General versus domain-specific grit in the work context.

Researchers have questioned whether grit should be conceptualized and measured as a global (i.e., domain-general) or domain-specific construct. Although evidence is beginning to appear that grit in educational and sport contexts may be measured as domain-specific, it has not yet been explored in the organizational context. The objective of this research was to study the psychometric properties of grit as domain-specific for subsequently analyzing if such domain-specific grit (labor grit) improves the predictive validity of different organizational results. A sample of 326 active workers was used (Myears = 37.52; SD = 9.85). Their grit levels in the general domain and specific domain were evaluated, as well as their main personality traits and other organizational results such as work engagement and work performance. The grit instrument as domain-specific showed excellent reliability (ω = 0.92), and the unidimensionality of the instrument was confirmed. The results point to the fact that giving an organizational connotation to the grit items does not improve the predictability of the results. However, labor grit adds incremental validity over personality traits and work engagement to predict task and contextual performance (Δr2 = 0.13), but not to predict counterproductive behavior.

Evaluation of Different Doses in Inhaled Therapy: A Comprehensive Analysis.

BACKGROUND: Currently, there is a considerable degree of confusion over the dosage of inhaled medications. Here, we carried out a review of all the doses used for the devices used in inhalation therapy. METHODS: We first performed a systematic search of the different inhalation devices included on the July 2023 Spanish Ministry of Health Billing List. We then consulted the Spanish Agency for Medicines and Health Products to find the updated official label and to obtain the information on the exact composition. RESULTS: We identified 90 unique products, of which 22 were long-acting bronchodilators (and combinations thereof) and 68 were products containing inhaled corticosteroids (ICS). Overall, 10 products with bronchodilators and 40 with ICS were marketed with the metered dose, while 11 with bronchodilators and 28 with ICS were marketed with the delivered dose. In addition, in some bronchodilators, the drug was referred to as a type of salt, whereas in others the information referred to the drug itself. CONCLUSIONS: Our data show that for each inhaled drug there may be up to four different doses and that the marketed name may refer to any of these. Clinicians must be aware of these different dosages when prescribing inhaled medications.

Documento de consenso sobre asma y tabaquismo del Foro Autonómico de Asma de la SEPAR / Consensus document on asthma and smoking of the Regional Asthma Forum of SEPAR

La prevalencia de tabaquismo activo en adultos con asma es similar ala de la población general. El tabaquismo se asocia con un peor control clínico de la enfermedad, una disminución acelerada de la función pulmonar y una respuesta irregular a la terapia con glucocorticoides. El consumo de tabaco impacta negativamente en la calidad devida de los pacientes asmáticos y provoca un incremento en el númerode visitas y de hospitalizaciones por exacerbaciones. Además, el tabaquismo aumenta el riesgo de cáncer de pulmón, comorbilidades cardiovasculares y muerte en pacientes asmáticos. A pesar de todo ello,las guías actuales del manejo del asma no incluyen recomendacionesespecíficas para el manejo de los pacientes asmáticos fumadores. Poreste motivo, se procedió a una revisión narrativa de la literatura paraun consenso mediante metodología de grupo nominal desarrolladaa lo largo del año 2019 para extraer recomendaciones prácticas quepermitieran mejorar el diagnóstico y el tratamiento del asma en fumadores, así como el tratamiento del tabaquismo en asmáticos. Lasconclusiones y recomendaciones fueron validadas en el congreso nacional de la SEPAR del mismo año. Entre las más relevantes, se incidió en la necesidad de abordar el tabaquismo en las personas conasma mediante consejo sanitario, tratamiento farmacológico y terapiaconductual, al ser un factor que impacta negativamente en la sintomatología, el pronóstico y la respuesta al tratamiento del asma. En elfumador con sospecha de asma, se debe evaluar la presencia de enfisema y el diagnóstico diferencial de otras enfermedades y considerarel impacto del tabaquismo en el resultado de las pruebas diagnósticas.También se concluye que el hábito tabáquico reduce la respuesta altratamiento con corticoides inhalados, por lo que se recomienda terapia combinada con broncodilatadores. (AU)

