Transcriptional Evaluation of Neuropeptides, Hormones, and Tissue Repair Modulators in the Skin of Gilthead Sea Bream (Sparus aurata L.) Subjected to Mechanical Damage.

The skin of bony fish is the first physical barrier and is responsible for maintaining the integrity of the fish. Lesions make the skin vulnerable to potential infection by pathogens present in the aquatic environment. In this way, wound repair has barely been studied in gilthead sea bream. Thus, this study investigated the modulation of peripheral neuro-endocrine and tissue repair markers at the transcriptional level in the skin of teleost fish subjected to mechanical damage above or below the lateral line (dorsal and ventral lesions, respectively). Samples were evaluated using RT-qPCR at 2-, 4-, and 20-days post-injury. Fish with a ventral lesion presented a trend of progressive increase in the expressions of corticotropin-releasing hormone (crh), pro-opiomelanocortin-A (pomca), proenkephalin-B (penkb), cholecystokinin (cck), oxytocin (oxt), angiotensinogen (agt), and (less pronounced) somatostatin-1B (sst1b). By contrast, fish with a dorsal lesion registered no significant increase or biological trend for the genes evaluated at the different sampling times. Collectively, the results show a rapid and more robust response of neuro-endocrine and tissue repair markers in the injuries below than above the lateral line, which could be attributable to their proximity to vital organs.

Lessons Learned in Elective Surgeries After 6 Pandemic Waves of SARS-CoV-2. A Single European Center Experience.

BACKGROUND: The reported high surgical morbidity and mortality in patients with SARS-CoV-2 prompted preoperative screening and modification of surgical protocols. Although vaccination and treatment of COVID-19 have resulted in lower hospitalization rates and infection severity, publications on postoperative results have not been updated. The aim of the study was to analyze the outcomes of patients undergoing surgery in two periods with high incidence of SARS-CoV-2 infection, before and after vaccination. MATERIALS AND METHODS: This is a prospective cohort study of patients undergoing surgery in two periods: March-June 2020 (Group2020) and December 2021-February 2022 (Group2022) (after massive vaccination). RESULTS: In total, 618 patients who underwent surgery were included in the analysis (Group2020: 343 vs. Group2022: 275). Significantly more oncological procedures were performed in Group2020, and there were no differences in postoperative complications. Nosocomial SARS-CoV-2 infection occurred in 4 patients in Group2020 and 1 patient in Group2022. In Group 2022, 70 patients (25.4%) had COVID-19 prior to surgery, and 68 (97.1%) were vaccinated. Comparative analysis between patients with past COVID-19 and those without showed no difference in postoperative morbidity and mortality. According to the time elapsed between SARS-CoV-2 infection and surgery (≤ 7 or > 7 weeks), comparative analysis showed no significant differences. CONCLUSION: The establishment of preoperative screening protocols for SARS-CoV-2 infection results in a low incidence of nosocomial infection and optimal postoperative outcomes. Preoperative SARS-CoV-2 infection in vaccinated patients was not associated with increased postoperative complications, even in shorter periods after infection. In surgical patients, individualized preoperative evaluation after SARS-CoV-2 infection may be more important than strict time limitation.

miRNA as biomarker in lung cancer.

Lung cancer has a high prevalence and mortality due to its late diagnosis and limited treatment, so it is essential to find biomarkers that allow a faster diagnosis and improve the survival of these patients. In this sense, biomarkers based on miRNAs have supposed a considerable advance. miRNAs, which are small RNA sequences, can regulate gene expression, so they play an essential role not only as a diagnostic biomarker but also as a therapeutic and prognostic one. Also, miRNA biomarkers can be obtained from liquid biopsies, which are less intrusive than lung biopsies, and have better accessibility, safety and repeatability, which allows using those biomarkers both for diagnosis and monitoring of patients. In this review, we highlight the importance of miRNAs and collect the existing evidence of their relationship with lung cancer.

