Cystic lesion of pectoralis minor muscle: learning from mistakes

Hydatidosis is a frequent infestation in large endemic areas, caused by helminths. Primary localization within the muscle or bone tissues is rare. We report the case of a 52-year-old woman with a cystic lesion located in the right pectoralis minor muscle, who was initially diagnosed with cystic lymphangioma by imaging examination. She was submitted for surgical treatment; in block resection of the tumor along with the involved muscle was performed. The histopathological diagnosis was of hydatid cyst. The contribution of the ancillary lab tests is analyzed for a precise preoperative diagnostic approach. This case well illustrates that the most likely is not always what it appears to be. Facing of a cystic lesion in the lungs, liver or muscle, clinicians should always think on hydatid disease, particularly in endemic areas

Improved Mechanical, Thermal, and Hydrophobic Properties of PLA Modified with Alkoxysilanes by Reactive Extrusion Process

[EN] An eco-friendly strategy for the modification of polylactic acid (PLA) surface properties, using a solvent-free process, is reported. Reactive extrusion (REX) allowed the formation of new covalent bonds between functional molecules and the PLA polymeric matrix, enhancing its mechanical properties and modifying surface hydrophobicity. To this end, the PLA backbone was modified using two alkoxysilanes, phenyltriethoxysilane and N-octyltriethoxysilane. The reactive extrusion process was carried out under mild conditions, using melting temperatures between 150 and 180 degrees C, 300 rpm as screw speed, and a feeding rate of 3 kg center dot h(-1). To complete the study, flat tapes of neat and functionalized PLA were obtained through monofilament melt extrusion to quantify the enhancement of mechanical properties and hydrophobicity. The results verified that PLA modified with 3 wt% of N-octyltriethoxysilane improves mechanical and thermal properties, reaching Young's modulus values of 4.8 GPa, and PLA hydrophobic behavior, with values of water contact angle shifting from 68.6 degrees to 82.2 degrees.This research work was funded by the Conselleria d'Economia Sostenible, Sectors Productius, Comerc i Treball de la Generalitat Valenciana through IVACE. Project references: GREENFILS, IMAMCI/2019/1 and BIOREX, IMAMCI/2020/1.Torres, E.; Gaona, A.; García-Bosch, N.; Muñoz, M.; Fombuena, V.; Moriana, R.; Vallés Lluch, A. (2021). Improved Mechanical, Thermal, and Hydrophobic Properties of PLA Modified with Alkoxysilanes by Reactive Extrusion Process. Polymers. 13(15):1-16. https://doi.org/10.3390/polym13152475S116131

Systemic analysis framework for the impact of economic and financial risks

Este documento presenta el marco de referencia del Banco de España para el análisis del impacto de la materialización de riesgos macroeconómicos y financieros sobre la actividad real y la estabilidad financiera. Este marco incluye un amplio conjunto de modelos y métodos, tanto empíricos como teóricos, con el fin de capturar la heterogeneidad de las diversas fuentes de riesgo y sus distintas características. En particular, se describe su aplicación para medir el impacto de riesgos, derivados tanto de fuentes endógenas (como la acumulación de desequilibrios macroeconómicos y financieros a lo largo del ciclo) como de fuentes exógenas. Respecto a estas últimas, se presenta la aplicación de estos modelos en el contexto de la irrupción de la pandemia de COVID-19 y de las medidas de política económica adoptadas en respuesta la crisis resultante, tanto en los ámbitos fiscal y monetario como en el prudencial. Igualmente, se presenta su aplicación en el contexto de la invasión rusa de Ucrania y de la intensificación de las tensiones inflacionarias y de incertidumbre económica.This paper presents the Banco de España’s reference framework for the analysis of macroeconomic and financial risk, and the impact of the materialisation of this risk on financial stability and the real economy. The framework encompasses a broad set of empirical and theoretical models and methods, with the aim of capturing heterogeneity in the characteristics of different sources of risk. In particular, the paper describes how these models are used to identify the impact of endogenous sources of risk, such as the build-up of macro-financial imbalances over the cycle, and of exogenous shocks. Regarding the latter, the paper presents an application of the models to the main exogenous events that have occurred recently: the COVID-19 pandemic, including the fiscal, monetary and prudential measures adopted as a response to this shock; the Russian invasion of Ukraine; and the subsequent high inflation and economic uncertainty environment

