El uso de glucocorticoides en neumonía grave adquirida de la comunidad

La neumonía es la inflamación del parénquima pulmonar debida a un agente infeccioso.Cuando afecta a la población no ingresada en un hospital, se denomina neumonía adquirida en la comunidad(NAC). La NAC grave suele representar entre el 3 y 18% de las NAC hospitalizadas con una mortalidadentre el 21 y 54%. Para evaluar la gravedad de la NAC se utilizan los criterios PSI (Pneumonia severityIndex). Los corticoesteroides son hormonas esteroideas, participan en diferentes procesos regulando lainflamación, el sistema inmunitario, así como la respuesta del organismo al estrés, etc. Los corticoidessintéticos y semisintéticos se utilizan en numerosos procesos patológicos.METODOLOGÍA: Desde la exposición de un escenario clínico, se planteó una pregunta estructurada paraluego realizar una búsqueda bibliográfica, con el objetivo de dar respuesta a la pregunta sobre si el uso decorticoterapia adyuvante en pacientes con NAC grave disminuye la mortalidad y la necesidad de asistenciarespiratoria mecánica.Se realizó una búsqueda en PubMed y se seleccionó el artículo: “Efficacy and safety of glucocorticoids inthe treatment of severe community-acquired pneumonia”ANALISIS DEL ARTICULO: Se realizó un análisis definiendo los valores de riesgo absoluto, riesgorelativo y el número necesario a tratar del grupo problema y grupo control tomando en cuenta las variablesmortalidad y necesidad de asistencia respiratoria mecánica. Por otro lado, se determinó el odds ratio con surespectivo intervalo de confianza del 95%.RECOMENDACIÓN FINAL: se recomienda el uso de corticoterapia adyuvante como tratamiento contrala NAC grave

XPO1 Gene Therapy Attenuates Cardiac Dysfunction in Rats with Chronic Induced Myocardial Infarction

Transcriptomic signature of XPO1 was highly expressed and inversely related to left ventricular function in ischemic cardiomyopathy patients. We hypothesized that treatment with AAV9-shXPO1 attenuates left ventricular dysfunction and remodeling in a myocardial infarction rat model. We induced myocardial infarction by coronary ligation in Sprague-Dawley rats (n = 10), which received AAV9-shXPO1 (n = 5) or placebo AAV9-scramble (n = 5) treatment. Serial echocardiographic assessment was performed throughout the study. After myocardial infarction, AAV9-shXPO1-treated rats showed partial recovery of left ventricular fractional shortening (16.8 +/- 2.8 vs 24.6 +/- 4.1%, P < 0.05) and a maintained left ventricular dimension (6.17 +/- 0.95 vs 4.70 +/- 0.93 mm, P < 0.05), which was not observed in non-treated rats. Furthermore, lower levels of EXP-1 (P < 0.05) and lower collagen fibers and fibrosis in cardiac tissue were observed. However, no differences were found in the IL-6 or TNFR1 plasma levels of the myocardium of AAV9-shXPO1 rats. AAV9-shXPO1 administration attenuates cardiac dysfunction and remodeling in rats after myocardial infarction, producing the gene silencing of XPO1

COVID‐19: The immediate response of European academic dental institutions and future implications for dental education

The COVID‐19 pandemic has had an immediate and dramatic impact on dental education. The Association of Dental Education in Europe decided to carry out an investigation to assess the immediate response of European Academic Dental Institutions. An online survey was sent to both member and non‐member dental schools to investigate the impact on non‐clinical and clinical education, assessment and the well‐being/pastoral care measures implemented. The preliminary findings and discussion are presented in this paper, for the responses collected between the 25th March and 5th April 2020. The survey at this time of publication is ongoing and detailed results can be accessed https://adee.org/covid-19-european-dental-education%E2%80%99s-immediate-response

