Multicenter study of plastic vs. self-expanding metal stents in endoscopic ultrasound-guided drainage of walled-off pancreatic necrosis - PROMETHEUS: a randomized controlled trial protocol.

Background: It seems that lumen-apposing metal stents (LAMS) are displacing plastic stents in the therapy of pancreatic-fluid collection in walled-off necrosis (WON). To date, there is no quality of evidence to recommend LAMS as the standard treatment in the management of WON. The theoretical benefit of LAMS over plastic stents needs to be proven. Methods/design: This is a randomized controlled, multicenter, prospective clinical trial with two parallel groups, without masking. One-hundred and fourteen patients with WON will undergo endoscopic ultrasound (EUS)-guided transmural draining in nine tertiary hospitals in Spain and will be randomized to the LAMS or plastic-stent group. The primary endpoint is the short-term (4 weeks) clinical success determined by the reduction of the collection (to < 50% or < 5 cm in size), along with clinical improvement. Secondary endpoints: long-term (4 months) clinical success (total resolution or 5 cm), procedure duration, level of difficulty, safety, and recurrences. Discussion: The PROMETHEUS trial has been designed to determine whether LAMS are superior to plastic stents in EUS-guided transmural drainage of WON

The Binding of Triclosan to SmeT, the Repressor of the Multidrug Efflux Pump SmeDEF, Induces Antibiotic Resistance in Stenotrophomonas maltophilia

The wide utilization of biocides poses a concern on the impact of these compounds on natural bacterial populations. Furthermore, it has been demonstrated that biocides can select, at least in laboratory experiments, antibiotic resistant bacteria. This situation has raised concerns, not just on scientists and clinicians, but also on regulatory agencies, which are demanding studies on the impact that the utilization of biocides may have on the development on resistance and consequently on the treatment of infectious diseases and on human health. In the present article, we explored the possibility that the widely used biocide triclosan might induce antibiotic resistance using as a model the opportunistic pathogen Stenotrophomonas maltophilia. Biochemical, functional and structural studies were performed, focusing on SmeDEF, the most relevant antibiotic- and triclosan-removing multidrug efflux pump of S. maltophilia. Expression of smeDEF is regulated by the repressor SmeT. Triclosan released SmeT from its operator and induces the expression of smeDEF, thus reducing the susceptibility of S. maltophilia to antibiotics in the presence of the biocide. The structure of SmeT bound to triclosan is described. Two molecules of triclosan were found to bind to one subunit of the SmeT homodimer. The binding of the biocide stabilizes the N terminal domain of both subunits in a conformation unable to bind DNA. To our knowledge this is the first crystal structure obtained for a transcriptional regulator bound to triclosan. This work provides the molecular basis for understanding the mechanisms allowing the induction of phenotypic resistance to antibiotics by triclosan

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Curso de especialidad en la carrera de Administración y Negocios Internacionales, de carácter teórico-práctico, dirigido a los estudiantes del 1er ciclo, que aborda los principios básicos de la teoría administrativa global y su evolución, naturaleza y funcionamiento, desde una perspectiva del libre comercio en el contexto de la globalización del Siglo XXI. Los contenidos teóricos, además, están asociados al estudio de factores internos y externos para la definición de la estrategia de negocios, midiendo y analizando variables vinculadas a la cultura, las relaciones laborales, los entornos empresariales, el mercado y las actividades de los competidores nacionales e internacionales. 1La globalización de los negocios significa que los decisores y el personal gerencial administrativo de una organización trabajen e interactúen con miembros de otras culturas, valorando los distintos entornos y siendo capaces de gestionarlo de manera eficiente para lograr los resultados de una organización empresarial

Factibilidad de convertir a la bolsa de valores en una bolsa de valores y de comercio. ventajas y desventajas. requerimientos para su implantacion

