CD44-high neural crest stem-like cells are associated with tumour aggressiveness and poor survival in neuroblastoma tumours

BACKGROUND: Neuroblastoma is a paediatric tumour originated from sympathoadrenal precursors and characterized by its heterogeneity and poor outcome in advanced stages. Intra-tumoral cellular heterogeneity has emerged as an important feature in neuroblastoma, with a potential major impact on tumour aggressiveness and response to therapy. CD44 is an adhesion protein involved in tumour progression, metastasis and stemness in different cancers; however, there has been controversies about the significance of CD44 expression in neuroblastoma and its relationship with tumour progression. METHODS: We have performed transcriptomic analysis on patient tumour samples studying the outcome of patients with high CD44 expression. Adhesion, invasion and proliferation assays were performed in sorted CD44high neuroblastoma cells. Tumoursphere cultures have been used to enrich in undifferentiated stem-like cells and to asses self-renewal and differentiation potential. We have finally performed in vivo tumorigenic assays on cell line-derived or Patient-derived xenografts. FINDINGS: We show that high CD44 expression is associated with low survival in high-grade human neuroblastoma, independently of MYCN amplification. CD44 is expressed in a cell population with neural crest stem-like features, and with the capacity to generate multipotent, undifferentiated tumourspheres in culture. These cells are more invasive and proliferative in vitro. CD44 positive cells obtained from tumours are more tumorigenic and metastatic, giving rise to aggressive neuroblastic tumours at high frequency upon transplantation. INTERPRETATION: We describe an unexpected intra-tumoural heterogeneity within cellular entities expressing CD44 in neuroblastoma, and propose that CD44 has a role in neural crest stem-like undifferentiated cells, which can contribute to tumorigenesis and malignancy in this type of cancer. FUNDING: Research supported by grants from the "Asociación Española contra el Cáncer" (AECC), the Spanish Ministry of Science and Innovation SAF program (SAF2016-80412-P), and the European Research Council (ERC Starting Grant to RP).Spanish Ministry of Science and Innovation SAF program (SAF2016-80412-P

Percepción de la cultura de seguridad del paciente en enfermeros de atención primaria

Objetivo: describir la percepción que tienen 201 enfermeros en relación a la Seguridad del Paciente (SP) en sus centros, valorar cuáles son los puntos fuertes y las áreas de mejora en los Distritos Sanitarios de la provincia de Almería. Metodología: Se ha utilizado el cuestionario denominado MOSPSC (Medical Office Survey on Patient Safety Culture), traducido, adaptado y validado para profesionales españoles de Atención Primaria. A través del programa estadístico SPSS, se calculó la media y el intervalo de confianza al 95% de cada una de las dimensiones del cuestionario. Resultados: se observa una percepción positiva de la SP en casi todas las dimensiones, a excepción de la “Comunicación sobre el error”, el “Seguimiento de la atención a los pacientes”, la “Comunicación franca” y el “Ritmo y Carga de trabajo”. Uno de los puntos fuertes de los enfermeros es el “trabajo en equipo”. Conclusiones: Los resultados de esta investigación también han destacado “el intercambio de información con otros equipos”; en cambio, entre las áreas de mejora que deberían tenerse en cuenta se halla, “la Comunicación franca y sobre el error”. Estos resultados deberían ayudar a evaluar la importancia de la SP en las organizaciones, para dialogar sobre los errores y crear un clima de aprendizaje y deseo de mejora en los profesionales que repercuta en la calidad de la atención ofrecida a los usuarios

