Estudio de factores que permitan la estratificación del riesgo de leucoencefalopatía multifocal progresiva en pacientes con esclerosis múltiple candidatos a recibir tratamiento con Natalizumab

El riesgo de desarrollar leucoencefalopatía multifocal progresiva (LMP), una infección oportunista causada por el virus John Cunningham (JC), restringe el uso del natalizumab (NTZ), un tratamiento altamente eficaz para la esclerosis múltiple (EM). La presencia de anticuerpos anti-JC, la inmunosupresión previa y la duración del tratamiento se han identificado como variables que contribuyen a estratificar el riesgo de LMP. Sin embargo, se ha prestado menos atención al estado inmunológico del paciente. Este hecho es sorprendente, ya que la aparición de la LMP se suele asociar con una respuesta inmune comprometida. En esta línea, se ha descrito que, en pacientes con una EM con baja actividad inflamatoria, que se asocia con una ausencia de bandas oligoclonales IgM lípido-específicas (BOCM-LE) en líquido cefalorraquídeo (LCR), presentan un mayor riesgo de desarrollar LMP de manera secundaria al tratamiento con NTZ. Este hecho podría explicarse debido a que el NTZ actúa como un potente antiinflamatorio, pudiendo inducir una inmunosupresión excesiva en pacientes con un curso de EM más benigno. Para evaluar esta asociación, exploramos si las variables clínicas y demográficas asociadas con el curso de la EM pueden contribuir a identificar a los pacientes con un riesgo bajo de LMP antes del inicio del tratamiento con NTZ..

University musical training in a blended-learning context

This research study analyses the teaching of music through a blended-learning approach in a primary teaching degree programme offered by a faculty of education. A multi-method approach with qualitative and quantitative tools was used. These tools enabled us to analyse the effectiveness of the training and the variables that affect how students rate the training they receive. The results were satisfactory with the training meeting the expectations of students and teachers alike. The results illustrate the need to offer students technical assistance, the importance of the role of the teacher, and the fundamental need to carry out face-to-face sessions. We conclude that there is a need in society for continuing education which is difficult to combine with work life. Therefore, it is essential to change how we understand and experience universities; they should provide greater flexibility and be more closely connected with the real world.Este estudio expone una investigación sobre la enseñanza de la música en una Facultad de Educación que imparte formación en modalidad blended-learning en el Grado de Maestro en Educación Primaria. Se ha desarrollado un estudio multimetódico, utilizando herramientas cualitativas y cuantitativas. A través de ellas, se ha analizado la efectividad de la formación y las variables que influyen en la valoración que realizan los estudiantes sobre la formación recibida. Los resultados han sido satisfactorios, y la formación recibida ha cumplido con las expectativas de alumnos y profesores. Los resultados exponen la necesidad de ofrecer ayuda técnica a los estudiantes, la importancia de la función del profesor y la obligatoriedad de realizar sesiones presenciales. Concluimos que la sociedad tiene una necesidad de formación permanente difícil de compaginar con la vida laboral, por lo que se hace necesario un cambio en la forma de entender y vivir el entorno universitario que debe aportar flexibilidad y estar en conexión con el mundo actual

New algorithms improving PML risk stratification in MS patients treated with natalizumab

Overview: We assessed the role of age and disease activity as new factors contributing to establish the risk of progressive multifocal leucoencephalopathy in multiple sclerosis patients treated with natalizumab in 36 University Hospitals in Europe. We performed the study in 1,307 multiple sclerosis patients (70.8% anti-John Cunninghan virus positive antibodies) treated with natalizumab for a median time of 3.28 years. Epidemiological, clinical, and laboratory variables were collected. Lipid-specific IgM oligoclonal band status was available in 277 patients. Factors associated with progressive multifocal leucoencephalopathy onset were explored by uni- and multivariate logistic regression. Results: Thirty-five patients developed progressive multifocal leucoencephalopathy. The multivariate analysis identified anti-John Cunninghan virus antibody indices and relapse rate as the best predictors for the onset of this serious opportunistic infection in the whole cohort. They allowed to stratify progressive multifocal leucoencephalopathy risk before natalizumab initiation in individual patients [area under the curve (AUC) = 0.85]. The risk ranged from 0.5, to 1/50 in the opposite case. In patients with lipid-specific IgM oligoclonal bands assessment, age at natalizumab onset, anti-John Cunninghan virus antibody indices, and lipid-specific IgM oligoclonal band status predicted progressive multifocal leucoencephalopathy risk (AUC = 0.92). The absence of lipid-specific IgM oligoclonal bands was the best individual predictor (OR = 40.94). The individual risk ranged from <1/10,000 in patients younger than 45 years at natalizumab initiation, who showed anti John Cunningham virus antibody indices <0.9 and lipid-specific IgM oligoclonal bands to 1/33 in the opposite case. Conclusions: In a perspective of personalized medicine, disease activity, anti-lipid specific IgM oligoclonal bands, anti Jonh Cunninghan virus antibody levels, and age can help tailor natalizumab therapy in multiple sclerosis patients, as predictors of progressive multifocal leucoencephalopathy

