Patient preferences in chronic immune-mediated inflammatory diseases potentially treated with biological drugs: discrete choice analysis using real-world data analysis.

OBJECTIVES: Immune-mediated inflammatory diseases (IMIDs) represent a high burden due to their chronicity, high prevalence, and associated comorbidities. Chronic patients' preferences must be considered in IMIDs treatment and follow-up. The objective of this study was to further understand patient's preferences in private settings. METHODS: A literature review was performed to choose the most relevant criteria for patients. A D-efficient discrete choice experiment was designed to elicit preferences of adult patients with IMIDs and potential biological treatment prescription. Participants were collected from private practices (rheumatology, dermatology, and gastroenterology) from February to May 2022. Patients chose between option pairs, characterized by six health-care attributes, as well as monthly out-of-pocket drug price. Responses were analyzed through a conditional logit model. RESULTS: Eighty-seven patients answered the questionnaire. The most frequent pathologies were Rheumatoid Arthritis (31%) and Psoriatic Arthritis (26%). The most relevant criteria were choosing the preferred physician (OR 2.25 [SD0.26]); reducing time until visit with specialist (OR 1.79 [SD0.20]), access through primary care (OR 1.60 [SD0.08]), and an increase in monthly out-of-pocket price from 100€ to 300€ (OR 0.55 [SD0.06]) and to 600€ (OR 0.08 [SD0.02]). CONCLUSIONS: Chronic IMIDs patients showed a preference toward a faster, personalized service, even with a trade-off in terms of out-of-pocket price.

Experimental transmission of Caligus rogercresseyi between two different fish species.

Caligus rogercresseyi is the dominant sea louse parasite affecting the salmon and trout industry in southern Chile. This parasite has a wide range of native and endemic fish hosts. The Patagonian blenny Eleginops maclovinus, which is parasitized mostly by the caligid species Lepeophtheirus spp. and C. rogercresseyi, is presumably responsible for the transmission of C. rogercresseyi to salmonids. The aim of this study was to characterize the transmission of parasites between different fish species and parasite cohort development under laboratory conditions. Parasite abundances and intensities were quantified. Transmission of parasites from Patagonian blenny to Atlantic salmon Salmo salar was lower (~9%, mainly corresponding to C. rogercresseyi) than from salmon to Patagonian blenny (14.7-26.9%, where only C. rogercresseyi were observed). This suggests that the transmission of C. rogercresseyi from salmon individuals is higher than the transmission from a native fish. Parasite cohorts developed successfully on both fish species, but apparently under different developmental rates. Water temperature, oxygen, and juvenile abundances were the variables that better explained cohort development success and variation in C. rogercresseyi adult abundances over time.

Intussusceptive angiogenesis and its counterpart intussusceptive lymphangiogenesis.

Intussusceptive angiogenesis (IA) is currently considered an important alternative and complementary form of sprouting angiogenesis (SA). Conversely, intussusceptive lymphangiogenesis (IL) is in an initial phase of study. We compare their morphofunctional characteristics, since many can be shared by both processes. To that end, the following aspects are considered: A) The concept of IA and IL as the mechanism by which blood and lymphatic vessels split, expand and remodel through transluminal pillar formations (hallmarks of intussusception). B) Terminology and historical background, with particular reference to the group of Burri, including Djonov and Patan, who initiated and developed the vessel intussusceptive concept in blood vessels. C) Incidence in normal (e.g. in the sinuses of developing lymph nodes) and pathologic conditions, above all in vessel diseases, such as dilated veins in hemorrhoidal disease, intravascular papillary endothelial hyperplasia (IPEH), sinusoidal hemangioma, lobular capillary hemangioma, lymphangiomas/lymphatic malformations and vascular transformation of lymph nodes. D) Differences and complementarity between vessel sprouting and intussusception. E) Characteristics of the cover (endothelial cells) and core (connective tissue components) of pillars and requirements for pillar identification. F) Structures involved in pillar formation, including endothelial contacts of opposite vessel walls, interendothelial bridges, merged adjacent capillaries, vessel loops and spilt pillars. G) Structures resulting from pillars with intussusceptive microvascular growth, arborization, remodeling and segmentation (compartmentalization). H) Influence of intussusception in the morphogenesis of vessel tumors/ pseudotumors; and I) Hemodynamic and molecular control of vessel intussusception, including VEGF, PDGF BB, Hypoxia, Notch, Endoglobin and Nitric oxide.

