Usefulness of multidetector computed tomography to differentiate between renal cell carcinoma and oncocytoma. A model validation

OBJECTIVE: The purpose of this study is to validate a multivariable predictive model previously developed to differentiate between renal cell carcinoma (RCC) and oncocytoma using CT parameters. METHODS AND MATERIALS: We included 100 renal lesions with final diagnosis of RCC or oncocytoma studied before surgery with 4-phase multidetector CT (MDCT). We evaluated the characteristics of the tumors and the enhancement patterns at baseline, arterial, nephrographic and excretory MDCT phases. RESULTS: Histopathologically 15 tumors were oncocytomas and 85 RCCs. RCCs were significantly larger (median 4.4 cm vs 2.8 cm, p = 0.006). There were significant differences in nodule attenuation in the excretory phase compared to baseline (median: 31 vs 42, p = 0.015), with RCCs having lower values. Heterogeneous enhancement patterns were also more frequent in RCCs (85.9% vs 60%, p = 0.027).Multivariable analysis showed that the independent predictors of malignancy were the enhancement pattern, with oncocytomas being more homogeneous in the nephrographic phase [Odds Ratio (OR) 0.16 (95% CI 0.03 to 0.75, p = 0.02)], nodule enhancement in the excretory phase compared to baseline, with RCCs showing lower enhancement [OR 0.96 (95% CI 0.93 to 0.99, p = 0.005)], and a size > 4 cm, with RCCs being larger [OR 5.89 (95% CI 1.10 to 31.58), p = 0.038]. CONCLUSION: The multivariable predictive model previously developed which combines different MDCT parameters, including lesion size > 4 cm, lesion enhancement in the excretory phase compared to baseline and enhancement heterogeneity, can be successfully applied to distinguish RCC from oncocytoma. ADVANCES IN KNOWLEDGE: This study confirms that multiparametric assessment using MDCT (including parameters such as size, homogeneity and enhancement differences between the excretory and the baseline phases) can help distinguish between RCCs and oncocytomas. While it is true that this multiparametric predictive model may not always correctly classify renal tumors such as RCC or oncocytoma, it can be used to determine which patients would benefit from pre-surgical biopsy to confirm that the tumor is in fact an oncocytoma, and thereby avoid unnecessary surgical treatments

Synthetic RGB photometry of bright stars: definition of the standard photometric system and UCM library of spectrophotometric spectra

Although the use of RGB photometry has exploded in the last decades due to the advent of high-quality and inexpensive digital cameras equipped with Bayer-like color filter systems, there is surprisingly no catalogue of bright stars that can be used for calibration purposes. Since due to their excessive brightness, accurate enough spectrophotometric measurements of bright stars typically cannot be performed with modern large telescopes, we have employed historical 13-color medium-narrow-band photometric data, gathered with quite reliable photomultipliers, to fit the spectrum of 1346 bright stars using stellar atmosphere models. This not only constitutes a useful compilation of bright spectrophotometric standards well spread in the celestial sphere, the UCM library of spectrophotometric spectra, but allows the generation of a catalogue of reference RGB magnitudes, with typical random uncertainties $\sim 0.01$ mag. For that purpose, we have defined a new set of spectral sensitivity curves, computed as the median of 28 sets of empirical sensitivity curves from the literature, that can be used to establish a standard RGB photometric system. Conversions between RGB magnitudes computed with any of these sets of empirical RGB curves and those determined with the new standard photometric system are provided. Even though particular RGB measurements from single cameras are not expected to provide extremely accurate photometric data, the repeatability and multiplicity of observations will allow access to a large amount of exploitable data in many astronomical fields, such as the detailed monitoring of light pollution and its impact on the night sky brightness, or the study of meteors, solar system bodies, variable stars, and transient objects. In addition, the RGB magnitudes presented here make the sky an accessible and free laboratory for the calibration of the cameras themselves.Comment: 19 pages, 18 figures, 7 tables. Accepted for publication in MNRA

Safety and immunogenicity of the protein-based PHH-1V compared to BNT162b2 as a heterologous SARS-CoV-2 booster vaccine in adults vaccinated against COVID-19 : a multicentre, randomised, double-blind, non-inferiority phase IIb trial

