Lesión de la mucosa intestinal asociada a cristales: Serie de casos y revisión de la literatura

La lesión de la mucosa asociada a cristales es un cuadro clínico importante en un subconjunto de pacientes urémicos a los que se les administran resinas de intercambio catiónico como el sulfonato de poliestireno sódico (Kayexalate) y sevelamer para el tratamiento de la hiperpotasemia y la hiperfosfatemia, respectivamente. La necrosis colónica en estos pacientes es rara, pero puede estar asociada a una lesión gastrointestinal mortal, con una tasa de mortalidad del 33%. Los secuestrantes de ácidos biliares son otro tipo de resina que teóricamente son biológicamente inertes. Se presentan dos casos de colitis asociada a cristales. El primer paciente tenía antecedentes de múltiples intervenciones quirúrgicas y patologías del tracto gastrointestinal, y estaba en manejo con colestiramina. Se realizó una sigmoidectomía en la que se encontraron varios focos de cristales. El segundo paciente tenía antecedente de enfermedad renal crónica que requirió el uso de Kayexalate y se presentó al servicio de urgencias con una hemorragia grave del tracto gastrointestinal inferior. Se realizó una colectomía parcial en la que se detectaron cambios morfológicos relacionados con el depósito de cristales. Las resinas pueden producir un amplio espectro de lesiones mortales de la mucosa, por lo que el diagnóstico precoz es fundamental para disminuir la mortalidad y mejorar el pronóstico. Sin embargo, es incierto si el consumo de colestiramina y Kayexalate, así como el depósito de sus cristales en el tracto gastrointestinal son el factor causal de la lesión de las mucosas. Por tanto, la presencia de resinas debería ayudar a establecer el diagnóstico correcto y el tratamiento médico oportuno para evitar resultados nocivos.Crystal-associated mucosal injury is a crucial clinical picture in a subset of uremic patients who are given ca-tion exchange resins such as sodium polystyrene sulfonate (Kayexalate) and sevelamer to treat hyperkalemia and hyperphosphatemia, respectively. Colonic necrosis in these patients is rare but may be associated with fatal gastrointestinal injury, with a mortality rate of 33%. Bile acid sequestrants are another type of resin that is theoretically biologically inert. Two cases of colitis associated with crystals are presented. The first patient had a history of multiple surgeries and pathologies of the gastrointestinal tract and was treated with choles-tyramine. A sigmoidectomy was performed in which several crystal foci were found. The second patient had a history of chronic kidney disease requiring Kayexalate and attended the emergency department with severe lower GI bleeding. A partial colectomy was performed in which morphological changes related to the deposit of crystals were detected. Resins can cause a broad spectrum of malignant mucosal lesions, so early diagnosis is essential to reduce mortality and improve prognosis. However, it is uncertain whether the consumption of cholestyramine and kayexalate, as well as the deposition of their crystals in the GI tract, are the causative factor of mucosal damage. Therefore, resins should help establish the correct diagnosis and prompt medical treatment to avoid harmful results

Influence of a Physical Exercise Program in the Anxiety and Depression in Children with Obesity

[EN] Background: The high prevalence of childhood obesity and its multicausal etiology make it necessary to approach it through different strategies, whose objective is to promote the physical, mental, and social well-being of children. Regular physical activity, in addition to having positive effects on the physical environment of those who practice it, influences positively in psychological aspects such as anxiety and depression, which are very frequent in children with obesity and overweight. (2) Objective: To analyze the changes produced by a program of physical exercise based on anthropometric indicators and levels of anxiety and depression in a population of Mexican children with obesity. (3) Methods: A longitudinal study with experimental group (EG) and control group (CG). The analysis population consisted of 105 children with a body mass index (BMI) for their gender and age group above the 95th percentile, of which 60 were girls and 45 were boys, with a mean age of 10.02 years (SD ± 0.79). By randomizing the participants, 54 were part of the EG and 51 of the, CG The EG participated in a physical exercise program, distributed in two weekly sessions, each lasting 50 minutes, for 20 consecutive weeks. The CG group continued its usual activities during the intervention period. An inferential analysis was performed between the socio-demographic, anthropometric and psychological variables. (4) Results: The implementation of a physical exercise program in children with obesity favors the appearance of positive thoughts, with improvements in their emotional well-being, self-perception and self-concept; although it does not produce significant changes in weight, height, Z-Score, level of anxiety or depressive thoughts. (5) Discussion: Regular physical exercise practice has positive effects on mental health, although new studies are required to analyze specifically its influence on anxiety and depression in children with obesity.S