Oval Domes: History, Geometry and Mechanics

An oval dome may be defined as a dome whose plan or profile (or both) has an oval form. The word Aoval@ comes from the latin Aovum@, egg. Then, an oval dome has an egg-shaped geometry. The first buildings with oval plans were built without a predetermined form, just trying to close an space in the most economical form. Eventually, the geometry was defined by using arcs of circle with common tangents in the points of change of curvature. Later the oval acquired a more regular form with two axis of symmetry. Therefore, an “oval” may be defined as an egg-shaped form, doubly symmetric, constructed with arcs of circle; an oval needs a minimum of four centres, but it is possible also to build polycentric ovals. The above definition corresponds with the origin and the use of oval forms in building and may be applied without problem until, say, the XVIIIth century. Since then, the teaching of conics in the elementary courses of geometry made the cultivated people to define the oval as an approximation to the ellipse, an “imperfect ellipse”: an oval was, then, a curve formed with arcs of circles which tries to approximate to the ellipse of the same axes. As we shall see, the ellipse has very rarely been used in building. Finally, in modern geometrical textbooks an oval is defined as a smooth closed convex curve, a more general definition which embraces the two previous, but which is of no particular use in the study of the employment of oval forms in building. The present paper contains the following parts: 1) an outline the origin and application of the oval in historical architecture; 2) a discussion of the spatial geometry of oval domes, i. e., the different methods employed to trace them; 3) a brief exposition of the mechanics of oval arches and domes; and 4) a final discussion of the role of Geometry in oval arch and dome design

A novel path to runaway electron mitigation via deuterium injection and current-driven MHD instability

Relativistic electron (RE) beams at high current density (low safety factor, q ( a )) yet very low free-electron density accessed with D-2 secondary injection in the DIII-D and JET tokamak are found to exhibit large-scale MHD instabilities that benignly terminate the RE beam. In JET, this technique has enabled termination of MA-level RE currents without measurable first-wall heating. This scenario thus offers an unexpected alternate pathway to achieve RE mitigation without collisional dissipation. Benign termination is explained by two synergistic effects. First, during the MHD-driven RE loss events both experiment and MHD orbit-loss modeling supports a significant increase in the wetted area of the RE loss. Second, as previously identified at JET and DIII-D, the fast kink loss timescale precludes RE beam regeneration and the resulting dangerous conversion of magnetic to RE kinetic energy. During the termination, the RE kinetic energy is lost to the wall, but the current fully transfers to the cold bulk thus enabling benign Ohmic dissipation of the magnetic energy on longer timescales via a conventional current quench. Hydrogenic (D-2) secondary injection is found to be the only injected species that enables access to the benign termination. D-2 injection: (1) facilitates access to low q ( a ) in existing devices (via reduced collisionality & resistivity), (2) minimizes the RE avalanche by 'purging' the high-Z atoms from the RE beam, (3) drives recombination of the background plasma, reducing the density and Alfven time, thus accelerating the MHD growth. This phenomenon is found to be accessible when crossing the low q ( a ) stability boundary with rising current, falling toroidal field, or contracting minor radius-the latter being the expected scenario for vertically unstable RE beams in ITER. While unexpected, this path scales favorably to fusion-grade tokamaks and offers a novel RE mitigation scenario in principle accessible with the day-one disruption mitigation system of ITER

The actin-myosin regulatory MRCK kinases: regulation, biological functions and associations with human cancer

The contractile actin-myosin cytoskeleton provides much of the force required for numerous cellular activities such as motility, adhesion, cytokinesis and changes in morphology. Key elements that respond to various signal pathways are the myosin II regulatory light chains (MLC), which participate in actin-myosin contraction by modulating the ATPase activity and consequent contractile force generation mediated by myosin heavy chain heads. Considerable effort has focussed on the role of MLC kinases, and yet the contributions of the myotonic dystrophy-related Cdc42-binding kinases (MRCK) proteins in MLC phosphorylation and cytoskeleton regulation have not been well characterized. In contrast to the closely related ROCK1 and ROCK2 kinases that are regulated by the RhoA and RhoC GTPases, there is relatively little information about the CDC42-regulated MRCKα, MRCKβ and MRCKγ members of the AGC (PKA, PKG and PKC) kinase family. As well as differences in upstream activation pathways, MRCK and ROCK kinases apparently differ in the way that they spatially regulate MLC phosphorylation, which ultimately affects their influence on the organization and dynamics of the actin-myosin cytoskeleton. In this review, we will summarize the MRCK protein structures, expression patterns, small molecule inhibitors, biological functions and associations with human diseases such as cancer

