Sistema de diálogo oral para la consulta de las Loterías y Apuestas del Estado mediante VoiceXML

El principal objetivo de este proyecto es acercar la información o hacer más fácil la obtención de la información a todas las personas. Ahora mismo existen muchos tipos de mecanismos para obtener información, pero cuantas más posibilidades o variantes tengamos disponibles, más fácil nos es obtenerla. En este caso se plantea la obtención de información mediante un contestador Voz IP, es decir, se ofrece un número de teléfono desde el cual un usuario puede llamar y obtener los resultados de la lotería nacional y saber si su número ha sido premiado. Todo ello automatizado por un sistema de diálogo gestionado por un ordenador. Este tipo de información tiene varias formas de ser consultada, por ordenador, por televisión, si eres lo bastante rápido como para seguir las letras, o bien acercándose físicamente al sitio donde compró el boleto. Hay mucha gente, que por sus condiciones físicas, no pueden usar un ordenador o les es muy complicado. Por lo tanto, este proyecto plantea una alternativa para ofrecer la información o hacer su obtención más sencilla, de esta manera todo el mundo lo tiene a su disposición siempre que quiera o siempre que tenga un móvil desde el que realizar la llamada. Para hacer el sistema incluso más cómodo se han añadido módulos que se encargan de hacer un estudio de los usuarios que lo utilizan y ofrecer directamente los resultados sin la necesidad de realizar todo el proceso de presentación. De esta manera el sistema es más dinámico y gestiona las petición muchísimo más rápida. La aplicación utiliza una plataforma denominada Voxeo, la cual es gestionada con un tipo de lenguaje específico llamado VoiceXML. Esta plataforma es la encarga de ofrecer la gestión de la entrada y la salida de voz de la aplicación. Además el proyecto también se apoya en otros lenguajes de programación como PHP y SQL. PHP es el encargado de llevar la gestión de las elecciones y SQL es el que nos permite la comunicación con la base de datos instalada en el sistema. Tras el análisis y el estudio de los diferentes lenguajes utilizados se ha desarrollado la aplicación y se ha instalado en un servidor web. Una vez completado esto se ha realizado un estudio de viabilidad del sistema con la ayuda de algunos usuarios que han testeado la aplicación.The main objective of this project is to bring the information closer or make the information more obtainable for everyone. At the moment a lot of ways of obtaining information exist, but if we offer more possibilities it could be easier to obtain this kind. In this project I aim to show another kind of method of getting information. For example, a voice over IP answering machine, that is, you can call a telephone number and the answering machine answers you and gives you the result of the national lottery. Furthermore the answering machine is able to know if your lottery numbers have won the prize. The machine is automatic and it is managed by a computer. The information has some methods of being obtained, like computer or a television (if you read faster than a television shows you), or you can go wherever you can to buy a ticket. A lot of people can´t use some of these methods, maybe as a result of their physical problems or maybe because they don´t know how to use a computer very well. So this project puts forward another method of obtaining information in the easiest possible way. Everyone who has a mobile phone is able to obtain the information. To make the system more comfortable, the project has some modules which are responsible for studying the user who use the system. These modules recognize the lottery that the users play every time and it shows the result directly without having to go through the presentation process. The application uses a platform called Voxeo, which is managed with a specific type of programming language called VoiceXML. This platform is responsible for providing management of input and output voice sounds. In addition the project also uses other programming languages like PHP and SQL. PHP brings the way of the execution and SQL allows the project to communicate with the database installed in the system. After analyzing and studying the different programming languages, the application has been developed and installed on a web server. Then, a viability analysis of the system has been made, with some users‟ help who have tested the application.Ingeniería Técnica en Informática de Gestió

Disseny conceptual d'un sistema autònom per a facilitar la mobilitat en un context de platja per a persones amb mobilitat reduïda

