Biodiversidad de plantas vasculares en cuatro dehesas mediterráneas bajo un gradiente climático

El sistema dehesa proporciona valiosos servicios ambientales, entre ellos la biodiversidad. El objetivo de este trabajo es actualizar y comprender la información de riqueza de plantas vasculares en el hábitat dehesa. Se seleccionaron cuatro municipios a lo largo de un gradiente climático y florístico, representando tres tipos climáticos de dehesa. Dentro de cada uno se muestrearon tres mesohábitats frecuentes del paisaje dehesa: la dehesa pura, en abandono y con influencia de agua superficial. En definitiva, se muestrearon 12 parcelas para calcular la riqueza de especies y la similitud florística entre mesohábitats y tipos de dehesa. La ?-diversidad media de los mesohábitats fue 75,6 especies, y la media para cada tipo de dehesa fue 146,3. La ?-diversidad evaluada para el hábitat dehesa en conjunto fue de 340 especies. No se encontraron diferencias en la riqueza de especies entre los tipos de dehesa, pero sí se observó que el mesohábitat dehesa pura fue significativamente menos diverso que las otras. Los resultados de similitud mostraron un gradiente climático y biogeográfico entre los tres tipos de dehesa lo que resalta la importancia de considerar todo el rango de distribución de este hábitat en las acciones de conservación de flora y fauna de las dehesas

Gut Microbiota and Bariatric Surgery

The gut microbiota comprise all the living organisms in our intestine. Microbiota has key roles in metabolic homeostasis, digestion and nutrient metabolism protection against pathogens or modulation of the immune system. Advances in techniques such as metagenomics or metabolomics have expanded our knowledge of the intestinal ecosystem. Beyond genetic, behavioral, or environmental factors, alterations of gut microbiota parameters such as composition, diversity, or metabolites including short-chain fatty acids, have shown to be associated with cardiovascular comorbidities. In this chapter, we described the role of the gut microbiota in obesity and type 2 diabetes pathophysiology, and the changes it undergoes during bariatric surgery, as well as explored the possibilities of modifying the microbiome to obtain potential clinical benefits

Planeamiento estratégico del sector salud

El planeamiento estratégico propuesto tiene como objetivo analizar y comprender el funcionamiento actual de la salud y su ecosistema en el Perú, evaluando los principales factores que impactan sobre la salud en la población y proponiendo estrategias que permitan posicionar la salud en el país como un referente internacional de acuerdo a la visión establecida. Así mismo, para determinar las estrategias, es necesario analizar la interrelación de los factores internos y externos, fortalezas, oportunidades, debilidades y amenazas que conducen al sector, que lleven a la salud hacia la universalidad, contando con un servicio de calidad, oportuno y que atienda de manera descentralizada a toda la población. La salud es una prioridad y se busca su universalidad, sin embargo, deberá haber estrategias convergentes que mejoren las vías de comunicación y que a su vez permitan el desarrollo sostenible de la infraestructura en salud. El Perú hoy en día se encuentra en una posición privilegiada con respecto a otros países del globo terrestre. Este fenómeno de transición demográfica llamado “bono demográfico” le da la oportunidad al Perú de maximizar el potencial productivo y mejorar la economía del país, en este sentido, la salud toma un rol fundamental, si las personas no están saludables, no podrán volcar esa productividad hacia el país, y si esa productividad no se da, el Perú no aprovechará uno de los grandes momentos históricos que tiene para el desarrollo del mismo. Es por esto que una planificación estratégica formal del sector deberá permitirle al país salir de este círculo vicioso, y tomar un aprovechamiento definitivo de los recursos humanos, quienes serán los principales protagonistas del crecimiento del Perú.The main objective of the proposed strategic plan is to analyze and understand the current operation and environment of the health sector in Peru, evaluating the main factors that impact on population´s health, and proposing strategies to position Peruvian health sector, as an international reference in accordance with the established vision. To determine strategies is necessary to analyze the interplay of internal and external factors, strengths, weaknesses, opportunities and threats, that lead the health sector and that allow the universality of the health services with quality, effectiveness, timely and decentralized. Health is a priority and seeks its universality; however, convergent strategies to improve the lines of communication must be generated to get in turn the sustainable development of the health infrastructure. Peru is in a privileged position compared to other countries of the globe, due to the demographic transition phenomenon called "demographic bonus”, which gives the chance to maximize the productive potential and improve the country's economy. Health plays a vital role in this regard, if people are not healthy, their productivity will not dump into the economy, also without productivity, Peru will not leverage one of the great historical moments that have as an opportunity for development. Consequently, a formal strategic planning focused on the health sector, will enable the country to get out from the vicious circle in which is immersed, and maximize the utilization of human resources, who are the main protagonists of the growth in Peru.Tesi