The prevalence of active smoking in adults with asthma is similar inthe total population. Smoking is associated with worse clinical control of the disease, a rapid reduction of lung function and a variableresponse to corticoids. Tobacco consumption negatively affects thequality of life of asthmatic patients as well as increasing the numberof medical visits and hospital admissions due to exacerbations. Moreover, smoking entails a higher risk of developing lung cancer, cardiovascular comorbidities and death in asthmatic patients. Nevertheless,current asthma guidelines do not include specific recommendationson the management of smoking asthmatic patients and the treatmentof the smoking habit in this subpopulation. For this reason, a narrativereview of the literature was carried out for consensus using a nominalgroup methodology developed throughout 2019 to extract practicalrecommendations that would allow the diagnosis and treatment ofasthma in smokers, as well as the treatment of smoking in asthmatics,to be improved. The conclusions and recommendations were validated at the SEPAR national congress of the same year. Among the mostrelevant, the need to address smoking in people with asthma throughhealth advice, pharmacological treatment and behavioral therapy wasemphasized, as this is a factor that negatively impacts the symptoms,prognosis and response to asthma treatment. In smokers with suspected asthma, the presence of emphysema and the differential diagnosisof other diseases should be evaluated and the impact of smoking onthe result of diagnostic tests should be considered. It is also concluded that smoking reduces the response to treatment with inhaled corticosteroids, which is why combined therapy with bronchodilators isrecommended (AU)

Human Resources Analytics: A systematic Review from a Sustainable Management Approach / La analítica de recursos humanos: una revisión sistemática desde la perspectiva de una gestión sostenible

Human Resources Analytics (HRA) is drawing more attention every year, and will be crucial to human resource development. However, the literature around the topic would appear to be more promotional than descriptive. With this in mind, we conducted a systematic literature review and content analysis with the following objectives: first, to address the current state of HRA and second, to propose a framework for the development of HRA as a sustainable practice. We analyzed 79 articles from research databases and found 34 empirical studies for subsequent content analysis. While the main results reflect the relative newness of the field of HRA, with the majority of the empirical articles focusing on financial aspects, they also reveal the growing importance given to ethics. Finally, we propose a framework for the development of sustainable HRA based on the triple bottom line and discuss the implications of our findings for researchers and practitioners.(AU)

La analítica de recursos humanos (ARH) atrae cada vez más atención en los últimos años y será crucial para el desarrollo del ámbito de los recursos humanos. No obstante, la literatura sobre el tema parece ser más promocional que descriptiva. Para comprobar esto, llevamos a cabo una revisión sistemática de la literatura y un análisis de contenido con los siguientes objetivos: primero, abordar el estado actual la ARH y segundo, proponer un marco para el desarrollo de la AHR como una práctica sostenible. Analizamos 79 artículos de investigación incluidos en las más prestigiosas bases de datos y encontramos 34 estudios empíricos para su posterior análisis de contenido. Los principales resultados reflejan la relativa novedad del campo de la ARH, estando centrados la mayoría de los artículos en los aspectos financieros. No obstante, también se observa la creciente importancia dada a la ética. Finalmente, proponemos un marco para el desarrollo de una ARH basada en la triple cuenta de resultados (económica, social y medioambiental, y se discuten las implicaciones prácticas y teóricas de nuestros hallazgos.(AU)

Avoidant/resistant rather than tolerant olive rootstocks are more effective in controlling Verticillium wilt.

