Encuesta nacional sobre cambios en las políticas de comunicación, visitas y cuidados al final de la vida en las unidades de cuidados intensivos durante las diferentes olas de la pandemia de COVID-19 (estudio COVIFAUCI) / National survey on changes in visitation, communication and end-of-life care policies in intensive care units through the different COVID-19 pandemic's waves (COVIFAUCI study)

Introducción La pandemia derivada de la infección por SARS-CoV-2 propició cambios en los cuidados tanto a familiares como a pacientes de cuidados intensivos durante las diferentes olas de incidencia del virus. La línea de humanización seguida por la mayoría de los hospitales se vio gravemente afectada por las restricciones aplicadas. Como objetivo, planteamos conocer las modificaciones experimentadas durante las diferentes olas de la pandemia por SARS-CoV-2 en España respecto a la política de visitas a los pacientes en UCI, el acompañamiento al final de la vida, y el uso de las nuevas tecnologías de la comunicación entre familiares, pacientes y profesionales. Métodos Estudio descriptivo transversal multicéntrico mediante encuesta a las UCI españolas desde febrero a abril de 2022. Se realizaron métodos de análisis estadísticos a los resultados según lo apropiado. El estudio fue avalado por la Sociedad Española de Enfermería Intensiva y Unidades Coronarias. Resultados Respondieron un 29% de las unidades contactadas. Los minutos de visita diarios de los familiares se redujeron drásticamente de 135 (87,5-255) a 45 (25-60) en el 21,2% de las unidades que permitían su acceso, mejorando levemente con el paso de las olas. En el caso de duelo, la permisividad fue mayor, aumentando el uso de las nuevas tecnologías para la comunicación paciente-familia en el caso del 96,5% de las unidades. Conclusiones Las familias de los pacientes ingresados en UCI durante las diferentes olas de la pandemia por COVID-19 han experimentado restricciones en las visitas y cambio de la presencialidad por técnicas virtuales de comunicación. Los tiempos de acceso se redujeron a niveles mínimos durante la primera ola, recuperándose con el avance de la pandemia pero sin llegar nunca a los niveles iniciales... (AU)

Introduction The pandemic derived from the SARS-CoV-2 infection led to changes in care for both relatives and intensive care patients during the different waves of incidence of the virus. The line of humanization followed by the majority of the hospitals was seriously affected by the restrictions applied. As an objective, we propose to know the modifications suffered during the different waves of the SARS-CoV-2 pandemic in Spain regarding the policy of visits to patients in the ICU, monitoring at the end of life, and the use of new technologies of communication between family members, patients and professionals. Methods Multicenter cross-sectional descriptive study through a survey of Spanish ICUs from February to April 2022. Statistical analysis methods were performed on the results as appropriate. The study was endorsed by the Spanish Society of Intensive Nursing and Coronary Units. Results Twenty-nine percent of the units contacted responded. The daily visiting minutes of relatives dropped drastically from 135 (87.5-255) to 45 (25-60) in the 21.2% of units that allowed their access, improving slightly with the passing of the waves. In the case of bereavement, the permissiveness was greater, increasing the use of new technologies for patient-family communication in the case of 96.5% of the units. Conclusions The family of patients admitted to the ICU during the different waves of the COVID-19 pandemic have suffered restrictions on visits and a change from face-to-face to virtual communication techniques. Access times were reduced to minimum levels during the first wave, recovering with the advance of the pandemic but never reaching initial levels. Despite the implemented solutions and virtual communication, efforts should be directed towards improving the protocols for the humanization of healthcare that allow caring for families and patients whatever the healthcare context. (AU)

Encuesta nacional sobre cambios en las políticas de comunicación, visitas y cuidados al final de la vida en las unidades de cuidados intensivos durante las diferentes olas de la pandemia de COVID-19 (estudio COVIFAUCI) / National survey on changes in visitation, communication and end-of-life care policies in intensive care units through the different COVID-19 pandemic's waves (COVIFAUCI study)

Introducción La pandemia derivada de la infección por SARS-CoV-2 propició cambios en los cuidados tanto a familiares como a pacientes de cuidados intensivos durante las diferentes olas de incidencia del virus. La línea de humanización seguida por la mayoría de los hospitales se vio gravemente afectada por las restricciones aplicadas. Como objetivo, planteamos conocer las modificaciones experimentadas durante las diferentes olas de la pandemia por SARS-CoV-2 en España respecto a la política de visitas a los pacientes en UCI, el acompañamiento al final de la vida, y el uso de las nuevas tecnologías de la comunicación entre familiares, pacientes y profesionales. Métodos Estudio descriptivo transversal multicéntrico mediante encuesta a las UCI españolas desde febrero a abril de 2022. Se realizaron métodos de análisis estadísticos a los resultados según lo apropiado. El estudio fue avalado por la Sociedad Española de Enfermería Intensiva y Unidades Coronarias. Resultados Respondieron un 29% de las unidades contactadas. Los minutos de visita diarios de los familiares se redujeron drásticamente de 135 (87,5-255) a 45 (25-60) en el 21,2% de las unidades que permitían su acceso, mejorando levemente con el paso de las olas. En el caso de duelo, la permisividad fue mayor, aumentando el uso de las nuevas tecnologías para la comunicación paciente-familia en el caso del 96,5% de las unidades. Conclusiones Las familias de los pacientes ingresados en UCI durante las diferentes olas de la pandemia por COVID-19 han experimentado restricciones en las visitas y cambio de la presencialidad por técnicas virtuales de comunicación. Los tiempos de acceso se redujeron a niveles mínimos durante la primera ola, recuperándose con el avance de la pandemia pero sin llegar nunca a los niveles iniciales... (AU)