A SARS-CoV-2 protein-based heterodimer vaccine, PHH-1V, has been shown to be safe and well-tolerated in healthy young adults in a first-in-human, Phase I/IIa study dose-escalation trial. Here, we report the interim results of the Phase IIb HH-2, where the immunogenicity and safety of a heterologous booster with PHH-1V is assessed versus a homologous booster with BNT162b2 at 14, 28 and 98 days after vaccine administration. The HH-2 study is an ongoing multicentre, randomised, active-controlled, double-blind, non-inferiority Phase IIb trial, where participants 18 years or older who had received two doses of BNT162b2 were randomly assigned in a 2:1 ratio to receive a booster dose of vaccine-either heterologous (PHH-1V group) or homologous (BNT162b2 group)-in 10 centres in Spain. Eligible subjects were allocated to treatment stratified by age group (18-64 versus ≥65 years) with approximately 10% of the sample enrolled in the older age group. The primary endpoints were humoral immunogenicity measured by changes in levels of neutralizing antibodies (PBNA) against the ancestral Wuhan-Hu-1 strain after the PHH-1V or the BNT162b2 boost, and the safety and tolerability of PHH-1V as a boost. The secondary endpoints were to compare changes in levels of neutralizing antibodies against different variants of SARS-CoV-2 and the T-cell responses towards the SARS-CoV-2 spike glycoprotein peptides. The exploratory endpoint was to assess the number of subjects with SARS-CoV-2 infections ≥14 days after PHH-1V booster. This study is ongoing and is registered with , . From 15 November 2021, 782 adults were randomly assigned to PHH-1V (n = 522) or BNT162b2 (n = 260) boost vaccine groups. The geometric mean titre (GMT) ratio of neutralizing antibodies on days 14, 28 and 98, shown as BNT162b2 active control versus PHH-1V, was, respectively, 1.68 (p < 0.0001), 1.31 (p = 0.0007) and 0.86 (p = 0.40) for the ancestral Wuhan-Hu-1 strain; 0.62 (p < 0.0001), 0.65 (p < 0.0001) and 0.56 (p = 0.003) for the Beta variant; 1.01 (p = 0.92), 0.88 (p = 0.11) and 0.52 (p = 0.0003) for the Delta variant; and 0.59 (p ≤ 0.0001), 0.66 (p < 0.0001) and 0.57 (p = 0.0028) for the Omicron BA.1 variant. Additionally, PHH-1V as a booster dose induced a significant increase of CD4 + and CD8 + T-cells expressing IFN-γ on day 14. There were 458 participants who experienced at least one adverse event (89.3%) in the PHH-1V and 238 (94.4%) in the BNT162b2 group. The most frequent adverse events were injection site pain (79.7% and 89.3%), fatigue (27.5% and 42.1%) and headache (31.2 and 40.1%) for the PHH-1V and the BNT162b2 groups, respectively. A total of 52 COVID-19 cases occurred from day 14 post-vaccination (10.14%) for the PHH-1V group and 30 (11.90%) for the BNT162b2 group (p = 0.45), and none of the subjects developed severe COVID-19. Our interim results from the Phase IIb HH-2 trial show that PHH-1V as a heterologous booster vaccine, when compared to BNT162b2, although it does not reach a non-inferior neutralizing antibody response against the Wuhan-Hu-1 strain at days 14 and 28 after vaccination, it does so at day 98. PHH-1V as a heterologous booster elicits a superior neutralizing antibody response against the previous circulating Beta and the currently circulating Omicron BA.1 SARS-CoV-2 variants in all time points assessed, and for the Delta variant on day 98 as well. Moreover, the PHH-1V boost also induces a strong and balanced T-cell response. Concerning the safety profile, subjects in the PHH-1V group report significantly fewer adverse events than those in the BNT162b2 group, most of mild intensity, and both vaccine groups present comparable COVID-19 breakthrough cases, none of them severe. HIPRA SCIENTIFIC, S.L.U

