Pragmatica en qve sv Magestad manda, que los reales de à ocho de la fabrica, y cuño que al presente corren valgan diez reales de plata, con el nombre de escudos: Y los que nuevamente se fabricaren con nuevo cuño, valgan ocho reales de plata. Y los doblones de a dos, qve al presente por Pragmaticas de estos Reynos tienen el valor treinta reales de plata, le tengan de treinta y ocho reales de plata. Y qve todas estas monedas corran con el premio, y reducccion de à cincuenta por ciento

Caplletra xil. ornada a l'inici del textEscut reial xil. a port.Pragmàtica, 1686-10-14 : "EN la Villa de Madrid à catorce dias del més de Octubre de mil y seiscientos y ochenta y seis años"ReclamsSign.: A6Última pàgina : "Domingo Leal de Saavedra"Pragmàtica en la qual sa Majestat ordena, que els reals de vuit de la fàbrica, i encuny que actualment corren valguin deu reals de plata, amb el nom d'escuts: I els que novament es fabriquin amb nou encuny, valguin vuit reals de plata (…).

Women’s preference to apply shared decision-making in breast cancer screening: a discrete choice experiment

ObjectiveTo analyse women's stated preferences for establishing the relative importance of each attribute of shared decision-making (SDM) and their willingness to pay (WTP) for more participatory care in breast cancer screening programmes (BCSP). DesignA discrete choice experiment was designed with 12 questions (choice tasks). It included three attributes: 'How the information is obtained', regarding benefits and harms; whether there is a 'Dialogue for scheduled mammography' between the healthcare professional and the woman; and, 'Who makes the decision', regarding participation in BCSP. Data were obtained using a survey that included 12 choice tasks, 1 question on WTP and 7 socioeconomic-related questions. The analysis was performed using conditional mixed-effect logit regression and stratification according to WTP. SettingData collection related to BCSP was conducted between June and November 2021 in Catalonia, Spain. ParticipantsSixty-five women aged between 50 and 60. Main outcome measuresWomen's perceived utility of each attribute, trade-off on these attributes and WTP for SDM in BCSP. ResultThe only significant attribute was 'Who makes the decision'. The decision made alone (coefficient=2.879; 95% CI=2.297 to 3.461) and the decision made together with a healthcare professional (2.375; 95% CI=1.573 to 3.177) were the options preferred by women. The former contributes 21% more utility than the latter. Moreover, 52.3% of the women stated a WTP of Euro10 or more for SDM. Women's preferences regarding attributes did not influence their WTP.ConclusionsThe participant women refused a current paternalistic model and preferred either SDM or informed decision-making in BCSP

Development of support material for health professionals who are implementing Shared Decision-making in breast cancer screening: validation using the Delphi technique

Background The Literature is no report support material on Shared Decision-making applied to breast cancer screening that is intended for Spanish health professionals. The researcher created both a handbook and a guide for this topic using an adaption of the Three-talk model. Objective A Delphi method will be used to reach an agreement among experts on the contents and design of a manual and guide, designed by the research team, and to be used by health professionals in the application of SDM in breast cancer screening. Design A qualitative study. The content and design of the handbook and the guide was discussed by 20 experts. The Delphi techniques was in an online mode between July and October 2020 and researchers used Google forms in three rounds with open and closed questions. The criterion established for consensus was a coefficient of concordance (Cc) above 75, for questions using a Likert scale of 1-6-in which 1 meant 'completely disagree' and 6 'completely agree'-with a cut-off point equal to or higher than 4. Results Participants considered the Three-talk model suitable for the screening context. The handbook sections and level of detail were considered satisfactory (Cc=90). The summary provided by the clinical practice guide was considered necessary (Cc=75), as it was the self-assessment tool for professionals (Cc=85). Content was added: addressing the limitations of the SDM model; extending the number of sample dialogues for health professionals; providing supplementary resources on using Patient Decisions aids and adding references on communication skills. Conclusions and applications The first handbook and clinical practice guide providing unique SDM support material for health professionals have been developed. The handbook and guide are useful and innovative as supporting material for health professionals, but training strategies for SDM and a piloting plan for the use of materials are requested, in order to facilitate its implementation

