Paciente femenina de 58 años de edad con debilidad muscular progresiva de 6 meses de evolución

Muscle weakness is one of the most common disorders that presents in the family physician’s practice, especially in the elderly population but without discriminating the pediatric population. Although the cause of muscular weakness may be apparent in some patients, in others it has a doubtful etiology and it becomes a challenge for the doctor to look for its origin...La debilidad musculares uno de los trastornos más comunes que se presentan en la consulta de medicina familiar, especialmente en la población adulta mayor pero sin discriminar a la población pediátrica. Aunque la causa de debilidad muscular puede ser aparente en algunos pacientes, en otros presenta etiología dudosa y se vuelve un reto para el médico el buscar su origen..

Nuevas formas de gestión indirecta de los servicios públicos : especial mención a la legislación de contratos

Treball Final de Grau en Dret. Codi: DR1052. Curs: 2020/2021El objeto del presente trabajo va a ser el estudio de las nuevas formas de gestión indirecta de los servicios públicos, centrándose especialmente en delimitar las formas contractuales configuradas en la Ley 9/2017, de 8 de noviembre, de Contratos del Sector Público ya que ofrece una «nueva» regulación un tanto confusa e incompleta, cuya necesidad ha sido muy criticada por la doctrina española. El punto de partida va a ser el estudio del servicio público, concepto esencial para entender las distintas formas de gestión y cuya explicación se va a desarrollar en el segundo título. El servicio público como actividad prestacional de la administración, junto a la acción de policía y de fomento, constituye un medio idóneo para hacer efectivos y ampliar los derechos de los ciudadanos, en el marco del Estado de bienestar. Se trata de un concepto histórico que, teniendo su origen en el ámbito local, ha evolucionado y se ha ampliado en gran medida hasta hoy.This work will focus on the study of new forms of indirect management of public services, focusing especially on delimiting the contractual forms set out in Law 9/2017, of November 8, on Public Sector Contracts (LCSP en ahead) as it offers a somewhat confusing and incomplete "new" regulation, the need for which has been widely criticized by Spanish doctrine

Relationship between chewing side preference and handedness and lateral asymmetry of peripheral factors

Objective: To determine whether chewing side preference is related to handedness and lateral asymmetry of occlusal characteristics, muscular force and temporomandibular disorders (TMD) in a dentate population. Design: One hundred and seventeen dentate adults participated in this cross-sectional study. Static and dynamic occlusal characteristics were determined at the maximal intercuspal position and at the lateral excursions by scanning interocclusal records and analysing them using image software. Unilateral maximum bite force and finger-thumb grip force were measured by means of a gnathodynamometer. TMD were assessed according to the Research Diagnostic Criteria for TMD. Chewing side preference and masticatory laterality were determined by observing the jaw's movement while each subject chewed silicone. Asymmetry or side difference of the variables was calculated. Correlation between side difference variables and masticatory laterality was studied using Spearman correlation coefficient. Results: Fifty-nine subjects chewed on the right, 15 on the left and 43 chewed on both sides. There was no relationship between preferred chewing side and handedness, lateral asymmetry of TMD or side difference in finger-thumb grip force. Significant and positive correlations were observed between masticatory laterality and side differences in bite force and side differences in occlusal contact area at intercuspal position (P<0.01). Conclusions: Chewing side preference in a dentate population is related to lateral asymmetry of bite force and asymmetry of occlusal contact area at the intercuspal position but not to handedness

Making sense of metabolomic data: comprehensive analysis of altered metabolic pathways in diabetes and obesity

Podeu consultar el III Workshop anual INSA-UB complet a: http://hdl.handle.net/2445/118993Sessió 1. Pòster núm.

Metabolomic insights into the intricate gut microbial-host interaction in the development of obesity and type 2 diabetes

Gut microbiota has recently been proposed as a crucial environmental factor in the development of metabolic diseases such as obesity and type 2 diabetes, mainly due to its contribution in the modulation of several processes including host energy metabolism, gut epithelial permeability, gut peptide hormone secretion, and host inflammatory state. Since the symbiotic interaction between the gut microbiota and the host is essentially reflected in specific metabolic signatures, much expectation is placed on the application of metabolomic approaches to unveil the key mechanisms linking the gut microbiota composition and activity with disease development. The present review aims to summarize the gut microbialhost co-metabolites identified so far by targeted and untargeted metabolomic studies in humans, in association with impaired glucose homeostasis and/or obesity. An alteration of the co-metabolism of bile acids, branched fatty acids, choline, vitamins (i.e., niacin), purines, and phenolic compounds has been associated so far with the obese or diabese phenotype, in respect to healthy controls. Furthermore, anti-diabetic treatments such as metformin and sulfonylurea have been observed to modulate the gut microbiota or at least their metabolic profiles, thereby potentially affecting insulin resistance through indirect mechanisms still unknown. Despite the scarcity of the metabolomic studies currently available on the microbialhost crosstalk, the data-driven results largely confirmed findings independently obtained from in vitro and animal model studies, putting forward the mechanisms underlying the implication of a dysfunctional gut microbiota in the development of metabolic disorders

Evaluation and comparison of bioinformatic tools for the enrichment analysis of metabolomics data

