The effect of skin-to-skin contact at birth, early versus immediate, on the duration of exclusive human lactancy in full-term newborns treated at the Clínica Universidad de La Sabana: study protocol for a randomized clinical trial

9 páginasBackground Human lactancy is a simple and cost-effective strategy that influences infant and maternal mortality rates. Skin-to-skin contact (SSC) is an immediate postpartum period strategy that has proven to benefit the initiation and continuation of human lactation and to decrease hospitalization during the first week of life. This study aims to determine the effect of SSC initiation at birth (immediate versus early) in healthy, full-term newborns treated at the Universidad de La Sabana Clinic on the duration of exclusive human lactation

Unraveling the mystery about the negative valence bias: does arousal account for processing differences in unpleasant words?

Many studies have found that the emotional content of words affects visual word recognition. However, most of them have only considered affective valence, finding inconsistencies regarding the direction of the effects, especially in unpleasant words. Recent studies suggest that arousal might explain why not all unpleasant words elicit the same behavior. The aim of the present research was to study the role of arousal in unpleasant word recognition. To do that, we carried out an ERP experiment in which participants performed a lexical decision task that included unpleasant words which could vary across three levels of arousal (intermediate, high, and very high) and words which were neutral in valence and had an intermediate level of arousal. Results showed that, within unpleasant words, those intermediate in arousal evoked smaller LPC amplitudes than words that were high or very high in arousal, indicating that arousal affects unpleasant word recognition. Critically, arousal determined whether the effect of negative valence was found or not. When arousal was not matched between unpleasant and neutral valenced words, the effect of emotionality was weak in the behavioral data and absent in the ERP data. However, when arousal was intermediate in both unpleasant and neutral valenced words, larger EPN amplitudes were reported for the former, pointing to an early allocation of attention. Interestingly, these unpleasant words which had an intermediate level of arousal showed a subsequent inhibitory effect in that they evoked smaller LPC amplitudes and led to slower reaction times and more errors than neutral words. Our results highlight the relevance that the arousal level has for the study of negative valence effects in word recognitionThis study was supported by the Spanish Ministry of Science, Innovation and Universities (PID2019-107206GB-I00 and RED2018-102615-T), the Spanish Ministry of Science and Innovation (PID2019-110583GB-I00), the Autonomous Government of Galicia (Consellería de Educación, Xunta de Galicia, GRC 2015/006), and the Universitat Rovira i Virgili (2019PFR-URV-B2-32)S

Masked Phenolic-Selenium Conjugates: Potent and Selective Antiproliferative Agents Overcoming P-gp Resistance

Cancer accounts for one of the most complex diseases nowadays due to its multifactorial nature. Despite the vast number of cytotoxic agents developed so far, good therapeutic approaches are not always reached. In recent years, multitarget drugs are gaining great attention against multifactorial diseases in contraposition to polypharmacy. Herein we have accomplished the conjugation of phenolic derivatives with an ample number of organochalcogen motifs with the aim of developing novel antiproliferative agents. Their antioxidant, and antiproliferative properties (against six tumour and one non-tumour cell lines) were analysed. Moreover, in order to predict P-gp-mediated chemoresistance, the P-glycoprotein assay was also conducted in order to determine whether compounds prepared herein could behave as substrates of that glycoprotein. Selenium derivatives were found to be significantly stronger antiproliferative agents than their sulfur isosters. Moreover, the length and the nature of the tether, together with the nature of the organoselenium scaffold were also found to be crucial features in the observed bioactivities. The lead compound, bearing a methylenedioxyphenyl moiety, and a diselenide functionality, showed a good activity (GI50 = 0.88-2.0 µM) and selectivity towards tumour cell lines (selectivity index: 14-32); moreover, compounds considered herein were not substrates for the P-gp efflux pump, thus avoiding the development of chemoresistance coming from such mechanism, commonly found for widely-used chemotherapeutic agents

Challenges in assessing and managing multi-hazard risks: a European stakeholders perspective