Epidemiologia de la Peritonitis Bacteriana Espontània en el nostre medi

Objectius: . Descriure l'epidemiologia de les PBE del nostre hospital. Material i Mètodes: S'analitzen les característiques de les PBE diagnosticades entre 2007-2010. Resultats: S'identificaren 44 episodis (73% extrahospitalàries). La taxa de cultius positius fou del 52% (52%BGN; 34%CGP). S'observà : 18% d'Escherichia coli amb resistència a quinolones; 57% de Klebsiella spp BLEA. Aparegué insuficiència renal en un 20%. La mortalitat fou del 27%. Conclusions: No s'observà una major proporció de CGP en el grup nosocomial. La resistència a quinolones i la producció de BLEA és inferior a la reportada. La mortalitat fou superior en el grup nosocomial

A lower starting point for the medial cut increases the posterior slope in opening-wedge high tibial osteotomy : a cadaveric study

The objective of this study was to evaluate the effects on the posterior tibial slope of different distances from the joint line to start the osteotomy and of varying the placement of the opening wedge in high tibial osteotomy. Starting the osteotomy more distally and an incorrect location for the tibial opening wedge were hypothesized to increase the posterior tibial slope. A cadaveric study was conducted using 12 knees divided into two groups based on the distance from the joint line to the start of the osteotomy: 3 and 4 cm. The preintervention posterior tibial slope was measured radiologically. Once the osteotomy was performed, the medial cortex of the tibia was divided into anteromedial, medial, and posteromedial thirds. A 10° opening wedge was sequentially placed in each third, and the effect on the posterior tibial slope was evaluated radiographically. Results: Significant changes were observed only in the 3-cm group (p = 0.02) when the wedge was placed in the anteromedial zone. In contrast, in the 4-cm group, significant differences were observed when the opening wedge was placed at both the medial (p = 0.04) and anteromedial (p = 0.012) zones. Correct control of the posterior tibial slope can be achieved by avoiding a low point when beginning the osteotomy and placing the opening wedge in the posteromedial third of the tibia when performing an opening-wedge high tibial osteotomy. Controlled laboratory study

Lysine 27 dimethylation of Drosophila linker histone dH1 contributes to heterochromatin organization independently of H3K9 methylation

Post-translational modifications (PTMs) of core histones are important epigenetic determinants that correlate with functional chromatin states. However, despite multiple linker histone H1s PTMs have been identified, little is known about their genomic distribution and contribution to the epigenetic regulation of chromatin. Here, we address this question in Drosophila that encodes a single somatic linker histone, dH1. We previously reported that dH1 is dimethylated at K27 (dH1K27me2). Here, we show that dH1K27me2 is a major PTM of Drosophila heterochromatin. At mitosis, dH1K27me2 accumulates at pericentromeric heterochromatin, while, in interphase, it is also detected at intercalary heterochromatin. ChIPseq experiments show that >98% of dH1K27me2 enriched regions map to heterochromatic repetitive DNA elements, including transposable elements, simple DNA repeats and satellite DNAs. Moreover, expression of a mutated dH1K27A form, which impairs dH1K27me2, alters heterochromatin organization, upregulates expression of heterochromatic transposable elements and results in the accumulation of RNA:DNA hybrids (R-loops) in heterochromatin, without affecting H3K9 methylation and HP1a binding. The pattern of dH1K27me2 is H3K9 methylation independent, as it is equally detected in flies carrying a H3K9R mutation, and is not affected by depletion of Su(var)3–9, HP1a or Su(var)4–20. Altogether these results suggest that dH1K27me2 contributes to heterochromatin organization independently of H3K9 methylation.MICIN/AEI 10.13039/501100011033 [BFU2015-65082-P and PGC2018-094538-B-100]; ‘FEDER, una manera de hacer Europa’; Generalitat de Catalunya [SGR2014-204, SGR2017-475]; this work was carried out within the framework of the ‘Centre de Referencia en Biotecnologia’ of ` the Generalitat de Catalunya. Funding for open access charge: MINECO [PGC2018-094538-B-100]. Conflict of interest statement. None declared

Trombosis venosas múltiples de instauración rápida

[spa] Varón de 61 años con trombosis venosa bilateral de rápida instauración y fracaso multiorgánico[eng] 61 year old male with rapid establishment of bilateral venous thrombosis and multiorgan failur

Multiancestry analysis of the HLA locus in Alzheimer’s and Parkinson’s diseases uncovers a shared adaptive immune response mediated by HLA-DRB1*04 subtypes

Across multiancestry groups, we analyzed Human Leukocyte Antigen (HLA) associations in over 176,000 individuals with Parkinson’s disease (PD) and Alzheimer’s disease (AD) versus controls. We demonstrate that the two diseases share the same protective association at the HLA locus. HLA-specific fine-mapping showed that hierarchical protective effects of HLA-DRB1*04 subtypes best accounted for the association, strongest with HLA-DRB1*04:04 and HLA-DRB1*04:07, and intermediary with HLA-DRB1*04:01 and HLA-DRB1*04:03. The same signal was associated with decreased neurofibrillary tangles in postmortem brains and was associated with reduced tau levels in cerebrospinal fluid and to a lower extent with increased Aβ42. Protective HLA-DRB1*04 subtypes strongly bound the aggregation-prone tau PHF6 sequence, however only when acetylated at a lysine (K311), a common posttranslational modification central to tau aggregation. An HLA-DRB1*04-mediated adaptive immune response decreases PD and AD risks, potentially by acting against tau, offering the possibility of therapeutic avenues

Estudios sobre la eficacia terapéutica de los procedimientos psicoanalíticos

Objetivo. El psicoanálisis y la terapia psicoanalítica prolongada han sido ampliamente utilizados en el tratamiento de diversos trastornos mentales, pero su eficacia terapéutica ha sido puesta en duda por numerosos autores. Se ha intentado llegar a una conclusión sobre esta disyuntiva mediante la valoración de los estudios clínicos publicados desde los inicios de la teoría psicoanalítica hasta diciembre de 2010. Método. Revisión bibliográfica manual y sistematizada, en la que se han considerado ambos procedimientos terapéuticos y el tipo de estudio clínico utilizado. Se ha resumido cada una de las publicaciones registradas y han sido valoradas en cuanto «nivel de certeza» y «fuerza de la recomendación» según las normas del National Institute for Health and Clinical Excellence. Resultados. Psicoanálisis: se han registrado 8 revisiones de conjunto, 56 casos clínicos, 19 series de casos, 17 estudios de cohortes y 4 ensayos clínicos; en total, 104 estudios. La terapia psicoanalítica prolongada proporcionó 5 revisiones de conjunto, 5 encuestas, 19 series de casos, 20 estudios de cohortes, 2 estudios de coste-beneficio, 12 ensayos clínicos y 6 metaanálisis; en total, 69 estudios. Se han registrado los siguientes resultados: 1. Las revisiones de conjunto y las encuestas no cumplen con las exigencias metodológicas correspondientes a una valoración de carácter objetivo; los resultados obtenidos a partir del estudio de casos clínicos no permiten recomendar ni desaconsejar las intervenciones estudiadas. 2. Mediante series de casos se han constatado resultados favorables en el 76% de los pacientes tratados mediante psicoanálisis durante más de 200 horas y fue posible confirmar la efectividad de la terapia psicoanalítica en psiconeurosis, bulimia y trastornos de la personalidad. 3. Los estudios de cohortes proporcionan resultados favorables para el psicoanálisis en caso de trastornos psicosomáticos, siendo posible concluir que «existen pruebas científicas que permiten recomendar la intervención», pero con considerables limitaciones: sólo una tercera parte de los pacientes afectos de dichos procesos resultan adecuados para el tratamiento psicoanalítico, sólo la mitad llega a completarlo y se constata mejoría en sólo el 62% (95% CI = 38%-87%) de los pacientes que completan el tratamiento. 4. Asimismo, mediante estudios de cohortes se ha constatado que «existen pruebas que permiten recomendar la terapia psicoanalítica prolongada en pacientes con trastorno límite de la personalidad»; en estos pacientes, la eficacia se encuentra asociada con la duración del tratamiento; no se detectaron diferencias entre terapia psicoanalítica y terapia conductista. 5. Los estudios de coste-beneficio orientan respecto a una reducción significativa de los costes asociados con la salud en los pacientes tratados con terapia psicoanalítica prolongada. 6. Solo un ensayo clínico sugiere una posible eficacia del psicoanálisis, pero al haber utilizado una variable subrogada (glucemia) el nivel de certeza es limitado; en otro ensayo clínico no se constataron diferencias entre psicoanálisis, terapia psicodinámica y terapia conductista. 