Clinical validation of risk scoring systems to predict risk of delayed bleeding after EMR of large colorectal lesions

[Background and Aims]: The Endoscopic Resection Group of the Spanish Society of Endoscopy (GSEED-RE) model and the Australian Colonic Endoscopic Resection (ACER) model were proposed to predict delayed bleeding (DB) after EMR of large superficial colorectal lesions, but neither has been validated. We validated and updated these models.[Methods]: A multicenter cohort study was performed in patients with nonpedunculated lesions ≥20 mm removed by EMR. We assessed the discrimination and calibration of the GSEED-RE and ACER models. Difficulty performing EMR was subjectively categorized as low, medium, or high. We created a new model, including factors associated with DB in 3 cohort studies.[Results]: DB occurred in 45 of 1034 EMRs (4.5%); it was associated with proximal location (odds ratio [OR], 2.84; 95% confidence interval [CI], 1.31-6.16), antiplatelet agents (OR, 2.51; 95% CI, .99-6.34) or anticoagulants (OR, 4.54; 95% CI, 2.14-9.63), difficulty of EMR (OR, 3.23; 95% CI, 1.41-7.40), and comorbidity (OR, 2.11; 95% CI, .99-4.47). The GSEED-RE and ACER models did not accurately predict DB. Re-estimation and recalibration yielded acceptable results (GSEED-RE area under the curve [AUC], .64 [95% CI, .54-.74]; ACER AUC, .65 [95% CI, .57-.73]). We used lesion size, proximal location, comorbidity, and antiplatelet or anticoagulant therapy to generate a new model, the GSEED-RE2, which achieved higher AUC values (.69-.73; 95% CI, .59-.80) and exhibited lower susceptibility to changes among datasets.[Conclusions]: The updated GSEED-RE and ACER models achieved acceptable prediction levels of DB. The GSEED-RE2 model may achieve better prediction results and could be used to guide the management of patients after validation by other external groups. (Clinical trial registration number: NCT 03050333.)Research support for this study was received from “La Caixa/Caja Navarra” Foundation (ID 100010434;project PR15/11100006)

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Innovación en las enseñanzas universitarias: experiencias presentadas en las III Jornadas de Innovación Educativa de la ULL

En este libro se recoge un conjunto de experiencias de innovación educativa desarrolladas en la ULL en el curso 2011-12. Se abordan distintos ámbitos y ramas del conocimiento, y ocupan temáticas variadas que han sido desarrolladas con rigor, y con un claro potencial para su extrapolación a efectos de la mejora educativa en el ámbito universitario. Esta publicación constituye una primera edición de una serie que irá recogiendo las experiencias de innovación educativa de la ULL. Este es un paso relevante para su impulso en nuestra institución, como lo es el de su vinculación con la investigación educativa, para potenciar su publicación en las revistas científicas en este ámbito cada vez más pujante y relevante para las universidades. Sobre todo representan el deseo y el compromiso del profesorado de la ULL para la mejora del proceso educativo mediante la investigación, la evaluación y la reflexión compartida de nuestras prácticas y planteamientos docentes

Complement component C4 structural variation and quantitative traits contribute to sex-biased vulnerability in systemic sclerosis

Altres ajuts: Fondo Europeo de Desarrollo Regional (FEDER), "A way of making Europe".Copy number (CN) polymorphisms of complement C4 play distinct roles in many conditions, including immune-mediated diseases. We investigated the association of C4 CN with systemic sclerosis (SSc) risk. Imputed total C4, C4A, C4B, and HERV-K CN were analyzed in 26,633 individuals and validated in an independent cohort. Our results showed that higher C4 CN confers protection to SSc, and deviations from CN parity of C4A and C4B augmented risk. The protection contributed per copy of C4A and C4B differed by sex. Stronger protection was afforded by C4A in men and by C4B in women. C4 CN correlated well with its gene expression and serum protein levels, and less C4 was detected for both in SSc patients. Conditioned analysis suggests that C4 genetics strongly contributes to the SSc association within the major histocompatibility complex locus and highlights classical alleles and amino acid variants of HLA-DRB1 and HLA-DPB1 as C4-independent signals

O31 Integrative analysis reveals a molecular stratification of systemic autoimmune diseases

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Efecto de la deforestación en la hidrología del sur y oeste de la Ciudad de México, 1973-2002.

