Disfuncion renal crónica postrasplante hepático

La disfunción renal crónica(DRC) postrasplante hepático(posTOH), es una complicación que oscila entre el 25 y el 45% a los 10 años. Aunque el mejor control de los factores asociados tanto pre como posTOH y el mejor manejo de la inmunosupresión parecen haber hecho disminuir la incidencia, no hay muchos estudios que lo demuestren OBJETIVO: Conocer la tasa de DRC en un grupo de pacientes trasplantados hepáticos en los últimos 14 años, comparar los resultados con series históricas y e identificar los factores asociados a la aparición de DRC posTOH. MATERIAL Y METODOS Estudiamos retrospectivamente la evolución de 386 pacientes trasplantados en nuestro Centro desde el noviembre de 2001 hasta el 31 de diciembre de 2013. Todos los pacientes tenían al menos un año de seguimiento. Se excluyeron a los pacientes que precisaron retrasplante y se consideró pérdida del paciente. Estudiamos la Tasa de Filtrado Glomerular(TFG) mediante MDRD-4 inmediatamente pretrasplante, el peor valor en el postoperatorio inmediato(POI), al tercer mes, al año, cinco y diez años posTOH. Consideramos DRC TFG<60 mL/min/1,73m2. Además recogimos los niveles medios de inmunosupresión en los mismos periodos del estudioDepartamento de Medicina, Dermatología y Toxicologí

El sector emprendedor de las TIC, el comercio electrónico y la colaboración con usuarios: efectos sobre el resultado innovador de la empresa

pp. 87-102El extraordinario avance que han experimentado las tecnologías de la información y las comunicaciones (TIC) durante las últimas décadas y la enorme variedad de sus aplicaciones ha provocado importantes cambios sociales y económicos. Sus efectos no solo afectan a las empresas que las emplean, sino que también repercuten sobre el conjunto del sistema económico.S

Efeitos da colaboração com clientes sobre o tipo de inovação desenvolvido

Recentemente, a colaboração com usuários para o desenvolvimento de inovações tem adquirido uma notável relevância tanto no mundo acadêmico como empresarial. Prova disso é o aumento de pesquisas publicadas sobre esta matéria e que cada vez mais empresas optam por esta estratégia para desenvolver inovações. Não obstante, ainda são muitos os aspectos deste fenômeno que necessitam ser pesquisados mais a fundo. Uma dessas questões, e que constitui o objetivo principal deste trabalho, é o estudo dos efeitos da colaboração com usuários sobre o output inovador da empresa. Mais concretamente, se tem analisado a influência que tem esta colaboração sobre a probabilidade de obter dois tipos de inovações: de produto e de processo. Assim, a partir de dos modelos Probit Bivariáveis e utilizando uma mostra de 11.881 empresas manufatureiras espanholas durante o período 1998-2005, tem-se observado empiricamente que na Espanha, tanto o simples fato de colaborar tecnologicamente com usuários como a intensidade/continuidade dessa colaboração influem positivamente no desenvolvimento de ambos tipos de inovações.Récemment, la collaboration avec les utilisateurs pour le développement d'innovations a acquis une grande importance dans le milieu académique tout comme dans l'entreprise. Ceci est prouvé par l'augmentation de recherches publiées sur ce thème et par le fait qu'un nombre croissant d'entreprises décide d'utiliser cette stratégie pour développer des innovations. Cependant, de nombreux aspects de ce phénomène doivent encore être soumis à la recherche. Une des questions qui constitue également l'objet principal de ce travail consiste dans l'étude des effets de la collaboration avec les utilisateurs sur le résultat innovateur de l'entreprise. D'une façon plus concrète, l'influence de cette collaboration a été analysée sur la probabilité d'obtenir deux types d'innovations : innovation de produits et innovation de processus. À partir de deux modèles Probit Bivariants et utilisant un échantillon de 11.881 entreprises manufacturières espagnoles durant la période 1998-2005, des observations empiriques ont démontré qu'en Espagne, le simple fait de collaborer technologiquement avec les usagers tout comme l'intensité/continuité de cette collaboration ont une influence positive sur le développement des deux types d'innovations.Cooperating with users for developing innovation has currently acquired noteworthy importance in both the academic and business worlds. The proof of this lies in the increasing number of research articles about this topic which have been published in recent years; more firms are now using this strategy for developing innovation. However, many aspects of this phenomenon demand deeper analysis. One such question (constituting the present paper's main objective) concerns studying the effects of cooperating with users in terms of firms' innovation output; the influence of such cooperation on the likelihood of obtaining two types of innovation has thus been analysed: product innovation compared to process innovation. Two bivariate probit models and a sample of 11,881 Spanish manufacturing firms from 1998-2005 have been used to demonstrate that cooperating with users in Spain, as well as the intensity/continuity of such relationship, has had a positive influence on developing both kinds of innovation.Recientemente, la colaboración con usuarios para el desarrollo de innovaciones ha adquirido una notable relevancia tanto en el mundo académico como en el empresarial. Prueba de ello es el aumento de investigaciones publicadas sobre esta materia y que cada vez más empresas optan por esta estrategia para desarrollar innovaciones. No obstante, aún son muchos los aspectos de este fenómeno que necesitan ser investigados más a fondo. Una de esas cuestiones -y que constituye el objetivo principal de este trabajo-, es el estudio de los efectos de la colaboración con usuarios sobre el output innovador de la empresa. Más concretamente, se ha analizado la influencia que tiene esta colaboración sobre la probabilidad de obtener dos tipos de innovaciones: de producto y de proceso. Así, a partir de dos modelos Probit Bivariantes y utilizando una muestra de 11.881 empresas manufactureras españolas a lo largo del periodo 1998-2005, se ha observado empíricamente que en España, tanto el simple hecho de colaborar tecnológicamente con usuarios como la intensidad/continuidad de esa colaboración influyen positivamente en el desarrollo de ambos tipos de innovaciones

Efectos de la colaboración con usuarios sobre el tipo de innovación desarrollado

pp. 87-110Recientemente, la colaboración con usuarios para el desarrollo de innovaciones ha adquirido una notable relevancia tanto en el mundo académico como en el empresarial. Prueba de ello es el aumento de investigaciones publicadas sobre esta materia y que cada vez más empresas optan por esta estrategia para desarrollar innovaciones. No obstante, aún son muchos los aspectos de este fenómeno que necesitan ser investigados más a fondo. Una de esas cuestiones –y que constituye el objetivo principal de este trabajo–, es el estudio de los efectos de la colaboración con usuarios sobre el output innovador de la empresa. Más concretamente, se ha analizado la influencia que tiene esta colaboración sobre la probabilidad de obtener dos tipos de innovaciones: de producto y de proceso. Así, a partir de dos modelos Probit Bivariantes y utilizando una muestra de 11.881 empresas manufactureras españolas a lo largo del periodo 1998-2005, se ha observado empíricamente que en España, tanto el simple hecho de colaborar tecnológicamente con usuarios como la intensidad/continuidad de esa colaboración influyen positivamente en el desarrollo de ambos tipos de innovaciones.S

Fuentes externas de información para el desarrollo de innovaciones: un análisis de la evidencia en Europa y España

p. 181-238La creciente complejidad y dinamismo que caracterizan los entornos actuales han obligado a las empresas a complementar su base interna de conocimientos con otros procedentes del exterior. Así, entre las diversas alternativas existentes, la cooperación con clientes y usuarios en materia de innovación se perfila como una de las más importantes fuentes de ideas innovadoras. Por este motivo, el presente trabajo profundiza en el análisis de distintas fuentes de información utilizadas por empresas europeas y españolas para el desarrollo de innovaciones, resaltando la importancia de las aportaciones realizadas por estos agentes. La investigación se completa con un estudio empírico en el que se compara la influencia de cuatro tipos de cooperación (con clientes, proveedores, universidades y expertos/ firmas consultoras) sobre la intensidad de la actividad innovadora en un conjunto de veinte sectores productivos españoles. De él se desprende que la colaboración con clientes para el desarrollo de innovaciones incide significativamente sobre dicha intensidad y que es un buen indicador de la importancia que la organización otorga a estas actividades.S

Role of Rapid Antigen Testing in Population-Based SARS-CoV-2 Screening

Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).[EN] This study evaluates a population‐based screening of asymptomatic people, using a rapid antigen diagnostic test (RADT), in areas of high transmission. To detect sources of SARS‐CoV‐2 infection, nasopharyngeal samples were taken and were tested using RADT. Confirmatory RT-qPCR tests were performed in both positive and negative cases. The internal validity of the RADT, the prevalence of infection, and the positive and negative predictive values (PPV and NPV) were estimated, based on the percentages of confirmed cases with 95% confidence interval.. Of the 157,920 people registered, 50,492 participated in the screening; 50,052 were negative, and 440 were positive on the RADT (0.87%). A total of 221 positive RADT samples were reanalysed using RT-qPCR and 214 were confirmed as positive (96.8%; 95% CI: 93.5–98.7%), while 657 out of 660 negative RADT samples were confirmed as RT‐qPCR negative (99.5%; 95% CI 98.7–99.9%). The sensitivity obtained was 65.1% (38.4–90.2%) and the specificity was 99.97% (99.94–99.99%). The prevalence of infection was 1.30% (0.95–2.13%). The PPVs were 95.4% (85.9–98.9%) and 97.9% (93.3–99.5%), respectively, while the NPVs were 99.7% (99.4–100%) and 99.2% (98.7–100%), respectively. The high specificity found allow us to report a high screening performance in asymptomatic patients, even in areas where the prevalence of infection was less than 2%.SIThis research received no external funding.Authors are grateful the collaboration of the Primary Care Management and all workers and volunteers who participated in the screenings

Tenofovir vs lamivudine plus adefovir in chronic hepatitis B: TENOSIMP-B study

AIM To demonstrate the non-inferiority (15% non-inferiority limit) of monotherapy with tenofovir disoproxil fumarate (TDF) vs the combination of lamivudine (LAM) plus adefovir dipivoxil (ADV) in the maintenance of virologic response in patients with chronic hepatitis B (CHB) and prior failure with LAM. METHODS This study was a Phase IV prospective, randomized, open, controlled study with 2 parallel groups (TDF and LAM+ADV) of adult patients with hepatitis B e antigen (HBeAg)-negative CHB, prior failure with LAM, on treatment with LAM+ADV for at least 6 mo, without prior resistance to ADV and with an undetectable viral load at the start of the study, in 14 Spanish hospitals. The follow-up time for each patient was 48 wk after randomization, with quarterly visits in which the viral load, biochemical and serological parameters, adverse effects, adherence to treatment and consumption of hospital resources were analysed. RESULTS Forty-six patients were evaluated [median age: 55.4 years (30.2-75.2); 84.8% male], including 22 patients with TDF and 24 with LAM+ADV. During study development, hepatitis B virus DNA (HBV-DNA) remained undetectable, all patients remained HBeAg negative, and hepatitis B surface antigen (HBsAg) positive. Alanine aminotransferase (ALT) values at the end of the study were similar in the 2 groups (25.1 ± 7.65, TDF vs 24.22 ± 8.38, LAM+ADV, P = 0.646). No significant changes were observed in creatinine or serum phosphorus values in either group. No significant differences between the 2 groups were noted in the identification of adverse effects (AEs) (53.8%, TDF vs 37.5%, LAM+ADV, P = 0.170), and none of the AEs which occurred were serious. Treatment adherence was 95.5% and 83.3% in the TDF and the LAM+ADV groups, respectively (P = 0.488). The costs associated with hospital resource consumption were significantly lower with the TDF treatment than the LAM+ADV treatment (€4943 ± 1059 vs €5811 ± 1538, respectively, P < 0.001). CONCLUSION TDF monotherapy proved to be safe and not inferior to the LAM+ADV combination therapy in maintaining virologic response in patients with CHB and previous LAM failure. In addition, the use of TDF generated a significant savings in hospital costs

Everolimus plus minimized tacrolimus on kidney function in liver transplantation: REDUCE, a prospective, randomized controlled study

Background and aim: reduction in calcineurin inhibitor levels is considered crucial to decrease the incidence of kidney dysfunction in liver transplant (LT) recipients. The aim of this study was to evaluate the safety and impact of everolimus plus reduced tacrolimus (EVR + rTAC) vs. mycophenolate mofetil plus tacrolimus (MMF + TAC) on kidney function in LT recipients from Spain. Methods: the REDUCE study was a 52-week, multicenter, randomized, controlled, open-label, phase 3b study in de novo LT recipients. Eligible patients were randomized (1:1) 28 days post-transplantation to receive EVR + rTAC (TAC levels <_ 5 ng/mL) or to continue with MMF + TAC (TAC levels = 6-10 ng/mL). Mean estimated glomerular filtration rate (eGFR), clinical benefit in renal function, and safety were evaluated. Results: in the EVR + rTAC group (n = 105), eGFR increased from randomization to week 52 (82.2 [28.5] mL/min/1.73 m2 to 86.1 [27.9] mL/min/1.73 m2) whereas it decreased in the MMF + TAC (n = 106) group (88.4 [34.3] mL/min/1.73 m2 to 83.2 [25.2] mL/min/1.73 m2), with significant (p < 0.05) differences in eGFR throughout the study. However, both groups had a similar clinical benefit regarding renal function (improvement in 18.6 % vs. 19.1 %, and stabilization in 81.4 % vs. 80.9 % of patients in the EVR + rTAC vs. MMF + TAC groups, respectively). There were no significant differences in the incidence of acute rejection (5.7 % vs. 3.8 %), deaths (5.7 % vs. 2.8 %), and serious adverse events (51.9 % vs. 44.0 %) between the 2 groups. Conclusion: EVR + rTAC allows a safe reduction in tacrolimus exposure in de novo liver transplant recipients, with a significant improvement in eGFR but without significant differences in renal clinical benefit 1 year after liver transplantation

High efficacy of Sofosbuvir plus Simeprevir in a large cohort of Spanish cirrhotic patients infected with genotypes 1 and 4

[Abstract] Background and Aims. Hepatitis C (HCV) therapy with Sofosbuvir (SOF)/Simeprevir (SMV) in clinical trials and real‐world clinical practice, showed high rates of sustained virological response (SVR) in non‐cirrhotic genotype (GT)‐1 and GT‐4 patients. These results were slightly lower in cirrhotic patients. We investigated real‐life effectiveness and safety of SOF/SMV with or without ribavirin (RBV) in a large cohort of cirrhotic patients. Methods. This collaborative multicentre study included data from 968 patients with cirrhosis infected with HCV‐GT1 or 4, treated with SOF/SMV±RBV in 30 centres across Spain between January‐2014 and December‐2015. Demographic, clinical, virological and safety data were analysed. Results. Overall SVR was 92.3%; the majority of patients were treated with RBV (62%) for 12 weeks (92.4%). No significant differences in SVR were observed between genotypes (GT1a:94.3%; GT1b:91.7%; GT4:91.1%). Those patients with more advanced liver disease (Child B/C, MELD≥10) or portal hypertension (platelet count≤100×109/L, transient elastography≥21 Kpa) showed significantly lower SVR rates (84.4%‐91.9%) than patients with less advanced liver disease (93.8%‐95.9%, P<.01 in all cases). In the multivariate analysis, the use of RBV, female gender, baseline albumin≥35 g/L, MELD<10 and lack of exposure to a triple therapy regimen were independent predictors of SVR (P<.05). Serious adverse events (SAEs) and SAE‐associated discontinuation events occurred in 5.9% and 2.6%. Conclusions. In this large cohort of cirrhotic patients managed in the real‐world setting in Spain, SOF/SMV±RBV yielded to excellent SVR rates, especially in patients with compensated liver cirrhosis. In addition, this combination showed to be safe, with low rates of SAEs and early discontinuations.Instituto de Salud Carlos III; PI15/0015

Safety and Efficacy of Sofosbuvir plus Simeprevir in a Spanish Cohort of 622 Cirrhotic Patients Infected with Genotypes 1 or 4

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