Autologous stem cell transplantation may be curative for patients with follicular lymphoma with early therapy failure without the need for immunotherapy

Objective/Background: Patients with follicular lymphoma (FL) with early therapy failure (ETF) within 2 years of frontline therapy have poor overall survival (OS). We recently reported the results of autologous stem cell transplantation (ASCT) in patients from the Grupo Español de Linfomas y Trasplantes de Médula Ósea (GELTAMO) registry treated with rituximab prior to ASCT and with ETF after first-line immunochemotherapy, leading to 81% 5-year OS since ASCT. We explored whether ASCT is also an effective option in the pre-rituximab era—that is, in patients treated in induction and rescued only with chemotherapy. Methods: ETF was defined as relapse/progression within 2 years of starting first-line therapy. We identified two groups: the ETF cohort (n = 87) and the non-ETF cohort (n = 47 patients receiving ASCT but not experiencing ETF following first-line therapy). Results: There was a significant difference in 5-year progression-free survival between the ETF and non-ETF cohorts (43% vs. 57%, respectively; p = .048). Nevertheless, in patients with ETF with an interval from first relapse after primary treatment to ASCT of <1 year, no differences were observed in 5-year progression-free survival (48% vs. 66%, respectively; p = .44) or in 5-year OS (69% vs. 77%, p = .4). Patients in the ETF cohort transplanted in complete remission showed a plateau in the OS curves, at 56%, beyond 13.7 years of follow-up. Conclusion: ASCT may be a curative option for ETF in patients who respond to rescue chemotherapy, without the need for immunotherapy or other therapies, and should be considered as an early consolidation, especially in patients with difficult access to rituximab

Diplopia is frequent and associated with motor and non-motor severity in parkinson's disease : Results from the COPPADIS cohort at 2-year follow-up

Background and objective: Diplopia is relatively common in Parkinson's disease (PD) but is still understudied. Our aim was to analyze the frequency of diplopia in PD patients from a multicenter Spanish cohort, to compare the frequency with a control group, and to identify factors associated with it. Patients and Methods: PD patients who were recruited from January 2016 to November 2017 (baseline visit; V0) and evaluated again at a 2-year ± 30 days follow-up (V2) from 35 centers of Spain from the COPPADIS cohort were included in this longitudinal prospective study. The patients and controls were classified as "with diplopia" or "without diplopia" according to item 15 of the Non-Motor Symptoms Scale (NMSS) at V0, V1 (1-year ± 15 days), and V2 for the patients and at V0 and V2 for the controls. Results: The frequency of diplopia in the PD patients was 13.6% (94/691) at V0 (1.9% in controls [4/206]; p < 0.0001), 14.2% (86/604) at V1, and 17.1% (86/502) at V2 (0.8% in controls [1/124]; p < 0.0001), with a period prevalence of 24.9% (120/481). Visual hallucinations at any visit from V0 to V2 (OR = 2.264; 95%CI, 1.269-4.039; p = 0.006), a higher score on the NMSS at V0 (OR = 1.009; 95%CI, 1.012-1.024; p = 0.015), and a greater increase from V0 to V2 on the Unified Parkinson's Disease Rating Scale-III (OR = 1.039; 95%CI, 1.023-1.083; p < 0.0001) and Neuropsychiatric Inventory (OR = 1.028; 95%CI, 1.001-1.057; p = 0.049) scores were independent factors associated with diplopia (R = 0.25; Hosmer and Lemeshow test, p = 0.716). Conclusions: Diplopia represents a frequent symptom in PD patients and is associated with motor and non-motor severity