Activation and disease control of patients on chronic hemodialysis: An observational study.

BACKGROUND AND OBJECTIVE: Patient activation is a concept that refers to the willingness to manage one's health and medical care. To assess it, a patient activation measure (PAM) has been developed and validated. Several studies report low activation in patients with chronic diseases. However, information on activation in hemodialysis patients is scarce. The aim of the present study is to describe the activation level of patients on chronic treatment in an HD unit and its relationship with disease control parameters. MATERIALS AND METHODS: Cross-sectional observational study in patients with advanced chronic kidney disease on chronic HD treatment. Ninety-six patients were included. Activation was measured with the PAM-13 questionnaire. Its relationship with descriptive variables (age, sex, comorbidity, studies, habitat) and disease control variables (vascular access, blood flow, potassaemia, phosphataemia, interdialytic gain) was studied. For this purpose, Spearman's correlation test, multiple linear regression model and logistic model were used as statistical methods. RESULTS: The mean (SD) PAM-13 score was 63.19 (15.21). Activation was significantly associated with vascular access (P = 0.003), blood flow (P = 0.024), and interdialytic gain of patients (P = 0.008). CONCLUSIONS: Activation in patients on chronic hemodialysis treatment is low. Higher activation is related having an arteriovenous fistula, higher blood flow and lower interdialytic gain. Future studies are needed to confirm and apply our results.

Establishing a national indicator-based surveillance system for hospital bed utilization by COVID-19 patients in the Philippines.

In March 2020, the Philippine Department of Health (DOH) designed and rapidly implemented a national surveillance system for the utilization of hospital beds by patients with coronavirus disease (COVID-19) to produce complete and timely data for use by various levels of governance in response to the COVID-19 pandemic. The DOH launched the DOH DataCollect (DDC) Bed Tracker system, a web-based application that collects information from all 1906 public and private hospitals and infirmaries across the country using a modular data collection tool. Data on the maximum number of occupied COVID-19-designated beds (n = 28 261), hospital bed utilization rate (71.7%), and mechanical ventilator number (n = 1846) and utilization rate (58.5%) were recorded in September 2021 during the Delta surge of cases in the Philippines. Data on human resources, personal protective equipment and supplies, and other operational indicators were added to the system during various modifications. Information from the DDC was used to inform the COVID-19 response and operations at national and local levels and facilitated research at academic and nongovernmental agencies. The development of the DDC system demonstrates that an effective surveillance system for use by all health-care facilities is achievable through strong national leadership, the use of available technology and adaptive information systems, and the establishment of networks across different health facilities and stakeholders.

MRI texture-based radiomics analysis for the identification of altered functional networks in alcoholic patients and animal models.

Alcohol use disorder (AUD) is a complex condition representing a leading risk factor for death, disease and disability. Its high prevalence and severe health consequences make necessary a better understanding of the brain network alterations to improve diagnosis and treatment. The purpose of this study was to evaluate the potential of resting-state fMRI 3D texture features as a novel source of biomarkers to identify AUD brain network alterations following a radiomics approach. A longitudinal study was conducted in Marchigian Sardinian alcohol-preferring msP rats (N = 36) who underwent resting-state functional and structural MRI before and after 30 days of alcohol or water consumption. A cross-sectional human study was also conducted among 33 healthy controls and 35 AUD patients. The preprocessed functional data corresponding to control and alcohol conditions were used to perform a probabilistic independent component analysis, identifying seven independent components as resting-state networks. Forty-three radiomic features extracted from each network were compared using a Wilcoxon signed-rank test with Holm correction to identify the network most affected by alcohol consumption. Features extracted from this network were then used in the machine learning process, evaluating two feature selection methods and six predictive models within a nested cross-validation structure. The classification was evaluated by computing the area under the ROC curve. Images were quantized using different numbers of gray-levels to test their influence on the results. The influence of ageing, data preprocessing, and brain iron accumulation were also analyzed. The methodology was validated using structural scans. The striatal network in alcohol-exposed msP rats presented the most significant number of altered features. The radiomics approach supported this result achieving good classification performance in animals (AUC = 0.915 ± 0.100, with 12 features) and humans (AUC = 0.724 ± 0.117, with 9 features) using a random forest model. Using the structural scans, high accuracy was achieved with a multilayer perceptron in both species (animals: AUC > 0.95 with 2 features, humans: AUC > 0.82 with 18 features). The best results were obtained using a feature selection method based on the p-value. The proposed radiomics approach is able to identify AUD patients and alcohol-exposed rats with good accuracy, employing a subset of 3D features extracted from fMRI. Furthermore, it can help identify relevant networks in drug addiction.