ATEROGENESIS

La aterosclerosis humana es un proceso patológico complejo, de causa multifactorial, compuesto de dos fenómenos estrechamente relacionados: la aterosis, que se caracteriza por la acumulación de lípidos tanto intra como extracelularmente y que incluye la formación de las llamadas células espumosas y reacción inflamatoria; y la esclerosis, que es el endurecimiento cicatrizal de la pared arterial, caracterizado por el incremento de miocitos, distrofia de la matriz extracelular, calcificación, necrobiosis y mayor reacción inflamatoria. El endotelio es quizá el órgano más grande del cuerpo con funciones endócrinas, autócrinas y parácrinas. Realiza varias funciones, entre las que se hallan, la regulación del intercambio de moléculas entre la sangre y la pared vascular; controla el tono vascular a través del óxido nítrico y la prostaglandina I2, causando relajación del músculo liso vascular, así como también, desarrolla funciones antitrombóticas-fibrinolíticas entre otras. Un factor fundamental en la aterosclerosis es la disfunción endotelial, cuyo aspecto clave es la disminución del óxido nítrico, la cual pudiera deberse a un aumento en su degradación metabólica ó bien, a una reducción en su síntesis. De igual importancia es la participación de las lipoproteínas de baja densidad (LDL), que en condiciones de disfunción endotelial, permanecen un tiempo mayor en el espacio subendotelial, donde son oxidadas (modificadas),originando las LDL mínimamente modificadas (MM-LDL).Las células que participan directamente en la formación de la placa ateromatosa son los monocitos, que al madurar en el espacio subendotelial se convierten en macrófagos. Por otro lado, las MM-LDL se exponen a un mayor grado de oxidación y son capaces de estimular ó activar al macrófago, el cual, al no contar con un mecanismo que limite la entrada de colesterol, degrada pobremente a las LDL oxidadas. A consecuencia de la incorporación no controlada de colesterol, el macrófago se ceba y se convierte en una célula espumosa, la cual al morir, los lípidos restantes formarán el núcleo ateromatoso junto con sustancias tóxicas, las que lesionarán al endotelio, que pasa de presentar una disfunción sin anomalías morfológicas hasta ser un endotelio dañado, que en algunas zonas puede inclusive, ser destruido y desaparecer. La exposición de este endotelio no funcional a la sangre del colágeno subyacente, estimula la adhesión plaquetaria, las que en conjunto con los macrófagos secretan factores de crecimiento, que terminan por estimular la proliferación y migración de células musculares lisas de la capa media.Palabras claves: aterogenesis, ateroma, aterosclerosis humanaatherogenesis, atheroma, human atherosclerosi

Genomics of Serratia marcescens isolates causing outbreaks in the same pediatric unit 47 years apart: Position in an updated phylogeny of the species