The identification of rootstocks of low susceptibility to Verticillium dahliae can become a valuable procedure to achieve effective control of Verticillium wilt in the olive grove. This not only involves the identification of suitable genotypes, but also the study of the interaction between the rootstock and the grafted scion. Thus, a rootstock that prevents or minimizes V. dahliae proliferation (avoidance/resistance strategy) can have very different effects on a susceptible scion compared to a rootstock that shows few or no symptoms despite being infected (tolerance strategy). Both resistance and tolerance mechanisms have been recently identified in wild olive genotypes with low susceptibility to V. dahliae. When used as rootstocks of the highly susceptible variety 'Picual', we found that resistant genotypes, including the cultivar 'Frantoio', were more effective than tolerant genotypes in controlling Verticillium wilt. Furthermore, tolerant genotypes were as ineffective as susceptible or extremely susceptible genotypes in controlling Verticillium wilt. We also identified rootstock-scion combinations with behaviours that were not expected according to the degree of susceptibility previously observed in the non-grafted rootstock. Although the rootstocks were able to control Verticillium wilt according to its degree of susceptibility to V. dahliae, the ability to control the infection was not adequately transferred to the grafted scion. Our results confirmed that: the degree of susceptibility to Verticillium wilt of an olive variety does not predict its performance as a rootstock; to use a very low susceptible genotype as rootstock of a susceptible scion increases the susceptibility of the genotype used as rootstock; in any case, avoidant/resistant rootstocks are more effective than tolerant rootstocks in reducing the susceptibility of the grafted plant to V. dahliae.

Nitrogen assimilation and photorespiration become more efficient under chloride nutrition as a beneficial macronutrient.

Chloride (Cl-) and nitrate ( NO 3 - ) are closely related anions involved in plant growth. Their similar physical and chemical properties make them to interact in cellular processes like electrical balance and osmoregulation. Since both anions share transport mechanisms, Cl- has been considered to antagonize NO 3 - uptake and accumulation in plants. However, we have recently demonstrated that Cl- provided at beneficial macronutrient levels improves nitrogen (N) use efficiency (NUE). Biochemical mechanisms by which beneficial Cl- nutrition improves NUE in plants are poorly understood. First, we determined that Cl- nutrition at beneficial macronutrient levels did not impair the NO 3 - uptake efficiency, maintaining similar NO 3 - content in the root and in the xylem sap. Second, leaf NO 3 - content was significantly reduced by the treatment of 6 mM Cl- in parallel with an increase in NO 3 - utilization and NUE. To verify whether Cl- nutrition reduces leaf NO 3 - accumulation by inducing its assimilation, we analysed the content of N forms and the activity of different enzymes and genes involved in N metabolism. Chloride supply increased transcript accumulation and activity of most enzymes involved in NO 3 - assimilation into amino acids, along with a greater accumulation of organic N (mostly proteins). A reduced glycine/serine ratio and a greater ammonium accumulation pointed to a higher activity of the photorespiration pathway in leaves of Cl--treated plants. Chloride, in turn, promoted higher transcript levels of genes encoding enzymes of the photorespiration pathway. Accordingly, microscopy observations suggested strong interactions between different cellular organelles involved in photorespiration. Therefore, in this work we demonstrate for the first time that the greater NO 3 - utilization and NUE induced by beneficial Cl- nutrition is mainly due to the stimulation of NO 3 - assimilation and photorespiration, possibly favouring the production of ammonia, reductants and intermediates that optimize C-N re-utilization and plant growth. This work demonstrates new Cl- functions and remarks on its relevance as a potential tool to manipulate NUE in plants.

Feasibility and cost of a telemedicine-based short-term plan for initial access in general dermatology in Andalusia, Spain.

BACKGROUND: In developed countries, health care delivery in dermatology is hampered by the low availability of dermatologists. OBJECTIVE: To analyze the feasibility of a teledermatology-based action plan to provide initial dermatologic care in areas with low availability of dermatologists. METHODS: A cross-sectional study describing the feasibility and cost of a 12-month action plan based on a store-and-forward teledermatology (TD) connecting primary care centers and a TD center. Teleconsultations from patients complaining of any cutaneous condition were included. The primary outcome measure was the percentage of patients not referred to the local dermatologist. RESULTS: Among the total of 15,523 teleconsultations attended in the TD-based action plan, 3360 (21.65%) required a face-to-face visit with a local dermatologist. In 32.32% (n = 5017) of the cases, a therapeutic and follow-up plan report was issued. The most common conditions managed were melanocytic nevi (15.63%, n = 2426), followed by seborrheic keratosis (14.89%, n = 2312), and actinic keratosis (8.65%, n = 1342). The average response time was 14.52 days (95% CI 14.35-15.23). The additional total investment in this action plan was $142,681.01, with a unit cost of 9.20$/patient. LIMITATIONS: Noncontrolled study. CONCLUSIONS: Experienced dermatologists working with store-and-forward TD can deliver a fast and effective response in health care areas with access limitations.