Formación musical universitaria en un contexto de enseñanza blended-learning

This research study analyses the teaching of music through a blended-learning approach in a primary teaching degree programme offered by a faculty of education. A multi-method approach with qualitative and quantitative tools was used. These tools enabled us to analyse the effectiveness of the training and the variables that affect how students rate the training they receive. The results were satisfactory with the training meeting the expectations of students and teachers alike. The results illustrate the need to offer students technical assistance, the importance of the role of the teacher, and the fundamental need to carry out face-to-face sessions. We conclude that there is a need in society for continuing education which is difficult to combine with work life. Therefore, it is essential to change how we understand and experience universities; they should provide greater flexibility and be more closely connected with the real world.Este estudio expone una investigación sobre la enseñanza de la música en una Facultad de Educación que imparte formación en modalidad blended-learning en el Grado de Maestro en Educación Primaria. Se ha desarrollado un estudio multimetódico, utilizando herramientas cualitativas y cuantitativas. A través de ellas, se ha analizado la efectividad de la formación y las variables que influyen en la valoración que realizan los estudiantes sobre la formación recibida. Los resultados han sido satisfactorios, y la formación recibida ha cumplido con las expectativas de alumnos y profesores. Los resultados exponen la necesidad de ofrecer ayuda técnica a los estudiantes, la importancia de la función del profesor y la obligatoriedad de realizar sesiones presenciales. Concluimos que la sociedad tiene una necesidad de formación permanente difícil de compaginar con la vida laboral, por lo que se hace necesario un cambio en la forma de entender y vivir el entorno universitario que debe aportar flexibilidad y estar en conexión con el mundo actual

Quantitation of cell-free DNA and RNA in plasma during tumor progression in rats

<p>Abstract</p> <p>Background</p> <p>To clarify the implications of cell-free nucleic acids (cfNA) in the plasma in neoplastic disease, it is necessary to determine the kinetics of their release into the circulation.</p> <p>Methods</p> <p>To quantify non-tumor and tumor DNA and RNA in the plasma of tumor-bearing rats and to correlate such levels with tumor progression, we injected DHD/K12-PROb colon cancer cells subcutaneously into syngenic BD-IX rats. Rats were sacrificed and their plasma was analyzed from the first to the eleventh week after inoculation.</p> <p>Results</p> <p>The release of large amounts of non-tumor DNA into plasma was related to tumor development from its early stages. Tumor-specific DNA was detected in 33% of tumor-bearing rats, starting from the first week after inoculation and at an increasing frequency thereafter. Animals that were positive for tumor DNA in the plasma had larger tumors than those that were negative (p = 0.0006). However, the appearance of both mutated and non-mutated DNA fluctuated with time and levels of both were scattered among individuals in each group. The release of non-tumor mRNA was unaffected by tumor progression and we did not detect mutated RNA sequences in any animals.</p> <p>Conclusions</p> <p>The release of normal and tumor cfDNA into plasma appeared to be related to individual-specific factors. The contribution of tumor DNA to the elevated levels of plasma DNA was intermittent. The release of RNA into plasma during cancer progression appeared to be an even more selective and elusive phenomenon than that of DNA.</p

Repercusión del cuidado de nietos sobre la salud percibida en las mujeres del área sanitaria de Toledo.