The first documented nosocomial outbreak caused by Serratia marcescens in Spain occurred in 1969 at the neonatal intensive care unit (NICU) of the tertiary La Paz Children’s Hospital in Madrid, Spain, and based on the available phenotyping techniques at this time, it was considered as a monoclonal outbreak. Only 47 years later, another S. marcescens outbreak of an equivalent dimension occurred at the same NICU. The aim of the present study was to study isolates from these historical and contemporary outbreaks by phenotypic analysis and whole-genome sequencing techniques and to position these strains along with 444 publicly available S. marcescens genomes, separately comparing core genome and accessory genome contents. Clades inferred by both approaches showed high correlation, indicating that core and accessory genomes seem to evolve in the same manner for S. marcescens. Nine S. marcescens clusters were identified, and isolates were grouped in two of them according to sampling year. One exception was isolate 13F-69, the most genetically distant strain, located in a different cluster. Categorical functions in the annotated accessory genes of both collections were preserved among all isolates. No significant differences in frequency of insertion sequences in historical (0.18–0.20)—excluding the outlier strain—versus contemporary isolates (0.11–0.19) were found despite the expected resting effect. The most dissimilar isolate, 13F-69, contains a highly preserved plasmid previously described in Bordetella bronchiseptica. This strain exhibited a few antibiotic resistance genes not resulting in a resistant phenotype, suggesting the value of gene down expression in adaptation to long-term starvation.CS was supported by “Fundación Mutua Madrileña” grant to RC achieved in 2017 call with reference number AP165902017. MP-A was supported by the Programa Operativo de Empleo Juvenil, cofinanced by the European Social Fund Investing in your future (ESF) and ERDF (PEJD-2018-PRE/BMD-8237). BP-V was funded by H2020 FTIPilot 2016 project no. 730713 “FAST-bact “A novel fast and automated test for antibiotic susceptibility testing for Gram positive and negative bacteria” and co-funded by Instituto de Salud Carlos III and the European Regional Development Fund (ERDF, “A way to achieve Europe”). FB was supported by grants from the Madrid Regional Government (InGEMICS-C; S2017/BMD-3691) and CIBER (CIBER in Epidemiology and Public Health, CIBERESP; CB06/02/0053), co-funded by Instituto de Salud Carlos III and the European Regional Development Fund (ERDF, “A way to achieve Europe”). This work was supported by the Instituto de Salud Carlos III, PI17/00115 (RC), and REIPI (RD16/0016/0011) actions, cofinanced by the European Development Regional Fund “A way to achieve Europe” (ERDF

Fecal Metabolome and Bacterial Composition in Severe Obesity:Impact of Diet and Bariatric Surgery

The aim of this study was to monitor the impact of a preoperative low-calorie diet and bariatric surgery on the bacterial gut microbiota composition and functionality in severe obesity and to compare sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB). The study also aimed to incorporate big data analysis for the omics results and machine learning by a Lasso-based analysis to detect the potential markers for excess weight loss. Forty patients who underwent bariatric surgery were recruited (14 underwent SG, and 26 underwent RYGB). Each participant contributed 4 fecal samples (baseline, post-diet, 1 month after surgery and 3 months after surgery). The bacterial composition was determined by 16S rDNA massive sequencing using MiSeq (Illumina). Metabolic signatures associated to fecal concentrations of short-chain fatty acids, amino acids, biogenic amines, gamma-aminobutyric acid and ammonium were determined by gas and liquid chromatography. Orange 3 software was employed to correlate the variables, and a Lasso analysis was employed to predict the weight loss at the baseline samples. A correlation between Bacillota (formerly Firmicutes) abundance and excess weight was observed only for the highest body mass indexes. The low-calorie diet had little impact on composition and targeted metabolic activity. RYGB had a deeper impact on bacterial composition and putrefactive metabolism than SG, although the excess weight loss was comparable in the two groups. Significantly higher ammonium concentrations were detected in the feces of the RYGB group. We detected individual signatures of composition and functionality, rather than a gut microbiota characteristic of severe obesity, with opposing tendencies for almost all measured variables in the two surgical approaches. The gut microbiota of the baseline samples was not useful for predicting excess weight loss after the bariatric process

Sex as a prognostic factor for mortality in critically ill adults with sepsis: a systematic review and meta-analysis.