El delito contra la libertad sexual en el anciano: una realidad escondida difícil de detectar / Sexual abuse of the elderly: A hidden, difficult to detect, reality

El maltrato a personas mayores es un problema de salud pública; existen diversos tipos de maltrato; el abuso sexual en el anciano es uno de los menos estudiados y comúnmente no se detecta. Este trabajo presenta el caso de una paciente que fue llevada al hospital por la sospecha de que pudiera haber sido víctima de un delito contra la libertad sexual. La paciente se encontraba ingresada en una residencia geriátrica y presentaba una demencia de 10 años de evolución. En el artículo se expone la vulnerabilidad de este tipo de pacientes y las dificultades encontradas para el diagnóstico, y se reflexiona sobre la necesidad de trabajar en la prevención e intervención efectiva desde el ámbito sanitario

Abuse of the elderly is an important public health problem. There are different types of abuse, with sexual abuse being one of the least studied, and usually underdiagnosed. A forensic case-study is presented on a female patient who was taken to the hospital under the suspicion that she had have been a victim of sexual assault. The patient was admitted to a geriatric centre and had been diagnosed with senile dementia type I of 10 years onset. In this article, an analysis is carried out on the vulnerability of this kind of patient, the difficulties in diagnosis, and on the need to work on prevention and effective intervention from a health care perspective

Efficacy and Safety of Reslizumab in Patients with Severe Asthma with Inadequate Response to Omalizumab: A Multicenter, Open-Label Pilot Study.

BACKGROUND: Patients with severe allergic and eosinophilic asthma could qualify for different biologic therapies. OBJECTIVE: To evaluate the efficacy and safety of weight-based intravenous reslizumab dosing in patients who have previously failed therapy with omalizumab. METHODS: We carried out a 24-week prospective, multicenter, open-label, single-group, self-controlled study in patients with severe eosinophilic asthma who had previously failed to respond to omalizumab. The main objective was to determine whether treatment with reslizumab significantly improved asthma symptoms assessed by the Asthma Control Test (ACT) at week 24. Secondary objectives were to evaluate symptoms at weeks 4 and 12, change in FEV1 at week 24, and the incidence of severe exacerbations over the study period. RESULTS: Twenty-nine patients (62.1% women, median age, 50.8 years) were included in the study. The median ACT score significantly increased from 13.0 (interquartile range, 8.0-18.0) at baseline to 21.0 (interquartile range, 14.0-24.0) at 24 weeks (P = .002). Only 2 of 29 patients developed at least 1 severe exacerbation during follow-up and none of them required hospitalization. Overall, 15 of 25 patients (60%) were considered as being controlled (ACT score of ≥20 and no exacerbations) at week 24. The percentage of patients who were receiving daily systemic corticosteroids significantly decreased from 72.4% to 52.0% (P = .019). Adverse events were mostly moderate and within the range of previously reported side effects with reslizumab. CONCLUSION: Reslizumab is an effective and safe option for patients with severe eosinophilic asthma and a history of omalizumab failure.

Documento de consenso para el manejo del paciente asmático en urgencias / Management of asthma in the emergency department: a consensus statement

El presente documento de consenso se ha desarrollado con el objetivo de facilitar una herramienta para el manejo del paciente asmático en los servicios de urgencias españoles y mejorar la calidad asistencial. Un equipo multidisciplinar formado por tres especialistas en medicina de urgencias, tres especialistas en neumología y tres especialistas en alergología elaboró un listado de preguntas clínicas y utilizó cuatro guías de práctica clínica sobre el manejo del asma para responderlas. Después de un periodo de trabajo individual, se discutieron y consensuaron en una reunión los contenidos del presente documento. Las recomendaciones y los algoritmos incluidos en él van dirigidos a detectar al paciente asmático a su llegada al servicio de urgencias, establecer un diagnóstico correcto, unificar los criterios terapéuticos y realizar posteriormente una correcta derivación al neumólogo, alergólogo o al médico de atención primaria, según proceda. Las definiciones que se ofrecen en el presente documento proporcionan un lenguaje común que puede ayudar a unificar la actividad asistencial en los servicios de urgencias. Los criterios diagnósticos, las pautas de tratamiento y los criterios de alta y hospitalización recogidos en esta guía pueden ser de utilidad para el manejo del paciente asmático en los servicios de urgencias españoles

The purpose of this consensus statement is to provide a tool to assist in the management of asthma in Spanish emergency departments and to improve care of patients with asthma. A multidisciplinary team of 3 emergency medicine specialists, 3 respiratory medicine specialists, and 3 allergy specialists made a list of clinical questions and chose 4 clinical practice guidelines on asthma management to prioritize when answering the questions. The team members first worked individually and then discussed their findings in a meeting to reach consensus about the content of the present statement. The recommendations and clinical algorithms in the statement contribute to detecting the asthmatic patient on arrival at the emergency department, establishing the diagnosis, following unified treatment criteria, and referring the patient to a respiratory medicine specialist, an allergy specialist, or a primary care physician, as appropriate. The definitions used in this statement provide a common language for asthma in the interest of helping to unify care practices in emergency departments. The diagnostic criteria, treatment guidelines, and criteria for discharging and admitting patients provided should be useful for managing asthma in Spanish emergency departments

Management of asthma in the emergency department: a consensus statement. / Documento de consenso para el manejo del paciente asmático en urgencias.

EN: The purpose of this consensus statement is to provide a tool to assist in the management of asthma in Spanish emergency departments and to improve care of patients with asthma. A multidisciplinary team of 3 emergency medicine specialists, 3 respiratory medicine specialists, and 3 allergy specialists made a list of clinical questions and chose 4 clinical practice guidelines on asthma management to prioritize when answering the questions. The team members first worked individually and then discussed their findings in a meeting to reach consensus about the content of the present statement. The recommendations and clinical algorithms in the statement contribute to detecting the asthmatic patient on arrival at the emergency department, establishing the diagnosis, following unified treatment criteria, and referring the patient to a respiratory medicine specialist, an allergy specialist, or a primary care physician, as appropriate. The definitions used in this statement provide a common language for asthma in the interest of helping to unify care practices in emergency departments. The diagnostic criteria, treatment guidelines, and criteria for discharging and admitting patients provided should be useful for managing asthma in Spanish emergency departments.

El presente documento de consenso se ha desarrollado con el objetivo de facilitar una herramienta para el manejo del paciente asmático en los servicios de urgencias españoles y mejorar la calidad asistencial. Un equipo multidisciplinar formado por tres especialistas en medicina de urgencias, tres especialistas en neumología y tres especialistas en alergología elaboró un listado de preguntas clínicas y utilizó cuatro guías de práctica clínica sobre el manejo del asma para responderlas. Después de un periodo de trabajo individual, se discutieron y consensuaron en una reunión los contenidos del presente documento. Las recomendaciones y los algoritmos incluidos en él van dirigidos a detectar al paciente asmático a su llegada al servicio de urgencias, establecer un diagnóstico correcto, unificar los criterios terapéuticos y realizar posteriormente una correcta derivación al neumólogo, alergólogo o al médico de atención primaria, según proceda. Las definiciones que se ofrecen en el presente documento proporcionan un lenguaje común que puede ayudar a unificar la actividad asistencial en los servicios de urgencias. Los criterios diagnósticos, las pautas de tratamiento y los criterios de alta y hospitalización recogidos en esta guía pueden ser de utilidad para el manejo del paciente asmático en los servicios de urgencias españoles.