Consideraciones para una óptima salud en el puesto de trabajo

La ergonomía desempeña un papel creciente en la solución del problema de rehabilitación de personas que en una u otra medida han perdido la capacidad de trabajo; también se estudian las aptitudes y peculiaridades psíquicas y físicas de las personas de edad avanzada y de aquellos individuos considerados como trabajadores especialmente sensibles. Por ello los principios ergonómicos se aplican para optimizar las condiciones de trabajo en relación al bienestar de la persona, su salud y su seguridad, sin olvidar la eficiencia tecnológica y económica. El abordaje de los factores de riesgo que intervienen en la producción de problemas de espalda en los profesionales, incluye al ser humano en sentido integral, desde el punto de vista físico, psicológico y social. En nuestro trabajo nos vamos a centrar en los factores físicos principalmente, destacaremos la adopción de posturas forzadas, movimientos bruscos, así como la inadecuada preparación física y el sedentarismo en una profesión sanitaria, la del técnico en transporte sanitario. Pero no debemos dejar de hacer mención de los otros puntos de vista: el estrés laboral, el apremio de tiempo, que da lugar a que se trabaje con mayor ritmo y no precisamente adoptando posiciones correctas. Aspectos relacionados con la satisfacción laboral también acentúan el estrés y la tensión muscular. La ausencia de una formación preventiva adecuada respecto a técnicas de movilización de enfermos. La falta de personal en los centros de trabajo, que implican una sobrecarga; el deficiente o nulo uso de medios mecánicos adecuadamente diseñados desde el punto de vista ergonómico.Ergonomics plays an increasing role in solving the problem of rehabilitation of people have lost the ability to work, it also examines the skills and mental and physical peculiarities of the elderly and those individuals considered workers are particularly sensitive. Therefore apply ergonomic principles to optimize the conditions of work for the welfare of the person, their health and safety, not forgetting the technological and economic efficiency. The approach of the risk factors involved in the production of back problems in the professionals, including the human being in integral sense from the standpoint of physical, psychological and social. In our work we focus mainly on physical factors, we will highlight the adoption of awkward postures, sudden movements, as well as inadequate physical fitness and physical inactivity in a health profession, the technician in health transport. But we must not fail to mention the other points of view: work stress, time pressure, which leads you to work with greater pace and not just taking proper positions. Aspects related to job satisfaction also accentuate stress and muscle tension. The absence of adequate preventive training on techniques of mobilization of patients. The lack of staff in the workplace, resulting in an overload, the poor or no use of properly designed mechanical means from the ergonomic standpoint.peerReviewe

Coaching in clinical psychology: fundamental issues of possibilities and limits

En el texto se hace un abordaje de lo que es el Coaching, de las teorías dentro de la Psicología del que se basa éste y de su aplicabilidad en la Psicología clínica. Se podría definir el Coaching como el proceso interactivo y transparente mediante el cual el Coach o entrenador y la persona o grupo implicados en dicho proceso (Coachee) buscan el camino más eficaz para alcanzar los objetivos fijados usando sus propios recursos y habilidades. Esta definición se asemeja al rol que psicólogo y cliente adoptarían en las sesiones. Por lo cual, la psicología clínica ha empezado a interesarse por el proceso de Coaching en psicoterapia cómo una herramienta más a utilizar dentro de nuestro campo. De ahí la conveniencia de elaborar un modelo de intervención integrador con la inclusión del Coaching en población clínica. El “coaching” se hace interesante para la Psicología porque es una manera de intervenir con una persona. Esta manera de intervenir, propia del “coaching”, se aplica en los contextos naturales de la persona. En estos contextos naturales es donde se desarrolla e interacciona la persona con su medio. Es decir, que este modo de actuar con las técnicas adecuadas a cada caso se podría considerar muy positivo para aquellas personas que necesiten una intervención aplicada en sus contextos naturales.In this text we talk about Coaching, how it is based on psychological theories and its applicability in clinical psychology. The Coaching could be defined as the interactive and transparent process throught which the coach is the trainer and the coachee is the person that searches the better way to find his objective using its own resources and abilities. This definition is similar to the roll that psychologist and client would adopt in the sessions. Thus, clinical psychology has begun to be interested in the process of Coaching in psychotherapy, as one tool more to use within our field. Therefore, the convenience to ellaborate a model of intervention integrates coaching in clinical Psychology population. Coaching becomes interesting for psychologists because it is a way of intervention with the person. This way of intervention, own of coaching, it is applied in natural contexts of the person. In this natural contexts it is were the person with her atmosphere is developed and interacted. Therefore, this way to act with the techniques adapted to each case, it would be considered very positive for those people that they need an intervention applied in its natural contexts.peerReviewe

Coaching in clinical psychology: fundamental issues of possibilities and limits

En el texto se hace un abordaje de lo que es el Coaching, de las teorías dentro de la Psicología del que se basa éste y de su aplicabilidad en la Psicología clínica. Se podría definir el Coaching como el proceso interactivo y transparente mediante el cual el Coach o entrenador y la persona o grupo implicados en dicho proceso (Coachee) buscan el camino más eficaz para alcanzar los objetivos fijados usando sus propios recursos y habilidades. Esta definición se asemeja al rol que psicólogo y cliente adoptarían en las sesiones. Por lo cual, la psicología clínica ha empezado a interesarse por el proceso de Coaching en psicoterapia cómo una herramienta más a utilizar dentro de nuestro campo. De ahí la conveniencia de elaborar un modelo de intervención integrador con la inclusión del Coaching en población clínica. El “coaching” se hace interesante para la Psicología porque es una manera de intervenir con una persona. Esta manera de intervenir, propia del “coaching”, se aplica en los contextos naturales de la persona. En estos contextos naturales es donde se desarrolla e interacciona la persona con su medio. Es decir, que este modo de actuar con las técnicas adecuadas a cada caso se podría considerar muy positivo para aquellas personas que necesiten una intervención aplicada en sus contextos naturales.In this text we talk about Coaching, how it is based on psychological theories and its applicability in clinical psychology. The Coaching could be defined as the interactive and transparent process throught which the coach is the trainer and the coachee is the person that searches the better way to find his objective using its own resources and abilities. This definition is similar to the roll that psychologist and client would adopt in the sessions. Thus, clinical psychology has begun to be interested in the process of Coaching in psychotherapy, as one tool more to use within our field. Therefore, the convenience to ellaborate a model of intervention integrates coaching in clinical Psychology population. Coaching becomes interesting for psychologists because it is a way of intervention with the person. This way of intervention, own of coaching, it is applied in natural contexts of the person. In this natural contexts it is were the person with her atmosphere is developed and interacted. Therefore, this way to act with the techniques adapted to each case, it would be considered very positive for those people that they need an intervention applied in its natural contexts.peerReviewe