Estudio de intervención para comprobar el efecto de la música clásica en directo durante hemodiálisis sobre la calidad de vida de pacientes con enfermedad renal crónica / Intervention study to verify the effect of live classic music during hemodialysis on the quality of life of patients with chronic kidney disease

Introducción y objetivo: La música ha estado estrechamente unida a la medicina desde la antigüedad, y ha aportado numerosos beneficios a la salud de los pacientes. El paciente con enfermedad renal crónica en tratamiento de hemodiálisis (HD), generalmente, presenta una calidad de vida relacionada con la salud (CVRS) inferior a los valores de referencia de la población general. El objetivo del presente estudio es verificar si la intervención de música clásica en directo e in situ’ durante el tratamiento de HD tiene efectos sobre la CVRS de los pacientes.Materiales y métodos: Se realizó un estudio de intervención, prospectivo y aleatorizado por grupos, en pacientes con enfermedad renal crónica en tratamiento con HD. Durante 4 semanas un grupo de pacientes recibía la intervención con música clásica en directo 30 o 40min durante las sesiones de HD, mientras el grupo control realizaba el tratamiento habitual. Variables descriptivas: edad, sexo, meses en tratamiento, Kt/V, hemoglobina y albúmina. Variable resultado: CVRS, se midió con el cuestionario de salud Kidney Diseasse Quality of life (KDQOL-SF) antes y después de la intervención musical. (AU)

Introduction and objective: Music has been closely linked to medicine since ancient times, and has brought numerous benefits to the health of patients. Patients with chronic kidney disease undergoing hemodialysis (HD) generally have a health-related quality of life (HRQL) lower than the reference values of the general population. The objective of the present study is to verify if the intervention of classical music live and “in situ” during the treatment of HD has effects on the HRQL of the patients.Materials and methods: A prospective, group-randomized intervention study of 4 weeks’ duration was carried out in patients with chronic kidney disease undergoing HD. Descriptive variables are included for data analysis: age, sex, months in treatment, Kt/V, hemoglobin and albumin. Result variable: HRQL, measured with the Kidney Disease health questionnaire Quality of Life (KDQOL-SF) before and after the musical intervention. (AU)

Impact of an intradialysis virtual-reality-based exercise program on healthcare resources expenditure: a micro-costing analysis.

BACKGROUND: Engagement in exercise by haemodialysis (HD) patients has been shown to generate benefits both in terms of improved functional capacity and in the health-related quality of life. The use of non-immersive virtual reality (VR) games represents a new format for the implementation of intradialysis exercise. Some studies have shown that engaging in exercise for 6 months reduces the consumption of antihypertensive drugs and decreases the time spent admitted to hospital among individuals receiving HD treatments. The objective of this study was to evaluate changes in the consumption of healthcare resources and micro-costing for patients on HD who completed a VR exercise program. MATERIALS AND METHODS: Design: This study is a secondary analysis of a clinical trial. The participants performed an intradialysis exercise program with non-immersive virtual reality for 3 months. The variables were recorded in two periods: 12 months before and 12 months after the start of the exercise program. RESULTS: The micro-costing analysis showed a significant decrease in the mean cost, in euros, for the consumption of laboratory tests - 330 (95% CI:[- 533, - 126];p = 0.003), outpatient visits - 351 ([- 566, - 135];p = 0.003), and radiology tests - 111 ([- 209, - 10];p = 0.03) in the 12 months after the implementation of the exercise program relative to the 12 months prior to its start. CONCLUSION: The implementation of intradialysis exercise programs decreased the expenditure of some healthcare resources. Future studies could help clarify if longer interventions would have a stronger impact on these cost reductions.