Objective To assess the role of sex as an independent prognostic factor for mortality in patients with sepsis admitted to intensive care units (ICUs). Design Systematic review and meta-analysis. Data sources MEDLINE, Embase, Web of Science, ClinicalTrials. gov and the WHO Clinical Trials Registry from inception to 17 July 2020. Study selection Studies evaluating independent associations between sex and mortality in critically ill adults with sepsis controlling for at least one of five core covariate domains prespecified following a literature search and consensus among experts. Data extraction and synthesis Two authors independently extracted and assessed the risk of bias using Quality In Prognosis Studies tool. Meta-analysis was performed by pooling adjusted estimates. The Grades of Recommendations, Assessment, Development and Evaluation approach was used to rate the certainty of evidence. Results From 14 304 records, 13 studies (80 520 participants) were included. Meta-analysis did not find sex-based differences in all-cause hospital mortality (OR 1.02, 95% CI 0.79 to 1.32; very low-certainty evidence) and all-cause ICU mortality (OR 1.19, 95% CI 0.79 to 1.78; very low-certainty evidence). However, females presented higher 28-day all-cause mortality (OR 1.18, 95% CI 1.05 to 1.32; very low-certainty evidence) and lower 1-year all-cause mortality (OR 0.83, 95% CI 0.68 to 0.98; low-certainty evidence). There was a moderate risk of bias in the domain adjustment for other prognostic factors in six studies, and the certainty of evidence was further affected by inconsistency and imprecision. Conclusion The prognostic independent effect of sex on all-cause hospital mortality, 28-day all-cause mortality and all-cause ICU mortality for critically ill adults with sepsis was uncertain. Female sex may be associated with decreased 1-year all-cause mortality.post-print1281 K

Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Meta-Analysis of Treatment Outcome and Predictors of Response

Background Deep brain stimulation (DBS) has been proposed as an alternative to ablative neurosurgery for severe treatment-resistant Obsessive-Compulsive Disorder (OCD), although with partially discrepant results probably related to differences in anatomical targetting and stimulation conditions. We sought to determine the efficacy and tolerability of DBS in OCD and the existence of clinical predictors of response using meta-analysis. Methods We searched the literature on DBS for OCD from 1999 through January 2014 using PubMed/MEDLINE and PsycINFO. We performed fixed and random-effect meta-analysis with score changes (pre-post DBS) on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) as the primary-outcome measure, and the number of responders to treatment, quality of life and acceptability as secondary measures. Findings Thirty-one studies involving 116 subjects were identified. Eighty-three subjects were implanted in striatal areas anterior limb of the internal capsule, ventral capsule and ventral striatum, nucleus accumbens and ventral caudate 27 in the subthalamic nucleus and six in the inferior thalamic peduncle. Global percentage of Y-BOCS reduction was estimated at 45.1% and global percentage of responders at 60.0%. Better response was associated with older age at OCD onset and presence of sexual/religious obsessions and compulsions. No significant differences were detected in efficacy between targets. Five patients dropped out, but adverse effects were generally reported as mild, transient and reversible. Conclusions Our analysis confirms that DBS constitutes a valid alternative to lesional surgery for severe, therapy-refractory OCD patients. Well-controlled, randomized studies with larger samples are needed to establish the optimal targeting and stimulation conditions and to extend the analysis of clinical predictors of outcome

Recent advances in the application of stable isotopes as nutritional tools in aquaculture

From an ecological point of view, aquaculture systems consist of simple food webs having a limited number of nutritional sources. These characteristics facilitate the application of stable isotope ratios of carbon and nitrogen (δ13C and δ15N) to assess the flow of dietary components. Due to rapid and measurable bioaccumulation of the heavier stable isotopes, such isotopic shifts can be tracked at different times and at each trophic step to provide an indicator of what dietary components are being incorporated into animal tissue and how fast. The present manuscript presents results from recent, controlled nutritional experiments designed to quantify the relative contribution of dietary carbon and nitrogen supplied by different dietary items. Stable isotopes ratios were measured in a range of food sources and experimental animals. In a first experiment, juvenile shrimp Litopenaeus vannamei were reared on co-feeding regimes having different proportions of live biomass of the green macroalgae Ulva clathrata and inert feed in order to identify nutritional contributions to tissue growth using dual stable isotope analysis. In another trial, nitrogen stable isotopes were measured to explore the relative dietary nitrogen contributions from fish meal and pea meal (Pisum sativum) to the growth of white shrimp postlarvae fed low protein diets having different proportions of both ingredients. In a third, multidisciplinary experiment, Senegalese sole (Solea senegalensis) larvae were used as a model to evaluate the effect of different larval feeding regimes on (1) trypsinogen gene expression (ssetryp1), (2) trypsin and chymotrypsin activities and (3) changes in stable isotope composition to estimate the assimilation of dietary carbon from the larval diets