Calpain-5 gene variants are associated with diastolic blood pressure and cholesterol levels

BACKGROUND: Genes implicated in common complex disorders such as obesity, type 2 diabetes mellitus (T2DM) or cardiovascular diseases are not disease specific, since clinically related disorders also share genetic components. Cysteine protease Calpain 10 (CAPN10) has been associated with T2DM, hypertension, hypercholesterolemia, increased body mass index (BMI) and polycystic ovary syndrome (PCOS), a reproductive disorder of women in which isunlin resistance seems to play a pathogenic role. The calpain 5 gene (CAPN5) encodes a protein homologue of CAPN10. CAPN5 has been previously associated with PCOS by our group. In this new study, we have analysed the association of four CAPN5 gene variants(rs948976A>G, rs4945140G>A, rs2233546C>T and rs2233549G>A) with several cardiovascular risk factors related to metabolic syndrome in general population. METHODS: Anthropometric measurements, blood pressure, insulin, glucose and lipid profiles were determined in 606 individuals randomly chosen from a cross-sectional population-based epidemiological survey in the province of Segovia in Central Spain (Castille), recruited to investigate the prevalence of anthropometric and physiological parameters related to obesity and other components of the metabolic syndrome. Genotypes at the four polymorphic loci in CAPN5 gene were detected by polymerase chain reaction (PCR). RESULTS: Genotype association analysis was significant for BMI (p ≤ 0.041), diastolic blood pressure (p = 0.015) and HDL-cholesterol levels (p = 0.025). Different CAPN5 haplotypes were also associated with diastolic blood pressure (DBP) (0.0005 ≤ p ≤ 0.006) and total cholesterol levels (0.001 ≤ p ≤ 0.029). In addition, the AACA haplotype, over-represented in obese individuals, is also more frequent in individuals with metabolic syndrome defined by ATPIII criteria (p = 0.029). CONCLUSION: As its homologue CAPN10, CAPN5 seems to influence traits related to increased risk for cardiovascular diseases. Our results also may suggest CAPN5 as a candidate gene for metabolic syndrome

Consenso mexicano sobre detección y tratamiento del cáncer gástrico incipiente

El cáncer gástrico representa una de las neoplasias más frecuentes en el aparato digestivo y en la mayoría de los casos es el resultado de la progresión de lesiones premalignas. La detección oportuna de estas lesiones es relevante ya que un tratamiento oportuno brinda la posibilidad de curación. En nuestro país no existía un consenso respecto a la detección temprana del cáncer gástrico, por lo que la Asociación Mexicana de Gastroenterología reunió aun grupo de expertos y realizó el Consenso sobre detección y tratamiento del cáncer gástricoincipiente (CGI) para establecer recomendaciones de utilidad para la comunidad médica. Eneste consenso se utilizó la metodología Delphi y se emitieron 38 recomendaciones al respectodel CGI. El consenso define el CGI como aquel que al momento del diagnóstico se encuentralimitado a la mucosa y a la submucosa, independientemente de metástasis en ganglios linfáticos.En México, como otras partes del mundo, los factores asociados al CGI incluyen la infección porHelicobacter pylori, los antecedentes familiares, el tabaquismo y los factores dietéticos. Para eldiagnóstico se recomienda utilizar cromoendoscopia, magnificación y equipos con luz mejorada.Un diagnóstico histopatológico preciso es invaluable para tomar de decisiones terapéuticas. Eltratamiento endoscópico del CGI, ya sea disección o resección de la mucosa, debe ser preferidoal manejo quirúrgico cuando se puedan obtener resultados semejantes en términos de curaciónoncológica. La vigilancia endoscópica se deberá de individualizar

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

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection