Eficacia del primer tratamiento sistémico con glucocorticoides en la enfermedad inflamatoria intestinal. Revisión sistemática y serie de casos

Los glucocorticoides son un fármaco de eficacia alta en pacientes con enfermedad inflamatoria intestinal, consiguiendo inducir respuesta en aproximadamente un 70% de los pacientes, respuesta que perdura a largo plazo en casi la mitad de los casos. La mayor edad al diagnóstico y al inicio del primer tratamiento son los principales factores predoctores de mala respuesta a los glucocorticoides. Una política de inmunosupresión precoz de los pacientes que no se hubieran beneficiado a largo plazo de un ciclo de glucocorticoides reduce la necesidad de cirugía

Eficacia del primer tratamiento sistémico con glucocorticoides en la enfermedad inflamatoria intestinal. Revisión sistemática y serie de casos

Los glucocorticoides son un fármaco de eficacia alta en pacientes con enfermedad inflamatoria intestinal, consiguiendo inducir respuesta en aproximadamente un 70% de los pacientes, respuesta que perdura a largo plazo en casi la mitad de los casos. La mayor edad al diagnóstico y al inicio del primer tratamiento son los principales factores predoctores de mala respuesta a los glucocorticoides. Una política de inmunosupresión precoz de los pacientes que no se hubieran beneficiado a largo plazo de un ciclo de glucocorticoides reduce la necesidad de cirugía

Non-linear gain - look-up table based approach for modeling a family of DC to DC converters based on transient response analysis

The purpose of this work is to propose a structure for simulating power systems using behavioral models of nonlinear DC to DC converters implemented through a look-up table of gains. This structure is specially designed for converters whose output impedance depends on the load current level, e.g. quasi-resonant converters. The proposed model is a generic one whose parameters can be obtained by direct measuring the transient response at different operating points. It also includes optional functionalities for modeling converters with current limitation and current sharing in paralleling characteristics. The pusposed structured also allows including aditional characteristics of the DC to DC converter as the efficency as a function of the input voltage and the output current or overvoltage and undervoltage protections. In addition, this proposed model is valid for overdamped and underdamped situations

Evaluation of Glycerylphytate Crosslinked Semi- and Interpenetrated Polymer Membranes of Hyaluronic Acid and Chitosan for Tissue Engineering

In the present study, semi- and interpenetrated polymer network (IPN) systems based on hyaluronic acid (HA) and chitosan using ionic crosslinking of chitosan with a bioactive crosslinker, glycerylphytate (G1Phy), and UV irradiation of methacrylate were developed, characterized and evaluated as potential supports for tissue engineering. Semi- and IPN systems showed significant differences between them regarding composition, morphology, and mechanical properties after physicochemical characterization. Dual crosslinking process of IPN systems enhanced HA retention and mechanical properties, providing also flatter and denser surfaces in comparison to semi-IPN membranes. The biological performance was evaluated on primary human mesenchymal stem cells (hMSCs) and the systems revealed no cytotoxic effect. The excellent biocompatibility of the systems was demonstrated by large spreading areas of hMSCs on hydrogel membrane surfaces. Cell proliferation increased over time for all the systems, being significantly enhanced in the semi-IPN, which suggested that these polymeric membranes could be proposed as an effective promoter system of tissue repair. In this sense, the developed crosslinked biomimetic and biodegradable membranes can provide a stable and amenable environment for hMSCs support and growth with potential applications in the biomedical field.The authors thanks to “La Caixa” Foundation (ID 100010434), which supported Ana Mora-Boza (scholarship code LCF/BQ/ES16/11570018) and to the Spanish Ministry of Economy and Competitiveness for financial support (project RTC-2016-5451-1) and the Fundación Mutua Madrileña (project FMM-AP17196-2019). M. R. Aguilar and B. Vázquez-Lasa are members of the SusPlast platform (Interdisciplinary Platform for Sustainable Plastics towards a Circular Economy) from the Spanish National Research Council (CSIC)

Uso de museos y exposiciones de Madrid para el estudio del cambio social. Una propuesta de mejora en las prácticas docentes de los estudios de comunicación

Este proyecto de innovación docente se propone alinear las necesidades docentes de la enseñanza del Cambio Social, la necesaria formación en contenidos audiovisuales y la disposición de los museos y exposiciones de abrirse a público joven y convertirse en espacios formativos y de reflexión sobre el cambio social. Es clara la necesidad de las profesiones comunicativas de encontrar nichos de empleo

Indicaciones y contraindicaciones del trasplante y retrasplante hepático

Este documento nació por la inciativa conjunta de la Organización Nacional de Trasplantes (ONT) y la Agencia de Evaluación de Tecnologías Sanitarias (AETS), ante la necesidad compartida por los diferentes equipos de trasplante hepático de disponer de un documento marco que exprese la realidad actual del trasplante y retrasplante hepático en España, y que recoja las indicaciones y contraindicaciones comúnmente aceptadas de estas técnicas, y los criterios de prioridad para el acceso a esta terapéutica.Abreviaturas, Metodología, Introducción, Aspectos generales de las indicaciones, contraindicaciones y factores de riesgo para el trasplante hepático, Trasplante en enfermedades colestásicas Indicaciones y contraindicaciones de crónica parenquimaosa, Trasplantes en hepatitis virales, Fallo hepático fulminante, Tumores, Trasplante hepático pediátrico, Retrasplante, Criterios de prioridad para trasplante y retrasplante hepático, Resumen y conclusiones, Bibliografía, Summary and conclusions, Abstract

