Prediction of morbidity and mortality after early cholecystectomy for acute calculous cholecystitis: results of the S.P.Ri.M.A.C.C. study

Artículo escrito por un elevado número de autores, solo se referencian el que aparece en primer lugar, el nombre del grupo de colaboración, si lo hubiere, y los autores pertenecientes a la UAMLess invasive alternatives than early cholecystectomy (EC) for acute calculous cholecystitis (ACC) treat‑ ment have been spreading in recent years. We still lack a reliable tool to select high-risk patients who could beneft from these alternatives. Our study aimed to prospectively validate the Chole-risk score in predicting postoperative complications in patients undergoing EC for ACC compared with other preoperative risk prediction models. Method The S.P.Ri.M.A.C.C. study is a World Society of Emergency Surgery prospective multicenter observational study. From 1st September 2021 to 1st September 2022, 1253 consecutive patients admitted in 79 centers were included. The inclusion criteria were a diagnosis of ACC and to be a candidate for EC. A Cochran-Armitage test of the trend was run to determine whether a linear correlation existed between the Chole-risk score and a complicated postoperative course. To assess the accuracy of the analyzed prediction models—POSSUM Physiological Score (PS), modifed Frailty Index, Charlson Comorbidity Index, American Society of Anesthesiologist score (ASA), APACHE II score, and ACC severity grade—receiver operating characteristic (ROC) curves were generated. The area under the ROC curve (AUC) was used to compare the diagnostic abilities. Results A 30-day major morbidity of 6.6% and 30-day mortality of 1.1% were found. Chole-risk was validated, but POSSUM PS was the best risk prediction model for a complicated course after EC for ACC (in-hospital mortality: AUC 0.94, p<0.001; 30-day mortality: AUC 0.94, p<0.001; in-hospital major morbidity: AUC 0.73, p<0.001; 30-day major morbidity: AUC 0.70, p<0.001). POSSUM PS with a cutof of 25 (defned in our study as a ‘Chole-POSSUM’ score) was then validated in a separate cohort of patients. It showed a 100% sensitivity and a 100% negative predictive value for mortality and a 96–97% negative predictive value for major complications. Conclusions The Chole-risk score was externally validated, but the CHOLE-POSSUM stands as a more accurate pre‑ diction model. CHOLE-POSSUM is a reliable tool to stratify patients with ACC into a low-risk group that may represent a safe EC candidate, and a high-risk group, where new minimally invasive endoscopic techniques may fnd the most useful feld of actio

Hallazgos clínico-patológicos en autopsias médico-legales

[ES] La investigación establece como hipótesis las siguientes: Las diferencias conceptuales entre las autopsias clínicas y médico-legales nos hacen plantearnos la importancia del estudio de las lesiones anatomopatológicas incidentales en los casos de autopsias médico-legales. Su estudio puede aportar importantes conocimientos sobre lesiones, más o menos comunes en la población general, que de no haberse producido la muerte “legal”, posiblemente no habríamos conocido. Pretendemos, por tanto, analizar las lesiones anatomopatológicas, relacionadas o no con la muerte legal, y conocer, más detenidamente, las lesiones más frecuentes, observadas en dichas autopsias. Los objetivos que se pretenden conseguir son: 1.- Analizar y describir todas las lesiones anatomopatológicas y, sobre todo, las consideradas como “hallazgos casuales” o “incidentales” en las autopsias médico-legales estudiadas. 2.- Establecer su posible correlación clínico-patológica. 3.- Determinar el tipo de relación existente entre los datos clínicos analizados, como: la edad, el sexo y los antecedentes patológicos de los fallecidos, y las lesiones encontradas. 4.- Concretar el tipo de relación existente entre los hallazgos patológicos (comunes e incidentales) detectados en las muestras examinadas, y: la causa inicial o fundamental de la muerte, la causa inmediata de la misma, y su etiología médico-legal. 5.- Interpretar los resultados y detallar sus repercusiones

Fungal model systems and the elucidation of pathogenicity determinants

Under a Creative Commons license.Fungi have the capacity to cause devastating diseases of both plants and animals, causing significant harvest losses that threaten food security and human mycoses with high mortality rates. As a consequence, there is a critical need to promote development of new antifungal drugs, which requires a comprehensive molecular knowledge of fungal pathogenesis. In this review, we critically evaluate current knowledge of seven fungal organisms used as major research models for fungal pathogenesis. These include pathogens of both animals and plants; Ashbya gossypii, Aspergillus fumigatus, Candida albicans, Fusarium oxysporum, Magnaporthe oryzae, Ustilago maydis and Zymoseptoria tritici. We present key insights into the virulence mechanisms deployed by each species and a comparative overview of key insights obtained from genomic analysis. We then consider current trends and future challenges associated with the study of fungal pathogenicity. © 2014 The Authors.This review was carried out by members of the EU-Initial Training Network Ariadne (PITN-GA-2009-237936), which provided financial support for C.B., S.D., M.E.G., E.G., E.M., P.V.M., M.M., V.N., M.F.A.N., T.O., M.O.R., K.S. and L.W. Open Access funded by Wellcome TrustPeer Reviewe