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

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

75 años como referente de la investigación agraria y medioambiental española en condiciones de clima mediterráneo [Sitio Web]

1 .pdf con imagen de acceso al “website”, su url y los créditos relacionados con su creación y diseño.-- Créditos: Organización, Estación Experimental de Aula Dei (EEAD-CSIC); Dirección, Jesús Val Falcón; Coordinación, Ana Álvarez-Fernandez, Jorge Álvaro-Fuentes, Ernesto Igartua; Contenido, Anunciación Abadía, Javier Abadía, Carlos Albiñana, Miguel Alfonso, Arancha Arbeloa, Raúl Arbués, Isabel Armillas, Manuel Becana, Santiago Beguería, Carmen Castañeda, Ana Castillo, José Cavero, Bruno Contreras, Azahara Díaz, Edgar García, Elena García, Juan Manuel Gascuñana, Leticia Gaspar, Yolanda Gogorcena, Juan Herrero, Victoria Lafuente, María Victoria López, Juan Antonio Marín, José Martínez, José Carlos Martínez-Giménez, Ana Pilar Mata, Manuel Matamoros, Pierre Mignard, María Ángeles Moreno, Paula Murillo, Ana Navas, Antonio Pérez, Rafael Picorel, María Pilar Vallés, Irene Villar, Inmaculada Yruela, Nery Zapata, Isabel Zarazaga; Diseño y programación: DigitalWorks (Juanjo Ascaso y Asun Dieste); Vídeo, Delegación del CSIC en Aragón (Sara Gutiérrez y Yolanda Hernáiz); Fotografía, Archivo EEAD-CSIC, Anunciación Abadía, Jorge Álvaro-Fuentes, Arancha Arbeloa, Juanjo Ascaso, Santiago Beguería, Elena García, Ernesto Igartua, Ignasi Iglesias, José Manuel Lasa, José Carlos Martínez-Giménez, Pierre Mignard, María Ángeles Moreno, Rubén Sancho, Kosana Suvocarev, María Pilar Vallés, Nery Zapata."Sitio web" de nueva creación y conmemorativo del 75 Aniversario de la EEAD-CSIC que contiene: 1) Foto esférica de su personal en activo; 2) Recopilación de sus hitos históricos más destacados, en orden cronológico; 3) Un vídeo con participación de su personal y muestra de algunas de sus instalaciones; 4) Un mapa con la distribución geográfica de los egresado del Instituto; 5) Algunas fotos, destacando las tomadas a su personal en las celebraciones del 25 y 50 Aniversarios de la EEAD-CSIC.Presentado durante la "Jornada. 75 Aniversario EEAD-CSIC (Zaragoza, Patio de la Infanta. 30 octubre 2019)".Financiación: CSIC, Vicepresidencia Adjunta de Organización y Cultura Científica.N