The latest evidence suggests that multi-hazards and their interrelationships (e.g., triggering, compound, and consecutive hazards) are becoming more frequent across Europe, underlying a need for resilience building by moving from single-hazard-focused to multi-hazard risk assessment and management. Although significant advancements were made in our understanding of these events, mainstream practice is still focused on risks due to single hazards (e.g., flooding, earthquakes, droughts), with a limited understanding of the stakeholder needs on the ground. To overcome this limitation, this paper sets out to understand the challenges for moving towards multi-hazard risk management through the perspective of European stakeholders. Based on five workshops across different European pilots (Danube Region, Veneto Region, Scandinavia, North Sea, and Canary Islands) and an expert workshop, we identify five prime challenges: i) governance, ii) knowledge of multi-hazards and multi-risks, iii) existing approaches to disaster risk management, iv) translation of science to policy and practice, and v) lack of data. These challenges are inherently linked and cannot be tackled in isolation with path dependency posing a significant hurdle in transitioning from single- to multi-hazard risk management. Going forward, we identify promising approaches for overcoming some of the challenges, including emerging approaches for multi-hazard characterisation, a common understanding of terminology, and a comprehensive framework for guiding multi-hazard risk assessment and management. We argue for a need to think beyond natural hazards and include other threats in creating a comprehensive overview of multi-hazard risks, as well as promoting thinking of multi-hazard risk reduction in the context of larger development goals

Aire. Apoyo Integral Respiratorio en Emergencias

El desarrollo de la formación académica en vía aérea difícil concluyó en el texto que se presenta ahora bajo el nombre de AIRE, Apoyo Integral Respiratorio en Emergencias. Este proyecto se inició hace 5 años con el objetivo de desarrollar un curso adquirieran las aptitudes y los conocimientos necesarios para el manejo básico y avanzado de la vía aérea del paciente urgente. Así mismo, respondió a la necesidad creciente de entrenamiento para el manejo avanzado de la vía aérea en el entorno de los servicios de urgencias intra y extra hospitalarias por parte de los médicos generales, especialistas en Medicina de Emergencias, Anestesia, Cirugía General, Medicina Interna, y de todo el personal relacionado con el cuidado del paciente crítico. Fue así como un grupo de conformado por dos emergeciólogos, cuatro residentes de Medicina de Emergencias y una terapeuta respiratoria comenzamos a convertirnos en facilitadores para el aprendizaje de este difícil tema

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Brugada syndrome

El síndrome de Brugada, en ausencia de cardiopatía estructural, se considera una canalopatía que predispone a arritmias ventriculares y muerte súbita. Se describió inicialmente en la década de los 90 y hasta el momento se ha avanzado significativamente en el entendimiento de su fisiopatología, procurando cada vez más su diagnóstico temprano. Las alteraciones en las corrientes iónicas durante las fases iniciales del potencial de acción en los miocitos cardíacos generan un gradiente transmural potencialmente arritmogénico, manifestándose en el electrocardiograma (en derivaciones precordiales derechas) como elevación del segmento ST en diferentes magnitudes y variaciones de la onda T. Debe siempre sospecharse en los pacientes pediátricos que consulten a los servicios de urgencias por síncope, ya que este puede ser una de sus manifestaciones clínicas.Brugada syndrome is a channelopathy that predisposes to ventricular arrhythmias, and sudden death in the absence of structural heart disease. It was first described in the early nineties, and significant progress has been made understanding its physiopathology, seeking an early diagnosis. Alterations in the ionic currents during the initial phases of the action potential in cardiac myocytes generate a potentially arrhythmogenic transmural gradient with characteristic electrocardiographic changes in right precordial leads, consisting of elevation of the ST segment, and variations of the T wave. This syndrome should always be suspected in pediatric patients that come to the emergency room with a syncope, because it may be the first clinical manifestation of the Brugada syndrome

Brugada syndrome

El síndrome de Brugada, en ausencia de cardiopatía estructural, se considera una canalopatía que predispone a arritmias ventriculares y muerte súbita. Se describió inicialmente en la década de los 90 y hasta el momento se ha avanzado significativamente en el entendimiento de su fisiopatología, procurando cada vez más su diagnóstico temprano. Las alteraciones en las corrientes iónicas durante las fases iniciales del potencial de acción en los miocitos cardíacos generan un gradiente transmural potencialmente arritmogénico, manifestándose en el electrocardiograma (en derivaciones precordiales derechas) como elevación del segmento ST en diferentes magnitudes y variaciones de la onda T. Debe siempre sospecharse en los pacientes pediátricos que consulten a los servicios de urgencias por síncope, ya que este puede ser una de sus manifestaciones clínicas.Brugada syndrome is a channelopathy that predisposes to ventricular arrhythmias, and sudden death in the absence of structural heart disease. It was first described in the early nineties, and significant progress has been made understanding its physiopathology, seeking an early diagnosis. Alterations in the ionic currents during the initial phases of the action potential in cardiac myocytes generate a potentially arrhythmogenic transmural gradient with characteristic electrocardiographic changes in right precordial leads, consisting of elevation of the ST segment, and variations of the T wave. This syndrome should always be suspected in pediatric patients that come to the emergency room with a syncope, because it may be the first clinical manifestation of the Brugada syndrome