Real-World Attainment of Low-Density Lipoprotein Cholesterol Goals in Patients at High Risk of Cardiovascular Disease Treated with High-Intensity Statins: The TERESA Study

Despite steady improvements in cardiovascular disease (CVD) prevention, a scarce proportion of patients achieve the recommended LDL-C goals, even under high-intensity lipid-lowering therapy (LLT). Our study aimed to evaluate the attainment rate of LDL-C targets recommended by the 2019 European guidelines, and to characterize potential factors associated with LDL-C goal achievement and change patterns in LLT. We conducted a retrospective, observational study on patients treated with high-intensity atorvastatin or rosuvastatin +/- ezetimibe at cardiology and internal medicine clinics across Spain. It included 1570 evaluable patients (median age: 62 years; established CVD: 77.5% [myocardial infarction: 34.3%]; and 85.8% at very high cardiovascular risk). Rosuvastatin +/- ezetimibe was the LLT in 52.2% of patients, and atorvastatin +/- ezetimibe in 47.8%. LLT had been modified in 36.8% of patients (side effects: 10%), being the most common switch from atorvastatin- to rosuvastatin-based treatment (77.2%). The risk-based LDL-C goal attainment rate was 31.1%, with 78.2% high-risk and 71.7% very high-risk patients not achieving the recommended LDL-C targets. Established CVD and familial hypercholesterolemia were significantly associated with the non-achievement of LDL-C goals. Although having limitations, this study shows that the guideline-recommended LDL-C goal attainment rate is still suboptimal despite using high-intensity statin therapy in a real-world setting in Spain

Residual Compressive Strength of Recycled Aggregate Concretes after High Temperature Exposure

Sustainability requirements are gaining importance in the construction industry, which needs to take specific measures in the design and construction of concrete structures. The use of recycled aggregates in concrete may be of special interest. Recycling a construction waste will close the life cycle of the original materials (e.g., concrete). Thus, environmental benefits would come from the lower waste generation, and from a lower necessity of raw materials for new structures. The current Spanish code for structural concrete considers the use of recycled aggregates in replacement rates up to 20% by aggregate mass, assimilating their properties with those of concretes without aggregate replacement. Higher substitution percentages would require further testing. In this work, substitution of coarse aggregate for recycled aggregates (with replacement percentages of 25%, 50% and 100%) has been studied, and the concrete’s residual properties after exposure to high temperatures (between 350 °C and 850 °C) have been assessed. Compressive strength and capillary water absorption tests were made after heating, and the experiments showed higher residual strength in concretes with the greatest content of recycled aggregates. However, a statistical analysis made with additional data available in the literature seemed to predict otherwise, and the recycled aggregate replacement would have a negative effect on the residual strength.This research was funded by Generalitat Valenciana, grant number GV/2018/015

Panorama epidemiológico de exposición a plaguicidas inhibidores de colinesterasa en 17 departamentos del país

Organophosphorates and carbamates are responsible for the greater part of the pesticide poisonings which are presented in the country. They are potent inhibitors of the acetylcholinesterase enzyme, causing serious acute work-related poisoning as well as long term effects. In 1982, faced by this problem, the Instituto Nacional de Salud (INS), through its Environrnental Health Laboratory (Laboratorio de Salud Ambientao created the epidemiological vigilance for organophosphorate and carbamate pesticides (Programa de Vigilancia Epidemiológica de Plaguicidas Organofosforados y Carbarnatos (VEO)), employing the Lovibond method to determine acetylcholinesterase (ACHE) as indicator, in order to detect cases of high pesticide absorption. From 1993 onwards, information from 17 of the countty's departments was ready, this being the data which was analysed. The total number of people who participated in the study during the years 1993 to 1995 was 41,899, al1 of whom had antecedents of exposure to organophosphorate or catbarnate pesticides 80% of the workers who participated in the study were male, the age-group rnost affected being 18 to 40 years old. The greatest prevalence of ACHE abnormality, according to economic activity, was for urban application and related to the jobs of mixer-sprayerwarehousing. In relation to the social security of the 23,917 workers, only 31.7% were found to be afiiliated to this type of entity. The data obtained allowed an epidemiological panorama to be established concerning poisoning by cholinesterase inhibitor pesticides, thus determining the population at greatest risk, which will lead to new research studies of this population.Los organofosforados y carbamatos son los responsables de la mayor parte de intoxicaciones por plaguicidas que se presentan en el país; son potentes inhibidores de la enzima acetilcolinesterasa, causando graves intoxicaciones agudas de tipo laboral como también efectos a largo plazo. Ante esta problemática, en 1982, el lnstituto Nacional de Salud (INS), a través del Laboratorio de Salud Ambiental creó el Programa de Vigilancia Epidemiológica de plaguicidas organofosforados y carbamatos (VEO), empleando el método Lovibond para la determinación de la acetilcolinesterasa (ACHE) como indicador, con el fin de detectar precozmente los casos de absorción elevada de plaguicidas. A partir de 1993, se cuenta con información de 17 departamentos del país, datos que se analizaron La totalidad de las personas que participó en el estudio de 1993 a 1995 fueron 41.899, las cuales tenían antecedentes de exposición a plaguicidas organofosforados o carbamatos. El 80% de los trabajadores que ingresaron al estudio pertenecían al género masculino, siendo el grupo de edad más afectado el de 18 a 40 años. Las mayores prevalencias de anormalidad para ACHE, según actividad económica, fue para la aplicación urbana y en relación a los oficios, para mezclador-tanqueador-formulador. Con relación a la seguridad social de 23.917 trabajadores, tan sólo 31,7% se encontraba afiliada a entidades de este tipo. Los datos obtenidos permitieron establecer el panorama epidemiológico de la intoxicación por plaguicidas inhibidores de colinesterasa, determinando la población de mayor riesgo, lo que conllevará a plantear nuevos estudios de investigación en esta población

La gestión de información y la infotecnología en la formación del profesional de las Ciencias Económicas y Empresariales

Se analizó la gestión de información y su relación con la infotecnología para la formación profesional del estudiante de la carrera Licenciatura en Economía. Se evidenció la necesidad de desarrollar sistemáticamente la habilidad gestión de información durante el proceso formativo del alumno. Se elaboró una estrategia basada en la realización de actividades con el uso de herramientas infotecnológicas que fomente el conocimiento de mecanismos para: la navegación, la búsqueda, la revisión, el procesamiento y la socialización de la información en formato digital

A predictive model and risk factors for case fatality of covid-19

This study aimed to create an individualized analysis model of the risk of intensive care unit (ICU) admission or death for coronavirus disease 2019 (COVID-19) patients as a tool for the rapid clinical management of hospitalized patients in order to achieve a resilience of medical resources. This is an observational, analytical, retrospective cohort study with longitudinal follow-up. Data were collected from the medical records of 3489 patients diagnosed with COVID-19 using RT-qPCR in the period of highest community transmission recorded in Europe to date: February–June 2020. The study was carried out in in two health areas of hospital care in the Madrid region: the central area of the Madrid capital (Hospitales de Madrid del Grupo HM Hospitales (CH-HM), n = 1931) and the metropolitan area of Madrid (Hospital Universitario Príncipe de Asturias (MH-HUPA) n = 1558). By using a regression model, we observed how the different patient variables had unequal importance. Among all the analyzed variables, basal oxygen saturation was found to have the highest relative importance with a value of 20.3%, followed by age (17.7%), lymphocyte/leukocyte ratio (14.4%), CRP value (12.5%), comorbidities (12.5%), and leukocyte count (8.9%). Three levels of risk of ICU/death were established: low-risk level (20%). At the high-risk level, 13% needed ICU admission, 29% died, and 37% had an ICU–death outcome. This predictive model allowed us to individualize the risk for worse outcome for hospitalized patients affected by COVID-19

Autoregulatory loop of nuclear corepressor 1 expression controls invasion, tumor growth, and metastasis

Nuclear corepressor 1 (NCoR) associates with nuclear receptors and other transcription factors leading to transcriptional repression. We show here that NCoR depletion enhances cancer cell invasion and increases tumor growth and metastatic potential in nude mice. These changes are related to repressed transcription of genes associated with increased metastasis and poor prognosis in patients. Strikingly, transient NCoR silencing leads to heterochromatinization and stable silencing of the NCoR gene, suggesting that NCoR loss can be propagated, contributing to tumor progression even in the absence of NCoR gene mutations. Down-regulation of the thyroid hormone receptor β1 (TRβ) appears to be associated with cancer onset and progression. We found that expression of TRβ increases NCoR levels and that this induction is essential in mediating inhibition of tumor growth and metastasis by this receptor. Moreover, NCoR is down-regulated in human hepatocarcinomas and in the more aggressive breast cancer tumors, and its expression correlates positively with that of TRβ. These data provide a molecular basis for the anticancer actions of this corepressor and identify NCoR as a potential molecular target for development of novel cancer therapiesThis work was supported by Grants BFU2011-28058 and BFU2014-53610-P from Ministerio de Economía y Competitividad; Grant S2011/BMD-2328 from the Comunidad de Madrid; Grant RD12/0036/0030 from the Instituto de Salud Carlos III (to A.A.); Grants PI080971 and RD12 0036/0064 from the Instituto de Salud Carlos III (to J.P.); and Grant PI12/00386 from the Instituto de Salud Carlos III (to I.I.d.C.). O.A.M.-I. is supported by an Asociación Española Contra el Cáncer contrac

A Predictive Model and Risk Factors for Case Fatality of COVID-19

This study aimed to create an individualized analysis model of the risk of intensive care unit (ICU) admission or death for coronavirus disease 2019 (COVID-19) patients as a tool for the rapid clinical management of hospitalized patients in order to achieve a resilience of medical resources. This is an observational, analytical, retrospective cohort study with longitudinal follow-up. Data were collected from the medical records of 3489 patients diagnosed with COVID-19 using RT-qPCR in the period of highest community transmission recorded in Europe to date: February-June 2020. The study was carried out in in two health areas of hospital care in the Madrid region: the central area of the Madrid capital (Hospitales de Madrid del Grupo HM Hospitales (CH-HM), n = 1931) and the metropolitan area of Madrid (Hospital Universitario Príncipe de Asturias (MH-HUPA) n = 1558). By using a regression model, we observed how the different patient variables had unequal importance. Among all the analyzed variables, basal oxygen saturation was found to have the highest relative importance with a value of 20.3%, followed by age (17.7%), lymphocyte/leukocyte ratio (14.4%), CRP value (12.5%), comorbidities (12.5%), and leukocyte count (8.9%). Three levels of risk of ICU/death were established: low-risk level (20%). At the high-risk level, 13% needed ICU admission, 29% died, and 37% had an ICU-death outcome. This predictive model allowed us to individualize the risk for worse outcome for hospitalized patients affected by COVID-19

The Use of Corticosteroids or Tocilizumab in COVID-19 Based on Inflammatory Markers

SEMI-COVID-19 Network.[Background] The inflammatory cascade is the main cause of death in COVID-19 patients. Corticosteroids (CS) and tocilizumab (TCZ) are available to treat this escalation but which patients to administer it remains undefined.[Objective] We aimed to evaluate the efficacy of immunosuppressive/anti-inflammatory therapy in COVID-19, based on the degree of inflammation. .[Design] A retrospective cohort study with data on patients collected and followed up from March 1st, 2020, to May 1st, 2021, from the nationwide Spanish SEMI-COVID-19 Registry. Patients under treatment with CS vs. those under CS plus TCZ were compared. Effectiveness was explored in 3 risk categories (low, intermediate, high) based on lymphocyte count, C-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, and d-dimer values.[Patients] A total of 21,962 patients were included in the Registry by May 2021. Of these, 5940 met the inclusion criteria for the present study (5332 were treated with CS and 608 with CS plus TCZ).[Main Measures] The primary outcome of the study was in-hospital mortality. Secondary outcomes were the composite variable of in-hospital mortality, requirement for high-flow nasal cannula (HFNC), non-invasive mechanical ventilation (NIMV), invasive mechanical ventilation (IMV), or intensive care unit (ICU) admission.[Key Results] A total of 5940 met the inclusion criteria for the present study (5332 were treated with CS and 608 with CS plus TCZ). No significant differences were observed in either the low/intermediate-risk category (1.5% vs. 7.4%, p=0.175) or the high-risk category (23.1% vs. 20%, p=0.223) after propensity score matching. A statistically significant lower mortality was observed in the very high–risk category (31.9% vs. 23.9%, p=0.049).[Conclusions] The prescription of CS alone or in combination with TCZ should be based on the degrees of inflammation and reserve the CS plus TCZ combination for patients at high and especially very high risk.Peer reviewe

Expression and activity profiles of DPP IV/CD26 and NEP/CD10 glycoproteins in the human renal cancer are tumor-type dependent

[Background] Cell-surface glycoproteins play critical roles in cell-to-cell recognition, signal transduction and regulation, thus being crucial in cell proliferation and cancer etiogenesis and development. DPP IV and NEP are ubiquitous glycopeptidases closely linked to tumor pathogenesis and development, and they are used as markers in some cancers. In the present study, the activity and protein and mRNA expression of these glycoproteins were analysed in a subset of clear-cell (CCRCC) and chromophobe (ChRCC) renal cell carcinomas, and in renal oncocytomas (RO).[Methods] Peptidase activities were measured by conventional enzymatic assays with fluorogen-derived substrates. Gene expression was quantitatively determined by qRT-PCR and membrane-bound protein expression and distribution analysis was performed by specific immunostaining.Peer reviewe

Bladder cancer index: cross-cultural adaptation into Spanish and psychometric evaluation

BACKGROUND: The Bladder Cancer Index (BCI) is so far the only instrument applicable across all bladder cancer patients, independent of tumor infiltration or treatment applied. We developed a Spanish version of the BCI, and assessed its acceptability and metric properties. METHODS: For the adaptation into Spanish we used the forward and back-translation method, expert panels, and cognitive debriefing patient interviews. For the assessment of metric properties we used data from 197 bladder cancer patients from a multi-center prospective study. The Spanish BCI and the SF-36 Health Survey were self-administered before and 12 months after treatment. Reliability was estimated by Cronbach's alpha. Construct validity was assessed through the multi-trait multi-method matrix. The magnitude of change was quantified by effect sizes to assess responsiveness. RESULTS: Reliability coefficients ranged 0.75-0.97. The validity analysis confirmed moderate associations between the BCI function and bother subscales for urinary (r = 0.61) and bowel (r = 0.53) domains; conceptual independence among all BCI domains (r ≤ 0.3); and low correlation coefficients with the SF-36 scores, ranging 0.14-0.48. Among patients reporting global improvement at follow-up, pre-post treatment changes were statistically significant for the urinary domain and urinary bother subscale, with effect sizes of 0.38 and 0.53. CONCLUSIONS: The Spanish BCI is well accepted, reliable, valid, responsive, and similar in performance compared to the original instrument. These findings support its use, both in Spanish and international studies, as a valuable and comprehensive tool for assessing quality of life across a wide range of bladder cancer patients