Sex and Gender Differences in Acute Stroke Care: Metrics, Access to Treatment and Outcome. A Territorial Analysis of the Stroke Code System of Catalonia

INTRODUCTION: Previous studies have reported differences in the management and outcome of women stroke patients in comparison with men. We aim to analyze sex and gender differences in the medical assistance, access to treatment and outcome of acute stroke patients in Catalonia. PATIENTS AND METHODS: Data were obtained from a prospective population-based registry of stroke code activations in Catalonia (CICAT) from January/2016 to December/2019. The registry includes demographic data, stroke severity, stroke subtype, reperfusion therapy, and time workflow. Centralized clinical outcome at 90 days was assessed in patients receiving reperfusion therapy. RESULTS: A total of 23,371 stroke code activations were registered (54% men, 46% women). No differences in prehospital time metrics were observed. Women more frequently had a final diagnosis of stroke mimic, were older and had a previous worse functional situation. Among ischemic stroke patients, women had higher stroke severity and more frequently presented proximal large vessel occlusion. Women received more frequently reperfusion therapy (48.2% vs 43.1%, DISCUSSION AND CONCLUSION: We found some differences by sex in that acute stroke was more frequent in older women and the stroke severity was higher. We found no differences in medical assistance times, access to reperfusion treatment and early complications. Worse clinical outcome at 90 days in women was conditioned by stroke severity and older age, but not by sex itself

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Multiancestry analysis of the HLA locus in Alzheimer’s and Parkinson’s diseases uncovers a shared adaptive immune response mediated by HLA-DRB1*04 subtypes

Across multiancestry groups, we analyzed Human Leukocyte Antigen (HLA) associations in over 176,000 individuals with Parkinson’s disease (PD) and Alzheimer’s disease (AD) versus controls. We demonstrate that the two diseases share the same protective association at the HLA locus. HLA-specific fine-mapping showed that hierarchical protective effects of HLA-DRB1*04 subtypes best accounted for the association, strongest with HLA-DRB1*04:04 and HLA-DRB1*04:07, and intermediary with HLA-DRB1*04:01 and HLA-DRB1*04:03. The same signal was associated with decreased neurofibrillary tangles in postmortem brains and was associated with reduced tau levels in cerebrospinal fluid and to a lower extent with increased Aβ42. Protective HLA-DRB1*04 subtypes strongly bound the aggregation-prone tau PHF6 sequence, however only when acetylated at a lysine (K311), a common posttranslational modification central to tau aggregation. An HLA-DRB1*04-mediated adaptive immune response decreases PD and AD risks, potentially by acting against tau, offering the possibility of therapeutic avenues

Papel de la vitamina B12 en la síntesis de carotenos regulada por la luz en Myxococcus xanthus / Mari Cruz Pérez Marín : directores, Montserrat Elías Arnanz, Francisco J. Murillo Araujo.

Tesis-Universidad de Murcia.Consulte la tesis en: BCA. GENERAL. ARCHIVO UNIVERSITARIO. T.M. 3424

The N terminus of Myxococcus xanthus CarA repressor is an autonomously folding domain that mediates physical and functional interactions with both operator DNA and antirepressor protein

11 pages, 9 figures, 1 table.-- PMID: 15163666 [PubMed].-- Printed version published Aug 6, 2004.-- Full-text version available Open Access at the journal site.Expression of the Myxococcus xanthus carB operon, which encodes the majority of the enzymes involved in light-induced carotenogenesis, is down-regulated in the dark by the CarA repressor binding to its bipartite operator. CarS, produced on illumination, relieves repression of carB by physically interacting with CarA to dis-mantle CarA-DNA complexes. Here, we demonstrate that the N- and C-terminal portions of CarA are organized as distinct structural and functional domains. Specifically, we show that the 78 N-terminal residues of CarA, CarA(Nter), form a monomeric, highly helical, autonomously folding unit with significant structural stability. Significantly, CarA(Nter) houses both the operator and CarS binding specificity determinants of CarA. CarA(Nter) binds operator with a lower affinity than whole CarA, and the CarA(Nter)-CarS complex has a 1:1 stoichiometry. In vitro, sufficiently high concentrations of CarA(Nter) block M. xanthus RNA polymerase-promoter binding, and this is relieved by CarS. In vivo, substitution of the gene carA by that for CarA(Nter) results in constitutive expression of carB just as in a carA-deleted background. However, re-engineering the latter strain to overexpress CarA(Nter) restores repression of carB. Thus, the 78-residue N-terminal portion of CarA is an autonomously folded, dual function domain that orchestrates specific DNA-protein and protein-protein interactions and, when overexpressed, can be functionally competent in vivo.This work was supported by Ministerio de Ciencia y Tecnología, Spain, Grants BMC2003-00658 (to F.J.M.) and BMC2002-00539 and Programa Ramón y Cajal (to S.P.). N.C.P.-M. was supported by a fellowship from the Ministerio de Educación, Cultura y Deportes (Spain). J.J.L.-R. was supported by a fellowship from Fundación Séneca (Murcia, Spain).Peer reviewe