En la actualidad en el Ecuador están establecidas las Bolsas de Valores, tanto en Quito como en Guayaquil, cómo entidades autónomas privadas sin fines de lucro que tienen como finalidad fomentar el desarrollo del mercado de valores del Ecuador, incentivando las transacciones de activos financieros (renta fija y renta variable mayoritariamente). También existe la Bolsa de Productos (en Guayaquil) cuya finalidad es potenciar el mercado de productos agro-industriales permitiendo mejores coincidencias entre productores, ofertantes y demandantes lo cual se esperaría ayude a dinamizar el mercado. En este contexto, se plantea la conveniencia, para ambas instituciones y el mercado, de establecer una bolsa de comercio, como existe en otros países, donde se transan además de activos financieros, productos agroindustriales, minerales-metales, hidrocarburos, etc. y valores en base a contratos/documentos sobre estos bienes y/o activos. El presente estudio tiene la finalidad de emitir un juicio respecto a la conveniencia de que la bolsa de valores (Guayaquil y Quito) se convierta en bolsa de valores y comercio, para lo cual se deben establecer las ventajas (beneficios) y desventajas (costos) de esta eventual acción, que se presenten a nivel de todos los involucrados del mercado de valores; bolsa de valores, operadores/casa de valores, agentes cotizados en bolsa, inversionistas, etc. Adicionalmente, de ser el caso, se propondrán acciones, actividades y reformas (institucionales, legales y técnicas) estratégicas necesarias para implementar una eventual transformación teniendo en cuenta las limitaciones del caso

Multicenter study of plastic vs. self-expanding metal stents in endoscopic ultrasound-guided drainage of walled-off pancreatic necrosis - PROMETHEUS : A randomized controlled trial protocol

It seems that lumen-apposing metal stents (LAMS) are displacing plastic stents in the therapy of pancreatic-fluid collection in walled-off necrosis (WON). To date, there is no quality of evidence to recommend LAMS as the standard treatment in the management of WON. The theoretical benefit of LAMS over plastic stents needs to be proven. This is a randomized controlled, multicenter, prospective clinical trial with two parallel groups, without masking. One-hundred and fourteen patients with WON will undergo endoscopic ultrasound (EUS)-guided transmural draining in nine tertiary hospitals in Spain and will be randomized to the LAMS or plastic-stent group. The primary endpoint is the short-term (4 weeks) clinical success determined by the reduction of the collection (to < 50% or < 5 cm in size), along with clinical improvement. Long-term (4 months) clinical success (total resolution or 5 cm), procedure duration, level of difficulty, safety, and recurrences. The PROMETHEUS trial has been designed to determine whether LAMS are superior to plastic stents in EUS-guided transmural drainage of WON. ClinicalTrials.gov, ID: NCT03100578. Registered on 4 April 2017. https://clinicaltrials.gov/ct2/home

Estimulación multisensorial y realidad virtual para mejorar procesos educativos en la comunicación audiovisual

Depto. de Ciencias de la Comunicación AplicadaFac. de Ciencias de la InformaciónFALSEsubmitte

Population-scale tissue transcriptomics maps long non-coding RNAs to complex disease

Long non-coding RNA (lncRNA) genes have well-established and important impacts on molecular and cellular functions. However, among the thousands of lncRNA genes, it is still a major challenge to identify the subset with disease or trait relevance. To systematically characterize these lncRNA genes, we used Genotype Tissue Expression (GTEx) project v8 genetic and multi-tissue transcriptomic data to profile the expression, genetic regulation, cellular contexts, and trait associations of 14,100 lncRNA genes across 49 tissues for 101 distinct complex genetic traits. Using these approaches, we identified 1,432 lncRNA gene-trait associations, 800 of which were not explained by stronger effects of neighboring protein-coding genes. This included associations between lncRNA quantitative trait loci and inflammatory bowel disease, type 1 and type 2 diabetes, and coronary artery disease, as well as rare variant associations to body mass index.[Display omitted]•29% of lncRNA genes with eQTLs show tissue-specific genetic regulation•Co-expression networks and single-cell data provide annotations for 94% of lncRNAs•Rare variants near lncRNA expression outliers impact complex traits, like BMI•We identify 800 lncRNA-trait relationships not explained by protein-coding genesA systematic analysis of NIH Genotype Tissue Expression (GTEx) project data provides insights into lncRNA expression patterns and functions, explores the impact of genetic variation on lncRNAs, and connects lncRNAs to complex traits and human disease