"INTERGROWTH21st vs customized fetal growth curves in the assessment of the neonatal nutritional status: a retrospective cohort study of gestational diabetes"

Background Gestational diabetes mellitus is associated with increased incidence of adverse perinatal outcomes including newborns large for gestational age, macrosomia, preeclampsia, polyhydramnios, stillbirth, and neonatal morbidity. Thus, fetal growth should be monitored by ultrasound to assess for fetal overnutrition, and thereby, its clinical consequence, macrosomia. However, it is not clear which reference curve to use to define the limits of normality. Our aim is to determine which method, INTERGROWTH21st or customized curves, better identifies the nutritional status of newborns of diabetic mothers. Methods This retrospective cohort study compared the risk of malnutrition in SGA newborns and the risk of overnutrition in LGA newborns using INTERGROWTH21st and customized birth weight references in gestational diabetes. The nutritional status of newborns was assessed using the ponderal index. Additionally, to determine the ability of both methods in the identification of neonatal malnutrition and overnutrition, we calculate sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratios. Results Two hundred thirty-one pregnant women with GDM were included in the study. The rate of SGA indentified by INTERGROWTH21st was 4.7% vs 10.7% identified by the customized curves. The rate of LGA identified by INTERGROWTH21st was 25.6% vs 13.2% identified by the customized method. Newborns identified as SGA by the customized method showed a higher risk of malnutrition than those identified as SGA by INTERGROWTH21st. (RR 4.24 vs 2.5). LGA newborns according to the customized method also showed a higher risk of overnutrition than those classified as LGA according to INTERGROWTH21st. (RR 5.26 vs 3.57). In addition, the positive predictive value of the customized method was superior to that of INTERGROWTH21st in the identification of malnutrition (32% vs 27.27%), severe malnutrition (22.73% vs 20%), overnutrition (51.61% vs 32.20%) and severe overnutrition (28.57% vs 14.89%). Conclusions In pregnant women with DMG, the ability of customized fetal growth curves to identify newborns with alterations in nutritional status appears to exceed that of INTERGROWTH21s

Non-funerary Bell Beakers in the province of Toledo: the site of Las Vegas (the valley of Huecas once again).

Presentamos los resultados de los sondeos del yacimiento de Las Vegas, Huecas (Toledo). Se trata de un área abierta, junto al arroyo y al pie de la necrópolis de Valle de las Higueras. Un fuerte depósito de coluvión sepulta el yacimiento. Sin evidencias en superficie, su detección se realizó mediante prospección geofísica. Carece de estructuras y está formado por un único estrato, un depósito secundario que contiene campaniforme Ciempozuelos y metal, con una fecha C14 de la 2ª mitad del III milenio a.C. La cerámica es el material más abundante. Su estudio macroscópico y mediante fluorescencia de rayos X (FRX) avala su producción local, la rápida formación del depósito y su larga exposición en superficie. Planteamos que el depósito procede de la limpieza y mantenimiento de un área de ocupación anexa. El patrón de poblamiento parece seguir las tierras bajas del valle con ocupaciones cuyas producciones cerámicas difieren de las de los contextos funerarios.This article presents the latest results of the excavations at the site of Las Vegas in Huecas (Toledo). The site is located in an open area, near a stream and at the foot of the Valle de las Higueras necropolis. It is buried by a considerable colluvial deposition and was detected by geophysical survey. The site lacks structures and is made up of a single archaeological layer: it is a secondary deposit, containing Bell Beaker pottery and metal. A 14C sample has dated it to the second half of the 3rd millennium BC. Ceramics are the most abundant remain from this deposit. Macroscopic and X‑ray Fluorescence (FRX) analysis of the ceramics indicates a local production, the fast formation of this deposit, and its long‑term exposure on the surface. We suggest that it was formed by cleaning and maintenance activities carried out in a nearby occupational area. We suggest that settlement occurred in the valley bottom, with occupations whose ceramic productions differ from the ones found in funerary contexts