CAR density influences antitumoral efficacy of BCMA CAR T cells and correlates with clinical outcome

Identification of new markers associated with long-term efficacy in patients treated with CAR T cells is a current medical need, particularly in diseases such as multiple myeloma. In this study, we address the impact of CAR density on the functionality of BCMA CAR T cells. Functional and transcriptional studies demonstrate that CAR T cells with high expression of the CAR construct show an increased tonic signaling with up-regulation of exhaustion markers and increased in vitro cytotoxicity but a decrease in in vivo BM infiltration. Characterization of gene regulatory networks using scRNA-seq identified regulons associated to activation and exhaustion up-regulated in CARHigh T cells, providing mechanistic insights behind differential functionality of these cells. Last, we demonstrate that patients treated with CAR T cell products enriched in CARHigh T cells show a significantly worse clinical response in several hematological malignancies. In summary, our work demonstrates that CAR density plays an important role in CAR T activity with notable impact on clinical response

Renal tubule Cpt1a overexpression protects from kidney fibrosis by restoring mitochondrial homeostasis

Chronic kidney disease (CKD) remains a major epidemiological, clinical, and biomedical challenge. During CKD, renal tubular epithelial cells (TECs) present a persistent inflammatory and profibrotic response. Fatty acid oxidation (FAO), the main source of energy for TECs, is reduced in kidney fibrosis and contributes to its pathogenesis. To determine whether gain of function in FAO (FAO-GOF) could protect from fibrosis, we generated a conditional transgenic mouse model with overexpression of the fatty acid shuttling enzyme carnitine palmitoyl-transferase 1A (CPT1A) in TECs. Cpt1a-knockin (CPT1A-KI) mice subjected to 3 models of renal fibrosis (unilateral ureteral obstruction, folic acid nephropathy [FAN], and adenine-induced nephrotoxicity) exhibited decreased expression of fibrotic markers, a blunted proinflammatory response, and reduced epithelial cell damage and macrophage influx. Protection from fibrosis was also observed when Cpt1a overexpression was induced after FAN. FAO-GOF restored oxidative metabolism and mitochondrial number and enhanced bioenergetics, increasing palmitate oxidation and ATP levels, changes that were also recapitulated in TECs exposed to profibrotic stimuli. Studies in patients showed decreased CPT1 levels and increased accumulation of short- and middle-chain acylcarnitines, reflecting impaired FAO in human CKD. We propose that strategies based on FAO-GOF may constitute powerful alternatives to combat fibrosis inherent to CKD

A Complex Regulatory Network Governs the Expression of Symbiotic Genes in Sinorhizobium Fredii HH103