Hallazgos citogenéticos y edad materna en pacientes con síndrome down en un hospital de referencia pediátrico en el Perú

Introducción: El síndrome Down es un trastorno congénito originado por una trisomía total o parcial del cromosoma 21 y es considerada la causa genética más común de malformaciones congénitas y discapacidad intelectual. El objetivo de este estudio fue describir las alteraciones citogenéticas de pacientes con Síndrome Down y su relación con la edad materna. Métodos: Estudio transversal, descriptivo-analítico. Se incluyó 436 pacientes con Síndrome Down admitidos en el Instituto Nacional de Salud del Niño durante el período 2017-2019. Se analizaron las variables: alteración citogenética y edad materna. Resultados: Se encontró que el 99,3% (n=433) de pacientes presentaron algún tipo de alteración citogenética y tres pacientes presentaron cariotipo normal. La edad de los pacientes al momento de la toma de muestra estuvo comprendida entre los 0,03 y 17 años, la relación masculino/femenino fue de 1.2:1. La alteración citogenética más frecuente fue la trisomía 21 libre (94,7%), seguida por la translocación Robertsoniana (n=16) y el mosaicismo (n=6). En el caso de la edad materna se encontró una mediana de 37 años (rango: 13-47). Conclusiones: La trisomía 21 libre es la alteración citogenética más común en Síndrome Down; sin embargo, la translocación Robertsoniana y los mosaicismos fueron más frecuentes en edad materna menor de 35 años, sugiriendo que existe otros factores de riesgo diferentes a la edad materna avanzada en este grupo etario.

Introduction: Down syndrome is a congenital disorder caused by a total or partial trisomy of chromosome 21 and is considered the most common genetic cause of congenital malformations and intellectual disability. The objective of this study was to describe the cytogenetic alterations of patients with Down syndrome and their relationship with maternal age. Methods: Cross-sectional, descriptive-analytical study. 436 patients with Down syndrome admitted to the Instituto Nacional de Salud del Niño during the 2017-2019 period were included. The variables analyzed were: cytogenetic diagnosis and maternal age. Results: It was found that 99,3% (n=433) of patients presented some type of cytogenetic alteration and three patients presented a normal karyotype. The age of the patients at the time of sampling was between 0,03 and 17 years, the male/female ratio was 1.2:1. The most frequent cytogenetic alteration was free trisomy 21 (94,7%), followed by Robertsonian translocation (n=16) and mosaicism (n=6). In the case of maternal age, a median of 37 years was found (range: 13-47). Conclusions: Free trisomy 21 is the most common cytogenetic condition in Down syndrome; however, the Robertsonian translocation and mosaicisms were more frequent in patients whose mothers were les than 35 years old, suggesting that there are other risk factors than advanced maternal age in this group.

Technologies and social services. An overview of technology use by users of social services.

Information and communication technologies have significantly transformed the way advanced societies interact, produce, deliver services and consume resources. All walks of life are now touched by these technologies. However, compared to other areas of society, digital penetration is much lower in the development of and access to social services. The main objective of this paper was to find out what technological devices are used, how they are used and the way citizens interact with public bodies using technology to deliver social services. This has been part of a wider project on innovation in social services using participative methodologies centred on the development of local Hubs. The findings reveal a digital divide in technology-enabled access to social services that excludes the very people most in need of benefits and support.

Construction of miRNA–mRNA networks for the identification of lung cancer biomarkers in liquid biopsies

Lung cancer (LC) is the most common cause of cancer death worldwide mostly due to the low survival rate: 75% of cases are identified in advanced stages. In this study, the list of useful biomarkers to make an early diagnosis using liquid biopsies was expanded. A total of 30 samples of LC were analyzed to define potential miRNA biomarkers in liquid biopsies for LC. The biomarkers have been identified in interaction networks miRNA–mRNA. The potential biomarkers have been then validated in large cohorts. A total of 15 candidate miRNAs, that regulate the repression of 30 mRNAs, have been identified as a specific functional interaction network for squamous carcinoma, while the specific functional interaction network of adenocarcinoma consists of four candidate miRNAs that seem to handle the repression of five mRNA. Inspection of expression levels in larger cohorts validates the usefulness of the 11 candidates as biomarkers in liquid biopsies. The 11 candidate miRNAs found could be utilized to form diagnostic predictive biomarkers for LC in liquid biopsies (AU)

Promising biomedical subcutaneous delivery system in opioid disaccustom process: In vitro/in vivo evaluation of naloxone microparticles on antagonist effect of morphine.