Correlation between clinical parameters characterising peri-implant and periodontal health : a practice-based research in Spain in a series of patients with implants installed 4-5 years ago

Objectives: To explore peri-implant health (and relation with periodontal status) 4-5 years after implant insertion. Study D esign: A practice-based dental research network multicentre study was performed in 11 Spanish centres. The first patient/month with implant insertion in 2004 was considered. Per patient four teeth (one per quadrant) showing the highest bone loss in the 2004 panoramic X-ray were selected for periodontal status assessment. Bone losses in implants were calculated as the differences between 2004 and 2009 bone levels in radiographs. Results: A total of 117 patients were included. Of the 408 teeth considered, 73 (17.9%) were lost in 2009 (losing risk: >50% for bone losses ?7mm). A total of 295 implants were reviewed. Eight of 117 (6.8%) patients had lost implants (13 of 295 implants installed; 4.4%). Implant loss rate (quadrant status) was 1.4% (edentulous), 3.6% (preserved teeth), and 11.1% (lost teeth) (p=0.037). The percentage of implant loss significantly (p<0.001) increased when the medial/distal bone loss was ?3 mm. The highest (p?0.001) pocket depths were found in teeth with ?5mm and implants with ?3mm bone losses, with similar mean values (?4mm), associated with higher rates of plaque index and bleeding by probing. Conclusions: The significant bi-directional relation between plaque and bone loss, and between each of these two parameters/signs and pocket depths or bleeding (both in teeth and implants, and between them) together with the higher percentage of implants lost when the bone loss of the associated teeth was ?3 mm suggest that the patient?s periodontal status is a critical issue in predicting implant health/lesion

MEGARA, the R=6000-20000 IFU and MOS of GTC

MEGARA is the new generation IFU and MOS optical spectrograph built for the 10.4m Gran Telescopio CANARIAS (GTC). The project was developed by a consortium led by UCM (Spain) that also includes INAOE (Mexico), IAA-CSIC (Spain) and UPM (Spain). The instrument arrived to GTC on March 28th 2017 and was successfully integrated and commissioned at the telescope from May to August 2017. During the on-sky commissioning we demonstrated that MEGARA is a powerful and robust instrument that provides on-sky intermediate-to-high spectral resolutions R_(FWHM) ~ 6,000, 12,000 and 20,000 at an unprecedented efficiency for these resolving powers in both its IFU and MOS modes. The IFU covers 12.5 x 11.3 arcsec2 while the MOS mode allows observing up to 92 objects in a region of 3.5 x 3.5 arcmin^(2) . In this paper we describe the instrument main subsystems, including the Folded-Cassegrain unit, the fiber link, the spectrograph, the cryostat, the detector and the control subsystems, and its performance numbers obtained during commissioning where the fulfillment of the instrument requirements is demonstrated

Effect of Intra-arterial Alteplase vs Placebo Following Successful Thrombectomy on Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke: The CHOICE Randomized Clinical Trial.

Importance: It is estimated that only 27% of patients with acute ischemic stroke and large vessel occlusion who undergo successful reperfusion after mechanical thrombectomy are disability free at 90 days. An incomplete microcirculatory reperfusion might contribute to these suboptimal clinical benefits. Objective: To investigate whether treatment with adjunct intra-arterial alteplase after thrombectomy improves outcomes following reperfusion. Design, setting, and participants: Phase 2b randomized, double-blind, placebo-controlled trial performed from December 2018 through May 2021 in 7 stroke centers in Catalonia, Spain. The study included 121 patients with large vessel occlusion acute ischemic stroke treated with thrombectomy within 24 hours after stroke onset and with an expanded Treatment in Cerebral Ischemia angiographic score of 2b50 to 3. Interventions: Participants were randomized to receive intra-arterial alteplase (0.225 mg/kg; maximum dose, 22.5 mg) infused over 15 to 30 minutes (n = 61) or placebo (n = 52). Main outcomes and measures: The primary outcome was the difference in proportion of patients achieving a score of 0 or 1 on the 90-day modified Rankin Scale (range, 0 [no symptoms] to 6 [death]) in all patients treated as randomized. Safety outcomes included rate of symptomatic intracranial hemorrhage and death. Results: The study was terminated early for inability to maintain placebo availability and enrollment rate because of the COVID-19 pandemic. Of 1825 patients with acute ischemic stroke treated with thrombectomy at the 7 study sites, 748 (41%) patients fulfilled the angiographic criteria, 121 (7%) patients were randomized (mean age, 70.6 [SD, 13.7] years; 57 women [47%]), and 113 (6%) were treated as randomized. The proportion of participants with a modified Rankin Scale score of 0 or 1 at 90 days was 59.0% (36/61) with alteplase and 40.4% (21/52) with placebo (adjusted risk difference, 18.4%; 95% CI, 0.3%-36.4%; P = .047). The proportion of patients with symptomatic intracranial hemorrhage within 24 hours was 0% with alteplase and 3.8% with placebo (risk difference, -3.8%; 95% CI, -13.2% to 2.5%). Ninety-day mortality was 8% with alteplase and 15% with placebo (risk difference, -7.2%; 95% CI, -19.2% to 4.8%). Conclusions and relevance: Among patients with large vessel occlusion acute ischemic stroke and successful reperfusion following thrombectomy, the use of adjunct intra-arterial alteplase compared with placebo resulted in a greater likelihood of excellent neurological outcome at 90 days. However, because of study limitations, these findings should be interpreted as preliminary and require replication. Trial registration: ClinicalTrials.gov Identifier: NCT03876119; EudraCT Number: 2018-002195-40