angiography

SUMMARY: One of the most common causes of stroke is rupture of aneurysms whose approach requires knowledge of anatomical variants. The aim of this study was to determine the prevalence of anatomical variants of the anterior cerebral artery (ACA) and the anterior communicating artery (AComA) by 3D computed tomography angiography (3D CTA) in Mexican individuals. A retrospective, observational, cross-sectional descriptive study of 283 patients, independent of sex or age, in which morphometric measurements of cerebral vessels were evaluated using contrasted 3D CTA from a period of two years was performed. We found at least one "atypical" variant in a third of the study population (33.93 %). The most common "atypical" variant was the absence of the AComA (14.1 %). A significant association between the hypoplastic variant of the right A1 segment and hypoplasia of the left A1 and the right A2 was found, while hypoplasia of the left A1 was associated with hypoplasia of the right A2. There is a difference in the prevalence of anatomical variants of the ACA-AComA complex in Mexican population in relation to other populations. The typical variant is the most prevalent form in the study population. However, the presence of atypical variants represents an important number that should be taken into account in clinical and surgical procedures. KEY WORDS: Anterior cerebral artery; Anatomical variant; Anterior communicating artery; Cerebral arterial circle; Subarachnoid hemorrhage; Cerebral endovascular surgery

Yeast Biodiversity in Fermented Doughs and Raw Cereal Matrices and the Study of Technological Traits of Selected Strains Isolated in Spain

[EN] Bakers use pure microorganisms and/or traditional sourdoughs as the leavening agent for making bread. The performance of each starter and the substances produced by the microorganisms greatly affect the dough rheology and features of breads. Modern sourdoughs inoculated with selected lactic acid bacteria and yeasts are microbiologically stable, safer than traditional sourdoughs, and easy to use. However, the commercial repertoire of baker’s yeasts is still limited. Therefore, there is a demand for new strains of yeast species, capable of conferring distinctive traits to breads made from a variety of agri-food matrices, in the design of innovative starters. In this context, we report the first comprehensive study on yeasts isolated from a wide range of fermented doughs, cereal flours, and grains of Spain. Nine yeast species were identified from 433 isolates, which were distributed among separate clades. Moreover, phenotypic traits of potential technological relevance were identified in selected yeast strains. Mother doughs (MDs) showed the greatest yeast biodiversity, whereas commercial Saccharomyces starters or related and wild strains often dominated the bakery doughs. A metataxonomic analysis of wheat and tritordeum MDs revealed a greater richness of yeast species and percentage variations related to the consistency, flour type, and fermentation time of MDs