Les persones amb mobilitat reduïda (PMR) són aquelles que pateixen una limitació funcional de les extremitats inferiors que afecta a les seves capacitats per al moviment, a efectes de desplaçar-se amb normalitat i autonomia o utilitzar mitjans de transport. El desplaçament és una de les accions més fonamentals de l'ésser humà: per a relacionar-se, alimentar-se, en conclusió per a viure. Una de les activitats més gratificants és gaudir d’un entorn de platja amb independència i autonomia, però aquest medi imposa unes evidents restriccions als sistemes de mobilitat que utilitzen aquestes persones per a desplaçar-se habitualment. Donada la proximitat d’un cas concret, va sorgir l’idea de millorar i facilitar la qualitat de vida de les persones PMR amb la realització d’aquest projecte. Després d’una avaluació de les necessitats de l’usuari i dels dispositius comercialitzats en el mercat, es va concloure que existien solucions que cobrien la necessitat de desplaçament autònom per a la sorra, però de forma individualitzada per a l’usuari i amb un preu molt costós Així, es va iniciar el desenvolupament de la solució que es presenta, un dispositiu que afavoreix el desplaçament dels mitjans de mobilitat habituals dels usuaris PMR (cadira de rodes manual o automàtica, crosses, caminadors, etc…). Aquesta mobilitat de l’usuari i el seu dispositiu habitual, es realitzarà de forma autònoma i el permetrà el desplaçament a qualsevol indret de la platja, observant les especificacions i requeriments del projecte. En concret s’elabora una solució multiusuari, un dispositiu adaptable de forma ergonòmica a qualsevol persona, amb mecanismes de regulació dels sistemes de retenció de l’usuari al compartiment de transport i de conducció. L’usuari podrà accedir-hi mitjançant una rampa, després ajustar-se els sistemes d’ancoratge de l’usuari PMR i del seu sistema de desplaçament habitual, recollir la rampa esmentada i procedir al comandament del dispositiu, i tot això autònomament. Aquest disseny ha suposat la implementació dels principis d'eficàcia, eficiència i estabilitat. S’han observat les mesures de protecció del medi ambient, mitjançant l'ús de materials reciclables i l’adaptació del disseny de les peces i dels processos de fabricació. El projecte, així considerat, estaria orientat a facilitar un dispositiu a una administració pública, entitat o associació d'àmbit sanitari o social que volgués oferir a aquestes persones amb limitacions un servei per a desplaçar-se i millorar la seva qualitat de vida.Las personas con movilidad reducida (PMR) cuando acceden en las playas con sus dispositivos de movilidad habituales sufren las dificultades que la arena provoca en su movimiento. Es muy dificultoso acceder al lado del mar para disfrutar de un día de playa como el resto de personas. Este proyecto desarrolla una solución conceptual mediante un dispositivo que transporta al usuario y su silla de ruedas a cualquier lugar que desee dentro del entorno de playa, siempre que se cumplan los requerimientos y limitaciones establecidas para su utilización. El sistema se puede adaptar también a las personas con muletas o caminadores utilizando una silla auxiliar al dispositivo.People with reduced mobility (PRM) are those who suffer from a functional limitation of the lower limbs that affects their ability to move, to move around normally and independently or to use means of transportation. Moving around is one of the most fundamental actions of human beings: to interact, to feed oneself, in short, to live. One of the most rewarding activities is to enjoy a beach context with independence and autonomy, but this environment imposes obvious restrictions on the mobility systems used by these people to move around regularly. Given the proximity of a specific case, the idea of improving and facilitating the quality of life of PRM people with the implementation of this project arose. After an evaluation of the user's needs and the devices available on the market, it was concluded that there are solutions that cover the need for autonomous movement around the sand, but in an individualized way for the user and with a very expensive price. Thus, the development of the presented solution began, a device that facilitates the displacement of the usual means of mobility of PRM users (manual or automatic wheelchair, crutches, walkers, etc. ...). This mobility of the user and his usual device, will be done autonomously and will allow him to move anywhere on the beach, observing the specifications and requirements of the project. Specifically, a multi-user solution is developed, a device ergonomically adaptable to any person, with mechanisms for regulating the user's restraint to the transport compartment and driving systems. The user will be able to access it by means of a ramp, after adjusting the anchoring systems of the PRM user and his usual displacement system, pick up the mentioned ramp and proceed to the control of the device, and all this in an autonomous way. This design has involved the implementation of the principles of effectiveness, efficiency and stability. Environmental protection measures have been observed, through the use of recyclable materials and the adaptation of the design of the parts and manufacturing processes. The project, thus considered, would be oriented to provide a device to a public administration, entity or association of health or social field that would like to offer these people with limitations a service to move and improve their quality of life