RELACIÓN ENTRE CLIMA SOCIAL FAMILIAR Y NIVEL DE AUTOESTIMA

El presente trabajo de investigación tiene como objetivo general determinar la relación entre el clima social familiar y el nivel de autoestima enestudiantes pertenecientes al 5to grado de la I.E. 82105 Escuela Concertada Solaris - Alto Trujillo. El estudio se realizó con una poblaciónmuestral de 25 alumnos, para identificar la relación entre las variables se utilizó la Prueba de Correlación de Pearson. Los resultados de climasocial familiar indican que el 48% de alumnos tienen un nivel adecuado y el 52 % tienen un nivel inadecuado, lo cual se debería a que en loshogares de estos niños no tienen una buena relación, cohesión y no se han desarrollado familiarmente. En cuanto a la variable de autoestima seevidencia que el nivel autoestima en riesgo, ocupa un 44% siendo el de mayor porcentaje, mientras que el nivel baja autoestima ocupa un 4%siendo este el nivel más bajo, esto se debería a que estos alumnos no han desarrollado sus dimensiones de autonomía, identidad personal,emociones, motivación, socialización y familia. Finalmente al observar que en un 44% de estudiantes con nivel de autoestima en riesgo prevalecíaun nivel de clima inadecuado, y que en un 4% de estudiantes con nivel de autoestima bajo también prevalecía el nivel inadecuado del clima socialfamiliar y siendo estos los porcentajes más alto y bajo se llegó a la conclusión que si existe una relación (directa) ya que al bajar un nivel elotro también cae; por lo tanto el clima social familiar y la autoestima de los estudiantes del 5to grado de la I.E. 82105 Escuela Concertada Solaris- Alto Trujillo, guardan relación

Marco de análisis sistémico del impacto de los riesgos económicos y financieros

This paper presents the Banco de España’s reference framework for the analysis of macroeconomic and financial risk, and the impact of the materialisation of this risk on financial stability and the real economy. The framework encompasses a broad set of empirical and theoretical models and methods, with the aim of capturing heterogeneity in the characteristics of different sources of risk. In particular, the paper describes how these models are used to identify the impact of endogenous sources of risk, such as the build-up of macro-financial imbalances over the cycle, and of exogenous shocks. Regarding the latter, the paper presents an application of the models to the main exogenous events that have occurred recently: the COVID-19 pandemic, including the fiscal, monetary and prudential measures adopted as a response to this shock; the Russian invasion of Ukraine; and the subsequent high inflation and economic uncertainty environment.Este documento presenta el marco de referencia del Banco de España para el análisis del impacto de la materialización de riesgos macroeconómicos y financieros sobre la actividad real y la estabilidad financiera. Este marco incluye un amplio conjunto de modelos y métodos, tanto empíricos como teóricos, con el fin de capturar la heterogeneidad de las diversas fuentes de riesgo y sus distintas características. En particular, se describe su aplicación para medir el impacto de riesgos, derivados tanto de fuentes endógenas (como la acumulación de desequilibrios macroeconómicos y financieros a lo largo del ciclo) como de fuentes exógenas. Respecto a estas últimas, se presenta la aplicación de estos modelos en el contexto de la irrupción de la pandemia de COVID-19 y de las medidas de política económica adoptadas en respuesta la crisis resultante, tanto en los ámbitos fiscal y monetario como en el prudencial. Igualmente, se presenta su aplicación en el contexto de la invasión rusa de Ucrania y de la intensificación de las tensiones inflacionarias y de incertidumbre económica

Cryopreservation of unrelated donor hematopoietic stem cells: the right answer for transplantations during the COVID-19 pandemic?

Cryopreservation was recommended to ensure continuity of unrelated donor (UD) hematopoietic stem cell transplantation (HSCT) during COVID-19 pandemic. However, its impact on clinical outcomes and feasibility was not well known. We compared 32 patients who underwent UD HSCT using cryopreserved peripheral blood stem cells (PBSC) during the COVID-19 pandemic with 32 patients who underwent UD HSCT using fresh PBSC in the previous period. Median neutrophil engraftment was 17.5 and 17.0 days with cryopreserved and fresh grafts, respectively. Non-significant delays were found in platelet recovery days (25.5 versus 19.0; P = 0.192) and full donor chimerism days (35.0 and 31.5; P = 0.872) using cryopreserved PBSC. The rate of acute graft-versus-host disease at 100 days was 41% (95% CI [21-55%]) in cryopreserved group versus 31% (95% CI [13-46%]) in fresh group (P = 0.380). One-hundred days progression-relapse free survival and overall survival did not differ significantly. During COVID-19 pandemic, six frozen UD donations were not transfused and logistical and clinical issues regarding cryopreservation procedure, packaging, and transporting appeared. In summary, UD HSCT with cryopreserved PBSC was safe during this challenging time. More efforts are needed to ensure that all frozen grafts are transplanted and cryopreservation requirements are harmonized

Al margen. Reflexiones en torno a la imagen

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Real-world effectiveness of caplacizumab vs the standard of care in immune thrombotic thrombocytopenic purpura

Immune thrombotic thrombocytopenic purpura (iTTP) is a thrombotic microangiopathy caused by anti-ADAMTS13 antibodies. Caplacizumab is approved for adults with an acute episode of iTTP in conjunction with plasma exchange (PEX) and immunosuppression. The objective of this study was to analyze and compare the safety and efficacy of caplacizumab vs the standard of care and assess the effect of the concomitant use of rituximab. A retrospective study from the Spanish TTP Registry of patients treated with caplacizumab vs those who did not receive it was conducted. A total of 155 patients with iTTP (77 caplacizumab, 78 no caplacizumab) were included. Patients initially treated with caplacizumab had fewer exacerbations (4.5% vs 20.5%; P <.05) and less refractoriness (4.5% vs 14.1%; P <.05) than those who were not treated. Time to clinical response was shorter when caplacizumab was used as initial treatment vs caplacizumab used after refractoriness or exacerbation. The multivariate analysis showed that its use in the first 3 days after PEX was associated with a lower number of PEX (odds ratio, 7.5; CI, 2.3-12.7; P <.05) and days of hospitalization (odds ratio, 11.2; CI, 5.6-16.9; P <.001) compared with standard therapy. There was no difference in time to clinical remission in patients treated with caplacizumab compared with the use of rituximab. No severe adverse event was described in the caplacizumab group. In summary, caplacizumab reduced exacerbations and refractoriness compared with standard of care regimens. When administered within the first 3 days after PEX, it also provided a faster clinical response, reducing hospitalization time and the need for PEX

