295 research outputs found
Colonic adenocarcinoma an underlying malignancy of dermatomyositis: case report
Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of chronic, autoimmune connective tissue disorders that affect muscles primarily. A few cases have reported the correlation between IIM and paraneoplastic manifestations, primarily dermatomyositis (DM). We described the case of a 47-year-old woman with dermatomyositis and the finding of a colonic adenocarcinoma, who presented alternating diarrhoea and hematochezia. The immunoassay for myositis-specific antibodies showed anti-Mi-2a, anti-MDA5, and anti-Ro52 antibodies, while the colonoscopy showed a one-centimetre mass in the sigmoid. Literature reviews have contemplated an underlying malignancy in patients with dermatomyositis, particularly in those with anti-Mi-2 antibodies and atypical features or unexplained symptoms. A correlation between DM and colonic adenocarcinoma has-been documented in a few reports, particularly in patients with unexplained gastrointestinal symptoms or weight loss. The mechanisms of the association of dermatomyositis and malignancies, especially colonic malignancies, are still unknown and need more research for better strategies
HispaVeg: a new online vegetation plot database for Spain
We describe a new online database, named HispaVeg, which currently holds data from 2663 vegetation plots of Spanish woodlands, scrublands and grasslands. Unlike other similar databases, a detailed description of the structure is stored with the floristic data of each plot (i.e., number and physiognomy of the vertical layers, cover values for each layer).Most of the vegetation plots are large rectangles (400 to 2000 square meters) with an average of 34 species per plot. The survey dates range from 1956 to present, with most of the records between 1964 and 1994. The elevation of the plots ranges from 0 to 2880, with most of the plots between 300 and 1500 m. HispaVeg is freely available to the scientific community. Users can query the online database, view printable reports for each plot and download spreadsheet-like raw data for subsets of vegetation plots
X-ray diffraction, cements and environment, three worlds in one
This keynote lecture will be focused on the strategies for reducing CO2 emissions in the cement production. Concretely, the production of ecocements with optimised formulations that yield reductions in CO2 emissions of up to 25%, when compared to OPC production. Phase assemblage has to be carefully optimised to be competitive and these new ecocements should develop compressive strengths of at least 50 MPa at 28 days of hydration. Optimised compositions of several ecocements will be discussed, but all of them are ye'elimite or calcium sulphoaluminate containing ones: belite-ye'elimite-ferrite (BYF), belite-alite-ye'elimite (BAY) and ye'elimite rich ones (CSA). The clinkering temperature of BYF and BAY has to be established to obtain the targeted phase assemblages. Moreover, the stabilisation of alpha-forms of belite is needed to develop high mechanical strengths at early ages. The benefits of the use of waste materials (such as fly ash or slag) as additions to ecocements are three-fold: lower CO2 emissions due to clinker replacement; valorisation of “useless” products that need a lot of landscape and the consequent efficient consumption of raw materials; and to enhance mechanical properties of the corresponding mortars. The design of appropriate CSA, BYF and BAY mortars, with the final aim of knowing and controlling the hydration mechanisms, will be presented. Particularly, the role of i) type and amount of set regulator (gypsum, anhydrite, etc.), ii) water/cement ratio (w/c); iii) superplasticiser; and iv) pozzolanic additions will be discussed. The role of these parameters in the microstructure and hydraulic behaviour has been investigated through traditional techniques as well as advanced synchrotron characterisation. The formers include laboratory/synchrotron X-ray powder diffraction combined with Rietveld methodology (to obtain phase assemblage), electron microscopy techniques for paste microstructure determination, rheological studies (to control the effect of the different additives, w/c ratio and setting time retarders) and mechanical tests (setting times, compressive strengths and dimensional stability). The latters comprise a group of techniques available at synchrotrons such as: i) high temperature x-ray diffraction for clinkering studies and ii) total scattering data to be analysed by pair distribution function, PDF.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech.
