¿Interesa la creación de grupos interdisciplinarios para el tratamiento integral del anciano con fractura de cadera?

Las personas mayors de 65 años con fractura de cadera suelen tener antecedents de fracturas vertebrales o de muñeca, así como presentar patologías crónicas de cierta importancia (enfermedades cardiovasculares, insuficiencia respiratoria, alteraciones metabólicas, etc.) y, una vez presentada la fractura, complicaciones postquirúrgicas (mortalidad entre el 11-20%, descompensación de patologías crónicas previas, etc.). En nuestro trabajo encontramos que para disminuir las complicaciones es necesaria la intervención de grupos interdisciplinarios de profesionales (Cirujano ortopédico, anestesista, médico internista o geriatra, rehabilitador, enfermeras, asistentes y trabajadores sociales, médico de atención primaria o de cabecera, siendo discutible la creación de Equipos de atención domiciliaria) para el tratamiento integral e integrado de los pacientes con fractura de cadera.Subjects with hip fracture aged over 65 years used to have antecedents of wrist or vertebral fractures, in addition to other severe chronic illnesses (cardiovascular disease, respiratory insufficiency, metabolic disturbances, etc.) and, after the occurrence of the hip fracture, post-surgical complications (mortality between 11-20%, alterations of previous chromic illnesses, etc.). In this study we found that in order to diminish those complications it is necessary an interdisciplinary approach to provide an integral treatment to those patients through groups of professionals (orthopaedist surgeon, anaesthetist, internist or geriatrician, rehabilitative, nurses, social workers, family doctors, being under discussion the establishment of domiciliary care units)

Electronic health record and problem lists in Leeds, United Kingdom: Variability of general practitioners’ views

Data sharing of Electronic Health Records from general practices to secondary care in Leeds occurs through the so-called Leeds Care Records, which collects a specific set of codes from primary care, known as ‘Active Problems’, and presents it to the user. Variability on its content is a known issue. To explore general practitioners’ views on their use of ‘Active Problems’ and on sharing data, so lessons could be learnt on how to homogenise and improve shared data. Assessing Leeds general practitioners’ views through two parallel processes (60 online surveys and 17 interviews). General practitioners feel they do not have the time nor the training required for keeping a shared approach to concise and current Problem Lists in electronic patient records. Action is needed to reduce current variability, and to improve the quality of shared information. Some types of codes currently present in Problem Lists have very little support among general practitioners who consider the focus should be on long-term conditions and probably adding current acute diagnoses and life expectancy items and not omitting sensitive information. There is a perceived need of training and time to update Problem Lists if their quality is to improve

Identification of individuals at high-risk for pancreatic cancer using a digital patient-input tool combining family cancer history screening and new-onset diabetes

Capturing family history might be a valuable tool for identification of individuals at increased risk of pancreatic cancer, which would allow enrollment into pancreatic surveillance programs. In addition, weight loss and concurrent new-onset diabetes may be utilized as an early marker for pancreatic cancer. This study evaluates the yield of combining family history and the Enriching New-Onset Diabetes for Pancreatic Cancer (ENDPAC) model to identify individuals who could benefit from pancreatic surveillance. A novel questionnaire and digital input tool was created that combined questions on family cancer history and criteria of the ENDPAC model. Individuals meeting ENDPAC criteria were enrolled directly in the high-risk pancreatic clinic. Individuals who met the criteria for a significant family history of cancer were offered referral to a genetic counselor. The questionnaire was completed by 453 patients. Of those, 25.8% (117/453) had significant familial risk factors. Eighteen individuals (15.4%) completed genetic testing previously, of whom five had a pathogenic variant. Thirty-four (29.9%) out of 117 individuals with a strong family history – flagged by the questionnaire – underwent genetic testing. Four (11.8%) of these patients harbored a pathogenic variant. Additionally, through cascade family testing, two siblings were found to carry pathogenic variants. Four (0.9%) of the 453 patients matched ENDPAC criteria. Two were diagnosed with pancreatic cancer and the others were enrolled in the surveillance program. In conclusion, identification of high-risk individuals for pancreatic cancer can be achieved by combining family history screening and the ENDPAC model to facilitate referral to genetic counseling and high-risk clinics.Gastroenterology and Hepatolog

Inter-relations of precipitation, aerosols, and clouds over Andalusia, southern Spain, revealed by the Andalusian Global ObseRvatory of the Atmosphere (AGORA)

