Endocarditis infecciosa sobre válbula protésica: relación entre sus características, el intervalo de tiempo entre la cirugía y el diagnóstico y el microorganismo causal

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina. Departamento de Medicina. Fecha de lectura: 22-Mayo-200

Multiagent systems

Our future is that of a mixed society of people and AI artifacts. A multitude of devices in our homes will need not only to make intelligent decisions, but they will also need to coordinate with each other to serve us well. Cars will have to coordinate to allow safe road crossings, avoiding accidents. Also, the industry is already beginning to integrate teams of humans and robots collaborating to solve complex problems...Peer reviewe

Metodologías y recursos para la mejora del trabajo del estudiante con bibliográfica científica

Memoria ID2022-090. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2022-2023

Genetic diversity of HLA system in four populations from Baja California, Mexico: Mexicali, La Paz, Tijuana and rural Baja California

We studied HLA class I (HLA-A, -B) and class II (HLA-DRB1, -DQB1) alleles by PCR-SSP based typing in 250 Mexicans from the states of Baja California Norte and Baja California Sur living in Mexicali (N = 100), La Paz (N = 75), Tijuana (N = 25) and rural communities (N = 50) to obtain information regarding allelic and haplotypic frequencies. The most frequent haplotypes for the Baja California region include nine Native American and five European haplotypes. Admixture estimates revealed that the main genetic components are European (50.45 ± 1.84% by ML; 42.03% of European haplotypes) and Native American (43.72 ± 2.36% by ML; 40.24% of Native American haplotypes), while the African genetic component was less apparent (5.83 ± 0.98% by ML; 9.36% of African haplotypes)

Los contratos sobre el buque en Derecho Español. Análisis práctico

Prólogo / José Luis Gabaldón García (pp. 9-13). -- Introducción (pp. 15-18). -- El contrato de construcción naval: aspectos prácticos / Gonzalo Alvar Ezquerra (pp. 19-37). -- El contrato de compraventa / Carlos López-Quiroga, Luz Martínez de Azcoitia y José Sánchez-Fayos Martín-Peña (pp. 39-58). -- El contrato de arrendamiento de buque / Rodolfo González Lebrero (pp. 59-75). -- El contrato de fletamento por tiempo / José María Alcántara González (pp. 77-102). -- El contrato de fletamento por viaje: contenido obligacional / Juan Pablo Rodríguez Delgado (pp. 103-144). -- El contrato de transporte marítimo en régimen de conocimiento de embarque / Javier del Corte (pp. 145-186). -- Los documentos de transporte / Carlos Llorente (pp. 187-205). -- Contratos de utilización del buque para fines distintos del transporte de mercancías / José Manuel G. Pellicer (pp. 207-221). -- El contrato de arrendamiento náutico / León von Ondarza (pp. 223-244). -- El contrato de pasaje marítimo / Hannah de Bustos, Antonio Quirós de Sas y Julio López Quiroga (pp. 245-260). -- Los contratos de gestión naval para la dotación del buque / Bernardo Ruiz Lima (pp. 261-279). -- El contrato de gestión naval / Víctor Mata Garrido (pp. 281-302). -- El contrato de consignación de buques /Jesús Barbadillo Eyzaguirre (pp. 303-323). -- El contrato de manipulación portuaria / Carlos Pérez (pp. 325-338). -- El contrato de practicaje / Alicia Velasco Nates (pp. 339-356). -- Los contratos de mediación en la explotación del buque / Carmen Codes Cid y Martín Prieto Sulleiro (pp. 357-372). -- El contrato de remolque / Ana Sánchez Horneros (pp. 373- 392). -- El contrato de remolque / Jaime de Castro (pp. 393-412). -- El contrato de salvamento / Luis Souto (pp. 413-430). -- El contrato de remoción de restos / Verónica Meana (pp. 431-446). -- El contrato de clasificación del buque / Jaime Rodrigo de Larrucea (pp. 447-463). -- El seguro de casco y máquina / Carlos Cerdá Donat y Diego de San Simón Palacios (pp. 465-491). -- Los clubes de protección e indemnización (P&I) / Miguel Caballero (pp. 493-504). -- El seguro de protección e indemnización (P&I) / Jaime Albors (pp. 505-524). -- El seguro del acreedor hipotecario / Luis F. Gómez de Mariaca Fernández (pp. 525-540)

Long-Term Real-World Effectiveness and Safety of Ustekinumab in Crohn’s Disease Patients: The SUSTAIN Study