Introduction: The establishment of the rhizobium-legume nitrogen-fixing symbiosis relies on the interchange of molecular signals between the two symbionts. We have previously studied by RNA-seq the effect of the symbiotic regulators NodD1, SyrM, and TtsI on the expression of the symbiotic genes (the nod regulon) of Sinorhizobium fredii HH103 upon treatment with the isoflavone genistein. In this work we have further investigated this regulatory network by incorporating new RNA-seq data of HH103 mutants in two other regulatory genes, nodD2 and nolR. Both genes code for global regulators with a predominant repressor effect on the nod regulon, although NodD2 acts as an activator of a small number of HH103 symbiotic genes. Methods: By combining RNA-seq data, qPCR experiments, and b-galactosidase assays of HH103 mutants harbouring a lacZ gene inserted into a regulatory gene, we have analysed the regulatory relations between the nodD1, nodD2, nolR, syrM, and ttsI genes, confirming previous data and discovering previously unknown relations. Results and discussion: Previously we showed that HH103 mutants in the nodD2, nolR, syrM, or ttsI genes gain effective nodulation with Lotus japonicus, a model legume, although with different symbiotic performances. Here we show that the combinations of mutations in these genes led, in most cases, to a decrease in symbiotic effectiveness, although all of them retained the ability to induce the formation of nitrogen-fixing nodules. In fact, the nodD2, nolR, and syrM single and double mutants share a set of Nod factors, either overproduced by them or not generated by the wild-type strain, that might be responsible for gaining effective nodulation with L. japonicus.Ministerio de Ciencia e Innovación PID2019-107634RB-I0

Salt lakes of La Mancha (Central Spain): A hot spot for tiger beetle (Carabidae, Cicindelinae) species diversity

The tiger beetle assemblage of the wetlands of La Mancha (central Spain) comprises nine species: Calomera littoralis littoralis, Cephalota maura maura, Cephalota circumdata imperialis, Cephalota dulcinea, Cicindela campestris campestris, Cicindela maroccana, Cylindera paludosa, Lophyra flexuosa flexuosa, and Myriochila melancholica melancholica. This assemblage represents the largest concentration of tiger beetles in a single 1º latitude / longitude square in Europe. General patterns of spatial and temporal segregation among species are discussed based on observations of 1462 specimens registered during an observation period of one year, from April to August. The different species of Cicindelini appear to be distributed over space and time, with little overlapping among them. Three sets of species replace each other phenologically as the season goes on. Most of the species occupy drying or dried salt lakes and salt marshes, with sparse vegetation cover. Spatial segregation is marked in terms of substrate and vegetation use. Calomera littoralis and M. melancholica have been observed mainly on wet soils; C. circumdata on dry open saline flats; C. dulcinea and C. paludosa in granulated substrates with typical halophytic vegetation; C. maura is often present in man-modified areas. Cephalota circumdata and C. dulcinea are included as species of special interest in the list of protected species in Castilla–La Mancha. Conservation problems for the Cicindelini assemblage arise from agricultural activities and inadequate use of sport vehicles. Attempts at restoring the original habitat, supressing old semi-industrial structures, may affect the spatial heterogeneity of the lakes, and have an effect on Cicindelinae diversity.This study was possible thanks to the support from the Fundación Global Nature through the European Life European Community Project Humedales de La Mancha (LIFE10 NAT/ES/000563), Spanish Ministry of Agriculture, Food and Environment and to the facilities provided by the Museo Nacional de Ciencias Naturales (MNCN-CSIC).Peer reviewe

Predictive Power of the "Trigger Tool" for the detection of adverse events in general surgery: a multicenter observational validation study

Background In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new “Trigger Tool” represents a sensitive predictor of adverse events in general surgery. Methods An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described “Trigger Tool” based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis. Results The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The “Trigger Tool” had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse events. A total of 12 selected triggers of overall 40 triggers were identified for optimizing the predictive power of the “Trigger Tool”. Conclusions The “Trigger Tool” has a high predictive capacity for predicting adverse events in surgical procedures. We recommend a revision of the original 40 triggers to 12 selected triggers to optimize the predictive power of this tool, which will have to be validated in future studies

Post-Franco Theatre

In the multiple realms and layers that comprise the contemporary Spanish theatrical landscape, “crisis” would seem to be the word that most often lingers in the air, as though it were a common mantra, ready to roll off the tongue of so many theatre professionals with such enormous ease, and even enthusiasm, that one is prompted to wonder whether it might indeed be a miracle that the contemporary technological revolution – coupled with perpetual quandaries concerning public and private funding for the arts – had not by now brought an end to the evolution of the oldest of live arts, or, at the very least, an end to drama as we know it