Individualizing anaemia therapy

Individualized strategies for managing renal anaemia with erythropoiesis-stimulating agents (ESAs) need to be advanced. Recent outcomes from clinical studies prompted a narrowing of the guideline-recommended haemoglobin target (11–12 g/dL) due to increased mortality and morbidity when targeting higher haemoglobin concentrations. Maintaining a narrow target is a clinical challenge, as haemoglobin concentration tends to fluctuate. The goal of individualized treatment is to achieve the haemoglobin target at the lowest ESA dose while avoiding significant fluctuations in haemoglobin concentrations and persistently low or high concentrations. This may require changes to the ESA dose and dosing frequency over the course of treatment

Identificación de parámetros de vehículos mediante dinámica de sistemas multicuerpo y el filtro de Kalman extendido (EKF)

Este artículo presenta el modelo multicuerpo de una furgoneta IVECO Daily 35C15 que ha sido desarrollado en Matlab™ con el objetivo de identificar los parámetros fundamentales necesarios para obtener una simulación dinámica lo más parecida posible a la realidad. Utiliza un método topológico semi-recursivo cuyas funciones críticas están programadas en C/C++ para mejorar su eficiencia. Se presentan los resultados obtenidos en la identificación utilizando como medidas reales, en un primer caso, los resultados de una simulación previa realizada con el mismo modelo matemático que utiliza el filtro y, después, medidas obtenidas de un ensayo realizado en la pista de pruebas del INSIA. El objetivo final del trabajo es validar el modelo de la furgoneta IVECO para poder utilizar dicho modelo en simulaciones más complejas

Propensity score matching and persistence correction to reduce bias incomparative effectiveness: the effect of cinacalcet use on all-causemortality

Purpose: The generalisability of randomised controlled trials (RCTs) may be limited by restrictive entry criteria or by their experimental nature. Observational research can provide complementary findings but is prone to bias. Employing propensity score matching, to reduce such bias, we compared the real-life effect of cinacalcet use on all-cause mortality (ACM) with findings from the Evaluation of Cinacalcet Therapy to Lower Cardiovascular Events (EVOLVE) RCT in chronic haemodialysis patients. Methods: Incident adult haemodialysis patients receiving cinacalcet, recruited in a prospective observational cohort from 2007-2009 (AROii; n = 10,488), were matched to non-exposed patients regardless of future exposure status. The effect of treatment crossover was investigated with inverse probability of censoring weighted and lag-censored analyses. EVOLVE ACM data were analysed largely as described for the primary composite endpoint. Results: AROii patients receiving cinacalcet (n = 532) were matched to 1790 non-exposed patients. The treatment effect of cinacalcet on ACM in the main AROii analysis (hazard ratio 1.03 [95% confidence interval (CI) 0.78-1.35]) was closer to the null than for the Intention to Treat (ITT) analysis of EVOLVE (0.94 [95%CI 0.85-1.04]). Adjusting for non-persistence by 0- and 6-month lag-censoring and by inverse probability of censoring weight, the hazard ratios in AROii (0.76 [95%CI 0.51-1.15], 0.84 [95%CI 0.60-1.18] and 0.79 [95%CI 0.56-1.11], respectively) were comparable with those of EVOLVE (0.82 [95%CI 0.67-1.01], 0.83 [95%CI 0.73-0.96] and 0.87 [95%CI 0.71-1.06], respectively). Conclusions: Correcting for treatment crossover, we observed results in the 'real-life' setting of the AROii observational cohort that closely mirrored the results of the EVOLVE RCT. Persistence-corrected analyses revealed a trend towards reduced ACM in haemodialysis patients receiving cinacalcet therapy.Funding: DWreports having received research funding from Abbott,Genzyme and AstraZeneca and honoraria from Amgen,Abbott, Fresenius, Janssen, Otsuka, Shire and Vifor

Retinoic acid, under cerebrospinal fluid control, induces neurogenesis during early brain development

Producción CientíficaOne of the more intriguing subjects in neuroscience is how a precursor or stem cell is induced to differentiate into a neuron. Neurogenesis begins early in brain development and suddenly becomes a very intense process, which is related with the influence of Retinoic Acid. Here, using a biological test (F9-1.8 cells) in chick embryos, we show that ―in vivo‖ embryonic cerebrospinal fluid regulates mesencephalic-rombencephalic Isthmic Retinoic Acid synthesis and this effect has a direct influence on mesencephalic neuroepithelial precursors, inducing a significant increase in neurogenesis. This effect is mediated by the Retinol Binding Protein present in the embryonic cerebrospinal fluid. The knowledge of embryonic neurogenetic stimulus could be useful in the control of adult brain neurogenesis.Ministerio de Educación y Ciencia (BFU207/6516)Junta de Castilla y León (Consejería de Educación, GR195