The south-central interior of Andalusia experiences intricate precipitation patterns as a result of its semi-arid Mediterranean climate and the impact of Saharan dust and human-made pollutants. The primary aim of this study is to monitor the inter-relations between various factors, such as aerosols, clouds, and meteorological variables, and precipitation systems in Granada using ground-based remote sensing and in situ instruments including a microwave radiometer, ceilometer, cloud radar, nephelometer, and weather station. Over an 11-year period, we detected rain events using a physical retrieval method that employed microwave radiometer measurements. A composite analysis was applied to them to construct a climatology of the temporal evolution of precipitation. It was found that convective rain is the dominant precipitation type in Granada, accounting for 68 % of the rain events. The height of the cloud base is mainly distributed at an altitude of 2 to 7 km. Integrated water vapor (IWV) and integrated cloud liquid water (ILW) increase rapidly before the onset of rain. Aerosol scattering at the surface level and hence the aerosol concentration are reduced during rain, and the predominant mean size distribution of aerosol particles before, during, and after rain is almost the same. A meteorological environment favorable for virga formation is observed in Granada. The surface weather station detected rainfall later than the microwave radiometer, indicating virga according to ceilometer and cloud radar data. We used 889 rain-day events identified by weather station data to determine precipitation intensity classes and found that light rain is the main precipitation intensity class in Granada, accounting for 72 % of the rain-day events. This can be a result of the high tropospheric temperature induced by the Andalusian climate and the reduction of cloud droplet size by the high availability of aerosol particles in the urban atmosphere. This study provides evidence that aerosols, clouds, and meteorological variables have a combined impact on precipitation which can be considered for water resource management and improving rain forecasting accuracy.</p

Structural and electrical transport properties of superconducting Au{0.7}In{0.3} films: A random array of superconductor-normal metal-superconductor (SNS) Josephson junctions

The structural and superconducting properties of Au{0.7}In{0.3} films, grown by interdiffusion of alternating Au and In layers, have been studied. The films were found to consist of a uniform solid solution of Au{0.9}In{0.1}, with excess In precipitated in the form of In-rich grains of various Au-In phases (with distinct atomic compositions), including intermetallic compounds. As the temperature was lowered, these individual grains became superconducting at a particular transition temperature (Tc), determined primarily by the atomic composition of the grain, before a fully superconducting state of zero resistance was established. From the observed onset Tc, it was inferred that up to three different superconducting phases could have formed in these Au{0.7}In{0.3} films, all of which were embedded in a uniform Au{0.9}In{0.1} matrix. Among these phases, the Tc of a particular one, 0.8 K, is higher than any previously reported for the Au-In system. The electrical transport properties were studied down to low temperatures. The transport results were found to be well correlated with those of the structural studies. The present work suggests that Au{0.7}In{0.3} can be modeled as a random array of superconductor-normal metal-superconductor (SNS) Josephson junctions. The effect of disorder and the nature of the superconducting transition in these Au{0.7}In{0.3} films are discussed.Comment: 8 text pages, 10 figures in one separate PDF file, submitted to PR

MicroRNA signature from extracellular vesicles of HCV/HIV co-infected individuals differs from HCV mono-infected

Hepatitis C virus (HCV) coinfection with human immunodeficiency virus (HIV) has a detrimental impact on disease progression. Increasing evidence points to extracellular vesicles (EVs) as important players of the host-viral cross-talk. The microRNAs (miRNAs), as essential components of EVs cargo, are key regulators of normal cellular processes and also promote viral replication, viral pathogenesis, and disease progression. We aimed to characterize the plasma-derived EVs miRNA signature of chronic HCV infected and HIV coinfected patients to unravel the molecular mechanisms of coinfection. EVs were purified and characterized from 50 plasma samples (21 HCV mono- and 29 HCV/HIV co-infected). EV-derived small RNAs were isolated and analyzed by massive sequencing. Known and de novo miRNAs were identified with miRDeep2. Significant differentially expressed (SDE) miRNA identification was performed with generalized linear models and their putative dysregulated biological pathways were evaluated. Study groups were similar for most clinical and epidemiological characteristics. No differences were observed in EVs size or concentration between groups. Therefore, HCV/HIV co-infection condition did not affect the concentration or size of EVs but produced a disturbance in plasma-derived EVs miRNA cargo. Thus, a total of 149 miRNAs were identified (143 known and 6 de novo) leading to 37 SDE miRNAs of which 15 were upregulated and 22 downregulated in HCV/HIV co-infected patients. SDE miRNAs regulate genes involved in inflammation, fibrosis, and cancer, modulating different biological pathways related to HCV and HIV pathogenesis. These findings may help to develop new generation biomarkers and treatment strategies, in addition to elucidate the mechanisms underlying virus-host interaction. KEY MESSAGES: HCV and HCV/HIV displayed similar plasma-EV size and concentration. EVs- derived miRNA profile was characterized by NGS. 37 SDE miRNAs between HCV and HCV/HIV were observed. SDE miRNAs regulate genes involved in inflammation, fibrosis and cancer.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. This work has been supported by grants from (1) Institute of Health Carlos III, Spain [PI18CIII/00020/ to AFR], (2) PID2021–126781OB-I00 funded by MCIN/AEI/10.13039/501100011033 and by “ERDF A way of making Europe”, (3) The SPANISH AIDS Research Network RD16CIII/0002/0002 - ISCIII – FEDER, (4) Centro de Investigación en Red en Enfermedades Infecciosas (CIBERINFEC) CB21/13/00044, (5) the National Agency for Scientific and Technology Promotion (ANPCyT) (PICT 2017 Nº713), and (6) the National Research Council (CONICET, PIP 2021-2023). V.C. received funding form the Asociación Universitaria Iberoamericana de Postgrado (AUIP) for the Academic Mobility Scholarship Program. P.V., E.D.M., and M.V.P. are members of the CONICET-Research Career Program. V.C. is a fellow from ANPCyT. The funder’s had no role in the study design, data collection and analysis, decision to publish, or the preparation of the manuscript.S