Melanoma in Solid Organ Transplant Recipients

Melanoma; Skin cancer; Solid organ transplantMelanoma; Cáncer cutáneo; Trasplante de órgano sólidoMelanoma; Càncer cutani; Trasplantament d'òrgan sòlidEl melanoma en receptores de un trasplante de órgano sólido (RTOS) puede aparecer en 3 situaciones clínicas, objeto de esta revisión: pacientes con historia de melanoma previa al trasplante, pacientes que desarrollan el melanoma posteriormente al trasplante y pacientes con melanoma procedente del donante. Los factores más relevantes a considerar en pacientes con antecedentes de melanoma candidatos a un trasplante son el estadio del tumor, la presencia o no de enfermedad residual y el periodo entre el diagnóstico y el trasplante. Los RTOS tienen mayor riesgo de padecer un melanoma que la población inmunocompetente. La mortalidad por melanoma es también mayor, especialmente en aquellos con estadios avanzados, que suponen un verdadero reto terapéutico. Finalmente, la historia clínica y la exploración física del donante son las herramientas más útiles para evitar la transmisión de un melanoma al receptor, situación con pronóstico infausto.In this review, we analyze the 3 clinical scenarios related to the development of melanoma in solid organ transplant recipients: melanoma in patients with a history of the tumor prior to a transplant, de novo melanoma following a transplant, and melanoma of donor origin. The main factors to consider in organ-transplant candidates with a history of melanoma are tumor stage, presence or absence of residual disease, and time from diagnosis to transplantation. Solid organ transplant recipients have a greater risk of melanoma than immunocompetent individuals. Mortality is also higher in this population, especially in patients with advanced melanoma, as treatment is especially challenging. Clinical history and physical examination provide the most useful information for preventing donor-to-recipient transmission of melanoma. Donor-derived melanoma has a very poor prognosis

A myxoid fibrotic reaction pattern is associated with metastatic risk in cutaneous squamous cell carcinoma

Metastasis; Fibrosis; Cutaneous squamous cell carcinomaMetástasis; Fibrosis; Carcinoma cutáneo de células escamosasMetàstasi; Fibrosi; Carcinoma cutani de cèl·lules escamosesAlthough desmoplasia has been associated with poor prognoses in cutaneous squamous cell carcinoma, little attention has been paid to the patterns of fibrosis. This study aimed to examine the different stromal fibrotic patterns as markers of metastatic risk. We performed a multicenter retrospective study that included 102 cutaneous squamous cell carcinomas (52 non-metastatic and 50 metastatic carcinomas). Clinical and histopa-thological data were registered. The fibrotic reaction pattern was classified as mature, intermediate or immature depending on the presence of keloid-like collagen and myxoid stroma. The immature pattern (areas characterized by myxoid changes with no inflammation) was observed in 18 samples and its presence was significantly associated with immuno-suppression, budding, desmoplasia, perineural invasion, anatomic level, tumoural depth and metastatic risk in the multivariate analysis. Our findings suggest that the presence of an immature myxoid fibrotic pattern, which can be easily identified by routine hematoxylin-eosin staining, is strongly associated with metastatic risk.This work has been supported by grant PI15/00236 from Fondo de Investigación Sanitaria (FIS), Fondo Europeo de Desarrollo Regional (FEDER), Instituto de Salud Carlos III, Ministerio de Sanidad, and the ‘‘Xarxa de Bancs de Tumours”

Changes in the microbiological diagnosis and epidemiology of cutaneous leishmaniasis in real-time PCR era: A six-year experience in a referral center in Barcelona

Leishmania; Reacción en cadena de la polimerasa; EspañaLeishmania; Polymerase chain reaction; SpainLeishmania; Reacció en cadena de la polimerasa; EspanyaBackground Leishmaniasis is a neglected disease caused by different species of the protozoa Leishmania spp. Cutaneous lesions are the most common clinical manifestation. This disease is prevalent in tropical and subtropical areas, including the Mediterranean basin. In Spain, Leishmania (L.) infantum is the only endemic species, but imported cases are often diagnosed. Different classical parasitological methods can be performed for cutaneous leishmaniasis (CL) diagnosis; but currently molecular techniques serve as a relevant tool for the detection and characterization of Leishmania parasites. We aimed to evaluate clinical and epidemiological characteristics of CL diagnosed patients by real-time PCR in a tertiary hospital over a six-year period. Methodology/Principal findings Clinical, epidemiological and microbiological data were retrospectively collected and analyzed. In our study, CL was confirmed in 59 (31.4%) out of 188 patients by real-time PCR, showing an increase over recent years: 11 cases of CL between 2014 and 2016 and 48 between 2017 and 2019. Real-time PCR was performed on skin swabs and/or biopsies samples, with a positivity of 38.5% and 26.5%, respectively. Results were 100% concordant when biopsy and skin swab were performed simultaneously. L. (L.) infantum was the most frequent species detected (50%), followed by L. (L.) major (45%) and Viannia subgenus (5%), which were detected only in imported cases. L. (L.) major was almost entirely detected in travelers/migrants from Morocco. Multiple and atypical skin lesions were more common in imported cases than in autochthonous cases (44.4% vs. 21.8%). Conclusions/Significance An increase in both autochthonous and imported CL cases has been observed in past years in our hospital. Molecular techniques assist in improving CL diagnosis and characterization of the Leishmania species, mainly in imported cases.The author(s) received no specific funding for this work

