To analyse the overall effectiveness and cost-efficiency of a mobile application (APP) as a community health asset (HA) with recommendations and recovery exercises created bearing in mind the main ...symptoms presented by patients in order to improve their quality of life, as well as other secondary variables, such as the number and severity of ongoing symptoms, physical and cognitive functions, affective state, and sleep quality.
The first step was to design and develop the technologic community resource, the APP, following the steps involved in the process of recommending health assets (RHA). After this, a protocol of a randomised clinical trial for analysing its effectiveness and cost-efficiency as a HA was developed. The participants will be assigned to: (1st) usual treatment by the primary care practitioner (TAU), as a control group; and (2nd) TAU + use of the APP as a HA and adjuvant treatment in their recovery + three motivational interviews (MI), as an interventional group. An evaluation will be carried out at baseline with further assessments three and six months following the end of the intervention.
Although research and care for these patients are still in their initial stages, it is necessary to equip patients and health care practitioners with tools to assist in their recovery. Furthermore, enhanced motivation can be achieved through telerehabilitation (TR).
To assess the value of machine learning approaches in the development of a multivariable model for early prediction of ICU death in patients with acute respiratory distress syndrome (ARDS).
A ...development, testing, and external validation study using clinical data from four prospective, multicenter, observational cohorts.
A network of multidisciplinary ICUs.
A total of 1,303 patients with moderate-to-severe ARDS managed with lung-protective ventilation.
None.
We developed and tested prediction models in 1,000 ARDS patients. We performed logistic regression analysis following variable selection by a genetic algorithm, random forest and extreme gradient boosting machine learning techniques. Potential predictors included demographics, comorbidities, ventilatory and oxygenation descriptors, and extrapulmonary organ failures. Risk modeling identified some major prognostic factors for ICU mortality, including age, cancer, immunosuppression, Pa o2 /F io2 , inspiratory plateau pressure, and number of extrapulmonary organ failures. Together, these characteristics contained most of the prognostic information in the first 24 hours to predict ICU mortality. Performance with machine learning methods was similar to logistic regression (area under the receiver operating characteristic curve AUC, 0.87; 95% CI, 0.82-0.91). External validation in an independent cohort of 303 ARDS patients confirmed that the performance of the model was similar to a logistic regression model (AUC, 0.91; 95% CI, 0.87-0.94).
Both machine learning and traditional methods lead to promising models to predict ICU death in moderate/severe ARDS patients. More research is needed to identify markers for severity beyond clinical determinants, such as demographics, comorbidities, lung mechanics, oxygenation, and extrapulmonary organ failure to guide patient management.
Genetic testing is becoming increasingly important for diagnosis and personalized treatments in aortopathies. Here, we aimed to genetically diagnose a group of acute aortic syndrome (AAS) patients ...consecutively admitted to an intensive care unit and to explore the clinical usefulness of AAS-associated variants during treatment decision-making and family traceability.
We applied targeted next-generation sequencing, covering 42 aortic diseases genes in AAS patients with no signs consistent with syndromic conditions. Detected variants were segregated by Sanger sequencing in available family members. Demographic features, risk factors and clinical symptoms were statistically analyzed by Fisher or Fisher-Freeman-Halton Exact tests, to assess their relationship with genetic results.
Analysis of next-generation sequencing data in 73 AAS patients led to the detection of 34 heterozygous candidate variants in 14 different genes in 32 patients. Family screening was performed in 31 relatives belonging to 9 families. We found 13 relatives harboring the family variant, of which 10 showed a genotype compatible with the occurrence of AAS. Statistical tests revealed that the factors associated with a positive genetic diagnosis were the absence of hypertension, lower age, family history of AAS and absence of pain.
Our findings broaden the spectrum of the genetic background for AAS. In addition, both index patients and studied relatives benefited from the results obtained, establishing the most appropriate level of surveillance for each group. Finally, this strategy could be reinforced by the use of stastistically significant clinical features as a predictive tool for the hereditary character of AAS.
ClinicalTrials.gov (Identifier: NCT04751058)
El papel de la genética en el diagnóstico y la personalización de los tratamientos de las aortopatías, es cada vez mayor. En este estudio se analizó la prevalencia de variantes genéticas en pacientes con síndrome aórtico agudo (SAA) admitidos consecutivamente en una unidad de cuidados intensivos y se evaluó su utilidad clínica.
Mediante secuenciación masiva, se analizó 42 genes asociados a aortopatías en pacientes con SAA no sindrómico. Las variantes identificadas se segregaron mediante secuenciación Sanger en los familiares disponibles. Además, se estudió la relación entre los resultados genéticos y algunas características clínicas mediante la aplicación de los test exactos de Fisher y de Fisher-Freeman-Halton.
El análisis de los datos genómicos de 73 pacientes de SAA dio como resultado la identificación de 34 variantes candidatas en 32 individuos, localizadas en 14 genes diferentes. La segregación familiar se realizó en 31 individuos pertenecientes a 9 familias, donde se encontraron 13 portadores de los que 10 mostraron un genotipo compatible con SAA. El estudio estadístico indicó que la ausencia de hipertensión, una menor edad, una historia familiar de SAA y la ausencia de dolor están asociadas con un estudio genético positivo.
Se amplió el espectro mutacional asociado a SAA. Además, tanto los pacientes índice como los familiares estudiados se han visto beneficiados por estos resultados, por lo que se puede establecer el protocolo de seguimiento adecuado para cada uno de ellos. Por último, es importante destacar la posibilidad de utilizar variables clínicas estadísticamente significativas como factores predictores del carácter hereditario del SAA.
ClinicalTrials.gov (Identifier: NCT04751058)
El papel de la genética en el diagnóstico y la personalización de los tratamientos de las aortopatías, es cada vez mayor. En este estudio se analizó la prevalencia de variantes genéticas en pacientes ...con síndrome aórtico agudo (SAA) admitidos consecutivamente en una unidad de cuidados intensivos y se evaluó su utilidad clínica.
Mediante secuenciación masiva, se analizó 42 genes asociados a aortopatías en pacientes con SAA no sindrómico. Las variantes identificadas se segregaron mediante secuenciación Sanger en los familiares disponibles. Además, se estudió la relación entre los resultados genéticos y algunas características clínicas mediante la aplicación de los test exactos de Fisher y de Fisher-Freeman-Halton.
El análisis de los datos genómicos de 73 pacientes de SAA dio como resultado la identificación de 34 variantes candidatas en 32 individuos, localizadas en 14 genes diferentes. La segregación familiar se realizó en 31 individuos pertenecientes a 9 familias, donde se encontraron 13 portadores de los que 10 mostraron un genotipo compatible con SAA. El estudio estadístico indicó que la ausencia de hipertensión, una menor edad, una historia familiar de SAA y la ausencia de dolor están asociadas con un estudio genético positivo.
Se amplió el espectro mutacional asociado a SAA. Además, tanto los pacientes índice como los familiares estudiados se han visto beneficiados por estos resultados, por lo que se puede establecer el protocolo de seguimiento adecuado para cada uno de ellos. Por último, es importante destacar la posibilidad de utilizar variables clínicas estadísticamente significativas como factores predictores del carácter hereditario del SAA.
ClinicalTrials.gov (Identifier: NCT04751058)
Genetic testing is becoming increasingly important for diagnosis and personalized treatments in aortopathies. Here, we aimed to genetically diagnose a group of acute aortic syndrome (AAS) patients consecutively admitted to an intensive care unit and to explore the clinical usefulness of AAS-associated variants during treatment decision-making and family traceability.
We applied targeted next-generation sequencing, covering 42 aortic diseases genes in AAS patients with no signs consistent with syndromic conditions. Detected variants were segregated by Sanger sequencing in available family members. Demographic features, risk factors and clinical symptoms were statistically analyzed by Fisher or Fisher-Freeman-Halton Exact tests, to assess their relationship with genetic results.
Analysis of next-generation sequencing data in 73 AAS patients led to the detection of 34 heterozygous candidate variants in 14 different genes in 32 patients. Family screening was performed in 31 relatives belonging to 9 families. We found 13 relatives harboring the family variant, of which 10 showed a genotype compatible with the occurrence of AAS. Statistical tests revealed that the factors associated with a positive genetic diagnosis were the absence of hypertension, lower age, family history of AAS and absence of pain.
Our findings broaden the spectrum of the genetic background for AAS. In addition, both index patients and studied relatives benefited from the results obtained, establishing the most appropriate level of surveillance for each group. Finally, this strategy could be reinforced by the use of stastistically significant clinical features as a predictive tool for the hereditary character of AAS.
ClinicalTrials.gov (Identifier: NCT04751058)
Resumen Desde el modelo de atención primaria integral y bajo el principio de la continuidad asistencial, se propone el desarrollo de cauces de comunicación e integración entre el primer y segundo ...nivel asistencial en relación con la atención a la salud mental. Se presenta la experiencia pionera instaurada en el Servicio Sanitario de Lanzarote en la que se ha desplazado la figura del psicólogo clínico a los centros de salud para desarrollar un programa conjunto y comunitario desde la atención primaria. Las líneas de actuación se han centrado en el trabajo directo con el paciente así como con el personal, tanto a nivel individual como grupal. El objetivo es la sensibilización y normalización del tratamiento para la enfermedad mental desde los centros de salud. Se ha llevado a cabo dicho trabajo con una valoración positiva por parte de pacientes y personal del centro, que al mismo tiempo ha reclamado mayor accesibilidad para una instauración plena del modelo de trabajo conjunto centrado en la promoción, prevención, detección y tratamiento para la salud mental.