Síndrome de apneas-hipopneas y narcolepsia. Descripción de una serie hospitalaria / Sleep apnoea-hypopnoea syndrome and narcolepsy. Description of a series of hospital patients

Introducción. Los trastornos del sueño son muy prevalentes en la población general; sin embargo, la asociación de síndrome de apneas-hipopneas (SAHS) en pacientes con narcolepsia se ha descrito en pocas ocasiones. Se revisan los trastornos del sueño encontrados en pacientes con narcolepsia, la prevalencia de SAHS asociado a estos pacientes y su respuesta a los tratamientos. Pacientes y métodos. Análisis descriptivo retrospectivo observacional de 25 pacientes, con diagnóstico de narcolepsia, atendidos en nuestro centro desde octubre de 2012 hasta diciembre de 2016. Resultados. De 470 pacientes valorados en la consulta monográfica de neurología, hemos diagnosticado a 25 pacientes con narcolepsia (5,31%); el 65% eran hombres, y el 35%, mujeres. Edad media en el momento del diagnóstico: 40 años. El 60% presenta otros trastornos del sueño asociados, el más frecuente es el SAHS (36%). La eficacia del tratamiento con presión aérea positiva continua nasal (CPAP) es del 66% en los pacientes con SAHS con indicación de CPAP. Conclusiones. El 60% de los pacientes con narcolepsia asocia un segundo trastorno del sueño (mayor que la incidencia de coexistencia en la población general, del 20-25% de los pacientes), y los descritos también son los más frecuentes en la población general (SAHS, síndrome de piernas inquietas, movimientos periódicos de las piernas). El 36% de los pacientes con narcolepsia asocia SAHS. De ellos, en el 78% se ha conseguido un control de eventos respiratorios adecuado; el 57% se ha controlado con CPAP y el 43% restante no ha precisado CPAP por corrección de eventos con otros métodos (AU)

Introduction. Sleep disorders are highly prevalent among the general population, although very few cases of sleep apnoea-hypopnoea syndrome (SAHS) have been reported in patients with narcolepsy. This study reviews the sleep disorders found in patients with narcolepsy, the prevalence of SAHS associated with these patients and their response to the different treatments. Patients and methods. We conducted an observation-based retrospective descriptive analysis of 25 patients diagnosed with narcolepsy, who were treated in our centre between October 2012 and December 2016. Results. Of 470 patients evaluated in the specialised neurology consultation unit, 25 patients were diagnosed with narcolepsy (5.31%); 65% were males and the remaining 35% were females; the mean age at the time of diagnosis was 40 years. 60% presented other associated sleep disorders, the most frequent being SAHS (36%). The efficacy rate of treatment with continuous positive airway pressure (CPAP) is 66% in patients with SAHS with an indication of CPAP. Conclusions. Altogether, 60% of patients with narcolepsy have a second associated sleep disorder (greater than the incidence of coexistence in the general population, of 20-25% of patients), and those reported are also the most frequent among the general population (SAHS, restless legs syndrome, periodic limb movement disorder). 36% of patients with narcolepsy have SAHS as an associated condition. Of these, 78% have reached a suitable degree of control over respiratory events; 57% have achieved control with CPAP, and the remaining 43% did not require CPAP for event correction with other methods (AU)

Increasing Frequency of Seborrheic Keratosis Diagnoses as a Favorable Consequence of Teledermatology-Based Skin Cancer Screening: A Cross-sectional Study of 34,553 Patients.