Lens capsule HSPG-Perlecan regulates lens fibre differentiation during chick embryo development

Producción CientíficaLens fibre differentiation is a life-long process related with lens transparency, and is particularly intense during development, being related with an FGF-2 antero-posterior gradient at the equator level as the main growth factor involved which has been related with the basal membrane of the lens anlagen known as “Lens capsule”. However the lens fibre differentiation induced by FGF2 depends, as in other biological systems, on the local bioavailability of FGF-2 regulated by their relationship with extracellular matrix molecules as Heparan Sulphate Proteoglycans. Here, we try to clarify how Perlecan (a heparan sulphate proteoglycan specific from basement membranes) is involved in lens fibre differentiation at earliest stages of eye development. Our results show that Perlecan, is a major component in the lens capsule during the earliest stages of lens development in chick embryos being present during lens plate induction, lens vesicle stage and the onset of lens fibre differentiation. In order to demonstrate a direct involvement of HSPG-Perlecan in lens fibre differentiation, we generate depleted lenses by HSPG-Perlecan synthesis disruption and specific enzymatic digestion. The HSPG-Perlecan depleted lens show a significant delay or abolition in the lens fibre differentiation which remains in an immature cells displaying DNA synthesis in the posterior epithelium and a decrease in FGF2 lens expression. These data support the hypothesis that lens capsule HSPG-Perlecan is a key molecule involved in lens fibre differentiation during development, probably by involvement in FGF-2 biodisponibility.Ministerio de Educación y Ciencia (Grant BFU207/6516)Instituto de Salud Carlos III (Grant PIO20961)Junta de Castilla y León (Grants VA21A07, VA049/04, SAN673/VA15/08

Cuestionarios conceptuales en Física: evaluación de resultados de aprendizaje y conceptos erróneos en Mecánica y Electromagnetismo = Concept Inventories in Physics: assessment of learning outcomes and misconceptions in Mechanics and Electromagnetism

En este trabajo presentamos los resultados de la aplicación de dos cuestionarios conceptuales (FCI, Force Concept Inventory, y BEMA, Brief Electricity and Magnetism Assessment) a estudiantes de primer curso de Grados en Ingeniería en la Universidad Politécnica de Madrid. Hemos utilizado los cuestionarios conceptuales como una herramienta de investigación educativa orientada a identificar fortalezas y debilidades en el perfil de entrada de los alumnos y en los resultados de aprendizaje de las asignaturas de Física General I y II. Además, hemos identificado los errores conceptuales más importantes. Los resultados obtenidos nos permiten dirigir las acciones de innovación educativa a objetivos mucho más concretos. Hemos comprobado que los cuestionarios conceptuales son una herramienta válida para complementar la evaluación de los resultados de aprendizaje de la Física en Ingeniería

Infant coraliform lithiasis: metabolic diagnosis and treatment

Introducción: La litiasis compleja (coraliforme y pseudocoraliforme) es poco frecuente en edad infantil en el mundo desarrollado, sin embargo cuando está presente, requiere de un tratamiento y abordaje enérgico para minimizar el daño renal. El objetivo de este trabajo es analizar nuestra experiencia con este tipo de litiasis y revisar la literatura al respecto. Material y métodos: Presentamos entre los años 1997 y 2010, 15 pacientes de entre 8 meses y 15 años diagnosticados de litiasis renal compleja (9 casos litiasis coraliforme y 6 casos litiasis pseudocoraliforme). No casos de bilateralidad. Se realiza tratamiento con cirugía abierta en 7 casos, ESWL en 5 casos y nefrolitotomía percutánea + ESWL en 3 casos. Resultados: Obtenemos éxito con el tratamiento en el 66.6% de los pacientes, sin observar litiasis residual. En el 13.4% se observa litiasis residual no susceptible de tratamiento. En el 20% hay litiasis residual, por lo que se resuelve el tratamiento con ESWL, cirugía abierta o nefrolitotomía percutánea. La alteración metabólica más frecuente fue la hipocitraturia y la composición del cálculo más frecuente fue fosfato amónico magnésico. Conclusión: La litiasis compleja en el infante requiere un diagnóstico metabólico exhaustivo, basado en análisis del cálculo y metabólico y un tratamiento habitualmente múltiple.Introduction: Complex lithiasis (coraliform and pseudocoraliform) is rare in young children in the developed world, but when present, it requires an aggressive approach and treatment to minimize kidney damage. The aim of this paper was to analyze our experience with this type of lithiasis and to review the existing literature regarding this subject. Material and methods: Between 1997 and 2010, 15 patients between the ages of 8 months old and 15 years old were diagnosed with complex renal lithiasis (9 cases with coraliform lithiasis and 6 cases with pseudocoraliform lithiasis). No cases were bilateral. Open surgery was performed in 7 cases, extracorporeal shock wave lithotripsy was performed in 5 cases, and percutaneous nephrolithotomy + extracorporeal shock wave lithotripsy was performed in 3 cases. Results: We achieved successful treatment in 66.6% of patients, with no observation of residual lithiasis. In patients who did not respond to treatment, 13.4% residual lithiasis was observed. In 20% of the cases, residual lithiasis was treated with extracorporeal shock wave lithotripsy, open surgery, or percutaneous nephrolithotomy. The most frequent metabolic disorder was hypocitraturia, and the most common composition of calculi was magnesium ammonium phosphate. Conclusion: Complex lithiasis in infants requires a thorough metabolic diagnosis based on calculus analysis and metabolic analysis and usually requires various treatment