Low-density cell culture of the postnatal cerebellum, combined with live imaging and single-cell tracking, allows the behavior of postnatal cerebellar neural stem cells (NSCs) and their progeny to be ...monitored. Cultured cerebellar NSCs maintain their neurogenic nature giving rise, in the same relative proportions that exist in vivo, to the neuronal progeny generated by the three postnatal cerebellar neurogenic niches. This protocol describes the identification of the nature of the progeny through both post-imaging immunocytochemistry and patch-clamp recordings.
For complete details on the use and execution of this protocol, please refer to Paniagua-Herranz et al. (2020b).
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•Protocol to culture postnatal mouse cerebellar neural stem cells (NSCs) in low density•The behavior of isolated postnatal cerebellar NSC can be monitored at single-cell level•Protocol for simultaneous monitoring of the three postnatal cerebellar neurogenic niches•Procedures of live imaging and single cell tracking for lineage tracing
Low-density cell culture of the postnatal cerebellum, combined with live imaging and single-cell tracking, allows the behavior of postnatal cerebellar neural stem cells (NSCs) and their progeny to be monitored. Cultured cerebellar NSCs maintain their neurogenic nature giving rise, in the same relative proportions that exist in vivo, to the neuronal progeny generated by the three postnatal cerebellar neurogenic niches. This protocol describes the identification of the nature of the progeny through both post-imaging immunocytochemistry and patch-clamp recordings.
Atherosclerosis is a complex disease that can lead to life-threatening events, such as myocardial infarction and ischemic stroke. Despite the severity of this disease, diagnosing plaque vulnerability ...remains challenging due to the lack of effective diagnostic tools. Conventional diagnostic protocols lack specificity and fail to predict the type of atherosclerotic lesion and the risk of plaque rupture. To address this issue, technologies are emerging, such as noninvasive medical imaging of atherosclerotic plaque with customized nanotechnological solutions. Modulating the biological interactions and contrast of nanoparticles in various imaging techniques, including magnetic resonance imaging, is possible through the careful design of their physicochemical properties. However, few examples of comparative studies between nanoparticles targeting different hallmarks of atherosclerosis exist to provide information about the plaque development stage. Our work demonstrates that Gd (III)-doped amorphous calcium carbonate nanoparticles are an effective tool for these comparative studies due to their high magnetic resonance contrast and physicochemical properties. In an animal model of atherosclerosis, we compare the imaging performance of three types of nanoparticles: bare amorphous calcium carbonate and those functionalized with the ligands alendronate (for microcalcification targeting) and trimannose (for inflammation targeting). Our study provides useful insights into ligand-mediated targeted imaging of atherosclerosis through a combination of in vivo imaging, ex vivo tissue analysis, and in vitro targeting experiments.
Most care for people with chronic or disabling conditions living in the community is provided in the family context, and this care is traditionally provided by women. Providing informal care has a ...negative impact on caregivers' quality of life, which adds to existing health inequalities associated with gender. The aim of this study was to analyze factors associated with the health-related quality of life of caregivers and to determine their differences in a gender-differentiated analysis.
An observational, cross-sectional, multicenter study was conducted in primary healthcare. A total of 218 caregivers aged 65 years or older were included, all of whom assumed the primary responsibility for caring for people with disabling conditions for at least 6 months per year and agreed to participate in the CuidaCare study. The dependent variable was health-related quality of life, assessed with the EQ-5D. The explanatory variables tested were grouped into sociodemographic variables, subjective burden, caregiving role, social support and variables related to the dependent person. The associations between these variables and health-related quality of life were estimated by fitting robust linear regression models. Separate analyses were conducted for women and men.
A total of 72.8% of the sample were women, and 27.2% were men. The mean score on the EQ-5D for female caregivers was 0.64 (0.31); for male caregivers, it was 0.79 (0.23). There were differences by gender in the frequency of reported problems in the dimensions of pain/comfort and anxiety/depression. The variables that were associated with quality of life also differed. Having a positive depression screening was negatively associated with quality of life for both genders: -0.31 points (95% CI: -0.47; -0.15) for female caregivers and -0.48 points (95% CI: -0.92; -0.03) for male caregivers. Perceived burden was associated with quality of life in the adjusted model for women (-0.12 points; 95% CI: -0.19; -0.06), and domestic help was associated in the adjusted model for male caregivers (-0.12 points; 95% CI: -0.19; -0.05).