Introduction The pandemic derived from the SARS-CoV-2 infection led to changes in care for both relatives and intensive care patients during the different waves of incidence of the virus. The line of humanization followed by the majority of the hospitals was seriously affected by the restrictions applied. As an objective, we propose to know the modifications suffered during the different waves of the SARS-CoV-2 pandemic in Spain regarding the policy of visits to patients in the ICU, monitoring at the end of life, and the use of new technologies of communication between family members, patients and professionals. Methods Multicenter cross-sectional descriptive study through a survey of Spanish ICUs from February to April 2022. Statistical analysis methods were performed on the results as appropriate. The study was endorsed by the Spanish Society of Intensive Nursing and Coronary Units. Results Twenty-nine percent of the units contacted responded. The daily visiting minutes of relatives dropped drastically from 135 (87.5-255) to 45 (25-60) in the 21.2% of units that allowed their access, improving slightly with the passing of the waves. In the case of bereavement, the permissiveness was greater, increasing the use of new technologies for patient-family communication in the case of 96.5% of the units. Conclusions The family of patients admitted to the ICU during the different waves of the COVID-19 pandemic have suffered restrictions on visits and a change from face-to-face to virtual communication techniques. Access times were reduced to minimum levels during the first wave, recovering with the advance of the pandemic but never reaching initial levels. Despite the implemented solutions and virtual communication, efforts should be directed towards improving the protocols for the humanization of healthcare that allow caring for families and patients whatever the healthcare context. (AU)

Molecular identification of Borrelia and SFG Rickettsia spp. in hard ticks parasitizing domestic and wild animals in southeastern Spain.

Lyme disease and the spotted fever group rickettsiosis, involve bacteria belonging to the genus Borrelia and Rickettsia, respectively. These infections are the most important tick-borne zoonotic diseases involving ticks as vectors. Descriptive and epidemiological studies are essential to determine the animal hosts involved in the maintenance of these diseases. In the present study, 94 tick pool samples from 15 different host species located in the Region of Murcia (southeastern, Spain) were analysed. Ticks were morphologically identified as: Dermacentor marginatus, Hyalomma lusitanicum, Ixodes Ricinus, and Rhipicephalus sanguineus. Our results showed that 5.3% of the tick pool samples carried Borrelia spp. DNA, and 20.2% carried SFG Rickettsia DNA. In every hard tick pool Spot Fever Group (SFG) Rickettsia spp. DNA were detected, except for H. lusitanicum. Likewise, D. marginatum was the only species in which Borrelia spp. DNA was not detected. Barbary sheep and wild boar were the host species in which tick pools showed DNA presence of both pathogens. This study increases the knowledge about the presence of Borrelia spp. DNA and SFG Rickettsia spp. DNA in different hard tick species from this geographical area.

National survey on changes in visitation, communication and end-of-life care policies in intensive care units through the different COVID-19 pandemic's waves (COVIFAUCI study).

INTRODUCTION: The pandemic derived from the SARS-CoV-2 infection led to changes in care for both relatives and intensive care patients during the different waves of incidence of the virus. The line of humanization followed by the majority of the hospitals was seriously affected by the restrictions applied. As an objective, we propose to know the modifications suffered during the different waves of the SARS-CoV-2 pandemic in Spain regarding the policy of visits to patients in the ICU, monitoring at the end of life, and the use of new technologies. of communication between family members, patients and professionals. METHODS: Multicenter cross-sectional descriptive study through a survey of Spanish ICUs from February to April 2022. Statistical analysis methods were performed on the results as appropriate. The study was endorsed by the Spanish Society of Intensive Nursing and Coronary Units. RESULTS: 29% of the units contacted responded. The daily visiting minutes of relatives dropped drastically from 135 (87.5-255) to 45 (25-60) in the 21.2% of units that allowed their access, improving slightly with the passing of the waves. In the case of bereavement, the permissiveness was greater, increasing the use of new technologies for patient-family communication in the case of 96.5% of the units. CONCLUSIONS: The family of patients admitted to the ICU during the different waves of the COVID-19 pandemic have suffered restrictions on visits and a change from face-to-face to virtual communication techniques. Access times were reduced to minimum levels during the first wave, recovering with the advance of the pandemic but never reaching initial levels. Despite the implemented solutions and virtual communication, efforts should be directed towards improving the protocols for the humanization of healthcare that allow caring for families and patients whatever the healthcare context.

Stress distribution in occlusal veneers with different finish lines when applying vertical and tangential forces / Distribución de estrés en carillas con diferentes líneas de terminación aplicando fuerzas verticales y tangenciales

Abstract To evaluate stress distribution when applying vertical and tangential forces to 1mm thick occlusal veneers with different finish lines preparations, using the finite element method. One extracted third molar was prepared for occlusal veneers, firstly without any bevel. It was scanned in order to design two groups of lithium disilicate (G1A, G2A) and composite resin (G1B, G2B) occlusal veneers. Then, the third molar preparation was modified, beveling the finish line and it was subsequently scanned again to design the occlusal veneer groups with bevel (LD: G3A, G4A and CR: G3B, G4B). The four groups were subjected to different forces (400 N vertical and 900 N tangential). At 400 N, the non-beveled veneers showed slightly higher Von Mises stress values (G1A: 783 MPa and G1B 736.5 MPa) than the beveled veneers (G3A: 685.7 MPa and G3B: 675.8 MPa). However, when 900 N tangential forces were applied, the beveled occlusal veneers showed higher Von Mises stress values (G4A: 4297 MPa and G4B: 4133 MPa) than the non-beveled occlusal veneers (G2A: 2581.1 MPa and G2B: 3519.1 MPa). Furthermore, it was observed that the tissue under the occlusal veneers with bevel showed higher Von Mises stress values than the models without any bevel. Beveled and non-beveled occlusal veneers of lithium disilicate and composite resin presented similar stress distribution values when vertical forces of 400 N were applied; whereas with tangential forces of 900 N applied near to the finish line, the beveled groups presented notably higher stress values than the non-beveled groups. However, both finish line preparations presented adequate values for possible clinical performance.

Resumen Evaluar la distribución de estrés al aplicar fuerzas verticales y tangenciales en carillas oclusales de 1mm de espesor con diferentes líneas de terminación marginal por el método de elementos finitos. Se preparó un tercer molar extraído para carilla oclusal, primero sin bisel. Se escaneó para diseñar dos grupos de carillas oclusales de disilicato de litio (G1A, G2A) y resina compuesta (G1B, G2B). Después, esta preparación molar fue modificada, biselando la línea de terminación y escaneándola nuevamente para diseñar los grupos de carillas oclusales con bisel (DL: G3A, G4A and RC: G3B, G4B). Los 4 grupos fueron sometidos a fuerzas diferentes (400 N vertical y 900 N tangencial). Con 400 N, las carillas sin bisel presentaron ligera mayor tensión de Von Mises (G1A: 783 MPa y G1B 736.5 MPa) que las carillas con bisel (G3A: 685.7 MPa y G3B: 675.8 MPa). De distinta forma, al aplicar fuerzas tangenciales de 900 N, las carillas oclusales con bisel presentaron mayor tensión de Von Mises (G4A: 4297 MPa y G4B: 4133 MPa) que las carillas oclusales sin bisel (G2A: 2581.1 MPa y G2B: 3519.1 MPa). Además, se observó que los tejidos subyacentes a las carillas oclusales con bisel, presentaron mayor tensión de Von Mises, frente a los modelos sin bisel. Las carillas oclusales con y sin bisel de disilicato de litio y resina compuesta presentaron una distribución de estrés similar con fuerzas verticales de 400 N, por otro lado, con fuerzas tangenciales de 900 N, los grupos con bisel presentaron notablemente mayor tensión que los grupos sin bisel. Sin embargo, ambos diseños de terminación marginal presentaron valores adecuados para un posible desempeño clínico.

[Clinical and epidemiological differences and similarities of viral pneumonias in two pandemics]. / Diferencias y similitudes clínicas y epidemiológicas de la neumonía viral en dos pandemias.

BACKGROUND: In a decade, we faced two pandemic viruses, influenza A H1N1pdm09 and SARS CoV-2, whose most serious manifestation is pneumonia. AIM: To compare the clinical, epidemiological and management aspects of pneumonias caused by each pandemic virus in adults requiring hospitalization. MATERIAL AND METHODS: Comparative, observational study carried out at a regional Chilean hospital, including 75 patients with influenza A H1N1pdm09 prospectively studied in 2009 and 142 patients with SARS-CoV-2 studied in 2020. RESULTS: Patients with SARS-CoV-2 pneumonia were older (56 and 39.7 years respectively, p < 0.01) and had significantly more comorbidities. Cough, fever and myalgias were more frequent in influenza. Dyspnea was more frequent in COVID-19. Patients with COVID-19 had more extensive lung involvement and a longer hospitalization (13.6 and 8.6 days respectively, p = 0.01). There was no difference on ICU admission requirements and mortality attributable to pneumonia. Patients with influenza had greater APACHE scores and a higher frequency of a PaO2/FiO2 ratio ≤ 200. During COVID-19pandemic chest sean replaced x-ray examination. Also high-flow nasal cannulas and awake prone position ventilation were added as treatments. CONCLUSIONS: COVID-19 patients were older, had fewer classic flu symptoms but more dyspnea and longer hospitalization periods than patients with influenza.