Insight into antibiotics removal: Exploring the photocatalytic performance of a Fe3O4/ZnO nanocomposite in a novel magnetic sequential batch reactor.

The purpose of this research was the preparation and photocatalytic evaluation of a novel nanocomposite (NC) based on Fe3O4/ZnO, to eliminate four persistent antibiotics in surface waters: sulfamethoxazole, trimethoprim, erythromycin and roxithromycin. Prior to the operation of the photocatalytic reactor, the influence of pH (3-9), catalyst concentration (50-800 mg L-1), oxidant dose (0-100 mg L-1) and concentration of different targets (10-100 µg L-1) on the catalytic efficiency was evaluated. The analysis of reaction kinetics showed that degradation processes of the four antibiotics followed a pseudo-first-order kinetic model. Antibiotics adsorption onto the nanocomposite surface depended on their electrostatic nature and played an important role when decreasing the initial concentration of antibiotics. In this context, kinetic rates were higher at lower initial levels of organic pollutants, which is a favourable effect from a practical application perspective. On the other hand, a synergistic effect of the available Fe in the nanocomposite was found, contributing to the oxidation of antibiotics by photo-Fenton as a secondary reaction. Then, a magnetic photocatalytic reactor was operated under optimal conditions. The enhanced photonic efficiency of Fe3O4/ZnO in the system, as well as the ease of the magnetic separation and catalyst reusability, indicate the viability of this reactor configuration.

Sinusoidal hemangioma and intravascular papillary endothelial hyperplasia: Interrelated processes that share a histogenetic piecemeal angiogenic mechanism.

Sinusoidal hemangioma, characterized by interconnecting thin-walled vascular spaces, may present papillae/pseudo-papillae and zones that resemble intravascular papillary endothelial hyperplasia (IPEH). Our objectives are to explore the existence of zones in IPEH with sinusoidal hemangioma characteristics, the mechanism of papillary and septa formation in sinusoidal hemangioma and the comparison of this mechanism with that in IPEH. For these purposes, specimens of 4 cases of each entity were selected and studied by serial histologic sections and by immunochemistry and immunofluorescence procedures. The results showed a) zones with characteristics of sinusoidal hemangioma in IPEH cases, b) presence in both entities of papillae with a cover formed by a monolayer of CD34+ and CD31+ endothelial cells (ECs) and a core formed by either type I collagen and αSMA+ cells (presenting a pericyte/smooth muscle cell aspect) or thrombotic components, and c) a similar piecemeal angiogenic mechanism in papillary formation, including sprouting of intimal ECs toward the vessel wall itself or intravascular thrombi, formation of vascular loops that encircle and separate vessel wall or thrombus components, and parietal or thrombotic papillae development. The major differences between both entities were the number, arrangement and substrate of papillae: myriad, densely grouped, parietal and thrombotic papillae in IPEH, and a linear arrangement of predominant parietal papillae in sinusoidal hemangioma, originating septa (segmentation). In conclusion, sinusoidal hemangioma and IPEH are interrelated processes, which share morphologic findings and a piecemeal angiogenic mechanism, combining sprouting and intussusceptive angiogenesis, and leading to papillary formation and vessel segmentation.

Delta-like protein 1 in the pituitary-adipose axis in the adult male mouse.