BACKGROUND: Screening of skin cancer by teledermatology (TD) has improved the early detection of skin cancer by enhancing access to skin cancer clinics. OBJECTIVE: We sought to analyze how TD-based skin cancer screening has changed the frequency of consultations for benign lesions. PATIENTS AND METHODS: A cross-sectional study including teleconsultations received during a 7-year period was conducted to analyze and compare the trendlines of each lesion type over the study period. Trendlines were analyzed using a linear regression model with the R-squared (R 2) test for goodness of fit. RESULTS: A total of 34,553 teleconsultations were included in the study. Seborrheic keratoses, followed by benign melanocytic lesions, were the most frequent lesions diagnosed. The pick-up rate for malignant lesions was 1:8.6 teleconsultations. Seborrheic keratoses and precancerous lesions showed a positive trendline with good fit to the linear model (R 2 = 0.8 and R 2 = 0.8, respectively). Tis-T1 malignant melanoma (in situ melanoma or melanoma with a Breslow thickness <1 mm) showed an increasing trendline with moderate-to-low fit to the model (R 2 = 0.4). CONCLUSIONS: TD-based screening of skin cancer is associated with an increasing rate of consultations involving seborrheic keratoses, which can be considered a consequence of improved access to dermatologists resulting from TD implementation.

Internet-based skin cancer screening using clinical images alone or in conjunction with dermoscopic images: A randomized teledermoscopy trial.

BACKGROUND: Teledermoscopy involves the use of dermoscopic images for remote consultation and decision-making in skin cancer screening. OBJECTIVE: We sought to analyze the potential benefits gained from the addition of dermoscopic images to an internet-based skin cancer screening system. METHODS: A randomized clinical trial assessed the diagnostic performance and cost-effectiveness of clinical teleconsultations (CTC) and clinical with dermoscopic teleconsultations. RESULTS: A total of 454 patients were enrolled in the trial (nCTC = 226, nclinical with dermoscopic teleconsultation = 228). Teledermoscopy improved sensitivity and specificity (92.86% and 96.24%, respectively) compared with CTC (86.57% and 72.33%, respectively). Correct decisions were made in 94.30% of patients through clinical with dermoscopic teleconsultations and in 79.20% in CTC (P < .001). The only variable associated with an increased likelihood of correct diagnosis was management using teledermoscopy (odds ratio 4.04; 95% confidence interval 2.02-8.09; P < .0001). The cost-effectiveness analysis showed teledermoscopy as the dominant strategy, with a lower cost-effectiveness ratio (65.13 vs 80.84). LIMITATIONS: Potentially, a limitation is the establishment of an experienced dermatologist as the gold standard for the in-person evaluation. CONCLUSIONS: The addition of dermoscopic images significantly improves the results of an internet-based skin cancer screening system, compared with screening systems based on clinical images alone.

Telomere Length Defines the Cardiomyocyte Differentiation Potency of Mouse Induced Pluripotent Stem Cells.

Induced pluripotent stem cells (iPSCs) can be differentiated in vitro and in vivo to all cardiovascular lineages and are therefore a promising cell source for cardiac regenerative therapy. However, iPSC lines do not all differentiate into cardiomyocytes (CMs) with the same efficiency. Here, we show that telomerase-competent iPSCs with relatively long telomeres and high expression of the shelterin-complex protein TRF1 (iPSChighT ) differentiate sooner and more efficiently into CMs than those with relatively short telomeres and low TRF1 expression (iPSClowT ). Ascorbic acid, an enhancer of cardiomyocyte differentiation, further increases the cardiomyocyte yield from iPSChighT but does not rescue the cardiomyogenic potential of iPSClowT . Interestingly, although iPSCslowT differentiate very poorly to the mesoderm and endoderm lineages, they differentiate very efficiently to the ectoderm lineage, indicating that cell fate can be determined by in vitro selection of iPSCs with different telomere content. Our findings highlight the importance of selecting iPSCs with ample telomere reserves in order to generate high numbers of CMs in a fast, reliable, and efficient way. Stem Cells 2017;35:362-373.

Histopathological environment besides the focus score in Sjögren's syndrome.