[Features of patients admitted with COVID-19 to a Chilean regional hospital during the first stages of the pandemic]. / COVID-19 en adultos en el Hospital de Puerto Montt en la primera etapa de la pandemia.

BACKGROUND: The COVID-19 pandemic posed a great strain in health services. AIM: To describe the epidemiological and clinical features of patients with SARS-CoV-2 admitted to a regional hospital in southern Chile between April and August 2020. MATERIAL AND METHODS: Clinical records of all hospitalized patients with RT-PCR (+) for SARS-CoV-2 were retrospectively analyzed. RESULTS: During the study period 226 patients aged 55 ± 18 years (55% men) were admitted. The main comorbidities were high blood pressure in 45%, diabetes in 31% and obesity in 21%. The main symptoms were dyspnea in 70%, cough in 69%, fever in 62% and myalgia in 47%. Pneumonia was the main cause of admission in 66%. Images on admission were compatible with pneumonia in 81%, and with a typical COVID-19 pattern in 84%. In 76% there was five-lobe involvement. Eighty-seven cases (39%) were admitted to critical care, with an APACHE score of 10.9 ± 7.1. Invasive mechanical ventilation was used in 16%, 30% required prone position and 13%, a high-flow nasal cannula. The mean stay in critical care was 13.3 days. The mean duration of invasive mechanical ventilation was 14.1 days. Antimicrobials were used in 55% and dexamethasone in 36%. Twenty-two (9.7%) patients aged 71.7 ± 14 died. A Charlson comorbidity index > 3, heart failure and connection to invasive mechanical ventilation were independent risk factors for death. An age > 65 years alone and other comorbidities were not risk factors. CONCLUSIONS: Viral pneumonia is the main cause of hospitalization for COVID-19, usually extensive and bilateral. The greater severity and poor prognosis of these patients are mainly related to comorbidities.

COVID-19 en adultos en el Hospital de Puerto Montt en la primera etapa de la pandemia / Features of patients admitted with COVID-19 to a Chilean regional hospital during the first stages of the pandemic

BACKGROUND: The COVID-19 pandemic posed a great strain in health services. AIM: To describe the epidemiological and clinical features of patients with SARS-CoV-2 admitted to a regional hospital in southern Chile between April and August 2020. MATERIAL AND METHODS: Clinical records of all hospitalized patients with RT-PCR (+) for SARS-CoV-2 were retrospectively analyzed. RESULTS: During the study period 226 patients aged 55 ± 18 years (55% men) were admitted. The main comorbidities were high blood pressure in 45%, diabetes in 31% and obesity in 21%. The main symptoms were dyspnea in 70%, cough in 69%, fever in 62% and myalgia in 47%. Pneumonia was the main cause of admission in 66%. Images on admission were compatible with pneumonia in 81%, and with a typical COVID-19 pattern in 84%. In 76% there was five-lobe involvement. Eighty-seven cases (39%) were admitted to critical care, with an APACHE score of 10.9 ± 7.1. Invasive mechanical ventilation was used in 16%, 30% required prone position and 13%, a high-flow nasal cannula. The mean stay in critical care was 13.3 days. The mean duration of invasive mechanical ventilation was 14.1 days. Antimicrobials were used in 55% and dexamethasone in 36%. Twenty-two (9.7%) patients aged 71.7 ± 14 died. A Charlson comorbidity index > 3, heart failure and connection to invasive mechanical ventilation were independent risk factors for death. An age > 65 years alone and other comorbidities were not risk factors. CONCLUSIONS: Viral pneumonia is the main cause of hospitalization for COVID-19, usually extensive and bilateral. The greater severity and poor prognosis of these patients are mainly related to comorbidities.

Diferencias y similitudes clínicas y epidemiológicas de la neumonía viral en dos pandemias / Clinical and epidemiological differences and similarities of viral pneumonias in two pandemics

BACKGROUND: In a decade, we faced two pandemic viruses, influenza A H1N1pdm09 and SARS CoV-2, whose most serious manifestation is pneumonia. AIM: To compare the clinical, epidemiological and management aspects of pneumonias caused by each pandemic virus in adults requiring hospitalization. Material and Methods: Comparative, observational study carried out at a regional Chilean hospital, including 75 patients with influenza A H1N1pdm09 prospectively studied in 2009 and 142 patients with SARS-CoV-2 studied in 2020. RESULTS: Patients with SARS-CoV-2 pneumonia were older (56 and 39.7 years respectively, p < 0.01) and had significantly more comorbidities. Cough, fever and myalgias were more frequent in influenza. Dyspnea was more frequent in COVID-19. Patients with COVID-19 had more extensive lung involvement and a longer hospitalization (13.6 and 8.6 days respectively, p = 0.01). There was no difference on ICU admission requirements and mortality attributable to pneumonia. Patients with influenza had greater APACHE scores and a higher frequency of a PaO2/FiO2 ratio ≤ 200. During COVID-19pandemic chest sean replaced x-ray examination. Also high-flow nasal cannulas and awake prone position ventilation were added as treatments. Conclusions: COVID-19 patients were older, had fewer classic flu symptoms but more dyspnea and longer hospitalization periods than patients with influenza.

[Surveillance of rare diseases in Spain: Spanish Registry of Rare Diseases (ReeR).] / Vigilancia de las enfermedades raras en España: el Registro Estatal de Enfermedades Raras (ReeR).

Traditionally, epidemiological surveillance has focused on infectious diseases, but the concept of Public Health surveillance, introduced in Spain with the Law 33/2011, is broader and includes chronic diseases. Health strategies for these diseases need epidemiological information to improve understanding of socio-health needs and to facilitate the efficient management of resources. The European Union defines rare diseases (RD) as those that, being life-threatening or chronically debilitating, have a prevalence of less than 5 cases per 10,000 inhabitants. The RD Strategy of the National Health System, approved in 2009 and updated in 2014, recommends the development of regional registries of rare diseases (RAER), in addition to a national registry. The REpIER and Spain-RDR projects of the Institute of Health Carlos III (ISCIII) promoted the creation and regulation of 94% of the RAER. After more than 10 years of initiatives and work to improve the knowledge of RD's epidemiology in Spain, it was possible to implement the Spanish Registry of Rare Diseases (ReeR) in 2015, becoming one of the first population surveillance systems for chronic diseases of state scope. The ReeR procedures manual is the result of consensus between the RAER, the Ministry of Health, the ISCIII and the patient associations. The participatory methodology used for the implementation and launching of ReeR is considered an added value. The information system implemented will allow improving knowledge about the prevalence and distribution of RD in Spain.

Tradicionalmente la vigilancia epidemiológica se ha centrado en enfermedades transmisibles, pero el concepto de vigilancia en Salud Pública, incorporado en España con la Ley 33/2011, es más amplio e incluye las enfermedades crónicas. Las estrategias de salud para estas enfermedades necesitan disponer de información epidemiológica para mejorar el conocimiento de las necesidades sociosanitarias y facilitar la gestión eficiente de recursos. La Unión Europea define las enfermedades raras (ER) como aquellas que, con peligro de muerte o invalidez crónica, presentan una prevalencia inferior a 5 casos por cada 10.000 habitantes. La Estrategia en ER del Sistema Nacional de Salud, aprobada en 2009 y actualizada en 2014, recomienda desarrollar registros autonómicos de enfermedades raras (RAER) y uno estatal. Los proyectos REpIER y Spain-RDR del Instituto de Salud Carlos III (ISCIII) impulsaron la creación y regulación del 94% de los RAER; y tras más de 10 años de iniciativas y trabajos para mejorar el conocimiento de la epidemiología de las ER en España, se logró implementar el Registro Estatal de Enfermedades Raras (ReeR) en 2015, convirtiéndose en uno de los primeros sistemas de vigilancia poblacional de enfermedades crónicas de ámbito estatal. El manual de procedimientos del ReeR es el resultado del consenso entre los RAER, Ministerio de Sanidad, ISCIII y asociaciones de pacientes. La metodología participativa empleada para la implementación y puesta en funcionamiento del ReeR es considerada un valor añadido. El sistema de información implementado va a permitir mejorar el conocimiento sobre la prevalencia y distribución de las ER en España.

Influence of organised sports practice during adolescence on health of adult women with special emphasis on participation in aesthetic sports.

This study aimed to assess the differences in psychosocial health and cardiometabolic risk during adulthood in women based on previously organised sport (OS) participation during adolescence and current activity levels, with emphasis on participation in aesthetic sports. The study included 1947 women aged 18-55 years who were categorised into four groups: 355 aesthetic athletes during adolescence, 494 non- aesthetic athletes during adolescence, 791 non-athletes during adolescence with similar current levels of physical activity (PA) to OS groups and 307 currently inactive non-athletes during adolescence. Participants answered questionnaires regarding sport participation, psychosocial health and cardiometabolic risk. The results show that non-athletes during adolescence who are currently inactive reported significantly lower psychosocial health and higher cardiometabolic risk scores. Women with currently homogenous PA levels (χ² = 0.514) reported similar physical quality of life (QoL), exercise addiction, anxiety and depression symptoms regardless of participation in OS during adolescence (P > .05), except aesthetic athletes who reported the worst sleep and mental QoL. Very high training volumes in aesthetic athletes did not influence psychological outcomes and cardiometabolic risk in adulthood compared to lower training volumes. In conclusion, the effects of PA during adulthood appear to be powerful enough to induce beneficial adaptations in health outcomes that match those observed in women who participate in OS during adolescence, except for aesthetic sports participants, who show a high risk of lower quality of sleep in adulthood. PA should be promoted in adults and especially women who have not participated in OS during adolescence.

The fungal elicitor AsES requires a functional ethylene pathway to activate the innate immunity in strawberry.

Acremonium strictum Elicitor Subtilisin (AsES) is a fungal elicitor that activates innate immunity, conferring disease resistance in strawberry (Fragaria × ananassa Duch.), Arabidopsis and other plant species. The aim of the present work was to evaluate the involvement of the ethylene (ET) signalling pathway in AsES-mediated immune response in strawberry. Ethylene production and expression of the genes responsible for ET synthesis, perception and response were measured after AsES treatment. ROS (H2 O2 ) accumulation and immunity induced by AsES were studied after ET perception was blocked by 1-methylcyclopropene (1-MCP). Biochemical and molecular results showed that AsES induced a marked increase in local and systemic biosynthesis of ET, both in a biphasic manner. Blocking of ET perception by 1-MCP prior to AsES induction reduced production of ROS (H2 O2 ) and prevented AsES from eliciting defence against fungal pathogens having different lifestyles, such as Botrytis cinerea (necrotrophic) and Colletotrichum acutatum (hemibiotrophic). These findings contribute to elucidate the mode of action of the novel elicitor subtilase, AsES, specifically regarding the role of ET signalling in the activation of plant innate immunity, in addition to the multitude of processes regulated by ET in plants.

Ki67 in endocrine neoplasms: to count or not to count, this is the question! A systematic review from the English language literature.

BACKGROUND: Endocrine neoplasms are generally slow-growing tumors that can show hormonal activity and give metastases. In most cases they are benign and clearly malignant forms are easy to diagnose. However, borderline forms may occur and be, for the pathologists, very difficult to classify. In these cases, there is a strong need to identify factors that may aid. Official classification systems for endocrine neoplasms are based on the evaluation of proliferation and, in most cases, they rely on mitotic count. In support, the study of Ki67 is carried out which, however, has not yet been included in any official classification system, except for neuroendocrine neoplasms of the gastro-entero-pancreatic tract. PURPOSE: The aim of the present study was to investigate the proven or unproven role of Ki67 in endocrine neoplasms, in different districts, in order to bring to light the substantial differences, in terms of proliferation, existing between neoplasms so similar, but at the same time, so different. METHODS: A thorough search of English language literature was performed, looking for articles concerning Ki67 in five endocrine neoplasms (pituitary adenomas, thyroid neoplasms, adrenocortical neoplasms, pheochromocytomas and paragangliomas). RESULTS: From 2170, 236 articles were selected and it was seen that the endocrine neoplasm in which Ki67 was most studied was the pituitary, where it still shows a controversial role. In other neoplasms different roles were identified. CONCLUSION: The pathologist should be aware of the contribution that this proliferative marker can give to the diagnosis and, sometimes, to the therapy selection, for the clinician.

Clustering of known low and moderate risk alleles rather than a novel recessive high-risk gene in non-BRCA1/2 sib trios affected with breast cancer.

Breast cancer risk is approximately twice as high in first-degree relatives of female breast cancer cases than in women in the general population. Less than half of this risk can be attributed to the currently known genetic risk factors. Recessive risk alleles represent a relatively underexplored explanation for the remainder of familial risk. To address this, we selected 19 non-BRCA1/2 breast cancer families in which at least three siblings were affected, while no first-degree relatives of the previous or following generation had breast cancer. Germline DNA from one of the siblings was subjected to exome sequencing, while all affected siblings were genotyped using SNP arrays to assess haplotype sharing and to calculate a polygenic risk score (PRS) based on 160 low-risk variants. We found no convincing candidate recessive alleles among exome sequencing variants in genomic regions for which all three siblings shared two haplotypes. However, we found two families in which all affected siblings carried the CHEK2*1100delC. In addition, the average normalized PRS of the "recessive" family probands (0.81) was significantly higher than that in both general population cases (0.35, P = .026) and controls (P = .0004). These findings suggest that the familial aggregation is, at least in part, explained by a polygenic effect of common low-risk variants and rarer intermediate-risk variants, while we did not find evidence of a role for novel recessive risk alleles.

Detection of a novel Chlamydia species in captive spur-thighed tortoises (Testudo graeca) in southeastern Spain and proposal of Candidatus Chlamydia testudinis.

