Peritumoral immune infiltrates in primary tumours are not associated with the presence of axillary lymph node metastasis in breast cancer: a retrospective cohort study

Background. The axillary lymph nodes (ALNs) in breast cancer patients are the body regions to where tumoral cells most often first disseminate. The tumour immune response is important for breast cancer patient outcome, and some studies have evaluated its involvement in ALN metastasis development. Most studies have focused on the intratumoral immune response, but very few have evaluated the peritumoral immune response. The aim of the present article is to evaluate the immune infiltrates of the peritumoral area and their association with the presence of ALN metastases. Methods. The concentration of 11 immune markers in the peritumoral areas was studied in 149 patients diagnosed with invasive breast carcinoma of no special type (half of whom had ALN metastasis at diagnosis) using tissue microarrays, immunohistochemistry and digital image analysis procedures. The differences in the concentration of the immune response of peritumoral areas between patients diagnosed with and without metastasis in their ALNs were evaluated. A multivariate logistic regression model was developed to identify the clinical-pathological variables and the peritumoral immune markers independently associated with having or not having ALN metastases at diagnosis. Results. No statistically significant differences were found in the concentrations of the 11 immune markers between patients diagnosed with or without ALN metastases. Patients with metastases in their ALNs had a higher histological grade, more lymphovascular and perineural invasion and larger-diameter tumours. The multivariate analysis, after validation by bootstrap simulation, revealed that only tumour diameter (OR = 1.04; 95% CI [1.00-1.07]; p = 0.026), lymphovascular invasion (OR = 25.42; 95% CI [9.57-67.55]; p<0.001) and histological grades 2 (OR = 3.84; 95% CI [1.11-13.28]; p = 0.033) and 3 (OR = 5.18; 95% CI [1.40-19.17]; p = 0.014) were associated with the presence of ALN metastases at diagnosis. This study is one of the first to study the association of the peritumoral immune response with ALN metastasis. We did not find any association of peritumoral immune infiltrates with the presence of ALN metastasis. Nevertheless, this does not rule out the possibility that other peritumoral immune populations are associated with ALN metastasis. This matter needs to be examined in greater depth, broadening the types of peritumoral immune cells studied, and including new peritumoral areas, such as the germinal centres of the peritumoral tertiary lymphoid structures found in extensively infiltrated neoplastic lesions

Revista de Vertebrados de la Estación Biológica de Doñaña

Alimentación de la boga del Guadiana (Chondrostoma polylepis wi/lkommi, Stein. 1866) en la interfase río-embalse de Sierra Boyera (Córdoba. España)Predación del búho real (Bubo bubo) sobre la perdiz roja (Alectoris rufa): selección de edad y sexoAlimentación de la nutria (Lutra lufra L, 1758)en el Nordeste de la Península IbéricaDatos sobre la distribución espacialde micromamíferos en el Parque Nacionalde DoñanaGuía para el reconocimiento microscópico de los pelos de los mamíferos de la Patagonia.Sobre la distribución geográfica de Anaecypris hispanica (STEINDACHNER, 1866) (OSTEICHTHYES, CYPRINIDAE)Cronología del periodo reproductor de Rana temporaria L. en La Coruña (NW de España).Un nuevo caso de melanismo en Natrix natrix (LINNAEUS 1758) procedente de Fuente Dé (Santander)Nuevas citas de anfibios y reptiles para el SE de la Península Ibérica.Datos sobre la dieta invernal del Búho chico (Asia atus) en la provinvia de LeónLa Distribucióndel Mara (Dolichotis patagonum) según criterios ecológicos e históricosSolapamiento entre la dieta de la cabra montés (Capra pyrenaica) y la del muflón (Ovis musimon)Nota sobre dietas de carnívoros e índices de abundancia en una Reserva de caza del norte de España.Discriminación osteométrica en el géneroTalpa (LINNEO, 1758), en el norte IbéricoObservaciones sobre el comportamiento depredativo de algunos colúbridos Ibéricos en estado salvajePeer reviewe

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p &lt; 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

Sobre el aprendizaje de pesos en operadores de agregación: la media ponderada y operadores OWA

We study the determination of weights for two types of aggregation operators: the weighted mean and the OWA operator. We assume that there is at our disposal a set of examples for which the outcome of the aggregation operator is known. In the case of the OWA operator, we compare the results obtained by our method with another one in the literature. We show that the optimal weighting vector is reached with less cost.The author acknowledges partial support of the CICYT project SMASH (TIC96-1138-C04-04).Peer reviewe

Máster Universitario en Profesorado de Enseñanza Secundaria Obligatoria, Bachillerato, Formación Profesional y Enseñanza de Idiomas (MAES) : Hostelería y Turismo