PhD D. Londono-Zuluaga thanks Colciencias and Enlaza Mundos program PhD grant. Spanish MINECO (BIA2014-57658-C2-2-R, which is co-funded by FEDER, BIA2014-57658-C2-1-R and I3 (IEDI-2016-0079) grants) are acknowledged
Una base de datos de inventarios de vegetación: HISPAVEG
Las bases de datos de inventarios de vegetación son una importante fuente de información en relación a un conjunto amplio de aspectos del medio natural, entre los que destacan los efectos de la gestión forestal en la diversidad vegetal, los estudios de autoecología basados en modelos de distribución de especies y la observación a largo plazo de las comunidades vegetales. Desde esta valoración esta comunicación presenta HispaVeg, una base de datos de inventarios de vegetación online, abierta y viva, con las siguientes características y resultados: Permite introducir inventarios de vegetación con diversas metodologías (estructural, como la fisionómica-estructural de Ruiz de la Torre y de la escuela de Zurich-Montpelier). En la actualidad contiene 2.663 inventarios históricos del profesor Juan Ruiz de la Torre realizados entre los años 1950 y 2000, de superficie de parcela entre 400 y 3.600 m2, tanto de formaciones arboladas como de matorrales y pastizales, con número medio de especies por inventario de 34 y distribuidos por toda la España peninsular e Islas Baleares, en un intervalo altitudinal entre 0 y 2880 m
Genetically determined Amerindian ancestry correlates with increased frequency of risk alleles for systemic lupus erythematosus
Objective To assess whether genetically determined Amerindian ancestry predicts increased presence of risk alleles of known susceptibility genes for systemic lupus erythematosus (SLE). Methods Single-nucleotide polymorphisms (SNPs) within 16 confirmed genetic susceptibility loci for SLE were genotyped in a set of 804 Mestizo lupus patients and 667 Mestizo healthy controls. In addition, 347 admixture informative markers were genotyped. Individual ancestry proportions were determined using STRUCTURE. Association analysis was performed using PLINK, and correlation between ancestry and the presence of risk alleles was analyzed using linear regression. Results A meta-analysis of the genetic association of the 16 SNPs across populations showed that TNFSF4 , STAT4 , ITGAM , and IRF5 were associated with lupus in a Hispanic Mestizo cohort enriched for European and Amerindian ancestry. In addition, 2 SNPs within the major histocompatibility complex region, previously shown to be associated in a genome-wide association study in Europeans, were also associated in Mestizos. Using linear regression, we predicted an average increase of 2.34 risk alleles when comparing an SLE patient with 100% Amerindian ancestry versus an SLE patient with 0% Amerindian ancestry ( P < 0.0001). SLE patients with 43% more Amerindian ancestry were predicted to carry 1 additional risk allele. Conclusion Our results demonstrate that Amerindian ancestry is associated with an increased number of risk alleles for SLE.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78480/1/27753_ftp.pd
Impact of late presentation of HIV infection on short-, mid- and long-term mortality and causes of death in a multicenter national cohort: 2004–2013
SummaryObjectivesTo analyze the impact of late presentation (LP) on overall mortality and causes of death and describe LP trends and risk factors (2004–2013).MethodsCox models and logistic regression were used to analyze data from a nation-wide cohort in Spain. LP is defined as being diagnosed when CD4 < 350 cells/ml or AIDS.ResultsOf 7165 new HIV diagnoses, 46.9% (CI95%:45.7–48.0) were LP, 240 patients died.First-year mortality was the highest (aHRLP.vs.nLP = 10.3[CI95%:5.5–19.3]); between 1 and 4 years post-diagnosis, aHRLP.vs.nLP = 1.9(1.2–3.0); and >4 years, aHRLP.vs.nLP = 1.5(0.7–3.1).First-year's main cause of death was HIV/AIDS (73%); and malignancies among those surviving >4 years (32%). HIV/AIDS-related deaths were more likely in LP (59.2% vs. 25.0%; p < 0.001). LP declined from 55.9% (2004–05) to 39.4% (2012–13), and reduced in 46.1% in men who have sex with men (MSM) and 37.6% in heterosexual men, but increased in 22.6% in heterosexual women.Factors associated with LP: sex (ORMEN.vs.WOMEN = 1.4[1.2–1.7]); age (OR31–40.vs.<30 = 1.6[1.4–1.8], OR41–50.vs.<30 = 2.2[1.8–2.6], OR>50.vs.<30 = 3.6[2.9–4.4]); behavior (ORInjectedDrugUse.vs.MSM = 2.8[2.0–3.8]; ORHeterosexual.vs.MSM = 2.2[1.7–3.0]); education (ORPrimaryEducation.vs.University = 1.5[1.1–2.0], ORLowerSecondary.vs.University = 1.3[1.1–1.5]); and geographical origin (ORSub-Saharan.vs.Spain = 1.6[1.3–2.0], ORLatin-American.vs.Spain = 1.4[1.2–1.8]).ConclusionsLP is associated with higher mortality, especially short-term- and HIV/AIDS-related mortality. Mid-term-, but not long-term mortality, remained also higher in LP than nLP. LP decreased in MSM and heterosexual men, not in heterosexual women. The groups most affected by LP are low educated, non-Spanish and heterosexual women
Spanish cohort of VEXAS syndrome : clinical manifestations, outcome of treatments and novel evidences about UBA1 mosaicism