Prevalence of hazardous alcohol use among Spanish primary care providers

BackgroundAlcohol use by health care professionals is one of the potential factors that may affect the prevention of hazardous drinking in Primary Care (PC). The objective of the study was to estimate the prevalence of hazardous alcohol use by PC professionals and assess the existing relationship between socio-demographic and occupational variables of PC professionals and their alcohol use.MethodsA descriptive, cross-sectional, observational, multicenter study was performed. Location: PC sites of the Spanish National Health Care System (NHS). Participants: Physicians and nurses, who completed an online questionnaire intended to identify the pattern of hazardous alcohol use through the AUDIT-C test. The study population was recruited through random sampling stratified by regions of the PC sites in the NHS. The primary measurements: Frequency of alcohol use, number of drinks containing alcohol on a typical day, frequency of six or more drinks on one occasion.ResultsOne thousand seven hundred sixty professionals completed the questionnaire. Hazardous alcohol use was detected in 27.80% (95% CI: 25.5-29.7) of PC providers. The prevalence of hazardous alcohol use was higher in males (34.2%) [95% CI: 30.4-37.6] and professionals aged 56years or over (34.2%) [95% CI: 28.2-40.2]. The multiple logistic regression analysis revealed a higher hazardous use in males (OR=1.52; 95% CI: 1.22-1.90), PC physicians (OR=1.42; 95% CI: 1.01-2.02) and professionals with more time worked (OR=1.03; 95% CI: 1.01-1.05).ConclusionOur study shows the current prevalence of hazardous alcohol use among Spanish PC providers, revealing a higher percentage of hazardous alcohol use in healthcare professionals compared to the Spanish general population. Further interventions are required to increase the awareness of negative consequences derived from alcohol use among PC professionals and its impact on the clinical setting

Clinical Factors, Preventive Behaviours and Temporal Outcomes Associated with COVID-19 Infection in Health Professionals at a Spanish Hospital

The authors thank K. Shashok for improving the use of English in the manuscript.The novel coronavirus disease (COVID-19) outbreak has quickly spread around the world, with Spain being one of the most severely affected countries. Healthcare professionals are an important risk group given their exposure. The aims of this study were to determine the prevalence of symptoms, main concerns as patients, preventive behaviours of healthcare professionals, and the different temporal outcomes associated with the negativization of PCR results. A total of 238 professionals were analysed and follow-up was conducted from 11 March to 21 April 2020 through clinical records, in-depth surveys, and telephone interviews. Symptoms, concerns, and preventive measures were documented, and temporal outcomes (start and end of symptoms, first positive PCR, and negativization of PCR) were analysed through survival analyses. A high prevalence of gastrointestinal symptoms (especially in women and older professionals), fever, cough, and fatigue were reported. The main concern was contagion in the work and home environment. Professionals (especially men) reported low use of face masks before the pandemic. Our analysis indicates that the median times for the negativization of PCR testing to confirm the resolution of infection is 15 days after the end of symptoms, or 25 days after the first positive PCR test. Our results suggest that these times are longer for women and for professionals aged ≥55 years, therefore follow-up strategies should be optimized in light of both variables. This is the first study we are aware of to report factors associated with the time to negativization of PCR results. We present the first rigorous estimates of time outcomes and hope that these data can be valuable to continue feeding the prediction models that are currently being developed. Similar studies are required to corroborate our results.Chair of Teaching and Research in Family Medicine SEMERGEN-UGR. University of Granad