7. Terapia psicoanalítica prolongada: los resultados de doce ensayos clínicos permiten recomendar esta intervención para el tratamiento de trastornos alimentarios, trastorno límite de la personalidad, psiconeurosis y esquizofrenia. 8. La evaluación global de seis metaanálisis sobre eficacia de la terapia psicoanalítica prolongada no permite utilizarlos para definir la fuerza de la recomendación en cuanto adoptar o no la intervención estudiada. Conclusiones. El psicoanálisis es una alternativa terapéutica que puede recomendarse para el tratamiento de determinados trastornos mentales, pero con considerables limitaciones. Los 69 estudios clínicos revisados abogan positivamente acerca de la eficacia de la terapéutica psicoanalítica prolongada.Objective. Psychoanalysis and long-lasting psychoanalytic therapy have been broadly applied for the treatment of some mental disorders, but its efficacy has been put in doubt by numerous authors. In order to get a decision about this dilemma, an evaluation of the clinical studies published from the beginning of the psychoanalytical theory till December 2010 has been performed. Method. Manual and systematic bibliographic reviews taking into account both therapeutic approaches and type of the applied clinical study. Each publication have been summarized and evaluated in regard to «certainty level» and «recommendation strength» according to the proposals of the National Institute for Health and Clinical Excellence. Results. Psychoanalysis: 8 reviews, 56 case histories, 19 case series, 17 cohort studies, and 4 clinical trials, all together 104 clinical studies have been reviewed. Long lasting psychoanalytic therapy: 5 reviews, 5 surveys, 19 case series, 20 cohort studies, 2 cost-benefit studies, 12 clinical trials and 5 metaanalyses, totaling 69 studies have been also reviewed. Following results have been reported: 1. Reviews and surveys do not keep the methodological requirements of an objective evaluation; from the results of case studies, therapeutic approaches cannot be recommended nor disregarded 2. Through case series, favorable results have been reported in 76% of patients being treated with psychoanalysis over 200 hours. Case series confirmed also the effectiveness of long-lasting psychoanalytic therapy in case of psychoneurosis, bulimia and personality disorders. 3. Cohort studies provided favorable results in the case of psychosomatic complaints treated with psychoanalysis, being possible to conclude that “a scientific demonstration to recommend the therapeutic intervention is available” although with important limitations: only a third of the patients are adequate for the psychoanalytic treatment, only the half of them finish treatment, and only 62% (95% CI = 38%-87%) of the completed treatments lead to clinical improvement. 4. From cohort studies it can also be verified that “there are evidences available to recommend the longlasting psychoanalytic therapy for patient with borderline personality disorder”; in these patients, efficacy is associated with treatment duration; no differences between psychoanalytic and behavior therapy have been found. 5. Cost-benefit studies suggest a significant reduction of health associated costs in patients treated with long-lasting psychoanalytic therapy. 6. A single clinical trial suggest the possible efficacy of psychoanalysis, although being related to a subrogate variable (glycemic control) its certainty level is limited; in a second clinical trial no differences between psychoanalysis, psychoanalytic therapy and behavior therapy have been verified. 7. Long-lasting psychoanalytic therapy: from the results of twelve clinical trials it can be recommended this intervention in the case of eating disorders, borderline personality disorder, psychoneurosis and schizophrenia. 8. The evaluation of six meta-analyses on the efficacy of long-lasting psychoanalytic therapy does not allow defining any recommendation in order to adopt or not to adopt the studied intervention. Conclusions. Psychoanalysis is an alternative therapeutic procedure that can be recommended for the treatment of some mental disorders, although with important limitations. The reviewed clinical studies speak in favor of the efficacy of the long-lasting psychoanalytic therapy

