Fournier’s Gangrene under Sodium–Glucose Cotransporter-2 Inhibitors Therapy in Gynecological Patients

La gangrena de Fournier (GF) es una patología grave de los tejidos blandos y fascia del perineo y región genital con una alta morbimortalidad. En los últimos años, el antidiabético oral inhibidor de SGLT-2 se ha relacionado con esta entidad. Según las nuevas advertencias de las principales agencias de drogas, se ha iniciado una recopilación de casos para establecer o negar una posible relación causal. La mayoría de estos casos han sido reportados en hombres. Sin embargo, es importante no subestimar esta entidad en el campo ginecológico, ya que es de extrema gravedad y requiere un tratamiento agresivo intenso y rápido basado en cirugía y antibioterapia empírica. Posteriormente son necesarios algunos cuidados que implican la reconstrucción quirúrgica de los defectos introducidos por el desbridamiento. Como resultado de la baja incidencia de FG, los datos de los ensayos clínicos pueden ser insuficientes para evaluar de manera sólida este problema debido al número limitado de participantes. La evidencia del mundo real puede ayudar a aclarar la asociación entre SGLT2i y FG. El objetivo de esta revisión es describir y comparar los casos informados de FG en mujeres diabéticas que recibieron inhibidores de SGLT2 como agentes antiglucemiantesThis research received no external funding. Partial funding for open access charge: Universidad de Málag

Clinical guidelines for late-onset Pompe disease

English version available at www.neurologia.comHasta 2006, la enfermedad de Pompe o glucogenosis tipo II era una enfermedad incurable y con tratamiento meramente paliativo. El desarrollo de la terapia de sustitución con la enzima α-glucosidasa recombinante humana ha constituido el primer tratamiento específico para esta enfermedad. El objetivo de esta guía es servir de referencia en el manejo de la variedad de inicio tardío de la enfermedad de Pompe, es decir, la que aparece después del primer año de vida. En la guía, un grupo de expertos españoles hace recomendaciones específicas en cuanto a diagnóstico, seguimiento y tratamiento de esta enfermedad. En cuanto al diagnóstico, el método de la muestra en sangre seca es imprescindible como primer paso para el diagnóstico de la enfermedad de Pompe, y el diagnóstico de confirmación de la enfermedad de Pompe debe realizarse mediante un estudio de la actividad enzimática en muestra líquida en linfocitos aislados o mediante el análisis mutacional del gen de la alfa-glucosidasa. En cuanto al tratamiento de la enfermedad con terapia de sustitución enzimática, los expertos afirman que es eficaz en la mejoría o estabilización de la función motora y pulmonar, y debe iniciarse cuando aparezcan los síntomas atribuibles a la enfermedad de PompeBefore 2006, Pompe disease or glycogenosis storage disease type II was an incurable disease whose treatment was merely palliative. The development of a recombinant human alpha-glucosidase enzymatic replacement therapy has become the first specific treatment for this illness. The aim of this guide is to serve as reference for the management of the late-onset Pompe disease, the type of Pompe disease that develops after one year of age. In the guide a group of Spanish experts make specific recommendations about diagnosis, follow-up and treatment of this illness. With regard to diagnosis, the dried blood spots method is essential as the first step for the diagnosis of Pompe disease. The confirmation of the diagnosis of Pompe disease must be made by means of an study of enzymatic activity in isolated lymphocytes or a mutation analysis of the alpha-glucosidase gene. With regard to treatment with enzymatic replacement therapy, the experts say that is effective improving or stabilizating the motor function and the respiratory function and it must be introduced when the first symptoms attributable to Pompe disease appea

Implementation and performance of automated software to compute the RV/LV diameter ratio from CT pulmonary angiography images

Objective: The aim of this study was to prospectively test the performance and potential for clinical integration of software that automatically calculates the right-to-left ventricular (RV/LV) diameter ratio from computed tomography pulmonary angiography images. Methods: Using 115 computed tomography pulmonary angiography images that were positive for acute pulmonary embolism, we prospectively evaluated RV/LV ratio measurements that were obtained as follows: (1) completely manual measurement (reference standard), (2) completely automated measurement using the software, and (3 and 4) using a customized software interface that allowed 2 independent radiologists to manually adjust the automatically positioned calipers. Results: Automated measurements underestimated (P < 0.001) the reference standard (1.09 [0.25] vs1.03 [0.35]). With manual correction of the automatically positioned calipers, the mean ratio became closer to the reference standard (1.06 [0.29] by read 1 and 1.07 [0.30] by read 2), and the correlation improved (r = 0.675 to 0.872 and 0.887). The mean time required for manual adjustment (37 [20] seconds) was significantly less than the time required to perform measurements entirely manually (100 [23] seconds). Conclusions: Automated CT RV/LV diameter ratio software shows promise for integration into the clinical workflow for patients with acute pulmonary embolism