Los bosques ubicados al sur y oeste de la Ciudad de México son muy importantes para la recarga de mantos acuíferos que suministran agua a los habitantes de esta ciudad, pero se encuentran afectados por tala, incendios forestales, plagas, enfermedades y urbanización. En el presente estudio relacioné los patrones de cobertura vegetal de la región con otros elementos del paisaje (geología, geomorfología, suelos, clima) y estimé el efecto de la pérdida de cobertura vegetal a través de tiempo, sobre el patrón de escurrimiento superficial de agua en la zona, a través de modelado conceptual y cartográfico. Estimé el nivel de cambio en superficie de los bosques en el periodo 1973-2002, utilizando imágenes de satélite Landsat (MSS y ETM), con apoyo de cartografía existente, ortofotos y observaciones directas de campo. Además, obtuve un mapa de unidades geográficas y un mapa de unidades de paisaje utilizando un sistema de información geográfica (SIG). Modelé la relación entre los cambios de cobertura vegetal y las condiciones hidrológicas de la región a escala 1:250,000; también analicé el nivel de escurrimiento de una cuenca de ca. de 3,000 has de la zona a través de un modelado cartográfico a nivel local (escala 1:20,000). Encontré que se perdió el 17 % de bosque en 29 años, con tasas de deforestación anuales de 0.2 % en el periodo 1973-1985; 0.4 % en el periodo 1985-1989 y 0.3 % en el periodo 1989-2002. La transformación de cobertura vegetal ocurrió principalmente en las zonas bajas de la región, el cambio fue de cultivos y pastizales y, probablemente, bosque de encino a zonas urbanas. La zona de mayor recarga es la Sierra de Chichinautzin, pero las partes bajas de la Sierra de las Cruces son también sitios de infiltración y de recarga, facilitada por formaciones volcánicas clásticas. Sin embargo, estas zonas han sido impermeabilizadas, en gran medida, con asfalto, impidiendo la infiltración del agua proveniente de las partes altas de la montaña. El daño infringido al bosque en casi tres décadas permite suponer un aumento de escurrimiento superficial que no está siendo capturada por el subsuelo y, por lo tanto, no llega a los mantos acuíferos lo cual tendrá consecuencias negativas tanto para la disponibilidad de agua para la ciudad como para el incremento de casos de inundación. La simulación de escurrimiento realizado para la cuenca del río Magdalena reportó valores simulados fueron semejantes (0.70 m3 s-1) a los promedios de datos registrados por la CNA (0.63 m3 s-1) en un periodo de 24 años.________The forests located at the south and west of Mexico City are very important for nearby aquifers recharge, that provide water to inhabitants of this city; but are being seriously affected by urban encroachment. In this study I related land cover patterns with other landscape elements (geology, geomorphology, soils and climate), and I estimated the effect of deforestation for the 1973 -2002 period on runoff, through conceptual and cartographic modeling. I carried on a change detection analysis using Landsat images (MSS and ETM), existing maps, orthophotos, and ground truth data. I used a geographic information system to obtain a map of geographic units and a map of land units at scale 1:250,000 in order to model the effect of changes in land cover on the hydrologic conditions of the region. Additionally, I estimated the runoff for a small watershed (3,000 ha) within this region through cartographic modeling at scale 1:20,000. I found that in a 29 year period 17% of forest coverage was lost; the annual deforestation rates were 0.2% in 1973-1985; 0.4% in 1985-1989 and 0.3% in 1989-2002. Vegetation index analysis showed that major changes of land cover occurred at the region’s lowlands; changes were from filed crops, grasslands and, very likely, oak forests to urban areas. Fieldwork data revealed other environmental problems besides deforestation such as drought, forest fires, diseases, pests, and so on. Sierra de Chichinautzin is the main groundwater recharging area, but the foot slopes of the Sierra de las Cruces are also important infiltration and recharging zones as a result of the abundance of clastic volcanic forms therein. However, most of these zones have been asphalted preventing infiltration of runoff from the mountains. Damage to the forest in 29 years has increased runoff that is not being infiltrated and, therefore flooding problems are frequent, and will increase in the near future, and water sources tend to be depleted in the long run. Runoff analysis at a small watershed yielded estimates (0.70 m3 s-1) similar to those reported by the Comisión Nacional del Agua, CNA (0.63 m3 s-1), confirming the validity of the present analysis. Decisions on forest conservation should take into account not only reported data on deforestation rates but also estimations of forest conservation level.Tesis (Doctorado en Ciencias, especialista en Botánica).- Colegio de Postgraduados, 2008.CONACY

Distribución de los estrógenos sintéticos aplicados por técnicas mesoterápicas

La aplicación de estrógenos para el control de la reproducción canina y determinadas patologías sexuales de las hembras domésticas, supone un factor de riesgo desencadenante de hipoplásia y aplasia medular, trastornos hepáticos, alteraciones fetales, etc. Mediante la aplicación de estrógenos por vía mesoterápica se busca una fármaco-cinética distinta que evite la biotransformación de los estrógenos epor vía hepática y digestiva, a la vez que menores dosis para conseguir respuestas positivas, a los test biológicos de distribución estrogénica en conejas ovariohisterectomizadas.Depto. de FisiologíaFac. de VeterinariaFALSEpu