Validation of the Adult Attachment Questionnaire-Revised (CAA-r).

The Adult Attachment Questionnaire-Revised and its psychometric properties are presented for dimensional and categorical evaluation of adult attachment style. Eight items were added to the original questionnaire (CAA; Melero and Cantero, 2008) that expanded avoidance dimension assessment and sensitivity evaluation. The exploratory factor analysis EFA led to 35 items grouped in 4 affective dimensions. (1) Anxiety: Need for approval, negative self-esteem, fear for rejection/abandonment and relationship anxiety; (2) Socioemotional competence: Emotional openness, sensitivity, and confidence; (3) Avoidance: Self-reliance and emotional discomfort with intimacy, and (4) Anger: Resentment, anger and intransigence. The cluster analysis confirmed the categorization of the 4 styles of attachment described by Bartholomew (Bartholomew and Horowitz, 1991). The questionnaire showed satisfactory levels of reliability and validity.

Healthcare service use for children with chronic complex diseases: A longitudinal six-year follow-up study.

PURPOSE: The objective was analysed the patterns use of healthcare services of this population and the influence of their clinical and sociodemographic characteristics. DESIGN AND METHODS: A six-year longitudinal follow-up study was performed to evaluate the annual healthcare resources use and clinical data among children with complex chronic diseases in Spain between 2015 and 2021. The sample trends in healthcare usage and the associated factors were analysed using ANCOVA and multivariable linear regression models. RESULTS: Patients had high attendance during the follow-up period, with >15 episodes year. This trend decreased over time, especially in children with oncological diseases compared with other diseases (F (16.75; 825.4) = 32.457; p < 0.001). A multivariable model showed that children with a greater number of comorbidities (ß = 0.17), shorter survival time (ß = -0.23), who had contact with the palliative care unit (ß = 0.16), and whose mothers had a higher professional occupation (ß = 0.14), had a greater use of the healthcare system. CONCLUSIONS: Children with a higher number of comorbidities and the use of medical devices made a greater frequentation of health services, showing a trend of decreasing use over time. Socioeconomic factors such as mothers' occupational status determine healthcare frequentation. These results suggest the existence of persistent gaps in care coordination sustained over time. PRACTICAL IMPLICATIONS: Systematized and coordinated models of care for this population should consider the presence of inequalities in health care use.

Osteosarcoma cells exhibit functional interactions with stromal cells, fostering a lung microenvironment conducive to the establishment of metastatic tumor cells.

BACKGROUND: Osteosarcoma (OS) stands out as the most common bone tumor, with approximately 20% of the patients receiving a diagnosis of metastatic OS at their initial assessment. A significant challenge lies in the frequent existence of undetected metastases during the initial diagnosis. Mesenchymal stem cells (MSCs) possess unique abilities that facilitate tumor growth, and their interaction with OS cells is crucial for metastatic spread. METHODS AND RESULTS: We demonstrated that, in vitro, MSCs exhibited a heightened migration response toward the secretome of non-metastatic OS cells. When challenged to a secretome derived from lungs preloaded with OS cells, MSCs exhibited greater migration toward lungs colonized with metastatic OS cells. Moreover, in vivo, MSCs displayed preferential migratory and homing behavior toward lungs colonized by metastatic OS cells. Metastatic OS cells, in turn, demonstrated an increased migratory response to the MSCs' secretome. This behavior was associated with heightened cathepsin D (CTSD) expression and the release of active metalloproteinase 2 (MMP2) by metastatic OS cells. CONCLUSIONS: Our assessment focused on two complementary tumor capabilities crucial to metastatic spread, emphasizing the significance of inherent cell features. The findings underscore the pivotal role of signaling integration within the niche, with a complex interplay of migratory responses among established OS cells in the lungs, prometastatic OS cells in the primary tumor, and circulating MSCs. Pulmonary metastases continue to be a significant factor contributing to OS mortality. Understanding these mechanisms and identifying differentially expressed genes is essential for pinpointing markers and targets to manage metastatic spread and improve outcomes for patients with OS.

Psychological burden and quality of life in newly diagnosed inflammatory bowel disease patients.