Autosomal dominant polycystic kidney disease in young adults

Background The clinical manifestations of autosomal dominant polycystic kidney disease (ADPKD) usually appear in adulthood, however pediatric series report a high morbidity. The objective of the study was to analyze the clinical characteristics of ADPKD in young adults. Methods Family history, hypertension, albuminuria, estimated glomerular filtration rate (eGFR) and imaging tests were examined in 346 young adults (18-30 years old) out of 2521 patients in the Spanish ADPKD registry (REPQRAD). A literature review searched for reports on hypertension in series with more than 50 young (age <30 years) ADPKD patients. Results The mean age of this young adult cohort was 25.24 (SD 3.72) years. The mean age at diagnosis of hypertension was 21.15 (SD 4.62) years, while in the overall REPQRAD population was aged 37.6 years. The prevalence of hypertension was 28.03% and increased with age (18-24 years, 16.8%; 25-30 years, 36.8%). Although prevalence was lower in women than in men, the age at onset of hypertension (21 years) was similar in both sexes. Mean eGFR was 108 (SD 21) mL/min/1.73 m(2), 38.0% had liver cysts and 3.45% of those studied had intracranial aneurysms. In multivariate analyses, hematuria episodes and kidney length were independent predictors of hypertension (area under the curve 0.75). The prevalence of hypertension in 22 pediatric cohorts was 20%-40%, but no literature reports on hypertension in young ADPKD adults were found. Conclusions Young adults present non-negligible ADPKD-related morbidity. This supports the need for a thorough assessment of young adults at risk of ADPKD that allows early diagnosis and treatment of hypertension. Lay Summary Impairment of renal function usually develops from the fourth decade of life in autosomal dominant polycystic kidney disease (ADPKD). However, hypertension precedes the onset of renal insufficiency. In published pediatric series, the prevalence of hypertension is 20%-40%. However, clinical information on young adults with ADPKD is scarce. We present the largest cohort of young adults (age 18-30 years) with ADPKD published to date. Prevalence of hypertension is 28% and increases with age, reaching 36.8% in the subgroup aged 25-30 years, despite normal glomerular filtration rate and albuminuria. The prevalence of hypertension is higher in males, but the mean age at diagnosis (21 years) was similar in both sexes. Young adults present non-negligible ADPKD-related morbidity. This supports the need for a thorough assessment that allows early diagnosis and treatment of hypertension, before decline of estimated glomerular filtration rate. Ambulatory blood pressure monitoring may be especially useful in this regard.11 página

A blood microRNA classifier for the prediction of ICU mortality in COVID-19 patients: a multicenter validation study

Background: The identification of critically ill COVID-19 patients at risk of fatal outcomes remains a challenge. Here, we first validated candidate microRNAs (miRNAs) as biomarkers for clinical decision-making in critically ill patients. Second, we constructed a blood miRNA classifier for the early prediction of adverse outcomes in the ICU. Methods: This was a multicenter, observational and retrospective/prospective study including 503 critically ill patients admitted to the ICU from 19 hospitals. qPCR assays were performed in plasma samples collected within the first 48 h upon admission. A 16-miRNA panel was designed based on recently published data from our group. Results: Nine miRNAs were validated as biomarkers of all-cause in-ICU mortality in the independent cohort of critically ill patients (FDR < 0.05). Cox regression analysis revealed that low expression levels of eight miRNAs were associated with a higher risk of death (HR from 1.56 to 2.61). LASSO regression for variable selection was used to construct a miRNA classifier. A 4-blood miRNA signature composed of miR-16-5p, miR-192-5p, miR-323a-3p and miR-451a predicts the risk of all-cause in-ICU mortality (HR 2.5). Kaplan‒Meier analysis confirmed these findings. The miRNA signature provides a significant increase in the prognostic capacity of conventional scores, APACHE-II (C-index 0.71, DeLong test p-value 0.055) and SOFA (C-index 0.67, DeLong test p-value 0.001), and a risk model based on clinical predictors (C-index 0.74, DeLong test-p-value 0.035). For 28-day and 90-day mortality, the classifier also improved the prognostic value of APACHE-II, SOFA and the clinical model. The association between the classifier and mortality persisted even after multivariable adjustment. The functional analysis reported biological pathways involved in SARS-CoV infection and inflammatory, fibrotic and transcriptional pathways. Conclusions: A blood miRNA classifier improves the early prediction of fatal outcomes in critically ill COVID-19 patients.11 página