The use of fluoroproline in MUC1 antigen enables efficient detection of antibodies in patients with prostate cancer

A structure-based design of a new generation of tumor-associated glycopeptides with improved affinity against two anti-MUC1 antibodies is described. These unique antigens feature a fluorinated proline residue, such as a (4S)-4-fluoro-l-proline or 4,4-difluoro-l-proline, at the most immunogenic domain. Binding assays using biolayer interferometry reveal 3-fold to 10-fold affinity improvement with respect to the natural (glyco)peptides. According to X-ray crystallography and MD simulations, the fluorinated residues stabilize the antigen-antibody complex by enhancing key CH/π interactions. Interestingly, a notable improvement in detection of cancer-associated anti-MUC1 antibodies from serum of patients with prostate cancer is achieved with the non-natural antigens, which proves that these derivatives can be considered better diagnostic tools than the natural antigen for prostate cancer.We thank the Ministerio de Economía y Competitividad (projects CTQ2015-67727-R, UNLR13-4E-1931, CTQ2013-44367-C2-2-P, CTQ2015-64597-C2-1P, and BFU2016-75633-P). I.A.B. thanks the Asociación Española Contra el Cancer en La Rioja for a grant. I.S.A. and G.J.L.B. thank FCT Portugal (Ph.D. studentship and FCT Investigator, respectively) and EPSRC. G.J.L.B. holds a Royal Society URF and an ERC StG (TagIt). F.C. and G.J.L.B thank the EU (Marie-Sklodowska Curie ITN, Protein Conjugates). R.H-G. thanks Agencia Aragonesa para la Investigación y Desarrollo (ARAID) and the Diputación General de Aragón (DGA, B89) for financial support. The research leading to these results has also received funding from the FP7 (2007-2013) under BioStruct-X (grant agreement no. 283570 and BIOSTRUCTX_5186). We thank synchrotron radiation source DIAMOND (Oxford) and beamline I04 (number of experiment mx10121-19). The Hokkaido University group acknowledges JSPS KAKENHI grant no. 25220206 and JSPS Wakate B KAKENHI grant no. 24710242. We also thank CESGA (Santiago de Compostela) for computer support.Peer reviewedPeer Reviewe

Intimate Partner Violence: perspective of convicts and psychologists of penitentiary institutions. A Qualitative analysis with focus groups

Intimate Partner Violence is a complex process in which individual, relational and contextual variables intervene. The aim of this study was to explore coping strategies and relational dynamics in conflict situations involving people convicted of intimate partner violence with their partners. Focus groups were conducted with convicted intimate partner violence offenders (12 participants) and with psychology professionals (4 participants). The data were explored through thematic analysis following the Nested Ecological Model. The group of convicted perpetrators showed roles of authority and superiority over the woman, a feeling of vulnerability and rejection of the existing legal framework, fear of being arrested for wanting to continue the relationship, the need to control the partner driven by jealousy, justification or denial of responsibility in violent situations or instrumentalization of the children in common. The professionals point out cultural aspects that facilitate violent patterns and roles in the couple's dynamics, communication problems, denial or low awareness of the crime, among other issues. The results are of special interest both for professionals who wish to learn or deepen their knowledge on the subject, as well as for those who work in intervention and/or prevention of intimate partner violence.n. La violencia de género es un proceso complejo en el cual intervienen variables individuales, relacionales y contextuales. El presente estudio tiene como objetivo explorar las estrategias de afrontamiento y dinámicas relacionales en situaciones conflictivas en condenados por violencia de género con sus parejas. Se realizaron grupos focales con condenados por violencia de género (12 participantes) y con profesionales de la psicología (4 participantes). Los datos se exploraron mediante análisis temático siguiendo el Modelo Ecológico Anidado. El grupo de condenados muestra roles de autoridad y superioridad sobre la mujer, sensación de vulnerabilidad y rechazo ante el marco jurídico existente, miedo a sufrir arrestos por querer continuar con la relación, la necesidad de control de la pareja impulsada por lo celos, la justificación o negación de responsabilidad en las situaciones violentas o instrumentalización de los hijos/as en común. Los profesionales señalan aspectos culturales que facilitan esquemas y roles violentos en la dinámica de pareja, problemas de comunicación, negación o baja conciencia del delito, entre otros temas. Los resultados son de especial interés tanto para los profesionales que deseen conocer o profundizar en la temática, como para quienes trabajen en la intervención y/o prevención en violencia de género