The vacuoles, E1-enzyme, X linked, autoinflammatory and somatic (VEXAS) syndrome is an adult-onset autoinflammatory disease (AID) due to postzygotic UBA1 variants. To investigate the presence of VEXAS syndrome among patients with adult-onset undiagnosed AID. Additional studies evaluated the mosaicism distribution and the circulating cytokines. Gene analyses were performed by both Sanger and amplicon-based deep sequencing. Patients' data were collected from their medical charts. Cytokines were quantified by Luminex. Genetic analyses of enrolled patients (n=42) identified 30 patients carrying UBA1 pathogenic variants, with frequencies compatible for postzygotic variants. All patients were male individuals who presented with a late-onset disease (mean 67.5 years; median 67.0 years) characterised by cutaneous lesions (90%), fever (66.7%), pulmonary manifestations (66.7%) and arthritis (53.3%). Macrocytic anaemia and increased erythrocyte sedimentation rate and ferritin were the most relevant analytical abnormalities. Glucocorticoids ameliorated the inflammatory manifestations, but most patients became glucocorticoid-dependent. Positive responses were obtained when targeting the haematopoietic component of the disease with either decitabine or allogeneic haematopoietic stem cell transplantation. Additional analyses detected the UBA1 variants in both haematopoietic and non-haematopoietic tissues. Finally, analysis of circulating cytokines did not identify inflammatory mediators of the disease. Thirty patients with adult-onset AID were definitively diagnosed with VEXAS syndrome through genetic analyses. Despite minor interindividual differences, their main characteristics were in concordance with previous reports. We detected for the first time the UBA1 mosaicism in non-haematopoietic tissue, which questions the previous concept of myeloid-restricted mosaicism and may have conceptual consequences for the disease mechanisms
Effects of intubation timing in patients with COVID-19 throughout the four waves of the pandemic : a matched analysis
The primary aim of our study was to investigate the association between intubation timing and hospital mortality in critically ill patients with COVID-19-associated respiratory failure. We also analysed both the impact of such timing throughout the first four pandemic waves and the influence of prior non-invasive respiratory support on outcomes. This is a secondary analysis of a multicentre, observational and prospective cohort study that included all consecutive patients undergoing invasive mechanical ventilation due to COVID-19 from across 58 Spanish intensive care units (ICU) participating in the CIBERESUCICOVID project. The study period was between 29 February 2020 and 31 August 2021. Early intubation was defined as that occurring within the first 24 h of intensive care unit (ICU) admission. Propensity score (PS) matching was used to achieve balance across baseline variables between the early intubation cohort and those patients who were intubated after the first 24 h of ICU admission. Differences in outcomes between early and delayed intubation were also assessed. We performed sensitivity analyses to consider a different timepoint (48 h from ICU admission) for early and delayed intubation. Of the 2725 patients who received invasive mechanical ventilation, a total of 614 matched patients were included in the analysis (307 for each group). In the unmatched population, there were no differences in mortality between the early and delayed groups. After PS matching, patients with delayed intubation presented higher hospital mortality (27.3% versus 37.1%, p =0.01), ICU mortality (25.7% versus 36.1%, p=0.007) and 90-day mortality (30.9% versus 40.2%, p=0.02) when compared to the early intubation group. Very similar findings were observed when we used a 48-hour timepoint for early or delayed intubation. The use of early intubation decreased after the first wave of the pandemic (72%, 49%, 46% and 45% in the first, second, third and fourth wave, respectively; first versus second, third and fourth waves p<0.001). In both the main and sensitivity analyses, hospital mortality was lower in patients receiving high-flow nasal cannula (n=294) who were intubated earlier. The subgroup of patients undergoing NIV (n=214) before intubation showed higher mortality when delayed intubation was set as that occurring after 48 h from ICU admission, but not when after 24 h. In patients with COVID-19 requiring invasive mechanical ventilation, delayed intubation was associated with a higher risk of hospital mortality. The use of early intubation significantly decreased throughout the course of the pandemic. Benefits of such an approach occurred more notably in patients who had received high-flow nasal cannul
Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: A multicenter, observational study