Objective: Psychological factors, such as stress, anxiety, and depression, are frequently related to inflammatory bowel disease (IBD). However, few studies have examined these factors in patients newly diagnosed with IBD. The aim of the present study was to test the psychological burden in patients with a recent diagnosis of IBD and the factors related to this psychological burden. Methods: We performed a prospective, multi-center, observational study in patients with a new diagnosis of IBD (≤6 months). The patients were recruited from four different Spanish hospitals. Clinical and demographic characteristics were collected. Patients were evaluated using the Hospital Anxiety and Depression Scale and quality of life questionnaire for patients with inflammatory bowel disease (IBDQ-32). The Scale of Stress Perceived by the Disease was used to assess stressful life events. Results: We included 156 patients newly diagnosed with IBD [69 women; 80 Crohn's disease (CD) and 76 ulcerative colitis (UC)], with a mean age of 42.3 (SD 16.21) years. A total of 37.2% of patients had symptoms of anxiety and 17.3% had symptoms of depression. Quality of life was affected in 30.1% of patients. Factors related to anxiety in early IBD were being a woman and having CD. The only factor related to depression was the presence of comorbidity. Being a woman and having suffered previous stressful life events were factors related to impaired quality of life. Conclusion: Anxiety, depression, and impaired quality of life are frequent in patients with a recent diagnosis of IBD. This psychological burden is greater in women.

[Effect of gender equality on mortality from non-communicable diseases]. / Efecto de la igualdad de género en la mortalidad por enfermedades no transmisibles.

OBJECTIVE: Relate gender inequalities with the probability of mortality from non-communicable diseases (NCD), in the countries of the world from the year 2000 to 2019, to detect the progress of Target 3.4 of the Sustainable Development Goal 3, to reduce NCD by one third between the ages of 30 and 70 by 2030. METHOD: Exploratory ecological study on the association between the probability of death from NCD and the gender inequality index (GII) at the global level in 2000, 2015 and 2019. Logistic regression estimation of the risk of not being on track to meet Target 3.4 by 2019 by gender inequality. RESULTS: The mean probability of death from NCD decreased progressively in all countries. Median 2000/2015/2019: women 20.20/16.58/16; men 26.59/22.45/21.88; total 23.14/20.10/19.23. The risk of not achieving the goal in 2019 is greater in countries with a lower GII than in countries with a higher GII (OR: 2.13; 95% CI: 1.14-3.99; p=0.018), being the higher risk in women (OR: 2.64; 95% CI: 1.40-5.06; p=0.003) than in men (OR: 2.12; 95% CI: 1.44-3.98; p=0.017). CONCLUSIONS: The risk of deaths from NCD has decreased in both sexes in all countries of the world since the year 2000; but progress is slow, so the greater gender inequality in the countries, there is a greater risk of not achieving the reduction needed to comply with the agreement to reduce mortality from NCD by one third in 2030; this risk being greater in women than in men.

[Response to the COVID-19 Health Crisis from a Gender Perspective: Lessons Learned]. / Respuesta a la crisis sanitaria de la COVID-19 desde la perspectiva de género: lecciones aprendidas.

OBJECTIVE: To delve deeper from a gender perspective into the lessons learned during the COVID-19 pandemic to address future health crises. METHOD: Study with key informants with experience in public health and gender from the Ministerio de Sanidad, ministries of the autonomous communities, Institut Català de la Salut, Hospital de La Princesa, Escuela Andaluza de Salud Pública and Universidad País Vasco. SOURCE OF INFORMATION: individual open-ended questionnaire on health and health inequalities/gender inequalities related to COVID-19. After presenting the findings, the key informants group discussed them in a meeting until reaching a consensus on the lessons learned. RESULTS: The lack of clinical statistics by sex could compromise epidemiological surveillance, losing the opportunity to characterize the disease. The performance of essential services fell more on women, exhausting them with double and triple shifts; with the differences according to sex in the clinical presentation of COVID-19, and the criteria for hospitalization/admission to the intensive care unit, their access to health care decreased. Increased: gender violence and mental health problems; delaying recognition of the second effects of vaccines in women; partially due to information biases in clinical trials. The gender perspective was lacking in academic, healthcare, and health management areas. CONCLUSIONS: Women's gender dimensions determined their higher frequency of COVID-19 and played a fundamental role in its control. Broadly considering the lessons learned will strengthen prevention systems and be able to provide effective responses to future health crises.

Respuesta a la crisis sanitaria de la COVID-19 desde la perspectiva de género: lecciones aprendidas / Response to the COVID-19 Health Crisis from a Gender Perspective: Lessons Learned

Objetivo: Profundizar desde la perspectiva de género en las lecciones aprendidas durante la pandemia de COVID-19 para hacer frente a futuras crisis de salud. Método: Estudio con informantes clave con experiencia en salud pública y género del Ministerio de Sanidad, Consejerías de las comunidades autónomas, Institut Català de la Salut, Hospital de La Princesa, Escuela Andaluza de Salud Pública y Universidad del País Vasco. Fuente de información: cuestionario individual de respuestas abiertas sobre inequidades o desigualdades de género sanitarias y en salud relacionadas con la COVID-19. Tras presentar los hallazgos, el grupo de informantes clave se reunió y debatió hasta llegar a un consenso sobre las lecciones aprendidas. Resultados: La falta de estadísticas clínicas por sexo pudo comprometer la vigilancia epidemiológica, perdiendo una oportunidad para caracterizar la enfermedad. El desempeño de los servicios esenciales recayó más en las mujeres, extenuándolas con dobles y triples jornadas, lo cual, junto con las diferencias según sexo en la presentación clínica de la COVID-19 y los criterios de hospitalización y de ingreso en la unidad de cuidados intensivos, disminuyó su acceso a la atención sanitaria. Aumentaron la violencia de género y los problemas de salud mental, retrasando el reconocer los efectos secundarios de las vacunas en las mujeres parcialmente por sesgos de información en los ensayos clínicos. La perspectiva de género faltó en los ámbitos académicos, asistenciales y de gestión sanitaria. Conclusiones: Las dimensiones de género de las mujeres determinaron su mayor frecuencia de COVID-19 y desempeñaron un papel fundamental en su control. Considerar las lecciones aprendidas fortalecerá los sistemas de prevención y permitirá poder dar respuestas eficaces a futuras crisis de salud.(AU)

Objective: To delve deeper from a gender perspective into the lessons learned during the COVID-19 pandemic to address future health crises. Method: Study with key informants with experience in public health and gender from the Ministerio de Sanidad, ministries of the autonomous communities, Institut Català de la Salut, Hospital de La Princesa, Escuela Andaluza de Salud Pública and Universidad País Vasco. Source of information: individual open-ended questionnaire on health and health inequalities/gender inequalities related to COVID-19. After presenting the findings, the key informants group discussed them in a meeting until reaching a consensus on the lessons learned. Results: The lack of clinical statistics by sex could compromise epidemiological surveillance, losing the opportunity to characterize the disease. The performance of essential services fell more on women, exhausting them with double and triple shifts; with the differences according to sex in the clinical presentation of COVID-19, and the criteria for hospitalization/admission to the intensive care unit, their access to health care decreased. Increased: gender violence and mental health problems; delaying recognition of the second effects of vaccines in women; partially due to information biases in clinical trials. The gender perspective was lacking in academic, healthcare, and health management areas. Conclusions: Women's gender dimensions determined their higher frequency of COVID-19 and played a fundamental role in its control. Broadly considering the lessons learned will strengthen prevention systems and be able to provide effective responses to future health crises.(AU)

Efecto de la igualdad de género en la mortalidad por enfermedades no transmisibles / Effect of gender equality on mortality from non-communicable diseases

Objetivo: Relacionar las desigualdades de género con la probabilidad de mortalidad por enfermedades no transmisibles (ENT) en los países del mundo desde 2000 hasta 2019, para detectar el progreso de la Meta 3.4 del Objetivo de Desarrollo Sostenible 3, de reducir en un tercio las ENT entre los 30 y los 70 años para 2030. Método: Estudio ecológico exploratorio sobre la asociación entre la probabilidad de fallecimiento por ENT y el índice de desigualdad de género (IDG) en el mundo en 2000, 2015 y 2019. Estimación mediante regresión logística del riesgo de no estar en proceso de cumplir la Meta 3.4 en 2019 según desigualdad de género. Resultados: La probabilidad media de fallecimiento por ENT descendió progresivamente en todos los países. Medianas 2000/2015/2019: mujeres 20,20/16,58/16; hombres 26,59/22,45/21,88; total 23,14/20,10/19,23. El riesgo de no estar logrando la meta en 2019 es mayor en los países con menor IDG que en los países con mayor IDG (OR: 2,13; IC95%: 1,14-3,99; p = 0,018), siendo el riesgo mayor en las mujeres (OR: 2,64; IC95%: 1,40-5,06; p = 0,003) que en los hombres (OR: 2,12; IC95%: 1,44-3,98; p = 0,017). Conclusiones: El riesgo de fallecimiento por ENT descendió en ambos sexos en todos los países del mundo desde el año 2000, pero el progreso es lento y, a mayor desigualdad de género en los países, mayor riesgo de no estar logrando el descenso necesitado para cumplir con el acuerdo de reducir un tercio la mortalidad por ENT en 2030, siendo este riesgo mayor en las mujeres que en los hombres.(AU)

Objective: Relate gender inequalities with the probability of mortality from non-communicable diseases (NCD), in the countries of the world from the year 2000 to 2019, to detect the progress of Target 3.4 of the Sustainable Development Goal 3, to reduce NCD by one third between the ages of 30 and 70 by 2030. Method: Exploratory ecological study on the association between the probability of death from NCD and the gender inequality index (GII) at the global level in 2000, 2015 and 2019. Logistic regression estimation of the risk of not being on track to meet Target 3.4 by 2019 by gender inequality. Results: The mean probability of death from NCD decreased progressively in all countries. Median 2000/2015/2019: women 20.20/16.58/16; men 26.59/22.45/21.88; total 23.14/20.10/19.23. The risk of not achieving the goal in 2019 is greater in countries with a lower GII than in countries with a higher GII (OR: 2.13; 95% CI: 1.14–3.99; p = 0.018), being the higher risk in women (OR: 2.64; 95% CI: 1.40–5.06; p = 0.003) than in men (OR: 2.12; 95% CI: 1.44–3.98; p = 0.017). Conclusions: The risk of deaths from NCD has decreased in both sexes in all countries of the world since the year 2000; but progress is slow, so the greater gender inequality in the countries, there is a greater risk of not achieving the reduction needed to comply with the agreement to reduce mortality from NCD by one third in 2030; this risk being greater in women than in men.(AU)

Role of the microtubules in the electrical activity of the primary cilium of renal epithelial cells.

The primary cilium is a non-motile sensory organelle that transduces environmental cues into cellular responses. It comprises an axoneme, a core of nine doublet microtubules (MTs) coated by a specialized membrane populated by receptors, and a high density of ion channels. Dysfunctional primary cilia generate the pathogenesis of several diseases known as ciliopathies. However, the electrical role of MTs in ciliary signaling remains largely unknown. Herein, we determined by the patch clamp technique the electrical activity of cytoplasmic and axonemal MTs from wild-type LLC-PK1 renal epithelial cells. We observed electrical oscillations with fundamental frequencies at ∼39 Hz and ∼93 Hz in sheets of cytoplasmic MTs. We also studied in situ and isolated, intact and Triton X-permeabilized primary cilia, observing electrical oscillations with peak frequencies at either 29-49 Hz (non-permeabilized) or ∼40-49 Hz (permeabilized) and ∼93 Hz (both). We applied Empirical Mode Decomposition (EMD), Continuous Wavelet Transform (CWT), and Cross-Correlation Analysis (CCA) to assess the differences and the coherence in the Time-Frequency domains of electrical oscillations between cytoplasmic and axonemal MTs. The data indicate that axonemal and cytoplasmic MTs show different patterns of electrical oscillations preserving coherence at specific frequency peaks that may serve as electromagnetic communication between compartments. Further, the electrical behavior of axonemal MTs was modified by siRNA deletion of polycystin-2 (PC2), which lengthens primary cilia, thus linking ciliary channels to the morphological and electrical behavior of cilia in ciliopathies. The encompassed evidence indicates that the primary cilium behaves as an electrical antenna, with an excitable MT structure that produces electrical oscillations whose synchronization and propagation constitute a novel cell signaling mechanism.

Accompaniment of minors during health care procedures.

In clinical practice, it is not rare to encounter situations in which parents and families are asked to leave the child alone with the health care team in rooms full of devices throughout the performance of procedures, which at times may give rise not only to conflicts but, more importantly, emotional sequelae in children or adolescents. We conducted a narrative review of the literature by searching the digital library of the public health care system of Andalusia for articles concerning the experiences of health care professionals and families with the accompaniment of paediatric patients during health care procedures. We restricted the search to studies published in Spanish or English and conducted in humans. The review evinced the need to humanise care in order to improve care quality. The need to accompany minors is supported by the evidence from works that have analysed the factors involved in the persistence of these behaviours and attitudes in both professionals and parents. We consider it necessary to develop institutional policies and appoint mediators to compile the statements of different national and international societies, taking into account legal aspects but, above all, the pertinent values from a health care ethics perspective, and in pursuit of the best interests of the child.