Complications after open Latarjet procedure: influence of arm positioning on musculocutaneous and axillary nerve function.

BACKGROUND: Alterations in the anatomical relationships of the musculocutaneous (MCN) and axillary nerves and the influence of arm positioning on these relationships after a Latarjet procedure have been demonstrated in the cadaver, but there are no studies in the literature that establish if there is any neurophysiological repercussion. METHODS: We retrospectively identified 24 patients with a primary or revision open Latarjet procedure. A prospective clinical (Constant-Murley, Rowe and Walch-Duplay and active range of motion), radiographic (with CT), and electrodiagnostic evaluation was made at the most recent follow-up. RESULTS: Nonunion occurred in four patients (22%); there were, as well, one case of partial coracoid reabsorption (5%) and two (11%) with mild glenohumeral osteoarthritis. In the anatomical position, we found no alterations in the musculocutaneous nerve and two cases (11%) in the axillary nerve slight motor unit loss. In the risk position, 11 cases (61%) had neurophysiological involvement (36% had neurophysiological changes in the musculocutaneous nerve and 64% in the axillary nerve). No differences between patients with or without neurophysiologic changes were found: Constant 87/83; Rowe 89/90; Walch-Duplay 84/78; Forward elevation 175º/170º, abduction 165°/175°; external rotation 48°/45°. CONCLUSION: The rate of clinical electromyographic changes in the axillary and MCN in the abducted and externally rotated arm position (risk dislocation position) is higher than in neutral position. Nonunion of the coracoid process must play a role in these neurophysiological changes. Although in the medium-term they don't have clinical impact, further randomized prospective studies with a larger sample size are necessary to determine their true repercussion. LEVEL OF EVIDENCE: Level IV.

Intervention study to verify the effect of live classic music during hemodialysis on the quality of life of patients with chronic kidney disease.

INTRODUCTION AND OBJECTIVE: Music has been closely linked to medicine since ancient times, and has brought numerous benefits to the health of patients. Patients with chronic kidney disease (CKD) undergoing hemodialysis (HD) generally have a health-related quality of life (HRQL) lower than the reference values ​​of the general population. The objective of the present study is to verify if the intervention of classical music live and "in situ" during the treatment of HD has effects on the HRQoL of the patients. MATERIALS AND METHODS: A prospective, group-randomized intervention study of 4 weeks' duration was carried out in patients with chronic kidney disease undergoing hemodialysis. Descriptive variables are included for data analysis: age, sex, months in treatment, Kt/V, hemoglobinand albumin. Result variable: HRQL, measured with the Kidney Diseasse health questionnaire Quality of life (KDQOL-SF) before and after the musical intervention. RESULTS: Patients participated in 2 groups, the intervention group and the control group. The analysis of the results shows that the intervention group improved their quality of life compared to the initial measurement. The difference between the pre and post time of the intervention group with respect to the control group increased the mean score (pm) in all the scales significantly, except in the Work situation, Sexual function and Social support scales. The most important results were given on the Symptoms/problems scale with an increase of 15.78 (p < 0.001) pm; in scale Effects of kidney disease with an increase of 14.96 (p < 0.001) pm; in scale Burden of kidney disease with an increase of 16.36 (p < 0.001) pm; on the Dream scale with an increase of 14.78 (p < 0.001) pm; on the Vitality scale with an increase of 25.46 (p < 0.001) pm; on the Emotional well-being scale with an increase of 29.57 (p < 0.001) pm; on the Pain scale with an increase of 41.92 (p < 0.001) pm and on the General Health scale with an increase of 23.39 (p < 0.001) pm. CONCLUSION: Intervention with live music and on-site while receiving hemodialysis treatment improves self-perceived HRQL in patients with chronic kidney disease.

Optimizing health facility location for universal health care: A case study from the Philippines.