Inervación peptidérgica del corazón : patrón de distribución de sustancia P(SP), péptido intestinal vasoactivo (VIP) y neuropéptido y (NPY)

Tesis Univ. Complutense de MadridDepto. de Anatomía y EmbriologíaFac. de MedicinaTRUEpu

Assessing regional convergence of the size of middle classes in Euro-Mediterranean countries

Historically, Euro-Mediterranean European countries have presented high levels of intra- and interregional socio-economic inequalities and are regular recipients of financial support under European Union Cohesion Policy. This paper provides evidence of regional convergence in the size of lower- and upper-middle-income classes across regions of France, Greece, Italy and Spain for the period 2004-17. Our results also reveal that changes in class size in neighbouring regions are associated with changes in the same direction in the lower- and upper-middle classes of the region of interest. As regards growth of class size in neighbouring regions, the convergence process is offset in both middle-income groups, but only partially for the upper-middle class. Furthermore, the economic cycle affects the process of regional convergence in the size of the middle class, although the effects are non-homogeneous for both middle-class groups. While increases or decreases in gross domestic product (GDP) do not seem to be closely related to upper-middle-class size, relatively persistent decreases rather than increases in GDP over time tend to be more linked to lower-middle-class size. These findings point to significant differences in the convergence dynamics between lower- and upper-middle classes, with the former being more sensitive to both neighbouring regions and the business cycle.University of MalagaUniversity of GranadaRegional Government of Andalusia [UMA18-FEDERJA-005]Spanish Ministry of Science and Innovation [AEI/10.13039/501100011033

Creative Drama and Forum Theatre in initial teacher education: Fostering students’ empathy and awareness of professional conflicts

Two studies examined the impact of a programme that used Creative Drama and Forum Theatre on the social, emotional, and ethical skills of student teachers. The first study qualitatively analysed 49 teaching conflict situations devised by 280 students. The second analysed the programme's effect on 626 students? empathy and perception of their teaching-learning processes. The types of conflicts, contexts, and ethical dilemmas involved were categorised. Pedagogical tools and their effect on self-knowledge, perspectivetaking, and socio-moral sensitivity and reflection were favourably assessed. The emotional understanding component of empathy significantly improved. The results support a more comprehensive training of future teachers

How Much Are Individuals Left Behind in Central and Eastern Compared to Western European Countries? A Fuzzy Comparative Analysis.

This paper examines the extent to which individuals of Central and Eastern European (CEE) countries are left behind compared to individuals from Western European (WE) countries based on a fuzzy approach applied to a multidimensional setting. Three decades after transitions from non-democratic regimes to liberal democracy and from centrally planned economies to market economies of these countries, we observe a certain process of convergence between both blocs of countries over the period 2007-2019, essentially as a result of the decrease in the level individuals are left behind in the CEE countries, reaching similar levels to WE countries. Furthermore, we reveal significant disparities across CEE countries, ranging from Czech Republic, Slovenia and Slovakia, where citizens are less left behind, to Bulgaria, Lithuania and Romania, with higher levels of leaving behind. Differences in the degree individuals are left behind along the income distribution and by sociodemographic characteristics are also analysed, highlighting dissimilarities of lagging socioeconomic profiles across countries.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

How much are Individuals Left Behind in Central and Eastern Europe after Three Decades of Capitalism? A Comparative Analysis with Western Europe

This study examines the extent to which individuals of Central and Eastern European (CEE) countries are left behind compared to individuals from Western European (WE) countries based on a fuzzy approach applied to a multidimensional setting. Three decades after transitions from non-democratic regimes to liberal democracy and from centrally planned economies to market economies of these countries, we observe a certain process of convergence between both blocs of countries over the period 2007-2019, essentially as a result of the decrease in the level individuals are left behind in the CEE countries, reaching similar levels to WE countries. Furthermore, we reveal significant disparities across CEE countries, ranging from Czech Republic, Slovenia and Slovakia, where citizens are less left behind, to Bulgaria, Lithuania and Romania, with higher levels of leaving behind. Differences in the degree individuals are left behind along the income distribution and by sociodemographic characteristics are also analysed, highlighting dissimilarities of lagging socioeconomic profiles across countries.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech