An Intelligent Scheduling of Non-Critical Patients Admission for Emergency Department

The combination of the progressive growth of an aging population, increased life expectancy and a greater number of chronic diseases all contribute significantly to the growing demand for emergency medical care, and thus, causing saturation in Emergency Departments (EDs). This saturation is usually due to the admission of non-urgent patients, who constitute a high percentage of patients in an ED. The Agent-based Model (ABM) is one of the most important tools that helps to study complex systems and explores the emergent behavior of this type of department. Its simulation more accurately reflects the complexity of the operation of real systems. Our proposal is the design of an ABM to schedule the access of these non-critical patients into an ED, which can be useful for the service management dealing with the actual growing demand for emergency care. We suppose that a relocation of these non-critical patients within the expected input pattern, provided initially by historical records, enables a reduction in waiting time for all patients, and therefore, it will lead to an improvement in the quality of service. It would also allow us to avoid long waiting times. This research offers the availability of relevant knowledge for Emergency Department managers in order to help them make decisions to improve the quality of the service, in anticipation of the expected growing demand of the service in the very near future

Evaluation of response capacity to patient attention demand in an Emergency Department

The progressive growth of aging, increased life expectancy and a greater number of chronic diseases contribute significantly to the growing demand of emergency medical care, and thus, on saturation of Emergency Departments. This is one of the most important current problems in healthcare systems worldwide. This work proposes an analytical model to calculate the theoretical throughput of a particular sanitary staff configuration in a Hospital Emergency Department, which is, the number of patients it can attend per unit time given its composition. The analytical model validation is based on data generated by simulation of the real system, based on an agent based model of the system, which makes it possible to take into account different valid sanitary staff configurations and different number of patients entering the emergency service. In fact, we aim to evaluate the response capacity of an ED, specifically of doctors, nurses, admission and triage personnel, who make up a specific sanitary staff configuration, for any possible configuration, according to the patient flow throughout the service. It would not be possible to test the different possible situations in the real system and this is the main reason why we obtain the necessary information about the system performance for the validation of the model using a simulator as a sensor of the real system. The theoretical throughput is a measure of the response capacity to patient's attention in the system and, moreover, it will be a reference in order to make possible a model for planning the entry of non-critical patients into the service by its relocation in the current input pattern, which is an immediate future goal in our current research. This research offers the availability of relevant knowledge to the managers of the Emergency Departments to make decisions to improve the quality of the service in anticipation of the expected growing demand of the service in the very near future

Neuronal induction and bioenergetics characterization of human forearm adipose stem cells from Parkinson’s disease patients and healthy controls

Parkinson's disease; Stem regenerative medicine; BioenergeticsEnfermedad de Parkinson; Medicina regenerativa del tallo; BioenergéticaMalaltia de Parkinson; Medicina regenerativa de tija; BioenergèticaNeurodegenerative diseases, such as Parkinson's disease, are heterogeneous disorders with a multifactorial nature involving impaired bioenergetics. Stem-regenerative medicine and bioenergetics have been proposed as promising therapeutic targets in the neurologic field. The rationale of the present study was to assess the potential of human-derived adipose stem cells (hASCs) to transdifferentiate into neuronal-like cells (NhASCs and neurospheres) and explore the hASC bioenergetic profile. hASC neuronal transdifferentiation was performed through neurobasal media and differentiation factor exposure. High resolution respirometry was assessed. Increased MAP-2 neuronal marker protein expression upon neuronal induction (p<0.05 undifferentiated hASCs vs. 28-36 days of differentiation) and increased bIII-tubulin neuronal marker protein expression upon neuronal induction (p<0.05 undifferentiated hASCs vs. 6-28-36 days of differentiation) were found. The bioenergetic profile was detectable through high-resolution respirometry approaches in hASCs but did not lead to differential oxidative capacity rates in healthy or clinically diagnosed PD-hASCs. We confirmed the capability of transdifferentiation to the neuronal-like profile of hASCs derived from the forearms of human subjects and characterized the bioenergetic profile. Suboptimal maximal respiratory capacity trends in PD were found. Neuronal induction leading to positive neuronal protein expression markers is a relevant issue that encourages the suitability of NhASC models in neurodegeneration

Serum metabolic biomarkers for synucleinopathy conversion in isolated REM sleep behavior disorder

Neurodegeneració; Malaltia de Parkinson; Marcadors predictiusNeurodegeneración; Enfermedad de Parkinson; Marcadores predictivosNeurodegeneration; Parkinson's disease; Predictive markersIsolated rapid eye movement (REM) sleep behavior disorder (iRBD) is a prodromal stage of Lewy-type synucleinopathies (LTS), which can present either with an initial predominant parkinsonism (Parkinson’s disease (PD)) or dementia (dementia with Lewy bodies (DLB)). To provide insights into the underlying pathogenic mechanisms, the lipoprotein and protein glycosylation profile of 82 iRBD patients, collected before and/or after their conversion to an overt LTS, and 29 matched control serum samples were assessed by nuclear magnetic resonance (NMR) spectroscopy. Data were statistically analyzed to identify altered metabolites and construct predictive models. Univariant analysis detected no differences between iRBD patients with an LTS compared to controls. However, significant differences were found when the analysis distinguished between iRBD patients that manifested initially predominant parkinsonism (pre-PD) or dementia (pre-DLB). Significant differences were also found in the analysis of paired iRBD samples pre- and post-LTS diagnosis. Predictive models were built and distinguished between controls and pre-DLB patients, and between pre-DLB and pre-PD patients. This allowed a prediction of the possible future clinical outcome of iRBD patients. We provide evidence of altered lipoprotein and glycosylation profiles in subgroups of iRBD patients. Our results indicate that metabolic alterations and inflammation are involved in iRBD pathophysiology, and suggest biological differences underlying the progression of LTS in iRBD patients. Our data also indicate that profiling of serum samples by NMR may be a useful tool for identifying short-term high-risk iRBD patients for conversion to parkinsonism or dementia.The study was funded by the Fondo de Investigación Sanitaria-Instituto de Salud Carlos III (FIS-ISCIII, Spain)-European Regional Development Fund (FEDER, E.U.) (PI13/01897 to M.V.), Ministerio de Economía y Competitividad (MINECO, Spain) (SAF2015-73997-JIN to A.L. and SAF2016-77541-R to M.V.), Fundació Bancària La Caixa (Junior Leader Fellowship LCF/BQ/PR19/11700005 to A.L. and Health Research Project HR17-00513 to M.V.) and CIBERNED (to M.V. and E.T.). A.L. was the recipient of a postdoctoral contract SAF2015-73997-JIN from MINECO (Spain) with co-funding from FEDER (E.U.) and is currently funded by the Junior Leader Program from Fundació Bancària La Caixa (grant LCF/BQ/PR19/11700005). H.X. is the recipient of a Radboud University Personal Ph.D. Grant

Ultrasonografía transcraneal : utilidad en los Trastornos del Movimiento

El diagnóstico de enfermedad de Parkinson Idiopática (EPI) y otros trastornos del movimiento (TM) se basa en criterios clínicos, aunque la ultrasonografía transcraneal ha demostrado cierta utilidad en el diagnóstico. En este trabajo, describimos los hallazgos ultrasonográficos en 291 pacientes con TM y evaluamos su utilidad clínica. Encontramos que la hiperecogenicidad de la sustancia nigra (SN) es más frecuente y extensa en la EPI y que el área de hiperecogenicidad de la SN y el tamaño del tercer ventrículo son útiles para predecir EPI, parálisis supranuclear progresiva y atrofia multisistémica. Según nuestros resultados, la ultrasonografía transcraneal es una técnica complementaria válida y segura para el diagnóstico de EPI.Malgrat que el diagnòstic de malaltia de Parkinson Idiopática (MPI) i d'altres trastorns del moviment (TM) es fonamenta en criteris clínics, la ultrasonografía transcranial ha demostrat certa utilitat en el diagnòstic. En aquest treball, descrivim les troballes ultrasonográficas en 291 pacients amb TM i avaluem la seva utilitat clínica. Trobem que la hiperecogenicitat de la substància nigra (SN) és més freqüent i extensa en la MPI i que l'àrea de hiperecogenicitat de la SN i el tamany del tercer ventricle són útils per a predir MPI, paràlisi supranuclear progressiva i atròfia multisistémica. Segons els nostres resultats, la ultrasonografía transcranial és una tècnica complementària vàlida i segura per al diagnòstic de MPI

Infancias confinadas: construyendo la escuela desde la educación artística

[Resumen]: El presente trabajo tiene por objeto mantener la comunicación emocional entre las educadoras de la Escuela Infantil “Carmen Cervigón” de A Coruña y las familias, durante la etapa de confinamiento derivado de la Covid-19, para ello, se crea un canal de interacción, que permite a las familias expresar los miedos, las expectativas, los aprendizajes y las vivencias, de modo que éstas sean escuchadas, simbolizadas de modo artístico y sirvan de punto de partida, en la organización escolar del curso 2020-2021. Los mensajes obtenidos fueron analizados a través de la técnica cualitativa de panel Sun Woong (2008), adaptada por De Keulenaer (2008), para dar voz a la experiencia compartida por un conjunto de personas, de modo que, a partir del reconocimiento de la subjetividad individual nazca un relato común que ofrezca una descripción comunitaria de lo vivido. Dicha narración, una vez construida, se representó en una instalación de arte contemporáneo, con el fin de significar la memoria de lo acontecido y generar símbolo comunitario.[Abstract]: The purpose of this paper is to maintain emotional communication between the educators of the Infant School “Carmen Cervigón” in A Coruña and the families, during the lockdown stage derived from Covid-19, for this, an interaction channel is created, that allows families to express fears, expectations, learning experiences and life lessons so that they can be heard, symbolized in an artistic way so they can serve as a starting point, in the school organization of the 2020-2021 academic year. In order to achieve this, the obtained messages were analyzed through the qualitative panel technique Sun Woong, (2008), adapted by De Keulenaer, (2008), to give voice to the joined experience shared by a group of people, so that, from the recognition of the individual subjectivity a common story is born, which offers a communal description of what was lived. This narration, once built, was represented in a contemporary art installation, in order to signify the memory of what happened and generate a communal symbol

Periaqueductal gray matter echogenicity as a marker of migraine chronification : a case control study

Migraine is one of the most prevalent and disabling medical diseases in the world. The periaqueductal gray matter and the red nucleus play an important role in its pathogenesis. Our aim was to evaluate the echogenicity of the periaqueductal gray matter and the red nucleus in patients with migraine, by means of transcranial ultrasound. In this cross-sectional study, a group of patients with migraine (according to the International Classification of Headache Disorders) and a group of control subjects with comparable age-and-sex distribution were prospectively included. We evaluated the area and echogenicity of the periaqueductal gray matter and the red nucleus by means of transcranial ultrasound, both bedside and posteriorly analyzed with the medical image viewer Horos. We included 115 subjects: 65 patients with migraine (39 of them with chronic migraine and 26 with episodic migraine), and 50 controls. Median disease duration in patients with chronic migraine was 29 (IQR: 19; 40) years, with a median of 18 (IQR: 14; 27) days of migraine per month. The area of the periaqueductal gray matter was larger in patients with chronic migraine compared to episodic migraine and controls (0.15[95%CI 0.12;0.22]cm 2 ; 0.11[95%CI 0.10;0.14]cm 2 and 0.12[95%CI 0.09;0.15]cm 2, respectively; p = 0.043). Chronic migraine patients showed an intensity of the periaqueductal gray matter echogenicity lower than controls (90.57[95%CI 70.87;117.26] vs 109.56[95%CI 83.30;122.64]; p = 0.035). The coefficient of variation of periaqueductal gray matter echogenicity was the highest in chronic migraine patients (p = 0.009). No differences were observed regarding the area or intensity of red nucleus echogenicity among groups. Patients with chronic migraine showed a larger area of echogenicity of periaqueductal gray matter, a lower intensity of its echogenicity and a higher heterogenicity within this brainstem structure compared to patients with episodic migraine and controls. The echogenicity of the periaqueductal gray matter should be further investigated as a biomarker of migraine chronification. The online version contains supplementary material available at 10.1186/s10194-023-01576-3

Exploratory study on microRNA profiles from plasma-derived extracellular vesicles in Alzheimer's disease and dementia with Lewy bodies

Altres ajuts: This work was also supported by the MaratóTV3 grant 201405/10.Because of the increasing life expectancy in our society, aging-related neurodegenerative disorders are one of the main issues in global health. Most of these diseases are characterized by the deposition of misfolded proteins and a progressive cognitive decline. Among these diseases, Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) are the most common types of degenerative dementia. Although both show specific features, an important neuropathological and clinical overlap between them hampers their correct diagnosis. In this work, we identified molecular biomarkers aiming to improve the misdiagnosis between both diseases. Plasma extracellular vesicles (EVs) -from DLB, AD and healthy controls- were isolated using size-exclusion chromatography (SEC) and characterized by flow cytometry, Nanoparticle Tracking Analysis (NTA) and cryo-electron microscopy. Next Generation Sequencing (NGS) and related bibliographic search was performed and a selected group of EV-associated microRNAs (miRNAs) was analysed by qPCR. Results uncovered two miRNAs (hsa-miR-451a and hsa-miR-21-5p) significantly down-regulated in AD samples respect to DLB patients, and a set of four miRNAs (hsa-miR-23a-3p, hsa-miR-126-3p, hsa-let-7i-5p, and hsa-miR-151a-3p) significantly decreased in AD respect to controls. The two miRNAs showing decreased expression in AD in comparison to DLB provided area under the curve (AUC) values of 0.9 in ROC curve analysis, thus suggesting their possible use as biomarkers to discriminate between both diseases. Target gene analysis of these miRNAs using prediction online tools showed accumulation of phosphorylation enzymes, presence of proteasome-related proteins and genes involved in cell death among others. Our data suggest that plasma-EV associated miRNAs may reflect a differential profile for a given dementia-related disorder which, once validated in larger cohorts of patients, could help to improve the differential diagnosis of DLB versus AD. The online version of this article (10.1186/s40035-019-0169-5) contains supplementary material, which is available to authorized users

Expression Levels of an Alpha-Synuclein Transcript in Blood May Distinguish between Early Dementia with Lewy Bodies and Parkinson's Disease

Lewy body diseases (LBD) including dementia with Lewy bodies (DLB) and Parkinson disease (PD) are characterized by alpha-synuclein pathology. DLB is difficult to diagnose and peripheral biomarkers are urgently needed. Therefore, we analyzed the expression of five alpha-synuclein gene (SNCA) transcripts, SNCAtv1, SNCAtv2, SNCAtv3, SNCA126, and SNCA112, in 45 LBD and control temporal cortex samples and in the blood of 72 DLB, 59 PD, and 54 control subjects. The results revealed overexpression of SNCAtv1 and SNCA112 in DLB, and SNCAtv2 in PD temporal cortices. In DLB blood, diminution of all SNCA transcripts was observed. SNCAtv1 and SNCAtv2 were diminished in PD with disease onset before 70 years. SNCAtv3, driven by its own promoter, showed opposite expression in early DLB and PD, suggesting that its amount may be an early, DLB specific biomarker. Correlation between blood transcript levels and disease duration was positive in DLB and negative in PD, possibly reflecting differences in brain alpha-synuclein aggregation rates associated with differences in disease courses. In conclusion, SNCA transcripts showed a disease-specific increase in the brain and were diminished in blood of LBD patients. SNCAtv3 expression was decreased in early DLB and increased in early PD and could be a biomarker for early DLB diagnosis

Platelet miRNA Biosignature Discriminates between Dementia with Lewy Bodies and Alzheimer’s Disease

Dementia with Lewy bodies (DLB) is one of the most common causes of degenerative dementia, after Alzheimer's disease (AD), and presents pathological and clinical overlap with both AD and Parkinson's disease (PD). Consequently, only one in three DLB cases is diagnosed correctly. Platelets, previously related to neurodegeneration, contain microRNAs (miRNAs) whose analysis may provide disease biomarkers. Here, we profiled the whole platelet miRNA transcriptome from DLB patients and healthy controls. Differentially expressed miRNAs were further validated in three consecutive studies from 2017 to 2019 enrolling 162 individuals, including DLB, AD, and PD patients, and healthy controls. Results comprised a seven-miRNA biosignature, showing the highest diagnostic potential for the differentiation between DLB and AD. Additionally, compared to controls, two miRNAs were down-regulated in DLB, four miRNAs were up-regulated in AD, and two miRNAs were down-regulated in PD. Predictive target analysis identified three disease-specific clusters of pathways as a result of platelet-miRNA deregulation. Our cross-sectional study assesses the identification of a novel, highly specific and sensitive platelet-associated miRNA-based biosignature, which distinguishes DLB from AD