Esdeveniments adversos posteriors a la colangiopancreatografia retrògrada endoscòpica en els pacients amb cirrosi hepàtica i en els receptors de trasplantament hepàtic

[cat] Aquesta tesi doctoral analitza els esdeveniments adversos posteriors a la colangiopancreatografia retrògrada endoscòpica (CPRE) en els pacients amb cirrosi i en els receptors de trasplantament hepàtic. Els esdeveniments adversos posteriors a la CPRE en la població general apareixen al voltant del 5-10% i fonamentalment en forma de pancreatitis, hemorràgia i colangitis. Tanmateix, els resultats d’aquest procediment endoscòpic en els pacients amb cirrosi i en els receptors de trasplantament hepàtic no són del tot coneguts. La hipertensió portal, la coagulopatia i el risc d’infeccions són característiques dels pacients amb cirrosi; la immunosupressió farmacològica i les complicacions biliars ho són en els pacients que han rebut un trasplantament hepàtic. Les dades prèviament publicades suggereixen que el risc de presentar esdeveniments adversos post-CPRE en els pacients amb trasplantament hepàtic és similar al de la població general, però es desconeix quin és l’efecte dels fàrmacs immunosupressors sobre el desenvolupament de pancreatitis post-CPRE. En el primer treball que forma part d’aquesta tesi s’ha observat que la taxa de pancreatitis post-CPRE en els receptors de trasplantament hepàtic sotmesos a CPRE és del 3% i que els corticoides utilitzats en el protocol d’immunosupressió exerceixen un paper protector. La hipòtesi per a explicar aquesta observació es basa en l’ús crònic o a llarg termini dels corticoides en el post- trasplantament. D’altra banda, els pacients amb cirrosi sotmesos a CPRE presenten un major risc de desenvolupar esdeveniments adversos post-CPRE, sobretot en presència de descompensacions i quan la insuficiència hepàtica és avançada. En canvi, no hi ha informació sobre el risc de desenvolupar la síndrome d’insuficiència hepàtica aguda sobre crònica (ACLF) posterior a una CPRE en els pacients amb cirrosi. El segon article analitza 158 pacients amb cirrosi i 283 sense cirrosi en un estudi retrospectiu de dos centres. La taxa d’esdeveniments adversos en els pacients amb cirrosi va ser significativament superior respecte al grup control (17% vs 9.5%) i la complicació més freqüent entre els cirròtics va ser la colangitis (6.3%), detectant un 30% d’infeccions per microbis amb resistència a les quinolones i un 20% de multiresistents. Així mateix, tant la cirrosi com l’esfinterotomia endoscòpica van comportar-se com a factors de risc independents per al desenvolupament d’esdeveniments adversos post- CPRE. El fet més rellevant d’aquest estudi ha estat l’observació d’un 11.4% de pacients que presenten la síndrome d’ACLF post-CPRE i que és similar a la taxa observada (17%) en altres procediments. Els pacients cirròtics que van desenvolupar esdeveniments adversos post-CPRE, els descompensats i aquells amb un MELD ≥15 van presentar taxes d’ACLF post-CPRE més elevades. En conclusió, els corticoides utilitzats a llarg termini podrien tenir un efecte protector enfront l’aparició de pancreatitis aguda post-CPRE en els pacients amb trasplantament hepàtic. En segon terme, els pacients amb cirrosi sotmesos a CPRE presenten taxes més elevades d’esdeveniments adversos post-CPRE (hemorràgia i colangitis) respecte els pacients sense cirrosi. La realització d’aquest procediment endoscòpic també comporta l’aparició d’ACLF en un 11.4% dels casos i en relació a diversos factors (com ara l’aparició d’esdeveniments adversos post-CPRE i la presència de descompensacions). En conjunt, tot això implicaria la modificació d’alguns aspectes del consentiment informat i la millora de les estratègies preventives per a evitar l’aparició d’esdeveniments adversos post-CPRE en aquests pacients.[eng] This doctoral thesis explores the development of adverse events after endoscopic retrograde cholangiopancreatography (ERCP) in patients with cirrhosis and those with liver transplantation (LT). The frequency of acute pancreatitis after ERCP (PEP) and its predictors in LT recipients is not well established. Likewise, there are no studies evaluating whether post-ERCP adverse events could precipitate “acute-on-chronic liver failure” (ACLF) in patients with cirrhosis, as it has been suggested with other procedures. In line with this, the first article studies patients with liver transplantation undergoing ERCP and determines the rate of PEP in this population and its predictors, especially among immunosupressive agents. The study offers two important findings. Firstly, the overall rate of PEP was 3%. Secondly, prednisone use was found to have a protective effect in both univariate with multivariate analysis, after adjustments for difficult biliary cannulation and post-LT index ERCP. The second article aims to examine the outcome of patients with cirrhosis after ERCP, non-ERCP interventions and without any interventions, and the appearance of ACLF in this group of patients. The overall rate of adverse events after all ERCPs was significantly higher in cases (17%) compared to controls (9.5%). Logistic regression identified cirrhosis and sphincterotomy as risk factors of adverse events. A total of 11.4% developed ACLF after ERCP. Otherwise, 3.2% patients without interventions developed ACLF compared to 17.5% who developed ACLF after non-ERCP interventions. Finally, patients with decompensated cirrhosis at ERCP and those with a MELD score ≥ 15 had a higher risk of developing ACLF. In conclusion, the development of ACLF is common after ERCP and other invasive procedures. ACLF can be precipitated by numerous factors which include preceding events before the procedure and adverse events after an ERCP