Site selection of health facilities is critical in ensuring universal access to basic healthcare services. However, in many low and middle-income countries (LMICs) like the Philippines, site selection is traditionally based on political and pragmatic considerations. Moreover, literature that demonstrates the application of facility location models in the Philippine healthcare setting remains scarce, and their usage in actual facility planning is even more limited. In this study, we proposed a variation of cooperative covering maximal models to identify the optimal location of primary care facilities. We demonstrated the feasibility of implementing such a model by using open source data on an actual city in the Philippines. Our results generated multiple candidate locations of primary care facilities depending on the equity and efficiency parameters. This approach could be used as one of the critical considerations in evidence-based, multi-criterion health facility location decisions of governments, and can also be adapted in other industries, given the model's use of readily available open source datasets.

Frequency of non-alcoholic fatty liver disease in a series of forensic cases in Mexico / Frecuencia de hígado graso no alcohólico en una serie de casos forenses en México

Abstract Objective: To determine the frequency of non-alcoholic fatty liver in individuals with not known history of liver disease, who died instantly in a traffic accident. Materials and Methods: It was a prospective and cross-sectional study of a series of autopsy cases, with a convenience sample obtained from the forensic medical service in the municipality of Boca del Río, Mexico, during the period from January to December 2016. The variables studied included age, sex, weight, height, abdominal circumference, thickness of the adipose panicle, cause of death and findings of liver biopsy. Results: A 78.1% of the 32 cases studied were men. The average age was 48 years old (range 20-80 years old). The body mass index range was 17-33. 34% of the cases had fatty liver. 27.3% of cases with fatty liver had a normal body mass index. Conclusions: This postmortem study showed a higher frequency of asymptomatic hepatic steatosis than previously reported in the Mexican population. It is necessary to establish timely national measures to detect and to prevent complications of this disease.

Resumen Objetivo: Determinar la frecuencia de hígado graso no alcohólico en individuos sin antecedentes conocidos de enfermedad hepática, que murieron instantáneamente en un accidente de tráfico. Materiales y Métodos: Fue un estudio prospectivo y transversal, de una serie de casos de autopsia, con una muestra por conveniencia obtenida en el servicio médico forense en el municipio de Boca del Río, México, durante el período de enero a diciembre de 2016. Las variables estudiadas incluyeron edad, sexo, peso, altura, perímetro abdominal, grosor del panículo adiposo, causa de muerte y hallazgos de la biopsia hepática. Resultados: De los 32 casos estudiados, el 78,1% eran hombres. La edad promedio fue de 48 años (rango 20-80 años). El rango del índice de masa corporal fue de 17-33. Un 34% de los casos tenían hígado graso. El 27.3% de los casos con hígado graso tenían un índice de masa corporal normal. Conclusiones: Este estudio postmortem mostró una frecuencia más alta de esteatosis hepática asintomática que la reportada previamente en la población mexicana. Es necesario establecer medidas nacionales oportunas para detectar y prevenir complicaciones de esta enfermedad.

Investigating the relationships between chemical element concentrations and discharge to improve our understanding of their transport patterns in rural catchments under subtropical climate conditions.

Solute and particulate elemental concentrations (C) exhibit different responses to changes in discharge (Q), and those relationships are not well understood in subtropical agricultural environments. The objective is to describe the transport processes of different chemical elements during a set of contrasted rainfall events (2011-2015) that occurred in a small rural catchment under subtropical climate. The study was carried out in the Lajeado Ferreira Creek catchment (1.23 km2), southern Brazil. To this end, the concentrations in dissolved organic carbon (DOC), Cl-, NO3-, SO4-, ten chemical elements (in either dissolved or particulate forms) and suspended sediment concentrations (SSC) were determined. Metric indices were then calculated to characterize their transport patterns: (i) the best fit slope between log-C and log-Q (ß), (ii) the coefficient of variation of C and Q, (iii) shape of the hysteresis loop and hysteresis index, and (iv) the flushing index. All particulate elements along with the dissolved inorganic phosphorus (PO4-3) were shown to be controlled by the sediment dynamics. Geogenic elements (Fe2+, Zn2+, Cu2+, Mn2+, Si4+) showed a dilution effect with increasing Q values, likely because they were mainly transported with subsurface and base flow. Dissolved elements that are mainly supplied with fertilizers (Na+ and Cl-) as well as DOC showed a dilution effect, although they were mainly transported by surface runoff. Finally, a chemostatic behavior was found for those chemical elements (Mg2+, K+, Ca2+, NO3- and SO42-) that are supplied by more than one flow pathways. The results demonstrate that under subtropical climate conditions, the transport of essential nutrients including PO4-3 and metals (in particulate form), are mainly transported with surface runoff. Accordingly, runoff control on cultivated hillslopes should be improved to reduce the potential contaminant supply to the river and to reduce the potentially deleterious impacts that they may cause in downstream regions.