Background: Bioinformatic tools for the enrichment of 'omics' datasets facilitate interpretation and understanding of data. To date few are suitable for metabolomics datasets. The main objective of this work is to give a critical overview, for the first time, of the performance of these tools. To that aim, datasets from metabolomic repositories were selected and enriched data were created. Both types of data were analysed with these tools and outputs were thoroughly examined. Results: An exploratory multivariate analysis of the most used tools for the enrichment of metabolite sets, based on a non-metric multidimensional scaling (NMDS) of Jaccard's distances, was performed and mirrored their diversity. Codes (identifiers) of the metabolites of the datasets were searched in different metabolite databases (HMDB, KEGG, PubChem, ChEBI, BioCyc/HumanCyc, LipidMAPS, ChemSpider, METLIN and Recon2). The databases that presented more identifiers of the metabolites of the dataset were PubChem, followed by METLIN and ChEBI. However, these databases had duplicated entries and might present false positives. The performance of over-representation analysis (ORA) tools, including BioCyc/HumanCyc, ConsensusPathDB, IMPaLA, MBRole, MetaboAnalyst, Metabox, MetExplore, MPEA, PathVisio and Reactome and the mapping tool KEGGREST, was examined. Results were mostly consistent among tools and between real and enriched data despite the variability of the tools. Nevertheless, a few controversial results such as differences in the total number of metabolites were also found. Disease-based enrichment analyses were also assessed, but they were not found to be accurate probably due to the fact that metabolite disease sets are not up-to-date and the difficulty of predicting diseases from a list of metabolites. Conclusions: We have extensively reviewed the state-of-the-art of the available range of tools for metabolomic datasets, the completeness of metabolite databases, the performance of ORA methods and disease-based analyses. Despite the variability of the tools, they provided consistent results independent of their analytic approach. However, more work on the completeness of metabolite and pathway databases is required, which strongly affects the accuracy of enrichment analyses. Improvements will be translated into more accurate and global insights of the metabolome

Metabolomics-guided insights on bariatric surgery versus behavioral interventions for weight loss.

Despite evidence to support their utility, lifestyle-based strategies for weight loss and treatment of obesity (i.e., based on diet and physical activity) have met so far with little success in the long term in terms of permanent weight loss (1). Bariatric surgery is the only current treatment for obesity leading to sustained weight loss (2) and to improvements in glucose regulation, up to a complet

Luminiscent and Magnetic Tb-MOF Flakes Deposited on Silica

The synthesis of a terbium-based 2D metal-organic framework (MOF), of formula [Tb(MeCOO)(PhCOO)2] (1), a crystalline material formed by neutral nanosheets held together by Van der Waals interactions, is presented. The material can be easily exfoliated by sonication and deposited onto different substrates. Uniform distributions of Tb-2D MOF flakes onto silicon were obtained by spin-coating. We report the luminescent and magnetic properties of the deposited flakes compared with those of the bulk. Complex 1 is luminescent in the visible and has a sizeable quantum yield of QY = 61% upon excitation at 280 nm. Photoluminescence measurements performed using a micro-Raman set up allowed us to characterize the luminescent spectra of individual flakes on silicon. Magnetization measurements of flakes-on-silicon with the applied magnetic field in-plane and out-of-plane display anisotropy. Ac susceptibility measurements show that 1 in bulk exhibits field-induced slow relaxation of the magnetization through two relaxation paths and the slowest one, with a relaxation time of tlf ⇡ 0.5 s, is assigned to a direct process mechanism. The reported exfoliation of lanthanide 2D-MOFs onto substrates is an attractive approach for the development of multifunctional materials and devices for different applications

Metabotypes of response to bariatric surgery independent of the magnitude of weight loss

Objective Bariatric surgery is considered the most efficient treatment for morbid obesity and its related diseases. However, its role as a metabolic modifier is not well understood. We aimed to determine biosignatures of response to bariatric surgery and elucidate short-term metabolic adaptations. Methods We used a LC- and FIA-ESI-MS/MS approach to quantify acylcarnitines, (lyso)phosphatidylcholines, sphingomyelins, amino acids, biogenic amines and hexoses in serum samples of subjects with morbid obesity (n = 39) before and 1, 3 and 6 months after bariatric surgery. K-means cluster analysis allowed to distinguish metabotypes of response to bariatric surgery. Results For the first time, global metabolic changes following bariatric surgery independent of the baseline health status of the subjects have been revealed. We identify two metabolic phenotypes (metabotypes) at the interval 6 months-baseline after surgery, which presented differences in the levels of compounds of urea metabolism, gluconeogenic precursors and (lyso)phospholipid particles. Clinically, metabotypes were different in terms of the degree of improvement in insulin resistance, cholesterol, low-density lipoproteins and uric acid independent of the magnitude of weight loss. Conclusions This study opens new perspectives and new hypotheses on the metabolic benefits of bariatric surgery and understanding of the biology of obesity and its associated diseases

Characterization of metabolomic profile associated with metabolic improvement after bariatric surgery in subjects with morbid obesity

The exact impact of bariatric surgery in metabolically 'healthy' (MH) or 'unhealthy' (MU) phenotypes for the study of the metabolic improvement is still unknown. We applied an untargeted LC-ESI-TripleTOF-MS-driven metabolomics approach in serum samples from 39 patients with morbid obesity (MH and MU) 1, 3, and 6 months after bariatric surgery. Multiple factor analysis, along with correlation and enrichment analyses, was carried out to distinguish those metabolites associated with metabolic improvement. Hydroxypropionic acids, medium-/long-chain hydroxy fatty acids, and bile acid glucuronides were the most discriminative biomarkers of response between MH and MU phenotypes. Hydroxypropionic (hydroxyphenyllactic-related) acids, amino acids, and glycerolipids were the most significant clusters of metabolites altered after bariatric surgery in MU ( p < 0.001). After surgery, MU and MH changed toward a common metabolic state 3 months after surgery. We observed a negative correlation with changes in waist circumference and cholesterol levels with metabolites of lipid metabolism. Glycemic variables were correlated with hexoses, which, in turn, correlated with gluconic acid and amino acid metabolism. Finally, we noted that hydroxyphenyllactic acid was associated with amino acid and lipid metabolism. Microbial metabolism of amino acid and BA glucuronidation pathways may be the key points of metabolic rearrangement after surgery