With the aim of studying delta-like protein 1 (DLK1) with respect to the relationship between adipocyte leptin and adenohypophyseal hormones, we carried out an immunohistochemical study analysing the presence of receptors for these hormones in the pituitary and adipose cells of male wild-type (WT) mice (Dlk1+/+ ) compared to knockout (KO) mice (Dlk1-/- ). The mRNA expression of these molecules was also determined using the reverse transcriptase-polymerase chain reaction. The results obtained showed that, in WT adipose cells, all of the adenohypophyseal hormone receptors were present, with a higher mRNA expression for growth hormone (GH) receptor and thyroid-stimulating hormone (TSH) receptor. Of the total cells in the anterior pituitary lobe, 17.09±0.9% were leptin receptor (LEPR) immunoreactive (-IR), mainly in GH-IR and prolactin (PRL)-IR cells (41.5±3.8%; 13.5±1.7%, respectively). In Dlk1-/- mice, adipocyte cells showed a significant increase in the TSH receptor mRNA expression level. Moreover, the percentage of LEPR-IR GH cells showed a statistically significant increase compared to controls, from 41.5±3.8% to 53.1±4.0%. By contrast, only 3.0±0.6% of LEP-IR anterior pituitary cells were detected in Dlk1 KO mice, as opposed to 6.8±1.1% observed in WT mice. The results suggest that relationships exist between adipocytes and pituitary GH, PRL and TSH cells, in addition to an influence with respect to the synthesis and release of pituitary leptin, particularly in PRL cells.

Ovarian Leydig cells (OLC): A histomorphological and immunohistochemical study.

Testicular Leydig cells (LC) regulate the proper development of male individuals, both during fetal life (fetal LC) and puberty (adult LC). In the ovaries of adult women, there are cells that are very similar to Leydig cells, the ovarian hilus cells (OHC), which also produce testosterone. The origin of these cells, in both sexes, remains unknown and is still a matter of debate. We have studied the location, characteristics and relationships of the OHC in 90 patients. The indications for oophorectomy were: metrorrhagia (n=9), prolapse (n=8), endometrial hyperplasia (n=14), cancer (endometrial, myometrial, or cervical) (n=35), uterine leiomyomata (n=14), and various ovarian tumors (cysts and benign tumors, borderline and malignant) (n=10). In addition to the hilus, occasionally the nodules, nests and clusters of OHC were located in the mesovarium, the mesosalpinx, and in the medullar and cortical regions of the ovaries. The morphological (including crystalloids of Reinke) and immunohistochemical (positivity for calretinin and alpha-inhibin) findings were similar to those described for testicular LC. Therefore, OHC can be considered ovarian Leydig cells (OLC). LC are usually found in small numbers in the ovaries, but if one looks for them intentionally, one always finds them. Close relationships were observed between the OLC with nerves and vessels. Moreover, an intraneural location of the OLC was demonstrated in all cases, and these intraneural cells showed similar characteristics to extraneural OLC, suggesting that they derive from endoneural cells which are present in the vegetative nerves of the ovaries.

Novel synthetic routes of large-pore magnetic mesoporous nanocomposites (SBA-15/Fe3O4) as potential multifunctional theranostic nanodevices.

In this paper, novel magnetic silica nanocomposites were prepared by anchoring magnetite nanoparticles onto the outer surface of mesoporous SBA-15 silica; the magnetic nanoparticles were prepared by microemulsion and solvothermal methods, varying the synthesis conditions in order to control the final physicochemical, textural and magnetic properties. The morphology and mesostructure of the materials were characterized by X-ray diffraction (XRD), Fourier-Transform Infrared Spectroscopy (FTIR), N2 adsorption-desorption, and Transmission and Scanning Electron Microscopy (TEM and SEM). Magnetic silica nanocomposites feature a two-dimensional hexagonal arrangement constituted by a homogeneous pore channel system with diameters between 13 and 18 nm and a Brunauer-Emmett-Teller (BET) surface area higher than 260 m2 g-1. The different morphologies of the samples are given by the presence of diverse magnetic nanoparticle arrangements covalently linked onto the outer surface of the mesoporous silica rods. This confers on them a superparamagnetic behaviour with a magnetic response between 50-80 emu g-1, even though the weight percent of magnetite present in the samples does not exceed 21.7%. In addition, the magnetic nanocomposites exhibit magnetic hyperthermia with moderate Specific Absorption Rate (SAR) values.