Glioblastomas and brain metastases differentiation following an MRI texture analysis-based radiomics approach.

PURPOSE: To evaluate the potential of 2D texture features extracted from magnetic resonance (MR) images for differentiating brain metastasis (BM) and glioblastomas (GBM) following a radiomics approach. METHODS: This retrospective study included 50 patients with BM and 50 with GBM who underwent T1-weighted MRI between December 2010 and January 2017. Eighty-eight rotation-invariant texture features were computed for each segmented lesion using six texture analysis methods. These features were also extracted from the four images obtained after applying the discrete wavelet transform (88 features × 4 images). Three feature selection methods and five predictive models were evaluated. A 5-fold cross-validation scheme was used to randomly split the study group into training (80 patients) and testing (20 patients), repeating the process ten times. Classification was evaluated computing the average area under the receiver operating characteristic curve. Sensibility, specificity and accuracy were also computed. The whole process was tested quantizing the images with different gray-level values to evaluate their influence in the final results. RESULTS: Highest classification accuracy was obtained using the original images quantized with 128 gray-levels and a feature selection method based on the p-value. The best overall performance was achieved using a support vector machine model with a subset of 32 features (AUC = 0.896 ± 0.067, sensitivity of 82% and specificity of 80%). Naïve Bayes and k-nearest neighbors models showed also valuable results (AUC ≈ 0.8) with a lower number of features (<13), thus suggesting that these models may be more generalizable when using external validations. CONCLUSION: The proposed radiomics MRI approach is able to discriminate between GBM and BM with high accuracy employing a set of 2D texture features, thus helping in the diagnosis of brain lesions in a fast and non-invasive way.

Identification of the presence of ischaemic stroke lesions by means of texture analysis on brain magnetic resonance images.

BACKGROUND: The differential quantification of brain atrophy, white matter hyperintensities (WMH) and stroke lesions is important in studies of stroke and dementia. However, the presence of stroke lesions is usually overlooked by automatic neuroimage processing methods and the-state-of-the-art deep learning schemes, which lack sufficient annotated data. We explore the use of radiomics in identifying whether a brain magnetic resonance imaging (MRI) scan belongs to an individual that had a stroke or not. MATERIALS AND METHODS: We used 1800 3D sets of MRI data from three prospective studies: one of stroke mechanisms and two of cognitive ageing, evaluated 114 textural features in WMH, cerebrospinal fluid, deep grey and normal-appearing white matter, and attempted to classify the scans using a random forest and support vector machine classifiers with and without feature selection. We evaluated the discriminatory power of each feature independently in each population and corrected the result against Type 1 errors. We also evaluated the influence of clinical parameters in the classification results. RESULTS: Subtypes of ischaemic strokes (i.e. lacunar vs. cortical) cannot be discerned using radiomics, but the presence of a stroke-type lesion can be ascertained with accuracies ranging from 0.7 < AUC < 0.83. Feature selection, tissue type, stroke subtype and MRI sequence did not seem to determine the classification results. From all clinical variables evaluated, age correlated with the proportion of images classified correctly using either different or the same descriptors (Pearson r = 0.31 and 0.39 respectively, p < 0.001). CONCLUSIONS: Texture features in conventionally automatically segmented tissues may help in the identification of the presence of previous stroke lesions on an MRI scan, and should be taken into account in transfer learning strategies of the-state-of-the-art deep learning schemes.

ALTEA: A Software Tool for the Evaluation of New Biomarkers for Alzheimer's Disease by Means of Textures Analysis on Magnetic Resonance Images.