The bacterial tubulin homolog FtsZ generates electrical oscillations.

FtsZ, a major cytoskeletal protein in all bacteria and archaea, forms a ring that directs cytokinesis. Bacterial FtsZ is considered the ancestral homolog of the eukaryotic microtubule (MT)-forming tubulins, sharing GTPase activity and the ability to assemble into protofilaments, rings, and sheets, but not MTs. Previous studies from our laboratory demonstrated that structures of isolated brain MTs spontaneously generate electrical oscillations and bursts of electrical activity similar to action potentials. No information about whether the prokaryotic tubulins may share similar properties is available. Here, we obtained by ammonium sulfate precipitation an enriched protein fraction of the endogenous FtsZ from wild-type Escherichia coli ATCC 25922 without any transfection or overexpression of the protein. As revealed by electron microscopy, FtsZ was detected by dot blot analysis and immunofluorescence that assembled into filaments and sheets in a polymerization buffer. We used the patch-clamp technique to explore the electrical properties of sheets of FtsZ and bacterial cells. Electrical recordings at various holding potentials ranging from ±200 mV showed a complex oscillatory behavior, with several peak frequencies between 12 and 110 Hz in the power spectra and a linear mean current response. To confirm the oscillatory electrical behavior of FtsZ we also conducted experiments with commercial recombinant FtsZ, with similar results. We also detected, by local field potentials, similar electrical oscillations in K+-depolarized pellets of E. coli cultures. FtsZ oscillations had a wider range of frequency peaks than MT sheets from eukaryotic origin. The findings indicate that the bacterial cytoskeleton generates electrical oscillators that may play a relevant role in cell division and unknown signaling mechanisms in bacterial populations.

[Morbidity due to chronic diseases and their health care in Asturias: a gender analysis]. / Morbilidad por enfermedades crónicas y su atención sanitaria en Asturias: análisis de género.

OBJECTIVE: To determine gender differences in the magnitude and complexity of chronic diseases and gender inequalities in health care in the adult population of Asturias in 2022. METHOD: A cross-sectional population study in people (>14 years) with at least one diagnosis of chronic disease (780,566 inhabitants). SOURCES OF INFORMATION: computer program for morbidity groups (Ministry of Health), Electronic medical record of primary care and hospital. Comparative analysis by sex and age, the mean values of chronic diseases and complexity index (Student's t test and one-way ANOVA), and probability (odds ratio and 95% CI) of suffering from specific chronic diseases, making one or more visits to the hospital emergency department or one or more admissions to hospital. RESULTS: 89.9% of women and 82.1% of men were registered with at least one chronic disease. The mean was higher in women (4.36) than in men (3.22) (p<0.001). Complexity index: men 4.56 and women 5.85 (p<0.001). Results show that women are more likely to attend the hospital emergency department, with an attendance rate of 50% for the diseases cited, compared with men at 29%. The rate of hospital admission is higher in men in 13 of the 14 diseases studied (85%). CONCLUSIONS: Gender analysis can also be applied to secondary sources of the National Health System. Despite the greater magnitude and complexity of chronic diseases in women, there is a higher frequency of hospital admissions in men compared to women with the same diseases. This implies an unequal care profile in the field of hospital admissions that the scientific literature associates with gender biases in health care.

Acompañamiento a los menores durante los procedimientos asistenciales / Accompaniment of minors during health care procedures