SARS-CoV-2 Infection and C-Section: A Prospective Observational Study

Pregnant women are particularly vulnerable to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. In addition to unfavorable perinatal outcomes, there has been an increase in obstetric interventions. With this study, we aimed to clarify the reasons, using Robson's classification model, and risk factors for cesarean section (C-section) in SARS-CoV-2-infected mothers and their perinatal results. This was a prospective observational study that was carried out in 79 hospitals (Spanish Obstetric Emergency Group) with a cohort of 1704 SARS-CoV-2 PCR-positive pregnant women that were registered consecutively between 26 February and 5 November 2020. The data from 1248 pregnant women who delivered vaginally (vaginal + operative vaginal) was compared with those from 456 (26.8%) who underwent a C-section. C-section patients were older with higher rates of comorbidities, in vitro fertilization and multiple pregnancies (p < 0.05) compared with women who delivered vaginally. Moreover, C-section risk was associated with the presence of pneumonia (p < 0.001) and 41.1% of C-sections in patients with pneumonia were preterm (Robson's 10th category). However, delivery care was similar between asymptomatic and mild-moderate symptomatic patients (p = 0.228) and their predisposing factors to C-section were the presence of uterine scarring (due to a previous C-section) and the induction of labor or programmed C-section for unspecified obstetric reasons. On the other hand, higher rates of hemorrhagic events, hypertensive disorders and thrombotic events were observed in the C-section group (p < 0.001 for all three outcomes), as well as for ICU admission. These findings suggest that this type of delivery was associated with the mother's clinical conditions that required a rapid and early termination of pregnancy.This project was supported by public funds that were obtained in competitive calls: Grant COV20/00021 (EUR 43,000 from the Instituto de Salud Carlos III-Spanish Ministry of Health) and co-financed with Fondo Europeo de Desarrollo Regional (FEDER) funds

Campaniforme no funerario en la provincia de Toledo: el yacimiento de Las Vegas. De nuevo el Valle de Huecas

This article presents the latest results of the excavations at the site of Las Vegas in Huecas (Toledo). The site is located in an open area, near a stream and at the foot of the Valle de las Higueras necropolis. It is buried by a considerable colluvial deposition and was detected by geophysical survey. The site lacks structures and is made up of a single archaeological layer: it is a secondary deposit, containing Bell Beaker pottery and metal. A 14C sample has dated it to the second half of the 3rd millennium BC. Ceramics are the most abundant remain from this deposit. Macroscopic and X-ray Fluorescence (FRX) analysis of the ceramics indicates a local production, the fast formation of this deposit, and its long-term exposure on the surface. We suggest that it was formed by cleaning and maintenance activities carried out in a nearby occupational area. We suggest that settlement occurred in the valley bottom, with occupations whose ceramic productions differ from the ones found in funerary contexts.Presentamos los resultados de los sondeos del yacimiento de Las Vegas, Huecas (Toledo). Se trata de un área abierta, junto al arroyo y al pie de la necrópolis de Valle de las Higueras. Un fuerte depósito de coluvión sepulta el yacimiento. Sin evidencias en superficie, su detección se realizó mediante prospección geofísica. Carece de estructuras y está formado por un único estrato, un depósito secundario que contiene campaniforme Ciempozuelos y metal, con una fecha C14 de la 2ª mitad del III milenio a.C. La cerámica es el material más abundante. Su estudio macroscópico y mediante fluorescencia de rayos X (FRX) avala su producción local, la rápida formación del depósito y su larga exposición en superficie. Planteamos que el depósito procede de la limpieza y mantenimiento de un área de ocupación anexa. El patrón de poblamiento parece seguir las tierras bajas del valle con ocupaciones cuyas producciones cerámicas difieren de las de los contextos funerarios

Polymorphisms within the TNFSF4 and MAPKAPK2 Loci influence the risk of developing invasive aspergillosis: A two-stage case control study in the context of the aspBIOmics consortium