The spur-thighed tortoise (Testudo graeca) is an endangered Mediterranean tortoise that lives in North Africa, Southern Europe and Southwest Asia. In the wake of recent legislation making their keeping as domestic animals illegal, many of these animals have been returned to wildlife recovery centers in Spain. In the present study, a population of such tortoises showing signs of ocular disease and nasal discharge was examined for the presence of Chlamydia spp. Cloacal, conjunctival and/or choanal swabs were collected from 58 animals. Using a real-time PCR specific for the family Chlamydiaceae, 57/58 animals tested positive in at least one sample. While only a few samples proved positive for C. pecorum, sequencing of the 16S rRNA gene revealed a sequence identical to previously published sequences from specimens of German and Polish tortoises. Whole-genome sequences obtained from two conjunctival swab samples, as well as ANIb, TETRA values and a scheme based on 9 taxonomic marker genes revealed that the strain present in the Spanish tortoises represented a new yet non-classified species, with C. pecorum being its closest relative. We propose to designate the new species Candidatus Chlamydia testudinis.

Improving quality of care and clinical outcomes for rectal cancer through clinical audits in a multicentre cancer care organisation.

INTRODUCTION: Colorectal cancer treatment requires a complex, multidisciplinary approach. Because of the potential variability, monitoring through clinical audits is advisable. This study assesses the effects of a quality improvement action plan in patients with locally advanced rectal cancer and treated with radiotherapy. METHODS: Comparative, multicentre study in two cohorts of 120 patients each, selected randomly from patients diagnosed with rectal cancer who had initiated radiotherapy with a curative intent. Based on the results from a baseline clinical audit in 2013, a quality improvement action plan was designed and implemented; a second audit in 2017 evaluated its impact. RESULTS: Standardised information was present on 77.5% of the magnetic resonance imaging (MRI) staging reports. Treatment strategies were similar in all three study centres. Of the patients whose treatment was interrupted, just 9.7% received a compensation dose. There was an increase in MRI re-staging from 32.5 to 61.5%, and a significant decrease in unreported circumferential resection margins following neoadjuvant therapy (ypCRM), from 34.5 to 5.6% (p <  0.001). CONCLUSIONS: The comparison between two clinical audits showed improvements in neoadjuvant radiotherapy in rectal cancer patients. Some indicators reveal areas in need of additional efforts, for example to reduce the overall treatment time.

Prevalencia y morfología del segundo conducto en la raíz mesiovestibular de primeros molares superiores en base a cuatro técnicas ex vivo / Prevalence and morphology of second mesiobuccal canal in maxillary first molars based on four ex vivo techniques

Los objetivos principales del tratamiento de endodoncia no quirúrgico son la prevención y/o tratamiento de periodontitis apical junto con la resolución de signos y síntomas de las lesiones pulpares irreversibles. Debido a la compleja morfología del sistema de conductos radicular, la persistencia de un conducto no tratado puede mantener la contaminación y sintomatología pulpar y periapical. La prevalencia para MV2 reportado a nivel mundial para el primer molar superior varía ampliamente según las técnicas in vivo o ex vivo empleadas en cada estudio, es por esto que el presente trabajo tiene por objetivo evaluar la prevalencia de MV2 en primeros molares superiores en base a cuatro técnicas diagnósticas aplicadas ex vivo. Se realizó un estudio transversal observacional en 101 primeros molares superiores extraídos bajo consentimiento informado para determinar la prevalencia del conducto MV2 y su morfología en base a las técnicas de radiografía ortoradial, tomografía Cone Beam, apertura coronaria con microscopio quirúrgico (16x) y cortes radiculares axiales de aplicación ex vivo. La prevalencia encontrada para MV2 por cada técnica fue de 81,1 % para cortes radiculares y tomografía Cone Beam, 59,4 % para la apertura coronal con microscopio (16x) y 32,6 % con radiografía ortoradial. En el 3,96 % de la muestra se encontró un tercer conducto mesiovestibular en base a la técnica de corte radicular. La morfología interna del sistema de conductos radiculares fue de 36 % clase II, 19 % clase I y 16 % clase IV de Vertucci. Los resultados del presente estudio están en concordancia con lo reportado en la literatura y confirman la mayor prevalencia reportada en estudios ex vivo para esta situación. La presencia de MV2 en el primer molar superior es una condición frecuente que el endodoncista debe considerar, empleando técnicas imagenológicas y tecnologías de magnificación para asegurar el éxito terapéutico en estos dientes.

