Influencia de la comunicaci?n t?cnica en la coordinaci?n de la atenci?n geri?trica durante la crisis del COVID-19 en la provincia de Lugo. Estudio prospectivo

Introducci?n: La pandemia producida por el coronavirus SARS-CoV-2 supone un gran reto sanitario con efectos econ?micos y sociales patentes. La salud de la poblaci?n mundial peligra y las formas habituales de afrontar situaciones epid?micas son puestas en cuesti?n, lo que hace necesario un esfuerzo de coordinaci?n en la atenci?n a las personas mayores. Objetivo: Conocer la influencia que la comunicaci?n t?cnica producida durante la crisis sanitaria generada a ra?z del COVID-19 podr? ejercer sobre la coordinaci?n de la atenci?n geri?trica en la provincia de Lugo. Metodolog?a: Estudio prospectivo Delphi empleando un cuestionario de doble circulaci?n a cumplimentar por expertos en Geriatr?a y Gerontolog?a de la provincia de Lugo constituidos en dos paneles. Resultados: N = 26 (20 mujeres, 6 hombres). Rango de edad: 25 ? 63 a?os. Las respuestas medias de ambos paneles se han aproximado y los rangos se han estrechado en la segunda circulaci?n de la encuesta. Conclusi?n: Una estrategia de comunicaci?n bidireccional entre los profesionales de la Geriatr?a y la Gerontolog?a, basada en documentaci?n t?cnica y cient?fica, facilitar? la coordinaci?n entre niveles asistenciales y mejorar? las expectativas de salud de las personas mayores en situaciones de crisis aunque tambi?n en la cronicidad

A model of indirect cell death caused by tumor vascular damage after high-dose radiotherapy

There is increasing evidence that high doses of radiotherapy, like those delivered in stereotactic body radiotherapy (SBRT), trigger indirect mechanisms of cell death. Such effect seems to be two-fold. High doses may trigger an immune response and may cause vascular damage, leading to cell starvation and death. Development of mathematical response models, including indirect death, may help clinicians to design SBRT optimal schedules. Despite increasing experimental literature on indirect tumor cell death caused by vascular damage, efforts on modeling this effect have been limited. In this work, we present a biomathematical model of this effect. In our model, tumor oxygenation is obtained by solving the reaction-diffusion equation; radiotherapy kills tumor cells according to the linear-quadratic model, and also endothelial cells (EC), which can trigger loss of functionality of capillaries. Capillary death will affect tumor oxygenation, driving nearby tumor cells into severe hypoxia. Capillaries can recover functionality due to EC proliferation. Tumor cells entering a predetermined severe hypoxia status die according to a hypoxia-death model. This model fits recently published experimental data showing the effect of vascular damage on surviving fractions. It fits surviving fraction curves and qualitatively reproduces experimental values of percentages of functional capillaries 48 hours postirradiation, and hypoxic cells pre- and 48 hours postirradiation. This model is useful for exploring aspects of tumor and EC response to radiotherapy and constitutes a stepping stone toward modeling indirect tumor cell death caused by vascular damage and accounting for this effect during SBRT planning. SIGNIFICANCE: A novel biomathematical model of indirect tumor cell death caused by vascular radiation damage could potentially help clinicians interpret experimental data and design better radiotherapy schedules

Anorexia induced by activation of serotonin 5-HT4 receptors is mediated by increases in CART in the nucleus accumbens

Anorexia nervosa is a growing concern in mental health, often inducing death. The potential neuronal deficits that may underlie abnormal inhibitions of food intake, however, remain largely unexplored. We hypothesized that anorexia may involve altered signaling events within the nucleus accumbens (NAc), a brain structure involved in reward. We show here that direct stimulation of serotonin (5-hydroxytryptamine, 5-HT) 4 receptors (5-HT4R) in the NAc reduces the physiological drive to eat and increases CART (cocaine- and amphetamine-regulated transcript) mRNA levels in fed and food-deprived mice. It further shows that injecting 5-HT4R antagonist or siRNA-mediated 5-HT4R knockdown into the NAc induced hyperphagia only in fed mice. This hyperphagia was not associated with changes in CART mRNA expression in the NAc in fed and food-deprived mice. Results include that 5-HT4R control CART mRNA expression into the NAc via a cAMP/PKA signaling pathway. Considering that CART may interfere with food- and drug-related rewards, we tested whether the appetite suppressant properties of 3,4-N-methylenedioxymethamphetamine (MDMA, ecstasy) involve the 5-HT4R. Using 5-HT4R knockout mice, we demonstrate that 5-HT4R are required for the anorectic effect of MDMA as well as for the MDMA-induced enhancement of CART mRNA expression in the NAc. Directly injecting CART peptide or CART siRNA into the NAc reduces or increases food consumption, respectively. Finally, stimulating 5-HT4R- and MDMA-induced anorexia were both reduced by injecting CART siRNA into the NAc. Collectively, these results demonstrate that 5-HT4R-mediated up-regulation of CART in the NAc triggers the appetite-suppressant effects of ecstasy