AIM: To compare the prevalence of diverse histopathologic features among patients with Sjögren's syndrome (SS) and controls, and to evaluate their relationship with age, a focus score (FS) ≥ 1 and some clinical and serological SS features. METHODS: A blinded pathologist examined 63 SS and 11 control minor salivary gland biopsies. Focal lymphocytic sialadenitis (FLS) was defined as a focus score (FS) ≥ 1. We also evaluated lymphoepithelial lesions, germinal centers (GCs), epithelial metaplasia, dilatation and hyperplasia in the main secretory duct, perivascular cell infiltrate, adipose infiltration, acinar atrophy, interstitial fibrosis and lymphocytes/plasma cells remote from the FLS. We registered demographics, anti-Ro/La status and clinical features. We used Kendall's tau coefficients and logistic regression analysis. RESULTS: Sjögren's syndrome patients had a higher frequency of FS ≥ 1 (92% vs. 27%), acinar atrophy (78% vs. 18%), lymphocytes and plasma cells external to the FSL (92% vs. 64%) and stromal fibrosis (68% vs. 36%). A FS ≥ 1 correlated with the presence of GCs and acinar atrophy; whereas age correlated with duct dilation, duct epithelial hyperplasia, adipose infiltration and fibrosis. SS patients with hepatic involvement exhibited more frequent duct dilatation. After adjusting by age, anti-Ro/SSA (odds ratio [OR] 30.8, 95% CI 2.2-423.5, P = 0.01), a FS ≥ 1 (OR 54.3, 95% CI 4.8-612, P = 0.001) and fibrosis (OR 15.2, 95% CI 1.2-186.2, P = 0.03) were associated with SS. CONCLUSION: Other histologic findings coexist with FLS, but only GC formation and acinar atrophy correlated with a FS ≥ 1. Age is mostly correlated with the remaining histological features. However, the clinical relevance of these findings is unknown.

Anaplastic lymphoma kinase-positive large B-cell lymphoma: a case report with particular immunophenotypic features.

Anaplastic lymphoma kinase-positive large B-cell lymphoma is a rare and aggressive B-cell lymphoma mostly associated with t(2:17) involving the clathrin gene at 17q23 and the anaplastic lymphoma kinase gene at 2p23. The characteristic immunophenotype includes a granular cytoplasmic anaplastic lymphoma kinase expression, CD20 negativity and the presence of plasma cell markers (CD138, VS38c, and CD38). We report a case with aberrant immunophenotype (CD138-, VS38c-, CD38+/-) and discuss the utility of other immunohistochemical markers in establishing a terminal B-cell differentiation.

Randomized clinical trial of lovastatin in HIV-infected, HAART naïve patients (NCT00721305).

BACKGROUND: Evidence suggests that statins may modify the immune response against HIV. The aim was to evaluate the antiretroviral and immunomodulatory effects of lovastatin in HIV-infected patients, naïve for antiretroviral therapy. METHODS: Randomized, double-blinded, placebo-controlled, phase-II clinical trial. Primary outcomes were plasma viral load and circulating CD4+ T cell count, after 6 and 12 months of treatment; secondary outcomes were CD8+ T cell count, expression of activation markers (CD38 and HLA-DR) on T cells, and clinical outcomes. With a power of 90% to detect both a decrease of 0.3 log10 in plasma HIV-1 RNA copies and an increase of 20% in the CD4+ T cell count, we estimated a required sample size of 110 HIV-infected patients (55 per group). The results were analyzed by a model of repeated measurements using Generalized Estimating Equations. RESULTS: Patients were randomized to receive either lovastatin (n = 55) or placebo (n = 57). During the 12-month follow-up, there was no effect of lovastatin either on viral load (estimated average change = 0.157 copies/mL; CI 95% = -0.099 to 0.414), or on the CD4+ T cell count (estimated average change = -26.1 cells/µL; CI 95% = -89.8 to 37.6). Moreover, there were no significant differences in secondary outcomes. CONCLUSIONS: Daily administration of lovastatin (40 mg) for one year in HIV-infected patients, naïve for antiretroviral therapy, had no significant effect on HIV replication, the CD4+ T cell count, or the activation level of T cells. (www.clinicaltrials.gov; ID NCT00721305).