Paper del contrast radiològic en la valoració de tumors sòlids urològics

[cat] L’ús de contrast en proves d’imatge facilita el diagnòstic i classificació dels tumors urològics, però el seu us pot ser prescindible en alguns escenaris clínics. Els diferents tipus de contrast poden tenir diferents efectes adversos i encareixen per altre banda les proves diagnostiques. El seu us esta fonamentat i justificat per la millora diagnostica que ofereixen però cal avaluar el seu us en situacions especifiques en que el seu paper i benefici pot ser discutible. En aquest sentit, l’objectiu d’aquesta tesi és avaluar el paper del contrast en les proves d’imatge realitzades per la valoració de tumors urològics sòlids, mitjançant dos objectius secundaris: 1. Aportació del contrast en el diagnòstic diferencial de tumors renals entre lesions benignes i malignes, específicament en la diferenciació entre carcinoma de cèl·lules renals de tipus papil·lar i els angiomiolipomes pobres en greix. 2. Avaluar si es prescindible l’us del contrast en la RM en el diagnòstic del càncer de pròstata.[spa] Tesis presentada en formato de compendio de artículos en base a dos artículos. Se valora la necesidad del uso del contraste radiològico en el diagnóstico diferencial de tumores renales para diferenciar entre angiomiolipoma pobre en grasa (AMLpg) y el carcinoma de células renales de tipo papilar (CCRp) y por otra parte si es necesario el contraste en la valoración del cáncer de próstata con el sistema PIRADS. Se valoran los efectos adversos de los distintos agentes de contraste radiológicos y la necesidad de optimirzar su uso. En el primer artículo se valoran retrospectiavmente los hallazgos TC de 67 CCRp y 13 AMLpg resecados con nefrectomía parcial mediante regresión logística hasta obtener el mejor módelo de regresión que permite el diagnóstico diferencial y que incluyen el sexo del paciente, el ángulo de la lesión con el parénquima renal y la captación de la lesión en fase venosa. En el segundo artículo se valoran retrospectiamente 200 pacientes a los que se realiza una resonancia magnética prostática para diagnóstico de lesiones sospechosas de cáncer de próstata con el sistema PIRADS con una valoración biparamétrica sin imágenes con contraste y posteriormente una multiparamétrica valorando el estudio dinámico con contraste. En la valoración biparamétrica 87 pacientes presentaban algún tipo de artefacto en difusión que alteraba la valoración de la zona periférica prostática y otros 15 pacientes presentaban lesiones PIRADS 3 que debían ser valoradas con contraste. La conclusión es que el contraste radiológico es necesario y conveniente en el diagnóstico diferencial de tumores renales sólidos para diferenciar el AMLpg del CCRp y también en el diagnóstico de cáncer de próstata en la valoración PIRADS de la RM prostática

Paper del contrast radiològic en la valoració de tumors sòlids urològics

Programa de Doctorat en Medicina i Recerca Translacional[cat] L’ús de contrast en proves d’imatge facilita el diagnòstic i classificació dels tumors urològics, però el seu us pot ser prescindible en alguns escenaris clínics. Els diferents tipus de contrast poden tenir diferents efectes adversos i encareixen per altre banda les proves diagnostiques. El seu us esta fonamentat i justificat per la millora diagnostica que ofereixen però cal avaluar el seu us en situacions especifiques en que el seu paper i benefici pot ser discutible. En aquest sentit, l’objectiu d’aquesta tesi és avaluar el paper del contrast en les proves d’imatge realitzades per la valoració de tumors urològics sòlids, mitjançant dos objectius secundaris: 1. Aportació del contrast en el diagnòstic diferencial de tumors renals entre lesions benignes i malignes, específicament en la diferenciació entre carcinoma de cèl·lules renals de tipus papil·lar i els angiomiolipomes pobres en greix. 2. Avaluar si es prescindible l’us del contrast en la RM en el diagnòstic del càncer de pròstata.[spa] Tesis presentada en formato de compendio de artículos en base a dos artículos. Se valora la necesidad del uso del contraste radiològico en el diagnóstico diferencial de tumores renales para diferenciar entre angiomiolipoma pobre en grasa (AMLpg) y el carcinoma de células renales de tipo papilar (CCRp) y por otra parte si es necesario el contraste en la valoración del cáncer de próstata con el sistema PIRADS. Se valoran los efectos adversos de los distintos agentes de contraste radiológicos y la necesidad de optimirzar su uso. En el primer artículo se valoran retrospectiavmente los hallazgos TC de 67 CCRp y 13 AMLpg resecados con nefrectomía parcial mediante regresión logística hasta obtener el mejor módelo de regresión que permite el diagnóstico diferencial y que incluyen el sexo del paciente, el ángulo de la lesión con el parénquima renal y la captación de la lesión en fase venosa. En el segundo artículo se valoran retrospectiamente 200 pacientes a los que se realiza una resonancia magnética prostática para diagnóstico de lesiones sospechosas de cáncer de próstata con el sistema PIRADS con una valoración biparamétrica sin imágenes con contraste y posteriormente una multiparamétrica valorando el estudio dinámico con contraste. En la valoración biparamétrica 87 pacientes presentaban algún tipo de artefacto en difusión que alteraba la valoración de la zona periférica prostática y otros 15 pacientes presentaban lesiones PIRADS 3 que debían ser valoradas con contraste. La conclusión es que el contraste radiológico es necesario y conveniente en el diagnóstico diferencial de tumores renales sólidos para diferenciar el AMLpg del CCRp y también en el diagnóstico de cáncer de próstata en la valoración PIRADS de la RM prostática