BRAF activation by metabolic stress promotes glycolysis sensitizing NRASQ61-mutated melanomas to targeted therapy

NRAS-mutated melanoma lacks a specific line of treatment. Metabolic reprogramming is considered a novel target to control cancer; however, NRAS-oncogene contribution to this cancer hallmark is mostly unknown. Here, we show that NRAS(Q61)-mutated melanomas specific metabolic settings mediate cell sensitivity to sorafenib upon metabolic stress. Mechanistically, these cells are dependent on glucose metabolism, in which glucose deprivation promotes a switch from CRAF to BRAF signaling. This scenario contributes to cell survival and sustains glucose metabolism through BRAF-mediated phosphorylation of 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase-2/3 (PFKFB2/PFKFB3). In turn, this favors the allosteric activation of phosphofructokinase-1 (PFK1), generating a feedback loop that couples glycolytic flux and the RAS signaling pathway. An in vivo treatment of NRAS(Q61) mutant melanomas, including patient-derived xenografts, with 2-deoxy-D-glucose (2-DG) and sorafenib effectively inhibits tumor growth. Thus, we provide evidence for NRAS-oncogene contributions to metabolic rewiring and a proof-of-principle for the treatment of NRAS(Q61)-mutated melanoma combining metabolic stress (glycolysis inhibitors) and previously approved drugs, such as sorafenib. Targeted therapeutic options for NRAS-mutant melanoma are limited. Here, the authors show that under metabolic stress NRAS-mutant melanoma cells activate a BRAF-dependent glycolysis pathway for survival, leading to improve efficacy of sorafenib when combined with glycolysis inhibitors

Expanding the clinical and genetic spectra of primary immunodeficiency-related disorders with clinical exome sequencing: expected and unexpected findings

Inmunodeficiencias primarias; Secuenciación de próxima generación; Secuenciación clínica del exomaImmunodeficiències primàries; Seqüenciació de propera generació; Seqüenciació clínica d’exomesPrimary immunodeficiencies; Next generation sequencing; Clinical exome sequencingPrimary immunodeficiencies (PIDs) refer to a clinically, immunologically, and genetically heterogeneous group of over 350 disorders affecting development or function of the immune system. The increasing use of next-generation sequencing (NGS) technology has greatly facilitated identification of genetic defects in PID patients in daily clinical practice. Several NGS approaches are available, from the unbiased whole exome sequencing (WES) to specific gene panels. Here, we report on a 3-year experience with clinical exome sequencing (CES) for genetic diagnosis of PIDs. We used the TruSight One sequencing panel, which includes 4,813 disease-associated genes, in 61 unrelated patients (pediatric and adults). The analysis was done in 2 steps: first, we focused on a virtual PID panel and then, we expanded the analysis to the remaining genes. A molecular diagnosis was achieved in 19 (31%) patients: 12 (20%) with mutations in genes included in the virtual PID panel and 7 (11%) with mutations in other genes. These latter cases provided interesting and somewhat unexpected findings that expand the clinical and genetic spectra of PID-related disorders, and are useful to consider in the differential diagnosis. We also discuss 5 patients (8%) with incomplete genotypes or variants of uncertain significance. Finally, we address the limitations of CES exemplified by 7 patients (11%) with negative results on CES who were later diagnosed by other approaches (more specific PID panels, WES, and comparative genomic hybridization array). In summary, the genetic diagnosis rate using CES was 31% (including a description of 12 novel mutations), which rose to 42% after including diagnoses achieved by later use of other techniques. The description of patients with mutations in genes not included in the PID classification illustrates the heterogeneity and complexity of PID-related disorders.This study was funded by Instituto de Salud Carlos III, grants PI14/00405 and PI17/00660, cofinanced by the European Regional Development Fund (ERDF)

BRAF activation by metabolic stress promotes glycolysis sensitizing NRASQ61-mutated melanomas to targeted therapy