716 páginasLa educación secundaria ha experimentado cambios notables en los últimos años. La Ley Orgánica 8/2013, de 9 de diciembre, para la mejora de la calidad educativa, supuso una reestructuración de las etapas educativas, sobre todo a partir de la figura del “consejo orientador”, que adelanta la elección entre el itinerario académico y el de formación profesional a los 15 años, introduciendo la Formación Profesional Básica. Asimismo, la Ley Orgánica 3/2022, de 31 de marzo, de ordenación e integración de la Formación Profesional, supone una profunda reorganización de la formación profesional, para contribuir a eliminar el elevado desempleo estructural y dar respuesta a las necesidades del sistema productivo, con la intención de cubrir algunas de sus ofertas de empleo, sobre todo en niveles intermedios de cualificación –vinculados a la formación profesional- y, más en concreto, en aquellas actividades directamente relacionas con la modernización del sistema económico exigida por el cambio tecnológico y la nueva economía verde. Así lo indica el preámbulo de la Ley al señalar que “El escaso desarrollo de las cualificaciones intermedias en la estructura formativa española exige duplicar, con rapidez, el número de personas con formación intermedia para poder responder a las necesidades del sistema productivo”. Por otra parte, los docentes profesionales de la actual sociedad digital deben poseer una serie de conocimientos y destrezas profesionales que les permitan comprender y tratar de superar las dificultades de aprendizaje de su alumnado, diseñar materiales educativos y actividades motivadoras, fomentar la convivencia y la participación del alumnado, utilizar las nuevas tecnologías, el aprendizaje activo y significativo, mejorar el proceso de evaluación, orientar y tutorizar al alumnado, implicarse en el funcionamiento colectivo de los centros educativos, etc. Es en este marco en el que cobra más sentido aún la exigencia de profesionalización docente, que se introdujera ya con el Real Decreto 1393/2007, de 29 de octubre, por el que se establece la ordenación de las enseñanzas universitarias oficiales, en el marco del Espacio Europeo de Educación Superior. Asimismo, con independencia del nivel educativo o la especialidad en que imparte el profesorado, su formación debe ser académica y multidisciplinar. En este contexto es en el que se ha diseñado este Título de Máster de Profesorado en la UNIA, que atiende a la demanda de estudiantes que se orientan profesionalmente hacia la docencia en niveles de Educación Secundaria Profesional, respondiendo a la obligatoriedad de cursar estudios de Máster para ejercer la docencia en estos ámbitos dispuesta en la Ley Orgánica de Educación 2/2006 de 24 de mayo, y según la regulación establecida para estos Másteres en la Orden 3858/2007 de 27 de diciembre, que ahora se refuerza con la Ley Orgánica de Ordenación e Integración de la Formación Profesional en trámite parlamentario

Sobre el aprendizaje de pesos en operadores de agregación: la media ponderada y operadores OWA

We study the determination of weights for two types of aggregation operators: the weighted mean and the OWA operator. We assume that there is at our disposal a set of examples for which the outcome of the aggregation operator is known. In the case of the OWA operator, we compare the results obtained by our method with another one in the literature. We show that the optimal weighting vector is reached with less cost.The author acknowledges partial support of the CICYT project SMASH (TIC96-1138-C04-04).Peer reviewe

Discovering HIV related information by means of association rules and machine learning

Acquired immunodeficiency syndrome (AIDS) is still one of the main health problems worldwide. It is therefore essential to keep making progress in improving the prognosis and quality of life of affected patients. One way to advance along this pathway is to uncover connections between other disorders associated with HIV/AIDS-so that they can be anticipated and possibly mitigated. We propose to achieve this by using Association Rules (ARs). They allow us to represent the dependencies between a number of diseases and other specific diseases. However, classical techniques systematically generate every AR meeting some minimal conditions on data frequency, hence generating a vast amount of uninteresting ARs, which need to be filtered out. The lack of manually annotated ARs has favored unsupervised filtering, even though they produce limited results. In this paper, we propose a semi-supervised system, able to identify relevant ARs among HIV-related diseases with a minimal amount of annotated training data. Our system has been able to extract a good number of relationships between HIV-related diseases that have been previously detected in the literature but are scattered and are often little known. Furthermore, a number of plausible new relationships have shown up which deserve further investigation by qualified medical experts

COVID-19 in hospitalized HIV-positive and HIV-negative patients : A matched study