Acceso a Internet vía Satélite, servicios agregados de VoIP y telefonía nacional a zona rural para el Distrito de Ilabaya

Siendo ex-alumnos de la Universidad Ricardo Palma, ahora Bachilleres de la carrera profesional de Ingeniería Electrónica, tenemos la gran responsabilidad de ejercer nuestra profesión de manera adecuada, esto quiere decir, usar el poder del conocimiento adquirido para el bien y el desarrollo. El tener presente esta premisa ayuda a comprender la justificación de un proyecto enfocado a las zonas rurales de nuestro territorio. Cursos como Comunicaciones Rurales muestran realidades ignoradas por muchos en un país centralizado como es el Perú. Parte del desarrollo consiste en romper barreras sociales e ideologías que nos separan a pesar que todos pertenecemos a la misma patria y, de cierta forma, dotar de tecnología a las zonas que lo necesiten intercomunicándonos unso a otros ayudará a la integración. Reconozcamos que el crecimiento y beneficio de un grupo social determinado no traerá nayor trascendencia, los verdaderos cambios positivos significativos para el Perú llegarán con la descentralización, la unión y el apoyo del conjunto, siendo la tecnología de la información vital para este propósito.Tesi

RGB photometric calibration of 15 million Gaia stars

Although a catalogue of synthetic RGB magnitudes, providing photometric data for a sample of 1346 bright stars, has been recently published, its usefulness is still limited due to the small number of reference stars available, considering that they are distributed throughout the whole celestial sphere, and the fact that they are restricted to Johnson V < 6.6 mag. This work presents synthetic RGB magnitudes for ∼15 million stars brighter than Gaia G = 18 mag, making use of a calibration between the RGB magnitudes of the reference bright star sample and the corresponding high-quality photometric G, GBP, and GRP magnitudes provided by the Gaia EDR3. The calibration has been restricted to stars exhibiting -0.5 < GBP - GRP < 2.0 mag, and aims to predict RGB magnitudes within an error interval of ±0.1 mag. Since the reference bright star sample is dominated by nearby stars with slightly undersolar metallicity, systematic variations in the predictions are expected, as modelled with the help of stellar atmosphere models. These deviations are constrained to the ±0.1-mag interval when applying the calibration only to stars scarcely affected by interstellar extinction and with metallicity compatible with the median value for the bright star sample. The large number of Gaia sources available in each region of the sky should guarantee high-quality RGB photometric calibrations. © 2021 The Author(s) Published by Oxford University Press on behalf of Royal Astronomical Society.The authors acknowledge financial support from the Spanish Programa Estatal de I+D + i Orientada a los Retos de la Sociedad under grant RTI2018-096188B-I00, which is partly funded by the European Regional Development Fund (ERDF), S2018/NMT-4291 (TEC2SPACE-CM), and ACTION, a project funded by the European Union H2020-SwafS-2018-1-824603. The participation of ICCUB researchers was (partially) supported by the Spanish Ministry of Science, Innovation and University (MICIU/FEDER, UE) through grant RTI2018095076-B-C21, and the Institute of Cosmos Sciences University of Barcelona (ICCUB, Unidad de Excelencia 'María de Maeztu') through grant CEX2019-000918-M. SB acknowledges Xunta de Galicia for financial support under grant ED431B 2020/29. The participation of ASdM was (partially) supported by the EMISSI@N project (NERC grant NE/P01156X/1). This work has made use of data from the European Space Agency (ESA) mission Gaia (https://www.cosmos.esa.int/gaia), processed by the Gaia Data Processing and Analysis Consortium (DPAC, https://www.cosmos.esa.int/web/gaia/dpac/consortium). Funding for the DPAC has been provided by national institutions, in particular the institutions participating in the Gaia Multilateral Agreement.With funding from the Spanish government through the Severo Ochoa Centre of Excellence accreditation SEV-2017-0709.Peer reviewe