Síndrome «humpy-backed» en cerdos en España

El síndrome «humpy-backed» fue descrito en cerdos por primera vez en el Reino Unido en 1984. El síndrome ha sido observado en algunos países pero la etiología y la patogenia son todavía desconocidas. Este caso describe la aparición de cerdos con «humpy-backed» en la lechonera de una granja de 3.800 cerdas situada en el noreste de España. El problema afectó aproximadamente al 3% de la progenie semanal de una línea genética particular de la granja compuesta por 450 cerdas. La incidencia alcanzó picos del 9-11% en algunas semanas. Los lechones aparecían deprimidos, con pelaje hirsuto y deterioro físico progresivo. En la necropsia, a pesar de la apariencia de lordosis, no se detectaron alteraciones en los huesos y articulaciones de la columna vertebral. Microscópicamente se observó periarteritis linfoplasmocítica en corazón, bazo, intestino, hígado, riñón, músculo esquelético, pulmón y meninges. También se observó miocarditis y miositis linfoplasmocítica con degeneración de fibras musculares esqueléticas. La apariencia macroscópica de lordosis se relacionó con infiltrado celular inflamatorio multiorgánico. Se asoció a un problema de tipo genético de los animales afectados, aunque podría haber una posible implicación de circovirus porcino tipo 2 (PCV2) y el virus del síndrome reproductivo y respiratorio porcino (PRRS) en la patogenia del síndrome, debido a la seropositividad frente a los mismos detectada en la granja.ABSTRACT: «Humpy-backed» pigs’ syndrome was firstly described in the United Kingdom in 1984. The syndrome has been reported in a few countries, but the ethiology and pathogenesis remains unclear. This report describes the appearance of «humpy-backed» piglets aetiology in the nursery of a 3800-sow farm in Northeast Spain. The problem affected around 3% of the weekly offspring from one particular genetic line present on the farm composed of 450 sows. The incidence reached peaks of 9-11% in some weeks. The piglets appeared depressed, with rough hair coat and progressive clinical deterioration. In the necropsy, despite the appearance of lordosis, no defect in the bones and joint of the vertebral spine were detected. Lympho-plasmacytic periarteritis was observed in heart, spleen, gut, liver, kidney, skeletal muscle, lung and meninges. Lympho-plasmacytic myocarditis and skeletal myositis with muscular fibre degeneration was also observed. The macroscopic appearance of lordosis was associated with a multiorganic inflammatory cell infiltration. There was an association with the genetic background of the affected animals although seropositivity to porcine circovirus type 2 (PCV2) and porcine reproductive and respiratory syndrome virus (PRRSV) was also found in the farm, pointing to a possible implication of viral infection in the pathogenesis of the syndrome

Risk of thrombosis according to need of phlebotomies in patients with polycythemia vera treated with hydroxyurea.

Hematocrit control below 45% is associated with a lower rate of thrombosis in polycythemia vera. In patients receiving hydroxyurea, this target can be achieved with hydroxyurea alone or with the combination of hydroxyurea plus phlebotomies. However, the clinical implications of phlebotomy requirement under hydroxyurea therapy are unknown. The aim of this study was to evaluate the need for additional phlebotomies during the first five years of hydroxyurea therapy in 533 patients with polycythemia vera. Patients requiring 3 or more phlebotomies per year (n=85, 16%) showed a worse hematocrit control than those requiring 2 or less phlebotomies per year (n=448, 84%). There were no significant differences between the two study groups regarding leukocyte and platelet counts. Patients requiring 3 or more phlebotomies per year received significantly higher doses of hydroxyurea than the remaining patients. A significant higher rate of thrombosis was found in patients treated with hydroxyurea plus 3 or more phlebotomies per year compared to hydroxyurea with 0-2 phlebotomies per year (20.5% vs. 5.3% at 3 years; P<0.0001). In multivariate analysis, independent risk factors for thrombosis were phlebotomy dependency (HR: 3.3, 95%CI: 1.5-6.9; P=0.002) and thrombosis at diagnosis (HR: 4.7, 95%CI: 2.3-9.8; P<0.0001). The proportion of patients fulfilling the European LeukemiaNet criteria of resistance/intolerance to hydroxyurea was significantly higher in the group requiring 3 or more phlebotomies per year (18.7% vs. 7.1%; P=0.001) mainly due to extrahematologic toxicity. In conclusion, phlebotomy requirement under hydroxyurea therapy identifies a subset of patients with increased proliferation of polycythemia vera and higher risk of thrombosis.This work was supported by a grant from the Instituto de Salud Carlos III, Spanish Health Ministry, PI13/00557, PI1300393. The GEMFIN received a grant from Novartis for the development of the Spanish Registry of Polycythemia Vera and for conducting the present project

Investigación educativa en las aulas de primaria

Reúne trabajos derivados de la experiencias de diversos docentes en educación primaria en los siguientes temas: Tecnología de Información y Comunicación, educación inclusiva, enseñanza de la música, educación física, enseñanza de la historia, acoso escolar, auto-evaluación, métodos de enseñanza, inteligencia emocional, percepción del alumno, marco cognitivo en comprensión lectora y comunicación escuela-familia