The current criteria for diagnosing Alzheimer's disease (AD) require the presence of relevant cognitive deficits, so the underlying neuropathological damage is important by the time the diagnosis is made. Therefore, the evaluation of new biomarkers to detect AD in its early stages has become one of the main research focuses. The purpose of the present study was to evaluate a set of texture parameters as potential biomarkers of the disease. To this end, the ALTEA (ALzheimer TExture Analyzer) software tool was created to perform 2D and 3D texture analysis on magnetic resonance images. This intuitive tool was used to analyze textures of circular and spherical regions situated in the right and left hippocampi of a cohort of 105 patients: 35 AD patients, 35 patients with early mild cognitive impairment (EMCI) and 35 cognitively normal (CN) subjects. A total of 25 statistical texture parameters derived from the histogram, the Gray-Level Co-occurrence Matrix and the Gray-Level Run-Length Matrix, were extracted from each region and analyzed statistically to study their predictive capacity. Several textural parameters were statistically significant (p < 0.05) when differentiating AD subjects from CN and EMCI patients, which indicates that texture analysis could help to identify the presence of AD.

Classifying brain metastases by their primary site of origin using a radiomics approach based on texture analysis: a feasibility study.

OBJECTIVE: To examine the capability of MRI texture analysis to differentiate the primary site of origin of brain metastases following a radiomics approach. METHODS: Sixty-seven untreated brain metastases (BM) were found in 3D T1-weighted MRI of 38 patients with cancer: 27 from lung cancer, 23 from melanoma and 17 from breast cancer. These lesions were segmented in 2D and 3D to compare the discriminative power of 2D and 3D texture features. The images were quantized using different number of gray-levels to test the influence of quantization. Forty-three rotation-invariant texture features were examined. Feature selection and random forest classification were implemented within a nested cross-validation structure. Classification was evaluated with the area under receiver operating characteristic curve (AUC) considering two strategies: multiclass and one-versus-one. RESULTS: In the multiclass approach, 3D texture features were more discriminative than 2D features. The best results were achieved for images quantized with 32 gray-levels (AUC = 0.873 ± 0.064) using the top four features provided by the feature selection method based on the p-value. In the one-versus-one approach, high accuracy was obtained when differentiating lung cancer BM from breast cancer BM (four features, AUC = 0.963 ± 0.054) and melanoma BM (eight features, AUC = 0.936 ± 0.070) using the optimal dataset (3D features, 32 gray-levels). Classification of breast cancer and melanoma BM was unsatisfactory (AUC = 0.607 ± 0.180). CONCLUSION: Volumetric MRI texture features can be useful to differentiate brain metastases from different primary cancers after quantizing the images with the proper number of gray-levels. KEY POINTS: • Texture analysis is a promising source of biomarkers for classifying brain neoplasms. • MRI texture features of brain metastases could help identifying the primary cancer. • Volumetric texture features are more discriminative than traditional 2D texture features.

A radiomics evaluation of 2D and 3D MRI texture features to classify brain metastases from lung cancer and melanoma.

Brain metastases are occasionally detected before diagnosing their primary site of origin. In these cases, simple visual examination of medical images of the metastases is not enough to identify the primary cancer, so an extensive evaluation is needed. To avoid this procedure, a radiomics approach on magnetic resonance (MR) images of the metastatic lesions is proposed to classify two of the most frequent origins (lung cancer and melanoma). In this study, 50 T1-weighted MR images of brain metastases from 30 patients were analyzed: 27 of lung cancer and 23 of melanoma origin. A total of 43 statistical texture features were extracted from the segmented lesions in 2D and 3D. Five predictive models were evaluated using a nested cross-validation scheme. The best classification results were achieved using 3D texture features for all the models, obtaining an average AUC > 0.9 in all cases and an AUC = 0.947 ± 0.067 when using the best model (naïve Bayes).

