Primeros auxilios en edad infantil

Se recogen los primeros auxilios básicos a llevar a cabo en la edad infantil.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Subtipado molecular del cáncer de mama masculino con PAM50: Correlación con el subtipaje inmunohistoquímico y estudio de supervivencia.

Introducción: El cáncer de mama masculino es una enfermedad rara aún poco conocida, que principalmente corresponde a subtipo luminal usando la clasificación molecular subrogada a inmunohistoquímica. En este estudio, se evalúa por primera vez la correlación entre los subtipos moleculares basados en un panel inmunohistoquímico de seis marcadores y el obtenido mediante la firma PAM50 en el cáncer de mama masculino, así como la evolución clínica de los diferentes subtipos encontrados. Material y métodos: Se recogieron 67 muestras quirúrgicas de cáncer de mama masculino invasivo de cuatro diferentes Servicios de Anatomía Patológica. La tinción inmunohistoquímica se realizó sobre tissue-microarrays, con un panel de seis marcadores (RE, RP, Her2, Ki67, CK 5-6 y EGFR). Los subtipos de PAM50 se determinaron mediante nCounter Analysis System. Se estudió la asociación entre los subtipos obtenidos mediante inmunohistoquímica y los determinados por PAM50, así como la supervivencia global y la supervivencia libre de enfermedad en los diferentes subtipos de cada clasificación. Resultados: La distribución de los subtipos moleculares tumorales según PAM50 fue: 60% luminal B, 30% luminal A y 10% Her2-enriched. Sólo uno de los tumores Her2-enriched también fue detectado por inmunohistoquímica y tratado con trastuzumab. No se obtuvo ningún tumor de subtipo basal-like. Utilizando la clasificación inmunohistoquímica, 51% de los tumores fueron luminal B, 43% luminal A, 3,5% triple negativo y 1,5% Her2-positivo. Las características clínico-patológicas no difirieron significativamente entre los subtipos inmunohistoquímicos y PAM50. Se observó una supervivencia global menor en los tumores Her2-enriched comparados con los luminales. Conclusión: El cáncer de mama masculino es principalmente una enfermedad genómica luminal con un predominio del subtipo luminal B. Además, se observaron casos de pacientes Her2-negativos por inmunohistoquímica, pero de perfil Her2-enriched por PAM50, con peor evolución clínica comparado con el subtipo luminal, que podrían haberse beneficiado de terapia anti-Her2.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Oligodendrocyte metabolism throughout its differentiation: immunocytochemistry study and its impact in remyelination

Introduction: Oligodendrocytes (OL) role in demyelinating pathologies such as multiple sclerosis and other neurodegenerative diseases is only recently being subject of extensive research. While the genetic and molecular aspects have been thoroughly studied, their metabolism was overshadowed. In order to develop new therapies to promote remyelination of already damaged axons, we need to accurately describe how OL metabolism affects axon myelination and trophic support (1). The objective of this study is to obtain cytological evidence of the extent of both glycolytic metabolism and oxidative phosphorylation by immunocytochemistry throughout the development of OL. Methods: Oligodendroglia cells from post-natal mice cortices were obtained and cultured. A wide assortment of differentiation-stage-specific cell surface antigens, a glycolytic and an oxidative phosphorylation marker were combined in several immunofluorescences to study both metabolic pathways in each step of differentiation. Results: After analysing them under confocal microscopy and imaging software, we observed a constant upregulation of glycolytic metabolism throughout differentiation, while oxidative phosphorylation seemed to increase with differentiation to then decrease when oligodendrocytes achieved their final maturation stage. Conclusions: Therefore, oxidative phosphorylation may be crucial in the differentiation of precursors and glycolysis would thus be the preferred metabolic pathway for fully matured OL. [1] Rosko L. et al. Neuroscientist. 2019;25(4):334–43.Supported by UMA and IBIMA and funding from two ongoing projects: - ‘Modulation of oligodendrocyte metabolism via blood vessel remodelling as target to promote remyelination’ (funding by NEURATRIS). - ‘Blood vessel remodelling modulates remyelination by oligodendrocyte metabolic reprogramming’ (funding by Arsep Foundation). Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tec

Gastrointestinal Stromal Tumor (GIST) and its relationship with germline mutations

We present the case of a 38-year-old man with a history of abdominal paraganglioma 10 years ago, who consulted for hematemesis and asthenia of 5 days' evolution. An upper gastrointestinal endoscopy was performed where a raised submucosal lesion, about 2 cm, with ulceration on its surface, was observed at the corporal-antral junction. The CT scan revealed nodular thickening of the gastric wall at the level of the lesser curvature. After the resolution of his hematemesis, it was decided to intervene on the patient, performing a partial gastrectomyUniversidad de Málaga. Campus de Excelencia Internacional Andalucía Tec

Acupuncture and rehabilitation of the painful shoulder: study protocol of an ongoing multicentre randomised controlled clinical trial [ISRCTN28687220]