The addiction induced by the misuse of opioids, is not only a public health emergency but also a social and economic welfare. The main therapy is based on opioid antagonists. Oral and injectable naltrexone administration is the most widely used, presenting some inconveniences: poor patient adherence to the oral daily dosing schedule, cases of hepatitis and clinically significant liver dysfunction. This study proposes the in vitro e in vivo evaluation of anti-opioid properties of naloxone loaded-poly(lactic-co-glycolic) acid microparticles (NX-MP). In previous studies, NX-MP showed in vitro sustained naloxone release for one week at least. Our results demonstrate the in vitro efficacy of the NX-MP antagonizing for 7 days the morphine effect in SH-SY5Y cells and myenteric plexus-longitudinal muscle preparations isolated from guinea-pig ileum. The in vivo evaluation of the NX-MP was carried out in mice testing the antagonism of the antinociceptive effect of morphine. Results showed that subcutaneous administration of NX-MP blocked the morphine effect. The results of this work suggest that the subcutaneous administration of NX-MP enhances naloxone therapeutic efficacy as non-addictive medication and could be a promising alternative to naltrexone. Furthermore, the dose of NX-MP can be adapted to the patient necessities. It would be an interesting advantage to treat opioid-addiction.

Construction of miRNA-mRNA networks for the identification of lung cancer biomarkers in liquid biopsies.

Lung cancer (LC) is the most common cause of cancer death worldwide mostly due to the low survival rate: 75% of cases are identified in advanced stages. In this study, the list of useful biomarkers to make an early diagnosis using liquid biopsies was expanded. A total of 30 samples of LC were analyzed to define potential miRNA biomarkers in liquid biopsies for LC. The biomarkers have been identified in interaction networks miRNA-mRNA. The potential biomarkers have been then validated in large cohorts. A total of 15 candidate miRNAs, that regulate the repression of 30 mRNAs, have been identified as a specific functional interaction network for squamous carcinoma, while the specific functional interaction network of adenocarcinoma consists of four candidate miRNAs that seem to handle the repression of five mRNA. Inspection of expression levels in larger cohorts validates the usefulness of the 11 candidates as biomarkers in liquid biopsies. The 11 candidate miRNAs found could be utilized to form diagnostic predictive biomarkers for LC in liquid biopsies.

Ecografía clínica multiventana: diagnóstico inusual en la UCIP / Unusual diagnostic in PICU by POCUS head-to-toe

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Conversion from Roux-En-Y Gastric Bypass to Single Anastomosis Duodenoileal Bypass (SADI-S) for Weight Regain.

BACKGROUND: Revisional bariatric surgery presents a challenge for bariatric surgeons. This procedure can be considered for patients with inadequate weight loss or weight regain after an initial satisfactory response following bariatric surgery. However, the surgical management of weight regain following RYGB remains controversial. We present a case of successful weight gain management after a single anastomosis duodenoileal bypass with sleeve gastrectomy (SADIS) as a revisional procedure for patients with weight regain after RYGB. METHODS: A 23-year-old female with a body mass index (BMI) of 52 kg/m2 and no comorbidities underwent RYGB. Postoperatively, she reached an excess weight loss of 75% of her initial body weight, with a BMI of 32 kg/m2. Eight years after her RYGB, she started regaining weight, reaching a BMI of 47 kg/m2. The surgical team decided to perform a revisional surgery, a conversion of RYGB to SADIS. RESULTS: There were no intraoperative complications. An upper gastrointestinal series was obtained on the third postoperative day which resulted normal and oral feedings were resumed. The patient was then discharged on fifth postoperative day. There were no complications within the first 30 postoperative days. CONCLUSIONS: We attach a video that illustrates the management and technique used to deal with the weight regain after primary bariatric surgery RYGB. We consider that in patients with super morbid obesity refractory to RYGB, conversion to SADIS is an excellent alternative due to its safety and feasibility.

Brunneroma: an infrequent duodenal neoplasm.

An 83-year-old male presented to the Emergency Department with long lasting epigastric discomfort, weight loss and diarrhea. Physical exam and basic laboratory tests showed no remarkable findings. Upper endoscopy revealed a sessile lesion (Paris 0-IIa) in the anterior wall of the duodenal bulb, with smooth surface and slightly ulcerated at the top.