Применение оксидно-рутениевых титановых анодов, модифицированных сурьмой для очистки воды

Rationale: Unlike conventional dendritic cells, plasmacytoid DCs (PDC) are poor in antigen presentation and critical for type 1 interferon response. Though proposed to be present in human atherosclerotic lesions, their role in atherosclerosis remains elusive. Objective: To investigate the role of PDC in atherosclerosis. Methods and Results: We show that PDC are scarcely present in human atherosclerotic lesions and almost absent in mouse plaques. Surprisingly, PDC depletion by 120G8 mAb administration was seen to promote plaque T-cell accumulation and exacerbate lesion development and progression in LDLr(-/-) mice. PDC depletion was accompanied by increased CD4(+) T-cell proliferation, interferon-gamma expression by splenic T cells, and plasma interferon-gamma levels. Lymphoid tissue PDC from atherosclerotic mice showed increased indoleamine 2,3-dioxygenase (IDO) expression and IDO blockage abrogated the PDC suppressive effect on T-cell proliferation. Conclusions: Our data reveal a protective role for PDC in atherosclerosis, possibly by dampening T-cell proliferation and activity in peripheral lymphoid tissue, rendering PDC an interesting target for future therapeutic interventions. (Circ Res. 2011;109:1387-1395.

Severity-Related Changes of Bronchial Microbiome in Chronic Obstructive Pulmonary Disease

Bronchial colonization by potentially pathogenic microorganisms (PPMs) is often demonstrated in chronic obstructive pulmonary disease (COPD), but culture-based techniques identify only a portion of the bacteria in mucosal surfaces. The aim of the study was to determine changes in the bronchial microbiome of COPD associated with the severity of the disease. The bronchial microbiome of COPD patients was analyzed by 16S rRNA gene amplification and pyrosequencing in sputum samples obtained during stable disease. Seventeen COPD patients were studied (forced expiratory volume in the first second expressed as a percentage of the forced vital capacity [FEV1%] median, 35.0%; interquartile range [IQR], 31.5 to 52.0), providing a mean of 4,493 (standard deviation [SD], 2,598) sequences corresponding to 47 operational taxonomic units (OTUs) (SD, 17) at a 97% identity level. Patients were dichotomized according to their lung function as moderate to severe when their FEV1% values were over the median and as advanced when FEV1% values were lower. The most prevalent phyla in sputum were Proteobacteria (44%) and Firmicutes (16%), followed by Actinobacteria (13%). A greater microbial diversity was found in patients with moderate-to-severe disease, and alpha diversity showed a statistically significant decrease in patients with advanced disease when assessed by Shannon (ρ = 0.528; P = 0.029, Spearman correlation coefficient) and Chao1 (ρ = 0.53; P = 0.028, Spearman correlation coefficient) alpha-diversity indexes. The higher severity that characterizes advanced COPD is paralleled by a decrease in the diversity of the bronchial microbiome, with a loss of part of the resident flora that is replaced by a more restricted microbiota that includes PPMs

Factores que condicionan la recuperación del anciano con fractura de cadera

En el presente estudio se realiza una valoración de la influencia que diversos factores, relacionados con el paciente o propios de la fractura, tienen sobre el pronóstico vital y funcional del anciano con fractura de cadera. el estado de salud previo es el mayor condicionante del pronóstico vital y funcional. Demencia, ceguera, edad superior a ochenta y cinco años y aparición de complicaciones postoperatorias son también decisivos. La concurrencia de varios factores no determinantes puede ensombrecer igualmente el pronóstico de estos ancianos. Un conocimiento pormenorizado de estos factores, aplicando su valoración en el manejo y la elección terapéutica del anciano con fractura de cadera, es necesario para mejorar el pronóstico funcional y vital de estos pacientesIn this study, an assessment of the influence of different prognostic factors related to both the patient and the fracture type way conducted in terms of survival and functional recovery of older patients predicting survival and functional recovery. Demens blindness, age over 85 years and postoperative complications are abow crucial. The concomitant presence of several no-determinant factors seems to make worse the prognosis in these older patients. A comprehensive knowledge of all this factors in each case is necessary for a better therapeutic management of the patients in order to improve their functional recovery and surviva