Here, we assessed whether 36 single nucleotide polymorphisms (SNPs) within the TNFSF4 and MAPKAPK2 loci influence the risk of developing invasive aspergillosis (IA). We conducted a two-stage case control study including 911 high-risk patients diagnosed with hematological malignancies that were ascertained through the aspBIOmics consortium. The meta-analysis of the discovery and replication populations revealed that carriers of the TNFSF4rs7526628T/T genotype had a significantly increased risk of developing IA (p = 0.00022). We also found that carriers of the TNFSF4rs7526628T allele showed decreased serum levels of TNFSF14 protein (p = 0.0027), and that their macrophages had a decreased fungicidal activity (p = 0.048). In addition, we observed that each copy of the MAPKAPK2rs12137965G allele increased the risk of IA by 60% (p = 0.0017), whereas each copy of the MAPKAPK2rs17013271T allele was estimated to decrease the risk of developing the disease (p = 0.0029). Mechanistically, we found that carriers of the risk MAPKAPK2rs12137965G allele showed increased numbers of CD38+IgM-IgD- plasmablasts in blood (p = 0.00086), whereas those harboring two copies of the allele had decreased serum concentrations of thymic stromal lymphopoietin (p = 0.00097). Finally, we also found that carriers of the protective MAPKAPK2rs17013271T allele had decreased numbers of CD27-IgM-IgD- B cells (p = 0.00087) and significantly lower numbers of CD14+ and CD14+CD16- cells (p = 0.00018 and 0.00023). Altogether, these results suggest a role of the TNFSF4 and MAPKAPK2 genes in determining IA risk.This study was supported by grants PI20/01845, PI12/02688, and ISCIII-FEDER PI17/02276 from Fondo de Investigaciones Sanitarias (Madrid, Spain), PIM2010EPA-00756 from the ERA-NET PathoGenoMics (0315900A), the Collaborative Research Center/Transregio 124 FungiNet, the Fundacao para a Ciencia e Tecnologia (FCT) (PTDC/SAU-SER/29635/2017, PTDC/MED-GEN/28778/2017, CEECIND/03628/2017, and CEECIND/04058/2018), the European Union's Horizon 2020 research and innovation programme under grant agreement no. 847507, and the "la Caixa" Foundation (ID 100010434) and FCT under the agreement LCF/PR/HP17/52190003)

Steroid hormone-related polymorphisms associate with the development of bone erosions in rheumatoid arthritis and help to predict disease progression: Results from the REPAIR consortium

Here, we assessed whether 41 SNPs within steroid hormone genes associated with erosive disease. The most relevant finding was the rheumatoid factor (RF)-specific effect of the CYP1B1, CYP2C9, ESR2, FcγR3A, and SHBG SNPs to modulate the risk of bone erosions (P = 0.004, 0.0007, 0.0002, 0.013 and 0.015) that was confirmed through meta-analysis of our data with those from the DREAM registry (P = 0.000081, 0.0022, 0.00074, 0.0067 and 0.0087, respectively). Mechanistically, we also found a gender-specific correlation of the CYP2C9rs1799853T/T genotype with serum vitamin D3 levels (P = 0.00085) and a modest effect on IL1β levels after stimulation of PBMCs or blood with LPS and PHA (P = 0.0057 and P = 0.0058). An overall haplotype analysis also showed an association of 3 ESR1 haplotypes with a reduced risk of erosive arthritis (P = 0.009, P = 0.002, and P = 0.002). Furthermore, we observed that the ESR2, ESR1 and FcγR3A SNPs influenced the immune response after stimulation of PBMCs or macrophages with LPS or Pam3Cys (P = 0.002, 0.0008, 0.0011 and 1.97•10−7). Finally, we found that a model built with steroid hormone-related SNPs significantly improved the prediction of erosive disease in seropositive patients (PRF+ = 2.46•10−8) whereas no prediction was detected in seronegative patients (PRF− = 0.36). Although the predictive ability of the model was substantially lower in the replication population (PRF+ = 0.014), we could confirm that CYP1B1 and CYP2C9 SNPs help to predict erosive disease in seropositive patients. These results are the first to suggest a RF-specific association of steroid hormone-related polymorphisms with erosive disease

Jornada de Grandes infraestructuras europeas de Ciencias Sociales y Humanidades en el CSIC: DARIAH y CLARÍN en el horizonte (11 de mayo de 2023)