Background Large real-world-evidence studies are required to confirm the durability of response, effectiveness, and safety of ustekinumab in Crohn’s disease (CD) patients in real-world clinical practice. Methods A retrospective, multicentre study was conducted in Spain in patients with active CD who had received ≥1 intravenous dose of ustekinumab for ≥6 months. Primary outcome was ustekinumab retention rate; secondary outcomes were to identify predictive factors for drug retention, short-term remission (week 16), loss of response and predictive factors for short-term efficacy and loss of response, and ustekinumab safety. Results A total of 463 patients were included. Mean baseline Harvey-Bradshaw Index was 8.4. A total of 447 (96.5%) patients had received prior biologic therapy, 141 (30.5%) of whom had received ≥3 agents. In addition, 35.2% received concomitant immunosuppressants, and 47.1% had ≥1 abdominal surgery. At week 16, 56% had remission, 70% had response, and 26.1% required dose escalation or intensification; of these, 24.8% did not subsequently reduce dose. After a median follow-up of 15 months, 356 (77%) patients continued treatment. The incidence rate of ustekinumab discontinuation was 18% per patient-year of follow-up. Previous intestinal surgery and concomitant steroid treatment were associated with higher risk of ustekinumab discontinuation, while a maintenance schedule every 12 weeks had a lower risk; neither concomitant immunosuppressants nor the number of previous biologics were associated with ustekinumab discontinuation risk. Fifty adverse events were reported in 39 (8.4%) patients; 4 of them were severe (2 infections, 1 malignancy, and 1 fever). Conclusions Ustekinumab is effective and safe as short- and long-term treatment in a refractory cohort of CD patients in real-world clinical practice

Using Interpretable Machine Learning to Identify Baseline Predictive Factors of Remission and Drug Durability in Crohn’s Disease Patients on Ustekinumab

Ustekinumab has shown efficacy in Crohn's Disease (CD) patients. To identify patient profiles of those who benefit the most from this treatment would help to position this drug in the therapeutic paradigm of CD and generate hypotheses for future trials. The objective of this analysis was to determine whether baseline patient characteristics are predictive of remission and the drug durability of ustekinumab, and whether its positioning with respect to prior use of biologics has a significant effect after correcting for disease severity and phenotype at baseline using interpretable machine learning. Patients' data from SUSTAIN, a retrospective multicenter single-arm cohort study, were used. Disease phenotype, baseline laboratory data, and prior treatment characteristics were documented. Clinical remission was defined as the Harvey Bradshaw Index <= 4 and was tracked longitudinally. Drug durability was defined as the time until a patient discontinued treatment. A total of 439 participants from 60 centers were included and a total of 20 baseline covariates considered. Less exposure to previous biologics had a positive effect on remission, even after controlling for baseline disease severity using a non-linear, additive, multivariable model. Additionally, age, body mass index, and fecal calprotectin at baseline were found to be statistically significant as independent negative risk factors for both remission and drug survival, with further risk factors identified for remission

Dietary Iron, Anemia Markers, Cognition, and Quality of Life in Older Community-Dwelling Subjects at High Cardiovascular Risk

Anemia causes hypo-oxygenation in the brain, which could lead to cognitive disorders. We examined dietary iron intake as well as anemia markers (i.e., hemoglobin, hematocrit, mean corpuscular volume) and diabetes coexistence in relation to neuropsychological function and quality of life. In this study, 6117 community-dwelling adults aged 55-75 years (men) and 60-75 years (women) with overweight/obesity and metabolic syndrome were involved. We performed the Mini-Mental State Examination (MMSE), the Trail Making Test parts A and B (TMT-A/B), Semantic Verbal Fluency of animals (VFT-a), Phonological Verbal Fluency of letter P (VFT-p), Digit Span Test (DST), the Clock Drawing Test (CDT), and the Short Form-36 Health Survey (SF36-HRQL test). Dietary iron intake did not influence neuropsychological function or quality of life. However, anemia and lower levels of anemia markers were associated with worse scores in all neurophysiological and SF36-HRQL tests overall, but were especially clear in the MMSE, TMT-B (cognitive flexibility), and the physical component of the SF36-HRQL test. The relationships between anemia and diminished performance in the TMT-A/B and VFT tasks were notably pronounced and statistically significant solely among participants with diabetes. In brief, anemia and reduced levels of anemia markers were linked to inferior cognitive function, worse scores in different domains of executive function, as well as a poorer physical, but not mental, component of quality of life. It was also suggested that the coexistence of diabetes in anemic patients may exacerbate this negative impact on cognition. Nevertheless, dietary iron intake showed no correlation with any of the outcomes. To make conclusive recommendations for clinical practice, our findings need to be thoroughly tested through methodologically rigorous studies that minimize the risk of reverse causality