Queratosis actínica: nuevo concepto y actualización terapéutica / Actinic keratosis: New concept and therapeutic update

La queratosis actínica (QA) es motivo de consulta frecuente tanto en atención primaria como en atención especializada. Supone el tercer o cuarto motivo más frecuente de consulta en dermatología, llegando a representar hasta un 5-6% de los pacientes atendidos. Además, se ha observado que esta prevalencia ha ido en aumento en los últimos 10 años, en comparación con otras dermatosis, y se prevé que seguirá aumentado por la mayor esperanza de vida y por los cambios de hábitos de exposición solar acontecidos desde mediados del siglo pasado. El objetivo de este artículo es actualizar los conceptos de QA y de campo de cancerización, y exponer las herramientas terapéuticas disponibles actualmente (AU)

Actinic keratosis (AK) is a common reason for consultation in both Primary Care and Specialised Care. It is the third or fourth most common reason for consultation in dermatology, accounting for up to 5-6% of patients attended. It has also been observed that its prevalence has been increasing in the last 10 years, compared to other dermatoses. This is also expected to continue to increase due to longer life expectancy, and by the changes in sun exposure habits since the middle of the last century. The aim of this article is to update the concepts of AK, cancerisation field and to present the currently available therapeutic tools (AU)

El hombre y los microorganismos: el eje cerebro-intestino / Man and microorganisms: the gut-brain axis

Las bacterias han colonizado al Homo sapiens como parásitos (provocando la enfermedad y la muerte) y también como mutualistas (microbioma). Como mutualistas el microbioma se utiliza como marcador de enfermedades específicas, y se propone la existencia de un eje microbiota-intestino-cerebro cuyo funcionamiento incorrecto es responsable de trastornos cerebrales: comportamiento, ansiedad, depresión, esclerosis múltiple, enfermedad de Alzheimer… Entre los posibles intermediarios que conectan el intestino con el cerebro se encuentran el sistema inmunitario, neuropéptidos y metabolitos microbianos. La conexión con el cerebro puede canalizarse por el nervio vago pero también por el sistema nervioso autónomo. Se han obtenido imágenes cerebrales en humanos que relacionan la composición de la microbiota con la emoción y actualmente necesitamos que los estudios realizados con roedores se amplíen a humanos para poder confirmar que los probioticos tienen efecto sobre la salud mental. El microbioma forma parte de un ecosistema mutualista necesario al Homo sapiens para que pueda sobrevivir como especie (AU)

Bacteria have colonized Homo sapiens as parasites (causing disease and death) and also as mutualists (microbioma). As a mutualist the microbioma is used as a marker of specific diseases and it is proposed the existence of a microbiota-intestine-brain axis whose incorrect functioning is responsible for brain disorders: behavior, anxiety, depression, multiple sclerosis, Alzheimer's disease… Among the possible intermediates that connect the intestine with the brain are the immune system, neuropeptides and microbial metabolites. The connection to the brain can be channeled through the vagus nerve but also through the autonomous nervous system. Human brain images have been obtained that relate the composition of the microbiota to emotion, and we now need the studies done with rodents to be extended to humans in order to confirm that probiotics have an effect on mental health. The microbiome is part of a mutualistic ecosystem necessary to Homo sapiens so that it can survive as a species (AU)

[Actinic keratosis: New concept and therapeutic update]. / Queratosis actínica: nuevo concepto y actualización terapéutica.

Actinic keratosis (AK) is a common reason for consultation in both Primary Care and Specialised Care. It is the third or fourth most common reason for consultation in dermatology, accounting for up to 5-6% of patients attended. It has also been observed that its prevalence has been increasing in the last 10years, compared to other dermatoses. This is also expected to continue to increase due to longer life expectancy, and by the changes in sun exposure habits since the middle of the last century. The aim of this article is to update the concepts of AK, cancerisation field and to present the currently available therapeutic tools.

Workshop on reconstruction schemes for magnetic resonance data: summary of findings and recommendations.

The high-fidelity reconstruction of compressed and low-resolution magnetic resonance (MR) data is essential for simultaneously improving patient care, accuracy in diagnosis and quality in clinical research. Sponsored by the Royal Society through the Newton Mobility Grant Scheme, we held a half-day workshop on reconstruction schemes for MR data on 17 August 2016 to discuss new ideas from related research fields that could be useful to overcome the shortcomings of the conventional reconstruction methods that have been evaluated to date. Participants were 21 university students, computer scientists, image analysts, engineers and physicists from institutions from six different countries. The discussion evolved around exploring new avenues to achieve high resolution, high quality and fast acquisition of MR imaging. In this article, we summarize the topics covered throughout the workshop and make recommendations for ongoing and future works.