Glycolysis; Melanomas; Targeted therapyGlucólisis; Melanomas; Terapia dirigidaGlucòlisi; Melanomes; Teràpia dirigidaNRAS-mutated melanoma lacks a specific line of treatment. Metabolic reprogramming is considered a novel target to control cancer; however, NRAS-oncogene contribution to this cancer hallmark is mostly unknown. Here, we show that NRASQ61-mutated melanomas specific metabolic settings mediate cell sensitivity to sorafenib upon metabolic stress. Mechanistically, these cells are dependent on glucose metabolism, in which glucose deprivation promotes a switch from CRAF to BRAF signaling. This scenario contributes to cell survival and sustains glucose metabolism through BRAF-mediated phosphorylation of 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase-2/3 (PFKFB2/PFKFB3). In turn, this favors the allosteric activation of phosphofructokinase-1 (PFK1), generating a feedback loop that couples glycolytic flux and the RAS signaling pathway. An in vivo treatment of NRASQ61 mutant melanomas, including patient-derived xenografts, with 2-deoxy-D-glucose (2-DG) and sorafenib effectively inhibits tumor growth. Thus, we provide evidence for NRAS-oncogene contributions to metabolic rewiring and a proof-of-principle for the treatment of NRASQ61-mutated melanoma combining metabolic stress (glycolysis inhibitors) and previously approved drugs, such as sorafenib.This work was funded by Instituto de Salud Carlos III and co-funded by European Union (ERDF/ESF, “A way to make Europe”/“Investing in your future”) PI14/0375-Fondos FEDER J.A.R., PI17/00043-Fondos FEDER; J.A.R., PI20/0384-Fondos FEDER; J.A.R., Euronanomed2-ISCIII (AC16/00019)-Fondos FEDER; J.A.R., Asociación Española Contra el Cancer (AECC-GCB15152978SOEN) (supported P.G.M., K.M.); J.A.R., Ramón Areces Foundation (supported K.M. and research); J.A.R. (PI17/00412)-Fondos FEDER; R.B., A.M., A.N.S. We thank A. Zorzano’s laboratory for technical assistance and performance of Seahorse technology

Treatment of Complex Cutaneous Leishmaniasis with Liposomal Amphotericin B

Leishmania; Anfotericina B liposomal; Terapia sistémicaLeishmania; Liposomal amphotericin B; Systemic therapyLeishmania; Amfotericina B liposomal; Teràpia sistèmicaBackground: There is no consensus for the best treatment of complex cutaneous leishmaniasis (CL). We aimed to describe a cohort of CL, focusing on liposomal amphotericin B (L-AmB) treatment outcome. Methods: We performed a retrospective study in Vall d’Hebron University Hospital (Barcelona, Spain). All patients with parasitologically proven CL diagnosed from 2012 to 2018 were included. Results: The analysis included 41 patients with CL. The median age was 39 years (IQR 12- 66); 12 (29%) were children, and 29 (71%) were men. Regarding treatment, 24 (59%) received local treatment, whereas 17 (41%) had complex CL and were offered intravenous systemic treatment. Sixteen patients received L-AmB; eight (50%) had adverse events, and three (19%) discontinued treatment for safety reasons. All cases were considered cured within the first year post-treatment. Conclusions: L-AmB for complex CL showed no treatment failures, offering an alternative treatment option for patients with complex CL. Clinicians should pay close attention to the potential adverse events of L-AmB and adopt an active drug safety surveillance scheme to rapidly detect reversible side effects.This research received no external funding

A facility and community-based assessment of scabies in rural Malawi.

Background Scabies is a neglected tropical disease of the skin, causing severe itching, stigmatizing skin lesions and systemic complications. Since 2015, the DerMalawi project provide an integrated skin diseases clinics and Tele-dermatology care in Malawi. Clinic based data suggested a progressive increase in scabies cases observed. To better identify and treat individuals with scabies in the region, we shifted from a clinic-based model to a community based outreach programme. Methodology/principal findings From May 2015, DerMalawi project provide integrated skin diseases and Tele-dermatological care in the Nkhotakota and Salima health districts in Malawi. Demographic and clinical data of all patients personally attended are recorded. Due to a progressive increase in the number of cases of scabies the project shifted to a community-based outreach programme. For the community outreach activities, we conducted three visits between 2018 to 2019 and undertook screening in schools and villages of Alinafe Hospital catchment area. Treatment was offered for all the cases and school or household contacts. Scabies increased from 2.9% to 39.2% of all cases seen by the DerMalawi project at clinics between 2015 to 2018. During the community-based activities approximately 50% of the population was assessed in each of three visits. The prevalence of scabies was similar in the first two rounds, 15.4% (2392) at the first visit and 17.2% at the second visit. The prevalence of scabies appeared to be lower (2.4%) at the third visit. The prevalence of impetigo appeared unchanged and was 6.7% at the first visit and 5.2% at the final visit. Conclusions/significance Prevalence of scabies in our setting was very high suggesting that scabies is a major public health problem in parts of Malawi. Further work is required to more accurately assess the burden of disease and develop appropriate public health strategies for its control