Background The clinical heterogeneity of COVID-19 suggests the existence of different phenotypes with prognostic implications. We aimed to analyze comorbidity patterns in critically ill COVID-19 patients and assess their impact on in-hospital outcomes, response to treatment and sequelae. Methods Multicenter prospective/retrospective observational study in intensive care units of 55 Spanish hospitals. 5866 PCR-confirmed COVID-19 patients had comorbidities recorded at hospital admission; clinical and biological parameters, in-hospital procedures and complications throughout the stay; and, clinical complications, persistent symptoms and sequelae at 3 and 6 months. Findings Latent class analysis identified 3 phenotypes using training and test subcohorts: low-morbidity (n=3385; 58%), younger and with few comorbidities; high-morbidity (n=2074; 35%), with high comorbid burden; and renal-morbidity (n=407; 7%), with chronic kidney disease (CKD), high comorbidity burden and the worst oxygenation profile. Renal-morbidity and high-morbidity had more in-hospital complications and higher mortality risk than low-morbidity (adjusted HR (95% CI): 1.57 (1.34-1.84) and 1.16 (1.05-1.28), respectively). Corticosteroids, but not tocilizumab, were associated with lower mortality risk (HR (95% CI) 0.76 (0.63-0.93)), especially in renal-morbidity and high-morbidity. Renal-morbidity and high-morbidity showed the worst lung function throughout the follow-up, with renal-morbidity having the highest risk of infectious complications (6%), emergency visits (29%) or hospital readmissions (14%) at 6 months (p<0.01). Interpretation Comorbidity-based phenotypes were identified and associated with different expression of in-hospital complications, mortality, treatment response, and sequelae, with CKD playing a major role. This could help clinicians in day-to-day decision making including the management of post-discharge COVID-19 sequelae. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd
Effectiveness of an mHealth intervention combining a smartphone app and smart band on body composition in an overweight and obese population: Randomized controlled trial (EVIDENT 3 study)
Background: Mobile health (mHealth) is currently among the supporting elements that may contribute to an improvement in health markers by helping people adopt healthier lifestyles. mHealth interventions have been widely reported to achieve greater weight loss than other approaches, but their effect on body composition remains unclear.
Objective: This study aimed to assess the short-term (3 months) effectiveness of a mobile app and a smart band for losing weight and changing body composition in sedentary Spanish adults who are overweight or obese.
Methods: A randomized controlled, multicenter clinical trial was conducted involving the participation of 440 subjects from primary care centers, with 231 subjects in the intervention group (IG; counselling with smartphone app and smart band) and 209 in the control group (CG; counselling only). Both groups were counselled about healthy diet and physical activity. For the 3-month intervention period, the IG was trained to use a smartphone app that involved self-monitoring and tailored feedback, as well as a smart band that recorded daily physical activity (Mi Band 2, Xiaomi). Body composition was measured using the InBody 230 bioimpedance device (InBody Co., Ltd), and physical activity was measured using the International Physical Activity Questionnaire.
Results: The mHealth intervention produced a greater loss of body weight (–1.97 kg, 95% CI –2.39 to –1.54) relative to standard counselling at 3 months (–1.13 kg, 95% CI –1.56 to –0.69). Comparing groups, the IG achieved a weight loss of 0.84 kg more than the CG at 3 months. The IG showed a decrease in body fat mass (BFM; –1.84 kg, 95% CI –2.48 to –1.20), percentage of body fat (PBF; –1.22%, 95% CI –1.82% to 0.62%), and BMI (–0.77 kg/m2, 95% CI –0.96 to 0.57). No significant changes were observed in any of these parameters in men; among women, there was a significant decrease in BMI in the IG compared with the CG. When subjects were grouped according to baseline BMI, the overweight group experienced a change in BFM of –1.18 kg (95% CI –2.30 to –0.06) and BMI of –0.47 kg/m2 (95% CI –0.80 to –0.13), whereas the obese group only experienced a change in BMI of –0.53 kg/m2 (95% CI –0.86 to –0.19). When the data were analyzed according to physical activity, the moderate-vigorous physical activity group showed significant changes in BFM of –1.03 kg (95% CI –1.74 to –0.33), PBF of –0.76% (95% CI –1.32% to –0.20%), and BMI of –0.5 kg/m2 (95% CI –0.83 to –0.19).
Conclusions: The results from this multicenter, randomized controlled clinical trial study show that compared with standard counselling alone, adding a self-reported app and a smart band obtained beneficial results in terms of weight loss and a reduction in BFM and PBF in female subjects with a BMI less than 30 kg/m2 and a moderate-vigorous physical activity level. Nevertheless, further studies are needed to ensure that this profile benefits more than others from this intervention and to investigate modifications of this intervention to achieve a global effect
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