Sedación paliativa en la agonía realizada por un servicio de urgencias de Atención Primaria a nivel domiciliario. Estudio observacional retrospectivo / Palliative sedation in agony performed at home by a primary care emergency service. A retrospective study

Objetivos: El objetivo de este estudio fue conocer las características de la sedación paliativa en la agonía a nivel domiciliario realizada por personal no especializado en cuidados paliativos y detectar áreas de mejora. Material y método: Estudio observacional retrospectivo. Se incluyeron todos los pacientes falle- cidos en domicilio entre septiembre de 2020 y febrero de 2021, que precisaron sedación indicada por el Servicio de Urgencias de Atención Primaria (SUAP) Málaga. Resultados: El porcentaje de sedación paliativa fue del 16,4 % [9,8-23,2 %]. Solo el 36 % [27- 45 %] de los pacientes se encontraba incluido en el proceso de cuidados paliativos. En el 67,2 % [59-76 %] de los casos, eran crónicos no oncológicos. La disnea fue el síntoma más prevalente (76,1 % [68-83 %]). El delirium estuvo presente en el 21,4 % [13-28 %] de los pacientes. El fár- maco más utilizado fue el midazolam (94,9 % [91-99 %]). La media de tiempo que pasa desde el inicio de la sedación hasta el fallecimiento es de 24,3 h [19,3-29,2h]. Las diferencias en las medias de supervivencia entre hombres (20,765 [13,7-27,7]) y mujeres (29,2 [22,1-33,3]) fueron estadísticamente significativas. El 72 % [64 %-80 %] de los pacientes no recibió ningún tipo de seguimiento desde el inicio de la sedación hasta el fallecimiento. Conclusiones: Existe concordancia entre los resultados obtenidos en este trabajo y los encontra- dos en la bibliografía consultada, en cuanto a la proporción de pacientes con sedación paliativa en la agonía, tiempo de duración de la misma y principales fármacos empleados. La edad media de los pacientes fue mayor en este estudio, así como la prevalencia de patología crónica no oncológica y de disnea como principal síntoma refractario. Llama la atención el desconocimien- to del nivel de sedación de nuestros pacientes, la falta de seguimiento y la infrautilización de levomepromazina en delirium. (AU)

Objectives: The objective of this study was to assess the characteristics of at-home palliative sedation in agony as carried out by care providers who are not specialists in palliative care, and to detect areas for improvement. Material and method: A retrospective, observational study. All patients who died at home be- tween September 2020 and February 2021, who required sedation as indicated by the Primary Care Emergency Service (SUAP) in Malaga, were included. Results: The percentage of palliative sedation was 16.4 % [9.8 %-23.2 %]. Only 36 % [27 %-45 %] of the patients were included in the palliative care process. In 67.2 % [59 %-76 %] of cases, they had non-cancer chronic conditions. Dyspnea was the most prevalent symptom (76.1 % [68 %-83 %]). Delirium was present in 21.4 % [13 %-28 %] of patients. The most widely used drug was midazolam (94.9 % [91 %-99 %]). Mean time from start of sedation to death is 24.3h [19.3h- 29.2h]. The differences in mean survival rate between men 20.765 [13.7-27.7] and women 29.2 [22.1-33.3] were statistically significant; 72 %[64 %-80 %] of the patients did not undergo any follow-up from start of sedation to death. Conclusions: There is agreement between the results obtained in this study and those found in the consulted bibliography regarding the proportion of patients with palliative sedation in agony, its duration, and the main drugs used. The mean age of the patients was higher in this study, as well as the prevalence of non-oncological chronic disease, with dyspnea as the main refractory symptom. The perceived lack of knowledge regarding sedation levels in our patients, as wellas lack of follow-up and underuse of levomepromazine in delirium, are striking. (AU)

Telework and Social Services in Spain during the COVID-19 Pandemic.

This paper analyses teleworking in social services during the state of alarm caused by the COVID-19 pandemic in Spain. It has a double objective: To analyse the profile of the professional who teleworked in social services and, on the other hand, to analyse the perception of teleworkers of working conditions during this period, as well as the degree to which they have been affected by them depending on whether they work face-to-face or telematically. To this end, a questionnaire was administered to Spanish social service professionals working, obtaining a sample of 560 professionals in the sector. The profile obtained in relation to teleworking may be especially useful when considering the progressive incorporation of more non-presential activity in social services, and the results show that, although teleworking has been perceived as an efficient way of overcoming the limitations to face-to-face work arising from the pandemic, both the positive and negative consequences of the implementation of this modality of work should be carefully assessed.