BACKGROUND: Although the painful shoulder is one of the most common dysfunctions of the locomotor apparatus, and is frequently treated both at primary healthcare centres and by specialists, little evidence has been reported to support or refute the effectiveness of the treatments most commonly applied. According to the bibliography reviewed, physiotherapy, which is the most common action taken to alleviate this problem, has not yet been proven to be effective, because of the small size of sample groups and the lack of methodological rigor in the papers published on the subject. No reviews have been made to assess the effectiveness of acupuncture in treating this complaint, but in recent years controlled randomised studies have been made and these demonstrate an increasing use of acupuncture to treat pathologies of the soft tissues of the shoulder. In this study, we seek to evaluate the effectiveness of physiotherapy applied jointly with acupuncture, compared with physiotherapy applied with a TENS-placebo, in the treatment of painful shoulder caused by subacromial syndrome (rotator cuff tendinitis and subacromial bursitis). METHODS/DESIGN: Randomised controlled multicentre study with blind evaluation by an independent observer and blind, independent analysis. A study will be made of 465 patients referred to the rehabilitation services at participating healthcare centres, belonging to the regional public health systems of Andalusia and Murcia, these patients presenting symptoms of painful shoulder and a diagnosis of subacromial syndrome (rotator cuff tendinitis and subacromial bursitis). The patients will be randomised into two groups: 1) experimental (acupuncture + physiotherapy); 2) control (TENS-placebo + physiotherapy); the administration of rescue medication will also be allowed. The treatment period will have a duration of three weeks. The main result variable will be the change produced on Constant's Shoulder Function Assessment (SFA) Scale; as secondary variables, we will record the changes in diurnal pain intensity on a visual analogue scale (VAS), nocturnal pain intensity on the VAS, doses of non-steroid anti-inflammatory drugs (NSAIDs) taken during the study period, credibility scale for the treatment, degree of improvement perceived by the patient and degree of improvement perceived by the evaluator. A follow up examination will be made at 3, 6 and 12 months after the study period has ended. Two types of population will be considered for analysis: per protocol and per intention to treat. DISCUSSION: The discussion will take into account the limitations of the study, together with considerations such as the choice of a simple, safe method to treat this shoulder complaint, the choice of the control group, and the blinding of the patients, evaluators and those responsible for carrying out the final analysis

Implementation of virtual learning environments as a motivating strategy for the development of reading skills

El presente artículo presenta los resultados derivados del estudio Implementación de Ambientes virtuales de Aprendizaje como estrategia motivadora para el desarrollo de competencias lectoras. Además de analizar el uso de ambientes virtuales de aprendizaje como estrategia motivadora para el desarrollo de competencias lectoras, se proponen alternativas pertinentes para dinamizar los espacios de enseñanza-aprendizaje. La problemática general en las aulas de clases en torno al proceso de aprendizaje y en específico de las competencias lectoras de los estudiantes, promueve la búsqueda de caminos para el aprovechamiento y la estructuración de oportunidades para que el colectivo de docentes fortalezcna e innoven en sus prácticas pedagógicas y así generar mayor interés y motivación en ellos. La población objeto de estudio estuvo conformada por estudiantes de 9 grado de la Institución Educativa Néstor Andrés Rangel Alfaro. El estudio tuvo como propósito fomentar los ambientes virtuales de aprendizaje como una estrategia motivadora que fortalece el del desarrollo de las competencias lectorasThis article presents the results derived from the study Implementation of virtual learning environments as a motivating strategy for the development of reading skills; In addition to establishing how the use of virtual learning environments as a motivating strategy for the development of reading skills, it is relevant to boost the teaching-learning spaces. The general problems in the classroom around the learning process and specifically the reading skills of students, promotes the structuring of opportunities for teachers to strengthen and innovate in their pedagogical practices and thus generate greater interest and motivation in them. The population studied was made up of 9th grade students from the Néstor Andrés Rangel Alfaro Educational Institution. The purpose of the study was to promote virtual learning environments as a motivating strategy that strengthens the development of reading skills

Famílies botàniques de plantes medicinals

Facultat de Farmàcia, Universitat de Barcelona. Ensenyament: Grau de Farmàcia, Assignatura: Botànica Farmacèutica, Curs: 2013-2014, Coordinadors: Joan Simon, Cèsar Blanché i Maria Bosch.Els materials que aquí es presenten són els recull de 175 treballs d’una família botànica d’interès medicinal realitzats de manera individual. Els treballs han estat realitzat per la totalitat dels estudiants dels grups M-2 i M-3 de l’assignatura Botànica Farmacèutica durant els mesos d’abril i maig del curs 2013-14. Tots els treballs s’han dut a terme a través de la plataforma de GoogleDocs i han estat tutoritzats pel professor de l’assignatura i revisats i finalment co-avaluats entre els propis estudiants. L’objectiu principal de l’activitat ha estat fomentar l’aprenentatge autònom i col·laboratiu en Botànica farmacèutica

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

The Fifteenth Data Release of the Sloan Digital Sky Surveys: First Release of MaNGA-derived Quantities, Data Visualization Tools, and Stellar Library

Twenty years have passed since first light for the Sloan Digital Sky Survey (SDSS). Here, we release data taken by the fourth phase of SDSS (SDSS-IV) across its first three years of operation (2014 July–2017 July). This is the third data release for SDSS-IV, and the 15th from SDSS (Data Release Fifteen; DR15). New data come from MaNGA—we release 4824 data cubes, as well as the first stellar spectra in the MaNGA Stellar Library (MaStar), the first set of survey-supported analysis products (e.g., stellar and gas kinematics, emission-line and other maps) from the MaNGA Data Analysis Pipeline, and a new data visualization and access tool we call "Marvin." The next data release, DR16, will include new data from both APOGEE-2 and eBOSS; those surveys release no new data here, but we document updates and corrections to their data processing pipelines. The release is cumulative; it also includes the most recent reductions and calibrations of all data taken by SDSS since first light. In this paper, we describe the location and format of the data and tools and cite technical references describing how it was obtained and processed. The SDSS website (www.sdss.org) has also been updated, providing links to data downloads, tutorials, and examples of data use. Although SDSS-IV will continue to collect astronomical data until 2020, and will be followed by SDSS-V (2020–2025), we end this paper by describing plans to ensure the sustainability of the SDSS data archive for many years beyond the collection of data

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life