Telocyte Behaviour During Inflammation, Repair and Tumour Stroma Formation.

In this chapter, we outline the role of human CD34+ stromal cells/telocytes (CD34+ SC/TCs) as progenitor cells during repair. The in vivo activation phenomena of CD34+ SC/TCs in this process include increased size; separation from the neighbouring structures (mainly of the vascular walls); association with inflammatory cells, predominantly macrophages; development of the organelles of synthesis (rough endoplasmic reticulum and Golgi apparatus); cell proliferation with presence of mitosis and high proliferative index (transit-amplifying cells); and fibroblastic and myofibroblastic differentiation. A procedure to study these tissue-resident cells, comparison of their behaviour in vivo and in vitro and different behaviour depending on location, time, type of injury (including tumour stroma) and greater or lesser proximity to the injury are also considered.

Hábito tabáquico en trabajadores del mar / Smoke habit in seafarers

Objetivo: estudiar la prevalencia del hábito tabáquico en trabajadores del mar entre 2009 y 2015. Material y método: estudio descriptivo transversal de los datos informatizados de los reconocimientos médicos previos a embarque (RMPE) en los años 2009-2015 en los que se analizó la frecuencia del hábito tabáquico en la población total, así como por sexo, edad (< y ≥ 45 años) y puesto de trabajo (oficiales y no oficiales). Resultados: el tabaquismo resultó más prevalente en los varones, en los sujetos menores de 45 años (con significación estadística en 2014) y en los no oficiales (estadísticamente significativo en 2009 y 2011). Conclusiones: se observó una tendencia a la disminución del hábito tabáquico en los años estudiados, que fue superior a la de la población general española, tal vez por el efecto de las recomendaciones dadas durante los reconocimientos médicos laborales, por lo que recomendamos seguir dándolas durante los RMPE (AU)

Objective: The aim of this work was to determine the prevalence of smoke habit in a group of seafarers in the years 2009-2015. Methods: Data obtained of the pre-embarkation medical checkups files finished between January 1st and December 31st of each year were included. Smoke habit’s prevalence was determined in the subjects studied, also by sex, age (< y ≥ 45 years) and job (officers and no officers). Results: Smoking was more prevalent among men, younger than 45 (statistically significant in 2014) and among no officers (significant in 2009 and 2011). Conclusions: We observed a trend to diminish smoke habit along the studied years, higher than in Spanish general population, perhaps due to the beneficial effects of the recommendations given during the medical pre-embarkation checkup to diminish smoking in the studied subjects, so we recommend giving medical advice during pre-embarkation medical examinations (AU)

Stress response of Salmo salar (Linnaeus 1758) facing low abundance infestation of Caligus rogercresseyi (Boxshall & Bravo 2000), an object in the tank, and handling.

This study looks at how low infestation loads of adult Caligus rogercresseyi and other stressors affect the physiology of Salmo salar. Experimental fish groups were with (infested) or without (control) exposure to the parasite. The parasite cohort was followed for 78 days post-infestation (dpi), and only adult lice were observed. Additional stressors were applied at 60 and 75 dpi. The analysis included measurements of fish physiology and weight. Low-level infestations by adult C. rogercresseyi for more than 50 dpi induced moderate stress in S. salar as well as a high energy demand and increased small skin mucous cells. Threshold lice loads were identified, and above those loads, a high stress response was observed. Additional stressors altered fish physiology, inducing downregulation of the cortisol response after the first stressor and upregulation after the second stressor, but infested fish responded more strongly. Parasitism by C. rogercresseyi is energetically demanding, affecting the primary and secondary responses (e.g. cortisol and glucose levels), as well as the tertiary response (fish weight).

Caryospora neofalconis and other enteroparasites in raptors from Mexico.

A coprological survey of enteroparasites in raptors (60 Falconiformes) from Central Mexico is reported. Three samples contained coccidian unsporulated oocysts, one contained Eimeria sp., one contained trematode eggs and one contained capillarid and trematode eggs and Eimeria sp. After sporulation at the laboratory, oocysts from a Falco peregrinus were identified as Caryospora neofalconis. The phylogenetic analysis of the C. neofalconis (GenBank accession number KT037081) showed a close relationship to the Australian strain RY 2014 isolate 16710 (GenBank accession number KJ634019) of Caryospora daceloe, with 99.2% similarity. As far as we are aware, this is the first report of C. neofalconis in raptors from Mexico and the Americas.

Role of the non-canonical notch ligand delta-like protein 1 in hormone-producing cells of the adult male mouse pituitary.

To better understand the role of the non-canonical Notch ligand delta-like protein 1 (DLK1), in hormone-producing cells, we studied the cell distribution and subcellular localisation of DLK1 in the pituitary of male adult 129/SvJ mice, and analysed the variations in the hormone-producing cells associated with the lack of this gene in Dlk1 knockout mice. The results obtained showed the presence of DLK1-immunoreactive (ir) cells in all hormone-producing cells of the anterior pituitary. Immunoelectron microscopy showed DLK1-ir in the rough endoplasmic reticulum and inside secretory vesicles, suggesting that DLK1 is released together with pituitary hormones. Moreover, we found that prolactin (PRL)-DLK1-ir cells are in intimate contact with follicle-stimulating hormone (FSH)-ir-DLK1-negative cells. In Dlk1 knockout mice, we detected a significantly lower number of gowth hormone (GH)-ir cells, a reduction in the FSH and PRL immunostaining intensity, and a significant decrease in FSH mRNA expression compared to wild-type mice. An increase in pituitary GH mRNA expression and serum leptin levels was also found. These findings provide evidence supporting several regulatory functions of DLK1 in the pituitary gland.

Salud laboral y género. Apuntes para la incorporación de la perspectiva de género en el ámbito de la prevención de riesgos laborales / Occupational health and gender. Notes to incorporate the gender mainstreaming in the occupational risks prevention field

En el ámbito nacional e internacional existe un amplio marco normativo y programático que vincula las acciones de entidades públicas y privadas con la igualdad de oportunidades para mujeres y hombres; sin embargo, las condiciones en que se desenvuelven unas y otros siguen siendo extremadamente diferentes y desiguales. En el contexto de la salud laboral, como en otros, se añade a esto la incapacidad de las instituciones para conocer la situación real de las y los trabajadores y por tanto, la imposibilidad de emprender acciones que promuevan adecuadamente la salud de hombres y mujeres en dicho medio. La incorporación de la perspectiva de género en el actuar de los servicios de prevención contribuye a detectar y corregir los sesgos de género en las actividades preventivas y de vigilancia de la salud. El presente documento pretende apuntar algunas acciones específicas que sirvan de herramientas prácticas para la incorporación de la perspectiva de género en las actividades que se realizan desde los servicios de Salud Laboral (AU)

At national and international level, there is a wide legal frame enlacing public and private entities´actions with the equal opportunities for men and women; nevertheless, the conditions in which they work are extremely different. In the occupational health context, like in others, the entities´ incapacity to know the real situation of men and women and the impossibility, as a result, to develop actions to improve accurately men and women´s health, are summed to the actual inequity. The gender mainstreaming in the occupational risks prevention world contribute to detect and correct the gender slant in the preventive activities and in the health surveillance. This paper aims to provide some simple tools to facilitate the incorporation of gender perspective in the activities developed by the Occupational Health Services (AU)

[The registered population and its characteristics as adjustment element for individualized pharmacy budget allocation]. / La población adscrita y sus características como elemento de ajuste para la asignación presupuestaria individualizada en farmacia.