Introduccion:Los cambios socioeconómicos producidos en nuestro entorno han modificado la configuración de la familia en donde la mujer como cuidadora informal del grupo de nietos desarrolla un papel muy activo. Analizar la repercusión sobre su salud percibida y su posible relación con la ansiedad y el apoyo social, nos va a permitir conocer la existencia o no de un perfil de abuela vulnerable con necesidad de cuidados enfermeros.Objetivos: Conocer la repercusión del cuidado de nietos sobre la percepción de salud en mujeres de 50 a 75 años.Material y Metodo: Estudio observacional descriptivo, transversal y multicéntrico, de tipo comparativo entre dos grupos de mujeres del Área de Salud de Toledo. Para la obtención de la muestra se realizará en primer lugar para la selección de los Centros de Salud un muestreo por conglomerados. Seguidamente un muestreo aleatorio proporcional en función de la población de Tarjeta Sanitaria Individual de los Centros de Salud seleccionados en el tramo de edad elegido y finalmente un muestreo aleatorio simple mediante listado aleatorio del censo de Tarjeta Sanitaria Individual. Se formarán dos grupos: un grupo de 74 serán cuidadoras habituales y el otro grupo de 148 serán cuidadoras ocasionales/no cuidadoras. La captación y reclutamiento de las participantes se realizará por los investigadores que citarán a las mujeres seleccionadas mediante llamada telefónica.   Abstract: Introduction: Socioeconomic changes produced in our environment have changed the configuration of the family where the female caretaker grandchildren informal group developed a very active role. Analyze the impact on their perceived health and its possible relationship to anxiety and social support will allow us to know the existence of a profile of vulnerable grandmother in need of nursing care. Objectives: To determine the impact of caring for grandchildren on perceived health in women 50 to 75 years. Material and Method: Observational descriptive, cross-sectional multicenter, comparative rate between two groups of women of Toledo Health Area. To obtain the sample is held primarily for the selection of health centers cluster sampling. Then proportional random sampling based on the population of Individual Health Card Health Centers in selected age group and finally selected a simple random sampling using census Random List Personal Health Card. They form two groups: a group of 74 normal and careers will be another group of 148 will be occasional caretakers / caregivers not. The recruitment and recruitment of participants will be cited by researchers selected women by telephone. Selected participants completed a survey that in addition to sociodemographic and clinical variables included the following questionnaires: SF-12 perceived health, social support UNC Duke and STAI.   Palabra Clave: Anciano; Salud del Anciano; Apoyo Social; Familia; Calidad de Vida. Key Words: Aged; Health of the Elderly; Social Support; Family; Quality of Life

Repercusión del cuidado de nietos sobre la salud percibida en las mujeres del área sanitaria de Toledo

Introduction. Socioeconomic changes produced in our environment have changed the configuration of the family where the female caretaker grandchildren informal group developed a very active role. Analyze the impact on their perceived health and its possible relationship to anxiety and social support will allow us to know the existence of a profile of vulne-rable grandmother in need of nursing care. Objectives. To determine the impact of caring for grandchildren on perceived health in women 50 to 75 years. Material and Method. Observational descriptive, cross-sectional multicenter, compara-tive rate between two groups of women of Toledo Health Area. To obtain the sample is held primarily for the selection of health centers cluster sampling. Then proportional random sampling based on the population of Individual Health Card Health Centers in selected age group and finally selected a simple random sampling using census Random List Personal Health Card. They form two groups: a group of 74 normal and careers will be another group of 148 will be occasional caretakers / caregivers not.The recruitment and recruitment of participants will be cited by researchers selected women by telephone. Selected participants completed a survey that in addition to sociodemographic and clinical variables included the following ques-tionnaires: SF-12 perceived health, social support UNC Duke and STAI.Introduccion. Los cambios socioeconómicos producidos en nuestro entorno han modificado la configuración de la familia en donde la mujer como cuidadora informal del grupo de nietos desarrolla un papel muy activo. Analizar la repercusión sobre su salud percibida y su posible relación con la ansiedad y el apoyo social, nos va a permitir conocer la existencia o no de un perfil de abuela vulnerable con necesidad de cuidados enfermeros. Objetivos. Conocer la repercusión delcuidado de nietos sobre la percepción de salud en mujeres de 50 a 75 años. Material y Metodo. Estudio observacional descriptivo, transversal y multicéntrico, de tipo comparativo entre dos grupos de mujeres del Área de Salud de Toledo. Para la obtención de la muestra se realizará en primer lugar para la selección de los Centros de Salud un muestreo por conglomerados. Seguidamente un muestreo aleatorio proporcional en función de la población de Tarjeta Sanitaria In-dividual de los Centros de Salud seleccionados en el tramo de edad elegido y finalmente un muestreo aleatorio simple mediante listado aleatorio del censo de Tarjeta Sanitaria Individual. Se formarán dos grupos: un grupo de 74 serán cuidadoras habituales y el otro grupo de 148 serán cuidadoras ocasionales/no cuidadoras.La captación y reclutamiento de las participantes se realizará por los investigadores que citarán a las mujeres selec-cionadas mediante llamada telefónica. Las participantes seleccionadas cumplimentarán una encuesta que además de variables sociodemográficas y clínicas incluye los siguientes cuestionarios: SF-12 sobre salud percibida, Duke UNC de apoyo social y STAI