Hepatic reactive lymphoid hyperplasia: a difficult differential diagnosis with hepatocarcinoma.

Hepatic reactive lymphoid hyperplasia (HRLH) is an uncommon lesion. We present the case of a 58-year-old patient with a liver nodule incidentally found by abdominal ultrasonography (US). Liver function, tumor markers, viral serology and immunology were normal. Magnetic resonance imaging (MRI) showed a 16 mm nodule in segment VI-VII, with hypervascular enhancement in the arterial phase, wash-out in late phases, without contrast-retention in the hepatobiliary phase and restriction on diffusion-weighted imaging, suggestive of hepatocellular carcinoma (HCC).

Cooperation in the face of thresholds, risk, and uncertainty: Experimental evidence in fisher communities from Colombia.

Cooperation is thought to be a necessary condition to solve collective action dilemmas such as climate change or the sustainable use of common pool resources. Yet, it is poorly understood how situations pervaded by thresholds shape the behaviour of people facing collective dilemmas. Here we provide empirical evidence that resource users facing thresholds maintain on average cooperative behaviours in the sense of maximising their individual earnings while ensuring future group opportunities. A framed field experiment in the form of a dynamic game with 256 Colombian fishers helped us investigate individual behavioural responses to the existence of thresholds, risk and uncertainty. Thresholds made fishers extract less fish compared to situation without thresholds, but risk had a stronger effect on reducing individual fishing effort. Contrary to previous expectations, cooperation did not break down. If cooperation can be maintained in the face of thresholds, then communicating uncertainty is more policy-relevant than estimating precisely where tipping points lay in social-ecological systems.

Schwannoma: Differential diagnosis of a subepithelial gastric lesion. Two case report.

The pre-operative differential diagnosis of gastric subepithelial lesions is complex. We can find pathologies with a very different behavior. Some of them, like gastrointestinal (GI) stromal tumors, can present a malignant behavior, and others like schwannomas are practically benign. Schwannomas of the GI tract originate from the Schwann cells of the Auerbach plexus and their most frequent location is the stomach. The definitive diagnosis is made by immunohistochemical analysis of the surgical specimen and its resection is curative. We report two cases of gastric subepithelial lesions with a definitive diagnosis of schwannoma.

El diagnóstico diferencial preoperatorio de las lesiones subepiteliales gástricas es complejo. Podemos encontrar patologías con un comportamiento muy diferente. Algunas de ellas, como los GIST (gastrointestinal stromal tumours), pueden presentar un comportamiento maligno, y otras, como los schwannomas, son prácticamente benignas. Los schwannomas del tracto gastrointestinal se originan de las células de Schwann del plexo de Auerbach y su localización más frecuente es el estómago. El diagnóstico definitivo se realiza mediante el análisis inmunohistoquímico de la pieza quirúrgica, y su resección es curativa. Reportamos dos casos de lesiones subepiteliales gástricas con diagnóstico definitivo de schwannoma.

COVID-19 and social services in Spain.

During the state of alarm declared in Spain by COVID-19 due to the pandemic, the country's authorities declared Social Services and their workers to be essential, considering that the activity of these professionals with the vulnerable population was crucial and that services should continue to be provided to guarantee the well-being of users in this exceptionally serious situation. This article analyzes the impact that the COVID-19 and the state of alarm has had on Spanish social service professionals. An ad hoc questionnaire was used, administered on-line, individually, voluntarily and anonymously to 560 professionals working in social services, both in the public and private sectors, based throughout Spain. This questionnaire has five different parts: socio-demographic profiling, impact that the health crisis has had on the practice of professional functions, degree of knowledge of the measures imposed to guarantee the protection and safety of professionals and users, impact that it has had on the professional and personal development of social services professionals and, the fifth and last part, degree of adaptation of the measures aimed at the care of the vulnerable population. These results are discussed based on the situation in which professionals working in this sector find themselves in the face of the changes they are experiencing in the development of their work, and we are able to determine the profile of the workers who have felt most affected by the situation, with the consequent and foreseeable mental and emotional affectation that this implies. These professionals tend to value more negatively the set of measures developed to mitigate the impact of COVID-19 on Spanish social services.