Calibration and performance tests of detectors for laser-accelerated protons

We present the calibration and performance tests carried out with two detectors for intense proton pulses accelerated by lasers. Most of the procedures were realized with proton beams of 0.46-5.60 MeV from a tandem accelerator. One approach made use of radiochromic films, for which we calibrated the relation between optical density and energy deposition over more than three orders of magnitude. The validity of these results and of our analysis algorithms has been confirmed by controlled irradiation of film stacks and reconstruction of the total beam charge for strongly non-uniform beam profiles. For the spectral analysis of protons from repeated laser shots, we have designed an online monitor based on a plastic scintillator. The resulting signal from a photomultiplier directly measured on a fast oscilloscope is especially useful for time-of-flight applications. Variable optical filters allow for suppression of saturation and an extension of the dynamic range. With pulsed proton beams we have tested the detector response to a wide range of beam intensities from single particles to 3 ×105 protons per 100 ns time interval.Project funded by the Spanish Ministry of Economy and Competitiveness and co-funded with FEDER's funds within the INNPACTO 2011 program under Grant No. IPT-2011-0862-900000. This work was supported by the Spanish Plan Nacional de Investigacion Cientifica, Desarrollo e Innovacion Tecnologica (I+D+i) under Grant No. TEC 2013-48036-C3-1-R and the Valencian Local Government under Grants PROMETEOII/2013/010 and ISIC 2011/013. The work of A. J. Gonzalez is financed by CSIC with a JAE-Doc contract under Junta de Ampliacion de Estudios program, cofinanced by the European Social Fund.Peer Reviewe

A precision medicine test predicts clinical response after idarubicin and cytarabine induction therapy in AML patients

Complete remission (CR) after induction therapy is the first treatment goal in acute myeloid leukemia (AML) patients and has prognostic impact. Our purpose is to determine the correlation between the observed CR/CRi rate after idarubicin (IDA) and cytarabine (CYT) 3 + 7 induction and the leukemic chemosensitivity measured by an ex vivo test of drug activity. Bone marrow samples from adult patients with newly diagnosed AML were included in this study. Whole bone marrow samples were incubated for 48 h in well plates containing IDA, CYT, or their combination. Pharmacological response parameters were estimated using population pharmacodynamic models. Patients attaining a CR/CRi with up to two induction cycles of 3 + 7 were classified as responders and the remaining as resistant. A total of 123 patients fulfilled the inclusion criteria and were evaluable for correlation analyses. The strongest clinical predictors were the area under the curve of the concentration response curves of CYT and IDA. The overall accuracy achieved using MaxSpSe criteria to define positivity was 81%, predicting better responder (93%) than non-responder patients (60%). The ex vivo test provides better yet similar information than cytogenetics, but can be provided before treatment representing a valuable in-time addition. After validation in an external cohort, this novel ex vivo test could be useful to select AML patients for 3 + 7 regimen vs. alternative schedules

Transmitted Fetal Immune Response in Cases of SARS-CoV-2 Infections during Pregnancy