OBJECTIVE: To find an equation that can calculate quality reference standards on the sum expected per doctor, adjusted for the size of his/her list, his/her characteristics and patients included in chronically ill services. This objective is posed within a strategy of individualizing information and evaluation as a tool to promote improvement. DESIGN: Crossover, descriptive study. SETTING: Autonomous community of the Canary Islands. Tenerife Health Area, primary care management. PARTICIPANTS: The study was performed with 51 doctors belonging to 10 primary care teams, for whom there was quality information available due to their having used the CRONOS computer programme for a sufficient period of time. The period analyzed ran from January to November 1997. MEASUREMENTS AND MAIN RESULTS: Multiple regression analysis through automatic algorithm of step-by-step selection of variables. There was a close relationship between the variability of the pharmacy sum per doctor (adjusted r2: 0.81; F, 66.05; p < 0.000) and the size of the list; also between the former and the characteristics of the users on the list. The most relevant variables were the percentage of women over 55 and the mean drug consumption per consultation with patients during the study period. It was seen, in relation to this last variable, that the percentage of pensioners and the number of hyper-intense patients included were important. CONCLUSION: Given the high variability explained, we propose broadening the study to all the doctors, so as to give the results greater consistency and offer quality reference information, in line with the above-mentioned improvement plan.

La población adscrita y sus características como elemento de ajuste para la asignación presupuestaria individualizada en farmacia / The registered population and its characteristics, as an element of adjustment to individualised pharmacy budget allocation

Objetivo. Obtener una ecuación que permita ofrecer patrones de referencia de calidad sobre el importe esperado por facultativo, ajustado por tamaño del cupo, sus características y pacientes incluidos en servicios de crónicos. Este objetivo se plantea dentro de una estrategia de particularizar la información y evaluación como instrumento promotor de la mejora. Diseño. Estudio descriptivo transversal. Emplazamiento. Comunidad Autónoma de Canarias. Área de Salud de Tenerife, Gerencia de Atención Primaria. Participantes. Se realiza con 51 facultativos pertenecientes a 10 equipos de atención primaria (EAP), para los que se dispone de información de calidad como consecuencia de llevar un período de tiempo suficiente utilizando el programa informático CRONOS. El período de tiempo analizado ha sido de enero de 1997 a noviembre del mismo año. Mediciones y resultados principales. Análisis de regresión múltiple mediante algoritmo automático de selección de variables paso a paso. Se obtuvo una fuerte relación entre la variabilidad del importe de farmacia por facultativo (r2 ajustada, 0,81; F, 66,05; p < 0,000) y el tamaño del cupo, así como con las características de los usuarios adscritos al mismo, surgiendo como variables más relevantes el porcentaje de mujeres mayores de 55 años y el consumo medio de consultas por paciente visto durante el período de estudio; respecto a esta última variable, se vio que era importante el porcentaje de pensionista adscritos y el número de hipertensos incluidos en servicio. Conclusión. Dada la alta variabilidad explicada, nos proponemos ampliar el estudio con la totalidad de los facultativos, a fin de dar mayor consistencia a los resultados y poder ofrecer información de referencia de calidad, de acuerdo con el expresado planteamiento de mejora (AU)

Belladona en un canino: un caso poco común / Belladona in a dog: uncommon case

En el presente artículo se expone un caso poco común de Belladona en un canino, aunque Belladona es utilizada principalmente en casos agudos, en esta oportunidad se administró como medicamento de fondo. La finalidad de este artículo es ampliar la imagen de tan valioso policresto

Belladona en un canino: un caso poco común / Belladona in a dog: uncommon case

En el presente artículo se expone un caso poco común de Belladona en un canino, aunque Belladona es utilizada principalmente en casos agudos, en esta oportunidad se administró como medicamento de fondo. La finalidad de este artículo es ampliar la imagen de tan valioso policresto (AU)