Gender differences are present in informal caregiving. The impact of providing informal care is different for male and female caregivers, and so are the factors that affect their perceived quality of life. It could be useful it incorporates a gender perspective in the design of nursing support interventions for caregivers to individualize care and improve the quality of life of caregivers.
NCT01478295 https://ClinicalTrials.gov . 23/11/2011.
Individuals who are carriers of deletions of various sizes that cause haploinsufficiency in the contiguous WT1 and PAX6 genes, located on chromosome 11p13 approximately 4Mb centromeric to the BDNF ...gene, are susceptible to Wilms tumor, aniridia, mental retardation, genitourinary anomalies and obesity (WAGRO syndrome). The molecular characterization of the wide deletion 11p15.1p12 arr (18676926–36576388) x1 dn in a child with 3years and 4months of age only affected by aniridia, predicts not only other serious associated diseases, but also allows us to hypothesize a specific phenotype of mental impairment, conduct alterations and childhood obesity, possibly added to the onset of metabolic alterations. The variable appearance and/or description of haploinsufficiency for obesity susceptibility in the WAGR syndrome mainly depends on the critical region located within 80kb of exon 1 of BDNF. The relationship between genetic variation based on the genotype combinations of the 4 gene SNPs tagging the BDNF gene and the body mass index (BMI) was studied. The polymorphic variability was similarly distributed in 218 children suffering a severe and non-syndromic obesity from families at high risk for obesity, as compared with 198 controls. The corroborated role of the BDNF gene as highly susceptible to severe syndromic obesity has not already been evidenced in the molecular basis of overweight attributed to the common polygenic principles. Its potential role as risk modifier variant to provoke more severe phenotype has not yet been demonstrated. Some genetic variants of brain-derived neurotrophic factor (BDNF) have resulted in important disorders of energy balance, but it is essential to know exactly their deleterious human capacity because they play a fundamental role in the development and plasticity of the central nervous system in regulating food intake. The existence of polymorphic amino acid changes of unknown functional significance in patients carrying the haploinsufficiency of the BDNF gene could constitute an adequate model to study in depth their effects.
► Great deletion in the region responsible for the syndrome of WARG ► Obesity as main clinical feature among cases of WARG syndrome ► The molecular characterization concretes the susceptibilities due to the deletion. ► Functional V66M variant in BDNF gene versus no capacity to non-syndromic obesity
Nolz1 is a zinc finger transcription factor whose expression is enriched in the lateral ganglionic eminence (LGE), although its function is still unknown.
Here we analyze the role of Nolz1 during LGE ...development. We show that Nolz1 expression is high in proliferating neural progenitor cells (NPCs) of the LGE subventricular zone. In addition, low levels of Nolz1 are detected in the mantle zone, as well as in the adult striatum. Similarly, Nolz1 is highly expressed in proliferating LGE-derived NPC cultures, but its levels rapidly decrease upon cell differentiation, pointing to a role of Nolz1 in the control of NPC proliferation and/or differentiation. In agreement with this hypothesis, we find that Nolz1 over-expression promotes cell cycle exit of NPCs in neurosphere cultures and negatively regulates proliferation in telencephalic organotypic cultures. Within LGE primary cultures, Nolz1 over-expression promotes the acquisition of a neuronal phenotype, since it increases the number of β-III tubulin (Tuj1)- and microtubule-associated protein (MAP)2-positive neurons, and inhibits astrocyte generation and/or differentiation. Retinoic acid (RA) is one of the most important morphogens involved in striatal neurogenesis, and regulates Nolz1 expression in different systems. Here we show that Nolz1 also responds to this morphogen in E12.5 LGE-derived cell cultures. However, Nolz1 expression is not regulated by RA in E14.5 LGE-derived cell cultures, nor is it affected during LGE development in mouse models that present decreased RA levels. Interestingly, we find that Gsx2, which is necessary for normal RA signaling during LGE development, is also required for Nolz1 expression, which is lost in Gsx2 knockout mice. These findings suggest that Nolz1 might act downstream of Gsx2 to regulate RA-induced neurogenesis. Keeping with this hypothesis, we show that Nolz1 induces the selective expression of the RA receptor (RAR)β without altering RARα or RARγ. In addition, Nozl1 over-expression increases RA signaling since it stimulates the RA response element. This RA signaling is essential for Nolz1-induced neurogenesis, which is impaired in a RA-free environment or in the presence of a RAR inverse agonist. It has been proposed that Drosophila Gsx2 and Nolz1 homologues could cooperate with the transcriptional co-repressors Groucho-TLE to regulate cell proliferation. In agreement with this view, we show that Nolz1 could act in collaboration with TLE-4, as they are expressed at the same time in NPC cultures and during mouse development.
Nolz1 promotes RA signaling in the LGE, contributing to the striatal neurogenesis during development.
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