The main objectives of non-surgical endodontic treatment are the prevention and / or treatment of apical periodontitis, as well as resolving signs and symptoms of irreversible pulpal lesions. Considering the complex morphology of the root canal system, the a canal left untreated, can generate contamination, pulp and periapical symptoms. The prevalence for MV2 reported worldwide for the upper first molar, varies depending on the ex vivo or ex vivo techniques used in each study. Consequently, the present work aims to assess the prevalence of MV2 in first upper molars based on four ex vivo diagnostic techniques applied. An observational crosssectional study was performed in 101 upper first molars extracted under informed consent to determine the prevalence of the MV2 duct and its morphology based on orthoradial radiography, Cone Beam tomography, coronary opening with a surgical microscope (16x), and axial root cuts applied ex vivo. The prevalence found for MV2 by each technique was 81.1 % for root cuts and Cone Beam tomography, 59.4 % for coronal opening with a microscope (16x) and 32.6 % with orthoradial radiography. In 3.96 % of the sample, a third mesiovestibular canal was found based on the root cutting technique. The internal morphology of the root canal system was 36 % Vertucci´s class II, 19 % class I and 16 % class IV. The results of the present study coincide with that reported in the literature, and confirm the higher prevalence reported in ex vivo studies for this situation. The presence of MV2 in the upper first molar is a frequent condition that the endodontist must consider, using imaging techniques and magnification technology to ensure therapeutic success in these teeth.

Effect of progesterone on the vaccination and immune response against Chlamydia abortus in sheep.

Chlamydia abortus produces ovine enzootic abortion (OEA). Symptoms are not observed until the organism colonises the placenta, eventually causing abortion. Infected animals become carriers and will shed the organism in the following oestruses. This process suggests that sex hormones might play an important role in the physiopathology of OEA, affecting the success of chlamydial clearance and also jeopardising the effectiveness of vaccination. However, the mechanisms through which sex hormones are involved in chlamydial pathogenicity remain unclear. The aim of this study, therefore, was to determine the effect of progesterone on the immune response against C. abortus and on the protection conferred by an experimental inactivated vaccine in sheep. Eighteen sheep were ovariectomised and divided into four groups: vaccinated and progesterone-treated (V-PG), vaccinated and non-treated (V-NT), non-vaccinated and non-treated (NV-NT) and non-vaccinated and progesterone-treated sheep (NV-PG). Animals from both PG groups were treated with commercial medroxyprogesterone acetate impregnated intravaginal sponges before and during the vaccination (V-PG) or just before challenge (NV-PG). The animals from both V groups were subcutaneously immunised with an experimental inactivated vaccine, which was seen to confer high protection in previous studies. All sheep were challenged intratracheally with C. abortus strain AB7 and were sacrificed on day 8 post-infection. Morbidity was measured as the variation in rectal temperature and samples of sera were collected for antibody and cytokine (IFN-γ and IL-10) analysis by commercial ELISA. In addition, lung and lymph node samples were collected for chlamydial detection by qPCR and for histopathological and immunohistochemical analyses. Sheep from the V-PG group showed less severe or no lesions and lower morbidity than the other groups. They also had the highest abundance of regulatory T-cells. The sheep from V-NT also manifested high antibody levels against C. abortus and less severe lesions than those observed in non-vaccinated sheep, which showed high morbidity, low antibody levels and severe lesions, especially in NV-NT. These results confirm the effectiveness of the experimental vaccine employed and suggest that progesterone could enhance the effect.

Effect of female sex hormones on the developmental cycle of Chlamydia abortus compared to a penicillin-induced model of persistent infection.

BACKGROUND: Chlamydia abortus, an obligate intracellular pathogen with an affinity for placenta, causes reproductive failure. In non-pregnant animals, an initial latent infection is established until the next gestation, when the microorganism is reactivated, causing abortion. The precise mechanisms that trigger the awakening of C. abortus are still unknown. Sexual hormones such as estradiol and progesterone have been shown to affect the outcome of infection in other species of the family Chlamydiaceae, while estrogens increase chlamydial infection, progesterone has the opposite effect. To try to establish whether there is a relationship between these events and the latency/ reactivation of C. abortus in the reproductive tract of small ruminants, ovine endometrial (LE) and trophoblastic (AH-1) cells were treated with estradiol or progesterone prior to their infection with C. abortus. The results are compared with those obtained for treatment with penicillin prior to infection, which is a well-established model for studying persistent infection in other chlamydial species. Cells were examined by transmission electron microscopy, and an mRNA expression analysis of 16 genes related to the chlamydial developmental cycle was made. RESULTS: The changes observed in this study by the action of sex hormones seem to depend on the type of cell where the infection develops. In addition, while the changes are morphologically similar to those induced by treatment with penicillin, the patterns of gene expression are different. Gene expression patterns therefore, seem to depend on the persistence induced models of C. abortus used. Hormone treatments induced aberrant forms in infected endometrial cells but did not affect the chlamydial morphology in trophoblast cells. At the genetic level, hormones did not induce significant changes in the expression of the studied genes. CONCLUSIONS: The results suggest that penicillin induces a state of persistence in in vitro cultured C. abortus with characteristic morphological features and gene transcriptional patterns. However, the influence of hormones on the C. abortus developmental cycle is mediated by changes in the host cell environment. Furthermore, a persistent state in C. abortus cannot be characterised by a single profile of gene expression pattern, but may change depending on the model used to induce persistence.