CatedresObjectives: We compared the characteristics and clinical outcomes of hospitalized individuals with COVID-19 with [people with HIV (PWH)] and without (non-PWH) HIV co-infection in Spain during the first wave of the pandemic. Methods: This was a retrospective matched cohort study. People with HIV were identified by reviewing clinical records and laboratory registries of 10 922 patients in active-follow-up within the Spanish HIV Research Network (CoRIS) up to 30 June 2020. Each hospitalized PWH was matched with five non-PWH of the same age and sex randomly selected from COVID-19@Spain, a multicentre cohort of 4035 patients hospitalized with confirmed COVID-19. The main outcome was all-cause in-hospital mortality. Results: Forty-five PWH with PCR-confirmed COVID-19 were identified in CoRIS, 21 of whom were hospitalized. A total of 105 age/sex-matched controls were selected from the COVID-19@Spain cohort. The median age in both groups was 53 (Q1-Q3, 46-56) years, and 90.5% were men. In PWH, 19.1% were injecting drug users, 95.2% were on antiretroviral therapy, 94.4% had HIV-RNA < 50 copies/mL, and the median (Q1-Q3) CD4 count was 595 (349-798) cells/μL. No statistically significant differences were found between PWH and non-PWH in number of comorbidities, presenting signs and symptoms, laboratory parameters, radiology findings and severity scores on admission. Corticosteroids were administered to 33.3% and 27.4% of PWH and non-PWH, respectively (P = 0.580). Deaths during admission were documented in two (9.5%) PWH and 12 (11.4%) non-PWH (P = 0.800). Conclusions: Our findings suggest that well-controlled HIV infection does not modify the clinical presentation or worsen clinical outcomes of COVID-19 hospitalization

How do women living with HIV experience menopause? Menopausal symptoms, anxiety and depression according to reproductive age in a multicenter cohort

CatedresBackground: To estimate the prevalence and severity of menopausal symptoms and anxiety/depression and to assess the differences according to menopausal status among women living with HIV aged 45-60 years from the cohort of Spanish HIV/AIDS Research Network (CoRIS). Methods: Women were interviewed by phone between September 2017 and December 2018 to determine whether they had experienced menopausal symptoms and anxiety/depression. The Menopause Rating Scale was used to evaluate the prevalence and severity of symptoms related to menopause in three subscales: somatic, psychologic and urogenital; and the 4-item Patient Health Questionnaire was used for anxiety/depression. Logistic regression models were used to estimate odds ratios (ORs) of association between menopausal status, and other potential risk factors, the presence and severity of somatic, psychological and urogenital symptoms and of anxiety/depression. Results: Of 251 women included, 137 (54.6%) were post-, 70 (27.9%) peri- and 44 (17.5%) pre-menopausal, respectively. Median age of onset menopause was 48 years (IQR 45-50). The proportions of pre-, peri- and post-menopausal women who had experienced any menopausal symptoms were 45.5%, 60.0% and 66.4%, respectively. Both peri- and post-menopause were associated with a higher likelihood of having somatic symptoms (aOR 3.01; 95% CI 1.38-6.55 and 2.63; 1.44-4.81, respectively), while post-menopause increased the likelihood of having psychological (2.16; 1.13-4.14) and urogenital symptoms (2.54; 1.42-4.85). By other hand, post-menopausal women had a statistically significant five-fold increase in the likelihood of presenting severe urogenital symptoms than pre-menopausal women (4.90; 1.74-13.84). No significant differences by menopausal status were found for anxiety/depression. Joint/muscle problems, exhaustion and sleeping disorders were the most commonly reported symptoms among all women. Differences in the prevalences of vaginal dryness (p = 0.002), joint/muscle complaints (p = 0.032), and sweating/flush (p = 0.032) were found among the three groups. Conclusions: Women living with HIV experienced a wide variety of menopausal symptoms, some of them initiated before women had any menstrual irregularity. We found a higher likelihood of somatic symptoms in peri- and post-menopausal women, while a higher likelihood of psychological and urogenital symptoms was found in post-menopausal women. Most somatic symptoms were of low or moderate severity, probably due to the good clinical and immunological situation of these women

Demographic, clinical, and functional determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation

Altres ajuts: Alliance Bristol-Myers Squibb/Pfizer.Background: This study assessed the sociodemographic, functional, and clinical determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation (NVAF) attended in the internal medicine setting. Methods: A multicenter, cross-sectional study was conducted in NVAF patients who attended internal medicine departments for either a routine visit (outpatients) or hospitalization (inpatients). Results: A total of 961 patients were evaluated. Their antithrombotic management included: no treatment (4.7%), vitamin K antagonists (VKAs) (59.6%), direct oral anticoagulants (DOACs) (21.6%), antiplatelets (6.6%), and antiplatelets plus anticoagulants (7.5%). Permanent NVAF and congestive heart failure were associated with preferential use of oral anticoagulation over antiplatelets, while intermediate-to high-mortality risk according to the PROFUND index was associated with a higher likelihood of using antiplatelet therapy instead of oral anticoagulation. Longer disease duration and institutionalization were identified as determinants of VKA use over DOACs. Female gender, higher education, and having suffered a stroke determined a preferential use of DOACs. Conclusions: This real-world study showed that most elderly NVAF patients received oral anticoagulation, mainly VKAs, while DOACs remained underused. Antiplatelets were still offered to a proportion of patients. Longer duration of NVAF and institutionalization were identified as determinants of VKA use over DOACs. A poor prognosis according to the PROFUND index was identified as a factor preventing the use of oral anticoagulation