(1) Background: Little is known about the effects of SARS-CoV-2 on the placenta, and whether the maternal inflammatory response is transmitted vertically. This research aims to provide information about the effects of SARS-CoV-2 infection on maternal and fetal immunity. (2) Methods: We have studied placental changes and humoral and cellular immunity in maternal and umbilical cord blood (UCB) samples from a group of pregnant women delivering after the diagnosis of SARS-CoV-2 infection during pregnancy. IgG and IgM SARS-CoV-2 antibodies, Interleukin 1b (IL1b), Interleukin 6 (IL6), and gamma-Interferon (IFN-γ), have been studied in the UCB samples. Lymphocyte subsets were studied according to CD3, CD8, CD4, CD34, and invariant natural Killer T cells (iNKT) markers. We used in situ hybridization techniques for the detection of viral RNA in placentas. (3) Results: During the study period, 79 pregnant women and their corresponding newborns were recruited. The main gestational age at the time of delivery was 39.1 weeks (SD 1.3). We did not find traces of the SARS-CoV-2 virus RNA in any of the analyzed placental samples. Detectable concentrations of IgG anti-SARS-CoV-2 antibodies, IL1b, IL6, and IFN-γ, in UCB were found in all cases, but IgM antibodies anti-ARS-CoV-2 were systematically undetectable. We found significant correlations between fetal CD3+ mononuclear cells and UCB IgG concentrations. We also found significant correlations between UCB IgG concentrations and fetal CD3+/CD4+, as well as CD3+/CD8+ T cells subsets. We also discovered that fetal CD3+/CD8+ cell counts were significantly higher in those cases with placental infarctions. (4) Conclusion: we have not verified the placental transfer of SARS-CoV-2. However, we have discovered that a significant immune response is being transmitted to the fetus in cases of SARS-CoV-2 maternal infection.Partial funding for open access charge: Universidad de Málaga. This research was funded by Ferring COVID-19 Investigational Grant Placental injury and immune reaction transmitted to the neonates in cases of SARS-CoV-2 infections during pregnancy. Study on placental and blood cord samples. The APC was funded by University of Málaga. Funding institutions did not participate in the design, recruitment, analysis, or interpretation of the results

Integrando escalas y métodos LTER para comprender la dinámica global de un espacio protegido de montaña: el Parque Nacional de Ordesa y Monte Perdido.

Los espacios protegidos, por el hecho de albergar una gran geo-biodiversidad y asegurar una baja intervención humana, constituyen lugares muy adecuados para el seguimiento de organismos y procesos a escala ecológica, así como para la obtención de series temporales largas a escala geológica. En el marco de la red LTER-España, el Parque Nacional de Ordesa y Monte Perdido (PNOMP) y el Instituto Pirenaico de Ecología-CSIC están impulsando estudios para la detección de cambios a distintas escalas mediante variados métodos y aproximaciones. Destacamos aquí los más consolidados, entre los que se encuentran los análisis de registros de sedimentos en lagos, espeleotemas en cuevas, la dinámica de uno de los pocos glaciares activos de la Península ibérica, el análisis físico-químico de aguas corrientes e ibones de alta montaña, el registro del cambio climático actual en árboles longevos, la afección que éste ejerce sobre masas actuales de pinos en el límite superior del bosque y de abetales en zonas húmedas, la matorralización de algunos pastos y los procesos mecanicistas que subyacen, la reorganización de la diversidad florística en pastos tras el abandono paulatino o drástico de la ganadería, la biodiversidad de las comunidades alpinas y la dinámica poblacional de especies amenazadas o indicadoras de hábitats o de motores de cambio global. Los seguimientos ecológicos actuales muestran que tanto el cambio climático como el de usos del suelo están teniendo una considerable trascendencia en la fisionomía y la estructura de algunos de los ambientes más icónicos y frecuentes del parque (deterioro del glaciar, termofilización de la flora en cumbres alpinas, densificación del bosque en su límite superior, pérdida de productividad en algunos pastos supraforestales, etc.). También sugieren una importante variabilidad espacial en los procesos (por ej. en el PNOMP conviven pastos matorralizados y pastos muy estables), y evidencian que los cambios observados no siempre siguen los paradigmas establecidos (por ej., las especies amenazadas mantienen dinámicas poblacionales estables). La integración de resultados parciales proporcionados por cada aproximación relativiza la importancia de las percepciones que cada estudio destaca por separado, y permite medir los cambios actuales en el marco de referencia de los cambios a escala geológica.Predecir la resistencia y resiliencia de los ecosistemas o las poblaciones de seres vivos para enfrentarse a los futuros cambios ambientales es complicado, no sólo por la falta de conocimientos disponibles sino también porque las respuestas que observamos no siempre son tan rápidas o lineales como se espera. La modelización constituye una herramienta cada vez más utilizada, pero requiere de evidencias reales para validar sus pronósticos, por lo que la observación de los procesos que actúan en el PNOMP ha de incluir un esfuerzo continuado de monitorización multiescalar y multidisciplinar de los distintos componentes de la geo, hidro-, crio- y biosfera, sin olvidar el componente humano. Entender la complejidad supone conectar las interacciones que existen entre todos los sistemas y ponderar sus efectos según las escalas de trabajo