En la práctica clínica no es infrecuente observar situaciones en las cuales se invita a los progenitores y la familia a dejar a los menores en soledad junto al equipo asistencial en estancias repletas de tecnología durante la realización de procedimientos, dando lugar en ocasiones a conflictos, pero sobre todo con consecuencias emocionales en los niños o adolescentes.Se ha realizado una revisión narrativa de la literatura mediante búsqueda bibliográfica en la biblioteca virtual del sistema sanitario público de Andalucía, siendo los criterios de inclusión utilizados, estudios que conciernen a las experiencias de profesionales sanitarios y familiares sobre el acompañamiento de la población pediátrica en los procedimientos asistenciales. El resultado de la búsqueda se limitó a trabajos en humanos en español e inglés.Esta revisión pone de manifiesto la necesidad de humanizar la asistencia sanitaria para mejorar la calidad de la atención. Se justifica la necesidad de acompañamiento de los menores, a través de trabajos que han analizado los factores que intervienen en la permanencia de estas conductas y actitudes tanto por profesionales como padres. Se recomienda la necesidad de políticas institucionales y figuras mediadoras que recojan las declaraciones de algunas sociedades nacionales e internacionales teniendo en cuenta aspectos legales, pero sobre todo los valores en juego desde una ética del cuidado y búsqueda del interés superior del menor.(AU)

In clinical practice, it is not rare to encounter situations in which parents and families are asked to leave the child alone with the health care team in rooms full of devices throughout the performance of procedures, which at times may give rise not only to conflicts but, more importantly, emotional sequelae in children or adolescents.We conducted a narrative review of the literature by searching the digital library of the public health care system of Andalusia for articles concerning the experiences of health care professionals and families with the accompaniment of paediatric patients during health care procedures. We restricted the search to studies published in Spanish or English and conducted in humans.The review evinced the need to humanise care in order to improve care quality. The need to accompany minors is supported by the evidence from works that have analysed the factors involved in the persistence of these behaviours and attitudes in both professionals and parents. We consider it necessary to develop institutional policies and appoint mediators to compile the statements of different national and international societies, taking into account legal aspects but, above all, the pertinent values from a health care ethics perspective, and in pursuit of the best interests of the child.(AU)

Hepatic SPARC Expression Is Associated with Inflammasome Activation during the Progression of Non-Alcoholic Fatty Liver Disease in Both Mice and Morbidly Obese Patients.

The severity of non-alcoholic fatty liver disease (NAFLD) ranges from simple steatosis to steatohepatitis, and it is not yet clearly understood which patients will progress to liver fibrosis or cirrhosis. SPARC (Secreted Protein Acidic and Rich in Cysteine) has been involved in NAFLD pathogenesis in mice and humans. The aim of this study was to investigate the role of SPARC in inflammasome activation, and to evaluate the relationship between the hepatic expression of inflammasome genes and the biochemical and histological characteristics of NAFLD in obese patients. In vitro studies were conducted in a macrophage cell line and primary hepatocyte cultures to assess the effect of SPARC on inflammasome. A NAFLD model was established in SPARC knockout (SPARC-/-) and SPARC+/+ mice to explore inflammasome activation. A hepatic RNAseq database from NAFLD patients was analyzed to identify genes associated with SPARC expression. The results were validated in a prospective cohort of 59 morbidly obese patients with NAFLD undergoing bariatric surgery. Our results reveal that SPARC alone or in combination with saturated fatty acids promoted IL-1ß expression in cell cultures. SPARC-/- mice had reduced hepatic inflammasome activation during the progression of NAFLD. NAFLD patients showed increased expression of SPARC, NLRP3, CASP1, and IL-1ß. Gene ontology analysis revealed that genes positively correlated with SPARC are linked to inflammasome-related pathways during the progression of the disease, enabling the differentiation of patients between steatosis and steatohepatitis. In conclusion, SPARC may play a role in hepatic inflammasome activation in NAFLD.

Sedation in pediatric palliative care: The role of pediatric palliative care teams.

OBJECTIVES: Palliative sedation (PS) consists of the use of drugs to alleviate the suffering of patients with refractory symptoms, through a reduction in consciousness. The aim of this study is to describe the incidence of and indications for PS in patients treated by pediatric palliative care teams (PPCT), and the relationship between PS, the place of death, and the characteristics of the care teams. METHODS: Ambispective study with the participation of 14 PPCT working in Spain. RESULTS: From January to December 2019, a total of 164 patients attended by these PPCT died. Of these, 83 (50.6%) received PS during their last 24 hours. The most frequent refractory symptoms were terminal suffering (n = 40, 48.2%), dyspnea (n = 9, 10.8%), pain (n = 8, 9.6%), and convulsive state (n = 7, 8.4%). Sedation in the last 24 hours of life was more likely if the patient died in hospital, rather than at home (62.9% vs. 33.3%, p < 0.01); if the parents had not expressed their preference regarding the place of death (69.2% vs. 45.2%, p = 0.009); and if the PPCT had less than 5 years' experience (66.7% vs. 45.5%, p = 0.018). SIGNIFICANCE OF RESULTS: PS is a real possibility in pediatric end-of-life care and relates to care planning and team expertise.