Peer reviewe

Alta precoz en la puerpera

INTRODUCCIÓN La hospitalización posparto tien 2 finalidades principales: la identificación las complicaciones maternas o neonatales después del nacimiento y ofrecer asistencia profesional a la madre y a su neonato; garantizando que la primera se haya recuperado y preparado para cuidarse por sí misma y cuidar a su hijo. Para lo cual, la estancia hospitalaria posparto recomendada en un parto vaginal sin complicaciones es de un mínimo de 48 horas, excluyendo el día del nacimiento. El alta precoz en el hospital después de nacimiento por vía vaginal consistiría, por tanto, en egreso de la madre, el neonato o de ambos en menos de 48 horas posnacimiento. En todos los metaanálisis existentes sobre el tema llegan a la misma conclusión: "la existencia de importantes errores metodológicos de los estudios, lo que desvaloriza las conclusiones de los mismos, además, no existían evidencias que apoyan o denegaran la utilidad de esta práctica, y que con los datos disponibles no se puede definir cual es la duración ideal de la estancia de estos niños y estas madres". HIPÓTESIS DE TRABAJO Nos proponemos demostrar que el alta precoz (AP) posparto vaginal sin complicaciones en gestación a término: A,- Garantiza las finalidades de alta hospitalaria posparto con un ingreso hospitalario menor de 48 horas y seguimiento en su domicilio por personal cualificado. B,- Que esta práctica conlleva una mejoría del bienestar materno-familiar. C,- Que supone un ahorro a los sistemas de salud. Para ello intentamos confirmar la seguridad de alta hospitalaria precoz obstétrico-pediátrico posparto en comparación con el alta hospitalaria tradicional según los métodos actuales de investigación en medicina basada en pruebas, es decir, mediante un estudio aleatorio con control y seguiendo las recomendaciones de los metaanálisis existentes sobre el tema. TIPO DE ESTUDIO Estudio epidemiológico (longitudinal de seguimiento), prospectivo, randomizado y con grupo de control de madres y recién nacidos. Una estimación de 189 casos por grupos de estudio para un error del 5%, una precisión del 2% y una tasa de reingreso materno y neonatal del 2%. RESULTADOS Valoramos 430 casos, con un 3,5% de casos pérdidos. Una tasa de reingreso materno del 1,9% en el grupo de AP versus un 2,3% en el grupo CO (alta tradicional) (RR 0,81; 95% IC 0,21-3,03). Tasa de reingreso neonatal del 1,4% en el grupo de AP versus un 2,3% en el grupo CO (RR 061; 95% IC 0,15-2,56). No se encontraron diferencias estadísticamente significativas en las variables de estudio: Tasa de reingreso materno o neonatal, patología puerperal materna, ansiedad-depresión-fatiga materna y consultas a sistemas de salud por problemas maternos o neonatales, entre los grupos de estudio. Se encontró diferencia estadísticamente significativa en el seguimiento de la lactancia materna a los 3 meses a favor del grupo AP. Existió una alta satisfacción en las pacientes con esta práctica. Y hubo un ahorro estimado en un 18%. CONCLUSIONES El estudio realizado demuestra que con el alta precoz posparto se pueden garantizar las finalidades de la hospitalización posparto, se obtiene una alta satisfacción materna y supone un ahorro económic

Torsión anexial sin patología ovárica en gestante del primer trimestre

La torsión anexial durante el embarazo es una entidad muy poco frecuente y casi siempre ocurre en el contexto de una masa anexial. Es importante establecer el diagnóstico mediante ecografía y en caso de duda se recomienda la utilización de laparoscopia diagnóstica para realizar el tratamiento lo más precozmente posible.Adnexal torsion during pregnancy is a rare entity and usually occurs in the context of an increase in the mass of the annex. It is important to establish the diagnosis by ultrasound and in case of doubt we recommend the use of diagnostic laparoscopy for treatment as early as possible

Interobserver variability of ultrasound measurements for the differential diagnosis of uterine prolapse and cervical elongation without uterine prolapse

Objectives: Our study aims to determine the interobserver variability of different ultrasound measurements (pubis-cervix distance, pubis-uterine fundus distance, and pubis-Douglascul-de-sac distance) previously analyzed for the ultrasound differential diagnosis of uterine prolapse (UP) and cervical elongation CE without UP. Materials and methods: We conducted a prospective observational study with 40 patients scheduled to undergo surgical correction of UP and CE without UP. All patients underwent pelvic floor ultrasound examination by an examiner (E1) who acquired ultrasound images. Using these images, E1 measured the distances for the ultrasound differential diagnosis of UP and CE without UP, and these distances were compared with those measured by the other examiner (E2). Values were analyzed by calculating ICCs with 95% CIs. Results: For UP, excellent reliability was obtained for all measurements except the pubis-Douglascul-de-sac measurement at rest, which was moderate (ICC 0.596; p = 0.028) and for the difference between the pubis-Douglascul-de-sac measurement at rest and during the Valsalva maneuver, which was good (ICC 0.691; p < 0.0005). For CE without UP, interobserver reliability was excellent for all measurements analyzed except the pubis-cervix measurement during the Valsalva maneuver, which was moderate (ICC 0.535; p = 0.052) and for the pubis-Douglascul-de-sac measurement at rest, which was good (ICC 0.768; p < 0.0005). Conclusions: There is excellent interobserver reliability in measurements of the difference in the distance from the pubic symphysis to the uterine fundus at rest and during the Valsalva maneuver for both UP and CE without UP, which are used for the ultrasound differential diagnosis of UP and CE without UP