Storage proteins are driving pediatric hazelnut allergy in a lipid transfer protein-rich area

This article belongs to the Special Issue Molecular Approaches to Food Allergy Diagnosis, Treatment and Identification of Allergens.Oral food challenge (OFC) remains the gold standard for the diagnosis of food allergies. However, this test is not without risks, given that severe allergic reactions can be triggered while it is conducted. The purpose of this study is to identify potential demographic variables, clinical characteristics of the patients and biomarkers that may be associated with severe reactions during the hazelnut oral challenge test. The sample included 22 children allergic to hazelnut who underwent a tree nut skin prick test (SPT), specific IgE (sIgE) to hazelnut, component-resolved diagnosis (CRD) with different hazelnut allergens (Cor a 1, Cor a 8, Cor a 9, Cor a 11, Cor a 14), and a single-blind placebo-controlled challenge with hazelnut. A statistically significant relationship was found between the severity of the reaction and the highest values of sIgE to hazelnut, Cor a 11 and Cor a 14, cumulative symptom-triggering dose and sunflower seed sensitization. The use of the CRD is a useful tool to identify patients at higher risk of developing a severe reaction. In this pediatric population sample from Spain, storage proteins were confirmed to be most involved in hazelnut allergy and the development of severe reactions.This research was funded by SEAIC Foundation of the Spanish Society of Allergy and Clinical Immunology.Peer reviewe

Predicting aggressive multiple sclerosis with intrathecal IgM synthesis among patients with a clinically isolated syndrome

OBJECTIVE: To determine the best method to measure intrathecal immunoglobulin (Ig) M synthesis (ITMS), a biomarker of worse prognosis in multiple sclerosis (MS). We compared the ability for predicting a poor evolution of 4 methods assessing ITMS (IgM oligoclonal bands [OCMBs], lipid-specific OCMBs [LS-OCMBs], Reibergram, and IgM index) in patients with a clinically isolated syndrome (CIS). METHODS: Prospective study with consecutive patients performed at a referral MS center. We used unadjusted and multivariate Cox regressions for predicting a second relapse, Expanded Disability Status Scale (EDSS) scores of 4 and 6, and development of secondary progressive MS (SPMS). RESULTS: A total of 193 patients were included, with a median (interquartile range) age of 31 (25–38) years and a median follow-up of 12.9 years. Among all methods, only OCMB, LS-OCMB, and Reibergram significantly identified patients at risk of some of the pre-established outcomes, being LS-OCMB the technique with the strongest associations. Adjusted hazard ratio (aHR) of LS-OCMB for predicting a second relapse was 2.50 (95% CI 1.72–3.64, p < 0.001). The risk of reaching EDSS scores of 4 and 6 and SPMS was significantly higher among patients with LS-OCMB (aHR 2.96, 95% CI 1.54–5.71, p = 0.001; aHR 4.96, 95% CI 2.22–11.07, p < 0.001; and aHR 2.31, 95% CI 1.08–4.93, p = 0.03, respectively). CONCLUSIONS: ITMS predicts an aggressive MS at disease onset, especially when detected as LS-OCMB. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that lipid-specific IgM oligoclonal bands can predict progression from CIS to MS and a worse disease course over a follow-up of at least 2 years