The electrical properties of isolated microtubules.

This study examines the electrical properties of isolated brain microtubules (MTs), which are long hollow cylinders assembled from αß-tubulin dimers that form cytoskeletal structures engaged in several functions. MTs are implicated in sensory functions in cilia and flagella and cellular activities that range from cell motility, vesicular traffic, and neuronal processes to cell division in the centrosomes and centrioles. We determined the electrical properties of the MTs with the loose patch clamp technique in either the presence or absence of the MT stabilizer Paclitaxel. We observed electrical oscillations at different holding potentials that responded accordingly in amplitude and polarity. At zero mV in symmetrical ionic conditions, a single MT radiated an electrical power of 10-17 W. The spectral analysis of the time records disclosed a single fundamental peak at 39 Hz in the Paclitaxel-stabilized MTs. However, a richer oscillatory response and two mean conductances were observed in the non-Paclitaxel MTs. The findings evidence that the brain MTs are electrical oscillators that behave as "ionic-based" transistors to generate, propagate, and amplify electrical signals.

High calcium transport by Polycystin-2 (TRPP2) induces channel clustering and oscillatory currents.

The regulation by Ca2+ of Ca2+-permeable ion channels represents an important mechanism in the control of cell function. Polycystin-2 (PC2, TRPP2), a member of the TRP channel family (Transient Potential Receptor), is a Ca2+ permeable non-selective cation channel. Previous studies from our laboratory demonstrated that physiological concentrations of Ca2+ do not regulate in vitro translated PC2 (PC2iv) channel activity. However, the issue as to PC2's Ca2+ permeability and regulation remain ill-defined, in particular because Ca2+ transport is usually observed in the presence of other ionic gradients. In this study, we assessed Ca2+ transport by PC2iv in a lipid bilayer reconstitution system in a high Ca2+ gradient (CaCl2 100 mM cis, CaCl2 10 mM trans) in the presence of either 3:7 or 7:3 1-palmitoyl-2-oleoyl-choline and ethanolamine lipid mixtures. Reconstituted PC2iv showed spontaneous Ca2+ currents in both lipid mixtures, with a maximum conductance of 63 ± 13 pS (n = 19) and 105 pS ± 9.8 (n = 9), respectively. In both cases, we best fitted the experimental data with the Goldman-Hodgkin-Katz equation, observing a reversal potential (Vrev âˆ¼ -27 mV) consistent with strict Ca2+ selectivity. The R742X mutated PC2 (PC2R742X), lacking the carboxy terminal domain of the channel showed no differences with wild type PC2. Interestingly, we also observed the onset of spontaneous Ca2+ current oscillations whenever PC2-containing samples were reconstituted in the 3:7, but not 7:3 POPC:POPE lipid mixture. The amplitude and frequency of the ionic oscillations were highly dependent on the applied voltage, the imposed Ca2+ gradient, and the presence of high Ca2+, which induced PC2 channel clustering as observed by atomic force microscopy (AFM). We also used the QuB suite to kinetically model the PC2 channel Ca2+ oscillations based on the presence of subconductance states in the channel. The encompassed evidence supports a high Ca2+ permeability by PC2, and a novel oscillatory mechanism dependent on the presence of Ca2+ and phospholipids that provides the first evidence for the relation between stochasticity and deterministic processes mediated by ion channels.

[Primary care pathways and locations during the pandemic in a rural area of Alicante]. / Vías y lugares de atención primaria durante la pandemia en una zona rural de Alicante.

This paper describes the means of health care used in a primary health care centre (PHCC) in a rural area to care for patients during the COVID-19 pandemic. After conducting a cross-sectional study using health questionnaire with 243 patients (100 COVID-19 and 143 other pathologies), we observed that general medical care was 100% by telephone, and little use was made of the portal for citizen information and appointment requests of the Conselleria de Sanitat de la Comunidad Valenciana. Nursing attended 100% by telephone, as did the PHCC doctors and the PHCC emergencies; in the case of taking samples, blood samples and wound care it was face-to-face (men 91%, women 88%), and at home (9% and 12%). In conclusion, different care patterns are observed according to the PHCC professionals, and the need to improve the online pathway with care management.